2013-11-15T14:56:16-06:00 2012-12-31 861065772 DELOITTE TAX LLP 1111 BAGBY STREET SUITE 4500 HOUSTON TX 770022591 990 2012-01-01 431550298 AUDRAIN HEALTH CARE INC AUDR 5735825000 620 E MONROE MEXICO MO 652652963 DAVID NEUENDORF 5735828103 2013-11-15 1 BROOKE KITCHEN P00849302 7139822000 2012 2016-03-07 17:11:31Z SEE SCHEDULE O DAVID NEUENDORF 620 E MONROE MEXICO MO 652652963 55970381 0 X WWW.AUDRAINMEDICALCENTER.COM X 1918 MO SEE SCHEDULE O 14 11 518 120 0 0 1271149 1020213 55617531 51352851 108941 62770 414868 416126 57412489 52851960 35203 19292 0 0 27856793 27970980 0 0 0 31950698 27640514 59842694 55630786 -2430205 -2778826 31018249 29984118 26536821 27186694 4481428 2797424 X TO CARE FOR THE SICK AND INFURED AND TO CONTINUOUSLY IMPROVE THE HEALTH AND WELL-BEING OF THE COMMUNITIES WE SERVE, IN PARTNERSHIP WITH PHYSICIANS, HEALTHCARE PROVIDERS AND RESIDENTS. 0 0 15287803 19292 10476371 AUDRAIN MEDICAL CENTER PROVIDES INPATIENT CARE TO THE COMMUNITY REGARDLESS OF AN INDIVIDUAL'S ABILITY TO PAY. INPATIENT CARE SERVICES WERE PROVIDED TO 2,263 CUSTOMERS. SEE SCHEDULE O. 23098621 33423468 AUDRAIN MEDICAL CENTER PROVIDES OUTPATIENT CARE TO THE COMMUNITY REGARDLESS OF AN INDIVIDUAL'S ABILITY TO PAY. OUTPATIENT CARE SERVICES WERE PROVIDED TO 78,056 CUSTOMERS. SEE SCHEDULE O. 9703679 7453012 AUDRAIN MEDICAL CENTER CLINICS (MEDCHOICE) PROVIDE OUTPATIENT CLINICAL SERVICES TO THE COMMUNITY REGARDLESS OF ANY INDIVIDUAL'S ABILITY TO PAY. AMC CLINICS PROVIDED OUTPATIENT SERVICES TO 58,965 CUSTOMERS IN 2012. SEE SCHEDULE O. 48090103 1 1 0 1 0 0 0 0 0 1 1 0 0 0 1 1 1 0 0 0 0 0 0 0 0 0 1 1 1 0 1 0 0 0 0 0 0 1 0 0 0 0 0 0 1 0 0 0 1 218 0 1 518 1 0 0 0 0 0 0 0 0 0 0 0 X 14 11 0 0 0 0 0 0 0 1 1 0 0 0 1 1 1 1 1 1 1 0 X JENNIFER OGDEN 5735828095 620 EAST MONROE MEXICO MO 652652963 N EUGENE THOMAS 40.50 X X 404326 0 0 NEUENDORF DAVID A 40.80 X X 213314 0 2400 CHARLES SCHAFER 1.00 X X 0 0 0 SUSAN WILBURN 1.00 X X 0 0 0 CHARLES TILLMAN 0.90 X X 0 0 0 GENEVA ALLISON 0.80 X 0 0 0 JOHN DIAL 0.70 X 0 0 0 KATHY MILLER 0.80 X 0 0 0 STERLING OLIVER 1.40 X X 0 0 0 KIM RETTENMAIER 0.90 X 0 0 0 RANDAL ROBLEY 0.80 X 0 0 0 SUE WAECHTER 1.40 X X 0 0 0 WILLIAM DUBBERT 0.40 X X 0 0 0 JO ELLEN CRAGHEAD 0.40 X 0 0 0 SHAW GREG 40.00 X 118525 0 9113 SHAHID WAHEED 40.00 X 553234 0 3779 PETER D PERLL 40.00 X 386023 0 0 PEGGY A BARJENBRUCH 40.00 X 364092 0 5329 MICHAEL QUINLAN 40.00 X 340031 0 8142 JOAN SLAUGHTER 40.00 X 269770 0 4000 2649315 0 32763 27 0 1 0 AUDRAIN EMERGENCY GROUP LLC PO BOX 82368 LAFAYETTE LA 70598 ER PHYSICIANS 486260 DR BRADLEY BUCHANAN 3 SOUTHMOR MEXICO MO 65265 ANESTHESIOLOGY 469332 MEXICO CARDIOGRAPHICS 720 MEDICAL PARK DRIVE MEXICO MO 65265 EEG/EKG READING 367950 PATHOLOGY LABORATORIES PO BOX 7406 COLUMBIA MO 65205 LAB SERVICES 345119 LTA COMPANY LLC PO BOX 207 MEXICO MO 65265 ANESTHESIOLOGY 264000 15 308930 691283 20000 1020213 OUTPATIENT REVENUE 621400 32162153 32162153 INPATIENT REVENUE 621110 9930296 9930296 AMC & MEDCHOICE PHYSICIAN REVENUE 621400 6948011 6948011 ELECTRONIC HEALTH RECORDS REVENUE 900099 2312391 2312391 51352851 18175 18175 113369 0 113369 113369 113369 3163016 3116869 1552 46147 -1552 44595 44595 CAFETERIA 722210 183748 183748 DISCOUNTS AND REBATES 900099 92313 92313 MEDICAL RECORDS 561000 26696 26696 302757 52851960 51352851 0 478896 X 19292 19292 872796 775264 97532 21592979 19180231 2412748 2006465 1774317 232148 2041878 1805632 236246 1456862 1288303 168559 133892 133892 100312 100312 7583078 6522407 1060671 103768 89254 14514 13034347 11087257 1947090 613445 613445 1700070 1462275 237795 52388 45060 7328 376409 288978 87431 3149764 2418145 731619 308637 265467 43170 MEDICAL SUPPLIES 272575 272575 DUES AND SUBSCRIPTIONS 165910 142704 23206 RECRUITMENT ALLOCATION 45919 39497 6422 55630786 48090103 7540683 0 3505 1040496 1116435 1203978 5711562 6066629 513223 447959 1508022 1682590 83281888 67038126 17992875 16243762 3525227 2137467 603054 489825 44346 671412 31018249 29984118 5930339 6181748 7172151 5450265 0 430000 13434331 15124681 26536821 27186694 X 4016462 2456018 282688 159128 182278 182278 4481428 2797424 31018249 29984118 X -2778826 145828 948994 X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 1 10516 0 0 0 10516 0 ORGANIZATIONS DIRECT AND INDIRECT POLITICAL CAMPAIGN ACTIVITIES: PART I-A, LINE 1: THE ORGANIZATION IS A MEMBER OF THE MISSOURI HOSPITAL ASSOCIATION, AND A PORTION OF THE DUES PAID ARE ATTRIBUTABLE TO LOBBYING ACTIVITIES. 3959469 0 -585196 0 12851 19294 3342128 4026494 0 -8789 0 42838 15398 3959469 4394652 43181 -296457 500 105437 8945 4026494 4084478 244672 1808806 0 1724140 19164 4394652 5028947 443106 550679 500 1913138 24617 4084477 1.00000 1 0 782780 782780 37970514 28670577 9299937 33584793 29067137 4517656 10943801 9300412 1643389 16243762 ESTIMATED PENSION LIABILITY 13134086 ASSET RETIREMENT OBLIGATION 498919 PROFESSIONAL LIABILITY RESERVE 642227 DUE TO THIRD-PARTY PAYORS 849449 15124681 X 52851950 0 52851950 10 10 52851960 55630786 0 55630786 0 55630786 DESCRIPTION OF INTENDED USE OF ENDOWMENT FUNDS: PART V, LINE 4: ALL FUNDS ARE USED TO PROVIDE HEALTH CARE SERVICES AND FUND CAPITAL IMPROVEMENTS. THE BONDS ARE HELD BY A TRUSTEE. DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: PART X, LINE 2: MANAGEMENT HAS EVALUATED THE ORGANIZATION'S INCOME TAX POSITIONS UNDER THE GUIDANCE INCLUDED IN ASC 740. BASED ON THEIR REVIEW, MANAGEMENT HAS NOT IDENTIFIED ANY MATERIAL UNCERTAIN TAX POSITIONS TO BE RECORDED OR DISCLOSED IN THE FINANCIAL STATEMENTS. 1 1 1 X 1 X 1 1 1 0 1 1 1482606 1482606 0.02670 7270000 5790000 1480000 0.02660 8752606 5790000 2962606 0.05330 44012 7324 36688 0.00070 8955 1687 7268 0.00010 50258 50258 0.00090 103225 9011 94214 0.00170 8855831 5799011 3056820 0.05500 3706 3706 0.00010 171403 171403 0.00310 37375 37375 0.00070 212484 212484 0.00390 1 1473161 17684880 18865712 -1180832 X 1 1 1 1 AUDRAIN MEDICAL CENTER

620 E MONROE MEXICO MO 65265

X X X AUDRAIN MEDICAL CENTER 1 1 1 100.000000000000 1 200.000000000000 1 X X 1 1 X X X X 1 0 1 X 0 0 12 MEXICO HEALTH SERVICES

600 MEDICAL PARK DRIVE MEXICO MO 65265

OUTPATIENT PHYSICIAN CLINIC MEXICO FAMILY HEALTH CARE

626 SUMMIT SUITE L MEXICO MO 65265

OUTPATIENT PHYSICIAN CLINIC MEXICO PEDIATRIC SERVICES

1025 OLD FARM ROAD MEXICO MO 65265

OUTPATIENT PHYSICIAN CLINIC WELLSVILLE MEDICAL CLINIC

111 W BATES WELLSVILLE MO 63384

OUTPATIENT PHYSICIAN CLINIC SUMMIT MEDICAL PARK LAB & X-RAY

626 SUMMIT MEXICO MO 65265

LAB & X-RAY MEXICO SURGICAL SERVICES

626 SUMMIT SUITE F MEXICO MO 65265

OUTPATIENT PHYSICIAN CLINIC MONTGOMERY CITY MEDICAL CLINIC

240 N PICKERING MONTGOMERY CITY MO 63361

OUTPATIENT PHYSICIAN CLINIC MEDICAL PARK FAMILY PRACTICE

809 MEDICAL PARK DRIVE SUITE 101 MEXICO MO 65265

OUTPATIENT PHYSICIAN CLINIC VANDALIA MEDICAL CLINIC

204 W WASHINGTON VANDALIA MO 63382

OUTPATIENT PHYSICIAN CLINIC PERRY MEDICAL CLINIC

1223 MAIN STREET PERRY MO 63462

OUTPATIENT PHYSICIAN CLINIC PARIS MEDICAL CLINIC

221 N MAIN STREET PARIS MO 65275

OUTPATIENT PHYSICIAN CLINIC AUDRAIN FAMILY HEALTH

625 SUMMIT SUITE B MEXICO MO 65265

OUTPATIENT PHYSICIAN CLINIC PART I, LINE 7: THE COSTS REPORTED IN THE TABLE IN PART I, LINE 7 USED A COST ACCOUNTING METHOD. THIS METHODOLOGY WAS USED FOR ALL PATIENT SEGMENTS. FORM 990, SCHEDULE H, PART III PART III, LINES 2-4:ACCOUNTS ARE CONSIDERED DELINQUENT AND SUBSEQUENTLY WRITTEN OFF AS BAD DEBT BASED ON INDIVIDUAL CREDIT EVALUATION AND SPECIFIC CIRCUMSTANCES OF THE ACCOUNT. COSTING METHODOLOGY BAD DEBT IS ESTIMATED USING THE PERCENTAGE OF OPERATING EXPENSE TO PATIENT REVENUE. IT IS DIFFICULT TO DETERMINE THE AMOUNT OF BAD DEBT EXPENSE ATTRIBUTABLE TO PATIENTS WHO COULD QUALIFY FOR CHARITY CARE DUE TO THE LIMITED NUMBER OF FINANCIAL APPLICATIONS COMPLETED BY PATIENTS. IN ADDITION, BECAUSE WE ARE A COMMUNITY HOSPITAL, WE WILL NOT ATTACH LIENS TO REAL OR PERSONAL PROPERTY AND WE DON'T GARNISH WAGES.PART III, LINE 8: LINE 6 IS REPORTED PER THE COST REPORT, WORKSHEET D, PART V, OUTPATIENT, WORKSHEET D-4, HOSPITAL AND SUB PROVIDER.PART III, LINE 9B:PATIENTS IN NEED OF FINANCIAL ASSISTANCE COMPLETE AN APPLICATION AND THE LATEST AVAILABLE FPG IS USED TO DETERMINE WHO QUALIFIES. NORMAL COLLECTION EFFORTS ARE MADE ON ANY REMAINING BALANCE AFTER CHARITY CARE OR FINANCIAL ASSISTANCE WRITE OFF'S ARE APPLIED TO THE ACCOUNT. AUDRAIN MEDICAL CENTER PART V, SECTION B, LINE 20D: AMC PROVIDES AN AUTOMATIC 25% DISCOUNT FOR SELF-PAY PATIENTS. FURTHER DISCOUNTS OF UP TO 100% ARE GIVEN TO PATIENTS IF THEY QUALIFY UNDER THE FAP. FORM 990, SCHEDULE H NEEDS ASSESSMENT:THE ORGANIZATION PROVIDES A NUMBER OF PROGRAMS AND SERVICES SUCH AS :PROMOTING HEALTH AND EDUCATION, HEALTH SCREENING, TRAINING OF HEALTHPROFESSIONALS, AND COMMUNITY HEALTH IMPROVEMENT ADVOCACY. PROGRAMS LIKETHESE ALONG WITH INPUT FROM THE COMMUNITY ALLOWS US TO ASSESS THE HEALTH CARE AND SPECIAL NEEDS OF OUR COMMUNITY AND SURROUNDING COUNTIES.PATIENT EDUCATION OF ELIGIBILITY FOR ASSISTANCE:AT THE TIME OF REGISTRATION, THE PATIENT (OR THE RESPONSIBLE PARTY) WILL BE INFORMED OF PAYMENT EXPECTATIONS FOR SERVICES RECEIVED. A PATIENT CREDIT SERVICES EMPLOYEE WILL BE AVAILABLE TO DISCUSS FINANCIAL CONCERNS WITH THE RESPONSIBLE PARTY, INCLUDING EDUCATING THE RESPONSIBLE PARTY ON VARIOUS OPTIONS AVAILABLE TO THEM INCLUDING MEDICAID, MEDICARE, AS WELL AS CHARITY CARE.COMMUNITY INFORMATION:AUDRAIN HEALTH CARE, INC. IS THE SOLE HEALTH CARE PROVIDER IN THECOMMUNITY SERVING THREE COUNTIES WITH A POPULATION OF 47,000. THEORGANIZATION ALSO PROVIDES HEALTH CARE SERVICES THROUGH A NUMBER OFCLINICS.PROMOTION OF COMMUNITY HEALTH:AUDRAIN HEALTH CARE, INC. PROVIDES CLASSES AND SUPPORT GROUP MEETINGSCOVERING AN ARRAY OF TOPICS , EXAMPLES OF WHICH INCLUDE THE FOLLOWING:DIABETES SUPPORT GROUP, CANCER SUPPORT GROUP, NUTRITION EDUCATION FROM PRESCHOOL TO ELDERLY, DIVER SAFETY CLASSES, WOMEN'S HEALTH CONFERENCE,SAFE SITTER CLASSES, WELLNESS SCREENINGS, HEALTH FAIRS, SCOLIOSISSCREENING, CHILDBIRTH AND BREASTFEEDING CLASSES, GRIEF SUPPORT GROUPS,AND MANY MORE. STATE FILING OF COMMUNITY BENEFIT REPORT:MO 1 AUDRAIN CITY-COUNTY HEALTH UNIT OF AUDRAIN COUNTY 605 EAST PROMENADE MEXICO MO 65265 430783311 19292 OPERATING EXPENSES 1 0 PROCEDURE FOR MONITORING GRANTS IN THE U.S.: PART I, LINE 2: SCHEDULE I, PART I, LINE 2: THE ORGANIZATION REVIEWS REPORTS OF OPERATING EXPENSES RECEIVED FROM THE RECIPIENT THOUGHOUT THE YEAR. X X 0 0 0 0 0 0 0 0 0 N EUGENE THOMAS 393209 0 0 0 11117 0 0 0 0 0 404326 0 0 0 NEUENDORF DAVID A 210336 0 0 0 2978 0 0 0 2400 0 215714 0 0 0 SHAHID WAHEED 549215 0 0 0 4019 0 0 0 3779 0 557013 0 0 0 PETER D PERLL 384195 0 0 0 1828 0 0 0 0 0 386023 0 0 0 PEGGY A BARJENBRUCH 360647 0 0 0 3445 0 0 0 5329 0 369421 0 0 0 MICHAEL QUINLAN 339375 0 0 0 656 0 0 0 8142 0 348173 0 0 0 JOAN SLAUGHTER 267430 0 0 0 2340 0 0 0 4000 0 273770 0 0 0 LISA NEUENDORF FAMILY MEMBER OF CEO, D. NEUENDORF 64752 EMPLOYMENT 0 SHELLIE SHAW FAMILY MEMBER OF VP-CFO, G. SHAW 47852 EMPLOYMENT 0 ORGANIZATION MISSION STATEMENT FORM 990, PART I, LINE 1, DESCRIPTION OF ORGANIZATION MISSION: TO CARE FOR THE SICK AND INJURED AND TO CONTINUOUSLY IMPROVE THE HEALTH AND WELL BEING OF THE COMMUNITIES WE SERVE, IN PARTNERSHIP WITH PHYSICIANS, HEALTHCARE PROVIDERS AND RESIDENTS. FORM 990, PART VI, SECTION B, LINE 11 MANAGEMENT SUBMITS INFORMATION TO AN INDEPENDENT ACCOUNTING FIRM WHO PREPARES THE FORM 990. ONCE THE 990 IS COMPLETED, GREG SHAW, VP CFO, REVIEWS IT AND SUGGESTS EDITS AS NEEDED. THEN, THE BOARD OF DIRECTORS RECEIVE A COPY TO REVIEW AND DISCUSS AT THE NEXT BOARD MEETING. FORM 990, PART VI, SECTION B, LINE 12C THE ORGANIZATION'S CONFLICT OF INTEREST POLICY COVERS ANY PERSON SERVING THE ORGANIZATION AS A BOARD MEMBER, OFFICER, OR EMPLOYEE. THE CORPORATE COMPLIANCE COMMITTEE REVIEWS CONFLICTS OF INTEREST FOR EMPLOYEES, AND THE BOARD REVIEWS CONFLICTS OF INTEREST FOR DIRECTORS AND OFFICERS. A CONFLICT IS HANDLED THROUGH FULL DISCLOSURE OF ANY SUCH INTEREST, TOGETHER WITH NONINVOLVEMENT IN ANY DISCUSSION AND VOTE WHEREIN THE INTEREST IS INVOLVED. FORM 990, PART VI, SECTION B, LINE 15 A. EXECUTIVE COMPENSATION IS DETERMINED BY THE EXECUTIVE COMMITTEE OF THE BOARD OF DIRECTORS USING MISSOURI HOSPITAL ASSOCIATION COMPENSATION REPORTS THAT PROVIDE BENCHMARKS FOR HOSPITAL CEO'S IN MISSOURI BY BED SIZE, OPERATING BUDGET AND NUMBER OF FULL TIME EMPLOYEES. B. DIRECTOR OF HUMAN RESOURCES COMPARES INFORMATION USING MISSOURI HOSPITAL ASSOCIATION DATA. FORM 990, PART VI, SECTION C, LINE 19 DOCUMENTATION IS AVAILABLE UPON WRITTEN REQUEST. OTHER FEES FORM 990, PART IX, LINE 11G FEES: PHYSICIAN, THERAPIST, OTHER PROFESSIONAL, O/S LAB: PROGRAM SERVICE EXPENSES 2,931,114. MANAGEMENT AND GENERAL EXPENSES 476,657. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 3,407,771. SERVICES: PURCHASES, COLLECTIONS, O/S: PROGRAM SERVICE EXPENSES 3,204,269. MANAGEMENT AND GENERAL EXPENSES 521,076. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 3,725,345. ARAMARK, LINEN: PROGRAM SERVICE EXPENSES 387,024. MANAGEMENT AND GENERAL EXPENSES 62,938. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 449,962. CHANGES IN NET ASSETS OR FUND BALANCES: FORM 990, PART XI, LINE 9: CHANGE IN MINIMUM PENSION LIABILITY 1,072,563. CHANGE IN BENEFICIAL INTEREST OF FOUNDATION -123,569. FORM 990, PART I, DOING BUSINESS AS: SSM AUDRAIN HEALTH CARE, INC. CURRENTLY UTILIZES THE FOLLOWING FICTITIOUS NAMES AND EVIDENCE OF SUCH FILINGS WITH THE APPROPRIATE STATE AGENCY FOLLOW: 1. AUDRAIN ANESTHESIA SERVICES 2. AUDRAIN HEALTH CARE, INC. PHYSICIANS 3. AUDRAIN MEDICAL CENTER 4. AUDRAIN MEDICAL CLINIC - AUXVASSE 5. AUDRAIN MEDICAL CLINIC- WOMEN'S HEALTH 6. HEALTHWORKS 7. J.B. & GREETA B. ARTHUR CANCER CENTER 8. JORDAN-WATERS HEART CENTER 9. MEDCHOICE 10. MEDICAL PARK FAMILY PRACTICE 11. MEXICO FAMILY HEALTH CARE 12. MEXICO HEALTH SERVICES 13. MEXICO PEDIATRIC SERVICES 14. MEXICO SURGICAL SERVICES 15. MONTGOMERY CITY MEDICAL CLINIC 16. PARIS HEALTH CARE CLINIC 17. PERRY MEDICAL CLINIC 18. SPECIALTY SERVICES OF MEXICO 19. VANDALIA MEDICAL CLINIC 20. WELLSVILLE MEDICAL CLINIC AUDRAIN MEDICAL CENTER FOUNDATION 620 E MONROE MEXICO MO 65265 431265060 SUPPORT HOSP MO 501(C)(3) LINE 11A, I N/A 0 AUDRAIN MEDICAL CENTER AUXILIARY 620 E MONROE MEXICO MO 65265 431258870 SUPPORT HOSP MO 501(C)(3) LINE 9 N/A 0 0 0 1 0 0 0 0 0 0 0 0 1 1 1 1 1 0 0 0 AUDRAIN MEDICAL CENTER FOUNDATION C 244285 CASH CONTRIBUTION AUDRAIN MEDICAL CENTER AUXILIARY C 64645 CASH CONTRIBUTION