TY 2023 Form 990

(A) Name and title	(B) Average hours per week (list any hours for related organizations below dotted line)	(C) Position (do not check more than one box, unless person is both an officer and a director/trustee)	(E) Reportable compensation from related organizations (W-2/1099-MISC/1099-NEC)
(1) LYNN FAUR MD...................................................................... BOARD MEMBER/PHYSICIAN	40.00 ................. 2.00	X			291,107	0	27,915
(2) JOHN MCCOY...................................................................... CHAIR	2.00 ................. 2.00	X	X		0	0	0
(3) ANN RICE...................................................................... VICE CHAIR	2.00 ................. 2.00	X			0	0	0
(4) TODD RUMSEY MD...................................................................... TREASURER/PHYSICIAN	35.00 ................. 2.00	X	X		564,030	0	24,659
(5) DONNA ELBRECHT...................................................................... SECRETARY	2.00 ................. 2.00	X	X		0	0	0
(6) DEBORAH MCHENRY...................................................................... IMMEDIATE PAST CHAIR	2.00 ................. 2.00	X	X		0	0	0
(7) MIKE CONNELL...................................................................... BOARD MEMBER	2.00 ................. 2.00	X			0	0	0
(8) JONATHAN CRESS...................................................................... BOARD MEMBER	2.00 ................. 2.00	X			0	0	0
(9) SCOTT GRUNER...................................................................... BOARD MEMBER	2.00 ................. 2.00	X			0	0	0
(10) JEFFERY NICKEL MD...................................................................... BOARD MEMBER	2.00 ................. 2.00	X			0	0	0
(11) ANGELA LOGAN...................................................................... CHIEF EXECUTIVE OFFICER	42.00 ................. 2.00		X		467,923	0	17,829
(12) CHRISTOPHER GASAWAY...................................................................... PHYSICIAN	40.00 .................			X	270,618	0	16,457
(13) CHARLES MACLEAN...................................................................... PHYSICIAN	36.00 .................			X	348,122	0	24,245
(14) DEAN MATTOX II MD...................................................................... PHYSICIAN	41.00 .................			X	397,231	0	22,769
(15) MATTHEW SIELOFF...................................................................... PHYSICIAN	40.00 .................			X	353,392	0	10,794
(16) JOHN VARNER MD...................................................................... PHYSICIAN	36.00 .................			X	773,925	0	29,345

(A) Name and business address	(B) Description of services	(C) Compensation
JICI INC 319 POKAGON TRAIL STE A ANGOLA,IN46703	CONSTRUCTION SERVICES	5,689,019
WEIGANC CONSTRUCTION INC 7808 HONEYWELL DRIVE FORT WAYNE,IN46825	CONSTRUCTION SERVICES	2,626,576
FORT WAYNE ORTHOPAEDICS LLC PO BOX 2526 FORT WAYNE,IN468012526	ORTHOPAEDIC SERVICES	1,166,040
HOSPITAL CARE GROUP PC 6435 WEST JEFFERSON BLVD PMB 109 FORT WAYNE,IN46804	HOSPITALIST PROGRAM	834,154
HIRONS & COMPANY 422 E NEW YORK ST INDINAPOLIS,IN46202	MARKETING SERVICES	640,411
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 23

- TIN:

SCHEDULE A
(Form 990)

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

Go to www.irs.gov/Form990 for instructions and the latest information.

OMB No. 1545-0047

2023

Open to Public
Inspection

Name of the organization

CAMERON MEMORIAL COMMUNITY HOSPITAL

Employer identification number

35-0211370

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 12, check only one box.)

A church, convention of churches, or association of churches described in section 170(b)(1)(A)(i).

A school described in section 170(b)(1)(A)(ii). (Attach Schedule E (Form 990).)

A hospital or a cooperative hospital service organization described in section 170(b)(1)(A)(iii).

A medical research organization operated in conjunction with a hospital described in section 170(b)(1)(A)(iii). Enter the hospital's name, city, and state:

An organization operated for the benefit of a college or university owned or operated by a governmental unit described in section 170(b)(1)(A)(iv). (Complete Part II.)

A federal, state, or local government or governmental unit described in section 170(b)(1)(A)(v).

An organization that normally receives a substantial part of its support from a governmental unit or from the general public described in section 170(b)(1)(A)(vi). (Complete Part II.)

A community trust described in section 170(b)(1)(A)(vi). (Complete Part II.)

An agricultural research organization described in 170(b)(1)(A)(ix) operated in conjunction with a land-grant college or university or a non-land grant college of agriculture. See instructions. Enter the name, city, and state of the college or university:

An organization that normally receives: (1) more than 33 1/3% of its support from contributions, membership fees, and gross receipts from activities related to its exempt functions—subject to certain exceptions, and (2) no more than 33 1/3% 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.)

An organization organized and operated exclusively to test for public safety. See section 509(a)(4).

An organization organized and operated exclusively for the benefit of, to perform the functions of, or to carry out the purposes of one or more publicly supported organizations described in section 509(a)(1) or section 509(a)(2). See section 509(a)(3). Check the box on lines 12a through 12d that describes the type of supporting organization and complete lines 12e, 12f, and 12g.

Type I. A supporting organization operated, supervised, or controlled by its supported organization(s), typically by giving the supported organization(s) the power to regularly appoint or elect a majority of the directors or trustees of the supporting organization. You must complete Part IV, Sections A and B.

Type II. A supporting organization supervised or controlled in connection with its supported organization(s), by having control or management of the supporting organization vested in the same persons that control or manage the supported organization(s). You must complete Part IV, Sections A and C.

Type III functionally integrated. A supporting organization operated in connection with, and functionally integrated with, its supported organization(s) (see instructions). You must complete Part IV, Sections A, D, and E.

Type III non-functionally integrated. A supporting organization operated in connection with its supported organization(s) that is not functionally integrated. The organization generally must satisfy a distribution requirement and an attentiveness requirement (see instructions). You must complete Part IV, Sections A and D, and Part V.

Check this box if the organization received a written determination from the IRS that it is a Type I, Type II, Type III functionally integrated, or Type III non-functionally integrated supporting organization.

Enter the number of supported organizations ...............................

Provide the following information about the supported organization(s).

(i) Name of supported organization	(ii) EIN	(iv) Is the organization listed in your governing document?		(v) Amount of monetary support (see instructions)	(vi) Amount of other support (see instructions)
(i) Name of supported organization	(ii) EIN	Yes	No	(v) Amount of monetary support (see instructions)	(vi) Amount of other support (see instructions)


Total

For Paperwork Reduction Act Notice, see the Instructions for
Form 990 or 990-EZ.

Cat. No. 11285F

Schedule A (Form 990) 2023

Page 2

Part II

Support Schedule for Organizations Described in Sections 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 failed to qualify under the tests listed below, please complete Part III.)

Section A. Public Support

Calendar year (or fiscal year beginning in)		(a) 2019	(b) 2020	(c) 2021	(d) 2022	(e) 2023	(f) Total
1	Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grant.") ..
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) 2019	(b) 2020	(c) 2021	(d) 2022	(e) 2023	(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. Do not include gain or loss from the sale of capital assets (Explain in Part VI.)..
11	Total support. Add lines 7 through 10

Gross receipts from related activities, etc. (see instructions) ..................

First 5 years. If the Form 990 is for the organization's first, second, third, fourth, or fifth tax year as a section 501(c)(3) organization, check this box and stop here ........................................ right arrow

Section C. Computation of Public Support Percentage

Public support percentage for 2023 (line 6, column (f) divided by line 11, column (f)) .........

Public support percentage for 2022 Schedule A, Part II, line 14 ...............

16a

33 1/3% support test—2023. If the organization did not check the box on line 13, and line 14 is 33 1/3% or more, check this box
and stop here. The organization qualifies as a publicly supported organization ....................... right arrow

33 1/3% support test—2022. If the organization did not check a box on line 13 or 16a, and line 15 is 33 1/3% or more, check this
box and stop here. The organization qualifies as a publicly supported organization ..................... right arrow

17a

10%-facts-and-circumstances test—2023. If the organization did not check a box on line 13, 16a, or 16b, and line 14 is 10% or more, and if the organization meets the "facts-and-circumstances" test, check this box and stop here. Explain in Part VI how the organization meets the "facts-and-circumstances" test. The organization qualifies as a publicly supported organization ............ right arrow

10%-facts-and-circumstances test—2022. If the organization did not check a box on line 13, 16a, 16b, or 17a, and line 15 is 10% or more, and if the organization meets the "facts-and-circumstances" test, check this box and stop here. Explain in Part VI how the organization meets the "facts-and-circumstances" test. The organization qualifies as a publicly supported organization ............ right arrow

Private foundation. If the organization did not check a box on line 13, 16a, 16b, 17a, or 17b, check this box and see
instructions ..................................................... right arrow

Schedule A (Form 990) 2023

Page 3

Part III

Support Schedule for Organizations Described in Section 509(a)(2)
(Complete only if you checked the box on line 10 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) 2019	(b) 2020	(c) 2021	(d) 2022	(e) 2023	(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) 2019	(b) 2020	(c) 2021	(d) 2022	(e) 2023	(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 on 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 VI.) ..
13	Total support. (Add lines 9, 10c, 11, and 12.)..

First 5 years. If the Form 990 is for the organization's first, second, third, fourth, or fifth tax year as a section 501(c)(3) organization, check this box and stop here................................................. right arrow

Section C. Computation of Public Support Percentage

Public support percentage for 2023 (line 8, column (f) divided by line 13, column (f)) .........

Public support percentage from 2022 Schedule A, Part III, line 15 ...............

Section D. Computation of Investment Income Percentage

Investment income percentage for 2023 (line 10c, column (f) divided by line 13, column (f)) ......

Investment income percentage from 2022 Schedule A, Part III, line 17 .............

19a

33 1/3% support tests-2023. If the organization did not check the box on line 14, and line 15 is more than 33 1/3%, and line 17 is not more than 33 1/3%, check this box and stop here. The organization qualifies as a publicly supported organization ....... right arrow

33 1/3 % support tests—2022. If the organization did not check a box on line 14 or line 19a, and line 16 is more than 33 1/3% and line 18 is not more than 33 1/3%, check this box and stop here. The organization qualifies as a publicly supported organization ..... right arrow

Private foundation. If the organization did not check a box on line 14, 19a, or 19b, check this box and see instructions .... right arrow

Schedule A (Form 990) 2023

Page 4

Part IV

Supporting Organizations

(Complete only if you checked a box on line 12 of Part I. If you checked box 12a, of Part I, complete Sections A and B. If you checked box 12b, of Part I, complete Sections A and C. If you checked box 12c, of Part I, complete Sections A, D, and E. If you checked box12d, of Part I, complete Sections A and D, and complete Part V.)

Section A. All Supporting Organizations

Yes

Are all of the organization’s supported organizations listed by name in the organization’s governing documents?
If "No," describe in Part VI how the supported organizations are designated. If designated by class or purpose,
describe the designation. If historic and continuing relationship, explain.

Did the organization have any supported organization that does not have an IRS determination of status under section 509(a)(1) or (2)? If "Yes," explain in Part VI how the organization determined that the supported organization was described in section 509(a)(1) or (2).

Did the organization have a supported organization described in section 501(c)(4), (5), or (6)? If "Yes," answer lines 3b and 3c below.

Did the organization confirm that each supported organization qualified under section 501(c)(4), (5), or (6) and satisfied the public support tests under section 509(a)(2)? If "Yes," describe in Part VI when and how the organization made the determination.

Did the organization ensure that all support to such organizations was used exclusively for section 170(c)(2)(B) purposes? If "Yes," explain in Part VI what controls the organization put in place to ensure such use.

Was any supported organization not organized in the United States ("foreign supported organization")? If “Yes” and if you checked box 12a or 12b in Part I, answer lines 4b and 4c below.

Did the organization have ultimate control and discretion in deciding whether to make grants to the foreign supported organization? If “Yes,” describe in Part VI how the organization had such control and discretion despite being controlled or supervised by or in connection with its supported organizations.

Did the organization support any foreign supported organization that does not have an IRS determination under sections 501(c)(3) and 509(a)(1) or (2)? If “Yes,” explain in Part VI what controls the organization used to ensure that all support to the foreign supported organization was used exclusively for section 170(c)(2)(B) purposes.

Did the organization add, substitute, or remove any supported organizations during the tax year? If “Yes,” answer lines 5b and 5c below (if applicable). Also, provide detail in Part VI, including (i) the names and EIN numbers of the supported organizations added, substituted, or removed; (ii) the reasons for each such action; (iii) the authority under the organization's organizing document authorizing such action; and (iv) how the action was accomplished (such as by amendment to the organizing document).

Type I or Type II only. Was any added or substituted supported organization part of a class already designated in the organization's organizing document?

Substitutions only. Was the substitution the result of an event beyond the organization's control?

Did the organization provide support (whether in the form of grants or the provision of services or facilities) to anyone other than (i) its supported organizations, (ii) individuals that are part of the charitable class benefited by one or more of its supported organizations, or (iii) other supporting organizations that also support or benefit one or more of the filing organization’s supported organizations? If “Yes,” provide detail in Part VI.

Did the organization provide a grant, loan, compensation, or other similar payment to a substantial contributor (defined in section 4958(c)(3)(C)), a family member of a substantial contributor, or a 35% controlled entity with regard to a substantial contributor? If “Yes,” complete Part I of Schedule L (Form 990) .

Did the organization make a loan to a disqualified person (as defined in section 4958) not described on line 7? If “Yes,” complete Part I of Schedule L (Form 990).

Was the organization controlled directly or indirectly at any time during the tax year by one or more disqualified persons, as defined in section 4946 (other than foundation managers and organizations described in section 509(a)(1) or (2))? If “Yes,” provide detail in Part VI.

Did one or more disqualified persons (as defined on line 9a) hold a controlling interest in any entity in which the supporting organization had an interest? If “Yes,” provide detail in Part VI.

Did a disqualified person (as defined on line 9a) have an ownership interest in, or derive any personal benefit from, assets in which the supporting organization also had an interest? If “Yes,” provide detail in Part VI.

10a

Was the organization subject to the excess business holdings rules of section 4943 because of section 4943(f) (regarding certain Type II supporting organizations, and all Type III non-functionally integrated supporting organizations)? If “Yes,” answer line 10b below.

10a

Did the organization have any excess business holdings in the tax year? (Use Schedule C, Form 4720, to determine whether the organization had excess business holdings).

10b

Schedule A (Form 990) 2023

Page 5

Part IV

Supporting Organizations (continued)

Yes

Has the organization accepted a gift or contribution from any of the following persons?

A person who directly or indirectly controls, either alone or together with persons described on lines 11b and 11c below, the governing body of a supported organization?

11a

A family member of a person described on 11a above?

11b

A 35% controlled entity of a person described on line 11a or 11b above? If “Yes” to 11a, 11b, or 11c, provide detail in Part VI.

11c

Section B. Type I Supporting Organizations

Yes

Did the officers, directors, trustees, or membership of one or more supported organizations have the power to regularly appoint or elect at least a majority of the organization’s directors or trustees at all times during the tax year? If “No,” describe in Part VI how the supported organization(s) effectively operated, supervised, or controlled the organization’s activities. If the organization had more than one supported organization, describe how the powers to appoint and/or remove directors or trustees were allocated among the supported organizations and what conditions or restrictions, if any, applied to such powers during the tax year.

Did the organization operate for the benefit of any supported organization other than the supported organization(s) that operated, supervised, or controlled the supporting organization? If “Yes,” explain in Part VI how providing such benefit carried out the purposes of the supported organization(s) that operated, supervised or controlled the supporting organization.

Section C. Type II Supporting Organizations

Yes

Were a majority of the organization’s directors or trustees during the tax year also a majority of the directors or trustees of each of the organization’s supported organization(s)? If “No,” describe in Part VI how control or management of the supporting organization was vested in the same persons that controlled or managed the supported organization(s).

Section D. All Type III Supporting Organizations

Yes

Did the organization provide to each of its supported organizations, by the last day of the fifth month of the organization’s tax year, (i) a written notice describing the type and amount of support provided during the prior tax year, (ii) a copy of the Form 990 that was most recently filed as of the date of notification, and (iii) copies of the organization’s governing documents in effect on the date of notification, to the extent not previously provided?

Were any of the organization’s officers, directors, or trustees either (i) appointed or elected by the supported organization(s) or (ii) serving on the governing body of a supported organization? If "No," explain in Part VI how the organization maintained a close and continuous working relationship with the supported organization(s).

By reason of the relationship described in line 2 above, did the organization’s supported organizations have a significant voice in the organization’s investment policies and in directing the use of the organization’s income or assets at all times during the tax year? If "Yes," describe in Part VI the role the organization’s supported organizations played in this regard.

Section E. Type III Functionally-Integrated Supporting Organizations

Check the box next to the method that the organization used to satisfy the Integral Part Test during the year (see instructions):

The organization satisfied the Activities Test. Complete line 2 below.

The organization is the parent of each of its supported organizations. Complete line 3 below.

The organization supported a governmental entity. Describe in Part VI how you supported a government entity (see instructions)

Activities Test. Answer lines 2a and 2b below.

Yes

Did substantially all of the organization’s activities during the tax year directly further the exempt purposes of the supported organization(s) to which the organization was responsive? If "Yes," then in Part VI identify those supported organizations and explain how these activities directly furthered their exempt purposes, how the organization was responsive to those supported organizations, and how the organization determined that these activities constituted substantially all of its activities.

Did the activities described on line 2a, above constitute activities that, but for the organization’s involvement, one or more of the organization’s supported organization(s) would have been engaged in? If "Yes," explain in Part VI the reasons for the organization’s position that its supported organization(s) would have engaged in these activities but for the organization’s involvement.

Parent of Supported Organizations. Answer lines 3a and 3b below.

Did the organization have the power to regularly appoint or elect a majority of the officers, directors, or trustees of each of the supported organizations?If "Yes" or "No", provide details in Part VI.

Did the organization exercise a substantial degree of direction over the policies, programs and activities of each of its supported organizations? If "Yes," describe in Part VI. the role played by the organization in this regard.

Schedule A (Form 990) 2023

Page 6

Part V

Type III Non-Functionally Integrated 509(a)(3) Supporting Organizations

Check here if the organization satisfied the Integral Part Test as a qualifying trust on Nov. 20, 1970 (explain in Part VI). See instructions. All other Type III non-functionally integrated supporting organizations must complete Sections A through E.

	Section A - Adjusted Net Income		(A) Prior Year	(B) Current Year (optional)
1	Net short-term capital gain	1
2	Recoveries of prior-year distributions	2
3	Other gross income (see instructions)	3
4	Add lines 1 through 3	4
5	Depreciation and depletion	5
6	Portion of operating expenses paid or incurred for production or collection of gross income or for management, conservation, or maintenance of property held for production of income (see instructions)	6
7	Other expenses (see instructions)	7
8	Adjusted Net Income (subtract lines 5, 6 and 7 from line 4)	8

	Section B - Minimum Asset Amount		(A) Prior Year	(B) Current Year (optional)
1	Aggregate fair market value of all non-exempt-use assets (see instructions for short tax year or assets held for part of year):	1
a	Average monthly value of securities	1a
b	Average monthly cash balances	1b
c	Fair market value of other non-exempt-use assets	1c
d	Total (add lines 1a, 1b, and 1c)	1d
e	Discount claimed for blockage or other factors (explain in detail in Part VI):
2	Acquisition indebtedness applicable to non-exempt use assets	2
3	Subtract line 2 from line 1d	3
4	Cash deemed held for exempt use. Enter 0.015 of line 3 (for greater amount, see instructions).	4
5	Net value of non-exempt-use assets (subtract line 4 from line 3)	5
6	Multiply line 5 by 0.035	6
7	Recoveries of prior-year distributions	7
8	Minimum Asset Amount (add line 7 to line 6)	8

	Section C - Distributable Amount		Current Year
1	Adjusted net income for prior year (from Section A, line 8, Column A)	1
2	Enter 85% of line 1	2
3	Minimum asset amount for prior year (from Section B, line 8, Column A)	3
4	Enter greater of line 2 or line 3	4
5	Income tax imposed in prior year	5
6	Distributable Amount. Subtract line 5 from line 4, unless subject to emergency temporary reduction (see instructions)	6

Check here if the current year is the organization's first as a non-functionally-integrated Type III supporting organization (see instructions)

Schedule A (Form 990) 2023

Page 7

Part V

Type III Non-Functionally Integrated 509(a)(3) Supporting Organizations(continued)

Section D - Distributions		Current Year
1 Amounts paid to supported organizations to accomplish exempt purposes	1
2 Amounts paid to perform activity that directly furthers exempt purposes of supported organizations, in excess of income from activity	2
3 Administrative expenses paid to accomplish exempt purposes of supported organizations	3
4 Amounts paid to acquire exempt-use assets	4
5 Qualified set-aside amounts (prior IRS approval required - provide details in Part VI)	5
6 Other distributions (describe in Part VI). See instructions	6
7Total annual distributions. Add lines 1 through 6.	7
8 Distributions to attentive supported organizations to which the organization is responsive (provide details in Part VI). See instructions	8
9 Distributable amount for 2023 from Section C, line 6	9
10 Line 8 amount divided by Line 9 amount	10

Section E - Distribution Allocations (see instructions)		(i) Excess Distributions	(ii) Underdistributions Pre-2023	(iii) Distributable Amount for 2023
1 Distributable amount for 2023 from Section C, line 6
2 Underdistributions, if any, for years prior to 2023 (reasonable cause required-- explain in Part VI). See instructions.
3 Excess distributions carryover, if any, to 2023:
a From 2018.......
b From 2019.......
c From 2020.......
d From 2021.......
e From 2022.......
fTotal of lines 3a through e
g Applied to underdistributions of prior years
h Applied to 2023 distributable amount
i Carryover from 2018 not applied (see instructions)
j Remainder. Subtract lines 3g, 3h, and 3i from line 3f.
4Distributions for 2023 from Section D, line 7:
$
a Applied to underdistributions of prior years
b Applied to 2023 distributable amount
c Remainder. Subtract lines 4a and 4b from line 4.
5 Remaining underdistributions for years prior to 2023, if any. Subtract lines 3g and 4a from line 2. If the amount is greater than zero, explain in Part VI. See instructions.
6 Remaining underdistributions for 2023. Subtract lines 3h and 4b from line 1. If the amount is greater than zero, explain in Part VI. See instructions.
7 Excess distributions carryover to 2024. Add lines 3j and 4c.
8 Breakdown of line 7:
a Excess from 2019.....
b Excess from 2020.....
c Excess from 2021.....
d Excess from 2022.....
e Excess from 2023.....

Schedule A (Form 990) (2023)

Schedule A (Form 990) 2023

Page 8

Part VI

Supplemental Information. Provide the explanations required by Part II, line 10; Part II, line 17a or 17b; Part III, line 12; Part IV, Section A, lines 1, 2, 3b, 3c, 4b, 4c, 5a, 6, 9a, 9b, 9c, 11a, 11b, and 11c; Part IV, Section B, lines 1 and 2; Part IV, Section C, line 1; Part IV, Section D, lines 2 and 3; Part IV, Section E, lines 1c, 2a, 2b, 3a and 3b; Part V, line 1; Part V, Section B, line 1e; Part V Section D, lines 5, 6, and 8; and Part V, Section E, lines 2, 5, and 6. Also complete this part for any additional information. (See instructions).

Facts And Circumstances Test

Return Reference	Explanation

Schedule A (Form 990) 2023

Additional Data

Software ID:
Software Version:

- TIN:

Schedule B
(Form 990)

Department of the Treasury
Internal Revenue Service

Schedule of Contributors

Attach to Form 990, 990-EZ, or 990-PF.

Go to www.irs.gov/Form990 for the latest information.

OMB No. 1545-0047

2023

Name of the organization

CAMERON MEMORIAL COMMUNITY HOSPITAL

Employer identification number

35-0211370

Organization type (check one):

Filers of:

Section:

Form 990 or 990-EZ

501(c)( ) (enter number) organization

4947(a)(1) nonexempt charitable trust not treated as a private foundation

527 political organization

Form 990-PF

501(c)(3) exempt private foundation

4947(a)(1) nonexempt charitable trust treated as a private foundation

501(c)(3) taxable private foundation

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

For an organization filing Form 990, 990-EZ, or 990-PF that received, during the year, contributions totaling $5,000 or more (in money or other property) from any one contributor. Complete Parts I and II. See instructions for determining a contributor's total contributions.

Special Rules

For an organization described in section 501(c)(3) filing Form 990 or 990-EZ that met the 33¹/3% support test of the regulations
under sections 509(a)(1) and 170(b)(1)(A)(vi), that checked Schedule A (Form 990 or 990-EZ), Part II, line 13, 16a, or 16b, and that received from any one contributor, during the year, total contributions of the greater of (1) $5,000 or (2) 2% of the amount on (i) Form 990, Part VIII, line 1h, or (ii) Form 990-EZ, line 1. Complete Parts I and II.

For an organization described in section 501(c)(7), (8), or (10) filing Form 990 or 990-EZ that received from any one contributor,
during the year, total contributions of more than $1,000 exclusively for religious, charitable, scientific, literary, or educational purposes, or for the prevention of cruelty to children or animals. Complete Parts I, II, and III.

For an organization described in section 501(c)(7), (8), or (10) filing Form 990 or 990-EZ that received from any one contributor,
during the year, contributions exclusively for religious, charitable, etc., purposes, but no such contributions totaled more than $1,000. If this box is checked, enter here the total contributions that were received during the year for an exclusively religious, charitable, etc., purpose. Don't complete any of the parts unless the General Rule applies to this organization because it received nonexclusively religious, charitable, etc., contributions totaling $5,000 or more during the year ......... Arrow Bullet

Caution: An organization that isn't covered by the General Rule and/or the Special Rules doesn't 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 its Form 990PF, Part I, line 2, to certify that it doesn't 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) (2023)

Schedule B (Form 990) (2023) Page 2

Name of organization CAMERON MEMORIAL COMMUNITY HOSPITAL

Part I Contributors	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	Person Payroll Noncash (Complete Part II for noncash contributions.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II for noncash contributions.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II for noncash contributions.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II for noncash contributions.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II for noncash contributions.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II for noncash contributions.)
Schedule B (Form 990) (2023)

Schedule B (Form 990) (2023)

Page 3

Name of organization CAMERON MEMORIAL COMMUNITY HOSPITAL		Employer identification number 35-0211370

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) (2023)

Schedule B (Form 990) (2023)

Page 4


Name of organization CAMERON MEMORIAL COMMUNITY HOSPITAL			Employer identification number 35-0211370
Part III Exclusively religious, charitable, etc., contributions to organizations described in section 501(c)(7), (8), or (10) that total more than $1,000 for the year from any one contributor. 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.) $ Use duplicate copies of Part III if additional space is needed.

(a)
No. from Part I

(b) Purpose 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

(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

(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

(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) (2023)

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE C
(Form 990)

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

right arrow

Complete if the organization is described below. right arrow

Attach to Form 990 or Form 990-EZ.
right arrow

Go to www.irs.gov/Form990 for instructions and the latest information.

OMB No. 1545-0047

2022

Open to Public
Inspection

If the organization answered "Yes" on 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" on 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" on Form 990, Part IV, Line 5 (Proxy Tax) (see separate instructions) or Form 990-EZ, Part V, line 35c (Proxy Tax) (see separate instructions), then
Round Bullet

Section 501(c)(4), (5), or (6) organizations: Complete Part III.

Name of the organization

CAMERON MEMORIAL COMMUNITY HOSPITAL

Employer identification number

35-0211370

Part I-A

Complete if the organization is exempt under section 501(c) or is a section 527 organization.

Provide a description of the organization’s direct and indirect political campaign activities in Part IV. See instructions for definition of “political campaign activities."

Political campaign activity expenditures. See instructions .................................................................... right arrow

Volunteer hours for political campaign activities. See instructions ..................................................................

Part I-B

Complete if the organization is exempt under section 501(c)(3).

Enter the amount of any excise tax incurred by the organization under section 4955 ................................ right arrow

Enter the amount of any excise tax incurred by organization managers under section 4955 ....................... right arrow

If the organization incurred a section 4955 tax, did it file Form 4720 for this year? .........................................

Yes No

Was a correction made? ......................................................................................................................

Yes No

If "Yes," describe in Part IV.

Part I-C

Complete if the organization is exempt under section 501(c), except section 501(c)(3).

Enter the amount directly expended by the filing organization for section 527 exempt function activities ..... right arrow

Enter the amount of the filing organization's funds contributed to other organizations for section 527 exempt function activities ............................................................................................................................ right arrow

Total exempt function expenditures. Add lines 1 and 2. Enter here and on Form 1120-POL, line 17b........... right arrow

Did the filing organization file Form 1120-POL for this year? ...................................................................

Yes No

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-.
1
2
3
4
5
6

For Paperwork Reduction Act Notice, see the instructions for Form 990.

Cat. No. 50084S

Schedule C (Form 990) 2022

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 right arrow

if the filing organization belongs to an affiliated group (and list in Part IV each affiliated group member's name, address, EIN, expenses, and share of excess lobbying expenditures).
B Check right arrow

if the filing organization checked box A and "limited control" provisions apply.

Limits on Lobbying Expenditures (The term "expenditures" means amounts paid or incurred.)		(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? ...................................................................................................................	Yes No

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 separate instructions for lines 2a through 2f.)
Lobbying Expenditures During 4-Year Averaging Period
	Calendar year (or fiscal year beginning in)	(a) 2019	(b) 2020	(c) 2021	(d) 2022	(e) Total

2a	Lobbying nontaxable 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) 2022

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 on lines 1a through 1i below, provide in Part IV a detailed description of the lobbying activity.

(a)

Yes|No

(b)

Amount

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:

Volunteers? ...........................................................................................................

Paid staff or management (include compensation in expenses reported on lines 1c through 1i)? ........

Media advertisements? ...................................................................................................

Mailings to members, legislators, or the public? .............................................................................

Publications, or published or broadcast statements? ...........................................................

Grants to other organizations for lobbying purposes? ..........................................................

Direct contact with legislators, their staffs, government officials, or a legislative body? .......................

Rallies, demonstrations, seminars, conventions, speeches, lectures, or any similar means? ..................

Other activities? ...................................................................................................................

Yes

1,984

Total. Add lines 1c through 1i ....................................................................................................

1,984

Did the activities in line 1 cause the organization to be not described in section 501(c)(3)? .....

If "Yes," enter the amount of any tax incurred under section 4912 ...........................................

If "Yes," enter the amount of any tax incurred by organization managers under section 4912 ...................

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

Were substantially all (90% or more) dues received nondeductible by members? ...............................................

Did the organization make only in-house lobbying expenditures of $2,000 or less? ............................................

Did the organization agree to carry over lobbying and political expenditures from the prior year? .................................

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."

Dues, assessments and similar amounts from members ......................................................................

Section 162(e) nondeductible lobbying and political expenditures (do not include amounts of political expenses for which the section 527(f) tax was paid).

Current year .............................................................................................................................

Carryover from last year ............................................................................................................

Total ...........................................................................................................................................

Aggregate amount reported in section 6033(e)(1)(A) notices of nondeductible section 162(e) dues .

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? ......................................................................................................................

Taxable amount of lobbying and political expenditures. See Instructions .........................................

Part IV

Supplemental Information

Provide the descriptions required for Part l-A, line 1; Part l-B, line 4; Part l-C, line 5; Part II-A (affiliated group list); Part II-A, lines 1 and 2 (see instructions), and Part ll-B, line 1. Also, complete this part for any additional information.

Return Reference	Explanation
PART II-B, LINE 1:	DURING FISCAL YEAR 2024 A PORTION OF THE HOSPITAL'S ASSOCIATION MEMBERSHIP DUES PAID TO INDIANA HOSPITAL ASSOCIATION (IHA) AND AMERICAN HOSPITAL ASSOCIATION (AHA) WAS ALLOCATED TO LOBBYING EXPENDITURES.

Schedule C (Form 990) 2022

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE D
(Form 990)

Department of the Treasury
Internal Revenue Service

Supplemental Financial Statements

Complete if the organization answered "Yes," on Form 990,
Part IV, line 6, 7, 8, 9, 10, 11a, 11b, 11c, 11d, 11e, 11f, 12a, or 12b.
right arrow

Attach to Form 990.
right arrow

Go to www.irs.gov/Form990 for instructions and the latest information.

OMB No. 1545-0047

2022

Open to Public Inspection

Name of the organization

CAMERON MEMORIAL COMMUNITY HOSPITAL

Employer identification number

35-0211370

Part I

Organizations Maintaining Donor Advised Funds or Other Similar Funds or Accounts. Complete if the organization answered "Yes" on Form 990, Part IV, line 6.

		(a) Donor advised funds	(b) Funds and other accounts
1	Total number at end of year .........
2	Aggregate value of contributions to (during year)
3	Aggregate value of grants from (during year)
4	Aggregate value at end of year ........

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? ............

Yes No

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? ...................................

Yes No

Part II

Conservation Easements.
Complete if the organization answered "Yes" on Form 990, Part IV, line 7.

Purpose(s) of conservation easements held by the organization (check all that apply).

Preservation of land for public use (e.g., recreation or education) Preservation of an historically important land area

Protection of natural habitat Preservation of a certified historic structure

Preservation of open space

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.


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 July 25, 2006, and not on a historic structure listed in the National Register ...	2d

Number of conservation easements modified, transferred, released, extinguished, or terminated by the organization during the
tax year right arrow

Number of states where property subject to conservation easement is located right arrow

Does the organization have a written policy regarding the periodic monitoring, inspection, handling of violations, and enforcement of the conservation easements it holds? ............

Yes No

Staff and volunteer hours devoted to monitoring, inspecting, handling of violations, and enforcing conservation easements during the year
right arrow

Amount of expenses incurred in monitoring, inspecting, handling of violations, and enforcing conservation easements during the year
right arrow

Does each conservation easement reported on line 2(d) above satisfy the requirements of section 170(h)(4)(B)(i) and section 170(h)(4)(B)(ii)? .............................

Yes No

In Part XIII, 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" on Form 990, Part IV, line 8.

If the organization elected, as permitted under FASB 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 XIII, the text of the footnote to its financial statements that describes these items.

If the organization elected, as permitted under FASB 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)

Revenue included on Form 990, Part VIII, line 1 ......................... right arrow

(ii)

Assets included in Form 990, Part X ............................... right arrow

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 FASB ASC 958 relating to these items:

Revenue included on Form 990, Part VIII, line 1 .......................... right arrow

Assets included in Form 990, Part X ............................... right arrow

For Paperwork Reduction Act Notice, see the Instructions for Form 990.

Cat. No. 52283D

Schedule D (Form 990) 2022

Page 2

Part III

Organizations Maintaining Collections of Art, Historical Treasures, or Other Similar Assets (continued)

Using the organization’s acquisition, accession, and other records, check any of the following that are a significant use of its collection items (check all that apply):

Public exhibition

Loan or exchange programs

Scholarly research

Other

Preservation for future generations

Provide a description of the organization’s collections and explain how they further the organization’s exempt purpose in
Part XIII.

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?...

Yes No

Part IV

Escrow and Custodial Arrangements. Complete if the organization answered "Yes" on Form 990, Part IV, line 9, or reported an amount on Form 990, Part X, line 21.

Is the organization an agent, trustee, custodian or other intermediary for contributions or other assets not
included on Form 990, Part X? ....................................

Yes No


b	If "Yes," explain the arrangement in Part XIII 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

Did the organization include an amount on Form 990, Part X, line 21, for escrow or custodial account liability? ...

Yes No

If "Yes," explain the arrangement in Part XIII. Check here if the explanation has been provided in Part XIII ....

Part V

Endowment Funds.
Complete if the organization answered "Yes" on 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 ....
b	Contributions ...
c	Net investment earnings, gains, and losses
d	Grants or scholarships ...
e	Other expenditures for facilities and programs ...
f	Administrative expenses ....
g	End of year balance ......

Provide the estimated percentage of the current year end balance (line 1g, column (a)) held as:

Board designated or quasi-endowment right arrow

Permanent endowment right arrow

Term endowment right arrow

The percentages on lines 2a, 2b, and 2c should equal 100%.

Are there endowment funds not in the possession of the organization that are held and administered for the
organization by:

Yes

(i) Unrelated organizations .................

3a(i)

(ii) Related organizations .................

3a(ii)

If "Yes" on 3a(ii), are the related organizations listed as required on Schedule R? .........

Describe in Part XIII the intended uses of the organization's endowment funds.

Part VI

Land, Buildings, and Equipment.
Complete if the organization answered "Yes" on Form 990, Part IV, line 11a. 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 .....	2,240,172		2,240,172
b	Buildings ....	61,742,281	38,464,370	23,277,911
c	Leasehold improvements
d	Equipment ....	22,582,763	16,619,334	5,963,429
e	Other .....	11,700,491		11,700,491
Total. Add lines 1a through 1e. (Column (d) must equal Form 990, Part X, column (B), line 10(c).)..				43,182,003

Schedule D (Form 990) 2022

Page 3

Part VII

Investments - Other Securities.
Complete if the organization answered "Yes" on Form 990, Part IV, line 11b. 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........
(3)Other
(A)
(B)
(C)
(D)
(E)
(F)
(G)
(H)
Total. (Column (b) must equal Form 990, Part X, col. (B) line 12.)

Part VIII

Investments - Program Related. Complete if the organization answered 'Yes' on Form 990, Part IV, line 11c. See Form 990, Part X, line 13.

(a) Description of investment	(b) Book value	(c) Method of valuation: Cost or end-of-year market value

(1)
(2)
(3)
(4)
(5)
(6)
(7)
(8)
(9)
Total. (Column (b) must equal Form 990, Part X, col.(B) line 13.)

Part IX

Other Assets.
Complete if the organization answered 'Yes' on Form 990, Part IV, line 11d. See Form 990, Part X, line 15.

(a) Description				(b) Book value
(1)ASSETS LIMITED AS TO USE - RESTRICTED FOR CAPITAL IMPROVEMENTS				10,178,323
(2)ASSETS LIMITED AS TO USE - DONOR RESTRICTED				346,118
(3)ASSETS LIMITED AS TO USE - RESTRICTED FOR EMPLOYEE BENEFIT PROGRAMS				807,638
(4)RELATED PARTY RECEIVABLE				582,139
(5)ROU ASSETS - OPERATING LEASES				3,012,343
(5)
(6)
(7)
(8)
(9)
Total. (Column (b) must equal Form 990, Part X, col.(B) line 15.)...........				14,926,561

Part X

Other Liabilities.
Complete if the organization answered 'Yes' on Form 990, Part IV, line 11e or 11f. See Form 990, Part X, line 25.

1.(a) Description of liability	(b) Book value
(1) Federal income taxes
ESTIMATED THIRD-PARTY SETTLEMENT	250,055
RECOURSE OBLIGATION, PATIENT PAYABLE	145,996
CAMERON WOODS SECURITY DEPOSITS	2,500






Total. (Column (b) must equal Form 990, Part X, col.(B) line 25.)	398,551
2. Liability for uncertain tax positions. In Part XIII, 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 (ASC 740). Check here if the text of the footnote has been provided in Part XIII

Schedule D (Form 990) 2022

Page 4

Part XI Reconciliation of Revenue per Audited Financial Statements With Revenue per Return. Complete if the organization answered 'Yes' on Form 990, Part IV, line 12a.
1	Total revenue, gains, and other support per audited financial statements .......		1
2	Amounts included on line 1 but not on Form 990, Part VIII, line 12:
a	Net unrealized gains (losses) on investments ....	2a
b	Donated services and use of facilities .........	2b
c	Recoveries of prior year grants ...........	2c
d	Other (Describe in Part XIII.) ...........	2d
e	Add lines 2a through 2d .....................		2e
3	Subtract line 2e from line 1..................		3
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 XIII.) ...........	4b
c	Add lines 4a and 4b....................		4c
5	Total revenue. Add lines 3 and 4c. (This must equal Form 990, Part I, line 12.) ......		5

Part XII Reconciliation of Expenses per Audited Financial Statements With Expenses per Return. Complete if the organization answered 'Yes' on Form 990, Part IV, line 12a.
1	Total expenses and losses per audited financial statements ...........		1
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 XIII.) ...........	2d
e	Add lines 2a through 2d....................		2e
3	Subtract line 2e from line 1...................		3
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 XIII.) ...........	4b
c	Add lines 4a and 4b.....................		4c
5	Total expenses. Add lines 3 and 4c. (This must equal Form 990, Part I, line 18.) ......		5

Part XIII

Supplemental Information

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, line 2; Part XI, lines 2d and 4b; and Part XII, lines 2d and 4b. Also complete this part to provide any additional information.

Return Reference	Explanation

Schedule D (Form 990) 2022

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE G (Form 990)

Department of the Treasury
Internal Revenue Service

Supplemental Information Regarding
Fundraising or Gaming Activities

Complete if the organization answered "Yes" on Form 990, Part IV, lines 17, 18, or 19, or if the organization entered more than $15,000 on Form 990-EZ, line 6a. right arrow

Attach to Form 990 or Form 990-EZ.
right arrow

Go to www.irs.gov/Form990 for instructions and the latest information.

OMB No. 1545-0047

2023

Open to Public Inspection

Name of the organization
CAMERON MEMORIAL COMMUNITY HOSPITAL

Employer identification number

35-0211370

Part I

Fundraising Activities.Complete if the organization answered "Yes" on Form 990, Part IV, line 17.

Form 990-EZ filers are not required to complete this part.

Indicate whether the organization raised funds through any of the following activities. Check all that apply.

a	Mail solicitations	e	Solicitation of non-government grants
b	Internet and email solicitations	f	Solicitation of government grants
c	Phone solicitations	g	Special fundraising events
d	In-person solicitations

Did the organization have a written or oral agreement with any individual (including officers, directors, trustees

or key employees listed in Form 990, Part VII) or entity in connection with professional fundraising services?

YesNo

If "Yes," list the 10 highest paid individuals or entities (fundraisers) pursuant to agreements under which the fundraiser is
to be compensated at least $5,000 by the organization.

(i) Name and address of individual or entity (fundraiser)		(ii) Activity	(iii) Did fundraiser have custody or control of contributions?		(iv) Gross receipts from activity	(v) Amount paid to (or retained by) fundraiser listed in col. (i)	(vi) Amount paid to (or retained by) organization
			Yes	No
	HILLARY LYONS ASSOCIATES PO BOX 99 DIAMONDALE, MI48821	SUPPORT, PLANNING AND ORGANIZING FUNDRAISING EVENTS		No	0	48,000	-48,000









Total . . . . . . . . . . . . . . . . . . . .						48,000	-48,000

List all states in which the organization is registered or licensed to solicit contributions or has been notified it is exempt from registration or licensing.

For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.

Cat. No. 50083H

Schedule G (Form 990) 2023

Page 2

Part II

Fundraising Events. Complete if the organization answered "Yes" on Form 990, Part IV, line 18, or reported more than $15,000 of fundraising event contributions and gross income on Form 990-EZ, lines 1 and 6b. List events with gross receipts greater than $5,000.

		(a) Event #1 GOLF OUTING (event type)	(b) Event #2 (event type)	(c) Other events (total number)	(d) Total events (add col. (a) through col. (c))
1	Gross receipts . . . . .	52,536			52,536
2	Less: Contributions . . . .	8,448			8,448
3	Gross income (line 1 minus line 2) . . . . . .	44,088			44,088

4	Cash prizes . . . . .	700	700
5	Noncash prizes . . . .	3,201	3,201
6	Rent/facility costs . . . .	8,940	8,940
7	Food and beverages . . .	6,082	6,082
8	Entertainment . . . .
9	Other direct expenses . . .	2,876	2,876
10	Direct expense summary. Add lines 4 through 9 in column (d) . . . . . . . . . .		21,799
11	Net income summary. Subtract line 10 from line 3, column (d). . . . . . . . . .		22,289

Part III

Gaming. Complete if the organization answered "Yes" on Form 990, Part IV, line 19, or reported more than $15,000 on Form 990-EZ, line 6a.

		(a) Bingo	(b) Pull tabs/Instant bingo/progressive bingo	(c) Other gaming	(d) Total gaming (add col.(a) through col.(c))
1	Gross revenue . . . . .

2	Cash prizes . . . . .
3	Noncash prizes . . . .
4	Rent/facility costs . . . .
5	Other direct expenses . . .

Volunteer labor . . . .

	Yes %
	No

	Yes %
	No

	Yes %
	No

Direct expense summary. Add lines 2 through 5 in column (d) . . . . . . . . . . right arrow

Net gaming income summary. Subtract line 7 from line 1, column (d). . . . . . . . . right arrow

Enter the state(s) in which the organization conducts gaming activities:

Is the organization licensed to conduct gaming activities in each of these states? . . . . . . . .

YesNo

If "No," explain:

10a

Were any of the organization's gaming licenses revoked, suspended or terminated during the tax year? . . .

YesNo

If "Yes," explain:

Schedule G (Form 990) 2023

Page 3

Does the organization conduct gaming activities with nonmembers? . . . . . . . . . . .

YesNo

Is the organization a grantor, beneficiary or trustee of a trust or a member of a partnership or other entity

formed to administer charitable gaming? . . . . . . . . . . . . . . . . .

YesNo

Indicate the percentage of gaming activity conducted in:

The organization's facility . . . . . . . . . . . . . . . . . .

13a

An outside facility . . . . . . . . . . . . . . . . . . . .

13b

Enter the name and address of the person who prepares the organization's gaming/special events books and records:

Name

Address

15a

Does the organization have a contract with a third party from whom the organization receives gaming

revenue? . . . . . . . . . . . . . . . . . . . . . . . .

YesNo

If "Yes," enter the amount of gaming revenue received by the organization right arrow

$ and the

amount of gaming revenue retained by the third party right arrow

$ .

If "Yes," enter name and address of the third party:

Name

Address

Gaming manager information:

Name

Gaming manager compensation right arrow

Description of services provided right arrow

Director/officer Employee Independent contractor

Mandatory distributions:

Is the organization required under state law to make charitable distributions from the gaming proceeds to

retain the state gaming license? . . . . . . . . . . . . . . . . . . .

YesNo

Enter the amount of distributions required under state law distributed to other exempt organizations or spent

in the organization's own exempt activities during the tax year right arrow

Part IV

Supplemental Information. Provide the explanations required by Part I, line 2b, columns (iii) and (v); and Part III, lines 9, 9b, 10b, 15b, 15c, 16, and 17b, as applicable. Also provide any additional information. See instructions.

Return Reference	Explanation
SCHEDULE G, PART I, LINE 2B, COLUMN (V)	THE ORGANIZATION CONSULTED WITH THE LISTED PERSONS FOR SUPPORT ON THE PLANNING OF THEIR FUNDRAISING EVENTS.

Schedule G (Form 990) 2023

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE H
(Form 990)

Department of the Treasury
Internal Revenue Service

Hospitals

Complete if the organization answered "Yes" on Form 990, Part IV, question 20a.
Medium right arrow

Attach to Form 990.
Medium right arrow

Go to www.irs.gov/Form990EZ for instructions and the latest information.

OMB No. 1545-0047

2023

Open to Public Inspection

Name of the organization

CAMERON MEMORIAL COMMUNITY HOSPITAL

Employer identification number

35-0211370

Part I

Financial Assistance and Certain Other Community Benefits at Cost

Yes

Did the organization have a financial assistance policy during the tax year? If "No," skip to question 6a . . . .

Yes

If "Yes," was it a written policy? ......................

Yes

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.

Applied uniformly to all hospital facilities Applied uniformly to most hospital facilities Generally tailored to individual hospital facilities

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.

Did the organization use Federal Poverty Guidelines (FPG) as a factor in determining eligibility for providing free care?

If "Yes," indicate which of the following was the FPG family income limit for eligibility for free care:

Yes

100% 150% 200% Other %

Did the organization use FPG as a factor in determining eligibility for providing discounted care? If "Yes," indicate

which of the following was the family income limit for eligibility for discounted care: . . . . . . . .

Yes

200% 250% 300% 350% 400% Other %

If the organization used factors other than FPG in determining eligibility, describe in Part VI the criteria used 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, as a factor in determining eligibility for free or discounted care.

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"? . . . . . . . . . . . . .

Yes

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

Yes

If "Yes," did the organization's financial assistance expenses exceed the budgeted amount? . . . . . .

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? . . . . . . . . . . . . .

Did the organization prepare a community benefit report during the tax year? . . . . . . . . .

Yes

If "Yes," did the organization make it available to the public? . . . . . . . . . . . . .

Yes

Complete the following table using the worksheets provided in the Schedule H instructions. Do not submit these worksheets with the Schedule H.

Financial Assistance and Certain Other Community Benefits at Cost

Financial Assistance and Means-Tested Government Programs		(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) . . .	136,996		136,996	0.130 %
b	Medicaid (from Worksheet 3, column a) . . . . .	15,484,351	10,303,552	5,180,799	4.850 %
c	Costs of other means-tested government programs (from Worksheet 3, column b) . .
d	Total Financial Assistance and Means-Tested Government Programs . . . . .	15,621,347	10,303,552	5,317,795	4.980 %
Other Benefits
e	Community health improvement services and community benefit operations (from Worksheet 4).	223,553		223,553	0.210 %
f	Health professions education (from Worksheet 5) . . .
g	Subsidized health services (from Worksheet 6) . . . .	568,378	334,229	234,149	0.220 %
h	Research (from Worksheet 7) .
i	Cash and in-kind contributions for community benefit (from Worksheet 8) . . . .	55,746		55,746	0.050 %
j	Total. Other Benefits . .	847,677	334,229	513,448	0.480 %
k	Total. Add lines 7d and 7j .	16,469,024	10,637,781	5,831,243	5.460 %

For Paperwork Reduction Act Notice, see the Instructions for Form 990. Cat. No. 50192T Schedule H (Form 990) 2023

Schedule H (Form 990) 2023

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			52,155		52,155	0.050 %
4	Environmental improvements
5	Leadership development and training for community members
6	Coalition building			1,572		1,572	0 %
7	Community health improvement advocacy
8	Workforce development			11,976		11,976	0.010 %
9	Other
10	Total			65,703		65,703	0.060 %

Part III

Bad Debt, Medicare, & Collection Practices

Section A. Bad Debt Expense

Yes

Did the organization report bad debt expense in accordance with Healthcare Financial Management Association Statement No. 15? ..........................

Yes

Enter the amount of the organization's bad debt expense. Explain in Part VI the methodology used by the organization to estimate this amount. ......

2,580,824

Enter the estimated amount of the organization's bad debt expense attributable to patients eligible under the organization's financial assistance policy. Explain in Part VI the methodology used by the organization to estimate this amount and the rationale, if any, for including this portion of bad debt as community benefit. ......

55,459

Provide in Part VI the text of the footnote to the organization’s financial statements that describes bad debt expense or the page number on which this footnote is contained in the attached financial statements.

Section B. Medicare

Enter total revenue received from Medicare (including DSH and IME).....

16,991,947

Enter Medicare allowable costs of care relating to payments on line 5.....

16,994,451

Subtract line 6 from line 5. This is the surplus (or shortfall)........

-2,504

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:

Cost accounting system Cost to charge ratio Other

Section C. Collection Practices

Did the organization have a written debt collection policy during the tax year? ..........

Yes

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 .........................

Yes

Part IV

Management Companies and Joint Ventures(owned 10% or more by officers, directors, trustees, key employees, and physicians—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) 2023

Page

Part VFacility Information

Section A. Hospital Facilities (list in order of size from largest to smallest—see instructions)How many hospital facilities did the organization operate during the tax year?1Name, address, primary website address, and state license number (and if a group return, the name and EIN of the subordinate hospital organization that operates the hospital facility)
1	CAMERON MEMORIAL COMMUNITY HOSPITAL INC 416 E MAUMEE STREET ANGOLA,IN46703 WWW.CAMERONMCH.COM 22-005037-1	X	X	X	X

Schedule H (Form 990) 2023

Page 4

Part VFacility Information (continued)

Section B. Facility Policies and Practices

(Complete a separate Section B for each of the hospital facilities or facility reporting groups listed in Part V, Section A)

	CAMERON MEMORIAL COMMUNITY HOSPITAL INC
Name of hospital facility or letter of facility reporting group

Line number of hospital facility, or line numbers of hospital facilities in a facility
reporting group (from Part V, Section A):

Yes

Community Health Needs Assessment

Was the hospital facility first licensed, registered, or similarly recognized by a state as a hospital facility in the current tax year or the immediately preceding tax year?........................

Was the hospital facility acquired or placed into service as a tax-exempt hospital in the current tax year or the immediately preceding tax year? If “Yes,” provide details of the acquisition in Section C...............

During the tax year or either of the two immediately preceding tax years, did the hospital facility conduct a community health needs assessment (CHNA)? If "No," skip to line 12......................

Yes

If "Yes," indicate what the CHNA report describes (check all that apply):

A definition of the community served by the hospital facility

Demographics of the community

Existing health care facilities and resources within the community that are available to respond to the health needs of the community

How data was obtained

The significant health needs of the community

Primary and chronic disease needs and other health issues of uninsured persons, low-income persons, and minority groups

The process for identifying and prioritizing community health needs and services to meet the community health needs

The process for consulting with persons representing the community’s interests

The impact of any actions taken to address the significant health needs identified in the hospital facility's prior CHNA(s)

Other (describe in Section C)

Indicate the tax year the hospital facility last conducted a CHNA: 20 21

In conducting its most recent CHNA, did the hospital facility take into account input from persons who represent the broad interests of the community served by the hospital facility, including those with special knowledge of or expertise in public health? If "Yes," describe in Section C how the hospital facility took into account input from persons who represent the community, and identify the persons the hospital facility consulted .................

Yes

6 a

Was the hospital facility’s CHNA conducted with one or more other hospital facilities? If "Yes," list the other hospital facilities in Section C..................................

Was the hospital facility’s CHNA conducted with one or more organizations other than hospital facilities?” If “Yes,” list the other organizations in Section C. ............................

Yes

Did the hospital facility make its CHNA report widely available to the public?..............

Yes

If "Yes," indicate how the CHNA report was made widely available (check all that apply):

Hospital facility’s website (list url): SEE PART V, SECTION C, LINE 7D

Other website (list url):

Made a paper copy available for public inspection without charge at the hospital facility

Other (describe in Section C)

Did the hospital facility adopt an implementation strategy to meet the significant community health needs
identified through its most recently conducted CHNA? If "No," skip to line 11. ..............

Yes

Indicate the tax year the hospital facility last adopted an implementation strategy: 20 22

Is the hospital facility's most recently adopted implementation strategy posted on a website?.........

Yes

If "Yes" (list url): HTTPS://WWW.CAMERONMCH.COM/RESOURCES/COMMUNITY-HEALTH-ASSESSMENT/

If "No," is the hospital facility’s most recently adopted implementation strategy attached to this return? ......

10b

Describe in Section C how the hospital facility is addressing the significant needs identified in its most recently conducted CHNA and any such needs that are not being addressed together with the reasons why such needs are not being addressed.

12a

Did the organization incur an excise tax under section 4959 for the hospital facility's failure to conduct a CHNA as required by section 501(r)(3)?...............................

12a

If "Yes" on line 12a, did the organization file Form 4720 to report the section 4959 excise tax?........

12b

If "Yes" on line 12b, what is the total amount of section 4959 excise tax the organization reported on Form 4720 for all of its hospital facilities? $

Schedule H (Form 990) 2023

Page 5

Part VFacility Information (continued)

Financial Assistance Policy (FAP)

	CAMERON MEMORIAL COMMUNITY HOSPITAL INC
Name of hospital facility or letter of facility reporting group

Yes

Did the hospital facility have in place during the tax year a written financial assistance policy that:

Explained eligibility criteria for financial assistance, and whether such assistance included free or discounted care?

Yes

If “Yes,” indicate the eligibility criteria explained in the FAP:

Federal poverty guidelines (FPG), with FPG family income limit for eligibility for free care of 100.000000000000%
and FPG family income limit for eligibility for discounted care of 350.000000000000%

Income level other than FPG (describe in Section C)

Asset level

Medical indigency

Insurance status

Underinsurance discount

Residency

Other (describe in Section C)

Explained the basis for calculating amounts charged to patients?.................

Yes

Explained the method for applying for financial assistance?...................

Yes

If “Yes,” indicate how the hospital facility’s FAP or FAP application form (including accompanying instructions) explained the method for applying for financial assistance (check all that apply):

Described the information the hospital facility may require an individual to provide as part of his or her application

Described the supporting documentation the hospital facility may require an individual to submit as part of his or
her application

Provided the contact information of hospital facility staff who can provide an individual with information about the
FAP and FAP application process

Provided the contact information of nonprofit organizations or government agencies that may be sources of
assistance with FAP applications

Other (describe in Section C)

Was widely publicized within the community served by the hospital facility?........

Yes

If "Yes," indicate how the hospital facility publicized the policy (check all that apply):

The FAP was widely available on a website (list url):

HTTPS://CAMERONMCH.COM/RESOURCES/BILLING-PRICING/

The FAP application form was widely available on a website (list url):

HTTPS://CAMERONMCH.MYFA.APP/FA-APPLICATION/

A plain language summary of the FAP was widely available on a website (list url):
HTTPS://CAMERONMCH.COM/FINANCIAL-ASSISTANCE-PLAIN-LANGUAGE-SUMMARY-ENGLISH/

The FAP was available upon request and without charge (in public locations in the hospital facility and by mail)

The FAP application form was available upon request and without charge (in public locations in the hospital facility
and by mail)

A plain language summary of the FAP was available upon request and without charge (in public locations in the
hospital facility and by mail)

Individuals were notified about the FAP by being offered a paper copy of the plain language summary of the FAP, by
receiving a conspicuous written notice about the FAP on their billing statements, and via conspicuous public displays or
other measures reasonably calculated to attract patients' attention

Notified members of the community who are most likely to require financial assistance about availability of the FAP

The FAP, FAP application form, and plain language summary of the FAP were translated into the primary language(s)
spoken by LEP populations

Other (describe in Section C)

Schedule H (Form 990) 2023

Page 6

Part VFacility Information (continued)

Billing and Collections

	CAMERON MEMORIAL COMMUNITY HOSPITAL INC
Name of hospital facility or letter of facility reporting group

Yes

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 all of the actions the hospital facility or other authorized party may take upon nonpayment?..................................

Yes

Check all of the following actions against an individual that were permitted under the hospital facility's policies during the tax year before making reasonable efforts to determine the individual’s eligibility under the facility’s FAP:

Reporting to credit agency(ies)

Selling an individual’s debt to another party

Deferring, denying, or requiring a payment before providing medically necessary care due to nonpayment of a previous
bill for care covered under the hospital facility's FAP

Actions that require a legal or judicial process

Other similar actions (describe in Section C)

None of these actions or other similar actions were permitted

Did the hospital facility or other authorized party perform any of the following actions during the tax year before making reasonable efforts to determine the individual’s eligibility under the facility’s FAP?............

If "Yes," check all actions in which the hospital facility or a third party engaged:

Reporting to credit agency(ies)

Selling an individual’s debt to another party

Deferring , denying, or requiring a payment before providing medically necessary care due to nonpayment of a previous
bill for care covered under the hospital facility's FAP

Actions that require a legal or judicial process

Other similar actions (describe in Section C)

Indicate which efforts the hospital facility or other authorized party made before initiating any of the actions listed (whether or not checked) in line 19. (check all that apply):

Provided a written notice about upcoming ECAs (Extraordinary Collection Action) and a plain language summary of the
FAP at least 30 days before initiating those ECAs (if not, describe in Section C)

Made a reasonable effort to orally notify individuals about the FAP and FAP application process (if not, describe in
Section C)

Processed incomplete and complete FAP applications (if not, describe in Section C)

Made presumptive eligibility determinations (if not, describe in Section C)

Other (describe in Section C)

None of these efforts were made

Policy Relating to Emergency Medical Care

Did the hospital facility have in place during the tax year a written policy relating to emergency medical care that required 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?..................

Yes

If "No," indicate why:

The hospital facility did not provide care for any emergency medical conditions

The hospital facility’s policy was not in writing

The hospital facility limited who was eligible to receive care for emergency medical conditions (describe in Section C)

Other (describe in Section C)

Schedule H (Form 990) 2023

Page 7

Part VFacility Information (continued)

Charges to Individuals Eligible for Assistance Under the FAP (FAP-Eligible Individuals)

	CAMERON MEMORIAL COMMUNITY HOSPITAL INC
Name of hospital facility or letter of facility reporting group

Yes

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.

The hospital facility used a look-back method based on claims allowed by Medicare fee-for-service during a prior 12-month period

The hospital facility used a look-back method based on claims allowed by Medicare fee-for-service and all private health insurers that pay claims to the hospital facility during a prior 12-month period

The hospital facility used a look-back method based on claims allowed by Medicaid, either alone or in combination with
Medicare fee-for-service and all private health insurers that pay claims to the hospital facility during a prior 12-month
period

The hospital facility used a prospective Medicare or Medicaid method

During the tax year, did the hospital facility charge any FAP-eligible individual 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? ...............................

If "Yes," explain in Section C.

During the tax year, did the hospital facility charge any FAP-eligible individual an amount equal to the gross charge for any service provided to that individual? ...........................

If "Yes," explain in Section C.

Schedule H (Form 990) 2023

Page 8

Part V

Facility Information (continued)

Section C. Supplemental Information for Part V, Section B. Provide descriptions required for Part V, Section B, lines 2, 3j, 5, 6a, 6b, 7d, 11, 13b, 13h, 15e, 16j, 18e, 19e, 20a, 20b, 20c, 20d, 20e, 21c, 21d, 23, and 24. If applicable, provide separate descriptions for each hospital facility in a facility reporting group, designated by facility reporting group letter and hospital facility line number from Part V, Section A (“A, 1,” “A, 4,” “B, 2,” “B, 3,” etc.) and name of hospital facility.
Form and Line Reference	Explanation
CAMERON MEMORIAL COMMUNITY HOSPITAL, INC.	PART V, SECTION B, LINE 5: CAMERON MEMORIAL COMMUNITY HOSPITAL PARTNERED WITH THE INDIANA RURAL HEALTH ASSOCIATION (IRHA) TO CONDUCT A COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA) TO BETTER UNDERSTAND AND ADDRESS THE HEALTHCARE PRIORITIES OF STEUBEN COUNTY. THE PROCESS BEGAN WITH IRHA IDENTIFYING THE COMMUNITY SERVED BY CMCH THROUGH DISCUSSIONS WITH HOSPITAL LEADERSHIP. BY ANALYZING PATIENT ZIP CODES, THE HOSPITAL DEFINED ITS PRIMARY SERVICE AREA AS ALL POSTAL CODES WITHIN STEUBEN COUNTY AND PROVIDED A DETAILED SERVICE AREA MAP.TO GUIDE THE ASSESSMENT, A STEERING COMMITTEE WAS FORMED WITH REPRESENTATIVES FROM ACROSS STEUBEN COUNTY, COORDINATED WITH THE SUPPORT OF THE CAMERON MEMORIAL COMMUNITY HOSPITAL CEO. THE COMMITTEE INCLUDED BUSINESS OWNERS, LOCAL OFFICIALS, HEALTHCARE PROVIDERS, MINORITY LEADERS, CLERGY, STUDENT REPRESENTATIVES, AND OTHER COMMUNITY STAKEHOLDERS. THESE MEMBERS GATHERED TO DISCUSS THE COUNTY'S MOST PRESSING HEALTH CONCERNS AND IDENTIFY KEY AREAS OF NEED.BASED ON THESE DISCUSSIONS, A 43-QUESTION SURVEY WAS DEVELOPED TO CAPTURE COMMUNITY PERSPECTIVES ON LOCAL HEALTH CHALLENGES. THE SURVEY COVERED TOPICS SUCH AS THE IMPACT OF ILLEGAL DRUGS, TRANSPORTATION BARRIERS, POVERTY, AND THE NEED FOR ADDITIONAL HEALTHCARE SERVICES AND FACILITIES. TO ENSURE BROAD PARTICIPATION, THE SURVEY WAS DISTRIBUTED THROUGH MULTIPLE CHANNELS, INCLUDING THE CAMERON MEMORIAL COMMUNITY HOSPITAL WEBSITE, IN-PERSON POLLING AT THE YMCA OF STEUBEN COUNTY AND SUTTON'S DELI IN ANGOLA, AND AN ONLINE VERSION HOSTED ON SURVEYMONKEY. THIS COMPREHENSIVE APPROACH ALLOWED CAMERON TO GATHER VALUABLE INSIGHTS DIRECTLY FROM RESIDENTS, HELPING SHAPE INITIATIVES THAT ENHANCE HEALTHCARE ACCESS AND SERVICES IN STEUBEN COUNTY.
CAMERON MEMORIAL COMMUNITY HOSPITAL, INC.	PART V, SECTION B, LINE 6B: INDIANA RURAL HEALTH ASSOCIATION
CAMERON MEMORIAL COMMUNITY HOSPITAL, INC.	PART V, SECTION B, LINE 7D: SECTION B, LINE 7A:HTTPS://WWW.CAMERONMCH.COM/RESOURCES/COMMUNITY-HEALTH-ASSESSMENT/SECTION B, LINE 7D:LOCATION TO CHNA: ON THE WEB PAGE UNDER "RESOURCES" CLICK ON THE LINK "ANNUAL REPORT & COMMUNITY HEALTH NEEDS ASSESSMENT" TO ACCESS CMCH'S MOST CURRENT COMMUNITY HEALTH NEEDS ASSESSMENT OR COPY AND ENTER THE LINK ABOVE "SECTION B, LINE 7A" INTO THE INTERNET BROWSER.
CAMERON MEMORIAL COMMUNITY HOSPITAL, INC.	PART V, SECTION B, LINE 11: FOLLOWING THE 2022 COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA), THREE KEY AREAS OF FOCUS WERE IDENTIFIED. BELOW IS A SUMMARY OF THE PRIORITIZED NEEDS OUTLINED IN THE APPROVED IMPLEMENTATION STRATEGY, ALONG WITH AN UPDATE ON OUR PROGRESS.1. MENTAL HEALTH SERVICES & TREATMENT (INPATIENT, YOUTH, STIGMA REDUCTION)IN 2024, CAMERON CONTINUED TO MAKE SIGNIFICANT PROGRESS IN EXPANDING MENTAL HEALTH SERVICES, REINFORCING OUR COMMITMENT TO HOLISTIC WELL-BEING. WE HAVE BROADENED OUR NETWORK OF MENTAL HEALTH PROVIDERS, INCREASING ACCESS TO SPECIALIZED CARE FOR INDIVIDUALS OF ALL AGES. RECOGNIZING THE UNIQUE CHALLENGES FACED BY YOUNG PATIENTS UNDER 18, WE HAVE ENHANCED OUR SERVICES WITH DEDICATED RESOURCES AND TAILORED PROGRAMS TO BETTER SUPPORT THEIR NEEDS.ADDITIONALLY, WE ARE ACTIVELY COLLABORATING WITH LOCAL SCHOOLS AND COMMUNITY AGENCIES TO PROMOTE MENTAL HEALTH EDUCATION AND REDUCE STIGMA. BY PROVIDING SPEAKERS, WORKSHOPS, AND OUTREACH PROGRAMS, WE ARE FOSTERING A CULTURE OF OPENNESS AND UNDERSTANDING. THESE EFFORTS HELP ENSURE THAT INDIVIDUALS FEEL SUPPORTED IN SEEKING CARE WHILE REINFORCING THE IMPORTANCE OF MENTAL HEALTH AWARENESS IN OUR COMMUNITY.2. SUBSTANCE USE (PREVENTION, TOBACCO/VAPING, STIGMA REDUCTION)CAMERON REMAINS STEADFAST IN ADDRESSING SUBSTANCE USE DISORDER THROUGH EDUCATION, PREVENTION, AND COMMUNITY COLLABORATION. OUR PARTNERSHIPS WITH LOCAL SCHOOLS FOCUS ON EARLY INTERVENTION AND EDUCATION PROGRAMS, EQUIPPING STUDENTS WITH THE KNOWLEDGE AND SKILLS TO MAKE INFORMED, HEALTHY CHOICES. THROUGH INTERACTIVE WORKSHOPS AND TAILORED RESOURCES, WE EMPOWER YOUNG PEOPLE TO RESIST PEER PRESSURE AND UNDERSTAND THE RISKS ASSOCIATED WITH SUBSTANCE USE, INCLUDING VAPING AND TOBACCO USE.BEYOND SCHOOL-BASED INITIATIVES, CAMERON IS ACTIVELY ENGAGED IN MULTI-AGENCY COLLABORATIONS WITH LAW ENFORCEMENT, HEALTHCARE PROVIDERS, AND COMMUNITY ORGANIZATIONS TO TACKLE SUBSTANCE ABUSE AT ITS ROOT. THESE PARTNERSHIPS FACILITATE ACCESS TO TREATMENT PROGRAMS, COORDINATE CARE PLANS, AND PROVIDE ONGOING SUPPORT FOR INDIVIDUALS AND FAMILIES IMPACTED BY ADDICTION. THROUGH THESE COMBINED EFFORTS, WE STRIVE TO CREATE A SUPPORTIVE ENVIRONMENT FOR PREVENTION, TREATMENT, AND LONG-TERM RECOVERY.3. YOUTH-FOCUSED SERVICESCAMERON REMAINS DEDICATED TO EXPANDING YOUTH-CENTERED PROGRAMS THAT PROMOTE HEALTH, WELLNESS, AND POSITIVE LIFESTYLE CHOICES. THROUGHOUT THE YEAR, WE CONTINUE TO COLLABORATE WITH COMMUNITY ORGANIZATIONS INCLUDING THE YMCA OF STEUBEN COUNTY, SHAPE UP STEUBEN, PURDUE EXTENSION, SCHOOLS, FAITH-BASED GROUPS, AND OTHER YOUTH-FOCUSED ORGANIZATIONS TO INTEGRATE HEALTHY LIVING CONCEPTS INTO DAILY LIFE.ONE OF OUR KEY INITIATIVES IS THE STRENGTHENING FAMILIES PROGRAM, LAUNCHED IN PARTNERSHIP WITH PURDUE EXTENSION IN JUNE 2019. THIS SEVEN-SESSION COURSE IS DESIGNED FOR YOUTH AGES 10-14 AND THEIR FAMILIES, HELPING THEM NAVIGATE FAMILY DYNAMICS, COMMUNICATION, PEER PRESSURE, AND GOAL SETTING. THE PROGRAM ORIGINALLY SERVED COURT-APPOINTED FAMILIES THROUGH JUVENILE PROBATION PROGRAMS BUT HAS SINCE EXPANDED TO THE GENERAL PUBLIC AT NO COST, THANKS TO GRANT FUNDING FROM PURDUE EXTENSION AND THE STEUBEN COUNTY COMMUNITY FOUNDATION.CAMERON HAS ALSO INTRODUCED A THERAPY DOG PROGRAM, LAUNCHED IN SEPTEMBER 2022, WHICH PROVIDES COMFORT AND SUPPORT TO PATIENTS OF ALL AGES, WITH A SPECIAL FOCUS ON YOUTH RECEIVING INPATIENT CARE AND THERAPY SERVICES. THESE THERAPY DOGS HAVE PROVEN TO BE AN INVALUABLE RESOURCE, OFFERING EMOTIONAL SUPPORT AND HELPING TO EASE ANXIETY IN A VARIETY OF HEALTHCARE SETTINGS, INCLUDING THE LAB AND INPATIENT UNITS.ADDITIONALLY, CAMERON MEDICAL GROUP IS COMMITTED TO EDUCATING AND ENGAGING WITH LOCAL YOUTH AND FAMILIES THROUGH HOSPITAL TOURS, INTERACTIVE SCHOOL EVENTS, AND COMMUNITY OUTREACH. FROM PARTICIPATING IN YMCA SUMMER DAY CAMPS TO TEACHING CHILDREN ABOUT HAND HYGIENE AND THE IMPORTANCE OF ROUTINE HEALTHCARE VISITS, WE ARE DEDICATED TO EQUIPPING FAMILIES WITH KNOWLEDGE AND RESOURCES THAT PROMOTE LIFELONG WELL-BEING.
CAMERON MEMORIAL COMMUNITY HOSPITAL, INC.	PART V, SECTION B, LINE 13B: IN ADDITION TO FPG, ELIGIBILITY FOR FINANCIAL ASSISTANCE ALSO CONSIDERS THE FOLLOWING INCOME SOURCES IF PATIENTS CLAIM NO INCOME: INCOME FROM CHILD SUPPORT, PENSION, RENTAL, EDUCATION, AND OTHER FINANCIAL SUPPORT FROM FAMILY MEMBERS NOT LIVING IN THE HOUSEHOLD.
CAMERON MEMORIAL COMMUNITY HOSPITAL, INC.	PART V, SECTION B, LINE 16J: ON THE WEB PAGE UNDER "RESOURCES" CLICK ON THE LINK "BILLING & PRICING" TO ACCESS THE HOSPITAL'S FINANCIAL ASSISTANCE POLICY INFORMATION.
CAMERON MEMORIAL COMMUNITY HOSPITAL, INC.	PART V, SECTION B, LINE 20E: FOR INPATIENTS, A HOSPITAL REPRESENTATIVE VISITS THE PATIENT AND DISCUSSES WITH THEM ABOUT PAYMENT OPTIONS INCLUDING THE FINANCIAL ASSISTANCE POLICY; FOR OUTPATIENTS AND OTHER PATIENTS THE BUSINESS OFFICE CALLS AND DISCUSSES THE SAME OPTIONS.

Schedule H (Form 990) 2023

Page 9

Part VFacility Information (continued)

Section D. 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?
Name and address		Type of Facility (describe)
1
2
3
4
5
6
7
8
9
10

Schedule H (Form 990) 2023

Page 10

Part VI

Supplemental Information

Provide the following information.

1	Required descriptions. Provide the descriptions required for Part I, lines 3c, 6a, and 7; Part II and Part III, lines 2, 3, 4, 8 and 9b.
2	Needs assessment. Describe how the organization assesses the health care needs of the communities it serves, in addition to any CHNAs 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.

Form and Line Reference	Explanation
PART I, LINE 3C:	CAMERON MEMORIAL COMMUNITY HOSPITAL, INC.'S FINANCIAL ASSISTANCE POLICY EXPLAINS THE FOLLOWING ELIGIBILITY CRITERIA FOR FINANCIAL ASSISTANCE IN ADDITION TO THE FPG:INCOME LEVEL OTHER THAN FPG (E.G., CHILD SUPPORT, PENSION INCOME, RENTAL INCOME, EDUCATIONAL INCOME, AND OTHER FINANCIAL SUPPORT FROM FAMILY MEMBERS NOT LIVING IN THE HOUSEHOLD), ASSET LEVEL, MEDICAL INDIGENCY, INSURANCE STATUS, UNDERINSURANCE STATUS, AND RESIDENCY.
PART I, LINE 7G:	THE ORGANIZATION IS INCLUDING THE GASTROENTEROLOGY DEPARTMENT IN ITS SUBSIDIZED SERVICES CALCULATION. TOTAL COMMUNITY BENEFIT EXPENSE OF $568,378, DIRECTOR OFFSETTING REVENUE OF $334,229 AND NET COMMUNITY BENEFIT EXPENSE OF $234,149 IS ATTRIBUTABLE TO THE GASTROENTEROLOGY DEPARTMENT.
PART I, LINE 7, COLUMN (F):	THE BAD DEBT EXPENSE INCLUDED ON FORM 990, PART IX, LINE 25, COLUMN (A), BUT SUBTRACTED FOR PURPOSES OF CALCULATING THE PERCENTAGE IN THIS COLUMN IS $ 6,325,815.
PART II, COMMUNITY BUILDING ACTIVITIES:	CAMERON MEMORIAL COMMUNITY HOSPITAL HAS BEEN A TRUSTED HEALTHCARE PROVIDER IN STEUBEN COUNTY SINCE 1926, SERVING GENERATION AFTER GENERATION WITH A COMMITMENT TO IMPROVING COMMUNITY HEALTH. AS A 25-BED, NOT-FOR-PROFIT FACILITY, WE TAKE PRIDE IN DELIVERING HIGH-QUALITY, PERSONALIZED CARE THROUGH ADVANCED TECHNOLOGY AND A DEDICATED TEAM OF PHYSICIANS, HEALTHCARE PROFESSIONALS, AND STAFF. OUR MISSION IS TO ENHANCE THE QUALITY OF LIFE FOR THOSE WE SERVE BY FOSTERING RELATIONSHIPS BUILT ON HEALTH, WELLNESS, AND COMMUNITY ENGAGEMENT. GUIDED BY OUR CORE VALUES: SAFETY, COMPASSION, INTEGRITY, TEAMWORK, STEWARDSHIP, EXCELLENCE, RESPECT, AND WELLNESS WE STRIVE TO MAKE A LASTING IMPACT EVERY DAY.AS PART OF OUR ONGOING COMMITMENT TO EDUCATION AND WORKFORCE DEVELOPMENT, CAMERON RECENTLY OPENED THE CAMERON EDUCATION AND INNOVATION CENTER TO SUPPORT THE TRAINING AND ADVANCEMENT OF HEALTHCARE PROFESSIONALS. THIS STATE-OF-THE-ART FACILITY SERVES AS A HUB FOR LEARNING, PROFESSIONAL DEVELOPMENT, AND COMMUNITY ENGAGEMENT. A KEY INITIATIVE WITHIN THE CENTER IS OUR PARTNERSHIP WITH TRINE UNIVERSITY TO OFFER AN ASSOCIATE OF SCIENCE IN NURSING (ASN) PROGRAM, PROVIDING STUDENTS WITH HANDS-ON TRAINING AND EDUCATION TO PREPARE THEM FOR SUCCESSFUL CAREERS IN HEALTHCARE. BY INVESTING IN THE NEXT GENERATION OF NURSES, CAMERON IS ACTIVELY WORKING TO STRENGTHEN THE LOCAL HEALTHCARE WORKFORCE AND ENSURE ACCESS TO HIGH-QUALITY CARE FOR YEARS TO COME.ONE OF OUR KEY COMMUNITY INITIATIVES IS THE HEALTH OCCUPATIONS EDUCATION (H.O.E.) PROGRAM, WHICH PROVIDES HIGH SCHOOL STUDENTS WITH HANDS-ON EXPOSURE TO THE HEALTHCARE FIELD. THESE STUDENTS, CHOSEN FOR THEIR INTEREST IN PURSUING MEDICAL CAREERS, ROTATE THROUGH HOSPITAL DEPARTMENTS, CLINICS, AND MEDICAL OFFICES, GAINING REAL-WORLD EXPERIENCE UNDER THE SUPERVISION OF EXPERTS. THEY ALSO RECEIVE CPR TRAINING AND ACTIVELY PARTICIPATE IN HEALTH FAIRS AND SCREENINGS THROUGHOUT THE COMMUNITY. BY INVESTING IN THIS PROGRAM, CAMERON HELPS SHAPE THE NEXT GENERATION OF HEALTHCARE PROFESSIONALS, ENSURING CONTINUED QUALITY CARE FOR OUR COMMUNITY.RECOGNIZING THE GROWING DEMAND FOR MENTAL HEALTH SERVICES, CAMERON HAS MADE SIGNIFICANT INVESTMENTS IN EXPANDING ACCESS TO CARE. FOLLOWING THE 2019 AND 2022 COMMUNITY HEALTH NEEDS ASSESSMENTS, CONDUCTED IN PARTNERSHIP WITH THE INDIANA STATE OFFICE OF RURAL HEALTH, CAMERON LAUNCHED AND HAS GROWN CAMERON PSYCHIATRY SERVICES TO ADDRESS THIS CRITICAL NEED. SINCE THEN, WE HAVE STEADILY EXPANDED OUR PROGRAM, ADDING MULTIPLE THERAPISTS, ADVANCED PRACTICE PROVIDERS, AND THERAPY PROGRAMS. IN 2023, WE HIRED A FULL-TIME PSYCHIATRIST AND AN ADDITIONAL PART-TIME PHYSICIAN, ALONG WITH EIGHT NEW ADVANCED PRACTICE PROVIDERS, ALL OF WHOM BEGAN SEEING PATIENTS IN EARLY 2024. THESE EFFORTS REFLECT OUR COMMITMENT TO MAKING HIGH-QUALITY MENTAL HEALTH CARE ACCESSIBLE TO ALL.IN ADDITION TO CLINICAL SERVICES, CAMERON ACTIVELY PROMOTES WELLNESS THROUGH COMMUNITY-WIDE HEALTH SCREENINGS AT LOCAL HIGH SCHOOLS, OFFERING REDUCED-COST LAB TESTS FOR ADULTS. WE ALSO LAUNCHED A TELEHEALTH PROGRAM IN PARTNERSHIP WITH A LOCAL SCHOOL SYSTEM, ALLOWING STUDENTS TO CONNECT WITH A PEDIATRICIAN VIA VIDEO VISITS WITH PARENTAL CONSENT. THIS INITIATIVE ENSURES THAT CHILDREN RECEIVE TIMELY MEDICAL CARE WITHOUT REQUIRING PARENTS TO TAKE TIME OFF WORK FOR IN-OFFICE VISITS.UNDERSTANDING THE ESSENTIAL ROLE OF NUTRITION IN OVERALL HEALTH, WE CONTINUE TO OFFER THE CAMERON COMMUNITY WELLNESS GARDEN AT NO COST TO COMMUNITY MEMBERS. GARDENERS RESERVE PLOTS EACH SEASON, MAINTAINING THEM THROUGH THE FALL, AND FOR THE FOURTH CONSECUTIVE YEAR, ALL PLOTS HAVE BEEN FILLED. WE ARE ALSO EXPLORING ADDITIONAL PARTNERSHIPS, INCLUDING A FARM-TO-SCHOOL PROGRAM, TO FURTHER PROMOTE HEALTHY EATING HABITS IN LOCAL SCHOOLS. BY INTEGRATING EDUCATION AND ACCESS TO FRESH, LOCALLY GROWN PRODUCE, WE SUPPORT LONG-TERM COMMUNITY WELLNESS.THROUGH THESE AND MANY OTHER INITIATIVES, CAMERON REMAINS DEEPLY COMMITTED TO STRENGTHENING THE HEALTH OF OUR COMMUNITY, NOT JUST THROUGH EXCEPTIONAL MEDICAL CARE, BUT THROUGH PROGRAMS THAT EMPOWER INDIVIDUALS AND FAMILIES TO LEAD HEALTHIER LIVES.
PART III, LINE 2:	MANAGEMENT REGULARLY REVIEWS DATA ABOUT THE MAJOR PAYOR SOURCES OF REVENUE IN EVALUATING THE SUFFICIENCY OF THE ALLOWANCE FOR UNCOLLECTIBLE ACCOUNTS. FOR RECEIVABLES ASSOCIATED WITH SERVICES PROVIDED TO PATIENTS WHO HAVE THIRD PARTY COVERAGE, THE HOSPITAL ANALYZES CONTRACTUALLY DUE AMOUNTS AND PROVIDES AN ALLOWANCE FOR UNCOLLECTIBLE ACCOUNTS AND PROVISION FOR BAD DEBTS, IF NECESSARY. FOR RECEIVABLES ASSOCIATED WITH SELF-PAY PAYMENTS, WHICH INCLUDES BOTH PATIENTS WITHOUT INSURANCE AND PATIENTS WITH DEDUCTIBLE AND COPAYMENT BALANCES DUE FOR WHICH THIRD PARTY COVERAGE EXISTS FOR PART OF THE BILL, THE HOSPITAL RECORDS A SIGNIFICANT PROVISION FOR BAD DEBTS IN THE PERIOD OF SERVICE ON THE BASIS OF PAST EXPERIENCE, WHICH INDICATES THAT MANY PATIENTS ARE UNABLE OR UNWILLING TO PAY THE PORTION OF THEIR BILL FOR WHICH THEY ARE FINANCIALLY RESPONSIBLE. THE PROVISION FOR BAD DEBTS RELATING TO PATIENT SERVICE REVENUE HAS BEEN PRESENTED AT THE ACTUAL AMOUNT OF CHARGES WRITTEN OFF.
PART III, LINE 3:	THE HOSPITAL HAS A DETAILED FINANCIAL ASSISTANCE POLICY WHICH STATES THAT TO PARTICIPATE IN CHARITY CARE CANDIDATES MUST COOPERATE FULLY. IN ADDITION, THE HOSPITAL EDUCATES PATIENTS WILL LIMITED ABILITY TO PAY REGARDING FINANCIAL ASSISTANCE. FOR THIS REASON, THE ORGANIZATION BELIEVES THAT IT ACCURATELY CAPTURES ALL CHARITY CARE DEDUCTIONS PROVIDED ACCORDING TO THE FINANCIAL ASSISTANCE POLICY AND THE AMOUNT OF BAD DEBT EXPENSE ATTRIBUTABLE TO PATIENTS ELIGIBLE UNDER THE ORGANIZATION'S CHARITY CARE POLICY IS NEGLIGIBLE.
PART III, LINE 4:	EXPLANATION OF FINANCIAL STATEMENT FOOTNOTE:SEE THE AUDITED FINANCIAL STATEMENT FOOTNOTE 1 "PATIENT ACCOUNTS RECEIVABLE & CREDIT POLICY" LOCATED ON PAGE 10 OF THE AUDITED FINANCIAL STATEMENTS.
PART III, LINE 9B:	THE BILLING AND COLLECTION POLICY ADDRESSES THE ACTIONS THAT MAY BE TAKEN IN THE EVENT OF NONPAYMENT FOR MEDICAL CARE, ENSURES APPROPRIATE BILLING AND COLLECTION PROCEDURES ARE UNIFORMLY FOLLOWED, AND ENSURES THAT REASONABLE EFFORTS ARE MADE TO DETERMINE WHETHER THE INDIVIDUAL(S) RESPONSIBLE FOR PAYMENT OF ALL OR A PORTION OF A PATIENT ACCOUNT IS ELIGIBLE FOR ASSISTANCE UNDER THE FINANCIAL ASSISTANCE POLICY. FINANCIAL ASSISTANCE STAFF AND MANAGEMENT ARE RESPONSIBILITY FOR ENSURING REASONABLE EFFORTS HAVE BEEN MET ON APPLICABLE ACCOUNTS PRIOR TO INITIATION OF ANY EXTRAORDINARY COLLECTION ACTIONS.
PART VI, LINE 2:	DESCRIPTION OF HOW COMMUNITY HEALTH CARE NEEDS ARE ASSESSED: IN ADDITION TO CONDUCTING THE TRIENNIAL COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA) THE HOSPITAL BOARD OF DIRECTORS AND MANAGEMENT WORK ONGOING THROUGHOUT THE YEAR WITH COMMUNITY LEADERS, VOLUNTEERS, LOCAL COMMUNITY MEMBERS TO KEEP UP TO DATE ON ISSUES WITHIN THE COMMUNITY. THE HOSPITAL PROVIDES MANY EDUCATIONAL OPPORTUNITIES AND SUPPORT ACTIVITIES BEYOND ACUTE MEDICAL AND SURGICAL CARE.
PART VI, LINE 4:	DESCRIPTION OF COMMUNITY DEMOGRAPHICS:CAMERON MEMORIAL COMMUNITY HOSPITAL WAS OPENED IN 1926 AND IS LOCATED IN ANGOLA, INDIANA. ANGOLA IS LOCATED IN STEUBEN COUNTY, APPROXIMATELY 45 MILES NORTH OF FORT WAYNE, INDIANA. SINCE CAMERON HOSPITAL IS LOCATED IN EXTREME NORTHEAST INDIANA, IT SERVES PATIENTS FROM COMMUNITIES IN SOUTHWEST MICHIGAN AND NORTHWEST OHIO AS WELL. CAMERON HOSPITAL IS ONE OF THE LARGEST EMPLOYERS IN STEUBEN COUNTY. THE HEALTH CARE SECTOR IS IMPORTANT TO THE COUNTY'S ECONOMY, AS IT EMPLOYS A LARGE NUMBER OF ITS RESIDENTS, WHO PURCHASE A LARGE AMOUNT OF GOODS AND SERVICES FROM THE BUSINESSES LOCATED IN STEUBEN COUNTY. AS OF THE 2020 CENSUS, THE CITY OF ANGOLA HAD A POPULATION OF 9,340, WHILE THE STEUBEN COUNTY POPULATION WAS 34,435. DURING THE SUMMER MONTHS THE POPULATION IN STEUBEN COUNTY DRASTICALLY INCREASES DUE TO THE NUMEROUS LAKES IN THE COUNTY. THE CHARACTERISTICS OF THE POPULATION ARE FACTORS IN DETERMINING THE HEALTH CARE SERVICES THAT OUR COMMUNITY REQUIRES. THE PERCENTAGE OF THE POPULATION IN THE COMMUNITY OVER 65 YEARS OLD IS 21.0%. IN FISCAL YEAR 2020, CAMERON HOSPITAL HAD 169,800 OUTPATIENT VISITS AND 86% OF OUR PATIENT REVENUE WAS OUTPATIENT. THE FACILITY OPERATES AS AN INDEPENDENT CRITICAL ACCESS HOSPITAL AND RECEIVES COST-BASED REIMBURSEMENT.
PART VI, LINE 5:	DESCRIPTION OF OTHER COMMUNITY HEALTH PROMOTION:THE HOSPITAL IS VERY COMMITTED TO THE COMMUNITY BY SUPPORTING VARIOUS GROUPS AND NOT-FOR-PROFIT ORGANIZATIONS. NUMEROUS HAVE BEEN PROVIDED THROUGHOUT THE YEAR, SUPPORTING THE AREAS OF HEALTH, EDUCATION, AND SAFETY. ADDITIONALLY, HOSPITAL STAFF AND PHYSICIANS DONATE MANY HOURS OF THEIR TIME TO SERVE IN THE FAITH COMMUNITY CLINIC WHICH ASSISTS THE POOR AND UNDERSERVED OF THE COMMUNITY. FINALLY, THE HOSPITAL PARTNERS WITH AREA EMERGENCY PERSONNEL TO ASSIST WITH DISASTER PREPAREDNESS IN OUR COUNTY. THE HOSPITAL FEELS THAT DISASTER PREPAREDNESS IS AN IMPORTANT ROLE FOR IT TO PLAY IN OUR COMMUNITY, ASSISTING RESIDENTS IN THE EVENT OF A NATURAL DISASTER, INDUSTRIAL ACCIDENT, OR OTHER LARGE-SCALE EMERGENCY. THE HOSPITAL OPERATES AN EMERGENCY ROOM OPEN TO ALL PERSONS REGARDLESS OF ABILITY TO PAY. IN ADDITION TO PROVIDING EMERGENCY SERVICES, THE HOSPITAL PROVIDES MINOR EMERGENCY AND URGENT CARE SERVICES TO ALL REGARDLESS OF ABILITY TO PAY. THE HOSPITAL PARTICIPATES IN MEDICAID, MEDICARE, CHAMPUS, AND/OR OTHER GOVERNMENT SPONSORED HEALTH PROGRAMS. IN ADDITION TO OUR PARTICIPATION IN THESE PROGRAMS, THE HOSPITAL ABSORBED MORE THAN $360,080 IN UNREIMBURSED MEDICARE COSTS DURING 2024. IN ADDITION, THE HOSPITAL ALSO ABSORBED $5,180,799 IN UNREIMBURSED MEDICAID COSTS DURING 2024. THE HOSPITAL ALSO PARTICIPATES IN A COMMUNITY CLINIC FOR POOR AND LOW-INCOME RESIDENTS, WHEREIN LAB, RADIOLOGY, AND REHAB COST ARE ENTIRELY WRITTEN OFF. ALTHOUGH THE PRIMARY CARE PHYSICIANS ARE NOT EMPLOYED STAFF OF THE HOSPITAL, A NUMBER OF PHYSICIANS VOLUNTEER THEIR SERVICES AT THE CLINIC. THE HOSPITAL OFFERS A COMPASSIONATE CARE PROGRAM TO ELIGIBLE PARTICIPANTS BASED ON THE FEDERAL POVERTY GUIDELINES AT THE 350% LEVEL. IN 2024, THE HOSPITAL ABSORBED $136,996 IN CHARITY CARE COSTS. CAMERON ALSO PROVIDES SCREENINGS FOR RESIDENTS WHO ARE UNINSURED OR UNDERINSURED INCLUDING: PSA SCREENINGS, SKIN CANCER SCREENINGS, BREAST CANCER SCREENINGS AND BLOOD GLUCOSE TESTING FOR DIABETES OR PRE-DIABETES. THE HOSPITAL HAS AN OPEN MEDICAL STAFF WITH PRIVILEGES AVAILABLE TO ALL QUALIFIED IN THE AREA. THE GOVERNING BODY (BOARD OF DIRECTORS) CONSISTS OF INDEPENDENT PEOPLE REPRESENTATIVE OF THE COMMUNITY WE SERVE. THE HOSPITAL RECEIVES STRONG SUPPORT FROM AREA RESIDENTS AS EVIDENCED BY THE LARGE BODY OF VOLUNTEERS COMMITTED TO FURTHERING THE HOSPITAL'S MISSION.
PART VI, LINE 7, REPORTS FILED WITH STATES	IN

Schedule H (Form 990) 2023

Additional Data

Software ID:
Software Version:

- TIN:

Note: To capture the full content of this document, please select landscape mode (11" x 8.5") when printing.

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," on Form 990, Part IV, line 21 or 22.
lBullet

Attach to Form 990.
lBullet

Go to www.irs.gov/Form990 for the latest information.

OMB No. 1545-0047

2023

Open to Public
Inspection

Name of the organization
CAMERON MEMORIAL COMMUNITY HOSPITAL

Employer identification number
35-0211370

Part I

General Information on Grants and Assistance

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? ........................

Yes No

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 Domestic Organizations and Domestic Governments. Complete if the organization answered "Yes" on Form 990, Part IV, line 21, for any recipient

that received more than $5,000. Part II can be duplicated if additional space is needed.

(a) Name and address of organization or government	(b) EIN	(c) IRC section (if applicable)	(d) Amount of cash grant	(h) Purpose of grant or assistance
(1) STEUBEN COUNTY COMMUNITY FOUNDATION 1701 N WAYNE STREET ANGOLA,IN46703	35-1857065	501(C)(3)	10,000	GENERAL SUPPORT
(2) TRINE UNIVERSITY 1 UNIVERSITY AVE ANGOLA,IN46703	35-0715530	501(C)(3)	15,650	GENERAL SUPPORT
(3) YMCA OF STEUBEN COUNTY 500 E HARCOURT ANGOLA,IN46703	35-1999599	501(C)(3)	8,900	BANNER PROGRAM SUPPORT

Enter total number of section 501(c)(3) and government organizations listed in the line 1 table ................. Bullet Image

Enter total number of other organizations listed in the line 1 table ........................ . Bullet Image

For Paperwork Reduction Act Notice, see the Instructions for Form 990.

Cat. No. 50055P

Schedule I (Form 990) 2023

Page 2

Part III

Grants and Other Assistance to Domestic Individuals. Complete if the organization answered "Yes" on Form 990, Part IV, line 22.
Part III can be duplicated if additional space is needed.

(a) Type of grant or assistance	(b) Number of recipients	(c) Amount of cash grant	(d) Amount of noncash assistance	(e) Method of valuation (book, FMV, appraisal, other)	(f) Description of noncash assistance

(1)
(2)
(3)
(4)
(5)
(6)
(7)

Part IV

Supplemental Information. Provide the information required in Part I, line 2; Part III, column (b); and any other additional information.

Return Reference	Explanation
PART I, LINE 2:	CAMERON MEMORIAL COMMUNITY HOSPITAL, INC. WILL FROM TIME TO TIME SELECT A RECIPIENT FOR DONATION WITH THE APPROVAL OF THE BOARD. THE HOSPITAL DOES NOT SEEK REQUESTS FROM ORGANIZATIONS TO DONATE TO BUT USES EARNINGS FROM INVESTMENTS TO PROVIDE A BENEFIT TO THE COMMUNITY THAT IT SERVES ACCORDING OT THEIR INVESTMENT SPENDING POLICY.

Schedule I (Form 990) 2023

Additional Data

Software ID:
Software Version:

- TIN:

Schedule J
(Form 990)

Department of the Treasury
Internal Revenue Service

Compensation Information

For certain Officers, Directors, Trustees, Key Employees, and Highest
Compensated Employees
medium right arrow graphic

Complete if the organization answered "Yes" on Form 990, Part IV, line 23.
medium right arrow graphic

Attach to Form 990.
medium right arrow graphic

Go to www.irs.gov/Form990 for instructions and the latest information.

OMB No. 1545-0047

2023

Open to Public Inspection

Name of the organization

CAMERON MEMORIAL COMMUNITY HOSPITAL

Employer identification number

35-0211370

Part I

Questions Regarding Compensation

Yes

Check the appropiate box(es) if the organization provided any of the following to or for a person listed on Form
990, Part VII, Section A, line 1a. Complete Part III to provide any relevant information regarding these items.

First-class or charter travel Housing allowance or residence for personal use

Travel for companions Payments for business use of personal residence

Tax idemnification and gross-up payments Health or social club dues or initiation fees

Discretionary spending account Personal services (e.g., maid, chauffeur, chef)

If any of the boxes on Line 1a are checked, did the organization follow a written policy regarding payment or reimbursement or provision of all of the expenses described above? If "No," complete Part III to explain .....

Did the organization require substantiation prior to reimbursing or allowing expenses incurred by all
directors, trustees, officers, including the CEO/Executive Director, regarding the items checked on Line 1a? ....

Indicate which, if any, of the following the filing organization used 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.

Compensation committee Written employment contract

Independent compensation consultant Compensation survey or study

Form 990 of other organizations Approval by the board or compensation committee

During the year, did any person listed on Form 990, Part VII, Section A, line 1a, with respect to the filing organization or a related organization:

Receive a severance payment or change-of-control payment? .............

Participate in, or receive payment from, a supplemental nonqualified retirement plan? .........

Participate in, or receive payment from, an equity-based compensation arrangement? .........

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), 501(c)(4), and 501(c)(29) organizations must complete lines 5-9.

For persons listed on Form 990, Part VII, Section A, line 1a, did the organization pay or accrue any
compensation contingent on the revenues of:

The organization? ....................

Any related organization? .......................

If "Yes," on line 5a or 5b, describe in Part III.

For persons listed on Form 990, Part VII, Section A, line 1a, did the organization pay or accrue any
compensation contingent on the net earnings of:

The organization? ..................

Any related organization? ......................

If "Yes," on line 6a or 6b, describe in Part III.

For persons listed on Form 990, Part VII, Section A, line 1a, did the organization provide any nonfixed
payments not described in lines 5 and 6? If "Yes," describe in Part III ............

Were any amounts reported on 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 ..........................

If "Yes" on line 8, did the organization also follow the rebuttable presumption procedure described in Regulations section 53.4958-6(c)? .........................

For Paperwork Reduction Act Notice, see the Instructions for Form 990.

Cat. No. 50053T

Schedule J (Form 990) 2023

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 on 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 (E) amounts for that individual.

(A) Name and Title		(B) Breakdown of W-2, 1099-MISC compensation, and/or 1099-NEC			(C) Retirement and other deferred compensation	(D) Nontaxable benefits	(E) Total of columns (B)(i)-(D)	(F) Compensation in column (B) reported as deferred on prior Form 990
(A) Name and Title		(i) Base compensation	(ii) Bonus & incentive compensation	(iii) Other reportable compensation	(C) Retirement and other deferred compensation	(D) Nontaxable benefits	(E) Total of columns (B)(i)-(D)
1JOHN VARNER MD PHYSICIAN	(i) (ii)	740,176 ------------- 0	32,403 ------------- 0	1,346 ------------- 0	13,200 ------------- 0	16,145 ------------- 0	803,270 ------------- 0	0 ------------- 0
2TODD RUMSEY MD TREASURER/PHYSICIAN	(i) (ii)	545,222 ------------- 0	16,196 ------------- 0	2,612 ------------- 0	13,200 ------------- 0	11,459 ------------- 0	588,689 ------------- 0	0 ------------- 0
3ANGELA LOGAN CHIEF EXECUTIVE OFFICER	(i) (ii)	352,791 ------------- 0	102,077 ------------- 0	13,055 ------------- 0	13,200 ------------- 0	4,629 ------------- 0	485,752 ------------- 0	0 ------------- 0
4DEAN MATTOX II MD PHYSICIAN	(i) (ii)	390,700 ------------- 0	2,670 ------------- 0	3,861 ------------- 0	13,200 ------------- 0	9,569 ------------- 0	420,000 ------------- 0	0 ------------- 0
5CHARLES MACLEAN PHYSICIAN	(i) (ii)	258,203 ------------- 0	87,403 ------------- 0	2,516 ------------- 0	13,200 ------------- 0	11,045 ------------- 0	372,367 ------------- 0	0 ------------- 0
6MATTHEW SIELOFF PHYSICIAN	(i) (ii)	350,236 ------------- 0	2,670 ------------- 0	486 ------------- 0	0 ------------- 0	10,794 ------------- 0	364,186 ------------- 0	0 ------------- 0
7LYNN FAUR MD BOARD MEMBER/PHYSICIAN	(i) (ii)	285,921 ------------- 0	2,670 ------------- 0	2,516 ------------- 0	11,458 ------------- 0	16,457 ------------- 0	319,022 ------------- 0	0 ------------- 0
8CHRISTOPHER GASAWAY PHYSICIAN	(i) (ii)	242,363 ------------- 0	27,670 ------------- 0	585 ------------- 0	0 ------------- 0	16,457 ------------- 0	287,075 ------------- 0	0 ------------- 0

Schedule J (Form 990) 2023

Page 3

Part III

Supplemental Information

Provide the information, explanation, or descriptions required for Part I, lines 1a, 1b, 3, 4a, 4b, 4c, 5a, 5b, 6a, 6b, 7, and 8, and for Part II. Also complete this part for any additional information.

Return Reference	Explanation

Schedule J (Form 990) 2023

Additional Data

Software ID:
Software Version:

- TIN:

Schedule L
(Form 990)

Department of the Treasury
Internal Revenue Service

Transactions with Interested Persons

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, line 38a or 40b.
Attach to Form 990 or Form 990-EZ.
Go to www.irs.gov/Form990 for instructions and the latest information.

OMB No. 1545-0047

2023

Open to Public Inspection

Name of the organization

CAMERON MEMORIAL COMMUNITY HOSPITAL

Employer identification number

35-0211370

Part I

Excess Benefit Transactions (section 501(c)(3), section 501(c)(4), and section 501(c)(29) 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	(c) Description of transaction	(d) Corrected?
1(a) Name of disqualified person	(c) Description of transaction	Yes	No

Enter the amount of tax incurred by the organization managers or disqualified persons during the year under section 4958. ........................... $

Enter the amount of tax, if any, on line 2, above, reimbursed by the organization ........ $

Part II

Loans to and/or From Interested Persons.
Complete if the organization answered "Yes" on Form 990-EZ, Part V, line 38a, or Form 990, Part IV, line 26; or if the organization reported an amount on Form 990, Part X, line 5, 6, or 22

(a) Name of interested person	(b) Relationship with organization	(c) Purpose of loan	(d) Loan to or from the organization?		(e) Original principal amount	(f) Balance due	(g) In default?		(h) Approved by board or committee?		(i) Written agreement?
(a) Name of interested person	(b) Relationship with organization	(c) Purpose of loan	To	From	(e) Original principal amount	(f) Balance due	Yes	No	Yes	No	Yes	No




Total ............... $

Part III

Grants or Assistance Benefiting 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 assistance	(d) Type of assistance	(e) Purpose of assistance

For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.

Cat. No. 50056A

Schedule L (Form 990) 2023

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?
(a) Name of interested person		(c) Amount of transaction	(d) Description of transaction	Yes	No
(1) TAMMI MCCOY	FAMILY MEMBER OF JOHN MCCOY	91,202	EMPLOYMENT COMPENSATION		No

Part V

Supplemental Information
Provide additional information for responses to questions on Schedule L (see instructions).

Return Reference	Explanation

Schedule L (Form 990) 2023

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE O
(Form 990)

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 990-EZ or to provide any additional information.
Attach to Form 990 or 990-EZ.
Go to www.irs.gov/Form990 for the latest information.

OMB No. 1545-0047

2023

Open to Public
Inspection

Name of the organization

CAMERON MEMORIAL COMMUNITY HOSPITAL

Employer identification number

35-0211370

Return Reference	Explanation
FORM 990, PART VI, SECTION B, LINE 11B	THE PROCESS OF REVIEWING THE FORM 990 INCLUDES A DETAILED REVIEW OF THE FORM AND REQUIRED SCHEDULES BY THE CHIEF EXECUTIVE OFFICER, CHIEF FINANCIAL OFFICER, AND INDEPENDENT ACCOUNTING FIRM. EACH VOTING MEMBER OF THE GOVERNING BODY RECEIVES A COPY OF THE FORM 990 INCLUDING REQUIRED SCHEDULES, AS ULTIMATELY FILED WITH THE IRS, PRIOR TO FILING.
FORM 990, PART VI, SECTION B, LINE 12C	A QUESTIONNAIRE IS SENT OUT ANNUALLY TO ALL OFFICERS, DIRECTORS OR TRUSTEES, AND KEY EMPLOYEES TO DISCLOSE PERSONAL AND BUSINESS RELATIONSHIPS. THE QUESTIONNAIRES ARE REVIEWED ANNUALLY. IF A CONFLICT EXISTS RESTRICTIONS WILL BE IMPOSED ON PERSONS WITH A CONFLICT SUCH AS PROHIBITING THEM FROM PARTICIPATING IN THE GOVERNING BODY'S DELIBERATIONS AND DECISIONS IN THE TRANSACTIONS.
FORM 990, PART VI, SECTION B, LINE 15	THE PROCESS FOR DETERMINING COMPENSATION OF THE CEO, COO, CFO, AND KEY EMPLOYEES INVOLVES REVIEW AND APPROVAL BY THE BOARD INCLUDING REVIEW OF COMPARABLE DATA FROM INDIANA HOSPITAL ASSOCIATION AND COMPDATA. THIS PROCESS IS DOCUMENTED IN THE BOARD MINUTES.
FORM 990, PART VI, SECTION C, LINE 19	CAMERON MEMORIAL COMMUNITY HOSPITAL KEEPS COPIES OF THEIR GOVERNING DOCUMENTS, CONFLICTS OF INTEREST POLICY, AND FINANCIAL STATEMENTS ON SITE AND ARE AVAILABLE UPON REQUEST.
FORM 990, PART IX, LINE 11G	MAINTENANCE SERVICES: PROGRAM SERVICE EXPENSES 1,883,813. MANAGEMENT AND GENERAL EXPENSES 7,015. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,890,828. PHYSICIAN SERVICES: PROGRAM SERVICE EXPENSES 3,287,860. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 3,287,860. MEDICAL AND OTHER SERVICES: PROGRAM SERVICE EXPENSES 5,465,236. MANAGEMENT AND GENERAL EXPENSES 1,461,392. FUNDRAISING EXPENSES 2,946. TOTAL EXPENSES 6,929,574.

For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.

Cat. No. 51056K

Schedule O (Form 990) 2023

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE R
(Form 990)

Department of the Treasury
Internal Revenue Service

Related Organizations and Unrelated Partnerships

Complete if the organization answered "Yes" on Form 990, Part IV, line 33, 34, 35b, 36, or 37.
Attach to Form 990.
Go to www.irs.gov/Form990 for instructions and the latest information.

OMB No. 1545-0047

2023

Open to Public Inspection

Name of the organization

CAMERON MEMORIAL COMMUNITY HOSPITAL

Employer identification number

35-0211370

Part I

Identification of Disregarded Entities. Complete if the organization answered "Yes" on Form 990, Part IV, line 33.

(a) Name, address, and EIN (if applicable) 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 entity?
(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	Yes	No
(1)CAMERON MEDICAL OUTREACH INC 416 E MAUMEE STREET ANGOLA,IN46702 26-1105702	ASSISTED LIVING	IN	501(C)(3)	LINE 10	CAMERON MEMORIAL COMMUNITY HOSPITAL INC	Yes

For Paperwork Reduction Act Notice, see the Instructions for Form 990.

Cat. No. 50135Y

Schedule R (Form 990) 2023

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	(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
(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Direct controlling entity	(f) Share of total income	(g) Share of end-of-year assets	Yes	No	(i) Code V-UBI amount in box 20 of Schedule K-1 (Form 1065)	Yes	No	(k) Percentage ownership

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	(i) Section 512(b)(13) controlled entity?
(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	Yes	No

Schedule R (Form 990) 2023

Page 3

Part V

Transactions With Related Organizations. Complete if the organization answered "Yes" on Form 990, Part IV, line 34, 35b, or 36.

Note. Complete line 1 if any entity is listed in Parts II, III, or IV of this schedule.

Yes

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, or (iv) rent from a controlled entity .....................

b Gift, grant, or capital contribution to related organization(s) ............................

c Gift, grant, or capital contribution from related organization(s) ............................

d Loans or loan guarantees to or for related organization(s) ............................

e Loans or loan guarantees by related organization(s) ............................

f Dividends from related organization(s) ............................

g Sale of assets to related organization(s) ............................

h Purchase of assets from related organization(s) ............................

i Exchange of assets with related organization(s) ............................

j Lease of facilities, equipment, or other assets to related organization(s) .......................

k Lease of facilities, equipment, or other assets from related organization(s) ......................

Yes

l Performance of services or membership or fundraising solicitations for related organization(s) .....................

m Performance of services or membership or fundraising solicitations by related organization(s) .................

n Sharing of facilities, equipment, mailing lists, or other assets with related organization(s) ...................

Yes

o Sharing of paid employees with related organization(s) ............................

Yes

p Reimbursement paid to related organization(s) for expenses ............................

q Reimbursement paid by related organization(s) for expenses ............................

Yes

r Other transfer of cash or property to related organization(s) ............................

s Other transfer of cash or property from related organization(s) ............................

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 related organization	(b) Transaction type (a-s)	(c) Amount involved	(d) Method of determining amount involved
(1) CAMERON MEDICAL OUTREACH INC	K	106,656	FAIR MARKET VALUE
(2) CAMERON MEDICAL OUTREACH INC	Q	2,603,045	FAIR MARKET VALUE

Schedule R (Form 990) 2023

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)	(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
(a) Name, address, and EIN of entity	(b) Primary activity	(c) Legal domicile (state or foreign country)	Yes	No	(f) Share of total income	(g) Share of end-of-year assets	Yes	No	(i) Code V-UBI amount in box 20 of Schedule K-1 (Form 1065)	Yes	No	(k) Percentage ownership

Schedule R (Form 990) 2023

Page 5

Part VII

Supplemental Information

Provide additional information for responses to questions on Schedule R. See instructions.

Return Reference	Explanation

Schedule R (Form 990) 2023

Additional Data

Software ID:
Software Version:

1	Briefly describe the organization’s mission or most significant activities: CMCH IS AN INDEPENDENT, NOT FOR PROFIT, CRITICAL ACCESS HOSPITAL OFFERING HEALTH & WELLNESS SERVICES.
2	Check this box
3	Number of voting members of the governing body (Part VI, line 1a) ........	3	10
4	Number of independent voting members of the governing body (Part VI, line 1b) .....	4	8
5	Total number of individuals employed in calendar year 2023 (Part V, line 2a) ......	5	759
6	Total number of volunteers (estimate if necessary) .............	6	71
7a	Total unrelated business revenue from Part VIII, column (C), line 12 ........	7a	0
b	Net unrelated business taxable income from Form 990-T, Part I, line 11 .........	7b	0

		Prior Year	Current Year
8	Contributions and grants (Part VIII, line 1h) .........	1,196,114	2,709,837
9	Program service revenue (Part VIII, line 2g) .........	105,162,867	114,161,680
10	Investment income (Part VIII, column (A), lines 3, 4, and 7d ) ....	976,776	1,048,129
11	Other revenue (Part VIII, column (A), lines 5, 6d, 8c, 9c, 10c, and 11e)	899,018	983,111
12	Total revenue—add lines 8 through 11 (must equal Part VIII, column (A), line 12)	108,234,775	118,902,757
13	Grants and similar amounts paid (Part IX, column (A), lines 1–3 )...	106,039	123,993
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)	50,774,495	55,594,508
16a	Professional fundraising fees (Part IX, column (A), line 11e) .....	0	48,000
b	Total fundraising expenses (Part IX, column (D), line 25) 451,775
17	Other expenses (Part IX, column (A), lines 11a–11d, 11f–24e)....	54,645,839	57,311,100
18	Total expenses. Add lines 13–17 (must equal Part IX, column (A), line 25)	105,526,373	113,077,601
19	Revenue less expenses. Subtract line 18 from line 12.......	2,708,402	5,825,156
		Beginning of Current Year	End of Year
20	Total assets (Part X, line 16).............	115,765,241	129,916,917
21	Total liabilities (Part X, line 26).............	55,577,010	56,319,695
22	Net assets or fund balances. Subtract line 21 from line 20.....	60,188,231	73,597,222

Sign Here

	Signature of officer	Date

	Type or print name and title


4a	(Code: ) (Expenses $ 88,202,940 including grants of $ 123,993 ) (Revenue $ 114,388,996 )
	CAMERON MEMORIAL COMMUNITY HOSPITAL, INC. (HOSPITAL), A NOT FOR PROFIT ORGANIZATION, IS A GENERAL ACUTE CARE FACILITY IN ANGOLA, INDIANA WITH 25 LICENSED BEDS AND ASSOCIATED ANCILLARY SERVICE DEPARTMENTS INCLUDING OUTPATIENT SERVICES, HOME HEALTH CARE AND AN URGENT CARE CENTER IN ANGOLA, INDIANA. THE HOSPITAL PROVIDES HEALTH CARE SERVICES PRIMARILY IN THE NORTHEAST PORTION OF INDIANA. EXPENSES RELATE TO THE PROVISION OF MEDICAL CARE AND RELATED GENERAL AND ADMINISTRATIVE COSTS.

4b	(Code: ) (Expenses $ including grants of $ ) (Revenue $ )
	SURGERY SERVICE IS A PROGRAM OFFERED TO PATIENTS AT THE HOSPITAL. OVER 4,000 PROCEDURES ARE PERFORMED ANNUALLY, WITH 89% OF THE PROCEDURES BEING OUTPATIENT RELATED.

4c	(Code: ) (Expenses $ including grants of $ ) (Revenue $ )
	OTHER PROGRAMS INCLUDE RADIOLOGY, LAB SERVICES AND EMERGENCY ROOM.RADIOLOGY SERVICE IS OFFERED TO PATIENTS AT THE HOSPITAL. ANNUALLY THE HOSPITAL PERFORMS OVER 46,700 PROCEDURES, INCLUDING GENERAL RADIOLOGY SERVICES, CT SCANS, PET SCANS AND AN OPEN BORE MRI. LAB SERVICES IS THE FOURTH LARGEST PROGRAM OFFERED TO PATIENTS AT THE HOSPITAL. OVER 242,400 ARE DONE WITH 89% BEING OUTPATIENT RELATED. EMERGENCY ROOM SERVICES IS THE THIRD LARGEST PROGRAM OFFERED TO PATIENTS AT CMCH. OVER 16,900 PATIENTS CAME THROUGH CAMERON'S EMERGENCY ROOM.

4d	Other program services (Describe in Schedule O.)
	(Expenses $ including grants of $ ) (Revenue $ )
4e	Total program service expenses88,202,940

1b	Sub-Total..............
c	Total from continuation sheets to Part VII, Section A..
d	Total (add lines 1b and 1c).........	3,466,348	0	174,013

1a	Federated campaigns..		1a
b	Membership dues..		1b
c	Fundraising events..		1c	8,448
d	Related organizations		1d
e	Government grants (contributions)		1e	2,079,563

f	All other contributions, gifts, grants, and similar amounts not included above		1f	621,826

g	Noncash contributions included in lines 1a - 1f:$		1g

h Total. Add lines 1a-1f.......		2,709,837

		Business Code
2a	NET PATIENT SERVICE REVENUE	621400	111,930,192	111,930,192
b	340B PHARMACY REVENUE	623990	1,877,272	1,877,272
c	RELATED PARTY MANAGEMENT FEE	541610	337,001	337,001
d	MEALS ON WHEELS	624200	17,215	17,215
e
f	All other program service revenue.
g	Total. Add lines 2a–2f .....		114,161,680

3 Investment income (including dividends, interest, and othersimilar amounts) ......			1,069,201			1,069,201
4 Income from investment of tax-exempt bond proceeds
5 Royalties...........
			(i) Real	(ii) Personal
6a	Gross rents	6a	229,439
b	Less: rental expenses	6b	0
c	Rental income or (loss)	6c	229,439
d	Net rental income or (loss).......			229,439			229,439
			(i) Securities	(ii) Other
7a	Gross amount from sales of assets other than inventory	7a		18,000
b	Less: cost or other basis and sales expenses	7b	10,145	28,927
c	Gain or (loss)	7c	-10,145	-10,927
d	Net gain or (loss).........			-21,072			-21,072
8a	Gross income from fundraising events (not including $ 8,448of contributions reported on line 1c). See Part IV, line 18 ....
			8a	44,088
b	Less: direct expenses ...		8b	21,799
c	Net income or (loss) from fundraising events..			22,289			22,289
9a	Gross income from gaming activities. See Part IV, line 19 ...
			9a
b	Less: direct expenses ...		9b
c	Net income or (loss) from gaming activities..
10a	Gross sales of inventory, less returns and allowances ..
			10a
b	Less: cost of goods sold ..		10b
c	Net income or (loss) from sales of inventory..

Business Code
11a	CAFETERIA REVENUE		722514	322,921			322,921
b	PHARMACY REVENUE		900099	11,467			11,467
c	VENDING		900099	3,909			3,909
d	All other revenue ....			393,086	227,316		165,770
e	Total. Add lines 11a–11d ......			731,383
12	Total revenue. See instructions.....			118,902,757	114,388,996	0	1,803,924

1	Grants and other assistance to domestic organizations and domestic governments. See Part IV, line 21 ....	123,993	123,993
2	Grants and other assistance to domestic individuals. See Part IV, line 22 ...........
3	Grants and other assistance to foreign organizations, foreign governments, and foreign individuals. See Part IV, lines 15 and 16. .............
4	Benefits paid to or for members .......
5	Compensation of current officers, directors, trustees, and key employees ...........	3,736,319	2,840,198	881,767	14,354
6	Compensation not included above, to disqualified persons (as defined under section 4958(f)(1)) and persons described in section 4958(c)(3)(B) .........
7	Other salaries and wages........	38,513,508	29,276,402	9,089,146	147,960
8	Pension plan accruals and contributions (include section 401(k) and 403(b) employer contributions) ....	1,116,961	813,647	298,094	5,220
9	Other employee benefits .......	9,273,943	6,772,534	2,458,512	42,897
10	Payroll taxes ...........	2,953,777	2,159,197	780,973	13,607
11	Fees for services (non-employees):
a	Management ......
b	Legal .........	139,449	1,065	138,384
c	Accounting ...........	178,631		178,631
d	Lobbying ...........	1,984		1,984
e	Professional fundraising services. See Part IV, line 17	48,000			48,000
f	Investment management fees ......
g	Other (If line 11g amount exceeds 10% of line 25, column (A) amount, list line 11g expenses on Schedule O)	12,108,262	10,636,909	1,468,407	2,946
12	Advertising and promotion ....	614,173		613,423	750
13	Office expenses .......	1,349,797	747,336	591,022	11,439
14	Information technology ......	2,847,518	467,653	2,371,546	8,319
15	Royalties ..
16	Occupancy ...........	2,320,516	2,320,516
17	Travel ............	108,353	44,071	64,211	71
18	Payments of travel or entertainment expenses for any federal, state, or local public officials .
19	Conferences, conventions, and meetings ....	157,402	84,526	71,673	1,203
20	Interest ...........	1,370,230	1,243,510	124,963	1,757
21	Payments to affiliates .......
22	Depreciation, depletion, and amortization ..	4,625,781	4,189,092	430,498	6,191
23	Insurance ...	733,618	201,431	532,187
24	Other expenses. Itemize expenses not covered above (List miscellaneous expenses in line 24e. If line 24e amount exceeds 10% of line 25, column (A) amount, list line 24e expenses on Schedule O.)
a	MEDICAL SUPPLIES	16,478,246	16,471,449	6,115	682
b	BAD DEBT EXPENSE	6,325,815	6,325,815
c	HAF EXPENSE	3,760,790		3,760,790
d	MINOR EQUIPMENT	1,559,433	1,248,811	310,580	42
e	All other expenses	2,631,102	2,234,785	249,980	146,337
25	Total functional expenses. Add lines 1 through 24e	113,077,601	88,202,940	24,422,886	451,775
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 if following SOP 98-2 (ASC 958-720).

1	Cash–non-interest-bearing ........			130,998	1	164,769
2	Savings and temporary cash investments .........			19,668,145	2	16,012,258
3	Pledges and grants receivable, net ......				3
4	Accounts receivable, net .............			11,519,464	4	12,485,328
5	Loans and other receivables from any current or former officer, director, trustee, key employee, creator or founder, substantial contributor, or 35% controlled entity or family member of any of these persons .......
					5
6	Loans and other receivables from other disqualified persons (as defined under section 4958(f)(1)), and persons described in section 4958(c)(3)(B) ...
					6
7	Notes and loans receivable, net ...........			562,014	7	1,852,247
8	Inventories for sale or use ............			1,476,430	8	1,822,148
9	Prepaid expenses and deferred charges ......			1,474,959	9	1,748,092
10a	Land, buildings, and equipment: cost or other basis. Complete Part VI of Schedule D	10a	98,265,707
b	Less: accumulated depreciation	10b	55,083,704	33,358,463	10c	43,182,003
11	Investments—publicly traded securities .			27,204,218	11	33,663,448
12	Investments—other securities. See Part IV, line 11 .....			3,329,020	12	3,329,020
13	Investments—program-related. See Part IV, line 11 ..				13
14	Intangible assets ...............			804,596	14	731,043
15	Other assets. See Part IV, line 11 ...........			16,236,934	15	14,926,561
16	Total assets. Add lines 1 through 15 (must equal line 33)...			115,765,241	16	129,916,917

17	Accounts payable and accrued expenses .....	9,325,025	17	13,987,517
18	Grants payable ...		18
19	Deferred revenue .........	6,018	19	6,018
20	Tax-exempt bond liabilities .........		20
21	Escrow or custodial account liability. Complete Part IV of Schedule D		21
22	Loans and other payables to any current or former officer, director, trustee, key employee, creator or founder, substantial contributor, or 35% controlled entity or family member of any of these persons .........
			22
23	Secured mortgages and notes payable to unrelated third parties ..	45,817,870	23	41,927,609
24	Unsecured notes and loans payable to unrelated third parties ..		24
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	428,097	25	398,551
26	Total liabilities. Add lines 17 through 25..	55,577,010	26	56,319,695

	Organizations that follow FASB ASC 958, check here and complete lines 27, 28, 32, and 33.
27	Net assets without donor restrictions ..........	59,439,831	27	72,125,880
28	Net assets with donor restrictions ...........	748,400	28	1,471,342
	Organizations that do not follow FASB ASC 958, check here and complete lines 29 through 33.
29	Capital stock or trust principal, or current funds .....		29
30	Paid-in or capital surplus, or land, building or equipment fund ...		30
31	Retained earnings, endowment, accumulated income, or other funds		31
32	Total net assets or fund balances ...........	60,188,231	32	73,597,222
33	Total liabilities and net assets/fund balances ........	115,765,241	33	129,916,917