2018-04-17T16:12:33-05:00 2017-05-31 410746749 CLIFTONLARSONALLEN LLP 220 SOUTH SIXTH STREET SUITE 300 MINNEAPOLIS MN 55402 990 2016-06-01 731719218 MADELIA COMMUNITY HOSPITAL FOUNDATION MADE 5076423255 121 DREW AVENUE SOUTHEAST MADELIA MN 56062 CANDACE FENSKE MCH CEO 5076423255 2018-04-17 1 RYAN ENGEBRETSON P01585625 6123764500 67.137.57.251 2018-04-17 12:29:32 CD P C43F11DC38FDB773C4BD4FBCA7AA9CEFA61E85E3 18BC5E18286226E9DF068D3E208D48F3336BB66D 2016 2021-01-29 14:40:06Z CANDACE FENSKE 121 DREW AVENUE SOUTHEAST MADELIA MN 56062 97588 0 X WWW.MCHOSPITAL.ORG X 2004 MN TO SUPPORT THE MISSION OF MADELIA COMMUNITY HOSPITAL, INCORPORATED. 11 10 0 66 0 0 38653 55234 0 0 6927 5865 -37739 21960 7841 83059 0 83966 0 0 35890 49350 0 0 0 105 13608 35995 146924 -28154 -63865 684418 699349 224854 219684 459564 479665 X 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. 0 0 115446 83966 0 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:- PURCHASED A NEW COLONOSCOPE AND ENDOSCOPE FOR HOSPITAL USE. OTHER PURCHASES INCLUDED ITEMS FOR HOME HEALTH, THE LAB, AND HEALTH INFORMATION. THE FOUNDATION PROVIDED APPROXIMATELY $84,000 IN FUNDING FOR EQUIPMENT AT THE HOSPITAL & CLINIC.- SPONSORED A 5TH GRADE HEALTH FAIR.- PURCHASED IMPACT CONCUSSION SOFTWARE LICENSURE AND PROVIDED BASELINE CONCUSSION TESTING FOR MADELIA HIGH SCHOOL STUDENT SPORTS PROGRAMS.- CONTINUED ITS SUPPORT OF HEALTH CARE EDUCATION BY OFFERING MADELIA STUDENT SCHOLARSHIPS FOR GRADUATING SENIORS. THIS YEAR'S RECIPIENTS WERE JULIA GOODBURN AND MCKENZIE GLAUBITZ (FOUNDATION HEALTHCARE SCHOLARSHIPS) AND KORI SCHAFFER (YOSHIKO MASTERS MEMORIAL SCHOLARSHIP).- PARTNERED WITH MADELIA ROTARY TO SPONSOR TWO WINTER BOWLING NIGHTS FOR MADELIA AREA STUDENTS.- 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 FOUNDATION HOSTED TWO ANNUAL EVENTS AND ONE BI-ANNUAL EVENT:- THE 12TH ANNUAL GOLF OUTING AT THE MADELIA GOLF COURSE ATTRACTED 96 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. 103 PARTICIPANTS, AGES 4 - 67, PARTICIPATED- THE GALA EVENT SCOPE-A-PALOOZA! WAS HELD NOVEMBER 12, 2016. 160 SUPPORTERS ENJOYED AN EVENING OF GOOD FOOD AND ENTERTAINMENT. THROUGH THE GENEROSITY OF SPONSORS AND DONORS, A NET OF NEARLY $43,000 WAS RAISED.FUNDRAISING- THE FOUNDATION INTRODUCED IT'S FIRST EVER MEMORIAL DAY SOLICITATION. THIS MAILING YIELDED JUST OVER $9,500. MORE IMPORTANTLY, 36 FIRST-TIME DONORS TO THE FOUNDATION RESPONDED TO THIS MAILING.- THE FOUNDATION RECEIVED JUST OVER $100,000 DURING YEAR, AN INCREASE OF 14% OVER THE PREVIOUS YEAR.- ADDITIONALLY THE NUMBER OF INDIVIDUAL DONORS TO THE FOUNDATION GREW FROM 156 IN 2016 TO 220 IN 2017, A 41% INCREASE. 115446 1 1 0 0 0 0 0 0 0 1 1 0 0 1 1 1 0 1 0 0 0 0 0 0 1 0 0 1 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 0 0 1 0 0 0 0 0 0 0 0 1 1 0 0 0 0 X 11 10 0 0 0 0 1 1 0 1 1 0 0 0 1 1 1 1 1 0 0 0 MN X X MONIQUE HOFFMANN 5076423255 121 DREW AVENUE SOUTHEAST MADELIA MN 56062 DAVID CERNY BOARD MEMBER 0.20 X 0 0 0 PATRICIA WANZEK BOARD MEMBER 0.20 X 0 0 0 TOM AMES BOARD MEMBER 0.20 X 0 0 0 JOELEEN KRIER BOARD MEMBER 0.20 X 0 0 0 TRACI HENRY BOARD MEMBER 0.20 X X 0 0 0 CONSTANCE ROLLINGS BOARD MEMBER 0.20 X 0 0 0 DEBBIE KING-QUALE BOARD MEMBER THROUGH 12/31/16 0.20 X 0 0 0 JAMES HOPMAN BOARD PRESIDENT 0.20 X X 0 0 0 MARGARET KOBEROSKI BOARD SECRETARY 0.20 X X 0 0 0 DANIEL GAHLER BOARD TREASURER 0.20 X X 0 0 0 WENDY HENNAGER BOARD VICE-PRESIDENT THROUGH 12/31/16 0.20 X X 0 0 0 CANDACE FENSKE MCH CEO 0.20 40.00 X X 0 151216 19092 DENNIS ARDUSER MCH GOVERNING BOARD PRESIDENT 0.20 1.00 X X 0 1800 0 STEVEN COOLING MCH GOVERNING BOARD PRESIDENT THROUGH 12/31/16 0.20 1.00 X X 0 1800 0 BRUCE TAYLOR EXECUTIVE DIRECTOR 32.00 X 0 44179 1767 MONIQUE HOFFMANN MCH CFO 0.20 40.00 X 0 101920 7950 0 300915 28809 0 0 1 0 0 33181 22053 4679 55234 5865 5865 36489 33181 14529 21960 21960 83059 0 0 27825 83966 83966 44821 22411 22410 1061 531 530 3468 1734 1734 3074 1537 1537 MISCELLANEOUS 10534 5267 5267 146924 115446 31478 0 445395 463400 10853 10853 3074 0 235949 235949 684418 699349 224854 219684 224854 219684 X 223615 243716 235949 235949 459564 479665 684418 699349 X -63865 83966 X X 0 1 X 1 0 X X 1 MADELIA COMMUNITY HOSPITAL INC 410758512 3 1 83966 0 1 83966 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 235949 235949 235949 235949 122717 113232 235949 122717 122717 94757 27960 122717 0.00000 1.00000 0.00000 0 0 10853 10853 0 0 PERMANENTLY RESTRICTED ENDOWMENTS 235949 235949 DUE TO RELATED PARTY 219684 219684 X 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. SCOPE-A-PALOOZA 52726 23356 29370 4168 100 5072 GOLF OUTING 14366 8575 5791 1140 1108 458 1200 1 2578 1250 1328 128 78 1077 69670 33181 36489 1140 128 1108 4704 100 7349 14529 21960 1 MADELIA COMMUNITY HOSPITAL INCORPORATED 121 DREW AVENUE SOUTHEAST MADELIA MN 56062 410758512 501(C)(3) 83966 FMV FUNDS FOR THE PURCHASE OF EQUIPMENT AND SUPPLIES. 0 0 0 0 0 0 0 0 0 CANDACE FENSKE MCH CEO 0 151216 0 0 0 0 0 10585 0 8507 0 170308 0 0 PART I, LINE 3 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. 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 83,966. 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. MADELIA COMMUNITY HOSPITAL INCORPORATED 121 DREW AVENUE SE MADELIA MN 56062 410758512 HOSPITAL MN 501(C)(3) 3 N/A 0 0 1 0 0 0 0 0 0 0 0 0 1 1 1 1 0 0 1 0 MADELIA COMMUNITY HOSPITAL INCORPORATED B 83966 MARKET VALUE