2011-02-10T13:00:10-06:00 2010-09-30 ECK SCHAFER & PUNKE LLP 600 East Adams Street Springfield IL 627011624 990 2009-10-01 363637465 HOOPESTON COMMUNITY MEMORIAL HOSPITAL HOOP 2172835531 701 E ORANGE STREET HOOPESTON IL 60942 RUSS LEIGH 2172835531 2011-02-08 1 Brent Leach 2175251111 2009 2016-02-24 21:20:13Z RUSS LEIGH 701 E ORANGE STREET HOOPESTON IL 60942 21274943 0 X www.hoopestonhospital.org X 1962 IL PROVIDE ACUTE AND SKILLED NURSING CARE FOR RESIDENTS OF HOOPESTON AND THE SURROUNDING AREAS. 11 11 306 12 21426 864 25914 1005 20661037 21077296 105834 110256 71557 86386 20864342 21274943 0 0 8579214 9918245 0 0 10353834 11304574 18933048 21222819 1931294 52124 17000329 17546086 11230704 11684286 5769625 5861800 PROVIDE ACUTE AND SKILLED NURSING CARE FOR RESIDENTS OF HOOPESTON AND THE SURROUNDING AREAS. 0 0 16748640 21077296 PROVIDE ACUTE INPATIENT AND OUTPATIENT HEALTHCARE SERVICES AND LONG TERM HEALTH CARE SERVICES 16748640 1 0 0 0 0 0 0 0 0 1 1 0 0 0 0 0 0 0 0 0 1 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 30 0 1 306 1 1 1 0 0 0 0 0 0 11 11 1 1 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 0 IL X KEN FOZDAR CONTROLLER 2172835531 701 E ORANGE HOOPESTON IL 60942 X RUSS LEIGH 1.00 X X 0 0 0 RICHARD READ 1.00 X X 0 0 0 LYNN GALLOWAY 1.00 X X 0 0 0 KARLA COON 1.00 X 0 0 0 LONI GRESS 1.00 X 0 0 0 TODD HARRIS 1.00 X 0 0 0 GREG LANE 1.00 X 0 0 0 ED LAYDEN JR 1.00 X 0 0 0 DAVE MCFADDEN 1.00 X 0 0 0 HANK HORNBECK 1.00 X 0 0 0 ANGELA TOTHEROH 1.00 X 0 0 0 JAY COLBERT MD 40.00 X 229146 0 0 DR HILARY FRESCOLN 20.00 X 113599 0 0 DENNIS PRICE 40.00 X 155983 0 0 498728 0 0 3 0 1 0 HOOPESTON ER MEDICAL SPECIALISTS 810 QUAIL RIDGE DRIVE WESTMONT IL 60559 ER & HOSPITALIST DOCTORS 1005150 CARLE FOUNDATION HOSPITAL 611 W PARK STREET URBANA IL 61801 REHAB PT, OT ST LABORATORY, RADIOLOGY RE 898953 QUORUM HEALTH RESOURCES 105 CONTINENTAL PLACE BRENTWOOOD TN 37027 HEALTHCARE MANAGEMENT SERVICES 807068 SIGHTPATH MEDICAL 5775 W OLD SHAKOPEE ROAD SUITE 90 BLOOMINGTON MN 55437 MEDICAL/SURGICAL SUPPLIES 447661 FARNSWORTH GROUP PO BOX 843219 KANSAS CITY MO 64184 ENGINEERING/ARCHITECTURAL 447099 23 1005 1005 NET PATIENT SERVICES 621990 20405006 20405006 OTHER 900099 672290 672290 21077296 110256 110256 15594 15594 15594 15594 CAFETERIA 722320 70792 21426 49366 70792 21274943 21077296 21426 175216 8167946 6611800 1556146 57866 46841 11025 1115191 862876 252315 577242 465032 112210 444575 444575 20707 20707 76931 76931 1870265 1870265 254202 232933 21269 1832583 960935 871648 207914 207914 70297 48565 21732 42438 34463 7975 579702 457490 122212 788422 622207 166215 310651 282640 28011 DRUGS AND OTHER SUPPLIE 2423975 2297594 126381 BAD DEBTS 1577812 1577812 PURCHASED SERVICES/PROF 804100 377187 426913 21222819 16748640 4474179 0 776428 1749598 2190787 217051 232022 52344 53597 15910498 6749195 8456950 9161303 2015894 1678639 3732064 4229738 17000329 17546086 2039889 2880764 8965498 8551776 225317 251746 11230704 11684286 X 2262812 2314936 3506813 3546864 5769625 5861800 17000329 17546086 X 0 1 1 X 0 X 10318754 3684698 6634056 4243011 2911357 1331654 1348733 153140 1195593 9161303 INVESTMENTS LIMITED TO USE 1678639 F 1678639 BENEFICIAL INTEREST IN PERPETUAL TRUST 3546864 DEFERRED FINANCING COSTS 370759 ESTIMATED AMOUNTS DUE FROM THIRD-PARTY PAYERS 312115 4229738 ASSET RETIREMENT OBLIGATION 129313 CASH OVERDRAFT 122433 251746 21274943 21222819 52124 40051 40051 92175 21274943 0 21274943 0 21274943 21222819 0 21222819 0 21222819 Part X: Description of Uncertain Tax Positions Under FIN 48: Effective October 1, 2009, the Center adopted the new requirements related to the accounting for uncertainty in income taxes (as initially required by Financial Accounting Standards Board Financial Interpretation No. 48 and subsequently superseded by Accounting Standards Codification 740). This guidance sets a minimum threshold for financial statement recognition of the benefit of a tax position taken or expected to be taken in a tax return. Tax positions for the open tax years as of Septemeber 30, 2010 were reviewed, and it was determined that no provision for uncertain tax positions is required. Part XI, Line 8 - Other Adjustments: CHANGE IN VALUATION OF PERMANENTLY RESTRICTED NET ASSET 1 1 1 X 125.000000000000 1 X 1 1 1 0 0 669 712735 712735 0.03630 669 712735 712735 0.03630 17884 1370 16514 0.00080 17884 1370 16514 0.00080 669 730619 1370 729249 0.03710 1 1577812 419033 5315455 5557396 -241941 X 1 1 Quorum Health Resources Management and Consulting 0.00000 0.00000 0.00000 HOOPESTON COMMUNITY MEMORIAL HOSPITAL

701 E ORANGE HOOPESTON IL 60942

X X X X HOOPESTON COM MEMORIAL NURSING HOM

701 E ORANGE HOOPESTON IL 60942

LONG TERM CARE/NURSING HOME COUNTRY TERRACE INDEPENDENT LIVING APART

705 E ORANGE HOOPESTON IL 60942

SENIOR INDEPENDENT LIVING APTS BRIDGEWAY CLINIC

843 E ORANGE HOOPESTON IL 60942

MEDICAL CLINIC HOOPESTON BUSINESS OFFICE

847 E ORANGE HOOPESTON IL 60942

ACCTING, BO, HR, IT & MASSAGE THERAPY ROSSVILLE MEDICAL CLINIC

112 N CHICAGO ROSSVILLE IL 60963

MEDICAL CLINIC CISSNA PARK MEDICAL CLINIC

141 W GARFIELD CISSNA PARK IL 60924

MEDICAL CLINIC HOOPESTON AMBULANCE SERVICES

413 E MAIN HOOPESTON IL 60942

AMBULANCE SERVICES CHARLOTTE ANN RUSSELL MEDICAL CENTER

801 E ORANGE HOOPESTON IL 60942

MEDICAL CLINIC Part VI, Line 2: Hoopeston Regional Health Center assesses community needs on an annual basis through a publicly advertised state of the hospital meeting, where community residents are surveyed upon entry concerning the most significant health concerns they may have in our community today. Through these assessments the hospital has initiated the following programs over the past 2 years;1. Nurse to do head checks in the local school system. We provide this service for free2. Vision and hearing testing for all schools in the region. We provide this service for free.3. Athletic trainer to care for student athletes, specializing in concussion care. We provide this service for free.4. After hours care program. We have expanded our clinic hours until 8pm during the week and offer Saturday appointments.5. Hired a general surgeon for our community.6. Free diabetes education from our Registered Dietician. Classroom and individual counseling are offered.7. Future program developments will include aging and obesity.We perform a formal 3rd party assessment once every three years and will be completed again in 2012. All surveys and assessments are discussed at our annual strategic planning sessions with the community board of directors each September. Part VI, Line 3: Patients are educated on the financial assistance policies and availability in the following ways;1. Signs are posted at all areas of patient registration for services.2. Once a bill reaches 45 days past due, our internal financial staff calls and discusses needs with the individual. We then help determine if they are available for state Medicaid or if they qualify for charity care under our policy. If so, we assist them with the application process. Part VI, Line 4: Hoopeston Regional Health Center serves a zip code with 7,000 people. 6,000 of these people live in an urban environment while the remaining live in a rural environment. A vast majority of the people living in this area are of a white race. The estimated median household income in 2009 is $34,000. In 2009, 22% of the population have an income below the poverty line. Part VI, Line 5: The hospitals building program will enhance the healthcare of the community by providing easier access to services and a greater number of services to be provided locally;1. New Emergency Room to be complete in 20122. New Surgery Suite to be complete in 20123. New Clinic in Rossville, IL to be complete in 20114. Replacement Nursing Home facility to be complete in 2012 Part VI, Line 6: The hospital further health in the community by;1. Providing childrens activities throughout the year free of charge. Ie; Movie, pony rides, fireworks2. Maintains an open medical staff to encourage physician membership in our organization and provide choice for local patients3. 11 members community board serves on a volunteer basis 0 0 0 0 0 0 0 0 0 JAY COLBERT MD 229146 0 0 0 0 0 0 0 0 0 229146 0 0 0 DR HILARY FRESCOLN 113599 0 0 0 0 0 0 0 0 0 113599 0 0 0 DENNIS PRICE 155983 0 0 0 0 0 0 0 0 0 155983 0 0 0 Form 990, Part VI, Section A, line 2 Two board members, Karla Coon and Angela Totheroh, are step-mother and step-daughter. Form 990, Part VI, Section A, line 3 The CEO of the organization is employed by Quorum Health Resources. The organization negotiated a management contract with that Firm. Form 990, Part VI, Section B, line 11 Form 990 is prepared by our independent accountants and provided to the governing body prior to filing. Form 990, Part VI, Section B, line 12c Conflict of interest disclosure forms are annually completed by employees and board members. Form 990, Part VI, Section B, line 15 The CEO of the organization is employed by Quorum Health Resources. The organization negotiated a management contract with that Firm. There is currently no CFO. Form 990, Part VI, Section C, line 19 All documents available upon request.