2013-08-15T07:01:02-05:00 2012-09-30 481026809 Wendling Noe Nelson & Johnson LLC 534 S Kansas Ave Suite 1500 Topeka KS 666033491 990 2011-10-01 440668347 Cameron Regional Medical Center CAME 8166322101 1600 East Evergreen Street Cameron MO 64429 Joseph Abrutz Jr 8166322101 2013-08-02 1 Derek H Hart P01054116 7852334226 2013-08-02 2011 2016-02-25 16:41:14Z Joseph Abrutz Jr 1600 East Evergreen Street Cameron MO 64429 55307376 0 X N/A X 1963 MO To provide acute inpatient and outpatient medical care to area residents regardless of ability to pay. 12 10 495 120 0 0 8004 51623 51136034 54000316 976338 1051924 188493 159718 52308869 55263581 0 0 0 0 22743648 23775178 0 0 1645 25397049 28132839 48140697 51908017 4168172 3355564 58637423 66680403 23152981 25585331 35484442 41095072 X Our mission at Cameron Regional Medical Center, Inc., 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. CRMC will provide services in an atmosphere that involves compliance with governmental mandates. Throughout our organization, our employees strive to provide sensitive, 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/growth of the facility. 0 0 46850679 54305589 Acute care hospital organized to provide inpatient and outpatient care to area residents regardless of ability to pay. 46850679 1 1 0 0 0 0 0 0 0 0 1 0 0 1 1 1 1 0 0 0 0 0 0 0 1 0 1 1 0 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 1 34 0 1 495 1 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 0 0 0 MO X Joseph Abrutz Jr 8166322101 1600 East Evergreen St Cameron MO 64429 Warren McElwain 1.00 X X 0 0 0 Steve Huitt 1.00 X X 0 0 0 Jennifer White 1.00 X X 0 0 0 Michael Poland 1.00 X X 0 0 0 Weldon Wilhoit 1.00 X 0 0 0 Barbara Ballew 1.00 X 0 0 0 Ken Raffety 1.00 X 0 0 0 Steve Tinnen 1.00 X 0 0 0 Mike Brown 1.00 X 0 0 0 David Just 1.00 X 0 0 0 Kendall DeSelms DO 41.00 X 254092 0 0 Muhammad Amin DO 40.00 X 278096 0 0 Joseph F Abrutz Jr 40.00 X 388953 0 9210 Rosa Patti 41.50 X 94088 0 14000 John Barton III 40.00 X 353773 0 0 John Schiro 40.00 X 244888 0 0 William Spalding 40.00 X 269108 0 0 Shahzad Shafique 40.00 X 288466 0 0 Laeeq Azmat 40.00 X 591431 0 0 2762895 0 23210 19 0 1 0 Cameron Emergency Physicians PC 1600 E Evergreen Cameron MO 64429 Emergency physicians 1176986 Premier Specialty Network 1835 E Republic Rd Suite 200 Springfield MO 65804 Physician specialists 849851 Wendling Noe Nelson & Johnson 534 S Kansas Ave Suite 1500 Topeka KS 66603 Auditing/Accounting 194844 Weatherby Locums Inc PO Box 972633 Dallas TX 75397 Surgeon 149271 Barton & Associates 10 Dearborn Rd Peabody MA 01960 Emergency physicians 140420 7 51623 51623 Patient service revenu 621990 54000316 54000316 54000316 724575 724575 22076 22076 52565 0 52565 52565 52565 307929 833 0 3489 307929 -2656 305273 305273 66477 40306 26171 26171 Cafeteria 722210 77542 77542 Other income 900099 3440 3440 80982 55263581 54305589 0 906369 1017010 541758 475252 18940244 17590968 1349276 294694 272898 21796 2145446 1968382 177064 1377784 1253315 124469 169964 169964 149357 149357 344297 128320 215977 1025659 717033 308626 510641 442165 68476 320174 266429 53745 970952 970952 2771429 2397009 374420 267418 39635 227783 Bad debts 7448059 7448059 Medical professional fe 3276712 3187813 88899 Medical supplies 3192948 3192948 Pharmaceuticals 2714979 2714979 4970250 3718016 1250589 1645 51908017 46850679 5055693 1645 23604 0 7154136 6474364 10848960 13087101 780492 657159 288529 291482 47021079 26628128 17996208 20392951 18141018 21890670 0 3404476 3886676 58637423 66680403 3518980 4364436 18670542 20534810 963459 686085 23152981 25585331 X 34881578 40487386 602864 607686 35484442 41095072 58637423 66680403 X 3355564 2255066 X X 0 1 1 X 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 16182264 7976119 8206145 25370392 18473703 6896689 5468423 178306 5290117 20392951 Deferred debt issuance costs 468995 Third party payor settlements 2563301 Beneficial interest in net assets of CRMC Foundation 428805 Other receivables 380928 Accrued interest and dividends 44647 3886676 Capital lease obligations 574084 Third party payor settlements 112001 686085 55263581 51908017 3355564 2190869 64197 2255066 5610630 47855828 40306 40306 47815522 7448059 7448059 55263581 44500264 40306 40306 44459958 7448059 7448059 51908017 Description of Uncertain Tax Positions Under FIN 48: Part X: The Medical Center is a not-for-profit corporation as described in Section 501(c)(3) of the Internal Revenue Code and is exempt from federal income taxes on its related income pursuant to Section 501(a) of the Code. Management is not aware of any uncertainties in income tax positions. The years ended September 30, 2012, 2011, 2010, and 2009, remain subject to examination for both federal and state purposes. Part XI, Line 8 - Other Adjustments: Change in beneficial interest in net assets of CRMC Foundation 88,433. Other decreases in temporarily restricted net assets -24,236. Total to Schedule D, Part XI, Line 8: 64,197. Part XII, Line 2d - Other Adjustments: Fundraising event direct expenses 40,306. Part XII, Line 4b - Other Adjustments: Provision for bad debts 7,448,059. Part XIII, Line 2d - Other Adjustments: Fundraising event direct expenses 40,306. Part XIII, Line 4b - Other Adjustments: Provision for bad debts 7,448,059. Golf Tournament 66477 66477 5815 15935 12471 3174 2911 66477 66477 5815 15935 12471 3174 2911 40306 26171 1 1 1 X 1 X 127.000000000000 1 1 0 1 1 841497 780374 61123 0.00140 6775762 5490076 1285686 0.02890 7617259 6270450 1346809 0.03030 199153 3508 195645 0.00440 38564 11125 27439 0.00060 7371910 4672717 2699193 0.06070 18132 18132 0.00040 7627759 4687350 2940409 0.06610 15245018 10957800 4287218 0.09640 1 2997002 299700 16295960 17806663 -1510703 X 1 0 1 1 Cameron Regional Medical Center

1600 East Evergreen Street Cameron MO 64429

X X X Cameron Regional Medical Center Inc 1 1 1 100.000000000000 1 127.000000000000 0 1 1 X 1 0 1 X 0 0 13 Cameron Medical Clinic

1600 E Evergreen Cameron MO 64429

Medical Clinic Walnut Medical Clinic

221 E 7th Street Cameron MO 64429

Medical Clinic Westside Medical Offices

1608 E Evergreen Cameron MO 64429

Medical Clinic Cameron Specialists - Internal Medicine

1608 E Evergreen Cameron MO 64429

Medical Clinic Hamilton Family Health Center

212 N Davis Hamilton MO 64644

Rural Health Clinic Plattsburg Family Medicine

214 N Main Plattsburg MO 64477

Rural Health Clinic Jamesport Outreach Clinic

409 W Auberry Grove Jamesport MO 64648

Rural Health Clinic Stewartsville Medical Clinic

106 E 4th Stewartsville MO 64490

Rural Health Clinic Pattonsburg Medical Clinic

110 N Central Ave Pattonsburg MO 64670

Rural Health Clinic Polo Family Health Center

101 E Meadowbrook Polo MO 64671

Rural Health Clinic Gallatin Family Medicine

502 S Main Gallatin MO 64640

Rural Health Clinic Lathrop Medical Clinic

705 Oak Street Lathrop MO 64465

Medical Clinic Bethany Medical Clinic

3202 Millter St Bethany MO 64424

Medical Clinic Part I, Line 7: A cost-to-charge ratio derived from Worksheet 2 was used to clculate 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 $5,019,506. 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 $ 7448059. Part III, Line 4: 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.The amount on line 3 was determined based on the overall income level of patients that submit all required documentation under the Medical Center's financial assistance policy.Financial statement footnote: On the basis of historical experience, a significant portion of the Medical Center's uninsured patients will be unable or unwilling to pay for the services rendered. Thus, the Medical Center records a significant provision for bad debts related to uninsured patients in the period the services are provided. Part III, Line 8: Medicare costs were obtained from the Medical Center's as-filed Medicare cost report for the tax year.The shortfall is 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. 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 the residents from the primary service area. Part VI, Line 3: The Medical Center employs a social worker that informs all patients of all available payment options. Each patient receives a HELP program brochure to ensure that the patient has all information needed. Part VI, Line 4: Cameron Regional Medical Center and its seven 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 51,492 individuals that reside in the primary service area. Of these residents approximately 11.1% of them have an annual income below the federal poverty level. The median annual income per household for the four counties is approximately $44,587. Approximately 47% of the total services provided are for Medicare patients and 15% 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 the 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. X X X 0 0 0 0 0 0 0 0 0 Kendall DeSelms DO 254092 0 0 0 0 0 0 0 0 0 254092 0 0 0 Muhammad Amin DO 278096 0 0 0 0 0 0 0 0 0 278096 0 0 0 Joseph F Abrutz Jr 262467 0 126486 0 0 0 0 0 9210 0 398163 0 0 0 John Barton III 353773 0 0 0 0 0 0 0 0 0 353773 0 0 0 John Schiro 244888 0 0 0 0 0 0 0 0 0 244888 0 0 0 William Spalding 260608 0 8500 0 0 0 0 0 0 0 269108 0 0 0 Shahzad Shafique 288466 0 0 0 0 0 0 0 0 0 288466 0 0 0 Laeeq Azmat 591431 0 0 0 0 0 0 0 0 0 591431 0 0 0 The Industrial Development Authority of the City of Cameron Missouri 431679396 133451BF0 2007-05-17 10000000 Refund Series 2000 bonds issued on 12/13/2000 0 0 0 The Industrial Development Authority of Clinton County Missouri 521734480 133451AB6 2007-05-17 9994879 Refund Series 2000 bonds issued on 12/13/2000 and purchase equipment 0 0 0 1685000 10000000 197701 4037 9798262 2007 0 1 1 1 9994879 197054 913437 8884388 2007 0 1 1 1 0 0 0 0 1 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 X Form 990, Part VI, Section B, line 11 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 C, line 19 Organization makes its governing documents available upon request. Changes in Net Assets or Fund Balances: Form 990, Part XI, line 5: Net unrealized gains on investments: 2,190,869. Change in beneficial interest in net assets of CRMC Foundation 88,433. Other decreases in temporarily restricted net assets -24,236. Total to Form 990, Part XI, Line 5: 2,255,066. Financial Statements and Reporting 990, Part XI, Page 11, Line 2c Cameron Regional Medical Center's Finance Committee is responsible for each of these functions. 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) 170(b)(1) (A)(vi) 0 0 0 1 0 0 0 0 0 0 0 0 0 1 1 0 1 0 0