2018-05-14T10:57:00-05:00 2017-06-30 420714325 RSM US LLP 1 S WACKER DRIVE STE 800 CHICAGO IL 60606 990 2016-07-01 440545289 HEARTLAND REGIONAL MEDICAL CENTER HEAR 8162717070 5325 FARAON STREET ST JOSEPH MO 64506 DWAIN STILSON OFFICER 8162717070 2018-05-11 1 WAYNE HARDER P00294296 3126343400 108.171.131.187 2018-05-11 11:08:13 CD P 4B8E1423B9F197D509CCF13AB357181C17C415CB 4EC0B96C62AE7F3F798FFAAE8A06701F68EED858 2016 2021-01-29 14:40:06Z MOSAIC LIFE CARE DWAIN STILSON 5325 FARAON STREET ST JOSEPH MO 64506 887829506 0 X WWW.MYMOSAICLIFECARE.ORG X 1985 MO SEE SCHEDULE O TO IMPROVE POPULATION HEALTH OUTCOMES IN OUR REGION BY PROVIDING THE RIGHT CARE, AT THE RIGHT TIME, PLACE AND COST. 13 9 4627 459 1575463 0 645354 580266 564223618 632544479 50235912 24962821 23848502 22569155 638953386 680656721 2785232 2954095 0 0 321468642 343111274 0 0 153058 274368439 303790632 598622313 649856001 40331073 30800720 859768385 900919281 359153351 373385281 500615034 527534000 X TO IMPROVE POPULATION HEALTH OUTCOMES IN OUR REGION BY PROVIDING THE RIGHT CARE, AT THE RIGHT TIME, PLACE AND COST. 0 1 590094205 2954095 652821802 SEE SCHEDULE O 590094205 1 1 0 1 0 0 0 0 0 0 1 0 0 0 1 0 0 1 0 0 0 0 0 0 0 0 1 1 1 0 1 1 0 0 0 0 0 0 0 0 1 0 0 0 0 0 1 1 1 1 0 0 1 272 0 1 4627 1 1 1 0 0 0 0 0 0 0 0 0 X 13 9 1 0 0 0 1 0 1 1 1 0 0 1 1 1 1 1 1 1 1 1 1 CA MO NC X DWAIN STILSON 8162717070 5325 FARAON STREET ST JOSEPH MO 64506 DAN HECKMAN DIRECTOR 1.00 1.00 X 2500 0 0 DR JOHN OLSON DIRECTOR/PHYSICIAN(UNTIL 12/2016) 1.00 39.00 X 696848 0 35272 STEVE SCHRAM DIRECTOR/CHAIR(UNTIL 12/2016) 1.00 1.00 X X 2500 0 0 BARBARA WURTZLER DIRECTOR/CHAIR/VICE CHAIR 1.00 1.00 X X 2500 0 0 DR MARK LANEY DIRECTOR/PRESIDENT/CEO 34.00 3.00 X X 1075453 0 28769 DR DENNIS DOBYAN DIRECTOR 1.00 1.00 X 2500 74416 0 ADAM STEIN DIRECTOR 1.00 1.00 X 2500 0 0 BRAD MCANALLY DIRECTOR(UNTIL 12/2016) 1.00 1.00 X 2500 0 0 SERENA NAYLOR DIRECTOR 1.00 3.00 X 2500 18000 0 DR CHRIS LOONEY DIRECTOR/VICE CHAIR 1.00 1.00 X 60640 0 0 BRENDA SHARPE DIRECTOR 1.00 1.00 X 2500 0 0 BRIAN BRADLEY DIRECTOR 1.00 1.00 X 2500 0 0 OPHELIA LAVELL RUCKER DIRECTOR 1.00 1.00 X 2500 0 0 MICHAEL LANE DIRECTOR (AS OF 01/2017) 1.00 1.00 X 0 0 0 DR LUCINDA HAYDEN DIRECTOR (AS OF 01/2017) 1.00 39.00 X 505292 0 26126 STET SCHANZE DIRECTOR (AS OF 01/2017) 1.00 1.00 X 0 0 0 CURT KRETZINGER COO (UNTIL 01/2017) 33.00 7.00 X 739075 0 81923 MICHAEL PULIDO CHIEF OPERATING OFFICER/SECRETARY 34.00 6.00 X 481420 0 107602 JOHN WILSON SECRETARY/TREASURER(UNTIL 01/2017) 33.00 7.00 X 600461 0 13667 DWAIN STILSON CFO/TREASURER 33.00 7.00 X 359407 0 74958 KAREN DITTEMORE ASSISTANT SECRETARY 39.00 2.00 X 68170 0 12958 JODIE ROETTGER ASSISTANT TREASURER 39.00 2.00 X 182214 0 23389 DR DAVIN TURNER PRESIDENT 40.00 0.00 X 426186 0 80381 BRADY D DUBOIS PRESIDENT 40.00 0.00 X 356190 0 81942 CAROLYN S PADEN ADMINISTRATOR 40.00 0.00 X 222926 0 17219 BRENNAN LEHMAN CHIEF INFORMATION OFFICER 40.00 0.00 X 312648 0 62293 DR RONY M ABOU-JAWDE STAFF PHYSICIAN 40.00 0.00 X 995534 0 34873 DR MOHAN R HINDUPUR STAFF PHYSICIAN 40.00 0.00 X 1046888 0 28719 DR ROBERT GRANT STAFF PHYSICIAN 40.00 0.00 X 950349 0 37373 DR ARVIND K SHARMA STAFF PHYSICIAN 40.00 0.00 X 960436 0 34542 DR RAJAGOPAL RANGINENI STAFF PHYSICIAN 40.00 0.00 X 958567 0 28819 11023704 92416 810825 412 0 1 0 QUEST DIAGNOSTICS PO BOX 14730 ST LOUIS MO 63150 MEDICAL SERVICES 1636978 POLSINELLI SHUGHART PC 3103 FREDERICK AVENUE ST JOSEPH MO 64506 ATTORNEY SERVICES 1344784 CAPITAL PERFORMANCE MANAGEMENT 11709 ROE AVENUE SUITE D236 LEAWOOD KS 66211 CONSTRUCTION MANAGEMENT 937302 BKD LLP 1201 WALNUT STREET SUITE 1700 KANSAS CITY MO 64106 FINANCIAL SERVICES 679045 KEMBERTON HEALTHCARE SERV LLC 501 CORPORATE CENTRE DRIVE SUITE 6 FRANKLIN TN 37067 HEALTHCARE SERVICES 651794 34 580266 580266 NET PATIENT SERVICE REVENUE 621110 601465862 601465862 340B PHARMACY REVENUE 621110 30802835 30802835 MEANINGFUL USE PAYMENTS 621110 275782 275782 632544479 10946821 10946821 818722 0 818722 818722 102353 716369 220946000 206930000 14016000 14016000 14016000 127660 242785 -115125 -115125 REFERRAL LAB 111000 7089535 7023670 65865 CAFETERIA 722514 2347238 2347238 COPYING REVENUE 541380 567642 567642 11861143 10338773 1522370 21865558 680656721 652821802 1575463 25679190 2954095 2954095 6297849 2448383 3849466 636947 636947 267363097 253241130 14059617 62350 8208534 7829073 377054 2407 43905124 37299941 6587989 17194 16699723 15291938 1403426 4359 2761264 2761264 317406 317406 102750 102750 43437521 35963061 7471952 2508 3068554 168897 2899657 24899357 20638172 4249547 11638 3003131 2670619 309051 23461 13877597 12315972 1561625 924783 852789 71856 138 2174343 1734875 430711 8757 6445932 29957 6415975 27897956 23053739 4825038 19179 10608703 9883319 725384 MEDICAL SUPPLIES 92379193 92379193 PROVISION FOR UNCOLLECT 43681877 43681877 FRA TAX 25824000 25824000 DUES & SUBSCRIPTIONS 2386265 1196228 1188970 1067 649856001 590094205 59608738 153058 26904573 24279275 72432584 74402014 7757338 8120167 7577204 19780020 601678289 394564944 237121763 207113345 476258585 527244126 7478444 8180362 7306483 16057532 32673851 859768385 900919281 130076130 155383775 215724479 209693134 2483921 2130598 10868821 6177774 359153351 373385281 X 500223735 526938349 391299 595651 500615034 527534000 859768385 900919281 X 30800720 34281148 -38162902 X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 1 34120 0 0 1 102750 136870 0 SCHEDULE C, PART II-B, LINE 1F PORTION OF DUES PAID TO HOSPITAL ASSOCIATIONS THAT ARE USED FOR LOBBYING PURPOSES BY THE HOSPITAL ASSOCIATIONS. SCHEDULE C, PART II-B, LINE 1I CONTRACTED WITH VARIOUS PARTIES FOR LEGISLATIVE LOBBYING IN SUPPORT OF HOSPITAL REIMBURSEMENT AND COMMUNITY SUPPORT. 23444059 23444059 297016559 157275415 139741144 22685257 14138702 8546555 197109028 164478191 32630837 61423386 58672636 2750750 207113345 DERIVATIVE INSTRUMENTS 6117774 MINORITY INTEREST 60000 6177774 X PART X, LINE 2: THE MEDICAL CENTER IS A NONPROFIT CORPORATION DESCRIBED IN SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE AND IS EXEMPT FROM FEDERAL INCOME TAXES ON RELATED INCOME PRUSUANT TO SECTION 501(A) OF THE INTERNAL REVENUE CODE. HOWEVER, THE MEDICAL CENTER IS SUBJECT TO FEDERAL INCOME TAX ON ANY UNRELATED BUSINESS TAXABLE INCOME. WITH A FEW EXCEPTIONS, THE MEDICAL CENTER IS NO LONGER SUBJECT TO U.S. FEDERAL, STATE, AND LOCAL INCOME TAX EXAMINATIONS BY TAXING AUTHORITIES BEFORE 2013. TAX POSITIONS ARE NOT OFFSET OR AGGREGATED WITH OTHER POSITIONS. TAX POSITIONS THAT MEET THE "MORE LIKELY THAN NOT RECOGNITION THRESHOLD ARE MEASURED AS THE LARGEST AMOUNT OF TAX BENEFIT THAT IS MORE THAN 50 PERCENT LIKELY TO BE REALIZED ON SETTLEMENT WITH THE APPLICABLE TAXING AUTHORITY. THE PORTION OF THE BENEFITS ASSOCIATED WITH TAX POSITIONS TAKEN THAT EXCEEDS THE AMOUNT MEASURED AS DESCRIBED ABOVE IS REFLECTED AS A LIABLITY FOR UNCERTAIN TAX BENEFITS IN THE ACCOMPANYING BALANCE SHEET ALONG WITH ANY ASSOCIATED INTEREST AND PENALTIES THAT WOULD BE PAYABLE TO THE TAXING AUTHORITIES UPON EXAMINATION. AS OF JUNE 30, 2017 AND 2016, THERE WERE NO UNCERTAIN TAX POSITIONS IDENTIFIED AND RECORDED AS A LIABILITY. 1 1 X 1 X 300.000000000000 0 1 1 1 0 1 1 22411362 22411362 0.03450 98205168 74369697 23835471 0.03670 120616530 74369697 46246833 0.07120 4049149 297412 3751737 0.00580 390057 52218 337839 0.00050 2025603 2025603 0.00310 6464809 349630 6115179 0.00940 127081339 74719327 52362012 0.08060 112118 112118 0.00020 111000 111000 0.00020 260473 13080 247393 0.00040 483591 13080 470511 0.00080 0 18636327 10378653 137476771 180008062 -42531291 X 1 1 1 1 HEARTLAND REGIONAL MEDICAL CENTER 5325 FARAON ST ST JOSEPH MO 64506 WWW.MYMOSAICLIFECARE.ORG 426-19 X X X PHARMICIST INTERN PROGRAM HEARTLAND REGIONAL MEDICAL CENTER 1 0 0 1 X X X X X X X X X X 15 1 1 0 1 X SEE PART V, SECTION C X 1 15 1 SEE PART V, SECTION C 0 1 X 300.000000000000 X 1 1 X X X X 1 X SEE PART V, SECTION C X SEE PART V, SECTION C X SEE PART V, SEC C X X X X X 1 X 0 X X X X X 1 X 0 0 HEARTLAND REGIONAL MEDICAL CENTER PART V, SECTION B, LINE 3J: COMMUNITY PARTNERS INCLUDING THE ST JOSEPH SCHOOL DISTRICT AND MISSOURI WESTERN STATE UNIVERSITY. HEARTLAND REGIONAL MEDICAL CENTER PART V, SECTION B, LINE 5: TO ENSURE INPUT WAS TAKEN INTO ACCOUNT FROM PERSONS WHO REPRESENT THE COMMUNITY, THE MEDICAL CENTER UTILITIZED AN INDEPENDENT CONSULTING FIRM NAMED LAN RESOURCES, LLC. THIS FIRM CONDUCTED A TELEPHONE SURVEY AND SIX FOCUS GROUPS TO DETERMINE HEALTH PRIORITIES BASED ON THE OPINIONS OF COMMUNITY MEMBERS. THE TELEPHONE SURVEY INVOLVED 381 RESIDENTS FROM THE MEDICAL SYSTEM'S SERVICE AREA AND WAS DESIGNED TO OBTAIN FEEDBACK AT A 95% CONFIDENCE INTERVAL. THE SAMPLE INCLUDED MEN AND WOMEN FROM 18 TO OVER 65 WITH HOUSEHOLD INCOMES RANGING FROM LESS THAN $10K TO OVER $75K. TO COMPLETE THE QUALITATIVE ASPECT OF DATA GATHERING ASSOCIATED WITH COMMUNITY HEALTH NEEDS, SIX FOCUS GROUPS WERE CONVENED THAT INCLUDED COMMUNITY REPRESENTATIVES WITH BROAD INTERESTS AND THOSE WITH SPECIAL KNOWLEDGE OF THE SUBJECT. THE ORGANIZATION RECRUITED INTERNAL PARTICIPANTS, WHILE THE CONSULTING FIRM RECRUITED ALL EXTERNAL PARTICIPANTS AND MODERATED EACH FOCUS GROUP. THE SIX FOCUS GROUPS CONSISTED OF PHYSICIANS, COMMUNITY MEMBERS AT-LARGE, CLINICAL STAFF (NURSES, CARE MANAGERS AND SOCIAL WORKERS), AND COMMUNITY LEADERS. TWO OF THE FOCUS GROUPS WERE COMPRISED SOLELY OF COMMUNITY MEMBERS AT-LARGE. HEARTLAND REGIONAL MEDICAL CENTER PART V, SECTION B, LINE 6A: HEARTLAND LONG TERM ACUTE CARE HOSPITAL.PART V, SECTION B, LINE 7A:HTTPS://WWW.MYMOSAICLIFECARE.ORG/GENERAL/COMMUNITY-HEALTH-NEEDS-ASSESSMENTPART V, SECTION B, LINE 10:HTTPS://WWW.MYMOSAICLIFECARE.ORG/GENERAL/COMMUNITY-HEALTH-NEEDS-ASSESSMENT HEARTLAND REGIONAL MEDICAL CENTER PART V, SECTION B, LINE 11: THE COMMUNITY HEALTH NEEDS ASSESSMENT WAS CONDUCTED AND AN IMPLEMENTATION PLAN FOR ADDRESSING THE IDENTIFIED NEEDS WAS ADOPTED IN THE 2015 TAX YEAR. THE TOP THREE SIGNIFICANT NEEDS IDENTIFIED WERE: 1) ACCESS TO AFFORDABLE HEALTH CARE AND MEDICATION; 2) ADULT AND CHILDHOOD OBESITY; AND 3) MENTAL HEALTH SERVICES. THE MEDICAL CENTER'S ROLE IS MUCH MORE THAN BEING A HOSPITAL. IT IS A FULLY ENGAGED COMMUNITY PARTNER STRIVING TO ADDRESS THE UNIQUE HEALTH AND SOCIAL ISSUES THAT CHALLENGE THE REGION. MANAGEMENT RECOGNIZES THAT THE COMMUNITY'S MAJOR HEALTH PROBLEMS STEM, IN LARGE PART, FROM SOCIAL DETERMINANTS OF HEALTH. SOCIAL DETERMINANTS THAT AFFECT ACCESS TO HEALTH CARE (HEALTHY PEOPLE 2020 FRAMEWORK)INCLUDE: ECONOMIC STABILITY, POVERTY, EMPLOYMENT, FOOD SECURITY, HOUSING STABILITY, EDUCATION, HIGH SCHOOL GRADUATION, ENROLLMENT IN HIGHER EDUCATION, LANGUAGE AND LITERACY, EARLY CHILDHOOD, NEIGHBORHOOD AND BUILT ENVIRONMENT, ACCESS TO HEALTHY FOOD, QUALITY OF HOUSING, CRIME AND VIOLENCE, ENVIRONMENTAL CONDITIONS, CIVIC PARTICIPATION, PERCEPTIONS OF DISCRIMINATION/EQUITY, AND INCARCERATION/INSTITUTIONALIZATION.TO POSITIVELY IMPACT THE SOCIAL DETERMINANTS OF HEALTH, THE MEDICAL CENTER INTRODUCED THE COMMUNITY CONNECT PROGRAM FOR POPULATION HEALTH. COMMUNITY CONNECT IS A REQUEST FOR PROPOSAL (RFP) PROCESS IN WHICH NONPROFIT COMMUNITY ORGANIZATIONS MAY APPLY FOR FUNDING TO IMPLEMENT INNOVATIVE PROGRAMS THAT ADDRESS ONE OR MORE OF THE THREE PRIMARY HEALTH NEEDS AS DETERMINED BY THE COMMUNITY HEALTH NEEDS ASSESSMENT. COMMUNITY CONNECT IS AN IMPORTANT PART OF THE FY2016 FY2019 CHNA ACTION PLAN.TO FULLY MEET THE NEEDS IDENTIFIED BY THE COMMUNITY HEALTH NEEDS ASSESSMENT, THE MEDICAL CENTER IMPLEMENTED A THREE-YEAR ACTION PLAN COMPRISED OF THE FOLLOWING COMPONENTS. SIGNIFICANT NEED #1: ACCESS TO AFFORDABLE HEALTH CARE AND MEDICATION PLAN: A) SUPPORT COMMUNITY CONNECT PROGRAMS THAT ADDRESS ACCESS TO CARE B) PROVIDE A CLINIC WITH ENHANCED SERVICES FOR OUR MOST VULNERABLE POPULATIONS.SIGNIFICANT NEED #2: ADULT AND CHILDHOOD OBESITY PLAN: A) CONTINUE AND EXPAND CURRENT HEALTH IMPROVEMENT PROGRAMS SUCH AS POUND PLUNGE,1-2-3-4-5 FIT-TASTIC BASED ON SUCCESFUL MODEL LED BY CHILDREN'S MERCY HOSPITAL, 4TH GRADE CHALLENGE, ETC. B) SUPPORT COMMUNITY CONNECT PROGRAMS THAT ADDRESS OBESITY PREVENTIONSIGNIFICANT NEED #3: MENTAL HEALTH SERVICES PLAN: A) SUPPORT COMMUNITY CONNECT PROGRAMS THAT ADDRESS MENTAL HEALTH NEEDS. B) CONTINUE TO PROVIDE FINANCIAL SUPPORT TO ORGANIZATIONS PROVIDING MENTAL HEALTH SUPPORT TO THE COMMUNITY SUCH AS THE CENTER, HEALTH GROUP AND HILLCREST TRANSITIONAL HOUSING AND BIG BROTHERS BIG SISTERS WHICH PROVIDES COUNSELING SERVICES TO CHILDREN.DURING FY17, THE COMMUNITY CONNECT ALLOCATIONS COMMITTEE AWARDED FUNDING OF $1.2 MILLION TO 10 NON-PROFIT COMMUNITY ORGANIZATIONS WHICH ADDRESSES ONE OR MORE OF THE PRIMARY HEALTH NEEDS FROM THE MOST RECENTLY COMPLETED COMMUNITY HEALTH NEEDS ASSESSMENT.THE COMPLETE CHNA WITH IMPLEMENTATION STRATEGY CAN BE FOUND AT: HTTPS://WWW.MYMOSAICLIFECARE.ORG/GENERAL/COMMUNITY-HEALTH-NEEDS-ASSESSMENT/ST-JOSEPH-CHNA/PART V, SECTION B, LINE 16A, FAP WEBSITE:HTTPS://WWW.MYMOSAICLIFECARE.ORG/GLOBALASSETS/FAP-05222017-REDUCED-SIZE.PDFPART V, LINE 16B, FAP APPLICATION WEBSITE:HTTPS://WWW.MYMOSAICLIFECARE.ORG/GLOBALASSETS/FINANCIAL-ASSISTANCE-APPLICATION-WITH-1557-REDUCED-SIZE.PDFPART V, LINE 16C, FAP PLAIN LANGUAGE SUMMARY WEBSITE:HTTPS://WWW.MYMOSAICLIFECARE.ORG/MAIN/LOCATION/ST-JOSEPH-MO/MOSAIC-LIFE-CARE-AT-ST.-JOSEPH/MEDICAL-CENTER/HRMC-FINANCIAL-AND-INSURANCE-INFORMATION/FINANCIAL-ASSISTANCE-GUIDELINES/ HEARTLAND REGIONAL MEDICAL CENTER PART V, SECTION B, LINE 20E: FINANCIAL COUNSELORS ARE AVAILABLE ONSITE TO EXPLAIN AND HELP PATIENTS AND RESPONSIBLE PARTIES WITH THE FINANCIAL ASSISTANCE POLICY. 43 1 - CAMERON MOSAIC LIFE CARE 215 SOUTH WALNUT STREET SUITE A CAMERON MO 64429 FAMILY CARE 2 - MOSAIC LIFE CARE CLINICS 902 N RIVERSIDE SAINT JOSEPH MO 64507 MEDICAL ONCOL, RADIATION ONCOL,PEDIATRICS 3 - MOSAIC LIFE CARE CLINICS 705 N COLLEGE ALBANY MO 64402 CARDIOVASC, GEN SURG, NEUROL, PODIATRY, VASC SURG, WOMENS HEALTH 4 - MOSAIC LIFE CARE CLINICS 2600 MILLER ST BETHANY MO 64424 CARDIOLOGY, NEUROL, RHEUMATOLOGY 5 - MOSAIC LIFE CARE CLINICS 901 HEARTLAND ROAD SAINT JOSEPH MO 64506 INFECT DISEASE, DIABETES, ENDO, INTRNL MED, CAREGIVER, SLEEP DISORDER, WOMEN 6 - MOSAIC LIFE CARE CLINICS 5301 FARAON SUITES 160 200 210 210B SAINT JOSEPH MO 64506 ENT, OCCUPA MED, PULM & CRIT CARE 7 - EXCELSIOR SPRINGS MOSAIC LIFE CARE 2370 VINTAGE COURT EXCELSIOR SPRINGS MO 64024 FAMILY CARE 8 - MOSAIC LIFE CARE CLINICS 711 N 36TH STREET SUITE 100 LOWER LVL SAINT JOSEPH MO 64506 FAMILY CARE, HOME HEALTH, HOSPICE, CARE AT HOME 9 - MOSAIC LIFE CARE CLINICS 5210 NORTH BELT HIGHWAY ENTRANCES B C SAINT JOSEPH MO 64506 FAMILY CARE, WOMENS HEALTH 10 - MOSAIC LIFE CARE CLINICS 2701 RUNNING HORSE ROAD PLATTE CITY MO 64079 FAMILY CARE, OUTPT THER, SPORTS MEDICINE 11 - MOSAIC LIFE CARE CLINICS 9784 N ASH AVENUE KANSAS CITY MO 64157 FAMILY CARE, GASTRO 12 - INTERNAL MEDICINE BECK RD ST JOSEPH MOSA 3715 BECK ROAD BUILDING F SAINT JOSEPH MO 64506 INTERNAL MEDICINE 13 - MOSAIC LIFE CARE CLINICS 5514 CORPORATE DRIVE SUITE 120 150 SAINT JOSEPH MO 64507 CARDIOVASC, INTERNAL MEDICINE 14 - MOSAIC LIFE CARE CLINICS 105 FAR WEST DRIVE SUITE 100 201 202 SAINT JOSEPH MO 64506 INTRNL MED, PEDIATRICS, FAMILY CARE, NEUROL, OUTPT BEHAV HEALTH 15 - KEARNEY MOSAIC LIFE CARE 425 WEST MOSAIC LIFE CARE WAY KEARNEY MO 64060 FAMILY CARE 16 - MOSAIC LIFE CARE CLINICS 802 NORTH RIVERSIDE SAINT JOSEPH MO 64506 BARIATRIC, BREAST, CARDIOTHORACIC SURG, GEN SURG, PHYS MED & REHAB, PAIN MGM 17 - MEDICAL ONCOLOGY MOSAIC LIFE CARE 1610 E EVERGREEN SUITE B CAMERON MO 64429 MEDICAL ONCOLOGY 18 - MOSAIC LIFE CARE CLINICS 2016 S MAIN MARYVILLE MO 64468 MEDICAL ONCOLOGY, NEUROSURG 19 - MOSAIC LIFE CARE BURLINGTON CREEK CLINIC 6301 N LUCERNE KANSAS CITY MO 64151 PHYS MED & REHA, IMAGING, OCCUP MED, ORTHO, SPECIALTY CLINICS 20 - MOSAIC LIFE CARE SHOAL CREEK CLINIC 8880 NE 82ND TERRACE KANSAS CITY MO 64158 PHYS MED & REHAB, FAMILY CARE, IMAGING, OCCUP MED, URGENT CARE, SPECIALTIES 21 - MOSAIC LIFE CARE HOSPICE AT STANBERRY PINE VIEW MANOR RM 507 307 PINEVIEW ST STANBERRY MO 64489 HOSPICE 22 - MOSAIC LIFE CARE SURGERY CENTER SHOAL CR 8860 NE 82ND TERRACE KANSAS CITY MO 64158 OUTPATIENT SURGERY 23 - NORTHWEST MEDICAL CENTER HOME HEALTH AGE 1607 E US HIGHWAY 136 ALBANY MO 64402 HOME HEALTH 24 - MOSAIC LIFE CARE CLINICS 3620 FREDERICK AVENUE SAINT JOSEPH MO 64506 OUTPT IMAGING, COUNSELING CARE 25 - OP THERAPY FREDERICK AVE ST JOSEPH MOSAI 3107 FREDERICK AVE LOWER LEVEL SAINT JOSEPH MO 64506 OUTPT THERAPY 26 - MOSAIC LIFE CARE CLINICS 3007 NORTH BELT HIGHWAY SAINT JOSEPH MO 64506 OUTPT THERAPY, CHIROPRACTIC CARE 27 - PAIN MANAGEMENT MOSAIC LIFE CARE 100 CENTRAL ST CHILLICOTHE MO 64601 PAIN MANAGEMENT 28 - PLASTIC SURGERY & DERMATOLOGY MOSAIC LIF 5204 NORTH BELT HIGHWAY SUITE A2016 S SAINT JOSEPH MO 64506 PLASTIC SURG, DERMATOLOGY 29 - PARKVILLE COMMONS MOSAIC LIFE CARE 6301 N LUCERNE KANSAS CITY MO 64151 FAMILY CARE, SPECIALTIES 30 - PODIATRY ST JOSEPH MOSAIC LIFE CARE 5202 FARAON SUITE A SAINT JOSEPH MO 64506 PODIATRY 31 - MOSAIC LIFE CARE CLINICS 1600 E EVERGREEN PO BOX 557 CAMERON MO 64429 PULMONARY & CRIT CARE, RHEUMATOLOGY 32 - MOSAIC LIFE CARE CLINICS MARYVILLE SPECIALTY CLINIC 2024 S MAIN MARYVILLE MO 64468 ENT, PULM & CRIT CARE, NEUROLOGY, PODIATRY 33 - SMITHVILLE MOSAIC LIFE CARE 1103 SOUTH US HIGHWAY 169 SMITHVILLE MO 64089 FAMILY CARE 34 - MOSAIC LIFE CARE CLINICS 1701 EAST 9TH STREET TRENTON MO 64683 FAMILY CARE, NEUROLOGY 35 - TRENTON OCCUPATIONAL MEDICINE MOSAIC LIF 1707 EAST 9TH STREET TRENTON MO 64683 OCCUPATIONAL MEDICINE 36 - URGENT CARE ST JOSEPH MOSAIC LIFE CARE 1115 NORTH BELT HIGHWAY SAINT JOSEPH MO 64506 URGENT CARE 37 - MOSAIC LIFE CARE CLINIC 810 RAVENHILL DR SUITE 103 ATCHISON KS 66002 SPECIALTIES 38 - MOSAIC LIFE CARE CLINIC 104 N 6TH ATCHISON KS 66002 MEDICAL ONCOLOGY 39 - HIAWATHA MOSAIC LIFE CARE 300 UTAH HIAWATHA KS 66434 FAMILY CARE 40 - TROY MOSAIC LIFE CARE 207 SOUTH MAIN TROY KS 66087 FAMILY CARE 41 - ENDOCRINOLOGY MOSAIC LIFE CARE 220 ESSIE DAVISON DRIVE CLARINDA IA 51632 ENDOCRINOLOGY 42 - MOSAIC LIFE CARE CLINICS 1301 NORTH 3RD ATCHISON KS 66002 SPECIALTIES 43 - ENDOCRINOLOGY MOSAIC LIFE CARE 820 RAVEN HILL DRIVE ATCHISON KS 66002 ENDOCRINOLOGY PART I, LINE 3C: SEE PART I, LINE 3B - DURING FY17 THE ORGANIZATION DID NOT OFFER DISCOUNTED CARE, HOWEVER STARTING IN FY18 THE ORGANIZATION NOW OFFERS DISCOUNTED CARE.SEE PART VI, SECTION B, LINE 13 FOR THE LIST OF FACTORS USED IN THE ELIGIBILITY CRITERIA EXPLAINED IN THE FAP FOR PROVIDING FREE AND DISCOUNT CARE. PART I, LINE 7: THE COSTING METHODOLOGY USED TO CALCULATE THE AMOUNTS REPORTED IN THE TABLE WAS THE COST TO CHARGE RATIO DERIVED FROM THE CALCULATIONS FROM WORKSHEET 2.PART I, LINES 7A AND 7B:FINANCIAL ASSISTANCE AT COST WAS 27,840,000 AND 25,290,000 FOR YEARS ENDED 6/30/16 AND 6/30/2017, RESPECTIVELY. DURING FISCAL YEAR 2016, A MEDICAL DEBT GRACE PERIOD WAS PROVIDED BY THE MEDICAL CENTER WHICH RESULTED IN HIGHER COSTS. DURING FISCAL YEAR 2017, THE FINANCIAL ASSISTANCE POLICY WAS EXPANDED TO 300% OF THE FEDERAL POVERTY GUIDELINES WHICH RESULTED IN INCREASED COSTS. MEDICAID NET COMMUNITY BENEFIT EXPENSE WAS 41,450,000 AND 33,141,000 FOR YEARS ENDED 6/30/16 AND 6/30/17, RESPECTIVELY. THE MEDICAL CENTER RECEIVES REIMBURSEMENT FROM THE MEDICAID PROGRAM IN RELATION TO THE PERCENTAGE OF MEDICAID AND INDIGENT POPULATION THEY SERVE. FUNDING RECEIVED IN EXCESS OF COSTS TO PROVIDE THESE SERVICES MAY BE REFUNDED TO THE STATE. DURING 2016, THROUGH MANAGEMENT'S CONTINUED REVIEW OF PROGRAM RESULTS, ADDITIONAL INFORMATION FROM IMPROVEMENTS IN THE REPORTING PROCESS AND REVISIONS TO THE CURRENT ESTIMATION PROCESS, THE MEDICAL CENTER RECORDED AN ADDITIONAL ESTIMATED LIABILITY FOR PROGRAM YEARS 2013, 2014 AND 2015 OF APPROXIMATELY 24,650,000 AND APPROXIMATELY 14,075,000 FOR PROGRAM YEAR 2016 BASED ON ACTUAL AND ESTIMATED FUNDING RECEIVED IN EXCESS OF COSTS. DUE TO THE SUBJECTIVITY INVOLVED IN MAKING THESE ESTIMATES AND THE LACK OF HISTORICAL PRECEDENCE WITH RESPECT TO HOW THE STATE ADMINISTERS THE PROGRAM, THERE IS AT LEAST A REASONABLE POSSIBILITY THAT RECORDED ESTIMATES SILL CHANGE BY A MATERIAL AMOUNT IN THE NEAR TERM.PART I, LINE 7 COLUMN (F):THE TOTAL EXPENSE USED AS THE DENOMINATOR IN CALCULATING THE PERCENT OF TOTAL EXPENSE IS THE TOTAL FUNCTIONAL EXPENSE FOUND ON FORM 990, PART IX, LINE 25, COLUMN (A) NET OF THE PROVISION FOR UNCOLLECTIBLE ACCOUNTS OF 43,881,000 FOUND ON FORM 990, PART IX, LINE 24A, COLUMN A. PART II, COMMUNITY BUILDING ACTIVITIES: THE MEDICAL CENTER'S COMMUNITY BUILDING ACTIVITIES PROMOTED THE HEALTH OF THE COMMUNITIES SERVED BY PROVIDING ECONOMIC SUPPORT TO HELP RE-VITALIZE THE DOWNTOWN ST JOSEPH AREA AND FACILITATE JOB GROWTH THROUGHOUT THE GREATER ST JOSEPH AREA. AMONG OTHER COMMUNITY BUILDING ACTIVITIES, THE MEDICAL CENTER FUNDS AND MAINTAINS A TEAM FOCUSED ON DISASTER READINESS, COORDINATION AND RELIEF. PART III, LINE 2: THE FOLLOWING EXPLANATION OF THE DETERMINATION OF BAD DEBT EXPENSE APPLIES TO ACCOUNTS RECEIVABLE THAT ARE NOT ELIGIBLE FOR FINANCIAL ASSISTANCE.IN EVALUATING THE COLLECTABILITY OF ACCOUNTS RECEIVABLE, THE MEDICAL CENTER ANALYZES ITS PAST HISTORY AND IDENTIFIES TRENDS FOR EACH OF ITS MAJOR PAYER SOURCES OF REVENUE TO ESTIMATE THE APPROPRIATE ALLOWANCE FOR DOUBTFUL ACCOUNTS AND PROVISION FOR UNCOLLECTIBLE ACCOUNTS.MANAGEMENT REGULARLY REVIEWS DATA ABOUT THESE MAJOR PAYER SOURCES OF REVENUE IN EVALUATING THE SUFFICIENCY OF THE ALLOWANCE FOR DOUBTFUL ACCOUNTS AND BAD DEBT EXPENSE.FOR RECEIVABLES ASSOCIATED WITH SERVICES PROVIDED TO PATIENTS WHO HAVE THIRD-PARTY COVERAGE, THE MEDICAL CENTER ANALYZES CONTRACTUALLY DUE AMOUNTS AND PROVIDES AN ALLOWANCE FOR DOUBTFUL ACCOUNTS AND A PROVISION FOR UNCOLLECTIBLE ACCOUNTS (BAD DEBT EXPENSE), IF NECESSARY (FOR EXAMPLE, FOR EXPECTED UNCOLLECTIBLE DEDUCTIBLES AND COPAYMENTS ON ACCOUNTS FOR WHICH THE THIRD-PARTY PAYER HAS NOT YET PAID, OR FOR PAYERS WHO ARE KNOWN TO BE HAVING FINANCIAL DIFFICULTIES THAT MAKE THE REALIZATION OF AMOUNTS DUE UNLIKELY).FOR RECEIVABLES ASSOCIATED WITH SELF-PAY PATIENTS (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 MEDICAL CENTER RECORDS A SIGNIFICANT PROVISION FOR UNCOLLECTIBLE ACCOUNTS (BAD DEBT EXPENSE) IN THE PERIOD OF SERVICE ON THE BASIS OF ITS 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 DIFFERENCE BETWEEN THE STANDARD RATES (OR THE DISCOUNTED RATES IF NEGOTIATED OR PROVIDED BY POLICY) AND THE AMOUNTS ACTUALLY COLLECTED AFTER ALL REASONABLE COLLECTION EFFORTS HAVE BEEN EXHAUSTED IS CHARGED OFF AGAINST THE ALLOWANCE FOR DOUBTFUL ACCOUNTS.THE MEDICAL CENTER'S ALLOWANCE OF DOUBTFUL ACCOUNTS FOR SELF-PAY PATIENTS DECREASED FROM 95% OF GROSS SELF-PAY ACCOUNTS RECEIVABLE AT JUNE 30, 2016 TO 93% OF GROSS SELF-PAY ACCOUNTS RECEIVABLE AT JUNE 30, 2017. IN ADDITION, THE MEDICAL CENTER'S WRITE-OFFS INCREASED APPROXIMATELY $3,635,000 FROM APPROXIMATELY $53,000,000 FOR THE YEAR ENDED JUNE 30, 2016 TO APPROXIMATELY $56,635,000 FOR THE YEAR ENDED JUNE 30, 2017 PRIMARILY DUE TO A TIMING CHANGE IN THE COLLECTIONS PROCESS.DURING 2016, THE MEDICAL CENTER IMPLEMENTED AN AMNESTY PERIOD FOR PATIENT ACCOUNTS PREVIOUSLY WRITTEN OFF TO BAD DEBTS. TO QUALIFY FOR THE AMNESTY, THE PATIENTS WERE REQUIRED TO FILE AN APPLICATION FOR CHARITY CARE DURING 2016. AS A RESULT OF THIS AMNESTY PERIOD, THE MEDICAL CENTER QUALIFIED AS CHARITY CARE APPROXIMATELY $24,5000,000 OF GROSS CHARGES ON ACCOUNTS PREVIOUSLY RECORDED TO BAD DEBTS.BAD DEBT EXPENSE REPORTED IN PART III ON LINE 2 IS SHOWN AT COST. THE AMOUNT WAS DETERMINED BY MULTIPLYING THE ORGANIZATION'S TOTAL BAD DEBT EXPENSE BY THE COST TO CHARGE PERCENTAGE. PART III, LINE 3: IT IS ESTIMATED THAT ADDITIONAL BAD DEBT EXPENSE WOULD HAVE QUALIFIED FOR CHARITY CARE UNDER THE MEDICAL CENTER'S FINANCIAL ASSISTANCE POLICY. THE METHODOLOGY TO FORMULATE THIS ESTIMATE INVOLVED USING U.S. CENSUS BUREAU, 2012-2016 AMERICAN COMMUNITY SURVEY 5-YEAR ESTIMATES DATA FOR INCOME POVERTY LEVELS AT OR BELOW 300%. IN ACCORDANCE WITH THE MEDICAL CENTER'S FINANCIAL ASSISTANCE POLICY, PATIENTS WHOSE INCOME DOES NOT EXCEED 300% OF FEDERAL POVERTY GUIDELINES RECEIVE FREE MEDICAL CARE. THE AMOUNT OF BAD DEBT EXPENSE INCLUDED IN THIS CALCULATION FOR THESE PATIENTS WAS DETERMINED BY MULTIPLYING THE PERCENT OF THE POPULATION WHOSE INCOME DID NOT EXCEED 300% OF THE POVERTY LEVEL BY 100%. THE RESULTING EFFECTIVE CHARITY DISCOUNT PERCENTAGES WERE THEN MULTIPLIED BY THE MEDICAL CENTERS TOTAL BAD DEBT EXPENSE. THE CALCULATED BAD DEBT AT THE 300% LEVEL WAS THEN MULTIPLIED BY THE COST TO CHARGE RATIO TO OBTAIN THE BAD DEBT EXPENSE TO BE INCLUDED IN SCHEDULE H, PART III, LINE 3. PART III, LINE 4: THE BAD DEBT EXPENSE FOOTNOTE IS ON PAGE 11 OF THE ATTACHED AUDITED FINANCIAL STATEMENTS. SEE ALSO THE PARAGRAPH IN THE CHARITY CARE FOOTNOTE ON THE TOP OF PAGE 17 THAT REFERENCES THE 2016 AMNESTY PERIOD RELATED TO BAD DEBT EXPENSE. PART III, LINE 8: THE MEDICARE ALLOWABLE FAILS TO COVER COST. NON-PAYMENT BY MEDICARE RECIPIENTS FOR THEIR DEDUCTIBLE AND COINSURANCE AMOUNTS INCREASES FINANCIAL ASSISTANCE AND BAD DEBT. THESE SHORTFALLS DECREASE THE ORGANIZATIONS'S POOL OF ASSETS AND IT'S ABILITY TO SUCCESSFULLY ATTRACT HIGHLY-TRAINED STAFF AND INVEST IN MEDICAL TECHNOLOGY. IF SERVICES ARE TO BE MAINTAINED, THEN THE COSTS HAVE TO BE COVERED BY THOSE WHO PAY. THE BURDEN FALLS ON THE COMMUNITY. PART III, LINE 9B: THE MEDICAL CENTER'S FINANCIAL ASSISTANCE POLICY CONTAINS PROVISIONS ON COLLECTION PRACTICES TO BE FOLLOWED FOR PATIENTS WHO ARE KNOWN TO QUALIFY FOR FINANCIAL ASSISTANCE. ACCORDING TO THIS POLICY, FINANCIAL ASSISTANCE ELIGIBILITY CRITERIA ARE BASED ON RESIDENCY, GROSS HOUSEHOLD INCOME AND HOUSEHOLD SIZE.RESIDENCY: TO BE ELIGIBLE TO RECEIVE FINANCIAL ASSISTANCE, THE PERSON APPLYING FOR ASSISTANCE MUST BE A RESIDENT IN THE MOSAIC LIFE CARE SERVICE AREA AS LISTED ON ATTACHMENT B (PRIMARY, SECONDARY, TERTIARY, AND EXPANSION AREA). A STUDENT ATTENDING SCHOOL IN THE PRIMARY, SECONDARY, TERRITORY, OR EXPANSION SERVICE AREA AT THE TIME CARE WAS GIVEN, IS ELIGIBLE TO APPLY FOR ASSISTANCE. A STUDENT WHO IS NOT CLAIMED AS A DEPENDENT ON HIS OR HER PARENT'S OR PARENTS' TAX RETURN WILL BE EVALUATED BASED ON THE STUDENT'S INCOME. IF THE STUDENT IS CLAIMED AS A DEPENDENT, THE PARENT'S OR PARENTS' HOUSEHOLD INCOME WILL BE USED TO DETERMINE IF HE OR SHE IS ELIGIBLE FOR FINANCIAL ASSISTANCE. GROSS INCOME AND HOUSEHOLD SIZE:FREE CARE IS GRANTED TO ELIGIBLE PATIENTS WITH A HOUSEHOLD INCOME UP TO 300 PERCENT OF FEDERAL POVERTY GUIDELINES. EMERGENCY MEDICAL SERVICES - MOSAIC LIFE CARE WILL PROVIDE EMERGENCY CARE IN ACCORDANCE WITH FEDERAL EMERGENCY MEDICAL TREATMENT AND LABOR ACT (EMTALA) REGULATIONS. ALL PATIENTS ARE SEEN AND GIVEN CARE PRIOR TO BEING SCREENED FOR FINANCIAL ASSISTANCE AND/OR PAYMENT ABILITY IN AN EMERGENCY. CARE WILL BE PROVIDED AT AN EQUAL LEVEL FOR ALL PATIENTS, REGARDLESS OF ABILITY TO PAY. FINANCIAL ASSISTANCE: FINANCIAL ASSISTANCE MAY BE GIVEN TO PATIENTS, OR THEIR GUARANTORS, WHO MEET THE GUIDELINES FOR WHAT IS REQUIRED IN TERMS OF RESIDENCY AND INCOME LEVELS UNDER THIS POLICY. MOSAIC LIFE CARE EXPECTS PATIENTS OR GUARANTORS TO COOPERATE BY APPLYING FOR ASSISTANCE OR OTHER PUBLIC PROGRAMS WE IDENTIFY AS SOURCES OF HELP TO COVER THE COST OF SERVICES AND CARE. PATIENTS OR GUARANTORS WHO CHOOSE NOT TO COOPERATE MAY BE DENIED FINANCIAL ASSISTANCE.ELIGIBLE APPLICANTS QUALIFY FOR ONE OF THE FOLLOWING:FULL FREE CARE: THE FULL AMOUNT OF CHARGES, FOR ELIGIBLE SERVICES GIVEN AT THE MEDICAL CENTER ARE WAIVED AND COVERED FOR THE PATIENT, OR GUARANTOR, IF THE FOLLOWING GUIDELINES ARE MET: 1. THE APPLICANT MEETS ELIGIBILITY CRITERIA AND HAS A YEARLY HOUSEHOLD INCOME THAT DOES NOT EXCEED 300 PERCENT OF FEDERAL POVERTY GUIDELINES, AND 2. ALL OTHER PAYMENT SOURCES HAVE BEEN EXPLORED AND APPLIED FOR INCLUDING PRIVATE COVERAGE, FEDERAL, STATE AND LOCAL MEDICAL ASSISTANCE PROGRAMS, AND OTHER FORMS OF FINANCIAL ASSISTANCE OFFERED BY THIRD PARTIES.FOR ELIGIBLE SERVICES PROVIDED AT CLINICS OWNED BY MEDICAL CENTER, ALL AMOUNTS DUE FROM THE PATIENT, WITH THE EXCEPTION OF CO-PAYS, ARE WAIVED IF THE FOLLOWING GUIDELINES ARE MET: 1. THE APPLICANT MEETS ELIGIBILITY CRITERIA AND HAS A YEARLY HOUSEHOLD INCOME THAT DOES NOT EXCEED 300 PERCENT OF THE FEDERAL POVERTY GUIDELINES, AND 2. ALL OTHER PAYMENT SOURCES HAVE BEEN EXPLORED AND APPLIED FOR INCLUDING PRIVATE COVERAGE, FEDERAL, STATE AND LOCAL MEDICAL ASSISTANCE PROGRAMS, AND OTHER FORMS OF ASSISTANCE PROVIDED BY THIRD PARTIES.PRESUMPTIVE ELIGIBILITY: SOME PATIENTS OR GUARANTORS ARE PRESUMED TO BE ELIGIBLE FOR FINANCIAL ASSISTANCE BASED ON INDIVIDUAL LIFE CIRCUMSTANCES, FOR EXAMPLE, THOSE WHO ARE HOMELESS OR HAVE QUALIFIED FOR NEEDS-BASED ASSISTANCE PROGRAMS. THIS IS CALLED PRESUMPTIVE ELIGIBILITY. THESE PATIENTS OR GUARANTORS DO NOT NEED TO COMPLETE THE FINANCIAL ASSISTANCE APPLICATION IF THEY PROVIDE PROOF THAT THEY QUALIFY FOR CERTAIN PROGRAMS THAT EXIST TO BENEFIT PEOPLE WHO DO NOT HAVE ENOUGH RESOURCES TO PAY FOR SERVICES AND CARE. PRESUMPTIVE ELIGIBILITY IS USED TO GIVE A 100 PERCENT DISCOUNT TO PATIENTS WHO ARE ELIGIBLE BECAUSE THEY MEET THE RESIDENCY AND ONE OF THE PRESUMPTIVE ELIGIBILITY CRITERIA LISTED IN THE MEDICAL CENTER'S FINANCIAL ASSISTANCE POLICY.AMOUNTS BILLED TO PATIENTS ELIGIBLE FOR FINANCIAL ASSISTANCE:BASIS FOR CALCULATING AMOUNTS GENERALLY BILLED: FOLLOWING A DETERMINATION OF FINANCIAL-ASSISTANCE ELIGIBILITY, AN INDIVIDUAL IS NOT CHARGED MORE THAN THE AMOUNTS GENERALLY BILLED (AGB) INDIVIDUALS WITH INSURANCE COVERING THE SAME CARE FOR EMERGENCY OR OTHER MEDICALLY NECESSARY CARE. THE AGB IS CALCULATED, OR DETERMINED, USING THE PROSPECTIVE MEDICARE METHOD.COLLECTION ACTIONS: NO ACCOUNT WILL BE SUBJECT TO COLLECTION ACTIONS WITHIN 120 DAYS OF ISSUING THE FIRST POSTDISCHARGE STATEMENT AND WITHOUT FIRST MAKING REASONABLE EFFORTS TO DETERMINE WHETHER THE PATIENT IS ELIGIBLE FOR FINANCIAL ASSISTANCE. NO EXTRAORDINARY COLLECTION ACTIONS WILL BE PURSUED AGAINST A PATIENT IF THE PATIENT OR GUARANTOR HAS PROVIDED DOCUMENTATION SHOWING THAT AN APPLICATION HAS BEEN SUBMITTED FOR MEDICAID OR OTHER PUBLICLY SPONSORED HEALTH PROGRAMS, AND THAT AN ELIGIBILITY DETERMINATION IS STILL PENDING. IF A STATEMENT IS SENT TO A PATIENT OR GUARANTOR, AND MAIL IS RETURNED AS UNDELIVERABLE, MOSAIC LIFE CARE WILL ATTEMPT TO FIND A CORRECT ADDRESS. IF THE CORRECT ADDRESS CANNOT BE FOUND, MOSAIC LIFE CARE WILL ATTEMPT TO CONTACT THE PATIENT OR GUARANTOR BY TELEPHONE AT THE NUMBER LISTED BY THE PATIENT OR GUARANTOR. IF EFFORTS TO COMMUNICATE WITH THE PATIENT OR GUARANTOR FAIL, ACCOUNTS WILL BE SENT TO A COLLECTION AGENCY.REASONABLE EFFORTS TO INFORM PATIENT OF FINANCIAL ASSISTANCE: PRIOR TO SENDING AN ACCOUNT TO A COLLECTION AGENCY, THE PATIENT OR GUARANTOR WILL GENERALLY RECEIVE A MINIMUM OF FOUR WRITTEN STATEMENTS INCLUDING THE FIRST POST-DISCHARGE STATEMENT AND THREE SUBSEQUENT STATEMENTS. THESE STATEMENTS WILL INCLUDE A TELEPHONE NUMBER FOR INFORMATION ON PAYING PATIENT BALANCES AND A NOTICE ABOUT FINANCIAL ASSISTANCE.IF AN AGREEMENT HAS NOT BEEN MADE TO RESOLVE THE ACCOUNT, THE FOURTH AND FINAL STATEMENT WILL BE SENT TO THE PATIENT OR GUARANTOR. THIS STATEMENT ACTS AS A NOTICE TO THE ACCOUNT OWNER OF THE AMOUNT OWED TO MOSAIC LIFE CARE AND THAT THE ACCOUNT WILL BE PLACED WITH A THIRD-PARTY COLLECTION AGENCY IN 30 DAYS. THIS STATEMENT WILL INCLUDE A PLAIN LANGUAGE SUMMARY AND WILL OUTLINE ANY COLLECTION ACTIONS THAT MAY BE TAKEN IF A PLAN IS NOT PUT IN PLACE TO SETTLE THE ACCOUNT. THERE ARE OTHER TIMES WHEN ACCOUNTS MAY BE PLACED IN COLLECTIONS INCLUDING WHEN: 1. THE PATIENT OR GUARANTOR HAS NOT MADE TIMELY PAYMENTS ACCORDING TO THE AGREED-UPON PAYMENT PLAN. 2. THE PATIENT OR GUARANTOR HAS RECEIVED A FINANCIAL ASSISTANCE DISCOUNT, BUT IS NO LONGER WORKING WITH MOSAIC LIFE CARE IN GOOD FAITH TO PAY OFF THE REMAINING AMOUNT OWED. EXTRAORDINARY COLLECTION ACTIVITIES: ONCE AN ACCOUNT IS WITH THE COLLECTION AGENCY, THE FOLLOWING ACTIONS MAY BE TAKEN TO MAKE SURE DEBT FOR SERVICES AND CARE IS PAID. THEY ARE "EXTRAORDINARY COLLECTION ACTIVITIES: 1. SEIZING THE PATIENT'S OR GUARANTOR'S BANK ACCOUNT 2. CIVIL ACTIONS 3. PROPERTY LIENS 4. GARNISHING OF WAGES 5. REPORTING ADVERSE INFORMATION TO CREDIT BUREAUS BEFORE EXTRAORDINARY COLLECTION ACTIVITIES CAN BEGIN, THE ACCOUNT MUST BE REVIEWED AND APPROVAL MUST BE GIVEN BY MOSAIC LIFE CARE PATIENT BILLING LEADERSHIP. WHEN ONE OF THESE ACTIONS IS TO BE TAKEN AGAINST A PATIENT OR GUARANTOR, THE PATIENT OR GUARANTOR WILL BE GIVEN A 30-DAY WRITTEN NOTICE OF THE ACTION TO BE TAKEN. THE PATIENT OR GUARANTOR WILL ALSO BE INFORMED OF THE MOSAIC LIFE CARE FINANCIAL ASSISTANCE POLICY AND HOW TO APPLY FOR IT. A PLAIN LANGUAGE SUMMARY OF THE FINANCIAL ASSISTANCE POLICY WILL BE INCLUDED WITH THE NOTICE. THE MEDICAL CENTER COMPLIES WITH ALL FEDERAL, STATE AND LOCAL LAWS, RULES AND REGULATIONS AS WELL AS REPORTING NEEDS THAT MAY APPLY TO THE WORK AND ACTIONS DONE AS A RESULT OF OUR FINANCIAL ASSISTANCE POLICY.THE ORGANIZATION MAKES ITS FINANCIAL ASSISTANCE POLICY AND OTHER RELATED DOCUMENTS AVAILABLE TO PATIENTS ON ITS WEBSITE AT: HTTPS://MYMOSAICLIFECARE.ORG/FINANCIAL-AND-INSURANCE-INFORMATION.(PLEASE NOTE THAT THIS POLICY WAS REVISED EFFECTIVE JULY 1, 2017, AND SOME OF THE PROVISIONS DESCRIBED HEREIN WERE UPDATED IN THE CURRENT ONLINE VERSION OF THE POLICY.) PART VI, LINE 2: HEARTLAND REGIONAL MEDICAL CENTER HAS A ROBUST APPROACH FOR ASSESSING THE NEEDS OF THE COMMUNITIES IT SERVES. THIS ONGOING COMMITMENT INCLUDES COLLABORATING WITH LOCAL GROUPS, SCHOOL DISTRICTS AND CITY AND COUNTY AGENCIES TO IDENTIFY NEEDS, PROMOTE HEALTHY LIVING, ASSURE THAT AFFORDABLE MEDICAL SERVICES ARE AVAILABLE, DEVELOP STRATEGIES FOR IMPROVING EDUCATION AND ECONOMIC STRENGTH, AND PROVIDING ONGOING SUPPORT. PART VI, LINE 3: THE MEDICAL CENTER INFORMS AND EDUCATES PATIENTS AND PERSONS WHO MAY BE BILLED FOR PATIENT CARE ABOUT THEIR ELIGIBILITY FOR FINANCIAL ASSISTANCE BEGINNING AT THE REGISTRATION DESK AND CONTINUING WITH FINANCIAL ASSISTANCE INFORMATION BEING INCLUDED ON EVERY BILLING STATEMENT A PATIENT RECEIVES FROM THE MEDICAL CENTER. GUIDELINES FOR THE PROGRAM ARE AVAILABLE AT EACH REGISTRATION DESK AND ARE INCLUDED IN ALL ADMISSION PACKETS FOR UNINSURED PATIENTS. PATIENTS ARE CONTACTED IF THE PATIENT IS EXPECTED TO HAVE A FINANCIAL RESPONSIBILITY FOR THE VISIT. A FINANCIAL COUNSELOR ATTEMPTS TO VISIT THE ROOM OF EVERY UNINSURED PATIENT THAT IS ADMITTED TO OUR FACILITY FOR OBSERVATION OR INPATIENT CARE. THE COUNSELOR DISCUSSES PAYMENT OPTIONS WITH THE PATIENT AND CAN ASSIST THEM WITH VARIOUS OPTIONS THAT INCLUDE, BUT ARE NOT LIMITED TO, MEDICAID APPLICATION, HEALTH CARE EXCHANGE ELIGIBILITY AND ELIGIBILITY UNDER THE ORGANIZATION'S FINANCIAL ASSISTANCE POLICY. COUNSELORS ALSO WORK WITH OUR CARE MANAGEMENT STAFF TO SUPPORT THE DISCHARGE PROCESSES SO THAT FINANCIAL HARDSHIP DOES NOT KEEP THE PATIENT FROM RECEIVING THE APPROPRIATE FOLLOW-UP CARE. THIS ASSISTANCE INCLUDES INSTRUCTIONS FOR SCHEDULING AN APPOINTMENT WITH A FINANCIAL COUNSELOR WHO CAN ASSIST THEM IN COMPLETING THE FINANCIAL ASSISTANCE APPLICATION. PART VI, LINE 4: THE ORGANIZATION'S PRIMARY AND SECONDARY SERVICE AREA IS A 20 COUNTY URBAN/RURAL REGION LOCATED IN NORTHWEST MISSOURI AND NORTHEAST KANSAS. THE POPULATION IS ELDERLY AND UNDER-INSURED. THE LOCAL ECONOMY CONSISTS OF AGRICULTURAL, SMALL MANUFACTURING AND SELF-EMPLOYED BUSINESSES, PRIMARILY BLUE COLLAR WORKERS.THE ORGANIZATION SUPPORTS A PAYOR MIX OF 60.9% MEDICARE AND MEDICAID, 33.3% COMMERCIAL AND 5.8% SELF PAY. 19.9% OF THE POPULATION IS BELOW THE POVERTY LEVEL; 18.7 % OF THE POPULATION SMOKES; AND 35.9 % HAVE A BODY MASS INDEX GREATER THAN 30. MORE THAN 63.1% OF THE ELEMENTARY AGE STUDENTS RECEIVE FREE OR REDUCED-COST LUNCHES. PART VI, LINE 5: THE ORGANIZATION OFFERS MANY EDUCATION PROGRAMS THROUGHOUT THE YEAR TO HELP MAINTAIN A HEALTHY LIFESTYLE. THESE ARE WELL-ADVERTISED AND MOST OF THEM ARE FREE OF CHARGE.ONE SUCH PROGRAM IS THE POUND PLUNGE. FOR THE PAST ELEVEN YEARS, THE ORGANIZATION HAS SPONSORED THIS THREE-MONTH LONG EVENT TO ENCOURAGE WEIGHT LOSS, EXERCISE AND HEALTHY EATING. MORE THAN 21,000 PEOPLE HAVE PARTICIPATED AND OVER 136,000 POUNDS HAVE BEEN LOST. AT THE END OF THE PROGRAM IN 2017, 88% OF RESPONDENTS TO THE SURVEY AGREED THAT THE POUND PLUNGE WAS BENEFICIAL TO OUR COMMUNITY, AND 79% AGREED THAT THEY ARE CURRENTLY CONTINUING A HEALTHY LIFESTYLE AS A RESULT OF THE POUND PLUNGE.ANOTHER AREA OF FOCUS HAS BEEN IN PREVENTING CHILDHOOD OBESITY. SEVERAL YEARS AGO THE ORGANIZATION'S INTERNAL CLINICAL PROTOCOLS ADDRESSING CHILDHOOD OBESITY WERE FOUND TO BE LACKING. THIS HAS BEEN RECTIFIED.APPROPRIATE PROTOCOLS ARE NOW FULLY ESTABLISHED AND HAVE BEEN GIVEN THE APPROVAL OF THE EVIDENCED-BASED PRACTICE GROUP AND ARE EMBEDDED IN THE ELECTRONIC MEDICAL RECORD.ACCOMPANYING THESE ESTABLISHED PROTOCOLS IS A THOROUGH PROVIDER EDUCATION PLAN TO ASSURE THAT THE NEW PROTOCOLS ARE UNDERSTOOD AND USED. EDUCATION ON THE 1-2-3-4-5 FIT-TASTIC! GUIDELINES HAVE BEEN PROVIDED TO ALL CLINICS TO ASSURE A CONSISTENT PATIENT EXPERIENCE. IN PARTNERSHIP WITH THE ST. JOSEPH SCHOOL DISTRICT, THE ORGANIZATION HAS CONTINUED AND EXPANDED THE 4TH GRADE CHALLENGE, WHICH HAS BEEN PROVIDED IN 26 ELEMENTARY SCHOOLS FOR 9 YEARS. PRE AND POST PROGRAM SURVEYING OF STUDENTS SHOWED AT LEAST A 44.75% INCREASE IN KNOWLEDGE OF THE FIT-TASTIC GUIDELINES AFTER COMPLETING THE PROGRAM. 100% OF SCHOOL COACHES AGREED THAT THE 4TH GRADE CHALLENGE IS AN EFFECTIVE PROGRAM THAT TEACHES STUDENTS ABOUT HEALTH, EXERCISE AND NUTRITION, AND 93.4% OF SCHOOL COACHES AGREED THAT THE 4TH GRADE CHALLENGE IS A GREAT HEALTH PROGRAM THAT HELPS FIGHT CHILDHOOD OBESITY.IN 2017, THE NUMBER OF SCHOOL AND COMMUNITY GARDENS WAS EXPANDED TO 9 ELEMENTARY SCHOOLS. MORE THAN 26,000 POUNDS OF FRESH PRODUCE HAS BEEN GROWN SINCE 2012, AND IS FREE FOR THE COMMUNITY MEMBERS TO HARVEST AND USE FOR MEALS. FOR SOME ECONOMICALLY DISADVANTAGED AREAS, THE GARDENS SUPPLY FRUITS AND VEGETABLES TO FAMILIES WHO WOULD NOT HAVE ACCESS TO THEM OTHERWISE.THE 340B DRUG PRICING PROGRAM ("340B PROGRAM") ENABLES SAFETY NET HEALTHCARE ORGANIZATIONS SERVING UNINSURED, VULNERABLE AND INDIGENT POPULATIONS TO PURCHASE OUTPATIENT PRESCRIPTION DRUGS AT A DISCOUNT. THE MEDICAL CENTER HAS PARTICIPATED IN THIS PROGRAM SINCE 2011. THIS PARTICIPATION HAS GENERATED REVENUE FROM THE CONTRACTED RETAIL PHARMACY RELATIONSHIPS ($56M LTD), CURRENTLY THREATENED BY REGULATION CHALLENGES. THE MEDICAL CENTER HAS RECOGNIZED REDUCED DRUG PRICING FOR OUTPATIENT MEDICATIONS ($42M LTD), CURRENTLY THREATENED BY LEGISLATIVE CHALLENGES. BECAUSE OF THE MEDICAL CENTER'S 340B PROGRAM OUR LOCAL PATIENTS HAVE BENEFITED FROM SAVINGS BY ACCESSING 340B CASH PRICING FOR THEIR MEDICATIONS AT CONTRACTED LOCAL RETAIL PHARMACIES ($65M LTD*). THE COMMUNITY SAVINGS OUT OF POCKET IS CALCULATED BASED ON WHAT THE PATIENT WOULD HAVE PAID IN CASH (NON 340B) VERSUS WHAT THEY DID PAY ON THE 340B CASH PROGRAM. IN FY17 THE 340B PROGRAM RESULTED IN COMMUNITY SAVINGS OF $32 MILLION AS WELL AS ALLOWED THE MEDICAL CENTER TO SUPPORT $25 MILLION WORTH OF COMMUNITY PROGRAMS. PART VI, LINE 6: THE ORGANIZATION IS AFFILIATED, THROUGH A PARENT BOARD, WITH A COMMUNITY FOUNDATION, AN ACUTE LONG TERM CARE HOSPITAL, A CRITICAL ACCESS RURAL HOSPITAL, A RURAL COMMUNITY FOUNDATION AND A COMMUNITY HEALTH IMPROVEMENT SOLUTIONS SERVICE, ALL OF WHICH COLLABORATE WITH EDUCATIONAL, GOVERNMENTAL AND LOCAL BUSINESS LEADERS TO IMPLEMENT PROGRAMS TO HELP IMPROVE HEALTH HABITS AND, IN THE LONG-TERM, THE HEALTH OF THE COMMUNITIES SERVED BY THE MEDICAL CENTER.THE PARENT BOARD IS COMPRISED OF COMMUNITY LEADERS WHO REPRESENT THE EDUCATIONAL, MEDICAL, GOVERNMENTAL AND BUSINESS SECTORS IN THE COMMUNITY. THE ORGANIZATION PROVIDES ACUTE, EMERGENT AND OUTPATIENT CLINIC CARE FOR ALL, REGARDLESS OF THEIR ABILITY TO PAY. THE ORGANIZATION MAINTAINS AN ONGOING COMMITMENT TO PROVIDE SUPPORT FOR THE BETTERMENT OF THE COMMUNITY.THE COMMUNITY FOUNDATION OVERSEES A NUMBER OF PROGRAMS WORKING TO IMPROVE HEALTH IN THE COMMUNITY. THE ACUTE LONG TERM CARE HOSPITAL IS A FACILITY DEDICATED TO THE CARE OF PATIENTS WHO HAVE CHRONIC CONDITIONS REQUIRING A LONGER LENGTH OF STAY THAN IS NORMALLY PORVIDED IN AN ACUTE CARE HOSPITAL.THE CRITICAL ACCESS RURAL HOSPITAL PROVIDES ACUTE, EMERGENT AND OUTPATIENT CLINIC ARE FOR THOSE IN THE RURAL COMMUNITY AREA. THE RURAL COMMUNITY FOUNDATION SUPPORTS THE CRITICAL ACCESS RURAL HOSPITAL. THE COMMUNITY HEALTH IMPROVEMENT SOLUTIONS SERVICE WORKS WITH EMPLOYERS IN THE COMMUNITY TO EFFECT HEALTHY CHANGES IN THEIR WORKFORCES. 1 HEARTLAND FOUNDATION 5325 FARAON STREET ST JOSEPH MO 64506 431262768 501(C)3 848925 117468 FMV SUPPORT; EQUIPMENT CONTRIBUTED TO EMPOWER U MISSOURI WESTERN STATE UNIVERSITY FOUNDATION INC 5425 DOWNS DRIVE ST JOSEPH MO 64507 237035423 501(C)3 307400 FMV SPONSORSHIP SECOND HARVEST COMMUNITY FOOD BANK 915 DOUGLAS STREET ST JOSEPH MO 64505 431268319 501(C)3 187750 FMV SUPPORT SOCIAL WELFARE BOARD 904 S 10TH STREET SUITE A ST JOSEPH MO 64503 446000455 501(C)3 187000 FMV SUPPORT UNITED WAY OF GREATER ST JOSEPH 118 S 5TH STREET ST JOSEPH MO 64501 440547802 501(C)3 183760 FMV SUPPORT COMMUNITY MISSIONS CORPORATION 700 OLIVE STREET ST JOSEPH MO 64501 900180479 501(C)3 175000 FMV SUPPORT CATHOLIC CHARITIES OF KC 1302 FARAON STREET ST JOSEPH MO 64501 430887779 501(C)3 125000 FMV SUPPORT HABITAT FOR HUMANITY PO BOX 6528 ST JOSEPH MO 64506 431733608 501(C)3 100000 FMV SUPPORT LEGAL AID OF WESTERN MISSOURI 1125 GRAND BLVD SUITE 1900 KANSAS CITY MO 64106 430824638 501(C)3 91000 FMV SUPPORT NORTHWEST MISSOURI CHILDRENS ADVOCACY CENTER 1807 WOODBINE ROAD ST JOSEPH MO 64506 431910148 501(C)3 60506 FMV SUPPORT FAMILY GUIDANCE CENTER FOR BEHAVIORAL HEALTHCARE 724 N 22ND STREET ST JOSEPH MO 64506 440666362 501(C)3 50000 FMV SUPPORT BIG BROTHERS BIG SISTERS OF GREATER ST JOSEPH 1202 S 28TH STREET ST JOSEPH MO 64507 501(C)3 45000 FMV SUPPORT THE CENTER 902 EDMOND STREET SUITE 203 ST JOSEPH MO 64501 431615018 501(C)3 40500 FMV SUPPORT COMMUNITY ALLIANCE 3003 FREDERICK AVENUE ST JOSEPH MO 64506 050587096 501(C)3 20490 FMV SUPPORT ST JOSEPH AREA CHAMBER OF COMMERCE 3003 FREDERICK AVENUE ST JOSEPH MO 64506 440419460 501(C)6 16350 FMV SPONSORSHIP GREATER KANSAS CITY CHAMBER OF COMMERCE 30 W PERSHING ROAD SUITE 301 KANSAS CITY MO 64108 440196840 501(C)6 13700 FMV SPONSORSHIP BIG BROTHERS BIG SISTERS OF GREATER KANSAS CITY 1709 WALNUT STREET KANSAS CITY MO 64108 436068464 501(C)3 12500 FMV SPONSORSHIP AMERICAN RED CROSS OF NORTHWEST MISSOURI 401 N 12TH STREET ST JOSEPH MO 64501 530196605 501(C)3 12500 FMV SPONSORSHIP SYNERGY SERVICES INC 400 E 6TH STREET PARKVILLE MO 64152 430970674 501(C)3 10000 FMV SPONSORSHIP ST JOSEPH MUSEUMS INC PO BOX 8096 ST JOSEPH MO 64508 436038202 501(C)3 10000 FMV SPONSORSHIP LADIES UNION BENEVOLENT ASSOCIATION DBA NOYES HOME FOR CHILDREN 801 N NOYES BOULEVARD ST JOSEPH MO 64506 440563788 501(C)3 10000 FMV SUPPORT NORTHLAND REGIONAL CHAMBER OF COMMERCE 634 NW ENGLEWOOD ROAD KANSAS CITY MO 64118 431279100 501(C)6 6200 FMV SPONSORSHIP ALBRECHT-KEMPER MUSEUM OF ART FOUNDATIONS 2818 FREDERICK AVENUE ST JOSEPH MO 64506 431855334 501(C)3 5750 FMV SUPPORT SALVATION ARMY 602 MESSANIE STREET ST JOSEPH MO 64502 440545998 501(C)3 5540 FMV SPONSORSHIP PLATTE COUNTY ECONOMIC DEVELOPMENT COUNCIL INC 11724 NW PLAZA CIRCLE SUITE 200 KANSAS CITY MO 64153 431484127 501(C)3 5025 FMV SUPPORT 22 3 PART I, LINE 2: THE ORGANIZATION IS COMMITTED TO THE DEVELOPMENT OF A HEALTHY COMMUNITY WHICH INCLUDES THE HEALTH OF INDIVIDUALS, AN ADEQUATE NUMBER OF JOBS FOR THE WORKFORCE AND SUCCESSFUL BUSINESSES TO BOOST THE LOCAL ECONOMY. GRANTS ARE PROVIDED TO LOCAL GROUPS THAT ACHIEVE THESE OBJECTIVES. GENERALLY OUR OFFICERS, DIRECTORS OR EMPLOYEES ARE IN A VOLUNTEER POSITION OR ARE A BOARD MEMBER OF THE RECIPIENT ORGANIZATION. X 1 1 X X X X 1 1 0 0 0 0 0 0 0 DR JOHN OLSON DIRECTOR/PHYSICIAN(UNTIL 12/2016) 555432 0 137075 0 4341 0 10600 0 24672 0 732120 0 0 0 DR MARK LANEY DIRECTOR/PRESIDENT/CEO 832348 0 238400 0 4705 0 10600 0 18169 0 1104222 0 0 0 DR LUCINDA HAYDEN DIRECTOR (AS OF 01/2017) 464918 0 39114 0 1260 0 10600 0 15526 0 531418 0 0 0 CURT KRETZINGER COO (UNTIL 01/2017) 514296 0 92148 0 132631 0 67794 0 14129 0 820998 0 127926 0 MICHAEL PULIDO CHIEF OPERATING OFFICER/SECRETARY 361990 0 57142 0 62288 0 81110 0 26492 0 589022 0 59263 0 JOHN WILSON SECRETARY/TREASURER(UNTIL 01/2017) 468353 0 6947 0 125161 0 13667 0 0 0 614128 0 118524 0 DWAIN STILSON CFO/TREASURER 301830 0 56848 0 729 0 48516 0 26442 0 434365 0 0 0 JODIE ROETTGER ASSISTANT TREASURER 171482 0 9027 0 1705 0 6745 0 16644 0 205603 0 0 0 DR DAVIN TURNER PRESIDENT 348585 0 74576 0 3025 0 56439 0 23942 0 506567 0 0 0 BRADY D DUBOIS PRESIDENT 300630 0 53999 0 1561 0 57913 0 24029 0 438132 0 0 0 CAROLYN S PADEN ADMINISTRATOR 52329 0 0 0 170597 0 0 0 17219 0 240145 0 0 0 BRENNAN LEHMAN CHIEF INFORMATION OFFICER 265616 0 45482 0 1550 0 38836 0 23457 0 374941 0 0 0 DR RONY M ABOU-JAWDE STAFF PHYSICIAN 981104 0 12861 0 1569 0 10600 0 24273 0 1030407 0 0 0 DR MOHAN R HINDUPUR STAFF PHYSICIAN 906849 0 128642 0 11397 0 10600 0 18119 0 1075607 0 0 0 DR ROBERT GRANT STAFF PHYSICIAN 850990 0 96698 0 2661 0 10600 0 26773 0 987722 0 0 0 DR ARVIND K SHARMA STAFF PHYSICIAN 829133 0 128642 0 2661 0 10600 0 23942 0 994978 0 0 0 DR RAJAGOPAL RANGINENI STAFF PHYSICIAN 947170 0 0 0 11397 0 10600 0 18219 0 987386 0 0 0 PART I, LINE 1A TRAVEL FOR COMPANIONS WAS NOT INCLUDED AS TAXABLE COMPENSATION AS IT WAS 100% FOR BUSINESS PURPOSES. PART I, LINE 3 SENIOR EXECUTIVES HAVE A WRITTEN EMPLOYMENT CONTRACT. PART I, LINES 4A-B PER THE TERMS OF SEVERANCE AGREEEMNT BETWEEN CAROLYN PADEN AND THE ORGANIZATION SHE RECIEVED $168,084 OF SEVERANCE THAT WAS TREATED AS TAXABLE IN 2016 AND IS INCLUDED IN SCHEDULE J, PART II, COLUMN (B)(III). SCHEDULE J, PART I, LINE 4B DAVIN TURNER, DO - VESTED $0 ; ACCRUED $45,720 BRADY DUBOIS - VESTED $0 ; ACCRUED $47,739 CURT KRETZINGER - VESTED $127,926 ; ACCRUED $57,194 DWAIN STILSON - VESTED $0 ; ACCRUED $36,850 MICHAEL PULIDO - VESTED $59,263 ; ACCRUED $69,899 JOHN WILSON - VESTED $118,524 ; ACCRUED $3,067 THOSE LISTED ABOVE HAVE SIGNED SUPPLEMENTAL EXECUTIVE RETIREMENT PLANS WHICH RECOGNIZE THE VALUE OF THE INDIVIDUAL AND THE MUTUAL BENEFIT OF CONTINUED EMPLOYMENT FOR AN EXTENDED PERIOD OF TIME BY ESTABLISHING A 457F PLAN THE PLAN IS FUNDED YEARLY AS THE RESULT OF A CALCULATION DESCRIBED IN THE AGREEMENT WHICH WILL REWARD THE INDIVIDUALS WITH 100% VESTING BASED ON A 5-YEAR CLIFF VESTING SCHEDULE AND AT NORMAL RETIREMENT AGE OR UPON DEATH OR UPON SEPARATION FROM SERVICE DUE TO DISABILITY OR UPON INVOLUNTARY SEPARATION FROM SERVICE WITHOUT CAUSE, WITH LUMP SUM PAYMENT WITHIN 90 DAYS OF EACH SITUATION TAKING INTO CONSIDERATION A NON-COMPETE COVENANT SEPARATION WITH CAUSE MAKES SUPPLEMENTAL EXECUTIVE RETIREMENT AGREEMENTS NULL AND VOID. A SEE PART VI 431203910 79075LAB3 2009-02-26 70000000 SEE PART VI 0 0 0 B SEE PART VI 431203910 79075LAD9 2011-09-30 25250000 SEE PART VI 0 0 0 C SEE PART VI 431178966 60637ACP5 2012-10-03 51489534 SEE PART VI 0 0 0 D SEE PART VI 431203910 2015-11-18 81225000 SEE PART VI 0 0 0 A 1390000 70956418 70956418 2014 0 0 1 1 B 12490000 25250000 25250000 2005 1 0 1 1 C 51535780 708053 50827726 1 2014 0 0 1 1 D 4112500 81225000 362060 80862940 2005 1 0 1 1 A 0 0 0 0 0.00000 0.00000 0.00000 0 0 1 C 0 1 0 0 0.03370 0.00000 0.03370 0 0 1 A 0 0 0 1 1 0 0 1 1 B 1 0 0 0 0 1 C 0 0 0 1 0 0 0 0 1 D 0 0 1 0 1 1 WELLS FARGO BANK NA 11.100000000000 0 0 0 0 1 A 1 B 1 C 1 D 1 PART I, COLUMN A, LINE A, LINE B, AND LINE D THE INDUSTRIAL DEVELOPMENT AUTHORITY OF ST. JOSEPH, MISSOURI PART IV, COLUMN A, LINE 2C THE ARBITRAGE REBATE ANALYSIS WAS PERFORMED AS OF 2/1/2014 PART IV, COLUMN C, LINE 2C THE ARBITRAGE REBATE ANALYSIS WAS PERFORMED AS OF 9/1/2014 PART IV, COLUMN A, LINE 6 THE PROJECT FUND WAS INVESTED BEYOND THE THREE YEAR TEMPORARY PERIOD BUT NO EXCESS YIELD LIABILITY WAS GENERATED PART I, COLUMN A, LINE C HEALTH AND EDUCATIONAL FACILITIES AUTHORITY OF THE STATE OF MISSOURI PART I, COLUMN F, LINE A FINANCE THE CONSTRUCTION AND EQUIPPING OF CERTAIN HEALTHCARE FACILITIES PART I, COLUMN F, LINE B REFUND 2001 AB BONDS ISSUED ON 11/29/2001, 2001 D BONDS ISSUES ON 11/29/2001 AND 2003 E BONDS ISSUED ON 5/22/2003 PART I, COLUMN F, LINE C TO ACQUIRE, CONSTRUCT, REMODEL, RENOVATE AND EQUIP CERTAIN HEALTHCARE FACILITIES PART I, COLUMN F, LINE D REFUND 2001 AB AND 2001 D BONDS ISSUED ON 11/29/2001 PART II, COLUMN A, LINE 3 AMOUNT DOES NOT EQUAL TO ISSUE PRICE LISTED IN PART I COLUMN (E) DUE TO INVESTMENT EARNINGS PART II, COLUMN C, LINE 3 AMOUNT DOES NOT EQUAL TO ISSUE PRICE LISTED IN PART I COLUMN (E) DUE TO INVESTMENT EARNINGS PART III, COLUMN B PART III FOR 2011 BONDS HAS NOT BEEN COMPLETED. THE 2011 BONDS WERE USED TO REFINANCE PROJECTS ORIGINALLY FINANCED WITH BONDS ISSUED PRIOR TO JANUARY 1, 2003. PART III, COLUMN D PART III FOR 2015 AB BONDS HAS NOT BEEN COMPLETED. THE 2015 AB BONDS WERE USED TO REFINANCE PROJECTS ORIGINALLY FINANCED WITH BONDS ISSUED PRIOR TO JANUARY 1, 2003 DONNA WILSON SEE PART V 106856 SEE PART V 0 CORINNE KOELLIKER SEE PART V 33986 SEE PART V 0 JON KOELLIKER SEE PART V 109256 SEE PART V 0 MARINA KOELLIKER SEE PART V 108957 SEE PART V 0 TRACY HOWERY SEE PART V 124698 SEE PART V 0 JILLIAN KOELLIKER SEE PART V 43419 SEE PART V 0 MARY KOELLIKER SEE PART V 34718 SEE PART V 0 NIKKI LEHMAN SEE PART V 61004 SEE PART V 0 SCHEDULE L, PART IV, LINE 1, COLUMN B DONNA WILSON IS THE SERVICE LEADER FOR YOUTH AND ADULT PARTNERSHIPS FOR HEARTLAND REGIONAL MEDICAL CENTER AND IS THE WIFE OF JOHN WILSON, WHO IS THE CHIEF TREASURY OFFICER OF HEARTLAND REGIONAL MEDICAL CENTER. SCHEDULE L, PART IV, LINE 1, COLUMN D SALARY AND OTHER COMPENSATION FOR SERVICE LEADER SERVICES SCHEDULE L, PART IV, LINE 2, COLUMN B CORINNE KOELLIKER IS A LASER TECHNICIAN FOR HEARTLAND REGIONAL MEDICAL CENTER, AND IS THE SISTER OF SCOTT KOELLIKER, WHO IS A FORMER KEY EMPLOYEE OF HEARTLAND REGIONAL MEDICAL CENTER. SCHEDULE L, PART IV, LINE 2, COLUMN D SALARY AND OTHER COMPENSATION FOR LASER TECHNICIAN SERVICES SCHEDULE L, PART IV, LINE 3, COLUMN B JON KOELLIKER IS A TS APPLICATIONS ANALYST FOR HEARTLAND REGIONAL MEDICAL CENTER, AND IS THE BROTHER OF SCOTT KOELLIKER, WHO IS A FORMER KEY EMPLOYEE OF HEARTLAND REGIONAL MEDICAL CENTER. SCHEDULE L, PART IV, LINE 3, COLUMN D SALARY AND OTHER COMPENSATION FOR TS APPLICATIONS ANALYST SERVICES SCHEDULE L, PART IV, LINE 4, COLUMN B MARINA KOELLIKER IS A REGISTERED NURSE FOR HEARTLAND REGIONAL MEDICAL CENTER, AND IS THE WIFE OF SCOTT KOELLIKER, WHO IS A FORMER KEY EMPLOYEE OF HEARTLAND REGIONAL MEDICAL CENTER. SCHEDULE L, PART IV, LINE 4, COLUMN D SALARY FOR REGISTERED NURSE SERVICES SCHEDULE L, PART IV, LINE 5, COLUMN B TRACY HOWERY IS AN ADVANCED PRACTICE REGISTERED NURSE FOR HEARTLAND REGIONAL MEDICAL CENTER, AND IS THE DAUGHTER-IN-LAW OF DAVE HOWERY, WHO IS A FORMER DIRECTOR OF HEARTLAND REGIONAL MEDICAL CENTER. SCHEDULE L, PART IV, LINE 5, COLUMN D SALARY FOR ADVANCED PRACTICE REGISTERED NURSE SERVICES SCHEDULE L, PART IV, LINE 6, COLUMN B JILLIAN KOELLIKER IS A STAFF NURSE FOR HEARTLAND REGIONAL MEDICAL CENTER, AND IS THE DAUGHTER OF SCOTT KOELLIKER, WHO IS A FORMER KEY EMPLOYEE OF HEARTLAND REGIONAL MEDICAL CENTER. SCHEDULE L, PART IV, LINE 6, COLUMN D SALARY FOR STAFF NURSE SCHEDULE L, PART IV, LINE 7, COLUMN B MARY KOELLIKER IS A THERAPY DEPARTMENT EMPLOYEE FOR HEARTLAND REGIONAL MEDICAL CENTER, AND IS THE SISTER-IN-LAW OF SCOTT KOELLIKER, WHO IS A FORMER KEY EMPLOYEE OF HEARTLAND REGIONAL MEDICAL CENTER. SCHEDULE L, PART IV, LINE 7, COLUMN D SALARY FOR THERAPY DEPARTMENT SERVICES SCHEDULE L, PART IV, LINE 8, COLUMN B NIKKI LEHMAN IS A REVENUE CYCLE ANALYST AT HEARTLAND REGIONAL MEDICAL CENTER, AND IS THE SPOUSE OF BRENNAN LEHMAN, WHO IS THE CHIEF INFORMATION OFFICER OF HEARTLAND REGIONAL MEDICAL CENTER. SCHEDULE L, PART IV, LINE 8, COLUMN D SALARY AND OTHER COMPENSATION FOR REVENUE CYCLE ANALYST SERVICES FORM 990, PART III, LINE 3 ON JULY 1, 2014, HEARTLAND HEALTH, THE HOLDING COMPANY OF THE HEARTLAND REGIONAL MEDICAL CENTER, TRANSFERRED THE REGIONAL EMERGENCY MEDICAL SERVICES AUTHORITY AND ITS OPERATIONS AND ASSETS TO BUCHANAN COUNTY. DURING THE TRANSITION, THE MEDICAL CENTER IS LEASING PERSONNEL AND OPERATING SPACE TO ASSIST WITH OPERATIONS. FORM 990, PART III, LINE 4A HEARTLAND REGIONAL MEDICAL CENTER IS A 352-BED MEDICAL SURGICAL HOSPITAL LOCATED IN ST JOSEPH, MISSOURI. IT SERVES A COMMUNITY OF 77,000 RESIDENTS. BECAUSE ST JOSEPH IS A BORDER CITY, IT ALSO PROVIDES SERVICES TO THOSE LIVING IN THE ADJACENT STATES OF KANSAS, NEBRASKA AND IOWA. THE ECONOMY OF THE REGION IS BASED ON AGRICULTURE, MINOR MANUFACTURING AND SMALL BUSINESSES RESULTING IN A PAYOR MIX FOR THE MEDICAL CENTER OF 61% GOVERNMENTAL, 33% MANAGED CARE/COMMERCIAL AND 6% UNINSURED. 19.9% OF THE POPULATION HAVE INCOME THAT IS BELOW THE FEDERAL POVERTY LEVEL. THE HOSPITAL PROVIDES A WIDE RANGE OF INPATIENT AND OUTPATIENT SERVICES INCLUDING CARDIO-THORACIC, VASCULAR, ORTHOPEDIC AND GENERAL SURGERIES, MENTAL HEALTH SERVICES, ALONG WITH A FULL ARRAY OF DIAGNOSTIC AND THERAPEUTIC SERVICES. IT OPERATES A 24-HOUR EMERGENCY ROOM DESIGNATED AS A TRAUMA II CENTER BY THE STATE OF MISSOURI. THE HOSPITAL'S OBSTETRICS DEPARTMENT PROVIDES 18 LABOR/DELIVERY/RECOVERY/POST-PARTUM BEDS WHICH ARE ALSO DESIGNATED AS A LEVEL II CENTER. THE HOSPITAL PROVIDES RADIATION ONCOLOGY SERVICES, HOME HEALTH VISITS AND HOSPICE CARE. THE ORGANIZATION IS A MEMBER OF THE MAYO NETWORK FOR CLINICAL CONSULTATIONS. DURING THE YEAR, APPROXIMATELY 16,200 PATIENTS WERE ADMITTED TO THE HOSPITAL RESULTING IN APPROXIMATELY 68,000 PATIENT DAYS. A TOTAL OF APPROXIMATELY 10,000 SURGERIES WERE PERFORMED, THE EMERGENCY ROOM SERVED APPROXIMATELY 61,000 PATIENTS AND APPROXIMATELY 185,000 VISITS WERE GENERATED BY OUTPATIENTS. THE MEDICAL CENTER EMPLOYS APPROXIMATELY 4,300 FULL-TIME EQUIVALENT CARE GIVERS. THE MEDICAL STAFF INCLUDES APPROXIMATELY 300 PROVIDERS COVERING PRIMARY CARE AND SPECIALTY CLINICS AT 58 LOCATIONS THROUGHOUT THE REGION. THERE WERE APPROXIMATELY 901,000 PATIENT VISITS DURING THE YEAR. FINANCIAL AMNESTY PERIOD OFFERED: IN ORDER TO ASSIST ITS PATIENTS AND IN ACCORDANCE WITH ITS TAX-EXEMPT PURPOSE, THE MEDICAL CENTER OFFERRED A THREE MONTH FINANCIAL AMNESTY PERIOD DURING 2015-2016 FOR PATIENTS WHOSE ACCOUNTS WERE PREVIOUSLY WRITTEN OFF TO BAD DEBT. TO QUALIFY FOR THE AMNESTY, THE PATIENTS WERE REQUIRED TO FILE AN APPLICATION FOR CHARITY CARE DURING THE THREE-MONTH PERIOD. AS A RESULT OF THIS AMNESTY PERIOD, THE MEDICAL CENTER QUALIFIED AS CHARITY CARE APPROXIMATELY $24,500,000 OF ACCOUNTS PREVIOUSLY RECORDED TO BAD DEBTS. ACO: 2016 IS THE FOURTH YEAR THAT MOSAIC LIFE CARE HAS BEEN AN ACCOUNTABLE CARE ORGANIZATION (ACO). AN ACO IS A GROUP OF DOCTORS AND OTHER HEALTH-CARE PROVIDERS WHO AGREE TO VOLUNTARILY WORK TOGETHER WITH MEDICARE TO PROVIDE HIGH-QUALITY MEDICAL CARE AND SERVICE AT THE RIGHT TIME AND IN THE RIGHT SETTING. THE ACO PROGRAM ENCOMPASSES QUALITY METRICS. PROVIDING EXCEPTIONAL HEALTH CARE AT LOWER COSTS THROUGH THE ACO MODEL FURTHERS MOSAIC'S TAX EXEMPT MISSION. MOSAIC PARTICIPATES IN THE MEDICARE SHARED SAVINGS ACO PROGRAM AND WORKS CLOSELY WITH NON-MOSAIC DOCTORS AND OTHER HEALTH-CARE PROVIDERS TO PROVIDE CARE FOR BENEFICIARIES WHO HAVE TRADITIONAL MEDICARE. BENEFICIARIES BENEFIT BECAUSE THEIR DOCTORS ARE PART OF A TEAM THAT FOCUSES ON THE COORDINATION AND QUALITY OF THEIR MEDICAL CARE.FOR CALENDAR YEAR 2015, MOSAIC ACHIEVED 96.11% QUALITY SCORE. IN 2016, THE MEDICAL CENTER EARNED BACK-TO-BACK FIVE STAR RATINGS FROM CMS AND IS THE ONLY HOSPITAL IN MISSOURI TO HAVE EARNED FIVE STARS. IN THE MOST RECENT RELEASE, JUST 83 INSITUTIONS OUT OF 3,629 HOSPITALS, OR 2.2 PERCENT, EARNED FIVE STARS NATIONWIDE. FOR CALENDAR 2016, MOSAIC REVIEVED A QUALITY SCORE OF 99.06%. MOSAIC RECEIVED A EARNED PERFORMANCE PAYMENT OF $2.86M. MOSAIC IS NO LONGER PARTICIPATING IN THE MSSP PROGRAM AS OF JULY 31, 2017. MOSAIC ALSO PARTICIPATES IN AN ACO WITH BLUE CROSS BLUE SHIELD OF KANSAS CITY (BCBSKC). FOR CALENDAR YEAR 2015, MOSAIC REALIZED EARNED SAVINGS RELATIVE TO BCBSKC TARGETS FOR THE THIRD YEAR IN A ROW. DURING 2016, MOSAIC DID NOT REALIZE SHARED SHAVINGS. QUALITY MEASURES WERE NOT AVAILABLE FROM BSBCKC. OTHER PROGRAM SERVICES: THE MEDICAL CENTER HAS A 340B DESIGNATION FROM HRSA (FEDERAL GOVERNMENT). THIS ALLOWS THE MEDICAL CENTER TO RECEIVE OUTPATIENT DRUGS AT REDUCED PRICES FROM THE DRUG MANUFACTURERS. THE 340B PROGRAM ENABLES COVERED ENTITIES TO STRETCH SCARCE FEDERAL RESOURCES AS FAR AS POSSIBLE, REACHING MORE ELIGIBLE PATIENTS AND PROVIDING MORE COMPREHENSIVE SERVICES. THE PROGRAM IS AVAILABLE TO HOSPITALS THAT PROVIDE CARE FOR A DISPROPORTIONATE NUMBER OF PATIENTS THAT RANGE FROM NO INCOME TO LOW INCOME. FORM 990, PART VI, SECTION A, LINE 2 JOHN P. WILSON, CURT KRETZINGER, MARK LANEY, M.D., MICHAEL PULIDO AND DWAIN STILSON HAVE A BUSINESS RELATIONSHIP WITH MIDWESTERN HEALTH MANAGEMENT, INC. AND HHS PROPERTIES, INC. THEY SERVE AS EITHER OFFICERS AND/OR DIRECTORS OF MIDWESTERN HEALTH MANAGMENT, INC. AND HHS PROPERTIES, INC., WHICH ARE RELATED FOR-PROFIT CORPORATIONS. JOHN P. WILSON, CURT KRETZINGER, MARK LANEY, M.D., DWAIN STILSON, DAVIN TURNER, D.O., MICHAEL PULIDO, AND BRENNAN LEHMAN HAVE A BUSINESS RELATIONSHIP WITH COMMUNITY HEALTH PLAN INSURANCE COMPANY. THEY SERVE AS EITHER OFFICERS AND/OR DIRECTORS FOR COMMUNITY HEALTH PLAN INSURANCE COMPANY, WHICH IS A RELATED FOR-PROFIT CORPORATION. JOHN P. WILSON, CURT KRETZINGER, AND DWAIN STILSON HAVE A BUSINESS RELATIONSHIP WITH UPTOWN HOUSING, INC. THEY SERVE AS EITHER OFFICERS AND/OR DIRECTORS OF UPTOWN HOUSING, INC. WHICH IS A RELATED FOR-PROFIT CORPORATION. FORM 990, PART VI, SECTION A, LINE 6 HEARTLAND HEALTH, A MISSOURI NONPROFIT CORPORATION, IS THE SOLE MEMBER OF HEARTLAND REGIONAL MEDICAL CENTER. FORM 990, PART VI, SECTION A, LINE 7B THE SOLE MEMBER (HEARTLAND HEALTH) SHALL HAVE THE FOLLOWING POWERS: OVERALL STRATEGIC DIRECTION (EXCLUDING MATTERS RELATED PRIMARILY TO THE ACCOUNTABLE CARE ORGANIZATION (ACO) OPERATED BY THE HOSPITAL, INCLUDING SPECIFICALLY ANY MEDICARE SHARED SAVINGS PROGRAM CREATED UNDER THE AFFORDABLE CARE ACT), APPOINTMENT OF AUDITORS AND LEGAL COUNSEL, ESTABLISHMENT OF BANKING RELATIONSHIPS AND MANAGEMENT OF CASH AND OTHER ASSETS (EXCLUDING ACO SHARED SAVINGS DISTRIBUTIONS AND REPAYMENT OF SHARED LOSSES), LONG-RANGE PLANNING, ADOPTION OF ANNUAL OPERATING PLANS AND APPLICATION FOR CERTIFICATES OF NEED. FORM 990, PART VI, SECTION B, LINE 11B AN INDEPENDENT ACCOUNTING FIRM PREPARES AND REVIEWS THE FORM 990 WITH INFORMATION PROVIDED FROM HEARTLAND REGIONAL MEDICAL CENTER'S ACCOUNTING STAFF. THE INDEPENDENT ACCOUNTING FIRM REVIEWS A DRAFT OF THE FORM 990 WITH THE INTERNAL TAX DEPARTMENT OF HEARTLAND REGIONAL MEDICAL CENTER. THE DRAFT FORM 990 IS REVISED FOR ANY CORRECTIONS OR CLARIFICATIONS BASED ON THE REVIEW. THE INDEPENDENT ACCOUNTING FIRM THEN CONDUCTS A REVIEW OF THE FORM 990 WITH THE CONTROLLER AND CHIEF FINANCIAL OFFICER OF HEARTLAND REGIONAL MEDICAL CENTER. AFTER ANY NECESSARY CORRECTIONS OR CLARIFICATIONS ARE MADE TO THE FORM 990, A COMPLETE COPY OF THE FORM 990 IS PROVIDED TO ALL VOTING MEMBERS OF THE HEARTLAND REGIONAL MEDICAL CENTER BOARD OF DIRECTORS PRIOR TO ELECTRONICALLY FILING THE RETURN. FORM 990, PART VI, SECTION B, LINE 12C UPON AGREEING TO FILL A BOARD POSITION, THE PROSPECTIVE MEMBER IS REQUIRED TO SIGN A CONFLICT OF INTEREST DOCUMENT WHICH DISCLOSES FAMILY AND BUSINESS RELATIONSHIPS THAT COULD BE CONSIDERED IN CONFLICT WITH HIS/HER POSITION ON THE BOARD. IN THIS DOCUMENT, THE MEMBER AGREES TO DISCLOSE ANY ACTIVITIES IN WHICH HE/SHE MAY NOT BE INDEPENDENT IN REGARDS TO A TRANSACTION. THIS DOCUMENT IS DISTRIBUTED AND HELD BY THE CORPORATE COMPLIANCE OFFICE AND LEGAL COUNSEL. THE NEW MEMBER ALSO SIGNS HEARTLAND'S CODE OF CONDUCT DOCUMENT IN WHICH THE MEMBER AGREES TO COMPLY WITH THE ORGANIZATION'S ETHICAL STANDARDS AND CONFIDENTIALITY POLICIES. THIS DOCUMENT IS HELD BY THE CORPORATE COMPLIANCE OFFICE. ANNUALLY, THE CORPORATE COMPLIANCE OFFICER DISTRIBUTES A SURVEY TO EACH BOARD MEMBER TO FACILITATE DISCLOSURE OF ANY REPORTABLE ACTIVITIES. DURING THE COURSE OF BOARD MEETINGS, BOARD MEMBERS WILL DISMISS THEMSELVES FROM MEETINGS AND/OR ABSTAIN FROM VOTING DURING DISCUSSIONS OF ISSUES THAT RELATE TO THOSE SPECIFIC MEMBERS OR THE COMPANIES THAT THEY REPRESENT. FOR EXAMPLE, PHYSICIAN BOARD MEMBERS ABSTAIN FROM VOTING ON THEIR OWN RE-CREDENTIALING; UNIVERSITY BOARD MEMBERS ARE DISMISSED DURING DISCUSSIONS OF UNIVERSITY-RELATED ACTIVITIES; AND LEGAL COUNSEL IS DISMISSED DURING DISCUSSION AND VOTING ON LEGAL COUNSEL REVIEW AND SELECTION. ALL DISMISSALS AND ABSTENTIONS ARE RECORDED IN THE MINUTES OF THE BOARD MEETING. ANNUALLY, THE BOARD MEMBERS ALONG WITH OFFICERS AND KEY EMPLOYEES ARE REQUIRED TO RE-SIGN THE CODE OF CONDUCT DOCUMENT IN WHICH THEY AGREE TO COMPLY WITH THE ORGANIZATION'S ETHICAL STANDARDS AND CONFIDENTIALITY POLICIES. THEY ALSO RECEIVE A QUESTIONNAIRE WHICH FACILITATES THE DISCLOSURE OF ANY REPORTABLE ACTIVITIES TO THE CORPORATE COMPLIANCE OFFICER. FORM 990, PART VI, SECTION B, LINE 15 COMPENSATION IS ESTABLISHED BY HEARTLAND HEALTH, A RELATED ENTITY. AN ANNUAL REVIEW WAS PERFORMED DURING THE PRIOR FISCAL YEAR FOR THE CURRENT YEAR'S COMPENSATION. MARKET DATA IS PROVIDED BY AN INDEPENDENT COMPENSATION CONSULTANT. A COMPENSATION COMMITTEE COMPRISED OF THE HEARTLAND HEALTH BOARD CHAIR, HEARTLAND HEALTH BOARD VICE-CHAIR AND THREE ADDITIONAL HEARTLAND HEALTH BOARD MEMBERS AND LEGAL COUNSEL, AS SCRIBE, OVERSEE AN ANNUAL SALARY REVIEW PROCESS FOR OFFICERS, ADMINISTRATORS AND KEY EMPLOYEES. FOR EACH POSITION TO BE REVIEWED, THE FULL SCOPE OF DUTIES AND RESPONSIBILITIES, NUMBERS OF STAFF MANAGED, PROCESSES MANAGED, APPROXIMATE REVENUE, EXPENSE, OR CAPITAL DOLLARS MANAGED ARE PROVIDED TO A THIRD PARTY CONSULTANT THAT SPECIALIZES IN RESEARCH MARKET SALARY DATA. FACILITY SIZE, NOT-FOR-PROFIT STATUS AND THE SCOPE OF EACH JOB POSITION IS COMPARED TO SIMILAR FACILITIES TO DETERMINE BASE COMPENSATION AND INCENTIVE COMPENSATION FOR EACH POSITION. THE DATA GATHERED BY THE MARKET RESEARCH FIRM IS REVIEWED BY THE COMPENSATION COMMITTEE, OUTLIER ISSUES ARE RESOLVED AND BASED UPON PRESENT FINANCIAL INDICATORS, THE COMMITTEE MAKES THEIR DETERMINATION OF COMPENSATION LEVELS FOR THE NEXT PAY YEAR. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION MAKES ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY & FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UPON WRITTEN REQUEST. FORM 990, PART XI, LINE 9: CHANGE IN FAIR VALUE OF DERIVATIVE INSTRUMENTS 3,366,174. CHANGE IN FAIR VALUE OF CASH FLOW HEDGING DERIVATIVES 352,724. CHANGE IN DEFINED BENEFIT PENSION PLAN -752,071. NET ASSET TRANSFERS -4,296,216. ASSET IMPAIRMENT AND OTHER RESTRUCTURING INCOME -35,281,927. PENSION INTEREST AND AMORTIZATION OF ACTURIAL LOSS -1,551,586. 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