2014-11-14T13:09:44-06:00 2013-12-31 ERNST & YOUNG US LLP 111 MONUMENT CIRCLE SUITE 4000 INDIANAPOLIS IN 46204 990 2013-01-01 363637465 Hoopeston Community Memorial Hospital % DENNIS HESCH EXEC VP & CFO HOOP 2172835531 701 E Orange Street Suite Hoopeston IL 60942 DENNIS P HESCH EXEC VP & CFO 2014-11-13 JENNIFER RHODERICK P00395735 2013 2015-11-30 17:44:51Z CARLE HOOPESTON REGIONAL HEALTH CTR DENNIS HESCH EXEC VP CFO 611 W PARK ST URBANA IL 61801 26778844 false X www.carle.org/hoopeston X 1956 IL TO PROVIDE QUALITY HEALTH CARE AND OTHER MEDICALLY RELATED SERVICES AND EDUCATION TO THE COMMUNITY THROUGH THE OPERATION OF A CRITICAL ACCESS HOSPITAL. 7 4 232 0 24792 2910 954 38867 5377136 25964439 7113 18422 76941 602558 5462144 26624286 19000 33528 0 0 2802683 12873555 0 0 0 3447884 16126714 6269567 29033797 -807423 -2409511 33293949 34747313 27494128 31271627 5799821 3475686 X MISSION STATEMENT SECTION 1. GENERAL PURPOSES. THE CORPORATION IS ORGANIZED AND SHALL BE EXCLUSIVELY OPERATED AS A NOT-FOR-PROFIT CORPORATION FOR CHARITABLE, BENEVOLENT, SCIENTIFIC AND EDUCATIONAL PURPOSES WITHIN THE MEANING OF SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE OF 1986, AS AMENDED, OR THE CORRESPONDING PROVISIONS OF ANY FUTURE UNITED STATES INTERNAL REVENUE LAW (THE "CODE"). AND, IN FURTHERANCE OF SUCH CHARITABLE PURPOSES, THE CORPORATION SHALL ENGAGE IN THE ACTIVITIES DESCRIBED IN SECTION 2 OF THIS STATEMENT. SECTION 2. SPECIFIC PURPOSES. THE CORPORATION'S PURPOSES SHALL INCLUDE, BUT NOT BE LIMITED TO, THE FOLLOWING: (A) TO PROVIDE AND TO ASSIST IN PROVIDING FACILITIES FOR THE RENDERING OF HEALTH CARE SERVICES ON AN INPATIENT OR OTHER BASIS THROUGH THE OPERATION OF A CRITICAL ACCESS HOSPITAL AND RURAL HEALTH CLINICS, AND OTHER CLINICAL SERVICES THROUGH ALL OTHER APPROPRIATE MEANS; AND (B) TO TRAIN AND TO PROVIDE CONTINUING EDUCATION FOR PERSONS ENGAGED IN PROVIDING HEALTH false false 23611674 33528 25971168 Hoopeston Community Memorial Hospital (HCMH), a 25 bed Critical Access Hospital located in Hoopeston, IL serves Hoopeston, Vermilion County and the surrounding area. HCMH employs more than 200 staff members with 22 physicians and advanced practice providers. HCMH is committed to providing quality, dependable health services. HCMH offers specialty services with cardiology, orthopedics, gynecology, mental health, urology and diagnostic services including nuclear medicine, digital mammography, radiology and laboratory. Emergency medicine and surgical services are provided in state of the art facilities which opened in 2012. HCMH provides access to primary care with clinics in Hoopeston, Rossville, Milford, Cissna Park, Danville, and Watseka, IL. HCMH has been dedicated to caring for those in the area for over 50 years. 23611674 true true false true false false false false false false true false false true true true false true false false false false false false false false true true true false true false false false false false false true false false false false false false true true true false false true 34 0 true 232 true true true false false false false false false false false false X 7 4 false false false false true true true true true false false true true true true true true false false false IL X X DENNIS HESCH EXEC VP CFO 2173833311 611 WEST PARK ST URBANA IL 61801 X Russ Leigh Chairman of Board 1.0 0.0 X X 0 0 0 Lynn Galloway Secretary/Treasurer of Board 2.0 0.0 X X 0 0 0 Ed Layden Jr Trustee 1.0 0.0 X X 0 0 0 Karla Coon Trustee 0.5 0.0 X 0 0 0 Henry Hornbeck Trustee 1.0 0.0 X 0 0 0 Joseph Barkmeier MD Trustee 1.0 39.0 X 0 494117 117808 Letha Kramer Trustee 0.4 39.6 X 0 139329 19148 Harry Brockus Ex-Officio Board, CEO 40.0 0.0 X 173951 0 39058 Dennis Hesch Exec VP & CFO 1.0 39.0 X 0 686195 183568 Laurence Fallon SVP-Legal Affairs & HR 1.0 39.0 X 0 565126 146298 Jay Colbert DO DPM Ex-Officio Brd,CMO & Physician 40.0 0.0 X 330891 0 19342 Daniel Chase MD Physician 40.0 0.0 X 364375 0 20075 William McCarthy MD Physician 40.0 0.0 X 240498 0 2313 Albert Tanlim MD Physician 40.0 0.0 X 208296 0 20862 Teresita Torres MD Physician 40.0 0.0 X 186403 0 145923 Dennis Price PA-C Physician Assistant 40.0 0.0 X 159043 0 6809 1663457 1884767 721204 7 false true false HOOPESTON EMERGENCY MEDICINE SPECIA 6948 WINDSOR AVE BERWYN IL 60402 PHYSICIAN STAFFING 901848 DMS IMAGING INC 26273 NETWORK PL CHICAGO IL 606731262 IMAGING SERVICES 184851 MED ONE CAPITAL FUNDING ILLINOIS LP PO BOX 271128 SALT LAKE CITY UT 84127 MEDICAL EQUIP LEASIN 158553 3 0 30677 8190 0 38867 Net Patient Services 622110 25964439 25964439 0 0 25964439 18422 18422 0 0 81373 154558 -73185 0 -73185 -73185 0 0 0 0 Catering 722320 91835 0 24792 67043 INTEREST ON PAYOR ACCOUNTS 900099 115810 0 0 115810 Perpetual Trust Interest 900099 421262 0 0 421262 46836 6729 40107 675743 26624286 25971168 24792 589459 X 33528 33528 0 0 0 0 0 0 585398 0 585398 0 101276 101276 0 0 9745471 9136299 609172 0 100314 95560 4754 0 1572087 1416419 155668 0 769009 682283 86726 0 0 0 0 0 19528 0 19528 0 23127 0 23127 0 22554 0 22554 0 0 0 0 0 0 0 2285148 1898496 386652 0 148393 4889 143504 0 1857903 1407471 450432 0 487936 56207 431729 0 0 0 0 0 462768 331246 131522 0 105335 76282 29053 0 0 0 0 0 43533 40516 3017 0 431471 367212 64259 0 0 0 0 0 1582899 933919 648980 0 523567 472966 50601 0 OTHER TAXES 600576 598898 1678 0 INTERNAL PURCH SERVICES 1187098 1126515 60583 0 PATIENT CARE SUPPLIES 2312756 2312756 INTERNAL MANAGEMENT FEES 3548225 2310029 1238196 0 483897 208907 274990 29033797 23611674 5422123 0 0 0 2682596 0 0 170720 0 4685337 6994575 0 0 0 0 0 0 0 0 275266 158421 18274137 2022027 16228466 16252110 0 0 0 0 0 0 1744690 4444690 10189470 4214921 33293949 34747313 5987870 1384904 0 0 0 0 0 0 0 0 0 0 10206032 11362003 0 0 11300226 18524720 27494128 31271627 X 2236064 -97543 0 0 3563757 3573229 5799821 3475686 33293949 34747313 X -2409511 12344 63560 9472 X X false true X true false X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED false false false 0 false 0 false 0 false 0 false 0 false 0 true 22554 22554 false PART II-B, LINE 1I other activities $6,429 - PORTION OF AMERICAN HOSPITAL ASSOCIATION (AHA) DUES ATTRIBUTABLE TO LOBBYING $15,969 - PORTION OF ILLINOIS HOSPITAL ASSOCIATION (IHA) DUES ATTRIBUTABLE TO LOBBYING $156 - PORTION OF MISCELLANEOUS HEALTH CARE ORGANIZATION DUES ATTRIBUTABLE TO LOBBYING 97500 97500 10220514 739458 9481056 25226 2132 23094 6830916 1194304 5636612 1099981 86133 1013848 16252110 CONSTRUCTION FUNDS SHORT TERM 539211 DEVL LIMITED ASSETS 57175 BENEFICIARY INTEREST IN TRUST 3573229 BOND FINANCE CHARGES 2011 45306 4214921 0 THIRD PARTY SETTLEMENTS 252661 INTERCOMPANY PAYABLES 18127709 ASSET RETIREMENT OBLIGATION 144350 18524720 X Schedule D, Part X, Line 2 FIN 48 (ASC740) FOOTNOTE THE GUIDANCE ON ACCOUNTING FOR UNCERTAINTY IN INCOME TAXES PRESCRIBES A MORE-LIKELY-THAN-NOT RECOGNITION THRESHOLD AND MEASUREMENT ATTRIBUTE FOR FINANCIAL STATEMENTS RECOGNITION OF A TAX POSITION TAKEN OR EXPECTED TO BE TAKEN. THERE WERE NO UNCERTAIN TAX BENEFITS IDENTIFIED OR RECORDED AS A LIABILITY AS OF DECEMBER 31, 2013 AND 2012. true true X true X 125. true X true true true false false 830525 830525 0.02870 5005751 4333936 671815 0.02320 5836276 4333936 1502340 0.05190 270380 0 270380 0.00930 23826 23826 0.00080 294206 0 294206 0.01010 6130482 4333936 1796546 0.06200 2796 2796 0.00010 15884 15884 0.00050 976 976 19656 19656 0.00060 true 1048045 524023 7412429 9808868 -2396439 X true true 1 1 Hoopeston Community Memorial Hospital 701 E Orange St Hoopeston IL 609421801 www.carle.org/hoopeston 0004200 X X X X Hoopeston Community Memorial Hospital 1 true X X X X X X X X X 13 true false true X see part vi X X X X X X X X X false false true true 125. true 300. true X X X X X X true true X X X true false X X X X true X false false SCHEDULE H, PART V SUPPLEMENTAL INFORMATION COMMUNITY HEALTH NEEDS ASSESSMENT (PART V, SECT B, LINE 1J) A COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA) WAS COMPLETED IN 2013 TO COVER PROGRAMS for 2014-2016. SURVEYS AND ASSESSMENTS WERE DISCUSSED AT THE ANNUAL STRATEGIC PLANNING SESSION WITH THE COMMUNITY BOARD OF DIRECTORS. SUBSEQUENTLY, THE 2014-16 CHNA AND IMPLEMENTATION PLAN WAS APPROVED BY THE BOARD IN DECEMBER 2013. COMMUNITY HEALTH NEEDS ASSESSMENT (PART V, SEC B, LINE 3) THE CHNA INCLUDED DISCUSSIONS WITH COMMUNITY LEADERS, INCLUDING HUMAN SERVICE AGENCY ADMINISTRATORS, PUBLIC HEALTH REPRESENTATIVES AND HOOPESTON COMMUNITY MEMORIAL HOSPITAL LEADERSHIP. AN 11-MEMBER COMMUNITY BOARD SERVES ON A VOLUNTEER BASIS, CONSISTING OF 7 VOTING MEMBERS AND 4 NON-VOTING STAFF MEMBERS. COMMUNITY HEALTH NEEDS ASSESSMENT (PART V, SEC B, LINE 5a) URL FOR CHNA: http://www.carle.org/About/ServingOurCommunity/Community-Health-Needs-Asse ssment.aspx COMMUNITY HEALTH NEEDS ASSESSMENT (PART V, SEC B, LINE 7) While there were a number of additional needs identified by the data and input from community leaders, as a Critical Access Hospital, Hoopeston Community Memorial Hospital (HCMH) does not have the resources to address all of them. The issues that will not be addressed in this implementation plan are lower priority because the need was not as significant; they are not central to the hospitals mission; and HCMH has determined it does not have the ability to make a measurable impact in those areas. HCMH will not focus the Community Benefit Implementation Plan on addressing community health challenges related to Disabilities; Exercise, Nutrition and Weight; Immunization and Infectious Diseases; Maternal, Fetal and Infant Health; Mental Health; Older Adults and Aging; Respiratory Diseases or Substance Abuse. HCMH will continue its work to improve the overall health of the community through service to its patients and that will include emphasis on Access to Health Services, Heart Disease and Stroke and the other specialties and services the hospital or Carle health system provides. The Carle Foundation, parent organization for HCMH, is diligently working to improving access and services throughout the east central Illinois region, not just for this geographic area. Many of the other concerns are also addressed through services provided for Carle patients, but these areas are not the primary emphasis of the Community Benefit Implementation Plan which targets more specific low income populations in Vermilion County. FINANCIAL ASSISTANCE POLICY (PART V, SEC B, LINE 14) SIGNS ARE POSTED AROUND THE HOSPITAL AND IN ALL AREAS OF PATIENT REGISTRATION. PATIENTS CAN DISCUSS A DIFFICULTY OR NEED WITH REGISTRATION STAFF TO DETERMINE IF THEY MAY BE ELIGIBLE FOR FINANCIAL ASSISTANCE, AND STAFF WILL THEN ASSIST THEM IN THE APPROPRIATE APPLICATION PROCESS. IT WILL LATER BE DETERMINED IF THEY ARE ELIGIBLE FOR STATE MEDICAID OR IF THEY QUALIFY FOR THE HOSPITAL'S FINANCIAL ASSISTANCE PROGRAM. WHILE HOOPESTON COMMUNITY MEMORIAL HOSPITAL'S FINANCIAL ASSISTANCE POLICY WAS HEAVILY PROMOTED USING THE MEANS LISTED, THE FINANCIAL ASSISTANCE POLICY IS AVAILABLE IN ITS ENTIRETY ON THE ORGANIZATION'S WEBSITE AND UPON REQUEST. PART V, SECT B, LINE 20D The amounts charged to all patients for emergency or other medically necessary care are consistent with Hoopeston Community Memorial Hospital's standard fee schedule. Patients that qualify under the organization's Financial Assistance Policy (FAP) were charged at a rate commensurate with their eligible discount as is stated in the FAP. necessary care are consistent with Hoopeston Community Memorial Hospital's standard fee schedule. Patients that qualify under the organization's Financial Assistance Policy (FAP) were charged at a rate commensurate with their eligible discount as is stated in the FAP. 7 Hoopeston Ambulance Services 413 E Main Hoopeston IL 60942 Ambulance Services Rossville Medical Center 619 N Chicago St Rossville IL 60963 Medical Clinic Roberts Clinic 845 S 4th St Watseka IL 60970 Medical Clinic Milford Clinic 322 Chicago St Milford IL 60953 Medical Clinic Cissna Park Medical Clinic 141 W Garfield Ave Cissna Park IL 60924 Medical Clinic Charlotte Ann Russell 801 E Orange St Hoopeston IL 60942 Medical Clinic DANVILLE ON FAIRCHILD 311 W FAIRCHILD DANVILLE IL 61832 MEDICAL CLINIC SCHEDULE H SUPPLEMENTAL INFORMATION SCHEDULE H, PART VI 1 - REQUIRED Descriptions INCOME BASED CRITERIA FOR DETERMINING ELIGIBILITY FOR FREE OR DISCOUNTED CARE (PART I, QUESTION 3C) THERE ARE THREE WAYS A PATIENT MAY BE DEEMED TO HAVE FINANCIAL NEED: (I) BY A DETERMINATION THAT THE PATIENT'S INCOME IS BELOW CERTAIN FEDERAL POVERTY GUIDELINES AND THE PATIENT HAS LIMITED ASSETS THAT, IF LIQUID, WOULD LIFT HIM OR HER ABOVE SUCH FEDERAL POVERTY GUIDELINES ("INCOME" INCLUDES SALARIES, LEGAL JUDGMENTS, UNEMPLOYMENT COMPENSATION, SOCIAL SECURITY INCOME, ALIMONY, DIVIDENDS, AND INTEREST CHECKS; "ASSETS" INCLUDE SAVINGS, CERTIFICATES OF DEPOSIT, INDIVIDUAL RETIREMENT ACCOUNTS AND PROPERTY OTHER THAN A PATIENT'S PRIMARY RESIDENCE); (II) BY A DETERMINATION THAT THE PATIENT HAS EXPERIENCED A MEDICAL HARDSHIP; AND (III) BY A DETERMINATION THAT AN ALTERNATE HOSPITAL HAS MADE FINANCIAL ASSISTANCE AVAILABLE TO THE PATIENT, ALL AS FURTHER DESCRIBED BELOW. 1. FINANCIAL HARDSHIP: IF A PATIENT'S INCOME AND ASSETS ARE BELOW 300% OF THE FEDERAL POVERTY GUIDELINES, THE PATIENT WILL RECEIVE SOME FORM OF FINANCIAL ASSISTANCE FOR FACILITY SERVICES; IF A PATIENT'S INCOME AND ASSETS ARE BELOW 200% OF THE FEDERAL POVERTY GUIDELINES, THE PATIENT WILL RECEIVE SOME FORM OF FINANCIAL ASSISTANCE FOR CLINIC PROFESSIONAL SERVICES. THE FINANCIAL ASSISTANCE FOR COVERED SERVICES MAY BE EITHER A COMPLETE WAIVER OF ALL PATIENT RESPONSIBILITY OR A DISCOUNT OR REDUCED PATIENT OBLIGATION RELATING TO SUCH COVERED SERVICES, DEPENDING ON THE EXACT LEVEL OF THE PATIENT'S INCOME. (A) IN GENERAL. IF A PATIENT'S INCOME FALLS BELOW 125% OF THE FEDERAL POVERTY GUIDELINES AND THE PATIENT DOES NOT HAVE ASSETS THAT, IF LIQUID, WOULD LIFT THE PATIENT ABOVE 125% OF THE FEDERAL POVERTY GUIDELINES, THE PATIENT WILL HAVE NO FINANCIAL RESPONSIBILITY FOR THE COVERED SERVICES. THIS MEANS THAT FEES FOR THE FACILITY SERVICES AND CLINIC PROFESSIONAL SERVICES DESCRIBED IN SECTION II.A OF THE FINANCIAL ASSISTANCE POLICY, AND THE COPAYMENT AND DEDUCTIBLE AMOUNTS FOR SUCH SERVICES, ARE COMPLETELY WAIVED. (B)FACILITY SERVICES. IF A PATIENT'S INCOME FALLS BETWEEN 126% AND LESS THAN 300% OF THE FEDERAL POVERTY GUIDELINES AND THE PATIENT DOES NOT HAVE ASSETS THAT, IF LIQUID, WOULD LIFT THE PATIENT TO AT LEAST 300% OF THE FEDERAL POVERTY GUIDELINES, THE PATIENT IS ELIGIBLE FOR FINANCIAL ASSISTANCE FOR FACILITY SERVICES DESCRIBED IN SECTION II.A. OF THE FINANCIAL ASSISTANCE POLICY IN THE FORM OF A DISCOUNT ON CHARGES TO 135% OF HCMH'S COSTS FOR THE FACILITY SERVICES EXCEEDING $300 IN ANY ONE INPATIENT ADMISSION OR OUTPATIENT SERVICE, AS DETERMINED BY HCMH IN ACCORDANCE WITH APPLICABLE LAW, AS SET FORTH ON EXHIBIT 1 OF THE FINANCIAL ASSISTANCE POLICY. (C) CLINIC PROFESSIONAL SERVICES. IF A PATIENT'S INCOME FALLS BETWEEN 126% AND LESS THAN 200% OF THE FEDERAL POVERTY GUIDELINES AND THE PATIENT DOES NOT HAVE ASSETS THAT, IF LIQUID, WOULD LIFT THE PATIENT TO AT LEAST 200% OF THE FEDERAL POVERTY GUIDELINES, THE PATIENT IS ELIGIBLE FOR FINANCIAL ASSISTANCE FOR CLINIC PROFESSIONAL SERVICES DESCRIBED IN SECTION II.A. OF THE FINANCIAL ASSISTANCE POLICY IN THE FORM OF A 50% DISCOUNT ON CHARGES FOR SUCH SERVICES, AS SET FORTH ON EXHIBIT 1. THIS MEANS THAT 50% OF THE FEES FOR THE CLINIC PROFESSIONAL SERVICES DESCRIBED IN SECTION II.A, AND THE COPAYMENT AND DEDUCTIBLE AMOUNTS FOR SUCH SERVICES, ARE WAIVED. 2. MEDICAL HARDSHIP: HCMH ALSO WILL CONSIDER FINANCIAL ASSISTANCE FOR COVERED SERVICES WHERE A PATIENT'S MEDICAL BILLS FOR SERVICES RENDERED AT THE HOSPITAL OR THE CLINIC ARE OF SUCH AN AMOUNT THAT PAYMENT THREATENS THE PATIENT'S FINANCIAL SURVIVAL. SUCH FINANCIAL ASSISTANCE MAY BE IN ADDITION TO FINANCIAL ASSISTANCE FOR FINANCIAL HARDSHIP, AND SHALL BE DETERMINED BASED ON AN INDIVIDUAL ASSESSMENT OF A PATIENT'S FINANCIAL RESOURCES AND THE SIZE OF THE PATIENT'S BILL FOR SERVICES RENDERED AT THE HOSPITAL AND THE CLINIC. 3. RECIPROCITY. IF A PATIENT IS NOT ELIGIBLE FOR FINANCIAL ASSISTANCE BASED ON FINANCIAL HARDSHIP OR MEDICAL HARDSHIP, BUT THE PATIENT HAS BEEN PROVIDED FINANCIAL ASSISTANCE BY AN ALTERNATE HOSPITAL LOCATED WITHIN 30 MILES OF HOSPITAL, THE HOSPITAL WILL PROVIDE THE PATIENT WITH FINANCIAL ASSISTANCE FOR FACILITY SERVICES DESCRIBED IN SECTION II.A. OF THE FINANCIAL ASSISTANCE POLICY TO THE SAME EXTENT AS SUCH OTHER HOSPITAL, PROVIDED HOWEVER, THAT THE PATIENT MUST PROVIDE HOSPITAL WITH WRITTEN PROOF OF THE NATURE AND AMOUNT OF FINANCIAL ASSISTANCE PROVIDED BY SUCH OTHER HOSPITAL THAT IS ACCEPTABLE TO HCMH, IN ITS SOLE DISCRETION. 4. DOCUMENTATION. TO DETERMINE WHETHER A PATIENT IS ELIGIBLE FOR FINANCIAL ASSISTANCE FOR COVERED SERVICES, THE PATIENT WILL BE REQUIRED TO COMPLETE THE PATIENT FINANCIAL WORKSHEET. HCMH WILL ASSIST PATIENTS WITH THIS FORM AS REQUESTED BY THE PATIENT. EXPLANATION OF COSTING METHODOLOGY (PART I, LINE 7 AND PART III, LINE 2) TO COMPUTE AND CONVERT FINANCIAL ASSISTANCE, UNREIMBURSED MEDICAID, MEANS-TESTED PROGRAMS AND BAD DEBT CHARGES TO COST; A CONSISTENT GAAP (GENERALLY ACCEPTED ACCOUNTING PRINCIPLES) BASED COST-TO-CHARGE RATIO WAS USED ACROSS ALL PAYERS. ALTHOUGH THE METHODOLOGY WAS SIMILAR TO WORKSHEET #2, FOR SIMPLICITY PURPOSES CERTAIN IMMATERIAL VALUES WERE OMITTED. OTHER BENEFITS COSTS WERE REPORTED AT THE ACTUAL EXPENSE INCURRED. PATIENT'S RECEIVABLE PAYMENTS WERE RECORDED AT TIME OF RECEIPT AND RELATED DISCOUNTS WERE ALSO RECORDED AT ACTUAL AMOUNTS AT THE TIME OF PAYMENT RECEIPT. A SEPARATE GAAP BASED PROVISION FOR ESTIMATED BAD DEBTS AND DISCOUNTS WAS RECOGNIZED FOR ACCOUNTS IN PROCESS AND PENDING ADJUDICATION AND PAYMENT. THE ESTIMATED PORTION WAS BASED ON HISTORICAL TRENDS AND ADJUSTED TO ACTUAL IN FUTURE PERIODS WHEN THE ACCOUNT'S ADJUDICATION AND PAYMENT OCCUR. ACCOUNTS DETERMINED TO BE ELIGIBLE FOR FINANCIAL ASSISTANCE WERE PROCESSED IMMEDIATELY FOR FINANCIAL ASSISTANCE DISCOUNT WITH NO COLLECTION EFFORT. FOR ACCOUNTS WITH INSUFFICIENT INFORMATION AND DOCUMENTATION TO DETERMINE FINANCIAL ASSISTANCE ELIGIBILITY, THE HOSPITAL CONSULTED WITH A VARIETY OF ALTERNATIVE SOURCES TO HELP DETERMINE AN INDIVIDUAL'S FINANCIAL MEANS (OR LACK OF MEANS) TO PAY. BASED ON RELATED TRENDS, THE HOSPITAL FURTHER DEVELOPED A GENERAL ESTIMATE OF FINANCIAL ASSISTANCE WHICH CONTINUED TO RESIDE WITHIN BAD DEBTS. COMMUNITY BUILDING ACTIVITIES (PART II) ECONOMIC DEVELOPMENT THE HOOPESTON ECONOMIC DEVELOPMENT COMMITTEE HELD FOUR MEETINGS PER MONTH TO DISCUSS A NUMBER OF ISSUES THAT IMPACT THE COMMUNITY'S HEALTH AND SAFETY. TWO MEMBERS OF HCMH LEADERSHIP AND STAFF ATTENDED MEETINGS, AMOUNTING TO 48 HOURS TOTAL, OR $2,796 OF IN-KIND SUPPORT IN 2013. COMMUNITY SUPPORT A PORTION OF HCMH'S COMMUNITY-BUILDING ACTIVITIES ($4,192) FOCUSED ON COMMUNITY SUPPORT, INCLUDING CASH, IN-KIND DONATIONS AND BUDGETED EXPENDITURES FOR THE CITY, BUSINESS ASSOCIATIONS AND OTHER PROGRAMS IN HOOPESTON. ALTHOUGH THESE ITEMS WERE NOT COUNTED AS COMMUNITY BENEFIT, THIS SUPPORT IS AN IMPORTANT PART OF CONTRIBUTING TO THE ECONOMIC VIABILITY OF THE COMMUNITY. THE ADDITIONAL FUNDS CAPTURED AS COMMUNITY SUPPORT ($11,692) WERE FOR DISASTER READINESS - THOSE HOURS AND STAFF TIME SPENT ABOVE AND BEYOND NORMAL REQUIREMENTS FOR A HOSPITAL. AT HCMH, EMERGENCY PREPAREDNESS WAS A PRIORITY, WITH ONE STAFF MEMBER SERVING AS THE DISASTER PREPAREDNESS COORDINATOR. THIS INDIVIDUAL SAT ON THE HOOPESTON EMERGENCY MANAGEMENT AGENCY AS A REPRESENTATIVE OF CARLE HOOPESTON, ATTENDED DISASTER MEETINGS, AND PARTICIPATED IN DRILLS. SHE ALSO CONTINUED TO PARTICIPATE IN REGULAR DISCUSSIONS WITH THE REGION, INCLUDING THE CARLE EMERGENCY MANAGEMENT COMMITTEE, WORKING TOGETHER AND STANDING READY IF THE NEED OCCURS. OTHER NEARLY $1,000 OF HCMH'S COMMUNITY-BUILDING ACTIVITIES WAS TIME DEVELOPING THE 2014-16 COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA). THOUGH THE PRIORITIZED NEEDS AND IMPLEMENTATION PLAN DO NOT TAKE EFFECT UNTIL 2014, THIS CHNA WAS REQUIRED TO BE COMPLETED IN 2013. THIS INCLUDES STAFF TIME TO COMPLETE THE CHNA, BOTH BY LEADERSHIP AND BY COMMUNICATIONS STAFF, WITH 22 HOURS ON RESEARCH, DISCUSSIONS WITH COMMUNITY LEADERS, PRIORITIZATION, REVIEWING DOCUMENTATION AND FINAL PLANS. BAD DEBT, MEDICARE, & COLLECTION PRACTICES (PART III, LINE 3) HOOPESTON COMMUNITY MEMORIAL HOSPITAL (HCMH) USES 50% AS A GENERAL ESTIMATE OF THE ORGANIZATION'S BAD DEBT EXPENSE ATTRIBUTABLE TO PATIENTS ELIGIBLE UNDER THE ORGANIZATION'S FINANCIAL ASSISTANCE POLICY. BAD DEBT FOOTNOTE (PART III, LINE 4) THE FOOTNOTE PERTAINING TO BAD DEBT EXPENSE CAN BE FOUND ON PAGE 27 OF THE ATTACHED CONSOLIDATED FINANCIAL STATEMENTS. EXPLANATION OF MEDICARE COST REPORT COSTING METHODOLOGY (PART III, LINE 8) THE NUMERATOR (TOTAL EXPENSE) AND DENOMINATOR (TOTAL GROSS CHARGES) OF THE SIMPLE RATIO OF PATIENT CARE COST TO CHARGES IS ADJUSTED BY ELIMINATING NON-PATIENT CARE THAT GENERATES OTHER REVENUE, BAD DEBT EXPENSE, MEDICAID AND OTHER PROVIDER TAXES AND THE TOTAL COST OF COMMUNITY BENEFIT ACTIVITIES AND PROGRAMS. ALSO, ANY GROSS PATIENT CHARGES FOR PROGRAMS NOT RELYING ON THE RATIO ARE ELIMINATED FROM BOTH THE NUMERATOR 2 - NEEDS ASSESSMENT HOOPESTON COMMUNITY MEMORIAL HOSPITAL USED EXISTING DATA, INFORMAL DISCUSSIONS, AND A COMPREHENSIVE QUALITATIVE COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA) TO DETERMINE IF EXISTING PROGRAMS ARE ON TRACK; WHAT NEEDS TO BE ADDED, DELETED OR ENHANCED; AND WHERE OUR FOCUS NEEDED TO BE PLACED IN THE FUTURE. THE CHNA INCLUDED DISCUSSIONS WITH COMMUNITY LEADERS, INCLUDING HUMAN SERVICE AGENCY ADMINISTRATORS, PUBLIC HEALTH REPRESENTATIVES AND HOOPESTON COMMUNITY MEMORIAL HOSPITAL LEADERSHIP. 3 - PATIENT EDUCATION FOR ELIGIBILITY FOR ASSISTANCE HOOPESTON COMMUNITY MEMORIAL HOSPITAL IS ACUTELY AWARE OF THE NEED FOR ACCESS TO CARE AND AS A RESULT, OFFERS A STRONG FINANCIAL ASSISTANCE PROGRAM THAT IS BASED IN A PHILOSOPHY OF DOING THE RIGHT THING FOR THE COMMUNITY AND PATIENTS AND BALANCED BY A CAREFUL STEWARDSHIP OF THE COMMUNITY'S RESOURCES. BY DETERMINING THE FINANCIAL STATUS OF PATIENTS UP-FRONT, WE HAVE BEEN ABLE TO PINPOINT THOSE NEEDING FINANCIAL ASSISTANCE EARLY IN THE PROCESS, MINIMIZING BAD DEBT AND OPTIMIZING OUR ABILITY TO HELP. STAFF IS ALSO DILIGENT IN FOLLOWING UP WITH PATIENTS DURING HOSPITALIZATION AND AFTER DISCHARGE IF THERE'S ANY REASON TO BELIEVE THE PATIENT COULD BENEFIT FROM FINANCIAL ASSISTANCE. HOOPESTON COMMUNITY MEMORIAL HOSPITAL HAS MADE A CONCERTED, CONTINUOUS EFFORT TO BE SURE THAT PEOPLE HAVE ACCESS TO INFORMATION THAT WILL HELP THEM WITH THEIR MEDICAL BILLS. THIS INCLUDES: - A SIMPLIFIED APPLICATION FORM THAT CLEARLY EXPLAINS PATIENT RIGHTS AND HCMH'S EXPECTATIONS. - INFORMATION ABOUT THE FINANCIAL ASSISTANCE PROGRAM ON ALL BILLING STATEMENTS, COLLECTION LETTERS AND HOSPITAL ADMISSION PACKETS. - INFORMATION AND APPLICATION FORMS READILY AVAILABLE AT WWW.CARLE.ORG/HOOPESTON. - FINANCIAL ASSISTANCE APPLICATION FORMS AND BROCHURES AVAILABLE AT ALL INPATIENT AND OUTPATIENT REGISTRATION POINTS, AS WELL AS IN THE HOSPITAL'S MAIN LOBBY. - MEETING WITH OUR OWN STAFF TO KEEP THEM INFORMED ABOUT THE PROGRAM AND WHAT BENEFITS ARE AVAILABLE TO PATIENTS. - FINANCIAL ASSISTANCE REPRESENTATIVES AVAILABLE AT VARIOUS COMMUNITY FORUMS. 4 - COMMUNITY INFORMATION TARGETED POPULATIONS INCLUDE THE UNINSURED AND UNDERINSURED, AND CHILDREN AT RISK-FROM CONCEPTION THROUGH CHILDHOOD. FOR THE CURRENT PLAN, RESEARCH AND REMEDIES ARE DIRECTED TOWARDS COMMUNITY HEALTH ISSUES IDENTIFIED IN VERMILION COUNTY. POCKETS OF EXTREME POVERTY EXIST THROUGHOUT THIS REGION AND THE PROGRAMS WITHIN OUR COMMUNITY BENEFIT PLAN GENERALLY HAVE AN IMPACT UPON ALL OF THESE TARGETED COMMUNITIES, WITH CERTAIN PROGRAMS DIRECTED AT SPECIFIC POPULATIONS. 5 - PROMOTION OF COMMUNITY HEALTH HOOPESTON COMMUNITY MEMORIAL HOSPITAL HAS AN OPEN MEDICAL STAFF AND IS GOVERNED BY A COMMUNITY BOARD. SURPLUS FUNDS ARE REINVESTED INTO THE ORGANIZATION FOR TECHNOLOGY REPLACEMENT AND ADVANCEMENT, CLINICAL SERVICE EXPANSION AND QUALITY IMPROVEMENT. FUNDS ARE ALSO INVESTED INTO OUR COMMUNITIES TO MEET IDENTIFIED HEALTH NEEDS WHICH CONTRIBUTE TO THE OVERALL WELL-BEING OF THE RESIDENTS OF THE COMMUNITIES WE SERVE. CASH AND IN-KIND DONATIONS MORE THAN $20,000 WAS GIVEN TO CHARITABLE ORGANIZATIONS IN THE COMMUNITY VIA CASH AND IN-KIND DONATIONS, INCLUDING PROGRAMS AIMED TO HELP YOUTH, HEALTH IMPROVEMENT AND HEALTH EDUCATION, WITH AN ADDITIONAL $7,000 FOR COMMUNITY BUILDING AND ECONOMIC DEVELOPMENT SUPPORT. TO MAKE USE OF SPACE THAT HCMH NO LONGER NEEDED, A BUILDING WAS DONATED TO DANVILLE AREA COMMUNITY COLLEGE (DACC), COMPLETELY FREE OF CHARGE, TO MAKE A HIGHER-EDUCATION FACILITY IN HOOPESTON. HCMH ALSO PAID FOR RENOVATIONS AND ASBESTOS ABATEMENT TO THE FACILITY. THIS RENOVATED BUILDING NOW OCCUPIES STUDENTS YEAR-ROUND, AND OFFERS BOTH CREDITED AND NON-CREDITED COURSES. SCHOOL-BASED EDUCATION HCMH STAFF MAINTAINED A PRESENCE IN THE LOCAL SCHOOL SYSTEM, PROVIDING HEAD LICE CHECKS, VISION AND HEARING TESTING FOR SCHOOLS IN THE REGION. THE HOSPITAL ALSO PROVIDED FULL-TIME ATHLETIC TRAINERS TO SCHOOLS IN HOOPESTON, CISSNA PARK AND MILFORD. SERVICE IS PROVIDED TO ALL STUDENT ATHLETES, REGARDLESS OF WHERE THEY RECEIVE CARE, AND IS FREE OF CHARGE TO THE SCHOOL DISTRICTS. ADDITIONALLY, AT THE REQUEST OF THE HOOPESTON HIGH SCHOOL PRINCIPAL, STAFF BEGAN PREPARING STD AND SAFE SEX CURRICULUM INTENDED FOR HIGH SCHOOL STUDENTS. THOUGH NO PRESENTATIONS WERE GIVEN IN 2013, CURRICULUM WAS DEVELOPED AND ALSO OFFERED TO OTHER AREA HIGH SCHOOLS. PROGRAMS FOCUSED ON TEEN PREGNANCY AND STD PREVENTION TARGETING A SIGNIFICANT NEED IN THE COMMUNITY, AS SHOWN BY HCMH'S 2014-16 CHNA, AND THE INTENT IS FOR THIS CURRICULUM to BE UTILIZED GOING FORWARD TO ADDRESS THIS GROWING PROBLEM. DISASTER READINESS EMERGENCY PREPAREDNESS WAS A PRIORITY, WITH ONE STAFF MEMBER SERVING AS THE DISASTER PREPAREDNESS COORDINATOR. THIS INDIVIDUAL SAT ON THE HOOPESTON EMERGENCY MANAGEMENT AGENCY AS A REPRESENTATIVE OF CARLE HOOPESTON, ATTENDED DISASTER MEETINGS, AND PARTICIPATED IN DRILLS. SHE ALSO CONTINUED TO PARTICIPATE IN REGULAR DISCUSSIONS WITH THE REGION, INCLUDING THE CARLE EMERGENCY MANAGEMENT COMMITTEE, WORKING TOGETHER AND STANDING READY IF THE NEED OCCURS. BECAUSE THE NEEDS ARE GREAT AND VARIED AND IT WOULD BE UNREASONABLE TO ADDRESS EACH AND EVERY IDENTIFIED NEED, WE SET PRIORITIES AND USE OUR RESOURCES TO FOCUS PRIMARILY ON IDENTIFIED NEEDS WITHIN THE COMMUNITY BENEFIT PRIORITIES SET. MANY OF THESE NEEDS ARE ADDRESSED THROUGH PARTNERSHIPS AND COLLABORATIVE EFFORTS. 6 - AFFILIATED HEALTH CARE SYSTEM Hoopeston Community Memorial Hospital is a critical access hospital committed to improving quality of life in Northern Vermilion County and the surrounding area. HCMH integrated with The Carle Foundation in 2012 to provide more access to primary and specialty care. Though HCMH falls under the umbrella of The Carle Foundation, it maintains a separate Board of Directors and senior leadership, and conducted its own Community Health Needs Assessment and implementation plan in 2013. While HCMHs CHNA and community benefit reporting is separate from The Carle Foundation Hospital, it follows the same guidelines and principles as Carle. HCMH staff are involved in the CHNA and implementation plan, and serve on human services agency boards and committees to provide support to help address identified community needs in Northern Vermilion County, including childrens health, teen and adolescent health, oral health, cancer and diabetes. 7 - STATE FILING OF COMMUNITY BENEFIT REPORT NOT APPLICABLE DUE TO CRITICAL ACCESS HOSPITAL UNDER 100 BEDS. true CITY OF HOOPESTON 301 W MAIN ST HOOPESTON IL 609421507 376002234 501(c)(3) 10000 0 cash Sponsorship 1 0 Form 990, Schedule I DESCRIPTION OF ORGANIZATION'S PROCEDURES FOR MONITORING THE USE OF GRANTS ANY CHARITABLE ORGANIZATION WISHING TO REQUEST FUNDS IS ASKED TO SUBMIT THEIR REQUEST IN WRITING. EMAIL REQUESTS ARE ACCEPTABLE. THE REQUEST MUST INCLUDE A DESCRIPTION OF THE PURPOSE OF THE CONTRIBUTION AND OTHER RELEVANT INFORMATION SUCH AS REQUESTORS NAME, AMOUNT OF THE REQUEST, ETC. THE REQUESTS ARE REVIEWED AND EVALUATED TO CONFIRM THE REQUESTED FUNDS FURTHER THE EXEMPT PURPOSE OF HOOPESTON COMMUNITY MEMORIAL HOSPITAL. MOST DONATIONS ARE MADE TO ImPROVE HEALTHCARE/ACCESS TO HEALTHCARE OR ARE IN LINE WITH OUR ROLE AS A CORPORATE CITIZEN. ASSESSED NEED IS A COMMON CRITERIA. REQUESTS UNDER $25,000 ARE APPROVED AND ADMINISTED BY THE CEO. IN THE CASE OF MOST DONATIONS OF $5,000 OR MORE, SUCH AS TO COLLEGES OR CHARITABLE ORGANIZATIONS IN THE COMMUNITY, WRITTEN AGREEMENTS ARE IN PLACE AND WE HAVE REGULAR, CASUAL CONTACT WITH THOSE ORGANIZATIONS, OFTEn TIMES THROUGH A HOOPESTON COMMUNITY MEMORIAL HOSPITAL CONTACT PERSON TO ASSURE THAT THE DONATIONS ARE BEING USED AS AGREED UPON. RECORDS ARE MAINTAINED IN ADMINISTRATION. true true false false false false false true false Joseph Barkmeier MD Trustee 0 441547 0 43515 0 9055 0 108200 0 9608 0 611925 0 0 Letha Kramer Trustee 0 128328 0 10722 0 279 0 10477 0 8671 0 158477 0 0 Harry Brockus Ex-Officio Board, CEO 169812 0 0 0 4139 0 18805 0 20253 0 213009 0 0 0 Dennis Hesch Exec VP & CFO 0 468947 0 116351 0 100897 0 161988 0 21580 0 869763 0 70558 Laurence Fallon SVP-Legal Affairs & HR 0 399625 0 71040 0 94461 0 125343 0 20955 0 711424 0 82833 Jay Colbert DO DPM Ex-Officio Brd,CMO & Physician 328190 0 0 0 2701 0 0 0 19342 0 350233 0 0 0 Daniel Chase MD Physician 361926 0 0 0 2449 0 0 0 20075 0 384450 0 0 0 William McCarthy MD Physician 226085 0 0 0 14413 0 1000 0 1313 0 242811 0 0 0 Albert Tanlim MD Physician 206358 0 0 0 1938 0 1000 0 19862 0 229158 0 0 0 Teresita Torres MD Physician 123925 0 0 0 62478 0 143172 0 2751 0 332326 0 0 0 Dennis Price PA-C Physician Assistant 157386 0 0 0 1657 0 1000 0 5809 0 165852 0 0 0 SUPPLEMENTAL COMPENSATION INFORMATION SCHEDULE J, PART I, QUESTION 3 THE BOARD OF TRUSTEES OF THE CARLE FOUNDATION, THE PARENT COMPANY OF HOOPESTON COMMUNITY MEMORIAL HOSPITAL, THROUGH ITS COMPENSATION COMMITTEE COMPRISED OF INDEPENDENT MEMBERS FREE OF CONFLICT, ANNUALLY REVIEWS EXECUTIVE COMPENSATION LEVELS AND ESTABLISHES APPROPRIATE SALARY RANGES AND OTHER FEATURES OF THE COMPENSATION PLAN IN ACCORDANCE WITH THE ORGANIZATION'S APPROVED COMPENSATION PHILOSOPHY AND STRATEGY: *THE COMMITTEE IS COMPRISED OF MEMBERS OF THE BOARD OF TRUSTEES; WHO ARE INDEPENDENT OF THE CARLE FOUNDATION MANAGEMENT; HAVE NO PERSONAL INTEREST IN THE COMPENSATION ARRANGEMENTS; ARE NOT RELATED TO, OR UNDER THE CONTROL OF ANY INDIVIDUAL WHOSE COMPENSATION ARRANGEMENT IS BEING REVIEWED; AND HAVE NO MATERIAL BUSINESS RELATIONSHIP WITH THE CARLE FOUNDATION. *THE CHIEF EXECUTIVE OFFICER'S COMPENSATION IS DETERMINED BY THE COMPENSATION COMMITTEE IN RELATION TO APPROPRIATE COMPARABILITY DATA. COMPENSATION FOR OTHER MEMBERS OF THE EXECUTIVE STAFF IS DEVELOPED BY THE CEO, EVALUATED AGAINST MARKET DATA, AND REVIEWED AND APPROVED BY THE COMMITTEE. *THE COMMITTEE APPROVES ALL COMPENSATION DECISIONS IN ADVANCE OF THEIR IMPLEMENTATION AND DOCUMENTS ITS DETERMINATIONS AND DISCUSSIONS. *THE COMPENSATION COMMITTEE USES A NUMBER OF EXTERNAL RESOURCES AND COMPARISONS, AND ITS ANALYSIS INCLUDES TOTAL COMPENSATION (CASH COMPENSATION PLUS BENEFITS PROVIDED BY THE CARLE FOUNDATION) IN RELATION TO ORGANIZATIONAL PERFORMANCE AND PREVAILING INDUSTRY PRACTICES FOR LIKE RESPONSIBILITIES AT COMPARABLY-SIZED ORGANIZATIONS. THE COMMITTEE HAS ENGAGED THE SERVICES OF A COMPENSATION CONSULTING FIRM SPECIALIZING IN THE NOT-FOR-PROFIT SECTOR WHICH HAS WORKED WITH THE CARLE FOUNDATION AND REPORTS DIRECTLY TO THE COMPENSATION COMMITTEE. SCHEDULE J, PART I, QUESTION 4A TERESITA TORRES RECEIVED SEVERANCE PAYMENTS IN THE AMOUNT OF $57,828. SCHEDULE J, PART I, QUESTION 4B PARTICIPANTS IN THE 457(F) PLAN OFFERED BY THE CARLE FOUNDATION, THE PARENT ORGANIZATION OF HOOPESTON COMMUNITY MEMORIAL HOSPITAL, THAT ARE LISTED IN THE 990 PART VII INCLUDE JOSEPH BARKMEIER, MD, HARRY BROCKUS, DENNIS HESCH, AND LAURENCE FALLON. IN 2013, PAYMENTS FROM THE 457(F) PLAN WERE MADE TO DENNIS HESCH ($70,558), AND LAURENCE FALLON ($82,833). SCHEDULE J, PART I, QUESTION 7 PART OF THE CEO'S COMPENSATION INCLUDES AN INCENTIVE COMPONENT WHICH IS DESIGNED TO ENCOURAGE AND PROMOTE THE ACHIEVEMENT OF CERTAIN QUALITY, OPERATIONAL, AND EFFICIENCY IMPROVEMENTS. ALTHOUGH THIS INCENTIVE COMPONENT IS BASED ON THE ORGANIZATION MEETING CERTAIN MINIMUM FINANCIAL THRESHOLDS, ALL PAYMENTS MUST BE APPROVED BY THE BOARD OF DIRECTORS PRIOR TO ANY INCENTIVE PAYOUT. ELIZABETH SILVER FAMILY MEMB OF BOARD CHR 51624 EMPLOYMENT false SHAUN GILLINS FAMILY MEMB OF BOARD CHR 49653 EMPLOYMENT false form 990, supplemental information FORM 990, PART VI, QUESTION 6 HOOPESTON COMMUNITY MEMORIAL HOSPITAL HAS ONE MEMBER WHICH IS THE PARENT COMPANY, THE CARLE FOUNDATION. FORM 990, PART VI, QUESTION 7A HOOPESTON COMMUNITY MEMORIAL HOSPITAL'S SOLE MEMBER, THE CARLE FOUNDATION, ACTING THROUGH ITS BOARD OF TRUSTEES, HAS THE EXCLUSIVE POWER TO ELECT AND REMOVE MEMBERS OF THE BOARD OF TRUSTEES FOR THE CORPORATION IN ADDITION TO FILLING VACANCIES. FORM 990, PART VI, QUESTION 7B HOOPESTON COMMUNITY MEMORIAL HOSPITAL'S BOARD OF TRUSTEES MUST HAVE THE APPROVAL OF ITS SOLE MEMBER, THE CARLE FOUNDATION, THROUGH ITS BOARD OF TRUSTEES, WHEN VOTING ON MATTERS INCLUDING THE AMENDING OF THE BY-LAWS; AMENDMENTS TO THE ARTICLES OF INCORPORATION; AUTHORIZING ANY NON-BUDGETED EXPENDITURE IN EXCESS OF $50,000 (THE EXCESS OF ANY PROPOSED EXPENDITURE OVER THE PREVIOUSLY APPROVED BUDGETED AMOUNT SHALL BE DEEMED A NON-BUDGETED EXPENDITURE); TO ADOPT ANY NEW OR ANY CHANGES TO EXISTING LONG TERM OR MASTER INSTITUTIONAL PLANS OF THE CORPORATION; TO ORGANIZE OR ACQUIRE, OR TO AUTHORIZE OR APPROVE THE ORGANIZATION'S ACQUISITION OF ANY SUBSIDIARY OR AFFILIATE OF THE CORPORATION; THE AUTHORIZATION TO ENTER INTO ANY CONTRACT OR ENGAGE IN ANY TRANSACTION OR ACTIVITY WHICH REQUIRES APPLICATION TO THE ILLINOIS HEALTH FACILITIES PLANNING BOARD FOR A PERMIT OR CERTIFICATE OF NEED AND FOR RECOMMENDING THE CEO OF THE CORPORATION TO THE HOOPESTON BOARD OF TRUSTEES. FORM 990, PART VI, QUESTION 11B THE FORM 990 WAS PREPARED BY STAFF AND AN EXTERNAL TAX ADVISOR AND REVIEWED BY MANAGEMENT. PRIOR TO FILING THIS FORM 990, A FULL AND COMPLETE COPY WAS PROVIDED TO THE GOVERNING BODY. AT THEIR DISCRETION, THE GOVERNING MEMBERS HAVE THE OPPORTUNITY TO CONTACT MANAGEMENT OR DISCUSS AND ADDRESS CONCERNS AT SUBSEQUENT BOARD MEETINGS. FORM 990, PART VI, QUESTION 12C THE ORGANIZATION'S ESTABLISHED CONFLICT OF INTEREST POLICIES REQUIRE ANNUAL DISCLOSURE OF ACTUAL AND POTENTIAL CONFLICTS OF INTEREST FOR OFFICERS, DIRECTORS, TRUSTEES, MEMBERS OF BOARD COMMITTEES, ADMINISTRATIVE AND MANAGERIAL EMPLOYEES AS WELL AS ALL EMPLOYEES OF THE PURCHASING DEPARTMENT. IF CIRCUMSTANCES CHANGE DURING THE COURSE OF A YEAR, INTERIM DISCLOSURE IS ALSO REQUIRED OF THE SAME INDIVIDUALS. THE DISCLOSURES OF EMPLOYEES ARE REVIEWED INITIALLY BY THE HUMAN RESOURCES DEPARTMENT AND ANY IDENTIFIED CONFLICTS ARE REFERRED TO, AND ADDRESSED BY, THE ORGANIZATION'S INTERNAL LEGAL COUNSEL AND/OR CORPORATE INTEGRITY OFFICER. THE DISCLOSURES OF TRUSTEES AND MEMBERS OF BOARD COMMITTEES ARE REVIEWED BY THE CHAIR OF THE BOARD. THE ENTIRE BOARD ABSENT THE SUBJECT TRUSTEE OR COMMITTEE MEMBER DETERMINES WHETHER A CONFLICT EXISTS. TRUSTEES AND/OR BOARD COMMITTEE MEMBERS WITH IDENTIFIED CONFLICTS ARE REQUIRED TO RECUSE THEMSELVES FROM VOTING ON MATTERS RELATED TO THEIR CONFLICTS. THE ORGANIZATION ALSO MAINTAINS PURCHASING POLICIES REQUIRING COUNTER SIGNATURES TO FURTHER MINIMIZE THE RISK ASSOCIATED WITH CONFLICTS OF INTEREST. FORM 990, PART VI, QUESTIONS 15A & 15B THE BOARD OF TRUSTEES OF THE CARLE FOUNDATION, THE PARENT COMPANY OF HOOPESTON COMMUNITY MEMORIAL HOSPITAL, THROUGH ITS COMPENSATION COMMITTEE COMPRISED OF INDEPENDENT MEMBERS FREE OF CONFLICT, ANNUALLY REVIEWS EXECUTIVE COMPENSATION LEVELS AND ESTABLISHES APPROPRIATE SALARY RANGES AND OTHER FEATURES OF THE COMPENSATION PLAN IN ACCORDANCE WITH THE ORGANIZATION'S APPROVED COMPENSATION PHILOSOPHY AND STRATEGY: *THE COMMITTEE IS COMPRISED OF MEMBERS OF THE BOARD OF TRUSTEES; WHO ARE INDEPENDENT OF THE CARLE FOUNDATION MANAGEMENT; HAVE NO PERSONAL INTEREST IN THE COMPENSATION ARRANGEMENTS; ARE NOT RELATED TO, OR UNDER THE CONTROL OF ANY INDIVIDUAL WHOSE COMPENSATION ARRANGEMENT IS BEING REVIEWED; AND HAVE NO MATERIAL BUSINESS RELATIONSHIP WITH THE CARLE FOUNDATION. *THE CHIEF EXECUTIVE OFFICER'S COMPENSATION IS DETERMINED BY THE COMPENSATION COMMITTEE IN RELATION TO APPROPRIATE COMPARABILITY DATA. COMPENSATION FOR OTHER MEMBERS OF THE EXECUTIVE STAFF IS DEVELOPED BY THE CEO OF THE CARLE FOUNDATION, EVALUATED AGAINST MARKET DATA, AND REVIEWED AND APPROVED BY THE COMMITTEE. *THE COMMITTEE APPROVES ALL COMPENSATION DECISIONS IN ADVANCE OF THEIR IMPLEMENTATION AND DOCUMENTS ITS DETERMINATIONS AND DISCUSSIONS. *THE COMPENSATION COMMITTEE USES A NUMBER OF EXTERNAL RESOURCES AND COMPARISONS, AND ITS ANALYSIS INCLUDES TOTAL COMPENSATION (CASH COMPENSATION PLUS BENEFITS PROVIDED BY THE CARLE FOUNDATION) IN RELATION TO ORGANIZATIONAL PERFORMANCE AND PREVAILING INDUSTRY PRACTICES FOR LIKE RESPONSIBILITIES AT COMPARABLY-SIZED ORGANIZATIONS. THE COMMITTEE HAS ENGAGED THE SERVICES OF A COMPENSATION CONSULTING FIRM SPECIALIZING IN THE NOT-FOR-PROFIT SECTOR WHICH HAS WORKED WITH THE CARLE FOUNDATION AND REPORTS DIRECTLY TO THE COMPENSATION COMMITTEE. FORM 990, PART VI, QUESTIONS 18 & 19 THE CARLE FOUNDATION, THE SOLE MEMBER OF HOOPESTON COMMUNITY MEMORIAL HOSPITAL, PUBLISHES THROUGH WWW.DACBOND.COM ITS QUARTERLY UNAUDITED FINANCIAL STATEMENTS, ANNUAL AUDITED FINANCIAL STATEMENTS, A MANAGEMENT'S DISCUSSION & ANALYSIS TO ACCOMPANY THE FINANCIAL STATEMENTS, AND AN ANNUAL REPORT OF CERTAIN OPERATING AND FINANCIAL INFORMATION. ADDITIONALLY, OFFICIAL STATEMENTS FOR OUTSTANDING MUNICIPAL BOND ISSUES FOR WHICH THE CARLE FOUNDATION IS OBLIGATED ARE AVAILABLE AT THIS WEBSITE. THESE DOCUMENTS INCLUDE EXTENSIVE INFORMATION ABOUT THE ORGANIZATION'S HEALTH CARE DELIVERY SYSTEM MODEL, RECENT HIGHLIGHTS/ACCOMPLISHMENTS, GOVERNANCE AND ADMINISTRATION, STRATEGIC PLAN, FACILITIES, CLINICAL PROGRAMS, MEDICAL STAFF, SERVICE AREA, COMPETITIVE ENVIRONMENT, DEMOGRAPHIC DATA, UTILIZATION STATISTICS, SUMMARY FINANCIAL INFORMATION, ACADEMIC AFFILIATIONS AND EDUCATIONAL PROGRAMS, MEDICAL RESEARCH, ACCREDITATIONS, AND ITS EMPLOYEES. THIS INFORMATION IS AVAILABLE AT NO CHARGE TO THOSE WHO REGISTER AT THE WWW.DACBOND.COM WEBSITE. IN ADDITION, THE FORM 990S OF THE ORGANIZATION'S FILING ENTITIES ARE AVAILABLE THROUGH DACBOND. QUARTERLY FINANCIAL STATEMENTS ARE AVAILABLE UPON REQUEST DELIVERED TO THE ORGANIZATION'S ADMINISTRATIVE OFFICES. THE ORGANIZATION'S GOVERNING DOCUMENTS AND CONFLICT OF INTEREST POLICIES ARE ALSO AVAILABLE UPON REQUEST TO THE ORGANIZATION'S ADMINISTRATIVE OFFICES. FORM 990, PART VII, SECTION A, COLUMN B THE AVERAGE ESTIMATED HOURS PER WEEK LISTED FOR THE REPORTING ORGANIZATION AND RELATED ORGANIZATIONS ARE BASED ON A STANDARD 40 HOUR WEEK. MEMBERS MAY FREQUENTLY DEVOTE MORE THAN 40 HOURS OF SERVICE TO THE ENTIRE ORGANIZATION DURING AN AVERAGE WEEK. FORM 990, PART XI, 8 $63,560 REVERSAL OF PRIOR YEAR LEGAL FEE ACCRUAL. FORM 990, PART XI, LINE 9 THE OTHER CHANGE IN NET ASSETS IS AN INCREASE IN PERMANANTLY RESTRICTED ASSETS FOR THE CHANGE IN VALUE OF THE BENEFICIAL INTEREST IN A PERPETUAL TRUST $9,472. FORM 990, PART XII, LINES 2A, B, C AND PART IV, LINES 12A & 12B THE FINANCIAL STATEMENTS FOR HOOPESTON COMMUNITY MEMORIAL HOSPITAL WERE REVIEWED ON A CONSOLIDATED BASIS UNDER THE PARENT ORGANIZATION, THE CARLE FOUNDATION. THE CARLE FOUNDATION DOES HAVE AN AUDIT COMMITTEE CONSISTING OF MEMBERS OF THE GOVERNING BOARD AND THE CHIEF FINANCIAL OFFICER WHO TOGETHER ASSUME RESPONSIBILITY FOR OVERSIGHT OF THE REVIEW AND AUDIT OF ITS FINANCIAL STATEMENTS AND SELECTION OF AN INDEPENDENT ACCOUNTANT. THE CARLE FOUNDATION HOSPITAL 611 W PARK ST URBANA IL 618012595 371119538 HOSPITAL SERV IL 501(c)(3) 3 TCF true THE CARLE FOUNDATION 611 W PARK ST URBANA IL 618012595 370673465 PARENT/INVmgt IL 501(c)(3) 11b TYPE II NA false CARLE HEALTH CARE INCORPORATED 611 W PARK ST URBANA IL 618012595 371140016 VAR SVCS IL 501(c)(3) 9 TCF true CARLE RETIREMENT CENTERS INC 611 W PARK ST URBANA IL 618012595 371160033 RTRMT LIVING IL 501(C)(3) 9 TCF true THE CARLE DEVELOPMENT FOUNDATION 611 W PARK ST URBANA IL 618012595 371159978 FUNDRAISING IL 501(c)(3) 7 TCF true CARLE COMMUNITY HEALTH CORPORATION 611 W PARK ST URBANA IL 618012595 364458371 FDN MISSION IL 501(c)(3) 11a TYPE I TCDF true CHAMPAIGN SURGICENTER LLC 611 W PARK ST URBANA IL 618012595 201915925 SURGICAL CENTER IL CHC RELATED HEALTH SYSTEMS INSURANCE LIMITED GOVERNORS SQ 2ND FL BLDG 3 GRAND CAYMAN CJ KY1-1102 INSURANCE CJ TCF C Corp true CARLE HOLDING COMPANY INC 611 W PARK ST URBANA IL 618012595 371188284 HOLDING COMPANY IL TCF C Corp true CARLE RISK MANAGEMENT COMPANY 611 W PARK ST URBANA IL 618012595 371217973 RISK MANAGEMENT IL CFH C Corp true EVALIDATA INC 611 W PARK ST URBANA IL 618012595 462022658 PHYS CREDENTIAL IL CFH C Corp true HEALTH ALLIANCE CONNECT INC 301 S VINE ST URBANA IL 61801 464796891 HEALTH CARE COORD IL TCF C Corp true HEALTH ALLIANCE MEDICAL PLANS INC 301 S VINE ST URBANA IL 61801 371260731 HEALTH COVERAGE IL CHC C CORP true false false false false false false false true false false false true true false false true false true false Carle Health Care Incorporated h 311988 Book Value Health Alliance Medical Plans Inc l 3547122 Book Value Carle Health Care Incorporated m 713433 Book Value The Carle Foundation Hospital m 127169 Book Value Carle Health Care Incorporated p 414331 Book value