HOPEDALE MEDICAL FOUNDATION: Form 990, tax year 2010

View the entire original 990 at ProPublica ↗

Organization: HOPEDALE MEDICAL FOUNDATION (EIN 37-0808925)
Tax period: 2010-07-01 to 2011-06-30
Filed: 2012-05-15
IRS object ID: 201211379349300741
Schema version: 2010v3.4
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 D
Schedule G
Schedule H
Schedule I
Schedule J
Schedule K
Schedule L
Schedule M
Schedule O
Schedule R

Return header ReturnHeader

Field	Value	IRS element (for citing)
Timestamp	2012-05-15T13:47:14-05:00	Timestamp
Tax Period End Date	2011-06-30	TaxPeriodEndDate

Preparer Firm PreparerFirm

Preparer Firm Business Name PreparerFirmBusinessName

Field	Value	IRS element (for citing)
Business Name Line1	MCGLADREY LLP	BusinessNameLine1

Preparer Firm US Address PreparerFirmUSAddress

Field	Value	IRS element (for citing)
Address Line1	400 LOCUST ST STE 640	AddressLine1
City	DES MOINES	City
State	IA	State
ZIP Code	503092354	ZIPCode

Field	Value	IRS element (for citing)
Return Type	990	ReturnType
Tax Period Begin Date	2010-07-01	TaxPeriodBeginDate

Filer Filer

Field	Value	IRS element (for citing)
EIN	370808925	EIN

Name Name

Field	Value	IRS element (for citing)
Business Name Line1	THE HOPEDALE MEDICAL FOUNDATION	BusinessNameLine1

Field	Value	IRS element (for citing)
Name Control	HOPE	NameControl
Phone	3094494298	Phone

US Address USAddress

Field	Value	IRS element (for citing)
Address Line1	PO BOX 267	AddressLine1
City	HOPEDALE	City
State	IL	State
ZIP Code	61747	ZIPCode

Officer Officer

Field	Value	IRS element (for citing)
Name	ALFRED ROSSI	Name
Title	PRESIDENT	Title
Phone	3094494298	Phone
Date Signed	2012-05-14	DateSigned
Authorize Third Party	1	AuthorizeThirdParty

Preparer Preparer

Field	Value	IRS element (for citing)
Name	CRYSTAL JOLIN	Name
Phone	5155586600	Phone

Field	Value	IRS element (for citing)
Tax Year	2010	TaxYear
Build TS	2016-02-24 21:20:13Z	BuildTS

Form 990 IRS990

Doing Business As DoingBusinessAs

Field	Value	IRS element (for citing)
Business Name Line1	HOPEDALE MEDICAL COMPLEX	BusinessNameLine1

Field	Value	IRS element (for citing)
Name Of Principal Officer Person	ALFRED ROSSI	NameOfPrincipalOfficerPerson

Address Principal Officer US AddressPrincipalOfficerUS

Field	Value	IRS element (for citing)
Address Line1	PO BOX 267	AddressLine1
City	HOPEDALE	City
State	IL	State
ZIP Code	61747	ZIPCode

Field	Value	IRS element (for citing)
Gross Receipts	25287748	GrossReceipts
Group Return For Affiliates	0	GroupReturnForAffiliates
Organization501c3	X	Organization501c3
Web Site	WWW.HOPEDALEMEDICALCOMPLEX.COM	WebSite
Type Of Organization Corporation	X	TypeOfOrganizationCorporation
Year Formation	1961	YearFormation
State Legal Domicile	IL	StateLegalDomicile
Activity Or Mission Description	MAINTAIN A MEDICAL COMPLEX THAT INCLUDES AN ACUTE CARE HOSPITAL AND HEALTH CARE FACILITY.	ActivityOrMissionDescription
Nbr Voting Members Governing Body	9	NbrVotingMembersGoverningBody
Nbr Independent Voting Members	6	NbrIndependentVotingMembers
Total Nbr Employees	423	TotalNbrEmployees
Total Nbr Volunteers	35	TotalNbrVolunteers
Total Gross UBI	108868	TotalGrossUBI
Net Unrelated Business Txbl Income	-43278	NetUnrelatedBusinessTxblIncome
Contributions Grants Prior Year	588756	ContributionsGrantsPriorYear
Contributions Grants Current Year	755989	ContributionsGrantsCurrentYear
Program Service Revenue Prior Year	21735669	ProgramServiceRevenuePriorYear
Program Service Revenue CY	19423183	ProgramServiceRevenueCY
Investment Income Prior Year	115927	InvestmentIncomePriorYear
Investment Income Current Year	99277	InvestmentIncomeCurrentYear
Other Revenue Prior Year	380764	OtherRevenuePriorYear
Other Revenue Current Year	3079291	OtherRevenueCurrentYear
Total Revenue Prior Year	22821116	TotalRevenuePriorYear
Total Revenue Current Year	23357740	TotalRevenueCurrentYear
Grants And Similar Amnts Prior Year	43974	GrantsAndSimilarAmntsPriorYear
Grants And Similar Amnts CY	30721	GrantsAndSimilarAmntsCY
Benefits Paid To Members Prior Year	0	BenefitsPaidToMembersPriorYear
Benefits Paid To Members CY	0	BenefitsPaidToMembersCY
Salaries Etc Prior Year	12205423	SalariesEtcPriorYear
Salaries Etc Current Year	11701562	SalariesEtcCurrentYear
Total Prof Fundrsng Exp Prior Year	0	TotalProfFundrsngExpPriorYear
Total Prof Fundrsng Exp CY	0	TotalProfFundrsngExpCY
Total Fundrsng Exp Current Year	25123	TotalFundrsngExpCurrentYear
Other Expense Prior Year	10014683	OtherExpensePriorYear
Other Expenses Current Year	9764168	OtherExpensesCurrentYear
Total Expenses Prior Year	22264080	TotalExpensesPriorYear
Total Expenses Current Year	21496451	TotalExpensesCurrentYear
Revenues Less Expenses Prior Year	557036	RevenuesLessExpensesPriorYear
Revenues Less Expenses CY	1861289	RevenuesLessExpensesCY
Total Assets BOY	20276587	TotalAssetsBOY
Total Assets EOY	22894079	TotalAssetsEOY
Total Liabilities BOY	8522457	TotalLiabilitiesBOY
Total Liabilities EOY	9224768	TotalLiabilitiesEOY
Net Assets Or Fund Balances BOY	11754130	NetAssetsOrFundBalancesBOY
Net Assets Or Fund Balances EOY	13669311	NetAssetsOrFundBalancesEOY
Info In Schedule O Part III	X	InfoInScheduleOPartIII
Mission Description	THE HOPEDALE MEDICAL FOUNDATION IS A NON-PORFIT, CHARITABLE CORPORATION COMMITTED TO EXCELLENCE IN PROMOTING GOOD HEALTH AND WELLNESS TO ALL, AND SERVING THE HEALTHCARE NEEDS OF THE SICK AND ELDERLY, 24 HOURS A DAY, 7 DAYS A WEEK, WITHOUT DISCRIMINATION AND REGARDLESS OF ONE'S ABILITY TO PAY.	MissionDescription
Significant New Program Services	0	SignificantNewProgramServices
Significant Change	0	SignificantChange
Expense	14882128	Expense
Grants	30721	Grants
Revenue	17197344	Revenue
Description	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, MACINAW 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 1,000 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 TOGEATHER 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 SERVICESTEH 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.	Description

Activity2 Activity2

Field	Value	IRS element (for citing)
Expense	2343334	Expense
Revenue	2673379	Revenue
Description	HOPEDALE NURSING HOME IS A 74-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.	Description

Activity3 Activity3

Field	Value	IRS element (for citing)
Expense	1603031	Expense
Revenue	1608042	Revenue
Description	HOPEDALE COMMONS IS A 67-BED INDEPENDENT AND ASSISTED LIVING FACILITY. IT IS ALSO LOCATED ON CAMPUS AND IS LOCATED NEAR THE HOSPITAL, NURSING HOME, AND PHYSICIAN OFFICE FOR THE CONVENIENCE OF OUR RESIDENTS AND THEIR FAMILIES.	Description

Activity Other ActivityOther (2 entries)

DescriptionDescription
RENEWED HOPE - SENIOR PROGRAM TO HELP SENIORS COPE WITH DEPRESSION, UNRESOLVED GRIEF, ANXIETY, NERVOUSNESS, WORRY, ISOLATION, LONELINESS, COPING WITH HEALTH/PHYSICAL CHANGES, DIFFICULTY CONCENTRATING, SLEEP OR APPETITE CHANGES, FEELINGS OF HOPELESSNESS/HELPLESSNESS, ANGER, LOW SELF-ESTEEM AND PERSONALITY CHANGES.
OTHER COMMUNITY ACTIVITIES -HEALTH FAIR AT WELLNESS CENTERTHE HMC WELLNESS FAIR (FIT FAIR) ACCOMPLISHES THE GOAL OF EDUCATING THE COMMUNITY ABOUT HEALTH. AREA CITIZENS ARE EXPOSED TO THE MOST CURRENT HEALTH INSURANCE AS WELL AS EDUCATION ON IMPORTANT LIFESTYLE CHOICES. THE EVENT REACHES BETWEEN 200 AND 500 INDIVIDUALS EACH YEAR. EVENT INCLUDES SPEAKERS, BOOTHS, SCREENINGS, RAFFLES, CHILDREN'S INFLATABLES, LIFE FLIGHT HELICOPTER DISPLAY, AND THE CHILDREN'S TRIATHALON. SCHOLARSHIP AWARD WINNERS ARE ANNOUNCED.GO RED FOR WOMENGO RED FOR WOMEN ACCOMPLISHES THE GOAL OF EDUCATING THE COMMUNITY ABOUT WOMEN'S HEALTH. THE INFORMATION FOCUSES ON HEART HEALTH WITH THE ADDITION OF OTHER CURRENT WOMEN'S HEALTH TOPICS. ANNUALLY, BETWEEN 100 AND 200 WOMEN ATTEND. THE EVENT INCLUDES SPEAKERS, DEMONSTRATIONS, FOOD AND RAFFLES.ANNUAL 5K RUN/WALKEACH JULY 4TH, THE HOPEDALE WELLNESS CENTER SPONSORS A 5K RUN/WALK OPEN TO ALL RESIDENTS OF THE COMMUNITY. AWARDS ARE GIVEN TO DIFFERENT WINNERS OF VARIOUS AGE GROUPS OF RUNNERS AND WALKERS.DIETICIAN HEALTHY EATING SEMINARSTHE HOPEDALE MEDICAL FOUNDATION DIETICIAN HOLDS VARIOUS SEMINARS ANNUALLY TO HELP RESIDENTS OF THE COMMUNITY AND EMPLOYEES TO EAT A HEALTHIER DIET. VARIOUS RECIPES ARE GIVEN TO PARTICIPANTS WHICH ENCOURAGE HEALTHIER DIETS.

DescriptionDescription

RENEWED HOPE - SENIOR PROGRAM TO HELP SENIORS COPE WITH DEPRESSION, UNRESOLVED GRIEF, ANXIETY, NERVOUSNESS, WORRY, ISOLATION, LONELINESS, COPING WITH HEALTH/PHYSICAL CHANGES, DIFFICULTY CONCENTRATING, SLEEP OR APPETITE CHANGES, FEELINGS OF HOPELESSNESS/HELPLESSNESS, ANGER, LOW SELF-ESTEEM AND PERSONALITY CHANGES.

OTHER COMMUNITY ACTIVITIES -HEALTH FAIR AT WELLNESS CENTERTHE HMC WELLNESS FAIR (FIT FAIR) ACCOMPLISHES THE GOAL OF EDUCATING THE COMMUNITY ABOUT HEALTH. AREA CITIZENS ARE EXPOSED TO THE MOST CURRENT HEALTH INSURANCE AS WELL AS EDUCATION ON IMPORTANT LIFESTYLE CHOICES. THE EVENT REACHES BETWEEN 200 AND 500 INDIVIDUALS EACH YEAR. EVENT INCLUDES SPEAKERS, BOOTHS, SCREENINGS, RAFFLES, CHILDREN'S INFLATABLES, LIFE FLIGHT HELICOPTER DISPLAY, AND THE CHILDREN'S TRIATHALON. SCHOLARSHIP AWARD WINNERS ARE ANNOUNCED.GO RED FOR WOMENGO RED FOR WOMEN ACCOMPLISHES THE GOAL OF EDUCATING THE COMMUNITY ABOUT WOMEN'S HEALTH. THE INFORMATION FOCUSES ON HEART HEALTH WITH THE ADDITION OF OTHER CURRENT WOMEN'S HEALTH TOPICS. ANNUALLY, BETWEEN 100 AND 200 WOMEN ATTEND. THE EVENT INCLUDES SPEAKERS, DEMONSTRATIONS, FOOD AND RAFFLES.ANNUAL 5K RUN/WALKEACH JULY 4TH, THE HOPEDALE WELLNESS CENTER SPONSORS A 5K RUN/WALK OPEN TO ALL RESIDENTS OF THE COMMUNITY. AWARDS ARE GIVEN TO DIFFERENT WINNERS OF VARIOUS AGE GROUPS OF RUNNERS AND WALKERS.DIETICIAN HEALTHY EATING SEMINARSTHE HOPEDALE MEDICAL FOUNDATION DIETICIAN HOLDS VARIOUS SEMINARS ANNUALLY TO HELP RESIDENTS OF THE COMMUNITY AND EMPLOYEES TO EAT A HEALTHIER DIET. VARIOUS RECIPES ARE GIVEN TO PARTICIPANTS WHICH ENCOURAGE HEALTHIER DIETS.

Field	Value	IRS element (for citing)
Total Program Service Expense	18828493	TotalProgramServiceExpense
Described In501 C3	1	DescribedIn501C3
Schedule B Required	1	ScheduleBRequired
Political Activities	0	PoliticalActivities
Lobbying Activities	0	LobbyingActivities
Donor Advised Funds	0	DonorAdvisedFunds
Conservation Easements	0	ConservationEasements
Collections Of Art	0	CollectionsOfArt
Credit Counseling	1	CreditCounseling
Term Or Permanent Endowments	0	TermOrPermanentEndowments
Report Land Bldg Equip	1	ReportLandBldgEquip
Report Invest Oth Securities	0	ReportInvestOthSecurities
Report Prog Rel Invest	0	ReportProgRelInvest
Report Other Assets	0	ReportOtherAssets
Report Other Liabilities	1	ReportOtherLiabilities
Report Fin48 Footnote	1	ReportFin48Footnote
Independent Audit Financial Stmt	0	IndependentAuditFinancialStmt
Consolidated Audit Financial Stmt	1	ConsolidatedAuditFinancialStmt
School	0	School
Foreign Office	0	ForeignOffice
Foreign Activities	0	ForeignActivities
More Than5000 K To Organizations	0	MoreThan5000KToOrganizations
More Than5000 K To Individuals	0	MoreThan5000KToIndividuals
Professional Fundraising	0	ProfessionalFundraising
Fundraising Activities	1	FundraisingActivities
Gaming	0	Gaming
Hospital	1	Hospital
Financial Stmt Attached	1	FinancialStmtAttached
Grants To Organizations	1	GrantsToOrganizations
Grants To Individuals	1	GrantsToIndividuals
Schedule J Required	1	ScheduleJRequired
Tax Exempt Bonds	1	TaxExemptBonds
Invest Tax Exempt Bonds	0	InvestTaxExemptBonds
Escrow Account	0	EscrowAccount
On Behalf Of Issuer	0	OnBehalfOfIssuer
Excess Benefit Transaction	0	ExcessBenefitTransaction
Prior Excess Benefit Transaction	0	PriorExcessBenefitTransaction
Loan To Officer Or DQP	1	LoanToOfficerOrDQP
Grant To Related Person	0	GrantToRelatedPerson
Bsnss Rltnshp With Organization	1	BsnssRltnshpWithOrganization
Bsnss Rltnshp Thru Family Member	1	BsnssRltnshpThruFamilyMember
Officer Entity With Bsnss Rltnshp	1	OfficerEntityWithBsnssRltnshp
Deductible Non Cash Contributions	1	DeductibleNonCashContributions
Deductible Contributions Of Art	0	DeductibleContributionsOfArt
Terminated	0	Terminated
Partial Liquidation	0	PartialLiquidation
Disregarded Entity	1	DisregardedEntity
Related Entity	1	RelatedEntity
Related Org Controlled Entity	1	RelatedOrgControlledEntity
Transaction Related Entity	1	TransactionRelatedEntity
Transfers To Exempt Non Chrtbl Org	0	TransfersToExemptNonChrtblOrg
Activities Conducted Partnership	0	ActivitiesConductedPartnership
Schedule O Required	1	ScheduleORequired
Number Forms Transmitted With1096	74	NumberFormsTransmittedWith1096
Number W2 G Included	0	NumberW2GIncluded
Compliance With Backup Witholding	1	ComplianceWithBackupWitholding
Number Of Employees	423	NumberOfEmployees
Employment Tax Returns Filed	1	EmploymentTaxReturnsFiled
Unrelated Business Income	1	UnrelatedBusinessIncome
Form990-T Filed	1	Form990-TFiled
Foreign Financial Account	0	ForeignFinancialAccount
Prohibited Tax Shelter Trans	0	ProhibitedTaxShelterTrans
Taxable Party Notification	0	TaxablePartyNotification
Non Deductible Contributions	0	NonDeductibleContributions
Quid Pro Quo Contributions	0	QuidProQuoContributions
Form8282 Property Disposed Of	0	Form8282PropertyDisposedOf
Funds To Pay Premiums	0	FundsToPayPremiums
Premiums Paid	0	PremiumsPaid
Indoor Tanning Services	0	IndoorTanningServices
Info In Schedule O Part VI	X	InfoInScheduleOPartVI
Nbr Voting Governing Body Members	9	NbrVotingGoverningBodyMembers
Number Independent Voting Members	6	NumberIndependentVotingMembers
Family Or Business Relationship	1	FamilyOrBusinessRelationship
Delegation Of Management Duties	0	DelegationOfManagementDuties
Changes To Organizing Docs	0	ChangesToOrganizingDocs
Material Diversion Or Misuse	0	MaterialDiversionOrMisuse
Members Or Stockholders	1	MembersOrStockholders
Election Of Board Members	1	ElectionOfBoardMembers
Decisions Subject To Approval	1	DecisionsSubjectToApproval
Minutes Of Governing Body	1	MinutesOfGoverningBody
Minutes Of Committees	1	MinutesOfCommittees
Officer Mailing Address	0	OfficerMailingAddress
Local Chapters	1	LocalChapters
Policies Reference Chapters	1	PoliciesReferenceChapters
Form990 Provided To Governing Body	1	Form990ProvidedToGoverningBody
Conflict Of Interest Policy	1	ConflictOfInterestPolicy
Annual Disclosure Covered Persons	1	AnnualDisclosureCoveredPersons
Regular Monitoring Enforcement	1	RegularMonitoringEnforcement
Whistleblower Policy	1	WhistleblowerPolicy
Document Retention Policy	1	DocumentRetentionPolicy
Compensation Process CEO	1	CompensationProcessCEO
Compensation Process Other	1	CompensationProcessOther
Investment In Joint Venture	0	InvestmentInJointVenture
States Where Copy Of Return Is Filed	IL	StatesWhereCopyOfReturnIsFiled
Upon Request	X	UponRequest

The Books Are In Care Of TheBooksAreInCareOf

Name Business NameBusiness

Field	Value	IRS element (for citing)
Business Name Line1	LARRY KLOC	BusinessNameLine1

Field	Value	IRS element (for citing)
Telephone Number	3094494375	TelephoneNumber

Address US AddressUS

Field	Value	IRS element (for citing)
Address Line1	107 TREMONT STREET	AddressLine1
City	HOPEDALE	City
State	IL	State
ZIP Code	61747	ZIPCode

Field	Value	IRS element (for citing)
Info In Schedule O Part VII	X	InfoInScheduleOPartVII

Form990 Part VII Section A Form990PartVIISectionA (13 entries)

TitleTitle	Average Hours Per WeekAverageHoursPerWeek	Individual Trustee Or DirectorIndividualTrusteeOrDirector	OfficerOfficer	Reportable Comp From OrganizationReportableCompFromOrganization	Reportable Comp From Related OrgsReportableCompFromRelatedOrgs	Other CompensationOtherCompensation	Highest Compensated EmployeeHighestCompensatedEmployee
ALFRED N ROSSI MD
CHAIRMAN; PHYSICIAN	2.00	X	X	65947	0	0
MATTHEW B ROSSI MD
SECRETARY/TREASURER; PHYSICIAN	2.00	X	X	92290	0	7677
MICHAEL J MCLAUGHLIN
DIRECTOR	2.00	X		0	0	0
ROLAND RICH
DIRECTOR	2.00	X		0	0	0
TOM HIESER
DIRECTOR	2.00	X		0	0	0
RAY SLACK
DIRECTOR	2.00	X		0	0	0
JARIE SLACK
DIRECTOR	2.00	X		0	0	0
DONALD OSWALD
DIRECTOR; EMPLOYEE	2.00	X		14244	0	0
HENRY ALLEN
DIRECTOR	2.00	X		0	0	0
MARK F ROSSI
COO	40.00		X	117814	46296	7652
LARRY KLOC
CFO	40.00		X	92432	0	16872
JOHN ZANON
RETAIL PHARMACY DIRECTOR	40.00			114736	0	12447	X
WENDY MOBERLY
HOSPITAL PHARMACY DIRECTOR	40.00			108982	0	5446	X

Field	Value	IRS element (for citing)
Total Reportable Comp From Org	606445	TotalReportableCompFromOrg
Total Reportable Comp Frm Rltd Orgs	46296	TotalReportableCompFrmRltdOrgs
Total Other Compensation	50094	TotalOtherCompensation
Number Individuals GT100 K	3	NumberIndividualsGT100K
Formers Listed	0	FormersListed
Total Comp GT150 K	1	TotalCompGT150K
Compensation From Other Sources	0	CompensationFromOtherSources

Contractor Compensation ContractorCompensation (5 entries)

Address Line1AddressOfContractor/AddressUS/AddressLine1	CityAddressOfContractor/AddressUS/City	StateAddressOfContractor/AddressUS/State	ZIP CodeAddressOfContractor/AddressUS/ZIPCode	Description Of ServicesDescriptionOfServices	CompensationCompensation
EMERGENCY PHYSICIAN STAFFING SOLUTIONS
12528 SR 78	HAVANA	IL	62644	STAFFING AGENCY	1006905
CTSI
17314 SHERWOOD FOREST RD	HAVANA	IL	62644	TRANSCRIPTION SERVICES	133667
TRI COUNTY ANESTHESIA SC
PO BOX 267	HOPEDALE	IL	61747	ANESTHESIA SERVICES	122100
EIDE BAILLY
3999 PENNSYLVANIA AVE	DUBUQUE	IA	52002	ACCOUNTING	113570
HELPING HANDS HOME HEALTHCARE
627 S MAIN ST	CREVE COEUR	IL	61610	STAFFING AGENCY	109626

Field	Value	IRS element (for citing)
Number Of Contractors GT100 K	6	NumberOfContractorsGT100K
Fundraising Events	12100	FundraisingEvents
Government Grants	55039	GovernmentGrants
All Other Contributions	688850	AllOtherContributions
Total Contributions	755989	TotalContributions

Program Service Revenue ProgramServiceRevenue (5 entries)

DescriptionDescription	Business CodeBusinessCode	Total Revenue ColumnTotalRevenueColumn	Related Or Exempt Function IncomeRelatedOrExemptFunctionIncome	Unrelated Business RevenueUnrelatedBusinessRevenue
PATIENT SERVICE REVENU	621110	14722679	14722679
NURSING HOME	623000	2673379	2673379
ASSISTED/INDEPENDENT	623000	1608042	1608042
WELLNESS CENTER	713940	341317	341317
MASSAGE THERAPY	621300	77766		77766

Field	Value	IRS element (for citing)
Total Program Service Revenue	19423183	TotalProgramServiceRevenue

Investment Income InvestmentIncome

Field	Value	IRS element (for citing)
Total Revenue Column	125598	TotalRevenueColumn
Exclusion	$125,598	ExclusionAmount

Gross Rents GrossRents

Field	Value	IRS element (for citing)
Real	649232	Real

Rental Income Or Loss RentalIncomeOrLoss

Field	Value	IRS element (for citing)
Real	649232	Real

Net Rental Income Or Loss NetRentalIncomeOrLoss

Field	Value	IRS element (for citing)
Total Revenue Column	649232	TotalRevenueColumn
Exclusion	$649,232	ExclusionAmount

Gross Amount Sales Assets GrossAmountSalesAssets

Field	Value	IRS element (for citing)
Securities	75168	Securities

Less Cost Oth Basis Sales Expenses LessCostOthBasisSalesExpenses

Field	Value	IRS element (for citing)
Securities	77342	Securities
Other	24147	Other

Gain Or Loss GainOrLoss

Field	Value	IRS element (for citing)
Securities	-2174	Securities
Other	-24147	Other

Net Gain Or Loss Investments NetGainOrLossInvestments

Field	Value	IRS element (for citing)
Total Revenue Column	-26321	TotalRevenueColumn
Exclusion	-$26,321	ExclusionAmount

Field	Value	IRS element (for citing)
Gross Income Fundraising Events	11932	GrossIncomeFundraisingEvents
Cntrbtns Rprtd Fundraising Events	12100	CntrbtnsRprtdFundraisingEvents
Fundraising Direct Expenses	10733	FundraisingDirectExpenses

Net Income From Fundraising Events NetIncomeFromFundraisingEvents

Field	Value	IRS element (for citing)
Total Revenue Column	1199	TotalRevenueColumn
Exclusion	$1,199	ExclusionAmount

Field	Value	IRS element (for citing)
Gross Sales Of Inventory	3948047	GrossSalesOfInventory
Cost Of Goods Sold	1817786	CostOfGoodsSold

Net Income Or Loss NetIncomeOrLoss

Field	Value	IRS element (for citing)
Total Revenue Column	2130261	TotalRevenueColumn
Related Or Exempt Function Income	2099159	RelatedOrExemptFunctionIncome
Unrelated Business Revenue	31102	UnrelatedBusinessRevenue

Other Revenue Misc OtherRevenueMisc (3 entries)

DescriptionDescription	Business CodeBusinessCode	Total Revenue ColumnTotalRevenueColumn	ExclusionExclusionAmount	Related Or Exempt Function IncomeRelatedOrExemptFunctionIncome
CHILD CARE	624410	180957	$180,957
CAFETERIA INCOME	722210	83453	$83,453
SPORTS CLINIC	621300	26430		26430

Miscellaneous Revenue MiscellaneousRevenue

Field	Value	IRS element (for citing)
Total Revenue Column	7759	TotalRevenueColumn
Related Or Exempt Function Income	7759	RelatedOrExemptFunctionIncome

Field	Value	IRS element (for citing)
Total Other Revenue	298599	TotalOtherRevenue

Total Revenue TotalRevenue

Field	Value	IRS element (for citing)
Total Revenue Column	23357740	TotalRevenueColumn
Related Or Exempt Function Income	21478765	RelatedOrExemptFunctionIncome
Unrelated Business Revenue	108868	UnrelatedBusinessRevenue
Exclusion	$1,014,118	ExclusionAmount

Grants To Domestic Orgs GrantsToDomesticOrgs

Field	Value	IRS element (for citing)
Total	11408	Total
Program Services	11408	ProgramServices

Grants To Domestic Individuals GrantsToDomesticIndividuals

Field	Value	IRS element (for citing)
Total	19313	Total
Program Services	19313	ProgramServices

Comp Current Officers Directors CompCurrentOfficersDirectors

Field	Value	IRS element (for citing)
Total	408473	Total
Program Services	182504	ProgramServices
Management And General	225969	ManagementAndGeneral

Comp Disqual Persons CompDisqualPersons

Field	Value	IRS element (for citing)
Total	439979	Total
Program Services	373139	ProgramServices
Management And General	66840	ManagementAndGeneral

Other Salaries And Wages OtherSalariesAndWages

Field	Value	IRS element (for citing)
Total	9164816	Total
Program Services	8593929	ProgramServices
Management And General	570887	ManagementAndGeneral

Pension Plan Contributions PensionPlanContributions

Field	Value	IRS element (for citing)
Total	110041	Total
Program Services	89532	ProgramServices
Management And General	20509	ManagementAndGeneral

Other Employee Benefits OtherEmployeeBenefits

Field	Value	IRS element (for citing)
Total	977642	Total
Program Services	894490	ProgramServices
Management And General	83020	ManagementAndGeneral
Fundraising	132	Fundraising

Payroll Taxes PayrollTaxes

Field	Value	IRS element (for citing)
Total	600611	Total
Program Services	545116	ProgramServices
Management And General	55495	ManagementAndGeneral

Fees For Services Management FeesForServicesManagement

Field	Value	IRS element (for citing)
Total	125219	Total
Management And General	125219	ManagementAndGeneral

Fees For Services Legal FeesForServicesLegal

Field	Value	IRS element (for citing)
Total	43810	Total
Management And General	43810	ManagementAndGeneral

Fees For Services Accounting FeesForServicesAccounting

Field	Value	IRS element (for citing)
Total	124427	Total
Management And General	124427	ManagementAndGeneral

Fees For Services Other FeesForServicesOther

Field	Value	IRS element (for citing)
Total	1037129	Total
Program Services	874308	ProgramServices
Management And General	147821	ManagementAndGeneral
Fundraising	15000	Fundraising

Advertising Advertising

Field	Value	IRS element (for citing)
Total	184590	Total
Program Services	115473	ProgramServices
Management And General	66341	ManagementAndGeneral
Fundraising	2776	Fundraising

Office Expenses OfficeExpenses

Field	Value	IRS element (for citing)
Total	2573379	Total
Program Services	2368489	ProgramServices
Management And General	201372	ManagementAndGeneral
Fundraising	3518	Fundraising

Occupancy Occupancy

Field	Value	IRS element (for citing)
Total	911310	Total
Program Services	812532	ProgramServices
Management And General	98778	ManagementAndGeneral

Travel Travel

Field	Value	IRS element (for citing)
Total	42224	Total
Program Services	25753	ProgramServices
Management And General	12774	ManagementAndGeneral
Fundraising	3697	Fundraising

Interest Interest

Field	Value	IRS element (for citing)
Total	136103	Total
Program Services	113362	ProgramServices
Management And General	22741	ManagementAndGeneral

Depreciation Depletion DepreciationDepletion

Field	Value	IRS element (for citing)
Total	1097904	Total
Program Services	1027980	ProgramServices
Management And General	69924	ManagementAndGeneral

Insurance Insurance

Field	Value	IRS element (for citing)
Total	210137	Total
Program Services	106783	ProgramServices
Management And General	103354	ManagementAndGeneral

Other Expenses OtherExpenses (5 entries)

DescriptionDescription	TotalTotal	Program ServicesProgramServices	Management And GeneralManagementAndGeneral
SERVICES	1328654	1103280	225374
BAD DEBT EXPENSE	1253682	1253682
REPAIRS & MAINTENANCE	301897	276905	24992
MEDICAID TAXES	268168	40515	227653
COLLECTIONS	125535		125535

Total Functional Expenses TotalFunctionalExpenses

Field	Value	IRS element (for citing)
Total	21496451	Total
Program Services	18828493	ProgramServices
Management And General	2642835	ManagementAndGeneral
Fundraising	25123	Fundraising

Cash Non Interest Bearing CashNonInterestBearing

Field	Value	IRS element (for citing)
EOY	2555	EOY

Savings And Temp Cash Investments SavingsAndTempCashInvestments

Field	Value	IRS element (for citing)
BOY	2567410	BOY
EOY	5807895	EOY

Pledges And Grants Receivable PledgesAndGrantsReceivable

Field	Value	IRS element (for citing)
BOY	356123	BOY
EOY	453831	EOY

Accounts Receivable AccountsReceivable

Field	Value	IRS element (for citing)
BOY	2916276	BOY
EOY	2806496	EOY

Receivables From Officers Etc ReceivablesFromOfficersEtc

Field	Value	IRS element (for citing)
BOY	34811	BOY
EOY	54589	EOY

Receivables From Disqual Persons ReceivablesFromDisqualPersons

Field	Value	IRS element (for citing)
BOY	111677	BOY
EOY	76139	EOY

Other Notes Loans Receivable Net OtherNotesLoansReceivableNet

Field	Value	IRS element (for citing)
EOY	49311	EOY

Inventories For Sale Or Use InventoriesForSaleOrUse

Field	Value	IRS element (for citing)
BOY	778367	BOY
EOY	813119	EOY

Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges

Field	Value	IRS element (for citing)
BOY	190191	BOY
EOY	273715	EOY

Field	Value	IRS element (for citing)
Land Buildings Equipment Basis	31900938	LandBuildingsEquipmentBasis
Land Bldg Equipment Accum Deprec	21206368	LandBldgEquipmentAccumDeprec

Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet

Field	Value	IRS element (for citing)
BOY	11097450	BOY
EOY	10694570	EOY

Investments Pub Traded Securities InvestmentsPubTradedSecurities

Field	Value	IRS element (for citing)
BOY	1541118	BOY
EOY	905979	EOY

Other Assets Total OtherAssetsTotal

Field	Value	IRS element (for citing)
BOY	683164	BOY
EOY	955880	EOY

Total Assets TotalAssets

Field	Value	IRS element (for citing)
BOY	20276587	BOY
EOY	22894079	EOY

Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses

Field	Value	IRS element (for citing)
BOY	2125875	BOY
EOY	2023039	EOY

Deferred Revenue DeferredRevenue

Field	Value	IRS element (for citing)
BOY	364053	BOY
EOY	370998	EOY

Tax Exempt Bond Liabilities TaxExemptBondLiabilities

Field	Value	IRS element (for citing)
BOY	4700000	BOY
EOY	4275000	EOY

Mort Notes Pybl Secured Invest Prop MortNotesPyblSecuredInvestProp

Field	Value	IRS element (for citing)
BOY	308881	BOY
EOY	479040	EOY

Other Liabilities OtherLiabilities

Field	Value	IRS element (for citing)
BOY	1023648	BOY
EOY	2076691	EOY

Total Liabilities TotalLiabilities

Field	Value	IRS element (for citing)
BOY	8522457	BOY
EOY	9224768	EOY

Field	Value	IRS element (for citing)
Follow SFAS117	X	FollowSFAS117

Unrestricted Net Assets UnrestrictedNetAssets

Field	Value	IRS element (for citing)
BOY	11244630	BOY
EOY	12459726	EOY

Temporarily Restricted Net Assets TemporarilyRestrictedNetAssets

Field	Value	IRS element (for citing)
BOY	509500	BOY
EOY	1209585	EOY

Total Net Assets Fund Balances TotalNetAssetsFundBalances

Field	Value	IRS element (for citing)
BOY	11754130	BOY
EOY	13669311	EOY

Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances

Field	Value	IRS element (for citing)
BOY	20276587	BOY
EOY	22894079	EOY

Field	Value	IRS element (for citing)
Info In Schedule O Part XI	X	InfoInScheduleOPartXI
Reconcilation Revenue Expenses	1861289	ReconcilationRevenueExpenses
Reconcilation Other Changes	53892	ReconcilationOtherChanges
Info In Schedule O Part XII	X	InfoInScheduleOPartXII
Method Of Accounting Accrual	X	MethodOfAccountingAccrual
Accountant Compile Or Review	0	AccountantCompileOrReview
FS Audited	1	FSAudited
Audit Committee	1	AuditCommittee
Financial Statement Consolidated	X	FinancialStatementConsolidated
Federal Grant Audit Required	0	FederalGrantAuditRequired

Schedule A IRS990ScheduleA

Field	Value	IRS element (for citing)
Hospital170b1 Aiii	X	Hospital170b1Aiii

Schedule B IRS990ScheduleB

Contributor Info ContributorInfo

Field	Value	IRS element (for citing)
Contributor Number	RESTRICTED	ContributorNumber

Contributor Name Business ContributorNameBusiness

Field	Value	IRS element (for citing)
Business Name Line1	RESTRICTED	BusinessNameLine1

Contributor Address US ContributorAddressUS

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)
Aggregate Contributions	RESTRICTED	AggregateContributions

Schedule D IRS990ScheduleD

Field	Value	IRS element (for citing)
Agent Trustee Etc	1	AgentTrusteeEtc
Beginning Balance	1743	BeginningBalance
Additions During Year	2250	AdditionsDuringYear
Distributions During Year	1337	DistributionsDuringYear
Ending Balance	2656	EndingBalance
Included On FS	0	IncludedOnFS

Land Land

Field	Value	IRS element (for citing)
Other Cost Or Other Basis	663463	OtherCostOrOtherBasis
Book Value	663463	BookValue

Buildings Buildings

Field	Value	IRS element (for citing)
Other Cost Or Other Basis	15707952	OtherCostOrOtherBasis
Depreciation	7196366	Depreciation
Book Value	8511586	BookValue

Equipment Equipment

Field	Value	IRS element (for citing)
Other Cost Or Other Basis	14620828	OtherCostOrOtherBasis
Depreciation	13206722	Depreciation
Book Value	1414106	BookValue

Other Land Buildings OtherLandBuildings

Field	Value	IRS element (for citing)
Other Cost Or Other Basis	908695	OtherCostOrOtherBasis
Depreciation	803280	Depreciation
Book Value	105415	BookValue

Field	Value	IRS element (for citing)
Total Of Book Value Land Buildings	10694570	TotalOfBookValueLandBuildings

Other Liabilities OtherLiabilities (4 entries)

DescriptionDescription	AmountAmount
ACCRUED PROFESSIONAL LIABILITY	$25,000
ACCRETION LIABILITY	$255,339
CAPITALIZED LEASE OBLIGATIONS	$201,605
ESTIMATED THIRD PARTY PAYOR SETTLEMENT	$1,594,747

Field	Value	IRS element (for citing)
Total Of Amounts	2076691	TotalOfAmounts
Total Revenue	23357740	TotalRevenue
Total Expenses	21496451	TotalExpenses
Excess Or Deficit For Year	1861289	ExcessOrDeficitForYear
Net Unrealized GL On Investments	57879	NetUnrealizedGLOnInvestments
Other	-$3,987	OtherAmount
Total Adjustments	53892	TotalAdjustments
Excess Or Deficit Per FS	1915181	ExcessOrDeficitPerFS

Form990 Schedule D Part XIV Form990ScheduleDPartXIV (3 entries)

Return ReferenceReturnReference	ExplanationExplanation	IdentifierIdentifier
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:	THE HOPEDALE MEDICAL FOUNDATION HAS BEEN RECOGNIZED AS TAX EXEMPT PURSUANT TO SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE AND A SIMILAR PROVISION OF STATE LAW. HOWEVER, THE FOUNDATION IS SUBJECT TO FEDERAL INCOME TAX ON ANY UNRELATED BUSINESS TAXABLE INCOME. HOPEDALE MEDICAL FOUNDATION FILES A FORM 990 (RETURN OF ORGANIZATION EXEMPT FROM INCOME TAX) ANNUALLY. WHEN THESE RETURNS ARE 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 AND VARIOUS POSITIONS RELATIVE TO POTENTIAL SOURCES OF UNRELATED BUSINESS TAXABLE INCOME (UBIT). UBIT IS REPORTED ON FORM 990T, 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. 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, 2011 AND 2010, THERE WERE NO UNCERTAIN TAX BENEFITS RELATED TO UNCERTAIN TAX POSITIONS IDENTIFIED AND RECORDED AS A LIABILITY. FORMS 990 AND 990-T FILED BY THE FOUNDATION ARE SUBJECT TO EXAMINATION BY THE INTERNAL REVENUE SERVICE UP TO THREE YEARS FROM THE EXTENDED DUE DATE OF EACH RETURN. GENERALLY, FORMS 990 AND 990-T FILED BY THE FOUNDATION ARE NO LONGER SUBJECT TO EXAMINATION FOR THE YEARS 2007 AND PRIOR.	DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48:
	PRIOR PERIOD ADJUSTMENT -3,987.	PART XI, LINE 8 - OTHER ADJUSTMENTS:

Schedule G IRS990ScheduleG

Events Information EventsInformation

Field	Value	IRS element (for citing)
Name Of Event1	GALA	NameOfEvent1
Gross Receipts Event1	24032	GrossReceiptsEvent1
Charitable Contributions Event1	12100	CharitableContributionsEvent1
Gross Revenue Event1	11932	GrossRevenueEvent1
Food And Beverage Event1	5018	FoodAndBeverageEvent1
Entertainment Event1	852	EntertainmentEvent1
Other Direct Expenses Event1	4863	OtherDirectExpensesEvent1
Gross Receipts Total	24032	GrossReceiptsTotal
Charitable Contributions Total	12100	CharitableContributionsTotal
Gross Revenue Total Events	11932	GrossRevenueTotalEvents
Food And Beverage Total Events	5018	FoodAndBeverageTotalEvents
Entertainment Total Events	852	EntertainmentTotalEvents
Other Direct Expenses Total Events	4863	OtherDirectExpensesTotalEvents
Direct Expense Summary Events	10733	DirectExpenseSummaryEvents
Net Income Summary	1199	NetIncomeSummary

Schedule H IRS990ScheduleH

Field	Value	IRS element (for citing)
Charity Care Policy	1	CharityCarePolicy
Written Policy	1	WrittenPolicy
FPG Reference Free Care	1	FPGReferenceFreeCare

Other Percentage OtherPercentage

Field	Value	IRS element (for citing)
Other	X	Other
Free Other Percentage	300.000000000000	FreeOtherPercentage

Field	Value	IRS element (for citing)
FPG Reference Discounted Care	1	FPGReferenceDiscountedCare
Pcent300	X	Pcent300
Free Disc Care Medically Indigent	1	FreeDiscCareMedicallyIndigent
Amounts Budgeted For Charity Care	1	AmountsBudgetedForCharityCare
Expenses Exceeded Budget	1	ExpensesExceededBudget
Unable To Provide Care	0	UnableToProvideCare
Annual Community Benefit Report	0	AnnualCommunityBenefitReport

Charity Care At Cost CharityCareAtCost

Field	Value	IRS element (for citing)
Total Community Benefit Expense	632968	TotalCommunityBenefitExpense
Direct Offsetting Revenue	0	DirectOffsettingRevenue
Net Community Benefit Expense	632968	NetCommunityBenefitExpense
Percent Of Total Expense	0.03130	PercentOfTotalExpense

Unreimbursed Medicaid UnreimbursedMedicaid

Field	Value	IRS element (for citing)
Total Community Benefit Expense	847914	TotalCommunityBenefitExpense
Direct Offsetting Revenue	461485	DirectOffsettingRevenue
Net Community Benefit Expense	386429	NetCommunityBenefitExpense
Percent Of Total Expense	0.01910	PercentOfTotalExpense

Unreimbursed Costs UnreimbursedCosts

Field	Value	IRS element (for citing)
Total Community Benefit Expense	0	TotalCommunityBenefitExpense
Direct Offsetting Revenue	0	DirectOffsettingRevenue

Total Charity Care TotalCharityCare

Field	Value	IRS element (for citing)
Total Community Benefit Expense	1480882	TotalCommunityBenefitExpense
Direct Offsetting Revenue	461485	DirectOffsettingRevenue
Net Community Benefit Expense	1019397	NetCommunityBenefitExpense
Percent Of Total Expense	0.05040	PercentOfTotalExpense

Community Health Services CommunityHealthServices

Field	Value	IRS element (for citing)
Total Community Benefit Expense	723705	TotalCommunityBenefitExpense
Direct Offsetting Revenue	421012	DirectOffsettingRevenue
Net Community Benefit Expense	302693	NetCommunityBenefitExpense
Percent Of Total Expense	0.01500	PercentOfTotalExpense

Health Professions Education HealthProfessionsEducation

Field	Value	IRS element (for citing)
Total Community Benefit Expense	6736	TotalCommunityBenefitExpense
Direct Offsetting Revenue	0	DirectOffsettingRevenue
Net Community Benefit Expense	6736	NetCommunityBenefitExpense
Percent Of Total Expense	0.00030	PercentOfTotalExpense

Cash And In Kind Contributions CashAndInKindContributions

Field	Value	IRS element (for citing)
Total Community Benefit Expense	30721	TotalCommunityBenefitExpense
Direct Offsetting Revenue	0	DirectOffsettingRevenue
Net Community Benefit Expense	30721	NetCommunityBenefitExpense
Percent Of Total Expense	0.00150	PercentOfTotalExpense

Total Other Benefits TotalOtherBenefits

Field	Value	IRS element (for citing)
Total Community Benefit Expense	761162	TotalCommunityBenefitExpense
Direct Offsetting Revenue	421012	DirectOffsettingRevenue
Net Community Benefit Expense	340150	NetCommunityBenefitExpense
Percent Of Total Expense	0.01680	PercentOfTotalExpense

Total Community Benefits TotalCommunityBenefits

Field	Value	IRS element (for citing)
Total Community Benefit Expense	2242044	TotalCommunityBenefitExpense
Direct Offsetting Revenue	882497	DirectOffsettingRevenue
Net Community Benefit Expense	1359547	NetCommunityBenefitExpense
Percent Of Total Expense	0.06720	PercentOfTotalExpense

Field	Value	IRS element (for citing)
Bad Debt Expense Reported	1	BadDebtExpenseReported
Bad Debt Expense	$611,726	BadDebtExpenseAmount
Amount Attributable To	0	AmountAttributableTo
Amount Reimbursed By Medicare	7005535	AmountReimbursedByMedicare
Cost Of Care Reimbursed By Medicare	6885537	CostOfCareReimbursedByMedicare
Medicare Surplus Or Shortfall	119998	MedicareSurplusOrShortfall

Costing Methodology Used CostingMethodologyUsed

Field	Value	IRS element (for citing)
Other	X	Other

Field	Value	IRS element (for citing)
Written Debt Collection Policy	1	WrittenDebtCollectionPolicy
Provision For Charity Care	1	ProvisionForCharityCare
Number Of Hospital Facilities	1	NumberOfHospitalFacilities

Form990 Schedule H Part V Section A Form990ScheduleHPartVSectionA

Field	Value	IRS element (for citing)
Facility Number	1	FacilityNumber

Name Name

Field	Value	IRS element (for citing)
Business Name Line1	HOPEDALE MEDICAL COMPLEX	BusinessNameLine1

Address Address

Field	Value	IRS element (for citing)
Address Line1	PO BOX 267	AddressLine1
City	HOPEDALE	City
State	IL	State
ZIP Code	61747	ZIPCode

Field	Value	IRS element (for citing)
Licensed Hospital	X	LicensedHospital
General Medical And Surgical	X	GeneralMedicalAndSurgical
Critical Access Hospital	X	CriticalAccessHospital
Er24 Hours	X	Er24Hours

Form990 Schedule H Part V Section B Form990ScheduleHPartVSectionB

Hospital Facility Name HospitalFacilityName

Field	Value	IRS element (for citing)
Business Name Line1	HOPEDALE MEDICAL COMPLEX	BusinessNameLine1

Field	Value	IRS element (for citing)
Hospital Facility Number	1	HospitalFacilityNumber

Form990 Schedule H Part V Section C Form990ScheduleHPartVSectionC

Field	Value	IRS element (for citing)
Number Of Other Facilities	8	NumberOfOtherFacilities

Other Facilities OtherFacilities (8 entries)

Address Line1Address/AddressLine1	CityAddress/City	StateAddress/State	ZIP CodeAddress/ZIPCode	Facility TypeFacilityType
HOPEDALE NURSING HOME
111 TREMONT STREET	HOPEDALE	IL	61747	NURSING HOME
HOPEDALE COMMONS
211 221 SW RAILROAD STREET	HOPEDALE	IL	61747	ASSISTED AND INDEPENDENT LIVING
HOPEDALE WELLNESS CENTER
107 TREMONT STREET	HOPEDALE	IL	61747	WELLNESS & FITNESS CENTER
MEDICAL ARTS PHYSICIAN BUILDING
107 TREMONT STREET	HOPEDALE	IL	61747	OUTPATIENT PHYSICIAN CLINIC
DELAVAN DOCTOR'S OFFICE
115 E 4TH STREET	DELAVAN	IL	61734	OUTPATIENT PHYSICIAN CLINIC
ATLANTA DOCTOR'S OFFICE
108 SW ARCH STREET	ATLANTA	IL	61723	OUTPATIENT PHYSICIAN CLINIC
MACKINAW DOCTOR'S OFFICE
407 S ORCHARD STREET	MACKINAW	IL	61755	OUTPATIENT PHYSICIAN CLINIC
MANITO DOCTOR'S OFFICE
101 E MASON	MANITO	IL	61546	OUTPATIENT PHYSICIAN CLINIC

Form990 Schedule H Part VI Form990ScheduleHPartVI (14 entries)

ExplanationExplanation	IdentifierIdentifier	Return ReferenceReturnReference
PART I, LINE 7: THE ORGANIZATION CALCULATED THE COST AMOUNTS NOTED IN PART I, LINE 7 BY UTILIZING ITS CURRENT COST ACCOUNTING SYSTEM. THE COST ACCOUNTING SYSTEM ADDRESSES ALL PATIENT SEGMENTS REPORTED ON, INCLUDING, BUT NOT LIMITED TO INPATIENT, OUTPATIENT, MEDICAID, UNINSURED, AND MEDICARE.
PART I, LINE 7, COLUMN (F): THE BAD DEBT EXPENSE INCLUDED ON FORM 990, PART IX, LINE 25, COLUMN (A), BUT SUBTRACTED FOR PURPOSES OF CALCULATING THE PERCENTAGE IN THIS COLUMN IS $ 1253682.
HOPEDALE MEDICAL FOUNDATION BEGAN TO ACCUMULATE DATA AND INPUT FROM THE COMMUNITY ON SPECIFIC NEEDS DURING THE LATER PART OF CALENDAR YEAR 2011. MEETINGS WITH VARIOUS COMMUNITY GROUPS AND LEADERS HAVE BEEN FRUITFUL WITH IDEAS AND SUGGESTIONS THAT WILL BE INCORPORATED INTO OUR COMMUNITY BENEFIT REPORT. HOPEDALE MEDICAL FOUNDATION HAS CONTRACTED WITH ICAHN (ILLINOIS CRITICAL ACCESS HOSPITAL NETWORK) TO ACCUMULATE ALL THE DATA THAT WILL BE NEEDED TO COMPLETE THE REPORT THAT WILL BE SHARED WITH THE LOCAL COMMUNITY.	COMMUNITY BETTERMENT REPORT:	PART I, LINE 6A:
PART III, LINE 4: THE ORGANIZATION USED A COST TO CHARGE RATIO TO DETERMINE THE COST AMOUNT OF THE BAD DEBT EXPENSE. WORKSHEET 2, RATIO OF PATIENT CARE COST TO CHARGES, AS PROVIDED IN THE IRS INSTRUCTIONS WAS USED TO DETERMINE THE APPROPRIATE RATIO.THE ORGANIZATION DOES NOT ISSUE A STANDALONE FINANCIAL STATEMENT; HOWEVER, IT IS INLCUDED AS A PART OF THE HOPEDALE RURAL HEALTH ASSOCIATION, INC. AND SUBSIDIARIES CONSOLIDATED FINANCIAL STATEMENTS. THE BAD DEBT FOOTNOTE DISCLOSURE FROM THE CONSOLIDATED FINANCIAL STATEMENTS IS AS FOLLOWS: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 ACOUNTS 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.THE CHARITY CARE FOONOTE DISCLOSURE FROM THE CONSOLIDATED FINANCIAL STATEMENT IS AS FOLLOWS:HOPEDALE MEDICAL FOUNDATION PROVIDES CARE TO PATIENTS WHO MEET CERTAIN CRITERIA UNDER ITS CHARITY CARE POLICY WITHOUT CHARGE OR AT AMOUNTS LESS THAN ITS ESTABLISHED RATES. BECAUSE HOPEDALE MEDICAL FOUNDATION DOES NOT PURSUE COLLECTION OF AMOUNTS DETERMINED TO QUALIFY AS CHARITY CARE, THESE AMOUNTS ARE NOT REPORTED AS NET PATIENT SERVICE REVENUE. HOPEDALE MEDICAL FOUNDATION HAS A CHARITY CARE POLICY AND MAINTAINS RECORDS TO IDENTIFY AND MONITOR THE LEVEL OF CHARITY CARE IT PROVIDES.
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 % 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.
THE FILING ORGANIZATION REPORTS BAD DEBT IN ACCORDANCE WITH GENERALLY ACCEPTED ACCOUNTING PRINCIPLES (GAAP). HEALTHCARE FINANCIAL MANAGEMENT ASSOCIATION STATEMENT 15 IS FOLLOWED TO THE EXTENT THAT IT ALIGNS WITH THE GUIDELINES SET FORTH BY GAAP.		PART III, SECTION A, LINE 1
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: SIXTY-FIVE PERCENT OF ADMISSIONS COME FROM 9 CENSUS TRACTS SURROUNDING THE HOSPITAL, THE PRIMARY SERVICE AREA. AN ADDITIONAL EIGHTEEN PERCENT COME FROM 8 CENSUS TRACTS, THE SECONDARY SERVICE AREA, FURTHER, BUT CONTIGUOUS TO THE PRIMARY SERVICE AREA. THE TOTAL SERVICE AREA POPULATION IS 134,000. AGES 45-65 COMPOSE 26.5% AND AGE 65+ COMPOSES 15.5% OF THE AREA POPULATION.
PART VI, LINE 6: THE FOUNDATION MAINTAINS A WELLNESS CENTER WHICH HAS THERAPY AND EXCERCISE POOLS, WEIGHT ROOM AND GYMNASIUM AREAS, A LAP TRACT, EXCERCISE MACHINES, AND MEETING ROOMS. WEIGHT-LOSS, NUTRITION COUNSELING, CHRONIC CONDITION MANAGEMENT SESSIONS ARE HELD IN THE MEETING ROOMS, AS WELL AS COMMUNITY MEETINGS. BLOOD DRIVES ARE REGULARY SCHEDULED. THE COST TO OPERATE THE WELLNESS CENTER IS MORE THAN THE REVENUE THAT IS DERIVED FROM THE HEALTH MEMBERSHIP. THE DIFFERENCE REPRESENTS A BENEFIT TO THE MEMBERS OF AREA COMMUNITIIES.ANNUAL 5K RUN/WALK - EACH JULY 4TH THE HOPEDALE WELLNESS CENTER SPONSORS A 5K RUN/WALK OPEN TO ALL RESIDENTS OF THE COMMUNITY. AWARDS ARE GIVEN TO DIFFERENT WINNERS OF VARIOUS AGE GROUPS OF RUNNERS AND WALKERS.GO RED FOR WOMEN - GO RED FOR WOMEN ACCOMPLISHES THE GOAL OF EDUCATING THE COMMUNITY ABOUT WOMEN'S HEALTH. THE INFORMATION FOCUSES ON HEART HEALTH WITH THE ADDITION OF OTHER CURRENT WOMEN'S HEALTH TOPICS. ANNUALLY, BETWEEN 100 AND 200 WOMEN ATTEND. EVENT INCLUDES SPEAKERS, DEMONSTRATIONS, FOOD AND RAFFLES.DIETITIAN HEALTHY EATING SEMINARS - THE HOPEDALE MEDICAL COMPLEX DIETITIAN HOLDS VARIOUS SEMINARS ANNUALLY TO HELP RESIDENTS OF THE COMMUNITY AND EMPLOYEES TO EAT A HEALTHIER DIET. VARIOUS RECIPES ARE GIVEN TO PARTICIPANTS WHICH ENCOURAGE HEALTHIER DIETS.EMERGENCY SERVICES - 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 LEADERS - HOPEDALE MEDICAL FOUNDATION'S BOARD OF DIRECTORS IS COMPOSED OF VARIOUS LEADERS FROM THE COMMUNITY. THE DIRECTORS REPRESENT DIVERSE BACKGROUNDS AND INDUSTRIES WITHIN THE COMMUNITY.MEDICAL STAFF - THE MEDICAL STAFF AT HOPEDALE MEDICAL COMPLEX IS OPEN AND OFFERS PRIVILEGES TO ALL QUALIFIED PHYSICIANS IN THE AREA.EXCESS FUNDS - HOPEDALE MEDICAL FOUNDATION IS COMMITTED TO SERVING THE RESIDENTS OF AREA COMMUNITIES. THE HOSPITAL CONTINUES THESE EFFORTS BY USING EXCESS FUNDS TO EXPAND ITS FACILITIES AND SERVICES TO BETTER SERVE THE COMMUNITY.
PART VI, LINE 7: THE FOUNDATION IS NOT PART OF AN AFFILIATED GROUP.
IL	REPORTS FILED WITH STATES	PART VI, LINE 7
THE FOUNDATION IS LOCATED IN THE MIDDLE OF CENTRAL ILLINOIS; GENERALLY ALL PATIENTS ARE FROM THE SURROUNDING COMMUNITIES. ANNUAL HOSPITAL QUESTIONNAIRES ARE SENT TO THE ILLINOIS DEPARTMENT OF PUBLIC HEALTH WHICH INCLUDE A REVIEW OF COMMUNITY BENEFIT ACTIVITIES.		PART VI, LINE 7:

Schedule I IRS990ScheduleI

Field	Value	IRS element (for citing)
Records Maintained	1	RecordsMaintained
No Grant More Than5000	X	NoGrantMoreThan5000

Form990 Schedule I Part III Form990ScheduleIPartIII

Field	Value	IRS element (for citing)
Type Of Grant	SCHOLARSHIPS FOR STUDENTS ENTERING FIELDS OF HEALTHCARE & AG	TypeOfGrant
Number Of Recipients	26	NumberOfRecipients
Amount Of Cash Grant	19313	AmountOfCashGrant

Form990 Schedule I Part IV Form990ScheduleIPartIV

Field	Value	IRS element (for citing)
Identifier	PROCEDURE FOR MONITORING GRANTS IN THE U.S.:	Identifier
Return Reference	PART I, LINE 2:	ReturnReference
Explanation	SCHEDULE I, PART I, LINE 2: IN KEEPING WITH THE SUPPORT OF EDUCATION OF THE YOUTH IN THE AREA COMMUNITIES, AND ENCOURAGING THEM TO ENTER THE IMPORTANT FIELDS OF HEALTHCARE AND AGRICULTURE, HOPEDALE MEDICAL FOUNDATION AWARDS SCHOLARSHIPS TO HIGH SCHOOL STUDENTS AND COLLEGE FRESHMAN. HOPEDALE MEDICAL FOUNDATION REQUIRES AN APPLICATION FROM STUDENTS FROM QUALIFYING SCHOOLS IN THE LOCAL AREA. SCHOLARSHIPS ARE AWARDED BY AN INDEPENDENT JUDGE BASED ON RECOMMENDATIONS, ACT SCORES, STUDENT NARRATIVE, AND CLASS RANKING. SCHOLARSHIP MONEY IS SENT DIRECTLY TO THE RECIPIENT'S SCHOOL TO ENSURE THE MONEY IS USED TOWARDS TUITION.	Explanation

Schedule J IRS990ScheduleJ

Field	Value	IRS element (for citing)
Compensation Committee	X	CompensationCommittee
Independent Consultant	X	IndependentConsultant
Written Employment Contract	X	WrittenEmploymentContract
Compensation Survey	X	CompensationSurvey
Board Or Committee Approval	X	BoardOrCommitteeApproval
Severance Payment	0	SeverancePayment
Supplemental Nonqual Retire Plan	0	SupplementalNonqualRetirePlan
Equity Based Comp Arrangement	0	EquityBasedCompArrangement
Comp Based On Revenue Of Filing Org	0	CompBasedOnRevenueOfFilingOrg
Comp Based On Revenue Related Orgs	0	CompBasedOnRevenueRelatedOrgs
Comp Based Net Earnings Filing Org	0	CompBasedNetEarningsFilingOrg
Comp Based Net Earnings Relate Orgs	0	CompBasedNetEarningsRelateOrgs
Any Non Fixed Payments	0	AnyNonFixedPayments
Initial Contract Exception	0	InitialContractException

Form990 Schedule J Part II Form990ScheduleJPartII

Field	Value	IRS element (for citing)
Name Person	MARK F ROSSI	NamePerson
Base Compensation Filing Org	117814	BaseCompensationFilingOrg
Comp Based On Related Orgs	0	CompBasedOnRelatedOrgs
Bonus Filing Org	0	BonusFilingOrg
Bonus Related Orgs	0	BonusRelatedOrgs
Other Compensation Filing Org	0	OtherCompensationFilingOrg
Other Compensation Related Orgs	46296	OtherCompensationRelatedOrgs
Deferred Comp Filing Org	6968	DeferredCompFilingOrg
Deferred Comp Related Orgs	0	DeferredCompRelatedOrgs
Nontaxable Benefits Filing Org	684	NontaxableBenefitsFilingOrg
Nontaxable Benefits Related Orgs	0	NontaxableBenefitsRelatedOrgs
Total Compensation Filing Org	125466	TotalCompensationFilingOrg
Total Compensation Related Orgs	46296	TotalCompensationRelatedOrgs
Comp Report Prior990 Filing Org	0	CompReportPrior990FilingOrg
Comp Report Prior990 Related Orgs	0	CompReportPrior990RelatedOrgs

Schedule K IRS990ScheduleK

Form990 Schedule K Part I Form990ScheduleKPartI

Issuer Name IssuerName

Field	Value	IRS element (for citing)
Business Name Line1	VILLAGE OF HOPEDALE ILLINOIS VARIABLE RATE DEMAND REVENUE BONDS SERIES 09	BusinessNameLine1

Field	Value	IRS element (for citing)
Issuer EIN	376002155	IssuerEIN
CUSIP Number	43950QAA0	CUSIPNumber
Date Issued	2009-09-23	DateIssued
Issue Price	5500000	IssuePrice
Description Of Purpose	REFINANCE 1998 BONDS AND CONSTRUCTION COSTS	DescriptionOfPurpose
Defeased	0	Defeased
On Behalf Of Issuer	0	OnBehalfOfIssuer
Pool Financing	0	PoolFinancing

Form990 Schedule K Part II Form990ScheduleKPartII

Field	Value	IRS element (for citing)
Total Proceeds	5500000	TotalProceeds
Issuance Costs From Proceeds	110000	IssuanceCostsFromProceeds
Credit Enhancement	49744	CreditEnhancement
Capital Expenditures	1178060	CapitalExpenditures
Other Spent Proceeds	4150580	OtherSpentProceeds
Amount Unspent	11616	AmountUnspent
Year Of Subst Completion	2011	YearOfSubstCompletion
Current Refunding	1	CurrentRefunding
Advance Refunding	0	AdvanceRefunding
Final Allocation Made	0	FinalAllocationMade
Adequate Books And Recds Maintaind	1	AdequateBooksAndRecdsMaintaind

Form990 Schedule K Part III Form990ScheduleKPartIII

Field	Value	IRS element (for citing)
Owning Bond Financed Property	0	OwningBondFinancedProperty
Any Lease Arrangements	0	AnyLeaseArrangements
Mngment Cntrct Bond Financd Prprty	0	MngmentCntrctBondFinancdPrprty
Any Research Agreements	0	AnyResearchAgreements
Prcntge Prvt Business Use By Others	0.00000	PrcntgePrvtBusinessUseByOthers
Percentage Of Prvt Business Re UBI	0.00600	PercentageOfPrvtBusinessReUBI
Total Private Business Use	0.00600	TotalPrivateBusinessUse
Post Issuance Compliance Procdrs	1	PostIssuanceComplianceProcdrs

Form990 Schedule K Part IV Form990ScheduleKPartIV

Field	Value	IRS element (for citing)
Form8038 T Filed	0	Form8038TFiled
Variable Rate Issue	1	VariableRateIssue
Hedge Identified In Books And Recds	0	HedgeIdentifiedInBooksAndRecds
Gross Proceeds Invested In GIC	0	GrossProceedsInvestedInGIC
Gross Proceeds Invested	0	GrossProceedsInvested
Exception To Rebate	0	ExceptionToRebate

Schedule L IRS990ScheduleL

Loan Table LoanTable (6 entries)

Purpose Of LoanPurposeOfLoan	Loan From OrganizationLoanFromOrganization	Original PrincipalOriginalPrincipalAmount	Balance DueBalanceDue	DefaultDefault	Approved By BoardApprovedByBoard	Written AgreementWrittenAgreement
DR JOSEPH ROSSI
LOAN TO OPEN THE DELAVAN OFFICE	X	$32,118	32118	0	1	1
DR MATT ROSSI
PHYSICIAN RENT RECEIVABLE	X	$32,812	32812	0	1	1
DR LARRY ROSSI
PHYSICIAN RENT RECEIVABLE	X	$4,764	4764	0	1	1
DR ALFRED ROSSI
PHYSICIAN RENT RECEIVABLE	X	$21,777	21777	0	1	1
AARON ROSSI
LOAN TO SUPPORT COMPLETION OF MEDICAL SCHOOL	X	$16,800	16800	0	1	1
DR PHIL ROSSI
PHYSICIAN RENT RECEIVABLE	X	$22,457	22457	0	1	1

Field	Value	IRS element (for citing)
Total Balance Due	130728	TotalBalanceDue

Form990 Schedule L Part IV Form990ScheduleLPartIV (10 entries)

RelationshipRelationship	Amount Of TransactionAmountOfTransaction	Description Of TransactionDescriptionOfTransaction	Sharing Of RevenuesSharingOfRevenues
DR PHILLIP ROSSI
FAMILY RELATIONSHIP	172652	COMPENSATION FOR ER SERVICES	0
LISA MCLAUGHLIN
FAMILY RELATIONSHIP	43684	COMPENSATION FOR EMPLOYMENT AS PHARMACY DIRECTOR	0
CYNTHIA NOREUIL
FAMILY RELATIONSHIP	52321	COMPENSATION FOR EMPLOYMENT AS DIRECTOR OF ASSISTED AND INDEPENDENT LIVING FACILITIES	0
LARRY NOREUIL
FAMILY RELATIONSHIP	62059	COMPENSATION FOR EMPLOYMENT AS ASSOC NURSING HOME ADMINISTRATOR AND ENVIRONMENTAL HEALTH DIRECTOR	0
DR LARRY ROSSI
FAMILY RELATIONSHIP	131700	ANESTESIA SERVICES - LARRY ROSSI IS OWNER OF TRI-COUNTY ANESTHESIA. TRI-COUNTY ANESTHSIA PROVIDES SERVICES TO THE ORGANIZATION.	0
PEGGIE ROSSI
FAMILY RELATIONSHIP	35887	COMPENSATION FOR EMPLOYMENT AS PHYSICIAN BILLING AND RECEIVABLES ACCOUNTANT	0
LORAYNE ROSSI
FAMILY RELATIONSHIP	6000	PAYMENT FOR REAL ESTATE/INSURANCE/MAINTENANCE ON PROPERTY DONATED TO HOSPITAL UPON HER DEATH	0
(no name)
			0
PHILLIP NOREUIL
FAMILY RELATIONSHIP	29286	COMPENSATION FOR EMPLOYMENT AS MAINTENANCE SPECIALIST.	0
LAURA MURRAY
FAMILY RELATIONSHIP	35988	COMPENSATION FOR EMPLOYMENT AS NURSE.	0

Form990 Schedule L Part V Form990ScheduleLPartV (3 entries)

IdentifierIdentifier	Return ReferenceReturnReference	ExplanationExplanation
SCHEDULE L, PAGE 2, PART IV	EXPLANATION OF TRANSACTIONS	HOPEDALE MEDICAL FOUNDATION PROVIDES A BUILDING AND SERVICES (NURSING, SECRETARIAL AND OTHER SERVICES) FOR PRIVATE PHYSICIANS, SOME OF WHOM ARE DIRECTORS/OFFICERS OF THE FOUNDATION AND THEIR FAMILY MEMBERS. THE FACILITY AND SERVICES ARE PROVIDED IN EXCHANGE FOR ER SERVICES PROVIDED FOR THE FOUNDATION BY THE PHYSICIANS. THE EXCHANGE IS BELIEVED TO BE IN THE ORDINARY COURSE OF HOSPITAL BUSINESS AND IS REPORTED AT ARM'S LENGTH.THE VALUE OF THE ER SERVICES PROVIDED BY DIRECTORS AND OFFICERS AND THEIR FAMILY MEMBERS IN EXCHANGE FOR USE OF BUILDING SPACE AND SERVICES ARE AS FOLLOWS AND ARE INCLUDED IN AMOUNTS REPORTED IN PART IV.DR. PHILLIP ROSSI $159,591DR. MATTHEW ROSSI $82,270DR. ALFRED ROSSI $65,947
SCHEDULE L, PART II	LOANS TO INTERESTED PERSONS:	HOPEDALE MEDICAL FOUNDATION EXTENDS CREDIT TO DOCTORS, INCLUDING THOSE DOCTORS THAT ARE ON AND RELATED TO THE BOARD OF DIRECTORS. CREDIT IS FOR RENT THAT IS DUE TO THE HOSPITAL, TO SUPPORT A NEW CLINIC IN A NEARBY COMMUNITY AND TO SUPPORT COMPLETION OF MEDICAL SCHOOL. BELIEVED TO BE IN THE ORDINARY CORUSE OF HOSPITAL BUSINESS AND PROVIDED AT ARMS LENGTH.
SCHEDULE L	DESCRIPTION OF FAMILY RELATIONSHIPS:	LAWRENCE ROSSI WAS THE FOUNDER OF THE HOPEDALE MEDICAL FOUNDATION. HIS WIFE IS LORAYNE ROSSI. ALFRED ROSSI, LARRY ROSSI, MATT ROSSI, PHILLIP ROSSI, MARK ROSSI, CYNTHIA NOREUIL, LISA MCLAUGHLIN, AND LAURA MURRAY ARE CHILDREN OF LAWRENCE AND LORAYNE ROSSI. SPOUSES OF THE ABOVE ARE PEGGIE ROSSI, LARRY NOREUIL AND MICHAEL MCLAUGHLIN. GRANDCHILDREN OF LAWRENCE AND LORAYNE ARE AARON ROSSI AND PHILLIP NOREUIL.

Schedule M IRS990ScheduleM

Real Estate Other RealEstateOther

Field	Value	IRS element (for citing)
Non Cash Checkbox	X	NonCashCheckbox
Number Of Contributions	1	NumberOfContributions
Noncash Contribs Rptd F990	265000	NoncashContribsRptdF990
Method Of Determining Revenues	INTEREST IN LAND TRUST	MethodOfDeterminingRevenues

Field	Value	IRS element (for citing)
Any Property That Must Be Held	0	AnyPropertyThatMustBeHeld
Review Process Unusual NC Gifts	0	ReviewProcessUnusualNCGifts
Third Parties Used	0	ThirdPartiesUsed

Schedule O IRS990ScheduleO

General Explanation GeneralExplanation (13 entries)

IdentifierIdentifier	ExplanationExplanation	Return ReferenceReturnReference
FORM 990, PART VI, SECTION A, LINE 2	ALFRED ROSSI, DIRECTOR, MATTHEW ROSSI, DIRECTOR, MIKE MCLAUGHLIN, DIRECTOR, AND MARK F. ROSSI, COO 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 A, LINE 6	THE SOLE MEMBER OF HOPEDALE MEDICAL FOUNDATION IS HOPEDALE RURAL HEALTH ASSOCIATION, INC., AN ILLINOIS NOT FOR PORFIT CORPORATION.
FORM 990, PART VI, SECTION A, LINE 7A	DIRECTORS SHALL BE APPOINTED TO THE BOARD BY THE BOARD OF DIRECTORS OF THE SOLE MEMBER FROM AMONG THOSE PERSONS NOMINATED BY THE NOMINATING COMMITTEE OF THE SOLE MEMBER.
FORM 990, PART VI, SECTION A, LINE 7B	THE SOLE MEMBER OF HOPEDALE MEDICAL FOUNDATION, HOPEDALE RURAL HEALTH ASSOCIATION, INC. HAS THE FOLLOWING RIGHTS AND POWERS: A. TO ELECT OR REMOVE, WITH OR WITHOUT CAUSE, MEMBERS OF THE BOARD OF DIRECTORS OF THE FOUNDATION; B. TO ELECT OR REMOVE, WITH OR WITHOUT CAUSE, THE CHAIR, VICE CHAIR, PRESIDENT AND OTHER OFFICERS OF THE FOUNDATION; C. TO ELECT OR REMOVE, WITH OR WITHOUT CAUSE, THE AUDITORS OF THE FOUNDATION; D. TO APPROVE ANY CHANGES TO THE GOVERNANCE DOCUMENTS OF THE FOUNDATION; E. TO APPROVE THE MERGER, CONSOLIDATION, CHANGE IN CORPORATE MEMBERSHIP, CORPORATE REORGANIZATION OR DISSOLUTION OF THE FOUNDATION; F. TO APPROVE THE CREATION OF NEW SUBSIDIARIES OR AFFILIATES BY THE FOUNDATION; G. TO APPROVE THE STRATEGIC AND FINANCIAL PLANS AND THE CAPITAL AND OPERATING BUDGETS OF THE FOUNDATION; H. TO APPROVE DEBT INCURRED BY THE FOUNDATION IN EXCESS OF $500,000; I. TO APPROVE THE PURCHASE, SALE, LEASE, TRANSFER, ENCUMBRANCE OR OTHER DISPOSITION OF ASSETS IN EXCESS OF $150,000; J. TO APPROVE ALL NON-BUDGETED DEBT OR TRANSFERS OF ASSETS IN EXCESS OF AN AMOUNT ESTABLISHED FROM TIME TO TIME BY THE SOLE MEMBER; K. TO APPROVE THE MANAGED CARE POLICY OF THE FOUNDATION; AND L. TO APPROVE THE FILING OF THE BANKRUPTCY BY THE FOUNDATION.
FORM 990, PART VI, SECTION B, LINE 11	THE ORGANIZATION'S CFO AND CONTROLLER REVIEW THE FORM 990 WITH EXTERNAL ACCOUNTANTS. THE BOARD IS THEN PROVIDED A FINAL COPY OF THE FORM 990 BEFORE IT IS FILED.
	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. 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 12C
	THE COO'S COMPENSATION IS REVEIWED 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 CFO'S COMPENSATION IS REVIEWED AND APPROVED BY THE CHAIRMAN OF THE BOARD, THE COO, AND THE HR DIRECTOR. THE HR DIRECTOR OVERSEES THE SALARY PROGRAM FOR ALL OTHER EMPLOYEES.	FORM 990, PART VI, SECTION B, LINE 15
	THE GOVERNING DOCUMENTS, FINANCIAL STATEMENTS AND CONFLICT OF INTEREST POLICY ARE MADE AVAILABLE TO THE PUBLIC UPON REQUEST.	FORM 990, PART VI, SECTION C, LINE 19
VOLUNTEER BOARD OF DIRECTORS:	THE BOARD OF DIRECTORS ARE NOT COMPENSATED FOR THEIR SERVICES AS THE BOARD OF DIRECTORS. COMPENSATION REPORTED TO BOARD MEMBERS ON PART VII IS RELATED TO COMPENSATION FOR SERVICES AS EMPLOYEES AND ER PHYSICIANS. AVERAGE HOURS PER WEEK REPORTED FOR EACH BOARD MEMBER IS AN ESTIMATE OF TIME SPENT SOLELY ON BOARD OF DIRECTOR DUTIES.	PART VII
OFFICER HOURS:	HOURS DEVOTED TO POSITION WITH RELATED ORGANIZATION: MARK ROSSI WAS EMPLOYED BY HOPEDALE MEDICAL FOUNDATION BETWEEN JAN - SEPT 2010. MARK ROSSI WAS EMPLOYED BY HOPEDALE REAL ESTATE SERVICES BETWEEN OCT 2010 AND JUNE 2011. DURING ALL OF THE ABOVE EMPLOYMENT PERIOD, HE SPENT APPROXIMATELY 50% OF HIS TIME ON EACH ORGANIZATION.	PART VII
CHANGES IN NET ASSETS OR FUND BALANCES:	NET UNREALIZED GAINS ON INVESTMENTS: 57,879. PRIOR PERIOD ADJUSTMENT -3,987. TOTAL TO FORM 990, PART XI, LINE 5: 53,892.	FORM 990, PART XI, LINE 5:
FINANCIAL STATEMENTS AUDIT OVERSIGHT:	THERE WERE NO CHANGES IN THE PROCESS DURING THE YEAR.	FORM 990, PART XII, LINE 2C:
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 I, LINE 6:

Schedule R IRS990ScheduleR

Form990 Schedule R Part I Form990ScheduleRPartI

Name Of Disregarded Entity NameOfDisregardedEntity

Field	Value	IRS element (for citing)
Business Name Line1	MISS MONA'S LLC	BusinessNameLine1

Address US AddressUS

Field	Value	IRS element (for citing)
Address Line1	107 TREMONT ST	AddressLine1
City	HOPEDALE	City
State	IL	State
ZIP Code	61747	ZIPCode

Field	Value	IRS element (for citing)
Primary Activities	DAY CARE	PrimaryActivities
Legal Domicile State	IL	LegalDomicileState
Total Income	180958	TotalIncome
EOY Assets	69397	EOYAssets

Direct Controlling Entity Name DirectControllingEntityName

Field	Value	IRS element (for citing)
Business Name Line1	HOPEDALE REAL ESTATE SERVICES INC	BusinessNameLine1

Form990 Schedule R Part II Form990ScheduleRPartII (2 entries)

Address Line1AddressUS/AddressLine1	CityAddressUS/City	StateAddressUS/State	ZIP CodeAddressUS/ZIPCode	EINEIN	Primary ActivitiesPrimaryActivities	Legal Domicile StateLegalDomicileState	Exempt Code SectionExemptCodeSection	Public Charity StatusPublicCharityStatus	Business Name Line1DirectControllingEntityName/BusinessNameLine1	Controlled OrgControlledOrg	Direct Controlling Entity NADirectControllingEntityNA
PRAIRIE HEALTH SERVICES INC
PO BOX 267	HOPEDALE	IL	61747	371390103	PROMOTE PUBLIC HEALTH AND WELFARE	IL	501(C)(3)	PF	HOPEDALE RURAL HEALTH ASSOCIATION INC	1
HOPEDALE RURAL HEALTH ASSOCIATION INC
PO BOX 267	HOPEDALE	IL	61747	391390105	SUPPORT HEALTHCARE, EDUCATION AND RESEARCH	IL	501(C)(3)	PF		0	N/A

Form990 Schedule R Part IV Form990ScheduleRPartIV

Name Of Related Org NameOfRelatedOrg

Field	Value	IRS element (for citing)
Business Name Line1	HOPEDALE REAL ESTATE SERVICES INC	BusinessNameLine1

Address US AddressUS

Field	Value	IRS element (for citing)
Address Line1	107 TREMONT STREET	AddressLine1
City	HOPEDALE	City
State	IL	State
ZIP Code	61747	ZIPCode

Field	Value	IRS element (for citing)
EIN	371406582	EIN
Primary Activity	PROPERTY RENTAL	PrimaryActivity
Legal Domicile State	IL	LegalDomicileState

Direct Controlling Entity Name DirectControllingEntityName

Field	Value	IRS element (for citing)
Business Name Line1	PRAIRIE HEALTH SERVICES INC	BusinessNameLine1

Field	Value	IRS element (for citing)
Type Of Entity	C	TypeOfEntity

Field	Value	IRS element (for citing)
Receipt Of Int Ann Rents Royalties	0	ReceiptOfIntAnnRentsRoyalties
Gift Grant Or Cap Contr To Other Org	0	GiftGrantOrCapContrToOtherOrg
Gift Grant Or Cap Contr Fr Other Org	0	GiftGrantOrCapContrFrOtherOrg
Loans Or Guarantees To Other Org	0	LoansOrGuaranteesToOtherOrg
Loans Or Guarantees From Other Org	0	LoansOrGuaranteesFromOtherOrg
Sale Of Assets To Other Org	0	SaleOfAssetsToOtherOrg
Purchase Of Assets From Other Org	0	PurchaseOfAssetsFromOtherOrg
Exchange Of Assets	0	ExchangeOfAssets
Rental Of Facilities To Other Orgs	1	RentalOfFacilitiesToOtherOrgs
Rental Of Facilities Fr Other Orgs	0	RentalOfFacilitiesFrOtherOrgs
Perform Of Services For Other Orgs	0	PerformOfServicesForOtherOrgs
Perform Of Services By Other Orgs	0	PerformOfServicesByOtherOrgs
Sharing Of Facilities	0	SharingOfFacilities
Sharing Of Paid Employees	1	SharingOfPaidEmployees
Reimbursement Paid To Other Org	0	ReimbursementPaidToOtherOrg
Reimbursement Paid By Other Org	0	ReimbursementPaidByOtherOrg
Other Transfer To Other Org	1	OtherTransferToOtherOrg
Other Transfer From Other Org	1	OtherTransferFromOtherOrg

Transactions Related Orgs Table TransactionsRelatedOrgsTable (4 entries)

Transaction TypeTransactionType	Amount InvolvedAmountInvolved	Method Of Amt DeterminationMethodOfAmtDetermination
HOPEDALE REAL ESTATE SERVICES INC
I	7014	GAAP
HOPEDALE REAL ESTATE SERVICES INC
N	125219	GAAP
HOPEDALE REAL ESTATE SERVICES INC
Q	101746	GAAP
HOPEDALE REAL ESTATE SERVICES INC
R	3565	GAAP