2024-05-14T09:16:33-05:00 2023-09-30 390758449 WIPFLI LLP 1502 LONDON ROAD SUITE 200 DULUTH MN 55812 990 2022-10-01 350211370 CAMERON MEMORIAL COMMUNITY HOSPITAL CAME 2606652141 416 E MAUMEE STREET ANGOLA IN 46703 ANGELA LOGAN CEO 2606652141 2024-05-06 1 ANGELA LOGAN 999009999 0 MICHAEL J PETERSON CPA P01833529 2187224705 2024-05-06 2 AAL1 IAL1 2022 2023-04-26 12:10:37Z ANGELA LOGAN 416 E MAUMEE STREET ANGOLA IN 46703 108277767 0 X WWW.CAMERONMCH.COM X 1972 IN CMCH IS AN INDEPENDENT, NOT FOR PROFIT, CRITICAL ACCESS HOSPITAL OFFERING HEALTH & WELLNESS SERVICES. 14 10 745 59 0 0 2122612 1196114 99681076 105162867 38673 976776 725372 899018 102567733 108234775 160000 106039 0 0 46167282 50774495 0 0 414059 45921542 54645839 92248824 105526373 10318909 2708402 106565543 115765241 52715848 55577010 53849695 60188231 THE MISSION OF CAMERON MEMORIAL COMMUNITY HOSPITAL IS TO IMPROVE THE QUALITY OF LIFE FOR THOSE WE SERVE THROUGH RELATIONSHIPS FOCUSED ON HEALTH AND WELLNESS. 0 0 81497799 106039 105351352 CAMERON MEMORIAL COMMUNITY HOSPITAL, INC. (HOSPITAL), A NOT FOR PROFIT ORGANIZATION, IS A GENERAL ACUTE CARE FACILITY IN ANGOLA, INDIANA WITH 25 LICENSED BEDS AND ASSOCIATED ANCILLARY SERVICE DEPARTMENTS INCLUDING OUTPATIENT SERVICES, HOME HEALTH CARE AND AN URGENT CARE CENTER IN ANGOLA, INDIANA. THE HOSPITAL PROVIDES HEALTH CARE SERVICES PRIMARILY IN THE NORTHEAST PORTION OF INDIANA. EXPENSES RELATE TO THE PROVISION OF MEDICAL CARE AND RELATED GENERAL AND ADMINISTRATIVE COSTS. SURGERY SERVICE IS A PROGRAM OFFERED TO PATIENTS AT THE HOSPITAL. OVER 4,000 PROCEDURES ARE PERFORMED ANNUALLY, WITH 90% OF THE PROCEDURES BEING OUTPATIENT RELATED. OTHER PROGRAMS INCLUDE RADIOLOGY, LAB SERVICES AND EMERGENCY ROOM.RADIOLOGY SERVICE IS OFFERED TO PATIENTS AT THE HOSPITAL. ANNUALLY THE HOSPITAL PERFORMS OVER 44,400 PROCEDURES, INCLUDING GENERAL RADIOLOGY SERVICES, CT SCANS, PET SCANS AND AN OPEN BORE MRI. LAB SERVICES IS THE FOURTH LARGEST PROGRAM OFFERED TO PATIENTS AT THE HOSPITAL. OVER 185,300 ARE DONE WITH 88% BEING OUTPATIENT RELATED. EMERGENCY ROOM SERVICES IS THE THIRD LARGEST PROGRAM OFFERED TO PATIENTS AT CMCH. OVER 17,200 PATIENTS CAME THROUGH CAMERON'S EMERGENCY ROOM. 81497799 1 1 0 1 0 0 0 0 0 0 1 0 0 0 1 0 0 1 0 0 0 0 0 1 1 0 1 1 1 0 1 0 0 0 0 0 0 1 0 0 0 0 0 0 1 1 1 0 0 1 41 0 745 1 0 0 0 0 0 0 0 0 0 0 0 0 X 14 10 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 0 IN X ANGELA LOGAN 2606652141 416 E MAUMEE STREET ANGOLA IN 46703 JOHN VARNER MD PHYSICIAN 31.00 X 771421 0 17022 TODD RUMSEY MD TREASURER/PHYSICIAN 40.00 2.00 X X 691633 0 31172 ANGELA LOGAN CHIEF EXECUTIVE OFFICER 38.00 2.00 X 439832 0 17934 TOM MILLER MD BOARD MEMBER/PHYSICIAN 27.00 2.00 X 422724 0 30673 CHARLES MACLEAN PHYSICIAN 28.00 X 321661 0 25759 DEAN MATTOX II MD PHYSICIAN 33.00 X 422969 0 23174 MELCHOR MERCADO PHYSICIAN 33.00 X 307781 0 22340 LYNN FAUR MD BOARD MEMBER/PHYSICIAN 34.00 2.00 X X 286283 0 30513 JESSICA OTTENWELLEN-BUTCHER PHYSICIAN 32.00 X 291269 0 16753 CONSTANCE MCCAHILL FORMER CHIEF EXECUTIVE OFF 0.00 X 145468 0 0 TERESA KING MD SECRETARY/PHYSICIAN 40.00 2.00 X X 108783 0 4888 DEBORAH MCHENRY CHAIR 2.00 2.00 X X 0 0 0 JOHN MCCOY VICE CHAIR 2.00 2.00 X X 0 0 0 JONATHAN CRESS BOARD MEMBER 2.00 2.00 X 0 0 0 MIKE CONNELL BOARD MEMBER 2.00 2.00 X 0 0 0 JENNIFER DANIC BOARD MEMBER 2.00 2.00 X 0 0 0 DONNA ELBRECHT BOARD MEMBER 2.00 2.00 X 0 0 0 SCOTT GRUNER BOARD MEMBER 2.00 2.00 X 0 0 0 JEFFERY NICKEL MD BOARD MEMBER 2.00 2.00 X 0 0 0 ANN RICE BOARD MEMBER 2.00 2.00 X 0 0 0 BARBARA SHORT BOARD MEMBER 2.00 2.00 X 0 0 0 4209824 0 220228 80 1 1 0 AYA HEALTHCARE INC LOCKBOX 674907 1200 E CAMPBELL RD RICHARDSON TX 75081 STAFFING SERVICES 879469 FORT WAYNE ORTHOPAEDICS LLC PO BOX 2526 FORT WAYNE IN 468012526 ORTHOPAEDIC SERVICES 804409 HOSPITAL CARE GROUP PC 6435 WEST JEFFERSON BLVD PMB 109 FORT WAYNE IN 46804 HOSPITALIST PROGRAM 740938 ASSOC ANESTHESIOLOGISTS 10315 DAWSONS CREK SUITE A/B FORT WAYNE IN 46825 ANESTHESIOLOGY SERVICES 682121 HIRONS & COMPANY 422 E NEW YORK ST INDINAPOLIS IN 46202 MARKETING SERVICES 595911 22 4710 859143 332261 1196114 NET PATIENT SERVICE REVENUE 621400 104260967 104260967 340B PHARMACY REVENUE 623990 572649 572649 RELATED PARTY MANAGEMENT FEE 541610 313771 313771 MEALS ON WHEELS 624200 15480 15480 105162867 984773 984773 251773 0 251773 251773 251773 17400 25397 -7997 -7997 -7997 42517 4710 17595 24922 24922 CAFETERIA REVENUE 722514 289995 289995 INCENTIVE PAYMENTS 900099 188485 188485 PHARMACY REVENUE 900099 14283 14283 129560 129560 622323 108234775 105351352 0 1687309 X 106039 106039 1812694 1378001 428308 6385 35927245 27311730 8488985 126530 1110256 812986 292585 4685 9256693 6785419 2432391 38883 2667607 1955860 700553 11194 111119 868 110251 82959 82959 1984 1984 13441171 11807235 1566469 67467 793231 793231 1322355 706794 599680 15881 2621000 462327 2154294 4379 2311275 2282687 28588 89297 35121 46525 7651 109026 60948 47617 461 1333328 1208755 122845 1728 4579871 4148582 425171 6118 687435 140139 547296 MEDICAL SUPPLIES 11468480 11462822 5621 37 BAD DEBT EXPENSE 5656779 5656779 HAF EXPENSE 4277063 4277063 MINOR EQUIPMENT 1317344 1059455 257889 4442122 4115252 204210 122660 105526373 81497799 23614515 414059 203009 130998 21361045 19668145 11881560 11519464 284118 562014 1529058 1476430 2613081 1474959 85445955 52087492 35436274 33358463 24115445 27204218 3329020 3329020 897483 804596 4915450 16236934 106565543 115765241 10647167 9325025 743489 6018 40791070 45817870 534122 428097 52715848 55577010 X 53435697 59439831 413998 748400 53849695 60188231 106565543 115765241 2708402 3630134 0 X 0 1 X 1 1 1 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 2527 2527 0 PART II-B, LINE 1: DURING FISCAL YEAR 2023 A PORTION OF THE HOSPITAL'S ASSOCIATION MEMBERSHIP DUES PAID TO INDIANA HOSPITAL ASSOCIATION (IHA) AND AMERICAN HOSPITAL ASSOCIATION (AHA) WAS ALLOCATED TO LOBBYING EXPENDITURES. 2019703 2019703 61381451 35131656 26249795 21206348 16955836 4250512 838453 838453 33358463 ASSETS LIMITED AS TO USE - RESTRICTED FOR CAPITAL IMPROVEMENTS 9142078 ASSETS LIMITED AS TO USE - DONOR RESTRICTED 6230249 RELATED PARTY RECEIVABLE 864607 16236934 ESTIMATED THIRD-PARTY SETTLEMENT 251486 RECOURSE OBLIGATION, PATIENT PAYABLE 171611 CAMERON WOODS SECURITY DEPOSITS 5000 428097 X X X X X X 1 HILLARY LYONS ASSOCIATES PO BOX 99 DIAMONDALE MI 48821 SUPPORT, PLANNING AND ORGANIZING FUNDRAISING EVENTS 0 0 60000 -60000 60000 -60000 IN GOLF OUTING 47227 4710 42517 1102 2805 6800 5653 1235 47227 4710 42517 1102 2805 6800 5653 1235 17595 24922 SCHEDULE G, PART I, LINE 2B, COLUMN (V) THE ORGANIZATION CONSULTED WITH THE LISTED PERSONS FOR SUPPORT ON THE PLANNING OF THEIR FUNDRAISING EVENTS. 1 1 X 1 X 1 X 1 1 0 1 1 120014 120014 0.00120 14384129 9993404 4390725 0.04400 14504143 9993404 4510739 0.04520 101670 101670 0.00100 49962 49962 0.00050 151632 151632 0.00150 14655775 9993404 4662371 0.04670 56077 56077 0.00060 5311 5311 0.00010 6396 6396 0.00010 67784 67784 0.00080 1 2207450 97906 18419112 18054838 364274 X 1 1 1 1 CAMERON MEMORIAL COMMUNITY HOSPITAL INC 416 E MAUMEE STREET ANGOLA IN 46703 WWW.CAMERONMCH.COM 22-005037-1 X X X X CAMERON MEMORIAL COMMUNITY HOSPITAL INC 1 0 0 1 X X X X X X X X X 21 1 0 1 1 X SEE PART V, SECTION C, LINE 7D X X 1 22 1 HTTPS://WWW.CAMERONMCH.COM/RESOURCES/COMMUNITY-HEALTH-ASSESSMENT/ 0 1 X 100.000000000000 350.000000000000 X X X X X X 1 1 X X X 1 X HTTPS://WWW.CAMERONMCH.COM/RESOURCES/BILLING-PRICING/ X HTTPS://WWW.CAMERONMCH.COM/RESOURCES/BILLING-PRICING/ X HTTPS://WWW.CAMERONMCH.COM/RESOURCES/BILLING-PRICING/ X X X X X X X 1 X 0 X X X X X 1 X 0 0 CAMERON MEMORIAL COMMUNITY HOSPITAL, INC. PART V, SECTION B, LINE 5: CONTRACTED WITH THE INDIANA RURAL HEALTH ASSOCIATION (IRHA) TO CONDUCT THE COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA). IRHA FIRST IDENTIFIED THE COMMUNITY SERVED BY CMCH THROUGH CONVERSATIONS WITH THE HOSPITAL. BASED ON A REVIEW OF PATIENT ZIP CODES, THE HOSPITAL WAS ABLE TO DEFINE THE COMMUNITY SERVED AS ALL POSTAL CODES WITHIN THE GEOGRAPHIC AREA OF STEUBEN COUNTY. THE HOSPITAL PROVIDED A PRIMARY SERVICE AREA MAP WITH ZIP CODES. NEXT, A STEERING COMMITTEE OF STEUBEN COUNTY REPRESENTATIVES WAS ORGANIZED WITH THE HELP OF THE CAMERON MEMORIAL COMMUNITY HOSPITAL CEO. BUSINESS OWNERS, LOCAL OFFICIALS, HEALTHCARE PROVIDERS, MINORITY LEADERS, CLERGY, STUDENT REPRESENTATIVES, AND ANY OTHER INTERESTED PARTIES WERE INVITED TO ATTEND THE MEETING TO DISCUSS THE HEALTH-RELATED NEEDS OF THE COUNTY WITH A VIEW TO IDENTIFYING THE AREAS OF GREATEST CONCERN. FROM THE INFORMATION OBTAINED IN THE STEERING COMMITTEE, A 43-QUESTION SURVEY WAS DEVELOPED TO GAIN THE PERSPECTIVE OF THE INHABITANTS OF THE COMMUNITY. QUESTIONS INCLUDED QUERIES ABOUT THE EFFECT OF VARIOUS FACTORS (SUCH AS ILLEGAL DRUGS, TRANSPORTATION, AND POVERTY), AS WELL AS PROBES INTO THE PERCEIVED NEED FOR VARIOUS SERVICES AND FACILITIES IN THE COUNTY. THE SURVEY WAS DISSEMINATED TO THE RESIDENTS OF STEUBEN COUNTY THROUGH INCLUSION ON THE CAMERON MEMORIAL COMMUNITY HOSPITAL'S WEBSITE, FACE-TO-FACE POLLING AT THE YMCA OF STEUBEN COUNTY AND SUTTON'S DELI, A RESTAURANT ON THE TOWN SQUARE IN ANGOLA. AN ONLINE SURVEY POSTED ON SURVEYMONKEY.COM WAS ALSO MADE AVAILABLE TO THE PUBLIC. CAMERON MEMORIAL COMMUNITY HOSPITAL, INC. PART V, SECTION B, LINE 6B: INDIANA RURAL HEALTH ASSOCIATION CAMERON MEMORIAL COMMUNITY HOSPITAL, INC. PART V, SECTION B, LINE 7D: SECTION B, LINE 7A:HTTPS://WWW.CAMERONMCH.COM/RESOURCES/COMMUNITY-HEALTH-ASSESSMENT/SECTION B, LINE 7D:LOCATION TO CHNA: ON THE WEB PAGE UNDER "RESOURCES" CLICK ON THE LINK "ANNUAL REPORT & COMMUNITY HEALTH NEEDS ASSESSMENT" TO ACCESS CMCH'S MOST CURRENT COMMUNITY HEALTH NEEDS ASSESSMENT OR COPY AND ENTER THE LINK ABOVE "SECTION B, LINE 7A" INTO THE INTERNET BROWSER. CAMERON MEMORIAL COMMUNITY HOSPITAL, INC. PART V, SECTION B, LINE 11: THERE WERE THREE SIGNIFICANT NEEDS IDENTIFIED FOLLOWING THE 2022 CHNA. BELOW IS A SUMMARY OF THE NEEDS IDENTIFIED AND PRIORITIZED IN THE APPROVED IMPLEMENTATION STRATEGY WITH AN UPDATE FOR THE YEAR.1. MENTAL HEALTH SERVICES/TREATMENT, IN-PATIENT, YOUTH, STIGMA REDUCTIONAS MENTIONED ABOVE, CAMERON HAS MADE SIGNIFICANT STRIDES IN ENHANCING MENTAL HEALTH SERVICES, DEMONSTRATING A DEEP COMMITMENT TO SUPPORTING HOLISTIC WELL-BEING. WE HAVE EXPANDED OUR NETWORK OF PROVIDERS, ENSURING ACCESS TO DIVERSE AND SPECIALIZED CARE OPTIONS. ADDITIONALLY, WE HAVE PLACED ADDITIONAL EMPHASIS AND FOCUS ON SUPPORTING YOUNG PATIENTS UNDER 18, RECOGNIZING THE UNIQUE CHALLENGES THEY FACE. THROUGH INCREASED RESOURCES AND SPECIALIZED PROGRAMS, WE AIM TO PROVIDE COMPREHENSIVE CARE TAILORED TO THEIR SPECIFIC NEEDS. FURTHERMORE, CAMERON IS WORKING WITH LOCAL SCHOOLS AND AGENCIES, PROVIDING SPEAKERS AND EDUCATION, AIMED AT REDUCING THE STIGMA SURROUNDING MENTAL HEALTH CARE, FOSTERING A CULTURE OF OPENNESS AND UNDERSTANDING. THESE EFFORTS REFLECT OUR DEDICATION TO PROMOTING MENTAL HEALTH AWARENESS AND ACCESSIBILITY, ENSURING THAT EVERYONE FEELS SUPPORTED AND EMPOWERED ON THEIR WELLNESS JOURNEY.2. SUBSTANCE USE SUBSTANCE USE, TOBACCO/VAPING, STIGMA REDUCTIONCAMERON IS COMMITTED TO ADDRESSING SUBSTANCE USE DISORDER WITHIN OUR COMMUNITY THROUGH A MULTIFACETED APPROACH THAT EMPHASIZES EDUCATION, COLLABORATION, AND SUPPORT. WE HAVE ESTABLISHED PARTNERSHIPS WITH LOCAL SCHOOLS TO PROVIDE EDUCATION AND PREVENTION PROGRAMS, AIMING TO EQUIP STUDENTS WITH THE KNOWLEDGE AND SKILLS NEEDED TO MAKE HEALTHY CHOICES AND AVOID SUBSTANCE ABUSE. THESE INITIATIVES INCLUDE INTERACTIVE WORKSHOPS, INFORMATIONAL SESSIONS, AND RESOURCES TAILORED TO DIFFERENT AGE GROUPS, ENSURING THAT STUDENTS RECEIVE AGE-APPROPRIATE EDUCATION ON THE RISKS OF SUBSTANCE USE.IN ADDITION TO OUR SCHOOL PARTNERSHIPS, CAMERON ACTIVELY ENGAGES IN INTER-AGENCY EFFORTS TO COMBAT SUBSTANCE ABUSE. BY COLLABORATING WITH LAW ENFORCEMENT, HEALTHCARE PROVIDERS, AND COMMUNITY ORGANIZATIONS, WE WORK TO IDENTIFY AND ADDRESS THE ROOT CAUSES OF SUBSTANCE USE DISORDER, WHILE ALSO ENSURING THAT THOSE AFFECTED RECEIVE THE SUPPORT AND TREATMENT THEY NEED. OUR EFFORTS INCLUDE COORDINATING CARE PLANS, FACILITATING ACCESS TO TREATMENT PROGRAMS, AND PROVIDING ONGOING SUPPORT TO INDIVIDUALS AND FAMILIES AFFECTED BY SUBSTANCE USE DISORDER. THROUGH THESE COLLABORATIVE EFFORTS, CAMERON AIMS TO CREATE A COMMUNITY WHERE INDIVIDUALS ARE EMPOWERED TO MAKE HEALTHY CHOICES AND WHERE THOSE STRUGGLING WITH SUBSTANCE USE DISORDER RECEIVE THE SUPPORT AND CARE THEY NEED TO RECOVER.3. YOUTH FOCUSED SERVICESTHIS IS AN ONGOING STRATEGIC IMPERATIVE AT CAMERON. WE CONTINUE TO COLLABORATE WITH NEED IS BEING ADDRESSED DURING THE YEAR: CMCH WILL COLLABORATE WITH COMMUNITY ORGANIZATIONS FOCUSED ON YOUTH TO INCLUDE HEALTHY LIVING CONCEPTS AS PART OF DAILY LIFE INCLUDING: YMCA OF STEUBEN COUNTY, SHAPE UP STEUBEN AND PURDUE EXTENSION, ALONG WITH OTHER SOCIAL ACTIVITY/CLUBS, FITNESS ORGANIZATIONS, LOCAL GATHERING PLACES, SCHOOLS AND FAITH-BASED ORGANIZATIONS. CAMERON AND THE LOCAL PURDUE EXTENSION OFFICE HAVE LAUNCHED A PROGRAM CALLED STRENGTHENING FAMILIES IN JUNE 2019. THIS PROGRAM IS A 7-SESSION COURSE FOR AGES 10-14. THE PROGRAM MEETS WEEKLY FOR 2.5 HOURS TO WORK WITH FAMILY-LIFE ISSUES, PARENT-CHILD RELATIONSHIPS, COMMUNICATION TOOLS, PEER PRESSURE AND SETTING & ACHIEVING GOALS. THE FIRST SESSION WAS OPEN ONLY FOR COURT-APPOINTMENT FAMILIES FROM THE JUVENILE DELINQUENCY PROBATION PROGRAMS. SUBSEQUENT SESSIONS WERE OPENED TO THE PUBLIC. THIS PROGRAM WAS MADE AVAILABLE AT NO COST TO THE FAMILIES THROUGH GRANTS OBTAINED THROUGH PURDUE EXTENSION AND THE STEUBEN COUNTY COMMUNITY FOUNDATION. CAMERON HAS ALSO INTRODUCED A THERAPY PROGRAM. IN SEPTEMBER OF 2022. (END OF FY 22) THESE COMFORT AND THERAPY DOGS FREQUENTLY VISIT WITH ALL PATIENTS, BUT HAVE BEEN VERY HELPFUL WITH YOUTH WHILE STAYING AS AN IN-PATIENT, THERAPY, AND OFFERING COMFORT IN THE LAB.CAMERON MEDICAL GROUP IS COMMITTED TO EDUCATING OUR COMMUNITY, SPECIFICALLY PARENTS AND YOUTH. FROM TOURS OF THE HOSPITAL, PARTICIPATING IN FUN EDUCATIONAL EVENTS AT LOCAL SCHOOLS, THERAPY DOGS, ATTENDING YMCA SUMMER DAY CAMP PROVIDING HEALTHY TIPS ON WASHING HANDS, THE IMPORTANCE OF SEEING YOUR PEDIATRICIAN/FAMILY PROVIDER AND SO MUCH MORE. CAMERON MEMORIAL COMMUNITY HOSPITAL, INC. PART V, SECTION B, LINE 13B: IN ADDITION TO FPG, ELIGIBILITY FOR FINANCIAL ASSISTANCE ALSO CONSIDERS THE FOLLOWING INCOME SOURCES IF PATIENTS CLAIM NO INCOME: INCOME FROM CHILD SUPPORT, PENSION, RENTAL, EDUCATION, AND OTHER FINANCIAL SUPPORT FROM FAMILY MEMBERS NOT LIVING IN THE HOUSEHOLD. CAMERON MEMORIAL COMMUNITY HOSPITAL, INC. PART V, SECTION B, LINE 16J: ON THE WEB PAGE UNDER "RESOURCES" CLICK ON THE LINK "BILLING & PRICING" TO ACCESS THE HOSPITAL'S FINANCIAL ASSISTANCE POLICY INFORMATION. CAMERON MEMORIAL COMMUNITY HOSPITAL, INC. PART V, SECTION B, LINE 20E: FOR INPATIENTS, A HOSPITAL REPRESENTATIVE VISITS THE PATIENT AND DISCUSSES WITH THEM ABOUT PAYMENT OPTIONS INCLUDING THE FINANCIAL ASSISTANCE POLICY; FOR OUTPATIENTS AND OTHER PATIENTS THE BUSINESS OFFICE CALLS AND DISCUSSES THE SAME OPTIONS. PART I, LINE 3C: CAMERON MEMORIAL COMMUNITY HOSPITAL, INC.'S FINANCIAL ASSISTANCE POLICY EXPLAINS THE FOLLOWING ELIGIBILITY CRITERIA FOR FINANCIAL ASSISTANCE IN ADDITION TO THE FPG:INCOME LEVEL OTHER THAN FPG (E.G., CHILD SUPPORT, PENSION INCOME, RENTAL INCOME, EDUCATIONAL INCOME, AND OTHER FINANCIAL SUPPORT FROM FAMILY MEMBERS NOT LIVING IN THE HOUSEHOLD), ASSET LEVEL, MEDICAL INDIGENCY, INSURANCE STATUS, UNDERINSURANCE STATUS, AND RESIDENCY. PART I, LINE 7, COLUMN (F): THE BAD DEBT EXPENSE INCLUDED ON FORM 990, PART IX, LINE 25, COLUMN (A), BUT SUBTRACTED FOR PURPOSES OF CALCULATING THE PERCENTAGE IN THIS COLUMN IS $ 5,656,779. PART II, COMMUNITY BUILDING ACTIVITIES: DESCRIPTION OF COMMUNITY BUILDING ACTIVITIES:CAMERON MEMORIAL COMMUNITY HOSPITAL HAS ROOTS IN THIS AREA DATING BACK TO 1926, HELPING GENERATION AFTER GENERATION ENJOY BETTER HEALTH AND LIVE COMFORTABLY. TODAY, WE'RE A 25-BED, NOT-FOR-PROFIT FACILITY PROUDLY SERVING THE TOWNS AND CITIES OF STEUBEN COUNTY. THE HOSPITAL'S MISSION IS TO IMPROVE THE QUALITY OF LIFE FOR THOSE WE SERVE THROUGH RELATIONSHIPS FOCUSED ON HEALTH AND WELLNESS. OUR TEAM OF EXPERIENCED PHYSICIANS, PROFESSIONAL HEALTHCARE PROVIDERS AND KNOWLEDGEABLE STAFF STRIVE TO MEET THIS MISSION EVERY DAY BY PROVIDING OUTSTANDING, PERSONALIZED CARE BACKED BY ADVANCED TECHNOLOGY AND A COMMITMENT TO OUR COMMUNITY. WE VALUE SAFETY, COMPASSION, INTEGRITY, TEAMWORK, STEWARDSHIP, EXCELLENCE, RESPECT, AND WELLNESS.EACH YEAR, CAMERON HOSPITAL HOSTS HIGH SCHOOL STUDENTS THROUGH THE HEALTH OCCUPATIONS EDUCATION PROGRAM (H.O.E.). THESE STUDENTS ARE SELECTED BASED ON THEIR INTEREST IN PURSUING A CAREER IN HEALTHCARE AFTER GRADUATION. DURING THEIR SENIOR YEAR, THE STUDENTS ARE ASSIGNED TO VARIOUS DEPARTMENTS IN THE HOSPITAL, CLINICS, AND MEDICAL OFFICES TO OBSERVE AND IN MANY INSTANCES, HAVE "HANDS-ON" EXPERIENCE, MONITORED BY EXPERTS IN THE FIELD. THE STUDENTS ARE ALSO TRAINED IN CPR, PARTICIPATE IN HEALTH FAIRS AND SCREENINGS THROUGHOUT THE COMMUNITY. BY SUPPORTING THE H.O.E. PROGRAM, CAMERON HOSPITAL CONTINUOUSLY ENCOURAGES AND PROMOTES QUALITY HEALTHCARE FOR OUR COMMUNITY FOR GENERATIONS TO COME.CAMERON'S 2019 COMMUNITY HEALTH NEEDS ASSESSMENT, CONDUCTED IN COLLABORATION WITH THE INDIANA STATE OFFICE OF RURAL HEALTH, IDENTIFIED A CRITICAL NEED FOR MENTAL HEALTH SERVICES WITHIN STEUBEN COUNTY. THAT SAME YEAR, CAMERON PSYCHIATRY SERVICES, BRINGING A LICENSED PSYCHIATRIST WITH OVER 40 YEARS' EXPERIENCE TO STEUBEN COUNTY. IN THE YEARS THAT HAVE FOLLOWED, CAMERON HAS CONTINUED TO INVEST IN THE PROGRAM TO IMPROVE ACCESS INCLUDING ADDING MULTIPLE THERAPISTS, ADVANCED PRACTICE PROVIDERS AND MULTIPLE THERAPY PROGRAMS. IN 2023, FOLLOWING THE RETIREMENT OF ITS PREVIOUS PSYCHIATRIST, CAMERON HIRED A NEW PSYCHIATRIST, FULL TIME. THE ORGANIZATION ALSO HIRED AN ADDITIONAL PHYSICIAN PART TIME AND EIGHT ADDITIONAL ADVANCED PRACTICE PROVIDERS, ALL OF WHOM STARTED IN EARLY 2024. OTHER EXAMPLES OF CAMERON'S COMMUNITY BUILDING ACTIVITIES INCLUDE OFFERING COMMUNITY-WIDE WELLNESS SCREENING AT A LOCAL HIGH SCHOOLS WITH REDUCED PRICES ON LAB TESTS FOR ADULTS. THE ORGANIZATION ALSO LAUNCHED A TELEHEALTH PROGRAM WITH A LOCAL SCHOOL SYSTEM, ALLOWING CHILDREN TO BE SEEN FOR A VIDEO VISIT WITH A PEDIATRICIAN, WITH A SIGNED CONSENT FROM A PARENT/GUARDIAN ON FILE, WITH BILLING SET-UP THE SAME WAY AS IF A PARENT WERE TO BRING THEIR CHILD INTO THE SPECIALIST'S OFFICE. LASTLY, BECAUSE WE UNDERSTAND THE IMPORTANCE OF ACCESS TO HEALTHY FOOD AND BALANCED NUTRITION, WE CONTINUE TO OFFER THE CAMERON COMMUNITY WELLNESS GARDEN TO OUR COMMUNITY MEMBERS AT NO COST. THE GARDENERS RESERVE THEIR SPOTS AND MAINTAIN THEIR CROPS UNTIL THE FALL. FOR THE FOURTH YEAR IN A ROW, WE ARE PLEASED TO PRESENT, THE PLOTS HAVE ALL BEEN FILLED. WE CONTINUE TO EXPLORE ADDITIONAL PARTNERSHIP TO FURTHER COLLABORATE ON HEALTHY FOOD PROGRAMMING INCLUDING EXPLORING A FARM-TO-SCHOOL PROGRAM FOR LOCAL SCHOOLS AND HAVE REACHED OUT TO SCHOOLS TO OFFER EDUCATIONAL OPPORTUNITIES THROUGH THE CAMERON COMMUNITY WELLNESS GARDEN. PART III, LINE 2: MANAGEMENT REGULARLY REVIEWS DATA ABOUT THE MAJOR PAYOR SOURCES OF REVENUE IN EVALUATING THE SUFFICIENCY OF THE ALLOWANCE FOR UNCOLLECTIBLE ACCOUNTS. FOR RECEIVABLES ASSOCIATED WITH SERVICES PROVIDED TO PATIENTS WHO HAVE THIRD PARTY COVERAGE, THE HOSPITAL ANALYZES CONTRACTUALLY DUE AMOUNTS AND PROVIDES AN ALLOWANCE FOR UNCOLLECTIBLE ACCOUNTS AND PROVISION FOR BAD DEBTS, IF NECESSARY. FOR RECEIVABLES ASSOCIATED WITH SELF-PAY PAYMENTS, WHICH INCLUDES BOTH PATIENTS WITHOUT INSURANCE AND PATIENTS WITH DEDUCTIBLE AND COPAYMENT BALANCES DUE FOR WHICH THIRD PARTY COVERAGE EXISTS FOR PART OF THE BILL, THE HOSPITAL RECORDS A SIGNIFICANT PROVISION FOR BAD DEBTS IN THE PERIOD OF SERVICE ON THE BASIS OF PAST EXPERIENCE, WHICH INDICATES THAT MANY PATIENTS ARE UNABLE OR UNWILLING TO PAY THE PORTION OF THEIR BILL FOR WHICH THEY ARE FINANCIALLY RESPONSIBLE. THE PROVISION FOR BAD DEBTS RELATING TO PATIENT SERVICE REVENUE HAS BEEN PRESENTED AT THE ACTUAL AMOUNT OF CHARGES WRITTEN OFF. PART III, LINE 3: THE HOSPITAL HAS A DETAILED FINANCIAL ASSISTANCE POLICY WHICH STATES THAT TO PARTICIPATE IN CHARITY CARE CANDIDATES MUST COOPERATE FULLY. IN ADDITION, THE HOSPITAL EDUCATES PATIENTS WILL LIMITED ABILITY TO PAY REGARDING FINANCIAL ASSISTANCE. FOR THIS REASON, THE ORGANIZATION BELIEVES THAT IT ACCURATELY CAPTURES ALL CHARITY CARE DEDUCTIONS PROVIDED ACCORDING TO THE FINANCIAL ASSISTANCE POLICY AND THE AMOUNT OF BAD DEBT EXPENSE ATTRIBUTABLE TO PATIENTS ELIGIBLE UNDER THE ORGANIZATION'S CHARITY CARE POLICY IS NEGLIGIBLE. PART III, LINE 4: EXPLANATION OF FINANCIAL STATEMENT FOOTNOTE:SEE THE AUDITED FINANCIAL STATEMENT FOOTNOTE 1 "PATIENT ACCOUNTS RECEIVABLE & CREDIT POLICY" LOCATED ON PAGE 10 OF THE AUDITED FINANCIAL STATEMENTS. PART III, LINE 8: THE SOURCE USED TO DETERMINE THE AMOUNT OF MEDICARE ALLOWABLE COSTS REPORTED FOR PART III, SECTION B, MEDICARE HAS BEEN PROVIDED FROM THE YEAR ENDED 9/30/2022 MEDICARE COST REPORT: HOSPITAL STATEMENT OF REIMBURSABLE COST. PART III, LINE 9B: THE BILLING AND COLLECTION POLICY ADDRESSES THE ACTIONS THAT MAY BE TAKEN IN THE EVENT OF NONPAYMENT FOR MEDICAL CARE, ENSURES APPROPRIATE BILLING AND COLLECTION PROCEDURES ARE UNIFORMLY FOLLOWED, AND ENSURES THAT REASONABLE EFFORTS ARE MADE TO DETERMINE WHETHER THE INDIVIDUAL(S) RESPONSIBLE FOR PAYMENT OF ALL OR A PORTION OF A PATIENT ACCOUNT IS ELIGIBLE FOR ASSISTANCE UNDER THE FINANCIAL ASSISTANCE POLICY. FINANCIAL ASSISTANCE STAFF AND MANAGEMENT ARE RESPONSIBILITY FOR ENSURING REASONABLE EFFORTS HAVE BEEN MET ON APPLICABLE ACCOUNTS PRIOR TO INITIATION OF ANY EXTRAORDINARY COLLECTION ACTIONS. PART VI, LINE 2: DESCRIPTION OF HOW COMMUNITY HEALTH CARE NEEDS ARE ASSESSED: IN ADDITION TO CONDUCTING THE TRIENNIAL COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA) THE HOSPITAL BOARD OF DIRECTORS AND MANAGEMENT WORK ONGOING THROUGHOUT THE YEAR WITH COMMUNITY LEADERS, VOLUNTEERS, LOCAL COMMUNITY MEMBERS TO KEEP UP TO DATE ON ISSUES WITHIN THE COMMUNITY. THE HOSPITAL PROVIDES MANY EDUCATIONAL OPPORTUNITIES AND SUPPORT ACTIVITIES BEYOND ACUTE MEDICAL AND SURGICAL CARE. PART VI, LINE 4: DESCRIPTION OF COMMUNITY DEMOGRAPHICS:CAMERON MEMORIAL COMMUNITY HOSPITAL WAS OPENED IN 1926 AND IS LOCATED IN ANGOLA, INDIANA. ANGOLA IS LOCATED IN STEUBEN COUNTY, APPROXIMATELY 45 MILES NORTH OF FORT WAYNE, INDIANA. SINCE CAMERON HOSPITAL IS LOCATED IN EXTREME NORTHEAST INDIANA, IT SERVES PATIENTS FROM COMMUNITIES IN SOUTHWEST MICHIGAN AND NORTHWEST OHIO AS WELL. CAMERON HOSPITAL IS ONE OF THE LARGEST EMPLOYERS IN STEUBEN COUNTY. THE HEALTH CARE SECTOR IS IMPORTANT TO THE COUNTY'S ECONOMY, AS IT EMPLOYS A LARGE NUMBER OF ITS RESIDENTS, WHO PURCHASE A LARGE AMOUNT OF GOODS AND SERVICES FROM THE BUSINESSES LOCATED IN STEUBEN COUNTY. AS OF THE 2020 CENSUS, THE CITY OF ANGOLA HAD A POPULATION OF 9,340, WHILE THE STEUBEN COUNTY POPULATION WAS 34,435. DURING THE SUMMER MONTHS THE POPULATION IN STEUBEN COUNTY DRASTICALLY INCREASES DUE TO THE NUMEROUS LAKES IN THE COUNTY. THE CHARACTERISTICS OF THE POPULATION ARE FACTORS IN DETERMINING THE HEALTH CARE SERVICES THAT OUR COMMUNITY REQUIRES. THE PERCENTAGE OF THE POPULATION IN THE COMMUNITY OVER 65 YEARS OLD IS 21.0%. IN FISCAL YEAR 2020, CAMERON HOSPITAL HAD 169,800 OUTPATIENT VISITS AND 86% OF OUR PATIENT REVENUE WAS OUTPATIENT. THE FACILITY OPERATES AS AN INDEPENDENT CRITICAL ACCESS HOSPITAL AND RECEIVES COST-BASED REIMBURSEMENT. PART VI, LINE 5: DESCRIPTION OF OTHER COMMUNITY HEALTH PROMOTION:THE HOSPITAL IS VERY COMMITTED TO THE COMMUNITY BY SUPPORTING VARIOUS GROUPS AND NOT-FOR-PROFIT ORGANIZATIONS. NUMEROUS HAVE BEEN PROVIDED THROUGHOUT THE YEAR, SUPPORTING THE AREAS OF HEALTH, EDUCATION, AND SAFETY. ADDITIONALLY, HOSPITAL STAFF AND PHYSICIANS DONATE MANY HOURS OF THEIR TIME TO SERVE IN THE FAITH COMMUNITY CLINIC WHICH ASSISTS THE POOR AND UNDERSERVED OF THE COMMUNITY. FINALLY, THE HOSPITAL PARTNERS WITH AREA EMERGENCY PERSONNEL TO ASSIST WITH DISASTER PREPAREDNESS IN OUR COUNTY. THE HOSPITAL FEELS THAT DISASTER PREPAREDNESS IS AN IMPORTANT ROLE FOR IT TO PLAY IN OUR COMMUNITY, ASSISTING RESIDENTS IN THE EVENT OF A NATURAL DISASTER, INDUSTRIAL ACCIDENT, OR OTHER LARGE-SCALE EMERGENCY. THE HOSPITAL OPERATES AN EMERGENCY ROOM OPEN TO ALL PERSONS REGARDLESS OF ABILITY TO PAY. IN ADDITION TO PROVIDING EMERGENCY SERVICES, THE HOSPITAL PROVIDES MINOR EMERGENCY AND URGENT CARE SERVICES TO ALL REGARDLESS OF ABILITY TO PAY. THE HOSPITAL PARTICIPATES IN MEDICAID, MEDICARE, CHAMPUS, AND/OR OTHER GOVERNMENT SPONSORED HEALTH PROGRAMS. IN ADDITION TO OUR PARTICIPATION IN THESE PROGRAMS, THE HOSPITAL ABSORBED MORE THAN $360,080 IN UNREIMBURSED MEDICARE COSTS DURING 2023. IN ADDITION, THE HOSPITAL ALSO ABSORBED $4,390,725 IN UNREIMBURSED MEDICAID COSTS DURING 2023. THE HOSPITAL ALSO PARTICIPATES IN A COMMUNITY CLINIC FOR POOR AND LOW-INCOME RESIDENTS, WHEREIN LAB, RADIOLOGY, AND REHAB COST ARE ENTIRELY WRITTEN OFF. ALTHOUGH THE PRIMARY CARE PHYSICIANS ARE NOT EMPLOYED STAFF OF THE HOSPITAL, A NUMBER OF PHYSICIANS VOLUNTEER THEIR SERVICES AT THE CLINIC. THE HOSPITAL OFFERS A COMPASSIONATE CARE PROGRAM TO ELIGIBLE PARTICIPANTS BASED ON THE FEDERAL POVERTY GUIDELINES AT THE 350% LEVEL. IN 2023, THE HOSPITAL ABSORBED $120,015 IN CHARITY CARE COSTS. CAMERON ALSO PROVIDES SCREENINGS FOR RESIDENTS WHO ARE UNINSURED OR UNDERINSURED INCLUDING: PSA SCREENINGS, SKIN CANCER SCREENINGS, BREAST CANCER SCREENINGS AND BLOOD GLUCOSE TESTING FOR DIABETES OR PRE-DIABETES. THE HOSPITAL HAS AN OPEN MEDICAL STAFF WITH PRIVILEGES AVAILABLE TO ALL QUALIFIED IN THE AREA. THE GOVERNING BODY (BOARD OF DIRECTORS) CONSISTS OF INDEPENDENT PEOPLE REPRESENTATIVE OF THE COMMUNITY WE SERVE. THE HOSPITAL RECEIVES STRONG SUPPORT FROM AREA RESIDENTS AS EVIDENCED BY THE LARGE BODY OF VOLUNTEERS COMMITTED TO FURTHERING THE HOSPITAL'S MISSION. PART VI, LINE 7, REPORTS FILED WITH STATES IN 1 STEUBEN COUNTY COMMUNITY FOUNDATION 1701 N WAYNE STREET ANGOLA IN 46703 351857065 501(C)(3) 20000 0 POVERTY SIMULATION FUND 2023, GENERAL SUPPORT TRINE UNIVERSITY 1 UNIVERSITY AVE ANGOLA IN 46703 350715530 501(C)(3) 16807 0 GENERAL SUPPORT YMCA OF STEUBEN COUNTY 500 E HARCOURT ANGOLA IN 46703 351999599 501(C)(3) 9400 0 BANNER PROGRAM SUPPORT 3 PART I, LINE 2: CAMERON MEMORIAL COMMUNITY HOSPITAL, INC. WILL FROM TIME TO TIME SELECT A RECIPIENT FOR DONATION WITH THE APPROVAL OF THE BOARD. THE HOSPITAL DOES NOT SEEK REQUESTS FROM ORGANIZATIONS TO DONATE TO BUT USES EARNINGS FROM INVESTMENTS TO PROVIDE A BENEFIT TO THE COMMUNITY THAT IT SERVES ACCORDING OT THEIR INVESTMENT SPENDING POLICY. X X X 1 0 0 0 0 0 0 0 0 JOHN VARNER MD PHYSICIAN 750000 0 21421 0 0 0 16144 0 878 0 788443 0 0 0 TODD RUMSEY MD TREASURER/PHYSICIAN 500573 0 191060 0 0 0 12200 0 18972 0 722805 0 0 0 ANGELA LOGAN CHIEF EXECUTIVE OFFICER 356093 0 83739 0 0 0 12720 0 5214 0 457766 0 0 0 TOM MILLER MD BOARD MEMBER/PHYSICIAN 400003 0 22721 0 0 0 12200 0 18473 0 453397 0 0 0 CHARLES MACLEAN PHYSICIAN 285817 0 35844 0 0 0 12200 0 13559 0 347420 0 0 0 DEAN MATTOX II MD PHYSICIAN 343022 0 79947 0 0 0 11091 0 12083 0 446143 0 0 0 MELCHOR MERCADO PHYSICIAN 283267 0 24514 0 0 0 11330 0 11010 0 330121 0 0 0 LYNN FAUR MD BOARD MEMBER/PHYSICIAN 285052 0 1231 0 0 0 11542 0 18971 0 316796 0 0 0 JESSICA OTTENWELLEN-BUTCHER PHYSICIAN 291269 0 0 0 0 0 0 0 16753 0 308022 0 0 0 CONSTANCE MCCAHILL FORMER CHIEF EXECUTIVE OFF 0 0 0 0 145468 0 0 0 0 0 145468 0 0 0 PART I, LINE 4A DURING CALENDAR YEAR 2022 CONSTANCE MCCAHILL, FORMER CEO, RECEIVED A SEVERANCE PAYMENT IN THE AMOUNT OF $145,468. TAMMI MCCOY FAMILY MEMBER OF JOHN MCCOY 90147 EMPLOYMENT COMPENSATION 0 FORM 990, PART VI, SECTION B, LINE 11B THE PROCESS OF REVIEWING THE FORM 990 INCLUDES A DETAILED REVIEW OF THE FORM AND REQUIRED SCHEDULES BY THE CHIEF EXECUTIVE OFFICER, CHIEF FINANCIAL OFFICER, AND INDEPENDENT ACCOUNTING FIRM. EACH VOTING MEMBER OF THE GOVERNING BODY RECEIVES A COPY OF THE FORM 990 INCLUDING REQUIRED SCHEDULES, AS ULTIMATELY FILED WITH THE IRS, PRIOR TO FILING. FORM 990, PART VI, SECTION B, LINE 12C A QUESTIONNAIRE IS SENT OUT ANNUALLY TO ALL OFFICERS, DIRECTORS OR TRUSTEES, AND KEY EMPLOYEES TO DISCLOSE PERSONAL AND BUSINESS RELATIONSHIPS. THE QUESTIONNAIRES ARE REVIEWED ANNUALLY. IF A CONFLICT EXISTS RESTRICTIONS WILL BE IMPOSED ON PERSONS WITH A CONFLICT SUCH AS PROHIBITING THEM FROM PARTICIPATING IN THE GOVERNING BODY'S DELIBERATIONS AND DECISIONS IN THE TRANSACTIONS. FORM 990, PART VI, SECTION B, LINE 15 THE PROCESS FOR DETERMINING COMPENSATION OF THE CEO, COO, CFO, AND KEY EMPLOYEES INVOLVES REVIEW AND APPROVAL BY THE BOARD INCLUDING REVIEW OF COMPARABLE DATA FROM INDIANA HOSPITAL ASSOCIATION AND COMPDATA. THIS PROCESS IS DOCUMENTED IN THE BOARD MINUTES. FORM 990, PART VI, SECTION C, LINE 19 CAMERON MEMORIAL COMMUNITY HOSPITAL KEEPS COPIES OF THEIR GOVERNING DOCUMENTS, CONFLICTS OF INTEREST POLICY, AND FINANCIAL STATEMENTS ON SITE AND ARE AVAILABLE UPON REQUEST. FORM 990, PART IX, LINE 11G MAINTENANCE SERVICES: PROGRAM SERVICE EXPENSES 2,580,672. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 2,580,672. PHYSICIAN SERVICES: PROGRAM SERVICE EXPENSES 3,265,834. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 3,265,834. MEDICAL AND OTHER SERVICES: PROGRAM SERVICE EXPENSES 5,960,729. MANAGEMENT AND GENERAL EXPENSES 1,566,469. FUNDRAISING EXPENSES 67,467. TOTAL EXPENSES 7,594,665. CAMERON MEDICAL OUTREACH INC 416 E MAUMEE STREET ANGOLA IN 46702 261105702 ASSISTED LIVING IN 501(C)(3) LINE 10 CAMERON MEMORIAL COMMUNITY HOSPITAL INC 1 0 0 0 0 0 0 0 0 0 0 1 0 0 1 1 0 1 0 0 CAMERON MEDICAL OUTREACH INC K 122784 FAIR MARKET VALUE CAMERON MEDICAL OUTREACH INC Q 2598170 FAIR MARKET VALUE