2025-04-25T11:20:46-05:00 2024-09-30 410746749 CLIFTONLARSONALLEN LLP 220 SOUTH SIXTH STREET SUITE 300 MINNEAPOLIS MN 55402 990 2023-10-01 410706115 MADISON HEALTHCARE SERVICES MADI 3205987536 900 SECOND AVENUE MADISON MN 562561006 ERIK BJERKE PRESIDENT/CEO 3205987536 2025-04-24 1 0 RYAN STRUSZ P01604381 6123764500 2025-04-02 2023 2025-03-06 01:10:19Z ERIK BJERKE 900 SECOND AVENUE MADISON MN 562561006 21285927 0 X MHSMN.ORG X 1945 MN WE COMMIT TO ENRICH THE LIVES OF EVERYONE WE SERVE, GUIDED BY OUR CHRISTIAN HERITAGE AND VALUES. 7 7 218 10 0 0 1335292 520967 18611979 20238692 467390 197706 320302 326201 20734963 21283566 36017 30597 0 0 11663135 12155778 0 0 0 9219940 9565630 20919092 21752005 -184129 -468439 44800779 45584186 13699872 13397333 31100907 32186853 X MADISON HEALTHCARE SERVICES, WHICH INCLUDES THE MADISON LUTHERAN HOME, MADISON HOSPITAL, LAC QUI PARLE CLINIC, AND SUBSIDIARIES, IS COMMITTED TO ENRICH THE LIVES OF EVERYONE WE SERVE, GUIDED BY OUR CHRISTIAN HERITGAGE AND VALUES. 0 0 7307036 13945 10086776 MADISON HOSPITAL IS A 12-BED HOSPITAL, WHICH PROVIDES SERVICE TO THE COMMUNITY IN THE AREA OF ACUTE INPATIENT CARE AND SKILLED SWING BED REHABILITATION THE ORGANIZATION ALSO PROVIDES SOCIAL SERVICES BY PROVIDING EMOTIONAL, SOCIAL, AND ECONMOIC SUPPORT/REFERRAL TO RESIDENTS AND FAMILIES, PEDIATRICS, SURGERY, EMERGENCY CARE, CARDIAC REHAB, OUTPATIENT, OUTREACH AND INPATIENT CARE. THE HOSPITAL HAD 11,266 OUTPATIENT VISITS AND 700 MED/SURGERY AND SSB DAYS. THE ORGANIZATION MAINTAINS RECORDS TO IDENTIFY AND MONITOR THE LEVEL OF CHARITY CARE IT PROVIDES. THESE RECORDS INCLUDE THE AMOUNT OF CHARGES FORGONE FOR SERVICES AND SUPPLIES FURNISHED UNDER ITS CHARITY CARE POLICY AND EQUIVALENT SERVICE STATISTICS. THE AMOUNT OF CHARGES FOREGONE, BASED ON ESTABLISHED RATES, WAS $818 FOR THE YEAR ENDED SEPTEMBER 30, 2024. 6177496 11789 7849228 MADISON HEALTHCARE SERVICES IS A NONPROFIT HEALTHCARE ORGANIZATION DEDICATED TO PROVIDING HIGH-QUALITY MEDICAL CARE AND WELLNESS SERVICES TO WESTERN MINNESOTA. OUR MISSION IS TO ENHANCE THE HEALTH AND WELL-BEING OF INDIVIDUALS BY OFFERING COMPREHENSIVE HEALTHCARE SOLUTIONS, INCLUDING INPATIENT AND OUTPATIENT SERVICES, SPECIALTY CARE CLINIC, LONG-TERM CARE, HOME CARE, ASSISTED LIVING.IN THE PAST YEAR, MADISON HEALTHCARE SERVICES HAS CONTINUED TO EXPAND ITS OFFERINGS TO BETTER SERVE THE NEEDS OF OUR PATIENTS. WE PROVIDE ESSENTIAL MEDICAL SERVICES SUCH AS EMERGENCY CARE, PRIMARY CARE, SURGICAL PROCEDURES, REHABILITATION, AND LONG-TERM CARE TO OUR REGION. ADDITIONALLY, WE HAVE INVESTED IN STATE-OF-THE-ART MEDICAL TECHNOLOGY AND ENHANCED OUR EFFORTS TO REACH UNDERSERVED POPULATIONS.MADISON HEALTHCARE SERVICES IS DEEPLY COMMITTED TO COMMUNITY OUTREACH AND EDUCATION. WE CONDUCT HEALTH SCREENINGS, VACCINATION DRIVES, AND WELLNESS PROGRAMS TO PROMOTE PREVENTIVE CARE. THROUGH PARTNERSHIPS WITH LOCAL ORGANIZATIONS AND OUR OWN HEALTHCARE PROFESSIONALS, WE STRIVE TO ADDRESS SOCIAL DETERMINANTS OF HEALTH AND IMPROVE OVERALL COMMUNITY WELL-BEING.MADISON HEALTHCARE SERVICES REMAINS FINANCIALLY RESPONSIBLE AND TRANSPARENT IN ITS OPERATIONS, REINVESTING INTO ITSELF TO IMPROVE PATIENT CARE, UPDATE FACILITIES, AND TO EDUCATE OUR STAFF. OUR UNWAVERING COMMITMENT TO PATIENT-CENTERED CARE AND COMMUNITY ENGAGEMENT REFLECTS OUR CORE VALUES AND ENSURES THAT WE CONTINUE TO MAKE A MEANINGFUL IMPACT ON PUBLIC HEALTH. 2548502 4863 2557779 THE MEDICAL STAFF AT THE CLINIC CONSISTS OF THREE M.D.'S , TWO PA-C'S, AND TWO NURSE PRACTIONERS AVAILABLE 5-DAYS-A-WEEK AND HALF ON SATURDAY. THE CLINIC WORKS WITH THE NURSING STAFF TO PROVIDE QUALITY CARE TO ITS PATIENTS. ATTACHED DIRECTLY TO THE MADISON HOSPITAL, THE CLINIC HAS EASY ACCESS TO MEDICAL SERVICES SUCH AS LAB, X-RAY, PHARMACY, AND OTHER DIAGNOSTIC SERVICES. 16033034 1 1 0 1 0 0 0 0 1 0 1 0 0 0 1 1 0 1 0 0 0 0 0 0 0 0 1 1 1 0 1 1 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 1 1 0 0 0 1 5 0 1 218 1 0 0 0 0 0 0 0 0 0 0 0 0 X 7 7 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 0 MN X CAROL BORGERSON 3206987152 900 SECOND AVENUE MADISON MN 562561006 KARIN MOEN CHAIRWOMAN 1.00 0.00 X X 0 0 0 BART HILL SECRETARY 1.00 0.00 X X 0 0 0 SCOTT OMLAND DIRECTOR 1.00 0.00 X 0 0 0 DAVID HALL DIRECTOR 1.00 0.00 X 0 0 0 JEANENE MUNSTERMAN DIRECTOR 1.00 0.00 X 0 0 0 TIM VOLK DIRECTOR 1.00 0.00 X 0 0 0 TRUDY HASTAD DIRECTOR 1.00 0.00 X 0 0 0 LYNN ZIMMERMAN CHAIRWOMAN 1.00 0.00 X X 0 0 0 ERIK BJERKE CEO 40.00 0.50 X 212000 0 60444 CAROL BORGERSON CFO 40.00 1.00 X 110444 0 18556 BRANT HACKER MD MD 40.00 0.00 X 447237 0 35800 MARIA NOLTE MD MD 40.00 0.00 X 227684 0 51172 HANNAH FIELDS MD MD 40.00 0.00 X 346967 0 30928 MICHAEL DEYO PA PHYSICIAN ASSISTANT 32.00 0.00 X 111174 0 34533 PAUL HODGE NP NURSE PRACTITIONER 40.00 0.00 X 157620 0 15087 1613126 0 246520 9 0 1 0 BIG STONE THERAPIES 340 WASHINGTON ORTONVILLE MN 56278 CONTRACT THERAPY SERVICES 927963 MEDICAL SOLUTIONS 1010 N 102ND STREET SUITE OMAHA MN 68114 AGENCY STAFFING NURSING 473125 CENTRACARE HEALTH 1406 6TH AVENUE N ST CLOUD MN 56303 EMR SOFTWARE SUPPORT/LICENSING/ETC. 406208 CENTRAL MINNESOTA DIAGNOSTICS 150 10TH STREET W MILACA MN 56353 CONTRACT CT AND ULTRASOUND 316547 FUSION MEDICAL STAFFING PO BOX 82674 LINCOLN NE 68501 AGENCY STAFFING 290606 7 5400 470157 45410 520967 NET PATIENT AND RESIDENT SERVICE 621400 19918715 19918715 CLINIC REVENUE 621400 154444 154444 HOSPITAL REVENUE 623000 141751 141751 NURSING HOME OFFICE RENTAL 621400 10231 10231 MISCELLANEOUS REVENUE 623000 7716 7716 5835 5835 20238692 197706 197706 255091 0 255091 255091 255091 7650 5400 2361 5289 5289 CAFETERIA & OTHER INCOME 624210 39381 39381 OTHER MISCELLANEOUS REVENUE 561499 26440 26440 65821 21283566 20493783 0 268816 X 30597 30597 411749 411749 8904604 6500361 2404243 167479 122260 45219 1544368 1127389 416979 1127578 823132 304446 43631 43631 79879 79879 4125500 3153945 971555 64359 64359 118527 86525 32002 453079 330748 122331 298815 218135 80680 12893 9412 3481 307220 224271 82949 332639 222535 110104 1879585 1644637 234948 146575 146575 SUPPLIES 892380 892380 TAXES AND LICENSES 303329 221430 81899 REPAIRS AND MAINTENANCE 245289 179061 66228 ALL OTHER EXPENSES 218456 205350 13106 43474 40866 2608 21752005 16033034 5718971 0 1037060 1267826 2695282 2942547 24000 144341 1919378 2404232 282163 268720 167218 155156 49055829 26102135 24555039 22953694 10225860 12179117 1580032 1625921 2314747 1642632 44800779 45584186 1283946 1562758 11596573 11051327 9603 10647 542604 558228 267146 214373 13699872 13397333 X 30992644 32077360 108263 109493 31100907 32186853 44800779 45584186 -468439 1554385 0 X X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 1 917 0 0 1 917 0 PART II-B, LINE 1: THE MHA WORKS TO DEVELOP, PROMOTE, AND IMPLEMENT HEALTH CARE POLICY AT THE STATE AND FEDERAL LEVELS OF GOVERNMENT TO BENEFIT HOSPITAL PATIENTS, EMPLOYEES, AND COMMUNITIES. THEIR GOVERNMENT RELATIONS OFFICERS WORK CLOSELY WITH MEMBERS TO BRING HOSPITALS' CONCERNS TO ST. PAUL, MINNESOTA AND WASHINGTON D.C. MHA PARTNERS WITH HEALTH CARE PROVIDERS, COMMUNITY GROUPS, AND OTHER STAKEHOLDERS TO ADVANCE THEIR COMMON INTERESTS. 0 1 X 6522 6522 40212699 19187288 21025411 8746122 6876005 1870117 90486 38842 51644 22953694 LEASE LIABILITY 214373 214373 X PART IV, LINE 2B: THE NURSING CARE CENTER RESIDENT TRUST FUND IS USED BY RESIDENTS AND/OR THEIR FAMILIES TO DEPOSIT MONEY INTO A SEPARATE CHECKING ACCOUNT. THE RESIDENTS CAN WITHDRAW THESE FUNDS AT ANY TIME FOR CARE SERVICES, GIFT SHOP PURCHASES, CASH FOR SODA, CANDY OR GIFTS, ETC. PART X, LINE 2: THE ORGANIZATION IS A TAX-EXEMPT CORPORATION AS DESCRIBED IN SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE (THE CODE) AND IS EXEMPT FROM FEDERAL INCOME TAXES ON RELATED INCOME PURSUANT TO SECTION 501(A) OF THE CODE. THE ORGANIZATION IS ALSO EXEMPT FROM STATE AND LOCAL INCOME TAXES ON RELATED INCOME. THE ORGANIZATION FOLLOWS THE GUIDANCE IN THE ACCOUNTING STANDARDS REGARDING THE RECOGNITION AND MEASUREMENT OF UNCERTAIN TAX POSITIONS. THE APPLICATION OF THE STANDARD AS NO EFFECT ON THE CONSOLIDATED FINANCIAL STATEMENTS. THE ORGANIZATION'S INCOME TAX RETURNS ARE SUBJECT TO REVIEW AND EXAMINATION BY FEDERAL, STATE, AND LOCAL AUTHORITIES. 1 1 X 1 X 1 X 275.000000000000 1 1 1 0 1 1 818 818 0.00000 5628609 5302604 326005 0.01500 2575504 1629938 945566 0.04360 8204931 6932542 1272389 0.05860 111941 9655 102286 0.00470 30597 0 30597 0.00140 142538 9655 132883 0.00610 8347469 6942197 1405272 0.06470 0 43474 0 3949528 5017737 -1068209 X 1 1 1 1 MADISON HOSPITAL - EIN 41-1653496 820 THIRD AVENUE MADISON MN 56256 WWW.MSHMN.ORG 327711 X X X X X RURAL HEALTH MADISON HOSPITAL 1 0 0 1 X X X X X X X X X 21 1 0 1 1 X SEE PART V, SECTION B, LINE 7D X X 1 21 1 SEE PART V, SECTION B, LINE 7D 0 1 X 100.000000000000 275.000000000000 X X X X 1 1 X X X 1 X HTTPS://MHSMN.ORG/PATIENTS-VISITORS/CHARITY-CARE-POLICY-FINANCIAL/ X HTTPS://MHSMN.ORG/PATIENTS-VISITORS/CHARITY-CARE-POLICY-FINANCIAL/ X HTTPS://MHSMN.ORG/PATIENTS-VISITORS/CHARITY-CARE-POLICY-FINANCIAL/ X X X X X X X 1 X 0 X X X X 1 X 0 0 MADISON HOSPITAL PART V, SECTION B, LINE 5: THE HOSPITAL CONDUCTED A COMMUNITY SURVEY, INTERVIEWED PROVIDERS AT OUR FACILITY, MEMBERS IN THE COMMUNITY OF MADISON, AND CONSISTENTLY MET WITH A PUBLIC HEALTH NURSE. MADISON HOSPITAL PART V, SECTION B, LINE 6B: MADISON HEALTHCARE SERVICES PARTNERED WITH COUNTRYSIDE PUBLIC HEALTH, PRAIRIE FIVE RIDES, LAC QUI PARLE COUNTY FAMILY SERVICE CENTER, LAC QUI PARLE VALLEY SCHOOL DISTRIC AND THE CITY OF MADISON IN ORDER TO ADDRESS THE HEALTH NEEDS OF THE REGION. MADISON HOSPITAL PART V, SECTION B, LINE 7D: THE ORGANIZATION'S COMMUNITY HEALTH NEEDS ASSESSMENT REPORT AND IMPLEMENTATION STRATEGY ARE AVAILABLE ONLINE AT HTTPS://MHSMN.ORG/PATIENTS-VISITORS/COMMUNITY-NEEDS-ASSESSMENT/. MADISON HOSPITAL PART V, SECTION B, LINE 11: BY UTILIZING PRIMARY AND SECONDARY DATA, THE MADISON HEALTHCARE SERVICES COMMUNITY HEALTH NEEDS ADVISORY COMMITTEE IDENTIFIED AND PRIORITIZED THREE KEY HEALTH NEEDS WITHIN THE COMMUNITY. 1. MENTAL HEALTHMADISON HEALTHCARE SERVICES (MHS) HAS DEVOTED SIGNIFICANT RESOURCES TO PROVIDING COMPREHENSIVE THERAPY FOR MENTAL AND BEHAVIORAL HEALTH PATIENTS. MHS HAS A CONTRACTED PSYCHIATRIC NURSE PRACTITIONER (NP) TO MANAGE MEDICATION FOR PATIENTS AND A LICENSED INDEPENDENT CLINICAL SOCIAL WORKER TO PROVIDE COUNSELING SERVICES AT BOTH THE CLINIC AND CARE CENTER. RECOGNIZING THE ONGOING DEMAND FOR MENTAL HEALTH SERVICES, MHS CURRENTLY OFFERS THE SERVICES OF A LICENSED COUNSELOR AND PSYCHIATRIC NURSE PRACTITIONER THREE DAYS PER WEEK, ENSURING CONSISTENT AND COMPASSIONATE CARE FOR OUR PATIENT POPULATION. OUR BEHAVIORAL HEALTH PROVIDERS HAVE PRESENTED TO VARIOUS COMMUNITY GROUPS THIS PAST YEAR TO BOTH PROMOTE THE SERVICE AND REDUCE THE STIGMA SURROUNDING THE NEED FOR MENTAL HEALTH SERVICES. MHS HAS ALSO PARTNERED WITH LAC QUI PARLE VALLEY SCHOOLS TO ENSURE MENTAL HEALTH SERVICES ARE ACCESSIBLE TO CHILDREN AND YOUNG ADULTS AT THE MIDDLE AND HIGH SCHOOL LEVEL THROUGH SERVICES THAT ARE EASIER FOR THEM TO ATTEND. MHS REMAINS COMMITTED TO EXPANDING ITS MENTAL HEALTH SERVICES AND ADDRESSING THE NEEDS OF THE COMMUNITY. 2. OBSTETRICS & GYNECOLOGYOBSTETRIC SERVICES ARE AVAILABLE WITHIN A REASONABLE DISTANCE FOR PATIENTS. WHILE DELIVERIES WERE DISCONTINUED IN 2018 DUE TO LOW DEMAND, MHS CONTINUES TO PROVIDE PRENATAL CARE THROUGH ITS CLINIC PROVIDERS. OUR PROVIDER GROUP HAS EXPANDED CONNECTIONS WITH OB/GYN SPECIALISTS FROM WATERTOWN, ORTONVILLE AND MONTEVIDEO FOR CONSULTATIONS AND REFERRALS TO ENSURE CONTINUITY OF CARE FOR EXPECTANT MOTHERS THROUGHOUT THEIR PREGNANCIES. BREASTFEEDING EDUCATION HAS ALSO BEEN PRESENTED AS PART OF MONTHLY RADIO SEGMENTS.3. HEALTH & WELLNESS EDUCATIONMHS IS DEDICATED TO EDUCATING PATIENTS AND ADDRESSING THEIR HEALTH-RELATED QUESTIONS. MONTHLY RADIO SEGMENTS LED BY OUR PROVIDER GROUP COVER A VARIETY OF HEALTH TOPICS TO EDUCATE THE PUBLIC FROM BREASTFEEDING TO SUNSCREEN SAFETY. MHS HAS ALSO CONDUCTED LUNCH AND LEARNS WHERE THE PUBLIC HAS HAD A CHANCE TO INTERACT WITH A PROVIDER TO ANSWER HEALTH RELATED QUESTIONS DURING CLINICAL OR HOSPITAL VISITS, PATIENTS RECEIVE DETAILED EDUCATIONAL MATERIALS TO HELP THEM UNDERSTAND THEIR CONDITIONS AND TREATMENTS. MADISON HOSPITAL PART V, SECTION B, LINE 13H: IF THE APPLICATION IS NOT RETURNED OR RETURNED INCOMPLETE, OTHER PATIENT MARKERS CAN BE USED TO APPROVE THE PATIENT FOR CHARITY CARE, SUCH AS WIC, FOOD STAMPS, FREE LUNCHES, MEDICAL ASSISTANCE, AND LOW-INCOME HOUSING. PATIENTS WHO MEET PRESUMPTIVE ELIGIBILITY CRITERIA MAY BE GRANTED FINANCIAL ASSISTANCE WITHOUT COMPLETING AN APPLICATION. MHS ALSO HAS A FOOD BANK OF NON PERISHABLE ITEMS AVAILABLE TO SEND HOME WITH PATIENTS IN NEED AND VOUCHERS FOR THEM TO GET A LIMITED AMOUNT OF PERISHABLES UNTIL THEY ARE ABLE TO GET OTHER ASSISTANCE. WE REALIZE THE IMMEDIATE NEED OF THESE RESOURCES. MADISON HOSPITAL PART V, SECTION B, LINE 16J: WHEN IT HAS BEEN DISCOVERED THAT PATIENTS ARE HAVING DIFFICULTIES PAYING THEIR BILL AND PRIVATE PAY PATIENTS NOT MAKING PAYMENTS, THE PATIENT IS CALLED TO MAKE PAYMENT ARRANGEMENTS AND UPON DISCUSSION WITH THEM, THE HOSPITAL WILL MAIL THEM THE CHARITY CARE APPLICATION. IN ADDITION, ON THE ORGANIZATION'S WEBSITE UNDER THE FINANCIAL INFORMATION PAGE IT IS INDICATED THAT AN APPLICATION FOR CHARITY CARE IS AVAILABLE AND THAT ASSISTANCE WITH THE APPLICATION FOR FINANCIAL ASSISTANCE IS AVAILABLE UPON REQUEST. 1 1 - LAC QUI PARLE CLINIC 900 SECOND AVENUE MADISON MN 56256 RURAL HEALTH CLINIC PART I, LINE 3C: FOR A PERSON TO QUALIFY FOR CHARITY CARE UNDER MADISON HOSPITAL'S CHARITY CARE AND FINANCIAL ASSISTANCE POLICY, AN INDIVIDUAL MUST HAVE FAMILY NET ASSETS LESS THAN $10,000, HAVE INCOME BELOW 275% OF FEDERAL POVERTY GUIDELINES, AND EITHER SUBMIT A COMPLETE APPLICATION OR BE PROVEN TO QUALIFY THROUGH PRESUMPTIVE DETERMINATIONS. AN INDIVIDUAL IS PRESUMPTIVELY ELIGIBLE FOR ASSISTANCE IF THEY EXPIRE WITHOUT AN ESTATE, WERE ON MEDICAL ASSISTANCE OR SIMILAR COVERAGE WITHIN THE PAST 12 MONTHS AND HAVE NO CHANGE IN EMPLOYMENT STATUS, OR FILED AND WERE APPROVED FOR BANKRUPTCY. PART I, LINE 7: THE COST-TO-CHARGE RATIO WAS DERIVED USING WORKSHEET 2 FROM THE IRS TO CALCULATE THE AMOUNTS INCLUDED ON LINES 7A AND 7B. COMMUNITY HEALTH IMPROVEMENT SERVICES AND COMMUNITY BENEFIT OPERATIONS INCLUDED ON LINE 7E AND HEALTH PROFESSIONAL EDUCATION ARE REPORTED AT COST. 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 $ 43,474. PART III, LINE 2: BAD DEBT EXPENSE IS CALCULATED UTILIZING DIRECT BAD DEBT COSTS FROM NONPAYMENT AFTER CONTRACTUAL DISCOUNTS AND PAYMENTS HAVE BEEN RECEIVED. THE STANDARD FORMULA FOR ACCOUNTS RECEIVABLE HAS BEEN UTILIZED FOR ANY OUTSTANDING ACCOUNTS AFTER CONTRACTUAL DISCOUNTS WERE TAKEN. PART III, LINE 3: DUE TO THE PUBLIC SHOWING, ADVERTISEMENT, PREQUALIFICATION, AND FOLLOW-UP NOTIFICATIONS OF OUR FINANCIAL ASSISTANCE POLICY VIA OUR BILLING PROCEDURES, WE DO NOT FEEL THAT THE IMPACT IS ABOVE ZERO. PART III, LINE 4: THE ORGANIZATION'S BAD DEBT EXPENSE IS DISCUSSED IN THE "PATIENT AND RESIDENT ACCOUNTS RECEIVABLE" SECTION OF NOTE 1 TO THE FINANCIAL STATEMENTS, ON PAGE 11 OF THE ATTACHED AUDITED FINANCIAL STATEMENTS. PART III, LINE 8: THE MEDICARE SHORTFALL OF $1,068,209 IS MADE UP MOSTLY OF PATIENT DEDUCTIBLES AND COINSURANCE. IF WE BACK THESE AMOUNTS OUT OF THE SHORTFALL, WE ARE LEFT WITH A TRUE SHORTFALL OF $0.THE MEDICARE ALLOWABLE COSTS INCLUDED IN PART III, LINE 6 WERE DERIVED FROM THE 2024 FILED MEDICARE COST REPORT. PART III, LINE 9B: IF PATIENTS HAVE COMPLETED ALL PAPERWORK AND QUALIFY FOR CHARITY CARE, THE PATIENT IS NOT BILLED FOR ANY BALANCE AND ACCOUNT IS WRITTEN OFF. IF THE PATIENT HAS MEDICAL ASSISTANCE, THAT PROGRAM IS BILLED FOR CHARGES AND THE PAYMENT IS CONSIDERED PAYMENT IN FULL, UNLESS MEDICAL ASSISTANCE NOTIFIES US THAT THE PATIENT HAS RESPONSIBILITY FOR SPEND DOWN OR CO-PAY PAYMENTS.MADISON HEALTHCARE SERVICES WILL NOT ENGAGE IN EXTRAORDINARY COLLECTION ACTIONS BEFORE REASONABLE EFFORTS HAVE BEEN MADE TO DETERMINE IF THE PERSON QUALIFIES FOR FINANCIAL ASSISTANCE. REASONABLE EFFORT WILL BE TAKEN TO REQUEST AND ASSIST IN COMPLETING APPLICATION, INCLUDING MEETING WITH INDIVIDUAL AND ASSISTING WITH THE APPLICATION PROCESS.IF THE INDIVIDUAL FAILS TO SUBMIT THE CHARITY CARE APPLICATION WITHIN 120 DAYS OF THE FIRST BILLING STATEMENT THE FACILITY HAS THE OPTION TO PROCEED WITH COLLECTION PROCESS. AT LEAST 30 DAYS PRIOR TO INITIATING THE COLLECTION PROCESS A WRITTEN NOTICE WILL BE PROVIDED INDICATING IF INDIVIDUAL DOES NOT SUBMIT THE APPLICATION OR PAY THE AMOUNT DUE BY INDICATED DEADLINE THE ACCOUNT WILL BE SENT TO A COLLECTION AGENCY. THE FACILITY HAS THE DISCRETION TO CONSIDER FOR CHARITY CARE WITHOUT COMPLETION OF CHARITY CARE APPLICATION.IF THE INDIVIDUAL COMPLETES THE APPLICATION WITHIN THE 240 DAY REQUIREMENT FOLLOWING TREATMENT, THE FACILITY WILL SUSPEND ANY COLLECTION EFFORTS. IF THE INDIVIDUAL SUBMITS AN INCOMPLETE APPLICATION WRITTEN NOTICE WILL BE PROVIDED WITH ADDITIONAL INFORMATION NEEDED AND REASONABLE TIME WILL BE GIVEN TO SUBMIT MISSING INFORMATION. AN AFFIVIDAVIT OF SERVICE IS SERVED UPON PATIENT BEING SENT TO COLLECTIONS. PART VI, LINE 2: TO ASSESS THE HEALTHCARE NEEDS OF THE COMMUNITY, MHS PERFORMED A DEMOGRAPHIC ANALYSIS OF LAC QUI PARLE COUNTY USING DATA FROM THE U.S. CENSUS BUREAU AND COUNTY HEALTH RANKINGS. ADDITIONAL RESOURCES, INCLUDING THE MINNESOTA DEPARTMENT OF HEALTH AND COUNTRYSIDE PUBLIC HEALTH, WERE UTILIZED. PRIMARY DATA WAS COLLECTED THROUGH A COMMUNITY SURVEY.MHS COLLABORATED WITH ORGANIZATIONS SUCH AS COUNTRYSIDE PUBLIC HEALTH, PRAIRIE FIVE RIDES, LAC QUI PARLE COUNTY FAMILY SERVICE CENTER, LQPV SCHOOLS, AND THE CITY OF MADISON TO IDENTIFY HEALTH NEEDS. THE COMMUNITY HEALTH NEEDS COMMITTEE USED THIS DATA TO PRIORITIZE NEEDS AND IMPLEMENTED STRATEGIES IN PARTNERSHIP WITH RIVER VALLEY HEALTH NETWORK, THE LAC QUI PARLE SCHOOL DISTRICT, AND OTHER LOCAL ORGANIZATIONS.ONGOING PROGRAM MONITORING ENSURES THAT COMMUNITY NEEDS ARE MET EFFECTIVELY. THE QUALITY COUNCIL OVERSEES THESE EFFORTS THROUGH INTERNAL AND EXTERNAL REVIEWS AND COMPLIANCE WITH STATE AND FEDERAL QUALITY REPORTING MEASURES. PART VI, LINE 3: MHS INFORMS PATIENTS ABOUT ASSISTANCE PROGRAMS THROUGH PATIENT ADMISSION PACKETS AND THE HOSPITAL'S WEBSITE. THE WEBSITE PROVIDES DETAILS ON INSURANCE CLAIM FILING, PAYMENT OPTIONS, CHARITY CARE APPLICATIONS, AND OTHER FINANCIAL ASSISTANCE RESOURCES. PATIENTS CAN ALSO EASILY APPLY ONLINE FOR CHARITY CARE THROUGH OUR WEBSITE ANYTIME OF DAY, WHEN IT MOST CONVENIENT FOR THEM.PATIENTS WITH PRIVATE PAY BALANCES RECEIVE THREE STATEMENTS AND FOLLOW-UP LETTERS BEFORE ACCOUNTS ARE SENT TO COLLECTIONS. THE HOSPITAL'S STAFF OFTEN CONTACTS PATIENTS DIRECTLY TO OFFER PAYMENT ARRANGEMENTS OR ASSISTANCE APPLICATIONS, ENSURING ALL OPTIONS ARE EXPLORED TO AVOID FINANCIAL STRAIN. INPATIENTS ARE VISITED BY OFFICE STAFF AND PROVIDED WITH APPLICATIONS FOR MEDICAL ASSISTANCE.MHS DOES NOT CHARGE FINANCE FEES ON UNPAID BALANCES, CONSIDERING THIS A VITAL COMMUNITY SERVICE. THIS APPROACH SUPPORTS PATIENTS WHO CAN ONLY MAKE SMALL PAYMENTS, ENCOURAGING THEM TO CONTINUE WITHOUT FINANCIAL DISCOURAGEMENT. PART VI, LINE 4: MHS SERVES A PREDOMINANTLY RURAL AND AGING COMMUNITY, INCLUDING LAC QUI PARLE, BIG STONE, SWIFT, YELLOW MEDICINE AND BORDER COUNTIES IN SOUTH DAKOTA. THE CLOSEST ALTERNATIVE HEALTHCARE FACILITIES ARE LOCATED 10 - 25 MILES AWAY IN CANBY, DAWSON, APPLETON, AND ORTONVILLE.THE AREA'S AVERAGE INDIVIDUAL INCOME IS APPROXIMATELY $35,859, WITH A POVERTY RATE OF 8.32%. AROUND 43.72% OF THE POPULATION HOLDS LESS THAN A HIGH SCHOOL DEGREE OR EQUIVALENT, WHILE 96.03% OF RESIDENTS IDENTIFY AS WHITE. APPROXIMATELY 24.09% OF FAMILIES RELY ON MEDICAID OR OTHER PUBLIC HEALTH PROGRAMS.MHS EVALUATED COMMUNITY HEALTH BEHAVIORS AND DEMOGRAPHICS, NOTING THAT LAC QUI PARLE COUNTY LAGS IN SOME NATIONAL HEALTH BENCHMARKS. ADULT OBESITY IS 34.5%, SLIGHTLY ABOVE THE NATIONAL BENCHMARK OF 29.4%. ACCESS TO EXERCISE OPPORTUNITIES IS 27%, SIGNIFICANTLY LOWER THAN THE BENCHMARK OF 86%. HOWEVER, THE COUNTY HAS IMPROVED IN SEVERAL AREAS, INCLUDING MENTAL HEALTH METRICS, WHERE FREQUENT MENTAL DISTRESS RATES ALIGN WITH THE NATIONAL BENCHMARK AT 13%.EFFORTS CONTINUE TO ADDRESS THESE GAPS, LEVERAGING COLLABORATIONS, SURVEYS, AND QUALITY MONITORING TO ENHANCE COMMUNITY HEALTH OUTCOMES. PART VI, LINE 5: THE HOSPITAL'S BOARD IS COMPRISED OF PERSONS WHO RESIDE IN THE COMMUNITYAND ARE NEITHER EMPLOYEES NOR CONTRACTORS OF THE ORGANIZATION. THE ORGANIZATION EXTENDS MEDICAL STAFF PRIVILEGES TO ALL QUALIFIED PHYSICIANS IN ITS COMMUNITY SUCH AS DR. CLINT BONN, CHIROPRACTOR. DR. BONN UTILIZED MADISON HOSPITAL LABORATORY FOR DOT DRUG TESTING AND MADISON HOSPITAL RADIOLOGY FOR ALL X-RAY AND CT STUDIES. THREE TIMES A YEAR, THE RADIOLOGY DEPARTMENT HOLDS VASCULAR SCREENINGS IN WHICH COMMUNITY MEMBERS MAY HAVE VASCULAR SCREENINGS TO DETECT STROKES, PERIPHERAL VASCULAR DISEASE, AND ABDOMINAL AORTIC ANEURYSMS. THIS IS A CASH BASED SCREENING AND IS AVAILABLE AT A SUBSTANTIALLY REDUCED RATE AND A DOCTOR'S ORDER IS NOT REQUIRED. MADISON HOSPITAL LAB OFFERS DIRECT ACCESS LAB TESTING TO ITS COMMUNITY MEMBERS. THIS IS A CASH BASED PROGRAM WHERE LAB TESTS ARE OFFERED ON A CASH BASIS AT A SUBSTANTIALLY REDUCED RATE. LAST YEAR, OUR USERS SAVED OVER $12,000. MADISON HOSPITAL AND LAC QUI PARLE CLINIC DONATE ALL UNUSED MEDICAL EQUIPMENT TO A MISSION FOR MEDICAL USE. ALL EXPIRED LABORATORY SUPPLIES ARE SENT TO THE MEDICAL LAB TECHNICIAN PROGRAMS FOR USE IN THEIR STUDENT LABS. MADISON HOSPITAL IS CONSTANTLY STRIVING TO ADD NEW SERVICES, INCLUDING OUTREACH SERVICES TO BETTER SERVE THE NEEDS OF OUR COMMUNITY. A LEADERSHIP TEAM HAS BEEN FORMED TO MEET THE COMMUNITY NEEDS, CONTINUE TO LOOK AT ADDING NEW SERVICES, CONTINUE TO LOOK AT UPDATING OUR CURRENT FACILITY, AND ASKING FOR COMMUNITY INVOLVEMENT IN FINAL DECISION MAKING. WITH OUR AGING POPULATION, WE STRIVE TO BRING THE SERVICES TO THE PATIENTS, RATHER THAN THE PATIENTS HAVING TO DRIVE HOURS FROM HOME TO GET THE SERVICES. MADISON HOSPITAL PROVIDED HEALTH CARE SCREENINGS AT REDUCED RATES TO THE COMMUNITY. PART VI, LINE 7, REPORTS FILED WITH STATES MN 1 LITTLE EAGLES DAYCARE 8100 SCHOOL ROAD EDEN PRAIRIE MN 55344 550695712 501(C)(3) 20000 0 N/A N/A SUPPORT TO DAYCARE 1 0 PART I, LINE 2: GRANTS ARE MADE TO LOCAL ORGANIZATIONS WITH WHOM MADISON HEALTHCARE SERVICES HAS LONG-STANDING RELATIONSHIPS. BECAUSE THESE CONTRIBUTIONS ARE INTENDED AS GENERAL OPERATING SUPPORT,NO SPECIFIC FOLLOW-UP IS CONDUCTED REGARDING THE SPECIFIC USE OF GRANTED FUNDS. X 0 0 0 0 0 0 0 0 0 BRANT HACKER MD MD 269155 0 0 0 178082 0 35800 0 0 0 483037 0 0 0 HANNAH FIELDS MD MD 299817 0 0 0 47150 0 0 0 30928 0 377895 0 0 0 MARIA NOLTE MD MD 185064 0 0 0 42620 0 5911 0 45261 0 278856 0 0 0 ERIK BJERKE CEO 209000 0 3000 0 0 0 15183 0 45261 0 272444 0 0 0 PAUL HODGE NP NURSE PRACTITIONER 124116 0 23789 0 9715 0 0 0 15087 0 172707 0 0 0 A CITY OF MADISON MINNESOTA 416005335 2020-09-23 6705000 REFUNDING 2020 BONDS, FINANCE OF FACILITY EXPANSION 0 0 0 B CITY OF BELLINGHAM MINNESOTA 416004967 2020-09-23 6705000 REFUNDING 2020 BONDS, FINANCE OF FACILITY EXPANSION 0 0 0 A 349010 6705000 6705000 2021 1 0 1 1 B 349010 6705000 6705000 2021 1 0 1 1 A 0 0 0 0 0.00000 0.00000 0.00000 0 0 1 B 0 0 0 0 0.00000 0.00000 0.00000 0 0 1 A 0 1 0 0 1 1 OLD NATIONAL BANK 8.500000000000 0 0 0 0 1 B 0 1 0 0 1 1 OLD NATIONAL BANK 8.500000000000 0 0 0 0 1 A 1 B 1 DR MARIA NOLTE DAUGHTER OF CAROL BORGERSON, CFO 281467 COMPENSATION 0 FORM 990, PART VI, SECTION A, LINE 1A THERE SHALL BE AN EXECUTIVE COMMITTEE OF THE ORGANIZATION, CONSISTING OF (3) PERSONS ELECTED BY THE BOARD OF DIRECTORS TO SERVE FOR ONE (1) YEAR TERMS. THE EXECUTIVE COMMITTEE SHALL CONSIST OF THE CHAIRMAN, THE PRESIDENT/TREASURER, AND THE SECRETARY OF THE ORGANIZATION. IF THE CHAIRMAN OF THE ORGANIZATION IS A MEMBER OF THE EXECUTIVE COMMITTEE, HE OR SHE SHALL BE THE CHAIRMAN OF THE EXECUTIVE COMMITTEE; OTHERWISE THE PRESIDENT SHALL BE THE CHAIRMAN OF THE EXECUTIVE COMMITTEE. THE EXECUTIVE COMMITTEE SHALL MEET ON CALL OF THE CHAIRMAN OR PRESIDENT, SHALL ACT ONLY IN THE INTERVALS BETWEEN MEETINGS OF THE BOARD OF DIRECTORS, SHALL AT ALL TIMES BE SUBJECT TO THE DIRECTION AND CONTROL OF THE BOARD OF DIRECTORS, AND, SUBJECT ALWAYS TO THE FOREGOING, SHALL, UNLESS EXPRESSLY SPECIFIED TO THE CONTRARY BY RESOLUTION ADOPTED BY THE BOARD OF DIRECTORS, HAVE AND EXERCISE THE AUTHORITY OF THE BOARD OF DIRECTORS IN THE MANAGEMENT OF THE BUSINESS AND AFFAIRS OF THE ORGANIZATION. FORM 990, PART VI, SECTION A, LINE 6 THE ORGANIZATION'S MEMBERS ARE THE LUTHERAN CONGREGATIONS WITHIN THE COMMUNITY. THE MAJORITY OF THE MEMBERS MUST AT ALL TIMES BE CONGREGATIONS WITHIN THE EVANGELICAL LUTHERAN CHURCH IN AMERICA (ELCA). EACH MEMBER CONGREGATION SHALL BE REPRESENTED AT MEETINGS OF THE MEMBERS BY THREE DELEGATES, SELECTED FROM THE COMMUNICANT MEMBERS OF THE CONGREGATION. ALL DELEGATES SHALL HAVE EQUAL VOTING RIGHTS AND VOTING BY PROXY SHALL BE PROHIBITED. FORM 990, PART VI, SECTION A, LINE 7A THE ORGANIZATION'S MEMBERS ARE THE LUTHERAN CONGREGATIONS WITHIN THE COMMUNITY. DELEGATES OF LUTHERAN CONGREGATIONS ELECT THE BOARD OF DIRECTORS OF MADISON HEALTHCARE SERVICES. FORM 990, PART VI, SECTION A, LINE 7B AMENDMENTS TO THE BYLAWS MUST BE APPROVED BY THE MEMBER CONGREGATION DELEGATES. FORM 990, PART VI, SECTION B, LINE 11B THE FORM 990 IS PRESENTED TO THE BOARD OF DIRECTORS FOR APPROVAL PRIOR TO SUBMISSION TO THE INTERNAL REVENUE SERVICE. FORM 990, PART VI, SECTION B, LINE 12C THE ORGANIZATION MONITORS THE CONFLICT OF INTEREST POLICY AS CONFLICTS ARISE. IF ANY DIRECTOR OR EMPLOYEE OF THE ORGANIZATION HAS ANY DIRECT OR INDIRECT INTEREST IN, OR RELATIONSHIP WITH, ANY INDIVIDUAL OR ORGANIZATION THAT PROPOSES TO ENTER INTO ANY TRANSACTION WITH THE CORPORATION, INCLUDING BUT NOT LIMITED TO TRANSACTIONS INVOLVING: A. THE SALE, PURCHASE, LEASE OR RENTAL OF ANY PROPERTY OR OTHER ASSET; B. EMPLOYMENT OR RENDITION OF SERVICES, PERSONAL OR OTHERWISE; C. THE AWARD OF ANY CONTRACT SUCH PERSON SHALL GIVE NOTICE OF SUCH INTEREST OR RELATIONSHIP AND SHALL THEREAFTER REFRAIN FROM DISCUSSING OR VOTING ON THE PARTICULAR TRANSACTION IN WHICH HE HAS AN INTEREST, OR OTHERWISE ATTEMPTING TO EXERT ANY INFLUENCE ON THE CORPORATION, OR ITS COMPONENTS TO AFFECT A DECISION TO PARTICIPATE OR NOT PARTICIPATE IN SUCH TRANSACTION. CONFLICTS OF INTEREST OR REVIEWED AT THE ADMINISTRATION AND BOARD LEVEL. ALL PROCEEDINGS RESULTING FROM A CONFLICT OF INTEREST ARE RECORDED IN THE BOARD MEETING MINUTES. FORM 990, PART VI, SECTION B, LINE 15 THE ORGANIZATION USES COMPARABILITY DATA FROM SURVEYS OF OTHER ORGANIZATIONS OF SIMILAR SIZE IN THE SURROUNDING AREAS TO DETERMINE COMPENSATION OF TOP MANAGEMENT AND OFFICERS OF THE ORGANIZATION. THE MEDISOTA SALARY SURVEY IS UTILIZED IN THIS DETERMINATION. THE BOARD OF DIRECTORS REVIEWS AND APPROVES PRESIDENT/CEO COMPENSATION ANNUALLY. THE PRESIDENT/CEO APPROVES THE COMPENSATION OF THE CFO. THIS PROCESS IS DOCUMENTED IN THE MEETING MINUTES AND THE PRESIDENT/CEO'S PERSONNEL FILE. THIS PROCESS WAS LAST CONDUCTED IN 2024. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION DOES NOT MAKE ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY OR FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC. FORM 990, PART IX, LINE 11G NURSING/OTHER PROFESSIONAL: PROGRAM SERVICE EXPENSES 3,147,984. MANAGEMENT AND GENERAL EXPENSES 969,719. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 4,117,703. CONSULTANTS: PROGRAM SERVICE EXPENSES 5,961. MANAGEMENT AND GENERAL EXPENSES 1,836. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 7,797. FORM 990, PART XII, LINE 2C: THE BOARD OF DIRECTORS IS TASKED WITH SELECTING AN INDEPENDENT PUBLIC ACCOUNTING FIRM TO AUDIT THE ORGANIZATION'S FINANCIAL STATEMENTS AND RETAIN SUCH PERSON OR FIRM FOR ADDITIONAL SERVICES IT MAY DEEM APPROPRIATE. THIS PROCESS HAS NOT CHANGED FROM THE PREVIOUS FISCAL YEAR. HILLTOP RESIDENCE INC 915 FIRST AVENUE MADISON MN 56256 411376605 MHS MANAGES HUD HOUSING - HILLTOP APARTMENTS MN 501(C)(3) LINE 10 MADISON HEALTHCARE SERVICES 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 0 0 0