UNITED HOSPITAL DISTRICT INC: Form 990, tax year 2016
View the entire original 990 at ProPublica ↗
- Organization
- UNITED HOSPITAL DISTRICT INC (EIN 45-4165628)
- Tax period
- 2016-01-01 to 2016-12-31
- Filed
- 2017-10-19
- IRS object ID
- 201732929349300403
- Schema version
- 2016v3.0
- 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 ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return | 2017-10-19T07:48:29-05:00 | ReturnTs |
| Tax Period End | 2016-12-31 | 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 | BusinessNameLine1Txt |
Preparer US Address PreparerUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 800 Nicollet Mall Ste 1300 | AddressLine1Txt |
| City | Minneapolis | CityNm |
| State Abbreviation | MN | StateAbbreviationCd |
| ZIP | 554027033 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnTypeCd |
| Tax Period Begin | 2016-01-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 454165628 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | United Hospital District Inc | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | UNIT | BusinessNameControlTxt |
| Phone | 5075263273 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 515 S Moore Street | AddressLine1Txt |
| City | Blue Earth | CityNm |
| State Abbreviation | MN | StateAbbreviationCd |
| ZIP | 56013 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | Patrick Justin | PersonNm |
| Person Title | CFO | PersonTitleTxt |
| Phone | 5075263273 | PhoneNum |
| Signature | 2017-10-16 | SignatureDt |
| Discuss With Paid Preparer | Yes (1) | DiscussWithPaidPreparerInd |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | Kim Hunwardsen CPA | PreparerPersonNm |
| PTIN | P00484560 | PTIN |
| Phone | 6122536500 | PhoneNum |
| Preparation | 2017-10-16 | PreparationDt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2016 | TaxYr |
| Build TS | 2022-09-23 18:48:47Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Principal Officer | Richard Ash | PrincipalOfficerNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 515 S Moore Street | AddressLine1Txt |
| City | Blue Earth | CityNm |
| State Abbreviation | MN | StateAbbreviationCd |
| ZIP | 56013 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $31,863,397 | GrossReceiptsAmt |
| Group Return For Affiliates | 0 | GroupReturnForAffiliatesInd |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | www.uhd.org | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 2011 | FormationYr |
| Legal Domicile State | MN | LegalDomicileStateCd |
| Activity Or Mission | Provision of health care services | ActivityOrMissionDesc |
| Voting Members Governing Body | 9 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 7 | VotingMembersIndependentCnt |
| Total Employee | 273 | TotalEmployeeCnt |
| Total Volunteers | 45 | TotalVolunteersCnt |
| Total Gross UBI | $0 | TotalGrossUBIAmt |
| Net Unrelated Bus Txbl Incm | $0 | NetUnrelatedBusTxblIncmAmt |
| PY Contributions Grants | $27,488,275 | PYContributionsGrantsAmt |
| CY Contributions Grants | $110,490 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $28,917,256 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $31,693,147 | CYProgramServiceRevenueAmt |
| PY Investment Income | $60,330 | PYInvestmentIncomeAmt |
| CY Investment Income | $57,410 | CYInvestmentIncomeAmt |
| PY Other Revenue | $2,735 | PYOtherRevenueAmt |
| CY Other Revenue | $2,350 | CYOtherRevenueAmt |
| PY Total Revenue | $56,468,596 | PYTotalRevenueAmt |
| CY Total Revenue | $31,863,397 | CYTotalRevenueAmt |
| PY Grants And Similar Paid | $1,800 | PYGrantsAndSimilarPaidAmt |
| CY Grants And Similar Paid | $4,701 | CYGrantsAndSimilarPaidAmt |
| PY Benefits Paid To Members | $0 | PYBenefitsPaidToMembersAmt |
| CY Benefits Paid To Members | $0 | CYBenefitsPaidToMembersAmt |
| PY Salaries Comp Emp Bnft Paid | $15,132,010 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $15,434,067 | CYSalariesCompEmpBnftPaidAmt |
| PY Total Prof Fndrsng Expns | $0 | PYTotalProfFndrsngExpnsAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $0 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $13,929,042 | PYOtherExpensesAmt |
| CY Other Expenses | $16,223,349 | CYOtherExpensesAmt |
| PY Total Expenses | $29,062,852 | PYTotalExpensesAmt |
| CY Total Expenses | $31,662,117 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | $27,405,744 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | $201,280 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $40,091,033 | TotalAssetsBOYAmt |
| Total Assets EOY | $39,731,237 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $12,685,289 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $12,124,213 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $27,405,744 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $27,607,024 | NetAssetsOrFundBalancesEOYAmt |
| Info In Schedule O Part III | Yes (X) | InfoInScheduleOPartIIIInd |
| Mission | 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. | MissionDesc |
| Significant New Program Srvc | Yes (1) | SignificantNewProgramSrvcInd |
| Significant Change | 0 | SignificantChangeInd |
| Expense | $28,205,328 | ExpenseAmt |
| Grant | $4,701 | GrantAmt |
| Revenue | $31,693,147 | RevenueAmt |
| Desc | 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 2016, United Hospital District, Inc. provided $41,000 worth of financial assistance based on established rates of charges foregone. The estimated costs of the charges forgone was $22,000 based upon an overall cost-to-charge ratio calculation. | Desc |
| Total Program Service Expenses | $28,205,328 | 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 | 0 | 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 | Yes (1) | IndependentAuditFinclStmtInd |
| Consolidated Audit Fincl Stmt | 0 | 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 | 0 | TaxExemptBondsInd |
| Engaged In Excess Benefit Trans | 0 | EngagedInExcessBenefitTransInd |
| PY Excess Benefit Trans | 0 | PYExcessBenefitTransInd |
| Loan Outstanding | Yes (1) | 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 | 0 | RelatedEntityInd |
| Related Organization Ctrl Ent | 0 | RelatedOrganizationCtrlEntInd |
| Trnsfr Exmpt Non Chrtbl Rltd Org | 0 | TrnsfrExmptNonChrtblRltdOrgInd |
| Activities Conducted Prtshp | 0 | ActivitiesConductedPrtshpInd |
| Schedule O Required | Yes (1) | ScheduleORequiredInd |
| IRP Document | 86 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Backup Wthld Compliance | Yes (1) | BackupWthldComplianceInd |
| Employee | 273 | 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 | 9 | 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 | 0 | 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 | Yes (1) | WhistleblowerPolicyInd |
| Document Retention Policy | Yes (1) | DocumentRetentionPolicyInd |
| Compensation Process CEO | Yes (1) | CompensationProcessCEOInd |
| Compensation Process Other | 0 | 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 | Patrick Justin | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Phone | 5075267907 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 515 S Moore Street | AddressLine1Txt |
| City | Blue Earth | CityNm |
| State Abbreviation | MN | StateAbbreviationCd |
| ZIP | 56013 | ZIPCd |
Form990 Part VII Section A Form990PartVIISectionAGrp (17 entries)
| TitleTitleTxt | Average Hours Per WeekAverageHoursPerWeekRt | Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd | OfficerOfficerInd | Reportable Comp From OrgReportableCompFromOrgAmt | Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt | Other CompensationOtherCompensationAmt | Highest Compensated EmployeeHighestCompensatedEmployeeInd |
|---|---|---|---|---|---|---|---|
| Melanie Humburg | |||||||
| Chairman | 1.00 | Yes (X) | Yes (X) | $1,548 | $0 | $0 | |
| Larry Anderson | |||||||
| Vice President | 1.00 | Yes (X) | Yes (X) | $2,410 | $0 | $0 | |
| Barbara Hanson | |||||||
| Secretary | 1.00 | Yes (X) | Yes (X) | $1,376 | $0 | $0 | |
| Jeanette Eichorn | |||||||
| Treasurer | 1.00 | Yes (X) | Yes (X) | $1,027 | $0 | $0 | |
| Roger Hanson | |||||||
| Board Member | 1.00 | Yes (X) | $2,227 | $0 | $0 | ||
| Douglas Johanson | |||||||
| Board Member | 1.00 | Yes (X) | $1,078 | $0 | $0 | ||
| Aaron Johnson MD | |||||||
| Board Member/Physician | 40.00 | Yes (X) | $319,019 | $0 | $17,964 | ||
| Bobby Karp MD | |||||||
| Board Member/Physician | 40.00 | Yes (X) | $404,876 | $0 | $33,298 | ||
| Cheryl Keithahn | |||||||
| Board Member | 1.00 | Yes (X) | $1,125 | $0 | $0 | ||
| Richard Ash | |||||||
| CEO | 40.00 | Yes (X) | $205,091 | $0 | $32,010 | ||
| Patrick Justin | |||||||
| CFO | 40.00 | Yes (X) | $98,914 | $0 | $10,096 | ||
| Candance Arends | |||||||
| CNO | 40.00 | Yes (X) | $131,181 | $0 | $26,731 | ||
| Alex Wong | |||||||
| Surgeon | 40.00 | $460,307 | $0 | $33,686 | Yes (X) | ||
| Joanne Roehr | |||||||
| Physician (Jan-June) | 40.00 | $184,631 | $0 | $6,000 | Yes (X) | ||
| Mary Trites | |||||||
| Physician | 40.00 | $208,694 | $0 | $7,155 | Yes (X) | ||
| Shawna Barnett | |||||||
| CRNA | 40.00 | $204,970 | $0 | $32,742 | Yes (X) | ||
| Carmelle McHarge | |||||||
| CRNA | 40.00 | $216,180 | $0 | $17,649 | Yes (X) | ||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $2,444,654 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $0 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $217,331 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 17 | IndivRcvdGreaterThan100KCnt |
| Former Ofcr Employees Listed | 0 | FormerOfcrEmployeesListedInd |
| Total Comp Greater Than150 K | Yes (1) | TotalCompGreaterThan150KInd |
| Compensation From Other Srcs | 0 | CompensationFromOtherSrcsInd |
Contractor Compensation ContractorCompensationGrp (5 entries)
| Address Line1ContractorAddress/USAddress/AddressLine1Txt | CityContractorAddress/USAddress/CityNm | State AbbreviationContractorAddress/USAddress/StateAbbreviationCd | ZIPContractorAddress/USAddress/ZIPCd | ServicesServicesDesc | CompensationCompensationAmt |
|---|---|---|---|---|---|
| Acute Care Inc | |||||
| 1609 N Ankeny Blvd | Ankeny | IA | 50023 | ED MD Coverage | $1,196,634 |
| Staff Care Inc | |||||
| 8840 Cypress Waters Blvd 300 | Coppell | TX | 75019 | Locums MD Coverage | $396,364 |
| Orthopaedic & Fracture Clinic | |||||
| 1431 Premier Drive | Mankato | MN | 56001 | Ortho MD's | $320,064 |
| Cloudwave | |||||
| 100 Crowley Dr | Marlborough | MA | 01752 | Computer host | $306,567 |
| CMDI | |||||
| 150 10th St NW | Milaca | MN | 56353 | CT & Mammography Srvcs | $306,481 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cntrct Rcvd Greater Than100 K | 10 | CntrctRcvdGreaterThan100KCnt |
| Government Grants | $9,051 | GovernmentGrantsAmt |
| All Other Contributions | $101,439 | AllOtherContributionsAmt |
| Total Contributions | $110,490 | TotalContributionsAmt |
Program Service Revenue ProgramServiceRevenueGrp (5 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt |
|---|---|---|---|
| Patient Service Revenue | 621110 | $30,203,341 | $30,203,341 |
| 340B Program Revenue | 621110 | $1,172,048 | $1,172,048 |
| Other Supporting Revenue | 900099 | $196,371 | $196,371 |
| Equity in Net Income of JV | 900099 | $84,000 | $84,000 |
| Electronic Health Records | 900099 | $37,387 | $37,387 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $31,693,147 | TotalProgramServiceRevenueAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $56,645 | TotalRevenueColumnAmt |
| Exclusion | $56,645 | ExclusionAmt |
Gross Rents GrossRentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $2,350 | 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 | $2,350 | RealAmt |
Net Rental Income Or Loss NetRentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $2,350 | TotalRevenueColumnAmt |
| Exclusion | $2,350 | ExclusionAmt |
Gross Amount Sales Assets GrossAmountSalesAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | $765 | OtherAmt |
Less Cost Oth Basis Sales Expnss LessCostOthBasisSalesExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | $0 | OtherAmt |
Gain Or Loss GainOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | $765 | OtherAmt |
Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $765 | TotalRevenueColumnAmt |
| Exclusion | $765 | ExclusionAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $31,863,397 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $31,693,147 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $0 | UnrelatedBusinessRevenueAmt |
| Exclusion | $59,760 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part IX | Yes (X) | InfoInScheduleOPartIXInd |
Grants To Domestic Orgs GrantsToDomesticOrgsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $4,701 | TotalAmt |
| Program Services | $4,701 | ProgramServicesAmt |
Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,272,349 | TotalAmt |
| Program Services | $740,790 | ProgramServicesAmt |
| Management And General | $531,559 | ManagementAndGeneralAmt |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $10,924,874 | TotalAmt |
| Program Services | $10,042,957 | ProgramServicesAmt |
| Management And General | $881,917 | ManagementAndGeneralAmt |
Pension Plan Contributions PensionPlanContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $459,888 | TotalAmt |
| Program Services | $427,035 | ProgramServicesAmt |
| Management And General | $32,853 | ManagementAndGeneralAmt |
Other Employee Benefits OtherEmployeeBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,975,233 | TotalAmt |
| Program Services | $1,777,355 | ProgramServicesAmt |
| Management And General | $197,878 | ManagementAndGeneralAmt |
Payroll Taxes PayrollTaxesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $801,723 | TotalAmt |
| Program Services | $711,609 | ProgramServicesAmt |
| Management And General | $90,114 | ManagementAndGeneralAmt |
Fees For Services Legal FeesForServicesLegalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $58,578 | TotalAmt |
| Management And General | $58,578 | ManagementAndGeneralAmt |
Fees For Services Accounting FeesForServicesAccountingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $76,846 | TotalAmt |
| Management And General | $76,846 | ManagementAndGeneralAmt |
Fees For Services Other FeesForServicesOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $4,727,247 | TotalAmt |
| Program Services | $3,968,658 | ProgramServicesAmt |
| Management And General | $758,589 | ManagementAndGeneralAmt |
Advertising AdvertisingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $14,047 | TotalAmt |
| Program Services | $1,758 | ProgramServicesAmt |
| Management And General | $12,289 | ManagementAndGeneralAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $850,553 | TotalAmt |
| Program Services | $606,415 | ProgramServicesAmt |
| Management And General | $244,138 | ManagementAndGeneralAmt |
Information Technology InformationTechnologyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $511,982 | TotalAmt |
| Program Services | $24,833 | ProgramServicesAmt |
| Management And General | $487,149 | ManagementAndGeneralAmt |
Occupancy OccupancyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $733,888 | TotalAmt |
| Program Services | $725,132 | ProgramServicesAmt |
| Management And General | $8,756 | ManagementAndGeneralAmt |
Travel TravelGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $211,678 | TotalAmt |
| Program Services | $187,913 | ProgramServicesAmt |
| Management And General | $23,765 | ManagementAndGeneralAmt |
Conferences Meetings ConferencesMeetingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $96,286 | TotalAmt |
| Program Services | $74,421 | ProgramServicesAmt |
| Management And General | $21,865 | ManagementAndGeneralAmt |
Interest InterestGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $398,225 | TotalAmt |
| Program Services | $398,225 | ProgramServicesAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,483,739 | TotalAmt |
| Program Services | $2,483,739 | ProgramServicesAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $161,420 | TotalAmt |
| Program Services | $153,342 | ProgramServicesAmt |
| Management And General | $8,078 | ManagementAndGeneralAmt |
Other Expenses OtherExpensesGrp (4 entries)
| DescDesc | TotalTotalAmt | Program ServicesProgramServicesAmt | Management And GeneralManagementAndGeneralAmt |
|---|---|---|---|
| Medical Supplies | $3,738,912 | $3,738,912 | |
| Bad Debt | $1,279,101 | $1,279,101 | |
| MN Care Tax | $238,883 | $238,883 | |
| Equipment Rental/Repair | $159,173 | $154,897 | $4,276 |
All Other Expenses AllOtherExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $482,791 | TotalAmt |
| Program Services | $464,652 | ProgramServicesAmt |
| Management And General | $18,139 | ManagementAndGeneralAmt |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $31,662,117 | TotalAmt |
| Program Services | $28,205,328 | ProgramServicesAmt |
| Management And General | $3,456,789 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Savings And Temp Cash Invst SavingsAndTempCashInvstGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $10,352,510 | BOYAmt |
| EOY | $10,570,138 | EOYAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $4,097,706 | BOYAmt |
| EOY | $4,515,086 | EOYAmt |
Receivables From Officers Etc ReceivablesFromOfficersEtcGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $169,917 | BOYAmt |
| EOY | $71,429 | EOYAmt |
Oth Notes Loans Receivable Net OthNotesLoansReceivableNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $7,501 | BOYAmt |
| EOY | $172,250 | EOYAmt |
Inventories For Sale Or Use InventoriesForSaleOrUseGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $825,220 | BOYAmt |
| EOY | $861,631 | EOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $246,350 | BOYAmt |
| EOY | $91,128 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $45,050,465 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $24,406,869 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $21,611,037 | BOYAmt |
| EOY | $20,643,596 | EOYAmt |
Investments Pub Traded Sec InvestmentsPubTradedSecGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,324,142 | BOYAmt |
| EOY | $2,402,900 | EOYAmt |
Investments Program Related InvestmentsProgramRelatedGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $456,650 | BOYAmt |
| EOY | $403,079 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $40,091,033 | BOYAmt |
| EOY | $39,731,237 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,035,132 | BOYAmt |
| EOY | $2,434,456 | EOYAmt |
Mortg Notes Pybl Scrd Invst Prop MortgNotesPyblScrdInvstPropGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $10,362,129 | BOYAmt |
| EOY | $9,468,757 | EOYAmt |
Other Liabilities OtherLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $288,028 | BOYAmt |
| EOY | $221,000 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $12,685,289 | BOYAmt |
| EOY | $12,124,213 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Organization Follows SFAS117 | Yes (X) | OrganizationFollowsSFAS117Ind |
Unrestricted Net Assets UnrestrictedNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $27,391,841 | BOYAmt |
| EOY | $27,607,024 | EOYAmt |
Temporarily Rstr Net Assets TemporarilyRstrNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $13,903 | BOYAmt |
| EOY | $0 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $27,405,744 | BOYAmt |
| EOY | $27,607,024 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $40,091,033 | BOYAmt |
| EOY | $39,731,237 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Reconcilation Revenue Expnss | $201,280 | ReconcilationRevenueExpnssAmt |
| Other Changes In Net Assets | $0 | 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) |
|---|---|---|
| Separate Basis Fincl Stmt | Yes (X) | SeparateBasisFinclStmtInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Audit Committee | Yes (1) | 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
Land LandGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $632,000 | OtherCostOrOtherBasisAmt |
| Book Value | $632,000 | BookValueAmt |
Buildings BuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $29,860,879 | OtherCostOrOtherBasisAmt |
| Depreciation | $13,619,377 | DepreciationAmt |
| Book Value | $16,241,502 | BookValueAmt |
Leasehold Improvements LeaseholdImprovementsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $835,933 | OtherCostOrOtherBasisAmt |
| Depreciation | $389,792 | DepreciationAmt |
| Book Value | $446,141 | BookValueAmt |
Equipment EquipmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $13,695,761 | OtherCostOrOtherBasisAmt |
| Depreciation | $10,397,700 | DepreciationAmt |
| Book Value | $3,298,061 | BookValueAmt |
Other Land Buildings OtherLandBuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $25,892 | OtherCostOrOtherBasisAmt |
| Book Value | $25,892 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $20,643,596 | TotalBookValueLandBuildingsAmt |
Other Liabilities Org OtherLiabilitiesOrgGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | Estimated 3rd Party Payor Settlements | Desc |
| Amt | $221,000 | Amt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Liability | $221,000 | TotalLiabilityAmt |
| Footnote Text | Yes (X) | FootnoteTextInd |
| Total Rev Etc Audited Fincl Stmt | $30,584,296 | TotalRevEtcAuditedFinclStmtAmt |
| Other Revenue | -$1,279,101 | OtherRevenueAmt |
| Revenue Not Reported | -$1,279,101 | RevenueNotReportedAmt |
| Revenue Subtotal | $31,863,397 | RevenueSubtotalAmt |
| Revenue Not Reported Fincl Stmt | $0 | RevenueNotReportedFinclStmtAmt |
| Total Revenue Per Form990 | $31,863,397 | TotalRevenuePerForm990Amt |
| Tot Expns Etc Audited Fincl Stmt | $30,383,016 | TotExpnsEtcAuditedFinclStmtAmt |
| Expenses Not Reported | $0 | ExpensesNotReportedAmt |
| Expenses Subtotal | $30,383,016 | ExpensesSubtotalAmt |
| Other Expenses Not Included | $1,279,101 | OtherExpensesNotIncludedAmt |
| Expenses Not Rpt Fincl Stmt | $1,279,101 | ExpensesNotRptFinclStmtAmt |
| Total Expenses Per Form990 | $31,662,117 | TotalExpensesPerForm990Amt |
Supplemental Information Detail SupplementalInformationDetail (3 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| 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. The Hospital believes that they have 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 -1,279,101. |
| Part XII, Line 4b - Other Adjustments: | Bad debt expense included in revenue for financial statements 1,279,101. |
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 |
| Percent150 | Yes (X) | Percent150Ind |
| FPG Reference Discounted Care | Yes (1) | FPGReferenceDiscountedCareInd |
Discounted Care Oth Percentage DiscountedCareOthPercentageGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | Yes (X) | OtherInd |
| Discounted Care Other | 225.000000000000 | DiscountedCareOtherPct |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Free Care Medically Indigent | 0 | FreeCareMedicallyIndigentInd |
| Financial Assistance Budget | 0 | FinancialAssistanceBudgetInd |
| Annual Community Bnft Report | 0 | AnnualCommunityBnftReportInd |
Financial Assistance At Cost Typ FinancialAssistanceAtCostTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $22,000 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $22,000 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00070 | TotalExpensePct |
Unreimbursed Medicaid UnreimbursedMedicaidGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $5,825,741 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $3,992,563 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $1,833,178 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.06030 | TotalExpensePct |
Total Financial Assistance Typ TotalFinancialAssistanceTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $5,847,741 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $3,992,563 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $1,855,178 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.06100 | TotalExpensePct |
Subsidized Health Services SubsidizedHealthServicesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $3,980,051 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $1,429,604 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $2,550,447 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.08390 | TotalExpensePct |
Total Other Benefits TotalOtherBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $3,980,051 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $1,429,604 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $2,550,447 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.08390 | TotalExpensePct |
Total Community Benefits TotalCommunityBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $9,827,792 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $5,422,167 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $4,405,625 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.14490 | TotalExpensePct |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | 0 | BadDebtExpenseReportedInd |
| Bad Debt Expense | $1,279,101 | BadDebtExpenseAmt |
| Bad Debt Expense Attributable | $319,775 | BadDebtExpenseAttributableAmt |
| Reimbursed By Medicare | $8,150,360 | ReimbursedByMedicareAmt |
| Cost Of Care Reimbursed By Medcr | $8,198,452 | CostOfCareReimbursedByMedcrAmt |
| Medicare Surplus Or Shortfall | -$48,092 | 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 | United Hospital District | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 515 S Moore Street | AddressLine1Txt |
| City | Blue Earth | CityNm |
| State Abbreviation | MN | StateAbbreviationCd |
| ZIP | 56013 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Website Address | www.uhd.org | WebsiteAddressTxt |
| State License | 375736 | 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 |
| Other | 3 Provider based clinics, 1 Fee for service clinic | OtherDesc |
Hospital Fclty Policies Prctc HospitalFcltyPoliciesPrctcGrp
Hospital Facility Name HospitalFacilityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | United Hospital District | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 1 | FacilityNum |
| First Licensed CY Or PY | Yes (1) | FirstLicensedCYOrPYInd |
| Tax Exempt Hospital CY Or PY | Yes (1) | TaxExemptHospitalCYOrPYInd |
| CHNA Conducted | 0 | CHNAConductedInd |
| Organization Incur Excise Tax | 0 | OrganizationIncurExciseTaxInd |
| Elig Criteria Explained | Yes (1) | EligCriteriaExplainedInd |
| FPG Family Incm Lmt Free Dscnt | Yes (X) | FPGFamilyIncmLmtFreeDscntInd |
| FPG Family Incm Lmt Free Care | 150.000000000000 | FPGFamilyIncmLmtFreeCarePct |
| FPG Family Incm Lmt Dscnt Care | 225.000000000000 | FPGFamilyIncmLmtDscntCarePct |
| Other Criteria | Yes (X) | OtherCriteriaInd |
| Explained Basis | Yes (1) | ExplainedBasisInd |
| App Financial Asst Expln | Yes (1) | AppFinancialAsstExplnInd |
| Described Info | Yes (X) | DescribedInfoInd |
| Described Suprt Doc | Yes (X) | DescribedSuprtDocInd |
| Provided Hospital Contact | Yes (X) | ProvidedHospitalContactInd |
| Provided Nonprofit Contact | Yes (X) | ProvidedNonprofitContactInd |
| Other Method | Yes (X) | OtherMethodInd |
| Includes Publicity Measures | Yes (1) | IncludesPublicityMeasuresInd |
| FAP Available On Website | Yes (X) | FAPAvailableOnWebsiteInd |
| FAP Available On Website URL | www.uhd.org/billing.php | FAPAvailableOnWebsiteURLTxt |
| FAP Summary On Website | Yes (X) | FAPSummaryOnWebsiteInd |
| FAP Summary On Website URL | www.uhd.org/billing.php | FAPSummaryOnWebsiteURLTxt |
| FAP Avlbl On Request No Charge | Yes (X) | FAPAvlblOnRequestNoChargeInd |
| FAP App Avlbl On Request No Chrg | Yes (X) | FAPAppAvlblOnRequestNoChrgInd |
| FAP Sum Avlbl On Request No Chrg | Yes (X) | FAPSumAvlblOnRequestNoChrgInd |
| Notified FAP Copy Bill Display | Yes (X) | NotifiedFAPCopyBillDisplayInd |
| Communtity Notified FAP | Yes (X) | CommuntityNotifiedFAPInd |
| FAP Actions On Nonpayment | Yes (1) | FAPActionsOnNonpaymentInd |
| Permit No Actions | Yes (X) | PermitNoActionsInd |
| Collection Activities | 0 | CollectionActivitiesInd |
| Provided Written Notice | Yes (X) | ProvidedWrittenNoticeInd |
| Made Effort Orally Notify | Yes (X) | MadeEffortOrallyNotifyInd |
| Processed FAP Application | Yes (X) | ProcessedFAPApplicationInd |
| Made Presumptive Elig Determ | Yes (X) | MadePresumptiveEligDetermInd |
| Nondis Emergency Care Policy | Yes (1) | NondisEmergencyCarePolicyInd |
| Look Back Medicare | Yes (X) | LookBackMedicareInd |
| Amounts Generally Billed | 0 | AmountsGenerallyBilledInd |
| Gross Charges | 0 | GrossChargesInd |
Supplemental Information SupplementalInformationGrp (4 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| United Hospital District | Part V, Section B, Line 2: Effective January 1, 2015, United Hospital District, Inc. (the Hospital) entered into a lease agreement with United Hospital District (the District). In connection with the Lease Agreement, the District contributed the operations and certain assets of the 25-bed hospital, medical clinics in Blue Earth, Wells and Winnebago, Minnesota and a 24-bed adolescent treatment center in Winnebago, Minnesota, to the Hospital and certain liabilities were assumed by the Hospital. The Hospital agreed to lease from the District all land, buildings, and fixed equipment associated with these operations (receivable, supplies, equipment, furniture, fixtures, prepaid expenses, operating fund investments, and depreciation funds). The Hospital began operations as a tax-exempt hospital on January 1, 2015. |
| 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, Section B, line 16b: | The Organization did not have their Financial Assistance Application posted on their website as of 12/31/16. The Organization had thought the Financial Assistance Application was included with and attached to the Financial Assistance Policy on their website, however they recently became aware that the actual Financial Assistance Application was missing. The Application was referenced in their Financial Assistance Policy, however it was not published to their website. The Financial Assistance Application has been subsequently published to the website as of August 31st, 2017. It is separate from the previously published Financial Assistance Policy and Plain Language Summary. It is located at www.uhd.org/billing.php. During 2016 all registration staff had copies of the Financial Assistance Application available. There were also signs posted at registration desks indicating Financial Assistance was available. |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 2 | FacilityNum |
Oth Hlth Care Fclts Not Hospital OthHlthCareFcltsNotHospitalGrp
Oth Hlth Care Fclts OthHlthCareFcltsGrp (2 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | FacilityFacilityTxt |
|---|---|---|---|---|
| 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 |
Supplemental Information Detail SupplementalInformationDetail (11 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| 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 $1,279,101. |
| Part III, Line 2: | Bad debt expense is reported at 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 9 of the attached audited financial statements. |
| Part III, Line 8: | United Hospital District is a critical access hospital. There was a shortfall for 2016 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 2016 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 patients obligation. Each account is reviewed by a business office staff member before placing with a collection agency. If an individual is determined to be eligible for financial assistance, no 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, ATCW and the clinic Medical Home. 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, 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 - 52 miles east (This hospital is shutting down in-patient services over the next 2 years.)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. |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Written Employment Contract | Yes (X) | WrittenEmploymentContractInd |
| 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 | 0 | 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 | Yes (1) | AnyNonFixedPaymentsInd |
| Initial Contract Exception | 0 | InitialContractExceptionInd |
Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp (9 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 |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Aaron Johnson MD | ||||||||||||||
| Board Member/Physician | $240,515 | $0 | $78,504 | $0 | $0 | $0 | $0 | $0 | $19,771 | $0 | $338,790 | $0 | $0 | $0 |
| Bobby Karp MD | ||||||||||||||
| Board Member/Physician | $311,242 | $0 | $65,446 | $0 | $28,188 | $0 | $12,861 | $0 | $22,594 | $0 | $440,331 | $0 | $0 | $0 |
| Richard Ash | ||||||||||||||
| CEO | $204,990 | $0 | $101 | $0 | $0 | $0 | $10,644 | $0 | $22,325 | $0 | $238,060 | $0 | $0 | $0 |
| Candance Arends | ||||||||||||||
| CNO | $131,080 | $0 | $101 | $0 | $0 | $0 | $6,845 | $0 | $20,565 | $0 | $158,591 | $0 | $0 | $0 |
| Alex Wong | ||||||||||||||
| Surgeon | $426,848 | $0 | $25,102 | $0 | $8,357 | $0 | $13,250 | $0 | $22,800 | $0 | $496,357 | $0 | $0 | $0 |
| Joanne Roehr | ||||||||||||||
| Physician (Jan-June) | $145,537 | $0 | $25,000 | $0 | $14,094 | $0 | $1,826 | $0 | $5,221 | $0 | $191,678 | $0 | $0 | $0 |
| Mary Trites | ||||||||||||||
| Physician | $200,918 | $0 | $102 | $0 | $7,674 | $0 | $0 | $0 | $8,095 | $0 | $216,789 | $0 | $0 | $0 |
| Shawna Barnett | ||||||||||||||
| CRNA | $204,869 | $0 | $101 | $0 | $0 | $0 | $10,645 | $0 | $23,536 | $0 | $239,151 | $0 | $0 | $0 |
| Carmelle McHarge | ||||||||||||||
| CRNA | $216,079 | $0 | $101 | $0 | $0 | $0 | $10,071 | $0 | $9,035 | $0 | $235,286 | $0 | $0 | $0 |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | Part I, Line 7 | FormAndLineReferenceDesc |
| Explanation | Bonus and incentive compensation reported in schedule J, Part II, column (ii) for Aaron Johnson, Bobby Karp, and Alex Wong is incentive compensation paid based on RVU's. | ExplanationTxt |
Schedule L IRS990ScheduleL
Loans Btwn Org Interested Prsn LoansBtwnOrgInterestedPrsnGrp (2 entries)
| Relationship With OrgRelationshipWithOrgTxt | Loan PurposeLoanPurposeTxt | Loan From OrganizationLoanFromOrganizationInd | Original PrincipalOriginalPrincipalAmt | Balance DueBalanceDueAmt | DefaultDefaultInd | Board Or Committee ApprovalBoardOrCommitteeApprovalInd | Written AgreementWrittenAgreementInd |
|---|---|---|---|---|---|---|---|
| Bobby Karp | |||||||
| Medical Provider | Signing Incentive | Yes (X) | $125,000 | $50,000 | 0 | Yes (1) | Yes (1) |
| Alex Wong | |||||||
| Medical Provider | Signing Incentive | Yes (X) | $50,000 | $21,429 | 0 | Yes (1) | Yes (1) |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Balance Due | $71,429 | TotalBalanceDueAmt |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (8 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Form 990, Part III, line 2 | United Hospital District opened a new clinic April 1, 2016 in Fairmont, Minnesota which is 18 miles away. Laboratory, x-ray and physical therapy services are available on-site. |
| 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 Services: Program service expenses 3,606,568. Management and general expenses 443,863. Fundraising expenses 0. Total expenses 4,050,431. Licenses/Dues: Program service expenses 48,619. Management and general expenses 69,626. Fundraising expenses 0. Total expenses 118,245. Other Fees: Program service expenses 313,471. Management and general expenses 245,100. Fundraising expenses 0. Total expenses 558,571. |