CAMERON MEMORIAL COMMUNITY HOSPITAL INC: Form 990, tax year 2020
View the entire original 990 at ProPublica ↗
- Organization
- CAMERON MEMORIAL COMMUNITY HOSPITAL INC (EIN 35-0211370)
- Tax period
- 2020-10-01 to 2021-09-30
- Filed
- 2022-08-15
- IRS object ID
- 202222279349302257
- Schema version
- 2020v4.2
- 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
- Form 990
- Schedule A
- Schedule B
- Schedule C
- Schedule D
- Schedule G
- Schedule H
- Schedule J
- Schedule L
- Schedule O
- Schedule R
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return | 2022-08-15T11:30:46-05:00 | ReturnTs |
| Tax Period End | 2021-09-30 | TaxPeriodEndDt |
Preparer Firm PreparerFirmGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Firm EIN | 351178661 | PreparerFirmEIN |
Preparer Firm Name PreparerFirmName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | BLUE & CO LLC | BusinessNameLine1Txt |
Preparer US Address PreparerUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 500 N MERIDIAN ST SUITE 200 | AddressLine1Txt |
| City | INDIANAPOLIS | CityNm |
| State Abbreviation | IN | StateAbbreviationCd |
| ZIP | 46204 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnTypeCd |
| Tax Period Begin | 2020-10-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 350211370 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | CAMERON MEMORIAL COMMUNITY HOSPITAL INC | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | CAME | BusinessNameControlTxt |
| Phone | 2606652141 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 416 E MAUMEE STREET | AddressLine1Txt |
| City | ANGOLA | CityNm |
| State Abbreviation | IN | StateAbbreviationCd |
| ZIP | 46703 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | ANGELA LOGAN | PersonNm |
| Person Title | CEO | PersonTitleTxt |
| Phone | 2606652141 | PhoneNum |
| Signature | 2022-08-14 | SignatureDt |
| Discuss With Paid Preparer | Yes (1) | DiscussWithPaidPreparerInd |
Signing Officer SigningOfficerGrp
Person Full Name PersonFullName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person First | ANGELA | PersonFirstNm |
| Person Last | LOGAN | PersonLastNm |
| Field | Value | IRS element (for citing) |
|---|---|---|
| SSN | 999009999 | SSN |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | NATHAN A RODGERS CPA | PreparerPersonNm |
| PTIN | P01568275 | PTIN |
| Phone | 3176334705 | PhoneNum |
| Preparation | 2022-08-09 | PreparationDt |
Additional Filer Information AdditionalFilerInformation
Trusted Customer TrustedCustomerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Trusted Customer | 2 | TrustedCustomerCd |
| Authentication Assurance Level | AAL1 | AuthenticationAssuranceLevelCd |
| Identity Assurance Level | IAL1 | IdentityAssuranceLevelCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2020 | TaxYr |
| Build TS | 2022-09-23 18:48:47Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Principal Officer | ANGELA LOGAN | PrincipalOfficerNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 416 E MAUMEE STREET | AddressLine1Txt |
| City | ANGOLA | CityNm |
| State Abbreviation | IN | StateAbbreviationCd |
| ZIP | 46703 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $125,779,313 | GrossReceiptsAmt |
| Group Return For Affiliates | 0 | GroupReturnForAffiliatesInd |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | WWW.CAMERONMCH.COM | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 1972 | FormationYr |
| Legal Domicile State | IN | LegalDomicileStateCd |
| Activity Or Mission | CMCH IS AN INDEPENDENT, NOT FOR PROFIT, CRITICAL ACCESS HOSPITAL OFFERING HEALTH & WELLNESS SERVICES. | ActivityOrMissionDesc |
| Voting Members Governing Body | 11 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 7 | VotingMembersIndependentCnt |
| Total Employee | 692 | TotalEmployeeCnt |
| Total Volunteers | 40 | TotalVolunteersCnt |
| Total Gross UBI | $0 | TotalGrossUBIAmt |
| Net Unrelated Bus Txbl Incm | $0 | NetUnrelatedBusTxblIncmAmt |
| PY Contributions Grants | $2,508,753 | PYContributionsGrantsAmt |
| CY Contributions Grants | $4,572,414 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $68,282,118 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $85,050,740 | CYProgramServiceRevenueAmt |
| PY Investment Income | $1,625,775 | PYInvestmentIncomeAmt |
| CY Investment Income | $572,495 | CYInvestmentIncomeAmt |
| PY Other Revenue | $816,319 | PYOtherRevenueAmt |
| CY Other Revenue | $965,590 | CYOtherRevenueAmt |
| PY Total Revenue | $73,232,965 | PYTotalRevenueAmt |
| CY Total Revenue | $91,161,239 | CYTotalRevenueAmt |
| PY Grants And Similar Paid | $15,836 | PYGrantsAndSimilarPaidAmt |
| CY Grants And Similar Paid | $15,183 | CYGrantsAndSimilarPaidAmt |
| PY Benefits Paid To Members | $0 | PYBenefitsPaidToMembersAmt |
| CY Benefits Paid To Members | $0 | CYBenefitsPaidToMembersAmt |
| PY Salaries Comp Emp Bnft Paid | $35,762,948 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $41,997,908 | CYSalariesCompEmpBnftPaidAmt |
| PY Total Prof Fndrsng Expns | $0 | PYTotalProfFndrsngExpnsAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $367,656 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $37,398,415 | PYOtherExpensesAmt |
| CY Other Expenses | $39,588,614 | CYOtherExpensesAmt |
| PY Total Expenses | $73,177,199 | PYTotalExpensesAmt |
| CY Total Expenses | $81,601,705 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | $55,766 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | $9,559,534 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $95,583,801 | TotalAssetsBOYAmt |
| Total Assets EOY | $108,637,429 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $60,284,984 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $59,609,452 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $35,298,817 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $49,027,977 | NetAssetsOrFundBalancesEOYAmt |
| Info In Schedule O Part III | Yes (X) | InfoInScheduleOPartIIIInd |
| Mission | THE MISSION OF CAMERON MEMORIAL COMMUNITY HOSPITAL IS TO IMPROVE THE QUALITY OF LIFE FOR THOSE WE SERVE THROUGH RELATIONSHIPS FOCUSED ON HEALTH AND WELLNESS. | MissionDesc |
| Significant New Program Srvc | 0 | SignificantNewProgramSrvcInd |
| Significant Change | 0 | SignificantChangeInd |
| Expense | $54,465,770 | ExpenseAmt |
| Grant | $15,183 | GrantAmt |
| Revenue | $33,929,504 | RevenueAmt |
| Desc | CAMERON MEMORIAL COMMUNITY HOSPITAL, INC. (HOSPITAL), A NOT FOR PROFIT ORGANIZATION, IS A GENERAL ACUTE CARE FACILITY IN ANGOLA, INDIANA WITH 25 LICENSED BEDS AND ASSOCIATED ANCILLARY SERVICE DEPARTMENTS INCLUDING OUTPATIENT SERVICES, HOME HEALTH CARE AND AN URGENT CARE CENTER IN ANGOLA, INDIANA. THE HOSPITAL PROVIDES HEALTH CARE SERVICES PRIMARILY IN THE NORTHEAST PORTION OF INDIANA. EXPENSES RELATE TO THE PROVISION OF MEDICAL CARE AND RELATED GENERAL AND ADMINISTRATIVE COSTS. | Desc |
Prog Srvc Accom Acty2 ProgSrvcAccomActy2Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expense | $3,167,000 | ExpenseAmt |
| Revenue | $17,163,300 | RevenueAmt |
| Desc | RADIOLOGY SERVICE IS OFFERED TO PATIENTS AT THE HOSPITAL. ANNUALLY THE HOSPITAL PERFORMS OVER 36,700 PROCEDURES, INCLUDING GENERAL RADIOLOGY SERVICES, CT SCANS, PET SCANS AND AN OPEN BORE MRI. RADIOLOGY GROSS REVENUE IS $40,865,000 BEFORE CONTRACTUAL ALLOWANCES AND CHARITY CARE. | Desc |
Prog Srvc Accom Acty3 ProgSrvcAccomActy3Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expense | $6,005,000 | ExpenseAmt |
| Revenue | $13,882,880 | RevenueAmt |
| Desc | SURGERY SERVICE IS A PROGRAM OFFERED TO PATIENTS AT THE HOSPITAL. OVER 4,600 PROCEDURES ARE PERFORMED ANNUALLY, WITH 93% OF THE PROCEDURES BEING OUTPATIENT RELATED. SURGERY GROSS REVENUE SERVICE IS $31,552,000 BEFORE CONTRACTUAL ALLOWANCES AND CHARITY CARE. | Desc |
Prog Srvc Accom Acty Other ProgSrvcAccomActyOtherGrp (2 entries)
| ExpenseExpenseAmt | RevenueRevenueAmt | DescDesc |
|---|---|---|
| $2,307,000 | $9,262,280 | EMERGENCY ROOM SERVICES IS THE THIRD LARGEST PROGRAM OFFERED TO PATIENTS AT CMCH. OVER 15,500 PATIENTS CAME THROUGH CAMERON'S EMERGENCY ROOM. EMERGENCY ROOM SERVICES GROSS REVENUE IS $27,242,000 BEFORE CONTRACTUAL ALLOWANCES AND CHARITY CARE. |
| $3,400,000 | $11,062,380 | LAB SERVICES IS THE FOURTH LARGEST PROGRAM OFFERED TO PATIENTS AT THE HOSPITAL. OVER 208,300 ARE DONE WITH 83% BEING OUTPATIENT RELATED. LAB GROSS REVENUE SERVICES IS $26,339,000 BEFORE CONTRACTUAL ALLOWANCES AND CHARITY CARE. |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Other Prog Srvc Expense | $5,707,000 | TotalOtherProgSrvcExpenseAmt |
| Total Other Prog Srvc Revenue | $20,324,660 | TotalOtherProgSrvcRevenueAmt |
| Total Program Service Expenses | $69,344,770 | TotalProgramServiceExpensesAmt |
| Described In Section501c3 | Yes (1) | DescribedInSection501c3Ind |
| Schedule B Required | Yes (1) | ScheduleBRequiredInd |
| Political Campaign Acty | 0 | PoliticalCampaignActyInd |
| Lobbying Activities | Yes (1) | LobbyingActivitiesInd |
| Subject To Proxy Tax | 0 | SubjectToProxyTaxInd |
| Donor Advised Fund | 0 | DonorAdvisedFundInd |
| Conservation Easements | 0 | ConservationEasementsInd |
| Collections Of Art | 0 | CollectionsOfArtInd |
| Credit Counseling | 0 | CreditCounselingInd |
| Donor Rstr Or Quasi Endowments | 0 | DonorRstrOrQuasiEndowmentsInd |
| Report Land Building Equipment | Yes (1) | ReportLandBuildingEquipmentInd |
| Report Investments Other Sec | 0 | ReportInvestmentsOtherSecInd |
| Report Program Related Invst | 0 | ReportProgramRelatedInvstInd |
| Report Other Assets | 0 | ReportOtherAssetsInd |
| Report Other Liabilities | Yes (1) | ReportOtherLiabilitiesInd |
| Include FIN48 Footnote | Yes (1) | IncludeFIN48FootnoteInd |
| Independent Audit Fincl Stmt | 0 | IndependentAuditFinclStmtInd |
| Consolidated Audit Fincl Stmt | Yes (1) | ConsolidatedAuditFinclStmtInd |
| School Operating | 0 | SchoolOperatingInd |
| Foreign Office | 0 | ForeignOfficeInd |
| Foreign Activities | 0 | ForeignActivitiesInd |
| More Than5000 K To Org | 0 | MoreThan5000KToOrgInd |
| More Than5000 K To Individuals | 0 | MoreThan5000KToIndividualsInd |
| Professional Fundraising | 0 | ProfessionalFundraisingInd |
| Fundraising Activities | Yes (1) | FundraisingActivitiesInd |
| Gaming Activities | 0 | GamingActivitiesInd |
| Operate Hospital | Yes (1) | OperateHospitalInd |
| Audited Financial Stmt Att | Yes (1) | AuditedFinancialStmtAttInd |
| Grants To Organizations | 0 | GrantsToOrganizationsInd |
| Grants To Individuals | 0 | GrantsToIndividualsInd |
| Schedule J Required | Yes (1) | ScheduleJRequiredInd |
| Tax Exempt Bonds | 0 | TaxExemptBondsInd |
| Engaged In Excess Benefit Trans | 0 | EngagedInExcessBenefitTransInd |
| PY Excess Benefit Trans | 0 | PYExcessBenefitTransInd |
| Loan Outstanding | 0 | LoanOutstandingInd |
| Grant To Related Person | 0 | GrantToRelatedPersonInd |
| Business Rln With Org Mem | 0 | BusinessRlnWithOrgMemInd |
| Business Rln With Fam Mem | Yes (1) | BusinessRlnWithFamMemInd |
| Business Rln With35 Ctrl Ent | 0 | BusinessRlnWith35CtrlEntInd |
| Deductible Non Cash Contri | 0 | DeductibleNonCashContriInd |
| Deductible Art Contribution | 0 | DeductibleArtContributionInd |
| Terminate Operations | 0 | TerminateOperationsInd |
| Partial Liquidation | 0 | PartialLiquidationInd |
| Disregarded Entity | 0 | DisregardedEntityInd |
| Related Entity | Yes (1) | RelatedEntityInd |
| Related Organization Ctrl Ent | Yes (1) | RelatedOrganizationCtrlEntInd |
| Transaction With Control Ent | Yes (1) | TransactionWithControlEntInd |
| Trnsfr Exmpt Non Chrtbl Rltd Org | Yes (1) | TrnsfrExmptNonChrtblRltdOrgInd |
| Activities Conducted Prtshp | 0 | ActivitiesConductedPrtshpInd |
| Schedule O Required | Yes (1) | ScheduleORequiredInd |
| IRP Document | 47 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Backup Wthld Compliance | Yes (1) | BackupWthldComplianceInd |
| Employee | 692 | EmployeeCnt |
| Employment Tax Returns Filed | Yes (1) | EmploymentTaxReturnsFiledInd |
| Unrelated Bus Incm Over Limit | 0 | UnrelatedBusIncmOverLimitInd |
| Foreign Financial Account | 0 | ForeignFinancialAccountInd |
| Prohibited Tax Shelter Trans | 0 | ProhibitedTaxShelterTransInd |
| Taxable Party Notification | 0 | TaxablePartyNotificationInd |
| Nondeductible Contributions | 0 | NondeductibleContributionsInd |
| Quid Pro Quo Contributions | 0 | QuidProQuoContributionsInd |
| Form8282 Property Disposed Of | 0 | Form8282PropertyDisposedOfInd |
| Rcv Fnds To Pay Prsnl Bnft Cntrct | 0 | RcvFndsToPayPrsnlBnftCntrctInd |
| Pay Premiums Prsnl Bnft Cntrct | 0 | PayPremiumsPrsnlBnftCntrctInd |
| Indoor Tanning Services | 0 | IndoorTanningServicesInd |
| Subj To Tax Rmnrtn Ex Prcht Pymt | 0 | SubjToTaxRmnrtnExPrchtPymtInd |
| Subject To Excs Tax Net Invst Inc | 0 | SubjectToExcsTaxNetInvstIncInd |
| Info In Schedule O Part VI | Yes (X) | InfoInScheduleOPartVIInd |
| Governing Body Voting Members | 11 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 7 | IndependentVotingMemberCnt |
| Family Or Business Rln | 0 | FamilyOrBusinessRlnInd |
| Delegation Of Mgmt Duties | 0 | DelegationOfMgmtDutiesInd |
| Change To Org Documents | 0 | ChangeToOrgDocumentsInd |
| Material Diversion Or Misuse | 0 | MaterialDiversionOrMisuseInd |
| Members Or Stockholders | 0 | MembersOrStockholdersInd |
| Election Of Board Members | 0 | ElectionOfBoardMembersInd |
| Decisions Subject To Approva | 0 | DecisionsSubjectToApprovaInd |
| Minutes Of Governing Body | Yes (1) | MinutesOfGoverningBodyInd |
| Minutes Of Committees | Yes (1) | MinutesOfCommitteesInd |
| Officer Mailing Address | 0 | OfficerMailingAddressInd |
| Local Chapters | 0 | LocalChaptersInd |
| Form990 Provided To Gvrn Body | Yes (1) | Form990ProvidedToGvrnBodyInd |
| Conflict Of Interest Policy | Yes (1) | ConflictOfInterestPolicyInd |
| Annual Disclosure Covered Prsn | Yes (1) | AnnualDisclosureCoveredPrsnInd |
| Regular Monitoring Enfrc | Yes (1) | RegularMonitoringEnfrcInd |
| Whistleblower Policy | Yes (1) | WhistleblowerPolicyInd |
| Document Retention Policy | Yes (1) | DocumentRetentionPolicyInd |
| Compensation Process CEO | Yes (1) | CompensationProcessCEOInd |
| Compensation Process Other | Yes (1) | CompensationProcessOtherInd |
| Investment In Joint Venture | 0 | InvestmentInJointVentureInd |
| States Where Copy Of Return Is Fld | IN | StatesWhereCopyOfReturnIsFldCd |
| Upon Request | Yes (X) | UponRequestInd |
Books In Care Of Detail BooksInCareOfDetail
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | ANGELA LOGAN | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Phone | 2606652141 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 416 E MAUMEE STREET | AddressLine1Txt |
| City | ANGOLA | CityNm |
| State Abbreviation | IN | StateAbbreviationCd |
| ZIP | 46703 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part VII | Yes (X) | InfoInScheduleOPartVIIInd |
Form990 Part VII Section A Form990PartVIISectionAGrp (19 entries)
| TitleTitleTxt | Average Hours Per WeekAverageHoursPerWeekRt | Average Hours Per Week Rltd OrgAverageHoursPerWeekRltdOrgRt | Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd | OfficerOfficerInd | Reportable Comp From OrgReportableCompFromOrgAmt | Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt | Other CompensationOtherCompensationAmt | Highest Compensated EmployeeHighestCompensatedEmployeeInd | Former Ofcr Director TrusteeFormerOfcrDirectorTrusteeInd |
|---|---|---|---|---|---|---|---|---|---|
| DEBORAH MCHENRY | |||||||||
| CHAIR | 2.00 | 2.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | ||
| JOHN MCCOY | |||||||||
| VICE CHAIR | 2.00 | 2.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | ||
| TERESA KING MD | |||||||||
| SECRETARY | 40.00 | 2.00 | Yes (X) | Yes (X) | $506,139 | $0 | $16,020 | ||
| TODD RUMSEY MD | |||||||||
| TREASURER | 40.00 | 2.00 | Yes (X) | Yes (X) | $642,526 | $0 | $29,080 | ||
| MIKE CONNELL | |||||||||
| BOARD MEMBER | 2.00 | 2.00 | Yes (X) | $0 | $0 | $0 | |||
| JONATHAN CRESS | |||||||||
| BOARD MEMBER | 2.00 | 2.00 | Yes (X) | $0 | $0 | $0 | |||
| JENNIFER DANIC | |||||||||
| BOARD MEMBER | 2.00 | 2.00 | Yes (X) | $0 | $0 | $0 | |||
| TOM MILLER MD | |||||||||
| BOARD MEMBER | 40.00 | 2.00 | Yes (X) | $427,219 | $0 | $23,668 | |||
| JEFFERY NICKEL MD | |||||||||
| BOARD MEMBER | 2.00 | 2.00 | Yes (X) | $0 | $0 | $0 | |||
| ANN RICE | |||||||||
| BOARD MEMBER | 2.00 | 2.00 | Yes (X) | $0 | $0 | $0 | |||
| BARBARA SHORT | |||||||||
| BOARD MEMBER | 2.00 | 2.00 | Yes (X) | $0 | $0 | $0 | |||
| CONSTANCE M MCCAHILL | |||||||||
| CHIEF EXECUTIVE OFFICER | 38.00 | 2.00 | Yes (X) | $248,269 | $0 | $15,240 | |||
| CARLOS ALCAZAR | |||||||||
| CFO | 38.00 | 2.00 | Yes (X) | $63,954 | $0 | $0 | |||
| LYNN FAUR | |||||||||
| PHYSICIAN | 40.00 | 0.00 | $307,694 | $0 | $28,197 | Yes (X) | |||
| ANGELA LOGAN | |||||||||
| CNO | 40.00 | 0.00 | $216,841 | $0 | $9,343 | Yes (X) | |||
| CHARLES MACLEAN | |||||||||
| PHYSICIAN | 40.00 | 0.00 | $330,438 | $0 | $23,668 | Yes (X) | |||
| MELCHOR MERCADO | |||||||||
| PHYSICIAN | 40.00 | 0.00 | $350,671 | $0 | $9,769 | Yes (X) | |||
| KELLY KEIRNS | |||||||||
| EXECUTIVE DIRECTOR-SALES & MARKETING | 40.00 | 0.00 | $162,443 | $0 | $12,222 | Yes (X) | |||
| DOUGLAS C BOMBA | |||||||||
| FORMER CFO | 0.00 | 0.00 | $159,491 | $0 | $3,595 | Yes (X) | |||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $3,415,685 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $0 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $170,802 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 45 | IndivRcvdGreaterThan100KCnt |
| Former Ofcr Employees Listed | Yes (1) | FormerOfcrEmployeesListedInd |
| Total Comp Greater Than150 K | Yes (1) | TotalCompGreaterThan150KInd |
| Compensation From Other Srcs | 0 | CompensationFromOtherSrcsInd |
Contractor Compensation ContractorCompensationGrp (5 entries)
| Address Line1ContractorAddress/USAddress/AddressLine1Txt | CityContractorAddress/USAddress/CityNm | State AbbreviationContractorAddress/USAddress/StateAbbreviationCd | ZIPContractorAddress/USAddress/ZIPCd | ServicesServicesDesc | CompensationCompensationAmt |
|---|---|---|---|---|---|
| FORT WAYNE ORTHOPAEDICS LLC | |||||
| PO BOX 2526 | FORT WAYNE | IN | 46801 | SEE SCHEDULE O | $1,050,182 |
| HOSPITAL CARE GROUP | |||||
| 6435 WEST JEFFERSON BLVD | FORT WAYNE | IN | 46804 | SEE SCHEDULE O | $743,209 |
| ASSOCIATED ANESTHESIOLOGISTS | |||||
| 10315 DAWSONS CREEK SUITE A/B | FORT WAYNE | IN | 46825 | SEE SCHEDULE O | $671,719 |
| LABCORP INDIANA INC | |||||
| PO BOX 8014 | BURLINGTON | NC | 27216 | SEE SCHEDULE O | $658,927 |
| AMERI EBO LLC | |||||
| 1851 S ALVERNO ROAD | MANITOWOC | WI | 54221 | SEE SCHEDULE O | $445,411 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cntrct Rcvd Greater Than100 K | 19 | CntrctRcvdGreaterThan100KCnt |
| Fundraising | $6,400 | FundraisingAmt |
| Government Grants | $4,294,381 | GovernmentGrantsAmt |
| All Other Contributions | $271,633 | AllOtherContributionsAmt |
| Total Contributions | $4,572,414 | TotalContributionsAmt |
Program Service Revenue ProgramServiceRevenueGrp (3 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt |
|---|---|---|---|
| NET PATIENT SERVICE REVENUE | 621400 | $84,758,508 | $84,758,508 |
| 340B PHARMACY REVENUE | 446110 | $285,544 | $285,544 |
| MEALS ON WHEELS | 624200 | $6,688 | $6,688 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $85,050,740 | TotalProgramServiceRevenueAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $21,842 | TotalRevenueColumnAmt |
| Exclusion | $21,842 | ExclusionAmt |
Gross Rents GrossRentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $249,604 | RealAmt |
Less Rental Expenses LessRentalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $0 | RealAmt |
Rental Income Or Loss RentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $249,604 | RealAmt |
Net Rental Income Or Loss NetRentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $249,604 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $249,604 | RelatedOrExemptFuncIncomeAmt |
Gross Amount Sales Assets GrossAmountSalesAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $35,154,979 | SecuritiesAmt |
Less Cost Oth Basis Sales Expnss LessCostOthBasisSalesExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $34,597,490 | SecuritiesAmt |
| Other | $6,836 | OtherAmt |
Gain Or Loss GainOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $557,489 | SecuritiesAmt |
| Other | -$6,836 | OtherAmt |
Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $550,653 | TotalRevenueColumnAmt |
| Exclusion | $550,653 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Fundraising Gross Income | $37,250 | FundraisingGrossIncomeAmt |
| Contri Rpt Fundraising Event | $6,400 | ContriRptFundraisingEventAmt |
| Fundraising Direct Expenses | $13,748 | FundraisingDirectExpensesAmt |
Net Incm From Fundraising Evt NetIncmFromFundraisingEvtGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $23,502 | TotalRevenueColumnAmt |
| Exclusion | $23,502 | ExclusionAmt |
Other Revenue Misc OtherRevenueMiscGrp (3 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | ExclusionExclusionAmt |
|---|---|---|---|
| CAFETERIA | 900099 | $202,759 | $202,759 |
| PHARMACY | 900099 | $8,320 | $8,320 |
| VENDING | 900099 | $4,381 | $4,381 |
Miscellaneous Revenue MiscellaneousRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $477,024 | TotalRevenueColumnAmt |
| Exclusion | $477,024 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Revenue Total | $692,484 | OtherRevenueTotalAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $91,161,239 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $85,300,344 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $0 | UnrelatedBusinessRevenueAmt |
| Exclusion | $1,288,481 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part IX | Yes (X) | InfoInScheduleOPartIXInd |
Grants To Domestic Individuals GrantsToDomesticIndividualsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $15,183 | TotalAmt |
| Program Services | $15,183 | ProgramServicesAmt |
Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,352,178 | TotalAmt |
| Program Services | $1,151,145 | ProgramServicesAmt |
| Management And General | $195,855 | ManagementAndGeneralAmt |
| Fundraising | $5,178 | FundraisingAmt |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $30,595,058 | TotalAmt |
| Program Services | $26,046,385 | ProgramServicesAmt |
| Management And General | $4,431,517 | ManagementAndGeneralAmt |
| Fundraising | $117,156 | FundraisingAmt |
Pension Plan Contributions PensionPlanContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $934,120 | TotalAmt |
| Program Services | $797,474 | ProgramServicesAmt |
| Management And General | $133,154 | ManagementAndGeneralAmt |
| Fundraising | $3,492 | FundraisingAmt |
Other Employee Benefits OtherEmployeeBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $6,899,951 | TotalAmt |
| Program Services | $5,890,606 | ProgramServicesAmt |
| Management And General | $983,553 | ManagementAndGeneralAmt |
| Fundraising | $25,792 | FundraisingAmt |
Payroll Taxes PayrollTaxesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,216,601 | TotalAmt |
| Program Services | $1,892,350 | ProgramServicesAmt |
| Management And General | $315,965 | ManagementAndGeneralAmt |
| Fundraising | $8,286 | FundraisingAmt |
Fees For Services Legal FeesForServicesLegalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $99,631 | TotalAmt |
| Program Services | $84,686 | ProgramServicesAmt |
| Management And General | $14,863 | ManagementAndGeneralAmt |
| Fundraising | $82 | FundraisingAmt |
Fees For Services Accounting FeesForServicesAccountingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $275,290 | TotalAmt |
| Program Services | $233,996 | ProgramServicesAmt |
| Management And General | $41,068 | ManagementAndGeneralAmt |
| Fundraising | $226 | FundraisingAmt |
Fees For Services Other FeesForServicesOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $12,204,880 | TotalAmt |
| Program Services | $10,374,148 | ProgramServicesAmt |
| Management And General | $1,820,809 | ManagementAndGeneralAmt |
| Fundraising | $9,923 | FundraisingAmt |
Advertising AdvertisingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $186,243 | TotalAmt |
| Program Services | $159,070 | ProgramServicesAmt |
| Management And General | $26,336 | ManagementAndGeneralAmt |
| Fundraising | $837 | FundraisingAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,042,581 | TotalAmt |
| Program Services | $881,578 | ProgramServicesAmt |
| Management And General | $160,583 | ManagementAndGeneralAmt |
| Fundraising | $420 | FundraisingAmt |
Information Technology InformationTechnologyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $17,191 | TotalAmt |
| Program Services | $14,683 | ProgramServicesAmt |
| Management And General | $2,431 | ManagementAndGeneralAmt |
| Fundraising | $77 | FundraisingAmt |
Occupancy OccupancyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $5,103,732 | TotalAmt |
| Program Services | $4,456,697 | ProgramServicesAmt |
| Management And General | $647,035 | ManagementAndGeneralAmt |
Travel TravelGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $3,050 | TotalAmt |
| Program Services | $2,605 | ProgramServicesAmt |
| Management And General | $431 | ManagementAndGeneralAmt |
| Fundraising | $14 | FundraisingAmt |
Conferences Meetings ConferencesMeetingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $87,453 | TotalAmt |
| Program Services | $74,693 | ProgramServicesAmt |
| Management And General | $12,367 | ManagementAndGeneralAmt |
| Fundraising | $393 | FundraisingAmt |
Interest InterestGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,485,960 | TotalAmt |
| Program Services | $1,263,066 | ProgramServicesAmt |
| Management And General | $220,476 | ManagementAndGeneralAmt |
| Fundraising | $2,418 | FundraisingAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $5,009,776 | TotalAmt |
| Program Services | $4,258,309 | ProgramServicesAmt |
| Management And General | $751,467 | ManagementAndGeneralAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $554,745 | TotalAmt |
| Program Services | $471,533 | ProgramServicesAmt |
| Management And General | $83,212 | ManagementAndGeneralAmt |
Other Expenses OtherExpensesGrp (4 entries)
| DescDesc | TotalTotalAmt | Program ServicesProgramServicesAmt | Management And GeneralManagementAndGeneralAmt | FundraisingFundraisingAmt |
|---|---|---|---|---|
| MEDICAL SUPPLIES | $8,943,435 | $7,638,575 | $1,304,860 | |
| HAF EXPENSE | $2,552,155 | $2,179,792 | $360,894 | $11,469 |
| MINOR EQUIPMENT | $798,292 | $681,820 | $112,885 | $3,587 |
| DUES & SUB. | $544,250 | $464,843 | $76,961 | $2,446 |
All Other Expenses AllOtherExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $679,950 | TotalAmt |
| Program Services | $311,533 | ProgramServicesAmt |
| Management And General | $192,557 | ManagementAndGeneralAmt |
| Fundraising | $175,860 | FundraisingAmt |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $81,601,705 | TotalAmt |
| Program Services | $69,344,770 | ProgramServicesAmt |
| Management And General | $11,889,279 | ManagementAndGeneralAmt |
| Fundraising | $367,656 | FundraisingAmt |
Cash Non Interest Bearing CashNonInterestBearingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $7,160,106 | BOYAmt |
| EOY | $5,926,833 | EOYAmt |
Savings And Temp Cash Invst SavingsAndTempCashInvstGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $11,515,868 | BOYAmt |
| EOY | $19,284,207 | EOYAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $8,491,630 | BOYAmt |
| EOY | $10,803,145 | EOYAmt |
Oth Notes Loans Receivable Net OthNotesLoansReceivableNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $834,811 | BOYAmt |
| EOY | $930,598 | EOYAmt |
Inventories For Sale Or Use InventoriesForSaleOrUseGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,395,002 | BOYAmt |
| EOY | $1,529,187 | EOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $736,753 | BOYAmt |
| EOY | $890,001 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $80,910,849 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $43,595,425 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $38,119,220 | BOYAmt |
| EOY | $37,315,424 | EOYAmt |
Investments Pub Traded Sec InvestmentsPubTradedSecGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $22,209,247 | BOYAmt |
| EOY | $26,826,290 | EOYAmt |
Investments Other Securities InvestmentsOtherSecuritiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $3,329,021 | BOYAmt |
| EOY | $3,329,021 | EOYAmt |
Intangible Assets IntangibleAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $885,713 | BOYAmt |
| EOY | $990,371 | EOYAmt |
Other Assets Total OtherAssetsTotalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $906,430 | BOYAmt |
| EOY | $812,352 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $95,583,801 | BOYAmt |
| EOY | $108,637,429 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $9,831,648 | BOYAmt |
| EOY | $10,332,401 | EOYAmt |
Grants Payable GrantsPayableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $57,542 | BOYAmt |
| EOY | $0 | EOYAmt |
Mortg Notes Pybl Scrd Invst Prop MortgNotesPyblScrdInvstPropGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $42,347,161 | BOYAmt |
| EOY | $41,618,823 | EOYAmt |
Other Liabilities OtherLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $8,048,633 | BOYAmt |
| EOY | $7,658,228 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $60,284,984 | BOYAmt |
| EOY | $59,609,452 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Organization Follows FASB117 | Yes (X) | OrganizationFollowsFASB117Ind |
No Donor Restriction Net Assets NoDonorRestrictionNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $34,754,730 | BOYAmt |
| EOY | $48,624,924 | EOYAmt |
Donor Restriction Net Assets DonorRestrictionNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $544,087 | BOYAmt |
| EOY | $403,053 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $35,298,817 | BOYAmt |
| EOY | $49,027,977 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $95,583,801 | BOYAmt |
| EOY | $108,637,429 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Reconcilation Revenue Expnss | $9,559,534 | ReconcilationRevenueExpnssAmt |
| Net Unrlzd Gains Losses Invst | $4,169,626 | NetUnrlzdGainsLossesInvstAmt |
| Other Changes In Net Assets | $0 | OtherChangesInNetAssetsAmt |
| Info In Schedule O Part XII | Yes (X) | InfoInScheduleOPartXIIInd |
| Method Of Accounting Accrual | Yes (X) | MethodOfAccountingAccrualInd |
| Accountant Compile Or Review | 0 | AccountantCompileOrReviewInd |
| FS Audited | Yes (1) | FSAuditedInd |
FS Audited Basis FSAuditedBasisGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Consolidated Basis Fincl Stmt | Yes (X) | ConsolidatedBasisFinclStmtInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Audit Committee | Yes (1) | AuditCommitteeInd |
| Federal Grant Audit Required | 0 | FederalGrantAuditRequiredInd |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital | Yes (X) | HospitalInd |
Schedule B IRS990ScheduleB
Contributor Information ContributorInformationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Contributor | RESTRICTED | ContributorNum |
Contributor Business Name ContributorBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | RESTRICTED | BusinessNameLine1 |
Contributor US Address ContributorUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | RESTRICTED | AddressLine1 |
| Address Line2 | RESTRICTED | AddressLine2 |
| City | RESTRICTED | City |
| State | RESTRICTED | State |
| ZIP Code | RESTRICTED | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Contributions | RESTRICTED | TotalContributionsAmt |
Schedule C IRS990ScheduleC
| Field | Value | IRS element (for citing) |
|---|---|---|
| Volunteers | 0 | VolunteersInd |
| Paid Staff Or Management | 0 | PaidStaffOrManagementInd |
| Media Advertisements | 0 | MediaAdvertisementsInd |
| Mailings Members | 0 | MailingsMembersInd |
| Publications Or Broadcast | 0 | PublicationsOrBroadcastInd |
| Grants Other Organizations | 0 | GrantsOtherOrganizationsInd |
| Direct Contact Legislators | 0 | DirectContactLegislatorsInd |
| Rallies Demonstrations | 0 | RalliesDemonstrationsInd |
| Other Activities | Yes (1) | OtherActivitiesInd |
| Other Activities | $1,810 | OtherActivitiesAmt |
| Total Lobbying Expenditures | $1,810 | TotalLobbyingExpendituresAmt |
| Not Described Section501c3 | 0 | NotDescribedSection501c3Ind |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | PART II-B, LINE 1: | FormAndLineReferenceDesc |
| Explanation | DURING FISCAL YEAR 2021 A PORTION OF THE HOSPITAL'S ASSOCIATION MEMBERSHIP DUES PAID TO INDIANA HOSPITAL ASSOCIATION (IHA) AND AMERICAN HOSPITAL ASSOCIATION (AHA) WAS ALLOCATED TO LOBBYING EXPENDITURES. | ExplanationTxt |
Schedule D IRS990ScheduleD
CY Endwmt Fund CYEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $544,585 | BeginningYearBalanceAmt |
| Contributions | $106,439 | ContributionsAmt |
| Investment Earnings Or Losses | $18,723 | InvestmentEarningsOrLossesAmt |
| Grants Or Scholarships | $3,788 | GrantsOrScholarshipsAmt |
| Other Expenditures | $262,909 | OtherExpendituresAmt |
| End Year Balance | $403,050 | EndYearBalanceAmt |
CY Minus1 Yr Endwmt Fund CYMinus1YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $461,371 | BeginningYearBalanceAmt |
| Contributions | $144,344 | ContributionsAmt |
| Investment Earnings Or Losses | $24,383 | InvestmentEarningsOrLossesAmt |
| Grants Or Scholarships | $6,690 | GrantsOrScholarshipsAmt |
| Other Expenditures | $78,823 | OtherExpendituresAmt |
| End Year Balance | $544,585 | EndYearBalanceAmt |
CY Minus2 Yr Endwmt Fund CYMinus2YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $444,584 | BeginningYearBalanceAmt |
| Contributions | $92,875 | ContributionsAmt |
| Investment Earnings Or Losses | $23,825 | InvestmentEarningsOrLossesAmt |
| Grants Or Scholarships | $4,676 | GrantsOrScholarshipsAmt |
| Other Expenditures | $95,237 | OtherExpendituresAmt |
| End Year Balance | $461,371 | EndYearBalanceAmt |
CY Minus3 Yr Endwmt Fund CYMinus3YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $2,705,600 | BeginningYearBalanceAmt |
| Contributions | $40,914 | ContributionsAmt |
| Investment Earnings Or Losses | $124,106 | InvestmentEarningsOrLossesAmt |
| Other Expenditures | $2,426,036 | OtherExpendituresAmt |
| End Year Balance | $444,584 | EndYearBalanceAmt |
CY Minus4 Yr Endwmt Fund CYMinus4YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $238,610 | BeginningYearBalanceAmt |
| Contributions | $2,546,669 | ContributionsAmt |
| Investment Earnings Or Losses | $166,722 | InvestmentEarningsOrLossesAmt |
| Other Expenditures | $246,401 | OtherExpendituresAmt |
| End Year Balance | $2,705,600 | EndYearBalanceAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Term Endowment Balance EOY | 1.00000 | TermEndowmentBalanceEOYPct |
| Endowments Held Unrelated Org | 0 | EndowmentsHeldUnrelatedOrgInd |
| Endowments Held Related Org | Yes (1) | EndowmentsHeldRelatedOrgInd |
| Related Org List Sch R | Yes (1) | RelatedOrgListSchRInd |
Land LandGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $2,019,703 | OtherCostOrOtherBasisAmt |
| Book Value | $2,019,703 | BookValueAmt |
Buildings BuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $59,345,235 | OtherCostOrOtherBasisAmt |
| Depreciation | $28,215,380 | DepreciationAmt |
| Book Value | $31,129,855 | BookValueAmt |
Equipment EquipmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $19,429,417 | OtherCostOrOtherBasisAmt |
| Depreciation | $15,380,045 | DepreciationAmt |
| Book Value | $4,049,372 | BookValueAmt |
Other Land Buildings OtherLandBuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $116,494 | OtherCostOrOtherBasisAmt |
| Book Value | $116,494 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $37,315,424 | TotalBookValueLandBuildingsAmt |
Other Liabilities Org OtherLiabilitiesOrgGrp (2 entries)
| DescDesc | AmtAmt |
|---|---|
| ESTIMATED THIRD-PARTY SETTLEMENT | $7,385,569 |
| RECOURSE OBLIGATION, PATIENT RECEIVABLE | $272,659 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Liability | $7,658,228 | TotalLiabilityAmt |
| Footnote Text | Yes (X) | FootnoteTextInd |
Supplemental Information Detail SupplementalInformationDetail (2 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| PART V, LINE 4: | THE HOSPITAL HAS TEMPORARILY RESTRICTED NET ASSETS, THE USE OF WHICH IS RESTRICTED BY DONORS OR GRANTORS, INTENDED FOR USE ON HEALTH CARE SERVICES FOR HOME HEALTH CARE AND THE HOSPITAL'S EXPANSION PROJECT. |
| PART X, LINE 2: | ACCOUNTING PRINCIPLES GENERALLY ACCEPTED IN THE UNITED STATES OF AMERICA REQUIRE MANAGEMENT TO EVALUATE TAX POSITIONS TAKEN BY THE HOSPITAL AND CMO AND RECOGNIZE A TAX LIABILITY IF THE HOSPITAL OR CMO HAVE TAKEN AN UNCERTAIN POSITION THAT MORE LIKELY THAN NOT WOULD NOT BE SUSTAINED UPON EXAMINATION BY VARIOUS FEDERAL AND STATE TAXING AUTHORITIES. MANAGEMENT HAS ANALYZED THE TAX POSITIONS TAKEN BY THE HOSPITAL AND CMO, AND HAS CONCLUDED THAT AS OF SEPTEMBER 30, 2021 AND 2020, THERE ARE NO UNCERTAIN POSITIONS TAKEN OR EXPECTED TO BE TAKEN THAT WOULD REQUIRE RECOGNITION OF A LIABILITY OR DISCLOSURE IN THE ACCOMPANYING CONSOLIDATED FINANCIAL STATEMENTS. THE HOSPITAL AND CMO ARE SUBJECT TO ROUTINE AUDITS BY TAXING JURISDICTIONS; HOWEVER, THERE ARE CURRENTLY NO AUDITS FOR ANY TAX PERIODS IN PROGRESS. |
Schedule G IRS990ScheduleG
Fundraising Event Information FundraisingEventInformationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Event1 | GOLF OUTING | Event1Nm |
| Gross Receipts Event1 | $43,650 | GrossReceiptsEvent1Amt |
| Charitable Contri Event1 | $6,400 | CharitableContriEvent1Amt |
| Gross Revenue Event1 | $37,250 | GrossRevenueEvent1Amt |
| Rent Facility Costs Event1 | $5,251 | RentFacilityCostsEvent1Amt |
| Other Direct Expenses Event1 | $8,497 | OtherDirectExpensesEvent1Amt |
| Gross Receipts Total | $43,650 | GrossReceiptsTotalAmt |
| Charitable Contributions Tot | $6,400 | CharitableContributionsTotAmt |
| Gross Revenue Total Events | $37,250 | GrossRevenueTotalEventsAmt |
| Rent Fclty Costs Total Events | $5,251 | RentFcltyCostsTotalEventsAmt |
| Oth Direct Expnss Total Events | $8,497 | OthDirectExpnssTotalEventsAmt |
| Direct Expense Summary Events | $13,748 | DirectExpenseSummaryEventsAmt |
| Net Income Summary | $23,502 | NetIncomeSummaryAmt |
Schedule H IRS990ScheduleH
| Field | Value | IRS element (for citing) |
|---|---|---|
| Financial Assistance Policy | Yes (1) | FinancialAssistancePolicyInd |
| Written Policy | Yes (1) | WrittenPolicyInd |
| All Hospitals Policy | Yes (X) | AllHospitalsPolicyInd |
| FPG Reference Free Care | Yes (1) | FPGReferenceFreeCareInd |
| Percent100 | Yes (X) | Percent100Ind |
| FPG Reference Discounted Care | Yes (1) | FPGReferenceDiscountedCareInd |
| Percent350 | Yes (X) | Percent350Ind |
| Free Care Medically Indigent | Yes (1) | FreeCareMedicallyIndigentInd |
| Financial Assistance Budget | Yes (1) | FinancialAssistanceBudgetInd |
| Expenses Exceed Budget | Yes (1) | ExpensesExceedBudgetInd |
| Unable To Provide Care | 0 | UnableToProvideCareInd |
| Annual Community Bnft Report | Yes (1) | AnnualCommunityBnftReportInd |
| Report Publically Available | Yes (1) | ReportPublicallyAvailableInd |
Financial Assistance At Cost Typ FinancialAssistanceAtCostTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $73,364 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $73,364 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00090 | TotalExpensePct |
Unreimbursed Medicaid UnreimbursedMedicaidGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $11,325,985 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $8,138,687 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $3,187,298 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.03910 | TotalExpensePct |
Total Financial Assistance Typ TotalFinancialAssistanceTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $11,399,349 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $8,138,687 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $3,260,662 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.04000 | TotalExpensePct |
Community Health Services CommunityHealthServicesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $123,288 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $123,288 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00150 | TotalExpensePct |
Cash And In Kind Contributions CashAndInKindContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $122,272 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $122,272 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00150 | TotalExpensePct |
Total Other Benefits TotalOtherBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $245,560 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $245,560 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00300 | TotalExpensePct |
Total Community Benefits TotalCommunityBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $11,644,909 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $8,138,687 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $3,506,222 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.04300 | TotalExpensePct |
Workforce Development WorkforceDevelopmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $8,447 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $8,447 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00010 | TotalExpensePct |
Total Communtity Building Acty TotalCommuntityBuildingActyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $8,447 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $8,447 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00010 | TotalExpensePct |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | Yes (1) | BadDebtExpenseReportedInd |
| Bad Debt Expense | $4,737,561 | BadDebtExpenseAmt |
| Bad Debt Expense Attributable | $73,977 | BadDebtExpenseAttributableAmt |
| Reimbursed By Medicare | $17,003,828 | ReimbursedByMedicareAmt |
| Cost Of Care Reimbursed By Medcr | $16,368,366 | CostOfCareReimbursedByMedcrAmt |
| Medicare Surplus Or Shortfall | $635,462 | MedicareSurplusOrShortfallAmt |
Costing Methodology Used CostingMethodologyUsedGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | Yes (X) | OtherInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Written Debt Collection Policy | Yes (1) | WrittenDebtCollectionPolicyInd |
| Financial Assistance Prvsn | Yes (1) | FinancialAssistancePrvsnInd |
| Hospital Facilities | 1 | HospitalFacilitiesCnt |
Hospital Facilities HospitalFacilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 1 | FacilityNum |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | CAMERON MEMORIAL COMMUNITY HOSPITAL INC | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 416 E MAUMEE STREET | AddressLine1Txt |
| City | ANGOLA | CityNm |
| State Abbreviation | IN | StateAbbreviationCd |
| ZIP | 46703 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Website Address | WWW.CAMERONMCH.COM | WebsiteAddressTxt |
| State License | 22-005037-1 | StateLicenseNum |
| Licensed Hospital | Yes (X) | LicensedHospitalInd |
| General Medical And Surgical | Yes (X) | GeneralMedicalAndSurgicalInd |
| Critical Access Hospital | Yes (X) | CriticalAccessHospitalInd |
| Emergency Room24 Hrs | Yes (X) | EmergencyRoom24HrsInd |
Hospital Fclty Policies Prctc HospitalFcltyPoliciesPrctcGrp
Hospital Facility Name HospitalFacilityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | CAMERON MEMORIAL COMMUNITY HOSPITAL INC | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 1 | FacilityNum |
| First Licensed CY Or PY | 0 | FirstLicensedCYOrPYInd |
| Tax Exempt Hospital CY Or PY | 0 | TaxExemptHospitalCYOrPYInd |
| CHNA Conducted | Yes (1) | CHNAConductedInd |
| Community Definition | Yes (X) | CommunityDefinitionInd |
| Community Demographics | Yes (X) | CommunityDemographicsInd |
| Existing Resources | Yes (X) | ExistingResourcesInd |
| How Data Obtained | Yes (X) | HowDataObtainedInd |
| Community Health Needs | Yes (X) | CommunityHealthNeedsInd |
| Other Health Issues | Yes (X) | OtherHealthIssuesInd |
| Community Hlth Needs Id Process | Yes (X) | CommunityHlthNeedsIdProcessInd |
| Consulting Process | Yes (X) | ConsultingProcessInd |
| Prior CHNA Impact | Yes (X) | PriorCHNAImpactInd |
| CHNA Conducted | 18 | CHNAConductedYr |
| Take Into Account Others Input | Yes (1) | TakeIntoAccountOthersInputInd |
| CHNA Conducted With Other Fclts | 0 | CHNAConductedWithOtherFcltsInd |
| CHNA Conducted With Non Fclts | Yes (1) | CHNAConductedWithNonFcltsInd |
| CHNA Report Widely Available | Yes (1) | CHNAReportWidelyAvailableInd |
| Rpt Available On Own Website | Yes (X) | RptAvailableOnOwnWebsiteInd |
| Own Website URL | SEE PART V | OwnWebsiteURLTxt |
| Paper Copy Public Inspection | Yes (X) | PaperCopyPublicInspectionInd |
| Rpt Available Thru Other Method | Yes (X) | RptAvailableThruOtherMethodInd |
| Implementation Strategy Adopt | Yes (1) | ImplementationStrategyAdoptInd |
| Implementation Strategy Adpt | 19 | ImplementationStrategyAdptYr |
| Strategy Posted Website | 0 | StrategyPostedWebsiteInd |
| Strategy Attached | Yes (1) | StrategyAttachedInd |
| Organization Incur Excise Tax | 0 | OrganizationIncurExciseTaxInd |
| Elig Criteria Explained | Yes (1) | EligCriteriaExplainedInd |
| FPG Family Incm Lmt Free Dscnt | Yes (X) | FPGFamilyIncmLmtFreeDscntInd |
| FPG Family Incm Lmt Free Care | 100.000000000000 | FPGFamilyIncmLmtFreeCarePct |
| FPG Family Incm Lmt Dscnt Care | 350.000000000000 | FPGFamilyIncmLmtDscntCarePct |
| Income Level Criteria | Yes (X) | IncomeLevelCriteriaInd |
| Asset Level Criteria | Yes (X) | AssetLevelCriteriaInd |
| Medical Indigency Criteria | Yes (X) | MedicalIndigencyCriteriaInd |
| Insurance Status Criteria | Yes (X) | InsuranceStatusCriteriaInd |
| Underinsurance Stat Criteria | Yes (X) | UnderinsuranceStatCriteriaInd |
| Residency Criteria | Yes (X) | ResidencyCriteriaInd |
| Explained Basis | Yes (1) | ExplainedBasisInd |
| App Financial Asst Expln | Yes (1) | AppFinancialAsstExplnInd |
| Described Info | Yes (X) | DescribedInfoInd |
| Described Suprt Doc | Yes (X) | DescribedSuprtDocInd |
| Provided Hospital Contact | Yes (X) | ProvidedHospitalContactInd |
| Includes Publicity Measures | Yes (1) | IncludesPublicityMeasuresInd |
| FAP Available On Website | Yes (X) | FAPAvailableOnWebsiteInd |
| FAP Available On Website URL | SEE PART V | FAPAvailableOnWebsiteURLTxt |
| FAP App Available On Website | Yes (X) | FAPAppAvailableOnWebsiteInd |
| FAP App Available On Website URL | SEE PART V | FAPAppAvailableOnWebsiteURLTxt |
| FAP Summary On Website | Yes (X) | FAPSummaryOnWebsiteInd |
| FAP Summary On Website URL | SEE PART V | FAPSummaryOnWebsiteURLTxt |
| FAP Avlbl On Request No Charge | Yes (X) | FAPAvlblOnRequestNoChargeInd |
| FAP App Avlbl On Request No Chrg | Yes (X) | FAPAppAvlblOnRequestNoChrgInd |
| FAP Sum Avlbl On Request No Chrg | Yes (X) | FAPSumAvlblOnRequestNoChrgInd |
| Notified FAP Copy Bill Display | Yes (X) | NotifiedFAPCopyBillDisplayInd |
| Communtity Notified FAP | Yes (X) | CommuntityNotifiedFAPInd |
| FAP Translated | Yes (X) | FAPTranslatedInd |
| Other Publicity | Yes (X) | OtherPublicityInd |
| FAP Actions On Nonpayment | Yes (1) | FAPActionsOnNonpaymentInd |
| Permit No Actions | Yes (X) | PermitNoActionsInd |
| Collection Activities | 0 | CollectionActivitiesInd |
| Provided Written Notice | Yes (X) | ProvidedWrittenNoticeInd |
| Made Effort Orally Notify | Yes (X) | MadeEffortOrallyNotifyInd |
| Processed FAP Application | Yes (X) | ProcessedFAPApplicationInd |
| Made Presumptive Elig Determ | Yes (X) | MadePresumptiveEligDetermInd |
| Other Actions Taken | Yes (X) | OtherActionsTakenInd |
| Nondis Emergency Care Policy | Yes (1) | NondisEmergencyCarePolicyInd |
| Look Back Medicare Private | Yes (X) | LookBackMedicarePrivateInd |
| Amounts Generally Billed | 0 | AmountsGenerallyBilledInd |
| Gross Charges | 0 | GrossChargesInd |
Supplemental Information SupplementalInformationGrp (9 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| CAMERON MEMORIAL COMMUNITY HOSPITAL, INC. | PART V, SECTION B, LINE 5: CAMERON MEMORIAL COMMUNITY HOSPITAL (CMCH) CONTRACTED WITH THE INDIANA RURAL HEALTH ASSOCIATION (IRHA) TO CONDUCT THE COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA). IRHA FIRST IDENTIFIED THE COMMUNITY SERVED BY CMCH THROUGH CONVERSATIONS WITH THE HOSPITAL. BASED ON A REVIEW OF PATIENT ZIP CODES, THE HOSPITAL WAS ABLE TO DEFINE THE COMMUNITY SERVED AS ALL POSTAL CODES WITHIN THE GEOGRAPHIC AREA OF STEUBEN COUNTY. THE HOSPITAL PROVIDED A PRIMARY SERVICE AREA MAP WITH ZIP CODES. NEXT, A STEERING COMMITTEE OF STEUBEN COUNTY REPRESENTATIVES WAS ORGANIZED WITH THE HELP OF THE CAMERON MEMORIAL COMMUNITY HOSPITAL CEO. BUSINESS OWNERS, LOCAL OFFICIALS, HEALTHCARE PROVIDERS, MINORITY LEADERS, CLERGY, STUDENT REPRESENTATIVES, AND ANY OTHER INTERESTED PARTIES WERE INVITED TO ATTEND THE MEETING TO DISCUSS THE HEALTH-RELATED NEEDS OF THE COUNTY WITH A VIEW TO IDENTIFYING THE AREAS OF GREATEST CONCERN. FROM THE INFORMATION OBTAINED IN THE STEERING COMMITTEE, A 43-QUESTION SURVEY WAS DEVELOPED TO GAIN THE PERSPECTIVE OF THE INHABITANTS OF THE COMMUNITY. QUESTIONS INCLUDED QUERIES ABOUT THE EFFECT OF VARIOUS FACTORS (SUCH AS ILLEGAL DRUGS, TRANSPORTATION, AND POVERTY), AS WELL AS PROBES INTO THE PERCEIVED NEED FOR VARIOUS SERVICES AND FACILITIES IN THE COUNTY. THE SURVEY WAS DISSEMINATED TO THE RESIDENTS OF STEUBEN COUNTY THROUGH INCLUSION ON THE CAMERON MEMORIAL COMMUNITY HOSPITAL'S WEBSITE, FACE-TO-FACE POLLING AT THE YMCA OF STEUBEN COUNTY AND SUTTON'S DELI, A RESTAURANT ON THE TOWN SQUARE IN ANGOLA. AN ONLINE SURVEY POSTED ON SURVEYMONKEY.COM WAS ALSO MADE AVAILABLE TO THE PUBLIC. |
| CAMERON MEMORIAL COMMUNITY HOSPITAL, INC. | PART V, SECTION B, LINE 6B: CAMERON MEMORIAL COMMUNITY HOSPITAL (CMCH) CONTRACTED WITH THE INDIANA RURAL HEALTH ASSOCIATION (IRHA) TO CONDUCT THE COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA). |
| CAMERON MEMORIAL COMMUNITY HOSPITAL, INC. | PART V, SECTION B, LINE 7D: LOCATION TO CHNA:ON THE WEB PAGE UNDER "RESOURCES" CLICK ON THE LINK "ANNUAL REPORT & COMMUNITY HEALTH NEEDS ASSESSMENT" TO ACCESS CMCH'S MOST CURRENT COMMUNITY HEALTH NEEDS ASSESSMENT OR COPY AND ENTER THE FOLLOWING WEB ADDRESS INTO THE INTERNET BROWSER: HTTPS://WWW.CAMERONMCH.COM/COMMUNITY-HEALTH-ASSESSMENT/ |
| CAMERON MEMORIAL COMMUNITY HOSPITAL, INC. | PART V, SECTION B, LINE 11: THERE WERE FOUR SIGNIFICANT NEEDS IDENTIFIED IN THE HOSPITAL'S MOST RECENTLY CONDUCTED FISCAL YEAR ENDING 2019 CHNA. BELOW IS A SUMMARY OF THE NEEDS IDENTIFIED AND PRIORITIZED IN THE APPROVED IMPLEMENTATION STRATEGY WITH AN UPDATE FOR THE YEAR.NEED 1: ACCESS AND/OR EDUCATION FOR UNINSURED, UNDERINSURED, AND LOW-INCOME POPULATIONS, AS WELL AS COST OF CARE AND TRANSPARENCY.NEED IS BEING ADDRESSED DURING THE YEAR: CMCH WILL INVESTIGATE OPPORTUNITIES FOR PARTNERSHIPS WITH AREA AGENCIES AND ALL PUBLIC AID OPTIONS FOR FINANCIAL RESOURCES. WE WILL INCLUDE BUSINESS ENTITIES SUCH AS CLAIM-AID OR SIMILAR FIRMS TO EXHAUST ALL OPTIONS FOR MEDICAID ENROLLMENT. WE WILL ALSO CONSULT WITH LOCAL CLERGY TO EXPLORE FAITH-BASED FINANCIAL SUPPORT PROGRAMS. UPDATE: NUMEROUS STAFF FROM CMCH ARE ON COMMUNITY BOARDS SUCH AS SCHOOL BOARDS, THE UNITED WAY OF STEUBEN COUNTY, MAYOR'S ARTS COUNCIL, SHAPE UP STEUBEN, THE ANGOLA CHAMBER, AND THE YMCA OF STEUBEN COUNTY. WE ARE REGULARLY COLLABORATING ON PROGRAMS GEARED TO EDUCATING THE COMMUNITY ON A VARIETY OF HEALTH AND WELLNESS TOPICS, INCLUDING BRINGING TELEHEALTH TO LOCAL STUDENTS AND COMMUNITY MEMBERS.CMCH'S WELLNESS COORDINATOR IS ALSO LEADING SHAPE-UP STEUBEN AND ORGANIZING MULTIPLE EDUCATIONAL OPPORTUNITIES FOR LOCAL STUDENTS THROUGHOUT THE SCHOOL YEAR. THIS POSITION IS ADDITIONALLY RESPONSIBLE TO HELP PROMOTE HEALTH AND WELLNESS INTERNALLY BY ORGANIZING WELLNESS CHALLENGES THROUGHOUT THE YEAR FOR OUR INTERNAL EMPLOYEES AND HELPING TO PROVIDE GUIDANCE WITH AGGREGATE BIOMETRIC SCREENINGS TO OFFER EDUCATIONAL OPPORTUNITIES ON HEALTH AND WELLNESS.NEED 2: EDUCATION, TREATMENT, AND PREVENTION FOR ILLEGAL DRUG USE, PRESCRIPTION DRUG/OPIOID ABUSE, ALCOHOL ABUSE, METHAMPHETAMINE, AND TOBACCO USE:NEED IS BEING ADDRESSED DURING THE YEAR: CMCH WILL COLLABORATE WITH LOCAL EXPERTS AND PROFESSIONAL RESOURCES TO OFFER EDUCATIONAL MEETINGS TO DISCUSS SUBSTANCE USE DISORDER, INCLUDING DRUG AND TOBACCO ISSUES. UPDATE: THROUGH COMMUNITY OUTREACH PROGRAMS, WE WILL CONTINUE TO WORK WITH SCHOOLS TO EDUCATE YOUTH/STUDENTS ON THE IMPORTANCE OF HEALTH AND WELLNESS, AND AVOIDING ILLEGAL DRUG, ALCOHOL, AND TOBACCO USE. EDUCATIONAL SERVICES OFFERED BY CMCH TO SERVE THOSE IN NEED WILL ALSO INCLUDE LOCAL EMPLOYERS, CHURCHES, SCHOOLS, ETC. MOST SPECIFICALLY, CAMERON HOSPITAL HAS PARTNERED WITH DRUG FREE STEUBEN TO EDUCATE OUR COMMUNITY.NEED 3: MENTAL HEALTH TREATMENT AND FACILITIES.NEED IS BEING ADDRESSED DURING THE YEAR: CMCH MAKE ADDITIONAL RESOURCES AVAILABLE BY PROVIDING ADDITIONAL RESOURCES FOR MENTAL HEALTH. UPDATE: IN JUNE 2019 CAMERON PSYCHIATRY OPENED FOR PATIENTS AGES 15 AND UP TO PROVIDE COUNSELING AND CARE TO THOSE DEALING WITH EMOTIONAL AND BEHAVIORAL CHALLENGES SUCH AS DEPRESSION, ANXIETY, FAMILY ISSUES, RELATIONSHIP CONCERNS, STRESS AND MORE. ALL TREATMENT IS PROVIDED ON AN OUTPATIENT BASIS. CAMERON PSYCHIATRY CONTINUES TO BE A CATALYST FOR OUR COMMUNITY AND AN EFFECTIVE TOOL FOR MENTAL HEALTH. IN FISCAL YEAR 2021, CAMERON PSYCHIATRY BROADENED THEIR AGE GROUP WITH THE ADDITION OF ADOLESCENT THERAPY ALLOWING CAMERON TO PROVIDE CARE TO CHILDREN STARTING AT AGE 6.NEED 4: SERVICES FOR YOUTHNEED IS BEING ADDRESSED DURING THE YEAR: CMCH WILL COLLABORATE WITH COMMUNITY ORGANIZATIONS FOCUSED ON YOUTH TO INCLUDE HEALTHY LIVING CONCEPTS AS PART OF DAILY LIFE INCLUDING: YMCA OF STEUBEN COUNTY, SHAPE UP STEUBEN AND PURDUE EXTENSION, ALONG WITH OTHER SOCIAL ACTIVITY/CLUBS, FITNESS ORGANIZATIONS, LOCAL GATHERING PLACES, SCHOOLS AND FAITH-BASED ORGANIZATIONS. WE WILL ALSO COLLABORATE WITH COMMUNITY LEADERS AND LAW ENFORCEMENT TO SPECIFICALLY IDENTIFY AREAS WHERE YOUTH CONGREGATE; AND BASED ON THOSE DEMOGRAPHICS, DEVELOP PROGRAMS TO ORGANIZE ACTIVITIES WHICH WILL CAPTURE THEIR INTEREST. UPDATE: CMCH HAS COLLABORATED WITH PURDUE EXTENSION TO LAUNCH STRENGTHENING FAMILIES IN JUNE 2019. THIS PROGRAM IS A 7-SESSION COURSE FOR AGES 10-14. THE PROGRAM MET WEEKLY FOR 2.5 HOURS TO WORK WITH FAMILY-LIFE ISSUES, PARENT-CHILD RELATIONSHIPS, COMMUNICATION TOOLS, PEER PRESSURE AND SETTING & ACHIEVING GOALS. THE FIRST SESSION WAS OPEN ONLY FOR COURT-APPOINTMENT FAMILIES FROM THE JUVENILE DELINQUENCY PROBATION PROGRAMS. WE PLAN TO HAVE FUTURE SESSIONS OPEN TO THE PUBLIC. THIS PROGRAM WAS MADE AVAILABLE AT NO COST TO THE FAMILIES THROUGH GRANTS OBTAINED THROUGH PURDUE EXTENSION AND THE STEUBEN COUNTY COMMUNITY FOUNDATION. ADDITIONALLY, DINNER WAS PROVIDED AT NO COST AS A DONATION FROM CMCH. CAMERON IS EXCITED TO COLLABORATE WITH COMMUNITY ORGANIZATIONS FOCUSED ON YOUTH NOW THAT COVID-19 RESTRICTIONS HAVE ALLOWED FOR THESE INTERACTIONS.CAMERON MEDICAL GROUP IS COMMITTED TO EDUCATING OUR COMMUNITY, SPECIFICALLY PARENTS AND YOUTH. FROM TOURS OF THE HOSPITAL, PARTICIPATING IN FUN EDUCATIONAL EVENTS AT LOCAL SCHOOLS, THERAPY DOGS, ATTENDING YMCA SUMMER DAY CAMP PROVIDING HEALTHY TIPS ON WASHING HANDS, THE IMPORTANCE OF SEEING YOUR PEDIATRICIAN/FAMILY PROVIDER AND SO MUCH MORE. |
| CAMERON MEMORIAL COMMUNITY HOSPITAL, INC. | PART V, SECTION B, LINE 13B: IN ADDITION TO FPG, ELIGIBILITY FOR FINANCIAL ASSISTANCE ALSO CONSIDERS THE FOLLOWING INCOME SOURCES IF PATIENTS CLAIM NO INCOME: INCOME FROM CHILD SUPPORT, PENSION, RENTAL, EDUCATION, AND OTHER FINANCIAL SUPPORT FROM FAMILY MEMBERS NOT LIVING IN THE HOUSEHOLD. |
| CAMERON MEMORIAL COMMUNITY HOSPITAL, INC. | PART V, SECTION B, LINE 16J: LOCATION TO FINANCIAL ASSITANCE POLICIES AND FORMS:ON THE WEB PAGE UNDER "RESOURCES" CLICK ON THE LINK "BILLING INFO" TO ACCESS THE HOSPITAL'S FINANCIAL ASSISTANCE POLICY INFORMATION. |
| CAMERON MEMORIAL COMMUNITY HOSPITAL, INC. | PART V, SECTION B, LINE 20E: OTHER ACTIONS TAKEN BEFORE INITIATING ANY COLLECTION ACTIONS:FOR INPATIENTS A HOSPITAL REPRESENTATIVE VISITS THE PATIENT AND DISCUSSES WITH THEM ABOUT PAYMENT OPTIONS INCLUDING THE FINANCIAL ASSISTANCE POLICY; FOR OUTPATIENTS AND OTHER PATIENTS THE BUSINESS OFFICE CALLS AND DISCUSSES THE SAME OPTIONS. |
| CAMERON MEMORIAL COMMUNITY HOSPITAL, INC.: | PART V, SECTION B, LINE 7A HOSPITAL FACILITY'S WEBSITE:HTTPS://WWW.CAMERONMCH.COM/COMMUNITY-HEALTH-ASSESSMENT/ |
| CAMERON MEMORIAL COMMUNITY HOSPITAL, INC.: | SCHEDULE H, PART V, LINE 16A:HTTPS://WWW.CAMERONMCH.COM/BILLING-INFO/SCHEDULE H, PART V, LINE 16B:HTTPS://WWW.CAMERONMCH.COM/BILLING-INFO/SCHEDULE H, PART V, LINE 16C:HTTPS://WWW.CAMERONMCH.COM/BILLING-INFO/ |
Supplemental Information Detail SupplementalInformationDetail (12 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| PART I, LINE 3C: | CAMERON MEMORIAL COMMUNITY HOSPITAL INC.'S FINANCIAL ASSISTANCE POLICY EXPLAINS THE FOLLOWING ELIGIBILITY CRITERIA FOR FINANCIAL ASSISTANCE IN ADDITION TO THE FPG:INCOME LEVEL OTHER THAN FPG (E.G. CHILD SUPPORT, PENSION INCOME, RENTAL INCOME, EDUCATIONAL INCOME, AND OTHER FINANCIAL SUPPORT FROM FAMILY MEMBERS NOT LIVING IN THE HOUSEHOLD), ASSET LEVEL, MEDICAL INDIGENCY, INSURANCE STATUS, UNDERINSURANCE STATUS, AND RESIDENCY. |
| PART I, LINE 7: | CAMERON MEMORIAL COMMUNITY HOSPITAL CALCULATED THE COST OF FINANCIAL ASSISTANCE AND MEANS-TESTED GOVERNMENT PROGRAMS USING THE COST-TO-CHARGE RATIO DERIVED FROM IRS WORKSHEET 2, RATIO OF PATIENT CARE COST-TO-CHARGES. |
| PART II, COMMUNITY BUILDING ACTIVITIES: | CAMERON MEMORIAL COMMUNITY HOSPITAL HAS ROOTS IN THIS AREA DATING BACK TO 1926, HELPING GENERATION AFTER GENERATION ENJOY BETTER HEALTH AND LIVE COMFORTABLY. TODAY, WE'RE A 25-BED, NOT-FOR-PROFIT FACILITY PROUDLY SERVING ANGOLA AND STEUBEN COUNTY. THE HOSPITAL'S MISSION IS TO IMPROVE THE QUALITY OF LIFE FOR THOSE WE SERVE THROUGH RELATIONSHIPS FOCUSED ON HEALTH AND WELLNESS. OUR TEAM OF EXPERIENCED PHYSICIANS, PROFESSIONAL HEALTHCARE PROVIDERS AND KNOWLEDGEABLE STAFF STRIVE TO MEET THIS MISSION EVERY DAY BY PROVIDING OUTSTANDING, PERSONALIZED CARE BACKED BY ADVANCED TECHNOLOGY AND A COMMITMENT TO OUR COMMUNITY. WE VALUE SAFETY, COMPASSION, INTEGRITY, TEAMWORK, STEWARDSHIP, EXCELLENCE, RESPECT AND WELLNESS.EACH YEAR, CAMERON HOSPITAL HOSTS HIGH SCHOOL STUDENTS THROUGH THE HEALTH OCCUPATIONS EDUCATION PROGRAM (HOE). THESE STUDENTS ARE SELECTED BASED ON THEIR INTERESTED IN PURSUING A CAREER IN HEALTHCARE AFTER GRADUATION. DURING THEIR SENIOR YEAR, THE STUDENTS ARE ASSIGNED TO VARIOUS DEPARTMENTS IN THE HOSPITAL, CLINICS, AND MEDICAL OFFICES TO OBSERVE AND IN MANY INSTANCES, HAVE "HANDS-ON" EXPERIENCE, MONITORED BY EXPERTS IN THE FIELD. THE STUDENTS ARE ALSO TRAINED IN CPR, PARTICIPATE IN HEALTH FAIRS AND SCREENINGS THROUGHOUT THE COMMUNITY. BY SUPPORTING THE HOE PROGRAM, CAMERON HOSPITAL CONTINUOUSLY ENCOURAGES AND PROMOTES QUALITY HEALTHCARE FOR OUR COMMUNITY FOR GENERATIONS TO COME. IN 2019, OUR COMMUNITY HEALTH NEEDS ASSESSMENT IDENTIFIED AREAS OF OPPORTUNITY FOR MENTAL HEALTH SUPPORT. IN 2019, CAMERON HOSPITAL ADDED CAMERON PSYCHIATRY TO OUR SERVICE LINE OFFERINGS, BRINGING A LICENSED PSYCHIATRIST WITH OVER 40 YEARS' EXPERIENCE TO STEUBEN COUNTY. AS PART OF CAMERON MEDICAL GROUP, DR. MERCADO AND HIS TEAM CARE FOR THE PSYCHOLOGICAL WELL-BEING OF PATIENTS 15 YEARS AND OLDER STRUGGLING WITH TRAUMA, ANXIETY OR DEPRESSION IN AN OUTPATIENT SETTING. IN THE PAST, CAMERON HAS OFFERED A COMMUNITY-WIDE WELLNESS SCREENING DAY AT A LOCAL HIGH SCHOOL WITH REDUCED PRICES ON LAB TESTS FOR ADULTS. WE LAUNCHED A TELEHEALTH PROGRAM WITH A LOCAL SCHOOL SYSTEM, ALLOWING CHILDREN TO BE SEEN FOR A VIDEO VISIT WITH A PEDIATRICIAN, WITH A SIGNED CONSENT FROM A PARENT/GUARDIAN ON FILE, WITH BILLING SET-UP THE SAME WAY AS IF A PARENT WERE TO BRING THEIR CHILD INTO THE SPECIALIST'S OFFICE. WE RECENTLY EXPANDED TELEHEALTH PROGRAMS WITHIN FREMONT COMMUNITY SCHOOLS AND ARE EXCITED FOR THE FUTURE WITH THIS PROGRAM. LASTLY, BECAUSE WE UNDERSTAND THE IMPORTANCE OF ACCESS TO HEALTHY FOOD AND BALANCED NUTRITION, WE CONTINUE TO OFFER THE CAMERON COMMUNITY WELLNESS GARDEN TO OUR COMMUNITY MEMBERS AT NO COST. THE GARDENERS RESERVE THEIR SPOTS AND MAINTAIN THEIR CROPS UNTIL THE FALL. FOR THE THIRD YEAR IN A ROW, WE ARE PLEASED TO PRESENT, THE PLOTS HAVE ALL BEEN FILLED. WE ALSO PLAN TO PARTNER WITH A LARGER HEALTHCARE SYSTEM TO COLLABORATE ON A FARM-TO-SCHOOL PROGRAM FOR LOCAL SCHOOLS AND HAVE REACHED OUT TO SCHOOLS TO OFFER EDUCATIONAL OPPORTUNITIES THROUGH THE CAMERON COMMUNITY WELLNESS GARDEN. |
| PART III, LINE 2: | MANAGEMENT REGULARY REVIEWS DATA ABOUT THE MAJOR PAYOR SOURCES OF REVENUE IN EVALUATING THE SUFFICIENCY OF THE ALLOWANCE FOR UNCOLLECTIBLE ACCOUNTS. FOR RECEIVABLES ASSOCIATED WITH SERVICES PROVIDED TO PATIENTS WHO HAVE THIRD PARTY COVERAGE, THE HOSPITAL ANALYZES CONTRACTUALLY DUE AMOUNTS AND PROVIDES AN ALLOWANCE FOR UNCOLLECTIBLE ACCOUNTS AND PROVISION FOR BAD DEBTS, IF NECESSARY. FOR RECEIVABLES ASSOCIATED WITH SELF PAY PAYMENTS, WHICH INCLUDES BOTH PATIENTS WITHOUT INSURANCE AND PATIENTS WITH DEDUCTIBLE AND COPAYMENT BALANCES DUE FOR WHICH THIRD PARTY COVERAGE EXISTS FOR PART OF THE BILL, THE HOSPITAL RECORDS A SIGNIFICANT PROVISION FOR BAD DEBTS IN THE PERIOD OF SERVICE ON THE BASIS OF PAST EXPERIENCE, WHICH INDICATES THAT MANY PATIENTS ARE UNABLE OR UNWILLING TO PAY THE PORTION OF THEIR BILL FOR WHICH THEY ARE FINANCIALLY RESPONSIBLE. THE PROVISION FOR BAD DEBTS RELATING TO PATIENT SERVICE REVENUE HAS BEEN PRESENTED AT THE ACTUAL AMOUNT OF CHARGES WRITTEN OFF. |
| PART III, LINE 3: | THE HOSPITAL HAS A DETAILED FINANCIAL ASSISTANCE POLICY WHICH STATES THAT TO PARTICIPATE IN CHARITY CARE CANDIDATES MUST COOPERATE FULLY. IN ADDITION THE HOSPITAL EDUCATES PATIENTS WILL LIMITED ABILITY TO PAY REGARDING FINANCIAL ASSISTANCE. FOR THIS REASON THE ORGANIZATION BELIEVES THAT IT ACCURATELY CAPTURES ALL CHARITY CARE DEDUCTIONS PROVIDED ACCORDING TO THE FINANCIAL ASSISTANCE POLICY AND THE AMOUNT OF BAD DEBT EXPENSE ATTRIBUTABLE TO PATIENTS ELIGIBLE UNDER THE ORGANIZATION'S CHARITY CARE POLICY IS NEGLIGIBLE. |
| PART III, LINE 4: | EXPLANATION OF FINANCIAL STATEMENT FOOTNOTE:SEE THE AUDITED FINANCIAL STATEMENT FOOTNOTE 1 "PATIENT ACCOUNTS RECEIVABLE, PATIENT SERVICE REVENUE AND ESTIMATED THIRD-PARTY PAYOR SETTLEMENTS" LOCATED ON PAGE 7 AND 8 OF THE AUDITED FINANCIAL STATEMENTS. |
| PART III, LINE 8: | THE SOURCE USED TO DETERMINE THE AMOUNT OF MEDICARE ALLOWABLE COSTS REPORTED FOR PART III, SECTION B, MEDICARE HAS BEEN PROVIDED FROM THE YEAR ENDED 9/30/2021 MEDICARE COST REPORT: HOSPITAL STATEMENT OF REIMBURSABLE COST. |
| PART III, LINE 9B: | THE BILLING AND COLLECTION POLICY ADDRESSES THE ACTIONS THAT MAY BE TAKEN IN THE EVENT OF NONPAYMENT FOR MEDICAL CARE, ENSURES APPROPRIATE BILLING AND COLLECTION PROCEDURES ARE UNIFORMLY FOLLOWED, AND ENSURES THAT REASONABLE EFFORTS ARE MADE TO DETERMINE WHETHER THE INDIVIDUAL(S) RESPONSIBLE FOR PAYMENT OF ALL OR A PORTION OF A PATIENT ACCOUNT IS ELIGIBLE FOR ASSISTANCE UNDER THE FINANCIAL ASSISTANCE POLICY. FINANCIAL ASSISTANCE STAFF AND MANAGEMENT ARE RESPONSIBILITY FOR ENSURING REASONABLE EFFORTS HAVE BEEN MET ON APPLICABLE ACCOUNTS PRIOR TO INITIATION OF ANY EXTRAORDINARY COLLECTION ACTIONS. |
| PART VI, LINE 2: | DESCRIPTION OF HOW COMMUNITY HEALTH CARE NEEDS ARE ASSESSED:IN ADDITION TO CONDUCTING THE TRIENNIAL COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA) THE HOSPITAL BOARD OF DIRECTORS AND MANAGEMENT WORK ONGOING THROUGHOUT THE YEAR WITH COMMUNITY LEADERS, VOLUNTEERS, LOCAL COMMUNITY MEMBERS TO KEEP UP-TO-DATE ON ISSUES WITHIN THE COMMUNITY. THE HOSPITAL PROVIDES MANY EDUCATIONAL OPPORTUNITIES AND SUPPORT ACTIVITIES BEYOND ACUTE MEDICAL AND SURGICAL CARE. |
| PART VI, LINE 3: | DESCRIPTION OF PATIENT EDUCATION OF ELIGIBILITY FOR ASSISTANCE:THE CHARITY CARE POLICY IS AVAILABLE IN THE ER AND REGISTRATION AREAS OF THE HOSPITAL. CAMERON DISTRIBUTES AN "IMPORTANT BILLING INFORMATION FOR UNINSURED PATIENTS" HANDOUT TO EVERY UNINSURED PATIENT. THIS HANDOUT IS DESIGNED TO HELP PATIENTS UNDERSTAND THE BILLING PROCESS, PAYMENT OPTIONS AND FINANCIAL ASSISTANCE THAT IS AVAILABLE. WE HAVE FINANCIAL COUNSELORS AVAILABLE TO DISCUSS WITH THE PATIENTS' FEDERAL, STATE AND HOSPITAL FINANCIAL ASSISTANCE PROGRAMS AND ASSIST WITH ENROLLMENT PROGRAMS, WHEN APPLICABLE. CAMERON IS AN APPROVED INDIANA MEDICAID ENROLLMENT CENTER FOR OUR PATIENTS. |
| PART VI, LINE 4: | DESCRIPTION OF COMMUNITY DEMOGRAPHICS:CAMERON MEMORIAL COMMUNITY HOSPITAL WAS OPENED IN 1926 AND IS LOCATED IN ANGOLA, INDIANA. ANGOLA IS LOCATED IN STEUBEN COUNTY, APPROXIMATELY 45 MILES NORTH OF FORT WAYNE, INDIANA. SINCE CAMERON HOSPITAL IS LOCATED IN EXTREME NORTHEAST INDIANA, IT SERVES PATIENTS FROM COMMUNITIES IN SOUTHWEST MICHIGAN AND NORTHWEST OHIO AS WELL. CAMERON HOSPITAL IS ONE OF THE LARGEST EMPLOYERS IN STEUBEN COUNTY. THE HEALTH CARE SECTOR IS IMPORTANT TO THE COUNTY'S ECONOMY, AS IT EMPLOYS A LARGE NUMBER OF ITS RESIDENTS, WHO PURCHASE A LARGE AMOUNT OF GOODS AND SERVICES FROM THE BUSINESSES LOCATED IN STEUBEN COUNTY. AS OF THE 2020 CENSUS, THE CITY OF ANGOLA HAD A POPULATION OF 9,340, WHILE THE STEUBEN COUNTY POPULATION WAS 34,435. DURING THE SUMMER MONTHS THE POPULATION IN STEUBEN COUNTY DRASTICALLY INCREASES DUE TO THE NUMEROUS LAKES IN THE COUNTY. THE CHARACTERISTICS OF THE POPULATION ARE FACTORS IN DETERMINING THE HEALTH CARE SERVICES THAT OUR COMMUNITY REQUIRES. THE PERCENTAGE OF THE POPULATION IN THE COMMUNITY OVER 65 YEARS OLD IS 21.0%. IN FISCAL YEAR 2020, CAMERON HOSPITAL HAD 169,800 OUTPATIENT VISITS AND 86% OF OUR PATIENT REVENUE WAS OUTPATIENT. THE FACILITY OPERATES AS AN INDEPENDENT CRITICAL ACCESS HOSPITAL AND RECEIVES COST-BASED REIMBURSEMENT. |
| PART VI, LINE 5: | DESCRIPTION OF OTHER COMMUNITY HEALTH PROMOTION:THE HOSPITAL IS VERY COMMITTED TO THE COMMUNITY BY SUPPORTING VARIOUS GROUPS AND NOT-FOR-PROFIT ORGANIZATIONS. NUMEROUS HAVE BEEN PROVIDED THROUGHOUT THE YEAR, SUPPORTING THE AREAS OF HEALTH, EDUCATION, AND SAFETY. ADDITIONALLY, HOSPITAL STAFF AND PHYSICIANS DONATE MANY HOURS OF THEIR TIME TO SERVE IN THE FAITH COMMUNITY CLINIC WHICH ASSISTS THE POOR AND UNDERSERVED OF THE COMMUNITY. FINALLY, THE HOSPITAL PARTNERS WITH AREA EMERGENCY PERSONNEL TO ASSIST WITH DISASTER PREPAREDNESS IN OUR COUNTY. THE HOSPITAL FEELS THAT DISASTER PREPAREDNESS IS AN IMPORTANT ROLE FOR IT TO PLAY IN OUR COMMUNITY, ASSISTING RESIDENTS IN THE EVENT OF A NATURAL DISASTER, INDUSTRIAL ACCIDENT OR OTHER LARGE-SCALE EMERGENCY. THE HOSPITAL OPERATES AN EMERGENCY ROOM OPEN TO ALL PERSONS REGARDLESS OF ABILITY TO PAY. IN ADDITION TO PROVIDING EMERGENCY SERVICES, THE HOSPITAL PROVIDES MINOR EMERGENCY AND URGENT CARE SERVICES TO ALL REGARDLESS OF ABILITY TO PAY. THE HOSPITAL PARTICIPATES IN MEDICAID, MEDICARE, CHAMPUS, AND/OR OTHER GOVERNMENT SPONSORED HEALTH PROGRAMS. IN ADDITION TO OUR PARTICIPATION IN THESE PROGRAMS, THE HOSPITAL ABSORBED MORE THAN $635,462 IN UNREIMBURSED MEDICARE COSTS DURING 2021. IN ADDITION, THE HOSPITAL ALSO ABSORBED $3,187,298.46 IN UNREIMBURSED MEDICAID COSTS DURING 2021. THE HOSPITAL ALSO PARTICIPATES IN A COMMUNITY CLINIC FOR POOR AND LOW-INCOME RESIDENTS, WHEREIN LAB, RADIOLOGY, AND REHAB COST ARE ENTIRELY WRITTEN OFF. ALTHOUGH THE PRIMARY CARE PHYSICIANS ARE NOT EMPLOYED STAFF OF THE HOSPITAL, A NUMBER OF PHYSICIANS VOLUNTEER THEIR SERVICES AT THE CLINIC. THE HOSPITAL OFFERS A COMPASSIONATE CARE PROGRAM TO ELIGIBLE PARTICIPANTS BASED ON THE FEDERAL POVERTY GUIDELINES AT THE 350% LEVEL. IN 2021 THE HOSPITAL ABSORBED $73,364 IN CHARITY CARE COSTS. CAMERON ALSO PROVIDES SCREENINGS FOR RESIDENTS WHO ARE UNINSURED OR UNDERINSURED INCLUDING: PSA SCREENINGS, SKIN CANCER SCREENINGS, BREAST CANCER SCREENINGS AND BLOOD GLUCOSE TESTING FOR DIABETES OR PRE-DIABETES. THE HOSPITAL HAS AN OPEN MEDICAL STAFF WITH PRIVILEGES AVAILABLE TO ALL QUALIFIED IN THE AREA. THE GOVERNING BODY (BOARD OF DIRECTORS) CONSISTS OF INDEPENDENT PEOPLE REPRESENTATIVE OF THE COMMUNITY WE SERVE. THE HOSPITAL RECEIVES STRONG SUPPORT FROM AREA RESIDENTS AS EVIDENCED BY THE LARGE BODY OF VOLUNTEERS COMMITTED TO FURTHERING THE HOSPITAL'S MISSION. CAMERON IS PROUD TO PROVIDE OUR COMMUNITY WITH AN STI CLINIC WHICH OPENED IN AUGUST 2018. WE ARE ALSO HONORED TO STAFF THE CLINIC WITH AN AMAZING TEAM OF SKILLED CAMERON VOLUNTEERS INCLUDING A CAMERON MIDWIFE, NURSE PRACTITIONER, STAFF NURSE, A LAB TECHNICIAN, A LICENSED COUNSELOR, AND A MEMBER OF OUR OFFICE STAFF WHO HELPS TO REGISTER PATIENTS. FURTHERMORE, THIS INCREDIBLE TEAM HAS VOLUNTEERED 609 HOURS OF TIME IN 2021 TO ENSURE PATIENT NEEDS AT THIS CLINIC ARE BEING FULFILLED. |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Compensation Committee | Yes (X) | CompensationCommitteeInd |
| Compensation Survey | Yes (X) | CompensationSurveyInd |
| Board Or Committee Approval | Yes (X) | BoardOrCommitteeApprovalInd |
| Severance Payment | 0 | SeverancePaymentInd |
| Supplemental Nonqual Rtr Plan | 0 | SupplementalNonqualRtrPlanInd |
| Equity Based Comp Arrngm | 0 | EquityBasedCompArrngmInd |
| Comp Based On Revenue Of Flng Org | 0 | CompBasedOnRevenueOfFlngOrgInd |
| Comp Bsd On Rev Related Orgs | 0 | CompBsdOnRevRelatedOrgsInd |
| Comp Bsd Net Earns Flng Org | 0 | CompBsdNetEarnsFlngOrgInd |
| Comp Bsd Net Earns Rltd Orgs | 0 | CompBsdNetEarnsRltdOrgsInd |
| Any Non Fixed Payments | 0 | AnyNonFixedPaymentsInd |
| Initial Contract Exception | 0 | InitialContractExceptionInd |
Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp (10 entries)
| TitleTitleTxt | Base Compensation Filing OrgBaseCompensationFilingOrgAmt | Compensation Based On Rltd OrgsCompensationBasedOnRltdOrgsAmt | Bonus Filing OrganizationBonusFilingOrganizationAmount | Bonus Related OrganizationsBonusRelatedOrganizationsAmt | Other Compensation Filing OrgOtherCompensationFilingOrgAmt | Other Compensation Rltd OrgsOtherCompensationRltdOrgsAmt | Deferred Compensation Flng OrgDeferredCompensationFlngOrgAmt | Deferred Comp Rltd OrgsDeferredCompRltdOrgsAmt | Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgAmt | Nontaxable Benefits Rltd OrgsNontaxableBenefitsRltdOrgsAmt | Total Compensation Filing OrgTotalCompensationFilingOrgAmt | Total Compensation Rltd OrgsTotalCompensationRltdOrgsAmt | Comp Report Prior990 Filing OrgCompReportPrior990FilingOrgAmt | Comp Report Prior990 Rltd OrgsCompReportPrior990RltdOrgsAmt |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| TODD RUMSEY MD | ||||||||||||||
| TREASURER | $642,526 | $0 | $0 | $0 | $0 | $0 | $11,400 | $0 | $17,680 | $0 | $671,606 | $0 | $0 | $0 |
| TERESA KING MD | ||||||||||||||
| SECRETARY | $506,139 | $0 | $0 | $0 | $0 | $0 | $11,400 | $0 | $4,620 | $0 | $522,159 | $0 | $0 | $0 |
| TOM MILLER MD | ||||||||||||||
| BOARD MEMBER | $427,219 | $0 | $0 | $0 | $0 | $0 | $11,400 | $0 | $12,268 | $0 | $450,887 | $0 | $0 | $0 |
| MELCHOR MERCADO | ||||||||||||||
| PHYSICIAN | $330,671 | $0 | $20,000 | $0 | $0 | $0 | $5,149 | $0 | $4,620 | $0 | $360,440 | $0 | $0 | $0 |
| CHARLES MACLEAN | ||||||||||||||
| PHYSICIAN | $291,938 | $0 | $38,500 | $0 | $0 | $0 | $11,400 | $0 | $12,268 | $0 | $354,106 | $0 | $0 | $0 |
| LYNN FAUR | ||||||||||||||
| PHYSICIAN | $279,373 | $0 | $28,321 | $0 | $0 | $0 | $10,517 | $0 | $17,680 | $0 | $335,891 | $0 | $0 | $0 |
| CONSTANCE M MCCAHILL | ||||||||||||||
| CHIEF EXECUTIVE OFFICER | $248,269 | $0 | $0 | $0 | $0 | $0 | $9,708 | $0 | $5,532 | $0 | $263,509 | $0 | $0 | $0 |
| ANGELA LOGAN | ||||||||||||||
| CNO | $216,841 | $0 | $0 | $0 | $0 | $0 | $4,723 | $0 | $4,620 | $0 | $226,184 | $0 | $0 | $0 |
| KELLY KEIRNS | ||||||||||||||
| EXECUTIVE DIRECTOR-SALES & MARKETING | $162,443 | $0 | $0 | $0 | $0 | $0 | $6,646 | $0 | $5,576 | $0 | $174,665 | $0 | $0 | $0 |
| DOUGLAS C BOMBA | ||||||||||||||
| FORMER CFO | $159,491 | $0 | $0 | $0 | $0 | $0 | $2,280 | $0 | $1,315 | $0 | $163,086 | $0 | $0 | $0 |
Schedule L IRS990ScheduleL
Bus Tr Involve Interested Prsn BusTrInvolveInterestedPrsnGrp
Name Of Interested NameOfInterested
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | TAMMI MCCOY | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Relationship Description | FAMILY MEMBER OF JOHN MCCOY | RelationshipDescriptionTxt |
| Transaction | $111,490 | TransactionAmt |
| Transaction | COMPENSATION PAID BY HOSPITAL | TransactionDesc |
| Sharing Of Revenues | 0 | SharingOfRevenuesInd |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (7 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| FORM 990, PART VI, SECTION B, LINE 11B | THE PROCESS OF REVIEWING THE FORM 990 INCLUDES A DETAILED REVIEW OF THE FORM AND REQUIRED SCHEDULES BY THE CHIEF EXECUTIVE OFFICER, CHIEF FINANCIAL OFFICER, AND INDEPENDENT ACCOUNTING FIRM. EACH VOTING MEMBER OF THE GOVERNING BODY RECEIVES A COPY OF THE FORM 990 INCLUDING REQUIRED SCHEDULES, AS ULTIMATELY FILED WITH THE IRS, PRIOR TO FILING. |
| FORM 990, PART VI, SECTION B, LINE 12C | A QUESTIONNAIRE IS SENT OUT ANNUALLY TO ALL OFFICERS, DIRECTORS OR TRUSTEES, AND KEY EMPLOYEES TO DISCLOSE PERSONAL AND BUSINESS RELATIONSHIPS. THE QUESTIONNAIRES ARE REVIEWED ANNUALLY. IF A CONFLICT EXISTS RESTRICTIONS WILL BE IMPOSED ON PERSONS WITH A CONFLICT SUCH AS PROHIBITING THEM FROM PARTICIPATING IN THE GOVERING BODY'S DELIBERATIONS AND DECISIONS IN THE TRANSACTIONS. |
| FORM 990, PART VI, SECTION B, LINE 15 | THE PROCESS FOR DETERMINING COMPENSATION OF THE CEO, COO, CFO, AND KEY EMPLOYEES INVOLVES REVIEW AND APPROVAL BY THE BOARD INCLUDING REVIEW OF COMPARABLE DATA FROM INDIANA HOSPITAL ASSOCIATION AND COMPDATA. THIS PROCESS IS DOCUMENTED IN THE BOARD MINUTES. |
| FORM 990, PART VI, SECTION C, LINE 19 | CAMERON MEMORIAL COMMUNITY HOSPITAL KEEPS COPIES OF THEIR GOVERNING DOCUMENTS, CONFLICTS OF INTEREST POLICY, AND FINANCIAL STATEMENTS ON SITE AND ARE AVAILABLE UPON REQUEST. |
| FORM 990, PART VII, SECTION B, LINE 1, COLUMN B: | DESCRIPTION OF SERVICES - INDEPENDENT CONTRACTORS: NAME: FORT WAYNE ORTHOPAEDICS, LLC SERVICE: ORTHOPAEDICS NAME: LABCORP INDIANA, INC. SERVICE: LABORATORY NAME: AMERI EBO LLC SERVICE: BUSINESS OFFICE EXTENSION NAME: HOSPITAL CARE GROUP SERVICE: HOSPITALIST PROGRAM NAME: ASSOCIATED ANESTHESIOLOGISTS SERVICE: ANESTHESIOLOGY |
| FORM 990, PART IX, LINE 11G | PURCHASED MEDICAL SERVICES: PROGRAM SERVICE EXPENSES 9,561,613. MANAGEMENT AND GENERAL EXPENSES 1,678,089. FUNDRAISING EXPENSES 9,255. TOTAL EXPENSES 11,248,957. COLLECTION FEE SERVICES: PROGRAM SERVICE EXPENSES 812,535. MANAGEMENT AND GENERAL EXPENSES 142,720. FUNDRAISING EXPENSES 668. TOTAL EXPENSES 955,923. |
| FORM 990, PART XII, LINE 2C, OVERSIGHT OF AUDIT: | THE AUDIT COMMITTEE ASSUMES RESPONSIBLITY FOR OVERSIGHT OF THE AUDIT OF THE FINANCIAL STATEMENTS AND SELECTION OF THE INDEPENDENT ACCOUNTANT, AND NO PROCESSES HAVE CHANGED FROM PRIOR YEAR. |
Schedule R IRS990ScheduleR
Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp
Disregarded Entity Name DisregardedEntityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | CAMERON MEDICAL OUTREACH INC | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 416 E MAUMEE STREET | AddressLine1Txt |
| City | ANGOLA | CityNm |
| State Abbreviation | IN | StateAbbreviationCd |
| ZIP | 46702 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 261105702 | EIN |
| Primary Activities | ASSISTED LIVING | PrimaryActivitiesTxt |
| Legal Domicile State | IN | LegalDomicileStateCd |
| Exempt Code Section | 501(C)(3) | ExemptCodeSectionTxt |
| Public Charity Status | LINE 10 | PublicCharityStatusTxt |
Direct Controlling Entity Name DirectControllingEntityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | CAMERON MEMORIAL COMMUNITY HOSPITAL | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Controlled Organization | Yes (1) | ControlledOrganizationInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Annts Rnts Rylts | 0 | ReceiptOfIntAnntsRntsRyltsInd |
| Gift Grnt Or Cap Contri To Oth Org | 0 | GiftGrntOrCapContriToOthOrgInd |
| Gift Grnt Cap Contri From Oth Org | 0 | GiftGrntCapContriFromOthOrgInd |
| Loans Or Guarantees To Other Org | 0 | LoansOrGuaranteesToOtherOrgInd |
| Loans Or Guarantees From Oth Org | 0 | LoansOrGuaranteesFromOthOrgInd |
| Div Related Organization | 0 | DivRelatedOrganizationInd |
| Asset Sale To Other Org | 0 | AssetSaleToOtherOrgInd |
| Asset Purchase From Other Org | 0 | AssetPurchaseFromOtherOrgInd |
| Asset Exchange | 0 | AssetExchangeInd |
| Rental Of Facilities To Oth Org | 0 | RentalOfFacilitiesToOthOrgInd |
| Rental Of Fclts From Oth Org | Yes (1) | RentalOfFcltsFromOthOrgInd |
| Perform Of Services For Oth Org | 0 | PerformOfServicesForOthOrgInd |
| Perform Of Services By Other Org | 0 | PerformOfServicesByOtherOrgInd |
| Sharing Of Facilities | Yes (1) | SharingOfFacilitiesInd |
| Paid Employees Sharing | Yes (1) | PaidEmployeesSharingInd |
| Reimbursement Paid To Other Org | 0 | ReimbursementPaidToOtherOrgInd |
| Reimbursement Paid By Other Org | Yes (1) | ReimbursementPaidByOtherOrgInd |
| Transfer To Other Org | 0 | TransferToOtherOrgInd |
| Transfer From Other Org | 0 | TransferFromOtherOrgInd |
Transactions Related Org TransactionsRelatedOrgGrp (2 entries)
| Transaction TypeTransactionTypeTxt | InvolvedInvolvedAmt | Method Of Amount DeterminationMethodOfAmountDeterminationTxt |
|---|---|---|
| CAMERON MEDICAL OUTREACH | ||
| K | $138,912 | FMV |
| CAMERON MEDICAL OUTREACH | ||
| Q | $2,008,661 | FMV |