2020-04-13T14:24:07-05:00 2019-05-31 410746749 CLIFTONLARSONALLEN LLP 220 SOUTH SIXTH STREET SUITE 300 MINNEAPOLIS MN 55402 990 2018-06-01 410758512 MADELIA COMMUNITY HOSPITAL INCORPORATED MADE 5076423255 121 DREW AVENUE SOUTHEAST MADELIA MN 56062 JEFF MENGENHAUSEN CEO 5076423255 2020-04-10 1 RYAN ENGEBRETSON P01585625 6123764500 67.137.57.251 2020-04-10 10:31:39 CD P F7E35B63400230345D2F018ED440CE5992BA784B 3F449F054D48A8326DD42E3CAE2ABA233D1F16C9 2018 2020-09-23 17:36:50Z MADELIA COMMUNITY HOSPITAL & CLINIC JEFF MENGENHAUSEN 121 DREW AVENUE SOUTHEAST MADELIA MN 56062 13213489 0 X WWW.MCHOSPITAL.ORG X 1950 MN PROVIDE QUALITY HEALTHCARE SERVICES TO THE LOCAL COMMUNITY. 9 9 140 60 0 0 182834 392430 10694815 11118862 136089 133118 96134 91580 11109872 11735990 0 0 0 0 7212414 7806127 0 0 0 4600173 5019556 11812587 12825683 -702715 -1089693 17445824 16110240 6171605 6077361 11274219 10032879 X THE MISSION OF MADELIA COMMUNITY HOSPITAL IS TO PROVIDE SAFE AND QUALITY HEALTHCARE SERVICES TO THOSE WE SERVE IN AN ENVIRONMENT BASED ON RESPECT, DIGNITY, AND EXCELLENCE. 0 0 9282476 11118862 MADELIA COMMUNITY HOSPITAL & CLINIC PROVIDES GENERAL MEDICAL/SURGICAL SERVICES ON INPATIENTS, SWING BED PATIENTS, OUTPATIENTS AND HOME CARE CLIENTS. DURING THE FISCAL YEAR 2019 THERE WERE 86 ACUTE CARE ADMISSIONS, 70 SWING BED ADMISSIONS, 12,519 HOME CARE VISITS TO 1,156 HOME CARE CLIENTS, AND 4,453 TOTAL OUTPATIENT VISITS. DURING OUR FISCAL YEAR 2019, MADELIA COMMUNITY HOSPITAL AND CLINIC PROVIDED $28,872 IN CHARITY CARE. A VARIETY OF COMMUNITY BENEFIT SERVICES ARE DONE EACH YEAR BY VOLUNTEER HOSPITAL EMPLOYEES AND COMMUNITY VOLUNTEERS. COMMUNITY BENEFIT ACTIVITIES INCLUDED:COORDINATION OF DRIVERS FOR THE WATONWAN COUNTY SENIOR DRIVER PROGRAM, A NONPROFIT GROUP FURNISHING TRANSPORTATION FOR THE ELDERLY SENIOR POPULATION.DELIVERY OF 2,261 HOSPITAL-PREPARED MEALS FOR THE MEALS ON WHEELS PROGRAM IN MADELIAINTERPRETIVE AND TRANSLATION FROM ENGLISH TO SPANISH FOR PATIENTS AT MCHCCOLLABORATIVE HISPANIC OUTREACH SERVICES INCLUDING POPULATION HEALTH EDUCATIONAL SERVICES FOR THE PREVENTION OF DIABETES, OBESITY, HEART DISEASE, AND HYPERTENSIONHOSPICE ADVISORY COMMITTEEFREE HEEL SCANS TO DETECT OSTEOPOROSISFREE BLOOD PRESSURE CHECKS AT THE MADELIA COMMUNITY HOSPITAL & CLINIC AND AT HEALTH FAIRS IN THE AREA AND AT CHURCH EVENTSWORKING SIDE BY WITH STUDENTS FROM AREA UNIVERSITIES AND COLLEGES FOR STUDENTS IN THE NURSE PRACTITIONER, CLINIC, NURSING, LABORATORY TECHNICIAN AND PHYSICAL THERAPY PROGRAMS.INDUSTRY SPONSORS FOR THE HIGH STEP HEALTH SCIENCE ACADEMY, A PROGRAM FOR MADELIA HIGH SCHOOL STUDENTS THAT INTRODUCES THEM TO CAREER OPPORTUNITIES IN THE HEALTH CARE FIELD. PROVIDED MEETING FACILITIES FOR STUDENTS AND INSTRUCTION ONE HOUR PER WEEK DURING THE SCHOOL YEAR.DELIVERY OF PHARMACEUTICALS FOR HOME BOUND PATIENTSPHYSICIAN PROVIDING SKIN CHECKS FOR THE MADELIA HIGH SCHOOL WRESTLING TEAM.HIGH SCHOOL ATHLETE TRAINING AND CARE FOR SMALL AND NONLIFE THREATENING INJURIES. "IMPACT" (CONCUSSION) EVALUATION FOR MADELIA STUDENTS.PHYSICAL THERAPY DEPARTMENT HOSTED TWO FREE BALANCE AND FALL SCREENING SESSIONS - ONE IN LAKE CRYSTAL AND ONE IN MADELIA.HOSTED AG RESPIRATOR SESSIONS SO FARMERS COULD BE FITTED FOR APPROPRIATE FACEMASKS FREE OF CHARGE.HELD A SPECIAL HEALTH CARE CLINIC FOR AREA HUNTERS AT A REDUCED FEE. PEOPLE THAT ATTENDED HAD THEIR HEIGHT AND WEIGHT RECORDED, THEIR BLOOD PRESSURE CHECKED, AND THEIR VISION SCREENED. THEY ALSO HAD BLOOD TESTS TO SCREEN FOR HIGH CHOLESTEROL, DIABETES, PROSTATE CANCER/THYROID FUNCTION, AND AN EKG. TESTING WAS PRICED UNDER MCHC COST. SPONSORED AND HOSTED AN EDUCATIONAL EVENT ON THE CHANGES IN MEDICARE FOR 2019 WITH A SPEAKER FROM THE SENIOR LINKAGE LINE.COMMUNITY AND SCHOOL HEALTH FAIR PARTICIPATIONSMALL FEE FOOT AND NAIL CLINIC (SOAKING FEET, TRIMMING TOENAILS AND MASSAGING FEET OF ELDERLY PATIENTS). AN AVERAGE OF 60 PATIENTS PER MONTH PARTAKE IN THIS SERVICE.HOSTED THREE ART & HEALTH CLASSES TO ENHANCE THE HEALTH OF MIND AND BODY. EVENTS WERE SPONSORED BY RADIOLOGY, CLINIC AND HOME CARE DEPARTMENTS. ACTIVE AND CHARTER MEMBERS OF THE MADELIA COMMUNITY BASED COLLABORATIVE (MCBC). THIS GROUP IS COMPRISED OF HOSPITAL STAFF, NURSING PROFESSORS FROM MINNESOTA STATE UNIVERSITY - MANKATO, MEMBERS OF THE MANKATO GLEN TAYLOR NURSING INSTITUTE FOR FAMILY AND SOCIETY, WATONWAN COUNTY PUBLIC HEALTH REPRESENTATIVES, STATEWIDE HEALTH INITIATIVE PROGRAM (SHIP) REPRESENTATIVE, UNIVERSITY OF MINNESOTA EXTENSION EDUCATOR, ADMINISTRATIVE STAFF FROM THE LOCAL SCHOOL DISTRICT, AND COMMUNITY MEMBERS. MEMBERS OF MCBC, INCLUDING HOSPITAL STAFF, ALSO PARTNER WITH THE WATONWAN COMMUNITY FOOD PARTNERSHIP WHICH FOCUSES ON BRINGING FRESH FRUITS AND VEGETABLES INTO THE COMMUNITIES OF WATONWAN COUNTY.THE VISION OF MCBC IS WORKING TOGETHER TO ACHIEVE A HEALTHIER COMMUNITY. ITS MISSION IS TO PROMOTE THE WELL-BEING OF MADELIA RESIDENTS THROUGH COMMUNITY-BASED PARTNERSHIPS AND THE VALUES ARE EQUITY, COLLABORATION, COMMUNITY ENGAGEMENT, HEALTH & WELL-BEING.USING DATA FROM THE 2015 - 2016 COMMUNITY HEALTH NEEDS ASSESSMENT, THIS GROUP DECIDED ON TWO STRATEGIC FOCUSED AREAS, 1) OBESITY AND 2) MENTAL HEALTH WELL-BEING. OBESITY CONTINUES TO BE THE NUMBER ONE HEALTH CONCERN IN THE COMMUNITY. RECOGNIZING THAT MENTAL HEALTH WELL-BEING PLAYS A ROLE IN OBESITY AND WAS ALSO IDENTIFIED AS A SIGNIFICANT CONCERN IN THE NEEDS ASSESSMENT, MCBC DECIDED TO WORK COLLABORATIVELY ON A PROJECT THAT WOULD ADDRESS PHYSICAL AND MENTAL HEALTH. THE PROJECT THEME WAS "OH THE THINGS YOU CAN DO THAT ARE GOOD FOR YOU: ALL ABOUT STAYING HEALTHY," WITH A FOCUS ON THE IMPORTANCE OF EATING WELL, STAYING ACTIVE, AND GETTING GOOD SLEEP. THE GOAL IS TO DEMONSTRATE HOW THESE AREAS AFFECT YOUR PHYSICAL HEALTH AS WELL AS YOUR MENTAL HEALTH. IN ADDITION, MCBC IS PLANNING WORK IN THE FOCUS AREA OF OBESITY THAT WILL BRING FRESH FRUITS AND VEGETABLES TO THOSE IN NEED. IN THE FOCUS AREA OF MENTAL HEALTH WELL-BEING, THE GROUP IS PLANNING TRAINING AND EDUCATION THAT WILL TOUCH PEOPLE OF ALL AGES. THE ACCOMPLISHMENTS THIS YEAR INCLUDE: 1. EDUCATION PROVIDED TO 3RD AND 4TH GRADE STUDENTS ON, "OH THE THINGS YOU CAN DO THAT ARE GOOD FOR YOU: ALL ABOUT STAYING HEALTHY." THIS WAS FOLLOWED BY A POSTER CONTEST. THE POSTER CONTEST INCLUDED PRIZES OF "A BUCKETS OF THINGS THAT ARE GOOD FOR YOU AND A GRAND PRIZE OF A FAMILY POOL PASS.2. LET IT GROW BARRELS WERE AGAIN USED IN THE MADELIA MOBILE HOME PARK TO PROVIDE RESIDENTS WITH ACCESS TO FREE FRESH TOMATOES, PEPPERS, AND HERBS. MOST RESIDENTS ARE LOW-INCOME. 3. MCHC BECAME A REFERRAL SOURCE FOR THE MADELIA FOOD SHELF.4. EDUCATION WAS PROVIDED DURING THE COMMUNITY CELEBRATION WHICH INCLUDED:A. RETHINK YOUR DRINK DISPLAY WITH VEGETABLE AND FRUIT INFUSED WATER SAMPLESB. FRUIT AND VEGETABLE DISPLAYS C. MENTAL HEALTH DISPLAY ADDRESSING FEELINGS WITH TAKE HOME PACKETS FOR KIDS, PARENTS, AND GRANDPARENTS5. HOSTED MENTAL HEALTH MONDAY EVENTS IN NOVEMBER AND JANUARY, FOCUSING ON VARIOUS MENTAL HEALTH TOPICS.6. PROVIDED MONTHLY FARE FOR ALL DISTRIBUTION IN MADELIA AT THE LUTHER MEMORIAL HOME. FARE FOR ALL IS A FOOD PROGRAM AVAILABLE TO ALL COMMUNITY MEMBERS THAT OFFERS FRESH PRODUCE AND FROZEN MEATS FOR A SUBSTANTIALLY LOWER PRICE THAN CAN BE FOUND AT LOCAL GROCERS. 9282476 1 1 0 0 0 0 0 0 0 0 1 0 0 0 1 1 0 1 0 0 0 0 0 0 0 0 1 1 0 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 0 0 1 68 0 140 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 0 1 1 1 1 1 1 1 0 MN X X MONIQUE HOFFMANN-URBAN 5076423255 121 DREW AVENUE SOUTHEAST MADELIA MN 56062 DENNIS ARDUSER BOARD PRESIDENT 1.00 0.00 X X 1800 0 0 STEVEN COOLING BOARD VP & TREASURER 1.00 0.00 X X 1800 0 0 BARBARA OVERLIE BOARD SECRETARY 1.00 0.00 X X 1800 0 0 KENNETH GRONEWOLD BOARD MEMBER 1.00 0.00 X 1200 0 0 NORMA KRUMWIEDE BOARD MEMBER 1.00 0.00 X 1200 0 0 BRIAN MCCABE BOARD MEMBER 1.00 0.00 X 1200 0 0 ELIZABETH SCHMIDT BOARD MEMBER 1.00 0.00 X 1200 0 0 STEVEN SORENSEN BOARD MEMBER 1.00 0.00 X 1200 0 0 RYAN VISHER BOARD MEMBER 1.00 0.00 X 1200 0 0 JEFF MENGENHAUSEN CEO 40.00 0.20 X 144475 0 28449 MONIQUE HOFFMANN-URBAN CFO 40.00 0.20 X 100782 0 16298 JANE MALMSKOG MEDICATION THERAPY MANAGEMENT 40.00 0.00 X 127026 0 18086 JENNIFER MCLAUGHLIN OR/ER MANAGER 40.00 0.00 X 114909 0 11303 MICHAEL NELSON EMERGENCY MEDICINE 36.00 0.00 X 124313 0 0 624105 0 74136 5 0 1 0 MANKATO CLINIC LTD 1230 E MAIN ST MANKATO MN 56002 PHYSICIAN CLINIC PROVIDERS 815024 WHITESELL MEDICAL STAFFING PO BOX 997 ANNADALE MN 55302 MEDICAL STAFFING 810881 WMG LYFJABERG LLC 107 FLYNN DRIVE SUITE 600 MILBANK SD 57252 MEDICAL STAFFING 414394 CARDINAL HEALTH 3900 W AVERA DRIVE SUITE 301 SIOUX FALLS SD 57108 AVERA CARE-EPHARMACY & EEMERGENCY 371866 MARCO TECHNOLOGIES 4510 HEATHERWOOD ROAD SAINT CLOUD MN 56301 IT SUPPORT 143362 12 146426 245734 270 392430 NET PATIENT REVENUE 624100 11036045 11036045 PHYSICAL THERAPY 624310 68526 68526 LABORATORY 621500 11967 11967 PHARMACY 446110 2324 2324 11118862 192337 192337 30434 30434 59133 38113 21020 21020 21020 1380167 1371514 67872 8653 -67872 -59219 -59219 EMPLOYEE MEALS 900099 21129 21129 MISC INCOME 900099 16236 16236 MEDICAL RECORDS 900099 2761 2761 40126 11735990 11118862 0 224698 227252 227252 6305530 5198603 1106927 171802 129296 42506 761665 615102 146563 339878 243164 96714 309465 79377 230088 22219 22219 547801 547801 187920 187920 97504 64280 33224 275649 275649 779074 779074 MEDICAL SUPPLIES 1608053 1608053 REPAIRS/MAINTENANCE 442404 442404 BAD DEBTS 354812 354812 CLINIC EXPENSES 210715 210715 183940 183940 12825683 9282476 3543207 0 2451307 1344333 4493012 4634974 13051 9717 1857821 2087316 299621 284805 138197 188275 17610867 11882877 6354275 5727990 1158029 1158462 680511 674368 17445824 16110240 1201251 1299241 4825000 4660000 105354 78120 40000 40000 6171605 6077361 X 11274219 9894879 138000 11274219 10032879 17445824 16110240 X -1089693 -5221 -146426 X X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 194207 194207 6936493 4208270 2728223 4822396 3234614 1587782 5657771 4439993 1217778 5727990 ASSET RETIREMENT OBLIGATION 40000 40000 X PART X, LINE 2: THE HOSPITAL IS CLASSIFIED BY THE IRS AS A TAX-EXEMPT ORGANIZATION UNDER SECTION 501(C)(3) OF THE IRC AND IS SUBJECTED TO FEDERAL INCOME TAX ONLY ON NET UNRELATED BUSINESS INCOME. THE HOSPITAL FOLLOWS THE GUIDANCE IN THE INCOME TAX STANDARD REGARDING RECOGNITION AND MEASUREMENT OF UNCERTAIN TAX POSITIONS. THE APPLICATION OF THIS STANDARD HAS NO EFFECT ON THE FINANCIAL STATEMENTS. 1 1 X 1 X 1 X 1 1 0 1 1 23869 23869 0.00190 1630588 1017903 612685 0.04910 1654457 1017903 636554 0.05100 76817 76817 0.00620 367 367 0.00000 77184 77184 0.00620 1731641 1017903 713738 0.05720 3291 3291 0.00030 16845 16845 0.00140 3020 3020 0.00020 4049 4049 0.00030 27205 27205 0.00220 1 354812 70962 3660600 4328816 -668216 X 1 1 1 1 MADELIA COMMUNITY HOSPITAL 121 DREW AVE SE MADELIA MN 56062 WWW.MCHOSPITAL.ORG 385015 X X X X MADELIA COMMUNITY HOSPITAL INCORPORATED 1 0 0 1 X X X X X X X X X 18 1 0 0 1 X WWW.MCHOSPITAL.ORG/COMMUNITY-NEEDS-ASSESSMENT X 1 18 0 1 0 1 X 100.000000000000 200.000000000000 X 1 1 X X X X X 1 X HTTPS://WWW.MCHOSPITAL.ORG/FINANCIAL-ASSISTANCE X HTTPS://WWW.MCHOSPITAL.ORG/FINANCIAL-ASSISTANCE X HTTPS://WWW.MCHOSPITAL.ORG/FINANCIAL-ASSISTANCE X X X X X X X 1 X 0 X X X X 1 X 0 0 MADELIA COMMUNITY HOSPITAL, INCORPORATED PART V, SECTION B, LINE 5: FOR MADELIA COMMUNITY HOSPITAL'S MAY 2019 COMMUNITY HEALTH NEEDS ASSESSMENT, THE HOSPITAL SOLICITED INPUT FROM THE COMMUNITY THROUGH A SURVEY THAT WAS MAILED TO EVERY HOME IN SIX ZIP CODES - 7,494 IN TOTAL. WE RECEIVED 253 RESPONSES, INCLUDING 43 FROM INDIVIDUALS WHO SELF-IDENTIFIED AS LOW-INCOME, SIX FROM INDIVIDUALS WHO IDENTIFIED AS LATINO, 130 FROM INDIVIDUALS WHO IDENTIFIED AS ELDERLY, AND 45 FROM MEDICAL PROFESSIONALS. MADELIA COMMUNITY HOSPITAL, INCORPORATED PART V, SECTION B, LINE 11: IT IS UNDERSTOOD THAT IT WILL TAKE A NUMBER OF YEARS TO OBTAIN MEASURABLE DATA TO DEMONSTRATE ACTUAL EDUCATION IN OBESITY. THE CURRENT STRATEGY FOCUSES ON SHORT TERM GOALS. THE FOLLOWING SHORT TERM GOALS HAVE BEEN ESTABLISHED TO REMOVE THE BARRIERS TO HEALTHY EATING AND INCREASE PHYSICAL EXERCISE: DEVELOP PARTNERSHIPS WITH COMMUNITY & COUNTY ORGANIZATIONS WHO SHARE THE SAME VISION TO IMPROVE THE ACCESS OF FRESH FRUITS AND VEGETABLES WITHIN THE COMMUNITY. DEVELOP OPPORTUNITIES TO PROVIDE LOW-COST OR NO-COST FRUITS AND VEGETABLES TO THOSE IN NEED. INCREASE COMMUNITY AWARENESS OF PROGRAMS THAT WILL ALLOW THEM TO OBTAIN FRESH FRUITS AND VEGETABLES AT LOW AND NO COST. EDUCATE CHILDREN ON HEALTHY EATING. EDUCATE CHILDREN ON THE RELATIONSHIP BETWEEN PHYSICAL ACTIVITY AND OVERALL HEALTH. PARTNER WITH MCHC ON THE JUMP ROPE FOR HEARTS PROJECT. PROVIDE OPPORTUNITIES FOR THE COMMUNITY TO TASTE FRUITS AND VEGETABLES COMMON TO DIFFERENT CULTURES REPRESENTED IN THE COMMUNITY.DIABETES, HEART DISEASE, AND CANCER. MCHC RECOGNIZES THE IMPORTANCE OF RESOURCE UTILIZATION IS DONE IN A WAY THAT WILL HAVE THE GREATEST IMPACT ON THE COMMUNITY AS A WHOLE. BY FOCUSING ON OBESITY BY SETTING GOALS AND PROVIDING EDUCATION, REDUCING OBESITY WILL ALSO REDUCE THE RISK OF DIABETES AND CANCER. MADELIA COMMUNITY HOSPITAL, INCORPORATED PART V, SECTION B, LINE 13H: ALL PATIENTS ARE CHARGED THE SAME FOR SERVICES RENDERED AT MCH NO MATTER WHAT THE PATIENT'S FINANCIAL STATUS CONSISTS OF. MADELIA COMMUNITY HOSPITAL, INCORPORATED PART V, SECTION B, LINE 15E: PATIENT BILLS CONTAIN A STATEMENT REGARDING THE FAP AVAILABILITY FOR FURTHER INQUIRY OF ASSISTANCE. MADELIA COMMUNITY HOSPITAL, INCORPORATED PART V, SECTION B, LINE 16J: THE FAP APPLICATION IS AUTOMATICALLY MAILED OUT TO UNINSURED AND UNDERINSURED PATIENTS. MADELIA COMMUNITY HOSPITAL, INCORPORATED 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 I, LINE 3C: AGI UNDER 100% OF FPG RECEIVED FULL DISCOUNT, AGI BETWEEN 100%-200% FPG RECEIVED A DISCOUNT BASED ON FORMULARY CALCULATION. AN AGI OVER 200% DOES NOT QUALIFY FOR ASSISTANCE. PART I, LINE 7: THE FINANCIAL ASSISTANCE AT COST AND MEDICAID AMOUNTS REPORTED IN PART I, LINES 7A AND 7B, RESPECTIVELY, WERE COMPUTED USING A RATIO OF COST TO CHARGES THAT WAS DERIVED FROM WORKSHEET 2 OF THE SCHEDULE H INSTRUCTIONS. THE COMMUNITY HEALTH IMPROVEMENT SERVICES AND COMMUNITY BENEFIT OPERATIONS AND HEALTH PROFESSIONS EDUCATION AMOUNTS REPORTED IN PART I, LINES 7E AND 7F, RESPECTIVELY, WERE 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 $ 354,812. PART II, COMMUNITY BUILDING ACTIVITIES: STAFF PARTICIPATE IN COMMUNITY ORGANIZATIONS TO PROVIDE HEALTHCARE REPRESENTATION AND INFORMATION TO ENHANCE THOSE ORGANIZATIONS EVENTS, ETC. MADELIA COMMUNITY BASED COLLABORATIVE (MCBC) IS A COMMUNITY BASED PROJECT THAT MADELIA COMMUNITY HOSPITAL PARTICIPATES IN TO SUPPORT HEALTHY LIFE STYLES. THROUGH THIS COLLABORATION, MADELIA COMMUNITY HOSPITAL IS ABLE TO PARTNER WITH OTHER AREA HEALTH BASED COMMUNITY EMPLOYERS AND EDUCATORS, AS WELL AS NON-HEALTH BASED EMPLOYERS THAT HAVE EXPRESSED AN INTEREST IN IMPROVING THE HEALTH OF THEIR EMPLOYEES. THE COMMUNITY HEALTH NEEDS ASSESSMENT COMPLETED BY MADELIA COMMUNITY HOSPITAL HELPS MCBC DETERMINE WHAT AREAS THEY WILL FOCUS THEIR EFFORTS IN ORDER TO GAIN THE MOST BENEFIT FOR THE COMMUNITY. STAFF FROM MADELIA COMMUNITY HOSPITAL HAVE A SIGNIFICANT ROLE IN THIS DEVELOPMENT AND CARRYING OUT THE ACTION PLANS. PART III, LINE 2: PAYMENT FOR SERVICES IS REQUIRED UPON RECEIPT OF A BILL, AFTER PAYMENT BY INSURANCE, IF ANY. SELF-PAY ACCOUNTS ARE ANALYZED FOR COLLECTIBILITY BASED ON THE MONTHS PAST DUE AND PAYMENT HISTORY. AN ALLOWANCE IS ESTIMATED FOR THESE ACCOUNTS BASED ON THE HISTORICAL EXPERIENCE OF THE HOSPITAL. ACCOUNTS THAT ARE DETERMINED TO BE UNCOLLECTIBLE ARE SENT TO A COLLECTION AGENCY AND WRITTEN OFF AT THAT TIME.THE AMOUNT OF BAD DEBT EXPENSE REPORTED IN PART III, LINE 2 IS CALCULATED AS FOLLOWS: PAYMENT ARRANGEMENT INCLUDE PROSPECTIVELY DETERMINED RATES PER DISCHARGE, REIMBURSED COSTS, DISCOUNTED CHARGES AND PER DIEM PAYMENTS. NET PATIENT SERVICE REVENUE IS REPORTED AT THE ESTIMATED NET REALIZABLE AMOUNTS FROM PATIENTS, THIRD-PARTY PAYORS, AND OTHERS FOR SERVICES RENDERED, INCLUDING ESTIMATED RETROACTIVE ADJUSTMENTS UNDER REIMBURSEMENT AGREEMENTS WITH THIRD-PARTY PAYORS. PART III, LINE 4: THE FOLLOWING IS FROM THE "PATIENT RECEIVABLES" PARAGRAPH IN NOTE 1 TO THE HOSPITAL'S FINANCIAL STATEMENTS:"PATIENT RECEIVABLES ARE REDUCED BY AN ALLOWANCE FOR DOUBTFUL ACCOUNTS. PATIENTS ARE NOT REQUIRED TO PROVIDE COLLATERAL FOR SERVICES RENDERED. PAYMENT FOR SERVICES IS REQUIRED UPON RECEIPT OF AN INVOICE, AFTER PAYMENT BY INSURANCE, IF ANY. IN EVALUATING THE COLLECTABILITY OF PATIENT ACCOUNTS RECEIVABLE, THE HOSPITAL ANALYZES ITS PAST HISTORY AND IDENTIFIES TRENDS FOR EACH OF ITS MAJOR PAYOR SOURCES OF REVENUE TO ESTIMATE THE APPROPRIATE ALLOWANCE FOR DOUBTFUL ACCOUNTS AND PROVISION FOR UNCOLLECTIBLE ACCOUNTS. MANAGEMENT REGULARLY REVIEWS DATA ABOUT THESE MAJOR PAYOR SOURCES OF REVENUE IN EVALUATING THE SUFFICIENCY OF THE ALLOWANCE FOR DOUBTFUL ACCOUNTS. FOR RECEIVABLES ASSOCIATED WITH SERVICES PROVIDED TO PATIENTS WHO HAVE THIRD-PARTY COVERAGE, THE HOSPITAL ANALYZES CONTRACTUALLY DUE AMOUNTS AND PROVIDES AN ALLOWANCE FOR DOUBTFUL ACCOUNTS AND A PROVISION FOR UNCOLLECTIBLE ACCOUNTS, IF NECESSARY (FOR EXAMPLE, FOR EXPECTED UNCOLLECTIBLE DEDUCTIBLES AND COPAYMENTS ON ACCOUNTS FOR WHICH THE THIRD-PARTY PAYOR HAS NOT YET PAID, OR FOR PAYORS WHO ARE KNOWN TO BE HAVING FINANCIAL DIFFICULTIES THAT MAKE THE REALIZATION OF AMOUNTS DUE UNLIKELY). FOR RECEIVABLES ASSOCIATED WITH SELF-PAY PATIENTS (WHICH INCLUDES BOTH PATIENTS WITHOUT INSURANCE AND PATIENTS WITH DEDUCTIBLE AND COPAYMENT BALANCES DUE FOR WHICH THIRD-PARTY COVERAGE EXISTS FOR PART OF THE BILL), THE HOSPITAL RECORDS A SIGNIFICANT PROVISION FOR UNCOLLECTIBLE ACCOUNTS IN THE PERIOD OF SERVICE ON THE BASIS OF ITS PAST EXPERIENCE, WHICH INDICATES THAT MANY PATIENTS ARE UNABLE OR UNWILLING TO PAY THE PORTION OF THEIR BILL FOR WHICH THEY ARE FINANCIALLY RESPONSIBLE. THE DIFFERENCE BETWEEN THE STANDARD RATES (OR THE DISCOUNTED RATES IF NEGOTIATED) AND THE AMOUNTS ACTUALLY COLLECTED AFTER ALL REASONABLE COLLECTION EFFORTS HAVE BEEN EXHAUSTED IS CHARGED OFF AGAINST THE ALLOWANCE FOR DOUBTFUL ACCOUNTS. ACCOUNTS THAT ARE DETERMINED TO BE UNCOLLECTIBLE ARE SENT TO A COLLECTION AGENCY AND WRITTEN OFF AT THAT TIME." PART III, LINE 8: THE REVENUE RECEIVED AND ALLOWABLE COSTS WERE BASED ON THE 2019 FILED MEDICARE COST REPORT.THE MEDICARE SHORTFALL ON PART III, LINE 7 IS NOT TREATED AS A COMMUNITY BENEFIT. PART III, LINE 9B: EACH WEEK, STATEMENTS ARE SENT OUT THROUGH OUR EDI PROCESS WITH STATEMENTS BEING MAILED OUT 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.SHOULD NO RESPONSE BE RECEIVED WITHIN FIVE (5) DAYS OF THE LAST LETTER, A TELEPHONE CALL IS ISSUED TO NEGOTIATE A PAYMENT PLAN. IF 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 WILL 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 IN TO A PROFESSIONAL COLLECTION AGENCY.CHARITY CARE CONSIDERATIONS WILL BE MADE BY BUSINESS OFFICE MANAGER WHEN ALL NECESSARY DOCUMENTATION IS PRESENTED AND SHOULD IT BE EVIDENT THAT THE PATIENT'S LACK OF FINANCES WARRANT THIS AND CHARITY CARE THE BEST ETHICAL DECISION FOR THE PATIENT. PART VI, LINE 2: THRU THE COMMUNITY ASSESSMENT PROCESS, HEALTHCARE NEEDS & SERVICES WERE IDENTIFIED AND PROGRAMS WERE DEVELOPED (SEE MCH WEBSITE FOR THE 2016 COMMUNITY HEALTH DIALOGUE). 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 THAT REPRESENTS THE COMMUNITY AND BRINGS TO THE TABLE ISSUES, CONCERNS, AND RECCOMMENDATIONS FOR HEALTH CARE SERVICES. 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 ACCOUNTS IDENTIFIED AS UNINSURED AND UNDERINSURED. PART VI, LINE 4: MADELIA COMMUNITY HOSPITAL SERVES A 25 MILE RADIUS OF RURAL COMMUNITIES CONSISTING MAJORLY OF A CULTURALLY DIVERSE AND SENIOR POPULATION. PART VI, LINE 5: THERE WERE PUBLIC MEETINGS INFORMING THE COMMUNITY OF THE ASSESSMENT PROCESS AND ENCOURAGING THEIR PARTICIPATION. THIS WAS COMMUNICATED THRU THE NEWS MEDIA AND DIRECT CLIENT/FAMILY CONTACTS THRU MCH SERVICES. MADELIA COMMUNITY HOSPITAL (MCH) PARTNERED WITH THE MINNESOTA UNIVERSITY, MANKATO, NURSING STUDENTS TO DEVELOP AND CONDUCT A COMMUNITY-WIDE HEATHCARE ASSESSMENT. THIS WILL BE AN ONGOING PROCESS WHICH STARTED IN THE FALL OF 2011 AND WILL BE A CONTINUATION OF FOLLOWUP TO MEASURE THE PROGRESS OF COMMUNITY WELLNESS PROGRAMS THAT HAVE BEEN IMPLEMENTED AND TO IDENTIFY AWARENESS OF ANY NEW COMMUNITY HEALTH NEEDS.IN ADDITION TO THE ABOVE, MCH COLLABORATED WITH OTHER LOCAL ORGANIZATIONS REFERRED TO AS THE MADELIA COMMUNITY BASED COLLABORATIVE (MCBC) WHICH INCLUDED THE FOLLOWING PARTICIPANT ORGANIZATIONS: MADELIA COMMUNITY HOSPITAL AND CLINICSMINNESOTA STATE UNIVERSITY, MANKATO SCHOOL OF NURSINGGLEN TAYLOR NURSING INSTITUTE FOR FAMILY AND SOCIETYWATONWAN COUNTY PUBLIC HEALTH DEPARTMENTMADELIA SCHOOL SYSTEMLUTHER MEMORIAL HOMEDOWNS FOOD GROUP (MAJOR INDUSTRY IN MADELIA AND WATONWAN COUNTY)MADELIA CITY COUNCILMADELIA CHAMBER OF COMMERCE PART VI, LINE 7, REPORTS FILED WITH STATES MN 0 0 0 0 0 0 0 0 0 JEFF MENGENHAUSEN CEO 144475 0 0 0 0 0 0 0 28449 0 172924 0 0 0 A CITY OF MADELIA 416005334 556401AR8 2006-10-31 6495000 CONSTRUCT HOSPITAL ADDITION 0 0 0 A 1835000 6495000 161893 16238 113662 6203207 2008 0 0 1 1 A 0 0 0 0 0 0 0 A 0 0 1 0 0 0 0 0 0 A 1 FORM 990, PART VI, SECTION A, LINE 1 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 OF THIS CORPORATION SHALL BE OPEN TO ANY NATURAL PERSON WHO MEETS THE FOLLOWING QUALIFICATIONS AT THE TIME OF 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, PARTNERSHIP OR OTHER ASSOCIATION; 4) SUBMITS A WRITTEN APPLICATION FOR MEMBERSHIP TO THE BOARD OF TRUSTEES ON A FORM APPROVED BY THE BOARD OF TRUSTEES; AND 5) SUBMITS A MEMBERSHIP 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 IS REVIEWED BY THE GOVERNING BOARD OF TRUSTEES SUBSEQUENT TO FILING THE FORM 990 WITH THE IRS. THE FORM 990 WILL BE PRESENTED BY FINANCE AT THE REGULAR MEETING OF THE BOARD OF TRUSTEES. 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 APPORVED BY TWO-THIRDS OF THE MEMBERS ENTITLED TO VOTE, OTHER THAN THE INTERESTED DIRECTOR OR TRUSTEE; AND 3) ALL MATERIAL FACTS ARE FULLLY DISCLOSED TO THE BOARD OF TRUSTEES OR A COMMITTEE, AND THE BOARD OR COMMITTEE 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 15 MADELIA COMMUNITY HOSPITAL 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 ANNUAL MN HOSPITAL ASSOCIATION SURVEY . THE BOARD DETERMINES THE CEO'S BASE SALARY, IN ITS SOLE DISCRETION. THIS WAS MOST RECENTLY COMPLETED IN 2019. COMPENSATION OF THE OFFICER AND KEY EMPLOYEES IS EVALUATED AND INCREASED ANNUALLY BASED ON PERFORMANCE BY THE CEO. ANNUAL INCREASES ARE BASED ON A REGIONAL SURVERY 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. THIS WAS MOST RECENTLY COMPLETED IN 2019. FORM 990, PART VI, SECTION C, LINE 19 MADELIA COMMUNITY HOSPITAL MAKES ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC AT THE ANNUAL CORPORATION MEETING AND UPON REQUEST. FORM 990, PART XI, LINE 9: RECONCILIATION FOR CONTRIBUTION FROM RELATED ENTITY -146,426. FORM 990, PART XII, LINE 2C THE ORGANIZATIONS BOARD OF TRUSTEES ASSUMES RESPONSIBILITY FOR OVERSIGHT OF THE AUDIT OF ITS FINANCIAL STATEMENTS AND THE SELECTION OF ITS INDEPENDENT ACCOUNTANT. THIS PROCESS HAS NOT CHANGED FROM PRIOR YEARS. MADELIA COMMUNITY HOSPITAL 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 COMMUNITY HOSPITAL INC 1 0 0 1 0 0 0 0 0 0 0 0 1 1 1 1 0 0 0 1 MADELIA COMMUNITY HOSPITAL FOUNDATION C 146426 FMV