2011-10-19T07:26:13-07:00 2010-06-30 Gordon Stockman & Waugh PC 8726 N Industrial Rd Peoria IL 61615 990 2009-07-01 370808925 The Hopedale Medical Foundation DBA Hopedale medical complex HOPE 3094494298 PO Box 267 Hopedale IL 61747 Mark F Rossi 2011-10-19 Matt Waugh 3096924030 2009 2016-03-07 17:11:31Z Mark F Rossi PO Box 267 Hopedale IL 61747 23102074 false false X www.hopedalemc.com X 1989 IL MAINTAIN A MEDICAL COMPLEX THAT INCLUDES AN ACUTE CARE HOSPITAL AND HEALTH CARE FACILITY 8 4 440 56 137878 94198 588756 23340904 21735669 120157 115927 661281 380764 24216540 22821116 43948 43974 0 12040168 12205423 0 89205 10395096 10014683 22479212 22264080 1737328 557036 18984500 20276587 7969953 8522457 11014547 11754130 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. false false 17232288 43974 18391218 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 1580927 2712540 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. 832144 1262074 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. 19645359 true true false false false false false false false false true false true false false false false false false false false true true true true false false false false false false true false true true false true false false false false true false false false true 65 0 true 440 true true true false false false false false false false false false 0 false false false false false false false false 8 4 true false false false true true true true true false false false true true true true true true true false false false IL X X larry kloc 3094494375 107 Tremont Street Hopedale IL 61747 WENDY MOBLEY 40.00 X 106756 0 2928 TOM HIESER 2.00 X 0 0 0 MICHAEL MCLAUGHLIN 2.00 X 0 0 0 Mark F Rossi 40.00 X 165181 0 4955 LARRY KLOC 40.00 X 60288 0 0 JOHN ZANON 40.00 X 119768 0 3776 JOE SERANGELI 2.00 X 0 0 0 HENRY ALLEN 2.00 X 0 0 0 DR MATTHEW B ROSSI 2.00 X X 0 0 0 DR ALFRED ROSSI 2.00 X X 0 0 0 451993 11659 3 false true false 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 115500 32959 555797 588756 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 21735669 115927 115927 0 0 307281 307281 307281 307281 0 0 0 354441 280958 73483 73483 0 22821116 21671274 137878 423208 21554 21554 22420 22420 0 0 256378 224818 31560 0 10105642 9001284 1104358 136145 115580 20565 1042562 879651 162911 664696 586330 78366 0 4675 4675 104168 104168 0 0 0 1729281 1413159 316122 158131 35664 122467 175606 139843 35763 0 0 886965 886965 22813 18363 4450 0 29361 19678 9683 301783 301783 0 1006517 1006517 133000 133000 SUPPLIES 2268849 2196044 72805 REPAIRS AND MAINTENANCE 188141 188141 medicaid assesment 182347 182347 Drugs 1503998 1503998 Bad debt 930094 930094 388954 153473 146276 89205 22264080 19645359 2529516 89205 0 2370902 2567410 356123 3222833 2916276 27310 34811 97096 111677 0 1029534 778367 244615 190191 31289176 20191726 10125893 11097450 1053874 1541118 0 0 0 812443 683164 18984500 20276587 1612189 2125875 338833 364053 33328 4458237 5008881 1527366 1023648 7969953 8522457 X 11014293 11244630 254 509500 11014547 11754130 18984500 20276587 X false true true X false false X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 663463 663463 14852957 6332245 8520712 15262837 13548336 1714501 509919 311145 198774 11097450 Estimated Third Party Payor Settlement 419480 capitalized lease obligations 348698 asbestos accretion liability 230470 accrued professional liability 25000 1023648 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 true true false true X true true true false false false 446031 446031 0.02000 1141094 558150 582944 0.02620 1587125 558150 1028975 0.04620 980316 2417 977899 0.04390 980316 2417 977899 0.04390 2567441 560567 2006874 0.09010 12 2104 10018 2417 7601 0.00030 12 2104 10018 2417 7601 0.00030 true 437051 7011781 6942357 69424 X true true 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 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. 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. 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." Reference is made in both the Bad Debt Policy and the Community Care Policy to the Community Care application process. 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. 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. 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. 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. Use Other Community Activities and Go Red for Women descriptions from Sched O, Form 990, Line 4D-Other Program Service Description 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. The Foundation is not part of an affiliated group. IL true X 0 0 SCHOLARSHIPS FOR STUDENTS ENTERING FIELDS OF HEALTHCARE & AG 24 22420 Grantmaker's Description of How Grants are Used 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. X X X X false false false false false false false false false false Mark F Rossi 165181 4955 170136 164972 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 32492 32118 false true true DR PETER ROSSI LOAN TO OPEN THE DELAVAN OFFICE X 195003 55340 false true true 132369 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 X 1 14150 X 1 28000 false false false 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. 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 HOPEDALE REAL ESTATE SERVICES INC 107 TREMONT STREET HOPEDALE IL 61747 371406582 PROPERTY RENTAL IL N/A C Corp false false false false false false false false false false false false true true false false false false