2024-10-31T14:23:47-05:00 2023-12-31 251408703 SCHNEIDER DOWNS & CO INC ONE PPG PLACE SUITE 1700 PITTSBURGH PA 15222 990 2023-01-01 310876202 MADISON COUNTY HOSPITAL INC MADI 7408457015 210 NORTH MAIN STREET LONDON OH 43140 DANA E ENGLE CEO 7408457015 2024-10-21 1 0 ERIN F WOOD P01710275 4122613644 2023 2024-10-15 13:58:12Z DANA E ENGLE 210 NORTH MAIN STREET LONDON OH 43140 2538512 0 X HTTP://WWW.MADISON-HEALTH.COM X 1975 OH MANAGE INVESTMENTS AND ASSETS IN FURTHERANCE OF THE EXEMPT PURPOSES OF MADISON CTY COMMUNITY HOSPITAL 9 9 0 9 0 0 0 0 2299356 2282460 455385 255485 0 0 2754741 2537945 0 0 0 0 0 0 0 0 0 3432407 3408714 3432407 3408714 -677666 -870769 39161769 38920934 35619114 34790313 3542655 4130621 THE MISSION OF MADISON COUNTY HOSPITAL, INC. IS TO MANAGE THE ASSETS OF THE MADISON COUNTY COMMUNITY HOSPITAL (MCCH) AND MAKE INVESTMENTS TO FURTHER THE EXEMPT PURPOSE OF THE HOSPITAL. 0 0 3408714 2282460 STEWARDSHIP OF INVESTMENTS AND ASSETS FOR THE FURTHERANCE OF THE EXEMPT PURPOSE OF THE MADISON COUNTY COMMUNITY HOSPITAL (DBA MADISON HEALTH), A 501(C)(3) ENTITY. 3408714 1 0 0 0 0 0 0 0 0 0 1 0 0 1 1 1 0 1 0 0 0 0 0 0 0 0 0 0 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 X 9 9 1 0 0 0 0 1 1 1 1 0 0 1 1 1 1 0 0 0 0 0 OH X MICHAEL S BROWNING 7408457015 210 NORTH MAIN STREET LONDON OH 43140 DAN BLAZER CHAIR 2.00 2.00 X X 0 0 0 TODD FISHER VICE CHAIR 2.00 2.00 X X 0 0 0 MARVIN HOMAN TREASURER 2.00 2.00 X X 0 0 0 HENRY COMER SECRETARY 2.00 2.00 X X 0 0 0 JOSH ALCOTT BOARD MEMBER 2.00 2.00 X 0 0 0 MISTY BRADLEY BOARD MEMBER 2.00 2.00 X 0 0 0 JIM EVANS BOARD MEMBER 2.00 2.00 X 0 0 0 MELISSA NOBLE BOARD MEMBER 2.00 2.00 X 0 0 0 SUSAN THOMPSON BOARD MEMBER 2.00 2.00 X 0 0 0 DANA E ENGLE MCCH CEO 2.00 43.00 X 0 537592 71116 MICHAEL S BROWNING MCCH CFO 2.00 43.00 X 0 329317 21701 0 866909 92817 0 0 1 0 0 AFFILIATE RENTALS 900002 2282460 2282460 2282460 197479 197479 58573 567 58006 58006 58006 2537945 2282460 0 255485 45425 45425 29000 29000 1459800 1459800 1872789 1872789 LETTER OF CREDIT FEES 1500 1500 STATE REGISTRATION FEE 200 200 3408714 3408714 0 0 717858 128664 7174 5610 1765540 1728700 49700520 24043999 27529310 25656521 6965885 9233833 2176002 2167606 39161769 38920934 133520 125880 35119081 34297920 366513 366513 35619114 34790313 X 3542655 4130621 3542655 4130621 39161769 38920934 X -870769 1467131 -8396 X X 0 1 X 1 0 X X 1 MADISON COUNTY COMMUNITY HOSPITAL 311657206 3 1 3408714 0 1 3408714 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 X 1 1 SCHEDULE A, PART IV, SECTION D, LINE 3 THE ORGANIZATION AND THE SUPPORTED ORGANIZATION FUNCTION AS THE SAME ENTITY. SCHEDULE A, PART IV, SECTION E, LINE 3A THE SUPPORTED ORGANIZATION APPOINTS THREE MEMBERS OF THE ORGANIZATION'S BOARD. SCHEDULE A, PART IV, SECTION E, LINE 3B THE ORGANIZATION AND THE SUPPORTED ORGANIZATION FUNCTION AS THE SAME ENTITY. 2058728 2058728 40838935 19021933 21817002 6050791 4617251 1433540 752066 404815 347251 25656521 INTEREST RATE SWAP 2167606 2167606 DEPOSIT -MEDICAL OFFICE BUILDING 366513 366513 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. 0 0 0 0 0 0 0 0 0 DANA E ENGLE MCCH CEO 0 503785 0 0 0 33807 0 20978 0 50138 0 608708 0 0 MICHAEL S BROWNING MCCH CFO 0 327511 0 0 0 1806 0 16547 0 5154 0 351018 0 0 PART I, LINE 3 MADISON COUNTY HOSPITAL, INC. 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 A COUNTY OF MADISON OH SERIES 2017 316400075 000000000 2017-06-07 39000000 FINANCE CAPITAL EXPANSION PROJECT AND REFINANCING OUTSTANDING DEBT 0 0 0 A 4120000 39000000 1720000 623455 24906666 11868000 2017 1 0 1 1 A 0 0 0 0 0.00000 0.00000 0.00000 0 0 1 A 0 0 0 1 1 0 0 0 0 A 0 SCHEDULE K, PART IV, LINE 1C THE PROCEEDS OF THE BONDS WERE FULLY EXPENDED. THE CALCULATION FOR THE PERIOD 6/7/2017-6/7/2022 WAS THE FINAL CALCULATION. FORM 990, PART VI, SECTION A, LINE 2 OFFICERS MARVIN HOMAN, JIM EVANS, DANA E. ENGLE AND MICHAEL S. BROWNING HAVE A BUSINESS RELATIONSHIP. FORM 990, PART VI, SECTION A, LINE 7A THE BOARD CONSISTS OF NINE DIRECTORS, MAJORITY OF WHOM ARE ELECTED BY THE MEMBERS OF THE CORPORATION AND ONE OF WHOM IS APPOINTED BY THE MADISON COUNTY COMMISSIONERS. FORM 990, PART VI, SECTION A, LINE 7B THE FOLLOWING MAJOR DECISIONS SHALL REQUIRE APPROVAL OF AT LEAST A MAJORITY OF THE TOTAL NUMBER OF COMMUNITY MEMBERS: A) ANY SALE, TRANSFER, EXCHANGE OR OTHER DISPOSITION OF ALL OR SUBSTANTIALLY ALL OF THE ASSETS OF THE CORPORATION AND B) ANY MERGER, CONSOLIDATION OR DISSOLUTION OF THE CORPORATION. FORM 990, PART VI, SECTION B, LINE 11B THE FORM 990 WILL BE MADE AVAILABLE PRIOR TO FILING TO ALL BOARD MEMBERS ONLY BY WAY OF SECURED WEB PORTAL. PRIOR TO POSTING ON THE WEB PORTAL, THE FORM 990 IS REVIEWED BY MANAGEMENT. FORM 990, PART VI, SECTION B 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 HEALTH. 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 (MADISON HEALTH). ANNUALLY, THE CEO, CFO, ALL BOARD MEMBERS AND DEPARTMENT MANAGERS RECEIVE A COPY OF MADISON HEALTH'S CONFLICT OF INTEREST POLICY. IN ADDITION, THEY ARE ASKED TO COMPLETE AND RETURN THE CONFLICT OF INTEREST AGREEMENT AND ANNUAL DISCLOSURE STATEMENT TO THE MADISON HEALTH'S ADMINISTRATIVE OFFICE. THE CONFLICT OF INTEREST STATEMENTS ARE REVIEWED AND RETAINED ON FILE. ANY INTERESTS SO DISCLOSED ARE DEALT WITH APPROPRIATELY AS THE CONFLICT ARISES AND IN ACCORDANCE WITH POLICY PROCEDURES. ALL OFFICERS AND DIRECTORS OF MADISON COUNTY HOSPITAL, INC. ARE ALSO OFFICERS AND DIRECTORS OF MADISON HEALTH. FORM 990, PART VI, SECTION B, LINE 15 THE ORGANIZATION DOES NOT HAVE EMPLOYEES, BUT RATHER, ITS CORPORATE OFFICERS ARE EMPLOYEES OF MADISON COUNTY COMMUNITY HOSPITAL (MADISON HEALTH), WHOSE PROCESS FOR DETERMINING COMPENSATION INCLUDES A REVIEW AND APPROVAL BY INDEPENDENT PERSONS, USE OF COMPARABILITY DATA AND CONTEMPORANEOUS DOCUMENTATION OF THE DELIBERATION AND PROCESS. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION'S CONFLICT OF INTEREST POLICY, FINANCIAL STATEMENTS AND GOVERNING DOCUMENTS ARE AVAILABLE UPON REQUEST. FORM 990, PART XI, LINE 9: CHANGE IN FAIR VALUE OF INTEREST RATE SWAP -8,396. FORM 990, PART XII, QUESTION 2C, OVERSIGHT OF FINANCIAL STATEMENT AUDIT: MADISON COUNTY HOSPITAL, INC.'S 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 COMMUNITY HOSPITAL (DBA MADISON HEALTH) 210 NORTH MAIN STREET LONDON OH 43140 311657206 HOSPITAL OH 501(C)(3) LINE 3 MCHI 1 MADISON FAMILY HEALTH CORPORATION 210 NORTH MAIN STREET LONDON OH 43140 311514418 PHYSICIAN SERVICES OH 501(C)(3) LINE 12A, I MCCH (DBA MADISON HEALTH) 1 MADISON COUNTY HOSPITAL FOUNDATION INC 211 NORTH MAIN STREET LONDON OH 43140 237423524 FUNDRAISING OH 501(C)(3) LINE 7 N/A 0 MADISON HEALTH PAIN MANAGEMENT LLC 210 N MAIN STREET LONDON OH 43140 842913421 PAIN MANAGEMENT OH N/A 0 0 0 0 0 0 1 0 0 0 0 1 0 0 0 1 1 0 0 0 0 MADISON COUNTY COMMUNITY HOSPITAL J 2282460 CASH PART V, LINE 1(E): MADISON COUNTY COMMUNITY AND MADISON COUNTY HOSPITAL FOUNDATION ARE MEMBERS 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.