2019-11-14T07:11:29-06:00 2018-12-31 450250958 Eide Bailly LLP 800 Nicollet Mall Ste 1300 Minneapolis MN 554027033 990 2018-01-01 454165628 United Hospital District Inc UNIT 5075263273 515 S Moore Street Blue Earth MN 56013 Richard Ash CEO 5075263273 2019-11-13 1 Kim Hunwardsen CPA P00484560 6122536500 2019-11-13 216.147.181.49 2019-11-13 13:09:01 CS P D8A1E5117AA53286D53F57459EBB2DE5C7CA50FC F9BEE9501A3B4F00F190E63700B8BF2BC70C7B96 2018 2020-04-17 16:48:07Z Richard Ash 515 S Moore Street Blue Earth MN 56013 37613988 0 X www.uhd.org X 2011 MN Provision of health care services 9 7 283 45 0 0 94732 1527919 33242394 35876525 116982 209044 2350 500 33456458 37613988 6070 7871 0 0 16947059 18644142 0 0 0 15252793 17803293 32205922 36455306 1250536 1158682 41330603 39724836 12473043 9708594 28857560 30016242 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 31415692 7871 35876525 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 as well as a 24-bed adolescent treatment center in Winnebago, Minnesota. In 2018, United Hospital District, Inc. provided $499,000 worth of financial assistance based on established rates of charges foregone. The estimated costs of the charges forgone was $243,000 based upon an overall cost-to-charge ratio calculation. 31415692 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 1 0 0 0 0 0 0 0 0 1 135 0 1 283 1 0 0 0 0 0 0 0 0 0 0 0 0 X 9 7 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 Bob Karp MD Chairman 40.00 X X 401786 0 37697 Larry Anderson Vice Chairman 1.00 X X 803 0 0 Barbara Hanson Secretary 1.00 X X 0 0 0 Wyatt Rollenhagen Treasurer 1.00 X X 0 0 0 Crystal Hanson Board Member 1.00 X 0 0 0 Melanie Humburg Board Member 1.00 X 761 0 0 Doug Johanson Board Member 1.00 X 650 0 0 Cheryl Keithahn Board Member 1.00 X 650 0 0 Aaron Johnson MD Board Member 40.00 X 300227 0 23285 Richard Ash CEO 40.00 X 227950 0 36670 Patrick Justin CFO 40.00 X 137765 0 16851 Christopher Gran MD Physician 40.00 X 484258 0 25141 Alex Wong MD Surgeon 40.00 X 466860 0 45501 Joseph Montanaro MD Physician 40.00 X 406337 0 34260 Mark Gundersen MD Physician 40.00 X 275765 0 34260 Mary Trites MD Physician 40.00 X 251055 0 20706 2954867 0 274371 22 0 1 0 Acute Care Inc 1609 N Ankeny Blvd Ankeny IA 50023 ED MD Coverage 1281837 Orthopaedic & Fracture Clinic 1431 Premier Drive Mankato MN 56001 Ortho MD's 429381 Mankato Clinic 1230 E Main St PO Box 8674 Mankato MN 560028674 Radiology Coverage 402104 Cloudwave 100 Crowley Dr Marlborough MA 01752 Computer host 318540 CMDI 150 10th St NW Milaca MN 56353 CT & MRI Services 224996 12 1527919 1438929 1527919 Patient Service Revenue 621110 34247885 34247885 340B Program Revenue 621110 1223242 1223242 Supporting Revenue 900099 333066 333066 Equity earnings in CDMI 900099 72332 72332 35876525 208854 208854 500 0 500 500 500 190 0 190 190 190 37613988 35876525 0 209544 X 7871 7871 1190845 747795 443050 13329324 12202956 1126368 616351 579470 36881 2573642 2373013 200629 933980 853338 80642 65962 65962 57245 57245 4755246 3961814 793432 13929 7736 6193 1103040 724658 378382 582562 27257 555305 794708 760967 33741 208062 175701 32361 121774 93584 28190 295760 254107 41653 2089324 1799524 289800 156052 2766 153286 Medical Supplies 3812392 3812392 Bad Debt 2387699 2387699 MN Care Tax 330346 330346 Equipment Rental/Repair 211029 204774 6255 818163 438270 379893 36455306 31415692 5039614 0 10990346 9177185 5434827 5237505 164286 118269 194788 492937 923685 1010453 116122 493021 46356564 27380564 19617486 18976000 3564114 3895062 324949 324404 41330603 39724836 2608745 2958260 6093893 8715335 141585 1148963 514856 12473043 9708594 X 28857560 30016242 28857560 30016242 41330603 39724836 1158682 0 X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 632000 632000 29937897 15872142 14065755 920458 529043 391415 14206541 10979379 3227162 659668 659668 18976000 Estimated 3rd Party Payor Settlements 514856 514856 X 35226289 -2387699 -2387699 37613988 0 37613988 34067607 0 34067607 2387699 2387699 36455306 Part X, Line 2: The Hospital is organized as a Minnesota 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 Hospital is annually required to file a Return of Organization Exempt from Income Tax (Form 990) with the IRS. In addition, the Hospital is subject to income tax on net income that is derived from business activities that are unrelated to its exempt purpose. Management has determined that the Hospital 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 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. Part XI, Line 2d - Other Adjustments: Bad debt expense included in revenue for financial statements -2,387,699. Part XII, Line 4b - Other Adjustments: Bad debt expense included in revenue for financial statements 2,387,699. 1 1 X 1 X 225.000000000000 1 X 275.000000000000 0 1 0 0 243000 243000 0.00710 6595951 4107878 2488073 0.07300 6838951 4107878 2731073 0.08010 4137692 127745 4009947 0.11770 4137692 127745 4009947 0.11770 10976643 4235623 6741020 0.19780 0 2387699 596925 9357833 9409274 -51441 X 1 1 1 1 United Hospital District 515 S Moore Street Blue Earth MN 56013 www.uhd.org 375736 X 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 17 1 0 0 1 X See Schedule H, Part V, Line 10a X 1 17 1 https://www.uhd.org/community-needs-assessment 0 1 X 225.000000000000 275.000000000000 X 1 1 X X X X X 1 X www.uhd.org/financial-assistance-and-hospital-clinic-charges/ X www.uhd.org/financial-assistance-and-hospital-clinic-charges/ X www.uhd.org/financial-assistance-and-hospital-clinic-charges/ X X X X X 1 X 0 X X X X 1 X 0 0 United Hospital District Part V, Section B, Line 5: An external consulting firm was subcontracted to perform the assessment, data collection and analysis. Two focus groups were held. The first was on 3-23-17 in Wells, Minnesota and the second group on 3-31-17 in Blue Earth, Minnesota. The 68 group members were recruited by phone to invite their participation with an email follow-up reminder. Due to weather constraints, the final sessions had 12 participants in the 2 groups. The stakeholders consisted of representation from area school districts, city government and numerous businesses. United Hospital District Part V, Section B, Line 11: The CHNA conducted in 2017 was our first one after becoming a tax exempt 501(c)(3) organization as of January 1, 2015. The CHNA was completed in September 2017 and approved by the Hospital Board on October 3rd, 2017. The needs identified in the report of findings, while partly highlighting specific service gaps, largely centered on issues related to healthy living and lifestyles. As a result, three key goals were identified as well as action items to address those goals. The goals identified in our action plan are as follows:**Goal 1: Raise awareness of healthcare and healthcare-related services currently provided by UHD*Action Item A: Review and update existing print and online materials, both available to the public and distributed internally to UHD staff and partners***A communications position was created and filled in August of 2018. Responsibilities of the position include updating existing informational material and creating/distributing improved healthcare services information internally and more intensively externally to the communities we serve. The UHD website rebuild was started in early 2018 and was near completion by December of 2018. It went live in early 2019. The site was redesigned to provide improved access to healthcare services information and availability.*Action Item B: Assess and expand public education and public information activities specifically related to:a) smoking cessation, specifically including smoking cessation options for pregnant womenb) weight loss/weight controlc) healthy dietsd) exercise/activitye) moderation in alcohol consumption***During 2018 action Item B was addressed in the following ways:-On the first Friday of each month at our local AM radio station, one of UHD's providers discussed one relevant health topic related to smoking cessation, weight loss/weight control, healthy diets or other areas of public health concern.-A full time dietitian was hired to improve access and services to inpatients and outpatients regarding healthy nutrition and meals. The dietitian has also created a healthy meals campaign for staff and the public who receive meals at UHD's cafeteria.*Action Item C: Build a system for regular periodic review and assessment of the activities executed under this goal to determine success and make changes as necessary. This activity should begin with determining both outcome/impact and process indicators of success.***The organization has begun a process of review and assessment of progress as part of the initial preparations for our next CHNA of which has begun in 2019. The CHNA will be a part of the strategic planning process as well.**Goal 2: Service collaboration and coordination with external community partners*Action Item A: Develop outreach activities based on the CHNA report of findings and other available resources to solicit interest in, and partners for, a more formalized system of multiorganizational community support for community residents. As the hospital's identified single point of contact for community relations and collaborations, the CEO should lead this effort.*Action Item B: Based on (A) above, UHD should actively participate in the implementation of a coordinated community support information and referral service. This includes participation in service coordination activities led by other agencies serving UHD's service area.***To help address Action Items A and B, UHD is part of the core leadership group of a newly formed Faribault and Martin Counties Community Health Collaborative. The representatives of the collaborative are from Mayo Clinic Hospital, Fairmont, United Hospital District, Blue Earth, Martin and Faribault county public health and human services, Blue Earth and Fairmont schools and several community-based organizations and service clubs. Three action planning teams have been created to address the following: Access to Care, Chronic Disease and Community Resiliency.**Goal 3: Operational feasibility planning to address potential service additions*Action Item A: Based on the information contained in the CHNA report of findings and other available information, develop an inventory of service gaps and personnel needs.*Action Item B: Develop potential financial and operational plans to address the identified service gaps and personnel needs. 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. 2 1 - UHD Home Health and Hospice 125 South Main Street Blue Earth MN 56013 Comprehensive home care Hospice Program 2 - Adolescent Treatment Center 620 1st Avenue SW Winnebago MN 56098 Children's residential, Supervised living, Chemical dependency treatment 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 I, Ln 7 Col(f): The amount of bad debt expense removed from the denominator is $2,387,699. Part III, Line 2: Bad debt expense is reported as charges as recorded by the organization. All discounts and payments on a patient's account are accounted for prior to determining bad debt expense. Part III, Line 3: The Organization estimates that 25% of bad debt expense is 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 can be found on page 8 of the attached audited financial statements. Part III, Line 8: United Hospital District is a critical access hospital. There was a shortfall for 2018 due to sequestration. Even though Medicare was at a loss, the Hospital provides services to these patients because access to healthcare and individual's health is important to the Hospital. Therefore, the Medicare shortfall is considered a community benefit.Medicare allowable costs were obtained from the 2018 Medicare cost report.The Medicare Cost Report is completed based on the rules and regulationsset 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 dayof care. 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 westAlbert Lea, MN - Mayo Clinic Health Systems - 42 miles east (Albert Lea Hospital closed its inpatient services effective 10/30/19.)Mankato, 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 Bob Karp MD Chairman 307119 0 60275 0 34392 0 13226 0 26514 0 441526 0 0 0 Aaron Johnson MD Board Member 222560 0 77667 0 0 0 0 0 24790 0 325017 0 0 0 Richard Ash CEO 227848 0 102 0 0 0 11761 0 25971 0 265682 0 0 0 Patrick Justin CFO 137664 0 101 0 0 0 7007 0 10555 0 155327 0 0 0 Christopher Gran MD Physician 417783 0 25102 0 41373 0 13750 0 13230 0 511238 0 0 0 Alex Wong MD Surgeon 409008 0 50102 0 7750 0 13750 0 33680 0 514290 0 0 0 Joseph Montanaro MD Physician 332629 0 44333 0 29375 0 13750 0 22575 0 442662 0 0 0 Mark Gundersen MD Physician 225663 0 50102 0 0 0 13750 0 22201 0 311716 0 0 0 Mary Trites MD Physician 200953 0 50102 0 0 0 12502 0 9322 0 272879 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 9428450 188569 3053221 6186660 1 0 0 0 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 Bobby Karp Medical Provider Signing Incentive X 125000 118269 0 1 1 118269 X 1 25000 FMV on date of transfer X See Part II 1 1413929 Fair Market Value 0 0 0 0 Part I, Column (b): SCHEDULE M, PART I, LINE 25: Land, building, fixed equipment and related debt The Hospital leased land, building, and fixed equipment from the United Hospital District of Fairbault County, Minnesota (District) under a noncancelable long-term lease agreement through October 2018 when the District's debt was refinanced, and the land, building, fixed equipment and related debt was transferred from the District to the Hospital. A non-cash contribution of $1,413,929 was recorded by the Hospital. Form 990, Part VI, Section A, line 1 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. The Senior Executive Suite, including the CEO, CFO, CNO and CMO approve the salaries for all other key employees and managers on a yearly basis. 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 3,738,100. Management and general expenses 419,651. Fundraising expenses 0. Total expenses 4,157,751. Other Fees : Program service expenses 223,714. Management and general expenses 373,781. Fundraising expenses 0. Total expenses 597,495.