2026-05-15T16:02:58-05:00 2025-06-30 410746749 CLIFTONLARSONALLEN LLP 600 WASHINGTON AVENUE SUITE 1800 ST LOUIS MO 63101 990 2024-07-01 370808925 THE HOPEDALE MEDICAL FOUNDATION HOPE 3094493321 107 TREMONT ST HOPEDALE IL 61747 EMILY WHITSON CHIEF OPERATING OFFICER 3094493321 2026-05-15 1 0 AMBER HAMILTON P01251012 3149254300 2026-05-15 2024 2025-03-06 01:10:19Z HOPEDALE MEDICAL COMPLEX EMILY WHITSON 107 TREMONT ST HOPEDALE IL 61747 52193868 0 X WWW.HOPEDALEMC.COM X 1961 IL TO PROVIDE OUTSTANDING PHYSICIAN-DIRECTED HEALTH, WELLNESS, & RESIDENTIAL SERVICES IN A PERSONAL, PRIVATE, FAMILY ATMOSPHERE. 10 6 435 50 2792325 0 12660 69938 37900158 50211554 1129480 995798 5385887 889716 44428185 52167006 16718 31056 0 0 23351814 19447075 0 0 0 13459845 22810034 36828377 42288165 7599808 9878841 74307140 83857894 18245851 16971530 56061289 66886364 X TO PROVIDE OUTSTANDING PHYSICIAN-DIRECTED HEALTH, WELLNESS, AND RESIDENTIAL SERVICES IN A PERSONAL, PRIVATE, FAMILY ATMOSPHERE. 0 0 27779744 31056 41992383 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 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 SEURGERY, PLASTIC RECONSTRUCTIVE SURGERY, AND OPEN MRI AND CT SCANNER. THE HOPEDALE MEDICAL COMPLEX ALSO OFFERS PHYSICIAN SERVICES THROUGH FIVE SATELITE OFFICES IN ATLANTA, MANITO, MACKINAW, DELAVAN, AND TREMONT. 2100294 0 3174844 HOPEDALE NURSING HOME IS A 59-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. 1489795 0 2252002 HOPEDALE COMMONS IS A 67-BED INDEPENDENT AND ASSISTED LIVING FACILITY. IT IS ALSO LOCATED ON CAMPUS AND IS LOCATED NEAR THE HOSPITAL FOR THE CONVENIENCE OF OUR RESIDENTS AND THEIR FAMILIES. 31369833 1 1 0 1 0 0 0 0 1 0 1 0 0 0 1 1 0 1 0 0 0 0 0 0 1 0 1 1 1 1 1 1 0 0 0 0 0 1 0 1 1 0 0 0 0 0 0 1 1 0 0 0 1 44 0 435 1 1 1 0 0 0 0 0 0 0 0 0 0 0 X 10 6 1 0 0 0 0 0 0 1 1 0 0 0 1 1 1 1 1 1 1 0 IL X EMILY WHITSON 3094493321 107 TREMONT ST HOPEDALE IL 61747 X NICHOLAS B ROSSI MD SECRETARY/TREASURER/PHYSICIAN 40.00 0.00 X X 1500000 0 0 MATTHEW B ROSSI MD CHAIRMAN/CEO 2.00 0.00 X X 103400 0 8982 ALFRED N ROSSI MD DIRECTOR 2.00 0.00 X 0 0 0 EMILY WHITSON CHIEF OPERATING OFFICER 40.00 0.00 X X 294283 0 36154 PHILLIP J ROSSI MD DIRECTOR 2.00 0.00 X 23400 0 14311 CHRISTOPHER CAMPBELL DIRECTOR 2.00 0.00 X 0 0 0 JOAN HARRISON DIRECTOR 2.00 0.00 X 0 0 0 TOM HIESER DIRECTOR 2.00 0.00 X 0 0 0 DONALD G OSWALD DIRECTOR 2.00 0.00 X 0 0 0 ROLAND RICH DIRECTOR 2.00 0.00 X 0 0 0 TIMOHTY SONDAG SENIOR NURSING OFFICER 40.00 0.00 X 191366 0 13526 ISOLINA ROSSI MD PHYSICIAN 40.00 0.00 X 420000 0 11225 MICHAEL KEEDY CERTIFIED RN ANESTHETIST 40.00 0.00 X 308712 0 24766 BRAD KAUFMANN CERTIFIED RN ANESTHETIST 40.00 0.00 X 287614 0 24027 JASON KOBLER CERTIFIED RN ANESTHETIST 40.00 0.00 X 287381 0 23804 3416156 0 156795 15 0 1 0 EMERGENCY PHYSICIAN STAFFING SOLUTIONS 12528 SR 78 HAVANA IL 62644 STAFFING AGENCY 1630211 ORTHOPEDICS OF ILLINOIS 2200 FORT JESSE ROAD NORMAL IL 61761 PHYSICIAN AND ORTHOPEDIC SERVICES 217857 FIDELITY ON CALL 9006 N INDUSTRIAL ROAD PEORIA IL 616151512 STAFFING AGENCY 194515 360 TRANSCRIPTION CORP 14977 KING RD DANVERS IL 61732 TRANSCRIPTION SERVICES 146717 4 9428 60510 69938 PATIENT SERVICE REVENUE 621110 41992383 41992383 NURSING HOME 623000 3174844 3174844 PHARMACY REVENUE 456110 2715272 2715272 RESIDENT SERVICE REVENUE 623000 2252002 2252002 MASSAGE THERAPY 621300 77053 77053 50211554 992748 992748 356544 0 356544 356544 356544 3050 0 3050 3050 3050 6284 9428 12108 -5824 -5824 27990 14754 13236 13236 CHILD CARE 624410 176197 176197 CAFETERIA AND MEALS 722514 165015 165015 MEDICAL RECORDS 623000 125822 125822 58726 58726 525760 52167006 47419229 2792325 1885514 X 17981 17981 13075 13075 1891500 1599187 292313 688101 555600 132501 13554686 9099613 4455073 301544 267803 33741 1866047 6040 1860007 1145197 792231 352966 37387 37387 114000 114000 12025 12025 45402 45402 7058214 5727725 1330489 100133 4071 96062 4048947 3243353 805594 57536 57536 889765 799127 90638 98540 72041 26499 379376 379376 2523103 2370103 153000 547967 81648 466319 DRUGS AND HEALTH 2483353 2475285 8068 BAD DEBT EXPENSE 2057579 2057579 TAXES 1384797 1324726 60071 MEAL EXPENSE 455320 269364 185956 516590 213905 302685 42288165 31369833 10918332 0 28825188 98114 529769 39869341 4371469 5226498 0 101251 12526 822677 819930 463782 452257 65209563 42417415 25697121 22792148 11734654 11337572 924134 1862480 2224123 74307140 83857894 3112478 3557030 0 432213 389837 11007609 9780237 0 22779 3693551 3221647 18245851 16971530 X 55541305 66320624 519984 565740 56061289 66886364 74307140 83857894 9878841 946234 0 X X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 12025 12025 0 PART II-B, LINE 1: LOBBYING EXPENDITURES RELATED TO MEMBERSHIP DUES INCLUDED: 43.5% OF MEMBERSHIP DUES PAID TO THE ILLINOIS HOSPITAL ASSOCIATION, OR $12,025. 1 2705 11336 10529 3512 0 157256 2583192 2740448 31277549 16895063 14382486 3117498 2216481 901017 27590441 23305871 4284570 483627 483627 22792148 ESTIMATED THIRD PARTY PAYOR SETTLEMENT 2901343 ROU LIABILITY 320304 3221647 X PART IV, LINE 1B: SOME NURSING HOME PATIENTS HOLD SMALL AMOUNTS OF FUNDS ON DEPOSIT WITH THE HOPEDALE MEDICAL FOUNDATION (FOUNDATION) FOR INCIDENTALS AND LOW VALUE SERVICES, SUCH AS HAIR-CUTS. THE FOUNDATION DOES NOT RECORD THE AMOUNTS AS ASSETS OF THE FOUNDATION. PART X, LINE 2: AT JUNE 30, 2025 AND 2024, THERE WERE NO UNRECOGNIZED TAX BENEFITS IDENTIFIED OR RECORDED. ANNUAL 5K RUN/WALK 15712 9427 6285 625 350 11133 15712 9427 6285 625 350 11133 12108 -5823 1 1 X 1 X 1 X 600.000000000000 1 1 0 1 1 359874 359874 0.00890 1297200 320749 976451 0.02430 1657074 320749 1336325 0.03320 762844 323058 439786 0.01090 762844 323058 439786 0.01090 2419918 643807 1776111 0.04410 1 2057579 928773 10439741 10439735 6 X 1 1 1 1 HOPEDALE MEDICAL FOUNDATION 107 TREMONT STREET HOPEDALE IL 61747 WWW.HOPEDALEMC.COM 1024 X X X X HOPEDALE MEDICAL COMPLEX 1 0 0 1 X X X X X X X X X 24 1 0 1 1 X SEE PART V, SECTION C X 1 21 1 SEE PART V, SECTION C 0 1 X 200.000000000000 600.000000000000 X X X 1 1 X X X X 1 X SEE PART V, SECTION C X SEE PART V, SECTION C X SEE PART V, SECTION C X X X X X X 1 X 0 X X X X 1 X 0 0 HOPEDALE MEDICAL COMPLEX PART V, SECTION B, LINE 5: HOPEDALE MEDICAL COMPLEX CONDUCTED ITS COMMUNITY HEALTH NEEDS ASSESSMENT IN PARTNERSHIP WITH THE ILLINOIS CRITICAL ACCESS HOSPITAL NETWORK AND OBTAINED INPUT FROM COMMUNITY REPRESENTATIVES THROUGH FOCUS GROUPS AND A COMMUNITY STAKEHOLDER MEETING. PARTICIPANTS INCLUDED REPRESENTATIVES FROM HEALTHCARE PROVIDERS, PUBLIC HEALTH ORGANIZATIONS, COMMUNITY SERVICE ORGANIZATIONS, SCHOOLS, FAITH-BASED ORGANIZATIONS, LOCAL GOVERNMENT, AND OTHER COMMUNITY LEADERS, MANY OF WHOM SERVE UNDERSERVED POPULATIONS. THE HOSPITAL INCORPORATED THIS INPUT BY COMBINING FEEDBACK FROM THESE DISCUSSIONS WITH SECONDARY DATA ANALYSIS AND PRESENTING THE RESULTS TO A PRIORITIZATION GROUP, WHICH EVALUATED AND RANKED THE COMMUNITY'S MOST SIGNIFICANT HEALTH NEEDS AND HELPED GUIDE THE DEVELOPMENT OF IMPLEMENTATION STRATEGIES. HOPEDALE MEDICAL COMPLEX PART V, SECTION B, LINE 6B: ILLINOIS CRITICAL ACCESS HOSPITAL NETWORK (ICAHN) HOPEDALE MEDICAL COMPLEX PART V, SECTION B, LINE 11: PRIORITY #1 - IMPROVE ACCESS TO HEALTHY FOODS AND NUTRITION INFORMATION ACROSS THE SERVICE AREA: PLANNED COLLABORATION BETWEEN THE HOSPITAL AND LOCAL FOOD PANTRIES TO OFFER ASSISTANCE FOR COORDINATION OF SERVICES THROUGH THE WELLNESS CENTER, CREATION AND MAINTENANCE OF A ROBUST LIBRARY OF NUTRITION INFORMATION AND RESOURCES THAT WILL BE AVAILABLE AT A NUTRITION INFORMATION STATION AT THE WELLNESS CENTER, AND UTILIZATION OF SOCIAL AND PRINT MEDIA RESOURCES TO MAKE MORE INFORMATION AVAILABLE ABOUT ACCESS TO HEALTH FOODS AND NUTRITION INFORMATION.PRIORITY #2 - IMPROVE ACCESS TO TARGETED EDUCATION AND INFORMATION ABOUT LOCAL RESOURCES FOR ACHIEVING AND MAINTAINING WELLNESS: PLANNED COLLABORATION WITH LOCAL SCHOOLS TO PROVIDE INFORMATION ABOUT LOCAL WELLNESS RESOURCES FOR HEALTH AND WELLNESS FOR YOUTH AND THE CONTINUATION OF SOCIAL AND PRINT MEDIA EFFORTS TO PROVIDE INFORMATION ABOUT LOCAL WELLNESS RESOURCES FOR HEALTH AND WELLNESS FOR YOUTH AND ADULTS.PRIORITY #3 - RE-ESTABLISH COMMUNICATION AMONG COMMUNITY PARTNERS POST-PANDEMIC: CONTINUATION OF BROAD SOCIAL MEDIA OUTREACH WITHIN THE SERVICE AREA, UTILIZATION OF A NEWSLETTER TO INFORM THE COMMUNITY AND PARTNER ORGANIZATIONS OF DEVELOPMENTS AND OPPORTUNITIES AT HMC, AND THE HOPEDALE MEDICAL FOUNDATION 37-0808925 UPDATING AND RE-ESTABLISHING LINES OF COMMUNICATION WITH PARTNER ORGANIZATIONS.PRIORITY #4 - ADDRESS TRANSPORTATION ISSUES, INCLUDING TRANSPORTATION TO AND FROM PRIMARY CARE AND EMS RESPONSE TIME: EXPLORATION OF POTENTIAL TRANSPORTATION SOLUTIONS WITH LOCAL PARTNERS AND THROUGH THE ILLINOIS CRITICAL ACCESS HOSPITAL NETWORK.PRIORITY #5 - EXPAND CHRONIC CARE MANAGEMENT TO REDUCE HOSPITAL VISITS: CONTINUATION AND EXPANSION OF CRITICAL CARE MANAGEMENT BASED ON REVIEW OF PROGRESS AND IMPACT AND NEEDS ANALYSIS. PART V, SECTION B, LINE 7A - HOSPITAL WEBSITE FOR CHNA HTTPS://HOPEDALEMC.COM/MEDIA-LIBRARY/DOCUMENTS/CHNA/HOPEDALE_MEDICAL_COMPLEX_CHNA_2025.PDF PART V, SECTION B, LINE 10A - HOSPITAL'S IMPLEMENTATION STRATEGY HTTPS://HOPEDALEMC.COM/MEDIA-LIBRARY/DOCUMENTS/CHNA/HOPEDALE_MEDICAL_COMPLEX_CHNA_2025.PDF PART V, LINE 16A, FAP WEBSITE HTTPS://HOPEDALEMC.COM/PATIENTS-VISITORS/CURRENT-PATIENTS/FINANCIAL-ASSISTANCE-PROGRAM PART V, LINE 16B, FAP APPLICATION WEBSITE HTTPS://HOPEDALEMC.COM/MEDIA-LIBRARY/DOCUMENTS/FINANCIAL-ASSISTANCE-PROGRAM-2019.PDF PART V, LINE 16C, FAP PLAIN LANGUAGE SUMMARY WEBSITE HTTPS://HOPEDALEMC.COM/MEDIA-LIBRARY/DOCUMENTS/FINANCIAL-ASSISTANCE-SUMMARY.PDF 9 1 - HOPEDALE NURSING HOME 111 TREMONT STREET HOPEDALE IL 61747 NURSING HOME 2 - HOPEDALE COMMONS 211 221 SW RAILROAD STRET HOPEDALE IL 61747 ASSISTED AND INDEPENDENT LIVING 3 - HOPEDALE WELLNESS CENTER 107 TREMONT STEET HOPEDALE IL 61747 WELLNESS & FITNESS CENTER 4 - MEDICAL ARTS PHYSICIAN BUILDING 107 TREMONT STEET HOPEDALE IL 61747 OUTPATIENT PHYSICIAN CLINIC 5 - TREMONT MEDICAL ARTS 150 LAKE STREET TREMONT IL 61568 OUTPATIENT PHYSICIAN CLINIC 6 - DELAVAN DOCTORS' OFFICE 115 EAST 4TH STREET DELAVAN IL 61734 OUTPATIENT PHYSICIAN CLINIC 7 - ATLANTA DOCTORS' OFFICE 108 SW ARCH STREET ATLANTA IL 61723 OUTPATIENT PHYSICIAN CLINIC 8 - MACKINAW DOCTORS' OFFICE 407 S ORCHARD STREET MACKINAW IL 61755 OUTPATIENT PHYSICIAN CLINIC 9 - MANITO DOCTORS' OFFICE 101 E MASON MANITO IL 61546 OUTPATIENT PHYSICIAN CLINIC PART I, LINE 7: COST TO CHARGE RATIO WAS DERIVED USING WORKSHEET 2 FROM THE IRS TO CALCULATE THE AMOUNTS INCLUDED IN SCHEDULE H, PART I, LINE 7A & &B. COMMUNITY HEALTH IMPROVEMENT SERVICES & COMMUNITY BENEFIT OPERATIONS (LINE 7E) AND HEALTH PROFESSIONAL EDUCATION ARE REPORTED AT COST 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 $ 2,057,579. PART II, COMMUNITY BUILDING ACTIVITIES: THE HOPEDALE MEDICAL 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, AND CHRONIC CONDITION MANAGEMENT SESSIONS ARE HELD IN THE MEETING ROOMS, AS WELL AS COMMUNITY ORGANIZATION MEETINGS. BLOOD DRIVES ARE REGULARLY SCHEDULED. PART III, LINE 2: BAD DEBT IS REPORTED AT THE FULL-ESTABLISHED CHARGE FROM THE MOST RECENT AUDITED FINANCIAL REPORT. ANY RECOVERIES ARE RECORDED AS A REDUCTION OF BAD DEBT EXPENSE WHEN RECEIVED. PART III, LINE 3: 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 ACCOUNTS AND BY HISTORICAL EXPERIENCE APPLIED TO AN AGING OF ACCOUNTS. THE HOPEDALE MEDICAL FOUNDATION 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 THE HOPEDALE MEDICAL FOUNDATION 37-0808925 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. PART III, LINE 4: SEE THE "PATIENT SERVICE REVENUE" FOOTNOTE 2 ON PAGES 16-19 OF THE ATTACHED FINANCIAL STATEMENTS. PART III, LINE 8: NO BAD DEBT EXPENSE WAS INCLUDED IN THE DENOMINATOR BECAUSE BAD DEBT WAS REPORTED IN LINE 2A OF PART VIII, STATEMENT OF REVENUE. THE ORGANIZATION'S TOTAL COMMUNITY BENEFIT EXPENSE AS A PERCENTAGE OF TOTAL EXPENSES IS 4.82%, AND THE PERCENTAGE INCREASES TO 32.74% IF MEDICARE ALLOWABLE COSTS ARE INCLUDED IN TOTAL COMMUNTY BENEFIT EXPENSE. PART III, LINE 9B: THE HOPEDALE MEDICAL FOUNDATION 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 FOUNDATION 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. PART VI, LINE 2: SERVICES OFFERED BY THE HOPEDALE MEDICAL FOUNDATION (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 FOUNDATION 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: HOPEDALE MEDICAL FOUNDATION'S SERVICE AREA IS COMPRISED OF APPROXIMATELY 586 SQUARE MILES WITH A POPULATION OF APPROXIMATELY 67,503 AND A POPULATION DENSITY OF 115 PER SQUARE MILE. THE SERVICE AREA CONSISTS OF THE FOUR CITIES/TOWNS AND SIX VILLAGES. POPULATION BY GENDER IN THE REGION IS 50% MALE AND 50% FEMALE. POVERTY IS CONSIDERED A KEY DRIVER OF HEALTH STATUS. WITHIN THE REPORT AREA, 10.08% OR 6,601 INDIVIDUALS ARE LIVING IN HOUSEHOLDS WITH INCOME BELOW 100% OF THE FEDERAL POVERTY LEVEL (FPL). PART VI, LINE 5: THE HOPEDALE MEDICAL 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, AND CHRONIC CONDITION MANAGEMENT SESSIONS ARE HELD IN THE MEETING ROOMS, AS WELL AS COMMUNITY ORGANIZATION MEETINGS. BLOOD DRIVES ARE REGULARLY SCHEDULED. PART VI, LINE 7, REPORTS FILED WITH STATES IL 1 CHRISTIAN LIFE ACADEMY 222 TREMONT STREET HOPEDALE IL 61747 300465566 501(C)(3) 11250 0 GENERAL SUPPORT 1 SCHOLARSHIPS FOR STUDENTS ENTERING FIELDS OF HEALTHCARE OR AGRICULTURE 3 13075 PART I, LINE 2: HOPEDALE MEDICAL FOUNDATION PROVIDES FUNDS TO CHRISTIAN LIFE ACADEMY TO BE USED AT ITS DISCRETION. 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. X X X X 0 0 0 0 0 0 0 0 0 NICHOLAS B ROSSI MD SECRETARY/TREASURER/PHYSICIAN 1500000 0 0 0 0 0 0 0 0 0 1500000 0 0 0 ISOLINA ROSSI MD PHYSICIAN 390000 0 30000 0 0 0 6300 0 4925 0 431225 0 0 0 MICHAEL KEEDY CERTIFIED RN ANESTHETIST 298712 0 10000 0 0 0 10455 0 14311 0 333478 0 0 0 EMILY WHITSON CHIEF OPERATING OFFICER 294283 0 0 0 0 0 13017 0 23137 0 330437 0 0 0 BRAD KAUFMANN CERTIFIED RN ANESTHETIST 277614 0 10000 0 0 0 9716 0 14311 0 311641 0 0 0 JASON KOBLER CERTIFIED RN ANESTHETIST 277381 0 10000 0 0 0 9494 0 14310 0 311185 0 0 0 TIMOHTY SONDAG SENIOR NURSING OFFICER 191366 0 0 0 0 0 8466 0 5060 0 204892 0 0 0 PART I, LINE 7 EMILY WHITSON, CHIEF OPERATING OFFICER, AND SENIOR MANAGEMENT STAFF ESTABLISHED A BONUS ARRANGEMENT BASED ON GOALS ACHIEVED DURING ANNUAL TRACKED PERFORMANCE AND PROVIDED EVIDENCE TO EMILY AS GOALS WERE MET. PERFORMANCE EVALUATION REVIEWS. EACH VICE PRESIDENT AND SENIOR MANAGER BONUSES WERE PROVIDED IN ACCORDANCE WITH THE ESTABLISHED ARRANGEMENT. A VILLAGE OF HOPEDALE ILLINOIS 376002155 2017-10-18 8878892 REFUNDING REVENUE BONDS ISSUED 10/16/2012 0 0 0 B VILLAGE OF HOPEDALE ILLINOIS 376002155 2017-11-02 9471108 CAPITAL IMPROVEMENT AND REFUNDING REVENUE BONDS ISSUED 10/16/12 0 0 0 A 4152621 8878892 8878892 2017 1 0 1 1 B 4269203 9471108 7013315 2457793 2019 1 0 1 1 A 0 1 1 0 0 0.00000 0.00000 0.00000 0 0 1 B 0 1 1 0 0 0.00000 0.00000 0.00000 0 0 1 A 0 0 1 0 1 0 0 0 1 B 0 0 0 0 1 0 0 0 1 A 1 B 1 ALDO M ROSSI SON OF MATTHEW B. ROSSI, M.D. AND BROTHER OF NICHOLAS B. ROSSI, M.D. PHYSICIAN MONTHLY RENTS X 22779 22779 0 1 1 MATTHEW B ROSSI MD BOARD MEMBER PHYSICIAN MONTHLY RENTS X 1 1 0 1 1 PHILLIP J ROSSI MD BOARD MEMBER PHYSICIAN MONTHLY RENTS X 5940 5940 0 1 1 TRENT PROEHL RELATED BUSINESS RELATIONSHIP WITH HMF PHYSICIAN MONTHLY RENTS X 5055 5055 0 1 1 REBECCA PROEHL RELATED BUSINESS RELATIONSHIP WITH HMF PHYSICIAN MONTHLY RENTS X 7471 7471 0 1 1 ISOLINA ROSSI DAUGHTER OF MATTHEW B. ROSSI, M.D. PHYSICIAN MONTHLY RENTS X 95310 95310 0 1 1 136556 ALDO M ROSSI SON OF MATTHEW B. ROSSI, M.D. AND BROTHER OF NICHOLAS B. ROSSI, M.D. 134740 COMPENSATION FOR SENIOR DIRECTOR OF PATIENT CARE SERVICES 0 LISA ROSSI-MCLAUGHLIN SISTER OF ALFRED N. ROSSI, M.D. AND MATTHEW B. ROSSI 159535 COMPENSATION AS DIRECTOR OF PHARMACY 0 JOSEPH WHITSON SPOUSE OF EMILY WHITSON 132501 COMPENSATION AS THE DIRECTOR OF PROFESSIONAL AND FACILITY SERVICES 0 ISOLINA ROSSI MD DAUGHTER OF MATTHEW B. ROSSI, M.D. 408718 COMPENSATION AS A PHYSICIAN 0 FORM 990, PART VI, SECTION A, LINE 1A HOPEDALE MEDICAL FOUNDATION'S BYLAWS PROVIDE THAT THE EXECUTIVE COMMITTEE SHALL HAVE THE POWERS AND AUTHORITY OF THE BOARD OF DIRECTORS AND MAY ACT ON BEHALF OF THE BOARD OF DIRECTORS BETWEEN MEETINGS OF THE BOARD, SUBJECT TO SUCH LIMITATIONS AS MAY BE ESTABLISHED IN LAW, THE ARTICLES OF INCORPORATION, THE BYLAWS AND BY THE BOARD OF DIRECTORS. FORM 990, PART VI, SECTION A, LINE 2 ALFRED N. ROSSI, M.D., MATTHEW B. ROSSI, M.D., PHILLIP J ROSSI, M.D, AND NICHOLAS B. ROSSI, M.D. HAVE A FAMILY RELATIONSHIP. FORM 990, PART VI, SECTION B, LINE 11B THE EXECUTIVE TEAM WILL REVIEW THE FORM 990 AND AUTHORIZE IT FOR FILING. THE 990 WILL THEN BE PRESENTED TO THE BOARD AS THE 'AS FILED' 990 FOR THE ORGANIZATION. FORM 990, PART VI, SECTION B, LINE 12C THE CONFLICT OF INTEREST POLICY APPLIES TO ALL MEMBERS OF THE BOARD OF DIRECTORS AND ALL CORPORATE OFFICERS, AGENTS AND EMPLOYEES OF THE HOPEDALE MEDICAL FOUNDATION (FOUNDATION), INCLUDING INDEPENDENT CONTRACTORS AND 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 HOPEDALE MEDICAL 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 15 THE CHIEF OPERATING OFFICER'S COMPENSATION IS REVIEWED AND APPROVED ANNUALLY BY THE COMPENSATION COMMITTEE. THE MEMBERS OF THE ENTIRE GOVERNING BODY MAKE UP THE COMPENSATION COMMITTEE. THE HOPEDALE MEDICAL FOUNDATION 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. THE PROCESS LAST TOOK PLACE AT THE BOARD MEETING ON DECEMBER 6, 2024. ALL OTHER OFFICERS ARE INCLUDED IN THE ANNUAL PAYROLL REVIEW PROCESS. THE CHIEF OPERATING OFFICER PROPOSES INCREASES BASED ON MARKET RATE ANALYSIS AND OTHER FACTORS. FINAL APPROVAL IS FROM DR. MATT ROSSI. FORM 990, PART VI, SECTION C, LINE 19 THE GOVERNING DOCUMENTS, AUDITED FINANCIAL STATEMENTS AND CONFLICT OF INTEREST POLICY ARE MADE AVAILABLE TO THE PUBLIC UPON REQUEST. FORM 990, PART VII, SECTION A: REPORTABLE COMPENSATION INCLUDED IN PART VII FOR MATTHEW B. ROSSI, M.D. IS FOR SERVICES RENDERED TO HOPEDALE MEDICAL FOUNDATION AS MEDICAL DIRECTOR. NICHOLAS B. ROSSI, M.D. IS COMPENSATED FOR SERVICES RENDERED TO HOPEDALE MEDICAL FOUNDATION AS A NEURO AND SPINE PHYSICIAN. REPORTABLE COMPENSATION INCLUDED IN PART VII FOR PHILLIP J. ROSSI, M.D IS FOR SERVICES RENDERED TO HOPEDALE MEDICAL FOUNDATION AS AN EMERGENCY ROOM PHYSICIAN. NO MEMBER OF THE BOARD OF DIRECTORS IS COMPENSATED IN THEIR CAPACITY AS A DIRECTOR, AND AVERAGE HOURS PER WEEK REPORTED FOR EACH DIRECTOR IS AN ESTIMATE OF TIME SPENT IN SUCH CAPACITY ONLY. FORM 990, PART IX, LINE 11G CONTRACT LABOR: PROGRAM SERVICE EXPENSES 2,405,617. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 2,405,617. PROFESSIONAL SERVICES: PROGRAM SERVICE EXPENSES 1,588,895. MANAGEMENT AND GENERAL EXPENSES 1,314,236. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 2,903,131. DIRECTORSHIP: PROGRAM SERVICE EXPENSES 80,220. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 80,220. COLLECTIONS: PROGRAM SERVICE EXPENSES 0. MANAGEMENT AND GENERAL EXPENSES 16,253. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 16,253. LOCUM TENENS STAFFING: PROGRAM SERVICE EXPENSES 1,652,993. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,652,993. FORM 990, PART XII, LINE 2C: THE OVERSIGHT AND SELECTION PROCESS HAS NOT CHANGED FROM THE PRIOR TAX YEAR. HOPEDALE REAL ESTATE SERVICES INC 107 TREMONT STREET HOPEDALE IL 61747 371406582 PROPERTY RENTAL IL HOPEDALE MEDICAL FOUNDATION C 153155 3066541 1.00000 1 0 0 0 0 0 0 0 0 0 0 1 0 0 1 1 0 0 0 0 HOPEDALE REAL ESTATE SERVICES INC K 153000 GL DETAIL