MADISON HEALTHCARE SERVICES: Form 990, tax year 2020
View the entire original 990 at ProPublica ↗
- Organization
- MADISON HEALTHCARE SERVICES (EIN 41-0706115)
- Tax period
- 2020-10-01 to 2021-09-30
- Filed
- 2022-08-10
- IRS object ID
- 202242229349300509
- Schema version
- 2020v4.2
- 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
- Form 990
- Schedule A
- Schedule B
- Schedule C
- Schedule D
- Schedule G
- Schedule H
- Schedule I
- Schedule J
- Schedule K
- Schedule O
- Schedule R
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return | 2022-08-10T07:34:02-05:00 | ReturnTs |
| Tax Period End | 2021-09-30 | TaxPeriodEndDt |
Preparer Firm PreparerFirmGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Firm EIN | 410746749 | PreparerFirmEIN |
Preparer Firm Name PreparerFirmName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | CLIFTONLARSONALLEN LLP | BusinessNameLine1Txt |
Preparer US Address PreparerUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 220 SOUTH SIXTH STREET SUITE 300 | AddressLine1Txt |
| City | MINNEAPOLIS | CityNm |
| State Abbreviation | MN | StateAbbreviationCd |
| ZIP | 55402 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnTypeCd |
| Tax Period Begin | 2020-10-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 410706115 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | MADISON HEALTHCARE SERVICES | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | MADI | BusinessNameControlTxt |
| Phone | 3205987536 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 900 SECOND AVENUE | AddressLine1Txt |
| City | MADISON | CityNm |
| State Abbreviation | MN | StateAbbreviationCd |
| ZIP | 562561006 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | ERIK BJERKE | PersonNm |
| Person Title | PRESIDENT/CEO | PersonTitleTxt |
| Phone | 3205987536 | PhoneNum |
| Signature | 2022-08-09 | SignatureDt |
| Discuss With Paid Preparer | Yes (1) | DiscussWithPaidPreparerInd |
Signing Officer SigningOfficerGrp
Person Full Name PersonFullName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person First | ERIK | PersonFirstNm |
| Person Last | BJERKE | PersonLastNm |
| Field | Value | IRS element (for citing) |
|---|---|---|
| SSN | 999009999 | SSN |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | RYAN STRUSZ | PreparerPersonNm |
| PTIN | P01604381 | PTIN |
| Phone | 6123764500 | PhoneNum |
| Preparation | 2022-08-01 | PreparationDt |
Additional Filer Information AdditionalFilerInformation
Trusted Customer TrustedCustomerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Trusted Customer | 2 | TrustedCustomerCd |
| Authentication Assurance Level | AAL1 | AuthenticationAssuranceLevelCd |
| Identity Assurance Level | IAL1 | IdentityAssuranceLevelCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2020 | TaxYr |
| Build TS | 2022-09-23 18:48:47Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Principal Officer | ERIK BJERKE | PrincipalOfficerNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 900 SECOND AVENUE | AddressLine1Txt |
| City | MADISON | CityNm |
| State Abbreviation | MN | StateAbbreviationCd |
| ZIP | 562561006 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $23,225,810 | GrossReceiptsAmt |
| Group Return For Affiliates | 0 | GroupReturnForAffiliatesInd |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | MHSMN.ORG | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 1945 | FormationYr |
| Legal Domicile State | MN | LegalDomicileStateCd |
| Activity Or Mission | TO PROVIDE HEALTH CARE, RESIDENTIAL, AND COMMUNITY SERVICE IN A COMPETENT AND CARING MANNER. | ActivityOrMissionDesc |
| Voting Members Governing Body | 7 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 7 | VotingMembersIndependentCnt |
| Total Employee | 226 | TotalEmployeeCnt |
| Total Volunteers | 55 | TotalVolunteersCnt |
| Total Gross UBI | $0 | TotalGrossUBIAmt |
| Net Unrelated Bus Txbl Incm | $0 | NetUnrelatedBusTxblIncmAmt |
| PY Contributions Grants | $119,455 | PYContributionsGrantsAmt |
| CY Contributions Grants | $6,003,811 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $17,652,349 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $16,864,691 | CYProgramServiceRevenueAmt |
| PY Investment Income | $288,457 | PYInvestmentIncomeAmt |
| CY Investment Income | $208,922 | CYInvestmentIncomeAmt |
| PY Other Revenue | $104,580 | PYOtherRevenueAmt |
| CY Other Revenue | $146,374 | CYOtherRevenueAmt |
| PY Total Revenue | $18,164,841 | PYTotalRevenueAmt |
| CY Total Revenue | $23,223,798 | CYTotalRevenueAmt |
| PY Grants And Similar Paid | $7,120 | PYGrantsAndSimilarPaidAmt |
| CY Grants And Similar Paid | $13,475 | CYGrantsAndSimilarPaidAmt |
| PY Benefits Paid To Members | $0 | PYBenefitsPaidToMembersAmt |
| CY Benefits Paid To Members | $0 | CYBenefitsPaidToMembersAmt |
| PY Salaries Comp Emp Bnft Paid | $9,073,593 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $9,570,710 | CYSalariesCompEmpBnftPaidAmt |
| PY Total Prof Fndrsng Expns | $0 | PYTotalProfFndrsngExpnsAmt |
| CY Total Prof Fndrsng Expns | $45,600 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $45,600 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $8,131,649 | PYOtherExpensesAmt |
| CY Other Expenses | $8,521,923 | CYOtherExpensesAmt |
| PY Total Expenses | $17,212,362 | PYTotalExpensesAmt |
| CY Total Expenses | $18,151,708 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | $952,479 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | $5,072,090 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $36,432,435 | TotalAssetsBOYAmt |
| Total Assets EOY | $39,706,321 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $12,933,562 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $8,955,022 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $23,498,873 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $30,751,299 | NetAssetsOrFundBalancesEOYAmt |
| Info In Schedule O Part III | Yes (X) | InfoInScheduleOPartIIIInd |
| Mission | MADISON HEALTHCARE SERVICES, WHICH INCLUDES THE MADISON LUTHERAN HOME, MADISON HOSPITAL, LAC QUI PARLE CLINIC, AND SUBSIDIARIES, EXISTS AS A NON-PROFIT CHRISTIAN ORGANIZATION CALLED BY GOD TO AFFIRM THE WORTH OF ALL PEOPLE, TO PROVIDE HEALTH CARE, RESIDENTIAL, AND COMMUNITY SERVICES IN A COMPETENT AND CARING MANNER. | MissionDesc |
| Significant New Program Srvc | 0 | SignificantNewProgramSrvcInd |
| Significant Change | 0 | SignificantChangeInd |
| Expense | $8,493,516 | ExpenseAmt |
| Grant | $5,784 | GrantAmt |
| Revenue | $9,545,901 | RevenueAmt |
| Desc | 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, OBSTETRICS, PEDIATRICS, SURGERY, EMERGENCY CARE, CARDIAC REHAB, OUTPATIENT, OUTREACH AND INPATIENT CARE. THE HOSPITAL HAD 11,612 OUTPATIENT VISITS AND 778 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 $22,238 FOR THE YEAR ENDED SEPTEMBER 30, 2021. | Desc |
Prog Srvc Accom Acty2 ProgSrvcAccomActy2Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expense | $6,083,135 | ExpenseAmt |
| Grant | $7,241 | GrantAmt |
| Revenue | $5,219,556 | RevenueAmt |
| Desc | MADISON LUTHERAN HOME IS A 56 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. REMODELING CONTINUES ON A NEW CHAPEL, BEAUTY SHOP, ENTRY AND BISTRO. THE NURSING HOME PROVIDES QUALITY CARE OF THE RESIDENTS BY ASSISTING THE RESIDENTS TO ACHIEVE THEIR HIGHEST LEVEL OF FUNCTION AND PROVIDING A MORE HOME-LIKE ATMOSPHERE. | Desc |
Prog Srvc Accom Acty3 ProgSrvcAccomActy3Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expense | $2,332,502 | ExpenseAmt |
| Grant | $450 | GrantAmt |
| Revenue | $2,099,234 | RevenueAmt |
| Desc | THE MEDICAL STAFF AT THE CLINIC CONSISTS OF TWO M.D.'S , TWO PA-C'S, AND TWO NURSE PRACTIONERS AVAILABLE 5-DAYS-A-WEEK AND HALF OF 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. | Desc |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Expenses | $16,909,153 | TotalProgramServiceExpensesAmt |
| Described In Section501c3 | Yes (1) | DescribedInSection501c3Ind |
| Schedule B Required | Yes (1) | ScheduleBRequiredInd |
| Political Campaign Acty | 0 | PoliticalCampaignActyInd |
| Lobbying Activities | Yes (1) | LobbyingActivitiesInd |
| Subject To Proxy Tax | 0 | SubjectToProxyTaxInd |
| Donor Advised Fund | 0 | DonorAdvisedFundInd |
| Conservation Easements | 0 | ConservationEasementsInd |
| Collections Of Art | 0 | CollectionsOfArtInd |
| Credit Counseling | Yes (1) | CreditCounselingInd |
| Donor Rstr Or Quasi Endowments | 0 | DonorRstrOrQuasiEndowmentsInd |
| Report Land Building Equipment | Yes (1) | ReportLandBuildingEquipmentInd |
| Report Investments Other Sec | Yes (1) | 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 | 0 | IndependentAuditFinclStmtInd |
| Consolidated Audit Fincl Stmt | Yes (1) | 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 | Yes (1) | 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 | Yes (1) | GrantsToIndividualsInd |
| Schedule J Required | Yes (1) | ScheduleJRequiredInd |
| Tax Exempt Bonds | Yes (1) | TaxExemptBondsInd |
| Invest Tax Exempt Bonds | 0 | InvestTaxExemptBondsInd |
| Escrow Account | 0 | EscrowAccountInd |
| On Behalf Of Issuer | 0 | OnBehalfOfIssuerInd |
| Engaged In Excess Benefit Trans | 0 | EngagedInExcessBenefitTransInd |
| PY Excess Benefit Trans | 0 | PYExcessBenefitTransInd |
| Loan Outstanding | 0 | LoanOutstandingInd |
| Grant To Related Person | 0 | GrantToRelatedPersonInd |
| Business Rln With Org Mem | 0 | BusinessRlnWithOrgMemInd |
| Business Rln With Fam Mem | 0 | BusinessRlnWithFamMemInd |
| Business Rln With35 Ctrl Ent | 0 | BusinessRlnWith35CtrlEntInd |
| 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 | Yes (1) | RelatedEntityInd |
| Related Organization Ctrl Ent | Yes (1) | RelatedOrganizationCtrlEntInd |
| Transaction With Control Ent | 0 | TransactionWithControlEntInd |
| Trnsfr Exmpt Non Chrtbl Rltd Org | 0 | TrnsfrExmptNonChrtblRltdOrgInd |
| Activities Conducted Prtshp | 0 | ActivitiesConductedPrtshpInd |
| Schedule O Required | Yes (1) | ScheduleORequiredInd |
| IRP Document | 9 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Backup Wthld Compliance | Yes (1) | BackupWthldComplianceInd |
| Employee | 226 | 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 |
| Subj To Tax Rmnrtn Ex Prcht Pymt | 0 | SubjToTaxRmnrtnExPrchtPymtInd |
| Subject To Excs Tax Net Invst Inc | 0 | SubjectToExcsTaxNetInvstIncInd |
| Info In Schedule O Part VI | Yes (X) | InfoInScheduleOPartVIInd |
| Governing Body Voting Members | 7 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 7 | IndependentVotingMemberCnt |
| Family Or Business Rln | Yes (1) | FamilyOrBusinessRlnInd |
| Delegation Of Mgmt Duties | 0 | DelegationOfMgmtDutiesInd |
| Change To Org Documents | 0 | ChangeToOrgDocumentsInd |
| Material Diversion Or Misuse | 0 | MaterialDiversionOrMisuseInd |
| Members Or Stockholders | Yes (1) | MembersOrStockholdersInd |
| Election Of Board Members | Yes (1) | ElectionOfBoardMembersInd |
| Decisions Subject To Approva | Yes (1) | 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 | Yes (1) | CompensationProcessOtherInd |
| Investment In Joint Venture | 0 | InvestmentInJointVentureInd |
| States Where Copy Of Return Is Fld | MN | StatesWhereCopyOfReturnIsFldCd |
| Upon Request | Yes (X) | UponRequestInd |
Books In Care Of Detail BooksInCareOfDetail
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | CAROL BORGERSON | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Phone | 3206987152 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 900 SECOND AVENUE | AddressLine1Txt |
| City | MADISON | CityNm |
| State Abbreviation | MN | StateAbbreviationCd |
| ZIP | 562561006 | ZIPCd |
Form990 Part VII Section A Form990PartVIISectionAGrp (14 entries)
| TitleTitleTxt | Average Hours Per WeekAverageHoursPerWeekRt | Average Hours Per Week Rltd OrgAverageHoursPerWeekRltdOrgRt | Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd | OfficerOfficerInd | Reportable Comp From OrgReportableCompFromOrgAmt | Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt | Other CompensationOtherCompensationAmt | Highest Compensated EmployeeHighestCompensatedEmployeeInd |
|---|---|---|---|---|---|---|---|---|
| LYNN ZIMMERMAN | ||||||||
| CHAIRMAN | 1.00 | 0.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | |
| DENISE CONNOR | ||||||||
| SECRETARY | 1.00 | 0.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | |
| KARIN MOEN | ||||||||
| DIRECTOR | 1.00 | 0.00 | Yes (X) | $0 | $0 | $0 | ||
| BRANDON ULSTAD | ||||||||
| DIRECTOR | 1.00 | 0.00 | Yes (X) | $0 | $0 | $0 | ||
| KIRSTEN GLOEGE | ||||||||
| DIRECTOR | 1.00 | 0.00 | Yes (X) | $0 | $0 | $0 | ||
| JEANENE MUNSTERMAN | ||||||||
| DIRECTOR | 1.00 | 0.00 | Yes (X) | $0 | $0 | $0 | ||
| TIM VOLK | ||||||||
| DIRECTOR | 1.00 | 0.00 | Yes (X) | $0 | $0 | $0 | ||
| ERIK BJERKE | ||||||||
| CEO | 40.00 | 0.50 | Yes (X) | $179,163 | $0 | $49,630 | ||
| CAROL BORGERSON | ||||||||
| CFO | 40.00 | 1.00 | Yes (X) | $80,282 | $0 | $19,992 | ||
| BRANT HACKER MD | ||||||||
| MD | 40.00 | 0.00 | $418,208 | $0 | $34,806 | Yes (X) | ||
| MARIA NOLTE MD | ||||||||
| MD | 40.00 | 0.00 | $254,933 | $0 | $45,389 | Yes (X) | ||
| MICHAEL DEYO PA | ||||||||
| PHYSICIAN ASSISTANT | 32.00 | 0.00 | $131,153 | $0 | $19,137 | Yes (X) | ||
| MARIBETH OLSON PA | ||||||||
| PHYSICIAN ASSISTANT | 24.00 | 0.00 | $120,404 | $0 | $4,413 | Yes (X) | ||
| PAUL HODGE NP | ||||||||
| NURSE PRACTITIONER | 40.00 | 0.00 | $124,724 | $0 | $12,390 | Yes (X) | ||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $1,308,867 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $0 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $185,757 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 8 | 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 |
|---|---|---|---|---|---|
| BIG STONE THERAPIES | |||||
| 340 WASHINGTON | ORTONVILLE | MN | 56278 | CONTRACT THERAPY SERVICES | $853,597 |
| MEDICAL SOLUTIONS | |||||
| 1010 N 102ND STREET SUITE 300 | OMAHA | NE | 68114 | AGENCY NURSING | $534,994 |
| CENTRACARE HEALTH | |||||
| 1406 6TH AVENUE N | ST CLOUD | MN | 56303 | EMR SOFTWARE SUPPORT/LICENSING/ETC. | $319,874 |
| CENTRAL MINNESOTA DIAGNOSTICS | |||||
| 150 10TH STREET W | MILACA | MN | 56353 | CONTRACT CT AND ULTRASOUND | $268,931 |
| PATHWAY HEALTH | |||||
| 11240 STILLWATER BLVD N | LAKE ELMO | MN | 55042 | CONTRACT OF INTERIM DIRECTOR OF NURSING | $188,221 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cntrct Rcvd Greater Than100 K | 11 | CntrctRcvdGreaterThan100KCnt |
| Fundraising | $3,500 | FundraisingAmt |
| Government Grants | $5,765,029 | GovernmentGrantsAmt |
| All Other Contributions | $235,282 | AllOtherContributionsAmt |
| Total Contributions | $6,003,811 | TotalContributionsAmt |
Program Service Revenue ProgramServiceRevenueGrp (5 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt |
|---|---|---|---|
| NET PATIENT AND RESIDENT SERVICE | 621400 | $16,388,332 | $16,388,332 |
| HOSPITAL REVENUE | 623000 | $347,517 | $347,517 |
| CLINIC REVENUE | 621400 | $105,101 | $105,101 |
| NURSING HOME OFFICE RENTAL | 621400 | $9,372 | $9,372 |
| MISCELLANEOUS REVENUE | 623000 | $7,894 | $7,894 |
Total Oth Program Service Rev TotalOthProgramServiceRevGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $6,475 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $6,475 | RelatedOrExemptFuncIncomeAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $16,864,691 | TotalProgramServiceRevenueAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $202,422 | TotalRevenueColumnAmt |
| Exclusion | $202,422 | ExclusionAmt |
Gross Amount Sales Assets GrossAmountSalesAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | $6,500 | 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 | $6,500 | OtherAmt |
Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $6,500 | TotalRevenueColumnAmt |
| Exclusion | $6,500 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Fundraising Gross Income | $6,000 | FundraisingGrossIncomeAmt |
| Contri Rpt Fundraising Event | $3,500 | ContriRptFundraisingEventAmt |
| Fundraising Direct Expenses | $2,012 | FundraisingDirectExpensesAmt |
Net Incm From Fundraising Evt NetIncmFromFundraisingEvtGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $3,988 | TotalRevenueColumnAmt |
| Exclusion | $3,988 | ExclusionAmt |
Other Revenue Misc OtherRevenueMiscGrp (2 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | ExclusionExclusionAmt |
|---|---|---|---|
| CAFETERIA & OTHER INCOME | 722210 | $76,789 | $76,789 |
| OTHER MISCELLANEOUS REVENUE | 561499 | $65,597 | $65,597 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Revenue Total | $142,386 | OtherRevenueTotalAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $23,223,798 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $16,864,691 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $0 | UnrelatedBusinessRevenueAmt |
| Exclusion | $355,296 | 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 | $7,684 | TotalAmt |
| Program Services | $7,684 | ProgramServicesAmt |
Grants To Domestic Individuals GrantsToDomesticIndividualsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $5,791 | TotalAmt |
| Program Services | $5,791 | ProgramServicesAmt |
Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $398,027 | TotalAmt |
| Management And General | $398,027 | ManagementAndGeneralAmt |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $7,265,592 | TotalAmt |
| Program Services | $7,020,742 | ProgramServicesAmt |
| Management And General | $244,850 | ManagementAndGeneralAmt |
Pension Plan Contributions PensionPlanContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $117,642 | TotalAmt |
| Program Services | $113,607 | ProgramServicesAmt |
| Management And General | $4,035 | ManagementAndGeneralAmt |
Other Employee Benefits OtherEmployeeBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,194,779 | TotalAmt |
| Program Services | $1,137,549 | ProgramServicesAmt |
| Management And General | $57,230 | ManagementAndGeneralAmt |
Payroll Taxes PayrollTaxesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $594,670 | TotalAmt |
| Program Services | $544,361 | ProgramServicesAmt |
| Management And General | $50,309 | ManagementAndGeneralAmt |
Fees For Services Legal FeesForServicesLegalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,639 | TotalAmt |
| Management And General | $1,639 | ManagementAndGeneralAmt |
Fees For Services Accounting FeesForServicesAccountingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $70,982 | TotalAmt |
| Management And General | $70,982 | ManagementAndGeneralAmt |
Fees For Services Prof Fundraising FeesForServicesProfFundraising
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $45,600 | TotalAmt |
| Fundraising | $45,600 | FundraisingAmt |
Fees For Services Other FeesForServicesOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $4,383,522 | TotalAmt |
| Program Services | $4,382,835 | ProgramServicesAmt |
| Management And General | $687 | ManagementAndGeneralAmt |
Advertising AdvertisingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $58,056 | TotalAmt |
| Management And General | $58,056 | ManagementAndGeneralAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $212,461 | TotalAmt |
| Program Services | $209,508 | ProgramServicesAmt |
| Management And General | $2,953 | ManagementAndGeneralAmt |
Information Technology InformationTechnologyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $476,012 | TotalAmt |
| Program Services | $469,395 | ProgramServicesAmt |
| Management And General | $6,617 | ManagementAndGeneralAmt |
Occupancy OccupancyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $237,484 | TotalAmt |
| Program Services | $214,804 | ProgramServicesAmt |
| Management And General | $22,680 | ManagementAndGeneralAmt |
Travel TravelGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $12,232 | TotalAmt |
| Program Services | $8,549 | ProgramServicesAmt |
| Management And General | $3,683 | ManagementAndGeneralAmt |
Conferences Meetings ConferencesMeetingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $88,489 | TotalAmt |
| Program Services | $85,825 | ProgramServicesAmt |
| Management And General | $2,664 | ManagementAndGeneralAmt |
Interest InterestGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $112,146 | TotalAmt |
| Program Services | $101,436 | ProgramServicesAmt |
| Management And General | $10,710 | ManagementAndGeneralAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,184,033 | TotalAmt |
| Program Services | $1,070,958 | ProgramServicesAmt |
| Management And General | $113,075 | ManagementAndGeneralAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $142,882 | TotalAmt |
| Management And General | $142,882 | ManagementAndGeneralAmt |
Other Expenses OtherExpensesGrp (4 entries)
| DescDesc | TotalTotalAmt | Program ServicesProgramServicesAmt | Management And GeneralManagementAndGeneralAmt |
|---|---|---|---|
| SUPPLIES | $934,175 | $934,175 | |
| TAXES AND LICENSES | $332,740 | $332,740 | |
| REPAIRS AND MAINTENANCE | $177,059 | $177,059 | |
| BAD DEBT EXPENSE | $74,962 | $70,464 | $4,498 |
All Other Expenses AllOtherExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $23,049 | TotalAmt |
| Program Services | $21,671 | ProgramServicesAmt |
| Management And General | $1,378 | ManagementAndGeneralAmt |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $18,151,708 | TotalAmt |
| Program Services | $16,909,153 | ProgramServicesAmt |
| Management And General | $1,196,955 | ManagementAndGeneralAmt |
| Fundraising | $45,600 | FundraisingAmt |
Cash Non Interest Bearing CashNonInterestBearingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $4,481,588 | BOYAmt |
| EOY | $3,772,159 | EOYAmt |
Savings And Temp Cash Invst SavingsAndTempCashInvstGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $11,643,356 | BOYAmt |
| EOY | $2,390,924 | EOYAmt |
Pledges And Grants Receivable PledgesAndGrantsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $65,250 | EOYAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,141,414 | BOYAmt |
| EOY | $1,758,201 | EOYAmt |
Inventories For Sale Or Use InventoriesForSaleOrUseGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $234,876 | BOYAmt |
| EOY | $281,404 | EOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $150,964 | BOYAmt |
| EOY | $220,994 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $39,965,801 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $21,886,115 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $9,274,352 | BOYAmt |
| EOY | $18,079,686 | EOYAmt |
Investments Pub Traded Sec InvestmentsPubTradedSecGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $7,253,290 | BOYAmt |
| EOY | $10,603,258 | EOYAmt |
Investments Other Securities InvestmentsOtherSecuritiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,175,803 | BOYAmt |
| EOY | $2,197,543 | EOYAmt |
Other Assets Total OtherAssetsTotalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $76,792 | BOYAmt |
| EOY | $336,902 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $36,432,435 | BOYAmt |
| EOY | $39,706,321 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,239,979 | BOYAmt |
| EOY | $2,454,576 | EOYAmt |
Deferred Revenue DeferredRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $4,568,242 | BOYAmt |
| EOY | $824,418 | EOYAmt |
Tax Exempt Bond Liabilities TaxExemptBondLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $5,500,981 | BOYAmt |
| EOY | $5,249,006 | EOYAmt |
Escrow Account Liability EscrowAccountLiabilityGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $3,070 | BOYAmt |
| EOY | $2,567 | EOYAmt |
Unsecured Notes Loans Payable UnsecuredNotesLoansPayableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,550,500 | BOYAmt |
| EOY | $151,974 | EOYAmt |
Other Liabilities OtherLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $70,790 | BOYAmt |
| EOY | $272,481 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $12,933,562 | BOYAmt |
| EOY | $8,955,022 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Organization Follows FASB117 | Yes (X) | OrganizationFollowsFASB117Ind |
No Donor Restriction Net Assets NoDonorRestrictionNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $23,365,641 | BOYAmt |
| EOY | $30,618,375 | EOYAmt |
Donor Restriction Net Assets DonorRestrictionNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $133,232 | BOYAmt |
| EOY | $132,924 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $23,498,873 | BOYAmt |
| EOY | $30,751,299 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $36,432,435 | BOYAmt |
| EOY | $39,706,321 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Reconcilation Revenue Expnss | $5,072,090 | ReconcilationRevenueExpnssAmt |
| Net Unrlzd Gains Losses Invst | $2,180,336 | NetUnrlzdGainsLossesInvstAmt |
| Other Changes In Net Assets | $0 | OtherChangesInNetAssetsAmt |
| Info In Schedule O Part XII | Yes (X) | InfoInScheduleOPartXIIInd |
| 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) |
|---|---|---|
| Consolidated Basis Fincl Stmt | Yes (X) | ConsolidatedBasisFinclStmtInd |
| 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 C IRS990ScheduleC
| Field | Value | IRS element (for citing) |
|---|---|---|
| Volunteers | 0 | VolunteersInd |
| Paid Staff Or Management | 0 | PaidStaffOrManagementInd |
| Media Advertisements | 0 | MediaAdvertisementsInd |
| Mailings Members | 0 | MailingsMembersInd |
| Publications Or Broadcast | 0 | PublicationsOrBroadcastInd |
| Grants Other Organizations | Yes (1) | GrantsOtherOrganizationsInd |
| Grants Other Organizations | $210 | GrantsOtherOrganizationsAmt |
| Direct Contact Legislators | 0 | DirectContactLegislatorsInd |
| Rallies Demonstrations | 0 | RalliesDemonstrationsInd |
| Other Activities | Yes (1) | OtherActivitiesInd |
| Total Lobbying Expenditures | $210 | TotalLobbyingExpendituresAmt |
| Not Described Section501c3 | 0 | NotDescribedSection501c3Ind |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | PART II-B, LINE 1: | FormAndLineReferenceDesc |
| Explanation | 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. | ExplanationTxt |
Schedule D IRS990ScheduleD
| Field | Value | IRS element (for citing) |
|---|---|---|
| Agent Trustee Etc | 0 | AgentTrusteeEtcInd |
| Incl Escrow Custodial Acct Liab | Yes (1) | InclEscrowCustodialAcctLiabInd |
| Explanation Provided | Yes (X) | ExplanationProvidedInd |
Land LandGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $6,522 | OtherCostOrOtherBasisAmt |
| Book Value | $6,522 | BookValueAmt |
Buildings BuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $22,204,738 | OtherCostOrOtherBasisAmt |
| Depreciation | $15,979,465 | DepreciationAmt |
| Book Value | $6,225,273 | BookValueAmt |
Equipment EquipmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $7,691,388 | OtherCostOrOtherBasisAmt |
| Depreciation | $5,906,650 | DepreciationAmt |
| Book Value | $1,784,738 | BookValueAmt |
Other Land Buildings OtherLandBuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $10,063,153 | OtherCostOrOtherBasisAmt |
| Book Value | $10,063,153 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $18,079,686 | TotalBookValueLandBuildingsAmt |
Closely Held Equity Interests CloselyHeldEquityInterestsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Book Value | $335,428 | BookValueAmt |
| Method Valuation | C | MethodValuationCd |
Other Securities OtherSecuritiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | ANNUITIES | Desc |
| Book Value | $1,862,115 | BookValueAmt |
| Method Valuation | C | MethodValuationCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Securities | $2,197,543 | TotalBookValueSecuritiesAmt |
Other Liabilities Org OtherLiabilitiesOrgGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | THIRD PARTY PAYOR SETTLEMENT | Desc |
| Amt | $272,481 | Amt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Liability | $272,481 | TotalLiabilityAmt |
| Footnote Text | Yes (X) | FootnoteTextInd |
Supplemental Information Detail SupplementalInformationDetail (2 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| 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. |
Schedule G IRS990ScheduleG
| Field | Value | IRS element (for citing) |
|---|---|---|
| Mail Solicitations | Yes (X) | MailSolicitationsInd |
| In Person Solicitations | Yes (X) | InPersonSolicitationsInd |
| Agrmt Prof Fundraising Acty | Yes (1) | AgrmtProfFundraisingActyInd |
Fundraiser Activity Info FundraiserActivityInfoGrp
Organization Business Name OrganizationBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | HILLARY LYONS | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | PO BOX 99 | AddressLine1Txt |
| City | DIMONDALE | CityNm |
| State Abbreviation | MI | StateAbbreviationCd |
| ZIP | 48821 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Activity | CAPITAL CAMPAIGN | ActivityTxt |
| Fundraiser Control Of Funds | 0 | FundraiserControlOfFundsInd |
| Gross Receipts | $234,804 | GrossReceiptsAmt |
| Retained By Contractor | $45,600 | RetainedByContractorAmt |
| Net To Organization | $0 | NetToOrganizationAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Gross Receipts | $234,804 | TotalGrossReceiptsAmt |
| Total Retained By Contractors | $45,600 | TotalRetainedByContractorsAmt |
| Licensed States | MN | LicensedStatesCd |
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 |
| Percent100 | Yes (X) | Percent100Ind |
| 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 | 275.000000000000 | DiscountedCareOtherPct |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Free Care Medically Indigent | Yes (1) | FreeCareMedicallyIndigentInd |
| Financial Assistance Budget | Yes (1) | FinancialAssistanceBudgetInd |
| Expenses Exceed Budget | Yes (1) | ExpensesExceedBudgetInd |
| Unable To Provide Care | 0 | UnableToProvideCareInd |
| Annual Community Bnft Report | Yes (1) | AnnualCommunityBnftReportInd |
| Report Publically Available | Yes (1) | ReportPublicallyAvailableInd |
Financial Assistance At Cost Typ FinancialAssistanceAtCostTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $22,238 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $22,238 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00120 | TotalExpensePct |
Unreimbursed Medicaid UnreimbursedMedicaidGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $3,560,244 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $3,413,462 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $146,782 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00810 | TotalExpensePct |
Unreimbursed Costs UnreimbursedCostsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $3,208,987 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $1,906,857 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $1,302,130 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.07200 | TotalExpensePct |
Total Financial Assistance Typ TotalFinancialAssistanceTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $6,791,469 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $5,320,319 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $1,471,150 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.08130 | TotalExpensePct |
Community Health Services CommunityHealthServicesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $116,368 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $18,362 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $98,006 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00540 | TotalExpensePct |
Total Other Benefits TotalOtherBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $116,368 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $18,362 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $98,006 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00540 | TotalExpensePct |
Total Community Benefits TotalCommunityBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $6,907,837 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $5,338,681 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $1,569,156 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.08670 | TotalExpensePct |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | 0 | BadDebtExpenseReportedInd |
| Bad Debt Expense | $74,962 | BadDebtExpenseAmt |
| Bad Debt Expense Attributable | $0 | BadDebtExpenseAttributableAmt |
| Reimbursed By Medicare | $3,578,496 | ReimbursedByMedicareAmt |
| Cost Of Care Reimbursed By Medcr | $4,657,438 | CostOfCareReimbursedByMedcrAmt |
| Medicare Surplus Or Shortfall | -$1,078,942 | MedicareSurplusOrShortfallAmt |
Costing Methodology Used CostingMethodologyUsedGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cost To Charge Ratio | Yes (X) | CostToChargeRatioInd |
| 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 | MADISON HOSPITAL | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 820 THIRD AVENUE | AddressLine1Txt |
| City | MADISON | CityNm |
| State Abbreviation | MN | StateAbbreviationCd |
| ZIP | 56256 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Website Address | WWW.MSHMN.ORG | WebsiteAddressTxt |
| State License | 327711 | 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 |
| Emergency Room Other | Yes (X) | EmergencyRoomOtherInd |
| Other | RURAL HEALTH | OtherDesc |
Hospital Fclty Policies Prctc HospitalFcltyPoliciesPrctcGrp
Hospital Facility Name HospitalFacilityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | MADISON HOSPITAL | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 1 | FacilityNum |
| First Licensed CY Or PY | 0 | FirstLicensedCYOrPYInd |
| Tax Exempt Hospital CY Or PY | 0 | TaxExemptHospitalCYOrPYInd |
| CHNA Conducted | Yes (1) | CHNAConductedInd |
| Community Definition | Yes (X) | CommunityDefinitionInd |
| Community Demographics | Yes (X) | CommunityDemographicsInd |
| Existing Resources | Yes (X) | ExistingResourcesInd |
| How Data Obtained | Yes (X) | HowDataObtainedInd |
| Community Health Needs | Yes (X) | CommunityHealthNeedsInd |
| Other Health Issues | Yes (X) | OtherHealthIssuesInd |
| Community Hlth Needs Id Process | Yes (X) | CommunityHlthNeedsIdProcessInd |
| Consulting Process | Yes (X) | ConsultingProcessInd |
| Prior CHNA Impact | Yes (X) | PriorCHNAImpactInd |
| CHNA Conducted | 18 | CHNAConductedYr |
| Take Into Account Others Input | Yes (1) | TakeIntoAccountOthersInputInd |
| CHNA Conducted With Other Fclts | 0 | CHNAConductedWithOtherFcltsInd |
| CHNA Conducted With Non Fclts | Yes (1) | CHNAConductedWithNonFcltsInd |
| CHNA Report Widely Available | Yes (1) | CHNAReportWidelyAvailableInd |
| Rpt Available On Own Website | Yes (X) | RptAvailableOnOwnWebsiteInd |
| Own Website URL | HTTPS://MHSMN.ORG/PATIENTS-VISITORS/COMMUNITY-NEEDS-ASSESSMENT/ | OwnWebsiteURLTxt |
| Paper Copy Public Inspection | Yes (X) | PaperCopyPublicInspectionInd |
| Implementation Strategy Adopt | Yes (1) | ImplementationStrategyAdoptInd |
| Implementation Strategy Adpt | 18 | ImplementationStrategyAdptYr |
| Strategy Posted Website | Yes (1) | StrategyPostedWebsiteInd |
| Strategy Website URL | HTTPS://MHSMN.ORG/PATIENTS-VISITORS/COMMUNITY-NEEDS-ASSESSMENT/ | StrategyWebsiteURLTxt |
| 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 | 100.000000000000 | FPGFamilyIncmLmtFreeCarePct |
| FPG Family Incm Lmt Dscnt Care | 275.000000000000 | FPGFamilyIncmLmtDscntCarePct |
| Asset Level Criteria | Yes (X) | AssetLevelCriteriaInd |
| Medical Indigency Criteria | Yes (X) | MedicalIndigencyCriteriaInd |
| Residency Criteria | Yes (X) | ResidencyCriteriaInd |
| 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 |
| Includes Publicity Measures | Yes (1) | IncludesPublicityMeasuresInd |
| FAP Available On Website | Yes (X) | FAPAvailableOnWebsiteInd |
| FAP Available On Website URL | HTTPS://MHSMN.ORG/PATIENTS-VISITORS/CHARITY-CARE-POLICY-FINANCIAL/ | FAPAvailableOnWebsiteURLTxt |
| FAP App Available On Website | Yes (X) | FAPAppAvailableOnWebsiteInd |
| FAP App Available On Website URL | HTTPS://MHSMN.ORG/PATIENTS-VISITORS/CHARITY-CARE-POLICY-FINANCIAL/ | FAPAppAvailableOnWebsiteURLTxt |
| FAP Summary On Website | Yes (X) | FAPSummaryOnWebsiteInd |
| FAP Summary On Website URL | HTTPS://MHSMN.ORG/PATIENTS-VISITORS/CHARITY-CARE-POLICY-FINANCIAL/ | 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 |
| FAP Translated | Yes (X) | FAPTranslatedInd |
| Other Publicity | Yes (X) | OtherPublicityInd |
| 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 Private | Yes (X) | LookBackMedicarePrivateInd |
| Amounts Generally Billed | 0 | AmountsGenerallyBilledInd |
| Gross Charges | 0 | GrossChargesInd |
Supplemental Information SupplementalInformationGrp (5 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| 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, LAC QUI PARLE COUNTY FAMILY SERVICE CENTER, LAC QUI PARLE HEALTH NETWORK, AND MADISON HEALTHCARE AUXILIARY IN ORDER TO ADDRESS THE HEALTH NEEDS OF THE REGION. |
| MADISON HOSPITAL | PART V, SECTION B, LINE 11: ONE OF THE PRIMARY FOCUSES OF ANY HEALTHCARE FACILITY IS IDENTIFYING AND ADDRESSING THE HEALTH NEEDS OF THE AREA THEY SERVE. MADISON HEALTHCARE SERVICES (MHS) HAS PUT FORTH TIME, EFFORT, AND RESOURCES TO DOING JUST THAT. AS A NON-PROFIT FACILITY, MHS IS DEDICATED TO REINVESTING IN OUR HEALTHCARE SYSTEM TO MEET THE NEEDS OF THE COMMUNITIES WE PROVIDE SERVICES TO. MADISON HEALTHCARE SERVICES CONDUCTED A COMMUNITY HEALTH NEEDS ASSESSMENT ON THE COUNTY OF LAC QUI PARLE IN MINNESOTA, WHERE THE MAJORITY OF OUR PATIENTS RESIDE. WE UTILIZED ADDITIONAL RESOURCES INCLUDING THE MINNESOTA DEPARTMENT OF HEALTH, AND COUNTRYSIDE PUBLIC HEALTH TO FURTHER OUR ASSESSMENT. WE FINISHED OUR EVALUATION WITH PRIMARY DATA WE COMPILED THROUGH A COMMUNITY SURVEY. WE COLLABORATED WITH COUNTRYSIDE PUBLIC HEALTH, PRAIRIE FIVE RIDES, LAC QUI PARLE COUNTY FAMILY SERVICE CENTER, LAC QUI PARLE COUNTY COMMISSIONERS, LAC QUI PARLE VALLEY SCHOOL DISTRICT, AND THE CITY OF MADISON. USING ALL THIS INFORMATION, OUR COMMUNITY HEALTH NEEDS COMMITTEE DETERMINED THE HEALTH NEEDS FOR THE COUNTY. THE COMMITTEE IDENTIFIED TWO MAIN HEALTH NEEDS IN OUR AREA WHICH ARE BACK/JOINT PAIN AND MENTAL HEALTH. OUR AREA EXPERIENCES LACK OF EDUCATION, LOCAL OUTREACH PROVIDER SERVICES TO TREAT THESE CONDITIONS, AND PREVENTION WHEN FACING THESE PROBLEMS. SINCE WE ARE LOCATED IN A RURAL AREA, WE REALIZE THE IMPORTANCE OF COLLABORATING WITH LOCAL MEMBERS OF OUR COMMUNITIES, PUBLIC HEALTH OFFICIALS, AND NUMEROUS ORGANIZATIONS TO ADDRESS HEALTH CONCERNS IN THE REGION. TOGETHER, WE CAN RECOGNIZE WHERE IMPROVEMENTS ARE NEEDED AND STRIVE TO INCREASE THE QUALITY OF CARE WE PROVIDE TO OUR PATIENTS. IN ORDER TO ADDRESS THESE CHRONIC AND ACUTE DISEASES, WE WANT TO POSITIVELY INFLUENCE THE HEALTH HABITS OF PEOPLE IN OUR REGION BY PROVIDING EDUCATION ON PREVENTING AND MANAGING THEM.BACK AND JOINT PAIN HAVE BEEN AN ONGOING ISSUE IN OUR COMMUNITY AND WILL BE A CONTINUED AREA OF FOCUS FOR OUR COMMITTEE. MADISON HEALTHCARE SERVICES IS STRIVING TO PROVIDE THE SERVICES AND PROCEDURES NEEDED TO RELIEVE BACK AND JOINT PAIN SO ONE CAN GET BACK TO THE ACTIVITIES THAT HE/SHE ENJOYS. MADISON HEALTHCARE SERVICES HAS ORTHOPEDIC SERVICES ALONG WITH ITS LONG LIST OF SPECIALTY SERVICES. MADISON HEALTHCARE SERVICES IS ABLE TO OFFER TOTAL JOINT REPLACEMENTS, PARTIAL JOINT REPLACEMENTS AND A VARIETY OF JOINT INJECTION PROCEDURES TO HELP RELIEVE JOINT PAIN. PATIENTS ARE NOW ABLE TO HAVE JOINT REPLACEMENT SURGERY, RECOVERY AND PHYSICAL THERAPY RIGHT IN THEIR COMMUNITY WITHOUT THE NEED TO TRAVEL FOR THESE SERVICES. IN ADDITION TO OUR ORTHOPEDIC SURGERY OPTIONS, MHS OFFERS PAIN INJECTION PROCEDURES PERFORMED BY AN INTERVENTIONAL RADIOLOGIST ON A MONTHLY BASIS. PAIN INJECTION PROCEDURES ARE PERFORMED TO HELP ALLEVIATE SEVERE NECK AND BACK PAIN AND OFFER A GREAT ALTERNATIVE TO NARCOTIC PRESCRIPTION USE. TO FURTHER EXPAND NON-SURGICAL TREATMENTS FOR JOINT AND BACK PAIN, OUR THERAPY DEPARTMENT RECENTLY RECEIVED CERTIFICATIONS IN THERAPEUTIC PAIN RELIEF. MADISON HEALTHCARE SERVICES FURTHER IDENTIFIED MENTAL HEALTH AS A GAP IN OUR COMMUNITY. MADISON HEALTHCARE SERVICES IS WORKING TO ADDRESS THIS NEED FURTHER. THE LAC QUI PARLE HEALTH NETWORK (LQPHN), TOGETHER WITH WOODLAND CENTERS, RECEIVED A GRANT TO IMPROVE THE ACCESS FOR BEHAVIORAL HEALTH PATIENTS IN OUR COMMUNITY BY INTEGRATING BEHAVIORAL HEALTH INTO FAMILY PRACTICE AND TO REDUCE THE STIGMA OF MENTAL HEALTH USING MARKETING AND EDUCATION CAMPAIGNS. IN ADDITION TO IMPROVING ACCESS TO BEHAVIORAL HEALTH SERVICES FOR OUR PATIENTS, WE ARE AGGRESSIVELY MARKETING TO THE COMMUNITY TO REDUCE THE STIGMA AND INCREASE THEIR AWARENESS OF SERVICES. IN JUNE 2020, WORKING WITH JOHNSON MEMORIAL HOSPITAL IN DAWSON, MADISON HEALTHCARE SERVICES ADDED A MENTAL HEALTH THERAPIST THAT SEES PATIENTS AT LAC QUI PARLE CLINIC 2.5 DAYS A WEEK. IN ADDITION, THE MENTAL HEALTH THERAPIST SENDS OUT EMAILS TO ALL STAFF MONDAY THROUGH FRIDAY WITH MENTAL HEALTH TIPS, ADVICE, SUGGESTIONS, AND INFORATION. WORKING WITH JOHNSON MEMORIAL, DAWSON, A PSYCHIATRIC MENTAL HEALTH NURSE PRACTITIONER WAS HIRED TO SEE PATIENTS TWO AND A HALF DAYS A WEEK I THE CLINIC. AMY DEE DID A PRESENTATION FOR STAFF AND THE COMMUNITY ON MENTAL FLEXIBILITY - SHIFT YOUR PERSPECTIVE, CHANGE YOUR LIFE IN JUNE 2021.COMMUNITY WELLNESSDUE TO COVID-19, WE WERE UNABLE TO DO ANY IN-PERSON PRESENTATIONS TO THE COMMUNITY. TO KEEP THE COMMUNITY UP TO DATE WITH COVID-19 INFORMATION, WE PUT COVID-19 RELATED ARTICLES IN THE LOCAL NEWSPAPER; OUR PROVIDERS DID SPOTS ON THE LOCAL RADIO STATION TALKING ABOUT VACCINES AND VACCINATION IMPORTANCE, MASKING, SOCIAL DISTANCING, ETC AND WE PUT INFORMATION ON OUR WEBSITE AND OUR FACEBOOK PAGE.TELEHEALTH SERVICES CONTINUES FOR CLINIC AND MENTAL HEALTH APPOINTMENTS FOR OUR PATIENTS. THIS SERVICE WAS UTILIZED BY MANY PATIENTS SO THEY COULD STAY IN THEIR HOMES AND STILL TALK WITH THEIR PROVIDERS WITHOUT THE RISK OF COMING INTO CONTACT WITH OTHER PATIENTS.DUE TO COVID-19, MADISON HEALTHCARE SERVICES CONTINUES TO HAVE ONE PROVIDER TRIAGE CALLS FOR PATIENTS WITH SYMPTOMS AND CALL PATIENTS WITH RESULTS. TO COMBAT THE SPREAD OF COVID-19 AND KEEP STAFF HEALTHY, THE HOSPITAL RECEIVED WEEKLY ALLOCATIONS OF COVID-19 TESTING SUPPLIES FOR RAPID RESULTS, THE HOSPITAL UTILIZED THESE SUPPLIES FOR PATIENTS WITH SYMPTOMS. A DRIVE UP PROCESS WAS ESTABLISHED FOR COVID-19 TESTING AND A ROOM WITH SEPARATE ENTRANCE IN THE CLINIC WAS UTILIZED FOR RESPIRATORY TREATMENT.STAFF TESTING FOR COVID-19 WAS DONE WEEKLY ONCE COUNTY INFECTION RATES INCREASED TO KEEP OUR STAFF, PATIENTS, RESIDENTS AND COMMUNITY SAFE. STAFF AND RESIDENT TESTING DONE TWICE WEEKLY WHEN ANY STAFF OR RESIDENT TEST POSITIVE. MHS FOLLOWED THE CDC/MDIT GUIDELINES FOR TESTING.DIRECT ACCESS LABIN ORDER TO ADDRESS THE UNINSURED, LOW-INCOME, AND MINORITY GROUPS, BY LAW OUR HOSPITAL CANNOT REFUSE TO SEE ANYONE REGARDLESS OF THEIR ABILITY TO PAY. THE DIRECT ACCESS LAB PROGRAM ALLOWS CASH PAYMENT FOR LAB SERVICES WITHOUT A PROVIDERS ORDERS AND IS ANOTHER SOURCE FOR THOSE WHO ARE UNINSURED AND WANT LAB WORK PERFORMED AT A LOWER COST. MADISON HEALTHCARE SERVICES ALSO OFFERS A 20% OFF UNINSURED DISCOUNT THEY ARE ABLE TO RECEIVE FOR GETTING SERVICES HERE.MHS CLINIC RECERTIFIED AS HEALTHCARE HOMETHE MINNESOTA DEPARTMENT OF HEALTH HAS RECERTIFIED THE LAC QUI PARLE CLINIC AS A HEALTH CARE HOME. THIS MEANS THAT THE CLINIC HAS MET A SET OF RIGOROUS STANDARDS TO PROVIDE PATIENT AND FAMILY-CENTERED CARE AND IS WORKING TO IMPROVE BOTH THE OVERALL QUALITY AND AFFORDABILITY OF HEALTHCARE. CHRONIC CARE MANAGEMENT IS THE CENTERPIECE OF THIS PROJECT IN THE CLINIC AND GIVES PATIENTS WITH TWO OR MORE CHRONIC CONDITIONS ACCESS TO NURSES TO HELP COORDINATE THEIR CARE AND PROVIDES ADVICE AND WELLNESS CHECKS.UPGRADED EQUIPMENTMADISON HEALTHCARE SERVICES STRIVES TO PROVIDE PATIENTS ACCESS TO THE BEST MEDICAL EQUIPMENT IN THE REGION. IN THE HOSPITAL VITAL MONITORS THAT ARE MOUNTED ON THE WALL IN EACH OF THE PATIENT AND OR ROOMS WERE PURCHASED TO REPLACE THE MOBILE VITAL MONITORS THAT WERE MOVED FROM PATIENT TO PATIENT. A VENTILATOR WAS PURCHASED ALONG WITH AN ADDITIONAL ANESTHESIA MACHINE DUE TO COVID AND INABILITY TO TRANSFER PATIENTS TO LARGER FACILITIES. A NEW MINDRAY MONITORING SYSTEM WAS PURCHASED TO BE INSTALLED IN DECEMBER TO REPLACE OUR CURRENT SYSTEM THAT WAS REACHING END OF LIFE. THE NEW SYSTEM HAS CAPABILITIES TO MONITOR PATIENTS FROM ANYWHERE WITHOUT ENTERING THE PATIENT ROOM. A VEIN VISUALIZATION SYSTEM WAS PURCHASED ALONG WITH AN AUTO LOCKING CART, HOVER MAT FOR PATIENT TRANSFER. A FREEZER WAS PURCHASED FOR COVID VACCINES. OTHER ITEMS PURCHASED INCLUDE TREADMILL, EST STAT 6 ANALYZER, BLANKET WARMER, OXIMETERS, PHARMACY CABINET, OVERHEAD TABLES, MICROSCOPE, TELESCOPES AND SABO SAG SAW.THE CLINIC PURCHASED A MOBILE ISOLATION STATION FOR COVID TESTING ALONG WITH A NEW CEILING MOUNT LIGHT AND EXAM CHAIRS |
| 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. |
| 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. |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 1 | FacilityNum |
Oth Hlth Care Fclts Not Hospital OthHlthCareFcltsNotHospitalGrp
Oth Hlth Care Fclts OthHlthCareFcltsGrp
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | 1 - LAC QUI PARLE CLINIC | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 900 SECOND AVENUE | AddressLine1Txt |
| City | MADISON | CityNm |
| State Abbreviation | MN | StateAbbreviationCd |
| ZIP | 56256 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | RURAL HEALTH CLINIC | FacilityTxt |
Supplemental Information Detail SupplementalInformationDetail (13 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| 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 RESIDE WITHIN A 50-MILE RADIUS OF THE HOSPITAL, 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 $ 74,962. |
| 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 11 OF THE ATTACHED AUDITED FINANCIAL STATEMENTS. |
| PART III, LINE 8: | THE MEDICARE SHORTFALL OF $1,078,942 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 2021 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. |
| PART VI, LINE 2: | TO ASSESS THE HEALTH CARE NEEDS OF THE COMMUNITY MHS FIRST PERFORMED A DEMOGRAPHIC ANALYSIS OF LAC QUI PARLE COUNTY USING DATA FROM THE U.S. CENSUS BUREAU AND COUNTY HEALTH RANKINGS. TO FURTHER THE ASSESSMENT ADDITIONAL RESOURCES WERE UTILIZED, INCLUDING THE MN DEPARTMENT OF HEALTH AND COUNTRYSIDE PUBLIC HEALTH. MHS FINISHED THE EVALUATION WITH PRIMARY DATA COMPILED THROUGH A COMMUNITY SURVEY. MHS COLLABORATED WITH COUNTRYSIDE PUBLIC HEALTH, PRAIRIE FIVE RIDES, LAC QUI PARLE COUNTY FAMILY SERVICE CENTER, LAC QUI PARLE COUNTY COMMISSIONERS, LAC QUI PARLE VALLEY SCHOOL DISTRICT, AND THE CITY OF MADISON. USING THE INFORMATION COLLECTED, THE COMMUNITY HEALTH NEEDS COMMITTEE DETERMINED THE HEALTH NEEDS FOR THE COUNTY. |
| 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. |
| 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'S LABORATORY FOR DEPARTMENT OF TRANSPORTATION DRUG TESTING AND MADISON HOSPITAL'S RADIOLOGY FOR ALL X-RAYS AND CT STUDIES. MADISON HOSPITAL'S 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 $33,000. 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 ASK 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. AFTER MUCH DISCUSSION, IT WAS DECIDED TO MOVE AHEAD WITH A BUILDING PROJECT FOR THE CARE CENTER, WHICH CREATED A NEW WING AND REPLACES AN OLDER AREA WITH UNDERGROUND ISSUES. RESIDENTS MOVED IN AUGUST 18, 2021 WHICH CREATES A HOMELIKE ATMOSPHERE FOR THE RESIDENTS AND EFFICIENCIES FOR THE STAFF. THE CURRENT AREA WAS DEMOLISHED, AND A 12-UNIT INDEPENDENT/ASSISTED LIVING FACILITY IS BEING BUILT TO SERVE THE COMMUNITY NEEDS. THIS IS SCHEDULED TO BE COMPLETED IN THE FALL OF 2022.THE HOSPITAL WAS RECERTIFIED IN 2019 AS A HEALTHCARE HOME, WHICH ALLOWS FOR COORDINATED CARE TO IMPROVE OVERALL HEALTH AND WELL-BEING TO THE PATIENTS. MADISON HOSPITAL ADDED A PSYCHIATRIC MENTAL HEALTH NURSE PRACTITIONER WHO PROVIDES SERVICES IN THE CLINIC TWO AND HALF DAYS A WEEK.MADISON HOSPITAL ADDED TWO UROLOGISTS FOLLOWING RETIREMENT OF OUR UROLOGIST. THESE PROVIDERS COME FROM SIOUX FALLS, SD AND PROVIDE SERVICES TWO DAYS A MONTH (CONSULTS AND PROCEDURES).MADISON HOSPITAL ADDED A SURGEON WHO COMES FROM MONTEVIDEO AND SEES PATIENTS AND DOES PROCEDURES TWO DAYS A MONTH - WE NOW HAVE WEEKLY SURGEON COVERAGE.MADISON HOSPITAL ADDED A ENT SPECIALIST THAT SEES PATIENTS AND DOES PROCEDURES TWICE A MONTH AND REPLACES AN ENT PROVIDER THAT RETIRED. |
| PART VI, LINE 7, REPORTS FILED WITH STATES | MN |
Schedule I IRS990ScheduleI
| Field | Value | IRS element (for citing) |
|---|---|---|
| Grant Records Maintained | 0 | GrantRecordsMaintainedInd |
Grants Other Asst To Indiv In US GrantsOtherAsstToIndivInUSGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Grant Type | SCHOLARSHIPS | GrantTypeTxt |
| Recipient | 6 | RecipientCnt |
| Cash Grant | $5,791 | CashGrantAmt |
| Non Cash Assistance | $0 | NonCashAssistanceAmt |
| Valuation Method Used | N/A | ValuationMethodUsedDesc |
| Non Cash Assistance | N/A | NonCashAssistanceDesc |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| 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 | 0 | AnyNonFixedPaymentsInd |
| Initial Contract Exception | 0 | InitialContractExceptionInd |
Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp (4 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 |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| BRANT HACKER MD | ||||||||||||||
| MD | $251,518 | $0 | $1,200 | $0 | $165,490 | $0 | $34,806 | $0 | $0 | $0 | $453,014 | $0 | $0 | $0 |
| MARIA NOLTE MD | ||||||||||||||
| MD | $203,608 | $0 | $1,200 | $0 | $50,125 | $0 | $6,672 | $0 | $38,717 | $0 | $300,322 | $0 | $0 | $0 |
| ERIK BJERKE | ||||||||||||||
| CEO | $177,963 | $0 | $1,200 | $0 | $0 | $0 | $12,913 | $0 | $36,717 | $0 | $228,793 | $0 | $0 | $0 |
| MICHAEL DEYO PA | ||||||||||||||
| PHYSICIAN ASSISTANT | $129,789 | $0 | $1,200 | $0 | $164 | $0 | $7,947 | $0 | $11,190 | $0 | $150,290 | $0 | $0 | $0 |
Schedule K IRS990ScheduleK
Tax Exempt Bonds Issues TaxExemptBondsIssuesGrp (2 entries)
| Bond ReferenceBondReferenceCd | Bond Issuer EINBondIssuerEIN | Bond IssuedBondIssuedDt | Issue PriceIssuePriceAmt | PurposePurposeDesc | DefeasedDefeasedInd | On Behalf Of IssuerOnBehalfOfIssuerInd | Pool FinancingPoolFinancingInd |
|---|---|---|---|---|---|---|---|
| CITY OF MADISON MINNESOTA | |||||||
| A | 416005335 | 2020-09-23 | $6,705,000 | REFUNDING 2020 BONDS, FINANCE OF FACILITY EXPANSION | 0 | 0 | 0 |
| CITY OF BELLINGHAM MINNESOTA | |||||||
| B | 416004967 | 2020-09-23 | $6,705,000 | REFUNDING 2020 BONDS, FINANCE OF FACILITY EXPANSION | 0 | 0 | 0 |
Tax Exempt Bonds Proceeds TaxExemptBondsProceedsGrp (2 entries)
| Bond ReferenceBondReferenceCd | Total ProceedsTotalProceedsAmt | Other Spent ProceedsOtherSpentProceedsAmt | UnspentUnspentAmt | Substantial CompletionSubstantialCompletionYr | Refunding Tax Exempt BondsRefundingTaxExemptBondsInd | Refunding Taxable BondsRefundingTaxableBondsInd | Final Allocation MadeFinalAllocationMadeInd | Adequate Books And Rec MaintAdequateBooksAndRecMaintInd |
|---|---|---|---|---|---|---|---|---|
| A | $6,705,000 | $2,742,133 | $3,962,867 | 2021 | Yes (1) | 0 | 0 | 0 |
| B | $6,705,000 | $2,742,133 | $3,962,867 | 2021 | Yes (1) | 0 | 0 | 0 |
Tax Exempt Bonds Private Bus Use TaxExemptBondsPrivateBusUseGrp (2 entries)
| Bond ReferenceBondReferenceCd | Owning Bond Financed PropertyOwningBondFinancedPropertyInd | Any Lease ArrangementsAnyLeaseArrangementsInd | Mgmt Contract Bond Fincd PropMgmtContractBondFincdPropInd | Any Research AgreementsAnyResearchAgreementsInd | Private Bus Use By OthersPrivateBusUseByOthersPct | Private Bus Concerning UBIPrivateBusConcerningUBIPct | Total Private Business UseTotalPrivateBusinessUsePct | Bond Iss Meet Prvt Sec Pymt TestBondIssMeetPrvtSecPymtTestInd | Change In Use Bond Financed PropChangeInUseBondFinancedPropInd | Procs Nonqualified Bond RemdtdProcsNonqualifiedBondRemdtdInd |
|---|---|---|---|---|---|---|---|---|---|---|
| A | 0 | 0 | 0 | 0 | 0.00000 | 0.00000 | 0.00000 | 0 | 0 | Yes (1) |
| B | 0 | 0 | 0 | 0 | 0.00000 | 0.00000 | 0.00000 | 0 | 0 | Yes (1) |
Tax Exempt Bonds Arbitrage TaxExemptBondsArbitrageGrp (2 entries)
| Bond ReferenceBondReferenceCd | Form8038 T FiledForm8038TFiledInd | Rebate Not Due YetRebateNotDueYetInd | Exception To RebateExceptionToRebateInd | No Rebate DueNoRebateDueInd | Variable Rate IssueVariableRateIssueInd | Hedge Identified In Bks And RecHedgeIdentifiedInBksAndRecInd | Term Of HedgeTermOfHedgePct | Superintegrated HedgeSuperintegratedHedgeInd | Hedge TerminatedHedgeTerminatedInd | Gross Proceeds Invested In GICGrossProceedsInvestedInGICInd | Gross Proceeds InvestedGrossProceedsInvestedInd | Written Proc To Monitor ReqsWrittenProcToMonitorReqsInd |
|---|---|---|---|---|---|---|---|---|---|---|---|---|
| OLD NATIONAL BANK | ||||||||||||
| A | 0 | Yes (1) | 0 | 0 | Yes (1) | Yes (1) | 8.500000000000 | 0 | 0 | 0 | 0 | Yes (1) |
| OLD NATIONAL BANK | ||||||||||||
| B | 0 | Yes (1) | 0 | 0 | Yes (1) | Yes (1) | 8.500000000000 | 0 | 0 | 0 | 0 | Yes (1) |
Procedures Corrective Action ProceduresCorrectiveActionGrp (2 entries)
| Bond ReferenceBondReferenceCd | Procedures Corrective ActionProceduresCorrectiveActionInd |
|---|---|
| A | Yes (1) |
| B | Yes (1) |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (11 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| FORM 990, PART VI, SECTION A, LINE 1 | 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 2 | CAROL BORGERSON, CFO, AND D. MARIA NOLTE HAVE A FAMILY RELATIONSHIP |
| 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 2021. |
| 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 4,364,329. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 4,364,329. CONSULTANTS: PROGRAM SERVICE EXPENSES 18,506. MANAGEMENT AND GENERAL EXPENSES 687. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 19,193. |
| 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. |
Schedule R IRS990ScheduleR
Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp
Disregarded Entity Name DisregardedEntityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | HILLTOP RESIDENCE INC | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 915 FIRST AVENUE | AddressLine1Txt |
| City | MADISON | CityNm |
| State Abbreviation | MN | StateAbbreviationCd |
| ZIP | 56256 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 411376605 | EIN |
| Primary Activities | MHS MANAGES HUD HOUSING - HILLTOP APARTMENTS | PrimaryActivitiesTxt |
| Legal Domicile State | MN | LegalDomicileStateCd |
| Exempt Code Section | 501(C)(3) | ExemptCodeSectionTxt |
| Public Charity Status | LINE 10 | PublicCharityStatusTxt |
Direct Controlling Entity Name DirectControllingEntityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | MADISON HEALTHCARE SERVICES | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Controlled Organization | Yes (1) | ControlledOrganizationInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Annts Rnts Rylts | 0 | ReceiptOfIntAnntsRntsRyltsInd |
| Gift Grnt Or Cap Contri To Oth Org | 0 | GiftGrntOrCapContriToOthOrgInd |
| Gift Grnt Cap Contri From Oth Org | 0 | GiftGrntCapContriFromOthOrgInd |
| Loans Or Guarantees To Other Org | 0 | LoansOrGuaranteesToOtherOrgInd |
| Loans Or Guarantees From Oth Org | 0 | LoansOrGuaranteesFromOthOrgInd |
| Div Related Organization | 0 | DivRelatedOrganizationInd |
| Asset Sale To Other Org | 0 | AssetSaleToOtherOrgInd |
| Asset Purchase From Other Org | 0 | AssetPurchaseFromOtherOrgInd |
| Asset Exchange | 0 | AssetExchangeInd |
| Rental Of Facilities To Oth Org | 0 | RentalOfFacilitiesToOthOrgInd |
| Rental Of Fclts From Oth Org | 0 | RentalOfFcltsFromOthOrgInd |
| Perform Of Services For Oth Org | 0 | PerformOfServicesForOthOrgInd |
| Perform Of Services By Other Org | 0 | PerformOfServicesByOtherOrgInd |
| Sharing Of Facilities | Yes (1) | SharingOfFacilitiesInd |
| Paid Employees Sharing | Yes (1) | PaidEmployeesSharingInd |
| Reimbursement Paid To Other Org | Yes (1) | ReimbursementPaidToOtherOrgInd |
| Reimbursement Paid By Other Org | 0 | ReimbursementPaidByOtherOrgInd |
| Transfer To Other Org | 0 | TransferToOtherOrgInd |
| Transfer From Other Org | 0 | TransferFromOtherOrgInd |
Comments