MADISON HEALTHCARE SERVICES: Form 990, tax year 2009
View the entire original 990 at ProPublica ↗
- Organization
- MADISON HEALTHCARE SERVICES (EIN 41-0706115)
- Tax period
- 2009-10-01 to 2010-09-30
- Filed
- 2011-05-03
- IRS object ID
- 201131239349300723
- Schema version
- 2009v1.7
- 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 C
- Schedule D
- Schedule H
- Schedule J
- Schedule L
- Schedule O
- Schedule R
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Timestamp | 2011-05-03T11:01:38-05:00 | Timestamp |
| Tax Period End Date | 2010-09-30 | TaxPeriodEndDate |
Preparer Firm PreparerFirm
Preparer Firm Business Name PreparerFirmBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | WIPFLI LLP | BusinessNameLine1 |
Preparer Firm US Address PreparerFirmUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 7601 FRANCE AVENUE SOUTH SUITE 400 | AddressLine1 |
| City | MINNEAPOLIS | City |
| State | MN | State |
| ZIP Code | 55435 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnType |
| Tax Period Begin Date | 2009-10-01 | TaxPeriodBeginDate |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 410706115 | EIN |
Name Name
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Madison Lutheran Home | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Control | MADI | NameControl |
| Phone | 3205987536 | Phone |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 900 Second Avenue | AddressLine1 |
| City | Madison | City |
| State | MN | State |
| ZIP Code | 56256 | ZIPCode |
Officer Officer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | Scott Larson | Name |
| Title | CEO | Title |
| Phone | 3205987536 | Phone |
| Date Signed | 2011-04-28 | DateSigned |
| Authorize Third Party | 1 | AuthorizeThirdParty |
Preparer Preparer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | Richard Ruvelson | Name |
| Phone | 9525483400 | Phone |
| Date Prepared | 2011-04-28 | DatePrepared |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax Year | 2009 | TaxYear |
| Build TS | 2016-02-24 21:20:13Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Of Principal Officer Person | Scott Larson | NameOfPrincipalOfficerPerson |
Address Principal Officer US AddressPrincipalOfficerUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 900 Second Avenue | AddressLine1 |
| City | Madison | City |
| State | MN | State |
| ZIP Code | 56256 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | 15892682 | GrossReceipts |
| Group Return For Affiliates | 0 | GroupReturnForAffiliates |
| Group Exemption Number | 9386 | GroupExemptionNumber |
| Organization501c | X | Organization501c |
| Web Site | www.mlhmn.org | WebSite |
| Type Of Organization Corporation | X | TypeOfOrganizationCorporation |
| Year Formation | 1945 | YearFormation |
| State Legal Domicile | MN | StateLegalDomicile |
| Activity Or Mission Description | Madison Lutheran Home, which includes the Madison Hospital, Lac qui Parle Clinic and subsidiaries, exists as a non-profit Christian organization called by God to affirm the worth of all people, to provide health care, residential and community service in a competent and caring manner. | ActivityOrMissionDescription |
| Nbr Voting Members Governing Body | 9 | NbrVotingMembersGoverningBody |
| Nbr Independent Voting Members | 9 | NbrIndependentVotingMembers |
| Total Nbr Employees | 315 | TotalNbrEmployees |
| Total Nbr Volunteers | 500 | TotalNbrVolunteers |
| Total Gross UBI | 1300 | TotalGrossUBI |
| Net Unrelated Business Txbl Income | 0 | NetUnrelatedBusinessTxblIncome |
| Contributions Grants Prior Year | 517504 | ContributionsGrantsPriorYear |
| Contributions Grants Current Year | 1032707 | ContributionsGrantsCurrentYear |
| Program Service Revenue Prior Year | 13735158 | ProgramServiceRevenuePriorYear |
| Program Service Revenue CY | 14389388 | ProgramServiceRevenueCY |
| Investment Income Prior Year | 82324 | InvestmentIncomePriorYear |
| Investment Income Current Year | 103157 | InvestmentIncomeCurrentYear |
| Other Revenue Prior Year | 204671 | OtherRevenuePriorYear |
| Other Revenue Current Year | 363297 | OtherRevenueCurrentYear |
| Total Revenue Prior Year | 14539657 | TotalRevenuePriorYear |
| Total Revenue Current Year | 15888549 | TotalRevenueCurrentYear |
| Grants And Similar Amnts Prior Year | 709 | GrantsAndSimilarAmntsPriorYear |
| Grants And Similar Amnts CY | 4139 | GrantsAndSimilarAmntsCY |
| Benefits Paid To Members CY | 0 | BenefitsPaidToMembersCY |
| Salaries Etc Prior Year | 7656442 | SalariesEtcPriorYear |
| Salaries Etc Current Year | 7978803 | SalariesEtcCurrentYear |
| Total Prof Fundrsng Exp CY | 0 | TotalProfFundrsngExpCY |
| Total Fundrsng Exp Current Year | 0 | TotalFundrsngExpCurrentYear |
| Other Expense Prior Year | 5593871 | OtherExpensePriorYear |
| Other Expenses Current Year | 6370572 | OtherExpensesCurrentYear |
| Total Expenses Prior Year | 13251022 | TotalExpensesPriorYear |
| Total Expenses Current Year | 14353514 | TotalExpensesCurrentYear |
| Revenues Less Expenses Prior Year | 1288635 | RevenuesLessExpensesPriorYear |
| Revenues Less Expenses CY | 1535035 | RevenuesLessExpensesCY |
| Total Assets BOY | 17119858 | TotalAssetsBOY |
| Total Assets EOY | 18619443 | TotalAssetsEOY |
| Total Liabilities BOY | 2537067 | TotalLiabilitiesBOY |
| Total Liabilities EOY | 2094609 | TotalLiabilitiesEOY |
| Net Assets Or Fund Balances BOY | 14582791 | NetAssetsOrFundBalancesBOY |
| Net Assets Or Fund Balances EOY | 16524834 | NetAssetsOrFundBalancesEOY |
| Mission Description | Madison Lutheran Home, which includes the Madison Hospital, Lac qui Parle Clinic and subsidiaries, exists as a non-profit Christian organization called by God to affirm the worth of all people, to provide health care, residential and community service in a competent and caring manner. | MissionDescription |
| Significant New Program Services | 0 | SignificantNewProgramServices |
| Significant Change | 0 | SignificantChange |
| Expense | 12877088 | Expense |
| Grants | 4139 | Grants |
| Revenue | 14368781 | Revenue |
| Description | Madison Lutheran Home is a 12-bed hospital, 87 bed nursing facility and clinic located in Madison, Minnesota. The organization also operated a clinic in Marietta, Minnesota.The organization provides home health services. During the year home health had 3,039 skilled nursing visits and 4,768 aide visits, with an average clientele of 43 clients. Home Health also provides Assisted Living services to an average of 29 residents.The hospital provides service to the community in the area of acute inpatient care and skilled swing bed rehabilitation. The nursing home provides quality care of the residents by assisting the residents to achieve their highest level of function.The organization also provides social services by providing emotional, social, and economic support/referral to residents and families, obstetrics, pediatrics, surgery, emergency care, cardiac rehab, outreach and inpatient care. The hospital provided care to 448 inpatients, 2969 outpatient visits, 747 emergency room patients, 9 newborn admits, 48 skilled swing bed admits, and 8 hospice/respite admits.The organization maintains records to identify and monitor the level of charity care it provides. These records include the amount of charges foregone for services and supplies furnished under its charity care policy and equivalent service statistics. The amount of charges foregone, based on established rates, was $19,237.41 for the year ended September 30, 2010. | Description |
Activity2 Activity2
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expense | 238956 | Expense |
| Revenue | 20607 | Revenue |
| Description | The Meals on Wheels program began in the Madison, MN community in 1972. Our goal is service to our community. We provide meals to the town of Madison, and it is a cooperative service with the area churches. The churches provide the volunteer drivers and the Madison Lutheran Home provides the meals. Meals are delivered 5 days a week, including holidays. We send 2 meals, if requested, on Thursdays and Fridays to provide meals through the weekend. The meals include meat, potato, vegetable, dessert, fruit sauce, bread and milk or juice. Our program receives no State of Federal funding. Donations are given to the Meals on Wheels program through area churches, Madison Community Fund, area individuals and other area organizations. These donations help keep the cost reasonable for the participants.Besides the meals we provide, one of the benefits of the program is that someone is checking on the clients daily when the meal is delivered. If a client does not answer the door to accept the meal, we call the client, clients family or proper authorities to check on the safety of the client This program has found community members that have fallen or are in some other difficulty and have helped to obtain needed assistance. This program has been a valuable piece of the services in our community that enable people to stay in their homes. | Description |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Expense | 13116044 | TotalProgramServiceExpense |
| Described In501 C3 | 1 | DescribedIn501C3 |
| Schedule B Required | 1 | ScheduleBRequired |
| Political Activities | 0 | PoliticalActivities |
| Lobbying Activities | 1 | LobbyingActivities |
| Donor Advised Funds | 0 | DonorAdvisedFunds |
| Conservation Easements | 0 | ConservationEasements |
| Collections Of Art | 0 | CollectionsOfArt |
| Credit Counseling | 0 | CreditCounseling |
| Term Or Permanent Endowments | 0 | TermOrPermanentEndowments |
| Balance Sheet Amounts Reported | 1 | BalanceSheetAmountsReported |
| Independent Audit Financial Stmt | 0 | IndependentAuditFinancialStmt |
| Consolidated Audit Financial Stmt | 1 | ConsolidatedAuditFinancialStmt |
| School | 0 | School |
| Foreign Office | 0 | ForeignOffice |
| Foreign Activities | 0 | ForeignActivities |
| More Than5000 K To Organizations | 0 | MoreThan5000KToOrganizations |
| More Than5000 K To Individuals | 0 | MoreThan5000KToIndividuals |
| Professional Fundraising | 0 | ProfessionalFundraising |
| Fundraising Activities | 0 | FundraisingActivities |
| Gaming | 0 | Gaming |
| Hospital | 1 | Hospital |
| Grants To Organizations | 0 | GrantsToOrganizations |
| Grants To Individuals | 0 | GrantsToIndividuals |
| Schedule J Required | 1 | ScheduleJRequired |
| Tax Exempt Bonds | 0 | TaxExemptBonds |
| Excess Benefit Transaction | 0 | ExcessBenefitTransaction |
| Prior Excess Benefit Transaction | 0 | PriorExcessBenefitTransaction |
| Loan To Officer Or DQP | 1 | LoanToOfficerOrDQP |
| Grant To Related Person | 0 | GrantToRelatedPerson |
| Bsnss Rltnshp With Organization | 0 | BsnssRltnshpWithOrganization |
| Bsnss Rltnshp Thru Family Member | 0 | BsnssRltnshpThruFamilyMember |
| Officer Entity With Bsnss Rltnshp | 0 | OfficerEntityWithBsnssRltnshp |
| Deductible Non Cash Contributions | 0 | DeductibleNonCashContributions |
| Deductible Contributions Of Art | 0 | DeductibleContributionsOfArt |
| Terminated | 0 | Terminated |
| Partial Liquidation | 0 | PartialLiquidation |
| Disregarded Entity | 0 | DisregardedEntity |
| Related Entity | 1 | RelatedEntity |
| Related Org Controlled Entity | 0 | RelatedOrgControlledEntity |
| Transfers To Exempt Non Chrtbl Org | 0 | TransfersToExemptNonChrtblOrg |
| Activities Conducted Partnership | 0 | ActivitiesConductedPartnership |
| Schedule O Required | 1 | ScheduleORequired |
| Number Forms Transmitted With1096 | 4 | NumberFormsTransmittedWith1096 |
| Number W2 G Included | 0 | NumberW2GIncluded |
| Number Of Employees | 315 | NumberOfEmployees |
| Employment Tax Returns Filed | 1 | EmploymentTaxReturnsFiled |
| Unrelated Business Income | 1 | UnrelatedBusinessIncome |
| Form990-T Filed | 1 | Form990-TFiled |
| Foreign Financial Account | 0 | ForeignFinancialAccount |
| Prohibited Tax Shelter Trans | 0 | ProhibitedTaxShelterTrans |
| Taxable Party Notification | 0 | TaxablePartyNotification |
| Non Deductible Contributions | 0 | NonDeductibleContributions |
| Quid Pro Quo Contributions | 0 | QuidProQuoContributions |
| Form8282 Property Disposed Of | 0 | Form8282PropertyDisposedOf |
| Nbr Voting Governing Body Members | 9 | NbrVotingGoverningBodyMembers |
| Number Independent Voting Members | 9 | NumberIndependentVotingMembers |
| Family Or Business Relationship | 0 | FamilyOrBusinessRelationship |
| Delegation Of Management Duties | 0 | DelegationOfManagementDuties |
| Changes To Organizing Docs | 0 | ChangesToOrganizingDocs |
| Material Diversion Or Misuse | 0 | MaterialDiversionOrMisuse |
| Members Or Stockholders | 1 | MembersOrStockholders |
| Election Of Board Members | 1 | ElectionOfBoardMembers |
| Decisions Subject To Approval | 0 | DecisionsSubjectToApproval |
| Minutes Of Governing Body | 1 | MinutesOfGoverningBody |
| Minutes Of Committees | 1 | MinutesOfCommittees |
| Officer Mailing Address | 0 | OfficerMailingAddress |
| Local Chapters | 0 | LocalChapters |
| Form990 Provided To Governing Body | 1 | Form990ProvidedToGoverningBody |
| Conflict Of Interest Policy | 1 | ConflictOfInterestPolicy |
| Annual Disclosure Covered Persons | 1 | AnnualDisclosureCoveredPersons |
| Regular Monitoring Enforcement | 0 | RegularMonitoringEnforcement |
| Whistleblower Policy | 1 | WhistleblowerPolicy |
| Document Retention Policy | 1 | DocumentRetentionPolicy |
| Compensation Process CEO | 1 | CompensationProcessCEO |
| Compensation Process Other | 1 | CompensationProcessOther |
| Investment In Joint Venture | 0 | InvestmentInJointVenture |
| States Where Copy Of Return Is Filed | MN | StatesWhereCopyOfReturnIsFiled |
| Upon Request | X | UponRequest |
The Books Are In Care Of TheBooksAreInCareOf
Name Business NameBusiness
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Carol Borgerson | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Telephone Number | 3205987536 | TelephoneNumber |
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 900 Second Avenue | AddressLine1 |
| City | Madison | City |
| State | MN | State |
| ZIP Code | 56256 | ZIPCode |
Form990 Part VII Section A Form990PartVIISectionA (14 entries)
| TitleTitle | Average Hours Per WeekAverageHoursPerWeek | Individual Trustee Or DirectorIndividualTrusteeOrDirector | Reportable Comp From OrganizationReportableCompFromOrganization | Reportable Comp From Related OrgsReportableCompFromRelatedOrgs | Other CompensationOtherCompensation | OfficerOfficer | Highest Compensated EmployeeHighestCompensatedEmployee |
|---|---|---|---|---|---|---|---|
| Pam Weber | |||||||
| Director | 1.00 | X | 0 | 0 | 0 | ||
| Brent Zupan | |||||||
| Director | 1.00 | X | 0 | 0 | 0 | ||
| Gene Koosmann | |||||||
| Director | 1.00 | X | 0 | 0 | 0 | ||
| Robert Wittnebel | |||||||
| Director | 1.00 | X | 0 | 0 | 0 | ||
| Tom Miller | |||||||
| Director | 1.00 | X | 0 | 0 | 0 | ||
| Eunice Mork | |||||||
| Secretary | 1.00 | X | 0 | 0 | 0 | X | |
| Patty Schuelke | |||||||
| Director | 1.00 | X | 0 | 0 | 0 | ||
| Tom Daline | |||||||
| Director | 1.00 | X | 0 | 0 | 0 | ||
| Jeff Kallhoff | |||||||
| Chairman | 1.00 | X | 0 | 0 | 0 | X | |
| Scott Larson | |||||||
| President/CEO | 40.00 | 111350 | 0 | 8703 | X | ||
| Laura Hong | |||||||
| Medical Doctor | 40.00 | 168568 | 0 | 24668 | X | ||
| Brant Hacker | |||||||
| Medical Doctor | 40.00 | 258375 | 0 | 18491 | X | ||
| Larry Grong | |||||||
| Medical Doctor | 40.00 | 262259 | 0 | 18161 | X | ||
| Michael Deyo | |||||||
| Physician's Assistant | 40.00 | 108985 | 0 | 10456 | X | ||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | 909537 | TotalReportableCompFromOrg |
| Total Reportable Comp Frm Rltd Orgs | 0 | TotalReportableCompFrmRltdOrgs |
| Total Other Compensation | 80479 | TotalOtherCompensation |
| Number Individuals GT100 K | 5 | NumberIndividualsGT100K |
| Formers Listed | 0 | FormersListed |
| Total Comp GT150 K | 1 | TotalCompGT150K |
| Compensation From Other Sources | 0 | CompensationFromOtherSources |
Contractor Compensation ContractorCompensation (5 entries)
| Address Line1AddressOfContractor/AddressUS/AddressLine1 | CityAddressOfContractor/AddressUS/City | StateAddressOfContractor/AddressUS/State | ZIP CodeAddressOfContractor/AddressUS/ZIPCode | Description Of ServicesDescriptionOfServices | CompensationCompensation |
|---|---|---|---|---|---|
| Doom & Cuypers | |||||
| 331 Burlington Cir | Marshall | MN | 56258 | general Contractor | 664651 |
| Healthland | |||||
| 625 South Lakeshore Drive | Glenwood | MN | 56334 | EMR/Software/Training/Maintenance | 626683 |
| Big Stone Therapy | |||||
| 820 Roy Street | Ortonville | MN | 56278 | Contract Therapy | 507418 |
| Cardinal Health | |||||
| 7000 Cardinal Place | Dublin | OH | 43017 | Pharmacy | 430274 |
| Dallas Hanson | |||||
| 700 US Highway 75 | Ortonville | MN | 56278 | Construction Contractor | 233025 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Contractors GT100 K | 12 | NumberOfContractorsGT100K |
| All Other Contributions | 1032707 | AllOtherContributions |
| Total Contributions | 1032707 | TotalContributions |
Program Service Revenue ProgramServiceRevenue (4 entries)
| DescriptionDescription | Business CodeBusinessCode | Total Revenue ColumnTotalRevenueColumn | Related Or Exempt Function IncomeRelatedOrExemptFunctionIncome |
|---|---|---|---|
| Net patient and reside | 621400 | 14257004 | 14257004 |
| Other Operating Revenu | 900099 | 80268 | 80268 |
| Management Fee Revenue | 531310 | 31509 | 31509 |
| Co-pay fee revenue | 621610 | 20607 | 20607 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | 14389388 | TotalProgramServiceRevenue |
Investment Income InvestmentIncome
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 103157 | TotalRevenueColumn |
| Exclusion | $103,157 | ExclusionAmount |
Gross Rents GrossRents
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | 3225 | Real |
Less Rental Expenses LessRentalExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | 4133 | Real |
Rental Income Or Loss RentalIncomeOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | -908 | Real |
Net Rental Income Or Loss NetRentalIncomeOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | -908 | TotalRevenueColumn |
| Exclusion | -$908 | ExclusionAmount |
Other Revenue Misc OtherRevenueMisc (3 entries)
| DescriptionDescription | Business CodeBusinessCode | Total Revenue ColumnTotalRevenueColumn | ExclusionExclusionAmount | Unrelated Business RevenueUnrelatedBusinessRevenue |
|---|---|---|---|---|
| Employee and Guest Mea | 900099 | 207639 | $207,639 | |
| Miscellaneous revenue | 900099 | 152447 | $151,147 | 1300 |
| Hospital Supply Revenu | 900099 | 2977 | $2,977 |
Miscellaneous Revenue MiscellaneousRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 1142 | TotalRevenueColumn |
| Exclusion | $1,142 | ExclusionAmount |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Other Revenue | 364205 | TotalOtherRevenue |
Total Revenue TotalRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 15888549 | TotalRevenueColumn |
| Related Or Exempt Function Income | 14389388 | RelatedOrExemptFunctionIncome |
| Unrelated Business Revenue | 1300 | UnrelatedBusinessRevenue |
| Exclusion | $465,154 | ExclusionAmount |
Grants To Domestic Individuals GrantsToDomesticIndividuals
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 4139 | Total |
| Program Services | 4139 | ProgramServices |
Comp Current Officers Directors CompCurrentOfficersDirectors
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 125893 | Total |
| Management And General | 125893 | ManagementAndGeneral |
Other Salaries And Wages OtherSalariesAndWages
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 6613863 | Total |
| Program Services | 6287493 | ProgramServices |
| Management And General | 326370 | ManagementAndGeneral |
Pension Plan Contributions PensionPlanContributions
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 110342 | Total |
| Program Services | 104897 | ProgramServices |
| Management And General | 5445 | ManagementAndGeneral |
Other Employee Benefits OtherEmployeeBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 481691 | Total |
| Program Services | 457921 | ProgramServices |
| Management And General | 23770 | ManagementAndGeneral |
Payroll Taxes PayrollTaxes
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 647014 | Total |
| Program Services | 605352 | ProgramServices |
| Management And General | 41662 | ManagementAndGeneral |
Fees For Services Legal FeesForServicesLegal
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 2527 | Total |
| Management And General | 2527 | ManagementAndGeneral |
Fees For Services Accounting FeesForServicesAccounting
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 30247 | Total |
| Management And General | 30247 | ManagementAndGeneral |
Fees For Services Other FeesForServicesOther
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1432237 | Total |
| Program Services | 1403509 | ProgramServices |
| Management And General | 28728 | ManagementAndGeneral |
Advertising Advertising
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 44930 | Total |
| Program Services | 44930 | ProgramServices |
Office Expenses OfficeExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1142317 | Total |
| Program Services | 945261 | ProgramServices |
| Management And General | 197056 | ManagementAndGeneral |
Information Technology InformationTechnology
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 23417 | Total |
| Program Services | 23417 | ProgramServices |
Occupancy Occupancy
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 301788 | Total |
| Program Services | 301788 | ProgramServices |
Travel Travel
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 36254 | Total |
| Program Services | 36254 | ProgramServices |
Conferences Meetings ConferencesMeetings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 67603 | Total |
| Program Services | 67603 | ProgramServices |
Interest Interest
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 45424 | Total |
| Program Services | 45424 | ProgramServices |
Depreciation Depletion DepreciationDepletion
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 900331 | Total |
| Program Services | 900331 | ProgramServices |
Insurance Insurance
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 56033 | Total |
| Program Services | 12560 | ProgramServices |
| Management And General | 43473 | ManagementAndGeneral |
Other Expenses OtherExpenses (5 entries)
| DescriptionDescription | TotalTotal | Program ServicesProgramServices | Management And GeneralManagementAndGeneral |
|---|---|---|---|
| Pharmacy Drugs | 674025 | 674025 | |
| Lab/XRay/Other Testing | 389197 | 389197 | |
| Surcharge and MN Care T | 371682 | 13534 | 358148 |
| Patient Service Costs | 294143 | 294143 | |
| Provision for Bad Debt | 217464 | 217464 |
All Other Expenses AllOtherExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 340953 | Total |
| Program Services | 286802 | ProgramServices |
| Management And General | 54151 | ManagementAndGeneral |
Total Functional Expenses TotalFunctionalExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 14353514 | Total |
| Program Services | 13116044 | ProgramServices |
| Management And General | 1237470 | ManagementAndGeneral |
| Fundraising | 0 | Fundraising |
Cash Non Interest Bearing CashNonInterestBearing
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1240 | BOY |
| EOY | 1240 | EOY |
Savings And Temp Cash Investments SavingsAndTempCashInvestments
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 514135 | BOY |
| EOY | 622789 | EOY |
Accounts Receivable AccountsReceivable
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 2319074 | BOY |
| EOY | 2493197 | EOY |
Inventories For Sale Or Use InventoriesForSaleOrUse
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 230035 | BOY |
| EOY | 182417 | EOY |
Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 136473 | BOY |
| EOY | 146597 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Buildings Equipment Basis | 15764247 | LandBuildingsEquipmentBasis |
| Land Bldg Equipment Accum Deprec | 9112218 | LandBldgEquipmentAccumDeprec |
Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 6821665 | BOY |
| EOY | 6652029 | EOY |
Investments Pub Traded Securities InvestmentsPubTradedSecurities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 7007919 | BOY |
| EOY | 8392475 | EOY |
Investments Other Securities InvestmentsOtherSecurities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 66059 | BOY |
| EOY | 128699 | EOY |
Other Assets Total OtherAssetsTotal
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 23258 | BOY |
| EOY | 0 | EOY |
Total Assets TotalAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 17119858 | BOY |
| EOY | 18619443 | EOY |
Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1182133 | BOY |
| EOY | 832303 | EOY |
Mort Notes Pybl Secured Invest Prop MortNotesPyblSecuredInvestProp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1024125 | BOY |
| EOY | 996640 | EOY |
Other Liabilities OtherLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 330809 | BOY |
| EOY | 265666 | EOY |
Total Liabilities TotalLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 2537067 | BOY |
| EOY | 2094609 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Follow SFAS117 | X | FollowSFAS117 |
Unrestricted Net Assets UnrestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 14563458 | BOY |
| EOY | 15515690 | EOY |
Temporarily Restricted Net Assets TemporarilyRestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 19333 | BOY |
| EOY | 1009144 | EOY |
Total Net Assets Fund Balances TotalNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 14582791 | BOY |
| EOY | 16524834 | EOY |
Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 17119858 | BOY |
| EOY | 18619443 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Method Of Accounting Accrual | X | MethodOfAccountingAccrual |
| Accountant Compile Or Review | 0 | AccountantCompileOrReview |
| FS Audited | 1 | FSAudited |
| Audit Committee | 1 | AuditCommittee |
| Financial Statement Consolidated | X | FinancialStatementConsolidated |
| Federal Grant Audit Required | 0 | FederalGrantAuditRequired |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Publicly Supported Org509a2 | X | PubliclySupportedOrg509a2 |
Gifts Grants Contrib Received509 GiftsGrantsContribReceived509
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | 529229 | CurrentTaxYearMinus4Years |
| Current Tax Year Minus3 Years | 86102 | CurrentTaxYearMinus3Years |
| Current Tax Year Minus2 Years | 37082 | CurrentTaxYearMinus2Years |
| Current Tax Year Minus1 Year | 519562 | CurrentTaxYearMinus1Year |
| Current Tax Year | 42707 | CurrentTaxYear |
| Total | 1214682 | Total |
Gross Receipts From Admissions GrossReceiptsFromAdmissions
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | 11330296 | CurrentTaxYearMinus4Years |
| Current Tax Year Minus3 Years | 12488712 | CurrentTaxYearMinus3Years |
| Current Tax Year Minus2 Years | 12173456 | CurrentTaxYearMinus2Years |
| Current Tax Year Minus1 Year | 14005888 | CurrentTaxYearMinus1Year |
| Current Tax Year | 14753593 | CurrentTaxYear |
| Total | 64751945 | Total |
Total509 Total509
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | 11859525 | CurrentTaxYearMinus4Years |
| Current Tax Year Minus3 Years | 12574814 | CurrentTaxYearMinus3Years |
| Current Tax Year Minus2 Years | 12210538 | CurrentTaxYearMinus2Years |
| Current Tax Year Minus1 Year | 14525450 | CurrentTaxYearMinus1Year |
| Current Tax Year | 14796300 | CurrentTaxYear |
| Total | 65966627 | Total |
Amts Recd From Disqual Persons AmtsRecdFromDisqualPersons
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus1 Year | 492508 | CurrentTaxYearMinus1Year |
| Total | 492508 | Total |
Amts From Subst Contributors AmtsFromSubstContributors
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Support From DQ Ps Etc SupportFromDQPsEtc
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus1 Year | 492508 | CurrentTaxYearMinus1Year |
| Total | 492508 | Total |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Public Support Total509 | 65474119 | PublicSupportTotal509 |
Gross Investment Income509 GrossInvestmentIncome509
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | 215951 | CurrentTaxYearMinus4Years |
| Current Tax Year Minus3 Years | 256608 | CurrentTaxYearMinus3Years |
| Current Tax Year Minus2 Years | 230470 | CurrentTaxYearMinus2Years |
| Current Tax Year Minus1 Year | 82324 | CurrentTaxYearMinus1Year |
| Current Tax Year | 103157 | CurrentTaxYear |
| Total | 888510 | Total |
Investment Income And UBTI InvestmentIncomeAndUBTI
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | 215951 | CurrentTaxYearMinus4Years |
| Current Tax Year Minus3 Years | 256608 | CurrentTaxYearMinus3Years |
| Current Tax Year Minus2 Years | 230470 | CurrentTaxYearMinus2Years |
| Current Tax Year Minus1 Year | 82324 | CurrentTaxYearMinus1Year |
| Current Tax Year | 103157 | CurrentTaxYear |
| Total | 888510 | Total |
Total Support Total TotalSupportTotal
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | 12075476 | CurrentTaxYearMinus4Years |
| Current Tax Year Minus3 Years | 12831422 | CurrentTaxYearMinus3Years |
| Current Tax Year Minus2 Years | 12441008 | CurrentTaxYearMinus2Years |
| Current Tax Year Minus1 Year | 14607774 | CurrentTaxYearMinus1Year |
| Current Tax Year | 14899457 | CurrentTaxYear |
| Total | 66855137 | Total |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Public Support Percentage509 | 0.97930 | PublicSupportPercentage509 |
| Prior Year Support Percentage | 0.97770 | PriorYearSupportPercentage |
| Investment Income Percentage | 0.01330 | InvestmentIncomePercentage |
| Prior Yr Invest Income Percentage | 0.01460 | PriorYrInvestIncomePercentage |
| Thirty Three Percnt Tests CY509 | X | ThirtyThreePercntTestsCY509 |
| General Explanation | Schedule A, Part IV, List of Unusual Grants: Trust Grant Date: 09/30/10 Amount: 990000. | GeneralExplanation |
Schedule B IRS990ScheduleB
Contributor Info ContributorInfo
| Field | Value | IRS element (for citing) |
|---|---|---|
| Contributor Number | RESTRICTED | ContributorNumber |
Contributor Name Business ContributorNameBusiness
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | RESTRICTED | BusinessNameLine1 |
Contributor Address US ContributorAddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | RESTRICTED | AddressLine1 |
| Address Line2 | RESTRICTED | AddressLine2 |
| City | RESTRICTED | City |
| State | RESTRICTED | State |
| ZIP Code | RESTRICTED | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Aggregate Contributions | RESTRICTED | AggregateContributions |
Schedule C IRS990ScheduleC
| Field | Value | IRS element (for citing) |
|---|---|---|
| Volunteers | 0 | Volunteers |
| Paid Staff Or Management | 0 | PaidStaffOrManagement |
| Media Advertisements | 0 | MediaAdvertisements |
| Mailings Members | 0 | MailingsMembers |
| Publications Or Broadcast | 0 | PublicationsOrBroadcast |
| Grants Other Organizations | 0 | GrantsOtherOrganizations |
| Direct Contact Legislators | 0 | DirectContactLegislators |
| Rallies Demonstrations | 0 | RalliesDemonstrations |
| Other Activities | 1 | OtherActivities |
| Other Activities | $4,769 | OtherActivitiesAmount |
| Total Lobbying Expenditures IIB | 4769 | TotalLobbyingExpendituresIIB |
| Not Described In501c3 | 0 | NotDescribedIn501c3 |
Form990 Schedule C Part IV Form990ScheduleCPartIV
| Field | Value | IRS element (for citing) |
|---|---|---|
| Identifier | Part II-B, Line 1i: | Identifier |
| Return Reference | Explanation of Other Lobbying Activities: | ReturnReference |
| Explanation | Madison Lutheran Home is a member of the Minnesota Hospital Association and Aging Services of Minnesota. A portion of their dues are for lobbying expenses. | Explanation |
Schedule D IRS990ScheduleD
Land Land
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 6522 | OtherCostOrOtherBasis |
| Book Value | 6522 | BookValue |
Buildings Buildings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 12012367 | OtherCostOrOtherBasis |
| Depreciation | 6367351 | Depreciation |
| Book Value | 5645016 | BookValue |
Equipment Equipment
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 3739132 | OtherCostOrOtherBasis |
| Depreciation | 2744867 | Depreciation |
| Book Value | 994265 | BookValue |
Other Land Buildings OtherLandBuildings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 6226 | OtherCostOrOtherBasis |
| Book Value | 6226 | BookValue |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Book Value Land Buildings | 6652029 | TotalOfBookValueLandBuildings |
Other Liabilities OtherLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| Description | Deferred Compensation Plan | Description |
| Amount | $265,666 | Amount |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Amounts | 265666 | TotalOfAmounts |
Form990 Schedule D Part XIV Form990ScheduleDPartXIV
| Field | Value | IRS element (for citing) |
|---|---|---|
| Identifier | Part X: | Identifier |
| Return Reference | Description of Uncertain Tax Positions Under FIN 48: | ReturnReference |
| Explanation | The Organization recorded no assets or liabilities for uncertain tax positions or unrecognized tax benefits. Federal and state informational returns for 2007 and subsequent years remain subject to examination by major tax jurisdictions. | Explanation |
Schedule H IRS990ScheduleH
| Field | Value | IRS element (for citing) |
|---|---|---|
| Charity Care Policy | 1 | CharityCarePolicy |
| Written Policy | 1 | WrittenPolicy |
| FPG Reference Free Care | 1 | FPGReferenceFreeCare |
Other Percentage OtherPercentage
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | X | Other |
| Free Other Percentage | 250.000000000000 | FreeOtherPercentage |
| Field | Value | IRS element (for citing) |
|---|---|---|
| FPG Reference Discounted Care | 1 | FPGReferenceDiscountedCare |
| Pcent250 | X | Pcent250 |
| Free Disc Care Medically Indigent | 1 | FreeDiscCareMedicallyIndigent |
| Amounts Budgeted For Charity Care | 1 | AmountsBudgetedForCharityCare |
| Expenses Exceeded Budget | 1 | ExpensesExceededBudget |
| Unable To Provide Care | 0 | UnableToProvideCare |
| Annual Community Benefit Report | 1 | AnnualCommunityBenefitReport |
| Report Publically Available | 1 | ReportPublicallyAvailable |
Charity Care At Cost CharityCareAtCost
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 48539 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 48539 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00340 | PercentOfTotalExpense |
Unreimbursed Medicaid UnreimbursedMedicaid
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 193228 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 109708 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 83520 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00590 | PercentOfTotalExpense |
Total Charity Care TotalCharityCare
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 241767 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 109708 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 132059 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00930 | PercentOfTotalExpense |
Community Health Services CommunityHealthServices
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Activities Or Programs | 11 | NumberOfActivitiesOrPrograms |
| Persons Served | 1894 | PersonsServed |
| Total Community Benefit Expense | 17118 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 2125 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 14993 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00110 | PercentOfTotalExpense |
Health Professions Education HealthProfessionsEducation
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 4139 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 4139 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00030 | PercentOfTotalExpense |
Total Other Benefits TotalOtherBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Activities Or Programs | 11 | NumberOfActivitiesOrPrograms |
| Persons Served | 1894 | PersonsServed |
| Total Community Benefit Expense | 21257 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 2125 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 19132 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00140 | PercentOfTotalExpense |
Total Community Benefits TotalCommunityBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Activities Or Programs | 11 | NumberOfActivitiesOrPrograms |
| Persons Served | 1894 | PersonsServed |
| Total Community Benefit Expense | 263024 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 111833 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 151191 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.01070 | PercentOfTotalExpense |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | 0 | BadDebtExpenseReported |
| Bad Debt Expense | $40,576 | BadDebtExpenseAmount |
| Amount Attributable To | 26494 | AmountAttributableTo |
| Amount Reimbursed By Medicare | 2750340 | AmountReimbursedByMedicare |
| Cost Of Care Reimbursed By Medicare | 3377136 | CostOfCareReimbursedByMedicare |
| Medicare Surplus Or Shortfall | -626796 | MedicareSurplusOrShortfall |
Costing Methodology Used CostingMethodologyUsed
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cost To Charge Ratio | X | CostToChargeRatio |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Written Debt Collection Policy | 1 | WrittenDebtCollectionPolicy |
| Provision For Charity Care | 1 | ProvisionForCharityCare |
Form990 Schedule H Part V Form990ScheduleHPartV
Name Name
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Madison Hospital | BusinessNameLine1 |
Address Address
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 820 Third Avenue | AddressLine1 |
| City | Madison | City |
| State | MN | State |
| ZIP Code | 56256 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Licensed Hospital | X | LicensedHospital |
| General Medical And Surgical | X | GeneralMedicalAndSurgical |
| Critical Access Hospital | X | CriticalAccessHospital |
| Er24 Hours | X | Er24Hours |
Form990 Schedule H Part VI Form990ScheduleHPartVI
| Field | Value | IRS element (for citing) |
|---|---|---|
| Costing Method Used | Part I, Line 7: The costing methodology is the cost to charge ratio per worksheet 2 of the instructions. | CostingMethodUsed |
| Bad Debt Footnote | Part III, Line 4: The actual accounts written off is $40,576 for Madison Hospital and does not include Medicare bad debt accounts. This amount is adjusted using the cost to charge ratio. Management provides for probable uncollectible amounts, primarily from uninsured patients and residents and amounts patients and residents are personally responsible for, through a charge to operations and a credit to a valuation allowance based on its assessment of historical collection likelihood and the current status of individual accounts. Balances that are still outstanding after management has used reasonable collection efforts are written off through a charge to the valuation allowance and a credit to patient and resident accounts receivable. | BadDebtFootnote |
| Shortfall As Community Benefit | Part III, Line 8: The costing methodology used to determine the Medicare allowable cost reported in the Medicare cost report is the cost to charge ratio. | ShortfallAsCommunityBenefit |
| Debt Collection Policy | Part III, Line 9b: If patients have completed all paperwork and qualify for charity care, the patient is not billed for any balance and account is written off. If patient has medical assistance, that program is billed for charges and that payment is payment in full unless Medical Assistance notifies us that the patient has responsibility for spend down or co-pay payments. | DebtCollectionPolicy |
| General Explanation | Part I, Line 7, Column FAs allowed, the denominator has been reduced by $217,464, the amount of bad debt reported in Part IX, Line 25 of Form 990. | GeneralExplanation |
| Needs Assessment | Part VI, Line 2: We work with the Countryside Health to assess the needs of the community, along with various other church organizations. We also have a survey that is sent out by the Rural Health Coop. | NeedsAssessment |
| Patient Education Assistance | Part VI, Line 3: Inpatients are given a packet with all of our billing information as well as the charity policy and where to obtain one. We do have the billing information posted in the entry. If a patient is admitted that has no insurance the Accounting manager does meet with them prior to discharge to discuss options for payment that may be available to them, including an application for Medical Assistance. The staff has charity applications available in the admissions office, along with the Accounting Manager. | PatientEducationAssistance |
| Community Information | Part VI, Line 4: The area being served by the Madison Hospital and Lac qui Parle Clinic is primarily rural. The patient base is made up of both working class and farmers. The counties that we serve are Lac qui Parle, Big Stone and some border counties of South Dakota. The closest facility is 25 miles away, being Canby, Dawson, Appleton or Ortonville. The average individual income is approximately $24,000.00 gross. On average the poverty level in the county is at about 30 to 35% with many people being laid off, and families of 3 or more. The percentage of families on Medicaid would probably be approximately 35%, receiving some type of medical assistance or county assistance. | CommunityInformation |
| Community Building Activities | Part VI, Line 5: N/A | CommunityBuildingActivities |
| Other Information | Part VI, Line 6: Madison Lutheran Home consists of a hospital, clinic and nursing home. The Charity Care percentage on Part I line 7(k) column f appears low however excluding the nursing home gross patient charges(39% of gross patient charges) increases this percentage to 1.50%. Madison Hospital is constantly striving to add new services, including outreach services to better serve the needs of our community. A leadership team has been formed to meet the community needs, continue to look at adding new services, continue to look at updating our current facility, and asking for community involvement in final decision making. With our aging population, we strive to bring the services to the patients, rather than the patients having to drive hours from home to get the services.One of the services Madison Hospital provides is a Caregiver Support Group. This is a community support group lead by the Madison Hospital Home Care Department. This group meets monthly on the third Wednesday of the month. This is a confidential group meeting, where members can voice frustrations and concerns being a caregiver with other who are going through the same ordeal. We as a Home Care agency also provide education to this group on various topics from daily cares to disease process and positive encouragement.Madison Hospital provided health care screenings at reduced rates to the community. | OtherInformation |
| Affiliated Health Care System | Part VI, Line 7: N/A | AffiliatedHealthCareSystem |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Compensation Survey | X | CompensationSurvey |
| Severance Payment | 0 | SeverancePayment |
| Supplemental Nonqual Retire Plan | 0 | SupplementalNonqualRetirePlan |
| Equity Based Comp Arrangement | 0 | EquityBasedCompArrangement |
| Comp Based On Revenue Of Filing Org | 1 | CompBasedOnRevenueOfFilingOrg |
| Comp Based On Revenue Related Orgs | 0 | CompBasedOnRevenueRelatedOrgs |
| Comp Based Net Earnings Filing Org | 0 | CompBasedNetEarningsFilingOrg |
| Comp Based Net Earnings Relate Orgs | 0 | CompBasedNetEarningsRelateOrgs |
| Any Non Fixed Payments | 0 | AnyNonFixedPayments |
| Initial Contract Exception | 0 | InitialContractException |
Form990 Schedule J Part II Form990ScheduleJPartII (3 entries)
| Base Compensation Filing OrgBaseCompensationFilingOrg | Comp Based On Related OrgsCompBasedOnRelatedOrgs | Bonus Filing OrgBonusFilingOrg | Bonus Related OrgsBonusRelatedOrgs | Other Compensation Filing OrgOtherCompensationFilingOrg | Other Compensation Related OrgsOtherCompensationRelatedOrgs | Deferred Comp Filing OrgDeferredCompFilingOrg | Deferred Comp Related OrgsDeferredCompRelatedOrgs | Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrg | Nontaxable Benefits Related OrgsNontaxableBenefitsRelatedOrgs | Total Compensation Filing OrgTotalCompensationFilingOrg | Total Compensation Related OrgsTotalCompensationRelatedOrgs | Comp Report Prior990 Filing OrgCompReportPrior990FilingOrg | Comp Report Prior990 Related OrgsCompReportPrior990RelatedOrgs |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Laura Hong | |||||||||||||
| 168568 | 0 | 0 | 0 | 0 | 0 | 15285 | 0 | 9383 | 0 | 193236 | 0 | 0 | 0 |
| Brant Hacker | |||||||||||||
| 258375 | 0 | 0 | 0 | 0 | 0 | 7471 | 0 | 11020 | 0 | 276866 | 0 | 0 | 0 |
| Larry Grong | |||||||||||||
| 262259 | 0 | 0 | 0 | 0 | 0 | 7398 | 0 | 10763 | 0 | 280420 | 0 | 0 | 0 |
Form990 Schedule J Part III Form990ScheduleJPartIII
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Reference | Part I, Line 5 | ReturnReference |
| Explanation | Physicians are able to receive a bonus based on revenue generated. | Explanation |
Schedule L IRS990ScheduleL
Loan Table LoanTable
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Person | Dr Brant Hacker | NamePerson |
| Purpose Of Loan | Compensation package | PurposeOfLoan |
| Loan From Organization | X | LoanFromOrganization |
| Default | 0 | Default |
| Approved By Board | 1 | ApprovedByBoard |
| Written Agreement | 1 | WrittenAgreement |
Schedule O IRS990ScheduleO
General Explanation GeneralExplanation (7 entries)
| IdentifierIdentifier | ExplanationExplanation |
|---|---|
| Form 990, Part VI, Section A, line 6 | The organization's members are The Lutheran congregations that were members of Lac Qui Parle Health Care Services on the date of Merger with Madison Lutheran Home on July 10, 1992. |
| Form 990, Part VI, Section A, line 7a | The members of the Lutheran congregations elect the Board members of Madison Lutheran Home. |
| Form 990, Part VI, Section B, line 11 | The Form 990 is presented to the Board of Directors for approval prior to submission. |
| Form 990, Part VI, Section B, line 12 | The organization monitors the conflict of interest policy as conflicts arise. |
| Form 990, Part VI, Section B, line 15 | The organization uses comparability data from surveys of other organizations of similar size in the surrounding areas to determine compensation of top management and officers of the organization. |
| Form 990, Part VI, Section C, line 19 | The organization does not make its governing documents, conflict of interest polciy, or financial statements available to the public. |
| Form 990, Part XI, Line 2c | The board of directors assumes oversight of the audit of its financial statements and selection of an independent accountant. |
Schedule R IRS990ScheduleR
Form990 Schedule R Part II Form990ScheduleRPartII (3 entries)
| Address Line1AddressUS/AddressLine1 | CityAddressUS/City | StateAddressUS/State | ZIP CodeAddressUS/ZIPCode | EINEIN | Primary ActivitiesPrimaryActivities | Legal Domicile StateLegalDomicileState | Exempt Code SectionExemptCodeSection | Public Charity StatusPublicCharityStatus | Business Name Line1DirectControllingEntityName/BusinessNameLine1 |
|---|---|---|---|---|---|---|---|---|---|
| Hilltop Residence Inc | |||||||||
| 900 Second Avenue | Madison | MN | 56256 | 411376605 | Housing for handicapped and elderly | MN | 501(c)(3) | 509(a)(2) | Madison Lutheran Home |
| Madison Hospital Inc | |||||||||
| 900 Second Avenue | madison | MN | 56256 | 411653496 | Assist injured and sick individuals | MN | 501(c)(7) | Madison Lutheran Home | |
| Lac Qui Parle Clinic Inc | |||||||||
| 900 Second Avenue | madison | MN | 56256 | 411702606 | Assist injured and sick individuals | MN | 501(c)(7) | madison Lutheran Home | |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Ann Rents Royalties | 0 | ReceiptOfIntAnnRentsRoyalties |
| Gift Grant Or Cap Contr To Other Org | 0 | GiftGrantOrCapContrToOtherOrg |
| Gift Grant Or Cap Contr Fr Other Org | 0 | GiftGrantOrCapContrFrOtherOrg |
| Loans Or Guarantees To Other Org | 0 | LoansOrGuaranteesToOtherOrg |
| Loans Or Guarantees From Other Org | 0 | LoansOrGuaranteesFromOtherOrg |
| Sale Of Assets To Other Org | 0 | SaleOfAssetsToOtherOrg |
| Purchase Of Assets From Other Org | 0 | PurchaseOfAssetsFromOtherOrg |
| Exchange Of Assets | 0 | ExchangeOfAssets |
| Rental Of Facilities To Other Orgs | 0 | RentalOfFacilitiesToOtherOrgs |
| Rental Of Facilities Fr Other Orgs | 0 | RentalOfFacilitiesFrOtherOrgs |
| Perform Of Services For Other Orgs | 1 | PerformOfServicesForOtherOrgs |
| Perform Of Services By Other Orgs | 0 | PerformOfServicesByOtherOrgs |
| Sharing Of Facilities | 0 | SharingOfFacilities |
| Sharing Of Paid Employees | 0 | SharingOfPaidEmployees |
| Reimbursement Paid To Other Org | 0 | ReimbursementPaidToOtherOrg |
| Reimbursement Paid By Other Org | 1 | ReimbursementPaidByOtherOrg |
| Other Transfer To Other Org | 0 | OtherTransferToOtherOrg |
| Other Transfer From Other Org | 0 | OtherTransferFromOtherOrg |