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MADELIA HEALTH FOUNDATION: Form 990, tax year 2021

View the entire original 990 at ProPublica ↗

Organization
MADELIA HEALTH FOUNDATION (EIN 73-1719218)
Tax period
2021-06-01 to 2022-05-31
Filed
2024-01-25
IRS object ID
202410259349300841
Schema version
2021v4.2
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)
Return2024-01-25T16:21:50-06:00ReturnTs
Tax Period End2022-05-31TaxPeriodEndDt

Preparer Firm PreparerFirmGrp

FieldValueIRS element (for citing)
Preparer Firm EIN450250958PreparerFirmEIN

Preparer Firm Name PreparerFirmName

FieldValueIRS element (for citing)
Business Name Line1EIDE BAILLY LLPBusinessNameLine1Txt

Preparer US Address PreparerUSAddress

FieldValueIRS element (for citing)
Address Line1345 N REID PL STE 400AddressLine1Txt
CitySIOUX FALLSCityNm
State AbbreviationSDStateAbbreviationCd
ZIP571037034ZIPCd
FieldValueIRS element (for citing)
Return Type990ReturnTypeCd
Tax Period Begin2021-06-01TaxPeriodBeginDt

Filer Filer

FieldValueIRS element (for citing)
EIN731719218EIN

Business Name BusinessName

FieldValueIRS element (for citing)
Business Name Line1MADELIA HEALTH FOUNDATIONBusinessNameLine1Txt
FieldValueIRS element (for citing)
Business Name ControlMADEBusinessNameControlTxt
Phone5076423255PhoneNum

US Address USAddress

FieldValueIRS element (for citing)
Address Line1121 DREW AVE SEAddressLine1Txt
CityMADELIACityNm
State AbbreviationMNStateAbbreviationCd
ZIP56062ZIPCd

Business Officer BusinessOfficerGrp

FieldValueIRS element (for citing)
PersonDAVID WALZPersonNm
Person TitleCEOPersonTitleTxt
Phone5076423255PhoneNum
Signature2024-01-25SignatureDt
Discuss With Paid PreparerYes (1)DiscussWithPaidPreparerInd

Signing Officer SigningOfficerGrp

Person Full Name PersonFullName

FieldValueIRS element (for citing)
Person FirstDAVIDPersonFirstNm
Person LastWALZPersonLastNm
FieldValueIRS element (for citing)
SSN999009999SSN

Preparer Person PreparerPersonGrp

FieldValueIRS element (for citing)
Preparer PersonLAURIE HANSON CPAPreparerPersonNm
PTINP00851848PTIN
Phone6053391999PhoneNum
Preparation2024-01-25PreparationDt

Additional Filer Information AdditionalFilerInformation

Trusted Customer TrustedCustomerGrp

FieldValueIRS element (for citing)
Trusted Customer3TrustedCustomerCd
Authentication Assurance LevelAAL1AuthenticationAssuranceLevelCd
Identity Assurance LevelIAL1IdentityAssuranceLevelCd
FieldValueIRS element (for citing)
Tax2021TaxYr
Build TS2023-04-26 12:10:37ZBuildTS

Form 990 IRS990

FieldValueIRS element (for citing)
Name ChangeYes (X)NameChangeInd
Principal OfficerDAVID WALZPrincipalOfficerNm

US Address USAddress

FieldValueIRS element (for citing)
Address Line1121 DREW AVE SEAddressLine1Txt
CityMADELIACityNm
State AbbreviationMNStateAbbreviationCd
ZIP56062ZIPCd
FieldValueIRS element (for citing)
Gross Receipts$72,803GrossReceiptsAmt
Group Return For Affiliates0GroupReturnForAffiliatesInd
Organization501c3Yes (X)Organization501c3Ind
Website AddressWWW.MCHOSPITAL.ORGWebsiteAddressTxt
Type Of Organization CorpYes (X)TypeOfOrganizationCorpInd
Formation2004FormationYr
Legal Domicile StateMNLegalDomicileStateCd
Activity Or MissionTO SUPPORT THE MISSION OF MADELIA HEALTH, INCORPORATED.ActivityOrMissionDesc
Voting Members Governing Body9VotingMembersGoverningBodyCnt
Voting Members Independent8VotingMembersIndependentCnt
Total Employee0TotalEmployeeCnt
Total Volunteers64TotalVolunteersCnt
Total Gross UBI$0TotalGrossUBIAmt
Net Unrelated Bus Txbl Incm$0NetUnrelatedBusTxblIncmAmt
PY Contributions Grants$115,554PYContributionsGrantsAmt
CY Contributions Grants$61,165CYContributionsGrantsAmt
PY Program Service Revenue$0PYProgramServiceRevenueAmt
CY Program Service Revenue$0CYProgramServiceRevenueAmt
PY Investment Income$27,931PYInvestmentIncomeAmt
CY Investment Income$11,638CYInvestmentIncomeAmt
PY Other Revenue$0PYOtherRevenueAmt
CY Other Revenue$0CYOtherRevenueAmt
PY Total Revenue$143,485PYTotalRevenueAmt
CY Total Revenue$72,803CYTotalRevenueAmt
PY Grants And Similar Paid$261,946PYGrantsAndSimilarPaidAmt
CY Grants And Similar Paid$66,173CYGrantsAndSimilarPaidAmt
PY Benefits Paid To Members$0PYBenefitsPaidToMembersAmt
CY Benefits Paid To Members$0CYBenefitsPaidToMembersAmt
PY Salaries Comp Emp Bnft Paid$59,042PYSalariesCompEmpBnftPaidAmt
CY Salaries Comp Emp Bnft Paid$40,454CYSalariesCompEmpBnftPaidAmt
PY Total Prof Fndrsng Expns$0PYTotalProfFndrsngExpnsAmt
CY Total Prof Fndrsng Expns$0CYTotalProfFndrsngExpnsAmt
CY Total Fundraising Expense$69,684CYTotalFundraisingExpenseAmt
PY Other Expenses$39,356PYOtherExpensesAmt
CY Other Expenses$29,230CYOtherExpensesAmt
PY Total Expenses$360,344PYTotalExpensesAmt
CY Total Expenses$135,857CYTotalExpensesAmt
PY Revenues Less Expenses-$216,859PYRevenuesLessExpensesAmt
CY Revenues Less Expenses-$63,054CYRevenuesLessExpensesAmt
Total Assets BOY$1,080,951TotalAssetsBOYAmt
Total Assets EOY$1,034,846TotalAssetsEOYAmt
Total Liabilities BOY$46,799TotalLiabilitiesBOYAmt
Total Liabilities EOY$56,872TotalLiabilitiesEOYAmt
Net Assets Or Fund Balances BOY$1,034,152NetAssetsOrFundBalancesBOYAmt
Net Assets Or Fund Balances EOY$977,974NetAssetsOrFundBalancesEOYAmt
MissionMADELIA HEALTH FOUNDATION EXISTS TO BE STEWARDS OF DONATIONS GIVEN TO SUPPORT THE STATE-OF-THE-ART HEALTH SERVICES PROVIDED BY MADELIA HEALTH. THE FOUNDATION SERVES AS THE BRIDGE BETWEEN MADELIA HEALTH, ITS PATIENTS, AREA FRIENDS AND SUPPORTERS.MissionDesc
Significant New Program Srvc0SignificantNewProgramSrvcInd
Significant Change0SignificantChangeInd
Expense$66,173ExpenseAmt
Grant$66,173GrantAmt
Revenue$0RevenueAmt
DescMADELIA HEALTH FOUNDATION EXISTS TO BE STEWARDS OF DONATIONS GIVEN TO SUPPORT THE STATE-OF-THE-ART HEALTH SERVICES PROVIDED BY MADELIA HEALTH. THE FOUNDATION, SERVES AS THE BRIDGE BETWEEN MADELIA HEALTH, ITS PATIENTS, AREA FRIENDS AND SUPPORTERS.Desc
Total Program Service Expenses$66,173TotalProgramServiceExpensesAmt
Described In Section501c3Yes (1)DescribedInSection501c3Ind
Schedule B Required0ScheduleBRequiredInd
Political Campaign Acty0PoliticalCampaignActyInd
Lobbying Activities0LobbyingActivitiesInd
Subject To Proxy Tax0SubjectToProxyTaxInd
Donor Advised Fund0DonorAdvisedFundInd
Conservation Easements0ConservationEasementsInd
Collections Of Art0CollectionsOfArtInd
Credit Counseling0CreditCounselingInd
Donor Rstr Or Quasi Endowments0DonorRstrOrQuasiEndowmentsInd
Report Land Building EquipmentYes (1)ReportLandBuildingEquipmentInd
Report Investments Other Sec0ReportInvestmentsOtherSecInd
Report Program Related Invst0ReportProgramRelatedInvstInd
Report Other Assets0ReportOtherAssetsInd
Report Other LiabilitiesYes (1)ReportOtherLiabilitiesInd
Include FIN48 FootnoteYes (1)IncludeFIN48FootnoteInd
Independent Audit Fincl Stmt0IndependentAuditFinclStmtInd
Consolidated Audit Fincl StmtYes (1)ConsolidatedAuditFinclStmtInd
School Operating0SchoolOperatingInd
Foreign Office0ForeignOfficeInd
Foreign Activities0ForeignActivitiesInd
More Than5000 K To Org0MoreThan5000KToOrgInd
More Than5000 K To Individuals0MoreThan5000KToIndividualsInd
Professional Fundraising0ProfessionalFundraisingInd
Fundraising Activities0FundraisingActivitiesInd
Gaming Activities0GamingActivitiesInd
Operate Hospital0OperateHospitalInd
Grants To OrganizationsYes (1)GrantsToOrganizationsInd
Grants To Individuals0GrantsToIndividualsInd
Schedule J RequiredYes (1)ScheduleJRequiredInd
Tax Exempt Bonds0TaxExemptBondsInd
Engaged In Excess Benefit Trans0EngagedInExcessBenefitTransInd
PY Excess Benefit Trans0PYExcessBenefitTransInd
Loan Outstanding0LoanOutstandingInd
Grant To Related Person0GrantToRelatedPersonInd
Business Rln With Org Mem0BusinessRlnWithOrgMemInd
Business Rln With Fam Mem0BusinessRlnWithFamMemInd
Business Rln With35 Ctrl Ent0BusinessRlnWith35CtrlEntInd
Deductible Non Cash Contri0DeductibleNonCashContriInd
Deductible Art Contribution0DeductibleArtContributionInd
Terminate Operations0TerminateOperationsInd
Partial Liquidation0PartialLiquidationInd
Disregarded Entity0DisregardedEntityInd
Related EntityYes (1)RelatedEntityInd
Related Organization Ctrl Ent0RelatedOrganizationCtrlEntInd
Trnsfr Exmpt Non Chrtbl Rltd Org0TrnsfrExmptNonChrtblRltdOrgInd
Activities Conducted Prtshp0ActivitiesConductedPrtshpInd
Schedule O RequiredYes (1)ScheduleORequiredInd
IRP Document0IRPDocumentCnt
IRP Document W2 G0IRPDocumentW2GCnt
Employee0EmployeeCnt
Unrelated Bus Incm Over Limit0UnrelatedBusIncmOverLimitInd
Foreign Financial Account0ForeignFinancialAccountInd
Prohibited Tax Shelter Trans0ProhibitedTaxShelterTransInd
Taxable Party Notification0TaxablePartyNotificationInd
Nondeductible Contributions0NondeductibleContributionsInd
Quid Pro Quo Contributions0QuidProQuoContributionsInd
Form8282 Property Disposed Of0Form8282PropertyDisposedOfInd
Indoor Tanning Services0IndoorTanningServicesInd
Subj To Tax Rmnrtn Ex Prcht Pymt0SubjToTaxRmnrtnExPrchtPymtInd
Subject To Excs Tax Net Invst Inc0SubjectToExcsTaxNetInvstIncInd
Info In Schedule O Part VIYes (X)InfoInScheduleOPartVIInd
Governing Body Voting Members9GoverningBodyVotingMembersCnt
Independent Voting Member8IndependentVotingMemberCnt
Family Or Business Rln0FamilyOrBusinessRlnInd
Delegation Of Mgmt Duties0DelegationOfMgmtDutiesInd
Change To Org DocumentsYes (1)ChangeToOrgDocumentsInd
Material Diversion Or Misuse0MaterialDiversionOrMisuseInd
Members Or StockholdersYes (1)MembersOrStockholdersInd
Election Of Board MembersYes (1)ElectionOfBoardMembersInd
Decisions Subject To Approva0DecisionsSubjectToApprovaInd
Minutes Of Governing BodyYes (1)MinutesOfGoverningBodyInd
Minutes Of CommitteesYes (1)MinutesOfCommitteesInd
Officer Mailing Address0OfficerMailingAddressInd
Local Chapters0LocalChaptersInd
Form990 Provided To Gvrn Body0Form990ProvidedToGvrnBodyInd
Conflict Of Interest PolicyYes (1)ConflictOfInterestPolicyInd
Annual Disclosure Covered PrsnYes (1)AnnualDisclosureCoveredPrsnInd
Regular Monitoring EnfrcYes (1)RegularMonitoringEnfrcInd
Whistleblower PolicyYes (1)WhistleblowerPolicyInd
Document Retention PolicyYes (1)DocumentRetentionPolicyInd
Compensation Process CEO0CompensationProcessCEOInd
Compensation Process Other0CompensationProcessOtherInd
Investment In Joint Venture0InvestmentInJointVentureInd
States Where Copy Of Return Is FldMNStatesWhereCopyOfReturnIsFldCd
Upon RequestYes (X)UponRequestInd

Books In Care Of Detail BooksInCareOfDetail

Business Name BusinessName

FieldValueIRS element (for citing)
Business Name Line1BRUCE CRAVENBusinessNameLine1Txt
FieldValueIRS element (for citing)
Phone5076423255PhoneNum

US Address USAddress

FieldValueIRS element (for citing)
Address Line1121 DREW AVENUE SOUTHEASTAddressLine1Txt
CityMADELIACityNm
State AbbreviationMNStateAbbreviationCd
ZIP56062ZIPCd

Form990 Part VII Section A Form990PartVIISectionAGrp (13 entries)

TitleTitleTxtAverage Hours Per WeekAverageHoursPerWeekRtAverage Hours Per Week Rltd OrgAverageHoursPerWeekRltdOrgRtIndividual Trustee Or DirectorIndividualTrusteeOrDirectorIndOfficerOfficerIndReportable Comp From OrgReportableCompFromOrgAmtReportable Comp From Rltd OrgReportableCompFromRltdOrgAmtOther CompensationOtherCompensationAmt
JIM HOPMAN
BOARD CHAIR0.200.00Yes (X)Yes (X)$0$0$0
ALLIE KIECKER
VICE CHAIR0.200.00Yes (X)Yes (X)$0$0$0
DAN GAHLER
TREASURER0.200.00Yes (X)Yes (X)$0$0$0
JOELEEN KRIER
SECRETARY0.200.00Yes (X)Yes (X)$0$0$0
DENNIS ARDUSER
MCH GOVERNING BOARD PRESIDENT0.201.00Yes (X)Yes (X)$0$1,800$0
PHIL CARTER
BOARD MEMEBER FROM 05/20220.200.00Yes (X)$0$0$0
JENNIFER BULTER
BOARD MEMEBER FROM 09/20210.200.00Yes (X)$0$0$0
MELANIE KNAAK-GUYER
BOARD MEMBER FROM 07/20210.200.00Yes (X)$0$0$0
CONNIE MILLER
BOARD MEMBER FROM 05/20220.200.00Yes (X)$0$0$0
JEFF MENGENHAUSEN
MCH CEO-EX OFFICIO MEMBER UNTIL 09/20210.2040.00Yes (X)Yes (X)$0$207,486$22,915
JAKE REDDEN
MCH CEO-EX OFFICIO MEMBER FROM 10/20210.2040.00Yes (X)Yes (X)$0$52,876$2,345
SARA SCHAUER
FOUNDATION DIRECTOR32.000.00Yes (X)$0$46,877$86
BRUCE CARVEN
CFO FROM 10/20210.2040.00Yes (X)$0$32,402$2,364
FieldValueIRS element (for citing)
Total Reportable Comp From Org$0TotalReportableCompFromOrgAmt
Tot Reportable Comp Rltd Org$341,441TotReportableCompRltdOrgAmt
Total Other Compensation$27,710TotalOtherCompensationAmt
Indiv Rcvd Greater Than100 K4IndivRcvdGreaterThan100KCnt
Former Ofcr Employees Listed0FormerOfcrEmployeesListedInd
Total Comp Greater Than150 KYes (1)TotalCompGreaterThan150KInd
Compensation From Other Srcs0CompensationFromOtherSrcsInd
Cntrct Rcvd Greater Than100 K0CntrctRcvdGreaterThan100KCnt
All Other Contributions$61,165AllOtherContributionsAmt
Total Contributions$61,165TotalContributionsAmt

Investment Income InvestmentIncomeGrp

FieldValueIRS element (for citing)
Total Revenue Column$11,638TotalRevenueColumnAmt
Exclusion$11,638ExclusionAmt

Total Revenue TotalRevenueGrp

FieldValueIRS element (for citing)
Total Revenue Column$72,803TotalRevenueColumnAmt
Related Or Exempt Func Income$0RelatedOrExemptFuncIncomeAmt
Unrelated Business Revenue$0UnrelatedBusinessRevenueAmt
Exclusion$11,638ExclusionAmt
FieldValueIRS element (for citing)
Info In Schedule O Part IXYes (X)InfoInScheduleOPartIXInd

Grants To Domestic Orgs GrantsToDomesticOrgsGrp

FieldValueIRS element (for citing)
Total$66,173TotalAmt
Program Services$66,173ProgramServicesAmt

Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp

FieldValueIRS element (for citing)
Total$37,543TotalAmt
Fundraising$37,543FundraisingAmt

Payroll Taxes PayrollTaxesGrp

FieldValueIRS element (for citing)
Total$2,911TotalAmt
Fundraising$2,911FundraisingAmt

Office Expenses OfficeExpensesGrp

FieldValueIRS element (for citing)
Total$29,204TotalAmt
Fundraising$29,204FundraisingAmt

Travel TravelGrp

FieldValueIRS element (for citing)
Total$26TotalAmt
Fundraising$26FundraisingAmt

Total Functional Expenses TotalFunctionalExpensesGrp

FieldValueIRS element (for citing)
Total$135,857TotalAmt
Program Services$66,173ProgramServicesAmt
Management And General$0ManagementAndGeneralAmt
Fundraising$69,684FundraisingAmt

Cash Non Interest Bearing CashNonInterestBearingGrp

FieldValueIRS element (for citing)
BOY$284,160BOYAmt
EOY$284,947EOYAmt
FieldValueIRS element (for citing)
Land Bldg Equip Cost Or Other Bss$10,853LandBldgEquipCostOrOtherBssAmt
Land Bldg Equip Accum Deprec$10,853LandBldgEquipAccumDeprecAmt

Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Investments Pub Traded Sec InvestmentsPubTradedSecGrp

FieldValueIRS element (for citing)
BOY$796,791BOYAmt
EOY$749,899EOYAmt

Total Assets TotalAssetsGrp

FieldValueIRS element (for citing)
BOY$1,080,951BOYAmt
EOY$1,034,846EOYAmt

Other Liabilities OtherLiabilitiesGrp

FieldValueIRS element (for citing)
BOY$46,799BOYAmt
EOY$56,872EOYAmt

Total Liabilities TotalLiabilitiesGrp

FieldValueIRS element (for citing)
BOY$46,799BOYAmt
EOY$56,872EOYAmt
FieldValueIRS element (for citing)
Organization Follows FASB117Yes (X)OrganizationFollowsFASB117Ind

No Donor Restriction Net Assets NoDonorRestrictionNetAssetsGrp

FieldValueIRS element (for citing)
BOY$551,021BOYAmt
EOY$618,025EOYAmt

Donor Restriction Net Assets DonorRestrictionNetAssetsGrp

FieldValueIRS element (for citing)
BOY$483,131BOYAmt
EOY$359,949EOYAmt

Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp

FieldValueIRS element (for citing)
BOY$1,034,152BOYAmt
EOY$977,974EOYAmt

Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp

FieldValueIRS element (for citing)
BOY$1,080,951BOYAmt
EOY$1,034,846EOYAmt
FieldValueIRS element (for citing)
Info In Schedule O Part XIYes (X)InfoInScheduleOPartXIInd
Reconcilation Revenue Expnss-$63,054ReconcilationRevenueExpnssAmt
Net Unrlzd Gains Losses Invst-$57,297NetUnrlzdGainsLossesInvstAmt
Other Changes In Net Assets$64,173OtherChangesInNetAssetsAmt
Method Of Accounting AccrualYes (X)MethodOfAccountingAccrualInd
Accountant Compile Or Review0AccountantCompileOrReviewInd
FS AuditedYes (1)FSAuditedInd

FS Audited Basis FSAuditedBasisGrp

FieldValueIRS element (for citing)
Consolidated Basis Fincl StmtYes (X)ConsolidatedBasisFinclStmtInd
FieldValueIRS element (for citing)
Audit CommitteeYes (1)AuditCommitteeInd
Federal Grant Audit Required0FederalGrantAuditRequiredInd

Schedule A IRS990ScheduleA

FieldValueIRS element (for citing)
Supporting Organization509a3Yes (X)SupportingOrganization509a3Ind
Supporting Org Type1Yes (X)SupportingOrgType1Ind
Supported Organizations1SupportedOrganizationsCnt

Supported Org Information SupportedOrgInformationGrp

Supported Organization Name SupportedOrganizationName

FieldValueIRS element (for citing)
Business Name Line1MADELIA HEALTH INCBusinessNameLine1Txt
FieldValueIRS element (for citing)
EIN410758512EIN
Organization Type3OrganizationTypeCd
Governing Document ListedYes (1)GoverningDocumentListedInd
Support$66,173SupportAmt
Other Support$0OtherSupportAmt
FieldValueIRS element (for citing)
Supported Organizations Total1SupportedOrganizationsTotalCnt
Support Sum$66,173SupportSumAmt
Other Support Sum$0OtherSupportSumAmt

Form990 Sch A Supporting Org Form990SchASupportingOrgGrp

FieldValueIRS element (for citing)
Listed By Name Governing DocYes (1)ListedByNameGoverningDocInd
Suprt Org No IRS Determination0SuprtOrgNoIRSDeterminationInd
Supported Org Section C4560SupportedOrgSectionC456Ind
Supported Org Not Organized US0SupportedOrgNotOrganizedUSInd
Organization Change Suprt Org0OrganizationChangeSuprtOrgInd
Support Non Supported Org0SupportNonSupportedOrgInd
Payment Substantial Contribtr0PaymentSubstantialContribtrInd
Loan Disqualified Person0LoanDisqualifiedPersonInd
Controlled Disqualified Prsn0ControlledDisqualifiedPrsnInd
Disqualified Prsn Controll Int0DisqualifiedPrsnControllIntInd
Disqualified Prsn Ownr Int0DisqualifiedPrsnOwnrIntInd
Excess Business Holdings Rules0ExcessBusinessHoldingsRulesInd
Contribution Controller0ContributionControllerInd
Contribution Family0ContributionFamilyInd
Contribution35 Controlled0Contribution35ControlledInd

Form990 Sch A Type1 Suprt Org Form990SchAType1SuprtOrgGrp

FieldValueIRS element (for citing)
Power Appoint Majority Dir TrstYes (1)PowerAppointMajorityDirTrstInd
Operate Benefit Non Suprt Org0OperateBenefitNonSuprtOrgInd

Schedule D IRS990ScheduleD

CY Endwmt Fund CYEndwmtFundGrp

FieldValueIRS element (for citing)
Beginning Year Balance$359,949BeginningYearBalanceAmt
Investment Earnings Or Losses$55,745InvestmentEarningsOrLossesAmt
End Year Balance$415,694EndYearBalanceAmt

CY Minus1 Yr Endwmt Fund CYMinus1YrEndwmtFundGrp

FieldValueIRS element (for citing)
Beginning Year Balance$359,949BeginningYearBalanceAmt
Investment Earnings Or Losses$61,458InvestmentEarningsOrLossesAmt
End Year Balance$359,949EndYearBalanceAmt

CY Minus2 Yr Endwmt Fund CYMinus2YrEndwmtFundGrp

FieldValueIRS element (for citing)
Beginning Year Balance$235,949BeginningYearBalanceAmt
Contributions$124,000ContributionsAmt
End Year Balance$359,949EndYearBalanceAmt

CY Minus3 Yr Endwmt Fund CYMinus3YrEndwmtFundGrp

FieldValueIRS element (for citing)
Beginning Year Balance$235,949BeginningYearBalanceAmt
End Year Balance$235,949EndYearBalanceAmt

CY Minus4 Yr Endwmt Fund CYMinus4YrEndwmtFundGrp

FieldValueIRS element (for citing)
Beginning Year Balance$235,949BeginningYearBalanceAmt
End Year Balance$235,949EndYearBalanceAmt
FieldValueIRS element (for citing)
Board Designated Balance EOY0.00000BoardDesignatedBalanceEOYPct
Prmnnt Endowment Balance EOY0.86590PrmnntEndowmentBalanceEOYPct
Term Endowment Balance EOY0.13410TermEndowmentBalanceEOYPct
Endowments Held Unrelated Org0EndowmentsHeldUnrelatedOrgInd
Endowments Held Related Org0EndowmentsHeldRelatedOrgInd

Equipment EquipmentGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$10,853OtherCostOrOtherBasisAmt
Depreciation$10,853DepreciationAmt
Book Value$0BookValueAmt
FieldValueIRS element (for citing)
Total Book Value Land Buildings$0TotalBookValueLandBuildingsAmt

Other Liabilities Org OtherLiabilitiesOrgGrp

FieldValueIRS element (for citing)
DescDUE TO RELATED PARTYDesc
Amt$56,872Amt
FieldValueIRS element (for citing)
Total Liability$56,872TotalLiabilityAmt
Footnote TextYes (X)FootnoteTextInd

Supplemental Information Detail SupplementalInformationDetail (2 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
PART V, LINE 4:THE INTENDED USE OF THE ENDOWMENT FUNDS ARE TO BE PERIODICALLY DETERMINED BY THE FOUNDATION BOARD OF DIRECTORS TO SUPPORT THE PURPOSE OF THE FOUNDATION.
PART X, LINE 2:THE FOUNDATION BELIEVES THAT IT HAS 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 FINANCIAL STATEMENTS. THE FOUNDATION 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.

Schedule I IRS990ScheduleI

FieldValueIRS element (for citing)
Grant Records MaintainedYes (1)GrantRecordsMaintainedInd

Recipient Table RecipientTable

Recipient Business Name RecipientBusinessName

FieldValueIRS element (for citing)
Business Name Line1MADELIA HEALTHBusinessNameLine1Txt

US Address USAddress

FieldValueIRS element (for citing)
Address Line1121 DREW AVE SEAddressLine1Txt
CityMADELIACityNm
State AbbreviationMNStateAbbreviationCd
ZIP56062ZIPCd
FieldValueIRS element (for citing)
Recipient EIN410758512RecipientEIN
IRC Section501(C)(3)IRCSectionDesc
Cash Grant$66,173CashGrantAmt
Non Cash Assistance$0NonCashAssistanceAmt
Purpose Of GrantFUNDING FOR EQUIPMENT, SUPPLIES, IMPROVEMENTSPurposeOfGrantTxt
FieldValueIRS element (for citing)
Total501c3 Org1Total501c3OrgCnt

Supplemental Information Detail SupplementalInformationDetail

FieldValueIRS element (for citing)
Form And Line ReferencePART I, LINE 2:FormAndLineReferenceDesc
ExplanationALL GRANTS ARE MADE TO A RELATED ORGANIZATION THAT IS UNDER COMMON MANAGEMENT WHO REGULARLY MONITORS THE ACTIVITIES, REVENUES, AND EXPENDITURES OF THE RELATED ORGANIZATION.ExplanationTxt

Schedule J IRS990ScheduleJ

FieldValueIRS element (for citing)
Severance Payment0SeverancePaymentInd
Supplemental Nonqual Rtr Plan0SupplementalNonqualRtrPlanInd
Equity Based Comp Arrngm0EquityBasedCompArrngmInd
Comp Based On Revenue Of Flng Org0CompBasedOnRevenueOfFlngOrgInd
Comp Bsd On Rev Related Orgs0CompBsdOnRevRelatedOrgsInd
Comp Bsd Net Earns Flng Org0CompBsdNetEarnsFlngOrgInd
Comp Bsd Net Earns Rltd Orgs0CompBsdNetEarnsRltdOrgsInd
Any Non Fixed Payments0AnyNonFixedPaymentsInd
Initial Contract Exception0InitialContractExceptionInd

Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp

FieldValueIRS element (for citing)
PersonJEFF MENGENHAUSENPersonNm
TitleMCH CEO-EX OFFICIO MEMBER UNTIL 09/2TitleTxt
Base Compensation Filing Org$0BaseCompensationFilingOrgAmt
Compensation Based On Rltd Orgs$207,486CompensationBasedOnRltdOrgsAmt
Bonus Filing Organization$0BonusFilingOrganizationAmount
Bonus Related Organizations$0BonusRelatedOrganizationsAmt
Other Compensation Filing Org$0OtherCompensationFilingOrgAmt
Other Compensation Rltd Orgs$0OtherCompensationRltdOrgsAmt
Deferred Compensation Flng Org$0DeferredCompensationFlngOrgAmt
Deferred Comp Rltd Orgs$14,463DeferredCompRltdOrgsAmt
Nontaxable Benefits Filing Org$0NontaxableBenefitsFilingOrgAmt
Nontaxable Benefits Rltd Orgs$9,190NontaxableBenefitsRltdOrgsAmt
Total Compensation Filing Org$0TotalCompensationFilingOrgAmt
Total Compensation Rltd Orgs$231,139TotalCompensationRltdOrgsAmt
Comp Report Prior990 Filing Org$0CompReportPrior990FilingOrgAmt
Comp Report Prior990 Rltd Orgs$0CompReportPrior990RltdOrgsAmt

Supplemental Information Detail SupplementalInformationDetail

FieldValueIRS element (for citing)
Form And Line ReferenceSCHEDULE J PART I LINE 3FormAndLineReferenceDesc
ExplanationTHE FOUNDATION RELIED ON THE RELATED ORGANIZATION, MADELIA HEALTH, FOR DETERMINING THE COMPENSATION FOR THE CEO USING THE METHODS DESCRIBED IN PART I, LINE 3.ExplanationTxt

Schedule O IRS990ScheduleO

Supplemental Information Detail SupplementalInformationDetail (10 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
FORM 990, PART VI, SECTION A, LINE 1ATHE EXECUTIVE COMMITTEE SHALL CONSIST OF THE CHAIRPERSON, THE VICE CHAIRPERSON, THE EXECUTIVE DIRECTOR, THE SECRETARY, AND THE TREASURER AS EX OFFICIO VOTING MEMBERS THEREOF. THE EXECUTIVE COMMITTEE SHALL HAVE AND EXERCISE THE FULL AUTHORITY OF THE BOARD EXCEPT AS OTHERWISE LIMITED BY LAW, BY THE BOARD, OR BY THESE BYLAWS. THE EXECUTIVE COMMITTEE SHALL TRANSACT THE BUSINESS OF THE FOUNDATION DURING THE PERIOD BETWEEN MEETINGS OF THE BOARD.
FORM 990, PART VI, SECTION A, LINE 4THE ORGANIZATION HAS CHANGED ITS NAME FROM MADELIA COMMUNITY HOSPITAL FOUNDATION TO MADELIA HEALTH FOUNDATION.
FORM 990, PART VI, SECTION A, LINE 6THE SOLE MEMBER OF THE FOUNDATION IS MADELIA HEALTH.
FORM 990, PART VI, SECTION A, LINE 7ATHE MEMBER IS ALLOWED TO ELECT MEMBERS OF THE GOVERNING BODY.
FORM 990, PART VI, SECTION B, LINE 11BTHE FORM 990 IS REVIEWED BY THE BOARD OF DIRECTORS SUBSEQUENT TO FILING THE FORM 990 WITH THE IRS. THE FORM 990 WILL BE PRESENTED BY FINANCE AT THE REGULAR MEETING OF THE BOARD OF DIRECTORS.
FORM 990, PART VI, SECTION B, LINE 12CTHE FOUNDATION'S CONFLICT OF INTEREST POLICY APPLIES TO ALL MEMBERS OF THE BOARD AND CORPORATE OFFICERS, AGENTS AND EMPLOYEES OF THE FOUNDATION. IT IS THE OBLIGATION OF THE FOUNDATION'S MANAGEMENT TO PUBLICIZE THIS POLICY TO ALL SUCH PARTIES ON A RECURRING BASIS. THE CONFLICT OF INTEREST POLICY AND AN ANNUAL DISCLOSURE STATEMENT ARE CIRCULATED TO DIRECTORS AND OFFICERS TO ASSIST THEM IN CONSIDERING SUCH DISCLOSURES, BUT DISCLOSURE IS APPROPIRATE WHENEVER A CONFLICT MAY OCCUR. THE WRITTEN NOTICES OF DISCLOSURE OF CONFLICTS OR DUALITIES OF INTEREST ARE FILED WITH THE EXECUTIVE DIRECTOR OR ANY OTHER OFFICER. IF A CONFLICT OF INTEREST EXISTS, THE CONFLICTED INDIVIDUAL REFRAINS FROM BOTH DISCUSSION AND VOTING ON THE MATTER.
FORM 990, PART VI, SECTION B, LINE 15MADELIA HEALTH FOUNDATION STAFFING IS FUNDED THROUGH MADELIA HEALTH. THAT ENSURES THAT THE COMPENSATION PAID TO ITS EMPLOYEES AND ADMINISTRATIVE STAFF BE CONSISTENT WITH POLICY AND PROVIDE EQUITABLE STANDARDS FOR WAGE AND BENEFITS BASED ON ANNUAL REGIONAL SURVEY OF COMPARABLE ENTITIES. THE GOVERNING BOARD REVIEWS ANNUALLY THE FOUNDATION DIRECTOR'S PERFORMANCE AND THE BASIS IS THE ANNUAL MEDISOTA SALARY SURVEY AND RATE INCREASE AS AWARDED TO ALL STAFF.
FORM 990, PART VI, SECTION C, LINE 19MADELIA HEALTH FOUNDATION MAKES ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC AT THE ANNUAL CORPORATION MEETING AND UPON REQUEST.
FORM 990 PART IX, LINE 5 TO LINE 10MADELIA HEALTH FOUNDATION DOES NOT HAVE ANY EMPLOYEES. THE SALARY AND BENEFITS EXPENSES ON PAGE 10 OF THE 990 ARE AMOUNTS THAT ARE ALLOCATED TO MADELIA HEALTH FOUNDATION FROM MADELIA HEALTH FOR THE FOUNDATION'S PORTION OF THE EXPENSES.
FORM 990, PART XI, LINE 9:INTERCOMPANY TRANSFERS 66,173. NET ASSET RELEASED FROM RESTRICTION FOR CAPITAL EXPENDITURE -2,000.

Schedule R IRS990ScheduleR

Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp

Disregarded Entity Name DisregardedEntityName

FieldValueIRS element (for citing)
Business Name Line1MADELIA HEALTHBusinessNameLine1Txt

US Address USAddress

FieldValueIRS element (for citing)
Address Line1121 DREW AVENUE SEAddressLine1Txt
CityMADELIACityNm
State AbbreviationMNStateAbbreviationCd
ZIP56062ZIPCd
FieldValueIRS element (for citing)
EIN410758512EIN
Primary ActivitiesHOSPITALPrimaryActivitiesTxt
Legal Domicile StateMNLegalDomicileStateCd
Exempt Code Section501(C)(3)ExemptCodeSectionTxt
Public Charity StatusLINE 3PublicCharityStatusTxt
Direct Controlling NAN/ADirectControllingNACd
Controlled Organization0ControlledOrganizationInd
FieldValueIRS element (for citing)
Receipt Of Int Annts Rnts Rylts0ReceiptOfIntAnntsRntsRyltsInd
Gift Grnt Or Cap Contri To Oth OrgYes (1)GiftGrntOrCapContriToOthOrgInd
Gift Grnt Cap Contri From Oth Org0GiftGrntCapContriFromOthOrgInd
Loans Or Guarantees To Other Org0LoansOrGuaranteesToOtherOrgInd
Loans Or Guarantees From Oth Org0LoansOrGuaranteesFromOthOrgInd
Div Related Organization0DivRelatedOrganizationInd
Asset Sale To Other Org0AssetSaleToOtherOrgInd
Asset Purchase From Other Org0AssetPurchaseFromOtherOrgInd
Asset Exchange0AssetExchangeInd
Rental Of Facilities To Oth Org0RentalOfFacilitiesToOthOrgInd
Rental Of Fclts From Oth Org0RentalOfFcltsFromOthOrgInd
Perform Of Services For Oth OrgYes (1)PerformOfServicesForOthOrgInd
Perform Of Services By Other Org0PerformOfServicesByOtherOrgInd
Sharing Of FacilitiesYes (1)SharingOfFacilitiesInd
Paid Employees SharingYes (1)PaidEmployeesSharingInd
Reimbursement Paid To Other Org0ReimbursementPaidToOtherOrgInd
Reimbursement Paid By Other Org0ReimbursementPaidByOtherOrgInd
Transfer To Other OrgYes (1)TransferToOtherOrgInd
Transfer From Other Org0TransferFromOtherOrgInd

Reasonable Cause Explanation ReasonableCauseExplanation

FieldValueIRS element (for citing)
ExplanationTHE ORGANIZATION IS FILING THIS RETURN LATE AS THE IRS HAS REJECTED THE PAPER FILING OF THE RETURN. THE RETURN WAS PAPER FILED DUE TO INELIGIBILITY FOR ELECTRONIC FILING AS THE ORGANIZATION HAD A NAME CHANGE DURING FISCAL YEAR ENDED JUNE 30, 2022. THE SOFTWARE USED TO PREPARE THE RETURN DID NOT HAVE AN OPTION TO ATTACH THE AMENDED ARTICLES OF INCORPORATION THAT REFLECT THE NAME CHANGE. THE SOFTWARE PROVIDER HAS SINCE DEVELOPED AN OVERRIDE CODE TO ALLOW FOR ATTACHMENT OF THE REQUIRED AMENDMENT TO THE ARTICLES OF INCORPORATION AND ELECTRONIC FILING OF THE FORM 990 FOR THE YEAR ENDED JUNE 30, 2022. THE ORGANIZATION BELIEVES IT HAS REASONABLE CAUSE FOR NOT ELECTRONICALLY FILING FORM 990 IN A TIMELY MANNER. THE ORGANIZATION BELIEVES IT HAS REASONABLE CAUSE FOR LATE FILING OF FORM 990. LATE FILING IS NOT DUE TO WILLFUL NEGLECT. THE ORGANIZATION MADE REASONABLE ATTEMPTS TO FILE FORM 990 WITH THE IRS IN A TIMELY MANNER. THE RETURN WAS ORIGINALLY FILED ON APRIL 15, 2023 AND RECEIVED BY THE IRS ON MAY 3, 2023. THE ORIGINAL FILING WAS REJECTED. THE TAXPAYER RESUBMITTED THE RETURN WITH AN EXPLANATION AS TO WHY THE RETURN WAS BEING FILED VIA PAPER WHICH THE IRS RECEIVED ON OCTOBER 10, 2023. THE IRS RETURNED THE FORM 990 TO THE TAXPAYER ON DECEMBER 26, 2023. DUE TO IRS ELECTRONIC SHUT DOWN FOR MAINTENANCE, THE TAXPAYER WAS NOT ABLE TO ELECTRONICALLY SUBMIT ITS RETURN UNTIL LATER IN JANUARY, 2024. THE ORGANIZATION RESPECTFULLY REQUESTS ABATEMENT OF SEC. 6652(C)(1) PENALTY FOR FAILURE TO FILE A TAX RETURN OR FAILURE TO INCLUDE COMPLETE OR CORRECT INFORMATION ON THE TAX RETURN.ATTACHED TO THIS RETURN IS THE AMENDMENT TO THE ARTICLES OF INCORPORATION, DECEMBER 26, 2023 REJECTION LETTER AND PAGE 1 OF FORM 990 AS ORIGINALLY FILED AND RECEIVED BY THE IRS.ExplanationTxt