MADISON HEALTHCARE SERVICES: Form 990, tax year 2014
View the entire original 990 at ProPublica ↗
- Organization
- MADISON HEALTHCARE SERVICES (EIN 41-0706115)
- Tax period
- 2014-10-01 to 2015-09-30
- Filed
- 2017-01-09
- IRS object ID
- 201730099349301028
- Schema version
- 2014v6.0
- 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 H
- Schedule J
- Schedule K
- Schedule O
- Schedule R
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return | 2017-01-09T15:29:13-06:00 | ReturnTs |
| Tax Period End | 2015-09-30 | TaxPeriodEndDt |
Preparer Firm PreparerFirmGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Firm EIN | 420714325 | PreparerFirmEIN |
Preparer Firm Name PreparerFirmName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | RSM US LLP | BusinessNameLine1Txt |
Preparer US Address PreparerUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 801 NICOLLET MALL SUITE 1100 | AddressLine1Txt |
| City | MINNEAPOLIS | CityNm |
| State Abbreviation | MN | StateAbbreviationCd |
| ZIP | 55402 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnTypeCd |
| Tax Period Begin | 2014-10-01 | 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 | 56256 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | ERIK BJERKE | PersonNm |
| Person Title | PRESIDENT/CEO | PersonTitleTxt |
| Phone | 3205987536 | PhoneNum |
| Signature | 2017-01-09 | SignatureDt |
| Discuss With Paid Preparer | Yes (1) | DiscussWithPaidPreparerInd |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | TODD A JACKSON | PreparerPersonNm |
| PTIN | P00092672 | PTIN |
| Phone | 6123324300 | PhoneNum |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2014 | TaxYr |
| Build TS | 2017-02-10 21:41:12Z | 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 | 56256 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $15,404,104 | GrossReceiptsAmt |
| Group Return For Affiliates | 0 | GroupReturnForAffiliatesInd |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | WWW.MLHMN.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 | 292 | TotalEmployeeCnt |
| Total Volunteers | 250 | TotalVolunteersCnt |
| Total Gross UBI | $0 | TotalGrossUBIAmt |
| Net Unrelated Bus Txbl Incm | $0 | NetUnrelatedBusTxblIncmAmt |
| PY Contributions Grants | $104,195 | PYContributionsGrantsAmt |
| CY Contributions Grants | $600,295 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $14,319,890 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $14,463,561 | CYProgramServiceRevenueAmt |
| PY Investment Income | $288,239 | PYInvestmentIncomeAmt |
| CY Investment Income | $187,674 | CYInvestmentIncomeAmt |
| PY Other Revenue | $41,811 | PYOtherRevenueAmt |
| CY Other Revenue | $152,574 | CYOtherRevenueAmt |
| PY Total Revenue | $14,754,135 | PYTotalRevenueAmt |
| CY Total Revenue | $15,404,104 | CYTotalRevenueAmt |
| PY Grants And Similar Paid | $44,326 | PYGrantsAndSimilarPaidAmt |
| CY Grants And Similar Paid | $3,538 | CYGrantsAndSimilarPaidAmt |
| PY Benefits Paid To Members | $0 | PYBenefitsPaidToMembersAmt |
| CY Benefits Paid To Members | $0 | CYBenefitsPaidToMembersAmt |
| PY Salaries Comp Emp Bnft Paid | $8,421,111 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $8,188,662 | CYSalariesCompEmpBnftPaidAmt |
| PY Total Prof Fndrsng Expns | $0 | PYTotalProfFndrsngExpnsAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $0 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $7,580,166 | PYOtherExpensesAmt |
| CY Other Expenses | $7,370,951 | CYOtherExpensesAmt |
| PY Total Expenses | $16,045,603 | PYTotalExpensesAmt |
| CY Total Expenses | $15,563,151 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | -$1,291,468 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | -$159,047 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $24,965,209 | TotalAssetsBOYAmt |
| Total Assets EOY | $25,083,482 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $8,280,347 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $8,701,422 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $16,684,862 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $16,382,060 | NetAssetsOrFundBalancesEOYAmt |
| Info In Schedule O Part III | Yes (X) | InfoInScheduleOPartIIIInd |
| Mission | MADISON HEALTHCARE SERVICES, WHICH INCLUDES THE 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 SERVICE IN A COMPETENT AND CARING MANNER. | MissionDesc |
| Significant New Program Srvc | 0 | SignificantNewProgramSrvcInd |
| Significant Change | 0 | SignificantChangeInd |
| Expense | $7,740,080 | ExpenseAmt |
| Grant | $3,538 | GrantAmt |
| Revenue | $8,887,495 | RevenueAmt |
| Desc | 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 21,449 VISITS. 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 $79,003 FOR THE YEAR ENDED SEPTEMBER 30, 2015. | Desc |
Prog Srvc Accom Acty2 ProgSrvcAccomActy2Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expense | $5,010,280 | ExpenseAmt |
| Revenue | $4,333,075 | RevenueAmt |
| Desc | 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, 2015 WAS 62 RESIDENTS. | Desc |
Prog Srvc Accom Acty3 ProgSrvcAccomActy3Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expense | $1,962,599 | ExpenseAmt |
| Revenue | $1,387,866 | RevenueAmt |
| Desc | LAC QUI PARLE CLINIC -THE MEDICAL STAFF AT THE CLINIC CONSISTS OF TWO M.D.'S AND TWO PA-C'S 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 | $14,712,959 | 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 |
| Temp Or Permanent Endowments | 0 | TempOrPermanentEndowmentsInd |
| 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 | 0 | 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 | 0 | 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 | 0 | 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 With Officer Ent | 0 | BusinessRlnWithOfficerEntInd |
| 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 | 13 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Backup Wthld Compliance | Yes (1) | BackupWthldComplianceInd |
| Employee | 292 | 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 |
| Info In Schedule O Part VI | Yes (X) | InfoInScheduleOPartVIInd |
| Governing Body Voting Members | 7 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 7 | IndependentVotingMemberCnt |
| Family Or Business Rln | 0 | FamilyOrBusinessRlnInd |
| Delegation Of Mgmt Duties | 0 | DelegationOfMgmtDutiesInd |
| Change To Org Documents | Yes (1) | 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 | 56256 | ZIPCd |
Form990 Part VII Section A Form990PartVIISectionAGrp (15 entries)
| TitleTitleTxt | Average Hours Per WeekAverageHoursPerWeekRt | Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd | OfficerOfficerInd | Reportable Comp From OrgReportableCompFromOrgAmt | Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt | Other CompensationOtherCompensationAmt | Average Hours Per Week Rltd OrgAverageHoursPerWeekRltdOrgRt | Highest Compensated EmployeeHighestCompensatedEmployeeInd |
|---|---|---|---|---|---|---|---|---|
| KIM LUND | ||||||||
| CHAIR | 0.50 | Yes (X) | Yes (X) | $0 | $0 | $0 | ||
| CLINT BONN | ||||||||
| SECRETARY | 0.50 | Yes (X) | Yes (X) | $0 | $0 | $0 | ||
| GENE KOOSMANN | ||||||||
| DIRECTOR | 0.50 | Yes (X) | $0 | $0 | $0 | 0.10 | ||
| WAYNE ENGER | ||||||||
| DIRECTOR | 0.50 | Yes (X) | $0 | $0 | $0 | 0.10 | ||
| DIANE MORKEN | ||||||||
| DIRECTOR | 0.50 | Yes (X) | $0 | $0 | $0 | |||
| JOEL CHURNESS | ||||||||
| DIRECTOR | 0.50 | Yes (X) | $0 | $0 | $0 | |||
| BRENT ZUPAN | ||||||||
| DIRECTOR | 0.50 | Yes (X) | $0 | $0 | $0 | 0.10 | ||
| STEVEN MOBURG | ||||||||
| PRESIDENT/CEO | 40.00 | Yes (X) | $144,561 | $0 | $24,050 | 0.10 | ||
| ALLEN ANDERSON | ||||||||
| HR/CO-ACTING INTERIM CEO (JAN-SEPT) | 40.00 | Yes (X) | $22,614 | $0 | $3,780 | 0.10 | ||
| ERIK BJERKE | ||||||||
| PRESIDENT/CEO (AS OF 9/28/15) | 40.00 | Yes (X) | $0 | $0 | $0 | 0.10 | ||
| CAROL BORGERSON | ||||||||
| CHIEF FINANCIAL OFFICER | 40.00 | Yes (X) | $72,042 | $0 | $14,487 | 2.00 | ||
| LAURA HONG MD | ||||||||
| MEDICAL DOCTOR | 40.00 | $188,159 | $0 | $27,640 | Yes (X) | |||
| BRANT HACKER MD | ||||||||
| MEDICAL DOCTOR | 40.00 | $317,625 | $0 | $42,011 | Yes (X) | |||
| MICHAEL DEYO PA | ||||||||
| PHYSICIAN ASSISTANT | 40.00 | $129,729 | $0 | $18,608 | Yes (X) | |||
| MARIBETH OLSON PA | ||||||||
| PHYSICIAN ASSISTANT | 40.00 | $103,330 | $0 | $3,099 | Yes (X) | |||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $978,060 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $0 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $133,675 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 5 | 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 INC | |||||
| 450 EASTVOLD AVE | ORTNOVILLE | MN | 56278 | CONTRACT THERAPY | $762,187 |
| CENTRAL MINNESOTA DIAGNOSTICS | |||||
| 150 10TH ST NW | MILACA | MN | 56353 | CT SCAN SERVICE | $252,507 |
| ACUTE CARE | |||||
| 1609 N ANDENY BLVD | ANKENY | IA | 50023 | CONTRACT ER COVERAGE | $251,123 |
| PATHWAYS HEALTH | |||||
| 2025 4TH STREET | WHITE BEAR LAKE | MN | 55110 | CONTRACT NH ADMINISTRATOR | $131,435 |
| JOHN SOVELL | |||||
| 430 JACKSON AVENUE | ORTNOVILLE | MN | 56278 | CONTRACT ANETHESTIST | $114,438 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cntrct Rcvd Greater Than100 K | 7 | CntrctRcvdGreaterThan100KCnt |
| All Other Contributions | $600,295 | AllOtherContributionsAmt |
| Total Contributions | $600,295 | TotalContributionsAmt |
Program Service Revenue ProgramServiceRevenueGrp (4 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt |
|---|---|---|---|
| NET PATIENT AND RESIDENT SERVICE | 621400 | $13,896,602 | $13,896,602 |
| HOSPITAL REVENUE | 623000 | $429,608 | $429,608 |
| NURSING HOME REVENUE | 623000 | $114,609 | $114,609 |
| CLINIC REVENUE | 621400 | $22,742 | $22,742 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $14,463,561 | TotalProgramServiceRevenueAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $187,674 | TotalRevenueColumnAmt |
| Exclusion | $187,674 | ExclusionAmt |
Gross Rents GrossRentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $7,699 | RealAmt |
Less Rental Expenses LessRentalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $0 | RealAmt |
Rental Income Or Loss RentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $7,699 | RealAmt |
Net Rental Income Or Loss NetRentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $7,699 | TotalRevenueColumnAmt |
| Exclusion | $7,699 | ExclusionAmt |
Other Revenue Misc OtherRevenueMiscGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | CAFETERIA & OTHER INCOME | Desc |
| Business | 722210 | BusinessCd |
| Total Revenue Column | $144,875 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $144,875 | RelatedOrExemptFuncIncomeAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Revenue Total | $144,875 | OtherRevenueTotalAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $15,404,104 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $14,608,436 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $0 | UnrelatedBusinessRevenueAmt |
| Exclusion | $195,373 | 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 | $3,538 | TotalAmt |
| Program Services | $3,538 | ProgramServicesAmt |
Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $239,466 | TotalAmt |
| Management And General | $239,466 | ManagementAndGeneralAmt |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $6,373,385 | TotalAmt |
| Program Services | $6,158,602 | ProgramServicesAmt |
| Management And General | $214,783 | ManagementAndGeneralAmt |
Pension Plan Contributions PensionPlanContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $117,738 | TotalAmt |
| Program Services | $113,700 | ProgramServicesAmt |
| Management And General | $4,038 | ManagementAndGeneralAmt |
Other Employee Benefits OtherEmployeeBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $708,204 | TotalAmt |
| Program Services | $674,281 | ProgramServicesAmt |
| Management And General | $33,923 | ManagementAndGeneralAmt |
Payroll Taxes PayrollTaxesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $749,869 | TotalAmt |
| Program Services | $686,430 | ProgramServicesAmt |
| Management And General | $63,439 | ManagementAndGeneralAmt |
Fees For Services Legal FeesForServicesLegalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $5,570 | TotalAmt |
| Program Services | $5,376 | ProgramServicesAmt |
| Management And General | $194 | ManagementAndGeneralAmt |
Fees For Services Accounting FeesForServicesAccountingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $53,736 | TotalAmt |
| Program Services | $49,561 | ProgramServicesAmt |
| Management And General | $4,175 | ManagementAndGeneralAmt |
Fees For Services Other FeesForServicesOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $3,259,649 | TotalAmt |
| Program Services | $3,258,980 | ProgramServicesAmt |
| Management And General | $669 | ManagementAndGeneralAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $454,655 | TotalAmt |
| Program Services | $448,335 | ProgramServicesAmt |
| Management And General | $6,320 | ManagementAndGeneralAmt |
Occupancy OccupancyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $260,868 | TotalAmt |
| Program Services | $235,955 | ProgramServicesAmt |
| Management And General | $24,913 | ManagementAndGeneralAmt |
Travel TravelGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $38,122 | TotalAmt |
| Program Services | $26,643 | ProgramServicesAmt |
| Management And General | $11,479 | ManagementAndGeneralAmt |
Conferences Meetings ConferencesMeetingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $106,018 | TotalAmt |
| Program Services | $102,827 | ProgramServicesAmt |
| Management And General | $3,191 | ManagementAndGeneralAmt |
Interest InterestGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $178,520 | TotalAmt |
| Program Services | $161,471 | ProgramServicesAmt |
| Management And General | $17,049 | ManagementAndGeneralAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,499,431 | TotalAmt |
| Program Services | $1,356,235 | ProgramServicesAmt |
| Management And General | $143,196 | ManagementAndGeneralAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $70,118 | TotalAmt |
| Management And General | $70,118 | ManagementAndGeneralAmt |
Other Expenses OtherExpensesGrp (3 entries)
| DescDesc | TotalTotalAmt | Program ServicesProgramServicesAmt |
|---|---|---|
| SUPPLIES | $717,549 | $717,549 |
| TAXES AND LICENSES | $414,005 | $414,005 |
| BAD DEBT EXPENSE | $89,454 | $89,454 |
All Other Expenses AllOtherExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $223,256 | TotalAmt |
| Program Services | $210,017 | ProgramServicesAmt |
| Management And General | $13,239 | ManagementAndGeneralAmt |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $15,563,151 | TotalAmt |
| Program Services | $14,712,959 | ProgramServicesAmt |
| Management And General | $850,192 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Cash Non Interest Bearing CashNonInterestBearingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $410,645 | BOYAmt |
| EOY | $877,138 | EOYAmt |
Savings And Temp Cash Invst SavingsAndTempCashInvstGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $4,403 | BOYAmt |
| EOY | $4,089 | EOYAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,966,616 | BOYAmt |
| EOY | $2,283,178 | EOYAmt |
Inventories For Sale Or Use InventoriesForSaleOrUseGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $225,395 | BOYAmt |
| EOY | $204,468 | EOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $251,924 | BOYAmt |
| EOY | $243,114 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $27,843,933 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $14,519,490 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $13,956,966 | BOYAmt |
| EOY | $13,324,443 | EOYAmt |
Investments Pub Traded Sec InvestmentsPubTradedSecGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $5,618,456 | BOYAmt |
| EOY | $4,370,363 | EOYAmt |
Investments Other Securities InvestmentsOtherSecuritiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,426,443 | BOYAmt |
| EOY | $3,683,923 | EOYAmt |
Other Assets Total OtherAssetsTotalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $104,361 | BOYAmt |
| EOY | $92,766 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $24,965,209 | BOYAmt |
| EOY | $25,083,482 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $937,270 | BOYAmt |
| EOY | $1,241,091 | EOYAmt |
Tax Exempt Bond Liabilities TaxExemptBondLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $6,823,239 | BOYAmt |
| EOY | $6,933,688 | EOYAmt |
Escrow Account Liability EscrowAccountLiabilityGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $4,902 | BOYAmt |
| EOY | $4,589 | EOYAmt |
Other Liabilities OtherLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $514,936 | BOYAmt |
| EOY | $522,054 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $8,280,347 | BOYAmt |
| EOY | $8,701,422 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Organization Follows SFAS117 | Yes (X) | OrganizationFollowsSFAS117Ind |
Unrestricted Net Assets UnrestrictedNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $16,632,202 | BOYAmt |
| EOY | $16,318,184 | EOYAmt |
Temporarily Rstr Net Assets TemporarilyRstrNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $52,660 | BOYAmt |
| EOY | $63,876 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $16,684,862 | BOYAmt |
| EOY | $16,382,060 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $24,965,209 | BOYAmt |
| EOY | $25,083,482 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part XI | Yes (X) | InfoInScheduleOPartXIInd |
| Reconcilation Revenue Expnss | -$159,047 | ReconcilationRevenueExpnssAmt |
| Net Unrlzd Gains Losses Invst | -$154,969 | NetUnrlzdGainsLossesInvstAmt |
| Other Changes In Net Assets | $11,214 | OtherChangesInNetAssetsAmt |
| 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 |
| Public Support PY509 | 0.98930 | PublicSupportPY509Pct |
| Investment Income PY | 0.01070 | InvestmentIncomePYPct |
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 | 0 | GrantsOtherOrganizationsInd |
| Direct Contact Legislators | 0 | DirectContactLegislatorsInd |
| Rallies Demonstrations | 0 | RalliesDemonstrationsInd |
| Other Activities | Yes (1) | OtherActivitiesInd |
| Other Activities | $363 | OtherActivitiesAmt |
| Total Lobbying Expenditures | $363 | 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 | MADISON LUTHERAN HOME IS A MEMBER OF THE MINNESOTA HOSPITAL ASSOCIATION (MHA). A PORTION OF THEIR DUES ARE FOR LOBBYING EXPENSES. THE MHA WORKS TO DEVELOP, PROMOTE, AND IMPLEMENT HEALTH CARE POLICY AT THE STATE AND FEDERAL LEVELS OF GOVERNMENT TO BENEFIT HOSPITALS' 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 | 0 | InclEscrowCustodialAcctLiabInd |
Land LandGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $689,385 | OtherCostOrOtherBasisAmt |
| Book Value | $689,385 | BookValueAmt |
Buildings BuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $21,658,888 | OtherCostOrOtherBasisAmt |
| Depreciation | $10,501,034 | DepreciationAmt |
| Book Value | $11,157,854 | BookValueAmt |
Equipment EquipmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $5,495,660 | OtherCostOrOtherBasisAmt |
| Depreciation | $4,018,456 | DepreciationAmt |
| Book Value | $1,477,204 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $13,324,443 | TotalBookValueLandBuildingsAmt |
Closely Held Equity Interests CloselyHeldEquityInterestsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Book Value | $200,467 | BookValueAmt |
| Method Valuation | C | MethodValuationCd |
Other Securities OtherSecuritiesGrp (5 entries)
| DescDesc | Book ValueBookValueAmt | Method ValuationMethodValuationCd |
|---|---|---|
| CERTIFICATES OF DEPOSIT | $1,140,892 | C |
| ANNUITIES | $621,019 | C |
| CASH AND INTEREST-BEARING DEPOSITS | $344,445 | C |
| RESIDENT DEPOSITS HELD IN TRUST | $22,274 | C |
| ASSETS LIMITED TO USE | $1,354,826 | C |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Securities | $3,683,923 | TotalBookValueSecuritiesAmt |
Other Liabilities Org OtherLiabilitiesOrgGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | DEFERRED COMPENSATION | Desc |
| Amt | $522,054 | Amt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Liability | $522,054 | TotalLiabilityAmt |
Schedule H IRS990ScheduleH
| Field | Value | IRS element (for citing) |
|---|---|---|
| Financial Assistance Policy | Yes (1) | FinancialAssistancePolicyInd |
| Written Policy | Yes (1) | WrittenPolicyInd |
| FPG Reference Free Care | Yes (1) | FPGReferenceFreeCareInd |
Free Care Oth Percentage FreeCareOthPercentageGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | Yes (X) | OtherInd |
| Free Care Other | 250.000000000000 | FreeCareOtherPct |
| Field | Value | IRS element (for citing) |
|---|---|---|
| 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 | 0 | AnnualCommunityBnftReportInd |
Financial Assistance At Cost Typ FinancialAssistanceAtCostTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $59,994 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $59,994 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00390 | TotalExpensePct |
Unreimbursed Medicaid UnreimbursedMedicaidGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $457,770 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $185,626 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $272,144 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.01760 | TotalExpensePct |
Total Financial Assistance Typ TotalFinancialAssistanceTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $517,764 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $185,626 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $332,138 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.02150 | TotalExpensePct |
Community Health Services CommunityHealthServicesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $109,210 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $14,216 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $94,994 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00610 | TotalExpensePct |
Cash And In Kind Contributions CashAndInKindContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $3,537 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $3,537 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00020 | TotalExpensePct |
Total Other Benefits TotalOtherBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $112,747 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $14,216 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $98,531 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00630 | TotalExpensePct |
Total Community Benefits TotalCommunityBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $630,511 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $199,842 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $430,669 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.02780 | TotalExpensePct |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | 0 | BadDebtExpenseReportedInd |
| Bad Debt Expense | $89,454 | BadDebtExpenseAmt |
| Reimbursed By Medicare | $498,061 | ReimbursedByMedicareAmt |
| Cost Of Care Reimbursed By Medcr | $378,222 | CostOfCareReimbursedByMedcrAmt |
| Medicare Surplus Or Shortfall | $119,839 | 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 | HTTP://MLHMN.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 |
| Information Gaps | Yes (X) | InformationGapsInd |
| CHNA Conducted | 12 | CHNAConductedYr |
| Take Into Account Others Input | Yes (1) | TakeIntoAccountOthersInputInd |
| CHNA Conducted With Other Fclts | 0 | CHNAConductedWithOtherFcltsInd |
| CHNA Conducted With Non Fclts | 0 | CHNAConductedWithNonFcltsInd |
| CHNA Report Widely Available | Yes (1) | CHNAReportWidelyAvailableInd |
| Rpt Available On Own Website | Yes (X) | RptAvailableOnOwnWebsiteInd |
| Own Website URL | MLHMN.ORG | OwnWebsiteURLTxt |
| Paper Copy Public Inspection | Yes (X) | PaperCopyPublicInspectionInd |
| Implementation Strategy Adopt | Yes (1) | ImplementationStrategyAdoptInd |
| Implementation Strategy Adpt | 13 | ImplementationStrategyAdptYr |
| Strategy Posted Website | Yes (1) | StrategyPostedWebsiteInd |
| Strategy Website URL | MLHMN.ORG | StrategyWebsiteURLTxt |
| Strategy Attached | 0 | StrategyAttachedInd |
| 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 | 250.000000000000 | FPGFamilyIncmLmtFreeCarePct |
| FPG Family Incm Lmt Dscnt Care | 275.000000000000 | FPGFamilyIncmLmtDscntCarePct |
| Asset Level Criteria | Yes (X) | AssetLevelCriteriaInd |
| Medical Indigency Criteria | Yes (X) | MedicalIndigencyCriteriaInd |
| Explained Basis | Yes (1) | ExplainedBasisInd |
| App Financial Asst Expln | Yes (1) | AppFinancialAsstExplnInd |
| Includes Publicity Measures | Yes (1) | IncludesPublicityMeasuresInd |
| FAP Avlbl On Request No Charge | Yes (X) | FAPAvlblOnRequestNoChargeInd |
| Other Publicity | Yes (X) | OtherPublicityInd |
| FAP Actions On Nonpayment | Yes (1) | FAPActionsOnNonpaymentInd |
| Permit No Actions | Yes (X) | PermitNoActionsInd |
| Collection Activities | 0 | CollectionActivitiesInd |
| Nondis Emergency Care Policy | Yes (1) | NondisEmergencyCarePolicyInd |
| Lowest Negotiated Rates | Yes (X) | LowestNegotiatedRatesInd |
| Amounts Generally Billed | 0 | AmountsGenerallyBilledInd |
| Gross Charges | 0 | GrossChargesInd |
Supplemental Information SupplementalInformationGrp (3 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, FEMALES IN THE COMMUNITY OF MADISON AND CONSISTENTLY MET WITH A PUBLIC HEALTH NURSE. |
| 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 ARE IN OUR AREA WAS EXPERIENCING HEALTH GAPS WHEN IT CAME TO THE SERVICES WE PROVIDED FOR THESE HEALTH CONDITIONS. USING RELIABLE SOURCES AND KEY INTERVIEWS WITH OUR COMMUNITY MEMBERS AND PROFESSIONALS, WE DECIDED TO FOCUS ON THREE KEY HEALTH NEEDS THAT OUR COMMUNITY WOULD GREATLY BENEFIT FROM. THE THREE HEALTH NEEDS IDENTIFIED AND PRIORITIZED BY OUR COMMITTEE INCLUDE: DIABETES, HEART DISEASE, AND STROKE.AN IMPLEMENTATION PLAN WAS DEVELOPED TO TREAT EACH OF THESE CHRONIC DISEASES AS A SEPARATE HEALTH NEED SINCE THEY ALL WILL REQUIRE DIFFERENT MEASURES TO BE TAKEN TO ADDRESS THE ISSUES. THE COMMUNITY ISSUES CONCERNING THESE CHRONIC DISEASES ARE THE LACK OF OUTREACH, EDUCATION AND RESOURCES, AND PREVENTATIVE ACTION. THE GOAL IS TO IMPLEMENT PROGRAMS THAT HELP SUPPORT THE PEOPLE AFFECTED BY CHRONIC DISEASE FINANCIALLY, EMOTIONALLY, AND PSYCHOLOGICALLY. THE COMMUNITY HEALTH NEEDS COMMITTEE DEVISED A BUDGET THAT WAS INTEGRATED INFO 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 IS A NON-PROFIT TAX-EXEMPT HOSPITAL SERVICES COOPERATIVE FOR 3 LOCAL, RURAL COMMUNITY HOSPITAL-BASED PROVIDER ORGANIZATIONS INCLUDING MADISON HEALTHCARE SERVICES, JOHNSON MEMORIAL HEALTH SERVICES, AND APPLETON AREA HEALTH SERVICES. THE OFFICE OF COMMUNITY ENGAGEMENT OF THE CLINICAL AND TRANSLATIONAL SCIENCE INSTITUTE AT THE UNIVERSITY OF MINNESOTA AWARDED THE RURAL COMMUNITY CAPACITY ENHANCEMENT GRANT, A TOTAL OF $38,000, TO THE LAC QUI PARLE HEALTH NETWORK. THIS GRANT WAS USED OF THE COMMUNITY WELLNESS PROGRAM CALL LIVE WELL, BE WELL. THE PURPOSE OF THE PROGRAM WAS TO IMPROVE WELLNESS OF THE MADISON, APPLETON, AND DAWSON COMMUNITIES. MEMBERS OF THE COMMUNITY WOULD FORM TEAMS OF 4 PARTICIPANTS THAT WOULD PARTICIPATE IN WEEKLY CHALLENGES IN ORDER TO ACCUMULATE POINTS. THESE ACTIVITIES WERE STRUCTURED TO ENCOURAGE PARTICIPANTS TO IMPROVE THEIR OVERALL HEALTH AS WELL AS INCREASE CAMARADERIE IN OUR COMMUNITIES. THE PROGRAM RAN FROM APRIL 1, 2013 - JUNE 28, 2013 AND ALLOWED PARTICIPANTS TO TAKE ADVANTAGE OF HEALTH AND FITNESS KNOWLEDGE AND RESOURCES USING A SUPPORTIVE ENVIRONMENT. SOME OF THE OPTIONS TO ACCUMULATE POINTS INCLUDED: PLANTING A GARDEN, VOLUNTEERING, GIVING BLOOD, DOING 90-150 MINUTES OF WEEKLY ACTIVITIES. MADISON HOSPITAL LABORATORY OFFERED GLUCOSE AND CHOLESTEROL TESTING TO ALL LIVE WELL, BE WELL PARTICIPANTS. ESTABLISHED EDUCATION RESOURCES - ONE OF THE BIGGEST CHALLENGES IN OUR RURAL COMMUNITIES WAS THE LACK OF EDUCATION PROVIDED ABOUT DIABETES, HEART DISEASE, AND STROKE. THERE WERE NOT MANY RESOURCES PEOPLE COULD TURN TO IF THEY NEEDED GUIDANCE WITH PROPERLY DEALING WITH DIABETES OR OTHER HEALTH ISSUES. MADISON HEALTHCARE SERVICES 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 MEDTRONIC IN ORDER TO ARRANGE AN INFORMATIONAL MEETING FOR ALL DIABETIC PATIENTS FROM OUR COMMUNITY. A DIABETES SUPPORT GROUP WAS ESTABLISHED FOR THE COMMUNITY THAT MEETS ONCE EACH MONTH. ANOTHER EDUCATION RESOURCE THAT WAS IMPLEMENTED IS HAVING ONE OF OUR PROVIDERS GO LIVE ON THE LOCAL RADIO STATION TO DISCUSS STROKE AND CARDIOVASCULAR DISEASE. HE REMINDED PEOPLE TO GET THEIR ANNUAL CHECK-UPS IN ORDER TO CONSISTENTLY MONITOR THEIR BLOOD PRESSURE, CHOLESTEROL, AND SO ON. DIRECT LAB ACCESS PROGRAM - ALLOWS PATIENTS TO ORDER AND RECEIVE LAB WORK WITHOUT A PHYSICIAN'S ORDER AND ON A CASH BASIS. PROGRAM 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 LAC 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. DIABETIC PRESENTATION FOR COMMUNITY - AN ON-STAFF RN HOSTED A DIABETIC PRESENTATION FOR THE PUBLIC AT MADISON LUTHERAN HOME. EDUCATION WAS PROVIDED ON WHAT DIABETES AND PRE-DIABETES IS, HOW THEY CAN BE PREVENTED, AND HOW THEY CAN BE TREATED.HEALTH BENEFIT FOCUSED ON DIABETES AND HEALTHY LIVING - EACH YEAR, MADISON LUTHERAN HOME PARTNERS WITH MADISON HEALTHCARE AUXILIARY TO HOST A HEALTH BENEFIT AT MADISON COUNTRY CLUB. THIS YEAR THE BENEFIT FOCUSED ON THE TREATMENT AND CARE OF DIABETES AS WELL AS HEALTHY EATING USING PORTION SIZING. |
| MADISON HOSPITAL | PART V, SECTION B, LINE 16I: WHEN IT HAS BEEN DISCOVERED THAT PATIENTS ARE HAVING DIFFICULTIES PAYING THEIR BILL AND PRIVATE PAY PATIENTS NOT MAKING PAYMENTS ARE 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 | 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 | CLINIC | FacilityTxt |
Supplemental Information Detail SupplementalInformationDetail (12 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| 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 $ 89,454. |
| PART II, COMMUNITY BUILDING ACTIVITIES: | MADISON HOSPITAL DOES LAB SCREENINGS AT REDUCED RATES TWICE A YEAR 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: | THIS AMOUNT IS CALCULATED BY MULTIPLYING THE TOTAL CHARGES FOR SERVICES WRITTEN OFF AS BAD DEBT BY THE COST TO CHARGE RATIO. |
| PART III, LINE 3: | THE ORGANIZATION TRACKS ACTUAL ACCOUNTS WRITTEN OFF VERY CLOSELY AND APPROXIAMATES THAT $125,928 ($96,965 AT COST) IS ASSOCIATED WITH ACCOUNTS ATTRIBUTABLE TO PATIENTS ELIGIBLE UNDERTHE ORGANIZATION'S CHARITY FINANCIAL ASSISTANCE POLICY. |
| PART III, LINE 4: | THE AUDITED FINANCIAL STATEMENTS DO NOT HAVE A FOOTNOTE ON THE BAD DEBT EXPENSE FOR THE ORGANIZATION. THE FOLLOWING IS A PORTION OF THE PATIENT AND RESIDENT ACCOUNTS RECEIVABLE AND CREDIT POLICY FOOTNOTE. MANAGEMENT PROVIDES FOR CONTRACTUAL ADJUSTMENTS UNDER TERMS OF THIRD-PARTY REIMBURSEMENT AGREEMENTS THROUGH A REDUCTION OF GROSS REVENUE AND A CREDIT TO PATIENT AND RESIDENT ACCOUNTS RECEIVABLE. IN ADDITION, MANAGEMENT PROVIDES FOR PROBABLE UNCOLLECTIBLE AMOUNTS, PRIMARILY FOR UNINSURED PATIENTS AND RESIDENTS AND AMOUNTS PATIENTS AND RESIDENTS ARE PERSONALLY RESPONSIBLE FOR, THROUGH A REDUCTION OF GROSS REVENUE AND A CREDIT TO A VALUATION ALLOWANCE. IN EVALUATING THE COLLECTABILITY OF PATIENT AND RESIDENT ACCOUNTS RECEIVABLE, THE ORGANIZATION ANALYZES PAST RESULTS AND IDENTIFIES TRENDS FOR EACH OF ITS MAJOR PAYER SOURCES OF REVENUE TO ESTIMATE THE APPROPRIATE ALLOWANCE FOR DOUBTFUL ACCOUNTS AND PROVISION FOR DOUBTFUL ACCOUNTS. MANAGEMENT REGULARLY REVIEWS DATA ABOUT THESE MAJOR PAYER SOURCES OF REVENUE IN EVALUATING THE SUFFICIENCY OF THE ALLOWANCE FOR DOUBTFUL ACCOUNTS. SPECIFICALLY, FOR RECEIVABLES ASSOCIATED WITH SERVICES PROVIDED TO PATIENTS AND RESIDENTS WHO HAVE THIRD-PARTY COVERAGE, 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 THAT PAYMENT IS PAYMENT IN FULL UNLESS MEDICAL ASSISTANCE NOTIFIES US THAT THE PATIENT HAS RESPONSIBILITY FOR SPEND DOWN OR CO-PAY PAYMENTS. |
| PART VI, LINE 2: | THE HOSPITAL HELD A SURVEY DURING OUR COMMUNITY WELLNESS EVENT IN WHICH COMMUNITY MEMBERS COULD VOICE WHAT THEY WOULD LIKE TO SEE FROM THEIR HEALTHCARE PROVIDERS. THE HOSPITAL BELONGS TO THE RURAL HEALTH CO-OP AND SURVEYS ON NUMEROUS DIFFERENT THINGS ARE SENT TO OUR PATIENTS. CLINIC SATISFACTION SURVEYS INCLUDE AN AREA FOR PATIENT COMMENTS WHICH ARE REVIEWED BY MANAGEMENT STAFF AND COMMENTS TAKEN INTO CONSIDERATION. |
| 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 $24,000.00 GROSS. ON AVERAGE THE POVERTY LEVEL IN THE COUNTY IS AT ABOUT 30 TO 35% WITH MANY PEOPLE BEING LAID OFF, AND FAMILIES OF 3 OR MORE. THE PERCENTAGE OF FAMILIES ON MEDICAID WOULD PROBABLY BE 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. EACH YEAR THE RADIOLOGY DEPARTMENT HOLDS A SPECIAL EDUCATION EVENT CALLED THE DD EVENT FOR BREAST CANCER AWARENESS. FUNDS ARE RAISED AND DONATED BACK TO THE COMMUNITY FOR CANCER RESEARCH. THREE TIMES A YEAR, THE RADIOLOGY DEPARTMENT HOLDS VASCULAR SCREENINGS IN WHICH COMMUNITY MEMBERS MAY HAVE VASCULAR SCREENINGS TO DETECT STROKES, PERIPHERAL VASCULAR DISEASE, AND ABDOMINAL AORTIC ANEURYSMS. THIS IS A CASH BASED SCREENING AND IS AVAILABLE AT A SUBSTANTIALLY REDUCED RATE AND A DOCTOR'S ORDER IS NOT REQUIRED. MADISON HOSPITAL LAB OFFERS DIRECT ACCESS LAB TESTING TO ITS COMMUNITY MEMBERS. THIS IS A CASH BASED PROGRAM WHERE LAB TESTS ARE OFFERED ON A CASH BASIS AT A SUBSTANTIALLY REDUCED RATE. LAST YEAR, OUR USERS SAVED OVER $12,000. MADISON HOSPITAL AND LAC QUI PARLE CLINIC DONATE ALL UNUSED MEDICAL EQUIPMENT TO A MISSION FOR MEDICAL USE.ALL EXPIRED LABORATORY SUPPLIES ARE SENT TO THE MEDICAL LAB TECHNICIAN PROGRAMS FOR USE IN THEIR STUDENT LABS.MADISON HOSPITAL IS CONSTANTLY STRIVING TO ADD NEW SERVICES, INCLUDING OUTREACH SERVICES TO BETTER SERVE THE NEEDS OF OUR COMMUNITY. A LEADERSHIP TEAM HAS BEEN FORMED TO MEET THE COMMUNITY NEEDS, CONTINUE TO LOOK AT ADDING NEW SERVICES, CONTINUE TO LOOK AT UPDATING OUR CURRENT FACILITY, AND ASKING FOR COMMUNITY INVOLVEMENT IN FINAL DECISION MAKING. WITH OUR AGING POPULATION, WE STRIVE TO BRING THE SERVICES TO THE PATIENTS, RATHER THAN THE PATIENTS HAVING TO DRIVE HOURS FROM HOME TO GET THE SERVICES.MADISON HOSPITAL PROVIDED HEALTH CARE SCREENINGS AT REDUCED RATES TO THE COMMUNITY. |
| PART VI, LINE 7, REPORTS FILED WITH STATES | MN |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Written Employment Contract | Yes (X) | WrittenEmploymentContractInd |
| Compensation Survey | Yes (X) | CompensationSurveyInd |
| Board Or Committee Approval | Yes (X) | BoardOrCommitteeApprovalInd |
| Severance Payment | Yes (1) | SeverancePaymentInd |
| Supplemental Nonqual Rtr Plan | Yes (1) | 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 |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| STEVEN MOBURG | ||||||||||||||
| PRESIDENT/CEO | $144,561 | $0 | $0 | $0 | $0 | $0 | $4,050 | $0 | $20,000 | $0 | $168,611 | $0 | $0 | $0 |
| LAURA HONG MD | ||||||||||||||
| MEDICAL DOCTOR | $188,159 | $0 | $0 | $0 | $0 | $0 | $15,500 | $0 | $12,140 | $0 | $215,799 | $0 | $0 | $0 |
| BRANT HACKER MD | ||||||||||||||
| MEDICAL DOCTOR | $317,625 | $0 | $0 | $0 | $0 | $0 | $26,328 | $0 | $18,078 | $0 | $362,031 | $0 | $0 | $0 |
| MICHAEL DEYO PA | ||||||||||||||
| PHYSICIAN ASSISTANT | $129,729 | $0 | $0 | $0 | $0 | $0 | $7,341 | $0 | $13,046 | $0 | $150,116 | $0 | $0 | $0 |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | PART I, LINES 4A-B | FormAndLineReferenceDesc |
| Explanation | THE ORGANIZATION PROVIDES AN UNQUALIFIED DEFERRED COMPENSATION PLAN WITH ONE 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 THE ACCRUED LIABILITIES ARE RECORDED AS LONG-TERM LIABILITIES. THE AGREEMENT CALLS FOR ANNUAL DEPOSITS OF $10,000 TO THE PLAN FROM THE ORGANIZATION. THIS AGREEMENT IS IN PLACE FOR DR. LAURA HONG AND $10,000 WAS DEPOSITED IN THE CURRENT TAX YEAR. STEVE MOBURG, CEO, RECEIVED A SEVERANCE PAYMENT OF $10,000 IN 2015. | ExplanationTxt |
Schedule K IRS990ScheduleK
Tax Exempt Bonds Issues TaxExemptBondsIssuesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bond Reference | A | BondReferenceCd |
Issuer Name IssuerName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | CITY OF MADISON MINNESOTA | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bond Issuer EIN | 416005335 | BondIssuerEIN |
| Bond Issued | 2012-05-03 | BondIssuedDt |
| Issue Price | $7,750,000 | IssuePriceAmt |
| Purpose | FINANCING FACILITY EXPANSION, RENOVATION, & EQUIPMENT | PurposeDesc |
| Defeased | 0 | DefeasedInd |
| On Behalf Of Issuer | 0 | OnBehalfOfIssuerInd |
| Pool Financing | 0 | PoolFinancingInd |
Tax Exempt Bonds Proceeds TaxExemptBondsProceedsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bond Reference | A | BondReferenceCd |
| Retired | $334,183 | RetiredAmt |
| Total Proceeds | $7,750,000 | TotalProceedsAmt |
| Issuance Costs From Proceeds | $155,000 | IssuanceCostsFromProceedsAmt |
| Working Capital Expenditures | $7,595,000 | WorkingCapitalExpendituresAmt |
| Capital Expenditures | $7,157,422 | CapitalExpendituresAmt |
| Other Spent Proceeds | $583,905 | OtherSpentProceedsAmt |
| Unspent | $8,673 | UnspentAmt |
| Current Refunding | 0 | CurrentRefundingInd |
| Advance Refunding | 0 | AdvanceRefundingInd |
| Final Allocation Made | 0 | FinalAllocationMadeInd |
| Adequate Books And Rec Maint | Yes (1) | AdequateBooksAndRecMaintInd |
Tax Exempt Bonds Private Bus Use TaxExemptBondsPrivateBusUseGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bond Reference | A | BondReferenceCd |
| Owning Bond Financed Property | 0 | OwningBondFinancedPropertyInd |
| Any Lease Arrangements | 0 | AnyLeaseArrangementsInd |
| Mgmt Contract Bond Fincd Prop | 0 | MgmtContractBondFincdPropInd |
| Any Research Agreements | 0 | AnyResearchAgreementsInd |
| Bond Iss Meet Prvt Sec Pymt Test | 0 | BondIssMeetPrvtSecPymtTestInd |
| Change In Use Bond Financed Prop | 0 | ChangeInUseBondFinancedPropInd |
| Procs Nonqualified Bond Remdtd | Yes (1) | ProcsNonqualifiedBondRemdtdInd |
Tax Exempt Bonds Arbitrage TaxExemptBondsArbitrageGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bond Reference | A | BondReferenceCd |
| Form8038 T Filed | 0 | Form8038TFiledInd |
| Rebate Not Due Yet | Yes (1) | RebateNotDueYetInd |
| Exception To Rebate | 0 | ExceptionToRebateInd |
| No Rebate Due | 0 | NoRebateDueInd |
| Variable Rate Issue | Yes (1) | VariableRateIssueInd |
| Hedge Identified In Bks And Rec | 0 | HedgeIdentifiedInBksAndRecInd |
| Gross Proceeds Invested In GIC | 0 | GrossProceedsInvestedInGICInd |
| Gross Proceeds Invested | 0 | GrossProceedsInvestedInd |
| Written Proc To Monitor Reqs | Yes (1) | WrittenProcToMonitorReqsInd |
Procedures Corrective Action ProceduresCorrectiveActionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bond Reference | A | BondReferenceCd |
| Procedures Corrective Action | Yes (1) | ProceduresCorrectiveActionInd |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (10 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| FORM 990, PART VI, SECTION A, LINE 4 | THE ARTICLES OF INCORPORATION WERE AMENDED TO CHANGE THE NAME FROM MADISON LUTHERAN HOME TO MADISON HEALTHCARE SERVICES, EFFECTIVE OCTOBER 7, 2015. |
| 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 LUTHERAN HOME. |
| 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 11 | 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. |
| 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 3,196,555. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 3,196,555. CONSULTANTS: PROGRAM SERVICE EXPENSES 62,425. MANAGEMENT AND GENERAL EXPENSES 669. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 63,094. |
| FORM 990, PART XI, LINE 9: | CONTRIBUTIONS FOR SPECIFIC PURPOSES 26,911. NET ASSETS RELEASED FROM RESTRICTIONS -15,695. ROUNDING -2. |
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 | 900 SECOND AVENUE | AddressLine1Txt |
| City | MADISON | CityNm |
| State Abbreviation | MN | StateAbbreviationCd |
| ZIP | 56256 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 411376605 | EIN |
| Primary Activities | HOUSING FOR HANDICAPPED AND ELDERLY | PrimaryActivitiesTxt |
| Legal Domicile State | MN | LegalDomicileStateCd |
| Exempt Code Section | 501(C)(3) | ExemptCodeSectionTxt |
| Public Charity Status | LINE 9 | PublicCharityStatusTxt |
Direct Controlling Entity Name DirectControllingEntityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | MADISON LUTHERAN HOME | 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 | Yes (1) | PerformOfServicesByOtherOrgInd |
| Sharing Of Facilities | Yes (1) | SharingOfFacilitiesInd |
| Paid Employees Sharing | 0 | 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 |
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