MADISON COMMUNITY HOSPITAL: Form 990, tax year 2012
View the entire original 990 at ProPublica ↗
- Organization
- MADISON COMMUNITY HOSPITAL (EIN 46-0228038)
- Tax period
- 2012-07-01 to 2013-06-30
- Filed
- 2014-01-28
- IRS object ID
- 201410289349300411
- Schema version
- 2012v2.1
- 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
| Field | Value | IRS element (for citing) |
|---|---|---|
| Timestamp | 2014-01-28T10:09:49-06:00 | Timestamp |
| Tax Period End Date | 2013-06-30 | TaxPeriodEndDate |
Preparer Firm PreparerFirm
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 450250958 | EIN |
Preparer Firm Business Name PreparerFirmBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | EIDE BAILLY LLP | BusinessNameLine1 |
Preparer Firm US Address PreparerFirmUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 200 EAST 10TH ST PO BOX 5125 | AddressLine1 |
| City | SIOUX FALLS | City |
| State | SD | State |
| ZIP Code | 571175125 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnType |
| Tax Period Begin Date | 2012-07-01 | TaxPeriodBeginDate |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 460228038 | EIN |
Name Name
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | MADISON COMMUNITY HOSPITAL | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Control | MADI | NameControl |
| Phone | 6052566551 | Phone |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 917 N WASHINGTON AVE | AddressLine1 |
| City | MADISON | City |
| State | SD | State |
| ZIP Code | 57042 | ZIPCode |
Officer Officer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | TAMARA MILLER | Name |
| Title | CEO | Title |
| Phone | 6052566551 | Phone |
| Date Signed | 2014-01-27 | DateSigned |
| Authorize Third Party | 1 | AuthorizeThirdParty |
Preparer Preparer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | LAURIE HANSON | Name |
| PTIN | P00851848 | PTIN |
| Phone | 6053391999 | Phone |
| Date Prepared | 2014-01-27 | DatePrepared |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax Year | 2012 | TaxYear |
| Build TS | 2015-11-30 17:44:51Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Of Principal Officer Person | TAMARA MILLER | NameOfPrincipalOfficerPerson |
Address Principal Officer US AddressPrincipalOfficerUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 917 N WASHINGTON AVE | AddressLine1 |
| City | MADISON | City |
| State | SD | State |
| ZIP Code | 57042 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | 16042561 | GrossReceipts |
| Group Return For Affiliates | 0 | GroupReturnForAffiliates |
| Organization501c3 | X | Organization501c3 |
| Web Site | WWW.MADISONHOSPITAL.COM | WebSite |
| Type Of Organization Corporation | X | TypeOfOrganizationCorporation |
| Year Formation | 1955 | YearFormation |
| State Legal Domicile | SD | StateLegalDomicile |
| Activity Or Mission Description | PROVIDE HEALTH CARE SERVICES TO AREA RESIDENTS. | ActivityOrMissionDescription |
| Nbr Voting Members Governing Body | 11 | NbrVotingMembersGoverningBody |
| Nbr Independent Voting Members | 11 | NbrIndependentVotingMembers |
| Total Nbr Employees | 176 | TotalNbrEmployees |
| Total Nbr Volunteers | 11 | TotalNbrVolunteers |
| Total Gross UBI | 0 | TotalGrossUBI |
| Net Unrelated Business Txbl Income | 0 | NetUnrelatedBusinessTxblIncome |
| Contributions Grants Prior Year | 161177 | ContributionsGrantsPriorYear |
| Contributions Grants Current Year | 1124816 | ContributionsGrantsCurrentYear |
| Program Service Revenue Prior Year | 13986864 | ProgramServiceRevenuePriorYear |
| Program Service Revenue CY | 14858672 | ProgramServiceRevenueCY |
| Investment Income Prior Year | 48799 | InvestmentIncomePriorYear |
| Investment Income Current Year | 29465 | InvestmentIncomeCurrentYear |
| Other Revenue Prior Year | 4425 | OtherRevenuePriorYear |
| Other Revenue Current Year | 950 | OtherRevenueCurrentYear |
| Total Revenue Prior Year | 14201265 | TotalRevenuePriorYear |
| Total Revenue Current Year | 16013903 | TotalRevenueCurrentYear |
| Grants And Similar Amnts Prior Year | 0 | GrantsAndSimilarAmntsPriorYear |
| Grants And Similar Amnts CY | 0 | GrantsAndSimilarAmntsCY |
| Benefits Paid To Members Prior Year | 0 | BenefitsPaidToMembersPriorYear |
| Benefits Paid To Members CY | 0 | BenefitsPaidToMembersCY |
| Salaries Etc Prior Year | 7192505 | SalariesEtcPriorYear |
| Salaries Etc Current Year | 7646479 | SalariesEtcCurrentYear |
| Total Prof Fundrsng Exp Prior Year | 0 | TotalProfFundrsngExpPriorYear |
| Total Prof Fundrsng Exp CY | 0 | TotalProfFundrsngExpCY |
| Total Fundrsng Exp Current Year | 0 | TotalFundrsngExpCurrentYear |
| Other Expense Prior Year | 5682834 | OtherExpensePriorYear |
| Other Expenses Current Year | 6115345 | OtherExpensesCurrentYear |
| Total Expenses Prior Year | 12875339 | TotalExpensesPriorYear |
| Total Expenses Current Year | 13761824 | TotalExpensesCurrentYear |
| Revenues Less Expenses Prior Year | 1325926 | RevenuesLessExpensesPriorYear |
| Revenues Less Expenses CY | 2252079 | RevenuesLessExpensesCY |
| Total Assets BOY | 12398488 | TotalAssetsBOY |
| Total Assets EOY | 14832248 | TotalAssetsEOY |
| Total Liabilities BOY | 1231475 | TotalLiabilitiesBOY |
| Total Liabilities EOY | 1441199 | TotalLiabilitiesEOY |
| Net Assets Or Fund Balances BOY | 11167013 | NetAssetsOrFundBalancesBOY |
| Net Assets Or Fund Balances EOY | 13391049 | NetAssetsOrFundBalancesEOY |
| Info In Schedule O Part III | X | InfoInScheduleOPartIII |
| Mission Description | 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. | MissionDescription |
| Significant New Program Services | 0 | SignificantNewProgramServices |
| Significant Change | 0 | SignificantChange |
| Expense | 12013129 | Expense |
| Revenue | 14719323 | Revenue |
| Description | MADISON COMMUNITY HOSPITAL (HOSPITAL) IS A 25-BED ACUTE CARE HOSPITAL LOCATED IN MADISON, SOUTH DAKOTA. FOR THE YEAR ENDED JUNE 30, 2013: ACUTE PATIENT DAYS = 1,132; NEWBORN DAYS = 75; SKILLED DAYS = 1,488; AND INTERMEDIATE DAYS = 27. | Description |
| Total Program Service Expense | 12013129 | TotalProgramServiceExpense |
| Described In501 C3 | 1 | DescribedIn501C3 |
| Schedule B Required | 1 | ScheduleBRequired |
| Political Activities | 0 | PoliticalActivities |
| Lobbying Activities | 0 | LobbyingActivities |
| Subject To Proxy Tax | 0 | SubjectToProxyTax |
| Donor Advised Funds | 0 | DonorAdvisedFunds |
| Conservation Easements | 0 | ConservationEasements |
| Collections Of Art | 0 | CollectionsOfArt |
| Credit Counseling | 0 | CreditCounseling |
| Term Or Permanent Endowments | 0 | TermOrPermanentEndowments |
| Report Land Bldg Equip | 1 | ReportLandBldgEquip |
| Report Invest Oth Securities | 0 | ReportInvestOthSecurities |
| Report Prog Rel Invest | 0 | ReportProgRelInvest |
| Report Other Assets | 0 | ReportOtherAssets |
| Report Other Liabilities | 0 | ReportOtherLiabilities |
| Report Fin48 Footnote | 1 | ReportFin48Footnote |
| Independent Audit Financial Stmt | 0 | IndependentAuditFinancialStmt |
| Consolidated Audit Financial Stmt | 1 | ConsolidatedAuditFinancialStmt |
| School | 0 | School |
| Foreign Office | 0 | ForeignOffice |
| Foreign Activities | 0 | ForeignActivities |
| More Than5000 K To Organizations | 0 | MoreThan5000KToOrganizations |
| More Than5000 K To Individuals | 0 | MoreThan5000KToIndividuals |
| Professional Fundraising | 0 | ProfessionalFundraising |
| Fundraising Activities | 0 | FundraisingActivities |
| Gaming | 0 | Gaming |
| Hospital | 1 | Hospital |
| Financial Stmt Attached | 1 | FinancialStmtAttached |
| Grants To Organizations | 0 | GrantsToOrganizations |
| Grants To Individuals | 0 | GrantsToIndividuals |
| Schedule J Required | 1 | ScheduleJRequired |
| Tax Exempt Bonds | 0 | TaxExemptBonds |
| Excess Benefit Transaction | 0 | ExcessBenefitTransaction |
| Prior Excess Benefit Transaction | 0 | PriorExcessBenefitTransaction |
| Loan To Officer Or DQP | 0 | LoanToOfficerOrDQP |
| Grant To Related Person | 0 | GrantToRelatedPerson |
| Bsnss Rltnshp With Organization | 0 | BsnssRltnshpWithOrganization |
| Bsnss Rltnshp Thru Family Member | 0 | BsnssRltnshpThruFamilyMember |
| Officer Entity With Bsnss Rltnshp | 0 | OfficerEntityWithBsnssRltnshp |
| Deductible Non Cash Contributions | 0 | DeductibleNonCashContributions |
| Deductible Contributions Of Art | 0 | DeductibleContributionsOfArt |
| Terminated | 0 | Terminated |
| Partial Liquidation | 0 | PartialLiquidation |
| Disregarded Entity | 0 | DisregardedEntity |
| Related Entity | 1 | RelatedEntity |
| Related Org Controlled Entity | 1 | RelatedOrgControlledEntity |
| Transaction Related Entity | 1 | TransactionRelatedEntity |
| Transfers To Exempt Non Chrtbl Org | 0 | TransfersToExemptNonChrtblOrg |
| Activities Conducted Partnership | 0 | ActivitiesConductedPartnership |
| Schedule O Required | 1 | ScheduleORequired |
| Number Forms Transmitted With1096 | 24 | NumberFormsTransmittedWith1096 |
| Number W2 G Included | 0 | NumberW2GIncluded |
| Compliance With Backup Witholding | 1 | ComplianceWithBackupWitholding |
| Number Of Employees | 176 | NumberOfEmployees |
| Employment Tax Returns Filed | 1 | EmploymentTaxReturnsFiled |
| Unrelated Business Income | 0 | UnrelatedBusinessIncome |
| Foreign Financial Account | 0 | ForeignFinancialAccount |
| Prohibited Tax Shelter Trans | 0 | ProhibitedTaxShelterTrans |
| Taxable Party Notification | 0 | TaxablePartyNotification |
| Non Deductible Contributions | 0 | NonDeductibleContributions |
| Quid Pro Quo Contributions | 0 | QuidProQuoContributions |
| Form8282 Property Disposed Of | 0 | Form8282PropertyDisposedOf |
| Funds To Pay Premiums | 0 | FundsToPayPremiums |
| Premiums Paid | 0 | PremiumsPaid |
| Indoor Tanning Services | 0 | IndoorTanningServices |
| Info In Schedule O Part VI | X | InfoInScheduleOPartVI |
| Nbr Voting Governing Body Members | 11 | NbrVotingGoverningBodyMembers |
| Number Independent Voting Members | 11 | NumberIndependentVotingMembers |
| Family Or Business Relationship | 0 | FamilyOrBusinessRelationship |
| Delegation Of Management Duties | 0 | DelegationOfManagementDuties |
| Changes To Organizing Docs | 0 | ChangesToOrganizingDocs |
| Material Diversion Or Misuse | 0 | MaterialDiversionOrMisuse |
| Members Or Stockholders | 0 | MembersOrStockholders |
| Election Of Board Members | 0 | ElectionOfBoardMembers |
| Decisions Subject To Approval | 0 | DecisionsSubjectToApproval |
| Minutes Of Governing Body | 1 | MinutesOfGoverningBody |
| Minutes Of Committees | 1 | MinutesOfCommittees |
| Officer Mailing Address | 0 | OfficerMailingAddress |
| Local Chapters | 0 | LocalChapters |
| Form990 Provided To Governing Body | 1 | Form990ProvidedToGoverningBody |
| Conflict Of Interest Policy | 1 | ConflictOfInterestPolicy |
| Annual Disclosure Covered Persons | 1 | AnnualDisclosureCoveredPersons |
| Regular Monitoring Enforcement | 1 | RegularMonitoringEnforcement |
| Whistleblower Policy | 1 | WhistleblowerPolicy |
| Document Retention Policy | 1 | DocumentRetentionPolicy |
| Compensation Process CEO | 1 | CompensationProcessCEO |
| Compensation Process Other | 0 | CompensationProcessOther |
| Investment In Joint Venture | 0 | InvestmentInJointVenture |
| Upon Request | X | UponRequest |
The Books Are In Care Of TheBooksAreInCareOf
Name Business NameBusiness
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | MRS TAMARA MILLER | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Telephone Number | 6052566551 | TelephoneNumber |
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 917 N WASHINGTON AVE | AddressLine1 |
| City | MADISON | City |
| State | SD | State |
| ZIP Code | 57042 | ZIPCode |
Form990 Part VII Section A Form990PartVIISectionA (15 entries)
| TitleTitle | Average Hours Per WeekAverageHoursPerWeek | Individual Trustee Or DirectorIndividualTrusteeOrDirector | OfficerOfficer | Reportable Comp From OrganizationReportableCompFromOrganization | Reportable Comp From Related OrgsReportableCompFromRelatedOrgs | Other CompensationOtherCompensation | Highest Compensated EmployeeHighestCompensatedEmployee |
|---|---|---|---|---|---|---|---|
| BRAD WILKENS | |||||||
| PRESIDENT | 1.00 | X | X | 0 | 0 | 0 | |
| GREG HOLLISTER | |||||||
| VICE PRESIDENT | 1.00 | X | X | 0 | 0 | 0 | |
| LOIS NIEDERT | |||||||
| SECRETARY | 1.00 | X | X | 0 | 0 | 0 | |
| CHRIS LEMAIR | |||||||
| TREASURER | 1.00 | X | X | 0 | 0 | 0 | |
| LOREN SCOTT | |||||||
| TREASURER THROUGH OCT 2012 | 1.00 | X | X | 0 | 0 | 0 | |
| DAN BROWN | |||||||
| TRUSTEE | 1.00 | X | 0 | 0 | 0 | ||
| PEGGY CASANOVA | |||||||
| TRUSTEE | 1.00 | X | 0 | 0 | 0 | ||
| ROBIN SCHWEBACH | |||||||
| TRUSTEE | 1.00 | X | 0 | 0 | 0 | ||
| LELAND WHITE | |||||||
| TRUSTEE | 1.00 | X | 0 | 0 | 0 | ||
| ABBY OFTEDAL | |||||||
| TRUSTEE | 1.00 | X | 0 | 0 | 0 | ||
| CINDY CALLIES | |||||||
| TRUSTEE | 1.00 | X | 0 | 0 | 0 | ||
| KEVIN HOFF | |||||||
| TRUSTEE | 1.00 | X | 0 | 0 | 0 | ||
| TAMARA MILLER | |||||||
| CEO | 40.00 | X | 0 | 139774 | 29902 | ||
| ROBERT SUMMERER | |||||||
| SURGEON | 40.00 | 0 | 379552 | 46325 | X | ||
| DARREL SIMON | |||||||
| CRNA | 40.00 | 0 | 195415 | 32071 | X | ||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | 0 | TotalReportableCompFromOrg |
| Total Reportable Comp Frm Rltd Orgs | 714741 | TotalReportableCompFrmRltdOrgs |
| Total Other Compensation | 108298 | TotalOtherCompensation |
| Number Individuals GT100 K | 0 | NumberIndividualsGT100K |
| Formers Listed | 0 | FormersListed |
| Total Comp GT150 K | 1 | TotalCompGT150K |
| Compensation From Other Sources | 0 | CompensationFromOtherSources |
Contractor Compensation ContractorCompensation (5 entries)
| Address Line1AddressOfContractor/AddressUS/AddressLine1 | CityAddressOfContractor/AddressUS/City | StateAddressOfContractor/AddressUS/State | ZIP CodeAddressOfContractor/AddressUS/ZIPCode | Description Of ServicesDescriptionOfServices | CompensationCompensation |
|---|---|---|---|---|---|
| TSP | |||||
| 112 N WEST AVE | SIOUX FALLS | SD | 57104 | ARCHITECT SERVICES | 1470019 |
| UNIVERSAL HOSPTIAL SERVICES | |||||
| 7505 S LOUISE AVE | SIOUX FALLS | SD | 57108 | BIO-MED CONTRACT | 299535 |
| INTERLAKES MEDICAL CENTER | |||||
| 903 N WASHINGTON AVE | MADISON | SD | 57042 | ER CALL COVERAGE | 263862 |
| NORTHLAND FAMILY PRACTICE | |||||
| 220 NE 9TH ST | MADISON | SD | 57042 | ER CALL COVERAGE & CONTRACTED PHYSICIANS | 222069 |
| AVERA MCKENNAN HOSPITAL | |||||
| 1325 S CLIFF AVE | SIOUX FALLS | SD | 57117 | PURCHASED SERVICES | 153110 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Contractors GT100 K | 7 | NumberOfContractorsGT100K |
| Government Grants | 453376 | GovernmentGrants |
| All Other Contributions | 671440 | AllOtherContributions |
| Total Contributions | 1124816 | TotalContributions |
Program Service Revenue ProgramServiceRevenue (4 entries)
| DescriptionDescription | Business CodeBusinessCode | Total Revenue ColumnTotalRevenueColumn | Related Or Exempt Function IncomeRelatedOrExemptFunctionIncome | ExclusionExclusionAmount |
|---|---|---|---|---|
| PATIENT SERVICE REVENUE | 900099 | 14663727 | 14663727 | |
| MEALS | 624210 | 95511 | $95,511 | |
| MCMC REVENUE | 621110 | 83304 | 83304 | |
| MISCELLANEOUS | 900099 | 16130 | $16,130 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | 14858672 | TotalProgramServiceRevenue |
Investment Income InvestmentIncome
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 58123 | TotalRevenueColumn |
| Exclusion | $58,123 | ExclusionAmount |
Gross Rents GrossRents
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | 950 | Real |
Less Rental Expenses LessRentalExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | 0 | Real |
Rental Income Or Loss RentalIncomeOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | 950 | Real |
Net Rental Income Or Loss NetRentalIncomeOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 950 | TotalRevenueColumn |
| Exclusion | $950 | ExclusionAmount |
Less Cost Oth Basis Sales Expenses LessCostOthBasisSalesExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | 28658 | Other |
Gain Or Loss GainOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | -28658 | Other |
Net Gain Or Loss Investments NetGainOrLossInvestments
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | -28658 | TotalRevenueColumn |
| Exclusion | -$28,658 | ExclusionAmount |
Total Revenue TotalRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 16013903 | TotalRevenueColumn |
| Related Or Exempt Function Income | 14747031 | RelatedOrExemptFunctionIncome |
| Unrelated Business Revenue | 0 | UnrelatedBusinessRevenue |
| Exclusion | $142,056 | ExclusionAmount |
Comp Current Officers Directors CompCurrentOfficersDirectors
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 170606 | Total |
| Management And General | 170606 | ManagementAndGeneral |
Other Salaries And Wages OtherSalariesAndWages
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 5904401 | Total |
| Program Services | 5358699 | ProgramServices |
| Management And General | 545702 | ManagementAndGeneral |
Pension Plan Contributions PensionPlanContributions
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 249710 | Total |
| Program Services | 228241 | ProgramServices |
| Management And General | 21469 | ManagementAndGeneral |
Other Employee Benefits OtherEmployeeBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 821080 | Total |
| Program Services | 729448 | ProgramServices |
| Management And General | 91632 | ManagementAndGeneral |
Payroll Taxes PayrollTaxes
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 500682 | Total |
| Program Services | 443899 | ProgramServices |
| Management And General | 56783 | ManagementAndGeneral |
Fees For Services Other FeesForServicesOther
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 836640 | Total |
| Program Services | 496911 | ProgramServices |
| Management And General | 339729 | ManagementAndGeneral |
Advertising Advertising
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 119793 | Total |
| Management And General | 119793 | ManagementAndGeneral |
Office Expenses OfficeExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 555318 | Total |
| Program Services | 435121 | ProgramServices |
| Management And General | 120197 | ManagementAndGeneral |
Occupancy Occupancy
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 132221 | Total |
| Program Services | 132221 | ProgramServices |
Travel Travel
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 38552 | Total |
| Program Services | 37443 | ProgramServices |
| Management And General | 1109 | ManagementAndGeneral |
Conferences Meetings ConferencesMeetings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 53702 | Total |
| Program Services | 37293 | ProgramServices |
| Management And General | 16409 | ManagementAndGeneral |
Depreciation Depletion DepreciationDepletion
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 595303 | Total |
| Program Services | 595303 | ProgramServices |
Insurance Insurance
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 180414 | Total |
| Management And General | 180414 | ManagementAndGeneral |
Other Expenses OtherExpenses (4 entries)
| DescriptionDescription | TotalTotal | Program ServicesProgramServices | Management And GeneralManagementAndGeneral |
|---|---|---|---|
| MEDICAL SUPPLIES | 2120438 | 2120438 | |
| BAD DEBTS | 899852 | 899852 | |
| MAINTENANCE AND REPAIRS | 335924 | 335924 | |
| DUES AND SUBSCRIPTIONS | 24241 | 24241 |
All Other Expenses AllOtherExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 222947 | Total |
| Program Services | 162336 | ProgramServices |
| Management And General | 60611 | ManagementAndGeneral |
Total Functional Expenses TotalFunctionalExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 13761824 | Total |
| Program Services | 12013129 | ProgramServices |
| Management And General | 1748695 | ManagementAndGeneral |
| Fundraising | 0 | Fundraising |
Savings And Temp Cash Investments SavingsAndTempCashInvestments
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 6126796 | BOY |
| EOY | 6120228 | EOY |
Accounts Receivable AccountsReceivable
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1961772 | BOY |
| EOY | 2021494 | EOY |
Other Notes Loans Receivable Net OtherNotesLoansReceivableNet
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 142082 | BOY |
| EOY | 161653 | EOY |
Inventories For Sale Or Use InventoriesForSaleOrUse
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 343487 | BOY |
| EOY | 354830 | EOY |
Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 239290 | BOY |
| EOY | 152034 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Buildings Equipment Basis | 14229799 | LandBuildingsEquipmentBasis |
| Land Bldg Equipment Accum Deprec | 8273218 | LandBldgEquipmentAccumDeprec |
Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 3491590 | BOY |
| EOY | 5956581 | EOY |
Other Assets Total OtherAssetsTotal
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 93471 | BOY |
| EOY | 65428 | EOY |
Total Assets TotalAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 12398488 | BOY |
| EOY | 14832248 | EOY |
Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 816288 | BOY |
| EOY | 1380678 | EOY |
Deferred Revenue DeferredRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 415187 | BOY |
| EOY | 60521 | EOY |
Total Liabilities TotalLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1231475 | BOY |
| EOY | 1441199 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Follow SFAS117 | X | FollowSFAS117 |
Unrestricted Net Assets UnrestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 11091402 | BOY |
| EOY | 13190873 | EOY |
Temporarily Restricted Net Assets TemporarilyRestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 75611 | BOY |
| EOY | 200176 | EOY |
Total Net Assets Fund Balances TotalNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 11167013 | BOY |
| EOY | 13391049 | EOY |
Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 12398488 | BOY |
| EOY | 14832248 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part XI | X | InfoInScheduleOPartXI |
| Reconcilation Revenue Expenses | 2252079 | ReconcilationRevenueExpenses |
| Reconcilation Other Changes | -28043 | ReconcilationOtherChanges |
| Method Of Accounting Accrual | X | MethodOfAccountingAccrual |
| Accountant Compile Or Review | 0 | AccountantCompileOrReview |
| FS Audited | 1 | FSAudited |
FS Audited Basis FSAuditedBasis
| Field | Value | IRS element (for citing) |
|---|---|---|
| Financial Statement Consolidated | X | FinancialStatementConsolidated |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Audit Committee | 0 | AuditCommittee |
| Federal Grant Audit Required | 0 | FederalGrantAuditRequired |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital170b1 Aiii | X | Hospital170b1Aiii |
Schedule B IRS990ScheduleB
Contributor Info ContributorInfo
| Field | Value | IRS element (for citing) |
|---|---|---|
| Contributor Number | RESTRICTED | ContributorNumber |
Contributor Name Business ContributorNameBusiness
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | RESTRICTED | BusinessNameLine1 |
Contributor Address US ContributorAddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | RESTRICTED | AddressLine1 |
| Address Line2 | RESTRICTED | AddressLine2 |
| City | RESTRICTED | City |
| State | RESTRICTED | State |
| ZIP Code | RESTRICTED | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Aggregate Contributions | RESTRICTED | AggregateContributions |
Schedule D IRS990ScheduleD
Buildings Buildings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 4663527 | OtherCostOrOtherBasis |
| Depreciation | 2978308 | Depreciation |
| Book Value | 1685219 | BookValue |
Equipment Equipment
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 6756204 | OtherCostOrOtherBasis |
| Depreciation | 5115727 | Depreciation |
| Book Value | 1640477 | BookValue |
Other Land Buildings OtherLandBuildings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 2810068 | OtherCostOrOtherBasis |
| Depreciation | 179183 | Depreciation |
| Book Value | 2630885 | BookValue |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Book Value Land Buildings | 5956581 | TotalOfBookValueLandBuildings |
| Footnote In Part XIII | X | FootnoteInPartXIII |
Form990 Schedule D Part XIII Form990ScheduleDPartXIII
| Field | Value | IRS element (for citing) |
|---|---|---|
| Identifier | DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: | Identifier |
| Return Reference | PART X, LINE 2: | ReturnReference |
| Explanation | THE HOSPITAL AND CENTER BELIEVE THAT THEY HAVE APPROPRIATE SUPPORT FOR ANY TAX POSITIONS TAKEN AFFECTING ITS ANNUAL FILING REQUIREMENTS, AND AS SUCH, DOES NOT HAVE ANY UNCERTAIN TAX POSITIONS THAT ARE MATERIAL TO THE CONSOLIDATED FINANCIAL STATEMENTS. THE HOSPITAL AND CLINIC 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. | Explanation |
Schedule H IRS990ScheduleH
| Field | Value | IRS element (for citing) |
|---|---|---|
| Charity Care Policy | 1 | CharityCarePolicy |
| Written Policy | 1 | WrittenPolicy |
| Policy Applied To All Hospitals | X | PolicyAppliedToAllHospitals |
| FPG Reference Free Care | 1 | FPGReferenceFreeCare |
| Pcent150 | X | Pcent150 |
| FPG Reference Discounted Care | 1 | FPGReferenceDiscountedCare |
| Pcent400 | X | Pcent400 |
| Free Disc Care Medically Indigent | 1 | FreeDiscCareMedicallyIndigent |
| Amounts Budgeted For Charity Care | 1 | AmountsBudgetedForCharityCare |
| Expenses Exceeded Budget | 1 | ExpensesExceededBudget |
| Unable To Provide Care | 0 | UnableToProvideCare |
| Annual Community Benefit Report | 0 | AnnualCommunityBenefitReport |
Charity Care At Cost CharityCareAtCost
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 104000 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 104000 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00760 | PercentOfTotalExpense |
Unreimbursed Medicaid UnreimbursedMedicaid
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 434234 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 387165 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 47069 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00340 | PercentOfTotalExpense |
Total Charity Care TotalCharityCare
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 538234 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 387165 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 151069 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.01100 | PercentOfTotalExpense |
Community Health Services CommunityHealthServices
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 3245 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 3245 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00020 | PercentOfTotalExpense |
Subsidized Health Services SubsidizedHealthServices
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 1363739 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 939789 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 423950 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.03080 | PercentOfTotalExpense |
Total Other Benefits TotalOtherBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 1366984 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 939789 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 427195 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.03100 | PercentOfTotalExpense |
Total Community Benefits TotalCommunityBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 1905218 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 1326954 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 578264 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.04200 | PercentOfTotalExpense |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | 0 | BadDebtExpenseReported |
| Bad Debt Expense | $899,852 | BadDebtExpenseAmount |
| Amount Attributable To | 108072 | AmountAttributableTo |
| Amount Reimbursed By Medicare | 5416095 | AmountReimbursedByMedicare |
| Cost Of Care Reimbursed By Medicare | 5362471 | CostOfCareReimbursedByMedicare |
| Medicare Surplus Or Shortfall | 53624 | MedicareSurplusOrShortfall |
Costing Methodology Used CostingMethodologyUsed
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | X | Other |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Written Debt Collection Policy | 1 | WrittenDebtCollectionPolicy |
| Provision For Charity Care | 1 | ProvisionForCharityCare |
| Number Of Hospital Facilities | 1 | NumberOfHospitalFacilities |
Form990 Schedule H Part V Section A Form990ScheduleHPartVSectionA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility Number | 1 | FacilityNumber |
Name Name
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | MADISON COMMUNITY HOSPITAL | BusinessNameLine1 |
Address Address
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 917 N WASHINGTON AVENUE | AddressLine1 |
| City | MADISON | City |
| State | SD | State |
| ZIP Code | 57042 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Licensed Hospital | X | LicensedHospital |
| Critical Access Hospital | X | CriticalAccessHospital |
| Er24 Hours | X | Er24Hours |
Form990 Schedule H Part V Section B Form990ScheduleHPartVSectionB
Hospital Facility Name HospitalFacilityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | MADISON COMMUNITY HOSPITAL | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital Facility Number | 1 | HospitalFacilityNumber |
| CHNA Conducted | 1 | CHNAConducted |
| Community Definition | X | CommunityDefinition |
| Community Demographics | X | CommunityDemographics |
| Existing Resources | X | ExistingResources |
| How Data Obtained | X | HowDataObtained |
| Community Health Needs | X | CommunityHealthNeeds |
| Other Health Issues | X | OtherHealthIssues |
| Identifying Process | X | IdentifyingProcess |
| Consulting Process | X | ConsultingProcess |
| Information Gaps | X | InformationGaps |
| Needs Assessment Conducted | 12 | NeedsAssessmentConducted |
| Take Into Account | 1 | TakeIntoAccount |
| Other Facilities | 0 | OtherFacilities |
| CHNA Widely Available | 1 | CHNAWidelyAvailable |
| On Request | X | OnRequest |
| Adopt Implement Strategy | X | AdoptImplementStrategy |
| Execute Implement Strategy | X | ExecuteImplementStrategy |
| Prioritize Health Needs | X | PrioritizeHealthNeeds |
| Prioritize Services | X | PrioritizeServices |
| All Needs Addressed | 1 | AllNeedsAddressed |
| Organization Incur Excise Tax | 0 | OrganizationIncurExciseTax |
| Eligibility Criteria Explained | 1 | EligibilityCriteriaExplained |
| Uses FPG Free | 1 | UsesFPGFree |
| FPG Free Percent | 150.000000000000 | FPGFreePercent |
| Uses FPG Discounted | 1 | UsesFPGDiscounted |
| FPG Discount Percent | 400.000000000000 | FPGDiscountPercent |
| Explains Basis | 1 | ExplainsBasis |
| Income Level | X | IncomeLevel |
| Asset Level | X | AssetLevel |
| Insurance Status | X | InsuranceStatus |
| Medicaid Medicare | X | MedicaidMedicare |
| Other Factors | X | OtherFactors |
| Explains Application Method | 1 | ExplainsApplicationMethod |
| Includes Publicity Measures | 1 | IncludesPublicityMeasures |
| Other Publicity | X | OtherPublicity |
| Actions On Nonpayment | 1 | ActionsOnNonpayment |
| Collection Activities | 0 | CollectionActivities |
| Notify Upon Admission | X | NotifyUponAdmission |
| Notify Before Discharge | X | NotifyBeforeDischarge |
| Notified All Patients | X | NotifiedAllPatients |
| Nondiscrim Emergency Care Policy | 1 | NondiscrimEmergencyCarePolicy |
| Average Negotiated Rates | X | AverageNegotiatedRates |
| Amounts Generally Billed | 0 | AmountsGenerallyBilled |
| Gross Charges | 0 | GrossCharges |
Form990 Schedule H Part VI Form990ScheduleHPartVI (13 entries)
| ExplanationExplanation | IdentifierIdentifier |
|---|---|
| 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, L7 COL(F): BAD DEBT EXPENSE OF $899,852 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 2013 POVERTY LEVEL PERCENTAGE FOR ITS AREA TO THE TOTAL AMOUNT SENT TO COLLECTIONS DURING THE FISCAL YEAR ENDED JUNE 30, 2013 TO DETERMINE AN ESTIMATE OF ELIGIBLE CHARITY CARE REPORTED AS BAD DEBT. C) FOOTNOTE FROM FINANCIAL STATEMENT: PLEASE SEE NOTE 1, FINANCIAL STATEMENT, PATIENT AND RESIDENT RECEIVABLES | |
| PART III, LINE 8: MEDICARE ALLOWABLE COST OF CARE WAS CALCULATED FROM THE MEDICARE COST REPORT FOR THE FISCAL YEAR ENDING 6/30/2013. | |
| PART III, LINE 9B: ACCOUNTS THAT MEET THE CRITERIA FOR 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. | |
| 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 IS AVAILABLE UPON REQUEST. IT WAS NOT ATTACHED TO THE RETURN IN COMPLIANCE WITH PROPOSED REGULATIONS DUE TO SOFTWARE LIMITATIONS. | MADISON COMMUNITY HOSPITAL |
| PART V, SECTION B, LINE 12H: HOUSEHOLD SIZE | MADISON COMMUNITY HOSPITAL |
| PART V, SECTION B, LINE 14G: 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. | MADISON COMMUNITY HOSPITAL |
| PART VI, LINE 2: IN ADDITION TO COMPLETING A COMMUNITY HEALTH NEEDS ASSESSMENT DURING THE FISCAL YEAR, 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. WE HAVE RECENTLY IMPLEMENTED A FINANCIAL COUNSELOR THAT MEETS ONE-ON-ONE WITH PATIENTS PRIOR TO DISCHARGE AS WELL TO GO OVER THEIR INSURANCE COVERAGE AND WHAT TO EXPECT ONCE INSURANCE PROCESSES. | |
| PART VI, LINE 4: MADISON COMMUNITY HOSPITAL IS THE ONLY HOSPITAL IN THE SERVICE AREA. SEVEN PHYSICIANS AND THREE 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 2012: $49,415. | |
| 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
| Field | Value | IRS element (for citing) |
|---|---|---|
| Compensation Survey | X | CompensationSurvey |
| Board Or Committee Approval | X | BoardOrCommitteeApproval |
| Severance Payment | 0 | SeverancePayment |
| Supplemental Nonqual Retire Plan | 0 | SupplementalNonqualRetirePlan |
| Equity Based Comp Arrangement | 0 | EquityBasedCompArrangement |
| Comp Based On Revenue Of Filing Org | 1 | CompBasedOnRevenueOfFilingOrg |
| Comp Based On Revenue Related Orgs | 0 | CompBasedOnRevenueRelatedOrgs |
| Comp Based Net Earnings Filing Org | 0 | CompBasedNetEarningsFilingOrg |
| Comp Based Net Earnings Relate Orgs | 0 | CompBasedNetEarningsRelateOrgs |
| Any Non Fixed Payments | 0 | AnyNonFixedPayments |
| Initial Contract Exception | 0 | InitialContractException |
Form990 Schedule J Part II Form990ScheduleJPartII (3 entries)
| TitleTitle | Base Compensation Filing OrgBaseCompensationFilingOrg | Comp Based On Related OrgsCompBasedOnRelatedOrgs | Bonus Filing OrgBonusFilingOrg | Bonus Related OrgsBonusRelatedOrgs | Other Compensation Filing OrgOtherCompensationFilingOrg | Other Compensation Related OrgsOtherCompensationRelatedOrgs | Deferred Comp Filing OrgDeferredCompFilingOrg | Deferred Comp Related OrgsDeferredCompRelatedOrgs | Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrg | Nontaxable Benefits Related OrgsNontaxableBenefitsRelatedOrgs | Total Compensation Filing OrgTotalCompensationFilingOrg | Total Compensation Related OrgsTotalCompensationRelatedOrgs | Comp Report Prior990 Filing OrgCompReportPrior990FilingOrg | Comp Report Prior990 Related OrgsCompReportPrior990RelatedOrgs |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| TAMARA MILLER | ||||||||||||||
| CEO | 0 | 139774 | 0 | 0 | 0 | 0 | 0 | 7727 | 0 | 23106 | 0 | 170607 | 0 | 0 |
| ROBERT SUMMERER | ||||||||||||||
| SURGEON | 0 | 379552 | 0 | 0 | 0 | 0 | 0 | 12500 | 0 | 34756 | 0 | 426808 | 0 | 0 |
| DARREL SIMON | ||||||||||||||
| CRNA | 0 | 195415 | 0 | 0 | 0 | 0 | 0 | 10833 | 0 | 22004 | 0 | 228252 | 0 | 0 |
Form990 Schedule J Part III Form990ScheduleJPartIII
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Reference | PART I, LINE 5 | ReturnReference |
| Explanation | ROBERT SUMMERER, DR. IS PAID BASED ON PRODUCTION. | Explanation |
Schedule O IRS990ScheduleO
General Explanation GeneralExplanation (6 entries)
| Return ReferenceReturnReference | ExplanationExplanation | IdentifierIdentifier |
|---|---|---|
| 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 NOT AVAILABLE TO THE GENERAL PUBLIC UPON REQUEST. | |
| FORM 990, PART XI, LINE 9: | LOSS FROM WHOLLY OWNED SUBSIDIARY -28,043. | CHANGES IN NET ASSETS OR FUND BALANCES: |
Schedule R IRS990ScheduleR
Form990 Schedule R Part IV Form990ScheduleRPartIV
Name Of Related Org NameOfRelatedOrg
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | MADISON COMMUNITY MEDICAL CENTER | BusinessNameLine1 |
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 917 N WASHINGTON AVENUE | AddressLine1 |
| City | MADISON | City |
| State | SD | State |
| ZIP Code | 57045 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 460398320 | EIN |
| Primary Activity | OFFICE RENTAL | PrimaryActivity |
| Legal Domicile State | SD | LegalDomicileState |
| Direct Controlling Entity NA | N/A | DirectControllingEntityNA |
| Type Of Entity | C | TypeOfEntity |
| Share Of Total Income | 119539 | ShareOfTotalIncome |
| Share Of EOY Assets | 244985 | ShareOfEOYAssets |
| Percentage Ownership | 1.00000 | PercentageOwnership |
| Controlled Org | 0 | ControlledOrg |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Ann Rents Royalties | 0 | ReceiptOfIntAnnRentsRoyalties |
| Gift Grant Or Cap Contr To Other Org | 0 | GiftGrantOrCapContrToOtherOrg |
| Gift Grant Or Cap Contr Fr Other Org | 0 | GiftGrantOrCapContrFrOtherOrg |
| Loans Or Guarantees To Other Org | 1 | LoansOrGuaranteesToOtherOrg |
| Loans Or Guarantees From Other Org | 0 | LoansOrGuaranteesFromOtherOrg |
| Dividends Related Organization | 0 | DividendsRelatedOrganization |
| Sale Of Assets To Other Org | 0 | SaleOfAssetsToOtherOrg |
| Purchase Of Assets From Other Org | 0 | PurchaseOfAssetsFromOtherOrg |
| Exchange Of Assets | 0 | ExchangeOfAssets |
| Rental Of Facilities To Other Orgs | 0 | RentalOfFacilitiesToOtherOrgs |
| Rental Of Facilities Fr Other Orgs | 0 | RentalOfFacilitiesFrOtherOrgs |
| Perform Of Services For Other Orgs | 0 | PerformOfServicesForOtherOrgs |
| Perform Of Services By Other Orgs | 0 | PerformOfServicesByOtherOrgs |
| Sharing Of Facilities | 0 | SharingOfFacilities |
| Sharing Of Paid Employees | 0 | SharingOfPaidEmployees |
| Reimbursement Paid To Other Org | 1 | ReimbursementPaidToOtherOrg |
| Reimbursement Paid By Other Org | 0 | ReimbursementPaidByOtherOrg |
| Other Transfer To Other Org | 1 | OtherTransferToOtherOrg |
| Other Transfer From Other Org | 0 | OtherTransferFromOtherOrg |
Transactions Related Orgs Table TransactionsRelatedOrgsTable
Name Of Other Organization NameOfOtherOrganization
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | MADISON COMMUNITY MEDICAL CENTER | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Transaction Type | P | TransactionType |
| Amount Involved | 83304 | AmountInvolved |
| Method Of Amt Determination | FMV | MethodOfAmtDetermination |
Comments