2017-11-06T14:53:41-06:00 2016-12-31 251408703 SCHNEIDER DOWNS & CO INC ONE PPG PLACE SUITE 1700 PITTSBURGH PA 15222 990 2016-01-01 311514418 MADISON FAMILY HEALTH CORPORATION MADI 7408457015 210 NORTH MAIN STREET LONDON OH 43140 DANA E ENGLE PRESIDENT 7408457015 2017-10-27 1 EUGENE J LOGAN P00227231 4122613644 208.79.164.82 2017-10-27 16:41:23 ED P 7D18BB02A8A97F1AFE599DA7CB32F00FE1CDD8C0 1454084FED4D0A8241A8015C5437B85B068593B4 2016 2017-02-10 21:41:12Z MADISON HEALTH PRIMARY CARE DANA E ENGLE 210 NORTH MAIN STREET LONDON OH 43140 2965462 0 X HTTP://WWW.MADISON-HEALTH.COM X 2008 OH THE PRACTICE OF MEDICINE IN THE STATE OF OHIO AND CARRYING OUT THE MISSION OF MCCH. 3 0 0 0 0 0 0 0 1658050 2965462 33 0 0 0 1658083 2965462 0 0 0 0 0 0 0 0 0 3363372 5325635 3363372 5325635 -1705289 -2360173 545090 806248 324219 665550 220871 140698 NONE FORMALLY ADOPTED. 0 0 5158392 2965462 MADISON HEALTH'S PHYSICIAN PRACTICE THAT PROVIDES HEALTHCARE CHOICES. 5158392 1 0 0 0 0 0 0 0 0 0 1 0 0 0 1 1 0 1 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 9 0 1 0 0 0 0 0 0 0 0 0 0 0 X 3 0 1 0 0 0 0 0 0 1 1 0 0 1 0 0 0 0 0 0 OH X MICHAEL S BROWNING 7408457015 210 NORTH MAIN STREET LONDON OH 43140 MITCHELL SPAHN MD BOARD MEMBER 1.00 6.00 X 0 15731 0 DANA E ENGLE CEO/PRESIDENT 1.00 44.00 X X 0 382828 48260 MICHAEL S BROWNING CFO, VP, SECRETARY, TREASU 1.00 44.00 X X 0 249757 16574 0 648316 64834 0 0 1 0 OSU PHYSICIANS 700 ACKERMAN ROAD SUITE 635 COLUMBUS OH 43202 MANAGEMENT/BILLING SERVICES 416810 1 PATIENT REVENUE 900099 2965462 2965462 2965462 2965462 2965462 0 0 X 935 935 3119467 3043969 75498 27296 27092 204 91718 91718 900 900 49623 49623 64304 64304 SHARED SERVICES 1544194 1454680 89514 MEDICAL SUPPLIES & DRUG 365428 365428 MINOR EQUIPMENT 23994 23278 716 BOOKS/EDUCATION 21112 21112 16664 16288 376 5325635 5158392 167243 0 94299 102469 268923 557149 7562 201126 62058 181868 139068 545090 806248 144443 317480 179776 348070 324219 665550 X 220871 140698 220871 140698 545090 806248 X -2360173 2280000 X X 0 1 X 1 0 X X 1 MADISON COUNTY COMMUNITY HOSPITAL 311657206 3 1 5158392 0 1 5158392 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 FORM 990, SCHEDULE A, PART VI, LINE 11A: MADISON FAMILY HEALTH CORPORATION RECEIVES SUPPORT FROM THE CONTROLLING ORGANIZATION, MADISON COUNTY COMMUNITY HOSPITAL. 201126 62058 139068 139068 DUE TO AFFILIATE 348070 348070 X 2965462 0 2965462 0 2965462 5325635 0 5325635 0 5325635 PART X, LINE 2: THE 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, 2016 AND 2015 RELATED TO UNCERTAIN TAX POSITIONS. THE HOSPITAL IS NO LONGER SUBJECT TO U.S. FEDERAL OR STATE TAX EXAMINATIONS FOR YEARS PRIOR TO 2013. 0 0 0 0 0 0 0 0 0 DANA E ENGLE CEO/PRESIDENT 0 372788 0 0 0 10040 0 13250 0 35010 0 431088 0 0 MICHAEL S BROWNING CFO, VP, SECRETARY, TREASU 0 248791 0 0 0 966 0 12570 0 4004 0 266331 0 0 FORM 990, PART VI, SECTION A, LINE 2 OFFICERS DANA E. ENGLE & MICHAEL S. BROWNING HAVE A BUSINESS RELATIONSHIP. FORM 990, PART VI, SECTION B, LINE 11B THE 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 C, LINE 19 THE ORGANIZATION'S CONFLICT OF INTEREST POLICY, FINANCIAL STATEMENTS, AND GOVERNING DOCUMENTS ARE AVAILABLE UPON REQUEST. FORM 990, PART IX, LINE 11G PHYSICIAN SALARY: PROGRAM SERVICE EXPENSES 2,451,632. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 2,451,632. PHYSICIAN FORGIVENESS: PROGRAM SERVICE EXPENSES 82,985. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 82,985. PURCHASED SERVICES: PROGRAM SERVICE EXPENSES 500,079. MANAGEMENT AND GENERAL EXPENSES 75,498. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 575,577. PRINTING: PROGRAM SERVICE EXPENSES 2,961. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 2,961. EQUIPMENT LEASE: PROGRAM SERVICE EXPENSES 76. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 76. EQUIPMENT REPAIR AND MAINTENANCE: PROGRAM SERVICE EXPENSES 5,977. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 5,977. PHYSICIAN RECRUITING: PROGRAM SERVICE EXPENSES 259. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 259. FORM 990, PART XI, LINE 9: NET ASSET TRANSFER TO MFHC 2,280,000. 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. MADISON COUNTY COMMUNITY HOSPITAL 210 NORTH MAIN STREET LONDON OH 43140 311657206 HOSPITAL OH 501(C)(3) LINE 4 N/A 0 MADISON COUNTY HOSPITAL FOUNDATION INC 210 NORTH MAIN STREET LONDON OH 43140 237423524 FUNDRAISING OH 501(C)(3) LINE 12A, I N/A 0 MADISON COUNTY HOSPITAL INC 210 NORTH MAIN STREET LONDON OH 43140 310876202 MANAGE HOSPITAL INVESTMENTS OH 501(C)(3) LINE 12A, I N/A 0 0 0 1 0 0 0 0 0 0 0 0 0 0 1 1 1 0 0 0