TY 2018 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) CHARLES W SHIELDS...................................................................... PRESIDENT/CEO/DIRECTOR	40.0 ................. 0.0	X	X	1,000,380	415,085
(2) PEGGY J DUNN...................................................................... PAST CHAIR/DIRECTOR	1.0 ................. 0.0	X	X	0	0
(3) DAVE BARBER...................................................................... VICE CHAIR/DIRECTOR	1.0 ................. 0.0	X	X	0	0
(4) PHILIP J SANDERS...................................................................... CHAIR/DIRECTOR	1.0 ................. 0.0	X	X	0	0
(5) DRED D SCOTT PHD...................................................................... VICE CHAIR/DIRECTOR	1.0 ................. 0.0	X	X	0	0
(6) TIMOTHY A WURST...................................................................... SECRETARY/VICE CHAIR/DIRECTOR	1.0 ................. 0.0	X	X	0	0
(7) KAREN ZECY...................................................................... TREASURER/DIRECTOR	1.0 ................. 0.0	X	X	0	0
(8) FORESTINE BEASLEY...................................................................... DIRECTOR	1.0 ................. 0.0	X		0	0
(9) ZANE M BURKE...................................................................... DIRECTOR	1.0 ................. 0.0	X		0	0
(10) ANN H CARY PHD...................................................................... DIRECTOR	1.0 ................. 0.0	X		0	0
(11) JAMES CORWIN...................................................................... DIRECTOR	1.0 ................. 0.0	X		0	0
(12) SEN KIKI CURLS...................................................................... DIRECTOR	1.0 ................. 0.0	X		0	0
(13) JOLIE L JUSTUS...................................................................... VICE CHAIR/DIRECTOR	1.0 ................. 0.0	X	X	0	0
(14) TRACEY LEWIS...................................................................... DIRECTOR	1.0 ................. 0.0	X		0	0
(15) MARVIN LYMAN...................................................................... DIRECTOR	1.0 ................. 0.0	X		0	0
(16) JON OTTO...................................................................... DIRECTOR	1.0 ................. 0.0	X		0	0
(17) MAHNAZ SHABBIR...................................................................... DIRECTOR	1.0 ................. 0.0	X		0	0

(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)
(18) MARK T STEELE MD........................................................................ DIRECTOR	20.0 .......................1.0	X			263,606	18,252
(19) ADAM ALGREN MD........................................................................ DIRECTOR	1.0 .......................0.0	X			0	0
(20) MICHAEL COLLINS........................................................................ DIRECTOR	1.0 .......................0.0	X			0	0
(21) CARLOS GOMEZ........................................................................ DIRECTOR	1.0 .......................0.0	X			0	0
(22) JIM HEETER........................................................................ DIRECTOR	1.0 .......................0.0	X			0	0
(23) ALISE MARTINY........................................................................ DIRECTOR	1.0 .......................0.0	X			0	0
(24) MELISSA ROBINSON........................................................................ DIRECTOR	1.0 .......................0.0	X			0	0
(25) MAULI AGRAWAL........................................................................ DIRECTOR	1.0 .......................0.0	X			0	0
(26) MARK BERNHARDT MD........................................................................ DIRECTOR	1.0 .......................0.0	X			0	0
(27) PAT CONTRERAS........................................................................ DIRECTOR	1.0 .......................0.0	X			0	0
(28) SEAN GRATTON MD........................................................................ DIRECTOR	1.0 .......................0.0	X			0	0
(29) STEVE HAWN........................................................................ DIRECTOR	1.0 .......................0.0	X			0	0
(30) MARY ANNE JACKSON MD........................................................................ DIRECTOR	1.0 .......................0.0	X			0	0
(31) LARRY RICCI DO........................................................................ DIRECTOR	1.0 .......................0.0	X			0	0
(32) GLEN TALBOY MD........................................................................ DIRECTOR	1.0 .......................0.0	X			0	0
(33) MUDASSAR ZIA MD........................................................................ DIRECTOR	1.0 .......................0.0	X			0	0
(34) LATOSHA ELIGON........................................................................ DIRECTOR	1.0 .......................0.0	X			0	0
(35) EILEEN WEIR........................................................................ DIRECTOR	1.0 .......................0.0	X			0	0
(36) WILLIAM H COLBY........................................................................ ASSISTANT SECRETARY	40.0 .......................2.0		X		701,151	107,682
(37) ALLEN M JOHNSON........................................................................ ASSISTANT TREASURER	40.0 .......................0.0		X		546,719	120,733
(38) JOHN GIANINO MD........................................................................ NEUROSURGEON	40.0 .......................0.0			X	638,201	103,211
(39) MITZI CARDENAS........................................................................ EXECUTIVE CHIEF ADMIN OFFICER	40.0 .......................0.0			X	348,133	65,863
(40) GERARD GRIMALDI........................................................................ VP HEALTH POLICY & GOVT RELATI	40.0 .......................0.0			X	327,255	81,654
(41) DOUGLAS BRANDT........................................................................ ASSOCIATE CFO	40.0 .......................0.0			X	512,370	90,726
(42) LYNETTE WHEELER........................................................................ COO	40.0 .......................0.0			X	318,250	78,994

(A) Name and business address	(B) Description of services	(C) Compensation
CERNER CORPORATION, PO BOX 412702 KANSAS CITY,MO64141	IT SERVICES	17,585,000
UNIVERSITY OF MISSOURI-KANSAS CITY, PO BOX 805111 KANSAS CITY,MO64180	MEDICAL SERVICES	16,877,032
MORRISON MANAGEMENT SPECIALISTS, PO BOX 102289 ATLANTA,GA30368	FOOD SERVICE	5,297,070
UNIVERSITY HEALTH PHYSICIANS, 2310 HOLMES SUITE 800 KANSAS CITY,MO64108	PHYSICIAN SERVICES	14,090,914
MEDICAL IMAGING PA, 127 W 10TH STREET SUITE 202 KANSAS CITY,MO64105	MEDICAL SERVICES	5,381,498
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 35

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

OMB No. 1545-0047

2018

Open to Public
Inspection

Name of the organization

TRUMAN MEDICAL CENTER INCORPORATED

Employer identification number

44-0661018

Part I

Reason for Public Charity Status (All organizations must complete this part.) See instructions.

The organization is not a private foundation because it is: (For lines 1 through 12, check only one box.)

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

A school described in section 170(b)(1)(A)(ii). (Attach Schedule E (Form 990 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 agricultural research organization described in 170(b)(1)(A)(ix) operated in conjunction with a land-grant college or university or a non-land grant college of agriculture. See instructions. Enter the name, city, and state of the college or university:

An organization that normally receives: (1) more than 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 12a through 12d that describes the type of supporting organization and complete lines 12e, 12f, and 12g.

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

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

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

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

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

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

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

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


Total

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

Cat. No. 11285F

Schedule A (Form 990 or 990-EZ) 2018

Page 2

Part II

Support Schedule for Organizations Described in Sections 170(b)(1)(A)(iv), 170(b)(1)(A)(vi), and 170(b)(1)(A)(ix)
(Complete only if you checked the box on line 5, 7, 8, or 9 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) 2014	(b) 2015	(c) 2016	(d) 2017	(e) 2018	(f) Total
1	Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grant.") ..
2	Tax revenues levied for the organization's benefit and either paid to or expended on its behalf....
3	The value of services or facilities furnished by a governmental unit to the organization without charge..
4	Total. Add lines 1 through 3
5	The portion of total contributions by each person (other than a governmental unit or publicly supported organization) included on line 1 that exceeds 2% of the amount shown on line 11, column (f)..
6	Public support. Subtract line 5 from line 4.

Section B. Total Support

Calendar year (or fiscal year beginning in)		(a) 2014	(b) 2015	(c) 2016	(d) 2017	(e) 2018	(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 2018 (line 6, column (f) divided by line 11, column (f)) .........

Public support percentage for 2017 Schedule A, Part II, line 14 ...............

16a

33 1/3% support test—2018. 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—2017. 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—2018. 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—2017. 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) 2018

Page 3

Part III

Support Schedule for Organizations Described in Section 509(a)(2)
(Complete only if you checked the box on line 10 of Part I or if the organization failed to qualify under Part II. If the organization fails to qualify under the tests listed below, please complete Part II.)

Section A. Public Support

Calendar year (or fiscal year beginning in)		(a) 2014	(b) 2015	(c) 2016	(d) 2017	(e) 2018	(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) 2014	(b) 2015	(c) 2016	(d) 2017	(e) 2018	(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 2018 (line 8, column (f) divided by line 13, column (f)) .........

Public support percentage from 2017 Schedule A, Part III, line 15 ...............

Section D. Computation of Investment Income Percentage

Investment income percentage for 2018 (line 10c, column (f) divided by line 13, column (f)) ......

Investment income percentage from 2017 Schedule A, Part III, line 17 .............

19a

331/3% support tests—2018. 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—2017. 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) 2018

Page 4

Part IV

Supporting Organizations

(Complete only if you checked a box on line 12 of Part I. If you checked 12a of Part I, complete Sections A and B. If you checked 12b of Part I, complete Sections A and C. If you checked 12c of Part I, complete Sections A, D, and E. If you checked 12d 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 12a or 12b 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) 2018

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) 2018

Page 6

Part V

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

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

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

	Section B - Minimum Asset Amount		(A) Prior Year	(B) Current Year (optional)
1	Aggregate fair market value of all non-exempt-use assets (see instructions for short tax year or assets held for part of year):	1
a	Average monthly value of securities	1a
b	Average monthly cash balances	1b
c	Fair market value of other non-exempt-use assets	1c
d	Total (add lines 1a, 1b, and 1c)	1d
e	Discount claimed for blockage or other factors (explain in detail in Part VI):
2	Acquisition indebtedness applicable to non-exempt use assets	2
3	Subtract line 2 from line 1d	3
4	Cash deemed held for exempt use. Enter 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) 2018

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 2018 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-2018	(iii) Distributable Amount for 2018
1 Distributable amount for 2018 from Section C, line 6
2 Underdistributions, if any, for years prior to 2018 (reasonable cause required-- explain in Part VI). See instructions.
3 Excess distributions carryover, if any, to 2018:
a From 2013.......
b From 2014.......
c From 2015.......
d From 2016.......
e From 2017.......
fTotal of lines 3a through e
g Applied to underdistributions of prior years
h Applied to 2018 distributable amount
i Carryover from 2013 not applied (see instructions)
j Remainder. Subtract lines 3g, 3h, and 3i from 3f.
4Distributions for 2018 from Section D, line 7:
$
a Applied to underdistributions of prior years
b Applied to 2018 distributable amount
c Remainder. Subtract lines 4a and 4b from 4.
5 Remaining underdistributions for years prior to 2018, if any. Subtract lines 3g and 4a from line 2. If the amount is greater than zero, explain in Part VI. See instructions.
6 Remaining underdistributions for 2018. Subtract lines 3h and 4b from line 1. If the amount is greater than zero, explain in Part VI. See instructions.
7 Excess distributions carryover to 2019. Add lines 3j and 4c.
8 Breakdown of line 7:
a Excess from 2014......
b Excess from 2015.....
c Excess from 2016.....
d Excess from 2017.....
e Excess from 2018.....

Schedule A (Form 990 or 990-EZ) (2018)

Schedule A (Form 990 or 990-EZ) 2018

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) 2018

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.

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

OMB No. 1545-0047

2018

Name of the organization

TRUMAN MEDICAL CENTER INCORPORATED

Employer identification number

44-0661018

Organization type (check one):

Filers of:

Section:

Form 990 or 990-EZ

501(c)( ) (enter number) organization

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

527 political organization

Form 990-PF

501(c)(3) exempt private foundation

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

501(c)(3) taxable private foundation

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

General Rule

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

Special Rules

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

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

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

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

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

Cat. No. 30613XSchedule B (Form 990, 990-EZ, or 990-PF) (2018)

Schedule B (Form 990, 990-EZ, or 990-PF) (2018) Page 2

Name of organization TRUMAN MEDICAL CENTER INCORPORATED

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) (2018)

Schedule B (Form 990, 990-EZ, or 990-PF) (2018)

Page 3

Name of organization TRUMAN MEDICAL CENTER INCORPORATED		Employer identification number 44-0661018

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) (2018)

Schedule B (Form 990, 990-EZ, or 990-PF) (2018)

Page 4


Name of organization TRUMAN MEDICAL CENTER INCORPORATED			Employer identification number 44-0661018
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) (2018)

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

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

OMB No. 1545-0047

2018

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

TRUMAN MEDICAL CENTER INCORPORATED

Employer identification number

44-0661018

Part I-A

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

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

Political campaign activity expenditures (see instructions) .................................................................... SchCMd Bullet

Volunteer hours for political campaign activities (see instructions) ..................................................................

Part I-B

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

Enter the amount of any excise tax incurred by the organization under section 4955 ................................ 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) 2018

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). Click to see attachment

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.)		(a) Filing organization's totals	(b) Affiliated group totals
1a	Total lobbying expenditures to influence public opinion (grass roots lobbying) ......................	44,175	44,175
b	Total lobbying expenditures to influence a legislative body (direct lobbying) ...............................	66,616	66,616
c	Total lobbying expenditures (add lines 1a and 1b) ...................................................................	110,791	110,791
d	Other exempt purpose expenditures ........................................................................	602,519,899	602,519,899
e	Total exempt purpose expenditures (add lines 1c and 1d) ...............................................	602,630,690	602,630,690
f	Lobbying nontaxable amount. Enter the amount from the following table in both columns.	1,000,000	1,000,000
	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) .................................................	250,000	250,000
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) 2015	(b) 2016	(c) 2017	(d) 2018	(e) Total

2a	Lobbying nontaxable amount	1,000,000	1,000,000	1,000,000	1,000,000	4,000,000

b	Lobbying ceiling amount (150% of line 2a, column(e))					6,000,000

c	Total lobbying expenditures	105,072	115,773	104,992	110,791	436,628

d	Grassroots nontaxable amount	250,000	250,000	250,000	250,000	1,000,000

e	Grassroots ceiling amount (150% of line 2d, column (e))					1,500,000

f	Grassroots lobbying expenditures	57,854	47,766	42,789	44,175	192,584

Schedule C (Form 990 or 990-EZ) 2018

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

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

65,516

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

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

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

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 (Form 990 or 990EZ) 2018

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.
SchDMd Bullet

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

OMB No. 1545-0047

2018

Open to Public Inspection

Name of the organization

TRUMAN MEDICAL CENTER INCORPORATED

Employer identification number

44-0661018

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 7/25/06, 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) 2018

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 ....	3,511,267	3,355,388	3,130,017	3,173,107	3,244,340
b	Contributions ...	5,000	5,000	944	0	0
c	Net investment earnings, gains, and losses	151,452	286,306	366,243	-82,203	42,279
d	Grants or scholarships ...				0	0
e	Other expenditures for facilities and programs ...	9,314	135,427	141,816	102,557	113,512
f	Administrative expenses ....				0	0
g	End of year balance ......	3,658,405	3,511,267	3,355,388	2,988,347	3,173,107

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

81.320 %

Temporarily restricted endowment SchDMd Bullet

18.680 %

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)

Yes

(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 .....	0	4,909,661		4,909,661
b	Buildings ....	0	335,176,538	221,005,432	114,171,106
c	Leasehold improvements
d	Equipment ....	0	203,587,918	162,579,278	41,008,640
e	Other .....	0	19,352,361		19,352,361
Total. Add lines 1a through 1e. (Column (d) must equal Form 990, Part X, column (B), line 10(c).)..					179,441,768

Schedule D (Form 990) 2018

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) ASSETS FOR CAPITAL ACQUISITION				3,690,012
(2) ASSETS EXTERNALLY RESTRICTED				988,221
(3) INTEREST IN ASSETS OF TMCCF				22,546,151
(4) ASSETS HELD BY BOND TRUSTEE				70,483,698
(5) OTHER RECEIVABLES				9,837,455
(6) OTHER ASSETS				729,997
(6)
(7)
(8)
(9)
Total. (Column (b) must equal Form 990, Part X, col.(B) line 15.)...........				108,275,534

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
457F PLAN LIABILITY	3,690,012
UNAMORTIZED PREMIUM	1,182,056
OTHER LIABILITIES	7,361,087
(4)
(5)
(6)
(7)
(8)
(9)
Total. (Column (b) must equal Form 990, Part X, col.(B) line 25.)	12,233,155
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) 2018

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	679,658,734
2	Amounts included on line 1 but not on Form 990, Part VIII, line 12:
a	Net unrealized gains (losses) on investments ....	2a	507,075
b	Donated services and use of facilities .........	2b
c	Recoveries of prior year grants ...........	2c
d	Other (Describe in Part XIII.) ............	2d	136,784,754
e	Add lines 2a through 2d .....................			2e	137,291,829
3	Subtract line 2e from line 1..................			3	542,366,905
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	66,505,626
c	Add lines 4a and 4b....................			4c	66,505,626
5	Total revenue. Add lines 3 and 4c. (This must equal Form 990, Part I, line 12.) ......			5	608,872,531

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	661,443,080
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	123,917,973
e	Add lines 2a through 2d....................			2e	123,917,973
3	Subtract line 2e from line 1...................			3	537,525,107
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	65,105,583
c	Add lines 4a and 4b.....................			4c	65,105,583
5	Total expenses. Add lines 3 and 4c. (This must equal Form 990, Part I, line 18.) ......			5	602,630,690

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 V, LINE 4	THE INVESTMENTS ARE TO BE HELD IN PERPETUITY AT TRUMAN MEDICAL CENTER CHARITABLE FOUNDATION; THE INCOME IS PRIMARILY RESTRICTED FOR THE PURPOSE OF FUNDING DEPARTMENT CHAIRMAN POSITIONS AT THE UNIVERSITY OF MISSOURI-KANSAS CITY SCHOOL OF MEDICINE. (THE MEDICAL CENTER IS THE TEACHING FACILITY FOR THE UMKC SCHOOL OF MEDICINE.)
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, PART XI, LINE 2D	NET ASSETS RELEASED FROM RESTRICTIONS 379,241 RELATED ORGANIZATION REVENUE 136,405,513 ------------- TOTAL $ 136,784,754
SCHEDULE D, PART XI, LINE 4B	MEDICAL STAFF REVENUE 185,116 TEMPORARILY RESTRICTED CONTRIBUTIONS 648,759 CONTRIBUTION USED FOR ASSET ACQUISITION 733,235 ELIMINATIONS 64,938,516 ------------ TOTAL $ 66,505,626
SCHEDULE D, PART XII, LINE 2D	RELATED ORGANIZATION EXPENSES $123,917,973
SCHEDULE D, PART XII, LINE 4B	ELIMINATIONS 64,938,516 MEDICAL STAFF EXPENSES 167,067 ------------ TOTAL $ 65,105,583

Schedule D (Form 990) 2018

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

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

OMB No. 1545-0047

2018

Open to Public Inspection

Name of the organization

TRUMAN MEDICAL CENTER INCORPORATED

Employer identification number

44-0661018

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: . . . . . . . .

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) . . .	137,042,874	112,045,595	24,997,279	4.150 %
b	Medicaid (from Worksheet 3, column a) . . . . .	175,260,347	170,384,471	4,875,876	0.810 %
c	Costs of other means-tested government programs (from Worksheet 3, column b) . .
d	Total Financial Assistance and Means-Tested Government Programs . . . . .	312,303,221	282,430,066	29,873,155	4.960 %
Other Benefits
e	Community health improvement services and community benefit operations (from Worksheet 4).	1,095,007	138,951	956,056	0.160 %
f	Health professions education (from Worksheet 5) . . .	37,856,504	31,847,187	6,009,317	1.000 %
g	Subsidized health services (from Worksheet 6) . . . .	6,089,848	3,033,682	3,056,166	0.510 %
h	Research (from Worksheet 7) .
i	Cash and in-kind contributions for community benefit (from Worksheet 8) . . . .	982,433
j	Total. Other Benefits . .	46,023,792	35,019,820	10,021,539	1.670 %
k	Total. Add lines 7d and 7j .	358,327,013	317,449,886	39,894,694	6.630 %

For Paperwork Reduction Act Notice, see the Instructions for Form 990. Cat. No. 50192T Schedule H (Form 990) 2018

Schedule H (Form 990) 2018

Page

Part II

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

		(a) Number of activities or programs (optional)	(b) Persons served (optional)	(c) Total community building expense	(d) Direct offsetting revenue	(e) Net community building expense	(f) Percent of total expense
1	Physical improvements and housing
2	Economic development
3	Community support
4	Environmental improvements
5	Leadership development and training for community members
6	Coalition building
7	Community health improvement advocacy
8	Workforce development
9	Other
10	Total

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

Yes

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

30,295,100

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. ......

22,721,325

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).....

69,691,443

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

63,037,552

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

6,653,891

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

Cost accounting system Cost to charge ratio Other

Section C. Collection Practices

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

Yes

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

Yes

Part IV

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

(a) Name of entity	(b) Description of primary activity of entity	(c) Organization's profit % or stock ownership %	(d) Officers, directors, trustees, or key employees' profit % or stock ownership %	(e) Physicians' profit % or stock ownership %
1
2
3
4
5
6
7
8
9
10
11
12
13

Schedule H (Form 990) 2018

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?2Name, address, primary website address, and state license number (and if a group return, the name and EIN of the subordinate hospital organization that operates the hospital facility)
1	TRUMAN MEDICAL CENTER - HOSPITAL HILL 2301 HOLMES KANSAS CITY,MO64108 WWW.TRUMED.ORG 285-39	X	X	X	X
2	TRUMAN MEDICAL CENTER - LAKEWOOD 7900 LEES SUMMIT ROAD KANSAS CITY,MO64139 WWW.TRUMED.ORG 195-54	X	X	X	X

Schedule H (Form 990) 2018

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)

	TRUMAN MEDICAL CENTER - HOSPITAL HILL
Name of hospital facility or letter of facility reporting group

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

Yes

Community Health Needs Assessment

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

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

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

Yes

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

A definition of the community served by the hospital facility

Demographics of the community

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

How data was obtained

The significant health needs of the community

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

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

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

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

Other (describe in Section C)

Indicate the tax year the hospital facility last conducted a CHNA: 20 18

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 18

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) 2018

Page 5

Part VFacility Information (continued)

Financial Assistance Policy (FAP)

	TRUMAN MEDICAL CENTER - HOSPITAL HILL
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 0.%

Income level other than FPG (describe in Section C)

Asset level

Medical indigency

Insurance status

Underinsurance discount

Residency

Other (describe in Section C)

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

Yes

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

Yes

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

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

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

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

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

Other (describe in Section C)

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

Yes

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

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

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)

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

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

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

Other (describe in Section C)

Schedule H (Form 990) 2018

Page 6

Part VFacility Information (continued)

Billing and Collections

	TRUMAN MEDICAL CENTER - HOSPITAL HILL
Name of hospital facility or letter of facility reporting group

Yes

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

Yes

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

Reporting to credit agency(ies)

Selling an individual’s debt to another party

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

Actions that require a legal or judicial process

Other similar actions (describe in Section C)

None of these actions or other similar actions were permitted

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

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

Reporting to credit agency(ies)

Selling an individual’s debt to another party

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

Actions that require a legal or judicial process

Other similar actions (describe in Section C)

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

Provided a written notice about upcoming ECAs (Extraordinary Collection Action) and a plain language summary of the
FAP at least 30 days before initiating those ECAs

Made a reasonable effort to orally notify individuals about the FAP and FAP application process

Processed incomplete and complete FAP applications

Made presumptive eligibility determinations

Other (describe in Section C)

None of these efforts were made

Policy Relating to Emergency Medical Care

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

Yes

If "No," indicate why:

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

The hospital facility’s policy was not in writing

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

Other (describe in Section C)

Schedule H (Form 990) 2018

Page 7

Part VFacility Information (continued)

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

	TRUMAN MEDICAL CENTER - HOSPITAL HILL
Name of hospital facility or letter of facility reporting group

Yes

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

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

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

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

The hospital facility used a prospective Medicare or Medicaid method

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

If "Yes," explain in Section C.

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

If "Yes," explain in Section C.

Schedule H (Form 990) 2018

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)

	TRUMAN MEDICAL CENTER - LAKEWOOD
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?........................

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

Yes

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

A definition of the community served by the hospital facility

Demographics of the community

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

How data was obtained

The significant health needs of the community

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

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

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

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

Other (describe in Section C)

Indicate the tax year the hospital facility last conducted a CHNA: 20 18

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 18

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

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) 2018

Page 5

Part VFacility Information (continued)

Financial Assistance Policy (FAP)

	TRUMAN MEDICAL CENTER - LAKEWOOD
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 0.%

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

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

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

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

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

Other (describe in Section C)

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

Yes

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

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

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)

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

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

Other (describe in Section C)

Schedule H (Form 990) 2018

Page 6

Part VFacility Information (continued)

Billing and Collections

	TRUMAN MEDICAL CENTER - LAKEWOOD
Name of hospital facility or letter of facility reporting group

Yes

Reporting to credit agency(ies)

Selling an individual’s debt to another party

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

Actions that require a legal or judicial process

Other similar actions (describe in Section C)

None of these actions or other similar actions were permitted

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

Reporting to credit agency(ies)

Selling an individual’s debt to another party

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

Actions that require a legal or judicial process

Other similar actions (describe in Section C)

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

Provided a written notice about upcoming ECAs (Extraordinary Collection Action) and a plain language summary of the
FAP at least 30 days before initiating those ECAs

Made a reasonable effort to orally notify individuals about the FAP and FAP application process

Processed incomplete and complete FAP applications

Made presumptive eligibility determinations

Other (describe in Section C)

None of these efforts were made

Policy Relating to Emergency Medical Care

Yes

If "No," indicate why:

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

The hospital facility’s policy was not in writing

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

Other (describe in Section C)

Schedule H (Form 990) 2018

Page 7

Part VFacility Information (continued)

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

	TRUMAN MEDICAL CENTER - LAKEWOOD
Name of hospital facility or letter of facility reporting group

Yes

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

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

The hospital facility used a prospective Medicare or Medicaid method

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) 2018

Page 8

Part V

Facility Information (continued)

Section C. Supplemental Information for Part V, Section B. Provide descriptions required for Part V, Section B, lines 2, 3j, 5, 6a, 6b, 7d, 11, 13b, 13h, 15e, 16j, 18e, 19e, 20e, 21c, 21d, 23, and 24. If applicable, provide separate descriptions for each hospital facility in a facility reporting group, designated by facility reporting group letter and hospital facility line number from Part V, Section A (“A, 1,” “A, 4,” “B, 2,” “B, 3,” etc.) and name of hospital facility.
Form and Line Reference	Explanation
SCHEDULE H, PART V, SECTION B, LINE 5 - BOTH FACILITIES	TMC conducted an electronic survey to engage community partners in the assessment process. A common set of questions was posed, and responses collected and summarized. Twenty-three partner organizations participated in the survey. This electronic survey established the set of issues of most interest to the community. Respondents were asked to select issues, and also to consider services they believed could be strengthened in terms of access, availability and/or quality. Responses were summarized to provide a consensus report. In addition, 395 TMC team members participated in an electronic survey in which they identified the most important issues they believe TMC needs to address based on their knowledge of issues facing patients and the community. Two surveys were conducted one for each TMC facility in order to establish unique priorities for each entity.
SCHEDULE H, PART V, SECTION B, LINE 6A	TMC COMPLETED CHNA REPORTS FOR TWO FACILITIES, TMC-HOSPITAL HILL AND TMC-LAKEWOOD. AS REQUIRED BY THE IRS, EACH FACILITY HAS A SEPARATE REPORT, WITH FACILITY-SPECIFIC PRIORITIES.
SCHEDULE H, PART V, SECTION B, LINE 7A	THE COMPLETE CHNA FOR TMC-HOSPITAL HILL CAN BE FOUND AT: https://www.trumed.org/files/publications/TMC-Hospital-Hill-2019.pdf THE COMPLETE CHNA FOR TMC-LAKEWOOD CAN BE FOUND AT: https://www.trumed.org/files/publications/TMC-Lakewood-2019.pdf
SCHEDULE H, PART V, SECTION B, LINE 10A - BOTH FACILITIES	THE IMPLEMENTATION STRATEGY FOR TMC-HOSPITAL HILL CAN BE FOUND AT: https://www.trumed.org/files/publications/TMC-Hospital-Hill-2019.pdf THE IMPLEMENTATION STRATEGY FOR TMC-LAKEWOOD CAN BE FOUND AT: https://www.trumed.org/files/publications/TMC-Lakewood-2019.pdf
SCHEDULE H, PART V, SECTION B, LINE 11 - BOTH FACILITIES	Assessing the needs of the community is an integral part of TMCs day-to-day operations. As a safety net provider with a significant population of uninsured patients, it is critical to TMCs survival to assure provision of care that meets community need and keeps the costs of care as reasonable as possible. A formal community health needs assessment process was initiated in the fall of 2012, in the fall of 2015, and again in 2019. This process included the following steps: Define Community. As part of this phase, TMC examined the current patient data file and other documentation of defined geographic service area for Hospital Hill and Lakewood facilities. This included: - Define geographic service area - Define specific target populations with broader reach than the geographic service area Identify Partners. TMC has many partners. As part of its ongoing work in meeting community need, TMC engages these organizations in strategic planning and in helping identify organizational priorities. During this phase, TMC completed the following: - Established an inventory of TMC involvement in community-based partnerships - Identified consumers and engaged them through focus groups and surveys Secondary Data: TMC assembled a broad set of data to measure and evaluate health status, health statistics and the incidence rates of disease, illness and accidents using secondary data sources. This phase of the assessment focused on not only on health outcomes, but also on factors that influence future health, such as health and wellness habits, experiences accessing care and attitudes that influence healthy behavior. Primary Data: This effort to measure and evaluate health status, health statistics and the incidence rates of disease, illness and accidents uses Truman Medical Centers data. The primary data collection effort focused on health outcomes and factors that influence health, such as homelessness, insurance coverage and health care system utilization for specific conditions; specific to the TMC patient experience. Aggregated Data: TMC assimilated Secondary and Primary data sets into a combined comprehensive report and overview of the TMC service areas and patients. The aggregated data report is reflected throughout this report. Identify & Prioritize Issues. This phase engaged the board, organizational leadership, key constituents and community partners to identify and prioritize community health issues; using the results of the data analysis. Multiple surveys were utilized during this process, with delineation of responses between TMC staff/leadership and the community overall. After analysis of responses, and considering the unique focus of TMC as an academic medical center and safety net health system, the following issues emerged: Access to Integrated Care; Chronic Disease; Behavioral Health; Maternal & Infant Health; and Violence Prevention. Integrated Care Access is an overarching theme in TMCs CHNA. As an Essential Hospital, TMC is the safety net health system for the greater Kansas City region. In this capacity, TMC has a continual focus on assuring access; access to outpatient clinical care, access to specific target populations, and access to services needed by the community at large. With the community continuing to experience a shortage of primary care providers, TMC remains committed to working with the regions Federally Qualified Health Centers to assure access to specialty care. Through a variety of mechanisms, TMC will continue its efforts to increase access to all types of care, for all community members. Using a health equity approach, which recognizes the impact of socio-ecological factors on a persons ability to access health care, TMC continues to identify locations for direct outreach, including community-based clinics and community-based health education. This approach is an underlying theme to everything TMC undertakes; with staff members educated in cultural competence and trauma-informed care. This approach was designed to create an atmosphere of welcome for all who interact with TMC. Because of this focus, TMC will continue its goal of being the provider of choice for key health conditions which include Sickle Cell disease, HIV and other chronic conditions that disproportionately impact minority populations in the greater Kansas City region. Chronic Care Because chronic diseases impact a significant number of TMCs patients, and their prevalence in the community is high, the focus in this area is on continuous improvement of programs and services across all initiatives. Community need, and patient demand, will continue to be monitored with services tailored to meet need. Chronic disease self-management programs will be delivered in neighborhood settings to encourage participation, and patients with significant, and co-occurring conditions will be encouraged to enroll in specialty programs for assistance with medication management, self-care and other supportive services. Behavioral Health The opioid crisis has become predominant in the community. TMC will continue to model integrated primary care and intensive mental health/substance abuse services, including development of a clinic designed specifically to assist patients with medication-assisted therapy to address their addiction. Maternal & Infant Health TMCs primary focus relative to the CHNA is to expand its community outreach and education efforts to bring more pregnant women into care earlier in their pregnancies. Furthering this approach, efforts under the Access area will place clinical points of care in neighborhoods throughout the service area offering more immediate access to providers. Violence Prevention Under this area, TMC will participate in the Aim for Peace initiative. This intervention model is designed specifically to reduce retaliatory violence. As a Level 1 Trauma Center, TMC experiences a significant volume of gang-related emergency department visits. As a result, staff are trained to identify potentially violent situations and engage the Aim for Peace model to diffuse situations.
SCHEDULE H, PART V, SECTION B, LINE 16A - BOTH FACILITIES	THE FAP CAN BE FOUND AT: https://www.trumed.org/files/financial-counseling/financial-assistance-pol icy-fap.pdf
SCHEDULE H, PART V, SECTION B, LINE 16B - BOTH FACILITIES	THE FAP APPLICATION CAN BE FOUND AT: http://www.trumed.org/files/financial-counseling/discount-application-elig ibility-statement.pdf
SCHEDULE H, PART V, SECTION B, LINE 16C - BOTH FACILITIES	THE PLAIN LANGUAGE SUMMARY CAN BE FOUND AT: https://www.trumed.org/patients-visitors/financial-services/financial-coun seling

Schedule H (Form 990) 2018

Page 9

Part VFacility Information (continued)

Section D. Other Health Care Facilities That Are Not Licensed, Registered, or Similarly Recognized as a Hospital Facility (list in order of size, from largest to smallest) How many non-hospital health care facilities did the organization operate during the tax year?1
Name and address		Type of Facility (describe)
1	TMC BEHAVIORAL HEALTH 300 WEST 19TH TERRACE KANSAS CITY,MO64108	MENTAL HEALTH FACILITY
2
3
4
5
6
7
8
9
10

Schedule H (Form 990) 2018

Page 10

Part VI

Supplemental Information

Provide the following information.

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

Form and Line Reference	Explanation
SCHEDULE H, PART I, LINE 3C	ASSET LEVEL, MEDICAL INDIGENCY, INSURANCE STATUS, UNDERINSURANCE STATUS AND RESIDENCY ARE OTHER FACTORS USED IN THE ELIGIBILITY CRITERIA EXPLAINED IN THE FAP FOR PROVIDING FREE CARE.
SCHEDULE H, PART I, LINE 7	THE COST METHOD USED TO CALCULATE THE AMOUNTS IN THIS TABLE IS A COST TO CHARGE RATIO.
SCHEDULE H, PART III, SECTION A, LINE 2	THE HOSPITAL HAS ADOPTED THE NEW REVENUE RECOGNITION STANDARD ASU 2014-09. UNDER ASU 2014-09, THE ESTIMATED AMOUNTS DUE FROM PATIENTS FOR WHICH THE HOSPITAL DOES NOT EXPECT TO BE ENTITLED OR COLLECT FROM THE PATIENTS ARE CONSIDERED IMPLICIT PRICE CONCESSIONS AND EXCLUDED FROM THE HOSPITAL'S ESTIMATION OF THE TRANSACTION PRICE OR REVENUE RECORDED. BAD DEBT EXPENSE WAS NOT SIGNIFICANT TO THE AUDITED FINANCIAL STATEMENTS FOR THE YEAR ENDED JUNE 30, 2019. HOWEVER, THE HOSPITAL INTERNALLY TRACKS BAD DEBT EXPENSE CONSISTENT WITH HISTORICAL PRACTICES AND THAT AMOUNT HAS BEEN REPORTED ON SCHEDULE H, PART III, SECTION A, LINE 2.
SCHEDULE H, PART III, SECTION B, LINE 3	TMC HAS DISCOVERED ABOUT 75% OF BAD DEBTS RESULT FROM PATIENTS WHO ARE INDIGENT OR DO NOT QUALIFY FOR MEDICAID.
SCHEDULE H, PART III, SECTION A, LINE 4	THE FOOTNOTE TO THE ORGANIZATION'S FINANCIAL STATEMENTS THAT DESCRIBES BAD DEBT EXPENSE IS IN AUDIT NOTE 1 ON PAGE 9 OF THE ATTACHED FINANCIAL STATEMENTS.
SCHEDULE H, PART III, SECTION C, LINE 9B	TMC DOES NOT PURSUE COLLECTION FOR UNPAID DISCOUNTED AMOUNTS FOR INDIVIDUALS WITHIN THE CATCHMENT AREA.
SCHEDULE H, PART VI, LINE 2 - NEEDS ASSESSMENT	TMC conducted an electronic survey to engage community partners in the assessment process. A common set of questions was posed, and responses collected and summarized. Twenty-three partner organizations participated in the survey. This electronic survey established the set of issues of most interest to the community. Respondents were asked to select issues, and also to consider services they believed could be strengthened in terms of access, availability and/or quality. Responses were summarized to provide a consensus report. In addition, 395 TMC team members participated in an electronic survey in which they identified the most important issues they believe TMC needs to address based on their knowledge of issues facing patients and the community. Two surveys were conducted one for each TMC facility in order to establish unique priorities for each entity.
SCHEDULE H, PART VI, LINE 3	Patient Education of Eligibility for Assistance If a patient is uninsured, TMC's financial counseling staff works to become a patient advocate. They assist the patient in applying for medicare, medicaid or TMC's charity care program. TMC posts its charity care and financial assistance policies throughout the hospital.
SCHEDULE H, PART VI, LINE 4 - COMMUNITY INFORMATION	The racial composition of TMCs Health Sciences District service area includes two primary categories: White and African American. These two categories comprise 90.06% of the customers within the Health Sciences District area. Racially, the TMC Health Sciences District service area reflects the greater Jackson County, Missouri racial mix, with 67.31% White, 22.75% African American, 2.06 % Asian, 0.46% Native American/Alaskan Native, 0.29% Native Hawaiian/Pacific Islander, 4.0% reporting some other race, and 3.13% reporting multiple races. The racial composition of TMCs Lakewood service area includes two primary categories: White and African American. These two categories comprise 90.17% of the customers within the Lakewood area. Racially, the TMC Lakewood service area reflects the greater Jackson County, Missouri racial mix, with 68.57% White, 21.6% African American, 2.04% Asian, 0.45% Native American/Alaskan Native, 0.29% Native Hawaiian/Pacific Islander, 3.91% reporting some other race, and 3.13% reporting multiple races.
SCHEDULE H, PART VI, LINE 7 - STATE FILING OF COMMUNITY BENEFIT REPORT	TMC has filed an annual community benefit report with the state of Missouri since 2005.

Schedule H (Form 990) 2018

Additional Data

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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

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

OMB No. 1545-0047

2018

Open to Public
Inspection

Name of the organization
TRUMAN MEDICAL CENTER INCORPORATED

Employer identification number
44-0661018

Part I

General Information on Grants and Assistance

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

Yes No

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

Part II

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

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

(a) Name and address of organization or government	(b) EIN	(c) IRC section (if applicable)	(d) Amount of cash grant	(h) Purpose of grant or assistance
(1) UNIVERSITY OF MISSOURI-KANSAS CITY 5100 Rockhill Road KANSAS CITY,MO64110	43-6003859	501(c)(3)	500,000	Friends of Psychiatry
(2) CITY OF KANSAS CITY MISSOURI 414 E 12TH ST Kansas City,MO64106		CITY OF KCMO	260,479	ATC FUNDING CRISIS
(3) TRUMAN MEDICAL CENTER CHARITABLE FOUNDATION 2310 HOLMES STREET STE 735 KANSAS CITY,MO64108	43-1194064	501(C)(3)	10,000	GOLF BABY GOLF FUNDRAISER

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) 2018

Page 2

Part III

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

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

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

Part IV

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

Return Reference	Explanation
SCHEDULE I, PART I, LINE 2	THE GRANTS PROVIDED WERE MADE TO OTHER PUBLIC ORGANIZATIONS WHO HAVE A CLOSE WORKING RELATIONSHIP WITH TRUMAN MEDICAL CENTER. THESE ORGANIZATIONS STRIVE TO FURTHER SUPPORT THE HOSPITAL OPERATIONS OF TRUMAN MEDICAL CENTER, INC. THEREFORE, THE USE OF THE GRANTED FUNDS IS MONITORED THROUGH THE CLOSE WORKING RELATIONSHIPS WITH THESE ORGANIZATIONS.

Schedule I (Form 990) 2018

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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

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

OMB No. 1545-0047

2018

Open to Public Inspection

Name of the organization

TRUMAN MEDICAL CENTER INCORPORATED

Employer identification number

44-0661018

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 .........

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? ..

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

Compensation committee Written employment contract

Independent compensation consultant Compensation survey or study

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

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

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

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

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

Yes

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

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

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

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

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

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

Cat. No. 50053T

Schedule J (Form 990) 2018

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)
1CHARLES W SHIELDS PRESIDENT/CEO/DIRECTOR	(i) (ii)	678,043 ------------- 0	284,554 ------------- 0	37,783 ------------- 0	389,657 ------------- 0	25,428 ------------- 0	1,415,465 ------------- 0	28,715 ------------- 0
2MARK T STEELE MD DIRECTOR	(i) (ii)	238,201 ------------- 0	23,227 ------------- 0	2,178 ------------- 0	5,500 ------------- 0	12,752 ------------- 0	281,858 ------------- 0	0 ------------- 0
3WILLIAM H COLBY ASSISTANT SECRETARY	(i) (ii)	460,383 ------------- 0	190,983 ------------- 0	49,785 ------------- 0	80,717 ------------- 0	26,965 ------------- 0	808,833 ------------- 0	29,085 ------------- 0
4ALLEN M JOHNSON ASSISTANT TREASURER	(i) (ii)	427,381 ------------- 0	27,745 ------------- 0	91,593 ------------- 0	95,299 ------------- 0	25,434 ------------- 0	667,452 ------------- 0	81,772 ------------- 0
5JOHN GIANINO MD NEUROSURGEON	(i) (ii)	497,859 ------------- 0	309 ------------- 0	140,033 ------------- 0	74,099 ------------- 0	29,112 ------------- 0	741,412 ------------- 0	132,363 ------------- 0
6MITZI CARDENAS EXECUTIVE CHIEF ADMIN OFFICER	(i) (ii)	320,781 ------------- 0	19,500 ------------- 0	7,852 ------------- 0	58,334 ------------- 0	7,529 ------------- 0	413,996 ------------- 0	0 ------------- 0
7GERARD GRIMALDI VP HEALTH POLICY & GOVT RELATI	(i) (ii)	252,027 ------------- 0	16,266 ------------- 0	58,962 ------------- 0	56,894 ------------- 0	24,760 ------------- 0	408,909 ------------- 0	35,398 ------------- 0
8DOUGLAS BRANDT ASSOCIATE CFO	(i) (ii)	297,635 ------------- 0	210,326 ------------- 0	4,409 ------------- 0	72,739 ------------- 0	17,987 ------------- 0	603,096 ------------- 0	0 ------------- 0
9LYNETTE WHEELER COO	(i) (ii)	268,351 ------------- 0	17,063 ------------- 0	32,836 ------------- 0	51,363 ------------- 0	27,631 ------------- 0	397,244 ------------- 0	24,785 ------------- 0

Schedule J (Form 990) 2018

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 4B	2018 2018 2018 ACCRUAL DISTRIBUTION TOTAL CHARLES SHIELDS $ 112,907 28,715 $ 141,622 WILLIAM COLBY $ 72,467 29,085 $ 101,552 ALLEN JOHNSON $ 68,584 81,772 $ 150,356 JOHN GIANINO $ 47,388 132,363 $ 179,751 MITZI CARDENAS $ 50,084 -0- $ 50,084 LYNETTE WHEELER $ 43,113 24,785 $ 67,898 GERARD GRIMALDI $ 40,503 35,398 $ 75,901 DOUG BRANDT $ 45,989 -0- $ 45,989
SCHEDULE J, PART I, LINE 6A	CERTAIN EMPLOYEES ARE ELIGIBLE FOR A SMALL ANNUAL BONUS RELATED TO MEETING OR EXCEEDING BUDGET.
PART VII, LINE 5 AND SCH J, PART II	TRUMAN MEDICAL CENTER, INC. (TMC) REIMBURSED UNIVERSITY HEALTH PHYSICIANS $263,606 FOR THE TIME MARK STEELE, M.D. SPENT ASSISTING TMC, INC. AS THE MEDICAL DIRECTOR.

Schedule J (Form 990) 2018

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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 Ⅵ, line 24a. Provide descriptions,
explanations, and any additional information in Part Ⅵ.
SchKMediumBullet

Attach to Form 990.
SchKMediumBullet

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

OMB No. 1545-0047

2018

Open to Public
Inspection

Name of the organization
TRUMAN MEDICAL CENTER INCORPORATED

Employer identification number
44-0661018

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	JACKSON COUNTY MISSOURI	44-6000524	467578FS4	05-17-2011	24,674,279	CONSTRUCTION AND EQUIPMENT		X		X		X
B	JACKSON COUNTY MISSOURI	44-6000524	467578GJ3	09-04-2012	41,180,185	REFUNDING BOND		X		X		X
C	JACKSON COUNTY MISSOURI	44-6000524		12-22-2017	70,000,000	BUILDING,EQUIPMENT &REFUNDING BOND		X		X		X

Part Ⅱ

Proceeds

	A		B		C		D
	1 Amount of bonds retired ..................	8,910,000		16,141,840		2,370,000
2 Amount of bonds legally defeased ..............	0		0		0
3 Total proceeds of issue ..................	24,674,279		37,597,509		70,000,000
4 Gross proceeds in reserve funds .............	0		0		0
5 Capitalized interest from proceeds .............	0		0		1,224,917
6 Proceeds in refunding escrows ...............	0		0		0
7 Issuance costs from proceeds ...............	289,279		451,929		485,984
8 Credit enhancement from proceeds .............	0		0		0
9 Working capital expenditures from proceeds .............	0		0		0
10 Capital expenditures from proceeds .............	24,385,000		0		9,686,527
11 Other spent proceeds .............	0		37,145,579		4,754,505
12 Other unspent proceeds .............	0		0		55,072,984
13 Year of substantial completion .............	2011		2012
	Yes	No	Yes	No	Yes	No	Yes	No
14 Were the bonds issued as part of a current refunding issue? ....		X	X		X
15 Were the bonds issued as part of an advance refunding issue? .....		X		X		X
16 Has the final allocation of proceeds been made? ..........	X		X			X
17 Does the organization maintain adequate books and records to support the final allocation of proceeds? ..................	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		X
2 Are there any lease arrangements that may result in private business use of bond-financed property? ...............		X		X		X

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

Cat. No. 50193E

Schedule K (Form 990) 2018

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			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?			X
c Are there any research agreements that may result in private business use of bond-financed property? .............		X		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 %		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 .............
7 Does the bond issue meet the private security or payment test? ...		X		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		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		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		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
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
4a Has the organization or the governmental issuer entered into a qualified hedge with respect to the bond issue?		X		X		X
b Name of provider ..........	0		0		0
c Term of hedge .........
d Was the hedge superintegrated? ......
e Was the hedge terminated? ........

Schedule K (Form 990) 2018

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
b Name of provider ..........	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
7 Has the organization established written procedures to monitor the requirements of section 148? ...	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

Part Ⅵ

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

Return Reference	Explanation
PART IV, LINE 2C, COLUMN A	THE ARBITRAGE REBATE ANALYSIS WAS PERFORMED 5-17-16.
PART IV, LINE 2C, COLUMN B	THE ARBITRAGE REBATE ANALYSIS WAS PERFORMED 12-6-17.

Schedule K (Form 990) 2018

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

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

OMB No. 1545-0047

2018

Open to Public
Inspection

Name of the organization

TRUMAN MEDICAL CENTER INCORPORATED

Employer identification number

44-0661018

Return Reference	Explanation
FORM 990, PART III, LINE 4A	One of Truman Medical Centers (TMC) greatest strengths is the ability to provide high quality, state-of-the-art healthcare to all our patients, regardless of their ability to pay. TMC offers more than 50 primary, specialty and mental health care clinics at its Health Sciences District and Lakewood campuses. TMC also has a number of community-based primary and behavioral health clinics. TMCs person-first approach puts the health needs of the patient above profit. The medical center is nationally recognized for programs in asthma, diabetes, sickle cell, orthopaedics, womens health and emergency/trauma services. In addition, TMC offers services that include ophthalmology, cardiology, gastroenterology, oral surgery and community-based behavioral health services. In fiscal year 2019, TMC provided more than a half a million (511,259 to be exact) outpatient care appointments, with more than 176,000 of those being outpatient behavioral health care visits. TMCs Medical Pavilions at Health Sciences District and Lakewood provide high-quality outpatient primary care, whether a patients needs include a general physical exam or help with a specific complaint. More than 70,000 TMC patients are living with at least one chronic disease. Internal medicine physicians are experts in chronic disease management, specifically: high cholesterol, osteoporosis, diabetes, high blood pressure, obesity and sickle cell disease. Chronic Disease Management Asthma At TMC, our goal is to provide superior and consistent care for the patient with asthma whether it is in the Emergency Department, inpatient unit, or clinic setting. TMC has a comprehensive asthma program that provides asthma education to outpatients and inpatients. In an effort to provide a consistent continuum of care, patients are treated in the Emergency Department using a standardized protocol based on national guidelines for the management of asthma and are referred for follow-up care to our outpatient pulmonary clinic to help break the cycle of emergent care. This program has resulted in a substantial reduction in admissions for asthma sufferers. Last year, its providers treated nearly 9,000 patients for the treatment and care of asthma. Diabetes At TMC, we know how devastating the effects of diabetes can be. With more than 16,000 patients visiting in our Diabetes Center in fiscal year 2019, we are well equipped to handle all aspects of the disease. The Diabetes Center offers a state-of-the-art facility to better serve the needs of our patients. We believe in helping our patients manage their diabetes on a planned, rather than episodic basis. The comprehensive team-approach connects patients with specially trained physicians and nursing staff. The team coordinates care with other specialty service providers, such as ophthalmology, cardiology, podiatry, and other referrals as needed. The Diabetes Center includes: A) A patient resource center with computer access B) A diabetes education classroom C) Large consultation rooms for group or individual instruction related to disease and nutrition D) A patient waiting area designed for comfort E) Expanded exam rooms with advanced technology with access to electronic health records Sickle Cell At TMC, providers strive to empower patients with Sickle Cell Disease to live life to the fullest. We provide a healing environment, individual attention and a strong support system for our patients, with a quality of care based on current treatment guidelines and benchmarks of care. In fiscal year 2019, providers treated 507 patients living with Sickle Cell Disease. During a crisis state, unlike an emergency department, the TMC Sickle Cell Center is able to treat patients' pain more efficiently in a quiet, soothing environment with the goal of initiating pain treatment within 30 minutes of arrival. Providers, aware of individuals medical history, create a custom treatment plan for each patient, including a holistic approach to encompass long-term goals. The Sickle Cell Center team sees the importance of providing chronic disease management and strategies to modify the individuals disease with the goal of decreasing acute pain episodes and supporting healthier outcomes. The center also provides primary care for other routine health needs such as sore throat, hypertension or diabetes management to not only the person with sickle cell but also their adult family member. Womens Health Services Obstetrics & Gynecology At Truman Medical Centers, we provide a wide variety of services and specialized care just for women, through all stages of their lives. Services include family planning, mid-life services, breast health, the specialized treatment of vulvar and pelvic pain diseases, obstetrics, hysteroscopic surgery and alternatives to hysterectomy, adolescent gynecology and well-woman exams. Patients can receive OB/GYN services and primary care, all in one location. High Risk Pregnancy As a regional referral center for high-risk pregnancies, and an academic medical center, TMC Health Sciences District offers specialized care to pregnant women. Maternal-Fetal Medicine (or perinatology) is a unique specialty of obstetrics that involves the diagnosis, evaluation and management of problems that may affect a mother or her unborn child. Families facing a fetal abnormality can come here with confidence knowing we provide expert care for their every need maternal expertise for care of the pregnant woman, fetal expertise for care of their unborn baby, and pediatric expertise for care of their newborn. Patients have access to level III neonatal intensive care unit (NICU) staffed by pediatricians from Childrens Mercy Hospital. In addition, they have immediate access (via a bridge, just steps away) to adjacent level IV NICU at Childrens Mercy Hospital the highest level of care available for premature and critically-ill newborns, including ECMO (extracorporeal membrane oxygenation) life support technology. The Birthplace At the TMC Birthplace, the focus is on providing a safe, comfortable and positive birth experience for families. TMC is proud to have delivered 3,380 babies in fiscal year 2019, making it the medical center where nearly half of all babies in Kansas City, Missouri are born. A Neonatal Intensive Care Unit nurse attends all deliveries, and if needed, our Level III Newborn Intensive Care Unit for infants with special needs is just steps away. Our staff also provides care to mothers who deliver at Childrens Mercy Hospital for emergency and critical care maternal fetal medicine issues. A bridge connects the two facilities for easy access between the hospitals. Womens Care Breast Center TMC provides diagnostic breast health services to women in the greater Kansas City area. The Women's Care Breast Center streamlines services by making virtually all of the components of a breast evaluation available in one campus location - and you can usually receive a diagnosis the same day. Providers offer clinical breast exams, mammograms, breast ultrasounds, fine-needle aspirations, and an imaging-assisted breast biopsy technique that is less invasive than a typical surgical breast biopsy. Patients have access to a dedicated breast nurse navigator who will guide them through their journey. A diverse and highly qualified dedicated breast team, including a fellowship-trained breast surgeon, plastic and reconstructive surgeon, gynecologist, and fellowship trained breast radiologist staff The Breast Center. Every patient who might be at risk will also receive comprehensive lymphedema education and preoperative assessment by our certified lymphedema specialist, referral to our high-risk prevention clinic, or genetic counselling as necessary. WIC TMC is also the largest provider of Women, Infants and Children (WIC) Services in the state of Missouri with 114,728 visits in fiscal year 2019. WIC provides healthy foods, nutrition education and referrals for women, infants, and children up to the age of five, who are at nutritional risk and meet program guidelines.
Cardiology Services	The TMC Cardiology Center offers patients a complete range of cardiac services for prevention, early diagnosis, treatment and recovery in a patient-centered environment. TMCs Cardiology Center specializes in interventional cardiology, which refers to non-surgical treatments for heart conditions. Providers rely on cardiac interventions to diagnose and treat coronary artery disease, valvular heart disease, heart failure and congenital heart disease. The Cardiology Center features a sophisticated cardiac catheterization laboratory, nine additional clinic rooms, increased echocardiography testing capabilities and a cardiac rehabilitation service to help prevent repeat heart problems. In fiscal year 2019, the Cardiology Center provided more than 9,000 outpatient clinic appointments, performed 645 diagnostic catheterization procedures, completed nearly 800 total catheterization laboratory procedures and placed 229 patient required cardiovascular stents. Gastroenterology Services Truman Medical Centers Gastroenterology (GI) Center at the Health Sciences District provides care for patients with all gastrointestinal diseases including but not limited to abdominal pain, constipation, reflux, Irritable Bowel Syndrome, Crohns Disease, and liver diseases. It offers procedures such as: colon cancer screening, upper endoscopy, endoscopic ultrasound, ERCP- which is used to diagnosis diseases of the bile ducts and pancreas, motility studies, and paracentesis. The Center features three procedure rooms, a dedicated prep and recovery area, patient monitoring equipment, including additional cardiac monitoring capabilities with a central monitor at the nursing station. The clinic has six exams rooms, a dedicated triage room, a large education classroom, and a spacious waiting room. The center provides "one-stop shopping" for patients, with registration/check-in and financial counseling all in same area. In fiscal year 2019, the TMC GI Center provided more than 9,300 outpatient visits and performed more than 7,900 procedures. Ophthalmology The Ophthalmology Clinics at TMC are full-service facilities for the medical and surgical treatment of eye diseases. Services range from prescribing glasses and fitting contact lenses to the treatment of complex ocular disorders. Providers perform outpatient surgery and laser treatment, including refractive laser surgery. In fiscal year 2019, the Ophthalmology Department provided care in 21,621 visits. Dentistry and Oral Surgery Services Oral & Maxillofacial surgeons practice a wide scope of care with expertise ranging from corrective jaw surgery to wisdom tooth removal. They also diagnose and treat facial injuries and perform a full range of dental implant procedures. The facial pain-temporomandibular joint syndrome (TMJ) clinic also offers diagnosis and treatment of facial pain and TMJ. More than 9,100 patients received oral surgical services at TMC in fiscal year 2019 and treated 22,516 dental patients at the TMC Lakewood Dental Clinic. Outpatient Behavioral Health Services In fiscal year 2019, TMC Behavioral Health provided 176,403 outpatient visits to 9,757 patients. These services are aimed at assisting clients in managing the symptoms of their illness, and improving their day-to-day lives. The services include case management, crisis and outreach services, mental health assessments, employment services, occupational therapies, peer support groups, medication management, rehabilitation, substance abuse treatment and therapy and counseling for children, adolescents, adults and families. Jackson County Health Department TMC contracts with the Jackson County, Missouri government to manage the Jackson County Health Department (JACOHD). In fiscal year 2019, the JACOHD provided nearly 130,926 community based encounters including vaccinations, community health education and adult traumatic brain injury case management. The JACOHD is dedicated to the prevention of disease and the maintenance of a high level of health in the family and community through education, immunization, inspection, and supportive care.
FORM 990, PART III, LINE 4B	Truman Medical Centers (TMC), an academic medical center, includes the campuses of TMC Health Sciences District, TMC Lakewood and TMC Behavioral Health. TMC is the core educational partner for the University of Missouri-Kansas City Schools of Medicine, Nursing, Dentistry and Pharmacy. The newest addition to TMC is University Health, which opened in October 2015. University Health is Kansas Citys only downtown surgical center and an outpatient clinic powered by Truman Medical Centers. Clinics at University Health include: audiology, the breast center, dermatology, ear, nose, throat, ophthalmology, OB/GYN, oral and maxillofacial surgery, pain management, orthopedics and plastic surgery. TMC providers cared for more than 118,000 individual patients in fiscal year 2019. Regardless of their financial situation or ability to pay, these patients receive quality, state-of-the-art inpatient, outpatient and emergency care that encompass both physical and mental health care. TMC is licensed for 359 inpatient acute care (including 19 NICU) and 188 long-term care beds. In fiscal year 2019, TMC had 22,856 inpatient admissions and provided 90,902 days of inpatient care and more than 62,000 days of long-term patient care. As the primary safety net hospital in the Kansas City, Missouri metropolitan area, TMC treats a vulnerable patient population with a high degree of health care disparity. These disparities cut across economic, racial and ethnic boundaries. Many of TMCs patients and clients have multiple chronic diseases such as diabetes, asthma, heart failure and hypertension. In fiscal year 2019, more than 70,000 of TMC patients suffered from at least one or more of these chronic diseases. Due to some social disparities, such as lack of transportation, or a language barrier, patients ability to manage their condition with proper medication and follow-up care is difficult and many times, providers end up admitting patients for their condition. TMC works diligently to overcome these ethnic, social and racial barriers when patients receive their care. TMC has specialized language interpreters on staff at both Health Sciences District and Lakewood locations to help ensure that patients with limited English proficiency or deaf patients receive high quality, individualized care with communication assistance. TMC is one of the few hospitals to have on staff interpreters available around the clock to assist patients with paperwork and communicating with medical professionals. TMC interpreter services has approximately 28 language interpreters on staff that provide face-to-face interpreting in three major languages: Spanish, Somali and Arabic. Additionally, over the phone interpreters in 150 languages are available via dual handset telephonic interpreting units. In Fiscal Year 2019, TMC language access provided 163,037 interpreted encounters for patients. Behavioral Health Behavioral Health is essential to well-being and can affect self-image, relationships, sleep, eating, and even physical health. Many times, patients with chronic diseases also suffer from mental illness and/or substance abuse and addiction problems. Gaining access to quality, behavioral health care services is often difficult and expensive. In many communities, inpatient mental health facilities do not exist or are at capacity nearly 100 percent of the time. TMC is one of only a few health systems that provides both inpatient medical and mental health care beds. TMC Behavioral Health offers a comprehensive array of mental health and substance abuse treatment services at both the TMC Health Sciences District and TMC Lakewood Counseling. All mental health services are aimed at assisting clients in managing the symptoms of their illnesses and in improving their day-to-day lives. TMC services also provide the support many people with mental illness need to regain a sense of meaning and purpose in life. TMC Behavioral Health has 66 inpatient mental health beds including a specialized geriatric inpatient unit at TMC Lakewood. In fiscal year 2019, TMC Behavioral Health treated 9,757 patients, with about 2,000 patients admitted for inpatient mental health care at a TMC facility. Womens Health TMC offers full Womens Health Services and is the birthplace to nearly half of all babies born in Jackson County, Missouri. TMC Health Sciences District specializes in high-risk pregnancies and births. It is home to a 19-bed, Level III neonatal intensive care unit (NICU), one of the largest in the area. In 2011, TMC Lakewood opened a renovated and expanded labor and delivery unit serving the people of eastern Jackson County. This unit also includes a Level II NICU. In fiscal year 2019, TMC proudly delivered 3,380 babies, which is nearly half of the number of all babies born in Kansas City, Missouri.
FORM 990, PART III, LINE 4C	Truman Medical Centers Emergency Departments provided care to 88,291 patients in fiscal year 2019, with more than 61,000 of those visits at TMC Health Sciences District, making it one of the busiest adult emergency departments in the Kansas City metro area. The TMC Health Sciences District Emergency Department (ED) is a state designated Level 1 Trauma Center. It consists of a team of nearly 25 physicians and more than 125 nurses specially trained in treating trauma and critical care injuries. Trauma surgeons and other members of the trauma team are in the hospital 24-hours a day, seven days a week. The TMC Lakewood Emergency Department has a staff of ten board certified emergency medicine physicians and 36 nurses providing immediate, compassionate, quality care to residents of eastern Jackson County, Missouri each year. Aim4Peace As an academic safety-net hospital in Kansas City, Missouri, TMC receives a significant amount of intentional trauma. Aim4Peace, a local organization that works to prevent violence is focused on the reduction of intentional gunshot incidents. As the primary hospital in association with Aim4Peace, TMC helps affect a culture shift in what is accepted as the norm among the perpetrators of violent crime while reducing recidivism in the emergency department. TMC is listed in the national directory of hospital-based violence intervention and prevention programs. Sexual Abuse Nurse Examiner (SANE) The TMC Health Sciences District Emergency Department (ED) has a Sexual Abuse Nurse Examiner (SANE) on site to provide a thorough forensic examination of women who report being a victim of sexual assault. When a woman enters the Emergency Department reporting a sexual assault or rape, she is sent to a SANE and taken to a private room for examination. The Kansas City SANE program has made a profound difference in the quality of care provided to sexual assault victims. SANEs offer victims prompt, compassionate care and comprehensive forensic evidence collection. In addition to helping preserve the victim's dignity and reduce psychological trauma, SANEs enhance evidence collection for more effective investigations and better prosecutions. TMCs SANE program has also helped to provide leadership in the community by educating and training other potential SANEs. Each year, the TMC SANE cares for and examines nearly 100 women in the Health Sciences District Emergency Department. Trauma Research The Trauma Research Team is currently conducting several exciting research projects including grant-funded research and original projects. All projects are designed with the objective of optimizing care of the traumatically injured patient. Research projects in progress during fiscal 2019 include: A) Investigator Initiated: Thorn in My Side Chest Tube Management; Dr. Geehan, PI B) Investigator Initiated: Fundamentals of Critical Care Support (Attitudinal Survey); Dr. Moncure, PI C) Investigator Initiated: Amendment to continue enrollment using additional indicators: Incidence of Primary Care in the Injured Patient; Dr. Geehan, PI. D) Measuring Immediate Responders Knowledge Gained Through "Stop the Bleed" Education and Training - Amendment approved to continue study in the lay public as a comparison; Teresa Lienhop, PI E) Millennium Pharmaceutical: TAKEDA: Enteral Feeding in Critical Care; Dr. Moncure, PI Performance Improvement Patient Safety Program (PIPS) The Performance Improvement Patient Safety (PIPS) is an important part of the trauma program at TMC Health Sciences District. PIPS works toward implementing a system of patient care delivery that focuses on the achievement of outcomes within effective time frames and with appropriate use of resources. The areas of monitoring and improving include pre-hospital care, emergency department, inpatient stay, and rehabilitation. The primary focus is on the promptness, documentation, and appropriateness of care along with patient outcomes. Advanced Trauma Care for Nurses Continuing medical education is not just a requirement it is a necessity to enhance the knowledge and abilities of the medical professional. Truman Medical Center Health Sciences District was the first hospital to bring Advanced Trauma Care for Nurses (ATCN) to the Kansas City metropolitan area. The course is geared toward nursing staff in the Emergency Department and Intensive Care Units. When nurses complete the ATCN class and work alongside trauma physicians certified in Advanced Trauma Life Support (ATLS), they find that their thought processes and actions are more aligned with the physicians approach, which simultaneously addresses the care of the trauma patient in a patient-centered and logical sequence. ATCN encourages a team approach to trauma care and is taught concurrently with ATLS, so both nurse ATCN and physician ATLS students attend the same lectures. Lectures are followed by a series of hands-on skills stations that include extensive training on initial patient assessment and management of airway, breathing, hemorrhagic shock, musculoskeletal, spinal, head and pediatric trauma.
FORM 990, PART VI, SECTION A, LINE 7A	ALL DIRECTORS ARE ELECTED BY THE SITTING TMC BOARD. SEVERAL DIRECTORS ARE DESIGNATED BY THE CHIEF EXECUTIVE OFFICERS OF VARIOUS REPRESENTED ENTITIES, INCLUDING THREE EACH FROM THE CITY OF KANSAS CITY, MISSOURI AND JACKSON COUNTY, MISSOURI, ONE FROM THE TMC MEDICAL STAFF AND FIVE FROM UNIVERSITY HEALTH PHYSICIANS, AND TWO EMPLOYEES OF TMC WHO REPRESENT NON-MANAGEMENT STAFF. IN ADDITION, THE MEDICAL SCHOOL DEAN AND CHANCELLOR OF THE UNIVERSITY OF MISSOURI-KANSAS CITY AND THE BOARD CHAIR OF THE TMC CHARITABLE FOUNDATION ARE NOMINATED EACH YEAR FOR BOARD ELECTION.
FORM 990, PART VI, SECTION B, LINE 11B	INFORMATION FOR THE FORM 990 IS GATHERED AND INDEPENDENTLY PREPARED BY THE DIRECTOR OF CORPORATE ACCOUNTING AND REVIEWED BY THE CFO BEFORE SUBMITTING TO AN INDEPENDENT ACCOUNTING FIRM. THE FORM 990 IS THEN PREPARED AND REVIEWED BY THE INDEPENDENT ACCOUNTING FIRM USING THE INFORMATION GATHERED. THE 990 IS THEN REVIEWED BY THE ORGANIZATION'S ACCOUNTING PERSONNEL, CFO AND CEO AND ANY QUESTIONS AND CONCERNS THE ORGANIZATION'S ACCOUNTING PERSONNEL, CFO AND CEO HAVE ARE ADDRESSED AND ANY CORRECTIONS OR CLARIFICATIONS THAT NEED TO BE MADE ARE MADE. DUE TO THE SIZE OF THE TMC, INC. BOARD, FINAL COPIES OF THE FORM 990 ARE NOT PROVIDED TO ALL VOTING MEMBERS OF THE BOARD PRIOR TO FILING THE 990.
FORM 990, PART VI, SECTION B, LINE 12C	THE TMC POLICY IS NO TMC EXECUTIVE WILL DISADVANTAGE TRUMAN MEDICAL CENTER'S, INCORPORATED (TMC'S) INTEREST AS A RESULT OF A PRIVATE INTEREST. THIS POLICY APPLIES TO TMC EMPLOYEES FROM THE LEVEL OF ASSOCIATE ADMINISTRATOR UP TO PRESIDENT, AND TO TMC-EMPLOYED PHYSICIANS (HEREINAFTER, COLLECTIVELY EXECUTIVES). THE PURPOSE OF THE POLICY AND PROCEDURE IS TO PROTECT THE INTEREST OF TMC, WHEN IT IS CONTEMPLATING ENTERING INTO A TRANSACTION OR ARRANGEMENT THAT MIGHT BENEFIT THE PRIVATE INTEREST OF A TMC EXECUTIVE. EXECUTIVES HAVE THE FIDUCIARY DUTY TO ACT IN GOOD FAITH WITH DUE REGARD FOR THE BEST INTERESTS OF THE INSTITUTION. WHENEVER AN EXECUTIVE FIRST BECOMES AWARE OF A PROPOSED OR ACTUAL TRANSACTION TO WHICH THE EXECUTIVE OR FAMILY MEMBER IS A PARTY, REGARDLESS OF THE DOLLAR AMOUNT OF THE TRANSACTION, THE EXECUTIVE SHALL MAKE A PROMPT, FULL AND FRANK DISCLOSURE TO THE CONFLICT OF INTEREST PANEL (VIA THE DIRECTOR OF INTERNAL AUDIT) OF ALL MATERIAL FACTS OF THE TRANSACTION AND THE EXECUTIVE'S INTEREST. THIS DISCLOSURE SHALL BE MADE BEFORE TMC ENTERS INTO OR APPROVES THE TRANSACTION AND THE EXECUTIVE SHALL NOT PARTICIPATE IN OR BE PRESENT DURING THE CONSIDERATION OF THE PROPOSED TRANSACTION, EXCEPT THAT THE EXECUTIVE MAY STATE A POSITION ON THE MATTER AND MAY ANSWER PERTINENT QUESTIONS. THE PANEL, WITH THE SUPPORT OF THE APPROPRIATE TMC MANAGERS OTHER THAN THE CONFLICTED EXECUTIVE, SHALL DETERMINE WHETHER TMC COULD OBTAIN A MORE ADVANTAGEOUS TRANSACTION WITH REASONABLE EFFORT FROM A PERSON OR ENTITY THAT WOULD NOT GIVE RISE TO A CONFLICT OF INTEREST. EACH EXECUTIVE SHALL ANNUALLY DISCLOSE THE NATURE OF PERSONAL INTERESTS OF THE EXECUTIVE OR FAMILY MEMBERS IN EACH ORGANIZATION WITH WHICH TMC HAS DONE BUSINESS IN THE PAST YEAR OR MAY DO BUSINESS IN THE COMING YEAR. THE DIRECTOR OF INTERNAL AUDIT SHALL RECEIVE, COMPILE, AND ANALYZE THE DISCLOSURES WITHIN 90 DAYS OF DISTRIBUTING THE ANNUAL DISCLOSURE STATEMENTS TO EXECUTIVES, AND SHALL IDENTIFY ANY POTENTIAL ISSUES. THE PANEL COLLECTIVELY IS RESPONSIBLE FOR ENSURING THAT EACH EXECUTIVE COMPLIES WITH THE POLICY AND WITH APPLICABLE RELATED POLICIES AND PROCEDURES. IF THE PANEL DETERMINES THAT AN EXECUTIVE HAS VIOLATED OR MAY VIOLATE SUCH A POLICY, THE PANEL SHALL NOTIFY THE EXECUTIVE OF THE STEPS TO BE TAKEN TO RECTIFY THE SITUATION. IF THE PANEL IS UNABLE TO EFFECT AN ADJUSTMENT OF THE MATTER TO ITS SATISFACTION, IT SHALL REPORT THE MATTER TO THE EXECUTIVE'S SUPERVISOR OR OTHER APPROPRIATE SUPERVISORY AUTHORITY WITH A RECOMMENDATION FOR REMEDY OR SANCTION. ADDITIONALLY, EXECUTIVES REMAIN SUBJECT TO THE RELATED POLICIES THAT APPLY TO ALL TMC EMPLOYEES, INCLUDING CONFLICT OF INTEREST POLICY, CORPORATE CODE OF CONDUCT AND EMPLOYEE HANDBOOK.
FORM 990, PART VI, SECTION B, LINE 15A & 15B	THE EXECUTIVE COMPENSATION COMMITTEE (ECC) IS A SEPARATE COMMITTEE OF THE BOARD OF DIRECTORS. THE ECC REVIEWS AND APPROVES THE COMPENSATION FOR ALL SENIOR EXECUTIVES ANNUALLY. THE ECC REVIEWS THE EMPLOYMENT AGREEMENT FOR THE CEO AND THAT PROPOSED COMPENSATION INCREASES MEET IRS GUIDELINES. ECC HIRES AN INDEPENDENT CONSULTANT COMPANY TO SUPPORT THE ECC ANALYSIS. 2019 WAS THE MOST RECENT REVIEW.
FORM 990, PART VI, SECTION C, LINE 19	THE ORGANIZATION'S GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY AND FINANCIAL STATEMENTS ARE AVAILABLE UPON REQUEST AS APPROVED BY THE CFO OR LEGAL DEPARTMENT.
FORM 990, PART XI, LINE 9	CHANGE IN NET ASSETS OF TMC FOUNDATION $ 9,243,418 CHANGE IN DEFINED BENEFIT PENSION PLAN (15,312,869) TRANSFER TO AFFILIATE 2,000,000 CHANGE IN OTHER RECONCILING ITEMS 25,001 ---------- TOTAL $ 4,044,450

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

Cat. No. 51056K

Schedule O (Form 990 or 990-EZ) 2018

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

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

OMB No. 1545-0047

2018

Open to Public Inspection

Name of the organization

TRUMAN MEDICAL CENTER INCORPORATED

Employer identification number

44-0661018

Part I

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

(a) Name, address, and EIN (if applicable) of disregarded entity	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Total income	(e) End-of-year assets	(f) Direct controlling entity

Part II

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

(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Exempt Code section	(e) Public charity status (if section 501(c)(3))	(f) Direct controlling entity	(g) Section 512(b)(13) controlled entity?
(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Exempt Code section	(e) Public charity status (if section 501(c)(3))	(f) Direct controlling entity	Yes	No
(1)AUXILIARY TO TRUMAN MEDICAL CENTER 2301 HOLMES KANSAS CITY,MO64108 43-6099279	SUPPORT	MO	501(C)(3)	10	NA		No
(2)TMC PROF AND GEN LIABILITY SELF INS TRUS 2301 HOLMES KANSAS CITY,MO64108 43-1946384	LIABILITY INS	MO	501(C)(3)	12B	NA		No
(3)TMC FINANCE SUPPORT CORPORATION 2301 HOLMES KANSAS CITY,MO64108 27-1994129	SUPPORT	MO	501(C)(3)	12A	TMC	Yes

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

Cat. No. 50135Y

Schedule R (Form 990) 2018

Page 2

Part III

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

(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Direct controlling entity	(f) Share of total income	(g) Share of end-of-year assets	(h) Disproprtionate allocations?		(i) Code V-UBI amount in box 20 of Schedule K-1 (Form 1065)	(j) General or managing partner?
(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

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

Schedule R (Form 990) 2018

Page 3

Part V

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

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

Yes

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Schedule R (Form 990) 2018

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) 2018

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) 2018

Additional Data

Software ID:
Software Version:

1	Briefly describe the organization’s mission or most significant activities: TRUMAN MEDICAL CENTER IS AN ACADEMIC HEALTH CENTER PROVIDING ACCESSIBLE, STATE-OF-THE-ART QUALITY HEALTHCARE TO OUR COMMUNITY REGARDLESS OF ABILITY TO PAY.
2	Check this box
3	Number of voting members of the governing body (Part VI, line 1a) ........	3	35
4	Number of independent voting members of the governing body (Part VI, line 1b) .....	4	33
5	Total number of individuals employed in calendar year 2018 (Part V, line 2a) ......	5	4,962
6	Total number of volunteers (estimate if necessary) .............	6	883
7a	Total unrelated business revenue from Part VIII, column (C), line 12 ........	7a	0
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) .........	11,097,006	11,873,856
9	Program service revenue (Part VIII, line 2g) .........	541,734,321	554,283,627
10	Investment income (Part VIII, column (A), lines 3, 4, and 7d ) ....	371,505	407,366
11	Other revenue (Part VIII, column (A), lines 5, 6d, 8c, 9c, 10c, and 11e)	37,946,468	42,307,682
12	Total revenue—add lines 8 through 11 (must equal Part VIII, column (A), line 12)	591,149,300	608,872,531
13	Grants and similar amounts paid (Part IX, column (A), lines 1–3 )...	546,552	789,194
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)	289,059,432	301,045,794
16a	Professional fundraising fees (Part IX, column (A), line 11e) .....	0	0
b	Total fundraising expenses (Part IX, column (D), line 25) 0
17	Other expenses (Part IX, column (A), lines 11a–11d, 11f–24e)....	292,721,271	300,795,702
18	Total expenses. Add lines 13–17 (must equal Part IX, column (A), line 25)	582,327,255	602,630,690
19	Revenue less expenses. Subtract line 18 from line 12.......	8,822,045	6,241,841
		Beginning of Current Year	End of Year
20	Total assets (Part X, line 16).............	356,565,389	392,721,691
21	Total liabilities (Part X, line 26).............	267,326,358	300,778,194
22	Net assets or fund balances. Subtract line 21 from line 20.....	89,239,031	91,943,497

Sign Here

	Signature of officer	Date

	Type or print name and title


4a	(Code: ) (Expenses $ 249,685,409 including grants of $ 528,715 ) (Revenue $ 274,432,002 )
	OUTPATIENT DEPARTMENT- SEE SCHEDULE O

4b	(Code: ) (Expenses $ 222,545,691 including grants of $ 0 ) (Revenue $ 244,602,437 )
	INPATIENT CARE- SEE SCHEDULE O

4c	(Code: ) (Expenses $ 70,563,268 including grants of $ 0 ) (Revenue $ 77,556,870 )
	EMERGENCY DEPARTMENT- SEE SCHEDULE O

4d	Other program services (Describe in Schedule O.)
	(Expenses $ including grants of $ ) (Revenue $ )
4e	Total program service expenses542,794,368

1b	Sub-Total................
c	Total from continuation sheets to Part VII, Section A....
d	Total (add lines 1b and 1c)...........	4,656,065	0	1,082,200

1a	Federated campaigns..		1a
b	Membership dues..		1b
c	Fundraising events..		1c
d	Related organizations		1d
e	Government grants (contributions)		1e	7,388,910

f	All other contributions, gifts, grants, and similar amounts not included above		1f	4,484,946

g	Noncash contributions included in lines 1a - 1f:$
h Total. Add lines 1a-1f.......		11,873,856

		Business Code
2a	NET PATIENT SERVICE REVENUE	621110	337,192,174	337,192,174
b	EXPENSE REIMBURSEMENT	621110	1,581,865	1,581,865
c	MEDICAID ENHANCEMENTS	621110	179,224,704	179,224,704
d	LOCAL GOVERNMENT SUBSIDY	900099	36,284,884	36,284,884
e
f	All other program service revenue.
g	Total. Add lines 2a–2f ....		554,283,627

3 Investment income (including dividends, interest, and othersimilar amounts) ......			220,721			220,721
4 Income from investment of tax-exempt bond proceeds			0
5 Royalties...........			0
		(ii) Personal	(i) Real
6a	Gross rents
b	Less: rental expenses
c	Rental income or (loss)	0	0
d	Net rental income or (loss)......			0
		(ii) Other	(i) Securities
7a	Gross amount from sales of assets other than inventory	297,290	233,557
b	Less: cost or other basis and sales expenses	344,202
c	Gain or (loss)	-46,912	233,557
d	Net gain or (loss).....			186,645			186,645
8a	Gross income from fundraising events (not including $ of contributions reported on line 1c). See Part IV, line 18 ....
	a		0
b	Less: direct expenses ...b		0
c	Net income or (loss) from fundraising events..			0
9a	Gross income from gaming activities. See Part IV, line 19 ...
	a		0
b	Less: direct expenses ...b		0
c	Net income or (loss) from gaming activities..			0
10a	Gross sales of inventory, less returns and allowances ..
	a		0
b	Less: cost of goods sold ..b		0
c	Net income or (loss) from sales of inventory..			0
Business Code			Miscellaneous Revenue
11a	340B REVENUE		900099	37,975,750	37,975,750
b	EHR MEANINGFUL USE		900099	576,579	576,579
c	LAB		900099	2,472,595	2,472,595
d	All other revenue ....			1,282,758	1,282,758
e	Total. Add lines 11a–11d ......			42,307,682
12	Total revenue. See Instructions......			608,872,531	596,591,309		407,366

1	Grants and other assistance to domestic organizations and domestic governments. See Part IV, line 21	789,194	789,194
2	Grants and other assistance to domestic individuals. See Part IV, line 22	0
3	Grants and other assistance to foreign organizations, foreign governments, and foreign individuals. See Part IV, line 15 and 16.	0
4	Benefits paid to or for members	0
5	Compensation of current officers, directors, trustees, and key employees ....	2,957,866		2,957,866
6	Compensation not included above, to disqualified persons (as defined under section 4958(f)(1)) and persons described in section 4958(c)(3)(B) ....	0
7	Other salaries and wages	242,369,322	220,450,826	21,918,496
8	Pension plan accruals and contributions (include section 401(k) and 403(b) employer contributions) ....	4,590,362	4,263,850	326,512
9	Other employee benefits .......	34,264,356	30,891,420	3,372,936
10	Payroll taxes ...........	16,863,888	15,335,711	1,528,177
11	Fees for services (non-employees):
a	Management ......	0
b	Legal .........	599,224		599,224
c	Accounting ...........	203,566		203,566
d	Lobbying ...........	110,791		110,791
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)	0
12	Advertising and promotion ....	0
13	Office expenses .......	173,564,457	149,098,648	24,465,809
14	Information technology ......	0
15	Royalties ..	0
16	Occupancy ...........	12,599,301	11,125,183	1,474,118
17	Travel ............	220,365	194,582	25,783
18	Payments of travel or entertainment expenses for any federal, state, or local public officials .	0
19	Conferences, conventions, and meetings ....	1,079,277	953,001	126,276
20	Interest ...........	2,314,405	2,059,820	254,585
21	Payments to affiliates .......	0
22	Depreciation, depletion, and amortization ..	20,981,120	18,673,197	2,307,923
23	Insurance ...	1,493,271	1,329,011	164,260
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	PHARMACEUTICALS	46,089,165	46,089,165
b	MEDICAL STAFF EXPENSES	167,067	167,067
c	MEDICAL SUPPLIES	41,373,693	41,373,693
d
e	All other expenses
25	Total functional expenses. Add lines 1 through 24e	602,630,690	542,794,368	59,836,322	0
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 ........			10,956,760	1	10,837,850
2	Savings and temporary cash investments .........			38,419	2	163,025
3	Pledges and grants receivable, net ......			910,279	3	719,123
4	Accounts receivable, net .............			64,033,709	4	74,519,059
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 ........			7,958,449	8	7,741,455
9	Prepaid expenses and deferred charges ......			4,734,147	9	3,673,043
10a	Land, buildings, and equipment: cost or other basis. Complete Part VI of Schedule D	10a	563,026,478
b	Less: accumulated depreciation	10b	383,584,710	162,947,165	10c	179,441,768
11	Investments—publicly traded securities .			10,181,403	11	7,350,834
12	Investments—other securities. See Part IV, line 11 .....			0	12	0
13	Investments—program-related. See Part IV, line 11 ..			0	13	0
14	Intangible assets ...............			0	14	0
15	Other assets. See Part IV, line 11 ...........			94,805,058	15	108,275,534
16	Total assets. Add lines 1 through 15 (must equal line 34)...			356,565,389	16	392,721,691

17	Accounts payable and accrued expenses .....	142,840,710	17	156,391,616
18	Grants payable ...	0	18	0
19	Deferred revenue .........	0	19	0
20	Tax-exempt bond liabilities .........	107,963,784	20	102,692,985
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 ..	3,680,503	23	29,460,438
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	12,841,361	25	12,233,155
26	Total liabilities. Add lines 17 through 25..	267,326,358	26	300,778,194

	Organizations that follow SFAS 117 (ASC 958), check here and complete lines 27 through 29, and lines 33 and 34.
27	Unrestricted net assets	75,217,594	27	68,409,124
28	Temporarily restricted net assets ...........	10,930,252	28	20,443,188
29	Permanently restricted net assets	3,091,185	29	3,091,185
	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 ...........	89,239,031	33	91,943,497
34	Total liabilities and net assets/fund balances ........	356,565,389	34	392,721,691