MADISON COMMUNITY HOSPITAL: Form 990, tax year 2009

View the entire original 990 at ProPublica ↗

Organization
MADISON COMMUNITY HOSPITAL (EIN 46-0228038)
Tax period
2009-07-01 to 2010-06-30
Filed
2011-03-21
IRS object ID
201100809349300605
Schema version
2009v1.7
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)
Timestamp2011-03-21T10:32:11-05:00Timestamp
Tax Period End Date2010-06-30TaxPeriodEndDate

Preparer Firm PreparerFirm

Preparer Firm Business Name PreparerFirmBusinessName

FieldValueIRS element (for citing)
Business Name Line1EIDE BAILLY LLPBusinessNameLine1

Preparer Firm US Address PreparerFirmUSAddress

FieldValueIRS element (for citing)
Address Line1200 EAST 10TH ST PO BOX 5125AddressLine1
CitySIOUX FALLSCity
StateSDState
ZIP Code571175125ZIPCode
FieldValueIRS element (for citing)
Return Type990ReturnType
Tax Period Begin Date2009-07-01TaxPeriodBeginDate

Filer Filer

FieldValueIRS element (for citing)
EIN460228038EIN

Name Name

FieldValueIRS element (for citing)
Business Name Line1Madison Community HospitalBusinessNameLine1
FieldValueIRS element (for citing)
Name ControlMADINameControl
Phone6052566551Phone

US Address USAddress

FieldValueIRS element (for citing)
Address Line1917 N Washington AveAddressLine1
CityMadisonCity
StateSDState
ZIP Code57042ZIPCode

Officer Officer

FieldValueIRS element (for citing)
NameTamara MillerName
TitleCEOTitle
Phone6052566551Phone
Date Signed2011-03-16DateSigned
Authorize Third Party1AuthorizeThirdParty

Preparer Preparer

FieldValueIRS element (for citing)
NameLaurie HansonName
Phone6053391999Phone
Date Prepared2011-03-16DatePrepared
FieldValueIRS element (for citing)
Tax Year2009TaxYear
Build TS2016-02-24 21:20:13ZBuildTS

Form 990 IRS990

FieldValueIRS element (for citing)
Name Of Principal Officer PersonTamara MillerNameOfPrincipalOfficerPerson

Address Principal Officer US AddressPrincipalOfficerUS

FieldValueIRS element (for citing)
Address Line1917 N Washington AveAddressLine1
CityMadisonCity
StateSDState
ZIP Code57042ZIPCode
FieldValueIRS element (for citing)
Gross Receipts12628111GrossReceipts
Group Return For Affiliates0GroupReturnForAffiliates
Organization501cXOrganization501c
Web Sitewww.madisonhospital.comWebSite
Type Of Organization CorporationXTypeOfOrganizationCorporation
Year Formation1955YearFormation
State Legal DomicileSDStateLegalDomicile
Activity Or Mission DescriptionProvide health care services to area residents.ActivityOrMissionDescription
Nbr Voting Members Governing Body11NbrVotingMembersGoverningBody
Nbr Independent Voting Members11NbrIndependentVotingMembers
Total Nbr Employees169TotalNbrEmployees
Total Nbr Volunteers15TotalNbrVolunteers
Total Gross UBI0TotalGrossUBI
Net Unrelated Business Txbl Income0NetUnrelatedBusinessTxblIncome
Contributions Grants Prior Year134593ContributionsGrantsPriorYear
Contributions Grants Current Year56283ContributionsGrantsCurrentYear
Program Service Revenue Prior Year12340260ProgramServiceRevenuePriorYear
Program Service Revenue CY12500713ProgramServiceRevenueCY
Investment Income Prior Year72469InvestmentIncomePriorYear
Investment Income Current Year65615InvestmentIncomeCurrentYear
Other Revenue Prior Year6400OtherRevenuePriorYear
Other Revenue Current Year5500OtherRevenueCurrentYear
Total Revenue Prior Year12553722TotalRevenuePriorYear
Total Revenue Current Year12628111TotalRevenueCurrentYear
Grants And Similar Amnts CY0GrantsAndSimilarAmntsCY
Benefits Paid To Members CY0BenefitsPaidToMembersCY
Salaries Etc Prior Year6347490SalariesEtcPriorYear
Salaries Etc Current Year6574529SalariesEtcCurrentYear
Total Prof Fundrsng Exp CY0TotalProfFundrsngExpCY
Total Fundrsng Exp Current Year0TotalFundrsngExpCurrentYear
Other Expense Prior Year5156133OtherExpensePriorYear
Other Expenses Current Year5284479OtherExpensesCurrentYear
Total Expenses Prior Year11503623TotalExpensesPriorYear
Total Expenses Current Year11859008TotalExpensesCurrentYear
Revenues Less Expenses Prior Year1050099RevenuesLessExpensesPriorYear
Revenues Less Expenses CY769103RevenuesLessExpensesCY
Total Assets BOY10856921TotalAssetsBOY
Total Assets EOY10200608TotalAssetsEOY
Total Liabilities BOY2208246TotalLiabilitiesBOY
Total Liabilities EOY803441TotalLiabilitiesEOY
Net Assets Or Fund Balances BOY8648675NetAssetsOrFundBalancesBOY
Net Assets Or Fund Balances EOY9397167NetAssetsOrFundBalancesEOY
Mission DescriptionMadison 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 Services0SignificantNewProgramServices
Significant Change0SignificantChange
Expense10090806Expense
Revenue12391351Revenue
DescriptionMadison Community Hospital (hospital) is a 25-bed acute care hospital located in Madison, South Dakota. For the year ended June 30, 2010: acute patient days = 1,172; newborn days = 87; skilled days = 1,572; and intermediate days =67.To fulfill its mission of community service, the hospital provides care to patients who meet certain criteria under its charity care policy without charge or at amounts less than its established rates. The hospital maintains records to identify and monitor the level of charity care it provides. These records include the amount of charges forgone for services and supplies furnished under its charity care policy and equivalent service statistics. The amounts forgone, based on established rates, were $127,454 for the year ended June 30, 2010.Description
Total Program Service Expense10090806TotalProgramServiceExpense
Described In501 C31DescribedIn501C3
Schedule B Required1ScheduleBRequired
Political Activities0PoliticalActivities
Lobbying Activities0LobbyingActivities
Donor Advised Funds0DonorAdvisedFunds
Conservation Easements0ConservationEasements
Collections Of Art0CollectionsOfArt
Credit Counseling0CreditCounseling
Term Or Permanent Endowments0TermOrPermanentEndowments
Balance Sheet Amounts Reported1BalanceSheetAmountsReported
Independent Audit Financial Stmt0IndependentAuditFinancialStmt
Consolidated Audit Financial Stmt1ConsolidatedAuditFinancialStmt
School0School
Foreign Office0ForeignOffice
Foreign Activities0ForeignActivities
More Than5000 K To Organizations0MoreThan5000KToOrganizations
More Than5000 K To Individuals0MoreThan5000KToIndividuals
Professional Fundraising0ProfessionalFundraising
Fundraising Activities0FundraisingActivities
Gaming0Gaming
Hospital1Hospital
Grants To Organizations0GrantsToOrganizations
Grants To Individuals0GrantsToIndividuals
Schedule J Required1ScheduleJRequired
Tax Exempt Bonds0TaxExemptBonds
Excess Benefit Transaction0ExcessBenefitTransaction
Prior Excess Benefit Transaction0PriorExcessBenefitTransaction
Loan To Officer Or DQP0LoanToOfficerOrDQP
Grant To Related Person0GrantToRelatedPerson
Bsnss Rltnshp With Organization0BsnssRltnshpWithOrganization
Bsnss Rltnshp Thru Family Member0BsnssRltnshpThruFamilyMember
Officer Entity With Bsnss Rltnshp0OfficerEntityWithBsnssRltnshp
Deductible Non Cash Contributions0DeductibleNonCashContributions
Deductible Contributions Of Art0DeductibleContributionsOfArt
Terminated0Terminated
Partial Liquidation0PartialLiquidation
Disregarded Entity0DisregardedEntity
Related Entity1RelatedEntity
Related Org Controlled Entity1RelatedOrgControlledEntity
Transfers To Exempt Non Chrtbl Org0TransfersToExemptNonChrtblOrg
Activities Conducted Partnership0ActivitiesConductedPartnership
Schedule O Required1ScheduleORequired
Number Forms Transmitted With10961NumberFormsTransmittedWith1096
Number W2 G Included0NumberW2GIncluded
Compliance With Backup Witholding1ComplianceWithBackupWitholding
Number Of Employees169NumberOfEmployees
Employment Tax Returns Filed1EmploymentTaxReturnsFiled
Unrelated Business Income0UnrelatedBusinessIncome
Foreign Financial Account0ForeignFinancialAccount
Prohibited Tax Shelter Trans0ProhibitedTaxShelterTrans
Taxable Party Notification0TaxablePartyNotification
Non Deductible Contributions0NonDeductibleContributions
Quid Pro Quo Contributions0QuidProQuoContributions
Form8282 Property Disposed Of0Form8282PropertyDisposedOf
Funds To Pay Premiums0FundsToPayPremiums
Premiums Paid0PremiumsPaid
Nbr Voting Governing Body Members11NbrVotingGoverningBodyMembers
Number Independent Voting Members11NumberIndependentVotingMembers
Family Or Business Relationship0FamilyOrBusinessRelationship
Delegation Of Management Duties0DelegationOfManagementDuties
Changes To Organizing Docs0ChangesToOrganizingDocs
Material Diversion Or Misuse0MaterialDiversionOrMisuse
Members Or Stockholders0MembersOrStockholders
Election Of Board Members0ElectionOfBoardMembers
Decisions Subject To Approval0DecisionsSubjectToApproval
Minutes Of Governing Body1MinutesOfGoverningBody
Minutes Of Committees0MinutesOfCommittees
Officer Mailing Address0OfficerMailingAddress
Local Chapters0LocalChapters
Form990 Provided To Governing Body1Form990ProvidedToGoverningBody
Conflict Of Interest Policy1ConflictOfInterestPolicy
Annual Disclosure Covered Persons1AnnualDisclosureCoveredPersons
Regular Monitoring Enforcement1RegularMonitoringEnforcement
Whistleblower Policy0WhistleblowerPolicy
Document Retention Policy1DocumentRetentionPolicy
Compensation Process CEO1CompensationProcessCEO
Compensation Process Other0CompensationProcessOther
Investment In Joint Venture0InvestmentInJointVenture
Upon RequestXUponRequest

The Books Are In Care Of TheBooksAreInCareOf

Name Business NameBusiness

FieldValueIRS element (for citing)
Business Name Line1Mrs Tamara MillerBusinessNameLine1
FieldValueIRS element (for citing)
Telephone Number6052566551TelephoneNumber

Address US AddressUS

FieldValueIRS element (for citing)
Address Line1917 N Washington AveAddressLine1
CityMadisonCity
StateSDState
ZIP Code57042ZIPCode

Form990 Part VII Section A Form990PartVIISectionA (15 entries)

TitleTitleAverage Hours Per WeekAverageHoursPerWeekIndividual Trustee Or DirectorIndividualTrusteeOrDirectorOfficerOfficerReportable Comp From OrganizationReportableCompFromOrganizationReportable Comp From Related OrgsReportableCompFromRelatedOrgsOther CompensationOtherCompensationHighest Compensated EmployeeHighestCompensatedEmployee
Brad Wilkens
President1.00XX000
Loren Scott
Vice President1.00XX000
Lois Niedert
Secretary1.00XX000
Chris LeMair
Treasurer1.00XX000
Norm Johnson
Trustee1.00X000
Dan Brown
Trustee1.00X000
Peggy Casanova
Trustee1.00X000
Robin Schwebach
Trustee1.00X000
Leland White
Trustee1.00X000
Jan Davis
Trustee1.00X000
Greg Hollister
Trustee1.00X000
Tamara Miller
CEO40.00X119019021125
Robert Summerer
Surgeon40.00430090041821X
Darrel Simon
CRNA40.00164731018664X
Darwin Egeberg
Pharmacist40.0010216309930X
FieldValueIRS element (for citing)
Total Reportable Comp From Org816003TotalReportableCompFromOrg
Total Reportable Comp Frm Rltd Orgs0TotalReportableCompFrmRltdOrgs
Total Other Compensation91540TotalOtherCompensation
Number Individuals GT100 K4NumberIndividualsGT100K
Formers Listed0FormersListed
Total Comp GT150 K1TotalCompGT150K
Compensation From Other Sources0CompensationFromOtherSources

Contractor Compensation ContractorCompensation (5 entries)

Address Line1AddressOfContractor/AddressUS/AddressLine1CityAddressOfContractor/AddressUS/CityStateAddressOfContractor/AddressUS/StateZIP CodeAddressOfContractor/AddressUS/ZIPCodeDescription Of ServicesDescriptionOfServicesCompensationCompensation
Universal Hosptial Services
7505 S Louise AveSioux FallsSD57108Bio-Med Contract357039
Interlakes Medical Center
903 N Washington AveMadisonSD57042ER Call Coverage273015
Sanford Laboratories
PO Box 5056Sioux FallsSD57117Reference Lab185800
Medical X-Ray Center
1417 S Minnesota AveSioux FallsSD57105Outreach MRI139485
DMS Imaging
SDS 12-2208 PO Box 86MinneapolisMN55486Outreach Nuc Med125278
FieldValueIRS element (for citing)
Number Of Contractors GT100 K5NumberOfContractorsGT100K
Government Grants35438GovernmentGrants
All Other Contributions20845AllOtherContributions
Total Contributions56283TotalContributions

Program Service Revenue ProgramServiceRevenue (4 entries)

DescriptionDescriptionBusiness CodeBusinessCodeTotal Revenue ColumnTotalRevenueColumnRelated Or Exempt Function IncomeRelatedOrExemptFunctionIncomeExclusionExclusionAmount
Patient Service Rev9000991231123612311236
Meals62421083741$83,741
MCMC Revenue6211107461574615
Miscellaneous90009931121$31,121
FieldValueIRS element (for citing)
Total Program Service Revenue12500713TotalProgramServiceRevenue

Investment Income InvestmentIncome

FieldValueIRS element (for citing)
Total Revenue Column64531TotalRevenueColumn
Exclusion$64,531ExclusionAmount

Gross Rents GrossRents

FieldValueIRS element (for citing)
Real5500Real

Rental Income Or Loss RentalIncomeOrLoss

FieldValueIRS element (for citing)
Real5500Real

Net Rental Income Or Loss NetRentalIncomeOrLoss

FieldValueIRS element (for citing)
Total Revenue Column5500TotalRevenueColumn
Related Or Exempt Function Income5500RelatedOrExemptFunctionIncome

Gross Amount Sales Assets GrossAmountSalesAssets

FieldValueIRS element (for citing)
Other1084Other

Gain Or Loss GainOrLoss

FieldValueIRS element (for citing)
Other1084Other

Net Gain Or Loss Investments NetGainOrLossInvestments

FieldValueIRS element (for citing)
Total Revenue Column1084TotalRevenueColumn
Exclusion$1,084ExclusionAmount

Total Revenue TotalRevenue

FieldValueIRS element (for citing)
Total Revenue Column12628111TotalRevenueColumn
Related Or Exempt Function Income12391351RelatedOrExemptFunctionIncome
Unrelated Business Revenue0UnrelatedBusinessRevenue
Exclusion$180,477ExclusionAmount

Comp Current Officers Directors CompCurrentOfficersDirectors

FieldValueIRS element (for citing)
Total149110Total
Management And General149110ManagementAndGeneral

Other Salaries And Wages OtherSalariesAndWages

FieldValueIRS element (for citing)
Total5003178Total
Program Services4690569ProgramServices
Management And General312609ManagementAndGeneral

Pension Plan Contributions PensionPlanContributions

FieldValueIRS element (for citing)
Total244868Total
Program Services229810ProgramServices
Management And General15058ManagementAndGeneral

Other Employee Benefits OtherEmployeeBenefits

FieldValueIRS element (for citing)
Total753008Total
Program Services710769ProgramServices
Management And General42239ManagementAndGeneral

Payroll Taxes PayrollTaxes

FieldValueIRS element (for citing)
Total424365Total
Program Services388553ProgramServices
Management And General35812ManagementAndGeneral

Fees For Services Legal FeesForServicesLegal

FieldValueIRS element (for citing)
Total100Total
Management And General100ManagementAndGeneral

Fees For Services Accounting FeesForServicesAccounting

FieldValueIRS element (for citing)
Total64360Total
Management And General64360ManagementAndGeneral

Fees For Services Other FeesForServicesOther

FieldValueIRS element (for citing)
Total550098Total
Program Services393413ProgramServices
Management And General156685ManagementAndGeneral

Advertising Advertising

FieldValueIRS element (for citing)
Total113123Total
Management And General113123ManagementAndGeneral

Office Expenses OfficeExpenses

FieldValueIRS element (for citing)
Total139105Total
Program Services44461ProgramServices
Management And General94644ManagementAndGeneral

Occupancy Occupancy

FieldValueIRS element (for citing)
Total349537Total
Program Services113538ProgramServices
Management And General235999ManagementAndGeneral

Travel Travel

FieldValueIRS element (for citing)
Total34804Total
Program Services34533ProgramServices
Management And General271ManagementAndGeneral

Conferences Meetings ConferencesMeetings

FieldValueIRS element (for citing)
Total29664Total
Program Services21040ProgramServices
Management And General8624ManagementAndGeneral

Interest Interest

FieldValueIRS element (for citing)
Total4964Total
Program Services4964ProgramServices

Depreciation Depletion DepreciationDepletion

FieldValueIRS element (for citing)
Total587423Total
Program Services587423ProgramServices

Insurance Insurance

FieldValueIRS element (for citing)
Total154527Total
Management And General154527ManagementAndGeneral

Other Expenses OtherExpenses (5 entries)

DescriptionDescriptionTotalTotalProgram ServicesProgramServicesManagement And GeneralManagementAndGeneral
Medical Supplies15119211511921
Outreach664932664932
Bad Debts599742599742
Maintenance and Repairs34430441502302802
Dues and Subscriptions2221622216

All Other Expenses AllOtherExpenses

FieldValueIRS element (for citing)
Total113659Total
Program Services53636ProgramServices
Management And General60023ManagementAndGeneral

Total Functional Expenses TotalFunctionalExpenses

FieldValueIRS element (for citing)
Total11859008Total
Program Services10090806ProgramServices
Management And General1768202ManagementAndGeneral
Fundraising0Fundraising

Savings And Temp Cash Investments SavingsAndTempCashInvestments

FieldValueIRS element (for citing)
BOY3724816BOY
EOY3950686EOY

Accounts Receivable AccountsReceivable

FieldValueIRS element (for citing)
BOY2485739BOY
EOY1588380EOY

Other Notes Loans Receivable Net OtherNotesLoansReceivableNet

FieldValueIRS element (for citing)
BOY110415BOY
EOY129540EOY

Inventories For Sale Or Use InventoriesForSaleOrUse

FieldValueIRS element (for citing)
BOY299291BOY
EOY309007EOY

Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges

FieldValueIRS element (for citing)
BOY77878BOY
EOY114019EOY
FieldValueIRS element (for citing)
Land Buildings Equipment Basis10386746LandBuildingsEquipmentBasis
Land Bldg Equipment Accum Deprec6704712LandBldgEquipmentAccumDeprec

Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet

FieldValueIRS element (for citing)
BOY3975674BOY
EOY3682034EOY

Other Assets Total OtherAssetsTotal

FieldValueIRS element (for citing)
BOY183108BOY
EOY426942EOY

Total Assets TotalAssets

FieldValueIRS element (for citing)
BOY10856921BOY
EOY10200608EOY

Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses

FieldValueIRS element (for citing)
BOY1608246BOY
EOY803441EOY

Mort Notes Pybl Secured Invest Prop MortNotesPyblSecuredInvestProp

FieldValueIRS element (for citing)
BOY600000BOY

Total Liabilities TotalLiabilities

FieldValueIRS element (for citing)
BOY2208246BOY
EOY803441EOY
FieldValueIRS element (for citing)
Follow SFAS117XFollowSFAS117

Unrestricted Net Assets UnrestrictedNetAssets

FieldValueIRS element (for citing)
BOY8501654BOY
EOY9336534EOY

Temporarily Restricted Net Assets TemporarilyRestrictedNetAssets

FieldValueIRS element (for citing)
BOY147021BOY
EOY60633EOY

Total Net Assets Fund Balances TotalNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY8648675BOY
EOY9397167EOY

Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY10856921BOY
EOY10200608EOY
FieldValueIRS element (for citing)
Method Of Accounting AccrualXMethodOfAccountingAccrual
Accountant Compile Or Review0AccountantCompileOrReview
FS Audited1FSAudited
Audit Committee1AuditCommittee
Financial Statement ConsolidatedXFinancialStatementConsolidated
Federal Grant Audit Required0FederalGrantAuditRequired

Schedule A IRS990ScheduleA

FieldValueIRS element (for citing)
Hospital170b1 AiiiXHospital170b1Aiii

Schedule B IRS990ScheduleB

Contributor Info ContributorInfo

FieldValueIRS element (for citing)
Contributor NumberRESTRICTEDContributorNumber

Contributor Name Business ContributorNameBusiness

FieldValueIRS element (for citing)
Business Name Line1RESTRICTEDBusinessNameLine1

Contributor Address US ContributorAddressUS

FieldValueIRS element (for citing)
Address Line1RESTRICTEDAddressLine1
Address Line2RESTRICTEDAddressLine2
CityRESTRICTEDCity
StateRESTRICTEDState
ZIP CodeRESTRICTEDZIPCode
FieldValueIRS element (for citing)
Aggregate ContributionsRESTRICTEDAggregateContributions

Schedule D IRS990ScheduleD

Buildings Buildings

FieldValueIRS element (for citing)
Other Cost Or Other Basis4663527OtherCostOrOtherBasis
Depreciation2542868Depreciation
Book Value2120659BookValue

Equipment Equipment

FieldValueIRS element (for citing)
Other Cost Or Other Basis5430910OtherCostOrOtherBasis
Depreciation4009001Depreciation
Book Value1421909BookValue

Other Land Buildings OtherLandBuildings

FieldValueIRS element (for citing)
Other Cost Or Other Basis292309OtherCostOrOtherBasis
Depreciation152843Depreciation
Book Value139466BookValue
FieldValueIRS element (for citing)
Total Of Book Value Land Buildings3682034TotalOfBookValueLandBuildings
Total Revenue12628111TotalRevenue
Total Expenses11859008TotalExpenses
Excess Or Deficit For Year769103ExcessOrDeficitForYear
Other-$20,611OtherAmount
Total Adjustments-20611TotalAdjustments
Excess Or Deficit Per FS748492ExcessOrDeficitPerFS
Tot Revenue Etc Audited Fincl Stmt12607500TotRevenueEtcAuditedFinclStmt
Revenue Not Rptd F9900RevenueNotRptdF990
Revenue Subtotal12607500RevenueSubtotal
Other Revenues Not Included20611OtherRevenuesNotIncluded
Revenue Not Rptd On Fin Stmt20611RevenueNotRptdOnFinStmt
Total Revenue Per Form99012628111TotalRevenuePerForm990
Tot Expenses Etc Audited Fincl Stmt11859008TotExpensesEtcAuditedFinclStmt
Expenses Not Rptd F9900ExpensesNotRptdF990
Expenses Subtotal11859008ExpensesSubtotal
Expenses Not Rptd On Fin Stmt0ExpensesNotRptdOnFinStmt
Total Expenses Per Form99011859008TotalExpensesPerForm990

Form990 Schedule D Part XIV Form990ScheduleDPartXIV (3 entries)

IdentifierIdentifierReturn ReferenceReturnReferenceExplanationExplanation
Part X:Description of Uncertain Tax Positions Under FIN 48:The Hospital has adopted the provisions of Financial Accounting Standards Board Accounting Standards Codification Topic ASC 740-10 (previously Financial Interpretation No. 48, Accounting for Uncertainty in Income Taxes), on July 1, 2009. The implementation of this standard had no impact on the financial statements. As of both the date of adoption, and as of June 30, 2010, the unrecognized tax benefit accrual was zero. The Hospital will recognize future accrued interest and penalties related to unrecognized tax benefits in income tax expense if incurred. The Hospital is no longer subject to Federal tax examinations by tax authorities for years before 2007.
Part XI, Line 8 - Other Adjustments:Loss from Wholly Owned Subsidiary: -20611.
Part XII, Line 4b - Other Adjustments:Loss from Wholly Owned Subsidiary: 20611.

Schedule H IRS990ScheduleH

FieldValueIRS element (for citing)
Charity Care Policy1CharityCarePolicy
Written Policy1WrittenPolicy
Policy Applied To All HospitalsXPolicyAppliedToAllHospitals
FPG Reference Free Care1FPGReferenceFreeCare

Other Percentage OtherPercentage

FieldValueIRS element (for citing)
OtherXOther
Free Other Percentage130.000000000000FreeOtherPercentage
FieldValueIRS element (for citing)
FPG Reference Discounted Care1FPGReferenceDiscountedCare
Pcent300XPcent300
Free Disc Care Medically Indigent1FreeDiscCareMedicallyIndigent
Amounts Budgeted For Charity Care1AmountsBudgetedForCharityCare
Expenses Exceeded Budget1ExpensesExceededBudget
Unable To Provide Care0UnableToProvideCare
Annual Community Benefit Report0AnnualCommunityBenefitReport

Charity Care At Cost CharityCareAtCost

FieldValueIRS element (for citing)
Total Community Benefit Expense76930TotalCommunityBenefitExpense
Net Community Benefit Expense76930NetCommunityBenefitExpense
Percent Of Total Expense0.00680PercentOfTotalExpense

Unreimbursed Medicaid UnreimbursedMedicaid

FieldValueIRS element (for citing)
Total Community Benefit Expense588737TotalCommunityBenefitExpense
Direct Offsetting Revenue383231DirectOffsettingRevenue
Net Community Benefit Expense205506NetCommunityBenefitExpense
Percent Of Total Expense0.01830PercentOfTotalExpense

Total Charity Care TotalCharityCare

FieldValueIRS element (for citing)
Total Community Benefit Expense665667TotalCommunityBenefitExpense
Direct Offsetting Revenue383231DirectOffsettingRevenue
Net Community Benefit Expense282436NetCommunityBenefitExpense
Percent Of Total Expense0.02510PercentOfTotalExpense

Community Health Services CommunityHealthServices

FieldValueIRS element (for citing)
Total Community Benefit Expense9934TotalCommunityBenefitExpense
Net Community Benefit Expense9934NetCommunityBenefitExpense
Percent Of Total Expense0.00090PercentOfTotalExpense

Subsidized Health Services SubsidizedHealthServices

FieldValueIRS element (for citing)
Number Of Activities Or Programs1NumberOfActivitiesOrPrograms
Total Community Benefit Expense567307TotalCommunityBenefitExpense
Direct Offsetting Revenue431168DirectOffsettingRevenue
Net Community Benefit Expense136139NetCommunityBenefitExpense
Percent Of Total Expense0.01210PercentOfTotalExpense

Cash And In Kind Contributions CashAndInKindContributions

FieldValueIRS element (for citing)
Total Community Benefit Expense5000TotalCommunityBenefitExpense
Net Community Benefit Expense5000NetCommunityBenefitExpense
Percent Of Total Expense0.00040PercentOfTotalExpense

Total Other Benefits TotalOtherBenefits

FieldValueIRS element (for citing)
Number Of Activities Or Programs1NumberOfActivitiesOrPrograms
Total Community Benefit Expense582241TotalCommunityBenefitExpense
Direct Offsetting Revenue431168DirectOffsettingRevenue
Net Community Benefit Expense151073NetCommunityBenefitExpense
Percent Of Total Expense0.01340PercentOfTotalExpense

Total Community Benefits TotalCommunityBenefits

FieldValueIRS element (for citing)
Number Of Activities Or Programs1NumberOfActivitiesOrPrograms
Total Community Benefit Expense1247908TotalCommunityBenefitExpense
Direct Offsetting Revenue814399DirectOffsettingRevenue
Net Community Benefit Expense433509NetCommunityBenefitExpense
Percent Of Total Expense0.03850PercentOfTotalExpense
FieldValueIRS element (for citing)
Bad Debt Expense Reported0BadDebtExpenseReported
Bad Debt Expense$362,040BadDebtExpenseAmount
Amount Attributable To49401AmountAttributableTo
Amount Reimbursed By Medicare4844733AmountReimbursedByMedicare
Cost Of Care Reimbursed By Medicare4956938CostOfCareReimbursedByMedicare
Medicare Surplus Or Shortfall-112205MedicareSurplusOrShortfall

Costing Methodology Used CostingMethodologyUsed

FieldValueIRS element (for citing)
OtherXOther
FieldValueIRS element (for citing)
Written Debt Collection Policy1WrittenDebtCollectionPolicy
Provision For Charity Care0ProvisionForCharityCare

Form990 Schedule H Part V Form990ScheduleHPartV

Name Name

FieldValueIRS element (for citing)
Business Name Line1Madison Community HospitalBusinessNameLine1

Address Address

FieldValueIRS element (for citing)
Address Line1917 N Washington AvenueAddressLine1
CityMadisonCity
StateSDState
ZIP Code57042ZIPCode
FieldValueIRS element (for citing)
Licensed HospitalXLicensedHospital
Critical Access HospitalXCriticalAccessHospital
Er24 HoursXEr24Hours

Form990 Schedule H Part VI Form990ScheduleHPartVI

FieldValueIRS element (for citing)
Costing Method UsedPart I, Line 7: Lines 7a and 7b were determined using the ratio of patient care costs to charges calculated in Worksheet 2. Line 7G was determined using the cost report. Lines 7e and 7i were determined using the general ledger.CostingMethodUsed
Percent Of Total Expense ExplnPart I, Line 7f: Bad debt expense of $599,742 was subtracted from total operating expense.PercentOfTotalExpenseExpln
Bad Debt FootnotePart III, Line 4: a) The cost-to-charge ratio was calculated using Worksheet 2.b) 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.c) The Hospital applied the 2008 poverty level percentage (most recent information available) for its area to the total amount sent to collections during the fiscal year ended June 30, 2010 to determine an estimate of eligible charity care reported as bad debt. d) Footnote from Financial Statement: The carrying amount of patient receivables is reduced by a valuation allowance that reflects management's best estimate of amounts that will not be collected from patients and third-party payors. Management reviews patient receivables by payor class and applies percentages to determine estimated amounts that will not be collected from third parties under contractual agreements and amounts that will not be collected from patients due to bad debts. Management considers historical write off and recovery information in determining the estimated bad debt provision. Management also reviews accounts to determine if classification as charity care is appropriate.BadDebtFootnote
Shortfall As Community BenefitPart III, Line 8: Medicare allowable cost of care was calculated from the medicare cost report for the fiscal year ending 6/30/2010. The entire Medicare shortfall is considered a community benefit. Madison Community Hospital provides services to patients under the Medicare program knowing they will not recover all the costs associated with providing these services. Providing these services is essential for the health of these patients and increases their access to healthcare services.ShortfallAsCommunityBenefit
Needs AssessmentPart VI, Line 2: A demographic and service line analysis was completed to determine community healthcare needs. In addition, a previously completed community healthcare needs assessment for our county is referred to frequently for information.NeedsAssessment
Patient Education AssistancePart VI, Line 3: Business office personnel/discharge planning counsels patients upon admission and through the discharge planning process on Medicaid, county welfare programs, charity care, etc. Payment planning is discussed. Financial assistance programs are detailed either in person or through a brochure that explains the hospital's financial assistance and payment requirements. Covered vs noncovered charges are discussed with the patient. A patient assessment is completed on each inpatient by discharge planning. Included in this assessment is discussion on financial responsibilities/concerns/government programs.PatientEducationAssistance
Community InformationPart VI, Line 4: Madison Community Hospital is the only hospital in the service area. Eight 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 2009: $43,517.CommunityInformation
Community Building ActivitiesPart VI, Line 5: The governing body of Madison Community Hospital is comprised of community members, none of which 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.CommunityBuildingActivities

Schedule J IRS990ScheduleJ

FieldValueIRS element (for citing)
Compensation SurveyXCompensationSurvey
Board Or Committee ApprovalXBoardOrCommitteeApproval
Severance Payment0SeverancePayment
Supplemental Nonqual Retire Plan0SupplementalNonqualRetirePlan
Equity Based Comp Arrangement0EquityBasedCompArrangement
Comp Based On Revenue Of Filing Org1CompBasedOnRevenueOfFilingOrg
Comp Based On Revenue Related Orgs0CompBasedOnRevenueRelatedOrgs
Comp Based Net Earnings Filing Org0CompBasedNetEarningsFilingOrg
Comp Based Net Earnings Relate Orgs0CompBasedNetEarningsRelateOrgs
Any Non Fixed Payments0AnyNonFixedPayments
Initial Contract Exception0InitialContractException

Form990 Schedule J Part II Form990ScheduleJPartII (2 entries)

Base Compensation Filing OrgBaseCompensationFilingOrgComp Based On Related OrgsCompBasedOnRelatedOrgsBonus Filing OrgBonusFilingOrgBonus Related OrgsBonusRelatedOrgsOther Compensation Filing OrgOtherCompensationFilingOrgOther Compensation Related OrgsOtherCompensationRelatedOrgsDeferred Comp Filing OrgDeferredCompFilingOrgDeferred Comp Related OrgsDeferredCompRelatedOrgsNontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgNontaxable Benefits Related OrgsNontaxableBenefitsRelatedOrgsTotal Compensation Filing OrgTotalCompensationFilingOrgTotal Compensation Related OrgsTotalCompensationRelatedOrgsComp Report Prior990 Filing OrgCompReportPrior990FilingOrgComp Report Prior990 Related OrgsCompReportPrior990RelatedOrgs
Robert Summerer
43009000000226230201200472833000
Darrel Simon
1647310000086780107470184156000

Form990 Schedule J Part III Form990ScheduleJPartIII

FieldValueIRS element (for citing)
Return ReferencePart I, Line 5ReturnReference
ExplanationRobert Summerer, DO is paid based on production.Explanation

Schedule O IRS990ScheduleO

General Explanation GeneralExplanation (5 entries)

IdentifierIdentifierExplanationExplanation
Form 990, Part VI, Section A, line 8bThe organization does utilize committees; however, any item recommended by the committees has to go to the Board of Directors for approval.
Form 990, Part VI, Section B, line 11The Administrator and Director of Accounting 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 Key Employees 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 not available to the general public other than as included on the website.

Schedule R IRS990ScheduleR

Form990 Schedule R Part IV Form990ScheduleRPartIV

Name Of Related Org NameOfRelatedOrg

FieldValueIRS element (for citing)
Business Name Line1Madison Community Medical CenterBusinessNameLine1

Address US AddressUS

FieldValueIRS element (for citing)
Address Line1917 N Washington AvenueAddressLine1
CityMadisonCity
StateSDState
ZIP Code57045ZIPCode
FieldValueIRS element (for citing)
EIN460398320EIN
Primary ActivityOffice RentalPrimaryActivity
Legal Domicile StateSDLegalDomicileState
Type Of EntityCTypeOfEntity
Share Of Total Income117419ShareOfTotalIncome
Share Of EOY Assets295072ShareOfEOYAssets
Percentage Ownership1.00000PercentageOwnership
FieldValueIRS element (for citing)
Receipt Of Int Ann Rents Royalties0ReceiptOfIntAnnRentsRoyalties
Gift Grant Or Cap Contr To Other Org0GiftGrantOrCapContrToOtherOrg
Gift Grant Or Cap Contr Fr Other Org0GiftGrantOrCapContrFrOtherOrg
Loans Or Guarantees To Other Org1LoansOrGuaranteesToOtherOrg
Loans Or Guarantees From Other Org0LoansOrGuaranteesFromOtherOrg
Sale Of Assets To Other Org0SaleOfAssetsToOtherOrg
Purchase Of Assets From Other Org0PurchaseOfAssetsFromOtherOrg
Exchange Of Assets0ExchangeOfAssets
Rental Of Facilities To Other Orgs0RentalOfFacilitiesToOtherOrgs
Rental Of Facilities Fr Other Orgs0RentalOfFacilitiesFrOtherOrgs
Perform Of Services For Other Orgs0PerformOfServicesForOtherOrgs
Perform Of Services By Other Orgs0PerformOfServicesByOtherOrgs
Sharing Of Facilities0SharingOfFacilities
Sharing Of Paid Employees0SharingOfPaidEmployees
Reimbursement Paid To Other Org0ReimbursementPaidToOtherOrg
Reimbursement Paid By Other Org1ReimbursementPaidByOtherOrg
Other Transfer To Other Org0OtherTransferToOtherOrg
Other Transfer From Other Org1OtherTransferFromOtherOrg

Transactions Related Orgs Table TransactionsRelatedOrgsTable (3 entries)

Transaction TypeTransactionTypeAmount InvolvedAmountInvolved
Madison Community Medical Center
D129540
Madison Community Medical Center
P74616
Madison Community Medical Center
R19125

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