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.
Attach to Form 990 or Form 990-EZ. See separate instructions.
OMB No. 1545-0047
2010
Open to Public Inspection
Name of the organization
Heartland Long Term Acute Care Hospital
Employer identification number
26-1972987
Part I
Reason for Public Charity Status
(All organizations must complete this part.) See instructions
The organization is not a private foundation because it is: (For lines 1 through 11, check only one box.)
1
2
3
4
5
section 170(b)(1)(A)(iv). (Complete Part II.)
6
7
8
9
receipts from activities related to its exempt functions—subject to certain exceptions, and (2) no more than 331/3% of
its support from gross investment income and unrelated business taxable income (less section 511 tax) from businesses
acquired by the organization after June 30, 1975. See section 509(a)(2). (Complete Part III.)
10
11
e
By checking this box, I certify that the organization is not controlled directly or indirectly by one or more disqualified persons other than foundation managers and other than one or more publicly supported organizations described in section 509(a)(1) or section 509(a)(2).
f
If the organization received a written determination from the IRS that it is a Type I, Type II or Type III supporting organization, check this box
..................................................
g
Since August 17, 2006, has the organization accepted any gift or contribution from any of the following persons?
(i) a person who directly or indirectly controls, either alone or together with persons described in (ii)
Yes
No
and (iii) below, the governing body of the the supported organization?
................
11g(i)
(ii)
a family member of a person described in (i) above?
......................
11g(ii)
(iii)
a 35% controlled entity of a person described in (i) or (ii) above?
................
11g(iii)
h
Provide the following information about the supported organization(s).
(i) Name of supported organization
(ii) EIN
(iii) Type of organization (described on lines 1- 9 above or IRC section (see instructions))
(iv) Is the organization in col. (i) listed in your governing document?
(v) Did you notify the organization in col. (i) of your support?
(vi) Is the organization in col. (i) organized in the U.S.?
(vii) Amount of support?
Yes
No
Yes
No
Yes
No
Total
For Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 11285F
Schedule A (Form 990 or 990-EZ) 2010
Schedule A (Form 990 or 990-EZ) 2010
Page 2
Part II
Support Schedule for Organizations Described in IRC 170(b)(1)(A)(iv) and 170(b)(1)(A)(vi) (Complete only if you checked the box on line 5, 7, or 8 of Part I or if the
organization failed to qualify under Part III. If the organization fails to
qualify under the tests listed below, please complete Part III.)
Section A. Public Support
Calendar year(or fiscal year beginning in)
(a) 2006
(b) 2007
(c) 2008
(d) 2009
(e) 2010
(f) Total
1
Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grants.") ....
2
Tax revenues levied for the organization's benefit and either paid to or expended on its behalf.......
3
The value of services or facilities furnished by a governmental unit to the organization without charge..
4
Total. Add lines 1 through 3..
5
The portion of total contributions by each person (other than a governmental unit or publicly supported organization) included
on line 1 that exceeds 2% of the amount shown on line 11, column (f)..
6
Public Support. Subtract line 5 from line 4.
Section B. Total Support
Calendar year(or fiscal year beginning in)
(a) 2006
(b) 2007
(c) 2008
(d) 2009
(e) 2010
(f) Total
7
Amounts from line 4..
8
Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources..
9
Net income from unrelated business activities, whether or not the business is regularly carried on..
10
Other income. (Explain in Part IV.) Do not include gain or loss from the sale of capital assets..
11
Total support (Add lines 7 through 10).
12
Gross receipts from related activities, etc. (See instructions.)
..................
12
13
First Five Years
If the Form 990 is for the organization's first, second, third, fourth, or fifth tax year as a 501(c)(3) organization,
check this box and stop here..........................................
Section C. Computation of Public Support Percentage
14
Public Support Percentage for 2010 (line 6 column (f) divided by line 11 column (f))
.........
14
15
Public Support Percentage for 2009 Schedule A, Part II, line 14
...............
15
16a
33 1/3% support test—2010.
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
......................
b
33 1/3% support test—2009.
If the organization did not check the 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
.....................
17a
10%-facts-and-circumstances test—2010.
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 IV how the organization meets the "facts and circumstances" test. The organization qualifies as a publicly supported
organization
..................................................
b
10%-facts-and-circumstances test—2009.
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 IV how the organization meets the "facts and circumstances" test. The organization qualifies as a publicly supported organization
..............................................
18
Private Foundation
If the organization did not check a box on line 13, 16a, 16b, 17a or 17b, check this box and see
instructions
...................................................
Schedule A (Form 990 or 990-EZ) 2010
Schedule A (Form 990 or 990-EZ) 2010
Page 3
Part III
Support Schedule for Organizations Described in IRC 509(a)(2) (Complete only if you checked the box on line 9 of Part I or if the organization
failed to qualify under Part II. If the organization fails to qualify under
the tests listed below, please complete Part II.)
Section A. Public Support
Calendar year(or fiscal year beginning in)
(a) 2006
(b) 2007
(c) 2008
(d) 2009
(e) 2010
(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) 2006
(b) 2007
(c) 2008
(d) 2009
(e) 2010
(f) Total
9
Amounts from line 6...
10a
Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources..
b
Unrelated business taxable income (less section 511 taxes) from businesses acquired after June 30, 1975.
c
Add lines 10a and 10b.
11
Net income from unrelated business activities not included in line 10b, whether or not the business is regularly carried on.
12
Other income. Do not include gain or loss from the sale of capital assets (Explain in Part IV.)
13
Total support (Add lines 9, 10c, 11 and 12.).
14
First Five Years
If the Form 990 is for the organization's first, second, third, fourth, or fifth tax year as a 501(c)(3) organization,
check this box and stop here.............................................
Section C. Computation of Public Support Percentage
15
Public Support Percentage for 2010 (line 8 column (f) divided by line 13 column (f))
.........
15
16
Public support percentage from 2009 Schedule A, Part III, line 15
...............
16
Section D. Computation of Investment Income Percentage
17
Investment income percentage for 2010 (line 10c column (f) divided by line 13 column (f))
......
17
18
Investment income percentage from 2009 Schedule A, Part III, line 17
.............
18
19a
33 1/3% support tests—2010.
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
..........
b
33 1/3% support tests—2009.
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
....
20
Private Foundation
If the organization did not check a box on line 14, 19a or 19b, check this box and see instructions
.....
Schedule A (Form 990 or 990-EZ) 2010
Schedule A (Form 990 or 990-EZ) 2010
Page 4
Part IV
Supplemental Information.
Supplemental Information. Complete this part to provide the explanation required by Part II, line 10; Part II, line 17a or 17b; or Part III, line 12. Also complete this part for any additional information. (See instructions).
Facts And Circumstances Test
Explanation
Schedule A (Form 990 or 990-EZ) 2010
Additional Data
Software ID:
Software Version:
-
TIN:
SCHEDULE O (Form 990 or 990-EZ)
Department of the Treasury Internal Revenue Service
Supplemental Information to Form 990 or 990-EZ
Complete to provide information for responses to specific questions on
Form 990 or to provide any additional information.
Attach to Form 990 or 990-EZ.
OMB No. 1545-0047
2010
Open to Public Inspection
Name of the organization
Heartland Long Term Acute Care Hospital
Employer identification number
26-1972987
Identifier
Return Reference
Explanation
PROGRAM SERVICE ACCOMPLISHMENTS
FORM 990, PART III, LINE 4A
HEARTLAND LONG TERM ACUTE CARE HOSPITAL OFFERS THE COMMUNITY AND SERVICE AREA OF NORTHWEST MISSOURI A NEW SPECIALIZED LEVEL OF INPATIENT CARE FOR THE MEDICALLY COMPLEX PATIENT WHO REQUIRES EXTENDED HOSPITALIZATION. THE 41-BED HOSPITAL-WITHIN-A-HOSPITAL IS CO-LOCATED WITHIN HEARTLAND REGIONAL MEDICAL CENTER IN ST. JOSEPH, MISSOURI. IT PROVIDES CARE TO THE MEDICALLY COMPLEX PATIENT AND ALSO OFFERS A CLOSE OBSERVATION UNIT CONSISTING OF 8 BEDS FOR PATIENTS WHO REQUIRE INCREASED NURSING-TO-PATIENT RATIOS AND TECHNICAL SUPPORT FOR MORE CRITICAL CARE NEEDS SUCH AS VENTILATOR WEANING AND TELEMETRIC MONITORING. PATIENTS HAVE AN AVERAGE LENGTH OF STAY OF LONGER THAN 25 DAYS. OUR PATIENTS REQUIRE DAILY PHYSICIAN VISITS, ROUND-THE-CLOCK NURSING CARE AS WELL AS SUCH MULTIDISCIPLINARY SERVICES AS RESPIRATORY THERAPISTS, DIETITIANS, DIALYSIS TECHNICIANS AND PHYSICAL, OCCUPATIONAL, AND SPEECH PATHOLOGISTS DUE TO THEIR MEDICAL COMPLICATIONS AND NEEDS. CARE FOR OUR PATIENTS IS PROVIDED IN A SMALL, PERSONALIZED ENVIRONMENT THAT OFFERS A LARGE ARRAY OF RESOURCES, PRIVATE ROOMS AND AMENITIES FOR FAMILIES. PATIENTS ARE TYPICALLY REFERRED TO HEARTLAND LONG TERM ACUTE CARE HOSPITAL AFTER RECEIVING CARE IN A HOSPITAL-BASED INTENSIVE CARE UNIT OR MEDICAL-SURGICAL UNIT.
BUSINESS/FAMILY RELATIONSHIPS
FORM 990, PART VI, SECTION A, LINE 2
CURT KRETZINGER AND JOHN P. WILSON HAVE A BUSINESS RELATIONSHIP. THEY ARE EITHER OFFICERS AND/OR DIRECTORS OF MIDWESTERN HEALTH MANAGEMENT, INC., COMMUNITY HEALTH PLAN, INC., COMMUNITY HEALTH PLAN INSURANCE COMPANY, HHS PROPERTIES, INC., AND UPTOWN HOUSING, INC., WHICH ARE RELATED FOR PROFIT CORPORATIONS. CURT KRETZINGER AND JOHN P. WILSON ARE OFFICERS OF HEARTLAND HEALTH, HEARTLAND REGIONAL MEDICAL CENTER, RELATED NOT-FOR-PROFIT CORPORATIONS.
DELEGATION OF MANAGEMENT DUTIES
FORM 990, PART VI, SECTION A, LINE 3
HEARTLAND LONG TERM ACUTE CARE HOSPITAL ENTERED INTO A MANAGEMENT SERVICES AGREEMENT WITH MURER CONSULTANTS, INC.
MEMBERS OR STOCKHOLDERS
FORM 990, PART VI, SECTION A, LINE 6
HEARTLAND HEALTH, A MISSOURI NONPROFIT CORPORATION, IS THE SOLE MEMBER OF HEARTLAND LONG TERM ACUTE CARE HOSPITAL (HEARTLAND LTACH). HEARTLAND HEALTH HAS THE RIGHT TO ELECT THE BOARD OF DIRECTORS OF HEARTLAND LTACH. HEARTLAND HEALTH IS NOT ENTITLED TO RECEIVE A SHARE OF HEARTLAND LTACH'S PROFITS OR EXCESS DUES. UPON DISSOLUTION OF HEARTLAND LTACH, THEY SHALL DISPOSE OF ALL OF THE ASSETS OF THE CORPORATION EXCLUSIVELY TO HEARTLAND HEALTH, HEARTLAND REGIONAL MEDICAL CENTER, OR THEIR SUCCESSORS, OR ASSIGNS, ASSUMING THAT AS OF THE DATE OF DISSOLUTION, SUCH ENTITIES REMAIN QUALIFIED AS EXEMPT ORGANIZATIONS UNDER SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE OF 1986.
MEMBERS OR STOCKHOLDERS MAY ELECT GOVERNING BODY
FORM 990, PART VI, SECTION A, LINE 7A
HEARTLAND HEALTH, BEING THE SOLE MEMBER OF HEARTLAND LTACH, HAS THE RIGHT TO ELECT ALL OF THE BOARD OF DIRECTORS.
GOVERNING BODY DECISIONS SUBJECT TO APPROVAL OF MEMBERS OR STOCKHOLDERS
FORM 990, PART VI, SECTION A, LINE 7B
THE CORPORATE BYLAWS OF HEARTLAND LTACH IDENTIFY CERTAIN RIGHTS AND POWERS WHICH ARE RESERVED TO HEARTLAND HEALTH, THE SOLE MEMBER. IN EACH INSTANCE, THE RIGHTS AND POWERS RESERVED TO THE SOLE MEMBER MAY BE SUMMARIZED AS FOLLOWS: A. ANY FUNDAMENTAL CHANGE IN THE MISSION, PURPOSE OR PHILOSOPHY OF THE HOPSITAL B. ANY CHANGE AFFECTING OR THREATENING HOST HOSPITAL'S COMPLIANCE AND REQUIRED QUALIFICATIONS AS A SOLE COMMUNITY PROVIDER, PARTICULARLY DURING THE FIRST SIX (6) MONTHS OF REQUISITE DATA COLLECTION UNDER CLASSIFICATION AS A SHORT TERM ACUTE CARE HOSPITAL, OR IN THE EVENT THE HOSPITAL REVERTS TO ITS INITIAL CMS CERTIFICATION AS A SHORT-TERM ACUTE CARE HOSPITAL C. THE INCURRENCE OF DEBT, INCLUDING WITHOUT LIMITATION, BORROWINGS, GUARANTEES, LOANS, ENCUMBRANCES, OPERATING LEASES, PURCHASE OR LEASE OF REAL ESTATE, AND CAPITAL LEASES, IN EXCESS OF FIVE HUNDRED THOUSAND DOLLARS ($500,000), MEASURED IN AN ANNUAL AGGREGATE D. ANY MERGER OR CONSOLIDATION TO WHICH THE HOSPITAL IS A PARTY E. THE SALE OR DISPOSITION OF ALL OR SUBSTANTIALLY ALL OF THE ASSETS OF THE HOSPITAL F. POLICIES PERTAINING TO CHARITY CARE G. ANY RELEASE OR CANCELLATION OF INDIVIDUAL CLAIMS IN EXCESS OF $75,000 H. ANY CAPITAL EXPENDITURES WHICH IN THE AGGREGATE EXCEED $250,000 ANNUALLY I. APPOINTMENT AND REMOVAL OF CORPORATE DIRECTORS J. THE DEFENSE, SETTLEMENT OR RESOLUTION OF ANY DISPUTE INVOLVING THE HOSPITAL IN WHICH THE AMOUNT IN CONTROVERSY IS IN EXCESS OF $250,000 K. THE DEFENSE, SETTLEMENT OR RESOLUTION OF ANY REGULATORY CHALLENGES TO THE LEGAL STRUCTURE OF THE HOSPITAL, ALLEGED OVERPAYMENTS FROM ANY GOVERNMENTAL AGENCY OR ANY ALLEGATIONS FROM A GOVERNMENTAL AGENCY OF FRAUD AND ABUSE L. AMEND THE BYLAWS OF THE HOSPITAL M. APPROVE THE STRATEGIC PLAN OF THE HOSPITAL
FORM 990 REVIEW PROCESS
FORM 990, PART VI, SECTION B, LINE 11B
AN INDEPENDENT ACCOUNTING FIRM PREPARES AND REVIEWS THE 990. THE CHIEF EXECUTIVE OFFICER, THE TREASURER, THE ASSISTANT TREASURER, AND THE TAX SPECIALIST OF HEARTLAND REGIONAL MEDICAL CENTER REVIEW THE 990. THE COMPLETE 990 IS THEN POSTED TO A WEBSITE FOR ALL VOTING MEMBERS TO ACCESS BEFORE IT IS FILED.
MONITORING THE CONFLICT OF INTEREST POLICY
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 THEIR POSITION ON THE BOARD. IN THIS DOCUMENT, THEY AGREE THAT THEY WILL DISCLOSE ANY ACTIVITIES IN WHICH THEY MAY NOT BE INDEPENDENT IN REGARDS TO A TRANSACTION. THIS DOCUMENT IS DISTRIBUTED AND HELD BY LEGAL COUNSEL. THE MEMBER ALSO SIGNS HEARTLAND'S CODE OF CONDUCT DOCUMENT IN WHICH THEY AGREE TO ETHICAL BEHAVIOR AND ADHERING TO 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. ALL DISMISSALS AND ABSTENTIONS ARE RECORDED IN THE MINUTES OF THE BOARD MEETING. ANNUALLY, THE OFFICERS AND KEY EMPLOYEES ARE REQUIRED TO SIGN A CODE OF CONDUCT DOCUMENT IN WHICH THEY AGREE TO ETHICAL BEHAVIOR AND ADHERING TO CONFIDENTIALITY POLICIES. THEY ALSO RECEIVE A QUESTIONNAIRE WHICH FACILITATES THE DISCLOSURE OF ANY REPORTABLE ACTIVITIES TO THE CORPORATE COMPLIANCE OFFICER.
COMPENSATION REVIEW
FORM 990, PART VI, SECTION B, LINES 15A & 15B
AN ANNUAL REVIEW WAS PERFORMED DURING FISCAL YEAR 2011. MARKET DATA IS PROVIDED BY INTEGRATED HEALTH STRATEGIES (IHS). A COMPENSATION COMMITTEE COMPRISED OF THE HEARTLAND HEALTH BOARD CHAIRMAN, HEARTLAND HEALTH BOARD VICE-CHAIRMAN AND THREE ADDITIONAL HEARTLAND HEALTH BOARD MEMBERS AND INDEPENDENT LEGAL COUNSEL, AS SCRIBE OVERSEE AN ANNUAL SALARY REVIEW PROCESS FOR OFFICERS AND ADMINISTRATORS. 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. OUR FACILITY SIZE, OUR NOT-FOR-PROFIT STATUS AND THE SCOPE OF EACH JOB POSITION IS COMPARED TO LIKE 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.
AVAILABILITY OF DOCUMENTS
FORM 990, PART VI, SECTION C, LINE 19
THE ORGANIZATION DOES NOT MAKE ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY OR FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC.