2023-02-15T18:24:15-06:00 2022-06-30 450250958 Eide Bailly LLP 800 Nicollet Mall Ste 1300 Minneapolis MN 554027033 990 2021-07-01 410307617 Hendricks Community Hospital Assn & Retirement Home HEND 5072753134 PO Box 106 Hendricks MN 56136 Jeff Gollaher CEO 5072753134 2023-02-15 1 Jeff Gollaher 999009999 Kim Hunwardsen CPA P00484560 6122536500 2023-02-15 3 AAL1 IAL1 2021 2023-03-07 01:45:13Z Jeff Gollaher PO Box 106 Hendricks MN 56136 15915994 0 X www.hendrickshosp.org X 1941 MN Provision of healthcare 9 9 195 60 0 0 5304030 1093378 14373057 14750536 12040 13990 26968 51006 19716095 15908910 4425 8491 0 0 7804107 8699988 0 0 0 6788839 6959922 14597371 15668401 5118724 240509 25862210 23986558 6786979 4970535 19075231 19016023 X Hendricks Community Hospital Assn & Retirement Home strives to provide the highest quality health and residential care in a Christian environment. 1 0 14516748 8491 14750536 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 71 acute, 56 swing bed, 6 transitional bed and 40 long-term care facility admissions for the year ended June 30, 2022; 457 visits to the Emergency Room; and 119 surgical cases (including ambulatory).The 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 $13,273 for the year ended June 30, 2022. The estimated cost of providing these services was $10,000 for the year ended June 30, 2022 based on average ratio of cost to gross charges. 14516748 1 1 0 1 0 0 0 0 1 0 1 0 0 0 1 1 1 0 0 0 0 0 0 0 0 0 1 1 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 57 0 1 195 1 0 0 0 0 0 0 0 0 0 0 0 0 X 9 9 0 0 1 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 1350 0 0 Mark VanEck Vice President 2.00 X X 1280 0 0 Dawn Popowski Secretary 2.00 X X 1030 0 0 Vince Robinson Treasurer 2.00 X X 960 0 0 Norris Patrick Director 2.00 X 1480 0 0 James Ness Director 2.00 X 1280 0 0 Jamie Engelstad Director 2.00 X 1270 0 0 John Engels Director 2.00 X 1310 0 0 Jacki Trooien Director 2.00 X 1119 0 0 Jeff Gollaher CEO 40.00 X 180917 0 23126 Travis Olsen CFO 40.00 X 101858 0 4074 Tabb McCluskey DO Physician 32.00 X 297937 0 48737 Grant Eyjolfson MD Physician 40.00 X 271723 0 48166 Rosemary Christianson RN/EMT 40.00 X 103346 0 4134 Kathryn Christensen Nurse Practitioner 40.00 X 127564 0 6949 Debra Browning Nurse Practitioner 40.00 X 115731 0 32081 1210155 0 167267 9 0 1 0 Wapiti Medical Group 107 Flynn Dr Milbank SD 57252 Locum/ER Providers 599376 Fusion Medical Staffing LLC PO Box 82674 Lincoln NE 68501 Contracted Nursing Service 206600 Medical Solutions LLC 1010 N 102nd St Omaha NE 68114 Contracted Nursing Service 199264 3 9413 1041167 42798 1093378 Net patient & resident service re 621110 14633787 14633787 116749 116749 14750536 8016 8016 8475 0 8475 8475 8475 5974 0 5974 5974 5974 4641 9413 3674 967 967 44974 3410 41564 41564 15908910 14750536 0 64996 X 3691 3691 4800 4800 323639 323639 6349950 6213869 136081 162859 162859 1404791 1330085 74706 458749 429444 29305 144902 144902 2353601 2200811 152790 23220 23220 121676 98244 23432 19734 19734 405590 405590 70670 70670 72745 67796 4949 144129 131648 12481 1100740 1032764 67976 228153 208395 19758 Medical Supplies 924118 924118 Repairs and Maintenance 886682 794577 92105 MN Care Tax 89621 89621 374341 304812 69529 15668401 14516748 1151653 0 9141759 6360373 2034032 1829672 3822 10133 38954 173566 181703 111307 145775 27550717 16895516 11412403 10655201 2908878 4741669 1287 6463 65023 26748 25862210 23986558 1085280 986448 29500 27000 4932744 3800256 739455 156831 6786979 4970535 X 19075231 19016023 19075231 19016023 25862210 23986558 X 240509 -258828 -40889 X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 275 275 0 Part II-B, Line 1: MN Hospital Association dues for FYE 2022 were $9,178 of which 3% is related to lobbying activities; total attributed to lobbying is $275. 1 73495 44975 10912 107558 1 X 15000 91512 106512 15950512 9760187 6190325 11493693 7135329 4358364 10655201 Insurance Loss Liability 156831 156831 X 15609193 -258828 -258828 15868021 40889 40889 15908910 15668401 0 15668401 0 15668401 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 for the Auxiliary was $102,426. In addition, the Hospital holds funds on behalf of its residents. The amount held at the end of the year for residents was $5,132. 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 41,564. Resident fund net revenue not included in financial statements -675. 1 1 X 1 X 1 X 125.000000000000 1 1 0 1 1 10000 10000 0.00060 3769906 3397495 372411 0.02380 3779906 3397495 382411 0.02440 11557 11557 0.00070 36782 36782 0.00230 5241263 2557038 2684225 0.17130 8491 8491 0.00050 5298093 2557038 2741055 0.17480 9077999 5954533 3123466 0.19920 1 203373 10000 3612633 3584069 28564 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 21 1 0 0 1 X www.hendrickshosp.org X 1 21 1 www.hendrickshosp.org 0 1 X 100.000000000000 125.000000000000 X X X X 1 1 X X X 1 X www.hendrickshosp.org/patientinfo.html X www.hendrickshosp.org/patientinfo.html X www.hendrickshosp.org/patientinfo.html 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: A community survey was mailed to all households in the HCHA service area and on-line completion was offered. Four focus group meetings with a total of 25 individuals were held in March of 2022. Of the surveys that were distributed 129 were returned. Hendricks Community Hospital Association Part V, Section B, Line 11: Based on the Community Health Needs Assessment completed in late spring of 2022, the hospital governing board and facility leadership team identified the following as priority community health needs:1) Educational opportunitiesThe top educational opportunities identified by the community health needs assessment are career education for young adults, nutrition for children 17 and under, exercise opportunities, and socialization programs. The secondary findings identify eating habits in Lincoln County as a problematic area that may indicate a need for more education in this area.2) Physical activitiesAccording to county health rankings, Lincoln County ranks higher than the state for physical inactivity, lack of access to exercise opportunities, and obesity. The focus group and survey responses mentioned availability and access to exercise options, with potential growth needed in biking and walking trails, wellness activities for all age populations, and more opportunities to engage in community activities. 3) Social interaction/activityTwo out of the four age group respondents indicated social interaction and social activities as a top concern. One focus group indicated wellness activities for all age populations to promote a healthy lifestyle and social interaction. The County Health ranking indicates Lincoln County has 24.7 known social associations, which is well above the average of Minnesota at 18.2. the area of concern may be the community's knowledge of the social events more than the lack of activities.4) Mental HealthMental health was identified in the assessment process, with 49% of the respondents indicating a concern. The focus groups also identified the concern but found it difficult to break down the barriers due to the complexity of the current situation nationwide. Over 59% of respondents felt HCHA was doing what it could to address mental health. A quality-of-life survey by Southwest Health and Human Services noted critical barriers to providing care for those with mental health issues, with the top response of not thinking it was severe enough at 58%. A variety of suggestions were offered, including mental health providers, educational sessions, support groups, and group therapy.5) Public transportationPublic transportation was identified as a concern in three out of the four age groups in the survey and a key topic area in the focus groups. The secondary source also identified transportation as a need for the community's health. Ideas in the focus groups revolved around partnering with other community members or organizations to help fulfill the community's needs.There were no needs identified that will not be addressed.With our new CHNA being complete during the late spring of 2022, we reviewed the assessment with our hospital board at our April 28, 2022 board meeting. With the five main needs of educational opportunities, physical activities, social interaction, mental health and public transportation, new committees were formed to determine the best strategies to tackle each topic. Each committee contains both employees and board members and the meetings have been and are being held during the fall of 2022 to determine solutions.Two priorities identified from the 2019 CHNA were addressed during the fiscal year. The first priority was to increase awareness of availability of health services in our community. We held a few task force meetings to establish actions to address. We committed to the purchase of a digital community sign that would be used to promote health services offered through HCHA and other community events. The new sign was finally installed at the end of December 2022. In addition we started a newspaper column that is published every other month describe and promote various health services that are offered through HCHA. We also established using our social media platforms to promote services. During the Covid epidemic the use of the social media increased significantly and is a tool we continue to use to support communication about our services through HCHA. This tool was extremely helpful in increasing our communities COVID vaccination rates as well.The second priority area was Behavior Health and Mental Health Access. We did have several task force meetings and determined that this was an enormous subject and hard to establish focus. Internally we updated lists of available resources for various mental health services and shared this information with staff and providers to ensure they had all options available when dealing with our customers. We also implemented an emergency service that allows for a behavioral consultant to see patients with in the emergency room to assist our providers. This remains a priority for us to continue to address but we elected to change our focus in the 2022 CHNA to address items we know we can have success in implementing for our community. 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 clients 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. The estimated cost of services provided that were uncollectible to patients that qualified for financial assistance are based on average ratio of cost to gross charges. Part III, Line 4: The footnote to the organization's financial statements addressing implicit price concessions may be found on page 9 and 10 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 clientele, as well as the clientele 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 $53,557 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. During the fiscal year ending 6/30/22, it was noted approximately 21% of our patients were insured through Medical Assistance programs, and approximately 8% were un-insured. 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 297937 0 0 0 0 0 11400 0 37337 0 346674 0 0 0 Grant Eyjolfson MD Physician 271723 0 0 0 0 0 11330 0 36836 0 319889 0 0 0 Jeff Gollaher CEO 180917 0 0 0 0 0 7413 0 15713 0 204043 0 0 0 Form 990, Part III, line 2 The 16-unit independent living facility transitioned to an assisted living facility during the year. 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 4 The by-laws were amended to combine the finance and investment committees and increase the number of members from two (2) to three (3). 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 CFO, 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 1,332,707. Management and general expenses 0. Fundraising expenses 0. Total expenses 1,332,707. Medical fees: Program service expenses 748,229. Management and general expenses 0. Fundraising expenses 0. Total expenses 748,229. Purchased services: Program service expenses 80,544. Management and general expenses 152,790. Fundraising expenses 0. Total expenses 233,334. Collection fees: Program service expenses 2,549. Management and general expenses 0. Fundraising expenses 0. Total expenses 2,549. Recruitment: Program service expenses 36,782. Management and general expenses 0. Fundraising expenses 0. Total expenses 36,782. Form 990, Part XI, line 9: Change in net assets for Hendricks Hospital Auxiliary -41,564. Change in net assets for Resident Funds 675.