2015-03-06T11:25:26-06:00 2014-06-30 450250958 EIDE BAILLY LLP 200 EAST 10TH ST PO BOX 5125 SIOUX FALLS SD 571175125 990 2013-07-01 460228038 MADISON COMMUNITY HOSPITAL MADI 6052566551 917 N WASHINGTON AVE MADISON SD 57042 TAMARA MILLER CEO 6052566551 2015-02-26 1 LAURIE HANSON P00851848 6053391999 2015-02-26 2013 2016-03-07 17:11:31Z TAMARA MILLER 917 N WASHINGTON AVE MADISON SD 57042 15898914 0 X WWW.MADISONHOSPITAL.COM X 1955 SD PROVIDE HEALTH CARE SERVICES TO AREA RESIDENTS. 11 11 178 11 0 0 1124816 304706 14858672 15539255 29465 54453 950 500 16013903 15898914 0 0 0 0 7646479 8150890 0 0 0 6115345 6621296 13761824 14772186 2252079 1126728 14832248 27510135 1441199 12992358 13391049 14517777 X MADISON 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. 0 0 12681021 15563370 MADISON COMMUNITY HOSPITAL (HOSPITAL) IS A 25-BED ACUTE CARE HOSPITAL LOCATED IN MADISON, SOUTH DAKOTA. FOR THE YEAR ENDED JUNE 30, 2014: ACUTE PATIENT DAYS = 908; NEWBORN DAYS = 22; SKILLED DAYS = 1,504; AND INTERMEDIATE DAYS = 71. 12681021 1 1 0 0 0 0 0 0 0 0 1 0 0 0 0 1 0 1 0 0 0 0 0 0 0 0 1 1 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 0 0 1 14 0 1 178 1 0 0 0 0 0 0 0 0 0 0 X 11 11 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 0 0 X MRS TAMARA MILLER 6052566551 917 N WASHINGTON AVE MADISON SD 57042 BRAD WILKENS PRESIDENT 1.00 1.00 X X 0 0 0 GREG HOLLISTER VICE PRESIDENT 1.00 0.00 X X 0 0 0 LOIS NIEDERT SECRETARY 1.00 0.00 X X 0 0 0 CHRIS LEMAIR TREASURER 1.00 0.00 X X 0 0 0 DAN BROWN TRUSTEE 1.00 0.00 X 0 0 0 PEGGY CASANOVA TRUSTEE 1.00 0.00 X 0 0 0 ROBIN SCHWEBACH TRUSTEE 1.00 1.00 X 0 0 0 LELAND WHITE TRUSTEE 1.00 1.00 X 0 0 0 ABBY OFTEDAL TRUSTEE 1.00 0.00 X 0 0 0 CINDY CALLIES TRUSTEE 1.00 1.00 X 0 0 0 KEVIN HOFF TRUSTEE 1.00 0.00 X 0 0 0 TAMARA MILLER CEO 40.00 1.00 X 152887 0 28743 ROBERT SUMMERER SURGEON 40.00 0.00 X 397342 0 31068 DARREL SIMON CRNA 40.00 1.00 X 202272 0 10297 RONALD JORGENSEN DIRECTOR OF PURCHASING/AMBULANCE 40.00 0.00 X 113216 0 14055 IAN ALVERSON DIRECTOR OF PHARMACY 40.00 0.00 X 102773 0 8952 968490 0 93115 5 0 1 0 INTERLAKES MEDICAL CENTER 903 N WASHINGTON AVE MADISON SD 57042 ER CALL COVERAGE 380588 UNIVERSAL HOSPTIAL SERVICES 7505 S LOUISE AVE SIOUX FALLS SD 57108 BIO-MED CONTRACT 328340 NORTHLAND FAMILY PRACTICE 220 NE 9TH ST MADISON SD 57042 ER CALL COVERAGE & CONTRACTED PHYSICIANS 253009 HEALTHCARE CAPITOL 14066 MAHOGANY AVE JACKSONVILLE FL 32258 FINANCIAL CONSULTING 190000 AVERA MCKENNAN HOSPITAL 1325 S CLIFF AVE SIOUX FALLS SD 57117 PURCHASED SERVICES 176246 10 265152 39554 304706 PATIENT SERVICE REVENUE 621300 15354266 15354266 MEALS 624210 102494 102494 MCMC REVENUE 621110 93184 93184 MISCELLANEOUS 900009 13426 13426 LOSS ON SUBSIDIARY 900009 -24115 -24115 15539255 39414 39414 500 0 500 500 500 15039 0 15039 15039 15039 15898914 15563870 0 30338 194483 194483 6295194 5654690 640504 270976 244364 26612 875836 770368 105468 514401 446761 67640 1180874 713298 467576 137346 137346 599415 474796 124619 145379 145379 35138 34844 294 56481 37672 18809 568196 568196 241085 241085 MEDICAL SUPPLIES 2328553 2328553 BAD DEBTS 826915 826915 MAINTENANCE AND REPAIRS 379936 379936 DUES AND SUBSCRIPTIONS 24183 24183 97795 55249 42546 14772186 12681021 2091165 0 6120228 10695130 2021494 1784828 161653 181736 354830 349888 152034 397876 22268096 8208734 5956581 14059362 65428 41315 14832248 27510135 1380678 2934244 60521 58114 10000000 1441199 12992358 X 13190873 14400535 200176 117242 13391049 14517777 14832248 27510135 1126728 0 X X 0 1 X 1 1 1 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 4661529 3111925 1549604 6372166 4909251 1462915 11234401 187558 11046843 14059362 X PART X, LINE 2: THE HOSPITAL IS A SOUTH DAKOTA NONPROFIT CORPORATION AND HAS BEEN RECOGNIZED BY THE INTERNAL REVENUE SERVICE (IRS) AS EXEMPT FROM FEDERAL INCOME TAXES UNDER INTERNAL REVENUE CODE SECTION 501(C)(3). THE FOUNDATION IS ORGANIZED AS A TAX EXEMPT ORGANIZATION UNDER THE SAME INTERNAL REVENUE CODE AND IS IN THE PROCESS OF OBTAINING ITS TAX EXEMPTION. 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 2011. 1 1 X 1 X 1 X 1 1 1 0 0 120000 120000 0.00810 458374 385084 73290 0.00500 578374 385084 193290 0.01310 10760 10760 0.00070 2866477 2111844 754633 0.05110 2877237 2111844 765393 0.05180 3455611 2496928 958683 0.06490 0 826915 116595 5767062 5799508 -32446 X 1 1 1 1 MADISON COMMUNITY HOSPITAL 917 N WASHINGTON AVENUE MADISON SD 57042 49870 X X X MADISON COMMUNITY HOSPITAL 1 1 X X X X X X X X X 12 1 0 1 X WWW.MADISONHOSPITAL.COM/NEEDS-ASSESSMENT. X X X X X 1 0 1 1 150.000000000000 1 400.000000000000 1 X X X X X 1 1 X 1 0 X X X 1 X 0 0 MADISON COMMUNITY HOSPITAL PART V, SECTION B, LINE 3: 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 HOSPITAL PART V, SECTION B, LINE 6I: THE IMPLEMENTATION STRATEGY BEGINS ON PAGE 5 OF OUR COMMUNITY HEALTH NEEDS ASSESSMENT. IT IS AVAILABLE UPON REQUEST AND THROUGH THE LINK ON OUR WEBPAGE AT 5A, ABOVE. MADISON COMMUNITY HOSPITAL PART V, SECTION B, LINE 12I: HOUSEHOLD SIZE MADISON COMMUNITY HOSPITAL PART V, SECTION B, LINE 14G: PLEASE REFER TO THE NARRATIVE FOR SCHEDULE H PART VI LINE 3. 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 MEDICARE COST REPORT. 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 $826,915 WAS SUBTRACTED FROM TOTAL OPERATING EXPENSE. PART III, LINE 4: A) 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.B) THE HOSPITAL APPLIED THE 2014 POVERTY LEVEL PERCENTAGE FOR ITS AREA TO THE TOTAL AMOUNT SENT TO COLLECTIONS DURING THE FISCAL YEAR ENDED JUNE 30, 2014 TO DETERMINE AN ESTIMATE OF ELIGIBLE CHARITY CARE REPORTED AS BAD DEBT. C) 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 6/30/2014.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: A COMMUNITY HEALTH NEEDS ASSESSMENT AND A DEMOGRAPHIC AND SERVICE LINE ANALYSIS TO DETERMINE COMMUNITY HEALTHCARE NEEDS WERE COMPLETED DURING THE PRIOR YEAR. 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 WAS CALCULATED AT 19,625 IN 2010. ESTIMATED MEDIAN HOUSEHOLD INCOME IN 2013: $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. X X 0 0 0 0 0 0 0 0 0 TAMARA MILLER CEO 152887 0 0 0 0 0 8190 0 20554 0 181631 0 0 0 ROBERT SUMMERER SURGEON 397342 0 0 0 0 0 12750 0 18318 0 428410 0 0 0 DARREL SIMON CRNA 202272 0 0 0 0 0 10101 0 196 0 212569 0 0 0 FORM 990, PART VI, SECTION A, LINE 1 THE 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 11 THE 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 12C ALL 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 15A THE 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 19 THESE DOCUMENTS ARE AVAILABLE TO THE GENERAL PUBLIC UPON REQUEST. PART XII, LINE 2C EXPLANATION THE ENTIRE BOARD OF DIRECTORS IS RESPONSIBLE FOR THE SELECTION AND OVERSIGHT OF THE INDEPENDENT PUBLIC ACCOUNTANT. MADISON COMMUNITY HOSPITAL FOUNDATION INC 917 N WASHINGTON AVE MADISON SD 57042 463925885 SUPPORT SD 501(C)(3) LINE 11A, I MADISON COMMUNITY HOSPITAL 0 MADISON COMMUNITY MEDICAL CENTER 917 N WASHINGTON AVENUE MADISON SD 57045 460398320 OFFICE RENTAL SD MADISON COMMUNITY HOSPITAL C -24113 238389 1.00000 1 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 1 0 1 0 MADISON COMMUNITY MEDICAL CENTER P 93184 FMV