2025-03-03T10:06:18-06:00 2023-09-30 410746749 CLIFTONLARSONALLEN LLP 121 WEST BRIDGE STREET OWATONNA MN 55060 990 2022-10-01 410724034 KITTSON MEMORIAL HOSPITAL KITT 2188433612 PO BOX 700 HALLOCK MN 56728 ANDREA SWENSON CEO 2188433612 2025-02-28 1 0 JUSTIN HARTERT P02236744 5074467100 2025-02-27 2022 2025-03-06 01:10:19Z X KITTSON MEMORIAL HEALTHCARE CENTER ANDREA SWENSON 1010 S BIRCH AVE HALLOCK MN 56728 18402466 0 X WWW.KITTSONHC.ORG X 1919 MN KITTSON ENSURES THAT NORTHWESTERN MINNESOTA RESIDENTS HAVE ACCESS TO HEALTH SERVICES. 9 9 225 9 7916 0 665648 746518 17099013 16910066 23416 473713 178368 264676 17966445 18394973 1000 675 0 0 9824278 8293665 0 0 0 8795579 9463691 18620857 17758031 -654412 636942 12750088 12005226 5406136 4020559 7343952 7984667 X CARING FOR FRIENDS AND NEIGHBORS, KITTSON MEMORIAL HEALTHCARE CENTER PROVIDES AND COOPERATES WITH OTHERS TO ENSURE THAT RESIDENTS HAVE ACCESS TO SERVICES NECESSARY TO MAINTAIN THEIR HEALTH AND WELL-BEING. 0 0 14577549 675 17066495 SINCE 1922, KITTSON HEALTHCARE PRIDES ITSELF ON PROVIDING CONTINUOUS SERVICE TO THE CITIZENS OF KITTSON COUNTY AND SURROUNDING AREAS. KITTSON HEALTHCARE HAS BEEN THE SOLE HOSPITAL IN KITTSON COUNTY SINCE JANUARY 1995. KITTSON COUNTY IS CONSIDERED DEEP RURAL OR A FRONTIER COUNTY AND HAS 1,098.8 SQUARE MILES OF LAND MAKING IT THE 18TH LARGEST COUNTY MINNESOTA BY TOTAL AREA. THE SERVICE AREA POPULATION AS OF 2020 CENSUS WAS LISTED AS 4207. TODAY, KITTSON HEALTHCARE IS A TWELVE-BED ACUTE CARE FEDERALLY DESIGNATED CRITICAL ACCESS HOSPITAL WITH EMERGENCY ROOM SERVICES AND FIFTY BED LONG TERM CARE FACILITY WHICH ALSO INCLUDES A HOME HEALTHCARE AGENCY, 8 BED ASSISTED LIVING FACILITY AND AN AMBULANCE SERVICE. THERE IS A MEDICAL CLINIC LOCATED IN THE COMPLEX AS WELL AS A SATELLITE MEDICAL CLINIC IN KARLSTAD, MINNESOTA. IN ACCORDANCE WITH LAWS SUCH AS THE EMERGENCY MEDICAL TREATMENT AND LABOR ACT AND SOCIAL SECURITY ACT, EMERGENCY SERVICES ARE PROVIDED REGARDLESS OF ABILITY TO PAY INCLUDING STABILIZATION AND TRANSFER IF APPROPRIATE OR REQUESTED. HOME HEALTH SERVICES PROVIDE MEDICAL AND PERSONAL ASSISTANCE TO THOSE PATIENTS WHO ARE HOME BOUND. THIS VALUED SERVICE PROVIDES AREA RESIDENTS WITH THE ASSISTANCE THEY NEED TO LIVE INDEPENDENTLY WHETHER IT BE HOUSEKEEPING SERVICES, MEDICATION DISPENSATION, OR DAILY DRESSING CHANGES. KITTSON HEALTHCARE'S ASSISTED LIVING COMPLEX PROVIDES AREA RESIDENTS WITH OPTIONS TO ASSIST IN THEIR TRANSGRESSION FROM LIVING INDEPENDENTLY TO CONGREGATE DINING WITH OTHER ASSISTED LIVING RESIDENTS, MEDICATION DISPENSATION ASSISTANCE, AND ACCESS TO ACTIVITIES IN THE NURSING HOME. RESIDENTS ARE ALSO ABLE TO "COME AND GO" AS THEY PLEASE WITH ACCESS TO THEIR OWN TRANSPORTATION OR TRANSPORTATION MAY BE ARRANGED. THE COMMUNITY CARE PROGRAM IS AVAILABLE THROUGH THE BUSINESS OFFICE TO ASSIST INDIVIDUALS WITH PAYING THEIR HEALTHCARE BILLS FOR SERVICES RENDERED AT KITTSON HEALTHCARE. THE BUSINESS OFFICE ASSISTS INDIVIDUALS WITH COMPLETING ENROLLMENT FORMS ARE AVAILABLE FOR ADDITIONAL INFORMATION. 14577549 1 0 0 1 0 0 0 0 1 1 1 0 0 0 1 1 1 0 0 0 0 0 0 0 1 0 1 1 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 22 0 225 1 1 1 0 0 0 0 1 1 0 0 0 0 0 0 X 9 9 0 0 0 0 1 1 0 1 1 0 0 1 1 1 1 1 1 1 1 0 MN X X CURTIS BACH 2188433802 1010 SOUTH BIRCH AVENUE HALLOCK MN 56728 DRROLAND LARTER BOARD MEMBER 1.00 X 1547 0 0 HUGH HUNT BOARD MEMBER 1.00 X 106 0 0 JANA RILEY-KRAULIK TREASURER 1.00 X X 369 0 0 JANELLE CRAIGMILE BOARD MEMBER 1.00 X 556 0 0 KENNETH HULTGREN BOARD MEMBER 1.00 X 0 0 0 MICHAEL SWANSON VICE PRESIDENT 1.00 X X 601 0 0 ROBERT JASZCZAK PRESIDENT 1.00 X X 500 0 0 SANDY WILSON BOARD MEMBER 1.00 X 669 0 0 STACY DIAMOND SECRETARY 1.00 X X 0 0 0 ANDREA SWENSON CEO 40.00 X 100166 0 5685 CURTIS BACH CFO 40.00 X 85191 0 1854 GABRIEL MOONEY CEO (THRU 12/22) 40.00 X 164874 0 0 AMANDA PINNOCK NURSE PRACTITIONER 32.00 X 153071 0 5160 JAMES SURDY MEDICAL DOCTOR 40.00 X 405786 0 15385 JULIE JOHNSON NURSE PRACTITIONER 32.00 X 175177 0 10441 VANESSA COOK MEDICAL DOCTOR 40.00 X 231000 0 7316 JENI SCHWENZFEIER FORMER CFO 0.00 X 129316 0 0 1448929 0 45841 7 1 1 0 TRIAD TRAVEL NURSING AGENCY 112 N UNIVERSITY DR FARGO ND 58102 NH TRAVEL STAFFING 640401 MEDICAL STAFFING PARTNERS 880 SW 15TH ST FOREST LAKE MN 55025 HOSPITAL TRAVEL STAFFING 578878 BIG STONE THERAPIES INC 500 PARK ST E ANNANDALE MN 55302 CONTRACT THERAPY SERVICES- PT, OT, SPEEC 574789 ROCK MEDICAL GROUP 2717 N 118TH ST SUITE 210 OMAHA NE 68164 NH TRAVEL STAFFING 259101 FUSION MEDICAL STAFFING LLC 18881 W DODGE RD STE 300W ELKHORN NE 68022 NH TRAVEL STAFFING 234170 5 623749 122769 746518 PATIENT & RESIDENT SER 623000 14607439 14607439 PHARMACY 456110 2191492 2191492 CENTRAL MN DIAGNOSTIC 451439 111135 111135 16910066 125703 125703 21050 0 21050 21050 21050 348010 0 348010 348010 348010 43892 7493 36399 36399 4194 0 4194 4194 PUBLIC HEALTH 624100 130555 130555 MISCELLANEOUS 561499 38688 38688 HOME HEALTH 621610 25874 25874 7916 7916 203033 18394973 17066495 7916 574044 X 675 675 340132 68027 272105 6786989 5708939 1078050 101340 99604 1736 606656 466901 139755 458548 386772 71776 7143 7143 285625 285625 4448375 4246100 202275 61317 9238 52079 808722 621848 186874 352781 86725 266056 335086 120375 214711 72062 62339 9723 77855 38695 39160 109406 33921 75485 528096 467623 60473 141042 141042 MEDICAL SUPPLIES 1313459 1313459 PHARMACY 314534 314534 FOOD 239597 231451 8146 BAD DEBT EXPENSE 233044 233044 135547 67279 68268 17758031 14577549 3180482 0 711 321 6730568 5553794 1413437 1356779 417384 163355 117029 126179 17666962 14877649 2737027 2789313 1044524 1600775 11667 0 277741 414710 12750088 12005226 1687938 1527831 1570446 10000 4834 2142918 2132809 0 349919 5406136 4020559 X 7257248 7894190 86704 90477 7343952 7984667 12750088 12005226 636942 3773 0 X 0 1 X 1 1 1 X 0 0 0 0 0 0 0 0 1 439 439 0 PART II-B, LINE 1: THE ORGANIZATION PAYS DUES TO THE MINNESOTA HOSPITAL ASSOCIATION AND AMERICAN HOSPITAL ASSOCIATION, A PORTION OF WHICH IS SPENT ON LOBBYING ON BEHALF OF ITS MEMBERS. 1 3847 3847 1 X 57383 3773 61156 59574 -2191 57383 54681 4893 59574 51714 4467 1500 54681 50547 1167 51714 0.00000 1.00000 0.00000 0 0 12985 12985 9189155 7948017 1241138 510196 397680 112516 7954626 6531952 1422674 2789313 THIRD PARTY PAYOR SETTLEMENTS 175255 LEASE LIABILITIES 174664 349919 X 18173195 3773 7493 11266 18161929 233044 233044 18394973 17532480 7493 7493 17524987 233044 233044 17758031 PART IV, LINE 1B: A SMALL AUXILIARY OPERATES UNDER THE HOSPITAL'S EIN. PART IV, LINE 2B: THE CENTER HOLDS FUNDS UNDER AN AGENCY RELATIONSHIP FOR THE RESIDENTS OF THE NURSING FACILITY. PART X, LINE 2: THE CENTER IS ORGANIZED AS A MINNESOTA NONPROFIT CORPORATION AND HAS BEEN RECOGNIZED BY THE INTERNAL REVENUE SERVICE (IRS) AS EXEMPT FROM FEDERAL INCOME TAXES UNDER INTERNAL REVENUE CODE SECTION 501(C)(3). THE CENTER UNDERGOES AN ANNUAL ANALYSIS OF ITS VARIOUS TAX POSITIONS, ASSESSING THE LIKELIHOOD OF THESE POSITIONS BEING UPHELD UPON EXAMINATION WITH RELEVANT TAX AUTHORITIES, AS DEFINED BY ACCOUNTING PRINCIPLES GENERALLY ACCEPTED IN THE UNITED STATES OF AMERICA. THE CENTER BELIEVES THAT IT IS COMPLIANT WITH ALL IRS TAX REGULATIONS AND AS OF SEPTEMBER 30, 2023 AND 2022 HAS NOT RECORDED LIABILITIES FOR INCOME TAXES. THE CENTER WILL RECOGNIZE FUTURE ACCRUED INTEREST AND PENALTIES RELATED TO UNRECOGNIZED TAX LIABILITIES IN INCOME TAX EXPENSE IF INCURRED. PART XI, LINE 2D - OTHER ADJUSTMENTS: FUNDRAISING EXPENSES 7,493. PART XI, LINE 4B - OTHER ADJUSTMENTS: PROVISION FOR UNCOLLECTIBLE ACCOUNTS 233,044. PART XII, LINE 2D - OTHER ADJUSTMENTS: FUNDRAISING EXPENSES 7,493. PART XII, LINE 4B - OTHER ADJUSTMENTS: PROVISION FOR UNCOLLECTIBLE ACCOUNTS 233,044. GOLF 43892 43892 2277 4280 936 43892 43892 2277 4280 936 7493 36399 1 1 X 1 X 1 X 1 1 0 1 1 11751741 9166608 2585133 0.14560 11751741 9166608 2585133 0.14560 11751741 9166608 2585133 0.14560 0 233044 0 2934915 3682374 -747459 X 1 1 1 1 KITTSON MEMORIAL HEALTHCARE CENTER 1010 SOUTH BIRCH AVENUE HALLOCK MN 56728 HTTPS://KITTSONHC.ORG/SERVICES/PATIENT 371450 X X X X KITTSON MEMORIAL HEALTHCARE CENTER 1 0 0 1 X X X X X X X X 21 1 0 0 1 X HTTPS://KITTSONHC.ORG/WHO-WE-ARE/COMMUNITY-HEALTH-NEEDS-ASSESSMENT.HTML X 1 21 1 HTTPS://KITTSONHC.ORG/WHO-WE-ARE/COMMUNITY-HEALTH-NEEDS-ASSESSMENT.HTML 0 1 X 100.000000000000 200.000000000000 X X 1 1 X X X X 1 X HTTPS://KITTSONHC.ORG/SERVICES/PATIENT-FINANCIAL-SERVICES/ X HTTPS://KITTSONHC.ORG/SERVICES/PATIENT-FINANCIAL-SERVICES/ X HTTPS://KITTSONHC.ORG/SERVICES/PATIENT-FINANCIAL-SERVICES/ X X X X X 1 X 0 X X 1 X 0 0 KITTSON MEMORIAL HEALTHCARE CENTER PART V, SECTION B, LINE 5: PRIOR TO COMPLETING THE 2022 CHNA, THE 2019 & 2016 ASSESSMENTS WERE REVIEWED BY A WORKGROUP THAT INCLUDED THE CEO, LEADERSHIP TEAM, HUMAN RESOURCES, PUBLIC RELATIONS AND PUBLIC HEALTH. THE 2022 CHNA AND IP WAS COMPLETED AND APPROVED BY THE GOVERNING BOARD THE END OF SEPTEMBER 2022. IN ADDITION TO THE INFORMATION AVAILABLE REFLECTING THE PAST TWO CHNA CYCLES, THE WORKGROUP REVIEWED CURRENT HEALTH TRENDS FOR KITTSON COUNTY AND THE SURROUNDING QUIN COMMUNITY HEALTH BOARD SERVICE AREA MAKING UP THE NW MN.THE NORTHWEST MN COMMUNITY HEALTH NEEDS ASSESSMENT SURVEY WAS MODIFIED TO INCLUDE SEVERAL QUESTIONS UNIQUE TO KITTSON COUNTY IN COLLABORATION WITH A PUBLIC HEALTH RESEARCH CONSULTANT. THIS SURVEY WAS THEN SENT TO EVERY DOOR IN KITTSON COUNTY AS WELL AS MADE AVAILABLE IN AN ELECTRONIC FORMAT. THE WORKGROUP TARGETED CITY LEADERS, SENIOR CENTERS, SCHOOL STAFF, PUBLIC HEALTH AND HOME HEALTH PARTICIPANTS, HEALTHCARE PROVIDERS, COUNTY EMPLOYEES, SOCIAL SERVICES, BUSINESS OWNERS, AND FAMILIES. NEARLY 100 RESPONSES WERE RECEIVED. FROM THESE RESPONSES, PRIORITIES WERE IDENTIFIED AND NARROWED TO FIVE IN WHICH THE PUBLIC WERE ASKED TO VOTE ON THEIR TOP THREE PRIORITIES. THESE ARE LISTED IN DETAIL IN THE IMPLEMENTATION PLAN. KITTSON MEMORIAL HEALTHCARE CENTER PART V, SECTION B, LINE 11: KITTSON HEALTHCARE IS A NON-PROFIT, NON-AFFILIATED, LOCALLY OWNED AND OPERATED 501(C) 3 ORGANIZATION THAT HAS SERVED THE COMMUNITY SINCE 1922. KITTSON HEALTHCARE IS A FEDERALLY DESIGNATED CRITICAL ACCESS HOSPITAL, A STATE-DESIGNATED SOLE COMMUNITY HOSPITAL AND AN ESSENTIAL COMMUNITY PROVIDER. KITTSON HEALTHCARE HAS BEEN THE SOLE HOSPITAL IN KITTSON COUNTY SINCE JANUARY 1995.KITTSON COUNTY IS CONSIDERED DEEP RURAL OR A FRONTIER COUNTY AND HAS 1,098.8 SQUARE MILES OF LAND MAKING IT THE 18TH LARGEST COUNTY IN MINNESOTA BY TOTAL AREA. KITTSON COUNTY, MN IS BORDERED BY PEMBINA COUNTY, ND TO THE WEST, ROSEAU COUNTY, MN TO THE EAST, MARSHALL COUNTY, MN TO THE SOUTH AND ONTARIO, CANADA TO THE NORTH. KITTSON HEALTHCARE'S PRIMARY SERVICE AREA INCLUDES KITTSON COUNTY, A PORTION OF NORTHWEST MARSHALL COUNTY AND THE NORTHEASTERN BOARDER OF NORTH DAKOTA. IN RESPONSE TO PREVIOUS COMMUNITY ASSESSMENTS, KITTSON HEALTHCARE CONTRACTS WITH ALLUMA, A COMMUNITY MENTAL HEALTH CENTER FOR OUTREACH MENTAL HEALTH AND WELLNESS SERVICES FOR IN PERSON AND/OR TELEHEALTH COUNSELING SERVICES. EMPLOYEES A CERTIFIED NURSE PRACTITIONER SPECIALIZING IN MEDICATION MANAGEMENT OF PSYCHIATRIC CONDITIONS AND AN ADDITIONAL BEHAVIORAL HEALTH THERAPIST WAS ADDED TO INCREASE CAPACITY AND FURTHER MEET DEMAND FOR COUNSELING SERVICES. IN RESPONSE TO COMMUNITY REQUESTS FOR LOCAL ACCESS TO SPECIALTY SERVICES, VISITING PROVIDERS WERE ADDED IN THE AREAS OF CARDIOLOGY, DERMATOLOGY, ENDOSCOPY, AND OBSTETRICS & GYNECOLOGY JUST TO NAME A FEW.THE PRIORITIES THAT EMERGED FROM THE 2022 CHNA THAT CURRENTLY SERVE AS A GUIDE TO MEETING THE NEEDS OF THE COMMUNITY INCLUDE; STRESS AND ANXIETY MANAGEMENT, HEART HEALTH, WEIGHT MANAGEMENT AND ACCESS TO HEALTHCARE SERVICES AND RESOURCES. IN AN EFFORT TO BUILD UPON PAST EFFORTS AND TO FURTHER MEET THE NEEDS OF THE COMMUNITY, FOCUS HAS BEEN TO SUSTAIN THE CURRENT WORKFORCE IN THE AREA OF MENTAL HEALTH AND WELLNESS. ALSO, THE HOSPITAL BASED PUBLIC HEALTH DEPARTMENT HAS BECOME A MEMBER IN TWO COMMUNITY COALITIONS THAT ADVOCATE AND RAISE AWARENESS OF MENTAL HEALTH AND MENTAL WELLNESS. THE PUBLIC RELATIONS & GRANT MANAGER HAS PRIORITIZED AND SCHEDULED WEEKLY PUBLIC MEDIA CAMPAIGNS RELATED TO MENTAL HEALTH AND WELLNESS TO INCREASE AWARENESS OF RESOURCES, NORMALIZE DIFFICULT CONVERSATIONS SUCH AS SUICIDE, DEPRESSION AND ANXIETY. RESOURCES FOR INDIVIDUALS WORKING IN AGRICULTURE HAVE ALSO BEEN HIGHLIGHTED. A GRANT TO SUPPORT THE MENTAL HEALTH OF THE ORGANIZATIONS HEALTHCARE WORKERS WAS SUCCESSFULLY AWARDED CURRENTLY IN PROGRESS. THERE IS STRONG SUPPORT THROUGHOUT THE COMMUNITY FOR THE KITTSON HEALTHCARE ORGANIZATION HOWEVER COVID-19 HAS REQUIRED AN INTERNAL FOCUS UPON THE ORGANIZATION AS THE RIPPLE EFFECTS OF STAFF TURNOVER, AGING POPULATION AND AGING FACILITY HAVE DEMANDED IT. THEREFORE, THE PRIORITY OF MENTAL HEALTH AND WELLNESS HAS BEEN THE FOCUS AT THIS TIME WITH ADDITIONAL PRIORITIES TO BE CONSIDERED THROUGHOUT THE YEAR. 1 1 - KITTSON MEMORIAL CLINIC OF KARLSTAD 205 ROOSEVELT AVENUE WEST KARLSTAD MN 56372 RURAL HEALTH CLINIC PART I, LINE 3C: TO QUALIFY FOR FINANCIAL ASSISTANCE, AN INDIVIDUAL MUST:(A) RECEIVE EMERGENCY MEDICAL CARE OR MEDICALLY NECESSARY CARE AT THE HOSPITAL;(B) HAVE TOTAL INCOME LESS THAN OR EQUAL TO 200 PERCENT OF FEDERAL POVERTY GUIDELINES;(C) APPLY FOR MEDICAID; AND(D) SUBMIT A COMPLETE COMMUNITY CARE (FINANCIAL ASSISTANCE) APPLICATION, INCLUDING REQUIRED DOCUMENTATION. PART I, LINE 6A: THE ANNUAL COMMUNITY BENEFIT REPORT IS MADE AVAILABLE UPON REQUEST. PART I, LINE 7: THE ORGANIZATION USED THE COST TO CHARGE RATIO FROM WORKSHEET 2 FROM THE IRS TO CALCULATE THE AMOUNTS IN LINE 7B AND USED ACTUAL COSTS TO CALCULATE THE AMOUNTS IN LINES 7G AND 7I. PART I, LINE 7G: SUBSIDIZED HEALTH SERVICES INCLUDED IN PART I, LINE 7G INCLUDE COSTS AND REVENUES ASSOCIATED WITH HALLOCK RURAL HEALTH CLINIC, KARLSTAD RURAL HEALTH CLINIC, EMERGENCY ROOM SERVICES, CARDIAC REHABILIATION SERVICES, THE SKILLED NURSING FACILITY, ADULTS & PEDIATRICS, MEDICAL SUPPLIES, AND OBSERVATION BEDS. PART I, LN 7 COL(F): THE BAD DEBT EXPENSE INCLUDED ON FORM 990, PART IX, LINE 25(A), BUT SUBTRACTED FOR PURPOSES OF CALCULATING THE PERCENTAGE IN THIS COLUMN IS $ 233,044. PART II, COMMUNITY BUILDING ACTIVITIES: KITTSON MANAGERS DELIVER COMMUNITY MEALS ON WHEELS FOR ONE MONTH EACHYEAR; SUPPORT A VIRTUAL "RELAY FOR LIFE" EVENT; PROVIDE AMBULANCE STAND-BYSERVICES AT LOCAL PUBLIC HIGH SCHOOL SPORTING VENTS; PROVIDE FREE BLOODPRESSURE CHECKS AT VARIOUS AREA EVENTS THROUGHOUT THE YEAR; PROVIDEFINANCIAL CONTRIBUTIONS TO HELP FUND TWO AREA PUBLIC SCHOOLS' "AFTER PROMPARTY" EVENTS; PROVIDE TO AREA CHARITIES FOR THEIR FUNDRAISING EVENTS, LABTESTING CERTIFICATES AS DOOR OR RAFFLE PRIZES; FREE AND REDUCED CARE;HEALTH INFORMATION BOOTH AT FOUR DAY COUNTY FAIR. KITTSON HEALTHCARE ALSOPROVIDES SERVICES THAT OTHER PRIVATE ENTITITES TYPICALLY WON'T CONSIDERPROVIDING SUCH AS ASSISTED LIVING SERVICES, NURSING HOME SERVICES, ELDERLYWAIVERED SERVICES, COMMUNITY FITNESS, AMBULANCE SERVICES, ETC. AS THEREIS LITTLE VOLUME AND MINIMAL FINANCIAL RETURN. HOWEVER, KITTSONHEALTHCARE'S GOVERNING BOARD VIEWS THESE SERVICES AS ESSENTIAL IN MEETINGTHE NEEDS AND SERVING THE RESIDENTS OF KITTSON COUNTY. PART III, LINE 2: IN EVALUATING THE COLLECTABILITY OF PATIENT AND RESIDENT ACCOUNTS RECEIVABLE, THE CENTER ANALYZES ITS COLLECTION HISTORY AND IDENTIFIES TRENDS FOR EACH OF ITS MAJOR PAYOR SOURCES OF REVENUE TO ESTIMATE THE APPROPRIATE ALLOWANCE FOR DOUBTFUL ACCOUNTS AND PROVISION FOR BAD DEBTS. MANAGEMENT REGULARLY REVIEWS DATA ABOUT THESE MAJOR PAYOR SOURCES OF REVENUE IN EVALUATING THE SUFFICIENCY OF THE ALLOWANCE FOR DOUBTFUL ACCOUNTS. FOR RECEIVABLES ASSOCIATED WITH SERVICES PROVIDED TO PATIENTS WHO HAVE THIRD-PARTY COVERAGE, THE CENTER ANALYZES CONTRACTUALLY DUE AMOUNTS AND PROVIDES AN ALLOWANCE FOR DOUBTFUL ACCOUNTS AND A PROVISION FOR BAD DEBTS, IF NECESSARY (FOR EXAMPLE, FOR EXPECTED UNCOLLECTIBLE DEDUCTIBLES AND COPAYMENTS ON ACCOUNTS FOR WHICH THE THIRD-PARTY PAYOR HAS NOT YET PAID, OR FOR PAYORS WHO ARE KNOWN TO BE HAVING FINANCIAL DIFFICULTIES THAT MAKE THE REALIZATION OF AMOUNTS DUE UNLIKELY). FOR RECEIVABLES ASSOCIATED WITH SELF-PAY PATIENTS (WHICH INCLUDES BOTH PATIENTS WITHOUT INSURANCE AND PATIENTS WITH DEDUCTIBLE AND COPAYMENT BALANCES DUE FOR WHICH THIRD-PARTY COVERAGE EXISTS FOR PART OF THE BILL), THE CENTER RECORDS A SIGNIFICANT PROVISION FOR BAD DEBTS IN THE PERIOD OF SERVICE ON THE BASIS OF ITS PAST EXPERIENCE, WHICH INDICATES THAT MANY PATIENTS ARE UNABLE OR UNWILLING TO PAY THE PORTION OF THEIR BILL FOR WHICH THEY ARE FINANCIALLY RESPONSIBLE. PART III, LINE 3: THE ORGANIZATION HAS NOT IDENTIFIED A METHOD TO REASONABLY ESTIMATE THE PORTION OF OUR BAD DEBT EXPENSE ATTRIBUTABLE TO PATIENTS ELIGIBLE UNDER OUR FINANCIAL ASSISTANCE POLICY. PART III, LINE 4: SEE THE "PATIENT AND RESIDENT RECEIVABLES" SECTION IN NOTE 1 (PAGE 9) TO THE FINANCIAL STATEMENTS FOR INFORMATION ABOUT THE CALCULATION OF BAD DEBT EXPENSE. PART III, LINE 8: THE MEDICARE SHORTFALL REPORTED IN PART III, LINE 7 IS DUE TO THE NON-ALLOWABLE/NON-REIMBURASABLE COSTS PER THE MEDICARE COST REPORT AND WOULDN'T NECESSARILY BE CONSIDERED COMMUNITY BENEFIT IN NATURE.THE MEDICARE ALLOWABLE COSTS REPORTED IN PART III, LINE 6 WERE DERIVED USING THE FY 2023 FILED MEDICARE COST REPORT. PART III, LINE 9B: COLLECTION EFFORTS ARE MADE BY CONTACTING THE PATIENT THROUGH WRITTEN CORRESPONDENCE AND PHONE CALLS. IF, THROUGHOUT THESE CONVERSATIONS, THE COLLECTOR AND PATIENT DISCUSS THAT THE PATIENT IS NOT ABLE TO AFFORD PAYMENTS AS REQUIRED BY OUR POLICY, THE PATIENT IS ENCOURAGED TO APPLY FOR COMMUNITY CARE. AN APPLICATION, PLAIN LANGUAGE SUMMARY, AND FAP ARE SENT TO THE PATIENT TO REVIEW AND COMPLETE. ACCORDING TO FEDERAL POVERTY GUIDELINES, THE PATIENT MAY QUALIFY FOR ALL OR A PERCENT OF CHARGES WRITTEN OFF THEIR ACCOUNT. PATIENTS MUST APPLY FOR MEDICAID PRIOR TO QUALIFYING FOR COMMUNITY CARE. ADDITIONAL INFORMATION IS OFFERED TO HELP THEM APPLY FOR STATE FUNDED PROGRAMS. PART VI, LINE 2: PUBLIC HEALTH CONDUCTS A COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA). THIS INFORMATION IS THEN SHARED WITH FACILITY MANAGEMENT AND THE BOARD OF DIRECTORS. GOING FORWARD, A CHNA WILL BE CONDUCTED EVERY THREE YEARS TO MAKE THIS ASSESSMENT.IN ADDITION TO CONDUCTING THE CHNA EVERY THREE YEARS, KITTSON INFORMALLY LISTENS TO THE PUBLIC'S REQUEST FOR SERVICES. THROUGH OUR PUBLIC HEALTH AND SCHOOL HEALTH WORK, WE ARE CONTINUALLY ASSESSING THE HEALTH NEEDS OF THE COMMUNITY AND MEETING THE NEEDS AT THE TIME. FOR EXAMPLE, KITTSON HELD PUBLIC MEETINGS WITH COUNSELORS WHEN THE COMMUNITY HAD A NEED FOR ADDITIONAL SUPPORT AND INFORMATION REGARDING SUICIDE. PART VI, LINE 3: IF A PATIENT IS UNABLE TO PAY THEIR BILL, THE PATIENT IS ENCOURAGED TO APPLY FOR COMMUNITY CARE. AN APPLICATION IS SUBSEQUENTLY SENT TO COMPLETE, ALONG WITH A COPY OF OUR FAP AND PLAIN LANGUAGE SUMMARY (A NOTICE IS INCLUDED IN THEIR MONTHLY STATEMENT TO CONTACT US REGARDING COMMUNITY CARE IF THEY ARE UNABLE TO PAY THEIR BILL). WE ARE ADDITIONALY ABLE TO PROVIDE PATIENTS WITH CONTACT INFORMATION AT THE COUNTY FOR QUALIFICATION/APPLICATION INFORMATION REGARDING GOVERNMENTAL FINANCIAL ASSISTANCE. INFORMATION REGARDING COMMUNITY CARE IS ALSO AVAILABLE IN THE ADMISSION AREA OF THE CLINIC. PART VI, LINE 4: KMHC PRIMARILY SERVES THE RESIDENTS OF KITTSON COUNTY, WHICH IS LOCATED IN NORTHWEST MINNESOTA, WITH A POPULATION OF APPROXIMATELY 4,200. THIS IS A VERY RURAL AREA WITH 3.9 PERSONS PER SQUARE MILE. THE MEDIAN HOUSEHOLD INCOME IS $60,676 WITH 10.2% OF THE POPULATION BELOW POVERTY LEVELS. PART VI, LINE 5: KITTSON MANAGERS DELIVER COMMUNITY MEALS ON WHEELS FOR ONE MONTH EACH YEAR; SUPPORT A VIRTUAL "RELAY FOR LIFE" EVENT; PROVIDE AMBULANCE STAND-BY SERVICES AT LOCAL PUBLIC HIGH SCHOOL SPORTING VENTS AS WELL AS THE COUNTY FAIR; PROVIDE FREE BLOOD PRESSURE CHECKS AT VARIOUS AREA EVENTS THROUGHOUT THE YEAR; PROVIDE FINANCIAL CONTRIBUTIONS TO HELP FUND TWO AREA PUBLIC SCHOOLS' "AFTER PROM PARTY" EVENTS; PROVIDE TO AREA CHARITIES FOR THEIR FUNDRAISING EVENTS, LAB TESTING CERTIFICATES AS DOOR OR RAFFLE PRIZES; FREE AND REDUCED CARE; HEALTH INFORMATION BOOTH AT FOUR DAY COUNTY FAIR. KITTSON HEALTHCARE ALSO PROVIDES SERVICES THAT OTHER PRIVATE ENTITITES TYPICALLY WON'T CONSIDER PROVIDING SUCH AS ASSISTED LIVING SERVICES, NURSING HOME SERVICES, ELDERLY WAIVERED SERVICES, COMMUNITY FITNESS, AMBULANCE SERVICES, ETC. AS THERE IS LITTLE VOLUME AND MINIMAL FINANCIAL RETURN. HOWEVER, KITTSON HEALTHCARE'S GOVERNING BOARD VIEWS THESE SERVICES AS ESSENTIAL IN MEETING THE NEEDS AND SERVING THE RESIDENTS OF KITTSON COUNTY. PART VI, LINE 7, REPORTS FILED WITH STATES MN X X X 0 0 0 0 0 0 0 0 0 JAMES SURDY MEDICAL DOCTOR 402676 0 0 0 3110 0 7813 0 7572 0 421171 0 0 0 VANESSA COOK MEDICAL DOCTOR 142665 0 86795 0 1540 0 5780 0 1536 0 238316 0 0 0 JULIE JOHNSON NURSE PRACTITIONER 119073 0 54900 0 1204 0 0 0 10441 0 185618 0 0 0 GABRIEL MOONEY CEO (THRU 12/22) 164874 0 0 0 0 0 0 0 0 0 164874 0 0 0 AMANDA PINNOCK NURSE PRACTITIONER 114013 0 38085 0 973 0 0 0 5160 0 158231 0 0 0 JENI SCHWENZFEIER FORMER CFO 129316 0 0 0 0 0 0 0 0 0 129316 0 0 0 FORM 990, PART VI, SECTION A, LINE 1A THE EXECUTIVE COMMITTEE SHALL CONSIST OF THE PRESIDENT AS CHAIRPERSON, THE VICE PRESIDENT, THE SECRETARY AND THE TEASURER. THE EXECUTIVE COMMITTEE SHALL HAVE THE POWER TO TRANSACT ALL REGULAR BUSINESS OF THE HOSPITAL DURING THE PERIOD BETWEEN THE MEETING OF THE BOARD OF DIRECTORS, SUBJECT TO ANY PRIOR LIMITATION IMPOSED BY THE BOARD OF DIRECTORS. THE EXECUTIVE COMMITTEE SHALL ALSO ADDRESS ANY MEDICAL STAFF, PERSONNEL OR BUILDING ISSUES ON AN AS-NEEDED BASIS OR MAY REFER SUCH ISSUES TO THE FULL BOARD OF DIRECTORS. FORM 990, PART VI, SECTION A, LINE 6 MEMBERSHIP IN THE ASSOCIATION SHALL BE ANY NATURAL PERSON OF LEGAL AGE PURCHASING ONE OR MORE MEMBERSHIP SHARES OF THE CORPORATION FOR THE SUM OF $50.00 EACH. FORM 990, PART VI, SECTION A, LINE 7A MEMBERS ARE ALLOWED TO VOTE FOR MEMBERS OF THE BOARD AT THE ANNUAL MEETING. FORM 990, PART VI, SECTION B, LINE 11B THE CFO REVIEWED THE PROPOSED FORM 990 AND VIRTUALLY DISTRIBUTED THE FORM 990 TO THE GOVERNING BOARD OF DIRECTORS FOR THEIR REVIEW AND APPROVAL. UPON APPROVAL BY THE GOVERNING BOARD, THE 990 WAS THEN FILED. FORM 990, PART VI, SECTION B, LINE 12C IT IS THE BOARD'S POLICY TO AVOID ANY POSSIBLE APPEARANCE OF IMPROPRIETY OR BREACH OF THE MEMBER'S FIDUCIARY RESPONSIBILITY BY HAVING BOARD MEMBERS ANNUALLY ACKNOWLEDGE ANY POTENTIAL BUSINESS OR PERSONAL CONFLICTS IN REGARDS TO KITTSON MEMORIAL'S BUSINESS AFFAIRS. IT IS NOT THE INTENTION OF THIS POLICY TO PRECLUDE A BOARD MEMBER FROM BEING INVOLVED IN THE DISCUSSION OF A SUBJECT WHERE THE BOARD MEMBER HAS A CONFLICT OF INTEREST. HOWEVER, DISCRETION SHOULD BE EXERCISED AND THE BOARD MEMBER IS EXPECTED TO ABSTAIN FROM VOTING ON THE MATTER. THE CONFLICT OF INTEREST POLICY IS SIGNED ANNUALLY AT THE BOARD'S REGULAR MEETING IN JANUARY. THIS STATEMENT IS RETAINED BY THE PRESIDENT AND A COPY FILED IN THE CEO'S OFFICE. THE PRESIDENT IS RESPONSIBLE TO CALL INTO QUESTION A POSSIBLE CONFLICT OF INTEREST OF A PARTICULAR BOARD MEMBER WHEN APPLICABLE IN THE EVENT THE BOARD MEMBER DOES NOT DECLARE A CONFLICT OF INTEREST. FORM 990, PART VI, SECTION B, LINE 15 THE CEO'S COMPENSATION IS DETERMINED BY A MAJORITY VOTE OF THE BOARD OF DIRECTORS. THE GOVERNING BOARD REVIEWS SALARY SURVEY INFORMATION FROM THE MN HOSPITAL ASSOCIATION AND OFFERS COMPETITIVE WAGES BASED ON THE SURVEY. THE DOCUMENTATION OF SUCH DECISION IS RECORDED AND FILED ON THE EMPLOYEE'S HR FILE. OTHER OFFICERS' COMPENSATION IS DETERMINED BY THE CEO. THE CEO REVIEWS SALARY SURVEY INFOMRATION FROM THE MN HOSPTIAL ASSOCAITON AND OFFERS THE KEY EMPLOYEE'S COMPETITIVE WAGES BASED ON THE SURVEY. THE DOCUMENTATION OF SUCH DECISION IS RECORDED AND FILED ON THE EMPLOYEE'S HR FILE. COMPENSATION WAS LAST REVIEWED IN 2023. FORM 990, PART VI, SECTION C, LINE 19 KITTSON MEMORIAL HOSPITAL'S GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS ARE MADE AVAILABE TO THE PUBLIC UPON REQUEST. FORM 990, PART IX, LINE 11G OTHER FEES: PROGRAM SERVICE EXPENSES 4,246,100. MANAGEMENT AND GENERAL EXPENSES 202,275. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 4,448,375. AMENDED FORM 990 THE ORGANIZATION'S FORM 990 HAS BEEN AMENDED TO REFLECT THE CHANGES MADE TO THE AUDITED FINANCIAL STATEMENTS. THE STATEMENT OF REVENUE, STATEMENT OF FUNCTIONAL EXPENSES, BALANCE SHEET AND SCHEDULE D WERE AFFECTED BY THESE CHANGES.