2018-05-15T14:40:47-05:00 2017-06-30 420714325 RSM US LLP 201 N HARRISON STREET SUITE 300 DAVENPORT IA 528011999 990 2016-07-01 370808925 THE HOPEDALE MEDICAL FOUNDATION HOPE 3094494298 PO BOX 267 HOPEDALE IL 61747 MARK F ROSSI PRESIDENT/CHIEF OPERATING OFFICER 3094494298 2018-05-15 1 JENIFER L CHASE P01306883 5638884000 2016 2022-09-23 18:48:47Z HOPEDALE MEDICAL COMPLEX MARK F ROSSI PO BOX 267 HOPEDALE IL 61747 27139456 0 X WWW.HOPEDALEMC.COM X 1961 IL TO PROVIDE OUTSTANDING PHYSICIAN-DIRECTED HEALTH, WELLNESS, AND RESIDENTIAL SERVICES IN A PERSONAL, PRIVATE, FAMILY ATMOSPHERE. 8 5 407 62 670873 -242080 47863 176201 20168253 21514143 90956 148399 3538057 3810398 23845129 25649141 29262 25669 0 0 13010929 13638487 0 0 6369 9309214 9898263 22349405 23562419 1495724 2086722 37148327 38997966 16557161 16138278 20591166 22859688 X TO PROVIDE OUTSTANDING PHYSICIAN-DIRECTED HEALTH, WELLNESS, AND RESIDENTIAL SERVICES IN A PERSONAL, PRIVATE, FAMILY ATMOSPHERE. 0 0 18167967 25669 18949089 THE HOPEDALE MEDICAL COMPLEX IS OWNED AND OPERATED BY THE NOT-FOR-PROFIT CHARITABLE CORPORATION KNOWN AS THE HOPEDALE MEDICAL FOUNDATION. THE HOPEDALE MEDICAL COMPLEX STARTED AS A 20-BED HOSPITAL IN 1955 IN HOPEDALE, ILLINOIS AND HAS EXPANDED OVER THE YEARS TO OFFER CONTINUUM OF CARE SERVICES, INCLUDING A 25-BED ACUTE CARE HOSPITAL, NURSING HOME, INDEPENDENT AND ASSISTED LIVING FACILITY AS WELL AS A WELLNESS CENTER.THE HOPEDALE HOSPITAL IS A CRITICAL ACCESS HOSPITAL AND OFFERS VIRTUALLY THE SAME SERVICES AS A LARGER, URBAN HOSPITAL, INCLUDING 24 HOUR EMERGENCY ROOM, ICU, GENERAL AND ADVANCED VASCULAR SURGERY, ORTHOPEDIC SURGERY, PLASTIC/RECONSTRUCTIVE SURGERY, OPEN MRI AND CT SCANNER. THE HOPEDALE MEDICAL COMPLEX ALSO OFFERS PHYSICIAN SERVICES THROUGH FIVE SATELLITE OFFICES IN ATLANTA, MANITO, MACKINAW, DELAVAN, AND TREMONT.HOPEDALE WELLNESS CENTER HAS AN INDOOR GYM, WALKING TRACK, THREE THERAPY POOLS, DAY CARE, PHYSICAL THERAPY DEPARTMENT AND ALL PURPOSE ROOM FOR THEIR MEMBERS TO USE. THE WELLNESS CENTER ALSO OFFERS CLUB MEMBERSHIPS TO THE RESIDENTS OF HOPEDALE AND SURROUNDING AREAS. PRESENTLY, THE WELLNESS CENTER HAS APPROXIMATELY 1,500 MEMBERS WHO ENROLLED IN VARIOUS PROGRAMS AND ACTIVITIES. A SPORTS MEDICINE PROGRAM HAS ALSO BEEN DEVELOPED FOR LOCAL SCHOOL DISTRICTS AND SPORTS TEAMS THAT THE COMPLEX SERVES TO IMPROVE CONDITIONING OF ATHLETES AND TO REDUCE SPORTS INJURIES. THE COST TO OPERATE THE WELLNESS CENTER IS MORE THAN THE REVENUE THAT IS DERIVED FROM THE HEALTH MEMBERSHIPS WITH THE DIFFERENCE REPRESENTING A BENEFIT TO THE RESIDENTS AND THE COMMUNITY.SERVICE AREATHE HOPEDALE MEDICAL COMPLEX SERVES THE MEDICAL NEEDS OF THE LOCAL CITIZENS WITHIN A 50 MILE RADIUS OF HOPEDALE, ILLINOIS. THE HOPEDALE MEDICAL COMPLEX OPERATES FIVE SATELLITE PHYSICIAN OFFICES IN ADDITION TO A PHYSICIAN'S OFFICE LOCATED ON THE MAIN CAMPUS FOR THE CONVENIENCE OF OUR PATIENTS WITHIN OUR SERVICES AREA.HOSPITAL STAFFTHE HOPEDALE MEDICAL COMPLEX HAS A DEDICATED STAFF OF TRAINED HEALTH PROFESSIONALS THAT HAVE JOINED TOGETHER AS A TEAM TO PROVIDE THE BEST POSSIBLE HEALTH CARE FOR THE PATIENTS AND RESIDENTS OF OUR COMMUNITY.FINANCIAL ASSISTANCE PROGRAMSTHE HOPEDALE MEDICAL COMPLEX HAS POLICIES IN PLACE TO ENSURE THAT NECESSARY HEALTH SERVICES ARE NOT DENIED BASED ON ABILITY TO PAY AND THAT ALL PATIENTS ARE TREATED FAIRLY AND EQUITABLY, AND WITH RESPECT AND COMPASSION. HOPEDALE MEDICAL COMPLEX ASSISTS PERSONS WITHOUT INSURANCE COVERAGE BY WAIVING ALL OR PART OF THE CHARGES FOR SERVICES IT PROVIDES. SIGNS ARE POSTED IN THE ADMITTING AREAS SO THAT HOSPITAL POLICIES ARE CLEARLY COMMUNICATED TO PATIENTS AND PROSPECTIVE PATIENTS.EMERGENCY SERVICESTHE HOPEDALE MEDICAL COMPLEX OPERATES AN EMERGENCY ROOM THAT IS OPEN 24 HOURS A DAY, 365 DAYS A YEAR. THE EMERGENCY ROOM PROVIDES SERVICE TO ALL INDIVIDUALS, REGARDLESS OF THEIR ABILITY TO PAY AND DENIES SERVICE TO NO ONE.COMMUNITY LEADERSHOPEDALE MEDICAL FOUNDATION'S BOARD OF DIRECTORS IS COMPOSED OF VARIOUS LEADERS FROM THE COMMUNITY. THE DIRECTOR'S REPRESENT DIVERSE BACKGROUNDS AND INDUSTRIES WITHIN THE COMMUNITY.MEDICAL STAFFTHE MEDICAL STAFF AT HOPEDALE MEDICAL CENTER IS OPEN AND OFFERS PRIVILEGES TO ALL QUALIFIED PHYSICIANS IN THE AREA.UNCOMPENSATED CARETHE HOPEDALE MEDICAL COMPLEX PARTICIPATES IN MEDICARE, MEDICAID, CHAMPUS, TRICARE AND OTHER GOVERNMENT SPONSORED HEALTH CARE PROGRAMS. THE CONTRACTED AMOUNT FOR THE ABOVE SERVICES EXCEPT MEDICARE IS OFTEN LESS THAN THE ACTUAL COST OF THE SERVICES, WITH THE DIFFERENCE REPRESENTING A BENEFIT TO THE PATIENT AND THE COMMUNITY. 1900596 3174346 HOPEDALE NURSING HOME IS A 54-BED LICENSED FACILITY OFFERING 24-HOUR NURSING CARE. IT IS PHYSICALLY LOCATED ON CAMPUS AND CONNECTED TO THE HOSPITAL FOR THE CONVENIENCE OF OUR RESIDENTS AND THEIR FAMILIES. 903204 1578696 HOPEDALE COMMONS IS A 67-BED INDEPENDENT AND ASSISTED LIVING FACILITY. IT IS ALSO LOCATED ON CAMPUS AND IS LOCATED NEAR THE HOSPITAL FOR THE CONVENIENCE OF OUR RESIDENTS AND THEIR FAMILIES. 20971767 1 1 0 1 0 0 0 0 1 0 1 0 0 0 1 1 0 1 0 0 0 0 0 0 0 0 1 1 0 1 1 1 0 0 0 0 0 0 0 1 1 1 0 0 0 0 1 1 1 1 0 0 1 69 0 1 407 1 1 1 0 0 0 0 0 0 0 0 0 X 8 5 1 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 0 IL X NICHOLAS PENN 3094494364 107 TREMONT STREET HOPEDALE IL 61747 X ALFRED N ROSSI MD CHAIRMAN/CHIEF EXECUTIVE OFFICER 2.00 X X 36210 0 0 MATTHEW B ROSSI MD SECRETARY/TREASURER 2.00 X X 45564 0 0 MICHAEL J MCLAUGHLIN DIRECTOR 2.00 X 0 0 0 ROLAND RICH DIRECTOR 2.00 X 0 0 0 TOM HIESER DIRECTOR 2.00 X 0 0 0 RAYMOND E SLACK DIRECTOR 2.00 X 0 0 0 JARIE A SLACK DIRECTOR 2.00 X 0 0 0 DONALD G OSWALD DIRECTOR 2.00 X 0 0 0 NICHOLAS PENN CHIEF FINANCE OFFICER 40.00 X 103877 0 17782 MARK F ROSSI PRESIDENT/CHIEF OPERATING OFFICER 40.00 X 261593 0 5501 MELODY COWDREY VICE PRESIDENT OF REVENUE CYCLE 40.00 X 126314 0 8162 LISA MCLAUGHLIN DIRECTOR OF RETAIL PHARMACY 32.00 X 138582 0 9522 ROBERT SEIDL MD PHYSICIAN 30.00 X 136056 0 0 TIMOTHY SONDAG CHIEF NURSING OFFICER 40.00 X 143640 0 18747 EMILY WHITSON VICE PRESIDENT OF CLINICAL OPERATIONS 40.00 X 126590 0 10914 1118426 0 70628 8 0 1 0 EMERGENCY PHYSICIAN STAFFING SOLUTIONS 12528 SR 78 HAVANA IL 62644 STAFFING AGENCY 1126522 TRI-COUNTY ANESTHESIA SC PO BOX 267 HOPEDALE IL 61747 ANESTHESIA SERVICES 445850 POINTCORE LLC 800 NE GLEN OAK PEORIA IL 61603 INFORMATION TECHNOLOGY 179369 360 TRANSCRIPTION 14977 KING ROAD DANVERS IL 61747 TRANSCRIPTION 147004 CENTRAL ILLINOIS IMAGING PO BOX 741127 LOS ANGELES CA 90074 IMAGING 105413 5 28106 148095 176201 PATIENT SERVICE REVENUE 621110 16705896 16705896 NURSING HOME 623000 3424722 3424722 ASSISTED AND INDEPENDENT 623000 1630875 1630875 WELLNESS CENTER 713940 281833 281833 MASSAGE THERAPY 621110 59695 59695 -588878 -588878 21514143 148399 12133 136266 284693 0 284693 284693 284693 4337043 1490315 2846728 2247683 599045 INTEREST RATE SWAP INCOME 900009 326917 326917 CHILD CARE 624410 155682 155682 CAFETERIA INCOME 722210 105173 105173 91205 91205 678977 25649141 23702131 670873 1099936 15169 15169 10500 10500 488857 81774 407083 241165 67057 174108 10753652 10164660 588992 149965 131542 18423 1278491 1183355 95136 726357 647012 79345 30111 30111 108384 108384 8740 8740 782332 540617 237923 3792 175841 46521 129320 2784507 2559620 223847 1040 10595 650 9945 911771 878621 33150 69328 59770 8021 1537 412955 412857 98 2079348 1983493 95855 181314 21460 159854 SERVICES 1247128 1140278 106850 MEDICAID PROVIDER TAXES 544624 544624 REPAIRS & MAINTENANCE 326448 306363 20085 DIRECTORSHIP EXPENSE 150000 150000 74837 25824 49013 23562419 20971767 2584283 6369 X 6283589 6020562 617051 668207 7646 0 2630111 3789165 794997 919468 231427 363626 50824148 28160312 22819242 22663836 2588090 2864526 1176174 1708576 37148327 38997966 2302524 2139865 423503 478617 11884377 11328052 1946757 2191744 16557161 16138278 X 20014187 22233665 576979 626023 20591166 22859688 37148327 38997966 X 2086722 167949 13851 X X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 8740 8740 0 PART II-B, LINE 1: PART II-B, LINE 1I, OTHER LOBBYING ACTIVITIES: LOBBYING EXPENDITURES RELATED TO MEMBERSHIP DUES INCLUDED: 39% OF MEMBERSHIP DUES PAID TO THE ILLINOIS HOSPITAL ASSOCIATION, OR $8,740. 1 2879 4350 3095 4134 0 917696 917696 23491959 10025950 13466009 23556812 16989609 6567203 2857681 1144753 1712928 22663836 ASBESTOS ACCRETION LIABILITY 193714 CAPITALIZED LEASE OBLIGATIONS 841966 ESTIMATED THIRD PARTY PAYOR SETTLEMENT 1004629 INTEREST RATE SWAP AGREEMENT 151435 2191744 X PART IV, LINE 1B: SOME NURSING HOME PATIENTS HOLD SMALL AMOUNTS OF FUNDS ON DEPOSIT WITH THE ORGANIZATION FOR INCIDENTALS AND LOW VALUE SERVICES, SUCH AS HAIR-CUTS. THE ORGANIZATION DOES NOT RECORD THE AMOUNTS AS ASSETS OF THE ORGANIZATION. PART X, LINE 2: THE FOUNDATION IS A NOT-FOR-PROFIT CORPORATION AS DESCRIBED IN SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE AND IS EXEMPT FROM FEDERAL INCOME TAXES ON RELATED INCOME PURSUANT TO SECTION 501(A) OF THE CODE. THE FOUNDATION FILES A FORM 990 (RETURN OF ORGANIZATION EXEMPT FROM INCOME TAX) ANNUALLY. WHEN THE RETURN IS FILED, IT IS HIGHLY CERTAIN THAT SOME POSITIONS TAKEN WOULD BE SUSTAINED UPON EXAMINATION BY THE TAXING AUTHORITIES, WHILE OTHERS ARE SUBJECT TO UNCERTAINTY ABOUT THE MERITS OF THE TAX POSITION TAKEN OR THE AMOUNT OF THE POSITION THAT WOULD ULTIMATELY BE SUSTAINED. EXAMPLES OF TAX POSITIONS COMMON TO HOSPITALS INCLUDE SUCH MATTERS AS THE FOLLOWING: THE TAX EXEMPT STATUS OF THE ENTITY, THE CONTINUED TAX EXEMPT STATUS OF BONDS ISSUED BY THE OBLIGATED GROUP, THE NATURE, THE CHARACTERIZATION AND TAXABILITY OF JOINT VENTURE INCOME AND VARIOUS POSITIONS RELATIVE TO POTENTIAL SOURCES OF UNRELATED BUSINESS INCOME (UBI). UBI IS REPORTED ON FORM 990-T, AS APPROPRIATE. THE BENEFIT OF A TAX POSITION IS RECOGNIZED IN THE FINANCIAL STATEMENTS IN THE PERIOD DURING WHICH, BASED ON ALL AVAILABLE EVIDENCE, MANAGEMENT BELIEVES THAT IT IS MORE LIKELY THAN NOT THAT THE POSITION WILL BE SUSTAINED UPON EXAMINATION, INCLUDING THE RESOLUTION OF APPEALS OR LITIGATION PROCESSES, IF ANY. HOPEDALE REAL ESTATE SERVICES (HRES) IS A FOR-PROFIT CORPORATION SUBJECT TO APPLICABLE FEDERAL AND ILLINOIS TAXES ON INCOME. HRES COMPUTES DEFERRED INCOME TAXES UNDER THE LIABILITY METHOD WHEREBY DEFERRED TAX ASSETS ARE RECOGNIZED FOR DEDUCTIBLE TEMPORARY DIFFERENCES AND NET OPERATING LOSS AND TAX CREDIT CARRYFORWARDS AND DEFERRED TAX LIABILITIES ARE RECOGNIZED FOR TAXABLE TEMPORARY DIFFERENCES. TEMPORARY DIFFERENCES ARE THE DIFFERENCES BETWEEN THE REPORTED AMOUNTS OF ASSETS AND LIABILITIES AND THEIR TAX BASES. DEFERRED TAX ASSETS ARE REDUCED BY A VALUATION ALLOWANCE WHEN, IN THE OPINION OF MANAGEMENT, IT IS MORE LIKELY THAN NOT THAT SOME OR ALL OF THE DEFERRED TAX ASSETS WILL NOT BE REALIZED. DEFERRED TAX ASSETS AND LIABILITIES ARE ADJUSTED FOR THE EFFECTS OF CHANGES IN TAX LAWS AND RATES ON THE DATE OF ENACTMENT. THE TAXABLE INCOME OF HRES AND ITS RELATED CURRENT AND DEFERRED INCOME TAXES ARE NOT SIGNIFICANT TO THE CONSOLIDATED FINANCIAL STATEMENTS AND ARE NOT, THEREFORE, SEPARATELY PRESENTED. TAX POSITIONS ARE NOT OFFSET OR AGGREGATED WITH OTHER POSITIONS. TAX POSITIONS THAT MEET THE "MORE LIKELY THAN NOT" RECOGNITION THRESHOLD ARE MEASURED AS THE LARGEST AMOUNT OF TAX BENEFIT THAT IS MORE THAN 50% LIKELY TO BE REALIZED ON SETTLEMENT WITH THE APPLICABLE TAXING AUTHORITY. THE DIFFERENCE BETWEEN THE BENEFIT OF A TAX POSITION RECORDED FOR FINANCIAL STATEMENT PURPOSES AND THE AMOUNT REFLECTED ON A TAX RETURN IS RECORDED AS A LIABILITY FOR UNCERTAIN TAX BENEFITS IN THE ACCOMPANYING BALANCE SHEETS ALONG WITH ANY ASSOCIATED INTEREST AND PENALTIES THAT WOULD BE PAYABLE TO THE TAXING AUTHORITIES UPON EXAMINATION. AS OF JUNE 30, 2017 AND 2016, THERE WERE NO UNCERTAIN TAX BENEFITS RELATED TO UNCERTAIN TAX POSITIONS IDENTIFIED AND RECORDED AS A LIABILITY. FORMS 990, 990-T, AND 1120 FILED BY THE ENTITIES ARE SUBJECT TO EXAMINATION BY THE INTERNAL REVENUE SERVICE (IRS) UP TO THREE YEARS FROM THE EXTENDED DUE DATE OF EACH RETURN. GENERALLY, FORMS 990, 990-T, AND 1120 FILED BY THESE ENTITIES ARE NO LONGER SUBJECT TO EXAMINATION FOR THE YEARS ENDED JUNE 30, 2013 AND PRIOR. ON JANUARY 5, 2016, THE FOURTH DISTRICT APPELLATE COURT OF ILLINOIS RULED THAT SECTION 15-86 OF THE ILLINOIS PROPERTY TAX CODE IS UNCONSTITUTIONAL. THIS VERSION WAS APPEALED TO THE ILLINOIS SUPREME COURT, WHICH ON MARCH 23, 2017, VACATED THE FOURTH DISTRICT APPELLATE COURT'S RULING, CITING A LACK OF JURISDICTION, AND REMANDED THE CASE TO CIRCUIT COURT FOR RECONSIDERATION. HOWEVER, IN ITS DECISION, THE ILLINOIS SUPREME COURT DID NOT RULE ON THE CONSTITUTIONALITY OF SECTION 15-86 OF THE ILLINOIS PROPERTY TAX CODE, AND ADDITIONAL LEGAL CHALLENGES MAY OCCUR. MANAGEMENT HAS CONSULTED WITH LEGAL COUNSEL ABOUT THE RAMIFICATIONS OF THIS LITIGATION AND CONTINUES TO BELIEVE THAT THE FOUNDATION MEETS THE REQUIREMENTS UNDER BOTH THE ILLINOIS STATUTES AND CONSTITUTION TO MAINTAIN ITS PROPERTY AND SALES TAX EXEMPTIONS REGARDLESS OF THE DECISION BY THE ILLINOIS SUPREME COURT. PART IV, LINE 1C: THE ACTIVITY IN THE ESCROW ACCOUNT WAS INADVERTENTLY MISSTATED ON THE HOPEDALE MEDICAL FOUNDATION'S 2015 TAX RETURN. THE BEGINNING BALANCE HAS BEEN RESTATED TO REFLECT THE ESCROW ACCOUNT'S CORRECT BALANCE. 1 1 1 X 1 X 600.000000000000 1 1 0 0 514020 514020 0.02180 769782 440027 329755 0.01400 136630 136630 0.00580 1420432 440027 980405 0.04160 725381 442958 282423 0.01200 1537 1537 0.00010 726918 442958 283960 0.01210 2147350 882985 1264365 0.05370 1 588878 8613239 8551040 62199 X 1 1 1 1 HOPEDALE MEDICAL FOUNDATION 107 TREMONT STREET HOPEDALE IL 61747 WWW.HOPEDALEMC.COM 1024 X X X X HOPEDALE MEDICAL COMPLEX 1 0 0 1 X X X X X X X X X 15 1 0 1 1 X WWW.HOPEDALEMC.COM X 1 15 0 1 0 1 X 200.000000000000 600.000000000000 X X X X 1 1 X X X X 1 X WWW.HOPEDALEMC.COM X WWW.HOPEDALEMC.COM X WWW.HOPEDALEMC.COM X X X X 1 X 0 X X 1 X 0 0 HOPEDALE MEDICAL COMPLEX PART V, SECTION B, LINE 5: HOPEDALE MEDICAL FOUNDATION CREATED THE FOLLOWING FOCUS GROUPS TO GATHER INPUT FOR THE COMMUNITY HEALTH NEEDS ASSESSMENT:1) A FOCUS GROUP MADE UP OF HEALTH PROFESSIONALS AND PARTNERS MET ON JULY 7, 2015. THE GROUP INCLUDED AREA HEALTHCARE PROVIDERS AND PARTNERS AND PERSONS WHO REPRESENT THE BROAD INTERESTS OF THE COMMUNITY SERVED BY THE HOSPITAL, INCLUDING THOSE WITH SPECIAL KNOWLEDGE OF, OR EXPERTISE IN, PUBLIC HEALTH.2) A FOCUS GROUP MADE UP OF COMMUNITY LEADERS AND ELECTED OFFICIALS MET ON JULY 7, 2015. THE GROUP INCLUDED: THE COUNTY BOARD CHAIRMAN, SCHOOL OFFICIALS, RELIGIOUS LEADERS, LOCAL MAYORS, HEALTH DEPARTMENT ADMINISTRATORS, AND VARIOUS COMMUNITY MEMBERS.3) THE STEERING GROUP MET ON SEPTEMBER 2, 2015 TO IDENTIFY AND PRIORITIZE THE COMMUNITY HEALTH NEEDS FACING THE HOPEDALE MEDICAL COMPLEX. THE GROUP CONSIDERED THE INPUT FROM THE FOCUS GROUPS AND A SUMMARY OF SECONDARY HEALTH DATA COMPILED FOR THEM BY THE CONSULTANT. HOPEDALE MEDICAL COMPLEX PART V, SECTION B, LINE 6B: HOPEDALE MEDICAL FOUNDATION'S COMMUNITY HEALTH NEEDS ASSESSMENT WAS CONDUCTED WITH THE FOLLOWING ORGANIZATIONS:MORTON FIRE DEPARTMENT, HOPEDALE BETTERMENT ASSOCIATION, TAZEWELL COUNTY HEALTH DEPARTMENT, VILLAGE OF MANITO, VILLAGE OF ATLANTA, HOPEDALE MENNONITE CHURCH, CHRISTIAN LIFE ACADEMY, TAZEWELL COUNTY GOVERNMENT, ST. MARY'S CHURCH, CENTRAL ILLINOIS AGENCY ON AGING, EMERGENCY PHYSICIANS STAFFING SERVICES, OLYMPIA SCHOOL DISTRICT, UNITY POINT HEALTH, DELAVAN COUNTY GOVERNMENT, AND MIDWEST FOOD BANK. HOPEDALE MEDICAL COMPLEX PART V, SECTION B, LINE 11: BY ASSESSING COMMUNITY HEALTH NEEDS THROUGH A REVIEW OF AVAILABLE HEALTH DATA AND DISCUSSIONS WITH AREA HEALTH CARE PARTNERS, COMMUNITY LEADERS AND REPRESENTATIVES OF THE MANY GROUPS SERVED BY THE HOSPITAL GIVES HOPEDALE MEDICAL FOUNDATION AND ITS HEALTH CARE PARTNERS THE OPPORTUNITY TO IDENTIFY AND ADDRESS THE AREA'S MOST PRESSING HEALTH CARE NEEDS. 9 1 - HOPEDALE NURSING HOME 111 TREMONT STREET HOPEDALE IL 61747 NURSING HOME 2 - HOPEDALE COMMONS 211 221 SW RAILROAD STREET HOPEDALE IL 61747 ASSISTED AND INDEPENDENT LIVING 3 - HOPEDALE WELLNESS CENTER 107 TREMONT STREET HOPEDALE IL 61747 WELLNESS & FITNESS CENTER 4 - MEDICAL ARTS PHYSICIAN BUILDING 107 TREMONT STREET HOPEDALE IL 61747 OUTPATIENT PHYSICIAN CLINIC 5 - TREMONT MEDICAL ARTS 150 LAKE STREET TREMONT IL 61568 OUTPATIENT PHYSICIAN CLINIC 6 - DELAVAN DOCTOR'S OFFICE 115 EAST 4TH STREET DELAVAN IL 61734 OUTPATIENT PHYSICIAN CLINIC 7 - ATLANTA DOCTOR'S OFFICE 108 SW ARCH STREET ATLANTA IL 61723 OUTPATIENT PHYSICIAN CLINIC 8 - MACKINAW DOCTOR'S OFFICE 407 S ORCHARD STREET MACKINAW IL 61755 OUTPATIENT PHYSICIAN CLINIC 9 - MANITO DOCTOR'S OFFICE 101 E MASON MANITO IL 61546 OUTPATIENT PHYSICIAN CLINIC PART I, LINE 3C: NOT APPLICABLE PART I, LINE 6A: NOT APPLICABLE PART I, LINE 7: HOPEDALE MEDICAL FOUNDATION UTILIZED WORKSHEET 2 TO CALCULATE ITS COST-TO-CHARGE RATIO, AND THIS RATIO WAS USED IN COMPUTING THE INFORMATION REPORTED IN PART I, LINE 7. PART I, LINE 7G: NOT APPLICABLE PART I, LN 7 COL(F): NO BAD DEBT EXPENSE WAS INCLUDED IN THE DENOMINATOR BECAUSE BAD DEBT WAS REPORTED IN LINE 2F OF PART VIII, STATEMENT OF REVENUE. THE ORGANIZATION'S TOTAL COMMUNITY BENEFIT EXPENSE AS A PERCENTAGE OF TOTAL EXPENSES IS 9.11%, AND THE PERCENTAGE INCREASES TO 45.40% IF MEDICARE ALLOWABLE COSTS ARE INCLUDED IN TOTAL COMMUNTY BENEFIT EXPENSE. PART II, COMMUNITY BUILDING ACTIVITIES: NOT APPLICABLE PART III, LINE 2: BAD DEBT IS REPORTED AT THE FULL-ESTABLISHED CHARGE FROM THE MOST RECENT AUDITED FINANCIAL REPORT. ANY RECOVERIES ARE RECORDED AS A REDUCTION OF BAD DEBT EXPENSE WHEN RECEIVED. PART III, LINE 3: NOT APPLICABLE PART III, LINE 4: PATIENT RECEIVABLES DUE DIRECTLY FROM THE PATIENTS ARE CARRIED AT THE ORIGINAL CHARGE FOR THE SERVICE PROVIDED LESS AMOUNTS COVERED BY THIRD-PARTY PAYORS AND LESS AN ESTIMATED ALLOWANCE FOR DOUBTFUL RECEIVABLES BASED ON A REVIEW OF ALL OUTSTANDING ACCOUNTS ON A MONTHLY BASIS. MANAGEMENT DETERMINES THE ALLOWANCE FOR DOUBTFUL ACCOUNTS BY IDENTIFYING TROUBLED ACCOUNTS AND BY HISTORICAL EXPERIENCE APPLIED TO AN AGING OF ACCOUNTS. THE ORGANIZATION DOES NOT CHARGE INTEREST ON PATIENT RECEIVABLES. PATIENT ACCOUNTS RECEIVABLE ARE DUE IN FULL WHEN BILLED. ACCOUNTS ARE CONSIDERED PAST DUE WHEN AN AMOUNT IS PAST DUE ACCORDING TO THE PAYORS' AGREED-UPON TERMS. PATIENT RECEIVABLES ARE WRITTEN OFF AS BAD DEBT EXPENSE WHEN DEEMED UNCOLLECTIBLE. RECOVERIES OF RECEIVABLES PREVIOUSLY WRITTEN OFF ARE RECORDED AS A REDUCTION OF BAD DEBT EXPENSE WHEN RECEIVED. AS A SERVICE TO THE PATIENT, THE ORGANIZATION BILLS THIRD-PARTY PAYORS DIRECTLY AND THE PATIENT WHEN THE PATIENT'S LIABILITY IS DETERMINED. PART III, LINE 8: THIS IS NOT APPLICABLE, AS THE ORGANIZATION HAS A MEDICARE SURPLUS. PART III, LINE 9B: THE ORGANIZATION APPLIES THE FOLLOWING PROCESSES AND PROCEDURES IN ITS COLLECTION PRACTICES FOR THOSE WHO MAY QUALIFY FOR FINANCIAL ASSISTANCE POLICY:THE DISTINCTION BETWEEN CHARITY CARE AND BAD DEBT IS THE INABILITY TO PAY VERSUS THE UNWILLINGNESS OF THE PERSON TO PAY THEIR ACCOUNT. THOSE WITH LOW INCOMES OR WITH CATASTROPHIC MEDICAL BILLS MAY BE MEDICALLY INDIGENT EVEN THOUGH THEY ARE ABLE TO MEET BASIC LIVING EXPENSES. HOPEDALE MEDICAL COMPLEX WILL NOT DENY SERVICES TO ANY PATIENT DUE TO RACE, COLOR, RELIGION, GENDER, ANCESTRY, SEXUAL ORIENTATION, FINANCIAL CLASS OR NATIONAL ORIGIN.HOPEDALE MEDICAL FOUNDATION IS COMMITTED, TO THE EXTENT RESOURCES ALLOW, TO PROVIDING QUALITY HEALTHCARE TO ITS PATIENTS AND RESIDENTS REGARDLESS OF THEIR ABILITY TO PAY.THE HOPEDALE MEDICAL FOUNDATION FINANCIAL ASSISTANCE PROGRAM ALLOWS FOR FREE OR REDUCED MEDICAL SERVICES TO PATIENTS WHO RECEIVE INPATIENT AND OUTPATIENT CARE; HAVE NO HEALTH COVERAGE OR HAVE COVERAGE THAT PAYS ONLY FOR PART OF THE BILL AND ARE INELIGIBLE FOR ANY PRIVATE OR GOVERNMENTAL SPONSORED COVERAGE (SUCH AS MEDICAID); AND MEET THE INCOME AND ASSETS ELIGIBILITY CRITERIA.FINANCIAL ASSISTANCE IS AVAILABLE FOR NECESSARY HOSPITAL AND PHYSICIAN CHARGES ONLY.ELIGIBILITY DETERMINATION:FINANCIAL ASSISTANCE FORMS AND INSTRUCTIONS SHALL BE FURNISHED TO PATIENTS WHEN FINANCIAL ASSISTANCE IS REQUESTED, WHEN NEED IS INDICATED, OR WHEN FINANCIAL SCREENING INDICATES POTENTIAL NEED, IN THE CASE OF PATIENTS WITHOUT HEALTH INSURANCE. ALL APPLICATIONS SHOULD BE FOLLOWED BY DOCUMENTATION TO VERIFY INCOME AMOUNTS INDICATED ON THE APPLICATION FORM. ALL INFORMATION RECEIVED RELATING TO THE APPLICATION WILL BE KEPT CONFIDENTIAL AND USED TO VERIFY FINANCIAL NEEDS. STEPS USED BY HOPEDALE MEDICAL FOUNDATION TO DETERMINE AND VERIFY FINANCIAL ASSISTANCE:1) HOSPITAL IDENTIFIES ANY UNINSURED, UNDERINSURED, OR SELF-PAY PATIENTS.2) PATIENT COMPLETES APPLICATION/FINANCIAL STATEMENT THAT INCLUDES INCOME, ASSETS, AND LIABILITIES.3) FINANCIAL COUNSELOR INTERVIEWS PATIENT TO ASSESS THE PATIENT'S ABILITY TO PAY IN FULL; ABILITY TO PAY REASONABLE MONTHLY INSTALLMENTS; AND QUALIFICATION FOR FINANCIAL ASSISTANCE.4) HOSPITAL MAKES INITIAL DETREMINATION BASED UPON APPLICATION AND ANY ORAL INFORMATION PROVIDED BY PATIENT. PATIENT SIGNS APPLICATION CONFIRMING ACCURACY OF INFORMATION PROVIDED.5) PATIENT SUPPLIES DOCUMENTATION OF RESOURCES AND OUTSTANDING OBLIGATIONS WITHIN 30 DAYS FROM DATE OF APPLICATION.6) HOSPITAL MAKES FINAL DETERMINATION REGARDING ELIGIBILITY FOR FINANCIAL ASSISTANCE.7) HOSPITAL SENDS NOTIFICATION LETTER TO THE PATIENT AND/OR FAMILY WITH THE DECISION. NOTICE WILL INCLUDE INSTRUCTIONS FOR ESTABLISHING A PAYMENT PLAN, IF NEEDED, AND REASON FOR DENIAL, IF APPLICABLE. PART VI, LINE 2: SERVICES OFFERED BY THE FOUNDATION INCLUDE MEDICAL/SURGICAL, SWING BED, CRITICAL CARE, OUTPATIENT SURGICAL SERVICES AND A SIGNIFICANT NUMBER OF OTHER ANCILLARY SERVICES NECESSARY TO MEET THE HEALTH CARE NEEDS OF THE COMMUNITY. THE HOSPITAL ALSO OFFERS 24-HOUR EMERGENCY ROOM SERVICES, LABORATORY AND DIAGNOSTIC IMAGING, PHYSICAL THERAPY AND OUTPATIENT/AMBULATORY PROCEDURES. ALTHOUGH CARE IS RENDERED TO ALL TO THE EXTENT POSSIBLE, MIDDLE AGED TO GERIATRIC PATIENT CARE COMPOSES BOTH THE PRIMARY AND SECONDARY SERVICE AREAS AND OUR PATIENT DEMOGRAPHICS. PART VI, LINE 3: SIGNS AND BROCHURES ARE LOCATED IN THE REGISTRATION AND MOST OTHER ENTRANCE AREAS. STAFF IN THE ADMISSIONS AND PATIENT REGISTRATION AREA ARE TRAINED TO RECOMMEND THAT PATIENTS MEET OUR PATIENT FINANCIAL COUNSELOR FOR AN APPLICATION AND TO DISCUSS BILLING AND COLLECTION PROCEDURES. PART VI, LINE 4: HOPEDALE MEDICAL COMPLEX'S SERVICE AREA IS COMPRISED OF APPROXIMATELY 487.90 SQUARE MILES WITH A POPULATION OF APPROXIMATELY 41,410 AND A POPULATION DENSITY OF 84.87 PER SQUARE MILE. THE SERVICE AREA CONSISTS OF THE FOUR CITIES/TOWNS AND SIX VILLAGES. POPULATION BY GENDER IN THE REGION IS 49.86% MALE AND 50.13% FEMALE. POVERTY IS CONSIDERED A KEY DRIVER OF HEALTH STATUS. WITHIN THE REPORT AREA, 5.34% OR 2,174 INDIVIDUALS ARE LIVING IN HOUSEHOLDS WITH INCOME BELOW 100% OF THE FEDERAL POVERTY LEVEL (FPL). PART VI, LINE 5: THE FOUNDATION MAINTAINS A WELLNESS CENTER WHICH HAS THERAPY AND EXERCISE POOLS, WEIGHT ROOM AND GYMNASIUM AREAS, A LAP TRACK, EXERCISE MACHINES AND MEETING ROOMS. WEIGHT-LOSS, NUTRITION COUNSELING, AND CHRONIC CONDITION MANAGEMENT SESSIONS ARE HELD IN THE MEETING ROOMS, AS WELL AS COMMUNITY ORGANIZATION MEETINGS. BLOOD DRIVES ARE REGULARLY SCHEDULED. PART VI, LINE 6: NOT APPLICABLE PART VI, LINE 7, REPORTS FILED WITH STATES IL 0 SCHOLARSHIPS FOR STUDENTS ENTERING FIELDS OF HEALTHCARE & AG 8 10500 PART I, LINE 2: IN KEEPING WITH THE SUPPORT OF EDUCATION OF THE YOUTH IN THE AREA COMMUNITIES, AND ENCOURAGING THEM TO ENTER THE IMPORTANT FIELDS OF HEALTHCARE AND AGRICULTURE, HOPEDALE MEDICAL FOUNDATION AWARDS SCHOLARSHIPS TO HIGH SCHOOL STUDENTS AND COLLEGE FRESHMAN. HOPEDALE MEDICAL FOUNDATION REQUIRES AN APPLICATION FROM STUDENTS FROM QUALIFYING SCHOOLS IN THE LOCAL AREA. SCHOLARSHIPS ARE AWARDED BY AN INDEPENDENT JUDGE BASED ON RECOMMENDATIONS, ACT SCORES, STUDENT NARRATIVE, AND CLASS RANKING. SCHOLARSHIP MONEY IS SENT DIRECTLY TO THE RECIPIENT'S SCHOOL TO ENSURE THE MONEY IS USED TOWARDS TUITION. X X X 0 0 0 0 0 0 0 1 0 MARK F ROSSI PRESIDENT/CHIEF OPERATING OFFICER 261593 0 0 0 0 0 4547 0 954 0 267094 0 0 0 TIMOTHY SONDAG CHIEF NURSING OFFICER 143640 0 0 0 0 0 4371 0 14376 0 162387 0 0 0 PART I, LINE 7 MARK F. ROSSI, CHIEF OPERATING OFFICER, AND SENIOR MANAGEMENT STAFF ESTABLISHED A BONUS ARRANGEMENT BASED ON GOALS ACHIEVED DURING ANNUAL PERFORMANCE EVALUATION REVIEWS. EACH VICE PRESIDENT AND SENIOR MANAGER TRACKED PERFORMANCE AND PROVIDED EVIDENCE TO MARK AS GOALS WERE MET. BONUSES WERE PROVIDED IN ACCORDANCE WITH THE ESTABLISHED ARRANGEMENT. A VILLAGE OF HOPEDALE 376002155 2012-10-16 10000000 CAPITAL IMPROVEMENTS - REFUNDING REVENUE BONDS 0 0 0 B VILLAGE OF HOPEDALE 376002155 2012-10-31 1000000 CAPITAL IMPROVEMENT REVENUE BONDS 0 0 0 C VILLAGE OF HOPEDALE 376002155 2012-10-31 2900000 CAPITAL IMPROVEMENT REVENUE BONDS 0 0 0 A 1791240 10000000 199142 2286169 7514689 2015 1 0 1 1 B 179124 1000000 63812 226105 710083 2015 0 0 1 1 C 401081 2900000 369144 2530856 2015 0 0 1 1 A 0 0 0 0 0.00000 0.00000 0.00000 0 0 1 B 0 0 0 0 0.00000 0.00000 0.00000 0 0 1 C 0 0 0 0 0.00000 0.00000 0.00000 0 0 1 A 0 1 0 0 1 1 HEARTLAND BANK 20.000000000000 0 0 0 0 1 B 0 1 0 0 1 1 HEARTLAND BANK 20.000000000000 0 0 0 0 1 C 0 1 0 0 1 0 0 0 1 A 1 B 1 C 1 TRI-COUNTY ANESTHESIA SC SEE BELOW IN PART V 445850 TRI-COUNTY ANESTHESIA PROVIDES ANESTHESIA SERVICES TO HOPEDALE MEDICAL FOUNDATION. 0 PHILLIP ROSSI MD SEE BELOW IN PART V 36044 PHILLIP ROSSI, M.D. RECEIVES COMPENSATION FROM THE HOPEDALE MEDICAL FOUNDATION FOR HIS SERVICES IN THE EMERGENCY ROOM. 0 PEGGIE ROSSI SEE BELOW IN PART V 26300 PEGGIE ROSSI RECEIVES COMPENSATION AS AN EMPLOYEE OF THE HOPEDALE MEDICAL FOUNDATION. 0 PHILLIP NOREUIL SEE BELOW IN PART V 36525 PHILLIP NOREUIL RECEIVES COMPENSATION AS AN EMPLOYEE OF THE HOPEDALE MEDICAL FOUNDATION. 0 FORM 990, SCHEDULE L, PART IV, COLUMN B: DESCRIPTION OF RELATIONSHIP - TRI-COUNTY ANESTHESIA, S.C.LARRY ROSSI, M.D. IS THE BROTHER TO MARK, ALFRED, AND MATTHEW ROSSI, ALL OFFICERS OF THE HOPEDALE MEDICAL FOUNDATION BOARD OF DIRECTORS. LARRY ROSSI, M.D. IS THE OWNER OF TRI-COUNTY ANESTHESIA, S.C. FORM 990, SCHEDULE L, PART IV, COLUMN B: DESCRIPTION OF RELATIONSHIP - PHILLIP ROSSI, M.D.PHILLIP ROSSI, M.D. IS THE BROTHER TO MARK, ALFRED, AND MATTHEW ROSSI, ALL OFFICERS OF THE HOPEDALE MEDICAL FOUNDATION BOARD OF DIRECTORS. FORM 990, SCHEDULE L, PART IV, COLUMN B: DESCRIPTION OF RELATIONSHIP - PEGGIE ROSSIPEGGIE ROSSI IS THE WIFE OF ALFRED N. ROSSI, M.D., OFFICER OF THE HOPEDALE MEDICAL FOUNDATION BOARD OF DIRECTORS. FORM 990, SCHEDULE L, PART IV, COLUMN B: DESCRIPTION OF RELATIONSHIP - PHILLIP NOREUILPHILLIP NOREUIL IS THE NEPHEW OF MARK, ALFRED, AND MATTHEW ROSSI, ALL OFFICERS OF THE HOPEDALE MEDICAL FOUNDATION BOARD OF DIRECTORS. FORM 990, PART I, LINE 6: VOLUNTEERS: VOLUNTEERS CONTRIBUTE BY WORKING IN THE GIFT SHOP, TRANSPORTING PATIENTS AND RESIDENTS OF THE COMPLEX TO/FROM APPOINTMENTS AND ASSIST WITH RESIDENT ACTIVITIES IN THE NURSING HOME AND ASSISTED LIVING FACILITY. FORM 990, PART VI, SECTION A, LINE 2 ALFRED N. ROSSI, MATTHEW B. ROSSI, MICHAEL J. MCLAUGHLIN, AND MARK F. ROSSI HAVE A FAMILY RELATIONSHIP. RAY SLACK AND JARIE SLACK HAVE A FAMILY RELATIONSHIP. FORM 990, PART VI, SECTION B, LINE 11B THE ORGANIZATION'S CFO AND COO REVIEW THE FORM 990 WITH EXTERNAL ACCOUNTANTS. THE BOARD IS THEN PROVIDED A FINAL COPY OF THE FORM 990 BEFORE IT IS FILED. FORM 990, PART VI, SECTION B, LINE 12C THE CONFLICT OF INTEREST POLICY APPLIES TO ALL MEMBERS OF THE BOARD OF DIRECTORS AND ALL CORPORATE OFFICERS, AGENTS AND EMPLOYEES OF THE FOUNDATION, INCLUDING INDEPENDENT CONTRACTORS, PROVIDERS OF SERVICES AND MATERIALS. AN ANNUAL DISCLOSURE STATEMENT IS COMPLETED BY ALL PERSONS TO WHOM THE CONFLICT OF INTEREST POLICY APPLIES TO ASSIST THEM IN CONSIDERING ALL REAL AND APPARENT CONFLICTS OR DUALITIES IN CONNECTION WITH THE FOUNDATION'S ACTIVITIES. DISCLOSURE IS ALSO REQUIRED WHENEVER CONFLICTS ARISE. THE WRITTEN DISCLOSURE NOTICES OF CONFLICTS ARE FILED WITH THE PRESIDENT OF THE FOUNDATION OR ANY OTHER PERSON DESIGNATED BY THE PRESIDENT. ALL DISCLOSURE NOTICES ARE NOTED FOR RECORD IN THE MINUTES OF A MEETING OF THE BOARD OF DIRECTORS. WHEN OFFICERS, DIRECTORS, EMPLOYEES OR AGENTS BELIEVE THEY HAVE A REAL OR APPARENT CONFLICT, THEY ABSTAIN FROM MAKING MOTIONS, VOTING, EXECUTING AGREEMENT OR TAKING ANY OTHER SIMILAR DIRECT ACTION ON BEHALF OF THE FOUNDATION. THEY ARE NOT PRECLUDED FROM DEBATE OR OTHER SIMILAR INVOLVEMENT ON BEHALF OF THE FOUNDATION. THEY ARE NOT PRECLUDED FROM DEBATE OR OTHER SIMILAR INVOLVEMENT ON BEHALF OF THE FOUNDATION. ANY VIOLATION OF THE DUTY OF THE DISCLOSURE BY DIRECTORS OR OFFICERS OF THE FOUNDATION IS GROUNDS FOR REMOVAL FROM THE OFFICE. FORM 990, PART VI, SECTION B, LINE 15 THE CHIEF OPERATING OFFICER'S COMPENSATION IS REVIEWED AND APPROVED BY THE COMPENSATION COMMITTEE. THE MEMBERS OF THE ENTIRE GOVERNING BODY MAKE UP THE COMPENSATION COMMITTEE. THE ORGANIZATION USES AN INDEPENDENT CONSULTANT TO GATHER COMPARABILITY DATA AND PROVIDE ADDITIONAL ANALYSIS. THE COMPENSATION COMMITTEE DOCUMENTS ITS DELIBERATIONS IN THE GOVERNING BOARD MINUTES AND ESTABLISHES A WRITTEN CONTRACT. THIS PROCESS TAKES PLACE ANNUALLY. THE HR DIRECTOR OVERSEES THE SALARY PROGRAM FOR ALL OTHER EMPLOYEES. FORM 990, PART VI, SECTION C, LINE 19 THE GOVERNING DOCUMENTS, FINANCIAL STATEMENTS AND CONFLICT OF INTEREST POLICY ARE MADE AVAILABLE TO THE PUBLIC UPON REQUEST. FORM 990, PART VII: VOLUNTEER BOARD OF DIRECTORS: FORM 990, PART VII, SECTION A: REPORTABLE COMPENSATION INCLUDED IN PART VII FOR ALFRED N. ROSSI, M.D. AND MATTHEW B. ROSSI, M.D IS FOR SERVICES RENDERED TO HOPEDALE MEDICAL FOUNDATION AS EMERGENCY ROOM PHYSICIANS. NO MEMBER OF THE BOARD OF DIRECTORS IS COMPENSATED IN THEIR CAPACITY AS A DIRECTOR, AND AVERAGE HOURS PER WEEK REPORTED FOR EACH DIRECTOR IS AN ESTIMATE OF TIME SPENT IN SUCH CAPACITY ONLY. FORM 990, PART X, LINES 15 AND 20: IN 2016, THE HOPEDALE MEDICAL FOUNDATION DETERMINED THAT IT WAS MORE APPROPRIATE TO INCLUDE IN COLUMN (B) (END OF YEAR) FOR LINE 20 (TAX-EXEMPT BOND LIABILITIES) CERTAIN ITEMS INCLUDED IN PRIOR YEAR FORMS 990 IN LINE 15 (OTHER ASSETS), RESPECTIVELY. CONFORMING ADJUSTMENTS HAVE BEEN MADE TO THE 2016 BEGINNING OF YEAR AMOUNTS LISTED IN COLUMN (A) OF PART X. FORM 990, PART XI, LINE 9: CHANGE IN INVESTMENT IN HOPEDALE REAL ESTATE SERVICES 25,984. INTEREST INCOME FROM HOPEDALE REAL ESTATE SERVICES, INC. -12,133. FORM 990, PART XII, LINE 2C: THE OVERSIGHT AND SELECTION PROCESS HAS NOT CHANGED FROM THE PRIOR TAX YEAR. MISS MONA'S LLC 107 TREMONT STREET HOPEDALE IL 61747 370808925 DAY CARE IL 155802 16608 HOPEDALE REAL ESTATE SERVICES INC HOPEDALE REAL ESTATE SERVICES INC 107 TREMONT STREET HOPEDALE IL 61747 371406582 PROPERTY RENTAL IL HOPEDALE MEDICAL FOUNDATION C 25984 1224326 1.00000 1 1 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 HOPEDALE REAL ESTATE SERVICES INC A 12133 FAIR MARKET VALUE HOPEDALE REAL ESTATE SERVICES INC D 506418 FAIR MARKET VALUE