2024-07-30T14:36:47-05:00 2023-09-30 481026809 Wendling Noe Nelson & Johnson LLC 623 SW 10th Ave Suite 300 Topeka KS 66612 990 2022-10-01 440668347 Cameron Regional Medical Center CAME 8166322101 1600 East Evergreen Street Cameron MO 64429 Joseph Abrutz Jr Administrator 8166322101 2024-07-25 1 0 Heather R Eichem P01515553 7852334226 2024-07-25 2022 2024-08-08 14:25:15Z Joseph Abrutz Jr 1600 East Evergreen Street Cameron MO 64429 76509710 0 X http://www.cameronregional.org/ X 1963 MO Provide inpatient and outpatient medical care to area residents regardless of ability to pay. 12 10 614 40 0 0 2350984 1618704 65012147 59395434 2497314 2201266 163933 171440 70024378 63386844 30000 67500 0 0 40465650 40100634 0 0 5007 32489719 32573928 72985369 72742062 -2960991 -9355218 97363822 89246397 40071011 37975399 57292811 51270998 X Our mission at Cameron Regional Medical Center (CRMC) is caring for all patients. To this end, we organize people, equipment, and facilities in a manner that best responds to their needs and to the needs of our service area. Our priorities are patients and families, physicians, and employees. Our goal is to be a regionally-recognized leader in patient satisfaction by exceeding customer expectations and continuing to achieve excellence in quality and cost-effective health care services. Cameron Regional Medical Center (CRMC) will provide services in an atmosphere that involves compliance with governmental mandates. Throughout our organization, our employees strive to provide sensitive and quality health care at all times by living our values. Lastly, CRMC recognizes the importance of viable and profitable operations to guarantee the continued existence and growth of the facility. 0 0 64198966 67500 59395434 Acute care hospital organized to provide inpatient and outpatient care to area residents regardless of ability to pay. 64198966 1 1 0 0 0 0 0 0 0 0 1 0 0 1 1 1 0 1 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 0 0 0 1 60 0 1 614 1 0 0 0 0 0 0 0 0 0 0 0 0 X 12 10 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 0 0 1 0 0 X Joseph Abrutz Jr 8166322101 1600 East Evergreen St Cameron MO 64429 Warren McElwain President 1.00 X X 0 0 0 Delvin Jackson Vice-President 1.00 X X 0 0 0 Jennifer White Secretary 1.00 X X 0 0 0 Michael Poland Treasurer 1.00 X X 0 0 0 Barbara Ballew Director 1.00 X 0 0 0 Ken Raffety Director (Thru May 2023) 1.00 X 0 0 0 Steve Tinnen Director 1.00 X 0 0 0 Mike Brown Director 1.00 X 0 0 0 David Just Director 1.00 X 0 0 0 JoEllen Pratt Director 1.00 X 0 0 0 Laeeq Azmat Tahirkheli Physician & Director 40.00 X 1000678 0 0 Laura Harbison Physician & Director 40.00 X 408518 0 0 Mark Baker Director 1.00 X 0 0 0 Joseph F Abrutz Jr Administrator 40.00 X 450404 0 13899 Rosa Patti Chief Financial Officer 40.00 X 200903 0 16729 Muhammad Amin Physician 40.00 X 583178 0 0 Shahzad Shafique Physician 40.00 X 669733 0 0 Ly Phan Physician 40.00 X 579296 0 0 Arihant Jain Physician 40.00 X 558003 0 0 Damond Erickson Pharmacy Director 40.00 X 554090 0 16870 5004803 0 47498 64 0 1 0 Premier Specialty Network 1835 E Republic Rd Suite 200 Springfield MO 65804 Physician specialists 1765930 Psychiatric Solutions Inc PO Box 840839 Dallas TX 75284 Operation of BHU unit 1564821 Cameron Emergency Physicians PC 1600 E Evergreen Cameron MO 64429 Emergency physicians 1105963 Laboratory Corporation of America PO Box 12140 Burlington NC 27216 Reference lab services 820614 Comp Health PO Box 972651 Dallas TX 75397 Physician services 765166 20 1458544 160160 1618704 Patient service revenue 622110 59395434 59395434 59395434 1082236 1082236 110181 110181 37190 0 37190 37190 37190 14131715 13122866 1008849 1008849 1008849 Cafeteria 722210 124648 124648 Other income 900099 9602 9602 134250 63386844 59395434 0 2372706 X 10000 10000 57500 57500 2133899 1481389 652510 31764650 29565777 2198873 533000 488601 44399 3375781 3122510 253271 2293304 2102272 191032 447994 447994 150716 150716 10614760 9881409 733351 315597 82731 232866 1429662 1153802 275860 668101 565368 102733 257637 193346 64291 1154388 995235 159153 2683596 2266227 417369 1256759 79197 1177562 Medical supplies 5897735 5897735 Pharmaceuticals 4247380 4247380 Repairs and maintenance 2070862 1405150 665712 Collection fees 504034 545 503489 874707 602792 266908 5007 72742062 64198966 8538089 5007 273176 1072858 15489984 5978389 10969906 11268679 1911047 1926640 351941 364174 83220810 59212787 23839091 24008023 40210306 39816895 4318371 4810739 97363822 89246397 7751065 8074721 28947595 27764120 472115 313791 35371 6903 2864865 1815864 40071011 37975399 X 56537898 50475092 754913 795906 57292811 51270998 97363822 89246397 X -9355218 3302426 30979 X X 0 1 X 1 1 1 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 3263004 3263004 30982202 19152869 11829333 44926004 38805428 6120576 4049600 1254490 2795110 24008023 Deferred debt issuance costs 451728 Third party payor settlements 3549904 Beneficial interest in net assets of CRMC Foundation 490973 Other receivables 216231 Accrued interest and dividends 52736 Cash value of life insurance 49167 4810739 Third party payor settlements 1815864 1815864 X Part X, Line 2: Management is not aware of any uncertainties in income tax positions. 1 1 1 X 1 X 1 1 0 1 1 645469 585938 59531 0.00080 10554670 5392458 5162212 0.07100 11200139 5978396 5221743 0.07180 350968 850 350118 0.00480 57500 57500 0.00080 21991735 12152797 9838938 0.13530 10000 10000 0.00010 22410203 12153647 10256556 0.14100 33610342 18132043 15478299 0.21280 1 4207262 420726 13334965 16909322 -3574357 X 1 1 1 1 Cameron Regional Medical Center 1600 East Evergreen Street Cameron MO 64429 X X X Cameron Regional Medical Center Inc 1 0 0 1 X X X X X X X X X 21 1 0 0 1 X http://www.cameronregional.org X 1 21 1 http://www.cameronregional.org 0 1 X 100.000000000000 300.000000000000 X X X X 1 1 X X X 1 X https://cameronregional.org/ X https://cameronregional.org/ X https://cameronregional.org/ X X X X X 1 X 0 X X 1 X 0 0 Cameron Regional Medical Center, Inc. Part V, Section B, Line 5: The Medical Center conducted a town hall meeting and invited local hospital, public health community, mental health community, free clinics, community-based clinics, service providers, local residents, community leaders, opinion leaders, school leaders, business leaders, local government, faith-based organizations and persons (or organizations serving them), people with chronic conditions, uninsured community members, low income residents, and minority groups. Cameron Regional Medical Center, Inc. Part V, Section B, Line 11: Although COVID-19 began its decline in calendar year 2023, Cameron Regional Medical Center (CRMC) continued to assign a significant portion of its resources throughout FYE 09/30/2023, to addressing patient cases and the long-term, lingering effects of this virus. Given the many unknowns associated with COVID-19, CRMC remained persistent in its containment and mitigation efforts such as maintaining its vigilance toward tracking county transmission rates and the Medical Center's positivity rates. Since the onset of COVID-19 in 2020, CRMC has tested approximately 32,489 individuals, with 3,034 positive results (9.3% overall positivity rate). In FYE 09/30/2023, CRMC tested approximately 3,920 individuals, with 236 positive results (6.0% overall positivity rate). As in the previous three years, attending to the impact of COVID-19 was once again a distinct COMMUNITY HEALTH NEED in FYE 2023.CRMC's COVID-19 Task Force continued to meet on a monthly basis until April 1, 2023, at which time it was combined with the Infection Surveillance/Prevention Committee and its quarterly meetings. The Medical Center's mask mandate, screening/temping protocols at the main entrance, secondary entrance closures, social distancing, and visitor restrictions were also lifted effective April 1, 2023. In the interest of public health, CRMC continued to make masks and infection prevention, disinfecting, and hygiene products readily available to all patients, visitors, and employees.CRMC's COVID CARE Line that was enacted June 1, 2020, remained intact for the public throughout FYE 2023. This telephone call-in line was initiated for the purpose of fielding COVID-related questions and/or concerns. CARE Line personnel continued to work closely with area physicians, clinics, and other providers.COVID-19 containment and mitigation efforts throughout the Medical Center, Home Health, Hospice, and CRMC's 18 satellite clinics continued to bring higher expenses via increasing charges for labor, inflation, purchased services, drugs, personal protective equipment (PPE), infection prevention/disinfecting/hygiene products, and other medical and safety supplies. Severe staffing shortages still presented one of the worst challenges experienced in the health care sector in years. Rural hospitals in particular continued to suffer major financial stressors as a result of the above issues/concerns.CRMC's COVID-19 expense figure for the 12-month period ended September 30, 2023, was approximately $335,549.Priority/Objective No. 1 - Mental HealthEven though a shortage of mental health providers persisted in northwest Missouri, CRMC remained persistent in shrinking this deficit and maintaining/growing its offerings in this specialty. During FYE 2023, five part-time Psychiatrists (including a Child Psychiatrist) provided outpatient clinics and services at CRMC on a regularly-scheduled basis. In addition, a full-time Geriatric Psychiatrist continued to provide inpatient services for CRMC's Behavioral Health Unit (BHU). CRMC continued to significantly underwrite/subsidize its mental health program financially in order to assure these services remained readily available to all patients/payors (Medicare, Medicaid, veterans, self-pay, etc.).In November 2022, Chacy Lancaster, M.D., Psychiatrist, provided a free two-hour public education session on Fentanyl (opioids) and other illicit drugs, addiction, anxiety, peer pressure, and depression/suicide. Due to the relevant and timely nature of the topic, the session was videotaped and placed on CRMC's website for online viewing.For the past many years, CRMC's mental health services have been marketed extensively throughout its service area. An Outpatient Clinic Calendar denoting mental health offerings is placed in approximately 14 area newspapers each month, as well as on the Medical Center's website. This monthly Outpatient Clinic Calendar is also distributed via CRMC's 18 satellite clinics and mailed to approximately 80 physicians and providers throughout northern Missouri.For over 30 years, CRMC has operated a free transportation system for its patients to obtain needed medical services. This essential service has been expanded continuously over the years and takes struggling patients who have no other viable means of travel to/from area physicians' offices, CRMC, its satellite clinics, its outpatient specialty clinics, and other medical facilities. Free transportation to area tertiary centers and ancillary services (dentist, drug store, etc.) is also made available based on need and special circumstances. Toward this purpose, five courtesy vans and the necessary drivers were utilized in FYE 2023 on a full-time basis (six days per week) to cover ten-plus counties in rural northwest Missouri. A high percentage of patients who utilize this service are seeking mental health services. As previously referenced, CRMC operates a system of 18 primary care satellite clinics located throughout five counties in northwest Missouri to facilitate ease of access for its patients. In FYE 2023, these 18 satellite clinics continued to serve as both education and referral centers for their patients' mental health needs. The majority of CRMC's satellite clinics still utilize the Patient Health Questionnaire-9 (PHQ-9) for depression screening purposes.CRMC's BHU utilized TelePsychiatry services at least one day per week during FYE 2023 in order to maintain/enhance physician coverage. The BHU continued to play a vital role in CRMC's medical community by providing solutions and relief for area nursing homes, families, and physicians. A new two-bed expansion of the Behavioral Health Unit (BHU) opened in August 2023, taking the Unit from 10 to 12 beds at a construction cost of approximately $696,670, plus soft costs, architectural/engineering fees, and start-up costs. As the BHU rooms are all semi-private, this provided more flexibility for admissions due to male/female demographics and room assignment.Through the CHNA process, Preferred Family Healthcare (PFH) in Kirksville, Missouri has become a valued partner for CRMC over the past many years, providing collective impact, resources, education, and brochures otherwise unavailable in the area for both mental/behavioral health and substance abuse (see next section). Many CRMC staff members have participated in PFH's annual Mental Health First Aid classes that instruct on how to recognize signs of mental health and/or substance abuse challenges.CRMC and area Family Guidance offices continued to work together closely on mental health cases in FYE 2023, particularly on suicidal patients presenting to the Emergency Room. Upon notification to their hotline, Family Guidance will send a representative to perform the screening process and intake evaluation, day or night, 24/7. Working closely with the E.R. physician on a treatment plan, Family Guidance will facilitate transfer to an appropriate Psychiatric facility, if needed.In the last calendar quarter of 2022, CRMC and the CRMC Foundation collectively donated $20,000 to Clinco Sheltered Industries in Cameron, Missouri. This sheltered workshop is a not-for-profit entity, providing employment for numerous developmentally- and intellectually-disabled individuals, while offering valuable services such as recycling, custodial work, and retail establishments (Dollar Barn and Thrift Store) to the area. Priority/Objective No. 2 - Substance AbuseCRMC primary care physicians and providers continued to deliver counseling on alcohol temperance, smoking cessation, proper use of drugs/medications (including opioids), and other substance abuse issues to their patients at both the Medical Center and its 18 satellite clinics in an effort to combat abuse, addiction, resultant drunk driving, altered mental states, and relapse. Educational materials are provided according to individual patient need.CRMC continued to include detailed information on smoking cessation in all admission packets in FYE 2023. For those Emergency Room patients whose diagnosis was related to smoking, cessation information was provided at the time of discharge. For many years, CRMC has financially supported area post-graduation and post-prom parties to assist in providing alternative activities to drinking for the safety of area high school students. This continued in FYE 2023.As previously referenced, in November 2022, Chacy Lancaster, M.D., Psychiatrist, provided a free two-hour public education session on Fentanyl (opioids) and other illicit drugs, addiction, anxiety, peer pressure, and depression/suicide. The session was videotaped and placed on CRMC's website for extended online viewing. Cameron Regional Medical Center, Inc. Part V, Section B, Line 11: In FYE 2023, the CRMC Medical Staff and Board of Directors continued to prohibit the use and/or possession of marijuana (medical or otherwise) on CRMC's campus, premises, and all outlying/satellite facilities. None of CRMC's Active Staff physicians provide Physician Certification for Qualifying Medical Conditions for the use of marijuana.CRMC continued to assist the Cameron Police Department with marketing its annual "Prescription Drug Take-Back Day" that is held in concert with the DEA. A similar effort by a local drug store was also marketed by CRMC in FYE 2023.For referral purposes, CRMC's Emergency Room still maintains a list of area substance abuse/addiction treatment facilities, disseminating to patients and family members as appropriate. CRMC's Regional Resource Directory also provides a listing of area substance abuse programs (see further discussion under Priority/Objective No. 3).CRMC, through its network of primary care clinics, physicians, mid-levels, and the hospital Pharmacy, continued to facilitate and promote concerted efforts against prescription drug/medication abuse. The Medical Center's e-prescribing software and communication protocols with area pharmacies assisted in monitoring/tracking "doctor shopping" efforts by patients suspected of abusing the system. As there is a distinct cross-over in staff, CRMC pharmacists who also work locally in the retail setting continued to take the following precautions: a) Patients are not allowed to fill controlled prescriptions more than five days early; b) Any prescription presented by a patient not residing in the immediate area or written by a prescriber not in the immediate area will be investigated; c) Local retail pharmacy personnel and hospital pharmacy personnel communicate on a regular basis regarding suspicious controlled substance prescribing trends; and d) Any controlled prescription where the patient offers to pay by cash instead of using insurance will automatically be red-flagged by the pharmacist for further investigation.Starting in 2023, Missouri enacted a statewide prescription drug monitoring program (PDMP). Pharmacies are required to submit information to the PDMP when they dispense any Schedule II, III, or IV prescriptions to patients. Prescribers and pharmacists can also use this tool to make informed decisions and reduce risk for patients.In terms of health-care professionals, the CRMC Medical Staff continued in FYE 2023 to donate a substantial sum on an annual basis to the Missouri Association of Osteopathic Physicians and Surgeons' (MAOPS') Physicians Health Program (PHP). PHP provides addiction treatment resources and coordinates the care of the affected health-care professional throughout his/her treatment program, with the goal of facilitating and expediting his/her return to health and a normal personal and professional life.The Medical Center continued to assist its employees financially with smoking cessation products.Smoking/vaping is still prohibited within all CRMC facilities.As previously mentioned above, PFH in Kirksville, Missouri has remained a valued partner for CRMC over the past many years through the CHNA process, providing collective impact, resources, education, and brochures otherwise unavailable in the area for both mental/behavioral health and substance abuse. Many CRMC staff members have participated in PFH's annual Mental Health First Aid classes that instruct on how to recognize signs of mental health and/or substance abuse challenges.Priority/Objective No. 3 - Comprehensive Four-County Health Care Resource Guide (Combined with Priority/Objective No. 8 - see below)Priority/Objective No. 8 - Public Awareness of Health Care ServicesAs previously referenced, CRMC's Regional Resource Directory was developed several years ago and is updated on a regular basis. Covering CRMC's four-county primary service area (Clinton, Caldwell, Daviess and DeKalb), plus regional resources of importance, the Directory includes mental health services, alcohol/drug treatment (substance abuse) programs, physicians/medical clinics, wellness/fitness centers, nutrition resources, dentists, applicable government agencies, and several other categories addressing the health and well-being of area residents. It is distributed to the public upon request and disseminated at certain public meetings and educational events sponsored by CRMC. It is also shared with area organizations, health departments, coalitions, etc. upon request. During FYE 2023, CRMC's Regional Resource Directory was enhanced by the addition of a list of area Inpatient Mental Health facilities as provided by the staff of CRMC's BHU. Additionally, a list of basic living resources such as housing and utilities assistance had been developed as a result of CRMC's Diversity, Equity, and Inclusion (DEI) efforts and added to the Regional Resource Directory.CRMC's 21st Annual Health Fair was held in early Fall 2023 and was widely publicized, as it is each year. This Fair represented the fourth such event whereby a "distributed" format was used in order to decrease crowd size and help protect somewhat from COVID-19. The Health Fair was held in six different locations throughout five counties in rural northwest Missouri: 1) Orthopedic & Rehab Center at CRMC (Cameron, MO - Clinton County); 2) Bethany Health Services in Bethany, MO - Harrison County; 3) Hamilton Family Health Center in Hamilton, MO - Caldwell County; 4) Jamesport Outreach Clinic in Jamesport, MO - Daviess County; 5) Maysville Family Health Clinic in Maysville, MO - DeKalb County; and 6) Lathrop Medical Clinic in Lathrop, MO - Clinton County. Extensive blood work (anemia, blood sugar, thyroid, cholesterol panel, iron, hemoglobin A1C, GFR, and BUN/creatinine), blood pressures, and pulse oximetry were provided free of charge at all six locations. Moreover, carotid artery screenings and skin cancer screenings were offered free of charge at CRMC. Medical providers were on site at each location and available to counsel/educate attendees regarding medications, vaccinations, mental health, exercise, nutrition, diabetes, CRMC and satellite clinic services, etc. A record turn-out was experienced, with approximately 463 participants attending this annual health and wellness event.In FYE 2023, K.U. Medical Center and its Urology Residency Program, as hosted by CRMC under the direction of Moben Mirza, M.D., provided free quarterly education sessions at CRMC on various medical topics of interest for the public, such as UTIs, kidney stones, hematuria, and prostate cancer. These sessions continue to present day and are held in an attempt to enlighten area residents of the variety of Urology health care services available at CRMC.In FYE 2023, CRMC's Active Staff physicians provided free periodic education sessions for the public on various medical topics of interest, including antibiotic stewardship, abdominal pain, cardiac disease, and wound care. These sessions continue to present day and are held to inform area residents of the variety of health care services offered at CRMC.In FYE 2023, CRMC continued to sponsor free training/education classes focusing on diabetes, nutrition, food labels, and healthy eating. These are performed by CRMC's Registered Dieticians at least every 60 days, with excellent participation rates and feedback. These classes help inform the public of CRMC's available Health & Wellness services.In tandem with the Caldwell County Health Department, CRMC offered Prenatal Classes in FYE 2023. Breastfeeding and other prenatal topics were included to help create an awareness of CRMC's Obstetrics program.As previously mentioned, CRMC's monthly Outpatient Clinic Calendar denoting all specialists' clinics is still placed in approximately 14 area newspapers on a monthly basis, as well as on the Medical Center's website, in order to increase public awareness of CRMC's available health care services. This Outpatient Clinic Calendar is also distributed via CRMC's 18 satellite clinics and mailed to approximately 80 physicians and providers throughout northern Missouri.In FYE 2023, CRMC continued to utilize a broad spectrum of marketing mediums to educate the public on the health care services available at the Medical Center and its 18 satellite clinics. Marketing efforts include newspaper, radio, promotional flyers, website, social media, search engine optimization, and two large electronic message centers located on major highways.Priority/Objective No. 4 - Affordable and Safe Child Care Services (Not directly addressed - see below) Priority/Objective No. 5 - School Health (Not directly addressed - see below)Priority/Objective No. 6 - Long-Term Care Staffing and Training (Not directly addressed - see below)Priority/Objective No. 7 - Reimbursement for Providers Cameron Regional Medical Center, Inc. Part V, Section B, Line 11: As hospitals and physicians are at the mercy of their private third-party payors, CRMC has hired an outside firm for the past several years to audit/review the Medical Center's incoming remit advices to make sure reimbursement is in compliance with the respective third-party payor contract. In particular, this effort includes commercial insurance plans and Medicare Advantage plans.As third-party Recovery Audit Contractors (RACs) over the years have increasingly become a source of Lost Revenue for hospitals, CRMC continued to conduct monthly RACs meetings in FYE 2023 to investigate each claim being challenged by RACs. These RACs challenges originally involved Medicare and Medicare Advantage claims; however, in recent years, private third-party payors such as United HealthCare and Ambetter have joined in the "take-back" program and hired companies such as Optum and Cotiviti to audit CRMC's health care claims on a percentage basis. These post-service RACs practices continue even though the pre-authorization requirements of the third-party payor are always followed by CRMC. For these reasons, CRMC continues to appeal each RACs challenge to the maximum extent allowed by regulations. Free public education meetings continue to be held two to three times per year, centering on Medicare, Medicaid, the Patient Protection and Affordable Care Act (PPACA), Medicare Advantage, and other third-party payor plans. In an attempt to assist individuals with understanding the complexities of health care reimbursement, these question-and-answer sessions cover all facets of the public's health-care concerns, including insurance coverage specifics, Open Enrollment periods, deductibles/co-pays, CRMC billing/ collecting, Medigap policies, Part D, etc.Part of a nationwide issue, rural northwest Missouri has been experiencing for some time certain "health care deserts," including Obstetric and Renal Dialysis services. Both of these are critical, life-saving services where long drive-times are not conducive to favorable medical outcomes. Additionally, both services are costly to operate, with low reimbursement levels. CRMC has continued to underwrite these services because they are crucial to area residents and not readily available due to area closures being executed by other health care entities. Being the only hospital in a four-county area (Clinton, Caldwell, Daviess, and DeKalb), CRMC provides vital medical services such as these to a rural, low-income population of approximately 50,000 in its primary service area. Likewise, CRMC's secondary service area encompasses another six counties, stretching to the Iowa border and representing an even-more-so, low-income, underserved population, with a high percentage of elderly. As CRMC has continued to provide Obstetric and Renal Dialysis services on a long-standing basis, and as the State of Missouri has begun realizing the severity of these rural "deserts," the Medical Center continues to work with the State and MO HealthNet on a special budget designation to assist in covering some of the costs associated with these much-needed, scarce, and under-reimbursed services.Priority/Objective No. 8 - Awareness of Health Care Services (Combined with Priority/Objective No. 3 - see above)Priority/Objective No. 9 - Transitional Senior CareIn addition to general acute and surgical care, CRMC has provided multiple services and care settings over the years to assist with the various transitional phases of the aging process. From 18 satellite outpatient (primary care) clinics providing physician care, to Skilled, SwingBed, Behavioral Health (GeroPsychiatric), and Inpatient Rehabilitation hospital care; from outpatient Cardiac Rehab and Home Health services, to Comfort Care Hospice - CRMC has numerous programs designed to help individuals regain strength, restore function, and improve health through professional care and effective rehabilitation services. Social Workers throughout the CRMC system provide and guide a path from hospital to home, assisting physicians and other health care providers with their patients' smooth transition from one health care setting to another.CRMC maintains good working relationships with all area nursing homes and tertiary centers, providing free transportation to/from these facilities for medically-appropriate patients in need of same. As a Level III Stroke Center certified by the State of Missouri, CRMC has a special collaboration agreement with St. Luke's for the timely transfer of stroke patients in need of further neurovascular care.The following identified needs were not a direct part of the Medical Center's mission or normal operations in FYE 9-30-23. Rather, CRMC provided support measures and partnered with other entities throughout the area ("key stakeholders") as needed and appropriate.Priority/Objective No. 4 - Affordable and Safe Child Care ServicesAs child care is not a core component of CRMC's mission or operations, the Medical Center plays only a supporting role in addressing this need. The Medical Center has continuously cooperated with area economic development efforts toward promoting new businesses whenever feasible in the hope of realizing additional pre-schools and child daycare centers in rural northwest Missouri. CRMC supports the Cameron R-1 School District in multiple ways, indirectly benefitting the District's extensive and sorely-needed pre-kindergarten/pre-school program.Priority/Objective No. 5 - School HealthAlthough School Health is not a main focus of the Medical Center, CRMC has become increasingly involved with Sports Medicine and area high school athletics over the past three years. Athletic trainer coverage is provided year-round for numerous area high school sporting events. This service is offered in tandem with a comprehensive program covering annual sports physicals and annual baseline concussion testing with balance assessment, as well as baseline EKGs for those student athletes with cardiac risk factors. Approximately 10 - 12 area school districts take advantage of these health/wellness services.Priority/Objective No. 6 - Long-Term Care Staffing and TrainingAs CRMC does not provide long-term care, this Priority/Objective does not pertain to the Medical Center's mission or operations, other than the cooperative and interactive nature of its relationships with area nursing homes and assisted-living facilities. That being said, CRMC sponsors three separate scholarship programs for students entering a specific health care field of study after high school and/or entering medical school. Recipients can be going into nursing, medicine, any of the therapies, Laboratory Technology, Radiologic Technology, or other Allied Health field. The oldest of these offerings has been in existence for 35 years, is renewable, and will address four years of college study. It is entirely possible that recipients of these scholarships could ultimately choose the long-term care field as their profession. 19 1 - Cameron Medical Clinic 1600 E Evergreen Cameron MO 64429 Medical Clinic 2 - Westside Medical Offices 1608 E Evergreen Cameron MO 64429 Medical Clinic 3 - Walnut Medical Clinic 921 N Walnut Cameron MO 64429 Rural Health Clinic 4 - Bethany Health Services 903 North 25th Street Bethany MO 64424 Medical Clinic 5 - Hamilton Family Health Center 103 N Davis Hamilton MO 64644 Rural Health Clinic 6 - Cameron Specialists - Internal Medicine 1608 E Evergreen Cameron MO 64429 Medical Clinic 7 - NW Missouri Obstetrics & Gynecology 221 E 7th Street Cameron MO 64429 Medical Clinic 8 - Maysville Family Health 1007 S Polk Maysville MO 64469 Rural Health Clinic 9 - Gallatin Family Medicine 502 S Main Gallatin MO 64640 Rural Health Clinic 10 - Lathrop Medical Clinic 106 North Street Lathrop MO 64465 Medical Clinic 11 - Cameron Nephrology Clinic 1600 E Evergreen Suite B Cameron MO 64429 Medical Clinic 12 - Jamesport Outreach Clinic 409 W Auberry Grove Jamesport MO 64648 Rural Health Clinic 13 - Plattsburg Family Medicine 214 N Main Plattsburg MO 64477 Rural Health Clinic 14 - Polo Family Health Center 198 Main Street Polo MO 64671 Rural Health Clinic 15 - Eagleville Medical Clinic 12050 12th Street Eagleville MO 64442 Rural Health Clinic 16 - Pattonsburg Medical Clinic 110 N Central Ave Pattonsburg MO 64670 Rural Health Clinic 17 - Gilman City Medical Clinic 427 Main Street Gilman City MO 64642 Rural Health Clinic 18 - Stewartsville Medical Clinic 106 E 4th Stewartsville MO 64490 Rural Health Clinic 19 - Cameron Obstetrics & Gynecology 1600 E Evergreen Suite A Cameron MO 64429 Medical Clinic Part I, Line 7: A cost-to-charge ratio derived from Worksheet 2 was used to calculate the amounts reported on line 7. Part I, Line 7g: The costs of subsidized health services include costs attributable to multiple physician clinics in the amount of $17,351,369. Part III, Line 4: See Note B (beginning on page 16) of the audited financial statements regarding the allowance for uncollectible accounts.Part III Line 2:This amount was determined by multiplying a cost-to-charge ratio derived from Worksheet 2 by the Medical Center's bad debt expense for the tax year.Part III, Line 3:This amount was determined based on the overall income level of patients that submit all required documentation under the Medical Center's financial assistance policy. As a tax-exempt hospital, we must provide necessary services regardless of the patient's ability to pay for that care. Making quality patient care available to all in our community, regardless of their economic means, qualfies these bad debts as a community benefit. Part III, Line 8: Medicare costs were obtained from the Medical Center's as-filed Medicare cost report for the tax year.Any shortfalls are a benefit to the Medical Center's community since it represents health care provided at less than cost to elderly and needy residents of the Medical Center's service area.Revenue included in Medicare Cost Report $13,334,965Fee schedule revenue excluded from Medicare Cost Report 497,256Total Medicare revenue 13,832,221Expenses included in Medicare Cost Report $16,909,322Fee schedule expenses excluded from Medicare Cost Report 1,187,274Total Medicare expense 18,096,596Total net Medicare loss 4,264,375 Part III, Line 9b: At the time of admission and before discharge, each patient will receive a notice that the Medical Center has a Financial Assistance Policy (with a brief description of such policy) and directions for obtaining additional information about such policy. All itemized statements sent to the patient include a notice that the Medical Center has a Financial Assistance Policy and directions for obtaining additional information about such policy. If a patient submits a Financial Assistance Policy application, all payment notifications and collection actions are suspended until it is determined whether the patient is eligible for the Financial Assitance Policy (and if so, notifications and collection actions will cease). Part VI, Line 2: The Medical Center relies on the feedback and requests taken from patients of the Medical Center and its numerous clinics, as well as residents from its primary service area. Part VI, Line 3: The Medical Center employs a social worker that informs all patients of all available payment options. Part VI, Line 4: Cameron Regional Medical Center and its eleven rural health clinics are located in Northwest Missouri. The primary service area is comprised of four rural counties consisting of Daviess, Caldwell, DeKalb, and Clinton. There are approximately 48,953 individuals that reside in the primary service area. Of these residents approximately 13.1% of them have an annual income below the federal poverty level. The median annual income per household for the four counties is approximately $63,095. Approximately 31% of the total services provided are for Medicare patients and 14% are for Medicaid patients. The nearest surrounding hospitals are located in Smithville, Excelsior Springs, and Richmond. The distance between these facilities and Cameron Regional Medical Center is approximately 28, 28, and 31 miles respectively. Part VI, Line 5: Cameron Regional Medical Center's governing body is comprised of residents from its primary service area. The Medical Center extends medical privileges to all local physicians who meet the requirements of the medical staff bylaws. All surplus funds are used to maintain and improve the medical facility and medical equipment in order to provide the best medical treatment possible to every patient. 1 Clinco Sheltered Industries Inc 1205 W Grand Ave Cameron MO 64429 431064239 501(c)(3) 10000 0 Operation of sheltered workshop for developmentally disabled individuals 1 College scholarships 52 57500 Part I, Line 2: Scholarships are paid directly to the college of the recipient. When making grants to domestic organizations, funds are disbursed directly to each organization with the Board of Directors' authorization. X X X 0 1 0 0 0 1 0 1 0 Laeeq Azmat Tahirkheli Physician & Director 688446 0 312232 0 0 0 0 0 0 0 1000678 0 0 0 Shahzad Shafique Physician 549662 0 120071 0 0 0 0 0 0 0 669733 0 0 0 Muhammad Amin Physician 447930 0 135248 0 0 0 0 0 0 0 583178 0 0 0 Ly Phan Physician 517868 0 61428 0 0 0 0 0 0 0 579296 0 0 0 Damond Erickson Pharmacy Director 549879 0 4211 0 0 0 0 0 16870 0 570960 0 0 0 Arihant Jain Physician 535745 0 22258 0 0 0 0 0 0 0 558003 0 0 0 Joseph F Abrutz Jr Administrator 354169 0 96235 0 0 0 0 0 13899 0 464303 0 0 0 Laura Harbison Physician & Director 403068 0 5450 0 0 0 0 0 0 0 408518 0 0 0 Rosa Patti Chief Financial Officer 121552 0 79351 0 0 0 0 0 16729 0 217632 0 0 0 Part I, Line 4b The Medical Center has established a deferred compensation plan (a 457 Plan subject to Code section 457(b)). The name of the Plan as adopted by the Medical Center is Cameron Regional Medical Center, Inc. 457(b) Plan. During the fiscal year end 09/30/2023, $2,962 was contributed to the Plan on behalf of Joseph F. Abrutz, Jr., Administrator of the Medical Center. Part I, Line 6 The Administrator is eligible for an annual bonus that is partially contingent on meeting a specific operating margin percentage. Part I, Line 7 The Administrator is eligible for an annual bonus that is partially contingent on meeting quality measure goals and strategic planning goals. The Chief Financial Officer also received a bonus during the fiscal year ending in 2023 for completing a variety of special projects for the Medical Center. A The Industrial Development Authority of Clinton County Missouri 431619770 18746NAM2 2017-09-06 10000000 Refund Series 2007B bonds issued on 05/17/2007 0 0 0 B The Industrial Development Authority of Clinton County Missouri 431619770 18746NAQ3 2017-09-06 3990000 Financing of capital project and equipment 0 0 0 C The Industrial Development Authority of the City of Cameron Missouri 431679396 133451BS2 2017-12-21 6105000 Refund Series 2011 bond and financing of capital project 0 0 0 D The Industrial Development Authority of the City of Cameron Missouri 431679396 NoneAvail 2019-08-22 2730000 Financing of capital projects 0 0 0 A 150000 10000000 486592 170257 9348788 2017 1 0 1 1 B 3990000 403675 68386 3504535 21250 2018 0 0 1 1 C 2065000 6105000 242812 121226 2827033 2939863 2019 1 0 1 1 D 2730000 177051 54600 2513835 2020 0 0 1 1 A 0 0 0 0 0 0 0 B 0 0 0 0 0 0 0 C 0 0 0 0 0 0 0 D 0 0 0 0 0 0 0 A 0 0 0 1 0 0 0 0 1 B 0 0 0 1 0 0 0 0 1 C 0 0 0 1 0 0 0 0 1 D 0 1 0 0 0 0 0 0 1 A 1 B 1 C 1 D 1 Date Rebate Computation Performed Issuer Name: The Industrial Development Authority of Clinton County, Missou Date the Rebate Computation was Performed: 09/01/2022 Issuer Name: The Industrial Development Authority of Clinton County, Missou Date the Rebate Computation was Performed: 09/01/2022 Issuer Name: The Industrial Development Authority of the City of Cameron, M Date the Rebate Computation was Performed: 12/01/2022 A Health and Educational Facilties Authority of the State of Missouri 431178966 NoneAvail 2022-04-20 5615000 Financing of capital projects 0 0 0 A 65000 5615000 505859 112000 5124183 1163 2023 0 0 0 1 A 0 0 0 0 0 0 0 A 0 1 0 0 0 0 0 0 1 A 1 Form 990, Part VI, Section B, line 11b A copy of Form 990 is made available to the governing body prior to filing. Form 990, Part VI, Section B, line 12c Employees and Directors are required to complete an annual disclosure information form. Form 990, Part VI, Section B, line 15a The Board of Trustees is responsible for determining the job performance standards for the Administrator/CEO and determining compensation according to the organization's policies. Form 990, Part VI, Section C, line 19 Organization makes its governing documents available upon request. Form 990, Part IX, line 11g Professional fees: Program service expenses 6,794,666. Management and general expenses 83,465. Fundraising expenses 0. Total expenses 6,878,131. Purchased services: Program service expenses 2,398,414. Management and general expenses 477,244. Fundraising expenses 0. Total expenses 2,875,658. Reference lab fees: Program service expenses 622,987. Management and general expenses 0. Fundraising expenses 0. Total expenses 622,987. Other fees for services: Program service expenses 65,342. Management and general expenses 172,642. Fundraising expenses 0. Total expenses 237,984. Form 990, Part XI, line 9: Change in beneficial interest in net assets of Foundation net of transfers 30,979. Form 990, Part XII, Line 2C: The audit committee assumes the responsibility for the oversight of the audited financial statements, review of the Form 990, and selection of the independent accounting firm. Cameron Regional Medical Center Provider Management Service Organization LL 1600 East Evergreen Street Cameron MO 64429 472649803 To provide support and administrative services to physician groups MO Cameron Regional Medical Center Cameron Regional Medical Center Foundation 1600 East Evergreen Street Cameron MO 64429 742933060 To support the operation of the Cameron Regional Medical Center, Inc. MO 501(c)(3) Line 7 0 0 0 1 0 1 0 0 0 0 0 0 1 1 1 1 0 0 0 0