Schedule L
(Form 990 or 990-EZ)
Department of the Treasury
Internal Revenue Service
Transactions with Interested Persons
MediumBullet Complete if the organization answered
"Yes" on Form 990, Part IV, lines 25a, 25b, 26, 27, 28a, 28b, or 28c,
or Form 990-EZ, Part V, line 38a or 40b.
MediumBullet Attach to Form 990 or Form 990-EZ.
MediumBulletInformation about Schedule L (Form 990 or 990-EZ) and its instructions is at www.irs.gov/form990.
OMB No. 1545-0047
2015
Open to Public Inspection
Name of the organization
Madison Community HospitalInc
 
Employer identification number

38-1901104
Part I
Excess Benefit Transactions (section 501(c)(3), section 501(c)(4), and 501(c)(29) organizations only).
Complete if the organization answered "Yes" on Form 990, Part IV, line 25a or 25b, or Form 990-EZ, Part V, line 40b.
1(a) Name of disqualified person (b) Relationship between disqualified person and organization (c) Description of transaction (d) Corrected?
Yes No
2
Enter the amount of tax incurred by organization managers or disqualified persons during the year under section 4958. ........................... Bullet Image$
 
3
Enter the amount of tax, if any, on line 2, above, reimbursed by the organization ........ Bullet Image$
 

Part II
Loans to and/or From Interested Persons.
Complete if the organization answered "Yes" on Form 990-EZ, Part V, line 38a, or Form 990, Part IV, line 26; or if the organization reported an amount on Form 990, Part X, line 5, 6, or 22
(a) Name of interested person (b) Relationship with organization (c) Purpose of loan (d) Loan to or from the organization? (e)Original principal amount (f)Balance due (g) In default? (h) Approved by board or committee? (i)Written agreement?
To From Yes No Yes No Yes No
(1) MRI Consultants LLC
 
Former Trustee Working Capital X   40,000 40,000   No Yes   Yes  
(2) T & G CorporationIn
 
Manager Working capital X   2,084,896 2,084,896   No Yes   Yes  
(3) Advocare Home Health
 
Common Ownership Working Capital X   46,000 46,000   No Yes   Yes  
(4) Bio-Behvioral Care S
 
Common Ownership Working Capital X   98,000 98,000   No Yes   Yes  
(5) BIO-MAGNETIC RESONAN
 
Former Trustee Working Capital X   62,000 62,000   No Yes   Yes  
(6) DIRECTOR Trustee Working Capital X   9,793 9,793   No Yes   Yes  
(7) GERIATRIC PSYCHIATRI
 
Common Ownership Working Capital X   245,000 245,000   No Yes   Yes  
(8) HLP 2 INC
 
Former Trustee Working Capital X   338,823 338,823   No Yes   Yes  
(9) RAM GUNABALAN Former Trustee Working Capital X   5,000 5,000   No Yes   Yes  
(10) RG Labs
 
Common Ownership Working Capital X   7,214 7,214   No Yes   Yes  
(11) Samaritan Behavioral
 
Same Entity Working Capital X   183,207 183,207   No Yes   Yes  
(12) Samaritan Rehab
 
Same Entity Working Capital X   8,967 8,967   No Yes   Yes  
(13) Others
 
Common Ownership Working Capital X   1,063 1,063   No Yes   Yes  
(14) T & G Corporation In
 
Manager Working Capital   X 1,736,165 1,736,165   No Yes   Yes  
(15) Biomag Imaging
 
Same entity Working Capital   X 169,348 169,348   No Yes   Yes  
(16) Bio-Behvioral Care S
 
Common Ownership Working Capital   X 150,000 150,000   No Yes   Yes  
(17) RAM GUNABALAN Former Trustee Working Capital   X 57,768 57,768   No Yes   Yes  
(18) T & G Corporation In
 
Manager Working Capital   X 1,845,031 1,845,031   No Yes   Yes  
Total ...............Small Bullet $ 7,088,275
Part III
Grants or Assistance Benefiting Interested Persons.
Complete if the organization answered "Yes" on Form 990, Part IV, line 27.
(a) Name of interested person (b) Relationship between interested person and the organization (c) Amount of assistance (d) Type of assistance (e) Purpose of assistance
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.
Cat. No. 50056A
Schedule L (Form 990 or 990-EZ) 2015
Page 2
Schedule L (Form 990 or 990-EZ) 2015
Page 2
Part IV
Business Transactions Involving Interested Persons.
Complete if the organization answered "Yes" on Form 990, Part IV, line 28a, 28b, or 28c.
(a) Name of interested person (b) Relationship between interested person and the organization (c) Amount of transaction (d) Description of transaction (e) Sharing of organization's revenues?
Yes No
(1) T & G CorporationInc
 
Former Trustee has a 70% ownership 1,195,751 Incurred overhead expenses   No
Part V
Supplemental Information
Provide additional information for responses to questions on Schedule L (see instructions).
Return Reference Explanation
Schedule L (Form 990 or 990-EZ) 2015


Additional Data


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