MADISON COUNTY HOSPITAL HEALTH SYSTEMS INC: Form 990, tax year 2015
View the entire original 990 at ProPublica ↗
- Organization
- MADISON COUNTY HOSPITAL HEALTH SYSTEMS INC (EIN 59-2319288)
- Tax period
- 2015-10-01 to 2016-09-30
- Filed
- 2017-05-01
- IRS object ID
- 201741219349300209
- Schema version
- 2015v3.0
- 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 C
- Schedule D
- Schedule H
- Schedule J
- Schedule K
- Schedule L
- Schedule O
- Schedule R
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return | 2017-05-01T09:30:10-04:00 | ReturnTs |
| Tax Period End | 2016-09-30 | TaxPeriodEndDt |
Preparer Firm PreparerFirmGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Firm EIN | 580914992 | PreparerFirmEIN |
Preparer Firm Name PreparerFirmName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | DRAFFIN & TUCKER LLP | BusinessNameLine1Txt |
Preparer US Address PreparerUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | PO BOX 71309 | AddressLine1Txt |
| City | ALBANY | CityNm |
| State Abbreviation | GA | StateAbbreviationCd |
| ZIP | 317081309 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnTypeCd |
| Tax Period Begin | 2015-10-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 592319288 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | MADISON COUNTY HOSPITAL HEALTH | BusinessNameLine1Txt |
| Business Name Line2 | SYSTEMS INC | BusinessNameLine2Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | MADI | BusinessNameControlTxt |
| Phone | 8509732271 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 224 NW CRANE AVENUE | AddressLine1Txt |
| City | MADISON | CityNm |
| State Abbreviation | FL | StateAbbreviationCd |
| ZIP | 323401400 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | PATRICK MCGEE | PersonNm |
| Person Title | CFO | PersonTitleTxt |
| Phone | 8509732271 | PhoneNum |
| Signature | 2017-05-15 | SignatureDt |
| Discuss With Paid Preparer | Yes (true) | DiscussWithPaidPreparerInd |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | JACQUELINE G ATKINS | PreparerPersonNm |
| PTIN | P00861721 | PTIN |
| Phone | 2298837878 | PhoneNum |
| Preparation | 2017-04-26 | PreparationDt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2015 | TaxYr |
| Build TS | 2021-01-29 14:40:06Z | BuildTS |
Form 990 IRS990
Doing Business As Name DoingBusinessAsName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | MADISON COUNTY MEMORIAL HOSPITAL | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Principal Officer | TAMMY STEVENS | PrincipalOfficerNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 224 NW CRANE AVENUE | AddressLine1Txt |
| City | MADISON | CityNm |
| State Abbreviation | FL | StateAbbreviationCd |
| ZIP | 323401400 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $9,291,530 | GrossReceiptsAmt |
| Group Return For Affiliates | false | GroupReturnForAffiliatesInd |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | WWW.MCMH.US | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 1938 | FormationYr |
| Legal Domicile State | FL | LegalDomicileStateCd |
| Activity Or Mission | TO PROVIDE QUALITY HEALTHCARE SERVICES TO THE COMMUNITY WHICH IT SERVES. THESE SERVICES INCLUDE ACUTE GENERAL INPATIENT AND OUTPATIENT CARE, AMBULATORY SURGERY, PHYSICAL THERAPY AND OTHER RELATED SERVICES. | ActivityOrMissionDesc |
| Voting Members Governing Body | 6 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 5 | VotingMembersIndependentCnt |
| Total Employee | 189 | TotalEmployeeCnt |
| Total Volunteers | 26 | TotalVolunteersCnt |
| Total Gross UBI | $0 | TotalGrossUBIAmt |
| PY Contributions Grants | $617,953 | PYContributionsGrantsAmt |
| CY Contributions Grants | $717,220 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $9,093,893 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $8,470,671 | CYProgramServiceRevenueAmt |
| PY Investment Income | $15,365 | PYInvestmentIncomeAmt |
| CY Investment Income | $14,363 | CYInvestmentIncomeAmt |
| PY Other Revenue | $98,377 | PYOtherRevenueAmt |
| CY Other Revenue | $89,276 | CYOtherRevenueAmt |
| PY Total Revenue | $9,825,588 | PYTotalRevenueAmt |
| CY Total Revenue | $9,291,530 | CYTotalRevenueAmt |
| CY Grants And Similar Paid | $0 | CYGrantsAndSimilarPaidAmt |
| CY Benefits Paid To Members | $0 | CYBenefitsPaidToMembersAmt |
| PY Salaries Comp Emp Bnft Paid | $4,658,977 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $4,663,367 | CYSalariesCompEmpBnftPaidAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $0 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $6,008,911 | PYOtherExpensesAmt |
| CY Other Expenses | $5,755,447 | CYOtherExpensesAmt |
| PY Total Expenses | $10,667,888 | PYTotalExpensesAmt |
| CY Total Expenses | $10,418,814 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | -$842,300 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | -$1,127,284 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $25,449,748 | TotalAssetsBOYAmt |
| Total Assets EOY | $23,517,039 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $24,847,358 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $24,041,933 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $602,390 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | -$524,894 | NetAssetsOrFundBalancesEOYAmt |
| Mission | TO PROVIDE QUALITY HEALTHCARE SERVICES TO THE COMMUNITY WHICH IT SERVES. THESE SERVICES INCLUDE ACUTE GENERAL INPATIENT AND OUTPATIENT CARE, AMBULATORY SURGERY, PHYSICAL THERAPY AND OTHER RELATED SERVICES. | MissionDesc |
| Significant New Program Srvc | false | SignificantNewProgramSrvcInd |
| Significant Change | false | SignificantChangeInd |
| Expense | $8,445,162 | ExpenseAmt |
| Revenue | $8,511,599 | RevenueAmt |
| Desc | THE HOSPITAL IS A 25-BED CRITICAL ACCESS FACILITY LICENSED BY THE STATE OF FLORIDA THROUGH THE AGENCY FOR HEALTHCARE ADMINISTRATION. THE HOSPITAL OFFERS SERVICES SUCH AS ROUTINE RADIOLOGY, ENDOSCOPY, MAMMOGRAPHY, ULTRASOUND, LABORATORY, RESPIRATORY THERAPY, 24 HOUR EMERGENCY ROOM, SWING BED SERVICES AND AN ACUTE CARE SETTING FOR PATIENTS. | Desc |
| Total Program Service Expenses | $8,445,162 | TotalProgramServiceExpensesAmt |
| Described In Section501c3 | Yes (true) | DescribedInSection501c3Ind |
| Schedule B Required | Yes (true) | ScheduleBRequiredInd |
| Political Campaign Acty | false | PoliticalCampaignActyInd |
| Lobbying Activities | Yes (true) | LobbyingActivitiesInd |
| Subject To Proxy Tax | false | SubjectToProxyTaxInd |
| Donor Advised Fund | false | DonorAdvisedFundInd |
| Conservation Easements | false | ConservationEasementsInd |
| Collections Of Art | false | CollectionsOfArtInd |
| Credit Counseling | false | CreditCounselingInd |
| Temp Or Permanent Endowments | Yes (true) | TempOrPermanentEndowmentsInd |
| Report Land Building Equipment | Yes (true) | ReportLandBuildingEquipmentInd |
| Report Investments Other Sec | false | ReportInvestmentsOtherSecInd |
| Report Program Related Invst | false | ReportProgramRelatedInvstInd |
| Report Other Assets | false | ReportOtherAssetsInd |
| Report Other Liabilities | false | ReportOtherLiabilitiesInd |
| Include FIN48 Footnote | Yes (true) | IncludeFIN48FootnoteInd |
| Independent Audit Fincl Stmt | Yes (true) | IndependentAuditFinclStmtInd |
| Consolidated Audit Fincl Stmt | false | ConsolidatedAuditFinclStmtInd |
| School Operating | false | SchoolOperatingInd |
| Foreign Office | false | ForeignOfficeInd |
| Foreign Activities | false | ForeignActivitiesInd |
| More Than5000 K To Org | false | MoreThan5000KToOrgInd |
| More Than5000 K To Individuals | false | MoreThan5000KToIndividualsInd |
| Professional Fundraising | false | ProfessionalFundraisingInd |
| Fundraising Activities | false | FundraisingActivitiesInd |
| Gaming Activities | false | GamingActivitiesInd |
| Operate Hospital | Yes (true) | OperateHospitalInd |
| Audited Financial Stmt Att | Yes (true) | AuditedFinancialStmtAttInd |
| Grants To Organizations | false | GrantsToOrganizationsInd |
| Grants To Individuals | false | GrantsToIndividualsInd |
| Schedule J Required | Yes (true) | ScheduleJRequiredInd |
| Tax Exempt Bonds | Yes (true) | TaxExemptBondsInd |
| Invest Tax Exempt Bonds | false | InvestTaxExemptBondsInd |
| Escrow Account | false | EscrowAccountInd |
| On Behalf Of Issuer | false | OnBehalfOfIssuerInd |
| Engaged In Excess Benefit Trans | false | EngagedInExcessBenefitTransInd |
| PY Excess Benefit Trans | false | PYExcessBenefitTransInd |
| Loan Outstanding | false | LoanOutstandingInd |
| Grant To Related Person | false | GrantToRelatedPersonInd |
| Business Rln With Org Mem | false | BusinessRlnWithOrgMemInd |
| Business Rln With Fam Mem | false | BusinessRlnWithFamMemInd |
| Business Rln With Officer Ent | Yes (true) | BusinessRlnWithOfficerEntInd |
| Deductible Non Cash Contri | false | DeductibleNonCashContriInd |
| Deductible Art Contribution | false | DeductibleArtContributionInd |
| Terminate Operations | false | TerminateOperationsInd |
| Partial Liquidation | false | PartialLiquidationInd |
| Disregarded Entity | false | DisregardedEntityInd |
| Related Entity | Yes (true) | RelatedEntityInd |
| Related Organization Ctrl Ent | false | RelatedOrganizationCtrlEntInd |
| Trnsfr Exmpt Non Chrtbl Rltd Org | false | TrnsfrExmptNonChrtblRltdOrgInd |
| Activities Conducted Prtshp | false | ActivitiesConductedPrtshpInd |
| Schedule O Required | Yes (true) | ScheduleORequiredInd |
| IRP Document | 16 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Employee | 189 | EmployeeCnt |
| Employment Tax Returns Filed | Yes (true) | EmploymentTaxReturnsFiledInd |
| Unrelated Bus Incm Over Limit | false | UnrelatedBusIncmOverLimitInd |
| Foreign Financial Account | false | ForeignFinancialAccountInd |
| Prohibited Tax Shelter Trans | false | ProhibitedTaxShelterTransInd |
| Taxable Party Notification | false | TaxablePartyNotificationInd |
| Nondeductible Contributions | false | NondeductibleContributionsInd |
| Quid Pro Quo Contributions | false | QuidProQuoContributionsInd |
| Form8282 Property Disposed Of | false | Form8282PropertyDisposedOfInd |
| Rcv Fnds To Pay Prsnl Bnft Cntrct | false | RcvFndsToPayPrsnlBnftCntrctInd |
| Pay Premiums Prsnl Bnft Cntrct | false | PayPremiumsPrsnlBnftCntrctInd |
| Indoor Tanning Services | false | IndoorTanningServicesInd |
| Info In Schedule O Part VI | Yes (X) | InfoInScheduleOPartVIInd |
| Governing Body Voting Members | 6 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 5 | IndependentVotingMemberCnt |
| Family Or Business Rln | false | FamilyOrBusinessRlnInd |
| Delegation Of Mgmt Duties | false | DelegationOfMgmtDutiesInd |
| Change To Org Documents | false | ChangeToOrgDocumentsInd |
| Material Diversion Or Misuse | false | MaterialDiversionOrMisuseInd |
| Members Or Stockholders | false | MembersOrStockholdersInd |
| Election Of Board Members | Yes (true) | ElectionOfBoardMembersInd |
| Decisions Subject To Approva | Yes (true) | DecisionsSubjectToApprovaInd |
| Minutes Of Governing Body | Yes (true) | MinutesOfGoverningBodyInd |
| Minutes Of Committees | Yes (true) | MinutesOfCommitteesInd |
| Officer Mailing Address | false | OfficerMailingAddressInd |
| Local Chapters | false | LocalChaptersInd |
| Form990 Provided To Gvrn Body | false | Form990ProvidedToGvrnBodyInd |
| Conflict Of Interest Policy | Yes (true) | ConflictOfInterestPolicyInd |
| Annual Disclosure Covered Prsn | Yes (true) | AnnualDisclosureCoveredPrsnInd |
| Regular Monitoring Enfrc | Yes (true) | RegularMonitoringEnfrcInd |
| Whistleblower Policy | Yes (true) | WhistleblowerPolicyInd |
| Document Retention Policy | Yes (true) | DocumentRetentionPolicyInd |
| Compensation Process CEO | Yes (true) | CompensationProcessCEOInd |
| Compensation Process Other | false | CompensationProcessOtherInd |
| Investment In Joint Venture | false | InvestmentInJointVentureInd |
| Upon Request | Yes (X) | UponRequestInd |
Books In Care Of Detail BooksInCareOfDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | PATRICK MCGEE | PersonNm |
| Phone | 8509732271 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 224 NW CRANE AVENUE | AddressLine1Txt |
| City | MADISON | CityNm |
| State Abbreviation | FL | StateAbbreviationCd |
| ZIP | 323401400 | ZIPCd |
Form990 Part VII Section A Form990PartVIISectionAGrp (12 entries)
| TitleTitleTxt | Average Hours Per WeekAverageHoursPerWeekRt | Average Hours Per Week Rltd OrgAverageHoursPerWeekRltdOrgRt | Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd | OfficerOfficerInd | Reportable Comp From OrgReportableCompFromOrgAmt | Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt | Other CompensationOtherCompensationAmt | Highest Compensated EmployeeHighestCompensatedEmployeeInd |
|---|---|---|---|---|---|---|---|---|
| SHIRLEY JOSEPH | ||||||||
| CHAIR | 1.00 | 1.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | |
| HOWARD PHILLIPS | ||||||||
| VICE CHAIR | 1.00 | 1.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | |
| ROSA RICHARDSON | ||||||||
| SECRETARY | 1.00 | 1.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | |
| KAREN ANNETTE JOHNSON | ||||||||
| MEMBER | 1.00 | 1.25 | Yes (X) | $0 | $0 | $0 | ||
| BEN HARRIS | ||||||||
| MEMBER | 1.00 | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| JIM SALE | ||||||||
| MEMBER | 1.00 | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| TAMMY STEVENS | ||||||||
| CEO | 40.00 | Yes (X) | $140,225 | $0 | $1,054 | |||
| PATRICK MCGEE | ||||||||
| CFO | 40.00 | Yes (X) | $74,022 | $0 | $5,610 | |||
| JARED SWIFT | ||||||||
| CNO | 40.00 | 0.25 | Yes (X) | $65,053 | $0 | $0 | ||
| CYNTHIA BURNETT | ||||||||
| HRO | 40.00 | Yes (X) | $57,894 | $0 | $17,504 | |||
| DANIEL PERKINS MD | ||||||||
| PHYSICIAN | 40.00 | $191,689 | $0 | $23,845 | Yes (X) | |||
| LUCILLA STRICKLAND | ||||||||
| NURSE PRACTI | 40.00 | $107,821 | $0 | $815 | Yes (X) | |||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $636,704 | TotalReportableCompFromOrgAmt |
| Total Other Compensation | $48,828 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 3 | IndivRcvdGreaterThan100KCnt |
| Former Ofcr Employees Listed | false | FormerOfcrEmployeesListedInd |
| Total Comp Greater Than150 K | Yes (true) | TotalCompGreaterThan150KInd |
| Compensation From Other Srcs | false | CompensationFromOtherSrcsInd |
Contractor Compensation ContractorCompensationGrp (5 entries)
| Address Line1ContractorAddress/USAddress/AddressLine1Txt | CityContractorAddress/USAddress/CityNm | State AbbreviationContractorAddress/USAddress/StateAbbreviationCd | ZIPContractorAddress/USAddress/ZIPCd | ServicesServicesDesc | CompensationCompensationAmt |
|---|---|---|---|---|---|
| HEALTHLAND | |||||
| P O BOX 850309 | MOBILE | AL | 36685 | COMPUTER SW | $347,538 |
| CARDINAL HEALTH | |||||
| P O BOX 402592 | ATLANTA | GA | 303842592 | PHARMACY | $270,332 |
| AHCA | |||||
| P O BOX 13749 | TALLAHASSEE | FL | 32317 | ASSESSMENTS | $231,627 |
| MADISON RADIOLOGY | |||||
| 3034 NW 68TH BLVD | JENNINGS | FL | 320534246 | RADIOLOGIST | $228,337 |
| SOUTHLAND | |||||
| P O BOX 5218 | NICEVILLE | FL | 325785218 | ER PHYSICIANS | $186,297 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cntrct Rcvd Greater Than100 K | 11 | CntrctRcvdGreaterThan100KCnt |
| Government Grants | $716,612 | GovernmentGrantsAmt |
| All Other Contributions | $608 | AllOtherContributionsAmt |
| Total Contributions | $717,220 | TotalContributionsAmt |
Program Service Revenue ProgramServiceRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | NET PATIENT SERVICES | Desc |
| Business | 623000 | BusinessCd |
| Total Revenue Column | $8,470,671 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $8,470,671 | RelatedOrExemptFuncIncomeAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $8,470,671 | TotalProgramServiceRevenueAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $14,363 | TotalRevenueColumnAmt |
| Exclusion | $14,363 | ExclusionAmt |
Other Revenue Misc OtherRevenueMiscGrp (3 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | ExclusionExclusionAmt | Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt |
|---|---|---|---|---|
| DEBT FORGIVEN | 621990 | $48,348 | $48,348 | |
| PHYSICIAN SALARY REIMBURSEMEN | 621990 | $16,879 | $16,879 | |
| PHYSICIAN OFFICE MANAGEMENT | 621990 | $14,185 | $14,185 |
Miscellaneous Revenue MiscellaneousRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $9,864 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $9,864 | RelatedOrExemptFuncIncomeAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Revenue Total | $89,276 | OtherRevenueTotalAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $9,291,530 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $8,511,599 | RelatedOrExemptFuncIncomeAmt |
| Exclusion | $62,711 | ExclusionAmt |
Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $361,362 | TotalAmt |
| Management And General | $361,362 | ManagementAndGeneralAmt |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $3,814,052 | TotalAmt |
| Program Services | $3,408,192 | ProgramServicesAmt |
| Management And General | $405,860 | ManagementAndGeneralAmt |
Pension Plan Contributions PensionPlanContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $7,965 | TotalAmt |
| Program Services | $7,405 | ProgramServicesAmt |
| Management And General | $560 | ManagementAndGeneralAmt |
Other Employee Benefits OtherEmployeeBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $188,540 | TotalAmt |
| Program Services | $173,769 | ProgramServicesAmt |
| Management And General | $14,771 | ManagementAndGeneralAmt |
Payroll Taxes PayrollTaxesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $291,448 | TotalAmt |
| Program Services | $239,280 | ProgramServicesAmt |
| Management And General | $52,168 | ManagementAndGeneralAmt |
Fees For Services Legal FeesForServicesLegalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $22,157 | TotalAmt |
| Management And General | $22,157 | ManagementAndGeneralAmt |
Fees For Services Accounting FeesForServicesAccountingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $74,877 | TotalAmt |
| Management And General | $74,877 | ManagementAndGeneralAmt |
Fees For Services Other FeesForServicesOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $936,534 | TotalAmt |
| Program Services | $839,211 | ProgramServicesAmt |
| Management And General | $97,323 | ManagementAndGeneralAmt |
Advertising AdvertisingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,948 | TotalAmt |
| Program Services | $136 | ProgramServicesAmt |
| Management And General | $1,812 | ManagementAndGeneralAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $323,417 | TotalAmt |
| Program Services | $243,266 | ProgramServicesAmt |
| Management And General | $80,151 | ManagementAndGeneralAmt |
Information Technology InformationTechnologyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $11,232 | TotalAmt |
| Program Services | $11,232 | ProgramServicesAmt |
Occupancy OccupancyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,296,101 | TotalAmt |
| Program Services | $1,007,719 | ProgramServicesAmt |
| Management And General | $288,382 | ManagementAndGeneralAmt |
Travel TravelGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $9,534 | TotalAmt |
| Program Services | $9,155 | ProgramServicesAmt |
| Management And General | $379 | ManagementAndGeneralAmt |
Conferences Meetings ConferencesMeetingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,746 | TotalAmt |
| Program Services | $1,326 | ProgramServicesAmt |
| Management And General | $1,420 | ManagementAndGeneralAmt |
Interest InterestGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $9,583 | TotalAmt |
| Management And General | $9,583 | ManagementAndGeneralAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,705,468 | TotalAmt |
| Program Services | $1,326,001 | ProgramServicesAmt |
| Management And General | $379,467 | ManagementAndGeneralAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $52,308 | TotalAmt |
| Program Services | $25,324 | ProgramServicesAmt |
| Management And General | $26,984 | ManagementAndGeneralAmt |
Other Expenses OtherExpensesGrp (4 entries)
| DescDesc | TotalTotalAmt | Program ServicesProgramServicesAmt | Management And GeneralManagementAndGeneralAmt |
|---|---|---|---|
| MEDICAL SUPPLIES | $746,251 | $746,251 | |
| REPAIRS & MAINTENANCE | $367,110 | $367,110 | |
| FINES & ASSESSMENTS | $123,185 | $123,185 | |
| LICENSE & FEES | $56,774 | $33,973 | $22,801 |
All Other Expenses AllOtherExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $16,222 | TotalAmt |
| Program Services | $5,812 | ProgramServicesAmt |
| Management And General | $10,410 | ManagementAndGeneralAmt |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $10,418,814 | TotalAmt |
| Program Services | $8,445,162 | ProgramServicesAmt |
| Management And General | $1,973,652 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Cash Non Interest Bearing CashNonInterestBearingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $7,505 | BOYAmt |
| EOY | $8,452 | EOYAmt |
Savings And Temp Cash Invst SavingsAndTempCashInvstGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,073,718 | BOYAmt |
| EOY | $2,103,287 | EOYAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,637,777 | BOYAmt |
| EOY | $1,388,736 | EOYAmt |
Inventories For Sale Or Use InventoriesForSaleOrUseGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $27,872 | BOYAmt |
| EOY | $26,942 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $23,690,234 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $4,067,293 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $21,288,358 | BOYAmt |
| EOY | $19,622,941 | EOYAmt |
Other Assets Total OtherAssetsTotalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $414,518 | BOYAmt |
| EOY | $366,681 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $25,449,748 | BOYAmt |
| EOY | $23,517,039 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,613,373 | BOYAmt |
| EOY | $896,350 | EOYAmt |
Tax Exempt Bond Liabilities TaxExemptBondLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $22,543,400 | BOYAmt |
| EOY | $22,543,400 | EOYAmt |
Mortg Notes Pybl Scrd Invst Prop MortgNotesPyblScrdInvstPropGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $232,000 | BOYAmt |
| EOY | $143,598 | EOYAmt |
Unsecured Notes Loans Payable UnsecuredNotesLoansPayableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $458,585 | BOYAmt |
| EOY | $458,585 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $24,847,358 | BOYAmt |
| EOY | $24,041,933 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Organization Follows SFAS117 | Yes (X) | OrganizationFollowsSFAS117Ind |
Unrestricted Net Assets UnrestrictedNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | -$959,608 | BOYAmt |
| EOY | -$1,765,179 | EOYAmt |
Temporarily Rstr Net Assets TemporarilyRstrNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,561,998 | BOYAmt |
| EOY | $1,240,285 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $602,390 | BOYAmt |
| EOY | -$524,894 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $25,449,748 | BOYAmt |
| EOY | $23,517,039 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Reconcilation Revenue Expnss | -$1,127,284 | ReconcilationRevenueExpnssAmt |
| Method Of Accounting Accrual | Yes (X) | MethodOfAccountingAccrualInd |
| Accountant Compile Or Review | false | AccountantCompileOrReviewInd |
| FS Audited | Yes (true) | FSAuditedInd |
FS Audited Basis FSAuditedBasisGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Separate Basis Fincl Stmt | Yes (X) | SeparateBasisFinclStmtInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Audit Committee | Yes (true) | AuditCommitteeInd |
| Federal Grant Audit Required | false | FederalGrantAuditRequiredInd |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital | Yes (X) | HospitalInd |
Schedule B IRS990ScheduleB
Contributor Information ContributorInformationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Contributor | RESTRICTED | ContributorNum |
Contributor Business Name ContributorBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | RESTRICTED | BusinessNameLine1 |
Contributor US Address ContributorUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | RESTRICTED | AddressLine1 |
| Address Line2 | RESTRICTED | AddressLine2 |
| City | RESTRICTED | City |
| State | RESTRICTED | State |
| ZIP Code | RESTRICTED | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Contributions | RESTRICTED | TotalContributionsAmt |
Schedule C IRS990ScheduleC
| Field | Value | IRS element (for citing) |
|---|---|---|
| Volunteers | false | VolunteersInd |
| Paid Staff Or Management | Yes (true) | PaidStaffOrManagementInd |
| Media Advertisements | false | MediaAdvertisementsInd |
| Mailings Members | false | MailingsMembersInd |
| Publications Or Broadcast | false | PublicationsOrBroadcastInd |
| Grants Other Organizations | false | GrantsOtherOrganizationsInd |
| Direct Contact Legislators | Yes (true) | DirectContactLegislatorsInd |
| Direct Contact Legislators | $492 | DirectContactLegislatorsAmt |
| Rallies Demonstrations | false | RalliesDemonstrationsInd |
| Other Activities | Yes (true) | OtherActivitiesInd |
| Other Activities | $834 | OtherActivitiesAmt |
| Total Lobbying Expenditures | $1,326 | TotalLobbyingExpendituresAmt |
| Not Described Section501c3 | false | NotDescribedSection501c3Ind |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | SCHEDULE C, PART II-B, LINE 1 | FormAndLineReferenceDesc |
| Explanation | THE ORGANIZATION PAYS MEMBERSHIP DUES TO STATE ORGANIZATIONS. A PORTION OF THOSE DUES IS ALLOCATED TO LOBBYING ACTIVITIES IN WHICH THAT ORGANIZATION PARTICIPATES. LOBBYING ACTIVITIES ALSO INCLUDE A PORTION OF SALARIES DIRECTLY RELATED TO LOBBYING ACTIVITIES. | ExplanationTxt |
Schedule D IRS990ScheduleD
CY Endwmt Fund CYEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $1,561,998 | BeginningYearBalanceAmt |
| Contributions | $563,604 | ContributionsAmt |
| Investment Earnings Or Losses | $14,542 | InvestmentEarningsOrLossesAmt |
| Other Expenditures | $899,859 | OtherExpendituresAmt |
| End Year Balance | $1,240,285 | EndYearBalanceAmt |
CY Minus1 Yr Endwmt Fund CYMinus1YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $1,702,179 | BeginningYearBalanceAmt |
| Contributions | $602,630 | ContributionsAmt |
| Investment Earnings Or Losses | $11,591 | InvestmentEarningsOrLossesAmt |
| Other Expenditures | $754,402 | OtherExpendituresAmt |
| End Year Balance | $1,561,998 | EndYearBalanceAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Term Endowment Balance EOY | 1.00000 | TermEndowmentBalanceEOYPct |
| Endowments Held Unrelated Org | Yes (true) | EndowmentsHeldUnrelatedOrgInd |
| Endowments Held Related Org | false | EndowmentsHeldRelatedOrgInd |
Land LandGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $490,000 | OtherCostOrOtherBasisAmt |
| Book Value | $490,000 | BookValueAmt |
Buildings BuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $19,793,366 | OtherCostOrOtherBasisAmt |
| Depreciation | $2,472,724 | DepreciationAmt |
| Book Value | $17,320,642 | BookValueAmt |
Leasehold Improvements LeaseholdImprovementsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $73,567 | OtherCostOrOtherBasisAmt |
| Depreciation | $67,567 | DepreciationAmt |
| Book Value | $6,000 | BookValueAmt |
Equipment EquipmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $3,333,301 | OtherCostOrOtherBasisAmt |
| Depreciation | $1,527,002 | DepreciationAmt |
| Book Value | $1,806,299 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $19,622,941 | TotalBookValueLandBuildingsAmt |
| Footnote Text | Yes (X) | FootnoteTextInd |
| Total Rev Etc Audited Fincl Stmt | $8,382,088 | TotalRevEtcAuditedFinclStmtAmt |
| Other Revenue | -$909,442 | OtherRevenueAmt |
| Revenue Not Reported | -$909,442 | RevenueNotReportedAmt |
| Revenue Subtotal | $9,291,530 | RevenueSubtotalAmt |
| Total Revenue Per Form990 | $9,291,530 | TotalRevenuePerForm990Amt |
| Tot Expns Etc Audited Fincl Stmt | $9,509,372 | TotExpnsEtcAuditedFinclStmtAmt |
| Other Expenses Included | -$909,442 | OtherExpensesIncludedAmt |
| Expenses Not Reported | -$909,442 | ExpensesNotReportedAmt |
| Expenses Subtotal | $10,418,814 | ExpensesSubtotalAmt |
| Total Expenses Per Form990 | $10,418,814 | TotalExpensesPerForm990Amt |
Supplemental Information Detail SupplementalInformationDetail (4 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| SCHEDULE D, PAGE 2, PART V, LINE 4 | THESE FUNDS ARE HELD BY MADISON COUNTY AND REPRESENT THE SURTAX COLLECTED FOR THE PURPOSE OF PAYMENT OF HOSPITAL REVENUE BOND PRINCIPAL AND INTEREST. |
| SCHEDULE D, PAGE 3, PART X | THE DISTRICT IS A GOVERNMENTAL ENTITY AND IS EXEMPT FROM INCOME TAXES. ACCORDINGLY, NO PROVISION FOR INCOME TAXES HAS BEEN CONSIDERED IN THE ACCOMPANYING FINANCIAL STATEMENTS. THE HOSPITAL IS A NOTFORPROFIT ORGANIZATION EXEMPT FROM INCOME TAXES, EXCEPT ON UNRELATED BUSINESS INCOME, UNDER INTERNAL REVENUE CODE SECTION 501(C)(3). THE HOSPITAL APPLIES ACCOUNTING POLICIES THAT PRESCRIBE WHEN TO RECOGNIZE AND HOW TO MEASURE THE FINANCIAL STATEMENT EFFECTS OF INCOME TAX POSITIONS TAKEN OR EXPECTED TO BE TAKEN ON ITS INCOME TAX RETURNS. THESE RULES REQUIRE MANAGEMENT TO EVALUATE THE LIKELIHOOD THAT, UPON EXAMINATION BY THE RELEVANT TAXING JURISDICTIONS, THOSE INCOME TAX POSITIONS WOULD BE SUSTAINED. BASED ON THAT EVALUATION, THE HOSPITAL ONLY RECOGNIZES THE MAXIMUM BENEFIT OF EACH INCOME TAX POSITION THAT IS MORE THAN 50% LIKELY OF BEING SUSTAINED. TO THE EXTENT THAT ALL OR A PORTION OF THE BENEFITS OF AN INCOME TAX POSITION ARE NOT RECOGNIZED, A LIABILITY WOULD BE RECOGNIZED FOR THE UNRECOGNIZED BENEFITS, ALONG WITH ANY INTEREST AND PENALTIES THAT WOULD RESULT FROM DISALLOWANCE OF THE POSITION. SHOULD ANY SUCH PENALTIES AND INTEREST BE INCURRED, THEY WOULD BE RECOGNIZED AS OPERATING EXPENSES. BASED ON THE RESULTS OF MANAGEMENTS EVALUATION, NO LIABILITY IS RECOGNIZED IN THE ACCOMPANYING BALANCE SHEET FOR UNRECOGNIZED INCOME TAX POSITIONS. FURTHER, NO INTEREST OR PENALTIES HAVE BEEN ACCRUED OR CHARGED TO EXPENSE AS OF SEPTEMBER 30, 2016 AND 2015 OR FOR THE YEARS THEN ENDED. THE HOSPITALS TAX RETURNS ARE SUBJECT TO POSSIBLE EXAMINATION BY THE TAXING AUTHORITIES. FOR FEDERAL INCOME TAX PURPOSES, THE TAX RETURNS ESSENTIALLY REMAIN OPEN FOR POSSIBLE EXAMINATION FOR A PERIOD OF THREE YEARS AFTER THE RESPECTIVE FILING DEADLINES OF THOSE RETURNS. LEGEND: THE DISTRICT REFERS TO MADISON COUNTY HEALTH AND HOSPITAL DISTRICT (DISTRICT), A RELATED ENTITY, AND AN INDEPENDENT SPECIAL DISTRICT ORGANIZED UNDER SECTION 2003333 OF THE LAWS OF FLORIDA FOR THE PURPOSE OF PROVIDING PUBLIC HEALTH CARE SERVICES. |
| SCHEDULE D, PAGE 4, PART XI, LINE 2D | INTEREST EXPENSE -909,442 |
| SCHEDULE D, PAGE 4, PART XII, LINE 2D | INTEREST EXPENSE -909,442 |
Schedule H IRS990ScheduleH
| Field | Value | IRS element (for citing) |
|---|---|---|
| Financial Assistance Policy | Yes (true) | FinancialAssistancePolicyInd |
| Written Policy | Yes (true) | WrittenPolicyInd |
| All Hospitals Policy | Yes (X) | AllHospitalsPolicyInd |
| FPG Reference Free Care | Yes (true) | FPGReferenceFreeCareInd |
| Percent100 | Yes (X) | Percent100Ind |
| FPG Reference Discounted Care | Yes (true) | FPGReferenceDiscountedCareInd |
Discounted Care Oth Percentage DiscountedCareOthPercentageGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | Yes (X) | OtherInd |
| Discounted Care Other | 1.250000000000 | DiscountedCareOtherPct |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Free Care Medically Indigent | Yes (true) | FreeCareMedicallyIndigentInd |
| Financial Assistance Budget | false | FinancialAssistanceBudgetInd |
| Annual Community Bnft Report | false | AnnualCommunityBnftReportInd |
Financial Assistance At Cost Typ FinancialAssistanceAtCostTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $164,824 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $164,824 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.01580 | TotalExpensePct |
Unreimbursed Medicaid UnreimbursedMedicaidGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $1,250,066 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $1,843,855 | DirectOffsettingRevenueAmt |
Total Financial Assistance Typ TotalFinancialAssistanceTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $1,414,890 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $1,843,855 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $164,824 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.01580 | TotalExpensePct |
Community Health Services CommunityHealthServicesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $813 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $813 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00010 | TotalExpensePct |
Total Other Benefits TotalOtherBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $813 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $813 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00010 | TotalExpensePct |
Total Community Benefits TotalCommunityBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $1,415,703 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $1,843,855 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $165,637 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.01590 | TotalExpensePct |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | Yes (true) | BadDebtExpenseReportedInd |
| Bad Debt Expense | $3,452,451 | BadDebtExpenseAmt |
| Reimbursed By Medicare | $5,603,482 | ReimbursedByMedicareAmt |
| Cost Of Care Reimbursed By Medcr | $5,641,378 | CostOfCareReimbursedByMedcrAmt |
| Medicare Surplus Or Shortfall | -$37,896 | MedicareSurplusOrShortfallAmt |
Costing Methodology Used CostingMethodologyUsedGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | Yes (X) | OtherInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Written Debt Collection Policy | Yes (true) | WrittenDebtCollectionPolicyInd |
| Financial Assistance Prvsn | false | FinancialAssistancePrvsnInd |
| Hospital Facilities | 1 | HospitalFacilitiesCnt |
Hospital Facilities HospitalFacilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 1 | FacilityNum |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | MADISON COUNTY MEMORIAL HOSPITAL | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 224 NW CRANE AVENUE | AddressLine1Txt |
| City | MADISON | CityNm |
| State Abbreviation | FL | StateAbbreviationCd |
| ZIP | 323401400 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Website Address | WWW.MCMH.US | WebsiteAddressTxt |
| State License | 4346 | StateLicenseNum |
| Licensed Hospital | Yes (X) | LicensedHospitalInd |
| General Medical And Surgical | Yes (X) | GeneralMedicalAndSurgicalInd |
| Critical Access Hospital | Yes (X) | CriticalAccessHospitalInd |
| Emergency Room24 Hrs | Yes (X) | EmergencyRoom24HrsInd |
| Other | SWING BED SNF | OtherDesc |
Hospital Fclty Policies Prctc HospitalFcltyPoliciesPrctcGrp
Hospital Facility Name HospitalFacilityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | MADISON COUNTY MEMORIAL HOSPITAL | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 1 | FacilityNum |
| First Licensed CY Or PY | false | FirstLicensedCYOrPYInd |
| Tax Exempt Hospital CY Or PY | false | TaxExemptHospitalCYOrPYInd |
| CHNA Conducted | Yes (true) | CHNAConductedInd |
| Community Definition | Yes (X) | CommunityDefinitionInd |
| Community Demographics | Yes (X) | CommunityDemographicsInd |
| Existing Resources | Yes (X) | ExistingResourcesInd |
| How Data Obtained | Yes (X) | HowDataObtainedInd |
| Community Health Needs | Yes (X) | CommunityHealthNeedsInd |
| Other Health Issues | Yes (X) | OtherHealthIssuesInd |
| Community Hlth Needs Id Process | Yes (X) | CommunityHlthNeedsIdProcessInd |
| Consulting Process | Yes (X) | ConsultingProcessInd |
| CHNA Conducted | 15 | CHNAConductedYr |
| Take Into Account Others Input | Yes (true) | TakeIntoAccountOthersInputInd |
| CHNA Conducted With Other Fclts | false | CHNAConductedWithOtherFcltsInd |
| CHNA Conducted With Non Fclts | false | CHNAConductedWithNonFcltsInd |
| CHNA Report Widely Available | Yes (true) | CHNAReportWidelyAvailableInd |
| Rpt Available On Own Website | Yes (X) | RptAvailableOnOwnWebsiteInd |
| Own Website URL | WWW.MCMH.US | OwnWebsiteURLTxt |
| Paper Copy Public Inspection | Yes (X) | PaperCopyPublicInspectionInd |
| Implementation Strategy Adopt | Yes (true) | ImplementationStrategyAdoptInd |
| Implementation Strategy Adpt | 16 | ImplementationStrategyAdptYr |
| Strategy Posted Website | Yes (true) | StrategyPostedWebsiteInd |
| Strategy Website URL | WWW.MCMH.US | StrategyWebsiteURLTxt |
| Strategy Attached | false | StrategyAttachedInd |
| Organization Incur Excise Tax | false | OrganizationIncurExciseTaxInd |
| Elig Criteria Explained | Yes (true) | EligCriteriaExplainedInd |
| FPG Family Incm Lmt Free Dscnt | Yes (X) | FPGFamilyIncmLmtFreeDscntInd |
| FPG Family Incm Lmt Free Care | 100.000000000000 | FPGFamilyIncmLmtFreeCarePct |
| FPG Family Incm Lmt Dscnt Care | 125.000000000000 | FPGFamilyIncmLmtDscntCarePct |
| Asset Level Criteria | Yes (X) | AssetLevelCriteriaInd |
| Insurance Status Criteria | Yes (X) | InsuranceStatusCriteriaInd |
| Explained Basis | Yes (true) | ExplainedBasisInd |
| App Financial Asst Expln | Yes (true) | AppFinancialAsstExplnInd |
| Described Info | Yes (X) | DescribedInfoInd |
| Described Suprt Doc | Yes (X) | DescribedSuprtDocInd |
| Provided Hospital Contact | Yes (X) | ProvidedHospitalContactInd |
| Includes Publicity Measures | Yes (true) | IncludesPublicityMeasuresInd |
| FAP Available On Website | Yes (X) | FAPAvailableOnWebsiteInd |
| FAP Available On Website URL | WWWMCMHUS | FAPAvailableOnWebsiteURLTxt |
| FAP Summary On Website | Yes (X) | FAPSummaryOnWebsiteInd |
| FAP Summary On Website URL | WWWMCMHUS | FAPSummaryOnWebsiteURLTxt |
| FAP Avlbl On Request No Charge | Yes (X) | FAPAvlblOnRequestNoChargeInd |
| FAP App Avlbl On Request No Chrg | Yes (X) | FAPAppAvlblOnRequestNoChrgInd |
| FAP Actions On Nonpayment | Yes (true) | FAPActionsOnNonpaymentInd |
| Permit No Actions | Yes (X) | PermitNoActionsInd |
| Collection Activities | Yes (true) | CollectionActivitiesInd |
| FAP Notified Upon Admission | Yes (X) | FAPNotifiedUponAdmissionInd |
| FAP Notified Before Discharge | Yes (X) | FAPNotifiedBeforeDischargeInd |
| FAP Notified All Patients | Yes (X) | FAPNotifiedAllPatientsInd |
| Documented Elig Determination | Yes (X) | DocumentedEligDeterminationInd |
| Nondis Emergency Care Policy | Yes (true) | NondisEmergencyCarePolicyInd |
| Medicare Rates | Yes (X) | MedicareRatesInd |
| Amounts Generally Billed | false | AmountsGenerallyBilledInd |
| Gross Charges | false | GrossChargesInd |
Supplemental Information SupplementalInformationGrp (2 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| FACILITY 1, MADISON COUNTY MEMORIAL HOSPITAL - PART V, LINE 5 | ON NOVEMBER 17, 2014, 15 COMMUNITY MEMBERS, EMPLOYERS, NOT-FOR-PROFIT ORGANIZATIONS, SCHOOL AND GOVERNMENT REPRESENTATIVES PARTICIPATED IN A FOCUS GROUP TO GAIN PERSPECTIVES ON COMMUNITY HEALTH NEEDS AND ISSUES. INFORMATION GATHERING, USING PUBLIC HEALTH SOURCES AND HOSPITAL-SPECIFIC DATA, OCCURRED IN OCTOBER AND NOVEMBER. A COMMUNITY HEALTH SUMMIT WAS CONDUCTED ON DECEMBER 16, 2014 WITH 40 COMMUNITY STAKEHOLDERS. THE AUDIENCE CONSISTED OF HEALTHCARE WORKERS, HEALTH DEPARTMENT PERSONNEL, BUSINESS LEADERS, PERSONNEL FROM THE SCHOOL SYSTEMS, GOVERNMENT REPRESENTATIVES, CLERGY AND OTHER COMMUNITY MEMBERS. PARTICIPATION IN THE FOCUS GROUP AND AT THE COMMUNITY SUMMIT CREATING THE MADISON COUNTY COMMUNITY HEALTH NEEDS ASSESSMENT AND IMPROVEMENT PLAN: MADISON COUNTY MEMORIAL HOSPITAL: INTERIM CEO, HUMAN RESOURCES, CFO, DIRECTOR OF MARKETING MADISON COUNTY MEMORIAL HOSPITAL BOARD OF DIRECTORS MADISON COUNTY EMS FOUR CHURCH PASTORS FLORIDA DEPARTMENT OF HEALTH - MADISON FLORIDA DEPARTMENT OF HEALTH HAMILTON COUNTY STUDSTILL LUMBER CITY OF GREENVILLE CITY OF MADISON ALLIED SCIENCES, NORTH FLORIDA COMMUNITY COLLEGE ALLIED HEALTH NORTH FLORIDA COMMUNITY COLLEGE GREATER MADISON CHAMBER OF COMMERCE CITIZENS (RETIRED TEACHER, RETIRED NURSE, MADISON COUNTY HEALTH DEPT., RETIRED PHYSICIAN) REFUGE HOUSE SUWANEE VALLEY NURSING CENTER MADISON CORRECTIONS INSTITUTE MADISON COUNTY PLANNING AND ZONING FLORIDA STATE UNIVERSITY, TALLAHASSEE MADISON ACADEMY N. FL RURAL HEALTHCARE DEVELOPMENT NETWORK TREASURES OF MADISON COUNTY NORTH FLORIDA COMMUNITY COLLEGE FRIENDS OF THE HOSPITAL, INC. MADISON COUNTY COMMUNITY BANK MADISON ACADEMY COVENANT HOSPICE HCA HEALTHCARE CAPITAL REGION MEDICAL CENTER HEALTHY START COALITION ST. LUKES EPISCOPAL CHURCH, LIVE OAK BIG BEND AHEC NORTH FLORIDA MEDICAL CENTERS, INC. MADISON HEALTH AND REHAB CENTER INSURANCE AND INVESTMENTS FLORIDA DEPARTMENT OF HEALTH - TALLAHASSEE |
| FACILITY 1, MADISON COUNTY MEMORIAL HOSPITAL - PART V, LINE 11 |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|
Supplemental Information Detail SupplementalInformationDetail (9 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| PART I, LINE 7 - COSTING METHODOLOGY EXPLANATION | COSTS FOR PART I, LINE 7A AND 7B WERE DETERMINED USING THE RCC CALCULATED IN WORKSHEET 2. OTHER COSTS WERE OBTAINED FROM THE ORGANIZATION'S ACCOUNTING RECORDS. |
| PART III, LINE 2 - BAD DEBT EXPENSE METHODOLOGY | AMOUNTS INCLUDED ON PART III LINE 2 REPRESENT THE AMOUNT OF CHARGES CONSIDERED UNCOLLECTIBLE AFTER REASONABLE ATTEMPTS TO COLLECT, AND WRITTEN OFF TO BAD DEBT EXPENSE. |
| BAD DEBT EXPENSE FOOTNOTE TO FINANCIAL STATEMENTS | THE HOSPITAL PROVIDES AN ALLOWANCE FOR DOUBTFUL ACCOUNTS BASED ON AN EVALUATION OF THE OVERALL COLLECTABILITY OF THE ACCOUNTS RECEIVABLE. AS ACCOUNTS ARE KNOWN TO BE UNCOLLECTIBLE, THE ACCOUNTS ARE CHARGED AGAINST THE ALLOWANCE. |
| PART III, LINE 8 - MEDICARE EXPLANATION | MEDICARE ALLOWABLE COSTS ARE COMPUTED IN ACCORDANCE WITH COST REPORTING METHODOLOGIES UTILIZED ON THE MEDICARE COST REPORT AND IN ACCORDANCE WITH RELATED REGULATIONS. INDIRECT COSTS ARE ALLOCATED TO DIRECT SERVICE AREAS USING THE MOST APPROPRIATE STATISTICAL BASIS. |
| PART III, LINE 9B - COLLECTION PRACTICES EXPLANATION | FOR PATIENTS WHO QUALIFY FOR CHARITY CARE AND FULL FINANCIAL ASSISTANCE UNDER THE HOSPITAL'S POLICY, THERE IS NO FINANCIAL OBLIGATION AND THE ACCOUNT IS WRITTEN OFF. FOR THOSE WHO QUALIFY FOR PARTIAL FINANCIAL ASSISTANCE, COLLECTION PROCEDURES FOLLOW THE SAME PROCESS AS ALL OTHER PATIENTS WHO ARE RESPONSIBLE FOR UNPAID BALANCES. |
| PART VI, LINE 2 - NEEDS ASSESSMENT | THE HOSPITAL COLLABORATES WITH NUMEROUS NOT-FOR-PROFIT AGENCIES AND PROGRAMS TO EXTEND AND STRENGTHEN OUR MISSION. THE ORGANIZATION CONTINUALLY CONDUCTS VARIOUS TYPES OF ASSESSMENTS TO DETERMINE THE COMMUNITY'S NEEDS FOR HEALTH AND PERSONAL SUPPORT SERVICES. WITH THE ASSISTANCE OF STRATASAN, A HEALTHCARE ANALYTICS AND FACILITATION COMPANY BASED IN NASHVILLE, TN, THE HOSPITAL CONDUCTED A COMMUNITY HEALTH NEEDS ASSESSMENT, COMPLETED AND PUBLISHED JANUARY 2015. BOTH THE CHNA AND IMPLEMENTATION PLAN CAN BE FOUND AT THE FOLLOWING WEBSITE ADDRESS: HTTP://WWW.MCMH.US/MAIN/COMMUNITYHEALTHNEEDSASSESSMENT COMMUNITY HEALTH NEEDS ASSESSMENT IMPLEMENTATION PROGRESS "PHYSICIAN RECRUITMENT/ACCESS EFFORTS: O THE HOSPITAL DEVELOPED A PARTNERSHIP WITH FLORIDA STATE UNIVERSITY (FSU) COLLEGE OF MEDICINE FOR SUCCESSIVE PHYSICIAN RECRUITMENT PLANNING THROUGH A WRITTEN AGREEMENT TO ALLOW THEIR MEDICAL STUDENTS TO SHADOW HOSPITAL PROVIDERS ON SITE. ONE STUDENT HAS SUCCESSFULLY COMPLETED A ROTATION AT MADISON COUNTY MEMORIAL HOSPITAL. THIS AGREEMENT ALLOWS THE STUDENTS TO LEARN ABOUT THE MANY ADVANTAGES OF PRACTICING IN RURAL COMMUNITIES, AND HOPEFULLY IN TURN BE INSTRUMENTAL IN ATTRACTING NEW PHYSICIANS TO CONSIDER FUTURE OPPORTUNITIES WITH THE HOSPITAL. O A NEW PHYSICIAN WITH A SPECIALTY IN GERIATRICS OPENED A PRIVATE PRACTICE ADJACENT TO THE HOSPITAL PROPERTY MAY 2016. O THE HOSPITAL AND TALLAHASSEE MEMORIAL HOSPITAL CONTINUE DISCUSSIONS ON A PARTNERSHIP FOR MENTAL HEALTH AND OTHER SPECIALIST CONSULTS BY WAY OF TELEMEDICINE. O THE LAST PUBLIC HEARING ON A RE-ZONING PROPOSAL BY THE CITY OF MADISON FOR THE PURPOSE OF ALLOWING PHYSICIANS/MEDICAL-RELATED BUSINESSES TO BUILD NEW OFFICES OR PURCHASE EXISTING BUILDINGS ADJACENT TO THE HOSPITAL WAS DECEMBER 2016. THIS IS A LONG-TERM INVESTMENT IN THE AREA AROUND THE HOSPITAL TO PROMOTE LAND PLANNING THAT SUPPORTS THE HOSPITAL AND MEDICAL COMMUNITY. "DIABETES EDUCATION AND WELLNESS PROGRAM: O THE HOSPITAL CONTINUES TO ENHANCE COMMUNITY EDUCATIONAL AWARENESS ON DECREASING THE INCIDENCE OF COMPLICATIONS OF DIABETES. FREE EDUCATIONAL CLASSES ARE HELD WITH SOCIAL MEDIA POSTING AND ADVERTISING VIA THE CHAMBER OF COMMERCE. IN DECEMBER, 2015 A HOSPITAL EMPLOYEE RECEIVED THEIR CERTIFICATION AS A DIABETIC TRAINER TO SATISFY THE HOSPITAL EFFORTS IN PROMOTING AND SUPPORTING A WORKFORCE THAT IS TRAINED AS DIABETES EDUCATORS. O EVIDENCE BASED DIABETES GUIDELINES ARE BEING DEVELOPED BY THE CHIEF MEDICAL OFFICER TO ASSIST IN THE MONITORING OF PATIENTS' ADHERENCE TO THE DIABETES STANDARD OF CARE. O THE HOSPITAL IMPLEMENTED A HOSPITAL WELLNESS INITIATIVE IN CONJUNCTION WITH THE LOCAL HEALTH DEPARTMENT AND WORKED CLOSELY WITH THE LOCAL GYMS FOR HEALTH CARE EMPLOYEE DISCOUNTS TO PROMOTE AND ENCOURAGE A HEALTHY LIFESTYLE. |
| PART VI, LINE 3 - PATIENT EDUCATION OF ELIGIBILITY FOR ASSISTANCE | THE HOSPITAL HAS CLEARLY WRITTEN FINANCIAL ASSISTANCE POLICIES POSTED IN THE BUSINESS OFFICE, ER REGISTRATION AREA, AND OUTPATIENT REGISTRATION AREA. SIGNS ARE PROMINENTLY POSTED ON THE AVAILABILITY OF FREE AND FINANCIAL AID. PATIENT EDUCATION ON THE ORGANIZATION'S FINANCIAL ASSISTANCE PROGRAMS ARE CONDUCTED DURING REGISTRATION AND/OR THROUGH FLOOR VISITS BY CASE MANAGERS AND COLLECTIONS REPRESENTATIVES FOR PATIENTS THAT HAVE CONCERNS IN MEETING THE FINANCIAL OBLIGATIONS FOR SERVICES PROVIDED. |
| PART VI, LINE 4 - COMMUNITY INFORMATION | THE ORGANIZATION SERVES POPULATIONS WITHIN MADISON COUNTY, INCLUDING THE CITIES OF MADISON, GREENVILLE, PINETTA, AND LEE, FLORIDA. MADISON COUNTY'S POPULATION OF APPROXIMATELY 19,500 HAS A MEDIAN AGE OF 40.6, A MEDIAN HOUSEHOLD INCOME OF 32,835, AND IS 56% WHITE, 39% BLACK, 5% HISPANIC AND 4% OTHER. THE POPULATION EXPERIENCES HIGH LEVELS OF DEPRESSION, DIABETES, HYPERTENSION, OBESITY, AND ASTHMA. |
| PART VI, LINE 5 - PROMOTION OF COMMUNITY HEALTH | THE ORGANIZATION'S VOLUNTEER BOARD IS COMPOSED OF COMMUNITY MEMBERS WITH DIVERSE PROFESSIONAL AND COMMUNITY SERVICE BACKGROUNDS. THE HOSPITAL OPERATES A FULL-TIME EMERGENCY ROOM WHICH ACCEPTS ALL IN NEED OF EMERGENCY MEDICAL TREATMENT, REGARDLESS OF ABILITY TO PAY. MEDICAL STAFF PRIVILEGES ARE AVAILABLE TO ALL QUALIFIED PHYSICIANS IN THE AREA. EXCESS FUNDS FROM OPERATIONS ARE REINVESTED INTO THE HOSPITAL'S SERVICES AND EXPANSION OR REPLACEMENT OF FACILITIES AND EQUIPMENT. |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Board Or Committee Approval | Yes (X) | BoardOrCommitteeApprovalInd |
| Severance Payment | false | SeverancePaymentInd |
| Supplemental Nonqual Rtr Plan | false | SupplementalNonqualRtrPlanInd |
| Equity Based Comp Arrngm | false | EquityBasedCompArrngmInd |
| Comp Based On Revenue Of Flng Org | false | CompBasedOnRevenueOfFlngOrgInd |
| Comp Bsd On Rev Related Orgs | false | CompBsdOnRevRelatedOrgsInd |
| Comp Bsd Net Earns Flng Org | false | CompBsdNetEarnsFlngOrgInd |
| Comp Bsd Net Earns Rltd Orgs | false | CompBsdNetEarnsRltdOrgsInd |
| Any Non Fixed Payments | false | AnyNonFixedPaymentsInd |
| Initial Contract Exception | false | InitialContractExceptionInd |
Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | DANIEL PERKINS MD | PersonNm |
| Title | PHYSICIAN | TitleTxt |
| Base Compensation Filing Org | $191,689 | BaseCompensationFilingOrgAmt |
| Deferred Compensation Flng Org | $1,580 | DeferredCompensationFlngOrgAmt |
| Nontaxable Benefits Filing Org | $22,265 | NontaxableBenefitsFilingOrgAmt |
| Total Compensation Filing Org | $215,534 | TotalCompensationFilingOrgAmt |
Schedule K IRS990ScheduleK
Tax Exempt Bonds Issues TaxExemptBondsIssuesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bond Reference | A | BondReferenceCd |
Issuer Name IssuerName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | MADISON COUNTY HEALTH AND HOSPITAL | BusinessNameLine1Txt |
| Business Name Line2 | SERIES 2014 BONDS | BusinessNameLine2Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bond Issuer EIN | 592319288 | BondIssuerEIN |
| CUSIP | NONENONEN | CUSIPNum |
| Bond Issued | 2014-10-30 | BondIssuedDt |
| Issue Price | $22,543,400 | IssuePriceAmt |
| Purpose | PAYOFF SERIES 2012 NOTES PAYABLE | PurposeDesc |
| Defeased | false | DefeasedInd |
| On Behalf Of Issuer | false | OnBehalfOfIssuerInd |
| Pool Financing | false | PoolFinancingInd |
Tax Exempt Bonds Proceeds TaxExemptBondsProceedsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bond Reference | A | BondReferenceCd |
| Total Proceeds | $22,543,400 | TotalProceedsAmt |
| Other Spent Proceeds | $22,543,400 | OtherSpentProceedsAmt |
| Substantial Completion | 2015 | SubstantialCompletionYr |
| Current Refunding | Yes (true) | CurrentRefundingInd |
| Advance Refunding | false | AdvanceRefundingInd |
| Final Allocation Made | Yes (true) | FinalAllocationMadeInd |
| Adequate Books And Rec Maint | Yes (true) | AdequateBooksAndRecMaintInd |
Tax Exempt Bonds Private Bus Use TaxExemptBondsPrivateBusUseGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bond Reference | A | BondReferenceCd |
| Owning Bond Financed Property | false | OwningBondFinancedPropertyInd |
| Any Lease Arrangements | false | AnyLeaseArrangementsInd |
| Mgmt Contract Bond Fincd Prop | false | MgmtContractBondFincdPropInd |
| Any Research Agreements | false | AnyResearchAgreementsInd |
| Bond Iss Meet Prvt Sec Pymt Test | false | BondIssMeetPrvtSecPymtTestInd |
| Change In Use Bond Financed Prop | false | ChangeInUseBondFinancedPropInd |
| Procs Nonqualified Bond Remdtd | false | ProcsNonqualifiedBondRemdtdInd |
Tax Exempt Bonds Arbitrage TaxExemptBondsArbitrageGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bond Reference | A | BondReferenceCd |
| Form8038 T Filed | false | Form8038TFiledInd |
| Rebate Not Due Yet | false | RebateNotDueYetInd |
| Exception To Rebate | false | ExceptionToRebateInd |
| No Rebate Due | Yes (true) | NoRebateDueInd |
| Variable Rate Issue | false | VariableRateIssueInd |
| Hedge Identified In Bks And Rec | false | HedgeIdentifiedInBksAndRecInd |
| Gross Proceeds Invested In GIC | false | GrossProceedsInvestedInGICInd |
| Gross Proceeds Invested | false | GrossProceedsInvestedInd |
| Written Proc To Monitor Reqs | false | WrittenProcToMonitorReqsInd |
Procedures Corrective Action ProceduresCorrectiveActionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bond Reference | A | BondReferenceCd |
| Procedures Corrective Action | false | ProceduresCorrectiveActionInd |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | SCHEDULE K - DATE REBATE COMPUTATION PERFORMED | FormAndLineReferenceDesc |
| Explanation | MADISON COUNTY HEALTH AND HOSPITAL 10/30/14 | ExplanationTxt |
Schedule L IRS990ScheduleL
Bus Tr Involve Interested Prsn BusTrInvolveInterestedPrsnGrp (2 entries)
| Relationship DescriptionRelationshipDescriptionTxt | TransactionTransactionAmt | TransactionTransactionDesc | Sharing Of RevenuesSharingOfRevenuesInd |
|---|---|---|---|
| HOWARD PHILLIPS | |||
| BOARD MEMBER | $871,014 | BANK CASH ACCOUNTS | false |
| HOWARD PHILLIPS | |||
| BOARD MEMBER | $143,598 | LINE OF CREDIT | false |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | SCHEDULE L, PART V | FormAndLineReferenceDesc |
| Explanation | HOWARD PHILLIPS, VICE CHAIRMAN OF THE BOARD, HOLDS THE POSITION OF EXECUTIVE VICE PRESIDENT AND CFO AT MADISON COUNTY COMMUNITY BANK (MCCB). THE ORGANIZATION MAINTAINS CASH ACCOUNT BALANCES AND A LINE OF CREDIT AT MCCB. AMOUNTS DISCLOSED ABOVE REPRESENT FISCAL YEAR END BALANCES. | ExplanationTxt |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (6 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| FORM 990, PAGE 6, PART VI, LINE 7A | MEMBERS OF THE MADISON COUNTY HEALTH AND HOSPITAL BOARD (DISTRICT), AN INDEPENDENT SPECIAL DISTRICT ORGANIZED UNDER SECTION 2003-333 OF THE LAWS OF FLORIDA FOR THE PURPOSE OF PROVIDING PUBLIC HEALTH CARE SERVICES, SERVE AS DIRECTORS OF THE FILING ORGANIZATION. THE DISTRICT HAS A SEVEN-MEMBER GOVERNING BOARD THAT IS APPOINTED BY THE GOVERNOR OF THE STATE OF FLORIDA. |
| FORM 990, PAGE 6, PART VI, LINE 7B | AS THE MADISON COUNTY HEALTH AND HOSPITAL BOARD (DISTRICT), THE TAXING AUTHORITY, SHARE THE SAME BOARD MEMBERS AS THE FILING ORGANIZATION, ALL ACTIONS AND DECISIONS ARE SUBJECT TO THE APPROVAL OF THE DISTRICT BOARD. |
| FORM 990, PAGE 6, PART VI, LINE 11B | THE FORM 990 IS REVIEWED BY THE HOSPITAL'S CFO BEFORE IT IS FILED WITH THE INTERNAL REVENUE SERVICE. A COPY OF THE FORM 990 WILL BE AVAILABLE TO BE REVIEWED BY THE BOARD MEMBERS. |
| FORM 990, PAGE 6, PART VI, LINE 12C | THE CHIEF FINANCIAL OFFICER OF MCMH, PATRICK MCGEE, SERVES AS THE CORPORATE COMPLIANCE OFFICER. THE CONFLICT OF INTEREST POLICY IS PART OF THE MADISON COUNTY HOSPITAL HEALTH SYSTEMS, INC.S CODE OF CONDUCT. THE CONFLICT POLICY INCLUDES ALL EMPLOYEES, HOSPITAL BOARD MEMBERS, AND VOLUNTEERS. ALL EMPLOYEES, BOARD MEMBERS, AND VOLUNTEERS MUST INFORM ADMINISTRATION ABOUT ALL POSSIBLE CONFLICTS OF INTEREST. IF ANY CONFLICT OF INTEREST POSSIBLY EXISTS IN THE ORGANIZATION, THE CORPORATE COMPLIANCE OFFICER WILL MAKE SENIOR MANAGEMENT AND THE CORPORATE COMPLIANCE BOARD AWARE IMMEDIATELY. THE DETERMINATION OF A CONFLICT IS REVIEWED BY HOSPITAL SENIOR MANAGEMENT (AND FURTHER DISCUSSED AT THE QUARTERLY CORPORATE COMPLIANCE MEETING IF NEEDED FOR FURTHER DETERMINATION). AFTER A DETERMINATION IS MADE OF A CONFLICTS EXISTENCE, SENIOR MANAGEMENT TAKES WHATEVER ACTION NECESSARY TO SOLVE THE PROBLEM INCLUDING DISCIPLINARY ACTION AND/OR TERMINATION. THE ADMINISTRATION/SENIOR MANAGEMENT DETERMINATION PROCESS WILL NOT INCLUDE ANY HOSPITAL MEMBER WHO IS PART OF THE CONFLICT. ALL CONFLICT INFORMATION WILL BE DELIVERED TO AND SHARED WITH THE CORPORATE COMPLIANCE TEAM AT THE QUARTERLY CORPORATE COMPLIANCE MEETING. BOARD DIRECTORS ABIDE BY A CONFLICT OF INTEREST POLICY, THE TERMS OF WHICH ARE SET FORTH IN THE BYLAWS. BOARD MEMBERS ARE PROHIBITED FROM VOTING IN AN OFFICIAL CAPACITY ON ANY MEASURES WHICH WOULD INURE TO PRIVATE GAIN OR LOSS, WHETHER DIRECT OR INDIRECT. |
| FORM 990, PAGE 6, PART VI, LINE 15A | COMPENSATION IS DETERMINED BY THE BOARD OF DIRECTORS WHO USE AN INDUSTRY AVERAGE GUIDE AS A REFERENCE TO DETERMINE EQUITABLE COMPENSATION. MINUTES OF THE BOARD MEETINGS, INCLUDING THOSE IN WHICH COMPENSATION IS DISCUSSED ARE KEPT ON A REGULAR BASIS. |
| FORM 990, PAGE 6, PART VI, LINE 19 | THE ORGANIZATION MAKES ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UPON REQUEST. |
Schedule R IRS990ScheduleR
Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp (2 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | EINEIN | Primary ActivitiesPrimaryActivitiesTxt | Legal Domicile StateLegalDomicileStateCd | Exempt Code SectionExemptCodeSectionTxt | Public Charity StatusPublicCharityStatusTxt | Business Name Line1DirectControllingEntityName/BusinessNameLine1Txt | Controlled OrganizationControlledOrganizationInd |
|---|---|---|---|---|---|---|---|---|---|---|
| MADISON CO HLTH & HOSPITAL DISTRICT | ||||||||||
| 224 NW CRANE AVENUE | MADISON | FL | 323401400 | 592319288 | TAX AUTHOR | FL | 501C3 | 3 | NA | false |
| FRIENDS OF THE HOSPITAL INC | ||||||||||
| 224 NW CRANE AVENUE | MADISON | FL | 323401400 | 272007199 | FOUNDATION | FL | 501C3 | 7 | NA | false |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Annts Rnts Rylts | false | ReceiptOfIntAnntsRntsRyltsInd |
| Gift Grnt Or Cap Contri To Oth Org | false | GiftGrntOrCapContriToOthOrgInd |
| Gift Grnt Cap Contri From Oth Org | false | GiftGrntCapContriFromOthOrgInd |
| Loans Or Guarantees To Other Org | false | LoansOrGuaranteesToOtherOrgInd |
| Loans Or Guarantees From Oth Org | Yes (true) | LoansOrGuaranteesFromOthOrgInd |
| Div Related Organization | false | DivRelatedOrganizationInd |
| Asset Sale To Other Org | false | AssetSaleToOtherOrgInd |
| Asset Purchase From Other Org | false | AssetPurchaseFromOtherOrgInd |
| Asset Exchange | false | AssetExchangeInd |
| Rental Of Facilities To Oth Org | false | RentalOfFacilitiesToOthOrgInd |
| Rental Of Fclts From Oth Org | Yes (true) | RentalOfFcltsFromOthOrgInd |
| Perform Of Services For Oth Org | Yes (true) | PerformOfServicesForOthOrgInd |
| Perform Of Services By Other Org | Yes (true) | PerformOfServicesByOtherOrgInd |
| Sharing Of Facilities | Yes (true) | SharingOfFacilitiesInd |
| Paid Employees Sharing | Yes (true) | PaidEmployeesSharingInd |
| Reimbursement Paid To Other Org | false | ReimbursementPaidToOtherOrgInd |
| Reimbursement Paid By Other Org | false | ReimbursementPaidByOtherOrgInd |
| Transfer To Other Org | false | TransferToOtherOrgInd |
| Transfer From Other Org | false | TransferFromOtherOrgInd |