MADISON FAMILY HEALTH CORPORATION: Form 990, tax year 2020

View the entire original 990 at ProPublica ↗

Organization
MADISON FAMILY HEALTH CORPORATION (EIN 31-1514418)
Tax period
2020-01-01 to 2020-12-31
Filed
2021-11-03
IRS object ID
202113079349302281
Schema version
2020v4.1
Source
Download XML · Original 990 at ProPublica

Every field in the e-filed return. Faint text is the IRS element name, for citing.

Return header ReturnHeader

FieldValueIRS element (for citing)
Return2021-11-03T15:41:04-05:00ReturnTs
Tax Period End2020-12-31TaxPeriodEndDt

Preparer Firm PreparerFirmGrp

FieldValueIRS element (for citing)
Preparer Firm EIN251408703PreparerFirmEIN

Preparer Firm Name PreparerFirmName

FieldValueIRS element (for citing)
Business Name Line1SCHNEIDER DOWNS & CO INCBusinessNameLine1Txt

Preparer US Address PreparerUSAddress

FieldValueIRS element (for citing)
Address Line1ONE PPG PLACE SUITE 1700AddressLine1Txt
CityPITTSBURGHCityNm
State AbbreviationPAStateAbbreviationCd
ZIP15222ZIPCd
FieldValueIRS element (for citing)
Return Type990ReturnTypeCd
Tax Period Begin2020-01-01TaxPeriodBeginDt

Filer Filer

FieldValueIRS element (for citing)
EIN311514418EIN

Business Name BusinessName

FieldValueIRS element (for citing)
Business Name Line1MADISON FAMILY HEALTH CORPORATIONBusinessNameLine1Txt
FieldValueIRS element (for citing)
Business Name ControlMADIBusinessNameControlTxt
Phone7408457015PhoneNum

US Address USAddress

FieldValueIRS element (for citing)
Address Line1210 NORTH MAIN STREETAddressLine1Txt
CityLONDONCityNm
State AbbreviationOHStateAbbreviationCd
ZIP43140ZIPCd

Business Officer BusinessOfficerGrp

FieldValueIRS element (for citing)
PersonDANA E ENGLEPersonNm
Person TitlePRESIDENTPersonTitleTxt
Phone7408457015PhoneNum
Signature2021-10-29SignatureDt
Discuss With Paid PreparerYes (1)DiscussWithPaidPreparerInd

Signing Officer SigningOfficerGrp

Person Full Name PersonFullName

FieldValueIRS element (for citing)
Person FirstDANAPersonFirstNm
Person LastENGLEPersonLastNm
FieldValueIRS element (for citing)
SSN999009999SSN

Preparer Person PreparerPersonGrp

FieldValueIRS element (for citing)
Preparer PersonMELANIE PANTALONEPreparerPersonNm
PTINP01614571PTIN
Phone4122613644PhoneNum

Additional Filer Information AdditionalFilerInformation

Trusted Customer TrustedCustomerGrp

FieldValueIRS element (for citing)
Trusted Customer2TrustedCustomerCd
Authentication Assurance LevelAAL1AuthenticationAssuranceLevelCd
Identity Assurance LevelIAL1IdentityAssuranceLevelCd
FieldValueIRS element (for citing)
Tax2020TaxYr
Build TS2022-09-23 18:48:47ZBuildTS

Form 990 IRS990

Doing Business As Name DoingBusinessAsName

FieldValueIRS element (for citing)
Business Name Line1MADISON HEALTH PRIMARY CAREBusinessNameLine1Txt
FieldValueIRS element (for citing)
Principal OfficerDANA E ENGLEPrincipalOfficerNm

US Address USAddress

FieldValueIRS element (for citing)
Address Line1210 NORTH MAIN STREETAddressLine1Txt
CityLONDONCityNm
State AbbreviationOHStateAbbreviationCd
ZIP43140ZIPCd
FieldValueIRS element (for citing)
Gross Receipts$10,570,871GrossReceiptsAmt
Group Return For Affiliates0GroupReturnForAffiliatesInd
Organization501c3Yes (X)Organization501c3Ind
Website AddressHTTP://WWW.MADISON-HEALTH.COMWebsiteAddressTxt
Type Of Organization CorpYes (X)TypeOfOrganizationCorpInd
Formation2008FormationYr
Legal Domicile StateOHLegalDomicileStateCd
Activity Or MissionTHE PRACTICE OF MEDICINE IN THE STATE OF OHIO AND CARRYING OUT THE MISSION OF MCCH.ActivityOrMissionDesc
Voting Members Governing Body3VotingMembersGoverningBodyCnt
Voting Members Independent0VotingMembersIndependentCnt
Total Employee0TotalEmployeeCnt
Total Volunteers0TotalVolunteersCnt
Total Gross UBI$0TotalGrossUBIAmt
Net Unrelated Bus Txbl Incm$0NetUnrelatedBusTxblIncmAmt
PY Contributions Grants$0PYContributionsGrantsAmt
CY Contributions Grants$3,460,037CYContributionsGrantsAmt
PY Program Service Revenue$6,943,319PYProgramServiceRevenueAmt
CY Program Service Revenue$7,110,834CYProgramServiceRevenueAmt
PY Investment Income$0PYInvestmentIncomeAmt
CY Investment Income$0CYInvestmentIncomeAmt
PY Other Revenue$0PYOtherRevenueAmt
CY Other Revenue$0CYOtherRevenueAmt
PY Total Revenue$6,943,319PYTotalRevenueAmt
CY Total Revenue$10,570,871CYTotalRevenueAmt
PY Grants And Similar Paid$0PYGrantsAndSimilarPaidAmt
CY Grants And Similar Paid$0CYGrantsAndSimilarPaidAmt
PY Benefits Paid To Members$0PYBenefitsPaidToMembersAmt
CY Benefits Paid To Members$0CYBenefitsPaidToMembersAmt
PY Salaries Comp Emp Bnft Paid$0PYSalariesCompEmpBnftPaidAmt
CY Salaries Comp Emp Bnft Paid$0CYSalariesCompEmpBnftPaidAmt
PY Total Prof Fndrsng Expns$0PYTotalProfFndrsngExpnsAmt
CY Total Prof Fndrsng Expns$0CYTotalProfFndrsngExpnsAmt
CY Total Fundraising Expense$0CYTotalFundraisingExpenseAmt
PY Other Expenses$10,394,971PYOtherExpensesAmt
CY Other Expenses$10,832,433CYOtherExpensesAmt
PY Total Expenses$10,394,971PYTotalExpensesAmt
CY Total Expenses$10,832,433CYTotalExpensesAmt
PY Revenues Less Expenses-$3,451,652PYRevenuesLessExpensesAmt
CY Revenues Less Expenses-$261,562CYRevenuesLessExpensesAmt
Total Assets BOY$1,090,750TotalAssetsBOYAmt
Total Assets EOY$929,787TotalAssetsEOYAmt
Total Liabilities BOY$456,180TotalLiabilitiesBOYAmt
Total Liabilities EOY$556,779TotalLiabilitiesEOYAmt
Net Assets Or Fund Balances BOY$634,570NetAssetsOrFundBalancesBOYAmt
Net Assets Or Fund Balances EOY$373,008NetAssetsOrFundBalancesEOYAmt
MissionTHE PRACTICE OF MEDICINE IN THE STATE OF OHIO AND CARRYING OUT THE MISSION OF MCCH.MissionDesc
Significant New Program Srvc0SignificantNewProgramSrvcInd
Significant Change0SignificantChangeInd
Expense$10,554,454ExpenseAmt
Revenue$7,110,834RevenueAmt
DescMADISON HEALTH'S PHYSICIAN PRACTICE THAT PROVIDES HEALTHCARE CHOICES.Desc
Total Program Service Expenses$10,554,454TotalProgramServiceExpensesAmt
Described In Section501c3Yes (1)DescribedInSection501c3Ind
Schedule B RequiredYes (1)ScheduleBRequiredInd
Political Campaign Acty0PoliticalCampaignActyInd
Lobbying Activities0LobbyingActivitiesInd
Subject To Proxy Tax0SubjectToProxyTaxInd
Donor Advised Fund0DonorAdvisedFundInd
Conservation Easements0ConservationEasementsInd
Collections Of Art0CollectionsOfArtInd
Credit Counseling0CreditCounselingInd
Donor Rstr Or Quasi Endowments0DonorRstrOrQuasiEndowmentsInd
Report Land Building EquipmentYes (1)ReportLandBuildingEquipmentInd
Report Investments Other Sec0ReportInvestmentsOtherSecInd
Report Program Related Invst0ReportProgramRelatedInvstInd
Report Other Assets0ReportOtherAssetsInd
Report Other LiabilitiesYes (1)ReportOtherLiabilitiesInd
Include FIN48 FootnoteYes (1)IncludeFIN48FootnoteInd
Independent Audit Fincl Stmt0IndependentAuditFinclStmtInd
Consolidated Audit Fincl StmtYes (1)ConsolidatedAuditFinclStmtInd
School Operating0SchoolOperatingInd
Foreign Office0ForeignOfficeInd
Foreign Activities0ForeignActivitiesInd
More Than5000 K To Org0MoreThan5000KToOrgInd
More Than5000 K To Individuals0MoreThan5000KToIndividualsInd
Professional Fundraising0ProfessionalFundraisingInd
Fundraising Activities0FundraisingActivitiesInd
Gaming Activities0GamingActivitiesInd
Operate Hospital0OperateHospitalInd
Grants To Organizations0GrantsToOrganizationsInd
Grants To Individuals0GrantsToIndividualsInd
Schedule J RequiredYes (1)ScheduleJRequiredInd
Tax Exempt Bonds0TaxExemptBondsInd
Engaged In Excess Benefit Trans0EngagedInExcessBenefitTransInd
PY Excess Benefit Trans0PYExcessBenefitTransInd
Loan Outstanding0LoanOutstandingInd
Grant To Related Person0GrantToRelatedPersonInd
Business Rln With Org Mem0BusinessRlnWithOrgMemInd
Business Rln With Fam Mem0BusinessRlnWithFamMemInd
Business Rln With35 Ctrl Ent0BusinessRlnWith35CtrlEntInd
Deductible Non Cash Contri0DeductibleNonCashContriInd
Deductible Art Contribution0DeductibleArtContributionInd
Terminate Operations0TerminateOperationsInd
Partial Liquidation0PartialLiquidationInd
Disregarded Entity0DisregardedEntityInd
Related EntityYes (1)RelatedEntityInd
Related Organization Ctrl Ent0RelatedOrganizationCtrlEntInd
Trnsfr Exmpt Non Chrtbl Rltd Org0TrnsfrExmptNonChrtblRltdOrgInd
Activities Conducted Prtshp0ActivitiesConductedPrtshpInd
Schedule O RequiredYes (1)ScheduleORequiredInd
IRP Document11IRPDocumentCnt
IRP Document W2 G0IRPDocumentW2GCnt
Backup Wthld ComplianceYes (1)BackupWthldComplianceInd
Employee0EmployeeCnt
Unrelated Bus Incm Over Limit0UnrelatedBusIncmOverLimitInd
Foreign Financial Account0ForeignFinancialAccountInd
Prohibited Tax Shelter Trans0ProhibitedTaxShelterTransInd
Taxable Party Notification0TaxablePartyNotificationInd
Nondeductible Contributions0NondeductibleContributionsInd
Quid Pro Quo Contributions0QuidProQuoContributionsInd
Form8282 Property Disposed Of0Form8282PropertyDisposedOfInd
Indoor Tanning Services0IndoorTanningServicesInd
Subj To Tax Rmnrtn Ex Prcht Pymt0SubjToTaxRmnrtnExPrchtPymtInd
Subject To Excs Tax Net Invst Inc0SubjectToExcsTaxNetInvstIncInd
Info In Schedule O Part VIYes (X)InfoInScheduleOPartVIInd
Governing Body Voting Members3GoverningBodyVotingMembersCnt
Independent Voting Member0IndependentVotingMemberCnt
Family Or Business RlnYes (1)FamilyOrBusinessRlnInd
Delegation Of Mgmt Duties0DelegationOfMgmtDutiesInd
Change To Org Documents0ChangeToOrgDocumentsInd
Material Diversion Or Misuse0MaterialDiversionOrMisuseInd
Members Or Stockholders0MembersOrStockholdersInd
Election Of Board Members0ElectionOfBoardMembersInd
Decisions Subject To Approva0DecisionsSubjectToApprovaInd
Minutes Of Governing BodyYes (1)MinutesOfGoverningBodyInd
Minutes Of CommitteesYes (1)MinutesOfCommitteesInd
Officer Mailing Address0OfficerMailingAddressInd
Local Chapters0LocalChaptersInd
Form990 Provided To Gvrn BodyYes (1)Form990ProvidedToGvrnBodyInd
Conflict Of Interest Policy0ConflictOfInterestPolicyInd
Whistleblower Policy0WhistleblowerPolicyInd
Document Retention Policy0DocumentRetentionPolicyInd
Compensation Process CEO0CompensationProcessCEOInd
Compensation Process Other0CompensationProcessOtherInd
Investment In Joint Venture0InvestmentInJointVentureInd
States Where Copy Of Return Is FldOHStatesWhereCopyOfReturnIsFldCd
Upon RequestYes (X)UponRequestInd

Books In Care Of Detail BooksInCareOfDetail

FieldValueIRS element (for citing)
PersonMICHAEL S BROWNINGPersonNm
Phone7408457015PhoneNum

US Address USAddress

FieldValueIRS element (for citing)
Address Line1210 NORTH MAIN STREETAddressLine1Txt
CityLONDONCityNm
State AbbreviationOHStateAbbreviationCd
ZIP43140ZIPCd

Form990 Part VII Section A Form990PartVIISectionAGrp (3 entries)

TitleTitleTxtAverage Hours Per WeekAverageHoursPerWeekRtAverage Hours Per Week Rltd OrgAverageHoursPerWeekRltdOrgRtIndividual Trustee Or DirectorIndividualTrusteeOrDirectorIndReportable Comp From OrgReportableCompFromOrgAmtReportable Comp From Rltd OrgReportableCompFromRltdOrgAmtOther CompensationOtherCompensationAmtOfficerOfficerInd
MITCHELL SPAHN MD
BOARD MEMBER1.004.00Yes (X)$0$136,719$4,989
DANA E ENGLE
CEO/PRESIDENT1.0045.00Yes (X)$0$432,618$64,566Yes (X)
MICHAEL S BROWNING
CFO, VP, SECRETARY, TREASURER1.0045.00Yes (X)$0$277,719$18,003Yes (X)
FieldValueIRS element (for citing)
Total Reportable Comp From Org$0TotalReportableCompFromOrgAmt
Tot Reportable Comp Rltd Org$847,056TotReportableCompRltdOrgAmt
Total Other Compensation$87,558TotalOtherCompensationAmt
Indiv Rcvd Greater Than100 K0IndivRcvdGreaterThan100KCnt
Former Ofcr Employees Listed0FormerOfcrEmployeesListedInd
Total Comp Greater Than150 KYes (1)TotalCompGreaterThan150KInd
Compensation From Other Srcs0CompensationFromOtherSrcsInd

Contractor Compensation ContractorCompensationGrp (3 entries)

Address Line1ContractorAddress/USAddress/AddressLine1TxtCityContractorAddress/USAddress/CityNmState AbbreviationContractorAddress/USAddress/StateAbbreviationCdZIPContractorAddress/USAddress/ZIPCdServicesServicesDescCompensationCompensationAmt
QWIKCARE URGENT CARE LLC COREY AMANN
575 TRILLIUM DRIVEGALLOWAYOH43119URGENT CARE-SERVICES$1,080,905
OSU PHYSICIANS
700 ACKERMAN ROAD SUITE 635COLUMBUSOH43202MANAGEMENT/BILLING SERVICES$638,692
BRENDA SICKLE SANTANELLO MD INC
4664 HAYDEN RUN ROADCOLUMBUSOH43221ONCOLOGY SURGERY PROVIDER SERVICES$134,320
FieldValueIRS element (for citing)
Cntrct Rcvd Greater Than100 K3CntrctRcvdGreaterThan100KCnt
Related Organizations$3,386,885RelatedOrganizationsAmt
Government Grants$73,152GovernmentGrantsAmt
Total Contributions$3,460,037TotalContributionsAmt

Program Service Revenue ProgramServiceRevenueGrp

FieldValueIRS element (for citing)
DescPATIENT REVENUEDesc
Business900099BusinessCd
Total Revenue Column$7,110,834TotalRevenueColumnAmt
Related Or Exempt Func Income$7,110,834RelatedOrExemptFuncIncomeAmt
FieldValueIRS element (for citing)
Total Program Service Revenue$7,110,834TotalProgramServiceRevenueAmt

Total Revenue TotalRevenueGrp

FieldValueIRS element (for citing)
Total Revenue Column$10,570,871TotalRevenueColumnAmt
Related Or Exempt Func Income$7,110,834RelatedOrExemptFuncIncomeAmt
Unrelated Business Revenue$0UnrelatedBusinessRevenueAmt
Exclusion$0ExclusionAmt
FieldValueIRS element (for citing)
Info In Schedule O Part IXYes (X)InfoInScheduleOPartIXInd

Fees For Services Legal FeesForServicesLegalGrp

FieldValueIRS element (for citing)
Total$5,196TotalAmt
Management And General$5,196ManagementAndGeneralAmt

Fees For Services Other FeesForServicesOtherGrp

FieldValueIRS element (for citing)
Total$7,043,526TotalAmt
Program Services$6,994,950ProgramServicesAmt
Management And General$48,576ManagementAndGeneralAmt

Office Expenses OfficeExpensesGrp

FieldValueIRS element (for citing)
Total$25,158TotalAmt
Program Services$24,334ProgramServicesAmt
Management And General$824ManagementAndGeneralAmt

Occupancy OccupancyGrp

FieldValueIRS element (for citing)
Total$165,169TotalAmt
Program Services$165,169ProgramServicesAmt

Travel TravelGrp

FieldValueIRS element (for citing)
Total$441TotalAmt
Program Services$341ProgramServicesAmt
Management And General$100ManagementAndGeneralAmt

Depreciation Depletion DepreciationDepletionGrp

FieldValueIRS element (for citing)
Total$18,762TotalAmt
Program Services$18,762ProgramServicesAmt

Insurance InsuranceGrp

FieldValueIRS element (for citing)
Total$107,682TotalAmt
Program Services$107,682ProgramServicesAmt

Other Expenses OtherExpensesGrp (4 entries)

DescDescTotalTotalAmtProgram ServicesProgramServicesAmtManagement And GeneralManagementAndGeneralAmt
SHARED SERVICES$2,549,062$2,330,221$218,841
MEDICAL SUPPLIES & DRUG$763,215$763,029$186
EQUIPMENT LEASE URGENT$88,634$88,634
DUES$27,200$26,644$556

All Other Expenses AllOtherExpensesGrp

FieldValueIRS element (for citing)
Total$38,388TotalAmt
Program Services$34,688ProgramServicesAmt
Management And General$3,700ManagementAndGeneralAmt

Total Functional Expenses TotalFunctionalExpensesGrp

FieldValueIRS element (for citing)
Total$10,832,433TotalAmt
Program Services$10,554,454ProgramServicesAmt
Management And General$277,979ManagementAndGeneralAmt
Fundraising$0FundraisingAmt

Cash Non Interest Bearing CashNonInterestBearingGrp

FieldValueIRS element (for citing)
BOY$338,248BOYAmt
EOY$219,380EOYAmt

Accounts Receivable AccountsReceivableGrp

FieldValueIRS element (for citing)
BOY$648,088BOYAmt
EOY$637,054EOYAmt

Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp

FieldValueIRS element (for citing)
BOY$52,783BOYAmt
EOY$40,484EOYAmt
FieldValueIRS element (for citing)
Land Bldg Equip Cost Or Other Bss$213,350LandBldgEquipCostOrOtherBssAmt
Land Bldg Equip Accum Deprec$180,481LandBldgEquipAccumDeprecAmt

Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp

FieldValueIRS element (for citing)
BOY$51,631BOYAmt
EOY$32,869EOYAmt

Total Assets TotalAssetsGrp

FieldValueIRS element (for citing)
BOY$1,090,750BOYAmt
EOY$929,787EOYAmt

Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp

FieldValueIRS element (for citing)
BOY$440,295BOYAmt
EOY$540,894EOYAmt

Other Liabilities OtherLiabilitiesGrp

FieldValueIRS element (for citing)
BOY$15,885BOYAmt
EOY$15,885EOYAmt

Total Liabilities TotalLiabilitiesGrp

FieldValueIRS element (for citing)
BOY$456,180BOYAmt
EOY$556,779EOYAmt
FieldValueIRS element (for citing)
Organization Follows FASB117Yes (X)OrganizationFollowsFASB117Ind

No Donor Restriction Net Assets NoDonorRestrictionNetAssetsGrp

FieldValueIRS element (for citing)
BOY$634,570BOYAmt
EOY$373,008EOYAmt

Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp

FieldValueIRS element (for citing)
BOY$634,570BOYAmt
EOY$373,008EOYAmt

Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp

FieldValueIRS element (for citing)
BOY$1,090,750BOYAmt
EOY$929,787EOYAmt
FieldValueIRS element (for citing)
Reconcilation Revenue Expnss-$261,562ReconcilationRevenueExpnssAmt
Other Changes In Net Assets$0OtherChangesInNetAssetsAmt
Info In Schedule O Part XIIYes (X)InfoInScheduleOPartXIIInd
Method Of Accounting AccrualYes (X)MethodOfAccountingAccrualInd
Accountant Compile Or Review0AccountantCompileOrReviewInd
FS AuditedYes (1)FSAuditedInd

FS Audited Basis FSAuditedBasisGrp

FieldValueIRS element (for citing)
Consolidated Basis Fincl StmtYes (X)ConsolidatedBasisFinclStmtInd
FieldValueIRS element (for citing)
Audit CommitteeYes (1)AuditCommitteeInd
Federal Grant Audit Required0FederalGrantAuditRequiredInd

Schedule A IRS990ScheduleA

FieldValueIRS element (for citing)
Supporting Organization509a3Yes (X)SupportingOrganization509a3Ind
Supporting Org Type1Yes (X)SupportingOrgType1Ind
Supported Organizations1SupportedOrganizationsCnt

Supported Org Information SupportedOrgInformationGrp

Supported Organization Name SupportedOrganizationName

FieldValueIRS element (for citing)
Business Name Line1MADISON COUNTY COMMUNITY HOSPITALBusinessNameLine1Txt
FieldValueIRS element (for citing)
EIN311657206EIN
Organization Type3OrganizationTypeCd
Governing Document ListedYes (1)GoverningDocumentListedInd
Support$10,832,433SupportAmt
Other Support$0OtherSupportAmt
FieldValueIRS element (for citing)
Supported Organizations Total1SupportedOrganizationsTotalCnt
Support Sum$10,832,433SupportSumAmt
Other Support Sum$0OtherSupportSumAmt

Form990 Sch A Supporting Org Form990SchASupportingOrgGrp

FieldValueIRS element (for citing)
Listed By Name Governing DocYes (1)ListedByNameGoverningDocInd
Suprt Org No IRS Determination0SuprtOrgNoIRSDeterminationInd
Supported Org Section C4560SupportedOrgSectionC456Ind
Supported Org Not Organized US0SupportedOrgNotOrganizedUSInd
Organization Change Suprt Org0OrganizationChangeSuprtOrgInd
Support Non Supported Org0SupportNonSupportedOrgInd
Payment Substantial Contribtr0PaymentSubstantialContribtrInd
Loan Disqualified Person0LoanDisqualifiedPersonInd
Controlled Disqualified Prsn0ControlledDisqualifiedPrsnInd
Disqualified Prsn Controll Int0DisqualifiedPrsnControllIntInd
Disqualified Prsn Ownr Int0DisqualifiedPrsnOwnrIntInd
Excess Business Holdings Rules0ExcessBusinessHoldingsRulesInd
Contribution Controller0ContributionControllerInd
Contribution Family0ContributionFamilyInd
Contribution35 Controlled0Contribution35ControlledInd

Form990 Sch A Type1 Suprt Org Form990SchAType1SuprtOrgGrp

FieldValueIRS element (for citing)
Power Appoint Majority Dir TrstYes (1)PowerAppointMajorityDirTrstInd
Operate Benefit Non Suprt Org0OperateBenefitNonSuprtOrgInd

Form990 Schedule A Part VI Form990ScheduleAPartVIGrp

FieldValueIRS element (for citing)
Form And Line ReferenceFORM 990, SCHEDULE A, PART IV, LINE 11A:FormAndLineReferenceDesc
ExplanationMADISON FAMILY HEALTH CORPORATION RECEIVES SUPPORT FROM THE CONTROLLING ORGANIZATION, MADISON COUNTY COMMUNITY HOSPITAL.ExplanationTxt

Schedule B IRS990ScheduleB

Contributor Information ContributorInformationGrp

FieldValueIRS element (for citing)
ContributorRESTRICTEDContributorNum

Contributor Business Name ContributorBusinessName

FieldValueIRS element (for citing)
Business Name Line1RESTRICTEDBusinessNameLine1

Contributor US Address ContributorUSAddress

FieldValueIRS element (for citing)
Address Line1RESTRICTEDAddressLine1
Address Line2RESTRICTEDAddressLine2
CityRESTRICTEDCity
StateRESTRICTEDState
ZIP CodeRESTRICTEDZIPCode
FieldValueIRS element (for citing)
Total ContributionsRESTRICTEDTotalContributionsAmt

Schedule D IRS990ScheduleD

Equipment EquipmentGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$213,350OtherCostOrOtherBasisAmt
Depreciation$180,481DepreciationAmt
Book Value$32,869BookValueAmt
FieldValueIRS element (for citing)
Total Book Value Land Buildings$32,869TotalBookValueLandBuildingsAmt

Other Liabilities Org OtherLiabilitiesOrgGrp

FieldValueIRS element (for citing)
DescDUE TO AFFILIATEDesc
Amt$15,885Amt
FieldValueIRS element (for citing)
Total Liability$15,885TotalLiabilityAmt
Footnote TextYes (X)FootnoteTextInd
Total Rev Etc Audited Fincl Stmt$10,570,871TotalRevEtcAuditedFinclStmtAmt
Revenue Not Reported$0RevenueNotReportedAmt
Revenue Subtotal$10,570,871RevenueSubtotalAmt
Revenue Not Reported Fincl Stmt$0RevenueNotReportedFinclStmtAmt
Total Revenue Per Form990$10,570,871TotalRevenuePerForm990Amt
Tot Expns Etc Audited Fincl Stmt$10,832,433TotExpnsEtcAuditedFinclStmtAmt
Expenses Not Reported$0ExpensesNotReportedAmt
Expenses Subtotal$10,832,433ExpensesSubtotalAmt
Expenses Not Rpt Fincl Stmt$0ExpensesNotRptFinclStmtAmt
Total Expenses Per Form990$10,832,433TotalExpensesPerForm990Amt

Supplemental Information Detail SupplementalInformationDetail

FieldValueIRS element (for citing)
Form And Line ReferencePART X, LINE 2:FormAndLineReferenceDesc
ExplanationTHE FOLLOWING FOOTNOTE IS INCLUDED IN THE CONSOLIDATED FINANCIAL STATEMENTS OF MADISON COUNTY HOSPITAL, INC. THE HOSPITAL IS AN OHIO NONPROFIT CORPORATION AND IS EXEMPT FROM FEDERAL INCOME TAX UNDER 501(C)(3) OF THE INTERNAL REVENUE CODE. THE ORGANIZATION HAS NOT IDENTIFIED ANY MATERIAL UNCERTAIN TAX POSITIONS REQUIRING AN ACCRUAL OR DISCLOSURE IN THE FINANCIAL STATEMENTS. THERE WERE NO INTEREST OR PENALTIES RECOGNIZED IN THE STATEMENT OF ACTIVITIES FOR THE YEARS ENDED DECEMBER 31, 2020 AND 2019 RELATED TO UNCERTAIN TAX POSITIONS. THE HOSPITAL IS NO LONGER SUBJECT TO U.S. FEDERAL OR STATE TAX EXAMINATIONS FOR YEARS PRIOR TO 2017.ExplanationTxt

Schedule J IRS990ScheduleJ

FieldValueIRS element (for citing)
Severance Payment0SeverancePaymentInd
Supplemental Nonqual Rtr Plan0SupplementalNonqualRtrPlanInd
Equity Based Comp Arrngm0EquityBasedCompArrngmInd
Comp Based On Revenue Of Flng Org0CompBasedOnRevenueOfFlngOrgInd
Comp Bsd On Rev Related Orgs0CompBsdOnRevRelatedOrgsInd
Comp Bsd Net Earns Flng Org0CompBsdNetEarnsFlngOrgInd
Comp Bsd Net Earns Rltd Orgs0CompBsdNetEarnsRltdOrgsInd
Any Non Fixed Payments0AnyNonFixedPaymentsInd
Initial Contract Exception0InitialContractExceptionInd

Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp (2 entries)

TitleTitleTxtBase Compensation Filing OrgBaseCompensationFilingOrgAmtCompensation Based On Rltd OrgsCompensationBasedOnRltdOrgsAmtBonus Filing OrganizationBonusFilingOrganizationAmountBonus Related OrganizationsBonusRelatedOrganizationsAmtOther Compensation Filing OrgOtherCompensationFilingOrgAmtOther Compensation Rltd OrgsOtherCompensationRltdOrgsAmtDeferred Compensation Flng OrgDeferredCompensationFlngOrgAmtDeferred Comp Rltd OrgsDeferredCompRltdOrgsAmtNontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgAmtNontaxable Benefits Rltd OrgsNontaxableBenefitsRltdOrgsAmtTotal Compensation Filing OrgTotalCompensationFilingOrgAmtTotal Compensation Rltd OrgsTotalCompensationRltdOrgsAmtComp Report Prior990 Filing OrgCompReportPrior990FilingOrgAmtComp Report Prior990 Rltd OrgsCompReportPrior990RltdOrgsAmt
DANA E ENGLE
CEO/PRESIDENT$0$401,895$0$0$0$30,723$0$17,843$0$46,723$0$497,184$0$0
MICHAEL S BROWNING
CFO, VP, SECRETARY, TREASURER$0$275,913$0$0$0$1,806$0$13,937$0$4,066$0$295,722$0$0

Supplemental Information Detail SupplementalInformationDetail

FieldValueIRS element (for citing)
Form And Line ReferencePART I, LINE 3FormAndLineReferenceDesc
ExplanationMADISON FAMILY HEALTH CORPORATION DOES NOT COMPENSATE ITS OFFICERS; RATHER COMPENSATION IS PAID BY THE RELATED ORGANIZATION MADISON COUNTY COMMUNITY HOSPITAL (MCCH). MCCH USES THE FOLLOWING TO ESTABLISH TOP MANAGEMENT OFFICIAL'S COMPENSATION: - COMPENSATION COMMITTEE - INDEPENDENT COMPENSATION CONSULTANT - COMPENSATION SURVEY OR STUDY - APPROVAL BY THE BOARD OR COMPENSATION COMMITTEEExplanationTxt

Schedule O IRS990ScheduleO

Supplemental Information Detail SupplementalInformationDetail (7 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
FORM 990, PART VI, SECTION A, LINE 2OFFICERS MITCHELL SPAHN, DANA E. ENGLE & MICHAEL S. BROWNING HAVE A BUSINESS RELATIONSHIP.
FORM 990, PART VI, SECTION B, LINE 11BTHE FORM 990 WILL BE MADE AVAILABLE PRIOR TO FILING TO ALL BOARD MEMBERS ONLY BY WAY OF SECURED WEB PORTAL. PRIOR TO POSTING ON THE WEB PORTAL, THE FORM 990 IS REVIEWED BY MANAGEMENT.
FORM 990, PART VI, SECTION B, LINE 12THE ORGANIZATION DOES NOT HAVE ITS OWN CONFLICT OF INTEREST POLICY BUT FOLLOWS THAT OF MADISON COUNTY COMMUNITY HOSPITAL (MADISON HEALTH). ANNUALLY, THE CEO, CFO, ALL BOARD MEMBERS AND DEPARTMENT MANAGERS RECEIVE A COPY OF MADISON HEALTH'S CONFLICT OF INTEREST POLICY. IN ADDITION, THEY ARE ASKED TO COMPLETE AND RETURN THE CONFLICT OF INTEREST AGREEMENT AND ANNUAL DISCLOSURE STATEMENT TO THE MADISON HEALTH'S ADMINISTRATIVE OFFICE. THE CONFLICT OF INTEREST STATEMENTS ARE REVIEWED AND RETAINED ON FILE. ANY INTERESTS SO DISCLOSED ARE DEALT WITH APPROPRIATELY AS THE CONFLICT ARISES AND IN ACCORDANCE WITH POLICY PROCEDURES. ALL OFFICERS AND DIRECTORS OF MADISON FAMILY HEALTH CORPORATION ARE ALSO OFFICERS AND DIRECTORS OF MADISON HEALTH.
FORM 990, PART VI, SECTION B, LINE 15THE ORGANIZATION DOES NOT HAVE EMPLOYEES, BUT RATHER, ITS OFFICERS ARE EMPLOYEES OF MADISON COUNTY COMMUNITY HOSPITAL (MADISON HEALTH), WHOSE PROCESS FOR DETERMINING COMPENSATION INCLUDES A REVIEW AND APPROVAL BY INDEPENDENT PERSONS, USE OF COMPARABILITY DATA AND CONTEMPORANEOUS DOCUMENTATION OF THE DELIBERATION AND PROCESS.
FORM 990, PART VI, SECTION C, LINE 19THE ORGANIZATION'S CONFLICT OF INTEREST POLICY, FINANCIAL STATEMENTS, AND GOVERNING DOCUMENTS ARE AVAILABLE UPON REQUEST.
FORM 990, PART IX, LINE 11GPHYSICIAN SALARY: PROGRAM SERVICE EXPENSES 5,893,165. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 5,893,165. PHYSICIAN FORGIVENESS: PROGRAM SERVICE EXPENSES 21,094. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 21,094. PURCHASED SERVICES: PROGRAM SERVICE EXPENSES 826,574. MANAGEMENT AND GENERAL EXPENSES 48,576. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 875,150. CONTRACT LABOR: PROGRAM SERVICE EXPENSES 254,117. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 254,117.
FORM 990, PART XII, QUESTION 2C, OVERSIGHT OF FINANCIAL STATEMENT AUDIT:THE ORGANIZATION'S FINANCIAL STATEMENTS ARE AUDITED ON A CONSOLIDATED BASIS WITH ITS AFFILIATES (MADISON COUNTY COMMUNITY HOSPITAL, MADISON COUNTY HOSPITAL, INC. AND MADISON COUNTY HOSPITAL FOUNDATION, INC.) BY AN INDEPENDENT ACCOUNTING FIRM. IN ADDITION, THE ORGANIZATION HAS A COMMITTEE THAT ASSUMES THE RESPONSIBILITY FOR OVERSIGHT OF THE AUDIT OF ITS FINANCIAL STATEMENTS AND ITS SELECTION OF THE INDEPENDENT ACCOUNTANT. THIS PROCESS HAS NOT CHANGED FROM THE PRIOR YEAR.

Schedule R IRS990ScheduleR

Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp (3 entries)

Address Line1USAddress/AddressLine1TxtCityUSAddress/CityNmState AbbreviationUSAddress/StateAbbreviationCdZIPUSAddress/ZIPCdEINEINPrimary ActivitiesPrimaryActivitiesTxtLegal Domicile StateLegalDomicileStateCdExempt Code SectionExemptCodeSectionTxtPublic Charity StatusPublicCharityStatusTxtDirect Controlling NADirectControllingNACdControlled OrganizationControlledOrganizationInd
MADISON COUNTY COMMUNITY HOSPITAL (DBA MADISON HEALTH)
210 NORTH MAIN STREETLONDONOH43140311657206HOSPITALOH501(C)(3)LINE 3N/A0
MADISON COUNTY HOSPITAL FOUNDATION INC
210 NORTH MAIN STREETLONDONOH43140237423524FUNDRAISINGOH501(C)(3)LINE 7N/A0
MADISON COUNTY HOSPITAL INC
210 NORTH MAIN STREETLONDONOH43140310876202MANAGE HOSPITAL INVESTMENTSOH501(C)(3)LINE 12A, IN/A0

Id Related Org Txbl Partnership IdRelatedOrgTxblPartnershipGrp

Related Organization Name RelatedOrganizationName

FieldValueIRS element (for citing)
Business Name Line1MADISON HEALTH PAIN MANAGEMENTBusinessNameLine1Txt

US Address USAddress

FieldValueIRS element (for citing)
Address Line1210 N MAIN STREETAddressLine1Txt
CityLONDONCityNm
State AbbreviationOHStateAbbreviationCd
ZIP43140ZIPCd
FieldValueIRS element (for citing)
EIN852913421EIN
Primary ActivitiesTECHNICAL COMPONENT OF PAIN MANAGEMENT SERVICESPrimaryActivitiesTxt
Legal Domicile StateOHLegalDomicileStateCd
Direct Controlling NAN/ADirectControllingNACd
Disproportionate Allocations0DisproportionateAllocationsInd
General Or Managing Partner0GeneralOrManagingPartnerInd
FieldValueIRS element (for citing)
Receipt Of Int Annts Rnts Rylts0ReceiptOfIntAnntsRntsRyltsInd
Gift Grnt Or Cap Contri To Oth Org0GiftGrntOrCapContriToOthOrgInd
Gift Grnt Cap Contri From Oth OrgYes (1)GiftGrntCapContriFromOthOrgInd
Loans Or Guarantees To Other Org0LoansOrGuaranteesToOtherOrgInd
Loans Or Guarantees From Oth Org0LoansOrGuaranteesFromOthOrgInd
Div Related Organization0DivRelatedOrganizationInd
Asset Sale To Other Org0AssetSaleToOtherOrgInd
Asset Purchase From Other Org0AssetPurchaseFromOtherOrgInd
Asset Exchange0AssetExchangeInd
Rental Of Facilities To Oth Org0RentalOfFacilitiesToOthOrgInd
Rental Of Fclts From Oth Org0RentalOfFcltsFromOthOrgInd
Perform Of Services For Oth Org0PerformOfServicesForOthOrgInd
Perform Of Services By Other Org0PerformOfServicesByOtherOrgInd
Sharing Of FacilitiesYes (1)SharingOfFacilitiesInd
Paid Employees SharingYes (1)PaidEmployeesSharingInd
Reimbursement Paid To Other OrgYes (1)ReimbursementPaidToOtherOrgInd
Reimbursement Paid By Other Org0ReimbursementPaidByOtherOrgInd
Transfer To Other Org0TransferToOtherOrgInd
Transfer From Other Org0TransferFromOtherOrgInd

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