2024-10-31T14:28:35-05:00 2023-12-31 251408703 SCHNEIDER DOWNS & CO INC ONE PPG PLACE SUITE 1700 PITTSBURGH PA 15222 990 2023-01-01 237423524 MADISON COUNTY HOSPITAL FOUNDATION MADI 7408457015 210 NORTH MAIN STREET LONDON OH 43140 VIRGINIA KRONK EXECUTIVE DIRECTOR 7408457015 2024-10-21 1 0 ERIN F WOOD P01710275 4122613644 2023 2024-10-15 13:58:12Z MADISON HEALTH FOUNDATION VIRGINIA KRONK 210 NORTH MAIN STREET LONDON OH 43140 3202821 0 X WWW.MADISON-HEALTH.COM X 1974 OH TO SUPPORT MADISON COUNTY COMMUNITY HOSPITAL & CLOSE-TO-HOME HEALTH CARE SERVICES & PROGRAMS. 21 17 0 45 0 0 307239 384805 0 0 32859 57770 28979 40988 369077 483563 59658 58168 0 0 0 0 0 0 0 14997 17017 74655 75185 294422 408378 3410788 4241671 2024 1476 3408764 4240195 THROUGH CHARITABLE GIFTS AND FUND-RAISING ACTIVITIES, THE MADISON COUNTY HOSPITAL FOUNDATION SUPPORTS MADISON COUNTY COMMUNITY HOSPITAL AND CLOSE-TO-HOME HEALTH CARE SERVICES. 0 0 58168 58168 STEWARDSHIP OF CHARITABLE GIFTS AND BEQUESTS FOR THE BENEFIT OF MADISON COUNTY COMMUNITY HOSPITAL. 58168 1 1 0 0 0 0 0 0 0 0 0 0 0 0 1 1 0 1 0 0 0 0 0 0 1 0 0 1 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 7 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 X 21 17 1 0 0 0 1 1 0 1 1 0 0 0 1 1 1 1 1 0 0 0 OH X MICHAEL S BROWNING 7408457015 210 NORTH MAIN STREET LONDON OH 43140 DANA E ENGLE MCCH CEO 3.00 43.00 X X 0 537592 71116 MICHAEL S BROWNING CFO, TREASURER 3.00 43.00 X X 0 329317 21701 VIRGINIA KRONK EXECUTIVE DIRECTOR 40.00 0.00 X X 0 102256 51563 JOEL RICE BOARD MEMBER 2.00 0.00 X 0 177107 38821 JAMIE ADAMSEMP GIFTS CHAIR VOL. & AUX COOR. (EXIT 07/23) 40.00 0.00 X 0 15181 757 MILLIE NEWMAN AUXILIARY PRESIDENT (EXIT 03/23) 2.00 0.00 X X 0 0 0 BARB SCHWAB KLACKO AUXILIARY PRESIDENT (ENTERED 03/23) 2.00 0.00 X X 0 0 0 TOM COX PRESIDENT 2.00 0.00 X X 0 0 0 SUE MCCLELLAND VICE PRESIDENT 2.00 0.00 X X 0 0 0 SUE HACKETT SECRETARY 2.00 0.00 X X 0 0 0 NICK ADKINS BOARD MEMBER 2.00 0.00 X 0 0 0 AMANDA ALCOTT BOARD MEMBER 2.00 0.00 X 0 0 0 TY BLAKE BOARD MEMBER 2.00 0.00 X 0 0 0 DIANE CAMPBELL BOARD MEMBER 2.00 0.00 X 0 0 0 RANDALL CRISP BOARD MEMBER 2.00 0.00 X 0 0 0 LORI EVANTS BOARD MEMBER (EXIT 03/23) 2.00 0.00 X 0 0 0 JEAN GODDEN BOARD MEMBER 2.00 0.00 X 0 0 0 BRYAN HOWARD BOARD MEMBER 2.00 0.00 X 0 0 0 AMY POPE-HARMAN BOARD MEMBER 2.00 0.00 X 0 0 0 VICTOR ROBERTSON BOARD MEMBER 2.00 0.00 X 0 0 0 BRYAN ROBINSON BOARD MEMBER 2.00 0.00 X 0 0 0 RUTH RODDY BOARD MEMBER 2.00 0.00 X 0 0 0 ZAHID SIDDIQI BOARD MEMBER 2.00 0.00 X 0 0 0 LAURA TOOPS BOARD MEMBER 2.00 0.00 X 0 0 0 TIM WRIGHT BOARD MEMBER 2.00 0.00 X 0 0 0 0 1161453 183958 0 0 1 0 0 390 181686 202729 384805 50732 50732 2640049 2633011 7038 7038 7038 88635 181686 61584 27051 27051 7035 1787 5248 5248 31565 22876 8689 8689 483563 0 0 98758 39223 39223 18945 18945 9494 9494 7398 7398 AUXILIARY CHRISTMAS PAR 125 125 75185 58168 17017 0 522094 434454 132455 380356 155098 107465 0 3303 2563151 3269696 37990 46397 3410788 4241671 663 -125 1361 1601 2024 1476 X 2182650 2795136 1226114 1445059 3408764 4240195 3410788 4241671 408378 423053 0 X X 0 1 X 1 0 X 422147 269924 297589 307239 384805 1681704 422147 269924 297589 307239 384805 1681704 446209 1235495 13596 -2024 41398 32859 50732 136561 60284 1039 21233 32299 114855 15382 2131 10562 7746 8689 44510 1977630 0.62470 0.72990 X SCHEDULE A, PART II, LINE 10, EXPLANATION OF OTHER INCOME: SALE OF INVENTORY - 2019 AMOUNT: $ 15,382. 2020 AMOUNT: $ 2,131. 2021 AMOUNT: $ 10,562. 2022 AMOUNT: $ 7,746. 2023 AMOUNT: $ 8,689. RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 DUE TO AFFILIATE 1601 1601 X PART X, LINE 2: THE FOLLOWING FOOTNOTE IS INCLUDED IN THE CONSOLIDATED FINANCIAL STATEMENTS OF MADISON COUNTY HOSPITAL, INC. THE HOSPITAL IS AN OHIO NONPROFIT CORPORATION AND IS EXEMPT FROM FEDERAL INCOME TAX UNDER 501(C)(3) OF THE INTERNAL REVENUE CODE. THE HOSPITAL HAS NOT IDENTIFIED ANY MATERIAL UNCERTAIN TAX POSITIONS REQUIRING AN ACCRUAL OR DISCLOSURE IN THE CONSOLIDATED FINANCIAL STATEMENTS. THERE WERE NO INTEREST OR PENALTIES RECOGNIZED IN THE CONSOLIDATED STATEMENT OF ACTIVITIES FOR THE YEARS ENDED DECEMBER 31, 2023 AND 2022 RELATED TO UNCERTAIN TAX POSITIONS. THE HOSPITAL IS NO LONGER SUBJECT TO U.S. FEDERAL OR STATE TAX EXAMINATIONS FOR YEARS PRIOR TO 2020. HEARTFELT HOLIDAYS 190032 119035 70997 700 22605 1000 16376 GOLF OUTING 48898 36575 12323 6460 4927 4470 1 31391 26076 5315 5046 270321 181686 88635 7160 27532 1000 25892 61584 27051 1 MADISON COUNTY COMMUNITY HOSPITAL 210 NORTH MAIN STREET LONDON OH 43140 311657206 501(C)(3) 39223 0 N/A N/A TO SUPPORT THE NON-PROFIT ACTIVITIES OF MADISON COUNTY COMMUNITY HOSPITAL 1 0 HOSPITAL EMPLOYEE BENEVOLENCE FUND 20 12562 N/A N/A HEARTFELT PATIENT ASSISTANCE FUND 6 1716 N/A N/A BREAST CANCER ENDOWMENT PATIENT ASSISTANCE FUND 9 4667 N/A N/A PART I, LINE 2: PART II: MADISON COUNTY HOSPITAL FOUNDATION, INC. SUPPORTS THE NON-PROFIT ACTIVITIES OF MADISON COUNTY COMMUNITY HOSPITAL, WHICH INCLUDES CAPITAL ACQUISITION AND OPERATING EXPENSE REIMBURSEMENT. ALL SUCH SUPPORT IS REVIEWED AND APPROVED BY THE BOARD. PART III: AN ALL INDEPENDENT COMMITTEE APPROVES AND SUPERVISES ALL DISBURSEMENTS PURSUANT TO PRE-APPROVED ELIGIBILITY CRITERIA. ELIGIBLE EMPLOYEES OF MADISON COUNTY COMMUNITY HOSPITAL WHO ARE EXPERIENCING UNEXPECTED HARDSHIPS MAY APPLY FOR FINANCIAL ASSISTANCE. 0 0 0 0 0 0 0 0 0 DANA E ENGLE MCCH CEO 0 503786 0 0 0 33806 0 20978 0 50138 0 608708 0 0 MICHAEL S BROWNING CFO, TREASURER 0 327511 0 0 0 1806 0 16547 0 5154 0 351018 0 0 JOEL RICE BOARD MEMBER 0 176858 0 0 0 249 0 9169 0 29652 0 215928 0 0 VIRGINIA KRONK EXECUTIVE DIRECTOR 0 101430 0 0 0 826 0 5314 0 46249 0 153819 0 0 PART I, LINE 3 MADISON COUNTY HOSPITAL FOUNDATION DOES NOT COMPENSATE ITS OFFICERS RATHER COMPENSATION IS PAID BY THE RELATED ORGANIZATION MADISON COUNTY COMMUNITY HOSPITAL (MCCH). MCCH USES THE FOLLOWING TO ESTABLISH TOP MANAGEMENT OFFICIAL'S COMPENSATION: - COMPENSATION COMMITTEE - INDEPENDENT COMPENSATION CONSULTANT - COMPENSATION SURVEY OR STUDY - APPROVAL BY THE BOARD OR COMPENSATION COMMITTEE FORM 990, PART VI, SECTION A, LINE 1A ANY POWER OR AUTHORITY HEREIN, OR BY LAW, CONFERRED UPON THE BOARD OF TRUSTEES, MAY, IN THE INTERVALS BETWEEN MEETINGS OF THE BOARD OF TRUSTEES, BE EXERCISED BY THE EXECUTIVE COMMITTEE. FORM 990, PART VI, SECTION A, LINE 2 OFFICERS DANA E. ENGLE, VIRGINIA KRONK AND MICHAEL S. BROWNING HAVE A BUSINESS RELATIONSHIP. FORM 990, PART VI, SECTION A, LINE 6 THE FOUNDATION'S CODE OF REGULATIONS PROVIDES THAT THE TRUSTEES OF THE CORPORATION SHALL BE THE MEMBERS OF THE CORPORATION FOR THE PURPOSE OF ANY STATUTE OR LAW RELATING TO CORPORATIONS. FORM 990, PART VI, SECTION A, LINE 7A THE CHIEF EXECUTIVE OFFICER, THE CHIEF FINANCIAL OFFICER, AND THE CHIEF DEVELOPMENT OFFICER OF MADISON COUNTY COMMUNITY HOSPITAL AND THE MCH AUXILIARY PRESIDENT SERVE AS FOUR OF THE TRUSTEES OF THE FOUNDATION BY VIRTUE OF THEIR POSITIONS WITH THE HOSPITAL. FORM 990, PART VI, SECTION B, LINE 11B THE FORM 990 WILL BE MADE AVAILABLE TO THE PRESIDENT OF THE BOARD ONLY BY WAY OF A SECURED WEB PORTAL AND TO THE EXECUTIVE DIRECTOR OF THE FOUNDATION IN PERSON. IN ADDITION, IT IS REVIEWED BY THE TREASURER OF THE ORGANIZATION. FORM 990, PART VI, SECTION B, LINE 12C THE ORGANIZATION DOES NOT HAVE ITS OWN CONFLICT OF INTEREST POLICY BUT FOLLOWS THAT OF MADISON COUNTY COMMUNITY HOSPITAL ("MCCH"). ANNUALLY, THE CEO, EXECUTIVE OFFICERS, TREASURER AND BOARD MEMBERS RECEIVE A COPY OF MCCH'S CONFLICT OF INTEREST POLICY. IN ADDITION, THEY ARE ASKED TO COMPLETE AND RETURN THE CONFLICT OF INTEREST AGREEMENT AND ANNUAL DISCLOSURE STATEMENT TO MCCH'S ADMINISTRATIVE OFFICE. THE CONFLICT OF INTEREST STATEMENTS ARE REVIEWED AND RETAINED ON FILE. ANY INTERESTS SO DISCLOSED ARE DEALT WITH APPROPRIATELY AS THE CONFLICT ARISES AND IN ACCORDANCE WITH POLICY PROCEDURES. FORM 990, PART VI, SECTION B, LINE 15 PROCESS FOR DETERMINING COMPENSATION: THE ORGANIZATION DOES NOT HAVE EMPLOYEES BUT RATHER THREE OF ITS BOARD MEMBERS ARE OR WERE EMPLOYEES OF MADISON COUNTY COMMUNITY HOSPITAL WHOSE PROCESS FOR DETERMINING COMPENSATION INCLUDES A REVIEW AND APPROVAL BY INDEPENDENT PERSONS, THE USE OF COMPARABILITY DATA AND CONTEMPORANEOUS DOCUMENTATION OF THE DELIBERATION AND PROCESS. FORM 990, PART VI, SECTION C, LINE 19 THE GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY AND FINANCIAL STATEMENTS ARE AVAILABLE TO THE PUBLIC UPON REQUEST. FORM 990, PART VI, SECTION B LINES 13 AND 14, POLICY ADOPTION: THE ORGANIZATION HAS NOT ADOPTED WHISTLEBLOWER OR DOCUMENT RETENTION AND DESTRUCTION POLICIES BUT THE ORGANIZATION DOES FOLLOW THE WHISTLEBLOWER AND DOCUMENT RETENTION AND DESTRUCTION POLICIES OF MADISON COUNTY COMMUNITY HOSPITAL. FORM 990, PART XII, QUESTION 2C, OVERSIGHT OF FINANCIAL STATEMENT AUDIT: MADISON COUNTY HOSPITAL FOUNDATION FINANCIAL STATEMENTS ARE AUDITED BY AN INDEPENDENT ACCOUNTING FIRM. IN ADDITION, THE ORGANIZATION HAS A JOINT COMMITTEE WITH MADISON HEALTH THAT ASSUMES THE RESPONSIBILITY FOR THE OVERSIGHT OF THE AUDIT OF ITS FINANCIAL STATEMENTS AND ITS SELECTION OF ITS INDEPENDENT ACCOUNTANT. THIS PROCESS HAS NOT CHANGED FROM THE PRIOR YEAR. MADISON COUNTY HOSPITAL INC 210 NORTH MAIN STREET LONDON OH 43140 310876202 INVESTMENTS OH 501(C)(3) 509(A)(3) TYPE III-F N/A 0 MADISON COUNTY COMMUNITY HOSPITAL 210 NORTH MAIN STREET LONDON OH 43140 311657206 HOSPITAL OH 501(C)(3) 170(B)(1) (A)(III) MCHI 0 MADISON FAMILY HEALTH CORPORATION 210 NORTH MAIN STREET LONDON OH 43140 311514418 INACTIVE OH 501(C)(3) 509(A)(3) TYPE I MCCH (DBA MADISON HEALTH) 0 MADISON HEALTH PAIN MANAGEMENT LLC 210 N MAIN STREET LONDON OH 43140 852913421 PAIN MANAGEMENT SERVICES OH N/A 0 0 0 1 0 0 0 0 0 0 0 0 0 0 1 1 1 0 0 0 0 PART V, LINE 1(D): MADISON COUNTY HOSPITAL FOUNDATION IS A MEMBER OF THE OBLIGATED GROUP WITH RESPECT TO MADISON COUNTY HOSPITAL'S REVENUE BONDS - OHIO, HOSPITAL FACILITIES MULTI-MODE FIXED RATE REVENUE REFUNDING BONDS, SERIES 2017. THE TOTAL AMOUNT OUTSTANDING AT 12/31/2023 WAS $34,880,000.