HOPEDALE MEDICAL FOUNDATION: Form 990, tax year 2015
View the entire original 990 at ProPublica ↗
- Organization
- HOPEDALE MEDICAL FOUNDATION (EIN 37-0808925)
- Tax period
- 2015-07-01 to 2016-06-30
- Filed
- 2017-02-28
- IRS object ID
- 201710599349300831
- Schema version
- 2015v3.0
- Source
- Download XML · Original 990 at ProPublica
Every field in the e-filed return. Faint text is the IRS element name, for citing.
- Return header
- Form 990
- Schedule A
- Schedule B
- Schedule C
- Schedule D
- Schedule H
- Schedule I
- Schedule J
- Schedule K
- Schedule L
- Schedule O
- Schedule R
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return | 2017-02-28T11:42:08-06:00 | ReturnTs |
| Tax Period End | 2016-06-30 | TaxPeriodEndDt |
Preparer Firm PreparerFirmGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Firm EIN | 420714325 | PreparerFirmEIN |
Preparer Firm Name PreparerFirmName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | RSM US LLP | BusinessNameLine1Txt |
Preparer US Address PreparerUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 201 N HARRISON STREET SUITE 300 | AddressLine1Txt |
| City | DAVENPORT | CityNm |
| State Abbreviation | IA | StateAbbreviationCd |
| ZIP | 528011999 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnTypeCd |
| Tax Period Begin | 2015-07-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 370808925 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | THE HOPEDALE MEDICAL FOUNDATION | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | HOPE | BusinessNameControlTxt |
| Phone | 3094494298 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | PO BOX 267 | AddressLine1Txt |
| City | HOPEDALE | CityNm |
| State Abbreviation | IL | StateAbbreviationCd |
| ZIP | 61747 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | MARK F ROSSI | PersonNm |
| Person Title | PRESIDENT/CHIEF OPERATING OFFICER | PersonTitleTxt |
| Phone | 3094494298 | PhoneNum |
| Signature | 2017-02-23 | SignatureDt |
| Discuss With Paid Preparer | Yes (1) | DiscussWithPaidPreparerInd |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | JOHN J ROMANO | PreparerPersonNm |
| PTIN | P00227323 | PTIN |
| Phone | 5638884000 | PhoneNum |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2015 | TaxYr |
| Build TS | 2021-01-29 14:40:06Z | BuildTS |
Form 990 IRS990
Doing Business As Name DoingBusinessAsName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | HOPEDALE MEDICAL COMPLEX | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Principal Officer | MARK F ROSSI | PrincipalOfficerNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | PO BOX 267 | AddressLine1Txt |
| City | HOPEDALE | CityNm |
| State Abbreviation | IL | StateAbbreviationCd |
| ZIP | 61747 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $25,496,080 | GrossReceiptsAmt |
| Group Return For Affiliates | 0 | GroupReturnForAffiliatesInd |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | WWW.HOPEDALEMC.COM | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 1961 | FormationYr |
| Legal Domicile State | IL | LegalDomicileStateCd |
| Activity Or Mission | TO PROVIDE OUTSTANDING PHYSICIAN-DIRECTED HEALTH, WELLNESS, AND RESIDENTIAL SERVICES IN A PERSONAL, PRIVATE, FAMILY ATMOSPHERE. | ActivityOrMissionDesc |
| Voting Members Governing Body | 8 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 5 | VotingMembersIndependentCnt |
| Total Employee | 420 | TotalEmployeeCnt |
| Total Volunteers | 60 | TotalVolunteersCnt |
| Total Gross UBI | $550,392 | TotalGrossUBIAmt |
| Net Unrelated Bus Txbl Incm | -$394,217 | NetUnrelatedBusTxblIncmAmt |
| PY Contributions Grants | $922,049 | PYContributionsGrantsAmt |
| CY Contributions Grants | $47,863 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $19,861,256 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $20,168,253 | CYProgramServiceRevenueAmt |
| PY Investment Income | -$9,642 | PYInvestmentIncomeAmt |
| CY Investment Income | $90,956 | CYInvestmentIncomeAmt |
| PY Other Revenue | $3,110,152 | PYOtherRevenueAmt |
| CY Other Revenue | $3,538,057 | CYOtherRevenueAmt |
| PY Total Revenue | $23,883,815 | PYTotalRevenueAmt |
| CY Total Revenue | $23,845,129 | CYTotalRevenueAmt |
| PY Grants And Similar Paid | $35,372 | PYGrantsAndSimilarPaidAmt |
| CY Grants And Similar Paid | $29,262 | CYGrantsAndSimilarPaidAmt |
| PY Benefits Paid To Members | $0 | PYBenefitsPaidToMembersAmt |
| CY Benefits Paid To Members | $0 | CYBenefitsPaidToMembersAmt |
| PY Salaries Comp Emp Bnft Paid | $13,486,828 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $13,010,929 | CYSalariesCompEmpBnftPaidAmt |
| PY Total Prof Fndrsng Expns | $0 | PYTotalProfFndrsngExpnsAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $2,647 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $8,188,776 | PYOtherExpensesAmt |
| CY Other Expenses | $9,309,214 | CYOtherExpensesAmt |
| PY Total Expenses | $21,710,976 | PYTotalExpensesAmt |
| CY Total Expenses | $22,349,405 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | $2,172,839 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | $1,495,724 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $37,377,752 | TotalAssetsBOYAmt |
| Total Assets EOY | $37,361,977 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $18,288,994 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $16,770,811 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $19,088,758 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $20,591,166 | NetAssetsOrFundBalancesEOYAmt |
| Info In Schedule O Part III | Yes (X) | InfoInScheduleOPartIIIInd |
| Mission | TO PROVIDE OUTSTANDING PHYSICIAN-DIRECTED HEALTH, WELLNESS, AND RESIDENTIAL SERVICES IN A PERSONAL, PRIVATE, FAMILY ATMOSPHERE. | MissionDesc |
| Significant New Program Srvc | 0 | SignificantNewProgramSrvcInd |
| Significant Change | 0 | SignificantChangeInd |
| Expense | $17,005,321 | ExpenseAmt |
| Grant | $29,262 | GrantAmt |
| Revenue | $17,966,740 | RevenueAmt |
| Desc | 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 A 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 FOUR SATELLITE OFFICES IN ATLANTA, MANITO, MACKINAW AND DELAVAN.HOPEDALE WELLNESS CENTER HAS AN INDOOR GYM, WALKING TRACK, THREE THERAPY POOLS, DAY CARE, PHYSICAL THERAPY DEPARTMENT AND CONFERENCE 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 FOUR 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. | Desc |
Prog Srvc Accom Acty2 ProgSrvcAccomActy2Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expense | $1,889,799 | ExpenseAmt |
| Revenue | $3,051,254 | RevenueAmt |
| Desc | 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. | Desc |
Prog Srvc Accom Acty3 ProgSrvcAccomActy3Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expense | $914,439 | ExpenseAmt |
| Revenue | $1,487,083 | RevenueAmt |
| Desc | 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. | Desc |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Expenses | $19,809,559 | TotalProgramServiceExpensesAmt |
| Described In Section501c3 | Yes (1) | DescribedInSection501c3Ind |
| Schedule B Required | Yes (1) | ScheduleBRequiredInd |
| Political Campaign Acty | 0 | PoliticalCampaignActyInd |
| Lobbying Activities | Yes (1) | LobbyingActivitiesInd |
| Subject To Proxy Tax | 0 | SubjectToProxyTaxInd |
| Donor Advised Fund | 0 | DonorAdvisedFundInd |
| Conservation Easements | 0 | ConservationEasementsInd |
| Collections Of Art | 0 | CollectionsOfArtInd |
| Credit Counseling | Yes (1) | CreditCounselingInd |
| Temp Or Permanent Endowments | 0 | TempOrPermanentEndowmentsInd |
| Report Land Building Equipment | Yes (1) | ReportLandBuildingEquipmentInd |
| Report Investments Other Sec | 0 | ReportInvestmentsOtherSecInd |
| Report Program Related Invst | 0 | ReportProgramRelatedInvstInd |
| Report Other Assets | 0 | ReportOtherAssetsInd |
| Report Other Liabilities | Yes (1) | ReportOtherLiabilitiesInd |
| Include FIN48 Footnote | Yes (1) | IncludeFIN48FootnoteInd |
| Independent Audit Fincl Stmt | 0 | IndependentAuditFinclStmtInd |
| Consolidated Audit Fincl Stmt | Yes (1) | ConsolidatedAuditFinclStmtInd |
| School Operating | 0 | SchoolOperatingInd |
| Foreign Office | 0 | ForeignOfficeInd |
| Foreign Activities | 0 | ForeignActivitiesInd |
| More Than5000 K To Org | 0 | MoreThan5000KToOrgInd |
| More Than5000 K To Individuals | 0 | MoreThan5000KToIndividualsInd |
| Professional Fundraising | 0 | ProfessionalFundraisingInd |
| Fundraising Activities | 0 | FundraisingActivitiesInd |
| Gaming Activities | 0 | GamingActivitiesInd |
| Operate Hospital | Yes (1) | OperateHospitalInd |
| Audited Financial Stmt Att | Yes (1) | AuditedFinancialStmtAttInd |
| Grants To Organizations | 0 | GrantsToOrganizationsInd |
| Grants To Individuals | Yes (1) | GrantsToIndividualsInd |
| Schedule J Required | Yes (1) | ScheduleJRequiredInd |
| Tax Exempt Bonds | Yes (1) | TaxExemptBondsInd |
| Invest Tax Exempt Bonds | 0 | InvestTaxExemptBondsInd |
| Escrow Account | 0 | EscrowAccountInd |
| On Behalf Of Issuer | 0 | OnBehalfOfIssuerInd |
| Engaged In Excess Benefit Trans | 0 | EngagedInExcessBenefitTransInd |
| PY Excess Benefit Trans | 0 | PYExcessBenefitTransInd |
| Loan Outstanding | 0 | LoanOutstandingInd |
| Grant To Related Person | 0 | GrantToRelatedPersonInd |
| Business Rln With Org Mem | Yes (1) | BusinessRlnWithOrgMemInd |
| Business Rln With Fam Mem | Yes (1) | BusinessRlnWithFamMemInd |
| Business Rln With Officer Ent | Yes (1) | BusinessRlnWithOfficerEntInd |
| Deductible Non Cash Contri | 0 | DeductibleNonCashContriInd |
| Deductible Art Contribution | 0 | DeductibleArtContributionInd |
| Terminate Operations | 0 | TerminateOperationsInd |
| Partial Liquidation | 0 | PartialLiquidationInd |
| Disregarded Entity | Yes (1) | DisregardedEntityInd |
| Related Entity | Yes (1) | RelatedEntityInd |
| Related Organization Ctrl Ent | Yes (1) | RelatedOrganizationCtrlEntInd |
| Transaction With Control Ent | Yes (1) | TransactionWithControlEntInd |
| Trnsfr Exmpt Non Chrtbl Rltd Org | 0 | TrnsfrExmptNonChrtblRltdOrgInd |
| Activities Conducted Prtshp | 0 | ActivitiesConductedPrtshpInd |
| Schedule O Required | Yes (1) | ScheduleORequiredInd |
| IRP Document | 71 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Backup Wthld Compliance | Yes (1) | BackupWthldComplianceInd |
| Employee | 420 | EmployeeCnt |
| Employment Tax Returns Filed | Yes (1) | EmploymentTaxReturnsFiledInd |
| Unrelated Bus Incm Over Limit | Yes (1) | UnrelatedBusIncmOverLimitInd |
| Form990 T Filed | Yes (1) | Form990TFiledInd |
| Foreign Financial Account | 0 | ForeignFinancialAccountInd |
| Prohibited Tax Shelter Trans | 0 | ProhibitedTaxShelterTransInd |
| Taxable Party Notification | 0 | TaxablePartyNotificationInd |
| Nondeductible Contributions | 0 | NondeductibleContributionsInd |
| Quid Pro Quo Contributions | 0 | QuidProQuoContributionsInd |
| Form8282 Property Disposed Of | 0 | Form8282PropertyDisposedOfInd |
| Rcv Fnds To Pay Prsnl Bnft Cntrct | 0 | RcvFndsToPayPrsnlBnftCntrctInd |
| Pay Premiums Prsnl Bnft Cntrct | 0 | PayPremiumsPrsnlBnftCntrctInd |
| Indoor Tanning Services | 0 | IndoorTanningServicesInd |
| Info In Schedule O Part VI | Yes (X) | InfoInScheduleOPartVIInd |
| Governing Body Voting Members | 8 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 5 | IndependentVotingMemberCnt |
| Family Or Business Rln | Yes (1) | FamilyOrBusinessRlnInd |
| Delegation Of Mgmt Duties | 0 | DelegationOfMgmtDutiesInd |
| Change To Org Documents | 0 | ChangeToOrgDocumentsInd |
| Material Diversion Or Misuse | 0 | MaterialDiversionOrMisuseInd |
| Members Or Stockholders | 0 | MembersOrStockholdersInd |
| Election Of Board Members | 0 | ElectionOfBoardMembersInd |
| Decisions Subject To Approva | 0 | DecisionsSubjectToApprovaInd |
| Minutes Of Governing Body | Yes (1) | MinutesOfGoverningBodyInd |
| Minutes Of Committees | Yes (1) | MinutesOfCommitteesInd |
| Officer Mailing Address | 0 | OfficerMailingAddressInd |
| Local Chapters | 0 | LocalChaptersInd |
| Form990 Provided To Gvrn Body | Yes (1) | Form990ProvidedToGvrnBodyInd |
| Conflict Of Interest Policy | Yes (1) | ConflictOfInterestPolicyInd |
| Annual Disclosure Covered Prsn | Yes (1) | AnnualDisclosureCoveredPrsnInd |
| Regular Monitoring Enfrc | Yes (1) | RegularMonitoringEnfrcInd |
| Whistleblower Policy | Yes (1) | WhistleblowerPolicyInd |
| Document Retention Policy | Yes (1) | DocumentRetentionPolicyInd |
| Compensation Process CEO | Yes (1) | CompensationProcessCEOInd |
| Compensation Process Other | Yes (1) | CompensationProcessOtherInd |
| Investment In Joint Venture | 0 | InvestmentInJointVentureInd |
| States Where Copy Of Return Is Fld | IL | StatesWhereCopyOfReturnIsFldCd |
| Upon Request | Yes (X) | UponRequestInd |
Books In Care Of Detail BooksInCareOfDetail
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | NICHOLAS PENN | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Phone | 3094494364 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 107 TREMONT STREET | AddressLine1Txt |
| City | HOPEDALE | CityNm |
| State Abbreviation | IL | StateAbbreviationCd |
| ZIP | 61747 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part VII | Yes (X) | InfoInScheduleOPartVIIInd |
Form990 Part VII Section A Form990PartVIISectionAGrp (14 entries)
| TitleTitleTxt | Average Hours Per WeekAverageHoursPerWeekRt | Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd | OfficerOfficerInd | Reportable Comp From OrgReportableCompFromOrgAmt | Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt | Other CompensationOtherCompensationAmt | Highest Compensated EmployeeHighestCompensatedEmployeeInd |
|---|---|---|---|---|---|---|---|
| ALFRED N ROSSI MD | |||||||
| CHAIRMAN/CHIEF EXECUTIVE OFFICER | 2.00 | Yes (X) | Yes (X) | $27,955 | $0 | $0 | |
| MATTHEW B ROSSI MD | |||||||
| SECRETARY/TREASURER | 2.00 | Yes (X) | Yes (X) | $50,809 | $0 | $0 | |
| MICHAEL J MCLAUGHLIN | |||||||
| DIRECTOR | 2.00 | Yes (X) | $0 | $0 | $0 | ||
| ROLAND RICH | |||||||
| DIRECTOR | 2.00 | Yes (X) | $0 | $0 | $0 | ||
| TOM HIESER | |||||||
| DIRECTOR | 2.00 | Yes (X) | $0 | $0 | $0 | ||
| RAYMOND E SLACK | |||||||
| DIRECTOR | 2.00 | Yes (X) | $0 | $0 | $0 | ||
| JARIE A SLACK | |||||||
| DIRECTOR | 2.00 | Yes (X) | $0 | $0 | $0 | ||
| DONALD G OSWALD | |||||||
| DIRECTOR | 2.00 | Yes (X) | $0 | $0 | $0 | ||
| NICHOLAS PENN | |||||||
| CHIEF FINANCE OFFICER | 40.00 | Yes (X) | $71,859 | $0 | $16,980 | ||
| MARK F ROSSI | |||||||
| PRESIDENT/CHIEF OPERATING OFFICER | 40.00 | Yes (X) | $257,907 | $0 | $8,036 | ||
| MELODY COWDREY | |||||||
| SENIOR DIRECTOR | 40.00 | $120,370 | $0 | $26,086 | Yes (X) | ||
| LISA MCLAUGHLIN | |||||||
| DIRECTOR OF RETAIL PHARMACY | 32.00 | $126,154 | $0 | $9,092 | Yes (X) | ||
| TIMOTHY SONDAG | |||||||
| SENIOR DIRECTOR | 40.00 | $142,955 | $0 | $18,630 | Yes (X) | ||
| EMILY WHITSON | |||||||
| DIRECTOR OF PHYSICAL THERAPY | 40.00 | $108,722 | $0 | $5,631 | Yes (X) | ||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $906,731 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $0 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $84,455 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 6 | IndivRcvdGreaterThan100KCnt |
| Former Ofcr Employees Listed | 0 | FormerOfcrEmployeesListedInd |
| Total Comp Greater Than150 K | Yes (1) | TotalCompGreaterThan150KInd |
| Compensation From Other Srcs | 0 | CompensationFromOtherSrcsInd |
Contractor Compensation ContractorCompensationGrp (5 entries)
| Address Line1ContractorAddress/USAddress/AddressLine1Txt | CityContractorAddress/USAddress/CityNm | State AbbreviationContractorAddress/USAddress/StateAbbreviationCd | ZIPContractorAddress/USAddress/ZIPCd | ServicesServicesDesc | CompensationCompensationAmt |
|---|---|---|---|---|---|
| EMERGENCY PHYSICIAN STAFFING SOLUTIONS | |||||
| 12528 SR 78 | HAVANA | IL | 62644 | STAFFING AGENCY | $995,125 |
| CORE CONSTRUCTION | |||||
| PO BOX 160 | MORTON | IL | 61550 | CONSTRUCTION | $909,755 |
| TRI-COUNTY ANESTHESIA SC | |||||
| PO BOX 267 | HOPEDALE | IL | 61747 | ANESTHESIA SERVICES | $401,400 |
| HELPING HANDS HOME HEALTHCARE | |||||
| 111 W WASHINGTON STREET | EAST PEORIA | IL | 61611 | STAFFING AGENCY | $214,497 |
| MENOLD CONSTRUCTION | |||||
| PO BOX 958 | MORTON | IL | 61550 | CONSTRUCTION | $173,751 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cntrct Rcvd Greater Than100 K | 8 | CntrctRcvdGreaterThan100KCnt |
| Government Grants | $39,235 | GovernmentGrantsAmt |
| All Other Contributions | $8,628 | AllOtherContributionsAmt |
| Total Contributions | $47,863 | TotalContributionsAmt |
Program Service Revenue ProgramServiceRevenueGrp (5 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt | Unrelated Business RevenueUnrelatedBusinessRevenueAmt |
|---|---|---|---|---|
| PATIENT SERVICE REVENUE | 621110 | $14,871,489 | $14,871,489 | |
| NURSING HOME | 623000 | $3,428,985 | $3,428,985 | |
| ASSISTED AND INDEPENDENT | 623000 | $1,579,698 | $1,579,698 | |
| WELLNESS CENTER | 713940 | $261,816 | $261,816 | |
| MASSAGE THERAPY | 621110 | $67,358 | $67,358 |
Total Oth Program Service Rev TotalOthProgramServiceRevGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | -$41,093 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | -$41,093 | RelatedOrExemptFuncIncomeAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $20,168,253 | TotalProgramServiceRevenueAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $90,956 | TotalRevenueColumnAmt |
| Unrelated Business Revenue | $3,466 | UnrelatedBusinessRevenueAmt |
| Exclusion | $87,490 | ExclusionAmt |
Gross Rents GrossRentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $249,509 | RealAmt |
Less Rental Expenses LessRentalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $0 | RealAmt |
Rental Income Or Loss RentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $249,509 | RealAmt |
Net Rental Income Or Loss NetRentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $249,509 | TotalRevenueColumnAmt |
| Exclusion | $249,509 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Sales Of Inventory | $4,534,701 | GrossSalesOfInventoryAmt |
| Cost Of Goods Sold | $1,650,951 | CostOfGoodsSoldAmt |
Net Income Or Loss NetIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $2,883,750 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $2,404,182 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $479,568 | UnrelatedBusinessRevenueAmt |
Other Revenue Misc OtherRevenueMiscGrp (3 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | ExclusionExclusionAmt |
|---|---|---|---|
| MISCELLANEOUS | 900099 | $174,093 | $174,093 |
| CHILD CARE | 624410 | $131,519 | $131,519 |
| CAFETERIA INCOME | 722210 | $99,186 | $99,186 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Revenue Total | $404,798 | OtherRevenueTotalAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $23,845,129 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $22,505,077 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $550,392 | UnrelatedBusinessRevenueAmt |
| Exclusion | $741,797 | ExclusionAmt |
Grants To Domestic Orgs GrantsToDomesticOrgsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $13,012 | TotalAmt |
| Program Services | $13,012 | ProgramServicesAmt |
Grants To Domestic Individuals GrantsToDomesticIndividualsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $16,250 | TotalAmt |
| Program Services | $16,250 | ProgramServicesAmt |
Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $465,541 | TotalAmt |
| Program Services | $78,764 | ProgramServicesAmt |
| Management And General | $386,777 | ManagementAndGeneralAmt |
Comp Disqual Persons CompDisqualPersonsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $441,932 | TotalAmt |
| Program Services | $133,151 | ProgramServicesAmt |
| Management And General | $308,781 | ManagementAndGeneralAmt |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $10,283,160 | TotalAmt |
| Program Services | $9,749,708 | ProgramServicesAmt |
| Management And General | $533,452 | ManagementAndGeneralAmt |
Pension Plan Contributions PensionPlanContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $141,626 | TotalAmt |
| Program Services | $119,468 | ProgramServicesAmt |
| Management And General | $22,158 | ManagementAndGeneralAmt |
Other Employee Benefits OtherEmployeeBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $979,855 | TotalAmt |
| Program Services | $931,272 | ProgramServicesAmt |
| Management And General | $48,583 | ManagementAndGeneralAmt |
Payroll Taxes PayrollTaxesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $698,815 | TotalAmt |
| Program Services | $617,931 | ProgramServicesAmt |
| Management And General | $80,884 | ManagementAndGeneralAmt |
Fees For Services Legal FeesForServicesLegalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $6,328 | TotalAmt |
| Management And General | $6,328 | ManagementAndGeneralAmt |
Fees For Services Accounting FeesForServicesAccountingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $93,224 | TotalAmt |
| Management And General | $93,224 | ManagementAndGeneralAmt |
Fees For Services Lobbying FeesForServicesLobbyingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $10,920 | TotalAmt |
| Management And General | $10,920 | ManagementAndGeneralAmt |
Fees For Services Other FeesForServicesOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $661,853 | TotalAmt |
| Program Services | $507,854 | ProgramServicesAmt |
| Management And General | $153,833 | ManagementAndGeneralAmt |
| Fundraising | $166 | FundraisingAmt |
Advertising AdvertisingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $131,009 | TotalAmt |
| Program Services | $25,161 | ProgramServicesAmt |
| Management And General | $105,848 | ManagementAndGeneralAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,540,014 | TotalAmt |
| Program Services | $2,292,470 | ProgramServicesAmt |
| Management And General | $245,869 | ManagementAndGeneralAmt |
| Fundraising | $1,675 | FundraisingAmt |
Information Technology InformationTechnologyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $4,682 | TotalAmt |
| Management And General | $4,682 | ManagementAndGeneralAmt |
Occupancy OccupancyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $770,525 | TotalAmt |
| Program Services | $738,992 | ProgramServicesAmt |
| Management And General | $31,533 | ManagementAndGeneralAmt |
Travel TravelGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $60,326 | TotalAmt |
| Program Services | $41,381 | ProgramServicesAmt |
| Management And General | $18,139 | ManagementAndGeneralAmt |
| Fundraising | $806 | FundraisingAmt |
Interest InterestGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $400,838 | TotalAmt |
| Program Services | $400,045 | ProgramServicesAmt |
| Management And General | $793 | ManagementAndGeneralAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,928,949 | TotalAmt |
| Program Services | $1,826,975 | ProgramServicesAmt |
| Management And General | $101,974 | ManagementAndGeneralAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $136,423 | TotalAmt |
| Program Services | $22,487 | ProgramServicesAmt |
| Management And General | $113,936 | ManagementAndGeneralAmt |
Other Expenses OtherExpensesGrp (4 entries)
| DescDesc | TotalTotalAmt | Program ServicesProgramServicesAmt | Management And GeneralManagementAndGeneralAmt |
|---|---|---|---|
| SERVICES | $1,239,769 | $1,043,800 | $195,969 |
| MEDICAID PROVIDER TAXES | $492,715 | $492,715 | |
| REPAIRS & MAINTENANCE | $324,850 | $304,134 | $20,716 |
| INTEREST RATE SWAP EXPE | $275,080 | $275,080 |
All Other Expenses AllOtherExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $231,709 | TotalAmt |
| Program Services | $178,909 | ProgramServicesAmt |
| Management And General | $52,800 | ManagementAndGeneralAmt |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $22,349,405 | TotalAmt |
| Program Services | $19,809,559 | ProgramServicesAmt |
| Management And General | $2,537,199 | ManagementAndGeneralAmt |
| Fundraising | $2,647 | FundraisingAmt |
Cash Non Interest Bearing CashNonInterestBearingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $5,850,466 | BOYAmt |
| EOY | $6,283,589 | EOYAmt |
Savings And Temp Cash Invst SavingsAndTempCashInvstGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $553,262 | BOYAmt |
| EOY | $617,051 | EOYAmt |
Pledges And Grants Receivable PledgesAndGrantsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $39,294 | BOYAmt |
| EOY | $7,646 | EOYAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $3,412,956 | BOYAmt |
| EOY | $2,630,111 | EOYAmt |
Inventories For Sale Or Use InventoriesForSaleOrUseGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $918,784 | BOYAmt |
| EOY | $794,997 | EOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $104,147 | BOYAmt |
| EOY | $231,427 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $48,913,352 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $26,094,110 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $23,682,854 | BOYAmt |
| EOY | $22,819,242 | EOYAmt |
Investments Pub Traded Sec InvestmentsPubTradedSecGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,556,476 | BOYAmt |
| EOY | $2,588,090 | EOYAmt |
Other Assets Total OtherAssetsTotalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,259,513 | BOYAmt |
| EOY | $1,389,824 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $37,377,752 | BOYAmt |
| EOY | $37,361,977 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $3,439,067 | BOYAmt |
| EOY | $2,302,524 | EOYAmt |
Deferred Revenue DeferredRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $414,634 | BOYAmt |
| EOY | $423,503 | EOYAmt |
Tax Exempt Bond Liabilities TaxExemptBondLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $12,649,226 | BOYAmt |
| EOY | $12,098,027 | EOYAmt |
Other Liabilities OtherLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,786,067 | BOYAmt |
| EOY | $1,946,757 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $18,288,994 | BOYAmt |
| EOY | $16,770,811 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Organization Follows SFAS117 | Yes (X) | OrganizationFollowsSFAS117Ind |
Unrestricted Net Assets UnrestrictedNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $18,505,693 | BOYAmt |
| EOY | $20,014,187 | EOYAmt |
Temporarily Rstr Net Assets TemporarilyRstrNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $583,065 | BOYAmt |
| EOY | $576,979 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $19,088,758 | BOYAmt |
| EOY | $20,591,166 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $37,377,752 | BOYAmt |
| EOY | $37,361,977 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part XI | Yes (X) | InfoInScheduleOPartXIInd |
| Reconcilation Revenue Expnss | $1,495,724 | ReconcilationRevenueExpnssAmt |
| Net Unrlzd Gains Losses Invst | $19,504 | NetUnrlzdGainsLossesInvstAmt |
| Other Changes In Net Assets | -$12,820 | OtherChangesInNetAssetsAmt |
| Info In Schedule O Part XII | Yes (X) | InfoInScheduleOPartXIIInd |
| Method Of Accounting Accrual | Yes (X) | MethodOfAccountingAccrualInd |
| Accountant Compile Or Review | 0 | AccountantCompileOrReviewInd |
| FS Audited | Yes (1) | FSAuditedInd |
FS Audited Basis FSAuditedBasisGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Consolidated Basis Fincl Stmt | Yes (X) | ConsolidatedBasisFinclStmtInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Audit Committee | Yes (1) | AuditCommitteeInd |
| Federal Grant Audit Required | 0 | FederalGrantAuditRequiredInd |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital | Yes (X) | HospitalInd |
Schedule B IRS990ScheduleB
Contributor Information ContributorInformationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Contributor | RESTRICTED | ContributorNum |
Contributor Business Name ContributorBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | RESTRICTED | BusinessNameLine1 |
Contributor US Address ContributorUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | RESTRICTED | AddressLine1 |
| Address Line2 | RESTRICTED | AddressLine2 |
| City | RESTRICTED | City |
| State | RESTRICTED | State |
| ZIP Code | RESTRICTED | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Contributions | RESTRICTED | TotalContributionsAmt |
Schedule C IRS990ScheduleC
| Field | Value | IRS element (for citing) |
|---|---|---|
| Volunteers | 0 | VolunteersInd |
| Paid Staff Or Management | 0 | PaidStaffOrManagementInd |
| Media Advertisements | 0 | MediaAdvertisementsInd |
| Mailings Members | 0 | MailingsMembersInd |
| Publications Or Broadcast | 0 | PublicationsOrBroadcastInd |
| Grants Other Organizations | 0 | GrantsOtherOrganizationsInd |
| Direct Contact Legislators | 0 | DirectContactLegislatorsInd |
| Rallies Demonstrations | 0 | RalliesDemonstrationsInd |
| Other Activities | Yes (1) | OtherActivitiesInd |
| Other Activities | $10,920 | OtherActivitiesAmt |
| Total Lobbying Expenditures | $10,920 | TotalLobbyingExpendituresAmt |
| Not Described Section501c3 | 0 | NotDescribedSection501c3Ind |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | PART II-B, LINE 1: | FormAndLineReferenceDesc |
| Explanation | 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 $10,920. | ExplanationTxt |
Schedule D IRS990ScheduleD
| Field | Value | IRS element (for citing) |
|---|---|---|
| Agent Trustee Etc | Yes (1) | AgentTrusteeEtcInd |
| Beginning Balance | $4,451 | BeginningBalanceAmt |
| Additions During Year | $5,572 | AdditionsDuringYearAmt |
| Distributions During Year | $2,172 | DistributionsDuringYearAmt |
| Ending Balance | $7,851 | EndingBalanceAmt |
| Incl Escrow Custodial Acct Liab | 0 | InclEscrowCustodialAcctLiabInd |
Land LandGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $917,696 | OtherCostOrOtherBasisAmt |
| Book Value | $917,696 | BookValueAmt |
Buildings BuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $23,248,624 | OtherCostOrOtherBasisAmt |
| Depreciation | $9,332,180 | DepreciationAmt |
| Book Value | $13,916,444 | BookValueAmt |
Equipment EquipmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $22,241,229 | OtherCostOrOtherBasisAmt |
| Depreciation | $15,857,367 | DepreciationAmt |
| Book Value | $6,383,862 | BookValueAmt |
Other Land Buildings OtherLandBuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $2,505,803 | OtherCostOrOtherBasisAmt |
| Depreciation | $904,563 | DepreciationAmt |
| Book Value | $1,601,240 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $22,819,242 | TotalBookValueLandBuildingsAmt |
Other Liabilities Org OtherLiabilitiesOrgGrp (4 entries)
| DescDesc | AmtAmt |
|---|---|
| ASBESTOS ACCRETION LIABILITY | $197,630 |
| CAPITALIZED LEASE OBLIGATIONS | $408,153 |
| ESTIMATED THIRD PARTY PAYOR SETTLEMENT | $862,622 |
| INTEREST RATE SWAP AGREEMENT | $478,352 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Liability | $1,946,757 | TotalLiabilityAmt |
| Footnote Text | Yes (X) | FootnoteTextInd |
Supplemental Information Detail SupplementalInformationDetail (2 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| 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. 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, 2016 AND 2015, 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, 2012 AND PRIOR. |
Schedule H IRS990ScheduleH
| Field | Value | IRS element (for citing) |
|---|---|---|
| Financial Assistance Policy | Yes (1) | FinancialAssistancePolicyInd |
| Written Policy | Yes (1) | WrittenPolicyInd |
| FPG Reference Free Care | Yes (1) | FPGReferenceFreeCareInd |
Free Care Oth Percentage FreeCareOthPercentageGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | Yes (X) | OtherInd |
| Free Care Other | 300.000000000000 | FreeCareOtherPct |
| Field | Value | IRS element (for citing) |
|---|---|---|
| FPG Reference Discounted Care | Yes (1) | FPGReferenceDiscountedCareInd |
| Percent300 | Yes (X) | Percent300Ind |
| Free Care Medically Indigent | Yes (1) | FreeCareMedicallyIndigentInd |
| Financial Assistance Budget | Yes (1) | FinancialAssistanceBudgetInd |
| Expenses Exceed Budget | 0 | ExpensesExceedBudgetInd |
| Annual Community Bnft Report | 0 | AnnualCommunityBnftReportInd |
Financial Assistance At Cost Typ FinancialAssistanceAtCostTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $627,239 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $627,239 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.02810 | TotalExpensePct |
Unreimbursed Medicaid UnreimbursedMedicaidGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $624,698 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $596,190 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $28,508 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00130 | TotalExpensePct |
Unreimbursed Costs UnreimbursedCostsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $140,143 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $140,143 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00630 | TotalExpensePct |
Total Financial Assistance Typ TotalFinancialAssistanceTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $1,392,080 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $596,190 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $795,890 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.03570 | TotalExpensePct |
Community Health Services CommunityHealthServicesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $732,387 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $403,752 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $328,635 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.01470 | TotalExpensePct |
Health Professions Education HealthProfessionsEducationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $806 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $806 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00000 | TotalExpensePct |
Total Other Benefits TotalOtherBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $733,193 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $403,752 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $329,441 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.01470 | TotalExpensePct |
Total Community Benefits TotalCommunityBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $2,125,273 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $999,942 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $1,125,331 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.05040 | TotalExpensePct |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | Yes (1) | BadDebtExpenseReportedInd |
| Bad Debt Expense | $41,093 | BadDebtExpenseAmt |
| Reimbursed By Medicare | $7,549,663 | ReimbursedByMedicareAmt |
| Cost Of Care Reimbursed By Medcr | $8,301,928 | CostOfCareReimbursedByMedcrAmt |
| Medicare Surplus Or Shortfall | -$752,265 | MedicareSurplusOrShortfallAmt |
Costing Methodology Used CostingMethodologyUsedGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cost To Charge Ratio | Yes (X) | CostToChargeRatioInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Written Debt Collection Policy | Yes (1) | WrittenDebtCollectionPolicyInd |
| Financial Assistance Prvsn | Yes (1) | FinancialAssistancePrvsnInd |
| Hospital Facilities | 1 | HospitalFacilitiesCnt |
Hospital Facilities HospitalFacilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 1 | FacilityNum |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | HOPEDALE MEDICAL FOUNDATION | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 107 TREMONT STREET | AddressLine1Txt |
| City | HOPEDALE | CityNm |
| State Abbreviation | IL | StateAbbreviationCd |
| ZIP | 61747 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Website Address | WWW.HOPEDALEMC.COM | WebsiteAddressTxt |
| State License | 1024 | StateLicenseNum |
| Licensed Hospital | Yes (X) | LicensedHospitalInd |
| General Medical And Surgical | Yes (X) | GeneralMedicalAndSurgicalInd |
| Critical Access Hospital | Yes (X) | CriticalAccessHospitalInd |
| Emergency Room24 Hrs | Yes (X) | EmergencyRoom24HrsInd |
Hospital Fclty Policies Prctc HospitalFcltyPoliciesPrctcGrp
Hospital Facility Name HospitalFacilityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | HOPEDALE MEDICAL COMPLEX | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 1 | FacilityNum |
| First Licensed CY Or PY | 0 | FirstLicensedCYOrPYInd |
| Tax Exempt Hospital CY Or PY | 0 | TaxExemptHospitalCYOrPYInd |
| CHNA Conducted | Yes (1) | CHNAConductedInd |
| Community Definition | Yes (X) | CommunityDefinitionInd |
| Community Demographics | Yes (X) | CommunityDemographicsInd |
| Existing Resources | Yes (X) | ExistingResourcesInd |
| How Data Obtained | Yes (X) | HowDataObtainedInd |
| Community Health Needs | Yes (X) | CommunityHealthNeedsInd |
| Other Health Issues | Yes (X) | OtherHealthIssuesInd |
| Community Hlth Needs Id Process | Yes (X) | CommunityHlthNeedsIdProcessInd |
| Consulting Process | Yes (X) | ConsultingProcessInd |
| Information Gaps | Yes (X) | InformationGapsInd |
| CHNA Conducted | 15 | CHNAConductedYr |
| Take Into Account Others Input | Yes (1) | TakeIntoAccountOthersInputInd |
| CHNA Conducted With Other Fclts | 0 | CHNAConductedWithOtherFcltsInd |
| CHNA Conducted With Non Fclts | Yes (1) | CHNAConductedWithNonFcltsInd |
| CHNA Report Widely Available | Yes (1) | CHNAReportWidelyAvailableInd |
| Rpt Available On Own Website | Yes (X) | RptAvailableOnOwnWebsiteInd |
| Own Website URL | WWW.HOPEDALEMC.COM | OwnWebsiteURLTxt |
| Paper Copy Public Inspection | Yes (X) | PaperCopyPublicInspectionInd |
| Implementation Strategy Adopt | Yes (1) | ImplementationStrategyAdoptInd |
| Implementation Strategy Adpt | 15 | ImplementationStrategyAdptYr |
| Strategy Posted Website | Yes (1) | StrategyPostedWebsiteInd |
| Strategy Website URL | WWW.HOPEDALEMC.COM | StrategyWebsiteURLTxt |
| Strategy Attached | 0 | StrategyAttachedInd |
| Organization Incur Excise Tax | 0 | OrganizationIncurExciseTaxInd |
| Elig Criteria Explained | Yes (1) | EligCriteriaExplainedInd |
| FPG Family Incm Lmt Free Dscnt | Yes (X) | FPGFamilyIncmLmtFreeDscntInd |
| FPG Family Incm Lmt Free Care | 300.000000000000 | FPGFamilyIncmLmtFreeCarePct |
| FPG Family Incm Lmt Dscnt Care | 300.000000000000 | FPGFamilyIncmLmtDscntCarePct |
| Asset Level Criteria | Yes (X) | AssetLevelCriteriaInd |
| Medical Indigency Criteria | Yes (X) | MedicalIndigencyCriteriaInd |
| Insurance Status Criteria | Yes (X) | InsuranceStatusCriteriaInd |
| Underinsurance Stat Criteria | Yes (X) | UnderinsuranceStatCriteriaInd |
| Explained Basis | Yes (1) | ExplainedBasisInd |
| App Financial Asst Expln | Yes (1) | AppFinancialAsstExplnInd |
| Described Info | Yes (X) | DescribedInfoInd |
| Described Suprt Doc | Yes (X) | DescribedSuprtDocInd |
| Provided Hospital Contact | Yes (X) | ProvidedHospitalContactInd |
| Provided Nonprofit Contact | Yes (X) | ProvidedNonprofitContactInd |
| Includes Publicity Measures | Yes (1) | IncludesPublicityMeasuresInd |
| FAP Available On Website | Yes (X) | FAPAvailableOnWebsiteInd |
| FAP Available On Website URL | WWW.HOPEDALEMC.COM | FAPAvailableOnWebsiteURLTxt |
| FAP App Available On Website | Yes (X) | FAPAppAvailableOnWebsiteInd |
| FAP App Available On Website URL | WWW.HOPEDALEMC.COM | FAPAppAvailableOnWebsiteURLTxt |
| FAP Summary On Website | Yes (X) | FAPSummaryOnWebsiteInd |
| FAP Summary On Website URL | WWW.HOPEDALEMC.COM | FAPSummaryOnWebsiteURLTxt |
| FAP Avlbl On Request No Charge | Yes (X) | FAPAvlblOnRequestNoChargeInd |
| FAP App Avlbl On Request No Chrg | Yes (X) | FAPAppAvlblOnRequestNoChrgInd |
| FAP Sum Avlbl On Request No Chrg | Yes (X) | FAPSumAvlblOnRequestNoChrgInd |
| FAP Notice Displayed | Yes (X) | FAPNoticeDisplayedInd |
| FAP Actions On Nonpayment | Yes (1) | FAPActionsOnNonpaymentInd |
| Permit No Actions | Yes (X) | PermitNoActionsInd |
| Collection Activities | 0 | CollectionActivitiesInd |
| FAP Notified Upon Admission | Yes (X) | FAPNotifiedUponAdmissionInd |
| FAP Notified Before Discharge | Yes (X) | FAPNotifiedBeforeDischargeInd |
| FAP Notified All Patients | Yes (X) | FAPNotifiedAllPatientsInd |
| Documented Elig Determination | Yes (X) | DocumentedEligDeterminationInd |
| Nondis Emergency Care Policy | Yes (1) | NondisEmergencyCarePolicyInd |
| Medicare Rates | Yes (X) | MedicareRatesInd |
| Amounts Generally Billed | 0 | AmountsGenerallyBilledInd |
| Gross Charges | 0 | GrossChargesInd |
Supplemental Information SupplementalInformationGrp (3 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| 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. |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 8 | FacilityNum |
Oth Hlth Care Fclts Not Hospital OthHlthCareFcltsNotHospitalGrp
Oth Hlth Care Fclts OthHlthCareFcltsGrp (8 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | FacilityFacilityTxt |
|---|---|---|---|---|
| 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 - DELAVAN DOCTOR'S OFFICE | ||||
| 115 EAST 4TH STREET | DELAVAN | IL | 61734 | OUTPATIENT PHYSICIAN CLINIC |
| 6 - ATLANTA DOCTOR'S OFFICE | ||||
| 108 SW ARCH STREET | ATLANTA | IL | 61723 | OUTPATIENT PHYSICIAN CLINIC |
| 7 - MACKINAW DOCTOR'S OFFICE | ||||
| 407 S ORCHARD STREET | MACKINAW | IL | 61755 | OUTPATIENT PHYSICIAN CLINIC |
| 8 - MANITO DOCTOR'S OFFICE | ||||
| 101 E MASON | MANITO | IL | 61546 | OUTPATIENT PHYSICIAN CLINIC |
Supplemental Information Detail SupplementalInformationDetail (17 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| 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 9.51%, AND THE PERCENTAGE INCREASES TO 46.66% 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: | THE ORGANIZATION DERIVED ITS COSTING METHODOLOGY USED TO DETERMINE THE MEDICARE ALLOWABLE COSTS REPORTED IN THE ORGANIZATION'S MEDICARE COST REPORT BY USING COST REPORT WORKSHEETS. MEDICARE COSTS ARE DETERMINED THROUGH THE MEDICARE COST FINDING PROCESS WHICH ALLOCATES GENERAL SERVICE CENTER COSTS TO REVENUE DEPARTMENTS. ROUTINE AND ICU COSTS ARE DETERMINED BASED ON AN AVERAGE COST PER DAY MULTIPLIED BY THE NUMBER OF MEDICARE ALLOWABLE DAYS. MEDICARE ANCILLARY COSTS ARE DETERMINED BY THE RATIO OF DEPARTMENT COSTS TO DEPARTMENT CHARGES THEN THE RESULTING PERCENTAGE IS APPLIED TO MEDICARE ALLOWABLE CHARGES. THE METHODOLOGY DESCRIBED IN THE INSTRUCTIONS TO SCHEDULE H, PART III, SECTION B, LINE 6 DOES NOT TAKE INTO ACCOUNT ALL COSTS INCURRED BY THE HOSPITAL AND DOES NOT REPRESENT THE TOTAL COMMUNITY BENEFIT CONFERRED IN THIS AREA. |
| 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 |
Schedule I IRS990ScheduleI
| Field | Value | IRS element (for citing) |
|---|---|---|
| Grant Records Maintained | 0 | GrantRecordsMaintainedInd |
Grants Other Asst To Indiv In US GrantsOtherAsstToIndivInUSGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Grant Type | SCHOLARSHIPS FOR STUDENTS ENTERING FIELDS OF HEALTHCARE & AG | GrantTypeTxt |
| Recipient | 5 | RecipientCnt |
| Cash Grant | $8,000 | CashGrantAmt |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | PART I, LINE 2: | FormAndLineReferenceDesc |
| Explanation | 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. | ExplanationTxt |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Compensation Committee | Yes (X) | CompensationCommitteeInd |
| Compensation Survey | Yes (X) | CompensationSurveyInd |
| Board Or Committee Approval | Yes (X) | BoardOrCommitteeApprovalInd |
| Severance Payment | 0 | SeverancePaymentInd |
| Supplemental Nonqual Rtr Plan | 0 | SupplementalNonqualRtrPlanInd |
| Equity Based Comp Arrngm | 0 | EquityBasedCompArrngmInd |
| Comp Based On Revenue Of Flng Org | 0 | CompBasedOnRevenueOfFlngOrgInd |
| Comp Bsd On Rev Related Orgs | 0 | CompBsdOnRevRelatedOrgsInd |
| Comp Bsd Net Earns Flng Org | 0 | CompBsdNetEarnsFlngOrgInd |
| Comp Bsd Net Earns Rltd Orgs | 0 | CompBsdNetEarnsRltdOrgsInd |
| Any Non Fixed Payments | Yes (1) | AnyNonFixedPaymentsInd |
| Initial Contract Exception | 0 | InitialContractExceptionInd |
Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp (2 entries)
| TitleTitleTxt | Base Compensation Filing OrgBaseCompensationFilingOrgAmt | Compensation Based On Rltd OrgsCompensationBasedOnRltdOrgsAmt | Bonus Filing OrganizationBonusFilingOrganizationAmount | Bonus Related OrganizationsBonusRelatedOrganizationsAmt | Other Compensation Filing OrgOtherCompensationFilingOrgAmt | Other Compensation Rltd OrgsOtherCompensationRltdOrgsAmt | Deferred Compensation Flng OrgDeferredCompensationFlngOrgAmt | Deferred Comp Rltd OrgsDeferredCompRltdOrgsAmt | Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgAmt | Nontaxable Benefits Rltd OrgsNontaxableBenefitsRltdOrgsAmt | Total Compensation Filing OrgTotalCompensationFilingOrgAmt | Total Compensation Rltd OrgsTotalCompensationRltdOrgsAmt | Comp Report Prior990 Filing OrgCompReportPrior990FilingOrgAmt | Comp Report Prior990 Rltd OrgsCompReportPrior990RltdOrgsAmt |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| MARK F ROSSI | ||||||||||||||
| PRESIDENT/CHIEF OPERATING OFFICER | $236,907 | $0 | $21,000 | $0 | $0 | $0 | $7,737 | $0 | $299 | $0 | $265,943 | $0 | $0 | $0 |
| TIMOTHY SONDAG | ||||||||||||||
| SENIOR DIRECTOR | $142,955 | $0 | $0 | $0 | $0 | $0 | $4,289 | $0 | $14,341 | $0 | $161,585 | $0 | $0 | $0 |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | PART I, LINE 7 | FormAndLineReferenceDesc |
| Explanation | THE EXECUTIVE COMPENSATION COMMITTEE (MADE UP OF NONRELATED BOARD MEMBERS) DETERMINED THAT AS PRESIDENT AND COO, MARK F. ROSSI'S COMPENSATION FELL BELOW COMPARABLE EXPECTATIONS BASED ON A COMPENSATION STUDY BY RSM US LLP. THEREFORE, A GOALS/BONUS ARRANGEMENT WAS ESTABLISHED BY THE COMMITTEE THAT PROVIDED AN OPPORTUNITY FOR MARK F. ROSSI TO OBTAIN AN ADDITIONAL 10 PERCENT OF HIS SALARY IF CERTAIN OBJECTIVES WERE MET. AFTER EVALUATION OF SAID GOALS, THE COMMITTEE DEEMED THAT MARK F. ROSSI HAD SATISFACTORILY MET 4 OUT OF 5 OF HIS GOALS IN 2015 AND DETERMINED THE AMOUNT OF HIS 2015 BONUS ACCORDINGLY. | ExplanationTxt |
Schedule K IRS990ScheduleK
Tax Exempt Bonds Issues TaxExemptBondsIssuesGrp (3 entries)
| Bond ReferenceBondReferenceCd | Bond Issuer EINBondIssuerEIN | Bond IssuedBondIssuedDt | Issue PriceIssuePriceAmt | PurposePurposeDesc | DefeasedDefeasedInd | On Behalf Of IssuerOnBehalfOfIssuerInd | Pool FinancingPoolFinancingInd |
|---|---|---|---|---|---|---|---|
| VILLAGE OF HOPEDALE | |||||||
| A | 376002155 | 2012-10-16 | $10,000,000 | CAPITAL IMPROVEMENTS - REFUNDING REVENUE BONDS | 0 | 0 | 0 |
| VILLAGE OF HOPEDALE | |||||||
| B | 376002155 | 2012-10-31 | $1,000,000 | CAPITAL IMPROVEMENT REVENUE BONDS | 0 | 0 | 0 |
| VILLAGE OF HOPEDALE | |||||||
| C | 376002155 | 2012-10-31 | $2,900,000 | CAPITAL IMPROVEMENT REVENUE BONDS | 0 | 0 | 0 |
Tax Exempt Bonds Proceeds TaxExemptBondsProceedsGrp (3 entries)
| Bond ReferenceBondReferenceCd | RetiredRetiredAmt | Total ProceedsTotalProceedsAmt | Issuance Costs From ProceedsIssuanceCostsFromProceedsAmt | Capital ExpendituresCapitalExpendituresAmt | Other Spent ProceedsOtherSpentProceedsAmt | Substantial CompletionSubstantialCompletionYr | Current RefundingCurrentRefundingInd | Advance RefundingAdvanceRefundingInd | Final Allocation MadeFinalAllocationMadeInd | Adequate Books And Rec MaintAdequateBooksAndRecMaintInd |
|---|---|---|---|---|---|---|---|---|---|---|
| A | $990,840 | $10,000,000 | $199,142 | $2,286,169 | $7,514,689 | 2015 | Yes (1) | 0 | Yes (1) | Yes (1) |
| B | $99,084 | $1,000,000 | $63,812 | $226,105 | $710,083 | 2015 | 0 | 0 | Yes (1) | Yes (1) |
| C | $216,758 | $2,900,000 | $369,144 | $2,530,856 | 2015 | 0 | 0 | Yes (1) | Yes (1) |
Tax Exempt Bonds Private Bus Use TaxExemptBondsPrivateBusUseGrp (3 entries)
| Bond ReferenceBondReferenceCd | Owning Bond Financed PropertyOwningBondFinancedPropertyInd | Any Lease ArrangementsAnyLeaseArrangementsInd | Mgmt Contract Bond Fincd PropMgmtContractBondFincdPropInd | Any Research AgreementsAnyResearchAgreementsInd | Private Bus Use By OthersPrivateBusUseByOthersPct | Private Bus Concerning UBIPrivateBusConcerningUBIPct | Total Private Business UseTotalPrivateBusinessUsePct | Bond Iss Meet Prvt Sec Pymt TestBondIssMeetPrvtSecPymtTestInd | Change In Use Bond Financed PropChangeInUseBondFinancedPropInd | Procs Nonqualified Bond RemdtdProcsNonqualifiedBondRemdtdInd |
|---|---|---|---|---|---|---|---|---|---|---|
| A | 0 | 0 | 0 | 0 | 0.00000 | 0.00000 | 0.00000 | 0 | 0 | Yes (1) |
| B | 0 | 0 | 0 | 0 | 0.00000 | 0.00000 | 0.00000 | 0 | 0 | Yes (1) |
| C | 0 | 0 | 0 | 0 | 0.00000 | 0.00000 | 0.00000 | 0 | 0 | Yes (1) |
Tax Exempt Bonds Arbitrage TaxExemptBondsArbitrageGrp (3 entries)
| Bond ReferenceBondReferenceCd | Form8038 T FiledForm8038TFiledInd | Rebate Not Due YetRebateNotDueYetInd | Exception To RebateExceptionToRebateInd | No Rebate DueNoRebateDueInd | Variable Rate IssueVariableRateIssueInd | Hedge Identified In Bks And RecHedgeIdentifiedInBksAndRecInd | Term Of HedgeTermOfHedgePct | Superintegrated HedgeSuperintegratedHedgeInd | Hedge TerminatedHedgeTerminatedInd | Gross Proceeds Invested In GICGrossProceedsInvestedInGICInd | Gross Proceeds InvestedGrossProceedsInvestedInd | Written Proc To Monitor ReqsWrittenProcToMonitorReqsInd |
|---|---|---|---|---|---|---|---|---|---|---|---|---|
| HEARTLAND BANK | ||||||||||||
| A | 0 | Yes (1) | 0 | 0 | Yes (1) | Yes (1) | 20.000000000000 | 0 | 0 | 0 | 0 | Yes (1) |
| HEARTLAND BANK | ||||||||||||
| B | 0 | Yes (1) | 0 | 0 | Yes (1) | Yes (1) | 20.000000000000 | 0 | 0 | 0 | 0 | Yes (1) |
| (no name) | ||||||||||||
| C | 0 | Yes (1) | 0 | 0 | Yes (1) | 0 | 0 | 0 | Yes (1) | |||
Procedures Corrective Action ProceduresCorrectiveActionGrp (3 entries)
| Bond ReferenceBondReferenceCd | Procedures Corrective ActionProceduresCorrectiveActionInd |
|---|---|
| A | Yes (1) |
| B | Yes (1) |
| C | Yes (1) |
Schedule L IRS990ScheduleL
Bus Tr Involve Interested Prsn BusTrInvolveInterestedPrsnGrp (8 entries)
| Relationship DescriptionRelationshipDescriptionTxt | TransactionTransactionAmt | TransactionTransactionDesc | Sharing Of RevenuesSharingOfRevenuesInd |
|---|---|---|---|
| TRI-COUNTY ANESTHESIA SC | |||
| SEE BELOW IN PART V | $401,400 | TRI-COUNTY ANESTHESIA PROVIDES ANESTHESIA SERVICES TO HOPEDALE MEDICAL FOUNDATION. | 0 |
| DAVID ROSSI | |||
| SEE BELOW IN PART V | $80,177 | DAVID ROSSI RECEIVES COMPENSATION AS AN EMPLOYEE OF THE HOPEDALE MEDICAL FOUNDATION. | 0 |
| CYNTHIA NOREUIL | |||
| SEE BELOW IN PART V | $41,594 | CYNTHIA NOREUIL RECEIVES COMPENSATION FROM THE HOPEDALE MEDICAL FOUNDATION AS THE DIRECTOR OF ASSISTED AND INDEPENDENT LIVING. | 0 |
| PHILLIP ROSSI MD | |||
| SEE BELOW IN PART V | $12,870 | 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 | $30,827 | PEGGIE ROSSI RECEIVES COMPENSATION AS AN EMPLOYEE OF THE HOPEDALE MEDICAL FOUNDATION. | 0 |
| PHILLIP NOREUIL | |||
| SEE BELOW IN PART V | $34,495 | PHILLIP NOREUIL RECEIVES COMPENSATION AS AN EMPLOYEE OF THE HOPEDALE MEDICAL FOUNDATION. | 0 |
| LARRY NOREUIL | |||
| SEE BELOW IN PART V | $17,839 | LARRY NOREUIL RECEIVES COMPENSATION AS AN EMPLOYEE OF THE HOPEDALE MEDICAL FOUNDATION. | 0 |
| ADAM ROSSI | |||
| SEE BELOW IN PART V | $21,797 | ADAM ROSSI RECEIVES COMPENSATION AS AN EMPLOYEE OF THE HOPEDALE MEDICAL FOUNDATION AS A SECURITY GUARD. | 0 |
Supplemental Information Detail SupplementalInformationDetail (6 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| 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 - DAVID ROSSIDAVID ROSSI IS THE SON 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 - CYNTHIA, LARRY, AND PHILLIP NOREUILCYNTHIA NOREUIL IS THE SISTER TO MARK, ALFRED, AND MATTHEW ROSSI, ALL OFFICERS OF THE HOPEDALE MEDICAL FOUNDATION BOARD OF DIRECTORS. LARRY NOREUIL IS CYNTHIA NOREUIL'S HUSBAND, AND PHILLIP NOREUIL IS HER SON. |
| 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 - ADAM ROSSIADAM ROSSI IS THE GRANDSON OF ALFRED N. ROSSI, M.D., OFFICER OF THE HOPEDALE MEDICAL FOUNDATION BOARD OF DIRECTORS. |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (9 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| 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 ROSSI, DIRECTOR; MATTHEW ROSSI, DIRECTOR; MIKE MCLAUGHLIN, DIRECTOR; AND MARK F. ROSSI, CHIEF OPERATING OFFICER, ALL HAVE A FAMILY RELATIONSHIP. SEE FURTHER DESCRIPTION REGARDING FAMILY RELATIONSHIPS ON SCH L, PART V. RAY SLACK AND JARIE SLACK HAVE A FAMILY RELATIONSHIP. |
| FORM 990, PART VI, SECTION B, LINE 11 | 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 XI, LINE 9: | CHANGE IN INVESTMENT IN HOPEDALE REAL ESTATE SERVICES -9,354. INTEREST INCOME FROM HOPEDALE REAL ESTATE SERVICES, INC. -3,466. |
| FORM 990, PART XII, LINE 2C: | THE OVERSIGHT AND SELECTION PROCESS HAS NOT CHANGED FROM THE PRIOR TAX YEAR. |
Schedule R IRS990ScheduleR
Id Disregarded Entities IdDisregardedEntitiesGrp
Disregarded Entity Name DisregardedEntityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | MISS MONA'S LLC | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 107 TREMONT STREET | AddressLine1Txt |
| City | HOPEDALE | CityNm |
| State Abbreviation | IL | StateAbbreviationCd |
| ZIP | 61747 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 370808925 | EIN |
| Primary Activities | DAY CARE | PrimaryActivitiesTxt |
| Legal Domicile State | IL | LegalDomicileStateCd |
| Total Income | $131,519 | TotalIncomeAmt |
| End Of Year Assets | $10,241 | EndOfYearAssetsAmt |
Direct Controlling Entity Name DirectControllingEntityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | HOPEDALE REAL ESTATE SERVICES INC | BusinessNameLine1Txt |
Id Related Org Txbl Corp Tr IdRelatedOrgTxblCorpTrGrp
Related Organization Name RelatedOrganizationName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | HOPEDALE REAL ESTATE SERVICES INC | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 107 TREMONT STREET | AddressLine1Txt |
| City | HOPEDALE | CityNm |
| State Abbreviation | IL | StateAbbreviationCd |
| ZIP | 61747 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 371406582 | EIN |
| Primary Activities | PROPERTY RENTAL | PrimaryActivitiesTxt |
| Legal Domicile State | IL | LegalDomicileStateCd |
Direct Controlling Entity Name DirectControllingEntityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | HOPEDALE MEDICAL FOUNDATION | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Entity Type | C | EntityTypeTxt |
| Share Of Total Income | -$9,354 | ShareOfTotalIncomeAmt |
| Share Of EOY Assets | $730,286 | ShareOfEOYAssetsAmt |
| Ownership | 1.00000 | OwnershipPct |
| Controlled Organization | Yes (1) | ControlledOrganizationInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Annts Rnts Rylts | Yes (1) | ReceiptOfIntAnntsRntsRyltsInd |
| Gift Grnt Or Cap Contri To Oth Org | 0 | GiftGrntOrCapContriToOthOrgInd |
| Gift Grnt Cap Contri From Oth Org | 0 | GiftGrntCapContriFromOthOrgInd |
| Loans Or Guarantees To Other Org | Yes (1) | LoansOrGuaranteesToOtherOrgInd |
| Loans Or Guarantees From Oth Org | 0 | LoansOrGuaranteesFromOthOrgInd |
| Div Related Organization | 0 | DivRelatedOrganizationInd |
| Asset Sale To Other Org | 0 | AssetSaleToOtherOrgInd |
| Asset Purchase From Other Org | 0 | AssetPurchaseFromOtherOrgInd |
| Asset Exchange | 0 | AssetExchangeInd |
| Rental Of Facilities To Oth Org | 0 | RentalOfFacilitiesToOthOrgInd |
| Rental Of Fclts From Oth Org | 0 | RentalOfFcltsFromOthOrgInd |
| Perform Of Services For Oth Org | 0 | PerformOfServicesForOthOrgInd |
| Perform Of Services By Other Org | 0 | PerformOfServicesByOtherOrgInd |
| Sharing Of Facilities | 0 | SharingOfFacilitiesInd |
| Paid Employees Sharing | 0 | PaidEmployeesSharingInd |
| Reimbursement Paid To Other Org | 0 | ReimbursementPaidToOtherOrgInd |
| Reimbursement Paid By Other Org | 0 | ReimbursementPaidByOtherOrgInd |
| Transfer To Other Org | 0 | TransferToOtherOrgInd |
| Transfer From Other Org | 0 | TransferFromOtherOrgInd |
Transactions Related Org TransactionsRelatedOrgGrp (2 entries)
| Transaction TypeTransactionTypeTxt | InvolvedInvolvedAmt | Method Of Amount DeterminationMethodOfAmountDeterminationTxt |
|---|---|---|
| HOPEDALE REAL ESTATE SERVICES INC | ||
| A | $3,466 | FAIR MARKET VALUE |
| HOPEDALE REAL ESTATE SERVICES INC | ||
| D | $69,005 | FAIR MARKET VALUE |
Comments