2020-08-17T12:33:35-05:00 2019-09-30 351178661 BLUE & CO LLC 500 N MERIDIAN ST SUITE 200 INDIANAPOLIS IN 46204 990 2018-10-01 350211370 CAMERON MEMORIAL COMMUNITY HOSPITAL INC CAME 2606652141 416 E MAUMEE STREET ANGOLA IN 46703 CONSTANCE MCCAHILL CHIEF EXECUTIVE OFFICER 2606652141 2020-08-17 1 NATHAN A RODGERS CPA P01568275 3176334705 2020-07-31 47.227.233.166 2020-08-17 12:16:01 ED P DA39A3EE5E6B4B0D3255BFEF95601890AFD80709 CF253C16AA79457DBB141110F0942FA5491417DB 2018 2020-09-23 17:36:50Z CONSTANCE MCCAHILL 416 E MAUMEE STREET ANGOLA IN 46703 69701975 0 X WWW.CAMERONMCH.COM X 1972 IN CMCH IS AN INDEPENDENT, NOT FOR PROFIT, CRITICAL ACCESS HOSPITAL OFFERING HEALTH & WELLNESS SERVICES. 13 10 722 52 0 0 40914 191405 61692232 66074283 433610 98674 1267649 563098 63434405 66927460 0 29126 0 0 30194768 32723090 0 0 285109 34831049 37858456 65025817 70610672 -1591412 -3683212 87970455 83271798 49420631 48381519 38549824 34890279 X 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. 0 0 46695718 29126 66164478 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. 3813000 RADIOLOGY SERVICE IS OFFERED TO PATIENTS AT THE HOSPITAL. ANNUALLY THE HOSPITAL PERFORMS OVER 33,800 PROCEDURES, INCLUDING GENERAL RADIOLOGY SERVICES, CT SCANS, PET SCANS AND AN OPEN BORE MRI. RADIOLOGY GROSS REVENUE IS $32,480,000 BEFORE CONTRACTUAL ALLOWANCES AND CHARITY CARE. 4793000 SURGERY SERVICE IS A PROGRAM OFFERED TO PATIENTS AT THE HOSPITAL. OVER 5,000 PROCEDURES ARE PERFORMED ANNUALLY, WITH 81% OF THE PROCEDURES BEING OUTPATIENT RELATED. SURGERY GROSS REVENUE SERVICE IS $24,244,000 BEFORE CONTRACTUAL ALLOWANCES AND CHARITY CARE. 2123000 EMERGENCY ROOM SERVICES IS THE THIRD LARGEST PROGRAM OFFERED TO PATIENTS AT CMCH. OVER 15,000 PATIENTS CAME THROUGH CAMERON'S EMERGENCY ROOM. EMERGENCY ROOM SERVICES GROSS REVENUE IS $17,458,000 BEFORE CONTRACTUAL ALLOWANCES AND CHARITY CARE. 2660000 LAB SERVICES IS THE FOURTH LARGEST PROGRAM OFFERED TO PATIENTS AT THE HOSPITAL. OVER 184,300 ARE DONE WITH 87% BEING OUTPATIENT RELATED. LAB GROSS REVENUE SERVICES IS $14,884,000 BEFORE CONTRACTUAL ALLOWANCES AND CHARITY CARE. 4783000 60084718 1 1 0 1 0 0 0 0 0 0 1 0 0 0 1 1 0 1 0 0 0 0 0 0 1 0 1 1 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 1 0 1 71 0 1 722 1 0 0 0 0 0 0 0 0 0 0 0 0 X 13 10 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 0 IN X CONSTANCE MCCAHILL 2606652141 416 E MAUMEE STREET ANGOLA IN 46703 X JENNIFER DANIC CHAIR 2.00 2.00 X X 0 0 0 DEBORAH MCHENRY VICE CHAIR 2.00 2.00 X X 0 0 0 BARBARA SHORT TREASURER 2.00 2.00 X X 0 0 0 DANIEL CARUSO SECRETARY 2.00 2.00 X X 0 0 0 JONATHAN CRESS BOARD MEMBER 2.00 2.00 X 0 0 0 TERESA KING MD BOARD MEMBER-TERM BEGAN JAN'19 40.00 2.00 X 514761 0 15632 JOHN MCCOY BOARD MEMBER 2.00 2.00 X 0 0 0 TOM MILLER MD BOARD MEMBER 40.00 2.00 X 393542 0 23166 JEFFERY NICKEL MD BOARD MEMBER 2.00 2.00 X 0 0 0 TODD RUMSEY MD BOARD MEMBER 40.00 2.00 X 523556 0 18095 OREN SKINNER BOARD MEMBER 2.00 2.00 X 0 0 0 TERRY VANETTE BOARD MEMBER 2.00 2.00 X 0 0 0 DENNIS ZENT DDS BOARD MEMBER 2.00 2.00 X 0 0 0 JONATHAN ALLEY DO BOARD MEMBER-TERM ENDED DEC'18 2.00 2.00 X 0 0 0 CONSTANCE M MCCAHILL CHIEF EXECUTIVE OFFICER 38.00 2.00 X 231831 0 14685 DOUGLAS C BOMBA CHIEF FINANCIAL OFFICER 36.00 4.00 X 207197 0 13864 KRISTOPHER D KEEN CHIEF INFORMATION OFFICER 40.00 0.00 X 190419 0 24084 LYNN FAUR URGENT CARE MEDICAL DIRECT 40.00 0.00 X 367845 0 21622 CHARLES MACLEAN PHYSICIAN 40.00 0.00 X 262853 0 22985 JAMES HUNTER PHYSICIAN ASSISTANT 40.00 0.00 X 169886 0 23272 LOIS CHAUNCEY EXECUTIVE DIRECTOR - HR 40.00 0.00 X 140582 0 4327 SHARON SPRINGER CHIEF NURSING OFFICER 40.00 0.00 X 129456 0 21628 3131928 0 203360 22 0 1 0 APRN - ALLIED MEDICAL SERVICES 1133 CORPORATE DRIVE HOLLAND OH 46804 SEE SCHEDULE O 1070561 AMERI EBO LLC 1851 S ALVERNO ROAD MANITOWOC WI 54221 SEE SCHEDULE O 596841 HOSPITAL CARE GROUP 6435 WEST JEFFERSON BLVD FORT WAYNE IN 46804 SEE SCHEDULE O 578488 ASSOCIATED ANESTHESIOLOGISTS 10315 DAWSONS CREEK SUITE A/B FORT WAYNE IN 46825 SEE SCHEDULE O 543278 NICHOLS COMPANY 229W BERRY STREET SUITE 100 FORT WAYNE IN 46802 SEE SCHEDULE O 489158 20 58386 133019 191405 NET PATIENT SERVICE REVENUE 621400 66062915 66062915 MEALS ON WHEELS 624200 10728 10728 COMMUNITY HEALTH 624200 640 640 66074283 937666 937666 90195 0 90195 90195 90195 1897838 2736485 345 -838647 -345 -838992 -838992 22157 58386 37685 -15528 -15528 CAFETERIA 900099 239970 239970 PHARMACY 900099 26843 26843 VENDING 900099 14343 14343 207275 207275 488431 66927460 66164478 0 571577 X 29126 29126 2170832 1848947 314355 7530 22990959 19581927 3329288 79744 861692 727370 131261 3061 4910308 4144882 747984 17442 1789299 1510381 272562 6356 34471 29300 5079 92 127100 108035 18727 338 4718 4010 695 13 11380157 9673134 1677180 29843 485579 415221 68178 2180 940290 790661 147314 2315 5453149 4755606 687064 10479 33603 28734 4718 151 245663 210068 34492 1103 1573276 1337285 233342 2649 6065262 5145260 909790 10212 511295 433740 76694 861 MEDICAL SUPPLIES 6289419 5378111 911308 HAF EXPENSE 2901749 2481299 407421 13029 MINOR EQUIPMENT 699835 598432 98261 3142 DUES & SUB. 452542 386971 63539 2032 660348 466218 101593 92537 70610672 60084718 10240845 285109 276421 256200 2396988 2252199 9809507 9534133 586817 396859 1745445 1746838 911631 810199 79460450 36092522 47341085 43367928 20176608 20231337 3329021 3329021 885713 885713 511219 461371 87970455 83271798 4754984 5062592 44194465 43162688 471182 156239 49420631 48381519 X 38105240 34428908 444584 461371 38549824 34890279 87970455 83271798 -3683212 23667 0 X X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 4718 4718 0 PART II-B, LINE 1: DURING FISCAL YEAR 2019 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. 444584 92875 23825 4676 95237 461371 2705600 40914 124106 2426036 444584 238610 2546669 166722 246401 2705600 402557 47003 1780 212730 238610 498767 262296 -6126 352380 402557 1.00000 0 1 1 1419368 1419368 57334515 20879411 36455104 20000166 15213111 4787055 706401 706401 43367928 ESTIMATED THIRD-PARTY SETTLEMENT 156239 156239 X 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 CENTER AND RECOGNIZE A TAX LIABILITY IF THE CENTER HAS 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 CENTER, AND HAS CONCLUDED THAT AS OF SEPTEMBER 30, 2019 AND 2018, THERE ARE NO UNCERTAIN POSITIONS TAKEN OR EXPECTED TO BE TAKEN THAT WOULD REQUIRE RECOGNITION OF A LIABILITY OR DISCLOSURE IN THE ACCOMPANYING FINANCIAL STATEMENTS. THE CENTER IS SUBJECT TO ROUTINE AUDITS BY TAXING JURISDICTIONS; HOWEVER, THERE ARE CURRENTLY NO AUDITS FOR ANY TAX PERIODS IN PROGRESS. GOLF OUTING 27420 19089 8331 7295 2411 5887 BENEFIT BALL 53123 39297 13826 1241 13310 2300 5241 80543 58386 22157 1241 20605 2411 2300 11128 37685 -15528 1 1 X 1 X 1 X 1 1 1 0 1 1 240395 240395 0.00340 10167182 6369549 3797633 0.05380 10407577 6369549 4038028 0.05720 176960 176960 0.00250 33100 33100 0.00050 210060 210060 0.00300 10617637 6369549 4248088 0.06020 16284 16284 0.00020 2925 2925 0.00000 19209 19209 0.00020 1 4969229 268596 14203155 14723095 -519940 X 1 1 1 1 CAMERON MEMORIAL COMMUNITY HOSPITAL INC 416 E MAUMEE STREET ANGOLA IN 46703 WWW.CAMERONMCH.COM 18-005037-1 X X X X CAMERON MEMORIAL COMMUNITY HOSPITAL INC 1 0 0 1 X X X X X X X X X 18 1 0 1 1 X SEE PART V X X 1 16 0 1 0 1 X 100.000000000000 350.000000000000 X X X X X X 1 1 X X X 1 X SEE PART V X SEE PART V X SEE PART V X X X X X X X 1 X 0 X X X X X 1 X 0 0 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 ADDRESS 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. 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.NEED 4: SERVICES FOR YOUTH. NEED 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 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/ 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: DESCRIPTION OF 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 AS A TOP 100 CRITICAL ACCESS HOSPITAL, A RECOGNITION THAT ILLUSTRATES THE EXCEPTIONAL VALUE CAMERON PROVIDES TO THE COMMUNITY. 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. WE ALSO 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 HOPE TO EXPAND THIS PROGRAM MORE INTO THE LOCAL SCHOOLS IN THE UPCOMING YEAR. 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 2 "ALLOWANCE FOR UNCOLLECTIBLE ACCOUNTS" LOCATED ON PAGE 10 AND 11 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 9/30/2019 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 2010 CENSUS, THE CITY OF ANGOLA HAD A POPULATION OF 8,612, WHILE THE STEUBEN COUNTY POPULATION WAS 34,185. 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 20.2%. IN FISCAL YEAR 2019, CAMERON HOSPITAL HAD 135,400 OUTPATIENT VISITS AND 85% 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 OFTHEIR 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 $519,940 IN UNREIMBURSED MEDICARE COSTS DURING 2019. IN ADDITION, THE HOSPITAL ALSO ABSORBED $3,800,057 IN UNREIMBURSED MEDICAID COSTS DURING 2019. 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 300% LEVEL. IN 2019 THE HOSPITAL ABSORBED $240,452 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 936 HOURS OF TIME IN 2019 TO ENSURE PATIENT NEEDS AT THIS CLINIC ARE BEING FULFILLED. X X X 0 0 0 0 0 0 0 0 0 TERESA KING MD BOARD MEMBER-TERM BEGAN JAN'19 472357 0 40250 0 2154 0 11000 0 4632 0 530393 0 0 0 TOM MILLER MD BOARD MEMBER 389001 0 250 0 4291 0 11000 0 12166 0 416708 0 0 0 TODD RUMSEY MD BOARD MEMBER 495953 0 250 0 27353 0 1200 0 16895 0 541651 0 0 0 CONSTANCE M MCCAHILL CHIEF EXECUTIVE OFFICER 224373 0 0 0 7458 0 9141 0 5544 0 246516 0 0 0 DOUGLAS C BOMBA CHIEF FINANCIAL OFFICER 202918 0 0 0 4279 0 8324 0 5540 0 221061 0 0 0 KRISTOPHER D KEEN CHIEF INFORMATION OFFICER 138944 0 50250 0 1225 0 7812 0 16272 0 214503 0 0 0 LYNN FAUR URGENT CARE MEDICAL DIRECT 288898 0 77000 0 1947 0 10891 0 10731 0 389467 0 0 0 CHARLES MACLEAN PHYSICIAN 260641 0 250 0 1962 0 10780 0 12205 0 285838 0 0 0 JAMES HUNTER PHYSICIAN ASSISTANT 158630 0 10250 0 1006 0 7000 0 16272 0 193158 0 0 0 SHARON SPRINGER CHIEF NURSING OFFICER 126934 0 250 0 2272 0 5356 0 16272 0 151084 0 0 0 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: APRN-ALLIED MEDICAL SERVICES SERVICE: RESPIRATORY AND SLEEP THERAPY NAME: AMERI EBO LLC SERVICE: BUSINESS OFFICE EXTENSION NAME: HOSPITAL CARE GROUP SERVICE: HOSPITALIST PROGRAM NAME: ASSOCIATED ANESTHESIOLOGISTS SERVICE: ANESTHESIOLOGY NAME: NICHOLS COMPANY SERVICE: MARKETING AGENCY FORM 990, PART IX, LINE 11G PURCHASED MEDICAL SERVICES: PROGRAM SERVICE EXPENSES 8,741,959. MANAGEMENT AND GENERAL EXPENSES 1,515,333. FUNDRAISING EXPENSES 27,365. TOTAL EXPENSES 10,284,657. COLLECTION FEE SERVICES: PROGRAM SERVICE EXPENSES 931,175. MANAGEMENT AND GENERAL EXPENSES 161,847. FUNDRAISING EXPENSES 2,478. TOTAL EXPENSES 1,095,500. 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. CAMERON MEDICAL OUTREACH INC 416 E MAUMEE STREET ANGOLA IN 46702 261105702 ASSISTED LIVING IN 501(C)(3) LINE 10 CAMERON MEMORIAL COMMUNITY HOSPITAL 1 0 0 0 0 0 0 0 0 0 0 1 0 0 1 1 0 1 0 0 CAMERON MEDICAL OUTREACH K 138912 FMV CAMERON MEDICAL OUTREACH Q 2185138 FMV