2025-03-19T14:40:01-05:00 2024-06-30 450250958 Eide Bailly LLP 4585 Coleman St Ste 200 Bismarck ND 58503 990 2023-07-01 410307617 Hendricks Community Hospital Association HEND 5072753134 PO Box 106 Hendricks MN 56136 Travis Olsen CFO 5072753134 2025-03-17 1 1 Lisa Chaffee CPA P00193453 7012551091 2025-03-17 2023 2025-03-06 01:10:19Z Jeff Gollaher PO Box 106 Hendricks MN 56136 16970015 0 X www.hendrickshosp.org X 1941 MN Provision of healthcare 9 9 193 60 0 0 3435928 495794 15639196 16183057 34871 214360 57104 60075 19167099 16953286 18026 9834 0 0 8578005 8542992 0 0 0 7503516 7766974 16099547 16319800 3067552 633486 27318418 28380138 4912205 4746537 22406213 23633601 X Hendricks Community Hospital Assn & Retirement Home strives to provide the highest quality health and residential care in a Christian environment. 0 0 14764001 9834 16183057 Hendricks Community Hospital, a 24-bed hospital, 48-bed long-term care facility, 16-unit assisted living facility, and home health agency promotes health of the community by providing a variety of health care services. The facility had 67 acute, 46 swing bed, 10 transitional bed and 21 long-term care facility admissions for the year ended June 30, 2024; 440 visits to the Emergency Room; and 112 surgical cases (including ambulatory).Continued on Schedule OThe hospital provides care to patients who meet certain criteria under its charity care policy without charge or at amounts less than established rates. Because the hospital does not pursue collection of amounts determined to qualify as charity care, they are not reported as patient and resident service revenue. The amount of charges foregone for services provided under the Hospital's charity care policy were approximately $19,000 for the year ended June 30, 2024. The estimated cost of providing these services was $14,000 for the year ended June 30, 2024 based on average ratio of cost to gross charges. 14764001 1 1 0 1 0 0 0 0 1 0 1 0 0 0 1 1 1 0 0 0 0 0 0 0 0 0 1 1 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 58 0 1 193 1 0 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 1 1 1 1 1 1 1 0 0 MN X Travis Olsen 5072753134 PO Box 106 Hendricks MN 56136 Allen Molascon President 3.00 X X 1060 0 0 Mark VanEck Vice President 2.00 X X 1110 0 0 Dawn Popowski Secretary 2.00 X X 1200 0 0 Vince Robinson Treasurer 2.00 X X 1510 0 0 Brittany Johnson Director 2.00 X 800 0 0 James Ness Director 2.00 X 1040 0 0 John Engels Director 2.00 X 500 0 0 Heidi Fier Director 2.00 X 1120 0 0 Heather Rae Shaw Director 2.00 X 1160 0 0 Jeff Gollaher CEO 40.00 X 204733 0 26886 Travis Olsen CFO 40.00 X 134874 0 6471 Tabb McCluskey DO Physician 40.00 X 291226 0 57890 Grant Eyjolfson MD Physician 40.00 X 286896 0 56144 Alecia Moe Director of Nursing 40.00 X 129168 0 45062 Kathryn Christensen Nurse Practitioner 40.00 X 130650 0 8219 Brenda Bullerman Physician Assistant 40.00 X 120935 0 35040 1307982 0 235712 13 0 1 0 Fusion Medical Staffing 11808 Grant St Ste 100 Omaha NE 68164 Contracted Nursing Service 893938 Wapiti Medical Group 912 Industrial Dr Milbank SD 57252 Locum/ER Providers 694402 GrapeTree Medical Staffing 2501 Boji Bend Dr Ste 100 Milford IA 51351 Medical Staffing 140668 3 380237 115557 495794 Net patient & resident service re 621110 16147466 16147466 35591 35591 16183057 193160 193160 18508 0 18508 18508 18508 21200 0 21200 21200 21200 58296 16729 41567 41567 16953286 16183057 0 274435 X 9834 9834 408556 408556 6572722 6303376 269346 161788 160134 1654 916059 848605 67454 483867 439295 44572 74350 74350 3031183 3017984 13199 16812 16812 127681 106143 21538 33338 33338 373023 373023 69274 69274 86399 66910 19489 102487 93612 8875 1027302 949489 77813 217962 199087 18875 Repairs and Maintenance 1043577 913069 130508 Medical Supplies 986961 986961 MN Care Tax 89818 89818 486807 87237 399570 16319800 14764001 1555799 0 4430041 6446058 4708108 3085074 27256 13972 152798 141078 149155 110576 28438009 18929423 9941193 9508586 7748481 9071281 161386 3513 27318418 28380138 1073307 867493 27500 30800 3587418 3368849 223980 479395 4912205 4746537 X 22406213 23633601 22406213 23633601 27318418 28380138 X 633486 592796 1106 X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 346 346 0 Part II-B, Line 1: For calendar year 2023, MHA has determined that 3.96% of its membership dues were used for lobbying purposes as defined by Medicare for cost report purposes. 1 45652 58296 62098 41850 1 X 12000 91512 103512 16270273 10794144 5476129 12064224 8135279 3928945 9508586 Insurance Loss Liability 331544 Estimated Third Party Payor 147851 479395 X 17547188 592796 592796 16954392 -1106 -1106 16953286 16319800 0 16319800 0 16319800 Part IV, Line 1b: The assets of Hendricks Hospital Auxiliary are held by Hendricks Community Hospital Association. The Auxiliary uses the EIN of the Hospital, therefore the activity is reported on Form 990 of the Hospital. The ending balance of the Auxiliary was $38,340. In addition, the hospital holds funds on behalf of its residents. The amount held at the end of the year for residents was $3,510. Part IV, Line 2b: The organization holds security deposits. Part X, Line 2: The Association believes 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 Association 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. Part XI, Line 4b - Other Adjustments: Net income from auxiliary not included in financial statements -3,802. Resident fund net revenue not included in financial statements 2,696. 1 1 X 1 X 1 X 1 1 0 1 1 14000 14000 0.00090 14000 14000 0.00090 10131 10131 0.00060 29269 29269 0.00180 5166037 2952179 2213858 0.13570 9834 9834 0.00060 5215271 2952179 2263092 0.13870 5229271 2952179 2277092 0.13960 1 156861 0 2831008 2790267 40741 X 1 1 1 1 Hendricks Community Hospital Association 503 East Lincoln Hendricks MN 56136 www.hendrickshosp.org 405662 X X X X 2 provider based RHC's Hendricks Community Hospital Association 1 0 0 1 X X X X X X X X X 21 1 0 0 1 X www.hendrickshosp.org/chna X 1 21 1 www.hendrickshosp.org/chna 0 1 X 100.000000000000 400.000000000000 X X X X 1 1 X X X 1 X www.hendrickshosp.org/financial-assistance X www.hendrickshosp.org/financial-assistance X www.hendrickshosp.org/financial-assistance X X X X X X 1 X 0 X X X X 1 X 0 0 Hendricks Community Hospital Association Part V, Section B, Line 5: A community survey was mailed to all households in the HCHA service area and on-line completion was offered. Four focus group meetings with a total of 25 individuals were held in March of 2022. Of the surveys that were distributed 129 were returned. Hendricks Community Hospital Association Part V, Section B, Line 11: The following priorities were identified as top priorities through the 2021 Community Health Needs Assessment process and recognized as focus areas by the HCHA Board of Directors:* Health and Wellness Activities* Health and Wellness Education* Transportation ServicesPriority: Health and Wellness ActivitiesHCHA recognizes that each community member offers unique strengths providing opportunities for all members to contribute to the overall health and wellness of the community. In creating a socially inclusive environment, communities can help individuals thrive in many areas of their lives and positively impact their overall wellness.Project impact:Physical activity benefits impact the community's health in terms of physical fitness, social interaction, community involvement, and mental health, creating a better quality of life for all community members.Goal:The improvement of physical activities for all ages across Lincoln County year round. Strategies:* Identify community events/activities HCHA promotes or sponsors to increase awareness of physical activity benefits.* Lead or support local efforts to provide the community with physical activities that include all generations of community members.* Individually or partnering with community businesses/organizations to engage in the development of a community wellness center.Outcome Objective:The improvement of health, fitness, and quality of life through daily physical activity at any age, skill, and fitness level. We did a focused community survey in regards to the wellness to gather more information. We have reviewed and shared the results from this survey, but have not taken any action. We have met with the school to look at some partnering options for a community/wellness center. To date we do have not had any substantive action for the community wellness center. Priority: Health and Wellness EducationHCHA is seen as a leading influence in the community, primarily related to health and wellness education. The Community Health Needs Assessment revealed the opportunity to expand education efforts on health and wellness by promoting healthy living. The health and wellness education would empower individuals, families, and the community to make healthier choices. The identified educational topics included physical inactivity, obesity, excessive drinking, and diabetes to improve the community's educational level. The assessment process also allowed HCHA to discuss how to increase collaboration with community partners to compile resources in an effort to make a long-lasting impact on individuals, families, and the community.Project Impact:Increasing the community's access to easy-to-understand information about healthy lifestyle behaviors by increasing knowledge and skills related to a healthy lifestyle for all community members.Goal:Educate and empower families across the lifecycle with the skills and information they need to make behavior changes that support a healthy lifestyle long-term.Strategies:* Identify opportunities to use technology to increase educational outreach impacting community members and non-community members by disseminating health and safety information that is accurate, accessible, and actionable.* Building local partnerships to reach all community members about the importance of healthy lifestyles.* Capitalize on community events to provide educational information and share healthy living opportunities.Outcome Objective:The increased understanding of healthy behaviors to improve individuals, families, and the overall community health. Over the last year we have been providing more targeted wellness information to the community through newspaper articles and postings our new community sign. Over the last year we have published approximately 1 column per month. Topics included podiatry care, hospice care, proper utilization of the ER, and ambulance services Priority: Transportation Services:HCHA recognizes transportation as a barrier in their community. The lack of transportation may lead to rescheduled or missed appointments delayed care or no care, and limited pharmacy access. Transportation for all community members to receive medical care, access to healthy food, employment, and social connection is essential for the overall health of their community on a multi generational level.Outcome Objective:The transportation committee has held focus committee meetings. In one of the meetings, we met with a representative that runs transportation services for Lyon and Lincoln counties. We discussed opportunities to better utilize these services in our community. We started the process of identifying our own volunteers in our community to provide private vehicle transportation for residents and patients. We are still in the process determining how to properly run this type of volunteer service. Project Impact:Having reliable transportation impacts a person's access to appropriate and well-coordinated healthcare, personal care, and community involvement.Goal:Ensuring all community members can get to and from their healthcare-related appointments allows them to receive proper care.Strategies: Defining the expectation of the HCHA public transportation service based on the need of the community HCHA serves. Collaborate with local resources to aid in planning initiatives about how a community's health can be affected by the lack of transportation to develop a viable solution. Engaging in opportunities that further the implementation of bringing transportation to disadvantaged patients from their homes to the HCHA or from HCHA to other facilities.Outcome Objective:The improvement of transportation and health care access for all community members to create a healthier community with access to all their healthcare needs.In the current year the facility has taken the following actions to address the top three hot topics of health and wellness activities, health and wellness education and transportation services. Beginning with our transportation services, we purchased a large, wheelchair accessible van which has brought much satisfaction among our staff and residents. Our staff has been able to safely transfer residents not only to short distance dental appointments but also to resident medical appointments which at times have been up to 90 miles away from our facility. We've also used the van for social activities for residents from both the nursing home and our assisted living. Staff have taken residents for rides to parades, small field trips and other local social events. The social connection this van has been able to give to our residents is actually emotional at times. It's proven to be a wonderful purchase and they can't wait to get out see all the Christmas lights around town soon!Regarding health and wellness education and activities, during fiscal year 2024, we were in contact with a professional fitness trainer whose services could benefit our entire community but a proper location for the fitness center was the barrier. We continued to push through and purchased a building on our local main street and that closing occurred in July of 2024. We had some remodeling to do to prepare the building for the purpose of having exercise equipment and an exercise studio for all ages. As the trainer could not afford the purchase, our hospital made the purchase and are currently leasing the building to the trainer. To promote and emphasize the need for health and wellness, we pay the trainer a fair monthly rate so all of our employees can use the facility at no cost to them. The facility opened in September of 2024 and it's been a huge success for our community. This couldn't have happened without the support from our board of trustees. Hendricks Community Hospital Association Part V, Section B, Line 13h: Discounted care eligibility is determined by utilizing asset and ability to pay information obtained from the patient or responsible party. Discounted care portion of the account is determined based on the patient's financial status and ability to pay the account. Hendricks Community Hospital Association Part V, Section B, Line 16j: Summaries of the financial assistance policy are posted in the hospital/clinic facilities, as well as waiting rooms and admission area. Billing statements to potentially eligible patients also include summary and contact information for obtaining the appropriate application. 2 1 - Hendricks Nursing Home 503 E Lincoln St Hendricks MN 56136 Long-term Care 2 - Lincoln Lane Villa 500 E Lincoln St Hendricks MN 56136 Assisted Living Part I, Line 3c: Discounted care eligibility is determined by utilizing asset and ability to pay information obtained from the patient or responsible party. Discounted care portion of the account is determined based on the patient's financial status and the ability to pay the account. Part I, Line 7: Charity care is based on an overall cost to charge ratio addressing all patient segments. Community health improvement services, health professions education, and cash and in-kind contributions for community benefit expenses are based on actual expenses recorded to the general ledger. Subsidized health services are reported according to costs allocated to the relevant cost centers on the Medicare Cost Report. Part III, Line 2: The amount reported on line 2 represents implicit price concessions. The Association determines its estimate of implicit price concessions based on its historical collection experience with this class of patients and residents. Part III, Line 3: Implicit price concessions are determined based on a patient's payment history as well as current known financial status. Such expense is determined by a patient's non-payment status and non-probability of payment. Part III, Line 4: The footnote to the organization's financial statements addressing implicit price concessions may be found on page 9 and 10 of the attached audited financial statements. Part III, Line 8: The Hospital provides services to Medicare patients because access to healthcare and patient's health is important to the Hospital. Total revenue received from Medicare is the gross reimbursement plus settlement. Both total revenue received from Medicare and the Medicare allowable costs are reported from the Medicare Cost Report. 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: Patients are classified in the poverty level utilizing the Federal poverty guidelines as also referenced in our facility collection policy. The guidelines are referenced when a patient fails to complete payment of his/her account in a timely manner. Prior to being turned over to a collection agency, a patient is offered 120 days to complete a charity care application, thereby allowing staff time to determine the income level of the patient and their qualification as a poverty level individual. If they so choose to not complete an application, their account will be referred to a collection agency. The hospital allows an additional 120 days for a patient to apply for financial assistance. If the patient is determined to be eligible for financial assistance, collection activities will cease. Part VI, Line 2: We are consistently addressing the additional service needs as voiced though the physicians who serve our patients, as well as the patients themselves.The community health needs assessment and implementation strategy has been established and is available on our website www.hendrickshosp.org Part VI, Line 3: Patient's insurance information is obtained upon admission, and those patients not having current third party coverage are informed of the ability to apply for medical assistance funding or visit with our business office staff and social service staff regarding alternative payments and the charity care options. In addition, the patient statements provide information related to contacting our business office personnel to complete alternative payment arrangements, i.e. charity care, Medicaid or planned payment schedule. Patients are offered an option of setting an appointment to meet with staff to complete such arrangements. These procedures are also detailed in our financial assistance/charity care policy. Part VI, Line 4: Hendricks Community Hospital serves a primarily rural population within a 30-mile radius of the community of Hendricks. The facility is located in Lincoln County, Minnesota, which is slated as one of the highest elderly population counties in the State. The median income for the county is $53,057 with the highest portion of the population being over 65 years of age. However, because of the high elderly population, many of those constituents are insured through federal government programs and do not necessarily relate to increased Medicaid levels. There is one other acute care facility in the county approximately 30 miles away. Our facility is also located within one mile of the South Dakota border, and a good margin of population served is located in that state. During the fiscal year ending 6/30/23, it was noted approximately 22% of our patients were insured through Medical Assistance programs, and approximately 8% were un-insured. Part VI, Line 5: The nine members of the Association's Board of Directors represent varying communities within the 30-mile service area. The board members provide valuable input on the health care needs of the area served.Medical staff privileges are extended to qualified physicians within the service area as well as outlying areas to provide the optimum level of care for our constituents. These privileges are granted to several specialty physicians to eliminate the need for additional travel for our patients.The Association continually allocates funds to the improvement of the facilities and equipment utilized to provide the optimum service to our patients. Surplus funds are also provided to enhance community services with donations to service organizations who offer additional health-enhancing services to the residents of the area. The rural health clinics in the Hendricks community and neighboring Ivanhoe community provide for improved community access. Particularily in the Ivanhoe community it has proved beneficial to be able to offer services to patients in their primary dwelling location.Emergency room services are available 24/7, and are offered regardless of payment source or ability to pay.The facility also participates in the Minnesota SAGE and South Dakota All Women Count programs which offer women yearly physical exams, including mammograms and pap smears at no cost to the patient.Facility staff is involved in community economic planning groups as well as community service organizations.Many area residents are involved as volunteers within our organization and participate on a daily basis enhancing the lives of the residents and patients in our facility. X X X 0 0 0 0 0 0 0 0 0 Tabb McCluskey DO Physician 291226 0 0 0 0 0 12418 0 45472 0 349116 0 0 0 Grant Eyjolfson MD Physician 286896 0 0 0 0 0 11965 0 44179 0 343040 0 0 0 Jeff Gollaher CEO 204733 0 0 0 0 0 8377 0 18509 0 231619 0 0 0 Alecia Moe Director of Nursing 129168 0 0 0 0 0 5434 0 39628 0 174230 0 0 0 Brenda Bullerman Physician Assistant 120935 0 0 0 0 0 5173 0 29867 0 155975 0 0 0 Form 990, Part VI, Section A, line 1a The Executive Committee is composed of the President, Vice-President, Secretary and Treasurer of the governing board. Responsibilities include: A. General management and control of the affairs of the corporation. In addition to formal meetings, the committee has informal conferences about corporation activities. B. Shall have the power to transact all regular business of the hospital during the interim between the meetings of the Board of Directors provided any action taken shall not conflict with the policies and expressed wishes of the Board of Directors, and that it shall refer all matters of major importance to the Board of Directors. C. It shall cause to be prepared and submit to the Board of Directors at its last meeting before the end of the fiscal year, a budget showing the expected receipts and income and expense for the ensuing year. It shall be the further duty of the Executive Committee to examine the monthly financial reports and to require an explanation from the Administrator for any material variation from the budget. D. The Executive Committee shall evaluate in April annually or as deemed necessary, the Chief Executive Officer's performance and recommend his/her remuneration to the full Board of Directors. This committee shall meet as necessary. Form 990, Part VI, Section A, line 6 There is one class of membership. Membership is open to any natural person who is of legal voting age and a voting resident within the organization's primary service area. Form 990, Part VI, Section A, line 7a Each member receives one vote. Form 990, Part VI, Section B, line 11b The return is reviewed by the CEO and CFO, then by the Board of Directors before it is filed. Form 990, Part VI, Section B, line 12c The policy covers all officers, directors, and key employees. A conflict of interest form is signed upon orientation to the Board of Directors. The form is reviewed by the CEO and any potential conflicts are reviewed with the Board of Directors. If a conflict exists, the person with the conflict is restricted from voting on related matters. Conflict of interest forms are completed annually by board of directors and key employees. These are reviewed by the HR director, and compliance report submitted to the governing board. Form 990, Part VI, Section B, line 15a The Executive Committee reviews the CEO's compensation annually and compares to similar positions at other hospitals of similar size and geographic location. The Board of Directors reviews and approves the recommendations of the Executive Committee. The compensation of other officers is determined by the CEO. The officers and directors of the board receive a stipend for attending meetings. The fee structure is based on meetings attended. This compensation process is determined by board members and the fee schedule is discussed by the board annually. Form 990, Part VI, Section C, line 19 The Organization makes its governing documents, conflict of interest policy, and financial statements available to the public upon request. Form 990, Part IX, line 11g Contracted Services: Program service expenses 1,865,510. Management and general expenses 0. Fundraising expenses 0. Total expenses 1,865,510. Medical Fees: Program service expenses 871,647. Management and general expenses 0. Fundraising expenses 0. Total expenses 871,647. Purchased Services: Program service expenses 251,051. Management and general expenses 13,199. Fundraising expenses 0. Total expenses 264,250. Collection Fees: Program service expenses 207. Management and general expenses 0. Fundraising expenses 0. Total expenses 207. Recruitment: Program service expenses 29,569. Management and general expenses 0. Fundraising expenses 0. Total expenses 29,569. Form 990, Part XI, line 9: Change in net assets for Hendricks Hospital Auxiliary 3,802. Change in net assets for Resident Funds -2,696.