HOPEDALE MEDICAL FOUNDATION: Form 990, tax year 2009
View the entire original 990 at ProPublica ↗
- Organization
- HOPEDALE MEDICAL FOUNDATION (EIN 37-0808925)
- Tax period
- 2009-07-01 to 2010-06-30
- Filed
- 2011-10-19
- IRS object ID
- 201112929349300406
- Schema version
- 2009v1.7
- 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 H
- Schedule I
- Schedule J
- Schedule L
- Schedule M
- Schedule O
- Schedule R
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Timestamp | 2011-10-19T07:26:13-07:00 | Timestamp |
| Tax Period End Date | 2010-06-30 | TaxPeriodEndDate |
Preparer Firm PreparerFirm
Preparer Firm Business Name PreparerFirmBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Gordon Stockman & Waugh PC | BusinessNameLine1 |
Preparer Firm US Address PreparerFirmUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 8726 N Industrial Rd | AddressLine1 |
| City | Peoria | City |
| State | IL | State |
| ZIP Code | 61615 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnType |
| Tax Period Begin Date | 2009-07-01 | 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 |
| Business Name Line2 | DBA Hopedale medical complex | BusinessNameLine2 |
| 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 | Mark F Rossi | Name |
| Title | COO | Title |
| Date Signed | 2011-10-19 | DateSigned |
Preparer Preparer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | Matt Waugh | Name |
| Phone | 3096924030 | Phone |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax Year | 2009 | TaxYear |
| Build TS | 2016-03-07 17:11:31Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Of Principal Officer Person | Mark F 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 | 23102074 | GrossReceipts |
| Group Return For Affiliates | false | GroupReturnForAffiliates |
| All Affiliates Included | false | AllAffiliatesIncluded |
| Organization501c | X | Organization501c |
| Web Site | www.hopedalemc.com | WebSite |
| Type Of Organization Corporation | X | TypeOfOrganizationCorporation |
| Year Formation | 1989 | 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 | 8 | NbrVotingMembersGoverningBody |
| Nbr Independent Voting Members | 4 | NbrIndependentVotingMembers |
| Total Nbr Employees | 440 | TotalNbrEmployees |
| Total Nbr Volunteers | 56 | TotalNbrVolunteers |
| Total Gross UBI | 137878 | TotalGrossUBI |
| Contributions Grants Prior Year | 94198 | ContributionsGrantsPriorYear |
| Contributions Grants Current Year | 588756 | ContributionsGrantsCurrentYear |
| Program Service Revenue Prior Year | 23340904 | ProgramServiceRevenuePriorYear |
| Program Service Revenue CY | 21735669 | ProgramServiceRevenueCY |
| Investment Income Prior Year | 120157 | InvestmentIncomePriorYear |
| Investment Income Current Year | 115927 | InvestmentIncomeCurrentYear |
| Other Revenue Prior Year | 661281 | OtherRevenuePriorYear |
| Other Revenue Current Year | 380764 | OtherRevenueCurrentYear |
| Total Revenue Prior Year | 24216540 | TotalRevenuePriorYear |
| Total Revenue Current Year | 22821116 | TotalRevenueCurrentYear |
| Grants And Similar Amnts Prior Year | 43948 | GrantsAndSimilarAmntsPriorYear |
| Grants And Similar Amnts CY | 43974 | GrantsAndSimilarAmntsCY |
| Benefits Paid To Members CY | 0 | BenefitsPaidToMembersCY |
| Salaries Etc Prior Year | 12040168 | SalariesEtcPriorYear |
| Salaries Etc Current Year | 12205423 | SalariesEtcCurrentYear |
| Total Prof Fundrsng Exp CY | 0 | TotalProfFundrsngExpCY |
| Total Fundrsng Exp Current Year | 89205 | TotalFundrsngExpCurrentYear |
| Other Expense Prior Year | 10395096 | OtherExpensePriorYear |
| Other Expenses Current Year | 10014683 | OtherExpensesCurrentYear |
| Total Expenses Prior Year | 22479212 | TotalExpensesPriorYear |
| Total Expenses Current Year | 22264080 | TotalExpensesCurrentYear |
| Revenues Less Expenses Prior Year | 1737328 | RevenuesLessExpensesPriorYear |
| Revenues Less Expenses CY | 557036 | RevenuesLessExpensesCY |
| Total Assets BOY | 18984500 | TotalAssetsBOY |
| Total Assets EOY | 20276587 | TotalAssetsEOY |
| Total Liabilities BOY | 7969953 | TotalLiabilitiesBOY |
| Total Liabilities EOY | 8522457 | TotalLiabilitiesEOY |
| Net Assets Or Fund Balances BOY | 11014547 | NetAssetsOrFundBalancesBOY |
| Net Assets Or Fund Balances EOY | 11754130 | NetAssetsOrFundBalancesEOY |
| Mission Description | THE HOPEDALE MEDICAL FOUNDATION IS A NON-PROFIT, 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 | false | SignificantNewProgramServices |
| Significant Change | false | SignificantChange |
| Expense | 17232288 | Expense |
| Grants | 43974 | Grants |
| Revenue | 18391218 | Revenue |
| Description | THE HOPEDALE MEDICAL COMPLEX IS OWNED AND OPERATED BY THE NOT-FOR-PROFIT CHARITABLE CORPORATION KNOWN AS THE "THE HOPEDALE MEDICAL FOUNDATION." THE COMMUNITY BENEFIT CONTRIBUTION OF HOPEDALE MEDICAL FOUNDATION INCLUDES PROGRAMS AND ACTIVITIES THE IMPROVE ACCESS TO HEALTH CARE AND IMPROVE HEALTH IN OUR COMMUNITIES. TO EXPLAIN THE FULL BREADTH OF OUR CONTRIBUTION, OUR COMMUNITY BENEFIT INFORMATION IS DESCRIBED BELOW:SECTION 1: QUALITATIVE DESCRIPTION OF COMMUNITY BENEFIT SERVICESTHE HOPEDALE MEDICAL COMPLEX STARTED AS A 20-BED HOSPITAL IN 1955 IN HOPEDALE, ILLINOIS AND HAS EXPANDED OVER THE YEARS TO OFFER A CONTINUUM OF CARE SERVICES, INCLUDING A 25-BED ACUTE CARE HOSPITAL, NURSING HOME, INDEPENDENT AND ASSISTED LIVING FACILITY AS WELL AS A WELLNESS CENTER.THE HOPEDALE HOSPITAL IS A CRITICAL ACCESS HOSPITAL AND OFFERS VIRTUALLY THE SAME SERVICES AS A LARGER, URBAN HOSPITAL, INCLUDING 24 HOUR EMERGENCY ROOM, ICU, GENERAL AND ADVANCED VASCULAR SURGERY, ORTHOPEDIC SURGERY, PLASTIC/RECONSTRUCTIVE SURGERY, OPEN MRI AND CT SCANNER. THE HOPEDALE MEDICAL COMPLEX ALSO OFFERS PHYSICIAN SERVICES THROUGH FOUR SATELLITE OFFICES IN ATLANTA, MANITO, MACKINAW AND DELAVAN.HOPEDALE WELLNESS CENTER HAS AN INDOOR GYM, WALKING TRACK, THREE THERAPY POOLS, DAY CARE, PHYSICAL THERAPY DEPARTMENT AND CONFERENCE ROOM FOR THEIR MEMBERS TO USE. THE WELLNESS CENTER ALSO OFFERS CLUB MEMBERSHIPS TO THE RESIDENTS OF HOPEDALE AND SURROUNDING AREAS. PRESENTLY THE WELLNESS CENTER HAS APPROXIMATELY 1,000 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 DEDICATED STAFF OF TRAINED HEALTH PROFESSIONALS THAT HAVE JOINED TOGETHER AS A TEAM TO PROVIDE THE BEST POSSIBLE HEALTH CARE FOR THE PATIENTS AND RESIDENTS OF OUR COMMUNITY. FINANCIAL ASSISTANCE PROGRAMSHOPEDALE 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 SERVICESHOPEDALE 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 COMPLEX IS OPEN AND OFFERS PRIVILEGES TO ALL QUALIFIED PHYSICIANS IN THE AREA.UNCOMPENSATED CAREHOPEDALE 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.SEE 990 PART III PAGE 2 LINE 4D FOR CONTINUATION | Description |
Activity2 Activity2
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expense | 1580927 | Expense |
| Revenue | 2712540 | 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 | 832144 | Expense |
| Revenue | 1262074 | Revenue |
| Description | HOPEDALE COMMONS IS AN 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 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Expense | 19645359 | TotalProgramServiceExpense |
| Described In501 C3 | true | DescribedIn501C3 |
| Schedule B Required | true | ScheduleBRequired |
| Political Activities | false | PoliticalActivities |
| Lobbying Activities | false | LobbyingActivities |
| Subject To Proxy Tax | false | SubjectToProxyTax |
| Donor Advised Funds | false | DonorAdvisedFunds |
| Conservation Easements | false | ConservationEasements |
| Collections Of Art | false | CollectionsOfArt |
| Credit Counseling | false | CreditCounseling |
| Term Or Permanent Endowments | false | TermOrPermanentEndowments |
| Balance Sheet Amounts Reported | true | BalanceSheetAmountsReported |
| Independent Audit Financial Stmt | false | IndependentAuditFinancialStmt |
| Consolidated Audit Financial Stmt | true | ConsolidatedAuditFinancialStmt |
| School | false | School |
| Foreign Office | false | ForeignOffice |
| Foreign Activities | false | ForeignActivities |
| More Than5000 K To Organizations | false | MoreThan5000KToOrganizations |
| More Than5000 K To Individuals | false | MoreThan5000KToIndividuals |
| Professional Fundraising | false | ProfessionalFundraising |
| Fundraising Activities | false | FundraisingActivities |
| Gaming | false | Gaming |
| Hospital | true | Hospital |
| Grants To Organizations | true | GrantsToOrganizations |
| Grants To Individuals | true | GrantsToIndividuals |
| Schedule J Required | true | ScheduleJRequired |
| Tax Exempt Bonds | false | TaxExemptBonds |
| Invest Tax Exempt Bonds | false | InvestTaxExemptBonds |
| Escrow Account | false | EscrowAccount |
| On Behalf Of Issuer | false | OnBehalfOfIssuer |
| Excess Benefit Transaction | false | ExcessBenefitTransaction |
| Prior Excess Benefit Transaction | false | PriorExcessBenefitTransaction |
| Loan To Officer Or DQP | true | LoanToOfficerOrDQP |
| Grant To Related Person | false | GrantToRelatedPerson |
| Bsnss Rltnshp With Organization | true | BsnssRltnshpWithOrganization |
| Bsnss Rltnshp Thru Family Member | true | BsnssRltnshpThruFamilyMember |
| Officer Entity With Bsnss Rltnshp | false | OfficerEntityWithBsnssRltnshp |
| Deductible Non Cash Contributions | true | DeductibleNonCashContributions |
| Deductible Contributions Of Art | false | DeductibleContributionsOfArt |
| Terminated | false | Terminated |
| Partial Liquidation | false | PartialLiquidation |
| Disregarded Entity | false | DisregardedEntity |
| Related Entity | true | RelatedEntity |
| Related Org Controlled Entity | false | RelatedOrgControlledEntity |
| Transfers To Exempt Non Chrtbl Org | false | TransfersToExemptNonChrtblOrg |
| Activities Conducted Partnership | false | ActivitiesConductedPartnership |
| Schedule O Required | true | ScheduleORequired |
| Number Forms Transmitted With1096 | 65 | NumberFormsTransmittedWith1096 |
| Number W2 G Included | 0 | NumberW2GIncluded |
| Compliance With Backup Witholding | true | ComplianceWithBackupWitholding |
| Number Of Employees | 440 | NumberOfEmployees |
| Employment Tax Returns Filed | true | EmploymentTaxReturnsFiled |
| Unrelated Business Income | true | UnrelatedBusinessIncome |
| Form990-T Filed | true | Form990-TFiled |
| Foreign Financial Account | false | ForeignFinancialAccount |
| Prohibited Tax Shelter Trans | false | ProhibitedTaxShelterTrans |
| Taxable Party Notification | false | TaxablePartyNotification |
| Form8886 T Filed | false | Form8886TFiled |
| Non Deductible Contributions | false | NonDeductibleContributions |
| Non Deductible Disclosure | false | NonDeductibleDisclosure |
| Quid Pro Quo Contributions | false | QuidProQuoContributions |
| Quid Pro Quo Disclosure | false | QuidProQuoDisclosure |
| Form8282 Property Disposed Of | false | Form8282PropertyDisposedOf |
| Number Of8282 Filed | 0 | NumberOf8282Filed |
| Funds To Pay Premiums | false | FundsToPayPremiums |
| Premiums Paid | false | PremiumsPaid |
| Form8899 Filed | false | Form8899Filed |
| Form1098 C Filed | false | Form1098CFiled |
| Excess Business Holdings | false | ExcessBusinessHoldings |
| Taxable Distributions | false | TaxableDistributions |
| Distribution To Donor | false | DistributionToDonor |
| Filed Lieu1041 | false | FiledLieu1041 |
| Nbr Voting Governing Body Members | 8 | NbrVotingGoverningBodyMembers |
| Number Independent Voting Members | 4 | NumberIndependentVotingMembers |
| Family Or Business Relationship | true | FamilyOrBusinessRelationship |
| Delegation Of Management Duties | false | DelegationOfManagementDuties |
| Changes To Organizing Docs | false | ChangesToOrganizingDocs |
| Material Diversion Or Misuse | false | MaterialDiversionOrMisuse |
| Members Or Stockholders | true | MembersOrStockholders |
| Election Of Board Members | true | ElectionOfBoardMembers |
| Decisions Subject To Approval | true | DecisionsSubjectToApproval |
| Minutes Of Governing Body | true | MinutesOfGoverningBody |
| Minutes Of Committees | true | MinutesOfCommittees |
| Officer Mailing Address | false | OfficerMailingAddress |
| Local Chapters | false | LocalChapters |
| Policies Reference Chapters | false | PoliciesReferenceChapters |
| Form990 Provided To Governing Body | true | Form990ProvidedToGoverningBody |
| Conflict Of Interest Policy | true | ConflictOfInterestPolicy |
| Annual Disclosure Covered Persons | true | AnnualDisclosureCoveredPersons |
| Regular Monitoring Enforcement | true | RegularMonitoringEnforcement |
| Whistleblower Policy | true | WhistleblowerPolicy |
| Document Retention Policy | true | DocumentRetentionPolicy |
| Compensation Process CEO | true | CompensationProcessCEO |
| Compensation Process Other | false | CompensationProcessOther |
| Investment In Joint Venture | false | InvestmentInJointVenture |
| Written Policy Or Procedure | false | WrittenPolicyOrProcedure |
| States Where Copy Of Return Is Filed | IL | StatesWhereCopyOfReturnIsFiled |
| Other Website | X | OtherWebsite |
| Upon Request | X | UponRequest |
The Books Are In Care Of TheBooksAreInCareOf
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Person | larry kloc | NamePerson |
| 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 |
Form990 Part VII Section A Form990PartVIISectionA (10 entries)
| TitleTitle | Average Hours Per WeekAverageHoursPerWeek | Highest Compensated EmployeeHighestCompensatedEmployee | Reportable Comp From OrganizationReportableCompFromOrganization | Reportable Comp From Related OrgsReportableCompFromRelatedOrgs | Other CompensationOtherCompensation | Individual Trustee Or DirectorIndividualTrusteeOrDirector | OfficerOfficer |
|---|---|---|---|---|---|---|---|
| WENDY MOBLEY | |||||||
| PHARMACIST | 40.00 | X | 106756 | 0 | 2928 | ||
| TOM HIESER | |||||||
| Director | 2.00 | 0 | 0 | 0 | X | ||
| MICHAEL MCLAUGHLIN | |||||||
| Director | 2.00 | 0 | 0 | 0 | X | ||
| Mark F Rossi | |||||||
| COO | 40.00 | 165181 | 0 | 4955 | X | ||
| LARRY KLOC | |||||||
| CFO | 40.00 | 60288 | 0 | 0 | X | ||
| JOHN ZANON | |||||||
| PHARMACIST | 40.00 | X | 119768 | 0 | 3776 | ||
| JOE SERANGELI | |||||||
| Director | 2.00 | 0 | 0 | 0 | X | ||
| HENRY ALLEN | |||||||
| Director | 2.00 | 0 | 0 | 0 | X | ||
| DR MATTHEW B ROSSI | |||||||
| Treasurer | 2.00 | 0 | 0 | 0 | X | X | |
| DR ALFRED ROSSI | |||||||
| President | 2.00 | 0 | 0 | 0 | X | X | |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | 451993 | TotalReportableCompFromOrg |
| Total Other Compensation | 11659 | TotalOtherCompensation |
| Number Individuals GT100 K | 3 | NumberIndividualsGT100K |
| Formers Listed | false | FormersListed |
| Total Comp GT150 K | true | TotalCompGT150K |
| Compensation From Other Sources | false | CompensationFromOtherSources |
Contractor Compensation ContractorCompensation (5 entries)
| Address Line1AddressOfContractor/AddressUS/AddressLine1 | CityAddressOfContractor/AddressUS/City | StateAddressOfContractor/AddressUS/State | ZIP CodeAddressOfContractor/AddressUS/ZIPCode | Description Of ServicesDescriptionOfServices | CompensationCompensation |
|---|---|---|---|---|---|
| TRI COUNTY ANESTHESIA SC | |||||
| PO BOX 267 | HOPEDALE | IL | 61747 | ANESTHESIA | 122100 |
| SPACE LLC | |||||
| 4168 MANCHESTER | ST LOUIS | MO | 63110 | ARCHITECTURAL DESIGN | 931896 |
| EPSS | |||||
| 12528 SR 78 | HAVANA | IL | 62644 | ER PHYSICIAN STAFFIN | 630847 |
| CTSI | |||||
| 17314 SHERWOOD FOREST RD | HAVANA | IL | 62644 | TRANSCRIPTION | 126722 |
| ACUTE CARE INC | |||||
| PO BOX 4130 | DES MOINES | IA | 50333 | ER Physician Staff | 239456 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Contractors GT100 K | 115500 | NumberOfContractorsGT100K |
| Government Grants | 32959 | GovernmentGrants |
| All Other Contributions | 555797 | AllOtherContributions |
| Total Contributions | 588756 | TotalContributions |
Program Service Revenue ProgramServiceRevenue (5 entries)
| DescriptionDescription | Business CodeBusinessCode | Total Revenue ColumnTotalRevenueColumn | Related Or Exempt Function IncomeRelatedOrExemptFunctionIncome | Unrelated Business RevenueUnrelatedBusinessRevenue |
|---|---|---|---|---|
| outpatient and inpatient | 900099 | 17024813 | 17024813 | |
| other supporting revenue | 900099 | 671847 | 671847 | |
| nursing home | 623000 | 2712540 | 2712540 | |
| massage therapy | 900099 | 64395 | 64395 | |
| assisted and independent | 623990 | 1262074 | 1262074 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | 21735669 | TotalProgramServiceRevenue |
Investment Income InvestmentIncome
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 115927 | TotalRevenueColumn |
| Exclusion | $115,927 | ExclusionAmount |
Income From Invest Bond Proceeds IncomeFromInvestBondProceeds
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 0 | TotalRevenueColumn |
Royalties Revenue RoyaltiesRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 0 | TotalRevenueColumn |
Gross Rents GrossRents
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | 307281 | Real |
Rental Income Or Loss RentalIncomeOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | 307281 | Real |
Net Rental Income Or Loss NetRentalIncomeOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 307281 | TotalRevenueColumn |
| Exclusion | $307,281 | ExclusionAmount |
Net Gain Or Loss Investments NetGainOrLossInvestments
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 0 | TotalRevenueColumn |
Net Income From Fundraising Events NetIncomeFromFundraisingEvents
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 0 | TotalRevenueColumn |
Net Income From Gaming NetIncomeFromGaming
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 0 | TotalRevenueColumn |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Sales Of Inventory | 354441 | GrossSalesOfInventory |
| Cost Of Goods Sold | 280958 | CostOfGoodsSold |
Net Income Or Loss NetIncomeOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 73483 | TotalRevenueColumn |
| Unrelated Business Revenue | 73483 | UnrelatedBusinessRevenue |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Other Revenue | 0 | TotalOtherRevenue |
Total Revenue TotalRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 22821116 | TotalRevenueColumn |
| Related Or Exempt Function Income | 21671274 | RelatedOrExemptFunctionIncome |
| Unrelated Business Revenue | 137878 | UnrelatedBusinessRevenue |
| Exclusion | $423,208 | ExclusionAmount |
Grants To Domestic Orgs GrantsToDomesticOrgs
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 21554 | Total |
| Program Services | 21554 | ProgramServices |
Grants To Domestic Individuals GrantsToDomesticIndividuals
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 22420 | Total |
| Program Services | 22420 | ProgramServices |
Foreign Grants ForeignGrants
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Benefits To Members BenefitsToMembers
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Comp Current Officers Directors CompCurrentOfficersDirectors
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 256378 | Total |
| Program Services | 224818 | ProgramServices |
| Management And General | 31560 | ManagementAndGeneral |
Comp Disqual Persons CompDisqualPersons
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Other Salaries And Wages OtherSalariesAndWages
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 10105642 | Total |
| Program Services | 9001284 | ProgramServices |
| Management And General | 1104358 | ManagementAndGeneral |
Pension Plan Contributions PensionPlanContributions
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 136145 | Total |
| Program Services | 115580 | ProgramServices |
| Management And General | 20565 | ManagementAndGeneral |
Other Employee Benefits OtherEmployeeBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1042562 | Total |
| Program Services | 879651 | ProgramServices |
| Management And General | 162911 | ManagementAndGeneral |
Payroll Taxes PayrollTaxes
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 664696 | Total |
| Program Services | 586330 | ProgramServices |
| Management And General | 78366 | ManagementAndGeneral |
Fees For Services Management FeesForServicesManagement
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Fees For Services Legal FeesForServicesLegal
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 4675 | Total |
| Management And General | 4675 | ManagementAndGeneral |
Fees For Services Accounting FeesForServicesAccounting
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 104168 | Total |
| Management And General | 104168 | ManagementAndGeneral |
Fees For Services Lobbying FeesForServicesLobbying
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Fees For Services Prof Fundraising FeesForServicesProfFundraising
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Fees For Services Invst Mgmnt Fees FeesForServicesInvstMgmntFees
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Fees For Services Other FeesForServicesOther
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1729281 | Total |
| Program Services | 1413159 | ProgramServices |
| Management And General | 316122 | ManagementAndGeneral |
Advertising Advertising
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 158131 | Total |
| Program Services | 35664 | ProgramServices |
| Management And General | 122467 | ManagementAndGeneral |
Office Expenses OfficeExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 175606 | Total |
| Program Services | 139843 | ProgramServices |
| Management And General | 35763 | ManagementAndGeneral |
Information Technology InformationTechnology
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Royalties Royalties
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Occupancy Occupancy
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 886965 | Total |
| Program Services | 886965 | ProgramServices |
Travel Travel
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 22813 | Total |
| Program Services | 18363 | ProgramServices |
| Management And General | 4450 | ManagementAndGeneral |
Travel Entrtnmnt Public Officials TravelEntrtnmntPublicOfficials
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Conferences Meetings ConferencesMeetings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 29361 | Total |
| Program Services | 19678 | ProgramServices |
| Management And General | 9683 | ManagementAndGeneral |
Interest Interest
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 301783 | Total |
| Program Services | 301783 | ProgramServices |
Payments To Affiliates PaymentsToAffiliates
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Depreciation Depletion DepreciationDepletion
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1006517 | Total |
| Program Services | 1006517 | ProgramServices |
Insurance Insurance
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 133000 | Total |
| Management And General | 133000 | ManagementAndGeneral |
Other Expenses OtherExpenses (5 entries)
| DescriptionDescription | TotalTotal | Program ServicesProgramServices | Management And GeneralManagementAndGeneral |
|---|---|---|---|
| SUPPLIES | 2268849 | 2196044 | 72805 |
| REPAIRS AND MAINTENANCE | 188141 | 188141 | |
| medicaid assesment | 182347 | 182347 | |
| Drugs | 1503998 | 1503998 | |
| Bad debt | 930094 | 930094 |
All Other Expenses AllOtherExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 388954 | Total |
| Program Services | 153473 | ProgramServices |
| Management And General | 146276 | ManagementAndGeneral |
| Fundraising | 89205 | Fundraising |
Total Functional Expenses TotalFunctionalExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 22264080 | Total |
| Program Services | 19645359 | ProgramServices |
| Management And General | 2529516 | ManagementAndGeneral |
| Fundraising | 89205 | Fundraising |
Cash Non Interest Bearing CashNonInterestBearing
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | 0 | EOY |
Savings And Temp Cash Investments SavingsAndTempCashInvestments
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 2370902 | BOY |
| EOY | 2567410 | EOY |
Pledges And Grants Receivable PledgesAndGrantsReceivable
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | 356123 | EOY |
Accounts Receivable AccountsReceivable
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 3222833 | BOY |
| EOY | 2916276 | EOY |
Receivables From Officers Etc ReceivablesFromOfficersEtc
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 27310 | BOY |
| EOY | 34811 | EOY |
Receivables From Disqual Persons ReceivablesFromDisqualPersons
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 97096 | BOY |
| EOY | 111677 | EOY |
Other Notes Loans Receivable Net OtherNotesLoansReceivableNet
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | 0 | EOY |
Inventories For Sale Or Use InventoriesForSaleOrUse
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1029534 | BOY |
| EOY | 778367 | EOY |
Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 244615 | BOY |
| EOY | 190191 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Buildings Equipment Basis | 31289176 | LandBuildingsEquipmentBasis |
| Land Bldg Equipment Accum Deprec | 20191726 | LandBldgEquipmentAccumDeprec |
Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 10125893 | BOY |
| EOY | 11097450 | EOY |
Investments Pub Traded Securities InvestmentsPubTradedSecurities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1053874 | BOY |
| EOY | 1541118 | EOY |
Investments Other Securities InvestmentsOtherSecurities
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | 0 | EOY |
Investments Program Related InvestmentsProgramRelated
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | 0 | EOY |
Intangible Assets IntangibleAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | 0 | EOY |
Other Assets Total OtherAssetsTotal
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 812443 | BOY |
| EOY | 683164 | EOY |
Total Assets TotalAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 18984500 | BOY |
| EOY | 20276587 | EOY |
Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1612189 | BOY |
| EOY | 2125875 | EOY |
Deferred Revenue DeferredRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 338833 | BOY |
| EOY | 364053 | EOY |
Loans From Officers Directors LoansFromOfficersDirectors
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 33328 | BOY |
Mort Notes Pybl Secured Invest Prop MortNotesPyblSecuredInvestProp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 4458237 | BOY |
| EOY | 5008881 | EOY |
Other Liabilities OtherLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1527366 | BOY |
| EOY | 1023648 | EOY |
Total Liabilities TotalLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 7969953 | BOY |
| EOY | 8522457 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Follow SFAS117 | X | FollowSFAS117 |
Unrestricted Net Assets UnrestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 11014293 | BOY |
| EOY | 11244630 | EOY |
Temporarily Restricted Net Assets TemporarilyRestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 254 | BOY |
| EOY | 509500 | EOY |
Total Net Assets Fund Balances TotalNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 11014547 | BOY |
| EOY | 11754130 | EOY |
Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 18984500 | BOY |
| EOY | 20276587 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Method Of Accounting Accrual | X | MethodOfAccountingAccrual |
| Accountant Compile Or Review | false | AccountantCompileOrReview |
| FS Audited | true | FSAudited |
| Audit Committee | true | AuditCommittee |
| Financial Statement Consolidated | X | FinancialStatementConsolidated |
| Federal Grant Audit Required | false | FederalGrantAuditRequired |
| Federal Grant Audit Performed | false | FederalGrantAuditPerformed |
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
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 | 14852957 | OtherCostOrOtherBasis |
| Depreciation | 6332245 | Depreciation |
| Book Value | 8520712 | BookValue |
Equipment Equipment
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 15262837 | OtherCostOrOtherBasis |
| Depreciation | 13548336 | Depreciation |
| Book Value | 1714501 | BookValue |
Other Land Buildings OtherLandBuildings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 509919 | OtherCostOrOtherBasis |
| Depreciation | 311145 | Depreciation |
| Book Value | 198774 | BookValue |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Book Value Land Buildings | 11097450 | TotalOfBookValueLandBuildings |
Other Liabilities OtherLiabilities (4 entries)
| DescriptionDescription | AmountAmount |
|---|---|
| Estimated Third Party Payor Settlement | $419,480 |
| capitalized lease obligations | $348,698 |
| asbestos accretion liability | $230,470 |
| accrued professional liability | $25,000 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Amounts | 1023648 | TotalOfAmounts |
Form990 Schedule D Part XIV Form990ScheduleDPartXIV (2 entries)
| IdentifierIdentifier | Return ReferenceReturnReference | ExplanationExplanation |
|---|---|---|
| Part X | Part X : FIN48 Footnote | THE ORGANIZATION ADOPTED THE PROVISIONS OF FASB INTERPRETATION N 48 (FIN 48) ACCOUNTING FOR UNCERTAINTY IN INCOME TAXES, ON JULY 1, 2007. UPON THE ADOPTION OF FIN 48 ON JULY 1, 2007 AND AS OF JUNE 30, 2010 AND 2009, THERE WERE NO UNCERTAIN TAX BENEFITS RELATED TO UNCERTAIN TAX POSITIONS IDENTIFIED AND RECORDED AS A LIABILITY. |
| Part XI, Line 8 | Part XI, Line 8: Other Changes in Net Assets or Fund Balances | change in fair value interest rate swap, net of settlements $59470 |
Schedule H IRS990ScheduleH
| Field | Value | IRS element (for citing) |
|---|---|---|
| Charity Care Policy | true | CharityCarePolicy |
| Written Policy | true | WrittenPolicy |
| FPG Reference Free Care | false | FPGReferenceFreeCare |
| FPG Reference Discounted Care | true | FPGReferenceDiscountedCare |
| Pcent300 | X | Pcent300 |
| Free Disc Care Medically Indigent | true | FreeDiscCareMedicallyIndigent |
| Amounts Budgeted For Charity Care | true | AmountsBudgetedForCharityCare |
| Expenses Exceeded Budget | true | ExpensesExceededBudget |
| Unable To Provide Care | false | UnableToProvideCare |
| Annual Community Benefit Report | false | AnnualCommunityBenefitReport |
| Report Publically Available | false | ReportPublicallyAvailable |
Charity Care At Cost CharityCareAtCost
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 446031 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 446031 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.02000 | PercentOfTotalExpense |
Unreimbursed Medicaid UnreimbursedMedicaid
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 1141094 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 558150 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 582944 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.02620 | PercentOfTotalExpense |
Total Charity Care TotalCharityCare
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 1587125 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 558150 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 1028975 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.04620 | PercentOfTotalExpense |
Community Health Services CommunityHealthServices
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 980316 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 2417 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 977899 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.04390 | PercentOfTotalExpense |
Total Other Benefits TotalOtherBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 980316 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 2417 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 977899 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.04390 | PercentOfTotalExpense |
Total Community Benefits TotalCommunityBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 2567441 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 560567 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 2006874 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.09010 | PercentOfTotalExpense |
Community Support CommunitySupport
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Activities Or Programs | 12 | NumberOfActivitiesOrPrograms |
| Persons Served | 2104 | PersonsServed |
| Total Community Building Expense | 10018 | TotalCommunityBuildingExpense |
| Direct Offsetting Revenue | 2417 | DirectOffsettingRevenue |
| Net Community Building Expense | 7601 | NetCommunityBuildingExpense |
| Percent Of Total Expense | 0.00030 | PercentOfTotalExpense |
Total Total
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Activities Or Programs | 12 | NumberOfActivitiesOrPrograms |
| Persons Served | 2104 | PersonsServed |
| Total Community Building Expense | 10018 | TotalCommunityBuildingExpense |
| Direct Offsetting Revenue | 2417 | DirectOffsettingRevenue |
| Net Community Building Expense | 7601 | NetCommunityBuildingExpense |
| Percent Of Total Expense | 0.00030 | PercentOfTotalExpense |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | true | BadDebtExpenseReported |
| Bad Debt Expense | $437,051 | BadDebtExpenseAmount |
| Amount Reimbursed By Medicare | 7011781 | AmountReimbursedByMedicare |
| Cost Of Care Reimbursed By Medicare | 6942357 | CostOfCareReimbursedByMedicare |
| Medicare Surplus Or Shortfall | 69424 | MedicareSurplusOrShortfall |
Costing Methodology Used CostingMethodologyUsed
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | X | Other |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Written Debt Collection Policy | true | WrittenDebtCollectionPolicy |
| Provision For Charity Care | true | ProvisionForCharityCare |
Form990 Schedule H Part V Form990ScheduleHPartV (8 entries)
| Address Line1Address/AddressLine1 | CityAddress/City | StateAddress/State | ZIP CodeAddress/ZIPCode | OtherOther | Licensed HospitalLicensedHospital | General Medical And SurgicalGeneralMedicalAndSurgical | Critical Access HospitalCriticalAccessHospital | Er24 HoursEr24Hours |
|---|---|---|---|---|---|---|---|---|
| MANITO DOCTORS OFFICE | ||||||||
| 101 E MASON | MANITO | IL | 61546 | OUTPATIENT PHYSICIAN CLINIC | ||||
| MACKINAW DOCTORSS OFFICE | ||||||||
| 407 S ORCHARD STREET | MACKINAW | IL | 61755 | OUTPATIENT PHYSICIAN CLINIC | ||||
| ATLANTA DOCTORS OFFICE | ||||||||
| 108 SW ARCH STREET | ATLANTA | IL | 61723 | OUTPATIENT PHYSICIAN CLINIC | ||||
| DELAVAN DOCTORS OFFICE | ||||||||
| 115 E 4TH STREET | DELAVAN | IL | 61734 | OUTPATIENT PHYSICIAN CLINIC | ||||
| MEDICAL ARTS PHYSICIAN BUILDIN | ||||||||
| 107 TREMONT STREET | HOPEDALE | IL | 61747 | OUTPATIENT PHYSICIAN CLINIC | ||||
| HOPEDALE COMMONS | ||||||||
| 211 221 SW RAILROAD STREET | HOPEDALE | IL | 61747 | ASSISTED AND INDEPENDENT LIVING | ||||
| HOPEDALE NURSING HOME | ||||||||
| 111 TREMONT STREET | HOPEDALE | IL | 61747 | NURSING HOME | ||||
| HOPEDALE MEDICAL COMPLEX | ||||||||
| PO BOX 267 | HOPEDALE | IL | 61747 | X | X | X | X | |
Form990 Schedule H Part VI Form990ScheduleHPartVI
| Field | Value | IRS element (for citing) |
|---|---|---|
| Income Based Criteria | Hopedale Medical Foundation uses the Federal Poverty Guideline to determine Charity Care. The Foundation's charges were also compared to other hospitals in the market area, and we found our charge structure to be lower than the median for most procedures. | IncomeBasedCriteria |
| Annual Community Benefit Expln | Hopedale Medical Foundation commits significant time and resources to endeavors and critical services which meet otherwise unfulfilled community needs. The Foundation also plans to prepare a community benefit report in the later half of calendar 2011. | AnnualCommunityBenefitExpln |
| Bad Debt Footnote | From Notes to Financial Statements, Patient and Resident Receivables, " The carrying amount of patient and resident receivables is reduced by a valuation allowance that reflects management's estimate of amounts that will not be collected from patients, residents and third-party payors. Management reviews patient and resident receivables by payor class and applies percentages to determine estimated amounts that will not be collected from third parties under contractual agreements and amounts that will not be collected from patients and residents due to bad debts. Management considers historical write off and recovery information in determining the estimated bad debt provision. Management also reviews accounts to determine if classification as charity care is appropriate." | BadDebtFootnote |
| Debt Collection Policy | Reference is made in both the Bad Debt Policy and the Community Care Policy to the Community Care application process. | DebtCollectionPolicy |
| General Explanation | Part V Number 8 The Foundation is located in the middle of central Illinois; practically 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. | GeneralExplanation |
| Needs Assessment | 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. | NeedsAssessment |
| Patient Education Assistance | Signs and brochures are located in the registration and most other entrance areas. Staff in the Admissions and Patient Registation area are trained to recommend that patients meet our Patient Financial Counselor for an application and to discuss billing and collection procedures. | PatientEducationAssistance |
| Community Information | 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. The ages 45-65 compose 26.5% and age 65+ composes 15.5% of the area population. | CommunityInformation |
| Community Building Activities | Use Other Community Activities and Go Red for Women descriptions from Sched O, Form 990, Line 4D-Other Program Service Description | CommunityBuildingActivities |
| Other Information | The Foundation maintains a Wellness Center which has therapy and exercise pools, weight room and gymnasium areas, a lap track, exercise machines and meeting rooms. Weight-loss, nutrition counseling, chronic condition management sessions are held in the meeting rooms, as well as community organization meetings. Blood drives are regularly scheduled. | OtherInformation |
| Affiliated Health Care System | The Foundation is not part of an affiliated group. | AffiliatedHealthCareSystem |
| Reports Filed With States | IL | ReportsFiledWithStates |
Schedule I IRS990ScheduleI
| Field | Value | IRS element (for citing) |
|---|---|---|
| Records Maintained | true | RecordsMaintained |
| No Grant More Than5000 | X | NoGrantMoreThan5000 |
| Total Nbr Of501 C3 And Govt Grants | 0 | TotalNbrOf501C3AndGovtGrants |
| Total Nbr Of Other Organizations | 0 | TotalNbrOfOtherOrganizations |
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 | 24 | NumberOfRecipients |
| Amount Of Cash Grant | 22420 | AmountOfCashGrant |
Form990 Schedule I Part IV Form990ScheduleIPartIV
| Field | Value | IRS element (for citing) |
|---|---|---|
| Identifier | Grantmaker's Description of How Grants are Used | Identifier |
| Explanation | IN KEEPING WITH THE SUPPORT OF EDUCATION OF THE YOUTH IN THE AREA COMMUNITIES, AND ENCOURAGING THEM TO ENTER THE IMPORTANT FIELDS OF HEALTHCARE AND AGRICULTURE, HOPEDALE MEDICAL FOUNDATION AWARDS SCHOLARSHIPS TO HIGH SCHOOL STUDENTS AND COLLEGE FRESHMAN. HOPEDALE MEDICAL FOUNDAION 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 |
| Written Employment Contract | X | WrittenEmploymentContract |
| Compensation Survey | X | CompensationSurvey |
| Board Or Committee Approval | X | BoardOrCommitteeApproval |
| Severance Payment | false | SeverancePayment |
| Supplemental Nonqual Retire Plan | false | SupplementalNonqualRetirePlan |
| Equity Based Comp Arrangement | false | EquityBasedCompArrangement |
| Comp Based On Revenue Of Filing Org | false | CompBasedOnRevenueOfFilingOrg |
| Comp Based On Revenue Related Orgs | false | CompBasedOnRevenueRelatedOrgs |
| Comp Based Net Earnings Filing Org | false | CompBasedNetEarningsFilingOrg |
| Comp Based Net Earnings Relate Orgs | false | CompBasedNetEarningsRelateOrgs |
| Any Non Fixed Payments | false | AnyNonFixedPayments |
| Initial Contract Exception | false | InitialContractException |
| Rebuttable Presumption Procedure | false | RebuttablePresumptionProcedure |
Form990 Schedule J Part II Form990ScheduleJPartII
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Person | Mark F Rossi | NamePerson |
| Base Compensation Filing Org | 165181 | BaseCompensationFilingOrg |
| Deferred Comp Filing Org | 4955 | DeferredCompFilingOrg |
| Total Compensation Filing Org | 170136 | TotalCompensationFilingOrg |
| Comp Report Prior990 Filing Org | 164972 | CompReportPrior990FilingOrg |
Schedule L IRS990ScheduleL
Loan Table LoanTable (5 entries)
| Purpose Of LoanPurposeOfLoan | Loan From OrganizationLoanFromOrganization | Balance DueBalanceDue | DefaultDefault | Approved By BoardApprovedByBoard | Written AgreementWrittenAgreement | Original PrincipalOriginalPrincipalAmount |
|---|---|---|---|---|---|---|
| DR AL ROSSI | ||||||
| PHYSICIAN RENT RECEIVABLE | X | 13988 | false | true | true | |
| DR LARRY ROSSI | ||||||
| PHYSICIAN RENT RECEIVABLE | X | 10100 | false | true | false | |
| DR MATT ROSSI | ||||||
| PHYSICIAN RENT RECEIVABLE | X | 20823 | false | true | true | |
| DR JOSEPH ROSSI | ||||||
| LOAN TO REPAY RURAL IMSE PROGRAM | X | 32118 | false | true | true | $32,492 |
| DR PETER ROSSI | ||||||
| LOAN TO OPEN THE DELAVAN OFFICE | X | 55340 | false | true | true | $195,003 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Balance Due | 132369 | TotalBalanceDue |
Form990 Schedule L Part IV Form990ScheduleLPartIV (6 entries)
| RelationshipRelationship | Amount Of TransactionAmountOfTransaction | Description Of TransactionDescriptionOfTransaction | Sharing Of RevenuesSharingOfRevenues |
|---|---|---|---|
| TRI COUNTY ANESTHESIA | |||
| LARRY BRO TO MARK | 122100 | CONTRACTED ER SERVICES | false |
| LARRY NOREUIL | |||
| BRO IN LAW MARK F | 57257 | COMPENSATION | false |
| CYNTHIA NOREUIL | |||
| SIS MARK F ROSSI | 48658 | COMPENSATION | false |
| LISA MCLAUGHLIN | |||
| SIS MARK F ROSSI | 43242 | COMPENSATION | false |
| DR MATT ROSSI | |||
| BRO MARK F ROSSI | 12480 | COMPENSATION | false |
| DR PHILIP ROSSI | |||
| BR TO MARK F ROSSI | 13440 | COMPENSATION | false |
Schedule M IRS990ScheduleM
Securities Publicly Traded SecuritiesPubliclyTraded
| Field | Value | IRS element (for citing) |
|---|---|---|
| Non Cash Checkbox | X | NonCashCheckbox |
| Number Of Contributions | 1 | NumberOfContributions |
| Noncash Contribs Rptd F990 | 14150 | NoncashContribsRptdF990 |
Real Estate Other RealEstateOther
| Field | Value | IRS element (for citing) |
|---|---|---|
| Non Cash Checkbox | X | NonCashCheckbox |
| Number Of Contributions | 1 | NumberOfContributions |
| Noncash Contribs Rptd F990 | 28000 | NoncashContribsRptdF990 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Any Property That Must Be Held | false | AnyPropertyThatMustBeHeld |
| Review Process Unusual NC Gifts | false | ReviewProcessUnusualNCGifts |
| Third Parties Used | false | ThirdPartiesUsed |
Schedule O IRS990ScheduleO
General Explanation GeneralExplanation (7 entries)
| IdentifierIdentifier | Return ReferenceReturnReference | ExplanationExplanation |
|---|---|---|
| Form 990, Part VI, Line 19 | Form 990, Part VI, Line 19: Other Organization Documents Publicly Available | AVAILABLE UPON REQUEST |
| Form 990, Part VI, Line 12c | Form 990, Part VI, Line 12c: Explanation of Monitoring and Enforcement of Conflicts | 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 OR 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, Line 11 | Form 990, Part VI, Line 11: Form 990 Review Process | THE ORGANIZATION'S CFO AND CONTROLLER REVIEW THE FORM 990 PRIOR TO THE BOARD REVIEWING THE FORM 990. THE BOARD APPROVES THE FINAL DRAFT OF THE FORM 990 BEFORE IT IS SUBMITTED. |
| Form 990, Part VI, Line 7a | Form 990, Part VI, Line 7a: How Members or Shareholders Elect Governing Body | THE SOLE MEMBER, HOPEDALE RURAL HEALTH ASSOCIATION, HAS THE POWER TO ELECT OR REMOVE, WITH OR WITHOUT CAUSE, MEMBERS OF THE BOARD OF DIRECTORS OF THE FOUNDATION. IN ALL ELECTIONS OF DIRECTORS, EVERY MEMBER ENTITLED TO VOTE HAS THE RIGHT TO CUMULATE HIS VOTE AND TO GIVE ONE CANDIDATE A NUMBER OF VOTES EQUAL TO HIS VOTE MULTIPLIED BY THE NUMBER OF DIRECTORS TO BE ELECTED OR TO DISTRIBUTE THE VOTES, ON THE SAME PRINCIPLE, AMONG AS MANY CANDIDATES AS HE SEES FIT. |
| Form 990, Part VI, Line 6 | Form 990, Part VI, Line 6: Explanation of Classes of Members or Shareholder | THE SOLE MEMBER OF HOPEDALE MEDICAL FOUNDATION IS HOPEDALE RURAL HEALTH ASSOCIATION, INC. IN ADDITION, THE ORGANIZATION HAS TWO CLASSES OF MEMBERS, VOTING MEMBERS AND HONORARY MEMBERS. THE VOTING MEMBERS ARE ENTITLED TO A VOTE ON EACH MATTER, HONORARY MEMBERS HAVE NO VOTING RIGHTS. |
| Form 990, Part VI, Line 2 | Form 990, Part VI, Line 2: Description of Business or Family Relationship of Officers, Directors, Et | CHAIRMAN OF THE BOARD, MARK F ROSSI, COO, MATTHEW B ROSSI, SECRETARY/TREASURER OF THE BOARD, AND MICHAEL MCLAUGHLIN, BOARD MEMBER, ALL HAVE A FAMILY RELATIONSHIP. |
| Form 990, Part III, Line 4d | Form 990, Part III, Line 4d : Other Program Services Description | OTHER PROGRAM SERVICES 4: HOPEDALE COMMONS IS AN 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. |
Schedule R IRS990ScheduleR
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 | Direct Controlling Entity NADirectControllingEntityNA |
|---|---|---|---|---|---|---|---|---|---|
| HOPEDALE RURAL ASSOCIATION INC | |||||||||
| PO BOX 267 | HOPEDALE | IL | 61747 | 371390105 | SUPPORT HEALTHCARE, EDUCATION AND RESEARCH | IL | 501(C)(3) | pf | N/A |
| PRAIRIE HEALTH SERVICES INC | |||||||||
| PO BOX 267 | HOPEDALE | IL | 61747 | 371390103 | PROMOTE PUBLIC HEALTH AND WELFARE | IL | 501(C)(3) | Pf | 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 NA | N/A | DirectControllingEntityNA |
| Type Of Entity | C Corp | TypeOfEntity |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Ann Rents Royalties | false | ReceiptOfIntAnnRentsRoyalties |
| Gift Grant Or Cap Contr To Other Org | false | GiftGrantOrCapContrToOtherOrg |
| Gift Grant Or Cap Contr Fr Other Org | false | GiftGrantOrCapContrFrOtherOrg |
| Loans Or Guarantees To Other Org | false | LoansOrGuaranteesToOtherOrg |
| Loans Or Guarantees From Other Org | false | LoansOrGuaranteesFromOtherOrg |
| Sale Of Assets To Other Org | false | SaleOfAssetsToOtherOrg |
| Purchase Of Assets From Other Org | false | PurchaseOfAssetsFromOtherOrg |
| Exchange Of Assets | false | ExchangeOfAssets |
| Rental Of Facilities To Other Orgs | false | RentalOfFacilitiesToOtherOrgs |
| Rental Of Facilities Fr Other Orgs | false | RentalOfFacilitiesFrOtherOrgs |
| Perform Of Services For Other Orgs | false | PerformOfServicesForOtherOrgs |
| Perform Of Services By Other Orgs | false | PerformOfServicesByOtherOrgs |
| Sharing Of Facilities | true | SharingOfFacilities |
| Sharing Of Paid Employees | true | SharingOfPaidEmployees |
| Reimbursement Paid To Other Org | false | ReimbursementPaidToOtherOrg |
| Reimbursement Paid By Other Org | false | ReimbursementPaidByOtherOrg |
| Other Transfer To Other Org | false | OtherTransferToOtherOrg |
| Other Transfer From Other Org | false | OtherTransferFromOtherOrg |
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