2022-11-08T07:40:30-06:00 2021-12-31 450250958 Eide Bailly LLP 800 Nicollet Mall Ste 1300 Minneapolis MN 554027033 990 2021-01-01 454165628 United Hospital District Inc UNIT 5075263273 515 S Moore Street Blue Earth MN 56013 Richard Ash CEO 5075263273 2022-11-07 1 Richard Ash 999009999 Kim Hunwardsen CPA P00484560 6122536500 2022-11-07 3 AAL1 IAL1 2021 2022-09-23 18:48:47Z Richard Ash 515 S Moore Street Blue Earth MN 56013 43623403 0 X www.uhd.org X 2011 MN Provision of health care services 11 9 254 9 0 0 5221308 4460807 33093718 38918609 -1221699 239058 210 4929 37093537 43623403 0 0 0 0 20007746 20578357 0 0 0 16102550 17470657 36110296 38049014 983241 5574389 50772048 51620519 17645545 12919627 33126503 38700892 At United Hospital District, we exist to provide and promote appropriate health care services to the communities we serve, doing so in a safe and healing environment which supports our patient-centered care philosophy. 0 0 32429353 38918609 United Hospital District, Inc. operates a 25-bed critical access hospital in Blue Earth, Minnesota. The Hospital also operates medical clinics in Blue Earth, Wells, Winnebago and Fairmont, Minnesota. The Hospital provides health care services to patients who meet certain criteria under its charity care policy without charge or at amounts less than established rates. The estimated cost of providing these services was $399,000 for the year ended December 31, 2021, calculated by multiplying the ratio of cost to gross charges for the Hospital by the gross uncompensated charges associated with providing charity care to its patients. 32429353 1 1 0 0 0 0 0 0 0 0 1 0 0 0 1 1 1 0 0 0 0 0 0 0 0 0 1 1 0 0 1 1 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 67 0 1 254 1 0 0 0 0 0 0 0 0 0 0 0 0 X 11 9 0 0 0 0 0 1 0 1 1 0 0 1 1 1 1 1 1 1 0 0 MN X Patrick Justin 5075267908 515 S Moore Street Blue Earth MN 56013 Wyatt Rollenhagen Chairman 1.00 X X 1223 0 0 Ryan Milbrandt Vice Chair 1.00 X X 400 0 0 Melanie Humburg Secretary 1.00 X X 389 0 0 Doug Johanson Treasurer 1.00 X X 562 0 0 Larry Anderson Board Member 1.00 X 1387 0 0 Chase Brandt Board Member 1.00 X 450 0 0 Joanne Hoffman Board Member 1.00 X 414 0 0 Debra McCarty DO Board Member (began Nov) 40.00 X 134736 0 4335 Bob Karp MD Board Member 40.00 X 459451 0 44329 Justin Miller Board Member 1.00 X 700 0 0 Richard Barke Board Member 1.00 X 692 0 0 Alex Wong MD Board Member (Feb-Nov) 40.00 X 567107 0 44329 Aaron Johnson MD Board Member (thru Feb) 40.00 X 340562 0 22596 Richard Ash CEO 40.00 X 252317 0 43506 Patrick Justin CFO 40.00 X 150517 0 16550 Timothy Bachenberg MD Physician 40.00 X 238957 0 40942 Christopher Gran MD Physician 40.00 X 483880 0 23552 Joseph Montanaro MD Physician 40.00 X 393557 0 36981 Laraine Klunder CRNA 40.00 X 236417 0 41618 Mary Trites MD Physician 40.00 X 228947 0 20242 3492665 0 338980 25 0 1 0 Orthopaedic & Fracture Clinic 1431 Premier Drive Mankato MN 56001 Ortho MD's 458518 CMDI 525 10th St NE Milaca MN 56353 CT Services 342178 Shared Medical Services 209 Limestone Pass PO Box 330 Cottage Grove MN 53527 CT Services 298260 Managed Accounts Receivable PO BOX 548 Anoka MN 55303 Collection Agency Services 295547 Cloudwave 100 Crowley Dr Marlborough MA 01752 Computer host 178208 6 4375580 85227 25000 4460807 Patient Service Revenue 621110 37868093 37868093 340B Program Revenue 621110 771809 771809 Equity earnings in CDMI 621110 156327 156327 Supporting Revenue 621110 122380 122380 38918609 130415 130415 4929 0 4929 4929 4929 108553 90 0 0 108553 90 108643 108643 43623403 38918609 0 243987 X 2094737 1591285 503452 13973789 12514519 1459270 815216 732002 83214 2628418 2331171 297247 1066197 938159 128038 67642 67642 69410 69410 5520166 4841081 679085 214878 214878 820169 562430 257739 775893 21627 754266 682753 543410 139343 158674 144734 13940 60060 34918 25142 260791 222141 38650 2251357 1730304 521053 214706 214706 Medical Supplies 4147120 4140325 6795 Equipment Rental/Repair 1177958 1121115 56843 MN Care Tax 665227 665227 Licenses/Dues 134181 62792 71389 249672 232113 17559 38049014 32429353 5619661 0 17534080 17273402 4093779 4056394 68269 43269 703251 515170 838100 1062109 363633 384662 53711676 30797401 20760250 22914275 4847170 4542492 357380 407549 1206136 421197 50772048 51620519 3190195 3270415 3690866 1413 7908529 7475492 58108 23499 2797847 0 2148808 17645545 12919627 X 33126503 38700892 33126503 38700892 50772048 51620519 5574389 0 X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 612000 612000 37811411 18436636 19374775 1004353 688010 316343 14283912 11672755 2611157 22914275 Third Party Payor Settlements 2148808 2148808 X 43623403 0 43623403 0 43623403 38049014 0 38049014 0 38049014 Part X, Line 2: The Hospital 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 Hospital would recognize future accrued interest and penalties related to unrecognized tax benefits and liabilities in income tax expense if such interest and penalties are incurred. 1 1 X 1 X 225.000000000000 1 X 275.000000000000 0 1 1 0 0 399000 399000 0.01050 7644841 6753492 891349 0.02340 8043841 6753492 1290349 0.03390 4938484 2135798 2802686 0.07370 4938484 2135798 2802686 0.07370 12982325 8889290 4093035 0.10760 1 2326977 581744 6795505 6728222 67283 X 1 1 1 1 United Hospital District 515 S Moore Street Blue Earth MN 56013 www.uhd.org 375736 X X X 3 Provider based clinics, 1 Fee for service clinic United Hospital District 1 0 0 1 X X X X X X X X X 20 1 0 0 1 X See Part V, Page 8 X 1 20 1 https://uhd.org/index.php/community-needs-assessment 0 1 X 225.000000000000 275.000000000000 X 1 1 X X X X X 1 X http://www.uhd.org/index.php/forms X http://www.uhd.org/index.php/forms X http://www.uhd.org/index.php/forms X X X X X 1 X 0 X X X 1 X 0 0 United Hospital District Part V, Section B, Line 5: In November 2020, the CHNA, a cover letter on UHD's letterhead, and a postage paid reply envelope were mailed first class to 800 randomly selected residents in the targeted region (fifteen zip codes). A press release was sent to local newspapers prior to the survey distribution announcing that UHD would conduct a CHNA throughout the region, in cooperation with The National Rural Health Resouce Center (The Center). The announcement was also shared on UHD's Facebook page. To assist with the assessment, UHD contracted with the National Rural Health Resource Center, headquartered in Duluth, Minnesota. The Center is a nonprofit organization dedicated to sustaining and improving health care in rural communities. The Center conducted demographic analysis and statistical research and surveys for the focus groups and key community stakeholder interviews were developed.Due to COVID-19 restrictions the focus groups were held virtually and included residents from several different communities in UHD's service area and represented young parents, seniors, veterans, schools, businesses, healthcare consumers, and social services. The key stakeholder meetings were one-on-one 60-minute interviews and included representatives of education, law enforcement, local business, faith leaders, and other community and elected leaders. United Hospital District Part V, Section B, Line 11: In 2020, United Hospital District (UHD) commissioned a community health needs assessment to evaluate the healthcare needs of its service area: Faribault, Freeborn, Martin, and Blue Earth Counties in Minnesota, and Kossuth and Winnebago Counties in Iowa. The priorities identified by the CHNA teams are as follows: **Goal 1: Provide and Promote Education Information and Opportunities to the Communities We Serve1. Survey responses indicate there is an opportunity to better communicate about services or available preventive support. 2. Some focus group respondents indicated that they were not sure what services UHD offers. 3. Leverage all modes of communication that will reach the senior population as well as younger community members. **Action Item A: The community education team met to brainstorm about how best to promote better education regarding the varied services available at UHD. The team is also exploring the methods to disseminate the information, i.e., via YouTube, podcasts, radio, and other outlets to reach the various demographic segments of UHD's service area. The team suggested that in Q1 of 2022 the CNO would meet with each department manager to get topics for discussions. The team would like to have frontline staff involved in the creation of the videos/podcasts that could then be uploaded to UHD's website.**Goal 2: Match the Scope of Services with the Needs of the Communities We Serve:1. The CHNA results encouraged UHD to continue developing partnerships with businesses, faith groups, and schools (including schools within the counties but not located in Blue Earth).**Action Item A: UHD has created an internal team for this as well. The team is exploring the feasibility of a Community Paramedicine/service delivery position. This entails meeting with the Medical Director of the Minnesota EMSRB (Emergency Medical Services Regulatory Board) to assist with the development of policy and protocol, outcome analysis and quality assurance initiatives. Currently UHD employs only one Paramedic. To move to a Community Paramedicine Program, UHD would need to hire additional staff, and convert the ambulance service from existing BLS (Basic Life Support) to part-time ALS (Advance Life Support).**Action Item B: Community Paramedicine Program: Weekly meetings began to look at the conversion of our ambulance service from BLS to part-time ALS. At this time UHD is putting together the supply list along with capital purchases required to move forward with part-time ALS. Next step is to accept the protocols and then UHD will move forward with the application process.**Action Item C: Ambulance Service from BLS to part-time ALS: The consulting physician of the Minnesota EMSRB visited UHD in Q4 of 2021. UHD will continue to work with the consortium for ambulance guidance. The consulting physician will remain a resource to UHD as we submit our application for ALS. A UHD physician has been invited to attend meetings of the consortium to learn more about ambulance directorship and the requirements.**Goal 3: Promote, Partner, and Enhance Mental Health Services1. As in many communities, there is an opportunity to address issues related to mental illness. Following best practice recommendations, this is not something the hospital can do alone. **Action Item A: An internal team has been created to coordinate efforts in this area. The team has already engaged UHD's MH (Mental Health) providers to appear on local radio once per month with a program dedicated to various MH topics. The MH resource information on UHD's website has been augmented with numerous additional links for patients. The team is also looking to collaborate with local school districts, nursing homes, and veteran's agencies to identify and connect services. UHD also continues to explore options for outpatient telehealth. **Action Item B: Radio spots continue to take place every other Friday with MH Providers. **Action Item C: 50-page Mental Health booklet was completed and printed. MH Providers have put it into use and has been well received.**Action Item D: MH Access Expanded (location and/or provider): MH PhD is up and running in the Fairmont location 3 days/week, currently limiting to 1 new referral per day due to current caseload. An interview is set up for a Psychiatric Mental Health Nurse Provider (PMHNP) to join the BE Clinic MH staff. A PMHNP can assist with medication management. **Action Item E: Outreach is planned to the local school district staff. United Hospital District Part V, Section B, Line 13h: Documents that may be reviewed include completed application, recent tax statements, bank denial and MA denial. The Organization also follows the state agreement. United Hospital District Part V, Section B, Line 15e: We have certified staff who assist with the MN State Exchange and MA. They also provide guidance with every patient's insurance carrier where needed. Schedule H, Part V, Line 7a: https://uhd.org/index.php/community-needs-assessment 1 1 - UHD Home Health and Hospice 125 South Main Street Blue Earth MN 56013 Comprehensive Home Care & Hospice Program Part I, Line 3c: In addition to the Federal Poverty Guidelines, documents that may be reviewed include completed application, recent tax statements, bank denial and MA denial. The Organization also follows the state agreement. Part I, Line 7: Charity care expense was converted to cost on line 7a based on an overall cost-to-charge ratio addressing all patient segments. Unreimbursed Medicaid on line 7b and subsidized health services on line 7g were determined using the costing methods to prepare the cost reports. Part III, Line 2: The amount reported on line 2 represents implicit price concessions. The Hospital determines its estimate of implicit price concessions based on its historical collection experience with this class of patients. Part III, Line 3: The Organization estimates that 25% of its implicit price concessions are attributable to patients eligible for financial assistance under the financial assistance policy. We estimate that 25% of those who should have completed financial assistance forms and applications could have qualified for financial assistance had they applied. Part III, Line 4: The footnote to the organization's financial statements addressing implicit price concessions may be found on pages 11 and 12 of the attached audited financial statements. Part III, Line 8: Medicare allowable costs were obtained from the 2021 Medicare cost report. The Medicare Cost Report is completed based on the rules and regulations set forth by the Centers for Medicare and Medicaid Services. Part III, Line 9b: Within 7 days after an insurance payment, the patient will start receiving monthly billings. Statements are sent on a monthly cycle basis. If no payment is received 30 days after the statement went out, the patient is contacted by phone. If no payment is received for 90 days, the patient is contacted by letter to advise him or her of further collection actions to be taken. When agreed upon amounts are not paid off, arrangements can be made for a series of payments to fulfill a patient's obligation. Each account is reviewed by a business office staff member before placing with a collection agency. A financial assistance application submitted by a patient will be processed for at least 240 days following their first post discharge billing statement. If an individual submits a financial assistance application after collection actions have started, collection actions will be suspended until financial assistance eligibility is determined. If an individual is determined to be eligible for financial assistance, no further collection actions will be taken. If an individual is determined to be eligible for financial assistance after collection actions have started, the collection actions will be reversed. Part VI, Line 2: UHD has standing advisory committees with representation from our communities for Home Health/Hospice and ATCW. Input from the members helps set the strategies and initiatives for improvement. We've also had Focus Groups to address Obstetrical services and another for Orthopedic services. Our patient satisfaction survey incorporates a comments section which gives our patients a voice to make suggestions. Part VI, Line 3: Whether in person or on our web-site, UHD provides the following information for financial assistance: (1) posts its charity care policy, or a summary thereof, and financial assistance contact information in admissions areas, emergency rooms, and other areas of the organization's facilities in which eligible patients are likely to be present; (2) provides a copy of the policy, or a summary thereof, and financial assistance contact information to patients as part of the intake process; (3) provides a copy of the policy, or a summary thereof, and financial assistance contact information to patients with discharge materials; (4) includes the policy, or a summary thereof, along with financial assistance contact information, in patient bills; and/or (5) discusses with the patient the availability of various government benefits, such as Medicaid or state programs, and assists the patient with qualification for such programs, where applicable. In addition, the Business Office has several certified individuals to assist with applications for both State and Federal insurance plans. Part VI, Line 4: UHD is located in Blue Earth, Minnesota, a community of approximately 3,400 situated in the west central end of Faribault County. The county borders Martin County to the west, Freeborn County to the east, Blue Earth County to the north, and two Iowa counties, Kossuth and Winnebago, to the south.UHD is the only hospital serving Faribault County and the northern Iowa adjacent counties. Faribault County comprises 82% of UHD outpatient admissions while the remaining adjacent counties comprises 95% of all outpatient encounters. The population within a 10-mile radius of Blue Earth is about 9,000 and within a 20-mile radius is about 30,000.The closet full-service hospitals are in:Fairmont, MN - Mayo Clinic Health Systems - 22 miles westMankato, MN - Mayo Clinic Health Systems - 45 miles northEmmetsburg, IA - Palo Alto County Hospital - 66 miles southwest Part VI, Line 5: United Hospital District's current board members reside in the service area. Medical staff privileges for physicians are provided to all qualified care providers who also primarily reside in the service area. The Hospital also has relationships for certain specialists who provide their medical care in our clinics and hospital. All surplus funds are reinvested in the program areas for the hospital and clinics. X X 0 0 0 0 0 0 0 0 0 Alex Wong MD Board Member (Feb-Nov) 564005 0 3102 0 0 0 14500 0 32117 0 613724 0 0 0 Christopher Gran MD Physician 480778 0 3102 0 0 0 14500 0 11031 0 509411 0 0 0 Bob Karp MD Board Member 456349 0 3102 0 0 0 14500 0 31718 0 505669 0 0 0 Joseph Montanaro MD Physician 390455 0 3102 0 0 0 14500 0 24127 0 432184 0 0 0 Aaron Johnson MD Board Member (thru Feb) 337460 0 3102 0 0 0 0 0 24046 0 364608 0 0 0 Richard Ash CEO 249215 0 3102 0 0 0 12981 0 31649 0 296947 0 0 0 Timothy Bachenberg MD Physician 235855 0 3102 0 0 0 10113 0 31902 0 280972 0 0 0 Laraine Klunder CRNA 233315 0 3102 0 0 0 11789 0 31373 0 279579 0 0 0 Mary Trites MD Physician 225845 0 3102 0 0 0 11250 0 10029 0 250226 0 0 0 Patrick Justin CFO 147416 0 3101 0 0 0 7498 0 9798 0 167813 0 0 0 A City of Frost Minnesota 416005176 2018-10-18 9428450 Refinance District's debt and remodel ER, lobby and other spaces 0 0 0 A 1789005 9428450 188569 3053221 2019 1 0 1 1 A 0 0 0 0 0.00000 0.00000 0.00000 0 0 1 A 0 0 0 0 0 0 0 0 1 A 1 Bob Karp MD Medical Provider Signing Incentive X 125000 43269 0 1 1 43269 Form 990, Part VI, Section A, line 1a The Organization has an Executive Committee consisting of the Chair, Vice Chair, Secretary and Treasurer. In addition, the CEO is an ex-officio, non-voting member of the Executive Committee. The Chair of the Board of Directors is the Chair of the Executive Committee. The Executive Committee has the authority of the Board of Directors in the management of the business of the Organization in intervals between meetings of the Board of Directors. Form 990, Part VI, Section A, line 7a The Board of Directors consists of no fewer than seven and no more than fifteen members. Three "District Directors" are appointed by the United Hospital District Board of Directors. There can be up to two "At-Large Directors" who are elected by the Board of Directors but need not be residents of the Geographic Service Area. There is one Ex Officio director, who is the physician serving as the Chief of Medical Staff of the hospital. The remaining members of the Board of Directors are "Area Directors" who are elected by the Board of Directors of this corporation and must be residents of the Geographic Service Area. The Geographic Service Area means all of the cities and townships comprising the District, plus any additional area contained within the lowest number of contiguous zip codes from which the hospital drew at least 75 percent of its inpatients during the previous fiscal year. Form 990, Part VI, Section B, line 11b The CFO reviews the Form 990 and a copy is provided to the board members prior to filing with the IRS. Form 990, Part VI, Section B, line 12c The organization has a conflict of interest policy in place which covers the officers and board members of the organization. Potential conflicts are reviewed and determined by the CEO and board chair. If an individual has a conflict of interest, they are asked to abstain from voting on the conflicting issue. Form 990, Part VI, Section B, line 15a CEO: The Executive Committee of the Board reviews salary surveys from the Minnesota Hospital Association in determining the salary for the CEO. Other officers: Similarly to the CEO, the results of the salary survey from the Minnesota Hospital Association is used in determining the salary for the remaining officers. The CEO approves these increases in compensation. Form 990, Part VI, Section C, line 19 The governing documents, conflict of interest policy and financial statements are not made available to the public Form 990, Part IX, line 11g Outside Consultants/Purchased Srvcs: Program service expenses 4,698,208. Management and general expenses 249,204. Fundraising expenses 0. Total expenses 4,947,412. Other Fees: Program service expenses 142,873. Management and general expenses 429,881. Fundraising expenses 0. Total expenses 572,754.