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SSM AUDRAIN HEALTH CARE INC: Form 990, tax year 2012

View the entire original 990 at ProPublica ↗

Organization
SSM AUDRAIN HEALTH CARE INC (EIN 43-1550298)
Tax period
2012-01-01 to 2012-12-31
Filed
2013-11-15
IRS object ID
201323199349308192
Schema version
2012v2.1
Source
Download XML · Original 990 at ProPublica

Every field in the e-filed return. Faint text is the IRS element name, for citing.

Return header ReturnHeader

FieldValueIRS element (for citing)
Timestamp2013-11-15T14:56:16-06:00Timestamp
Tax Period End Date2012-12-31TaxPeriodEndDate

Preparer Firm PreparerFirm

FieldValueIRS element (for citing)
EIN861065772EIN

Preparer Firm Business Name PreparerFirmBusinessName

FieldValueIRS element (for citing)
Business Name Line1DELOITTE TAX LLPBusinessNameLine1

Preparer Firm US Address PreparerFirmUSAddress

FieldValueIRS element (for citing)
Address Line11111 BAGBY STREET SUITE 4500AddressLine1
CityHOUSTONCity
StateTXState
ZIP Code770022591ZIPCode
FieldValueIRS element (for citing)
Return Type990ReturnType
Tax Period Begin Date2012-01-01TaxPeriodBeginDate

Filer Filer

FieldValueIRS element (for citing)
EIN431550298EIN

Name Name

FieldValueIRS element (for citing)
Business Name Line1AUDRAIN HEALTH CARE INCBusinessNameLine1
FieldValueIRS element (for citing)
Name ControlAUDRNameControl
Phone5735825000Phone

US Address USAddress

FieldValueIRS element (for citing)
Address Line1620 E MONROEAddressLine1
CityMEXICOCity
StateMOState
ZIP Code652652963ZIPCode

Officer Officer

FieldValueIRS element (for citing)
NameDAVID NEUENDORFName
TitlePRESIDENT/CEOTitle
Phone5735828103Phone
Date Signed2013-11-15DateSigned
Authorize Third Party1AuthorizeThirdParty

Preparer Preparer

FieldValueIRS element (for citing)
NameBROOKE KITCHENName
PTINP00849302PTIN
Phone7139822000Phone
FieldValueIRS element (for citing)
Tax Year2012TaxYear
Build TS2016-03-07 17:11:31ZBuildTS

Form 990 IRS990

Doing Business As DoingBusinessAs

FieldValueIRS element (for citing)
Business Name Line1SEE SCHEDULE OBusinessNameLine1
FieldValueIRS element (for citing)
Name Of Principal Officer PersonDAVID NEUENDORFNameOfPrincipalOfficerPerson

Address Principal Officer US AddressPrincipalOfficerUS

FieldValueIRS element (for citing)
Address Line1620 E MONROEAddressLine1
CityMEXICOCity
StateMOState
ZIP Code652652963ZIPCode
FieldValueIRS element (for citing)
Gross Receipts55970381GrossReceipts
Group Return For Affiliates0GroupReturnForAffiliates
Organization501c3XOrganization501c3
Web SiteWWW.AUDRAINMEDICALCENTER.COMWebSite
Type Of Organization CorporationXTypeOfOrganizationCorporation
Year Formation1918YearFormation
State Legal DomicileMOStateLegalDomicile
Activity Or Mission DescriptionSEE SCHEDULE OActivityOrMissionDescription
Nbr Voting Members Governing Body14NbrVotingMembersGoverningBody
Nbr Independent Voting Members11NbrIndependentVotingMembers
Total Nbr Employees518TotalNbrEmployees
Total Nbr Volunteers120TotalNbrVolunteers
Total Gross UBI0TotalGrossUBI
Net Unrelated Business Txbl Income0NetUnrelatedBusinessTxblIncome
Contributions Grants Prior Year1271149ContributionsGrantsPriorYear
Contributions Grants Current Year1020213ContributionsGrantsCurrentYear
Program Service Revenue Prior Year55617531ProgramServiceRevenuePriorYear
Program Service Revenue CY51352851ProgramServiceRevenueCY
Investment Income Prior Year108941InvestmentIncomePriorYear
Investment Income Current Year62770InvestmentIncomeCurrentYear
Other Revenue Prior Year414868OtherRevenuePriorYear
Other Revenue Current Year416126OtherRevenueCurrentYear
Total Revenue Prior Year57412489TotalRevenuePriorYear
Total Revenue Current Year52851960TotalRevenueCurrentYear
Grants And Similar Amnts Prior Year35203GrantsAndSimilarAmntsPriorYear
Grants And Similar Amnts CY19292GrantsAndSimilarAmntsCY
Benefits Paid To Members Prior Year0BenefitsPaidToMembersPriorYear
Benefits Paid To Members CY0BenefitsPaidToMembersCY
Salaries Etc Prior Year27856793SalariesEtcPriorYear
Salaries Etc Current Year27970980SalariesEtcCurrentYear
Total Prof Fundrsng Exp Prior Year0TotalProfFundrsngExpPriorYear
Total Prof Fundrsng Exp CY0TotalProfFundrsngExpCY
Total Fundrsng Exp Current Year0TotalFundrsngExpCurrentYear
Other Expense Prior Year31950698OtherExpensePriorYear
Other Expenses Current Year27640514OtherExpensesCurrentYear
Total Expenses Prior Year59842694TotalExpensesPriorYear
Total Expenses Current Year55630786TotalExpensesCurrentYear
Revenues Less Expenses Prior Year-2430205RevenuesLessExpensesPriorYear
Revenues Less Expenses CY-2778826RevenuesLessExpensesCY
Total Assets BOY31018249TotalAssetsBOY
Total Assets EOY29984118TotalAssetsEOY
Total Liabilities BOY26536821TotalLiabilitiesBOY
Total Liabilities EOY27186694TotalLiabilitiesEOY
Net Assets Or Fund Balances BOY4481428NetAssetsOrFundBalancesBOY
Net Assets Or Fund Balances EOY2797424NetAssetsOrFundBalancesEOY
Info In Schedule O Part IIIXInfoInScheduleOPartIII
Mission DescriptionTO CARE FOR THE SICK AND INFURED AND TO CONTINUOUSLY IMPROVE THE HEALTH AND WELL-BEING OF THE COMMUNITIES WE SERVE, IN PARTNERSHIP WITH PHYSICIANS, HEALTHCARE PROVIDERS AND RESIDENTS.MissionDescription
Significant New Program Services0SignificantNewProgramServices
Significant Change0SignificantChange
Expense15287803Expense
Grants19292Grants
Revenue10476371Revenue
DescriptionAUDRAIN MEDICAL CENTER PROVIDES INPATIENT CARE TO THE COMMUNITY REGARDLESS OF AN INDIVIDUAL'S ABILITY TO PAY. INPATIENT CARE SERVICES WERE PROVIDED TO 2,263 CUSTOMERS. SEE SCHEDULE O.Description

Activity2 Activity2

FieldValueIRS element (for citing)
Expense23098621Expense
Revenue33423468Revenue
DescriptionAUDRAIN MEDICAL CENTER PROVIDES OUTPATIENT CARE TO THE COMMUNITY REGARDLESS OF AN INDIVIDUAL'S ABILITY TO PAY. OUTPATIENT CARE SERVICES WERE PROVIDED TO 78,056 CUSTOMERS. SEE SCHEDULE O.Description

Activity3 Activity3

FieldValueIRS element (for citing)
Expense9703679Expense
Revenue7453012Revenue
DescriptionAUDRAIN MEDICAL CENTER CLINICS (MEDCHOICE) PROVIDE OUTPATIENT CLINICAL SERVICES TO THE COMMUNITY REGARDLESS OF ANY INDIVIDUAL'S ABILITY TO PAY. AMC CLINICS PROVIDED OUTPATIENT SERVICES TO 58,965 CUSTOMERS IN 2012. SEE SCHEDULE O.Description
FieldValueIRS element (for citing)
Total Program Service Expense48090103TotalProgramServiceExpense
Described In501 C31DescribedIn501C3
Schedule B Required1ScheduleBRequired
Political Activities0PoliticalActivities
Lobbying Activities1LobbyingActivities
Subject To Proxy Tax0SubjectToProxyTax
Donor Advised Funds0DonorAdvisedFunds
Conservation Easements0ConservationEasements
Collections Of Art0CollectionsOfArt
Credit Counseling0CreditCounseling
Term Or Permanent Endowments1TermOrPermanentEndowments
Report Land Bldg Equip1ReportLandBldgEquip
Report Invest Oth Securities0ReportInvestOthSecurities
Report Prog Rel Invest0ReportProgRelInvest
Report Other Assets0ReportOtherAssets
Report Other Liabilities1ReportOtherLiabilities
Report Fin48 Footnote1ReportFin48Footnote
Independent Audit Financial Stmt1IndependentAuditFinancialStmt
Consolidated Audit Financial Stmt0ConsolidatedAuditFinancialStmt
School0School
Foreign Office0ForeignOffice
Foreign Activities0ForeignActivities
More Than5000 K To Organizations0MoreThan5000KToOrganizations
More Than5000 K To Individuals0MoreThan5000KToIndividuals
Professional Fundraising0ProfessionalFundraising
Fundraising Activities0FundraisingActivities
Gaming0Gaming
Hospital1Hospital
Financial Stmt Attached1FinancialStmtAttached
Grants To Organizations1GrantsToOrganizations
Grants To Individuals0GrantsToIndividuals
Schedule J Required1ScheduleJRequired
Tax Exempt Bonds0TaxExemptBonds
Excess Benefit Transaction0ExcessBenefitTransaction
Prior Excess Benefit Transaction0PriorExcessBenefitTransaction
Loan To Officer Or DQP0LoanToOfficerOrDQP
Grant To Related Person0GrantToRelatedPerson
Bsnss Rltnshp With Organization0BsnssRltnshpWithOrganization
Bsnss Rltnshp Thru Family Member1BsnssRltnshpThruFamilyMember
Officer Entity With Bsnss Rltnshp0OfficerEntityWithBsnssRltnshp
Deductible Non Cash Contributions0DeductibleNonCashContributions
Deductible Contributions Of Art0DeductibleContributionsOfArt
Terminated0Terminated
Partial Liquidation0PartialLiquidation
Disregarded Entity0DisregardedEntity
Related Entity1RelatedEntity
Related Org Controlled Entity0RelatedOrgControlledEntity
Transfers To Exempt Non Chrtbl Org0TransfersToExemptNonChrtblOrg
Activities Conducted Partnership0ActivitiesConductedPartnership
Schedule O Required1ScheduleORequired
Number Forms Transmitted With1096218NumberFormsTransmittedWith1096
Number W2 G Included0NumberW2GIncluded
Compliance With Backup Witholding1ComplianceWithBackupWitholding
Number Of Employees518NumberOfEmployees
Employment Tax Returns Filed1EmploymentTaxReturnsFiled
Unrelated Business Income0UnrelatedBusinessIncome
Foreign Financial Account0ForeignFinancialAccount
Prohibited Tax Shelter Trans0ProhibitedTaxShelterTrans
Taxable Party Notification0TaxablePartyNotification
Non Deductible Contributions0NonDeductibleContributions
Quid Pro Quo Contributions0QuidProQuoContributions
Form8282 Property Disposed Of0Form8282PropertyDisposedOf
Number Of8282 Filed0NumberOf8282Filed
Funds To Pay Premiums0FundsToPayPremiums
Premiums Paid0PremiumsPaid
Indoor Tanning Services0IndoorTanningServices
Info In Schedule O Part VIXInfoInScheduleOPartVI
Nbr Voting Governing Body Members14NbrVotingGoverningBodyMembers
Number Independent Voting Members11NumberIndependentVotingMembers
Family Or Business Relationship0FamilyOrBusinessRelationship
Delegation Of Management Duties0DelegationOfManagementDuties
Changes To Organizing Docs0ChangesToOrganizingDocs
Material Diversion Or Misuse0MaterialDiversionOrMisuse
Members Or Stockholders0MembersOrStockholders
Election Of Board Members0ElectionOfBoardMembers
Decisions Subject To Approval0DecisionsSubjectToApproval
Minutes Of Governing Body1MinutesOfGoverningBody
Minutes Of Committees1MinutesOfCommittees
Officer Mailing Address0OfficerMailingAddress
Local Chapters0LocalChapters
Form990 Provided To Governing Body0Form990ProvidedToGoverningBody
Conflict Of Interest Policy1ConflictOfInterestPolicy
Annual Disclosure Covered Persons1AnnualDisclosureCoveredPersons
Regular Monitoring Enforcement1RegularMonitoringEnforcement
Whistleblower Policy1WhistleblowerPolicy
Document Retention Policy1DocumentRetentionPolicy
Compensation Process CEO1CompensationProcessCEO
Compensation Process Other1CompensationProcessOther
Investment In Joint Venture0InvestmentInJointVenture
Upon RequestXUponRequest

The Books Are In Care Of TheBooksAreInCareOf

Name Business NameBusiness

FieldValueIRS element (for citing)
Business Name Line1JENNIFER OGDENBusinessNameLine1
FieldValueIRS element (for citing)
Telephone Number5735828095TelephoneNumber

Address US AddressUS

FieldValueIRS element (for citing)
Address Line1620 EAST MONROEAddressLine1
CityMEXICOCity
StateMOState
ZIP Code652652963ZIPCode

Form990 Part VII Section A Form990PartVIISectionA (20 entries)

TitleTitleAverage Hours Per WeekAverageHoursPerWeekIndividual Trustee Or DirectorIndividualTrusteeOrDirectorOfficerOfficerReportable Comp From OrganizationReportableCompFromOrganizationReportable Comp From Related OrgsReportableCompFromRelatedOrgsOther CompensationOtherCompensationHighest Compensated EmployeeHighestCompensatedEmployee
N EUGENE THOMAS
PHYSICIAN, TREAS, BOT40.50XX40432600
NEUENDORF DAVID A
PRES/CEO, DIR BOD40.80XX21331402400
CHARLES SCHAFER
CHAIRMAN - BOARD OF DIR1.00XX000
SUSAN WILBURN
VICE CHAIRMAN - BOD1.00XX000
CHARLES TILLMAN
SEC/TREA - BOARD OF DIR0.90XX000
GENEVA ALLISON
DIRECTOR - BOARD OF DIR0.80X000
JOHN DIAL
DIRECTOR - BOARD OF DIR0.70X000
KATHY MILLER
DIRECTOR - BOARD OF DIR0.80X000
STERLING OLIVER
VICE CHAIR-BOT & DIR-BOD1.40XX000
KIM RETTENMAIER
DIRECTOR - BOARD OF DIR0.90X000
RANDAL ROBLEY
DIRECTOR - BOARD OF DIR0.80X000
SUE WAECHTER
CHAIRMAN - BOT & DIR-BOD1.40XX000
WILLIAM DUBBERT
SEC - BOARD OF TRUSTEES0.40XX000
JO ELLEN CRAGHEAD
DIRECTOR-BOT0.40X000
SHAW GREG
VP & CFO40.00X11852509113
SHAHID WAHEED
PHYSICIAN40.0055323403779X
PETER D PERLL
PHYSICIAN40.0038602300X
PEGGY A BARJENBRUCH
PHYSICIAN40.0036409205329X
MICHAEL QUINLAN
PHYSICIAN40.0034003108142X
JOAN SLAUGHTER
CRNA40.0026977004000X
FieldValueIRS element (for citing)
Total Reportable Comp From Org2649315TotalReportableCompFromOrg
Total Reportable Comp Frm Rltd Orgs0TotalReportableCompFrmRltdOrgs
Total Other Compensation32763TotalOtherCompensation
Number Individuals GT100 K27NumberIndividualsGT100K
Formers Listed0FormersListed
Total Comp GT150 K1TotalCompGT150K
Compensation From Other Sources0CompensationFromOtherSources

Contractor Compensation ContractorCompensation (5 entries)

Address Line1AddressOfContractor/AddressUS/AddressLine1CityAddressOfContractor/AddressUS/CityStateAddressOfContractor/AddressUS/StateZIP CodeAddressOfContractor/AddressUS/ZIPCodeDescription Of ServicesDescriptionOfServicesCompensationCompensation
AUDRAIN EMERGENCY GROUP LLC
PO BOX 82368LAFAYETTELA70598ER PHYSICIANS486260
DR BRADLEY BUCHANAN
3 SOUTHMORMEXICOMO65265ANESTHESIOLOGY469332
MEXICO CARDIOGRAPHICS
720 MEDICAL PARK DRIVEMEXICOMO65265EEG/EKG READING367950
PATHOLOGY LABORATORIES
PO BOX 7406COLUMBIAMO65205LAB SERVICES345119
LTA COMPANY LLC
PO BOX 207MEXICOMO65265ANESTHESIOLOGY264000
FieldValueIRS element (for citing)
Number Of Contractors GT100 K15NumberOfContractorsGT100K
Related Organizations308930RelatedOrganizations
Government Grants691283GovernmentGrants
All Other Contributions20000AllOtherContributions
Total Contributions1020213TotalContributions

Program Service Revenue ProgramServiceRevenue (4 entries)

DescriptionDescriptionBusiness CodeBusinessCodeTotal Revenue ColumnTotalRevenueColumnRelated Or Exempt Function IncomeRelatedOrExemptFunctionIncome
OUTPATIENT REVENUE6214003216215332162153
INPATIENT REVENUE62111099302969930296
AMC & MEDCHOICE PHYSICIAN REVENUE62140069480116948011
ELECTRONIC HEALTH RECORDS REVENUE90009923123912312391
FieldValueIRS element (for citing)
Total Program Service Revenue51352851TotalProgramServiceRevenue

Investment Income InvestmentIncome

FieldValueIRS element (for citing)
Total Revenue Column18175TotalRevenueColumn
Exclusion$18,175ExclusionAmount

Gross Rents GrossRents

FieldValueIRS element (for citing)
Real113369Real

Less Rental Expenses LessRentalExpenses

FieldValueIRS element (for citing)
Real0Real

Rental Income Or Loss RentalIncomeOrLoss

FieldValueIRS element (for citing)
Real113369Real

Net Rental Income Or Loss NetRentalIncomeOrLoss

FieldValueIRS element (for citing)
Total Revenue Column113369TotalRevenueColumn
Exclusion$113,369ExclusionAmount

Gross Amount Sales Assets GrossAmountSalesAssets

FieldValueIRS element (for citing)
Securities3163016Securities

Less Cost Oth Basis Sales Expenses LessCostOthBasisSalesExpenses

FieldValueIRS element (for citing)
Securities3116869Securities
Other1552Other

Gain Or Loss GainOrLoss

FieldValueIRS element (for citing)
Securities46147Securities
Other-1552Other

Net Gain Or Loss Investments NetGainOrLossInvestments

FieldValueIRS element (for citing)
Total Revenue Column44595TotalRevenueColumn
Exclusion$44,595ExclusionAmount

Other Revenue Misc OtherRevenueMisc (3 entries)

DescriptionDescriptionBusiness CodeBusinessCodeTotal Revenue ColumnTotalRevenueColumnExclusionExclusionAmount
CAFETERIA722210183748$183,748
DISCOUNTS AND REBATES90009992313$92,313
MEDICAL RECORDS56100026696$26,696
FieldValueIRS element (for citing)
Total Other Revenue302757TotalOtherRevenue

Total Revenue TotalRevenue

FieldValueIRS element (for citing)
Total Revenue Column52851960TotalRevenueColumn
Related Or Exempt Function Income51352851RelatedOrExemptFunctionIncome
Unrelated Business Revenue0UnrelatedBusinessRevenue
Exclusion$478,896ExclusionAmount
FieldValueIRS element (for citing)
Info In Schedule O Part IXXInfoInScheduleOPartIX

Grants To Domestic Orgs GrantsToDomesticOrgs

FieldValueIRS element (for citing)
Total19292Total
Program Services19292ProgramServices

Comp Current Officers Directors CompCurrentOfficersDirectors

FieldValueIRS element (for citing)
Total872796Total
Program Services775264ProgramServices
Management And General97532ManagementAndGeneral

Other Salaries And Wages OtherSalariesAndWages

FieldValueIRS element (for citing)
Total21592979Total
Program Services19180231ProgramServices
Management And General2412748ManagementAndGeneral

Pension Plan Contributions PensionPlanContributions

FieldValueIRS element (for citing)
Total2006465Total
Program Services1774317ProgramServices
Management And General232148ManagementAndGeneral

Other Employee Benefits OtherEmployeeBenefits

FieldValueIRS element (for citing)
Total2041878Total
Program Services1805632ProgramServices
Management And General236246ManagementAndGeneral

Payroll Taxes PayrollTaxes

FieldValueIRS element (for citing)
Total1456862Total
Program Services1288303ProgramServices
Management And General168559ManagementAndGeneral

Fees For Services Legal FeesForServicesLegal

FieldValueIRS element (for citing)
Total133892Total
Management And General133892ManagementAndGeneral

Fees For Services Accounting FeesForServicesAccounting

FieldValueIRS element (for citing)
Total100312Total
Management And General100312ManagementAndGeneral

Fees For Services Other FeesForServicesOther

FieldValueIRS element (for citing)
Total7583078Total
Program Services6522407ProgramServices
Management And General1060671ManagementAndGeneral

Advertising Advertising

FieldValueIRS element (for citing)
Total103768Total
Program Services89254ProgramServices
Management And General14514ManagementAndGeneral

Office Expenses OfficeExpenses

FieldValueIRS element (for citing)
Total13034347Total
Program Services11087257ProgramServices
Management And General1947090ManagementAndGeneral

Information Technology InformationTechnology

FieldValueIRS element (for citing)
Total613445Total
Program Services613445ProgramServices

Occupancy Occupancy

FieldValueIRS element (for citing)
Total1700070Total
Program Services1462275ProgramServices
Management And General237795ManagementAndGeneral

Travel Travel

FieldValueIRS element (for citing)
Total52388Total
Program Services45060ProgramServices
Management And General7328ManagementAndGeneral

Interest Interest

FieldValueIRS element (for citing)
Total376409Total
Program Services288978ProgramServices
Management And General87431ManagementAndGeneral

Depreciation Depletion DepreciationDepletion

FieldValueIRS element (for citing)
Total3149764Total
Program Services2418145ProgramServices
Management And General731619ManagementAndGeneral

Insurance Insurance

FieldValueIRS element (for citing)
Total308637Total
Program Services265467ProgramServices
Management And General43170ManagementAndGeneral

Other Expenses OtherExpenses (3 entries)

DescriptionDescriptionTotalTotalProgram ServicesProgramServicesManagement And GeneralManagementAndGeneral
MEDICAL SUPPLIES272575272575
DUES AND SUBSCRIPTIONS16591014270423206
RECRUITMENT ALLOCATION45919394976422

Total Functional Expenses TotalFunctionalExpenses

FieldValueIRS element (for citing)
Total55630786Total
Program Services48090103ProgramServices
Management And General7540683ManagementAndGeneral
Fundraising0Fundraising

Cash Non Interest Bearing CashNonInterestBearing

FieldValueIRS element (for citing)
BOY3505BOY
EOY1040496EOY

Savings And Temp Cash Investments SavingsAndTempCashInvestments

FieldValueIRS element (for citing)
BOY1116435BOY
EOY1203978EOY

Accounts Receivable AccountsReceivable

FieldValueIRS element (for citing)
BOY5711562BOY
EOY6066629EOY

Inventories For Sale Or Use InventoriesForSaleOrUse

FieldValueIRS element (for citing)
BOY513223BOY
EOY447959EOY

Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges

FieldValueIRS element (for citing)
BOY1508022BOY
EOY1682590EOY
FieldValueIRS element (for citing)
Land Buildings Equipment Basis83281888LandBuildingsEquipmentBasis
Land Bldg Equipment Accum Deprec67038126LandBldgEquipmentAccumDeprec

Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet

FieldValueIRS element (for citing)
BOY17992875BOY
EOY16243762EOY

Investments Pub Traded Securities InvestmentsPubTradedSecurities

FieldValueIRS element (for citing)
BOY3525227BOY
EOY2137467EOY

Investments Program Related InvestmentsProgramRelated

FieldValueIRS element (for citing)
BOY603054BOY
EOY489825EOY

Other Assets Total OtherAssetsTotal

FieldValueIRS element (for citing)
BOY44346BOY
EOY671412EOY

Total Assets TotalAssets

FieldValueIRS element (for citing)
BOY31018249BOY
EOY29984118EOY

Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses

FieldValueIRS element (for citing)
BOY5930339BOY
EOY6181748EOY

Mort Notes Pybl Secured Invest Prop MortNotesPyblSecuredInvestProp

FieldValueIRS element (for citing)
BOY7172151BOY
EOY5450265EOY

Unsecured Notes Loans Payable UnsecuredNotesLoansPayable

FieldValueIRS element (for citing)
BOY0BOY
EOY430000EOY

Other Liabilities OtherLiabilities

FieldValueIRS element (for citing)
BOY13434331BOY
EOY15124681EOY

Total Liabilities TotalLiabilities

FieldValueIRS element (for citing)
BOY26536821BOY
EOY27186694EOY
FieldValueIRS element (for citing)
Follow SFAS117XFollowSFAS117

Unrestricted Net Assets UnrestrictedNetAssets

FieldValueIRS element (for citing)
BOY4016462BOY
EOY2456018EOY

Temporarily Restricted Net Assets TemporarilyRestrictedNetAssets

FieldValueIRS element (for citing)
BOY282688BOY
EOY159128EOY

Permanently Restricted Net Assets PermanentlyRestrictedNetAssets

FieldValueIRS element (for citing)
BOY182278BOY
EOY182278EOY

Total Net Assets Fund Balances TotalNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY4481428BOY
EOY2797424EOY

Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY31018249BOY
EOY29984118EOY
FieldValueIRS element (for citing)
Info In Schedule O Part XIXInfoInScheduleOPartXI
Reconcilation Revenue Expenses-2778826ReconcilationRevenueExpenses
Reconciliation Unrealized Invest145828ReconciliationUnrealizedInvest
Reconcilation Other Changes948994ReconcilationOtherChanges
Method Of Accounting AccrualXMethodOfAccountingAccrual
Accountant Compile Or Review0AccountantCompileOrReview
FS Audited1FSAudited

FS Audited Basis FSAuditedBasis

FieldValueIRS element (for citing)
Financial Statement SeparateXFinancialStatementSeparate
FieldValueIRS element (for citing)
Audit Committee1AuditCommittee
Federal Grant Audit Required0FederalGrantAuditRequired

Schedule A IRS990ScheduleA

FieldValueIRS element (for citing)
Hospital170b1 AiiiXHospital170b1Aiii

Schedule B IRS990ScheduleB

Contributor Info ContributorInfo

FieldValueIRS element (for citing)
Contributor NumberRESTRICTEDContributorNumber

Contributor Name Business ContributorNameBusiness

FieldValueIRS element (for citing)
Business Name Line1RESTRICTEDBusinessNameLine1

Contributor Address US ContributorAddressUS

FieldValueIRS element (for citing)
Address Line1RESTRICTEDAddressLine1
Address Line2RESTRICTEDAddressLine2
CityRESTRICTEDCity
StateRESTRICTEDState
ZIP CodeRESTRICTEDZIPCode
FieldValueIRS element (for citing)
Aggregate ContributionsRESTRICTEDAggregateContributions

Schedule C IRS990ScheduleC

FieldValueIRS element (for citing)
Volunteers0Volunteers
Paid Staff Or Management0PaidStaffOrManagement
Media Advertisements0MediaAdvertisements
Mailings Members0MailingsMembers
Publications Or Broadcast0PublicationsOrBroadcast
Grants Other Organizations1GrantsOtherOrganizations
Grants Other Organizations$10,516GrantsOtherOrganizationsAmount
Direct Contact Legislators0DirectContactLegislators
Rallies Demonstrations0RalliesDemonstrations
Other Activities0OtherActivities
Total Lobbying Expenditures IIB10516TotalLobbyingExpendituresIIB
Not Described In501c30NotDescribedIn501c3

Form990 Schedule C Part IV Form990ScheduleCPartIV

FieldValueIRS element (for citing)
IdentifierORGANIZATIONS DIRECT AND INDIRECT POLITICAL CAMPAIGN ACTIVITIES:Identifier
Return ReferencePART I-A, LINE 1:ReturnReference
ExplanationTHE ORGANIZATION IS A MEMBER OF THE MISSOURI HOSPITAL ASSOCIATION, AND A PORTION OF THE DUES PAID ARE ATTRIBUTABLE TO LOBBYING ACTIVITIES.Explanation

Schedule D IRS990ScheduleD

Current Year CurrentYear

FieldValueIRS element (for citing)
Beginning Of Year Balance3959469BeginningOfYearBalance
Contributions0Contributions
Investment Earnings Or Losses-585196InvestmentEarningsOrLosses
Grants Or Scholarships0GrantsOrScholarships
Other Expenditures12851OtherExpenditures
Administrative Expenses19294AdministrativeExpenses
End Of Year Balance3342128EndOfYearBalance

Current Year Minus1 Year CurrentYearMinus1Year

FieldValueIRS element (for citing)
Beginning Of Year Balance4026494BeginningOfYearBalance
Contributions0Contributions
Investment Earnings Or Losses-8789InvestmentEarningsOrLosses
Grants Or Scholarships0GrantsOrScholarships
Other Expenditures42838OtherExpenditures
Administrative Expenses15398AdministrativeExpenses
End Of Year Balance3959469EndOfYearBalance

Current Year Minus2 Years CurrentYearMinus2Years

FieldValueIRS element (for citing)
Beginning Of Year Balance4394652BeginningOfYearBalance
Contributions43181Contributions
Investment Earnings Or Losses-296457InvestmentEarningsOrLosses
Grants Or Scholarships500GrantsOrScholarships
Other Expenditures105437OtherExpenditures
Administrative Expenses8945AdministrativeExpenses
End Of Year Balance4026494EndOfYearBalance

Current Year Minus3 Years CurrentYearMinus3Years

FieldValueIRS element (for citing)
Beginning Of Year Balance4084478BeginningOfYearBalance
Contributions244672Contributions
Investment Earnings Or Losses1808806InvestmentEarningsOrLosses
Grants Or Scholarships0GrantsOrScholarships
Other Expenditures1724140OtherExpenditures
Administrative Expenses19164AdministrativeExpenses
End Of Year Balance4394652EndOfYearBalance

Current Year Minus4 Years CurrentYearMinus4Years

FieldValueIRS element (for citing)
Beginning Of Year Balance5028947BeginningOfYearBalance
Contributions443106Contributions
Investment Earnings Or Losses550679InvestmentEarningsOrLosses
Grants Or Scholarships500GrantsOrScholarships
Other Expenditures1913138OtherExpenditures
Administrative Expenses24617AdministrativeExpenses
End Of Year Balance4084477EndOfYearBalance
FieldValueIRS element (for citing)
Board Designated EOY Balance1.00000BoardDesignatedEOYBalance
Endowments Held By Unrelated Orgs1EndowmentsHeldByUnrelatedOrgs
Endowments Held By Related Orgs0EndowmentsHeldByRelatedOrgs

Land Land

FieldValueIRS element (for citing)
Other Cost Or Other Basis782780OtherCostOrOtherBasis
Book Value782780BookValue

Buildings Buildings

FieldValueIRS element (for citing)
Other Cost Or Other Basis37970514OtherCostOrOtherBasis
Depreciation28670577Depreciation
Book Value9299937BookValue

Equipment Equipment

FieldValueIRS element (for citing)
Other Cost Or Other Basis33584793OtherCostOrOtherBasis
Depreciation29067137Depreciation
Book Value4517656BookValue

Other Land Buildings OtherLandBuildings

FieldValueIRS element (for citing)
Other Cost Or Other Basis10943801OtherCostOrOtherBasis
Depreciation9300412Depreciation
Book Value1643389BookValue
FieldValueIRS element (for citing)
Total Of Book Value Land Buildings16243762TotalOfBookValueLandBuildings

Other Liabilities OtherLiabilities (4 entries)

DescriptionDescriptionAmountAmount
ESTIMATED PENSION LIABILITY$13,134,086
ASSET RETIREMENT OBLIGATION$498,919
PROFESSIONAL LIABILITY RESERVE$642,227
DUE TO THIRD-PARTY PAYORS$849,449
FieldValueIRS element (for citing)
Total Of Amounts15124681TotalOfAmounts
Footnote In Part XIIIXFootnoteInPartXIII
Tot Revenue Etc Audited Fincl Stmt52851950TotRevenueEtcAuditedFinclStmt
Revenue Not Rptd F9900RevenueNotRptdF990
Revenue Subtotal52851950RevenueSubtotal
Other Revenues Not Included10OtherRevenuesNotIncluded
Revenue Not Rptd On Fin Stmt10RevenueNotRptdOnFinStmt
Total Revenue Per Form99052851960TotalRevenuePerForm990
Tot Expenses Etc Audited Fincl Stmt55630786TotExpensesEtcAuditedFinclStmt
Expenses Not Rptd F9900ExpensesNotRptdF990
Expenses Subtotal55630786ExpensesSubtotal
Expenses Not Rptd On Fin Stmt0ExpensesNotRptdOnFinStmt
Total Expenses Per Form99055630786TotalExpensesPerForm990

Form990 Schedule D Part XIII Form990ScheduleDPartXIII (2 entries)

IdentifierIdentifierReturn ReferenceReturnReferenceExplanationExplanation
DESCRIPTION OF INTENDED USE OF ENDOWMENT FUNDS:PART V, LINE 4:ALL FUNDS ARE USED TO PROVIDE HEALTH CARE SERVICES AND FUND CAPITAL IMPROVEMENTS. THE BONDS ARE HELD BY A TRUSTEE.
DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48:PART X, LINE 2:MANAGEMENT HAS EVALUATED THE ORGANIZATION'S INCOME TAX POSITIONS UNDER THE GUIDANCE INCLUDED IN ASC 740. BASED ON THEIR REVIEW, MANAGEMENT HAS NOT IDENTIFIED ANY MATERIAL UNCERTAIN TAX POSITIONS TO BE RECORDED OR DISCLOSED IN THE FINANCIAL STATEMENTS.

Schedule H IRS990ScheduleH

FieldValueIRS element (for citing)
Charity Care Policy1CharityCarePolicy
Written Policy1WrittenPolicy
FPG Reference Free Care1FPGReferenceFreeCare
Pcent100XPcent100
FPG Reference Discounted Care1FPGReferenceDiscountedCare
Pcent200 DXPcent200D
Free Disc Care Medically Indigent1FreeDiscCareMedicallyIndigent
Amounts Budgeted For Charity Care1AmountsBudgetedForCharityCare
Expenses Exceeded Budget1ExpensesExceededBudget
Unable To Provide Care0UnableToProvideCare
Annual Community Benefit Report1AnnualCommunityBenefitReport
Report Publically Available1ReportPublicallyAvailable

Charity Care At Cost CharityCareAtCost

FieldValueIRS element (for citing)
Total Community Benefit Expense1482606TotalCommunityBenefitExpense
Net Community Benefit Expense1482606NetCommunityBenefitExpense
Percent Of Total Expense0.02670PercentOfTotalExpense

Unreimbursed Medicaid UnreimbursedMedicaid

FieldValueIRS element (for citing)
Total Community Benefit Expense7270000TotalCommunityBenefitExpense
Direct Offsetting Revenue5790000DirectOffsettingRevenue
Net Community Benefit Expense1480000NetCommunityBenefitExpense
Percent Of Total Expense0.02660PercentOfTotalExpense

Total Charity Care TotalCharityCare

FieldValueIRS element (for citing)
Total Community Benefit Expense8752606TotalCommunityBenefitExpense
Direct Offsetting Revenue5790000DirectOffsettingRevenue
Net Community Benefit Expense2962606NetCommunityBenefitExpense
Percent Of Total Expense0.05330PercentOfTotalExpense

Community Health Services CommunityHealthServices

FieldValueIRS element (for citing)
Total Community Benefit Expense44012TotalCommunityBenefitExpense
Direct Offsetting Revenue7324DirectOffsettingRevenue
Net Community Benefit Expense36688NetCommunityBenefitExpense
Percent Of Total Expense0.00070PercentOfTotalExpense

Health Professions Education HealthProfessionsEducation

FieldValueIRS element (for citing)
Total Community Benefit Expense8955TotalCommunityBenefitExpense
Direct Offsetting Revenue1687DirectOffsettingRevenue
Net Community Benefit Expense7268NetCommunityBenefitExpense
Percent Of Total Expense0.00010PercentOfTotalExpense

Cash And In Kind Contributions CashAndInKindContributions

FieldValueIRS element (for citing)
Total Community Benefit Expense50258TotalCommunityBenefitExpense
Net Community Benefit Expense50258NetCommunityBenefitExpense
Percent Of Total Expense0.00090PercentOfTotalExpense

Total Other Benefits TotalOtherBenefits

FieldValueIRS element (for citing)
Total Community Benefit Expense103225TotalCommunityBenefitExpense
Direct Offsetting Revenue9011DirectOffsettingRevenue
Net Community Benefit Expense94214NetCommunityBenefitExpense
Percent Of Total Expense0.00170PercentOfTotalExpense

Total Community Benefits TotalCommunityBenefits

FieldValueIRS element (for citing)
Total Community Benefit Expense8855831TotalCommunityBenefitExpense
Direct Offsetting Revenue5799011DirectOffsettingRevenue
Net Community Benefit Expense3056820NetCommunityBenefitExpense
Percent Of Total Expense0.05500PercentOfTotalExpense

Community Support CommunitySupport

FieldValueIRS element (for citing)
Total Community Building Expense3706TotalCommunityBuildingExpense
Net Community Building Expense3706NetCommunityBuildingExpense
Percent Of Total Expense0.00010PercentOfTotalExpense

Coalition Building CoalitionBuilding

FieldValueIRS element (for citing)
Total Community Building Expense171403TotalCommunityBuildingExpense
Net Community Building Expense171403NetCommunityBuildingExpense
Percent Of Total Expense0.00310PercentOfTotalExpense

Health Improvement Advocacy HealthImprovementAdvocacy

FieldValueIRS element (for citing)
Total Community Building Expense37375TotalCommunityBuildingExpense
Net Community Building Expense37375NetCommunityBuildingExpense
Percent Of Total Expense0.00070PercentOfTotalExpense

Total Total

FieldValueIRS element (for citing)
Total Community Building Expense212484TotalCommunityBuildingExpense
Net Community Building Expense212484NetCommunityBuildingExpense
Percent Of Total Expense0.00390PercentOfTotalExpense
FieldValueIRS element (for citing)
Bad Debt Expense Reported1BadDebtExpenseReported
Bad Debt Expense$1,473,161BadDebtExpenseAmount
Amount Reimbursed By Medicare17684880AmountReimbursedByMedicare
Cost Of Care Reimbursed By Medicare18865712CostOfCareReimbursedByMedicare
Medicare Surplus Or Shortfall-1180832MedicareSurplusOrShortfall

Costing Methodology Used CostingMethodologyUsed

FieldValueIRS element (for citing)
Cost To Charge RatioXCostToChargeRatio
FieldValueIRS element (for citing)
Written Debt Collection Policy1WrittenDebtCollectionPolicy
Provision For Charity Care1ProvisionForCharityCare
Number Of Hospital Facilities1NumberOfHospitalFacilities

Form990 Schedule H Part V Section A Form990ScheduleHPartVSectionA

FieldValueIRS element (for citing)
Facility Number1FacilityNumber

Name Name

FieldValueIRS element (for citing)
Business Name Line1AUDRAIN MEDICAL CENTERBusinessNameLine1

Address Address

FieldValueIRS element (for citing)
Address Line1620 E MONROEAddressLine1
CityMEXICOCity
StateMOState
ZIP Code65265ZIPCode
FieldValueIRS element (for citing)
Licensed HospitalXLicensedHospital
General Medical And SurgicalXGeneralMedicalAndSurgical
Er24 HoursXEr24Hours

Form990 Schedule H Part V Section B Form990ScheduleHPartVSectionB

Hospital Facility Name HospitalFacilityName

FieldValueIRS element (for citing)
Business Name Line1AUDRAIN MEDICAL CENTERBusinessNameLine1
FieldValueIRS element (for citing)
Hospital Facility Number1HospitalFacilityNumber
Eligibility Criteria Explained1EligibilityCriteriaExplained
Uses FPG Free1UsesFPGFree
FPG Free Percent100.000000000000FPGFreePercent
Uses FPG Discounted1UsesFPGDiscounted
FPG Discount Percent200.000000000000FPGDiscountPercent
Explains Basis1ExplainsBasis
Income LevelXIncomeLevel
Asset LevelXAssetLevel
Explains Application Method1ExplainsApplicationMethod
Includes Publicity Measures1IncludesPublicityMeasures
Posted On WebsiteXPostedOnWebsite
Posted In Emergency RoomXPostedInEmergencyRoom
Posted In Admission OfficeXPostedInAdmissionOffice
Available On RequestXAvailableOnRequest
Actions On Nonpayment1ActionsOnNonpayment
Collection Activities0CollectionActivities
Nondiscrim Emergency Care Policy1NondiscrimEmergencyCarePolicy
Used Other MethodXUsedOtherMethod
Amounts Generally Billed0AmountsGenerallyBilled
Gross Charges0GrossCharges

Form990 Schedule H Part V Section C Form990ScheduleHPartVSectionC

FieldValueIRS element (for citing)
Number Of Other Facilities12NumberOfOtherFacilities

Other Facilities OtherFacilities (12 entries)

Address Line1Address/AddressLine1CityAddress/CityStateAddress/StateZIP CodeAddress/ZIPCodeFacility TypeFacilityType
MEXICO HEALTH SERVICES
600 MEDICAL PARK DRIVEMEXICOMO65265OUTPATIENT PHYSICIAN CLINIC
MEXICO FAMILY HEALTH CARE
626 SUMMIT SUITE LMEXICOMO65265OUTPATIENT PHYSICIAN CLINIC
MEXICO PEDIATRIC SERVICES
1025 OLD FARM ROADMEXICOMO65265OUTPATIENT PHYSICIAN CLINIC
WELLSVILLE MEDICAL CLINIC
111 W BATESWELLSVILLEMO63384OUTPATIENT PHYSICIAN CLINIC
SUMMIT MEDICAL PARK LAB & X-RAY
626 SUMMITMEXICOMO65265LAB & X-RAY
MEXICO SURGICAL SERVICES
626 SUMMIT SUITE FMEXICOMO65265OUTPATIENT PHYSICIAN CLINIC
MONTGOMERY CITY MEDICAL CLINIC
240 N PICKERINGMONTGOMERY CITYMO63361OUTPATIENT PHYSICIAN CLINIC
MEDICAL PARK FAMILY PRACTICE
809 MEDICAL PARK DRIVE SUITE 101MEXICOMO65265OUTPATIENT PHYSICIAN CLINIC
VANDALIA MEDICAL CLINIC
204 W WASHINGTONVANDALIAMO63382OUTPATIENT PHYSICIAN CLINIC
PERRY MEDICAL CLINIC
1223 MAIN STREETPERRYMO63462OUTPATIENT PHYSICIAN CLINIC
PARIS MEDICAL CLINIC
221 N MAIN STREETPARISMO65275OUTPATIENT PHYSICIAN CLINIC
AUDRAIN FAMILY HEALTH
625 SUMMIT SUITE BMEXICOMO65265OUTPATIENT PHYSICIAN CLINIC

Form990 Schedule H Part VI Form990ScheduleHPartVI (4 entries)

ExplanationExplanationReturn ReferenceReturnReferenceIdentifierIdentifier
PART I, LINE 7: THE COSTS REPORTED IN THE TABLE IN PART I, LINE 7 USED A COST ACCOUNTING METHOD. THIS METHODOLOGY WAS USED FOR ALL PATIENT SEGMENTS.
PART III, LINES 2-4:ACCOUNTS ARE CONSIDERED DELINQUENT AND SUBSEQUENTLY WRITTEN OFF AS BAD DEBT BASED ON INDIVIDUAL CREDIT EVALUATION AND SPECIFIC CIRCUMSTANCES OF THE ACCOUNT. COSTING METHODOLOGY BAD DEBT IS ESTIMATED USING THE PERCENTAGE OF OPERATING EXPENSE TO PATIENT REVENUE. IT IS DIFFICULT TO DETERMINE THE AMOUNT OF BAD DEBT EXPENSE ATTRIBUTABLE TO PATIENTS WHO COULD QUALIFY FOR CHARITY CARE DUE TO THE LIMITED NUMBER OF FINANCIAL APPLICATIONS COMPLETED BY PATIENTS. IN ADDITION, BECAUSE WE ARE A COMMUNITY HOSPITAL, WE WILL NOT ATTACH LIENS TO REAL OR PERSONAL PROPERTY AND WE DON'T GARNISH WAGES.PART III, LINE 8: LINE 6 IS REPORTED PER THE COST REPORT, WORKSHEET D, PART V, OUTPATIENT, WORKSHEET D-4, HOSPITAL AND SUB PROVIDER.PART III, LINE 9B:PATIENTS IN NEED OF FINANCIAL ASSISTANCE COMPLETE AN APPLICATION AND THE LATEST AVAILABLE FPG IS USED TO DETERMINE WHO QUALIFIES. NORMAL COLLECTION EFFORTS ARE MADE ON ANY REMAINING BALANCE AFTER CHARITY CARE OR FINANCIAL ASSISTANCE WRITE OFF'S ARE APPLIED TO THE ACCOUNT.FORM 990, SCHEDULE H, PART III
PART V, SECTION B, LINE 20D: AMC PROVIDES AN AUTOMATIC 25% DISCOUNT FOR SELF-PAY PATIENTS. FURTHER DISCOUNTS OF UP TO 100% ARE GIVEN TO PATIENTS IF THEY QUALIFY UNDER THE FAP.AUDRAIN MEDICAL CENTER
NEEDS ASSESSMENT:THE ORGANIZATION PROVIDES A NUMBER OF PROGRAMS AND SERVICES SUCH AS :PROMOTING HEALTH AND EDUCATION, HEALTH SCREENING, TRAINING OF HEALTHPROFESSIONALS, AND COMMUNITY HEALTH IMPROVEMENT ADVOCACY. PROGRAMS LIKETHESE ALONG WITH INPUT FROM THE COMMUNITY ALLOWS US TO ASSESS THE HEALTH CARE AND SPECIAL NEEDS OF OUR COMMUNITY AND SURROUNDING COUNTIES.PATIENT EDUCATION OF ELIGIBILITY FOR ASSISTANCE:AT THE TIME OF REGISTRATION, THE PATIENT (OR THE RESPONSIBLE PARTY) WILL BE INFORMED OF PAYMENT EXPECTATIONS FOR SERVICES RECEIVED. A PATIENT CREDIT SERVICES EMPLOYEE WILL BE AVAILABLE TO DISCUSS FINANCIAL CONCERNS WITH THE RESPONSIBLE PARTY, INCLUDING EDUCATING THE RESPONSIBLE PARTY ON VARIOUS OPTIONS AVAILABLE TO THEM INCLUDING MEDICAID, MEDICARE, AS WELL AS CHARITY CARE.COMMUNITY INFORMATION:AUDRAIN HEALTH CARE, INC. IS THE SOLE HEALTH CARE PROVIDER IN THECOMMUNITY SERVING THREE COUNTIES WITH A POPULATION OF 47,000. THEORGANIZATION ALSO PROVIDES HEALTH CARE SERVICES THROUGH A NUMBER OFCLINICS.PROMOTION OF COMMUNITY HEALTH:AUDRAIN HEALTH CARE, INC. PROVIDES CLASSES AND SUPPORT GROUP MEETINGSCOVERING AN ARRAY OF TOPICS , EXAMPLES OF WHICH INCLUDE THE FOLLOWING:DIABETES SUPPORT GROUP, CANCER SUPPORT GROUP, NUTRITION EDUCATION FROM PRESCHOOL TO ELDERLY, DIVER SAFETY CLASSES, WOMEN'S HEALTH CONFERENCE,SAFE SITTER CLASSES, WELLNESS SCREENINGS, HEALTH FAIRS, SCOLIOSISSCREENING, CHILDBIRTH AND BREASTFEEDING CLASSES, GRIEF SUPPORT GROUPS,AND MANY MORE. STATE FILING OF COMMUNITY BENEFIT REPORT:MOFORM 990, SCHEDULE H

Schedule I IRS990ScheduleI

FieldValueIRS element (for citing)
Records Maintained1RecordsMaintained

Recipient Table RecipientTable

Recipient Name Business RecipientNameBusiness

FieldValueIRS element (for citing)
Business Name Line1AUDRAIN CITY-COUNTY HEALTH UNIT OF AUDRAIN COUNTYBusinessNameLine1

Address US AddressUS

FieldValueIRS element (for citing)
Address Line1605 EAST PROMENADEAddressLine1
CityMEXICOCity
StateMOState
ZIP Code65265ZIPCode
FieldValueIRS element (for citing)
EIN Of Recipient430783311EINOfRecipient
Amount Of Cash Grant19292AmountOfCashGrant
Purpose Of GrantOPERATING EXPENSESPurposeOfGrant
FieldValueIRS element (for citing)
Total Nbr Of501 C3 And Govt Grants1TotalNbrOf501C3AndGovtGrants
Total Nbr Of Other Organizations0TotalNbrOfOtherOrganizations

Form990 Schedule I Part IV Form990ScheduleIPartIV

FieldValueIRS element (for citing)
IdentifierPROCEDURE FOR MONITORING GRANTS IN THE U.S.:Identifier
Return ReferencePART I, LINE 2:ReturnReference
ExplanationSCHEDULE I, PART I, LINE 2: THE ORGANIZATION REVIEWS REPORTS OF OPERATING EXPENSES RECEIVED FROM THE RECIPIENT THOUGHOUT THE YEAR.Explanation

Schedule J IRS990ScheduleJ

FieldValueIRS element (for citing)
Compensation SurveyXCompensationSurvey
Board Or Committee ApprovalXBoardOrCommitteeApproval
Severance Payment0SeverancePayment
Supplemental Nonqual Retire Plan0SupplementalNonqualRetirePlan
Equity Based Comp Arrangement0EquityBasedCompArrangement
Comp Based On Revenue Of Filing Org0CompBasedOnRevenueOfFilingOrg
Comp Based On Revenue Related Orgs0CompBasedOnRevenueRelatedOrgs
Comp Based Net Earnings Filing Org0CompBasedNetEarningsFilingOrg
Comp Based Net Earnings Relate Orgs0CompBasedNetEarningsRelateOrgs
Any Non Fixed Payments0AnyNonFixedPayments
Initial Contract Exception0InitialContractException

Form990 Schedule J Part II Form990ScheduleJPartII (7 entries)

TitleTitleBase Compensation Filing OrgBaseCompensationFilingOrgComp Based On Related OrgsCompBasedOnRelatedOrgsBonus Filing OrgBonusFilingOrgBonus Related OrgsBonusRelatedOrgsOther Compensation Filing OrgOtherCompensationFilingOrgOther Compensation Related OrgsOtherCompensationRelatedOrgsDeferred Comp Filing OrgDeferredCompFilingOrgDeferred Comp Related OrgsDeferredCompRelatedOrgsNontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgNontaxable Benefits Related OrgsNontaxableBenefitsRelatedOrgsTotal Compensation Filing OrgTotalCompensationFilingOrgTotal Compensation Related OrgsTotalCompensationRelatedOrgsComp Report Prior990 Filing OrgCompReportPrior990FilingOrgComp Report Prior990 Related OrgsCompReportPrior990RelatedOrgs
N EUGENE THOMAS
PHYSICIAN, TREAS, BOT3932090001111700000404326000
NEUENDORF DAVID A
PRES/CEO, DIR BOD210336000297800024000215714000
SHAHID WAHEED
PHYSICIAN549215000401900037790557013000
PETER D PERLL
PHYSICIAN384195000182800000386023000
PEGGY A BARJENBRUCH
PHYSICIAN360647000344500053290369421000
MICHAEL QUINLAN
PHYSICIAN33937500065600081420348173000
JOAN SLAUGHTER
CRNA267430000234000040000273770000

Schedule L IRS990ScheduleL

Form990 Schedule L Part IV Form990ScheduleLPartIV (2 entries)

RelationshipRelationshipAmount Of TransactionAmountOfTransactionDescription Of TransactionDescriptionOfTransactionSharing Of RevenuesSharingOfRevenues
LISA NEUENDORF
FAMILY MEMBER OF CEO, D. NEUENDORF64752EMPLOYMENT0
SHELLIE SHAW
FAMILY MEMBER OF VP-CFO, G. SHAW47852EMPLOYMENT0

Schedule O IRS990ScheduleO

General Explanation GeneralExplanation (8 entries)

IdentifierIdentifierReturn ReferenceReturnReferenceExplanationExplanation
ORGANIZATION MISSION STATEMENTFORM 990, PART I, LINE 1, DESCRIPTION OF ORGANIZATION MISSION:TO CARE FOR THE SICK AND INJURED AND TO CONTINUOUSLY IMPROVE THE HEALTH AND WELL BEING OF THE COMMUNITIES WE SERVE, IN PARTNERSHIP WITH PHYSICIANS, HEALTHCARE PROVIDERS AND RESIDENTS.
FORM 990, PART VI, SECTION B, LINE 11MANAGEMENT SUBMITS INFORMATION TO AN INDEPENDENT ACCOUNTING FIRM WHO PREPARES THE FORM 990. ONCE THE 990 IS COMPLETED, GREG SHAW, VP CFO, REVIEWS IT AND SUGGESTS EDITS AS NEEDED. THEN, THE BOARD OF DIRECTORS RECEIVE A COPY TO REVIEW AND DISCUSS AT THE NEXT BOARD MEETING.
FORM 990, PART VI, SECTION B, LINE 12CTHE ORGANIZATION'S CONFLICT OF INTEREST POLICY COVERS ANY PERSON SERVING THE ORGANIZATION AS A BOARD MEMBER, OFFICER, OR EMPLOYEE. THE CORPORATE COMPLIANCE COMMITTEE REVIEWS CONFLICTS OF INTEREST FOR EMPLOYEES, AND THE BOARD REVIEWS CONFLICTS OF INTEREST FOR DIRECTORS AND OFFICERS. A CONFLICT IS HANDLED THROUGH FULL DISCLOSURE OF ANY SUCH INTEREST, TOGETHER WITH NONINVOLVEMENT IN ANY DISCUSSION AND VOTE WHEREIN THE INTEREST IS INVOLVED.
FORM 990, PART VI, SECTION B, LINE 15A. EXECUTIVE COMPENSATION IS DETERMINED BY THE EXECUTIVE COMMITTEE OF THE BOARD OF DIRECTORS USING MISSOURI HOSPITAL ASSOCIATION COMPENSATION REPORTS THAT PROVIDE BENCHMARKS FOR HOSPITAL CEO'S IN MISSOURI BY BED SIZE, OPERATING BUDGET AND NUMBER OF FULL TIME EMPLOYEES. B. DIRECTOR OF HUMAN RESOURCES COMPARES INFORMATION USING MISSOURI HOSPITAL ASSOCIATION DATA.
FORM 990, PART VI, SECTION C, LINE 19DOCUMENTATION IS AVAILABLE UPON WRITTEN REQUEST.
OTHER FEESFORM 990, PART IX, LINE 11GFEES: PHYSICIAN, THERAPIST, OTHER PROFESSIONAL, O/S LAB: PROGRAM SERVICE EXPENSES 2,931,114. MANAGEMENT AND GENERAL EXPENSES 476,657. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 3,407,771. SERVICES: PURCHASES, COLLECTIONS, O/S: PROGRAM SERVICE EXPENSES 3,204,269. MANAGEMENT AND GENERAL EXPENSES 521,076. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 3,725,345. ARAMARK, LINEN: PROGRAM SERVICE EXPENSES 387,024. MANAGEMENT AND GENERAL EXPENSES 62,938. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 449,962.
CHANGES IN NET ASSETS OR FUND BALANCES:FORM 990, PART XI, LINE 9:CHANGE IN MINIMUM PENSION LIABILITY 1,072,563. CHANGE IN BENEFICIAL INTEREST OF FOUNDATION -123,569.
FORM 990, PART I, DOING BUSINESS AS:SSM AUDRAIN HEALTH CARE, INC. CURRENTLY UTILIZES THE FOLLOWING FICTITIOUS NAMES AND EVIDENCE OF SUCH FILINGS WITH THE APPROPRIATE STATE AGENCY FOLLOW: 1. AUDRAIN ANESTHESIA SERVICES 2. AUDRAIN HEALTH CARE, INC. PHYSICIANS 3. AUDRAIN MEDICAL CENTER 4. AUDRAIN MEDICAL CLINIC - AUXVASSE 5. AUDRAIN MEDICAL CLINIC- WOMEN'S HEALTH 6. HEALTHWORKS 7. J.B. & GREETA B. ARTHUR CANCER CENTER 8. JORDAN-WATERS HEART CENTER 9. MEDCHOICE 10. MEDICAL PARK FAMILY PRACTICE 11. MEXICO FAMILY HEALTH CARE 12. MEXICO HEALTH SERVICES 13. MEXICO PEDIATRIC SERVICES 14. MEXICO SURGICAL SERVICES 15. MONTGOMERY CITY MEDICAL CLINIC 16. PARIS HEALTH CARE CLINIC 17. PERRY MEDICAL CLINIC 18. SPECIALTY SERVICES OF MEXICO 19. VANDALIA MEDICAL CLINIC 20. WELLSVILLE MEDICAL CLINIC

Schedule R IRS990ScheduleR

Form990 Schedule R Part II Form990ScheduleRPartII (2 entries)

Address Line1AddressUS/AddressLine1CityAddressUS/CityStateAddressUS/StateZIP CodeAddressUS/ZIPCodeEINEINPrimary ActivitiesPrimaryActivitiesLegal Domicile StateLegalDomicileStateExempt Code SectionExemptCodeSectionPublic Charity StatusPublicCharityStatusDirect Controlling Entity NADirectControllingEntityNAControlled OrgControlledOrg
AUDRAIN MEDICAL CENTER FOUNDATION
620 E MONROEMEXICOMO65265431265060SUPPORT HOSPMO501(C)(3)LINE 11A, IN/A0
AUDRAIN MEDICAL CENTER AUXILIARY
620 E MONROEMEXICOMO65265431258870SUPPORT HOSPMO501(C)(3)LINE 9N/A0
FieldValueIRS element (for citing)
Receipt Of Int Ann Rents Royalties0ReceiptOfIntAnnRentsRoyalties
Gift Grant Or Cap Contr To Other Org0GiftGrantOrCapContrToOtherOrg
Gift Grant Or Cap Contr Fr Other Org1GiftGrantOrCapContrFrOtherOrg
Loans Or Guarantees To Other Org0LoansOrGuaranteesToOtherOrg
Loans Or Guarantees From Other Org0LoansOrGuaranteesFromOtherOrg
Dividends Related Organization0DividendsRelatedOrganization
Sale Of Assets To Other Org0SaleOfAssetsToOtherOrg
Purchase Of Assets From Other Org0PurchaseOfAssetsFromOtherOrg
Exchange Of Assets0ExchangeOfAssets
Rental Of Facilities To Other Orgs0RentalOfFacilitiesToOtherOrgs
Rental Of Facilities Fr Other Orgs0RentalOfFacilitiesFrOtherOrgs
Perform Of Services For Other Orgs1PerformOfServicesForOtherOrgs
Perform Of Services By Other Orgs1PerformOfServicesByOtherOrgs
Sharing Of Facilities1SharingOfFacilities
Sharing Of Paid Employees1SharingOfPaidEmployees
Reimbursement Paid To Other Org1ReimbursementPaidToOtherOrg
Reimbursement Paid By Other Org0ReimbursementPaidByOtherOrg
Other Transfer To Other Org0OtherTransferToOtherOrg
Other Transfer From Other Org0OtherTransferFromOtherOrg

Transactions Related Orgs Table TransactionsRelatedOrgsTable (2 entries)

Transaction TypeTransactionTypeAmount InvolvedAmountInvolvedMethod Of Amt DeterminationMethodOfAmtDetermination
AUDRAIN MEDICAL CENTER FOUNDATION
C244285CASH CONTRIBUTION
AUDRAIN MEDICAL CENTER AUXILIARY
C64645CASH CONTRIBUTION