MADELIA HEALTH FOUNDATION: Form 990, tax year 2017
View the entire original 990 at ProPublica ↗
- Organization
- MADELIA HEALTH FOUNDATION (EIN 73-1719218)
- Tax period
- 2017-06-01 to 2018-05-31
- Filed
- 2019-04-15
- IRS object ID
- 201931059349301423
- Schema version
- 2017v2.3
- 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
- Form 990
- Schedule A
- Schedule B
- Schedule D
- Schedule G
- Schedule I
- Schedule J
- Schedule O
- Schedule R
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return | 2019-04-15T16:02:55-05:00 | ReturnTs |
| Tax Period End | 2018-05-31 | TaxPeriodEndDt |
Preparer Firm PreparerFirmGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Firm EIN | 410746749 | PreparerFirmEIN |
Preparer Firm Name PreparerFirmName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | CLIFTONLARSONALLEN LLP | BusinessNameLine1Txt |
Preparer US Address PreparerUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 220 SOUTH SIXTH STREET SUITE 300 | AddressLine1Txt |
| City | MINNEAPOLIS | CityNm |
| State Abbreviation | MN | StateAbbreviationCd |
| ZIP | 55402 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnTypeCd |
| Tax Period Begin | 2017-06-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 731719218 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | MADELIA COMMUNITY HOSPITAL FOUNDATION | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | MADE | BusinessNameControlTxt |
| Phone | 5076423255 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 121 DREW AVENUE SOUTHEAST | AddressLine1Txt |
| City | MADELIA | CityNm |
| State Abbreviation | MN | StateAbbreviationCd |
| ZIP | 56062 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | JEFF MENGENHAUSEN | PersonNm |
| Person Title | MCH CEO | PersonTitleTxt |
| Phone | 5076423255 | PhoneNum |
| Signature | 2019-04-13 | SignatureDt |
| Discuss With Paid Preparer | Yes (1) | DiscussWithPaidPreparerInd |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | RYAN ENGEBRETSON | PreparerPersonNm |
| PTIN | P01585625 | PTIN |
| Phone | 6123764500 | PhoneNum |
Filing Security Information FilingSecurityInformation
IP Address IPAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| I Pv4 Address | 67.137.57.251 | IPv4AddressTxt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| IP | 2019-04-13 | IPDt |
| IP Tm | 09:50:17 | IPTm |
| IP Timezone | CD | IPTimezoneCd |
| Filing License Type | P | FilingLicenseTypeCd |
| At Submission Creation Device Id | 2D2ADA08DFBCD9CE63D4D49722A5A80C8B448248 | AtSubmissionCreationDeviceId |
| At Submission Filing Device Id | 0CF8DAA38DEF6BA010CDA025D5681F15700FEA11 | AtSubmissionFilingDeviceId |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2017 | TaxYr |
| Build TS | 2019-02-21 02:37:17Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Principal Officer | JEFF MENGENHAUSEN | PrincipalOfficerNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 121 DREW AVENUE SOUTHEAST | AddressLine1Txt |
| City | MADELIA | CityNm |
| State Abbreviation | MN | StateAbbreviationCd |
| ZIP | 56062 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $199,728 | GrossReceiptsAmt |
| Group Return For Affiliates | 0 | GroupReturnForAffiliatesInd |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | WWW.MCHOSPITAL.ORG | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 2004 | FormationYr |
| Legal Domicile State | MN | LegalDomicileStateCd |
| Activity Or Mission | TO SUPPORT THE MISSION OF MADELIA COMMUNITY HOSPITAL, INCORPORATED. | ActivityOrMissionDesc |
| Voting Members Governing Body | 11 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 11 | VotingMembersIndependentCnt |
| Total Employee | 0 | TotalEmployeeCnt |
| Total Volunteers | 58 | TotalVolunteersCnt |
| Total Gross UBI | $0 | TotalGrossUBIAmt |
| Net Unrelated Bus Txbl Incm | $0 | NetUnrelatedBusTxblIncmAmt |
| PY Contributions Grants | $55,234 | PYContributionsGrantsAmt |
| CY Contributions Grants | $185,301 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $0 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $0 | CYProgramServiceRevenueAmt |
| PY Investment Income | $5,865 | PYInvestmentIncomeAmt |
| CY Investment Income | $8,962 | CYInvestmentIncomeAmt |
| PY Other Revenue | $21,960 | PYOtherRevenueAmt |
| CY Other Revenue | -$346 | CYOtherRevenueAmt |
| PY Total Revenue | $83,059 | PYTotalRevenueAmt |
| CY Total Revenue | $193,917 | CYTotalRevenueAmt |
| PY Grants And Similar Paid | $83,966 | PYGrantsAndSimilarPaidAmt |
| CY Grants And Similar Paid | $121,980 | CYGrantsAndSimilarPaidAmt |
| PY Benefits Paid To Members | $0 | PYBenefitsPaidToMembersAmt |
| CY Benefits Paid To Members | $0 | CYBenefitsPaidToMembersAmt |
| PY Salaries Comp Emp Bnft Paid | $49,350 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $50,437 | CYSalariesCompEmpBnftPaidAmt |
| PY Total Prof Fndrsng Expns | $0 | PYTotalProfFndrsngExpnsAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $3,311 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $13,608 | PYOtherExpensesAmt |
| CY Other Expenses | $9,274 | CYOtherExpensesAmt |
| PY Total Expenses | $146,924 | PYTotalExpensesAmt |
| CY Total Expenses | $181,691 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | -$63,865 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | $12,226 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $699,349 | TotalAssetsBOYAmt |
| Total Assets EOY | $767,663 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $219,684 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $150,718 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $479,665 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $616,945 | NetAssetsOrFundBalancesEOYAmt |
| Info In Schedule O Part III | Yes (X) | InfoInScheduleOPartIIIInd |
| Mission | MADELIA COMMUNITY HOSPITAL FOUNDATION EXISTS TO BE STEWARDS OF DONATIONS GIVEN TO SUPPORT THE STATE-OF-THE-ART HEALTH SERVICES PROVIDED BY MADELIA COMMUNITY HOSPITAL. THE FOUNDATION, SERVES AS THE BRIDGE BETWEEN MADELIA COMMUNITY HOSPITAL, ITS PATIENTS, AREA FRIENDS AND SUPPORTERS. | MissionDesc |
| Significant New Program Srvc | 0 | SignificantNewProgramSrvcInd |
| Significant Change | 0 | SignificantChangeInd |
| Expense | $147,286 | ExpenseAmt |
| Grant | $121,980 | GrantAmt |
| Desc | THE MADELIA COMMUNITY HOSPITAL FOUNDATION CONTINUE ITS MISSION: THE FOUNDATION EXISTS TO BE STEWARD OF DONATIONS GIVEN TO SUPPORT THE STATE-OF-THE-ART HEALTH SERVICES PROVIDED BY MADELIA COMMUNITY HOSPITAL & CLINIC. THROUGH THE GENEROSITY OF DONORS AND SPONSORS, THE FOUNDATION SUPPORTED THE HOSPITAL AND SURROUNDING COMMUNITIES, PROMOTING AND IMPROVING HEALTH AND WELLNESS.THE FOUNDATION:- BEGAN FUNDING THE PURCHASE OF A 3D MAMMOGRAPHY MACHINE. THE TOTAL COST OF THIS EQUIPMENT IS JUST OVER $220,000; FY 2018 FUNDING PROVIDED BY THE FOUNDATION IS $117,000.- CONTINUED ITS SUPPORT OF HEALTH CARE EDUCATION BY OFFERING MADELIA STUDENT SCHOLARSHIPS FOR GRADUATING SENIORS AND AREA RESIDENTS. THIS YEAR'S RECIPIENTS WERE ALLYSON MISSLING OF MADELIA HIGH SCHOOL AND NICHOLAS NACHREINER OF LAKE CRYSTAL WELLCOME MEMORIAL HIGH SCHOOL (FOUNDATION HEALTHCARE SCHOLARSHIPS) AND MEGAN VANZANDT (YOSHIKO MASTERS MEMORIAL SCHOLARSHIP).THE FOUNDATION HOSTED THREE ANNUAL EVENTS (MAINTENANCE EVENTS):- PROVIDED THE COMMUNITY WITH HIGH QUALITY BELL BICYCLE HELMETS AT SIGNIFICANTLY REDUCED COSTS. THE FOUNDATION PARTNERED WITH THE MADELIA POLICE DEPARTMENT AND MADELIA LANES TO OFFER ICE CREAM CONE COUPONS TO CHILDREN OBSERVED RIDING THEIR BIKES WHILE WEARING A HELMET.- THE 13TH ANNUAL GOLF OUTING AT THE MADELIA GOLF COURSE ATTRACTED 90 GOLFERS AND RAISED NEARLY $10,000 TO SUPPORT THE HOSPITAL & CLINIC.- THE 5K RUN/WALK DREW RUNNERS AND WALKERS FROM SOUTHERN MINNESOTA HELD IN CONJUNCTION WITH MADELIA'S PARK DAYS. ANDERSON RACE MANAGEMENT GENEROUSLY CONTRIBUTED THEIR TIME AND EXPERTISE TO HELP THE 5K RUN /WALK PROMOTE THE ACTIVITIES OF THE FOUNDATION. 102 PARTICIPANTS, AGES 4 - 67, PARTICIPATED.FUNDRAISING- THE FOUNDATION RECEIVED A LARGE, UNEXPECTED BEQUEST FROM THE ERVIN TANDE ESTATE. THE FIRST SETTLEMENT CAME IN JUST BEFORE CHRISTMAS LAST YEAR AND WAS A CHECK FOR $100,000; SINCE THEN AN ADDITIONAL $70,000 HAS BEEN RECEIVED WITH A FINAL SETTLEMENT EXPECTED ANY DAY.- THIS YEAR, THE HOSPITAL'S CENTENNIAL, WE INITIATED THE W. J. MCCARTHY CENTENNIAL FUND. THROUGH MAY 31, 2018, OVER $25,000 IN DONATIONS CAME TO THE FOUNDATION THROUGH THIS FUND.- OUR FIRST EVER NON-EVENT RAISED $17,000 AND THE MEMORIAL DAY ANNUAL FUND SOLICIATION RAISED ANOTHER $3,700. THE NUMBER OF INDIVIDUAL DONORS TO THE FOUNDATION INCREASED AGAIN THIS YEAR FROM 220 TO 247.- TOTAL DONATIONS TO THE FOUNDATION IN FISCAL 2018 WERE JUST OVER $172,000 AND WE WERE ABLE TO TRANSFER $128,000 OF THAT TO THE HOSPITAL & CLINIC. | Desc |
| Total Program Service Expenses | $147,286 | TotalProgramServiceExpensesAmt |
| Described In Section501c3 | Yes (1) | DescribedInSection501c3Ind |
| Schedule B Required | Yes (1) | ScheduleBRequiredInd |
| Political Campaign Acty | 0 | PoliticalCampaignActyInd |
| Lobbying Activities | 0 | LobbyingActivitiesInd |
| Subject To Proxy Tax | 0 | SubjectToProxyTaxInd |
| Donor Advised Fund | 0 | DonorAdvisedFundInd |
| Conservation Easements | 0 | ConservationEasementsInd |
| Collections Of Art | 0 | CollectionsOfArtInd |
| Credit Counseling | 0 | CreditCounselingInd |
| Temp Or Permanent Endowments | Yes (1) | TempOrPermanentEndowmentsInd |
| Report Land Building Equipment | Yes (1) | ReportLandBuildingEquipmentInd |
| Report Investments Other Sec | 0 | ReportInvestmentsOtherSecInd |
| Report Program Related Invst | 0 | ReportProgramRelatedInvstInd |
| Report Other Assets | Yes (1) | ReportOtherAssetsInd |
| Report Other Liabilities | Yes (1) | ReportOtherLiabilitiesInd |
| Include FIN48 Footnote | Yes (1) | IncludeFIN48FootnoteInd |
| Independent Audit Fincl Stmt | 0 | IndependentAuditFinclStmtInd |
| Consolidated Audit Fincl Stmt | Yes (1) | ConsolidatedAuditFinclStmtInd |
| School Operating | 0 | SchoolOperatingInd |
| Foreign Office | 0 | ForeignOfficeInd |
| Foreign Activities | 0 | ForeignActivitiesInd |
| More Than5000 K To Org | 0 | MoreThan5000KToOrgInd |
| More Than5000 K To Individuals | 0 | MoreThan5000KToIndividualsInd |
| Professional Fundraising | 0 | ProfessionalFundraisingInd |
| Fundraising Activities | Yes (1) | FundraisingActivitiesInd |
| Gaming Activities | 0 | GamingActivitiesInd |
| Operate Hospital | 0 | OperateHospitalInd |
| Grants To Organizations | Yes (1) | GrantsToOrganizationsInd |
| Grants To Individuals | 0 | GrantsToIndividualsInd |
| Schedule J Required | Yes (1) | ScheduleJRequiredInd |
| Tax Exempt Bonds | 0 | TaxExemptBondsInd |
| Engaged In Excess Benefit Trans | 0 | EngagedInExcessBenefitTransInd |
| PY Excess Benefit Trans | 0 | PYExcessBenefitTransInd |
| Loan Outstanding | 0 | LoanOutstandingInd |
| Grant To Related Person | 0 | GrantToRelatedPersonInd |
| Business Rln With Org Mem | 0 | BusinessRlnWithOrgMemInd |
| Business Rln With Fam Mem | 0 | BusinessRlnWithFamMemInd |
| Business Rln With Officer Ent | 0 | BusinessRlnWithOfficerEntInd |
| Deductible Non Cash Contri | 0 | DeductibleNonCashContriInd |
| Deductible Art Contribution | 0 | DeductibleArtContributionInd |
| Terminate Operations | 0 | TerminateOperationsInd |
| Partial Liquidation | 0 | PartialLiquidationInd |
| Disregarded Entity | 0 | DisregardedEntityInd |
| Related Entity | Yes (1) | RelatedEntityInd |
| Related Organization Ctrl Ent | 0 | RelatedOrganizationCtrlEntInd |
| Trnsfr Exmpt Non Chrtbl Rltd Org | 0 | TrnsfrExmptNonChrtblRltdOrgInd |
| Activities Conducted Prtshp | 0 | ActivitiesConductedPrtshpInd |
| Schedule O Required | Yes (1) | ScheduleORequiredInd |
| IRP Document | 0 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Employee | 0 | EmployeeCnt |
| Unrelated Bus Incm Over Limit | 0 | UnrelatedBusIncmOverLimitInd |
| Foreign Financial Account | 0 | ForeignFinancialAccountInd |
| Prohibited Tax Shelter Trans | 0 | ProhibitedTaxShelterTransInd |
| Taxable Party Notification | 0 | TaxablePartyNotificationInd |
| Nondeductible Contributions | 0 | NondeductibleContributionsInd |
| Quid Pro Quo Contributions | Yes (1) | QuidProQuoContributionsInd |
| Quid Pro Quo Contri Discl | Yes (1) | QuidProQuoContriDisclInd |
| Form8282 Property Disposed Of | 0 | Form8282PropertyDisposedOfInd |
| Rcv Fnds To Pay Prsnl Bnft Cntrct | 0 | RcvFndsToPayPrsnlBnftCntrctInd |
| Pay Premiums Prsnl Bnft Cntrct | 0 | PayPremiumsPrsnlBnftCntrctInd |
| Indoor Tanning Services | 0 | IndoorTanningServicesInd |
| Info In Schedule O Part VI | Yes (X) | InfoInScheduleOPartVIInd |
| Governing Body Voting Members | 11 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 11 | IndependentVotingMemberCnt |
| Family Or Business Rln | 0 | FamilyOrBusinessRlnInd |
| Delegation Of Mgmt Duties | 0 | DelegationOfMgmtDutiesInd |
| Change To Org Documents | 0 | ChangeToOrgDocumentsInd |
| Material Diversion Or Misuse | 0 | MaterialDiversionOrMisuseInd |
| Members Or Stockholders | Yes (1) | MembersOrStockholdersInd |
| Election Of Board Members | Yes (1) | ElectionOfBoardMembersInd |
| Decisions Subject To Approva | 0 | DecisionsSubjectToApprovaInd |
| Minutes Of Governing Body | Yes (1) | MinutesOfGoverningBodyInd |
| Minutes Of Committees | Yes (1) | MinutesOfCommitteesInd |
| Officer Mailing Address | 0 | OfficerMailingAddressInd |
| Local Chapters | 0 | LocalChaptersInd |
| Form990 Provided To Gvrn Body | 0 | Form990ProvidedToGvrnBodyInd |
| Conflict Of Interest Policy | Yes (1) | ConflictOfInterestPolicyInd |
| Annual Disclosure Covered Prsn | Yes (1) | AnnualDisclosureCoveredPrsnInd |
| Regular Monitoring Enfrc | Yes (1) | RegularMonitoringEnfrcInd |
| Whistleblower Policy | Yes (1) | WhistleblowerPolicyInd |
| Document Retention Policy | Yes (1) | DocumentRetentionPolicyInd |
| Compensation Process CEO | 0 | CompensationProcessCEOInd |
| Compensation Process Other | 0 | CompensationProcessOtherInd |
| Investment In Joint Venture | 0 | InvestmentInJointVentureInd |
| States Where Copy Of Return Is Fld | MN | StatesWhereCopyOfReturnIsFldCd |
| Other Website | Yes (X) | OtherWebsiteInd |
| Upon Request | Yes (X) | UponRequestInd |
Books In Care Of Detail BooksInCareOfDetail
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | MONIQUE HOFFMANN-URBAN | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Phone | 5076423255 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 121 DREW AVENUE SOUTHEAST | AddressLine1Txt |
| City | MADELIA | CityNm |
| State Abbreviation | MN | StateAbbreviationCd |
| ZIP | 56062 | ZIPCd |
Form990 Part VII Section A Form990PartVIISectionAGrp (13 entries)
| TitleTitleTxt | Average Hours Per WeekAverageHoursPerWeekRt | Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd | Reportable Comp From OrgReportableCompFromOrgAmt | Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt | Other CompensationOtherCompensationAmt | OfficerOfficerInd | Average Hours Per Week Rltd OrgAverageHoursPerWeekRltdOrgRt |
|---|---|---|---|---|---|---|---|
| DAVID CERNY | |||||||
| BOARD MEMBER | 0.20 | Yes (X) | $0 | $0 | $0 | ||
| PATRICIA WANZEK | |||||||
| BOARD MEMBER | 0.20 | Yes (X) | $0 | $0 | $0 | ||
| TOM AMES | |||||||
| BOARD MEMBER | 0.20 | Yes (X) | $0 | $0 | $0 | ||
| JOELEEN KRIER | |||||||
| BOARD MEMBER | 0.20 | Yes (X) | $0 | $0 | $0 | ||
| ALLIE KIECKER | |||||||
| BOARD MEMBER | 0.20 | Yes (X) | $0 | $0 | $0 | ||
| COLLEEN JACOBS | |||||||
| BOARD MEMBER | 0.20 | Yes (X) | $0 | $0 | $0 | ||
| JAMES HOPMAN | |||||||
| BOARD PRESIDENT | 0.20 | Yes (X) | $0 | $0 | $0 | Yes (X) | |
| MARGARET KOBEROSKI | |||||||
| BOARD SECRETARY | 0.20 | Yes (X) | $0 | $0 | $0 | Yes (X) | |
| DANIEL GAHLER | |||||||
| BOARD TREASURER | 0.20 | Yes (X) | $0 | $0 | $0 | Yes (X) | |
| CANDACE FENSKE | |||||||
| MCH CEO | 0.20 | Yes (X) | $0 | $145,504 | $14,090 | Yes (X) | 40.00 |
| DENNIS ARDUSER | |||||||
| MCH GOVERNING BOARD PRESID | 0.20 | Yes (X) | $0 | $1,800 | $0 | Yes (X) | 1.00 |
| BRUCE TAYLOR | |||||||
| EXECUTIVE DIRECTOR | 32.00 | $0 | $44,342 | $0 | Yes (X) | ||
| MONIQUE HOFFMANN-URBAN | |||||||
| MCH CFO | 0.20 | $0 | $101,287 | $8,026 | Yes (X) | 40.00 | |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $0 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $292,933 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $22,116 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 0 | IndivRcvdGreaterThan100KCnt |
| Former Ofcr Employees Listed | 0 | FormerOfcrEmployeesListedInd |
| Total Comp Greater Than150 K | Yes (1) | TotalCompGreaterThan150KInd |
| Compensation From Other Srcs | 0 | CompensationFromOtherSrcsInd |
| Cntrct Rcvd Greater Than100 K | 0 | CntrctRcvdGreaterThan100KCnt |
| Fundraising | $9,702 | FundraisingAmt |
| All Other Contributions | $175,599 | AllOtherContributionsAmt |
| Total Contributions | $185,301 | TotalContributionsAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $8,962 | TotalRevenueColumnAmt |
| Exclusion | $8,962 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Fundraising Gross Income | $5,465 | FundraisingGrossIncomeAmt |
| Contri Rpt Fundraising Event | $9,702 | ContriRptFundraisingEventAmt |
| Fundraising Direct Expenses | $5,811 | FundraisingDirectExpensesAmt |
Net Incm From Fundraising Evt NetIncmFromFundraisingEvtGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | -$346 | TotalRevenueColumnAmt |
| Exclusion | -$346 | ExclusionAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $193,917 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $0 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $0 | UnrelatedBusinessRevenueAmt |
| Exclusion | $8,616 | ExclusionAmt |
Grants To Domestic Orgs GrantsToDomesticOrgsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $121,980 | TotalAmt |
| Program Services | $121,980 | ProgramServicesAmt |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $45,217 | TotalAmt |
| Program Services | $22,609 | ProgramServicesAmt |
| Management And General | $22,608 | ManagementAndGeneralAmt |
Pension Plan Contributions PensionPlanContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,765 | TotalAmt |
| Program Services | $883 | ProgramServicesAmt |
| Management And General | $882 | ManagementAndGeneralAmt |
Payroll Taxes PayrollTaxesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $3,455 | TotalAmt |
| Program Services | $1,727 | ProgramServicesAmt |
| Management And General | $1,728 | ManagementAndGeneralAmt |
Other Expenses OtherExpensesGrp (2 entries)
| DescDesc | TotalTotalAmt | Management And GeneralManagementAndGeneralAmt | FundraisingFundraisingAmt | Program ServicesProgramServicesAmt |
|---|---|---|---|---|
| MISCELLANEOUS | $9,099 | $5,788 | $3,311 | |
| MEETINGS & TRAVEL | $175 | $88 | $87 |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $181,691 | TotalAmt |
| Program Services | $147,286 | ProgramServicesAmt |
| Management And General | $31,094 | ManagementAndGeneralAmt |
| Fundraising | $3,311 | FundraisingAmt |
Savings And Temp Cash Invst SavingsAndTempCashInvstGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $463,400 | BOYAmt |
| EOY | $531,714 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $10,853 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $10,853 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Other Assets Total OtherAssetsTotalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $235,949 | BOYAmt |
| EOY | $235,949 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $699,349 | BOYAmt |
| EOY | $767,663 | EOYAmt |
Other Liabilities OtherLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $219,684 | BOYAmt |
| EOY | $150,718 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $219,684 | BOYAmt |
| EOY | $150,718 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Organization Follows SFAS117 | Yes (X) | OrganizationFollowsSFAS117Ind |
Unrestricted Net Assets UnrestrictedNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $243,716 | BOYAmt |
| EOY | $380,996 | EOYAmt |
Permanently Rstr Net Assets PermanentlyRstrNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $235,949 | BOYAmt |
| EOY | $235,949 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $479,665 | BOYAmt |
| EOY | $616,945 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $699,349 | BOYAmt |
| EOY | $767,663 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part XI | Yes (X) | InfoInScheduleOPartXIInd |
| Reconcilation Revenue Expnss | $12,226 | ReconcilationRevenueExpnssAmt |
| Other Changes In Net Assets | $125,054 | OtherChangesInNetAssetsAmt |
| Info In Schedule O Part XII | Yes (X) | InfoInScheduleOPartXIIInd |
| Method Of Accounting Accrual | Yes (X) | MethodOfAccountingAccrualInd |
| Accountant Compile Or Review | 0 | AccountantCompileOrReviewInd |
| FS Audited | Yes (1) | FSAuditedInd |
FS Audited Basis FSAuditedBasisGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Consolidated Basis Fincl Stmt | Yes (X) | ConsolidatedBasisFinclStmtInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Audit Committee | Yes (1) | AuditCommitteeInd |
| Federal Grant Audit Required | 0 | FederalGrantAuditRequiredInd |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Supporting Organization509a3 | Yes (X) | SupportingOrganization509a3Ind |
| Supporting Org Type1 | Yes (X) | SupportingOrgType1Ind |
| Supported Organizations | 1 | SupportedOrganizationsCnt |
Supported Org Information SupportedOrgInformationGrp
Supported Organization Name SupportedOrganizationName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | MADELIA COMMUNITY HOSPITAL INC | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 410758512 | EIN |
| Organization Type | 3 | OrganizationTypeCd |
| Governing Document Listed | Yes (1) | GoverningDocumentListedInd |
| Support | $121,980 | SupportAmt |
| Other Support | $0 | OtherSupportAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Supported Organizations Total | 1 | SupportedOrganizationsTotalCnt |
| Support Sum | $121,980 | SupportSumAmt |
| Other Support Sum | $0 | OtherSupportSumAmt |
Form990 Sch A Supporting Org Form990SchASupportingOrgGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Listed By Name Governing Doc | Yes (1) | ListedByNameGoverningDocInd |
| Suprt Org No IRS Determination | 0 | SuprtOrgNoIRSDeterminationInd |
| Supported Org Section C456 | 0 | SupportedOrgSectionC456Ind |
| Supported Org Not Organized US | 0 | SupportedOrgNotOrganizedUSInd |
| Organization Change Suprt Org | 0 | OrganizationChangeSuprtOrgInd |
| Support Non Supported Org | 0 | SupportNonSupportedOrgInd |
| Payment Substantial Contribtr | 0 | PaymentSubstantialContribtrInd |
| Loan Disqualified Person | 0 | LoanDisqualifiedPersonInd |
| Controlled Disqualified Prsn | 0 | ControlledDisqualifiedPrsnInd |
| Disqualified Prsn Controll Int | 0 | DisqualifiedPrsnControllIntInd |
| Disqualified Prsn Ownr Int | 0 | DisqualifiedPrsnOwnrIntInd |
| Excess Business Holdings Rules | 0 | ExcessBusinessHoldingsRulesInd |
| Contribution Controller | 0 | ContributionControllerInd |
| Contribution Family | 0 | ContributionFamilyInd |
| Contribution35 Controlled | 0 | Contribution35ControlledInd |
Form990 Sch A Type1 Suprt Org Form990SchAType1SuprtOrgGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Power Appoint Majority Dir Trst | Yes (1) | PowerAppointMajorityDirTrstInd |
| Operate Benefit Non Suprt Org | 0 | OperateBenefitNonSuprtOrgInd |
Schedule B IRS990ScheduleB
Schedule D IRS990ScheduleD
CY Endwmt Fund CYEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $235,949 | BeginningYearBalanceAmt |
| End Year Balance | $235,949 | EndYearBalanceAmt |
CY Minus1 Yr Endwmt Fund CYMinus1YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $235,949 | BeginningYearBalanceAmt |
| End Year Balance | $235,949 | EndYearBalanceAmt |
CY Minus2 Yr Endwmt Fund CYMinus2YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $235,949 | BeginningYearBalanceAmt |
| End Year Balance | $235,949 | EndYearBalanceAmt |
CY Minus3 Yr Endwmt Fund CYMinus3YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $122,717 | BeginningYearBalanceAmt |
| Contributions | $113,232 | ContributionsAmt |
| End Year Balance | $235,949 | EndYearBalanceAmt |
CY Minus4 Yr Endwmt Fund CYMinus4YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $122,717 | BeginningYearBalanceAmt |
| End Year Balance | $122,717 | EndYearBalanceAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Board Designated Balance EOY | 0.00000 | BoardDesignatedBalanceEOYPct |
| Prmnnt Endowment Balance EOY | 1.00000 | PrmnntEndowmentBalanceEOYPct |
| Term Endowment Balance EOY | 0.00000 | TermEndowmentBalanceEOYPct |
| Endowments Held Unrelated Org | 0 | EndowmentsHeldUnrelatedOrgInd |
| Endowments Held Related Org | 0 | EndowmentsHeldRelatedOrgInd |
Equipment EquipmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $10,853 | OtherCostOrOtherBasisAmt |
| Depreciation | $10,853 | DepreciationAmt |
| Book Value | $0 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $0 | TotalBookValueLandBuildingsAmt |
Other Assets Org OtherAssetsOrgGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | PERMANENTLY RESTRICTED ENDOWMENTS | Desc |
| Book Value | $235,949 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Other Assets | $235,949 | TotalBookValueOtherAssetsAmt |
Other Liabilities Org OtherLiabilitiesOrgGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | DUE TO RELATED PARTY | Desc |
| Amt | $150,718 | Amt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Liability | $150,718 | TotalLiabilityAmt |
| Footnote Text | Yes (X) | FootnoteTextInd |
Supplemental Information Detail SupplementalInformationDetail (2 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| 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 IS CLASSIFIED BY THE INTERNAL REVENUE SERVICES AS A TAX-EXEMPT ORGANIZATION UNDER SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE AND IS SUBJECTED TO FEDERAL INCOME TAX ONLY ON NET UNRELATED BUSINESS INCOME. THE FOUNDATION FOLLOWS THE GUIDANCE IN THE INCOME TAX STANDARD REGARDING RECOGNITION AND MEASUREMENT OF UNCERTAIN TAX POSITIONS. THE APPLICATION OF THIS STANDARD HAS NO EFFECT ON THE FINANCIAL STATEMENTS. |
Schedule G IRS990ScheduleG
Fundraising Event Information FundraisingEventInformationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Event1 | GOLF OUTING | Event1Nm |
| Gross Receipts Event1 | $12,921 | GrossReceiptsEvent1Amt |
| Charitable Contri Event1 | $9,702 | CharitableContriEvent1Amt |
| Gross Revenue Event1 | $3,219 | GrossRevenueEvent1Amt |
| Cash Prizes Event1 | $1,080 | CashPrizesEvent1Amt |
| Rent Facility Costs Event1 | $1,210 | RentFacilityCostsEvent1Amt |
| Food And Beverage Event1 | $213 | FoodAndBeverageEvent1Amt |
| Other Direct Expenses Event1 | $1,693 | OtherDirectExpensesEvent1Amt |
| Other Events Total | 2 | OtherEventsTotalCnt |
| Gross Receipts Other Events | $2,246 | GrossReceiptsOtherEventsAmt |
| Gross Revenue Other Events | $2,246 | GrossRevenueOtherEventsAmt |
| Oth Direct Expnss Other Events | $1,615 | OthDirectExpnssOtherEventsAmt |
| Gross Receipts Total | $15,167 | GrossReceiptsTotalAmt |
| Charitable Contributions Tot | $9,702 | CharitableContributionsTotAmt |
| Gross Revenue Total Events | $5,465 | GrossRevenueTotalEventsAmt |
| Cash Prizes Total Events | $1,080 | CashPrizesTotalEventsAmt |
| Rent Fclty Costs Total Events | $1,210 | RentFcltyCostsTotalEventsAmt |
| Food And Beverage Total Events | $213 | FoodAndBeverageTotalEventsAmt |
| Oth Direct Expnss Total Events | $3,308 | OthDirectExpnssTotalEventsAmt |
| Direct Expense Summary Events | $5,811 | DirectExpenseSummaryEventsAmt |
| Net Income Summary | -$346 | NetIncomeSummaryAmt |
Schedule I IRS990ScheduleI
| Field | Value | IRS element (for citing) |
|---|---|---|
| Grant Records Maintained | Yes (1) | GrantRecordsMaintainedInd |
Recipient Table RecipientTable
Recipient Business Name RecipientBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | MADELIA COMMUNITY HOSPITAL INCORPORATED | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 121 DREW AVENUE SOUTHEAST | AddressLine1Txt |
| City | MADELIA | CityNm |
| State Abbreviation | MN | StateAbbreviationCd |
| ZIP | 56062 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Recipient EIN | 410758512 | RecipientEIN |
| IRC Section | 501(C)(3) | IRCSectionDesc |
| Cash Grant | $121,980 | CashGrantAmt |
| Purpose Of Grant | FUNDS FOR THE PURCHASE OF EQUIPMENT AND SUPPLIES. | PurposeOfGrantTxt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total501c3 Org | 1 | Total501c3OrgCnt |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Severance Payment | 0 | SeverancePaymentInd |
| Supplemental Nonqual Rtr Plan | 0 | SupplementalNonqualRtrPlanInd |
| Equity Based Comp Arrngm | 0 | EquityBasedCompArrngmInd |
| Comp Based On Revenue Of Flng Org | 0 | CompBasedOnRevenueOfFlngOrgInd |
| Comp Bsd On Rev Related Orgs | 0 | CompBsdOnRevRelatedOrgsInd |
| Comp Bsd Net Earns Flng Org | 0 | CompBsdNetEarnsFlngOrgInd |
| Comp Bsd Net Earns Rltd Orgs | 0 | CompBsdNetEarnsRltdOrgsInd |
| Any Non Fixed Payments | 0 | AnyNonFixedPaymentsInd |
| Initial Contract Exception | 0 | InitialContractExceptionInd |
Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | CANDACE FENSKE | PersonNm |
| Title | MCH CEO | TitleTxt |
| Base Compensation Filing Org | $0 | BaseCompensationFilingOrgAmt |
| Compensation Based On Rltd Orgs | $145,504 | CompensationBasedOnRltdOrgsAmt |
| Bonus Filing Organization | $0 | BonusFilingOrganizationAmount |
| Bonus Related Organizations | $0 | BonusRelatedOrganizationsAmt |
| Other Compensation Filing Org | $0 | OtherCompensationFilingOrgAmt |
| Other Compensation Rltd Orgs | $0 | OtherCompensationRltdOrgsAmt |
| Deferred Compensation Flng Org | $0 | DeferredCompensationFlngOrgAmt |
| Deferred Comp Rltd Orgs | $6,044 | DeferredCompRltdOrgsAmt |
| Nontaxable Benefits Filing Org | $0 | NontaxableBenefitsFilingOrgAmt |
| Nontaxable Benefits Rltd Orgs | $8,046 | NontaxableBenefitsRltdOrgsAmt |
| Total Compensation Filing Org | $0 | TotalCompensationFilingOrgAmt |
| Total Compensation Rltd Orgs | $159,594 | TotalCompensationRltdOrgsAmt |
| Comp Report Prior990 Filing Org | $0 | CompReportPrior990FilingOrgAmt |
| Comp Report Prior990 Rltd Orgs | $6,044 | CompReportPrior990RltdOrgsAmt |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | PART I, LINE 3 | FormAndLineReferenceDesc |
| Explanation | THE CEO WAS PAID BY MADELIA COMMUNITY HOSPITAL, A RELATED ORGANIZATION. WHEN DETERMINING HER COMPENSATION THE FOLLOWING METHODS WERE USED: 1. COMPENSATION COMMITTEE 2. WRITTEN EMPLOYMENT CONTRACT 3. COMPENSATION SURVEY OR STUDY 4. APPROVAL BY THE BOARD OR COMPENSATION COMMITTEE. | ExplanationTxt |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (10 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| FORM 990, PART VI, SECTION A, LINE 1 | THE 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 6 | THE SOLE MEMBER OF THE FOUNDATION IS MADELIA COMMUNITY HOSPITAL, INCORPORATED. |
| FORM 990, PART VI, SECTION A, LINE 7A | THE MEMBER IS ALLOWED TO ELECT MEMBERS OF THE GOVERNING BODY. |
| FORM 990, PART VI, SECTION B, LINE 11B | THE 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 12C | THE 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 APPROPRIATE 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 15 | MADELIA COMMUNITY HOSPITAL FOUNDATION STAFFING IS FUNDED THROUGH THE MADELIA COMMUNITY HOSPITAL, INC., 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 19 | MADELIA COMMUNITY HOSPITAL 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 XI, LINE 9: | RECONCILIATION FOR DONATION TO RELATED ENTITY 121,980. ADJUSTMENT ON PY RE 3,074. |
| FORM 990, PART XII, LINE 2C | THE BOARD OF DIRECTORS OF THE FOUNDATION ASSUME RESPONSIBILITY FOR OVERSIGHT OF THE AUDIT OF ITS FINANCIAL STATEMENTS AND THE MADELIA COMMUNITY HOSPITAL'S BOARD OF DIRECTORS SELECT THE INDEPENDENT ACCOUNTANT DUE TO THE CONSOLIDATED AUDIT. THIS PROCESS HAS NOT CHANGED FROM THE PRIOR YEAR. |
| FORM 990, PART IX, LINES 5-10 | MADELIA COMMUNITY HOSPITAL FOUNDATION DOES NOT HAVE ANY EMPLOYEES. THE SALARY AND BENEFITS EXPENSES ON PAGE 10 OF THE 990 ARE AMOUNTS THAT ARE ALLOCATED TO MADELIA COMMUNITY HOSPITAL FOUNDATION FROM MADELIA COMMUNITY HOSPITAL FOR MADELIA COMMUNITY HOSPITAL FOUNDATION'S PORTION OF THE EXPENSES. |
Schedule R IRS990ScheduleR
Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp
Disregarded Entity Name DisregardedEntityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | MADELIA COMMUNITY HOSPITAL INCORPORATED | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 121 DREW AVENUE SE | AddressLine1Txt |
| City | MADELIA | CityNm |
| State Abbreviation | MN | StateAbbreviationCd |
| ZIP | 56062 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 410758512 | EIN |
| Primary Activities | HOSPITAL | PrimaryActivitiesTxt |
| Legal Domicile State | MN | LegalDomicileStateCd |
| Exempt Code Section | 501(C)(3) | ExemptCodeSectionTxt |
| Public Charity Status | 3 | PublicCharityStatusTxt |
| Direct Controlling NA | N/A | DirectControllingNACd |
| Controlled Organization | 0 | ControlledOrganizationInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Annts Rnts Rylts | 0 | ReceiptOfIntAnntsRntsRyltsInd |
| Gift Grnt Or Cap Contri To Oth Org | Yes (1) | GiftGrntOrCapContriToOthOrgInd |
| Gift Grnt Cap Contri From Oth Org | 0 | GiftGrntCapContriFromOthOrgInd |
| Loans Or Guarantees To Other Org | 0 | LoansOrGuaranteesToOtherOrgInd |
| Loans Or Guarantees From Oth Org | 0 | LoansOrGuaranteesFromOthOrgInd |
| Div Related Organization | 0 | DivRelatedOrganizationInd |
| Asset Sale To Other Org | 0 | AssetSaleToOtherOrgInd |
| Asset Purchase From Other Org | 0 | AssetPurchaseFromOtherOrgInd |
| Asset Exchange | 0 | AssetExchangeInd |
| Rental Of Facilities To Oth Org | 0 | RentalOfFacilitiesToOthOrgInd |
| Rental Of Fclts From Oth Org | 0 | RentalOfFcltsFromOthOrgInd |
| Perform Of Services For Oth Org | Yes (1) | PerformOfServicesForOthOrgInd |
| Perform Of Services By Other Org | Yes (1) | PerformOfServicesByOtherOrgInd |
| Sharing Of Facilities | Yes (1) | SharingOfFacilitiesInd |
| Paid Employees Sharing | Yes (1) | PaidEmployeesSharingInd |
| Reimbursement Paid To Other Org | 0 | ReimbursementPaidToOtherOrgInd |
| Reimbursement Paid By Other Org | 0 | ReimbursementPaidByOtherOrgInd |
| Transfer To Other Org | Yes (1) | TransferToOtherOrgInd |
| Transfer From Other Org | 0 | TransferFromOtherOrgInd |
Transactions Related Org TransactionsRelatedOrgGrp
Other Organization Name OtherOrganizationName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | MADELIA COMMUNITY HOSPITAL INCORPORATED | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Transaction Type | B | TransactionTypeTxt |
| Involved | $121,980 | InvolvedAmt |
| Method Of Amount Determination | MARKET VALUE | MethodOfAmountDeterminationTxt |