2024-07-31T08:21:50-05:00 2023-09-30 410746749 CLIFTONLARSONALLEN LLP 220 SOUTH SIXTH STREET SUITE 300 MINNEAPOLIS MN 55402 990 2022-10-01 410706115 MADISON HEALTHCARE SERVICES MADI 3205987536 900 SECOND AVENUE MADISON MN 562561006 ERIK BJERKE PRESIDENT/CEO 3205987536 2024-07-29 1 0 RYAN STRUSZ P01604381 6123764500 2024-07-17 2022 2024-08-08 14:25:15Z ERIK BJERKE 900 SECOND AVENUE MADISON MN 562561006 20738798 0 X MHSMN.ORG X 1945 MN WE COMMIT TO ENRICH THE LIVES OF EVERYONE WE SERVE, GUIDED BY OUR CHRISTIAN HERITAGE AND VALUES. 7 7 208 25 0 0 1119442 1335292 18876165 18611979 342769 467390 134540 320302 20472916 20734963 29065 36017 0 0 11110897 11663135 45600 0 0 9486817 9219940 20672379 20919092 -199463 -184129 46574607 44800779 16314696 13699872 30259911 31100907 X MADISON HEALTHCARE SERVICES, WHICH INCLUDES THE MADISON LUTHERAN HOME, MADISON HOSPITAL, LAC QUI PARLE CLINIC, AND SUBSIDIARIES, IS COMMITTED TO ENRICH THE LIVES OF EVERYONE WE SERVE, GUIDED BY OUR CHRISTIAN HERITGAGE AND VALUES. 0 0 9489566 17518 9552151 MADISON HOSPITAL IS A 12-BED HOSPITAL, WHICH PROVIDES SERVICE TO THE COMMUNITY IN THE AREA OF ACUTE INPATIENT CARE AND SKILLED SWING BED REHABILITATION THE ORGANIZATION ALSO PROVIDES SOCIAL SERVICES BY PROVIDING EMOTIONAL, SOCIAL, AND ECONMOIC SUPPORT/REFERRAL TO RESIDENTS AND FAMILIES, PEDIATRICS, SURGERY, EMERGENCY CARE, CARDIAC REHAB, OUTPATIENT, OUTREACH AND INPATIENT CARE. THE HOSPITAL HAD 14,139 OUTPATIENT VISITS AND 738 MED/SURGERY AND SSB DAYS. THE ORGANIZATION MAINTAINS RECORDS TO IDENTIFY AND MONITOR THE LEVEL OF CHARITY CARE IT PROVIDES. THESE RECORDS INCLUDE THE AMOUNT OF CHARGES FORGONE FOR SERVICES AND SUPPLIES FURNISHED UNDER ITS CHARITY CARE POLICY AND EQUIVALENT SERVICE STATISTICS. THE AMOUNT OF CHARGES FOREGONE, BASED ON ESTABLISHED RATES, WAS $5,707 FOR THE YEAR ENDED SEPTEMBER 30, 2023. 6948232 12828 6948186 MADISON LUTHERAN HOME IS A 51 BED SKILLED NURSING FACILITY. IT WAS ORIGINALLY CONSTRUCTED IN 1952 AND OVER THE YEARS IT HAS CONTINUALLY BEEN ADDED ONTO. THE ENTIRE FACILITY ONCE WAS A 176 BED FACILITY, BUT WAS DOWNSIZED TO 80 BEDS IN ORDER TO ACCOMMODATE MORE SINGLE ROOMS FOR RESIDENTS. DUE TO STAFFING SHORTAGES THE FACILITY WAS REDUCED TO 65 BEDS IN MAY 2015. IN JULY 2019, LICENSED BEDS WERE REDUCED FROM 65 TO 56 TO RESIZE TO AVERAGE OCCUPANCY AND STAFFING SHORTAGES. RESIDENTS MOVED INTO A NEWLY BUILT WING ON AUGUST 18, 2021 TO PROVIDE A MORE HOME LIKE ATMOSPHERE. A NEW CHAPEL, BEAUTY SHOP, ENTRY AND BISTRO WAS COMPLETED IN 2022. ALSO, MADISON LUTHERAN HOME UNDERWENT A MAJOR RENOVATION THAT STARTED IN 2019 AND FINISHED IN 2022. THE NURSING HOME PROVIDES QUALITY CARE OF THE RESIDENTS TO ACHIEVE THEIR HIGHEST LEVEL OF FUNCTION AND PROVIDING A MORE HOME-LIKE ATMOSPHERE. NURSING HOME OCCUPANCY AT SEPTEMBER 30, 2023 WAS 41 RESIDENTS. 3071945 5671 2318337 THE MEDICAL STAFF AT THE CLINIC CONSISTS OF THREE M.D.'S , TWO PA-C'S, AND TWO NURSE PRACTIONERS AVAILABLE 5-DAYS-A-WEEK AND HALF ON SATURDAY. THE CLINIC WORKS WITH THE NURSING STAFF TO PROVIDE QUALITY CARE TO ITS PATIENTS. ATTACHED DIRECTLY TO THE MADISON HOSPITAL, THE CLINIC HAS EASY ACCESS TO MEDICAL SERVICES SUCH AS LAB, X-RAY, PHARMACY, AND OTHER DIAGNOSTIC SERVICES. 19509743 1 1 0 1 0 0 0 0 1 0 1 0 0 1 1 1 0 1 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 0 0 0 1 9 0 1 208 1 0 0 0 0 0 0 0 0 0 0 0 0 X 7 7 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 0 MN X CAROL BORGERSON 3206987152 900 SECOND AVENUE MADISON MN 562561006 LYNN ZIMMERMAN CHAIRMAN 1.00 0.00 X X 0 0 0 KARIN MOEN SECRETARY 1.00 0.00 X X 0 0 0 BART HILL DIRECTOR 1.00 0.10 X 0 0 0 SCOTT OMLAND DIRECTOR 1.00 0.00 X 0 0 0 DAVID HALL DIRECTOR 1.00 0.10 X 0 0 0 JEANENE MUNSTERMAN DIRECTOR 1.00 0.00 X 0 0 0 TIM VOLK DIRECTOR 1.00 0.00 X 0 0 0 ERIK BJERKE CEO 40.00 0.50 X 201628 0 53043 CAROL BORGERSON CFO 40.00 1.00 X 109328 0 16204 BRANT HACKER MD MD 40.00 0.00 X 388421 0 35510 MARIA NOLTE MD MD 40.00 0.00 X 269980 0 44469 MICHAEL DEYO PA PHYSICIAN ASSISTANT 32.00 0.00 X 144813 0 21343 MARIBETH OLSON PHYSICIAN ASSISTANT 24.00 0.00 X 118711 0 4513 PAUL HODGE NP NURSE PRACTITIONER 40.00 0.00 X 169569 0 12851 1402450 0 187933 7 0 1 0 BIG STONE THERAPIES 340 WASHINGTON ORTONVILLE MN 56278 CONTRACT THERAPY SERVICES 1040215 KAREKREST LLC 5701 SHINGLE CREEK PARKWAY SUITE 2 BROOKLYN CENTER MN 55430 AGENCY STAFFING NURSING 664166 CENTRACARE HEALTH 1406 6TH AVENUE N ST CLOUD MN 56303 EMR SOFTWARE SUPPORT/LICENSING/ETC. 383199 CENTRAL MINNESOTA DIAGNOSTICS 150 10TH STREET W MILACA MN 56353 CONTRACT CT AND ULTRASOUND 315173 MEDICAL SOLUTIONS 1010 N 102ND STREET SUITE OMAHA MN 68114 AGENCY STAFFING NURSING 246194 20 6358 1220860 108074 1335292 NET PATIENT AND RESIDENT SERVICE 621400 18183206 18183206 HOSPITAL REVENUE 623000 277645 277645 CLINIC REVENUE 621400 133343 133343 NURSING HOME OFFICE RENTAL 621400 9186 9186 MISCELLANEOUS REVENUE 623000 4791 4791 3808 3808 18611979 467390 467390 206695 0 206695 206695 206695 6000 6358 3835 2165 2165 OTHER MISCELLANEOUS REVENUE 561499 66410 66410 CAFETERIA & OTHER INCOME 624210 45032 45032 111442 20734963 18818674 0 580997 X 28017 28017 8000 8000 407956 407956 8607764 8317682 290082 161783 156234 5549 1485386 1414236 71150 1000246 915625 84621 13139 13139 108200 108200 4149159 4148947 212 62402 62402 123109 121398 1711 421680 415819 5861 333383 301545 31838 18159 12691 5468 314381 304918 9463 229064 207188 21876 1494195 1351499 142696 120744 120744 SUPPLIES 839323 839323 TAXES AND LICENSES 313398 313398 BAD DEBT EXPENSE 241380 226897 14483 REPAIRS AND MAINTENANCE 239917 239917 198307 186409 11898 20919092 19509743 1409349 0 1072686 1037060 4501135 2695282 37000 24000 2045720 1919378 308851 282163 211824 167218 48848383 24293344 24834263 24555039 9220519 10225860 2266434 1580032 2076175 2314747 46574607 44800779 2727464 1283946 592142 0 12462904 11596573 4324 9603 527862 542604 0 267146 16314696 13699872 X 30150842 30992644 109069 108263 30259911 31100907 46574607 44800779 -184129 1025125 0 X X 0 1 X 1 1 1 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 1 604 0 0 1 604 0 PART II-B, LINE 1: THE MHA WORKS TO DEVELOP, PROMOTE, AND IMPLEMENT HEALTH CARE POLICY AT THE STATE AND FEDERAL LEVELS OF GOVERNMENT TO BENEFIT HOSPITAL PATIENTS, EMPLOYEES, AND COMMUNITIES. THEIR GOVERNMENT RELATIONS OFFICERS WORK CLOSELY WITH MEMBERS TO BRING HOSPITALS' CONCERNS TO ST. PAUL, MINNESOTA AND WASHINGTON D.C. MHA PARTNERS WITH HEALTH CARE PROVIDERS, COMMUNITY GROUPS, AND OTHER STAKEHOLDERS TO ADVANCE THEIR COMMON INTERESTS. 0 1 X 6522 6522 40212699 17822234 22390465 8553630 6437622 2116008 75532 33488 42044 24555039 DUE FROM RELATED ORGANIZATION 158382 INTEREST RATE SWAP 1775296 THIRD PARTY PAYOR RECEIVABLE 113923 ROU ASSET 267146 2314747 LEASE LIABILITY 267146 267146 X PART IV, LINE 2B: THE NURSING CARE CENTER RESIDENT TRUST FUND IS USED BY RESIDENTS AND/OR THEIR FAMILIES TO DEPOSIT MONEY INTO A SEPARATE CHECKING ACCOUNT. THE RESIDENTS CAN WITHDRAW THESE FUNDS AT ANY TIME FOR CARE SERVICES, GIFT SHOP PURCHASES, CASH FOR SODA, CANDY OR GIFTS, ETC. PART X, LINE 2: THE ORGANIZATION IS A TAX-EXEMPT CORPORATION AS DESCRIBED IN SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE (THE CODE) AND IS EXEMPT FROM FEDERAL INCOME TAXES ON RELATED INCOME PURSUANT TO SECTION 501(A) OF THE CODE. THE ORGANIZATION IS ALSO EXEMPT FROM STATE AND LOCAL INCOME TAXES ON RELATED INCOME. THE ORGANIZATION FOLLOWS THE GUIDANCE IN THE ACCOUNTING STANDARDS REGARDING THE RECOGNITION AND MEASUREMENT OF UNCERTAIN TAX POSITIONS. THE APPLICATION OF THE STANDARD AS NO EFFECT ON THE CONSOLIDATED FINANCIAL STATEMENTS. THE ORGANIZATION'S INCOME TAX RETURNS ARE SUBJECT TO REVIEW AND EXAMINATION BY FEDERAL, STATE, AND LOCAL AUTHORITIES. 1 1 X 1 X 1 X 275.000000000000 1 1 1 0 1 1 5707 5707 0.00030 4772063 4454456 317607 0.01540 2657466 1613718 1043748 0.05050 7435236 6068174 1367062 0.06620 120142 18180 101962 0.00490 28017 0 28017 0.00140 148159 18180 129979 0.00630 7583395 6086354 1497041 0.07250 0 241380 0 3976579 4992480 -1015901 X 1 1 1 1 MADISON HOSPITAL 820 THIRD AVENUE MADISON MN 56256 WWW.MSHMN.ORG 327711 X X X X X RURAL HEALTH MADISON HOSPITAL 1 0 0 1 X X X X X X X X X 21 1 0 1 1 X SEE PART VI SUPPLEMENTAL INFORMATION X 1 21 1 SEE PART VI SUPPLEMENTAL INFORMATION 0 1 X 100.000000000000 275.000000000000 X X X X 1 1 X X X 1 X HTTPS://MHSMN.ORG/PATIENTS-VISITORS/CHARITY-CARE-POLICY-FINANCIAL/ X HTTPS://MHSMN.ORG/PATIENTS-VISITORS/CHARITY-CARE-POLICY-FINANCIAL/ X HTTPS://MHSMN.ORG/PATIENTS-VISITORS/CHARITY-CARE-POLICY-FINANCIAL/ X X X X X X 1 X 0 X X X 1 X 0 0 MADISON HOSPITAL PART V, SECTION B, LINE 5: THE HOSPITAL CONDUCTED A COMMUNITY SURVEY, INTERVIEWED PROVIDERS AT OUR FACILITY, MEMBERS IN THE COMMUNITY OF MADISON, AND CONSISTENTLY MET WITH A PUBLIC HEALTH NURSE. MADISON HOSPITAL PART V, SECTION B, LINE 6B: MADISON HEALTHCARE SERVICES PARTNERED WITH COUNTRYSIDE PUBLIC HEALTH, PRAIRIE FIVE RIDES, LAC QUI PARLE COUNTY FAMILY SERVICE CENTER, LAC QUI PARLE VALLEY SCHOOL DISTRIC AND THE CITY OF MADISON IN ORDER TO ADDRESS THE HEALTH NEEDS OF THE REGION. MADISON HOSPITAL PART V, SECTION B, LINE 11: BY UTILIZING BOTH THE PRIMARY AND SECONDARY DATA WE RESEARCHED AND ANALYZED, THE COMMUNITY HEALTH NEEDS COMMITTEE WAS ABLE TO IDENTIFY AND PRIORITIZE HEALTH NEEDS IN OUR COMMUNITY. USING RESOURCES WITH OUR COMMUNITY MEMBERS AND PROFESSIONALS, WE DECIDED TO FOCUS ON THREE KEY HEALTH NEEDS THAT OUR COMMUNITY WOULD GREATLY BENEFIT FROM. THE THREE HEALTH NEEDS IDENTIFIED AND PRIORITIZED BY OUR COMMITTEE INCLUDE MENTAL HEALTH. MADISON HEALTHCARE SERVICES CONTINUES TO DEVOTE EXTENSIVE TIME AND MONEY TO PROVIDE COMPLEX THERAPY FOR MENTAL AND BEHAVIORAL HEALTHPATIENTS. IN 2018, WE CONTRACTED WITH OUR FIRST PSYCHIATRIC NP TO PROVIDE MEDICINE MANAGEMENT TO PATIENTS NEEDING THESE SERVICES. SHORTLY AFTER THE ADDITION OF OUR PSYCHIATRIC NP, WE ADDED A LICENSED INDEPENDENT CLINIC SOCIAL WORKER TO BEGIN COUNSELING SERVICES IN OUR CLINIC AND CARE CENTER. KNOWING THE NEED FOR MENTAL HEALTH SERVICES IN OUR COMMUNITY IS ONGOING, MHS OFFERS A LICENSED COUNSELOR AND PSYCHIATRIC NP THAT SEE PATIENTS IN THE CLINIC THREE DAYS EACH WEEK TO PROVIDE CONSISTENT AND COMPASSIONATE CARE. BOTH PROVIDERS ARE DEVOTED TO THE HEALTH OF THOSE THEY TREAT, AND THEIR SERVICES CONTINUE TO BE VERY SUCCESSFUL. MHS ALSO HAS PARTNERSHIPS WITH LOCAL SCHOOL DISTRICTS TO ENSURE THAT MENTAL HEALTH SERVICES ARE REACHING CHILDREN AND YOUNG ADULTS IN OUR COMMUNITIES. THERE IS ALSO AN AREA MENTAL HEALTH PROVIDER GROUP TO PROVIDE SUPPORT AND RESOURCES FOR THE MENTAL HEALTH PROVIDERS. IN ADDITION TO THE MENTAL HEALTH PROVIDER GROUP, WE HAVE A MENTAL HEALTH SUPPORT GROUP FOR PATIENTS THAT IS PROVING TO BE VERY BENEFICIAL. MHS WILL CONTINUE TO GROW THE SERVICES THEY PROVIDE FOR ALL MENTAL HEALTH PATIENTS AND IS DEDICATED TO DOING SO.2. OBSTETRICS & GYNECOLOGY: AFTER 6 MONTHS OF A CONTRACT WITH AN OB/GYN AND TRACKING SERVICES AND VISITS IT WAS DETERMINED THAT LOW OR NO VOLUME MONTHLY DID NOT JUSTIFY CONTINUING THE CONTRACT. SERVICES ARE AVAILABLE FOR OUR PATIENTS WITHIN A REASONABLE DISTRANCE. DUE TO LOW VOLUMES, MHS DISCONTINUED DELIVERIES IN 2018 HOWEVER PRENATAL SERVICES ARE STILL PROVIDED BY OUR PROVIDERS IN OUR CLINIC. OUR PROVIDERS HAVE CONTACT WITH A NUMBER OF OB/GYN PROVIDERS TO CONSULT AND REFER OUR PATIENTS.3. HEALTH & WELLNESS EDUCATIONMHS IS DEDICATED TO PROVIDING PATIENT EDUCATION TO ENSURE ALL PATIENTS NEEDS ARE MET AND QUESTIONS ARE ANSWERED REGARDING THEIR HEALTH. WE PROVIDE MONTHLY RADIO SPOTS BY VARIOUS PROVIDERS ON SPECIFIC HEALTH TOPICS TO HELP EDUCATE ON SPECIFIC HEALTH QUESTIONS. WEEKLY NEWSPAPER ARTICLES ARE WRITTEN REGARDING SPECIFIC HEALTH TOPICS AND SHARED WITH THE LOCAL NEWSPAPER FOR PUBLICATION. ALONG WITH THE BROAD EDUCATION THAT IS PROVIDED, EACH PATIENT THAT IS SEEN IN OUR CLINIC OR HOSPITAL IS GIVEN AN EDUCATION SHEET AT THE CONCLUSION OF THEIR APPOINTMENT TO HELP THE PATIENT UNDERSTAND EXACTLY WHAT THE CONDITION ENTAILS THAT THEY WERE BEING TREATED FOR. VARIOUS COMMUNITY SUPPORT GROUPS ARE AVAILABLE AND PROVIDE SUPPORT AND EDUCATION REGARDING MANY MEDICAL CONDITIONS, OBSTETRICS & GYNECOLOGY, AND HEALTH & WELLNESS EDUCATION. MADISON HOSPITAL PART V, SECTION B, LINE 13H: IF THE APPLICATION IS NOT RETURNED OR RETURNED INCOMPLETE, OTHER PATIENT MARKERS CAN BE USED TO APPROVE THE PATIENT FOR CHARITY CARE, SUCH AS WIC, FOOD STAMPS, FREE LUNCHES, MEDICAL ASSISTANCE, AND LOW-INCOME HOUSING. PATIENTS WHO MEET PRESUMPTIVE ELIGIBILITY CRITERIA MAY BE GRANTED FINANCIAL ASSISTANCE WITHOUT COMPLETING AN APPLICATION. MHS ALSO HAS A FOOD BANK OF NON PERISHABLE ITEMS AVAILABLE TO SEND HOME WITH PATIENTS IN NEED AND VOUCHERS FOR THEM TO GET A LIMITED AMOUNT OF PERISHABLES UNTIL THEY ARE ABLE TO GET OTHER ASSISTANCE. WE REALIZE THE IMMEDIATE NEED OF THESE RESOURCES. MADISON HOSPITAL PART V, SECTION B, LINE 16J: WHEN IT HAS BEEN DISCOVERED THAT PATIENTS ARE HAVING DIFFICULTIES PAYING THEIR BILL AND PRIVATE PAY PATIENTS NOT MAKING PAYMENTS, THE PATIENT IS CALLED TO MAKE PAYMENT ARRANGEMENTS AND UPON DISCUSSION WITH THEM, THE HOSPITAL WILL MAIL THEM THE CHARITY CARE APPLICATION. IN ADDITION, ON THE ORGANIZATION'S WEBSITE UNDER THE FINANCIAL INFORMATION PAGE IT IS INDICATED THAT AN APPLICATION FOR CHARITY CARE IS AVAILABLE AND THAT ASSISTANCE WITH THE APPLICATION FOR FINANCIAL ASSISTANCE IS AVAILABLE UPON REQUEST. 1 1 - LAC QUI PARLE CLINIC 900 SECOND AVENUE MADISON MN 56256 RURAL HEALTH CLINIC PART I, LINE 3C: FOR A PERSON TO QUALIFY FOR CHARITY CARE UNDER MADISON HOSPITAL'S CHARITY CARE AND FINANCIAL ASSISTANCE POLICY, AN INDIVIDUAL MUST HAVE FAMILY NET ASSETS LESS THAN $10,000, HAVE INCOME BELOW 275% OF FEDERAL POVERTY GUIDELINES, AND EITHER SUBMIT A COMPLETE APPLICATION OR BE PROVEN TO QUALIFY THROUGH PRESUMPTIVE DETERMINATIONS. AN INDIVIDUAL IS PRESUMPTIVELY ELIGIBLE FOR ASSISTANCE IF THEY EXPIRE WITHOUT AN ESTATE, WERE ON MEDICAL ASSISTANCE OR SIMILAR COVERAGE WITHIN THE PAST 12 MONTHS AND HAVE NO CHANGE IN EMPLOYMENT STATUS, OR FILED AND WERE APPROVED FOR BANKRUPTCY. PART I, LINE 7: THE COST-TO-CHARGE RATIO WAS DERIVED USING WORKSHEET 2 FROM THE IRS TO CALCULATE THE AMOUNTS INCLUDED ON LINES 7A AND 7B. COMMUNITY HEALTH IMPROVEMENT SERVICES AND COMMUNITY BENEFIT OPERATIONS INCLUDED ON LINE 7E AND HEALTH PROFESSIONAL EDUCATION ARE REPORTED AT COST. 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 $ 241,380. PART III, LINE 2: BAD DEBT EXPENSE IS CALCULATED UTILIZING DIRECT BAD DEBT COSTS FROM NONPAYMENT AFTER CONTRACTUAL DISCOUNTS AND PAYMENTS HAVE BEEN RECEIVED. THE STANDARD FORMULA FOR ACCOUNTS RECEIVABLE HAS BEEN UTILIZED FOR ANY OUTSTANDING ACCOUNTS AFTER CONTRACTUAL DISCOUNTS WERE TAKEN. PART III, LINE 3: DUE TO THE PUBLIC SHOWING, ADVERTISEMENT, PREQUALIFICATION, AND FOLLOW-UP NOTIFICATIONS OF OUR FINANCIAL ASSISTANCE POLICY VIA OUR BILLING PROCEDURES, WE DO NOT FEEL THAT THE IMPACT IS ABOVE ZERO. PART III, LINE 4: THE ORGANIZATION'S BAD DEBT EXPENSE IS DISCUSSED IN THE "PATIENT AND RESIDENT ACCOUNTS RECEIVABLE" SECTION OF NOTE 1 TO THE FINANCIAL STATEMENTS, ON PAGE 12 OF THE ATTACHED AUDITED FINANCIAL STATEMENTS. PART III, LINE 8: THE MEDICARE SHORTFALL OF $1,015,901 IS MADE UP MOSTLY OF PATIENT DEDUCTIBLES AND COINSURANCE. IF WE BACK THESE AMOUNTS OUT OF THE SHORTFALL, WE ARE LEFT WITH A TRUE SHORTFALL OF $0. THIS AMOUNT IS A RESULT OF THE FEDERAL GOVERNMENT'S SEQUESTRATION IMPLEMENTED BACK IN THE SUMMER OF 2016, OF WHICH WOULDN'T BE TREATED AS COMMUNITY BENEFIT.THE MEDICARE ALLOWABLE COSTS INCLUDED IN PART III, LINE 6 WERE DERIVED FROM THE 2023 FILED MEDICARE COST REPORT. PART III, LINE 9B: IF PATIENTS HAVE COMPLETED ALL PAPERWORK AND QUALIFY FOR CHARITY CARE, THE PATIENT IS NOT BILLED FOR ANY BALANCE AND ACCOUNT IS WRITTEN OFF. IF THE PATIENT HAS MEDICAL ASSISTANCE, THAT PROGRAM IS BILLED FOR CHARGES AND THE PAYMENT IS CONSIDERED PAYMENT IN FULL, UNLESS MEDICAL ASSISTANCE NOTIFIES US THAT THE PATIENT HAS RESPONSIBILITY FOR SPEND DOWN OR CO-PAY PAYMENTS.MADISON HEALTHCARE SERVICES WILL NOT ENGAGE IN EXTRAORDINARY COLLECTION ACTIONS BEFORE REASONABLE EFFORTS HAVE BEEN MADE TO DETERMINE IF THE PERSON QUALIFIES FOR FINANCIAL ASSISTANCE. REASONABLE EFFORT WILL BE TAKEN TO REQUEST AND ASSIST IN COMPLETING APPLICATION, INCLUDING MEETING WITH INDIVIDUAL AND ASSISTING WITH THE APPLICATION PROCESS.IF THE INDIVIDUAL FAILS TO SUBMIT THE CHARITY CARE APPLICATION WITHIN 120 DAYS OF THE FIRST BILLING STATEMENT THE FACILITY HAS THE OPTION TO PROCEED WITH COLLECTION PROCESS. AT LEAST 30 DAYS PRIOR TO INITIATING THE COLLECTION PROCESS A WRITTEN NOTICE WILL BE PROVIDED INDICATING IF INDIVIDUAL DOES NOT SUBMIT THE APPLICATION OR PAY THE AMOUNT DUE BY INDICATED DEADLINE THE ACCOUNT WILL BE SENT TO A COLLECTION AGENCY. THE FACILITY HAS THE DISCRETION TO CONSIDER FOR CHARITY CARE WITHOUT COMPLETION OF CHARITY CARE APPLICATION.IF THE INDIVIDUAL COMPLETES THE APPLICATION WITHIN THE 240 DAY REQUIREMENT FOLLOWING TREATMENT, THE FACILITY WILL SUSPEND ANY COLLECTION EFFORTS. IF THE INDIVIDUAL SUBMITS AN INCOMPLETE APPLICATION WRITTEN NOTICE WILL BE PROVIDED WITH ADDITIONAL INFORMATION NEEDED AND REASONABLE TIME WILL BE GIVEN TO SUBMIT MISSING INFORMATION. AN AFFIVIDAVIT OF SERVICE IS SERVED UPON PATIENT BEING SENT TO COLLECTIONS. PART V, LINE 7A, COMMUNITY HEALTH NEEDS ASSESSMENT WEBSITE HTTPS://MHSMN.ORG/PATIENTS-VISITORS/COMMUNITY-NEEDS-ASSESSMENT/ PART V, LINE 10A, HOSPITAL'S ADOPTED IMPLEMENTATION STRATEGY WEBSITE HTTPS://MHSMN.ORG/PATIENTS-VISITORS/COMMUNITY-NEEDS-ASSESSMENT/ PART VI, LINE 2: TO ASSESS THE HEALTH CARE NEEDS OF THE COMMUNITY MHS FIRST PERFORMED ADEMOGRAPHIC ANALYSIS OF LAC QUI PARLE COUNTY USING DATA FROM THE U.S.CENSUS BUREAU AND COUNTY HEALTH RANKINGS. TO FURTHER THE ASSESSMENTADDITIONAL RESOURCES WERE UTILIZED, INCLUDING THE MN DEPARTMENT OF HEALTHAND COUNTRYSIDE PUBLIC HEALTH. MHS FINISHED THE EVALUATION WITH PRIMARYDATA COMPILED THROUGH A COMMUNITY SURVEY. MHS COLLABORATED WITHCOUNTRYSIDE PUBLIC HEALTH, PRAIRIE FIVE RIDES, LAC QUI PARLE COUNTY FAMILYSERVICE CENTER, THE DIABETES FOUNDATION, AND THE CITY OF MADISON. USINGTHE INFORMATION COLLECTED, THE COMMUNITY HEALTH NEEDS COMMITTEE DETERMINEDTHE HEALTH NEEDS FOR THE COUNTY. THE NEXT STEP FOR MHS WAS TO FORMCOLLABORATIONS WITH THE RIVER VALLEY HEALTH NETOWRK, LAC QUI PARLE SCHOOLDISTRICT, AND THE COMMUNITY ORGANIZATION TO APPROACH AND EXECUTE ANIMPLEMENTATION STRATEGY. THE COMMUNITY HEALTH NEEDS COMMITTEE WILL DILIGENTLY MONITOR OUR CURRENT PROGRAMS TO ENSURE THEY ARE MEETING OUR IDENTIFIED COMMUNITY NEEDS. THE EXECUTION OF OUR IMPLEMENTATION PLAN HAS EXPERIENCED MANY SUCCESSES AND CONTINUES TO PROGRESS. OUR FOCUS WILL BE TO STRENGTHEN AND GROW OUR COLLABORATIONS WITH OTHER ORGANIZATIONS TO BETTER OUR EDUCATION, OUTREACH, AND RESOURCES FOR THE COMMUNITIES WE SERVE. MADISON HEALTHCARE SERVICES VALUES QUALITY ON ALL LEVELS AND WORKS DILIGENTLY TO IDENTIFY WAYS TO MAKE IMPROVEMENTS ON AN ONGOING BASIS. SERVICES ARE MONITORED THROUGH OUR QUALITY COUNCIL, INTERNAL AND EXTERNAL REVIEWS, AND PARTICIPATION IN STATE AND FEDERAL QUALITY REPORTING MEASURES. PART VI, LINE 3: THE ORGANIZATION INFORMS AND EDUCATES PATIENTS ABOUT THEIR ELIGIBILITY FOR ASSISTANCE UNDER THESE PROGRAMS IN THE PATIENT ADMISSION PACKET AND ON THE HOSPITAL'S WEBSITE. THE WEBSITE INDICATES THE HOSPITAL WILL FILE YOUR INSURANCE CLAIMS, CAN SET UP AUTOMATIC BANK WITHDRAWALS, THE HOSPITAL ACCEPTS CREDIT CARD PAYMENTS, YOU CAN REQUEST CHARITY CARE APPLICATIONS, THE HOSPITAL DOES NOT CHARGE FINANCE CHARGES, THE HOSPITAL ACCEPT PAYMENT ARRANGEMENTS, ITEMIZED BILL AVAILABLE UPON REQUEST AND GLAD TO ANSWER YOUR QUESTIONS.THE HOSPITAL SENDS 3 STATEMENTS TO PATIENTS WITH PRIVATE PAY BALANCES, ALSO SENDS 3 LETTERS INDICATING PAST DUE BALANCE AND TO PLEASE PAY OR YOUR ACCOUNT WILL BE SENT TO COLLECTION. MANY TIMES A PHONE CALL IS MADE TO PATIENT ASKING THEM TO SET UP PAYMENT ARRANGEMENT OR ASKING IF THEY WANT CHARITY CARE APPLICATION OR HOW THE HOSPITAL CAN ASSIST THEM TO GET THEIR BALANCE PAID PRIOR TO SENDING TO COLLECTION AGENCY. THE PAST DUE LETTERS SENT TO PATIENTS REQUEST THEM TO CALL THE HOSPITAL TO DISCUSS THEIR PAST DUE BILL AT WHICH TIME THE ASSISTANCE PROGRAMS CAN BE EXPLAINED. THE HOSPITAL DOES NOT CHARGE FINANCE CHARGES TO PATIENTS' UNPAID BALANCE. THE ORGANIZATION BELIEVES THIS IS A COMMUNITY SERVICE AND ASSISTS THOSE PATIENTS THAT CAN ONLY MAKE SMALL PAYMENTS - OTHERWISE FINANCE CHARGES COULD BE MORE THAN THEIR MONTHLY PAYMENT AND DISCOURAGE THEM FROM MAKING ANY PAYMENTS.PRIVATE PAY INPATIENTS ARE VISITED BY OFFICE STAFF AND GIVEN FORMS TO APPLY FOR MEDICAL ASSISTANCE. PART VI, LINE 4: THE AREA BEING SERVED BY THE MADISON HOSPITAL AND LAC QUI PARLE CLINIC IS PRIMARILY A RURAL AND AGING COMMUNITY. THE PATIENT BASE IS MADE UP OF BOTH WORKING CLASS AND FARMERS. THE COUNTIES THAT WE SERVE ARE LAC QUI PARLE, BIG STONE AND SOME BORDER COUNTIES OF SOUTH DAKOTA. THE CLOSEST FACILITIES ARE 25 MILES AWAY IN CANBY, DAWSON, APPLETON OR ORTONVILLE. THE AVERAGE INDIVIDUAL INCOME IS APPROXIMATELY $35,859, GROSS. ON AVERAGE, THE POVERTY LEVEL IN THE COUNTY IS ABOUT 8.32% WITH 43.72% OF THE POPULATION HAVING LESS THAN 9TH GRADE EDUCATION TO HIGH SCHOOL GRADUATE DEGREE. 96.03% OF THE POPULATION IS WHITE. 24.09% OF THE FAMILIES IN THE HOSPITALS SERVICE AREA ARE ON MEDICAID/UCARE PMAP/BLUE PLUS PMAP/PRIMEWEST PAMP. TO FURTHER EVALUATE THE DEOMOGRAPHICS OF THE COUNT WE COMPILED DATE FRINGE COUNTY HEALTH RANKINGS. GAPS PUT A LIMIT ON THE HOSPITAL'S ABILITY TO ASSESS ALL OF THE COMMUNITY NEEDS. IN OUR PARTICULAR SITUATION, INFORMATION GAPS THAT MAY HAVE OCCURRED IN OUR ASSESSMENT IS THAT OUR NEEDS MAY HAVE DEVELOPED ON THE BASIS OF OPINIONS FROM OUR COMMUNITY HEALTH NEEDS COMMITTEE AND THOSE THAT COMPLETED THE SURVEY. THESE OPINIONS MAY NOT REFLECT THE TRUE NEEDS OF THE POPULATION. AFTER REVIEWING THESE STATISTICS, WE ACKNOWLEDGED THAT LAC QUI PARLE COUNTY FAILS TO MEET THE NATIONAL BENCHMARK IN SOME HEALTH BEHAVIORS BUT HAS ALSO IMPROVED OR HAS NARROWED THE GAP BETWEEN THE NATIONAL BENCHMARKS. ADULT OBESITY IS AT 34.5% IN THE COUNTY, WHICH IS ONLY 5.1% LESS THAN THE NATIONAL BENCHMARK. PHYSICAL INACTIVITY WITHIN THE COUNTY IS AT 23%, WHICH IS THE SAME AS THE NATIONAL BENCHMARK. ACCESS TO EXERCISE OPPORTUNITIES IS AT 27% COMPARED TO THE NATIONAL BENCHMARK OF 86%. FREQUENTMENTAL DISTRESS IS 13% FOR BOTH LAC QUI PARLE COUNTY AND THE NATIONAL BENCHMARK. THE STATISTICS SHOW THAT 6% OF LAC QUI PARLE COUNTY ADULTS ARE UNINSURED. PRIMARY CARE PHYSICIANS ARE 1,104 PEOPLE PER PHYSICIAN. OTHER SOCIAL AND ECONOMIC FACTORS OF LAC QUI PARLE COUNTY INCLUDE A HIGH SCHOOL GRADUATION RATE OF 94.1% AND AN UNEMPLOYMENT RATE OF 4.7%. OVERALL, LAC QUI PARLE COUNTY RANKS 21ST ON HEALTH FACTORS OUT OF 87 COUNTIESIN MINNESOTA. PART VI, LINE 5: THE HOSPITAL'S BOARD IS COMPRISED OF PERSONS WHO RESIDE IN THE COMMUNITYAND ARE NEITHER EMPLOYEES NOR CONTRACTORS OF THE ORGANIZATION. THE ORGANIZATION EXTENDS MEDICAL STAFF PRIVILEGES TO ALL QUALIFIED PHYSICIANS IN ITS COMMUNITY SUCH AS DR. CLINT BONN, CHIROPRACTOR. DR. BONN UTILIZED MADISON HOSPITAL LABORATORY FOR DOT DRUG TESTING AND MADISON HOSPITAL RADIOLOGY FOR ALL X-RAY AND CT STUDIES. THREE TIMES A YEAR, THE RADIOLOGY DEPARTMENT HOLDS VASCULAR SCREENINGS IN WHICH COMMUNITY MEMBERS MAY HAVE VASCULAR SCREENINGS TO DETECT STROKES, PERIPHERAL VASCULAR DISEASE, AND ABDOMINAL AORTIC ANEURYSMS. THIS IS A CASH BASED SCREENING AND IS AVAILABLE AT A SUBSTANTIALLY REDUCED RATE AND A DOCTOR'S ORDER IS NOT REQUIRED. MADISON HOSPITAL LAB OFFERS DIRECT ACCESS LAB TESTING TO ITS COMMUNITY MEMBERS. THIS IS A CASH BASED PROGRAM WHERE LAB TESTS ARE OFFERED ON A CASH BASIS AT A SUBSTANTIALLY REDUCED RATE. LAST YEAR, OUR USERS SAVED OVER $12,000. MADISON HOSPITAL AND LAC QUI PARLE CLINIC DONATE ALL UNUSED MEDICAL EQUIPMENT TO A MISSION FOR MEDICAL USE. ALL EXPIRED LABORATORY SUPPLIES ARE SENT TO THE MEDICAL LAB TECHNICIAN PROGRAMS FOR USE IN THEIR STUDENT LABS. MADISON HOSPITAL IS CONSTANTLY STRIVING TO ADD NEW SERVICES, INCLUDING OUTREACH SERVICES TO BETTER SERVE THE NEEDS OF OUR COMMUNITY. A LEADERSHIP TEAM HAS BEEN FORMED TO MEET THE COMMUNITY NEEDS, CONTINUE TO LOOK AT ADDING NEW SERVICES, CONTINUE TO LOOK AT UPDATING OUR CURRENT FACILITY, AND ASKING FOR COMMUNITY INVOLVEMENT IN FINAL DECISION MAKING. WITH OUR AGING POPULATION, WE STRIVE TO BRING THE SERVICES TO THE PATIENTS, RATHER THAN THE PATIENTS HAVING TO DRIVE HOURS FROM HOME TO GET THE SERVICES. MADISON HOSPITAL PROVIDED HEALTH CARE SCREENINGS AT REDUCED RATES TO THE COMMUNITY. PART VI, LINE 7, REPORTS FILED WITH STATES MN 1 LITTLE EAGLES DAYCARE 8100 SCHOOL ROAD EDEN PRAIRIE MN 55344 550695712 501(C)(3) 20000 0 N/A N/A SUPPORT TO DAYCARE 1 0 SCHOLARSHIPS 2 8000 X X 0 0 0 0 0 0 0 0 0 BRANT HACKER MD MD 264775 0 2450 0 121196 0 35510 0 0 0 423931 0 0 0 MARIA NOLTE MD MD 223010 0 2450 0 44520 0 7043 0 37426 0 314449 0 0 0 ERIK BJERKE CEO 199178 0 2450 0 0 0 14490 0 38553 0 254671 0 0 0 PAUL HODGE NP NURSE PRACTITIONER 120421 0 36034 0 13114 0 0 0 12851 0 182420 0 0 0 MICHAEL DEYO PA PHYSICIAN ASSISTANT 142363 0 2450 0 0 0 8492 0 12851 0 166156 0 0 0 A CITY OF MADISON MINNESOTA 416005335 2020-09-23 6705000 REFUNDING 2020 BONDS, FINANCE OF FACILITY EXPANSION 0 0 0 B CITY OF BELLINGHAM MINNESOTA 416004967 2020-09-23 6705000 REFUNDING 2020 BONDS, FINANCE OF FACILITY EXPANSION 0 0 0 A 213075 6705000 6705000 2021 1 0 1 1 B 213075 6705000 6705000 2021 1 0 1 1 A 0 0 0 0 0.00000 0.00000 0.00000 0 0 1 B 0 0 0 0 0.00000 0.00000 0.00000 0 0 1 A 0 1 0 0 1 1 OLD NATIONAL BANK 8.500000000000 0 0 0 0 1 B 0 1 0 0 1 1 OLD NATIONAL BANK 8.500000000000 0 0 0 0 1 A 1 B 1 FORM 990, PART VI, SECTION A, LINE 1A THERE SHALL BE AN EXECUTIVE COMMITTEE OF THE ORGANIZATION, CONSISTING OF (3) PERSONS ELECTED BY THE BOARD OF DIRECTORS TO SERVE FOR ONE (1) YEAR TERMS. THE EXECUTIVE COMMITTEE SHALL CONSIST OF THE CHAIRMAN, THE PRESIDENT/TREASURER, AND THE SECRETARY OF THE ORGANIZATION. IF THE CHAIRMAN OF THE ORGANIZATION IS A MEMBER OF THE EXECUTIVE COMMITTEE, HE OR SHE SHALL BE THE CHAIRMAN OF THE EXECUTIVE COMMITTEE; OTHERWISE THE PRESIDENT SHALL BE THE CHAIRMAN OF THE EXECUTIVE COMMITTEE. THE EXECUTIVE COMMITTEE SHALL MEET ON CALL OF THE CHAIRMAN OR PRESIDENT, SHALL ACT ONLY IN THE INTERVALS BETWEEN MEETINGS OF THE BOARD OF DIRECTORS, SHALL AT ALL TIMES BE SUBJECT TO THE DIRECTION AND CONTROL OF THE BOARD OF DIRECTORS, AND, SUBJECT ALWAYS TO THE FOREGOING, SHALL, UNLESS EXPRESSLY SPECIFIED TO THE CONTRARY BY RESOLUTION ADOPTED BY THE BOARD OF DIRECTORS, HAVE AND EXERCISE THE AUTHORITY OF THE BOARD OF DIRECTORS IN THE MANAGEMENT OF THE BUSINESS AND AFFAIRS OF THE ORGANIZATION. FORM 990, PART VI, SECTION A, LINE 6 THE ORGANIZATION'S MEMBERS ARE THE LUTHERAN CONGREGATIONS WITHIN THE COMMUNITY. THE MAJORITY OF THE MEMBERS MUST AT ALL TIMES BE CONGREGATIONS WITHIN THE EVANGELICAL LUTHERAN CHURCH IN AMERICA (ELCA). EACH MEMBER CONGREGATION SHALL BE REPRESENTED AT MEETINGS OF THE MEMBERS BY THREE DELEGATES, SELECTED FROM THE COMMUNICANT MEMBERS OF THE CONGREGATION. ALL DELEGATES SHALL HAVE EQUAL VOTING RIGHTS AND VOTING BY PROXY SHALL BE PROHIBITED. FORM 990, PART VI, SECTION A, LINE 7A THE ORGANIZATION'S MEMBERS ARE THE LUTHERAN CONGREGATIONS WITHIN THE COMMUNITY. DELEGATES OF LUTHERAN CONGREGATIONS ELECT THE BOARD OF DIRECTORS OF MADISON HEALTHCARE SERVICES. FORM 990, PART VI, SECTION A, LINE 7B AMENDMENTS TO THE BYLAWS MUST BE APPROVED BY THE MEMBER CONGREGATION DELEGATES. FORM 990, PART VI, SECTION B, LINE 11B THE FORM 990 IS PRESENTED TO THE BOARD OF DIRECTORS FOR APPROVAL PRIOR TO SUBMISSION TO THE INTERNAL REVENUE SERVICE. FORM 990, PART VI, SECTION B, LINE 12C THE ORGANIZATION MONITORS THE CONFLICT OF INTEREST POLICY AS CONFLICTS ARISE. IF ANY DIRECTOR OR EMPLOYEE OF THE ORGANIZATION HAS ANY DIRECT OR INDIRECT INTEREST IN, OR RELATIONSHIP WITH, ANY INDIVIDUAL OR ORGANIZATION THAT PROPOSES TO ENTER INTO ANY TRANSACTION WITH THE CORPORATION, INCLUDING BUT NOT LIMITED TO TRANSACTIONS INVOLVING: A. THE SALE, PURCHASE, LEASE OR RENTAL OF ANY PROPERTY OR OTHER ASSET; B. EMPLOYMENT OR RENDITION OF SERVICES, PERSONAL OR OTHERWISE; C. THE AWARD OF ANY CONTRACT SUCH PERSON SHALL GIVE NOTICE OF SUCH INTEREST OR RELATIONSHIP AND SHALL THEREAFTER REFRAIN FROM DISCUSSING OR VOTING ON THE PARTICULAR TRANSACTION IN WHICH HE HAS AN INTEREST, OR OTHERWISE ATTEMPTING TO EXERT ANY INFLUENCE ON THE CORPORATION, OR ITS COMPONENTS TO AFFECT A DECISION TO PARTICIPATE OR NOT PARTICIPATE IN SUCH TRANSACTION. CONFLICTS OF INTEREST OR REVIEWED AT THE ADMINISTRATION AND BOARD LEVEL. ALL PROCEEDINGS RESULTING FROM A CONFLICT OF INTEREST ARE RECORDED IN THE BOARD MEETING MINUTES. FORM 990, PART VI, SECTION B, LINE 15 THE ORGANIZATION USES COMPARABILITY DATA FROM SURVEYS OF OTHER ORGANIZATIONS OF SIMILAR SIZE IN THE SURROUNDING AREAS TO DETERMINE COMPENSATION OF TOP MANAGEMENT AND OFFICERS OF THE ORGANIZATION. THE MEDISOTA SALARY SURVEY IS UTILIZED IN THIS DETERMINATION. THE BOARD OF DIRECTORS REVIEWS AND APPROVES PRESIDENT/CEO COMPENSATION ANNUALLY. THE PRESIDENT/CEO APPROVES THE COMPENSATION OF THE CFO. THIS PROCESS IS DOCUMENTED IN THE MEETING MINUTES AND THE PRESIDENT/CEO'S PERSONNEL FILE. THIS PROCESS WAS LAST CONDUCTED IN 2023. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION DOES NOT MAKE ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY OR FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC. FORM 990, PART IX, LINE 11G NURSING/OTHER PROFESSIONAL: PROGRAM SERVICE EXPENSES 4,129,135. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 4,129,135. CONSULTANTS: PROGRAM SERVICE EXPENSES 19,812. MANAGEMENT AND GENERAL EXPENSES 212. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 20,024. FORM 990, PART XII, LINE 2C: THE BOARD OF DIRECTORS IS TASKED WITH SELECTING AN INDEPENDENT PUBLIC ACCOUNTING FIRM TO AUDIT THE ORGANIZATION'S FINANCIAL STATEMENTS AND RETAIN SUCH PERSON OR FIRM FOR ADDITIONAL SERVICES IT MAY DEEM APPROPRIATE. THIS PROCESS HAS NOT CHANGED FROM THE PREVIOUS FISCAL YEAR. HILLTOP RESIDENCE INC 915 FIRST AVENUE MADISON MN 56256 411376605 MHS MANAGES HUD HOUSING - HILLTOP APARTMENTS MN 501(C)(3) LINE 10 MADISON HEALTHCARE SERVICES 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 0 0 0