2016-06-24T10:30:46-05:00 2015-09-30 481026809 Wendling Noe Nelson & Johnson LLC 534 S Kansas Ave Suite 1500 Topeka KS 666033491 990 2014-10-01 440668347 Cameron Regional Medical Center CAME 8166322101 1600 East Evergreen Street Cameron MO 64429 Joseph Abrutz Jr Administrator 8166322101 2016-06-16 1 Heather R Eichem P01515553 7852334226 2016-06-16 2014 2016-09-27 15:27:22Z Joseph Abrutz Jr 1600 East Evergreen Street Cameron MO 64429 59187136 0 X http://www.cameronregional.org/ X 1963 MO To provide acute inpatient and outpatient medical care to area residents regardless of ability to pay. 13 11 562 95 0 0 91961 230665 52771002 56581501 1542113 2023064 206003 351906 54611079 59187136 23750 34000 0 0 25519330 28137976 0 0 5638 24386253 25947400 49929333 54119376 4681746 5067760 79500894 82226290 27934418 27372288 51566476 54854002 X Our mission at Cameron Regional Medical Center (CRMC) is caring for all patients. To this end, we organize people, equipment, and facilities in a manner that best responds to their needs and to the needs of our service area. Our priorities are patients and families, physicians, and employees. Our goal is to be a regionally-recognized leader in patient satisfaction by exceeding customer expectations and continuing to achieve excellence in quality and cost-effective health care services. CRMC will provide services in an atmosphere that involves compliance with governmental mandates. Throughout our organization, our employees strive to provide sensitive, quality health care at all times by living our values. Lastly, CRMC recognizes the importance of viable and profitable operations to guarantee the continued existence and growth of the facility. 0 0 48508619 34000 57898112 Acute care hospital organized to provide inpatient and outpatient care to area residents regardless of ability to pay. 48508619 1 1 0 0 0 0 0 0 0 0 1 0 0 1 1 1 0 1 0 0 0 0 0 0 0 0 1 1 0 1 1 1 0 0 0 0 0 0 0 0 1 0 0 0 0 0 1 1 0 0 0 1 46 0 1 562 1 0 0 0 0 0 0 0 0 0 0 X 13 11 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 0 0 0 0 0 MO X Joseph Abrutz Jr 8166322101 1600 East Evergreen St Cameron MO 64429 Warren McElwain President 1.00 X X 0 0 0 Steve Huitt Vice-President 1.00 X X 0 0 0 Jennifer White Secretary 1.00 X X 0 0 0 Michael Poland Treasurer 1.00 X X 0 0 0 Don Gitthens Director 1.00 X 0 0 0 Rick Hatten Director 1.00 X 0 0 0 Barbara Ballew Director 1.00 X 0 0 0 Ken Raffety Director 1.00 X 0 0 0 Steve Tinnen Director 1.00 X 0 0 0 Mike Brown Director 1.00 X 0 0 0 David Just Director 1.00 X 0 0 0 Frederick Kiehl Physician & Director 8.00 X 48623 0 0 Stephanie Davis Physician & Director 1.00 X 0 0 0 Muhammad Amin Physician & Director thru 01/31/2015 40.00 X 341310 0 0 Joseph F Abrutz Jr Administrator 40.00 X 340547 0 10579 Rosa Patti Chief Financial Officer 47.00 X 154671 0 10579 John S Barton III Physician 39.00 X 345157 0 0 Doak Doolittle Physician 41.00 X 506856 0 0 Shahzad Shafique Physician 40.00 X 383926 0 0 Laeeq Tahirkheli Physician 40.00 X 641652 0 0 Kendall Deselms Physician 38.00 X 279393 0 0 3042135 0 21158 31 0 1 0 Premier Specialty Network 1835 E Republic Rd Suite 200 Springfield MO 65804 Physician specialists 1515711 Cameron Emergency Physicians PC 1600 E Evergreen Cameron MO 64429 Emergency physicians 1325500 Psychiatric Solutions Inc PO Box 840839 Dallas TX 75284 Operation of BHU unit 994440 CPSI PO Box 850309 Mobile AL 36685 Computer support services 379661 Orthopedic Surgeons Inc 2790 Clay Edwards Dr Suite 650 North Kansas City MO 64116 Surgeons 227841 8 18000 212665 230665 Patient service revenue 621990 55828772 55828772 EHR incentive payments 900099 752729 752729 56581501 693694 693694 12759 12759 77528 0 77528 77528 77528 1251611 65000 0 0 1251611 65000 1316611 1316611 Clinic management services 900099 126417 126417 Cafeteria 722210 97852 97852 Other income 900099 50109 50109 274378 59187136 57898112 0 1058359 34000 34000 963435 427385 536050 22794145 20999051 1795094 250134 226491 23643 2512421 2284639 227782 1617841 1464923 152918 148043 148043 144155 144155 303846 99838 204008 1167815 831327 336488 525397 484444 40953 555761 489874 65887 303153 251492 51661 1082241 1082241 3416993 3011396 405597 337969 36402 301567 Medical supplies 4590920 4590920 Medical professional fe 4107396 4051170 56226 Pharmaceuticals 3824589 3824589 Purchased services 2885004 2587679 297325 2554118 1730758 817722 5638 54119376 48508619 5605119 5638 46631 649088 5536814 7789282 17891250 18132479 889062 874661 277970 288876 56720926 35563724 22493275 21157202 27288298 27728434 5077594 5606268 79500894 82226290 5292390 5749844 21679753 20909781 580776 528103 381499 184560 27934418 27372288 X 51033638 54107958 532838 746044 51566476 54854002 79500894 82226290 X 5067760 -1988762 208528 X X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 1269433 1269433 22738937 11051172 11687765 31555300 24207364 7347936 1157256 305188 852068 21157202 Deferred debt issuance costs 359775 Third party payor settlements 3704286 Beneficial interest in net assets of CRMC Foundation 536648 Other receivables 924252 Accrued interest and dividends 33991 Cash value of life insurance 47316 5606268 Capital lease obligations 184560 184560 X 59187136 0 59187136 0 59187136 54119376 0 54119376 0 54119376 Part X, Line 2: Management is not aware of any uncertainties in income tax positions. 1 1 1 X 1 X 1 1 1 0 1 1 979261 928722 50539 0.00090 8076852 6452342 1624510 0.03000 9056113 7381064 1675049 0.03090 274613 3638 270975 0.00500 37080 2750 34330 0.00060 9424636 6078425 3346211 0.06180 1000 1000 0.00000 9737329 6084813 3652516 0.06740 18793442 13465877 5327565 0.09830 1 3987390 398739 17371147 19760984 -2389837 X 1 1 1 1 Cameron Regional Medical Center 1600 East Evergreen Street Cameron MO 64429 X X X Cameron Regional Medical Center Inc 1 0 0 1 X X X X X X X X X 12 1 0 0 1 X http://www.cameronregional.org X 1 12 0 1 0 1 X 100.000000000000 300.000000000000 X X X X X 1 1 X X X X 1 X http://www.cameronregional.org/business-office/ X http://www.cameronregional.org/business-office/ X http://www.cameronregional.org/business-office/ X X X X X 1 X 0 X X X X 1 X 0 0 Cameron Regional Medical Center, Inc. Part V, Section B, Line 5: The Medical Center conducted a town hall meeting and invited local hospital, public health community, mental health community, free clinics, community-based clinics, service providers, local residents, community leaders, opinion leaders, school leaders, business leaders, local government, faith-based organizations and persons (or organizations serving them), people with chronic conditions, uninsured community members, low income residents, and minority groups. Cameron Regional Medical Center, Inc. Part V, Section B, Line 11: 1) Due to a shortage of mental health providers in rural northwest Missouri and the growing need for this service, CRMC continues to focus on maintaining an adequate number of Psychiatrists on the Medical Staff. Five Psychiatrists, including a Child Psychiatrist and a Geriatric Psychiatrist, provide inpatient and outpatient services at CRMC on a regularly-scheduled basis. In addition, mental health counselors are now available at CRMC on an outpatient basis.2) CRMC continues to run 4 to 5 full-time Patient Courtesy Vans into 8 counties in rural northwest Missouri. Free transportation is provided Monday through Saturday to patients in need of medical services, but who have no other viable means of transportation. Patients are transported to and from the hospital, their physician's office, CRMC's satellite clinics, and/or CRMC's outpatient (specialty) clinics.3) CRMC's After-Hours Care continues to fill a definite void in the availability of evening health care services. After-hour providers are available Monday thru Thursday nights, 5:00 - 8:00 p.m., and are filled to capacity approximately 95% of the time. Additionally, early morning hours have been implemented five days per week at Westside Medical Offices, and evening hours are available at this clinic three nights per month.4) CRMC's 13th Annual Health Fair was expanded, with extensive blood work (anemia, blood sugar, thyroid, cholesterol, iron, GFR, & BUN/Creatinine), kidney function screenings, podiatry screenings, skin cancer spot checks, vein assessments, spirometries, weight management calculations, sleep study education, glucose testing, blood pressures, diabetes education, fall risk assessments, and bone densitometry screenings being offered to the public free of charge. Flu vaccinations were offered for a nominal charge. Almost 400 participants from 18 counties attended the comprehensive event.5) As has been the case for many years, CRMC's collection policies remain extremely lenient. Very small payments are accepted when necessary, and, as long as a consistent, good-faith effort is made to pay the bill, the account will remain with CRMC and the patient will not be sent to a collection agency. Charity care is available if the patient makes a good-faith effort, meets U.S. Federal Poverty Guidelines, and completes the applicable paperwork. CRMC's temperate collection policies are widely publicized in area media. Monthly audits are conducted to determine the public's satisfaction with CRMC's billing formats and practices.6) In terms of addressing obesity, CRMC continues to provide a regimented physician-assisted weight loss program at highly-discounted rates via one of its satellite clinics. In addition, free monthly training classes in diabetes, nutrition, and healthy eating are being held, with excellent participation rates.7) From fitness/wellness and obesity standpoints, both CRMC and the CRMC Foundation made sizeable donations to the recent relocation and expansion of the Cameron YMCA under terms of a five-year pledge.8) From fitness/wellness and obesity standpoints, the CRMC Foundation made sizeable donations/pledges to two area walking/fitness trails.9) CRMC and the CRMC Foundation continue to sponsor their annual 4-Mile Run, 2-Mile Walk, and Children's Fun Run on the Fourth of July. Approximately 250 runners, walkers, and children participate each year in this fitness/wellness event.10) Cameron Regional Medical Center, Inc. ("CRMC") continues to provide free public education seminars on Medicare, Medicaid, Medicare Advantage, managed care, commercial insurance, Part D, the PPACA, and other third-party payors on a semi-annual basis. The Medical Center also provides free enrollment assistance for both Medicaid and Medicare and free enrollment counseling for insurance, managed care, and other payors.11) A female OB/GYN has been recruited to start at CRMC in early spring 2016.Needs not being address by the Medical CenterNo. 6 Community Economic Development:As economic development is not a fundamental part of Cameron Regional Medical Center's mission or operations, CRMC plays a SUPPORTING ROLE ONLY in addressing this need. The Medical Center does cooperate in economic development efforts on an area-wide basis whenever possible in terms of financial support and manpower. Part V, Section B, Line 16 Financial Assistance Policy Website Availability Cameron Regional Medical Center, Inc. Part V, Section B, line 16a website: http://www.cameronregional.org/business-office/ Cameron Regional Medical Center, Inc. Part V, Section B, line 16b website: http://www.cameronregional.org/business-office/ Cameron Regional Medical Center, Inc. Part V, Section B, line 16c website: http://www.cameronregional.org/business-office/ 18 Cameron Medical Clinic 1600 E Evergreen Cameron MO 64429 Medical Clinic Walnut Medical Clinic 221 E 7th Street Cameron MO 64429 Medical Clinic Westside Medical Offices 1608 E Evergreen Cameron MO 64429 Medical Clinic Bethany Health Services 903 North 25th Street Bethany MO 64424 Medical Clinic Cameron Specialists - Internal Medicine 1608 E Evergreen Cameron MO 64429 Medical Clinic Cameron Obstetrics & Gynecology 1600 E Evergreen Suite A Cameron MO 64429 Medical Clinic Gallatin Family Medicine 502 S Main Gallatin MO 64640 Rural Health Clinic Hamilton Family Health Center 212 N Davis Hamilton MO 64644 Rural Health Clinic Stewartsville Medical Clinic 106 E 4th Stewartsville MO 64490 Rural Health Clinic Polo Family Health Center 101 E Meadowbrook Polo MO 64671 Rural Health Clinic Cameron Nephrology Clinic 1600 E Evergreen Suite B Cameron MO 64429 Medical Clinic Plattsburg Family Medicine 214 N Main Plattsburg MO 64477 Rural Health Clinic Lathrop Medical Clinic 705 Oak Street Lathrop MO 64465 Medical Clinic Pattonsburg Medical Clinic 110 N Central Ave Pattonsburg MO 64670 Rural Health Clinic Jamesport Outreach Clinic 409 W Auberry Grove Jamesport MO 64648 Rural Health Clinic Gilman City Medical Clinic 427 Main Street Gilman City MO 64642 Rural Health Clinic Eagleville Medical Clinic 12050 12th Street Eagleville MO 64442 Rural Health Clinic Lawson Family Practice 411 N Pennsylvania Avenue Lawson MO 64062 Medical Clinic Part I, Line 7: A cost-to-charge ratio derived from Worksheet 2 was used to calculate the amounts reported on line 7. Part I, Line 7g: The costs of subsidized health services include costs attributable to multiple physician clinics in the amount of $7,137,210. Part III, Line 4: See note A3 (page 8) of the audited financial statements regarding the allowance for uncollectible accounts.Part III Line 2:This amount was determined by multiplying a cost-to-charge ratio derived from Worksheet 2 by the Medical Center's bad debt expense for the tax year.Part III, Line 3:This amount was determined based on the overall income level of patients that submit all required documentation under the Medical Center's financial assistance policy. After the portion of bad debt cost attributed to subsidized health services, The Medical Center considers $310,808 of bad debt cost as community benefit. As a tax-exempt hospital, we must provide necessary services regardless of the patient's ability to pay for that care. Making quality patient care available to all in our community, regardless of their economic means, qualfies bad debts as a community benefit. Part III, Line 8: Medicare costs were obtained from the Medical Center's as-filed Medicare cost report for the tax year.The shortfall is a benefit to the Medical Center's community since it represents health care provided at less than cost to elderly and needy residents of the Medical Center's service area. Part III, Line 9b: At the time of admission and before discharge, each patient will receive a notice that the Medical Center has a Financial Assistance Policy (with a brief description of such policy) and directions for obtaining additional information about such policy. All itemized statements sent to the patient include a notice that the Medical Center has a Financial Assistance Policy and directions for obtaining additional information about such policy. If a patient submits a Financial Assistance Policy application, all payment notifications and collection actions are suspended until it is determined whether the patient is eligible for the Financial Assitance Policy (and if so, notifications and collection actions will cease). Part VI, Line 2: The Medical Center relies on the feedback and requests taken from patients of the Medical Center and its numerous clinics, as well as residents from its primary service area. Part VI, Line 3: The Medical Center employs a social worker that informs all patients of all available payment options. Part VI, Line 4: Cameron Regional Medical Center and its nine rural health clinics are located in Northwest Missouri. The primary service area is comprised of four rural counties consisting of Daviess, Caldwell, DeKalb, and Clinton. There are approximately 50,322 individuals that reside in the primary service area. Of these residents approximately 12.1% of them have an annual income below the federal poverty level. The median annual income per household for the four counties is approximately $45,556. Approximately 43% of the total services provided are for Medicare patients and 15% are for Medicaid patients. The nearest surrounding hospitals are located in Smithville, Excelsior Springs, and Richmond. The distance between these facilities and Cameron Regional Medical Center is approximately 28, 28, and 31 miles respectively. Part VI, Line 5: Cameron Regional Medical Center's governing body is comprised of residents from its primary service area. The Medical Center extends medical privileges to all local physicians who meet the requirements of the medical staff bylaws. All surplus funds are used to maintain and improve the medical facility and medical equipment in order to provide the best medical treatment possible to every patient. 1 College scholarships 42 34000 Part I, Line 2: Scholarships are paid directly to the college of the recipient. X X X 0 0 0 0 0 1 0 1 0 Muhammad Amin Physician & Director thru 01/31/2015 277831 0 63479 0 0 0 0 0 0 0 341310 0 0 0 Joseph F Abrutz Jr Administrator 275983 0 64564 0 0 0 0 0 10579 0 351126 0 0 0 Rosa Patti Chief Financial Officer 98979 0 55692 0 0 0 0 0 10579 0 165250 0 0 0 John S Barton III Physician 345157 0 0 0 0 0 0 0 0 0 345157 0 0 0 Doak Doolittle Physician 432856 0 74000 0 0 0 0 0 0 0 506856 0 0 0 Shahzad Shafique Physician 300718 0 83208 0 0 0 0 0 0 0 383926 0 0 0 Laeeq Tahirkheli Physician 517354 0 124298 0 0 0 0 0 0 0 641652 0 0 0 Kendall Deselms Physician 279393 0 0 0 0 0 0 0 0 0 279393 0 0 0 Part I, Line 6 The Administrator is eligible for an annual bonus that is partially contingent on meeting a specific operating margin percentage. Part I, Line 7 The Administrator is eligible for an annual bonus that is partially contingent on meeting quality measures goals and strategic planning goals. The Chief Financial Officer also received a bonus during the fiscal year ending in 2015. The Medical Center is mandated to meet all Meaningful Use Regulations to participate in the electronic health record program mandated by the federal government, with this in mind instead of hiring a special consultant on a contract basis, the CFO took it upon herself to meet the regulations needed to meaningful use, and therefore was approved a bonus based on the complexity of the meaningful use regulations. A The Industrial Development Authority of the City of Cameron Missouri 431679396 133451BF0 2007-05-17 10000000 Refund Series 2000 bonds issued on 12/13/2000 0 0 0 B The Industrial Development Authority of Clinton County Missouri 521734480 133451AB6 2007-05-17 9994879 Refund Series 2000 bonds issued on 12/13/2000 and purchase equipment 0 0 0 A 2865000 10000000 389600 197701 4037 9798262 2007 0 1 1 1 B 9994879 885243 197054 913437 8884388 2007 0 1 1 1 A 0 0 0 1 0 0 0 0 1 B 0 0 0 1 0 0 0 0 1 A 1 B 1 Date Rebate Computation Performed Issuer Name: The Industrial Development Authority of the City of Cameron, M Date the Rebate Computation was Performed: 12/01/2010 Issuer Name: The Industrial Development Authority of Clinton County, Missou Date the Rebate Computation was Performed: 12/01/2010 Markie Hadley Family member of Rosa Patti, CFO 25471 Employment 0 Form 990, Part VI, Section B, line 11 A copy of form 990 is made available to the governing body prior to filing. Form 990, Part VI, Section B, line 12c Employees and Directors are required to complete an annual disclosure information form. Form 990, Part VI, Section C, line 19 Organization makes its governing documents available upon request. Form 990, Part XI, line 9: Change in beneficial interest in net assets of CRMC Foundation 208,528. Form 990, Part XII, Line 2C: The audit committee assumes the responsibility for the oversight of the audited financial statements, review of the Form 990, and selection of the independent accounting firm. Cameron Regional Medical Center Provider Management Service Organization LL 1600 East Evergreen Street Cameron MO 64429 472649803 To provide support and administrative services to physician groups KS 126417 61891 Cameron Regional Medical Center Cameron Regional Medical Center Foundation 1600 East Evergreen Street Cameron MO 64429 742933060 To support the operation of the Cameron Regional Medical Center, Inc.. MO 501(c)(3) Line 7 0 0 1 1 0 0 0 0 0 0 0 0 0 0 1 1 0 0 0 0