2021-08-02T15:42:22-05:00 2020-09-30 410746749 CLIFTONLARSONALLEN LLP 220 SOUTH SIXTH STREET SUITE 300 MINNEAPOLIS MN 55402 990 2019-10-01 410706115 MADISON HEALTHCARE SERVICES MADI 3205987536 900 SECOND AVENUE MADISON MN 562561006 ERIK BJERKE PRESIDENT/CEO 3205987536 2021-07-29 1 KOREY BOELTER P00775161 6123764500 2019 2022-09-23 18:48:47Z ERIK BJERKE 900 SECOND AVENUE MADISON MN 562561006 20353938 0 X MHSMN.ORG X 1945 MN TO PROVIDE HEALTH CARE, RESIDENTIAL, AND COMMUNITY SERVICE IN A COMPETENT AND CARING MANNER. 7 7 232 60 0 0 368974 119455 17719145 17652349 278800 288457 126112 104580 18493031 18164841 21704 7120 0 0 8935531 9073593 0 0 0 7849176 8131649 16806411 17212362 1686620 952479 29483052 36432435 7296224 12933562 22186828 23498873 X 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. 0 0 8436060 4161 9319583 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 10,908 OUTPATIENT VISITS AND 1,004 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 $47,311 FOR THE YEAR ENDED SEPTEMBER 30, 2020. 5335847 2475 6038868 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. THE MADISON LUTHERAN HOME IS PLANNING TO REMODEL AND BUILD A NEW WING FOR RESIDENT ROOMS IN ORDER TO PROVIDE A MORE WARM WELCOMING ATMOSPHERE TO THE RESIDENTS THAT RESIDE HERE. 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. NURSING HOME OCCUPANCY AT SEPTEMBER 30, 2020 WAS 50 RESIDENTS. 2324871 484 2293898 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 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. 16096778 1 1 0 1 0 0 0 0 1 0 1 1 0 1 1 1 0 1 0 0 0 0 0 0 0 0 1 1 0 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 0 0 0 1 8 0 232 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 BRANT HACKER MD MEDICAL DOCTOR 40.00 0.00 X 397909 0 33379 MARIA NOLTE MD MEDICAL DOCTOR 40.00 0.00 X 239623 0 35010 ERIK BJERKE PRESIDENT/CEO 40.00 0.50 X 169468 0 36358 MICHAEL DEYO PA PHYSICIAN ASSISTANT 40.00 0.00 X 134875 0 12977 PAUL HODGE NP NURSE PRACTITIONER 40.00 0.00 X 123132 0 8250 MARIBETH OLSON PA PHYSICIAN ASSISTANT 40.00 0.00 X 113693 0 4200 CAROL BORGERSON CHIEF FINANCIAL OFFICER 40.00 1.00 X 73641 0 10167 BRANDON ULSTAD CHAIRMAN 1.00 0.10 X X 0 0 0 DENISE CONNOR SECRETARY 1.00 0.00 X X 0 0 0 KIRSTEN GLOEGE DIRECTOR 1.00 0.00 X 0 0 0 JOHN MAATZ DIRECTOR 1.00 0.00 X 0 0 0 KARIN MOEN DIRECTOR 1.00 0.00 X 0 0 0 ANGIE SHELSTAD DIRECTOR 1.00 0.10 X 0 0 0 LYNN ZIMMERMAN DIRECTOR 1.00 0.10 X 0 0 0 1252341 0 140341 6 0 1 0 BIG STONE THERAPIES 340 WASHINGTON ORTONVILLE MN 56278 CONTRACT THERAPY SERVICES 948792 HGA PO BOX 86 MINNEAPOLIS MN 55486 ARCHITECTURE FEES 688873 MEDICAL SOLUTIONS 1010 N 102ND STREET SUITE 300 OMAHA NE 68114 AGENCY NURSING 659553 CENTRAL MINNESOTA DIAGNOSTICS 150 10TH STREET W MILACA MN 56353 CONTRACT CT AND ULTRASOUND 195441 CENTRACARE HEALTH 1406 6TH AVENUE N ST CLOUD MN 56303 EMR SOFTWARE SUPPORT/LICENSING/ETC. 155410 7 2000 117455 119455 NET PATIENT AND RESIDENT SERVICE 621400 17170489 17170489 HOSPITAL REVENUE 623000 291086 291086 CLINIC REVENUE 621400 113707 113707 MISCELLANEOUS REVENUE 623000 57493 57493 NURSING HOME OFFICE RENTAL 621400 13072 13072 6502 6502 17652349 139378 139378 2336976 2187897 149079 149079 149079 1380 2000 1200 180 180 CAFETERIA & OTHER INCOME 722210 97316 97316 OTHER MISCELLANEOUS REVENUE 561499 7084 7084 104400 18164841 17652349 0 393037 X 5178 5178 1942 1942 337390 337390 6909582 6676729 232853 130739 126255 4484 1108502 1055405 53097 587380 537688 49692 35606 35606 72216 72216 3781968 3781860 108 46458 46458 188289 185672 2617 328615 324047 4568 231246 209162 22084 13931 9736 4195 96791 93878 2913 158060 142965 15095 1351804 1222707 129097 83866 83866 SUPPLIES 865796 865796 TAXES AND LICENSES 333913 333913 BAD DEBT EXPENSE 266090 250125 15965 REPAIRS AND MAINTENANCE 222364 222364 54636 51356 3280 17212362 16096778 1115584 0 4368815 4481588 2630 2718 2511279 2141414 214274 234876 141212 150964 29986435 20712083 9534913 9274352 6882896 7253290 5777810 4752769 49223 8140464 29483052 36432435 1604899 1239979 4568242 5687918 5500981 3407 3070 1550500 0 70790 7296224 12933562 X 22046143 23365641 140685 133232 22186828 23498873 29483052 36432435 952479 359566 0 X X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 0 PART II-B, LINE 1: MADISON HEALTHCARE SERVICES IS A MEMBER OF THE AMERICAN HOSPITAL ASSOCIATION (AHA) AND THE MINNESOTA HOSPITAL ASSOCIATION (MHA). A PORTION OF THEIR DUES ARE FOR LOBBYING EXPENSES. THE AHA INVESTS CONSIDERABLE DUES RESOURCES ON A BROAD RANGE OF ADVOCACY AND REPRESENTATION INITIATIVES TO HELP THE FIELD UNDERSTAND AND RESPOND TO THE LEGISLATIVE AND REGULATORY CHANGES ON THE HORIZON AND TO SUPPORT HOSPITALS AS THEY STRIVE TO DELIVER AN EVEN HIGHER QUALITY OF CARE IN THE FACE OF THOSE CHANGES. 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 22176863 15155707 7021156 6947551 5556376 1391175 855499 855499 9274352 286431 C CERTIFICATES OF DEPOSIT 1029231 C ANNUITIES 889372 C DEPOSITS 224187 C ASSETS LIMITED TO USE 2274761 C DONOR ADVISED FUNDS 48787 C 4752769 CONSTRUCTION DRAW ACCOUNT 8063672 DUE FROM RELATED ORGANIZATION 50884 OTHER RECEIVABLE 25908 8140464 THIRD PARTY PAYOR SETTLEMENT 70790 70790 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: BASED ON AN EVALUATION OF ITS TAX POSITIONS, THE ORGANIZATION HAS NOT RECORDED ANY ASSETS OR LIABILITIES RELATED TO UNCERTAIN TAX POSITIONS OR UNRECOGNIZED TAX BENEFITS AS OF SEPTEMBER 30, 2020 AND 2019. THE ORGANIZATION'S FEDERAL INFORMATIONAL RETURNS FOR TAX YEARS 2016 AND BEYOND REMAIN SUBJECT TO EXAMINATION BY THE IRS. 1 1 X 1 X 1 X 275.000000000000 1 1 1 0 1 1 33273 33273 0.00200 4615567 4322301 293266 0.01730 2246707 1365196 881511 0.05200 6895547 5687497 1208050 0.07130 121462 18280 103182 0.00610 121462 18280 103182 0.00610 7017009 5705777 1311232 0.07740 0 266090 0 3816868 4865216 -1048348 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 18 1 0 1 1 X HTTPS://MHSMN.ORG/PATIENTS-VISITORS/COMMUNITY-NEEDS-ASSESSMENT/ X 1 18 1 HTTPS://MHSMN.ORG/PATIENTS-VISITORS/COMMUNITY-NEEDS-ASSESSMENT/ 0 1 X 100.000000000000 275.000000000000 X X X X 1 1 X 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 X X X X X 1 X 0 X 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 COUNTY COMMISSIONERS, LAC QUI PARLE VALLEY SCHOOL DISTRICT, AND THE CITY OF MADISON 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 ADDED NEW ORTHOPEDIC SERVICES TO ITS LONG LIST OF SPECIALTY SERVICES. WITH THE ADDITION OF THIS NEW ORTHOPEDIC SURGEON, 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 APRIL OF 2019, MADISON HEALTHCARE SERVICES ADDED A PSYCHIATRIC MENTAL HEALTH NURSE PRACTITIONER TO OUR FAMILY PRACTICE TWO DAYS A MONTH. WE THEN ADDED MENTAL HEALTH COUNSELING SERVICES WEEKLY STARTING IN JULY OF 2019. 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. PLANS WERE TO HAVE AMY DEE DO A PRESENTATION FOR STAFF AND THE COMMUNITY ON MENTAL FLEXIBILITY - SHIFT YOUR PERSPECTIVE, CHANGE YOUR LIFE IN MAY 2020 - DUE TO COVID-19, THE PRESENTATION WAS POSTPONED AND PLANS ARE TO HOLD THE EVENT 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 MASKING, SOCIAL DISTANCING, ETC AND WE PUT INFORMATION ON OUR WEBSITE AND OUR FACEBOOK PAGE.TELEHEALTH SERVICES WERE ADDED 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 HAD 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.THE EMERGENCY PREPAREDNESS TEAM MET WEEKLY. STAFF TESTING FOR COVID-19 WAS DONE WEEKLY ONCE COUNTY INFECTION RATES INCREASED TO KEEP OUR STAFF, PATIENTS, RESIDENTS AND COMMUNITY SAFE.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 OPERATING ROOM, MADISON HOSPITAL ADDED A NEPTUNE ROVER, DOCKING STATION, AND ORTHOPEDIC SURGERY EQUIPMENT IN ORDER TO START DOING TOTAL JOINT SURGERIES AT THE FACILITY; ADDITIONALLY, A BLOOD GAS ANALYER AND ECG SYSTEM WERE ADDED/UPGRADED IN THE LAB. WIRELESS ACCESS EQUIPMENT WAS ADDED/UPDGRADED FOR STAFF TO REMOTE IN FROM HOME AS NECESSARY. THE HOPSITAL ADDED A NEW STRETCHER FOR THE EMERGENCY ROOM AND PURCHASED 4 ADDITIONAL STRYKER BEDS DUE TO RECEIVING TEMPORARY ADDITIONAL BED CPAACITY FOR COVID PATIENT OVERFLOW. 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. 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 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 $ 266,090. PART II, COMMUNITY BUILDING ACTIVITIES: MADISON HOSPITAL DOES ULTRASOUND SCREENINGS AT REDUCED RATES TWICE A YEAR AND HAS A VARIETY OF LAB TESTS AT REDUCED RATES (DIRECT-ACCESS LAB), AS WELL AS OTHER COMMUNITY BUILDING ACTIVITIES. MANY OF THE COMMUNITY BUILDING ACTIVITIES ARE NOT EASY OR COST EFFECTIVE TO TRACK IN THE ACCOUNTING SYSTEM AND ARE THEREFORE NOT REPORTED. 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 $1,048,348 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 $39,554. 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 2020 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 $53,071 GROSS. ON AVERAGE THE POVERTY LEVEL IN THE COUNTY IS ABOUT 9.5% WITH MANY PEOPLE BEING LAID OFF. THE PERCENTAGE OF FAMILIES ON MEDICAID IS APPROXIMATELY 34.44%, RECEIVING SOME TYPE OF MEDICAL ASSISTANCE OR COUNTY ASSISTANCE. 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. IN THE PAST, THE RADIOLOGY DEPARTMENT HOLDS VASCULAR SCREENINGS IN WHICH COMMUNITY MEMBERS MAY HAVE VASCULAR SCREENINGS TO DETECT STROKES, PERIPHERAL VASCULAR DISEASE, AND ABDOMINAL AORTIC ANEURYSMS THREE TIMES A YEAR. THIS IS A CASH-BASED SCREENING AND IS AVAILABLE AT A SUBSTANTIALLY REDUCED RATE AND A DOCTOR'S ORDER IS NOT REQUIRED. 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 $15,000. MADISON HOSPITAL AND LAC QUI PARLE CLINIC DONATE ALL UNUSED MEDICAL EQUIPMENT TO A MISSION FOR MEDICAL USE. DUE TO COVID-19, THESE SCREENINGS WERE PAUSED, BUT THE ORGANIZATION HOPES TO CONTINUE WITH SCREENINGS SOON.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 CREATES A NEW WING AND REPLACES AN OLDER AREA WITH UNDERGROUND ISSUES. THE NEW WING WILL CREATE A HOMELIKE ATMOSPHERE FOR THE RESIDENTS AND EFFICIENCIES FOR THE STAFF. THIS IS PLANNED TO BE COMPLETED NI JULY 2021. ONCE A CURRENT AREA IS DEMOLISHED, A 12-UNIT INDEPENDENT/ASSISTED LIVING FACILITY WILL BE BUILT TO SERVE THE COMMUNITY NEEDS. THIS IS SCHEDULED TO BE COMPLETED IN THE FALL OF 2022.MADISON HOSPITAL PROVIDED HEALTH CARE SCREENINGS AT REDUCED RATES TO THE COMMUNITY.IN THE PREVIOUS YEAR, MADISON HOSPITAL OFFERED A BREAST FEEDING CLASS FOR EXPECTING NEW MOTHERS TWICE DURING THE YEAR. THE CLASS WAS DISCONTINUED DUE TO COVID-19, BUT THE HOSPITAL HOPES TO CONTINUE CLASSES SOON.MADISON HOSPITAL ADDED ANOTHER ORTHOPEDIC SURGEON WITH PLANS TO DO SOME TOTAL JOINT SURGERIES IN THE UPCOMING YEAR SO PATIENTS DO NOT HAVE TO TRAVEL AND CAN RECOVER CLOSER TO HOME. MADISON HOSPITAL ADDED A MENTAL HEALTH PROVIDER IN 2019 WHO PROVIDES SERVICES IN THE CLINIC TWO DAYS A MONTH. ADDITIONALLY, A NEW SOCIAL WORKER ADDED DURING THE YEAR WHO PROVIDES COUNSELING SERVICES ONE DAY A WEEK. 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 UPDATE ITS DIGITAL X-RAY EQUIPMENT, INCLUDING A NEW PORTABLE DIGITAL X-RAY RESULTING IN MORE OPTIONS WHEN PERFORMING BEDSIDE IMAGING. PART VI, LINE 7, REPORTS FILED WITH STATES MN X X X 0 1 0 0 0 0 0 0 0 BRANT HACKER MD MEDICAL DOCTOR 246539 0 4400 0 146970 0 33379 0 0 0 431288 0 0 0 MARIA NOLTE MD MEDICAL DOCTOR 198183 0 0 0 41440 0 6199 0 28811 0 274633 0 0 0 ERIK BJERKE PRESIDENT/CEO 169468 0 0 0 0 0 12347 0 24011 0 205826 0 0 0 A CITY OF MADISON MINNESOTA 416005335 2012-05-03 7750000 FINANCE FACILITY EXPANSION 0 0 0 A 2265734 7750000 155000 7595000 7157422 583905 8673 2015 0 0 0 1 A 0 0 0 0 0 0 1 A 0 1 0 0 1 0 0 0 1 A 1 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 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 WAS 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. 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. 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 3,771,768. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 3,771,768. CONSULTANTS: PROGRAM SERVICE EXPENSES 10,092. MANAGEMENT AND GENERAL EXPENSES 108. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 10,200. 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 900 SECOND AVENUE MADISON MN 56256 411376605 HOUSING FOR HANDICAPPED AND ELDERLY 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 1