MADISON COMMUNITY HOSPITAL: Form 990, tax year 2014

View the entire original 990 at ProPublica ↗

Organization
MADISON COMMUNITY HOSPITAL (EIN 46-0228038)
Tax period
2014-07-01 to 2015-06-30
Filed
2016-03-14
IRS object ID
201600749349300015
Schema version
2014v6.0
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)
Return2016-03-14T10:09:24-05:00ReturnTs
Tax Period End2015-06-30TaxPeriodEndDt

Preparer Firm PreparerFirmGrp

FieldValueIRS element (for citing)
Preparer Firm EIN450250958PreparerFirmEIN

Preparer Firm Name PreparerFirmName

FieldValueIRS element (for citing)
Business Name Line1EIDE BAILLY LLPBusinessNameLine1Txt

Preparer US Address PreparerUSAddress

FieldValueIRS element (for citing)
Address Line1200 EAST 10TH ST PO BOX 5125AddressLine1Txt
CitySIOUX FALLSCityNm
State AbbreviationSDStateAbbreviationCd
ZIP571175125ZIPCd
FieldValueIRS element (for citing)
Return Type990ReturnTypeCd
Tax Period Begin2014-07-01TaxPeriodBeginDt

Filer Filer

FieldValueIRS element (for citing)
EIN460228038EIN

Business Name BusinessName

FieldValueIRS element (for citing)
Business Name Line1MADISON COMMUNITY HOSPITALBusinessNameLine1Txt
FieldValueIRS element (for citing)
Business Name ControlMADIBusinessNameControlTxt
Phone6052566551PhoneNum

US Address USAddress

FieldValueIRS element (for citing)
Address Line1323 SW 10TH STAddressLine1Txt
CityMADISONCityNm
State AbbreviationSDStateAbbreviationCd
ZIP57042ZIPCd

Business Officer BusinessOfficerGrp

FieldValueIRS element (for citing)
PersonTAMARA MILLERPersonNm
Person TitleCEOPersonTitleTxt
Phone6052566551PhoneNum
Signature2016-02-24SignatureDt
Discuss With Paid PreparerYes (1)DiscussWithPaidPreparerInd

Preparer Person PreparerPersonGrp

FieldValueIRS element (for citing)
Preparer PersonLAURIE HANSONPreparerPersonNm
PTINP00851848PTIN
Phone6053391999PhoneNum
Preparation2016-02-24PreparationDt
FieldValueIRS element (for citing)
Tax2014TaxYr
Build TS2016-08-17 19:52:53ZBuildTS

Form 990 IRS990

FieldValueIRS element (for citing)
Address ChangeYes (X)AddressChangeInd

Doing Business As Name DoingBusinessAsName

FieldValueIRS element (for citing)
Business Name Line1MADISON REGIONAL HEALTH SYSTEMBusinessNameLine1Txt
FieldValueIRS element (for citing)
Principal OfficerTAMARA MILLERPrincipalOfficerNm

US Address USAddress

FieldValueIRS element (for citing)
Address Line1323 SW 10TH STAddressLine1Txt
CityMADISONCityNm
State AbbreviationSDStateAbbreviationCd
ZIP57042ZIPCd
FieldValueIRS element (for citing)
Gross Receipts$20,329,217GrossReceiptsAmt
Group Return For Affiliates0GroupReturnForAffiliatesInd
Organization501c3Yes (X)Organization501c3Ind
Website AddressWWW.MADISONREGIONALHEALTH.ORGWebsiteAddressTxt
Type Of Organization CorpYes (X)TypeOfOrganizationCorpInd
Formation1955FormationYr
Legal Domicile StateSDLegalDomicileStateCd
Activity Or MissionPROVIDE HEALTH CARE SERVICES TO AREA RESIDENTS.ActivityOrMissionDesc
Voting Members Governing Body11VotingMembersGoverningBodyCnt
Voting Members Independent11VotingMembersIndependentCnt
Total Employee229TotalEmployeeCnt
Total Volunteers15TotalVolunteersCnt
Total Gross UBI$0TotalGrossUBIAmt
Net Unrelated Bus Txbl Incm$0NetUnrelatedBusTxblIncmAmt
PY Contributions Grants$304,706PYContributionsGrantsAmt
CY Contributions Grants$308,269CYContributionsGrantsAmt
PY Program Service Revenue$15,539,255PYProgramServiceRevenueAmt
CY Program Service Revenue$19,949,400CYProgramServiceRevenueAmt
PY Investment Income$54,453PYInvestmentIncomeAmt
CY Investment Income$45,223CYInvestmentIncomeAmt
PY Other Revenue$500PYOtherRevenueAmt
CY Other Revenue$26,325CYOtherRevenueAmt
PY Total Revenue$15,898,914PYTotalRevenueAmt
CY Total Revenue$20,329,217CYTotalRevenueAmt
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$8,150,890PYSalariesCompEmpBnftPaidAmt
CY Salaries Comp Emp Bnft Paid$10,933,102CYSalariesCompEmpBnftPaidAmt
PY Total Prof Fndrsng Expns$0PYTotalProfFndrsngExpnsAmt
CY Total Prof Fndrsng Expns$0CYTotalProfFndrsngExpnsAmt
CY Total Fundraising Expense$0CYTotalFundraisingExpenseAmt
PY Other Expenses$6,621,296PYOtherExpensesAmt
CY Other Expenses$7,691,852CYOtherExpensesAmt
PY Total Expenses$14,772,186PYTotalExpensesAmt
CY Total Expenses$18,624,954CYTotalExpensesAmt
PY Revenues Less Expenses$1,126,728PYRevenuesLessExpensesAmt
CY Revenues Less Expenses$1,704,263CYRevenuesLessExpensesAmt
Total Assets BOY$27,510,135TotalAssetsBOYAmt
Total Assets EOY$43,310,802TotalAssetsEOYAmt
Total Liabilities BOY$12,992,358TotalLiabilitiesBOYAmt
Total Liabilities EOY$27,088,762TotalLiabilitiesEOYAmt
Net Assets Or Fund Balances BOY$14,517,777NetAssetsOrFundBalancesBOYAmt
Net Assets Or Fund Balances EOY$16,222,040NetAssetsOrFundBalancesEOYAmt
Info In Schedule O Part IIIYes (X)InfoInScheduleOPartIIIInd
MissionMADISON COMMUNITY HOSPITAL SERVES AS A COMMUNITY HEALTH FOCAL POINT THROUGH THE PROVISION AND MAINTENANCE OF A PROGRESSIVE, EFFICIENT, AND WELL MANAGED HEALTHCARE INSTITUTION, COMMITTED TO QUALITY MEDICAL PRACTICE, AND HIGH ETHICAL STANDARDS.MADISON COMMUNITY HOSPITAL SERVES AS A COMMUNITY AND SERVICE AREA BASED PRIMARY CARE INSTITUTION WITH BASIC SECONDARY CARE SUPPORT SERVICES, AND FACILITIES PROVIDED TO MEET DEMONSTRATED NEEDS WHICH CAN BE MET WITHIN THE FINANCIAL AND RESOURCE CONSTRAINTS OF THE ORGANIZATION.MissionDesc
Significant New Program Srvc0SignificantNewProgramSrvcInd
Significant Change0SignificantChangeInd
Expense$16,301,287ExpenseAmt
Revenue$20,030,846RevenueAmt
DescMADISON COMMUNITY HOSPITAL (HOSPITAL) IS A 25-BED ACUTE CARE HOSPITAL LOCATED IN MADISON, SOUTH DAKOTA. FOR THE YEAR ENDED JUNE 30, 2015: ACUTE PATIENT DAYS = 805; NEWBORN DAYS = 11; SKILLED DAYS = 1,408; AND INTERMEDIATE DAYS = 51.Desc
Total Program Service Expenses$16,301,287TotalProgramServiceExpensesAmt
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
Temp Or Permanent Endowments0TempOrPermanentEndowmentsInd
Report Land Building EquipmentYes (1)ReportLandBuildingEquipmentInd
Report Investments Other Sec0ReportInvestmentsOtherSecInd
Report Program Related Invst0ReportProgramRelatedInvstInd
Report Other Assets0ReportOtherAssetsInd
Report Other Liabilities0ReportOtherLiabilitiesInd
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 HospitalYes (1)OperateHospitalInd
Audited Financial Stmt AttYes (1)AuditedFinancialStmtAttInd
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 With Officer Ent0BusinessRlnWithOfficerEntInd
Deductible Non Cash Contri0DeductibleNonCashContriInd
Deductible Art Contribution0DeductibleArtContributionInd
Terminate Operations0TerminateOperationsInd
Partial Liquidation0PartialLiquidationInd
Disregarded Entity0DisregardedEntityInd
Related EntityYes (1)RelatedEntityInd
Related Organization Ctrl EntYes (1)RelatedOrganizationCtrlEntInd
Transaction With Control EntYes (1)TransactionWithControlEntInd
Trnsfr Exmpt Non Chrtbl Rltd Org0TrnsfrExmptNonChrtblRltdOrgInd
Activities Conducted Prtshp0ActivitiesConductedPrtshpInd
Schedule O RequiredYes (1)ScheduleORequiredInd
IRP Document13IRPDocumentCnt
IRP Document W2 G0IRPDocumentW2GCnt
Backup Wthld ComplianceYes (1)BackupWthldComplianceInd
Employee229EmployeeCnt
Employment Tax Returns FiledYes (1)EmploymentTaxReturnsFiledInd
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
Rcv Fnds To Pay Prsnl Bnft Cntrct0RcvFndsToPayPrsnlBnftCntrctInd
Pay Premiums Prsnl Bnft Cntrct0PayPremiumsPrsnlBnftCntrctInd
Indoor Tanning Services0IndoorTanningServicesInd
Info In Schedule O Part VIYes (X)InfoInScheduleOPartVIInd
Governing Body Voting Members11GoverningBodyVotingMembersCnt
Independent Voting Member11IndependentVotingMemberCnt
Family Or Business Rln0FamilyOrBusinessRlnInd
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 PolicyYes (1)ConflictOfInterestPolicyInd
Annual Disclosure Covered PrsnYes (1)AnnualDisclosureCoveredPrsnInd
Regular Monitoring EnfrcYes (1)RegularMonitoringEnfrcInd
Whistleblower PolicyYes (1)WhistleblowerPolicyInd
Document Retention PolicyYes (1)DocumentRetentionPolicyInd
Compensation Process CEOYes (1)CompensationProcessCEOInd
Compensation Process Other0CompensationProcessOtherInd
Investment In Joint Venture0InvestmentInJointVentureInd
Upon RequestYes (X)UponRequestInd

Books In Care Of Detail BooksInCareOfDetail

Business Name BusinessName

FieldValueIRS element (for citing)
Business Name Line1TAMARA MILLERBusinessNameLine1Txt
FieldValueIRS element (for citing)
Phone6052566551PhoneNum

US Address USAddress

FieldValueIRS element (for citing)
Address Line1323 SW 10TH STAddressLine1Txt
CityMADISONCityNm
State AbbreviationSDStateAbbreviationCd
ZIP57042ZIPCd

Form990 Part VII Section A Form990PartVIISectionAGrp (17 entries)

TitleTitleTxtAverage Hours Per WeekAverageHoursPerWeekRtAverage Hours Per Week Rltd OrgAverageHoursPerWeekRltdOrgRtIndividual Trustee Or DirectorIndividualTrusteeOrDirectorIndOfficerOfficerIndReportable Comp From OrgReportableCompFromOrgAmtReportable Comp From Rltd OrgReportableCompFromRltdOrgAmtOther CompensationOtherCompensationAmtHighest Compensated EmployeeHighestCompensatedEmployeeInd
BRAD WILKENS
PRESIDENT1.001.00Yes (X)Yes (X)$0$0$0
GREG HOLLISTER
VICE PRESIDENT1.000.00Yes (X)Yes (X)$0$0$0
LOIS NIEDERT
SECRETARY1.000.00Yes (X)Yes (X)$0$0$0
CHRIS LEMAIR
TREASURER1.000.00Yes (X)Yes (X)$0$0$0
DAN BROWN
TRUSTEE1.000.00Yes (X)$0$0$0
PEGGY CASANOVA
TRUSTEE1.000.00Yes (X)$0$0$0
ROBIN SCHWEBACH
TRUSTEE1.001.00Yes (X)$0$0$0
LELAND WHITE
TRUSTEE1.001.00Yes (X)$0$0$0
ABBY OFTEDAL
TRUSTEE1.000.00Yes (X)$0$0$0
CINDY CALLIES
TRUSTEE1.001.00Yes (X)$0$0$0
KEVIN HOFF
TRUSTEE1.000.00Yes (X)$0$0$0
TAMARA MILLER
CEO40.001.00Yes (X)$168,684$0$16,626
ROBERT SUMMERER
SURGEON40.000.00$416,061$0$30,954Yes (X)
DARREL SIMON
CRNA40.001.00$200,332$0$10,004Yes (X)
MITCHELL POPPENS
PA-C40.000.00$126,387$0$9,087Yes (X)
LAUREL JENNINGS-JOHNSON
MD40.000.00$111,303$0$12,573Yes (X)
MARY BEECHER
MD40.000.00$113,490$0$6,396Yes (X)
FieldValueIRS element (for citing)
Total Reportable Comp From Org$1,136,257TotalReportableCompFromOrgAmt
Tot Reportable Comp Rltd Org$0TotReportableCompRltdOrgAmt
Total Other Compensation$85,640TotalOtherCompensationAmt
Indiv Rcvd Greater Than100 K9IndivRcvdGreaterThan100KCnt
Former Ofcr Employees Listed0FormerOfcrEmployeesListedInd
Total Comp Greater Than150 KYes (1)TotalCompGreaterThan150KInd
Compensation From Other Srcs0CompensationFromOtherSrcsInd

Contractor Compensation ContractorCompensationGrp (5 entries)

Address Line1ContractorAddress/USAddress/AddressLine1TxtCityContractorAddress/USAddress/CityNmState AbbreviationContractorAddress/USAddress/StateAbbreviationCdZIPContractorAddress/USAddress/ZIPCdServicesServicesDescCompensationCompensationAmt
SIOUX FALLS CONSTRUCTION COMPANY
4500 W 58TH STSIOUX FALLSSD57108CONSTRUCTION OF NEW BUILDING$13,006,130
TSPINC
1112 NORTHWEST AVESIOUX FALLSSD57104DESIGNING SERVICES$362,000
NATIONAL MEDICAL RESOURCES
2792 E BROADWAY AVEBISMARCKND58501EMERGENCY ROOM PHYSICIANS$309,766
INTERLAKES MEDICAL CENTER
323 10TH ST SWMADISONSD57042ER CALL COVERAGE$277,615
NORTHLAND FAMILY PRACTICE
220 NE 9TH STMADISONSD57042MEDICAL SERVICES$249,138
FieldValueIRS element (for citing)
Cntrct Rcvd Greater Than100 K8CntrctRcvdGreaterThan100KCnt
Related Organizations$30,000RelatedOrganizationsAmt
Government Grants$216,045GovernmentGrantsAmt
All Other Contributions$62,224AllOtherContributionsAmt
Total Contributions$308,269TotalContributionsAmt

Program Service Revenue ProgramServiceRevenueGrp (5 entries)

DescDescBusinessBusinessCdTotal Revenue ColumnTotalRevenueColumnAmtRelated Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmtExclusionExclusionAmt
PATIENT SERVICE REVENUE624210$19,868,758$19,868,758
MEALS621110$97,285$97,285
MCMC REVENUE900009$26,384$26,384
MISCELLANEOUS621110$12,094$12,094
LOSS ON SUBSIDIARY900009-$55,121-$55,121
FieldValueIRS element (for citing)
Total Program Service Revenue$19,949,400TotalProgramServiceRevenueAmt

Investment Income InvestmentIncomeGrp

FieldValueIRS element (for citing)
Total Revenue Column$29,723TotalRevenueColumnAmt
Exclusion$29,723ExclusionAmt

Gross Rents GrossRentsGrp

FieldValueIRS element (for citing)
Real$26,325RealAmt

Less Rental Expenses LessRentalExpensesGrp

FieldValueIRS element (for citing)
Real$0RealAmt

Rental Income Or Loss RentalIncomeOrLossGrp

FieldValueIRS element (for citing)
Real$26,325RealAmt

Net Rental Income Or Loss NetRentalIncomeOrLossGrp

FieldValueIRS element (for citing)
Total Revenue Column$26,325TotalRevenueColumnAmt
Related Or Exempt Func Income$26,325RelatedOrExemptFuncIncomeAmt

Gross Amount Sales Assets GrossAmountSalesAssetsGrp

FieldValueIRS element (for citing)
Other$15,500OtherAmt

Less Cost Oth Basis Sales Expnss LessCostOthBasisSalesExpnssGrp

FieldValueIRS element (for citing)
Other$0OtherAmt

Gain Or Loss GainOrLossGrp

FieldValueIRS element (for citing)
Other$15,500OtherAmt

Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp

FieldValueIRS element (for citing)
Total Revenue Column$15,500TotalRevenueColumnAmt
Exclusion$15,500ExclusionAmt

Total Revenue TotalRevenueGrp

FieldValueIRS element (for citing)
Total Revenue Column$20,329,217TotalRevenueColumnAmt
Related Or Exempt Func Income$20,030,846RelatedOrExemptFuncIncomeAmt
Unrelated Business Revenue$0UnrelatedBusinessRevenueAmt
Exclusion-$9,898ExclusionAmt

Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp

FieldValueIRS element (for citing)
Total$193,560TotalAmt
Management And General$193,560ManagementAndGeneralAmt

Other Salaries And Wages OtherSalariesAndWagesGrp

FieldValueIRS element (for citing)
Total$8,771,118TotalAmt
Program Services$7,898,332ProgramServicesAmt
Management And General$872,786ManagementAndGeneralAmt

Pension Plan Contributions PensionPlanContributionsGrp

FieldValueIRS element (for citing)
Total$259,337TotalAmt
Program Services$236,727ProgramServicesAmt
Management And General$22,610ManagementAndGeneralAmt

Other Employee Benefits OtherEmployeeBenefitsGrp

FieldValueIRS element (for citing)
Total$967,837TotalAmt
Program Services$809,047ProgramServicesAmt
Management And General$158,790ManagementAndGeneralAmt

Payroll Taxes PayrollTaxesGrp

FieldValueIRS element (for citing)
Total$741,250TotalAmt
Program Services$654,274ProgramServicesAmt
Management And General$86,976ManagementAndGeneralAmt

Fees For Services Other FeesForServicesOtherGrp

FieldValueIRS element (for citing)
Total$1,108,751TotalAmt
Program Services$688,627ProgramServicesAmt
Management And General$420,124ManagementAndGeneralAmt

Advertising AdvertisingGrp

FieldValueIRS element (for citing)
Total$96,649TotalAmt
Management And General$96,649ManagementAndGeneralAmt

Office Expenses OfficeExpensesGrp

FieldValueIRS element (for citing)
Total$884,873TotalAmt
Program Services$726,916ProgramServicesAmt
Management And General$157,957ManagementAndGeneralAmt

Occupancy OccupancyGrp

FieldValueIRS element (for citing)
Total$143,777TotalAmt
Program Services$143,777ProgramServicesAmt

Travel TravelGrp

FieldValueIRS element (for citing)
Total$37,212TotalAmt
Program Services$36,043ProgramServicesAmt
Management And General$1,169ManagementAndGeneralAmt

Conferences Meetings ConferencesMeetingsGrp

FieldValueIRS element (for citing)
Total$56,975TotalAmt
Program Services$40,122ProgramServicesAmt
Management And General$16,853ManagementAndGeneralAmt

Depreciation Depletion DepreciationDepletionGrp

FieldValueIRS element (for citing)
Total$602,437TotalAmt
Program Services$602,437ProgramServicesAmt

Insurance InsuranceGrp

FieldValueIRS element (for citing)
Total$200,984TotalAmt
Management And General$200,984ManagementAndGeneralAmt

Other Expenses OtherExpensesGrp (4 entries)

DescDescTotalTotalAmtProgram ServicesProgramServicesAmtManagement And GeneralManagementAndGeneralAmt
MEDICAL SUPPLIES$2,893,496$2,893,496
BAD DEBTS$1,129,947$1,129,947
MAINTENANCE AND REPAIRS$396,782$396,782
DUES AND SUBSCRIPTIONS$24,276$24,276

All Other Expenses AllOtherExpensesGrp

FieldValueIRS element (for citing)
Total$115,693TotalAmt
Program Services$44,760ProgramServicesAmt
Management And General$70,933ManagementAndGeneralAmt

Total Functional Expenses TotalFunctionalExpensesGrp

FieldValueIRS element (for citing)
Total$18,624,954TotalAmt
Program Services$16,301,287ProgramServicesAmt
Management And General$2,323,667ManagementAndGeneralAmt
Fundraising$0FundraisingAmt

Savings And Temp Cash Invst SavingsAndTempCashInvstGrp

FieldValueIRS element (for citing)
BOY$10,695,130BOYAmt
EOY$5,351,581EOYAmt

Accounts Receivable AccountsReceivableGrp

FieldValueIRS element (for citing)
BOY$1,784,828BOYAmt
EOY$2,747,622EOYAmt

Oth Notes Loans Receivable Net OthNotesLoansReceivableNetGrp

FieldValueIRS element (for citing)
BOY$181,736BOYAmt
EOY$206,211EOYAmt

Inventories For Sale Or Use InventoriesForSaleOrUseGrp

FieldValueIRS element (for citing)
BOY$349,888BOYAmt
EOY$420,894EOYAmt

Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp

FieldValueIRS element (for citing)
BOY$397,876BOYAmt
EOY$477,922EOYAmt
FieldValueIRS element (for citing)
Land Bldg Equip Cost Or Other Bss$42,788,298LandBldgEquipCostOrOtherBssAmt
Land Bldg Equip Accum Deprec$8,667,921LandBldgEquipAccumDeprecAmt

Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp

FieldValueIRS element (for citing)
BOY$14,059,362BOYAmt
EOY$34,120,377EOYAmt

Other Assets Total OtherAssetsTotalGrp

FieldValueIRS element (for citing)
BOY$41,315BOYAmt
EOY-$13,805EOYAmt

Total Assets TotalAssetsGrp

FieldValueIRS element (for citing)
BOY$27,510,135BOYAmt
EOY$43,310,802EOYAmt

Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp

FieldValueIRS element (for citing)
BOY$2,934,244BOYAmt
EOY$4,084,048EOYAmt

Deferred Revenue DeferredRevenueGrp

FieldValueIRS element (for citing)
BOY$58,114BOYAmt
EOY$0EOYAmt

Mortg Notes Pybl Scrd Invst Prop MortgNotesPyblScrdInvstPropGrp

FieldValueIRS element (for citing)
BOY$10,000,000BOYAmt
EOY$23,004,714EOYAmt

Total Liabilities TotalLiabilitiesGrp

FieldValueIRS element (for citing)
BOY$12,992,358BOYAmt
EOY$27,088,762EOYAmt
FieldValueIRS element (for citing)
Organization Follows SFAS117Yes (X)OrganizationFollowsSFAS117Ind

Unrestricted Net Assets UnrestrictedNetAssetsGrp

FieldValueIRS element (for citing)
BOY$14,400,535BOYAmt
EOY$16,084,646EOYAmt

Temporarily Rstr Net Assets TemporarilyRstrNetAssetsGrp

FieldValueIRS element (for citing)
BOY$117,242BOYAmt
EOY$137,394EOYAmt

Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp

FieldValueIRS element (for citing)
BOY$14,517,777BOYAmt
EOY$16,222,040EOYAmt

Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp

FieldValueIRS element (for citing)
BOY$27,510,135BOYAmt
EOY$43,310,802EOYAmt
FieldValueIRS element (for citing)
Reconcilation Revenue Expnss$1,704,263ReconcilationRevenueExpnssAmt
Other Changes In Net Assets$0OtherChangesInNetAssetsAmt
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)
HospitalYes (X)HospitalInd

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

Buildings BuildingsGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$4,661,529OtherCostOrOtherBasisAmt
Depreciation$3,244,734DepreciationAmt
Book Value$1,416,795BookValueAmt

Equipment EquipmentGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$7,104,994OtherCostOrOtherBasisAmt
Depreciation$5,227,253DepreciationAmt
Book Value$1,877,741BookValueAmt

Other Land Buildings OtherLandBuildingsGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$31,021,775OtherCostOrOtherBasisAmt
Depreciation$195,934DepreciationAmt
Book Value$30,825,841BookValueAmt
FieldValueIRS element (for citing)
Total Book Value Land Buildings$34,120,377TotalBookValueLandBuildingsAmt
Footnote TextYes (X)FootnoteTextInd

Supplemental Information Detail SupplementalInformationDetail

FieldValueIRS element (for citing)
Form And Line ReferencePART X, LINE 2:FormAndLineReferenceDesc
ExplanationTHE HOSPITAL AND FOUNDATION ARE SOUTH DAKOTA NONPROFIT CORPORATIONS AND HAVE BEEN RECOGNIZED BY THE INTERNAL REVENUE SERVICE (IRS) AS EXEMPT FROM FEDERAL INCOME TAXES UNDER INTERNAL REVENUE CODE SECTION 501(C)(3). THE HOSPITAL AND FOUNDATION ARE ANNUALLY REQUIRED TO FILE A RETURN OF ORGANIZATION EXEMPT FROM INCOME TAX (FORM 990) WITH THE IRS. THE HOSPITAL AND FOUNDATION ARE SUBJECT TO INCOME TAX ON NET INCOME THAT IS DERIVED FROM BUSINESS ACTIVITIES THAT ARE UNRELATED TO ITS EXEMPT PURPOSE. THE CENTER IS ORGANIZED AS A SOUTH DAKOTA TAXABLE CORPORATION AND IS REQUIRED TO FILE A TAX RETURN (FORM 1120) ON AN ANNUAL BASIS. THE HOSPITAL, FOUNDATION, AND CENTER BELIEVE THAT THEY HAVE APPROPRIATE SUPPORT FOR ANY TAX POSITIONS TAKEN AFFECTING THEIR ANNUAL FILING REQUIREMENTS, AND AS SUCH, DO NOT HAVE ANY UNCERTAIN TAX POSITIONS THAT ARE MATERIAL TO THE CONSOLIDATED FINANCIAL STATEMENTS. THE HOSPITAL, FOUNDATION, AND CENTER 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. THE HOSPITAL AND FOUNDATION HAS DETERMINED THAT THEY ARE NOT SUBJECT TO UNRELATED BUSINESS INCOME TAX AND HAS NOT FILED AN EXEMPT ORGANIZATION BUSINESS INCOME TAX RETURN (FORM 990T) WITH THE IRS. THE CENTER'S 1120 FILINGS ARE NO LONGER SUBJECT TO FEDERAL EXAMINATIONS BY TAX AUTHORITIES FOR YEARS BEFORE 2012.ExplanationTxt

Schedule H IRS990ScheduleH

FieldValueIRS element (for citing)
Financial Assistance PolicyYes (1)FinancialAssistancePolicyInd
Written PolicyYes (1)WrittenPolicyInd
All Hospitals PolicyYes (X)AllHospitalsPolicyInd
FPG Reference Free CareYes (1)FPGReferenceFreeCareInd
Percent150Yes (X)Percent150Ind
FPG Reference Discounted CareYes (1)FPGReferenceDiscountedCareInd
Percent400Yes (X)Percent400Ind
Free Care Medically IndigentYes (1)FreeCareMedicallyIndigentInd
Financial Assistance BudgetYes (1)FinancialAssistanceBudgetInd
Expenses Exceed Budget0ExpensesExceedBudgetInd
Annual Community Bnft Report0AnnualCommunityBnftReportInd

Financial Assistance At Cost Typ FinancialAssistanceAtCostTyp

FieldValueIRS element (for citing)
Total Community Benefit Expns$61,000TotalCommunityBenefitExpnsAmt
Net Community Benefit Expns$61,000NetCommunityBenefitExpnsAmt
Total Expense0.00350TotalExpensePct

Unreimbursed Medicaid UnreimbursedMedicaidGrp

FieldValueIRS element (for citing)
Total Community Benefit Expns$416,163TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue$369,671DirectOffsettingRevenueAmt
Net Community Benefit Expns$46,492NetCommunityBenefitExpnsAmt
Total Expense0.00270TotalExpensePct

Total Financial Assistance Typ TotalFinancialAssistanceTyp

FieldValueIRS element (for citing)
Total Community Benefit Expns$477,163TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue$369,671DirectOffsettingRevenueAmt
Net Community Benefit Expns$107,492NetCommunityBenefitExpnsAmt
Total Expense0.00620TotalExpensePct

Community Health Services CommunityHealthServicesGrp

FieldValueIRS element (for citing)
Total Community Benefit Expns$10,544TotalCommunityBenefitExpnsAmt
Net Community Benefit Expns$10,544NetCommunityBenefitExpnsAmt
Total Expense0.00060TotalExpensePct

Subsidized Health Services SubsidizedHealthServicesGrp

FieldValueIRS element (for citing)
Total Community Benefit Expns$5,722,380TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue$4,583,006DirectOffsettingRevenueAmt
Net Community Benefit Expns$1,139,374NetCommunityBenefitExpnsAmt
Total Expense0.06510TotalExpensePct

Total Other Benefits TotalOtherBenefitsGrp

FieldValueIRS element (for citing)
Total Community Benefit Expns$5,732,924TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue$4,583,006DirectOffsettingRevenueAmt
Net Community Benefit Expns$1,149,918NetCommunityBenefitExpnsAmt
Total Expense0.06570TotalExpensePct

Total Community Benefits TotalCommunityBenefitsGrp

FieldValueIRS element (for citing)
Total Community Benefit Expns$6,210,087TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue$4,952,677DirectOffsettingRevenueAmt
Net Community Benefit Expns$1,257,410NetCommunityBenefitExpnsAmt
Total Expense0.07190TotalExpensePct
FieldValueIRS element (for citing)
Bad Debt Expense Reported0BadDebtExpenseReportedInd
Bad Debt Expense$1,129,947BadDebtExpenseAmt
Bad Debt Expense Attributable$184,181BadDebtExpenseAttributableAmt
Reimbursed By Medicare$6,638,286ReimbursedByMedicareAmt
Cost Of Care Reimbursed By Medcr$6,671,668CostOfCareReimbursedByMedcrAmt
Medicare Surplus Or Shortfall-$33,382MedicareSurplusOrShortfallAmt

Costing Methodology Used CostingMethodologyUsedGrp

FieldValueIRS element (for citing)
OtherYes (X)OtherInd
FieldValueIRS element (for citing)
Written Debt Collection PolicyYes (1)WrittenDebtCollectionPolicyInd
Financial Assistance PrvsnYes (1)FinancialAssistancePrvsnInd
Hospital Facilities1HospitalFacilitiesCnt

Hospital Facilities HospitalFacilitiesGrp

FieldValueIRS element (for citing)
Facility1FacilityNum

Business Name BusinessName

FieldValueIRS element (for citing)
Business Name Line1MADISON COMMUNITY HOSPITALBusinessNameLine1Txt

US Address USAddress

FieldValueIRS element (for citing)
Address Line1323 SW 10TH STAddressLine1Txt
CityMADISONCityNm
State AbbreviationSDStateAbbreviationCd
ZIP57042ZIPCd
FieldValueIRS element (for citing)
Website AddressWWW.MADISONREGIONALHEALTH.ORGWebsiteAddressTxt
State License49870StateLicenseNum
Licensed HospitalYes (X)LicensedHospitalInd
Critical Access HospitalYes (X)CriticalAccessHospitalInd
Emergency Room24 HrsYes (X)EmergencyRoom24HrsInd

Hospital Fclty Policies Prctc HospitalFcltyPoliciesPrctcGrp

Hospital Facility Name HospitalFacilityName

FieldValueIRS element (for citing)
Business Name Line1MADISON COMMUNITY HOSPITALBusinessNameLine1Txt
FieldValueIRS element (for citing)
Facility1FacilityNum
First Licensed CY Or PY0FirstLicensedCYOrPYInd
Tax Exempt Hospital CY Or PY0TaxExemptHospitalCYOrPYInd
CHNA ConductedYes (1)CHNAConductedInd
Community DefinitionYes (X)CommunityDefinitionInd
Community DemographicsYes (X)CommunityDemographicsInd
Existing ResourcesYes (X)ExistingResourcesInd
How Data ObtainedYes (X)HowDataObtainedInd
Community Health NeedsYes (X)CommunityHealthNeedsInd
Other Health IssuesYes (X)OtherHealthIssuesInd
Community Hlth Needs Id ProcessYes (X)CommunityHlthNeedsIdProcessInd
Consulting ProcessYes (X)ConsultingProcessInd
Information GapsYes (X)InformationGapsInd
CHNA Conducted12CHNAConductedYr
Take Into Account Others InputYes (1)TakeIntoAccountOthersInputInd
CHNA Conducted With Other Fclts0CHNAConductedWithOtherFcltsInd
CHNA Conducted With Non Fclts0CHNAConductedWithNonFcltsInd
CHNA Report Widely AvailableYes (1)CHNAReportWidelyAvailableInd
Rpt Available On Own WebsiteYes (X)RptAvailableOnOwnWebsiteInd
Own Website URLWWW.MADISONREGIONALHEALTH.ORGOwnWebsiteURLTxt
Implementation Strategy AdoptYes (1)ImplementationStrategyAdoptInd
Implementation Strategy Adpt12ImplementationStrategyAdptYr
Strategy Posted WebsiteYes (1)StrategyPostedWebsiteInd
Strategy Website URLWWW.MADISONREGIONALHEALTH.ORGStrategyWebsiteURLTxt
Strategy Attached0StrategyAttachedInd
Organization Incur Excise Tax0OrganizationIncurExciseTaxInd
Elig Criteria ExplainedYes (1)EligCriteriaExplainedInd
FPG Family Incm Lmt Free DscntYes (X)FPGFamilyIncmLmtFreeDscntInd
FPG Family Incm Lmt Free Care150.000000000000FPGFamilyIncmLmtFreeCarePct
FPG Family Incm Lmt Dscnt Care400.000000000000FPGFamilyIncmLmtDscntCarePct
Income Level CriteriaYes (X)IncomeLevelCriteriaInd
Asset Level CriteriaYes (X)AssetLevelCriteriaInd
Medical Indigency CriteriaYes (X)MedicalIndigencyCriteriaInd
Insurance Status CriteriaYes (X)InsuranceStatusCriteriaInd
Other CriteriaYes (X)OtherCriteriaInd
Explained BasisYes (1)ExplainedBasisInd
App Financial Asst ExplnYes (1)AppFinancialAsstExplnInd
Described InfoYes (X)DescribedInfoInd
Described Suprt DocYes (X)DescribedSuprtDocInd
Provided Hospital ContactYes (X)ProvidedHospitalContactInd
Provided Nonprofit ContactYes (X)ProvidedNonprofitContactInd
Includes Publicity MeasuresYes (1)IncludesPublicityMeasuresInd
FAP App Available On WebsiteYes (X)FAPAppAvailableOnWebsiteInd
FAP App Available On Website URLWWW.MADISONREGIONALHEALTH.ORGFAPAppAvailableOnWebsiteURLTxt
FAP Summary On WebsiteYes (X)FAPSummaryOnWebsiteInd
FAP Summary On Website URLWWW.MADISONREGIONALHEALTH.ORGFAPSummaryOnWebsiteURLTxt
FAP Sum Avlbl On Request No ChrgYes (X)FAPSumAvlblOnRequestNoChrgInd
Other PublicityYes (X)OtherPublicityInd
FAP Actions On NonpaymentYes (1)FAPActionsOnNonpaymentInd
Permit No ActionsYes (X)PermitNoActionsInd
Collection Activities0CollectionActivitiesInd
FAP Notified Upon AdmissionYes (X)FAPNotifiedUponAdmissionInd
FAP Notified Before DischargeYes (X)FAPNotifiedBeforeDischargeInd
FAP Notified All PatientsYes (X)FAPNotifiedAllPatientsInd
Nondis Emergency Care PolicyYes (1)NondisEmergencyCarePolicyInd
Average Negotiated RatesYes (X)AverageNegotiatedRatesInd
Amounts Generally Billed0AmountsGenerallyBilledInd
Gross Charges0GrossChargesInd

Supplemental Information SupplementalInformationGrp (7 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
MADISON COMMUNITY HOSPITALPART V, SECTION B, LINE 5: THE SURVEY WAS DISTRIBUTED TO TWO PRIMARY AUDIENCES: 1--COMMUNITY MEMBERS AND 2--HEALTH CARE PROFESSIONALS WITH SPECIAL KNOWLEDGE OF OR EXPERTISE IN PUBLIC HEALTH. COMMUNITY MEMBERS RECEIVED NOTICE OF THE SURVEY THROUGH ELECTRONIC COMMUNICATIONS, THE MADISON DAILY LEADER NEWSPAPER AND LOCAL RADIO STATIONS. HEALTH CARE PROFESSIONALS RECEIVED NOTICE OF THE SURVEY DURING MANDATORY STAFF MEETINGS AT THE MADISON COMMUNITY HOSPITAL IN FEBRUARY 2013. SPECIFICALLY, THERE ARE ACTIVE MEDICAL STAFF MEMBERS WHO HAVE THEIR OWN CLINIC BUSINESS THAT WERE GIVEN THE SURVEY.
MADISON COMMUNITY HOSPITALPART V, SECTION B, LINE 11: ALL NEEDS IDENTIFIED THROUGH THE COMMUNITY HEALTH NEEDS ASSESSMENT SURVEY ARE BEING ADDRESSED BY MADISON COMMUNITY HOSPITAL. IDENTIFIED NEEDS INCLUDE ORTHOPEDICS, OB/GYN, MARKETING, COST, CUSTOMER SERVICE AND PARKING.ORTHOPEDICS-WE CONTINUE TO WORK WITH OUR OUTREACH ORTHOPEDIC PHYSICIANS ON PROVIDING MORE SERVICES AT OUR FACILITY. THIS IS A WORK IN PROGRESS.OB/GYN-WE HAVE RAMPED UP OUR OB SERVICES AND BEGAN DELIVERY BABIES IN OUR NEW FACILITY ON NOVEMBER 1ST. WE HAVE 2 OUTREACH OB/GYN PHYSICIANS.MARKETING-WE HAVE DRAMATICALLY INCREASED OUR MARKETING EFFORTS IN THE LOCAL MARKETS INCLUDING RADIO, NEWSPAPER, AND SOCIAL MEDIA. WE HAVE RECENTLY REDONE OUR WEBSITE AS WELL.COST-WE CONTINUE TO LOOK AT COST CUTTING MEASURES; THIS IS ONGOING.CUSTOMER SERVICE-WE HAVE DONE SEVERAL THINGS TO IMPROVE OUR CUSTOMER SERVICE EXPERIENCE INCLUDING EDUCATION OF STAFF, PATIENT SATISFACTION SURVEYS, AND MANY QUALITY IMPROVEMENT PROJECTS REVOLVING AROUND CUSTOMER SERVICE.PARKING-THIS ISSUE WAS RESOLVED WITH THE NEW FACILITY.
MADISON COMMUNITY HOSPITALPART V, SECTION B, LINE 13B: HOUSEHOLD SIZE
MADISON COMMUNITY HOSPITALPART V, SECTION B, LINE 16I: PLEASE REFER TO THE NARRATIVE FOR SCHEDULE H PART VI LINE 3.
PART V, SECTION B, LINE 16FINANCIAL ASSISTANCE POLICY WEBSITE AVAILABILITY
MADISON COMMUNITY HOSPITAL PART V, SECTION B, LINE 16B WEBSITE:WWW.MADISONREGIONALHEALTH.ORG
MADISON COMMUNITY HOSPITAL PART V, SECTION B, LINE 16C WEBSITE:WWW.MADISONREGIONALHEALTH.ORG

Supplemental Information Detail SupplementalInformationDetail (12 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
PART I, LINE 7:CHARITY CARE EXPENSE WAS CONVERTED TO COST ON LINE 7A BASED ON AN OVERALL COST-TO-CHARGE RATIO ADDRESSING ALL PATIENT SEGMENTS. LINE 7B AND LINE 7G WERE DETERMINED USING THE MEDICAID AND MEDICARE COST REPORTS, RESPECTIVELY. LINE 7E WAS DETERMINED USING THE GENERAL LEDGER.
PART I, LINE 7G:LINE 7G INCLUDES DIRECT COSTS OF $717,847 AND INDIRECT COSTS OF $349,952 FROM A PHYSICIAN CLINIC. THE NET COMMUNITY BENEFIT EXPENSE RELATED TO THE PHYSICIAN CLINIC IS $22,524.
PART I, LN 7 COL(F):BAD DEBT EXPENSE OF $1,129,947 WAS SUBTRACTED FROM TOTAL OPERATING EXPENSE.
PART III, LINE 2:BAD DEBT RECOVERIES AND DISCOUNTS APPLIED DURING THE COLLECTION PROCESS ARE POSTED IN A SEPARATE ACCOUNT ON THE GENERAL LEDGER. THIS ACCOUNT IS COMBINED WITH THE BAD DEBT EXPENSE ACCOUNT TO RESULT IN A NET BAD DEBT EXPENSE AMOUNT ON THE AUDITED FINANCIAL STATEMENT. THE BAD DEBT ALLOWANCE AND EXPENSE TAKES CONTRACTUAL ALLOWANCES INTO ACCOUNT. THE AMOUNT OF BAD DEBT SHOWN IS BASED ON CHARGES.
PART III, LINE 3:THE HOSPITAL APPLIED THE MOST RECENT POVERTY LEVEL PERCENTAGE PER THE U.S. CENSUS BUREAU FOR ITS AREA TO THE TOTAL AMOUNT SENT TO COLLECTIONS DURING THE FISCAL YEAR ENDED JUNE 30, 2015 TO DETERMINE AN ESTIMATE OF ELIGIBLE CHARITY CARE REPORTED AS BAD DEBT.
PART III, LINE 4:FOOTNOTE FROM FINANCIAL STATEMENT: PLEASE SEE PAGE 8 OF THE ATTACHED FINANCIAL STATEMENT FOR THE PATIENT RECEIVABLES FOOTNOTE.
PART III, LINE 8:MEDICARE ALLOWABLE COST OF CARE WAS CALCULATED FROM THE MEDICARE COST REPORT FOR THE FISCAL YEAR ENDING 6/30/2015.THE ENTIRE SHORTFALL SHOULD BE TREATED AS A COMMUNITY BENEFIT. THE SHORTFALL IS THE DIRECT RESULT OF SEQUESTRATION ENACTMENTS PUT IN PLACE BY THE FEDERAL GOVERNMENT.
PART III, LINE 9B:ACCOUNTS THAT MEET THE CRITERIA FOR THE FINANCIAL ASSISTANCE POLICY WILL BE WRITTEN OFF IN ACCORDANCE WITH THE FINANCIAL ASSISTANCE POLICY. ACCOUNTS THAT DO NOT MEET THE CRITERIA FOR FINANCIAL ASSISTANCE WILL PROCEED THROUGH THE COLLECTION PROCESS. IF, DURING THE COLLECTION PROCESS, IT IS DETERMINED THAT AN ACCOUNT IN COLLECTION BELONGS TO A PATIENT WHO IS ELIGIBLE FOR FINANCIAL ASSISTANCE, THE ACCOUNT WILL BE REMOVED FROM COLLECTION AND RETURNED TO THE HOSPITAL FOR RESOLUTION.
PART VI, LINE 2:IN ADDITION TO COMPLETING A COMMUNITY HEALTH NEEDS ASSESSMENT DURING THE YEAR ENDED JUNE 30, 2013, A DEMOGRAPHIC AND SERVICE LINE ANALYSIS WAS COMPLETED TO DETERMINE COMMUNITY HEALTHCARE NEEDS.
PART VI, LINE 3:A SUMMARY OF THE FACILITY'S FINANCIAL ASSISTANCE POLICY IS AVAILABLE ON THE HOSPITAL'S WEBSITE, ATTACHED TO BILLING INVOICES, POSTED IN THE EMERGENCY ROOM OR WAITING ROOMS, POSTED IN THE ADMISSIONS OFFICE, GIVEN TO PATIENTS ON ADMISSION, AND UPON REQUEST. DISCHARGE PLANNING PERSONNEL IN THE BUSINESS OFFICE COUNSEL PATIENTS UPON ADMISSION AND THROUGH THE DISCHARGE PLANNING PROCESS ON MEDICAID, COUNTY WELFARE PROGRAMS, CHARITY CARE, ETC. FINANCIAL ASSISTANCE PROGRAMS ARE DETAILED EITHER IN PERSON OR THROUGH A BROCHURE THAT EXPLAINS THE HOSPITAL'S FINANCIAL ASSISTANCE AND PAYMENT REQUIREMENTS. COVERED VS NON-COVERED CHARGES ARE DISCUSSED WITH THE PATIENT. A PATIENT ASSESSMENT, INCLUDING A DISCUSSION ON FINANCIAL RESPONSIBILITIES, CONCERNS, AND GOVERNMENT PROGRAMS, IS COMPLETED ON EACH INPATIENT BY DISCHARGE PLANNING. A FINANCIAL COUNSELOR MEETS ONE-ON-ONE WITH PATIENTS PRIOR TO DISCHARGE TO GO OVER INSURANCE COVERAGE AND WHAT TO EXPECT ONCE INSURANCE IS PROCESSED.
PART VI, LINE 4:MADISON COMMUNITY HOSPITAL IS THE ONLY HOSPITAL IN THE SERVICE AREA. FIVE PHYSICIANS AND TWO PHYSICIAN EXTENDERS PRACTICE IN THE COMMUNITY. THE SERVICE AREA FOR MCH INCLUDES 14 ZIP CODE COMMUNITIES THAT ARE WITHIN A 21-MILE RADIUS OF THE HOSPITAL. IT INCLUDES ALL OF LAKE COUNTY AND PORTIONS OF BROOKINGS, KINGSBURY, MINER, MOODY, MCCOOK AND MINNEHAHA COUNTIES. TOTAL SERVICE AREA POPULATION IS APPROXIMATELY 19,625. ESTIMATED MEDIAN HOUSEHOLD INCOME IS $54,453.
PART VI, LINE 5:THE GOVERNING BODY OF MADISON COMMUNITY HOSPITAL IS COMPRISED OF COMMUNITY MEMBERS, NONE OF WHOM ARE EMPLOYEES OR CONTRACTORS OF THE HOSPITAL. MEDICAL STAFF PRIVILEGES ARE EXTENDED TO ALL QUALIFIED PHYSICIANS IN THE COMMUNITY. SURPLUS FUNDS ARE USED TO IMPROVE PATIENT CARE AND FACILITIES. THE HOSPITAL OPERATES AN EMERGENCY ROOM WHICH IS AVAILABLE TO ALL REGARDLESS OF THEIR ABILITY TO PAY. THE HOSPITAL PARTICIPATES IN EDUCATION AND TRAINING OF HEALTHCARE PROFESSIONALS THROUGH RESIDENCIES AND INTERNSHIPS FOR NURSING STUDENTS, THERAPY STUDENTS, PHYSICIANS AND PHYSICIAN'S ASSISTANTS. THE HOSPITAL PARTICIPATES IN SEVERAL GOVERNMENT SPONSORED HEALTH PROGRAMS, INCLUDING BUT NOT LIMITED TO: MEDICARE, MEDICAID, VA, TRI-CARE, AND ALL-WOMEN-COUNT. THE HOSPITAL OFFERS VOLUNTEER OPPORTUNITIES TO MEMBERS OF THE COMMUNITY.

Schedule J IRS990ScheduleJ

FieldValueIRS element (for citing)
Compensation SurveyYes (X)CompensationSurveyInd
Board Or Committee ApprovalYes (X)BoardOrCommitteeApprovalInd
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 (3 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
TAMARA MILLER
CEO$168,684$0$0$0$0$0$8,852$0$8,963$0$186,499$0$0$0
ROBERT SUMMERER
SURGEON$416,061$0$0$0$0$0$13,000$0$18,652$0$447,713$0$0$0
DARREL SIMON
CRNA$200,073$0$0$0$259$0$10,004$0$238$0$210,574$0$0$0

Schedule O IRS990ScheduleO

Supplemental Information Detail SupplementalInformationDetail (5 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
FORM 990, PART VI, SECTION A, LINE 1THE EXECUTIVE COMMITTEE SHALL HAVE THE BOARD PRESIDENT AS ITS CHAIRMAN AND FOUR APPOINTED MEMBERS. THE EXECUTIVE COMMITTEE SHALL HAVE POWER TO TRANSACT ALL REGULAR BUSINESS OF THE FACILITY 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.
FORM 990, PART VI, SECTION B, LINE 11THE ADMINISTRATOR AND CHIEF FINANCIAL OFFICER REVIEW THE 990 IN DETAIL. AFTER THEIR REVIEW, THE 990 IS PROVIDED TO EACH BOARD MEMBER. THE ADMINISTRATOR PRESENTS THE 990 TO THE BOARD OF DIRECTORS AT THE MEETING HELD PRIOR TO ITS FILING IF SO REQUESTED BY ANY BOARD MEMBER. WHETHER PRESENTED IN A BOARD MEETING OR NOT, THE 990 IS NOT FILED UNTIL EACH BOARD MEMBER HAS BEEN GIVEN A COPY OF IT AND GIVEN AMPLE TIME TO REVIEW IT.
FORM 990, PART VI, SECTION B, LINE 12CALL BOARD MEMBERS AND OFFICERS ARE COVERED UNDER THE CONFLICT OF INTEREST POLICY. THE BOARD WILL REVIEW ACTUAL CONFLICTS AND MAKE DETERMINATIONS WHETHER A CONFLICT EXISTS. THE RESTRICTIONS ARE IMPOSED ON A CASE BY CASE BASIS BASED ON THE BOARD'S DETERMINATION.
FORM 990, PART VI, SECTION B, LINE 15ATHE CEO'S COMPENSATION AND BENEFITS ARE REVIEWED ON AN ANNUAL BASIS IN EXECUTIVE SESSION AT THE BOARD OF TRUSTEE MEETING. THE BOARD OF TRUSTEES APPROVES THE SALARY AND BENEFITS COMPENSATION.
FORM 990, PART VI, SECTION C, LINE 19THESE DOCUMENTS ARE AVAILABLE TO THE GENERAL PUBLIC UPON REQUEST.

Schedule R IRS990ScheduleR

Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp

Disregarded Entity Name DisregardedEntityName

FieldValueIRS element (for citing)
Business Name Line1MADISON COMMUNITY HOSPITAL FOUNDATION INCBusinessNameLine1Txt

US Address USAddress

FieldValueIRS element (for citing)
Address Line1323 SW 10TH STAddressLine1Txt
CityMADISONCityNm
State AbbreviationSDStateAbbreviationCd
ZIP57042ZIPCd
FieldValueIRS element (for citing)
EIN463925885EIN
Primary ActivitiesSUPPORTPrimaryActivitiesTxt
Legal Domicile StateSDLegalDomicileStateCd
Exempt Code Section501(C)(3)ExemptCodeSectionTxt
Public Charity StatusLINE 11A, IPublicCharityStatusTxt

Direct Controlling Entity Name DirectControllingEntityName

FieldValueIRS element (for citing)
Business Name Line1MADISON COMMUNITY HOSPITALBusinessNameLine1Txt
FieldValueIRS element (for citing)
Controlled Organization0ControlledOrganizationInd

Id Related Org Txbl Corp Tr IdRelatedOrgTxblCorpTrGrp

Related Organization Name RelatedOrganizationName

FieldValueIRS element (for citing)
Business Name Line1MADISON COMMUNITY MEDICAL CENTERBusinessNameLine1Txt

US Address USAddress

FieldValueIRS element (for citing)
Address Line1323 SW 10TH STAddressLine1Txt
CityMADISONCityNm
State AbbreviationSDStateAbbreviationCd
ZIP57042ZIPCd
FieldValueIRS element (for citing)
EIN460398320EIN
Primary ActivitiesOFFICE RENTALPrimaryActivitiesTxt
Legal Domicile StateSDLegalDomicileStateCd

Direct Controlling Entity Name DirectControllingEntityName

FieldValueIRS element (for citing)
Business Name Line1MADISON COMMUNITY HOSPITALBusinessNameLine1Txt
FieldValueIRS element (for citing)
Entity TypeCEntityTypeTxt
Share Of Total Income-$55,121ShareOfTotalIncomeAmt
Share Of EOY Assets$207,669ShareOfEOYAssetsAmt
Ownership1.00000OwnershipPct
Controlled OrganizationYes (1)ControlledOrganizationInd
FieldValueIRS element (for citing)
Receipt Of Int Annts Rnts Rylts0ReceiptOfIntAnntsRntsRyltsInd
Gift Grnt Or Cap Contri To Oth Org0GiftGrntOrCapContriToOthOrgInd
Gift Grnt Cap Contri From Oth Org0GiftGrntCapContriFromOthOrgInd
Loans Or Guarantees To Other OrgYes (1)LoansOrGuaranteesToOtherOrgInd
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 Facilities0SharingOfFacilitiesInd
Paid Employees Sharing0PaidEmployeesSharingInd
Reimbursement Paid To Other OrgYes (1)ReimbursementPaidToOtherOrgInd
Reimbursement Paid By Other Org0ReimbursementPaidByOtherOrgInd
Transfer To Other OrgYes (1)TransferToOtherOrgInd
Transfer From Other Org0TransferFromOtherOrgInd

Transactions Related Org TransactionsRelatedOrgGrp

Other Organization Name OtherOrganizationName

FieldValueIRS element (for citing)
Business Name Line1MADISON COMMUNITY MEDICAL CENTERBusinessNameLine1Txt
FieldValueIRS element (for citing)
Transaction TypePTransactionTypeTxt
Involved$26,384InvolvedAmt
Method Of Amount DeterminationFMVMethodOfAmountDeterminationTxt

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