TY 2019 Form 990

(A) Name and title	(B) Average hours per week (list any hours for related organizations below dotted line)	(C) Position (do not check more than one box, unless person is both an officer and a director/trustee)	(E) Reportable compensation from related organizations (W-2/1099-MISC)	(F) Estimated amount of other compensation from the organization and related organizations
(1) DENNIS HESCH...................................................................... EXEC VP & CFO	1.0 ................. 39.0		X			1,293,567	288,860
(2) LAURENCE FALLON...................................................................... Key Employee - Former	1.0 ................. 39.0				X	948,548	230,518
(3) Napoleon Knight MD...................................................................... MED DIR, REGIONAL ED	2.0 ................. 38.0			X		940,077	31,753
(4) CHARLES DENNIS MD...................................................................... Key Employee - Former	1.0 ................. 39.0				X	677,106	99,150
(5) BLAIR ROWITZ MD...................................................................... ASSOC CMO - SURGICAL SERVICES	1.0 ................. 39.0			X		712,168	43,544
(6) LYNETTE BARNES...................................................................... COO-CFH & SVP-FACILITIES	2.0 ................. 38.0			X		585,085	118,683
(7) ANDY ARWARI MD...................................................................... ACMO-REGIONAL HEALTH	0.2 ................. 39.8			X		582,601	48,616
(8) DOUGLAS MORTON MD...................................................................... MED DIR-RADIOLOGY	2.0 ................. 38.0			X		593,901	31,007
(9) PAMELA BIGLER...................................................................... SVP-NURSING & CNO	5.0 ................. 35.0			X		489,994	108,710
(10) IKECHUKWU UZOARU MD...................................................................... MED DIR-LAB	2.0 ................. 38.0			X		556,223	41,060
(11) LAUREN SCHMID...................................................................... EXEC VP, CHIEF HR OFFICER	2.0 ................. 38.0			X		430,309	98,880
(12) HARRY BROCKUS...................................................................... EX-OFFICIO, CEO	2.0 ................. 38.0		X			400,330	99,514
(13) DANIEL CHASE MD...................................................................... HIGHLY COMP EMP-FORMER	40.0 ................. 0.0				X	447,602	45,249
(14) SALLY SALMONS MD...................................................................... TRUSTEE & MEDICAL DIRECTOR	8.0 ................. 32.0	X				405,652	77,564
(15) CALEB MILLER...................................................................... SVP-SURGICAL & DIAG SVCS	1.0 ................. 39.0			X		375,903	100,840
(16) CORTNEY JONEIKIS ROS...................................................................... HIGHLY COMP EMP-FORMER	40.0 ................. 0.0				X	345,641	35,226
(17) WILLIAM MCCARTHY MD...................................................................... HIGHLY COMP EMP-FORMER	40.0 ................. 0.0				X	329,396	28,703

(A) Name and title	(B) Average hours per week (list any hours for related organizations below dotted line)	(C) Position (do not check more than one box, unless person is both an officer and a director/trustee)	(E) Reportable compensation from related organizations (W-2/1099-MISC)
(18) ALBERT TANLIM MD........................................................................ HIGHLY COMP EMP-FORMER	40.0 .......................0.0				X	0	312,493	44,596
(19) LETHA KRAMER........................................................................ TRUSTEE & VP-RISK	2.0 .......................38.0	X				0	282,462	70,058
(20) HEATHER TUCKER........................................................................ Hospital Administrator	40.0 .......................0.0			X		162,802	0	37,103
(21) DEBRA O BRIEN........................................................................ PHYSICIAN ASSISTANT	40.0 .......................0.0			X		158,769	0	30,008
(22) LARRY WHITAKER JR........................................................................ PHYSICIAN ASSISTANT	40.0 .......................0.0			X		146,914	0	36,147
(23) LARRY GERDOM........................................................................ PHYSICIAN ASSISTANT	40.0 .......................0.0			X		154,946	0	27,182
(24) Robert McConkey........................................................................ PT Op Lead - Therapy	40.0 .......................0.0			X		139,337	0	23,876
(25) RUSS LEIGH........................................................................ CHAIR OF BOARD	1.0 .......................1.0	X	X			0	0	0
(26) LYNN GALLOWAY........................................................................ VICE CHAIR OF BOARD	0.5 .......................0.0	X	X			0	0	0
(27) KARLA COON........................................................................ SEC/TREAS OF BOARD	1.0 .......................0.0	X	X			0	0	0
(28) HENRY HORNBECK........................................................................ TRUSTEE(Thru 1/2019)	1.0 .......................0.0	X				0	0	0
(29) ALICE JACOBS........................................................................ TRUSTEE	2.0 .......................1.0	X				0	0	0
(30) William Nicholls........................................................................ Trustee (START 06/19)	1.0 .......................0.0	X				0	0	0

(A) Name and business address	(B) Description of services	(C) Compensation
HOOPESTON EMERGENCY MEDICINE SPECIA, PO BOX 5977 CAROL STREAM,IL601975977	STAFFING	1,637,656
PHILIPS MEDICAL SYSTEMS, DBA PHILIPS HEALTHCARE PO BOX 1003 ATLANTA,GA303840355	EQUIPMENT MAINT	354,050
SENTRY DATA SYSTEMS INC, PO BOX 505353 ST LOUIS,MO631505353	SOFTWARE	209,412
DMS IMAGING INC, DBA DMS HEALTH TECH PO BOX 670747 DALLAS,TX752670747	IMAGING SERVICES	192,978
SENTRY ROOFING INC, 3245 WEST US HIGHWAY 136 COVINGTON,IN47932	CONSTRUCTION	186,783
2 Total number of independent contractors (including but not limited to those listed above) who received more than $100,000 of compensation from the organization 10

- TIN:

SCHEDULE A
(Form 990 or 990EZ)

Department of the Treasury
Internal Revenue Service

Public Charity Status and Public Support

Complete if the organization is a section 501(c)(3) organization or a section 4947(a)(1) nonexempt charitable trust.
right arrow

Attach to Form 990 or Form 990-EZ.
right arrow

Go to www.irs.gov/Form990 for instructions and the latest information.

OMB No. 1545-0047

2019

Open to Public
Inspection

Name of the organization

HOOPESTON COMMUNITY MEMORIAL HOSPITAL

Employer identification number

36-3637465

Part I

Reason for Public Charity Status (All organizations must complete this part.) See instructions.

The organization is not a private foundation because it is: (For lines 1 through 12, check only one box.)

A church, convention of churches, or association of churches described in section 170(b)(1)(A)(i).

A school described in section 170(b)(1)(A)(ii). (Attach Schedule E (Form 990 or 990-EZ).)

A hospital or a cooperative hospital service organization described in section 170(b)(1)(A)(iii).

A medical research organization operated in conjunction with a hospital described in section 170(b)(1)(A)(iii). Enter the hospital's name, city, and state:

An organization operated for the benefit of a college or university owned or operated by a governmental unit described in section 170(b)(1)(A)(iv). (Complete Part II.)

A federal, state, or local government or governmental unit described in section 170(b)(1)(A)(v).

An organization that normally receives a substantial part of its support from a governmental unit or from the general public described in section 170(b)(1)(A)(vi). (Complete Part II.)

A community trust described in section 170(b)(1)(A)(vi). (Complete Part II.)

An agricultural research organization described in 170(b)(1)(A)(ix) operated in conjunction with a land-grant college or university or a non-land grant college of agriculture. See instructions. Enter the name, city, and state of the college or university:

An organization that normally receives: (1) more than 331/3% of its support from contributions, membership fees, and gross receipts from activities related to its exempt functions—subject to certain exceptions, and (2) no more than 331/3% of its support from gross investment income and unrelated business taxable income (less section 511 tax) from businesses acquired by the organization after June 30, 1975. See section 509(a)(2). (Complete Part III.)

An organization organized and operated exclusively to test for public safety. See section 509(a)(4).

An organization organized and operated exclusively for the benefit of, to perform the functions of, or to carry out the purposes of one or more publicly supported organizations described in section 509(a)(1) or section 509(a)(2). See section 509(a)(3). Check the box in lines 12a through 12d that describes the type of supporting organization and complete lines 12e, 12f, and 12g.

Type I. A supporting organization operated, supervised, or controlled by its supported organization(s), typically by giving the supported organization(s) the power to regularly appoint or elect a majority of the directors or trustees of the supporting organization. You must complete Part IV, Sections A and B.

Type II. A supporting organization supervised or controlled in connection with its supported organization(s), by having control or management of the supporting organization vested in the same persons that control or manage the supported organization(s). You must complete Part IV, Sections A and C.

Type III functionally integrated. A supporting organization operated in connection with, and functionally integrated with, its supported organization(s) (see instructions). You must complete Part IV, Sections A, D, and E.

Type III non-functionally integrated. A supporting organization operated in connection with its supported organization(s) that is not functionally integrated. The organization generally must satisfy a distribution requirement and an attentiveness requirement (see instructions). You must complete Part IV, Sections A and D, and Part V.

Check this box if the organization received a written determination from the IRS that it is a Type I, Type II, Type III functionally integrated, or Type III non-functionally integrated supporting organization.

Enter the number of supported organizations ...............................

Provide the following information about the supported organization(s).

(i) Name of supported organization	(ii) EIN	(iv) Is the organization listed in your governing document?		(v) Amount of monetary support (see instructions)	(vi) Amount of other support (see instructions)
(i) Name of supported organization	(ii) EIN	Yes	No	(v) Amount of monetary support (see instructions)	(vi) Amount of other support (see instructions)


Total

For Paperwork Reduction Act Notice, see the Instructions for
Form 990 or 990-EZ.

Cat. No. 11285F

Schedule A (Form 990 or 990-EZ) 2019

Page 2

Part II

Support Schedule for Organizations Described in Sections 170(b)(1)(A)(iv) and 170(b)(1)(A)(vi)
(Complete only if you checked the box on line 5, 7, or 8 of Part I or if the organization failed to qualify under Part III. If the organization failed to qualify under the tests listed below, please complete Part III.)

Section A. Public Support

Calendar year (or fiscal year beginning in)		(a) 2015	(b) 2016	(c) 2017	(d) 2018	(e) 2019	(f) Total
1	Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grant.") ..
2	Tax revenues levied for the organization's benefit and either paid to or expended on its behalf....
3	The value of services or facilities furnished by a governmental unit to the organization without charge..
4	Total. Add lines 1 through 3
5	The portion of total contributions by each person (other than a governmental unit or publicly supported organization) included on line 1 that exceeds 2% of the amount shown on line 11, column (f)..
6	Public support. Subtract line 5 from line 4.

Section B. Total Support

Calendar year (or fiscal year beginning in)		(a) 2015	(b) 2016	(c) 2017	(d) 2018	(e) 2019	(f) Total
7	Amounts from line 4..
8	Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources...
9	Net income from unrelated business activities, whether or not the business is regularly carried on..
10	Other income. Do not include gain or loss from the sale of capital assets (Explain in Part VI.)..
11	Total support. Add lines 7 through 10

Gross receipts from related activities, etc. (see instructions) ..................

First five years. If the Form 990 is for the organization's first, second, third, fourth, or fifth tax year as a section 501(c)(3) organization, check this box and stop here........................................ right arrow

Section C. Computation of Public Support Percentage

Public support percentage for 2019 (line 6, column (f) divided by line 11, column (f)) .........

Public support percentage for 2018 Schedule A, Part II, line 14 ...............

16a

33 1/3% support test—2019. If the organization did not check the box on line 13, and line 14 is 33 1/3% or more, check this box
and stop here. The organization qualifies as a publicly supported organization ....................... right arrow

33 1/3% support test—2018. If the organization did not check a box on line 13 or 16a, and line 15 is 33 1/3% or more, check this
box and stop here. The organization qualifies as a publicly supported organization ..................... right arrow

17a

10%-facts-and-circumstances test—2019. If the organization did not check a box on line 13, 16a, or 16b, and line 14
is 10% or more, and if the organization meets the "facts-and-circumstances" test, check this box and stop here. Explain
in Part VI how the organization meets the "facts-and-circumstances" test. The organization qualifies as a publicly supported
organization ..................................................... right arrow

10%-facts-and-circumstances test—2018. If the organization did not check a box on line 13, 16a, 16b, or 17a, and line
15 is 10% or more, and if the organization meets the "facts-and-circumstances" test, check this box and stop here.
Explain in Part VI how the organization meets the "facts-and-circumstances" test. The organization qualifies as a publicly
supported organization ................................................ right arrow

Private foundation. If the organization did not check a box on line 13, 16a, 16b, 17a, or 17b, check this box and see
instructions ..................................................... right arrow

Schedule A (Form 990 or 990-EZ) 2019

Page 3

Part III

Support Schedule for Organizations Described in Section 509(a)(2)
(Complete only if you checked the box on line 10 of Part I or if the organization failed to qualify under Part II. If the organization fails to qualify under the tests listed below, please complete Part II.)

Section A. Public Support

Calendar year (or fiscal year beginning in)		(a) 2015	(b) 2016	(c) 2017	(d) 2018	(e) 2019	(f) Total
1	Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grants.") .
2	Gross receipts from admissions, merchandise sold or services performed, or facilities furnished in any activity that is related to the organization's tax-exempt purpose
3	Gross receipts from activities that are not an unrelated trade or business under section 513 .....
4	Tax revenues levied for the organization's benefit and either paid to or expended on its behalf...
5	The value of services or facilities furnished by a governmental unit to the organization without charge
6	Total. Add lines 1 through 5
7a	Amounts included on lines 1, 2, and 3 received from disqualified persons
b	Amounts included on lines 2 and 3 received from other than disqualified persons that exceed the greater of $5,000 or 1% of the amount on line 13 for the year.
c	Add lines 7a and 7b..
8	Public support. (Subtract line 7c from line 6.)

Section B. Total Support

Calendar year (or fiscal year beginning in)		(a) 2015	(b) 2016	(c) 2017	(d) 2018	(e) 2019	(f) Total
9	Amounts from line 6...
10a	Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources..
b	Unrelated business taxable income (less section 511 taxes) from businesses acquired after June 30, 1975.
c	Add lines 10a and 10b.
11	Net income from unrelated business activities not included in line 10b, whether or not the business is regularly carried on.
12	Other income. Do not include gain or loss from the sale of capital assets (Explain in Part VI.) ..
13	Total support. (Add lines 9, 10c, 11, and 12.)..

First five years. If the Form 990 is for the organization's first, second, third, fourth, or fifth tax year as a section 501(c)(3) organization,
check this box and stop here............................................. right arrow

Section C. Computation of Public Support Percentage

Public support percentage for 2019 (line 8, column (f) divided by line 13, column (f)) .........

Public support percentage from 2018 Schedule A, Part III, line 15 ...............

Section D. Computation of Investment Income Percentage

Investment income percentage for 2019 (line 10c, column (f) divided by line 13, column (f)) ......

Investment income percentage from 2018 Schedule A, Part III, line 17 .............

19a

331/3% support tests—2019. If the organization did not check the box on line 14, and line 15 is more than 33 1/3%, and line 17 is not more than 33 1/3%, check this box and stop here. The organization qualifies as a publicly supported organization ....... right arrow

33 1/3% support tests—2018. If the organization did not check a box on line 14 or line 19a, and line 16 is more than 33 1/3% and line 18 is not more than 33 1/3%, check this box and stop here. The organization qualifies as a publicly supported organization .... right arrow

Private foundation. If the organization did not check a box on line 14, 19a, or 19b, check this box and see instructions .... right arrow

Schedule A (Form 990 or 990-EZ) 2019

Page 4

Part IV

Supporting Organizations

(Complete only if you checked a box on line 12 of Part I. If you checked 12a of Part I, complete Sections A and B. If you checked 12b of Part I, complete Sections A and C. If you checked 12c of Part I, complete Sections A, D, and E. If you checked 12d of Part I, complete Sections A and D, and complete Part V.)

Section A. All Supporting Organizations

Yes

Are all of the organization’s supported organizations listed by name in the organization’s governing documents?
If "No," describe in Part VI how the supported organizations are designated. If designated by class or purpose,
describe the designation. If historic and continuing relationship, explain.

Did the organization have any supported organization that does not have an IRS determination of status under section 509(a)(1) or (2)? If "Yes," explain in Part VI how the organization determined that the supported organization was described in section 509(a)(1) or (2).

Did the organization have a supported organization described in section 501(c)(4), (5), or (6)? If "Yes," answer (b) and (c) below.

Did the organization confirm that each supported organization qualified under section 501(c)(4), (5), or (6) and satisfied the public support tests under section 509(a)(2)? If "Yes," describe in Part VI when and how the organization made the determination.

Did the organization ensure that all support to such organizations was used exclusively for section 170(c)(2)(B) purposes? If "Yes," explain in Part VI what controls the organization put in place to ensure such use.

Was any supported organization not organized in the United States ("foreign supported organization")? If “Yes” and if you checked 12a or 12b in Part I, answer (b) and (c) below.

Did the organization have ultimate control and discretion in deciding whether to make grants to the foreign supported organization? If “Yes,” describe in Part VI how the organization had such control and discretion despite being controlled or supervised by or in connection with its supported organizations.

Did the organization support any foreign supported organization that does not have an IRS determination under sections 501(c)(3) and 509(a)(1) or (2)? If “Yes,” explain in Part VI what controls the organization used to ensure that all support to the foreign supported organization was used exclusively for section 170(c)(2)(B) purposes.

Did the organization add, substitute, or remove any supported organizations during the tax year? If “Yes,” answer (b) and (c) below (if applicable). Also, provide detail in Part VI, including (i) the names and EIN numbers of the supported organizations added, substituted, or removed; (ii) the reasons for each such action; (iii) the authority under the organization's organizing document authorizing such action; and (iv) how the action was accomplished (such as by amendment to the organizing document).

Type I or Type II only. Was any added or substituted supported organization part of a class already designated in the organization's organizing document?

Substitutions only. Was the substitution the result of an event beyond the organization's control?

Did the organization provide support (whether in the form of grants or the provision of services or facilities) to anyone other than (i) its supported organizations, (ii) individuals that are part of the charitable class benefited by one or more of its supported organizations, or (iii) other supporting organizations that also support or benefit one or more of the filing organization’s supported organizations? If “Yes,” provide detail in Part VI.

Did the organization provide a grant, loan, compensation, or other similar payment to a substantial contributor (defined in section 4958(c)(3)(C)), a family member of a substantial contributor, or a 35% controlled entity with regard to a substantial contributor? If “Yes,” complete Part I of Schedule L (Form 990 or 990-EZ) .

Did the organization make a loan to a disqualified person (as defined in section 4958) not described in line 7? If “Yes,” complete Part I of Schedule L (Form 990 or 990-EZ).

Was the organization controlled directly or indirectly at any time during the tax year by one or more disqualified persons as defined in section 4946 (other than foundation managers and organizations described in section 509(a)(1) or (2))? If “Yes,” provide detail in Part VI.

Did one or more disqualified persons (as defined in line 9a) hold a controlling interest in any entity in which the supporting organization had an interest? If “Yes,” provide detail in Part VI.

Did a disqualified person (as defined in line 9a) have an ownership interest in, or derive any personal benefit from, assets in which the supporting organization also had an interest? If “Yes,” provide detail in Part VI.

10a

Was the organization subject to the excess business holdings rules of section 4943 because of section 4943(f) (regarding certain Type II supporting organizations, and all Type III non-functionally integrated supporting organizations)? If “Yes,” answer line 10b below.

10a

Did the organization have any excess business holdings in the tax year? (Use Schedule C, Form 4720, to determine whether the organization had excess business holdings).

10b

Schedule A (Form 990 or 990-EZ) 2019

Page 5

Part IV

Supporting Organizations (continued)

Yes

Has the organization accepted a gift or contribution from any of the following persons?

A person who directly or indirectly controls, either alone or together with persons described in (b) and (c) below, the governing body of a supported organization?

11a

A family member of a person described in (a) above?

11b

A 35% controlled entity of a person described in (a) or (b) above? If “Yes” to a, b, or c, provide detail in Part VI.

11c

Section B. Type I Supporting Organizations

Yes

Did the directors, trustees, or membership of one or more supported organizations have the power to regularly appoint or elect at least a majority of the organization’s directors or trustees at all times during the tax year? If “No,” describe in Part VI how the supported organization(s) effectively operated, supervised, or controlled the organization’s activities. If the organization had more than one supported organization, describe how the powers to appoint and/or remove directors or trustees were allocated among the supported organizations and what conditions or restrictions, if any, applied to such powers during the tax year.

Did the organization operate for the benefit of any supported organization other than the supported organization(s) that operated, supervised, or controlled the supporting organization? If “Yes,” explain in Part VI how providing such benefit carried out the purposes of the supported organization(s) that operated, supervised or controlled the supporting organization.

Section C. Type II Supporting Organizations

Yes

Were a majority of the organization’s directors or trustees during the tax year also a majority of the directors or trustees of each of the organization’s supported organization(s)? If “No,” describe in Part VI how control or management of the supporting organization was vested in the same persons that controlled or managed the supported organization(s).

Section D. All Type III Supporting Organizations

Yes

Did the organization provide to each of its supported organizations, by the last day of the fifth month of the organization’s tax year, (i) a written notice describing the type and amount of support provided during the prior tax year, (ii) a copy of the Form 990 that was most recently filed as of the date of notification, and (iii) copies of the organization’s governing documents in effect on the date of notification, to the extent not previously provided?

Were any of the organization’s officers, directors, or trustees either (i) appointed or elected by the supported organization(s) or (ii) serving on the governing body of a supported organization? If "No," explain in Part VI how the organization maintained a close and continuous working relationship with the supported organization(s).

By reason of the relationship described in (2), did the organization’s supported organizations have a significant voice in the organization’s investment policies and in directing the use of the organization’s income or assets at all times during the tax year? If "Yes," describe in Part VI the role the organization’s supported organizations played in this regard.

Section E. Type III Functionally-Integrated Supporting Organizations

Check the box next to the method that the organization used to satisfy the Integral Part Test during the year (see instructions):

The organization satisfied the Activities Test. Complete line 2 below.

The organization is the parent of each of its supported organizations. Complete line 3 below.

The organization supported a governmental entity. Describe in Part VI how you supported a government entity (see instructions)

Activities Test. Answer (a) and (b) below.

Yes

Did substantially all of the organization’s activities during the tax year directly further the exempt purposes of the supported organization(s) to which the organization was responsive? If "Yes," then in Part VI identify those supported organizations and explain how these activities directly furthered their exempt purposes, how the organization was responsive to those supported organizations, and how the organization determined that these activities constituted substantially all of its activities.

Did the activities described in (a) constitute activities that, but for the organization’s involvement, one or more of the organization’s supported organization(s) would have been engaged in? If "Yes," explain in Part VI the reasons for the organization’s position that its supported organization(s) would have engaged in these activities but for the organization’s involvement.

Parent of Supported Organizations. Answer (a) and (b) below.

Did the organization have the power to regularly appoint or elect a majority of the officers, directors, or trustees of each of the supported organizations? Provide details in Part VI.

Did the organization exercise a substantial degree of direction over the policies, programs and activities of each of its supported organizations? If "Yes," describe in Part VI. the role played by the organization in this regard.

Schedule A (Form 990 or 990-EZ) 2019

Page 6

Part V

Type III Non-Functionally Integrated 509(a)(3) Supporting Organizations

Check here if the organization satisfied the Integral Part Test as a qualifying trust on Nov. 20, 1970 (explain in Part VI). See instructions. All other Type III non-functionally integrated supporting organizations must complete Sections A through E.

	Section A - Adjusted Net Income		(A) Prior Year	(B) Current Year (optional)
1	Net short-term capital gain	1
2	Recoveries of prior-year distributions	2
3	Other gross income (see instructions)	3
4	Add lines 1 through 3	4
5	Depreciation and depletion	5
6	Portion of operating expenses paid or incurred for production or collection of gross income or for management, conservation, or maintenance of property held for production of income (see instructions)	6
7	Other expenses (see instructions)	7
8	Adjusted Net Income (subtract lines 5, 6 and 7 from line 4)	8

	Section B - Minimum Asset Amount		(A) Prior Year	(B) Current Year (optional)
1	Aggregate fair market value of all non-exempt-use assets (see instructions for short tax year or assets held for part of year):	1
a	Average monthly value of securities	1a
b	Average monthly cash balances	1b
c	Fair market value of other non-exempt-use assets	1c
d	Total (add lines 1a, 1b, and 1c)	1d
e	Discount claimed for blockage or other factors (explain in detail in Part VI):
2	Acquisition indebtedness applicable to non-exempt use assets	2
3	Subtract line 2 from line 1d	3
4	Cash deemed held for exempt use. Enter 1-1/2% of line 3 (for greater amount, see instructions).	4
5	Net value of non-exempt-use assets (subtract line 4 from line 3)	5
6	Multiply line 5 by .035	6
7	Recoveries of prior-year distributions	7
8	Minimum Asset Amount (add line 7 to line 6)	8

	Section C - Distributable Amount		Current Year
1	Adjusted net income for prior year (from Section A, line 8, Column A)	1
2	Enter 85% of line 1	2
3	Minimum asset amount for prior year (from Section B, line 8, Column A)	3
4	Enter greater of line 2 or line 3	4
5	Income tax imposed in prior year	5
6	Distributable Amount. Subtract line 5 from line 4, unless subject to emergency temporary reduction (see instructions)	6

Check here if the current year is the organization's first as a non-functionally-integrated Type III supporting organization (see instructions)

Schedule A (Form 990 or 990-EZ) 2019

Page 7

Part V

Type III Non-Functionally Integrated 509(a)(3) Supporting Organizations(continued)

Section D - Distributions		Current Year
1 Amounts paid to supported organizations to accomplish exempt purposes
2 Amounts paid to perform activity that directly furthers exempt purposes of supported organizations, in excess of income from activity
3 Administrative expenses paid to accomplish exempt purposes of supported organizations
4 Amounts paid to acquire exempt-use assets
5 Qualified set-aside amounts (prior IRS approval required)
6 Other distributions (describe in Part VI). See instructions
7Total annual distributions. Add lines 1 through 6.
8 Distributions to attentive supported organizations to which the organization is responsive (provide details in Part VI). See instructions
9 Distributable amount for 2019 from Section C, line 6
10 Line 8 amount divided by Line 9 amount

Section E - Distribution Allocations (see instructions)		(i) Excess Distributions	(ii) Underdistributions Pre-2019	(iii) Distributable Amount for 2019
1 Distributable amount for 2019 from Section C, line 6
2 Underdistributions, if any, for years prior to 2019 (reasonable cause required-- explain in Part VI). See instructions.
3 Excess distributions carryover, if any, to 2019:
a From 2014.......
b From 2015.......
c From 2016.......
d From 2017.......
e From 2018.......
fTotal of lines 3a through e
g Applied to underdistributions of prior years
h Applied to 2019 distributable amount
i Carryover from 2014 not applied (see instructions)
j Remainder. Subtract lines 3g, 3h, and 3i from 3f.
4Distributions for 2019 from Section D, line 7:
$
a Applied to underdistributions of prior years
b Applied to 2019 distributable amount
c Remainder. Subtract lines 4a and 4b from 4.
5 Remaining underdistributions for years prior to 2019, if any. Subtract lines 3g and 4a from line 2. If the amount is greater than zero, explain in Part VI. See instructions.
6 Remaining underdistributions for 2019. Subtract lines 3h and 4b from line 1. If the amount is greater than zero, explain in Part VI. See instructions.
7 Excess distributions carryover to 2020. Add lines 3j and 4c.
8 Breakdown of line 7:
a Excess from 2015.....
b Excess from 2016.....
c Excess from 2017.....
d Excess from 2018.....
e Excess from 2019.....

Schedule A (Form 990 or 990-EZ) (2019)

Schedule A (Form 990 or 990-EZ) 2019

Page 8

Part VI

Supplemental Information. Provide the explanations required by Part II, line 10; Part II, line 17a or 17b; Part III, line 12; Part IV, Section A, lines 1, 2, 3b, 3c, 4b, 4c, 5a, 6, 9a, 9b, 9c, 11a, 11b, and 11c; Part IV, Section B, lines 1 and 2; Part IV, Section C, line 1; Part IV, Section D, lines 2 and 3; Part IV, Section E, lines 1c, 2a, 2b, 3a and 3b; Part V, line 1; Part V, Section B, line 1e; Part V Section D, lines 5, 6, and 8; and Part V, Section E, lines 2, 5, and 6. Also complete this part for any additional information. (See instructions).

Facts And Circumstances Test

Return Reference	Explanation

Schedule A (Form 990 or 990-EZ) 2019

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE C
(Form 990 or 990-EZ)

Department of the Treasury
Internal Revenue Service

Political Campaign and Lobbying Activities

For Organizations Exempt From Income Tax Under section 501(c) and section 527

SchCMd Bullet

Complete if the organization is described below. SchCMd Bullet

Attach to Form 990 or Form 990-EZ.
SchCMd Bullet

Go to www.irs.gov/Form990 for instructions and the latest information.

OMB No. 1545-0047

2019

Open to Public
Inspection

If the organization answered "Yes" on Form 990, Part IV, Line 3, or Form 990-EZ, Part V, line 46 (Political Campaign Activities), then
Round Bullet

Section 501(c)(3) organizations: Complete Parts I-A and B. Do not complete Part I-C.
Round Bullet

Section 501(c) (other than section 501(c)(3)) organizations: Complete Parts I-A and C below. Do not complete Part I-B.
Round Bullet

Section 527 organizations: Complete Part I-A only.
If the organization answered "Yes" on Form 990, Part IV, Line 4, or Form 990-EZ, Part VI, line 47 (Lobbying Activities), then
Round Bullet

Section 501(c)(3) organizations that have filed Form 5768 (election under section 501(h)): Complete Part II-A. Do not complete Part II-B.
Round Bullet

Section 501(c)(3) organizations that have NOT filed Form 5768 (election under section 501(h)): Complete Part II-B. Do not complete Part II-A.
If the organization answered "Yes" on Form 990, Part IV, Line 5 (Proxy Tax) (see separate instructions) or Form 990-EZ, Part V, line 35c (Proxy Tax) (see separate instructions), then
Round Bullet

Section 501(c)(4), (5), or (6) organizations: Complete Part III.

Name of the organization

HOOPESTON COMMUNITY MEMORIAL HOSPITAL

Employer identification number

36-3637465

Part I-A

Complete if the organization is exempt under section 501(c) or is a section 527 organization.

Provide a description of the organization’s direct and indirect political campaign activities in Part IV (see instructions for definition of “political campaign activities")

Political campaign activity expenditures (see instructions) .................................................................... SchCMd Bullet

Volunteer hours for political campaign activities (see instructions) ..................................................................

Part I-B

Complete if the organization is exempt under section 501(c)(3).

Enter the amount of any excise tax incurred by the organization under section 4955 ................................ SchCMd Bullet

Enter the amount of any excise tax incurred by organization managers under section 4955 ....................... SchCMd Bullet

If the organization incurred a section 4955 tax, did it file Form 4720 for this year? .........................................

Yes No

Was a correction made? ......................................................................................................................

Yes No

If "Yes," describe in Part IV.

Part I-C

Complete if the organization is exempt under section 501(c), except section 501(c)(3).

Enter the amount directly expended by the filing organization for section 527 exempt function activities ..... SchCMd Bullet

Enter the amount of the filing organization's funds contributed to other organizations for section 527 exempt function activities ............................................................................................................................ SchCMd Bullet

Total exempt function expenditures. Add lines 1 and 2. Enter here and on Form 1120-POL, line 17b........... SchCMd Bullet

Did the filing organization file Form 1120-POL for this year? ...................................................................

Yes No

Enter the names, addresses and employer identification number (EIN) of all section 527 political organizations to which the filing
organization made payments. For each organization listed, enter the amount paid from the filing organization’s funds. Also enter the amount of political contributions received that were promptly and directly delivered to a separate political organization, such as a separate segregated fund or a political action committee (PAC). If additional space is needed, provide information in Part IV.

(a) Name	(b) Address	(c) EIN	(d) Amount paid from filing organization's funds. If none, enter -0-.	(e) Amount of political contributions received and promptly and directly delivered to a separate political organization. If none, enter -0-.
1
2
3
4
5
6

For Paperwork Reduction Act Notice, see the instructions for Form 990 or 990-EZ.

Cat. No. 50084S

Schedule C (Form 990 or 990-EZ) 2019

Page 2

Part II-A

Complete if the organization is exempt under section 501(c)(3) and filed Form 5768 (election under section 501(h)).

A Check SchCMd Bullet

if the filing organization belongs to an affiliated group (and list in Part IV each affiliated group member's name, address, EIN, expenses, and share of excess lobbying expenditures).
B Check SchCMd Bullet

if the filing organization checked box A and "limited control" provisions apply.

Limits on Lobbying Expenditures (The term "expenditures" means amounts paid or incurred.)		(b) Affiliated group totals
1a	Total lobbying expenditures to influence public opinion (grass roots lobbying) ......................
b	Total lobbying expenditures to influence a legislative body (direct lobbying) ........................
c	Total lobbying expenditures (add lines 1a and 1b) ............................................................
d	Other exempt purpose expenditures ...............................................................................
e	Total exempt purpose expenditures (add lines 1c and 1d) ..................................................
f	Lobbying nontaxable amount. Enter the amount from the following table in both columns.
	If the amount on line 1e, column (a) or (b) is:The lobbying nontaxable amount is:
	Not over $500,00020% of the amount on line 1e.
	Over $500,000 but not over $1,000,000$100,000 plus 15% of the excess over $500,000.
	Over $1,000,000 but not over $1,500,000$175,000 plus 10% of the excess over $1,000,000.
	Over $1,500,000 but not over $17,000,000$225,000 plus 5% of the excess over $1,500,000.
	Over $17,000,000$1,000,000.

g	Grassroots nontaxable amount (enter 25% of line 1f) .................................................
h	Subtract line 1g from line 1a. If zero or less, enter -0-. ................................................
i	Subtract line 1f from line 1c. If zero or less, enter -0-. ................................................
j	If there is an amount other than zero on either line 1h or line 1i, did the organization file Form 4720 reporting section 4911 tax for this year? ...................................................................................................................	Yes No

4-Year Averaging Period Under Section 501(h) (Some organizations that made a section 501(h) election do not have to complete all of the five columns below. See the separate instructions for lines 2a through 2f.)
Lobbying Expenditures During 4-Year Averaging Period
	Calendar year (or fiscal year beginning in)	(a) 2016	(b) 2017	(c) 2018	(d) 2019	(e) Total

2a	Lobbying nontaxable amount

b	Lobbying ceiling amount (150% of line 2a, column(e))

c	Total lobbying expenditures

d	Grassroots nontaxable amount

e	Grassroots ceiling amount (150% of line 2d, column (e))

f	Grassroots lobbying expenditures

Schedule C (Form 990 or 990-EZ) 2019

Page 3

Part II-B

Complete if the organization is exempt under section 501(c)(3) and has NOT filed Form 5768 (election under section 501(h)).

For each "Yes" response on lines 1a through 1i below, provide in Part IV a detailed description of the lobbying activity.

(a)

Yes|No

(b)

Amount

During the year, did the filing organization attempt to influence foreign, national, state or local legislation, including any attempt to influence public opinion on a legislative matter or referendum, through the use of:

Volunteers? ...........................................................................................................

Paid staff or management (include compensation in expenses reported on lines 1c through 1i)? ........

Media advertisements? ...................................................................................................

Mailings to members, legislators, or the public? .............................................................................

Publications, or published or broadcast statements? ...........................................................

Grants to other organizations for lobbying purposes? ..........................................................

Direct contact with legislators, their staffs, government officials, or a legislative body? .......................

Rallies, demonstrations, seminars, conventions, speeches, lectures, or any similar means? ..................

Other activities? ...................................................................................................................

Yes

4,857

Total. Add lines 1c through 1i ....................................................................................................

4,857

Did the activities in line 1 cause the organization to be not described in section 501(c)(3)? .....

If "Yes," enter the amount of any tax incurred under section 4912 ...........................................

If "Yes," enter the amount of any tax incurred by organization managers under section 4912 ...................

If the filing organization incurred a section 4912 tax, did it file Form 4720 for this year? ........................

Part III-A

Complete if the organization is exempt under section 501(c)(4), section 501(c)(5), or section 501(c)(6).

Yes

Were substantially all (90% or more) dues received nondeductible by members? ...............................................

Did the organization make only in-house lobbying expenditures of $2,000 or less? ............................................

Did the organization agree to carry over lobbying and political expenditures from the prior year? .................................

Part III-B

Complete if the organization is exempt under section 501(c)(4), section 501(c)(5), or section 501(c)(6) and if either (a) BOTH Part III-A, lines 1 and 2, are answered "No" OR (b) Part III-A, line 3, is answered “Yes."

Dues, assessments and similar amounts from members ......................................................................

Section 162(e) nondeductible lobbying and political expenditures (do not include amounts of political expenses for which the section 527(f) tax was paid).

Current year .............................................................................................................................

Carryover from last year ............................................................................................................

Total ...........................................................................................................................................

Aggregate amount reported in section 6033(e)(1)(A) notices of nondeductible section 162(e) dues .

If notices were sent and the amount on line 2c exceeds the amount on line 3, what portion of the excess does the organization agree to carryover to the reasonable estimate of nondeductible lobbying and political expenditure next year? ......................................................................................................................

Taxable amount of lobbying and political expenditures (see instructions) .........................................

Part IV

Supplemental Information

Provide the descriptions required for Part l-A, line 1; Part l-B, line 4; Part l-C, line 5; Part II-A (affiliated group list); Part II-A, lines 1 and 2 (see instructions), and Part ll-B, line 1. Also, complete this part for any additional information.

Return Reference	Explanation
PART II-B, LINE 1I	OTHER ACTIVITIES $4,676 - PORTION OF ILLINOIS HOSPITAL ASSOCIATION (IHA) DUES ATTRIBUTABLE TO LOBBYING $181- PORTION OF MISCELLANEOUS HEALTH CARE ORGANIZATION DUES ATTRIBUTABLE TO LOBBYING

Schedule C (Form 990 or 990EZ) 2019

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE D
(Form 990)

Department of the Treasury
Internal Revenue Service

Supplemental Financial Statements

Complete if the organization answered "Yes," on Form 990,
Part IV, line 6, 7, 8, 9, 10, 11a, 11b, 11c, 11d, 11e, 11f, 12a, or 12b.
SchDMd Bullet

Attach to Form 990.
SchDMd Bullet

Go to www.irs.gov/Form990 for instructions and the latest information.

OMB No. 1545-0047

2019

Open to Public Inspection

Name of the organization

HOOPESTON COMMUNITY MEMORIAL HOSPITAL

Employer identification number

36-3637465

Part I

Organizations Maintaining Donor Advised Funds or Other Similar Funds or Accounts. Complete if the organization answered "Yes" on Form 990, Part IV, line 6.

		(a) Donor advised funds	(b) Funds and other accounts
1	Total number at end of year .........
2	Aggregate value of contributions to (during year)
3	Aggregate value of grants from (during year)
4	Aggregate value at end of year ........

Did the organization inform all donors and donor advisors in writing that the assets held in donor advised funds are the organization’s property, subject to the organization’s exclusive legal control? ............

Yes No

Did the organization inform all grantees, donors, and donor advisors in writing that grant funds can be used only for charitable purposes and not for the benefit of the donor or donor advisor, or for any other purpose conferring impermissible private benefit? ...................................

Yes No

Part II

Conservation Easements.
Complete if the organization answered "Yes" on Form 990, Part IV, line 7.

Purpose(s) of conservation easements held by the organization (check all that apply).

Preservation of land for public use (e.g., recreation or education) Preservation of an historically important land area

Protection of natural habitat Preservation of a certified historic structure

Preservation of open space

Complete lines 2a through 2d if the organization held a qualified conservation contribution in the form of a conservation easement on the last day of the tax year.


a	Total number of conservation easements ......................	2a
b	Total acreage restricted by conservation easements ....................	2b
c	Number of conservation easements on a certified historic structure included in (a) .....	2c
d	Number of conservation easements included in (c) acquired after 7/25/06, and not on a historic structure listed in the National Register ...	2d

Number of conservation easements modified, transferred, released, extinguished, or terminated by the organization during the
tax year SchDMd Bullet

Number of states where property subject to conservation easement is located SchDMd Bullet

Does the organization have a written policy regarding the periodic monitoring, inspection, handling of violations, and enforcement of the conservation easements it holds? ............

Yes No

Staff and volunteer hours devoted to monitoring, inspecting, handling of violations, and enforcing conservation easements during the year
SchDMd Bullet

Amount of expenses incurred in monitoring, inspecting, handling of violations, and enforcing conservation easements during the year
SchDMd Bullet

Does each conservation easement reported on line 2(d) above satisfy the requirements of section 170(h)(4)(B)(i) and section 170(h)(4)(B)(ii)? .............................

Yes No

In Part XIII, describe how the organization reports conservation easements in its revenue and expense statement, and
balance sheet, and include, if applicable, the text of the footnote to the organization’s financial statements that describes
the organization’s accounting for conservation easements.

Part III

Organizations Maintaining Collections of Art, Historical Treasures, or Other Similar Assets.
Complete if the organization answered "Yes" on Form 990, Part IV, line 8.

If the organization elected, as permitted under FASB ASC 958, not to report in its revenue statement and balance sheet works of art, historical treasures, or other similar assets held for public exhibition, education, or research in furtherance of public service, provide, in Part XIII, the text of the footnote to its financial statements that describes these items.

If the organization elected, as permitted under FASB ASC 958, to report in its revenue statement and balance sheet works of art, historical treasures, or other similar assets held for public exhibition, education, or research in furtherance of public service, provide the following amounts relating to these items:

(i)

Revenue included on Form 990, Part VIII, line 1 ......................... SchDMd Bullet

(ii)

Assets included in Form 990, Part X ............................... SchDMd Bullet

If the organization received or held works of art, historical treasures, or other similar assets for financial gain, provide the
following amounts required to be reported under FASB ASC 958 relating to these items:

Revenue included on Form 990, Part VIII, line 1 .......................... SchDMd Bullet

Assets included in Form 990, Part X ............................... SchDMd Bullet

For Paperwork Reduction Act Notice, see the Instructions for Form 990.

Cat. No. 52283D

Schedule D (Form 990) 2019

Page 2

Part III

Organizations Maintaining Collections of Art, Historical Treasures, or Other Similar Assets (continued)

Using the organization’s acquisition, accession, and other records, check any of the following that are a significant use of its collection items (check all that apply):

Public exhibition

Loan or exchange programs

Scholarly research

Other

Preservation for future generations

Provide a description of the organization’s collections and explain how they further the organization’s exempt purpose in
Part XIII.

During the year, did the organization solicit or receive donations of art, historical treasures or other similar
assets to be sold to raise funds rather than to be maintained as part of the organization’s collection?...

Yes No

Part IV

Escrow and Custodial Arrangements. Complete if the organization answered "Yes" on Form 990, Part IV, line 9, or reported an amount on Form 990, Part X, line 21.

Is the organization an agent, trustee, custodian or other intermediary for contributions or other assets not
included on Form 990, Part X? ....................................

Yes No


b	If "Yes," explain the arrangement in Part XIII and complete the following table:		Amount
c	Beginning balance .............................	1c
d	Additions during the year ............................	1d
e	Distributions during the year ..........................	1e
f	Ending balance ................................	1f

Did the organization include an amount on Form 990, Part X, line 21, for escrow or custodial account liability? ...

Yes No

If "Yes," explain the arrangement in Part XIII. Check here if the explanation has been provided in Part XIII ....

Part V

Endowment Funds.
Complete if the organization answered "Yes" on Form 990, Part IV, line 10.

		(a) Current year	(b) Prior year	(c) Two years back	(d) Three years back	(e) Four years back

1a	Beginning of year balance ....
b	Contributions ...
c	Net investment earnings, gains, and losses
d	Grants or scholarships ...
e	Other expenditures for facilities and programs ...
f	Administrative expenses ....
g	End of year balance ......

Provide the estimated percentage of the current year end balance (line 1g, column (a)) held as:

Board designated or quasi-endowment SchDMd Bullet

Permanent endowment SchDMd Bullet

Term endowment SchDMd Bullet

The percentages on lines 2a, 2b, and 2c should equal 100%.

Are there endowment funds not in the possession of the organization that are held and administered for the
organization by:

Yes

(i) Unrelated organizations .................

3a(i)

(ii) Related organizations .................

3a(ii)

If "Yes" on 3a(ii), are the related organizations listed as required on Schedule R? .........

Describe in Part XIII the intended uses of the organization's endowment funds.

Part VI

Land, Buildings, and Equipment.
Complete if the organization answered "Yes" on Form 990, Part IV, line 11a. See Form 990, Part X, line 10.

Description of property		(a) Cost or other basis (investment)	(b) Cost or other basis (other)	(c) Accumulated depreciation	(d) Book value

1a	Land .....	110,211		110,211
b	Buildings ....	11,953,090	4,850,478	7,102,612
c	Leasehold improvements	1,735,646	1,592,660	142,986
d	Equipment ....	11,785,783	6,769,591	5,016,192
e	Other .....	1,473,195	592,887	880,308
Total. Add lines 1a through 1e. (Column (d) must equal Form 990, Part X, column (B), line 10(c).)..				13,252,309

Schedule D (Form 990) 2019

Page 3

Part VII

InvestmentsOther Securities.
Complete if the organization answered "Yes" on Form 990, Part IV, line 11b. See Form 990, Part X, line 12.

(a) Description of security or category (including name of security)	(b) Book value	(c) Method of valuation: Cost or end-of-year market value
(1) Financial derivatives.........
(2) Closely-held equity interests........
(3)Other
(B)
(C)
(D)
(E)
(F)
(G)
(H)
(I)
Total. (Column (b) must equal Form 990, Part X, col. (B) line 12.)

Part VIII

InvestmentsProgram Related. Complete if the organization answered 'Yes' on Form 990, Part IV, line 11c. See Form 990, Part X, line 13.

(a) Description of investment	(b) Book value	(c) Method of valuation: Cost or end-of-year market value

(2)
(3)
(4)
(5)
(6)
(7)
(8)
(9)
(10)
Total. (Column (b) must equal Form 990, Part X, col.(B) line 13.)

Part IX

Other Assets.
Complete if the organization answered 'Yes' on Form 990, Part IV, line 11d. See Form 990, Part X, line 15.

(a) Description				(b) Book value
(1)DEVL LIMITED ASSETS				33,242
(2)HRHC FCS ESCROW				571,189
(3)LONG TERM INVESTMENTS				3,604,787
(4)NET RIGHT-OF-USE ASSETS				457,155
(5)
(6)
(7)
(8)
(9)
(10)
Total. (Column (b) must equal Form 990, Part X, col.(B) line 15.)...........				4,666,373

Part X

Other Liabilities.
Complete if the organization answered 'Yes' on Form 990, Part IV, line 11e or 11f. See Form 990, Part X, line 25.

1.(a) Description of liability	(b) Book value
(1) Federal income taxes	0
(8)
(9)
Total. (Column (b) must equal Form 990, Part X, col.(B) line 25.)	25,773,633
2. Liability for uncertain tax positions. In Part XIII, provide the text of the footnote to the organization's financial statements that reports the organization's liability for uncertain tax positions under FIN 48 (ASC 740). Check here if the text of the footnote has been provided in Part XIII

Schedule D (Form 990) 2019

Page 4

Part XI Reconciliation of Revenue per Audited Financial Statements With Revenue per Return. Complete if the organization answered 'Yes' on Form 990, Part IV, line 12a.
1	Total revenue, gains, and other support per audited financial statements .......		1
2	Amounts included on line 1 but not on Form 990, Part VIII, line 12:
a	Net unrealized gains (losses) on investments ....	2a
b	Donated services and use of facilities .........	2b
c	Recoveries of prior year grants ...........	2c
d	Other (Describe in Part XIII.) ............	2d
e	Add lines 2a through 2d .....................		2e
3	Subtract line 2e from line 1..................		3
4	Amounts included on Form 990, Part VIII, line 12, but not on line 1:
a	Investment expenses not included on Form 990, Part VIII, line 7b .	4a
b	Other (Describe in Part XIII.) ...........	4b
c	Add lines 4a and 4b....................		4c
5	Total revenue. Add lines 3 and 4c. (This must equal Form 990, Part I, line 12.) ......		5

Part XII Reconciliation of Expenses per Audited Financial Statements With Expenses per Return. Complete if the organization answered 'Yes' on Form 990, Part IV, line 12a.
1	Total expenses and losses per audited financial statements ...........		1
2	Amounts included on line 1 but not on Form 990, Part IX, line 25:
a	Donated services and use of facilities .........	2a
b	Prior year adjustments ............	2b
c	Other losses ................	2c
d	Other (Describe in Part XIII.) ............	2d
e	Add lines 2a through 2d....................		2e
3	Subtract line 2e from line 1...................		3
4	Amounts included on Form 990, Part IX, line 25, but not on line 1:
a	Investment expenses not included on Form 990, Part VIII, line 7b ..	4a
b	Other (Describe in Part XIII.) ............	4b
c	Add lines 4a and 4b.....................		4c
5	Total expenses. Add lines 3 and 4c. (This must equal Form 990, Part I, line 18.) ......		5

Part XIII

Supplemental Information

Provide the descriptions required for Part II, lines 3, 5, and 9; Part III, lines 1a and 4; Part lV, lines 1b and 2b; Part V, line 4; Part X, line 2; Part XI, lines 2d and 4b; and Part XII, lines 2d and 4b. Also complete this part to provide any additional information.

Return Reference	Explanation
SCHEDULE D, PART X, LINE 2	FIN 48 (ASC740) FOOTNOTE THE GUIDANCE ON ACCOUNTING FOR UNCERTAINTY IN INCOME TAXES PRESCRIBES A MORE-LIKELY-THAN-NOT RECOGNITION THERESHOLD AND MEASUREMENT ATTRIBUTE FOR FINANCIAL STATEMENTS RECOGNITION OF A TAX POSITION TAKEN OR EXPECTED TO BE TAKEN. THERE WERE NO UNCERTAIN TAX BENEFITS IDENTIFIED OR RECORDED AS A LIABILITY AS OF DECEMBER 31, 2019 AND 2018.

Schedule D (Form 990) 2019

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE H
(Form 990)

Department of the Treasury
Internal Revenue Service

Hospitals

Complete if the organization answered "Yes" on Form 990, Part IV, question 20.
MediumBullet

Attach to Form 990.
MediumBullet

Go to www.irs.gov/Form990EZ for instructions and the latest information.

OMB No. 1545-0047

2019

Open to Public Inspection

Name of the organization

HOOPESTON COMMUNITY MEMORIAL HOSPITAL

Employer identification number

36-3637465

Part I

Financial Assistance and Certain Other Community Benefits at Cost

Yes

Did the organization have a financial assistance policy during the tax year? If "No," skip to question 6a . . . .

Yes

If "Yes," was it a written policy? ......................

Yes

If the organization had multiple hospital facilities, indicate which of the following best describes application of the financial assistance policy to its various hospital facilities during the tax year.

Applied uniformly to all hospital facilities Applied uniformly to most hospital facilities Generally tailored to individual hospital facilities

Answer the following based on the financial assistance eligibility criteria that applied to the largest number of the organization's patients during the tax year.

Did the organization use Federal Poverty Guidelines (FPG) as a factor in determining eligibility for providing free care?

If "Yes," indicate which of the following was the FPG family income limit for eligibility for free care:

Yes

100% 150% 200% Other %

Did the organization use FPG as a factor in determining eligibility for providing discounted care? If "Yes," indicate

which of the following was the family income limit for eligibility for discounted care: . . . . . . . .

Yes

200% 250% 300% 350% 400% Other %

If the organization used factors other than FPG in determining eligibility, describe in Part VI the criteria used for determining eligibility for free or discounted care. Include in the description whether the organization used an asset test or other threshold, regardless of income, as a factor in determining eligibility for free or discounted care.

Did the organization's financial assistance policy that applied to the largest number of its patients during the tax year provide for free or discounted care to the "medically indigent"? . . . . . . . . . . . . .

Yes

Did the organization budget amounts for free or discounted care provided under its financial assistance policy during
the tax year? . . . . . . . . . . . . . . . . . . . . . . .

Yes

If "Yes," did the organization's financial assistance expenses exceed the budgeted amount? . . . . . .

If "Yes" to line 5b, as a result of budget considerations, was the organization unable to provide free or discountedcare to a patient who was eligibile for free or discounted care? . . . . . . . . . . . . .

Did the organization prepare a community benefit report during the tax year? . . . . . . . . .

Yes

If "Yes," did the organization make it available to the public? . . . . . . . . . . . . .

Yes

Complete the following table using the worksheets provided in the Schedule H instructions. Do not submit these worksheets with the Schedule H.

Financial Assistance and Certain Other Community Benefits at Cost

Financial Assistance and Means-Tested Government Programs		(c) Total community benefit expense	(d) Direct offsetting revenue	(e) Net community benefit expense	(f) Percent of total expense
a	Financial Assistance at cost (from Worksheet 1) . . .	2,550,691		2,550,691	3.700 %
b	Medicaid (from Worksheet 3, column a) . . . . .	14,492,842	12,806,960	1,685,882	2.460 %
c	Costs of other means-tested government programs (from Worksheet 3, column b) . .
d	Total Financial Assistance and Means-Tested Government Programs . . . . .	17,043,533	12,806,960	4,236,573	6.160 %
Other Benefits
e	Community health improvement services and community benefit operations (from Worksheet 4).	217,277		217,277	0.320 %
f	Health professions education (from Worksheet 5) . . .
g	Subsidized health services (from Worksheet 6) . . . .
h	Research (from Worksheet 7) .
i	Cash and in-kind contributions for community benefit (from Worksheet 8) . . . .	32,876		32,876	0.050 %
j	Total. Other Benefits . .	250,153		250,153	0.370 %
k	Total. Add lines 7d and 7j .	17,293,686	12,806,960	4,486,726	6.530 %

For Paperwork Reduction Act Notice, see the Instructions for Form 990. Cat. No. 50192T Schedule H (Form 990) 2019

Schedule H (Form 990) 2019

Page

Part II

Community Building Activities Complete this table if the organization conducted any community building activities during the tax year, and describe in Part VI how its community building activities promoted the health of the communities it serves.

		(c) Total community building expense	(e) Net community building expense
1	Physical improvements and housing
2	Economic development
3	Community support	22,930	22,930
4	Environmental improvements
5	Leadership development and training for community members
6	Coalition building
7	Community health improvement advocacy
8	Workforce development
9	Other
10	Total	22,930	22,930

Part III

Bad Debt, Medicare, & Collection Practices

Section A. Bad Debt Expense

Yes

Did the organization report bad debt expense in accordance with Healthcare Financial Management Association Statement No. 15? ..........................

Yes

Enter the amount of the organization's bad debt expense. Explain in Part VI the methodology used by the organization to estimate this amount. ......

1,258,481

Enter the estimated amount of the organization's bad debt expense attributable to patients eligible under the organization's financial assistance policy. Explain in Part VI the methodology used by the organization to estimate this amount and the rationale, if any, for including this portion of bad debt as community benefit. ......

629,241

Provide in Part VI the text of the footnote to the organization’s financial statements that describes bad debt expense or the page number on which this footnote is contained in the attached financial statements.

Section B. Medicare

Enter total revenue received from Medicare (including DSH and IME).....

13,911,650

Enter Medicare allowable costs of care relating to payments on line 5.....

16,796,757

Subtract line 6 from line 5. This is the surplus (or shortfall)........

-2,885,107

Describe in Part VI the extent to which any shortfall reported in line 7 should be treated as community benefit.Also describe in Part VI the costing methodology or source used to determine the amount reported on line 6.Check the box that describes the method used:

Cost accounting system Cost to charge ratio Other

Section C. Collection Practices

Did the organization have a written debt collection policy during the tax year? ..........

Yes

If "Yes," did the organization’s collection policy that applied to the largest number of its patients during the tax year
contain provisions on the collection practices to be followed for patients who are known to qualify for financial assistance? Describe in Part VI .........................

Yes

Part IV

Management Companies and Joint Ventures(owned 10% or more by officers, directors, trustees, key employees, and physicians—see instructions)

(a) Name of entity	(b) Description of primary activity of entity	(c) Organization's profit % or stock ownership %	(d) Officers, directors, trustees, or key employees' profit % or stock ownership %	(e) Physicians' profit % or stock ownership %
1
2
3
4
5
6
7
8
9
10
11
12
13

Schedule H (Form 990) 2019

Page

Part VFacility Information

Section A. Hospital Facilities (list in order of size from largest to smallest—see instructions)How many hospital facilities did the organization operate during the tax year?1Name, address, primary website address, and state license number (and if a group return, the name and EIN of the subordinate hospital organization that operates the hospital facility)
1	Hoopeston Community Memorial Hospital 701 E Orange St Hoopeston,IL609421801 WWW.CARLE.ORG/HOOPESTON 0004200	X	X	X	X

Schedule H (Form 990) 2019

Page 4

Part VFacility Information (continued)

Section B. Facility Policies and Practices

(Complete a separate Section B for each of the hospital facilities or facility reporting groups listed in Part V, Section A)

	HOOPESTON COMMUNITY MEMORIAL HOSPITAL
Name of hospital facility or letter of facility reporting group

Line number of hospital facility, or line numbers of hospital facilities in a facility
reporting group (from Part V, Section A):

Yes

Community Health Needs Assessment

Was the hospital facility first licensed, registered, or similarly recognized by a state as a hospital facility in the current tax year or the immediately preceding tax year?........................

Was the hospital facility acquired or placed into service as a tax-exempt hospital in the current tax year or the immediately preceding tax year? If “Yes,” provide details of the acquisition in Section C...............

During the tax year or either of the two immediately preceding tax years, did the hospital facility conduct a community health needs assessment (CHNA)? If "No," skip to line 12......................

Yes

If "Yes," indicate what the CHNA report describes (check all that apply):

A definition of the community served by the hospital facility

Demographics of the community

Existing health care facilities and resources within the community that are available to respond to the health needs of the community

How data was obtained

The significant health needs of the community

Primary and chronic disease needs and other health issues of uninsured persons, low-income persons, and minority groups

The process for identifying and prioritizing community health needs and services to meet the community health needs

The process for consulting with persons representing the community’s interests

The impact of any actions taken to address the significant health needs identified in the hospital facility's prior CHNA(s)

Other (describe in Section C)

Indicate the tax year the hospital facility last conducted a CHNA: 20 18

In conducting its most recent CHNA, did the hospital facility take into account input from persons who represent the broad interests of the community served by the hospital facility, including those with special knowledge of or expertise in public health? If "Yes," describe in Section C how the hospital facility took into account input from persons who represent the community, and identify the persons the hospital facility consulted .................

Yes

6 a

Was the hospital facility’s CHNA conducted with one or more other hospital facilities? If "Yes," list the other hospital facilities in Section C..................................

Yes

Was the hospital facility’s CHNA conducted with one or more organizations other than hospital facilities?” If “Yes,” list the other organizations in Section C. ............................

Yes

Did the hospital facility make its CHNA report widely available to the public?..............

Yes

If "Yes," indicate how the CHNA report was made widely available (check all that apply):

Hospital facility’s website (list url): CARLE.ORG/CHNA

Other website (list url):

Made a paper copy available for public inspection without charge at the hospital facility

Other (describe in Section C)

Did the hospital facility adopt an implementation strategy to meet the significant community health needs
identified through its most recently conducted CHNA? If "No," skip to line 11. ..............

Yes

Indicate the tax year the hospital facility last adopted an implementation strategy: 20 18

Is the hospital facility's most recently adopted implementation strategy posted on a website?.........

Yes

If "Yes" (list url): CARLE.ORG/CHNA

If "No," is the hospital facility’s most recently adopted implementation strategy attached to this return? ......

10b

Describe in Section C how the hospital facility is addressing the significant needs identified in its most recently conducted CHNA and any such needs that are not being addressed together with the reasons why such needs are not being addressed.

12a

Did the organization incur an excise tax under section 4959 for the hospital facility's failure to conduct a CHNA as required by section 501(r)(3)?...............................

12a

If "Yes" on line 12a, did the organization file Form 4720 to report the section 4959 excise tax?........

12b

If "Yes" on line 12b, what is the total amount of section 4959 excise tax the organization reported on Form 4720 for all of its hospital facilities? $

Schedule H (Form 990) 2019

Page 5

Part VFacility Information (continued)

Financial Assistance Policy (FAP)

	HOOPESTON COMMUNITY MEMORIAL HOSPITAL
Name of hospital facility or letter of facility reporting group

Yes

Did the hospital facility have in place during the tax year a written financial assistance policy that:

Explained eligibility criteria for financial assistance, and whether such assistance included free or discounted care?

Yes

If “Yes,” indicate the eligibility criteria explained in the FAP:

Federal poverty guidelines (FPG), with FPG family income limit for eligibility for free care of 200.%
and FPG family income limit for eligibility for discounted care of 400.%

Income level other than FPG (describe in Section C)

Asset level

Medical indigency

Insurance status

Underinsurance discount

Residency

Other (describe in Section C)

Explained the basis for calculating amounts charged to patients?.................

Yes

Explained the method for applying for financial assistance?...................

Yes

If “Yes,” indicate how the hospital facility’s FAP or FAP application form (including accompanying instructions) explained the method for applying for financial assistance (check all that apply):

Described the information the hospital facility may require an individual to provide as part of his or her application

Described the supporting documentation the hospital facility may require an individual to submit as part of his or
her application

Provided the contact information of hospital facility staff who can provide an individual with information about the
FAP and FAP application process

Provided the contact information of nonprofit organizations or government agencies that may be sources of
assistance with FAP applications

Other (describe in Section C)

Was widely publicized within the community served by the hospital facility?........

Yes

If "Yes," indicate how the hospital facility publicized the policy (check all that apply):

The FAP was widely available on a website (list url):

SEE SUPPLEMENTAL INFORMATION

The FAP application form was widely available on a website (list url):

SEE SUPPLEMENTAL INFORMATION

A plain language summary of the FAP was widely available on a website (list url):
SEE SUPPLEMENTAL INFORMATION

The FAP was available upon request and without charge (in public locations in the hospital facility and by mail)

The FAP application form was available upon request and without charge (in public locations in the hospital facility
and by mail)

A plain language summary of the FAP was available upon request and without charge (in public locations in the
hospital facility and by mail)

Individuals were notified about the FAP by being offered a paper copy of the plain language summary of the FAP, by
receiving a conspicuous written notice about the FAP on their billing statements, and via conspicuous public displays or
other measures reasonably calculated to attract patients' attention

Notified members of the community who are most likely to require financial assistance about availability of the FAP

The FAP, FAP application form, and plain language summary of the FAP were translated into the primary language(s)
spoken by LEP populations

Other (describe in Section C)

Schedule H (Form 990) 2019

Page 6

Part VFacility Information (continued)

Billing and Collections

	HOOPESTON COMMUNITY MEMORIAL HOSPITAL
Name of hospital facility or letter of facility reporting group

Yes

Did the hospital facility have in place during the tax year a separate billing and collections policy, or a written financial assistance policy (FAP) that explained all of the actions the hospital facility or other authorized party may take upon nonpayment?..................................

Yes

Check all of the following actions against an individual that were permitted under the hospital facility's policies during the tax year before making reasonable efforts to determine the individual’s eligibility under the facility’s FAP:

Reporting to credit agency(ies)

Selling an individual’s debt to another party

Deferring, denying, or requiring a payment before providing medically necessary care due to nonpayment of a previous
bill for care covered under the hospital facility's FAP

Actions that require a legal or judicial process

Other similar actions (describe in Section C)

None of these actions or other similar actions were permitted

Did the hospital facility or other authorized party perform any of the following actions during the tax year before making reasonable efforts to determine the individual’s eligibility under the facility’s FAP?............

If "Yes," check all actions in which the hospital facility or a third party engaged:

Reporting to credit agency(ies)

Selling an individual’s debt to another party

Deferring , denying, or requiring a payment before providing medically necessary care due to nonpayment of a previous
bill for care covered under the hospital facility's FAP

Actions that require a legal or judicial process

Other similar actions (describe in Section C)

Indicate which efforts the hospital facility or other authorized party made before initiating any of the actions listed (whether or not checked) in line 19. (check all that apply):

Provided a written notice about upcoming ECAs (Extraordinary Collection Action) and a plain language summary of the
FAP at least 30 days before initiating those ECAs (if not, describe in Section C)

Made a reasonable effort to orally notify individuals about the FAP and FAP application process (if not, describe in
Section C)

Processed incomplete and complete FAP applications (if not, describe in Section C)

Made presumptive eligibility determinations (if not, describe in Section C)

Other (describe in Section C)

None of these efforts were made

Policy Relating to Emergency Medical Care

Did the hospital facility have in place during the tax year a written policy relating to emergency medical care that required the hospital facility to provide, without discrimination, care for emergency medical conditions to individuals regardless of their eligibility under the hospital facility’s financial assistance policy?..................

Yes

If "No," indicate why:

The hospital facility did not provide care for any emergency medical conditions

The hospital facility’s policy was not in writing

The hospital facility limited who was eligible to receive care for emergency medical conditions (describe in Section C)

Other (describe in Section C)

Schedule H (Form 990) 2019

Page 7

Part VFacility Information (continued)

Charges to Individuals Eligible for Assistance Under the FAP (FAP-Eligible Individuals)

	HOOPESTON COMMUNITY MEMORIAL HOSPITAL
Name of hospital facility or letter of facility reporting group

Yes

Indicate how the hospital facility determined, during the tax year, the maximum amounts that can be charged to FAP-eligible individuals for emergency or other medically necessary care.

The hospital facility used a look-back method based on claims allowed by Medicare fee-for-service during a prior 12-month period

The hospital facility used a look-back method based on claims allowed by Medicare fee-for-service and all private health insurers that pay claims to the hospital facility during a prior 12-month period

The hospital facility used a look-back method based on claims allowed by Medicaid, either alone or in combination with
Medicare fee-for-service and all private health insurers that pay claims to the hospital facility during a prior 12-month
period

The hospital facility used a prospective Medicare or Medicaid method

During the tax year, did the hospital facility charge any FAP-eligible individual to whom the hospital facility provided emergency or other medically necessary services more than the amounts generally billed to individuals who had insurance covering such care? ...............................

If "Yes," explain in Section C.

During the tax year, did the hospital facility charge any FAP-eligible individual an amount equal to the gross charge for any service provided to that individual? ...........................

If "Yes," explain in Section C.

Schedule H (Form 990) 2019

Page 8

Part V

Facility Information (continued)

Section C. Supplemental Information for Part V, Section B. Provide descriptions required for Part V, Section B, lines 2, 3j, 5, 6a, 6b, 7d, 11, 13b, 13h, 15e, 16j, 18e, 19e, 20a, 20b, 20c, 20d, 20e, 21c, 21d, 23, and 24. If applicable, provide separate descriptions for each hospital facility in a facility reporting group, designated by facility reporting group letter and hospital facility line number from Part V, Section A (“A, 1,” “A, 4,” “B, 2,” “B, 3,” etc.) and name of hospital facility.
Form and Line Reference	Explanation
COMMUNITY HEALTH NEEDS ASSESSMENT (PART V, SECT B, LINE 5)	THROUGHOUT 2017, THE CHAMPAIGN-VERMILION COUNTY REGIONAL EXECUTIVE COMMITTEE, CONSISTING OF REPRESENTATIVES FROM HOOPESTON COMMUNITY MEMORIAL HOSPITAL (HCMH), CARLE FOUNDATION HOSPITAL, CHAMPAIGN-URBANA PUBLIC HEALTH DISTRICT (CUPHD), OSF HEALTHCARE (FORMERLY PRESENCE COVENANT AND UNITED SAMARITANS MEDICAL CENTER), VERMILION COUNTY HEALTH DEPARTMENT, AND UNITED WAY OF CHAMPAIGN AND VERMILION COUNTIES, STARTED RESEARCH TO CONDUCT AN UPDATED COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA) IN VERMILION COUNTY IN PREPARATION FOR THE 2017-2022 ILLINOIS PROJECT FOR LOCAL ASSESSMENT OF NEEDS (IPLAN). DEVELOPMENT OF THIS PLAN WAS A COLLABORATIVE EFFORT, WORKING WITH COMMUNITY PARTNERS, REGIONAL SCHOOLS OF NURSING, LOCAL AND STATE GOVERNMENT REPRESENTATIVES, AND INPUT FROM COUNTY RESIDENTS. MORE THAN 50 COMMUNITY LEADERS FROM A VARIETY OF AGENCIES AND ORGANIZATIONS, AS WELL AS MORE THAN 1,500 COUNTY RESIDENTS, CONTRIBUTED TO THE ASSESSMENT VIA BOTH IN-PERSON MEETINGS AND SURVEYS. COLLECTIVELY, THESE PARTNERS PLAYED A ROLE IN REPRESENTING THE MEDICALLY UNDERSERVED, LOW-INCOME, OR MINORITY POPULATIONS IN VERMILION COUNTY. THOSE COMMUNITY PARTNERS INCLUDE HCMH, THE CARLE FOUNDATION HOSPITAL, OSF HEALTHCARE SACRED HEART MEDICAL CENTER (FORMERLY PRESENCE UNITED SAMARITANS MEDICAL CENTER), VERMILION VOUNTY HEALTH DISTRICT, UNITED WAY OF DANVILLE AREA, VERMILION COUNTY BOARD, CRIS HEALTHY AGING CENTER, AUNT MARTHA'S HEALTH CENTER (FQHC), BIG BROTHERS BIG SISTERS, HOUSING AUTHORITY OF THE CITY OF DANVILLE, DANVILLE COMMERCIAL NEWS, DANVILLE AREA COMMUNITY COLLEGE, CHILD CARE RESOURCE SERVICE (CCRS), FAITH IN ACTION, VA ILLIANA, DANVILLE FAMILY YMCA, DANVILLE SCHOOL DISTRICT 118, VERMILION COUNTY REGIONAL OFFICE OF EDUCATION, HOOPESTON COMMUNITY UNIT SCHOOL DISTRICT 11, UNIVERSITY OF ILLINOIS EXTENSION, VERMILION ADVANTAGE, EAST CENTRAL ILLINOIS COMMUNITY ACTION AGENCY, I SING THE BODY ELECTRIC, WDNL-WDAN-WRHK. VERMILION COUNTY EMERGENCY MANAGEMENT AGENCY, VERMILION COUNTY MENTAL HEALTH BOARD, HOOPESTON MULTI AGENCY, AND SURVIVOR RESOURCE CENTER (FORMERLY VERMILION COUNTY RAPE CRISIS CENTER). AFTER ASSESSING THE CURRENT HEALTH STATUS OF THE COMMUNITY AND IDENTIFIED NEEDS, THE REGIONAL EXECUTIVE COMMITTEE CREATED A COMPREHENSIVE PLAN TO IMPROVE OUR COMMUNITY'S HEALTH. BASED UPON THE COMMUNITY HEALTH NEEDS ASSESSMENT USING BOTH QUANTITATIVE AND QUALITATIVE RESEARCH, HCMH PRIORITIZED THE SIGNIFICANT COMMUNITY HEALTH NEEDS OF VERMILION COUNTY CONSIDERING SEVERAL CRITERIA INCLUDING: ALIGNMENT WITH THE HOSPITAL'S MISSION, EXISTING PROGRAMS, THE ABILITY TO MAKE AN IMPACT WITHIN A REASONABLE TIME FRAME, THE FINANCIAL AND HUMAN RESOURCES REQUIRED, AND WHETHER THERE WOULD BE A MEASURABLE OUTCOME TO GAUGE IMPROVEMENT. THE FOLLOWING FOUR HEALTH AREAS WERE SELECTED AS THE TOP PRIORITIES: 1. TEEN PREGNANCY 2. SUBSTANCE AND ALCOHOL ABUSE 3. OBESITY 4. MENTAL HEALTH HCMH'S COMMUNITY HEALTH NEEDS ASSESSMENT AND COMMUNITY BENEFIT IMPLEMENTATION PLAN WERE BOTH ADOPTED AND APPROVED BY HCMH'S BOARD OF TRUSTEES ON OCTOBER 25, 2018.
COMMUNITY HEALTH NEEDS ASSESSMENT (PART V, SECT B, LINE 6A)	CARLE FOUNDATION HOSPITAL, OSF HEALTHCARE SACRED HEART MEDICAL CENTER (FORMERLY PRESENCE UNITED SAMARITANS MEDICAL CENTER)
COMMUNITY HEALTH NEEDS ASSESSMENT (PART V, SECT B, LINE 6B)	UNITED WAY, VERMILION COUNTY HEALTH DEPARTMENT, I SING THE BODY ELECTRIC
COMMUNITY HEALTH NEEDS ASSESSMENT (PART V, SECT B, LINE 11)	HOOPESTON COMMUNITY MEMORIAL HOSPITAL CONTINUES ITS WORK TO IMPROVE THE OVERALL HEALTH OF THE COMMUNITY THROUGH SERVICE TO ITS PATIENTS, INCLUDING EMPHASIS ON ACCESS TO HEALTH SERVICES AND OTHER SPECIALTIES AND SERVICES THE HOSPITAL OR CARLE HEALTH SYSTEM PROVIDES. THE CARLE FOUNDATION IS DILIGENTLY WORKING TO IMPROVING ACCESS AND SERVICES THROUGHOUT THE EAST CENTRAL ILLINOIS REGION, NOT JUST FOR THIS GEOGRAPHIC AREA. MANY OF THE OTHER CONCERNS ARE ALSO ADDRESSED THROUGH SERVICES PROVIDED FOR CARLE PATIENTS, BUT THESE AREAS ARE NOT THE PRIMARY EMPHASIS OF THE COMMUNITY BENEFIT IMPLEMENTATION PLAN WHICH TARGETS MORE SPECIFIC LOW-INCOME POPULATIONS IN VERMILION COUNTY.
HOW HCMH IS ADDRESSING SIGNIFICANT HEALTH NEEDS	THROUGH THESE EFFORTS, HOOPESTON COMMUNITY MEMORIAL HOSPITAL INTENDS TO HELP IMPROVE THE OVERALL HEALTH OF THE COMMUNITY BY ADDRESSING THE MOST SIGNIFICANT NEEDS FACING THE POPULATION, WITH EMPHASIS ON THOSE IN GREATEST NEED.
PRIORITY #1: TEEN PREGNANCY	HCMH CONTINUES TO ADDRESS TEEN PREGNANCY THROUGH INCREASING PARENT INVOLVEMENT AND EXTRACURRICULAR ACTIVITIES, PROMOTING SEXUAL EDUCATION AND COMMUNITY PROGRAMS, AND TARGETING MALE TEENS / MALE INVOLVEMENT TO REDUCE THE TEEN PREGNANCY RATE. EVALUATION OF PRIOR IMPACT: TEEN AND ADOLESCENT HEALTH HAS BEEN A CONCERN IN VERMILION COUNTY FOR MANY YEARS. IN THE PREVIOUS IMPLEMENTATION PLAN, HOOPESTON COMMUNITY MEMORIAL HOSPITAL WORKED TO ADDRESS THIS SIGNIFICANT NEED BY IMPLEMENTING A NUMBER OF SAFE-SEX AND SEXUALLY TRANSMITTED DISEASE (STD) PREVENTION PROGRAMS IN THE REGION, AND THROUGH APPROPRIATE TESTING, TREATMENT AND CARE IN OUTPATIENT FACILITIES. THESE PROGRAMS CONTINUED IN 2019, WITH EVERY-OTHER-YEAR AGREEMENTS WITH HOOPESTON AREA HIGH SCHOOL AND MILFORD HIGH SCHOOL. BOTH SCHOOLS USED THIS PROGRAM IN 2015 AND AGAIN IN 2017. IN 2019, A QUALITY NURSE SPECIALIST ON HCMH STAFF CONTINUES TO WORK CLOSELY WITH THE LOCAL PUBLIC HEALTH DEPARTMENT TO TRACK TRENDS IN TEEN PREGNANCY AND STDS IN OUR REGION, AND SUPPORTS EDUCATIONAL PROGRAMS THROUGH THE PUBLIC HEALTH DEPARTMENT. HCMH CONTINUES TO PROMOTE WOMEN'S HEALTH SERVICES, ENCOURAGING YOUNG WOMEN TO RECEIVE THE APPROPRIATE CARE, WHICH THEY CAN RECEIVE FROM OBSTETRICS AND GYNECOLOGY PROVIDERS AT CARLE IN DANVILLE, AS WELL AS TWICE EACH MONTH IN 2019 AT THE OUTPATIENT FACILITY IN HOOPESTON. IN AN EFFORT TO HELP YOUNG MOTHERS IN NEED, HCMH CONTINUES TO PROVIDE "NECESSITY KITS" FOR ALL MOTHERS OR BABIES WHO VISIT THE EMERGENCY DEPARTMENT AND WOULD NOT BE ABLE TO PURCHASE THE SUPPLIES FOR THEMSELVES. THE KIT INCLUDES A PEDIATRIC INFORMATION BOOKLET, THERMOMETER, BASIC FIRST AID SUPPLIES, TEETHING TOYS, BOTTLES AND OTHER ESSENTIAL PRODUCTS TO HELP YOUNG MOTHERS THROUGH THEIR CHILD'S FIRST YEARS. SUPPLIES WERE BOUGHT THROUGH A GRANT FROM ILLINOIS CRITICAL ACCESS HOSPITAL NETWORK, AND EMERGENCY DEPARTMENT NURSES USED THEIR WORK TIME TO PUT TOGETHER THE KITS. IN 2018, HCMH ALSO ENTERED INTO A PARTNERSHIP WITH THE LOCAL VERMILION COUNTY HEALTH DEPARTMENT TO PROVIDE A SPACE FOR THEIR WOMEN'S INFANTS CHILDREN (WIC) PROGRAM TO MEET WEEKLY WITH YOUNG MOTHERS FROM NORTHERN VERMILION COUNTY. THIS SPACE IS PROVIDED FREE TO THE HEALTH DEPARTMENT. IN 2019, THIS PARTNERSHIP GREW TO TWICE A WEEK OFFERING THESE SERVICES TO THE COMMUNITY. AS PART OF HCMH'S COMMITMENT TO ENSURING THAT STRIDES ARE MADE IN THESE AREAS, EMPLOYEES FROM THE HEALTH SYSTEM PARTICIPATE IN SEVERAL COUNTY-WIDE WORKGROUPS THAT WERE ESTABLISHED AS PART OF THE JOINT CHNA. ONE OF THESE WORKGROUPS WAS ESTABLISHED TO ADDRESS TEEN PREGNANCY RATES IN VERMILION COUNTY. THE GROUP'S MAIN GOAL IS TO INCREASE AWARENESS AMONG TEENS BY PARTICIPATING IN LOCAL EVENTS, HEALTH FAIRS AND PUBLIC EDUCATION OPPORTUNITIES.
PRIORITY #2: SUBSTANCE AND ALCOHOL ABUSE	HCMH CONTINUES TO ADDRESS ALCOHOL AND SUBSTANCE ABUSE BY PLANNING AND IMPLEMENTING STRATEGIES THAT PREVENT AND REDUCE SUBSTANCE USE AND ITS ASSOCIATED CONSEQUENCES AMONG YOUTH AND ADULTS THROUGH COMMUNITY AND COUNTYWIDE COLLABORATIVE EFFORTS. EVALUATION OF PRIOR IMPACT: TO IMPROVE ACCESS TO BEHAVIORAL HEALTH SERVICES, HCMH AGAIN PARTNERED WITH IROQUOIS MENTAL HEALTH IN 2019 TO OFFER COUNSELING AT HOOPESTON'S OUTPATIENT CLINIC FOR HCMH PATIENTS. THIS PARTNERSHIP OFFERS ADDITIONAL HOURS AT THE HOOPESTON OUTPATIENT CLINIC, WHICH HELPS ADDRESS THE LACK OF MENTAL HEALTH ACCESS IN THE REGION. IN ADDITION, THE CARLE HEALTH SYSTEM RECOGNIZES THE NEED FOR MORE MENTAL HEALTH AND SUBSTANCE ABUSE SERVICES THROUGHOUT THE SERVICE AREA, AND CONTINUES TO RECRUIT PSYCHIATRY PROVIDERS FOR CLINICAL LOCATIONS IN DANVILLE. CARLE FOUNDATION HOSPITAL STARTED A PSYCHOLOGY RESIDENCY PROGRAM IN 2017, WHICH PROVIDES ADDITIONAL TRAINING FOR MENTAL HEALTH PROFESSIONALS, AND ALSO OFFERS AN EMPLOYEE ASSISTANCE PROGRAM WHICH PROVIDES SERVICE FOR SUBSTANCE AND ALCOHOL ABUSE FOR EMPLOYEES ACROSS THE SYSTEM, INCLUDING OUR IROQUOIS AND NORTHERN VERMILION LOCATIONS. IN 2019, HCMH ALSO PROVIDES IN-KIND SUPPORT TO THE VERMILION COUNTY SHERIFF'S DEPARTMENT FOR ITS DRUG ABUSE RESISTANCE EDUCATION (DARE) PROGRAM. THE LOCAL DARE PROGRAM EDUCATES GRADE SCHOOL CHILDREN ACROSS THE COUNTY ON THE EFFECTS OF SUBSTANCE ABUSE AND EFFECT STRATEGIES TO ESCAPE SITUATIONS WITH DRUGS OR ALCOHOL.
PRIORITY #3: OBESITY	HCMH CONTINUES TO ADDRESS OBESITY BY IMPROVING ACCESS TO HEALTHY FOOD OPTIONS, SUPPORTING LOCAL PRODUCE AND GARDEN SHARES, PROMOTING PHYSICAL ACTIVITY OPPORTUNITIES, AND ADVOCATING FOR COMMUNITY PROGRAMS. EVALUATION OF PRIOR IMPACT: WITH THE CONNECTION TO MANY HEALTH PROBLEMS, INCLUDING HEART DISEASE, STROKE AND DIABETES, HOOPESTON COMMUNITY MEMORIAL HOSPITAL WORKS TO EDUCATE PATIENTS AND THE COMMUNITY ABOUT RESOURCES AVAILABLE TO COMBAT OBESITY AND RELATED CONCERNS; IN 2019, THERE WERE NUTRITION COUNSELORS AND DIETETIC COUNSELORS AVAILABLE FOR CONSULTATIONS FOR PATIENTS IN THE HRHC SERVICE AREA - AND CONTINUE TO SUPPORT ACTIVITIES AIMED AT IMPROVING THE HEALTH OF CHILDREN AND ADULTS THROUGHOUT THE COMMUNITY. THIS INCLUDES FUNDING INITIATIVES HOOPESTON GRADE SCHOOLS' JUMP ROPE FOR HEART PROGRAMS, FELLOWSHIP OF CHRISTIAN ATHLETES, HOOPESTON HEAD START AND MORE. HCMH IS SUPPORTING HEALTHY VERMILION COUNTY IN SEVERAL EDUCATIONAL AND OUTREACH EFFORTS. BY PARTNERING WITH THIS WORKGROUP TO PRODUCE QUALITY INFORMATIONAL MATERIALS ON HEALTHY FOODS, AND PROVIDING IN-KIND SUPPORT TO AGENCIES HELPING WITH FOOD INSECURITY, HCMH INTENDS TO POSITIVELY IMPACT CHILDREN'S VIEW OF HEALTHY FOODS. CONTINUING INTO 2017, THE GROUP'S CAMPAIGN CALLED "RETHINK YOUR DRINK" IS AIMED AT EDUCATING PEOPLE ABOUT THE HIDDEN CALORIE AND SUGAR CONTENT OF MANY POPULAR DRINKS AND ENCOURAGING HEALTHIER OPTIONS. THIS CAMPAIGN CONTINUES THROUGH SOCIAL MEDIA, SIGNAGE AT AREA SCHOOLS AND PRESENCE IN LOCAL HEALTH FAIRS, AND HCMH OFFERS IN-KIND SUPPORT BY FUNDING MANY OF THE PRINTING COSTS. THIS WORK CONTINUED IN 2019, AND AS WELL AS HCMH SUPPORT FOR LOCAL FOOD PANTRIES, ENSURING THOSE IN NEED HAVE ACCESS TO HEALTHY FOOD OPTIONS AND RESOURCES.
PRIORITY #4: MENTAL HEALTH	HCMH CONTINUES TO ADDRESS MENTAL HEALTH BY IDENTIFYING RESOURCES, REDUCING STIGMA AND INVESTING IN COMMUNITY PROGRAMS. EVALUATION OF PRIOR IMPACT: WHILE MENTAL HEALTH WAS NOT CHOSEN AS A PRIORITY IN THE PREVIOUS VERMILION COUNTY NEEDS ASSESSMENT, THE GOALS TO REDUCE SUBSTANCE ABUSE MIRROR MANY OF THE GOALS THAT ADDRESS BEHAVIORAL HEALTH, IN GENERAL. TO IMPROVE ACCESS TO BEHAVIORAL HEALTH SERVICES, HCMH AGAIN PARTNERED WITH IROQUOIS MENTAL HEALTH IN 2019 TO OFFER COUNSELING AT HOOPESTON'S OUTPATIENT CLINIC FOR HCMH PATIENTS. THIS PARTNERSHIP OFFERS ADDITIONAL HOURS AT THE HOOPESTON OUTPATIENT CLINIC, WHICH HELPS ADDRESS THE LACK OF MENTAL HEALTH ACCESS IN THE REGION. IN ADDITION, THE CARLE HEALTH SYSTEM RECOGNIZES THE NEED FOR MORE MENTAL HEALTH AND SUBSTANCE ABUSE SERVICES THROUGHOUT THE SERVICE AREA, AND CONTINUES TO RECRUIT PSYCHIATRY PROVIDERS FOR CLINICAL LOCATIONS IN DANVILLE. CARLE FOUNDATION HOSPITAL STARTED A PSYCHOLOGY RESIDENCY PROGRAM IN 2017, WHICH PROVIDES ADDITIONAL TRAINING FOR MENTAL HEALTH PROFESSIONALS, AND ALSO OFFERS AN EMPLOYEE ASSISTANCE PROGRAM WHICH PROVIDES SERVICE FOR SUBSTANCE AND ALCOHOL ABUSE FOR EMPLOYEES ACROSS THE SYSTEM, INCLUDING OUR IROQUOIS AND NORTHERN VERMILION LOCATIONS. HCMH HAS ALSO COMMITTED TO A PARTNERSHIP WITH THE LOCAL HOOPESTON AREA SCHOOL DISTRICT. THERE ARE PLANS IN PLACE TO RECRUIT A LICENSED CLINICAL SOCIAL WORKER THAT WILL PROVIDE CARE EXCLUSIVELY IN THE SCHOOL DISTRICT, ENGAGING FAMILIES TO WORK TOGETHER TO ACHIEVE BETTER MENTAL HEALTH AND LOWER INSTANCES OF SUBSTANCE ABUSE AND BEHAVIORAL HEALTH ISSUES. IN 2019, THIS JOB LISTING REMAINS OPEN, AS HCMH CONTINUES TO SEARCH FOR A QUALIFIED CANDIDATE. THE CHALLENGE OF ADDRESSING BEHAVIORAL HEALTH AS IN OTHER PARTS OF THE UNITED STATES, BEHAVIORAL HEALTH SERVICES, IN ALL FORMS, IS A GROWING NEED IN MANY COMMUNITIES IN EAST-CENTRAL ILLINOIS. THE CHALLENGES OF MANAGING BEHAVIORAL HEALTH SERVICES ARE WELL-DOCUMENTED, INCLUDING POOR REIMBURSEMENT, A LIMITED POOL OF PROVIDERS, AND PENT-UP DEMAND AND COMPLICATIONS FROM YEARS OF FOREGONE TREATMENT. THESE CHALLENGES RESULT IN SIGNIFICANT INEFFICIENCIES IN THE BROADER HEALTH SYSTEM. BEHAVIORAL HEALTH PRESENTS, AND EVEN DEMANDS, AN OPPORTUNITY TO POOL RESOURCES AND EXPERTISE TO ADDRESS THE NEED. THIS IS DONE THROUGH COLLABORATION OF PROVIDERS, INCLUDING CARLE, ITS RURAL ALLIANCE PARTNERS AND OTHER ORGANIZATIONS, PAYORS, SUCH AS HEALTH ALLIANCE, AND OTHER POTENTIAL STAKEHOLDERS. THE CARLE BEHAVIORAL HEALTH PLANNING GROUP HAS DEVELOPED AREAS OF FOCUS SUCH AS COMMUNITY PARTNERSHIPS TO CREATE HIGH-PERFORMING NETWORKS OF CARE ACROSS MULTIPLE ORGANIZATIONS, ADDRESSING NEEDS OF PATIENTS ADMITTED TO CARLE, CARE DELIVERY MODELS AND UNDERSTANDING COST OF CARE.
OTHER COMMUNITY NEEDS/SCHOOL-BASED EDUCATION	- IN 2019, HCMH STAFF MAINTAINED A PRESENCE IN THE LOCAL SCHOOL SYSTEM, PROVIDING HEAD LICE CHECKS, HANDWASHING EDUCATION, AND VISION AND HEARING TESTING FOR SCHOOLS IN THE REGION. - THE HOSPITAL PROVIDED FULL-TIME ATHLETIC TRAINERS IN 2019 TO SCHOOLS IN HOOPESTON, CISSNA PARK AND MILFORD. SERVICE IS PROVIDED TO ALL STUDENT ATHLETES, REGARDLESS OF WHERE THEY RECEIVE CARE, AND IS FREE OF CHARGE TO THE SCHOOL DISTRICTS. - IN 2019, HCMH CONTINUED TO FUND THE DELTA DENTAL OF ILLINOIS' LAND OF SMILES PROGRAM IN VERMILION COUNTY WITH A $3,000 ANNUAL DONATION. THIS PROGRAM TEACHES CHILDREN IN THE COMMUNITY HOW TO TAKE CARE OF THEIR TEETH BY DEMONSTRATING PROPER BRUSHING AND FLOSSING TECHNIQUES, REVIEWING GOOD AND BAD FOODS FOR TEETH AND WHY IT IS IMPORTANT TO VISIT THE DENTIST REGULARLY. PRE- AND POST-TESTING ILLUSTRATES THAT CHILDREN IMPROVE THEIR KNOWLEDGE OF THE IMPORTANCE OF DENTAL CARE BOTH AT HOME AND AT THE DENTIST AFTER PARTICIPATING IN THE SESSION. OVER FIVE YEARS, THIS SUPPORT HAS HELPED LAND OF SMILES REACH NEARLY 2,400 CHILDREN IN ELEVEN SCHOOLS IN FOUR COUNTIES. CASH AND IN-KIND DONATIONS HOOPESTON COMMUNITY MEMORIAL HOSPITAL CONTRIBUTED NEARLY $33,000 TO CHARITABLE ORGANIZATIONS IN THE COMMUNITY VIA CASH AND IN-KIND DONATIONS, INCLUDING PROGRAMS AIMED TO HELP YOUTH, HEALTH IMPROVEMENT, HEALTH EDUCATION AND HEALTH PROFESSIONS EDUCATION. A SIGNIFICANT PORTION OF HCMH'S CASH DONATIONS - OVER $16,000 - WENT TOWARDS HEALTH IMPROVEMENT. THE LARGEST OF THIS CATEGORY, $5,000 WAS DONATED TO THE HOOPESTON MULTI AGENCY TO ENHANCE THE MULTITUDE OF IMPORTANT COMMUNITY BENEFIT SERVICES THEY OFFER. THE ORGANIZATION ADDRESSES NEEDS FOR DISABLED AND ELDERLY PATIENTS, INCLUDING RIDES THROUGHOUT HOOPESTON AND DANVILLE TO HELP MAINTAIN THEIR HEALTH AND LIFESTYLE, AND ASSISTING CLIENTS IN COORDINATING CARE APPOINTMENTS AND FINDING RESOURCES. HCMH CONTRIBUTED OVER $1,000 TO YOUTH FOCUSED PROGRAMMING IN THE COMMUNITY, INCLUDING SCHOLARSHIP FUNDS FOR HOOPESTON AREA FFA ALUMNI, WATSEKA FFA ALUMNI, ARMSTRONG FFA ALUMNI, AND SUPPORT OF PTO PROGRAMS FOR THE BISMARK HENNING COMMUNITY. HCMH ALSO SUPPORTS SEVERAL STATEWIDE AND NATIONWIDE ORGANIZATIONS WITH REGIONAL CHAPTERS, INCLUDING THE LION'S CLUB OF HOOPESTON, KNOWN FOR THEIR HUMANITARIAN EFFORTS ON BEHALF OF THE DEAF AND BLIND AND FOR PROVIDING EYEGLASSES FOR UNDERPRIVILEGED CHILDREN. OTHER LOCAL CHAPTERS INCLUDE HOOPESTON ROTARY CLUB, AND THE SPECIAL OLYMPICS OF ILLINOIS. EACH OF THESE ORGANIZATIONS HAS A MISSION AIMED TO IMPROVE HEALTH, ACTIVITY AND WELLBEING OF OUR YOUTH. NEEDS THAT HCMH IS NOT ADDRESSING WHILE THERE ARE A NUMBER OF ADDITIONAL CONCERNS IDENTIFIED BY THE DATA THAT ARE NOT MEETING STATE AND NATIONAL BENCHMARKS, INCLUDING SMOKING RATES, DIABETES, MOTOR VEHICLE CRASH DEATHS AND VIOLENCE, HCMH WILL NOT FOCUS ON ADDRESSING THOSE CHALLENGES AT THIS TIME. THE HOSPITAL AND IMPLEMENTATION COMMITTEE DETERMINED THESE ISSUES ARE LOWER PRIORITY BECAUSE THE NEEDS ARE NOT AS SIGNIFICANT; THEY ARE NOT CENTRAL TO THE HOSPITAL'S MISSION; AND HCMH DOES NOT HAVE THE ABILITY TO MAKE A MEASURABLE IMPACT IN THOSE AREAS, MANY REQUIRING IMPLEMENTATION FROM THE GROUND-UP.

Schedule H (Form 990) 2019

Page 9

Part VFacility Information (continued)

Section D. Other Health Care Facilities That Are Not Licensed, Registered, or Similarly Recognized as a Hospital Facility (list in order of size, from largest to smallest) How many non-hospital health care facilities did the organization operate during the tax year?8
Name and address		Type of Facility (describe)
1	Carle Danville on Fairchild 311 W Fairchild Danville,IL61832	Rural Health Clinic
2	Carle Mattoon on Hurst 2512 Hurst Drive Mattoon,IL61938	Rural Health Clinic
3	Charlotte Ann Russell Medical Center 801 E Orange St Hoopeston,IL60942	Rural Health Clinic
4	Carle Tuscola 301 E Southline Rd Tuscola,IL61953	Rural Health Clinic
5	Carle Watseka 1490 East Walnut Street Ste C Watseka,IL60970	Rural Health Clinic
6	Carle Rossville 619 N Chicago St Rossville,IL60963	Rural Health Clinic
7	Carle Milford 322 N Chicago St Milford,IL60953	Rural Health Clinic
8	Carle Cissna Park 141 W Garfield Ave Cissna Park,IL60924	Rural Health Clinic
9
10

Schedule H (Form 990) 2019

Page 10

Part VI

Supplemental Information

Provide the following information.

1	Required descriptions. Provide the descriptions required for Part I, lines 3c, 6a, and 7; Part II and Part III, lines 2, 3, 4, 8 and 9b.
2	Needs assessment. Describe how the organization assesses the health care needs of the communities it serves, in addition to any CHNAs reported in Part V, Section B.
3	Patient education of eligibility for assistance. Describe how the organization informs and educates patients and persons who may be billed for patient care about their eligibility for assistance under federal, state, or local government programs or under the organization’s financial assistance policy.
4	Community information. Describe the community the organization serves, taking into account the geographic area and demographic constituents it serves.
5	Promotion of community health. Provide any other information important to describing how the organization’s hospital facilities or other health care facilities further its exempt purpose by promoting the health of the community (e.g., open medical staff, community board, use of surplus funds, etc.).
6	Affiliated health care system. If the organization is part of an affiliated health care system, describe the respective roles of the organization and its affiliates in promoting the health of the communities served.
7	State filing of community benefit report. If applicable, identify all states with which the organization, or a related organization, files a community benefit report.

Form and Line Reference	Explanation
SCHEDULE H, SUPPLEMENTAL INFORMATION	SCHEDULE H, PART VI 1 - REQUIRED DESCRIPTIONS EXPLANATION OF COSTING METHODOLOGY (PART I, LINE 7 AND PART III, LINE 2) TO COMPUTE AND CONVERT FINANCIAL ASSISTANCE, UNREIMBURSED MEDICAID, MEANS-TESTED PROGRAMS AND BAD DEBT CHARGES TO COST; A CONSISTENT GAAP (GENERALLY ACCEPTED ACCOUNTING PRINCIPLES) BASED COST-TO-CHARGE RATIO WAS USED ACROSS ALL PAYERS. ALTHOUGH THE METHODOLOGY WAS SIMILAR TO WORKSHEET #2, FOR SIMPLICITY PURPOSES CERTAIN IMMATERIAL VALUES WERE OMITTED. OTHER COMMUNITY BENEFITS COSTS WERE REPORTED AT THE ACTUAL EXPENSE INCURRED. PATIENT RECEIVABLE PAYMENTS AND RELATED DISCOUNTS WERE RECORDED AT ACTUAL AMOUNTS AT THE TIME OF PAYMENT RECEIPT. A SEPARATE GAAP BASED PROVISION FOR ESTIMATED BAD DEBTS AND DISCOUNTS WAS RECOGNIZED FOR ACCOUNTS IN PROCESS AND PENDING ADJUDICATION AND PAYMENT. THE ESTIMATED PORTION WAS BASED ON HISTORICAL TRENDS AND ADJUSTED TO ACTUAL WHEN ADJUDICATION AND PAYMENT OCCUR. ACCOUNTS DETERMINED ELIGIBLE FOR FINANCIAL ASSISTANCE WERE PROCESSED IMMEDIATELY FOR FINANCIAL ASSISTANCE DISCOUNT WITH NO COLLECTION EFFORT. FOR ACCOUNTS WITH INSUFFICIENT INFORMATION AND DOCUMENTATION TO DETERMINE FINANCIAL ASSISTANCE ELIGIBILITY, THE HOSPITAL CONSULTED WITH A VARIETY OF ALTERNATIVE SOURCES TO HELP DETERMINE AN INDIVIDUAL'S FINANCIAL MEANS (OR LACK OF MEANS) TO PAY. BASED ON RELATED TRENDS, THE HOSPITAL FURTHER DEVELOPED A GENERAL ESTIMATE OF FINANCIAL ASSISTANCE WHICH CONTINUED TO RESIDE WITHIN BAD DEBTS.
COMMUNITY BUILDING ACTIVITIES (PART VI AND PART II)	HCMH'S SUPPORT OF COMMUNITY-BUILDING ACTIVITIES IS AN IMPORTANT PART OF CONTRIBUTING TO THE ECONOMIC VIABILITY OF THE COMMUNITY. A SIGNIFICANT PORTION OF THESE ACTIVITIES IS FOCUSED ON COMMUNITY SUPPORT AND ECONOMIC DEVELOPMENT, INCLUDING CASH, IN-KIND DONATIONS AND BUDGETED EXPENDITURES FOR THE CITY, BUSINESS ASSOCIATIONS AND OTHER PROGRAMS IN HOOPESTON. HCMH SPENT $31,898 ON COMMUNITY BUILDING ACTIVITIES FOR THE CURRENT YEAR. WHILE NOT PAID FOR BY HCMH BUT BY THE CARLE FOUNDATION, CARLE EMPLOYEES WERE ACTIVE ON COMMUNITY BOARDS AND COMMISSIONS IN 2019 IN THE HCMH SERVICE AREA, BRINGING LEADERSHIP TO THE COMMUNITIES, INCLUDING: ROTARY CLUBS, SHOES FOR LITTLE SOULS, AND SPEAKING ON COMMUNITY PANELS. BAD DEBT, MEDICARE, & COLLECTION PRACTICES (PART III, LINE 3) HCMH USES 50% AS A GENERAL ESTIMATE OF BAD DEBT EXPENSE ATTRIBUTABLE TO PATIENTS ELIGIBLE UNDER THE ORGANIZATION'S FINANCIAL ASSISTANCE POLICY. BAD DEBT FOOTNOTE (PART III, LINE 4) THE FOOTNOTES PERTAINING TO BAD DEBT EXPENSE CAN BE FOUND ON PAGE 28 OF THE ATTACHED CONSOLIDATED FINANCIAL STATEMENTS.
EXPLANATION OF MEDICARE COST REPORT COSTING METHODOLOGY (PART III, LINE 8)	THE NUMERATOR (TOTAL EXPENSE) AND DENOMINATOR (TOTAL GROSS CHARGES) OF THE SIMPLE RATIO OF PATIENT CARE COST TO CHARGES IS ADJUSTED BY ELIMINATING NON-PATIENT CARE THAT GENERATES OTHER REVENUE, BAD DEBT EXPENSE, MEDICAID AND OTHER PROVIDER TAXES AND THE TOTAL COST OF COMMUNITY BENEFIT ACTIVITIES AND PROGRAMS. ALSO, ANY GROSS PATIENT CHARGES FOR PROGRAMS NOT RELYING ON THE RATIO ARE ELIMINATED FROM BOTH THE NUMERATOR AND DENOMINATOR OF THE RATIO. THESE ADJUSTMENTS ARE INTENDED TO ELIMINATE ANY POTENTIAL FOR DOUBLE COUNTING OF COMMUNITY BENEFIT EXPENSES. THE RESULTANT RATIO ALIGNS WITH SCHEDULE H REQUIREMENTS. ILLINOIS LAW DEFINES GOVERNMENTAL-SPONSORED INDIGENT HEALTH CARE AS THE UNREIMBURSED COST OF MEDICARE, MEDICAID AND OTHER FEDERAL, STATE OR LOCAL INDIGENT CARE PROGRAMS. WHEN THERE IS A SHORTFALL, WE DO BELIEVE THIS IS A COMMUNITY BENEFIT BECAUSE, AS A HOSPITAL, WE ARE STEPPING UP TO CARRY THE BURDEN OF THE GOVERNMENT, ASSURING CARE TO SENIORS, AND THOSE LESS FORTUNATE DEMOGRAPHICS THAT HAVE EXPERIENCED INCREASING COSTS OVER THE PAST DECADE WHILE LIVING ON FIXED INCOMES.
COLLECTION PRACTICES (PART III, LINE 9B)	EFFECTIVE 1/1/16, CARLE COMBINED THE CARLE COMMUNITY CARE DISCOUNT PROGRAM WITH THE HCMH CHARITY PROGRAM TO MAKE ONE PROGRAM: THE CARLE FINANCIAL ASSISTANCE PROGRAM (CFAP). CFAP PROVIDES DISCOUNTED OR FREE CARE TO THOSE WHO NEED IT WITHIN THE CARLE FOUNDATION, INCLUDING HCMH. NOT ONLY DOES THIS MEAN A MORE TIMELY APPLICATION PROCESS, BUT MOST IMPORTANTLY, IT MEANS PATIENTS RECEIVE THE SAME DISCOUNT AT THE HOOPESTON HOSPITAL AND CLINICS IF THEY MIGHT NEED AN ADDITIONAL LEVEL OF SPECIALTY OR HOSPITAL CARE AT CARLE FOUNDATION HOSPITAL IN URBANA. WITH THIS PROGRAM, HCMH HAS A ROBUST PRESUMPTIVE ELIGIBILITY PROCESS. WE PRESUME ELIGIBILITY FOR VERIFIED HOMELESS, DECEASED WITH NO ESTATE, MENTAL INCAPACITATION, RECIPIENTS OF WIC (WOMEN, INFANTS AND CHILDREN NUTRITION PROGRAM), SNAP (SUPPLEMENTAL NUTRITION ASSISTANCE PROGRAM), LIHEAP (LOW INCOME HOME ENERGY ASSISTANCE PROGRAM), ILLINOIS FREE LUNCH AND BREAKFAST PROGRAM, RECEIPT OF GRANT ASSISTANCE FOR MEDICAL SERVICE, FRANCES NELSON HEALTH CENTER (PROMISE HEALTHCARE FQHC) DISCOUNT REFERRALS, MEDICAID TITLE XIX, XXI, AND IN-NETWORK MEDICAID MANAGED CARE PLANS. IN ADDITION, WE UTILIZE A VENDOR, EXPERIAN INFORMATION SOLUTIONS, INC., TO PROACTIVELY IDENTIFY PATIENTS WHO MAY BE PRESUMPTIVELY-QUALIFIED FOR ASSISTANCE - NOT ONLY FOR PUBLIC PROGRAMS LIKE MEDICAID, BUT ALSO BASED ON A NUMBER OF KEY FINANCIAL INDICATORS, INCLUDING CREDIT HISTORY, DEMOGRAPHICS AND GROSS INCOME. IDENTIFIED PATIENTS MAY BE PRESUMED ELIGIBLE AND AUTOMATICALLY ENROLLED IN THE PROGRAM, OR THEY MAY BE CONTACTED AND ENCOURAGED TO APPLY FOR ASSISTANCE. PATIENTS WHO ARE NOT DEEMED PRESUMPTIVELY-ELIGIBLE WOULD NEED TO REQUEST AND COMPLETE AN APPLICATION. IF THE PATIENT DOES NOT REQUEST OR COMPLETE AND RETURN THE APPLICATION, THEN THE BALANCE IS DEEMED THEIR RESPONSIBILITY TO PAY. FOR PATIENTS THAT DO NOT QUALIFY FOR CFAP, AND WHO MAY BE UNINSURED OR UNDERINSURED, HCMH HAS OTHER DISCOUNT OPTIONS AVAILABLE, SUCH AS PROMPT PAY, ILLINOIS UNINSURED DISCOUNT, AND CAPPED DISCOUNT - WHERE A PATIENT'S OUT-OF-POCKET MEDICAL EXPENSES ARE LIMITED TO 40% OF THEIR ANNUAL GROSS INCOME IF THEY EARN AT OR BELOW 400% OF THE FEDERAL POVERTY LEVEL. ONCE ALL APPLICABLE DISCOUNTS HAVE BEEN APPLIED, WE MAKE EVERY ATTEMPT TO WORK WITH THE PATIENT AND SET UP PAYMENT ARRANGEMENTS ON THE REMAINING BALANCE DUE. THE CURRENT MINIMUM IS 5% OF THE TOTAL BALANCE DUE OR $25.00 A MONTH. IF THEY CANNOT MEET THESE GUIDELINES, OUR IN-HOUSE BILLING STAFF MEMBERS WORK WITH THEM TO SET UP A TEMPORARY/SHORT TERM PAYMENT ARRANGEMENT UNTIL THEY CAN MAKE THE MINIMUM PAYMENT. IF THEY ARE UNABLE TO MAKE PAYMENT ON THE BALANCE DUE, THEN THE BALANCE MAY BE LISTED WITH AN OUTSIDE COLLECTION AGENCY. WHEN THE ACCOUNT IS STILL IN-HOUSE, THE MINIMUM NOTIFICATION IS MONTHLY ITEMIZED STATEMENTS. IF A PATIENT DOES NOT RESPOND, THE ACCOUNT IS GIVEN A FINAL NOTICE, EITHER BY LETTER OR PHONE, AND SENT TO AN OUTSIDE COLLECTION AGENCY. HCMH WILL NOT FILE COLLECTION SUIT LIENS ON A PRIMARY RESIDENCE, NOR DO WE AUTHORIZE AN AGENCY TO USE SO-CALLED "BODY ATTACHMENTS." THE AGENCIES ARE AWARE OF OUR CARLE FINANCIAL ASSISTANCE PROGRAM AND ARE TRAINED TO INFORM PATIENTS OF OUR PROGRAM AND TO SEND APPLICATIONS, WHEN APPLICABLE. THEY HAVE BEEN INSTRUCTED TO INFORM AN HCMH STAFF MEMBER IF THEY DEEM THE PATIENT IS UNABLE TO PAY. HCMH STAFF WILL THEN MAKE ONE MORE ATTEMPT TO WORK WITH THE PATIENT TO SEE IF HELP IS NEEDED. IF STAFF DETERMINES THAT THE PATIENT MIGHT QUALIFY, WE WILL ATTEMPT TO ENROLL THEM THROUGH OUR PRESUMPTIVE ELIGIBILITY TOOLS OR, IF ADDITIONAL INFORMATION IS NEEDED, WE WILL SEND THE PATIENT A CFAP APPLICATION. WE WILL THEN INSTRUCT THE AGENCY TO PUT A HOLD ON THE ACCOUNT; THE AVERAGE HOLD IS 60 DAYS. IF THE PATIENT IS THEN APPROVED FOR DISCOUNTS AT 100% FOR FINANCIAL ASSISTANCE, THE BALANCE IS ADJUSTED AND THE ACCOUNT IS CLOSED WITH THE AGENCY. IF THE PATIENT IS APPROVED FOR LESS THAN 100%, THE ADJUSTMENTS ARE REPORTED TO THE AGENCY AND THE AGENCY WILL BEGIN COLLECTION EFFORTS ON ANY REMAINING BALANCE.
2 - NEEDS ASSESSMENT	HOOPESTON COMMUNITY MEMORIAL HOSPITAL USED EXISTING DATA, INFORMAL DISCUSSIONS, AND A COMPREHENSIVE QUALITATIVE COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA) TO DETERMINE IF EXISTING PROGRAMS ARE ON TRACK; WHAT NEEDS TO BE ADDED, DELETED OR ENHANCED; AND WHERE OUR FOCUS NEEDED TO BE PLACED IN THE FUTURE. THE CHNA INCLUDED DISCUSSIONS WITH COMMUNITY LEADERS, INCLUDING HUMAN SERVICE AGENCY ADMINISTRATORS, PUBLIC HEALTH REPRESENTATIVES AND HOOPESTON COMMUNITY MEMORIAL HOSPITAL LEADERSHIP. 3 - PATIENT EDUCATION FOR ELIGIBILITY FOR ASSISTANCE OUR PRACTICE IS TO LOOK AT EACH PATIENT'S FINANCIAL STATUS IN RELATION TO OUR CARLE FINANCIAL ASSISTANCE PROGRAM (CFAP) AND THE CRITERIA OF THE UNINSURED PATIENT DISCOUNT ACT, AND TO PROVIDE THE PATIENT WITH THE DEEPEST DISCOUNT AVAILABLE. BY EXPANDING THE PRESUMPTIVE ELIGIBILITY SCREENING PROCESSES AND DETERMINING THE FINANCIAL STATUS OF PATIENTS UP-FRONT, WE HAVE BEEN ABLE TO PINPOINT THOSE NEEDING ASSISTANCE EARLY IN THE PROCESS, MINIMIZING BAD DEBT AND OPTIMIZING OUR ABILITY TO HELP. STAFF IS ALSO DILIGENT IN FOLLOWING UP WITH PATIENTS DURING HOSPITALIZATION AND AFTER DISCHARGE IF THERE'S ANY REASON TO BELIEVE THE PATIENT COULD BENEFIT FROM FINANCIAL ASSISTANCE. HOOPESTON COMMUNITY MEMORIAL HOSPITAL HAS MADE A CONCERTED, CONTINUOUS EFFORT TO BE SURE THAT PEOPLE HAVE ACCESS TO INFORMATION THAT WILL HELP THEM WITH THEIR MEDICAL BILLS. THESE INCLUDE: - ADVERTISING THE CARLE FINANCIAL ASSISTANCE PROGRAM, USING PRINT, BILLBOARDS AND WEB; CONTINUED PRESENCE IN APPROPRIATE COMMUNITY PUBLICATIONS; AND ON-SITE VIA DISPLAYS THROUGHOUT THE HOSPITAL AND CLINICS - SIMPLIFIED APPLICATION FORM, INCLUDING A VERSION IN SPANISH, THAT CONTAINS INFORMATION REGARDING THE CARLE FINANCIAL ASSISTANCE PROGRAM - PUBLICATION OF A PLAIN LANGUAGE SUMMARY AND ALL OTHER FINANCIAL ASSISTANCE RELATED INFORMATION ON CARLE.ORG/FINANCIALASSISTANCE - INFORMATION ABOUT THE CARLE FINANCIAL ASSISTANCE PROGRAM ON ALL STATEMENTS, COLLECTION LETTERS AND HOSPITAL ADMISSION PACKETS - CARLE FINANCIAL ASSISTANCE PROGRAM INFORMATION AND APPLICATIONS AT ALL REGISTRATION POINTS, HOSPITAL MAIN LOBBY AND CARLE.ORG - MEETINGS WITH LOCAL LEGISLATORS TO HELP THEM ASSIST CONSTITUENTS WITH HEALTHCARE NEEDS, INCLUDING FINANCIAL ASSISTANCE. 4 - COMMUNITY INFORMATION THE PRIMARY SERVICE AREA OF HOOPESTON COMMUNITY MEMORIAL HOSPITAL IS DEFINED AS THE GEOGRAPHICAL BOUNDARY OF VERMILION COUNTY, ILLINOIS. WHILE SOME RESIDENTS OF SURROUNDING COUNTIES UTILIZE HCMH'S SERVICES, OUR MOST RECENT CHNA TARGETED VERMILION COUNTY RESIDENTS, WHO MAKE UP THE MAJORITY OF HCMH PATIENTS. COMMUNITY BENEFIT REPORTING FOR HCMH ALSO INCLUDES OUTPATIENT FACILITIES IN CISSNA PARK, HOOPESTON, MILFORD, ROSSVILLE, WATSEKA, DANVILLE ON FAIRCHILD, MATTOON ON HURST AND TUSCOLA. POCKETS OF EXTREME POVERTY EXIST THROUGHOUT THIS REGION, WITH RATES HIGHEST AROUND THE CITY OF DANVILLE. THE PROGRAMS WITHIN OUR COMMUNITY BENEFIT PLAN GENERALLY HAVE IMPACT UPON ALL THE TARGETED COMMUNITIES, WITH CERTAIN PROGRAMS DIRECTED AT SPECIFIC POPULATIONS. IN 2019, VERMILION COUNTY HAD A POPULATION OF 75,758, BUT THE POPULATION CONTINUES TO DROP. THERE WAS A 9.72% DECREASE IN TOTAL POPULATION FROM 2000-2019 (2019 POPULATION BASED ON ESTIMATE). POVERTY RATES FOR BOTH ADULTS AND CHILDREN REMAIN VERY HIGH IN VERMILION COUNTY, WITH ALMOST 20% OF ADULTS AND 30% OF CHILDREN LIVING IN POVERTY IN VERMILION COUNTY IN 2019. MEDIAN HOUSEHOLD INCOME IN 2019 WAS $45,384 IN VERMILION COUNTY, STILL BELOW THE MEDIAN INCOME OF $57,444 (US CENSUS 2014 ). ONLY 31.72% OF FAMILIES IN VERMILION COUNTY REPORT A HOUSEHOLD INCOME OF $75,000 OR GREATER COMPARED TO 47.28% OF ILLINOIS FAMILIES. VERMILION COUNTY HAS ALSO SEEN A SLIGHT INCREASE IN BOTH THE HISPANIC AND BLACK POPULATION SINCE 2010. VERMILION COUNTY HAS A HIGHER PERCENTAGE OF PERSONS WITH DISABILITIES THAN ILLINOIS AND THE UNITED STATES THE UNEMPLOYMENT RATE IN VERMILION COUNTY HAS REMAINED ABOVE THE UNEMPLOYMENT RATE FOR THE STATE OF ILLINOIS SINCE 2010. HOWEVER, UNEMPLOYMENT IN VERMILION COUNTY PEAKED IN 2010 AT 13.5 AND HAS STEADILY GONE DOWN SINCE, BUT STILL IS HIGHER THAN MOST OF THE NEIGHBORING COUNTIES. IN RECENT DATA, THE RATIO OF THE POPULATION IN VERMILION COUNTY TO HEALTHCARE PROVIDERS WAS 2,210:1. THIS HAS INCREASED FROM 2015. WE CONTINUE TO BE FAR ABOVE THE STATE OF ILLINOIS AND US TOP PERFORMERS. IN 2019, WE IDENTIFIED THAT PERCENTAGE OF VERMILION COUNTY'S INSURED POPULATION RECEIVING MEDICAID IN VERMILION COUNTY IS MUCH HIGHER THAN THAT OF THE STATE OF ILLINOIS AND THE UNITED STATES, AT 29.63%. THERE ARE A HANDFUL OF OTHER HEALTHCARE PROVIDERS IN VERMILION COUNTY: PRIVATE-PRACTICE OFFICES, AS WELL AS TEAMS OF PHYSICIANS AT CARLE CLINIC, CHRISTIE CLINIC, AND CHARLOTTE ANNE RUSSELL MEDICAL CLINIC IN HOOPESTON, PROVIDE EXPERT SERVICES AND PERSONALIZED CARE UNIQUELY AVAILABLE IN A SMALLER COMMUNITY. OSF HEALTHCARE SACRED HEART MEDICAL CENTER INCLUDES A WOMEN'S HEALTH CENTER AND AN AWARD-WINNING CANCER CENTER. WITHIN 30 MINUTES, YOU WILL ALSO FIND A LEVEL 1 TRAUMA CENTER AT CARLE FOUNDATION HOSPITAL. THE COMMUNITY IS ALSO HOME TO THE VETERANS AFFAIRS ILLIANA HEALTH CARE SYSTEM. WHILE VERMILION COUNTY HAS SEEN SOME IMPROVEMENT IN THE EDUCATION ATTAINMENT, WE ARE FAR BELOW THE STATE OF ILLINOIS AND NATIONAL AVERAGES - THE NUMBER OF ADULTS 25 AND OLDER WITH LESS THAN A HIGH SCHOOL DIPLOMA OR EQUIVALENT WENT DOWN 1.4% IN MOST RECENT DATA. IN 2019, ABOUT 16.35% OF VERMILION COUNTY HOUSEHOLDS RECEIVE SUPPLEMENTAL NUTRITION ASSISTANCE PROGRAM (SNAP) BENEFITS, AND 61.9% OF CHILDREN QUALIFY TO RECEIVE FREE OR REDUCED LUNCHES AT SCHOOL. 5 - PROMOTION OF COMMUNITY HEALTH HOOPESTON COMMUNITY MEMORIAL HOSPITAL HAS AN OPEN MEDICAL STAFF AND IS GOVERNED BY AN 11-MEMBER COMMUNITY BOARD THAT SERVES ON A VOLUNTEER BASIS, WITH 7 VOTING MEMBERS AND 4 NON-VOTING STAFF MEMBERS. SURPLUS FUNDS ARE REINVESTED INTO THE ORGANIZATION FOR TECHNOLOGY REPLACEMENT AND ADVANCEMENT, CLINICAL SERVICE EXPANSION AND QUALITY IMPROVEMENT. FUNDS ARE ALSO INVESTED INTO OUR COMMUNITIES TO MEET IDENTIFIED HEALTH NEEDS WHICH CONTRIBUTE TO THE OVERALL WELL-BEING OF THE RESIDENTS OF THE COMMUNITIES WE SERVE.HOOPESTON COMMUNITY MEMORIAL HOSPITAL HAS AN OPEN MEDICAL STAFF AND IS GOVERNED BY AN 11-MEMBER COMMUNITY BOARD THAT SERVES ON A VOLUNTEER BASIS, WITH 7 VOTING MEMBERS AND 4 NON-VOTING STAFF MEMBERS. SURPLUS FUNDS ARE REINVESTED INTO THE ORGANIZATION FOR TECHNOLOGY REPLACEMENT AND ADVANCEMENT, CLINICAL SERVICE EXPANSION AND QUALITY IMPROVEMENT. FUNDS ARE ALSO INVESTED INTO OUR COMMUNITIES TO MEET IDENTIFIED HEALTH NEEDS WHICH CONTRIBUTE TO THE OVERALL WELL-BEING OF THE RESIDENTS OF THE COMMUNITIES WE SERVE. 6 - AFFILIATED HEALTH CARE SYSTEM HOOPESTON COMMUNITY MEMORIAL HOSPITAL IS A CRITICAL ACCESS HOSPITAL COMMITTED TO IMPROVING QUALITY OF LIFE IN NORTHERN VERMILION COUNTY AND THE SURROUNDING AREA. HCMH INTEGRATED WITH THE CARLE FOUNDATION IN 2012 TO PROVIDE MORE ACCESS TO PRIMARY AND SPECIALTY CARE. THOUGH HCMH FALLS UNDER THE UMBRELLA OF THE CARLE FOUNDATION, IT MAINTAINS A SEPARATE BOARD OF DIRECTORS AND SENIOR LEADERSHIP. WHILE HCMH'S CHNA AND COMMUNITY BENEFIT REPORTING IS SEPARATE FROM CARLE FOUNDATION HOSPITAL, IT FOLLOWS THE SAME GUIDELINES AND PRINCIPLES AS CARLE. HCMH STAFF IS INVOLVED IN THE CHNA AND IMPLEMENTATION PLAN, AND SERVE ON HUMAN SERVICES AGENCY BOARDS AND COMMITTEES TO PROVIDE SUPPORT TO HELP ADDRESS IDENTIFIED COMMUNITY NEEDS IN NORTHERN VERMILION COUNTY, INCLUDING TEEN PREGNANCY, ALCOHOL AND SUBSTANCE ABUSE, AND OBESITY. 7 - STATE FILING OF COMMUNITY BENEFIT REPORT N/A - AS A CRITICAL ACCESS HOSPITAL, HCMH IS NOT REQUIRED TO FILE A STATE COMMUNITY BENEFIT REPORT.

Schedule H (Form 990) 2019

Additional Data

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Schedule I
(Form 990)

Department of the Treasury
Internal Revenue Service

Grants and Other Assistance to Organizations,
Governments and Individuals in the United States

Complete if the organization answered "Yes," on Form 990, Part IV, line 21 or 22.
lBullet

Attach to Form 990.
lBullet

Go to www.irs.gov/Form990 for the latest information.

OMB No. 1545-0047

2019

Open to Public
Inspection

Name of the organization
HOOPESTON COMMUNITY MEMORIAL HOSPITAL

Employer identification number
36-3637465

Part I

General Information on Grants and Assistance

Does the organization maintain records to substantiate the amount of the grants or assistance, the grantees' eligibility for the grants or assistance, and
the selection criteria used to award the grants or assistance? ........................

Yes No

Describe in Part IV the organization's procedures for monitoring the use of grant funds in the United States.

Part II

Grants and Other Assistance to Domestic Organizations and Domestic Governments. Complete if the organization answered "Yes" on Form 990, Part IV, line 21, for any recipient

that received more than $5,000. Part II can be duplicated if additional space is needed.

(a) Name and address of organization or government	(b) EIN	(c) IRC section (if applicable)	(d) Amount of cash grant	(e) Amount of non-cash assistance	(f) Method of valuation (book, FMV, appraisal, other)	(g) Description of noncash assistance	(h) Purpose of grant or assistance
(1) HOOPESTON AREA COMMUNITY UNIT SCHL DIST #11 615 EAST ORANGE ST HOOPESTON,IL60942	36-2774495	501(c)(3)	10,000				CUSD #11 ALL-WEATHER TRACK

Enter total number of section 501(c)(3) and government organizations listed in the line 1 table ................. Bullet Image

Enter total number of other organizations listed in the line 1 table ........................ . Bullet Image

For Paperwork Reduction Act Notice, see the Instructions for Form 990.

Cat. No. 50055P

Schedule I (Form 990) 2019

Page 2

Part III

Grants and Other Assistance to Domestic Individuals. Complete if the organization answered "Yes" on Form 990, Part IV, line 22.
Part III can be duplicated if additional space is needed.

(a) Type of grant or assistance	(b) Number of recipients	(c) Amount of cash grant	(d) Amount of noncash assistance	(e) Method of valuation (book, FMV, appraisal, other)	(f) Description of noncash assistance

(1)
(2)
(3)
(4)
(5)
(6)
(7)

Part IV

Supplemental Information. Provide the information required in Part I, line 2; Part III, column (b); and any other additional information.

Return Reference

Explanation

Form 990, Schedule I, Part 1, Question 2

DESCRIPTION OF ORGANIZATION'S PROCEDURES FOR MONITORING THE USE OF GRANTS ANY CHARITABLE ORGANIZATION WISHING TO REQUEST FUNDS IS ASKED TO SUBMIT THEIR REQUEST IN WRITING. EMAILED REQUESTS ARE ACCEPTABLE. THE REQUEST MUST INCLUDE A DESCRIPTION OF THE PURPOSE OF THE CONTRIBUTION AND OTHER RELEVANT INFORMATION SUCH AS REQUESTORS NAME, AMOUNT OF THE REQUEST, ETC. THE REQUESTS ARE REVIEWED, EVALUATED, AND ADMINISTERED BY THE MARKETING AND COMMUNICATIONS (PUBLIC RELATIONS) DEPARTMENT, SEEKING ADDITIONAL INFORMATION FROM THE REQUESTOR, AS NEEDED, AND INPUT FROM ANY APPROPRIATE CARLE ADMINISTRATOR OR DIRECTOR. A SET OF ESTABLISHED GUIDELINES DRIVE THESE DECISIONS WHILE MOST ARE MADE TO IMPROVE HEALTHCARE/ACCESS TO HEALTHCARE OR ARE IN LINE WITH OUR ROLE AS A CORPORATE CITIZEN. ASSESSED NEED IS A COMMON CRITERIA. IN THE CASE OF MOST DONATIONS OF $5,000 OR MORE, SUCH AS TO COLLEGES AND UNIVERSITIES OR COMMUNITY CLINICS, WRITTEN AGREEMENTS ARE IN PLACE AND WE HAVE REGULAR CONTACT WITH THOSE ORGANIZATIONS, OFTENTIMES THROUGH A CARLE CONTACT PERSON TO ASSURE THAT THE DONATIONS ARE BEING USED AS AGREED UPON. THE RECORDS ARE EITHER MAINTAINED IN ADMINISTRATION OR PUBLIC RELATIONS.

Schedule I (Form 990) 2019

Additional Data

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Schedule J
(Form 990)

Department of the Treasury
Internal Revenue Service

Compensation Information

For certain Officers, Directors, Trustees, Key Employees, and Highest
Compensated Employees
SchJMediumBullet

Complete if the organization answered "Yes" on Form 990, Part IV, line 23.
SchJMediumBullet

Attach to Form 990.
SchJMediumBullet

Go to www.irs.gov/Form990 for instructions and the latest information.

OMB No. 1545-0047

2019

Open to Public Inspection

Name of the organization

HOOPESTON COMMUNITY MEMORIAL HOSPITAL

Employer identification number

36-3637465

Part I

Questions Regarding Compensation

Yes

Check the appropiate box(es) if the organization provided any of the following to or for a person listed on Form
990, Part VII, Section A, line 1a. Complete Part III to provide any relevant information regarding these items.

First-class or charter travel Housing allowance or residence for personal use

Travel for companions Payments for business use of personal residence

Tax idemnification and gross-up payments Health or social club dues or initiation fees

Discretionary spending account Personal services (e.g., maid, chauffeur, chef)

If any of the boxes on Line 1a are checked, did the organization follow a written policy regarding payment or reimbursement or provision of all of the expenses described above? If "No," complete Part III to explain .........

Did the organization require substantiation prior to reimbursing or allowing expenses incurred by all
directors, trustees, officers, including the CEO/Executive Director, regarding the items checked on Line 1a? ..

Indicate which, if any, of the following the filing organization used to establish the compensation of the
organization's CEO/Executive Director. Check all that apply. Do not check any boxes for methods
used by a related organization to establish compensation of the CEO/Executive Director, but explain in Part III.

Compensation committee Written employment contract

Independent compensation consultant Compensation survey or study

Form 990 of other organizations Approval by the board or compensation committee

During the year, did any person listed on Form 990, Part VII, Section A, line 1a, with respect to the filing organization or a related organization:

Receive a severance payment or change-of-control payment? .............

Participate in, or receive payment from, a supplemental nonqualified retirement plan? .........

Yes

Participate in, or receive payment from, an equity-based compensation arrangement? .........

If "Yes" to any of lines 4a-c, list the persons and provide the applicable amounts for each item in Part III.

Only 501(c)(3), 501(c)(4), and 501(c)(29) organizations must complete lines 5-9.

For persons listed on Form 990, Part VII, Section A, line 1a, did the organization pay or accrue any
compensation contingent on the revenues of:

The organization? ....................

Any related organization? .......................

If "Yes," on line 5a or 5b, describe in Part III.

For persons listed on Form 990, Part VII, Section A, line 1a, did the organization pay or accrue any
compensation contingent on the net earnings of:

The organization? ..................

Any related organization? ......................

If "Yes," on line 6a or 6b, describe in Part III.

For persons listed on Form 990, Part VII, Section A, line 1a, did the organization provide any nonfixed
payments not described in lines 5 and 6? If "Yes," describe in Part III ............

Yes

Were any amounts reported on Form 990, Part VII, paid or accured pursuant to a contract that was
subject to the initial contract exception described in Regulations section 53.4958-4(a)(3)? If "Yes," describe
in Part III ..........................

If "Yes" on line 8, did the organization also follow the rebuttable presumption procedure described in Regulations section 53.4958-6(c)? .........................

For Paperwork Reduction Act Notice, see the Instructions for Form 990.

Cat. No. 50053T

Schedule J (Form 990) 2019

Page 2

Part II

Officers, Directors, Trustees, Key Employees, and Highest Compensated Employees. Use duplicate copies if additional space is needed.

For each individual whose compensation must be reported on Schedule J, report compensation from the organization on row (i) and from related organizations, described in the
instructions, on row (ii). Do not list any individuals that are not listed on Form 990, Part VII.
Note. The sum of columns (B)(i)-(iii) for each listed individual must equal the total amount of Form 990, Part VII, Section A, line 1a, applicable column (D) and (E) amounts for that individual.

(A) Name and Title		(B) Breakdown of W-2 and/or 1099-MISC compensation			(C) Retirement and other deferred compensation	(D) Nontaxable benefits	(E) Total of columns (B)(i)-(D)	(F) Compensation in column (B) reported as deferred on prior Form 990
(A) Name and Title		(i) Base compensation	(ii) Bonus & incentive compensation	(iii) Other reportable compensation	(C) Retirement and other deferred compensation	(D) Nontaxable benefits	(E) Total of columns (B)(i)-(D)
1SALLY SALMONS MD TRUSTEE & MEDICAL DIRECTOR	(i) (ii)	0 ------------- 350,208	0 ------------- 48,601	0 ------------- 6,843	0 ------------- 62,826	0 ------------- 14,738	0 ------------- 483,216	0 ------------- 0
2LETHA KRAMER TRUSTEE & VP-RISK	(i) (ii)	0 ------------- 234,316	0 ------------- 33,248	0 ------------- 14,898	0 ------------- 49,151	0 ------------- 20,907	0 ------------- 352,520	0 ------------- 12,123
3HARRY BROCKUS EX-OFFICIO, CEO	(i) (ii)	0 ------------- 306,805	0 ------------- 39,773	0 ------------- 53,752	0 ------------- 77,284	0 ------------- 22,230	0 ------------- 499,844	0 ------------- 44,733
4DENNIS HESCH EXEC VP & CFO	(i) (ii)	0 ------------- 817,104	0 ------------- 188,433	0 ------------- 288,030	0 ------------- 273,284	0 ------------- 15,576	0 ------------- 1,582,427	0 ------------- 262,322
5LAURENCE FALLON Key Employee - Former	(i) (ii)	0 ------------- 586,747	0 ------------- 145,606	0 ------------- 216,195	0 ------------- 208,671	0 ------------- 21,847	0 ------------- 1,179,066	0 ------------- 187,071
6BLAIR ROWITZ MD ASSOC CMO - SURGICAL SERVICES	(i) (ii)	0 ------------- 651,656	0 ------------- 38,025	0 ------------- 22,487	0 ------------- 22,542	0 ------------- 21,002	0 ------------- 755,712	0 ------------- 0
7DOUGLAS MORTON MD MED DIR-RADIOLOGY	(i) (ii)	0 ------------- 584,639	0 ------------- 0	0 ------------- 9,262	0 ------------- 22,542	0 ------------- 8,465	0 ------------- 624,908	0 ------------- 0
8IKECHUKWU UZOARU MD MED DIR-LAB	(i) (ii)	0 ------------- 528,567	0 ------------- 0	0 ------------- 27,656	0 ------------- 22,542	0 ------------- 18,518	0 ------------- 597,283	0 ------------- 0
9LYNETTE BARNES COO-CFH & SVP-FACILITIES	(i) (ii)	0 ------------- 346,208	0 ------------- 72,337	0 ------------- 166,540	0 ------------- 112,772	0 ------------- 5,911	0 ------------- 703,768	0 ------------- 127,249
10PAMELA BIGLER SVP-NURSING & CNO	(i) (ii)	0 ------------- 314,121	0 ------------- 66,150	0 ------------- 109,723	0 ------------- 101,470	0 ------------- 7,240	0 ------------- 598,704	0 ------------- 76,662
11CHARLES DENNIS MD Key Employee - Former	(i) (ii)	0 ------------- 562,415	0 ------------- 89,059	0 ------------- 25,632	0 ------------- 79,334	0 ------------- 19,816	0 ------------- 776,256	0 ------------- 0
12LAUREN SCHMID EXEC VP, CHIEF HR OFFICER	(i) (ii)	0 ------------- 322,593	0 ------------- 40,818	0 ------------- 66,898	0 ------------- 76,250	0 ------------- 22,630	0 ------------- 529,189	0 ------------- 44,771
13CALEB MILLER SVP-SURGICAL & DIAG SVCS	(i) (ii)	0 ------------- 261,283	0 ------------- 51,283	0 ------------- 63,337	0 ------------- 74,476	0 ------------- 26,364	0 ------------- 476,743	0 ------------- 31,645
14LARRY GERDOM PHYSICIAN ASSISTANT	(i) (ii)	150,586 ------------- 0	500 ------------- 0	3,860 ------------- 0	0 ------------- 0	0 ------------- 0	154,946 ------------- 0	0 ------------- 0
15LARRY WHITAKER JR PHYSICIAN ASSISTANT	(i) (ii)	145,930 ------------- 0	500 ------------- 0	484 ------------- 0	11,084 ------------- 0	25,063 ------------- 0	183,061 ------------- 0	0 ------------- 0
16DEBRA O BRIEN PHYSICIAN ASSISTANT	(i) (ii)	156,695 ------------- 0	0 ------------- 0	2,074 ------------- 0	12,074 ------------- 0	17,934 ------------- 0	188,777 ------------- 0	0 ------------- 0
17HEATHER TUCKER Hospital Administrator	(i) (ii)	146,766 ------------- 0	13,094 ------------- 0	2,942 ------------- 0	12,256 ------------- 0	24,847 ------------- 0	199,905 ------------- 0	0 ------------- 0
18ANDY ARWARI MD ACMO-REGIONAL HEALTH	(i) (ii)	0 ------------- 544,198	0 ------------- 25,060	0 ------------- 13,343	0 ------------- 22,542	0 ------------- 26,074	0 ------------- 631,217	0 ------------- 0
19DANIEL CHASE MD HIGHLY COMP EMP-FORMER	(i) (ii)	0 ------------- 445,170	0 ------------- 0	0 ------------- 2,432	0 ------------- 22,542	0 ------------- 22,707	0 ------------- 492,851	0 ------------- 0
20WILLIAM MCCARTHY MD HIGHLY COMP EMP-FORMER	(i) (ii)	0 ------------- 298,963	0 ------------- 0	0 ------------- 30,433	0 ------------- 22,542	0 ------------- 6,161	0 ------------- 358,099	0 ------------- 0
21ALBERT TANLIM MD HIGHLY COMP EMP-FORMER	(i) (ii)	0 ------------- 309,831	0 ------------- 0	0 ------------- 2,662	0 ------------- 22,542	0 ------------- 22,054	0 ------------- 357,089	0 ------------- 0
22CORTNEY JONEIKIS ROSSER MD HIGHLY COMP EMP-FORMER	(i) (ii)	0 ------------- 344,964	0 ------------- 0	0 ------------- 677	0 ------------- 22,542	0 ------------- 12,684	0 ------------- 380,867	0 ------------- 0
23Napoleon Knight MD MED DIR, REGIONAL ED	(i) (ii)	0 ------------- 492,766	0 ------------- 0	0 ------------- 447,311	0 ------------- 22,542	0 ------------- 9,211	0 ------------- 971,830	0 ------------- 30,132
24Robert McConkey PT Op Lead - Therapy	(i) (ii)	131,624 ------------- 0	519 ------------- 0	7,194 ------------- 0	9,947 ------------- 0	13,929 ------------- 0	163,213 ------------- 0	0 ------------- 0

Schedule J (Form 990) 2019

Page 3

Part III

Supplemental Information

Provide the information, explanation, or descriptions required for Part I, lines 1a, 1b, 3, 4a, 4b, 4c, 5a, 5b, 6a, 6b, 7, and 8, and for Part II. Also complete this part for any additional information.

Return Reference	Explanation
SUPPLEMENTAL COMPENSATION INFORMATION	SCHEDULE J, PART I, QUESTION 3 THE BOARD OF TRUSTEES OF THE CARLE FOUNDATION, THE PARENT COMPANY OF HCMH, THROUGH ITS COMPENSATION COMMITTEE COMPRISED OF INDEPENDENT MEMBERS FREE OF CONFLICT, ANNUALLY REVIEWS EXECUTIVE COMPENSATION LEVELS AND ESTABLISHES APPROPRIATE SALARY RANGES AND OTHER FEATURES OF THE COMPENSATION PLAN IN ACCORDANCE WITH THE ORGANIZATION'S APPROVED COMPENSATION PHILOSOPHY AND STRATEGY: * THE COMMITTEE IS COMPRISED OF MEMBERS OF THE BOARD OF TRUSTEES; WHO ARE INDEPENDENT OF THE CARLE FOUNDATION MANAGEMENT; HAVE NO PERSONAL INTEREST IN THE COMPENSATION ARRANGEMENTS; ARE NOT RELATED TO, OR UNDER THE CONTROL OF ANY INDIVIDUAL WHOSE COMPENSATION ARRANGEMENT IS BEING REVIEWED; AND HAVE NO MATERIAL BUSINESS RELATIONSHIP WITH THE CARLE FOUNDATION. * THE CHIEF EXECUTIVE OFFICER'S COMPENSATION IS DETERMINED BY THE COMPENSATION COMMITTEE IN RELATION TO APPROPRIATE COMPARABILITY DATA. COMPENSATION FOR OTHER MEMBERS OF THE EXECUTIVE STAFF IS DEVELOPED BY THE CEO, EVALUATED AGAINST MARKET DATA, AND REVIEWED AND APPROVED BY THE COMMITTEE. * THE COMMITTEE APPROVES ALL ANNUAL COMPENSATION DECISIONS IN ADVANCE OF THEIR IMPLEMENTATION AND DOCUMENTS ITS DETERMINATIONS AND DISCUSSIONS. * THE COMPENSATION COMMITTEE RELIES UPON A NUMBER OF EXTERNAL RESOURCES AND COMPARISONS, AND ITS ANALYSIS INCLUDES TOTAL COMPENSATION (CASH COMPENSATION PLUS BENEFITS PROVIDED BY THE CARLE FOUNDATION) IN RELATION TO ORGANIZATIONAL PERFORMANCE AND PREVAILING INDUSTRY PRACTICES FOR LIKE RESPONSIBILITIES AT COMPARABLY-SIZED ORGANIZATIONS. THE COMMITTEE HAS ENGAGED THE SERVICES OF A COMPENSATION CONSULTING FIRM SPECIALIZING IN THE NOT-FOR-PROFIT SECTOR WHICH HAS WORKED WITH THE CARLE FOUNDATION AND MAKES ITS REPORTS DIRECTLY AVAILABLE TO THE COMPENSATION COMMITTEE.
SCHEDULE J, PART I, QUESTION 4B	THE 2019 PARTICIPANTS IN THE 457(F) PLAN OFFERED BY THE CARLE FOUNDATION, THE PARENT ORGANIZATION OF HCMH, THAT ARE LISTED IN THE 990 PART VII INCLUDE LYNETTE BARNES, PAMELA BIGLER, HARRY BROCKUS, LAURENCE FALLON, DENNIS HESCH, LEATHA KRAMER, CALEB MILLER, NAPOLEON KNIGHT, MD, CHARLES DENNIS, MD, SALLY SALMONS, MD AND LAUREN SCHMID. IN 2019, PAYMENTS FROM THE 457(F) PLAN WERE MADE TO LYNETTE BARNES ($127,249), PAMELA BIGLER ($76,662), HARRY BROCKUS ($44,733), LAURENCE FALLON ($187,071), DENNIS HESCH ($262,322), CALEB MILLER ($31,645), LETHA KRAMER ($12,123), NAPOLEON KNIGHT, MD ($30,132) AND LAUREN SCHMID ($44,771).
SCHEDULE J, PART I, QUESTION 7	PART OF THE CEO'S COMPENSATION INCLUDES AN INCENTIVE COMPONENT WHICH IS DESIGNED TO ENCOURAGE AND PROMOTE THE ACHIEVEMENT OF CERTAIN QUALITY, OPERATIONAL, AND EFFICIENCY IMPROVEMENTS. ALTHOUGH THIS INCENTIVE COMPONENT IS BASED ON THE ORGANIZATION MEETING CERTAIN MINIMUM FINANCIAL THRESHOLDS, ALL PAYMENTS MUST BE APPROVED BY THE BOARD OF DIRECTORS PRIOR TO ANY INCENTIVE PAYOUT.

Schedule J (Form 990) 2019

Additional Data

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Schedule L
(Form 990 or 990-EZ)

Department of the Treasury
Internal Revenue Service

Transactions with Interested Persons

Complete if the organization answered "Yes" on Form 990, Part IV, lines 25a, 25b, 26, 27, 28a, 28b, or 28c, or Form 990-EZ, Part V, line 38a or 40b.
MediumBullet

Attach to Form 990 or Form 990-EZ.
MediumBullet

Go to www.irs.gov/Form990 for instructions and the latest information.

OMB No. 1545-0047

2019

Open to Public Inspection

Name of the organization

HOOPESTON COMMUNITY MEMORIAL HOSPITAL

Employer identification number

36-3637465

Part I

Excess Benefit Transactions (section 501(c)(3), section 501(c)(4), and section 501(c)(29) organizations only).
Complete if the organization answered "Yes" on Form 990, Part IV, line 25a or 25b, or Form 990-EZ, Part V, line 40b.

1(a) Name of disqualified person	(c) Description of transaction	(d) Corrected?
1(a) Name of disqualified person	(c) Description of transaction	Yes	No

Enter the amount of tax incurred by the organization managers or disqualified persons during the year under section 4958. ........................... Bullet Image

Enter the amount of tax, if any, on line 2, above, reimbursed by the organization ........ Bullet Image

Part II

Loans to and/or From Interested Persons.
Complete if the organization answered "Yes" on Form 990-EZ, Part V, line 38a, or Form 990, Part IV, line 26; or if the organization reported an amount on Form 990, Part X, line 5, 6, or 22

(a) Name of interested person	(b) Relationship with organization	(c) Purpose of loan	(d) Loan to or from the organization?		(e) Original principal amount	(f) Balance due	(g) In default?		(h) Approved by board or committee?		(i) Written agreement?
(a) Name of interested person	(b) Relationship with organization	(c) Purpose of loan	To	From	(e) Original principal amount	(f) Balance due	Yes	No	Yes	No	Yes	No






Total ............... $

Part III

Grants or Assistance Benefiting Interested Persons.
Complete if the organization answered "Yes" on Form 990, Part IV, line 27.

(a) Name of interested person	(b) Relationship between interested person and the organization	(c) Amount of assistance	(d) Type of assistance	(e) Purpose of assistance

For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.

Cat. No. 50056A

Schedule L (Form 990 or 990-EZ) 2019

Page 2

Part IV

Business Transactions Involving Interested Persons.
Complete if the organization answered "Yes" on Form 990, Part IV, line 28a, 28b, or 28c.

(a) Name of interested person	(b) Relationship between interested person and the organization	(c) Amount of transaction	(d) Description of transaction	(e) Sharing of organization's revenues?
(a) Name of interested person		(c) Amount of transaction	(d) Description of transaction	Yes	No
(1) EMA NICHOLLS	FAMILY MEMBER OF TRUSTEE	117,533	EMPLOYMENT		No
(2) BRADLEY CRISTY JR	FAMILY MEMBER OF OFFICER	38,927	EMPLOYMENT		No
(3) HEATHER MOORE	FAMILY MEMBER OF OFFICER	142,972	EMPLOYMENT		No
(4) KIMBERLY HOUMES	FAMILY MEMBER OF OFFICER	107,394	EMPLOYMENT		No
(5) RACHEL MILLER	FAMILY MEMBER OF KEY EMPLOYEE	62,287	EMPLOYMENT		No

Part V

Supplemental Information
Provide additional information for responses to questions on Schedule L (see instructions).

Return Reference

Explanation

RELATIONSHIP BETWEEN INTERESTED PERSON AND THE ORGANIZATION

BRADLEY D CRISTY, JR IS AN EMPLOYEE OF HCMH AND HAS A FAMILY RELATIONSHIP WITH HARRY BROCKUS WHO SERVES AS CEO OF THE HOSPITAL'S BOARD OF DIRECTORS. KIMBERLY HOUMES IS AN EMPLOYEE OF HCMH AND HAS A FAMILY RELATIONSHIP WITH KARLA COON WHO SERVES AS THE SECRETARY/TREASURER OF THE BOARD FOR THE HOSPITAL. HEATHER MOORE IS AN EMPLOYEE OF HCMH AND HAS A FAMILY RELATIONSHIP WITH KARLA COON WHO SERVES AS THE SECRETARY/TREASURER OF THE BOARD FOR THE HOSPITAL. RACHEL MILLER IS AN EMPLOYEE OF HCMH AND HAS A FAMILY RELATIONSHIP WITH CALEB MILLER WHO SERVES AS A KEY EMPLOYEE FOR THE HOSPITAL. EMA NICHOLLS IS AN EMPLOYEE OF HCMH AND HAS A FAMILY RELATIONSHIP WITH WILLIAM NICHOLLS WHO SERVES AS A TRUSTEE FOR THE HOSPITAL.

Schedule L (Form 990 or 990-EZ) 2019

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE O
(Form 990 or 990-EZ)

Department of the Treasury
Internal Revenue Service

Supplemental Information to Form 990 or 990-EZ

Complete to provide information for responses to specific questions on
Form 990 or 990-EZ or to provide any additional information.
MediumBullet

Attach to Form 990 or 990-EZ.
MediumBullet

Go to www.irs.gov/Form990 for the latest information.

OMB No. 1545-0047

2019

Open to Public
Inspection

Name of the organization

HOOPESTON COMMUNITY MEMORIAL HOSPITAL

Employer identification number

36-3637465

Return Reference	Explanation
FORM 990, PART VI, QUESTION 2	HARRY BROCKUS (OFFICER) AND LETHA KRAMER (TRUSTEE) HAD A BUSINESS RELATIONSHIP.
FORM 990, PART VI, QUESTION 6	HCMH HAS ONE MEMBER WHICH IS THE PARENT COMPANY, THE CARLE FOUNDATION.
FORM 990, PART VI, QUESTION 7A	HCMH'S SOLE MEMBER, THE CARLE FOUNDATION, ACTING THROUGH ITS BOARD OF TRUSTEES, HAS THE EXCLUSIVE POWER TO ELECT AND REMOVE MEMBERS OF THE BOARD OF TRUSTEES FOR THE CORPORATION IN ADDITION TO FILLING VACANCIES.
FORM 990, PART VI, QUESTION 7B	HCMH'S BOARD OF TRUSTEES MUST HAVE THE APPROVAL OF ITS SOLE MEMBER, THE CARLE FOUNDATION, THROUGH ITS BOARD OF TRUSTEES, WHEN VOTING ON MATTERS INCLUDING THE AMENDING OF THE BY-LAWS; AMENDMENTS TO THE ARTICLES OF INCORPORATION; AUTHORIZING ANY NON-BUDGETED EXPENDITURE IN EXCESS OF $50,000 (THE EXCESS OF ANY PROPOSED EXPENDITURE OVER THE PREVIOUSLY APPROVED BUDGETED AMOUNT SHALL BE DEEMED A NON-BUDGETED EXPENDITURE); TO ADOPT ANY NEW OR ANY CHANGES TO EXISTING LONG TERM OR MASTER INSTITUTIONAL PLANS OF THE CORPORATION; TO ORGANIZE OR ACQUIRE, OR TO AUTHORIZE OR APPROVE THE ORGANIZATION'S ACQUISITION OF ANY SUBSIDIARY OR AFFILIATE OF THE CORPORATION; THE AUTHORIZATION TO ENTER INTO ANY CONTRACT OR ENGAGE IN ANY TRANSACTION OR ACTIVITY WHICH REQUIRES APPLICATION TO THE ILLINOIS HEALTH FACILITIES PLANNING BOARD FOR A PERMIT OR CERTIFICATE OF NEED AND FOR RECOMMENDING THE CEO OF THE CORPORATION TO THE HOOPESTON BOARD OF TRUSTEES.
FORM 990, PART VI, QUESTION 11B	THE FORM 990 WAS PREPARED BY STAFF AND AN EXTERNAL TAX ADVISOR AND REVIEWED BY MANAGEMENT. PRIOR TO FILING THIS FORM 990, A FULL AND COMPLETE COPY WAS PROVIDED TO THE GOVERNING BODY. AT THEIR DISCRETION, THE GOVERNING MEMBERS HAVE THE OPPORTUNITY TO CONTACT MANAGEMENT OR DISCUSS AND ADDRESS CONCERNS AT SUBSEQUENT BOARD MEETINGS.
FORM 990, PART VI, QUESTION 12C	THE ORGANIZATION'S ESTABLISHED CONFLICT OF INTEREST POLICIES REQUIRE ANNUAL DISCLOSURE OF ACTUAL AND POTENTIAL CONFLICTS OF INTEREST FOR OFFICERS, DIRECTORS, TRUSTEES, MEMBERS OF BOARD COMMITTEES, ADMINISTRATIVE AND MANAGERIAL EMPLOYEES AS WELL AS ALL EMPLOYEES OF THE PURCHASING DEPARTMENT. IF CIRCUMSTANCES CHANGE DURING THE COURSE OF A YEAR, INTERIM DISCLOSURE IS ALSO REQUIRED OF THE SAME INDIVIDUALS. THE DISCLOSURES OF EMPLOYEES ARE REVIEWED INITIALLY BY THE HUMAN RESOURCES DEPARTMENT AND ANY IDENTIFIED CONFLICTS ARE REFERRED TO, AND ADDRESSED BY, THE ORGANIZATION'S INTERNAL LEGAL COUNSEL AND/OR CORPORATE INTEGRITY OFFICER. THE DISCLOSURES OF TRUSTEES AND MEMBERS OF BOARD COMMITTEES ARE REVIEWED BY THE CHAIR OF THE BOARD. THE ENTIRE BOARD, ABSENT THE SUBJECT TRUSTEE OR COMMITTEE MEMBER DETERMINES WHETHER A CONFLICT EXISTS. TRUSTEES AND/OR BOARD COMMITTEE MEMBERS WITH IDENTIFIED CONFLICTS ARE REQUIRED TO RECUSE THEMSELVES FROM DELIBERATING AND VOTING ON MATTERS THAT MAY PRESENT A CONFLICT. THE ORGANIZATION ALSO MAINTAINS PURCHASING POLICIES REQUIRING COUNTER SIGNATURES TO FURTHER MINIMIZE THE RISK ASSOCIATED WITH ACTUAL AND/OR POTENTIAL CONFLICTS OF INTEREST.
FORM 990, PART VI, QUESTIONS 15A & 15B	THE BOARD OF TRUSTEES OF THE CARLE FOUNDATION, THE PARENT COMPANY OF HCMH, THROUGH ITS COMPENSATION COMMITTEE COMPRISED OF INDEPENDENT MEMBERS FREE OF CONFLICT, ANNUALLY REVIEWS EXECUTIVE COMPENSATION LEVELS AND ESTABLISHES APPROPRIATE SALARY RANGES AND OTHER FEATURES OF THE COMPENSATION PLAN IN ACCORDANCE WITH THE ORGANIZATION'S APPROVED COMPENSATION PHILOSOPHY AND STRATEGY: * THE COMMITTEE IS COMPRISED OF MEMBERS OF THE BOARD OF TRUSTEES; WHO ARE INDEPENDENT OF THE CARLE FOUNDATION MANAGEMENT; HAVE NO PERSONAL INTEREST IN THE COMPENSATION ARRANGEMENTS; ARE NOT RELATED TO, OR UNDER THE CONTROL OF ANY INDIVIDUAL WHOSE COMPENSATION ARRANGEMENT IS BEING REVIEWED; AND HAVE NO MATERIAL BUSINESS RELATIONSHIP WITH THE CARLE FOUNDATION. * THE CHIEF EXECUTIVE OFFICER'S COMPENSATION IS DETERMINED BY THE COMPENSATION COMMITTEE IN RELATION TO APPROPRIATE COMPARABILITY DATA. COMPENSATION FOR OTHER MEMBERS OF THE EXECUTIVE STAFF IS DEVELOPED BY THE CEO, EVALUATED AGAINST MARKET DATA, AND REVIEWED AND APPROVED BY THE COMMITTEE. * THE COMMITTEE APPROVES ALL ANNUAL COMPENSATION DECISIONS IN ADVANCE OF THEIR IMPLEMENTATION AND DOCUMENTS ITS DETERMINATIONS AND DISCUSSIONS. * THE COMPENSATION COMMITTEE RELIES UPON A NUMBER OF EXTERNAL RESOURCES AND COMPARISONS, AND ITS ANALYSIS INCLUDES TOTAL COMPENSATION (CASH COMPENSATION PLUS BENEFITS PROVIDED BY THE CARLE FOUNDATION) IN RELATION TO ORGANIZATIONAL PERFORMANCE AND PREVAILING INDUSTRY PRACTICES FOR LIKE RESPONSIBILITIES AT COMPARABLY-SIZED ORGANIZATIONS. THE COMMITTEE HAS ENGAGED THE SERVICES OF A COMPENSATION CONSULTING FIRM SPECIALIZING IN THE NOT-FOR-PROFIT SECTOR WHICH HAS WORKED WITH THE CARLE FOUNDATION AND MAKES ITS REPORTS DIRECTLY AVAILABLE TO THE COMPENSATION COMMITTEE.
FORM 990, PART VI, QUESTIONS 18 & 19	THE CARLE FOUNDATION, THE SOLE MEMBER OF HCMH, PUBLISHES THROUGH WWW.DACBOND.COM AND https://emma.msrb.org/ ITS QUARTERLY UNAUDITED FINANCIAL STATEMENTS, A MANAGEMENT'S DISCUSSION & ANALYSIS TO ACCOMPANY THE FINANCIAL STATEMENTS, AND AN ANNUAL REPORT OF CERTAIN OPERATING AND FINANCIAL INFORMATION. ADDITIONALLY, OFFICIAL STATEMENTS FOR OUTSTANDING MUNICIPAL BOND ISSUES FOR WHICH THE CARLE FOUNDATION IS OBLIGATED ARE AVAILABLE AT THIS WEBSITE. THESE DOCUMENTS INCLUDE EXTENSIVE INFORMATION ABOUT THE ORGANIZATION'S HEALTH CARE DELIVERY SYSTEM MODEL, RECENT HIGHLIGHTS/ACCOMPLISHMENTS, GOVERNANCE AND ADMINISTRATION, STRATEGIC PLAN, FACILITIES, CLINICAL PROGRAMS, MEDICAL STAFF, SERVICE AREA, COMPETITIVE ENVIRONMENT, DEMOGRAPHIC DATA, UTILIZATION STATISTICS, SUMMARY FINANCIAL INFORMATION, ACADEMIC AFFILIATIONS AND EDUCATIONAL PROGRAMS, MEDICAL RESEARCH, ACCREDITATIONS, AND ITS EMPLOYEES. THIS INFORMATION IS AVAILABLE AT NO CHARGE TO THOSE WHO REGISTER AT THE WWW.DACBOND.COM WEBSITE. IN ADDITION, THE FORM 990S OF THE ORGANIZATION'S FILING ENTITIES ARE AVAILABLE THROUGH DACBOND. QUARTERLY FINANCIAL STATEMENTS ARE ALSO AVAILABLE UPON REQUEST DELIVERED TO THE ORGANIZATION'S ADMINISTRATIVE OFFICES. THE ORGANIZATION'S GOVERNING DOCUMENTS AND CONFLICT OF INTEREST POLICIES ARE ALSO AVAILABLE UPON REQUEST TO THE ORGANIZATION'S ADMINISTRATIVE OFFICES.
FORM 990, PART VII, SECTION A, COLUMN B	THE AVERAGE ESTIMATED HOURS PER WEEK LISTED FOR THE REPORTING ORGANIZATION AND RELATED ORGANIZATIONS ARE BASED ON A STANDARD 40 HOUR WEEK. MEMBERS MAY FREQUENTLY DEVOTE MORE THAN 40 HOURS OF SERVICE TO THE ENTIRE ORGANIZATION DURING AN AVERAGE WEEK.
FORM 990, PART XI, LINE 9	PERMANANTLY RESTRICTED ASSETS DECREASED AS A RESULT OF A CHANGE IN VALUE OF THE BENEFICIAL INTEREST IN A PERPETUAL TRUST OF $35,726. TEMPORARILY RESTRICTED ASSETS DECREASED BY $373 RESULTING FROM CHANGES IN THE POLAND TRUST ACCOUNT WHICH IS A TEMPORARILY RESTRICTED FUND USED TO PROVIDE TUITION ASSITANCE FOR NURSING STUDENTS.
FORM 990, PART XII, LINES 2A, B, C AND PART IV, LINES 12A & 12B	THE FINANCIAL STATEMENTS FOR HCMH WERE REVIEWED ON A CONSOLIDATED BASIS UNDER THE PARENT ORGANIZATION, THE CARLE FOUNDATION. THE CARLE FOUNDATION HAS AN AUDIT COMMITTEE CONSISTING OF MEMBERS OF THE GOVERNING BOARD AND THE CHIEF FINANCIAL OFFICER WHO TOGETHER ASSUME RESPONSIBILITY FOR OVERSIGHT OF THE REVIEW AND AUDIT OF ITS FINANCIAL STATEMENTS AND SELECTION OF AN INDEPENDENT ACCOUNTANT OR AUDITOR.

For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.

Cat. No. 51056K

Schedule O (Form 990 or 990-EZ) 2019

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE R
(Form 990)

Department of the Treasury
Internal Revenue Service

Related Organizations and Unrelated Partnerships

Complete if the organization answered "Yes" on Form 990, Part IV, line 33, 34, 35b, 36, or 37.
MediumBullet

Attach to Form 990.
MediumBullet

Go to www.irs.gov/Form990 for instructions and the latest information.

OMB No. 1545-0047

2019

Open to Public Inspection

Name of the organization

HOOPESTON COMMUNITY MEMORIAL HOSPITAL

Employer identification number

36-3637465

Part I

Identification of Disregarded Entities. Complete if the organization answered "Yes" on Form 990, Part IV, line 33.

(a) Name, address, and EIN (if applicable) of disregarded entity	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Total income	(e) End-of-year assets	(f) Direct controlling entity

Part II

Identification of Related Tax-Exempt Organizations. Complete if the organization answered "Yes" on Form 990, Part IV, line 34 because it had one or more related tax-exempt organizations during the tax year.

(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Exempt Code section	(e) Public charity status (if section 501(c)(3))	(f) Direct controlling entity	(g) Section 512(b)(13) controlled entity?
(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Exempt Code section	(e) Public charity status (if section 501(c)(3))	(f) Direct controlling entity	Yes	No
(1)THE CARLE FOUNDATION 611 W PARK ST URBANA,IL61801 37-0673465	PARENT/INVMGT	IL	501(C)(3)	12c, III-FI	NA		No
(2)THE CARLE FOUNDATION HOSPITAL 611 W PARK ST URBANA,IL61801 37-1119538	HOSPITAL SVCS	IL	501(C)(3)	3	TCF	Yes
(3)CARLE HEALTH CARE INCORPORATED 611 W PARK ST URBANA,IL61801 37-1140016	VAR MED SVCS	IL	501(C)(3)	10	TCF	Yes
(4)THE CARLE DEVELOPMENT FOUNDATION 611 W PARK ST URBANA,IL61801 37-1159978	FUNDRAISING	IL	501(C)(3)	7	TCF	Yes
(5)CARLE COMMUNITY HEALTH CORPORATION 611 W PARK ST URBANA,IL61801 36-4458371	FNDN MISSION	IL	501(C)(3)	12a, Type I	TCDF	Yes
(6)RICHLAND MEMORIAL HOSPITAL INC 800 EAST LOCUST STREET OLNEY,IL62450 37-1363001	HOSPITAL SVCS	IL	501(C)(3)	3	TCF	Yes
(7)CARLE RETIREMENT CENTERS INC 611 W PARK ST URBANA,IL618012595 37-1160033	RETIREMENT	IL	501(C)(3)	10	TCF	Yes

For Paperwork Reduction Act Notice, see the Instructions for Form 990.

Cat. No. 50135Y

Schedule R (Form 990) 2019

Page 2

Part III

Identification of Related Organizations Taxable as a Partnership. Complete if the organization answered "Yes" on Form 990, Part IV, line 34, because it had one or more related organizations treated as a partnership during the tax year.

(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Direct controlling entity	(e) Predominant income(related, unrelated, excluded from tax under sections 512-514)	(f) Share of total income	(g) Share of end-of-year assets	(h) Disproprtionate allocations?		(i) Code V-UBI amount in box 20 of Schedule K-1 (Form 1065)	(j) General or managing partner?
(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Direct controlling entity		(f) Share of total income	(g) Share of end-of-year assets	Yes	No	(i) Code V-UBI amount in box 20 of Schedule K-1 (Form 1065)	Yes	No
(1) CHAMPAIGN SURGICENTER LLC 611 W PARK ST URBANA,IL618012595 20-1915925	SURGICAL CTR	IL	NA	N/A

Part IV

Identification of Related Organizations Taxable as a Corporation or Trust. Complete if the organization answered "Yes" on Form 990, Part IV, line 34 because it had one or more related organizations treated as a corporation or trust during the tax year.

(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Direct controlling entity	(e) Type of entity (C corp, S corp, or trust)	(f) Share of total income	(g) Share of end-of-year assets	(i) Section 512(b)(13) controlled entity?
(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Direct controlling entity	(e) Type of entity (C corp, S corp, or trust)	(f) Share of total income	(g) Share of end-of-year assets	Yes	No
(1) HEALTH SYSTEMS INSURANCE LIMITED GOVERNORS SQ 2ND FL BLDG 3 grand cayman ky1-1102 CJ	INSURANCE	CJ	NA	C CORP			Yes
(2) CARLE RISK MANAGEMENT COMPANY 611 W PARK ST URBANA,IL618012595 37-1217973	RISK MANAGEMENT	IL	NA	C CORP			Yes
(3) EVALIDATA INC 611 W PARK ST URBANA,IL618012595 46-2022658	PHYS CREDENTIALS	IL	NA	C CORP			Yes
(4) CHA HOLDING INC 3310 SOUTH FIELDS DR CHAMPAIGN,IL61822 47-1854275	HOLDING COMPANY	IL	NA	C CORP			Yes
(5) CARLE HOLDING COMPANY INC 611 W PARK ST URBANA,IL618012595 37-1188284	HOLDING COMPANY	IL	NA	C CORP			Yes
(6) HEALTH ALLIANCE MEDICAL PLANS INC 3310 SOUTH FIELDS DR CHAMPAIGN,IL61822 37-1260731	HEALTH COVERAGE	IL	NA	C CORP			Yes
(7) HEALTH ALLIANCE CONNECT INC 3310 SOUTH FIELDS DR CHAMPAIGN,IL61822 46-4796891	HEALTH CARE COORD	IL	NA	C CORP			Yes
(8) HEALTH ALLIANCE NORTHWEST HOLDING 820 N CHELAN AVE WENATCHEE,WA98801 46-1717578	HOLDING COMPANY	WA	NA	C CORP			Yes
(9) HEALTH ALLIANCE NORTHWEST HEALTH PLAN 820 N CHELAN AVE WENATCHEE,WA98801 46-1966323	HEALTH COVERAGE	WA	NA	C CORP			Yes
(10) HEALTH ALLIANCE MIDWEST INC 3310 SOUTH FIELDS CHAMPAIGN,IL61822 37-1354502	HEALTH COVERAGE	IL	NA	C CORP			Yes

Schedule R (Form 990) 2019

Page 3

Part V

Transactions With Related Organizations. Complete if the organization answered "Yes" on Form 990, Part IV, line 34, 35b, or 36.

Note. Complete line 1 if any entity is listed in Parts II, III, or IV of this schedule.

Yes

1 During the tax year, did the orgranization engage in any of the following transactions with one or more related organizations listed in Parts II-IV?

a Receipt of (i) interest, (ii) annuities, (iii) royalties, or (iv) rent from a controlled entity .....................

Yes

b Gift, grant, or capital contribution to related organization(s) ............................

c Gift, grant, or capital contribution from related organization(s) ............................

d Loans or loan guarantees to or for related organization(s) ............................

e Loans or loan guarantees by related organization(s) ............................

f Dividends from related organization(s) ............................

g Sale of assets to related organization(s) ............................

h Purchase of assets from related organization(s) ............................

i Exchange of assets with related organization(s) ............................

j Lease of facilities, equipment, or other assets to related organization(s) .......................

k Lease of facilities, equipment, or other assets from related organization(s) ......................

Yes

l Performance of services or membership or fundraising solicitations for related organization(s) .....................

Yes

m Performance of services or membership or fundraising solicitations by related organization(s) .................

Yes

n Sharing of facilities, equipment, mailing lists, or other assets with related organization(s) ...................

o Sharing of paid employees with related organization(s) ............................

p Reimbursement paid to related organization(s) for expenses ............................

Yes

q Reimbursement paid by related organization(s) for expenses ............................

r Other transfer of cash or property to related organization(s) ............................

Yes

s Other transfer of cash or property from related organization(s) ............................

Yes

If the answer to any of the above is "Yes," see the instructions for information on who must complete this line, including covered relationships and transaction thresholds.

(a) Name of related organization	(b) Transaction type (a-s)	(c) Amount involved	(d) Method of determining amount involved
(1) HEALTH ALLIANCE MEDICAL PLANS INC	l	5,038,379	BOOK VALUE
(2) HEALTH ALLIANCE CONNECT INC	l	3,716,013	BOOK VALUE
(3) CARLE HEALTH CARE INCORPORATED	m	13,016,792	BOOK VALUE
(4) THE CARLE FOUNDATION HOSPITAL	m	759,470	BOOK VALUE
(5) HEALTH SYSTEMS INSURANCE LIMITED	m	88,290	BOOK VALUE
(6) THE CARLE FOUNDATION HOSPITAL	p	90,730	BOOK VALUE
(7) THE CARLE FOUNDATION HOSPITAL	s	724,788	BOOK VALUE

Schedule R (Form 990) 2019

Page 4

Part VI

Unrelated Organizations Taxable as a Partnership. Complete if the organization answered "Yes" on Form 990, Part IV, line 37.

Provide the following information for each entity taxed as a partnership through which the organization conducted more than five percent of its activities (measured by total assets or gross revenue) that was not a related organization. See instructions regarding exclusion for certain investment partnerships.

(a) Name, address, and EIN of entity	(b) Primary activity	(c) Legal domicile (state or foreign country)	(e) Are all partners section 501(c)(3) organizations?		(f) Share of total income	(g) Share of end-of-year assets	(h) Disproprtionate allocations?		(i) Code V-UBI amount in box 20 of Schedule K-1 (Form 1065)	(j) General or managing partner?
(a) Name, address, and EIN of entity	(b) Primary activity	(c) Legal domicile (state or foreign country)	Yes	No	(f) Share of total income	(g) Share of end-of-year assets	Yes	No	(i) Code V-UBI amount in box 20 of Schedule K-1 (Form 1065)	Yes	No

Schedule R (Form 990) 2019

Page 5

Part VII

Supplemental Information

Provide additional information for responses to questions on Schedule R. (see instructions).

Return Reference	Explanation

Schedule R (Form 990) 2019

Additional Data

Software ID:
Software Version:

1	Briefly describe the organization’s mission or most significant activities: TO PROVIDE QUALITY HEALTH CARE AND OTHER MEDICALLY RELATED SERVICES AND EDUCATION TO THE COMMUNITY THROUGH THE OPERATION OF A CRITICAL ACCESS HOSPITAL AND RURAL HEALTH CLINICS.
2	Check this box
3	Number of voting members of the governing body (Part VI, line 1a) ........	3	7
4	Number of independent voting members of the governing body (Part VI, line 1b) .....	4	5
5	Total number of individuals employed in calendar year 2019 (Part V, line 2a) ......	5	375
6	Total number of volunteers (estimate if necessary) .............	6	0
7a	Total unrelated business revenue from Part VIII, column (C), line 12 ........	7a	19,468
b	Net unrelated business taxable income from Form 990-T, line 39 .........	7b	-2,744

		Prior Year	Current Year
8	Contributions and grants (Part VIII, line 1h) .........	0	3,125
9	Program service revenue (Part VIII, line 2g) .........	61,656,378	66,731,104
10	Investment income (Part VIII, column (A), lines 3, 4, and 7d ) ....	15,002	21,410
11	Other revenue (Part VIII, column (A), lines 5, 6d, 8c, 9c, 10c, and 11e)	447,547	574,795
12	Total revenue—add lines 8 through 11 (must equal Part VIII, column (A), line 12)	62,118,927	67,330,434
13	Grants and similar amounts paid (Part IX, column (A), lines 1–3 )...	53,576	47,830
14	Benefits paid to or for members (Part IX, column (A), line 4).....	0	0
15	Salaries, other compensation, employee benefits (Part IX, column (A), lines 5–10)	21,344,570	24,142,696
16a	Professional fundraising fees (Part IX, column (A), line 11e) .....	0	0
b	Total fundraising expenses (Part IX, column (D), line 25) 0
17	Other expenses (Part IX, column (A), lines 11a–11d, 11f–24e)....	40,862,481	44,383,448
18	Total expenses. Add lines 13–17 (must equal Part IX, column (A), line 25)	62,260,627	68,573,974
19	Revenue less expenses. Subtract line 18 from line 12.......	-141,700	-1,243,540
		Beginning of Current Year	End of Year
20	Total assets (Part X, line 16).............	28,723,603	28,873,260
21	Total liabilities (Part X, line 26).............	31,905,887	33,335,183
22	Net assets or fund balances. Subtract line 21 from line 20.....	-3,182,284	-4,461,923

Sign Here

	Signature of officer	Date

	Type or print name and title


4a	(Code: ) (Expenses $ 63,870,236 including grants of $ 47,830 ) (Revenue $ 67,052,388 )
	PART III, LINE 4A HOOPESTON COMMUNITY MEMORIAL HOSPITAL (HCMH), A 24 BED CRITICAL ACCESS HOSPITAL LOCATED IN HOOPESTON, IL SERVES HOOPESTON, VERMILION COUNTY AND THE SURROUNDING AREA. HCMH EMPLOYS MORE THAN 300 STAFF MEMBERS AND 75 PROVIDERS. HCMH IS COMMITTED TO PROVIDING QUALITY, DEPENDABLE HEALTH SERVICES. HCMH OFFERS SPECIALTY SERVICES WITH CARDIOLOGY, ORTHOPEDICS, GYNECOLOGY, MENTAL HEALTH, UROLOGY AND DIAGNOSTIC SERVICES INCLUDING NUCLEAR MEDICINE, DIGITAL MAMMOGRAPHY, RADIOLOGY AND LABORATORY. EMERGENCY MEDICINE AND SURGICAL SERVICES ARE PROVIDED IN STATE OF THE ART FACILITIES. HCMH PROVIDES ACCESS TO PRIMARY CARE WITH CLINICS IN HOOPESTON, ROSSVILLE, MILFORD, CISSNA PARK, DANVILLE, WATSEKA, TUSCOLA AND MATTOON, IL. HCMH HAS BEEN DEDICATED TO CARING FOR THOSE IN THE AREA FOR OVER 60 YEARS.

4b	(Code: ) (Expenses $ including grants of $ ) (Revenue $ )












4c	(Code: ) (Expenses $ including grants of $ ) (Revenue $ )












4d	Other program services (Describe in Schedule O.)
	(Expenses $ including grants of $ ) (Revenue $ )
4e	Total program service expenses63,870,236

1b	Sub-Total................
c	Total from continuation sheets to Part VII, Section A....
d	Total (add lines 1b and 1c)...........	762,768	10,709,058	1,796,847

1a	Federated campaigns..		1a
b	Membership dues..		1b
c	Fundraising events..		1c
d	Related organizations		1d
e	Government grants (contributions)		1e	3,125

f	All other contributions, gifts, grants, and similar amounts not included above		1f

g	Noncash contributions included in lines 1a - 1f:$		1g

h Total. Add lines 1a-1f.......		3,125

		Business Code
2a	NET PATIENT SERVICES	622110	66,730,167	66,730,167
b	RENT FROM RELATED ORGS	532000	937	937
c
d
e
f	All other program service revenue.
g	Total. Add lines 2a–2f .....		66,731,104

3 Investment income (including dividends, interest, and othersimilar amounts) ......			15,410			15,410
4 Income from investment of tax-exempt bond proceeds			0
5 Royalties...........			0
		(ii) Personal	(i) Real
6a	Gross rents		19,384	6a
b	Less: rental expenses		12,123	6b
c	Rental income or (loss)	0	7,261	6c
d	Net rental income or (loss).......			7,261			7,261
		(ii) Other	(i) Securities
7a	Gross amount from sales of assets other than inventory	6,000		7a
b	Less: cost or other basis and sales expenses			7b
c	Gain or (loss)	6,000		7c
d	Net gain or (loss).........			6,000			6,000
8a	Gross income from fundraising events (not including $ of contributions reported on line 1c). See Part IV, line 18 ....
			8a	0
b	Less: direct expenses ...		8b	0
c	Net income or (loss) from fundraising events..			0
9a	Gross income from gaming activities. See Part IV, line 19 ...
			9a	0
b	Less: direct expenses ...		9b	0
c	Net income or (loss) from gaming activities..			0
10a	Gross sales of inventory, less returns and allowances ..
			10a	0
b	Less: cost of goods sold ..		10b	0
c	Net income or (loss) from sales of inventory..			0
Business Code			Miscellaneous Revenue
11a	MEDICAID EMR INCENTIVE		622110	178,500	178,500
b	COFFEE SHOP		722212	34,531			34,531
c	PERPETUAL TRUST INCOME		900099	172,780			172,780
d	All other revenue ....			181,723	142,784	19,468	19,471
e	Total. Add lines 11a–11d ......			567,534
12	Total revenue. See instructions.....			67,330,434	67,052,388	19,468	255,453

1	Grants and other assistance to domestic organizations and domestic governments. See Part IV, line 21 ....	47,830	47,830
2	Grants and other assistance to domestic individuals. See Part IV, line 22 ...........	0	0
3	Grants and other assistance to foreign organizations, foreign governments, and foreign individuals. See Part IV, lines 15 and 16. .............	0	0
4	Benefits paid to or for members .......	0	0
5	Compensation of current officers, directors, trustees, and key employees ...........	0	0	0	0
6	Compensation not included above, to disqualified persons (as defined under section 4958(f)(1)) and persons described in section 4958(c)(3)(B) .........	469,112	469,112	0	0
7	Other salaries and wages........	18,489,586	17,255,686	1,233,900	0
8	Pension plan accruals and contributions (include section 401(k) and 403(b) employer contributions) ....	1,032,954	957,927	75,027	0
9	Other employee benefits .......	2,803,110	2,630,123	172,987	0
10	Payroll taxes ...........	1,347,934	1,233,926	114,008	0
11	Fees for services (non-employees):
a	Management ......	0	0	0	0
b	Legal .........	0	0	0	0
c	Accounting ...........	0	0	0	0
d	Lobbying ...........	4,857	0	4,857	0
e	Professional fundraising services. See Part IV, line 17	0			0
f	Investment management fees ......	0	0	0	0
g	Other (If line 11g amount exceeds 10% of line 25, column (A) amount, list line 11g expenses on Schedule O)	1,731,806	1,587,656	144,150	0
12	Advertising and promotion ....	28,494	653	27,841	0
13	Office expenses .......	1,468,693	1,230,021	238,672	0
14	Information technology ......	393,903	372,978	20,925	0
15	Royalties ..	0	0	0	0
16	Occupancy ...........	2,554,046	1,891,967	662,079	0
17	Travel ............	116,426	94,444	21,982	0
18	Payments of travel or entertainment expenses for any federal, state, or local public officials .	0	0	0	0
19	Conferences, conventions, and meetings ....	51,587	41,264	10,323	0
20	Interest ...........	244,103	244,103	0	0
21	Payments to affiliates .......	0	0	0	0
22	Depreciation, depletion, and amortization ..	1,979,973	1,447,891	532,082	0
23	Insurance ...	203,023	192,701	10,322	0
24	Other expenses. Itemize expenses not covered above (List miscellaneous expenses in line 24e. If line 24e amount exceeds 10% of line 25, column (A) amount, list line 24e expenses on Schedule O.)
a	INTERNAL PURCHASED SVCS	2,334,274	1,971,676	362,598	0
b	INTERNAL MANAGEMENT FEES	12,715,578	11,864,856	850,722	0
c	PATIENT CARE SUPPLIES	4,990,695	4,966,016	24,679	0
d	OTHER PURCHASED SERVICES	13,973,502	13,966,190	7,312	0
e	All other expenses	1,592,488	1,403,216	189,272
25	Total functional expenses. Add lines 1 through 24e	68,573,974	63,870,236	4,703,738	0
26	Joint costs. Complete this line only if the organization reported in column (B) joint costs from a combined educational campaign and fundraising solicitation. Check here if following SOP 98-2 (ASC 958-720).

1	Cash–non-interest-bearing ........			10,120	1	10,047
2	Savings and temporary cash investments .........			0	2	0
3	Pledges and grants receivable, net ......			6,265,016	3	6,342,312
4	Accounts receivable, net .............			0	4	0
5	Loans and other payables to any current or former officer, director, trustee, key employee, creator or founder, substantial contributor, or 35% controlled entity or family member of any of these persons .......
				0	5	0
6	Loans and other receivables from other disqualified persons (as defined under section 4958(f)(1)), and persons described in section 4958(c)(3)(B) ...
				0	6	0
7	Notes and loans receivable, net ...........			0	7	0
8	Inventories for sale or use ............			0	8	0
9	Prepaid expenses and deferred charges ......			169,383	9	157,529
10a	Land, buildings, and equipment: cost or other basis. Complete Part VI of Schedule D	10a	27,057,925
b	Less: accumulated depreciation	10b	13,805,616	13,604,488	10c	13,252,309
11	Investments—publicly traded securities .			0	11	0
12	Investments—other securities. See Part IV, line 11 .....			0	12	0
13	Investments—program-related. See Part IV, line 11 ..			0	13	0
14	Intangible assets ...............			4,444,690	14	4,444,690
15	Other assets. See Part IV, line 11 ...........			4,229,906	15	4,666,373
16	Total assets. Add lines 1 through 15 (must equal line 33)...			28,723,603	16	28,873,260

17	Accounts payable and accrued expenses .....	2,384,819	17	2,315,335
18	Grants payable ...	0	18	0
19	Deferred revenue .........	0	19	0
20	Tax-exempt bond liabilities .........	0	20	0
21	Escrow or custodial account liability. Complete Part IV of Schedule D	0	21	0
22	Loans and other payables to any current or former officer, director, trustee, key employee, creator or founder, substantial contributor, or 35% controlled entity or family member of any of these persons .........
		0	22	0
23	Secured mortgages and notes payable to unrelated third parties ..	5,590,857	23	5,246,215
24	Unsecured notes and loans payable to unrelated third parties ..	0	24	0
25	Other liabilities (including federal income tax, payables to related third parties, and other liabilities not included on lines 17 - 24). Complete Part X of Schedule D	23,930,211	25	25,773,633
26	Total liabilities. Add lines 17 through 25..	31,905,887	26	33,335,183

	Organizations that follow FASB ASC 958, check here and complete lines 27, 28, 32, and 33.
27	Net assets without donor restrictions ..........	-6,856,411	27	-8,099,952
28	Net assets with donor restrictions ...........	3,674,127	28	3,638,029
	Organizations that do not follow FASB ASC 958, check here and complete lines 29 through 33.
29	Capital stock or trust principal, or current funds .....		29
30	Paid-in or capital surplus, or land, building or equipment fund ...		30
31	Retained earnings, endowment, accumulated income, or other funds		31
32	Total net assets or fund balances ...........	-3,182,284	32	-4,461,923
33	Total liabilities and net assets/fund balances ........	28,723,603	33	28,873,260