TY 2015 Form 990

(A) Name and Title	(B) Average hours per week (list any hours for related organizations below dotted line)	(C) Position (do not check more than one box, unless person is both an officer and a director/trustee)	(E) Reportable compensation from related organizations (W- 2/1099-MISC)
(1) DAVE HOWERY...................................................................... DIRECTOR	1.0 ................. 0.0	X		2,500	0	0
(2) DAN HECKMAN...................................................................... DIRECTOR	1.0 ................. 0.0	X		2,500	0	0
(3) DR JOHN OLSON...................................................................... DIRECTOR/STAFF PHYSICIAN	39.0 ................. 1.0	X		708,479	0	34,779
(4) STEVE SCHRAM...................................................................... DIRECTOR/CHAIR	1.0 ................. 0.0	X	X	2,500	0	0
(5) BARBARA WURTZLER...................................................................... DIRECTOR/VICE CHAIR	1.0 ................. 0.0	X	X	2,500	0	0
(6) DR MARK LANEY...................................................................... DIRECTOR/PRESIDENT/CEO	34.0 ................. 6.0	X	X	1,101,121	0	33,016
(7) DR DENNIS DOBYAN...................................................................... DIRECTOR	1.0 ................. 0.0	X		16,214	65,244	0
(8) ADAM STEIN...................................................................... DIRECTOR	1.0 ................. 0.0	X		2,500	0	0
(9) BRAD MCANALLY...................................................................... DIRECTOR	1.0 ................. 0.0	X		2,500	0	0
(10) SERENA NAYLOR...................................................................... DIRECTOR	1.0 ................. 0.0	X		2,500	0	0
(11) DR CHRIS LOONEY...................................................................... DIRECTOR	1.0 ................. 0.0	X		87,554	0	0
(12) BRENDA SHARPE...................................................................... DIRECTOR	1.0 ................. 0.0	X		2,500	0	0
(13) BRIAN BRADLEY...................................................................... DIRECTOR	1.0 ................. 0.0	X		2,500	0	0
(14) OPHELIA LAVELL RUCKER...................................................................... DIRECTOR	1.0 ................. 0.0	X		0	0	0
(15) CAROL ROEVER...................................................................... DIRECTOR	1.0 ................. 0.0	X		2,360	0	0
(16) CURT KRETZINGER...................................................................... CHIEF OPERATING OFFICER	33.0 ................. 7.0		X	722,503	0	82,286
(17) JOHN WILSON...................................................................... CHIEF TREASURY OFFICER	32.0 ................. 8.0		X	683,337	0	56,241

(A) Name and Title	(B) Average hours per week (list any hours for related organizations below dotted line)	(E) Reportable compensation from related organizations (W- 2/1099-MISC)	(F) Estimated amount of other compensation from the organization and related organizations
(18) DWAIN STILSON........................................................................ CFO/TREASURER	35.0 .......................5.0	X				216,114	38,598
(19) KAREN DITTEMORE........................................................................ SECRETARY	38.0 .......................2.0	X				69,689	12,809
(20) CAROLYN PADEN........................................................................ ADMINISTRATOR	40.0 .......................0.0		X			252,441	16,576
(21) DR DAVIN TURNER........................................................................ ADMINISTRATOR	40.0 .......................0.0		X			431,787	77,973
(22) R S KOELLIKER........................................................................ ADMINISTRATOR	40.0 .......................0.0		X			409,538	28,568
(23) MICHAEL C PULIDO........................................................................ CHIEF ADMINISTRATIVE OFFICER	38.0 .......................2.0		X			446,612	92,483
(24) DR BONNIE GOINS........................................................................ STAFF PHYSICIAN	40.0 .......................0.0			X		1,087,812	25,676
(25) DR MOHAN R HINDUPUR........................................................................ STAFF PHYSICIAN	40.0 .......................0.0			X		985,731	27,882
(26) DR ROBERT GRANT........................................................................ STAFF PHYSICIAN	40.0 .......................0.0			X		971,628	36,379
(27) DR ARVIND K SHARMA........................................................................ STAFF PHYSICIAN	40.0 .......................0.0			X		911,570	36,048
(28) DR CODY HARLAN........................................................................ STAFF PHYSICIAN	40.0 .......................0.0			X		823,471	75,692
(29) DR MICHAEL NELLESTEIN........................................................................ STAFF PHYSICIAN	0.0 .......................0.0				X	104,138	0
(30) DR MAUREEN MANGANARO........................................................................ STAFF PHYSICIAN	0.0 .......................0.0				X	518,509	32,884

(A) Name and business address	(B) Description of services	(C) Compensation
ST JOSEPH ONCOLOGY INC, 902 N RIVERSIDE RD STE 200 ST JOSEPH,MO64507	ONCOLOGY	2,435,473
CAPITAL PERFORMANCE, 11709 ROE D236 LEAWOOD,KS66211	CONSTRUCTION MGMT	1,149,991
ACTION ELECTRIC CORP, 923 SOUTH 9TH ST JOSEPH,MO64503	ELECTRICIAN	1,149,356
POLSINELLI SHUGHART PC, 3101 FREDERICK AVE ST JOSEPH,MO64506	LEGAL	1,115,084
POBLOCKI SIGN COMPANY LLC, 922 S 70TH STREET WEST ALLIS,WI53214	SIGNAGE	1,051,659
2 Total number of independent contractors (including but not limited to those listed above) who received more than $100,000 of compensation from the organization 37

- TIN:

SCHEDULE A
(Form 990 or 990EZ)

Department of the Treasury
Internal Revenue Service

Public Charity Status and Public Support

Complete if the organization is a section 501(c)(3) organization or a section 4947(a)(1) nonexempt charitable trust.
right arrow

Attach to Form 990 or Form 990-EZ.
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Information about Schedule A (Form 990 or 990-EZ) and its instructions is at www.irs.gov/form990.

OMB No. 1545-0047

2015

Open to Public
Inspection

Name of the organization

HEARTLAND REGIONAL MEDICAL CENTER

Employer identification number

44-0545289

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.)

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

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

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

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

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

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

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

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

An organization that normally receives: (1) more than 331/3% of its support from contributions, membership fees, and gross receipts from activities related to its exempt functions—subject to certain exceptions, and (2) no more than 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.)

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

An organization organized and operated exclusively for the benefit of, to perform the functions of, or to carry out the purposes of one or more publicly supported organizations described in section 509(a)(1) or section 509(a)(2). See section 509(a)(3). Check the box in lines 11a through 11d that describes the type of supporting organization and complete lines 11e, 11f, and 11g.

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

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

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

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

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

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

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

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


Total

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

Cat. No. 11285F

Schedule A (Form 990 or 990-EZ) 2015

Page 2

Part II

Support Schedule for Organizations Described in Sections 170(b)(1)(A)(iv) and 170(b)(1)(A)(vi)
(Complete only if you checked the box on line 5, 7, or 8 of Part I or if the organization failed to qualify under Part III. If the organization fails to qualify under the tests listed below, please complete Part III.)

Section A. Public Support

Calendar year (or fiscal year beginning in)		(a) 2011	(b) 2012	(c) 2013	(d) 2014	(e) 2015	(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) 2011	(b) 2012	(c) 2013	(d) 2014	(e) 2015	(f) Total
7	Amounts from line 4..
8	Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources...
9	Net income from unrelated business activities, whether or not the business is regularly carried on..
10	Other income. Do not include gain or loss from the sale of capital assets (Explain in Part VI.)..
11	Total support. Add lines 7 through 10.

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

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

Section C. Computation of Public Support Percentage

Public support percentage for 2015 (line 6, column (f) divided by line 11, column (f)) .........

Public support percentage for 2014 Schedule A, Part II, line 14 ...............

16a

33 1/3% support test—2015. If the organization did not check the box on line 13, and line 14 is 33 1/3% or more, check this box
and stop here. The organization qualifies as a publicly supported organization ....................... right arrow

33 1/3% support test—2014. If the organization did not check a box on line 13 or 16a, and line 15 is 33 1/3% or more, check this
box and stop here. The organization qualifies as a publicly supported organization ..................... right arrow

17a

10%-facts-and-circumstances test—2015. If the organization did not check a box on line 13, 16a, or 16b, and line 14
is 10% or more, and if the organization meets the facts-and-circumstances test, check this box and stop here. Explain
in Part VI how the organization meets the "facts-and-circumstances" test. The organization qualifies as a publicly supported
organization ..................................................... right arrow

10%-facts-and-circumstances test—2014. If the organization did not check a box on line 13, 16a, 16b, or 17a, and line
15 is 10% or more, and if the organization meets the "facts-and-circumstances" test, check this box and stop here.
Explain in Part VI how the organization meets the "facts-and-circumstances" test. The organization qualifies as a publicly
supported organization ................................................ right arrow

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

Schedule A (Form 990 or 990-EZ) 2015

Page 3

Part III

Support Schedule for Organizations Described in Section 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) 2011	(b) 2012	(c) 2013	(d) 2014	(e) 2015	(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) 2011	(b) 2012	(c) 2013	(d) 2014	(e) 2015	(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 VI.) ..
13	Total support. (Add lines 9, 10c, 11, and 12.)..

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

Section C. Computation of Public Support Percentage

Public support percentage for 2015 (line 8, column (f) divided by line 13, column (f)) .........

Public support percentage from 2014 Schedule A, Part III, line 15 ...............

Section D. Computation of Investment Income Percentage

Investment income percentage for 2015 (line 10c, column (f) divided by line 13, column (f)) ......

Investment income percentage from 2014 Schedule A, Part III, line 17 .............

19a

331/3% support tests—2015. If the organization did not check the box on line 14, and line 15 is more than 33 1/3%, and line 17 is not more than 33 1/3%, check this box and stop here. The organization qualifies as a publicly supported organization ....... right arrow

33 1/3% support tests—2014. If the organization did not check a box on line 14 or line 19a, and line 16 is more than 33 1/3% and line 18 is not more than 33 1/3%, check this box and stop here. The organization qualifies as a publicly supported organization .... right arrow

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

Schedule A (Form 990 or 990-EZ) 2015

Page 4

Part IV

Supporting Organizations

(Complete only if you checked a box on line 11 of Part I. If you checked 11a of Part I, complete Sections A and B. If you checked 11b of Part I, complete Sections A and C. If you checked 11c of Part I, complete Sections A, D, and E. If you checked 11d of Part I, complete Sections A and D, and complete Part V.)

Section A. All Supporting Organizations

Yes

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

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

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

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

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

Was any supported organization not organized in the United States ("foreign supported organization")? If “Yes” and if you checked 11a or 11b in Part I, answer (b) and (c) below.

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

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

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

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

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

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

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

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

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

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

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

10a

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

10a

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

10b

Schedule A (Form 990 or 990-EZ) 2015

Page 5

Part IV

Supporting Organizations (continued)

Yes

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

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

11a

A family member of a person described in (a) above?

11b

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

11c

Section B. Type I Supporting Organizations

Yes

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

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

Section C. Type II Supporting Organizations

Yes

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

Section D. All Type III Supporting Organizations

Yes

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

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

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

Section E. Type III Functionally-Integrated Supporting Organizations

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

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

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

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

Activities Test. Answer (a) and (b) below.

Yes

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

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

Parent of Supported Organizations. Answer (a) and (b) below.

Did the organization have the power to regularly appoint or elect a majority of the officers, directors, or trustees of each of the supported organizations? Provide details in Part VI.

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

Schedule A (Form 990 or 990-EZ) 2015

Page 6

Part V

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

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

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

	Section B - Minimum Asset Amount		(A) Prior Year	(B) Current Year (optional)
1	Aggregate fair market value of all non-exempt-use assets (see instructions for short tax year or assets held for part of year):	1
a	Average monthly value of securities	1a
b	Average monthly cash balances	1b
c	Fair market value of other non-exempt-use assets	1c
d	Total (add lines 1a, 1b, and 1c)	1d
e	Discount claimed for blockage or other factors (explain in detail in Part VI):
2	Acquisition indebtedness applicable to non-exempt use assets	2
3	Subtract line 2 from line 1d	3
4	Cash deemed held for exempt use. Enter 1-1/2% of line 3 (for greater amount, see instructions).	4
5	Net value of non-exempt-use assets (subtract line 4 from line 3)	5
6	Multiply line 5 by .035	6
7	Recoveries of prior-year distributions	7
8	Minimum Asset Amount (add line 7 to line 6)	8

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

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

Schedule A (Form 990 or 990-EZ) 2015

Page 7

Part V

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

Section D - Distributions		Current Year
1 Amounts paid to supported organizations to accomplish exempt purposes
2 Amounts paid to perform activity that directly furthers exempt purposes of supported organizations, in excess of income from activity
3 Administrative expenses paid to accomplish exempt purposes of supported organizations
4 Amounts paid to acquire exempt-use assets
5 Qualified set-aside amounts (prior IRS approval required)
6 Other distributions (describe in Part VI). See instructions
7Total annual distributions. Add lines 1 through 6.
8 Distributions to attentive supported organizations to which the organization is responsive (provide details in Part VI). See instructions
9 Distributable amount for 2015 from Section C, line 6
10 Line 8 amount divided by Line 9 amount

Section E - Distribution Allocations (see instructions)		(i) Excess Distributions	(ii) Underdistributions Pre-2015	(iii) Distributable Amount for 2015
1 Distributable amount for 2015 from Section C, line 6
2 Underdistributions, if any, for years prior to 2015 (reasonable cause required--see instructions)
3 Excess distributions carryover, if any, to 2015:
a
b
c
d From 2013.......
e From 2014.......
fTotal of lines 3a through e
g Applied to underdistributions of prior years
h Applied to 2015 distributable amount
i Carryover from 2010 not applied (see instructions)
j Remainder. Subtract lines 3g, 3h, and 3i from 3f.
4Distributions for 2015 from Section D, line 7:
$
a Applied to underdistributions of prior years
b Applied to 2015 distributable amount
c Remainder. Subtract lines 4a and 4b from 4.
5 Remaining underdistributions for years prior to 2015, if any. Subtract lines 3g and 4a from line 2 (if amount greater than zero, see instructions)
6 Remaining underdistributions for 2015. Subtract lines 3h and 4b from line 1 (if amount greater than zero, see instructions)
7 Excess distributions carryover to 2016. Add lines 3j and 4c.
8 Breakdown of line 7:
a
b
c Excess from 2013.......
d From 2014.......
e From 2015.......

Schedule A (Form 990 or 990-EZ) (2015)

Schedule A (Form 990 or 990-EZ) 2015

Page 8

Part VI

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

Facts And Circumstances Test

Return Reference	Explanation

Schedule A (Form 990 or 990-EZ) 2015

Additional Data

Software ID:
Software Version:

- TIN:

Schedule B
(Form 990, 990-EZ,
or 990-PF)

Department of the Treasury
Internal Revenue Service

Schedule of Contributors

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

Information about Schedule B (Form 990, 990-EZ, or 990-PF) and its instructions is at www.irs.gov/form990.

OMB No. 1545-0047

2015

Name of the organization

HEARTLAND REGIONAL MEDICAL CENTER

Employer identification number

44-0545289

Organization type (check one):

Filers of:

Section:

Form 990 or 990-EZ

501(c)( ) (enter number) organization

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

527 political organization

Form 990-PF

501(c)(3) exempt private foundation

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

501(c)(3) taxable private foundation

Check if your organization is covered by the General Rule or a Special Rule.
Note. Only a section 501(c)(7), (8), or (10) organization can check boxes for both the General Rule and a Special Rule. See instructions.

General Rule

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

Special Rules

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

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

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

Caution. An organization that is not covered by the General Rule and/or the Special Rules does not file Schedule B (Form 990,
990-EZ, or 990-PF), but it must answer “No” on Part IV, line 2, of its Form 990; or check the box on line H of its
Form 990-EZ or on its Form 990PF, Part I, line 2, to certify that it does not meet the filing requirements of Schedule B (Form 990,
990-EZ, or 990-PF).

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

Cat. No. 30613XSchedule B (Form 990, 990-EZ, or 990-PF) (2015)

Schedule B (Form 990, 990-EZ, or 990-PF) (2015) Page 2

Name of organization HEARTLAND REGIONAL MEDICAL CENTER

Part I	Contributors (see instructions). Use duplicate copies of Part I if additional space is needed.
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
RESTRICTED	,	$ RESTRICTED	Person Payroll Noncash (Complete Part II for noncash contributions.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II for noncash contributions.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II for noncash contributions.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II for noncash contributions.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II for noncash contributions.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II for noncash contributions.)
Schedule B (Form 990, 990-EZ, or 990-PF) (2015)

Schedule B (Form 990, 990-EZ, or 990-PF) (2015)

Page 3

Name of organization HEARTLAND REGIONAL MEDICAL CENTER		Employer identification number 44-0545289

Part II	Noncash Property (see instructions). Use duplicate copies of Part II if additional space is needed.
(a) No.from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (see instructions)	(d) Date received
		$
(a) No.from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (see instructions)	(d) Date received
		$
(a) No.from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (see instructions)	(d) Date received
		$
(a) No.from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (see instructions)	(d) Date received
		$
(a) No.from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (see instructions)	(d) Date received
		$
(a) No.from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (see instructions)	(d) Date received
		$
Schedule B (Form 990, 990-EZ, or 990-PF) (2015)

Schedule B (Form 990, 990-EZ, or 990-PF) (2015)

Page 4


Name of organization HEARTLAND REGIONAL MEDICAL CENTER			Employer identification number 44-0545289
Part III Exclusively religious, charitable, etc., contributions to organizations described in section 501(c)(7), (8), or (10) that total more than $1,000 for the year from any one contributor. Complete columns (a) through (e) and the following line entry. For organizations completing Part III, enter the total of exclusively religious, charitable, etc., contributions of $1,000 or less for the year. (Enter this information once. See instructions.) $ Use duplicate copies of Part III if additional space is needed.

(a)
No.from Part I

(b) Purpose of gift

(d) Description of how gift is held

(e) Transfer of gift
Transferee's name, address, and ZIP 4	Relationship of transferor to transferee

(a)
No.from Part I

(b) Purpose of gift

(d) Description of how gift is held

(e) Transfer of gift
Transferee's name, address, and ZIP 4	Relationship of transferor to transferee

(a)
No.from Part I

(b) Purpose of gift

(d) Description of how gift is held

(e) Transfer of gift
Transferee's name, address, and ZIP 4	Relationship of transferor to transferee

(a)
No.from Part I

(b) Purpose of gift

(d) Description of how gift is held

(e) Transfer of gift
Transferee's name, address, and ZIP 4	Relationship of transferor to transferee

Schedule B (Form 990, 990-EZ, or 990-PF) (2015)

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE C
(Form 990 or 990-EZ)

Department of the Treasury
Internal Revenue Service

Political Campaign and Lobbying Activities

For Organizations Exempt From Income Tax Under section 501(c) and section 527
SchCMd Bullet

Complete if the organization is described below. SchCMd Bullet

Attach to Form 990 or Form 990-EZ.
SchCMd Bullet

Information about Schedule C (Form 990 or 990-EZ) and its instructions is at www.irs.gov/form990.

OMB No. 1545-0047

2015

Open to Public
Inspection

If the organization answered "Yes" on Form 990, Part IV, Line 3, or Form 990-EZ, Part V, line 46 (Political Campaign Activities), then
Round Bullet

Section 501(c)(3) organizations: Complete Parts I-A and B. Do not complete Part I-C.
Round Bullet

Section 501(c) (other than section 501(c)(3)) organizations: Complete Parts I-A and C below. Do not complete Part I-B.
Round Bullet

Section 527 organizations: Complete Part I-A only.
If the organization answered "Yes" on Form 990, Part IV, Line 4, or Form 990-EZ, Part VI, line 47 (Lobbying Activities), then
Round Bullet

Section 501(c)(3) organizations that have filed Form 5768 (election under section 501(h)): Complete Part II-A. Do not complete Part II-B.
Round Bullet

Section 501(c)(3) organizations that have NOT filed Form 5768 (election under section 501(h)): Complete Part II-B. Do not complete Part II-A.
If the organization answered "Yes" on Form 990, Part IV, Line 5 (Proxy Tax) (see separate instructions) or Form 990-EZ, Part V, line 35c (Proxy Tax) (see separate instructions), then
Round Bullet

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

Name of the organization

HEARTLAND REGIONAL MEDICAL CENTER

Employer identification number

44-0545289

Part I-A

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

Provide a description of the organization’s direct and indirect political campaign activities in Part IV.

Political expenditures ...................................................................................................................... SchCMd Bullet

Volunteer hours .............................................................................................................................

Part I-B

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

Enter the amount of any excise tax incurred by the organization under section 4955 ................................ SchCMd Bullet

Enter the amount of any excise tax incurred by organization managers under section 4955 ....................... SchCMd Bullet

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

Yes No

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

Yes No

If "Yes," describe in Part IV.

Part I-C

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

Enter the amount directly expended by the filing organization for section 527 exempt function activities ..... SchCMd Bullet

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

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

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

Yes No

Enter the names, addresses and employer identification number (EIN) of all section 527 political organizations to which the filing
organization made payments. For each organization listed, enter the amount paid from the filing organization’s funds. Also enter the amount of political contributions received that were promptly and directly delivered to a separate political organization, such as a separate segregated fund or a political action committee (PAC). If additional space is needed, provide information in Part IV.

(a) Name	(b) Address	(c) EIN	(d) Amount paid from filing organization's funds. If none, enter -0-.	(e) Amount of political contributions received and promptly and directly delivered to a separate political organization. If none, enter -0-.
1
2
3
4
5
6

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

Cat. No. 50084S

Schedule C (Form 990 or 990-EZ) 2015

Page 2

Part II-A

Complete if the organization is exempt under section 501(c)(3) and filed Form 5768 (election under section 501(h)).

A Check SchCMd Bullet

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

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

Limits on Lobbying Expenditures (The term "expenditures" means amounts paid or incurred.)		(b) Affiliated group totals
1a	Total lobbying expenditures to influence public opinion (grass roots lobbying) ...............................................
b	Total lobbying expenditures to influence a legislative body (direct lobbying) ...........................................
c	Total lobbying expenditures (add lines 1a and 1b) .......................................................................
d	Other exempt purpose expenditures .........................................................................................
e	Total exempt purpose expenditures (add lines 1c and 1d) ....................................................................
f	Lobbying nontaxable amount. Enter the amount from the following table in both columns.
	If the amount on line 1e, column (a) or (b) is:The lobbying nontaxable amount is:
	Not over $500,00020% of the amount on line 1e.
	Over $500,000 but not over $1,000,000$100,000 plus 15% of the excess over $500,000.
	Over $1,000,000 but not over $1,500,000$175,000 plus 10% of the excess over $1,000,000.
	Over $1,500,000 but not over $17,000,000$225,000 plus 5% of the excess over $1,500,000.
	Over $17,000,000$1,000,000.

g	Grassroots nontaxable amount (enter 25% of line 1f) ..........................................................................
h	Subtract line 1g from line 1a. If zero or less, enter -0-. ..........................................................................
i	Subtract line 1f from line 1c. If zero or less, enter -0-. ...........................................................................
j	If there is an amount other than zero on either line 1h or line 1i, did the organization file Form 4720 reporting section 4911 tax for this year? ..............................................................................................................	Yes No

4-Year Averaging Period Under section 501(h) (Some organizations that made a section 501(h) election do not have to complete all of the five columns below. See the separate instructions for lines 2a through 2f.)
Lobbying Expenditures During 4-Year Averaging Period
	Calendar year (or fiscal year beginning in)	(a) 2012	(b) 2013	(c) 2014	(d) 2015	(e) Total

2a	Lobbying nontaxable amount

b	Lobbying ceiling amount (150% of line 2a, column(e))

c	Total lobbying expenditures

d	Grassroots nontaxable amount

e	Grassroots ceiling amount (150% of line 2d, column (e))

f	Grassroots lobbying expenditures

Schedule C (Form 990 or 990-EZ) 2015

Page 3

Part II-B

Complete if the organization is exempt under section 501(c)(3) and has NOT filed Form 5768 (election under section 501(h)).

For each "Yes" response on lines 1a through 1i below, provide in Part IV a detailed description of the lobbying activity.

(a)

Yes

(b)

Amount

During the year, did the filing organization attempt to influence foreign, national, state or local legislation, including any attempt to influence public opinion on a legislative matter or referendum, through the use of:

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

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

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

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

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

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

Yes

36,225

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

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

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

Yes

115,125

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

151,350

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

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

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

If the filing organization incurred a section 4912 tax, did it file Form 4720 for this year? ........................

Part III-A

Complete if the organization is exempt under section 501(c)(4), section 501(c)(5), or section 501(c)(6).

Yes

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

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

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

Part III-B

Complete if the organization is exempt under section 501(c)(4), section 501(c)(5), or section 501(c)(6) and if either (a) BOTH Part III-A, lines 1 and 2, are answered "No" OR (b) Part III-A, line 3, is answered “Yes."

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

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

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

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

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

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

If notices were sent and the amount on line 2c exceeds the amount on line 3, what portion of the excess does the organization agree to carryover to the reasonable estimate of nondeductible lobbying and political expenditure next year? ......................................................................................................................

Taxable amount of lobbying and political expenditures (see instructions) .........................................

Part IV

Supplemental Information

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

Return Reference	Explanation
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.

Schedule C (Form 990 or 990EZ) 2015

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE D
(Form 990)

Department of the Treasury
Internal Revenue Service

Supplemental Financial Statements

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

Attach to Form 990.
Information about Schedule D (Form 990) and its instructions is at www.irs.gov/form990.

OMB No. 1545-0047

2015

Open to Public Inspection

Name of the organization

HEARTLAND REGIONAL MEDICAL CENTER

Employer identification number

44-0545289

Part I

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

			(a) Donor advised funds	(b) Funds and other accounts

1	Total number at end of year ....
2	Aggregate value of contributions to (during year)
3	Aggregate value of grants from (during year)
4	Aggregate value at end of year ....

Did the organization inform all donors and donor advisors in writing that the assets held in donor advised
funds are the organization's property, subject to the organization's exclusive legal control? ...........

Yes No

Did the organization inform all grantees, donors, and donor advisors in writing that grant funds can be
used only for charitable purposes and not for the benefit of the donor or donor advisor, or for any other purpose conferring impermissible private benefit? ............................

Yes No

Part II

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

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

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

Protection of natural habitat Preservation of a certified historic structure

Preservation of open space

Complete lines 2a through 2d if the organization held a qualified conservation contribution in the form of a conservation easement on the last day of the tax year.


a	Total number of conservation easements ......................	2a
b	Total acreage restricted by conservation easements ....................	2b
c	Number of conservation easements on a certified historic structure included in (a) .....	2c
d	Number of conservation easements included in (c) acquired after 8/17/06, and not on a historic structure listed in the National Register ...	2d

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

Number of states where property subject to conservation easement is located SchDMd Bullet

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

Yes No

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

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

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

Yes No

In Part XIII, describe how the organization reports conservation easements in its revenue and expense statement, and
balance sheet, and include, if applicable, the text of the footnote to the organization’s financial statements that describes
the organization’s accounting for conservation easements.

Part III

Organizations Maintaining Collections of Art, Historical Treasures, or Other Similar Assets.
Complete if the organization answered "Yes" on Form 990, Part IV, line 8.

If the organization elected, as permitted under SFAS 116 (ASC 958), not to report in its revenue statement and balance sheet works of art, historical treasures, or other similar assets held for public exhibition, education, or research in furtherance of public service, provide, in Part XIII, the text of the footnote to its financial statements that describes these items.

If the organization elected, as permitted under SFAS 116 (ASC 958), to report in its revenue statement and balance sheet works of art, historical treasures, or other similar assets held for public exhibition, education, or research in furtherance of public service, provide the following amounts relating to these items:

(i)

Revenue included on Form 990, Part VIII, line 1 ......................... SchDMd Bullet

(ii)

Assets included in Form 990, Part X ............................... SchDMd Bullet

If the organization received or held works of art, historical treasures, or other similar assets for financial gain, provide the
following amounts required to be reported under SFAS 116 (ASC 958) relating to these items:

Revenue included on Form 990, Part VIII, line 1 .......................... SchDMd Bullet

Assets included in Form 990, Part X ............................... SchDMd Bullet

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

Cat. No. 52283D

Schedule D (Form 990) 2015

Page 2

Part III

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

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

Public exhibition

Loan or exchange programs

Scholarly research

Other

Preservation for future generations

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

During the year, did the organization solicit or receive donations of art, historical treasures or other similar
assets to be sold to raise funds rather than to be maintained as part of the organization’s collection?...

Yes No

Part IV

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

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

Yes No


b	If "Yes," explain the arrangement in Part XIII and complete the following table:		Amount
c	Beginning balance .............................	1c
d	Additions during the year ............................	1d
e	Distributions during the year ..........................	1e
f	Ending balance ................................	1f

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

Yes No

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

Part V

Endowment Funds. Complete if the organization answered "Yes" on Form 990, Part IV, line 10.

		(a)Current year	(b)Prior year	(c)Two years back	(d)Three years back	(e)Four years back

1a	Beginning of year balance ....
b	Contributions ...
c	Net investment earnings, gains, and losses
d	Grants or scholarships ...
e	Other expenditures for facilities and programs ...
f	Administrative expenses ....
g	End of year balance ......

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

Board designated or quasi-endowment SchDMd Bullet

Permanent endowment SchDMd Bullet

Temporarily restricted endowment SchDMd Bullet

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

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

Yes

(i) unrelated organizations .................

3a(i)

(ii) related organizations .................

3a(ii)

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

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

Part VI

Land, Buildings, and Equipment.
Complete if the organization answered 'Yes' on Form 990, Part IV, line 11a. See Form 990, Part X, line 10.

Description of property		(a) Cost or other basis (investment)	(b)Cost or other basis (other)	(c) Accumulated depreciation	(d) Book value

1a	Land ...	19,043,491		19,043,491
b	Buildings	309,596,510	150,582,512	159,013,998
c	Leasehold improvements	37,378,172	22,436,771	14,941,401
d	Equipment ...	214,266,616	178,127,334	36,139,282
e	Other ...	57,242,052	49,258,461	7,983,591
Total. Add lines 1a through 1e. (Column (d) must equal Form 990, Part X, column (B), line 10(c).)..				237,121,763

Schedule D (Form 990) 2015

Page 3

Part VII

InvestmentsOther Securities. Complete if the organization answered 'Yes' on Form 990, Part IV, line 11b. See Form 990, Part X, line 12.

(a) Description of security or category (including name of security)	(b)Book value	(c)Method of valuation: Cost or end-of-year market value
(1)Financial derivatives
(2)Closely-held equity interests
(3)Other
(A)
(B)
(C)
(D)
(E)
(F)
(G)
(H)
Total. (Column (b) must equal Form 990, Part X, col. (B) line 12.)

Part VIII

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

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

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

Part IX

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

(a) Description				(b) Book value

(1)
(2)
(3)
(4)
(5)
(6)
(7)
(8)
(9)
Total. (Column (b) must equal Form 990, Part X, col.(B) line 15.)...........

Part X

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

1.(a) Description of liability	(b) Book value
(1) Federal income taxes	0
DERIVATIVE INSTRUMENTS	9,836,671
MINORITY INTEREST	1,032,150
(3)
(4)
(5)
(6)
(7)
(8)
(9)
Total. (Column (b) must equal Form 990, Part X, col.(B) line 25.)	10,868,821
2. Liability for uncertain tax positions. In Part XIII, provide the text of the footnote to the organization's financial statements that reports the organization's liability for uncertain tax positions under FIN 48 (ASC 740). Check here if the text of the footnote has been provided in Part XIII

Schedule D (Form 990) 2015

Page 4

Part XI Reconciliation of Revenue per Audited Financial Statements With Revenue per Return Complete if the organization answered 'Yes' on Form 990, Part IV, line 12a.
1	Total revenue, gains, and other support per audited financial statements .......		1
2	Amounts included on line 1 but not on Form 990, Part VIII, line 12:
a	Net unrealized gains (losses) on investments ....	2a
b	Donated services and use of facilities .........	2b
c	Recoveries of prior year grants ...........	2c
d	Other (Describe in Part XIII.) ............	2d
e	Add lines 2a through 2d .....................		2e
3	Subtract line 2e from line 1..................		3
4	Amounts included on Form 990, Part VIII, line 12, but not on line 1:
a	Investment expenses not included on Form 990, Part VIII, line 7b .	4a
b	Other (Describe in Part XIII.) ...........	4b
c	Add lines 4a and 4b....................		4c
5	Total revenue. Add lines 3 and 4c. (This must equal Form 990, Part I, line 12.) ......		5

Part XII Reconciliation of Expenses per Audited Financial Statements With Expenses per Return. Complete if the organization answered 'Yes' on Form 990, Part IV, line 12a.
1	Total expenses and losses per audited financial statements ...........		1
2	Amounts included on line 1 but not on Form 990, Part IX, line 25:
a	Donated services and use of facilities .........	2a
b	Prior year adjustments ............	2b
c	Other losses ................	2c
d	Other (Describe in Part XIII.) ............	2d
e	Add lines 2a through 2d....................		2e
3	Subtract line 2e from line 1...................		3
4	Amounts included on Form 990, Part IX, line 25, but not on line 1:
a	Investment expenses not included on Form 990, Part VIII, line 7b ..	4a
b	Other (Describe in Part XIII.) ............	4b
c	Add lines 4a and 4b.....................		4c
5	Total expenses. Add lines 3 and 4c. (This must equal Form 990, Part I, line 18.) ......		5

Part XIII

Supplemental Information

Provide the descriptions required for Part II, lines 3, 5, and 9; Part III, lines 1a and 4; Part lV, lines 1b and 2b;
Part V, line 4; Part X, line 2; Part XI, lines 2d and 4b; and Part XII, lines 2d and 4b. Also complete this part to provide any additional information.

Return Reference	Explanation
SCHEDULE D, PART X, LINE 2	MANAGEMENT HAS EVALUATED THEIR INCOME TAX POSITIONS UNDER THE GUIDANCE INCLUDED IN ASC 740. BASED ON THEIR REVIEW, MANAGEMENT HAS NOT IDENTIFIED ANY MATERIAL UNCERTAIN TAX POSITIONS TO BE RECORDED OR DISCLOSED IN THE FINANCIAL STATEMENTS

Schedule D (Form 990) 2015

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE H
(Form 990)

Department of the Treasury
Internal Revenue Service

Hospitals

Complete if the organization answered "Yes" on Form 990, Part IV, question 20.
MediumBullet

Attach to Form 990.
MediumBullet

Information about Schedule H (Form 990) and its instructions is at www.irs.gov/form990.

OMB No. 1545-0047

2015

Open to Public Inspection

Name of the organization

HEARTLAND REGIONAL MEDICAL CENTER

Employer identification number

44-0545289

Part I

Financial Assistance and Certain Other Community Benefits at Cost

Yes

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

Yes

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

Yes

If the organization had multiple hospital facilities, indicate which of the following best describes application of the financial assistance policy to its various hospital facilities during the tax year.

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

Answer the following based on the financial assistance eligibility criteria that applied to the largest number of the organization's patients during the tax year.

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

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

Yes

100% 150% 200% Other %

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

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

Yes

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

If the organization used factors other than FPG in determining eligibility, describe in Part VI the criteria used for determining eligibility for free or discounted care. Include in the description whether the organization used an asset test or other threshold, regardless of income, as a factor in determining eligibility for free or discounted care.

Did the organization's financial assistance policy that applied to the largest number of its patients during the tax year provide for free or discounted care to the "medically indigent"? . . . . . . . . . . . . .

Yes

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

Yes

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

Yes

If "Yes" to line 5b, as a result of budget considerations, was the organization unable to provide free or discountedcare to a patient who was eligibile for free or discounted care? . . . . . . . . . . . . .

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

Yes

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

Yes

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

Financial Assistance and Certain Other Community Benefits at Cost

Financial Assistance and Means-Tested Government Programs		(c) Total community benefit expense	(d) Direct offsetting revenue	(e) Net community benefit expense	(f) Percent of total expense
a	Financial Assistance at cost (from Worksheet 1) . . .	27,885,322		27,885,322	4.840 %
b	Medicaid (from Worksheet 3, column a) . . . . .	106,412,373	64,833,210	41,579,163	7.220 %
c	Costs of other means-tested government programs (from Worksheet 3, column b) . .
d	Total Financial Assistance and Means-Tested Government Programs . . . . .	134,297,695	64,833,210	69,464,485	12.060 %
Other Benefits
e	Community health improvement services and community benefit operations (from Worksheet 4).	4,333,310	423,495	3,909,815	0.680 %
f	Health professions education (from Worksheet 5) . . .
g	Subsidized health services (from Worksheet 6) . . . .
h	Research (from Worksheet 7) .	521,991	56,802	465,189	0.080 %
i	Cash and in-kind contributions for community benefit (from Worksheet 8) . . . .	2,047,548		2,047,548	0.360 %
j	Total. Other Benefits . .	6,902,849	480,297	6,422,552	1.120 %
k	Total. Add lines 7d and 7j .	141,200,544	65,313,507	75,887,037	13.180 %

For Paperwork Reduction Act Notice, see the Instructions for Form 990. Cat. No. 50192T Schedule H (Form 990) 2015

Schedule H (Form 990) 2015

Page

Part II

Community Building Activities Complete this table if the organization conducted any community building activities during the tax year, and describe in Part VI how its community building activities promoted the health of the communities it serves.

		(c) Total community building expense	(e) Net community building expense	(f) Percent of total expense
1	Physical improvements and housing	117,939	117,939	0.200 %
2	Economic development	141,608	141,608	0.250 %
3	Community support	168,849	168,849	0.290 %
4	Environmental improvements
5	Leadership development and training for community members
6	Coalition building
7	Community health improvement advocacy	115,125	115,125	0.200 %
8	Workforce development
9	Other
10	Total	543,521	543,521	0.940 %

Part III

Bad Debt, Medicare, & Collection Practices

Section A. Bad Debt Expense

Yes

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

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

11,254,997

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

5,142,030

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

Section B. Medicare

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

129,188,404

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

151,726,509

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

-22,538,105

Describe in Part VI the extent to which any shortfall reported in line 7 should be treated as community benefit.Also describe in Part VI the costing methodology or source used to determine the amount reported on line 6.Check the box that describes the method used:

Cost accounting system Cost to charge ratio Other

Section C. Collection Practices

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

Yes

If "Yes," did the organization’s collection policy that applied to the largest number of its patients during the tax year
contain provisions on the collection practices to be followed for patients who are known to qualify for financial assistance? Describe in Part VI .........................

Yes

Part IV

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

(a) Name of entity	(b) Description of primary activity of entity	(c) Organization's profit % or stock ownership %	(d) Officers, directors, trustees, or key employees' profit % or stock ownership %	(e) Physicians' profit % or stock ownership %
1NONE
2
3
4
5
6
7
8
9
10
11
12
13

Schedule H (Form 990) 2015

Page

Part VFacility Information

Section A. Hospital Facilities (list in order of size from largest to smallest—see instructions) How many hospital facilities did the organization operate during the tax year?1 Name, address, primary website address, and state license number (and if a group return, the name and EIN of the subordinate hospital organization that operates the hospital facility)					Other (Describe)
1	HEARTLAND REGIONAL MEDICAL CENTER 5325 FARAON ST ST JOSEPH,MO64506 WWW.MYMOSAICLIFECARE.ORG 426-19	X	X	X	PHARMICIST INTERN PROGRAM

Schedule H (Form 990) 2015

Page 4

Part VFacility Information (continued)

Section B. Facility Policies and Practices

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

	HEARTLAND REGIONAL MEDICAL CENTER
Name of hospital facility or letter of facility reporting group

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

Yes

Community Health Needs Assessment

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

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

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

Yes

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

A definition of the community served by the hospital facility

Demographics of the community

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

How data was obtained

The significant health needs of the community

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

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

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

Information gaps that limit the hospital facility’s ability to assess the community’s health needs

Other (describe in Section C)

Indicate the tax year the hospital facility last conducted a CHNA: 20 15

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

Yes

6 a

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

Yes

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

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

Yes

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

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

Other website (list url):

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

Other (describe in Section C)

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

Yes

Indicate the tax year the hospital facility last adopted an implementation strategy: 20 15

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

Yes

If "Yes" (list url): SEE PART V, SECTION C

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

10b

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

12a

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

12a

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

12b

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

Schedule H (Form 990) 2015

Page 5

Part VFacility Information (continued)

Financial Assistance Policy (FAP)

	HEARTLAND REGIONAL MEDICAL CENTER
Name of hospital facility or letter of facility reporting group

Yes

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

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

Yes

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

Federal poverty guidelines (FPG), with FPG family income limit for eligibility for free care of 200.% and FPG family income limit for eligibility for discounted care of 300.%

Income level other than FPG (describe in Section C)

Asset level

Medical indigency

Insurance status

Underinsurance discount

Residency

Other (describe in Section C)

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

Yes

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

Yes

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

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

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

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

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

Other (describe in Section C)

Included measures to publicize the policy within the community served by the hospital facility?........

Yes

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

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

SEE PART V, SECTION C

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

SEE PART V, SECTION C

A plain language summary of the FAP was widely available on a website (list url):
SEE PART V, SECTION C

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

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

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

Notice of availability of the FAP was conspicuously displayed throughout the hospital facility

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

Other (describe in Section C)

Billing and Collections

Did the hospital facility have in place during the tax year a separate billing and collections policy, or a written financial assistance policy (FAP) that explained all of the actions the hospital facility or other authorized party may take upon non-payment?..................................

Yes

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

Reporting to credit agency(ies)

Selling an individual’s debt to another party

Actions that require a legal or judicial process

Other similar actions (describe in Section C)

None of these actions or other similar actions were permitted

Schedule H (Form 990) 2015

Page 6

Part VFacility Information (continued)

	HEARTLAND REGIONAL MEDICAL CENTER
Name of hospital facility or letter of facility reporting group

Yes

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

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

Reporting to credit agency(ies)

Selling an individual’s debt to another party

Actions that require a legal or judicial process

Other similar actions (describe in Section C)

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

Notified individuals of the financial assistance policy on admission

Notified individuals of the financial assistance policy prior to discharge

Notified individuals of the financial assistance policy in communications with the individuals regarding the individuals’ bills

Documented its determination of whether individuals were eligible for financial assistance under the hospital facility’s financial assistance policy

Other (describe in Section C)

None of these efforts were made

Policy Relating to Emergency Medical Care

Did the hospital facility have in place during the tax year a written policy relating to emergency medical care that required the hospital facility to provide, without discrimination, care for emergency medical conditions to individuals regardless of their eligibility under the hospital facility’s financial assistance policy?..................

Yes

If "No," indicate why:

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

The hospital facility’s policy was not in writing

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

Other (describe in Section C)

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

Indicate how the hospital facility determined, during the tax year, the maximum amounts that can be charged to FAP-eligible individuals for emergency or other medically necessary care.

The hospital facility used its lowest negotiated commercial insurance rate when calculating the maximum amounts that
can be charged

The hospital facility used the average of its three lowest negotiated commercial insurance rates when calculating the maximum amounts that can be charged

The hospital facility used the Medicare rates when calculating the maximum amounts that can be charged

Other (describe in Section C)

During the tax year, did the hospital facility charge any FAP-eligible individual to whom the hospital facility provided emergency or other medically necessary services more than the amounts generally billed to individuals who had insurance covering such care? ...............................

If "Yes," explain in Section C.

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

If "Yes," explain in Section C.

Schedule H (Form 990) 2015

Page 7

Part V

Facility Information (continued)

Section C. Supplemental Information for Part V, Section B. Provide descriptions required for Part V, Section B, lines 2, 3j, 5, 6a, 6b, 7d, 11, 13b, 13h, 15e, 16i, 18d, 19d, 20e, 21c, 21d, 22d, 23, and 24. If applicable, provide separate descriptions for each hospital facility in a facility reporting group, designated by facility reporting group letter and hospital facility line number from Part V, Section A (“A, 1,” “A, 4,” “B, 2,” “B, 3,” etc.) and name of hospital facility.
Form and Line Reference	Explanation
SCHEDULE H, PART V, SECTION B, LINE 3J	COMMUNITY PARTNERS INCLUDING THE ST JOSEPH SCHOOL DISTRICT AND MISSOURI WESTERN STATE UNIVERSITY.
SCHEDULE H, 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 SYSTEMS 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.
SCHEDULE H, PART V, SECTION B, LINE 6A	HEARTLAND LONG TERM ACUTE CARE HOSPITAL
SCHEDULE H, PART V, SECTION B, LINE 7A	THE COMPLETE CHNA CAN BE FOUND AT: HTTPS://WWW.MYMOSAICLIFECARE.ORG/GENERAL/COMMUNITY-HEALTH-NEEDS-ASSESSMENT /ST-JOSEPH-CHNA/
SCHEDULE H, PART V, SECTION B, LINE 10A	THE IMPLEMENTATION STRATEGY CAN BE FOUND AT: HTTPS://WWW.MYMOSAICLIFECARE.ORG/GENERAL/COMMUNITY-HEALTH-NEEDS-ASSESSMENT /ST-JOSEPH-CHNA/
SCHEDULE H, 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 ISSUES IDENTIFIED WERE: 1) ACCESS TO AFFORDABLE HEALTH CARE AND MEDICATION; 2) ADULT AND CHILDHOOD OBESITY; AND 3) MENTAL HEALTH SERVICES. THE MEDICAL CENTERS 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 COMMMNITYS 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 FY2016FY2019 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 CHILDRENS MERCY HOSPITAL, 4TH GRADE CHALLENGE, ETC. B) SUPPORT COMMUNITY CONNECT PROGRAMS THAT ADDRESS OBESITY PREVENTION SIGNIFICANT 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 THE COMPLETE CHNA WITH IMPLEMENTATION STRATEGY CAN BE FOUND AT: HTTPS://WWW.MYMOSAICLIFECARE.ORG/GENERAL/COMMUNITY-HEALTH-NEEDS-ASSESSMENT /ST-JOSEPH-CHNA/
SCHEDULE H, PART V, SECTION B, LINE 16A	THE FAP CAN BE FOUND AT: https://www.mymosaiclifecare.org/globalassets/mosaic-fap-06232016_final_pu blic-reduced-size.pdf
SCHEDULE H, PART V, SECTION B, LINE 16B	THE FAP APPLICATION CAN BE FOUND AT: https://www.mymosaiclifecare.org/Main/Location/st-joseph-mo/mosaic-life-ca re-at-st.-joseph/Medical-Center/HRMC-Financial-and-Insurance-Information/m yfinancial-options/how-to-apply-for-financial-assistance/
SCHEDULE H, PART V, SECTION B, LINE 16C	THE PLAIN LANGUAGE SUMMARY CAN BE FOUND AT: https://www.mymosaiclifecare.org/Main/Location/st-joseph-mo/mosaic-life-ca re-at-st.-joseph/Medical-Center/HRMC-Financial-and-Insurance-Information/F inancial-Assistance-Guidelines/
SCHEDULE H, PART V, SECTION B, LINE 20E	FINANCIAL COUNSELORS ARE AVAILABLE ONSITE TO EXPLAIN AND HELP PATIENTS AND RESPONSIBLE PARTIES WITH THE FINANCIAL ASSISTANCE POLICY.

Schedule H (Form 990) 2015

Page 8

Part VFacility Information (continued)

Section D. Other Health Care Facilities That Are Not Licensed, Registered, or Similarly Recognized as a Hospital Facility (list in order of size, from largest to smallest) How many non-hospital health care facilities did the organization operate during the tax year?43
Name and address		Type of Facility (describe)
1	CAMERON MOSAIC LIFE CARE 215 South Walnut Street Suite A CAMERON,MO64429	CAMERON CLINIC
2	Heartland Clinic 902 N Riverside St Joseph,MO64507	CANCER, MEDICAL ONCOLOGY PEDIATRICS, RADIATION ONCOLOGY
3	CARDIOVASCULAR CARE MOSAIC LIFE CARE 705 N COLLEGE ALBANY,MO64402	CARDIOVASCULAR, GEN SURGERY, NEUROLOGY, PODIATRY, VASCULAR SURGERY AND WOMENS HEALTH CLIN
4	Heartland Clinic 2600 MILLER ST BETHANY,MO64424	CARDIOLOGY, NEUROLOGY AND RHEUMATOLOGY
5	CARE AT HOME MOSAIC LIFE CARE 137 North Belt Highway St Joseph,MO64506	HOME CARE, COUNSELING, HOME HEALTH AND HOSPICE CARE
6	Heartland Clinic 901 HEARTLAND ROAD St Joseph,MO64506	ADULT INFECTIOUS DISEASE, DIABETES, ENDO, IM, EE CLINIC, SLEEP DISORDERS, WOMEN, WOUND
7	ENT ST JOSEPH MOSAIC LIFE CARE 5301 FARAON SUITE 160 St Joseph,MO64506	ENT, OCCUPATIONAL MEDICINE PULMONARY AND CRITICAL CARE
8	EXCELSIOR SPRINGS MOSAIC LIFE CARE 2370 VINTAGE COURT EXCELSIOR SPRINGS,MO64024	EXCELSIOR
9	FAMILY CARE N 36TH ST JOSEPH MOSAIC LIFE 711 N 36TH STREET SUITE 100 St Joseph,MO64506	FAMILY
10	FAMILY CARE N POINTE B ST JOSEPH MOSAIC 5210 NORTH BELT HIGHWAY ENTRANCE B ST JOSEPH,MO64506	FAMILY MEDICINE AND WOMENS HEALTH
11	FAMILY CARE PLATTE CITY MOSAIC LIFE CARE 2703 RUNNING HORSE ROAD PLATTE CITY,MO64079	FAMILY MEDICINE, OP THERAPY AND SPORTS MEDICINE
12	GASTROENTEROLOGY HIGHLAND PLAZA MOSAIC 9784 N ASH AVENUE KANSAS CITY,MO64157	GASTROENTEROLOGY
13	INTERNAL MED BECK RD ST JOE MOSAIC LIFE 3715 BECK ROAD BUILDING F St Joseph,MO64506	INTERNAL MEDICINE
14	HEARTLAND CLINIC 5514 CORPORATE DRIVE SUITE 120 St Joseph,MO64507	CARDIOVASCULAR AND INTERNAL MEDICINE
15	INTERNAL MED PED & FAMILY ST JOE MOSAIC 105 FAR WEST DRIVE SUITE 100 St Joseph,MO64506	INTERNAL MEDICINE, NEUROLOGY AND OP BEHAVIORAL
16	KEARNEY MOSAIC LIFE CARE 425 WEST WASHINGTON STREET KEARNEY,MO64060	KEARNEY CLINIC
17	Heartland Clinic 802 NORTH RIVERSIDE St Joseph,MO64507	BARIATRIC, BREAST, CARDIOTHORA GEN SURGERY, MAMMOGRAPHY, ARTH PHY MED & REHAB, NEU, PAIN, RH
18	MEDICAL ONCOLOGY MOSAIC LIFE CARE 1610 E EVERGREEN SUITE B Cameron,MO64429	MEDICAL ONCOLOGY
19	MEDICAL ONCOLOGY MOSAIC LIFE CARE 2016 S MAIN MARYVILLE,MO64468	MEDICAL ONCOLOGY
20	MOSAIC LIFE CARE BURLINGTON CRK PHY MED 6301 N LUCERNE KANSAS CITY,MO64151	PHYSICAL MEDICINE & REHAB, IMAGING, OCCUPATIONAL MED, ORTHO & SPECIALITY CLINICS
21	MOSAIC LIFE CARE SHOAL CREEK PHY MED REH 8880 NE 82ND TERRACE KANSAS CITY,MO64158	PHYSICAL MEDICINE AND REHAB, FAMILY MED, IMAGING, OCC MED, URGENT CARE & SPECIALITY CLIN
22	MOSAIC LIFE CARE HOSPICE AT STANBERRY PINE VIEW MANORRM 507 307 PINEVIE STANBERRY,MO64489	HOSPICE
23	MOSAIC LIFE CARE-SURGERY CENTER SHOAL CR 8860 NE 82ND TERRACE KANSAS CITY,KS64158	SURGERY CENTER
24	NEUROSURGERY MOSAIC LIFE CARE MARYVILLE SPECIALITY CLINIC 2016 S MARYVILLE,MO64468	NEUROSURGERY
25	NORTHWEST MEDICAL CENTER HOME HEALTH AGE 1607 E US HIGHWAY 136 ALBANY,MO64402	NORTHWEST
26	OP IMAGING ST JOSEPH MOSAIC LIFE CARE 3620 FREDERICK AVENUE St Joseph,MO64506	OP IMAGING
27	OP THERAPHY FREDERICK AVE ST JOE MOSAIC 3107 FREDERICK LOWER LEVEL ST JOSEPH,MO64506	OP THERAPY
28	OP THERAPY N BELT ST JOSEPH MOSAIC LIFE 3007 NORTH BELT HIGHWAY STJOSEPH,MO64506	OUTPATIENT THERAPY & CHIROPRACTIC & OP THERAPY
29	PAIN MANAGEMENT MOSAIC LIFE CARE 100 CENTRAL ST CHILLICOTHE,MO64601	PAIN MANAGEMENT
30	PARKVILLE COMMONS MOSAIC LIFE CARE 6185 JEFFERSON AVENUE PARKVILLE,MO64152	PARKVILLE CLINIC
31	PLASTIC SURGERY & DERMATOLOGY MOSAIC 5204 NORTH BELT HIGHWAY SUITE A ST JOSEPH,MO64506	PLASTIC SURGERY AND DETMATOLOGY
32	PODIATRY ST JOSEPH MOSAIC LIFE CARE 5202 FARAON SUITE A ST JOSEPH,MO64506	PODIATRY
33	PULMONARY & CRITICAL CARE MOSAIC LIFE 1600 E EVERGREE PO BOX 557 CAMERON,MO64429	PULMONARY AND CRITICAL CARE AND RHEUMATOLOGY
34	PULMONARY & CRITICAL CARE MOSAIC LIFE MARYVILLE SPECIALITY CLINIC 2024 S MARYVILLE,MO64468	ENT, PULMONARY & CRITICAL CARE NEUROLOGY AND PODIATRY
35	SMITHVILLE MOSAIC LIFE CARE 1103 SOUTH US HIGHEWAY 169 SMITHVILLE,MO64089	SMITHVILLE CLINIC
36	TRENTON NEUROLOGY MOSAIC LIFE CARE 1701 EAST 9TH STREET TRENTON,MO64683	TRENTON NEUROLOGY
37	TRENTON OCCUPATIONAL MED MOSAIC LIFE 1707 EAST 9TH STREET TRENTON,MO64683	TRENTON OCCUPATIONAL MEDICINE
38	URGENT CARE ST JOSEPH MOSAIC LIFE CARE 1115 NORTH BELT HIGHWAY ST JOSEPH,MO64506	URGENT CARE AND OCCUPATIONAL MEDICINE
39	MOSAIC LIFE CARE AT ATCHISON-SPECIALITY 810 RAVENHILL DR SUITE 103 ATCHISON,KS66002	SPECIALITY CLINIC
40	MOSAIC LIFE CARE ATCHISON-MED ONCOLOGY 104 N 6TH ATCHISON,KS66002	MEDICAL ONCOLOGY
41	HIAWATHA MOSAIC LIFE CARE-FAMILY MED 300 UTAH HIAWATHA,KS66434	FAMILY MEDICINE
42	TROY MOSAIC LIFE CARE-FAMILY MEDICINE 207 SOUTH MAIN TROY,KS66087	FAMILY MEDICINE
43	ENDOCRINOLOGY MOSAIC LIFE CARE 220 ESSIE DAVISON DRIVE CLARINDA,IA51632	ENDOCRINOLOGY

Schedule H (Form 990) 2015

Page 9

Part VI

Supplemental Information

Provide the following information.

1	Required descriptions. Provide the descriptions required for Part I, lines 3c, 6a, and 7; Part II and Part III, lines 2, 3, 4, 8 and 9b.
2	Needs assessment. Describe how the organization assesses the health care needs of the communities it serves, in addition to any CHNAs reported in Part V, Section B.
3	Patient education of eligibility for assistance. Describe how the organization informs and educates patients and persons who may be billed for patient care about their eligibility for assistance under federal, state, or local government programs or under the organization’s financial assistance policy.
4	Community information. Describe the community the organization serves, taking into account the geographic area and demographic constituents it serves.
5	Promotion of community health. Provide any other information important to describing how the organization’s hospital facilities or other health care facilities further its exempt purpose by promoting the health of the community (e.g., open medical staff, community board, use of surplus funds, etc.).
6	Affiliated health care system. If the organization is part of an affiliated health care system, describe the respective roles of the organization and its affiliates in promoting the health of the communities served.
7	State filing of community benefit report. If applicable, identify all states with which the organization, or a related organization, files a community benefit report.

Form and Line Reference	Explanation
SCHEDULE H, PART I, LINE 3C	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.
SCHEDULE H, PART I, LINE 7	THE COSTING METHODOLOGY USED TO CALCULATE THE AMOUNTS REPORTED IN THE TABLE WAS THE COST TO CHARGE RATIO DERIVED FROM WORKSHEET 2. SCHEDULE H, PART I, LINES 7A & 7B FINANCIAL ASSISTANCE AT COST WAS $15,498,000 AND 27,840,000 FOR YEARS ENDED 6/30/2015 AND 6/30/2016, RESPECTIVELY. THE PRINCIPAL REASON FOR THE INCREASE WAS THE RECLASSIFICATION OF BAD DEBT EXPENSE TO FINANCIAL ASSISTANCE AS THE RESULT OF A MEDICAL DEBT GRACE PERIOD PROVIDED BY THE MEDICAL CENTER DURING THE 2016 FISCAL YEAR UNDER THE CURRENT FINANCIAL ASSISTANCE POLICY. MEDICAID NET COMMUNITY BENEFIT EXPENSE WAS 17,818,000 AND $41,450,000 FOR YEARS ENDED 6/30/2015 AND 6/30/2016, 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 MANAGEMENTS 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.
SCHEDULE H, 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 $22,816,142 FOUND ON FORM 990, PART IX, LINE 24.A COLUMN (A).
SCHEDULE H, PART II	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.
SCHEDULE H, PART III, SECTION A, 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 CENTERS ALLOWANCE FOR DOUBTFUL ACCOUNTS FOR SELF-PAY PATIENTS DECREASED FROM 97% OF GROSS SELF-PAY ACCOUNTS RECEIVABLE AT JUNE 30, 2015, TO 95% OF GROSS SELF-PAY ACCOUNTS RECEIVABLE AT JUNE 30, 2016. IN ADDITION, THE MEDICAL CENTERS WRITE-OFFS DECREASED APPROXIMATELY $25,000,000 FROM APPROXIMATELY $78,000,000 FOR THE YEAR ENDED JUNE 30, 2015, TO APPROXIMATELY $53,000,000 FOR THE YEAR ENDED JUNE 30, 2016 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 $24,500,000 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.
SCHEDULE H, PART III, SECTION A, LINE 3	IF DOCUMENTATION REQUIRED TO MAKE A DETERMINATION HAD BEEN PROVIDED, IT IS ESTIMATED THAT ADDITIONAL BAD DEBT EXPENSE WOULD HAVE QUALIFIED FOR CHARITY CARE UNDER THE MEDICAL CENTERS FINANCIAL ASSISTANCE POLICY. THE METHODOLOGY TO FORMULATE THIS ESTIMATE INVOLVED USING U.S. CENSUS BUREAU, 2011-2015 AMERICAN COMMUNITY SURVEY 5-YEAR ESTIMATES DATA FOR INCOME TO POVERTY LEVELS AT OR BELOW 200% AND 300%, RESPECTIVELY. IN ACCORDANCE WITH THE MEDICAL CENTERS FINANCIAL ASSISTANCE POLICY, PATIENTS WHOSE INCOME DOES NOT EXCEED 200% OF THE 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 200% OF THE PROVERTY LEVEL BY 100%. HOWEVER, PATIENTS WHOSE INCOME WAS BETWEEN 200% AND 300% OF THE FEDERAL POVERTY GUIDELINES WOULD HAVE RECEIVED A 50% DISCOUNT. ACCORDINGLY, THE AMOUNT OF BAD DEBT EXPENSE INCLUDED IN THIS CALCULATION FOR THESE PATIENTS WAS DETERMINED BY MULTIPLYING THE PERCENT OF THE POPULATION WHOSE INCOME FELL BETWEEN 200% AND 300% BY 50%. THE RESULTING EFFECTIVE CHARITY DISCOUNT PERCENTAGES WERE THEN MULTIPLIED BY THE MEDICAL CENTERS TOTAL BAD DEBT EXPENSE. THE CALCULATED BAD DEBT AT THE 200% AND 300% LEVELS WERE THEN ADDED AND MULTIPLED BY THE COST TO CHARGE RATIO TO OBTAIN THE BAD DEBT EXPENSE TO BE INCLUDED IN SCHEDULE H, PART III, LINE 3.
SCHEDULE H, PART III, LINE 4	THE BAD DEBT EXPENSE FOOTNOTE IS ON PAGE 9 OF THE ATTACHED AUDITED FINANCIAL STATEMENTS. SEE ALSO THE PARAGRAPH IN THE CHARITY CARE FOOTNOTE ON THE TOP OF PAGE 18 THAT REFERENCES THE 2016 AMNESTY PERIOD RELATED TO BAD DEBT EXPENSE.
SCHEDULE H, PART III, SECTION B, 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 ORGANIZATION'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.
SCHEDULE H, PART III, SECTION C, LINE 9B	THE MEDICAL CENTERS 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 PERMANENT RESIDENT IN THE MEDICAL CENTER SERVICE AREA (PRIMARY, SECONDARY OR TERTIARY). A STUDENT ATTENDING SCHOOL IN THE PRIMARY OR SECONDARY 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 PARENTS TAX RETURN IS EVALUATED BASED ON THE STUDENTS INCOME. IF THE STUDENT IS CLAIMED AS A DEPENDENT, THE PARENTS OR PARENTS HOUSEHOLD INCOME IS 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 200% OF FEDERAL POVERTY GUIDELINES. > A 50% DISCOUNT IS GIVEN TO PATIENTS OR GUARANTORS WHOSE HOUSEHOLD INCOME IS GREATER THAN 200% BUT LESS THAN 300% OF FEDERAL POVERTY GUIDELINES. EMERGENCY MEDICAL SERVICES THE MEDICAL CENTER PROVIDES 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 IS 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 THE POLICY. PATIENTS OR GUARANTORS ARE EXPECTED TO COOPERATE BY APPLYING FOR ASSISTANCE OR OTHER PUBLIC PROGRAMS IDENTIFIED 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 200% 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 100 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. DISCOUNTED CARE: FOR ELIGIBLE SERVICES RECEIVED AT THE MEDICAL CENTER, A 50 PERCENT DISCOUNT OFF OF GROSS CHARGES WILL APPLY FOR PATIENTS OR GUARANTORS, IF THE FOLLOWING GUIDELINES ARE MET: 1. THE APPLICANT MEETS ELIGIBILITY CRITERIA AND HAS A YEARLY HOUSEHOLD INCOME BETWEEN 200 300 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 CENTERS 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 LOOK-BACK METHOD AS FOLLOWS: 1. MOSAIC LIFE CARE REVIEWS ALL PAST CLAIMS THAT HAVE BEEN ALLOWED BY MEDICARE FEE-FOR-SERVICE AND ALL PRIVATE HEALTH INSURERS PAYING CLAIMS TO MOSAIC LIFE CARE FOR MEDICALLY NECESSARY CARE BY THE HOSPITAL IN THE PRIOR CALENDAR YEAR. THE TOTAL AMOUNT INCLUDES COPAYMENTS, DEDUCTIBLES AND COINSURANCE. 2. THE AGB PERCENTAGES ARE CALCULATED ANNUALLY BY DIVIDING THE SUM OF CLAIMS ALLOWED BY MEDICARE FEE-FOR-SERVICE TOGETHER WITH ALL PRIVATE HEALTH INSURERS TO MOSAIC LIFE CARE BY THE SUM OF THE ASSOCIATED GROSS CHARGES FOR THOSE CLAIMS. 3. THE PERCENTAGES ARE APPLIED BY THE 120TH DAY AFTER THE END OF THE CALENDAR YEAR MOSAIC LIFE CARE USES TO CALCULATE THE AGB PERCENTAGE(S). COLLECTION ACTIONS TAKEN IN EVENT OF NON-PAYMENT: COLLECTION ACTIONS: NO ACCOUNT IS SUBJECT TO COLLECTION ACTIONS WITHIN 180 DAYS OF ISSUING THE FIRST POST-DISCHARGE STATEMENT AND WITHOUT FIRST MAKING REASONABLE EFFORTS TO DETERMINE WHETHER THE PATIENT IS ELIGIBLE FOR FINANCIAL ASSISTANCE. NO EXTRAORDINARY COLLECTION ACTIONS ARE 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. THE 180-DAY TIMEFRAME MAY BE SHORTENED IF A DECISION HAS BEEN MADE ON FINANCIAL ASSISTANCE, OR WHEN A PAYMENT PLAN HAS BEEN ESTABLISHED AND AGREED TO, BUT THE PATIENT OR GUARANTOR IS NO LONGER MAKING THE REQUIRED PAYMENTS. IF A STATEMENT IS SENT TO A PATIENT OR GUARANTOR, AND MAIL IS RETURNED AS UNDELIVERABLE, THE MEDICAL CENTER ATTEMPTS TO FIND A CORRECT ADDRESS. IF THE CORRECT ADDRESS CANNOT BE FOUND, THE MEDICAL CENTER ATTEMPTS 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, THE ACCOUNT IS 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 GENERALLY RECEIVES A MINIMUM OF SIX WRITTEN STATEMENTS INCLUDING THE FIRST POST-DISCHARGE STATEMENT AND FIVE SUBSEQUENT STATEMENTS. THESE STATEMENTS 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, A SEVENTH AND FINAL STATEMENT IS SENT TO THE PATIENT OR GUARANTOR. THIS STATEMENT ACTS AS A NOTICE TO THE ACCOUNT OWNER OF THE AMOUNT OWED TO THE MEDICAL CENTER AND THAT THE ACCOUNT WILL BE PLACED WITH A THIRDPARTY COLLECTION AGENCY IN 30 DAYS. THIS STATEMENT INCLUDES A PLAIN LANGUAGE SUMMARY AND OUTLINES ANY COLLECTION ACTIONS THAT MAY BE TAKEN IF A PLAN IS NOT PUT IN PLACE TO SETTLE THE ACCOUNT. ORAL NOTIFICATION WILL BE ATTEMPTED AT THIS TIME AS WELL TO ENSURE THE PATIENT OR GUARANTOR IS AWARE OF MOSAIC LIFE CARES FINANCIAL ASSISTANCE POLICY AND THE DEBT THEY OWE. 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 AGREEDUPON PAYMENT PLAN. 2. THE PATIENT OR GUARANTOR HAS RECEIVED A FINANCIAL ASSISTANCE DISCOUNT, BUT IS NO LONGER WORKING WITH THE MEDICAL CENTER 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 PATIENTS OR GUARANTORS BANK ACCOUNT 2. CIVIL ACTIONS 3. PROPERTY LIENS 4. PROPERTY FORECLOSURES 5. GARNISHING OF WAGES 6. REPORTING ADVERSE INFORMATION TO CREDIT BUREAUS BEFORE EXTRAORDINARY COLLECTION ACTIVITIES CAN BEGIN, THE ACCOUNT MUST BE REVIEWED AND APPROVAL MUST BE GIVEN BY THE MEDICAL CENTERS PATIENT BILLING LEADERSHIP. WHEN ONE OF THESE ACTIONS IS TO BE TAKEN AGAINST A PATIENT OR GUARANTOR, THE PATIENT OR GUARANTOR IS GIVEN A 30DAY WRITTEN NOTICE OF THE ACTION TO BE TAKEN. THE PATIENT OR GUARANTOR IS ALSO INFORMED OF THE MEDICAL CENTERS FINANCIAL ASSISTANCE POLICY AND HOW TO APPLY FOR IT. A PLAIN LANGUAGE SUMMARY OF THE FINANCIAL
SCHEDULE H, 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.
SCHEDULE H, PART VI, LINE 3	THE MEDICAL CENTER INFORMS AND EDUCATES PATIENTS AND PERSONS WHO MAY BE BILLED FOR PATIENT CARE ABOUT THEIR ELIGBILITY 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 ORGANIZATIONS 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 AND APPOINTMENT WITH A FINANCIAL COUNSELOR WHO CAN ASSIST THEM IN COMPLETING THE FINANCIAL ASSISTANCE APPLICATION.
SCHEDULE H, PART VI, LINE 4	THE ORGANIZATION'S PRIMARY AND SECONDARY SERVICE AREA IS A 23 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% MEDICARE AND MEDICAID, 34% COMMERCIAL AND 6% SELF PAY. 18% OF THE POPULATION IS BELOW THE POVERTY LEVEL; 19% OF POPULATION SMOKE; AND 36% HAVE A BODY MASS INDEX GREATER THAN 30. MORE THAN 60 PERCENT OF THE ELEMENTARY AGE STUDENTS RECEIVE FREE OR REDUCED-COST LUNCHES.
SCHEDULE H, PART VI, LINE 5	THE ORGANIZATION OFFERS MANY EDUCATIONAL 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 19,500 PEOPLE HAVE PARTICIPATED AND OVER 125,000 POUNDS HAVE BEEN LOST. AT THE END OF THE PROGRAM IN 2016, 93.7 PERCENT OF RESPONDENTS TO THE SURVEY AGREED THAT THE POUND PLUNGE WAS BENEFICIAL TO OUR COMMUNITY, AND 90.6 PERCENT 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 WILL BE 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 WILL BE 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 EIGHT YEARS. PRE AND POST PROGRAM SURVEYING OF STUDENTS SHOWED AT LEAST A 40 PERCENT INCREASE IN KNOWLEDGE OF THE FIT-TASTIC GUIDELINES AFTER COMPLETING THE PROGRAM. 96 PERCENT OF SCHOOL COACHES AGREED THAT THE 4TH GRADE CHALLENGE IS AN EFFECTIVE PROGRAM THAT TEACHES STUDENTS ABOUT HEALTH, EXERCISE AND NUTRITION, AND 93 PERCENT OF SCHOOL COACHES AGREED THAT THE 4TH GRADE CHALLENGE IS A GREAT HEALTH PROGRAM THAT HELPS FIGHT CHILDHOOD OBESITY. IN 2015 THE NUMBER OF SCHOOL AND COMMUNITY GARDENS WAS EXPANDED FROM SIX TO EIGHT ELEMENTARY SCHOOLS. MORE THAN 16,825 LBS. OF FRESH PRODUCE HAS BEEN GROWN SINCE 2012, AND IS FREE FOR 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.
SCHEDULE H, PART VI, LINE 6	THE ORGANIZATION IS AFFILIATED, THROUGH A PARENT BOARD, WITH A FOUNDATION, AN ACUTE LONG TERM CARE HOSPITAL, A CRITICAL ACCESS RURAL HOSPITAL 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 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 PROVIDED IN AN ACUTE CARE HOSPITAL. THE COMMUNITY HEALTH IMPROVEMENT SOLUTIONS SERVICE WORKS WITH EMPLOYERS IN THE COMMUNITY TO EFFECT HEALTHY CHANGES IN THEIR WORKFORCES.

Schedule H (Form 990) 2015

Additional Data

Software ID:
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Schedule I
(Form 990)

Department of the Treasury
Internal Revenue Service

Grants and Other Assistance to Organizations,
Governments and Individuals in the United States

Complete if the organization answered "Yes," on Form 990, Part IV, line 21 or 22.
lBullet

Attach to Form 990.
lBullet

Information about Schedule I (Form 990) and its instructions is at www.irs.gov/form990.

OMB No. 1545-0047

2015

Open to Public
Inspection

Name of the organization
HEARTLAND REGIONAL MEDICAL CENTER

Employer identification number
44-0545289

Part I

General Information on Grants and Assistance

Does the organization maintain records to substantiate the amount of the grants or assistance, the grantees' eligibility for the grants or assistance, and
the selection criteria used to award the grants or assistance? ........................

Yes No

Describe in Part IV the organization's procedures for monitoring the use of grant funds in the United States.

Part II

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

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

(a) Name and address of organization or government	(b) EIN	(c) IRC section if applicable	(d) Amount of cash grant	(e) Amount of non-cash assistance	(f) Method of valuation (book, FMV, appraisal, other)	(g) Description of non-cash assistance	(h) Purpose of grant or assistance

(1) UNITED WAY OF GREATER ST JOSEPH 118 S 5TH STREET ST JOSEPH,MO64501	44-0547802	501(C)(3)	175,312				SUPPORT
(2) HEARTLAND FOUNDATION 5325 FARAON STREET ST JOSEPH,MO64506	43-1262768	501(C)(3)	773,793				SUPPORT
(3) MO WESTERN STATE UNIVERSITY FOUNDATION 5425 DOWNS DRIVE ST JOSEPH,MO64507	23-7035423	501(C)(3)	333,950				SPONSORSHIP
(4) ALLIED ARTS COUNCIL OF ST JOESEPH MO 118 S EIGHTH STREET ST JOSEPH,MO64501	43-0810827	501(C)(3)	26,500				SPONSORSHIP
(5) SECOND HARVEST COMMUNITY FOOD BANK 915 DOUGLAS STREET ST JOSEPH,MO64505	43-1268319	501(C)(3)	32,500	6,675	FMV	FOOD	SUPPORT
(6) ST JOSEPH AREA CHAMBER OF COMMERCE 3003 FREDERICK AVENUE ST JOSEPH,MO64506	44-0419460	501(C)(6)	14,550				SPONSORSHIP
(7) NORTHLAND REGIONAL CHAMBER OF COMMERCE 634 NW ENGLEWOOD ROAD ST JOSEPH,MO64118	43-1279100	501(C)(6)	14,139				SPONSORSHIP
(8) ALBRECHT-KEMPER MUSEUM OF ART FOUNDATION 2818 FREDERICK ST JOSEPH,MO64506	43-1855334	501(C)(3)	10,827				SUPPORT
(9) THE CENTER 902 EDMOND STREET STE 203 ST JOSEPH,MO64501	43-1615018	501(C)(3)	25,500				SUPPORT
(10) LADIES UNION BENEVOLENT ASSOCATION 801 N NOYES BLVD ST JOSEPH,MO64506	44-0563788	501(C)(3)	16,691				SUPPORT
(11) NORTHWEST HEALTH SERVICES INC 2303 VILLAGE DRIVE ST JOSEPH,MO64506	43-1323669	501(C)(3)	20,000				SUPPORT
(12) ST JOSEPH PARKS REC AND CIVIC FACILITIES 1920 GRAND AVE ST JOSEPH,MO64505	44-6000256	MUNICIPAL GOV'T	5,250				SUPPORT
(13) CITY OF ST JOSEPH 1100 FREDERICK AVENUE ST JOSEPH,MO64501	44-6000256	MUNICIPAL GOV'T		1,120,712	FMV	BUILDING	SUPPORT
(14) INNOVATION STOCKYARD 4221 MITCHELL AVENUE ST JOSEPH,MO64507	20-1215246	501(C)(3)	30,000				SPONSORSHIP
(15) COMMUNITY ALLIANCE 3003 FREDERICK AVENUE ST JOSEPH,MO64506	05-0587096	501(C)(3)	22,058				SUPPORT
(16) HILLCREST TRANSITIONAL HOUSING 4510 BELLEVIEW SUITE 300 KANSAS CITY,MO64111	27-1481997	501(C)(3)	14,000				SPONSORSHIP
(17) AMERICAN HEART ASSOCIATION 104 CORPORATE LAKE DRIVE COLUMBIA,MO65203	13-5613797	501(C)(6)	13,000				SPONSORSHIP
(18) ST JOSEPH YOUTH ALLIANCE 5223 MITCHELL AVE ST JOSEPH,MO64507	43-1680758	501(C)(3)	10,350				SUPPORT

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

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

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

Cat. No. 50055P

Schedule I (Form 990) 2015

Page 2

Part III

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

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

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

Part IV

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

Return Reference

Explanation

SCHEDULE I, 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.

Schedule I (Form 990) 2015

Additional Data

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Software Version:

- TIN:

Schedule J
(Form 990)

Department of the Treasury
Internal Revenue Service

Compensation Information

For certain Officers, Directors, Trustees, Key Employees, and Highest
Compensated Employees
SchJMediumBullet

Complete if the organization answered "Yes" on Form 990, Part IV, line 23.
SchJMediumBullet

Attach to Form 990.
SchJMediumBullet

Information about Schedule J (Form 990) and its instructions is at www.irs.gov/form990.

OMB No. 1545-0047

2015

Open to Public Inspection

Name of the organization

HEARTLAND REGIONAL MEDICAL CENTER

Employer identification number

44-0545289

Part I

Questions Regarding Compensation

Yes

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

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

Travel for companions Payments for business use of personal residence

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

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

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

Yes

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

Yes

Indicate which, if any, of the following the filing organization used to establish the compensation of the
organization's CEO/Executive Director. Check all that apply. Do not check any boxes for methods
used by a related organization to establish compensation of the CEO/Executive Director, but explain in Part III.

Compensation committee Written employment contract

Independent compensation consultant Compensation survey or study

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

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

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

Yes

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

Yes

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

If "Yes" to any of lines 4a-c, list the persons and provide the applicable amounts for each item in Part III.

Only 501(c)(3), 501(c)(4), and 501(c)(29) organizations must complete lines 5-9.

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

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

Any related organization?

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

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

The organization?

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

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

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

Were any amounts reported on Form 990, Part VII, paid or accured pursuant to a contract that was
subject to the initial contract exception described in Regulations section 53.4958-4(a)(3)? If "Yes," describe
in Part III .............................

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

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

Cat. No. 50053T

Schedule J (Form 990) 2015

Page 2

Part II

Officers, Directors, Trustees, Key Employees, and Highest Compensated Employees. Use duplicate copies if additional space is needed.

For each individual whose compensation must be reported on Schedule J, report compensation from the organization on row (i) and from related organizations, described in the
instructions, on row (ii). Do not list any individuals that are not listed on Form 990, Part VII.
Note. The sum of columns (B)(i)-(iii) for each listed individual must equal the total amount of Form 990, Part VII, Section A, line 1a, applicable column (D) and (E) amounts for that individual.

(A) Name and Title		(B) Breakdown of W-2 and/or 1099-MISC compensation			(C) Retirement and other deferred compensation	(D) Nontaxable benefits	(E) Total of columns (B)(i)-(D)	(F) Compensation in column(B) reported as deferred on prior Form 990
(A) Name and Title		(i) Base compensation	(ii) Bonus & incentive compensation	(iii) Other reportable compensation	(C) Retirement and other deferred compensation	(D) Nontaxable benefits	(E) Total of columns (B)(i)-(D)
1DR JOHN OLSONDIRECTOR/STAFF PHYSICIAN	(i) (ii)	557,229 ------------- 0	144,409 ------------- 0	6,841 ------------- 0	10,600 ------------- 0	24,179 ------------- 0	743,258 ------------- 0	0 ------------- 0
2DR MARK LANEYDIRECTOR/PRESIDENT/CEO	(i) (ii)	769,329 ------------- 0	327,087 ------------- 0	4,705 ------------- 0	10,600 ------------- 0	22,416 ------------- 0	1,134,137 ------------- 0	0 ------------- 0
3DR MICHAEL NELLESTEINSTAFF PHYSICIAN	(i) (ii)	0 ------------- 0	0 ------------- 0	104,138 ------------- 0	0 ------------- 0	0 ------------- 0	104,138 ------------- 0	0 ------------- 0
4DR MAUREEN MANGANAROSTAFF PHYSICIAN	(i) (ii)	445,089 ------------- 0	71,431 ------------- 0	1,989 ------------- 0	10,600 ------------- 0	22,284 ------------- 0	551,393 ------------- 0	0 ------------- 0
5CURT KRETZINGERCHIEF OPERATING OFFICER	(i) (ii)	475,549 ------------- 0	101,923 ------------- 0	145,031 ------------- 0	71,955 ------------- 0	10,331 ------------- 0	804,789 ------------- 0	121,672 ------------- 0
6JOHN WILSONCHIEF TREASURY OFFICER	(i) (ii)	444,078 ------------- 0	103,100 ------------- 0	136,159 ------------- 0	56,241 ------------- 0	0 ------------- 0	739,578 ------------- 0	112,348 ------------- 0
7DWAIN STILSONCFO/TREASURER	(i) (ii)	191,320 ------------- 0	24,091 ------------- 0	703 ------------- 0	8,150 ------------- 0	30,448 ------------- 0	254,712 ------------- 0	0 ------------- 0
8CAROLYN PADENADMINISTRATOR	(i) (ii)	219,353 ------------- 0	25,913 ------------- 0	7,175 ------------- 0	0 ------------- 0	16,576 ------------- 0	269,017 ------------- 0	0 ------------- 0
9DR DAVIN TURNERADMINISTRATOR	(i) (ii)	337,189 ------------- 0	91,573 ------------- 0	3,025 ------------- 0	55,025 ------------- 0	22,948 ------------- 0	509,760 ------------- 0	0 ------------- 0
10R S KOELLIKERADMINISTRATOR	(i) (ii)	310,921 ------------- 0	46,045 ------------- 0	52,572 ------------- 0	7,560 ------------- 0	21,008 ------------- 0	438,106 ------------- 0	50,129 ------------- 0
11MICHAEL C PULIDOCHIEF ADMINISTRATIVE OFFICER	(i) (ii)	311,782 ------------- 0	62,593 ------------- 0	72,237 ------------- 0	67,035 ------------- 0	25,448 ------------- 0	539,095 ------------- 0	57,211 ------------- 0
12DR BONNIE GOINSSTAFF PHYSICIAN	(i) (ii)	562,679 ------------- 0	520,792 ------------- 0	4,341 ------------- 0	10,600 ------------- 0	15,076 ------------- 0	1,113,488 ------------- 0	0 ------------- 0
13DR MOHAN R HINDUPURSTAFF PHYSICIAN	(i) (ii)	894,750 ------------- 0	79,584 ------------- 0	11,397 ------------- 0	10,600 ------------- 0	17,282 ------------- 0	1,013,613 ------------- 0	0 ------------- 0
14DR ROBERT GRANTSTAFF PHYSICIAN	(i) (ii)	835,777 ------------- 0	133,190 ------------- 0	2,661 ------------- 0	10,600 ------------- 0	25,779 ------------- 0	1,008,007 ------------- 0	0 ------------- 0
15DR ARVIND K SHARMASTAFF PHYSICIAN	(i) (ii)	826,983 ------------- 0	81,926 ------------- 0	2,661 ------------- 0	10,600 ------------- 0	25,448 ------------- 0	947,618 ------------- 0	0 ------------- 0
16DR CODY HARLANSTAFF PHYSICIAN	(i) (ii)	820,439 ------------- 0	1,463 ------------- 0	1,569 ------------- 0	10,600 ------------- 0	65,092 ------------- 0	899,163 ------------- 0	0 ------------- 0

Schedule J (Form 990) 2015

Page 3

Part III

Supplemental Information

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

Return Reference	Explanation
SCHEDULE J, PART I, LINE 1A	TRAVEL FOR COMPANIONS WAS NOT INCLUDED AS TAXABLE COMPENSATION AS IT WAS 100% FOR BUSINESS PURPOSES.
SCHEDULE J, PART I, LINE 4A	DR. MICHAEL NELLESTEIN $ 104,138
SCHEDULE J, PART I, LINE 4B	VESTED ACCRUED 6/30/2016 6/30/2016 --------- --------- MICHAEL C. PULIDO $ 57,211 $ 56,469 JOHN WILSON $ 112,348 $ 45,641 CURT KRETZINGER $ 121,672 $ 61,355 DR. DAVIN TURNER $ 0 $ 44,544 R S KOELLIKER $ 50,129 $ 0 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.

Schedule J (Form 990) 2015

Additional Data

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Software Version:

- TIN:

Schedule K
(Form 990)

Department of the Treasury
Internal Revenue Service

Supplemental Information on Tax Exempt Bonds

Complete if the organization answered "Yes" to Form 990, Part IV, line 24a. Provide descriptions,
explanations, and any additional information in Part VI.
SchKMediumBullet

Attach to Form 990.
SchKMediumBullet

Information about Schedule K (Form 990) and its instructions is at www.irs.gov/form990.

OMB No. 1545-0047

2015

Open to Public
Inspection

Name of the organization
HEARTLAND REGIONAL MEDICAL CENTER

Employer identification number
44-0545289

Part I

Bond Issues

(a) Issuer name		(b) Issuer EIN	(c) CUSIP #	(d) Date issued	(e) Issue price	(f) Description of purpose	(g) Defeased		(h) On behalf of issuer		(i) Pool financing
(a) Issuer name		(b) Issuer EIN	(c) CUSIP #	(d) Date issued	(e) Issue price	(f) Description of purpose	Yes	No	Yes	No	Yes	No
A	SEE PART VI	43-1203910	79075LAB3	02-26-2009	70,000,000	SEE PART VI		X		X		X
B	SEE PART VI	43-1203910	79075LAD9	09-30-2011	25,250,000	SEE PART VI		X		X		X
C	SEE PART VI	43-1178966	60637ACP5	10-03-2012	51,489,534	SEE PART VI		X		X		X
D	SEE PART VI	43-1203910		11-18-2015	81,225,000	SEE PART VI		X		X		X

Part II

Proceeds

	A		B		C		D
	1 Amount of bonds retired ..................	1,180,000		10,840,000		0		0
2 Amount of bonds legally defeased ..............	0		0		0		0
3 Total proceeds of issue ..................	70,956,418		25,250,000		51,535,780		81,225,000
4 Gross proceeds in reserve funds .............	0		0		0		0
5 Capitalized interest from proceeds .............	0		0		0		0
6 Proceeds in refunding escrows ...............	0		0		0		0
7 Issuance costs from proceeds ...............	0		0		708,053		362,060
8 Credit enhancement from proceeds .............	0		0		0		0
9 Working capital expenditures from proceeds .............	0		0		0		0
10 Capital expenditures from proceeds .............	70,956,418		0		50,827,727		0
11 Other spent proceeds .............	0		25,250,000		0		80,862,940
12 Other unspent proceeds .............	0		0		0		0
13 Year of substantial completion .............	2014		2005		2014		2005
	Yes	No	Yes	No	Yes	No	Yes	No
14 Were the bonds issued as part of a current refunding issue? ....		X	X			X	X
15 Were the bonds issued as part of an advance refunding issue? .....		X		X		X		X
16 Has the final allocation of proceeds been made? ..........	X		X		X		X
17 Does the organization maintain adequate books and records to support the final allocation of proceeds? ..................	X		X		X		X

Part III

Private Business Use

	A		B		C		D
	Yes	No	Yes	No	Yes	No	Yes	No
1 Was the organization a partner in a partnership, or a member of an LLC, which owned property financed by tax-exempt bonds? .............		X				X
2 Are there any lease arrangements that may result in private business use of bond-financed property? ...............		X			X

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

Cat. No. 50193E

Schedule K (Form 990) 2015

Page 2

Part III

Private Business Use (Continued)

	A		B		C		D
	Yes	No	Yes	No	Yes	No	Yes	No
3a Are there any management or service contracts that may result in private business use of bond-financed property? .............		X				X
b If "Yes" to line 3a, does the organization routinely engage bond counsel or other outside counsel to review any management or service contracts relating to the financed property?
c Are there any research agreements that may result in private business use of bond-financed property? .............		X				X
d If "Yes" to line 3c, does the organization routinely engage bond counsel or other outside counsel to review any research agreements relating to the financed property?
4 Enter the percentage of financed property used in a private business use by entities other than a section 501(c)(3) organization or a state or local government ....	0 %		0 %		6.730 %		0 %
5 Enter the percentage of financed property used in a private business use as a result of unrelated trade or business activity carried on by your organization, another section 501(c)(3) organization, or a state or local government .........
6 Total of lines 4 and 5 .............					6.730 %
7 Does the bond issue meet the private security or payment test? ...		X				X
8a Has there been a sale or disposition of any of the bond-financed property to a nongovernmental person other than a 501(c)(3) organization since the bonds were issued?.............		X				X
b If "Yes" to line 8a, enter the percentage of bond-financed property sold or disposed of. ..
c If "Yes" to line 8a, was any remedial action taken pursuant to Regulations sections 1.141-12 and 1.145-2? .............		X				X
9 Has the organization established written procedures to ensure that all nonqualified bonds of the issue are remediated in accordance with the requirements under Regulations sections 1.141-12 and 1.145-2? ........	X				X

Part IV

Arbitrage

	A		B		C		D
	Yes	No	Yes	No	Yes	No	Yes	No
1 Has the issuer filed Form 8038-T, Arbitrage Rebate, Yield Reduction and Penalty in Lieu of Arbitrage Rebate? ...		X	X			X		X
2 If "No" to line 1, did the following apply? ....
a Rebate not due yet? .......							X
b Exception to rebate? ........
c No rebate due? .........	X				X
If "Yes" to line 2c, provide in Part VI the date the rebate computation was performed ......
3 Is the bond issue a variable rate issue? .....	X			X		X	X
4a Has the organization or the governmental issuer entered into a qualified hedge with respect to the bond issue?		X		X		X	X
b Name of provider ..........	0		0		0		WELLS FARGO BANK
c Term of hedge .........							1110 %
d Was the hedge superintegrated? ......								X
e Was the hedge terminated? ........								X

Schedule K (Form 990) 2015

Page 3

Part IV

Arbitrage (Continued)

	A		B		C		D
	Yes	No	Yes	No	Yes	No	Yes	No
5a Were gross proceeds invested in a guaranteed investment contract (GIC)?		X		X		X		X
b Name of provider ..........	0		0		0		0
c Term of GIC .........
d Was the regulatory safe harbor for establishing the fair market value of the GIC satisfied? ........
6 Were any gross proceeds invested beyond an available temporary period?	X			X		X		X
7 Has the organization established written procedures to monitor the requirements of section 148? ...	X		X		X		X

Part V

Procedures To Undertake Corrective Action

	A		B		C		D
	Yes	No	Yes	No	Yes	No	Yes	No
Has the organization established written procedures to ensure that violations of federal tax requirements are timely identified and corrected through the voluntary closing agreement program if self-remediation is not available under applicable regulations?	X		X		X		X

Part VI

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

Return Reference	Explanation
SCHEDULE K, PART I, COLUMN A, LINE A, LINE B, AND LINE D	THE INDUSTRIAL DEVELOPMENT AUTHORITY OF ST. JOSEPH, MISSOURI
SCHEDULE K, PART I, COLUMN A, LINE C	HEALTH AND EDUCATIONAL FACILITIES AUTHORITY OF THE STATE OF MISSOURI
SCHEDULE K, PART I, COLUMN F, LINE A	Finance the construction and equipping of certain healthcare facilities.
SCHEDULE K, PART I, COLUMN F, LINE B	Refund 2001AB Bonds issued on 11/29/2001, 2001D Bonds issued on 11/29/2001 and 2003E Bonds issued on 5/22/2003.
SCHEDULE K, PART I, COLUMN F, LINE C	To acquire, construct, remodel, renovate and equip certain healthcare facilities.
SCHEDULE K, PART I, COLUMN F, LINE D	Refund 2001AB and 2001D Bonds issued on 11/29/2001.
SCHEDULE K, PART II, COLUMN A, LINE 3	Amount does not equal to issue price listed in Part I, Column (e) due to investment earnings.
SCHEDULE K, PART II, COLUMN C, LINE 3	Amount does not equal to issue price listed in Part I, Column (e) due to investment earnings.
SCHEDULE K, 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.
SCHEDULE K, PART III, COLUMN D	PART III FOR 2015AB BONDS HAS NOT BEEN COMPLETED. THE 2015AB BONDS WERE USED TO REFINANCE PROJECTS ORIGINALLY FINANCED WITH BONDS ISSUED PRIOR TO JANUARY 1, 2003.
SCHEDULE K, PART IV, COLUMN A, LINE 2C	The Arbitrage Rebate Analysis was performed as of 2/1/2014.
SCHEDULE K, PART IV, COLUMN C, LINE 2C	The Arbitrage Rebate Analysis was performed as of 9/1/2014.
SCHEDULE K, PART IV, COLUMN A, LINE 6	THE PROJECT FUND WAS INVESTED BEYOND THE THREE YEAR TEMPORARY PERIOD BUT NO EXCESS YIELD LIABILITY WAS GENERATED.

Schedule K (Form 990) 2015

Additional Data

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Software Version:

- TIN:

Schedule L
(Form 990 or 990-EZ)

Department of the Treasury
Internal Revenue Service

Transactions with Interested Persons

Complete if the organization answered
"Yes" on Form 990, Part IV, lines 25a, 25b, 26, 27, 28a, 28b, or 28c,
or Form 990-EZ, Part V, line 38a or 40b.
MediumBullet

Attach to Form 990 or Form 990-EZ.
MediumBullet

Information about Schedule L (Form 990 or 990-EZ) and its instructions is at www.irs.gov/form990.

OMB No. 1545-0047

2015

Open to Public Inspection

Name of the organization

HEARTLAND REGIONAL MEDICAL CENTER

Employer identification number

44-0545289

Part I

Excess Benefit Transactions (section 501(c)(3), section 501(c)(4), and 501(c)(29) organizations only).
Complete if the organization answered "Yes" on Form 990, Part IV, line 25a or 25b, or Form 990-EZ, Part V, line 40b.

1(a) Name of disqualified person	(c) Description of transaction	(d) Corrected?
1(a) Name of disqualified person	(c) Description of transaction	Yes	No

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

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

Part II

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

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










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

Part III

Grants or Assistance Benefiting Interested Persons.
Complete if the organization answered "Yes" on Form 990, Part IV, line 27.

(a) Name of interested person	(b) Relationship between interested person and the organization	(c) Amount of assistance	(d) Type of assistance	(e) Purpose of assistance

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

Cat. No. 50056A

Schedule L (Form 990 or 990-EZ) 2015

Page 2

Part IV

Business Transactions Involving Interested Persons.
Complete if the organization answered "Yes" on Form 990, Part IV, line 28a, 28b, or 28c.

(a) Name of interested person	(c) Amount of transaction	(d) Description of transaction	(e) Sharing of organization's revenues?
(a) Name of interested person	(c) Amount of transaction	(d) Description of transaction	Yes	No
(1) SEE PART V

Part V

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

Return Reference

Explanation

SCHEDULE L, PART IV

TRANSACTION #1 (A) DONNA WILSON (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. (C) $ 126,742 (D) SALARY AND OTHER COMPENSATION FOR SERVICE LEADER SERVICES (E) NO TRANSACTION #2 (A) CORINNE KOELLIKER (B) CORINNE KOELLIKER IS A LASER TECHNICIAN FOR HEARTLAND REGIONAL MEDICAL CENTER, AND IS THE SISTER OF SCOTT KOELLIKER, WHO IS A KEY EMPLOYEE OF HEARTLAND REGIONAL MEDICAL CENTER. (C) $ 34,601 (D) SALARY AND OTHER COMPENSATION FOR LASER TECHNICIAN SERVICES (E) NO TRANSACTION #3 (A) JON KOELLIKER (B) JON KOELLIKER IS A TS APPLICATIONS ANALYST FOR HEARTLAND REGIONAL MEDICAL CENTER, AND IS THE BROTHER OF SCOTT KOELLIKER, WHO IS A KEY EMPLOYEE OF HEARTLAND REGIONAL MEDICAL CENTER. (C) $ 108,039 (D) SALARY AND OTHER COMPENSATION FOR TS APPLICATIONS ANALYST SERVICES (E) NO TRANSACTION #4 (A) MARINA KOELLIKER (B) MARINA KOELLIKER IS A REGISTERED NURSE FOR HEARTLAND REGIONAL MEDICAL CENTER, AND IS THE WIFE OF SCOTT KOELLIKER, WHO IS A KEY EMPLOYEE OF HEARTLAND REGIONAL MEDICAL CENTER. (C) $ 74,863 (D) SALARY FOR REGISTERED NURSE SERVICES (E) NO TRANSACTION #5 (A) TRACY HOWERY (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 DIRECTOR OF HEARTLAND REGIONAL MEDICAL CENTER. (C) $ 120,734 (D) SALARY FOR ADVANCED PRACTICE REGISTERED NURSE SERVICES (E) NO TRANSACTION #6 (A) JILLIAN KOELLIKER (B) JILLIAN KOELLIKER IS A STAFF NURSE FOR HEARTLAND REGIONAL MEDICAL CENTER, AND IS THE DAUGHTER OF SCOTT KOELLIKER, WHO IS A KEY EMPLOYEE OF HEARTLAND REGIONAL MEDICAL CENTER. (C) $ 54,322 (D) SALARY FOR STAFF NURSE (E) NO TRANSACTION #7 (A) MARY KOELLIKER (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 KEY EMPLOYEE OF HEARTLAND REGIONAL MEDICAL CENTER. (C) $ 29,946 (D) SALARY FOR THERAPY DEPARTMENT SERVICES (E) NO

Schedule L (Form 990 or 990-EZ) 2015

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE M
(Form 990)

Department of the Treasury

Internal Revenue Service

Noncash Contributions

Complete if the organizations answered "Yes" on Form 990, Part IV, lines 29 or 30.
Right pointing arrow large image

Attach to Form 990.
Right pointing arrow large image

Information about Schedule M (Form 990) and its instructions is at www.irs.gov/form990

OMB No. 1545-0047

2015

Open to Public Inspection

Name of the organization

HEARTLAND REGIONAL MEDICAL CENTER

Employer identification number

44-0545289

Part I

Types of Property

	(a) Check if applicable	(b) Number of contributions or items contributed	(c) Noncash contribution amounts reported on Form 990, Part VIII, line 1g	(d) Method of determining noncash contribution amounts
1 Art—Works of art ....
2 Art—Historical treasures .
3 Art—Fractional interests ..
4 Books and publications ..
5 Clothing and household goods .......
6 Cars and other vehicles ..
7 Boats and planes ....
8 Intellectual property ...
9 Securities—Publicly traded .
10 Securities—Closely held stock .
11 Securities—Partnership, LLC, or trust interests ....
12 Securities—Miscellaneous ..
13 Qualified conservation contribution—Historic structures .....
14 Qualified conservation contribution—Other ...
15 Real estate—Residential .
16 Real estate—Commercial ..	X	1	225,000	APPRAISAL
17 Real estate—Other ...
18 Collectibles .....
19 Food inventory ...
20 Drugs and medical supplies .
21 Taxidermy ......
22 Historical artifacts ....
23 Scientific specimens ..
24 Archeological artifacts ...
25 Other ( )
26 Other ( )
27 Other ( )
28 Other ( )

Number of Forms 8283 received by the organization during the tax year for contributions
for which the organization completed Form 8283, Part IV, Donee Acknowledgement

Yes

30a

During the year, did the organization receive by contribution any property reported in Part I, lines 1 through 28, that

it must hold for at least three years from the date of the initial contribution, and which is not required to be used

for exempt purposes for the entire holding period? ..................

30a

If "Yes," describe the arrangement in Part II.

Does the organization have a gift acceptance policy that requires the review of any non-standard contributions?

32a

Does the organization hire or use third parties or related organizations to solicit, process, or sell noncash

contributions? ..........................

32a

If "Yes," describe in Part II.

If the organization did not report an amount in column (c) for a type of property for which column (a) is checked,

describe in Part II.

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

Cat. No. 51227J

Schedule M (Form 990) (2015)

Page 2

Part II

Supplemental Information. Provide the information required by Part I, lines 30b, 32b, and 33, and whether the organization is reporting in Part I, column (b), the number of contributions, the number of items received, or a combination of both. Also complete this part for any additional information.

Return Reference	Explanation
SCHEDULE M, PART I, COLUMN B	THE INFORMATION PRESENTED IN COLUMN B IS THE NUMBER OF CONTRIBUTIONS.

Schedule M (Form 990) (2015)

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 990-EZ or to provide any additional information.
MediumBullet

Attach to Form 990 or 990-EZ.
MediumBullet

Information about Schedule O (Form 990 or 990-EZ) and its instructions is at
www.irs.gov/form990.

OMB No. 1545-0047

2015

Open to Public
Inspection

Name of the organization

HEARTLAND REGIONAL MEDICAL CENTER

Employer identification number

44-0545289

Return Reference	Explanation
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 APPROXIMATELY 70% GOVERNMENTAL GOVERNMENTAL AND UNINSURED. 18% 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 15,400 PATIENTS WERE ADMITTED TO THE HOSPITAL RESULTING IN APPROXIMATELY 65,700 PATIENT DAYS. A TOTAL OF APPROXIMATELY 10,000 SURGERIES WERE PERFORMED, THE EMERGENCY ROOM SERVED APPROXIMATELY 62,000 PATIENTS AND APPROXIMATELY 191,000 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 43 LOCATIONS THROUGHOUT THE REGION. THERE WERE APPROXIMATELY 851,000 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 GROSS CHARGES ON 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 A 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. 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. 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	ALL BOARD MEMBERS ALSO SERVE ON THE BOARD OF THE SOLE MEMBER, HEARTLAND HEALTH. CURT KRETZINGER, JOHN P. WILSON AND DWAIN STILSON HAVE A BUSINESS RELATIONSHIP WITH HEARTLAND LONG-TERM ACUTE CARE HOSPITAL, A RELATED NOT-FOR-PROFIT CORPORATION. THEY SERVE AS EITHER A DIRECTOR OR OFFICER OF HEARTLAND LONG TERM ACUTE CARE HOSPITAL. JOHN P. WILSON, CURT KRETZINGER, MARK LANEY, M.D., DWAIN STILSON, SERENA NAYLOR AND MICHAEL PULIDO HAVE A BUSINESS RELATIONSHIP WITH NORTHWEST MEDICAL CENTER ASSOCIATION, INC. THEY SERVE AS EITHER OFFICERS AND/OR DIRECTORS FOR NORTHWEST MEDICAL CENTER ASSOCIATION, INC., WHICH IS A RELATED NOT-FOR-PROFIT CORPORATION. JOHN P. WILSON, CURT KRETZINGER, MARK LANEY, M.D., 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., LISA MICHAELIS, JAREN PIPPITT, BRENNAN LEHMAN AND MICHAEL PULIDO 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., AND SHOAL CREEK FAMILY MEDICINE & ALLERGY, INC. THEY SERVE AS EITHER OFFICERS AND/OR DIRECTORS OF UPTOWN HOUSING, INC. AND SHOAL CREEK FAMILY MEDICINE & ALLERGY, INC., WHICH ARE RELATED FOR-PROFIT CORPORATIONS.
FORM 990, PART VI, SECTION A, LINE 4	Heartland Regional Medical Center adopted amended bylaws on October 28, 2015. These bylaws provide that the Board of Directors shall have authority, by resolution, to fix the compensation, if any, of the Directors serving as directors of the Hospital and may provide for reimbursement of expense incurred by the Directors on behalf of the Hospital. The previous bylaws stated that Directors shall not receive any compensation for their services as Directors but may receive reimbursement for expenses incurred on bahalf of the Hospital.
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 B, 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 CENTERS 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 ORGANIZATIONS 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 HEARTLANDS 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 15A & 15B	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 AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UPON WRITTEN REQUEST.
FORM 990, PART XI, LINE 9	NET ASSET TRANSFER $ (4,143,244) CHANGE IN FAIR VALUE OF CASH FLOW HEDGING DERIVATES 352,724 CHANGE IN DEFINED BENEFIT PENSION PLAN LIABILITY (227,297) DECONSOLIDATION OF AFFILIATES (578,565) ------------- $ (4,596,382) =============

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

Cat. No. 51056K

Schedule O (Form 990 or 990-EZ) 2015

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE R
(Form 990)

Department of the Treasury
Internal Revenue Service

Related Organizations and Unrelated Partnerships

Complete if the organization answered "Yes" on Form 990, Part IV, line 33, 34, 35b, 36, or 37.
MediumBullet

Attach to Form 990.
MediumBullet

Information about Schedule R (Form 990) and its instructions is at www.irs.gov/form990.

OMB No. 1545-0047

2015

Open to Public Inspection

Name of the organization

HEARTLAND REGIONAL MEDICAL CENTER

Employer identification number

44-0545289

Part I

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

(a) Name, address, and EIN (if applicable) of disregarded entity	(b) Primary activity	(c) Legal domicile (state or foreign country)	(e) End-of-year assets	(f) Direct controlling entity
(1) NORTHLAND EXPANSION LLC 5325 FARAON ST ST JOSEPH,MO64506	DEVELOPMENT	MO	0	HRMC
(2) URGENT CARE PROPERTIES LLC 5325 FARAON ST ST JOSEPH,MO64506	DEVELOPMENT	MO	0	HRMC

Part II

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

(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Exempt Code section	(e) Public charity status (if section 501(c)(3))	(f) Direct controlling entity	(g) Section 512(b)(13) controlled entity?
(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Exempt Code section	(e) Public charity status (if section 501(c)(3))	(f) Direct controlling entity	Yes	No
(1)HEARTLAND HEALTH 5325 FARAON ST ST JOSEPH,MO64506 43-1283316	HEALTHCARE	MO	501(C)(3)	11B	NA		No
(2)HEARTLAND FOUNDATION 5325 FARAON ST ST JOSEPH,MO64506 43-1262768	SUPPORT	MO	501(C)(3)	7	HH	Yes
(3)HEARTLAND LONG TERM ACUTE CARE HOSPITAL 5325 FARAON ST ST JOSEPH,MO64506 26-1972987	HEALTHCARE	MO	501(C)(3)	3	HH	Yes
(4)HEARTLAND HEALTH CARE PLAN TRUST FUND 5325 FARAON ST ST JOSEPH,MO64506 43-1286484	VEBA	MO	501(C)(9)		HH	Yes
(5)NORTHWEST MEDICAL CENTER ASSOCATION INC 705 N COLLEGE ST ALBANY,MO64402 44-0580870	HEALTHCARE	MO	501(C)(3)	3	HH	Yes

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

Cat. No. 50135Y

Schedule R (Form 990) 2015

Page 2

Part III

Identification of Related Organizations Taxable as a Partnership Complete if the organization answered "Yes" on Form 990, Part IV, line 34 because it had one or more related organizations treated as a partnership during the tax year.

(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Direct controlling entity	(e) Predominant income(related, unrelated, excluded from tax under sections 512-514)	(f) Share of total income	(g) Share of end-of-year assets	(h) Disproprtionate allocations?		(i) Code V-UBI amount in box 20 of Schedule K-1 (Form 1065)	(j) General or managing partner?		(k) Percentage ownership
(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Direct controlling entity		(f) Share of total income	(g) Share of end-of-year assets	Yes	No	(i) Code V-UBI amount in box 20 of Schedule K-1 (Form 1065)	Yes	No
(1) MPACT HEALTH LLC 5325 FARAON ST ST JOSEPH,MO64506 81-2138259	HEALTHCARE	MO	NA	EXCLUDED	-270,632	60,208		No	0		No	33.000 %

Part IV

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

(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Direct controlling entity	(e) Type of entity (C corp, S corp, or trust)	(f) Share of total income	(g) Share of end-of-year assets	(i) Section 512(b)(13) controlled entity?
(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Direct controlling entity	(e) Type of entity (C corp, S corp, or trust)	(f) Share of total income	(g) Share of end-of-year assets	Yes	No
(1) MIDWESTERN HEALTH MANAGEMENT INC 5325 FARAON ST ST JOSEPH,MO64506 43-1264358	HEALTHCARE	MO	HH	C CORP	0	0	Yes
(2) COMMUNITY HEALTH PLAN INSURANCE COMPANY 5325 FARAON ST ST JOSEPH,MO64506 43-1210152	INSURANCE	MO	HH	C CORP	0	0	Yes
(3) HHS PROPERTIES INC 5325 FARAON ST ST JOSEPH,MO64506 43-1593799	INVESTMENT	MO	HH	C CORP	0	0	Yes
(4) UPTOWN HOUSING INC 5325 FARAON ST ST JOSEPH,MO64506 26-1416252	REDEVELOPMENT	MO	HH	C CORP	0	0	Yes
(5) UPTOWN ST JOSEPH REDEVELOPMENT CORP 5325 FARAON ST ST JOSEPH,MO64506 20-1742813	REDEVELOPMENT	MO	HH	C CORP	0	0	Yes

Schedule R (Form 990) 2015

Page 3

Part V

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

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

Yes

1 During the tax year, did the orgranization engage in any of the following transactions with one or more related organizations listed in Parts II-IV?

a Receipt of (i) interest, (ii) annuities, (iii) royalties, or (iv) rent from a controlled entity .....................

Yes

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

Yes

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

Yes

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

Yes

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

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

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

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

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

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

Yes

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

Yes

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

Yes

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

Yes

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

Yes

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

Yes

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

Yes

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

Yes

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

Yes

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

Yes

If the answer to any of the above is "Yes," see the instructions for information on who must complete this line, including covered relationships and transaction thresholds.

(a) Name of related organization	(b) Transaction type (a-s)	(c) Amount involved	(d) Method of determining amount involved
(1) MIDWESTERN HEALTH MANAGEMENT INC	B	3,779,850	FMV
(2) MIDWESTERN HEALTH MANAGEMENT INC	L	722,361	FMV
(3) MIDWESTERN HEALTH MANAGEMENT INC	Q	5,001,628	FMV
(4) HHS PROPERTIES INC	B	147,984	FMV
(5) HHS PROPERTIES INC	K	258,507	FMV
(6) HHS PROPERTIES INC	L	325,000	FMV
(7) HHS PROPERTIES INC	Q	197,219	FMV
(8) HEARTLAND HEALTH BUSINESS PLAZA LLC	K	1,045,153	FMV
(9) HEARTLAND LONG TERM ACUTE CARE HOSPITAL	A	1,092,127	FMV
(10) HEARTLAND LONG TERM ACUTE CARE HOSPITAL	L	5,217,821	FMV
(11) HEARTLAND LONG TERM ACUTE CARE HOSPITAL	Q	7,018,169	FMV
(12) HEARTLAND FOUNDATION	Q	1,547,371	FMV
(13) COMMUNITY HEALTH PLAN INSURANCE COMPANY	Q	95,325	FMV
(14) NORTHWEST MEDICAL CENTER ASSOCIATION INC	A	48,920	FMV
(15) NORTHWEST MEDICAL CENTER ASSOCIATION INC	L	1,000,000	FMV
(16) NORTHWEST MEDICAL CENTER ASSOCIATION INC	Q	20,655,318	FMV
(17) SHOAL CREEK FAMILY MEDICINE & ALLERGY INC	Q	141,951	FMV
(18) SHOAL CREEK FAMILY MEDICINE & ALLERGY INC	S	555,568	FMV
(19) MPACT HEALTH LLC	B	319,867	FMV

Schedule R (Form 990) 2015

Page 4

Part VI

Unrelated Organizations Taxable as a Partnership Complete if the organization answered "Yes" on Form 990, Part IV, line 37.

Provide the following information for each entity taxed as a partnership through which the organization conducted more than five percent of its activities (measured by total assets or gross revenue) that was not a related organization. See instructions regarding exclusion for certain investment partnerships.

(a) Name, address, and EIN of entity	(b) Primary activity	(c) Legal domicile (state or foreign country)	(e) Are all partners section 501(c)(3) organizations?		(f) Share of total income	(g) Share of end-of-year assets	(h) Disproprtionate allocations?		(i) Code V-UBI amount in box 20 of Schedule K-1 (Form 1065)	(j) General or managing partner?
(a) Name, address, and EIN of entity	(b) Primary activity	(c) Legal domicile (state or foreign country)	Yes	No	(f) Share of total income	(g) Share of end-of-year assets	Yes	No	(i) Code V-UBI amount in box 20 of Schedule K-1 (Form 1065)	Yes	No

Schedule R (Form 990) 2015

Page 5

Part VII

Supplemental Information

Provide additional information for responses to questions on Schedule R (see instructions).

Return Reference	Explanation

Schedule R (Form 990) 2015

Additional Data

Software ID:
Software Version:

1	Briefly describe the organization’s mission or most significant activities: TO IMPROVE POPULATION HEALTH OUTCOMES IN OUR REGION BY PROVIDING THE RIGHT CARE, AT THE RIGHT TIME, PLACE AND COST.
2	Check this box
3	Number of voting members of the governing body (Part VI, line 1a) ........	3	13
4	Number of independent voting members of the governing body (Part VI, line 1b) .....	4	9
5	Total number of individuals employed in calendar year 2015 (Part V, line 2a) ......	5	4,727
6	Total number of volunteers (estimate if necessary) .............	6	473
7a	Total unrelated business revenue from Part VIII, column (C), line 12 ........	7a	1,569,674
b	Net unrelated business taxable income from Form 990-T, line 34 .........	7b

		Prior Year	Current Year
8	Contributions and grants (Part VIII, line 1h) .........	1,684,519	645,354
9	Program service revenue (Part VIII, line 2g) .........	591,360,504	564,223,618
10	Investment income (Part VIII, column (A), lines 3, 4, and 7d ) ....	26,654,887	50,235,912
11	Other revenue (Part VIII, column (A), lines 5, 6d, 8c, 9c, 10c, and 11e)	29,329,312	23,848,502
12	Total revenue—add lines 8 through 11 (must equal Part VIII, column (A), line 12)	649,029,222	638,953,386
13	Grants and similar amounts paid (Part IX, column (A), lines 1–3 )...	2,181,013	2,785,232
14	Benefits paid to or for members (Part IX, column (A), line 4).....	0	0
15	Salaries, other compensation, employee benefits (Part IX, column (A), lines 5–10)	311,994,292	321,468,642
16a	Professional fundraising fees (Part IX, column (A), line 11e) .....	0	0
b	Total fundraising expenses (Part IX, column (D), line 25) 230,230
17	Other expenses (Part IX, column (A), lines 11a–11d, 11f–24e)....	292,940,427	274,368,439
18	Total expenses. Add lines 13–17 (must equal Part IX, column (A), line 25)	607,115,732	598,622,313
19	Revenue less expenses. Subtract line 18 from line 12.......	41,913,490	40,331,073
		Beginning of Current Year	End of Year
20	Total assets (Part X, line 16).............	830,946,761	859,768,385
21	Total liabilities (Part X, line 26).............	324,267,134	359,153,351
22	Net assets or fund balances. Subtract line 21 from line 20.....	506,679,627	500,615,034

Sign Here

	Signature of officer	Date

	Type or print name and title


4a	(Code: ) (Expenses $ 544,161,283 including grants of $ 2,785,232 ) (Revenue $ 587,240,890 )
	SEE SCHEDULE O

4b	(Code: ) (Expenses $ including grants of $ ) (Revenue $ )












4c	(Code: ) (Expenses $ including grants of $ ) (Revenue $ )












4d	Other program services (Describe in Schedule O.)
	(Expenses $ including grants of $ ) (Revenue $ )
4e	Total program service expenses544,161,283

1b	Sub-Total................
c	Total from continuation sheets to Part VII, Section A....
d	Total (add lines 1b and 1c)...........	10,573,108	65,244	707,890

1a	Federated campaigns..		1a
b	Membership dues..		1b
c	Fundraising events..		1c
d	Related organizations		1d	5,787
e	Government grants (contributions)		1e

f	All other contributions, gifts, grants, and similar amounts not included above		1f	639,567

g	Noncash contributions included in lines 1a-1f:$ 225,000
h Total.Add lines 1a-1f.......		645,354

			Business Code
2a	NET PATIENT SERVICE REVENUE	621110	536,153,817	536,153,817
b	340B PHARMACY REVENUE	621110	27,438,741	27,438,741
c	MEANINGFUL USE PAYMENTS	621110	631,060	631,060
d
e
f	All other program service revenue.
g Total.Add lines 2a–2f.....			564,223,618

3 Investment income (including dividends, interest, and othersimilar amounts) ..........			11,534,821			11,534,821
4 Income from investment of tax-exempt bond proceeds			0
5 Royalties...........			0
		(ii) Personal	(i) Real
6a	Gross rents		831,230
b	Less: rental expenses
c	Rental income or (loss)	0	831,230
d	Net rental income or (loss)......			831,230			831,230
		(ii) Other	(i) Securities
7a	Gross amount from sales of assets other than inventory	37,399	284,036,802
b	Less: cost or other basis and sales expenses	32,946	245,340,164
c	Gain or (loss)	4,453	38,696,638
d	Net gain or (loss).....			38,701,091			38,701,091
8a	Gross income from fundraising events (not including $ of contributions reported on line 1c). See Part IV, line 18 ....
	a
b	Less: direct expenses ...b
c	Net income or (loss) from fundraising events..			0
9a	Gross income from gaming activities. See Part IV, line 19 ...
	a
b	Less: direct expenses ...b
c	Net income or (loss) from gaming activities..			0
10a	Gross sales of inventory, less returns and allowances ..
	a		122,261
b	Less: cost of goods sold ..b		172,457
c	Net income or (loss) from sales of inventory..			-50,196		-50,196
Business Code			Miscellaneous Revenue
11a	Cafeteria		722514	2,207,127	2,207,127
b	Refferal Lab		111000	5,967,121	5,905,597	61,524
c	Copying Revenue		541380	545,211	545,211
d	All other revenue ....			14,348,009	12,789,663	1,558,346
e	Total. Add lines 11a–11d ......			23,067,468
12	Total revenue. See Instructions......			638,953,386	585,671,216	1,569,674	51,067,142

1	Grants and other assistance to domestic organizations and domestic governments. See Part IV, line 21	2,785,232	2,785,232
2	Grants and other assistance to individuals in the United States. See Part IV, line 22	0
3	Grants and other assistance to governments, organizations, and individuals outside the United States. See Part IV, lines 15 and 16	0
4	Benefits paid to or for members	0
5	Compensation of current officers, directors, trustees, and key employees ....	6,007,029	2,452,220	3,554,809
6	Compensation not included above, to disqualified persons (as defined under section 4958(f)(1)) and persons described in section 4958(c)(3)(B) ....	549,247	549,247
7	Other salaries and wages	250,841,909	232,703,316	18,058,542	80,051
8	Pension plan accruals and contributions (include section 401(k) and 403(b) employer contributions) ....	10,420,104	9,203,532	1,213,717	2,855
9	Other employee benefits .......	38,443,587	34,446,573	3,951,090	45,924
10	Payroll taxes ...........	15,206,766	13,919,826	1,280,806	6,134
11	Fees for services (non-employees):
a	Management ......	0
b	Legal .........	1,582,523		1,582,523
c	Accounting ...........	698,155		698,155
d	Lobbying ...........	115,125		115,125
e	Professional fundraising services. See Part IV, line 17	0
f	Investment management fees ......	0
g	Other (If line 11g amount exceeds 10% of line 25, column (A) amount, list line 11g expenses on Schedule O)	34,343,573	33,258,259	1,063,588	21,726
12	Advertising and promotion ....	3,503,478	79,195	3,424,283
13	Office expenses .......	28,638,885	25,224,706	3,390,353	23,826
14	Information technology ......	3,082,118	2,914,287	165,965	1,866
15	Royalties ..	0
16	Occupancy ...........	14,586,180	11,714,958	2,871,222
17	Travel ............	1,037,606	984,802	52,327	477
18	Payments of travel or entertainment expenses for any federal, state, or local public officials .	0
19	Conferences, conventions, and meetings ....	2,477,507	2,027,282	449,657	568
20	Interest ...........	6,329,282	27,438	6,301,844
21	Payments to affiliates .......	0
22	Depreciation, depletion, and amortization ..	29,495,102	25,004,769	4,444,909	45,424
23	Insurance ...	7,160,059	6,520,636	639,423
24	Other expenses. Itemize expenses not covered above (List miscellaneous expenses in line 24e. If line 24e amount exceeds 10% of line 25, column (A) amount, list line 24e expenses on Schedule O.)
a	PROVISION FOR UNCOLLECTIBLE	22,792,622	22,792,622
b	FRA TAX	26,450,624	26,450,624
c	MEDICAL SUPPLIES	89,655,423	89,643,644	11,779
d	DUES & SUBSCRIPTIONS	2,420,177	1,458,115	960,683	1,379
e	All other expenses
25	Total functional expenses. Add lines 1 through 24e	598,622,313	544,161,283	54,230,800	230,230
26	Joint costs. Complete this line only if the organization reported in column (B) joint costs from a combined educational campaign and fundraising solicitation. Check here if following SOP 98-2 (ASC 958-720).

1	Cash–non-interest-bearing ........			30,537,646	1	26,904,573
2	Savings and temporary cash investments .........			0	2	0
3	Pledges and grants receivable, net ......			0	3	0
4	Accounts receivable, net .............			63,765,326	4	72,432,584
5	Loans and other receivables from current and former officers, directors, trustees, key employees, and highest compensated employees. Complete Part II of Schedule L
				0	5	0
6	Loans and other receivables from other disqualified persons (as defined under section 4958(f)(1)), persons described in section 4958(c)(3)(B), and contributing employers and sponsoring organizations of section 501(c)(9) voluntary employees' beneficiary organizations (see instructions) Complete Part II of Schedule L
				0	6	0
7	Notes and loans receivable, net ....			0	7	0
8	Inventories for sale or use ........			7,226,668	8	7,757,338
9	Prepaid expenses and deferred charges ......			6,718,945	9	7,577,204
10a	Land, buildings, and equipment: cost or other basis. Complete Part VI of Schedule D	10a	637,526,841
b	Less: accumulated depreciation	10b	400,405,078	245,407,413	10c	237,121,763
11	Investments—publicly traded securities .			448,837,797	11	476,258,585
12	Investments—other securities. See Part IV, line 11 .....			7,722,147	12	7,478,444
13	Investments—program-related. See Part IV, line 11 ..			1,230,219	13	8,180,362
14	Intangible assets ...............			0	14	0
15	Other assets. See Part IV, line 11 ...........			19,500,600	15	16,057,532
16	Total assets. Add lines 1 through 15 (must equal line 34)...			830,946,761	16	859,768,385

17	Accounts payable and accrued expenses .....	91,228,402	17	130,076,130
18	Grants payable ...	0	18	0
19	Deferred revenue .........	0	19	0
20	Tax-exempt bond liabilities .........	220,393,323	20	215,724,479
21	Escrow or custodial account liability. Complete Part IV of Schedule D	0	21	0
22	Loans and other payables to current and former officers, directors, trustees, key employees, highest compensated employees, and disqualified
	persons. Complete Part II of Schedule L..	0	22	0
23	Secured mortgages and notes payable to unrelated third parties ..	2,895,501	23	2,483,921
24	Unsecured notes and loans payable to unrelated third parties ..	0	24	0
25	Other liabilities (including federal income tax, payables to related third parties, and other liabilities not included on lines 17-24). Complete Part X of Schedule D	9,749,908	25	10,868,821
26	Total liabilities. Add lines 17 through 25..	324,267,134	26	359,153,351

	Organizations that follow SFAS 117 (ASC 958), check here and complete lines 27 through 29, and lines 33 and 34.
27	Unrestricted net assets	506,288,328	27	500,223,735
28	Temporarily restricted net assets ...........	391,299	28	391,299
29	Permanently restricted net assets	0	29	0
	Organizations that do not follow SFAS 117 (ASC 958), check here and complete lines 30 through 34.
30	Capital stock or trust principal, or current funds .....		30
31	Paid-in or capital surplus, or land, building or equipment fund ...		31
32	Retained earnings, endowment, accumulated income, or other funds		32
33	Total net assets or fund balances ...........	506,679,627	33	500,615,034
34	Total liabilities and net assets/fund balances ........	830,946,761	34	859,768,385