CHRISTIAN UNITY HOSPITAL CORPORATION: Form 990, tax year 2013
View the entire original 990 at ProPublica ↗
- Organization
- CHRISTIAN UNITY HOSPITAL CORPORATION (EIN 45-0310159)
- Tax period
- 2013-07-01 to 2014-06-30
- Filed
- 2015-05-13
- IRS object ID
- 201501339349303850
- Schema version
- 2013v4.0
- Source
- Download XML · Original 990 at ProPublica
Every field in the e-filed return. Faint text is the IRS element name, for citing.
- Return header
- Form 990
- Schedule A
- Schedule B
- Schedule D
- Schedule H
- Schedule J
- Schedule K
- Schedule O
- Schedule R
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return | 2015-05-13T13:34:55-05:00 | ReturnTs |
| Tax Period End | 2014-06-30 | TaxPeriodEndDt |
Preparer Firm PreparerFirmGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Firm EIN | 450250958 | PreparerFirmEIN |
Preparer Firm Name PreparerFirmName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | EIDE BAILLY LLP | BusinessNameLine1 |
Preparer US Address PreparerUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 4310 17TH AVE S PO BOX 2545 | AddressLine1 |
| City | FARGO | City |
| State | ND | State |
| ZIP Code | 581082545 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnTypeCd |
| Tax Period Begin | 2013-07-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 450310159 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Christian Unity Hospital Corporation | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | CHRI | BusinessNameControlTxt |
| Phone | 7013521620 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 164 West 13th Street | AddressLine1 |
| City | Grafton | City |
| State | ND | State |
| ZIP Code | 58257 | ZIPCode |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | Alan O'Neil | PersonNm |
| Person Title | CEO | PersonTitleTxt |
| Phone | 7013521620 | PhoneNum |
| Signature | 2015-05-13 | SignatureDt |
| Discuss With Paid Preparer | Yes (1) | DiscussWithPaidPreparerInd |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | LISA CHAFFEE CPA | PreparerPersonNm |
| PTIN | P00193453 | PTIN |
| Phone | 7012398500 | PhoneNum |
| Preparation | 2015-05-13 | PreparationDt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2013 | TaxYr |
| Build TS | 2016-03-07 17:11:31Z | BuildTS |
Form 990 IRS990
Doing Business As Name DoingBusinessAsName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Unity Medical Center | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Principal Officer | Alan O'Neil | PrincipalOfficerNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 164 West 13th Street | AddressLine1 |
| City | Grafton | City |
| State | ND | State |
| ZIP Code | 58257 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $8,747,609 | GrossReceiptsAmt |
| Group Return For Affiliates | 0 | GroupReturnForAffiliatesInd |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | www.unitymedcenter.com | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 1970 | FormationYr |
| Legal Domicile State | ND | LegalDomicileStateCd |
| Activity Or Mission | Unity Medical Center provides access to quality health care for the region. | ActivityOrMissionDesc |
| Voting Members Governing Body | 8 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 7 | VotingMembersIndependentCnt |
| Total Employee | 120 | TotalEmployeeCnt |
| Total Volunteers | 31 | TotalVolunteersCnt |
| Total Gross UBI | $0 | TotalGrossUBIAmt |
| Net Unrelated Bus Txbl Incm | $0 | NetUnrelatedBusTxblIncmAmt |
| PY Contributions Grants | $473,853 | PYContributionsGrantsAmt |
| CY Contributions Grants | $445,827 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $7,976,691 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $8,291,378 | CYProgramServiceRevenueAmt |
| PY Investment Income | $740 | PYInvestmentIncomeAmt |
| CY Investment Income | $1,274 | CYInvestmentIncomeAmt |
| PY Other Revenue | $8,630 | PYOtherRevenueAmt |
| CY Other Revenue | $9,130 | CYOtherRevenueAmt |
| PY Total Revenue | $8,459,914 | PYTotalRevenueAmt |
| CY Total Revenue | $8,747,609 | CYTotalRevenueAmt |
| PY Grants And Similar Paid | $0 | PYGrantsAndSimilarPaidAmt |
| CY Grants And Similar Paid | $0 | CYGrantsAndSimilarPaidAmt |
| PY Benefits Paid To Members | $0 | PYBenefitsPaidToMembersAmt |
| CY Benefits Paid To Members | $0 | CYBenefitsPaidToMembersAmt |
| PY Salaries Comp Emp Bnft Paid | $4,940,262 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $4,888,973 | CYSalariesCompEmpBnftPaidAmt |
| PY Total Prof Fndrsng Expns | $0 | PYTotalProfFndrsngExpnsAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $0 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $3,610,352 | PYOtherExpensesAmt |
| CY Other Expenses | $3,919,015 | CYOtherExpensesAmt |
| PY Total Expenses | $8,550,614 | PYTotalExpensesAmt |
| CY Total Expenses | $8,807,988 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | -$90,700 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | -$60,379 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $5,395,232 | TotalAssetsBOYAmt |
| Total Assets EOY | $5,002,283 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $3,404,307 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $3,068,720 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $1,990,925 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $1,933,563 | NetAssetsOrFundBalancesEOYAmt |
| Info In Schedule O Part III | Yes (X) | InfoInScheduleOPartIIIInd |
| Mission | Unity Medical Center provides access to quality health care for the region. | MissionDesc |
| Significant New Program Srvc | 0 | SignificantNewProgramSrvcInd |
| Significant Change | 0 | SignificantChangeInd |
| Expense | $7,514,598 | ExpenseAmt |
| Revenue | $8,291,378 | RevenueAmt |
| Desc | Unity Medical Center is a 17 bed healthcare facility, which provides emergency care, acute care services, outpatient services and clinical medical services to the residents of Grafton, North Dakota and surrounding communities. The facility provides outreach services such as physical therapy, respiratory therapy, and flu vaccination clinics to other employers in the area as well. For the fiscal year ended June 30, 2014 the medical center provided as part of its mission 440 acute days, 1396 swing bed days, 87 respite days and 9,612 clinic visits. The amount of charges foregone for services provided under the Organization's charity care policy was approximately $45,000 for the fiscal year. Total direct and indirect costs related to these foregone charges was $33,000, based on an average ratio of costs to gross charges. | Desc |
| Total Program Service Expenses | $7,514,598 | TotalProgramServiceExpensesAmt |
| Described In Section501c3 | Yes (1) | DescribedInSection501c3Ind |
| Schedule B Required | Yes (1) | ScheduleBRequiredInd |
| Political Campaign Acty | 0 | PoliticalCampaignActyInd |
| Lobbying Activities | 0 | LobbyingActivitiesInd |
| Subject To Proxy Tax | 0 | SubjectToProxyTaxInd |
| Donor Advised Fund | 0 | DonorAdvisedFundInd |
| Conservation Easements | 0 | ConservationEasementsInd |
| Collections Of Art | 0 | CollectionsOfArtInd |
| Credit Counseling | Yes (1) | CreditCounselingInd |
| Temp Or Permanent Endowments | 0 | TempOrPermanentEndowmentsInd |
| Report Land Building Equipment | Yes (1) | ReportLandBuildingEquipmentInd |
| Report Investments Other Sec | 0 | ReportInvestmentsOtherSecInd |
| Report Program Related Invst | 0 | ReportProgramRelatedInvstInd |
| Report Other Assets | 0 | ReportOtherAssetsInd |
| Report Other Liabilities | Yes (1) | ReportOtherLiabilitiesInd |
| Include FIN48 Footnote | Yes (1) | IncludeFIN48FootnoteInd |
| Independent Audit Fincl Stmt | 0 | IndependentAuditFinclStmtInd |
| Consolidated Audit Fincl Stmt | Yes (1) | ConsolidatedAuditFinclStmtInd |
| School Operating | 0 | SchoolOperatingInd |
| Foreign Office | 0 | ForeignOfficeInd |
| Foreign Activities | 0 | ForeignActivitiesInd |
| More Than5000 K To Org | 0 | MoreThan5000KToOrgInd |
| More Than5000 K To Individuals | 0 | MoreThan5000KToIndividualsInd |
| Professional Fundraising | 0 | ProfessionalFundraisingInd |
| Fundraising Activities | 0 | FundraisingActivitiesInd |
| Gaming Activities | 0 | GamingActivitiesInd |
| Operate Hospital | Yes (1) | OperateHospitalInd |
| Audited Financial Stmt Att | Yes (1) | AuditedFinancialStmtAttInd |
| Grants To Organizations | 0 | GrantsToOrganizationsInd |
| Grants To Individuals | 0 | GrantsToIndividualsInd |
| Schedule J Required | Yes (1) | ScheduleJRequiredInd |
| Tax Exempt Bonds | Yes (1) | TaxExemptBondsInd |
| Invest Tax Exempt Bonds | 0 | InvestTaxExemptBondsInd |
| Escrow Account | 0 | EscrowAccountInd |
| On Behalf Of Issuer | 0 | OnBehalfOfIssuerInd |
| Engaged In Excess Benefit Trans | 0 | EngagedInExcessBenefitTransInd |
| PY Excess Benefit Trans | 0 | PYExcessBenefitTransInd |
| Loan Outstanding | 0 | LoanOutstandingInd |
| Grant To Related Person | 0 | GrantToRelatedPersonInd |
| Business Rln With Org Mem | 0 | BusinessRlnWithOrgMemInd |
| Business Rln With Fam Mem | 0 | BusinessRlnWithFamMemInd |
| Business Rln With Officer Ent | 0 | BusinessRlnWithOfficerEntInd |
| Deductible Non Cash Contri | 0 | DeductibleNonCashContriInd |
| Deductible Art Contribution | 0 | DeductibleArtContributionInd |
| Terminate Operations | 0 | TerminateOperationsInd |
| Partial Liquidation | 0 | PartialLiquidationInd |
| Disregarded Entity | 0 | DisregardedEntityInd |
| Related Entity | Yes (1) | RelatedEntityInd |
| Related Organization Ctrl Ent | Yes (1) | RelatedOrganizationCtrlEntInd |
| Transaction With Control Ent | Yes (1) | TransactionWithControlEntInd |
| Trnsfr Exmpt Non Chrtbl Rltd Org | 0 | TrnsfrExmptNonChrtblRltdOrgInd |
| Activities Conducted Prtshp | 0 | ActivitiesConductedPrtshpInd |
| Schedule O Required | Yes (1) | ScheduleORequiredInd |
| IRP Document | 12 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Backup Wthld Compliance | Yes (1) | BackupWthldComplianceInd |
| Employee | 120 | EmployeeCnt |
| Employment Tax Returns Filed | Yes (1) | EmploymentTaxReturnsFiledInd |
| Unrelated Bus Incm Over Limit | 0 | UnrelatedBusIncmOverLimitInd |
| Foreign Financial Account | 0 | ForeignFinancialAccountInd |
| Prohibited Tax Shelter Trans | 0 | ProhibitedTaxShelterTransInd |
| Taxable Party Notification | 0 | TaxablePartyNotificationInd |
| Nondeductible Contributions | 0 | NondeductibleContributionsInd |
| Quid Pro Quo Contributions | 0 | QuidProQuoContributionsInd |
| Form8282 Property Disposed Of | 0 | Form8282PropertyDisposedOfInd |
| Rcv Fnds To Pay Prsnl Bnft Cntrct | 0 | RcvFndsToPayPrsnlBnftCntrctInd |
| Pay Premiums Prsnl Bnft Cntrct | 0 | PayPremiumsPrsnlBnftCntrctInd |
| Indoor Tanning Services | 0 | IndoorTanningServicesInd |
| Info In Schedule O Part VI | Yes (X) | InfoInScheduleOPartVIInd |
| Governing Body Voting Members | 8 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 7 | IndependentVotingMemberCnt |
| Family Or Business Rln | 0 | FamilyOrBusinessRlnInd |
| Delegation Of Mgmt Duties | 0 | DelegationOfMgmtDutiesInd |
| Change To Org Documents | 0 | ChangeToOrgDocumentsInd |
| Material Diversion Or Misuse | 0 | MaterialDiversionOrMisuseInd |
| Members Or Stockholders | Yes (1) | MembersOrStockholdersInd |
| Election Of Board Members | Yes (1) | ElectionOfBoardMembersInd |
| Decisions Subject To Approva | 0 | DecisionsSubjectToApprovaInd |
| Minutes Of Governing Body | Yes (1) | MinutesOfGoverningBodyInd |
| Minutes Of Committees | Yes (1) | MinutesOfCommitteesInd |
| Officer Mailing Address | 0 | OfficerMailingAddressInd |
| Local Chapters | 0 | LocalChaptersInd |
| Form990 Provided To Gvrn Body | Yes (1) | Form990ProvidedToGvrnBodyInd |
| Conflict Of Interest Policy | Yes (1) | ConflictOfInterestPolicyInd |
| Annual Disclosure Covered Prsn | Yes (1) | AnnualDisclosureCoveredPrsnInd |
| Regular Monitoring Enfrc | Yes (1) | RegularMonitoringEnfrcInd |
| Whistleblower Policy | 0 | WhistleblowerPolicyInd |
| Document Retention Policy | Yes (1) | DocumentRetentionPolicyInd |
| Compensation Process CEO | Yes (1) | CompensationProcessCEOInd |
| Compensation Process Other | Yes (1) | CompensationProcessOtherInd |
| Investment In Joint Venture | 0 | InvestmentInJointVentureInd |
| Upon Request | Yes (X) | UponRequestInd |
Books In Care Of Detail BooksInCareOfDetail
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Alan O'Neil | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Phone | 7013529365 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 164 West 13th Street | AddressLine1 |
| City | Grafton | City |
| State | ND | State |
| ZIP Code | 58237 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part VII | Yes (X) | InfoInScheduleOPartVIIInd |
Form990 Part VII Section A Form990PartVIISectionAGrp (16 entries)
| TitleTitleTxt | Average Hours Per WeekAverageHoursPerWeekRt | Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd | OfficerOfficerInd | Reportable Comp From OrgReportableCompFromOrgAmt | Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt | Other CompensationOtherCompensationAmt | Average Hours Per Week Rltd OrgAverageHoursPerWeekRltdOrgRt | Highest Compensated EmployeeHighestCompensatedEmployeeInd |
|---|---|---|---|---|---|---|---|---|
| Keith Zikmund | ||||||||
| President | 1.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | ||
| Jo Petersen | ||||||||
| Vice President | 1.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | 1.00 | |
| JoAnn Lizakowski | ||||||||
| Secretary/Treasurer (July-September) | 1.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | ||
| Amy Vollrath Board MemberJuly- | ||||||||
| -Sept)/Secr./Treas. (Oct-June) | 1.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | ||
| Dale Martinson | ||||||||
| Board Member (July-September) | 1.00 | Yes (X) | $0 | $0 | $0 | |||
| Vicki Ham | ||||||||
| Board Member | 0.50 | Yes (X) | $0 | $0 | $0 | |||
| Pastor Chris Gaule | ||||||||
| Board Member | 0.50 | Yes (X) | $0 | $0 | $0 | |||
| Mary Houdek | ||||||||
| Board Member | 0.50 | Yes (X) | $0 | $0 | $0 | |||
| Roger Gorder | ||||||||
| Board Member | 0.50 | Yes (X) | $0 | $0 | $0 | |||
| Dr Linda Fillipi | ||||||||
| Physician/Medical Staff Pr | 41.00 | Yes (X) | $191,167 | $0 | $7,037 | |||
| Everett Butler | ||||||||
| CEO (July-March) | 40.00 | Yes (X) | $148,041 | $0 | $454 | |||
| Rachel Ray | ||||||||
| CFO/Interim CEO (March-May) | 40.00 | Yes (X) | $66,083 | $0 | $109 | |||
| Alan O'Neil | ||||||||
| CEO (June) | 40.00 | Yes (X) | $0 | $0 | $0 | |||
| Dr Joshua Omotunde | ||||||||
| MD | 40.00 | $236,916 | $0 | $18,475 | Yes (X) | |||
| Dr Anthony Kotnik | ||||||||
| MD | 40.00 | $181,959 | $0 | $17,847 | Yes (X) | |||
| Rodney Sigvaldson | ||||||||
| PA | 61.00 | $143,931 | $0 | $17,847 | Yes (X) | |||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $968,097 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $0 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $61,769 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 5 | IndivRcvdGreaterThan100KCnt |
| Former Ofcr Employees Listed | 0 | FormerOfcrEmployeesListedInd |
| Total Comp Greater Than150 K | Yes (1) | TotalCompGreaterThan150KInd |
| Compensation From Other Srcs | 0 | CompensationFromOtherSrcsInd |
Contractor Compensation ContractorCompensationGrp (4 entries)
| Address Line1ContractorAddress/USAddress/AddressLine1 | CityContractorAddress/USAddress/City | StateContractorAddress/USAddress/State | ZIP CodeContractorAddress/USAddress/ZIPCode | ServicesServicesDesc | CompensationCompensationAmt |
|---|---|---|---|---|---|
| DMS | |||||
| 26273 Network Place | Chicago | IL | 606731262 | Mobile Services | $280,740 |
| Altru | |||||
| PO Box 13780 | Grand Forks | ND | 582083780 | EPIC, Telepharmacy, etc. | $129,478 |
| St Paul Radiology | |||||
| PO Box 2923 | Indianapolis | IN | 462062923 | Radiology Readings | $127,357 |
| Sieman's | |||||
| PO Box 121102 | Dallas | TX | 753121102 | Services & Re-Agents | $101,951 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cntrct Rcvd Greater Than100 K | 4 | CntrctRcvdGreaterThan100KCnt |
| Related Organizations | $62,233 | RelatedOrganizationsAmt |
| Government Grants | $249,043 | GovernmentGrantsAmt |
| All Other Contributions | $134,551 | AllOtherContributionsAmt |
| Total Contributions | $445,827 | TotalContributionsAmt |
Program Service Revenue ProgramServiceRevenueGrp (4 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt |
|---|---|---|---|
| Net Patient Serv. Rev. | 621300 | $8,114,360 | $8,114,360 |
| EHR | 900099 | $106,000 | $106,000 |
| Misc income | 900099 | $65,618 | $65,618 |
| Auxiliary Income | 900099 | $5,400 | $5,400 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $8,291,378 | TotalProgramServiceRevenueAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $1,274 | TotalRevenueColumnAmt |
| Exclusion | $1,274 | ExclusionAmt |
Gross Rents GrossRentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $9,130 | RealAmt |
Less Rental Expenses LessRentalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $0 | RealAmt |
Rental Income Or Loss RentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $9,130 | RealAmt |
Net Rental Income Or Loss NetRentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $9,130 | TotalRevenueColumnAmt |
| Exclusion | $9,130 | ExclusionAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $8,747,609 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $8,291,378 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $0 | UnrelatedBusinessRevenueAmt |
| Exclusion | $10,404 | ExclusionAmt |
Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $414,991 | TotalAmt |
| Program Services | $194,735 | ProgramServicesAmt |
| Management And General | $220,256 | ManagementAndGeneralAmt |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $3,723,359 | TotalAmt |
| Program Services | $3,180,410 | ProgramServicesAmt |
| Management And General | $542,949 | ManagementAndGeneralAmt |
Other Employee Benefits OtherEmployeeBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $480,872 | TotalAmt |
| Program Services | $397,232 | ProgramServicesAmt |
| Management And General | $83,640 | ManagementAndGeneralAmt |
Payroll Taxes PayrollTaxesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $269,751 | TotalAmt |
| Program Services | $220,333 | ProgramServicesAmt |
| Management And General | $49,418 | ManagementAndGeneralAmt |
Fees For Services Legal FeesForServicesLegalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $3,850 | TotalAmt |
| Management And General | $3,850 | ManagementAndGeneralAmt |
Fees For Services Accounting FeesForServicesAccountingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $42,621 | TotalAmt |
| Management And General | $42,621 | ManagementAndGeneralAmt |
Fees For Services Other FeesForServicesOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $756,938 | TotalAmt |
| Program Services | $739,261 | ProgramServicesAmt |
| Management And General | $17,677 | ManagementAndGeneralAmt |
Advertising AdvertisingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $30,700 | TotalAmt |
| Management And General | $30,700 | ManagementAndGeneralAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $528,729 | TotalAmt |
| Program Services | $445,264 | ProgramServicesAmt |
| Management And General | $83,465 | ManagementAndGeneralAmt |
Information Technology InformationTechnologyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $126,616 | TotalAmt |
| Management And General | $126,616 | ManagementAndGeneralAmt |
Occupancy OccupancyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $146,398 | TotalAmt |
| Program Services | $145,949 | ProgramServicesAmt |
| Management And General | $449 | ManagementAndGeneralAmt |
Travel TravelGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $30,299 | TotalAmt |
| Program Services | $22,327 | ProgramServicesAmt |
| Management And General | $7,972 | ManagementAndGeneralAmt |
Conferences Meetings ConferencesMeetingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,854 | TotalAmt |
| Management And General | $2,854 | ManagementAndGeneralAmt |
Interest InterestGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $118,949 | TotalAmt |
| Program Services | $118,949 | ProgramServicesAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $465,326 | TotalAmt |
| Program Services | $465,326 | ProgramServicesAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $67,951 | TotalAmt |
| Program Services | $67,951 | ProgramServicesAmt |
Other Expenses OtherExpensesGrp (4 entries)
| DescDesc | TotalTotalAmt | Program ServicesProgramServicesAmt | Management And GeneralManagementAndGeneralAmt |
|---|---|---|---|
| Medical Supplies | $903,629 | $903,629 | |
| Provision for Bad Debts | $560,268 | $560,268 | |
| Communications | $37,798 | $37,798 | |
| Dues and Subscriptions | $20,030 | $5,858 | $14,172 |
All Other Expenses AllOtherExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $76,059 | TotalAmt |
| Program Services | $9,308 | ProgramServicesAmt |
| Management And General | $66,751 | ManagementAndGeneralAmt |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $8,807,988 | TotalAmt |
| Program Services | $7,514,598 | ProgramServicesAmt |
| Management And General | $1,293,390 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Savings And Temp Cash Invst SavingsAndTempCashInvstGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $347,892 | BOYAmt |
| EOY | $472,186 | EOYAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,688,190 | BOYAmt |
| EOY | $1,818,570 | EOYAmt |
Inventories For Sale Or Use InventoriesForSaleOrUseGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $109,984 | BOYAmt |
| EOY | $108,042 | EOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $30,405 | BOYAmt |
| EOY | $12,722 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $10,231,586 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $7,692,660 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,878,749 | BOYAmt |
| EOY | $2,538,926 | EOYAmt |
Other Assets Total OtherAssetsTotalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $340,012 | BOYAmt |
| EOY | $51,837 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $5,395,232 | BOYAmt |
| EOY | $5,002,283 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,015,759 | BOYAmt |
| EOY | $795,566 | EOYAmt |
Tax Exempt Bond Liabilities TaxExemptBondLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,135,000 | BOYAmt |
| EOY | $2,085,000 | EOYAmt |
Mortg Notes Pybl Scrd Invst Prop MortgNotesPyblScrdInvstPropGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $253,548 | BOYAmt |
| EOY | $78,854 | EOYAmt |
Other Liabilities OtherLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $109,300 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $3,404,307 | BOYAmt |
| EOY | $3,068,720 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Organization Follows SFAS117 | Yes (X) | OrganizationFollowsSFAS117Ind |
Unrestricted Net Assets UnrestrictedNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,877,635 | BOYAmt |
| EOY | $1,831,868 | EOYAmt |
Temporarily Rstr Net Assets TemporarilyRstrNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $113,290 | BOYAmt |
| EOY | $101,695 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,990,925 | BOYAmt |
| EOY | $1,933,563 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $5,395,232 | BOYAmt |
| EOY | $5,002,283 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part XI | Yes (X) | InfoInScheduleOPartXIInd |
| Reconcilation Revenue Expnss | -$60,379 | ReconcilationRevenueExpnssAmt |
| Other Changes In Net Assets | $3,017 | OtherChangesInNetAssetsAmt |
| Method Of Accounting Accrual | Yes (X) | MethodOfAccountingAccrualInd |
| Accountant Compile Or Review | 0 | AccountantCompileOrReviewInd |
| FS Audited | Yes (1) | FSAuditedInd |
FS Audited Basis FSAuditedBasisGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Consolidated Basis Fincl Stmt | Yes (X) | ConsolidatedBasisFinclStmtInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Audit Committee | 0 | AuditCommitteeInd |
| Federal Grant Audit Required | 0 | FederalGrantAuditRequiredInd |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital | Yes (X) | HospitalInd |
Schedule B IRS990ScheduleB
Contributor Information ContributorInformationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Contributor | RESTRICTED | ContributorNum |
Contributor Business Name ContributorBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | RESTRICTED | BusinessNameLine1 |
Contributor US Address ContributorUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | RESTRICTED | AddressLine1 |
| Address Line2 | RESTRICTED | AddressLine2 |
| City | RESTRICTED | City |
| State | RESTRICTED | State |
| ZIP Code | RESTRICTED | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Contributions | RESTRICTED | TotalContributionsAmt |
Schedule D IRS990ScheduleD
| Field | Value | IRS element (for citing) |
|---|---|---|
| Agent Trustee Etc | Yes (1) | AgentTrusteeEtcInd |
| Beginning Balance | $11,369 | BeginningBalanceAmt |
| Additions During Year | $5,400 | AdditionsDuringYearAmt |
| Distributions During Year | $8,417 | DistributionsDuringYearAmt |
| Ending Balance | $8,352 | EndingBalanceAmt |
| Incl Escrow Custodial Acct Liab | 0 | InclEscrowCustodialAcctLiabInd |
Land LandGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $43,017 | OtherCostOrOtherBasisAmt |
| Book Value | $43,017 | BookValueAmt |
Buildings BuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $7,424,829 | OtherCostOrOtherBasisAmt |
| Depreciation | $5,275,443 | DepreciationAmt |
| Book Value | $2,149,386 | BookValueAmt |
Equipment EquipmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $2,511,109 | OtherCostOrOtherBasisAmt |
| Depreciation | $2,236,456 | DepreciationAmt |
| Book Value | $274,653 | BookValueAmt |
Other Land Buildings OtherLandBuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $252,631 | OtherCostOrOtherBasisAmt |
| Depreciation | $180,761 | DepreciationAmt |
| Book Value | $71,870 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $2,538,926 | TotalBookValueLandBuildingsAmt |
Other Liabilities Org OtherLiabilitiesOrgGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | Estimated third party payor settlements | Desc |
| Amt | $109,300 | Amt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Liability | $109,300 | TotalLiabilityAmt |
| Footnote Text | Yes (X) | FootnoteTextInd |
| Total Rev Etc Audited Fincl Stmt | $8,181,941 | TotalRevEtcAuditedFinclStmtAmt |
| Other Revenue | -$560,268 | OtherRevenueAmt |
| Revenue Not Reported | -$560,268 | RevenueNotReportedAmt |
| Revenue Subtotal | $8,742,209 | RevenueSubtotalAmt |
| Other Revenues Not Included | $5,400 | OtherRevenuesNotIncludedAmt |
| Revenue Not Reported Fincl Stmt | $5,400 | RevenueNotReportedFinclStmtAmt |
| Total Revenue Per Form990 | $8,747,609 | TotalRevenuePerForm990Amt |
| Tot Expns Etc Audited Fincl Stmt | $8,239,303 | TotExpnsEtcAuditedFinclStmtAmt |
| Expenses Not Reported | $0 | ExpensesNotReportedAmt |
| Expenses Subtotal | $8,239,303 | ExpensesSubtotalAmt |
| Other Expenses Not Included | $568,685 | OtherExpensesNotIncludedAmt |
| Expenses Not Rpt Fincl Stmt | $568,685 | ExpensesNotRptFinclStmtAmt |
| Total Expenses Per Form990 | $8,807,988 | TotalExpensesPerForm990Amt |
Supplemental Information Detail SupplementalInformationDetail (5 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Part IV, Line 1b: | There is an auxiliary which operates under the EIN of the Hospital. |
| Part X, Line 2: | The Medical Center is organized as a North Dakota nonprofit corporation and has been recognized by the Internal Revenue Service (IRS) as exempt from federal income taxes under Internal Revenue Code Section 501(c)(3). The Medical Center is annually required to file a Return of Organization Exempt from Income Tax (Form 990) with the IRS. In addition, the Medical Center is subject to income tax on net income that is derived from business activities that are unrelated to its exempt purpose. The Medical Center has determined it is not subject to unrelated business income tax and has not filed an Exempt Organization Business Income Tax Return (Form 990T) with the IRS. The Medical Center believes that it has appropriate support for any tax positions taken affecting its annual filing requirements, and as such, does not have any uncertain tax positions that are material to the financial statements. The Medical Center would recognize future accrued interest and penalties related to unrecognized tax liabilities in income tax expense if such interest and penalties are incurred. |
| Part XI, Line 2d - Other Adjustments: | Provision for Bad Debts reported in Revenue in the F/S -560,268. |
| Part XI, Line 4b - Other Adjustments: | Auxiliary Revenue 5,400. |
| Part XII, Line 4b - Other Adjustments: | Provision for Bad Debts reported in Revenue in the F/S 560,268. Auxiliary expenses 8,417. |
Schedule H IRS990ScheduleH
| Field | Value | IRS element (for citing) |
|---|---|---|
| Financial Assistance Policy | Yes (1) | FinancialAssistancePolicyInd |
| Written Policy | Yes (1) | WrittenPolicyInd |
| All Hospitals Policy | Yes (X) | AllHospitalsPolicyInd |
| FPG Reference Free Care | Yes (1) | FPGReferenceFreeCareInd |
| Percent100 | Yes (X) | Percent100Ind |
| FPG Reference Discounted Care | Yes (1) | FPGReferenceDiscountedCareInd |
| Percent200 D | Yes (X) | Percent200DInd |
| Free Care Medically Indigent | 0 | FreeCareMedicallyIndigentInd |
| Financial Assistance Budget | Yes (1) | FinancialAssistanceBudgetInd |
| Expenses Exceed Budget | Yes (1) | ExpensesExceedBudgetInd |
| Unable To Provide Care | 0 | UnableToProvideCareInd |
| Annual Community Bnft Report | 0 | AnnualCommunityBnftReportInd |
Financial Assistance At Cost Typ FinancialAssistanceAtCostTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $33,000 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $33,000 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00400 | TotalExpensePct |
Unreimbursed Medicaid UnreimbursedMedicaidGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $503,847 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $451,028 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $52,819 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00640 | TotalExpensePct |
Total Financial Assistance Typ TotalFinancialAssistanceTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $536,847 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $451,028 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $85,819 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.01040 | TotalExpensePct |
Community Health Services CommunityHealthServicesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $2,650 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $2,650 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00030 | TotalExpensePct |
Subsidized Health Services SubsidizedHealthServicesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $1,650,178 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $1,372,544 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $277,634 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.03370 | TotalExpensePct |
Total Other Benefits TotalOtherBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $1,652,828 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $1,372,544 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $280,284 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.03400 | TotalExpensePct |
Total Community Benefits TotalCommunityBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $2,189,675 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $1,823,572 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $366,103 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.04440 | TotalExpensePct |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | 0 | BadDebtExpenseReportedInd |
| Bad Debt Expense | $560,268 | BadDebtExpenseAmt |
| Bad Debt Expense Attributable | $55,467 | BadDebtExpenseAttributableAmt |
| Reimbursed By Medicare | $3,185,664 | ReimbursedByMedicareAmt |
| Cost Of Care Reimbursed By Medcr | $3,207,579 | CostOfCareReimbursedByMedcrAmt |
| Medicare Surplus Or Shortfall | -$21,915 | MedicareSurplusOrShortfallAmt |
Costing Methodology Used CostingMethodologyUsedGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | Yes (X) | OtherInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Written Debt Collection Policy | Yes (1) | WrittenDebtCollectionPolicyInd |
| Financial Assistance Prvsn | Yes (1) | FinancialAssistancePrvsnInd |
| Hospital Facilities | 1 | HospitalFacilitiesCnt |
Hospital Facilities HospitalFacilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 1 | FacilityNum |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Christian Unity Hospital Corporation | BusinessNameLine1 |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 164 West 13th Street | AddressLine1 |
| City | Grafton | City |
| State | ND | State |
| ZIP Code | 58257 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Website Address | www.unitymedcenter.com | WebsiteAddressTxt |
| State License | 5020 | StateLicenseNum |
| Licensed Hospital | Yes (X) | LicensedHospitalInd |
| General Medical And Surgical | Yes (X) | GeneralMedicalAndSurgicalInd |
| Critical Access Hospital | Yes (X) | CriticalAccessHospitalInd |
| Emergency Room24 Hrs | Yes (X) | EmergencyRoom24HrsInd |
Hospital Fclty Policies Prctc HospitalFcltyPoliciesPrctcGrp
Hospital Facility Name HospitalFacilityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Christian Unity Hospital Corporation | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 1 | FacilityNum |
| CHNA Conducted | Yes (1) | CHNAConductedInd |
| Community Definition | Yes (X) | CommunityDefinitionInd |
| Community Demographics | Yes (X) | CommunityDemographicsInd |
| Existing Resources | Yes (X) | ExistingResourcesInd |
| How Data Obtained | Yes (X) | HowDataObtainedInd |
| Community Health Needs | Yes (X) | CommunityHealthNeedsInd |
| Community Hlth Needs Id Process | Yes (X) | CommunityHlthNeedsIdProcessInd |
| Consulting Process | Yes (X) | ConsultingProcessInd |
| Information Gaps | Yes (X) | InformationGapsInd |
| CHNA Conducted | 12 | CHNAConductedYr |
| Take Into Account Others Input | Yes (1) | TakeIntoAccountOthersInputInd |
| CHNA Conducted With Other Fclts | 0 | CHNAConductedWithOtherFcltsInd |
| CHNA Report Widely Available | Yes (1) | CHNAReportWidelyAvailableInd |
| Rpt Available On Own Website | Yes (X) | RptAvailableOnOwnWebsiteInd |
| Own Website URL | www.unitymedcenter.com | OwnWebsiteURLTxt |
| Rpt Available Upon Request | Yes (X) | RptAvailableUponRequestInd |
| Adopt Implementation Strategy | Yes (X) | AdoptImplementationStrategyInd |
| Exec Implementation Strategy | Yes (X) | ExecImplementationStrategyInd |
| Prioritize Health Needs | Yes (X) | PrioritizeHealthNeedsInd |
| Prioritize Services | Yes (X) | PrioritizeServicesInd |
| All Needs Addressed | 0 | AllNeedsAddressedInd |
| Organization Incur Excise Tax | 0 | OrganizationIncurExciseTaxInd |
| Elig Criteria Explained | Yes (1) | EligCriteriaExplainedInd |
| FPG Used Deter Elig Free Care | Yes (1) | FPGUsedDeterEligFreeCareInd |
| FPG Family Incm Lmt Free Care | 100.000000000000 | FPGFamilyIncmLmtFreeCarePct |
| FPG Used Determ Elig Dscnt Care | Yes (1) | FPGUsedDetermEligDscntCareInd |
| FPG Family Incm Lmt Dscnt Care | 200.000000000000 | FPGFamilyIncmLmtDscntCarePct |
| Explained Basis | Yes (1) | ExplainedBasisInd |
| Income Level | Yes (X) | IncomeLevelInd |
| App Financial Asst Expln | Yes (1) | AppFinancialAsstExplnInd |
| Includes Publicity Measures | Yes (1) | IncludesPublicityMeasuresInd |
| Available On Request | Yes (X) | AvailableOnRequestInd |
| Other Publicity | Yes (X) | OtherPublicityInd |
| FAP Actions On Nonpayment | Yes (1) | FAPActionsOnNonpaymentInd |
| Collection Activities | 0 | CollectionActivitiesInd |
| FAP Notified All Patients | Yes (X) | FAPNotifiedAllPatientsInd |
| Documented Elig Determination | Yes (X) | DocumentedEligDeterminationInd |
| Nondis Emergency Care Policy | Yes (1) | NondisEmergencyCarePolicyInd |
| Lowest Negotiated Rates | Yes (X) | LowestNegotiatedRatesInd |
| Amounts Generally Billed | 0 | AmountsGenerallyBilledInd |
| Gross Charges | Yes (1) | GrossChargesInd |
Supplemental Information SupplementalInformationGrp (5 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Christian Unity Hospital Corporation | Part V, Section B, Line 3: We had individuals from different aspects of the community including, Public Schools, Daycare Providers, County Health, Mental Health Community, and other various businesses. |
| Christian Unity Hospital Corporation | Part V, Section B, Line 6i: The Implementation Strategy can be found at: http://www.unitymedcenter.com/. |
| Christian Unity Hospital Corporation | Part V, Section B, Line 7: Two of the needs identified in the CHNA which are not being addressed were kidney dialysis and dermatology. Kidney dialysis requires a substantial financial outlay and the number of dialysis patients in our study does not support a dialysis unit, but, potentially, we could have a visiting physician address this issue. We have not been able to find a visiting physician to address this issue. As of June 2014, we were still not able to find anyone in our area to provide dermatology services here, however UMC is proud that they will begin offering dermatology services on a part time basis in May 2015. During the year, the organization began to address the need for increased colorectal cancer screenings. Our UMC employee, who was working on this, was out for an extended period of time, due to medical leave, and this was set aside. The Community Relations Committee plans to begin the education process through articles and brochures in the near future. |
| Christian Unity Hospital Corporation | Part V, Section B, Line 14g: Patients who do not pay after 90 days meet with the Patient Account Representative and go over their available options including financial assistance. The organization posts the EMTALA law in their emergency room. The organization is also weighing their options of how to make their financial assistance policy more widely available to the public including the possibility of posting the policy on their website. |
| Christian Unity Hospital Corporation | Part V, Section B, Line 22: All individuals eligible under the hospital financial assistance policy are provided a discount for emergency and other medically necessary care. FAP-eligible patients without insurance may be charged gross charges on elective procedures. |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 1 | FacilityNum |
Oth Hlth Care Fclts Not Hospital OthHlthCareFcltsNotHospitalGrp
Oth Hlth Care Fclts OthHlthCareFcltsGrp
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Grafton Family Clinic | BusinessNameLine1 |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 155 West 14th Street | AddressLine1 |
| City | Grafton | City |
| State | ND | State |
| ZIP Code | 58257 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | Rural Health Clinic | FacilityTxt |
Supplemental Information Detail SupplementalInformationDetail (14 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Part I, Line 3c: | The Organization does follow the Federal Poverty Guidelines (FPG) when determining discounted care, but they have set up three different ranges within the Guidelines. A patient will pay 30%, 60% or 80% of their bill depending upon where their income falls. The patient is responsible for 30% of their bill if their income is 100% to 132% of the FPG. The patient is responsible for 60% of their bill if their income falls between 133% to 166% of the FPG. The patient is responsible for 80% of their bill if their income falls between 167% and 200% of the FPG. If the individual falls below the minimum criteria, that person is eligible for 100% charity care allowance, or free care. |
| Part I, Line 7: | The organization used the following to determine the costs for Part I, Line 7:Row a: An average ratio of cost to gross charges which addresses all patient segmentsRow b: Unreimbursed Medicaid was calculated using the costing methods to prepare the cost reports.Row e: An estimate of actual costs were used based on the General LedgerRow g: The cost for subsidized health services was determined using the Medicare Cost Report. |
| Part I, Line 7g: | The amount of costs attributable to a rural health clinic is $1,610,019. |
| Part I, Ln 7 Col(f): | The amount of bad debt expense removed from the denominator is $560,268. |
| Part III, Line 2: | Discounts and payments are taken into account when determining bad debt expense. Payments on a previously written off account are recorded as a recovery of bad debt expense and they reduce bad debt expense. |
| Part III, Line 3: | 9.9% of the individuals in Walsh County, North Dakota (in which the Hospital is located) fall below the federal poverty levels according to Census.gov. Therefore, the organization estimates that 9.9% of the bad debt expense at cost is attributable to patients eligible under the organization's charity care policy. Care is given to individuals regardless of their ability to pay and so therefore this is a community benefit. |
| Part III, Line 4: | Footnote from organization's financial statements: The footnote that describes bad debt expense is found on page 9 of the attached audit report. |
| Part III, Line 8: | Medicare allowable costs of care are based on the Medicare cost report. The Medicare cost report is completed based on the rules and regulations set forth by Centers for Medicare and Medicaid Services.Christian Unity Hospital Corporation provides medically necessary care to all regardless of the ability to pay. Providing services to those eligible for Medicare is a benefit to the community as elderly are a charitable class. Therefore all of the shortfall should be treated as a community benefit. |
| Part III, Line 9b: | If an incomplete financial assistance application has been submitted, the Patient Accounts Representative will work with the patient to gather any missing or outstanding items. Any collection actions are stopped after the patient submits an application for financial assistance until it is determined whether or not the individual is eligible for financial assistance. If the patient qualifies for financial assistance, any collection actions already taken against the individual would be reversed. The Patient Accounts Representative documents whether or not the individual is eligible for financial assistance. |
| Part VI, Line 2: | We finalized our community health needs assessment early in FY2013 and our board of directors adopted an implementation strategy as a result of the findings at that time. We have community members from different backgrounds/occupations that serve on our Board of Directors. They are open to listening to other community members regarding health care needs. These are brought to the Board and considered at that time. UMC also brings in specialty doctors to our rural health clinic to enhance the services that are already offered. We offer services such as oncology, psychiatry, etc. UMC is proud that they will begin offering dermatology services, on a part time basis in May 2015. This has been a need brought to us over and over throughout the years. We have an individual in the community that will begin seeing patients in the Grafton Family Clinic. |
| Part VI, Line 3: | A sign near the entrance to the emergency room indicates we "provide medical care for those who cannot afford to pay." Another posting states that "the facility is legally obligated to serve the community." For those patients who do not pay on their balances, we contact them by phone. They visit with our Patient Account Representative. The Representative discusses payment arrangements, eligibility for certain programs, such as Medicaid, and then charity care, if necessary. If we cannot get those patients to come in and talk, we try to make arrangements over the phone and through the mail, if necessary. |
| Part VI, Line 4: | Grafton is a rural community of approximately 4,284 residents located in Walsh County, North Dakota. The median household income for Walsh County is $44,139 for 2006-2010 per the US Census Data. 9.9% of individuals in the Walsh County fall below the poverty level. Unity Medical Center serves the population of Grafton and several surrounding smaller communities. The area is also served by a hospital in Park River and a hospital in Grand Forks. Approximately 7.5% of the hospital's business in FY 2014 was to private pay individuals. Approximately 8.6% of our business was to Medicaid recipients. We also have a Migrant Health office in the community to serve migrant workers. |
| Part VI, Line 5: | The Unity Medical Center (UMC) governing body is comprised of persons who reside in our primary service area. The board members are neither contractors, or family members of the organization. Medical staff privileges are extended to those qualified physicians in our community who have applied for and been granted medical privileges, per our credentialing process. Surplus funds, when available, are used to purchase equipment or make purchases to improve the building structure for the purpose of improving patient care. Unity Medical Center Foundation also assists the hospital with capital purchases.UMC offers 24 hour access to emergency room care, which is available to all individuals, regardless of their ability to pay for the care. UMC offers acute care, swing bed care, general surgery, as well as many outpatient services. UMC does participate in education of healthcare professionals. We take approximately 2-3 medical students per year and several Physical Therapy students throughout the year from the University of North Dakota. We do training for students from technical schools, as well, as requested. UMC is the only hospital and clinic in the community; therefore, we are a viable part of this community. UMC offers programs such as diabetes screenings, flu vaccination clinics, free blood pressure checks, KIDS UMC (education for young children), etc. UMC also has a representative on the Mayor's Committee of Wellness for the community. UMC brings in specialty doctors to our clinic in order to offer more necessary services to our patient population, i.e. oncology, psychiatry, etc. We offer volunteer opportunities for high school students and adults. We have fourteen members of our UMC Auxiliary Services that volunteer here every week for the benefit of the facility. |
| Part VI, Line 6: | N/A |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Compensation Survey | Yes (X) | CompensationSurveyInd |
| Board Or Committee Approval | Yes (X) | BoardOrCommitteeApprovalInd |
| Severance Payment | 0 | SeverancePaymentInd |
| Supplemental Nonqual Rtr Plan | 0 | SupplementalNonqualRtrPlanInd |
| Equity Based Comp Arrngm | 0 | EquityBasedCompArrngmInd |
| Comp Based On Revenue Of Flng Org | Yes (1) | CompBasedOnRevenueOfFlngOrgInd |
| Comp Bsd On Rev Related Orgs | 0 | CompBsdOnRevRelatedOrgsInd |
| Comp Bsd Net Earns Flng Org | 0 | CompBsdNetEarnsFlngOrgInd |
| Comp Bsd Net Earns Rltd Orgs | 0 | CompBsdNetEarnsRltdOrgsInd |
| Any Non Fixed Payments | 0 | AnyNonFixedPaymentsInd |
| Initial Contract Exception | 0 | InitialContractExceptionInd |
Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp (4 entries)
| TitleTitleTxt | Base Compensation Filing OrgBaseCompensationFilingOrgAmt | Compensation Based On Rltd OrgsCompensationBasedOnRltdOrgsAmt | Bonus Filing OrganizationBonusFilingOrganizationAmount | Bonus Related OrganizationsBonusRelatedOrganizationsAmt | Other Compensation Filing OrgOtherCompensationFilingOrgAmt | Other Compensation Rltd OrgsOtherCompensationRltdOrgsAmt | Deferred Compensation Flng OrgDeferredCompensationFlngOrgAmt | Deferred Comp Rltd OrgsDeferredCompRltdOrgsAmt | Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgAmt | Nontaxable Benefits Rltd OrgsNontaxableBenefitsRltdOrgsAmt | Total Compensation Filing OrgTotalCompensationFilingOrgAmt | Total Compensation Rltd OrgsTotalCompensationRltdOrgsAmt | Comp Report Prior990 Filing OrgCompReportPrior990FilingOrgAmt | Comp Report Prior990 Rltd OrgsCompReportPrior990RltdOrgsAmt |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Dr Linda Fillipi | ||||||||||||||
| Physician/Medical Staff Pr | $191,167 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $7,268 | $0 | $198,435 | $0 | $0 | $0 |
| Dr Joshua Omotunde | ||||||||||||||
| MD | $236,916 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $28,072 | $0 | $264,988 | $0 | $0 | $0 |
| Dr Anthony Kotnik | ||||||||||||||
| MD | $181,959 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $24,947 | $0 | $206,906 | $0 | $0 | $0 |
| Rodney Sigvaldson | ||||||||||||||
| PA | $143,931 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $18,053 | $0 | $161,984 | $0 | $0 | $0 |
Supplemental Information Detail SupplementalInformationDetail (2 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Part I, Line 3 | The Organization bases salaries and wages on the ND Healthcare Survey. There is an annual performance evaluation completed and then a raise, up to 3%, (the percentage is agreed to by the Board of Directors) is given based on that evaluation. |
| Part I, Line 5 | Physician compensation is calculated monthly. Physicians earn 58 percent of gross revenues from gross professional charges. |
Schedule K IRS990ScheduleK
Tax Exempt Bonds Issues TaxExemptBondsIssuesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bond Reference | A | BondReferenceCd |
Issuer Name IssuerName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | City of Grafton | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bond Issuer EIN | 456002080 | BondIssuerEIN |
| CUSIP | 384455BF7 | CUSIPNum |
| Bond Issued | 2008-04-23 | BondIssuedDt |
| Issue Price | $2,363,560 | IssuePriceAmt |
| Purpose | Capital improvements to hospital | PurposeDesc |
| Defeased | 0 | DefeasedInd |
| On Behalf Of Issuer | 0 | OnBehalfOfIssuerInd |
| Pool Financing | 0 | PoolFinancingInd |
Tax Exempt Bonds Proceeds TaxExemptBondsProceedsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bond Reference | A | BondReferenceCd |
| Retired | $265,000 | RetiredAmt |
| Total Proceeds | $2,363,560 | TotalProceedsAmt |
| Issuance Costs From Proceeds | $47,000 | IssuanceCostsFromProceedsAmt |
| Capital Expenditures | $2,316,560 | CapitalExpendituresAmt |
| Substantial Completion | 2009 | SubstantialCompletionYr |
| Current Refunding | 0 | CurrentRefundingInd |
| Advance Refunding | 0 | AdvanceRefundingInd |
| Final Allocation Made | Yes (1) | FinalAllocationMadeInd |
| Adequate Books And Rec Maint | Yes (1) | AdequateBooksAndRecMaintInd |
Tax Exempt Bonds Private Bus Use TaxExemptBondsPrivateBusUseGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bond Reference | A | BondReferenceCd |
| Owning Bond Financed Property | 0 | OwningBondFinancedPropertyInd |
| Any Lease Arrangements | 0 | AnyLeaseArrangementsInd |
| Mgmt Contract Bond Fincd Prop | 0 | MgmtContractBondFincdPropInd |
| Any Research Agreements | 0 | AnyResearchAgreementsInd |
| Private Bus Use By Others | 0.00000 | PrivateBusUseByOthersPct |
| Private Bus Concerning UBI | 0.00000 | PrivateBusConcerningUBIPct |
| Total Private Business Use | 0.00000 | TotalPrivateBusinessUsePct |
| Bond Iss Meet Prvt Sec Pymt Test | 0 | BondIssMeetPrvtSecPymtTestInd |
| Change In Use Bond Financed Prop | 0 | ChangeInUseBondFinancedPropInd |
| Procs Nonqualified Bond Remdtd | 0 | ProcsNonqualifiedBondRemdtdInd |
Tax Exempt Bonds Arbitrage TaxExemptBondsArbitrageGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bond Reference | A | BondReferenceCd |
| Form8038 T Filed | 0 | Form8038TFiledInd |
| Rebate Not Due Yet | 0 | RebateNotDueYetInd |
| Exception To Rebate | Yes (1) | ExceptionToRebateInd |
| No Rebate Due | 0 | NoRebateDueInd |
| Variable Rate Issue | 0 | VariableRateIssueInd |
| Hedge Identified In Bks And Rec | 0 | HedgeIdentifiedInBksAndRecInd |
| Gross Proceeds Invested In GIC | 0 | GrossProceedsInvestedInGICInd |
| Gross Proceeds Invested | 0 | GrossProceedsInvestedInd |
| Written Proc To Monitor Reqs | 0 | WrittenProcToMonitorReqsInd |
Procedures Corrective Action ProceduresCorrectiveActionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bond Reference | A | BondReferenceCd |
| Procedures Corrective Action | 0 | ProceduresCorrectiveActionInd |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (9 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Form 990, Part VI, Section A, line 1 | The Organization has an Executive Committee which is made up of the President, Vice President, Secretary, Treasurer and a Member at Large. The Executive Committee has the power to transact regular business in between board meetings. The Executive Committee has the responsibility to serve as the nominating committee. The Executive Committee was active in the past year with the retirement of one CEO and hiring of another. |
| Form 990, Part VI, Section A, line 6 | Membership in the corporation shall be either lifetime or annual, and shall be limited to adult individuals as follows: 1) Those individuals or companies contributing $100 to the corporation, or to the development fund of the Medical Center Corporation, shall, upon specific request, be entitled to a life membership. If an individual or company makes a contribution of $200 or more, they shall be entitled to designate one additional immediate family member or company employee (limited to two per family or company), respectively, for lifetime membership effective retroactively. 2) Those individuals residing in the Unity Medical Center service area shall be granted annual membership at no fee. They shall be granted annual membership status by showing proof of residing in the Corporation service area. |
| Form 990, Part VI, Section A, line 7a | Each member of the corporation in good standing shall be qualified to cast one vote on any issue that may properly come before any meeting of the members of the corporation, and to hold any office in the corporation to which he or she may be elected or appointed. |
| Form 990, Part VI, Section B, line 11 | The CFO & CEO will review a draft of the Form 990. Unity Medical Center will provide the board members with a link and a password to an electronic copy of the 990. |
| Form 990, Part VI, Section B, line 12c | Annually board members must sign a conflict of interest policy. If a board member believes that a conflict exists it is their responsibility to bring the conflict to the attention of the board. The board will determine if a conflict exists. Any board members with a conflict of interest must abstain from voting on any issues relating to the conflict. |
| Form 990, Part VI, Section B, line 15 | A formal evaluation is completed for both the CEO and CFO. Comparability data is used from the North Dakota Hospital Association. At budget time each year the board will approve a percentage increase. The deliberation and decision is documented in the board minutes. The process was last completed in June 2013. A new CEO was hired and began work in June 2014. The annual increase did not happen with the previous CEO, as he retired in March 2014. |
| Form 990, Part VI, Section C, line 19 | The governing documents, conflict of interest policy and financial statements are made available upon request. |
| Form 990, Part VII: | Director Compensation and Hours Devoted: Dr. Linda Fillipi does not receive compensation for being the Medical Staff President on the Board of Directors. The compensation she received reported in Part VII is in relation to her medical services as a physician. She devoted 1 hour per week to her position as a Board Member. |
| Form 990, Part XI, line 9: | Change in Auxiliary net assets 3,017. |
Schedule R IRS990ScheduleR
Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp
Disregarded Entity Name DisregardedEntityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Unity Medical Center Foundation | BusinessNameLine1 |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 164 West 13th Street | AddressLine1 |
| City | Grafton | City |
| State | ND | State |
| ZIP Code | 58237 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 363522304 | EIN |
| Primary Activities | Fundraising for Unity Medical Center | PrimaryActivitiesTxt |
| Legal Domicile State | ND | LegalDomicileStateCd |
| Exempt Code Section | 501(c)(3) | ExemptCodeSectionTxt |
| Public Charity Status | Line 7 | PublicCharityStatusTxt |
Direct Controlling Entity Name DirectControllingEntityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Christian Unity Hospital Corporation DBA Unity Medical Center | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Controlled Organization | Yes (1) | ControlledOrganizationInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Annts Rnts Rylts | 0 | ReceiptOfIntAnntsRntsRyltsInd |
| Gift Grnt Or Cap Contri To Oth Org | 0 | GiftGrntOrCapContriToOthOrgInd |
| Gift Grnt Cap Contri From Oth Org | Yes (1) | GiftGrntCapContriFromOthOrgInd |
| Loans Or Guarantees To Other Org | 0 | LoansOrGuaranteesToOtherOrgInd |
| Loans Or Guarantees From Oth Org | Yes (1) | LoansOrGuaranteesFromOthOrgInd |
| Div Related Organization | 0 | DivRelatedOrganizationInd |
| Asset Sale To Other Org | 0 | AssetSaleToOtherOrgInd |
| Asset Purchase From Other Org | 0 | AssetPurchaseFromOtherOrgInd |
| Asset Exchange | 0 | AssetExchangeInd |
| Rental Of Facilities To Oth Org | 0 | RentalOfFacilitiesToOthOrgInd |
| Rental Of Fclts From Oth Org | 0 | RentalOfFcltsFromOthOrgInd |
| Perform Of Services For Oth Org | 0 | PerformOfServicesForOthOrgInd |
| Perform Of Services By Other Org | 0 | PerformOfServicesByOtherOrgInd |
| Sharing Of Facilities | Yes (1) | SharingOfFacilitiesInd |
| Paid Employees Sharing | Yes (1) | PaidEmployeesSharingInd |
| Reimbursement Paid To Other Org | 0 | ReimbursementPaidToOtherOrgInd |
| Reimbursement Paid By Other Org | Yes (1) | ReimbursementPaidByOtherOrgInd |
| Transfer To Other Org | 0 | TransferToOtherOrgInd |
| Transfer From Other Org | 0 | TransferFromOtherOrgInd |
Transactions Related Org TransactionsRelatedOrgGrp
Other Organization Name OtherOrganizationName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Unity Medical Center Foundation | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Transaction Type | C | TransactionTypeTxt |
| Involved | $62,233 | InvolvedAmt |
| Method Of Amount Determination | Contribution amount per GL | MethodOfAmountDeterminationTxt |
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