2020-11-05T08:16:54-06:00 2019-12-31 251408703 SCHNEIDER DOWNS & CO INC ONE PPG PLACE SUITE 1700 PITTSBURGH PA 15222 990 2019-01-01 311514418 MADISON FAMILY HEALTH CORPORATION MADI 7408457015 210 NORTH MAIN STREET LONDON OH 43140 DANA E ENGLE PRESIDENT 7408457015 2020-10-04 1 EUGENE J LOGAN P00227231 4122613644 69.231.80.123 2020-10-04 10:30:02 ED P C27DEABDA4EC5E58121BD650225FDE93C4AFF1C8 635F17B8B80C5766359C173BED265779F606AA2C 2019 2021-01-29 14:40:06Z MADISON HEALTH PRIMARY CARE DANA E ENGLE 210 NORTH MAIN STREET LONDON OH 43140 6943319 0 X HTTP://WWW.MADISON-HEALTH.COM X 2008 OH THE PRACTICE OF MEDICINE IN THE STATE OF OHIO AND CARRYING OUT THE MISSION OF MCCH. 3 0 0 0 0 0 0 0 5033421 6943319 0 0 0 0 5033421 6943319 0 0 0 0 0 0 0 0 0 7922567 10394971 7922567 10394971 -2889146 -3451652 661176 1090750 456419 456180 204757 634570 NONE FORMALLY ADOPTED. 0 0 10146698 6943319 MADISON HEALTH'S PHYSICIAN PRACTICE THAT PROVIDES HEALTHCARE CHOICES. 10146698 1 0 0 0 0 0 0 0 0 0 1 0 0 0 1 1 0 1 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 X 3 0 1 0 0 0 0 0 0 1 1 0 0 1 0 0 0 0 0 0 OH X MICHAEL S BROWNING 7408457015 210 NORTH MAIN STREET LONDON OH 43140 X MITCHELL SPAHN MD BOARD MEMBER 1.00 4.00 X 0 141582 5354 DANA E ENGLE CEO/PRESIDENT 1.00 45.00 X X 0 437276 56012 MICHAEL S BROWNING CFO, VP, SECRETARY, TREASU 1.00 45.00 X X 0 283513 17682 0 862371 79048 0 0 1 0 QWIKCARE URGENT CARE LLC COREY AMANN 575 TRILLIUM DRIVE GALLOWAY OH 43119 URGENT CARE-SERVICES 787727 OSU PHYSICIANS 700 ACKERMAN ROAD SUITE 635 COLUMBUS OH 43202 MANAGEMENT/BILLING SERVICES 617898 WEATHERBY LOCUMS INC PO BOX 972633 DALLAS TX 753972633 TEMP AGENCY FOR MEDICAL ONCOLOGIST 132104 3 PATIENT REVENUE 900099 6943319 6943319 6943319 6943319 6943319 0 0 X 1611 1611 6668272 6623139 45133 24326 23916 410 1119 1119 148112 148112 2070 2070 24500 24500 94817 94817 SHARED SERVICES 2469933 2270353 199580 MEDICAL SUPPLIES & DRUG 821648 821570 78 EQUIPMENT LEASE URGENT 59700 59700 BOOKS/EDUCATION 43063 42884 179 35800 34518 1282 10394971 10146698 248273 0 123619 338248 426429 648088 34996 52783 213350 161719 76132 51631 661176 1090750 440534 440295 15885 15885 456419 456180 X 204757 634570 204757 634570 661176 1090750 X -3451652 3881465 X X 0 1 X 1 0 X X 1 MADISON COUNTY COMMUNITY HOSPITAL 311657206 3 1 10394971 0 1 10394971 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 FORM 990, SCHEDULE A, PART IV, LINE 11A: MADISON FAMILY HEALTH CORPORATION RECEIVES SUPPORT FROM THE CONTROLLING ORGANIZATION, MADISON COUNTY COMMUNITY HOSPITAL. 213350 161719 51631 51631 DUE TO AFFILIATE 15885 15885 X 6943319 0 6943319 0 6943319 10394671 0 10394671 0 10394671 PART X, LINE 2: THE FOLLOWING FOOTNOTE IS INCLUDED IN THE CONSOLIDATED FINANCIAL STATEMENTS OF MADISON COUNTY HOSPITAL, INC. THE HOSPITAL IS AN OHIO NONPROFIT CORPORATION AND IS EXEMPT FROM FEDERAL INCOME TAX UNDER 501(C)(3) OF THE INTERNAL REVENUE CODE. THE ORGANIZATION HAS NOT IDENTIFIED ANY MATERIAL UNCERTAIN TAX POSITIONS REQUIRING AN ACCRUAL OR DISCLOSURE IN THE FINANCIAL STATEMENTS. THERE WERE NO INTEREST OR PENALTIES RECOGNIZED IN THE STATEMENT OF ACTIVITIES FOR THE YEARS ENDED DECEMBER 31, 2019 AND 2018 RELATED TO UNCERTAIN TAX POSITIONS. THE HOSPITAL IS NO LONGER SUBJECT TO U.S. FEDERAL OR STATE TAX EXAMINATIONS FOR YEARS PRIOR TO 2016. 1 0 0 0 0 0 0 0 0 0 DANA E ENGLE CEO/PRESIDENT 0 426470 0 0 0 10806 0 14000 0 42012 0 493288 0 0 MICHAEL S BROWNING CFO, VP, SECRETARY, TREASU 0 281707 0 0 0 1806 0 14000 0 3682 0 301195 0 0 PART I, LINE 3: MADISON FAMILY HEALTH CORPORATION DOES NOT COMPENSATE ITS OFFICERS; RATHER COMPENSATION IS PAID BY THE RELATED ORGANIZATION MADISON COUNTY COMMUNITY HOSPITAL (MCCH). MCCH USES THE FOLLOWING TO ESTABLISH TOP MANAGEMENT OFFICIAL'S COMPENSATION: - COMPENSATION COMMITTEE - INDEPENDENT COMPENSATION CONSULTANT - COMPENSATION SURVEY OR STUDY - APPROVAL BY THE BOARD OR COMPENSATION COMMITTEE FORM 990, PART VI, SECTION A, LINE 2 OFFICERS MITCHELL SPAHN, DANA E. ENGLE & MICHAEL S. BROWNING HAVE A BUSINESS RELATIONSHIP. FORM 990, PART VI, SECTION B, LINE 11B THE FORM 990 WILL BE MADE AVAILABLE PRIOR TO FILING TO ALL BOARD MEMBERS ONLY BY WAY OF SECURED WEB PORTAL. PRIOR TO POSTING ON THE WEB PORTAL, THE FORM 990 IS REVIEWED BY MANAGEMENT. FORM 990, PART VI, SECTION B, LINE 12 THE ORGANIZATION DOES NOT HAVE ITS OWN CONFLICT OF INTEREST POLICY BUT FOLLOWS THAT OF MADISON COUNTY COMMUNITY HOSPITAL (MADISON HEALTH). ANNUALLY, THE CEO, CFO, ALL BOARD MEMBERS AND DEPARTMENT MANAGERS RECEIVE A COPY OF MADISON HEALTH'S CONFLICT OF INTEREST POLICY. IN ADDITION, THEY ARE ASKED TO COMPLETE AND RETURN THE CONFLICT OF INTEREST AGREEMENT AND ANNUAL DISCLOSURE STATEMENT TO THE MADISON HEALTH'S ADMINISTRATIVE OFFICE. THE CONFLICT OF INTEREST STATEMENTS ARE REVIEWED AND RETAINED ON FILE. ANY INTERESTS SO DISCLOSED ARE DEALT WITH APPROPRIATELY AS THE CONFLICT ARISES AND IN ACCORDANCE WITH POLICY PROCEDURES. ALL OFFICERS AND DIRECTORS OF MADISON FAMILY HEALTH CORPORATION ARE ALSO OFFICERS AND DIRECTORS OF MADISON HEALTH. FORM 990, PART VI, SECTION B, LINE 15 THE ORGANIZATION DOES NOT HAVE EMPLOYEES, BUT RATHER, ITS OFFICERS ARE EMPLOYEES OF MADISON COUNTY COMMUNITY HOSPITAL (MADISON HEALTH), WHOSE PROCESS FOR DETERMINING COMPENSATION INCLUDES A REVIEW AND APPROVAL BY INDEPENDENT PERSONS, USE OF COMPARABILITY DATA AND CONTEMPORANEOUS DOCUMENTATION OF THE DELIBERATION AND PROCESS. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION'S CONFLICT OF INTEREST POLICY, FINANCIAL STATEMENTS, AND GOVERNING DOCUMENTS ARE AVAILABLE UPON REQUEST. FORM 990, PART IX, LINE 11G PHYSICIAN SALARY: PROGRAM SERVICE EXPENSES 5,550,954. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 5,550,954. PHYSICIAN FORGIVENESS: PROGRAM SERVICE EXPENSES 67,232. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 67,232. PURCHASED SERVICES: PROGRAM SERVICE EXPENSES 769,725. MANAGEMENT AND GENERAL EXPENSES 45,133. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 814,858. CONTRACT LABOR: PROGRAM SERVICE EXPENSES 235,228. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 235,228. FORM 990, PART XI, LINE 9: NET ASSET TRANSFER TO MFHC 3,881,465. FORM 990, PART XII, QUESTION 2C, OVERSIGHT OF FINANCIAL STATEMENT AUDIT: THE ORGANIZATION'S FINANCIAL STATEMENTS ARE AUDITED ON A CONSOLIDATED BASIS WITH ITS AFFILIATES (MADISON COUNTY COMMUNITY HOSPITAL, MADISON COUNTY HOSPITAL, INC. AND MADISON COUNTY HOSPITAL FOUNDATION, INC.) BY AN INDEPENDENT ACCOUNTING FIRM. IN ADDITION, THE ORGANIZATION HAS A COMMITTEE THAT ASSUMES THE RESPONSIBILITY FOR OVERSIGHT OF THE AUDIT OF ITS FINANCIAL STATEMENTS AND ITS SELECTION OF THE INDEPENDENT ACCOUNTANT. THIS PROCESS HAS NOT CHANGED FROM THE PRIOR YEAR. MADISON COUNTY COMMUNITY HOSPITAL (DBA MADISON HEALTH) 210 NORTH MAIN STREET LONDON OH 43140 311657206 HOSPITAL OH 501(C)(3) LINE 3 N/A 0 MADISON COUNTY HOSPITAL FOUNDATION INC 210 NORTH MAIN STREET LONDON OH 43140 237423524 FUNDRAISING OH 501(C)(3) LINE 7 N/A 0 MADISON COUNTY HOSPITAL INC 210 NORTH MAIN STREET LONDON OH 43140 310876202 MANAGE HOSPITAL INVESTMENTS OH 501(C)(3) LINE 12A, I N/A 0 0 0 1 0 0 0 0 0 0 0 0 0 0 1 1 1 0 0 0