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        <ReturnReference>Schedule C, Part II-B, Line 1i</ReturnReference>
        <Explanation>The University paid $15,000 during the year to a lobbyist firm for various legislative activities relating to the University's tax-exempt purpose.</Explanation>
      </Form990ScheduleCPartIV>
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      </CurrentYearMinus2Years>
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      <OtherAssets>
        <Description>Silverware</Description>
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        <NamePerson>THOMAS MCWILLIAMS</NamePerson>
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      <Form990ScheduleJPartII>
        <NamePerson>RANDY DANIELSEN</NamePerson>
        <Title>DEAN</Title>
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      <Form990ScheduleJPartII>
        <NamePerson>MICHAEL MCMANIS</NamePerson>
        <Title>VICE PRESIDENT</Title>
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        <CompBasedOnRelatedOrgs>0</CompBasedOnRelatedOrgs>
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      <Form990ScheduleJPartII>
        <NamePerson>MARGARET WILSON LEMLEY</NamePerson>
        <Title>DEAN</Title>
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      <Form990ScheduleJPartII>
        <NamePerson>JOHN HEARD</NamePerson>
        <Title>VICE PRESIDENT</Title>
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      <Form990ScheduleJPartII>
        <NamePerson>ROBERT BASHAM</NamePerson>
        <Title>VICE PRESIDENT</Title>
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      <Form990ScheduleJPartII>
        <NamePerson>KIMBERLY O'REILLY</NamePerson>
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        <NamePerson>KEVIN MARBERRY</NamePerson>
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      <Form990ScheduleJPartII>
        <NamePerson>MICHAEL D LOCKWOOD</NamePerson>
        <Title>CHAIRPERSON OF OMM</Title>
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        <NamePerson>OT WENDEL</NamePerson>
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        <NamePerson>ROBERT SCHNEIDER</NamePerson>
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        <NamePerson>RALPH BOLING</NamePerson>
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        <NamePerson>ANITA KALOUSEK</NamePerson>
        <Title>DEAN</Title>
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      <Form990ScheduleJPartIII>
        <Identifier>HEALTH OR SOCIAL CLUB DUES OR INITIATION FEES</Identifier>
        <ReturnReference>SCHEDULE J, PART I, LINE 1A</ReturnReference>
        <Explanation>THE UNIVERSITY PAID FOR AQUATIC CENTER AND HEALTH CENTER DUES FOR SEVERAL EMPLOYEES, WHICH WERE REPORTED AS TAXABLE INCOME ON THEIR W-2S. ALL EMPLOYEES OF THE UNIVERSITY ARE ALLOWED TO SIGN UP TO RECEIVE THIS BENEFIT.</Explanation>
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      <Form990ScheduleJPartIII>
        <Identifier>SEVERANCE PAYMENT</Identifier>
        <ReturnReference>SCHEDULE J, PART 1, LINE 4A</ReturnReference>
        <Explanation>DOUGLAS WOOD $190,869</Explanation>
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      <Form990ScheduleJPartIII>
        <Identifier>INCENTIVES CONTINGENT ON REVENUES OF A RELATED ORGANIZATION</Identifier>
        <ReturnReference>SCHEDULE J, PART 1, LINE 5B</ReturnReference>
        <Explanation>INCENTIVES ARE CALCULATED USING A FORMULA BASED ON RELATIVE VALUE UNITS IN THE MEDICAL CLINICS. THE CLINICIANS' SALARIES ARE PAID USING A FORMULA THAT IS CUSTOMARY IN THE CLINICAL SETTINGS AND THEREFORE THE CLINICIANS RECEIVED FAIR MARKET COMPENSATION. BONUSES WERE PAID AS FOLLOWS: MICHAEL LOCKWOOD $40,507 ROBERT SCHNEIDER $49,162 RALPH BOLING $103,976</Explanation>
      </Form990ScheduleJPartIII>
    </IRS990ScheduleJ>
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        <BondReferenceCd>A</BondReferenceCd>
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        <CUSIPNumber>040505BH1</CUSIPNumber>
        <DateIssued>2010-01-27</DateIssued>
        <IssuePrice>14377933</IssuePrice>
        <DescriptionOfPurpose>REFUND 2000 BONDS (8-4-2000)</DescriptionOfPurpose>
        <Defeased>false</Defeased>
        <OnBehalfOfIssuer>false</OnBehalfOfIssuer>
        <PoolFinancing>false</PoolFinancing>
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      <Form990ScheduleKPartI>
        <BondReferenceCd>B</BondReferenceCd>
        <IssuerName>
          <BusinessNameLine1>MISSOURI HEALTH &amp; EDUCATIONAL FACILITIES AUTHORITY</BusinessNameLine1>
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        <CUSIPNumber>60636ACP6</CUSIPNumber>
        <DateIssued>2011-11-15</DateIssued>
        <IssuePrice>25770587</IssuePrice>
        <DescriptionOfPurpose>CONSTR. EQUIP/FURNISH UNIV. FACILI</DescriptionOfPurpose>
        <Defeased>false</Defeased>
        <OnBehalfOfIssuer>false</OnBehalfOfIssuer>
        <PoolFinancing>false</PoolFinancing>
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        <IssuanceCostsFromProceeds>2933</IssuanceCostsFromProceeds>
        <CreditEnhancement>0</CreditEnhancement>
        <WorkingCapitalExpenditures>0</WorkingCapitalExpenditures>
        <CapitalExpenditures>0</CapitalExpenditures>
        <OtherSpentProceeds>14375000</OtherSpentProceeds>
        <AmountUnspent>0</AmountUnspent>
        <YearOfSubstCompletion>2001</YearOfSubstCompletion>
        <CurrentRefunding>true</CurrentRefunding>
        <AdvanceRefunding>false</AdvanceRefunding>
        <FinalAllocationMade>true</FinalAllocationMade>
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        <CreditEnhancement>0</CreditEnhancement>
        <WorkingCapitalExpenditures>0</WorkingCapitalExpenditures>
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        <MngmentCntrctBondFinancdPrprty>false</MngmentCntrctBondFinancdPrprty>
        <AnyResearchAgreements>false</AnyResearchAgreements>
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        <TotalPrivateBusinessUse>0.00000</TotalPrivateBusinessUse>
        <BondIssMeetPrvtSecurityPayTest>false</BondIssMeetPrvtSecurityPayTest>
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        <RemedialActionTaken>false</RemedialActionTaken>
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        <RebateNotDueYet>true</RebateNotDueYet>
        <ExceptionToRebate>false</ExceptionToRebate>
        <NoRebateDue>false</NoRebateDue>
        <VariableRateIssue>false</VariableRateIssue>
        <HedgeIdentifiedInBooksAndRecds>false</HedgeIdentifiedInBooksAndRecds>
        <NameOfHedgeProvider>
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        </NameOfHedgeProvider>
        <GrossProceedsInvestedInGIC>false</GrossProceedsInvestedInGIC>
        <NameOfGICProvider>
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        </NameOfGICProvider>
        <GrossProceedsInvested>false</GrossProceedsInvested>
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      <Form990ScheduleKPartIV>
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        <Form8038TFiled>false</Form8038TFiled>
        <RebateNotDueYet>true</RebateNotDueYet>
        <ExceptionToRebate>false</ExceptionToRebate>
        <NoRebateDue>false</NoRebateDue>
        <VariableRateIssue>false</VariableRateIssue>
        <HedgeIdentifiedInBooksAndRecds>false</HedgeIdentifiedInBooksAndRecds>
        <NameOfHedgeProvider>
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        </NameOfHedgeProvider>
        <GrossProceedsInvestedInGIC>false</GrossProceedsInvestedInGIC>
        <NameOfGICProvider>
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        <GrossProceedsInvested>false</GrossProceedsInvested>
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      <Form990ScheduleKPartV>
        <BondReferenceCd>B</BondReferenceCd>
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      </Form990ScheduleKPartV>
      <Form990ScheduleKPartVI>
        <Identifier>TOTAL PROCEEDS OF ISSUE</Identifier>
        <ReturnReference>SCHEDULE K, PART II, LINE 3, COLUMN B</ReturnReference>
        <Explanation>AMOUNT IS NOT EQUAL TO ISSUE PRICE DUE TO INVESTMENT EARNINGS EARNED DURING THE PROJECT PERIOD.</Explanation>
      </Form990ScheduleKPartVI>
      <Form990ScheduleKPartVI>
        <Identifier>PRIVATE BUSINESS USE</Identifier>
        <ReturnReference>SCHEDULE K, PART III, COLUMN A</ReturnReference>
        <Explanation>PROJECTS WERE ORIGINALLY FINANCED PRIOR TO JANUARY 1, 2003.</Explanation>
      </Form990ScheduleKPartVI>
    </IRS990ScheduleK>
    <IRS990ScheduleL documentId="IRS990ScheduleL">
      <Form990ScheduleLPartIV>
        <NameOfInterestedPerson>
          <NamePerson>See Schedule L Part V</NamePerson>
        </NameOfInterestedPerson>
      </Form990ScheduleLPartIV>
      <Form990ScheduleLPartV>
        <Identifier>BUSINESS TRANSACTIONS WITH INTERESTED PERSONS</Identifier>
        <ReturnReference>Schedule L, Part IV</ReturnReference>
        <Explanation>TRANSACTION 1 (A) RONALD WINKLER (B) RONALD WINKLER IS A TRUSTEE OF ATSU &amp; 100% OWNER OF KIRKSVILLE MINI STORAGE, INC. DBA WINKLER COMMUNICATION (C) $128,405 (D) KIRKSVILLE MINI STORAGE, INC. PROVIDED, INSTALLED, AND SERVICED THE COMMUNICATION EQUIPMENT AT THE KIRKSVILLE CAMPUS (E) NO</Explanation>
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        <ReturnReference>SCHEDULE M, PART I, COLUMN B</ReturnReference>
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      <GeneralExplanation>
        <Identifier>ORGANIZATION'S MISSION</Identifier>
        <ReturnReference>FORM 990, PART III, LINE 1</ReturnReference>
        <Explanation>A.T. Still University of Health Sciences serves as a learning-centered university dedicated to preparing highly competent professionals through innovative academic programs with a commitment to continue its osteopathic heritage and its focus on whole person healthcare, scholarship, community health, interprofessional education, diversity, and underserved populations.</Explanation>
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      <GeneralExplanation>
        <Identifier>Program Service Accomplishments</Identifier>
        <ReturnReference>Form 990, Part III, Line 4a</ReturnReference>
        <Explanation>ABOUT A.T. STILL UNIVERSITY Established in 1892 by Andrew Taylor Still, MD, DO, the founder of osteopathic medicine, A.T. Still University (ATSU) began as the nation's first college of osteopathic medicine and has evolved into a leading university of health sciences comprised of six schools on two campuses. The University's schools include the Kirksville College of Osteopathic Medicine (KCOM), School of Health Management (SHM), and Missouri School of Dentistry&amp; Oral Health (MOSDOH), located in Kirksville, Mo. The Arizona School of Health Sciences (ASHS), Arizona School of Dentistry &amp; Oral Health (ASDOH), and School of Osteopathic Medicine in Arizona (SOMA) are located in Mesa, Az. Student learning is at the heart of A.T. Still University. Our students and faculty are part of a distinguished heritage of humanistic healthcare based on an integrated approach that includes the body, mind, and spirit of the patient. This whole person approach to healthcare is the foundation of the educational experience and is integrated into each school's curricula, from audiology to dentistry, family practice to public health, and online to residential programs. ATSU received honors for exemplary service to America's communities by the Corporation for National and Community Service with a place on the President's Higher Education Community Service Honor Roll. At all levels of ATSU, beginning with the mission statement itself, the University practices two-way involvement in its communities, thus providing not only service but also true engagement. This is evidenced by listening and responding to community and profession needs through the development of programs, involvement in off-site clinics, emergency response teams, active membership and collaboration with various community organizations by both faculty and students, and communicating with University constituents to advance the mission of ATSU and respond to the needs of our greater community. Our programs Osteopathic Medicine (DO) Biomedical Sciences (MS) Athletic Training (MS) Audiology (AuD) Transitional Audiology (tAuD) Occupational Therapy (MS) Transitional Occupational Therapy (tOTD) Physician Assistant Studies (MS) Physical Therapy (DPT) Transitional Physical Therapy (tDPT) Advanced Occupational Therapy (MS) Advanced Physician Assistant Studies (MS) Health Sciences (DHSc) Human Movement (MS) Public Health (MPH) Health Administration (MHA) Health Administration (DHA) Health Education (DHEd) Dental Medicine (DMD) Certificates Orthodontics Public Health - Dental Emphasis Sports Conditioning Geriatric Exercise Science Exercise &amp; Sports Psychology Quick facts about ATSU Campus Locations Kirksville, MO Mesa, AZ Kirksville population 17,522 Mesa population 452,084 Campus size Kirksville, Mo. - 150 acres Mesa, Az. - 59 acres Enrollment (2012-13) Total - 3,141 Kirksville College of Osteopathic Medicine - 718 School of Osteopathic Medicine in Arizona - 425 Arizona School of Health Sciences - 1,311 School of Health Management - 390 Arizona School of Dentistry &amp; Oral Health - 297 Number of Programs (Fall 2012) Total - 24 Doctoral - 10 Master's - 9 Certificates - 5 International Enrollment (2012-13) Approximately 186 students from more than 44 countries Degrees Granted (2012-13) Doctoral - 729 Master's - 324 Certificates - 76 Living alumni (2012-13) Total: 14,594 - ASHS: 6,772 - ASDOH: 353 - KCOM: 6,498 - SHM: 1,122 - SOMA: 185 *Please note that some ATSU alumni have more than one ATSU degree. Full-Time Employees (2012-13) 725 Student/Faculty Ratio (2012-13) 14:1 (Full Time Faculty-224) Male/Female Students (2012-13) 1,429/1,712 Points of University Pride - The Health Resources and Services Administration (HRSA) granted (ATSU) eight awards totaling more than $5.86 million. These gifts will greatly benefit the Kirksville, Mo., and Mesa, AZ., communities, and beyond. In all, ATSU was awarded more than 60 percent of HRSA's Federal Health Professions grant funding in Missouri and more than 75 percent of all grants in Arizona. (Oct. 2010) - The American Heart Association has recognized ATSU for its outstanding efforts to create a fitness- and wellness-friendly environment on its campuses in Kirksville, Mo., and Mesa, Az. This is the sixth time that the University has been recognized as a Fit-Friendly Worksite. (June 2013) - ATSU has been touted as the nation's dominant graduate American Indian health professions institution. American Indian enrollment across the institution typically ranges between 40 and 50 students. KCOM - Founding college of osteopathic medicine - Graduated more than 15,000 DOs - Offers Master's in Biomedical Sciences (MS) - First osteopathic medical school to receive two NIH research grants for clinical OMM methodology - Home of the Museum of Osteopathic Medicine SOMA - Only medical school in the country to integrate physical diagnosis with ongoing didactic curriculum - Curriculum blends the case presentation model and the Harvard-Cambridge model ASDOH - Arizona's first dental school - One out of four dental school applicants nationwide applies to ASDOH - Nation's highest percentage of American Indian students at 6 percent - Operates Thunderbirds Charities Special care Unit at Dental Care West in Glendale, the only one of its kind in Arizona. - More than 75 full-time faculty members and nationally recognized experts teach one-week modules in their areas of expertise. - In a significant community investment to increase access to oral care for the uninsured and underinsured in the West Valley, Thunderbirds Charities has awarded $75,000 to expand Dental Care West a university-affiliated dental clinic run by (ATSU-ASDOH). (August 2010) - The American Association of Orthodontists awarded Jae Hyun Park, DMD, MSD, MS, PhD, director of the Postgraduate Orthodontic program at ATSU-ASDOH, the 2010 AAO Academy of Academic Leadership Sponsorship Program Award. (May 2010) - The Commission on Dental Accreditation has awarded a seven-year accreditation - the top accreditation - to ATSU-ASDOH) postgraduate orthodontic program. (Feb. 2010) - ASDOH typically has about half of the nation's American Indian dental students ASHS - Graduated more than 4,000 students - Audiology externs are placed in prestigious clinical facilities across the country. - The Physician Assistant Studies (PA) program is producing practitioners that work to provide primary care and other needed medical services to populations in need with a focus on the nation's rural and inner-city, underserved communities. - The most recent PA graduating class (2012) pass rate for the Physician Assistant National Certifying Exam currently stands at 96 percent for first-time takers. - 20 percent of all Native American Physician Assistants in the United States graduated from ASHS - The OT program received a 10-year accreditation (the longest possible) on its last re-accreditation. (ACOTE - our accrediting body awards 5 yr., 7 yr., and 10 yr. accreditation. The OT program's former accreditation was a 7 yr. term. The next re-accreditation will be AY 2019-2020.) - OT program first-time pass rates for new graduates on the NBCOT certification exam for the past 3 years (2009, 2010, and 2011) were above the national average. (2011: ATSU = 88%, National = 84%; 2010: ATSU = 88%, National = 82%; 2009: ATSU = 86%, National = 78%) - Overall pass rate on the NBCOT exam since the beginning of the program through 2011 is 100 percent. - The OT program continues to offer a variety of community-based practice experiences as part of coursework enrichment before clinical rotations. - OT students and faculty are involved in numerous and wide ranging professional and community service activities including international and interdisciplinary projects as well as with local community partners. - OT residential program has faculty-led research - which guides groups of students through the completion of a year-long project which culminates in formal research and poster presentations. - AMOT program students develop and implement practice-based capstone projects that provide them with opportunities to serve in their practice settings and/or special populations in unique and creative and innovative ways. - Partnerships with National Center for American Indian Health Professions(NCAIHP) - Physical Therapy program noted for tutelage of professors with doctorates from top notch universities like George Washington, Columbia, ASU, and NAU - In an era when healthcare reform is an ongoing concern for the public, students at Still ATSU are addressing fundamental issues facing today's healthcare system. ATSU-ASHS launched its first winter institute for its Doctor of Health Sciences (DHSc) program February 7-12. Approximately 70 students from the United States and several international students participated. (Feb. 2010) - Physician Assistant program has graduated some 20 percent of the nation's American Indian PAs</Explanation>
      </GeneralExplanation>
      <GeneralExplanation>
        <Identifier>SHM</Identifier>
        <ReturnReference>- First dental public health (MPH) curriculum to be offered 100 percent</ReturnReference>
        <Explanation>online - First dental public health certificate offered to dental medicine (DMD) students - Online writing center assists students - Ninety-seven percent of ATSU online students said they will recommend ATSU to others - Initial accreditation from Council on Dental Accreditation (CODA) for a Dental Public Health Residency program (2012) MOSDOH - ATSU opened the Missouri School of Dentistry &amp; Oral Health (MOSDOH) in Kirksville, Mo. in Oct. 2013. - MOSDOH is housed in the Interprofessional Education building, a new 61,000-square-foot facility on the Missouri campus. - Graduate oral health providers who will be caring, technologically adept dentists and who will become community and educational leaders - Graduates will have a strong foundation of critical inquiry, evidence- based practice, research, cultural competency, and cultural fluency, as well as an orientation to prevention and inter-professional and interdisciplinary healthcare experiences. - MOSDOH will strive to promote the delivery of optimal patient care and we will foster the transfer of newly acquired knowledge, skills, abilities, and technology to the profession and to the community. - The curriculum and training of students will intertwine the qualities of compassion, altruism, and community-focus, with the traditional educational components of oral health competencies, ethics, integrity, leadership, service, professionalism, and excellence.</Explanation>
      </GeneralExplanation>
      <GeneralExplanation>
        <Identifier>BUSINESS RELATIONSHIPS</Identifier>
        <ReturnReference>Form 990, Part VI, Section A, Line 2</ReturnReference>
        <Explanation>REID BUTLER &amp; PAUL LINES HAVE A BUSINESS RELATIONSHIP.</Explanation>
      </GeneralExplanation>
      <GeneralExplanation>
        <Identifier>Form 990 Review Process</Identifier>
        <ReturnReference>Form 990, Part VI, Section B, Line 11B</ReturnReference>
        <Explanation>THE UNIVERSITY POLICY, ADOPTED IN MAY 2009, STIPULATES THAT THE AUDIT TEAM OF THE BOARD OF TRUSTEES SHALL REVIEW AND APPROVE THE IRS FORM 990 ANNUAL TAX FILING PRIOR TO SUBMISSION. FOR THE TAX YEAR ENDING JUNE 30, 2013, THIS REVIEW AND APPROVAL TOOK PLACE ON JANUARY 24, 2014. THE MINUTES OF THIS MEETING DOCUMENT THIS REVIEW AND APPROVAL. A COMPLETE COPY OF THE FORM 990, INCLUDING ALL SCHEDULES, WERE PROVIDED TO EACH BOARD OF TRUSTEE MEMBER PRIOR TO ITS SUBMISSION TO THE INTERNAL REVENUE SERVICE.</Explanation>
      </GeneralExplanation>
      <GeneralExplanation>
        <Identifier>Conflict of Interest Policy</Identifier>
        <ReturnReference>Form 990, Part VI, Section B, Lines 12C</ReturnReference>
        <Explanation>AT THE TIME OF HIRE (OR ELECTION IN THE CASE OF TRUSTEES) AND ANNUALLY THEREAFTER, THE PRESIDENT OR HIS/HER DESIGNEE SHALL PROVIDE TO THE BOARD AND TO ALL EXECUTIVE OFFICERS AND KEY EMPLOYEES A COPY OF THE CONFLICT OF INTEREST POLICY AND THE APPLICABLE CONFLICT OF INTEREST DISCLOSURE FORM AND QUESTIONNAIRE, WHICH SHALL BE COMPLETED TO IDENTIFY ANY RELATIONSHIPS, POSITIONS OR CIRCUMSTANCES WITH RESPECT TO WHICH IT IS BELIEVED A CONFLICT MAY ARISE. SUCH ANNUAL MONITORING AND REVIEW PROCEDURES SHALL BE PART OF THE CORPORATE COMPLIANCE PLAN. AN APPROPRIATE REPORT SHALL BE SUBMITTED TO THE AUDIT TEAM CONCERNING ANY INTEREST SO DISCLOSED. EACH MEMBER OF THE BOARD OF TRUSTEES AND ALL MANAGEMENT ASSOCIATES SHALL DISCLOSE FULLY AND FRANKLY ANY AND ALL ACTUAL OR POTENTIAL CONFLICTS OR DUALITY OF INTEREST OR RESPONSIBILITY, WHETHER INDIVIDUAL, PERSONAL OR BUSINESS, WHICH MAY EXIST. IF IT IS DETERMINED THAT THERE IS A CONFLICT OF INTEREST WITH RESPECT TO A BOARD MEMBER, THE CONFLICT SHALL BE REPORTED TO THE FULL BOARD, AND THE AFFECTED BOARD MEMBER MUST ANSWER ANY QUESTIONS PERTAINING TO THE CONFLICT THAT OTHER BOARD MEMBERS MAY HAVE. IF A VOTE IS REQUIRED, THE AFFECTED BOARD MEMBER SHALL ABSTAIN FROM VOTING.</Explanation>
      </GeneralExplanation>
      <GeneralExplanation>
        <Identifier>Compensation Review</Identifier>
        <ReturnReference>Form 990, Part VI, Section B, Lines 15a &amp; b</ReturnReference>
        <Explanation>THE UNIVERSITY OPERATES UNDER A "KEY PERSONNEL COMPENSATION PROGRAM". The AUDIT Team of the Board administers the Compensation Program by recommending a competitive range of compensation for the officers and key employees of the University to be adopted by the full Board. The competitive ranges shall be determined by analyzing compensation structures for similar positions from similarly-situated organizations and from the independent compensation survey recently performed on the University by the Hay Group. The AUDIT Team reviews such data and when necessary, makes recommendations for amendments to the compensation ranges for consideration and adoption by the full board.</Explanation>
      </GeneralExplanation>
      <GeneralExplanation>
        <Identifier>Availability of Documents</Identifier>
        <ReturnReference>Form 990, Part VI, Section C, Line 19</ReturnReference>
        <Explanation>The organization's governing documents, conflict of interest policy and financial statements are available upon request.</Explanation>
      </GeneralExplanation>
      <GeneralExplanation>
        <Identifier>OTHER CHANGES IN NET ASSETS FOR FUND BALANCES</Identifier>
        <ReturnReference>FORM 990, PART XI, LINE 9</ReturnReference>
        <Explanation>GAIN/(LOSS) ON ANNUITY UNITRUST $156,848</Explanation>
      </GeneralExplanation>
      <GeneralExplanation>
        <Identifier>OTHER FEES FOR SERVICES FOR NON-EMPLOYEES</Identifier>
        <ReturnReference>FORM 990 PART IX LINE 11G</ReturnReference>
        <Explanation>DESCRIPTION:CHC AGREEMENTS &amp; PARTNERSHIPS TOTAL FEES:4111739</Explanation>
      </GeneralExplanation>
      <GeneralExplanation>
        <Identifier>OTHER FEES FOR SERVICES FOR NON-EMPLOYEES</Identifier>
        <ReturnReference>FORM 990 PART IX LINE 11G</ReturnReference>
        <Explanation>DESCRIPTION:AFFILIATED HOSPITAL SERVICES TOTAL FEES:1217597</Explanation>
      </GeneralExplanation>
      <GeneralExplanation>
        <Identifier>OTHER FEES FOR SERVICES FOR NON-EMPLOYEES</Identifier>
        <ReturnReference>FORM 990 PART IX LINE 11G</ReturnReference>
        <Explanation>DESCRIPTION:OTHER CONTRACTED SERVICES TOTAL FEES:6084474</Explanation>
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