2025-08-12T08:16:31-05:00 2024-09-30 390758449 WIPFLI LLP 1502 LONDON ROAD SUITE 200 DULUTH MN 55812 990 2023-10-01 350211370 CAMERON MEMORIAL COMMUNITY HOSPITAL CAME 2606652141 416 E MAUMEE STREET ANGOLA IN 46703 ANDREW KLEBER CFO 2606652141 2025-08-11 1 1 MICHAEL J PETERSON CPA P01833529 2187224705 2025-08-11 2023 2025-03-06 01:10:19Z ANDREW KLEBER 416 E MAUMEE STREET ANGOLA IN 46703 118963628 0 X WWW.CAMERONMCH.COM X 1972 IN CMCH IS AN INDEPENDENT, NOT FOR PROFIT, CRITICAL ACCESS HOSPITAL OFFERING HEALTH & WELLNESS SERVICES. 10 8 759 71 0 0 1196114 2709837 105162867 114161680 976776 1048129 899018 983111 108234775 118902757 106039 123993 0 0 50774495 55594508 0 48000 451775 54645839 57311100 105526373 113077601 2708402 5825156 115765241 129916917 55577010 56319695 60188231 73597222 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 88202940 123993 114388996 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. SURGERY SERVICE IS A PROGRAM OFFERED TO PATIENTS AT THE HOSPITAL. OVER 4,000 PROCEDURES ARE PERFORMED ANNUALLY, WITH 89% OF THE PROCEDURES BEING OUTPATIENT RELATED. OTHER PROGRAMS INCLUDE RADIOLOGY, LAB SERVICES AND EMERGENCY ROOM.RADIOLOGY SERVICE IS OFFERED TO PATIENTS AT THE HOSPITAL. ANNUALLY THE HOSPITAL PERFORMS OVER 46,700 PROCEDURES, INCLUDING GENERAL RADIOLOGY SERVICES, CT SCANS, PET SCANS AND AN OPEN BORE MRI. LAB SERVICES IS THE FOURTH LARGEST PROGRAM OFFERED TO PATIENTS AT THE HOSPITAL. OVER 242,400 ARE DONE WITH 89% BEING OUTPATIENT RELATED. EMERGENCY ROOM SERVICES IS THE THIRD LARGEST PROGRAM OFFERED TO PATIENTS AT CMCH. OVER 16,900 PATIENTS CAME THROUGH CAMERON'S EMERGENCY ROOM. 88202940 1 1 0 1 0 0 0 0 0 0 1 0 0 0 1 0 0 1 0 0 0 0 0 1 1 0 1 1 1 0 1 0 0 0 0 0 0 1 0 0 0 0 0 0 1 1 1 0 0 1 49 0 759 1 0 0 0 0 0 0 0 0 0 0 0 0 X 10 8 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 0 IN X ANGELA LOGAN 2606652141 416 E MAUMEE STREET ANGOLA IN 46703 LYNN FAUR MD BOARD MEMBER/PHYSICIAN 40.00 2.00 X 291107 0 27915 JOHN MCCOY CHAIR 2.00 2.00 X X 0 0 0 ANN RICE VICE CHAIR 2.00 2.00 X 0 0 0 TODD RUMSEY MD TREASURER/PHYSICIAN 35.00 2.00 X X 564030 0 24659 DONNA ELBRECHT SECRETARY 2.00 2.00 X X 0 0 0 DEBORAH MCHENRY IMMEDIATE PAST CHAIR 2.00 2.00 X X 0 0 0 MIKE CONNELL BOARD MEMBER 2.00 2.00 X 0 0 0 JONATHAN CRESS BOARD MEMBER 2.00 2.00 X 0 0 0 SCOTT GRUNER BOARD MEMBER 2.00 2.00 X 0 0 0 JEFFERY NICKEL MD BOARD MEMBER 2.00 2.00 X 0 0 0 ANGELA LOGAN CHIEF EXECUTIVE OFFICER 42.00 2.00 X 467923 0 17829 CHRISTOPHER GASAWAY PHYSICIAN 40.00 X 270618 0 16457 CHARLES MACLEAN PHYSICIAN 36.00 X 348122 0 24245 DEAN MATTOX II MD PHYSICIAN 41.00 X 397231 0 22769 MATTHEW SIELOFF PHYSICIAN 40.00 X 353392 0 10794 JOHN VARNER MD PHYSICIAN 36.00 X 773925 0 29345 3466348 0 174013 82 0 1 0 JICI INC 319 POKAGON TRAIL STE A ANGOLA IN 46703 CONSTRUCTION SERVICES 5689019 WEIGANC CONSTRUCTION INC 7808 HONEYWELL DRIVE FORT WAYNE IN 46825 CONSTRUCTION SERVICES 2626576 FORT WAYNE ORTHOPAEDICS LLC PO BOX 2526 FORT WAYNE IN 468012526 ORTHOPAEDIC SERVICES 1166040 HOSPITAL CARE GROUP PC 6435 WEST JEFFERSON BLVD PMB 109 FORT WAYNE IN 46804 HOSPITALIST PROGRAM 834154 HIRONS & COMPANY 422 E NEW YORK ST INDINAPOLIS IN 46202 MARKETING SERVICES 640411 23 8448 2079563 621826 2709837 NET PATIENT SERVICE REVENUE 621400 111930192 111930192 340B PHARMACY REVENUE 623990 1877272 1877272 RELATED PARTY MANAGEMENT FEE 541610 337001 337001 MEALS ON WHEELS 624200 17215 17215 114161680 1069201 1069201 229439 0 229439 229439 229439 18000 10145 28927 -10145 -10927 -21072 -21072 44088 8448 21799 22289 22289 CAFETERIA REVENUE 722514 322921 322921 PHARMACY REVENUE 900099 11467 11467 VENDING 900099 3909 3909 393086 227316 165770 731383 118902757 114388996 0 1803924 X 123993 123993 3736319 2840198 881767 14354 38513508 29276402 9089146 147960 1116961 813647 298094 5220 9273943 6772534 2458512 42897 2953777 2159197 780973 13607 139449 1065 138384 178631 178631 1984 1984 48000 48000 12108262 10636909 1468407 2946 614173 613423 750 1349797 747336 591022 11439 2847518 467653 2371546 8319 2320516 2320516 108353 44071 64211 71 157402 84526 71673 1203 1370230 1243510 124963 1757 4625781 4189092 430498 6191 733618 201431 532187 MEDICAL SUPPLIES 16478246 16471449 6115 682 BAD DEBT EXPENSE 6325815 6325815 HAF EXPENSE 3760790 3760790 MINOR EQUIPMENT 1559433 1248811 310580 42 2631102 2234785 249980 146337 113077601 88202940 24422886 451775 130998 164769 19668145 16012258 11519464 12485328 562014 1852247 1476430 1822148 1474959 1748092 98265707 55083704 33358463 43182003 27204218 33663448 3329020 3329020 804596 731043 16236934 14926561 115765241 129916917 9325025 13987517 6018 6018 45817870 41927609 428097 398551 55577010 56319695 X 59439831 72125880 748400 1471342 60188231 73597222 115765241 129916917 5825156 7583835 0 X 0 1 X 1 1 1 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 1984 1984 0 PART II-B, LINE 1: DURING FISCAL YEAR 2024 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. 2240172 2240172 61742281 38464370 23277911 22582763 16619334 5963429 11700491 11700491 43182003 ASSETS LIMITED AS TO USE - RESTRICTED FOR CAPITAL IMPROVEMENTS 10178323 ASSETS LIMITED AS TO USE - DONOR RESTRICTED 346118 ASSETS LIMITED AS TO USE - RESTRICTED FOR EMPLOYEE BENEFIT PROGRAMS 807638 RELATED PARTY RECEIVABLE 582139 ROU ASSETS - OPERATING LEASES 3012343 14926561 ESTIMATED THIRD-PARTY SETTLEMENT 250055 RECOURSE OBLIGATION, PATIENT PAYABLE 145996 CAMERON WOODS SECURITY DEPOSITS 2500 398551 X X X X X X 1 HILLARY LYONS ASSOCIATES PO BOX 99 DIAMONDALE MI 48821 SUPPORT, PLANNING AND ORGANIZING FUNDRAISING EVENTS 0 0 48000 -48000 48000 -48000 IN GOLF OUTING 52536 8448 44088 700 3201 8940 6082 2876 52536 8448 44088 700 3201 8940 6082 2876 21799 22289 SCHEDULE G, PART I, LINE 2B, COLUMN (V) THE ORGANIZATION CONSULTED WITH THE LISTED PERSONS FOR SUPPORT ON THE PLANNING OF THEIR FUNDRAISING EVENTS. 1 1 X 1 X 1 X 1 1 0 1 1 136996 136996 0.00130 15484351 10303552 5180799 0.04850 15621347 10303552 5317795 0.04980 223553 223553 0.00210 568378 334229 234149 0.00220 55746 55746 0.00050 847677 334229 513448 0.00480 16469024 10637781 5831243 0.05460 52155 52155 0.00050 1572 1572 0.00000 11976 11976 0.00010 65703 65703 0.00060 1 2580824 55459 16991947 16994451 -2504 X 1 1 1 1 CAMERON MEMORIAL COMMUNITY HOSPITAL INC 416 E MAUMEE STREET ANGOLA IN 46703 WWW.CAMERONMCH.COM 22-005037-1 X X X X CAMERON MEMORIAL COMMUNITY HOSPITAL INC 1 0 0 1 X X X X X X X X X 21 1 0 1 1 X SEE PART V, SECTION C, LINE 7D X X 1 22 1 HTTPS://WWW.CAMERONMCH.COM/RESOURCES/COMMUNITY-HEALTH-ASSESSMENT/ 0 1 X 100.000000000000 350.000000000000 X X X X X X 1 1 X X X 1 X HTTPS://CAMERONMCH.COM/RESOURCES/BILLING-PRICING/ X HTTPS://CAMERONMCH.MYFA.APP/FA-APPLICATION/ X HTTPS://CAMERONMCH.COM/FINANCIAL-ASSISTANCE-PLAIN-LANGUAGE-SUMMARY-ENGLISH/ 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 PARTNERED WITH THE INDIANA RURAL HEALTH ASSOCIATION (IRHA) TO CONDUCT A COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA) TO BETTER UNDERSTAND AND ADDRESS THE HEALTHCARE PRIORITIES OF STEUBEN COUNTY. THE PROCESS BEGAN WITH IRHA IDENTIFYING THE COMMUNITY SERVED BY CMCH THROUGH DISCUSSIONS WITH HOSPITAL LEADERSHIP. BY ANALYZING PATIENT ZIP CODES, THE HOSPITAL DEFINED ITS PRIMARY SERVICE AREA AS ALL POSTAL CODES WITHIN STEUBEN COUNTY AND PROVIDED A DETAILED SERVICE AREA MAP.TO GUIDE THE ASSESSMENT, A STEERING COMMITTEE WAS FORMED WITH REPRESENTATIVES FROM ACROSS STEUBEN COUNTY, COORDINATED WITH THE SUPPORT OF THE CAMERON MEMORIAL COMMUNITY HOSPITAL CEO. THE COMMITTEE INCLUDED BUSINESS OWNERS, LOCAL OFFICIALS, HEALTHCARE PROVIDERS, MINORITY LEADERS, CLERGY, STUDENT REPRESENTATIVES, AND OTHER COMMUNITY STAKEHOLDERS. THESE MEMBERS GATHERED TO DISCUSS THE COUNTY'S MOST PRESSING HEALTH CONCERNS AND IDENTIFY KEY AREAS OF NEED.BASED ON THESE DISCUSSIONS, A 43-QUESTION SURVEY WAS DEVELOPED TO CAPTURE COMMUNITY PERSPECTIVES ON LOCAL HEALTH CHALLENGES. THE SURVEY COVERED TOPICS SUCH AS THE IMPACT OF ILLEGAL DRUGS, TRANSPORTATION BARRIERS, POVERTY, AND THE NEED FOR ADDITIONAL HEALTHCARE SERVICES AND FACILITIES. TO ENSURE BROAD PARTICIPATION, THE SURVEY WAS DISTRIBUTED THROUGH MULTIPLE CHANNELS, INCLUDING THE CAMERON MEMORIAL COMMUNITY HOSPITAL WEBSITE, IN-PERSON POLLING AT THE YMCA OF STEUBEN COUNTY AND SUTTON'S DELI IN ANGOLA, AND AN ONLINE VERSION HOSTED ON SURVEYMONKEY. THIS COMPREHENSIVE APPROACH ALLOWED CAMERON TO GATHER VALUABLE INSIGHTS DIRECTLY FROM RESIDENTS, HELPING SHAPE INITIATIVES THAT ENHANCE HEALTHCARE ACCESS AND SERVICES IN STEUBEN COUNTY. CAMERON MEMORIAL COMMUNITY HOSPITAL, INC. PART V, SECTION B, LINE 6B: INDIANA RURAL HEALTH ASSOCIATION CAMERON MEMORIAL COMMUNITY HOSPITAL, INC. PART V, SECTION B, LINE 7D: SECTION B, LINE 7A:HTTPS://WWW.CAMERONMCH.COM/RESOURCES/COMMUNITY-HEALTH-ASSESSMENT/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 LINK ABOVE "SECTION B, LINE 7A" INTO THE INTERNET BROWSER. CAMERON MEMORIAL COMMUNITY HOSPITAL, INC. PART V, SECTION B, LINE 11: FOLLOWING THE 2022 COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA), THREE KEY AREAS OF FOCUS WERE IDENTIFIED. BELOW IS A SUMMARY OF THE PRIORITIZED NEEDS OUTLINED IN THE APPROVED IMPLEMENTATION STRATEGY, ALONG WITH AN UPDATE ON OUR PROGRESS.1. MENTAL HEALTH SERVICES & TREATMENT (INPATIENT, YOUTH, STIGMA REDUCTION)IN 2024, CAMERON CONTINUED TO MAKE SIGNIFICANT PROGRESS IN EXPANDING MENTAL HEALTH SERVICES, REINFORCING OUR COMMITMENT TO HOLISTIC WELL-BEING. WE HAVE BROADENED OUR NETWORK OF MENTAL HEALTH PROVIDERS, INCREASING ACCESS TO SPECIALIZED CARE FOR INDIVIDUALS OF ALL AGES. RECOGNIZING THE UNIQUE CHALLENGES FACED BY YOUNG PATIENTS UNDER 18, WE HAVE ENHANCED OUR SERVICES WITH DEDICATED RESOURCES AND TAILORED PROGRAMS TO BETTER SUPPORT THEIR NEEDS.ADDITIONALLY, WE ARE ACTIVELY COLLABORATING WITH LOCAL SCHOOLS AND COMMUNITY AGENCIES TO PROMOTE MENTAL HEALTH EDUCATION AND REDUCE STIGMA. BY PROVIDING SPEAKERS, WORKSHOPS, AND OUTREACH PROGRAMS, WE ARE FOSTERING A CULTURE OF OPENNESS AND UNDERSTANDING. THESE EFFORTS HELP ENSURE THAT INDIVIDUALS FEEL SUPPORTED IN SEEKING CARE WHILE REINFORCING THE IMPORTANCE OF MENTAL HEALTH AWARENESS IN OUR COMMUNITY.2. SUBSTANCE USE (PREVENTION, TOBACCO/VAPING, STIGMA REDUCTION)CAMERON REMAINS STEADFAST IN ADDRESSING SUBSTANCE USE DISORDER THROUGH EDUCATION, PREVENTION, AND COMMUNITY COLLABORATION. OUR PARTNERSHIPS WITH LOCAL SCHOOLS FOCUS ON EARLY INTERVENTION AND EDUCATION PROGRAMS, EQUIPPING STUDENTS WITH THE KNOWLEDGE AND SKILLS TO MAKE INFORMED, HEALTHY CHOICES. THROUGH INTERACTIVE WORKSHOPS AND TAILORED RESOURCES, WE EMPOWER YOUNG PEOPLE TO RESIST PEER PRESSURE AND UNDERSTAND THE RISKS ASSOCIATED WITH SUBSTANCE USE, INCLUDING VAPING AND TOBACCO USE.BEYOND SCHOOL-BASED INITIATIVES, CAMERON IS ACTIVELY ENGAGED IN MULTI-AGENCY COLLABORATIONS WITH LAW ENFORCEMENT, HEALTHCARE PROVIDERS, AND COMMUNITY ORGANIZATIONS TO TACKLE SUBSTANCE ABUSE AT ITS ROOT. THESE PARTNERSHIPS FACILITATE ACCESS TO TREATMENT PROGRAMS, COORDINATE CARE PLANS, AND PROVIDE ONGOING SUPPORT FOR INDIVIDUALS AND FAMILIES IMPACTED BY ADDICTION. THROUGH THESE COMBINED EFFORTS, WE STRIVE TO CREATE A SUPPORTIVE ENVIRONMENT FOR PREVENTION, TREATMENT, AND LONG-TERM RECOVERY.3. YOUTH-FOCUSED SERVICESCAMERON REMAINS DEDICATED TO EXPANDING YOUTH-CENTERED PROGRAMS THAT PROMOTE HEALTH, WELLNESS, AND POSITIVE LIFESTYLE CHOICES. THROUGHOUT THE YEAR, WE CONTINUE TO COLLABORATE WITH COMMUNITY ORGANIZATIONS INCLUDING THE YMCA OF STEUBEN COUNTY, SHAPE UP STEUBEN, PURDUE EXTENSION, SCHOOLS, FAITH-BASED GROUPS, AND OTHER YOUTH-FOCUSED ORGANIZATIONS TO INTEGRATE HEALTHY LIVING CONCEPTS INTO DAILY LIFE.ONE OF OUR KEY INITIATIVES IS THE STRENGTHENING FAMILIES PROGRAM, LAUNCHED IN PARTNERSHIP WITH PURDUE EXTENSION IN JUNE 2019. THIS SEVEN-SESSION COURSE IS DESIGNED FOR YOUTH AGES 10-14 AND THEIR FAMILIES, HELPING THEM NAVIGATE FAMILY DYNAMICS, COMMUNICATION, PEER PRESSURE, AND GOAL SETTING. THE PROGRAM ORIGINALLY SERVED COURT-APPOINTED FAMILIES THROUGH JUVENILE PROBATION PROGRAMS BUT HAS SINCE EXPANDED TO THE GENERAL PUBLIC AT NO COST, THANKS TO GRANT FUNDING FROM PURDUE EXTENSION AND THE STEUBEN COUNTY COMMUNITY FOUNDATION.CAMERON HAS ALSO INTRODUCED A THERAPY DOG PROGRAM, LAUNCHED IN SEPTEMBER 2022, WHICH PROVIDES COMFORT AND SUPPORT TO PATIENTS OF ALL AGES, WITH A SPECIAL FOCUS ON YOUTH RECEIVING INPATIENT CARE AND THERAPY SERVICES. THESE THERAPY DOGS HAVE PROVEN TO BE AN INVALUABLE RESOURCE, OFFERING EMOTIONAL SUPPORT AND HELPING TO EASE ANXIETY IN A VARIETY OF HEALTHCARE SETTINGS, INCLUDING THE LAB AND INPATIENT UNITS.ADDITIONALLY, CAMERON MEDICAL GROUP IS COMMITTED TO EDUCATING AND ENGAGING WITH LOCAL YOUTH AND FAMILIES THROUGH HOSPITAL TOURS, INTERACTIVE SCHOOL EVENTS, AND COMMUNITY OUTREACH. FROM PARTICIPATING IN YMCA SUMMER DAY CAMPS TO TEACHING CHILDREN ABOUT HAND HYGIENE AND THE IMPORTANCE OF ROUTINE HEALTHCARE VISITS, WE ARE DEDICATED TO EQUIPPING FAMILIES WITH KNOWLEDGE AND RESOURCES THAT PROMOTE LIFELONG WELL-BEING. 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: ON THE WEB PAGE UNDER "RESOURCES" CLICK ON THE LINK "BILLING & PRICING" TO ACCESS THE HOSPITAL'S FINANCIAL ASSISTANCE POLICY INFORMATION. CAMERON MEMORIAL COMMUNITY HOSPITAL, INC. PART V, SECTION B, LINE 20E: 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. 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 7G: THE ORGANIZATION IS INCLUDING THE GASTROENTEROLOGY DEPARTMENT IN ITS SUBSIDIZED SERVICES CALCULATION. TOTAL COMMUNITY BENEFIT EXPENSE OF $568,378, DIRECTOR OFFSETTING REVENUE OF $334,229 AND NET COMMUNITY BENEFIT EXPENSE OF $234,149 IS ATTRIBUTABLE TO THE GASTROENTEROLOGY DEPARTMENT. PART I, LINE 7, COLUMN (F): THE BAD DEBT EXPENSE INCLUDED ON FORM 990, PART IX, LINE 25, COLUMN (A), BUT SUBTRACTED FOR PURPOSES OF CALCULATING THE PERCENTAGE IN THIS COLUMN IS $ 6,325,815. PART II, COMMUNITY BUILDING ACTIVITIES: CAMERON MEMORIAL COMMUNITY HOSPITAL HAS BEEN A TRUSTED HEALTHCARE PROVIDER IN STEUBEN COUNTY SINCE 1926, SERVING GENERATION AFTER GENERATION WITH A COMMITMENT TO IMPROVING COMMUNITY HEALTH. AS A 25-BED, NOT-FOR-PROFIT FACILITY, WE TAKE PRIDE IN DELIVERING HIGH-QUALITY, PERSONALIZED CARE THROUGH ADVANCED TECHNOLOGY AND A DEDICATED TEAM OF PHYSICIANS, HEALTHCARE PROFESSIONALS, AND STAFF. OUR MISSION IS TO ENHANCE THE QUALITY OF LIFE FOR THOSE WE SERVE BY FOSTERING RELATIONSHIPS BUILT ON HEALTH, WELLNESS, AND COMMUNITY ENGAGEMENT. GUIDED BY OUR CORE VALUES: SAFETY, COMPASSION, INTEGRITY, TEAMWORK, STEWARDSHIP, EXCELLENCE, RESPECT, AND WELLNESS WE STRIVE TO MAKE A LASTING IMPACT EVERY DAY.AS PART OF OUR ONGOING COMMITMENT TO EDUCATION AND WORKFORCE DEVELOPMENT, CAMERON RECENTLY OPENED THE CAMERON EDUCATION AND INNOVATION CENTER TO SUPPORT THE TRAINING AND ADVANCEMENT OF HEALTHCARE PROFESSIONALS. THIS STATE-OF-THE-ART FACILITY SERVES AS A HUB FOR LEARNING, PROFESSIONAL DEVELOPMENT, AND COMMUNITY ENGAGEMENT. A KEY INITIATIVE WITHIN THE CENTER IS OUR PARTNERSHIP WITH TRINE UNIVERSITY TO OFFER AN ASSOCIATE OF SCIENCE IN NURSING (ASN) PROGRAM, PROVIDING STUDENTS WITH HANDS-ON TRAINING AND EDUCATION TO PREPARE THEM FOR SUCCESSFUL CAREERS IN HEALTHCARE. BY INVESTING IN THE NEXT GENERATION OF NURSES, CAMERON IS ACTIVELY WORKING TO STRENGTHEN THE LOCAL HEALTHCARE WORKFORCE AND ENSURE ACCESS TO HIGH-QUALITY CARE FOR YEARS TO COME.ONE OF OUR KEY COMMUNITY INITIATIVES IS THE HEALTH OCCUPATIONS EDUCATION (H.O.E.) PROGRAM, WHICH PROVIDES HIGH SCHOOL STUDENTS WITH HANDS-ON EXPOSURE TO THE HEALTHCARE FIELD. THESE STUDENTS, CHOSEN FOR THEIR INTEREST IN PURSUING MEDICAL CAREERS, ROTATE THROUGH HOSPITAL DEPARTMENTS, CLINICS, AND MEDICAL OFFICES, GAINING REAL-WORLD EXPERIENCE UNDER THE SUPERVISION OF EXPERTS. THEY ALSO RECEIVE CPR TRAINING AND ACTIVELY PARTICIPATE IN HEALTH FAIRS AND SCREENINGS THROUGHOUT THE COMMUNITY. BY INVESTING IN THIS PROGRAM, CAMERON HELPS SHAPE THE NEXT GENERATION OF HEALTHCARE PROFESSIONALS, ENSURING CONTINUED QUALITY CARE FOR OUR COMMUNITY.RECOGNIZING THE GROWING DEMAND FOR MENTAL HEALTH SERVICES, CAMERON HAS MADE SIGNIFICANT INVESTMENTS IN EXPANDING ACCESS TO CARE. FOLLOWING THE 2019 AND 2022 COMMUNITY HEALTH NEEDS ASSESSMENTS, CONDUCTED IN PARTNERSHIP WITH THE INDIANA STATE OFFICE OF RURAL HEALTH, CAMERON LAUNCHED AND HAS GROWN CAMERON PSYCHIATRY SERVICES TO ADDRESS THIS CRITICAL NEED. SINCE THEN, WE HAVE STEADILY EXPANDED OUR PROGRAM, ADDING MULTIPLE THERAPISTS, ADVANCED PRACTICE PROVIDERS, AND THERAPY PROGRAMS. IN 2023, WE HIRED A FULL-TIME PSYCHIATRIST AND AN ADDITIONAL PART-TIME PHYSICIAN, ALONG WITH EIGHT NEW ADVANCED PRACTICE PROVIDERS, ALL OF WHOM BEGAN SEEING PATIENTS IN EARLY 2024. THESE EFFORTS REFLECT OUR COMMITMENT TO MAKING HIGH-QUALITY MENTAL HEALTH CARE ACCESSIBLE TO ALL.IN ADDITION TO CLINICAL SERVICES, CAMERON ACTIVELY PROMOTES WELLNESS THROUGH COMMUNITY-WIDE HEALTH SCREENINGS AT LOCAL HIGH SCHOOLS, OFFERING REDUCED-COST LAB TESTS FOR ADULTS. WE ALSO LAUNCHED A TELEHEALTH PROGRAM IN PARTNERSHIP WITH A LOCAL SCHOOL SYSTEM, ALLOWING STUDENTS TO CONNECT WITH A PEDIATRICIAN VIA VIDEO VISITS WITH PARENTAL CONSENT. THIS INITIATIVE ENSURES THAT CHILDREN RECEIVE TIMELY MEDICAL CARE WITHOUT REQUIRING PARENTS TO TAKE TIME OFF WORK FOR IN-OFFICE VISITS.UNDERSTANDING THE ESSENTIAL ROLE OF NUTRITION IN OVERALL HEALTH, WE CONTINUE TO OFFER THE CAMERON COMMUNITY WELLNESS GARDEN AT NO COST TO COMMUNITY MEMBERS. GARDENERS RESERVE PLOTS EACH SEASON, MAINTAINING THEM THROUGH THE FALL, AND FOR THE FOURTH CONSECUTIVE YEAR, ALL PLOTS HAVE BEEN FILLED. WE ARE ALSO EXPLORING ADDITIONAL PARTNERSHIPS, INCLUDING A FARM-TO-SCHOOL PROGRAM, TO FURTHER PROMOTE HEALTHY EATING HABITS IN LOCAL SCHOOLS. BY INTEGRATING EDUCATION AND ACCESS TO FRESH, LOCALLY GROWN PRODUCE, WE SUPPORT LONG-TERM COMMUNITY WELLNESS.THROUGH THESE AND MANY OTHER INITIATIVES, CAMERON REMAINS DEEPLY COMMITTED TO STRENGTHENING THE HEALTH OF OUR COMMUNITY, NOT JUST THROUGH EXCEPTIONAL MEDICAL CARE, BUT THROUGH PROGRAMS THAT EMPOWER INDIVIDUALS AND FAMILIES TO LEAD HEALTHIER LIVES. PART III, LINE 2: MANAGEMENT REGULARLY 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 & CREDIT POLICY" LOCATED ON PAGE 10 OF THE AUDITED FINANCIAL STATEMENTS. 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 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 $360,080 IN UNREIMBURSED MEDICARE COSTS DURING 2024. IN ADDITION, THE HOSPITAL ALSO ABSORBED $5,180,799 IN UNREIMBURSED MEDICAID COSTS DURING 2024. 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 2024, THE HOSPITAL ABSORBED $136,996 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. PART VI, LINE 7, REPORTS FILED WITH STATES IN 1 STEUBEN COUNTY COMMUNITY FOUNDATION 1701 N WAYNE STREET ANGOLA IN 46703 351857065 501(C)(3) 10000 0 GENERAL SUPPORT TRINE UNIVERSITY 1 UNIVERSITY AVE ANGOLA IN 46703 350715530 501(C)(3) 15650 0 GENERAL SUPPORT YMCA OF STEUBEN COUNTY 500 E HARCOURT ANGOLA IN 46703 351999599 501(C)(3) 8900 0 BANNER PROGRAM SUPPORT 3 0 PART I, LINE 2: CAMERON MEMORIAL COMMUNITY HOSPITAL, INC. WILL FROM TIME TO TIME SELECT A RECIPIENT FOR DONATION WITH THE APPROVAL OF THE BOARD. THE HOSPITAL DOES NOT SEEK REQUESTS FROM ORGANIZATIONS TO DONATE TO BUT USES EARNINGS FROM INVESTMENTS TO PROVIDE A BENEFIT TO THE COMMUNITY THAT IT SERVES ACCORDING OT THEIR INVESTMENT SPENDING POLICY. X X X 0 0 0 0 0 0 0 0 0 JOHN VARNER MD PHYSICIAN 740176 0 32403 0 1346 0 13200 0 16145 0 803270 0 0 0 TODD RUMSEY MD TREASURER/PHYSICIAN 545222 0 16196 0 2612 0 13200 0 11459 0 588689 0 0 0 ANGELA LOGAN CHIEF EXECUTIVE OFFICER 352791 0 102077 0 13055 0 13200 0 4629 0 485752 0 0 0 DEAN MATTOX II MD PHYSICIAN 390700 0 2670 0 3861 0 13200 0 9569 0 420000 0 0 0 CHARLES MACLEAN PHYSICIAN 258203 0 87403 0 2516 0 13200 0 11045 0 372367 0 0 0 MATTHEW SIELOFF PHYSICIAN 350236 0 2670 0 486 0 0 0 10794 0 364186 0 0 0 LYNN FAUR MD BOARD MEMBER/PHYSICIAN 285921 0 2670 0 2516 0 11458 0 16457 0 319022 0 0 0 CHRISTOPHER GASAWAY PHYSICIAN 242363 0 27670 0 585 0 0 0 16457 0 287075 0 0 0 TAMMI MCCOY FAMILY MEMBER OF JOHN MCCOY 91202 EMPLOYMENT COMPENSATION 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 GOVERNING 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 IX, LINE 11G MAINTENANCE SERVICES: PROGRAM SERVICE EXPENSES 1,883,813. MANAGEMENT AND GENERAL EXPENSES 7,015. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,890,828. PHYSICIAN SERVICES: PROGRAM SERVICE EXPENSES 3,287,860. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 3,287,860. MEDICAL AND OTHER SERVICES: PROGRAM SERVICE EXPENSES 5,465,236. MANAGEMENT AND GENERAL EXPENSES 1,461,392. FUNDRAISING EXPENSES 2,946. TOTAL EXPENSES 6,929,574. CAMERON MEDICAL OUTREACH INC 416 E MAUMEE STREET ANGOLA IN 46702 261105702 ASSISTED LIVING IN 501(C)(3) LINE 10 CAMERON MEMORIAL COMMUNITY HOSPITAL INC 1 0 0 0 0 0 0 0 0 0 0 1 0 0 1 1 0 1 0 0 CAMERON MEDICAL OUTREACH INC K 106656 FAIR MARKET VALUE CAMERON MEDICAL OUTREACH INC Q 2603045 FAIR MARKET VALUE