2011-03-21T10:32:11-05:00 2010-06-30 EIDE BAILLY LLP 200 EAST 10TH ST PO BOX 5125 SIOUX FALLS SD 571175125 990 2009-07-01 460228038 Madison Community Hospital MADI 6052566551 917 N Washington Ave Madison SD 57042 Tamara Miller 6052566551 2011-03-16 1 Laurie Hanson 6053391999 2011-03-16 2009 2016-02-24 21:20:13Z Tamara Miller 917 N Washington Ave Madison SD 57042 12628111 0 X www.madisonhospital.com X 1955 SD Provide health care services to area residents. 11 11 169 15 0 0 134593 56283 12340260 12500713 72469 65615 6400 5500 12553722 12628111 0 0 6347490 6574529 0 0 5156133 5284479 11503623 11859008 1050099 769103 10856921 10200608 2208246 803441 8648675 9397167 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 10090806 12391351 Madison 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. 10090806 1 1 0 0 0 0 0 0 0 1 0 1 0 0 0 0 0 0 0 0 1 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 0 0 1 1 0 1 169 1 0 0 0 0 0 0 0 0 0 11 11 0 0 0 0 0 0 0 1 0 0 0 1 1 1 1 0 1 1 0 0 X Mrs Tamara Miller 6052566551 917 N Washington Ave Madison SD 57042 Brad Wilkens 1.00 X X 0 0 0 Loren Scott 1.00 X X 0 0 0 Lois Niedert 1.00 X X 0 0 0 Chris LeMair 1.00 X X 0 0 0 Norm Johnson 1.00 X 0 0 0 Dan Brown 1.00 X 0 0 0 Peggy Casanova 1.00 X 0 0 0 Robin Schwebach 1.00 X 0 0 0 Leland White 1.00 X 0 0 0 Jan Davis 1.00 X 0 0 0 Greg Hollister 1.00 X 0 0 0 Tamara Miller 40.00 X 119019 0 21125 Robert Summerer 40.00 X 430090 0 41821 Darrel Simon 40.00 X 164731 0 18664 Darwin Egeberg 40.00 X 102163 0 9930 816003 0 91540 4 0 1 0 Universal Hosptial Services 7505 S Louise Ave Sioux Falls SD 57108 Bio-Med Contract 357039 Interlakes Medical Center 903 N Washington Ave Madison SD 57042 ER Call Coverage 273015 Sanford Laboratories PO Box 5056 Sioux Falls SD 57117 Reference Lab 185800 Medical X-Ray Center 1417 S Minnesota Ave Sioux Falls SD 57105 Outreach MRI 139485 DMS Imaging SDS 12-2208 PO Box 86 Minneapolis MN 55486 Outreach Nuc Med 125278 5 35438 20845 56283 Patient Service Rev 900099 12311236 12311236 Meals 624210 83741 83741 MCMC Revenue 621110 74615 74615 Miscellaneous 900099 31121 31121 12500713 64531 64531 5500 5500 5500 5500 1084 1084 1084 1084 12628111 12391351 0 180477 149110 149110 5003178 4690569 312609 244868 229810 15058 753008 710769 42239 424365 388553 35812 100 100 64360 64360 550098 393413 156685 113123 113123 139105 44461 94644 349537 113538 235999 34804 34533 271 29664 21040 8624 4964 4964 587423 587423 154527 154527 Medical Supplies 1511921 1511921 Outreach 664932 664932 Bad Debts 599742 599742 Maintenance and Repairs 344304 41502 302802 Dues and Subscriptions 22216 22216 113659 53636 60023 11859008 10090806 1768202 0 3724816 3950686 2485739 1588380 110415 129540 299291 309007 77878 114019 10386746 6704712 3975674 3682034 183108 426942 10856921 10200608 1608246 803441 600000 2208246 803441 X 8501654 9336534 147021 60633 8648675 9397167 10856921 10200608 X 0 1 1 X 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 4663527 2542868 2120659 5430910 4009001 1421909 292309 152843 139466 3682034 12628111 11859008 769103 -20611 -20611 748492 12607500 0 12607500 20611 20611 12628111 11859008 0 11859008 0 11859008 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. 1 1 X 1 X 130.000000000000 1 X 1 1 1 0 0 76930 76930 0.00680 588737 383231 205506 0.01830 665667 383231 282436 0.02510 9934 9934 0.00090 1 567307 431168 136139 0.01210 5000 5000 0.00040 1 582241 431168 151073 0.01340 1 1247908 814399 433509 0.03850 0 362040 49401 4844733 4956938 -112205 X 1 0 Madison Community Hospital

917 N Washington Avenue Madison SD 57042

X X X Part 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. Part I, Line 7f: Bad debt expense of $599,742 was subtracted from total operating expense. Part 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. Part 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. Part 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. Part 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. Part 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. Part 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. X X 0 0 0 1 0 0 0 0 0 Robert Summerer 430090 0 0 0 0 0 22623 0 20120 0 472833 0 0 0 Darrel Simon 164731 0 0 0 0 0 8678 0 10747 0 184156 0 0 0 Part I, Line 5 Robert Summerer, DO is paid based on production. Form 990, Part VI, Section A, line 8b The 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 11 The 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 12c All 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 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 other than as included on the website. Madison Community Medical Center 917 N Washington Avenue Madison SD 57045 460398320 Office Rental SD C 117419 295072 1.00000 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 1 0 1 Madison Community Medical Center D 129540 Madison Community Medical Center P 74616 Madison Community Medical Center R 19125