2026-05-08T07:40:43-05:00 2025-06-30 450250958 Eide Bailly LLP 4585 Coleman St Ste 200 Bismarck ND 58503 990 2024-07-01 410307617 Hendricks Community Hospital Association HEND 5072753134 PO Box 106 Hendricks MN 56136 Travis Olsen CEO 5072753134 2026-05-05 1 1 Lisa Chaffee CPA P00193453 7012551091 2026-04-30 2024 2025-03-06 01:10:19Z Travis Olsen PO Box 106 Hendricks MN 56136 18489164 0 X www.hendrickshosp.org X 1941 MN Provision of healthcare 9 9 240 53 0 0 495794 574937 16183057 17599964 214360 228164 60075 78806 16953286 18481871 9834 12760 0 0 8542992 9645205 0 0 0 7766974 8287002 16319800 17944967 633486 536904 28380138 29877804 4746537 4910690 23633601 24967114 X Hendricks Community Hospital Assn & Retirement Home strives to provide the highest quality health and residential care in a Christian environment. 0 0 16380694 12760 17599964 Hendricks Community Hospital, a 24-bed hospital, 48-bed long-term care facility, 16-unit assisted living facility, and home health agency promotes health of the community by providing a variety of health care services. The facility had 68 acute, 45 swing bed, 8 transitional bed and 36 long-term care facility admissions for the year ended June 30, 2025; 524 visits to the Emergency Room; and 146 surgical cases (including ambulatory).Continued on Schedule OThe hospital provides care to patients who meet certain criteria under its charity care policy without charge or at amounts less than established rates. Because the hospital does not pursue collection of amounts determined to qualify as charity care, they are not reported as patient and resident service revenue. The amount of charges foregone for services provided under the Hospital's charity care policy were approximately $39,000 for the year ended June 30, 2025. The estimated cost of providing these services was $29,000 for the year ended June 30, 2025 based on average ratio of cost to gross charges. 16380694 1 1 0 1 0 0 0 0 1 0 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 49 0 1 240 1 0 0 0 0 0 0 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 0 0 MN X Travis Olsen 5072753134 PO Box 106 Hendricks MN 56136 Allen Molascon President 3.00 X X 1200 0 0 Mark VanEck Vice President 2.00 X X 1300 0 0 Dawn Popowski Secretary 2.00 X X 1000 0 0 Vince Robinson Treasurer 2.00 X X 1300 0 0 Brittany Johnson Director 2.00 X 600 0 0 James Ness Director 2.00 X 500 0 0 John Engels Director 2.00 X 600 0 0 Heidi Fier Director 2.00 X 550 0 0 Heather Rae Shaw Director 2.00 X 700 0 0 Jeff Gollaher CEO (thru 11/24) 40.00 X 88662 0 25688 Travis Olsen CFO thru 11/24) / CEO (From 11/24) 40.00 X 156249 0 1041 Tabb McCluskey DO Physician 40.00 X 299850 0 58519 Grant Eyjolfson MD Physician 40.00 X 295638 0 56591 Alecia Moe Director of Nursing 40.00 X 130566 0 44690 Kathryn Christensen Nurse Practitioner 40.00 X 136891 0 45360 Brenda Bullerman Physician Assistant 40.00 X 177007 0 28135 1292613 0 260024 14 0 1 0 Fusion Medical Staffing 11808 Grant St Ste 100 Omaha NE 68164 Contracted Nursing Service 853829 Wapiti Medical Group 912 Industrial Dr Milbank SD 57252 Locum/ER Providers 709712 Fusion Workforce Staffing PO Box 30133 Omaha NE 68103 Contracted Nursing Services 199015 3 16815 367278 190844 574937 Net patient & resident service re 621110 17454560 17454560 145404 145404 17599964 224664 224664 35406 0 35406 35406 35406 3500 0 3500 3500 3500 3355 16815 4357 -1002 -1002 47338 2936 44402 44402 18481871 17599964 0 306970 X 12760 12760 458335 458335 7275886 7086100 189786 191387 191387 1182581 1109455 73126 537016 495201 41815 85397 2014 83383 3149908 3078359 71549 17126 222 16904 216619 195274 21345 6114 6114 375206 370773 4433 82470 82470 96841 60316 36525 95720 87431 8289 957970 921444 36526 208371 190326 18045 Medical Supplies 1270964 1270964 Repairs and Maintenance 1218772 997103 221669 Care Tax and Surcharge 174255 174255 MN Care Tax 99268 99268 232001 123713 108288 17944967 16380694 1564273 0 6446058 7691437 0 159200 3085074 3296060 13972 30000 141078 140404 110576 112139 29662834 19867984 9508586 9794850 9071281 8346639 0 307075 3513 0 28380138 29877804 867493 1243471 30800 31800 3368849 3143512 479395 491907 4746537 4910690 X 23633601 24967114 23633601 24967114 28380138 29877804 X 536904 806655 -10046 X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 246 246 0 Part II-B, Line 1: For calendar year 2024, MHA has determined that a portion of its membership dues were used for lobbying purposes as defined by Medicare for cost report purposes. 1 41850 58105 48059 51896 1 X 91512 91512 16588152 11228242 5359910 12322672 8639742 3682930 660498 660498 9794850 Insurance Loss Liability 344226 Estimated Third Party Payor 147681 491907 X 19282837 806655 806655 18476182 5689 5689 18481871 17949324 0 17949324 -4357 -4357 17944967 Part IV, Line 1b: The assets of Hendricks Hospital Auxiliary are held by Hendricks Community Hospital Association. The Auxiliary uses the EIN of the Hospital, therefore the activity is reported on Form 990 of the Hospital. The ending balance of the Auxiliary was $46,619. In addition, the hospital holds funds on behalf of its residents. The amount held at the end of the year for residents was $5,277. Part IV, Line 2b: The organization holds security deposits. Part X, Line 2: The Association believes it has appropriate support for any tax positions taken affecting its annual filing requirements, and, as such, does not have any uncertain tax positions that are material to the financial statements. The Association would recognize future accrued interest and penalties related to unrecognized tax benefits and liabilities in income tax expense if such interest and penalties are incurred. Part XI, Line 4b - Other Adjustments: Net income from auxiliary not included in financial statements 8,279. Resident fund net revenue not included in financial statements 1,767. Fundraising Event Expense -4,357. Part XII, Line 4b - Other Adjustments: Fundraising Event Expense -4,357. Hospice Night of Hope 20170 16815 3355 3356 400 601 20170 16815 3355 3356 400 601 4357 -1002 1 1 X 1 X 1 X 1 1 0 1 1 29000 29000 0.00160 4418621 3887899 530722 0.02960 4447621 3887899 559722 0.03120 6165 6165 0.00030 20162 20162 0.00110 3848416 2469740 1378676 0.07680 11595 11595 0.00060 3886338 2469740 1416598 0.07880 8333959 6357639 1976320 0.11000 1 141166 0 3716784 3752348 -35564 X 1 1 1 1 Hendricks Community Hospital Association 503 East Lincoln Hendricks MN 56136 www.hendrickshosp.org 405662 X X X X 2 provider based RHC's Hendricks Community Hospital Association 1 0 0 1 X X X X X X X X X 24 1 0 0 1 X www.hendrickshosp.org/chna X 1 24 1 www.hendrickshosp.org/chna 0 1 X 100.000000000000 400.000000000000 X X X X 1 1 X X X 1 X www.hendrickshosp.org/financial-assistance X www.hendrickshosp.org/financial-assistance X www.hendrickshosp.org/financial-assistance X X X X X X 1 X 0 X X X X 1 X 0 0 Hendricks Community Hospital Association Part V, Section B, Line 5: HCHA provided DSI with utilization demographics and previous health needs assessments. A community postal patron was distributed to all households in the HCHA service areas of Hendricks and Ivanhoe, requesting residents to complete the survey online. In addition, an ad was run in the local newspapers in the cities of Hendricks, Ivanhoe, Lake Benton, Tyler, Minnesota, and White and Astoria, South Dakota. HCHA also promoted the online survey through online platforms. Four focus group meetings were held in March 2025: Administration, Providers, Board of Directors, and Community. Secondary data analysis included data from the county where HCHA is located (Lincoln County, Minnesota) and two surrounding counties in HCHA health service area (Deuel and Brookings County, South Dakota), along with data for the State of Minnesota and the United States.HCHA promoted an online survey across six communities in the health service area, garnering 72 responses. Additionally, 19 individuals participated in the four focus groups. To maintain confidentiality, no identifiable information is disclosed in the focus group summary. Hendricks Community Hospital Association Part V, Section B, Line 11: The top health priorities were identified through the Community Health Needs Assessment process and recognized as focus areas by the HCHA Board of Directors. The following priorities were identified as top priorities:* Physical Activity* Nutrition* Community InvolvementAfter the top community health needs were identified, the Board of Directors focused on what HCHA could do to meet the needs identified, considering the resources available to HCHA and discussing opportunities to partner with local organizations. The process focused on identifying specific action steps toward addressing the top health concerns in the community. The action plan includes the identified priorities, the project impact, the goal, strategies, and the outcome objective for each identified priority.The HCHA Board of Directors created its action plan based on community health priorities highlighted in the Community Health Needs Assessment. They selected priorities that would benefit the majority of residents in their service area. Each identified priority in the action plan includes the objective, project impact, goal, and strategies. This plan will guide efforts to address these priorities over the next three years.Priority: Physical ActivityHCHA recognizes that each community member offers unique strengths, providing opportunities for all members to contribute to the overall health and wellness of the community. In creating a socially inclusive environment, communities can help individuals thrive in many areas of their lives and positively impact their overall wellness.Project impact:Physical activity benefits the community's health by reducing chronic diseases while improving overall wellness through encouraging social interaction and community involvement. This builds a sense of community and creates a better quality of life for all members. In addition to the health benefits for the community, physical activity can provide economic advantages by attracting businesses and individuals to the health service area with active lifestyles while promoting positive lifestyles for all ages.Goal:HCHA aims to improve community health by increasing access to and participation in regular physical activity through identifying local needs, barriers, and opportunities. This goal seeks to enhance physical activities among community members by raising awareness and educating communities in the health service area.Strategies:* Raise awareness of the benefits of physical activity through education.* Identify community events and activities to promote and increase awareness of the advantages of daily physical activity.* Involve community stakeholders in creating and supporting activity-friendly initiatives.* Lead or support local efforts to provide the community with physical activities that ensure equal access for all community members.Outcome Objective:The improvement of health, fitness, and quality of life through daily physical activity at any age, skill, and fitness level.Priority: NutritionHCHA is acknowledged as a vital force in the community, especially in health and wellness education. The Community Health Needs Assessment revealed the opportunity to improve health education initiatives by promoting healthy lifestyles. Although there is awareness about the significance of healthy eating, many community members encounter barriers. HCHA intends to empower individuals, families, and the community by providing education on health and wellness. Key topics for education may include nutrition, physical activity, obesity, and other health conditions, all designed to increase the community's level of understanding. Additionally, HCHA will engage with community partners to gather resources, aiming for a long-lasting impact on individuals, families, and the entire community.Project Impact:Enhancing the community's understanding of nutritious foods and encouraging healthy habits will contribute to lasting decreases in obesity, diabetes, and other chronic illnesses, ultimately fostering a healthier food environment for all community members.Goal:To improve the community's overall health and well-being by encouraging healthy eating habits and lifestyles through educational and community-driven initiatives that foster long-term wellness.Strategies:* Identify opportunities to enhance educational outreach impacting both community and noncommunity members by providing accurate, accessible, and actionable health and safety information.* Establish local collaborations to engage all community members in comprehending the significance of healthy lifestyles.* Leverage community events to provide educational insights and promote opportunities for healthy living.Outcome Objective:The increased understanding of healthy behaviors to improve individuals, families, and the overall community health.Priority: Community InvolvementHCHA recognizes community involvement as a core priority for fostering a healthy community, which in turn creates a thriving, resilient, and inclusive environment. It empowers residents and enhances community well-being, improving access to healthy food, employment, and social connections, all of which are essential for the overall health of the community across generations.Project Impact:Meaningful community involvement allows individuals to reflect on community needs and fosters ownership and shared responsibility by promoting healthy lifestyles, ultimately impacting a person's access to appropriate and well-coordinated healthcare and personal care.Goal:To promote inclusive community engagement by involving all residents in recognizing the advantages of such participation for enhancing both individual and community health.Strategies:* Engage with key stakeholders to consolidate resources for the planning and execution of community activities by enhancing awareness, promoting participation in events, and educating the community regarding the benefits to both communal and individual health.* Utilizing various marketing channels to promote community activities that foster a healthy lifestyle, including social media, local media, and HCHA.* Encouraging community members to participate in sharing their life experiences concerning healthy living and community engagement.Outcome Objective:Enhancing community involvement promotes the health of all members and fosters a healthier community.During the fiscal year, the following steps were taken to address needs identified in the 2021 CHNA:As previously reported regarding our transportation services, the large, wheelchair accessible van we purchased has brought much satisfaction and among our staff and our residents. We have a process where our staff goes through a short training program to ensure they have the required knowledge of the van features and that it's used safely and appropriately. We have recently also trained some resident family members and added them to our insurance policy so they are able to drive their family to appointments, funerals, family gatherings, etc. These families and community members are very thankful their voice was heard about the need for this transportation. Regarding our health and wellness education and activities, as mentioned in the previous year we were ablet to purchase a building on our main street, have it remodeled into an appropriately exercise facility and find a professional trainer who now leases that building to provide classes to our patients and community residents. There are unique classes that are designed and developed solely for our aging population and these have been extremely popular. This has been a valuable addition to our community as the cliental continues to grow and classes fill quickly. We provide discounts to our own staff to attend these classes and continue to financially support the exercise facility. Hendricks Community Hospital Association Part V, Section B, Line 13h: Discounted care eligibility is determined by utilizing asset and ability to pay information obtained from the patient or responsible party. Discounted care portion of the account is determined based on the patient's financial status and ability to pay the account. Hendricks Community Hospital Association Part V, Section B, Line 16j: Summaries of the financial assistance policy are posted in the hospital/clinic facilities, as well as waiting rooms and admission area. Billing statements to potentially eligible patients also include summary and contact information for obtaining the appropriate application. 2 1 - Hendricks Nursing Home 503 E Lincoln St Hendricks MN 56136 Long-term Care 2 - Lincoln Lane Villa 500 E Lincoln St Hendricks MN 56136 Assisted Living Part I, Line 3c: Discounted care eligibility is determined by utilizing asset and ability to pay information obtained from the patient or responsible party. Discounted care portion of the account is determined based on the patient's financial status and the ability to pay the account. Part I, Line 7: Charity care is based on an overall cost to charge ratio addressing all patient segments. Community health improvement services, health professions education, and cash and in-kind contributions for community benefit expenses are based on actual expenses recorded to the general ledger. Subsidized health services are reported according to costs allocated to the relevant cost centers on the Medicare Cost Report. Part III, Line 2: The amount reported on line 2 represents implicit price concessions. The Association determines its estimate of implicit price concessions based on its historical collection experience with this class of patients and residents. Part III, Line 3: Implicit price concessions are determined based on a patient's payment history as well as current known financial status. Such expense is determined by a patient's non-payment status and non-probability of payment. Part III, Line 4: The footnote to the organization's financial statements addressing implicit price concessions may be found on page 11 and 12 of the attached audited financial statements. Part III, Line 8: The Hospital provides services to Medicare patients because access to healthcare and patient's health is important to the Hospital. Total revenue received from Medicare is the gross reimbursement plus settlement. Both total revenue received from Medicare and the Medicare allowable costs are reported from the Medicare Cost Report. The Medicare Cost Report is completed based on the rules and regulations set forth by the Centers for Medicare and Medicaid Services. Part III, Line 9b: Patients are classified in the poverty level utilizing the Federal poverty guidelines as also referenced in our facility collection policy. The guidelines are referenced when a patient fails to complete payment of his/her account in a timely manner. Prior to being turned over to a collection agency, a patient is offered 120 days to complete a charity care application, thereby allowing staff time to determine the income level of the patient and their qualification as a poverty level individual. If they so choose to not complete an application, their account will be referred to a collection agency. The hospital allows an additional 120 days for a patient to apply for financial assistance. If the patient is determined to be eligible for financial assistance, collection activities will cease. Part VI, Line 2: We are consistently addressing the additional service needs as voiced though the physicians who serve our patients, as well as the patients themselves.The community health needs assessment and implementation strategy has been established and is available on our website www.hendrickshosp.org Part VI, Line 3: Patient's insurance information is obtained upon admission, and those patients not having current third party coverage are informed of the ability to apply for medical assistance funding or visit with our business office staff and social service staff regarding alternative payments and the charity care options. In addition, the patient statements provide information related to contacting our business office personnel to complete alternative payment arrangements, i.e. charity care, Medicaid or planned payment schedule. Patients are offered an option of setting an appointment to meet with staff to complete such arrangements. These procedures are also detailed in our financial assistance/charity care policy. Part VI, Line 4: Hendricks Community Hospital serves a primarily rural population within a 30-mile radius of the community of Hendricks. The facility is located in Lincoln County, Minnesota, which is slated as one of the highest elderly population counties in the State. The median income for the county is $53,057 with the highest portion of the population being over 65 years of age. However, because of the high elderly population, many of those constituents are insured through federal government programs and do not necessarily relate to increased Medicaid levels. There is one other acute care facility in the county approximately 30 miles away. Our facility is also located within one mile of the South Dakota border, and a good margin of population served is located in that state. Part VI, Line 5: The nine members of the Association's Board of Directors represent varying communities within the 30-mile service area. The board members provide valuable input on the health care needs of the area served.Medical staff privileges are extended to qualified physicians within the service area as well as outlying areas to provide the optimum level of care for our constituents. These privileges are granted to several specialty physicians to eliminate the need for additional travel for our patients.The Association continually allocates funds to the improvement of the facilities and equipment utilized to provide the optimum service to our patients. Surplus funds are also provided to enhance community services with donations to service organizations who offer additional health-enhancing services to the residents of the area. The rural health clinics in the Hendricks community and neighboring Ivanhoe community provide for improved community access. Particularily in the Ivanhoe community it has proved beneficial to be able to offer services to patients in their primary dwelling location.Emergency room services are available 24/7, and are offered regardless of payment source or ability to pay.The facility also participates in the Minnesota SAGE and South Dakota All Women Count programs which offer women yearly physical exams, including mammograms and pap smears at no cost to the patient.Facility staff is involved in community economic planning groups as well as community service organizations.Many area residents are involved as volunteers within our organization and participate on a daily basis enhancing the lives of the residents and patients in our facility. X X X 0 0 0 0 0 0 0 0 0 Tabb McCluskey DO Physician 299850 0 0 0 0 0 12830 0 45689 0 358369 0 0 0 Grant Eyjolfson MD Physician 295638 0 0 0 0 0 12337 0 44254 0 352229 0 0 0 Brenda Bullerman Physician Assistant 177007 0 0 0 0 0 7357 0 20778 0 205142 0 0 0 Kathryn Christensen Nurse Practitioner 136891 0 0 0 0 0 5799 0 39561 0 182251 0 0 0 Alecia Moe Director of Nursing 130566 0 0 0 0 0 5530 0 39160 0 175256 0 0 0 Travis Olsen CFO thru 11/24) / CEO (From 11/24) 156249 0 0 0 0 0 0 0 1041 0 157290 0 0 0 Form 990, Part VI, Section A, line 1a The Executive Committee is composed of the President, Vice-President, Secretary and Treasurer of the governing board. Responsibilities include: A. General management and control of the affairs of the corporation. In addition to formal meetings, the committee has informal conferences about corporation activities. B. Shall have the power to transact all regular business of the hospital during the interim between the meetings of the Board of Directors provided any action taken shall not conflict with the policies and expressed wishes of the Board of Directors, and that it shall refer all matters of major importance to the Board of Directors. C. It shall cause to be prepared and submit to the Board of Directors at its last meeting before the end of the fiscal year, a budget showing the expected receipts and income and expense for the ensuing year. It shall be the further duty of the Executive Committee to examine the monthly financial reports and to require an explanation from the Administrator for any material variation from the budget. D. The Executive Committee shall evaluate in April annually or as deemed necessary, the Chief Executive Officer's performance and recommend his/her remuneration to the full Board of Directors. This committee shall meet as necessary. Form 990, Part VI, Section A, line 6 There is one class of membership. Membership is open to any natural person who is of legal voting age and a voting resident within the organization's primary service area. Form 990, Part VI, Section A, line 7a Each member receives one vote. Form 990, Part VI, Section B, line 11b The return is reviewed by the CEO and then by the Board of Directors before it is filed. Form 990, Part VI, Section B, line 12c The policy covers all officers, directors, and key employees. A conflict of interest form is signed upon orientation to the Board of Directors. The form is reviewed by the CEO and any potential conflicts are reviewed with the Board of Directors. If a conflict exists, the person with the conflict is restricted from voting on related matters. Conflict of interest forms are completed annually by board of directors and key employees. These are reviewed by the HR director, and compliance report submitted to the governing board. Form 990, Part VI, Section B, line 15a The Executive Committee reviews the CEO's compensation annually and compares to similar positions at other hospitals of similar size and geographic location. The Board of Directors reviews and approves the recommendations of the Executive Committee. The compensation of other officers is determined by the CEO. The officers and directors of the board receive a stipend for attending meetings. The fee structure is based on meetings attended. This compensation process is determined by board members and the fee schedule is discussed by the board annually. Form 990, Part VI, Section C, line 19 The Organization makes its governing documents, conflict of interest policy, and financial statements available to the public upon request. Form 990, Part IX, line 11g Contracted Services: Program service expenses 2,160,212. Management and general expenses 0. Fundraising expenses 0. Total expenses 2,160,212. Medical Fees: Program service expenses 655,046. Management and general expenses 0. Fundraising expenses 0. Total expenses 655,046. Purchased Services: Program service expenses 241,673. Management and general expenses 71,549. Fundraising expenses 0. Total expenses 313,222. Recruitment: Program service expenses 21,428. Management and general expenses 0. Fundraising expenses 0. Total expenses 21,428. Form 990, Part XI, line 9: Change in net assets for Hendricks Hospital Auxiliary -8,279. Change in net assets for Resident Funds -1,767.