2012-08-14T14:03:15-05:00 2011-09-30 Wendling Noe Nelson & Johnson LLC 534 S Kansas Ave Suite 1500 Topeka KS 666033491 990 2010-10-01 440668347 Cameron Regional Medical Center CAME 8166322101 1600 East Evergreen Street Cameron MO 64429 Joseph Abrutz Jr 8166322101 2012-08-14 1 Gary D Knoll 7852334226 2012-08-14 2010 2016-02-24 21:20:13Z Joseph Abrutz Jr 1600 East Evergreen Street Cameron MO 64429 52386222 0 X N/A X 1963 MO To provide acute inpatient and outpatient medical care to area residents regardless of ability to pay. 12 10 501 120 0 0 34985 8004 49424373 51136034 266887 976338 130073 188493 49856318 52308869 0 0 0 0 20855322 22743648 0 0 0 24784445 25397049 45639767 48140697 4216551 4168172 55590113 58637423 23552825 23152981 32037288 35484442 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 44366051 51534046 Acute care hospital organized to provide inpatient and outpatient care to area residents regardless of ability to pay. 44366051 1 1 0 0 0 0 0 0 0 1 1 0 1 1 1 1 0 0 0 0 0 0 0 0 0 1 1 0 0 1 1 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 1 0 0 0 0 1 49 0 1 501 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 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 Steve Huitt 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 40.00 X X 225305 0 0 Laeeq Azmat MD 40.00 X X 592020 0 0 Joseph F Abrutz Jr 40.00 X 278966 0 0 Rosa Patti 40.00 X 80616 0 0 John Barton III 40.00 X 349157 0 0 James Dancer 40.00 X 261474 0 0 Muhammad Amin 40.00 X 274834 0 0 James Neely 40.00 X 249506 0 0 Shahzad Shafique 40.00 X 288869 0 0 2600747 0 0 18 0 1 0 Cameron Emergency Physicians 1600 E Evergreen Suite A Cameron MO 64429 ER Coverage 851533 Premier Specialty Network 1835 E Republic Rd Suite 200 Springfield MO 65804 Contracted consulting physicians 559789 Wendling Noe Nelson & Johnson LLC 534 S Kansas Ave Suite 1500 Topeka KS 66603 Auditing/Accounting Services 152514 Benesto Tumanut MD 1101 SW 47th St Kansas City MO 64112 Physician 120000 Barton & Associates 10 Dearborn Rd Peabody MA 01960 ER Coverage 101925 12 8004 8004 Patient service revenu 621990 51136034 51136034 51136034 603642 603642 17982 17982 60122 60122 60122 60122 371002 16288 371002 -16288 354714 354714 72336 61065 11271 11271 Cafeteria 722210 73802 73802 Other income 900099 43298 43298 117100 52308869 51534046 0 766819 1242826 814299 428527 17681014 16470214 1210800 295889 273630 22259 2215066 2057401 157665 1308853 1194521 114332 106384 106384 165179 165179 253061 77562 175499 927482 845611 81871 486443 404010 82433 353791 313399 40392 936551 936551 2722628 2722628 449919 167192 282727 Bad debts 6010598 6010598 Medical supplies 3067908 3067908 Medical professional fe 2698296 2633632 64664 Purchased services 2469026 2119586 349440 Pharmaceuticals 2465866 2465866 2283917 1791443 492474 48140697 44366051 3774646 0 12723 23604 5962696 7154136 9138610 10848960 705461 780492 240476 288529 41880156 23883948 18591412 17996208 17101456 18141018 3837279 3404476 55590113 58637423 3845577 3518980 19015416 18670542 691832 963459 23552825 23152981 X 31463301 34881578 573987 602864 32037288 35484442 55590113 58637423 X 4168172 -721018 X X 0 1 1 X 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 15204131 7152408 8051723 17882615 12496336 5386279 8793410 4235204 4558206 17996208 Equity mutual funds 3595126 F Fixed income mutual funds 3730059 F Common stock 5848956 F Publicly traded funds 4966877 F 18141018 Deffered debt issuance costs 479911 Third party payer settlements 2054031 Beneficial interest in net assets of foundation 431169 Other receivables 439365 3404476 Capital Lease Obligations 963459 963459 52308869 48140697 4168172 -749895 28877 -721018 3447154 52369934 61065 61065 52308869 0 52308869 48201762 61065 61065 48140697 0 48140697 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 their related income pursuant to Section 501(a) of the Code. Management is not aware of any uncertainties in income tax positions. For the years ended September 30, 2011, 2010, 2009, and 2008, remain subject to examination for both federal and state purposes. Part XI, Line 8 - Other Adjustments: Change in beneficial interest in net assets of Foundation 29,102. Other decreases in restricted assets -35,989. Restricted Contributions 35,764. Part XII, Line 2d - Other Adjustments: Expenses associated with special fundraisers 61,065. Part XIII, Line 2d - Other Adjustments: Expenses associated with special fundraisers 61,065. Golf Fundraiser 57995 57995 5815 17611 5529 4901 7078 Fun Run Fundraiser 6501 6501 408 377 4808 2 7840 7840 102 1175 1720 3400 8141 72336 72336 5815 18121 6704 6621 3777 20027 61065 11271 1 1 1 X 1 X 127.000000000000 1 1 0 1 1 777820 813637 -35817 0.00000 5549316 3724535 1824781 0.04330 6327136 4538172 1788964 0.04330 169317 4410 164907 0.00390 31457 9000 22457 0.00050 5541518 2752090 2789428 0.06620 29427 29427 0.00070 5771719 2765500 3006219 0.07130 12098855 7303672 4795183 0.11460 1 2480283 248028 17302860 19233295 -1930435 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 0 1 1 100.000000000000 1 127.000000000000 1 1 X X 1 X X 1 X 1 12 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 Gallatin Family Medicine

502 S Main Gallatin MO 64640

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 Plattsburg Family Medicine

214 N Main Plattsburg MO 64477

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 Lathrop Medical Clinic

705 Oak Street Lathrop MO 64465

Medical Clinic 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 $ 6010598. Part III, Line 4: The Medical Center provides for accounts receivable that could become uncollectible in the future by establishing an allowance to reduce the carrying value of such receivables to their estimated net realizable value. The Medical Center estimates this allowance based on the aging of its accounts receivable and its historical collection experience for each type of payor.Part III, Line 2Provisions for bad debts are related to accounts that have been deemed uncollectible during the year. The uncollectible amount is then written off pursuant with Medical Center policy. The cost of the bad debts reported was determined using the cost to charge ratio and total bad debt expense.Part III, Line 3The estimate of provisions for bad debts attributable to patients eligible under the organization's financial assistance policy was determined using by a conservative estimate that 10 percent of all bad debt expense is attributable to patients eligible under the organization's financial assistance policy. Part III, Line 8: Amounts were obtained from the cost report filed with Medicare for the period ending September 30, 2011. The shortfall represents unpaid costs of public programs for low-income and elderly persons. Cameron Regional Medical Center, Inc. Part V, Section B, Line 19d: The Medical Center bills all patients and payer types equally for the gross charges of the services rendered. The Medical Center accounts for several factors including Medicare reimbursement when establishing acceptable charge rates for their services. Cameron Regional Medical Center, Inc. Part V, Section B, Line 21: The Medical Center bills all patients and payer types equally for the gross charges of the services rendered. Part VI, Line 2: The Medical Center relies on the feedback and request 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 51,500 individuals that reside in the primary service area. Of these residents approximately 11.6% of them have an annual income below the federal poverty level. The median annual income per household for the four counties is approximately $43,643. Approximately 45% of the total services provided are for Medicare patients and 13% 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 6: 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. 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 0 0 0 0 0 0 0 0 0 Kendall DeSelms DO 181882 0 0 0 43423 0 0 0 0 0 225305 0 132877 0 Laeeq Azmat MD 527947 0 0 0 64073 0 0 0 0 0 592020 0 399095 0 Joseph F Abrutz Jr 278966 0 0 0 0 0 0 0 0 0 278966 0 210052 0 John Barton III 329166 0 0 0 19991 0 0 0 0 0 349157 0 239510 0 James Dancer 243474 0 0 0 18000 0 0 0 0 0 261474 0 176162 0 Muhammad Amin 239481 0 0 0 35353 0 0 0 0 0 274834 0 144780 0 James Neely 230006 0 0 0 19500 0 0 0 0 0 249506 0 168082 0 Shahzad Shafique 240754 0 0 0 48115 0 0 0 0 0 288869 0 172098 0 The Industrial Development Authority of the City of Cameron Missouri 431679396 133451BF0 2007-05-17 10000000 Health Facilities Revenue Bonds, Series 2007A 0 0 0 The Industrial Development Authority of Clinton County Missouri 521734480 133451AB6 2007-05-17 9994879 Health Facilities Revenue Bonds, Series 2007B 0 0 0 The Industrial Development Authority of the City of Cameron Missouri 431679396 2006-12-06 664000 Health Facilities Revenue Bonds, Series 2006 0 0 0 9798262 197701 4037 2007 0 1 1 1 8884388 197054 913437 2007 0 1 1 1 589215 10000 64785 2006 1 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 Ken Raffety Director Cameron Region Director Cameron Regional Medical Center Foundation 0 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 losses on investments: -749,895. Change in beneficial interest in net assets of Foundation 29,102. Other decreases in restricted assets -35,989. Restricted Contributions 35,764. Total to Form 990, Part XI, Line 5: -721,018. 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 0 0 0 1 0 0 Cameron Regional Medical Center Foundation C 28805 Cameron Regional Medical Center Foundation P 10682