Form990
Click to see attachment
Department of the Treasury
Internal Revenue Service
Return of Organization Exempt From Income Tax
Under section 501(c), 527, or 4947(a)(1) of the Internal Revenue Code (except black lung benefit trust or private foundation)

MediumBullet The organization may have to use a copy of this return to satisfy state reporting requirements.
OMB No. 1545-0047
2011
Open to Public Inspection
A For the calendar year, or tax year beginning 01-01-2011 and ending 12-31-2011
BCheck if applicable:
CName of organization
Audrain Health Care Inc
 
Doing Business As
AUDRAIN MEDICAL CENTER
 
Number and street (or P.O. box if mail is not delivered to street address)
620 E MONROE
 
Room/suite
City or town, state or country, and ZIP + 4
MEXICO, MO652652963
D Employer identification number

43-1550298
E Telephone number

G Gross receipts $ 60,719,570
F Name and address of principal officer:
DAVID A NEUENDORF
620 E MONROE
MEXICO,MO652652963
I
Tax-exempt status: (   ) LeftBullet (insert no.) or
J
Website:MediumBullet
WWW.AUDRAINMEDICALCENTER.COM
H(a)
Is this a group return for
affiliates?
H(b)
Are all affiliates included?
If "No," attach a list. (see instructions)
H(c)
Group exemption number MediumBullet  
K Form of organization:
 
L Year of formation: 1918
M State of legal domicile: MO
Part I
Summary
Activities & Governance 1 Briefly describe the organization’s mission or most significant activities: 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.
2 Check this box MediumBullet
3 Number of voting members of the governing body (Part VI, line 1a)..... 3 15
4 Number of independent voting members of the governing body (Part VI, line 1b) .... 4 11
5 Total number of individuals employed in calendar year 2011 (Part V, line 2a) ... 5 604
6 Total number of volunteers (estimate if necessary) .... 6 0
7a Total unrelated business revenue from Part VIII, column (C), line 12 .. 7a 0
b Net unrelated business taxable income from Form 990-T, line 34 .. 7b  
Revenues; Prior Year Current Year
8 Contributions and grants (Part VIII, line 1h) ......... 1,259,552 1,271,149
9 Program service revenue (Part VIII, line 2g) ......... 56,451,449 55,617,531
10 Investment income (Part VIII, column (A), lines 3, 4, and 7d ) .... 228,092 108,941
11 Other revenue (Part VIII, column (A), lines 5, 6d, 8c, 9c, 10c, and 11e) 572,948 414,868
12 Total revenue—add lines 8 through 11 (must equal Part VIII, column (A), line 12)................... 58,512,041 57,412,489
Expenses; 13 Grants and similar amounts paid (Part IX, column (A), lines 1–3 )... 26,098 35,203
14 Benefits paid to or for members (Part IX, column (A), line 4)..... 0 0
15 Salaries, other compensation, employee benefits (Part IX, column (A), lines 5–10) 29,187,084 27,856,793
16a Professional fundraising fees (Part IX, column (A), line 11e)..... 0 0
b Total fundraising expenses (Part IX, column (D), line 25) MediumBullet0    
17 Other expenses (Part IX, column (A), lines 11a–11d, 11f–24f).... 32,041,230 31,950,698
18 Total expenses. Add lines 13–17 (must equal Part IX, column (A), line 25) 61,254,412 59,842,694
19 Revenue less expenses. Subtract line 18 from line 12....... -2,742,371 -2,430,205
Net Assets or Fund Balances; Beginning of Current Year End of Year
20 Total assets (Part X, line 16)............. 33,366,755 31,018,249
21 Total liabilities (Part X, line 26)............. 20,867,120 26,536,821
22 Net assets or fund balances. Subtract line 21 from line 20..... 12,499,635 4,481,428
Part II
Signature Block
Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief, it is true, correct, and complete. Declaration of preparer (other than officer) is based on all information of which preparer has any knowledge.
Sign Here
JumboBullet
Signature of officer Date
JumboBullet
Type or print name and title.
Paid preparer use only
Print/type preparer's name
 
Preparer's signature
Date
PTIN
Firm's name Right pointing arrowhead image

Firm's EIN Right pointing arrowhead image
Firm's address Right pointing arrowhead image



Phone no.
May the IRS discuss this return with the preparer shown above? See instructions .........bullet
For Paperwork Reduction Act Notice, see the separate instructions.
Cat. No. 11282Y
Form 990 (2011)
Form 990 (2011)
Page 2
Part III
Statement of Program Service Accomplishments
Check if Schedule O contains a response to any question in this Part III .........
1
Briefly describe the organization’s mission: OUR VISION... TO BE RECOGNIZED AS A "PATIENT FIRST, BEST PRACTICE" HEALTHCARE SYSTEM BY CONTINUOUSLY IMPROVING AND MAINTAINING OUR BALANCE OF: CLINICAL QUALITY, SERVICE/ACCESS, HUMAN RESOURCE DEVELOPMENT, AND FINANCIAL INTEGRITY.
2
Did the organization undertake any significant program services during the year which were not listed on
the prior Form 990 or 990-EZ? ....................
If “Yes,” describe these new services on Schedule O.
3
Did the organization cease conducting, or make significant changes in how it conducts, any program services? ..........................
If “Yes,” describe these changes on Schedule O.
4
Describe the organization’s program service accomplishments for each of its three largest program services, as measured by expenses. Section 501(c)(3) and 501(c)(4) organizations and section 4947(a)(1) trusts are required to report the amount of grants and allocations to others, the total expenses, and revenue, if any, for each program service reported.
4a (Code:   ) (Expenses $ 16,489,074 including grants of $ 35,203 ) (Revenue $ 12,603,546 )
AUDRAIN MEDICAL CENTER PROVIDES INPATIENT CARE TO THE COMMUNITY REGARDLESS OF AN INDIVIDUAL'S ABILITY TO PAY. INPATIENT CARE SERVICES WERE PROVIDED TO 2,742 CUSTOMERS IN 2011. SEE SCHEDULE O.
4b (Code:   ) (Expenses $ 22,018,465 including grants of $ 0 ) (Revenue $ 35,750,211 )
AUDRAIN MEDICAL CENTER PROVIDES OUTPATIENT CARE TO THE COMMUNITY REGARDLESS OF AN INDIVIDUAL'S ABILITY TO PAY. OUTPATIENT CARE SERVICES WERE PROVIDED TO 78,479 PATIENTS IN 2011. SEE SCHEDULE O.
4c (Code:   ) (Expenses $ 10,256,253 including grants of $ 0 ) (Revenue $ 7,263,775 )
AUDRAIN MEDICAL CENTER CLINICS (MEDCHOICE) PROVIDES OUTPATIENT CLINICAL SERVICES TO THE COMMUNITY REGARDLESS OF AN INDIVIDUAL'S ABILITY TO PAY. AMC CLINICS PROVIDED OUTPATIENT SERVICES TO 61,550 CUSTOMERS IN 2011. SEE SCHEDULE O.
4d Other program services (Describe in Schedule O.)
(Expenses $   including grants of $   ) (Revenue $   )
4e Total program service expensesMediumBullet$ 48,763,792
Form 990 (2011)
Form 990 (2011)
Page 3
Part IV
Checklist of Required Schedules
Yes
No
1
Is the organization described in section 501(c)(3) or 4947(a)(1) (other than a private foundation)? If “Yes,” complete Schedule AClick to see attachment.....................
1
Yes
 
2
Is the organization required to complete Schedule B, Schedule of Contributors? Click to see attachment........
2
Yes
 
3
Did the organization engage in direct or indirect political campaign activities on behalf of or in opposition to candidates for public office? If “Yes,” complete Schedule C, Part IClick to see attachment..........
3
 
No
4
Section 501(c)(3) organizations. Did the organization engage in lobbying activities? If “Yes,” complete Schedule C,
Part IIClick to see attachment.........................
4
Yes
 
5
Is the organization a section 501(c)(4), 501(c)(5), or 501(c)(6) organization that receives membership dues, assessments, or similar amounts as defined in Revenue Procedure 98-19? If “Yes,” complete Schedule C, Part III........................
5
 
 
6
Did the organization maintain any donor advised funds or any similar funds or accounts for which donors have the right to provide advice on the distribution or investment of amounts in such funds or accounts? If “Yes,” complete Schedule D, Part IClick to see attachment....................
6
 
No
7
Did the organization receive or hold a conservation easement, including easements to preserve open space,
the environment, historic land areas or historic structures? If “Yes,” complete Schedule D, Part IIClick to see attachment...
7
 
No
8
Did the organization maintain collections of works of art, historical treasures, or other similar assets? If “Yes,” complete Schedule D, Part III Click to see attachment....................
8
 
No
9
Did the organization report an amount in Part X, line 21; serve as a custodian for amounts not listed in Part X; or provide credit counseling, debt management, credit repair, or debt negotiation services? If “Yes,”
complete Schedule D, Part IVClick to see attachment...................
9
 
No
10
Did the organization, directly or through a related organization, hold assets in temporarily restricted endowments, permanent endowments, or quasi-endowments? If “Yes,” complete Schedule D, Part VClick to see attachment
10
Yes
 
11
If the organization’s answer to any of the following questions is ‘Yes,’ then complete Schedule D, Parts VI, VII, VIII, IX, or X as applicable:
a
Did the organization report an amount for land, buildings, and equipment in Part X, line10? If “Yes,” complete Schedule D, Part VI.Click to see attachment
11a
Yes
 
b
Did the organization report an amount for investments—other securities in Part X, line 12 that is 5% or more of its total assets reported in Part X, line 16? If “Yes,” complete Schedule D, Part VII.Click to see attachment
11b
 
No
c
Did the organization report an amount for investments—program related in Part X, line 13 that is 5% or more of its total assets reported in Part X, line 16? If “Yes,” complete Schedule D, Part VIII.Click to see attachment
11c
 
No
d
Did the organization report an amount for other assets in Part X, line 15 that is 5% or more of its total assets reported in Part X, line 16? If “Yes,” complete Schedule D, Part IX.Click to see attachment
11d
 
No
e
Did the organization report an amount for other liabilities in Part X, line 25? If “Yes,” complete Schedule D, Part X.Click to see attachment
11e
Yes
 
f
Did the organization’s separate or consolidated financial statements for the tax year include a footnote that addresses the organization’s liability for uncertain tax positions under FIN 48 (ASC 740)? If “Yes,” complete Schedule D, Part X.Click to see attachment
11f
 
No
12a
Did the organization obtain separate, independent audited financial statements for the tax year?
If “Yes,” complete Schedule D, Parts XI, XII, and XIII Click to see attachment
12a
Yes
 
b
Was the organization included in consolidated, independent audited financial statements for the tax year? If “Yes,” and if the organization answered ‘No’ to line 12a, then completing Schedule D, Parts XI, XII, and XIII is optional Click to see attachment
12b
 
No
13
Is the organization a school described in section 170(b)(1)(A)(ii)? If “Yes,” complete Schedule E
13
 
No
14a
Did the organization maintain an office, employees, or agents outside of the United States?....
14a
 
No
b
Did the organization have aggregate revenues or expenses of more than $10,000 from grantmaking, fundraising, business, investment, and program service activities outside the United States or aggregate foreign investments valued at $100,000 or more? If “Yes,” complete Schedule F, Part I.........
14b
 
No
15
Did the organization report on Part IX, column (A), line 3, more than $5,000 of grants or assistance to any organization or entity located outside the U.S.? If “Yes,” complete Schedule F, Part II..
15
 
No
16
Did the organization report on Part IX, column (A), line 3, more than $5,000 of aggregate grants or assistance to individuals located outside the U.S.? If “Yes,” complete Schedule F, Part III..
16
 
No
17
Did the organization report a total of more than $15,000, of expenses for professional fundraising services on Part IX, column (A), lines 6 and 11e? If “Yes,” complete Schedule G, Part I
17
 
No
18
Did the organization report more than $15,000 total of fundraising event gross income and contributions on Part VIII, lines 1c and 8a? If “Yes,” complete Schedule G, Part II..........
18
 
No
19
Did the organization report more than $15,000 of gross income from gaming activities on Part VIII, line 9a? If “Yes,” complete Schedule G, Part III...................
19
 
No
20a
Did the organization operate one or more hospitals? If “Yes,” complete Schedule H..... Click to see attachment
20a
Yes
 
b
If “Yes” to line 20a, did the organization attach a copy of its audited financial statement to this return? Note. All Form 990 filers that operated one or more hospitals must attach audited financial statements. Click to see attachment
20b
Yes
 
Form 990 (2011)
Form 990 (2011)
Page 4
Part IV
Checklist of Required Schedules (continued)
21
Did the organization report more than $5,000 of grants and other assistance to any government or organization in the United States on Part IX, column (A), line 1? If “Yes,” complete Schedule I, Parts I and II.. Click to see attachment
21
Yes
 
22
Did the organization report more than $5,000 of grants and other assistance to individuals in the United States on Part IX, column (A), line 2? If “Yes,” complete Schedule I, Parts I and III..... Click to see attachment
22
 
No
23
Did the organization answer “Yes” to Part VII, Section A, questions 3, 4, or 5, about compensation of the organization’s current and former officers, directors, trustees, key employees, and highest compensated employees? If “Yes,” complete Schedule J................ Click to see attachment
23
Yes
 
24a
Did the organization have a tax-exempt bond issue with an outstanding principal amount of more than $100,000 as of the last day of the year, that was issued after December 31, 2002? If “Yes,” answer questions 24b–24d and complete Schedule K. If “No,” go to line 25................
24a
 
No
b
Did the organization invest any proceeds of tax-exempt bonds beyond a temporary period exception?...
24b
 
 
c
Did the organization maintain an escrow account other than a refunding escrow at any time during the year
to defease any tax-exempt bonds?......................
24c
 
 
d
Did the organization act as an “on behalf of” issuer for bonds outstanding at any time during the year?...
24d
 
 
25a
Section 501(c)(3) and 501(c)(4) organizations. Did the organization engage in an excess benefit transaction with a disqualified person during the year? If “Yes,” complete Schedule L, Part I...... Click to see attachment
25a
 
No
b
Is the organization aware that it engaged in an excess benefit transaction with a disqualified person in a prior year, and that the transaction has not been reported on any of the organization’s prior Forms 990 or 990-EZ? If “Yes,” complete Schedule L, Part I................ Click to see attachment
25b
 
No
26
Was a loan to or by a current or former officer, director, trustee, key employee, highly compensated employee, or disqualified person outstanding as of the end of the organization’s tax year? If “Yes,” complete Schedule L,
Part II......................... Click to see attachment
26
 
No
27
Did the organization provide a grant or other assistance to an officer, director, trustee, key employee, substantial contributor or employee thereof, a grant selection committee member, or to a 35% controlled entity or family member of any of these persons? If “Yes,” complete Schedule L, Part III......... Click to see attachment
27
 
No
28
Was the organization a party to a business transaction with one of the following parties? (see Schedule L, Part IV instructions for applicable filing thresholds, conditions, and exceptions):
a
A current or former officer, director, trustee, or key employee? If “Yes,” complete Schedule L, Part IV ......................... Click to see attachment
28a
 
No
b
A family member of a current or former officer, director, trustee, or key employee? If “Yes,”
complete Schedule L, Part IV................... Click to see attachment
28b
Yes
 
c
An entity of which a current or former officer, director, trustee, or key employee (or a family member thereof) was an officer, director, trustee, or owner? If “Yes,” complete Schedule L, Part IV.. Click to see attachment
28c
 
No
29
Did the organization receive more than $25,000 in non-cash contributions? If “Yes,” complete Schedule M
29
 
No
30
Did the organization receive contributions of art, historical treasures, or other similar assets, or qualified conservation contributions? If “Yes,” complete Schedule M............
30
 
No
31
Did the organization liquidate, terminate, or dissolve and cease operations? If “Yes,” complete Schedule N,
Part I...........................
31
 
No
32
Did the organization sell, exchange, dispose of, or transfer more than 25% of its net assets? If “Yes,” complete Schedule N, Part II.......................
32
 
No
33
Did the organization own 100% of an entity disregarded as separate from the organization under Regulations sections 301.7701-2 and 301.7701-3? If “Yes,” complete Schedule R, Part I........ Click to see attachment
33
 
No
34
Was the organization related to any tax-exempt or taxable entity? If “Yes,” complete Schedule R, Parts II, III, IV, and V, line 1..................... Click to see attachment
34
Yes
 
35a
Did the organization have a controlled entity within the meaning of section 512(b)(13)?
35a
 
No
b
If ‘Yes’ to line 35a, did the organization receive any payment from or engage in any transaction with a controlled entity within the meaning of section 512(b)(13)? If “Yes,” complete Schedule R, Part V, line 2... Click to see attachment
35b
 
No
36
Section 501(c)(3) organizations. Did the organization make any transfers to an exempt non-charitable related organization? If “Yes,” complete Schedule R, Part V, line 2........... Click to see attachment
36
 
No
37
Did the organization conduct more than 5% of its activities through an entity that is not a related organization and that is treated as a partnership for federal income tax purposes? If “Yes,” complete Schedule R, Part VIClick to see attachment
37
 
No
38
Did the organization complete Schedule O and provide explanations in Schedule O for Part VI, lines 11 and 19? Note. All Form 990 filers are required to complete Schedule O. ............
38
Yes
 
Form 990 (2011)
Form 990 (2011)
Page 5
Part V
Statements Regarding Other IRS Filings and Tax Compliance
Check if Schedule O contains a response to any question in this Part V .........
Yes
No
1a
Enter the number reported in Box 3 of Form 1096. Enter -0- if not applicable. .......
1a
257
b
Enter the number of Forms W-2G included in line 1a. Enter -0- if not applicable.
1b
0
c
Did the organization comply with backup withholding rules for reportable payments to vendors and reportable gaming (gambling) winnings to prize winners? ..................
1c
Yes
 
2a
Enter the number of employees reported on Form W-3, Transmittal of Wage and Tax Statements filed for the calendar year ending with or within the year covered by this return .....................
2a
604
b
If at least one is reported on line 2a, did the organization file all required federal employment tax returns?

Note. If the sum of lines 1a and 2a is greater than 250, you may be required to e-file. (see instructions)
2b
Yes
 
3a
Did the organization have unrelated business gross income of $1,000 or more during the year?.............................
3a
 
No
b
If “Yes,” has it filed a Form 990-T for this year? If “No,” provide an explanation in Schedule O.....
3b
 
 
4a
At any time during the calendar year, did the organization have an interest in, or a signature or other authority over, a financial account in a foreign country (such as a bank account or securities account)?.......................
4a
 
No
b
If "Yes," enter the name of the foreign country: MediumBullet
See instructions for filing requirements for Form TD F 90-22.1, Report of Foreign Bank and Financial Accounts.
5a
Was the organization a party to a prohibited tax shelter transaction at any time during the tax year?..
5a
 
No
b
Did any taxable party notify the organization that it was or is a party to a prohibited tax shelter transaction?
5b
 
No
c
If “Yes” to line 5a or 5b, did the organization file Form 8886-T? ........
5c
 
 
6a
Does the organization have annual gross receipts that are normally greater than $100,000, and did the organization solicit any contributions that were not tax deductible?..........
6a
 
No
b
If “Yes,” did the organization include with every solicitation an express statement that such contributions or gifts were not tax deductible?........................
6b
 
 
7
Organizations that may receive deductible contributions under section 170(c).
a
Did the organization receive a payment in excess of $75 made partly as a contribution and partly for goods and services provided to the payor?....................
7a
 
No
b
If “Yes,” did the organization notify the donor of the value of the goods or services provided?.....
7b
 
 
c
Did the organization sell, exchange, or otherwise dispose of tangible personal property for which it was required to file Form 8282?...........................
7c
 
No
d
If “Yes,” indicate the number of Forms 8282 filed during the year ....
7d
 
e
Did the organization receive any funds, directly or indirectly, to pay premiums on a personal benefit contract?..........................
7e
 
No
f
Did the organization, during the year, pay premiums, directly or indirectly, on a personal benefit contract?..
7f
 
No
g
If the organization received a contribution of qualified intellectual property, did the organization file Form 8899 as required?...................
7g
 
 
h
If the organization received a contribution of cars, boats, airplanes, or other vehicles, did the organization file a Form 1098-C?...............
7h
 
 
8
Sponsoring organizations maintaining donor advised funds and section 509(a)(3) supporting organizations. Did the supporting organization, or a donor advised fund maintained by a sponsoring organization, have excess business holdings at any time during the year?................
8
 
 
9
Sponsoring organizations maintaining donor advised funds.
a
Did the organization make any taxable distributions under section 4966?.........
9a
 
 
b
Did the organization make a distribution to a donor, donor advisor, or related person?......
9b
 
 
10
Section 501(c)(7) organizations. Enter:
a
Initiation fees and capital contributions included on Part VIII, line 12 ...
10a
 
b
Gross receipts, included on Form 990, Part VIII, line 12, for public use of club facilities
10b
 
11
Section 501(c)(12) organizations. Enter:
a
Gross income from members or shareholders .........
11a
 
b
Gross income from other sources (Do not net amounts due or paid to other sources against amounts due or received from them) ........
11b
 
12a
Section 4947(a)(1) non-exempt charitable trusts. Is the organization filing Form 990 in lieu of Form 1041?
12a
 
 
b
If “Yes,” enter the amount of tax-exempt interest received or accrued during the year.
12b
 
13
Section 501(c)(29) qualified nonprofit health insurance issuers.
a
Is the organization licensed to issue qualified health plans in more than one state?
Note. All 501(c)(29) organizations must list in Schedule O each state in which they are licensed to issue qualified health plans, the amount of reserves required by each state, and the amount of reserves the organization allocated to each state.
13a
 
 
b
Enter the aggregate amount of reserves the organization is required to maintain by the states in which the organization is licensed to issue qualified health plans.
13b
 
c
Enter the aggregate amount of reserves on hand.
13c
 
14a
Did the organization receive any payments for indoor tanning services during the tax year?.....
14a
 
 
b
If "Yes," has it filed a Form 720 to report these payments? If “No,” provide an explanation in Schedule O..
14b
 
 
Form 990 (2011)
Form 990 (2011)
Page 6
Part VI
Governance, Management, and Disclosure For each “Yes” response to lines 2 through 7b below, and for a “No” response to lines 8a, 8b, or 10b below, describe the circumstances, processes, or changes in Schedule O. See instructions.
Check if Schedule O contains a response to any question in this Part VI .........
Section A. Governing Body and Management
Yes
No
1a
Enter the number of voting members of the governing body at the end of the tax year
If the governing body delegated broad authority to an executive committee or similar committee, explain in Schedule O.
1a
15
b
Enter the number of voting members included in line 1a, above, who are independent .................
1b
11
2
Did any officer, director, trustee, or key employee have a family relationship or a business relationship with any other officer, director, trustee, or key employee? .................
2
 
No
3
Did the organization delegate control over management duties customarily performed by or under the direct supervision of officers, directors or trustees, or key employees to a management company or other person? .
3
 
No
4
Did the organization make any significant changes to its governing documents since the prior Form 990 was filed?
4
 
No
5
Did the organization become aware during the year of a significant diversion of the organization’s assets? .
5
 
No
6
Did the organization have members or stockholders? ................
6
 
No
7a
Did the organization have members, stockholders, or other persons who had the power to elect or appoint one or more members of the governing body? .................
7a
 
No
b
Are any governance decisions of the organization reserved to (or subject to approval by) members, stockholders, or persons other than the governing body? ............
7b
 
No
8
Did the organization contemporaneously document the meetings held or written actions undertaken during the year by the following:
a
The governing body? .........................
8a
Yes
 
b
Each committee with authority to act on behalf of the governing body? ..........
8b
Yes
 
9
Is there any officer, director, trustee, or key employee listed in Part VII, Section A, who cannot be reached at the organization’s mailing address? If “Yes,” provide the names and addresses in Schedule O .....
9
 
No
Section B. Policies (This Section B requests information about policies not required by the Internal
Revenue Code.)
Yes
No
10a
Did the organization have local chapters, branches, or affiliates? ............
10a
 
No
b
If “Yes,” did the organization have written policies and procedures governing the activities of such chapters, affiliates, and branches to ensure their operations are consistent with the organization's exempt purposes? ....
10b
 
 
11a
Has the organization provided a complete copy of this Form 990 to all members of its governing body before filing the form?
11a
Yes
 
b
Describe in Schedule O the process, if any, used by the organization to review the Form 990. .....
12a
Did the organization have a written conflict of interest policy? If “No,” go to line 13.......
12a
Yes
 
b
Were officers, directors or trustees, and key employees required to disclose annually interests that could give rise to conflicts? ........................
12b
Yes
 
c
Did the organization regularly and consistently monitor and enforce compliance with the policy? If “Yes,” describe in Schedule O how this was done ....................
12c
Yes
 
13
Did the organization have a written whistleblower policy? ...............
13
Yes
 
14
Did the organization have a written document retention and destruction policy? .........
14
Yes
 
15
Did the process for determining compensation of the following persons include a review and approval by independent persons, comparability data, and contemporaneous substantiation of the deliberation and decision?
a
The organization’s CEO, Executive Director, or top management official ...........
15a
Yes
 
b
Other officers or key employees of the organization ................
15b
Yes
 
If "Yes," to line 15a or 15b, describe the process in Schedule O (see instructions).
16a
Did the organization invest in, contribute assets to, or participate in a joint venture or similar arrangement with a taxable entity during the year? ......................
16a
 
No
b
If “Yes,” did the organization follow a written policy or procedure requiring the organization to evaluate its participation in joint venture arrangements under applicable federal tax law, and take steps to safeguard the organization’s exempt status with respect to such arrangements? ............
16b
 
 
Section C. Disclosure
17
List the States with which a copy of this Form 990 is required to be filedMediumBullet
18
Section 6104 requires an organization to make its Form 1023 (or 1024 if applicable), 990, and 990-T (501(c)(3)s only) available for public inspection. Indicate how you made these available. Check all that apply.
19
Describe in Schedule O whether (and if so, how), the organization made its governing documents, conflict of interest policy, and financial statements available to the public during the tax year.
20
State the name, physical address, and telephone number of the person who possesses the books and records of the organization: MediumBullet
JENNIFER OGDEN
620 E MONROE
MEXICO,MO652652963
(573) 582-8095
Form 990 (2011)
Form 990 (2011)
Page 7
Part VII
Compensation of Officers, Directors,Trustees, Key Employees, Highest Compensated Employees, and Independent Contractors
Check if Schedule O contains a response to any question in this Part VII .........
Section A. Officers, Directors, Trustees, Key Employees, and Highest Compensated Employees
1a Complete this table for all persons required to be listed. Report compensation for the calendar year ending with or within the organization’s tax year.
RoundBullet List all of the organization’s current officers, directors, trustees (whether individuals or organizations), regardless of amount
of compensation, and current key employees. Enter -0- in columns (D), (E), and (F) if no compensation was paid.

RoundBullet List all of the organization’s current key employees, if any. See instructions for definition of "key employee."
RoundBullet List the organization’s five current highest compensated employees (other than an officer, director, trustee or key employee)
who received reportable compensation (Box 5 of Form W-2 and/or Box 7 of Form 1099-MISC) of more than $100,000 from the
organization and any related organizations.

RoundBullet List all of the organization’s former officers, key employees, or highest compensated employees who received more than $100,000
of reportable compensation from the organization and any related organizations.

RoundBullet List all of the organization’s former directors or trustees that received, in the capacity as a former director or trustee of the
organization, more than $10,000 of reportable compensation from the organization and any related organizations.

List persons in the following order: individual trustees or directors; institutional trustees; officers; key employees; highest
compensated employees; and former such persons.
Check this box if neither the organization nor any related organizations compensated any current or former officer, director, or trustee.
(A)
Name and Title 		(B)
Average hours per week (describe hours for related organizations in Schedule O) 		(C)
Position (do not check more than one box, unless person is both an officer and a director/trustee) 		(D)
Reportable compensation from the organization (W- 2/1099-MISC) 		(E)
Reportable compensation from related organizations (W- 2/1099-MISC) 		(F)
Estimated amount of other compensation from the organization and related organizations
Individual Trustee or Director; Institutional Trustee; Officer; Key Employee; Highest compensated employee; Former;
(1) DAVID A NEUENDORF
PRESIDENT/CEO & DIRECTOR
 41.58 X   X       198,660 0 2,400
(2) STERLING OLIVER
VICE CHAIR BOT & DIRECTOR BOD
 1.48 X   X       0 0 0
(3) CHARLES SCHAFER
CHAIRMAN BOARD OF DIRECTORS
 1.22 X   X       0 0 0
(4) DONNA PEAK
DIRECTOR - BOARD OF TRUSTEES
 .08 X           0 0 0
(5) SUE WAECHTER
CHAIRMAN-BOT/DIRECTOR-BOD
 1.61 X   X       0 0 0
(6) JOHN DIAL
DIRECTOR - BOARD OF DIRECTORS
 .92 X           0 0 0
(7) RANDAL ROBLEY
DIRECTOR - BOARD OF DIRECTORS
 1.04 X           0 0 0
(8) MICHAEL QUINLAN MD
PHYSICIAN & MEMBER BOD
 40.95 X           364,118 0 10,245
(9) GENE THOMAS MD
PHYSICIAN & TREASURER BOT
 40.4 X   X       400,127 0 0
(10) KATHY MILLER
DIRECTOR - BOARD OF DIRECTORS
 .94 X           0 0 0
(11) GENEVA ALLISON
CHAIRMAN - BOARD OF DIRECTORS
 .99 X   X       0 0 0
(12) WILLIAM DUBBERT
SECRETARY - BOARD OF TRUSTEES
 .44 X   X       0 0 0
(13) SUSAN WILBURN
SEC/TREAS - BOARD OF DIRECTORS
 1.06 X   X       0 0 0
(14) CHARLES TILLMAN
DIRECTOR - BOARD OF DIRECTORS
 .88 X           0 0 0
(15) JO ELLEN CRAGHEAD
DIRECTOR - BOARD OF TRUSTEES
 .37 X           56,376 0 3,972
(16) GREG SHAW
VP & CHIEF FINANCIAL OFFICER
 40.0     X       118,140 0 7,749
(17) KARI WILSON
VP/DIR OF CLINICAL SERVICES
 40.0     X       133,729 0 0
Form 990 (2011)
Form 990 (2011)
Page 8
Part VII
Section A. Officers, Directors, Trustees, Key Employees, and Highest Compensated Employees (continued)
(A)
Name and Title 		(B)
Average hours per week (describe hours for related organizations in Schedule O) 		(C)
Position (do not check more than one box, unless person is both an officer and a director/trustee) 		(D)
Reportable compensation from the organization (W- 2/1099-MISC) 		(E)
Reportable compensation from related organizations (W- 2/1099-MISC) 		(F)
Estimated amount of other compensation from the organization and related organizations
Individual Trustee or Director; Institutional Trustee; Officer; Key Employee; Highest compensated employee; Former;
(18) PETER PERLL MD
PHYSICIAN
 40.0         X   398,033 0 0
(19) PEGGY A BARJENBRUCH MD
PHYSICIAN
 40.0         X   355,610 0 9,402
(20) ERIC KONDRO MD
PHYSICIAN
 40.0         X   316,624 0 2,045
(21) SHAHID WAHEED MD
PHYSICIAN
 40.0         X   463,530 0 804
(22) JOAN SLAUGHTER
CRNA
 40.0         X   257,601 0 4,000
















1b Sub-Total................MediumBullet
c Total from continuation sheets to Part VII, Section A....MediumBullet
d Total (add lines 1b and 1c)............MediumBullet 3,062,548 0 40,617
2
Total number of individuals (including but not limited to those listed above) who received more than $100,000 of reportable compensation from the organizationMediumBullet27
Yes
No
3
Did the organization list any former officer, director or trustee, key employee, or highest compensated employee on line 1a? If “Yes,” complete Schedule J for such individual .............
3
 
No
4
For any individual listed on line 1a, is the sum of reportable compensation and other compensation from the organization and related organizations greater than $150,000? If “Yes,” complete Schedule J for such individual...........................
4
Yes
 
5
Did any person listed on line 1a receive or accrue compensation from any unrelated organization or individual for services rendered to the organization? If “Yes,” complete Schedule J for such person .....
5
 
No
Section B. Independent Contractors
1
Complete this table for your five highest compensated independent contractors that received more than $100,000 of compensation from the organization. Report compensation for the calendar year ending with or within the organization’s tax year.
(A)
Name and business address 		(B)
Description of services 		(C)
Compensation
DR BRADLEY BUCHANAN
3 SOUTHMOR
MEXICO,MO65265 		ANESTHESIOLOGY 469,332
AUDRAIN EMERGENCY MEDICAL GROUP LLC
PO BOX 82368
LAFAYETTE,LA70598 		ER PHYSICIANS 435,076
PATHOLOGY LABORATORIES
PO BOX 7406
COLUMBIA,MO65205 		LABORATORY SERVICES 430,064
MEXICO CARDIOGRAPHICS
720 MEDICAL PARK DRIVE
MEXICO,MO65265 		EEG/EKG READING 360,750
LTA COMPANY LLC
PO BOX 207
MEXICO,MO65265 		ANESTHESIOLOGY 313,875
2
Total number of independent contractors (including but not limited to those listed above) who received more than $100,000 of compensation from the organization MediumBullet19
Form 990 (2011)
Form 990 (2011)
Page 9
Part VIII
Statement of Revenue
(A)
Total revenue 		(B)
Related or
exempt
function
revenue 		(C)
Unrelated
business
revenue 		(D)
Revenue
excluded from
tax under sections
512, 513, or 514
Contributions, Gifts, Grants and Other Similar Amounts 1a Federated campaigns..1a  
b Membership dues....1b  
c Fundraising events....1c  
d Related organizations...1d 555,820
e Government grants (contributions)1e 708,631
f All other contributions, gifts, grants, and
similar amounts not included above1f 		6,698
g Noncash contributions included in lines 1a-1f:$  
h Total. Add lines 1a-1f.......MediumBullet 1,271,149
Program Service Revenue Business Code
2a HOSPITAL ROUTINE REVENUE 621,110 33,967,172 33,967,172    
b ANCILLARY REVENUE 621,400 12,535,345 12,535,345    
c AMC & MEDCHOICE PHYSICIAN REVENUE 621,400 8,890,014 8,890,014    
d ELECTRONIC HEALTH RECORDS REVENUE 900,099 225,000 225,000    
e
f All other program service revenue .        
g Total. Add lines 2a–2f........MediumBullet 55,617,531
Other Revenue 3 Investment income (including dividends, interest
and other similar amounts).....MediumBullet 139,278     139,278
4 Income from investment of tax-exempt bond proceeds..MediumBullet 0      
5 Royalties............MediumBullet 0      
(i) Real (ii) Personal
6a Gross rents 124,314  
b Less: rental expenses    
c Rental income or (loss) 124,314  
d Net rental income or (loss).......MediumBullet 124,314     124,314
(i) Securities (ii) Other
7a Gross amount from sales of assets other than inventory 3,276,744  
b Less: cost or other basis and sales expenses 3,307,081  
c Gain or (loss) -30,337  
d Net gain or (loss)..........MediumBullet -30,337     -30,337
8a Gross income from fundraising events (not including
$  
of contributions reported on line 1c). See Part IV, line 18 ...
a  
b Less: direct expenses ...b  
c Net income or (loss) from fundraising events..MediumBullet 0    
9a Gross income from gaming activities.
See Part IV, line 19 ...
a  
b Less: direct expenses ...b  
c Net income or (loss) from gaming activities...MediumBullet 0      
10a Gross sales of inventory, less
returns and allowances .
a  
b Less: cost of goods sold ..b  
c Net income or (loss) from sales of inventory..MediumBullet 0      
Miscellaneous Revenue Business Code
11a CAFETERIA 722,210 226,267     226,267
b MEDICAL RECORDS 561,000 26,364     26,364
c MISCELLANEOUS 900,099 37,923     37,923
d All other revenue ....        
e Total. Add lines 11a–11d ......MediumBullet 290,554
12 Total revenue. See Instructions....MediumBullet 57,412,489 55,617,531   523,809
Form 990 (2011)
Form 990 (2011)
Page 10
Part IX
Statement of Functional Expenses
Section 501(c)(3) and 501(c)(4) organizations must complete all columns. All other organizations must complete column (A) but are not required to complete columns (B), (C), and (D).
Check if Schedule O contains a response to any question in this Part IX. .........
Do not include amounts reported on lines 6b,
7b, 8b, 9b, and 10b of Part VIII. 		(A)
Total expenses 		(B)
Program service expenses 		(C)
Management and general expenses 		(D)
Fundraising expenses
1 Grants and other assistance to governments and organizations in the United States. See Part IV, line 21 35,203 35,203
2 Grants and other assistance to individuals in the United States. See Part IV, line 22 0  
3 Grants and other assistance to governments, organizations, and individuals outside the United States. See Part IV, lines 15 and 16 0  
4 Benefits paid to or for members 0  
5 Compensation of current officers, directors, trustees, and key employees .... 1,235,167 1,179,886 55,281  
6 Compensation not included above, to disqualified persons (as defined under section 4958(f)(1)) and persons described in section 4958(c)(3)(B) .... 0      
7 Other salaries and wages 21,002,907 18,390,848 2,612,059  
8 Pension plan accruals and contributions (include section 401(k) and 403(b) employer contributions) .... 1,859,322 1,375,898 483,424  
9 Other employee benefits ....... 2,272,773 1,998,811 273,962  
10 Payroll taxes ........... 1,486,624 1,100,102 386,522  
11 Fees for services (non-employees):        
a Management ...... 0      
b Legal ......... 133,651 98,902 34,749  
c Accounting ........... 93,751 69,376 24,375  
d Lobbying ........... 0      
e Professional fundraising. See Part IV, line 17.. 0  
f Investment management fees ...... 0      
g Other .......... 7,025,806 5,199,096 1,826,710  
12 Advertising and promotion .... 117,885 87,235 30,650  
13 Office expenses ....... 14,674,055 10,858,801 3,815,254  
14 Information technology ...... 0      
15 Royalties .. 0      
16 Occupancy ........... 1,794,366 1,327,831 466,535  
17 Travel ............ 49,539 36,659 12,880  
18 Payments of travel or entertainment expenses for any federal, state, or local public officials ...... 0      
19 Conferences, conventions, and meetings .... 0      
20 Interest ........... 494,957 379,723 115,234  
21 Payments to affiliates ....... 0      
22 Depreciation, depletion, and amortization ..... 3,437,589 2,637,259 800,330  
23 Insurance .............. 234,626 173,623 61,003  
24 Other expenses. Itemize expenses not covered above (List miscellaneous expenses in line 24f. If line 24f amount exceeds 10% of line 25, column (A) amount, list line 24f expenses on Schedule O.)
a BAD DEBTS 3,587,091 3,587,091    
b DUES & SUBSCRIPTIONS 190,151 140,712 49,439  
c RECRUITMENT ALLOCATION 117,211 86,736 30,475  
d OTHER - LESS THAN 5% OF TOTAL 20   20 0
e
f All other expenses        
25 Total functional expenses. Add lines 1 through 24f 59,842,694 48,763,792 11,078,902 0
26 Joint costs. Complete this line only if the organization reported in column (B) joint costs from a combined educational campaign and fundraising solicitation. Check here MediumBullet if following SOP 98-2 (ASC 958-720).        
Form 990 (2011)
Form 990 (2011)
Page 11
Part X Balance Sheet
(A)
Beginning of year 		(B)
End of year
Assets 1 Cash—non-interest-bearing .......... 4,515 1 3,505
2 Savings and temporary cash investments ....... 2,438,445 2 1,116,435
3 Pledges and grants receivable, net ......... 0 3 0
4 Accounts receivable, net ......... 5,918,704 4 5,711,562
5 Receivables from current and former officers, directors, trustees, key employees, and highest compensated employees. Complete Part II of
Schedule L .......... 0 5 0
6 Receivables from other disqualified persons (as defined under section 4958(f)(1)) and persons described in section 4958(c)(3)(B). Complete Part II of
Schedule L .......... 0 6 0
7 Notes and loans receivable, net ............. 0 7 0
8 Inventories for sale or use .............. 601,350 8 513,223
9 Prepaid expenses and deferred charges ............ 662,343 9 1,508,022
10a Land, buildings, and equipment: cost or other basis. Complete Part VI of Schedule D 10a 81,986,693
b Less: accumulated depreciation. ..... 10b 63,993,818 19,602,285 10c 17,992,875
11 Investments—publicly traded securities .......... 3,319,071 11 3,525,227
12 Investments—other securities. See Part IV, line 11 ...... 0 12 0
13 Investments—program-related. See Part IV, line 11 .. 756,331 13 603,054
14 Intangible assets ......... 0 14 0
15 Other assets. See Part IV, line 11 ........... 63,711 15 44,346
16 Total assets. Add lines 1 through 15 (must equal line 34)... 33,366,755 16 31,018,249
Liabilities 17 Accounts payable and accrued expenses . 4,506,968 17 5,930,339
18 Grants payable .......... 0 18 0
19 Deferred revenue .......... 0 19 0
20 Tax-exempt bond liabilities .......... 0 20 0
21 Escrow or custodial account liability. Complete Part IV of Schedule D.. 0 21 0
22 Payables to current and former officers, directors, trustees, key
employees, highest compensated employees, and disqualified
persons. Complete Part II of Schedule L.......... 0 22 0
23 Secured mortgages and notes payable to unrelated third parties .. 9,006,552 23 7,172,151
24 Unsecured notes and loans payable to unrelated third parties .... 0 24 0
25 Other liabilities (including federal income tax, payables to related third parties, and other liabilities not included on lines 17-24). Complete Part X of Schedule D..... 7,353,600 25 13,434,331
26 Total liabilities. Add lines 17 through 25..... 20,867,120 26 26,536,821
Net Assets or Fund Balance Organizations that follow SFAS 117, check here MediumBullet and complete lines 27 through 29, and lines 33 and 34.
27 Unrestricted net assets ..... 11,871,649 27 4,016,462
28 Temporarily restricted net assets ..... 445,708 28 282,688
29 Permanently restricted net assets ..... 182,278 29 182,278
Organizations that do not follow SFAS 117, check here MediumBullet and complete lines 30 through 34.
30 Capital stock or trust principal, or current funds .....   30  
31 Paid-in or capital surplus, or land, building or equipment fund .....   31  
32 Retained earnings, endowment, accumulated income, or other funds   32  
33 Total net assets or fund balances ..... 12,499,635 33 4,481,428
34 Total liabilities and net assets/fund balances ..... 33,366,755 34 31,018,249
Form 990 (2011)
Form 990 (2011)
Page 12
Part XI
Reconcilliation of Net Assets
Check if Schedule O contains a response to any question in this Part XI .........
1
Total revenue (must equal Part VIII, column (A), line 12) ...
1
57,412,489
2
Total expenses (must equal Part IX, column (A), line 25) ....
2
59,842,694
3
Revenue less expenses. Subtract line 2 from line 1 ...
3
-2,430,205
4
Net assets or fund balances at beginning of year (must equal Part X, line 33, column (A)) ..
4
12,499,635
5
Other changes in net assets or fund balances (explain in Schedule O) ...
5
-5,588,002
6
Net assets or fund balances at end of year. Combine lines 3, 4, and 5 (must equal Part X, line 33, column (B)) ....
6
4,481,428
Part XII
Financial Statements and Reporting
Check if Schedule O contains a response to any question in this Part XII .........
Yes
No
1
Accounting method used to prepare the Form 990:  
If the organization changed its method of accounting from a prior year or checked "Other," explain in
Schedule O.
2a
Were the organization’s financial statements compiled or reviewed by an independent accountant?....
2a
 
No
b
Were the organization’s financial statements audited by an independent accountant?........
2b
Yes
 
c
If “Yes,” to 2a or 2b, does the organization have a committee that assumes responsibility for oversight of the audit, review, or compilation of its financial statements and selection of an independent accountant? If the organization changed either its oversight process or selection process during the tax year, explain in Schedule O. ...........................
2c
Yes
 
d
If “Yes” to line 2a or 2b, check a box below to indicate whether the financial statements for the year were issued on a separate basis, consolidated basis, or both:
3a
As a result of a federal award, was the organization required to undergo an audit or audits as set forth in the Single Audit Act and OMB Circular A-133? ................
3a
 
No
b
If “Yes,” did the organization undergo the required audit or audits? If the organization did not undergo the required audit or audits, explain why in Schedule O and describe any steps taken to undergo such audits. ..
3b
 
 
Form 990 (2011)
Additional Data


Software ID:  
Software Version:  
Form 990, Special Condition Description:
Special Condition Description
SCHEDULE A
(Form 990 or 990EZ)

Department of the Treasury
Internal Revenue Service
Public Charity Status and Public Support

Complete if the organization is a section 501(c)(3) organization or a section
4947(a)(1) nonexempt charitable trust.
right arrow Attach to Form 990 or Form 990-EZ. right arrow See separate instructions.
OMB No. 1545-0047
2011
Open to Public
Inspection
Name of the organization
Audrain Health Care Inc
 
Employer identification number

43-1550298
Part I
Reason for Public Charity Status (All organizations must complete this part.) See instructions
The organization is not a private foundation because it is: (For lines 1 through 11, check only one box.)
1
2
3
4
5
section 170(b)(1)(A)(iv). (Complete Part II.)
6
7
8
9
receipts from activities related to its exempt functions—subject to certain exceptions, and (2) no more than 331/3% of
its support from gross investment income and unrelated business taxable income (less section 511 tax) from businesses
acquired by the organization after June 30, 1975. See section 509(a)(2). (Complete Part III.)
10
11
e
f
g
(i) a person who directly or indirectly controls, either alone or together with persons described in (ii)
Yes
No
and (iii) below, the governing body of the the supported organization? ................
11g(i)
 
 
(ii) a family member of a person described in (i) above? ......................
11g(ii)
 
 
(iii) a 35% controlled entity of a person described in (i) or (ii) above? ................
11g(iii)
 
 
h
(i)
Name of supported organization 		(ii)
EIN 		(iii)
Type of organization (described on lines 1- 9 above or IRC section (see instructions)) 		(iv)
Is the organization in col. (i) listed in your governing document? 		(v)
Did you notify the organization in col. (i) of your support? 		(vi)
Is the organization in col. (i) organized in the U.S.? 		(vii)
Amount of support?
Yes No Yes No Yes No
Total                  

For Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 11285F
Schedule A (Form 990 or 990-EZ) 2011
Schedule A (Form 990 or 990-EZ) 2011
Page 2
Part II
Support Schedule for Organizations Described in IRC 170(b)(1)(A)(iv) and 170(b)(1)(A)(vi)
(Complete only if you checked the box on line 5, 7, or 8 of Part I or if the organization failed to qualify under Part III. If the organization fails to qualify under the tests listed below, please complete Part III.)
Section A. Public Support
Calendar year(or fiscal year beginning in) (a) 2007 (b) 2008 (c) 2009 (d) 2010 (e) 2011 (f) Total
1 Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grants.") ....            
2 Tax revenues levied for the organization's benefit and either paid to or expended on its behalf.......            
3 The value of services or facilities furnished by a governmental unit to the organization without charge..            
4 Total. Add lines 1 through 3..            
5 The portion of total contributions by each person (other than a governmental unit or publicly supported organization) included on line 1 that exceeds 2% of the amount shown on line 11, column (f)..            
6 Public Support. Subtract line 5 from line 4.            
Section B. Total Support
Calendar year(or fiscal year beginning in) (a) 2007 (b) 2008 (c) 2009 (d) 2010 (e) 2011 (f) Total
7 Amounts from line 4..            
8 Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources..            
9 Net income from unrelated business activities, whether or not the business is regularly carried on..            
10 Other income. (Explain in Part IV.) Do not include gain or loss from the sale of capital assets..            
11 Total support (Add lines 7 through 10).            
12
12
 
13
Section C. Computation of Public Support Percentage
14
14
 
15
15
 
16a
b
17a
b
18
Schedule A (Form 990 or 990-EZ) 2011
Schedule A (Form 990 or 990-EZ) 2011
Page 3
Part III
Support Schedule for Organizations Described in IRC 509(a)(2)
(Complete only if you checked the box on line 9 of Part I or if the organization failed to qualify under Part II. If the organization fails to qualify under the tests listed below, please complete Part II.)
Section A. Public Support
Calendar year(or fiscal year beginning in) (a) 2007 (b) 2008 (c) 2009 (d) 2010 (e) 2011 (f) Total
1 Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grants.") .            
2 Gross receipts from admissions, merchandise sold or services performed, or facilities furnished in any activity that is related to the organization's tax-exempt purpose......            
3 Gross receipts from activities that are not an unrelated trade or business under section 513..            
4 Tax revenues levied for the organization's benefit and either paid to or expended on its behalf...            
5 The value of services or facilities furnished by a governmental unit to the organization without charge..            
6 Total. Add lines 1 through 5.            
7a Amounts included on lines 1, 2, and 3 received from disqualified persons...            
b Amounts included on lines 2 and 3 received from other than disqualified persons that exceed the greater of $5,000 or 1% of the amount on line 13 for the year.            
c Add lines 7a and 7b..            
8 Public Support (Subtract line 7c from line 6.)            
Section B. Total Support
Calendar year (or fiscal year beginning in) (a) 2007 (b) 2008 (c) 2009 (d) 2010 (e) 2011 (f) Total
9 Amounts from line 6...            
10a Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources..            
b Unrelated business taxable income (less section 511 taxes) from businesses acquired after June 30, 1975.            
c Add lines 10a and 10b.            
11 Net income from unrelated business activities not included in line 10b, whether or not the business is regularly carried on.            
12 Other income. Do not include gain or loss from the sale of capital assets (Explain in Part IV.)            
13 Total support (Add lines 9, 10c, 11 and 12.).            
14
Section C. Computation of Public Support Percentage
15
15
 
16
16
 
Section D. Computation of Investment Income Percentage
17
17
 
18
18
 
19a
b
20
Schedule A (Form 990 or 990-EZ) 2011
Schedule A (Form 990 or 990-EZ) 2011
Page 4
Part IV
Supplemental Information. Supplemental Information. Complete this part to provide the explanation required by Part II, line 10; Part II, line 17a or 17b; or Part III, line 12. Also complete this part for any additional information. (See instructions).
Facts And Circumstances Test
 
Explanation
 
 
 
 
Schedule A (Form 990 or 990-EZ) 2011

Additional Data


Software ID:  
Software Version:  
Schedule B
(Form 990, 990-EZ,
or 990-PF)
Department of the Treasury
Internal Revenue Service
Schedule of Contributors
Arrow Bullet Attach to Form 990, 990-EZ, or 990-PF.
OMB No. 1545-0047
2011
Name of organization
Audrain Health Care Inc
 
Employer identification number

43-1550298
Organization type (check one):
Filers of:
Section:
Form 990 or 990-EZ





Form 990-PF




Check if your organization is covered by the General Rule or a Special Rule.  
Note. Only a section 501(c)(7), (8), or (10) organization can check boxes for both the General Rule and a Special Rule. See instructions.
General Rule
Special Rules
......................... Arrow Bullet   $    
Caution. An Organization that is not covered by the General Rule and/or the Special Rules does not file Schedule B (Form 990,
990-EZ, or 990-PF), but it must answer “No” on Part IV, line 2, of its Form 990; or check the box on line H of its
Form 990-EZ or on Part I, line 2, of its Form 990-PF, to certify that it does not meet the filing requirements of Schedule B (Form 990,
990-EZ, or 990-PF).
For Paperwork Reduction Act Notice, see the Instructions
for Form 990, 990-EZ, or 990-PF.
Cat. No. 30613XSchedule B (Form 990, 990-EZ, or 990-PF) (2011)

Page 2
Schedule B (Form 990, 990-EZ, or 990-PF) (2011)
Name of organization
Audrain Health Care Inc
  		Employer identification number

43-1550298
Part I
Contributors (see Instructions). Use duplicate copies of Part I if additional space is needed.
     
(a)
No.		 (b)
Name, address, and ZIP + 4		 (c)
Total contributions		 (d)
Type of contribution
RESTRICTED
RESTRICTED
 

     
RESTRICTED
RESTRICTED  
RESTRICTED, RESTRICTED   RESTRICTED

$RESTRICTED




(Complete Part II if there is a noncash contribution.)
(a)
No.		 (b)
Name, address, and ZIP + 4		 (c)
Total contributions		 (d)
Type of contribution
 
 
 

     
 
   

$  




(Complete Part II if there is a noncash contribution.)
(a)
No.		 (b)
Name, address, and ZIP + 4		 (c)
Total contributions		 (d)
Type of contribution
 
 
 

     
 
   

$  




(Complete Part II if there is a noncash contribution.)
(a)
No.		 (b)
Name, address, and ZIP + 4		 (c)
Total contributions		 (d)
Type of contribution
 
 
 

     
 
   

$  




(Complete Part II if there is a noncash contribution.)
(a)
No.		 (b)
Name, address, and ZIP + 4		 (c)
Total contributions		 (d)
Type of contribution
 
 
 

     
 
   

$  




(Complete Part II if there is a noncash contribution.)
(a)
No.		 (b)
Name, address, and ZIP + 4		 (c)
Total contributions		 (d)
Type of contribution
 
 
 

     
 
   

$  




(Complete Part II if there is a noncash contribution.)
Schedule B (Form 990, 990-EZ, or 990-PF) (2011)

Page 3
Schedule B (Form 990, 990-EZ, or 990-PF) (2011)
Name of organization
Audrain Health Care Inc
  		Employer identification number

43-1550298
Part II
Noncash Property (see Instructions). Use duplicate copies of Part II if additional space is needed.
     
(a) No.
from
Part I		 (b)
Description of noncash property given		 (c)
FMV (or estimate)
(see instructions). 		(d)
Date received
 
$    
(a) No.
from
Part I		 (b)
Description of noncash property given		 (c)
FMV (or estimate)
(see instructions). 		(d)
Date received
 
$    
(a) No.
from
Part I		 (b)
Description of noncash property given		 (c)
FMV (or estimate)
(see instructions). 		(d)
Date received
 
$    
(a) No.
from
Part I		 (b)
Description of noncash property given		 (c)
FMV (or estimate)
(see instructions). 		(d)
Date received
 
$    
(a) No.
from
Part I		 (b)
Description of noncash property given		 (c)
FMV (or estimate)
(see instructions). 		(d)
Date received
 
$    
(a) No.
from
Part I		 (b)
Description of noncash property given		 (c)
FMV (or estimate)
(see instructions). 		(d)
Date received
 
$    
Schedule B (Form 990, 990-EZ, or 990-PF) (2011)

Page 4
Schedule B (Form 990, 990-EZ, or 990-PF) (2011)
Name of organization
Audrain Health Care Inc
  		Employer identification number

43-1550298
Part III
Exclusively religious, charitable, etc., individual contributions to section 501(c)(7), (8), or (10) organizations
that total more than $1,000 for the year. Complete columns (a) through (e) and the following line entry.
For organizations completing Part III, enter the total of exclusively religious, charitable, etc.,
contributions of $1,000 or less for the year. (Enter this information once. See instructions.) Arrow Bullet $  
Use duplicate copies of Part III if additional space is needed
(a) No.
from
Part I		 (b)
Purpose of gift		 (c)
Use of gift		 (d)
Description of how gift is held
 
(e)
Transfer of gift
Transferee's name, address, and ZIP 4 Relationship of transferor to transferee
 
 
       
 
(a) No.
from
Part I		 (b)
Purpose of gift		 (c)
Use of gift		 (d)
Description of how gift is held
 
(e)
Transfer of gift
Transferee's name, address, and ZIP 4 Relationship of transferor to transferee
 
 
       
 
(a) No.
from
Part I		 (b)
Purpose of gift		 (c)
Use of gift		 (d)
Description of how gift is held
 
(e)
Transfer of gift
Transferee's name, address, and ZIP 4 Relationship of transferor to transferee
 
 
       
 
(a) No.
from
Part I		 (b)
Purpose of gift		 (c)
Use of gift		 (d)
Description of how gift is held
 
(e)
Transfer of gift
Transferee's name, address, and ZIP 4 Relationship of transferor to transferee
 
 
       
 
Schedule B (Form 990, 990-EZ, or 990-PF) (2011)

Additional Data


Software ID:  
Software Version:  
SCHEDULE C
(Form 990 or 990-EZ)

Department of the Treasury
Internal Revenue Service
Political Campaign and Lobbying Activities

For Organizations Exempt From Income Tax Under section 501(c) and section 527
SchCMd Bullet Complete if the organization is described below.
SchCMd Bullet Attach to Form 990 or Form 990-EZ. SchCMd Bullet See separate instructions.
OMB No. 1545-0047
2011
Open to Public
Inspection
If the organization answered “Yes” to Form 990, Part IV, Line 3, or Form 990-EZ, Part V, line 46 (Political Campaign Activities), then
Round Bullet Section 501(c)(3) organizations: Complete Parts I-A and B. Do not complete Part I-C.
Round Bullet Section 501(c) (other than section 501(c)(3)) organizations: Complete Parts I-A and C below. Do not complete Part I-B.
Round Bullet Section 527 organizations: Complete Part I-A only.
If the organization answered “Yes” to Form 990, Part IV, Line 4, or Form 990-EZ, Part VI, line 47 (Lobbying Activities), then
Round Bullet Section 501(c)(3) organizations that have filed Form 5768 (election under section 501(h)) Complete Part II-A. Do not complete Part II-B.
Round Bullet Section 501(c)(3) organizations that have NOT filed Form 5768 (election under section 501(h)): Complete Part II-B. Do not complete Part II-A.
If the organization answered “Yes” to Form 990, Part IV, Line 5 (Proxy Tax) or Form 990-EZ, line 35c (Proxy Tax), then
Round Bullet Section 501(c)(4), (5), or (6) organizations: Complete Part III.
Name of the organization
Audrain Health Care Inc
 
Employer identification number

43-1550298
Part I-A
Complete if the organization is exempt under section 501(c) or is a section 527 organization.

1
Provide a description of the organization’s direct and indirect political campaign activities in Part IV.
2
Political expenditures ....................................SchCMd Bullet
$  
3
Volunteer hours ........................................
 

Part I-B
Complete if the organization is exempt under section 501(c)(3).
1
Enter the amount of any excise tax incurred by the organization under section 4955 .........SchCMd Bullet
$  
2
Enter the amount of any excise tax incurred by organization managers under section 4955 ......SchCMd Bullet
$  
3
If the organization incurred a section 4955 tax, did it file Form 4720 for this year? ..............
4a
Was a correction made? .........................................
b
If "Yes," describe in Part IV.
Part I-C
Complete if the organization is exempt under section 501(c) except section 501(c)(3).
1
Enter the amount directly expended by the filing organization for section 527 exempt function activities SchCMd Bullet
$  
2
Enter the amount of the filing organization's funds contributed to other organizations for section 527 exempt function activities ...................................SchCMd Bullet

$  
3
Total exempt function expenditures. Add lines 1 and 2. Enter here and on Form 1120-POL, line 17b..SchCMd Bullet

$  
4
Did the filing organization file Form 1120-POL for this year? ..........................
5
Enter the names, addresses and employer identification number (EIN) of all section 527 political organizations to which the filing
organization made payments. For each organization listed, enter the amount paid from the filing organization’s funds. Also enter the amount of political contributions received that were promptly and directly delivered to a separate political organization, such as a separate segregated fund or a political action committee (PAC). If additional space is needed, provide information in Part IV.
(a) Name (b) Address (c) EIN (d) Amount paid from filing organization's funds. If none, enter -0-. (e) Amount of political contributions received and promptly and directly delivered to a separate political organization. If none, enter -0-.










For Privacy Act and Paperwork Reduction Act Notice, see the instructions for Form 990.
Cat. No. 50084S
Schedule C (Form 990 or 990-EZ) 2011

Schedule C (Form 990 or 990-EZ) 2011
Page 2
Part II-A
Complete if the organization is exempt under section 501(c)(3) and filed Form 5768 (election under section 501(h)).
A Check expenses, and share of excess lobbying expenditures).
B Check
Limits on Lobbying Expenditures
(The term "expenditures" means amounts paid or incurred.) 		(a) Filing
organization's
totals 		(b) Affiliated group
totals
1a Total lobbying expenditures to influence public opinion (grass roots lobbying) ......    
b Total lobbying expenditures to influence a legislative body (direct lobbying) .......    
c Total lobbying expenditures (add lines 1a and 1b) ...................    
d Other exempt purpose expenditures ........................    
e Total exempt purpose expenditures (add lines 1c and 1d) ...............    
f Lobbying nontaxable amount. Enter the amount from the following table in both
columns.		    
  If the amount on line 1e, column (a) or (b) is:The lobbying nontaxable amount is:    
  Not over $500,00020% of the amount on line 1e.    
  Over $500,000 but not over $1,000,000$100,000 plus 15% of the excess over $500,000.    
  Over $1,000,000 but not over $1,500,000$175,000 plus 10% of the excess over $1,000,000.    
  Over $1,500,000 but not over $17,000,000$225,000 plus 5% of the excess over $1,500,000.    
  Over $17,000,000$1,000,000.    
       
g Grassroots nontaxable amount (enter 25% of line 1f) .................    
h Subtract line 1g from line 1a. If zero or less, enter -0-. ................    
i Subtract line 1f from line 1c. If zero or less, enter -0-. ................    
j If there is an amount other than zero on either line 1h or line 1i, did the organization file Form 4720 reporting
section 4911 tax for this year? ......................................

4-Year Averaging Period Under Section 501(h)
(Some organizations that made a section 501(h) election do not have to complete all of the five
columns below. See the instructions for lines 2a through 2f on page 4.)
Lobbying Expenditures During 4-Year Averaging Period
  Calendar year (or fiscal year
beginning in) 		(a) 2008 (b) 2009 (c) 2010 (d) 2011 (e) Total
             
2a Lobbying non-taxable amount          
             
b Lobbying ceiling amount
(150% of line 2a, column(e)) 		         
             
c Total lobbying expenditures          
             
d Grassroots nontaxable amount          
             
e Grassroots ceiling amount
(150% of line 2d, column (e))		          
             
f Grassroots lobbying expenditures          
Schedule C (Form 990 or 990-EZ) 2011


Schedule C (Form 990 or 990-EZ) 2011
Page 3
Part II-B
Complete if the organization is exempt under section 501(c)(3) and has NOT filed Form 5768 (election under section 501(h)).
For each “Yes” response to lines 1a through 1i below, provide in Part IV a detailed description of the lobbying activity.
(a)
Yes
No
(b)
Amount
1
During the year, did the filing organization attempt to influence foreign, national, state or local legislation, including any attempt to influence public opinion on a legislative matter or referendum, through the use of:
a
Volunteers? .........................................
 
No
b
Paid staff or management (include compensation in expenses reported on lines 1c through 1i)? ....
 
No
c
Media advertisements? ....................................
 
No
 
d
Mailings to members, legislators, or the public? .........................
 
No
 
e
Publications, or published or broadcast statements? .......................
 
No
 
f
Grants to other organizations for lobbying purposes? .......................
Yes
 
5,445
g
Direct contact with legislators, their staffs, government officials, or a legislative body? ........
 
No
 
h
Rallies, demonstrations, seminars, conventions, speeches, lectures, or any similar means? ......
 
No
 
i
Other activities? ..........................
 
No
 
j
Total. Add lines 1c through 1i ...............................
5,445
2a
Did the activities in line 1 cause the organization to be not described in section 501(c)(3)? .....
 
No
b
If "Yes," enter the amount of any tax incurred under section 4912 .................
 
c
If "Yes," enter the amount of any tax incurred by organization managers under section 4912 .....
 
d
If the filing organization incurred a section 4912 tax, did it file Form 4720 for this year? .......
 
 
Part III-A
Complete if the organization is exempt under section 501(c)(4), section 501(c)(5), or section 501(c)(6).
Yes
No
1
Were substantially all (90% or more) dues received nondeductible by members? ................
1
 
 
2
Did the organization make only in-house lobbying expenditures of $2,000 or less? ................
2
 
 
3
Did the organization agree to carry over lobbying and political expenditures from the prior year? ..........
3
 
 
Part III-B
Complete if the organization is exempt under section 501(c)(4), section 501(c)(5), or section 501(c)(6) and if either (a) BOTH Part III-A, lines 1 and 2 are answered “No” OR (b) Part III-A, line 3 is answered “Yes”.
1
Dues, assessments and similar amounts from members .....................
1
 
2
Section 162(e) nondeductible lobbying and political expenditures (do not include amounts of political
expenses for which the section 527(f) tax was paid).
a
Current year .........................................
2a
 
b
Carryover from last year ....................................
2b
 
c
Total ...........................................
2c
 
3
Aggregate amount reported in section 6033(e)(1)(A) notices of nondeductible section 162(e) dues .
3
 
4
If notices were sent and the amount on line 2c exceeds the amount on line 3, what portion of the excess does the organization agree to carryover to the reasonable estimate of nondeductible lobbying and political expenditure next year? ................................
4
 
5
Taxable amount of lobbying and political expenditures (see instructions) ..............
5
 
Part IV
Supplemental Information
Complete this part to provide the descriptions required for Part l-A, line 1; Part l-B, line 4; Part l-C, Part II-A; line 5; and Part ll-B, line 1.
Also, complete this part for any additional information.
Identifier Return Reference Explanation
ORGANIZATION'S DIRECT AND INDIRECT POLITICAL ACTIVITIES SCHEDULE C, PART I-A, LINE 1 THE ORGANIZATION IS A MEMBER OF THE MISSOURI HOSPITAL ASSOCIATION, WHICH A PORTION OF THE DUES PAID ARE ATTRIBUTABLE TO LOBBYING ACTIVITIES.
Schedule C (Form 990 or 990EZ) 2011

Additional Data


Software ID:  
Software Version:  

SCHEDULE D
(Form 990)
Department of the Treasury
Internal Revenue Service
Supplemental Financial Statements
SchDMd Bullet Complete if the organization answered "Yes," to Form 990,
Part IV, line 6, 7, 8, 9, 10, 11a, 11b, 11c, 11d, 11e, 11f, 12a, or 12b
SchDMd Bullet Attach to Form 990. SchDMd Bullet See separate instructions.
OMB No. 1545-0047
2011
Open to Public Inspection
Name of the organization
Audrain Health Care Inc
 
Employer identification number

43-1550298
Part I
Organizations Maintaining Donor Advised Funds or Other Similar Funds or Accounts. Complete if the organization answered "Yes" to Form 990, Part IV, line 6.
(a) Donor advised funds (b) Funds and other accounts
1 Total number at end of year .......    
2 Aggregate contributions to (during year) ...    
3 Aggregate grants from (during year) ...    
4 Aggregate value at end of year .......    
5
Did the organization inform all donors and donor advisors in writing that the assets held in donor advised
funds are the organization's property, subject to the organization's exclusive legal control? ............
6
Did the organization inform all grantees, donors, and donor advisors in writing that grant funds can be
used only for charitable purposes and not for the benefit of the donor or donor advisor, or for any other purpose conferring impermissible private benefit? ...................................
Part II
Conservation Easements. Complete if the organization answered "Yes" to Form 990, Part IV, line 7.
1
Purpose(s) of conservation easements held by the organization (check all that apply).
2
Complete lines 2a through 2d if the organization held a qualified conservation contribution in the form of a conservation easement on the last day of the tax year.
Held at the End of the Year
a Total number of conservation easements ....................... 2a  
b Total acreage restricted by conservation easements .................. 2b  
c Number of conservation easements on a certified historic structure included in (a) ..... 2c  
d Number of conservation easements included in (c) acquired after 8/17/06, and not on a historic structure listed in the National Register .................... 2d  
3
Number of conservation easements modified, transferred, released, extinguished, or terminated by the organization during
the tax year SchDMd Bullet  
4
Number of states where property subject to conservation easement is located SchDMd Bullet  
5
Does the organization have a written policy regarding the periodic monitoring, inspection, handling of violations, and
enforcement of the conservation easements it holds? .............................
6
Staff and volunteer hours devoted to monitoring, inspecting and enforcing conservation easements during the year SchDMd Bullet  
7
Amount of expenses incurred in monitoring, inspecting, and enforcing conservation easements during the year
SchDMd Bullet $  
8
Does each conservation easement reported on line 2(d) above satisfy the requirements of section
170(h)(4)(B)(i) and 170(h)(4)(B)(ii)? ....................................
9
In Part XIV, describe how the organization reports conservation easements in its revenue and expense statement, and
balance sheet, and include, if applicable, the text of the footnote to the organization’s financial statements that describes
the organization’s accounting for conservation easements.
Part III
Organizations Maintaining Collections of Art, Historical Treasures, or Other Similar Assets.
Complete if the organization answered "Yes" to Form 990, Part IV, line 8.
1a
If the organization elected, as permitted under SFAS 116 (ASC 958), not to report in its revenue statement and balance sheet works of
art, historical treasures, or other similar assets held for public exhibition, education or research in furtherance of public service,
provide, in Part XIV, the text of the footnote to its financial statements that describes these items.
b
If the organization elected, as permitted under SFAS 116 (ASC 958), to report in its revenue statement and balance sheet works of art,
historical treasures, or other similar assets held for public exhibition, education, or research in furtherance of public service,
provide the following amounts relating to these items:
(i)
Revenues included in Form 990, Part VIII, line 1 ........................SchDMd Bullet $  
(ii)
Assets included in Form 990, Part X ..............................SchDMd Bullet $  
2
If the organization received or held works of art, historical treasures, or other similar assets for financial gain, provide the
following amounts required to be reported under SFAS 116 (ASC 958), relating to these items:
a
Revenues included in Form 990, Part VIII, line 1 ..........................SchDMd Bullet $  
b
Assets included in Form 990, Part X ...............................SchDMd Bullet $  
For Privacy Act and Paperwork Reduction Act Notice, see the Intructions for Form 990
Cat. No. 52283D
Schedule D (Form 990) 2011

Schedule D (Form 990) 2011
Page 2
Part III
Organizations Maintaining Collections of Art, Historical Treasures, or Other Similar Assets (continued)
3
Using the organization’s accession and other records, check any of the following that are a significant use of its collection
items (check all that apply):
a
d
b
e
 
c
4
Provide a description of the organization’s collections and explain how they further the organization’s exempt purpose in
Part XIV.
5
During the year, did the organization solicit or receive donations of art, historical treasures or other similar
assets to be sold to raise funds rather than to be maintained as part of the organization’s collection?........
Part IV
Escrow and Custodial Arrangements. Complete if the organization answered "Yes" to Form 990,
Part IV, line 9, or reported an amount on Form 990, Part X, line 21.
1a
Is the organization an agent, trustee, custodian or other intermediary for contributions or other assets not
included on Form 990, Part X? ....................................
b
If "Yes," explain the arrangement in Part XIV and complete the following table:
Amount
c Beginning balance ................................. 1c  
d Additions during the year .............................. 1d  
e Distributions during the year ............................. 1e  
f Ending balance ................................... 1f  
2a
Did the organization include an amount on Form 990, Part X, line 21? .....................
b
If “Yes,” explain the arrangement in Part XIV.
Part V
Endowment Funds. Complete if the organization answered "Yes" to Form 990, Part IV, line 10.
(a)Current Year (b)Prior Year (c)Two Years Back (d)Three Years Back (e)Four Years Back
1a Beginning of year balance .... 4,026,495 4,394,653 4,084,478 5,028,947
b Contributions ........ 0 43,181 244,672 443,106
c Net investment earnings, gains, and losses ... -8,789 -296,457 1,808,806 550,679
d Grants or scholarships ..... 0 500   500
e Other expenditures for facilities
and programs ........ 		42,838 105,437 1,724,140 1,913,138
f Administrative expenses .... 15,398 8,945 19,164 24,616
g End of year balance ...... 3,959,470 4,026,495 4,394,652 4,084,478
2
Provide the estimated percentage of the year end balance (line 1g) held as:
a
Board designated or quasi-endowment SchDMd Bullet57.805 %
b
Permanent endowment SchDMd Bullet0 %
c
Temporarily restricted endowment SchDMd Bullet42.195 %
The percentages in lines 2a, 2b, and 2c should equal 100%.
3a
Are there endowment funds not in the possession of the organization that are held and administered for the
organization by:

Yes
No
(i) unrelated organizations ........................
3a(i)
Yes
 
(ii) related organizations ........................
3a(ii)
 
No
b
If "Yes" to 3a(ii), are the related organizations listed as required on Schedule R? .........
3b
 
 
4
Describe in Part XIV the intended uses of the organization's endowment funds.
Part VI
Land, Buildings, and Equipment. See Form 990, Part X, line 10.
Description of property (a) Cost or other basis (investment) (b)Cost or other basis (other) (c) Accumulated depreciation (d) Book value
1a Land .................   782,780 782,780
b Buildings ................   37,568,532 27,384,941 10,183,591
c Leasehold improvements ............        
d Equipment ................   39,888,813 34,340,884 5,547,929
e Other .................   3,746,568 2,267,993 1,478,575
Total. Add lines 1a through 1e. (Column (d) must equal Form 990, Part X, column (B), line 10(c).).......SchDMdBullet 17,992,875
Schedule D (Form 990) 2011

Schedule D (Form 990) 2011
Page 3
Part VII
Investments—Other Securities. See Form 990, Part X, line 12.
(a) Description of security or category
(including name of security)		 (b)Book value (c) Method of valuation:
Cost or end-of-year market value
(1)Financial derivatives    
(2)Closely-held equity interests    
Other








Total. (Column (b) must equal Form 990, Part X, col. (B) line 12.)Small Bullet  
Part VIII
Investments—Program Related. See Form 990, Part X, line 13.
(a) Description of investment type (b) Book value (c) Method of valuation:
Cost or end-of-year market value








Total. (Column (b) must equal Form 990, Part X, col.(B) line 13.)Small Bullet  
Part IX
Other Assets. See Form 990, Part X, line 15.
(a) Description (b) Book value








Total. (Column (b) must equal Form 990, Part X, col.(B) line 15.)...........Small Bullet  
Part X
Other Liabilities. See Form 990, Part X, line 25.
1.(a) Description of Liability (b) Book value
Federal Income Taxes 0
ESTIMATED PENSION LIABILITY 12,959,170
ASSET RETIREMENT OBLIGATION 475,161







Total. (Column (b) must equal Form 990, Part X, col.(B) line 25.)Small Bullet 13,434,331
2. Fin 48 (ASC 740) Footnote. In Part XIV, provide the text of the footnote to the organization's financial statements that reports the organization's liability for uncertain tax positions under FIN 48 (ASC740).
Schedule D (Form 990) 2011

Schedule D (Form 990) 2011
Page 4
Part XI Reconciliation of Change in Net Assets from Form 990 to Financial Statements
1 Total revenue (Form 990, Part VIII, column (A), line 12) .................... 1 57,412,489
2 Total expenses (Form 990, Part IX, column (A), line 25) ..................... 2 59,842,694
3 Excess or (deficit) for the year. Subtract line 2 from line 1 ............. 3 -2,430,205
4 Net unrealized gains (losses) on investments .......................... 4 -116,251
5 Donated services and use of facilities ............................. 5  
6 Investment expenses ................................... 6  
7 Prior period adjustments .................................. 7  
8 Other (Describe in Part XIV.) ................................. 8 -5,308,731
9 Total adjustments (net). Add lines 4 through 8 ......................... 9 -5,424,982
10 Excess or (deficit) for the year per financial statements. Combine lines 3 and 9 ......... 10 -7,855,187
Part XII Reconciliation of Revenue per Audited Financial Statements With Revenue per Return
1 Total revenue, gains, and other support per audited financial statements ....... 1 57,285,514
2 Amounts included on line 1 but not on Form 990, Part VIII, line 12:
a Net unrealized gains on investments .......... 2a -116,251
b Donated services and use of facilities ......... 2b  
c Recoveries of prior year grants ........... 2c  
d Other (Describe in Part XIV.) ............ 2d  
e Add lines 2a through 2d ..................... 2e -116,251
3 Subtract line 2e from line 1..................... 3 57,401,765
4 Amounts included on Form 990, Part VIII, line 12, but not on line 1:
a Investment expenses not included on Form 990, Part VIII, line 7b . 4a  
b Other (Describe in Part XIV.) ........... 4b 10,724
c Add lines 4a and 4b....................... 4c 10,724
5 Total Revenue. Add lines 3 and 4c. (This must equal Form 990, Part I, line 12.) ...... 5 57,412,489
Part XIII Reconciliation of Expenses per Audited Financial Statements With Expenses per Return
1 Total expenses and losses per audited financial statements ............. 1 59,822,226
2 Amounts included on line 1 but not on Form 990, Part IX, line 25:
a Donated services and use of facilities .......... 2a  
b Prior year adjustments .............. 2b  
c Other losses ................ 2c  
d Other (Describe in Part XIV.) ............ 2d  
e Add lines 2a through 2d...................... 2e  
3 Subtract line 2e from line 1..................... 3 59,822,226
4 Amounts included on Form 990, Part IX, line 25, but not on line 1:
a Investment expenses not included on Form 990, Part VIII, line 7b .. 4a  
b Other (Describe in Part XIV.) ............ 4b 20,468
c Add lines 4a and 4b....................... 4c 20,468
5 Total expenses. Add lines 3 and 4c. (This must equal Form 990, Part I, line 18.) ...... 5 59,842,694
Part XIV
Supplemental Information
Complete this part to provide the descriptions required for Part II, lines 3, 5, and 9; Part III, lines 1a and 4; Part lV, lines 1b and 2b;
Part V, line 4; Part X; Part XI, line 8; Part XII, lines 2d and 4b; and Part XIII, lines 2d and 4b. Also complete this part to provide any additional information.
Identifier Return Reference Explanation
USE OF ENDOWMENT FUNDS SCHEDULE D, PART V, LINE 4 ALL FUNDS ARE USED TO PROVIDE HEALTH CARE SERVICES, CAPITAL IMPROVEMENTS, AND FUND DEPRECIATION. THE BONDS ARE HELD BY THE TRUSTEE.
RECONCILIATION OF CHANGE IN NET ASSETS ON FORM 990 TO FINANCIAL STMTS SCHEDULE D, PART XI, LINE 8 CHANGE IN INTEREST IN NET ASSETS OF FOUNDATION 9,751 OTHER ADJUSTMENTS -7 CHANGE IN MINIMUM PENSION LIABILITY -5,318,475 - - - - TOTAL -5,308,731
RECONCILIATION OF REVENUE PER FINANCIAL STATEMENTS TO REVENUE PER RETURN SCHEDULE D, PART XII, LINE 4B INCOME INCLUDED IN AUDITED FINANCIAL STATEMENTS AS NEGATIVE EXPENSE 20,468 CHANGE IN INTEREST IN NET ASSETS OF FOUNDATION -9,751 OTHER ADJUSTMENTS 7 - - - - TOTAL 10,724
RECONCILIATION OF EXPENSE PER FINANCIAL STATEMENTS TO EXPENSE PER RETURN SCHEDULE D, PART XII, LINE 4B INCOME INCLUDED IN AUDITED FINANCIAL STATEMENTS AS NEGATIVE EXPENSE 20,468
FIN 48 DISCLOSURE PART X, LINE 2 MANAGEMENT HAS EVALUATED THEIR 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.
Schedule D (Form 990) 2011

Additional Data


Software ID:  
Software Version:  




SCHEDULE H (Form 990)
Department of the Treasury
Internal Revenue Service
Hospitals
MediumBullet Complete if the organization answered "Yes" to Form 990, Part IV, question 20.
MediumBullet Attach to Form 990. MediumBullet See separate instructions.
OMB No. 1545-0047
2011
Open to Public Inspection
Name of the organization
Audrain Health Care Inc
 
Employer identification number

43-1550298
Part I
Charity Care and Certain Other Community Benefits at Cost
Yes
No
1a
Did the organization have a financial assistance policy during the tax year? If "No," skip to question 6a....
1a
Yes
 
b
If "Yes," was it a written policy? .......................
1b
Yes
 
2
If the organization had multiple hospital facilities, indicate which of the following best describes application of the financial assistance policy to its various hospital facilities during the tax year.
3
Answer the following based on the financial assistance eligibility criteria that applied to the largest number of the organization's patients during the tax year.
a
Did the organization use Federal Poverty Guidelines (FPG) to determine eligibility for providing free care?
If "Yes," indicate which of the following was the FPG family income limit for eligibility for free care:
3a
Yes
 
b
Did the organization use FPG to determine eligibility for providing discounted care? If "Yes," indicate which of the
following was the family income limit for eligibility for discounted care: ............
3b
Yes
 
c
If the organization did not use FPG to determine eligibility, describe in Part VI the income based criteria for determining eligibility for free or discounted care. Include in the description whether the organization used an asset test or other threshold, regardless of income, to determine eligibility for free or discounted care.
4
Did the organization's financial assistance policy that applied to the largest number of its patients during the tax year provide for free or discounted care to the "medically indigent"? ..............

4

Yes

 
5a
Did the organization budget amounts for free or discounted care provided under its financial assistance policy during the tax year? ............................

5a

Yes

 
b
If "Yes," did the organization's financial assistance expenses exceed the budgeted amount?......
5b
Yes
 
c
If "Yes" to line 5b, as a result of budget considerations, was the organization unable to provide free or discountedcare to a patient who was eligibile for free or discounted care?...............
5c
 
No
6a
Did the organization prepare a community benefit report during the tax year?...........
6a
Yes
 
b
If "Yes," did the organization make it available to the public? ...............
6b
Yes
 
Complete the following table using the worksheets provided in the Schedule H instructions. Do not submit these worksheets with the Schedule H.
7
Financial Assistance and Certain Other Community Benefits at Cost
Financial Assistance
and Means-Tested Government Programs		 (a) Number of activities or programs (optional) (b) Persons served (optional) (c) Total community benefit expense (d) Direct offsetting revenue (e) Net community benefit expense (f) Percent of total expense
a Financial Assistance at cost
(from Worksheet 1) .. 		    1,372,529   1,372,529 2.440 %
b Medicaid (from Worksheet 3, column a) .....     8,190,000 7,455,000 735,000 1.310 %
c Costs of other means-tested government programs (from Worksheet 3, column b) .            
dTotal Financial Assistance and
Means-Tested Government Programs ..... 		    9,562,529 7,455,000 2,107,529 3.750 %
Other Benefits
e Community health improvement
services and community
benefit operations (from
(Worksheet 4) .... 		    57,284 11,278 46,006 0.080 %
f Health professions education
(from Worksheet 5) .. 		    15,458 2,600 12,858 0.020 %
g Subsidized health services
(from Worksheet 6) .. 		    17,832,007 9,823,747 8,008,260 10.940 %
h Research (from Worksheet 7)            
i Cash and in-kind contributions for community benefit (from Worksheet 8) ....     60,007   60,007 0.110 %
jTotal Other Benefits ...     17,964,756 9,837,625 8,127,131 11.150 %
kTotal. Add lines 7d and 7j. ..     27,527,285 17,292,625 10,234,660 14.900 %
For Paperwork Reduction Act Notice, see the Instructions for Form 990. Cat. No. 50192T Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
Part II
Community Building Activities Complete this table if the organization conducted any community building activities during the tax year, and describe in Part VI how its community building activities promoted the health of the communities it serves.
(a) Number of activities or programs (optional) (b) Persons served (optional) (c) Total community building expense (d) Direct offsetting
revenue 		(e) Net community building expense (f) Percent of total expense
1 Physical improvements and housing            
2 Economic development            
3 Community support     8,655   8,655 0.020 %
4 Environmental improvements            
5 Leadership development and training for community members            
6 Coalition building     203,425   203,425 0.360 %
7 Community health improvement advocacy     101,338   101,338 0.180 %
8 Workforce development            
9 Other            
10 Total     313,418   313,418 0.560 %
Part III
Bad Debt, Medicare, & Collection Practices
Section A. Bad Debt Expense
Yes
No
1
Did the organization report bad debt expense in accordance with Heathcare Financial Management Association Statement No. 15? ..........................
1
Yes
 
2
Enter the amount of the organization's bad debt expense........
2
1,441,652
3
Enter the estimated amount of the organization's bad debt expense attributable to patients eligible under the organization's financial assistance policy .....
3
0
4
Provide in Part VI the text of the footnote to the organization's financial statements that describes bad debt expense. In addition, describe the costing methodology used in determining the amounts reported on lines 2 and 3, and rationale for including a portion of bad debt amounts as community benefit.
Section B. Medicare
5
Enter total revenue received from Medicare (including DSH and IME).....
5
18,734,504
6
Enter Medicare allowable costs of care relating to payments on line 5.....
6
19,637,289
7
Subtract line 6 from line 5. This is the surplus or (shortfall)........
7
-902,785
8
Describe in Part VI the extent to which any shortfall reported in line 7 should be treated as community benefit.Also describe in Part VI the costing methodology or source used to determine the amount reported on line 6.Check the box that describes the method used:
Section C. Collection Practices
9a
Did the organization have a written debt collection policy during the tax year? ..........
9a
Yes
 
b
If "Yes," did the organization’s collection policy that applied to the largest number of its patients during the tax year contain provisions on the collection practices to be followed for patients who are known to qualify for financial assistance? Describe in Part VI.......................

9b

Yes

 
Part IV
Management Companies and Joint Ventures
(see instructions)
(a) Name of entity (b) Description of primary
activity of entity 		(c) Organization's
profit % or stock
ownership % 		(d) Officers, directors,
trustees, or key
employees' profit %
or stock ownership% 		(e) Physicians'
profit % or stock
ownership %
1
2
3
4
5
6
7
8
9
10
11
12
13
Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
Part VFacility Information
Section A. Hospital Facilities
(list in order of size from largest to smallest)
How many hospital facilities did the organization operate during the tax year?1
Name and address 		Licensed Hospital General-Medical-Surgical Children's Hospital Teaching Hospital Critical Hospital Research Facility ER-24Hours ER-Other Other (Describe)
1 AUDRAIN MEDICAL CENTER
620 E MONROE
MEXICO,MO65265 		X X         X    
Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
Part VFacility Information (continued)

Section B. Facility Policies and Practices.

(Complete a separate Section B for each of the hospital facilities listed in Part V, Section A)
AUDRAIN MEDICAL CENTER
Name of Hospital Facility:  
Line Number of Hospital Facility (from Schedule H, Part V, Section A):1

Yes No
Community Health Needs Assessment (Lines 1 through 7 are optional for 2011)
1 During the tax year or any prior tax year, did the hospital facility conduct a community health needs assessment (“Needs Assessment”)? If “No,” skip to question 8. ..................... 1    
If “Yes,” indicate what the Needs Assessment describes (check all that apply):
a A definition of the community served by the hospital facility
b Demographics of the community
c Existing health care facilities and resources within the community that are available to respond to the health needs of the community
d How data was obtained
e The health needs of the community
f Primary and chronic disease needs and other health issues of uninsured persons, low-income persons, and minority groups
g The process for identifying and prioritizing community health needs and services to meet the community health needs
h The process for consulting with persons representing the community’s interests
i Information gaps that limit the hospital facility’s ability to assess the community’s health needs
j Other (describe in Part VI)
2 Indicate the tax year the hospital facility last conducted a Needs Assessment: 20  
3 In conducting its most recent Needs Assessment, did the hospital facility take into account input from persons who represent the community served by the hospital facility? If “Yes,” describe in Part VI how the hospital facility took into account input from persons who represent the community, and identify the persons the hospital facility consulted. 3    
4 Was the hospital facility’s Needs Assessment conducted with one or more other hospital facilities? If “Yes,” list the other hospital facilities in Part VI............................ 4    
5 Did the hospital facility make its Needs Assessment widely available to the public? ........... 5    
If “Yes,” indicate how the Needs Assessment was made widely available (check all that apply):
a Hospital facility’s website
b Available upon request from the hospital facility
c Other (describe in Part VI)
6 If the hospital facility addressed needs identified in its most recently conducted Needs Assessment, indicate how (check all that apply):
a Adoption of an implementation strategy to address the health needs of the hospital facility’s community
b Execution of the implementation strategy
c Participation in the development of a community-wide community benefit plan
d Participation in the execution of a community-wide community benefit plan
e Inclusion of a community benefit section in operational plans
f Adoption of a budget for provision of services that address the needs identified in the Needs Assessment
g Prioritization of health needs in the community
h Prioritization of services that the hospital facility will undertake to meet health needs in its community
i Other (describe in Part VI)
7 Did the hospital facility address all of the needs identified in its most recently conducted Needs Assessment? If “No,” explain in Part VI which needs it has not addressed and the reasons why it has not addressed such needs. .... 7    
Financial Assistance Policy
Did the hospital facility have in place during the tax year a written financial assistance policy that:
8 Explained eligibility criteria for financial assistance, and whether such assistance includes free or discounted care? 8 Yes  
9 Used federal poverty guidelines (FPG) to determine eligibility for providing free care?........... 9 Yes  
If "Yes," indicate the FPG family income limit for eligibility for free care: 100%
If "No," explain in Part VI the criteria the hospital facility used.
Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
Part VFacility Information (continued)

Yes No
10 Used FPG to determine eligibility for providing discounted care?................. 10 Yes  
If “Yes,” indicate the FPG family income limit for eligibility for discounted care: 200.%
If "No," explain in Part VI the criteria the hospital facility used.
11 Explained the basis for calculating amounts charged to patients?................. 11 Yes  
If “Yes,” indicate the factors used in determining such amounts (check all that apply):
a Income level
b Asset level
c Medical indigency
d Insurance status
e Uninsured discount
f Medicaid/Medicare
g State regulation
h Other (describe in Part VI)
12 Explained the method for applying for financial assistance?................... 12 Yes  
13 Included measures to publicize the policy within the community served by the hospital facility?....... 13 Yes  
If “Yes,” indicate how the hospital facility publicized the policy (check all that apply):
a The policy was posted on the hospital facility’s web site
b The policy was attached to all billing invoices
c The policy was posted in the hospital facility’s emergency rooms or waiting rooms
d The policy was posted in the hospital facility’s admissions offices
e The policy was provided, in writing, to patients upon admission to the hospital facility
f The policy was available upon request
g Other (describe in Part VI)
Billing and Collections
14 Did the hospital facility have in place during the tax year a separate billing and collections policy, or a written financial assistance policy (FAP) that explained actions the hospital facility may take upon non-payment?....... 14 Yes  
15 Check all of the following collection actions against an individual that were permitted under the hospital facility's policies during the tax year before making reasonable efforts to determine the patient’s eligibility under the facility’s FAP:
a Reporting to credit agency
b Lawsuits
c Liens on residences
d Body attachments
e Other similar actions (describe in Part VI)
16 Did the hospital facility or an authorized third party perform any of the following actions during the tax year before making reasonable efforts to determine the patient’s eligibility under the facility’s FAP?.......... 16   No
If “Yes,” check all actions in which the hospital facility or a third party engaged:
a Reporting to credit agency
b Lawsuits
c Liens on residences
d Body attachments
e Other similar actions (describe in Part VI)
17 Indicate which efforts the hospital facility made before initiating any of the actions checked in line 16 (check all that apply):
a Notified patients of the financial assistance policy upon admission
b Notified patients of the financial assistance policy prior to discharge
c Notified patients of the financial assistance policy in communications with the patients regarding the patients’ bills
d Documented its determination of whether patients were eligible for financial assistance under the hospital facility’s financial assistance policy
e Other (describe in Part VI)
Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
Part VFacility Information (continued)

Policy Relating to Emergency Medical Care
Yes No
18 Did the hospital facility have in place during the tax year a written policy relating to emergency medical care that requires the hospital facility to provide, without discrimination, care for emergency medical conditions to individuals regardless of their eligibility under the hospital facility’s financial assistance policy?.......... 18 Yes  
If “No,” indicate why:
a The hospital facility did not provide care for any emergency medical conditions
b The hospital facility’s policy was not in writing
c The hospital facility limited who was eligible to receive care for emergency medical conditions (describe in Part VI)
d Other (describe in Part VI)
Individuals Eligible for Financial Assistance
19 Indicate how the hospital facility determined, during the tax year, the maximum amounts that can be charged to FAP-eligible individuals for emergency or other medically necessary care.
a The hospital facility used its lowest negotiated commercial insurance rate when calculating the maximum amounts that can be charged
b The hospital facility used the average of it's three lowest negotiated commercial insurance rates when calculating the maximum amounts that can be charged
c The hospital facility used the Medicare rates when calculating the maximum amounts that can be charged
d Other (describe in Part VI)
20 Did the hospital facility charge any of its patients who were eligible for assistance under the hospital facility’s financial assistance policy, and to whom the hospital facility provided emergency or other medically necessary services, more than the amounts generally billed to individuals who had insurance covering such care?......... 20   No
If “Yes,” explain in Part VI.
21 Did the hospital facility charge any of its FAP-eligible patients an amount equal to the gross charge for any services provided to that patient?............................... 21   No
If “Yes,” explain in Part VI.
Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
Part VFacility Information (continued)

Section C. Other Health Care Facilities That Are Not Licensed, Registered, or Similarly Recognized as a Hospital Facility
(list in order of size, from largest to smallest)
How many non-hospital health care facilities did the organization operate during the tax year?11
Name and address Type of Facility (describe)
1 MEXICO HEALTH SERVICES
600 MEDICAL PARK DR
MEXICO,MO65265 		OUTPATIENT PHYSICIAN CLINIC
2 MEXICO PEDIATRIC SERVICES
1025 OLD FARM RD
MEXICO,MO65265 		OUTPATIENT PHYSICIAN CLINIC
3 MEXICO FAMILY HEALTH CARE
626 SUMMIT SUITE L
MEXICO,MO65265 		OUTPATIENT PHYSICIAN CLINIC
4 WELLSVILLE MEDICAL CLINIC
111 W BATES
WELLSVILLE,MO63384 		OUTPATIENT PHYSICIAN CLINIC
5 SUMMIT MEDICAL PARK LAB & X-RAY
626 SUMMIT
MEXICO,MO65265 		LAB & X-RAY SERVICES
6 MEXICO SURGICAL SERVICES
625 SUMMIT SUITE F
MEXICO,MO65265 		OUTPATIENT PHYSICIAN CLINIC
7 MEDICAL PARK FAMILY PRACTICE
809 MEDICAL PARK DR SUITE 101
MEXICO,MO65265 		OUTPATIENT PHYSICIAN CLINIC
8 MONTGOMERY CITY MEDICAL CLINIC
240 NORTH PICKERING
MONTGOMERY CITY,MO63361 		OUTPATIENT PHYSICIAN CLINIC
9 VANDALIA MEDICAL CLINIC
204 W WASHINGTON
VANDALIA,MO63382 		OUTPATIENT PHYSICIAN CLINIC
10 AUDRAIN FAMILY HEALTH
625 SUMMIT SUITE B
MEXICO,MO65265 		OUTPATIENT PHYSICIAN CLINIC
11 PERRY MEDICAL CLINIC
1223 MAIN STREET
PERRY,MO63462 		OUTPATIENT PHYSICIAN CLINIC
Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
Part VI
Supplemental Information
Complete this part to provide the following information.
1 Required descriptions. Provide the descriptions required for Part I, lines 3c, 6a, and 7; Part II; Part III, lines 4, 8, and 9b; and Part V, Section B, lines 1j, 3, 4, 5c, 6i, 7, 9, 10, 11h, 13g, 15e, 16e, 17e, 18d, 19d, 20, and 21.
2 Needs assessment. Describe how the organization assesses the health care needs of the communities it serves, in addition to any needs assessments reported in Part V, Section B.
3 Patient education of eligibility for assistance. Describe how the organization informs and educates patients and persons who may be billed for patient care about their eligibility for assistance under federal, state, or local government programs or under the organization’s financial assistance policy.
4 Community information. Describe the community the organization serves, taking into account the geographic area and demographic constituents it serves.
5 Promotion of community health. Provide any other information important to describing how the organization’s hospital facilities or other health care facilities further its exempt purpose by promoting the health of the community (e.g., open medical staff, community board, use of surplus funds, etc.).
6 Affiliated health care system. If the organization is part of an affiliated health care system, describe the respective roles of the organization and its affiliates in promoting the health of the communities served.
7 State filing of community benefit report. If applicable, identify all states with which the organization, or a related organization, files a community benefit report.
Identifier ReturnReference Explanation
PART I, LINE 7G:   INCLUDED IN SCHEDULE H, PART I, LINE 7G ARE $6,156,528 OF EXPENSES ATTRIBUTABLE TO PHYSICIAN CLINICS.
PART I, LINE 7, COLUMN F:   THE ORGANIZATION HAD BAD DEBT EXPENSE OF $3,587,091 REPORTED ON PART IX, LINE 24A. HOWEVER, IT HAS BEEN SUBTRACTED FOR PURPOSES OF CALCULATING THE PERCENTAGE IN THIS COLUMN.
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.
PART III, LINE 4:   4A. RELATIVE PORTION OF PATIENT ACCOUNTS RECEIVABLE FOOTNOTE: "ACCOUNTS ARE CONSIDERED DELINQUENT AND SUBSEQUENTLY WRITTEN OFF AS BAD DEBTS BASED ON INDIVIDUAL CREDIT EVALUATION AND SPECIFIC CIRCUMSTANCES OF THE ACCOUNT." 4B. COSTING METHODOLOGY USED TO DETERMINE AMOUNTS REPORTED AS BAD DEBTS AND BAD DEBT ATTRIBUTABLE TO PATIENTS UNDER CHARITY CARE POLICY. 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 AS SHOWN ON THE ORGANIZATION'S 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 FEDERAL POVERTY GUIDELINE IS USED TO DETERMINE THOSE WHO QUALIFY. NORMAL COLLECTION EFFORTS ARE MADE ON ANY REMAINING BALANCE AFTER CHARITY CARE OR FINANCIAL ASSISTANCE WRITE OFF'S ARE APPLIED TO THE ACCOUNT.
PART V, LINE 19   AUDRAIN MEDICAL CENTER 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.
NEEDS ASSESSMENT:   THE ORGANIZATION PROVIDES A NUMBER OF PROGRAMS AND SERVICES SUCH AS: PROMOTING HEALTH AND EDUCATION, HEALTH SCREENING, TRAINING OF HEALTH PROFESSIONALS, AND COMMUNITY HEALTH IMPROVEMENT ADVOCACY. PROGRAMS LIKE THESE 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 THE COMMUNITY SERVING THREE COUNTIES WITH A POPULATION OF 47,000. THE ORGANIZATION ALSO PROVIDES HEALTH CARE SERVICES THROUGH A NUMBER OF CLINICS.
PROMOTION OF COMMUNITY HEALTH:   AUDRAIN HEALTH CARE, INC. PROVIDES CLASSES AND SUPPORT GROUP MEETINGS COVERING 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, SCOLIOSIS SCREENING, CHILDBIRTH AND BREASTFEEDING CLASSES, GRIEF SUPPORT GROUPS, AND MANY MORE.
STATE FILING OF COMMUNITY BENEFIT REPORT 990 SCHEDULE H, PART VI MO,
Schedule H (Form 990) 2011
Additional Data


Software ID:  
Software Version:  
Schedule I
(Form 990)
Department of the Treasury
Internal Revenue Service
Grants and Other Assistance to Organizations,
Governments and Individuals in the United States
Complete if the organization answered "Yes," to Form 990, Part IV, line 21 or 22.
lBullet Attach to Form 990
OMB No. 1545-0047
2011
Open to Public
Inspection
Name of the organization
Audrain Health Care Inc
 
Employer identification number
43-1550298
Part I
General Information on Grants and Assistance
1
Does the organization maintain records to substantiate the amount of the grants or assistance, the grantees' eligibility for the grants or assistance, and
the selection criteria used to award the grants or assistance? ....................................
2
Describe in Part IV the organization's procedures for monitoring the use of grant funds in the United States.
Part II
Grants and Other Assistance to Governments and Organizations in the United States. Complete if the organization answered "Yes" to
Form 990, Part IV, line 21 for any recipient that received more than $5,000. Check this box if no one recipient received more than $5,000. Use
Part IV and Schedule I-1 (Form 990) if additional space is needed ......................... lBullet
(a) Name and address of organization
or government		 (b) EIN (c) IRC Code section
if applicable		 (d) Amount of cash grant (e) Amount of non-cash
assistance		 (f) Method of valuation
(book, FMV, appraisal,
other)		 (g) Description of
non-cash assistance		 (h) Purpose of grant
or assistance
(1) AUDRAIN CITY-COUNTY HEALTH UNIT605 EAST PROMENADE
MEXICO,MO65265 		43-0783311   19,292       OPERATING EXPENSES






















2
Enter total number of section 501(c)(3) and government organizations listed in the line 1 table ................. Bullet Image
1
3
Enter total number of other organizations listed in the line 1 table ......................... . Bullet Image
 
For Privacy Act and Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 50055P
Schedule I (Form 990) 2011

Schedule I (Form 990) 2011
Page 2
Part III
Grants and Other Assistance to Individuals in the United States. Complete if the organization answered "Yes" to Form 990, Part IV, line 22.
Use Schedule I-1 (Form 990) if additional space is needed.
(a)Type of grant or assistance (b)Number of
recipients		 (c)Amount of
cash grant		 (d)Amount of
non-cash assistance		 (e)Method of valuation (book,
FMV, appraisal, other)		 (f)Description of non-cash assistance













Part IV
Supplemental Information. Complete this part to provide the information required in Part I, line 2, and any other additional information.
Identifier Return Reference Explanation
MONITORING PROCEDURES FOR GRANTS PAID SCHEDULE I, PART I, LINE 2 THE ORGANIZATION REVIEWS REPORTS OF OPERATING EXPENSES RECEIVED FROM THE RECIPIENT THROUGHOUT THE YEAR.
Schedule I (Form 990) 2011


Additional Data


Software ID:  
Software Version:  


Schedule J
(Form 990)
Department of the Treasury
Internal Revenue Service
Compensation Information
For certain Officers, Directors, Trustees, Key Employees, and Highest
Compensated Employees
SchJMediumBullet Complete if the organization answered "Yes" to Form 990,
Part IV, question 23.
SchJMediumBullet Attach to Form 990. SchJMediumBullet See separate instructions.
OMB No. 1545-0047
2011
Open to Public Inspection
Name of the organization
Audrain Health Care Inc
 
Employer identification number

43-1550298
Part I
Questions Regarding Compensation
Yes
No
1a
Check the appropiate box(es) if the organization provided any of the following to or for a person listed in Form
990, Part VII, Section A, line 1a. Complete Part III to provide any relevant information regarding these items.
b
If any of the boxes in line 1a are checked, did the organization follow a written policy regarding payment or reimbursement or provision of all the expenses described above? If "No," complete Part III to explain....
1b
 
 
2
Did the organization require substantiation prior to reimbursing or allowing expenses incurred by all
officers, directors, trustees, and the CEO/Executive Director, regarding the items checked in line 1a? ....
2
 
 
3
Indicate which, if any, of the following the organization uses to establish the compensation of the
organization's CEO/Executive Director. Check all that apply. Do not check any boxes for methods
used by a related organization to establish compensation of the CEO/Executive Director, but explain in Part III.
4
During the year, did any person listed in Form 990, Part VII, Section A, line 1a with respect to the filing organization or a related organization:
a
Receive a severance payment or change-of-control payment? ...............
4a
 
No
b
Participate in, or receive payment from, a supplemental nonqualified retirement plan? ........
4b
 
No
c
Participate in, or receive payment from, an equity-based compensation arrangement? ........
4c
 
No
If "Yes" to any of lines 4a-c, list the persons and provide the applicable amounts for each item in Part III.
Only 501(c)(3) and 501(c)(4) organizations only must complete lines 5-9.
5
For persons listed in form 990, Part VII, Section A, line 1a, did the organization pay or accrue any
compensation contingent on the revenues of:
a
The organization? ...........................
5a
 
No
b
Any related organization? .........................
5b
 
No
If "Yes," to line 5a or 5b, describe in Part III.
6
For persons listed in form 990, Part VII, Section A, line 1a, did the organization pay or accrue any
compensation contingent on the net earnings of:
a
The organization? ...........................
6a
 
No
b
Any related organization? .........................
6b
 
No
If "Yes," to line 6a or 6b, describe in Part III.
7
For persons listed in Form 990, Part VII, Section A, line 1a, did the organization provide any non-fixed
payments not described in lines 5 and 6? If "Yes," describe in Part III ............
7
 
No
8
Were any amounts reported in Form 990, Part VII, paid or accured pursuant to a contract that was
subject to the initial contract exception described in Regulations section 53.4958-4(a)(3)? If "Yes," describe
in Part III .............................
8
 
No
9
If "Yes" to line 8, did the organization also follow the rebuttable presumption procedure described in Regulations section 53.4958-6(c)? .........................
9
 
 
For Privacy Act and Paperwork Reduction Act Notice, see the Intructions for Form 990
Cat. No. 50053T
Schedule J (Form 990) 2011

Schedule J (Form 990) 2011
Page 2
Part II
Officers, Directors, Trustees, Key Employees, and Highest Compensated Employees. Use duplicate copies if additional space is needed.
For each individual whose compensation must be reported in Schedule J, report compensation from the organization on row (i) and from related organizations, described in the
instructions on row (ii). Do not list any individuals that are not listed on Form 990, Part VII.

Note. The sum of columns (B)(i)-(iii) for each listed individual must equal the total amount of Form 990, Part VII, Section A, line 1a, applicable column (D) and column (E) for that individual.
(A) Name (B) Breakdown of W-2 and/or 1099-MISC compensation (C) Retirement and other deferred compensation (D) Nontaxable
benefits		 (E) Total of columns
(B)(i)-(D) 		(F) Compensation
reported as deferred
in prior Form 990
(i) Base compensation (ii) Bonus & incentive compensation (iii) Other reportable compensation
(1) DAVID A NEUENDORF (i)
(ii)		 196,844
0 		0
0 		1,816
0 		0
0 		2,400
0 		201,060
0 		0
0
(2) PETER PERLL MD (i)
(ii)		 397,464
0 		0
0 		569
0 		0
0 		0
0 		398,033
0 		0
0
(3) PEGGY A BARJENBRUCH MD (i)
(ii)		 352,046
0 		0
0 		3,564
0 		0
0 		9,402
0 		365,012
0 		0
0
(4) ERIC KONDRO MD (i)
(ii)		 314,838
0 		0
0 		1,786
0 		0
0 		2,045
0 		318,669
0 		0
0
(5) MICHAEL QUINLAN MD (i)
(ii)		 363,507
0 		0
0 		611
0 		0
0 		10,245
0 		374,363
0 		0
0
(6) GENE THOMAS MD (i)
(ii)		 389,002
0 		0
0 		11,125
0 		0
0 		0
0 		400,127
0 		0
0
(7) SHAHID WAHEED MD (i)
(ii)		 459,660
0 		0
0 		3,870
0 		0
0 		804
0 		464,334
0 		0
0
(8) JOAN SLAUGHTER (i)
(ii)		 255,300
0 		0
0 		2,301
0 		0
0 		4,000
0 		261,601
0 		0
0








Schedule J (Form 990) 2011

Schedule J (Form 990) 2011
Page 3
Part III
Supplemental Information
Complete this part to provide the information, explanation, or descriptions required for Part I, lines 1a, 1b, 3, 4c, 5a, 5b, 6a, 6b, 7, and 8. Also complete this part for any additional information.
Identifier Return Reference Explanation
Schedule J (Form 990) 2011

Additional Data


Software ID:  
Software Version:  
Schedule L
(Form 990 or 990-EZ)
Department of the Treasury
Internal Revenue Service
Transactions with Interested Persons
MediumBullet Complete if the organization answered
"Yes" on Form 990, Part IV, lines 25a, 25b, 26, 27, 28a, 28b, or 28c,
or Form 990-EZ, Part V lines 38a or 40b.
MediumBullet Attach to Form 990 or Form 990-EZ. MediumBulletSee separate instructions.
OMB No. 1545-0047
2011
Open to Public Inspection
Name of the organization
Audrain Health Care Inc
 
Employer identification number

43-1550298
Part I
Excess Benefit Transactions (section 501(c)(3) and section 501 (c)(4) organizations only).
Complete if the organization answered "Yes" on Form 990, Part IV, line 25a or 25b, or Form 990-EZ, Part V, line 40b.
1(a) Name of disqualified person (b) Description of transaction (c) Corrected?
Yes No





2
Enter the amount of tax imposed on the organization managers or disqualified persons during the year under section 4958. ......................... Bullet Image$
 
3
Enter the amount of tax, if any, on line 2, above, reimbursed by the organization ....... Bullet Image$
 

Part II
Loans to and/or From Interested Persons.
Complete if the organization answered "Yes" on Form 990, Part IV, line 26, or Form 990-EZ, Part V, line 38a.
(a) Name of interested person and purpose (b) Loan to or from the organization? (c)Original principal amount (d)Balance due (e) In default? (f) Approved by board or committee? (g)Written agreement?
To From Yes No Yes No Yes No
Total ...............Small Bullet $  
Part III
Grants or Assistance Benefitting Interested Persons.
Complete if the organization answered "Yes" on Form 990, Part IV, line 27.
(a) Name of interested person (b)Relationship between interested person and the organization (c)Amount of grant or type of assistance
For Privacy Act and Paperwork Reduction Act Notice, see the
Instructions for Form 990 or 990-EZ.
Cat. No. 50056A
Schedule L (Form 990 or 990-EZ) 2011
Schedule L (Form 990 or 990-EZ) 2011
Page 2
Part IV
Business Transactions Involving Interested Persons.
Complete if the organization answered "Yes" on Form 990, Part IV, line 28a, 28b, or 28c.
(a) Name of interested person (b) Relationship between interested person and the organization (c) Amount of transaction (d) Description of transaction (e) Sharing of organization's revenues?
Yes No
(1) LISA NEUENDORF WIFE OF CEO, D. NEUENDORF 64,493 EMPLOYMENT   No
(2) SHELLIE SHAW WIFE OF VP-CFO, G. SHAW 51,317 EMPLOYMENT   No
Part V
Supplemental Information
Complete this part to provide additional information for responses to questions on Schedule L (see instructions).
Identifier Return Reference Explanation
Schedule L (Form 990 or 990-EZ) 2011

Additional Data


Software ID:  
Software Version:  




SCHEDULE O
(Form 990 or 990-EZ)

Department of the Treasury
Internal Revenue Service
Supplemental Information to Form 990 or 990-EZ

Complete to provide information for responses to specific questions on
Form 990 or to provide any additional information.
MediumBullet Attach to Form 990 or 990-EZ.
OMB No. 1545-0047
2011
Open to Public
Inspection
Name of the organization
Audrain Health Care Inc
 
Employer identification number

43-1550298
Identifier Return Reference Explanation
2011 COMMUNITY BENEFIT REPORT FORM 990, SUPPLEMENT TO PART III, LINE 4A, 4B, & 4C I. EXECUTIVE SUMMARY AUDRAIN MEDICAL CENTER WAS ESTABLISHED IN 1918 TO CARE FOR THE HEALTH AND WELL BEING OF THE COMMUNITIES WE SERVE AS MENTIONED IN OUR MISSION STATEMENT ON THE NEXT PAGE. AUDRAIN MEDICAL CENTER IS A LICENSED 88 BED HOSPITAL AND OWNS 10 PRIMARY CARE AND SPECIALTY CLINICS. THE HOSPITAL IS A SOLE COMMUNITY PROVIDER AND ALONG WITH ITS CLINICS IS OPERATED IN MEDICALLY UNDERSERVED AREAS AS DETERMINED BY THE FEDERAL GOVERNMENT. OUR PRIMARY SERVICE AREA CONSISTS OF THREE COUNTIES WITH A POPULATION OF OVER 47,000. AS PART OF A NATIONAL REPORTING PROJECT CALLED "THE QUALITY INITIATIVE: A PUBLIC RESOURCE ON HOSPITAL PERFORMANCE," WE COLLECTED AND REPORTED DATA ON HEART ATTACKS, HEART FAILURES, PNEUMONIA, SURGICAL COMPLICATION AND INFECTION PREVENTION, AND THE PERCENTAGE OF TIME WE GAVE THE CURRENTLY RECOMMENDED CARE. AUDRAIN MEDICAL CENTER CONTINUES TO BE ABOVE THE NATIONAL AVERAGE IN ALL CATEGORIES OF CARE. IN ADDITION TO THE HIGH QUALITY CARE PATIENTS RECEIVE AND THE SERVICES THAT ARE NORMALLY OFFERED AT RURAL COMMUNITY HOSPITALS, WE ALSO PROVIDE A NUMBER OF SERVICES THAT ARE NOT TYPICALLY FOUND AT THOSE SAME HOSPITALS. THESE SERVICES INCLUDE: ANGIOPLASTY CARDIAC CATHETERIZATION LAB CARDIAC REHAB CARDIOLOGY CHEMO THERAPY ECHO EKG GASTROENTEROLOGY NUCLEAR CARDIOLOGY OPHTHALMOLOGY OTOLARYNGOLOGY PET SCANS PULMONARY MEDICINE RADIATION THERAPY RHEUMATOLOGY STRESS TESTING UROLOGY VASCULAR STUDIES NOT ONLY DO WE PROVIDE HIGH QUALITY CARE, BUT WE ACHIEVE THAT LEVEL OF SERVICE WITH SOME OF THE LOWEST CHARGES IN MISSOURI. MEDICARE PROVIDER ANALYSIS AND REVIEW (MEDPAR) WHICH CONTAINS 100% OF MEDICARE HOSPITAL DISCHARGES AND IS BASED ON ACTUAL BILLS SUBMITTED BY PROVIDERS TO MEDICARE FOR PAYMENT SHOW THAT WE CONSISTENTLY HAVE CHARGES IN THE BOTTOM QUARTILE OF ALL HOSPITALS IN THE STATE OF MISSOURI. OUR 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. OUR VISION TO BE RECOGNIZED AS A "PATIENT FIRST, BEST PRACTICE" HEALTHCARE SYSTEM BY CONTINUOUSLY IMPROVING AND MAINTAINING OUR BALANCE OF: CLINICAL QUALITY SERVICE/SATISFACTION RESOURCE DEVELOPMENT FINANCIAL INTEGRITY OUR VALUES TO LIVE BY OUR STANDARDS OF SERVICE: STANDARD #1 - MAKE POSITIVE FIRST IMPRESSIONS OUR FIRST PRIORITY STANDARD #2 - TREAT OTHERS AS GUEST STANDARD #3 - DEVELOP "SERVICE RECOVERY" STANDARD #4 - COMMUNICATE EFFECTIVELY STANDARD #5 - SERVE OTHERS FROM THE TEAM-CENTERED APPROACH STANDARD #6 - PROJECT A POSITIVE ATTITUDE STANDARD #7 - MAKE EXCELLENCE THE GOAL OF EVERYTHING WE DO PROGRAMS FOR THE POOR AND BROADER COMMUNITY IN FISCAL YEAR 2011, WE HAD OVER 160,000 VISITS TO THE HOSPITAL AND CLINICS. A SIGNIFICANT NUMBER OF THOSE PEOPLE WOULD BE CLASSIFIED AS POOR. THE POOR ARE DEFINED AS THOSE PERSONS WHO BECAUSE OF INADEQUATE RESOURCES CANNOT AFFORD HEALTHCARE AND ARE UNINSURED OR UNDERINSURED. IN ADDITION TO DIRECT HEALTHCARE SERVICES, WE ALSO PROVIDE A NUMBER OF OTHER PROGRAMS AND SERVICES TO THE POOR AND BROADER COMMUNITY. PROGRAMS AND SERVICES INCLUDE HEALTH PROMOTION AND EDUCATION, HEALTH SCREENING, TRAINING OF HEALTH PROFESSIONALS, CASH AND IN-KIND DONATIONS TO OTHER LOCAL CHARITABLE ORGANIZATIONS, ECONOMIC DEVELOPMENT, LOCAL SUPPORT SYSTEM ENHANCEMENTS, AND COMMUNITY HEALTH IMPROVEMENT ADVOCACY. THE BENEFITS PROVIDED BY AUDRAIN MEDICAL CENTER TO THE COMMUNITY ARE QUANTIFIED ON THE NEXT PAGE.
2011 COMMUNITY BENEFIT REPORT CONTINUED   CHARITY CARE, BAD DEBT, AND UNINSURED DISCOUNT 1. TOTAL EXPENSE 3,135,000 2. OFFSETTING REVENUE - 3. NET COMMUNITY BENEFIT 3,135,000 4. % HOSPITAL EXPENSES 5.76% UNPAID COSTS OF PUBLIC PROGRAMS - MEDICAID 1. TOTAL EXPENSE 8,190,000 2. OFFSETTING REVENUE 7,455,000 3. NET COMMUNITY BENEFIT 735,000 4. % HOSPITAL EXPENSES 1.35% NONBILLED COMMUNITY HEALTH SERVICES - COMMUNITY EDUCATION/OUTREACH SCREENINGS, OTHER NONBILLED SERVICES 1. TOTAL EXPENSE 55,000 2. OFFSETTING REVENUE 10,000 3. NET COMMUNITY BENEFIT 45,000 4. % HOSPITAL EXPENSES 0.08% MEDICAL EDUCATION - PHYSICIANS, NURSES, TECHS, AND OTHER PROFESSIONALS 1. TOTAL EXPENSE 15,000 2. OFFSETTING REVENUE 2,500 3. NET COMMUNITY BENEFIT 12,500 4. % HOSPITAL EXPENSES 0.02% SUBSIDIZED HEALTH SERVICES - AMBULANCE, BEHAVIORAL HEALTH, EMERGENCY DEPARTMENT, OBSTETRICS, PRIMARY CARE CLINICS 1. TOTAL EXPENSE 17,830,000 2. OFFSETTING REVENUE 9,820,000 3. NET COMMUNITY BENEFIT 8,010,000 4. % HOSPITAL EXPENSES 14.73% CASH/IN-KIND DONATIONS 1. TOTAL EXPENSE 60,000 2. OFFSETTING REVENUE - 3. NET COMMUNITY BENEFIT 60,000 4. % HOSPITAL EXPENSES 0.11% COMMUNITY BUILDING ACTIVITIES 1. TOTAL EXPENSE 315,000 2. OFFSETTING REVENUE - 3. NET COMMUNITY BENEFIT 315,000 4. % HOSPITAL EXPENSES 0.58% TOTAL QUANTIFIABLE BENEFITS 1. TOTAL EXPENSE 29,600,000 2. OFFSETTING REVENUE 17,287,500 3. NET COMMUNITY BENEFIT 12,312,500 4. % HOSPITAL EXPENSES 22.64% TOTAL QUANTIFIABLE COMMUNITY BENEFITS THE TOTAL QUANTIFIABLE COMMUNITY BENEFITS TO THE POOR AND BROADER COMMUNITY FOR AUDRAIN MEDICAL CENTER FOR FISCAL YEAR 2011 WAS $12,312,500 IN UNREIMBURSED BENEFIT EXPENSES WHICH IS 23.02% OF AUDRAIN MEDICAL CENTER'S TOTAL EXPENSES. BEING A NON-PROFIT TAX EXEMPT ORGANIZATION, AUDRAIN MEDICAL CENTER INVESTED $12,312,500 OF ITS EXPENSE DOLLARS INTO PROGRAMS AND SERVICES THAT BENEFIT THE POOR AND THE BROADER COMMUNITY. IF AUDRAIN MEDICAL CENTER WAS A FOR-PROFIT TAX PAYING ENTITY, IT IS ESTIMATED THAT ITS 2011 BILL FOR FEDERAL, STATE, PROPERTY, AND SALES TAX WOULD HAVE TOTALED $2,100,000. IN FISCAL YEAR 2011, AUDRAIN MEDICAL CENTER INVESTED ITS OWN EXPENSE DOLLARS AT ALMOST 6-TO-1 OVER WHAT ITS TAX LIABILITY WOULD BE IF IT WERE A TAX-PAYING ORGANIZATION. THE ABOVE SERVICES WHICH ARE DESCRIBED IN MORE DETAIL LATER IN THIS REPORT REPRESENT THE OBLIGATIONS THAT ACCOMPANY OUR PRIVILEGE OF TAX-EXEMPT STATUS. II. COMMUNITY OUTREACH FOR THE POOR FINANCIAL ASSISTANCE COUNSELING STAFF IN PATIENT CREDIT SERVICES PROVIDE FINANCIAL COUNSELING TO PATIENTS WHO ARE UNABLE TO PAY THEIR HOSPITAL BILL. ASSISTANCE INCLUDES ASSESSING THE PATIENT'S LIABILITY, DETERMINING AVAILABLE FUNDING SOURCES SUCH AS MEDICAID OR MEDICARE, AND DETERMINING WHETHER THEY ARE ELIGIBLE FOR CHARITY CARE. WE ALSO DISCOUNT PATIENT BILLS BASED ON A SLIDING SCALE. PATIENTS WILL RECEIVE A 100% DISCOUNT IF THEY ARE AT OR BELOW THE FEDERAL POVERTY GUIDELINES. THE DISCOUNT GETS PHASED OUT AT 200% OF THE FEDERAL POVERTY GUIDELINES. UNINSURED DISCOUNT/ADMINISTRATIVE ADJUSTMENTS UNINSURED PATIENTS AUTOMATICALLY RECEIVE A 25% DISCOUNT OFF THEIR HOSPITAL BILL. IN ADDITION TO THE UNINSURED DISCOUNT, PATIENTS MAY ALSO RECEIVE AN ADMINISTRATIVE ADJUSTMENT DEPENDING UPON THEIR FINANCIAL SITUATION. PATIENTS RECEIVING AN ADMINISTRATIVE ADJUSTMENT WILL HAVE THEIR BILL DISCOUNTED FURTHER UP TO 100% IF THE AMOUNT OWED EQUALS OR EXCEEDS 50% OF THE ANNUAL INCOME OF THE PATIENT FOR THE LAST TWELVE MONTHS. III. COMMUNITY OUTREACH FOR THE BROADER COMMUNITY IN FISCAL YEAR 2011, AUDRAIN MEDICAL CENTER SERVED THE BROADER COMMUNITY THROUGH COMMUNITY HEALTH SERVICES, HEALTH PROFESSIONAL'S EDUCATION, SUBSIDIZED HEALTH SERVICES, CASH/IN-KIND DONATIONS, AND COMMUNITY BUILDING ACTIVITIES. THESE EFFORTS ARE DESCRIBED BELOW. A. COMMUNITY HEALTH SERVICES INCLUDED IN THIS CATEGORY ARE ACTIVITIES THAT HAVE BEEN CARRIED OUT TO IMPROVE THE HEALTH OF THE COMMUNITY. THESE ACTIVITIES DO NOT GENERATE INPATIENT OR OUTPATIENT BILLS, ALTHOUGH THERE MAY BE A NOMINAL FEE CHARGED TO PARTICIPANTS. " COMMUNITY HEALTH EDUCATION AUDRAIN MEDICAL CENTER HOSTED NUMEROUS CLASSES THROUGHOUT THE YEAR TO IMPROVE THE HEALTH OF AREA RESIDENTS. SOME OF THOSE CLASSES INCLUDED CHILDBIRTH; DIABETES AND HEALTHY FOOD EDUCATION; CANCER CONFERENCES INCLUDING AMERICAN CANCER SURVIVOR, CANCER CARE WORKSHOP, AND CANCER SCREENING; AND THE WOMEN'S HEALTH CONFERENCE. " COMMUNITY BASED CLINICAL SERVICES AUDRAIN MEDICAL CENTER ALSO SPONSORED NUMEROUS HEALTH FAIRS AND WELLNESS SCREENINGS THROUGHOUT THE SURROUNDING AREA. THESE EVENTS WERE HELD IN AUXVASSE, MEXICO, MONTGOMERY CITY, AND LOCAL BUSINESSES. " HEALTH CARE SUPPORT SERVICES FINALLY, AUDRAIN MEDICAL CENTER HAS 105 VOLUNTEERS WHO WORKED ALMOST 17,200 HOURS IN FISCAL YEAR 2011. THEY HELPED THE ELDERLY AT HOME BY OFFERING ASSISTANCE WITH SHOPPING, PAYING BILLS, TRANSPORTATION, CLEANING THEIR HOUSE, AND HELPING THEM MOVE TO NURSING HOMES. THE VOLUNTEERS ALSO HELPED AT THE VARIOUS WELLNESS SCREENINGS AND IMMUNIZATION CLINICS, ASSISTED PATIENTS AND FAMILIES DURING THEIR VISIT TO THE HOSPITAL AND WORKED IN THE GIFT SHOP. ALSO, INDIVIDUALS WHO ARE REQUIRED TO COMPLETE COMMUNITY SERVICE HAVE THAT ABILITY THROUGH THE VOLUNTEER PROGRAM AT AUDRAIN MEDICAL CENTER.
2011 COMMUNITY BENEFIT REPORT CONTINUED   B. MEDICAL EDUCATION AUDRAIN MEDICAL CENTER IS COMMITTED TO EDUCATING PHYSICIANS AND OTHER HEALTH PROFESSIONALS IN ORDER TO IMPROVE THEIR CLINICAL SKILLS. AN AREA OF EMPHASIS AT THE HOSPITAL IS THE DETECTION AND TREATMENT OF CANCER. TO EDUCATE PHYSICIANS IN NEW CONCEPTS OF TREATING CANCER AND MAKING APPROPRIATE REFERRALS WE HOST A MONTHLY SURGICAL ONCOLOGY CONFERENCE COMPRISED OF MEDICAL STAFF, CLINICAL AND SUPPORT DEPARTMENT EMPLOYEES. CASE PRESENTATIONS ARE GIVEN BY ATTENDING PHYSICIANS AND INVOLVE A MULTI-DISCIPLINARY DISCUSSION OF THE TREATMENT PLAN INCLUDING THE MEDICAL ONCOLOGIST, RADIATION ONCOLOGIST, AND ANCILLARY DEPARTMENTS. WE ALSO SPONSOR THE ANNUAL MID-MISSOURI REGIONAL CANCER CONFERENCE. THIS CONFERENCE IS DESIGNED FOR PHYSICIANS, NURSES, CLERGY, HOME HEALTH PROFESSIONALS, DIETITIANS AND OTHER HEALTHCARE PROFESSIONALS WHO SUPPORT AND CARE FOR PEOPLE WITH CANCER. TOPICS AT THE CONFERENCE INCLUDED IDENTIFYING CURRENT DRUGS USED IN CHRONIC PAIN MANAGEMENT AND VARIOUS METHODS OF DELIVERY, SUMMARIZING THE ROLE AND PURPOSE OF AN ONCOLOGY PATIENT ADVOCATE, AND IDENTIFYING ADJUVANT AND FIRST-LINE TREATMENT OPTIONS FOR COLON CANCER. IN 2005 THE AMERICAN COLLEGE OF SURGEONS COMMISSION ON CANCER (COC) RECOGNIZED OUR COMMITMENT TO QUALITY IN OUR CANCER PROGRAM BY AWARDING US THE OUTSTANDING ACHIEVEMENT AWARD. THE COC SETS STANDARDS FOR QUALITY AND MULTIDISCIPLINARY CANCER PATIENT CARE AND COLLECTS QUALITY DATA FROM FACILITIES TO DEVELOP EFFECTIVE EDUCATIONAL INTERVENTIONS TO IMPROVE CANCER CARE OUTCOMES AT THE NATIONAL, STATE AND LOCAL LEVEL. APPROVAL BY THE COC IS GIVEN ONLY TO THOSE FACILITIES THAT PROVIDE THE HIGHEST LEVEL OF QUALITY CANCER CARE AND UNDERGO A RIGOROUS EVALUATION PROCESS AND REVIEW OF THEIR PERFORMANCE. IN 2006 AND 2009 WE WERE GIVEN THE THREE YEAR APPROVAL AWARD WITH COMMENDATION AS THERE WERE NO DEFICIENCIES FOUND DURING THE SURVEY PROCESS. THE AMERICAN COLLEGE OF SURGEONS COMMISSION ON CANCER (COC) HAS AWARDED AUDRAIN MEDICAL CENTER AN OUTSTANDING ACHIEVEMENT AWARD, RECOGNIZING AMC'S COMMITMENT TO QUALITY IN ITS CANCER PROGRAM. AUDRAIN MEDICAL CENTER IS ONE OF ONLY 90 HOSPITALS NATIONWIDE AND THE ONLY ONE IN MISSOURI TO RECEIVE OUTSTANDING ACHIEVEMENT STATUS IN 2010. THIS IS THE THIRD CONSECUTIVE TIME AUDRAIN MEDICAL CENTER HAS ACHIEVED THIS LEVEL OF RECOGNITION FROM THE COC. AUDRAIN MEDICAL CENTER HAS ALSO BEEN RECOGNIZED IN CARECHEX 2011 FOR OUTSTANDING PERFORMANCE IN PATIENT SAFETY FOR OVERALL HOSPITAL CARE. AMC RANKED AMONG THE TOP 2% OF ALL HOSPITALS IN THE NATION IN THIS CATEGORY AT 98.7%. HEALTHGRADES USED THE AHRQ'S 13 PATIENT SAFETY INDICATORS - INCIDENTS SUCH AS FOREIGN OBJECTS LEFT IN A BODY FOLLOWING A PROCEDURE, EXCESSIVE BRUISING OR BLEEDING AS A RESULT OF SURGERY, BLOODSTREAM INFECTIONS FROM CATHETERS, AND BED SORES - TO IDENTIFY THOSE HOSPITALS PERFORMING IN THE TOP FIVE PERCENT IN THE NATION, NAMING THEM PATIENT SAFETY EXCELLENCE AWARD RECIPIENTS. AUDRAIN MEDICAL CENTER WAS NAMED A 2011 PATIENT SAFETY EXCELLENCE AWARD RECIPIENT. PRIMARY CARE CONFERENCES ARE OFFERED MONTHLY TO PHYSICIANS AS AN EDUCATIONAL TOOL. SOME OF THE TOPICS COVERED IN 2011 INCLUDED DEVELOPMENTAL SCREENING, TRAVEL MEDICINE/INFECTION DISEASE, CONSCIOUS SEDATION, WEIGHT LOSS MANAGEMENT, STROKE MANAGEMENT, AND DIABETES MELLITUS. WE ALSO PARTNERED WITH THE MOBERLY AREA COMMUNITY COLLEGE FOR THE NURSE CAMP PROGRAM. THIS IS A PROGRAM WHICH OFFERS CPR CLASSES TO HIGH SCHOOL STUDENTS LOOKING TO ENTER NURSING AS AN OCCUPATION. ACLS AND BLS CLASSES ARE PROVIDED TO HOSPITAL EMPLOYEES AND PRACTICAL NURSES FROM THE ADVANCED TECHNOLOGY CENTER. WE ALSO PROVIDE BLS TRAINING TO THE PUBLIC IN GENERAL. AUDRAIN MEDICAL CENTER ALSO SERVED AS A SITE FOR A SOCIAL WORKER INTERNSHIP IN 2011 FROM THE UNIVERSITY OF MISSOURI. FURTHERMORE, WE SERVE AS A CLINICAL ROTATION SITE FOR PHARMACY, DIETARY, PARAMEDIC, SURGICAL TECH, PHYSICAL THERAPY AND LAB TECH STUDENTS. RN STUDENTS ALSO ROTATE THROUGH OUR OBSTETRICS UNIT. C. SUBSIDIZED SERVICES WE OFFER SEVERAL CLINICAL PATIENT CARE SERVICES TO THE COMMUNITY THAT GENERATE A BILL FOR REIMBURSEMENT BUT WHICH DOES NOT COVER THE COSTS FOR THOSE SERVICES. THE SERVICES ARE PROVIDED DESPITE A NEGATIVE MARGIN BECAUSE THEY ARE NEEDED IN THE COMMUNITY AND OTHER PROVIDERS ARE UNWILLING TO PROVIDE THEM. SOME OF THE SUBSIDIZED SERVICES ARE DISCUSSED BELOW. OBSTETRICS. IN 2011 WE HAD 163 DELIVERIES THAT WERE IN THE HOSPITAL FOR 349 DAYS. WITHOUT THIS SERVICE BEING OFFERED BY THE HOSPITAL, PATIENTS WOULD HAVE TO TRAVEL MORE THAN 30 MILES TO THE NEXT AVAILABLE HOSPITAL. . PRIMARY AND SPECIALTY CARE CLINICS. IN ORDER TO IMPROVE ACCESS TO PRIMARY CARE IN THE COUNTIES OF AUDRAIN, MONTGOMERY, AND RALLS WHICH ARE ALL FEDERAL MEDICALLY UNDERSERVED AREAS, AUDRAIN MEDICAL CENTER OWNS AND OPERATES EIGHT DIFFERENT CLINICS IN THE TOWNS OF MEXICO, MONTGOMERY CITY, PERRY, VANDALIA AND WELLSVILLE. MEXICO IS THE LARGEST TOWN AT 11,320. THE OTHER TOWNS RANGE IN SIZE FROM 650 TO 3,770. D. CASH/IN-KIND DONATIONS " CASH DONATIONS. DURING 2011 AUDRAIN MEDICAL CENTER DONATED FUNDS TO NUMEROUS NON-PROFIT ORGANIZATIONS IN THE COMMUNITY. ORGANIZATIONS THAT RECEIVED FUNDS DURING THE YEAR INCLUDED AMERICAN CANCER SOCIETY/RELAY FOR LIFE, BUDDY PACK PROGRAM FOR LOCAL SCHOOL CHILDREN, MEXICO CHAMBER OF COMMERCE, MEXICO DIXIE GRAY BAND PARENTS, MEXICO LEDGER, MEXICO HIGH SCHOOL AFTER PROM COMMITTEE, MEXICO JAYCEES, MEXICO YMCA, MISSOURI PHYSICIANS HEALTH PROGRAM, AND THE ROTARY FOUNDATION. " IN-KIND DONATIONS. WE ALSO PROVIDED MEETING ROOM SPACE FOR VARIOUS COMMUNITY ORGANIZATIONS SUCH AS THE AUDRAIN COUNTY HUMAN SERVICES COUNCIL, COMMUNITY BLOOD DRIVE, THE COUNTY COMMISSIONER, RELAY FOR LIFE, THE UNITED WAY, AND AUDRAIN CITY-COUNTY HEALTH UNIT. FINALLY, EMPLOYEES HAVE JOINED AND PARTICIPATE IN VARIOUS SERVICE CLUBS AND ORGANIZATIONS SUCH AS AARP, ALTRUSA, AUDRAIN CITY-COUNTY HEALTH UNIT, AUDRAIN COUNTY HUMAN SERVICES COUNCIL, HATTON WOMEN'S CLUB, MEXICO CHAMBER OF COMMERCE, MEXICO COMMUNITY BETTERMENT, MEXICO HUMAN RESOURCE ASSOCIATION, MEXICO KIWANIS, MEXICO ROTARY CLUB, MEXICO WOMEN'S CLUB, MEXICO YMCA, MINISTERIAL ALLIANCE, PARIS CHAMBER OF COMMERCE, PARIS ROTARY CLUB, PRESSER HALL PERFORMING ARTS, SOCIETY FOR HEALTHCARE STRATEGY, VANDALIA CHAMBER OF COMMERCE, AND WELLSVILLE PRAIRIE HOME SOCIETY. E. COMMUNITY BUILDING ACTIVITIES WE ARE ALSO INVOLVED IN COMMUNITY HEALTH PROGRAMS AND COMMUNITY PARTNERSHIPS. IN 2011 WE PROVIDED DISASTER PREPAREDNESS CLASSES COVERING TOPICS SUCH AS NATURAL HAZARD MITIGATION PLANNING FOR MEXICO, NARROW BANDING AND RADIO EQUIPMENT, AND DECON ALLEY SET UP AND TAKE DOWN. WE ALSO PROVIDE A BUILDING TO THE COUNTY PUBLIC HEALTH DEPARTMENT. WE DO NOT CHARGE PUBLIC HEALTH FOR UTILITIES AND WE ALSO LET THE DEPARTMENT OCCUPY THE BUILDING FOR LESS THAN MARKET RENTAL RATES. WE ALSO ASSISTED A WOMEN'S SHELTER TO OBTAIN GRANTS AND PROVIDED TAXI SERVICE TO PATIENTS WHO HAD NO MEANS OF TRANSPORTATION TO RETURN HOME. IN 2011 WE PAID RECRUITMENT COSTS FOR PHYSICIAN AND OTHER HEALTH PROFESSIONALS TO IMPROVE HEALTH SERVICES TO THE COMMUNITY.
FORM 990 REVIEW PROCESS FORM 990, PART V1, SECTION A, LINE 11 THE VICE PRESIDENT/CFO OF AUDRAIN HEALTH CENTER REVIEWS THE FORM 990 BEFORE APPROPRIATE SIGNATURES AND FILING ACTION. A DRAFT OF THE FORM 990 IS ALSO PROVIDED TO THE BOARD OF DIRECTORS FOR REVIEW.
COMPLIANCE WITH CONFLICT OF INTEREST POLICY FORM 990, PART VI, SECTION B, LINE 12C BOARD MEMBERS ARE REQUIRED TO COMPLETE A CONFLICT OF INTEREST DISCLOSURE STATEMENT ANNUALLY, AND IT IS USUALLY DONE AT THE ANNUAL BOARD MEETINGS. THE CORPORATE COMPLIANCE COMMITTEE MEETS QUARTERLY IN ORDER TO MONITOR AND ENFORCE COMPLIANCE WITH THE CONFLICT OF INTEREST POLICY. A HOTLINE AND COMMENT BOX IS ALSO AVAILABLE FOR HOSPITAL EMPLOYEES AND OFFICERS TO ANONYMOUSLY DISCLOSE ANY CONFLICTS TO THE COMMITTEE. THIS COVERS ANY PERSON SERVING AMC AS A BOARD MEMBER, OFFICER, OR EMPLOYEE. THE CORPORATE COMPLIANCE COMMITTEE REVIEWS ALL CONFLICTS. THE CONFLICT IS HANDLED THROUGH FULL DISCLOSURE OF ANY SUCH INTEREST, TOGETHER WITH NONINVOLVEMENT IN ANY DISCUSSION AND VOTE WHEREIN THE INTEREST IS INVOLVED.
PROCESS FOR DETERMINING COMPENSATION FORM 990, SECTION B, LINE 15 A. EXECUTIVE SALARY/COMPENSATION INFORMATION IS DETERMINED BY THE EXECUTIVE COMMITTEE OF THE BOARD OF DIRECTORS USING MISSOURI HOSPITAL ASSOCIATION COMPENSATION REPORTS THAT PROVIDE BENCHMARKS FOR THE HOSPITAL CEO'S IN MISSOURI BY BED SIZE, OPERATING BUDGET AND NUMBER OF FTE'S. B. THE SALARY DATA AND POTENTIAL ADJUSTMENTS, FOR OTHER OFFICERS OF THE ORGANIZATION, ARE PRESENTED TO THE HUMAN RESOURCES DIRECTOR WHO COMPARES COMPENSATION WITH THE SAME MISSOURI HOSPITAL ASSOCIATION COMPENSATION REPORTS.
ADDITIONAL DOCUMENTS AVAILABLE TO THE PUBLIC FORM 990, SECTION C, LINE 19 THE GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS ARE MADE AVAILABLE TO THE PUBLIC UPON WRITTEN REQUEST.
OTHER CHANGES IN NET ASSETS FORM 990, PART XI, LINE 5 CHANGE IN INTEREST IN FOUNDATION -153,277 CHANGE IN MINIMUM PENSION LIABILITY -5,318,472 UNREALIZED LOSS ON INVESTMENTS -116,251 ROUNDING -2 - - - - TOTAL -5,588,002
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.
Cat. No. 51056K
Schedule O (Form 990 or 990-EZ) 2011

Additional Data


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SCHEDULE R
(Form 990)
Department of the Treasury
Internal Revenue Service
Related Organizations and Unrelated Partnerships
MediumBulletComplete if the organization answered "Yes" to Form 990, Part IV, line 33, 34, 35, 36, or 37.
MediumBulletAttach to Form 990. MediumBullet See separate instructions.

OMB No. 1545-0047
2011
Open to Public Inspection
Name of the organization
Audrain Health Care Inc
 
Employer identification number

43-1550298
Part I
Identification of Disregarded Entities (Complete if the organization answered "Yes" on Form 990, Part IV, line 33.)
(a)
Name, address, and EIN of disregarded entity


(b)
Primary activity


 		(c)
Legal domicile (state
or foreign country)

 		(d)
Total income
(e)
End-of-year assets


 		(f)
Direct controlling
entity

















Part II
Identification of Related Tax-Exempt Organizations (Complete if the organization answered "Yes" on Form 990, Part IV, line 34 because it had one or more related tax-exempt organizations during the tax year.)
(a)
Name, address, and EIN of related organization


(b)
Primary activity


 		(c)
Legal domicile (state
or foreign country)

 		(d)
Exempt Code section
(e)
Public charity status
(if section 501(c)(3))

 		(f)
Direct controlling
entity

 		(g)
Section 512(b)(13) controlled organization
Yes No
(1) AUDRAIN MEDICAL CENTER FOUNDATION

620 E MONROE

MEXICO,MO65265
43-1265060 		SUPPORT HOSP MO 501(C)(3) 11-I NA
 
 
No
(2) AUDRAIN MEDICAL CENTER AUXILIARY

620 E MONROE

MEXICO,MO65265
43-1258870 		SUPPORT HOSP MO 501(C)(3) 9 NA
 
 
No










For Privacy Act and Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 50135Y
Schedule R (Form 990) 2011
Schedule R (Form 990) 2011
Page 2
Part III
Identification of Related Organizations Taxable as a Partnership (Complete if the organization answered "Yes" on Form 990, Part IV, line 34 because it had one or more related organizations treated as a partnership during the tax year.)
(a)
Name, address, and EIN of
related organization



 		(b)
Primary activity




 		(c)
Legal
domicile
(state or foreign
country)


 		(d)
Direct controlling
entity



 		(e)
Predominant income(related, unrelated, excluded from tax under sections 512-514)

(f)
Share of total income




 		(g)
Share of end-of-year
assets



 		(h)
Disproprtionate allocations?




 		(i)
Code V—UBI
amount in box 20 of
Schedule K-1
(Form 1065)
 		(j)
General or
managing
partner?



 		(k)
Percentage
ownership
Yes No Yes No












Part IV
Identification of Related Organizations Taxable as a Corporation or Trust (Complete if the organization answered "Yes" on Form 990, Part IV, line 34 because it had one or more related organizations treated as a corporation or trust during the tax year.)
(a)
Name, address, and EIN of related organization



 		(b)
Primary activity



 		(c)
Legal domicile
(state or
foreign
country)
 		(d)
Direct controlling
entity


 		(e)
Type of entity
(C corp, S corp,
or trust)

 		(f)
Share of total income



 		(g)
Share of
end-of-year
assets

 		(h)
Percentage
ownership












Schedule R (Form 990) 2011
Schedule R (Form 990) 2011
Page 3
Part V
Transactions With Related Organizations (Complete if the organization answered "Yes" on Form 990, Part IV, line 34, 35, 35A, or 36.)
Note. Complete line 1 if any entity is listed in Parts II, III or IV.
Yes
No
1 During the tax year, did the orgranization engage in any of the following transactions with one or more related organizations listed in Parts II-IV?
a Receipt of (i) interest (ii) annuities (iii) royalties (iv) rent from a controlled entity . . . . . . . . . . . . . . . . . . . . . . .
1a
 
No
b Gift, grant, or capital contribution to related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1b
 
No
c Gift, grant, or capital contribution from related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1c
Yes
 
d Loans or loan guarantees to or for related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1d
 
No
e Loans or loan guarantees by related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1e
 
No
f Sale of assets to related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1f
 
No
g Purchase of assets from related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1g
 
No
h Exchange of assets with related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1h
 
No
i Lease of facilities, equipment, or other assets to related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1i
 
No
j Lease of facilities, equipment, or other assets from related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . .
1j
 
No
k Performance of services or membership or fundraising solicitations for related organization(s) . . . . . . . . . . . . . . . . . . . .
1k
 
No
l Performance of services or membership or fundraising solicitations by related organization(s) . . . . . . . . . . . . . . . . . . . .
1l
Yes
 
m Sharing of facilities, equipment, mailing lists, or other assets with related organization(s) . . . . . . . . . . . . . . . . . . . . .
1m
Yes
 
n Sharing of paid employees with related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1n
Yes
 
o Reimbursement paid to related organization(s) for expenses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1o
 
No
p Reimbursement paid by related organization(s) for expenses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1p
 
No
q Other transfer of cash or property to related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1q
 
No
r Other transfer of cash or property from related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1r
 
No
2
If the answer to any of the above is "Yes," see the instructions for information on who must complete this line, including covered relationships and transaction thresholds.
(a)
Name of other organization 		(b)
Transaction
type(a-r) 		(c)
Amount involved 		(d)
Method of determining amount involved
(1) AUDRAIN MEDICAL CENTER FOUNDATION

 C 399,929 CASH CONTRIB
(2) AUDRAIN MEDICAL CENTER AUXILIARY

 C 155,891 CASH CONTRIB
(3)
(4)
(5)
(6)
Schedule R (Form 990) 2011
Schedule R (Form 990) 2011
Page 4
Part VI
Unrelated Organizations Taxable as a Partnership (Complete if the organization answered "Yes" on Form 990, Part IV, line 37.)
Provide the following information for each entity taxed as a partnership through which the organization conducted more than five percent of its activities (measured by total assets or gross revenue) that was not a related organization. See instructions regarding exclusion for certain investment partnerships.
(a)
Name, address, and EIN of entity 		(b)
Primary activity 		(c)
Legal domicile
(state or foreign
country) 		(d)
Predominant income(related, unrelated, excluded from tax under sections 512-514)

(e)
Are all
partners
section
501(c)(3)
organizations? 		(f)
Share of total income




 		(g)
Share of
end-of-year
assets 		(h)
Disproprtionate allocations? 		(i)
Code V—UBI
amount in box
20 of Schedule K-1
(Form 1065) 		(j)
General or
managing
partner? 		(k)
Percentage
ownership
Yes No Yes No Yes No






























Schedule R (Form 990) 2011
Schedule R (Form 990) 2011
Page 5
Part VII
Supplemental Information
Complete this part to provide additional information for responses to questions on Schedule R (see instructions).
Identifier Return Reference Explanation
Additional Data


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