2016-10-24T09:39:32-05:00 2015-12-31 251408703 SCHNEIDER DOWNS & CO INC ONE PPG PLACE SUITE 1700 PITTSBURGH PA 15222 990 2015-01-01 311514418 MADISON FAMILY HEALTH CORPORATION MADI 7408457015 210 NORTH MAIN STREET LONDON OH 43140 DANA E ENGLE PRESIDENT 7408457015 2016-10-11 1 EUGENE J LOGAN P00227231 4122613644 2015 2017-02-10 21:41:12Z MADISON HEALTH PRIMARY CARE DANA E ENGLE 210 NORTH MAIN STREET LONDON OH 43140 1658083 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 280687 1658050 0 33 0 0 280687 1658083 0 0 0 0 0 0 0 0 0 824527 3363372 824527 3363372 -543840 -1705289 214057 545090 57897 324219 156160 220871 NONE FORMALLY ADOPTED. 0 0 3278341 1658050 MADISON HEALTH'S PHYSICIAN PRACTICE THAT PROVIDES HEALTHCARE CHOICES. 3278341 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 6 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 14000 0 DANA E ENGLE CEO/PRESIDENT 1.00 44.00 X X 0 342330 47178 MICHAEL S BROWNING CFO, VP, SECRETARY, TREASU 1.00 44.00 X X 0 236730 15580 0 593060 62758 0 0 1 0 0 PATIENT REVENUE 900099 1658050 1658050 1658050 33 33 1658083 1658050 0 33 X 5913 5913 1978442 1901057 77385 22534 22534 140766 140766 69 69 12435 12435 73333 73333 SHARED SERVICES 872909 872909 MEDICAL SUPPLIES & DRUG 206018 206018 MINOR EQUIPMENT 20410 19781 629 BOOKS/EDUCATION 15437 15437 15106 14002 1104 3363372 3278341 85031 0 29816 94299 120927 268923 7986 200359 18491 0 181868 55328 0 214057 545090 57897 144443 0 179776 57897 324219 X 156160 220871 156160 220871 214057 545090 X -1705289 1770000 X X 0 1 X 1 0 X X 1 MADISON COUNTY COMMUNITY HOSPITAL 311657206 3 1 3278341 0 1 3278341 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. 19853 19853 180506 18491 162015 181868 DUE TO AFFILIATE 179776 179776 X 1658083 0 1658083 0 1658083 3363372 0 3363372 0 3363372 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, 2015 AND 2014 RELATED TO UNCERTAIN TAX POSITIONS. THE HOSPITAL IS NO LONGER SUBJECT TO U.S. FEDERAL OR STATE TAX EXAMINATIONS FOR YEARS PRIOR TO 2012. 0 0 0 0 0 0 0 0 0 DANA E ENGLE CEO/PRESIDENT 0 332327 0 0 0 10003 0 13250 0 33928 0 389508 0 0 MICHAEL S BROWNING CFO, VP, SECRETARY, TREASU 0 235741 0 0 0 989 0 11910 0 3670 0 252310 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 11 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 CONTRACT MANAGEMENT: PROGRAM SERVICE EXPENSES 8,031. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 8,031. PHYSICIAN SALARY: PROGRAM SERVICE EXPENSES 1,287,048. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,287,048. PHYSICIAN FORGIVENESS: PROGRAM SERVICE EXPENSES 53,225. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 53,225. PURCHASED SERVICES: PROGRAM SERVICE EXPENSES 351,149. MANAGEMENT AND GENERAL EXPENSES 77,385. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 428,534. PRINTING: PROGRAM SERVICE EXPENSES 1,081. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,081. EMPLOYEE RECRUITMENT: PROGRAM SERVICE EXPENSES 116. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 116. EQUIPMENT: PROGRAM SERVICE EXPENSES 650. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 650. IT SOFTWARE: PROGRAM SERVICE EXPENSES 1,069. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,069. TEMPORARY HELP: PROGRAM SERVICE EXPENSES 2,423. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 2,423. PROFESSIONAL FEES: PROGRAM SERVICE EXPENSES 196,265. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 196,265. FORM 990, PART XI, LINE 9: NET ASSET TRANSFER TO MFHC 1,770,000. 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 11A, I N/A 0 MADISON COUNTY HOSPITAL INC 210 NORTH MAIN STREET LONDON OH 43140 310876202 MANAGE HOSPITAL INVESTMENTS OH 501(C)(3) LINE 11A, I N/A 0 0 0 1 0 0 0 0 0 0 0 0 0 0 1 1 1 0 0 0