2016-03-25T14:00:06-05:00 2015-05-31 410746749 CLIFTONLARSONALLEN LLP 220 SOUTH SIXTH STREET SUITE 300 MINNEAPOLIS MN 55402 990 2014-06-01 410758512 MADELIA COMMUNITY HOSPITAL INCORPORATED MADE 5076423255 121 DREW AVENUE SOUTHEAST MADELIA MN 56062 CANDACE FENSKE CEO 5076423255 2016-02-01 1 TRENT FAST P00692704 6123764500 2014 2016-08-17 19:52:53Z MADELIA COMMUNITY HOSPITAL & CLINIC CANDACE FENSKE 121 DREW AVENUE SOUTHEAST MADELIA MN 56062 11129015 0 X WWW.MCHOSPITAL.ORG X 1950 MN PROVIDE QUALITY HEALTHCARE SERVICES TO THE LOCAL COMMUNITY. 9 9 122 0 0 0 670981 146383 9410102 10642251 109619 107278 169815 173699 10360517 11069611 0 0 0 0 6029975 6493899 0 0 0 4447063 4681336 10477038 11175235 -116521 -105624 18580126 18954153 6465524 6936719 12114602 12017434 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. 1 0 7591439 10642251 MADELIA COMMUNITY HOSPITAL AND CLINIC PROVIDES GENERAL MEDICAL/SURGICAL SERVICES ON INPATIENTS, SWING BED PATIENTS, OUTPATIENTS, AND HOME CARE CLIENTS. DURING THE FISCAL YEAR 2015 THERE WERE 110 ACUTE CARE ADMISSIONS, 79 SWING BED ADMISSIONS, 16,395 HOME CARE VISITS TO 1,295 HOME CARE CLIENTS, AND 4,683 OUTPATIENT VISITS. DURING OUR FISCAL YEAR 2015 MADELIA COMMUNITY HOSPITAL AND CLINIC PROVIDED $87,016 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; PALLIATIVE CARE EDUCATIONAL SERIES; SENIOR EDUCATION SERIES INCLUDING EVIDENCE BASED PROGRAM, "LIVING WELL WITH CHRONIC CONDITIONS AND "MATTER OF BALANCE; FREE HEEL SCANS TO DETECT OSTEOPOROSIS; FREE BLOOD PRESSURE IN THE MADELIA COMMUNITY HOSPITAL AND CLINIC AND AT HEALTH FAIRS IN THE AREA AND AT CHURCH EVENTS; PARTICIPATION AT THE REGIONAL SENIOR HEALTH EXPO; WORKING SIDE BY SIDE WITH STUDENTS FROM AREA UNIVERSITIES AND COLLEGES FOR STUDENTS IN NURSING, LABORATORY TECHNICIANS, AND PHYSICAL THERAPY ASSISTANTS; 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 LAKE CRYSTAL STUDENTS; COMMUNITY AND SCHOOL HEALTH FAIR PARTICIPATION; NO-CHARGE FOOT AND NAIL CLINIC (SOAKING FEET, TRIMMING TOE NAILS, AND MASSAGING FEET OF ELDERLY PATIENTS). AN AVERAGE OF 55 PATIENTS PER MONTH PARTAKE IN THIS SERVICE.ACTIVE AND CHARTER MEMBERS OF THE MADELIA COMMUNITY BASED COLLABORATIVE (MCBC). THIS GROUP IS COMPRISED OF HOSPITAL AND CLINIC STAFF, COMMUNITY MEMBERS, A GRADE SCHOOL STUDENT, PARENTS, WATONWAN COUNTY PUBLIC HEALTH REPRESENTATION, AND MINNESOTA STATE UNIVERSITY, MANKATO GLEN TAYLOR NURSING INSTITUTE FOR FAMILY AND SOCIETY MEMBERS. THE PURPOSE OF THE MADELIA COMMUNITY BASED COLLABORATIVE IS TO ENHANCE HEALTH, IMPROVE THE QUALITY OF LIFE, AND EMPOWER MADELIA COMMUNITY MEMBERS. USING DATA FROM THE 2012 TO 2013 COMMUNITY ASSESSMENT, THIS GROUP HAS DETERMINED THREE KEY AREAS IN WHICH TO FOCUS: OBESITY, HEART DISEASE, AND DIABETES. THESE KEY AREAS HAVE LED THE GROUP TO WORK WITH THE MINNESOTA DEPARTMENT OF HEALTH - STATE HEALTH IMPROVEMENT PLAN (SHIP) ON A PROJECT CALLED "RETHINK YOUR DRINK". THIS PROJECT ENCOURAGES ALL AGE GROUPS TO LOOK AT THEIR BEVERAGE CHOICE. THE MCBC GROUP HAS EDUCATED THE PUBLIC ABOUT THE SUGARY BEVERAGES, OTHER HEALTHY CHOICES AND THEIR IMPACT ON OBESITY, DIABETES, AND HEART DISEASES. THEIR EDUCATION HAS FOCUSED ON ALL AGE GROUPS AT PUBLIC AND SCHOOL EVENTS BY PROVIDING WATER AS AN ALTERNATIVE. POSTER AND CHALK ART ON SIDEWALKS HAVE BEEN USED AS AN EDUCATIONAL TOOL TO HELP MADELIA CITIZENS FOCUS ON AN ALTERNATIVE TO SUGARY BEVERAGES. 7591439 1 1 0 0 0 0 0 0 0 0 1 0 0 1 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 0 0 0 1 59 0 122 1 0 0 0 0 0 0 0 0 0 0 X 9 9 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 0 MN X X DONNA KLINKNER 5076423255 121 DREW AVENUE SOUTHEAST MADELIA MN 56062 STEVEN COOLING BOARD PRESIDENT 1.00 X X 1800 0 0 DENNIS ARDUSER BOARD VP & TREASURER 1.00 X X 1800 0 0 TOM MCCABE BOARD VP & TREASURER 1.00 X X 0 0 0 BARBARA OVERLIE BOARD SECRETARY 1.00 X X 1800 0 0 CHUCK VOSS BOARD MEMBER 1.00 X 1100 0 0 MARK CHRISTENSON BOARD MEMBER 1.00 X 1200 0 0 NORMA KRUMWIEDE BOARD MEMBER 1.00 X 1200 0 0 JEANNE BURKE BOARD MEMBER 1.00 X 1200 0 0 TODD SIMPSON BOARD MEMBER 1.00 X 0 0 0 RYAN VISHER BOARD MEMBER 1.00 X 0 0 0 KENNETH GRONEWOLD BOARD MEMBER 1.00 X 0 0 0 RYAN STOTESBERY BOARD MEMBER 1.00 X 1200 0 0 CANDACE FENSKE CEO 40.00 X 139416 0 17125 DONNA KLINKNER CFO 40.00 X 88006 0 14252 JANE MALMSKOG PHARMACIST 32.00 X 100539 0 11832 339261 0 43209 2 0 1 0 WHITESELL MEDICAL STAFFING 1630 ANDERSON AVE BUFFALO MN 55313 ER & CLINIC PHYSICIAN COVERAGE 850770 MANKATO CLINIC LTD 1230 E MAIN ST MANKATO MN 56002 PHYSICIAN CLINIC PROVIDERS 630053 2 32976 113407 146383 NET PATIENT REVENUE 624100 10597054 10597054 PHYSICAL THERAPY 624310 37601 37601 LABORATORY 621500 6035 6035 PHARMACY 446110 1561 1561 10642251 108377 108377 125969 125969 48094 58305 -10211 -10211 -10211 1099 -1099 -1099 -1099 MISCELLANEOUS 900099 31524 31524 EMPLOYEE MEALS 900099 23500 23500 MEDICAL RECORDS 900099 2917 2917 57941 11069611 10642251 0 280977 270099 270099 5218931 4302045 916886 159491 109569 49922 557598 557598 287780 205134 82646 135068 60394 74674 30596 30596 268719 268719 95002 68841 26161 287454 287454 856517 856517 SUPPLIES 1594717 1488065 106652 ADMIN EXPENSES 467702 467702 REPAIRS/MAINTENANCE 369709 369709 BAD DEBTS 288116 288116 287736 212758 74978 11175235 7591439 3583796 0 1198037 2325910 4939545 4935549 269516 8036 1846094 1942296 167772 177411 174334 176556 17370269 9961660 8158800 7408609 984351 966347 841677 1013439 18580126 18954153 980400 1603642 5405000 5270000 40124 23077 40000 40000 6465524 6936719 X 12114602 11904202 0 113232 12114602 12017434 18580126 18954153 -105624 8456 0 X X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 185447 185447 6930784 3445992 3484792 4642754 2273824 2368930 5611284 4241844 1369440 7408609 BOND FUND 143504 BOND FUND RESERVE ACCOUNT 244912 BOND CONSTRUCTION ACCOUNT 104 DEFERRED FINANCING COSTS 134042 DUE FROM RELATED PARTY 471668 ACCRUED INTEREST RECEIVABLE 19209 1013439 ASSET RETIREMENT OBLIGATION 40000 40000 X PART X, LINE 2: THE HOSPITAL IS CLASSIFIED BY THE INTERNAL REVENUE SERVICES AS A TAX-EXEMPT ORGANIZATION UNDER SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE 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 100.000000000000 1 1 0 1 1 121360 121360 0.01110 1379762 1070410 309352 0.02840 1501122 1070410 430712 0.03950 79673 79673 0.00730 77648 77648 0.00710 157321 157321 0.01440 1658443 1070410 588033 0.05390 2888 2888 0.00030 5554 5554 0.00050 9693 9693 0.00090 10941 10941 0.00100 13827 13827 0.00130 42903 42903 0.00400 1 288116 2881 4038086 4061328 -23242 X 1 1 1 NA 1 1 MADELIA COMMUNITY HOSPITAL 121 DREW AVE SE MADELIA MN 56062 WWW.MCHOSPITAL.ORG 370999 X X X X MADELIA COMMUNITY HOSPITAL INCORPORATED 1 0 0 1 X X X X X X X X X 12 1 0 1 1 X WWW.MCHOSPITAL.ORG/COMMUNITY-NEEDS-ASSESSMENT X X 1 12 0 0 0 1 X 100.000000000000 100.000000000000 X X X X X X 1 1 X X X 1 X X X X X 1 0 X X X X X 1 X 0 0 MADELIA COMMUNITY HOSPITAL, INCORPORATED PART V, SECTION B, 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 MADELIA COMMUNITY HOSPITAL, INCORPORATED PART V, SECTION B, LINE 7D: MCH MADE ITS COMMUNITY NEEDS HEALTH ASSESSMENT AVAILABLE ON ITS WEBSITE AT WWW.MCHOSPITAL.ORG/COMMUNITY-NEEDS-ASSESSMENT. THEY ALSO MADE IT AVAILABLE ON PUBLIC FORUMS. MADELIA COMMUNITY HOSPITAL, INCORPORATED PART V, SECTION B, LINE 11: WHILE MCH RECOGNIZES THE IMPORTANCE OF THE OTHER IDENTIFIED HEALTH NEEDS, DIABETES AND CANCER, MCH HAS CHOSEN THE ONE PRIORITY HEALTH CONCERN THAT WAS IDENTIFIED IN ALL POPULATIONS, OBESITY. WE HAVE CHOSEN THIS BECAUSE OF OUR LIMITED RESOURCES, IN TERMS OF DOLLARS AND TIME, AND A DESIRE TO SEE A SIGNIFICANT IMPROVEMENT IN THESE HEALTH FACTORS IN OUR COMMUNITY. MADELIA COMMUNITY HOSPITAL, INCORPORATED PART V, SECTION B, LINE 13H: ELIGIBILITY IN MOST CASES IS DETERMINED BY MEASURING THE GROSS FAMILY INCOME AGAINST THE FEDERAL POVERY INCOME GUIDELINES. IN ADDITION OTHER RELEVANT NON-INCOME RESOURCES, INCLUDING BUT NOT BEING LIMITED TO REAL ESTATE, SAVINGS, LIFE INSURANCE, MOTOR VEHICLES, ETC. WILL BE CONSIDERED WHEN DETERMINING ELIGIBILITY. MADELIA COMMUNITY HOSPITAL, INCORPORATED PART V, SECTION B, LINE 15E: PATIENT BILLS HAVE A STATEMENT REGARDING THE FAP AVAILABILITY FOR FURTHER INQUIRY OF ASSISTANCE. MADELIA COMMUNITY HOSPITAL, INCORPORATED PART V, SECTION B, LINE 16I: 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, LETTERS INDICATING THE AGING OF THEIR ACCOUNT AND THE AVAILABILITY TO MAKE PAYMENT ARRANGEMENTS WITH SEVERAL OPTIONS OF RECEIVING A DISCOUNT. MADELIA COMMUNITY HOSPITAL, INCORPORATED PART V, SECTION B, LINE 22D: WE CALCULATE AMOUNTS GENERALLY BILLED IN ACCORDANCE WITH OUR AGREEMENT WITH THE MINNESOTA ATTORNEY GENERAL. AMOUNTS GENERALLY BILLED ARE BASED ON THE DISCOUNTED CHARGES TO OUR LARGEST INSURANCE PAYER, BY VOLUME. THE DISCOUNT GIVEN TO OUR LARGEST INSURANCE PAYER IS SMALLER THAN THE DISCOUNT AVAILABLE UNDER OUR FINANCIAL ASSISTANCE POLICY. 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, LN 7 COL(F): BAD DEBT EXPENSE OF $288,116 WAS SUBTRACTED FROM TOTAL EXPENSES OF $11,175,235 IN CALCULATING THE PERCENTAGES IN PART I, LINE 7, COLUMN F. 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 SIGNIFCANT ROLE IN THIS DEVELOPMENT AND CARRYING OUT THE ACTION PLANS. PART III, LINE 2: 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 3: IN HOUSE UNINSURED/UNDERINSURED THAT QUALIFIED FOR FINANCIAL ASSISTANCE FOR THE YEAR END WAS 1% OF TOTAL BAD DEBTS ACCOUNT AS REFLECTED IN PART III, LINE 3. CHARITY CARE ACCOUNTS ARE NOT INCLUDED IN BAD DEBTS. PART III, LINE 4: THE FOLLOWING IS FROM THE "PATIENT RECEIVABLES" PARAGRAPH IN NOTE 1 TO THE HOSPITAL'S FINANCIAL STATEMENTS:"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." PART III, LINE 8: FROM PART III, LINE 6, THE TOTAL ALLOWABLE COST REPORTED TO MEDICARE WAS BASED ON THE 2015 FILED MEDICARE COST REPORT.THE MEDICARE SHORTFALL REPORTED ON PART III, LINE 8 IS A RESULT OF THE FEDERAL SEQUESTRATION ADJUSTMENTS AND WOULD NOT OTHERWISE BE 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 THE 2013 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 POLULATION. PART VI, LINE 5: MADELIA COMMUNITY HOSPITAL PARTICIPATES AND ORGANIZES COMMUNITY EDUCATION AND SEMINARS TO PROVIDE HEALTHCARE INFORMATION TO ENHANCE THE QUALITY OF HEALTHY LIVING AND THE AVAILABILITY OF THESE SERVICES RIGHT IN THEIR OWN COMMUNITIES. RADIOLOGY STAFF MEMBERS HOSTED A "PRETTY IN PINK" MAMMOGRAM PARTY TO REMIND WOMEN TO FOLLOW THROUGH WITH THEIR PREVENTATIVE TESTS AS REGULAR MAMMOGRAMS REMAIN THE BEST TOOL FOR CATCHING BREAST CANCER IN ITS EARLIER, MORE TREATABLE STAGES AND AWARENESS OF BONE DENSITY TESTING. THE GUESTS FOR THIS PARTY WERE OFFERED REFRESHMENTS AND PAMPERED WITH A HAND MASSAGE, MANICURE, FOOT SOAK, AND FACIAL OR MAKE-UP CONSULTATION.MADELIA COMMUNITY HOSPITAL PHYSICAL THERAPISTS/ATHLETIC TRAINERS EXPANDED THEIR SPORTS MEDICINE DEPARTMENT AND TEAMED UP WITH THE SCHOOL DISTRICT TO ASSIST STUDENT ATHLETES. THEY ADMINISTERED IMPACT CONCUSSION TESTS TO LOCAL STUDENT ATHLETES; THE 20 MINUTE TEST MEASURES VERBAL AND VISUAL MEMORY WHILE PROCESSING SPEED AND REACTION TIME TO 1/100TH OF A SECOND AND HAS PROVEN TO BE A VALUABLE TOOL TO SHOW WHEN THE ATHLETE'S BRAIN HAS HEALED FROM A CONCUSSION. THE BASELINE TEST WAS ADMINISTERED TO 124 STUDENT ATHLETES IN GRADES 7-12TH FROM MADELIA AND TRUMAN. 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 SPORT. THIS YEAR, THREE STUDENT ATHLETES WERE REFERRED FOR A FOLLOW UP TEST. OUR CERTIFIED PHYSICAL THERAPIST/ATHLETIC TRAINER ATTENDED MOST HOME FOOTBALL GAMES AS WELL AS OTHER CONTACT SPORTS INCLUDING WRESTLING, BASKETBALL AND SOFTBALL.MADELIA COMMUNITY HOSPITAL PHYSICAL THERAPY STAFF MEMBERS HOSTED FREE PROGRAMS FOR THE COMMUNITY. LIVING WELL WITH CHRONIC CONDITIONS IS A WORKSHOP DESIGNED TO "PUT LIFE BACK IN YOUR LIFE." A MATTER OF BALANCE IS A WORKSHOP DESIGNED TO REDUCE THE FEAR OF FALLING AND INCREASE ACTIVITY LEVELS AMONG OLDER ADULTS. THE FREE ATHLETE CARE AND EVALUATION (A.C.E.) CLINIC ASSESSED 29 ATHLETES THROUGH THE YEAR; PROVIDING PREVENTION, EVALUATION AND TREATMENT WITH THE FOCUS OF GETTING THE ATHLETES BACK IN THE GAME.A BIKE SAFETY CLINIC WAS HELD DURING THE TOWN CELEBRATION TO PROMOTE SAFE BIKING HABITS AND ENCOURAGE HELMET USAGE. CHILDREN AND ADULTS WERE FITTED FOR BIKE HELMETS WHICH WERE OFFERD AT A NOMINAL COST.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.SET UP A "FARMERS MARKET" WITH NO CHARGE TO THE LOCAL VENDORS TO PROVIDE THEIR GARDEN PRODUCE FOR THE COMMUNITY. THIS PROJECT WAS WELL RECEIVED AND PATRONS ARE REQUESTING THIS SERVICE ANNUALLY.THE MADELIA COMMUNITY HOSPITAL DEPARTMENTS OF NURSING, HOME CARE, AND PHYSICAL THERAPY PARTAKE IN OFFERING THEIR TECHNICAL KNOWLEDGE FOR A CLINICAL EXPERIENCE FOR STUDENTS FROM MINNESOTA STATE UNIVERSITY, PRESENTATION COLLEGE AND NORTH IOWA COMMUNITY COLLEGE, 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. TTHIS 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 HOME CARE DEPARTMENT PARTICIPATED IN THE PALLIATIVE PROGRAM THAT ASSISTED FAMILIES WITH COPING SKILLS, AND SUPPORT SYSTEMS. THE HOME CARE NURSES DO BLOOD PRESSURE CLINICS AT THE HARTSHORN AND AMBERFIELD SENIOR HOUSING UNITS AND LOCAL CHURCHES, PARTICIPATED IN A SENIOR EXPO AT THE HARTSHORN SENIOR HOUSING, COLLABORATE WITH HOSPICE COMMUNITY WORKSHOPS AND ADVISORY COMMITTEE.OTHER COMMUNITY INVOLVEMENT: - SPANISH TRANSLATION SERVICES - COMMUNITY CPR CLASSES WERE PROVIDED PER THE REQUEST OF THE COMMUNITY - PARTICIPATION IN HEALTH AND CAREER FAIRS AT THE ELEMENTARY AND HIGH SCHOOLS - OPEN HOUSE OF FACILITY MEDICAL HEALTH SERVICES FOR COMMUNITY CHAMBER MEMBERS - 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 - "CARE FROM THE PEOPLE YOU KNOW"! PART VI, LINE 7, REPORTS FILED WITH STATES MN X X X X 0 0 0 0 0 0 0 0 0 CANDACE FENSKE CEO 139416 0 0 0 0 0 10171 0 6954 0 156541 0 0 0 A CITY OF MADELIA 416005334 556401AR8 2006-10-01 6495000 CONSTRUCT HOSPITAL ADDITION 0 0 0 A 1225000 6495000 161893 16238 113662 6203207 2008 0 0 1 1 A 0 0 0 0 0.00000 0.00000 0.00000 0 0 0 A 0 0 1 0 0 0 0 0 0 A 1 FORM 990, PART III, LINE 2 ACTIVE IN DEVELOPMENT OF THE COMMUNITY MADELIA COMMUNITY BASED COLLABORATIVE (MCBC) PROGRAM FOR HEALTHY LIVING INITIATIVES. 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 A, LINE 7B CORPORATE MEMBERS HAVE THE AUTHORITY TO VOTE ON CHANGES IN OR OF THE ARTICLES OF INCORPORATION FOR MADELIA COMMUNITY HOSPITAL. FORM 990, PART VI, SECTION B, LINE 11 THE FORM 990 IS REVIEWED BY THE GOVERNING BOARD OF DIRECTORS FOR APPROVAL BEFORE THE FORM 990 IS FILED. THE REVIEW WILL BE PRESENTED BY FINANCE AT THE REGULAR MEETING OF THE BOARD OF DIRECTORS. 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 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 EMPLOYEES AND ADMINISTRATIVE STAFF 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 (LAST PERFORMED SPRING 2015) 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. 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 XII, LINE 2C THE ORGANIZATIONS BOARD OF DIRECTORS 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) 11 - TYPE 1 MADELIA COMMUNITY HOSPITAL INC 0 0 0 1 0 0 0 0 0 0 0 0 1 1 1 1 0 0 0 1 NO TRANSACTIONS OVER 50000