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MADELIA HEALTH: Form 990, tax year 2011

View the entire original 990 at ProPublica ↗

Organization
MADELIA HEALTH (EIN 41-0758512)
Tax period
2011-06-01 to 2012-05-31
Filed
2013-02-28
IRS object ID
201310599349300416
Schema version
2011v1.5
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 ReturnHeader

FieldValueIRS element (for citing)
Timestamp2013-02-28T14:02:17-06:00Timestamp
Tax Period End Date2012-05-31TaxPeriodEndDate

Preparer Firm PreparerFirm

FieldValueIRS element (for citing)
EIN410746749EIN

Preparer Firm Business Name PreparerFirmBusinessName

FieldValueIRS element (for citing)
Business Name Line1CLIFTONLARSONALLEN LLPBusinessNameLine1

Preparer Firm US Address PreparerFirmUSAddress

FieldValueIRS element (for citing)
Address Line1220 SOUTH SIXTH STREET SUITE 300AddressLine1
CityMINNEAPOLISCity
StateMNState
ZIP Code55402ZIPCode
FieldValueIRS element (for citing)
Return Type990ReturnType
Tax Period Begin Date2011-06-01TaxPeriodBeginDate

Filer Filer

FieldValueIRS element (for citing)
EIN410758512EIN

Name Name

FieldValueIRS element (for citing)
Business Name Line1MADELIA COMMUNITY HOSPITAL INCORPORATEDBusinessNameLine1
FieldValueIRS element (for citing)
Name ControlMADENameControl
Phone5076423255Phone

US Address USAddress

FieldValueIRS element (for citing)
Address Line1121 DREW AVENUE SOUTHEASTAddressLine1
CityMADELIACity
StateMNState
ZIP Code56062ZIPCode

Officer Officer

FieldValueIRS element (for citing)
NameCANDACE FENSKEName
TitleCEOTitle
Phone5076423255Phone
Date Signed2013-02-11DateSigned
Authorize Third Party1AuthorizeThirdParty

Preparer Preparer

FieldValueIRS element (for citing)
NameTRENT FASTName
PTINP00692704PTIN
Phone6123764500Phone
FieldValueIRS element (for citing)
Tax Year2011TaxYear
Build TS2016-03-07 17:11:31ZBuildTS

Form 990 IRS990

Doing Business As DoingBusinessAs

FieldValueIRS element (for citing)
Business Name Line1MADELIA COMMUNITY HOSPITAL & CLINICBusinessNameLine1
FieldValueIRS element (for citing)
Name Of Principal Officer PersonCANDACE FENSKENameOfPrincipalOfficerPerson

Address Principal Officer US AddressPrincipalOfficerUS

FieldValueIRS element (for citing)
Address Line1121 DREW AVENUE SOUTHEASTAddressLine1
CityMADELIACity
StateMNState
ZIP Code56062ZIPCode
FieldValueIRS element (for citing)
Gross Receipts9092390GrossReceipts
Group Return For Affiliates0GroupReturnForAffiliates
Organization501c3XOrganization501c3
Web SiteWWW.MCHOSPITAL.ORGWebSite
Type Of Organization CorporationXTypeOfOrganizationCorporation
Year Formation1950YearFormation
State Legal DomicileMNStateLegalDomicile
Activity Or Mission DescriptionPROVIDE QUALITY HEALTHCARE SERVICES TO THE LOCAL COMMUNITY.ActivityOrMissionDescription
Nbr Voting Members Governing Body8NbrVotingMembersGoverningBody
Nbr Independent Voting Members8NbrIndependentVotingMembers
Total Nbr Employees113TotalNbrEmployees
Total Nbr Volunteers0TotalNbrVolunteers
Total Gross UBI0TotalGrossUBI
Net Unrelated Business Txbl Income0NetUnrelatedBusinessTxblIncome
Contributions Grants Prior Year162184ContributionsGrantsPriorYear
Contributions Grants Current Year563865ContributionsGrantsCurrentYear
Program Service Revenue Prior Year9692234ProgramServiceRevenuePriorYear
Program Service Revenue CY8179944ProgramServiceRevenueCY
Investment Income Prior Year150740InvestmentIncomePriorYear
Investment Income Current Year163720InvestmentIncomeCurrentYear
Other Revenue Prior Year268152OtherRevenuePriorYear
Other Revenue Current Year98480OtherRevenueCurrentYear
Total Revenue Prior Year10273310TotalRevenuePriorYear
Total Revenue Current Year9006009TotalRevenueCurrentYear
Grants And Similar Amnts Prior Year0GrantsAndSimilarAmntsPriorYear
Grants And Similar Amnts CY0GrantsAndSimilarAmntsCY
Benefits Paid To Members Prior Year0BenefitsPaidToMembersPriorYear
Benefits Paid To Members CY0BenefitsPaidToMembersCY
Salaries Etc Prior Year4043079SalariesEtcPriorYear
Salaries Etc Current Year5531948SalariesEtcCurrentYear
Total Prof Fundrsng Exp Prior Year0TotalProfFundrsngExpPriorYear
Total Prof Fundrsng Exp CY0TotalProfFundrsngExpCY
Total Fundrsng Exp Current Year0TotalFundrsngExpCurrentYear
Other Expense Prior Year4842527OtherExpensePriorYear
Other Expenses Current Year4832639OtherExpensesCurrentYear
Total Expenses Prior Year8885606TotalExpensesPriorYear
Total Expenses Current Year10364587TotalExpensesCurrentYear
Revenues Less Expenses Prior Year1387704RevenuesLessExpensesPriorYear
Revenues Less Expenses CY-1358578RevenuesLessExpensesCY
Total Assets BOY21081057TotalAssetsBOY
Total Assets EOY19542302TotalAssetsEOY
Total Liabilities BOY6916714TotalLiabilitiesBOY
Total Liabilities EOY6732342TotalLiabilitiesEOY
Net Assets Or Fund Balances BOY14164343NetAssetsOrFundBalancesBOY
Net Assets Or Fund Balances EOY12809960NetAssetsOrFundBalancesEOY
Info In Schedule O Part IIIXInfoInScheduleOPartIII
Mission DescriptionTHE MISSION OF MADELIA COMMUNITY HOSPITAL TO PROVIDE SAFE AND QUALITY HEALTHCARE SERVICES TO THOSE WE SERVE IN AN ENVIRONMENT BASED ON RESPECT, DIGNITY, AND EXCELLENCE.MissionDescription
Significant New Program Services1SignificantNewProgramServices
Significant Change1SignificantChange
Expense8463357Expense
Revenue8179944Revenue
DescriptionRURAL HEALTH CARE FACILITY PROVIDING GENERAL MEDICAL/SURGICAL SERVICES ON AN INPATIENT, OUTPATIENT, AND HOME CARE BASIS. FOR FISCAL YEAR 2012:192 ACUTE CARE ADMISSIONS, 12,690 HOME CARE VISITS, AND 4,529 OUTPATIENT VISITS. THE HOSPITAL ALSO PROVIDED $82,634 OF CHARITY CARE. MADELIA COMMUNITY HOSPITAL IS ALSO HEAVILY INVOLVED IN THEIR COMMUNITY, THEY OFFER A VARIETY OF COMMUNITY BENEFIT SERVICES BEYOND THE CORE HOSPITAL SERVICES. SOME OF THE BENEFIT SERVICES THAT THEY OFFER ARE; WATONWAN COUNTY SR. DRIVER PROGRAM, MEALS ON WHEELS, CULTURE OF WELLNESS PROGRAM, SPANISH INTERPRETIVE SERVICES, COLLABORATIVE HISPANIC OUTREACH SERVICES, DELIVERY OF PHARMACEUTICALS FOR HOME CARE PATIENTS, HOSPICE ADVISORY COMMITTEE, COMMUNITY EDUCATIONAL SERIES ON PALLIATIVE CARE AND HEALTHY LIFESTYLE WITH DIABETES, ELDERLY PATIENT EDUCATION SERIES SUCH AS LIVING WELL WITH CHRONIC CONDITIONS CLASS FOR 6 WEEKS, MATTER OF BALANCE CLASSES, FREE HEEL SCANS FOR THE PUBLIC, CLINICALS FOR STUDENTS OF SURROUNDING COLLEGES AND UNIVERSITIES, SKIN CHECKS AT WRESTLING TOURNAMENTS, BLOOD PRESSURE CLINIC AT COMMUNITY FUNDRAISING EVENTS AND ACTIVITIES, SENIOR HEALTH EXPO, NIMS (NATIONAL INCIDENT MANAGEMENT SYSTEM DISASTER/BIOTERRORISM PREPAREDNESS, A.C.E.(ATHLETE CARE & IMPACT EVALUATION) STUDENT ATHLETIC ASSESSMENTS, HOME CARE FLU SHOT CLINICS, AND OTHER COMMUNITY AND SCHOOL HEALTH FAIRS THROUGH OUT THE YEAR.Description
Total Program Service Expense8463357TotalProgramServiceExpense
Described In501 C31DescribedIn501C3
Schedule B Required1ScheduleBRequired
Political Activities0PoliticalActivities
Lobbying Activities0LobbyingActivities
Subject To Proxy Tax0SubjectToProxyTax
Donor Advised Funds0DonorAdvisedFunds
Conservation Easements0ConservationEasements
Collections Of Art0CollectionsOfArt
Credit Counseling0CreditCounseling
Term Or Permanent Endowments0TermOrPermanentEndowments
Report Land Bldg Equip1ReportLandBldgEquip
Report Invest Oth Securities0ReportInvestOthSecurities
Report Prog Rel Invest0ReportProgRelInvest
Report Other Assets0ReportOtherAssets
Report Other Liabilities1ReportOtherLiabilities
Report Fin48 Footnote1ReportFin48Footnote
Independent Audit Financial Stmt0IndependentAuditFinancialStmt
Consolidated Audit Financial Stmt1ConsolidatedAuditFinancialStmt
School0School
Foreign Office0ForeignOffice
Foreign Activities0ForeignActivities
More Than5000 K To Organizations0MoreThan5000KToOrganizations
More Than5000 K To Individuals0MoreThan5000KToIndividuals
Professional Fundraising0ProfessionalFundraising
Fundraising Activities0FundraisingActivities
Gaming0Gaming
Hospital1Hospital
Financial Stmt Attached1FinancialStmtAttached
Grants To Organizations0GrantsToOrganizations
Grants To Individuals0GrantsToIndividuals
Schedule J Required0ScheduleJRequired
Tax Exempt Bonds1TaxExemptBonds
Invest Tax Exempt Bonds0InvestTaxExemptBonds
Escrow Account0EscrowAccount
On Behalf Of Issuer0OnBehalfOfIssuer
Excess Benefit Transaction0ExcessBenefitTransaction
Prior Excess Benefit Transaction0PriorExcessBenefitTransaction
Loan To Officer Or DQP0LoanToOfficerOrDQP
Grant To Related Person0GrantToRelatedPerson
Bsnss Rltnshp With Organization0BsnssRltnshpWithOrganization
Bsnss Rltnshp Thru Family Member0BsnssRltnshpThruFamilyMember
Officer Entity With Bsnss Rltnshp0OfficerEntityWithBsnssRltnshp
Deductible Non Cash Contributions0DeductibleNonCashContributions
Deductible Contributions Of Art0DeductibleContributionsOfArt
Terminated0Terminated
Partial Liquidation0PartialLiquidation
Disregarded Entity0DisregardedEntity
Related Entity1RelatedEntity
Related Org Controlled Entity1RelatedOrgControlledEntity
Transaction Related Entity0TransactionRelatedEntity
Transfers To Exempt Non Chrtbl Org0TransfersToExemptNonChrtblOrg
Activities Conducted Partnership0ActivitiesConductedPartnership
Schedule O Required1ScheduleORequired
Number Forms Transmitted With109661NumberFormsTransmittedWith1096
Number W2 G Included0NumberW2GIncluded
Number Of Employees113NumberOfEmployees
Employment Tax Returns Filed1EmploymentTaxReturnsFiled
Unrelated Business Income0UnrelatedBusinessIncome
Foreign Financial Account0ForeignFinancialAccount
Prohibited Tax Shelter Trans0ProhibitedTaxShelterTrans
Taxable Party Notification0TaxablePartyNotification
Non Deductible Contributions0NonDeductibleContributions
Quid Pro Quo Contributions0QuidProQuoContributions
Form8282 Property Disposed Of0Form8282PropertyDisposedOf
Funds To Pay Premiums0FundsToPayPremiums
Premiums Paid0PremiumsPaid
Indoor Tanning Services0IndoorTanningServices
Info In Schedule O Part VIXInfoInScheduleOPartVI
Nbr Voting Governing Body Members8NbrVotingGoverningBodyMembers
Number Independent Voting Members8NumberIndependentVotingMembers
Family Or Business Relationship0FamilyOrBusinessRelationship
Delegation Of Management Duties0DelegationOfManagementDuties
Changes To Organizing Docs0ChangesToOrganizingDocs
Material Diversion Or Misuse0MaterialDiversionOrMisuse
Members Or Stockholders1MembersOrStockholders
Election Of Board Members1ElectionOfBoardMembers
Decisions Subject To Approval1DecisionsSubjectToApproval
Minutes Of Governing Body1MinutesOfGoverningBody
Minutes Of Committees1MinutesOfCommittees
Officer Mailing Address0OfficerMailingAddress
Local Chapters0LocalChapters
Form990 Provided To Governing Body1Form990ProvidedToGoverningBody
Conflict Of Interest Policy1ConflictOfInterestPolicy
Annual Disclosure Covered Persons1AnnualDisclosureCoveredPersons
Regular Monitoring Enforcement1RegularMonitoringEnforcement
Whistleblower Policy1WhistleblowerPolicy
Document Retention Policy1DocumentRetentionPolicy
Compensation Process CEO1CompensationProcessCEO
Compensation Process Other1CompensationProcessOther
Investment In Joint Venture0InvestmentInJointVenture
States Where Copy Of Return Is FiledMNStatesWhereCopyOfReturnIsFiled
Upon RequestXUponRequest

The Books Are In Care Of TheBooksAreInCareOf

Name Business NameBusiness

FieldValueIRS element (for citing)
Business Name Line1DONNA KLINKNERBusinessNameLine1
FieldValueIRS element (for citing)
Telephone Number5076423255TelephoneNumber

Address US AddressUS

FieldValueIRS element (for citing)
Address Line1121 DREW AVENUE SOUTHEASTAddressLine1
CityMADELIACity
StateMNState
ZIP Code56062ZIPCode

Form990 Part VII Section A Form990PartVIISectionA (10 entries)

TitleTitleAverage Hours Per WeekAverageHoursPerWeekIndividual Trustee Or DirectorIndividualTrusteeOrDirectorOfficerOfficerReportable Comp From OrganizationReportableCompFromOrganizationReportable Comp From Related OrgsReportableCompFromRelatedOrgsOther CompensationOtherCompensation
STEVEN COOLING
BOARD PRESIDENT1.00XX180000
TOM MCCABE
BOARD VICE PRESIDENT & TREASURER1.00XX180000
BARBARA OVERLIE
BOARD SECRETARY1.00XX180000
CHUCK VOSS
BOARD MEMBER1.00X120000
DENNIS ARDUSER
BOARD MEMBER1.00X120000
MARK CHRISTENSON
BOARD MEMBER1.00X120000
NORMA KRUMWIEDE
BOARD MEMBER1.00X120000
SHEILA SPITZNER
BOARD MEMBER1.00X120000
CANDACE FENSKE
CEO40.00X123135012278
DONNA KLINKNER
CFO40.00X94055012067
FieldValueIRS element (for citing)
Total Reportable Comp From Org228590TotalReportableCompFromOrg
Total Reportable Comp Frm Rltd Orgs0TotalReportableCompFrmRltdOrgs
Total Other Compensation24345TotalOtherCompensation
Number Individuals GT100 K1NumberIndividualsGT100K
Formers Listed0FormersListed
Total Comp GT150 K0TotalCompGT150K
Compensation From Other Sources0CompensationFromOtherSources

Contractor Compensation ContractorCompensation (3 entries)

Address Line1AddressOfContractor/AddressUS/AddressLine1CityAddressOfContractor/AddressUS/CityStateAddressOfContractor/AddressUS/StateZIP CodeAddressOfContractor/AddressUS/ZIPCodeDescription Of ServicesDescriptionOfServicesCompensationCompensation
WHITESELL MEDICAL STAFFING
1630 ANDERSON AVEBUFFALOMN55313ER & CLINIC PHYSICIAN COVERAGE401777
MADELIA PHYSICIANS
115 DREW AVE SEMADELIAMN56062EMERGENCY ROOM PHYSICIAN COVERAGE192965
EXPERIENCED RESOURCES
PO BOX 201005BLOOMINGTONMN55420CLINIC MGMT STAFFING AGENCY111629
FieldValueIRS element (for citing)
Number Of Contractors GT100 K3NumberOfContractorsGT100K
Government Grants55025GovernmentGrants
All Other Contributions508840AllOtherContributions
Total Contributions563865TotalContributions

Program Service Revenue ProgramServiceRevenue (4 entries)

DescriptionDescriptionBusiness CodeBusinessCodeTotal Revenue ColumnTotalRevenueColumnRelated Or Exempt Function IncomeRelatedOrExemptFunctionIncome
NET PATIENT REVENUE62410081461388146138
PHYSICAL THERAPY6243102907329073
LABORATORY62150043744374
SALE OF DRUGS446110359359
FieldValueIRS element (for citing)
Total Program Service Revenue8179944TotalProgramServiceRevenue

Investment Income InvestmentIncome

FieldValueIRS element (for citing)
Total Revenue Column147152TotalRevenueColumn
Exclusion$147,152ExclusionAmount

Royalties Revenue RoyaltiesRevenue

FieldValueIRS element (for citing)
Total Revenue Column37409TotalRevenueColumn
Exclusion$37,409ExclusionAmount

Gross Rents GrossRents

FieldValueIRS element (for citing)
Real79328Real

Less Rental Expenses LessRentalExpenses

FieldValueIRS element (for citing)
Real86381Real

Rental Income Or Loss RentalIncomeOrLoss

FieldValueIRS element (for citing)
Real-7053Real

Net Rental Income Or Loss NetRentalIncomeOrLoss

FieldValueIRS element (for citing)
Total Revenue Column-7053TotalRevenueColumn
Exclusion-$7,053ExclusionAmount

Gross Amount Sales Assets GrossAmountSalesAssets

FieldValueIRS element (for citing)
Other16568Other

Less Cost Oth Basis Sales Expenses LessCostOthBasisSalesExpenses

FieldValueIRS element (for citing)
Other0Other

Gain Or Loss GainOrLoss

FieldValueIRS element (for citing)
Other16568Other

Net Gain Or Loss Investments NetGainOrLossInvestments

FieldValueIRS element (for citing)
Total Revenue Column16568TotalRevenueColumn
Exclusion$16,568ExclusionAmount

Other Revenue Misc OtherRevenueMisc (3 entries)

DescriptionDescriptionBusiness CodeBusinessCodeTotal Revenue ColumnTotalRevenueColumnExclusionExclusionAmount
MISCELLANEOUS90009944410$44,410
EMPLOYEE MEALS90009921925$21,925
MEDICAL RECORDS9000991789$1,789
FieldValueIRS element (for citing)
Total Other Revenue68124TotalOtherRevenue

Total Revenue TotalRevenue

FieldValueIRS element (for citing)
Total Revenue Column9006009TotalRevenueColumn
Related Or Exempt Function Income8179944RelatedOrExemptFunctionIncome
Unrelated Business Revenue0UnrelatedBusinessRevenue
Exclusion$262,200ExclusionAmount

Comp Current Officers Directors CompCurrentOfficersDirectors

FieldValueIRS element (for citing)
Total241535Total
Management And General241535ManagementAndGeneral

Other Salaries And Wages OtherSalariesAndWages

FieldValueIRS element (for citing)
Total4405943Total
Program Services3836412ProgramServices
Management And General569531ManagementAndGeneral

Pension Plan Contributions PensionPlanContributions

FieldValueIRS element (for citing)
Total131779Total
Program Services97667ProgramServices
Management And General34112ManagementAndGeneral

Other Employee Benefits OtherEmployeeBenefits

FieldValueIRS element (for citing)
Total491810Total
Program Services334431ProgramServices
Management And General157379ManagementAndGeneral

Payroll Taxes PayrollTaxes

FieldValueIRS element (for citing)
Total260881Total
Program Services204599ProgramServices
Management And General56282ManagementAndGeneral

Fees For Services Other FeesForServicesOther

FieldValueIRS element (for citing)
Total179109Total
Program Services70777ProgramServices
Management And General108332ManagementAndGeneral

Information Technology InformationTechnology

FieldValueIRS element (for citing)
Total173506Total
Management And General173506ManagementAndGeneral

Travel Travel

FieldValueIRS element (for citing)
Total91685Total
Program Services64034ProgramServices
Management And General27651ManagementAndGeneral

Interest Interest

FieldValueIRS element (for citing)
Total313786Total
Program Services313786ProgramServices

Depreciation Depletion DepreciationDepletion

FieldValueIRS element (for citing)
Total1006001Total
Program Services1006001ProgramServices

Other Expenses OtherExpenses (4 entries)

DescriptionDescriptionTotalTotalProgram ServicesProgramServicesManagement And GeneralManagementAndGeneral
SUPPLIES14616021461602
ADMIN EXPENSES469402469402
BAD DEBTS390093390093
REPAIRS/MAINTENANCE342560342560

All Other Expenses AllOtherExpenses

FieldValueIRS element (for citing)
Total404895Total
Program Services341395ProgramServices
Management And General63500ManagementAndGeneral

Total Functional Expenses TotalFunctionalExpenses

FieldValueIRS element (for citing)
Total10364587Total
Program Services8463357ProgramServices
Management And General1901230ManagementAndGeneral
Fundraising0Fundraising

Cash Non Interest Bearing CashNonInterestBearing

FieldValueIRS element (for citing)
BOY2425712BOY
EOY807883EOY

Savings And Temp Cash Investments SavingsAndTempCashInvestments

FieldValueIRS element (for citing)
BOY5077189BOY
EOY5210180EOY

Pledges And Grants Receivable PledgesAndGrantsReceivable

FieldValueIRS element (for citing)
BOY49806BOY
EOY3000EOY

Accounts Receivable AccountsReceivable

FieldValueIRS element (for citing)
BOY1825116BOY
EOY2627633EOY

Inventories For Sale Or Use InventoriesForSaleOrUse

FieldValueIRS element (for citing)
BOY177928BOY
EOY165658EOY

Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges

FieldValueIRS element (for citing)
BOY80597BOY
EOY72490EOY
FieldValueIRS element (for citing)
Land Buildings Equipment Basis16655126LandBuildingsEquipmentBasis
Land Bldg Equipment Accum Deprec7707863LandBldgEquipmentAccumDeprec

Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet

FieldValueIRS element (for citing)
BOY9390662BOY
EOY8947263EOY

Investments Pub Traded Securities InvestmentsPubTradedSecurities

FieldValueIRS element (for citing)
BOY1307225BOY
EOY899889EOY

Other Assets Total OtherAssetsTotal

FieldValueIRS element (for citing)
BOY746822BOY
EOY808306EOY

Total Assets TotalAssets

FieldValueIRS element (for citing)
BOY21081057BOY
EOY19542302EOY

Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses

FieldValueIRS element (for citing)
BOY1053728BOY
EOY956869EOY

Tax Exempt Bond Liabilities TaxExemptBondLiabilities

FieldValueIRS element (for citing)
BOY5765000BOY
EOY5650000EOY

Mort Notes Pybl Secured Invest Prop MortNotesPyblSecuredInvestProp

FieldValueIRS element (for citing)
BOY57986BOY
EOY85473EOY

Other Liabilities OtherLiabilities

FieldValueIRS element (for citing)
BOY40000BOY
EOY40000EOY

Total Liabilities TotalLiabilities

FieldValueIRS element (for citing)
BOY6916714BOY
EOY6732342EOY
FieldValueIRS element (for citing)
Follow SFAS117XFollowSFAS117

Unrestricted Net Assets UnrestrictedNetAssets

FieldValueIRS element (for citing)
BOY14164343BOY
EOY12809960EOY

Total Net Assets Fund Balances TotalNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY14164343BOY
EOY12809960EOY

Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY21081057BOY
EOY19542302EOY
FieldValueIRS element (for citing)
Info In Schedule O Part XIXInfoInScheduleOPartXI
Reconcilation Revenue Expenses-1358578ReconcilationRevenueExpenses
Reconcilation Other Changes4195ReconcilationOtherChanges
Info In Schedule O Part XIIXInfoInScheduleOPartXII
Method Of Accounting AccrualXMethodOfAccountingAccrual
Accountant Compile Or Review0AccountantCompileOrReview
FS Audited1FSAudited
Audit Committee1AuditCommittee
Financial Statement ConsolidatedXFinancialStatementConsolidated
Federal Grant Audit Required0FederalGrantAuditRequired

Schedule A IRS990ScheduleA

FieldValueIRS element (for citing)
Hospital170b1 AiiiXHospital170b1Aiii

Schedule B IRS990ScheduleB

Contributor Info ContributorInfo

FieldValueIRS element (for citing)
Contributor NumberRESTRICTEDContributorNumber

Contributor Name Business ContributorNameBusiness

FieldValueIRS element (for citing)
Business Name Line1RESTRICTEDBusinessNameLine1

Contributor Address US ContributorAddressUS

FieldValueIRS element (for citing)
Address Line1RESTRICTEDAddressLine1
Address Line2RESTRICTEDAddressLine2
CityRESTRICTEDCity
StateRESTRICTEDState
ZIP CodeRESTRICTEDZIPCode
FieldValueIRS element (for citing)
Aggregate ContributionsRESTRICTEDAggregateContributions

Schedule D IRS990ScheduleD

Land Land

FieldValueIRS element (for citing)
Other Cost Or Other Basis185447OtherCostOrOtherBasis
Book Value185447BookValue

Buildings Buildings

FieldValueIRS element (for citing)
Other Cost Or Other Basis6915366OtherCostOrOtherBasis
Depreciation2750207Depreciation
Book Value4165159BookValue

Leasehold Improvements LeaseholdImprovements

FieldValueIRS element (for citing)
Other Cost Or Other Basis4609729OtherCostOrOtherBasis
Depreciation1516635Depreciation
Book Value3093094BookValue

Equipment Equipment

FieldValueIRS element (for citing)
Other Cost Or Other Basis4944584OtherCostOrOtherBasis
Depreciation3441021Depreciation
Book Value1503563BookValue
FieldValueIRS element (for citing)
Total Of Book Value Land Buildings8947263TotalOfBookValueLandBuildings

Other Liabilities OtherLiabilities

FieldValueIRS element (for citing)
DescriptionASSET RETIREMENT OBLIGATIONDescription
Amount$40,000Amount
FieldValueIRS element (for citing)
Total Of Amounts40000TotalOfAmounts

Form990 Schedule D Part XIV Form990ScheduleDPartXIV

FieldValueIRS element (for citing)
IdentifierDESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48:Identifier
Return ReferencePART X:ReturnReference
ExplanationTHE 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 HAS ELECTED TO ADOPT GUIDANCE IN THE INCOME TAX STANDARD REGARDING RECOGNITION AND MEASUREMENT OF UNCERTAIN TAX POSITIONS. THE HOSPITAL FOLLOWS THE ACCOUNTING STANDARD FOR CONTINGENCIES FOR EVALUATING UNCERTAIN TAX POSITIONS. THE ADOPTION OF THIS STANDARD HAS NO EFFECT ON THE FINANCIAL STATEMENTS. THE HOSPITAL'S TAX RETURNS ARE SUBJECT TO REVIEW AND EXAMINATION BY FEDERAL, STATE, AND LOCAL AUTHORITIES. THE TAX RETURNS FOR THE YEARS 2009 TO 2011 ARE OPEN TO EXAMINATION BY FEDERAL, STATE AND LOCAL AUTHORITIES.Explanation

Schedule H IRS990ScheduleH

FieldValueIRS element (for citing)
Charity Care Policy1CharityCarePolicy
Written Policy1WrittenPolicy
Policy Applied To All HospitalsXPolicyAppliedToAllHospitals
FPG Reference Free Care1FPGReferenceFreeCare
Pcent100XPcent100
FPG Reference Discounted Care1FPGReferenceDiscountedCare

Discounted Other DiscountedOther

FieldValueIRS element (for citing)
OtherXOther
Discounted Other Percentage100.000000000000DiscountedOtherPercentage
FieldValueIRS element (for citing)
Free Disc Care Medically Indigent1FreeDiscCareMedicallyIndigent
Amounts Budgeted For Charity Care1AmountsBudgetedForCharityCare
Expenses Exceeded Budget0ExpensesExceededBudget
Annual Community Benefit Report1AnnualCommunityBenefitReport
Report Publically Available0ReportPublicallyAvailable

Charity Care At Cost CharityCareAtCost

FieldValueIRS element (for citing)
Total Community Benefit Expense141403TotalCommunityBenefitExpense
Net Community Benefit Expense141403NetCommunityBenefitExpense
Percent Of Total Expense0.01360PercentOfTotalExpense

Unreimbursed Medicaid UnreimbursedMedicaid

FieldValueIRS element (for citing)
Total Community Benefit Expense1042237TotalCommunityBenefitExpense
Direct Offsetting Revenue522534DirectOffsettingRevenue
Net Community Benefit Expense519703NetCommunityBenefitExpense
Percent Of Total Expense0.05010PercentOfTotalExpense

Total Charity Care TotalCharityCare

FieldValueIRS element (for citing)
Total Community Benefit Expense1183640TotalCommunityBenefitExpense
Direct Offsetting Revenue522534DirectOffsettingRevenue
Net Community Benefit Expense661106NetCommunityBenefitExpense
Percent Of Total Expense0.06370PercentOfTotalExpense

Community Health Services CommunityHealthServices

FieldValueIRS element (for citing)
Total Community Benefit Expense175216TotalCommunityBenefitExpense
Net Community Benefit Expense175216NetCommunityBenefitExpense
Percent Of Total Expense0.01690PercentOfTotalExpense

Health Professions Education HealthProfessionsEducation

FieldValueIRS element (for citing)
Total Community Benefit Expense38864TotalCommunityBenefitExpense
Net Community Benefit Expense38864NetCommunityBenefitExpense
Percent Of Total Expense0.00370PercentOfTotalExpense

Total Other Benefits TotalOtherBenefits

FieldValueIRS element (for citing)
Total Community Benefit Expense214080TotalCommunityBenefitExpense
Net Community Benefit Expense214080NetCommunityBenefitExpense
Percent Of Total Expense0.02060PercentOfTotalExpense

Total Community Benefits TotalCommunityBenefits

FieldValueIRS element (for citing)
Total Community Benefit Expense1397720TotalCommunityBenefitExpense
Direct Offsetting Revenue522534DirectOffsettingRevenue
Net Community Benefit Expense875186NetCommunityBenefitExpense
Percent Of Total Expense0.08430PercentOfTotalExpense

Community Support CommunitySupport

FieldValueIRS element (for citing)
Total Community Building Expense523TotalCommunityBuildingExpense
Net Community Building Expense523NetCommunityBuildingExpense
Percent Of Total Expense0.00010PercentOfTotalExpense

Leadership Development LeadershipDevelopment

FieldValueIRS element (for citing)
Total Community Building Expense4422TotalCommunityBuildingExpense
Net Community Building Expense4422NetCommunityBuildingExpense
Percent Of Total Expense0.00040PercentOfTotalExpense

Coalition Building CoalitionBuilding

FieldValueIRS element (for citing)
Total Community Building Expense4749TotalCommunityBuildingExpense
Net Community Building Expense4749NetCommunityBuildingExpense
Percent Of Total Expense0.00050PercentOfTotalExpense

Health Improvement Advocacy HealthImprovementAdvocacy

FieldValueIRS element (for citing)
Total Community Building Expense13621TotalCommunityBuildingExpense
Net Community Building Expense13621NetCommunityBuildingExpense
Percent Of Total Expense0.00130PercentOfTotalExpense

Total Total

FieldValueIRS element (for citing)
Total Community Building Expense23315TotalCommunityBuildingExpense
Net Community Building Expense23315NetCommunityBuildingExpense
Percent Of Total Expense0.00230PercentOfTotalExpense
FieldValueIRS element (for citing)
Bad Debt Expense Reported1BadDebtExpenseReported
Bad Debt Expense$390,093BadDebtExpenseAmount
Amount Attributable To7802AmountAttributableTo
Amount Reimbursed By Medicare4056326AmountReimbursedByMedicare
Cost Of Care Reimbursed By Medicare4032240CostOfCareReimbursedByMedicare
Medicare Surplus Or Shortfall24086MedicareSurplusOrShortfall

Costing Methodology Used CostingMethodologyUsed

FieldValueIRS element (for citing)
Cost To Charge RatioXCostToChargeRatio
FieldValueIRS element (for citing)
Written Debt Collection Policy1WrittenDebtCollectionPolicy
Provision For Charity Care1ProvisionForCharityCare

Form990 Schedule H Part IV Form990ScheduleHPartIV

Name Of Entity NameOfEntity

FieldValueIRS element (for citing)
Business Name Line11 NABusinessNameLine1
FieldValueIRS element (for citing)
Number Of Hospital Facilities1NumberOfHospitalFacilities

Form990 Schedule H Part V Section A Form990ScheduleHPartVSectionA

FieldValueIRS element (for citing)
Facility Number1FacilityNumber

Name Name

FieldValueIRS element (for citing)
Business Name Line1MADELIA COMMUNITY HOSPITALBusinessNameLine1

Address Address

FieldValueIRS element (for citing)
Address Line1121 DREW AVE SEAddressLine1
CityMADELIACity
StateMNState
ZIP Code56062ZIPCode
FieldValueIRS element (for citing)
General Medical And SurgicalXGeneralMedicalAndSurgical

Form990 Schedule H Part V Section B Form990ScheduleHPartVSectionB

Hospital Facility Name HospitalFacilityName

FieldValueIRS element (for citing)
Business Name Line1MADELIA COMMUNITY HOSPITAL INCORPORATEDBusinessNameLine1
FieldValueIRS element (for citing)
Hospital Facility Number1HospitalFacilityNumber
Eligibility Criteria Explained1EligibilityCriteriaExplained
Uses FPG Free1UsesFPGFree
FPG Free Percent100.000000000000FPGFreePercent
Uses FPG Discounted1UsesFPGDiscounted
FPG Discount Percent100.000000000000FPGDiscountPercent
Explains Basis1ExplainsBasis
Income LevelXIncomeLevel
Medical IndigencyXMedicalIndigency
Insurance StatusXInsuranceStatus
Uninsured DiscountXUninsuredDiscount
Medicaid MedicareXMedicaidMedicare
State RegulationXStateRegulation
Other FactorsXOtherFactors
Explains Application Method1ExplainsApplicationMethod
Includes Publicity Measures1IncludesPublicityMeasures
Attached To InvoicesXAttachedToInvoices
Posted In Emergency RoomXPostedInEmergencyRoom
Posted In Admission OfficeXPostedInAdmissionOffice
Available On RequestXAvailableOnRequest
Other PublicityXOtherPublicity
Actions On Nonpayment1ActionsOnNonpayment
Permit Other ActionsXPermitOtherActions
Collection Activities1CollectionActivities
Report To Credit AgencyXReportToCreditAgency
LawsuitXLawsuit
Lien On ResidenceXLienOnResidence
Body AttachmentXBodyAttachment
Other ActionsXOtherActions
Notify Upon AdmissionXNotifyUponAdmission
Notified All PatientsXNotifiedAllPatients
Documented DeterminationXDocumentedDetermination
Other Actions TakenXOtherActionsTaken
Nondiscrim Emergency Care Policy1NondiscrimEmergencyCarePolicy
Used Other MethodXUsedOtherMethod
Amounts Generally Billed0AmountsGenerallyBilled
Gross Charges0GrossCharges

Form990 Schedule H Part VI Form990ScheduleHPartVI (18 entries)

ExplanationExplanationIdentifierIdentifierReturn ReferenceReturnReference
PART I, LINE 7: THE AMOUNTS REPORTED IN PART I, LINE 7 WERE COMPUTED USING A RATIO OF COST TO CHARGES THAT WAS DERIVED FROM WORKSHEET 2 OF THE SCHEDULE H INSTRUCTIONS.
PART I, L7 COL(F): BAD DEBT EXPENSE OF $390,093 WAS SUBTRACTED FROM TOTAL EXPENSES OF $10,364,587 IN CALCULATING THE PERCENTAGES IN PART I, LINE 7, COLUMN F. IN HOUSE UNINSURED/UNDERINSURED THAT QUALIFIED FOR FINANCIAL ASSISTANCE FOR THE YEAR END WAS 2% OF TOTAL BAD DEBTS ACCOUNT AS REFLECTED IN PART III, LINE 3. CHARITY CARE ACCOUNTS ARE NOT INCLUDED IN BAD DEBTS.
PART II: STAFF PARTICIPATE IN COMMUNITY ORGANIZATIONS TO PROVIDE HEALTHCARE REPRESENTATION AND INFORMATION TO ENHANCE THOSE ORGANIZATIONS EVENTS, ETC. THE CULTURE OF WELLNESS IS A COMMUNITY BASED PROJECT THAT MADELIA COMMUNITY HOSPITAL PARTICIPATED IN TO SUPPORT HEALTHY LIFE STYLES.
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."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 8: THERE WAS NO SHORTFALL REPORTED IN PART III, LINE 7. FROM PART III, LINE 6, THE TOTAL ALLOWABLE COST REPORTED TO MEDICARE WAS BASED ON THE 2012 FILED MEDICARE COST REPORT.
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 PATIENTS LACK OF FINANCES WARRANT THIS AND CHARITY CARE THE BEST ETHICAL DECISION FOR THE PATIENT.
PART V, SECTION B, LINE 9: ALL PATIENTS ARE CHARGED THE SAME FOR SERVICES RENDERED AT MCH NO MATTER WHAT THE PATIENT'S FINANCIAL STATUS CONSISTS OF.MADELIA COMMUNITY HOSPITAL, INCORPORATED
PART V, SECTION B, LINE 10: ALL PATIENTS ARE CHARGED THE SAME FOR SERVICES RENDERED AT MCH NO MATTER WHAT THE PATIENT'S FINANCIAL STATUS CONSISTS OF.MADELIA COMMUNITY HOSPITAL, INCORPORATED
PART V, SECTION B, LINE 11H: ALL PATIENTS ARE CHARGED THE SAME FOR SERVICES RENDERED AT MCH NO MATTER WHAT THE PATIENT'S FINANCIAL STATUS CONSISTS OF.MADELIA COMMUNITY HOSPITAL, INCORPORATED
PART V, SECTION B, LINE 15E: ANY TYPE OF COLLECTION ACTIONS FOR PAYMENT ARE HANDLED THROUGH THE CONTRACTED COLLECTION AGENCY.MADELIA COMMUNITY HOSPITAL, INCORPORATED
PART V, SECTION B, LINE 16E: THE COLLECTION AGENCY USES SEVERAL METHODS IN ATTEMPT TO COLLECT PAYMENT OF PATIENT BILLS. THEY NOTIFY MCH PRIOR TO TAKING ANY LEGAL ACTIONS IN CASE THERE HAS BEEN ANY NEW PATIENT ACCOUNT DEVELOPMENT OR COMMUNICATION OF PAYMENT ARRANGEMENTS.MADELIA COMMUNITY HOSPITAL, INCORPORATED
PART V, SECTION B, LINE 17E: 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 19D: ALL PATIENTS ARE TREATED AND CHARGED THE SAME FOR ANY MCH SERVICES.MADELIA COMMUNITY HOSPITAL, INCORPORATED
PART VI, LINE 2: 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 ATHLETES 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. 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 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"!
MNREPORTS FILED WITH STATESPART VI, LINE 7

Schedule K IRS990ScheduleK

Form990 Schedule K Part I Form990ScheduleKPartI

Issuer Name IssuerName

FieldValueIRS element (for citing)
Business Name Line1CITY OF MADELIABusinessNameLine1
FieldValueIRS element (for citing)
Issuer EIN416005334IssuerEIN
CUSIP Number556401AR8CUSIPNumber
Date Issued2006-10-01DateIssued
Issue Price6495000IssuePrice
Description Of PurposeCONSTRUCT HOSPITAL ADDITIONDescriptionOfPurpose
Defeased0Defeased
On Behalf Of Issuer0OnBehalfOfIssuer
Pool Financing0PoolFinancing

Form990 Schedule K Part II Form990ScheduleKPartII

FieldValueIRS element (for citing)
Amount Retired845000AmountRetired
Total Proceeds6495000TotalProceeds
Capitalized Interest161893CapitalizedInterest
Issuance Costs From Proceeds16238IssuanceCostsFromProceeds
Credit Enhancement113662CreditEnhancement
Capital Expenditures6203207CapitalExpenditures
Year Of Subst Completion2008YearOfSubstCompletion
Current Refunding0CurrentRefunding
Advance Refunding0AdvanceRefunding
Final Allocation Made1FinalAllocationMade
Adequate Books And Recds Maintaind1AdequateBooksAndRecdsMaintaind

Form990 Schedule K Part III Form990ScheduleKPartIII

FieldValueIRS element (for citing)
Owning Bond Financed Property0OwningBondFinancedProperty
Any Lease Arrangements0AnyLeaseArrangements
Mngment Cntrct Bond Financd Prprty0MngmentCntrctBondFinancdPrprty
Any Research Agreements0AnyResearchAgreements
Prcntge Prvt Business Use By Others0.00000PrcntgePrvtBusinessUseByOthers
Percentage Of Prvt Business Re UBI0.00000PercentageOfPrvtBusinessReUBI
Total Private Business Use0.00000TotalPrivateBusinessUse
Post Issuance Compliance Procdrs1PostIssuanceComplianceProcdrs

Form990 Schedule K Part IV Form990ScheduleKPartIV

FieldValueIRS element (for citing)
Form8038 T Filed0Form8038TFiled
Variable Rate Issue0VariableRateIssue
Hedge Identified In Books And Recds0HedgeIdentifiedInBooksAndRecds
Gross Proceeds Invested In GIC0GrossProceedsInvestedInGIC
Gross Proceeds Invested0GrossProceedsInvested
Exception To Rebate1ExceptionToRebate

Schedule O IRS990ScheduleO

General Explanation GeneralExplanation (11 entries)

IdentifierIdentifierReturn ReferenceReturnReferenceExplanationExplanation
NEW PROGRAM SERVICESFORM 990, PART III, LINE 2THE ORGANIZATION ADDED A PROVIDER BASE CLINIC TO CONTINUE PROVIDING HEALTHCARE SERVICES LOCALLY FOR THE COMMUNITIES THAT THEY SERVE.
CHANGES IN PROGRAM SERVICESFORM 990, PART III, LINE 3THE ORGANIZATION NOW HAS NO PHYSICIANS TO PROVIDE OB DELIVERY AT THE LOCAL FACILITY.
FORM 990, PART VI, SECTION A, LINE 6MEMBERSHIP 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 7AALL TRUSTEES ARE ELECTED BY THE MEMBERS.
FORM 990, PART VI, SECTION A, LINE 7BCORPORATE 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 11THE FORM 990 IS REVIEWED BY THE BOARD OF DIRECTORS FOR APPROVAL BEFORE IT 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 12CTHE CONFLICT OF INTEREST POLICY IS REVIEWED AT THE ANNUAL BOARD MEETING AND THROUGH THE BOARD AND DEPARTMENT HEADS. IF ANY CONFLICTS OF INTEREST ARISE, NOTIFICATIONS 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 15MADELIA 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 FEBRUARY 2012) AND THE BASIS IS ANNUAL 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 19MADELIA 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.
CHANGES IN NET ASSETS OR FUND BALANCES:FORM 990, PART XI, LINE 5:NET UNREALIZED GAINS ON INVESTMENTS: 4,195.
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.

Schedule R IRS990ScheduleR

Form990 Schedule R Part II Form990ScheduleRPartII

Name Of Disregarded Entity NameOfDisregardedEntity

FieldValueIRS element (for citing)
Business Name Line1MADELIA COMMUNITY HOSPITAL FOUNDATIONBusinessNameLine1

Address US AddressUS

FieldValueIRS element (for citing)
Address Line1121 DREW AVENUE SEAddressLine1
CityMADELIACity
StateMNState
ZIP Code56062ZIPCode
FieldValueIRS element (for citing)
EIN731719218EIN
Primary ActivitiesSOLICIT CONTRIBUTIONS ON BEHALF OF THE MADELIA COMMUNITY HOSPITAL.PrimaryActivities
Legal Domicile StateMNLegalDomicileState
Exempt Code Section501(C)(3)ExemptCodeSection
Public Charity Status11 - TYPE 1PublicCharityStatus

Direct Controlling Entity Name DirectControllingEntityName

FieldValueIRS element (for citing)
Business Name Line1MADELIA COMMUNITY HOSPITAL INCBusinessNameLine1
FieldValueIRS element (for citing)
Controlled Org1ControlledOrg
FieldValueIRS element (for citing)
Receipt Of Int Ann Rents Royalties0ReceiptOfIntAnnRentsRoyalties
Gift Grant Or Cap Contr To Other Org0GiftGrantOrCapContrToOtherOrg
Gift Grant Or Cap Contr Fr Other Org0GiftGrantOrCapContrFrOtherOrg
Loans Or Guarantees To Other Org0LoansOrGuaranteesToOtherOrg
Loans Or Guarantees From Other Org0LoansOrGuaranteesFromOtherOrg
Sale Of Assets To Other Org0SaleOfAssetsToOtherOrg
Purchase Of Assets From Other Org0PurchaseOfAssetsFromOtherOrg
Exchange Of Assets0ExchangeOfAssets
Rental Of Facilities To Other Orgs0RentalOfFacilitiesToOtherOrgs
Rental Of Facilities Fr Other Orgs0RentalOfFacilitiesFrOtherOrgs
Perform Of Services For Other Orgs1PerformOfServicesForOtherOrgs
Perform Of Services By Other Orgs1PerformOfServicesByOtherOrgs
Sharing Of Facilities1SharingOfFacilities
Sharing Of Paid Employees1SharingOfPaidEmployees
Reimbursement Paid To Other Org0ReimbursementPaidToOtherOrg
Reimbursement Paid By Other Org0ReimbursementPaidByOtherOrg
Other Transfer To Other Org0OtherTransferToOtherOrg
Other Transfer From Other Org1OtherTransferFromOtherOrg