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Agenda

Regular Meeting
Madison County Board of Supervisors
Tuesday, December 11, 2018 at 4:00 p.m.
County Administration Building, Auditorium
414 N Main Street, Madison, Virginia 22727
Call to Order

1. Call to Order, Pledge of Allegiance & Moment of Silence


2. Determine Presence of a Quorum / Adopt Agenda
3. Public Comment
4. Special Appearances
a. Discussion: Stormwater Management Regulations ................................................DEQ Representatives
b. Consideration: Wieland Site Plan (Zoning Case No. SP-09-18-10) ....... Zoning Administrator Grayson
c. Presentation: Shenandoah National Park ........................................................................ Jennifer Flynn
d. Presentation/Consideration: Broadband Project Proposal .................................................... Clint Hyde
e. Presentation/Consideration: Hazard Mitigation Plan ....Emergency Services Coordinator John Sherer

5. Constitutional Officers
6. County Departments
7. Committees or Organizations
a. Consideration: Social Services Board Appointment .................................................. Deputy Clerk Frye
b. Discussion: Upcoming Appointments ......................................................................... Deputy Clerk Frye

8. Finance ............................................. Director of Finance/Assistant County Administrator Costello


a. Consideration: Claims (December 7, 11)

9. Minutes
a. Consideration: November 27 & December 5, 2018 meeting minutes ........................ Deputy Clerk Frye

10.Old Business
a. Consideration of Leases ......................................................................................County Attorney Gregg
i. Free Clinic in the Health Department Building
ii. Literacy Council in the Moore Building
iii. Madison County Historical Society in the Arcade Building
iv. Rappahannock Rapidan Community Services Board in the Arcade Building
b. Consideration: Awarding Shelby Road Timber Contract........................... County Administrator Hobbs
c. Consideration: FY20 Budget Calendar .................................................... County Administrator Hobbs
d. Consideration: Board of Equalization Nomination Confirmation ............. County Administrator Hobbs
e. Discussion on Joint Meeting with Town Council in January ...................................... Supervisor Foster

11.New Business
a. Discussion on Paying Claims Prior to January 8, 2019 ............................................ Chairman Jackson

12.Information/Correspondence
a. Status Report on Projects ........................................................................... County Administrator Hobbs

13.Public Comment
14.Closed Session (Personnel and Legal)
15.Adjourn (Next meeting on January 2 at 9:00 AM unless the December 26, 2018 meeting is not cancelled)
MADISON COUNTY BOARD OF SUPERVISORS AGENDA ITEM STAFF REPORT
MEETING DATE: December 11, 2018
AGENDA TITLE: 4a Stormwater Management Regulations
INDICATED MOTION(s): N/A

STAFF LEAD: County Attorney Gregg

TIMING: In November, during the discussion on the South Park development grading plan
matter, the Board asked the County Attorney to request a meeting between the
Board and DEQ that would occur on December 11. DEQ agreed to send
representatives to that session.

DISCUSSION: DEQ noted in its August 2, 2018 plan review letter to the developer’s engineer that
the grading/stormwater management plan for the whole development needs to be
considered up-front per state regulations. As of this writing, full approval of the South
Park development as currently configured hinges on designs meeting stormwater
management regulations. Note that the plan review is done by DEQ and enforcement
is by Madison County.

The Virginia Department of Environmental Quality is the stormwater management


program authority in Madison County. Although the rules it enforces may have
changed down through the years and do not align very well with the “subdivide as
tenants are landed” concept associated with the development in question, the
requirement to submit a design package for the whole development up front is
reasonably clear. In short, the County might express its concern and support for a
resolution to such a predicament but does not have more authority than a property
owner in appealing decisions issued by state officials.

Staff has suggested that the developer’s options include (a) providing DEQ with the
indicated redesign and (b)altering the plan of development so that it is not a
“subdivision,” such as installing a road to serve a single business building at the rear
of the property.

FISCAL IMPACT: Although there is a suggestion of long-term economic impact to the County if the
stormwater management rules are not adjusted, that impact has not been quantified.

REFERENCES: N/A

HISTORY: Environmental regulations such as those for erosion and sediment control and
stormwater management have evolved over the last few decades and should be
expected to continue evolving and becoming more stringent in the near future.

RECOMMENDATION: Board members should discuss the issue with DEQ representatives. Before acting, the
Board should consider the practicality and ramifications of pursuing regulatory
change or directly participating in, much less “sponsoring”, a developer’s appeal of a
state agency’s decision.

ENCLOSURES:  Questions developed by the County Attorney and provided to DEQ


 Correspondence to and from the County and developer
THE LAW OFFICES OF SEAN D. GREGG, PLC

MEMORANDUM

TO: Jack Hobbs

FROM: SDG

DATE: December 7, 2018

SUBJECT: DEQ Questions

1. When a Plan is submitted, who determines the “future proposed development”?

• Can a Landowner revise his plans to eliminate future proposed development after
the plan is submitted?

2. When the DEQ receives a Site Development Plan, what investigation does it make to
determine the extent of the future development?

3. If a Landowner submits a site with proposed lot lines, does DEQ consider those lot lines
when it reviews the Storm Water Management Plan?

4. Have any other rural counties experienced difficulties with understanding the scope of the
rules between intensity of land use (i.e. impervious surfaces) and the rate of development
since the rules that might be good for urban areas are hard for rural Virginia developers to
meet?

5. Is there a way to allow a landowner to defer plans until he sees what uses are likely to be
made with a property?

6. If a Landowner were to divide his property and sell lots to other owners, would each
subsequent owner submit his own Storm Water Management Plan in anticipation of his
proposed uses of his property?

• Would a subdivider need to do a Storm Water Management Plan, and would a


subsequent individual lot owner need to conform to that plan or get his own
individual Storm Water Management Plan approved.

7. How does the DEQ determine “future proposed development”?

8. What is DEQ’s view of plans that are approved by a County subject to DEQ approval?

• What is required, or the best practice suggested by DEQ, in regard to the sequence
of Storm Water Management Plan approval and Board-level County approvals?

• Does a County’s “Pre-Approval” mean anything to DEQ?

Page 1 of 2

111 EAST MAIN STREET, P.O. BOX 1300, ORANGE, VIRGINIA 22960
PHONE: 540-670-7070 --- FAX:540-672-7077
sdgregg@sdgregglaw.com
THE LAW OFFICES OF SEAN D. GREGG, PLC

9. Does DEQ work with the Zoning and Planning Office to advise Landowners?

• Is there a process for such collaboration?

10. What level of detail is expected from a landowner’s engineer when DEQ asks for the
complete build-out to be shown?

• Does DEQ expect a detailed showing of the pads and parking areas on each lot with
Storm Water facilities, or just a “conceptual” rendering of what might possibly be
impervious surfaces on a lot if a buyer can be found for that lot in the future?

Page 2 of 2

111 EAST MAIN STREET, P.O. BOX 1300, ORANGE, VIRGINIA 22960
PHONE: 540-670-7070 --- FAX:540-672-7077
sdgregg@sdgregglaw.com
Gentry request for assistance with DEQ land disturbance permit - notes 9/5/2018

See 4 September email from Gentry

Issues:
1. Developer desires site (grading) plan approval at October 3 Board meeting but is stymied
by DEQ requirements.

The DEQ process is in addition to the County’s site plan approval process and to a large degree
separate from other processes.

2. Did DEQ require the Estes Family to provide a full Storm water/E&S buildout plan for
their remaining 91+ acre parcel zoned B-1/A-1 when they sold ten acres to Michael
Yoder /Yoder’s Market? Per M. Aylor: The County and VA DEQ did require Mr. Yoder
to submit an E & S and Stormwater Management plan. The property was purchased as
one parcel and developed for the purpose of the store and parking areas.

3. Did DEQ require Madison County to provide a full Storm water/E&S buildout plan for
the 181+- acres when the entrance, interior roads, pavilion, and ball fields at Hoover
Ridge were constructed? Per M. Aylor: Hoover’s Ridge did have an approved E & S plan
for the project. I am not sure if there was a Stormwater permit issued, or needed at the
time of the project. That project was also one parcel and the entire project laid out in a
site plan.

4. Developer requests County support in obtaining a better response from DEQ.

Ref: §62.1-44.15:51 & 9VAC25-95.H

Per M. Aylor:
The VA DEQ wording on who must apply for general permit coverage for Stormwater permits is
quite clear. Per VA DEQ’s website, “A common plan of development or sale is a contiguous
area where separate and distinct construction activities may be taking place at different times on
different schedules. General permit coverage is required if one or more acres of land will be
disturbed, regardless of the size of the individually owned or developed sites.”

The County opted out of the Stormwater program and therefore the VA DEQ is the Stormwater
Management Program Authority for Madison County. State Water Control Law, specifically
Article 2.4 Section 62.1-44.15:55 A, “Where Virginia Pollutant Discharge Elimination System
permit coverage is required, a VESCP authority (Madison County) shall be required to obtain
evidence of such coverage from the Department’s online reporting system prior to approving the
erosion and sediment control plan. Therefore, The County can not issue a land disturbance
permit for erosion and sediment control until the VA DEQ has approved the Stormwater plan and
issued a permit.

The plan for the Wieland property that was submitted did indicate (10) individual lots in the site
plan. With the plan being as per purposed, I think that it meets the definition of a common plan
of development. The purpose of building the rode is for future lots and development.

Owner

DEQ

Engineer

Developer Bill Gentry, Broker


Jefferson Land & Realty
40 Commerce Lane, Suite A
Rochelle, VA 22738
Tele: 540-948-5050
Cell: 540-718-4210
Jefferson-land.com
bgentry.broker@gmail.com
From: Jack Hobbs
To: "Bill Gentry"
Bcc: Clay Jackson; Matt Aylor; Wes Smith
Subject: FW: South Park-Wieland road plan submitted to Madison County
Date: Wednesday, September 05, 2018 11:04:00 AM
Attachments: 20180902153246.pdf
20180904103054.pdf
Gentry request for assistance with DEQ land disturbance permit - notes 180905.pdf

Mr. Gentry,
 
Answers to the two specific questions you raise are contained in the attached (Items 2 & 3).
 
The Virginia Department of Environmental Quality is the stormwater management program
authority in Madison County. Although the rules it enforces may have changed down through the
years and do not align very well with the “subdivide as tenants are landed” concept associated with
your proposed development, the requirement to submit a design package for the whole
development up front is reasonably clear. In short, the County might express its concern and support
for a resolution to this predicament but does not have more authority than a property owner in
appealing decisions issued by state officials.
 
Primary options available to you include (a) providing DEQ with the indicated redesign and (b)
altering the plan of development so that it is not a “subdivision,” such as installing a road to serve a
single business building at the rear of the property. What other option could the County help you
pursue? I suggest that his experience in working with this DEQ program makes your consultant
appropriately qualified to advise on that question.
 
Although a meeting to discuss this could be arranged, and the County might even be able to
encourage DEQ folks to attend such a session, it would be helpful to understand what you expect as
an outcome of that activity.
 
Let us know how you would prefer to proceed.
 
Jack Hobbs
Madison County
 
 
 
 
 
From: Bill Gentry [mailto:bgentry.broker@gmail.com]
Sent: Tuesday, September 04, 2018 10:24 AM
To: Jack Hobbs <jhobbs@madisonco.virginia.gov>
Cc: Clay Jackson <cjackson@madisonco.virginia.gov>; 'Marvin Hinchey'
<marvin@hincheybaines.com>; eat@hoagies.de; haenlefamily@gmail.com; heidiwieland@web.de;
wieland6@comcast.net
Subject: FW: South Park-Wieland road plan submitted to Madison County
 
 
Jack: thank you for your call this morning. I am sending the e-mail I sent to Clay plus an additional
attachments that may be helpful in our discussion with DEQ and others.
 
Did DEQ require the Estes Family to provide a full Storm water/E&S buildout plan for their remaining
91+ acre parcel zoned B-1/A-1 when they sold ten acres to Michael Yoder /Yoder’s Market?
 
Did DEQ require Madison County to provide a full Storm water/E&S buildout plan for the 181+- acres
when the entrance, interior roads, pavilion, and ball fields at Hoover Ridge were constructed?
 
After your review, please contact me or Marvin Hinchey to discuss our next move to get a logical and
workable response from DEQ. 
 
We will make ourselves available to meet with you and any other party  to move this project
forward.
 
We need to have this road development plan approved by DEQ prior to the October, joint meeting
with the Planning Commission and Board of Supervisors.
 
Best regards,  Bill
 
 
 
Bill Gentry, Broker
Jefferson Land & Realty
40 Commerce Lane, Suite A
Rochelle, VA  22738
Tele:  540-948-5050
Cell:  540-718-4210
Jefferson-land.com
 
 
 
From: Bill Gentry [mailto:bgentry.broker@gmail.com]
Sent: Sunday, September 02, 2018 3:27 PM
To: cjackson@madisonco.virginia.gov
Cc: eat@hoagies.de; heidiwieland@web.de; haenlefamily@gmail.com; wieland6@comcast.net; 'Marvin
Hinchey'
Subject: South Park-Wieland road plan submitted to Madison County
 
 
Clay:  I have attached all relevant communication between Mr. Wieland’s P.E. and DEQ for the storm
water plan review of the road work. We find it totally mind boggling that DEQ is requiring a “ full
project “ build out storm water plan. We are providing a plan for all current land disturbing activity.
 
There is no way anyone can determine how the ultimate buildout of the project will look like. What
size lot a potential buyer will need, the size of building, parking , etc.
 
As you can read in the attached documents ,Central Office for DEQ in Richmond has referred Marvin
back to Margaret Dannemann, Northern Regional Office in Woodbridge and is standing with her
decision which is totally unacceptable and worthless to Mr. Wieland.
 
We need your help to work through this acute and extremely frustrating stance from DEQ at your
earliest.
 
Mr. Wieland has been paying considerable real estate taxes on this property for many years in
addition to the significant cost for surveying , County application fees and Engineering services.
 
This project has the real prospect to provide considerable employment, various taxes to Madison
County government and goods and services to the citizens of Madison.
 
Currently we have one very good prospective buyer for one of the future lots for a medical related
office building and we have additional interest from two additional business buyers.
 
Please help us with a timey and constructive discussion to move forward past the DEQ roadblock.
 
We want to be in a position to have the Planning Commission and Board of Supervisors to approve
the road plan in the October 3, 2018 joint meeting.
 
Marvin and I are available for us to meet with you and any other County or State officials to move
forward.
 
Best regards, Bill
 
 
Bill Gentry, Broker
Jefferson Land & Realty
40 Commerce Lane, Suite A
Rochelle, VA  22738
Tele:  540-948-5050
Cell:  540-718-4210
Jefferson-land.com
 
 
MADISON COUNTY BOARD OF SUPERVISORS AGENDA ITEM STAFF REPORT
MEETING DATE: December 11, 2018
AGENDA TITLE: 4a Weiland Site Plan
INDICATED MOTION(s): Per the Board’s discretion
STAFF LEAD: Zoning Administrator Grayson with County Attorney Gregg
TIMING: This zoning case was heard by the Board on November 7. After discussion on
December 5, it was agreed that action should be considered after the Board’s session
with DEQ on December 11.

Except for the DEQ management plan issue, the matter appears to have matured and
is ripe for a decision.

DISCUSSION: A case file being prepared by the Zoning Administrator as of this writing has the
details.

FISCAL IMPACT: None known.


REFERENCES: N/A

HISTORY: N/A

RECOMMENDATION: The Planning Commission recommended that the Board should approve the site plan
with conditions. The County Attorney may have additional recommendations on the
specifics of any official Board action on this item.

ENCLOSURES: • Compiled case file prepared by the Zoning Administrator.


MADISON COUNTY BOARD OF SUPERVISORS AGENDA ITEM STAFF REPORT
MEETING DATE: December 11, 2018
AGENDA TITLE: 4c Shenandoah National Park
INDICATED MOTION(s): N/A

STAFF LEAD: Deputy Clerk Frye

TIMING: A report to the Board by Jennifer Flynn, the SNP superintendent, has been in the
works since October.

DISCUSSION: It appears that this is to be a routine “10-minute update”.

Active SNP matters include the Old Rag Mountain parking lot (and archaeology)
project and the ongoing Blue Ridge Committee for Shenandoah Park Relations.

FISCAL IMPACT: None

REFERENCES: N/A

HISTORY: N/A

RECOMMENDATION: Staff suggests that the Board should prepare to ask appropriate questions, if there
are any, after hearing the Superintendent’s report.

ENCLOSURES: • October 4 email requesting inclusion on a Board agenda


(Confirmation received that Ms. Flynn would be attending the December 11 meeting confirmed on December 4, 2018.)

From: Hurlbert, Sally <sally_hurlbert@nps.gov>


Sent: Thursday, October 4, 2018 4:17 PM
To: Jacqueline Frye
Subject: Presentation by Shenandoah National Park Superintendent at Madison County Board of
Supervisors meeting

Dear Jacqueline,
I’m writing to ask if Jennifer Flynn, Superintendent of Shenandoah National Park, can be placed on the
agenda to give a 10-minute update on the park to the Board of Supervisors at their meeting on October
9, 2018 at 4:00 pm. If this date doesn't work, would the November 13 or December 11 meeting work?

Thanks,

Sally Hurlbert
Management Specialist
Shenandoah National Park
3655 US Hwy 211 East
Luray, VA 22835
540-999-3500 x. 3300 (office)
540-742-8106 (cell)
sally_hurlbert@nps.gov
MADISON COUNTY BOARD OF SUPERVISORS AGENDA ITEM STAFF REPORT
MEETING DATE: December 11, 2018

AGENDA TITLE: 4d – Broadband Project Proposal

INDICATED MOTION(s): See page 2.

STAFF LEAD: Economic Development and Tourism Director Gardner

TIMING: Per discussion at the October 23 meeting, Clint Hyde is scheduled to give a
presentation on his full project proposal at the December 11 meeting. Board
approval is required at this meeting if Mr. Hyde is to meet the December 14 grant
application deadline (unless the meeting is continued).
DISCUSSION: As of this writing the details of Mr. Hyde’s broadband wireless project are still being
developed, but it appears that the high points involve:
• Mr. Hyde would be responsible for designs and acquiring permits and
approvals as required for the project and for compliance with all conditions
imposed by the funding agency.
• Two main tower-mounted transmission antennae that will communicate
between Blakey Ridge and Hyde’s office in downtown Madison.
• Distribution antennae on smaller poles or towers that will communicate
between the Blakey tower and serve approximately 300 users in a 1+/- mile
radius in the Wolftown, Criglersville, Rochelle and Brightwood communities.
• Up to 80% funding of capital costs by the Virginia Department of Housing and
Community Development’s Virginia Telecommunication Initiative (VATI)
program; Mr. Hyde would provide any other required cash, and County staff
time spent on the project would be offered as part of the “match”
requirement.
• Project administration by the Rappahannock-Rapidan Regional Commission.
• There would need to be a series of contracts and other paperwork developed
and approved by the Board if the grant monies are approved to the effect that
the County would be a pass-through agent for the funding.
FISCAL IMPACT: Everything is being done with the understanding that this is Clint Hyde’s project; as
such, his organization would be taking all of the risk possible, the County would not
be liable for anything, and his project has lower priority than many other issues
currently before the County.
REFERENCES: http://www.dhcd.virginia.gov/index.php/business-va-
assistance/telecommunications/254-virginia-telecommunication-planning-initiative-
vatpi.html
HISTORY: The County’s broadband problems have been known for some time.

RECOMMENDATION: Hear the presentation, provide guidance to Mr. Hyde and, if the Board finds it
acceptable, adopt the indicated motion.
ENCLOSURES: • Hyde’s presentation materials (to be provided when available)
A motion to support a proposal by Madison Gigabit Internet, Inc. to pursue grant funding
through the Virginia Department of Housing and Community Development’s Virginia
Telecommunication Initiative (VATI) program.

Whereas, Madison County is currently underserved by internet services in that many areas
have slow and unreliable service, if they have any service at all; and

Whereas, the Madison County Board of Supervisors desires to support the proliferation of
internet services to heretofore underserved areas of Madison County; and

Whereas, Madison Gigabit Internet, Inc. (MGI) has proposed a project with the following
features that will relieve the situation in several parts of the County:
• Two main tower-mounted transmission antennae that will communicate between Blakey Ridge
and Hyde’s office in downtown Madison.
• Distribution antennae on smaller poles or towers that will communicate between the Blakey
tower and serve approximately 300 users in a 1+/- mile radius in the Wolftown, Criglersville,
Rochelle and Brightwood communities.
• Up to 80% funding of capital costs by the Virginia Department of Housing and Community
Development’s Virginia Telecommunication Initiative (VATI) program; Mr. Hyde would provide
any other required cash, and County staff time spent on the project would be offered as part of
the “match” requirement.
• Project administration by the Rappahannock-Rapidan Regional Commission.
• A series of contracts and other paperwork developed and approved by the Board if the grant
monies are approved to the effect that the County would be a pass-through agent for the
funding; and.

Whereas, the project was presented as a public private partnership as required by the funding
program with the understanding that MGI would be taking all of the risk of the projects success
or failure, the County would not be liable for anything, and his project has lower priority than
many other issues currently before the County,

Now, Therefore, Be It Resolved that the Madison County Board of Supervisors supports the
project and authorizes the County Administrator to participate in filing the funding application
with the understanding that any contracts must be processed through the County Attorney’s
office prior and approved by the Board prior to signature and that budget amendments must
be approved prior to the expenditure of any funds supporting the project; and.

For item 6: Be it Further Resolved that, if the funding is approved, the Madison County Board
of Supervisors agrees to enter into a an appropriate contractual relationship articulating the
above with Madison Gigabit Internet, Inc. that holds Madison County and its agents harmless,
conveys all assets to Madison Gigabit Internet, Inc. as allowed by the funding agency; and

For items 8 & 10: Be it Further Resolved that Madison County agrees to provide an in-kind
contribution of to $5,000 in staff time and other non-financial support for the project.
MADISON COUNTY BOARD OF SUPERVISORS AGENDA ITEM STAFF REPORT
MEETING DATE: December 11, 2018
AGENDA TITLE: 4e Hazard Mitigation Plan
INDICATED MOTION(s): I move to adopt the resolution to adopt the 2018 Rappahannock-Rapidan Regional
Hazard Mitigation Plan as proposed.

STAFF LEAD: Emergency Services Coordinator Sherer

TIMING: A regional group has been working on this since March 2017. Since then, the
document has been processed through FEMA and is now ready for approval by all
local government participants.

DISCUSSION: As per the material provided, hazard mitigation planning is the process by which
threats to localities are identified, the likelihood of impacts determined, goals to
mitigate those threats are developed and appropriate strategies to eliminate or
reduce impacts are determined, prioritized, and implemented. Local programs,
ordinances and capabilities are considered. An approved all-hazard mitigation plan
will qualify the County for federal support for pre- and post-disaster hazard mitigation
projects.

These plans focus on natural disasters. In short, it is a federal requirement tied to


certain grant monies, a long and time consuming exercise that resulted in a very thick
document, relatively nominal changes from the last iteration.

FISCAL IMPACT: None, except that adoption will help the County qualify for grant monies.

REFERENCES: The document and supporting material is available


at http://www.rrregion.org/mitigation.html.

HISTORY: The plan presented is an updated version of the similar regional plans that were
adopted in 2005 and 2012.

RECOMMENDATION: If the Board is comfortable, adopt the prepared resolution as indicated.

ENCLOSURES: • Hazard Mitigation Plan resolution


• Email from RRRC
• Proposed Hazard Mitigation Strategies for Madison County (1-page summary)
Jack Hobbs
Chairman County Administrator
R. Clay Jackson
Sean Gregg
Vice-Chairman County Attorney
Jonathon Weakley
302 Thrift Road
BOARD MEMBERS Madison County Board of P. O. Box 705
Kevin McGhee Madison, Virginia 22727
Charlotte Hoffman Supervisors (540) 948-7500 (ph)
Amber Foster (540) 948-3843 (fax)

RESOLUTION TO ADOPT THE 2018 RAPPAHANNOCK-RAPIDAN REGIONAL


HAZARD MITIGATION PLAN
#2018-17

WHEREAS, the County/Town of Madison, like any jurisdiction, is vulnerable to an array of natural
and human-caused hazards that can result in loss of life and damages to public and private property;

WHEREAS, it is the intent of the Madison County Board of Supervisors/Town Council to protect its
citizens and property from the effects of natural hazards to the furthest extent possible; and

WHEREAS, the County/Town of Madison, with assistance from the Rappahannock-Rapidan Regional
Commission and other jurisdictions within the region, has gathered information and prepared the
Rappahannock-Rapidan Regional Hazard Mitigation Plan in accordance with the Disaster Mitigation
Act of 2000; and

WHEREAS, the Federal Emergency Management Agency and the Virginia Department of Emergency
Management have reviewed said plan, inclusive of the County/Town of Madison information prepared
with input from appropriate local and state officials, and has approved the plan pending the completion
of local adoption procedures;

NOW, THEREFORE, IT IS HEREBY RESOLVED that the Madison County Board of


Supervisors/Town Council hereby:

1. Adopts the 2018 Rappahannock-Rapidan Regional Hazard Mitigation Plan; and

2. Agrees to take such other official action as may be reasonably necessary to carry out the
proposed actions included in the County/Town of Madison, Virginia section of the Plan.

Adopted in Madison County, Virginia, this 11th day of December, 2018, on motion of
Supervisor , seconded by Supervisor .

____________________________________
R. Clay Jackson, Chairman
Madison Board of Supervisors
Aye Nay Absent Abstain

R. Clay Jackson ____ ____ ____ ____


Jonathon Weakley ____ ____ ____ ____
Kevin McGhee ____ ____ ____ ____
Charlotte Hoffman ____ ____ ____ ____
Amber Foster ____ ____ ____ ____
From: Patrick Mauney <plmauney@rrregion.org>
Sent: Wednesday, November 21, 2018 09:00
To: Makely, Sara; Bo Tucker; jsteward@remington-va.gov; Kevin Williams; Brian Gordon; William Lamar;
John Cooley; Debbie Kendall; nmort@orangecountyva.gov; rwilson@orangecountyva.gov; BILL OOTEN;
TONYA HOOSER; Jim Hoy
Subject: Hazard Mitigation Plan Update & Request for Adoption

Good Morning,

Following submission of the draft regional Hazard Mitigation Plan to FEMA in August
and one round of minor revisions, I am happy to share that FEMA has provided
conditional approval to the Rappahannock-Rapidan Regional Hazard Mitigation Plan.

At this time, the next step is for each of your jurisdiction's governing bodies to consider
adoption of the plan. I know that the process varies in terms of having items placed on
Board/Council agendas and/or having to go through a committee process prior to
Board/Council consideration. A template resolution is attached, and you may edit this
or create your own local resolution as needed. Once your Board/Council has adopted,
please forward a copy of the resolution via e-mail to me and we will consolidate and
send onto FEMA for their records.

The final plan documents can be accessed on the plan webpage


- http://www.rrregion.org/mitigation.html. These three documents are at the top of the
page:

• Hazard Mitigation Plan Document


• Appendix A: Mitigation Strategies & Report
• Appendix B: Supporting Documentation

RRRC staff is available to attend any local Board/Council/Committee meetings, as you


might request to support the local adoption process, depending on our
schedules. Please let me know if you would like an RRRC staff person to attend to
provide any background information on the plan, or if an outline/Executive Summary
document would be useful to you and we can develop in early December.

Thank you again for your assistance over the past year in reviewing and revising the
Hazard Mitigation plan, and please do not hesitate to reach out with any questions.

Finally, have a safe and Happy Thanksgiving!

Patrick Mauney
--
Patrick L. Mauney
Executive Director
Rappahannock-Rapidan Regional Commission
420 Southridge Parkway, Suite 106
Culpeper, VA 22701
P: 540.829.7450
Rappahannock-Rapidan Regional Hazard Mitigation Plan
Announcement: The draft Rappahannock-Rapidan Regional Hazard Mitigation is now available for review. The
revised plan was developed in 2017 and 2018 by the regional hazard mitigation steering committee and RRRC staff.

Rappahannock-Rapidan Regional Hazard Mitigation Plan (7 MB) - Approved Pending Adoption


Appendix A - Mitigation Strategies (1 MB)
Appendix B - Supporting Documentation (24 MB)
*Appendix B Supporting documents include meeting agendas, participation, presentations, outreach materials, and
other materials developed during the plan update process

Meeting Schedule & Materials


Steering Committee Meeting
May 23, 2018
Agenda
Presentation: Plan Update Status Report
Presentation: Flood & Wildfire Vulnerability Overview

Land Cover Data Workshop


December 15, 2017
*Note: This was a standalone workshop hosted by RRRC with information relevant to Hazard Mitigation
Presentation: Chesapeake Conservancy
Presentation: Regional Decision Systems
Presentation: RRRC Land Cover Data Overview

Floodplain Management Workshop


October 11, 2017
*Note: This was a separate workshop hosted by RRRC & the Department of Conservation & Recreation Division of
Floodplain Management
Agenda
Presentation Slides (1 per page)
Presentation Slides (3 per page)

Steering Committee Meeting


August 28, 2017 | 2:00pm RRRC Offices (Map)
Agenda
Presentation: Plan Update Status Report
Presentation: Rappahannock Watershed Stream Gauge Update

Kickoff Meeting
March 29, 2017 | 1:30pm
RRRC Offices (Map)
Agenda
Presentation: Hazard Mitigation Overview
Presentation: Plan Update Process

Hazard mitigation planning is the process by which threats to localities are identified, the likelihood of impacts
determined, goals to mitigate those threats are developed and appropriate strategies to eliminate or reduce impacts
are determined, prioritized, and implemented. FEMA approval of the updated all-hazard mitigation plan will qualify
participating jurisdictions for federal support for pre- and post-disaster hazard mitigation projects.

The collection and analysis of significant information is needed to assure the development of a useful updated plan
that meets the needs of each participating jurisdiction and the requirements of the Disaster Mitigation Act, 2000.
Essential data includes general background information from each locality, hazard and risk information, current
codes, ordinances, regulations and procedures related to loss minimization as well as an assessment of each
locality's technical and organizational abilities to perform hazard mitigation and/or loss prevention functions.

The Rappahannock-Rapidan Regional Commission, in coordination with with the Virginia Department of Emergency
Management (VDEM), the Federal Emergency Management Agency (FEMA) and its member jurisdictions, completed
the Rappahannock-Rapidan Multi- Jurisdictional Hazard Mitigation Plan in 2005. A subsequent update to the plan
was completed in 2012.
2018 Rappahannock-Rapidan Region Mitigation Strategies & Status Reports
Madison County

Project Strategy Year Hazard(s) Priority Estimated Cost Funding Sources Lead Agency/Department Status/Schedule Comments
# Added Addressed
1 Identify the two repetitive loss 2005 Flood Moderate Staff time None needed Madison County Emergency Not started Limited number of repetitive loss properties in the
properties in the county. Management County, and low cost-benefit of potential projects as
discussed with VDEM in the past
2 Develop a HAZMAT team to handle 2005 Hazardous Moderate Dependent on number of team Hazardous Material Madison County Emergency As funding Working through LEPC
possible spills on Route 29 Materials members and equipment Emergency Management Management allows
needed grant
3 Expand emergency shelter capabilities 2005 Multiple Moderate Dependent upon improvements FEMA Madison County Emergency Ongoing Reviewed as part of Emergency Operations Plan
for natural disasters and large-scale needed Management
evacuation
4 Upgrade internal GIS to be used for 2018 All Moderate Dependent upon extent of Local Funds, FEMA, VDEM Madison County Emergency Ongoing New strategy for 2018
emergency applications upgrades Management
5 Upgrade county-wide public safety radio 2018 All High > $5 million depending upon Local Funds, VDEM Madison County Emergency Ongoing New strategy for 2018
system to a regional P25 public safety stand-alone or shared system Management
grade system

2018 Rappahannock-Rapidan Region Mitigation Strategies & Status Reports


Town of Madison

Project Strategy Year Hazard(s) Addressed Priority Estimated Cost Funding Sources Lead Agency/Department Status/Schedule Comments
# Added
1 Improve stormwater runoff with the 2005 Flood High Town staff has estimates FEMA, USDA, Soil Town of Madison Administration As funding allows Work with Rapidan
implementation of stormwater management and Water Service Authority to
techniques Conservation complete
2 Protect utilities by placing overhead wires and 2005 High winds, Moderate Town staff has estimates for existing line CDBG Town of Madison Administration As funding allows, Not currently
cables underground tornadoes, burial; future line burial would be taken long-term financially feasible
hurricanes, winter care of via ordinance amendments
storms
3 Work with County and Regional partners to plan for 2018 Multiple Moderate Staff time Staff time Town of Madison, Madison Not started New strategy for
potential transportation issues related to County Emergency Management 2018
hazardous materials transported on Route 29
4 Work with local and regional partners on wildfire 2018 Wildfire Moderate Staff time Local funds, FEMA Town of Madison, Madison Not started New strategy for
mitigation actions in the town HMGP, PDM County Emergency Management, 2018
RRRC

Page A-10
Madison County Sheriffs Office
Erik J. Weaver, Sheriff
Sheriff's Report November 2018
Part-time Deputies
as per Va Code 15.2-1609.9

Part-Time Deputy Function Worked

MCSO Unit 11 Law Enforcement 124


MCSO Unit 30 Court 29
MCSO Unit 32 Investigator 62
MCSO Unit 33 Court Security 24
MCSO Unit 34 Court / LE 104.5
MCSO Unit 35 Court / LE 148.5
MCSO Unit 36 Court / LE 88.5
MADISON COUNTY BOARD OF SUPERVISORS AGENDA ITEM STAFF REPORT
MEETING DATE: December 11, 2018
AGENDA TITLE: 5a Request for Refund for Erroneous Real Estate Assessment
INDICATED MOTION(s): I move to authorize and direct the Treasurer to issue a $22,531.80 refund,
including interest, per §58.1-3981 of the Code of Virginia to Yates Properties
of Madison L C (Tax Map 55-14) in the total amount of to Yates to correct an
erroneous assessment.

STAFF LEAD: County Administrator Hobbs

TIMING: This matter just recently came to the staff’s attention.

DISCUSSION: It appears that the assessor has brought a clerical error made during the 2008
reassessment to the Commissioner of the Revenue’s attention but the refund is
limited to this tax year and the three prior.

Of course, this would need to be supplemented with the appropriate budget


adjustment action.

FISCAL IMPACT: In addition to the initial $22,531.80, the County would realize $4,796.04 less real
estate tax revenue per year (at the current tax rate and assessment).

REFERENCES: N/A

HISTORY: N/A

RECOMMENDATION: Approve the indicated motion.

ENCLOSURES: • Correspondence and material from Commissioner of the Revenue


• Sec. 58.1-3981 of the Code of Virginia (annotated)
From: Brian Daniel
To: Jack Hobbs
Cc: Mary Jane Costello; Sean Gregg; Stephanie Murray
Subject: Notice of Corrected assessment
Date: Thursday, December 06, 2018 2:34:43 PM
Attachments: corrected assessment Yates properties.pdf

Jack,
Attached is a memo certifying a corrected assessment.  With the amount being greater than $2500,
the BOS should acknowledge and direct Stephanie to refund as is my understanding of the
Code(58.1-3981).  Let me know if you have any questions.
Thanks,
 
Brian L. Daniel
Commissioner of Revenue
Madison County, VA
(o) 540-948-4421
(c) 540-923-0654
www.madisonco.virginia.gov
 
CONFIDENTIALITY NOTICE: This email message, including any attachments, is for the sole use of the intended recipient(s) and
may contain confidential information. Any unauthorized review, use, disclosure or distribution is prohibited. If you are not the
intended recipient, please contact the sender by reply email and delete all copies of the original message.
 
MADISON COUNTY
OFFICE OF THE COMMISSIONER OF THE REVENUE BRIAN L. DANIEL
COMMISSIONER
P.O. Box 56 ~ Madison, Virginia 22727
(540) 948-4421 ~ Fax: (540) 948-6732
www.madisonco.virginia.gov

Memorandum

To: Jack Hobbs – County Administrator


Mary Jane Costello – Assistant County Administrator
Sean Gregg – County Attorney
From: Brian L. Daniel, Commissioner of Revenue
Date: December 6, 2018
Re: Real Estate Assessment Correction

This memo is to serve as certification in accordance with § 58.1-3981, an erroneous


assessment was discovered and exonerated. It was discovered by Wingate Appraisal
Service that Yates Properties of Madison L C, Tax Map 55-14 may have been incorrectly
assessed. In review of the property card, previous assessment field sheets and physical
inspection of property it appears there was a clerical error made during the 2008
reassessment.

In accordance to Code of Virginia, the authorization to correct the assessment is limited


to the current year and previous three years. Below is an explanation of the refund due.
Included with this memo is a worksheet with explanation of corrected assessment.

Refund:
2018 - $4,796.04
2017 - $4,926.60 + $492.66 (interest calculated by Treasurer) = $5,419.26
2016 - $4,926.60 + $985.32 (interest calculated by Treasurer) = $5,911.92
2015 - $4,926.60 + $1,477.98 (interest calculated by Treasurer) = $6,404.58

Total Refund - $22,531.80


PAGE 1
RAR01O

MADISON COUNTY
NAMZ YATES PROPERTIES OF MADISON L C
14
24APit 55
ACCT 7727 R# 7727 DWL# 1 PART OF WEST BLDG

MAP# 55 14 OTHER IMPROVEMENTS AND BUILDING ADDITIONS

CODE DESCRIPTION SIZE COND RATE DEPR TOT VALUE BUILDING ADDITIONS

892 M.MINI WAREHOUSE 20.0X 60.0 A 20.00 10 21,600

892 ATT MINI WAREHOUSE 30.0X 110.0 A 20.00 10 59,400

892 M.MINI WAREHOUSE 24.0X 230.0 A 20.00 10 99,360 9/2015 AERIAL


892 M.MINI WAREHOUSE 30.0X 328.0 A 20.00 10 177,120

892 M.MINI WAREHOUSE 24.0X 430.0 A 20.00 10 185,760

892 M.MINI WAREHOUSE 24.0X 192.0 A 20.00 10 82,944

251 FENCE-CHAIN LINK A 4,000.00 10 3,600

570 PAVEMENT A 2,000.00 10 1,800

790 SIGN A 1,000.00 10 900

892 M.MINI WAREHOUSE 24.0X 240.0 A 20.00 10 103,680

892 WAREHOUSE MINI STOR 20.0X 210.0 A 20.00 10 75,600

892 WAREHOUSE MINI STOR 24.0X 230.0 A 20.00 10 99,360

892 WAREHOUSE MINI STOR 30.0X 330.0 A 20.00 10 178,200

892 WAREHOUSE MINI STOR 24.0X 430.0 A 20.00 10 185,760

892 WAREHOUSE MINI STOR 24.0X 430.0 A 20.00 10 185,760

000 ATT OFFICE 20.0X 30.0 G 40.00 10 21,600

000 ATT CLIMATE CONTRL 20.0X 30.0 G 24.00 10 12,960

TOTAL OTHER IMPROVEMENTS 1,495,404 **

10/2017 AERIAL

16X60 WAREHOUSE ADDED FOR 18


§ 58.1-3981. Correction by commissioner or other official performing his duties.
A. If the commissioner of the revenue, or other official performing the duties imposed on
commissioners of the revenue under this title, is satisfied that he has erroneously assessed such
applicant with any such tax, he shall correct such assessment. If the assessment exceeds the proper
amount, he shall exonerate the applicant from the payment of so much as is erroneously charged
if not paid into the treasury of the county or city. If the assessment has been paid, the governing
body of the county or city shall, upon the certificate of the commissioner with the consent of the
town, city or county attorney, or if none, the attorney for the Commonwealth, that such assessment
was erroneous, direct the treasurer of the county, city or town to refund the excess to the taxpayer,
with interest if authorized pursuant to § 58.1-3918 or in the ordinance authorized by § 58.1-3916,
or as otherwise authorized in that section. However, the governing body of the county, city or town
may authorize the treasurer to approve and issue any refund up to $2,500 as a result of an erroneous
assessment.
B. If the assessment is less than the proper amount, the commissioner shall assess such applicant with
the proper amount. If any assessment is erroneous because of a mere clerical error or calculation,
the same may be corrected as herein provided and with or without petition from the taxpayer. If
such error or calculation was made in work performed by others in connection with conducting
general assessments, such mistake may be corrected by the commissioner of the revenue.
C. If the commissioner of the revenue, or other official performing the duties imposed on
commissioners of the revenue under this title, is satisfied that any assessment is erroneous because
of a factual error made in work performed by others in connection with conducting general
reassessments, he shall correct such assessment as herein provided and with or without petition
from the taxpayer.
D. An error in the valuation of property subject to the rollback tax imposed under § 58.1-3237 for
those years to which such tax is applicable may be corrected within three years of the assessment
of the rollback tax.
E. A copy of any correction made under this section shall be certified by the commissioner or such
other official to the treasurer of his county, city or town. When an unpaid erroneous assessment of
real estate is corrected under this section and such real estate has been sold at a delinquent land
sale, the commissioner or such other official making such correction shall certify a copy of such
correction to the clerk of the circuit court of his county or city; and such clerk shall note such
correction in the delinquent land book opposite the entry of the tract or lot for the year or years for
which such correction is made.
F. In any action on application for correction under § 58.1-3980, if so requested by the applicant, the
commissioner or other such official shall state in writing the facts and law supporting the action
on such application and mail a copy of such writing to the applicant at his last known address.
Date: November 2018
Inspection
Commercial/Multi-Family Building YTD Electrical YTD Fuel Gas YTD Mechanical YTD Plumbing YTD Subtotal YTD
New Buildings 1 4 1 2 1 0 3 2 10
Additions 4 1 1 1 1 0 8
Renovations 4 29 3 24 4 2 16 2 18 11 91
Manufactured/Modular 3 5 0 3 3 0 14
A Other Building Related 2 17 11 0 01 1 3 29
B Other Non Building Related 6 12 6 8 2 5 51 4 18 31
Total 13 69 10 51
0 8 7 254 30 34 183
Residential Building YTD Electrical YTD Fuel Gas YTD Mechanical YTD Plumbing YTD Subtotal YTD
New Buildings 50 224 15 62 3 24 11 43 16 65 95 418
Additions 5 41 14 2 8 7 5 72
Renovations 18 76 14 70 7 20 7 42 8 41 54 249
Manufactured/Modular 7 26 1 11 2 3 2 11 10 53
A Other Building Related 16 103 9 45 6 1 4 7 26 165
B Other Non Building Related 11 1 18 13 0 3 1 45
Total 96 481 40 220 10 67 19 100 26 134 191 1002

Plan Review
Commercial/Multi-Family Building YTD Electrical YTD Fuel Gas YTD Mechanical YTD Plumbing YTD Subtotal YTD
New Buildings 2 0 0 0 0 0 2
Additions 0 0 0 0 0 4
Renovations 7 6 0 4 4 0 21
Manufactured/Modular 0 0 0 0 0 0 0
A Other Building Related 6 2 0 0 0 0 8
B Other Non Building Related 10 3 0 1 2 0 1 15
Total 0 25 0 11 0 0 1 6 0 4 1 50
Residential Building YTD Electrical YTD Fuel Gas YTD Mechanical YTD Plumbing YTD Subtotal YTD
New Buildings 4 23 0 0 0 0 4 23
Additions 1 15 0 0 0 0 1 15
Renovations 7 11 0 0 0 0 7 11
Manufactured/Modular 2 8 0 0 0 0 2 8
A Other Building Related* 5 17 2 0 0 0 5 19
B Other Non Building Related* 1 2 0 0 0 0 1 2
Total 20 76 0 2 0 0 0 0 0 0 20 78

Monthly Total of Inspections 225 Madison County Building Official


Monthly Total of Plan Reviews 21
Monthly Total of Zoning 18 Signature: ________________________________
Monthly Total of E&S Inspections 47
Monthly Total of Training Hours Print: ____________________________________
Monthly Total of Land Use 0
Date: ____________________________________

*Note A: Permits are building related; for example: barns, sheds, roofing, decks, demolition, house moving.
*Note B: Permits are not building related; for example: pools, signs and fences.
Jul Aug Sept Oct Nov Dec Jan Feb Mar Apr May Jun
Inspections 251 278 203 228 225 0 0 0 0 0 0 0
Plan Reviews 21 28 31 27 21 0 0 0 0 0 0 0
Zoning Inspections 4 13 8 24 18 0 0 0 0 0 0 0
E&S Inspections 58 74 31 52 47 0 0 0 0 0 0 0
Training Hours 9 0 3 33.5 0 0 0 0 0 0 0 0
Land Use 0 0 0 0 0 0 0 0 0 0 0 0

F. Y. 2018‐2019 Monthly Inspection Reports
300

250

200

150

100

50

0
Jul Aug Sept Oct Nov Dec Jan Feb Mar Apr May Jun
Inspections 251 278 203 228 225 0 0 0 0 0 0 0
Plan Reviews 21 28 31 27 21 0 0 0 0 0 0 0
Zoning Inspections 4 13 8 24 18 0 0 0 0 0 0 0
E&S Inspections 58 74 31 52 47 0 0 0 0 0 0 0
Training Hours 9 0 3 33.5 0 0 0 0 0 0 0 0
Land Use 0 0 0 0 0 0 0 0 0 0 0 0
Madison County Building Department - Monthly Permit and Revenue Report Date: November 2018
Permits
Commercial/Multi-Family Building YTD Electrical YTD Fuel Gas YTD Mechanical YTD Plumbing YTD Subtotal YTD
New Buildings 1 3 1 3 1 1 3 1 3 4 13
Additions 0 0 0 0 0 0 0
Renovations 4 2 12 6 4 4 2 30
Manufactured/Modular 0 0 0 0 0 0 0
A Other Building Related 3 2 0 1 1 0 7
B Other Non Building Related 2 10 0 0 0 0 2 10
Total 3 20 3 17 0 7 1 8 1 8 8 60
Residential Building YTD Electrical YTD Fuel Gas YTD Mechanical YTD Plumbing YTD Subtotal YTD
New Buildings 4 23 1 12 2 4 3 4 3 17 13 66
Additions 1 13 2 8 0 2 6 1 4 6 31
Renovations 4 11 7 37 4 27 4 18 4 10 23 103
Manufactured/Modular 5 11 5 11 1 5 11 4 10 19 44
A Other Building Related 5 30 3 13 2 0 2 8 48
B Other Non Building Related 3 1 0 0 0 0 4
Total 19 91 18 82 6 34 14 39 12 43 69 296
Erosion and Sediment Control Permits YTD
Agreement in lieu of a plan 2 26 *Note A: Permits that are building related; for example: barns, sheds, roofing, decks, demolition, house moving.
Plan Review 1 *Note B: Permits that are not building related; for example: pools, signs and fences.
Land disturbing permit 0
Total 2 27

Projected Revenue for Permit Applications


Commercial/Multi-Family Building YTD Electrical YTD Fuel Gas YTD Mechanical YTD Plumbing YTD Subtotal YTD
New Buildings $1,257.52 $2,202.81 $273.21 $426.21 $76.50 $273.21 $426.21 $116.50 $269.50 $1,920.44 $3,401.23
Additions $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00
Renovations $12,447.71 $2,010.87 $8,694.10 $535.50 $3,998.24 $1,175.26 $2,010.87 $26,850.81
Manufactured/Modular $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00
A Other Building Related $269.50 $244.00 $0.00 $116.50 $203.00 $0.00 $833.00
B Other Non Building Related $234.60 $979.20 $0.00 $0.00 $0.00 $0.00 $234.60 $979.20
Total $1,492.12 $15,899.22 $2,284.08 $9,364.31 $0.00 $612.00 $273.21 $4,540.95 $116.50 $1,647.76 $4,165.91 $32,064.24
Residential Building YTD Electrical YTD Fuel Gas YTD Mechanical YTD Plumbing YTD Subtotal YTD
New Buildings $2,575.09 $14,859.37 $110.38 $1,877.55 $153.00 $306.00 $229.50 $765.00 $275.40 $1,229.30 $3,343.37 $19,037.22
Additions $208.70 $2,469.81 $153.00 $743.83 $0.00 $153.00 $459.00 $76.50 $306.00 $591.20 $3,978.64
Renovations $595.42 $1,652.63 $504.90 $2,893.36 $306.00 $2,014.50 $306.00 $1,377.00 $306.00 $765.00 $2,018.32 $8,702.49
Manufactured/Modular $1,953.08 $4,710.08 $557.50 $1,309.93 $76.50 $382.50 $841.50 $306.00 $777.24 $3,199.08 $6,229.84
A Other Building Related $346.00 $2,827.92 $153.00 $708.90 $153.00 $51.00 $102.00 $499.00 $3,842.82
B Other Non Building Related $438.60 $51.00 $0.00 $0.00 $0.00 $0.00 $489.60
Total $5,678.29 $26,958.41 $1,478.78 $7,584.57 $459.00 $2,550.00 $1,071.00 $3,493.50 $963.90 $3,179.54 $9,650.97 $42,280.61
Erosion and Sediment Control Permits YTD
Agreement in lieu of a plan $250.00 $3,312.50
Plan Review $200.00
Land disturbing permit $0.00
Total $250.00 $3,512.50

Estimated Value of Construction


Commercial/Multi-Family Building YTD Electrical YTD Fuel Gas YTD Mechanical YTD Plumbing YTD Subtotal YTD
New Buildings $330,500 $445,000 $6,500 $33,000 $800 $15,500 $32,000 $4,500 $31,000 $357,000 $541,800
Additions $0 $0 $0 $0 $0 $0 $0
Renovations $12,065,718 $55,000 $476,228 $312,500 $303,299 $109,500 $55,000 $13,267,245
Manufactured/Modular $0 $0 $0 $0 $0 $0 $0
A Other Building Related $337,500 $7,000 $0 $1,250 $31,500 $0 $377,250
B Other Non Building Related $22,940 $86,020 $0 $0 $0 $0 $22,940 $86,020
Total $353,440 $12,934,238 $61,500 $516,228 $0 $313,300 $15,500 $336,549 $4,500 $172,000 $434,940 $14,272,315
Residential Building YTD Electrical YTD Fuel Gas YTD Mechanical YTD Plumbing YTD Subtotal YTD
New Buildings $744,500 $6,101,883 $3,500 $55,500 $2,801 $7,015 $21,500 $59,500 $11,500 $61,800 $783,801 $6,285,698
Additions $82,500 $1,447,690 $56,600 $181,119 $0 $9,000 $31,500 $1,250 $7,000 $149,350 $1,667,309
Renovations $263,000 $328,250 $10,582 $162,257 $6,388 $54,333 $15,500 $175,500 $7,800 $16,800 $303,270 $737,140
Manufactured/Modular $766,200 $2,039,887 $12,000 $24,500 $1,300 $33,500 $70,000 $9,500 $21,000 $821,200 $2,156,687
A Other Building Related $48,000 $647,850 $1,532 $50,982 $1,000 $8,000 $6,000 $49,532 $713,832
B Other Non Building Related $35,400 $697 $0 $0 $0 $0 $36,097
Total $1,904,200 $10,600,960 $84,214 $475,055 $9,189 $63,648 $79,500 $344,500 $30,050 $112,600 $2,107,153 $11,596,763

Monthly Total of Commercial Permits 8 Madison County Building Official


Monthly Total of Commercial Revenue $4,165.91
Monthly Total of Commercial Est. Value $434,940 Signature: ________________________________
Monthly Total of Residential Permits 69
Monthly Total of Residential Revenue $9,650.97 Print: ____________________________________
Monthly Total of Residential Est. Value $2,107,153
Monthly Total of E&S Permits 2 Date: ____________________________________
Monthly Total of E&S Revenue $250.00

Monthly Total of Permits 79


Monthly Total Revenue $14,066.88
Monthly Total Est. Value $2,542,093
Fees Waived $ -
Monthly Permits and Revenue Bar Graphs

Jul-18 Aug-18 Sep-18 Oct-18 Nov-18 Dec-18 Jan-18 Feb-18 Mar-18 Apr-18 May-18 Jun-18
Permits 124 78 69 86 79 0 0 0 0 0 0 0
Revenue $11,315.50 $10,922.36 $17,262.11 $12,601.70 $14,066.88 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00
Estimate Const. Value $3,217,852 $15,730,829 $1,779,817 $2,598,487 $2,542,093 $0 $0 $0 $0 $0 $0 $0

Permits
140

120

100

80

Permits
60

40

20

0
Jan‐18 Feb‐18 Mar‐18 Apr‐18 May‐18 Jun‐18 Jul‐18 Aug‐18 Sep‐18 Oct‐18 Nov‐18 Dec‐18

Revenue
$20,000.00

$18,000.00

$16,000.00

$14,000.00

$12,000.00

$10,000.00
Revenue
$8,000.00

$6,000.00

$4,000.00

$2,000.00

$0.00
Jan‐18 Feb‐18 Mar‐18 Apr‐18 May‐18 Jun‐18 Jul‐18 Aug‐18 Sep‐18 Oct‐18 Nov‐18 Dec‐18

Estimate Const. Value
$18,000,000

$16,000,000

$14,000,000

$12,000,000

$10,000,000
Estimate Const. Value
$8,000,000

$6,000,000

$4,000,000

$2,000,000

$0
Jan‐18 Feb‐18 Mar‐18 Apr‐18 May‐18 Jun‐18 Jul‐18 Aug‐18 Sep‐18 Oct‐18 Nov‐18 Dec‐18
Director of Emergency Communications
Monthly Report

November 2018

Deployments

• None

Meetings

• November 1, 2018 – Hostile Incident Planning Meeting


• November 7, 2018 – NG911 Boundary Meeting with State
• November 8, 2018 – PSAP Managers meeting, 911 Services Board Meeting
and RPACI
• November 13, 2018 – Motorola Radio Demonstration
• November 16, 2018 – Kickoff meeting with Black and Veatch
• November 27, 2018 – Technical Specification Document Received from
Black and Veatch

Operations

• Currently understaffed by one position, interview process is underway to


fill that position.

Brian J. Gordon

12-4-2018
Madison County E-911 Monthly Report

2018 Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Year Totals
2018 911 Home Phones 108 62 225 220 217 176 198 181 146 145 168 1846
2018 911 Wireless Phones 354 232 361 276 355 364 316 318 267 315 338 3496
2018 911 Total Calls 462 294 586 496 572 540 514 499 413 460 506 0 5342
2017 911 Total Calls 407 427 465 563 536 511 526 474 568 517 474 459 5927
2016 911 TOTALS 463 432 489 450 460 489 547 531 463 552 462 412 5750
2015 911 TOTALS 518 491 548 459 552 693 487 466 476 485 463 445 6083
2014 911 TOTALS 525 580 660 552 574 564 583 447 493 584 540 479 6581
2013 911 TOTALS 643 499 653 658 666 579 676 610 599 616 499 534 7232
2012 911 TOTALS 729 573 821 729 684 785 533 630 552 645 558 563 7802
2011 911 TOTALS 618 546 625 568 629 720 716 661 703 607 756 722 7871

2018 911 Hang Ups 11 10 20 21 35 14 24 35 28 37 23 258


2017 911 Hang-ups 23 39 14 19 15 21 26 27 11 15 18 21 249
2016 911 Hang-ups 13 11 22 22 22 14 23 19 17 13 5 11 192
2015 911 Hang-ups 38 24 34 30 35 26 18 17 9 26 16 18 291
2014 911 Hang-ups 26 36 39 35 29 29 33 48 35 35 48 31 424
2013 911 Hang-ups 17 17 18 22 25 9 20 19 6 23 12 19 207
2012 911 Hang-ups 19 13 14 8 8 8 11 14 16 24 16 12 163
2011 911 Hang-ups 30 17 9 24 25 20 17 14 20 8 11 19 214

2018 911 Mis-dials 10 15 13 14 13 17 22 17 10 12 17 160


2017 911 Mis-dials 6 18 8 8 14 20 3 14 11 10 5 17 134
2016 911 Mis-dials 13 8 8 10 18 15 15 20 6 10 18 10 151
2015 911 Mis-dials 15 24 18 13 16 7 14 17 16 16 15 10 332
2014 911 Mis-dials 24 24 18 13 13 22 14 19 16 15 11 12 201
2013 911 Mis-dials 6 6 8 9 11 6 11 9 17 14 5 7 109
2012 911 Mis-dials 8 6 8 6 9 8 5 11 6 3 8 3 81
2011 911 Mis-dials 4 3 6 6 10 4 2 7 5 5 8 8 68
Madison County E-911 Monthly Report

2018 Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Year Totals
2018 911 Open Lines 8 11 14 11 32 26 36 31 17 24 29 239
2017 911 Open Lines 6 14 15 18 10 21 24 9 19 17 12 10 175
2016 911 Open Lines 6 12 11 7 14 20 27 23 14 10 9 11 164
2015 911 Open Lines 14 18 26 18 28 20 13 16 11 13 10 7 194
2014 911 Open Lines 23 22 17 29 27 26 38 31 25 17 18 10 283
2013 911 Open Lines 5 8 2 6 3 8 7 7 4 8 4 16 78
2012 911 Open Lines 3 5 1 6 2 6 4 4 5 5 2 6 49
2011 911 Open Lines 4 3 6 3 4 3 3 7 5 8 4 1 51

2018 Alarm Calls 23 21 29 17 36 34 22 20 20 27 28 277


2017 Alarm Calls 35 71 24 33 40 37 27 26 25 24 21 17 380
2016 Alarm Calls 45 18 38 24 31 21 24 28 24 25 25 46 349
2015 Alarm Calls 27 26 26 22 44 28 30 32 27 34 38 23 357
2014 Alarm Calls 25 18 17 28 30 26 36 14 17 25 28 28 292
2013 Alarm Calls 15 12 22 22 25 23 17 23 19 18 23 28 247
2012 Alarm Calls 20 20 18 25 21 23 18 11 21 19 21 19 236
2011 Alarm Calls 11 30 27 22 26 41 27 18 23 20 18 13 276

2018 Animal Calls 62 44 63 66 67 64 43 34 48 60 66 617


2017 Animal Calls 59 105 87 73 81 71 63 56 61 74 59 61 850
2016 Animal Calls 64 58 75 60 97 70 64 50 75 92 101 65 871
2015 Animal Calls 58 46 55 80 69 61 76 58 45 75 67 64 754
2014 Animal Calls 58 30 81 64 72 80 82 84 64 79 55 80 829
2013 Animal Calls 53 51 49 55 95 60 80 75 74 67 67 32 758
2012 Animal Calls 55 58 82 64 65 80 61 71 87 56 64 55 798
2011 Animal Calls 69 41 80 69 69 73 83 64 73 73 81 76 851

2018 Rescue Calls 173 156 154 133 169 177 165 142 173 185 198 1825
2017 Rescue Calls 161 130 173 179 183 160 178 185 187 161 137 167 2001
2016 Rescue Calls 184 163 168 157 166 186 167 157 153 150 133 148 1932
2015 Rescue Calls 159 156 169 164 162 151 179 167 169 173 173 151 1973
2014 Rescue Calls 158 145 162 143 168 151 188 157 181 200 150 158 1961
2013 Rescue Calls 173 133 171 176 175 143 210 163 170 171 133 151 1969
2012 Rescue Calls 142 137 173 154 183 170 167 154 146 172 146 159 1903
2011 Rescue Calls 174 119 159 148 178 151 152 159 161 181 181 141 1904
Madison County E-911 Monthly Report

2018 Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Year Totals

2018 Fire Calls 51 25 89 38 39 43 50 33 33 68 51 520


2017 Fire Calls 22 35 44 37 46 54 31 30 35 38 33 26 431
2016 Fire Calls 39 33 24 26 27 42 40 35 29 48 48 50 441
2015 Fire Calls 56 56 51 43 29 18 25 36 40 31 53 38 476
2014 Fire Calls 34 40 49 36 38 33 40 25 36 44 34 29 438
2013 Fire Calls 42 30 64 33 32 26 24 27 23 33 30 44 408
2012 Fire Calls 29 27 32 40 29 60 36 24 26 38 24 26 391
2011 Fire Calls 49 59 27 31 31 33 46 37 29 35 35 24 436

2018 Auto Accidents 43 32 26 21 29 35 33 34 26 66 95 440


2017 Auto Accidents 41 69 45 47 39 43 30 37 59 46 39 26 521
2016 Auto Accidents 44 42 38 29 38 43 44 45 37 68 89 74 591
2015 Auto Accidents 70 46 48 20 40 29 27 36 42 54 66 36 514
2014 Auto Accidents 55 32 54 36 38 39 34 33 29 66 50 45 511
2013 Auto Accidents 34 24 49 37 39 31 23 21 43 51 66 60 478
2012 Auto Accidents 28 37 19 30 27 46 29 35 30 39 56 62 438
2011 Auto Accidents 76 30 28 29 29 31 29 22 28 53 58 41 454
2010 Auto Accidents 38 61 32 37 40 47 45 30 30 54 51 51 516

2018 Law Enforcement Calls 940 819 1041 952 1188 1069 1049 966 880 976 988 10868
2017 Law Enforcement Calls 950 925 1029 942 982 1070 985 1055 1060 1080 984 902 11964
2016 Law Enforcement Calls 872 855 1012 955 1021 983 1109 1299 1097 1111 1077 967 12358
2015 Law Enforcement Calls 916 880 992 994 1130 963 989 1148 1031 1038 917 912 11910
2014 Law Enforcement Calls 1048 862 1051 957 1016 1156 1179 1344 1194 1199 1222 922 13150
2013 Law Enforcement Calls 965 988 1077 1096 1059 1103 979 1070 954 1046 1040 995 12372
2012 Law Enforcement Calls 975 1043 990 898 1060 957 1072 1057 1039 1096 1053 1049 12289
2011 Law Enforcement Calls 969 835 1025 984 989 874 1010 848 835 969 960 984 11282
2010 Law Enforcement Calls 848 813 1149 1068 1086 992 1071 1127 1067 1008 965 1013 12207
2009 Law Enforcement Calls 919 812 851 1096 1132 1071 1051 1103 1073 1128 994 882 12112
2008 Law Enforcement Calls 897 839 872 801 849 885 965 915 1056 1008 843 774 10704
December 4, 2018
Attn: Board of Supervisors
Re: Eco-Dev&Tourism
• Scenic Byway Resolution for SR 230 from Greene to Madison (Wolftown-Hood Rd)
• Premiering the Crush Friday Old Rag video from our You Tube Channel today,
thanks to MAP Drones
• Over 4300 new views to the website
• CRUSH Friday commercials (last piece to the grant being finalized, still)
• Working and meetings regarding our GO VA $249,000 Crafting Higher Paying
Jobs grant with Nelson, PVCC, Germanna and partners in the industry
• Still sending out leads and refilling Welcome Center requests
• Working on upcoming event to include Dec 7th parade and tree lighting, Tree was
delivered today thanks to Aylor’s Garage and Towing, Roger Berry and Spruce
Rock Farm
• Attended Broadband meetings.
• Working on another possible Tourism Grant with a couple of counties for the
upcoming 50 Years of Love with Virginia Tourism
• Plan to attend VEDA Winter Membership meeting Dec 5th
• Tourism Committee meeting December 18th 130pm at the Visitor Center
• Talked to a couple of potential businesses

Respectfully submitted,
Tracey
Tracey Gardner
Economic Development & Tourism Director
Emergency Management report
November 2018

Responses
Smoke in the building, Waverly Yowell Elementary school

Highway incident Rt 29 Blocked for a short time (ice storm)

Sprinkler flow alarm, Madison wood

Pull station alarm, Early learning center

Meetings and correspondence

Mass Casualty incident Planning, Law enforcement, EMS, Fire , 11/1

Local Emergency Planning committee 11/16

Rappahannock EM 11/20

Virginia Dept. Of Emergency Management 11/26 (Grant Process)

John Sherer

12/3/2018
Madison County Department of EMS
Noah Hillstrom, EMS Director
1449 N. Main St., Madison VA, 22727
Phone: 540-948-4813 Fax: 540-948-4821

December 4, 2018
MONTHLY REPORT TO THE MADISON COUNTY BOARD OF SUPERVISORS

EMS Calls: November 1 through November 30, 2018:

Total calls toned: 112


Average In-County response time to the scene: 11 minutes. Additional reports beyond the total
calls and response times are available upon request.

Personnel:

Katie McGhee accepted a full-time medic position and is currently in orientation. She is released to
practice as an EMT for the interim until her medic orientation is complete.

Tacuma Nibbs accepted a full-time medic position and will be starting 12/17/18

Jacob Sadler accepted a part-time medic position and will be starting 12/14/18

Lieutenant Paul Goulart will be retiring on February 1, 2019.

Revised part-time employee department SOG to reflect a minimum of 24 hours are required each month
to remain in good standing.

Employee evaluations complete and under review

Projects:

Researching interim EMS station location


Hospital transport policy finalization
Updating department SOGs
Madison County Zoning Office - November, 2018 (FY 18/19)
Report of Fees Collected Number Collected Collected YTD Money Collected Money YTD
Zoning Permits 0 0
Zoning Certification Letter 1 50
Zoning Text Amendment 0 0
Special Use Permits 0 0
Variances 0 0
Rezoning 1 2 2000 4000
Plats:
Regular Division 4 7500
Family Division 1 3 150 450
Boundary Adjustments 2 13 500 3250
Physical Surveys 0 0
Boundary Surveys 1 50
Site Plans 2 2695
Copies 8 2
Other 0 0
Ordinances, etc.
Comprehensive Plan 0 0
Comprehensive Plan CD 0 0
Zoning Ordinance 0 0
Subdivision Ordinance 0 0
Site Plan Ordinance 0 0
Sub Total 1 4 34 2650 17997

Zoning Permits Number Issued Issued YTD Money Collected Money YTD
Single Family Dwelling 2 33 100 1650
Mobile Home 3 150
Addition to Single Family Dwelling 1 8 50 400
Decks 3 16 150 800
Accessory Structures 4 15 200 750
Commercial 1 7 50 350
Other 4 27 200 1350
Sub Total 2 15 109 750 5450

Agriculture Permit 2 6 50 175


Sub Total 3 2 6 50 175

Total (Sub 1 + Sub 2 + Sub 3) 21 149 3450 23622

Subdivision Plats Approved


Zone Approved YTD Total
Conservation-1 0 Madison County Zoning Administrator
Agriculture-1 1 4
Residential-1 Printed Name: _Carol Ann Davis____________________________
Residential-2
Residential-3 0 Signature: ____Carol Ann Davis________________
Other 0
Total 1 4 Date: December 3, 2018 2017
MADISON COUNTY BOARD OF SUPERVISORS AGENDA ITEM STAFF REPORT
MEETING DATE: December 11, 2018
AGENDA TITLE: 7a Social Services Board Appointment
INDICATED MOTION(s): Per the Board’s discretion
STAFF LEAD: Deputy Clerk Frye
TIMING: It was reported on November 13 that Tina Weaver’s term on the Social Services
Board expired on June 30, 2018 and an advertisement was placed so that applications
for appointment could be considered at the December 11 meeting.

DISCUSSION: Mrs. Weaver has applied for reappointment. There are no other applicants as of this
writing.

FISCAL IMPACT: N/A


REFERENCES: N/A

HISTORY: N/A

RECOMMENDATION: None

ENCLOSURES: • Application for reappointment from Ms. Weaver

Organization Meetings Term Members Term Expires


Social Services 4th Tues @ 8:30 a.m. 1 year Charlotte Hoffman, Board Rep. 12/31/2018
Social Services 4th Tues @ 8:30 a.m. 4 years Tina Weaver 6/30/2018
Social Services 4th Tues @ 8:30 a.m. 4 years Joseph Goodall 6/30/2020
Social Services 4th Tues @ 8:30 a.m. 4 years Norris John 6/30/2019
Social Services 4th Tues @ 8:30 a.m. 4 years Jerry J. Butler 6/30/2020
MADISON COUNTY BOARD OF SUPERVISORS AGENDA ITEM STAFF REPORT
MEETING DATE: December 11, 2018
AGENDA TITLE: 7b Upcoming Appointments
INDICATED MOTION(s): N/A
STAFF LEAD: Deputy Clerk Frye
TIMING: Since the practice is for Board to appoint individuals to a series of assignments and
committees in January, staff has taken the liberty of reviewing the non-Board
member assignments per the attached.

DISCUSSION: A series of clarifications on Committee members, terms, charters, etc. should help
both the Board and staff in making sure qualified individuals are properly appointed
to County boards and committees.

Staff requests some conversation on this topic.

FISCAL IMPACT: N/A


REFERENCES: N/A

HISTORY: N/A

RECOMMENDATION: Discuss the Committee roster with a focus on pending appointments.

ENCLOSURES: • Pending Committee Appointments as of December 11, 2018


• Current Committees Roster
Pending Committee Appointment Issues for Discussion as of December 11, 2018

Broadband Committee 21 members Not on the list, but term expiration dates for members of this committee is
(?) not clear. Since the Board may want to re-form this group, request direction
on December 11.
Celebrate Shenandoah 1 seat A partial and unsigned bylaws document indicates a two-year term for a
single County representative. Tracey Gardner has been asked to check into
this.
Criglersville School The charter for this group has expired. Need to remove the Committee from
Property Repurposing the list.
Committee
Parks & Recreation 3 seats This board has three Citizen seats that will expire on January 31. A total of
Authority eight members (including two from the Board of Supervisors) are shown on
the Authority’s roster. § 15.2-5703 requires an even number of Authority
members.
PD9 & PD10 Workforce 1 seat No issues
Planning Commission 3 seats No issues
Rappahannock Juvenile 1 seat A Board member is serving as the designated alternate
Detention Center Board
Rappahannock Rapidan 1 seats One of three terms should expire each year per §37.2-502. Note that the
Community Services Board Committee roster has two expiring on 12/31/2020. Note member
qualification requirements in §37.2-501.
Recycling Committee 5 members (?) Apparently this is considered an “as needed” group but has no members.
Consider removing it from the list. Until it is properly chartered and
members have been appointed.
Shenandoah National Park 2 seats Per bylaws dated May 21, 2015, up to three individuals may be appointed
Blue Ridge Committee per County. Any appointee needs to be a County resident to qualify.

Skyline Community Action 1 seat The list indicates that the County has two representatives on this panel with
Partnership Board one being a Board member.
Social Services Board 1 seat Since Valerie Ward is an employee and not a voting member of the Social
Services board, she should be removed from the list. Per §63.2-301 except
for members of the governing body, members cannot serve more than two
consecutive full 4-year terms.
Tourism Committee 4 seats (?) The number of appointees is discretionary per §58.1-3819.








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11
1

Meeting #42 - December 5


The Madison County Planning Commission and the Madison County Board of Supervisors held
a joint meeting on November 7, 2018 at 7:00 p.m. in the Madison County Administrative Center
Auditorium located at 414 N. Main Street:

PRESENT: R. Clay Jackson, Chairman


Jonathon Weakley, Vice-Chairman
Charlotte Hoffman, Member
Amber Foster, Member
Jack Hobbs, County Administrator
Sean Gregg, County Attorney
Betty Grayson, Zoning Administrator

ABSENT: Kevin McGhee, Member

Board members were present but did not participate during the Planning Commission
portion of the session.

1. Call to order. Chairman Jackson called the Board of Supervisors portion of the meeting
to order and declared that a quorum was present. Supervisor McGhee will be absent due to
work-related matters.

2. Approval of the Agenda


Supervisor Foster moved that tonight's Agenda be adopted as presented, seconded by Supervisor
Aye: Jackson, Weakley, Hoffman, Foster. Nay: (0). Absent: McGhee.

3. Action Items
a. Case No. S-12-18-15: Request by M. Andrew Gayheart and Marvin N. Jenkins
42-11 for a plat of a subdivision of land to create four (4) lots.
The lots will be served by a new 50-foot-wide ingress and
Egress easement "A" on property identified as Tax Map 42-
11. This property is located off Route 631 (off Leon Road)
near Leon, zoned A-1.

b. Case No. S-12-18-16 Request by M. Andrew Gayheart and Marvin N. Jenkins for
431 and 42-11A a plat of a subdivision of land to create three (3) lots that
will be served by a new 50-foot-wide ingress and egress
easement "B" (TM43-1) and 42-11A (existing lot) will use
easement "B" as the fourth lot. The 2.0032 acres (a portion
of TM 43-1) and the 0.2085 of an acre (portion of TM42-
11) will be added to the existing parcel of Kennedy (TM42-
11A) as a boundary adjustment for a total acreage of
12.2117 acres. These properties are located off Route 631
2

Supervisor Foster moved that Case No. S-12-18-15 be approved as recommended by the
Madison County Planning Commission, seconded by Supervisor Hoffman. Aye: Jackson,
Weakley, Hoffman, Foster. Nay: (0). Absent: McGhee.

Supervisor Weakley moved that Case No. S-12-18-16 be approved as recommended by the
Madison County Planning Commission, seconded by Supervisor Hoffman. Aye: Jackson,
Weakley, Hoffman, Foster. Nay: (0). Absent: McGhee.

Additional Items for Discussion:


Case No. SP-09-18-10: Request by Heinz D. or Heidrun E. Wieland for a site plan and soil and
erosion plan for the construction of a road. The disturbed acreage for the road construction will
be 11.3 acres. This property is located off Route 29 Southbound Lane and private Madison Plaza
Drive and contains 34.675 acres of land near Madison, zoned Conditional Business, B-1.

The Madison County Board of Supervisors has received a letter of confirmation from VDOT
along with an additional set of plans that show compliance with all VDOT specifications (email
dated December 4, 2018).

Bill Gentry was present and advised that to the best of his knowledge, the aforementioned case
was to be heard subject to VDOT concerns and storm water management issues. Additional
comments focused on:

• Expectations and what the applicant can do in order to move the proposed request
forward
• Whether the County would be considered as a stakeholder
• How these types of requests are handled in other localities
• Whether action will be taken by the Madison County Board of Supervisors based on
input from DEQ
• Whether an economical and logical approach will be considered
• The fact that storm measures will be initiated for the proposed roadway
• Quality and quantitative measures will be in place for the building of all future sites

The County Attorney referred to correspondence mailed to the Department of Environmental


Quality to invite them to attend a meeting to review storm water management issues in order to
advise of best practices and protocol on how to facilitate applicant needs' in the future.

It was further advised that the Madison County Board of Supervisors does not have the oversight
review of what the Department of Environmental Quality does. The County is in the process of
gaining insight as to the necessary guidelines involved with storm water management, and also
lacks any type of authority to override protocol that the Department of Environmental Quality
has in place. 

➢ Chairman Jackson: Verbalized support of acting on the case after input is provided from
DEQ; verbalized enthusiasm about the proposed project; also noted there are State
compliance factors that must be attained
3

It was further advised that the Madison County Board of Supervisors desires to work with
landowners and other local entities that desire to bring new ideas to the County.

▪ Fay Utz, Commission members, questioned if the proposed case would be approved after
discussions from DEQ are presented, and whether the Agenda will reflect any method of
action.

The County Administrator advised that the Madison County Board of Supervisors could offer to
have a motion to approve and ask the Department of Environmental Quality to provide process
and development of the matter. could propose provided a brief outline of the proposed approval
process.

▪ Carty Yowell, Commission Chair, advised that conditional approval following DEQ
presentation may be the most advantageous process.

➢ Supervisor Weakley: Questioned if a notation 'to consider approval' for the proposed
case could be noted on the Agenda document for the public; also referred to discussions
held within the Rapidan River Basin concerning storm water regulations and ways to
provide assistance with best development tactics; questioned if the revised report was
submitted to the Department of Environmental Quality for review; suggested that a
summary letter be provided.

➢ Chairman Jackson: Verbalized anticipation that DEQ will work with the community as a
whole (i.e. property and property owners).

It was further suggested that the applicant provide all submitted documentation readily available
at the upcoming meeting, along with sited comments on the aforementioned case.

▪ Pete Elliott, Commissioner member, questioned if DEQ representatives will provide input
as to what measures the County needs to take, or if discussions will focus mainly on the
proposed project; also feels that the County will not receive definitive answers from the
Department of Environmental Quality; also feels that the Department of Environmental
Quality will require input as to the design in place and how much impervious service will
be in place.

After discussion, Chairman Jackson advised that although he was in favor of taking action at
tonight's session, it's anticipated that discussions will focus on all aspects of the project being
proposed. It's felt that the educational component of the case will help facilitate more specifics
of the issues that the proposed case presents.

➢ Supervisor Hoffman: Suggested action not be undertaken tonight; feels there will be more
insight to gain in waiting until the next meeting.
4

It was further suggested that all items be presented to DEQ representatives for discussion and
consideration.

The County Attorney referred to a concern as to whether:

✓ There's a process for landowners to collaborate with the Department of Environmental


Quality
✓ What does the Department of Environmental Quality expect in terms of storm water
management on property sites

And

✓ The challenges between urban and rural area development

The County Attorney further noted that at this time, the Madison County Board of Supervisors is
seeking guidance from the Department of Environmental Quality, as guidelines in place for other
states/localities may not be most suitable for Madison County. It's also hoped that the discussion
will encourage the Department of Environmental Quality to work with the County.

▪ Carty Yowell, Commission Chair, questioned whether all revisions should be revealed
during the upcoming discussion.

After discussion, Chairman Jackson suggested the applicant resubmit revised plans which
haven't been reviewed by the Department of Environmental Quality.

▪ Mike Fisher, Commission member, encouraged the Madison County Board of


Supervisors to request that the Department of Environmental Quality provide input as to
what needs to be done on the part of the applicant; feels that a definitive answer will not
be received at next week's session; encouraged input be attained from Virginia
legislators.

Bill Gentry, applicant, requested that Case No. SP-09-18-10 be tabled until December 11, 2018.
He further suggested that a letter be forwarded to the Department of Environmental Quality
regarding disapproval of the proposed plans.

▪ Mike Mosko, Commission member, questioned (the applicant) if an administrative letter


of appeal been submitted to the Department of Environmental Quality regarding their
rejection of the application.

After discussion, based on the applicant's request, it was the consensus of the Board to refrain
from taking action until discussions are held with representatives from the Department of
Environmental Quality on December 11, 2018.

The Board also requested that all documentation pertaining to Case No. SP-09-18-10 be provided
for review at the December 11, 2018 Regular Meeting session.
5

4. Information/Correspondence:
a. Status Report on pending Ordinance changes (current drafts, hearing dates:
i. Seasonal or brief Ordinance:
ii. Solar Ordinances
The County Attorney advised that advertisements have not run for the aforementioned ordinance.

Betty Grayson, Zoning Administrator, advised that advertisements will be published on


December 13th and 20th. The public hearing will be scheduled for January 2, 2019.

▪ Fay Utz, Commissioner member, will meet with the County Attorney to ensure that all
required ordinances for advertisement are in order.

b. Discussion on the Planning Commission's September 24, 2018 memo regarding updating
land development ordinances: Chairman Jackson advised that Carty Yowell, Commission
Chair, has taken care of the land development ordinances matter.

c. Preparation for upcoming events:


i. V. R. Shackelford, III Reception (December 6'2018 - 3:00 p.m. to 6:00 p.m.:
Chairman Jackson reminded the Board members of the upcoming reception for V. R.
Shackelford, III. Presentation of a Resolution will commence at 4:00 p.m.

ii. FEMA Floodplain Work Session (December 11, 2018 at 9:30 a.m.): The County
Administrator advised that the meeting with FEMA Floodplain representatives will be held at the
administrative building. Representatives from Greene County will also be included in the
informational process.

Betty Grayson, Zoning Administrator, advised that flood plain maps will be available for review;
copies of the model ordinance will be provided for review; Brian Daniel, Commissioner, and
Matt Aylor, E&S Technician, have done preliminary work on the number of parcels that are in a
flood plain zone; about 1,257 letters will need to be mailed to property owners. It was noted that
the meeting has been advertised. Discussions are mainly being provided for County officials and
public comment may not be considered.
iii. Board Discussion with DEQ Representatives (December 11'2018 at 4:00 p.m.:
Chairman Jackson advised that a plan is in place for this matter.

iv. Board Discussion with Planning Commission on the Status of the Comprehensive
Plan (January 2'2019): The County Administrator advised that the Madison County Planning
Commission has requested that the Comprehensive Plan be discussed in January 2019.

▪ Mike Fisher, Commissioner member, advised that some of the goals noted in the
Comprehensive Plan will warrant input from Tracey Gardner, Director of Economic
Development & Tourism.
6

Chairman Jackson advised that he will work with Carty Yowell, Commission Chair, to assess
whether a summary can be compiled in February 2019.
Carty Yowell, Commission Chair, advised that an ad hoc committee (Pete Elliott, Mike Mosko
and Mike Fisher) that have been tasked to work on compiling a summary.

d. Discussion with the County Attorney on Madison County Historical Society's


November 7'2018 letter requesting rights to the Criglersville 'museum house': The County
Attorney advised that it the museum house becomes part of an easement, it will affect the value
of the property and may discourage anyone that may be interested in doing something with the
property. If a 'license' is issued, it can be revoked uncertain terms, but will diminish the value of
the property. It's felt the best technique would be to assess whether any interest is brought forth
and if so, initiate a negotiating process to include input from MCHS representatives. It was also
noted that there is a history to the area for the County, and there are many that would desire to
preserve what the MCHS is trying to do. In closing, he verbalized discomfort in suggesting the
County move forward with any type of action that would devalue the property.

▪ Max Lacy, MCHS, noted that it's anticipated for the museum to be open by the spring of
2019, if at all possible. In closing, he noted that the MCHS doesn't want to utilize further
funding until something more concrete is put into place for the property.

➢ Chairman Jackson: Questioned if smaller improvements could be initiated


➢ Supervisor Hoffman: Suggested that the MCHS refrain from doing any more work until
something more concrete is in place

▪ Mike Fisher, Commission Member, questioned if the County will request the historical
society to vacate the museum house if the property is sold.

It was also noted that the County has the option to give the historical society the building.
However, it was also noted that the County desires to attain the best option for the taxpayers.
Although several citizens would like to see the building remodeled, alternative measures may be
more positive for the County's tax base.

➢ Supervisor Weakley: Suggested the matter be resolved as soon as possible; verbalized


favor of preserving certain parts of the Criglersville property for the history of the
County overall (regardless what happens to the facility)

▪ Pete Elliott, Commission Member, referred to the several restrictions on the building;
feels it will be difficult to utilize the property for certain uses.

Discussions focused on whether the property could be subdivided with a portion being given to
the historical society. Additional options focused on to sell the building and to issue an easement
to the building only, which would allow the County to attain the land and the liability.

After discussion, the County Attorney advised that he will work with Betty Grayson, Zoning
Ordinance, to develop a memorandum for consideration in January 2019 to include:
7

▪ Licensure
▪ Easement
▪ Zoning and current restrictions
▪ Whether there is a quick pro quo for potential buyers
▪ Assess whether the grounds will continue to be kept in order

It was also questioned whether current issues at the property revolve around water quality and
sewer issues, which may contribute the lack of interest in the property, along with the fact that it
sits in a flood plain. In the event that someone is looking to convert the property into a picnic
area of exhibit, this may be the best use of the property.

➢ Supervisor Weakley: Suggested that storage use (for a potential buyer) also be
considered.

It was also encouraged that any potential buyers present their ideas.

The County Administrator advised that the Finance Director has requested that all Board
members return any old notebooks from the past year.

Closing discussions focused on VDOT and health department approvals.

Betty Grayson, Zoning Administrator, advised that the Site Plan Ordinance may need to be
amended if the County is going to request that approval from the aforementioned entities be in
place before cases are heard.

The County Attorney noted that the request does require some collaboration and suggested the
Board consider the fact that regulatory issues may arise. In closing, he suggested that
conditional approval would be an asset.

5. Closed Session (if necessary)


6. Adjournment. With there being no further action required, on motion of Supervisor Hoffman,
seconded by Supervisor Weakley, Chairman Jackson adjourned the meeting Aye: Jackson,
Weakley, Hoffman, Foster. Nay: (0). Absent: McGhee.
8

Agenda
Joint Meeting
Madison County Planning Commission &
Madison County Board of Supervisors
Wednesday, December 5, 2018.
County Administration Building Auditorium
414 N. Main Street, Madison, Virginia 22727

Planning Commission
Call to Order
Pledge of Allegiance & Moment of Silence

Planning Commission

Call to Order

Pledge of Allegiance & Moment of Silence

1. Determine Presence of a Quorum

2. Approval of Minutes

3. Action Items:

42-11 a. Case No. S-12-18-15: Request by M. Andrew Gayheart and Marvin N.


Jenkins for a plat of a subdivision of land to create four (4) lots. The lots will
be served by a new 50-foot-wide ingress and egress easement “A” on property
identified as Tax Map 42-11. This property is located off Route 631 (off Leon
Road) near Leon, zoned A-1.

43-1 and 42-11A b. Case No. S-12-18-16: Request by M. Andrew Gayheart and Marvin N. Jenkins
for a plat of a subdivision of land to create three (3) lots that will be served by a
9

new 50 foot wide ingress and egress easement “B” (TM 43-1) and 42-11A
(existing lot) will use easement “B” as the fourth lot. The 2.0032 acres (a
portion of TM 43-1) and the 0.2085 of an acre (portion of TM 42-11) will be
added to the existing parcel of Kennedy (TM 42-11A) as a boundary adjustment
for a total acreage of 12.2117 acres. These properties are located off Route 631
(off Leon Road) near Leon, zoned A-1.

48-13 and a c. Case No. Z-12-18-17: Request by Carlyle L. Weaver & Carlyle L. Weaver d/b/a
CW

Portion of 48-13J Properties to amend conditional rezoning application that was approved on February
4,

2009 to Conditional Residential, R-3 with Proffer Statement attached. This


property is

located off Route 29 Southbound Lane on private Madison Plaza Drive and Route
660

(Courthouse Mountain Road) near Madison and contains 7.517 acres (TM 48-13
contains

3.498 acres) and (4.019 acres, portion of TM 48-13J), zoned Conditional


Residential, R-3 with

Proffer Statement.

4. Adjournment

Board of Supervisors

Call to Order

1. Determine Presence of a Quorum

2. Adoption of Agenda

3. Action Items:
10

42-11 a. Case No. S-12-18-15: Request by M. Andrew Gayheart and Marvin N.


Jenkins for a plat

of a subdivision……………….

43-1 and 42-11A b. Case No. S-12-18-16: Request by M. Andrew Gayheart and Marvin N. Jenkins
for a plat of

subdivision ………………

48-13 and a c. Case No. Z-12-18-17: Request by Carlyle L. Weaver & Carlyle L. Weaver
d/b/a CW

Portion of 48-13J Properties to amend condition rezoning application………

The Madison County Board of Supervisors will hear the following case on December 5, 2018 which was
tabled from their joint meeting on November 7, 2018 by the applicant. (This case was recommended for
approval by the Madison County Planning Commission at their joint meeting on November 7, 2018.)

48-131 Case No. SP-09-18-10: Request by Heinz D. or Heidrun E. Wieland for a site plan and
soil and erosion plan for the construction of a road. The disturbed acreage for the road
construction will be 11.3 acres. This property is located off Route 29 Southbound Lane
and private Madison Plaza Drive and

contains 34.675 acres of land near Madison, zoned Conditional Business, B-1.

4. Information/Correspondence

a. Status Report on pending Ordinance changes (current drafts, hearing dates:

i. Seasonal or brief Ordinance

ii. Solar Ordinances

b. Discussion on the Planning Commission's September 24'2018 memo regarding updating land
development ordinances
11

c. Preparation for upcoming events:

i. V. R. Shackelford, III Reception (December 6'2018 - 3:00 p.m. to 6:00 p.m.

ii. FEMA floodplain work session (December 11'2018 at 9:30 a.m.)

iii, Board discussion with DEQ representatives (December 11'2018 at 4:00 p.m.)

iv. Board discussion with Planning Commission on the status of the Comprehensive Plan
(January 2'2019)

d. Discussion with the County Attorney on Madison County Historical Society's November 7'2018
letter requesting rights to the Criglersville 'museum house'

5.Closed Session (if necessary)

6. Adjournment
MADISON COUNTY BOARD OF SUPERVISORS AGENDA ITEM STAFF REPORT
MEETING DATE: December 11, 2018
AGENDA TITLE: 10a Consideration of Leases
INDICATED MOTION(s): Per the Board’s discretion

STAFF LEAD: County Attorney Gregg

TIMING: Several leases have been under discussion for several months.

DISCUSSION: Work toward resolving the lease issues is ongoing. Cases are listed on the agenda in
descending order of highest greatest to proceed. Materials related to others are in
the agenda package.

Staff suggests that it would be helpful if some of these could be resolved and taken
off the County Attorney and County Administrator’s plate.

Staff comments are in the attached.

FISCAL IMPACT: N/A

REFERENCES: N/A

HISTORY: N/A

RECOMMENDATION: Per attached comments

ENCLOSURES:  Comments on Pending Leases as of December 3, 2018


Comments on Pending Leases – 181203

1. Madison County Historical Society at the Criglersville Museum House


Per a written request received at the 7 November meeting, the Madison County Historical
Society asked for some sort of guarantee that it would be able to use the space described in its
September 12, 2017 lease indefinitely. Other relevant documents are the easement for the
monument on the property near the building, the (unrecorded) survey, and the RFP supporting
the property sale effort. Note that the lease is for an initial 5-year term with successive 5-year
(apparently unlimited) renewal terms except that either party may terminate the lease with a 6
month notice.

The Board asked that the County Attorney (a) review the matter in an attempt to find a
compromise to the issue of not tying the property up while the County is searching for a
purchaser and (b) provide a report at the December 5 meeting. I have no good ideas to offer on
this situation.

2. Free Clinic at the Old Health Department Building


From the edition of the lease presented at the 27 November Board of Supervisors meeting,
(a) Sec. 2: a monthly rent of $50 was suggested (slight objection in a November 30 email from
Brenda Clements) but not agreed upon.
(b) Sec. 5: we need to pro-rate the utilities.

The Board members seem to be pondering the rent rate, and I hope to stay out of that. I suggest
that the utilities could be pro-rated on a square footage basis. Roger Berry says the free clinic
area is 790 SF from the total 5,597 in the whole building, or 14.11%.

Remember to attach Exhibit A (the floor plan).

3. Madison County Historical Society at the Arcade Building


From the edition of the lease presented at the 27 November Board of Supervisors meeting,
(a) Sec. 2: The space for RRCSB is the bulk of the first floor, but that has the bathroom and that
space would be used to access the second floor.
(b) Sec. 2: I need to confer with Roger Berry on the details of the $600 for parking lot lighting
since there may have been a handshake deal that eliminates the need for that clause.
(c) Sec. 8: This is not clear. If this is meant to cover a sublease, note that the RRSCB document is
set up as a separate lease with the County. The original idea was that RRCSB would share
the first floor meeting room and could use it almost any time the historical society or others
are not using it.
(d) It should be clearer whether the intent is for this document to replace the 2013 lease in its
entirety.
4. RRCSB at the Arcade Building
From the edition of the lease presented at the 27 November Board of Supervisors meeting
(Moore building language deleted),
(a) consider whether this should be characterized as a sub-lease if it is between the County and
RRCSB. If it is to be between the historical society and RRSCB, need to adjust the party of the
first part and notice addresses in Section 6.
(b) As above, the original idea was that RRCSB would share the first floor meeting room and
could use it almost any time the historical society or others are not using it but the
document reads as if RRCSB would control the space.
(c) Sec. 10: MCHS’s theory is that it should be the recipient of any rent, but this is inconsistent
with it’s “free” use of Madison County’s building.

5. Literacy Council at the Moore Building


From the edition of the lease presented at the 27 November Board of Supervisors meeting,
(a) Sec. 1: The term clause should recognize that the County’s lease expires on 12/31/2019 and
so the one-year term needs to be contingent upon the County’s renewal of the lease or
purchase of the building.
(b) Sec. 2: Consider requiring all contact with the property owner to be through the County.
(c) Sec. 10: It is my understanding that the property has a second water meter and that the
tenant could set up its own water/sewer account with RSA for water and sewer service.
(d) Sec. 10: Be clear that the literacy council is to fund and manage any approved building
improvements it wants and to be responsible for its own trash removal and janitorial.

The County’s arrangement with the literacy council for the use of the 304 Thrift Road space
should be articulated in this document. For example, when would the Thrift Road space be
vacated by the literacy council, or is the County going to allow the free clinic to occupy both
spaces?

6. Electoral Board at the Brightwood Ruritan Club Precinct 7


Looks good.

7. Electoral Board at the Burnt Tree Grange Precinct 2


Looks good.
LEASE AGREEMENT

This LEASE AGREEMENT is entered into this ___ day of ________________, 2018, by
and between the County of Madison, and the Madison Free Clinic, Inc., (MFC).

SECTION ONE

MFC is in the business of providing health care, and desires to lease the office space from
the dates and times available from the County of Madison.
The County of Madison leases to MFC a portion of the premises of the building known as
the Old Health Department Building at 410 North Main Street in Madison, Virginia. The
premises shall be used for the purposes of providing health care referrals and patient visits and
for no other purposes.
MFC currently occupies the space indicated on the plan attached as Exhibit A.

SECTION TWO
RENT

MFC shall pay a total rent of $____________ per month, payable in monthly
installments.

SECTION THREE
MFC’S PROPERTY

A. Furnishings, trade fixtures, and equipment installed by MFC shall be the property
of MFC and may be removed by MFC at any time during the term of this Lease provided that
MFC is not in default under this Lease. On termination of this Lease, MFC shall remove any
such property. MFC shall repair any damage to the demised premises resulting from the
installation or removal of such property.

B. Any repairs undertaken by MFC in accordance with the requirements of this


section shall be subject to all terms and conditions for improvements and alterations set forth
herein.

C. If MFC shall fail to remove all of its effects from the demised premises upon
termination of this Lease for any reason whatsoever, County of Madison may, at its option,

1
remove such effects without liability to MFC for the loss of such items. In such event, MFC
agrees to pay County of Madison upon demand for any and all expenses incurred in removal,
including court costs and reasonable attorney fees and storage charges on such effects for any
length of time that they may be in County of Madison’s possession.

SECTION FOUR
INSURANCE

A. MFC shall pay its share of all fire and extended coverage insurance that County of
Madison is required to maintain on the building in which the demised premises are located. If
any other portion of the property is leased to other tenants, the insurance cost of the tenants will
be allocated among the tenants, based on the percentage of square footage the tenant occupies.

B. Each party shall obtain from this insurer or insurers provisions permitting waiver
of any claim against the other party for loss or damage within the scope of the above-specified
insurance.

SECTION FIVE
UTILITIES

In addition, MFC shall pay its share of water, sewer, electricity, and other utility charges
for which separate billings are not available, provided that separate charges may be made by
County of Madison to MFC to reflect unusual or excessive utility system demands where not
separately metered.

SECTION SIX
INDEMNIFICATION

A. MFC shall indemnify, defend and hold County of Madison harmless from any and
all claims and damages (including reasonable attorney fees and costs) arising from MFC’s use of
the demised premises or the conduct of its business or from any activity, work, or thing done,
permitted, or suffered by MFC, in or about the demised premises and/or the building in which
the demised premises are located, unless caused by County of Madison or County of Madison’s
agents or employees.

2
B. MFC shall further indemnify, defend, and hold County of Madison harmless from
any and all claims and damages (including reasonable attorney fees and costs) arising from any
breach or default in the terms of this Lease, or arising from any act, negligence, fault, or
omission of MFC or MFC’s agents, employees, or invitees, and from and against any and all
costs, reasonable attorney fees, expenses, and liabilities incurred in or about such claim or any
action or proceeding brought on such claim.

C. In case any action or proceeding shall be brought against County of Madison by


reason of any such claim, MFC, upon notice from County of Madison, shall defend it at MFC’s
expense by counsel approved in writing by County of Madison.

SECTION SEVEN
DAMAGE TO MFC’S PROPERTY

A. In spite of any provisions in this Lease to the contrary, County of Madison and
County of Madison’s agents shall not be liable to MFC for any damage to any property entrusted
to employees of the building in which the demised premises are located, loss of or damage to any
property by theft or otherwise, any injury or damage to persons or property resulting from fire,
explosion, falling plaster, steam, gas, electricity, water, or rain that may leak from any part of the
demised premises or the building in which the demised premises are located or from any part of
the building, street, or subsurface or from any other place or resulting from dampness, or any
other cause, excepting cases where damage is caused by County of Madison’s negligent acts or
omissions, or default in the performance of County of Madison’s obligations under this Lease.

B. County of Madison or its agents shall not be liable to MFC for any latent defects
in the demised premises or in the building in which the demised premises are located.

C. MFC shall give prompt notice to County of Madison in case of fire or accident in
or on the demised premises or the building in which the demised premises are located.

3
SECTION EIGHT
PARKING

MFC shall be entitled to parking in common with other tenants and County of Madison
upon such terms and conditions as may be established by County of Madison.

SECTION NINE
ACCESS BY COUNTY OF MADISON

A. MFC shall allow County of Madison access to the demised premises at reasonable
times on reasonable notice for the purpose of inspecting, altering, and repairing the demised
premises.

B. County of Madison shall at all times have and retain a key with which to unlock
all doors in and on the demised premises, excluding MFC’s vaults and safes.

C. County of Madison shall have the right to use any and all means that County of
Madison may deem proper to open doors in an emergency to obtain entry to the demised
premises.

SECTION TEN

The County of Madison shall have the absolute right to terminate this Lease at any time
and for any reason by providing MFC ninety (90) days written notice.

County of Madison Madison Free Clinic, Inc.

By: ___________________________ By: _______________________________


Clay Jackson, Chairman Name: _____________________________
Madison County Board of Supervisors Title: ______________________________

Z:\MADISON COUNTY ATTORNEY WORK\Madison County Free Clinic\2018.11 Lease MFC.docx

4
Lab

Rest
Room

Office 1

Entrance/Lobby

Office 2

1
Space where occupancy by the Doors and walls may be added by the County
free clinic may be allowed. to isolate the shaded area at a later date.
From: Brenda Clements [mailto:bclements@madisonfreeclinic.org]
Sent: Friday, November 30, 2018 3:30 PM
To: Jack Hobbs <jhobbs@madisonco.virginia.gov>; Jonathon Weakley
<jweakley@madisonco.virginia.gov>; Clay Jackson <cjackson@madisonco.virginia.gov>; Kevin McGhee
<kmcghee@madisonco.virginia.gov>; Charlotte Hoffman <choffman@madisonco.virginia.gov>; Amber
Foster <afoster@madisonco.virginia.gov>
Subject: Free Clinic lease

November 30, 2018

Dear Madison County Board of Supervisors and Mr. Hobbs,

When approached earlier this year about entering into an agreement to continue staying in the building
we currently occupy, I was asked to come up with a dollar amount that would NOT impact patient
services. The $50 figure I chose was what we decided would not adversely impact the services we
provide.

I explained at that time, we had not budgeted for rent and our fiscal year is July 1 to June 30. Any
amount that is not budgeted will certainly impact other areas, however with planning and additional
fundraising we could budget for FY19-20 a modest rent. Attached is our 990, balance sheet and income
statement.

In addition, to give you a better understanding on what rent amounts look like in terms of patients
services, I have made the following chart to show what that money does.

$50 per month $600 per year Inhalers for a year for one
patient
$100 per month $1200 per year One year of preventative and
restorative care of teeth for one
patient

$150 per month $1800 insulin for one diabetic


(Novalin)

As the figures go higher so do the number of patients impacted. We can and will budget rent if this is
something the County desires.

Warm Regards,

Brenda Clements
Executive Director
Madison Free Clinic
540-948-3667
bclements@madisonfreeclinic.org
www.madisonfreeclinic.org
From: Brenda Clements
Sent: 11/30/18, 3:30 PM
To: Jack Hobbs, Jonathon Weakley, Clay Jackson, Kevin McGhee, Charlotte Hoffman, Amber Foster
Subject: Free Clinic lease

November 30, 2018

Dear Madison County Board of Supervisors and Mr. Hobbs,

When approached earlier this year about entering into an agreement to continue staying in the building
we currently occupy, I was asked to come up with a dollar amount that would NOT impact patient
services. The $50 figure I chose was what we decided would not adversely impact the services we
provide.

I explained at that time, we had not budgeted for rent and our fiscal year is July 1 to June 30. Any
amount that is not budgeted will certainly impact other areas, however with planning and additional
fundraising we could budget for FY19-20 a modest rent. Attached is our 990, balance sheet and income
statement.

In addition, to give you a better understanding on what rent amounts look like in terms of patients
services, I have made the following chart to show what that money does.

$50 per month $600 per year Inhalers for a year for one
patient
$100 per month $1200 per year One year of preventative and
restorative care of teeth for one
patient

$150 per month $1800 insulin for one diabetic


(Novalin)

As the figures go higher so do the number of patients impacted. We can and will budget rent if this is
something the County desires.

Warm Regards,

Brenda Clements
Executive Director
Madison Free Clinic
540-948-3667
bclements@madisonfreeclinic.org
www.madisonfreeclinic.org
6:56 AM MADISON FREE CLINIC
11/30/18 Statement of Financial Position
Cash Basis As of November 30, 2018

Nov 30, 18
ASSETS
Current Assets
Checking/Savings
Petty Cash 33.00
Union Certificate of Deposit 46,460.04
Union Checking 43,230.40
Union Savings 176,471.09

Total Checking/Savings 266,194.53

Total Current Assets 266,194.53

Other Assets
Organizational Fund with NPCF 27,108.18

Total Other Assets 27,108.18

TOTAL ASSETS 293,302.71

LIABILITIES & EQUITY


Liabilities
Current Liabilities
Other Current Liabilities
Payroll Liabilities
Federal Tax Withheld 246.46
Medicare Payable 65.00
Medicare Withheld 65.00
Social Security Payable 277.96
Social Security Withheld 277.96
State Tax Withheld 315.56

Total Payroll Liabilities 1,247.94

Total Other Current Liabilities 1,247.94

Total Current Liabilities 1,247.94

Total Liabilities 1,247.94

Equity
Unrestricted Net Assets 213,394.22
Net Income 78,660.55

Total Equity 292,054.77

TOTAL LIABILITIES & EQUITY 293,302.71

Page 1
6:58 AM MADISON FREE CLINIC
11/30/18 Statement of Activities - Budget vs. Actual
Cash Basis July through November 2018

Jul - Nov 18 Budget $ Over Budget % of Budget


Ordinary Income/Expense
Income
Churches 241 4,450 (4,209) 5%
Civic Donations
COPN 3,278 12,270 (8,992) 27%
Madison Board of Supervisors 0 2,500 (2,500) 0%
Other Civic 450 610 (160) 74%

Total Civic Donations 3,728 15,380 (11,652) 24%

Direct Public Support


Business Contributions 1,009 4,410 (3,401) 23%
Give Local Piedmont 0 3,000 (3,000) 0%
Giving Tuesday 0 500 (500) 0%
Individual Gifts 128,031 13,390 114,641 956%

Total Direct Public Support 129,040 21,300 107,740 606%

Fundraiser
Auction 100 3,580 (3,480) 3%
Donations 2,638 13,470 (10,832) 20%
Sponsor 0 3,900 (3,900) 0%
Taste of the Mountains 2,172 1,320 852 165%

Total Fundraiser 4,910 22,270 (17,360) 22%

Grants
Browning 0 20,000 (20,000) 0%
Piedmont United Way 1,363 850 513 160%
Va Association of Free Clinics 6,554 36,340 (29,786) 18%

Total Grants 7,916 57,190 (49,274) 14%

Indirect Public Support


United Way, CFC Contributions 0 1,375 (1,375) 0%

Total Indirect Public Support 0 1,375 (1,375) 0%

Investments
Interest-Savings, Short-term CD 50 1,920 (1,870) 3%

Total Investments 50 1,920 (1,870) 3%

Miscellaneous Revenue 18
Vision Reimbursement 0 850 (850) 0%

Total Income 145,903 124,735 21,168 117%

Expense
Fundraising 571 4,850 (4,279) 12%
Medical Services
Dental Services 25,959 29,550 (3,591) 88%
Medical 132 1,220 (1,088) 11%
Prescriptions 8,713 22,450 (13,737) 39%

Total Medical Services 34,804 53,220 (18,416) 65%

Operations
Accounting Fees 0 800 (800) 0%
Advertising Expenses 310 400 (90) 78%
Business Registration Fees 55 60 (5) 92%
Check Printing 0 150 (150) 0%
Conference, Convention, Meeting 497 980 (483) 51%
Contract Services
Outside Contract Services 301 840 (539) 36%

Total Contract Services 301 840 (539) 36%

Page 1
6:58 AM MADISON FREE CLINIC
11/30/18 Statement of Activities - Budget vs. Actual
Cash Basis July through November 2018

Jul - Nov 18 Budget $ Over Budget % of Budget


Insurance - Liability, D and O 0 750 (750) 0%
Insurance - Workers Comp 45 900 (855) 5%
Memberships and Dues 0 150 (150) 0%
Office Supplies 424 1,010 (586) 42%
Other Costs 0 90 (90) 0%
Postage, Mailing Service 112 400 (288) 28%
Printing and Copying 0 680 (680) 0%
Software 1,051 1,050 1 100%
Telephone, Telecommunications 997 2,490 (1,493) 40%

Total Operations 3,793 10,750 (6,957) 35%

Payroll Expenses
Medicare Expenses 347 845 (498) 41%
Salaries and Wages 23,938 58,282 (34,344) 41%
Social Security Expenses 1,484 3,613 (2,129) 41%

Total Payroll Expenses 25,769 62,740 (36,971) 41%

VAFC Mgt Fees 1,439 4,650 (3,211) 31%


Visual Services
Examination Fees 316 1,220 (904) 26%
Frames 337 310 27 109%
Lenses 213 1,270 (1,057) 17%

Total Visual Services 866 2,800 (1,934) 31%

Total Expense 67,242 139,010 (71,768) 48%

Net Ordinary Income 78,661 (14,275) 92,936 (551)%

Net Income 78,661 (14,275) 92,936 (551)%

Page 2
ROBINSON, FARMER, COX ASSOCIATES
CERTIFIED PUBLIC ACCOUNTANTS - A PROFESSIONAL LIMITED LIABILITY COMPANY
P.O. Box 6580, Charlottesville, Virginia 22906
Street Address: 530 Westfield Road, Charlottesville, Virginia 22901
Telephone: (434) 973-8314 Fax: (434) 974-7363 Email: rfctax@rfca.com

October 31, 2018

CONFIDENTIAL

Madison Free Clinic, Inc.


P.O. Box 914
Madison, VA 22727

We have prepared the following returns from information provided by you.

Return of Organization Exempt From Income Tax (Form 990)

We suggest that you examine these returns carefully to fully acquaint yourself with all items
contained therein to ensure that there are no omissions or misstatements. Attached are
instructions for signing and filing each return. Please follow those instructions carefully.

Enclosed is any material you furnished for use in preparing the returns. If the returns are
examined, requests may be made for supporting documentation. Therefore, we recommend that
you retain all pertinent records for at least seven years.

In order that we may properly advise you of tax considerations, please keep us informed of any
significant changes in your financial affairs or of any correspondence received from taxing
authorities.

If you have any questions, or if we can be of assistance in any way, please call.

Sincerely,
Robinson Farmer Cox Associates

Matthew A. McLearen
Certified Public Accountant
Filing Instructions

Madison Free Clinic, Inc.

Exempt Organization Tax Return

Taxable Year Ended June 30, 2018

Date Due: November 15, 2018

Remittance: None is required. Your Form 990 for the tax year ended 6/30/18 shows no
balance due.

Signature: You are using a Personal Identification Number (PIN) for signing your return
electronically. Sign the IRS e-file Authorization and mail it as soon as possible
to:

Jenn Lyster
Robinson Farmer Cox Associates
530 Westfield Rd
Charlottesville, VA 22901-1726

Other: Initial and date the copy of the return, and retain it for your records.

Your return is being filed electronically with the IRS and is not required to be
mailed. Mailing a paper copy of your return to the IRS will delay the processing
of your return.
IRS e-file Signature Authorization
Form 8879-EO for an Exempt Organization OMB No. 1545-1878

For calendar year 2017, or fiscal year beginning . . . . . . .7/01


. . . . . . . . . , 2017, and ending . . . . .6/30
. . . . . . . , 20 .18
Department of the Treasury
Internal Revenue Service
Do not send to the IRS. Keep for your records.
Go to www.irs.gov/Form8879EO for the latest information.
.....
2017
Name of exempt organization Employer identification number

Madison Free Clinic, Inc. 31-1654015


Name and title of officer Carty Yowell
Treasurer
Part I Type of Return and Return Information (Whole Dollars Only)
Check the box for the return for which you are using this Form 8879-EO and enter the applicable amount, if any, from the return. If you
check the box on line 1a, 2a, 3a, 4a, or 5a, below, and the amount on that line for the return being filed with this form was blank, then
leave line 1b, 2b, 3b, 4b, or 5b, whichever is applicable, blank (do not enter -0-). But, if you entered -0- on the return, then enter -0- on
the applicable line below. Do not complete more than one line in Part I.
1a Form 990 check here X b Total revenue, if any (Form 990, Part VIII, column (A), line 12) . . . . . . . . . . . . . . . . . . . . 1b 132,322
2a Form 990-EZ check here b Total revenue, if any (Form 990-EZ, line 9) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2b
3a Form 1120-POL check here b Total tax (Form 1120-POL, line 22) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3b
4a Form 990-PF check here b Tax based on investment income (Form 990-PF, Part VI, line 5) . . . . . . . . . . . . . . 4b
5a Form 8868 check here b Balance Due (Form 8868, line 3c) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5b

Part II Declaration and Signature Authorization of Officer


Under penalties of perjury, I declare that I am an officer of the above organization and that I have examined a copy of the
organization’s 2017 electronic return and accompanying schedules and statements and to the best of my knowledge and belief, they
are true, correct, and complete. I further declare that the amount in Part I above is the amount shown on the copy of the
organization’s electronic return. I consent to allow my intermediate service provider, transmitter, or electronic return originator (ERO)
to send the organization’s return to the IRS and to receive from the IRS (a) an acknowledgement of receipt or reason for rejection of
the transmission, (b) the reason for any delay in processing the return or refund, and (c) the date of any refund. If applicable, I
authorize the U.S. Treasury and its designated Financial Agent to initiate an electronic funds withdrawal (direct debit) entry to the
financial institution account indicated in the tax preparation software for payment of the organization’s federal taxes owed on this
return, and the financial institution to debit the entry to this account. To revoke a payment, I must contact the U.S. Treasury Financial
Agent at 1-888-353-4537 no later than 2 business days prior to the payment (settlement) date. I also authorize the financial institutions
involved in the processing of the electronic payment of taxes to receive confidential information necessary to answer inquiries and
resolve issues related to the payment. I have selected a personal identification number (PIN) as my signature for the organization’s
electronic return and, if applicable, the organization’s consent to electronic funds withdrawal.
Officer's PIN: check one box only

X I authorize Robinson Farmer Cox Associates to enter my PIN 06062 as my signature


ERO firm name Enter five numbers, but
do not enter all zeros

on the organization’s tax year 2017 electronically filed return. If I have indicated within this return that a copy of the return is
being filed with a state agency(ies) regulating charities as part of the IRS Fed/State program, I also authorize the aforementioned
ERO to enter my PIN on the return’s disclosure consent screen.

As an officer of the organization, I will enter my PIN as my signature on the organization’s tax year 2017 electronically filed return.
If I have indicated within this return that a copy of the return is being filed with a state agency(ies) regulating charities as part of
the IRS Fed/State program, I will enter my PIN on the return’s disclosure consent screen.

Officer's signature Date 10/31/18


Part III Certification and Authentication
ERO's EFIN/PIN. Enter your six-digit electronic filing identification
number (EFIN) followed by your five-digit self-selected PIN. 54365177777
Do not enter all zeros

I certify that the above numeric entry is my PIN, which is my signature on the 2017 electronically filed return for the organization
indicated above. I confirm that I am submitting this return in accordance with the requirements of Pub. 4163, Modernized e-File (MeF)
Information for Authorized IRS e-file Providers for Business Returns.

ERO's signature Matthew A. McLearen Date 10/31/18


ERO Must Retain This Form — See Instructions
Do Not Submit This Form to the IRS Unless Requested To Do So
For Paperwork Reduction Act Notice, see back of form. Form 8879-EO (2017)

DAA
Form 990 (2017) Madison Free Clinic, Inc. 31-1654015 Page 2
Part III Statement of Program Service Accomplishments
Check if Schedule O contains a response or note to any line in this Part III ...................................... X
1 Briefly describe the organization's mission:
See
. . . . . .Schedule
..................O
.............................................................................................................................
. ....................................................................................................................................................
. ....................................................................................................................................................

2 Did the organization undertake any significant program services during the year which were not listed on the
prior Form 990 or 990-EZ? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Yes X No
If "Yes," describe these new services on Schedule O.
3 Did the organization cease conducting, or make significant changes in how it conducts, any program
services? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Yes X No
If "Yes," describe these changes on Schedule O.
4 Describe the organization's program service accomplishments for each of its three largest program services, as measured by
expenses. Section 501(c)(3) and 501(c)(4) organizations are required to report the amount of grants and allocations to others,
the total expenses, and revenue, if any, for each program service reported.

4a (Code: ........ ) (Expenses $ . . . . . . . . . . . .90,417 ............ including grants of $ . . . . . . . . . . . . . . . . . . . . . . . . ) (Revenue $ . . . . . . . . . . . . . . . . . . . . . . . . )


To. . . provide
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .prescriptions,
generic and non-generic . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . physician
. . . . . . . . . . . . . . . . . . . . . visits,
. . . . . . . . . . . . . . . . .eye
.........
glasses
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .residents
and dental services to uninsured indigent Madison County ...............
(below
. . . . . . . . . . . .150%
. . . . . . . . . . of
. . . . . . .Federal
. . . . . . . . . . . . . . . . Poverty
. . . . . . . . . . . . . . . . . Guidelines.)
.......................................................................................
. ....................................................................................................................................................
. ....................................................................................................................................................
. ....................................................................................................................................................
. ....................................................................................................................................................
. ....................................................................................................................................................
. ....................................................................................................................................................
. ....................................................................................................................................................
. ....................................................................................................................................................

4b (Code: ........ ) (Expenses $ ........................ including grants of $ ........................ ) (Revenue $ ........................ )


. ....................................................................................................................................................
. ....................................................................................................................................................
. ....................................................................................................................................................
. ....................................................................................................................................................
. ....................................................................................................................................................
. ....................................................................................................................................................
. ....................................................................................................................................................
. ....................................................................................................................................................
. ....................................................................................................................................................
. ....................................................................................................................................................
. ....................................................................................................................................................

4c (Code: ........ ) (Expenses $ ........................ including grants of $ ........................ ) (Revenue $ ........................ )


. ....................................................................................................................................................
. ....................................................................................................................................................
. ....................................................................................................................................................
. ....................................................................................................................................................
. ....................................................................................................................................................
. ....................................................................................................................................................
. ....................................................................................................................................................
. ....................................................................................................................................................
. ....................................................................................................................................................
. ....................................................................................................................................................
. ....................................................................................................................................................

4d Other program services (Describe in Schedule O.)


(Expenses $ including grants of $ ) (Revenue $ )
4e Total program service expenses 90,417
DAA Form 990 (2017)
Form 990 (2017) Madison Free Clinic, Inc. 31-1654015 Page 3
Part IV Checklist of Required Schedules
Yes No
1 Is the organization described in section 501(c)(3) or 4947(a)(1) (other than a private foundation)? If “Yes,”
complete Schedule A . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 X
2 Is the organization required to complete Schedule B, Schedule of Contributors (see instructions)? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 X
3 Did the organization engage in direct or indirect political campaign activities on behalf of or in opposition to
candidates for public office? If “Yes,” complete Schedule C, Part I . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 X
4 Section 501(c)(3) organizations. Did the organization engage in lobbying activities, or have a section 501(h)
election in effect during the tax year? If "Yes," complete Schedule C, Part II . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4 X
5 Is the organization a section 501(c)(4), 501(c)(5), or 501(c)(6) organization that receives membership dues,
assessments, or similar amounts as defined in Revenue Procedure 98-19? If "Yes," complete Schedule C,
Part III . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5 X
6 Did the organization maintain any donor advised funds or any similar funds or accounts for which donors
have the right to provide advice on the distribution or investment of amounts in such funds or accounts? If
“Yes,” complete Schedule D, Part I . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6 X
7 Did the organization receive or hold a conservation easement, including easements to preserve open space,
the environment, historic land areas, or historic structures? If “Yes,” complete Schedule D, Part II . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7 X
8 Did the organization maintain collections of works of art, historical treasures, or other similar assets? If “Yes,”
complete Schedule D, Part III . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8 X
9 Did the organization report an amount in Part X, line 21, for escrow or custodial account liability, serve as a
custodian for amounts not listed in Part X; or provide credit counseling, debt management, credit repair, or
debt negotiation services? If “Yes,” complete Schedule D, Part IV . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9 X
10 Did the organization, directly or through a related organization, hold assets in temporarily restricted
endowments, permanent endowments, or quasi-endowments? If “Yes,” complete Schedule D, Part V . . . . . . . . . . . . . . . . . . . . . . . . . . . 10 X
11 If the organization's answer to any of the following questions is “Yes,” then complete Schedule D, Parts VI,
VII, VIII, IX, or X as applicable.
a Did the organization report an amount for land, buildings, and equipment in Part X, line 10? If "Yes,"
complete Schedule D, Part VI . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11a X
b Did the organization report an amount for investments—other securities in Part X, line 12 that is 5% or more
of its total assets reported in Part X, line 16? If "Yes," complete Schedule D, Part VII . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11b X
c Did the organization report an amount for investments—program related in Part X, line 13 that is 5% or more
of its total assets reported in Part X, line 16? If "Yes," complete Schedule D, Part VIII . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11c X
d Did the organization report an amount for other assets in Part X, line 15 that is 5% or more of its total assets
reported in Part X, line 16? If "Yes," complete Schedule D, Part IX . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11d X
e Did the organization report an amount for other liabilities in Part X, line 25? If "Yes," complete Schedule D, Part X . . . . . . . . . . . . . . . 11e X
f Did the organization's separate or consolidated financial statements for the tax year include a footnote that addresses
the organization's liability for uncertain tax positions under FIN 48 (ASC 740)? If "Yes," complete Schedule D, Part X . . . . . . . . . . . . 11f X
12a Did the organization obtain separate, independent audited financial statements for the tax year? If “Yes,” complete
Schedule D, Parts XI and XII . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12a X
b Was the organization included in consolidated, independent audited financial statements for the tax year? If
"Yes," and if the organization answered "No" to line 12a, then completing Schedule D, Parts XI and XII is optional . . . . . . . . . . . . . . . 12b X
13 Is the organization a school described in section 170(b)(1)(A)(ii)? If “Yes,” complete Schedule E . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13 X
14a Did the organization maintain an office, employees, or agents outside of the United States? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14a X
b Did the organization have aggregate revenues or expenses of more than $10,000 from grantmaking,
fundraising, business, investment, and program service activities outside the United States, or aggregate
foreign investments valued at $100,000 or more? If “Yes,” complete Schedule F, Parts I and IV . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14b X
15 Did the organization report on Part IX, column (A), line 3, more than $5,000 of grants or other assistance to or
for any foreign organization? If “Yes,” complete Schedule F, Parts II and IV . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15 X
16 Did the organization report on Part IX, column (A), line 3, more than $5,000 of aggregate grants or other
assistance to or for foreign individuals? If “Yes,” complete Schedule F, Parts III and IV . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16 X
17 Did the organization report a total of more than $15,000 of expenses for professional fundraising services on
Part IX, column (A), lines 6 and 11e? If “Yes,” complete Schedule G, Part I (see instructions) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17 X
18 Did the organization report more than $15,000 total of fundraising event gross income and contributions on
Part VIII, lines 1c and 8a? If "Yes," complete Schedule G, Part II . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18 X
19 Did the organization report more than $15,000 of gross income from gaming activities on Part VIII, line 9a?
If "Yes," complete Schedule G, Part III . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19 X
Form 990 (2017)

DAA
Form 990 (2017) Madison Free Clinic, Inc. 31-1654015 Page 4
Part IV Checklist of Required Schedules (continued)
Yes No
20a Did the organization operate one or more hospital facilities? If “Yes,” complete Schedule H . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20a X
b If “Yes” to line 20a, did the organization attach a copy of its audited financial statements to this return? . . . . . . . . . . . . . . . . . . . . . . . . . . 20b
21 Did the organization report more than $5,000 of grants or other assistance to any domestic organization or
domestic government on Part IX, column (A), line 1? If “Yes,” complete Schedule I, Parts I and II . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21 X
22 Did the organization report more than $5,000 of grants or other assistance to or for domestic individuals on
Part IX, column (A), line 2? If “Yes,” complete Schedule I, Parts I and III . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22 X
23 Did the organization answer “Yes” to Part VII, Section A, line 3, 4, or 5 about compensation of the
organization's current and former officers, directors, trustees, key employees, and highest compensated
employees? If "Yes," complete Schedule J . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23 X
24a Did the organization have a tax-exempt bond issue with an outstanding principal amount of more than
$100,000 as of the last day of the year, that was issued after December 31, 2002? If “Yes,” answer lines 24b
through 24d and complete Schedule K. If “No,” go to line 25a . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24a X
b Did the organization invest any proceeds of tax-exempt bonds beyond a temporary period exception? . . . . . . . . . . . . . . . . . . . . . . . . . . . 24b
c Did the organization maintain an escrow account other than a refunding escrow at any time during the year
to defease any tax-exempt bonds? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24c
d Did the organization act as an “on behalf of” issuer for bonds outstanding at any time during the year? . . . . . . . . . . . . . . . . . . . . . . . . . . 24d
25a Section 501(c)(3), 501(c)(4), and 501(c)(29) organizations. Did the organization engage in an excess benefit
transaction with a disqualified person during the year? If “Yes,” complete Schedule L, Part I . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25a X
b Is the organization aware that it engaged in an excess benefit transaction with a disqualified person in a prior
year, and that the transaction has not been reported on any of the organization's prior Forms 990 or 990-EZ?
If "Yes," complete Schedule L, Part I . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25b X
26 Did the organization report any amount on Part X, line 5, 6, or 22 for receivables from or payables to any
current or former officers, directors, trustees, key employees, highest compensated employees, or
disqualified persons? If "Yes," complete Schedule L, Part II . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 26 X
27 Did the organization provide a grant or other assistance to an officer, director, trustee, key employee,
substantial contributor or employee thereof, a grant selection committee member, or to a 35% controlled
entity or family member of any of these persons? If “Yes,” complete Schedule L, Part III . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27 X
28 Was the organization a party to a business transaction with one of the following parties (see Schedule L,
Part IV instructions for applicable filing thresholds, conditions, and exceptions):
a A current or former officer, director, trustee, or key employee? If "Yes," complete Schedule L, Part IV . . . . . . . . . . . . . . . . . . . . . . . . . . . 28a X
b A family member of a current or former officer, director, trustee, or key employee? If "Yes," complete
Schedule L, Part IV . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 28b X
c An entity of which a current or former officer, director, trustee, or key employee (or a family member thereof)
was an officer, director, trustee, or direct or indirect owner? If “Yes,” complete Schedule L, Part IV . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 28c X
29 Did the organization receive more than $25,000 in non-cash contributions? If “Yes,” complete Schedule M . . . . . . . . . . . . . . . . . . . . . . 29 X
30 Did the organization receive contributions of art, historical treasures, or other similar assets, or qualified
conservation contributions? If “Yes,” complete Schedule M . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30 X
31 Did the organization liquidate, terminate, or dissolve and cease operations? If “Yes,” complete Schedule N,
Part I . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 31 X
32 Did the organization sell, exchange, dispose of, or transfer more than 25% of its net assets? If "Yes,"
complete Schedule N, Part II . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 32 X
33 Did the organization own 100% of an entity disregarded as separate from the organization under Regulations
sections 301.7701-2 and 301.7701-3? If “Yes,” complete Schedule R, Part I . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 33 X
34 Was the organization related to any tax-exempt or taxable entity? If “Yes,” complete Schedule R, Part II, III,
or IV, and Part V, line 1 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 34 X
35a Did the organization have a controlled entity within the meaning of section 512(b)(13)? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 35a X
b If "Yes" to line 35a, did the organization receive any payment from or engage in any transaction with a
controlled entity within the meaning of section 512(b)(13)? If “Yes,” complete Schedule R, Part V, line 2 . . . . . . . . . . . . . . . . . . . . . . . . . 35b
36 Section 501(c)(3) organizations. Did the organization make any transfers to an exempt non-charitable
related organization? If “Yes,” complete Schedule R, Part V, line 2 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 36 X
37 Did the organization conduct more than 5% of its activities through an entity that is not a related organization
and that is treated as a partnership for federal income tax purposes? If “Yes,” complete Schedule R,
Part VI . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 37 X
38 Did the organization complete Schedule O and provide explanations in Schedule O for Part VI, lines 11b and
19? Note. All Form 990 filers are required to complete Schedule O. 38 X
Form 990 (2017)

DAA
Form 990 (2017) Madison Free Clinic, Inc. 31-1654015 Page 5
Part V Statements Regarding Other IRS Filings and Tax Compliance
Check if Schedule O contains a response or note to any line in this Part V . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Yes No
1a Enter the number reported in Box 3 of Form 1096. Enter -0- if not applicable . . . . . . . . . . . . . . . . . . . . 1a 0
b Enter the number of Forms W-2G included in line 1a. Enter -0- if not applicable . . . . . . . . . . . . . . . . . 1b 0
c Did the organization comply with backup withholding rules for reportable payments to vendors and
reportable gaming (gambling) winnings to prize winners? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1c
2a Enter the number of employees reported on Form W-3, Transmittal of Wage and Tax
Statements, filed for the calendar year ending with or within the year covered by this return . . . . . 2a 2
b If at least one is reported on line 2a, did the organization file all required federal employment tax returns? . . . . . . . . . . . . . . . . . . . . . . . 2b X
Note. If the sum of lines 1a and 2a is greater than 250, you may be required to e-file (see instructions)
3a Did the organization have unrelated business gross income of $1,000 or more during the year? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3a X
b If “Yes,” has it filed a Form 990-T for this year? If “No” to line 3b, provide an explanation in Schedule O . . . . . . . . . . . . . . . . . . . . . . . . . 3b
4a At any time during the calendar year, did the organization have an interest in, or a signature or other authority
over, a financial account in a foreign country (such as a bank account, securities account, or other financial
account)? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4a X
b If “Yes,” enter the name of the foreign country: ...............................................................................
See instructions for filing requirements for FinCEN Form 114, Report of Foreign Bank and Financial Accounts
(FBAR).
5a Was the organization a party to a prohibited tax shelter transaction at any time during the tax year? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5a X
b Did any taxable party notify the organization that it was or is a party to a prohibited tax shelter transaction? . . . . . . . . . . . . . . . . . . . . . . 5b X
c If “Yes” to line 5a or 5b, did the organization file Form 8886-T? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5c
6a Does the organization have annual gross receipts that are normally greater than $100,000, and did the
organization solicit any contributions that were not tax deductible as charitable contributions? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6a X
b If “Yes,” did the organization include with every solicitation an express statement that such contributions or
gifts were not tax deductible? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6b
7 Organizations that may receive deductible contributions under section 170(c).
a Did the organization receive a payment in excess of $75 made partly as a contribution and partly for goods
and services provided to the payor? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7a
b If “Yes,” did the organization notify the donor of the value of the goods or services provided? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7b
c Did the organization sell, exchange, or otherwise dispose of tangible personal property for which it was
required to file Form 8282? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7c
d If “Yes,” indicate the number of Forms 8282 filed during the year . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7d
e Did the organization receive any funds, directly or indirectly, to pay premiums on a personal benefit contract? . . . . . . . . . . . . . . . . . . . 7e
f Did the organization, during the year, pay premiums, directly or indirectly, on a personal benefit contract? . . . . . . . . . . . . . . . . . . . . . . . 7f
g If the organization received a contribution of qualified intellectual property, did the organization file Form 8899 as required? . . . . . 7g
h If the organization received a contribution of cars, boats, airplanes, or other vehicles, did the organization file a Form 1098-C? . . 7h
8 Sponsoring organizations maintaining donor advised funds. Did a donor advised fund maintained by the
sponsoring organization have excess business holdings at any time during the year? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8
9 Sponsoring organizations maintaining donor advised funds.
a Did the sponsoring organization make any taxable distributions under section 4966? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9a
b Did the sponsoring organization make a distribution to a donor, donor advisor, or related person? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9b
10 Section 501(c)(7) organizations. Enter:
a Initiation fees and capital contributions included on Part VIII, line 12 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10a
b Gross receipts, included on Form 990, Part VIII, line 12, for public use of club facilities . . . . . . . . . . 10b
11 Section 501(c)(12) organizations. Enter:
a Gross income from members or shareholders . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11a
b Gross income from other sources (Do not net amounts due or paid to other sources
against amounts due or received from them.) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11b
12a Section 4947(a)(1) non-exempt charitable trusts. Is the organization filing Form 990 in lieu of Form 1041? . . . . . . . . . . . . . . . . . . 12a
b If “Yes,” enter the amount of tax-exempt interest received or accrued during the year . . . . . . . . . . . . 12b
13 Section 501(c)(29) qualified nonprofit health insurance issuers.
a Is the organization licensed to issue qualified health plans in more than one state? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13a
Note. See the instructions for additional information the organization must report on Schedule O.
b Enter the amount of reserves the organization is required to maintain by the states in which
the organization is licensed to issue qualified health plans . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13b
c Enter the amount of reserves on hand . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13c
14a Did the organization receive any payments for indoor tanning services during the tax year? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14a X
b If "Yes," has it filed a Form 720 to report these payments? If "No," provide an explanation in Schedule O . . . . . . . . . . . . . . . . . . . . . . . . 14b
DAA Form 990 (2017)
Form 990 (2017) Madison Free Clinic, Inc. 31-1654015 Page 6
Part VI Governance, Management, and Disclosure For each "Yes" response to lines 2 through 7b below, and for a "No"
response to line 8a, 8b, or 10b below, describe the circumstances, processes, or changes in Schedule O. See instructions.
Check if Schedule O contains a response or note to any line in this Part VI . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . X
Section A. Governing Body and Management
Yes No
1a Enter the number of voting members of the governing body at the end of the tax year . . . . . . . . . . . . . . . . . . . . . . . 1a 9
If there are material differences in voting rights among members of the governing body, or
if the governing body delegated broad authority to an executive committee or similar
committee, explain in Schedule O.
b Enter the number of voting members included in line 1a, above, who are independent . . . . . . . . . . . . . . . . . . . . . . . 1b 9
2 Did any officer, director, trustee, or key employee have a family relationship or a business relationship with
any other officer, director, trustee, or key employee? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 X
3 Did the organization delegate control over management duties customarily performed by or under the direct
supervision of officers, directors, or trustees, or key employees to a management company or other person? . . . . . . . . . . . . . . . . . . . . 3 X
4 Did the organization make any significant changes to its governing documents since the prior Form 990 was filed? . . . . . . . . . . . . . . 4 X
5 Did the organization become aware during the year of a significant diversion of the organization’s assets? . . . . . . . . . . . . . . . . . . . . . . 5 X
6 Did the organization have members or stockholders? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6 X
7a Did the organization have members, stockholders, or other persons who had the power to elect or appoint
one or more members of the governing body? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7a X
b Are any governance decisions of the organization reserved to (or subject to approval by) members,
stockholders, or persons other than the governing body? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7b X
8 Did the organization contemporaneously document the meetings held or written actions undertaken during the year by the following:
a The governing body? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8a X
b Each committee with authority to act on behalf of the governing body? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8b X
9 Is there any officer, director, trustee, or key employee listed in Part VII, Section A, who cannot be reached at
the organization’s mailing address? If “Yes,” provide the names and addresses in Schedule O . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9 X
Section B. Policies (This Section B requests information about policies not required by the Internal Revenue Code.)
Yes No
10a Did the organization have local chapters, branches, or affiliates? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10a X
b If “Yes,” did the organization have written policies and procedures governing the activities of such chapters,
affiliates, and branches to ensure their operations are consistent with the organization's exempt purposes? . . . . . . . . . . . . . . . . . . . . . 10b
11a Has the organization provided a complete copy of this Form 990 to all members of its governing body before filing the form? . . . . 11a X
b Describe in Schedule O the process, if any, used by the organization to review this Form 990.
12a Did the organization have a written conflict of interest policy? If “No,” go to line 13 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12a X
b Were officers, directors, or trustees, and key employees required to disclose annually interests that could give rise to conflicts? . 12b X
c Did the organization regularly and consistently monitor and enforce compliance with the policy? If “Yes,”
describe in Schedule O how this was done . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12c X
13 Did the organization have a written whistleblower policy? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13 X
14 Did the organization have a written document retention and destruction policy? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14 X
15 Did the process for determining compensation of the following persons include a review and approval by
independent persons, comparability data, and contemporaneous substantiation of the deliberation and decision?
a The organization’s CEO, Executive Director, or top management official . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15a X
b Other officers or key employees of the organization . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15b X
If “Yes” to line 15a or 15b, describe the process in Schedule O (see instructions).
16a Did the organization invest in, contribute assets to, or participate in a joint venture or similar arrangement
with a taxable entity during the year? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16a X
b If “Yes,” did the organization follow a written policy or procedure requiring the organization to evaluate its
participation in joint venture arrangements under applicable federal tax law, and take steps to safeguard the
organization’s exempt status with respect to such arrangements? ............................................................... 16b
Section C. Disclosure
17 List the states with which a copy of this Form 990 is required to be filed None
..........................................................................
18 Section 6104 requires an organization to make its Forms 1023 (or 1024 if applicable), 990, and 990-T (Section 501(c)(3)s only)
available for public inspection. Indicate how you made these available. Check all that apply.
Own website X Another's website X Upon request Other (explain in Schedule O)
19 Describe in Schedule O whether (and if so, how) the organization made its governing documents, conflict of interest policy, and
financial statements available to the public during the tax year.
20 State the name, address, and telephone number of the person who possesses the organization's books and records:
Carty Yowell P.O. Box 914
Madison VA 22727 540-948-3295
DAA Form 990 (2017)
Form 990 (2017) Madison Free Clinic, Inc. 31-1654015 Page 7
Part VII Compensation of Officers, Directors, Trustees, Key Employees, Highest Compensated Employees, and
Independent Contractors
Check if Schedule O contains a response or note to any line in this Part VII . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Section A. Officers, Directors, Trustees, Key Employees, and Highest Compensated Employees
1a Complete this table for all persons required to be listed. Report compensation for the calendar year ending with or within the
organization's tax year.

List all of the organization's current officers, directors, trustees (whether individuals or organizations), regardless of amount of
compensation. Enter -0- in columns (D), (E), and (F) if no compensation was paid.

List all of the organization's current key employees, if any. See instructions for definition of "key employee."

List the organization's five current highest compensated employees (other than an officer, director, trustee, or key employee)
who received reportable compensation (Box 5 of Form W-2 and/or Box 7 of Form 1099-MISC) of more than $100,000 from the
organization and any related organizations.

List all of the organization's former officers, key employees, and highest compensated employees who received more than
$100,000 of reportable compensation from the organization and any related organizations.

List all of the organization’s former directors or trustees that received, in the capacity as a former director or trustee of the
organization, more than $10,000 of reportable compensation from the organization and any related organizations.
List persons in the following order: individual trustees or directors; institutional trustees; officers; key employees; highest
compensated employees; and former such persons.
Check this box if neither the organization nor any related organization compensated any current officer, director, or trustee.
(A) (B) (C) (D) (E) (F)
Name and Title Average Position Reportable Reportable Estimated
hours per (do not check more than one compensation compensation from amount of
week box, unless person is both an from related other
(list any officer and a director/trustee) the organizations compensation
hours for organization (W-2/1099-MISC) from the
or director
Individual trustee

Institutional trustee

Officer

Key employee
employee
Highest compensated
Former

related (W-2/1099-MISC) organization


organizations and related
below dotted organizations
line)

(1) Dr. Eve Bargmann


. .................................................. 5.00
Med Dir Secretary 0.00 X X 0 0 0
(2) Lydia Hansen
. .................................................. 5.00
Member 0.00 X 0 0 0
(3) Norris John
. .................................................. 5.00
Member 0.00 X 0 0 0
(4) Dr William Laffond
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5.00
..........
Member 0.00 X 0 0 0
(5) Frank Lewis
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5.00
..........
Member 0.00 X 0 0 0
(6) Carty Yowell
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5.00
..........
Treasurer 0.00 X X 0 0 0
(7) Aliya Wilson M.D.
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5.00
..........
Member 0.00 X 0 0 0
(8) Beverly Teel
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5.00
..........
President 0.00 X X 0 0 0
(9) Cindy Napier
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5.00
..........
Vice President 0.00 X X 0 0 0
(10) Brenda Clements
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .20.00
............
Executive Director 0.00 X 23,660 0 0
(11)
. ..................................................

DAA Form 990 (2017)


Form 990 (2017) Madison Free Clinic, Inc. 31-1654015 Page 8
Part VII Section A. Officers, Directors, Trustees, Key Employees, and Highest Compensated Employees (continued)
(A) (B) (C) (D) (E) (F)
Name and title Average Position Reportable Reportable Estimated
hours per (do not check more than one compensation compensation from amount of
week box, unless person is both an from related other
(list any officer and a director/trustee) the organizations compensation
hours for organization (W-2/1099-MISC) from the

or director
Individual trustee

Institutional trustee

Officer

Key employee

employee
Highest compensated
Former
related (W-2/1099-MISC) organization
organizations and related
below dotted organizations
line)

. ..................................................

. ..................................................

. ..................................................

. ..................................................

. ..................................................

. ..................................................

. ..................................................

. ..................................................

1b Sub-total . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23,660
c Total from continuation sheets to Part VII, Section A . . . . . . .
d Total (add lines 1b and 1c) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23,660
2 Total number of individuals (including but not limited to those listed above) who received more than $100,000 of
reportable compensation from the organization 0
Yes No
3 Did the organization list any former officer, director, or trustee, key employee, or highest compensated
employee on line 1a? If “Yes,” complete Schedule J for such individual . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 X
4 For any individual listed on line 1a, is the sum of reportable compensation and other compensation from the
organization and related organizations greater than $150,000? If “Yes,” complete Schedule J for such
individual . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4 X
5 Did any person listed on line 1a receive or accrue compensation from any unrelated organization or individual
for services rendered to the organization? If “Yes,” complete Schedule J for such person . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5 X
Section B. Independent Contractors
1 Complete this table for your five highest compensated independent contractors that received more than $100,000 of
compensation from the organization. Report compensation for the calendar year ending with or within the organization's tax year.
(A) (B) (C)
Name and business address Description of services Compensation

2 Total number of independent contractors (including but not limited to those listed above) who
received more than $100,000 of compensation from the organization 0
DAA Form 990 (2017)
Form 990 (2017) Madison Free Clinic, Inc. 31-1654015 Page 9
Part VIII Statement of Revenue
Check if Schedule O contains a response or note to any line in this Part VIII ....................................
(A) (B) (C) (D)
Total revenue Related or Unrelated Revenue
exempt business excluded from tax
function revenue under sections
revenue 512-514
Gifts, Grants
and Other Similar Amounts

1a Federated campaigns . . . . . 1a
b Membership dues . . . . . . . . . 1b
c Fundraising events . . . . . . . 1c 20,180
d Related organizations . . . . . 1d
Program Service Revenue Contributions,

e Government grants (contributions) . . 1e 15,115


f All other contributions, gifts, grants,
and similar amounts not included above 1f 93,614
g Noncash contributions included in lines 1a-1f: $ . . . . . . . . . . . . . . . . . . .
h Total. Add lines 1a–1f . . . . . . . . . . . . . . . . . . . . . . . . . . . . 128,909
Busn. Code
2a . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
b . ..........................................
c . ..........................................
d . ..........................................
e . ..........................................
f All other program service revenue . . . . . . . .
g Total. Add lines 2a–2f . . . . . . . . . . . . . . . . . . . . . . . . . . . .
3 Investment income (including dividends, interest,
and other similar amounts) . . . . . . . . . . . . . . . . . . . . . . . . 1,710 1,710
4 Income from investment of tax-exempt bond proceeds
5 Royalties . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
(i) Real (ii) Personal

6a Gross rents
b Less: rental exps.
c Rental inc. or (loss)
d Net rental income or (loss) ........................
7a Gross amount from (i) Securities (ii) Other
sales of assets
other than inventory
b Less: cost or other
basis & sales exps.
c Gain or (loss)
d Net gain or (loss) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
8a Gross income from fundraising events
Other Revenue

(not including $ . . . . . . . . . .20,180


.........
of contributions reported on line 1c).
See Part IV, line 18 . . . . . . . . . . . . . . a
b Less: direct expenses . . . . . . . . . b
c Net income or (loss) from fundraising events . . . . . .
9a Gross income from gaming activities.
See Part IV, line 19 . . . . . . . . . . . . . . a
b Less: direct expenses . . . . . . . . . b
c Net income or (loss) from gaming activities . . . . . . .
10a Gross sales of inventory, less
returns and allowances . . . . . . . a
b Less: cost of goods sold . . . . . . b
c Net income or (loss) from sales of inventory . . . . . . .
Miscellaneous Revenue Busn. Code

11a . . Miscellaneous
.........................................
900099 1,703 1,703
b ...........................................
c ...........................................
d All other revenue . . . . . . . . . . . . . . . . . . . . . . . . .
e Total. Add lines 11a–11d . . . . . . . . . . . . . . . . . . . . . . . . . 1,703
12 Total revenue. See instructions. . . . . . . . . . . . . . . . . . 132,322 1,703 0 1,710
Form 990 (2017)
DAA
Form 990 (2017) Madison Free Clinic, Inc. 31-1654015 Page 10
Part IX Statement of Functional Expenses
Section 501(c)(3) and 501(c)(4) organizations must complete all columns. All other organizations must complete column (A).
Check if Schedule O contains a response or note to any line in this Part IX . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
(A) (B) (C) (D)
Do not include amounts reported on lines 6b, Total expenses Program service Management and Fundraising
7b, 8b, 9b, and 10b of Part VIII. expenses general expenses expenses

1 Grants and other assistance to domestic organizations


and domestic governments. See Part IV, line 21 . . . . . . . .
2 Grants and other assistance to domestic
individuals. See Part IV, line 22 . . . . . . . . . . .
3 Grants and other assistance to foreign
organizations, foreign governments, and foreign
individuals. See Part IV, lines 15 and 16 . . . . . . . .
4 Benefits paid to or for members . . . . . . . . . . .
5 Compensation of current officers, directors,
trustees, and key employees . . . . . . . . . . . . . . 23,660 16,562 5,915 1,183
6 Compensation not included above, to disqualified
persons (as defined under section 4958(f)(1)) and
persons described in section 4958(c)(3)(B) . . . . .
7 Other salaries and wages ................. 18,424 12,897 4,606 921
8 Pension plan accruals and contributions (include
section 401(k) and 403(b) employer contributions)
9 Other employee benefits . . . . . . . . . . . . . . . . . .
10 Payroll taxes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3,242 2,269 811 162
11 Fees for services (non-employees):
a Management . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
b Legal . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
c Accounting . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 900 900
d Lobbying . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
e Professional fundraising services. See Part IV, line 17
f Investment management fees . . . . . . . . . . . . .
g Other. (If line 11g amount exceeds 10% of line 25, column
(A) amount, list line 11g expenses on Schedule O.) . . . . . . 766 766
12 Advertising and promotion . . . . . . . . . . . . . . . . 360 360
13 Office expenses . . . . . . . . . . . . . . . . . . . . . . . . . . 7,055 2,643 4,412
14 Information technology . . . . . . . . . . . . . . . . . . . .
15 Royalties . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
16 Occupancy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
17 Travel . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
18 Payments of travel or entertainment expenses
for any federal, state, or local public officials
19 Conferences, conventions, and meetings . 750 750
20 Interest . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
21 Payments to affiliates . . . . . . . . . . . . . . . . . . . . .
22 Depreciation, depletion, and amortization .
23 Insurance . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1,543 1,543
24 Other expenses. Itemize expenses not covered
above (List miscellaneous expenses in line 24e. If
line 24e amount exceeds 10% of line 25, column
(A) amount, list line 24e expenses on Schedule O.)
a . . Healthcare
......................................... 30,513 30,513
b . . Prescriptions
......................................... 20,413 20,413
c . . Management fees
......................................... 4,231 4,231
d . . Telephone
......................................... 2,406 2,406
e All other expenses . . . . . . . . . . . . . . . . . . . . . . . . 740 740
25 Total functional expenses. Add lines 1 through 24e . . . 115,003 90,417 17,908 6,678
26 Joint costs. Complete this line only if the
organization reported in column (B) joint costs
from a combined educational campaign and
fundraising solicitation. Check here if
following SOP 98-2 (ASC 958-720) . . . . . . . . . . . .
DAA Form 990 (2017)
Form 990 (2017) Madison Free Clinic, Inc. 31-1654015 Page 11
Part X Balance Sheet
Check if Schedule O contains a response or note to any line in this Part X ..........................................................
(A) (B)
Beginning of year End of year
1 Cash—non-interest bearing . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 125,292 1 140,982
2 Savings and temporary cash investments . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 46,315 2 46,431
3 Pledges and grants receivable, net . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3
4 Accounts receivable, net . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4
5 Loans and other receivables from current and former officers, directors,
trustees, key employees, and highest compensated employees.
Complete Part II of Schedule L . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5
6 Loans and other receivables from other disqualified persons (as defined under section
4958(f)(1)), persons described in section 4958(c)(3)(B), and contributing employers and
sponsoring organizations of section 501(c)(9) voluntary employees' beneficiary
organizations (see instructions). Complete Part II of Schedule L . . . . . . . . . . . . . . . . . . . . . 6
Assets

7 Notes and loans receivable, net . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7


8 Inventories for sale or use . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8
9 Prepaid expenses and deferred charges . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9
10a Land, buildings, and equipment: cost or
other basis. Complete Part VI of Schedule D . . . . . . . . 10a
b Less: accumulated depreciation . . . . . . . . . . . . . . . . . . . . . 10b 10c
11 Investments—publicly traded securities . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11
12 Investments—other securities. See Part IV, line 11 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25,595 12 27,108
13 Investments—program-related. See Part IV, line 11 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13
14 Intangible assets . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14
15 Other assets. See Part IV, line 11 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15
16 Total assets. Add lines 1 through 15 (must equal line 34) . . . . . . . . . . . . . . . . . . . . . . . . . . 197,202 16 214,521
17 Accounts payable and accrued expenses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17
18 Grants payable . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18
19 Deferred revenue . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19
20 Tax-exempt bond liabilities . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20
21 Escrow or custodial account liability. Complete Part IV of Schedule D . . . . . . . . . . . . . . . 21
22 Loans and other payables to current and former officers, directors,
Liabilities

trustees, key employees, highest compensated employees, and


disqualified persons. Complete Part II of Schedule L . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22
23 Secured mortgages and notes payable to unrelated third parties . . . . . . . . . . . . . . . . . . . . 23
24 Unsecured notes and loans payable to unrelated third parties . . . . . . . . . . . . . . . . . . . . . . . 24
25 Other liabilities (including federal income tax, payables to related third
parties, and other liabilities not included on lines 17-24). Complete Part X
of Schedule D . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25
26 Total liabilities. Add lines 17 through 25 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 0 26 0
Organizations that follow SFAS 117 (ASC 958), check here X and
Net Assets or Fund Balances

complete lines 27 through 29, and lines 33 and 34.


27 Unrestricted net assets . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 197,202 27 214,521
28 Temporarily restricted net assets . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 28
29 Permanently restricted net assets . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 29
Organizations that do not follow SFAS 117 (ASC 958), check here and
complete lines 30 through 34.
30 Capital stock or trust principal, or current funds . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30
31 Paid-in or capital surplus, or land, building, or equipment fund . . . . . . . . . . . . . . . . . . . . . . . 31
32 Retained earnings, endowment, accumulated income, or other funds . . . . . . . . . . . . . . . . 32
33 Total net assets or fund balances . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 197,202 33 214,521
34 Total liabilities and net assets/fund balances . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 197,202 34 214,521
Form 990 (2017)

DAA
Form 990 (2017) Madison Free Clinic, Inc. 31-1654015 Page 12
Part XI Reconciliation of Net Assets
Check if Schedule O contains a response or note to any line in this Part XI . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1 Total revenue (must equal Part VIII, column (A), line 12) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 132,322
2 Total expenses (must equal Part IX, column (A), line 25) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 115,003
3 Revenue less expenses. Subtract line 2 from line 1 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 17,319
4 Net assets or fund balances at beginning of year (must equal Part X, line 33, column (A)) . . . . . . . . . . . . . . . . . . . . . . . . . 4 197,202
5 Net unrealized gains (losses) on investments . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5
6 Donated services and use of facilities . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6
7 Investment expenses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7
8 Prior period adjustments . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8
9 Other changes in net assets or fund balances (explain in Schedule O) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9
10 Net assets or fund balances at end of year. Combine lines 3 through 9 (must equal Part X, line
33, column (B)) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10 214,521
Part XII Financial Statements and Reporting
Check if Schedule O contains a response or note to any line in this Part XII ...............................................
Yes No
1 Accounting method used to prepare the Form 990: X Cash Accrual Other
If the organization changed its method of accounting from a prior year or checked “Other,” explain in
Schedule O.
2a Were the organization's financial statements compiled or reviewed by an independent accountant? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2a X
If "Yes," check a box below to indicate whether the financial statements for the year were compiled or
reviewed on a separate basis, consolidated basis, or both:
X Separate basis Consolidated basis Both consolidated and separate basis
b Were the organization's financial statements audited by an independent accountant? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2b X
If "Yes," check a box below to indicate whether the financial statements for the year were audited on a
separate basis, consolidated basis, or both:
Separate basis Consolidated basis Both consolidated and separate basis
c If “Yes” to line 2a or 2b, does the organization have a committee that assumes responsibility for oversight
of the audit, review, or compilation of its financial statements and selection of an independent accountant? . . . . . . . . . . . . . . . . . . . . . 2c X
If the organization changed either its oversight process or selection process during the tax year, explain in
Schedule O.
3a As a result of a federal award, was the organization required to undergo an audit or audits as set forth in
the Single Audit Act and OMB Circular A-133? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3a X
b If “Yes,” did the organization undergo the required audit or audits? If the organization did not undergo the
required audit or audits, explain why in Schedule O and describe any steps taken to undergo such audits. . . . . . . . . . . . . . . . . . . . . . . . 3b
Form 990 (2017)

DAA
SCHEDULE A Public Charity Status and Public Support OMB No. 1545-0047
(Form 990 or 990-EZ)
Complete if the organization is a section 501(c)(3) organization or a section 4947(a)(1) nonexempt charitable trust.
2017
Department of the Treasury Attach to Form 990 or Form 990-EZ. Open to Public
Internal Revenue Service
Go to www.irs.gov/Form990 for instructions and the latest information. Inspection
Name of the organization Employer identification number
Madison Free Clinic, Inc. 31-1654015
Part I Reason for Public Charity Status (All organizations must complete this part.) See instructions.
The organization is not a private foundation because it is: (For lines 1 through 12, check only one box.)
1 A church, convention of churches, or association of churches described in section 170(b)(1)(A)(i).
2 A school described in section 170(b)(1)(A)(ii). (Attach Schedule E (Form 990 or 990-EZ).)
3 A hospital or a cooperative hospital service organization described in section 170(b)(1)(A)(iii).
4 A medical research organization operated in conjunction with a hospital described in section 170(b)(1)(A)(iii). Enter the hospital's name,
city, and state: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
5 An organization operated for the benefit of a college or university owned or operated by a governmental unit described in
section 170(b)(1)(A)(iv). (Complete Part II.)
6 A federal, state, or local government or governmental unit described in section 170(b)(1)(A)(v).
7 X An organization that normally receives a substantial part of its support from a governmental unit or from the general public
described in section 170(b)(1)(A)(vi). (Complete Part II.)
8 A community trust described in section 170(b)(1)(A)(vi). (Complete Part II.)
9 An agricultural research organization described in section 170(b)(1)(A)(ix) operated in conjunction with a land-grant college
or university or a non-land grant college of agriculture (see instructions). Enter the name, city, and state of the college or
university: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
10 An organization that normally receives: (1) more than 33 1/3% of its support from contributions, membership fees, and gross
receipts from activities related to its exempt functions—subject to certain exceptions, and (2) no more than 33 1/3% of its
support from gross investment income and unrelated business taxable income (less section 511 tax) from businesses
acquired by the organization after June 30, 1975. See section 509(a)(2). (Complete Part III.)
11 An organization organized and operated exclusively to test for public safety. See section 509(a)(4).
12 An organization organized and operated exclusively for the benefit of, to perform the functions of, or to carry out the purposes
of one or more publicly supported organizations described in section 509(a)(1) or section 509(a)(2). See section 509(a)(3).
Check the box in lines 12a through 12d that describes the type of supporting organization and complete lines 12e, 12f, and 12g.
a Type I. A supporting organization operated, supervised, or controlled by its supported organization(s), typically by giving
the supported organization(s) the power to regularly appoint or elect a majority of the directors or trustees of the
supporting organization. You must complete Part IV, Sections A and B.
b Type II. A supporting organization supervised or controlled in connection with its supported organization(s), by having
control or management of the supporting organization vested in the same persons that control or manage the supported
organization(s). You must complete Part IV, Sections A and C.
c Type III functionally integrated. A supporting organization operated in connection with, and functionally integrated with,
its supported organization(s) (see instructions). You must complete Part IV, Sections A, D, and E.
d Type III non-functionally integrated. A supporting organization operated in connection with its supported organization(s)
that is not functionally integrated. The organization generally must satisfy a distribution requirement and an attentiveness
requirement (see instructions). You must complete Part IV, Sections A and D, and Part V.
e Check this box if the organization received a written determination from the IRS that it is a Type I, Type II, Type III
functionally integrated, or Type III non-functionally integrated supporting organization.
f Enter the number of supported organizations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
g Provide the following information about the supported organization(s).
(i) Name of supported (ii) EIN (iii) Type of organization (iv) Is the organization (v) Amount of monetary (vi) Amount of
organization (described on lines 1–10 listed in your governing support (see other support (see
above (see instructions)) document? instructions) instructions)
Yes No

(A)

(B)

(C)

(D)

(E)

Total
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ. Schedule A (Form 990 or 990-EZ) 2017

DAA
Schedule A (Form 990 or 990-EZ) 2017 Madison Free Clinic, Inc. 31-1654015 Page 2
Part II Support Schedule for Organizations Described in Sections 170(b)(1)(A)(iv) and 170(b)(1)(A)(vi)
(Complete only if you checked the box on line 5, 7, or 8 of Part I or if the organization failed to qualify under
Part III. If the organization fails to qualify under the tests listed below, please complete Part III.)
Section A. Public Support
Calendar year (or fiscal year beginning in) (a) 2013 (b) 2014 (c) 2015 (d) 2016 (e) 2017 (f) Total

1 Gifts, grants, contributions, and


membership fees received. (Do not
include any "unusual grants.") . . . . . . . . 126,547 122,321 122,207 74,834 128,909 574,818

2 Tax revenues levied for the


organization's benefit and either paid
to or expended on its behalf . . . . . . . . . .

3 The value of services or facilities


furnished by a governmental unit to the
organization without charge . . . . . . . . . .
4 Total. Add lines 1 through 3 . . . . . . . . . . 126,547 122,321 122,207 74,834 128,909 574,818
5 The portion of total contributions by
each person (other than a
governmental unit or publicly
supported organization) included on
line 1 that exceeds 2% of the amount
shown on line 11, column (f) . . . . . . . . . . 8,327
6 Public support. Subtract line 5 from line 4. 566,491
Section B. Total Support
Calendar year (or fiscal year beginning in) (a) 2013 (b) 2014 (c) 2015 (d) 2016 (e) 2017 (f) Total
7 Amounts from line 4 . . . . . . . . . . . . . . . . . . 126,547 122,321 122,207 74,834 128,909 574,818
8 Gross income from interest, dividends,
payments received on securities loans,
rents, royalties, and income from
similar sources . . . . . . . . . . . . . . . . . . . . . . . 100 47 54 677 1,710 2,588

9 Net income from unrelated business


activities, whether or not the business
is regularly carried on . . . . . . . . . . . . . . . . .
10 Other income. Do not include gain or
loss from the sale of capital assets
(Explain in Part VI.) . . . . . . . . . . . . . . . . . . . 598 1,990 3,649 6,237
11 Total support. Add lines 7 through 10 583,643
12 Gross receipts from related activities, etc. (see instructions) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12 1,703
13 First five years. If the Form 990 is for the organization’s first, second, third, fourth, or fifth tax year as a section 501(c)(3)
organization, check this box and stop here . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Section C. Computation of Public Support Percentage
14 Public support percentage for 2017 (line 6, column (f) divided by line 11, column (f)) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14 97.06 %
15 Public support percentage from 2016 Schedule A, Part II, line 14 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15 97.93 %
16a 33 1/3% support test—2017. If the organization did not check the box on line 13, and line 14 is 33 1/3% or more, check this
box and stop here. The organization qualifies as a publicly supported organization . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . X
b 33 1/3% support test—2016. If the organization did not check a box on line 13 or 16a, and line 15 is 33 1/3% or more, check
this box and stop here. The organization qualifies as a publicly supported organization . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
17a 10%-facts-and-circumstances test—2017. If the organization did not check a box on line 13, 16a, or 16b, and line 14 is
10% or more, and if the organization meets the "facts-and-circumstances" test, check this box and stop here. Explain in
Part VI how the organization meets the "facts-and-circumstances" test. The organization qualifies as a publicly supported
organization . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
b 10%-facts-and-circumstances test—2016. If the organization did not check a box on line 13, 16a, 16b, or 17a, and line
15 is 10% or more, and if the organization meets the "facts-and-circumstances" test, check this box and stop here.
Explain in Part VI how the organization meets the "facts-and-circumstances" test. The organization qualifies as a publicly
supported organization . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
18 Private foundation. If the organization did not check a box on line 13, 16a, 16b, 17a, or 17b, check this box and see
instructions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Schedule A (Form 990 or 990-EZ) 2017

DAA
Schedule A (Form 990 or 990-EZ) 2017 Madison Free Clinic, Inc. 31-1654015 Page 3
Part III Support Schedule for Organizations Described in Section 509(a)(2)
(Complete only if you checked the box on line 10 of Part I or if the organization failed to qualify under Part II.
If the organization fails to qualify under the tests listed below, please complete Part II.)
Section A. Public Support
Calendar year (or fiscal year beginning in) (a) 2013 (b) 2014 (c) 2015 (d) 2016 (e) 2017 (f) Total
1 Gifts, grants, contributions, and membership
fees received. (Do not include any "unusual grants.") .
2 Gross receipts from admissions, merchandise
sold or services performed, or facilities
furnished in any activity that is related to the
organization’s tax-exempt purpose . . . . . . . .
3 Gross receipts from activities that are not an
unrelated trade or business under section 513
4 Tax revenues levied for the
organization's benefit and either paid
to or expended on its behalf . . . . . . . . . .
5 The value of services or facilities
furnished by a governmental unit to the
organization without charge . . . . . . . . . .
6 Total. Add lines 1 through 5 ..........
7a Amounts included on lines 1, 2, and 3
received from disqualified persons . . . .
b Amounts included on lines 2 and 3
received from other than disqualified
persons that exceed the greater of $5,000
or 1% of the amount on line 13 for the year .
c Add lines 7a and 7b . . . . . . . . . . . . . . . . . .
8 Public support. (Subtract line 7c from
line 6.) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Section B. Total Support
Calendar year (or fiscal year beginning in) (a) 2013 (b) 2014 (c) 2015 (d) 2016 (e) 2017 (f) Total
9 Amounts from line 6 ..................
10a Gross income from interest, dividends,
payments received on securities loans, rents,
royalties, and income from similar sources .
b Unrelated business taxable income (less
section 511 taxes) from businesses
acquired after June 30, 1975 . . . . . . . . .

c Add lines 10a and 10b . . . . . . . . . . . . . . . .

11 Net income from unrelated business


activities not included in line 10b, whether
or not the business is regularly carried on . .
12 Other income. Do not include gain or
loss from the sale of capital assets
(Explain in Part VI.) . . . . . . . . . . . . . . . . . . .
13 Total support. (Add lines 9, 10c, 11,
and 12.) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
14 First five years. If the Form 990 is for the organization’s first, second, third, fourth, or fifth tax year as a section 501(c)(3)
organization, check this box and stop here . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Section C. Computation of Public Support Percentage
15 Public support percentage for 2017 (line 8, column (f) divided by line 13, column (f)) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15 %
16 Public support percentage from 2016 Schedule A, Part III, line 15 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16 %
Section D. Computation of Investment Income Percentage
17 Investment income percentage for 2017 (line 10c, column (f) divided by line 13, column (f)) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17 %
18 Investment income percentage from 2016 Schedule A, Part III, line 17 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18 %
19a 33 1/3% support tests—2017. If the organization did not check the box on line 14, and line 15 is more than 33 1/3%, and line
17 is not more than 33 1/3%, check this box and stop here. The organization qualifies as a publicly supported organization . . . . . . . . . . . . . . . .
b 33 1/3% support tests—2016. If the organization did not check a box on line 14 or line 19a, and line 16 is more than 33 1/3%, and
line 18 is not more than 33 1/3%, check this box and stop here. The organization qualifies as a publicly supported organization . . . . . . . . . . . .
20 Private foundation. If the organization did not check a box on line 14, 19a, or 19b, check this box and see instructions . . . . . . . . . . . . . . . . . . . .
Schedule A (Form 990 or 990-EZ) 2017
DAA
Schedule A (Form 990 or 990-EZ) 2017 Madison Free Clinic, Inc. 31-1654015 Page 4
Part IV Supporting Organizations
(Complete only if you checked a box in line 12 on Part I. If you checked 12a of Part I, complete Sections A
and B. If you checked 12b of Part I, complete Sections A and C. If you checked 12c of Part I, complete
Sections A, D, and E. If you checked 12d of Part I, complete Sections A and D, and complete Part V.)
Section A. All Supporting Organizations
Yes No
1 Are all of the organization’s supported organizations listed by name in the organization’s governing
documents? If "No," describe in Part VI how the supported organizations are designated. If designated by
class or purpose, describe the designation. If historic and continuing relationship, explain. 1
2 Did the organization have any supported organization that does not have an IRS determination of status
under section 509(a)(1) or (2)? If "Yes," explain in Part VI how the organization determined that the supported
organization was described in section 509(a)(1) or (2). 2
3a Did the organization have a supported organization described in section 501(c)(4), (5), or (6)? If "Yes," answer
(b) and (c) below. 3a
b Did the organization confirm that each supported organization qualified under section 501(c)(4), (5), or (6) and
satisfied the public support tests under section 509(a)(2)? If "Yes," describe in Part VI when and how the
organization made the determination. 3b
c Did the organization ensure that all support to such organizations was used exclusively for section 170(c)(2)(B)
purposes? If "Yes," explain in Part VI what controls the organization put in place to ensure such use. 3c
4a Was any supported organization not organized in the United States ("foreign supported organization")? If
"Yes," and if you checked 12a or 12b in Part I, answer (b) and (c) below. 4a
b Did the organization have ultimate control and discretion in deciding whether to make grants to the foreign
supported organization? If "Yes," describe in Part VI how the organization had such control and discretion
despite being controlled or supervised by or in connection with its supported organizations. 4b
c Did the organization support any foreign supported organization that does not have an IRS determination
under sections 501(c)(3) and 509(a)(1) or (2)? If "Yes," explain in Part VI what controls the organization used
to ensure that all support to the foreign supported organization was used exclusively for section 170(c)(2)(B)
purposes. 4c
5a Did the organization add, substitute, or remove any supported organizations during the tax year? If "Yes,"
answer (b) and (c) below (if applicable). Also, provide detail in Part VI, including (i) the names and EIN
numbers of the supported organizations added, substituted, or removed; (ii) the reasons for each such action;
(iii) the authority under the organization's organizing document authorizing such action; and (iv) how the action
was accomplished (such as by amendment to the organizing document). 5a
b Type I or Type II only. Was any added or substituted supported organization part of a class already
designated in the organization's organizing document? 5b
c Substitutions only. Was the substitution the result of an event beyond the organization's control? 5c
6 Did the organization provide support (whether in the form of grants or the provision of services or facilities) to
anyone other than (i) its supported organizations, (ii) individuals that are part of the charitable class benefited
by one or more of its supported organizations, or (iii) other supporting organizations that also support or
benefit one or more of the filing organization’s supported organizations? If "Yes," provide detail in Part VI. 6
7 Did the organization provide a grant, loan, compensation, or other similar payment to a substantial contributor
(defined in section 4958(c)(3)(C)), a family member of a substantial contributor, or a 35% controlled entity with
regard to a substantial contributor? If "Yes," complete Part I of Schedule L (Form 990 or 990-EZ). 7
8 Did the organization make a loan to a disqualified person (as defined in section 4958) not described in line 7?
If "Yes," complete Part I of Schedule L (Form 990 or 990-EZ). 8
9a Was the organization controlled directly or indirectly at any time during the tax year by one or more
disqualified persons as defined in section 4946 (other than foundation managers and organizations described
in section 509(a)(1) or (2))? If "Yes," provide detail in Part VI. 9a
b Did one or more disqualified persons (as defined in line 9a) hold a controlling interest in any entity in which
the supporting organization had an interest? If "Yes," provide detail in Part VI. 9b
c Did a disqualified person (as defined in line 9a) have an ownership interest in, or derive any personal benefit
from, assets in which the supporting organization also had an interest? If "Yes," provide detail in Part VI. 9c
10a Was the organization subject to the excess business holdings rules of section 4943 because of section
4943(f) (regarding certain Type II supporting organizations, and all Type III non-functionally integrated
supporting organizations)? If "Yes," answer 10b below. 10a
b Did the organization have any excess business holdings in the tax year? (Use Schedule C, Form 4720, to
determine whether the organization had excess business holdings.) 10b
Schedule A (Form 990 or 990-EZ) 2017

DAA
Schedule A (Form 990 or 990-EZ) 2017 Madison Free Clinic, Inc. 31-1654015 Page 5
Part IV Supporting Organizations (continued)
Yes No
11 Has the organization accepted a gift or contribution from any of the following persons?
a A person who directly or indirectly controls, either alone or together with persons described in (b) and (c)
below, the governing body of a supported organization? 11a
b A family member of a person described in (a) above? 11b
c A 35% controlled entity of a person described in (a) or (b) above? If "Yes" to a, b, or c, provide detail in Part VI. 11c
Section B. Type I Supporting Organizations
Yes No
1 Did the directors, trustees, or membership of one or more supported organizations have the power to
regularly appoint or elect at least a majority of the organization’s directors or trustees at all times during the
tax year? If "No," describe in Part VI how the supported organization(s) effectively operated, supervised, or
controlled the organization’s activities. If the organization had more than one supported organization,
describe how the powers to appoint and/or remove directors or trustees were allocated among the supported
organizations and what conditions or restrictions, if any, applied to such powers during the tax year. 1
2 Did the organization operate for the benefit of any supported organization other than the supported
organization(s) that operated, supervised, or controlled the supporting organization? If "Yes," explain in Part
VI how providing such benefit carried out the purposes of the supported organization(s) that operated,
supervised, or controlled the supporting organization. 2
Section C. Type II Supporting Organizations
Yes No
1 Were a majority of the organization’s directors or trustees during the tax year also a majority of the directors
or trustees of each of the organization’s supported organization(s)? If "No," describe in Part VI how control
or management of the supporting organization was vested in the same persons that controlled or managed
the supported organization(s). 1
Section D. All Type III Supporting Organizations
Yes No
1 Did the organization provide to each of its supported organizations, by the last day of the fifth month of the
organization’s tax year, (i) a written notice describing the type and amount of support provided during the prior tax
year, (ii) a copy of the Form 990 that was most recently filed as of the date of notification, and (iii) copies of the
organization’s governing documents in effect on the date of notification, to the extent not previously provided? 1
2 Were any of the organization’s officers, directors, or trustees either (i) appointed or elected by the supported
organization(s) or (ii) serving on the governing body of a supported organization? If "No," explain in Part VI how
the organization maintained a close and continuous working relationship with the supported organization(s). 2
3 By reason of the relationship described in (2), did the organization’s supported organizations have a
significant voice in the organization’s investment policies and in directing the use of the organization’s
income or assets at all times during the tax year? If "Yes," describe in Part VI the role the organization’s
supported organizations played in this regard. 3
Section E. Type III Functionally-Integrated Supporting Organizations
1 Check the box next to the method that the organization used to satisfy the Integral Part Test during the year (see instructions).
a The organization satisfied the Activities Test. Complete line 2 below.
b The organization is the parent of each of its supported organizations. Complete line 3 below.
c The organization supported a governmental entity. Describe in Part VI how you supported a government entity (see instructions).

2 Activities Test. Answer (a) and (b) below. Yes No


a Did substantially all of the organization’s activities during the tax year directly further the exempt purposes of
the supported organization(s) to which the organization was responsive? If "Yes," then in Part VI identify
those supported organizations and explain how these activities directly furthered their exempt purposes,
how the organization was responsive to those supported organizations, and how the organization determined
that these activities constituted substantially all of its activities. 2a
b Did the activities described in (a) constitute activities that, but for the organization’s involvement, one or more
of the organization’s supported organization(s) would have been engaged in? If "Yes," explain in Part VI the
reasons for the organization’s position that its supported organization(s) would have engaged in these
activities but for the organization’s involvement. 2b
3 Parent of Supported Organizations. Answer (a) and (b) below.
a Did the organization have the power to regularly appoint or elect a majority of the officers, directors, or
trustees of each of the supported organizations? Provide details in Part VI. 3a
b Did the organization exercise a substantial degree of direction over the policies, programs, and activities of each
of its supported organizations? If "Yes," describe in Part VI the role played by the organization in this regard. 3b
DAA Schedule A (Form 990 or 990-EZ) 2017
Schedule A (Form 990 or 990-EZ) 2017 Madison Free Clinic, Inc. 31-1654015 Page 6
Part V Type III Non-Functionally Integrated 509(a)(3) Supporting Organizations
1 Check here if the organization satisfied the Integral Part Test as a qualifying trust on Nov. 20, 1970 (explain in Part VI).See
instructions. All other Type III non-functionally integrated supporting organizations must complete Sections A through E.
(B) Current Year
Section A - Adjusted Net Income (A) Prior Year
(optional)
1 Net short-term capital gain 1
2 Recoveries of prior-year distributions 2
3 Other gross income (see instructions) 3
4 Add lines 1 through 3. 4
5 Depreciation and depletion 5
6 Portion of operating expenses paid or incurred for production or
collection of gross income or for management, conservation, or
maintenance of property held for production of income (see instructions) 6
7 Other expenses (see instructions) 7
8 Adjusted Net Income (subtract lines 5, 6 and 7 from line 4). 8
(B) Current Year
Section B - Minimum Asset Amount (A) Prior Year
(optional)
1 Aggregate fair market value of all non-exempt-use assets (see
instructions for short tax year or assets held for part of year):
a Average monthly value of securities 1a
b Average monthly cash balances 1b
c Fair market value of other non-exempt-use assets 1c
d Total (add lines 1a, 1b, and 1c) 1d
e Discount claimed for blockage or other
factors (explain in detail in Part VI):
2 Acquisition indebtedness applicable to non-exempt-use assets 2
3 Subtract line 2 from line 1d. 3
4 Cash deemed held for exempt use. Enter 1-1/2% of line 3 (for greater amount,
see instructions). 4
5 Net value of non-exempt-use assets (subtract line 4 from line 3) 5
6 Multiply line 5 by .035. 6
7 Recoveries of prior-year distributions 7
8 Minimum Asset Amount (add line 7 to line 6) 8
Section C - Distributable Amount Current Year

1 Adjusted net income for prior year (from Section A, line 8, Column A) 1
2 Enter 85% of line 1. 2
3 Minimum asset amount for prior year (from Section B, line 8, Column A) 3
4 Enter greater of line 2 or line 3. 4
5 Income tax imposed in prior year 5
6 Distributable Amount. Subtract line 5 from line 4, unless subject to
emergency temporary reduction (see instructions). 6
7 Check here if the current year is the organization's first as a non-functionally integrated Type III supporting organization (see
instructions).
Schedule A (Form 990 or 990-EZ) 2017

DAA
Schedule A (Form 990 or 990-EZ) 2017 Madison Free Clinic, Inc. 31-1654015 Page 7
Part V Type III Non-Functionally Integrated 509(a)(3) Supporting Organizations (continued)
Section D - Distributions Current Year
1 Amounts paid to supported organizations to accomplish exempt purposes
2 Amounts paid to perform activity that directly furthers exempt purposes of supported
organizations, in excess of income from activity
3 Administrative expenses paid to accomplish exempt purposes of supported organizations
4 Amounts paid to acquire exempt-use assets
5 Qualified set-aside amounts (prior IRS approval required)
6 Other distributions (describe in Part VI). See instructions.
7 Total annual distributions. Add lines 1 through 6.
8 Distributions to attentive supported organizations to which the organization is responsive
(provide details in Part VI). See instructions.
9 Distributable amount for 2017 from Section C, line 6
10 Line 8 amount divided by line 9 amount
(i) (ii) (iii)
Section E - Distribution Allocations (see instructions) Excess Distributions Underdistributions Distributable
Pre-2017 Amount for 2017
1 Distributable amount for 2017 from Section C, line 6
2 Underdistributions, if any, for years prior to 2017
(reasonable cause required-explain in Part VI). See
instructions.
3 Excess distributions carryover, if any, to 2017:
a
b From 2013
c From 2014 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
d From 2015 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
e From 2016 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
f Total of lines 3a through e
g Applied to underdistributions of prior years
h Applied to 2017 distributable amount
i Carryover from 2012 not applied (see instructions)
j Remainder. Subtract lines 3g, 3h, and 3i from 3f.
4 Distributions for 2017 from
Section D, line 7: $
a Applied to underdistributions of prior years
b Applied to 2017 distributable amount
c Remainder. Subtract lines 4a and 4b from 4.
5 Remaining underdistributions for years prior to 2017, if
any. Subtract lines 3g and 4a from line 2. For result
greater than zero, explain in Part VI. See instructions.
6 Remaining underdistributions for 2017. Subtract lines 3h
and 4b from line 1. For result greater than zero, explain in
Part VI. See instructions.
7 Excess distributions carryover to 2018. Add lines 3j
and 4c.
8 Breakdown of line 7:
a Excess from 2013
b Excess from 2014 . . . . . . . . . . . . . . . . . . . . . . .
c Excess from 2015 . . . . . . . . . . . . . . . . . . . . . . . .
d Excess from 2016 . . . . . . . . . . . . . . . . . . . . . . . .
e Excess from 2017 . . . . . . . . . . . . . . . . . . . . . . . .
Schedule A (Form 990 or 990-EZ) 2017

DAA
Schedule A (Form 990 or 990-EZ) 2017 Madison Free Clinic, Inc. 31-1654015 Page 8
Part VI Supplemental Information. Provide the explanations required by Part II, line 10; Part II, line 17a or 17b; Part
III, line 12; Part IV, Section A, lines 1, 2, 3b, 3c, 4b, 4c, 5a, 6, 9a, 9b, 9c, 11a, 11b, and 11c; Part IV, Section
B, lines 1 and 2; Part IV, Section C, line 1; Part IV, Section D, lines 2 and 3; Part IV, Section E, lines 1c, 2a, 2b,
3a and 3b; Part V, line 1; Part V, Section B, line 1e; Part V, Section D, lines 5, 6, and 8; and Part V, Section E,
lines 2, 5, and 6. Also complete this part for any additional information. (See instructions.)

. Part II, Line 10 - Other Income Detail


..........................................................................................................................................................

. Miscellaneous Income $ 6,237


..........................................................................................................................................................

. ..........................................................................................................................................................

. Supplemental Information
..........................................................................................................................................................

. 2016 was a short-year 1/1/17 - 6/30/17, due to a change in accounting


..........................................................................................................................................................

. period.
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. ..........................................................................................................................................................

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. ..........................................................................................................................................................

DAA Schedule A (Form 990 or 990-EZ) 2017


Schedule B Schedule of Contributors OMB No. 1545-0047
(Form 990, 990-EZ,
or 990-PF)
Department of the Treasury
Internal Revenue Service
Attach to Form 990, Form 990-EZ, or Form 990-PF.
Go to www.irs.gov/Form990 for the latest information.
2017
Name of the organization Employer identification number

Madison Free Clinic, Inc. 31-1654015


Organization type (check one):

Filers of: Section:

Form 990 or 990-EZ X 501(c)( 3 ) (enter number) organization

4947(a)(1) nonexempt charitable trust not treated as a private foundation

527 political organization

Form 990-PF 501(c)(3) exempt private foundation

4947(a)(1) nonexempt charitable trust treated as a private foundation

501(c)(3) taxable private foundation

Check if your organization is covered by the General Rule or a Special Rule.


Note: Only a section 501(c)(7), (8), or (10) organization can check boxes for both the General Rule and a Special Rule. See
instructions.

General Rule

For an organization filing Form 990, 990-EZ, or 990-PF that received, during the year, contributions totaling $5,000
or more (in money or property) from any one contributor. Complete Parts I and II. See instructions for determining a
contributor's total contributions.

Special Rules

X For an organization described in section 501(c)(3) filing Form 990 or 990-EZ that met the 331/3% support test of the
regulations under sections 509(a)(1) and 170(b)(1)(A)(vi), that checked Schedule A (Form 990 or 990-EZ), Part II, line
13, 16a, or 16b, and that received from any one contributor, during the year, total contributions of the greater of (1)
$5,000; or (2) 2% of the amount on (i) Form 990, Part VIII, line 1h; or (ii) Form 990-EZ, line 1. Complete Parts I and II.

For an organization described in section 501(c)(7), (8), or (10) filing Form 990 or 990-EZ that received from any one
contributor, during the year, total contributions of more than $1,000 exclusively for religious, charitable, scientific,
literary, or educational purposes, or for the prevention of cruelty to children or animals. Complete Parts I, II, and III.

For an organization described in section 501(c)(7), (8), or (10) filing Form 990 or 990-EZ that received from any one
contributor, during the year, contributions exclusively for religious, charitable, etc., purposes, but no such
contributions totaled more than $1,000. If this box is checked, enter here the total contributions that were received
during the year for an exclusively religious, charitable, etc., purpose. Don't complete any of the parts unless the
General Rule applies to this organization because it received nonexclusively religious, charitable, etc., contributions
totaling $5,000 or more during the year . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ .........................

Caution: An organization that isn't covered by the General Rule and/or the Special Rules doesn't file Schedule B (Form 990,
990-EZ, or 990-PF), but it must answer “No” on Part IV, line 2, of its Form 990; or check the box on line H of its Form 990-EZ or on its
Form 990-PF, Part I, line 2, to certify that it doesn't meet the filing requirements of Schedule B (Form 990, 990-EZ, or 990-PF).

For Paperwork Reduction Act Notice, see the instructions for Form 990, 990-EZ, or 990-PF. Schedule B (Form 990, 990-EZ, or 990-PF) (2017)

DAA
Schedule B (Form 990, 990-EZ, or 990-PF) (2017) Page 1 of 1 Page 2
Name of organization Employer identification number
Madison Free Clinic, Inc. 31-1654015
Part I Contributors (see instructions). Use duplicate copies of Part I if additional space is needed.
(a) (b) (c) (d)
No. Name, address, and ZIP + 4 Total contributions Type of contribution

1
. ..... Virginia Association of Free Clinics
. ....................................................................... Person X
PO Box 35720 Payroll
. ....................................................................... $ 48,452
......................... Noncash
. North
. . . . . . . . . . . . .Chesterfield
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .VA
. . . . . . 23235
................... (Complete Part II for
noncash contributions.)

(a) (b) (c) (d)


No. Name, address, and ZIP + 4 Total contributions Type of contribution

2
. ..... Lea Browning
. ....................................................................... Person X
16 Hughes River Road Payroll
. ....................................................................... $ 20,000
......................... Noncash
. Etlan
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .VA
. . . . . . 22719
................... (Complete Part II for
noncash contributions.)

(a) (b) (c) (d)


No. Name, address, and ZIP + 4 Total contributions Type of contribution

3
. ..... Virginia Health Care Foundation
. ....................................................................... Person X
707 East Main Street Suite 1350 Payroll
. ....................................................................... $ 11,965
......................... Noncash
. Richmond
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .VA
. . . . . . 23219
................... (Complete Part II for
noncash contributions.)

(a) (b) (c) (d)


No. Name, address, and ZIP + 4 Total contributions Type of contribution

. ..... . ....................................................................... Person


Payroll
. ....................................................................... $ ......................... Noncash
. ....................................................................... (Complete Part II for
noncash contributions.)

(a) (b) (c) (d)


No. Name, address, and ZIP + 4 Total contributions Type of contribution

. ..... . ....................................................................... Person


Payroll
. ....................................................................... $ ......................... Noncash
. ....................................................................... (Complete Part II for
noncash contributions.)

(a) (b) (c) (d)


No. Name, address, and ZIP + 4 Total contributions Type of contribution

. ..... . ....................................................................... Person


Payroll
. ....................................................................... $ ......................... Noncash
. ....................................................................... (Complete Part II for
noncash contributions.)

Schedule B (Form 990, 990-EZ, or 990-PF) (2017)


DAA
SCHEDULE D Supplemental Financial Statements OMB No. 1545-0047
(Form 990)
Department of the Treasury
Complete if the organization answered “Yes” on Form 990,
Part IV, line 6, 7, 8, 9, 10, 11a, 11b, 11c, 11d, 11e, 11f, 12a, or 12b.
Attach to Form 990.
2017
Open to Public
Internal Revenue Service Go to www.irs.gov/Form990 for instructions and the latest information. Inspection
Name of the organization Employer identification number

Madison Free Clinic, Inc. 31-1654015


Part I Organizations Maintaining Donor Advised Funds or Other Similar Funds or Accounts.
Complete if the organization answered “Yes” on Form 990, Part IV, line 6.
(a) Donor advised funds (b) Funds and other accounts

1 Total number at end of year . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .


2 Aggregate value of contributions to (during year) . . . . . . . . . . . . . . . . . .
3 Aggregate value of grants from (during year) . . . . . . . . . . . . . . . . . . . . . .
4 Aggregate value at end of year . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
5 Did the organization inform all donors and donor advisors in writing that the assets held in donor advised
funds are the organization’s property, subject to the organization’s exclusive legal control? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Yes No
6 Did the organization inform all grantees, donors, and donor advisors in writing that grant funds can be used
only for charitable purposes and not for the benefit of the donor or donor advisor, or for any other purpose
conferring impermissible private benefit? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Yes No
Part II Conservation Easements.
Complete if the organization answered “Yes” on Form 990, Part IV, line 7.
1 Purpose(s) of conservation easements held by the organization (check all that apply).
Preservation of land for public use (e.g., recreation or education) Preservation of a historically important land area
Protection of natural habitat Preservation of a certified historic structure
Preservation of open space
2 Complete lines 2a through 2d if the organization held a qualified conservation contribution in the form of a conservation
easement on the last day of the tax year. Held at the End of the Tax Year
a Total number of conservation easements . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2a
b Total acreage restricted by conservation easements . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2b
c Number of conservation easements on a certified historic structure included in (a) . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2c
d Number of conservation easements included in (c) acquired after 7/25/06, and not on a
historic structure listed in the National Register . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2d
3 Number of conservation easements modified, transferred, released, extinguished, or terminated by the organization during the
tax year ..............
4 Number of states where property subject to conservation easement is located . . . . . .
5 Does the organization have a written policy regarding the periodic monitoring, inspection, handling of
violations, and enforcement of the conservation easements it holds? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Yes No
6 Staff and volunteer hours devoted to monitoring, inspecting, handling of violations, and enforcing conservation easements during the year
...............
7 Amount of expenses incurred in monitoring, inspecting, handling of violations, and enforcing conservation easements during the year
$.........................
8 Does each conservation easement reported on line 2(d) above satisfy the requirements of section 170(h)(4)(B)(i)
and section 170(h)(4)(B)(ii)? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Yes No
9 In Part XIII, describe how the organization reports conservation easements in its revenue and expense statement, and
balance sheet, and include, if applicable, the text of the footnote to the organization’s financial statements that describes the
organization’s accounting for conservation easements.
Part III Organizations Maintaining Collections of Art, Historical Treasures, or Other Similar Assets.
Complete if the organization answered “Yes” on Form 990, Part IV, line 8.
1a If the organization elected, as permitted under SFAS 116 (ASC 958), not to report in its revenue statement and balance sheet
works of art, historical treasures, or other similar assets held for public exhibition, education, or research in furtherance of
public service, provide, in Part XIII, the text of the footnote to its financial statements that describes these items.
b If the organization elected, as permitted under SFAS 116 (ASC 958), to report in its revenue statement and balance sheet
works of art, historical treasures, or other similar assets held for public exhibition, education, or research in furtherance of
public service, provide the following amounts relating to these items:
(i) Revenue included on Form 990, Part VIII, line 1 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ .........................
(ii) Assets included in Form 990, Part X . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ .........................
2 If the organization received or held works of art, historical treasures, or other similar assets for financial gain, provide the
following amounts required to be reported under SFAS 116 (ASC 958) relating to these items:
a Revenue included on Form 990, Part VIII, line 1 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ .........................
b Assets included in Form 990, Part X . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $
For Paperwork Reduction Act Notice, see the Instructions for Form 990. Schedule D (Form 990) 2017
DAA
Schedule D (Form 990) 2017 Madison Free Clinic, Inc. 31-1654015 Page 2
Part III Organizations Maintaining Collections of Art, Historical Treasures, or Other Similar Assets (continued)
3 Using the organization’s acquisition, accession, and other records, check any of the following that are a significant use of its
collection items (check all that apply):
a Public exhibition d Loan or exchange programs
b Scholarly research e Other . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
c Preservation for future generations
4 Provide a description of the organization’s collections and explain how they further the organization’s exempt purpose in Part
XIII.
5 During the year, did the organization solicit or receive donations of art, historical treasures, or other similar
assets to be sold to raise funds rather than to be maintained as part of the organization’s collection? . . . . . . . . . . . . . . . . . . . . . . . . . . . . Yes No
Part IV Escrow and Custodial Arrangements.
Complete if the organization answered "Yes" on Form 990, Part IV, line 9, or reported an amount on Form
990, Part X, line 21.
1a Is the organization an agent, trustee, custodian or other intermediary for contributions or other assets not
included on Form 990, Part X? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Yes No
b If “Yes,” explain the arrangement in Part XIII and complete the following table:
Amount
c Beginning balance . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1c
d Additions during the year . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1d
e Distributions during the year . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1e
f Ending balance . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1f
2a Did the organization include an amount on Form 990, Part X, line 21, for escrow or custodial account liability? . . . . . . . . . . . . . . . . . . . Yes No
b If “Yes,” explain the arrangement in Part XIII. Check here if the explanation has been provided on Part XIII . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Part V Endowment Funds.
Complete if the organization answered “Yes” on Form 990, Part IV, line 10.
(a) Current year (b) Prior year (c) Two years back (d) Three years back (e) Four years back

1a Beginning of year balance . . . . . . . . . . . .


b Contributions . . . . . . . . . . . . . . . . . . . . . . . . .
c Net investment earnings, gains, and
losses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
d Grants or scholarships . . . . . . . . . . . . . . . .
e Other expenditures for facilities and
programs . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
f Administrative expenses . . . . . . . . . . . . . .
g End of year balance . . . . . . . . . . . . . . . . . .
2 Provide the estimated percentage of the current year end balance (line 1g, column (a)) held as:
a Board designated or quasi-endowment . . . . . . . . . . . . . %
b Permanent endowment ............ %
c Temporarily restricted endowment ............. %
The percentages on lines 2a, 2b, and 2c should equal 100%.
3a Are there endowment funds not in the possession of the organization that are held and administered for the
organization by: Yes No
(i) unrelated organizations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3a(i)
(ii) related organizations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3a(ii)
b If “Yes” on line 3a(ii), are the related organizations listed as required on Schedule R? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3b
4 Describe in Part XIII the intended uses of the organization’s endowment funds.
Part VI Land, Buildings, and Equipment.
Complete if the organization answered “Yes” on Form 990, Part IV, line 11a. See Form 990, Part X, line 10.
Description of property (a) Cost or other basis (b) Cost or other basis (c) Accumulated (d) Book value
(investment) (other) depreciation

1a Land . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
b Buildings . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
c Leasehold improvements . . . . . . . . . . . . . . . . .
d Equipment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
e Other . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Total. Add lines 1a through 1e. (Column (d) must equal Form 990, Part X, column (B), line 10c.) ............................
Schedule D (Form 990) 2017

DAA
Schedule D (Form 990) 2017 Madison Free Clinic, Inc. 31-1654015 Page 3
Part VII Investments—Other Securities.
Complete if the organization answered “Yes” on Form 990, Part IV, line 11b. See Form 990, Part X, line 12.
(a) Description of security or category (b) Book value (c) Method of valuation:
(including name of security) Cost or end-of-year market value

(1) Financial derivatives . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .


(2) Closely-held equity interests . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
(3) Other . . Investment NPCF pooled inv fu
............................................................. 27,108
(A)
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. . . .(B)
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. . . .(C)
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. . . .(D)
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. . . .(E)
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. . . .(F)
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. . . .(G)
.....................................................................
. . . .(H)
.....................................................................
Total. (Column (b) must equal Form 990, Part X, col. (B) line 12.) 27,108
Part VIII Investments—Program Related.
Complete if the organization answered “Yes” on Form 990, Part IV, line 11c. See Form 990, Part X, line 13.
(a) Description of investment (b) Book value (c) Method of valuation:
Cost or end-of-year market value

(1)
(2)
(3)
(4)
(5)
(6)
(7)
(8)
(9)
Total. (Column (b) must equal Form 990, Part X, col. (B) line 13.)
Part IX Other Assets.
Complete if the organization answered “Yes” on Form 990, Part IV, line 11d. See Form 990, Part X, line 15.
(a) Description (b) Book value

(1)
(2)
(3)
(4)
(5)
(6)
(7)
(8)
(9)
Total. (Column (b) must equal Form 990, Part X, col. (B) line 15.) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Part X Other Liabilities.
Complete if the organization answered "Yes" on Form 990, Part IV, line 11e or 11f. See Form 990, Part X,
line 25.
1. (a) Description of liability (b) Book value

(1) Federal income taxes


(2)
(3)
(4)
(5)
(6)
(7)
(8)
(9)
Total. (Column (b) must equal Form 990, Part X, col. (B) line 25.)
2. Liability for uncertain tax positions. In Part XIII, provide the text of the footnote to the organization’s financial statements that reports the
organization's liability for uncertain tax positions under FIN 48 (ASC 740). Check here if the text of the footnote has been provided in Part XIII ......
DAA Schedule D (Form 990) 2017
Schedule D (Form 990) 2017 Madison Free Clinic, Inc. 31-1654015 Page 4
Part XI Reconciliation of Revenue per Audited Financial Statements With Revenue per Return.
Complete if the organization answered “Yes” on Form 990, Part IV, line 12a.
1 Total revenue, gains, and other support per audited financial statements . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1
2 Amounts included on line 1 but not on Form 990, Part VIII, line 12:
a Net unrealized gains (losses) on investments . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2a
b Donated services and use of facilities . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2b
c Recoveries of prior year grants . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2c
d Other (Describe in Part XIII.) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2d
e Add lines 2a through 2d . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2e
3 Subtract line 2e from line 1 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3
4 Amounts included on Form 990, Part VIII, line 12, but not on line 1:
a Investment expenses not included on Form 990, Part VIII, line 7b . . . . . . . . . . . . . . . . . 4a
b Other (Describe in Part XIII.) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4b
c Add lines 4a and 4b . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4c
5 Total revenue. Add lines 3 and 4c. (This must equal Form 990, Part I, line 12.) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5
Part XII Reconciliation of Expenses per Audited Financial Statements With Expenses per Return.
Complete if the organization answered "Yes" on Form 990, Part IV, line 12a.
1 Total expenses and losses per audited financial statements . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1
2 Amounts included on line 1 but not on Form 990, Part IX, line 25:
a Donated services and use of facilities . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2a
b Prior year adjustments . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2b
c Other losses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2c
d Other (Describe in Part XIII.) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2d
e Add lines 2a through 2d . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2e
3 Subtract line 2e from line 1 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3
4 Amounts included on Form 990, Part IX, line 25, but not on line 1:
a Investment expenses not included on Form 990, Part VIII, line 7b . . . . . . . . . . . . . . . . . 4a
b Other (Describe in Part XIII.) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4b
c Add lines 4a and 4b . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4c
5 Total expenses. Add lines 3 and 4c. (This must equal Form 990, Part I, line 18.) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5
Part XIII Supplemental Information.
Provide the descriptions required for Part II, lines 3, 5, and 9; Part III, lines 1a and 4; Part IV, lines 1b and 2b; Part V, line 4; Part X, line
2; Part XI, lines 2d and 4b; and Part XII, lines 2d and 4b. Also complete this part to provide any additional information.
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Schedule D (Form 990) 2017

DAA
Schedule D (Form 990) 2017 Madison Free Clinic, Inc. 31-1654015 Page 5
Part XIII Supplemental Information (continued)

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Schedule D (Form 990) 2017

DAA
SCHEDULE G Supplemental Information Regarding Fundraising or Gaming Activities OMB No. 1545-0047

(Form 990 or 990-EZ)


Department of the Treasury
Complete if the organization answered “Yes” on Form 990, Part IV, line 17, 18, or 19, or if the
organization entered more than $15,000 on Form 990-EZ, line 6a.
Attach to Form 990 or Form 990-EZ.
2017
Open to Public
Internal Revenue Service Go to www.irs.gov/Form990 for the latest instructions. Inspection
Name of the organization Employer identification number
Madison Free Clinic, Inc. 31-1654015
Part I Fundraising Activities. Complete if the organization answered “Yes” on Form 990, Part IV, line 17.
Form 990-EZ filers are not required to complete this part.
1 Indicate whether the organization raised funds through any of the following activities. Check all that apply.
a Mail solicitations e Solicitation of non-government grants
b Internet and email solicitations f Solicitation of government grants
c Phone solicitations g Special fundraising events
d In-person solicitations
2a Did the organization have a written or oral agreement with any individual (including officers, directors, trustees,
or key employees listed in Form 990, Part VII) or entity in connection with professional fundraising services? . . . . . . . . . . . . . . . . . . . Yes No
b If “Yes,” list the 10 highest paid individuals or entities (fundraisers) pursuant to agreements under which the fundraiser is to be
compensated at least $5,000 by the organization.
(iii) Did fund- (v) Amount paid to (vi) Amount paid to
raiser have
(i) Name and address of individual (iv) Gross receipts (or retained by) (or retained by)
(ii) Activity custody or
or entity (fundraiser) control of from activity fundraiser listed in organization
contributions? col. (i)

Yes No
1

10

Total ...............................................................................
3 List all states in which the organization is registered or licensed to solicit contributions or has been notified it is exempt from
registration or licensing.
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For
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Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ. Schedule G (Form 990 or 990-EZ) 2017
DAA
Schedule G (Form 990 or 990-EZ) 2017 Madison Free Clinic, Inc. 31-1654015 Page 2
Part II Fundraising Events. Complete if the organization answered “Yes” on Form 990, Part IV, line 18, or reported more
than $15,000 of fundraising event contributions and gross income on Form 990-EZ, lines 1 and 6b. List events with
gross receipts greater than $5,000.
(a) Event #1 (b) Event #2 (c) Other events
(d) Total events

None (add col. (a) through


(event type) (event type) (total number) col. (c))
Revenue

1 Gross receipts .......

2 Less: Contributions . .
3 Gross income (line 1 minus
line 2) . . . . . . . . . . . . . . . .

4 Cash prizes . . . . . . . . . .

5 Noncash prizes ......


Direct Expenses

6 Rent/facility costs ....

7 Food and beverages .

8 Entertainment . . . . . . . .

9 Other direct expenses

10 Direct expense summary. Add lines 4 through 9 in column (d) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .


11 Net income summary. Subtract line 10 from line 3, column (d) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Part III Gaming. Complete if the organization answered “Yes” on Form 990, Part IV, line 19, or reported more
than $15,000 on Form 990-EZ, line 6a.
(b) Pull tabs/instant (d) Total gaming (add
Revenue

(a) Bingo (c) Other gaming


bingo/progressive bingo col. (a) through col. (c))

1 Gross revenue . . . . . . .

2 Cash prizes . . . . . . . . . .
Direct Expenses

3 Noncash prizes ......

4 Rent/facility costs ....

5 Other direct expenses


Yes . . . . . . . . . . . . . . . % Yes . . . . . . . . . . . . . . . % Yes . . . . . . . . . . . . . %
6 Volunteer labor ...... No No No

7 Direct expense summary. Add lines 2 through 5 in column (d) .....................................................

8 Net gaming income summary. Subtract line 7 from line 1, column (d) ..............................................

9 Enter the state(s) in which the organization conducts gaming activities: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .


a Is the organization licensed to conduct gaming activities in each of these states? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Yes No
b If “No,” explain:
. .....................................................................................................................................................
. .....................................................................................................................................................
10a Were any of the organization’s gaming licenses revoked, suspended, or terminated during the tax year? .......................... Yes No
b If “Yes,” explain:
. .....................................................................................................................................................
. .....................................................................................................................................................

DAA Schedule G (Form 990 or 990-EZ) 2017


Schedule G (Form 990 or 990-EZ) 2017 Madison Free Clinic, Inc. 31-1654015 Page 3
11 Does the organization conduct gaming activities with nonmembers? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Yes No
12 Is the organization a grantor, beneficiary or trustee of a trust, or a member of a partnership or other entity
formed to administer charitable gaming? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Yes No
13 Indicate the percentage of gaming activity conducted in:
a The organization’s facility . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13a %
b An outside facility . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13b %
14 Enter the name and address of the person who prepares the organization’s gaming/special events books and
records:

Name ................................................................................................................................

Address .............................................................................................................................

15a Does the organization have a contract with a third party from whom the organization receives gaming
revenue? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Yes No
b If “Yes,” enter the amount of gaming revenue received by the organization $ . . . . . . . . . . . . . . . . . . . . . . . . . . . and the
amount of gaming revenue retained by the third party $ ...........................
c If “Yes,” enter name and address of the third party:

Name ................................................................................................................................

Address .............................................................................................................................

16 Gaming manager information:

Name ........................................................................................................................

Gaming manager compensation $ ..........................

Description of services provided .............................................................................................

Director/officer Employee Independent contractor

17 Mandatory distributions:
a Is the organization required under state law to make charitable distributions from the gaming proceeds to
retain the state gaming license? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Yes No
b Enter the amount of distributions required under state law to be distributed to other exempt organizations or
spent in the organization’s own exempt activities during the tax year $
Part IV Supplemental Information. Provide the explanations required by Part I, line 2b, columns (iii) and (v); and
Part III, lines 9, 9b, 10b, 15b, 15c, 16, and 17b, as applicable. Also provide any additional information.
See instructions.
. ..........................................................................................................................................................
. ..........................................................................................................................................................
. ..........................................................................................................................................................
. ..........................................................................................................................................................
. ..........................................................................................................................................................
. ..........................................................................................................................................................
. ..........................................................................................................................................................
. ..........................................................................................................................................................
. ..........................................................................................................................................................
. ..........................................................................................................................................................
. ..........................................................................................................................................................
. ..........................................................................................................................................................
.
Schedule G (Form 990 or 990-EZ) 2017

DAA
SCHEDULE L Transactions With Interested Persons OMB No. 1545-0047

(Form 990 or 990-EZ)


Department of the Treasury
Complete if the organization answered “Yes” on Form 990, Part IV, line 25a, 25b, 26, 27, 28a,
28b, or 28c, or Form 990-EZ, Part V, line 38a or 40b.
Attach to Form 990 or Form 990-EZ.
2017
Open To Public
Internal Revenue Service Go to www.irs.gov/Form990 for instructions and the latest information. Inspection
Name of the organization Employer identification number

Madison Free Clinic, Inc. 31-1654015


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.
(b) Relationship between disqualified person and (d) Corrected?
1 (a) Name of disqualified person (c) Description of transaction
organization Yes No

(1)
(2)
(3)
(4)
(5)
(6)
2 Enter the amount of tax incurred by the organization managers or disqualified persons during the year
under section 4958 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $
3 Enter the amount of tax, if any, on line 2, above, reimbursed by the organization . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $

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 (c) Purpose of (d) Loan to (e) Original (f) Balance due (g) In default? (h) Approved (i) Written
with organization loan or from the principal amount by board or agreement?
org.? committee?
To From Yes No Yes No Yes No

(1)

(2)

(3)

(4)

(5)

(6)

(7)

(8)

(9)

(10)
Total ........................................................................................... $
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 (c) Amount of assistance (d) Type of assistance (e) Purpose of assistance
person and the organization

(1)
(2)
(3)
(4)
(5)
(6)
(7)
(8)
(9)
(10)
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ. Schedule L (Form 990 or 990-EZ) 2017
DAA
Schedule L (Form 990 or 990-EZ) 2017 Madison Free Clinic, Inc. 31-1654015 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.
(e) Sharing
(a) Name of interested person (b) Relationship between (c) Amount of (d) Description of transaction
of org.
interested person and the transaction revenues?
organization Yes No

(1) James Lamar, Willie Lamar Brd Adv/Vendor Prescription drugs X


(2)
(3)
(4)
(5)
(6)
(7)
(8)
(9)
(10)
Part V Supplemental Information
Provide additional information for responses to questions on Schedule L (see instructions).

Schedule L, Part V - Additional Information


The clinic purchases prescription drugs from the Lamar family who are the
owners of the Madison Drug Company. The Lamar's are Advisors to the Board
of Directors.

Schedule L (Form 990 or 990-EZ) 2017

DAA
SCHEDULE O Supplemental Information to Form 990 or 990-EZ OMB No. 1545-0047

(Form 990 or 990-EZ) Complete to provide information for responses to specific questions on
Form 990 or 990-EZ or to provide any additional information. 2017
Department of the Treasury Attach to Form 990 or 990-EZ. Open to Public
Internal Revenue Service Go to www.irs.gov/Form990 for the latest information. Inspection
Name of the organization Employer identification number

Madison Free Clinic, Inc. 31-1654015


Form 990 - Organization's Mission
. ..........................................................................................................................................................

The Madison Free Clinic, Inc. operates a voluntary not-for-profit


. ..........................................................................................................................................................

organization located in Madison, VA whose purpose is to provide medical


. ..........................................................................................................................................................

visits and prescription medication to the indigent Madison County


. ..........................................................................................................................................................

residents.
. ..........................................................................................................................................................

. ..........................................................................................................................................................

Form 990, Part VI, Line 7a - Election of Members and Their Rights
. ..........................................................................................................................................................

Board must approve


. ..........................................................................................................................................................

. ..........................................................................................................................................................

Form 990, Part VI, Line 11b - Organization's Process to Review Form 990
. ..........................................................................................................................................................

The 990 is reviewed and approved by the Executive Committee- president,


. ..........................................................................................................................................................

vice-president,secretary, and treasurer


. ..........................................................................................................................................................

. ..........................................................................................................................................................

Form 990, Part VI, Line 15a - Compensation Process for Top Official
. ..........................................................................................................................................................

Each year the Treasurer makes an oral proposal to the entire Board. The
. ..........................................................................................................................................................

Board votes and approves the compensation. Recorded in minutes.


. ..........................................................................................................................................................

. ..........................................................................................................................................................

Form 990, Part VI, Line 15b - Compensation Process for Officers
. ..........................................................................................................................................................

The Treasurer makes an oral proposal to the entire Board. The Board votes
. ..........................................................................................................................................................

and approves compensation . Recorded in minutes.


. ..........................................................................................................................................................

. ..........................................................................................................................................................

Form 990, Part VI, Line 19 - Governing Documents Disclosure Explanation


. ..........................................................................................................................................................

The Form 990 is available upon request. Additionally, the Form 990 can be
. ..........................................................................................................................................................

found on www.guidestar.org
. ..........................................................................................................................................................

. ..........................................................................................................................................................

For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ. Schedule O (Form 990 or 990-EZ) (2017)
DAA
SUB-LEASE AGREEMENT

This SUB-LEASE AGREEMENT is entered into this ____ day of _________________,


2018 by and between the County of Madison, Lessor, and the Literacy Council of Madison
County, Inc., Lessee.

WHEREAS, Madison is the lessor of certain real estate described as follows:

ALL that certain lot or parcel of land with improvements thereon


and appurtenances thereunto belonging located in the Town of
Madison containing .087 acres, more or less, as shown on a plat of
boundary survey by Milton T. Estes dated January 22, 2001 and
recorded in the Madison County Clerk’s Office as Instrument No.
010000417, Tax Map Parcel 39A-23A.

WHEREAS, Madison County has the right under the terms of its lease with
the owner to sublease the Property, without the approval of the Owner.

WHEREAS, the Literacy Council of Madison County, Inc. desires to rent space from
County of Madison pursuant to the terms and conditions set forth below.

WHEREFORE, in consideration of the foregoing, the parties agree as follows:

1. Term of Lease. This Lease shall be for one full calendar year, subject to renewal
on an annual basis. The Lessor reserves the right to terminate this Lease at any time and for
any reason, provided it provide the Lessee 90 days’ notice of the termination of the tenancy.
Any additional request to extend the lease beyond

2. Condition of the Premises. The County of Madison makes no representation as to


the quality of the premises or their fitness for the purposes intended by the Literacy Council of
Madison County, Inc. The Literacy Council of Madison County, Inc. shall have the right to
make any painting or cosmetic alterations to the building, so long as all such changes are
approved in advance by the Lessor. The Lessor shall have 15 days to review any proposed
changes to the building. Lessee specifically warrants that it is undertaking all improvements at
their own risk, and Lessee further understands that the lease may be terminated despite the fact
that the Lessee has made significant improvements to the property. All such improvements
must be approved in advance by the building owner, Kenneth Moore.

1
3. Use of Premises. The Lessee shall use the premises exclusively for maintaining its
office, and for conducting tutoring services and conducting meetings, as required. The
premises will not be used in the preparation of any food.

4. Termination. This Lease shall be terminated by either party upon 90 days written
notice as set forth above. If the Lease is terminated, the Lessee shall vacate the premises within
the 90 days provided, unless other arrangements have been made with the Madison County
Administrators Office.

5. Damage or Destruction of Premises. If, during the term of the Lease, the premises
are damaged by fire, flood, windstorm, earthquake, explosion, or other natural disaster,
including any acts of terrorism or civil disturbances that render the property unfit for
occupancy, the Lessee shall vacate the premises and surrender them to the Lessor. Under no
circumstance will the Lessor be responsible for any damages as a result of any such damage.

6. Notice. Any notices to the Lessor under this Lease shall be sent as follows:

Jack Hobbs
Madison County Administrator
302 Thrift Road
P.O. Box 705
Madison, Virginia 22727

If any notices are required to be sent to the Lessee they shall be sent to the Lessee at the
following address:
___________________
___________________
___________________

7. Insurance The Lessee shall carry all insurance on its leased premises and contents,
including, without limitation, fire, theft, breaking and entering, vandalism, malicious mischief,
act of God or nature, and public liability, and shall indemnify by and save the Lessor harmless
against any and all liabilities, claims, demands, actions, costs, and expenses of any kind and
any nature whatsoever which may be sustained by the Lessor by reason of the causes set forth
in this paragraph.

2
8. Loss or Damage to Property or Persons. All personal property belonging to the
Lessee located on or about the premises, shall be at the sole risk of the Lessee. The Lessor shall
not be liable for any damage or injury to the Lessee, its clientele, its officers, agents, or
employees, for any reason. In the event of an accident or emergency, the Lessee shall give
immediate notice to the Lessor of the occurrence. If this happens outside of regular business
hours, such notice shall be made through the Madison County Sheriff's office.

9. Repairs and Maintenance. The Lessee shall keep in good repair and shall take
good care of the premises and fixtures therein located and at the expiration or termination of
the Lease, shall render the premises and fixtures in good, broom clean condition. The Lessee
further represent that it will not store trash, food, or any other material on the premises.

10. Services and Utilities. The Lessee agrees to pay to the Lessor the sum of $50.00,
per month, to defray the costs of water, sewer and electricity. No other services or utilities will
be provided by Lessor. In the event any utilities breakdown, the Lessor shall not be liable for
any damages to the Lessee for the temporary failure of any such systems.

11. Signs. The Lessee shall have no right to erect or install canopies, marquees, or
advertising devices, without prior written approval of the Lessor and Kenneth Moore.

12. Assignment. The Lessee shall not assign or sublet the premises to any entity.

County of Madison Literacy Council of Madison County, Inc.

By: ___________________________ By: _______________________________


Clay Jackson, Chairman Name: _____________________________
Madison County Board of Supervisors Title: ______________________________

Z:\MADISON COUNTY ATTORNEY WORK\Madison County Literacy Council\2018.11 Lease Agreement LCMC.docx

3
AMENDED LEASE AGREEMENT

This AMENDED LEASE AGREEMENT is entered into this ___ day of


________________, 2018, by and between the MADISON COUNTY BOARD OF
SUPERVISORS, herein after referred to as Madison County, and the MADISON COUNTY
HISTORICAL SOCIETY, INC., herein referred to as Lessee, and the Rappahannock Rapidan
Community Service Board (RRCSB).

WHEREAS, Madison County and The Madison County Historical Society entered a lease
for the Arcade Building on September 10, 2013.

WITNESSETH:

For and in consideration of the benefits to each party, Lessor and agree to modify the
September 10, 2013 lease for the real property located in the Town of Madison, Virginia, known
as the Arcade Building, herein referred to as the Premises.

1. TERM: The term of the original lease commenced on October 2, 2014, and shall
terminate on April 30, 2029. This Lease may be terminated at any time by the Judge of the Circuit
Court of Madison County when, in the option of such Judge, the leased premises are needed for
any of the purposes enumerated in §15.2-638 of the Code of Virginia (1950), as amended.
2. ADDITIONAL TENANT: The parties agree that the Rappahannock Rapidan
Community Service Board (RRCSB) shall be renting the space identified as __________________
on the Premises, pursuant to the attached lease.
3. STRUCTURAL ALTERATION: Madison County Historical Society shall not
make any interior or exterior structured alteration to the Premises without advance written approval
from Lessor.
4. MAINTENANCE: Madison County Historical Society shall maintain the Premises
in good and clean condition.
5. UTILITIES: Madison County Historical Society shall pay all utility expenses,
including electricity, phone and fuel expenses, for the Premises; provided, however, since the
lighting for the parting lot adjacent to the Premises is measured collectively with the electricity for

1
the Premises on one meter located on the Premises, Madison County shall pay $600.00 per year to
offset the expense of lighting for said parking lot.
6. INSURANCE: Madison County shall maintain property and liability insurance on
the Premises with such coverage as Madison County deems best; provided, however, Madison
County shall have no liability for any claims by Madison County Historical Society related to
Madison County Historical Society’s occupancy of the Premises or for Madison County Historical
Society’s property located on the Premises.
7. USE OF PREMISES: Madison County Historical Society shall use the Premises
as a site for the display of historical artifact, collections, exhibits and documents and for such other
purposes as set for in Madison County Historical Society’s Articles of Incorporation.
8. ASSIGNMENT: Madison County Historical Society shall not assign this Lease
without the written consent of Lessor.

EXECUTED IN DUPLICATE.

WITNESS the following signatures and seals.

MADISON COUNTY BOARD OF SUPERVISORS

BY: ______________________________________

MADISON COUNTY HISTORICAL SOCIETY, INC.

BY:________________________________________

Z:\MADISON COUNTY ATTORNEY WORK\Madison County historical\2018.11 Lease MFC.docx

2
SUB-LEASE AGREEMENT

This SUB-LEASE AGREEMENT is entered into this ____ day of _________________,


2018 by and between the County of Madison, Lessor, and the Rappahannock Rapidan
Community Service Board, Lessee.

WHEREAS, the County of Madison is the owner of the property known as the Arcade
Building.

WHEREAS, the space has been leased to the Madison County Historical Society, who
has agreed to amend its lease so that the RRCSB can occupy a portion of the premises

WHEREAS, the RRCSB desires to rent space from County of Madison


pursuant to the terms and conditions set forth below.

WHEREFORE, in consideration of the foregoing, the parties agree as follows:

1. Term of Lease. This Lease shall be for one full calendar year, subject to renewal
on an annual basis. The Lessor reserves the right to terminate this Lease at any time and for
any reason, provided it provide the Lessee 90 days’ notice of the termination of the tenancy.
Any additional request to extend the lease beyond

2. Condition of the Premises. The County of Madison makes no representation as


to the quality of the premises or their fitness for the purposes intended by the RRCSB. The
RRCSB shall not have the right to make any painting or cosmetic alterations to the building,
without the approval of Madison County and The Madison County Historical Society.
Lessee specifically warrants that it is undertaking all improvements at their own risk, and
Lessee further understands that the lease may be terminated despite the fact that the Lessee
has made significant improvements to the property.

3. Use of Premises. The Lessee shall use the premises exclusively for maintaining
an office and meeting with its clients. The premises will not be used in the preparation of
any food.

1
4. Termination. This Lease shall be terminated by either party upon 90 days written
notice as set forth above. If the Lease is terminated, the Lessee shall vacate the premises
within the 90 days provided, unless other arrangements have been made with the Madison
County Administrators Office.

5. Damage or Destruction of Premises. If, during the term of the Lease, the
premises are damaged by fire, flood, windstorm, earthquake, explosion, or other natural
disaster, including any acts of terrorism or civil disturbances that render the property unfit for
occupancy, the RRCSB shall vacate the premises and surrender them to Madison County.
Under no circumstance will the Lessor be responsible for any damages as a result of any such
damage.

6. Notice. Any notices to the Lessor under this Lease shall be sent as follows:

Jack Hobbs
Madison County Administrator
302 Thrift Road
P.O. Box 705
Madison, Virginia 22727

If any notices are required to be sent to the Lessee they shall be sent to the Lessee at the
following address:
Rappahannock Rapidan Community Service Board
___________________
___________________

7. Insurance Madison County shall carry all insurance on its leased premises and
contents, including, without limitation, fire, theft, breaking and entering, vandalism,
malicious mischief, act of God or nature, and public liability, and shall indemnify by and
save Madison County harmless against any and all liabilities, claims, demands, actions, costs,
and expenses of any kind and any nature whatsoever which may be sustained by Madison
County by reason of the causes set forth in this paragraph.

8. Loss or Damage to Property or Persons. All personal property belonging to the


Lessee located on or about the premises, shall be at the sole risk of the Lessee. The Lessor
shall not be liable for any damage or injury to the Lessee, its clientele, its officers, agents, or

2
employees, for any reason. In the event of an accident or emergency, the Lessee shall give
immediate notice to the Lessor of the occurrence. If this happens outside of regular business
hours, such notice shall be made through the Madison County Sheriff's office.

9. Repairs and Maintenance. The Lessee shall keep in good repair and shall take
good care of the premises and fixtures therein located and at the expiration or termination of
the Lease, shall render the premises and fixtures in good, broom clean condition. The Lessee
further represent that it will not store trash, food, or any other material on the premises.

10. Services and Utilities. The Lessee agrees to pay to the Lessor the sum of $50.00,
per month, to defray the costs of water, sewer and electricity. No other services or utilities
will be provided by Lessor. In the event any utilities breakdown, the Lessor shall not be
liable for any damages to the Lessee for the temporary failure of any such systems.

11. Signs. The Lessee shall have no right to erect or install canopies, marquees, or
advertising devices, without prior written approval of the Lessor..

12. Assignment. The Lessee shall not assign or sublet the premises to any entity.

County of Madison Rappahannock Rapidan Community


Service Board

By: ___________________________
By: _______________________________
Clay Jackson, Chairman
Name: _____________________________
Madison County Board of Supervisors
Title: ______________________________

Z:\MADISON COUNTY ATTORNEY WORK\Madison County Literacy Council\2018.11 Lease Agreement LCMC.docx

3
Artist: Lou Messa

COUNTY OF MADISON, VIRGINIA


REQUEST FOR REAL ESTATE PROPOSALS

Issue Date: October 29, 2018

Due Date and Time: On or Before April 12, 2019. Proposals will be considered
on a rolling basis.

RFP #: 181029

Issuing Agency: Madison County Administrator’s Office


302 Thrift Road
P.O. Box 705
Madison, VA 22727

Procurement Contact: Jack Hobbs, County Administrator


Phone: 540-948-7500
E-mail: jhobbs@madisonco.virgina.gov

Request for Proposals


Madison County, Virginia requests proposals that will result in the
appropriate reuse of the former Criglersville Elementary School building
and grounds. The property encompasses a circa 1948 brick former
elementary school building with two dwellings on 5.83 acres. A packet
with property information and offer procedures is available at
www.madisonco.virginia.gov. Proposals, which may or may not involve
the sale of the property, will be received and considered until April 12,
2019.

1
Contents

I. INTRODUCTION AND BACKGROUND ......................................................................................................... 3


II. THE PROPERTY .......................................................................................................................................... 3
III. ZONING AND LAND USE ........................................................................................................................... 3
IV. PRIOR REPORTS AND DISCLOSURES ........................................................................................................ 3
V. OBJECTIVES/OFFER DEVELOPMENT GUIDELINES ..................................................................................... 4
VI. QUALIFICATIONS/ OFFER REQUIREMENTS .............................................................................................. 4
VII. OFFER PROCESS ...................................................................................................................................... 5
VIII. RECEIPT OF PROPOSALS; CONTACT INFORMATION .............................................................................. 5
Appendix A: Madison County Real Estate Tax Assessment Information ...................................................... 6
Appendix B: Tax Map Excerpt ....................................................................................................................... 7
Appendix C: Zoning ....................................................................................................................................... 8
Appendix D: Plat.......................................................................................................................................... 11
Appendix E: Real Estate Broker Registration .............................................................................................. 12
Appendix F: Real Estate Commission Agreement ....................................................................................... 13
Appendix G: Real Estate Bid/Contract Form ............................................................................................... 16

2
I. INTRODUCTION AND BACKGROUND
The County of Madison has studied the Criglersville Elementary School property and has determined that
that there is no good apparent use for the main building on the site. To facilitate the reuse or repurposing
of the facility, the County hereby solicits full, complete and written proposals from qualified parties that
articulate an appropriate disposition of some or all of the property. It is expected that proposers will
address all relevant County concerns. Although all options will be entertained, sale of the property with
no long-term commitments by the County is strongly desired.

II. THE PROPERTY


The subject property is the former Criglersville Elementary School site at 1120 Old Blue Ridge Turnpike
(TM# 21-61) in Criglersville, Virginia. It contains 5.83 acres and features one former brick elementary
school building and two other house-type buildings. Additional information on the property is available
in the appendices.

Note that any reuse of the property does come with challenges, such as:
 Location in a flood plain
 Absence of potable water and sanitary sewer facilities
 Zoning restrictions
 Presence of asbestos and (suspected) lead paint
 Location relative to a primary highway and a population center
 Limits on cellular telephone and broadband internet services

Access for the purpose of inspecting building interiors can be obtained on an appointment basis.

III. ZONING AND LAND USE


Use of the property is limited by Madison County zoning and subdivision ordinances which are available
online at www.madisonco.viriginia.gov. The property is zoned Agricultural, A-1 with Floodplain. A high
level review of land use regulations relative to the property is articulated in the Appendix. Current flood
elevation certificates are available for all three buildings.

IV. PRIOR REPORTS AND DISCLOSURES


An archive of material pertaining to the site is available for review at
https://www.dropbox.com/sh/3setn4ra3mi0p2s/AACuXU7b7fRUQnTc9G3xejOia?dl=0. This includes
original plans for the brick school building, reports on the impact of building and health codes on the reuse
of the building, facility assessments, plats, flood elevation certificates and inspection reports.

The County of Madison is aware of many significant items regarding the condition of the buildings and
restrictions on the use of the property and has disclosed them in documents that have been made
available to potential proposers. Potential proposers are encouraged to carefully inspect the buildings and
grounds prior to closing. Madison County desires any transfer the property to be on an "as is" basis
without any warrantees.

The buildings can be accessed on an appointment basis.

3
V. OBJECTIVES/OFFER DEVELOPMENT GUIDELINES
Understanding that the County would prefer to have a cash-only transaction at the earliest date,
respondents may offer to purchase or use the property with terms deemed to be reasonable at the County
of Madison’s sole discretion.

While attempting to allow potential buyers the latitude to make offers as they see fit and which meet
their individual needs, the County of Madison provides the following general guidelines regarding what it
would like to see within a formal written purchase and sale agreement.

 The asking price for the property is $422,100 with the understanding that other factors besides
price will be evaluated as elements of the “best offer”. The County will evaluate each offer
received with regard to the net proceeds to the County as well as other aspects of offers deemed
favorable to the County.
 The County expects offers to purchase to remain valid for 60 days with closing to occur within 90
days of acceptance of the offer. During the 90 day period, the purchaser would be responsible for
all due diligence and securing all necessary permits and approvals. Extended time periods will be
evaluated against deposit amounts, and other financial and timing factors in the total context of
the proposal offered.
 The County of Madison will grant reasonable right of entry to the accepted purchaser for the
purposes of conducting tests and surveys or evaluating site improvements prior to closing.
 The County of Madison will not pay any broker’s commission applicable to the sale of the property
unless agreed to in advance. Materials that would support such commissions are contained in the
Appendix.
 Guarantees through bonding or other mechanism such that the building(s) would be improved by
a date certain and to prevent the creation of an eyesore or nuisance situation.
 A minimum earnest money deposit of $10,000 which would be forfeited by the Proposer in the
event of Purchaser default is suggested.

VI. QUALIFICATIONS/ OFFER REQUIREMENTS


The County suggests that offers should include the following:

1. Name and contact information containing the legal name of the proposing person or corporate
entity firm as well as for the individual serving as the County’s sole point of contact.

2. A letter from a bank or financial institution demonstrating the proposer’s capacity to fund the
proposed redevelopment or sale.

3. A proposed timetable articulating offer, acceptance, inspections and closing milestones.

4. Purchase price proposed and any potential deductions thereto.

5. Conditions of the offer.

6. Clear and complete details of the offer.

7. The County desires that the Madison County Historical Society remain in the “museum house”
indefinitely beyond the end of that group’s current lease and to use the “voting house” as a

4
County polling place until December 31, 2019. Grounds maintenance around the historical
monument on the property (per the recorded easement) as well as around the community
playground are concerns. Proposers should clearly articulate a response to these concerns in the
initial proposal.

VII. OFFER PROCESS


1. The County is currently accepting proposals but may suspend this at any time at its sole discretion.
Proposals will be vetted by a committee for general completeness and clarity prior to being
presented for discussion at a closed session of the Madison County Board of Supervisors. Offers
will be held as confidential until either the Madison County Board of Supervisors or the proposer
deems there is no further negotiation possible at which time they would become open for public
inspection. It is anticipated that the Board of Supervisors will consider all proposals received as
quickly as practical.

2. Proposers are advised that this RFP may be amended or rescinded at any time.

3. Submittals should include ten written and bound copies of the offer and one electronic edition in
pdf format. Respondents submitting fewer than the number of copies requested may be
considered “non-responsive.”

4. Submittals may be mailed or delivered to the address listed at the end of this document. All offers
should be sealed and clearly marked: “Criglersville Elementary School Property Proposal”.

5. Verbal offers will not be accepted.

6. Any costs incurred by a proposer in the preparation of any offer is to be the sole responsibility of
the proposer.

7. Madison County reserves the right to reject any and/or all offers, or to withhold the award for
any reason it may determine and Madison County may waive or decline to waive irregularities in
any response.

8. Madison County may begin negotiations with any proposer at any time at the County’s discretion.
The County anticipates negotiations regarding purchase and sale or other terms to take place
immediately. If negotiations are successful, the proposer will be expected to present his proposal
to the public during a scheduled public meeting.

VIII. RECEIPT OF PROPOSALS; CONTACT INFORMATION


Proposals should be delivered to:
Jack Hobbs
County Administrator
302 Thrift Road
P.O. Box 750
Madison, VA 22727
Phone: 540/948-7500
jhobbs@madisonco.virginia.gov

5
Appendix A: Madison County Real Estate Tax Assessment Information

6
Appendix B: Tax Map Excerpt

Reference TM# 21-61 at https://www.webgis.net/va/Madison/

7
Appendix C: Zoning

Note: The following is provided for general information only. Proposers are expected to procure
all approvals and permits, including those under the auspices of the Commonwealth of Virginia
(such as for water, sanitary sewer, stormwater management and road access) as well as local
zoning, building and erosion control and other areas.
----------------------------
August 14, 2018 - Discussion with Criglersville School Committee at 7:15 PM in the
Madison Administrative Center Auditorium

Tax Map Number 21-61 - 5.830 acres in the name of Board of Supervisors of Madison
County, Virginia - zoned Agricultural, A-1 with Floodplain. The Floodplain zone is AE which
means base flood elevations have been determined. Most of it is in Floodplain except the
back corner of the property.

1. The minimum lot size in A-1 per lot is 3 acres with 250 feet of road frontage. Each use
also requires 3 acres even if you are not subdividing. Each lot has to have the minimum
acreage and frontage as well as house site, well site and each lot has to have a 10,000
square foot drainfield and reserve area. Article 4-5-3 Lots shall not contain peculiarly
shaped elongations solely to provide necessary square footage of area which would be
unusable for normal purposes.

VDOT also has to sign off on any subdivision plats for new entrances or existing
entrances.

2. The current Floodplain Ordinance was adopted on May 7, 2014 and the current
Floodplain Maps were adopted on January 5, 2007. FEMA is in the process of updating
our floodplain maps and we will get a new Floodplain Ordinance sometime the later
part of 2019 or the first part of 2020.

See Floodplain Ordinance Page 56 AE Zone requires the hydrologic and hydraulic
analysis performed by engineering practice that the proposed use will not result in any
increase in flood levels within the community during the occurrence of the base flood
discharge.

See pages 56, 57, 58 and 59 of the Floodplain Ordinance.

Article 13 Nonconforming Uses

13-1-1 If at the time of enactment or subsequent amendment of this ordinance, as


enacted or amended, any legal activity which is being pursued, or any lot or structure
legally utilized in a manner or for a purpose which does not conform to the provisions
of this ordinance, such manner of use or purpose may be continued.

8
13-1-3 If any nonconforming use (structure or activity) is discontinued for a period
exceeding two (2) years after the enactment of this ordinance, it shall be deemed
abandoned and any subsequent use shall conform to the requirements of this
ordinance. So the School has been closed for way more than 2 years so that is not a
grandfathered use. The voting house is a grandfathered use. The museum is
operating by special use permit issued on April 4, 2018 by the B/S.

Currently the only recognized uses of the property are the voting precinct
(grandfathered) and the museum that has a special use permit.

If the structures on the property are voluntarily torn down and you want to build back,
then you would have to be in full compliance with all ordinances including zoning
regulations for setbacks from all property lines and floodplain regulations.

Article 13-5 If a non-conforming structure is destroyed or damaged in any manner, it


may be restored or repaired without bringing said structure into conformance provided
such reconstruction is begun within 18 months of the calamity.

Open Picnic Shelter - Is this picnic shelter for the public to use at their discretion or
will this be like a business where you have to rent the facility? Are you thinking about
having this as a public park and playground? That is a use allowed by right in the C-1
and A-1 zone. Article 3-1-3

3. In the Conservation, C-1 zoning, there are uses allowed by right and by special use
permit. In the Agricultural, A-1 zone the same uses are allowed as for C-1 plus some
additional uses by right and by special use permit.

Approvals required for various scenarios:


County Storage - Are you wanting to use the school building or other buildings for storage
or do you want to build a storage structure. The County owns the property and if they want
to use the existing structures for storage of their own county property, that would be an
accessory use to the property.

Non-County Storage - A moving and storage facility is only listed in the Industrial, M-1
zoning by right (Art. 9-1-25) and Industrial , M- 2 zoning by right (Art. 10-1-38). Non- County
storage would not be an allowable use in A-1 zoning.

Auction house - Auction establishment (Art. 4-2- 23) Is a use allowed by special use permit.
Definition of Auction Establishment - A structure or enclosure in which goods and/or
livestock are displayed and sold by auction.

Community Center - We do not specifically have community center listed as a use in our
Zoning Ordinance, however, we do have public building by special use permit (Art. 3-2 -
14) Definition of public building - Any building owned or leased by a governmental or civic
organization for public use such as a town hall, courthouse, armory, office building, post
office, auditorium, museum, art gallery, school, college, university, hospital, clinic, library,

9
police, fire or rescue station. `As long as it met the definition of the above definition, I think
it would fall under this definition. Would the County be operating the community center?

Farmers Market - Allowed by special use permit in the A-1 zone (Art. 4-2-21). Definition
Farm Market - A building, structure or place used for the sale of farm or food products
or craft products to consumers where 51% or more of the products are grown, produced
or processed by the operator or under the operator's direction. A farm market must be
located at or beyond the setback line and must use an existing entrance as access.

Picnic Shelter - addressed under number 2.

Keep in mind the acreage requirements apply to most of these uses and you already have one
approved use (3 acres) by special use permit and you only have 5.830 acres so you do not
have enough acreage to have another use without applying for a variance to the BZA. So you
have the museum, voting precinct (public building - grandfathered in its current location) and if
you want another use, you would have to apply for a variance to the BZA to have 3 uses on
less than 9 acres.

Also parking regulations come into play for each use that you have on the property. The
number of spaces is determined by the use. Article 14-9 Pages 87, 88 and 89.

If you build a new structure for a new business/use, you will need a site plan for new
construction. See Site Plan Ordinance

If you construct additions to an existing structure over 500 square feet you will need
a site plan.

In addition to zoning requirements, you would have to seek comments/approvals from


VDOT, Health Department and Building Official.

Prepared by Zoning Administrator Betty Grayson

10
Appendix D: Plat

11
Appendix E: Real Estate Broker Registration

REGISTRATION OF AUTHORITY TO ACT AS BROKER


The undersigned, acting on behalf of _____________________________________
(“Prospective Buyer”) does hereby authorize and appoint __________________________
(“Broker”) to act as its exclusive agent and on its behalf, in negotiations and dealings with the
County of Madison, Virginia a political subdivision of the Commonwealth of Virginia, (the
“Seller”) regarding the purchase by Prospective Buyer of the Criglersville Elementary School
property (“Property”) located at 1120 Old Blue Ridge Turnpike (TM# 21-61).

Seller acknowledges that this statement only authorizes Broker to represent Prospective
Buyer in its negotiations and dealings with the Seller and Broker does not have the authority to
execute a contract on behalf of Prospective Buyer or to bind Prospective Buyer by any statement
or representation made by Broker. Neither Prospective Buyer nor the Seller shall be bound to
the other regarding the purchase and sale of the Property except by a contract in writing, duly
executed by the respective authorized representatives of the Seller.

This authorization and appointment shall automatically expire six (6) months from the
date hereof. This authorization and appointment may be renewed or reestablished by execution
by Prospective Buyer of another Registration of Authority to Act as Broker document.

Dated this day of , .

Prospective Buyer:

By: _____________________________________

Name/Title: _______________________________

Date: _____________________________________

Broker:
By: _____________________________________

Name/Title: _______________________________

Date: _____________________________________

12
Appendix F: Real Estate Commission Agreement

REAL ESTATE COMMISSION AGREEMENT

THIS AGREEMENT made this day of , _______, by and


between the OF COUNTY OF MADISON, VIRGINIA a political subdivision of the Commonwealth
of Virginia, (“Seller”) and , (“Broker”).

Recitals

This agreement is made for the purpose of setting forth the terms and conditions on
which the Seller will pay to Broker a commission on real estate sales made by the Seller to buyers
which Broker has found and brought to the Seller.

Now, Therefore, the parties hereto agree as follows:

1. The Seller agrees to pay to Broker a commission in an amount calculated as hereafter


provided in the event the Seller sells any of its real property to a buyer for whom Broker acts
as a registered broker as hereafter provided.
2. No commission shall be paid to Broker for any sale except a sale to a buyer who has registered
Broker with the Seller and pursuant to a contract of sale executed by such Buyer during the
period of registration as hereafter provided. Registration shall be made by filing with the
Seller a written registration statement, in the form attached hereto as Exhibit “A”, signed by
a prospective buyer which acknowledges that Broker is authorized to act on behalf of such
prospective buyer with respect to negotiations for the purchase of Seller’s property. Such
registration, which shall constitute recognition of Broker’s representation of a prospective
buyer, shall automatically expire six (6) months from the date thereof. Such registration may
be renewed or reestablished by filing another registration statement signed by the
prospective buyer as aforesaid.
3. It is the policy of the Seller to deal only with registered Brokers who hold a valid Virginia real
estate broker’s license. Only one broker may be registered to represent a prospective buyer
at any time, and payment of any commission shall be made only to such registered Broker as
provided in this agreement, notwithstanding the fact that other licensed real estate brokers
or sales agents may have assisted the registered Broker in negotiations leading to a sale, or
may have previously been registered to represent such buyer.
4. Notwithstanding any other provision of this agreement, no commission shall be paid by the
Seller to a broker who, by reason of ownership or otherwise, controls, is controlled by, or
under common control with the entity which is a buyer of Seller’s property.
5. The amount of commission to be paid to Broker under this agreement shall be 6% of the
advertised price for the land, before any deductions are taken for cost write-down or
incentives funded by government agencies.
6. The Seller and Broker understand and acknowledge that some contracts of sale may call for
the buyer to purchase the property which is subject to the contract in phases with separate
closings, provide for the purchase of property with an option for the buyer to purchase

13
additional property at a later time, purchased under lease-to-purchase terms, or leased under
long-term arrangements. In such cases, each shall be considered a sale under this contract
and pro-rated commission paid to the broker on the same basis as funding is made available
to the Seller, and the terms of such will be clearly articulated at or prior to closing.
7. No commission shall be paid by the Seller to Broker except pursuant to a written contract of
sale between the Seller and a buyer for whom Broker serves as a registered broker in
accordance with this agreement. Furthermore, no commission shall be paid to Broker unless
and until a sale is fully consummated and an actual closing on such sale occurs in which event
Broker shall be entitled to be paid a commission.
8. This agreement constitutes the entire understanding of the parties and may not be modified
or changed except by written instrument executed by both parties. This agreement shall be
construed, interpreted and applied according to the laws of the Commonwealth of Virginia.

In Witnesseth whereof the parties hereto have executed this agreement as of the
day and year first above written.

COUNTY OF MADISON, Virginia

By: _____________________________________

Name/Title: _______________________________

Date: _____________________________________

BROKER:
By: _____________________________________

Name/Title: _______________________________

Date: _____________________________________

STATE OF VIRGINIA
City/County of ________________, to-wit:

The foregoing Real Estate Commission Agreement dated the day of ,


_______, was acknowledged before me this day of ,
_______ by , who is the Chairman of
the Madison County Board of Supervisors.
____________________________________
Notary Public
(SEAL)
My commission expires: ________________________

14
STATE OF VIRGINIA
City/County of ________________, to-wit:

The foregoing Real Estate Commission Agreement dated the day of ,


_______, was acknowledged before me this day of ,
_______ by , who is of , on
behalf of the company.
____________________________________
Notary Public
(SEAL)
My commission expires: ________________________

15
Appendix G: Real Estate Bid/Contract Form
REAL ESTATE BID/CONTRACT
THIS COMMERCIAL REAL ESTATE CONTRACT (“Contract”) made as of this ___ day of ______________,
______, by and between County of Madison Virginia (“Seller”), and ______________________________
______________________________________________________ , the “Purchaser”.

WITNESSETH
In consideration of the mutual covenants, undertakings and the benefits to the parties herein, the
parties hereto agree as follows:
1. PROPERTY: Seller agrees to sell to Purchaser and Purchaser agrees to purchase from
seller the following real property with all improvements thereon and appurtenances
thereto belonging, consisting of the Criglersville Elementary School property
(“Property”) located at 1120 Old Blue Ridge Turnpike (TM# 21-61).

2. PURCHASE PRICE: The Purchase price shall be $_________________


or_____________________________________________ Dollars and 00/100. The Purchase
Price shall be paid in cash by wire transfer or certified cashier’s check to Seller, via the
closing attorney, at closing.
3. DEPOSIT: Purchaser will make a deposit of Ten Thousand and No/100 Dollars ($10,000.00)
with Seller, with this bid/contract. Said deposit will be held by Seller until settlement and
applied to the purchase price or returned to the Purchaser if title to the property is not
marketable.
4. LEASEHOLD TENANCIES: Seller shall deliver the property to Purchaser free of any leasehold
tenancies except for (a) Madison County Historical Society’s lease of the “museum house”
on the property under the terms of its current lease shall be valid until XXXX, XX, 20XX and
(b) Madison County shall be allowed to use the “voting house” on the property for elections
until December 31, 2019.
5. CONVEYANCE: Seller shall convey to Purchaser marketable title (defined as insurable by
Purchasers choice of Title Insurance Company at normal rates with no exceptions) to the
property by General Warranty deed with English Covenants of Title, subject to recorded
restrictions, easements, conditions and agreements now affecting the property which do
not render the title unmarketable.
6. AS IS- Seller is to convey the property “AS IS” without any representations expressed or
implied as to the condition of the property, except as expressly set forth herein.
7. INSPECTION PERIOD- Seller will allow purchaser 90 days after a mutual acceptance of the
Offer to Purchase to conduct inspections of the physical improvements on the property and
to secure all permits for Purchaser’s proposed use of the property. Seller will not make any
repairs or alteration as an outcome of these inspections, and the sole remedy available to
Purchaser will be to void this Purchase contract and have refunded the deposit monies. If
the contract is not voided after this period it will be deemed in full force and effect and
proceed to closing per the terms of this contract.
8. TITLE/SURVEY EXAMINATIONS: If the title examination or boundary survey reveals any
defect that renders the title unmarketable or adversely affects the Purchasers intended use
of the property, Seller shall attempt to cure such defects at Sellers expense. If the Seller is
unwilling or unable to correct title or survey objections within 30 days of receiving notice,
Purchaser may, at its option, either (i) terminate this contract and all rights and liabilities

16
herein shall cease with the Deposit being returned to the Purchaser, or (ii) waive the
foregoing right and proceed to close on the purchase of the property in accordance of the
terms of the contract with no reduction of the Purchase Price.
9. RISK OF LOSS: Risk of loss or damage to the property shall be the Sellers until closing has
occurred. In the event of loss due to fire, condemnation, windstorm, casualty or other loss
occurs, Seller shall be under no obligation to repair or restore the property, and Purchaser
may either (i) terminate the contract, or (ii) proceed to closing with no reduction in
purchase price, but with any insurance proceeds awarded to Purchaser.
10. CONDITION OF PROPERTY: The Seller covenants that the property will be in substantially
the same condition at closing as of the date of this contract.
11. CLOSING: Closing shall take place at the office at the offices of a local settlement agent or
attorney’s office on or before _________________, ____________.
12. CLOSING COSTS: Seller to pay for the costs of preparing a new deed of conveyance, as well
as the Grantors Tax applicable to Sellers in Virginia. Purchaser to pay for all costs of
acquiring any loans on the property, as well as the costs of recording the deed and loan
documents required by the lender, and all title insurance premiums, survey costs and costs
of the Purchasers attorney.
13. SELLERS CLOSING DOCUMENTS: At closing, seller shall provide the new Deed, any
reasonable documentation required by any title agency whereby the ability to sell the real
estate was authorized by the Madison County Board of Supervisors, a standard form
owner’s affidavit as to mechanics liens and possession and such other documents as may be
reasonably required by the title insurance company.
14. SELLER’S REPRESENTATIONS: Seller represents:
a. It has marketable, fee simple title in the property
b. It has the right to grant entry to Purchaser and its agents
c. It has no proceedings pending, nor are there any threatened against the
property.
d. There are no bankruptcy proceedings are pending or contemplated by or
against Seller
e. The property s not subject to any prior or other contracts on the property
f. That it will take no actions that would further encumber the property with any
lien, lease, covenant, condition or restriction during the period of this Contract.
15. PURCHASER’S REPRESENTATIONS: Purchaser shall, post cash, a bond, letter of credit or
other surety acceptable to the Madison County Attorney guaranteeing the improvement of
the brick school building such that it is ready for occupancy, as evidenced by an appropriate
occupancy permit issued by the Madison County Building Official, or removed to ground
level and all debris removed from the premises within two years of the effective date of the
sale. The amount of the guarantee shall be the greater of $250,000 or the purchase price of
the property. If Purchaser does not improve or remove the building as described, the
guarantee funds shall be used to demolish the building.
16. TAXES: The Seller is exempt from County real estate taxes.
17. DEFAULT: In the event Purchaser defaults under this contract, Seller shall be entitled, as its
sole remedy, to retain the Deposit as compensation for its loss. In the event Seller defaults,
purchaser shall be entitled to receive its Deposit returned as well as reimbursement for its
expenses, not to exceed Two Thousand Five Hundred and No/100 Dollars ($2,500) incurred
by purchaser in its financing, survey and legal work.

17
18. NOTICE: Whenever notice is to be given pursuant to any of the provisions of this contract,
such notice shall be delivered (i) by hand (ii) by overnight mail or (iii)certified mail to the
following addresses:
a. Seller: UPS/FedX-302 Thrift Road; Madison VA 22727
US Mail – P.O. Box 750 Madison VA 22727
b. Purchaser: ____________________________________________
c. ______________________________________________________
d. ______________________________________________________
19. Entire Agreement: This contract constitutes the entire agreement between the parties and
may not be modified or changed except by written instrument executed by all of the parties.
The Contract shall be construed, interpreted and applied according to the laws of the
Commonwealth of Virginia and shall be binding upon and inure to the benefits of the heirs,
successors and assigns of the parties.
20. Acceptance: This offer is consider a bid until accepted and signed by the seller. This offer
will remain valid until __________________________ at which time the bid will be accepted
or rejected by Seller. If accepted the contract will come into full force and effect and if
rejected, the deposit check will be returned to Purchaser and neither party shall have
further demands on the other.
21.
WITNESS the following signatures and seals:

PURCHASER(S):

_____________________ _________________________________________
Date

_____________________ _________________________________________
Date

SELLER:

County of Madison Virginia

_______________________ By:_____________________________________
Date Chairman, Madison County Board of Supervisors

18
MADISON COUNTY BOARD OF SUPERVISORS AGENDA ITEM STAFF REPORT
MEETING DATE: December 11, 2018

AGENDA TITLE: 10b Awarding Shelby Road Timber Contract

INDICATED MOTION(s): I move to authorize the County Administrator to negotiate and execute a timber
deed that will result in the sale of the Shelby Road timber to Verso Corporation.
STAFF LEAD: County Administrator Hobbs

TIMING: After extensive preparation and discussion, on December 6 bids for the timber at the
County’s Shelby Road (landfill/transfer station/animal shelter) property were
opened.
DISCUSSION: The process was “run” by Paul Haney under the timber consulting contract he has
with the County. Apparently everything ran smoothly and the bids came in higher
than anyone had hoped. All items appear to be in order.
The next step in the process is to award the bid and authorize signatures on a
“timber deed” contract.
FISCAL IMPACT: It appears that the net effect of this transaction will be a one-time positive
$366,000. Replanting is dependent on the appropriateness of the season after the
harvest has been completed.
REFERENCES: None

HISTORY: The County last sold the timber from this site in 2004 as a thinning operation.

RECOMMENDATION: Authorize the signing of a contract with the apparent high bidder per the indicated
motion.

ENCLOSURES:  Bid tabulation


 Net proceeds calculation
 Invitation to bid
 Proposed timber deed
Estimated Timber Sale Proceeds

Gross Sale Price $ 453,461.50

Less
Cairns Surveying $ 4,995.00
Environmental Timber Management 45,346.15 10% of gross
Tree Replanting 37,200.00 186 Aacres @$200/ac
Expenses $ 87,541.15

Net $ 365,920.35

Note: Replanting assumes the County does not qualify for a Virginia Department of
Forestry 35% "cost share" grant.
STANDING TIMBER FOR SALE
MADISON COUNTY, VIRGINIA

LOCK COMBO: 0206

Owner ......................... Madison County Board of Supervisors

Location ...................... One mile east of Route 29 on Route 662. 1st entrance after
the Madison County Transfer Station.

Type of Sale................ Sealed bids to be opened publicly.

Show Date .................. Friday, November 30, 2018 promptly at 10:00 a.m. or at
your convenience.

Sale Date ................... Thursday, December 6, 2018 promptly at 10:00 a.m.


at the entrance to the property (see attached map).

Harvest Type.............. All timber within the sale area (see attached map).

Estimated Volumes ... SEE NEXT PAGE.

Acreage ...................... 186 ACRES +/ -

Terms of Sale ............. 1/2 is due upon closing of the Timber Deed (within 2
weeks); 1/2 on March 15, 2019 or when logging begins,
whichever comes first.

Harvesting Period ...... 24 months from the date of the Timber Deed.

ADDITIONAL INFORMATION:
* The owner reserves the right to refuse any and all bids.
* Buyer will operate within the guidelines of the BEST MANAGEMENT
PRACTICES described by the Virginia Department of Forestry.
* A copy of the proposed contract is available upon request.
* Buyer shall have liability insurance with a minimum of $1,000,000.00 covering all
operations and will name seller as additionally insured and provide documentation
to seller.
* Bid may be presented at the scheduled bid opening or mailed to
P.O. Box 6761, Charlottesville, VA 22906. Please indicate on the
outside that it is a MADISON TIMBER BID and it will not
be opened until the scheduled time. All bids are confidential.

____________________
Paul M. Haney
November 6, 2018 Consulting Forester
TIMBER VOLUME ESTIMATE
MADISON TRACT
186 ACRES (GPS)
MADSION COUNTY, VIRGINIA

* VOLUMES ARE LISTED IN THOUSAND BOARD FEET (MBF).


* INTERNATIONAL 1/4" TREE SCALE USED.
* DBH MEANS DIAMETER OF THE TREE AT BREAST HEIGHT
(4.5 FEET ABOVE GROUND).

SALE DATE: Thursday, December 6, 2018 promptly at 10:00 a.m.

SAWTIMBER

LOBLOLLY YELLOW RED WHITE


DBH PINE POPLAR OAK OAK MISC.
10 88.1
12 236.4
14 500 28.1
16 732.9 77.4 2.7
18 507.5 80.5 1.6 5.5 5.6
20 256 71.3 6.3 2.8
22 38.9 52.2 6.9
24 11.5 23.5 3.5 2.3 3
26 36 39.6 2.4
28 7.8 3
30 10.2
32 4.3 3.1
34 7.5
TOTAL 2407.3 402.4 5.1 29.5 14.1

TOTAL VOLUME = 2858.4 MBF


PULPWOOD:
HDWD: 651 cds
PINE: 304 cds

THIS VOLUME ESTIMATE IS PROVIDED SOLELY FOR POTENTIAL BUYERS TO DETERMINE


INTEREST IN THE TIMBER. DUE TO VARIATIONS IN LOGGING METHODS AND UTILIZATION,
BUYERS SHOULD BASE THEIR BIDS ON THEIR OWN ESTIMATE OF THE QUALITY AND
QUANTITY OF THE TIMBER BEING OFFERED FOR SALE.

________________________
November 6, 2018 Paul M. Haney
Consulting Forester
MADISON COUNTY TRACT
Sale Entrance

SALE AREA
BID FORM
FOR
MADISON COUNTY BOARD of SUPERVISORS
MADISON COUNTY, VIRGINIA

SALE DATE: Thursday, December 6, 2018 promptly at 10:00 a.m.

I/We ________________________________ wish to submit a bid, based on my/our own


estimate of the quality and quantity of the timber being offered for sale on the MADISON
TIMBER BID one mile east of Route 29 on Route 662. 1st entrance after the Madison
County Transfer Station.

BID AMOUNT: $__________________________________________

By: ________________________ BID IS VALID FOR ________________

(MIN. 48 HRS)

Phone: _____________________

Address: ____________________________

____________________________
Deed to Convey Timber
This document
prepared by
Environmental THIS DEED made this 7th day of December, 2018, by and between Madison County
Timber Board of Supervisors, Grantor, and Verso Corporation, Grantee, whose address is 14231
Management, Burlingame Ln., Fredericksburg, VA 22407.
LLC

Tax Map 55 –
40B
W I T N E S S E T H:
That for and in consideration of the sum of $453,461.50 (FOUR HUNDRED
FIFTY THREE THOUSAND FOUR HUNDRED SIXTY ONE DOLLARS AND
50/100), with ½ payment due at signing, and with ½ payment due March 15, 2019 or
when logging begins, whichever comes first, the Grantor does hereby GRANT,
BARGAIN, SELL AND CONVEY with GENERAL WARRANTY and ENGLISH
COVENANTS OF TITLE unto the Grantee, ALL TIMBER located within the general
boundaries identified on the attached map and attached hereto of the property located in
the County of Madison, Virginia, which covers approximately 186 acres.

This conveyance is further made subject to all easements, restrictions, reservations and
other matter contained in duly recorded deeds, plats and other instruments constituting
constructive notice in the chain of title which have not expired by the time limitation
therein contained or otherwise become ineffective, as well as to the following conditions:

1. No marked boundary line trees are to be cut.

2. Damage, resulting from the timbering operation, to exterior fences, gates


or other structures or areas will be promptly repaired by the Grantee. Every effort will be
made to protect internal fences, but Grantee will not be held responsible for damage to
internal fences.

3. Roads must be continuously maintained at all times. Upon completion of


logging, the roads must be left in a condition equal to or better than the original condition
prior to the time of logging. Any newly constructed roads and log decks must be left in a
graded and seeded condition upon completion of logging. Grantee is responsible for
compliance with guidelines set forth in the BEST MANAGEMENT PRACTICES
MANUAL, as prescribed by the Virginia Department of Forestry, which apply to the
harvesting operations. Grantor, or Grantor’s agent and Grantee shall mutually agree upon
loading areas and major skidding road locations.

4. Grantee shall remove debris and trash resulting from the logging operation
including, but not limited to skidder tires and beverage containers, from the property, and
no oil shall be drained on the ground. In the event that any oil-based material is spilled,
the environmental clean up will be in accordance with all governmental regulations.
5. No treetops or laps may remain over property or cutting boundaries, or in
drains, roadways, streams or open fields; they must be pulled back and removed
immediately.

6. The Grantee shall have a period of 24 months, commencing from the date
of this Deed, to cut and remove the above described timber, after which time the timber
rights revert to the Grantor. In the event the logging is completed prior to the end of the
above described time period, Grantee agrees to execute a release to the timber and ingress
and egress rights to the tract.

7. Grantee shall notify Grantor or Grantor's agent at least 24 hours prior to


logging.

8. Grantee agrees and warrants that it will indemnify and save harmless
Grantor and/or Grantor's agent/s against claims, demands, actions or causes of action of
any manner or kind whatsoever, including, but not limited to, those for injury or death of
persons which may be due to operation of the Grantee upon these lands. Grantor will not
be held responsible for loss of harvestable timber covered by this deed due to theft or fire,
provided the Grantor is not responsible for the fire's origin.

9. Grantor assumes responsibility for compliance with the Virginia State


Seed Tree Law.

10. Grantor makes no guarantees as to the quality or quantity of the timber


being conveyed. Grantor retains all rights to the firewood.

11. For the entire period of this deed, the Grantor shall guarantee Grantee's
title to the forest products covered by this deed. Further, Grantor shall guarantee the right
of ingress and egress of said tract for the purpose of cutting and removing the timber.

12. Grantee agrees not to install a sawmill and assumes sole responsibility for
any water quality problem created by the harvesting of timber provided the Grantor or
Grantor's agent is not responsible for the water quality problem.

13. The Grantee shall observe all laws and take reasonable precautions with
regard to the Virginia forest fire laws. The Grantee shall practice forestry logging
techniques as outlined in the Virginia Department of Forestry's Best Management
Practices Handbook, where applicable.

14. Grantee shall protect from unnecessary injury, young growth and other
trees not designated for harvest by this deed. In the event that unnecessary damage occurs
to young growth or undesignated trees are cut, the Grantee shall pay for such trees at a
rate of three times the appraised value as determined by Environmental Timber
Management. The Grantee shall promptly pay for any costs associated with the inventory
and appraisal for the undesignated cut trees, as well as the value of the trees.
15. This Agreement shall be governed by and construed according to the laws
of the Commonwealth of Virginia. Jurisdiction and venue shall be in the State Courts of
Madison County, Virginia.

16. The Grantee shall have liability insurance with a minimum of


$1,000,000.00 covering all operations relating to this deed and will name Grantor as
additionally insured and provide documentation to Grantor.

Grantee agrees to purchase the above-described timber with the above conditions
applying as evidence by the signature of its authorized representative.

WITNESS the following signatures and seals:

COUNTY OF MADISON

By: ______________________________________
Jack Hobbs, County Administrator for
Madison County Board of Supervisors

STATE OF _____________________
COUNTY OF __________________, to-wit:

I, __________________________a Notary Public in and for the County and State aforesaid, do
hereby certify that Jack Hobbs whose name is signed to the foregoing deed bearing the date of
the _____day of ________________, 2018, have acknowledged the same before me in my
County aforesaid.

My commission expires: ________________________.

Given under my hand this _____day of ______, ________.

_______________________ _______________________
NOTARY PUBLIC Notary Registration Number
By: _____________________________
Donald Baird for
Verso Corporation

STATE OF _____________________
COUNTY OF __________________, to-wit:

I, __________________________a Notary Public in and for the County and State aforesaid, do
hereby certify that Donald Baird whose name is signed to the foregoing deed bearing the date of
the _____day of ________________, 2018, have acknowledged the same before me in my
County aforesaid.

My commission expires: ________________________.

Given under my hand this _____day of ______, ________.

_______________________ _______________________
NOTARY PUBLIC Notary Registration Number
MADISON COUNTY BOARD OF SUPERVISORS AGENDA ITEM STAFF REPORT

MEETING DATE: December 11, 2018


AGENDA TITLE: 10c FY20 Budget Calendar

INDICATED N/A
MOTION(s):
STAFF LEAD: County Administrator Hobbs

TIMING: The Madison County Board of Supervisors has historically engaged in the
annual budgeting process late in January with adoption in April. However, staff
work to support the effort begins earlier. Guidance on this issue was requested
on November 27.

DISCUSSION: The FY20 budget will be more complicated and difficult than in recent years
due to the reassessment, deferred capital improvements that need to be
addressed, adjustments to the personnel program and other anticipated
significant recurring operational costs.

Much time during Madison County’s budget development process is dedicated


to hearing presentations from a series of departments and “outside” agencies.
It would be helpful if the Board could suggest which it wants to focus on – i.e.
allot more than the 15 minute slot for each as was the “rule” last year – and
which it might not want to invite.

There are also a series of items of “special” concern such as tax rates, EMS
issues, IT plans, the results of the personnel study, and the capital planning
effort or school capital planning effort. It would be helpful if the Board
members would prioritize these or others so they can be developed for
discussion.

FISCAL IMPACT: N/A

REFERENCES: N/A

HISTORY: N/A

RECOMMENDATION: Discuss the proposed calendar and direct the staff as appropriate.

ENCLOSURES:  Proposed FY20 Budget Calendar


Madison County FY19‐20 Budget Development Schedule
7‐Dec‐18 Draft
12/7/2018 Issue Budget Request Instructions

12/11/2018 Budget Calendar Approved

1/11/2018 Agency Budget Requests Due

1/14/2018 Departmental Budget Requests Due

1/24/2019 Work Session #1 Review FY18 CAFR,FY19 YTD performance, FY20 Process


Debt Position
FY20 Issues, Goals & Strategy
Capital Improvement Planning

1/31/2019 Work Session #2 2:00 – 6:00 p.m. Departmental Presentations, Budget Books Delivered

2/7/2019 Work Session #3 2:00 – 6:00 p.m. Departmental & Outside Agency Presentations

2/11/2019 School Board Public Hearing 6:30 p.m. Anticipated

2/14/2019 Worksession #4 2:00 – 6:00 p.m. Departmental & Outside Agency Presentations

2/21/2019 Worksession #5 2:00 – 6:00 p.m. Late and Rescheduled Budget Request Presentations

2/28/2019 Work Session #6 2:00 – 6:00 p.m. Revenue Estimates

3/7/2019 Work Session #7 3:00 – 6:00 p.m. (May not be needed)

3/14/2019 Work Session #8 2:00 – 6:00 p.m. School budget; Discussion on then‐current status

3/21/2019 Work Session #9 2:00 – 6:00 p.m. Full budget proposal presentation; Board discussion


Budget Public hearing authorized
Usual and customary late ite
VRS ra
3/28/2018 School Board Budget Adoption Meeting 6:30 p.m. Health insurance r
Employee ra
VACORP/LODA r
4/9/2019 Public Hearing on Full Budget Proposal 7:00 p.m. (after the regular meeting) State budget
Comp Board fig
School Board budget req
4/15/2019 Relay status of any tax rate changes to Commissioner of the Revenue and Treasurer for billing purposes. Contingency fun
CIP project decis
4/23/2019 BoS Approves the Budget Regular Meeting

5/1/2019 Deadline for BoS to approve school budget (or 30 days after receipt of estimates of state funds if later)

6/25/2019 Budget Appropriation  Regular Meeting


MADISON COUNTY BOARD OF SUPERVISORS AGENDA ITEM STAFF REPORT

MEETING DATE: December 11, 2018


AGENDA TITLE: 10d Board of Equalization Nomination Confirmation

INDICATED I move to set the rate of pay for members of the Board of Equalization at $50
MOTION(s): per member per meeting attended.

STAFF LEAD: County Administrator Hobbs

TIMING: After an advertising and recruitment effort, the Board of Supervisors


nominated five individuals to serve on the Board of Equalization during its
meetings on September 25 and October 3, 2018. Certification that each had
received the training required for appointment by the circuit court was
received on December 4. That group would work to get organized so that it is
ready to receive assessment appeal applications by the end of January 2019.

DISCUSSION: Although the next step in the process is to request that the circuit appoint
these individuals, staff would pause to verify the following:
 Five members and no alternates are being recommended to the court for a
1-year appointment.
 The window for making appeals would open as soon as the process for
appealing to the assessor has run its course and end on December 31, 2018
as per past practice.
 The rate of pay for Board of Equalization members. Staff suggests paying
each members at least $50 per meeting after the members are officially
appointed.

FISCAL IMPACT: Outlays to support the Board of Equalization were included in the budget.

REFERENCES: N/A

HISTORY: N/A

RECOMMENDATION: Discuss the Board of Equalization’s formation and status, establish its pay rate
and direct staff as appropriate.

ENCLOSURES:  Roster of Board of Equalization nominees


 Board of Equalization Training Certificate (November 30, 2018)
 §58.1-3370 Appointment, §58.1-3374. Qualifications of members; vacancies and
§58.1-3378. Sittings; notices thereof (and authority to set appeal deadlines.
 Committee pay rate survey
 Board of Equalization budget
Board of Equalization Nominees (as of December 7, 2018)

Nominee Nomination Date


Phil Brockman September 25, 2018
3617 Beautiful Run Rd
Orange, VA 22960
540 672 2040 (Home)
434 996 3030 (Cell)
brockuno@comcast.net

John Quinley September 25, 2018


2981 Ruth Rd
Madison, VA 22727
H540/948-4304
M540/223-1960
gmva2005@gmail.com

Bill Gentry September 25, 2018


40 Commerce Lane, Suite A
Rochelle, VA 22738
B540-948-5050
M540-718-4210
bgentry.broker@gmail.com

Doug Fears September 25, 2018


214 Ashlawn Drive
Madison, VA 22727
H540/948-6003
dfears50@gmail.com

Kimberly Pumphrey October 3, 2018


634 River Road
Madison, VA 22727
H540 948 3033
M540-219-6367
kapump375@gmail.com
The following are excerpts from the Code of Virginia:

§ 58.1-3370. Appointment.
A. The circuit court having jurisdiction within each city and each county other than those counties
operating under § 58.1-3371 shall, in each tax year immediately following the year a general
reassessment or annual or biennial assessment is conducted in such city or county, appoint for such city
or county a board of equalization of real estate assessments, unless such county or city has a permanent
board of equalization appointed according to law. In addition, at the request of the local governing body,
the circuit court may appoint alternate members as provided in subsection B of § 58.1-3373, and the
provisions of that subsection shall apply mutatis mutandis.
B. The term of any board of equalization appointed under the authority of this section shall expire one
year after the effective date of the assessment for which it was appointed. However, if a taxpayer applies
to the commissioner of the revenue or other official performing the duties imposed on commissioners of
the revenue for relief from a real property tax assessment prior to the expiration of the board of
equalization's term, and the term of the board of equalization expires prior to a final determination on
such application for relief, and the taxpayer advises the circuit court that he wishes to appeal the
determination to the board of equalization, then the circuit court may reappoint the board of equalization
to hear and act on such appeal.

§ 58.1-3374. Qualifications of members; vacancies. (Last paragraph not included)


Except as provided in § 58.1-3371 or 58.1-3373, every board of equalization shall be composed of not
less than three members nor more than five members or the number of local election districts in the
locality, whichever is greater. In addition to such regular members, at the request of the local governing
body, the circuit court for any locality shall appoint one alternate member in the case of a board with
less than five members, and two alternate members in the case of a board with five or more members.
The qualifications, terms and compensation of alternate members shall be the same as those of regular
members. A regular member when he knows he will be absent from or will have to abstain from any
proceeding at a meeting shall notify the chairman of the board of equalization at least 24 hours prior to
the meeting of such fact. The chairman may select an alternate to serve in the absent or abstaining
member's place and the records of the board shall so note. Such alternate member may vote on any
proceeding in which a regular member is absent or abstains.
All members of every board of equalization, including alternate members, shall be residents, a majority
of whom shall be freeholders, in the county or city for which they are to serve and shall be selected from
the citizens of the county or city. Appointments to the board of equalization shall be broadly
representative of the community. Thirty percent of the members of the board shall be commercial or
residential real estate appraisers, other real estate professionals, builders, developers, or legal or financial
professionals, and at least one such member shall sit in all cases involving commercial, industrial or
multi-family residential property, unless waived by the taxpayer. No member of the board of assessors
shall be eligible for appointment to the board of equalization for the same reassessment. In order to be
eligible for appointment, each prospective member of such board shall attend and participate in the basic
course of instruction given by the Department of Taxation under § 58.1-206. In addition, at least once in
every four years of service on a board of equalization, each member of a board of equalization shall take
continuing education instruction provided by the Tax Commissioner pursuant to § 58.1-206. Any
vacancy occurring on any board of equalization shall be filled for the unexpired term by the authority
making the original appointment.

§ 58.1-3378. Sittings; notices thereof.


Each board of equalization shall sit at and for such time or times as may be necessary to discharge the
duties imposed and to exercise the powers conferred by this chapter. Of each sitting public notice shall
be given at least 10 days beforehand by publication in a newspaper having general circulation in the
county or city and, in a county, also by posting the notice at the courthouse and at each public library,
voting precinct or both. Such posting shall be done by the sheriff or his deputy. Such notice shall inform
the public that the board shall sit at the place or places and on the days named therein for the purpose of
equalizing real estate assessments in such county or city and for the purpose of hearing complaints of
inequalities wherein the property owners allege a lack of uniformity in assessment, or errors in acreage
in such real estate assessments. The board also shall hear complaints that real property is assessed at
more than fair market value. Except as otherwise provided by the Code of Virginia:
1. The fair market value of real property shall be established by the board as of January 1 of the applicable
year; or
2. If a county or city has adopted July 1 as its tax day for real property pursuant to § 58.1-3011, then, for
other than public service corporation property, the fair market value of real property shall be established
by the board as of July 1 of the applicable year.
The governing body of any county or city may provide by ordinance the date by which applications must
be made by property owners or lessees for relief. Such date shall not be earlier than 30 days after the
termination of the date set by the assessing officer to hear objections to the assessments as provided in
§ 58.1-3330. If no applications for relief are received by such date, the board of equalization shall be
deemed to have discharged its duties. Such governing body may also provide by ordinance the deadline
by which all applications must be finally disposed of by the board of equalization. All such deadlines
shall be clearly stated on the notice of assessment. Notwithstanding such deadlines, if a taxpayer applies
to the commissioner of the revenue or other official performing the duties imposed on commissioners of
the revenue for relief from a real property tax assessment prior to such deadlines, and such deadlines
occur prior to a final determination on such application for relief, and the taxpayer advises the circuit
court that he wishes to appeal the determination to the board of equalization, then the circuit court may
require the board of equalization to hear and act on such appeal. The governing body may provide for
applications for relief to be made electronically; however, taxpayers retain the right to file applications
on traditional paper forms provided by the governing body as long as such forms are submitted prior to
the established deadline. If such paper forms are mailed by the applicant, the postmark date shall be
considered the date of receipt by the governing body. A hearing for relief before the board of equalization
regarding an assessment on residential property shall not be denied on the basis of a lack of information
on the application for relief, as long as the application includes the address, the parcel number, and the
owner's proposed assessed value for the property. If the application for relief is sent electronically, the
date the applicant sends the application shall be considered the date of receipt by the governing body.
The application is considered sent when it meets the requirements of subsection (a) of § 59.1-493. A
hearing for relief before the board of equalization regarding an assessment on commercial, multi-family
residential, or industrial property on the basis of fair market value shall not be denied on the basis of a
lack of information on the application, as long as documentation of any applicable assessment
methodologies is submitted with the application, and the application includes the address, the parcel
number, and the owner's proposed assessed value for the property.
As of December, 2018 compensation is provided to board and committee members at the rates
shown:

Board of Supervisors Chairman: $10,000/yr


Other Supervisors: $9,000/yr

Planning Commission Chairman & Secretary: $115/meeting


Other Commissioners: $40/meeting

Board of Zoning Appeals $30/meeting

Building Code Appeals Board $30/meeting

Board of Equalization Not clearly established (Apparently $2,000/member in 2013)


MADISON COUNTY BOARD OF SUPERVISORS AGENDA ITEM STAFF REPORT
MEETING DATE: December 11, 2018

AGENDA TITLE: 10e Discussion on Joint meeting with Town Council in January

INDICATED MOTION(s): N/A

STAFF LEAD: County Administrator Hobbs

TIMING: Over the past few months Board members have mentioned the idea of a joint
meeting with the Madison Town Council.

DISCUSSION: It would be appropriate to begin preparing for a meeting between two governing
bodies if such a session it is to be held in January.
FISCAL IMPACT: None

REFERENCES: None

HISTORY: This has been talked about for at least a year.

RECOMMENDATION: Per the Board’s discretion.


ENCLOSURES: None
MADISON COUNTY BOARD OF SUPERVISORS AGENDA ITEM STAFF REPORT
MEETING DATE: December 11, 2018

AGENDA TITLE: 11a Discussion on Paying Claims Prior to January 8, 2019

INDICATED MOTION(s): N/A

STAFF LEAD: County Administrator Hobbs

TIMING: If the cancellation of the December 26 meeting stands, there will be no regular
meeting between December 11 and January 9.

DISCUSSION: The span of time is longer than normal and could lead to vendor payment issues. As
a reminder to the Board, staff plans to “pay the bills” during the interim without
Board approval with the understanding that reports will be delivered for ratification
in January.
FISCAL IMPACT: None

REFERENCES: None

HISTORY: This is consistent with what the Board allowed during the last holiday season.

RECOMMENDATION: Assuming Board members do not object, no action is necessary.


ENCLOSURES: None
MADISON COUNTY BOARD OF SUPERVISORS AGENDA ITEM STAFF REPORT

MEETING DATE: December 11, 2018


AGENDA TITLE: 12a – Status Report on Projects

INDICATED MOTION(s): N/A

STAFF LEAD: County Administrator Jack Hobbs

TIMING: This is a report on the current status of a series of ongoing projects and “open”
items.

DISCUSSION: Questions from the Board about any item on the list are welcome.

FISCAL IMPACT: N/A

REFERENCES: N/A

HISTORY: Staff work on an evolving list of projects and unresolved situations is ongoing. This
report is intended to remind and brief Board members on several of these.

RECOMMENDATION: Receive the report and make inquiries as appropriate.

ENCLOSURES:  Open projects list


Open and Active Projects as of December 7, 2018

Reassessment The field work by the assessment contractor seems to be wrapping up since
reassessment notices are expected to be issued any time now (although the court
approved the 90-day extension), and we anticipate assessor appeals to run through the
end of January. The certification that the Board of Equalization nominees have been
appropriately trained by the Department of Taxation has been received, and the clerk
hired to assist that group is being upfitted with an office and office equipment. A request
to set the Board’s pay rate and verify other features of its operation is scheduled for
consideration by the Board of Supervisors on December 11.
Recodification Work on the recodification project is still in the staff comment compilation phase.
Architect Procurement Consultants have not been selected for the County building renovation & move to health
department building project or the 101 N Main Street vs arcade building study.
Criglersville Property The Criglersville property RFP has been posted with an April 12, 2019 deadline.
Various Pending Studies  Solid Waste Management Plan Update: Documents have been filed and are under
Underway and Under review by DEQ.
Review  Hazard Mitigation Plan: The document has been approved by FEMA and is
scheduled for BoS review on December 11.
 Public Safety Radios: Reports on the radio project will be made as we work through
the “phase 2” study.
 Emergency Operations Plan: The EOP has been updated by the County’s
emergency services coordinator.
 Flood Plain Maps: A meeting with a “Consultation Coordinating Officer” from
FEMA is scheduled for December 11.
 Personnel Study: The personnel study project is proceeding with the various
elements coming together but slower than anticipated.

Equal Employment Staff is still working to meet the EEOP requirement through Springsted.
Opportunity Plan
Plow & Hearth Plow & Hearth attorneys have advised on “where to send” the check but signatures and
money transfer details have not been worked out.
Work to generate a list of potential projects and priorities that would support a
Projects & Priorities List
discussion that would frame our work plans is ongoing.
Set up for FY20 budget Staff will be working to develop a proposed FY20 budget process in the coming weeks.
process A request for staff to begin developing capital improvement plan requests has been
issued.
Leases An effort to compile County leases, contracts, etc. is underway. Work to develop
new or update “occupancy agreements” in all locations where the County owns
or uses space is ongoing.
Motion to Go Into Closed Session: December 11, 2018

I move that the Board convene in a closed session pursuant to Virginia Code Section 2.2-3711(A)(1) for discussion on
the performance of the County Administrator.

Foster Jackson Hoffman McGhee Weakley


Motion:
Second:
“Aye”:
“Nay”:

Motion to Reconvene In Open Session:


I move that the Board re-convene in open session.
Foster Jackson Hoffman McGhee Weakley
Motion:
Second:
“Aye”:
“Nay”:

Motion to Certify Compliance:


I move to certify by roll-call vote that only matters lawfully exempted from open meeting requirements
pursuant to Virginia Code Section 2.2-3711(A)(1), only matters that were identified in the motion to convene in
a closed session were heard, discussed or considered in the closed meeting.
Foster Jackson Hoffman McGhee Weakley
Motion:
Second:
“Aye”:
“Nay”:
§ 2.2-3711. Closed meetings authorized for certain limited purposes.
A. Public bodies may hold closed meetings only for the following purposes:
Personnel 1. Discussion, consideration, or interviews of prospective candidates for employment; assignment,
appointment, promotion, performance, demotion, salaries, disciplining, or resignation of specific public officers,
appointees, or employees of any public body; and evaluation of performance of departments or schools of public
institutions of higher education where such evaluation will necessarily involve discussion of the performance of
specific individuals. Any teacher shall be permitted to be present during a closed meeting in which there is a
discussion or consideration of a disciplinary matter that involves the teacher and some student and the student
involved in the matter is present, provided the teacher makes a written request to be present to the presiding officer
of the appropriate board. Nothing in this subdivision, however, shall be construed to authorize a closed meeting
by a local governing body or an elected school board to discuss compensation matters that affect the membership
of such body or board collectively.
Real Estate 3. Discussion or consideration of the acquisition of real property for a public purpose, or of the
disposition of publicly held real property, where discussion in an open meeting would adversely affect the
bargaining position or negotiating strategy of the public body.
Privacy 4. The protection of the privacy of individuals in personal matters not related to public business.
Economic Development 5. Discussion concerning a prospective business or industry or the expansion of an
existing business or industry where no previous announcement has been made of the business' or industry's
interest in locating or expanding its facilities in the community.
Legal 7. Consultation with legal counsel and briefings by staff members or consultants pertaining to actual or
probable litigation, where such consultation or briefing in open meeting would adversely affect the negotiating or
litigating posture of the public body. For the purposes of this subdivision, "probable litigation" means litigation
that has been specifically threatened or on which the public body or its legal counsel has a reasonable basis to
believe will be commenced by or against a known party. Nothing in this subdivision shall be construed to permit
the closure of a meeting merely because an attorney representing the public body is in attendance or is consulted
on a matter.
Legal 8. Consultation with legal counsel employed or retained by a public body regarding specific legal matters
requiring the provision of legal advice by such counsel. Nothing in this subdivision shall be construed to permit
the closure of a meeting merely because an attorney representing the public body is in attendance or is consulted
on a matter.
Public Safety 19. Discussion of plans to protect public safety as it relates to terrorist activity or specific
cybersecurity threats or vulnerabilities and briefings by staff members, legal counsel, or law-enforcement or
emergency service officials concerning actions taken to respond to such matters or a related threat to public safety;
discussion of information subject to the exclusion in subdivision 2 or 14 of § 2.2-3705.2, where discussion in an
open meeting would jeopardize the safety of any person or the security of any facility, building, structure,
information technology system, or software program; or discussion of reports or plans related to the security of
any governmental facility, building or structure, or the safety of persons using such facility, building or structure.
Negotiations 29. Discussion of the award of a public contract involving the expenditure of public funds, including
interviews of bidders or offerors, and discussion of the terms or scope of such contract, where discussion in an
open session would adversely affect the bargaining position or negotiating strategy of the public body.
Economic Development 39. Discussion or consideration of information subject to the exclusion in subdivision
3 of § 2.2-3705.6 related to economic development.