2025-04-15T14:17:26-05:00 2024-05-31 410746749 CLIFTONLARSONALLEN LLP 220 S 6TH STREET SUITE 300 MINNEAPOLIS MN 55402 990 2023-06-01 410758512 MADELIA HEALTH MADE 5076423255 121 DREW AVE SE MADELIA MN 56062 DAVID WALZ CEO 5076423255 2025-04-15 1 1 RYAN ENGEBRETSON P01585625 6123764500 2025-04-14 2023 2025-03-06 01:10:19Z DAVID WALZ 121 DREW AVE SE MADELIA MN 56062 21032634 0 X WWW.MADELIAHEALTH.ORG X 1950 MN PROVIDE QUALITY HEALTHCARE SERVICES TO THE LOCAL COMMUNITY. 8 5 215 0 108295 0 416679 372883 17466488 20327697 232663 115297 43817 216757 18159647 21032634 0 765413 0 0 12041060 13426192 0 0 0 8543037 9624991 20584097 23816596 -2424450 -2783962 17268036 13456499 6547292 5423175 10720744 8033324 THE MISSION OF MADELIA HEALTH IS TO PROVIDE SAFE AND QUALITY HEALTHCARE SERVICES TO THOSE WE SERVE IN AN ENVIRONMENT BASED ON RESPECT, DIGNITY, AND EXCELLENCE. 0 0 17189492 765413 20219402 MADELIA HEALTH PROVIDES GENERAL MEDICAL/SURGICAL SERVICES FOR INPATIENT, SWING BED PATIENTS, OUTPATIENTS, AND HOME CARE CLIENTS. DURING THE FISCAL YEAR 2023-2024 THERE WERE 141 ACUTE CARE ADMISSIONS WITH 482 PATIENT DAYS, 60 SWING BED PATIENTS WITH 553 PATIENT DAYS, 8,402 HOME CARE VISITS AND 885 PATIENTS, AND 21,552 TOTAL OUTPATIENT VISITS. 17189492 1 1 0 1 0 0 0 0 0 0 1 0 0 0 1 1 0 0 0 0 0 0 0 0 0 0 1 1 0 1 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 0 0 1 197 0 1 215 1 1 1 0 0 0 0 0 0 0 0 0 0 0 X 8 5 0 0 0 0 1 1 0 1 1 0 0 0 1 1 1 1 1 1 0 0 MN X DAVID WALZ 5076423255 121 DREW AVE SE MADELIA MN 56062 BRUCE ROREM PHYSICIAN 40.00 0.00 X 242328 0 52500 SARAH DRYDEN PHYSICIAN 40.00 0.00 X 258164 0 21753 DAVID WALZ CEO 40.00 0.20 X 222379 0 54872 JULIE DOLPHIN NURSE PRACTITIONER 36.00 0.00 X 188340 0 9576 JANE MALMSKOG PHARMACIST 40.00 0.00 X 164013 0 24602 ROZ SNYDER CCO 40.00 0.00 X 151137 0 23411 KARLA BOETTCHER NURSE PRACTITIONER 40.00 0.00 X 157262 0 16996 BRUCE CARVEN CFO (UNTIL 10/6/23) 40.00 0.20 X 138315 0 13200 JORDAN RICHARDSON CFO 40.00 0.20 X 74011 0 3873 BRIAN MCCABE CHAIR 1.00 0.20 X X 1800 0 0 STEVE SORENSON TREASURER/SECRETARY 1.00 0.00 X X 1800 0 0 RYAN VISHER VICE CHAIR 1.00 0.00 X X 1200 0 0 BRENT CHRISTENSEN DIRECTOR 1.00 0.00 X 1200 0 0 STEVE COOLING DIRETOR 1.00 0.00 X 1200 0 0 KEN GRONEWOLD DIRETOR 1.00 0.00 X 1200 0 0 WENDY HENNIGER DIRECTOR 1.00 0.20 X 1200 0 0 NORMA KRUMIEDE DIRECTOR 1.00 0.00 X 1200 0 0 ELIZABETH SCHMIDT DIRECTOR (UNTIL 01/2024) 1.00 0.00 X 1200 0 0 1607949 0 220783 28 0 1 0 PRAIRIEVIEW ANESTHESIA AND PAIN MNGMT 41130 620TH AVE BUTTERFIELD MN 56120 PAIN MANAGEMENT 287976 JENNIE LISE LLC 1ST ST SW MADELIA MN 56062 ANETHESIA 120673 SW MN ORTHOPEDICS & SPORTS MEDICINE INC 1401 NWAKAMA ST MARSHALL MN 56258 ORTHOPEDICS 116632 3 264977 107906 372883 NET PATIENT REVENUE 624100 18110942 18110942 PHARMACY 456199 2216755 2108460 108295 20327697 115297 115297 14128 14128 202629 0 202629 202629 202629 21032634 20219402 108295 332054 50 50 765363 765363 678359 678359 9653146 7938169 1714977 274226 255932 18294 2019260 1145648 873612 801201 566021 235180 8488 8488 202363 202363 67250 67250 11609 11609 2306835 1867504 439331 129694 6720 122974 840032 326694 513338 985691 232691 753000 664726 254291 410435 73050 62144 10906 45240 31972 13268 99190 85107 14083 743087 637586 105501 144963 2383 142580 MEDICAL SUPPLIES 2271346 2064861 206485 BAD DEBT 684949 684949 MN CARE TAX 142795 142795 DUES AND SUBSCRIPTION 132853 69813 63040 70830 48799 22031 23816596 17189492 6627104 0 9997 127591 3233667 4914187 362475 197692 66696 61419 23614104 15472278 7348870 8141826 6250508 3787 5820 17268036 13456499 1780757 2361951 260257 260257 3434794 1668190 150000 920000 921484 212777 6547292 5423175 X 10599562 7912142 121182 121182 10720744 8033324 17268036 13456499 -2783962 96542 0 X 0 0 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 542 542 0 PART II-B, LINE 1: MADELIA HEALTH PAID DUES TO ASSOCIATIONS, THESE ASSOCIATIONS PARTICIPATE IN LOBBYING ACTIVITIES RELATED TO HEALTHCARE. 225242 225242 8430240 5215909 3214331 12657455 10000386 2657069 2301167 255983 2045184 8141826 THIRD PARTY PAYOR SETTLEMENTS 212777 212777 X PART X, LINE 2: THE HOSPITAL BELIEVES THAT 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 HOPSITAL 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. 1 1 X 1 X 1 X 1 1 1 0 1 1 616535 616535 0.02670 345065 274151 70914 0.00310 961600 274151 687449 0.02980 52945 52945 0.00230 52945 52945 0.00230 1014545 274151 740394 0.03210 1 684949 66440 3111537 4210395 -1098858 X 1 1 1 1 MADELIA HEALTH 121 DREW AVE SE MADELIA MN 56062 WWW.MADELIAHEALTH.ORG 385015 X X X X PROVIDER BASED CLINIC MADELIA HEALTH 1 0 0 1 X X X X X X X X X 21 1 0 0 1 X SEE PART V, SECTION C X X 1 21 1 SEE PART V, SECTION C 0 1 X 100.000000000000 200.000000000000 X X 1 1 X X X X 1 X HTTPS://WWW.MADELIAHEALTH.ORG/FINANCIAL-ASSISTANCE/ X HTTPS://WWW.MADELIAHEALTH.ORG/FINANCIAL-ASSISTANCE/ X HTTPS://WWW.MADELIAHEALTH.ORG/FINANCIAL-ASSISTANCE/ X X X X X X X 1 X 0 X X X X 1 X 0 0 MADELIA HEALTH PART V, SECTION B, LINE 5: FOR MADELIA HEALTH'S MAY 2022 COMMUNITY HEALTH NEEDS ASSESSMENT, THE HOSPITAL SOLICITED INPUT THROUGH COMMUNITY FOCUS GROUPS AND SURVEYS, AND REVIEWED COUNTY HEALTH RANKINGS. INPUT RECEIVED INCLUDES QUALITATIVE AND QUANTITATIVE INFORMATION FROM LOCAL, STATE AND FEDERAL SOURCES. IN ADDITION, INPUT WAS RECEIVED FROM PERSONS THAT REPRESENTED A BROAD RANGE OF INTEREST IN THE COMMUNITY, PERSONS WITH PUBLIC HEALTH KNOWLEDGE AND EXPERTISE, AND PERSONS REPRESENTING MEDICALLY UNDERSERVED AND VOLNERABLE POPULATIONS. MADELIA HEALTH PART V, SECTION B, LINE 7D: HTTPS://WWW.MADELIAHEALTH.ORG/WP-CONTENT/UPLOADS/MADELIA-HEALTH-2022-CHNA-FINAL.PDF MADELIA HEALTH PART V, SECTION B, LINE 11: NEEDS IDENTIFIED IN THE MOST RECENT CHNA IMPLEMENTATION STRATEGY INCLUDE: MENTAL AND BEHAVIORAL HEALTH, OBESITY AND NUTRITION AND STROKE AWARENESS AND PREVENTION.SOME HEALTH ISSUES OR NEEDS THAT WERE IDENTIFIED THROUGH THE CHNA PROCESS ARE NOT PRIORITIZED AT THIS TIME DUE TO BEING OUTSIDE THE SCOPE/ABILITIES OF MADELIA HEALTH AND/OR THE ISSUE IS BEING ADDRESSED BY OTHER COMMUNITY RESOURCES OR ORGANIZATIONS. IN OTHER INSTANCES, THERE ARE ALREADY INITIATIVES IN PLACE AT MADELIA HEALTH TO ADDESS SOME NEEDS. MADELIA HEALTH IS NOT IGNORING THESE ISSUES BUT INTENDS TO COLLABORATE (WITHIN ITS ABILITY) WITH OTHER ORGANIZATIONS TO ADDRESS AND MAKE PROGRESS TOWARD THE NEEDS NOT SPECIFICALLY ADDRESS IN THE IMPLEMENTATION STRATEGY: TOBACCO USE, BULLYING, HOUSING SHORTAGE, DAYCARE SHORTAGE, STAFFING SHORTAGE, ETC.DURING FISCAL YEAR 2023, WE HIRED MENTAL HEALTH NURSE PRACTITIONERS AND WORKED WITH THE MADELIA COMMUNITY BASED COLLABORATIVE (MCBC) WHICH FOCUSED ON HEALTH NEEDS AND THE STROKE AWARENESS PROGRAM. THE AMBULANCE TEAM PROVIDED EDUCATION AND A STROKE SCREENING ULTRASOUND PROGRAM. WE STARTED TRY IT FRIDAY WHICH GIVES 1ST GRADERS THE OPPORTUNITY TO TRY "DIFFERENT" FRUITS AND VEGETABLES, AND THE ELEMENTARY STUDNETS HAD A POSTER CONTEST ON CONNECTING PROPER NUTRITION TO OBESITY AND HEALTH. MADELIA HEALTH PART V, SECTION B, LINE 13H: IF A PATIENT NEEDS CARE WITHIN ONE YEAR OF COMPLETION AND APPROVAL OF A FINANCIAL ASSISTANCE APPLICATION, THE ORGANIZATION WILL USE PRESUMPTIVE ELIGIBILITY BASED ON THE PREVIOUSLY COMPLETED APPLICATION. THE ORGANIZATION DOES NOT UTILIZE THIRD PARTY INFORMATION TO DETERMINE PRESUMPTIVE ELIGIBILITY FOR FINANCIAL ASSISTANCE. MADELIA HEALTH PART V, SECTION B, LINE 16J: THE FAP APPLICATION IS AUTOMATICALLY MAILED OUT TO UNINSURED AND UNDERINSURED PATIENTS. MADELIA HEALTH PART V, SECTION B, LINE 20E: PATIENTS ARE INFORMED OF THE STATUS OF THEIR ACCOUNT THROUGH BILLING STATEMENTS AND LETTERS INDICATING THE AGING OF THEIR ACCOUNT AND THE AVAILABILITY TO MAKE PAYMENT ARRANGEMENTS WITH SEVERAL OPTIONS OF RECEIVING A DISCOUNT. PART V, SECTION B, LINE 10A HTTPS://WWW.MADELIAHEALTH.ORG/WP-CONTENT/UPLOADS/IMPLEMENTATION-STRATEGY-2022.2024.FINAL_.PDF 4 1 - LAKE CRYSTAL CLINIC 221 S MURPHY ST LAKE CRYSTAL MN 56055 CLINIC 2 - LAKE CRYSTAL PHARMACY 210 S MAIN ST LAKE CRYSTAL MN 56055 PHARMACY 3 - LAKE CRYSTAL REHAB 621 W NATHAN ST LAKE CRYSTAL MN 56055 REHAB SERVICE SPACE WITHIN A COMMUNITY CENTER 4 - TRUMAN CLINIC 401 N 4TH AVE E TRUMAN MN 56088 CLINIC PART I, LINE 3C: THE METHODOLOGY USED TO DETERMINE ELIGIBILITY FOR FINANCIAL ASSISTANCE TAKES INTO CONSIDERATION INCOME, FAMILY SIZE AND ASSETS TO PAY FOR CARE. IF A PATIENT NEEDS CARE WITHIN ONE YEAR OF COMPLETION AND APPROVAL OF A FINANCIAL ASSISTANCE APPLICATION, THE ORGANIZATION WILL USE PRESUMPTIVE ELIGIBILITY BASED ON THE PREVIOUSLY COMPLETED APPLICATION. THE ORGANIZATION DOES NOT UTILILIZE THEIRD PARTY INFORMATION TO DETERMINE PRESUMPTIVE ELIGIBILITY FOR FINANCIAL ASSISTANCE. PART I, LINE 7: CHARITY CARE EXPENSE WAS CONVERTED TO COST BASED ON AN OVERALL COST-TO-CHARGE RATION WHICH ADDRESSES ALL PATIENT SEGMENTS. LINE 7B, UNREIMBURSED MEDICAID, WAS CALCULATED USING THE COSTING METHODS TO PREPARE THE COST REPORTS. LINE 7E WAS TAKEN FROM THE GENERAL LEDGER. LINE 7G, SUBSIDIZED HEALTH SERVICES, WAS CALCULATED USING THE MEDICARE COST REPORT. 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 $ 684,949. PART III, LINE 2: THE AMOUNT ON LINE 2 REPRESENTS IMPLICIT PRICE CONCESSIONS. THE ORGANIZATION DETERMINES ITS ESTIMATE OF IMPLICIT PRICE CONCESSIONS BASED ON ITS HISTORIAL COLLECTION EXPERIENCE WITH THIS CLASS OF PATIENTS. PART III, LINE 3: THE ESTIMATED AMOUNT OF THE ORGANIZATION'S IMPLICIT PRICE CONCESSIONS ATTRIBUTABLE TO PATIENTS ELIGIBLE UNDER THE ORGANIZATION'S CHARITY CARE POLICY IS CALCULATED BASED ON THE PERCENTAGE OF INDIVIDUALS LIVING BELOW THE POVERTY LEVEL IN 2023. THEREFORE, 9.7% OF IMPLICIT PRICE CONCESSIONS CAN REASONABLY BE CONSIDERED A COMMUNTIY BENEFIT AS IT WOULD HAVE BEEN WRITTEN OFF TO PART III, LINE 8: MEDICARE ALLOWABLE COST OF CARE WAS CALCULATED FROM THE MEDICARE COST REPORT FOR FISCAL YEAR ENDING 05/31/2024. MEDICAL SERVICES ARE PROVIDED TO PATIENTS WITH MEDICARE COVERAGE REGARDLESS OF WHETHER OR NOT A SURPLUS OR DEFICIT IS REALIZED. PROVIDING MEDICARE SERVICES PROMOTES ACCESS TO HEALTHCARE SERVICES WHICH ARE VITALLY NEEDED BY OUR COMMUNITY.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: EACH WEEK, STATEMENTS ARE SENT OUT THROUGH OUR EDI PROCESS WITH STATEMETNS BEING MAILED TO THE PATIENT BY A CLEARINGHOUSE. PATIENTS ARE BILLED AFTER MEDICARE OR COMMERCIAL INSURANCE HAS BEEN FILED AND PAYMENT HAS BEEN RECEIVED WITHIN A SIX-WEEK PERIOD. PATIENTS WILL BE BILLED FOR THE REMAINING BALANCE MONTHLY. ACCOUNTS ARE VERIFIED INTERNALLY PRIOR TO COLLECTION LETTERS BEING SENT. IF NO PAYMENT IS RECEIVED WITHIN 2 MONTHS OF BILLINGS, THE STATEMENT IS SENT WITH A NOTICE LETTER REQUESTING PAYMENT. LETTERS WILL ALSO BE SENT SHOULD NO PAYMENT BE RECEIVED WITHIN 60 AND 90 DAYS. SHOUDL NO RESPONSE BE RECEIVED WITHIN FIVE (5) DAYS OF THE LAST LETTER, A TELEPHONE CALL IS ISSUED TO NEGOTIATE A PAYMENT PLAN. IF THE ACCOUNT HOLDER MAY QUALIFY FOR OUR HEALTHCARE FINANCIAL PROGRAM, AN APPLICATION IS SENT TO BE COMPLETED AND RETURNED TO US. LACK OF RESPONSE TO THE TELEPHONE CALL WITH RESULT IN VERIFICATION OF THE ACCOUNT(S) BY THE INSURANCE BILLING CLERKS AND THEN REVIEWED BY THE BUSINESS OFFICE MANAGER FOR APPROVAL TO BEGIN FORMAL COLLECTION PROCESS. THESE ACCOUNTS ARE THEN TURNED OVER TO A PROFESSIONAL COLLECTION AGENCY. CHARITY CARE CONSIDERATIONS WILL BE MADE BY THE BUSINESS OFFICE MANAGER WHEN ALL NECESSARY DOCUMENTAION IS PRESENTED AND SHOULD IT BE EVIDENT THAT THE PATIENT'S LACK OF FINANCES WARRANT THIS AND CHARITY CARE IS THE BEST ETHICAL DECISION FOR THE PATIENT. PART VI, LINE 2: THROUGH THE COMMUNITY ASSESSMENT PROCESS, HEALTHCARE NEEDS AND SERVICES WERE IDENTIFIED AND PROGRAMS WERE DEVELOPED. STRATEGIC PLANNING ASSESSES THE NEEDS OF THE COMMUNITY AND PATIENTS THROUGH PATIENT SATISFACTION SURVEYS, COMMENT CARDS, COMMUNITY ASSESSMENTS, AND A DIVERSE MEMBERSHIP OF COMMUNITY ELECTED GOVERNING BOARD MEMBERS THAT REPRESENT THE COMMUNITY AND BRINGS TO THE TABLE ISSUES, CONCERNS, AND RECOMMENDATIONS FOR HEALTH CARE SERVICES.MADELIA HEALTH COLLABORATES WITH OTHER LOCAL ORGANIZATIONS REFERRED TO AS THE MADELIA COMMUNITY BASED COLLABORATIVE (MCBC) WHICH INCLUDES THE FOLLOWING PARTICIPANT ORGANIZATIONS: MADELIA HEALTH AND CLINICS, MINNESOTA STATE UNIVERSITY, MANKATO SCHOOL OF NURSING, GLEN TAYLOR NURSING INSTITUTE FOR FAMILY AND SOCIETY, WATONWAN COUNTY PUBLIC HEALTH DEPARTMENT, MADELIA SCHOOL SYSTEM, LUTHER MEMORIAL HOME, DOWNS FOOD GROUP INC, MADELIA CITY COUNCIL, AND MADELIA CHAMBER OF COMMERCE. THROUGH THIS COLLABORATION, MADELIA HEALTH IS ABLE TO PARTNER WITH OTHER ORGANIZATIONS THAT HAVE EXPRESSED AN INTEREST IN IMPROVING THE HEALTH OF THEIR EMPLOYEES. THE COMMUNITY HEALTH NEEDS ASSESSMENT COMPLETED BY MADELIA HEALTH HELPS MCDC DETERMINE WHAT AREAS THEY WILL FOCUS THEIR EFFORTS IN ORDER TO GAIN THE MOST BENEFIT FOR THE COMMUNITY. STAFF FROM MADELIA HEALTH HAVE A SIGNIFICANT ROLE IN THIS DEVELOPMENT AND CARRYING OUT OF THE ACTION PLANS. PART VI, LINE 3: PATIENTS ARE INFORMED OF FINANCIAL ASSISTANCE UPON ADMISSION TO THE HOSPITAL, THROUGH BILLING CLERKS ASSISTANCE WITH PATIENT ACCOUNTS, STATEMENTS ON THE BILLS, AND PERSONAL LETTERS SENT TO THE ACCOUNTS IDENTIFIED AS UNINSURED AND UNDERINSURED. PART VI, LINE 4: MADELIA HEALTH SERVES A 30 MILE RADIUS OF RURAL COMMUNITIES CONSISTING OF CULTURALLY DIVERSE AND SENIOR POPULATIONS. THE MAJORITY OF THE SERVICE AREA IS IN WATONWAN COUNTY, MINNESOTA. FOR THE ESTIMATED 4,877 HOUSEHOLDS IN THE COMMUNITY, THE MEDIAN HOUSEHOLD INCOME IS $70,593. THIS IS ABOUT $8,000 BELOW THAT OF THE STATE OF MINNESOTA. THE POVERY RATE FOR WATONWAN COUNTY IS 10%, AS COMPARED TO 11.1% FOR THE STATE OF MINNESOTA. THE UNEMPLOYMENT RATE FOR THE COUNTY IS 3.7% FOR 2021. APPROXIMATELY 21.2% OF INDIVIDUALS ARE OVER THE AGE OF 65. THE POPULATION IS 66.3% CAUCASIAN, 30.6% HISPANIC, AND 3.1% OTHER. PART VI, LINE 5: THE HOSPITAL SERVES ALL PERSONS IN THE COMMUNITY ON A NON-DISCRIMINATORY BASIS, AND OPERATES AN EMERGENCY ROOM THAT IS OPEN TO ALL PERSONS REGARDLESS OF THEIR ABILITY TO PAY. MADELIA HEALTH HAS AN OPEN MEDICAL STAFF WITH PRIVILEGES AVAILABLE TO ALL QUALIFIED PHYSICIANS IN THE AREA. THE GOVERNING BODY IS COMPRISED PRIMARILY OF INDEPENDENT PERSONS REPRESENTATIVE OF THE COMMUNITY.STAFF PARTICIPATE IN COMMUNITY ORGANIZATIONS TO PROVIDE HEALTHCARE REPRESENTATION AND INFORMATION TO ENHANCE THOSE ORGANIZATION'S EVENTS, ETC. 1 CHAIRTY CARE 18 765363 0 N/A N/A PART I, LINE 2: THE METHODOLOGY USED TO DETERMINE ELIGIBILITY FOR FINANCIAL ASSISTANCE TAKES INTO CONSIDERATION INCOME, FAMILY SIZE AND ASSETS TO PAY FOR CARE. IF A PATIENT NEEDS CARE WITHIN ONE YEAR OF COMPLETION AND APPROVAL OF A FINANCIAL ASSISTANCE APPLICATION, THE ORGANIZATION WILL USE PRESUMPTIVE ELIGIBILITY BASED ON THE PREVIOUSLY COMPLETED APPLICATION. THE ORGANIZATION DOES NOT UTILILIZE THEIRD PARTY INFORMATION TO DETERMINE PRESUMPTIVE ELIGIBILITY FOR FINANCIAL ASSISTANCE. X 1 0 X X 1 0 0 1 0 0 0 0 0 BRUCE ROREM PHYSICIAN 229111 0 13217 0 0 0 52500 0 0 0 294828 0 0 0 SARAH DRYDEN PHYSICIAN 213931 0 44233 0 0 0 19843 0 1910 0 279917 0 0 0 DAVID WALZ CEO 202379 0 20000 0 0 0 52500 0 2372 0 277251 0 0 0 JULIE DOLPHIN NURSE PRACTITIONER 157415 0 30925 0 0 0 8108 0 1468 0 197916 0 0 0 JANE MALMSKOG PHARMACIST 164013 0 0 0 0 0 24602 0 0 0 188615 0 0 0 ROZ SNYDER CCO 144546 0 2241 0 4350 0 22100 0 1311 0 174548 0 0 0 KARLA BOETTCHER NURSE PRACTITIONER 121159 0 36103 0 0 0 15820 0 1176 0 174258 0 0 0 BRUCE CARVEN CFO (UNTIL 10/6/23) 135997 0 2318 0 0 0 10439 0 2761 0 151515 0 0 0 PART I, LINE 1A HOUSING ALLOWANCE FOR CEO OF $5,000 WAS INCLUDED IN TAXABLE COMPENSATION. PART I, LINE 4A JAKE REDDEN RECEIVED SEVERANCE PAYMENT OF $69,583 IN 2023. THIS AMOUNT WAS INCLUDED IN W-2 WAGES. A CITY OF MADELIA MN 466005334 2021-02-26 4118000 REVENUE REFUNDING BOND SERIES 2021 0 0 0 A 2946573 4118000 81644 4036356 1 0 1 1 A 0 0 0 0 0.00000 0.00000 0.00000 0 0 0 A 0 0 0 0 1 0 0 0 0 A 0 FORM 990, PART VI, SECTION A, LINE 1A THE EXECUTIVE COMMITTEE SHALL CONSIST OF THE PRESIDENT, AS CHAIRPERSON, VICE PRESIDENT/TREASURER, SECRETARY, AND UP TWO (2) ADDITIONAL TRUSTEES. THE EXECUTIVE COMMITTEE SHALL HAVE POWER TO TRANSACT ALL REGULAR BUSINESS OF THE CORPORATION DURING THE PERIOD BETWEEN THE MEETINGS OF THE BOARD OF TRUSTEES, SUBJECT TO ANY POWER LIMITATION IMPOSED BY THE BOARD OF TRUSTEES. A QUORUM FOR THE EXECUTIVE COMMITTEE CAN ONLY BE MADE UP OF EXECUTIVE COMMITTEE MEMBERS AND ONLY EXECUTIVE COMMITTEE MEMBERS MAY VOTE DURING EXECUTIVE COMMITTEE MEETINGS. MINUTES OF THE EXECUTIVE MEETINGS SHALL BE SUBMITTED TO THE BOARD OF TRUSTEES. THE EXECUTIVE COMMITTEE SHALL ANNUALLY EVALUATE THE CHIEF EXECUTIVE OFFICER'S PERFORMANCE AND RECOMMEND HIS/HER REMUNERATION TO THE FULL BOARD OF TRUSTEES BASED ON THE CHIEF EXECUTIVE OFFICER'S PERFORMANCE IN RELATION TO THE CORPORATION'S OBJECTIVES AND GOALS. THIS COMMITTEE SHALL MEET AS NECESSARY. FORM 990, PART VI, SECTION A, LINE 6 MEMBERSHIP IS THIS CORPROATION SHALL BE OPEN TO ANY NATURAL PERSON WHO MEETS THE FOLLOWING QUALIFICATIONS AT THE TIME OF THE APPLICATION: 1) IS OF LEGAL VOTING AGE IN MINNESOTA 2) IS A VOTING RESIDENT WITHIN THE PRIMARY SERVICE AREA OF THE HOSPITAL, BEING DEFINED AS THE COUNTIES OF WATONWAN, BLUE EARTH, BROWN, MARTIN AND NICOLLET, STATE OF MINNESOTA; 3) IS A NATURAL PERSON AND NOT A CORPORATION, PARTNERSHIPS OR OTHER ASSOCIATION; 4) SUBMITS A WRITTEN APPLICATION FOR MEMBERSHIP TO THE BOARD OF TRUSTEES ON A FORM APPROVED BY THE BOARD OF TRUSTEES; 5) SUBMITS A MEMERSHIP FEE OF $25 OR MORE, WITH SAID APPLICATION. FORM 990, PART VI, SECTION A, LINE 7A ALL TRUSTEES ARE ELECTED BY THE CORPORATE MEMBERS. FORM 990, PART VI, SECTION B, LINE 11B THE FORM 990 WAS REVIEWED BY THE ACCOUNTANT AND CEO PRIOR PRIOR TO FILING AND WILL BE PRESENTED TO THE GOVERNING BOARD OF TRUSTEES BY FINANCE COMMITTEE AT THE FIRST REGULAR MEETING OF THE BOARD OF TRUSTEES SUBSEQUENT TO FILING. FORM 990, PART VI, SECTION B, LINE 12C THE CONFLICT OF INTEREST POLICY IS REVIEWED AT THE JANUARY BOARD MEETING BY THE GOVERNING BOARD AND DEPARTMENT MANAGERS. IF ANY CONFLICTS OF INTEREST ARISE, NOTIFICATION IS GIVEN TO ADMINISTRATION. A CONTRACT OR OTHER TRANSACTION THAT MAY INVOLVE A CONFLICT OF INTEREST IS NOT VOID OR VOIDABLE IF: 1) THE CONTRACT OR TRANSACTION WAS FAIR AND REASONABLE AS TO THE CORPORATION WHEN IT WAS AUTHORIZED, APPROVED, OR RATIFIED; 2) ALL MATERIAL FACTS ARE FULLY DISCLOSED TO THE MEMBERS AND THE CONTRACT OR TRANSACTION IS APPROVED BY TWO-THIRDS OF THE MEMBERS ENTITLED TO VOTE, OTHER THAN THE INTERESTED DIRECTOR OR TRUSTEE; AND 3) ALL MATERIAL FACTS ARE FULLY DISCLOSED TO THE BOARD OF TRUSTEES OR A COMMITTEE, AND THE BOARD ORCOMMITTEE APPROVES THE CONTRACT OR TRANSACTION BY A MAJORITY VOTE, BUT THE INTERESTED TRUSTEE MAY NOT TAKE PART IN THE DISCUSSION, AND MAY NOT VOTE. FORM 990, PART VI, SECTION B, LINE 15A MADELIA HEALTH ENSURES THAT THE COMPENSATION PAID TO ITS CEO BE CONSISTENT WITH POLICY AND PROVIDE EQUITABLE STANDARDS FOR WAGE AND BENEFITS BASED ON ANNUAL REGIONAL SURVEY OF COMPARABLE ENTITIES. THE GOVERNING BOARD REVIEWS ANNUALLY THE CEO'S PERFORMANCE AND THE BASIS IS THE ANNUAL MN HOSPITAL ASSOCIATON SURVEY. THE BOARD DETERMINES THE CEO'S BASE SALARY, IN ITS SOLE DISCRETION. THE CEO EVALUATES COMPENSATION OF OTHER OFFICERS AND EMPLOYEES ANNUALLY BASED ON THEIR PERFORMANCE. ANNUAL INCREASES ARE BASED ON A REGIONAL SURVEY OF COMPARABLE ENTITIES WITH SIMILAR POSITIONS ALONG WITH YEARS OF SERVICE AND NUMBER SUPERVISED. THE SURVEY RESULTS AND THE EMPLOYEES PERFORMANCE ARE EVALUATED FOR AN INCREASE IF DEEMED APPROPRIATE. FORM 990, PART VI, SECTION C, LINE 19 MADELIA HEALTH MAKES ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC AT THE ANNUAL CORPORATION MEETING AND UPON REQUEST. MADELIA HEALTH FOUNDATION 121 DREW AVENUE SE MADELIA MN 56062 731719218 SOLICIT CONTRIBUTIONS ON BEHALF OF THE MADELIA COMMUNITY HOSPITAL MN 501(C)(3) LINE 12A, I MADELIA HEALTH 1 0 0 1 0 0 0 0 0 0 0 0 0 1 1 1 1 1 1 1 MADELIA HEALTH FOUNDATION R 411370 COST MADELIA HEALTH FOUNDATION C 264977 CASH