2026-04-13T20:53:19-05:00 2025-05-31 410746749 CLIFTONLARSONALLEN LLP 121 WEST BRIDGE STREET OWATONNA MN 55060 990 2024-06-01 410758512 MADELIA HEALTH MADE 5076423255 121 DREW AVE SE MADELIA MN 56062 DAVID WALZ CEO 5076423255 2026-04-10 1 1 JUSTIN HARTERT P02236744 5074467100 2026-04-09 2024 2025-03-06 01:10:19Z DAVID WALZ 121 DREW AVE SE MADELIA MN 56062 25692898 0 X WWW.MADELIAHEALTH.ORG X 1950 MN PROVIDE QUALITY HEALTHCARE SERVICES TO THE LOCAL COMMUNITY. 9 9 215 0 115952 0 372883 995973 20327697 24113896 115297 -221790 216757 191738 21032634 25079817 765413 16 0 0 13426192 14744848 0 0 0 9624991 10606773 23816596 25351637 -2783962 -271820 13456499 12652762 5423175 4137464 8033324 8515298 X THE MISSION OF MADELIA HEALTH IS TO PROVIDE SAFE AND QUALITY HEALTHCARE SERVICES TO THOSE WE SERVE IN AN ENVIRONMENT BASED ON RESPECT, DIGNITY, AND EXCELLENCE. 0 1 17993619 16 23997944 MADELIA HEALTH PROVIDES GENERAL MEDICAL/SURGICAL SERVICES FOR INPATIENT, SWING BED PATIENTS, OUTPATIENTS. DURING THE FISCAL YEAR ENDED MAY 31, 2025, THERE WERE 168 ACUTE CARE ADMISSIONS WITH 498 PATIENT DAYS, 43 SWING BED PATIENTS WITH 417 PATIENT DAYS, AND 24,735 TOTAL OUTPATIENT VISITS. 17993619 1 1 0 1 0 0 0 0 0 0 1 0 0 1 0 1 0 1 0 0 0 0 0 0 0 0 1 1 0 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 0 0 0 1 197 0 1 215 1 1 1 0 0 0 0 0 0 0 0 0 0 0 X 9 9 0 0 0 0 1 1 0 1 1 0 0 0 1 1 1 1 1 1 1 0 MN X DAVID WALZ 5076423255 121 DREW AVE SE MADELIA MN 56062 BRIAN MCCABE CHAIR 1.00 0.20 X X 1800 0 0 RYAN VISHER VICE CHAIR 1.00 0.00 X X 1200 0 0 STEVE SORENSON TREASURER/SECRETARY 1.00 0.00 X X 1650 0 0 BRENT CHRISTENSEN DIRECTOR 1.00 0.00 X 1200 0 0 STEVE COOLING DIRECTOR 1.00 0.00 X 1200 0 0 KEN GRONEWOLD DIRECTOR 1.00 0.00 X 1200 0 0 WENDY HENNIGER DIRECTOR 1.00 0.20 X 1300 0 0 NORMA KRUMIEDE DIRECTOR 1.00 0.00 X 1200 0 0 ROBIN EKSTROM DIRECTOR 1.00 0.00 X 0 0 0 DAVID WALZ CEO 40.00 0.20 X 239954 0 23012 ROZ SNYDER CCO 40.00 0.00 X 162070 0 19909 JORDAN RICHARDSON CFO 40.00 0.20 X 92124 0 4514 BRUCE ROREM PHYSICIAN 40.00 0.00 X 226498 0 9192 SARAH DRYDEN PHYSICIAN 40.00 0.00 X 252082 0 11080 JULIE DOLPHIN NURSE PRACTITIONER 36.00 0.00 X 202546 0 9143 GRACE OUYANG PHYSICIAN 40.00 0.00 X 158682 0 630 LUIS MARTINEZ PHYSICIAN 33.00 0.00 X 235123 0 1209 1579829 0 78689 28 0 1 0 R1 RCM 29586 NETWORK PLACE CHICAGO IL 60673 REVENUE CYCLE MANAGEMENT 344070 PRAIRIEVIEW ANESTHESIA 41130 620TH AVENUE BUTTERFIELD MN 56120 PAIN MANAGEMENT 273734 TRIAGE LLC PO BOX 773328 CHICAGO IL 60677 CONTRACTED STAFFING 203845 STRATEGIC REIMBURSEMENT GROUP LLC 360 W BUTTERFIELD ROAD SUITE 310 ELMHURST IL 60126 COST REPORT CONSULTING 160384 JENNIE LISE LLC 8 1ST STREET SW MADELIA MN 56062 ANESTHESIA 108290 5 9902 986071 995973 NET PATIENT REVENUE 624100 20954203 20954203 PHARMACY 456199 3159693 3043741 115952 24113896 8091 8091 191738 0 191738 191738 191738 383200 613081 -229881 -229881 -229881 25079817 23997944 115952 -30052 X 16 16 624064 624064 10712884 8469463 2243421 295348 222703 72645 2280020 1630935 649085 832532 601979 230553 16338 16338 8815 8815 100830 100830 697 697 2600635 1721251 879384 120292 22876 97416 721880 289414 432466 654577 124424 530153 820568 302945 517623 43669 10936 32733 36364 25867 10497 159326 138531 20795 786511 683855 102656 180461 3844 176617 MEDICAL SUPPLIES 3054772 2845959 208813 BAD DEBT 810019 810019 MN CARE TAX 248211 248211 DUES AND SUBSCRIPTIONS 61332 37824 23508 181476 50778 130698 25351637 17993619 7358018 0 9997 0 127591 82927 4914187 4206042 197692 300062 61419 81448 21612023 14434865 8141826 7177158 3787 3961 0 801164 13456499 12652762 2361951 2501953 260257 30000 1668190 677912 920000 927599 212777 0 5423175 4137464 X 7912142 8394116 121182 121182 8033324 8515298 13456499 12652762 -271820 19950 733844 0 X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 477 477 0 PART II-B, LINE 1: MADELIA HEALTH PAID DUES TO ASSOCIATIONS, THESE ASSOCIATIONS PARTICIPATE IN LOBBYING ACTIVITIES RELATED TO HEALTHCARE. 172194 172194 9061217 5512301 3548916 11654139 8922564 2731575 724473 724473 7177158 THIRD PARTY RECEIVABLE 801164 801164 X PART X, LINE 2: THE HOSPITAL BELIEVES THAT IT HAS APPROPRIATE SUPPORT FOR ANY TAX POSITIONS TAKEN AFFECTING ITS ANNUAL FILING REQUIREMENTS, AND AS SUCH, DOES NOT HAVE ANY UNCERTAIN TAX POSITIONS THAT ARE MATERIAL TO THE FINANCIAL STATEMENTS. THE HOPSITAL WOULD RECOGNIZE FUTURE ACCRUED INTEREST AND PENALTIES RELATED TO UNRECOGNIZED TAX BENEFITS AND LIABILITIES IN INCOME TAX EXPENSE IF SUCH INTEREST AND PENALTIES ARE INCURRED. 1 1 X 1 X 1 X 1 1 1 0 1 1 3167802 2380017 787785 0.03370 3167802 2380017 787785 0.03370 49673 49673 0.00210 49673 49673 0.00210 3217475 2380017 837458 0.03580 810019 85862 3531970 4864421 -1332451 X 1 1 1 1 MADELIA HEALTH 121 DREW AVE SE MADELIA MN 56062 WWW.MADELIAHEALTH.ORG 385015 X X X X PROVIDER BASED CLINIC MADELIA HEALTH 1 0 0 1 X X X X X X X X X 24 1 0 0 1 X SEE PART V, SECTION B, LINE 7D X X 1 24 1 SEE PART V, SECTION B, LINE 7D 0 1 X 100.000000000000 200.000000000000 X X 1 1 X X X X 1 X SEE PART V, LINE 16J X SEE LINE 16J X SEE LINE 16J X X X X X X X 1 X 0 X X X X 1 X 0 0 MADELIA HEALTH PART V, SECTION B, LINE 5: FOR MADELIA HEALTH'S MAY 2025 COMMUNITY HEALTH NEEDS ASSESSMENT, THE HOSPITAL SOLICITED INPUT THROUGH COMMUNITY FOCUS GROUPS AND SURVEYS, AND REVIEWED COUNTY HEALTH RANKINGS. INPUT RECEIVED INCLUDES QUALITATIVE AND QUANTITATIVE INFORMATION FROM LOCAL, STATE AND FEDERAL SOURCES. IN ADDITION, INPUT WAS RECEIVED FROM PERSONS THAT REPRESENTED A BROAD RANGE OF INTEREST IN THE COMMUNITY, PERSONS WITH PUBLIC HEALTH KNOWLEDGE AND EXPERTISE, AND PERSONS REPRESENTING MEDICALLY UNDERSERVED AND VULNERABLE POPULATIONS. MADELIA HEALTH PART V, SECTION B, LINE 7D: THE COMMUNITY HEALTH NEEDS ASSESSMENT REPORT AND IMPLEMENTATION STRATEGY ARE AVAILABLE ON OUR WEBSITE AT: HTTPS://WWW.MADELIAHEALTH.ORG/CHNA/CHNA DIRECT LINK:HTTPS://WWW.MADELIAHEALTH.ORG/WP-CONTENT/UPLOADS/2025-COMMUNITY-HEALTH-NEEDS-ASSESSMENT-FINAL.PDFIMPLEMENTATION DIRECT LINK:HTTPS://WWW.MADELIAHEALTH.ORG/WP-CONTENT/UPLOADS/IMPLEMENTATION-STRATEGY-2022.2024.FINAL_.PDF MADELIA HEALTH PART V, SECTION B, LINE 11: NEEDS IDENTIFIED IN THE CHNA SURVEY AND INCLUDED IN THE IMPLEMENTATION STRATEGY INCLUDE: MENTAL AND BEHAVIORAL HEALTH, OBESITY AND NUTRITION, STROKE AWARENESS AND PREVENTION. OTHER NEEDS IDENTIFIED THAT WERE NOT SPECIFICALLY ADDRESSED BY MADELIA HEALTH ARE BEING ADDRESSED THROUGH OTHER INITIATIVES WITHIN THE COUNTY AND REGION. MADELIA HEALTH CHOSE TO SELECT THOSE WITHIN THE SCOPE AND ABILITIES OF MADELIA HEALTH.DURING FISCAL YEAR 2025, MUCH OF THE WORK STARTED IN THE FIRST YEAR CONTINUED THROUGHOUT THE THREE-YEAR PERIOD. MADELIA HEALTH CONTINUES TO SERVE THE MENTAL HEALTH NEEDS OF THE COMMUNITY BY OFFERING A MENTAL HEALTH CLINIC ON THE MADELIA CAMPUS. SERVICES INCLUDE MEDICATION MANAGEMENT AND THERAPY.MADELIA HEALTH CONTINUES TO COLLABORATE WITH MADELIA COMMUNITY BASED COLLABORATIVE IN EDUCATION EFFORTS TO PROMOTE HEALTH NUTRITION IN THE ELEMENTARY SCHOOLS. IN THE FALL, A HEALTH LIVING THEMED BOOK IS SELECTED AND SHARED WITH STUDENTS. THIS IS FOLLOWED BY ADDITIONAL EDUCATION AND A POSTER CONTEST WITH PRIZES FOR THE TOP POSTERS THAT REFLECT THE MESSAGE OF THE BOOK ENSURING THAT THE STUDENTS RETAINED THE LESSONS LEARNED. IN THE SPRING OF EACH YEAR, A MADELIA HEALTH PHYSICAL THERAPIST SPEAKS TO 1ST GRADE STUDENTS ABOUT THE IMPORTANCE OF TRYING DIFFERENT FRUITS AND VEGETABLES. TRY IT FRIDAY IS OFFERED 4-5 WEEKS GIVING STUDENTS THE OPPORTUNITY TO TRY DIFFERENT FRUITS AND VEGETABLES THEY MAY HAVE NEVER EATEN BEFORE. THIS HAS BEEN VERY SUCCESSFUL WITH COMMUNITY FEEDBACK EXCEPTIONAL.STROKE AWARENESS AND PREVENTION CONTINUES TO BE LED BY MADELIA HEALTH AMBULANCE SERVICES. THEY COLLABORATE WITH THE LOCAL PIZZA RESTAURANT TO CONDUCT THE ANNUAL PIZZA DELIVERY ONE DAY DURING STROKE AWARENESS MONTH. PIZZAS ARE DELIVERED BY EMS IN THE AMBULANCE. EDUCATIONAL MATERIALS AND SHORT CONVERSATIONS ON PREVENTION ARE PROVIDED WITH THE DELIVERY. MADELIA HEALTH PART V, SECTION B, LINE 13H: IF A PATIENT NEEDS CARE WITHIN ONE YEAR OF COMPLETION AND APPROVAL OF A FINANCIAL ASSISTANCE APPLICATION, THE ORGANIZATION WILL USE PRESUMPTIVE ELIGIBILITY BASED ON THE PREVIOUSLY COMPLETED APPLICATION. THE ORGANIZATION DOES NOT UTILIZE THIRD PARTY INFORMATION TO DETERMINE PRESUMPTIVE ELIGIBILITY FOR FINANCIAL ASSISTANCE. MADELIA HEALTH PART V, SECTION B, LINE 16J: THE FINANCIAL ASSISTANCE POLICY AND PLAIN LANGUAGE SUMMARY ARE AVAILABLE AT:HTTPS://WWW.MADELIAHEALTH.ORG/FINANCIAL-ASSISTANCE/FINANCIAL ASSISTANCE POLICY DIRECT LINK:HTTPS://WWW.MADELIAHEALTH.ORG/WP-CONTENT/UPLOADS/MADELIA-HEALTH-FINANCIAL-ASSISTANCE-SUMMARY-FINAL.PDFTHE INFORMATION ON THE WEBSITES EXPLAINS EXACTLY WHAT TO DO IN ORDER TO APPLY FOR FINANCIAL ASSISTANCE. THE APPLICATION FORM IS ALSO AVAILABLE AT REGISTRATION. A FINANCIAL ASSISTANCE APPLICATION AND LETTER IS SENT OUT TO PATIENTS WHO ARE NOT ABLE TO PAY THEIR BALANCES DUE.THE FAP APPLICATION IS AUTOMATICALLY MAILED OUT TO UNINSURED AND UNDERINSURED PATIENTS. MADELIA HEALTH PART V, SECTION B, LINE 20E: PATIENTS ARE INFORMED OF THE STATUS OF THEIR ACCOUNT THROUGH BILLING STATEMENTS AND LETTERS INDICATING THE AGING OF THEIR ACCOUNT AND THE AVAILABILITY TO MAKE PAYMENT ARRANGEMENTS WITH SEVERAL OPTIONS OF RECEIVING A DISCOUNT. 4 1 - LAKE CRYSTAL CLINIC 221 S MURPHY ST LAKE CRYSTAL MN 56055 CLINIC 2 - LAKE CRYSTAL PHARMACY 210 S MAIN ST LAKE CRYSTAL MN 56055 PHARMACY 3 - LAKE CRYSTAL REHAB 621 W NATHAN ST LAKE CRYSTAL MN 56055 REHAB SERVICE SPACE WITHIN A COMMUNITY CENTER 4 - TRUMAN CLINIC 401 N 4TH AVE E TRUMAN MN 56088 CLINIC PART I, LINE 3C: THE METHODOLOGY USED TO DETERMINE ELIGIBILITY FOR FINANCIAL ASSISTANCE TAKES INTO CONSIDERATION INCOME, FAMILY SIZE AND ASSETS TO PAY FOR CARE. IF A PATIENT NEEDS CARE WITHIN ONE YEAR OF COMPLETION AND APPROVAL OF A FINANCIAL ASSISTANCE APPLICATION, THE ORGANIZATION WILL USE PRESUMPTIVE ELIGIBILITY BASED ON THE PREVIOUSLY COMPLETED APPLICATION. THE ORGANIZATION DOES NOT UTILIZE THIRD PARTY INFORMATION TO DETERMINE PRESUMPTIVE ELIGIBILITY FOR FINANCIAL ASSISTANCE. PART I, LINE 7: LINE 7B, UNREIMBURSED MEDICAID, WAS CALCULATED USING THE COSTING METHODS TO PREPARE THE COST REPORTS. LINE 7E WAS TAKEN FROM THE GENERAL LEDGER. PART I, LN 7 COL(F): PATIENT RECEIVABLES ARE UNCOLLATERALIZED PATIENT AND THIRD-PARTY PAYOR OBLIGATIONS. PAYMENTS OF PATIENT RECEIVABLES ARE ALLOCATED TO THE SPECIFIC CLAIMS IDENTIFIED ON THE REMITTANCE ADVICE OR, IF UNSPECIFIED, ARE APPLIED TO THE EARLIEST UNPAID CLAIM.PATIENT ACCOUNTS RECEIVABLE CONSISTS OF AMOUNTS DUE FOR THE PROVISION OF HEALTH CARE SERVICES WHICH ARE RECORDED IN THE ACCOMPANYING CONSOLIDATED STATEMENTS OF FINANCIAL POSITION AT THE NET AMOUNT EXPECTED TO BE COLLECTED. IN EVALUATING THE COLLECTABILITY OF PATIENT ACCOUNTS RECEIVABLE, MANAGEMENT REGULARLY REVIEWS DATA AND DEVELOPS A LOSS RATE TO DETERMINE EXPECTED CREDIT LOSSES BASED ON SEVERAL FACTORS INCLUDING WHETHER A PATIENT HAS THIRD PARTY PAYOR COVERAGE OR IS UNINSURED, THE AGING OF RECEIVABLES, HISTORICAL COLLECTION AND LOSS EXPERIENCE, CURRENT CONTRACT PRICES OR CLAIMS PAID DATA, AND FORWARD LOOKING INFORMATION, SUCH AS FUTURE TRENDS FOR EACH OF ITS MAJOR PAYORS SOURCES OF REVENUE. THESE ESTIMATES ARE ADJUSTED FOR RECOVERIES AND ANY ANTICIPATED CHANGES IN TRENDS, INCLUDING SIGNIFICANT CHANGES IN PAYOR MIX, ECONOMIC CONDITIONS OR TRENDS IN FEDERAL AND STATE GOVERNMENTAL HEALTH CARE COVERAGE.MANAGEMENT BELIEVES THE COMPOSITION OF RECEIVABLES AT YEAR-END IS CONSISTENT WITH HISTORICAL CONDITIONS AS CREDIT TERMS AND PRACTICES AND THE CUSTOMER BASE HAS NOT CHANGED SIGNIFICANTLY; THEREFORE, THE HOSPITAL HAS MAINTAINED CONSISTENT METHODOLOGY IN ESTIMATION OF CREDIT LOSSES. MANAGEMENT HAS DETERMINED THE ESTIMATE OF EXPECTED CREDIT LOSSES IS NOT MATERIAL TO THE CONSOLIDATED FINANCIAL STATEMENTS. PART III, LINE 2: THE AMOUNT ON LINE 2 REPRESENTS IMPLICIT PRICE CONCESSIONS. THE ORGANIZATION DETERMINES ITS ESTIMATE OF IMPLICIT PRICE CONCESSIONS BASED ON ITS HISTORICAL COLLECTION EXPERIENCE WITH THIS CLASS OF PATIENTS. PART III, LINE 3: THE ESTIMATED AMOUNT OF THE ORGANIZATION'S IMPLICIT PRICE CONCESSIONS ATTRIBUTABLE TO PATIENTS ELIGIBLE UNDER THE ORGANIZATION'S CHARITY CARE POLICY IS CALCULATED BASED ON THE PERCENTAGE OF INDIVIDUALS LIVING BELOW THE POVERTY LEVEL IN 2024. THEREFORE, 10.60% OF IMPLICIT PRICE CONCESSIONS CAN REASONABLY BE CONSIDERED A COMMUNITY BENEFIT AS IT WOULD HAVE BEEN WRITTEN OFF TO CHARITY CARE. PART III, LINE 4: SEE THE "PATIENT ACCOUNTS RECEIVABLES" PARAGRAPHS ON PAGES 9-10 OF THE HOSPITAL'S ATTACHED AUDITED FINANCIAL STATEMENTS FOR AN EXPLANATION OF THE ORGANIZATION'S BAD DEBT EXPENSE. PART III, LINE 8: MEDICARE ALLOWABLE COST OF CARE WAS CALCULATED FROM THE MEDICARE COST REPORT FOR FISCAL YEAR ENDING 05/31/2025. MEDICAL SERVICES ARE PROVIDED TO PATIENTS WITH MEDICARE COVERAGE REGARDLESS OF WHETHER OR NOT A SURPLUS OR DEFICIT IS REALIZED. PROVIDING MEDICARE SERVICES PROMOTES ACCESS TO HEALTHCARE SERVICES WHICH ARE VITALLY NEEDED BY OUR COMMUNITY.THE MEDICARE COST REPORT IS COMPLETED BASED ON THE RULES AND REGULATIONS SET FORTH BY THE CENTERS FOR MEDICARE AND MEDICAID SERVICES. PART III, LINE 9B: EACH WEEK, STATEMENTS ARE SENT OUT THROUGH OUR EDI PROCESS WITH STATEMENTS BEING MAILED TO THE PATIENT BY A CLEARINGHOUSE. PATIENTS ARE BILLED AFTER MEDICARE OR COMMERCIAL INSURANCE HAS BEEN FILED AND PAYMENT HAS BEEN RECEIVED WITHIN A SIX-WEEK PERIOD. PATIENTS WILL BE BILLED FOR THE REMAINING BALANCE MONTHLY. ACCOUNTS ARE VERIFIED INTERNALLY PRIOR TO COLLECTION LETTERS BEING SENT. IF NO PAYMENT IS RECEIVED WITHIN 2 MONTHS OF BILLINGS, THE STATEMENT IS SENT WITH A NOTICE LETTER REQUESTING PAYMENT. LETTERS WILL ALSO BE SENT SHOULD NO PAYMENT BE RECEIVED WITHIN 60 AND 90 DAYS. SHOULD NO RESPONSE BE RECEIVED WITHIN FIVE (5) DAYS OF THE LAST LETTER, A TELEPHONE CALL IS ISSUED TO NEGOTIATE A PAYMENT PLAN. IF THE ACCOUNT HOLDER MAY QUALIFY FOR OUR HEALTHCARE FINANCIAL PROGRAM, AN APPLICATION IS SENT TO BE COMPLETED AND RETURNED TO US. LACK OF RESPONSE TO THE TELEPHONE CALL WITH 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 OVER TO A PROFESSIONAL COLLECTION AGENCY. CHARITY CARE CONSIDERATIONS WILL BE MADE BY THE BUSINESS OFFICE MANAGER WHEN ALL NECESSARY DOCUMENTATION IS PRESENTED AND SHOULD IT BE EVIDENT THAT THE PATIENT'S LACK OF FINANCES WARRANT THIS AND CHARITY CARE IS THE BEST ETHICAL DECISION FOR THE PATIENT. PART VI, LINE 2: THROUGH THE COMMUNITY ASSESSMENT PROCESS, HEALTHCARE NEEDS AND SERVICES WERE IDENTIFIED AND PROGRAMS WERE DEVELOPED. 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 MEMBERS THAT REPRESENT THE COMMUNITY AND BRINGS TO THE TABLE ISSUES, CONCERNS, AND RECOMMENDATIONS FOR HEALTH CARE SERVICES.MADELIA HEALTH COLLABORATES WITH OTHER LOCAL ORGANIZATIONS REFERRED TO AS THE MADELIA COMMUNITY BASED COLLABORATIVE (MCBC) WHICH INCLUDES THE FOLLOWING PARTICIPANT ORGANIZATIONS: MADELIA HEALTH AND CLINICS, MINNESOTA STATE UNIVERSITY, MANKATO SCHOOL OF NURSING, GLEN TAYLOR NURSING INSTITUTE FOR FAMILY AND SOCIETY, WATONWAN COUNTY PUBLIC HEALTH DEPARTMENT, MADELIA SCHOOL SYSTEM, LUTHER MEMORIAL HOME, DOWNS FOOD GROUP INC, MADELIA CITY COUNCIL, AND MADELIA CHAMBER OF COMMERCE. THROUGH THIS COLLABORATION, MADELIA HEALTH IS ABLE TO PARTNER WITH OTHER ORGANIZATIONS THAT HAVE EXPRESSED AN INTEREST IN IMPROVING THE HEALTH OF THEIR EMPLOYEES. THE COMMUNITY HEALTH NEEDS ASSESSMENT COMPLETED BY MADELIA HEALTH HELPS MCDC DETERMINE WHAT AREAS THEY WILL FOCUS THEIR EFFORTS IN ORDER TO GAIN THE MOST BENEFIT FOR THE COMMUNITY. STAFF FROM MADELIA HEALTH HAVE A SIGNIFICANT ROLE IN THIS DEVELOPMENT AND CARRYING OUT OF THE ACTION PLANS. 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 THE ACCOUNTS IDENTIFIED AS UNINSURED AND UNDERINSURED. PART VI, LINE 4: MADELIA HEALTH SERVES A 30 MILE RADIUS OF RURAL COMMUNITIES CONSISTING OF CULTURALLY DIVERSE AND SENIOR POPULATIONS. THE MAJORITY OF THE SERVICE AREA IS IN WATONWAN COUNTY, MINNESOTA. FOR THE ESTIMATED 4,227 HOUSEHOLDS IN THE COMMUNITY, THE MEDIAN HOUSEHOLD INCOME IS $71,699. THIS IS ABOUT $17,000 BELOW THAT OF THE STATE OF MINNESOTA. THE POVERY RATE FOR WATONWAN COUNTY IS 10.6%, AS COMPARED TO 9.3% FOR THE STATE OF MINNESOTA. THE UNEMPLOYMENT RATE FOR THE COUNTY IS 3.2% FOR 2021. APPROXIMATELY 21% OF INDIVIDUALS ARE OVER THE AGE OF 65. THE POPULATION IS 64.5% CAUCASIAN, 32.5% HISPANIC, AND 3% OTHER. PART VI, LINE 5: THE HOSPITAL SERVES ALL PERSONS IN THE COMMUNITY ON A NON-DISCRIMINATORY BASIS, AND OPERATES AN EMERGENCY ROOM THAT IS OPEN TO ALL PERSONS REGARDLESS OF THEIR ABILITY TO PAY. MADELIA HEALTH HAS AN OPEN MEDICAL STAFF WITH PRIVILEGES AVAILABLE TO ALL QUALIFIED PHYSICIANS IN THE AREA. THE GOVERNING BODY IS COMPRISED PRIMARILY OF INDEPENDENT PERSONS REPRESENTATIVE OF THE COMMUNITY.STAFF PARTICIPATE IN COMMUNITY ORGANIZATIONS TO PROVIDE HEALTHCARE REPRESENTATION AND INFORMATION TO ENHANCE THOSE ORGANIZATION'S EVENTS, ETC. PART VI, LINE 7, REPORTS FILED WITH STATES MN X 1 0 X X 0 0 0 1 0 0 0 0 0 SARAH DRYDEN PHYSICIAN 213437 0 38645 0 0 0 10170 0 910 0 263162 0 0 0 DAVID WALZ CEO 215766 0 24188 0 0 0 23012 0 0 0 262966 0 0 0 LUIS MARTINEZ PHYSICIAN 235123 0 0 0 0 0 369 0 840 0 236332 0 0 0 BRUCE ROREM PHYSICIAN 217319 0 9179 0 0 0 9192 0 0 0 235690 0 0 0 JULIE DOLPHIN NURSE PRACTITIONER 160629 0 41917 0 0 0 8233 0 910 0 211689 0 0 0 ROZ SNYDER CCO 154378 0 7692 0 0 0 18999 0 910 0 181979 0 0 0 GRACE OUYANG PHYSICIAN 158682 0 0 0 0 0 0 0 630 0 159312 0 0 0 PART I, LINE 1A IN CALENDAR YEAR 2024, THE CEO RECEIVED A HOUSING ALLOWANCE OF $5,000. THIS AMOUNT WAS INCLUDED IN THE CEO'S TAXABLE COMPENSATION. A CITY OF MADELIA MN 466005334 2021-02-26 4118000 REVENUE REFUNDING BOND SERIES 2021 0 0 0 A 3834883 4118000 81644 4036356 1 0 1 1 A 0 0 0 0 0.00000 0.00000 0.00000 0 0 0 A 0 1 0 0 1 0 0 0 0 FORM 990, PART III, LINE 3 CEASED ALL RETAIL PHARMACY ACTIVITY MAY 2025. FORM 990, PART VI, SECTION A, LINE 1A THE EXECUTIVE COMMITTEE SHALL CONSIST OF THE PRESIDENT, AS CHAIRPERSON, VICE PRESIDENT/TREASURER, SECRETARY, AND UP TWO (2) ADDITIONAL TRUSTEES. THE EXECUTIVE COMMITTEE SHALL HAVE POWER TO TRANSACT ALL REGULAR BUSINESS OF THE CORPORATION DURING THE PERIOD BETWEEN THE MEETINGS OF THE BOARD OF TRUSTEES, SUBJECT TO ANY POWER LIMITATION IMPOSED BY THE BOARD OF TRUSTEES. A QUORUM FOR THE EXECUTIVE COMMITTEE CAN ONLY BE MADE UP OF EXECUTIVE COMMITTEE MEMBERS AND ONLY EXECUTIVE COMMITTEE MEMBERS MAY VOTE DURING EXECUTIVE COMMITTEE MEETINGS. MINUTES OF THE EXECUTIVE MEETINGS SHALL BE SUBMITTED TO THE BOARD OF TRUSTEES. THE EXECUTIVE COMMITTEE SHALL ANNUALLY EVALUATE THE CHIEF EXECUTIVE OFFICER'S PERFORMANCE AND RECOMMEND HIS/HER REMUNERATION TO THE FULL BOARD OF TRUSTEES BASED ON THE CHIEF EXECUTIVE OFFICER'S PERFORMANCE IN RELATION TO THE CORPORATION'S OBJECTIVES AND GOALS. THIS COMMITTEE SHALL MEET AS NECESSARY. FORM 990, PART VI, SECTION A, LINE 6 MEMBERSHIP IN THIS CORPORATION SHALL BE OPEN TO ANY NATURAL PERSON WHO MEETS THE FOLLOWING QUALIFICATIONS AT THE TIME OF THE 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, PARTNERSHIPS OR OTHER ASSOCIATION; 4) SUBMITS A WRITTEN APPLICATION FOR MEMBERSHIP TO THE BOARD OF TRUSTEES ON A FORM APPROVED BY THE BOARD OF TRUSTEES; 5) SUBMITS A MEMBERSHIP FEE OF $25 OR MORE, WITH SAID APPLICATION. FORM 990, PART VI, SECTION A, LINE 7A ALL TRUSTEES ARE ELECTED BY THE CORPORATE MEMBERS. FORM 990, PART VI, SECTION B, LINE 11B THE FORM 990 WAS REVIEWED BY THE ACCOUNTANT AND CEO PRIOR TO FILING AND WILL BE PRESENTED TO THE GOVERNING BOARD OF TRUSTEES BY FINANCE COMMITTEE AT THE FIRST REGULAR MEETING OF THE BOARD OF TRUSTEES SUBSEQUENT TO FILING. FORM 990, PART VI, SECTION B, LINE 12C THE CONFLICT OF INTEREST POLICY IS REVIEWED AT THE JANUARY BOARD MEETING BY THE GOVERNING BOARD AND DEPARTMENT MANAGERS. IF ANY CONFLICTS OF INTEREST ARISE, NOTIFICATION IS GIVEN TO ADMINISTRATION. A CONTRACT OR OTHER TRANSACTION THAT MAY INVOLVE A CONFLICT OF INTEREST IS NOT VOID OR VOIDABLE IF: 1) THE CONTRACT OR TRANSACTION WAS FAIR AND REASONABLE AS TO THE CORPORATION WHEN IT WAS AUTHORIZED, APPROVED, OR RATIFIED; 2) ALL MATERIAL FACTS ARE FULLY DISCLOSED TO THE MEMBERS AND THE CONTRACT OR TRANSACTION IS APPROVED BY TWO-THIRDS OF THE MEMBERS ENTITLED TO VOTE, OTHER THAN THE INTERESTED DIRECTOR OR TRUSTEE; AND 3) ALL MATERIAL FACTS ARE FULLY DISCLOSED TO THE BOARD OF TRUSTEES OR A COMMITTEE, AND THE BOARD OR COMMITTEE APPROVES THE CONTRACT OR TRANSACTION BY A MAJORITY VOTE, BUT THE INTERESTED TRUSTEE MAY NOT TAKE PART IN THE DISCUSSION, AND MAY NOT VOTE. FORM 990, PART VI, SECTION B, LINE 15 MADELIA HEALTH ENSURES THAT THE COMPENSATION PAID TO ITS CEO BE CONSISTENT WITH POLICY AND PROVIDE EQUITABLE STANDARDS FOR WAGE AND BENEFITS BASED ON ANNUAL REGIONAL SURVEY OF COMPARABLE ENTITIES. THE GOVERNING BOARD REVIEWS ANNUALLY THE CEO'S PERFORMANCE AND THE BASIS IS THE ANNUAL MN HOSPITAL ASSOCIATION SURVEY. THE BOARD DETERMINES THE CEO'S BASE SALARY, IN ITS SOLE DISCRETION. THE CEO EVALUATES COMPENSATION OF OTHER OFFICERS AND EMPLOYEES ANNUALLY BASED ON THEIR PERFORMANCE. ANNUAL INCREASES ARE BASED ON A REGIONAL SURVEY OF COMPARABLE ENTITIES WITH SIMILAR POSITIONS ALONG WITH YEARS OF SERVICE AND NUMBER SUPERVISED. THE SURVEY RESULTS AND THE EMPLOYEES PERFORMANCE ARE EVALUATED FOR AN INCREASE IF DEEMED APPROPRIATE. FORM 990, PART VI, SECTION C, LINE 19 MADELIA HEALTH MAKES ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC AT THE ANNUAL CORPORATION MEETING AND UPON REQUEST. FORM 990, PART IX, LINE 11G PURCHASED SERVICES: PROGRAM SERVICE EXPENSES 1,721,251. MANAGEMENT AND GENERAL EXPENSES 879,384. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 2,600,635. MADELIA HEALTH FOUNDATION 121 DREW AVENUE SE MADELIA MN 56062 731719218 SOLICIT CONTRIBUTIONS ON BEHALF OF THE MADELIA COMMUNITY HOSPITAL MN 501(C)(3) LINE 12A, I MADELIA HEALTH 1 0 0 1 0 0 0 0 0 0 0 0 0 1 1 1 1 1 1 1