2024-05-06T14:48:41-05:00 2023-06-30 390758449 WIPFLI LLP 1502 LONDON ROAD SUITE 200 DULUTH MN 55812 990 2022-07-01 450310159 CHRISTIAN UNITY HOSPITAL CORPORATION CHRI 7013521620 164 WEST 13TH STREET GRAFTON ND 58237 BRAD WURGLER CHIEF FINANCIAL OFFICER 7013521620 2024-04-26 1 BRAD WURGLER 999009999 1 MICHAEL J PETERSON CPA P01833529 2187224705 2024-04-26 2 AAL1 IAL1 2022 2023-04-26 12:10:37Z UNITY MEDICAL CENTER ALAN O'NEIL 164 WEST 13TH STREET GRAFTON ND 58237 28523115 0 X WWW.UNITYMEDCENTER.COM X 1970 ND PROVIDE ACCESS TO QUALITY HEALTH CARE FOR THE REGION. 9 8 190 25 0 0 1622323 1385566 23689226 26970054 36407 167495 0 0 25347956 28523115 9890 14747 0 0 12998910 14807797 0 0 0 9953537 11459806 22962337 26282350 2385619 2240765 36728742 39284392 23624468 23758153 13104274 15526239 UNITY MEDICAL CENTER PROVIDES ACCESS TO QUALITY HEALTH CARE FOR THE REGION. 0 0 21555109 14747 26970054 UMC PROVIDES EMERGENCY CARE, ACUTE CARE SERVICES, SWING BED SERVICES, OUTPATIENT, AND CLINICAL MEDICAL SERVICES TO THE RESIDENTS OF GRAFTON, NORTH DAKOTA AND SURROUNDING COMMUNITIES. THE FACILITY PROVIDES OUTREACH SERVICES SUCH AS PHYSICAL THERAPY, RESPIRATORY THERAPY, AND FLU VACCINATION CLINICS TO OTHER EMPLOYERS IN THE AREA AS WELL. FOR THE FISCAL YEAR ENDED JUNE 30, 2023, THE MEDICAL CENTER PROVIDED AS PART OF ITS MISSION 463 ACUTE DAYS, 1,666 SWING BED DAYS, 11 RESPITE DAYS, AND 14,204 CLINIC VISITS. 21555109 1 1 0 1 0 0 0 0 0 0 1 0 0 0 1 0 0 1 0 0 0 0 0 0 0 0 1 1 1 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 0 0 1 35 0 190 1 0 0 0 0 0 0 0 0 0 0 0 0 X 9 8 0 0 0 0 1 1 0 1 1 0 0 1 1 1 1 1 1 1 1 0 X BRAD WURGLER 7013521620 164 WEST 13TH STREET GRAFTON ND 58237 DR MATTHEW VISCITO BOARD MEMBER/CHIEF OF MED. STAFF 40.00 X 450729 0 40682 JO PETERSON PRESIDENT 5.00 X X 0 0 0 PAUL MOHAGEN VICE PRESIDENT 1.50 X X 0 0 0 AMY GEIGER SECRETARY/TREASURER 2.00 X X 0 0 0 TOM CAMPBELL BOARD MEMBER 1.50 X 0 0 0 RUSSELL CARIGNAN BOARD MEMBER 1.50 1.00 X 0 0 0 ROGER GORDER BOARD MEMBER 1.50 X 0 0 0 TODD MORGAN BOARD MEMBER 1.50 X 0 0 0 HEIDI PAULSON BOARD MEMBER 2.00 X 0 0 0 ALAN O'NEIL CHIEF EXECUTIVE OFFICER 40.00 X 364480 0 31180 JENNIFER HOLAND CHIEF NURSING OFFICER 40.00 1.00 X 131633 0 7967 BRAD WURGLER CHIEF FINANCIAL OFFICER 40.00 X 120091 0 38503 DR JARED MARQUARDT PHYSICIAN 40.00 X 359976 0 38256 DR KRISTI MIDGARDEN PHYSICIAN 40.00 X 266247 0 38136 DR JENNIFER SHAW PHSYICIAN 40.00 X 261994 0 43118 JODI SHERVE FAMILY NURSE PRACTITIONER 40.00 X 163584 0 34844 MATTHEW MASSMANN PHYSICIAN ASSISTANT 40.00 X 167433 0 40265 2286167 0 312951 19 0 1 0 COMSTOCK 4511 15TH AVE N FARGO ND 58102 CONTRACTOR/SUBCONTRACTORS 795281 TRIAGE LLC PO BOX 773328 CHICAGO IL 60677 TRAVEL NURSING SERVICES 488727 ALTRU HEALTH SYSTEM PO BOX 13780 GRAND FORKS ND 58208 EPIC, TELEPHARMACY, PHARM INV, ANESTHESI 293562 TRIAD TRAVEL NURSING AGENCY 3155 BLUESTEM DR 115 WEST FARGO ND 58078 TRAVEL NURSING SERVICES 247612 DAVIN HEALTHCARE WORKFORCE SOLUTIONS PO BOX 1355 MIDDLETOWN OH 45042 TRAVEL NURSING SERVICES 242660 11 560086 381950 443530 1385566 NET PATIENT SERVICE REVENUE 621300 22108104 22108104 CLINIC SERVICE REVENUE 621400 4025047 4025047 340(B) PROGRAM REVENUE 456110 503370 503370 333533 333533 26970054 167495 167495 28523115 26970054 0 167495 14747 14747 1286972 276779 1010193 10909956 9530183 1379773 305304 278968 26336 1545706 1319665 226041 759859 616934 142925 14592 14592 100376 100376 3003 3003 10699 10699 1401373 1284504 116869 172657 172657 81567 21492 60075 263639 263639 395211 395211 131306 86146 45160 22312 22312 481506 434019 47487 2097165 1713756 383409 208080 208080 MEDICAL SUPPLIES 4148832 4148832 REPAIRS AND MAINTENANCE 538003 479512 58491 PROVISION FOR BAD DEBT 433883 433883 EMPLOYEE RELATIONS 303820 303820 651782 520478 131304 26282350 21555109 4727241 0 254860 57521 8968689 6056689 2417229 3375509 375986 245385 113350 144987 34914838 12176400 23463275 22738438 6225299 145873 128933 989480 311631 36728742 39284392 1756342 1993379 100000 0 21718126 21195672 50000 569102 23624468 23758153 X 13104274 15526239 13104274 15526239 36728742 39284392 2240765 181200 0 X 0 1 X 1 1 1 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 3003 3003 0 PART II-B, LINE 1: THE ORGANIZATION IS A MEMBER OF AMERICAN HOSPITAL ASSOCIATION AND NORTH DAKOTA HOSPITAL ASSOCIATION. A PORTION OF MEMBERSHIP DUES TO THE ABOVE LISTED ASSOCIATIONS IS USED FOR LOBBYING. THESE ASSOCIATIONS ADVOCATE ON BEHALF OF ITS MEMBERS FOR IMPROVING EFFICIENCY AND ACCESSIBILITY OF THE HEALTHCARE DELIVERY SYSTEMS AND THE HEALTH STATUS OF NORTH DAKOTA'S POPULATION. 101237 101237 18502897 5544996 12957901 15742322 6631404 9110918 568382 568382 22738438 DUE TO THIRD-PARTY REIMBURSEMENT PROGRAMS 200000 OPERATING LEASE OBLIGATIONS 121661 FINANCE LEASE OBLIGATIONS 177489 SPECIAL ASSESSMENT LIABILITY 69952 569102 1 1 X 0 1 X 1 0 0 55323 55323 0.00210 1375324 1208702 166622 0.00640 1430647 1208702 221945 0.00850 3497738 2144881 1352857 0.05230 3497738 2144881 1352857 0.05230 4928385 3353583 1574802 0.06080 0 390228 38633 13117459 13263391 -145932 X 1 1 1 1 CHRISTIAN UNITY HOSPITAL CORPORATION 164 WEST 13TH STREET GRAFTON ND 58257 WWW.UNITYMEDCENTER.COM 5020 X X X X X RURAL HOSPITAL CHRISTIAN UNITY HOSPITAL CORPORATION 1 0 0 1 X X X X X X X X X 21 1 1 1 1 X SEE PART V, SECTION C, LINE 7D X X 1 21 1 SEE PART V, SECTION C, LINE 7D 0 1 X 200.000000000000 X X 1 1 X X X X X 1 X HTTPS://WWW.UNITYMEDCENTER.COM/ABOUT-US/PRICE-TRANSPARENCY.HTML X HTTPS://WWW.UNITYMEDCENTER.COM/ABOUT-US/PRICE-TRANSPARENCY.HTML X HTTPS://WWW.UNITYMEDCENTER.COM/ABOUT-US/PRICE-TRANSPARENCY.HTML X X X X X X 1 X 0 X X X X X 1 X 0 0 CHRISTIAN UNITY HOSPITAL CORPORATION PART V, SECTION B, LINE 5: ONE-ON-ONE INTERVIEWS WITH FIVE KEY INFORMANTS WERE CONDUCTED BY PHONE ON SEVERAL DIFFERENT DATES BETWEEN JANUARY 11 TO FEBRUARY 2, 2022. A REPRESENTATIVE FROM CRH CONDUCTED THE INTERVIEWS. INTERVIEWS WERE HELD WITH SELECTED MEMBERS OF THE COMMUNITY WHO COULD PROVIDE INSIGHTS INTO THE COMMUNITY'S HEALTH NEEDS.INCLUDED AMONG THE INFORMANTS WERE PUBLIC HEALTH PROFESSIONALS WITH SPECIAL KNOWLEDGE IN PUBLIC HEALTH ACQUIRED THROUGH SEVERAL YEARS OF DIRECT EXPERIENCE IN THE COMMUNITY, INCLUDING WORKING WITH MEDICALLY UNDERSERVED, LOW INCOME, AND MINORITY POPULATIONS AS WELL AS WITH POPULATIONS WITH CHRONIC DISEASES.TOPICS COVERED DURING THE INTERVIEWS INCLUDED THE GENERAL HEALTH NEEDS OF THE COMMUNITY, THE GENERAL HEALTH OF THE COMMUNITY, COMMUNITY CONCERNS, DELIVERY OF HEALTH CARE BY LOCAL PROVIDERS, AWARENESS OF HEALTH SERVICES OFFERED LOCALLY, BARRIERS TO RECEIVING HEALTH SERVICES, AND SUGGESTIONS FOR IMPROVING COLLABORATION WITHIN THE COMMUNITY.A SURVEY WAS DISTRIBUTED TO SOLICIT FEEDBACK FROM THE COMMUNITY AND WAS NOT INTENDED TO BE A SCIENTIFIC OR STATISTICALLY VALID SAMPLING OF THE POPULATION. IT WAS DESIGNED TO BE AN ADDITIONAL TOOL FOR COLLECTING QUALITATIVE DATA FROM THE COMMUNITY AT LARGE - SPECIFICALLY, INFORMATION RELATED TO COMMUNITY-PERCEIVED HEALTH NEEDS. THE SURVEY WAS A COLLABORATIVE EFFORT BETWEEN FCHC AND UMC, SURVEYING WALSH COUNTY. IN COMBINATION OF PAPER FORMS AND ONLINE SURVEYS, A TOTAL OF 313 COMMUNITY MEMBER SURVEYS WERE COMPLETED. CHRISTIAN UNITY HOSPITAL CORPORATION PART V, SECTION B, LINE 6A: THE CHNA WAS CONDUCTED WITH FIRST CARE HEALTH CENTER. CHRISTIAN UNITY HOSPITAL CORPORATION PART V, SECTION B, LINE 6B: THE CHNA WAS CONDUCTED WITH WALSH COUNTY PUBLIC HEALTH. CHRISTIAN UNITY HOSPITAL CORPORATION PART V, SECTION B, LINE 7D: PART V, SECTION B, LINES 7A & 10A:HTTPS://WWW.UNITYMEDCENTER.COM/ABOUT-US/PATIENTRESOURCES.HTML CHRISTIAN UNITY HOSPITAL CORPORATION PART V, SECTION B, LINE 11: IN RESPONSE TO THE NEEDS IDENTIFIED IN THE 2019 CHNA PROCESS, THE FOLLOWING ACTIONS WERE TAKEN: UNITY MEDICAL CENTER (UMC) CHOSE NOT TO ADDRESS NEED 1: ATTRACTING AND RETAINING YOUNG FAMILIES DUE TO LIMITED RESOURCES AND THE NEED TO ALLOCATE SIGNIFICANT RESOURCES TO OTHER PRIORITY NEEDS. NUTRITION AND PHYSICAL INACTIVITY WERE ADDRESSED INSTEAD. NEED 2: AVAILABILITY OF MENTAL HEALTH SERVICES AND NEED 5: DEPRESSION/ANXIETY UMC IS HAPPY TO HOST TELEMEDICINE VISITS IN THEIR CLINIC LOCATIONS FOR PATIENTS WHO ARE SEEKING TREATMENT FROM MENTAL HEALTH PROVIDER SERVICES. ONLINE GRIEF SUPPORT IS ALSO AVAILABLE THROUGH ALTRU AND HOSPICE OF THE RED RIVER VALLEY. OTHER NEW CONTRACTS HAVE BEEN ESTABLISHED, AND OPPORTUNITIES TO EXPAND THESE OFFERINGS CONTINUE TO BE DISCUSSED. ALL PATIENTS OVER THE AGE OF 12 WHO ARE SEEN IN THE GRAFTON FAMILY CLINIC OR THE PARK RIVER FAMILY CLINIC ARE NOW SCREENED WITH A BRIEF MENTAL HEALTH QUESTIONNAIRE (PHQ-2). A POSITIVE SCREENING LEADS TO PATIENTS RECEIVING A MORE DETAILED ASSESSMENT FORM (PHQ-9) AND REFERRALS FOR OTHER SERVICES AS APPROPRIATE. THE WALSH COUNTY HEALTH DEPARTMENT (WCHD) KEEPS AN UPDATED LIST OF LOCAL BEHAVIORAL HEALTH CONTACTS AND RESOURCES FOR OUR PATIENTS AND ALL COMMUNITY MEMBERS.WALSH COUNTY PUBLIC HEALTH, ALONG WITH LOCAL HEALTHCARE AGENCIES, LED A CAMPAIGN FOR MENTAL HEALTH AND SUICIDE AWARENESS. THE SUICIDE AWARENESS FILM, JUMPER, WAS SHOWN AT THE LOCAL MOVIE THEATERS. THOSE PERSONS IN ATTENDANCE RECEIVED RESOURCES FOR SERVICES AVAILABLE IN OUR COMMUNITY AND THE SURROUNDING AREA. IN ADDITION, WALSH COUNTY PUBLIC HEALTH NURSES AND LOCAL COUNSELORS WERE AVAILABLE FOR QUESTIONS AFTER THE SHOWINGS. THIS EVENT HIGHLIGHTED A STRONG BOND BETWEEN THE SCHOOLS, THE COUNTY, AND THE LOCAL HEALTHCARE FACILITIES AND BROUGHT ABOUT FURTHER PARTNERSHIPS WITH THE SCHOOL SYSTEMS. NORTHEAST HUMAN SERVICE CENTER HAS BEGUN INTAKE VISITS WITH PATIENTS IN LOCAL HEALTHCARE FACILITIES BEFORE THE PATIENT IS DISCHARGED. THE IN-PERSON EVALUATIONS ARE PROVIDED TO INITIATE THE INTAKE PROCESS, WHILE THE PATIENT IS IN THE HOSPITAL OR EMERGENCY DEPARTMENT. MOTIVATED UMC STAFF ATTENDED NAMI (NATIONAL ALLIANCE FOR MENTALLY ILL) TRAINING TO BRING FURTHER RESOURCES TO OUR COMMUNITY. A SUPPORT GROUP WAS FORMED TO PROVIDE SUPPORT FOR FAMILIES CARING FOR THE MENTALLY ILL AND WAS WELL-RECEIVED. THE GROUP IS LOOKING TO REVITALIZE THE PROGRAM AND EXPAND OFFERINGS IN 2022. NEED 3: ALCOHOL USE AND ABUSE AND NEED 4: DRUG USE AND ABUSE THE WCHD REGULARLY PROMOTES ALCOHOL, TOBACCO, AND OTHER SUBSTANCE ABUSE PROGRAMS AND RESOURCES. UMC CONTINUES TO PARTICIPATE IN THE WALSH COUNTY SUBSTANCE ABUSE PREVENTION COALITION TO REDUCE ADULT BINGE DRINKING, UNDERAGE DRINKING, AND ILLICIT DRUG USE. UMC PROVIDERS LIMIT THE QUANTITY OF OPIOIDS THEY PRESCRIBE, AND THEY UTILIZE THE PRESCRIPTION DRUG MONITORING PROGRAM BEFORE ORDERING A CONTROLLED SUBSTANCE. MEDICATION ASSISTED TREATMENT IS NOW OFFERED LOCALLY THROUGH COMMUNITY HEALTH SERVICES, INC. IN GRAFTON FOR ADULTS WITH SUBSTANCE ABUSE DISORDER. UMC OFFERS A TOBACCO CESSATION PROGRAM, LED BY THE RESPIRATORY THERAPY DEPARTMENT. RECENTLY, TWO NURSING STAFF ATTENDED TRAINING TO BECOME CERTIFIED TOBACCO CESSATION SPECIALISTS AND WILL ASSIST THE PATIENTS ENROLLED IN THIS GROWING PROGRAM. NEED 6: NUTRITION AND PHYSICAL ACTIVITY SINCE THE LAST CHNA IN 2019, DIABETES EDUCATION AND MEDICAL NUTRITION THERAPY SERVICES AT UMC HAVE GROWN. THESE PROGRAMS, LED BY A REGISTERED NURSE AND A LICENSED DIETICIAN WEEKLY, ARE OFFERED TO OUR PATIENTS THROUGH PROVIDER REFERRALS. THE UMC DIETICIAN CONSISTENTLY OFFERS NUTRITION-FOCUSED EVENTS FOR THE COMMUNITY. MOST RECENTLY, CULINARY COOKING CLASSES AND WEIGHT LOSS CLASSES HAVE BEEN OPEN FOR COMMUNITY MEMBER ENROLLMENT. PARTICIPATION IN UMC KIDS CLINIC SHOWCASES HEALTHY FOOD CHOICES FOR CHILDREN. IN ADDITION, YOUTUBE INSTRUCTIONAL VIDEOS FOR HEALTHY SNACK PREPARATION WERE DEVELOPED FOR CHILDREN, AGED FIVE AND UP, AND POSTED ON SOCIAL MEDIA AND UMC'S WEBSITE. THE PARTNERSHIP BETWEEN UMC AND WALSH COUNTY SOCIAL SERVICES WAS EXTENDED THROUGH COMMUNITY HEALTH NEEDS ASSESSMENT 2022, UNIVERSITY OF NORTH DAKOTA CENTER FOR RURAL HEALTH 45 COLLABORATIVE CLASSES, FOCUSED ON UTILIZING HEALTHY FOOD SUBSTITUTES AND ALTERNATIVE COOKING METHODS. THIS INFORMATION WAS THEN PROVIDED TO THEIR CLIENTS. THE WALSH COUNTY FOOD PANTRY, LOCATED IN GRAFTON, IS AVAILABLE TO MEMBERS OF THE COMMUNITY. THE LOCAL CHURCH COMMUNITIES, THE WCHD, AND THE SCHOOL DISTRICTS ARE PARTNERING WITH THE FOOD PANTRY TO INCREASE ACCESS TO THE SERVICES AND PRODUCTS FOR CITIZENS IN NEED ACROSS THE COUNTY. THE PHYSICAL THERAPY DEPARTMENT HAS ALSO EXPANDED TO PROVIDE NUMEROUS NEW PROGRAMS FOR MANY DIFFERENT PATIENT POPULATIONS. UMC NOW OFFERS THE LSVT BIG PROGRAM TO ASSIST PEOPLE WITH PARKINSON'S DISEASE. WOMEN'S HEALTH AND BIRTH FIT CLASSES WERE ADDED TO IMPROVE THE HEALTH OF FEMALE PATIENTS. THERAPISTS HAVE ALSO ENHANCED ALREADY CLOSE RELATIONSHIPS WITH LOCAL BUSINESSES THROUGH WORKSITE WELLNESS AND INDUSTRIAL MEDICINE ASSESSMENTS AND ACTIVITIES OFFERED ONSITE. SPECIAL ATTENTION IS GIVEN TO EACH PATIENT THROUGH THE INDIVIDUALIZED PROGRAMMING, SUCH AS FUNCTIONAL MOVEMENT SCREENING FOR SCHOOL ATHLETES AND ATHLETIC INJURY SCREENING. PATIENTS OF ALL AGES SEEK TREATMENT, REHABILITATION, AND PERFORMANCE ENHANCEMENT COACHING FROM THE LARGE TEAM OF PROVIDERS. THE ABOVE IMPLEMENTATION PLAN FOR UMC IS POSTED ON THEIR WEBSITE AT HTTPS://WWW.UNITYMEDCENTER.COM/ ABOUT-US/PATIENTRESOURCES.HTML. CHRISTIAN UNITY HOSPITAL CORPORATION PART V, SECTION B, LINE 13H: UNITY MEDICAL CENTER WILL DETERMINE ELIGIBILITY FOR FINANCIAL ASSISTANCE ON THE BASIS OF THE PATIENT'S HOUSEHOLD ASSETS AND FAMILY INCOME. IF THE PATIENT'S ASSETS ARE INSUFFICIENT TO PAY THE AMOUNT DUE, THE PATIENT WILL QUALIFY FOR FINANCIAL ASSISTANCE ON A SLIDING SCALE COMPARING THE PATIENT'S HOUSEHOLD ADJUSTED GROSS INCOME TO THE FEDERAL POVERTY GUIDELINES. - PATIENT WILL QUALIFY FOR FINANCIAL ASSISTANCE ON A SLIDING SCALE COMPARING THE PATIENT'S HOUSEHOLD ADJUSTED GROSS INCOME TO THE FEDERAL POVERTY GUIDELINES FOR THAT YEAR. - UNITY MEDICAL CENTER MAY REVERSE A FINANCIAL ASSISTANCE ADJUSTMENT IF IT LATER LEARNS THE APPLICANT FAILED TO FULLY DISCLOSE FAMILY INCOME OR ASSETS, OR FALSIFIED INFORMATION SUBMITTED TO APPLY FOR FINANCIAL ASSISTANCE. CHRISTIAN UNITY HOSPITAL CORPORATION PART V, SECTION B, LINE 15E: PATIENTS WHO DO NOT PAY AFTER 90 DAYS MEET WITH THE PATIENT ACCOUNT REPRESENTATIVE AND GO OVER THEIR AVAILABLE OPTIONS INCLUDING FINANCIAL ASSISTANCE. THE ORGANIZATION POSTS THE EMTALA LAW IN THEIR EMERGENCY ROOM. THE ORGANIZATION IS ALSO WEIGHING THEIR OPTIONS OF HOW TO MAKE THEIR FINANCIAL ASSISTANCE POLICY MORE WIDELY AVAILABLE TO THE PUBLIC INCLUDING THE POSSIBILITY OF POSTING THE POLICY ON THEIR WEBSITE. CHRISTIAN UNITY HOSPITAL CORPORATION PART V, SECTION B, LINE 20E: FINANCIAL COUNSELOR MEETS WITH PATIENTS. 2 1 - GRAFTON FAMILY CLINIC 164 W 13TH STREET GRAFTON ND 58257 RURAL HEALTH CLINIC 2 - PARK RIVER FAMILY CLINIC 503 PARK ST W B PARK RIVER ND 58270 FAMILY PHYSICIAN CLINIC PART I, LINE 3C: UNITY MEDICAL CENTER WILL DETERMINE ELIGIBILITY FOR FINANCIAL ASSISTANCE ON THE BASIS OF THE PATIENT'S HOUSEHOLD ASSETS AND FAMILY INCOME. IF THE PATIENT'S ASSETS ARE INSUFFICIENT TO PAY THE AMOUNT DUE, THE PATIENT WILL QUALIFY FOR FINANCIAL ASSISTANCE ON A SLIDING SCALE COMPARING THE PATIENT'S HOUSEHOLD ADJUSTED GROSS INCOME TO THE FEDERAL POVERTY GUIDELINES. - PATIENT WILL QUALIFY FOR FINANCIAL ASSISTANCE ON A SLIDING SCALE COMPARING THE PATIENT'S HOUSEHOLD ADJUSTED GROSS INCOME TO THE FEDERAL POVERTY GUIDELINES FOR THAT YEAR. - UNITY MEDICAL CENTER MAY REVERSE A FINANCIAL ASSISTANCE ADJUSTMENT IF IT LATER LEARNS THE APPLICANT FAILED TO FULLY DISCLOSE FAMILY INCOME OR ASSETS, OR FALSIFIED INFORMATION SUBMITTED TO APPLY FOR FINANCIAL ASSISTANCE. PART I, LINE 7: THE ORGANIZATION USES THE COST-TO-CHARGE RATIO BASED ON WORKSHEET 2 OF SCHEDULE H. PART I, LINE 7G: AMOUNTS USED FOR SUBSIDIZED SERVICES WERE CALCULATED USING DETAILED REPORT DATA KEPT BY THE ORGANIZATION. THE ORGANIZATION INCLUDED DATA FOR EMERGENCY SERVICES AND ONE RURAL HEALTH CLINIC IN LINE 7G. SUBSIDIZED SERVICES ARE DETERMINED BY THE ORGANIZATION DUE TO THE NEED IN THE COMMUNITY THAT CAN ONLY BE FILLED BY THE ORGANIZATION. PART I, LINE 7, COLUMN (F): THE BAD DEBT EXPENSE INCLUDED ON FORM 990, PART IX, LINE 25, COLUMN (A), BUT SUBTRACTED FOR PURPOSES OF CALCULATING THE PERCENTAGE IN THIS COLUMN IS $ 433,883. PART III, LINE 2: THIS AMOUNT IS CALCULATED BY MULTIPLYING THE TOTAL CHARGES FOR SERVICES WRITTEN OFF AS BAD DEBT BY THE COST TO CHARGE RATIO. PART III, LINE 3: 9.90% OF THE INDIVIDUALS IN WALSH COUNTY, NORTH DAKOTA (IN WHICH THE HOSPITAL IS LOCATED) FALL BELOW THE FEDERAL POVERTY LEVELS ACCORDING TO CENSUS.GOV. THEREFORE, THE ORGANIZATION ESTIMATES THAT 9.90% OF THE BAD DEBT EXPENSE AT COST IS ATTRIBUTABLE TO PATIENTS ELIGIBLE UNDER THE ORGANIZATION'S CHARITY CARE POLICY. CARE IS GIVEN TO INDIVIDUALS REGARDLESS OF THEIR ABILITY TO PAY AND SO THEREFORE THIS IS A COMMUNITY BENEFIT. PART III, LINE 4: MANAGEMENT PROVIDES FOR PROBABLE UNCOLLECTIBLE AMOUNTS, PRIMARILY FOR UNINSURED PATIENTS AND AMOUNTS PATIENTS ARE PERSONALLY RESPONSIBLE FOR, THROUGH A REDUCTION OF GROSS REVENUE AND A CREDIT TO THE ALLOWANCE FOR DOUBTFUL ACCOUNTS.FOOTNOTE 1 OF THE AUDITED FINANCIAL STATEMENTS:THE ORGANIZATION ALSO PROVIDES SERVICES TO UNINSURED PATIENTS AND OFFERS THOSE UNINSURED PATIENTS A DISCOUNT, EITHER BY POLICY OR LAW, FROM STANDARD CHARGES. THE ORGANIZATION ESTIMATES THE TRANSACTION PRICE FOR PATIENTS WITH DEDUCTIBLES AND COINSURANCE AND FOR THOSE WHO ARE UNINSURED BASED ON HISTORICAL EXPERIENCE AND CURRENT MARKET CONDITIONS. THE INITIAL ESTIMATE OF THE TRANSACTION PRICE IS DETERMINED BY REDUCING THE STANDARD CHARGE BY ANY CONTRACTUAL ADJUSTMENTS, DISCOUNTS, AND IMPLICIT PRICE CONCESSIONS. SUBSEQUENT CHANGES TO THE ESTIMATE OF THE TRANSACTION PRICE ARE GENERALLY RECORDED AS ADJUSTMENTS TO PATIENT SERVICE REVENUE IN THE PERIOD OF THE CHANGE. SUBSEQUENT CHANGES THAT ARE DETERMINED TO BE THE RESULT OF AN ADVERSE CHANGE IN THE PATIENT'S ABILITY TO PAY ARE RECORDED AS BAD DEBT EXPENSE. BAD DEBT EXPENSE FOR THE YEARS ENDED JUNE 30, 2023 AND 2022, WAS NOT SIGNIFICANT. PART III, LINE 8: MEDICARE ALLOWABLE COSTS OF CARE ARE BASED ON THE MEDICARE COST REPORT. THE MEDICARE COST REPORT IS COMPLETED BASED ON THE RULES AND REGULATIONS SET FORTH BY CENTERS FOR MEDICARE AND MEDICAID SERVICES.CHRISTIAN UNITY HOSPITAL CORPORATION PROVIDES MEDICALLY NECESSARY CARE TO ALL REGARDLESS OF THE ABILITY TO PAY. PROVIDING SERVICES TO THOSE ELIGIBLE FOR MEDICARE IS A BENEFIT TO THE COMMUNITY AS ELDERLY ARE A CHARITABLE CLASS. THEREFORE, ALL OF THE SHORTFALL SHOULD BE TREATED AS A COMMUNITY BENEFIT. PART III, LINE 9B: IF AN INCOMPLETE FINANCIAL ASSISTANCE APPLICATION HAS BEEN SUBMITTED, THE PATIENT ACCOUNTS REPRESENTATIVE WILL WORK WITH THE PATIENT TO GATHER ANY MISSING OR OUTSTANDING ITEMS. ANY COLLECTION ACTIONS ARE STOPPED AFTER THE PATIENT SUBMITS AN APPLICATION FOR FINANCIAL ASSISTANCE UNTIL IT IS DETERMINED WHETHER OR NOT THE INDIVIDUAL IS ELIGIBLE FOR FINANCIAL ASSISTANCE. IF THE PATIENT QUALIFIES FOR FINANCIAL ASSISTANCE, ANY COLLECTION ACTIONS ALREADY TAKEN AGAINST THE INDIVIDUAL WOULD BE REVERSED. THE PATIENT ACCOUNTS REPRESENTATIVE DOCUMENTS WHETHER OR NOT THE INDIVIDUAL IS ELIGIBLE FOR FINANCIAL ASSISTANCE. PART VI, LINE 2: THROUGHOUT THE YEAR, UMC IS PROACTIVE IN DETERMINING WHAT NEEDS THEY CAN ADDRESS FOR THEIR COMMUNITY. THE UMC BOARD REVIEWS CURRENT SERVICES AND VISITS ABOUT POTENTIAL SERVICES THAT COULD BE ADDED EACH YEAR, OR AS THEY COME UP. PART VI, LINE 3: A SIGN NEAR THE ENTRANCE TO THE EMERGENCY ROOM INDICATES WE "PROVIDE MEDICAL CARE FOR THOSE WHO CANNOT AFFORD TO PAY." ANOTHER POSTING STATES THAT "THE FACILITY IS LEGALLY OBLIGATED TO SERVE THE COMMUNITY." FOR THOSE PATIENTS WHO DO NOT PAY ON THEIR BALANCES, WE CONTACT THEM BY PHONE AND/OR THROUGH THE MAIL. THEY VISIT WITH OUR PATIENT FINANCIAL COUNSELOR. THE COUNSELOR DISCUSSES PAYMENT ARRANGEMENTS, ELIGIBILITY FOR CERTAIN PROGRAMS, SUCH AS MEDICAID, AND THEN CHARITY CARE, IF NECESSARY. IF WE CANNOT GET THOSE PATIENTS TO COME IN AND TALK, WE ATTEMPT TO MAKE ARRANGEMENTS OVER THE PHONE AND THROUGH THE MAIL, IF NECESSARY. PART VI, LINE 4: UNITY MEDICAL CENTER SERVES THE POPULATION OF GRAFTON, NORTH DAKOTA AND SURROUNDING SMALLER COMMUNITIES. GRAFTON IS A RURAL COMMUNITY OF APPROXIMATELY 4,170 RESIDENTS LOCATED IN WALSH COUNTY, NORTH DAKOTA. THE MEDIAN HOUSEHOLD INCOME FOR WALSH COUNTY IS $58,429, AND 9.9% OF INDIVIDUALS IN THE WALSH COUNTY FALL BELOW THE FEDERAL POVERTY LEVEL. THE AREA IS ALSO SERVED BY HOSPITALS IN PARK RIVER AND GRAND FORKS AS WELL AS A COMMUNITY HEALTH CLINIC AND A VETERAN'S AFFAIRS CLINIC IN GRAFTON. APPROXIMATELY 6% OF THE HOSPITAL'S BUSINESS IN FY 2023 WAS TO PRIVATE PAY INDIVIDUALS AND 3% WAS TO MEDICAID RECIPIENTS. PART VI, LINE 5: THE UNITY MEDICAL CENTER (UMC) GOVERNING BODY IS COMPRISED OF PERSONS WHO RESIDE IN OUR PRIMARY SERVICE AREA. THE BOARD MEMBERS ARE NEITHER CONTRACTORS, NOR FAMILY MEMBERS OF THE ORGANIZATION. MEDICAL STAFF PRIVILEGES ARE EXTENDED TO THOSE QUALIFIED PHYSICIANS IN OUR COMMUNITY WHO HAVE APPLIED FOR AND BEEN GRANTED MEDICAL PRIVILEGES, PER OUR CREDENTIALING PROCESS. SURPLUS FUNDS, WHEN AVAILABLE, ARE USED TO PURCHASE EQUIPMENT OR MAKE PURCHASES TO IMPROVE THE BUILDING STRUCTURE FOR THE PURPOSE OF IMPROVING PATIENT CARE OR FOR THE RETENTION OF QUALITY EMPLOYEES. UNITY MEDICAL CENTER FOUNDATION ALSO ASSISTS THE HOSPITAL WITH CAPITAL PURCHASES.UMC OFFERS 24-HOUR ACCESS TO EMERGENCY ROOM CARE, AVAILABLE TO ALL INDIVIDUALS, REGARDLESS OF THEIR ABILITY TO PAY FOR THE CARE. UMC OFFERS ACUTE CARE, SWING BED CARE, GENERAL SURGERY, ORTHOPEDIC SURGERY, AS WELL AS MANY OUTPATIENT SERVICES. UMC DOES PARTICIPATE IN EDUCATION OF HEALTHCARE PROFESSIONALS. WE TAKE APPROXIMATELY 4 MEDICAL STUDENTS, 10 FNP/PA STUDENTS, AND MULTIPLE DIETETICS, AND SEVERAL PHYSICAL THERAPY STUDENTS THROUGHOUT THE YEAR FROM THE UNIVERSITY OF NORTH DAKOTA. WE ALSO TAKE NURSING AND SOCIAL WORK STUDENTS FROM UND. WE DO TRAINING FOR STUDENTS FROM TECHNICAL SCHOOLS, AS WELL, AS REQUESTED. UMC IS THE ONLY HOSPITAL IN THE COMMUNITY; THEREFORE, WE ARE A VIABLE PART OF THIS COMMUNITY. UMC OFFERS PROGRAMS SUCH AS DIABETES SCREENINGS, PRE-DIABETES CLASSES, FLU VACCINATION CLINICS, FREE BLOOD PRESSURE CHECKS, EDUCATIONAL EVENTS FOR CENTURY ELEMENTARY STUDENTS AND WALSH COUNTY HEAD START STUDENTS, ETC. UMC BRINGS IN SPECIALTY DOCTORS TO OUR CLINIC IN ORDER TO OFFER NECESSARY SERVICES TO OUR PATIENT POPULATION, I.E. ONCOLOGY, ORTHOPEDICS, OBSTETRICS, ETC. WE OFFER VOLUNTEER OPPORTUNITIES FOR HIGH SCHOOL STUDENTS AND ADULTS. WE HAVE SIX MEMBERS OF OUR UMC AUXILIARY SERVICES THAT VOLUNTEER AT THE HOSPITAL EVERY WEEK FOR THE BENEFIT OF THE FACILITY. PART VI, LINE 6: N/A 1 UNITY MEDICAL CENTER FOUNDATION 164 WEST 13TH STREET GRAFTON ND 58237 363522304 501(C)(3) 0 14747 FMV GOLF CART AND TRAVEL VOUCHER DONATION FOR FUNDRAISING EVENT 1 0 PART I, LINE 2: THE UNITY MEDICAL CENTER'S BOARD WORKS WITH THE FOUNDATION ADMINISTRATIOIN TO DETERMINE WHAT FUNDS WILL GO TOWARD. X X 0 0 0 0 0 0 0 0 0 DR MATTHEW VISCITO BOARD MEMBER/CHIEF OF MED. STAFF 420729 0 30000 0 0 0 10250 0 30432 0 491411 0 0 0 DR JARED MARQUARDT PHYSICIAN 319976 0 40000 0 0 0 7824 0 30432 0 398232 0 0 0 ALAN O'NEIL CHIEF EXECUTIVE OFFICER 314480 0 50000 0 0 0 9442 0 21738 0 395660 0 0 0 DR JENNIFER SHAW PHSYICIAN 261994 0 0 0 0 0 8049 0 35069 0 305112 0 0 0 DR KRISTI MIDGARDEN PHYSICIAN 266247 0 0 0 0 0 8054 0 30082 0 304383 0 0 0 MATTHEW MASSMANN PHYSICIAN ASSISTANT 156633 0 10800 0 0 0 5217 0 35048 0 207698 0 0 0 JODI SHERVE FAMILY NURSE PRACTITIONER 163584 0 0 0 0 0 4908 0 29936 0 198428 0 0 0 BRAD WURGLER CHIEF FINANCIAL OFFICER 120091 0 0 0 0 0 3808 0 34695 0 158594 0 0 0 FORM 990, PART VI, SECTION A, LINE 6 MEMBERSHIP IN THE CORPORATION SHALL BE EITHER LIFETIME OR ANNUAL, AND SHALL BE LIMITED TO ADULT INDIVIDUALS AS FOLLOWS: 1) THOSE INDIVIDUALS OR COMPANIES CONTRIBUTING $100 TO THE CORPORATION, OR TO THE DEVELOPMENT FUND OF THE MEDICAL CENTER CORPORATION, SHALL, UPON SPECIFIC REQUEST, BE ENTITLED TO A LIFE MEMBERSHIP. IF AN INDIVIDUAL OR COMPANY MAKES A CONTRIBUTION OF $200 OR MORE, THEY SHALL BE ENTITLED TO DESIGNATE ONE ADDITIONAL IMMEDIATE FAMILY MEMBER OR COMPANY EMPLOYEE (LIMITED TO TWO PER FAMILY OR COMPANY), RESPECTIVELY, FOR LIFETIME MEMBERSHIP EFFECTIVE RETROACTIVELY. 2) THOSE INDIVIDUALS RESIDING IN THE UNITY MEDICAL CENTER SERVICE AREA SHALL BE GRANTED ANNUAL MEMBERSHIP AT NO FEE. THEY SHALL BE GRANTED ANNUAL MEMBERSHIP STATUS BY SHOWING PROOF OF RESIDING IN THE CORPORATION SERVICE AREA. FORM 990, PART VI, SECTION A, LINE 7A EACH MEMBER OF THE CORPORATION IN GOOD STANDING SHALL BE QUALIFIED TO CAST ONE VOTE ON ANY ISSUE THAT MAY PROPERLY COME BEFORE ANY MEETING OF THE MEMBERS OF THE CORPORATION, AND TO HOLD ANY OFFICE IN THE CORPORATION TO WHICH HE OR SHE MAY BE ELECTED OR APPOINTED. FORM 990, PART VI, SECTION B, LINE 11B THE CFO & CEO WILL REVIEW A DRAFT OF THE FORM 990. UNITY MEDICAL CENTER WILL PROVIDE THE BOARD MEMBERS WITH A LINK AND A PASSWORD TO AN ELECTRONIC COPY OF THE 990 BEFORE SUBMISSION TO THE INTERNAL REVENUE SERVICE. FORM 990, PART VI, SECTION B, LINE 12C ANNUALLY BOARD MEMBERS MUST SIGN A CONFLICT OF INTEREST POLICY. IF A BOARD MEMBER BELIEVES THAT A CONFLICT EXISTS IT IS THEIR RESPONSIBILITY TO BRING THE CONFLICT TO THE ATTENTION OF THE BOARD. THE BOARD WILL DETERMINE IF A CONFLICT EXISTS. ANY BOARD MEMBERS WITH A CONFLICT OF INTEREST MUST ABSTAIN FROM VOTING ON ANY ISSUES RELATING TO THE CONFLICT. FORM 990, PART VI, SECTION B, LINE 15 A FORMAL EVALUATION IS COMPLETED FOR BOTH THE CEO AND CFO. COMPARABILITY DATA IS USED FROM THE NORTH DAKOTA HOSPITAL ASSOCIATION. AT BUDGET TIME EACH YEAR THE BOARD WILL APPROVE A PERCENTAGE INCREASE. THE DELIBERATION AND DECISION IS DOCUMENTED IN THE BOARD MINUTES. THE PROCESS WAS LAST COMPLETED IN JUNE 2021. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION MAKES ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC AND ANNOUNCES SUCH AT BOARD MEETINGS. UNITY MEDICAL CENTER FOUNDATION 164 WEST 13TH STREET GRAFTON ND 58237 363522304 FUNDRAISING FOR UNITY MEDICAL CENTER ND 501(C)(3) LINE 7 CHRISTIAN UNITY HOSPITAL CORPORATION DBA UNITY MEDICAL CENTER 1 0 1 1 0 0 0 0 0 0 0 0 0 1 1 1 1 1 0 0 UNITY MEDICAL CENTER FOUNDATION C 560086 CASH