Community Benefit Insight - Tax-exempt hospital

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United Hospital District Inc

United Hospital District

515 South Moore Street
Blue Earth, MN 56013

Bed count	43	Medicare provider number	241369	Member of the Council of Teaching Hospitals	NO	Children's hospital	NO

EIN: 454165628

Display data for year:

Community Benefit Spending- 2021
(as % of functional expenses, which all tax-exempt organizations report on Form 990 Schedule H)

10.76%

Spending by Community Benefit Category- 2021
(as % of total functional expenses)

* = CBI denoted preventative categories

Community Benefit Spending Compared to Functional Expenses, 2015-2021

Additional data

Community Benefit Expenditures: 2021

All tax-exempt organizations file a Form 990 with the IRS for every tax year. If the tax-exempt organization operates one or more hospital facilities during the tax year, the organization must attach a Schedule H to Form 990. On Part I of Schedule H, the organization records the expenditures it made during the tax year for various types of community benefits; 9 types are shown on this web tool. By default, this web tool presents community benefit expenditures as a percentage of the organization’s functional expenses, which it reports on Form 990, Part IX, Line 25, Column A. (The more commonly heard term, ‘total operating expenses’, which organizations report to CMS, is generally about 90% of the ‘functional expenses’). The user may change the default to see the dollar expenditures.
Amount spent in the following IRS community benefit categories:

Financial Assistance at cost as % of operating expenses	$ 399,000 1.05 %
Medicaid as % of operating expenses	$ 891,349 2.34 %
Costs of other means-tested government programs as % of operating expenses	$ 0 0 %
Health professions education as % of operating expenses	$ 0 0 %
Subsidized health services as % of operating expenses	$ 2,802,686 7.37 %
Research as % of operating expenses	$ 0 0 %
Community health improvement services and community benefit operations* as % of operating expenses Note: these two community benefit categories are reported together on the Schedule H, part I, line 7e.	$ 0 0 %
Cash and in-kind contributions for community benefit* as % of operating expenses	$ 0 0 %
Community building* as % of operating expenses	$ 0 0 %

* = CBI denoted preventative categories

Community building activities details:

Did tax-exempt hospital report community building activities?	Not available
Number of activities or programs (optional)	0
Physical improvements and housing	0
Economic development	0
Community support	0
Environmental improvements	0
Leadership development and training for community members	0
Coalition building	0
Community health improvement advocacy	0
Workforce development	0
Other	0
Persons served (optional)	0
Physical improvements and housing	0
Economic development	0
Community support	0
Environmental improvements	0
Leadership development and training for community members	0
Coalition building	0
Community health improvement advocacy	0
Workforce development	0
Other	0
Community building expense as % of operating expenses	$ 0 0 %
Physical improvements and housing as % of community building expenses	$ 0
Economic development as % of community building expenses	$ 0
Community support as % of community building expenses	$ 0
Environmental improvements as % of community building expenses	$ 0
Leadership development and training for community members as % of community building expenses	$ 0
Coalition building as % of community building expenses	$ 0
Community health improvement advocacy as % of community building expenses	$ 0
Workforce development as % of community building expenses	$ 0
Other as % of community building expenses	$ 0
Direct offsetting revenue	$ 0
Physical improvements and housing	$ 0
Economic development	$ 0
Community support	$ 0
Environmental improvements	$ 0
Leadership development and training for community members	$ 0
Coalition building	$ 0
Community health improvement advocacy	$ 0
Workforce development	$ 0
Other	$ 0

Other Useful Tax-exempt Hospital Information: 2021

In addition to community benefit and community building expenditures, the Schedule H worksheet includes sections on what percentage of bad debt can be attributable to patients eligible for financial assistance, and questions on the tax-exempt hospital's debt collection policy. When searching a specific tax-exempt hospital in this web tool, Section II provides information about bad debt and the financial assistance policy, and whether the state in which the tax-exempt hospital resides has expanded Medicaid coverage under the federal ACA.

Of the tax-exempt hospital’s overall operating expenses, amount reported as bad debt as % of operating expenses	$ 2,326,977 6.12 %
Is the tax-exempt hospital considered a "sole community hospital" under the Medicare program?	NO

Information about the tax-exempt hospital's Financial Assistance Policy and Debt Collection Policy
The Financial Assistance Policy section of Schedule H has changed over the years. The questions listed below reflect the questions on the 2009-2011 Schedule H forms and the answers tax-exempt hospitals provided for those years. The Financial Assistance Policy requirements were changed under the ACA. In the future, as the Community Benefit Insight web site is populated with 2022 data and subsequent years, the web tool will also be updated to reflect the new wording and requirements. In the meantime, if you have any questions about this section, we encourage you to contact your tax-exempt hospital directly.

Does the organization have a written financial assistance (charity care) policy?	YES
Did the tax-exempt hospital rely upon Federal Poverty Guidelines (FPG) to determine when to provide free or discounted care for patients?	YES
Amount of the tax-exempt hospital’s bad debt (at cost) attributed to patients eligible under the organization’s financial assistance (charity care) policy as % of operating expenses	$ 581,744 25.00 %

Did the tax-exempt hospital, or an authorized third party, take any of the following collection activities before determining whether the patient was eligible for financial assistance:
Under the ACA, states have the choice to expand Medicaid eligibility for their residents up to 138% of the federal poverty guidelines. The Medicaid expansion provision of the ACA did not go into effect until January 2014, so data in this web tool will not reflect each state's current Medicaid eligibility threshold. For up to date information, please visit the Terms and Glossary under the Resources tab.
The federal poverty guidelines (FPG) are set by the government and used to determine eligibility for many federal financial assistance programs. Tax-exempt hospitals often use FPG guidelines in their Financial Assistance policies to determine which patients will qualify for free or discounted care.
In addition to the federal requirements, some states have laws stipulating community benefit requirements as a result of tax-exemption. The laws vary from state to state and may require the tax-exempt hospitals to submit community benefit reports. Data on this web tool captures whether or not a state had a mandatory community benefit reporting law as of 2011. For more information, please see Community Benefit State Law Profiles Comparison at The Hilltop Institute.

Community Health Needs Assessment Activities: 2021

The ACA requires all 501(c)(3) tax-exempt hospitals to conduct a Community Health Needs Assessment (CHNA) every three years, starting with the hospital's tax year beginning after March 23, 2012. The 2011 Schedule H included an optional section of questions on the CHNA process. This web tool includes responses for those hospitals voluntary reporting this information. The web tool will be updated to reflect changes in these questions on the 2012 and subsequent Schedule H forms.

Did the tax-exempt hospital report that they had conducted a CHNA?	YES
Did the CHNA define the community served by the tax-exempt hospital?	YES
Did the CHNA consider input from individuals that represent the broad interests of the community served by the tax-exempt hospital?	YES
Did the tax-exempt hospital make the CHNA widely available (i.e. post online)?	YES
Did the tax-exempt hospital adopt an implementation strategy to address the community needs identified by the CHNA?	YES

Supplemental Information: 2021

This section presents qualitative information submitted by the hospital, verbatim from the 990H record.

Statement of Program Service Accomplishments
Description of the organization's program service accomplishments for each of its three largest program services, as measured by expenses. Section 501(c)(3) and 501(c)(4) organizations are required to report the amount of grants and allocations to others, the total expenses, and revenue, if any, for each program service reported.

4A (Expenses $ 32429353 including grants of $ 0) (Revenue $ 38918609)
United Hospital District, Inc. operates a 25-bed critical access hospital in Blue Earth, Minnesota. The Hospital also operates medical clinics in Blue Earth, Wells, Winnebago and Fairmont, Minnesota. The Hospital provides health care services to patients who meet certain criteria under its charity care policy without charge or at amounts less than established rates. The estimated cost of providing these services was $399,000 for the year ended December 31, 2021, calculated by multiplying the ratio of cost to gross charges for the Hospital by the gross uncompensated charges associated with providing charity care to its patients.

Facility Information

Schedule H (Form 990) Section C. Supplemental Information for Part V, Section B.

United Hospital District
Part V, Section B, Line 5: In November 2020, the CHNA, a cover letter on UHD's letterhead, and a postage paid reply envelope were mailed first class to 800 randomly selected residents in the targeted region (fifteen zip codes). A press release was sent to local newspapers prior to the survey distribution announcing that UHD would conduct a CHNA throughout the region, in cooperation with The National Rural Health Resouce Center (The Center). The announcement was also shared on UHD's Facebook page. To assist with the assessment, UHD contracted with the National Rural Health Resource Center, headquartered in Duluth, Minnesota. The Center is a nonprofit organization dedicated to sustaining and improving health care in rural communities. The Center conducted demographic analysis and statistical research and surveys for the focus groups and key community stakeholder interviews were developed.Due to COVID-19 restrictions the focus groups were held virtually and included residents from several different communities in UHD's service area and represented young parents, seniors, veterans, schools, businesses, healthcare consumers, and social services. The key stakeholder meetings were one-on-one 60-minute interviews and included representatives of education, law enforcement, local business, faith leaders, and other community and elected leaders.

United Hospital District
Part V, Section B, Line 11: In 2020, United Hospital District (UHD) commissioned a community health needs assessment to evaluate the healthcare needs of its service area: Faribault, Freeborn, Martin, and Blue Earth Counties in Minnesota, and Kossuth and Winnebago Counties in Iowa. The priorities identified by the CHNA teams are as follows: **Goal 1: Provide and Promote Education Information and Opportunities to the Communities We Serve1. Survey responses indicate there is an opportunity to better communicate about services or available preventive support. 2. Some focus group respondents indicated that they were not sure what services UHD offers. 3. Leverage all modes of communication that will reach the senior population as well as younger community members. **Action Item A: The community education team met to brainstorm about how best to promote better education regarding the varied services available at UHD. The team is also exploring the methods to disseminate the information, i.e., via YouTube, podcasts, radio, and other outlets to reach the various demographic segments of UHD's service area. The team suggested that in Q1 of 2022 the CNO would meet with each department manager to get topics for discussions. The team would like to have frontline staff involved in the creation of the videos/podcasts that could then be uploaded to UHD's website.**Goal 2: Match the Scope of Services with the Needs of the Communities We Serve:1. The CHNA results encouraged UHD to continue developing partnerships with businesses, faith groups, and schools (including schools within the counties but not located in Blue Earth).**Action Item A: UHD has created an internal team for this as well. The team is exploring the feasibility of a Community Paramedicine/service delivery position. This entails meeting with the Medical Director of the Minnesota EMSRB (Emergency Medical Services Regulatory Board) to assist with the development of policy and protocol, outcome analysis and quality assurance initiatives. Currently UHD employs only one Paramedic. To move to a Community Paramedicine Program, UHD would need to hire additional staff, and convert the ambulance service from existing BLS (Basic Life Support) to part-time ALS (Advance Life Support).**Action Item B: Community Paramedicine Program: Weekly meetings began to look at the conversion of our ambulance service from BLS to part-time ALS. At this time UHD is putting together the supply list along with capital purchases required to move forward with part-time ALS. Next step is to accept the protocols and then UHD will move forward with the application process.**Action Item C: Ambulance Service from BLS to part-time ALS: The consulting physician of the Minnesota EMSRB visited UHD in Q4 of 2021. UHD will continue to work with the consortium for ambulance guidance. The consulting physician will remain a resource to UHD as we submit our application for ALS. A UHD physician has been invited to attend meetings of the consortium to learn more about ambulance directorship and the requirements.**Goal 3: Promote, Partner, and Enhance Mental Health Services1. As in many communities, there is an opportunity to address issues related to mental illness. Following best practice recommendations, this is not something the hospital can do alone. **Action Item A: An internal team has been created to coordinate efforts in this area. The team has already engaged UHD's MH (Mental Health) providers to appear on local radio once per month with a program dedicated to various MH topics. The MH resource information on UHD's website has been augmented with numerous additional links for patients. The team is also looking to collaborate with local school districts, nursing homes, and veteran's agencies to identify and connect services. UHD also continues to explore options for outpatient telehealth. **Action Item B: Radio spots continue to take place every other Friday with MH Providers. **Action Item C: 50-page Mental Health booklet was completed and printed. MH Providers have put it into use and has been well received.**Action Item D: MH Access Expanded (location and/or provider): MH PhD is up and running in the Fairmont location 3 days/week, currently limiting to 1 new referral per day due to current caseload. An interview is set up for a Psychiatric Mental Health Nurse Provider (PMHNP) to join the BE Clinic MH staff. A PMHNP can assist with medication management. **Action Item E: Outreach is planned to the local school district staff.

United Hospital District
Part V, Section B, Line 13h: Documents that may be reviewed include completed application, recent tax statements, bank denial and MA denial. The Organization also follows the state agreement.

United Hospital District
Part V, Section B, Line 15e: We have certified staff who assist with the MN State Exchange and MA. They also provide guidance with every patient's insurance carrier where needed.

Schedule H, Part V, Line 7a:
https://uhd.org/index.php/community-needs-assessment

Supplemental Information

Schedule H (Form 990) Part VI

Part I, Line 3c:
In addition to the Federal Poverty Guidelines, documents that may be reviewed include completed application, recent tax statements, bank denial and MA denial. The Organization also follows the state agreement.

Part I, Line 7:
Charity care expense was converted to cost on line 7a based on an overall cost-to-charge ratio addressing all patient segments. Unreimbursed Medicaid on line 7b and subsidized health services on line 7g were determined using the costing methods to prepare the cost reports.

Part III, Line 2:
The amount reported on line 2 represents implicit price concessions. The Hospital determines its estimate of implicit price concessions based on its historical collection experience with this class of patients.

Part III, Line 3:
The Organization estimates that 25% of its implicit price concessions are attributable to patients eligible for financial assistance under the financial assistance policy. We estimate that 25% of those who should have completed financial assistance forms and applications could have qualified for financial assistance had they applied.

Part III, Line 4:
The footnote to the organization's financial statements addressing implicit price concessions may be found on pages 11 and 12 of the attached audited financial statements.

Part III, Line 8:
Medicare allowable costs were obtained from the 2021 Medicare cost report. The Medicare Cost Report is completed based on the rules and regulations set forth by the Centers for Medicare and Medicaid Services.

Part III, Line 9b:
Within 7 days after an insurance payment, the patient will start receiving monthly billings. Statements are sent on a monthly cycle basis. If no payment is received 30 days after the statement went out, the patient is contacted by phone. If no payment is received for 90 days, the patient is contacted by letter to advise him or her of further collection actions to be taken. When agreed upon amounts are not paid off, arrangements can be made for a series of payments to fulfill a patient's obligation. Each account is reviewed by a business office staff member before placing with a collection agency. A financial assistance application submitted by a patient will be processed for at least 240 days following their first post discharge billing statement. If an individual submits a financial assistance application after collection actions have started, collection actions will be suspended until financial assistance eligibility is determined. If an individual is determined to be eligible for financial assistance, no further collection actions will be taken. If an individual is determined to be eligible for financial assistance after collection actions have started, the collection actions will be reversed.

Part VI, Line 2:
UHD has standing advisory committees with representation from our communities for Home Health/Hospice and ATCW. Input from the members helps set the strategies and initiatives for improvement. We've also had Focus Groups to address Obstetrical services and another for Orthopedic services. Our patient satisfaction survey incorporates a comments section which gives our patients a voice to make suggestions.

Part VI, Line 3:
Whether in person or on our web-site, UHD provides the following information for financial assistance: (1) posts its charity care policy, or a summary thereof, and financial assistance contact information in admissions areas, emergency rooms, and other areas of the organization's facilities in which eligible patients are likely to be present; (2) provides a copy of the policy, or a summary thereof, and financial assistance contact information to patients as part of the intake process; (3) provides a copy of the policy, or a summary thereof, and financial assistance contact information to patients with discharge materials; (4) includes the policy, or a summary thereof, along with financial assistance contact information, in patient bills; and/or (5) discusses with the patient the availability of various government benefits, such as Medicaid or state programs, and assists the patient with qualification for such programs, where applicable. In addition, the Business Office has several certified individuals to assist with applications for both State and Federal insurance plans.

Part VI, Line 4:
UHD is located in Blue Earth, Minnesota, a community of approximately 3,400 situated in the west central end of Faribault County. The county borders Martin County to the west, Freeborn County to the east, Blue Earth County to the north, and two Iowa counties, Kossuth and Winnebago, to the south.UHD is the only hospital serving Faribault County and the northern Iowa adjacent counties. Faribault County comprises 82% of UHD outpatient admissions while the remaining adjacent counties comprises 95% of all outpatient encounters. The population within a 10-mile radius of Blue Earth is about 9,000 and within a 20-mile radius is about 30,000.The closet full-service hospitals are in:Fairmont, MN - Mayo Clinic Health Systems - 22 miles westMankato, MN - Mayo Clinic Health Systems - 45 miles northEmmetsburg, IA - Palo Alto County Hospital - 66 miles southwest

Part VI, Line 5:
United Hospital District's current board members reside in the service area. Medical staff privileges for physicians are provided to all qualified care providers who also primarily reside in the service area. The Hospital also has relationships for certain specialists who provide their medical care in our clinics and hospital. All surplus funds are reinvested in the program areas for the hospital and clinics.

Operating expenses	$ 38,049,014
Total amount spent on community benefits as % of operating expenses	$ 4,093,035 10.76 %