MADELIA HEALTH: Form 990, tax year 2017
View the entire original 990 at ProPublica ↗
- Organization
- MADELIA HEALTH (EIN 41-0758512)
- Tax period
- 2017-06-01 to 2018-05-31
- Filed
- 2019-04-15
- IRS object ID
- 201931059349301613
- Schema version
- 2017v2.3
- Source
- Download XML · Original 990 at ProPublica
Every field in the e-filed return. Faint text is the IRS element name, for citing.
- Return header
- Form 990
- Schedule A
- Schedule B
- Schedule D
- Schedule H
- Schedule J
- Schedule K
- Schedule O
- Schedule R
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return | 2019-04-15T16:03:19-05:00 | ReturnTs |
| Tax Period End | 2018-05-31 | TaxPeriodEndDt |
Preparer Firm PreparerFirmGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Firm EIN | 410746749 | PreparerFirmEIN |
Preparer Firm Name PreparerFirmName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | CLIFTONLARSONALLEN LLP | BusinessNameLine1Txt |
Preparer US Address PreparerUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 220 SOUTH SIXTH STREET SUITE 300 | AddressLine1Txt |
| City | MINNEAPOLIS | CityNm |
| State Abbreviation | MN | StateAbbreviationCd |
| ZIP | 55402 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnTypeCd |
| Tax Period Begin | 2017-06-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 410758512 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | MADELIA COMMUNITY HOSPITAL INCORPORATED | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | MADE | BusinessNameControlTxt |
| Phone | 5076423255 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 121 DREW AVENUE SOUTHEAST | AddressLine1Txt |
| City | MADELIA | CityNm |
| State Abbreviation | MN | StateAbbreviationCd |
| ZIP | 56062 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | JEFF MENGENHAUSEN | PersonNm |
| Person Title | CEO | PersonTitleTxt |
| Phone | 5076423255 | PhoneNum |
| Signature | 2019-04-15 | SignatureDt |
| Discuss With Paid Preparer | Yes (1) | DiscussWithPaidPreparerInd |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | RYAN ENGEBRETSON | PreparerPersonNm |
| PTIN | P01585625 | PTIN |
| Phone | 6123764500 | PhoneNum |
Filing Security Information FilingSecurityInformation
IP Address IPAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| I Pv4 Address | 67.137.57.251 | IPv4AddressTxt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| IP | 2019-04-15 | IPDt |
| IP Tm | 10:20:44 | IPTm |
| IP Timezone | CD | IPTimezoneCd |
| Filing License Type | P | FilingLicenseTypeCd |
| At Submission Creation Device Id | 2D2ADA08DFBCD9CE63D4D49722A5A80C8B448248 | AtSubmissionCreationDeviceId |
| At Submission Filing Device Id | 48DF7E18B51ED0D4ADE189227F60937B8E503023 | AtSubmissionFilingDeviceId |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2017 | TaxYr |
| Build TS | 2019-02-21 02:37:17Z | BuildTS |
Form 990 IRS990
Doing Business As Name DoingBusinessAsName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | MADELIA COMMUNITY HOSPITAL & CLINIC | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Principal Officer | JEFF MENGENHAUSEN | PrincipalOfficerNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 121 DREW AVENUE SOUTHEAST | AddressLine1Txt |
| City | MADELIA | CityNm |
| State Abbreviation | MN | StateAbbreviationCd |
| ZIP | 56062 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $12,125,389 | GrossReceiptsAmt |
| Group Return For Affiliates | 0 | GroupReturnForAffiliatesInd |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | WWW.MCHOSPITAL.ORG | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 1950 | FormationYr |
| Legal Domicile State | MN | LegalDomicileStateCd |
| Activity Or Mission | PROVIDE QUALITY HEALTHCARE SERVICES TO THE LOCAL COMMUNITY. | ActivityOrMissionDesc |
| Voting Members Governing Body | 9 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 9 | VotingMembersIndependentCnt |
| Total Employee | 137 | TotalEmployeeCnt |
| Total Volunteers | 0 | TotalVolunteersCnt |
| Total Gross UBI | $0 | TotalGrossUBIAmt |
| Net Unrelated Bus Txbl Incm | $0 | NetUnrelatedBusTxblIncmAmt |
| PY Contributions Grants | $206,149 | PYContributionsGrantsAmt |
| CY Contributions Grants | $182,834 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $10,742,198 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $10,694,815 | CYProgramServiceRevenueAmt |
| PY Investment Income | $144,850 | PYInvestmentIncomeAmt |
| CY Investment Income | $136,089 | CYInvestmentIncomeAmt |
| PY Other Revenue | $152,205 | PYOtherRevenueAmt |
| CY Other Revenue | $96,134 | CYOtherRevenueAmt |
| PY Total Revenue | $11,245,402 | PYTotalRevenueAmt |
| CY Total Revenue | $11,109,872 | CYTotalRevenueAmt |
| PY Grants And Similar Paid | $0 | PYGrantsAndSimilarPaidAmt |
| CY Grants And Similar Paid | $0 | CYGrantsAndSimilarPaidAmt |
| PY Benefits Paid To Members | $0 | PYBenefitsPaidToMembersAmt |
| CY Benefits Paid To Members | $0 | CYBenefitsPaidToMembersAmt |
| PY Salaries Comp Emp Bnft Paid | $6,893,780 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $7,212,414 | CYSalariesCompEmpBnftPaidAmt |
| PY Total Prof Fndrsng Expns | $0 | PYTotalProfFndrsngExpnsAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $0 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $4,668,692 | PYOtherExpensesAmt |
| CY Other Expenses | $4,600,173 | CYOtherExpensesAmt |
| PY Total Expenses | $11,562,472 | PYTotalExpensesAmt |
| CY Total Expenses | $11,812,587 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | -$317,070 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | -$702,715 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $18,653,797 | TotalAssetsBOYAmt |
| Total Assets EOY | $17,445,824 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $6,561,846 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $6,171,605 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $12,091,951 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $11,274,219 | NetAssetsOrFundBalancesEOYAmt |
| Info In Schedule O Part III | Yes (X) | InfoInScheduleOPartIIIInd |
| Mission | 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. | MissionDesc |
| Significant New Program Srvc | 0 | SignificantNewProgramSrvcInd |
| Significant Change | 0 | SignificantChangeInd |
| Expense | $7,981,970 | ExpenseAmt |
| Revenue | $10,694,815 | RevenueAmt |
| Desc | MADELIA COMMUNITY HOSPITAL & CLINIC PROVIDES GENERAL MEDICAL/SURGICAL SERVICES ON INPATIENTS, SWING BED PATIENTS, OUTPATIENTS AND HOME CARE CLIENTS. DURING THE FISCAL YEAR 2018 THERE WERE 96 ACUTE CARE ADMISSIONS, 52 SWING BED ADMISSIONS, 13,368 HOME CARE VISITS TO 1,217 HOME CARE CLIENTS AND 4,660 OUTPATIENT VISITS. DURING OUR FISCAL YEAR 2018, MADELIA COMMUNITY HOSPITAL AND CLINIC PROVIDED $7,770 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 MEALS FOR THE HOSPITAL PREPARED MEALS ON WHEELS IN MADELIA.INTERPRETIVE AND TRANSLATION FROM ENGLISH TO SPANISH.COLLABORATIVE HISPANIC OUTREACH SERVICES INCLUDING POPULATION HEALTH EDUCATIONAL SERVICES FOR THE PREVENTION OF DIABETES, OBESITY, HEART DISEASE, AND HYPERTENSION.HOSPICE ADVISORY COMMITTEE.FREE HEEL SCANS TO DETECT OSTEOPOROSIS.SENIOR EDUCATION SERIES INCLUDING EVIDENCE BASED PORGRAM, "LIVING WELL WITH CHRONIC CONDITIONS AND "MATTER OF BALANCE".FREE BLOOD PRESSURE IN THE MADELIA COMMUNITY HOSPITAL & CLINIC AND AT HEALTH FAIRS IN THE AREA AND AT CHURCH EVENTS.WORKING SIDE BY WITH STUDENTS FROM AREA UNIVERSITIES AND COLLEGES FOR STUDENTS IN THE NURSE PRACTITIONER, CLINIC, NURSING, LABORATORY TECHNICIAN AND PHYSICAL THERAPY PROGRAMS.DELIVERY OF PHARMACEUTICALS FOR HOME BOUND PATIENTS.PHYSICIAN 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 AND LKE CRYSTAL STUDENTSCOMMUNITY AND SCHOOL HEALTH FAIR PARTICIPATIONSMALL FEE FOOT AND NAIL CLINIC (SOAKING FEET, TRIMMING TOE NAILS AND MASSAGING FEET OF ELDERLY PATIENTS). AN AVERAGE OF 60 PATIENTS PER MONTH PARTAKE IN THIS SERVICE. | Desc |
| Total Program Service Expenses | $7,981,970 | TotalProgramServiceExpensesAmt |
| Described In Section501c3 | Yes (1) | DescribedInSection501c3Ind |
| Schedule B Required | Yes (1) | ScheduleBRequiredInd |
| Political Campaign Acty | 0 | PoliticalCampaignActyInd |
| Lobbying Activities | 0 | LobbyingActivitiesInd |
| Subject To Proxy Tax | 0 | SubjectToProxyTaxInd |
| Donor Advised Fund | 0 | DonorAdvisedFundInd |
| Conservation Easements | 0 | ConservationEasementsInd |
| Collections Of Art | 0 | CollectionsOfArtInd |
| Credit Counseling | 0 | CreditCounselingInd |
| Temp Or Permanent Endowments | 0 | TempOrPermanentEndowmentsInd |
| Report Land Building Equipment | Yes (1) | ReportLandBuildingEquipmentInd |
| Report Investments Other Sec | 0 | ReportInvestmentsOtherSecInd |
| Report Program Related Invst | 0 | ReportProgramRelatedInvstInd |
| Report Other Assets | 0 | ReportOtherAssetsInd |
| Report Other Liabilities | Yes (1) | ReportOtherLiabilitiesInd |
| Include FIN48 Footnote | Yes (1) | IncludeFIN48FootnoteInd |
| Independent Audit Fincl Stmt | 0 | IndependentAuditFinclStmtInd |
| Consolidated Audit Fincl Stmt | Yes (1) | ConsolidatedAuditFinclStmtInd |
| School Operating | 0 | SchoolOperatingInd |
| Foreign Office | 0 | ForeignOfficeInd |
| Foreign Activities | 0 | ForeignActivitiesInd |
| More Than5000 K To Org | 0 | MoreThan5000KToOrgInd |
| More Than5000 K To Individuals | 0 | MoreThan5000KToIndividualsInd |
| Professional Fundraising | 0 | ProfessionalFundraisingInd |
| Fundraising Activities | 0 | FundraisingActivitiesInd |
| Gaming Activities | 0 | GamingActivitiesInd |
| Operate Hospital | Yes (1) | OperateHospitalInd |
| Audited Financial Stmt Att | Yes (1) | AuditedFinancialStmtAttInd |
| Grants To Organizations | 0 | GrantsToOrganizationsInd |
| Grants To Individuals | 0 | GrantsToIndividualsInd |
| Schedule J Required | Yes (1) | ScheduleJRequiredInd |
| Tax Exempt Bonds | Yes (1) | TaxExemptBondsInd |
| Invest Tax Exempt Bonds | 0 | InvestTaxExemptBondsInd |
| Escrow Account | 0 | EscrowAccountInd |
| On Behalf Of Issuer | 0 | OnBehalfOfIssuerInd |
| Engaged In Excess Benefit Trans | 0 | EngagedInExcessBenefitTransInd |
| PY Excess Benefit Trans | 0 | PYExcessBenefitTransInd |
| Loan Outstanding | 0 | LoanOutstandingInd |
| Grant To Related Person | 0 | GrantToRelatedPersonInd |
| Business Rln With Org Mem | 0 | BusinessRlnWithOrgMemInd |
| Business Rln With Fam Mem | 0 | BusinessRlnWithFamMemInd |
| Business Rln With Officer Ent | 0 | BusinessRlnWithOfficerEntInd |
| Deductible Non Cash Contri | 0 | DeductibleNonCashContriInd |
| Deductible Art Contribution | 0 | DeductibleArtContributionInd |
| Terminate Operations | 0 | TerminateOperationsInd |
| Partial Liquidation | 0 | PartialLiquidationInd |
| Disregarded Entity | 0 | DisregardedEntityInd |
| Related Entity | Yes (1) | RelatedEntityInd |
| Related Organization Ctrl Ent | Yes (1) | RelatedOrganizationCtrlEntInd |
| Transaction With Control Ent | Yes (1) | TransactionWithControlEntInd |
| Trnsfr Exmpt Non Chrtbl Rltd Org | 0 | TrnsfrExmptNonChrtblRltdOrgInd |
| Activities Conducted Prtshp | 0 | ActivitiesConductedPrtshpInd |
| Schedule O Required | Yes (1) | ScheduleORequiredInd |
| IRP Document | 69 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Employee | 137 | EmployeeCnt |
| Employment Tax Returns Filed | Yes (1) | EmploymentTaxReturnsFiledInd |
| Unrelated Bus Incm Over Limit | 0 | UnrelatedBusIncmOverLimitInd |
| Foreign Financial Account | 0 | ForeignFinancialAccountInd |
| Prohibited Tax Shelter Trans | 0 | ProhibitedTaxShelterTransInd |
| Taxable Party Notification | 0 | TaxablePartyNotificationInd |
| Nondeductible Contributions | 0 | NondeductibleContributionsInd |
| Quid Pro Quo Contributions | 0 | QuidProQuoContributionsInd |
| Form8282 Property Disposed Of | 0 | Form8282PropertyDisposedOfInd |
| Rcv Fnds To Pay Prsnl Bnft Cntrct | 0 | RcvFndsToPayPrsnlBnftCntrctInd |
| Pay Premiums Prsnl Bnft Cntrct | 0 | PayPremiumsPrsnlBnftCntrctInd |
| Form8899 Filedind | 0 | Form8899Filedind |
| Form1098 C Filed | 0 | Form1098CFiledInd |
| Indoor Tanning Services | 0 | IndoorTanningServicesInd |
| Info In Schedule O Part VI | Yes (X) | InfoInScheduleOPartVIInd |
| Governing Body Voting Members | 9 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 9 | IndependentVotingMemberCnt |
| Family Or Business Rln | 0 | FamilyOrBusinessRlnInd |
| Delegation Of Mgmt Duties | 0 | DelegationOfMgmtDutiesInd |
| Change To Org Documents | 0 | ChangeToOrgDocumentsInd |
| Material Diversion Or Misuse | 0 | MaterialDiversionOrMisuseInd |
| Members Or Stockholders | Yes (1) | MembersOrStockholdersInd |
| Election Of Board Members | Yes (1) | ElectionOfBoardMembersInd |
| Decisions Subject To Approva | 0 | DecisionsSubjectToApprovaInd |
| Minutes Of Governing Body | Yes (1) | MinutesOfGoverningBodyInd |
| Minutes Of Committees | Yes (1) | MinutesOfCommitteesInd |
| Officer Mailing Address | 0 | OfficerMailingAddressInd |
| Local Chapters | 0 | LocalChaptersInd |
| Form990 Provided To Gvrn Body | 0 | Form990ProvidedToGvrnBodyInd |
| Conflict Of Interest Policy | Yes (1) | ConflictOfInterestPolicyInd |
| Annual Disclosure Covered Prsn | Yes (1) | AnnualDisclosureCoveredPrsnInd |
| Regular Monitoring Enfrc | Yes (1) | RegularMonitoringEnfrcInd |
| Whistleblower Policy | Yes (1) | WhistleblowerPolicyInd |
| Document Retention Policy | Yes (1) | DocumentRetentionPolicyInd |
| Compensation Process CEO | Yes (1) | CompensationProcessCEOInd |
| Compensation Process Other | Yes (1) | CompensationProcessOtherInd |
| Investment In Joint Venture | 0 | InvestmentInJointVentureInd |
| States Where Copy Of Return Is Fld | MN | StatesWhereCopyOfReturnIsFldCd |
| Other Website | Yes (X) | OtherWebsiteInd |
| Upon Request | Yes (X) | UponRequestInd |
Books In Care Of Detail BooksInCareOfDetail
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | MONIQUE HOFFMANN-URBAN | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Phone | 5076423255 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 121 DREW AVENUE SOUTHEAST | AddressLine1Txt |
| City | MADELIA | CityNm |
| State Abbreviation | MN | StateAbbreviationCd |
| ZIP | 56062 | ZIPCd |
Form990 Part VII Section A Form990PartVIISectionAGrp (14 entries)
| TitleTitleTxt | Average Hours Per WeekAverageHoursPerWeekRt | Average Hours Per Week Rltd OrgAverageHoursPerWeekRltdOrgRt | Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd | OfficerOfficerInd | Reportable Comp From OrgReportableCompFromOrgAmt | Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt | Other CompensationOtherCompensationAmt | Highest Compensated EmployeeHighestCompensatedEmployeeInd |
|---|---|---|---|---|---|---|---|---|
| STEVEN COOLING | ||||||||
| BOARD VP & TREASURER | 1.00 | 0.20 | Yes (X) | Yes (X) | $1,800 | $0 | $0 | |
| DENNIS ARDUSER | ||||||||
| BOARD PRESIDENT | 1.00 | Yes (X) | Yes (X) | $1,800 | $0 | $0 | ||
| BARBARA OVERLIE | ||||||||
| BOARD SECRETARY | 1.00 | Yes (X) | Yes (X) | $1,800 | $0 | $0 | ||
| KENNETH GRONEWOLD | ||||||||
| BOARD MEMBER | 1.00 | Yes (X) | $1,200 | $0 | $0 | |||
| NORMA KRUMWIEDE | ||||||||
| BOARD MEMBER | 1.00 | Yes (X) | $1,200 | $0 | $0 | |||
| BRIAN MCCABE | ||||||||
| BOARD MEMBER | 1.00 | Yes (X) | $1,200 | $0 | $0 | |||
| MELANIE RUNGE | ||||||||
| BOARD MEMBER | 1.00 | Yes (X) | $1,200 | $0 | $0 | |||
| STEVEN SORENSEN | ||||||||
| BOARD MEMBER | 1.00 | Yes (X) | $1,200 | $0 | $0 | |||
| RYAN VISHER | ||||||||
| BOARD MEMBER | 1.00 | Yes (X) | $1,200 | $0 | $0 | |||
| CANDACE FENSKE | ||||||||
| CEO | 40.00 | 0.20 | Yes (X) | $145,504 | $0 | $14,090 | ||
| MONIQUE HOFFMANN-URBAN | ||||||||
| CFO | 40.00 | 0.20 | Yes (X) | $101,287 | $0 | $8,026 | ||
| DEIDRE HRUBY | ||||||||
| DIRECTOR OF PATIENT CARE | 40.00 | 0.20 | $101,047 | $0 | $21,758 | Yes (X) | ||
| JANE MALMSKOG | ||||||||
| PHARMD | 40.00 | $128,298 | $0 | $14,717 | Yes (X) | |||
| JENNIFER MCLAUGHLIN | ||||||||
| OR/ER MANAGER | 40.00 | $111,636 | $0 | $13,760 | Yes (X) | |||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $600,372 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $0 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $72,351 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 5 | IndivRcvdGreaterThan100KCnt |
| Former Ofcr Employees Listed | 0 | FormerOfcrEmployeesListedInd |
| Total Comp Greater Than150 K | Yes (1) | TotalCompGreaterThan150KInd |
| Compensation From Other Srcs | 0 | CompensationFromOtherSrcsInd |
Contractor Compensation ContractorCompensationGrp (5 entries)
| Address Line1ContractorAddress/USAddress/AddressLine1Txt | CityContractorAddress/USAddress/CityNm | State AbbreviationContractorAddress/USAddress/StateAbbreviationCd | ZIPContractorAddress/USAddress/ZIPCd | ServicesServicesDesc | CompensationCompensationAmt |
|---|---|---|---|---|---|
| MANKATO CLINIC LTD | |||||
| 1230 E MAIN ST | MANKATO | MN | 56002 | PHYSICIAN CLINIC PROVIDERS | $1,124,010 |
| WHITESELL | |||||
| 1630 ANDERSON AVE SUITE 100 | BUFFALO | MN | 55313 | MEDICAL STAFFING | $910,045 |
| SIEMENS MEDICAL | |||||
| 1000 DEERFIELD PARKWAY | BUFFALO GROVE | IL | 60089 | CARDIAC MONITORS | $613,577 |
| US BANK TRUST NATIONAL ASSN | |||||
| 60 LIVINGSTON AVE | ST PAUL | MN | 55104 | BOND PAYMENTS | $411,695 |
| CARDINAL HEALTH | |||||
| 7000 CARDINAL PLACE | DUBLIN | OH | 43017 | PHARMACY | $301,741 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cntrct Rcvd Greater Than100 K | 12 | CntrctRcvdGreaterThan100KCnt |
| Related Organizations | $121,980 | RelatedOrganizationsAmt |
| Government Grants | $60,754 | GovernmentGrantsAmt |
| All Other Contributions | $100 | AllOtherContributionsAmt |
| Total Contributions | $182,834 | TotalContributionsAmt |
Program Service Revenue ProgramServiceRevenueGrp (4 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt |
|---|---|---|---|
| NET PATIENT REVENUE | 624100 | $10,624,117 | $10,624,117 |
| PHYSICAL THERAPY | 624310 | $59,282 | $59,282 |
| LABORATORY | 621500 | $9,945 | $9,945 |
| PHARMACY | 446110 | $1,471 | $1,471 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $10,694,815 | TotalProgramServiceRevenueAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $142,559 | TotalRevenueColumnAmt |
| Exclusion | $142,559 | ExclusionAmt |
Royalties Revenue RoyaltiesRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $25,694 | TotalRevenueColumnAmt |
| Exclusion | $25,694 | ExclusionAmt |
Gross Rents GrossRentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $59,133 | RealAmt |
Less Rental Expenses LessRentalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $39,651 | RealAmt |
Rental Income Or Loss RentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $19,482 | RealAmt |
Net Rental Income Or Loss NetRentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $19,482 | TotalRevenueColumnAmt |
| Exclusion | $19,482 | ExclusionAmt |
Gross Amount Sales Assets GrossAmountSalesAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $969,396 | SecuritiesAmt |
Less Cost Oth Basis Sales Expnss LessCostOthBasisSalesExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $975,866 | SecuritiesAmt |
Gain Or Loss GainOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | -$6,470 | SecuritiesAmt |
Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | -$6,470 | TotalRevenueColumnAmt |
| Exclusion | -$6,470 | ExclusionAmt |
Other Revenue Misc OtherRevenueMiscGrp (3 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | ExclusionExclusionAmt |
|---|---|---|---|
| MISCELLANEOUS | 900099 | $28,686 | $28,686 |
| EMPLOYEE MEALS | 900099 | $20,409 | $20,409 |
| MEDICAL RECORDS | 900099 | $1,863 | $1,863 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Revenue Total | $50,958 | OtherRevenueTotalAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $11,109,872 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $10,694,815 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $0 | UnrelatedBusinessRevenueAmt |
| Exclusion | $232,223 | ExclusionAmt |
Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $276,689 | TotalAmt |
| Management And General | $276,689 | ManagementAndGeneralAmt |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $5,732,709 | TotalAmt |
| Program Services | $4,770,964 | ProgramServicesAmt |
| Management And General | $961,745 | ManagementAndGeneralAmt |
Pension Plan Contributions PensionPlanContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $162,570 | TotalAmt |
| Program Services | $120,644 | ProgramServicesAmt |
| Management And General | $41,926 | ManagementAndGeneralAmt |
Other Employee Benefits OtherEmployeeBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $726,278 | TotalAmt |
| Management And General | $726,278 | ManagementAndGeneralAmt |
Payroll Taxes PayrollTaxesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $314,168 | TotalAmt |
| Program Services | $228,197 | ProgramServicesAmt |
| Management And General | $85,971 | ManagementAndGeneralAmt |
Fees For Services Other FeesForServicesOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $178,163 | TotalAmt |
| Program Services | $57,586 | ProgramServicesAmt |
| Management And General | $120,577 | ManagementAndGeneralAmt |
Advertising AdvertisingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $24,905 | TotalAmt |
| Management And General | $24,905 | ManagementAndGeneralAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $502,346 | TotalAmt |
| Management And General | $502,346 | ManagementAndGeneralAmt |
Information Technology InformationTechnologyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $173,208 | TotalAmt |
| Management And General | $173,208 | ManagementAndGeneralAmt |
Travel TravelGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $93,342 | TotalAmt |
| Program Services | $66,644 | ProgramServicesAmt |
| Management And General | $26,698 | ManagementAndGeneralAmt |
Interest InterestGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $284,011 | TotalAmt |
| Management And General | $284,011 | ManagementAndGeneralAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $774,836 | TotalAmt |
| Program Services | $774,836 | ProgramServicesAmt |
Other Expenses OtherExpensesGrp (4 entries)
| DescDesc | TotalTotalAmt | Program ServicesProgramServicesAmt | Management And GeneralManagementAndGeneralAmt |
|---|---|---|---|
| MEDICAL SUPPLIES | $1,395,165 | $1,395,165 | |
| REPAIRS/MAINTENANCE | $411,142 | $411,142 | |
| BAD DEBTS | $356,148 | $356,148 | |
| CLINIC EXPENSES | $211,786 | $211,786 |
All Other Expenses AllOtherExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $195,121 | TotalAmt |
| Management And General | $195,121 | ManagementAndGeneralAmt |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $11,812,587 | TotalAmt |
| Program Services | $7,981,970 | ProgramServicesAmt |
| Management And General | $3,830,617 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Cash Non Interest Bearing CashNonInterestBearingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $3,705,452 | BOYAmt |
| EOY | $2,451,307 | EOYAmt |
Savings And Temp Cash Invst SavingsAndTempCashInvstGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $4,927,807 | BOYAmt |
| EOY | $4,493,012 | EOYAmt |
Pledges And Grants Receivable PledgesAndGrantsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $11,514 | BOYAmt |
| EOY | $13,051 | EOYAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,563,172 | BOYAmt |
| EOY | $1,857,821 | EOYAmt |
Inventories For Sale Or Use InventoriesForSaleOrUseGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $266,786 | BOYAmt |
| EOY | $299,621 | EOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $119,821 | BOYAmt |
| EOY | $138,197 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $17,519,885 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $11,165,610 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $6,253,224 | BOYAmt |
| EOY | $6,354,275 | EOYAmt |
Investments Pub Traded Sec InvestmentsPubTradedSecGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,029,681 | BOYAmt |
| EOY | $1,158,029 | EOYAmt |
Other Assets Total OtherAssetsTotalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $776,340 | BOYAmt |
| EOY | $680,511 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $18,653,797 | BOYAmt |
| EOY | $17,445,824 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,410,792 | BOYAmt |
| EOY | $1,201,251 | EOYAmt |
Tax Exempt Bond Liabilities TaxExemptBondLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $4,980,000 | BOYAmt |
| EOY | $4,825,000 | EOYAmt |
Mortg Notes Pybl Scrd Invst Prop MortgNotesPyblScrdInvstPropGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $131,054 | BOYAmt |
| EOY | $105,354 | EOYAmt |
Other Liabilities OtherLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $40,000 | BOYAmt |
| EOY | $40,000 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $6,561,846 | BOYAmt |
| EOY | $6,171,605 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Organization Follows SFAS117 | Yes (X) | OrganizationFollowsSFAS117Ind |
Unrestricted Net Assets UnrestrictedNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $11,691,951 | BOYAmt |
| EOY | $11,274,219 | EOYAmt |
Temporarily Rstr Net Assets TemporarilyRstrNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $400,000 | BOYAmt |
| EOY | $0 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $12,091,951 | BOYAmt |
| EOY | $11,274,219 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $18,653,797 | BOYAmt |
| EOY | $17,445,824 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part XI | Yes (X) | InfoInScheduleOPartXIInd |
| Reconcilation Revenue Expnss | -$702,715 | ReconcilationRevenueExpnssAmt |
| Net Unrlzd Gains Losses Invst | $9,202 | NetUnrlzdGainsLossesInvstAmt |
| Other Changes In Net Assets | -$124,219 | OtherChangesInNetAssetsAmt |
| Info In Schedule O Part XII | Yes (X) | InfoInScheduleOPartXIIInd |
| Method Of Accounting Accrual | Yes (X) | MethodOfAccountingAccrualInd |
| Accountant Compile Or Review | 0 | AccountantCompileOrReviewInd |
| FS Audited | Yes (1) | FSAuditedInd |
FS Audited Basis FSAuditedBasisGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Consolidated Basis Fincl Stmt | Yes (X) | ConsolidatedBasisFinclStmtInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Audit Committee | Yes (1) | AuditCommitteeInd |
| Federal Grant Audit Required | 0 | FederalGrantAuditRequiredInd |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital | Yes (X) | HospitalInd |
Schedule B IRS990ScheduleB
Schedule D IRS990ScheduleD
Land LandGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $194,207 | OtherCostOrOtherBasisAmt |
| Book Value | $194,207 | BookValueAmt |
Buildings BuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $6,921,474 | OtherCostOrOtherBasisAmt |
| Depreciation | $4,004,483 | DepreciationAmt |
| Book Value | $2,916,991 | BookValueAmt |
Leasehold Improvements LeaseholdImprovementsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $4,733,772 | OtherCostOrOtherBasisAmt |
| Depreciation | $3,003,936 | DepreciationAmt |
| Book Value | $1,729,836 | BookValueAmt |
Equipment EquipmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $5,659,305 | OtherCostOrOtherBasisAmt |
| Depreciation | $4,157,191 | DepreciationAmt |
| Book Value | $1,502,114 | BookValueAmt |
Other Land Buildings OtherLandBuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $11,127 | OtherCostOrOtherBasisAmt |
| Book Value | $11,127 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $6,354,275 | TotalBookValueLandBuildingsAmt |
Other Liabilities Org OtherLiabilitiesOrgGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | ASSET RETIREMENT OBLIGATION | Desc |
| Amt | $40,000 | Amt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Liability | $40,000 | TotalLiabilityAmt |
| Footnote Text | Yes (X) | FootnoteTextInd |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | PART X, LINE 2: | FormAndLineReferenceDesc |
| Explanation | 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. | ExplanationTxt |
Schedule H IRS990ScheduleH
| Field | Value | IRS element (for citing) |
|---|---|---|
| Financial Assistance Policy | Yes (1) | FinancialAssistancePolicyInd |
| Written Policy | Yes (1) | WrittenPolicyInd |
| All Hospitals Policy | Yes (X) | AllHospitalsPolicyInd |
| FPG Reference Free Care | Yes (1) | FPGReferenceFreeCareInd |
| Percent100 | Yes (X) | Percent100Ind |
| FPG Reference Discounted Care | Yes (1) | FPGReferenceDiscountedCareInd |
| Percent200 D | Yes (X) | Percent200DInd |
| Free Care Medically Indigent | Yes (1) | FreeCareMedicallyIndigentInd |
| Financial Assistance Budget | Yes (1) | FinancialAssistanceBudgetInd |
| Expenses Exceed Budget | 0 | ExpensesExceedBudgetInd |
| Annual Community Bnft Report | Yes (1) | AnnualCommunityBnftReportInd |
| Report Publically Available | Yes (1) | ReportPublicallyAvailableInd |
Financial Assistance At Cost Typ FinancialAssistanceAtCostTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $6,071 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $6,071 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00050 | TotalExpensePct |
Unreimbursed Medicaid UnreimbursedMedicaidGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $1,934,207 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $932,354 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $1,001,853 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.08740 | TotalExpensePct |
Total Financial Assistance Typ TotalFinancialAssistanceTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $1,940,278 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $932,354 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $1,007,924 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.08790 | TotalExpensePct |
Community Health Services CommunityHealthServicesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $70,806 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $70,806 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00620 | TotalExpensePct |
Health Professions Education HealthProfessionsEducationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $49,760 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $49,760 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00430 | TotalExpensePct |
Total Other Benefits TotalOtherBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $120,566 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $120,566 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.01050 | TotalExpensePct |
Total Community Benefits TotalCommunityBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $2,060,844 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $932,354 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $1,128,490 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.09840 | TotalExpensePct |
Community Support CommunitySupportGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $3,337 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $3,337 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00030 | TotalExpensePct |
Leadership Development LeadershipDevelopmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $6,975 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $6,975 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00060 | TotalExpensePct |
Coalition Building CoalitionBuildingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $18,237 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $18,237 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00160 | TotalExpensePct |
Health Improvement Advocacy HealthImprovementAdvocacyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $6,106 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $6,106 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00050 | TotalExpensePct |
Total Communtity Building Acty TotalCommuntityBuildingActyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $34,655 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $34,655 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00300 | TotalExpensePct |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | Yes (1) | BadDebtExpenseReportedInd |
| Bad Debt Expense | $356,148 | BadDebtExpenseAmt |
| Bad Debt Expense Attributable | $50,000 | BadDebtExpenseAttributableAmt |
| Reimbursed By Medicare | $3,518,120 | ReimbursedByMedicareAmt |
| Cost Of Care Reimbursed By Medcr | $4,182,799 | CostOfCareReimbursedByMedcrAmt |
| Medicare Surplus Or Shortfall | -$664,679 | MedicareSurplusOrShortfallAmt |
Costing Methodology Used CostingMethodologyUsedGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cost To Charge Ratio | Yes (X) | CostToChargeRatioInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Written Debt Collection Policy | Yes (1) | WrittenDebtCollectionPolicyInd |
| Financial Assistance Prvsn | Yes (1) | FinancialAssistancePrvsnInd |
| Hospital Facilities | 1 | HospitalFacilitiesCnt |
Hospital Facilities HospitalFacilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 1 | FacilityNum |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | MADELIA COMMUNITY HOSPITAL INCORPORATED | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 121 DREW AVE SE | AddressLine1Txt |
| City | MADELIA | CityNm |
| State Abbreviation | MN | StateAbbreviationCd |
| ZIP | 56062 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Website Address | WWW.MCHOSPITAL.ORG | WebsiteAddressTxt |
| State License | 385015 | StateLicenseNum |
| Licensed Hospital | Yes (X) | LicensedHospitalInd |
| General Medical And Surgical | Yes (X) | GeneralMedicalAndSurgicalInd |
| Critical Access Hospital | Yes (X) | CriticalAccessHospitalInd |
| Emergency Room24 Hrs | Yes (X) | EmergencyRoom24HrsInd |
Hospital Fclty Policies Prctc HospitalFcltyPoliciesPrctcGrp
Hospital Facility Name HospitalFacilityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | MADELIA COMMUNITY HOSPITAL INCORPORATED | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 1 | FacilityNum |
| First Licensed CY Or PY | 0 | FirstLicensedCYOrPYInd |
| Tax Exempt Hospital CY Or PY | 0 | TaxExemptHospitalCYOrPYInd |
| CHNA Conducted | Yes (1) | CHNAConductedInd |
| Community Definition | Yes (X) | CommunityDefinitionInd |
| Community Demographics | Yes (X) | CommunityDemographicsInd |
| Existing Resources | Yes (X) | ExistingResourcesInd |
| How Data Obtained | Yes (X) | HowDataObtainedInd |
| Community Health Needs | Yes (X) | CommunityHealthNeedsInd |
| Other Health Issues | Yes (X) | OtherHealthIssuesInd |
| Community Hlth Needs Id Process | Yes (X) | CommunityHlthNeedsIdProcessInd |
| Consulting Process | Yes (X) | ConsultingProcessInd |
| Prior CHNA Impact | Yes (X) | PriorCHNAImpactInd |
| CHNA Conducted | 15 | CHNAConductedYr |
| Take Into Account Others Input | Yes (1) | TakeIntoAccountOthersInputInd |
| CHNA Conducted With Other Fclts | 0 | CHNAConductedWithOtherFcltsInd |
| CHNA Conducted With Non Fclts | 0 | CHNAConductedWithNonFcltsInd |
| CHNA Report Widely Available | Yes (1) | CHNAReportWidelyAvailableInd |
| Rpt Available On Own Website | Yes (X) | RptAvailableOnOwnWebsiteInd |
| Own Website URL | WWW.MCHOSPITAL.ORG/COMMUNITY-NEEDS-ASSESSMENT | OwnWebsiteURLTxt |
| Paper Copy Public Inspection | Yes (X) | PaperCopyPublicInspectionInd |
| Implementation Strategy Adopt | Yes (1) | ImplementationStrategyAdoptInd |
| Implementation Strategy Adpt | 15 | ImplementationStrategyAdptYr |
| Strategy Posted Website | 0 | StrategyPostedWebsiteInd |
| Strategy Attached | Yes (1) | StrategyAttachedInd |
| Organization Incur Excise Tax | 0 | OrganizationIncurExciseTaxInd |
| Elig Criteria Explained | Yes (1) | EligCriteriaExplainedInd |
| FPG Family Incm Lmt Free Dscnt | Yes (X) | FPGFamilyIncmLmtFreeDscntInd |
| FPG Family Incm Lmt Free Care | 100.000000000000 | FPGFamilyIncmLmtFreeCarePct |
| FPG Family Incm Lmt Dscnt Care | 200.000000000000 | FPGFamilyIncmLmtDscntCarePct |
| Asset Level Criteria | Yes (X) | AssetLevelCriteriaInd |
| Explained Basis | Yes (1) | ExplainedBasisInd |
| App Financial Asst Expln | Yes (1) | AppFinancialAsstExplnInd |
| Described Info | Yes (X) | DescribedInfoInd |
| Described Suprt Doc | Yes (X) | DescribedSuprtDocInd |
| Provided Hospital Contact | Yes (X) | ProvidedHospitalContactInd |
| Provided Nonprofit Contact | Yes (X) | ProvidedNonprofitContactInd |
| Includes Publicity Measures | Yes (1) | IncludesPublicityMeasuresInd |
| FAP Available On Website | Yes (X) | FAPAvailableOnWebsiteInd |
| FAP Available On Website URL | HTTPS://WWW.MCHOSPITAL.ORG/FINANCIAL-ASSISTANCE | FAPAvailableOnWebsiteURLTxt |
| FAP App Available On Website | Yes (X) | FAPAppAvailableOnWebsiteInd |
| FAP App Available On Website URL | HTTPS://WWW.MCHOSPITAL.ORG/FINANCIAL-ASSISTANCE | FAPAppAvailableOnWebsiteURLTxt |
| FAP Summary On Website | Yes (X) | FAPSummaryOnWebsiteInd |
| FAP Summary On Website URL | HTTPS://WWW.MCHOSPITAL.ORG/FINANCIAL-ASSISTANCE | FAPSummaryOnWebsiteURLTxt |
| FAP Avlbl On Request No Charge | Yes (X) | FAPAvlblOnRequestNoChargeInd |
| FAP App Avlbl On Request No Chrg | Yes (X) | FAPAppAvlblOnRequestNoChrgInd |
| FAP Sum Avlbl On Request No Chrg | Yes (X) | FAPSumAvlblOnRequestNoChrgInd |
| Notified FAP Copy Bill Display | Yes (X) | NotifiedFAPCopyBillDisplayInd |
| Communtity Notified FAP | Yes (X) | CommuntityNotifiedFAPInd |
| FAP Translated | Yes (X) | FAPTranslatedInd |
| Other Publicity | Yes (X) | OtherPublicityInd |
| FAP Actions On Nonpayment | Yes (1) | FAPActionsOnNonpaymentInd |
| Permit No Actions | Yes (X) | PermitNoActionsInd |
| Collection Activities | 0 | CollectionActivitiesInd |
| Provided Written Notice | Yes (X) | ProvidedWrittenNoticeInd |
| Made Effort Orally Notify | Yes (X) | MadeEffortOrallyNotifyInd |
| Processed FAP Application | Yes (X) | ProcessedFAPApplicationInd |
| Other Actions Taken | Yes (X) | OtherActionsTakenInd |
| Nondis Emergency Care Policy | Yes (1) | NondisEmergencyCarePolicyInd |
| Look Back Medicaid Medcr Prvt | Yes (X) | LookBackMedicaidMedcrPrvtInd |
| Amounts Generally Billed | 0 | AmountsGenerallyBilledInd |
| Gross Charges | 0 | GrossChargesInd |
Supplemental Information SupplementalInformationGrp (4 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| MADELIA COMMUNITY HOSPITAL, INCORPORATED | PART V, SECTION B, LINE 5: IN THIS COMMUNITY HEALTH NEEDS ASSESSMENT, MCHC SOLICITED INPUT FROM THE COMMUNITY IN A VARIETY OF WAYS. IN 2015, MCHC DISTRIBUTED A SURVEY THROUGHOUT THE COMMUNITY. WE RECEIVED 164 RESPONSES, INCLUDING 83 FROM LOW-INCOME INDIVIDUALS AND 77 FROM ELDERLY INDIVIDUALS. TO SOLICIT INPUT FROM MEDICAL PROFESSIONALS, MINORITIES AND THE GOVERNMENT, INTERVIEWS WERE CONDUCTED IN MARCH 2016. INDIVIDUALS FROM THE FOLLOWING ORGANIZATIONS PARTICIPATED IN THIS COMMUNITY HEALTH NEEDS ASSESSMENT THROUGH INTERVIEWS. - WATONWAN COUNTY PUBLIC HEALTH DEPARTMENT - WATONWAN COUNTY HUMAN SERVICES DEPARTMENT - MADELIA PUBLIC SCHOOLS, INDEPENDENT SCHOOL DISTRICT 837 - MADELIA COMMUNITY HOSPITAL & CLINIC FINALLY, IN THIS COMMUNITY HEALTH NEEDS ASSESSMENT, MCHC CONSIDERED THE RESULTS OF TWO LOCAL HEALTH NEEDS ASSESSMENTS PUBLISHED IN 2015. - FARIBAULT, MARTIN & WATONWAN COUNTIES COMMUNITY NEEDS ASSESSMENT - MINNESOTA DEPARTMENT OF HEALTH'S ECONOMIC IMPACT OF MADELIA COMMUNITY HOSPITAL & CLINIC AND RELATED HEALTH SECTORS OF WATONWAN COUNTY |
| MADELIA COMMUNITY HOSPITAL, INCORPORATED | PART V, SECTION B, LINE 11: 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 IS "MADELIA REFILL YOUR BUCKET," 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 TO MADELIA REFILL YOUR BUCKET, 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 COMMUNITY WIDE TRAINING AND EDUCATION THAT WILL TOUCH PEOPLE OF ALL AGES. THE ACCOMPLISHMENTS THIS YEAR INCLUDE: 1. EDUCATION PROVIDED TO ELEMENTARY STUDENTS ON EAT, MOVE, AND SLEEP. THIS WAS FOLLOWED BY A POSTER CONTEST. THE POSTER CONTEST INCLUDED PRIZES OF "BUCKETS OF FUN 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. THE MAJORITY OF THE 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:-RETHINK YOUR DRINK DISPLAY WITH VEGETABLE AND FRUIT INFUSED WATER SAMPLES-FRUIT AND VEGETABLE DISPLAY WITH DEMONSTRATION OF CUTTING JICAMA AND MANGO WITH SAMPLES PROVIDED-MENTAL HEALTH DISPLAY ADDRESSING FEELINGS WITH TAKE HOME PACKETS FOR KIDS, PARENTS, AND GRANDPARENTS5. PROVIDED MENTAL HEALTH FIRST AID TRAINING FOR PARAPROFESSIONALS IN THE MADELIA SCHOOLS.6. SET UP A TABLE DISPLAY AT THE MADELIA HIGH SCHOOL ABOUT DEPRESSION AND SUICIDE. INTERACTED WITH TEENS, GIVING THEM TEMPORARY SEMI COLON TATTOOS.7. HOSTED MONTHLY MENTAL HEALTH MONDAY EVENTS FROM SEPTEMBER THROUGH MAY, FOCUSING ON VARIOUS MENTAL HEALTH TOPICS.8. BROUGHT IN A NATIONAL SPEAKER FROM STAND FOR THE SILENT TO DO A PROGRAM FOR STUDENTS AND COMMUNITY MEMBERS. STAND FOR THE SILENT IS A PROGRAM THAT ADDRESSES YOUTH SUICIDE AND BULLYING. STAND FOR THE SILENT GAVE A MOVING PRESENTATION TO STUDENTS IN GRADES 6 THROUGH 12 AT MADELIA HIGH SCHOOL IN THE AFTERNOON. IN THE EVENING, A SIMILAR PRESENTATION WAS GIVEN TO PARENTS AND COMMUNITY MEMBERS. 9. BEGAN PROVIDING 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. |
| 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. |
Supplemental Information Detail SupplementalInformationDetail (13 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| 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 $ 356,148. |
| PART II, COMMUNITY BUILDING ACTIVITIES: | STAFF PARTICIPATE IN COMMUNITY ORGANIZATIONS, PROVIDING HEALTHCARE REPRESENTATION AND INFORMATION TO ENHANCE THOSE ORGANIZATION'S EVENTS. SOME ORGANIZATIONS THAT OUR STAFF IS INVOLVED IN INCLUDE: MADELIA SCHOOL BOARD, AMBULANCE SERVICE, CHAMBER OF COMMERCE, ROTARY, WOMEN OF TODAY, AND MCH AUXILIARY. STAFF MEMBERS ARE COACHES, SCOUT LEADERS, AND MENTORS THROUGHOUT THE COMMUNITY. MANY OF OUR STAFF MEMBERS ARE INVOLVED IN THE MADELIA COMMUNITY BASED COLLABORATIVE (MCBC). MCHC AND THE MINNESOTA STATE UNIVERSITY, MANKATO SCHOOL OF NURSING COLLABORATED TO COMPLETE A COMMUNITY HEALTH NEEDS ASSESSMENT IN MADELIA THAT WAS MANDATED BY THE AFFORDABLE CARE ACT IN 2012 AND AGAIN IN 2015. SINCE THAT INITIAL PROJECT, MCBC HAS GROWN TO INCLUDE MANY OTHER AREA PARTNERS, BUSINESSES AND COMMUNITY MEMBERS TO ADDRESS THE MAIN HEALTH CONCERNS IDENTIFIED IN THE ASSESSMENT: OBESITY, CANCER, HEART DISEASE AND DIABETES. MCBC MEETS ONCE A MONTH AT MCHC WITH OTHER SUB-COMMITTEES MEETING AS NEEDED. EVENT PLANNING AND COORDINATION IS ALSO DONE AT MCHC. PROMOTIONAL ACTIVITIES FOR MCBC ACTIVITIES ARE DONE BY MCHC STAFF AND INCLUDE: FACEBOOK PAGE MAINTENANCE, FLYER DESIGN AND DISTRIBUTION, ADVERTISING, PHOTOGRAPHY, ETC. THE VISION OF MCBC IS TO WORK TOGETHER TO ACHIEVE A HEALTHIER COMMUNITY. THE MISSION IS TO PROMOTE THE WELL-BEING OF MADELIA RESIDENTS THROUGH COMMUNITY-BASED PARTNERSHIPS, WITH THE CORE VALUES BEING: EQUITY, COLLABORATION, COMMUNITY ENGAGEMENT, HEALTH AND WELL-BEING. THE STRATEGIC FOCUS AREAS INCLUDE ENCOURAGING HEALTHY LIFESTYLE CHOICES AND MENTAL HEALTH WELLBEING. 1. HEALTHY LIFESTYLE CHOICES: IN 2014, MCBC LAUNCHED THE MADELIA RETHINK YOUR DRINK CAMPAIGN WITH THE GOAL OF IMPROVING THE HEALTH AND WELL-BEING OF MADELIA RESIDENTS. RETHINK YOUR DRINK IS NOT ABOUT BANNING OR TAKING ANYTHING AWAY, BUT EMPOWERING CITIZENS TO MAKE HEALTHY BEVERAGE CHOICES. THE RETHINK YOUR DRINK INITIATIVE EVOLVED INTO MADELIA RECHARGE YOURSELF, AN INITIATIVE THAT ENCOURAGES STUDENTS AND FAMILIES TO BE SURE TO EAT, MOVE AND SLEEP TO STAY "CHARGED." IN 2018 THIS AGAIN EVOLVED INTO THE MADELIA - REFILL YOUR BUCKET INITIATIVE. POSTER CONTESTS WERE HELD AT THE ELEMENTARY SCHOOLS IN MADELIA, AND A KIDS GAME AREA WAS PROVIDED DURING THE MADELIA PARK DAYS CELEBRATION TO PROMOTE THIS INITIATIVE. STARTING IN NOVEMBER 2017, MCBC BEGAN PROVIDING 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.2. MENTAL HEALTH: MCBC STARTED THE MENTAL HEALTH TASKFORCE IN RESPONSE TO COMMUNITY CONCERNS ABOUT SUICIDE AND UNMET MENTAL HEALTH NEEDS. THE TASKFORCE HOLDS FREE MENTAL HEALTH COMMUNITY FORUMS ON THE SECOND MONDAY OF EACH MONTH, PROVIDING EDUCATION ON SUICIDE, SUICIDE PREVENTION AND OTHER MENTAL HEALTH ISSUES. THROUGH MCBC, TWO MCHC STAFF MEMBERS HAVE BEEN TRAINED AS MENTAL HEALTH FIRST AID INSTRUCTORS, AND THESE TRAINERS OFFER MORE EXTENSIVE EDUCATIONAL CLASSES TO THE PUBLIC AT NO CHARGE. BEFORE THE SCHOOL YEAR STARTED IN 2017, THEY TRAINED ALL OF THE PARAPROFESSIONALS IN THE MADELIA SCHOOL DISTRICT IN MENTAL HEALTH FIRST AID. IN NOVEMBER, THEY ALSO TAUGHT A MENTAL HEALTH FIRST AID CLASS AT THE WATONWAN COUNTY HUMAN SERVICES COMMUNITY ROOM IN ST. JAMES. THE MENTAL HEALTH TASKFORCE OF MCBC BROUGHT IN A NATIONAL SPEAKER FROM STAND FOR THE SILENT TO DO A PROGRAM FOR STUDENTS AND COMMUNITY MEMBERS. STAND FOR THE SILENT IS A PROGRAM THAT ADDRESSES YOUTH SUICIDE AND BULLYING. STAND FOR THE SILENT GAVE A MOVING PRESENTATION TO STUDENTS IN GRADES 6 THROUGH 12 AT MADELIA HIGH SCHOOL IN THE AFTERNOON. IN THE EVENING, A SIMILAR PRESENTATION WAS GIVEN TO PARENTS AND COMMUNITY MEMBERS. |
| 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 2018 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 OR EXTEND A DISCOUNT OF 25% FOR ACCOUNT PAYOFF IN 60 DAYS; IF ACCOUNT HOLDER MAY QUALIFY FOR OUR HEALTHCARE FINANCIAL PROGRAM, AN APPLICATION IS SENT TO BE COMPLETED AND RETURNED TO US ALONG WITH TWO (2) DENIALS OF ALTERNATE COVERAGE OR PAYMENT ASSISTANCE.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 DETAILS REGARDING THE 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, 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: | THE MADELIA COMMUNITY HOSPITAL & CLINIC (MCHC) IS AN INTEGRAL PART OF THE COMMUNITY, PROVIDING HEALTHCARE AND SERVING AS A HUB FOR INFORMATION, PUBLIC HEALTH AND SOCIAL SERVICES. OUR RADIOLOGY DEPARTMENT STAFF REACHES OUT TO THE COMMUNITY IN MANY WAYS. DURING MAY, THEY OFFER FREE HEEL SCANS IN THE CLINIC TO HELP IDENTIFY BONE DENSITY ISSUES AT AN EARLY STAGE AND PREVENT OSTEOPOROSIS. THEY ATTEND THE HEALTH FAIR AT THE ELEMENTARY SCHOOL TO ENCOURAGE HEALTHY BONE DEVELOPMENT THROUGH DIET AND EXERCISE. DURING BREAST CANCER AWARENESS MONTH, THE DEPARTMENT PROMOTES MAMMOGRAMS BY OFFERING FREE GIFTS TO WOMEN WHO RECEIVE A MAMMOGRAM. THE RADIOLOGY STAFF ALSO CREATES DISPLAYS FOR THE MCHC EDUCATION TABLE DURING THESE MONTHS.MCHC PHYSICAL THERAPY DEPARTMENT ADMINISTERS IMPACT CONCUSSION TESTS TO LOCAL HIGH SCHOOL ATHLETES. THE 20-MINUTE TEST MEASURES VERBAL AND VISUAL MEMORY WHILE PROCESSING SPEED AND REACTION TIME TO 1/100TH OF A SECOND. IT HAS PROVEN TO BE A VALUABLE TOOL TO SHOW WHEN AN ATHLETE'S BRAIN HAS HEALED FROM A CONCUSSION. THE BASELINE TEST IS ADMINISTERED TO ALL STUDENT ATHLETES IN GRADES 7-12 IN MADELIA SCHOOLS. IF A PLAYER SUFFERS A HEAD INJURY, THEY ARE GIVEN THE TEST AGAIN TO MEASURE THE EXTENT OF THE DAMAGE AND TO MONITOR IF AN ATHLETE CAN SAFELY RETURN TO THEIR SPORT. IN ADDITION, THE PHYSICAL THERAPY STAFF ALSO OFFERS A STRENGTH & CONDITIONING CLINIC FOR STUDENT ATHLETES AT THE NEARBY LAKE CRYSTAL WELLCOME MEMORIAL HIGH SCHOOL DURING THE SUMMER MONTHS. WE ALSO OFFER FREE ATHLETE CARE AND EVALUATION (A.C.E.) CLINIC ASSESSMENTS TO IDENTIFY AN ATHLETE'S SOURCE OF PAIN OR LIMITATION AND TO RECOMMEND POSSIBLE TREATMENT OR REFERRAL.BEFORE THE SPRING CONCERT AT THE MADELIA ELEMENTARY SCHOOL, CHILDREN AND ADULTS WERE FITTED FOR BIKE HELMETS WHICH WERE SOLD FOR A NOMINAL FEE BY OUR FOUNDATION. THE FOUNDATION ALSO SUPPLIES OUR LOCAL POLICE FORCE WITH FREE ICE CREAM COUPONS THAT ARE GIVEN TO CHILDREN SEEN WEARING THEIR HELMETS WHILE BIKING IN THE COMMUNITY. THE FOUNDATION AWARDS THREE COLLEGE SCHOLARSHIPS EACH YEAR TO AREA STUDENTS INTERESTED IN PURSUING AN EDUCATION IN A HEALTH CARE FIELD. IN THE SUMMER, THE FOUNDATION ORGANIZES A 5K RUN/WALK TO ENCOURAGE COMMUNITY MEMBERS TO GET OUTSIDE AND EXERCISE.OUR EMERGENCY DEPARTMENT LEVEL 4 TRAUMA DESIGNATION ENABLES US TO PROVIDE LIFE-SAVING MEASURES TO SEVERELY INJURED PERSONS. THE HOSPITAL STAFF PARTICIPATED IN THE SOUTH CENTRAL DISASTER PREPAREDNESS FOR BOTH REGIONAL AND STATE DISASTER DRILLS.WE CONTINUE TO HOST THE MADELIA FARMERS MARKET ON WEDNESDAYS FROM 3:30 TO 6 P.M. DURING THE SUMMER AND FALL IN A PARKING LOT OWNED BY THE HOSPITAL. THERE IS NO CHARGE FOR LOCAL VENDORS TO SET UP A TENT TO SELL THEIR GARDEN PRODUCE TO THE COMMUNITY. WE TYPICALLY HAVE FROM 3 TO 8 VENDORS IN OUR MARKET EACH WEEK. MCHC PAYS THE COST FOR A VENDOR LUNCH IN THE SPRING, LOCAL PROMOTIONS, AND MAINTAINS A MADELIA FARMERS MARKET FACEBOOK PAGE.THE MADELIA COMMUNITY HOSPITAL DEPARTMENTS OF NURSING, HOME CARE, AND PHYSICAL THERAPY OFFER THEIR TECHNICAL KNOWLEDGE FOR CLINICAL EXPERIENCE FOR STUDENTS FROM MINNESOTA STATE UNIVERSITY-MANKATO, PRESENTATION COLLEGE, CONCORDIA UNIVERSITY ST. PAUL, BRIAR CLIFF UNIVERSITY, RASMUSSEN COLLEGE, AND SOUTH CENTRAL COLLEGE. THE CLINICAL STUDENTS ARE HERE IN THE SPRING AND FALL SEMESTERS.THE HOSPITAL NURSING STAFF OFFER A MONTHLY FOOT CLINIC FOR ANYONE WISHING TO RECEIVE FOOT CARE, INCLUDING FOOT SOAK AND NAIL TRIMMING. THIS CLINIC IS OFFERED FOR A NOMINAL DONATION TO COVER THE COST OF SUPPLIES BUT NO ONE IS TURNED AWAY FOR INABILITY TO PAY. THIS FOOT CLINIC PROVIDES FOR UNMET PHYSICAL NEEDS AS WELL AS PSYCHOSOCIAL NEEDS. THOSE WHO COME TO THE FOOT CLINIC ENJOY THE COFFEE, COOKIES AND SOCIALIZING THAT OCCURS WITH STAFF AND EACH OTHER. THE NURSING STAFF ALSO ASSISTS IN A SIXTH GRADE HEALTH FAIR AT THE MADELIA ELEMENTARY SCHOOL. DURING THE HEALTH FAIR THEY RECORD THE STUDENT'S HEIGHT AND WEIGHT, AND DO A BLOOD SUGAR TEST TO HELP ASSESS THEIR RISK OF DEVELOPING DIABETES.THE HOME CARE DEPARTMENT ASSISTS FAMILIES WITH COPING SKILLS AND FINDING SUPPORT SYSTEMS TO MEET PATIENT NEEDS. THE DEPARTMENT HOSTS AN OPEN HOUSE EACH YEAR DURING HOME CARE MONTH AND INVITES THE PUBLIC IN FOR A LARGE BUFFET OF APPETIZERS AND TREATS, ALONG WITH PROVIDING THEM WITH INFORMATION ABOUT THE HOME CARE SERVICES OFFERED AT MCHC. THE HOME CARE NURSES EACH YEAR ADMINISTER FLU SHOTS AT HARTSHORN SENIOR HOUSING, AMBERFIELD SENIOR HOUSING, AND HOMESTEAD APARTMENTS. THEY ALSO PARTICIPATE IN HOSPICE COMMUNITY WORKSHOPS AND ADVISORY COMMITTEES THROUGHOUT THE YEAR.OTHER COMMUNITY INVOLVEMENT: - SPANISH TRANSLATION SERVICES- FLU VACCINE CLINICS ONSITE AT LOCAL FACTORY AND COMMERCIAL BUSINESSES- PROMOTE MEDICATION RECONCILIATION AT ANY TIME FOR RESIDENTS- MEALS ON WHEELS DELIVERY TO HOME BOUND RESIDENTS- COLLABORATIVE HISPANIC OUTREACH SERVICES WITH LOCAL FACTORY AND WATONWAN COUNTY HUMAN SERVICES- PARTICIPATE IN THE COMMUNITY ORGANIZATIONS SUCH AS ROTARY AND CHAMBER OF COMMERCE- SCHEDULE DRIVERS FOR TRANSPORTATION FOR WATONWAN COUNTY SENIOR DRIVER PROGRAM TO ASSIST SENIORS TO TRAVEL TO MEDICAL APPOINTMENTS.OUR PRIMARY FOCUS IS TO MAKE HEALTHY LIFESTYLE AWARENESS AVAILABLE TO OUR SERVICE AREA - WE WILL BE HERE WHENEVER THEY NEED US WITH OPEN ARMS OFFERING - "CARE FROM THE PEOPLE YOU KNOW!" |
| PART VI, LINE 7, REPORTS FILED WITH STATES | MN |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Severance Payment | 0 | SeverancePaymentInd |
| Supplemental Nonqual Rtr Plan | 0 | SupplementalNonqualRtrPlanInd |
| Equity Based Comp Arrngm | 0 | EquityBasedCompArrngmInd |
| Comp Based On Revenue Of Flng Org | 0 | CompBasedOnRevenueOfFlngOrgInd |
| Comp Bsd On Rev Related Orgs | 0 | CompBsdOnRevRelatedOrgsInd |
| Comp Bsd Net Earns Flng Org | 0 | CompBsdNetEarnsFlngOrgInd |
| Comp Bsd Net Earns Rltd Orgs | 0 | CompBsdNetEarnsRltdOrgsInd |
| Any Non Fixed Payments | 0 | AnyNonFixedPaymentsInd |
| Initial Contract Exception | 0 | InitialContractExceptionInd |
Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | CANDACE FENSKE | PersonNm |
| Title | CEO | TitleTxt |
| Base Compensation Filing Org | $145,504 | BaseCompensationFilingOrgAmt |
| Compensation Based On Rltd Orgs | $0 | CompensationBasedOnRltdOrgsAmt |
| Bonus Filing Organization | $0 | BonusFilingOrganizationAmount |
| Bonus Related Organizations | $0 | BonusRelatedOrganizationsAmt |
| Other Compensation Filing Org | $0 | OtherCompensationFilingOrgAmt |
| Other Compensation Rltd Orgs | $0 | OtherCompensationRltdOrgsAmt |
| Deferred Compensation Flng Org | $6,044 | DeferredCompensationFlngOrgAmt |
| Deferred Comp Rltd Orgs | $0 | DeferredCompRltdOrgsAmt |
| Nontaxable Benefits Filing Org | $8,046 | NontaxableBenefitsFilingOrgAmt |
| Nontaxable Benefits Rltd Orgs | $0 | NontaxableBenefitsRltdOrgsAmt |
| Total Compensation Filing Org | $159,594 | TotalCompensationFilingOrgAmt |
| Total Compensation Rltd Orgs | $0 | TotalCompensationRltdOrgsAmt |
| Comp Report Prior990 Filing Org | $0 | CompReportPrior990FilingOrgAmt |
| Comp Report Prior990 Rltd Orgs | $0 | CompReportPrior990RltdOrgsAmt |
Schedule K IRS990ScheduleK
Tax Exempt Bonds Issues TaxExemptBondsIssuesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bond Reference | A | BondReferenceCd |
Issuer Name IssuerName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | CITY OF MADELIA | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bond Issuer EIN | 416005334 | BondIssuerEIN |
| CUSIP | 556401AR8 | CUSIPNum |
| Bond Issued | 2006-10-31 | BondIssuedDt |
| Issue Price | $6,495,000 | IssuePriceAmt |
| Purpose | CONSTRUCT HOSPITAL ADDITION | PurposeDesc |
| Defeased | 0 | DefeasedInd |
| On Behalf Of Issuer | 0 | OnBehalfOfIssuerInd |
| Pool Financing | 0 | PoolFinancingInd |
Tax Exempt Bonds Proceeds TaxExemptBondsProceedsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bond Reference | A | BondReferenceCd |
| Retired | $1,670,000 | RetiredAmt |
| Total Proceeds | $6,495,000 | TotalProceedsAmt |
| Capitalized Interest | $161,893 | CapitalizedInterestAmt |
| Issuance Costs From Proceeds | $16,238 | IssuanceCostsFromProceedsAmt |
| Credit Enhancement | $113,662 | CreditEnhancementAmt |
| Capital Expenditures | $6,203,207 | CapitalExpendituresAmt |
| Substantial Completion | 2008 | SubstantialCompletionYr |
| Current Refunding | 0 | CurrentRefundingInd |
| Advance Refunding | 0 | AdvanceRefundingInd |
| Final Allocation Made | Yes (1) | FinalAllocationMadeInd |
| Adequate Books And Rec Maint | Yes (1) | AdequateBooksAndRecMaintInd |
Tax Exempt Bonds Private Bus Use TaxExemptBondsPrivateBusUseGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bond Reference | A | BondReferenceCd |
| Owning Bond Financed Property | 0 | OwningBondFinancedPropertyInd |
| Any Lease Arrangements | 0 | AnyLeaseArrangementsInd |
| Mgmt Contract Bond Fincd Prop | 0 | MgmtContractBondFincdPropInd |
| Any Research Agreements | 0 | AnyResearchAgreementsInd |
| Bond Iss Meet Prvt Sec Pymt Test | 0 | BondIssMeetPrvtSecPymtTestInd |
| Change In Use Bond Financed Prop | 0 | ChangeInUseBondFinancedPropInd |
| Procs Nonqualified Bond Remdtd | 0 | ProcsNonqualifiedBondRemdtdInd |
Tax Exempt Bonds Arbitrage TaxExemptBondsArbitrageGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bond Reference | A | BondReferenceCd |
| Form8038 T Filed | 0 | Form8038TFiledInd |
| Rebate Not Due Yet | 0 | RebateNotDueYetInd |
| Exception To Rebate | Yes (1) | ExceptionToRebateInd |
| No Rebate Due | 0 | NoRebateDueInd |
| Variable Rate Issue | 0 | VariableRateIssueInd |
| Hedge Identified In Bks And Rec | 0 | HedgeIdentifiedInBksAndRecInd |
| Gross Proceeds Invested In GIC | 0 | GrossProceedsInvestedInGICInd |
| Gross Proceeds Invested | 0 | GrossProceedsInvestedInd |
| Written Proc To Monitor Reqs | 0 | WrittenProcToMonitorReqsInd |
Procedures Corrective Action ProceduresCorrectiveActionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bond Reference | A | BondReferenceCd |
| Procedures Corrective Action | Yes (1) | ProceduresCorrectiveActionInd |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (9 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| 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 ANNUAL BOARD MEETING BY THE BOARD AND DEPARTMENT HEADS. 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 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 EMPLOYEES AND ADMINISTRATIVE STAFF IS CONSISTENT WITH POLICY AND PROVIDES 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 AND RATE INCREASE AS AWARDED TO ALL STAFF. THE BOARD APPROVES BOTH STAFF AND ADMINISTRATIVE INCREASES THROUGH THE ANNUAL BUDGET. THIS WAS MOST RECENTLY COMPLETED IN 2018. |
| 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 -121,980. ADJUSTMENT ON PY RETAINED EARNINGS -3,074. REVERSE ADJUSTMENT MADE ON PRIOR YEAR RETURN 837. ROUNDING -2. |
| 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. |
Schedule R IRS990ScheduleR
Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp
Disregarded Entity Name DisregardedEntityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | MADELIA COMMUNITY HOSPITAL FOUNDATION | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 121 DREW AVENUE SE | AddressLine1Txt |
| City | MADELIA | CityNm |
| State Abbreviation | MN | StateAbbreviationCd |
| ZIP | 56062 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 731719218 | EIN |
| Primary Activities | SOLICIT CONTRIBUTIONS ON BEHALF OF THE MADELIA COMMUNITY HOSPITAL. | PrimaryActivitiesTxt |
| Legal Domicile State | MN | LegalDomicileStateCd |
| Exempt Code Section | 501(C)(3) | ExemptCodeSectionTxt |
| Public Charity Status | LINE 12A, I | PublicCharityStatusTxt |
Direct Controlling Entity Name DirectControllingEntityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | MADELIA COMMUNITY HOSPITAL INC | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Controlled Organization | Yes (1) | ControlledOrganizationInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Annts Rnts Rylts | 0 | ReceiptOfIntAnntsRntsRyltsInd |
| Gift Grnt Or Cap Contri To Oth Org | 0 | GiftGrntOrCapContriToOthOrgInd |
| Gift Grnt Cap Contri From Oth Org | Yes (1) | GiftGrntCapContriFromOthOrgInd |
| Loans Or Guarantees To Other Org | 0 | LoansOrGuaranteesToOtherOrgInd |
| Loans Or Guarantees From Oth Org | 0 | LoansOrGuaranteesFromOthOrgInd |
| Div Related Organization | 0 | DivRelatedOrganizationInd |
| Asset Sale To Other Org | 0 | AssetSaleToOtherOrgInd |
| Asset Purchase From Other Org | 0 | AssetPurchaseFromOtherOrgInd |
| Asset Exchange | 0 | AssetExchangeInd |
| Rental Of Facilities To Oth Org | 0 | RentalOfFacilitiesToOthOrgInd |
| Rental Of Fclts From Oth Org | 0 | RentalOfFcltsFromOthOrgInd |
| Perform Of Services For Oth Org | Yes (1) | PerformOfServicesForOthOrgInd |
| Perform Of Services By Other Org | Yes (1) | PerformOfServicesByOtherOrgInd |
| Sharing Of Facilities | Yes (1) | SharingOfFacilitiesInd |
| Paid Employees Sharing | Yes (1) | PaidEmployeesSharingInd |
| Reimbursement Paid To Other Org | 0 | ReimbursementPaidToOtherOrgInd |
| Reimbursement Paid By Other Org | 0 | ReimbursementPaidByOtherOrgInd |
| Transfer To Other Org | 0 | TransferToOtherOrgInd |
| Transfer From Other Org | Yes (1) | TransferFromOtherOrgInd |
Transactions Related Org TransactionsRelatedOrgGrp
Other Organization Name OtherOrganizationName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | MADELIA COMMUNITY HOSPITAL FOUNDATION | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Transaction Type | C | TransactionTypeTxt |
| Involved | $121,980 | InvolvedAmt |
| Method Of Amount Determination | FMV | MethodOfAmountDeterminationTxt |