2019-08-07T11:21:16-05:00 2018-09-30 420714325 RSM US LLP 801 NICOLLET MALL WEST TOWER STE 1100 MINNEAPOLIS MN 554022526 990 2017-10-01 410706115 MADISON HEALTHCARE SERVICES MADI 3205987536 900 SECOND AVENUE MADISON MN 562561006 ERIK BJERKE PRESIDENT/CEO 3205987536 2019-07-31 1 KACIE MCEWEN P01599614 6123324300 66.98.98.1 2019-07-31 14:40:34 CD P DA39A3EE5E6B4B0D3255BFEF95601890AFD80709 B56786F7D21A8F39D00ED83C272556B8DDCB8C36 2017 2019-02-21 02:37:17Z ERIK BJERKE 900 SECOND AVENUE MADISON MN 562561006 16896916 0 X MHSMN.ORG X 1945 MN TO PROVIDE HEALTH CARE, RESIDENTIAL AND COMMUNITY SERVICE IN A COMPETENT AND CARING MANNER. 7 7 222 125 0 0 51246 138743 16807296 16387755 159770 239951 140212 128102 17158524 16894551 10492 15228 0 0 8832527 8872042 0 0 0 7616805 7720112 16459824 16607382 698700 287169 28212878 28966413 8566499 8630055 19646379 20336358 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 7940771 15228 9045053 MADISON HOSPITAL & OUTREACH -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 ECONOMIC SUPPORT/REFERRAL TO RESIDENTS AND FAMILIES, OBSTETRICS, PEDIATRICS, SURGERY, EMERGENCY CARE, CARDIAC REHAB, OUTPATIENT, OUTREACH AND INPATIENT CARE. THE HOSPITAL HAD 12,834 OUTPATIENT VISITS AND 1,491 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 FOREGONE FOR SERVICES AND SUPPLIES FURNISHED UNDER ITS CHARITY CARE POLICY AND EQUIVALENT SERVICE STATISTICS. THE AMOUNT OF CHARGES FOREGONE, BASED ON ESTABLISHED RATES, WAS $79,886 FOR THE YEAR ENDED SEPTEMBER 30, 2018. 5277482 0 5129445 NURSING HOME -MADISON LUTHERAN HOME IS A 65 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. THE MADISON LUTHERAN HOME HAS DONE NUMEROUS REMODELING PROJECTS 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, 2018 WAS 45 RESIDENTS. 2470343 0 2188864 LAC QUI PARLE CLINIC -THE MEDICAL STAFF AT THE CLINIC CONSISTS OF THREE M.D.'S , TWO PA-C'S AND TWO NURSE PRACTIONER 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. 15688596 1 1 0 1 0 0 0 0 1 0 1 1 0 0 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 7 0 1 222 1 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 56256 JOEL CHURNESS CHAIRMAN 0.50 0.00 X X 0 0 0 BRANDON ULSTAD SECRETARY 0.50 0.10 X X 0 0 0 JOHN MAATZ DIRECTOR 0.50 0.00 X 0 0 0 ANGIE SHELSTAD DIRECTOR 0.50 0.00 X 0 0 0 DENISE CONNOR DIRECTOR 0.50 0.00 X 0 0 0 WAYNE ENGER DIRECTOR 0.50 0.10 X 0 0 0 LYNN ZIMMERMAN DIRECTOR 0.50 0.00 X 0 0 0 DIANE MORKEN DIRECTOR (10/1/17 - 12/31/17) 0.50 0.00 X 0 0 0 ERIK BJERKE PRESIDENT/CEO 40.00 0.10 X 128205 0 43154 CAROL BORGERSON CHIEF FINANCIAL OFFICER 40.00 2.00 X 65975 0 27437 LAURA HONG MD MEDICAL DOCTOR 40.00 0.00 X 187993 0 28000 BRANT HACKER MD MEDICAL DOCTOR 40.00 0.00 X 276805 0 144984 MICHAEL DEYO PA PHYSICIAN ASSISTANT 40.00 0.00 X 103634 0 15984 MARIA NOLTE PHYSICIAN 40.00 0.00 X 205544 0 29664 968156 0 289223 7 0 1 0 BIG STONE THERAPIES INC 340 WASHINGTON ORTONVILLE MN 56278 CONTRACT THERAPY SERVICES 928614 CENTRACARE HEALTH 1406 6TH AVENUE N ST CLOUD MN 56303 EMR - SOFTWARE, TRAINING 318385 CENTRAL MINNESOTA DIAGNOSTICS PO BOX 158 - 150 10TH ST W MILACA MN 56353 CONTRACT CT AND ULTRASOUND 244116 ACUTE CARE 1609 N ANKENY BLVD SUITE 200 ANKENY IA 50023 CONTRACT LOCUM COVERAGE 199933 RSM 5155 PAYSHPERE CIRCLE CHICAGO IL 60674 AUDIT, REPORTING, EMR SOFTWARE 126456 5 138743 138743 NET PATIENT AND RESIDENT SERVICE 621400 16029412 16029412 HOSPITAL REVENUE 623000 213927 213927 CLINIC REVENUE 621400 117442 117442 NURSING HOME OFFICE RENTAL 621400 15865 15865 HOSPITAL ROOM FEES 621400 8528 8528 2581 2581 16387755 230401 230401 9550 0 9550 9550 9550 7960 2365 5595 5595 CAFETERIA & OTHER INCOME 722210 122507 122507 122507 16894551 16387755 0 368053 X 13799 13799 1429 1429 250637 250637 7037928 6800750 237178 154670 149365 5305 830385 790610 39775 598422 547795 50627 18557 17911 646 103444 95406 8038 3016055 3015911 144 40151 39593 558 167731 165400 2331 339040 334327 4713 247517 223879 23638 24823 17349 7474 97575 94638 2937 184152 166565 17587 1853344 1676350 176994 72867 72867 SUPPLIES 724691 724691 TAXES AND LICENSES 380118 380118 REPAIRS AND MAINTENANCE 232286 218511 13775 BAD DEBT EXPENSE 157690 157690 60071 56509 3562 16607382 15688596 918786 0 2538991 4191388 1761 902 2468834 1749929 241555 225265 265701 237451 28153308 17656166 11939965 10497142 6210736 6745448 4545335 5270797 0 48091 28212878 28966413 1257329 1606988 6586644 6153325 3854 3377 718672 866365 8566499 8630055 X 19537426 20209653 108953 126705 19646379 20336358 28212878 28966413 287169 402809 0 X 0 1 X 1 0 X 0 0 0 0 0 0 0 0 1 1084 1084 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. THROUGHOUT 2017, THE AHA CONTINUED TO INVEST 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 620664 620664 21481391 13447527 8033864 6051253 4208639 1842614 10497142 248830 C CERTIFICATES OF DEPOSIT 715833 C ANNUITIES 710176 C CASH AND INTEREST-BEARING DEPOSITS 205938 C ASSETS LIMITED TO USE 3333638 C DONOR ADVISED FUNDS 56382 C 5270797 DEFERRED COMPENSATION 866365 866365 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, 2018 AND 2017. THE ORGANIZATION'S FEDERAL INFORMATIONAL RETURNS FOR TAX YEARS 2013 AND BEYOND REMAIN SUBJECT TO EXAMINATION BY THE INTERNAL REVENUE SERVICE. 1 1 X 1 X 1 X 275.000000000000 1 1 1 0 1 1 314724 0 314724 0.01910 3267247 4006554 0 0.00000 1203906 888810 315096 0.01920 4785877 4895364 629820 0.03830 138820 20569 118251 0.00720 0 0 0 0 0 0 0 0 138820 20569 118251 0.00720 4924697 4915933 748071 0.04550 0 157690 0 5091493 5090573 920 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 15 1 0 1 1 X HTTPS://MHSMN.ORG/PATIENTS-VISITORS/COMMUNITY-NEEDS-ASSESSMENT/ X 1 15 1 HTTPS://MHSMN.ORG/PATIENTS-VISITORS/CHARITY-CARE-POLICY-FINANCIAL/ 0 1 X 100.000000000000 275.000000000000 X X X X 1 1 X X X 1 X WWW.MHSMN.ORG/PATIENTS/CHARITY-CARE-POLICY-FINANCIAL/ X HTTPS://MHSMN.ORG/PATIENTS-VISITORS/CHARITY-CARE-POLICY-FINANCIAL/ X HTTPS://MHSMN.ORG/PATIENTS-VISITORS/CHARITY-CARE-POLICY-FINANCIAL/ X X X X X X 1 X 0 X X X 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 HELTH, LAC QUI PARLE COUNTY FAMILY SERVICE CENTER, LAC QUI PARLE HEALTH NETWORK AND MADISON HEALTHCARE AUXILIARY. MADISON HOSPITAL PART V, SECTION B, LINE 11: BY UTILIZING BOTH THE PRIMARY AND SECONDARY DATA, WE RESEARCHED AND ANALYZED, THE COMMUNITY HEALTH NEEDS COMMITTEE WAS ABLE TO IDENTIFY AND PRIORITIZE HEALTH NEEDS IN OUR COMMUNITY. SIGNIFICANT DATA ANALYZED AND DEVELOPED PROVIDED EVIDENCE THAT CARE IN OUR AREA WAS EXPERIENCING HEALTH GAPS WHEN IT CAME TO THE SERVICES WE PROVIDED FOR THESE HEALTH CONDITIONS. USING RESOURCES WITH OUR COMMUNITY MEMBERS AND PROFESSIONALS, WE DECIDED TO FOCUS ON TWO KEY HEALTH NEEDS THAT OUR COMMUNITY WOULD GREATLY BENEFIT FROM. THE TWO HEALTH NEEDS IDENTIFIED AND PRIORITIZED BY OUR COMMITTEE INCLUDE DIABETES AND PAIN MANAGEMENT.AN IMPLEMENTATION PLAN WAS DEVELOPED TO TREAT EACH OF THESE CHRONIC AND ACUTE DISEASES AS A SEPARATE HEALTH NEED SINCE THEY WILL REQUIRED DIFFERENT MEASURES TO BE TAKEN TO ADDRESS THE ISSUE. THE COMMUNITY ISSUES CONCERNING THESE CHRONIC AND ACUTE DISEASES ARE THE LACK OF LOCAL OUTREACH PROVIDER SERVICES, EDUCATION/RESOURCES, AND PREVENTATIVE ACTION. CHRONIC AND ACUTE DISEASES TAKE A TOLL ON WHOMEVER THEY AFFECT. LOW-INCOME AND UNINSURED INDIVIDUALS AND FAMILIES WHO ARE AFFECTED BY CHRONIC AND ACUTE DISEASE SUFFER HUGE FINANCIAL BURDENS. THE GOAL IS TO IMPLEMENT PROGRAMS THAT HELP SUPPORT THESE PEOPLE FINANCIALLY, EMOTIONALLY, AND PSYCHOLOGICALLY. THE COMMUNITY HEALTH NEEDS COMMITTEE DEVISED A BUDGET THAT WAS INTEGRATED INTO MADISON HOSPITAL'S OVERALL BUDGET AND STRATEGIC PLAN.THE IMPLEMENTATION PLAN WAS EXECUTED AND MONITORED WITH THE FOLLOWING ACTIONS:COMMUNITY WELLNESS PROGRAM - THE LAC QUI PARLE HEALTH NETWORK (LQPHN) IS A NON-PROFIT TAX-EXEMPT HOSPITAL SERVICES COOPERATIVE FOR THREE LOCAL, RURAL COMMUNITY HOSPITAL-BASED PROVIDER ORGANIZATIONS INCLUDING MADISON HEALTHCARE SERVICES, JOHNSON MEMORIAL HEALTH SERVICES, AND APPLETON AREA HEALTH SERVICES. IN AN EFFORT TO HELP MOTIVATE THE MADISON, APPLETON & DAWSON AREA TO GET ACTIVE THE LAC QUI PARLE HEALTH NETWORK (LQPHN) HOSTED A SIX-WEEK "FALL INTO FITNESS CHALLENGE". PARTICIPANTS WERE CHALLENGED TO MEET THE SET WEEKLY GOALS BY LOGGING MILES OR CONVERTING ANY MODE OF EXERCISE TO MILES. THE CHALLENGE STARTED ON SEPTEMBER 22ND AND ENDED NOVEMBER 2ND. THERE WAS A TOTAL OF 216 PARTICIPANTS THAT LOGGED A COMBINED TOTAL OF 14,561 MILES. OF THESE PARTICIPANTS, 83 MET THE MILE GOAL EACH WEEK.DIRECT LAB ACCESS PROGRAM - ALLOWS PATIENTS TO ORDER AND RECEIVE LAB WORK WITHOUT A PHYSICIAN'S ORDER AND ON A CASH BASIS.PROGRAMS FOR UNINSURED, LOW-INCOME AND MINORITY GROUPS - EVERY PATIENT IS TREATED REGARDLESS OF THEIR ABILITY TO PAY. MADISON HEALTHCARE SERVICES HAS A CHARITY CARE POLICY FOR PATIENTS WHO HAVE DEMONSTRATED AN INABILITY TO PAY.CONTRACT WITH LAC QUI PARLE SCHOOL DISTRICTS - MADISON HOSPITAL HAS CONTRACTED WITH LAQ QUI PARLE SCHOOL DISTRICTS TO PROVIDE HEALTH SCREENING TO THEIR EMPLOYEES ONCE A YEAR. WE ALSO WORKED WITH SCHOOL DISTRICTS AND A DIETICIAN TO MODIFY SCHOOL MENUS TO MAKE THEM HEALTHIER.ESTABLISHED EDUCATION RESOURCES - ONE OF THE BIGGEST CHALLENGES IN OUR RURAL COMMUNITIES WAS THE LACK OF EDUCATION ON CHRONIC AND ACUTE DISEASES. THERE WERE NOT MANY RESOURCES PEOPLE COULD TURN TO IF THEY NEEDED GUIDANCE WITH PROPERLY DEALING WITH DIABETES AND OTHER HEALTH ISSUES. AROUND 1 IN 4 PEOPLE WITH DIABETES DO NOT KNOW THAT THEY HAVE THE DISEASE (DEPARTMENT OF HEALTH) SO IT IS IMPERATIVE TO HAVE EDUCATION READILY AVAILABLE TO OUR COMMUNITY. MADISON HEALTHCARE SERVICES (MHS) HAS APPOINTED ONE OF OUR STAFF AS AN INSULIN PUMP TRAINER AND DIABETIC ADVOCATE FOR OUR COMMUNITY. SHE WORKS WITH PATIENTS TO GET THEIR INSULIN PUMP SET-UP CORRECTLY WITH THE CORRECT INSULIN DOSING PER PHYSICIAN ORDERS. SHE ALSO HAS BEEN IN CONTACT WITH OUR DIABETIC DISTRIBUTOR IN ORDER TO ARRANGE AN INFORMATIONAL MEETING FOR ALL DIABETIC PATIENTS FROM OUR COMMUNITY. THE LAC QUI PARLE DIABETIC GROUP HOLDS MEETINGS ONCE A MONTH APRIL-DECEMBER. AT THE MEETINGS, THEY HAVE SPEAKERS EDUCATE THEM ON DIFFERENT ASPECTS OF LIVING, TREATING, AND MANAGING DIABETES. MHS CONTINUES TO BE A RESOURCE FOR THEM AS WELL AS PROVIDING STAFF SPEAKERS TO PRESENT THROUGHOUT THE YEAR. THEY HAVE NEW SPEAKERS EVERY MONTH TO EDUCATE MEMBERS ON DIFFERENT ASPECTS OF DIABETES. ANOTHER EDUCATION RESOURCE THAT WE HOPE TO IMPLEMENT IS HAVING ONE OF OUR PROVIDERS GO LIVE ON THE LOCAL RADIO STATION TO DISCUSS CHRONIC AND ACUTE DISEASES. HE REMINDED PEOPLE TO GET THEIR ANNUAL CHECK-UPS IN ORDER TO CONSISTENTLY MONITOR THEIR BLOOD PRESSURE, CHOLESTEROL, AND SO ON. BY USING THE RADIO, WE ALSO ALLOWED PEOPLE TO CALL IN WITH QUESTIONS THEY WANTED TO ASK OUR PROVIDERS. MHS' RADIOLOGY DEPARTMENT ALSO OFFERS VASCULAR SCREENINGS ON A CASH-BASED SERVICE.DIABETIC PRESENTATION FOR COMMUNITY - MADISON HEALTHCARE SERVICES PROVIDES "EVERYONE WITH DIABETES COUNTS" CLASSES, WHICH IS A 6-WEEK LONG SESSION ON DIABETES EDUCATION AND WE LAST HELD IT IN JUNE 2018. CLINIC PROVIDERS AND NURSES ALSO RECEIVED FURTHER EDUCATION ON MEDTRONIC INSULIN PUMPS 11/13/2018 AND THE NEW BLOOD GLUCOSE MONITORING BY LAB STAFF (NOT SURE WHEN THAT WAS). THE CLINIC HAS CONTINUED TO SUPPLY SPEAKERS FOR THE DIABETIC CLUB IN TOWN.UPGRADED EQUIPMENT, SERVICES AND EXPANDED SPACE - MADISON HEALTHCARE SERVICES SURGERY DEPARTMENT IS NOW EQUIPPED AND HAS BEGUN PERFORMING RADIOFREQUENCY ABLATION FOR TREATMENT OF VARICOSE VEINS AND THOSE PATIENTS DIAGNOSED WITH VENOUS INSUFFICIENCY. TELEMEDICINE EQUIPMENT WAS PURCHASED IN 2015 WITH PLANS TO EXPAND THE TELEMEDICINE SERVICES IN THE AREAS OF INFECTIOUS DISEASE AND PULMONOLOGY. IN 2016, OMNICELL WAS PURCHASED FOR THE ER WITH PLANS TO GO-LIVE AFTER NOVEMBER OF 2016. THE HOSPITAL PURCHASED NEW SMART PUMPS FOR INPATIENTS IN JULY OF 2016. THESE ARE IV PUMPS WITH A BUILT-IN DRUG LIBRARY TO FACILITATE PATIENT SAFETY. IN MAY OF 2016 MADISON HEALTHCARE SERVICES HIRED A FULL TIME PHARMACIST FOR THE HOSPITAL.THE MINNESOTA DEPARTMENT OF HEALTH HAS CERTIFIED 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 HEALTH CARE. HEALTH CARE HOMES, ALSO KNOWN AS "MEDICAL HOMES," OFFER A TEAM APPROACH TO PRIMARY CARE MAKING IT EASIER FOR PATIENTS TO COMMUNICATE AND PARTNER WITH THEIR CARE TEAM. CARE TEAMS CAN INCLUDE CLINICIANS, NURSES, SPECIALISTS, CARE COORDINATORS AND COMMUNITY RESOURCES.THE LAC QUI PARLE CLINIC CONTINUES ITS CERTIFICATION AS A PATIENT CENTERED MEDICAL HOME FOCUSING ON POPULATION HEALTH AND CHRONIC CARE MANAGEMENT. THE MEDICAL HOME HAS A COMMUNITY CONNECTION TEAM MEETING QUARTERLY INCLUDING VARIOUS COMMUNITY RESOURCES SUCH AS FAMILY SERVICES, PUBLIC HEALTH, HOME CARE, THE LOCAL SCHOOLS, ETC. THE MEET TO SHARE HAPPENINGS AND VARIOUS RESOURCES AVAILABLE TO THE COMMUNITY. THE LAC QUI PARLE CLINIC IS ALSO PARTICIPATING IN THE ECHO PROJECT WITH ST. GABRIELS RURAL OPIOID PROGRAM, WHICH IS HELPING CLINICS AROUND THE STATE OF MINNESOTA COMBAT THE OPIOID CRISIS, EDUCATING PROVIDERS AND STAFF ON BEST PRACTICES AND PROCESSES MOVING FORWARD IN PROVIDING CARE FOR THESE PATIENTS. THIS INVOLVES A WEEKLY MEETING OPEN TO PROVIDERS AND STAFF IN THE CLINIC WITH EDUCATIONAL TOPICS PRESENTED. THE INFORMATION GATHERED HERE HAS ASSISTED US IN DEVELOPING OUR CURRENT POLICIES AND PROCESSES IN LINE WITH THE RECOMMENDATIONS BY MOH. MADISON HOSPITAL PART V, SECTION B, LINE 13H: IF THE APPLICATION IS NOT RETURNED OR RETURNED NOT COMPLETED IN FULL - OTHER PATIENT MARKERS CAN BE USED TO APPROVE PATIENT FOR CHARITY CARE - EXAMPLE WIC, FOOD STAMPS, FREE LUNCHES, MA SPEND DOWN, LOW INCOME HOUSING, ETC.. 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 CLINIC PART I, LINE 3C: IN ADDITION TO COMPARING THE FAMILY'S INCOME TO THE FEDERAL POVERTY GUIDELINES, FAMILY NET ASSETS MUST BE LESS THAN $10,000. 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 $ 157,690. PART II, COMMUNITY BUILDING ACTIVITIES: MADISON HOSPITAL DOES ULTRASOUND SCREENINGS AT REDUCED RATES TWICE A YEAR; HAS A VARIETY OF LAB TEST AT REDUCED RATES (CALLED DIRECT ACCESS LAB) ANY PATIENT CAN REQUEST AND PAY CASH 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: SEE EXPLANATION FOR PART III, LINE 4. PART III, LINE 4: THE FOLLOWING IS A PORTION OF THE PATIENT AND RESIDENT ACCOUNTS RECEIVABLE, FOOTNOTE 2 OF THE AUDITED FINANCIAL STATEMENT; PATIENT AND RESIDENT ACCOUNTS RECEIVABLE, DUE DIRECTLY FROM THE PATIENTS, ARE CARRIED AT THE ORIGINAL CHARGE FOR THE SERVICES PROVIDED LESS AMOUNTS COVERED BY THIRD-PARTY PAYORS AND LESS AN ESTIMATED ALLOWANCE FOR UNCOLLECTIBLE ACCOUNTS. THE ALLOWANCE FOR UNCOLLECTIBLE ACCOUNTS IS BASED UPON MANAGEMENT'S ASSESSMENT OF EXPECTED NET COLLECTIONS. CONSIDERING HISTORICAL NET COLLECTION, BUSINESS AND ECONOMIC CONDITIONS, TRENDS IN HEALTH CARE COVERAGE, AND OTHER COLLECTION INDICATORS. PERIODICALLY THROUGHOUT THE YEAR, MANAGEMENT ASSESSES THE ADEQUACY OF THE ALLOWANCE FOR UNCOLLECTIBLE ACCOUNTS BASED UPON HISTORICAL WRITE-OFF EXPERIENCE BY PAYOR CATEGORY. THE RESULTS OF THIS REVIEW ARE THEN USED TO MAKE ANY MODIFICATION TO THE PROVISION FOR UNCOLLECTIBLE ACCOUNTS TO ESTABLISH AN APPROPRIATE ALLOWANCE FOR UNCOLLECTIBLE ACCOUNTS. AFTER SATISFACTION OF AMOUNTS DUE FROM INSURANCE, THE ORGANIZATION FOLLOWS ESTABLISHED GUIDELINES FOR PLACING CERTAIN PAST-DUE BALANCES WITH COLLECTION AGENCIES, SUBJECT TO THE TERMS OF CERTAIN RESTRICTIONS ON COLLECTION EFFORTS AS DETERMINED BY THE ORGANIZATION. PART III, LINE 8: THE COSTING METHODOLOGY USED TO DETERMINE THE MEDICARE ALLOWABLE COST REPORTED IN THE MEDICARE COST REPORT IS THE COST TO CHARGE RATIO. 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 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 IN 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 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, THE DIABETES FOUNDATION, AND THE CITY OF MADISON. USING THE INFORMATION COLLECTED, THE COMMUNITY HEALTH NEEDS COMMITTEE DETERMINED THE HEALTH NEEDS FOR THE COUNTY. THE NEXT STEP FOR MHS WAS TO FORM COLLABORATIONS WITH THE LAC QUI PARLE HEALTH NETWORK, LAC QUI PARLE SCHOOL DISTRICT, AND THE MADISON HEALTHCARE AUXILIARY TO APPROACH AND EXECUTE AN IMPLEMENTATION STRATEGY. 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 FACILITY IS 25 MILES AWAY, BEING CANBY, DAWSON, APPLETON OR ORTONVILLE. THE AVERAGE INDIVIDUAL INCOME IS APPROXIMATELY $50,195 GROSS. ON AVERAGE THE POVERTY LEVEL IS THE COUNTY IS AT ABOUT 9.8% WITH MANY PEOPLE BEING LAID OFF, AND FAMILIES OF 3 OR MORE. THE PERCENTAGE OF FAMILIES ON MEDICAID IS APPROXIMATELY 35%, 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 COMMUNITY AND ARE NEITHER EMPLOYEES NOR CONTRACTORS OF THE ORGANIZATION. THE ORGANIZATION EXTENDS MEDICAL STAFF PRIVILEGES TO ALL QUALIFIED PHYSICIANS IN ITS COMMUNITY SUCH AS DR. CLINT BONN, CHIROPRACTOR. DR. BONN UTILIZED MADISON HOSPITAL LABORATORY FOR DOT DRUG TESTING AND MADISON HOSPITAL RADIOLOGY FOR ALL X-RAY AND CT STUDIES. THREE TIMES A YEAR, THE RADIOLOGY DEPARTMENT HOLDS VASCULAR SCREENINGS IN WHICH COMMUNITY MEMBERS MAY HAVE VASCULAR SCREENINGS TO DETECT STROKES, PERIPHERAL VASCULAR DISEASE, AND ABDOMINAL AORTIC ANEURYSMS. THIS IS A CASH BASED SCREENING AND IS AVAILABLE AT A SUBSTANTIALLY REDUCED RATE AND A DOCTOR'S ORDER IS NOT REQUIRED. MADISON HOSPITAL LAB OFFERS DIRECT ACCESS LAB TESTING TO ITS COMMUNITY MEMBERS. THIS IS A CASH BASED PROGRAM WHERE LAB TESTS ARE OFFERED ON A CASH BASIS AT A SUBSTANTIALLY REDUCED RATE. LAST YEAR, OUR USERS SAVED OVER $12,000. MADISON HOSPITAL AND LAC QUI PARLE CLINIC DONATE ALL UNUSED MEDICAL EQUIPMENT TO A MISSION FOR MEDICAL USE.ALL EXPIRED LABORATORY SUPPLIES ARE SENT TO THE MEDICAL LAB TECHNICIAN PROGRAMS FOR USE IN THEIR STUDENT LABS. MADISON HOSPITAL IS CONSTANTLY STRIVING TO ADD NEW SERVICES, INCLUDING OUTREACH SERVICES TO BETTER SERVE THE NEEDS OF OUR COMMUNITY. A LEADERSHIP TEAM HAS BEEN FORMED TO MEET THE COMMUNITY NEEDS, CONTINUE TO LOOK AT ADDING NEW SERVICES, CONTINUE TO LOOK AT UPDATING OUR CURRENT FACILITY, AND ASKING FOR COMMUNITY INVOLVEMENT IN FINAL DECISION MAKING. WITH OUR AGING POPULATION, WE STRIVE TO BRING THE SERVICES TO THE PATIENTS, RATHER THAN THE PATIENTS HAVING TO DRIVE HOURS FROM HOME TO GET THE SERVICES.ONE OF THE SERVICES MADISON HOSPITAL PROVIDES IS AN ALZHEIMERS CAREGIVER SUPPORT GROUP. THIS IS A COMMUNITY SUPPORT GROUP LEAD BY THE MADISON HOSPITAL HOME CARE DEPARTMENT. THIS GROUP MEETS MONTHLY. THIS IS A CONFIDENTIAL GROUP MEETING, WHERE MEMBERS CAN VOICE FRUSTRATIONS AND CONCERNS BEING A CAREGIVER WITH OTHERS WHO ARE GOING THROUGH THE SAME ORDEAL. WE AS A HOME CARE AGENCY ALSO PROVIDE EDUCATION TO THIS GROUP ON VARIOUS TOPICS FROM DAILY CARES TO DISEASE PROCESS AND POSITIVE ENCOURAGEMENT.MADISON HOSPITAL PROVIDED HEALTH CARE SCREENINGS AT REDUCED RATES TO THE COMMUNITY. PART VI, LINE 7, REPORTS FILED WITH STATES MN X X X 0 1 0 0 0 0 0 0 0 ERIK BJERKE PRESIDENT/CEO 128205 0 0 0 0 0 5473 0 37681 0 171359 0 0 0 LAURA HONG MD MEDICAL DOCTOR 187993 0 0 0 0 0 16000 0 12000 0 215993 0 0 0 BRANT HACKER MD MEDICAL DOCTOR 276805 0 0 0 0 0 66984 0 78000 0 421789 0 0 0 MARIA NOLTE PHYSICIAN 205544 0 0 0 0 0 6651 0 23013 0 235208 0 0 0 PART I, LINE 4B THE ORGANIZATION PROVIDES AN UNQUALIFIED DEFERRED COMPENSATION PLAN WITH PHYSICIAN AS PART OF THE EMPLOYMENT CONTRACT. INVESTMENTS IN MUTUAL FUNDS DESIGNATED FOR DEFERRED COMPENSATION UNDER THIS PLAN ARE RECORDED AS ASSETS LIMITED AS TO USE, AND CALLS FOR ANNUAL DEPOSITS OF $10,000 TO THE PLAN FROM THE ORGANIZATION. THIS AGREEMENT IS IN THE PLACE FOR DR. LAURA HONG AND DR. BRANT HACKER. FOR DR. LAURA HONG, $10,000 WAS DEPOSITED IN THE CURRENT YEAR AND FOR DR. BRANT HACKER, $28,000 WAS DEPOSITED IN THE CURRENT YEAR. A CITY OF MADISON MINNESOTA 416005335 2012-05-03 7750000 FINANCING FACILITY EXPANSION 0 0 0 A 1544814 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 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. 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 3,002,474. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 3,002,474. CONSULTANTS: PROGRAM SERVICE EXPENSES 13,437. MANAGEMENT AND GENERAL EXPENSES 144. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 13,581. 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 0