2017-01-09T15:29:13-06:00 2015-09-30 420714325 RSM US LLP 801 NICOLLET MALL SUITE 1100 MINNEAPOLIS MN 55402 990 2014-10-01 410706115 MADISON HEALTHCARE SERVICES MADI 3205987536 900 SECOND AVENUE MADISON MN 56256 ERIK BJERKE PRESIDENT/CEO 3205987536 2017-01-09 1 TODD A JACKSON P00092672 6123324300 2014 2017-02-10 21:41:12Z ERIK BJERKE 900 SECOND AVENUE MADISON MN 56256 15404104 0 X WWW.MLHMN.ORG X 1945 MN TO PROVIDE HEALTH CARE, RESIDENTIAL AND COMMUNITY SERVICE IN A COMPETENT AND CARING MANNER. 7 7 292 250 0 0 104195 600295 14319890 14463561 288239 187674 41811 152574 14754135 15404104 44326 3538 0 0 8421111 8188662 0 0 0 7580166 7370951 16045603 15563151 -1291468 -159047 24965209 25083482 8280347 8701422 16684862 16382060 X 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. 0 0 7740080 3538 8887495 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. 5010280 4333075 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. 1962599 1387866 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. 14712959 1 1 0 1 0 0 0 0 1 0 1 1 0 0 1 0 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 13 0 1 292 1 0 0 0 0 0 0 0 0 0 0 X 7 7 0 0 1 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 KIM LUND CHAIR 0.50 X X 0 0 0 CLINT BONN SECRETARY 0.50 X X 0 0 0 GENE KOOSMANN DIRECTOR 0.50 0.10 X 0 0 0 WAYNE ENGER DIRECTOR 0.50 0.10 X 0 0 0 DIANE MORKEN DIRECTOR 0.50 X 0 0 0 JOEL CHURNESS DIRECTOR 0.50 X 0 0 0 BRENT ZUPAN DIRECTOR 0.50 0.10 X 0 0 0 STEVEN MOBURG PRESIDENT/CEO 40.00 0.10 X 144561 0 24050 ALLEN ANDERSON HR/CO-ACTING INTERIM CEO (JAN-SEPT) 40.00 0.10 X 22614 0 3780 ERIK BJERKE PRESIDENT/CEO (AS OF 9/28/15) 40.00 0.10 X 0 0 0 CAROL BORGERSON CHIEF FINANCIAL OFFICER 40.00 2.00 X 72042 0 14487 LAURA HONG MD MEDICAL DOCTOR 40.00 X 188159 0 27640 BRANT HACKER MD MEDICAL DOCTOR 40.00 X 317625 0 42011 MICHAEL DEYO PA PHYSICIAN ASSISTANT 40.00 X 129729 0 18608 MARIBETH OLSON PA PHYSICIAN ASSISTANT 40.00 X 103330 0 3099 978060 0 133675 5 0 1 0 BIG STONE THERAPIES INC 450 EASTVOLD AVE ORTNOVILLE MN 56278 CONTRACT THERAPY 762187 CENTRAL MINNESOTA DIAGNOSTICS 150 10TH ST NW MILACA MN 56353 CT SCAN SERVICE 252507 ACUTE CARE 1609 N ANDENY BLVD ANKENY IA 50023 CONTRACT ER COVERAGE 251123 PATHWAYS HEALTH 2025 4TH STREET WHITE BEAR LAKE MN 55110 CONTRACT NH ADMINISTRATOR 131435 JOHN SOVELL 430 JACKSON AVENUE ORTNOVILLE MN 56278 CONTRACT ANETHESTIST 114438 7 600295 600295 NET PATIENT AND RESIDENT SERVICE 621400 13896602 13896602 HOSPITAL REVENUE 623000 429608 429608 NURSING HOME REVENUE 623000 114609 114609 CLINIC REVENUE 621400 22742 22742 14463561 187674 187674 7699 0 7699 7699 7699 CAFETERIA & OTHER INCOME 722210 144875 144875 144875 15404104 14608436 0 195373 X 3538 3538 239466 239466 6373385 6158602 214783 117738 113700 4038 708204 674281 33923 749869 686430 63439 5570 5376 194 53736 49561 4175 3259649 3258980 669 454655 448335 6320 260868 235955 24913 38122 26643 11479 106018 102827 3191 178520 161471 17049 1499431 1356235 143196 70118 70118 SUPPLIES 717549 717549 TAXES AND LICENSES 414005 414005 BAD DEBT EXPENSE 89454 89454 223256 210017 13239 15563151 14712959 850192 0 410645 877138 4403 4089 1966616 2283178 225395 204468 251924 243114 27843933 14519490 13956966 13324443 5618456 4370363 2426443 3683923 104361 92766 24965209 25083482 937270 1241091 6823239 6933688 4902 4589 514936 522054 8280347 8701422 X 16632202 16318184 52660 63876 16684862 16382060 24965209 25083482 X -159047 -154969 11214 X 0 1 X 1 0 X 0.98930 0.01070 RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 363 363 0 PART II-B, LINE 1: 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. 0 0 689385 689385 21658888 10501034 11157854 5495660 4018456 1477204 13324443 200467 C CERTIFICATES OF DEPOSIT 1140892 C ANNUITIES 621019 C CASH AND INTEREST-BEARING DEPOSITS 344445 C RESIDENT DEPOSITS HELD IN TRUST 22274 C ASSETS LIMITED TO USE 1354826 C 3683923 DEFERRED COMPENSATION 522054 522054 1 1 1 X 250.000000000000 1 X 275.000000000000 1 1 1 0 0 59994 59994 0.00390 457770 185626 272144 0.01760 517764 185626 332138 0.02150 109210 14216 94994 0.00610 3537 3537 0.00020 112747 14216 98531 0.00630 630511 199842 430669 0.02780 0 89454 498061 378222 119839 X 1 1 1 1 MADISON HOSPITAL 820 THIRD AVENUE MADISON MN 56256 HTTP://MLHMN.ORG 327711 X X X X X RURAL HEALTH MADISON HOSPITAL 1 0 0 1 X X X X X X X X X 12 1 0 0 1 X MLHMN.ORG X 1 13 1 MLHMN.ORG 0 0 1 X 250.000000000000 275.000000000000 X X 1 1 1 X X 1 X 0 1 X 0 0 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. 1 LAC QUI PARLE CLINIC 900 SECOND AVENUE MADISON MN 56256 CLINIC 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 X X X 1 1 0 0 0 0 0 0 0 STEVEN MOBURG PRESIDENT/CEO 144561 0 0 0 0 0 4050 0 20000 0 168611 0 0 0 LAURA HONG MD MEDICAL DOCTOR 188159 0 0 0 0 0 15500 0 12140 0 215799 0 0 0 BRANT HACKER MD MEDICAL DOCTOR 317625 0 0 0 0 0 26328 0 18078 0 362031 0 0 0 MICHAEL DEYO PA PHYSICIAN ASSISTANT 129729 0 0 0 0 0 7341 0 13046 0 150116 0 0 0 PART I, LINES 4A-B 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. A CITY OF MADISON MINNESOTA 416005335 2012-05-03 7750000 FINANCING FACILITY EXPANSION, RENOVATION, & EQUIPMENT 0 0 0 A 334183 7750000 155000 7595000 7157422 583905 8673 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 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. HILLTOP RESIDENCE INC 900 SECOND AVENUE MADISON MN 56256 411376605 HOUSING FOR HANDICAPPED AND ELDERLY MN 501(C)(3) LINE 9 MADISON LUTHERAN HOME 1 0 0 0 0 0 0 0 0 0 0 0 0 1 1 0 1 0 0 0