2015-10-29T09:17:30-05:00 2014-12-31 251408703 SCHNEIDER DOWNS & CO INC ONE PPG PLACE SUITE 1700 PITTSBURGH PA 15222 990 2014-01-01 311514418 MADISON FAMILY HEALTH CORPORATION MADI 7408457015 210 NORTH MAIN STREET LONDON OH 43140 DANA E ENGLE PRESIDENT 7408457015 2015-10-28 1 EUGENE J LOGAN P00227231 4122613644 2014 2016-02-25 16:41:14Z MADISON HEALTH PRIMARY CARE DANA E ENGLE 210 NORTH MAIN STREET LONDON OH 43140 280687 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 0 280687 0 0 0 0 0 280687 0 0 0 0 0 0 0 0 0 0 824527 0 824527 0 -543840 0 214057 0 57897 0 156160 NONE FORMALLY ADOPTED. 0 0 671458 280687 MADISON HEALTH'S PHYSICIAN PRACTICE THAT PROVIDES HEALTHCARE CHOICES. 671458 1 0 0 0 0 0 0 0 0 0 0 0 0 1 0 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 1 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 (ENTERED 01/2014) 1.00 6.00 X 0 14000 0 DANA E ENGLE CEO/PRESIDENT 1.00 44.00 X X 0 251646 39987 MICHAEL S BROWNING CFO, VP, SECRETARY, TREASUER 1.00 44.00 X X 0 221637 14343 0 487283 54330 0 0 1 0 0 PATIENT REVENUE 900099 280687 280687 280687 280687 280687 0 0 X 146181 1493 144688 363830 357292 6538 11308 9708 1600 132 132 309 309 4339 4208 131 SHARED SERVICES 195066 195066 MEDICAL SUPPLIES & DRUG 84579 84579 MINOR EQUIPMENT 17000 17000 DUES 1783 1671 112 824527 671458 153069 0 0 29816 0 120927 0 7986 0 55328 0 214057 0 57897 0 57897 X 0 156160 0 156160 0 214057 X -543840 700000 X X 0 1 X 1 0 X X 1 MADISON COUNTY COMMUNITY HOSPITAL 311657206 501(C)(3) 1 0 671458 1 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. 0 DUE FROM AFFILIATE 55328 55328 X 280687 0 280687 0 280687 824527 0 824527 0 824527 PART X, LINE 2: 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, 2014 AND 2013 RELATED TO UNCERTAIN TAX POSITIONS. THE HOSPITAL IS NO LONGER SUBJECT TO U.S. FEDERAL OR STATE TAX EXAMINATIONS FOR YEARS PRIOR TO 2011. 0 0 0 0 0 0 0 0 0 DANA E ENGLE CEO/PRESIDENT 0 241680 0 0 0 9966 0 0 0 39987 0 291633 0 0 MICHAEL S BROWNING CFO, VP, SECRETARY, TREASUER 0 220733 0 0 0 904 0 10698 0 3645 0 235980 0 0 FORM 990, PART VI NOT APPLICABLE 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 64,669. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 64,669. PHYSICIAN SALARY: PROGRAM SERVICE EXPENSES 196,826. MANAGEMENT AND GENERAL EXPENSES 6,538. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 203,364. PHYSICIAN FORGIVENESS: PROGRAM SERVICE EXPENSES 14,631. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 14,631. PURCHASED SERVICES: PROGRAM SERVICE EXPENSES 81,166. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 81,166. FORM 990, PART XI, LINE 9: NET ASSET TRANSFER FROM MFHC 700,000. FORM 990, PART XII, QUESTION 2 C, OVERSIGHT OF FINANCIAL STATEMENT AUDIT: MADISON FAMILY HEALTH CORPORATION'S FINANCIAL STATEMENTS ARE AUDITED BY AN INDEPENDENT ACCOUNTING FIRM. IN ADDITION, THE ORGANIZATION HAS A JOINT COMMITTEE WITH MADISON COUNTY COMMUNITY HOSPITAL (MCCH) THAT ASSUMES THE RESPONSIBILITY FOR THE OVERSIGHT OF THE AUDIT OF ITS FINANCIAL STATEMENTS AND ITS SELECTION OF ITS INDEPENDENT ACCOUNTANT. THIS PROCESS HAS NOT CHANGED FROM THE PRIOR YEAR. FORM 990, PART VI, SECTION B, LINE 12: THE ORGANIZATION DOES NOT HAVE ITS OWN CONFLICT OF INTEREST POLICY BUT FOLLOWS THAT OF MADISON COUNTY COMMUNITY HOSPITAL (MCCH). ANNUALLY, THE CEO, CFO, ALL BOARD MEMBERS AND DEPARTMENT MANAGERS RECEIVE A COPY OF MCCH'S CONFLICT OF INTEREST POLICY. IN ADDITION, THEY ARE ASKED TO COMPLETE AND RETURN THE CONFLICT OF INTEREST AGREEMENT AND ANNUAL DISCLOSURE STATEMENT TO MCCH'S ADMINISTRATIVE OFFICE. THE CONFLICT OF INTEREST STATEMENTS ARE REVIEWED AND RETAINED ON FILE. ANY INTERESTS DISCLOSED ARE DEALTH 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 COUNTY COMMUNITY HOSPITAL. FORM 990, PART VI, SECTION B, LINES 13 & 14, POLICY ADOPTION: THE ORGANIZATION HAS NOT ADOPTED A WHISTLEBLOWER OR DOCUMENT RETENTION AND DESTRUCTION POLICY BUT THE ORGANIZATION DOES FOLLOW THE WHISTLEBLOWER AND DOCUMENT RETENTION AND DESTRUCTION POLICY OF MADISON COUNTY COMMUNITY HOSPITAL. FORM 990, PART VI, SECTION B, LINE 15: THE ORGANIZATION DOES NOT HAVE EMPLOYEES, BUT RATHER, ITS OFFICERS ARE EMPLOYEES OF MADISON COUNTY COMMUNITY HOSPITAL, 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. 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 0 0 0 0 0 0