TY 2022 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/1099-NEC)
(1) STANLEY HOLM...................................................................... PRESIDENT/CEO	5.0 ................. 40.0		X		0	1,399,665	258,684
(2) JASON HANNAGAN...................................................................... SECRETARY/CHIEF LEGAL OFFICER	5.0 ................. 40.0		X		0	1,207,630	154,717
(3) KRYSTAL CLAYMORE...................................................................... TREASURER/CFO	6.0 ................. 44.0		X		0	1,151,323	138,799
(4) JEFF DOSSETT...................................................................... CHIEF OPERATING OFFICER	5.0 ................. 40.0		X		0	927,927	109,565
(5) ELIZABETH LONG...................................................................... CHIEF MEDICAL OFFICER	2.0 ................. 48.0		X		0	571,269	25,188
(6) TERESA KELLER...................................................................... SECY/ASSISTANT GENERAL COUNSEL	5.0 ................. 40.0		X		0	434,827	37,636
(7) JONATHAN NEWKIRK...................................................................... PHYSICIAN	50.0 ................. 0.0			X	345,201	0	38,757
(8) PAUL LUCE...................................................................... VICE PRESIDENT/COO - MCMC	45.0 ................. 0.0		X		338,151	0	23,431
(9) BRIAN COOKE...................................................................... PHYSICIAN	50.0 ................. 0.0			X	296,892	0	39,742
(10) SARA COBINE...................................................................... PHYSICIAN	50.0 ................. 0.0			X	249,260	0	31,392
(11) NATALIE HAGMAN...................................................................... PHYSICIAN	50.0 ................. 0.0			X	251,553	0	23,870
(12) GEORGINA GREEN...................................................................... PHYSICIAN	50.0 ................. 0.0			X	243,036	0	28,579
(13) JANELL AUST...................................................................... DIRECTOR/CHAIRPERSON	2.0 ................. 1.0	X	X		0	0	0
(14) BLAKE HEID...................................................................... DIRECTOR/VICE CHAIRPERSON	2.0 ................. 0.0	X	X		0	0	0
(15) CASSI VOHS...................................................................... DIRECTOR	1.0 ................. 0.0	X			0	0	0
(16) MARY DIANA NEAL...................................................................... DIRECTOR	1.0 ................. 0.0	X			0	0	0
(17) KATHY MINDEN...................................................................... DIRECTOR	1.0 ................. 0.0	X			0	0	0

(A) Name and business address	(B) Description of services	(C) Compensation
DR DONALD BRAUN, 14021 MELROSE OVERLAND PARK,KS66221	ER PHYSICIAN SERVICE	335,150
DR OSAMA ISMAEL, 14217 PARKHILL OVERLAND PARK,KS66221	ER PHYSICIAN SERVICE	424,752
DR MICHAEL MALIN, 4806 W 64TH STREET PRARIE VILLAGE,KS66208	ER PHYSICIAN SERVICE	421,976
VANGUARD RESOURCES INC, 6500 US HWY 281 N SPRING BRANCH,TX78070	OUTSIDE SERVICES	1,048,015
SODEXO OPERATIONS LLC, PO BOX 360170 PITTSBURGH,PA15251	OUTSIDE SERVICES	397,010
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 13

- TIN:

SCHEDULE A
(Form 990)

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.
right arrow

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

OMB No. 1545-0047

2022

Open to Public
Inspection

Name of the organization

MIAMI COUNTY MEDICAL CENTER INC

Employer identification number

48-1155548

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).)

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 33 1/3% 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 33 1/3% 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 on 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) 2022

Page 2

Part II

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

Section A. Public Support

Calendar year (or fiscal year beginning in)		(a) 2018	(b) 2019	(c) 2020	(d) 2021	(e) 2022	(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) 2018	(b) 2019	(c) 2020	(d) 2021	(e) 2022	(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 5 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 2022 (line 6, column (f) divided by line 11, column (f)) .........

Public support percentage for 2020 Schedule A, Part II, line 14 ...............

16a

33 1/3% support test—2022. 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—2021. 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—2022. 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—2021. 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) 2022

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) 2018	(b) 2019	(c) 2020	(d) 2021	(e) 2022	(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) 2018	(b) 2019	(c) 2020	(d) 2021	(e) 2022	(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 on 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 5 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 2022 (line 8, column (f) divided by line 13, column (f)) .........

Public support percentage from 2021 Schedule A, Part III, line 15 ...............

Section D. Computation of Investment Income Percentage

Investment income percentage for 2022 (line 10c, column (f) divided by line 13, column (f)) ......

Investment income percentage from 2021 Schedule A, Part III, line 17 .............

19a

33 1/3% support tests-2022. 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—2021. 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) 2022

Page 4

Part IV

Supporting Organizations

(Complete only if you checked a box on line 12 of Part I. If you checked box 12a, of Part I, complete Sections A and B. If you checked box 12b, of Part I, complete Sections A and C. If you checked box 12c, of Part I, complete Sections A, D, and E. If you checked box12d, 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 lines 3b and 3c 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 box 12a or 12b in Part I, answer lines 4b and 4c 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 lines 5b and 5c 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) .

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

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 on 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 on 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) 2022

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 on lines 11b and 11c below, the governing body of a supported organization?

11a

A family member of a person described on 11a above?

11b

A 35% controlled entity of a person described on line 11a or 11b above? If “Yes” to 11a, 11b, or 11c, provide detail in Part VI.

11c

Section B. Type I Supporting Organizations

Yes

Did the officers, 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 line 2 above, 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 lines 2a and 2b 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 on line 2a, above 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 lines 3a and 3b 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?If "Yes" or "No", 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) 2022

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 0.015 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 0.035	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) 2022

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	1
2 Amounts paid to perform activity that directly furthers exempt purposes of supported organizations, in excess of income from activity	2
3 Administrative expenses paid to accomplish exempt purposes of supported organizations	3
4 Amounts paid to acquire exempt-use assets	4
5 Qualified set-aside amounts (prior IRS approval required - provide details in Part VI)	5
6 Other distributions (describe in Part VI). See instructions	6
7Total annual distributions. Add lines 1 through 6.	7
8 Distributions to attentive supported organizations to which the organization is responsive (provide details in Part VI). See instructions	8
9 Distributable amount for 2022 from Section C, line 6	9
10 Line 8 amount divided by Line 9 amount	10

Section E - Distribution Allocations (see instructions)		(i) Excess Distributions	(ii) Underdistributions Pre-2022	(iii) Distributable Amount for 2022
1 Distributable amount for 2022 from Section C, line 6
2 Underdistributions, if any, for years prior to 2022 (reasonable cause required-- explain in Part VI). See instructions.
3 Excess distributions carryover, if any, to 2022:
a From 2017.......
b From 2018.......
c From 2019.......
d From 2020.......
e From 2021.......
fTotal of lines 3a through e
g Applied to underdistributions of prior years
h Applied to 2022 distributable amount
i Carryover from 2017 not applied (see instructions)
j Remainder. Subtract lines 3g, 3h, and 3i from line 3f.
4Distributions for 2022 from Section D, line 7:
$
a Applied to underdistributions of prior years
b Applied to 2022 distributable amount
c Remainder. Subtract lines 4a and 4b from line 4.
5 Remaining underdistributions for years prior to 2022, 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 2022. 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 2023. Add lines 3j and 4c.
8 Breakdown of line 7:
a Excess from 2018.....
b Excess from 2019.....
c Excess from 2020.....
d Excess from 2021.....
e Excess from 2022.....

Schedule A (Form 990) (2022)

Schedule A (Form 990) 2022

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) 2022

Additional Data

Software ID:
Software Version:

- TIN:

Schedule B
(Form 990)

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

2022

Name of the organization

MIAMI COUNTY MEDICAL CENTER INC

Employer identification number

48-1155548

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) (2022)

Schedule B (Form 990) (2022) Page 2

Name of organization MIAMI COUNTY MEDICAL CENTER INC

Part I Contributors	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) (2022)

Schedule B (Form 990) (2022)

Page 3

Name of organization MIAMI COUNTY MEDICAL CENTER INC		Employer identification number 48-1155548

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) (2022)

Schedule B (Form 990) (2022)

Page 4


Name of organization MIAMI COUNTY MEDICAL CENTER INC			Employer identification number 48-1155548
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) (2022)

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE C
(Form 990)

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

2021

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

MIAMI COUNTY MEDICAL CENTER INC

Employer identification number

48-1155548

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.

Cat. No. 50084S

Schedule C (Form 990) 2021

Page 2

Part II-A

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

A Check SchCMd Bullet

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

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

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

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

4-Year Averaging Period Under Section 501(h) (Some organizations that made a section 501(h) election do not have to complete all of the five columns below. See the separate instructions for lines 2a through 2f.)
Lobbying Expenditures During 4-Year Averaging Period
	Calendar year (or fiscal year beginning in)	(a) 2018	(b) 2019	(c) 2020	(d) 2021	(e) Total

2a	Lobbying nontaxable amount

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

c	Total lobbying expenditures

d	Grassroots nontaxable amount

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

f	Grassroots lobbying expenditures

Schedule C (Form 990) 2021

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|No

(b)

Amount

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

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

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

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

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

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

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

Yes

2,715

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

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

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

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

2,715

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

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

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

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

Part III-A

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

Yes

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

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

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

Part III-B

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

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

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

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

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

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

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

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

Taxable amount of lobbying and political expenditures. See Instructions .........................................

Part IV

Supplemental Information

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

Return Reference	Explanation
SCHEDULE C, PART II-B, LINE 1F	THE ORGANIZATION PAYS DUES TO VARIOUS HOSPITAL ASSOCIATIONS AND A PORTION OF THOSE DUES ARE ALLOCATED TO LOBBYING.

Schedule C (Form 990) 2021

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 instructions and the latest information.

OMB No. 1545-0047

2021

Open to Public Inspection

Name of the organization

MIAMI COUNTY MEDICAL CENTER INC

Employer identification number

48-1155548

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 FASB 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 FASB 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 FASB 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) 2021

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 ....	47,174,332	43,184,777	54,957,271	45,903,346	58,170,298
b	Contributions ...		750,000		68,295	58,891
c	Net investment earnings, gains, and losses	-6,111,939	3,638,491	3,373,945	9,099,797	-1,325,843
d	Grants or scholarships ...
e	Other expenditures for facilities and programs ...	2,688,763	390,596	15,146,439	114,167	11,000,000
f	Administrative expenses ....	7,337	8,340
g	End of year balance ......	38,366,293	47,174,332	43,184,777	54,957,271	45,903,346

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

Term endowment SchDMd Bullet

100.000 %

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

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

Yes

(i) Unrelated organizations .................

3a(i)

(ii) Related organizations .................

3a(ii)

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

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

Part VI

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

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

1a	Land .....	3,130,973		3,130,973
b	Buildings ....	19,851,150	13,555,395	6,295,755
c	Leasehold improvements	3,970	3,970	0
d	Equipment ....	15,959,134	12,974,436	2,984,698
e	Other .....	1,263,743	862,039	401,704
Total. Add lines 1a through 1e. (Column (d) must equal Form 990, Part X, column (B), line 10(c).)..				12,813,130

Schedule D (Form 990) 2021

Page 3

Part VII

Investments - Other 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) Investment in Affiliates	9,757,825	F
(B)
(C)
(D)
(E)
(F)
(G)
(H)
Total. (Column (b) must equal Form 990, Part X, col. (B) line 12.)	9,757,825

Part VIII

Investments - Program 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)Other Receivables				9,668
(2)Due from third party				260,224
(3)Right of Use Asset				119,661
(4)Due from Affiliate				10,637,387
(4)
(5)
(6)
(7)
(8)
(9)
Total. (Column (b) must equal Form 990, Part X, col.(B) line 15.)...........				11,026,940

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
(4)
(5)
(6)
(7)
(8)
(9)
Total. (Column (b) must equal Form 990, Part X, col.(B) line 25.)	10,527,938
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) 2021

Page 4

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

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

Part XIII

Supplemental Information

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

Return Reference	Explanation
SCHEDULE D, PART V, LINE 4	THE ENDOWMENT FUNDS ARE HELD FOR FUTURE CAPITAL AND EXPANSION NEEDS. IN ADDITION, THE FUNDS ALSO REPRESENT RESERVES FOR OPERATING NEEDS TO REMAIN FINANCIALLY STABLE.
SCHEDULE D, PART X, LINE 2	MANAGEMENT HAS EVALUATED THEIR INCOME TAX POSITIONS UNDER THE GUIDANCE INCLUDED IN ASC 740. BASED ON THEIR REVIEW, MANAGEMENT HAS NOT IDENTIFIED ANY MATERIAL UNCERTAIN TAX POSITIONS TO BE RECORDED OR DISCLOSED IN THE FINANCIAL STATEMENTS.

Schedule D (Form 990) 2021

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 20a.
MediumBullet

Attach to Form 990.
MediumBullet

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

OMB No. 1545-0047

2022

Open to Public Inspection

Name of the organization

MIAMI COUNTY MEDICAL CENTER INC

Employer identification number

48-1155548

Part I

Financial Assistance and Certain Other Community Benefits at Cost

Yes

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

Yes

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

Yes

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

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

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

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

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

Yes

100% 150% 200% Other %

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

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

Yes

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

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

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

Yes

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

Yes

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

Yes

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

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

Yes

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

Yes

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

Financial Assistance and Certain Other Community Benefits at Cost

Financial Assistance and Means-Tested Government Programs		(c) Total community benefit expense	(d) Direct offsetting revenue	(e) Net community benefit expense	(f) Percent of total expense
a	Financial Assistance at cost (from Worksheet 1) . . .	470,878		470,878	1.430 %
b	Medicaid (from Worksheet 3, column a) . . . . .	3,475,809	2,180,081	1,295,728	3.950 %
c	Costs of other means-tested government programs (from Worksheet 3, column b) . .
d	Total Financial Assistance and Means-Tested Government Programs . . . . .	3,946,687	2,180,081	1,766,606	5.380 %
Other Benefits
e	Community health improvement services and community benefit operations (from Worksheet 4).	15,744		15,744	0.050 %
f	Health professions education (from Worksheet 5) . . .	5,000		5,000	0.020 %
g	Subsidized health services (from Worksheet 6) . . . .	1,255,147		1,255,147	3.830 %
h	Research (from Worksheet 7) .
i	Cash and in-kind contributions for community benefit (from Worksheet 8) . . . .
j	Total. Other Benefits . .	1,275,891		1,275,891	3.900 %
k	Total. Add lines 7d and 7j .	5,222,578	2,180,081	3,042,497	9.280 %

For Paperwork Reduction Act Notice, see the Instructions for Form 990. Cat. No. 50192T Schedule H (Form 990) 2022

Schedule H (Form 990) 2022

Page

Part II

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

		(c) Total community building expense	(f) Percent of total expense
1	Physical improvements and housing	17,500	0.050 %
2	Economic development	900
3	Community support	4,537	0.010 %
4	Environmental improvements
5	Leadership development and training for community members
6	Coalition building
7	Community health improvement advocacy	7,186	0.020 %
8	Workforce development
9	Other
10	Total	30,123	0.080 %

Part III

Bad Debt, Medicare, & Collection Practices

Section A. Bad Debt Expense

Yes

Did the organization report bad debt expense in accordance with Healthcare 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. ......

908,823

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. ......

681,617

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).....

11,467,957

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

14,930,802

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

-3,462,845

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) 2022

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?1Name, 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	MIAMI COUNTY MEDICAL CENTER 2100 BAPTISTE DRIVE PAOLA,KS66071 WWW.OLATHEHEALTH.ORG H-061-001	X	X	X

Schedule H (Form 990) 2022

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)

	MIAMI COUNTY MEDICAL CENTER
Name of hospital facility or letter of facility reporting group

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

Yes

Community Health Needs Assessment

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

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

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

Yes

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

A definition of the community served by the hospital facility

Demographics of the community

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

How data was obtained

The significant health needs of the community

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

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

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

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 21

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

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 SCHEDULE H, 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 22

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

Yes

If "Yes" (list url): SEE SCHEDULE H, 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) 2022

Page 5

Part VFacility Information (continued)

Financial Assistance Policy (FAP)

	MIAMI COUNTY MEDICAL CENTER
Name of hospital facility or letter of facility reporting group

Yes

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

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

Yes

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

Federal poverty guidelines (FPG), with FPG family income limit for eligibility for free care of 150.%
and FPG family income limit for eligibility for discounted care of 300.%

Income level other than FPG (describe in Section C)

Asset level

Medical indigency

Insurance status

Underinsurance discount

Residency

Other (describe in Section C)

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

Yes

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

Yes

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

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

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

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

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

Other (describe in Section C)

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) 2022

Page 6

Part VFacility Information (continued)

Billing and Collections

	MIAMI COUNTY MEDICAL CENTER
Name of hospital facility or letter of facility reporting group

Yes

Did the hospital facility have in place during the tax year a 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 (if not, describe in Section C)

Made a reasonable effort to orally notify individuals about the FAP and FAP application process (if not, describe in
Section C)

Processed incomplete and complete FAP applications (if not, describe in Section C)

Made presumptive eligibility determinations (if not, describe in Section C)

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) 2022

Page 7

Part VFacility Information (continued)

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

	MIAMI COUNTY MEDICAL CENTER
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) 2022

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, 20a, 20b, 20c, 20d, 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	Miami County Medical Center, Inc. (MCMCI) conducted a town hall meeting in summer of 2021. The community members invited to this town hall represented the broad interests of the community served by the hospital facility, including individuals with special knowledge and expertise in public health. This includes people representing the following groups: local hospital, public health community, mental health community, free clinics, community-based clinics, service providers, local residents, community leaders, opinion leaders, school leaders, business leaders, local government, faith-based organizations, people with chronic conditions, uninsured community members, low income residents, and minority groups. Section V of the CHNA provides a list of the town hall attendees and notes from the meeting. All priority-setting and scoring processes at the town hall meeting involved the input of key stakeholders in attendance. The meeting included discussion of community health data; reflection on size and seriousness of any health concerns; and discussion of current community health strengths. Participants were then asked to rank the community health concerns cited during the meeting and from the primary and secondary research already completed. A preliminary research survey was conducted by VVV Research LLC on behalf of MCMCI.
SCHEDULE H, PART V, SECTION B, LINE 7A	https://www.olathehealth.org/patients-and-visitors/community-support/chna- chip/
SCHEDULE H, PART V, SECTION B, LINE 10A	https://www.olathehealth.org/patients-and-visitors/community-support/chna- chip/
SCHEDULE H, PART V, SECTION B, LINE 11	MCMCI began the process to reassess the healthcare needs of its communities in order to identify the top health-need priorities in 2021. MCMCI Board of Directors approved the assessment and its results in September 2021. A three-year plan to address these communities will be drafted for the 2023-2025 plan. Currently, MCMCI is in year three of the existing improvement plan, which was initiated in 2020. It addresses each health need priority, outlining MCMCI's initiative(s) to address the need and the anticipated community impact. You can read the full Community Health Needs Assessment and Community Health Improvement Plan documents on our website at olathehealth.org/community.
SCHEDULE H, PART V, SECTION B, LINE 13B	In addition to the items checked in this section, when annual household income is more than 300% of the federal poverty guidelines, individuals with extraordinary medical expenses may be eligible, on case by case basis, for financial assistance discount or extended payment arrangements.
SCHEDULE H, PART V, SECTION B, LINES 16A-C	WWW.OLATHEHEALTH.ORG/PATIENT-AND-VISITORS/FINANCIAL-ASSISTANCE

Schedule H (Form 990) 2022

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?6
Name and address		Type of Facility (describe)
1	LOUISBURG REHAB OF MIAMI CTY MEDICAL CTR 102 W CRESTVIEW CIRCLE LOUISBURG,KS66053	OUTPATIENT REHABILITATION CLINIC
2	OSAWATOMIE REHAB OF MIAMI CTY MED CENTER 635 MAIN STREET OSAWATOMIE,KS66064	OUTPATIENT REHABILITATION CLINIC
3	PAOLA REHAB OF MIAMI CTY MEDICAL CTR 1312 KANSAS AVENUE PAOLA,KS66071	OUTPATIENT REHABILITATION CLINIC
4	FAMILY MEDICINE - PAOLA 1318 KANSAS DRIVE PAOLA,KS66071	RURAL HEALTH CLINIC
5	FAMILY MEDICINE - LOUISBURG 102 WEST CRESTVIEW LOUISBURG,KS66053	RURAL HEALTH CLINIC
6	FAMILY MEDICINE - OSAWATOMIE 100 EAST MAIN ST OSAWATOMIE,KS66064	RURAL HEALTH CLINIC
7
8
9
10

Schedule H (Form 990) 2022

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	See Part VI, Section B, Line 13 for the list of factors used in the eligibility criteria explained in the FAP for providing free and discount care. Private pay primary (uninsured) receive an automatic 50% discount off of billed charges.
SCHEDULE H, PART I, LINE 7, COLUMN F	The bad debt expense is not considered a community benefit expense and is not included in Schedule H, Part I, Line 7. The amount excluded is $3,081,212.
SCHEDULE H, PART I, LINE 7	The costing methodology used to calculate the amounts contained in the table of Part I, Line 7, of Schedule H, is a cost accounting system.
SCHEDULE H, PART I, LINE 7G	No physician clinic costs are included in the Community Benefit expenses.
SCHEDULE H, PART II	Miami County Medical Center, Inc. (MCMCI) is committed to improving the communities we serve. The organization is involved in a variety of activities in our community that support the general economic improvement of our community; the health, well-being and safety of our area's residents; as well as supporting programs and other organizations that reach out to our citizens in need. A few examples of MCMCI's involvement in 2022 include: 1) Involvement in the Miami County Economic Development Advisory Board and local civic organizations. 2) Our support of the Health Partnership clinic, serving the uninsured of our community. 3) Our support of Lakemary Center, a nonprofit serving children and adults with developmental and intellectual disabilities. 4) Leadership participation on the Board of Directors for the Elizabeth Layton Center, a nonprofit community mental health center serving the mental health treatment needs of the residents of the communities it serves. 5) Participation in community organizations and events through donations and by providing health education and services, including the Miami County Cancer Foundation. 6) Leadership and participation in our area's emergency preparedness efforts by coordinating extensive drills to practice our response to potential situations. 7) Participation in the Flint Hills Trail Project working with the City of Osawatomie to develop walking and biking trails in and around Osawatomie.
SCHEDULE H, PART III, SECTION A, LINE 2	A cost accounting system is used to calculate the amount of MCMC's bad debt expense.
SCHEDULE H, PART III, SECTION A, LINE 3	The amount included on Line 3 that could be attributed to patients eligible under the organization's financial assistance policy was estimated by analyzing all private pay patient charges at cost less the cost for those patients that were eligible for financial assistance. This amount was then multiplied by the percentage of what has been historically collected from uninsured patients. The majority of the uninsured patients do not have the ability to pay and if the patients completed the financial assistance application they would be eligible for financial assistance.
SCHEDULE H, PART III, SECTION A, LINE 4	AS OF JANURY 1, 2023, A MEMBER SUBSTITUTION OCCURRED MAKING THE UNIVERSITY OF KANSAS HEALTH SYSTEM (UKHS) THE SOLE MEMBER OF OLATHE HEALTH SYSTEM, INC. AND ALL OF ITS SUPPORTED ORGANIZATIONS, INCLUDING MIAMI COUNTY MEDICAL CENTER, INC. UKHS OPERATES ON A FYE OF 6.30.2023, THEREFORE IT WAS DETERMINED OLATHE HEALTH SYSTEM, INC. WOULD NOT AUDIT THE FINANCIAL REPORTS AS OF 12.31.22 BUT WOULD BE INCLUDED IN THE AUDIT OF UKHS FINANCIAL REPORTING AUDIT OF 6.30.2023.
SCHEDULE H, PART III, SECTION B, LINE 8	Medicare allowable costs were calculated using a cost accounting system. Shortfalls arise from payments that are less than the costs to provide the services. The shortfalls should be considered community benefit as they must be absorbed in order to continue providing care to our community. It is also implied in Internal Revenue Service ruling 69-545 which established the community benefit standard for tax-exempt hospitals and indicates that participation in publicly-financed programs, such as Medicare, is evidence that a hospital meets the community benefit standard.
SCHEDULE H, PART III, SECTION C, LINE 9B	Before placement with collection agencies, MCMCI Patient Financial Services offers various options for patients with financial challenges. An internal short-term four-month payment plan is offered to those patients who express the need for help in meeting the financial obligation. If the four-month payment option would cause a financial hardship, an extended payment option through a third party is available at no cost or interest to the patient. The third party vendor offers hardship option to those patients who express the inability to manage the monthly payments. In addition to offering our own internal short term financial assistance and the extended payment option through a third party, MCMCI contracts with an outside agency that screens individuals for eligibility for programs such as Medicaid, Disability and Crime Victim's Compensation and then helps and supports the patient through the application process. MCMCI has language written in their collection agency contract that states, "Agency agrees to comply with the Internal Revenue Code 501(r)(6) and will not perform Extraordinary Collection Actions ("ECA") before Client has made reasonable efforts to determine whether the patient/debtor ("individual") is eligible for assistance under its financial assistance policy ("FAP") and will not engage in ECAs. If Client determines that the individual does not qualify, or is unable to determine whether an individual qualifies, THE Agency may, upon direction from Client engage in collection activities." If the collection agency is notified by the patient/debtor that this created an undue financial hardship or burden due to a change in their income or assets, the agency will notify MCMCI and await further direction from the hospital.
SCHEDULE H, PART VI, LINE 2	Miami County Medical Center, Inc. (MCMCI) is continually assessing the health needs of the communities it serves in a variety of ways. Informally, MCMCI is involved in multiple health fairs and other community outreach activities that involve screenings, questionnaires and general conversation that help us understand the needs of groups and individuals. Also, the MCMCI Community Advisory Council meets on a regular basis with representatives from a diverse group of individuals who provide helpful input from the organizations and communities they represent. MCMCI launched its fourth formal process of assessment in 2021 to begin implementation in 2023. In partnership with the Miami County Department of Health, and with the help of VVV Research and Development, MCMCI conducted a community health needs assessment for its primary service area (Miami County). This was done by performing research, collecting health data for the area and actively seeking input from the community through a survey and town hall meetings. The board approved the CHNA in September 2021. The research, survey and town hall meetings conducted in 2018 helped develop a picture of the health-related priorities of residents in our service area. Below are the top health need priorities in the primary service area for MCMCI for the 2020 - 2022 Community Health Improvement Plan. Health Need Priorities 2020-2022- MCMCI 1. Mental health, including screening, treatment and after-care 2. Opioid/drug abuse 3. Food insecurity 4. Suicide prevention 5. Local specialty care, specifically neurology, pulmonology, endocrinology and podiatry 6. Obesity 7. Senior care 8. Safe and affordable housing 9. Healthcare transportation 10. Immunizations In 2020, MCMCI launched its third Community Health Improvement Plan (CHIP). As a way to organize the health need priorities in a way where we incorporated further clarification from the community, MCMC categorized them in the following way in the CHIP: 1. Behavioral Health a. Mental health, including screening, treatment and after-care (CHNA Priority #1) b. Opioid/drug abuse (CHNA Priority #2) c. Suicide prevention (CHNA Priority #4) 2. Physical Health a. Food insecurity (CHNA Priority #3) b. Obesity (CHNA Priority #6) c. Immunizations (CHNA Priority #10) 3. Access to Care a. Local specialty care, specifically neurology, pulmonology, endocrinology and podiatry (CHNA Priority #5) b. Healthcare transportation (CHNA Priority #9) 4. Senior Care (CHNA Priority #7), including safe and affordable housing (CHNA Priority #8) To address the first priority of mental health, MCMCI began addressing this through increased collective community education, prevention, response and treatment for mental health conditions. One response involved the Olathe Health Family Medicine Clinics screening patients during wellness visits using the PHQ-9 depression screening, continue enhancements to care management for patients with mental illness through implementation of behavioral health care management for patients with mental health conditions. In 2022, the goal was to assess 80% of patients ages 12 and older annually for depression. Screenings were conducted at nearly 99% of all patient visits. For patients identified, they are followed-up with every three months to check in. The next step in this is to evaluate and expand resources available for these patients. Another key response is to work with community health partners to support patients within the Olathe Health network, specifically focusing on those with depression/anxiety diagnosis, those who have that diagnosis plus a chronic medical condition and those who have more than four chronic conditions by identifying key community partners and develop process for collaborating to increase access and enhance patient care. MCMC continued its partnership and support of the Elizabeth Layton Center (ELC). MCMC leadership continues to serve on the board for ELC and identify ways to enhance offerings to OHFM patients and the community. The Culture of Health initiative was led by the Marais des Cygnes District Research and Extension Office. This group of community representatives including MCMC, ELC, school district, Department of Child and Family Services and others came together to offer Mental Health First Aid training to the community, specifically those who work in professions such as youth coaches, hair dressers and other who work directly with the community. In 2022, the culture of health grant continued to provide resources to parents and students at the beginning of the school year on topics of depression and anxiety. An additional response to this was launching an online resource guide to provide the community with a single source for accessing key behavioral health services. The goal for this guide to undergo an annual audit to ensure information is updated. This was conducted in Q4 of 2022. The final response to address this health priority was to coordinate with Olathe Health Family Medicine to provide telemedicine opportunities for behavioral health services. Through the emergency department, telehealth behavioral health services are available through ELC. The future goal is to expand this beyond the ED and incorporate into an outpatient setting. The second health priority under behavioral health is to address the rise in the abuse and misuse of drugs and opioids. To do this, we must partner with key community entities to reduce the use of other illegal drugs. The most effective way for a hospital to address this is to partner with our medical providers. Through the creation of the Olathe Health Physician Opioid Task Force, this group can review prescription practices and provide appropriate education. This group launched a plan and infrastructure to monitor patients who have and do not have a controlled substance agreement. This group was able to launch an opioid toolkit through the EMR to help providers better monitor this information in a more user-friendly way. In 2022 the task force reviewed data to set future goals. Another key response was to ensure the rural health clinics had medication disposal systems in place for safe disposal. In 2022, the baseline data was analyzed to measure success of this program. Another effort was to make providers aware of local drop-off locations. This information was provided by the physician relations liaison. To address suicide prevention, MCMCI needs to partner with key community stakeholders to reduce the incidence of suicide and connect those with suicide ideation with the appropriate resources for assistance. The response is to work with community partners to develop a rapid response process to help with Olathe Health patients in crisis within our locations. Created resources for crisis management for clinic staff for suicidality including but not limited to iPad assessment in clinics, direct hotline, etc. Through a partnership with Elizabeth Layton Center, MCMCI is able to have patients appropriately screened in the emergency room. Another response to suicide prevention was to support the Healthy Minds Strong Communities workgroup in their effort to launch awareness/educational programs to help people develop resiliency. Continued a social media campaign with resources and educational videos on this topic. The campaign targeted different audiences including educators, healthcare workers, parents, youth and general community. MCMCI implemented the Yellow Ribbon Project in the communities we serve by sponsoring training days for community, including those who work directly with youth (i.e. non-school based athletic coaches, recreational leaders, etc.) Under the next heading of physical activity, MCMC focused on enhancing collaborative communication about accessible health wellness and prevention opportunities to encourage community members to engage and sustain positive behavior change. One effective way to provide this education is through the online resource guide that launched in December 2020. In addition to providing resources, there are opportunities to highlight community partnerships (such as the ones MCMCI has with the Osawatomie School District and the Ozone) and promote events. MCMCI also set a goal to participate in 10 community-based activities to provide preventative health and wellness screenings and/or education. In 2022, MCMC participated in 10 community-based events. Another key response was to focus on enhancing food insecurity. MCMCI approached this by screening Olathe Health Family Medicine patients for food insecurity to Establish a baseline in 2020 and then increase number of patients being connected to resources. In 2022, the number of patients identified through the screening process as being food insecure increased. MCMCI also chose to focus on education to youth and young families in the community by promoting the 1-2-3-4-5-Fit-TASTIC Program (a program that talks about incorporating healthy eating habits and other behaviors in their life
SCHEDULE H, PART VI, LINE 3	Patients of Miami County Medical Center, Inc. (MCMCI) are made aware of all opportunities available for financial assistance in a variety of ways. There are signs in the registration areas to notify patients and visitors of the availability of assistance programs. Every billing statement contains a notice of the availability of financial assistance and how to obtain additional information or apply. Applications and instructions are available on the medical center's website, in both English and Spanish. Patient Access, Patient Financial Services and social workers are trained to provide applications to patients if they express any concern regarding ability to pay for services or may be referred to an agency the medical center contracts with to help individuals through the application process for programs like Medicaid and disability. Patients that call or visit our Patient Financial Services department expressing concerns about being able to pay for their services or express that they are experiencing a financial hardship are advised of our assistance policy and encouraged to apply.
Schedule H, Part VI, Line 4	Miami County Medical Center, Inc. (MCMCI) serves the people of Miami and Linn Counties in Kansas. Miami and Linn Counties are both located in rural areas of the state of Kansas and are both federally designated medically underserved areas of Kansas. MCMCI is the only hospital in these two counties. However, there are several other hospitals located in nearby metropolitan areas, including Olathe and Overland Park, Kansas, and Kansas City, Missouri. MCMCI has four rural health clinics in Paola, LaCygne, Louisburg and Osawatomie, Kansas which serve underserved populations. In addition to the general healthcare services provided by the hospital and its associated physicians, MCMCI serves a diverse population of mentally disabled patients. The Osawatomie State Hospital, Lakemary Center, Medicalodge of Paola and the Tri-Ko are all organizations located in the primary service area. MCMCI supports each of these organizations by providing medical care to their residents, in addition to financial contributions to support programs for their residents. Below is a listing of economic levels for area residents. Time period: 2020 American Community Survey 5-Year Estimates Source: data.census.gov People Living Below Poverty Level Miami County: 6.9% Linn County: 15.3% Young Children Living Below Poverty Level Miami County: 8.2% Linn County: 17.8% Uninsured Adult Population Rate Miami County: 5.8% Linn County: 9.3%
Schedule H, Part VI, Line 5	In addition to the items listed above, Miami County Medical Center takes an active role in support of local, regional and national not-for-profit organizations with a focus on improving health and supporting those in need. MCMCI provides support financially and through volunteering time and talents to multiple area organizations. MCMCI provides athletic trainers to area school sports programs. The pandemic caused MCMC to transition to Drive-thru flu shot clinics and community screenings with restrictions related to pandemic protocols.
Schedule H, Part VI, Line 6	Miami County Medical Center, Inc. (MCMCI) is part of Olathe Health System, Inc. (OHSI). OHSI consists of two hospitals and a network of 40 clinics. OHSI and its affiliates, including MCMCI, take a leadership role in promoting the health of the communities served. OHSI hospitals and clinics are involved with community outreach education and screening programs across the entire service area. MCMCI collaborates with area companies and other health-related service providers to provide education and screenings to the public.
Schedule H, Part VI, Line 7	MCMCI is not required to file a community benefit report with the state, but we make our report available to anyone interested at www.olathehealth.org.

Schedule H (Form 990) 2022

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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

2022

Open to Public
Inspection

Name of the organization
MIAMI COUNTY MEDICAL CENTER INC

Employer identification number
48-1155548

Part I

General Information on Grants and Assistance

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

Yes No

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

Part II

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

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

(a) Name and address of organization or government	(b) EIN	(c) IRC section (if applicable)	(d) Amount of cash grant	(e) Amount of non-cash assistance	(f) Method of valuation (book, FMV, appraisal, other)	(g) Description of noncash assistance	(h) Purpose of grant or assistance
(1) PAOLA USD # 368 PO BOX 268 PAOLA,KS66071	48-0720746	GOVERNMENT		41,241	FMV	SPORTS MEDICINE	COMMUNITY WELLNESS
(2) OSAWATOMIE USD # 367 1200 TROJAN DRIVE OSAWATOMIE,KS66064	48-0698824	GOVERNMENT		41,241	FMV	SPORTS MEDICINE	COMMUNITY WELLNESS
(3) PRAIRIE VIEW USD # 362 13799 KS HWY 152 LA CYGNE,KS66040	48-0698988	GOVERNMENT		80,283	FMV	SPORTS MEDICINE	COMMUNITY WELLNESS
(4) LAKEMARY CENTER 100 LAKEMARY DR PAOLA,KS66071	23-7423516	501(C)3	7,500				COMMUNITY WELLNESS

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) 2022

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) SCHOLARSHIPS	5	5,000
(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	MIAMI COUNTY MEDICAL CENTER, INC. PROVIDED SPORTS TRAINERS TO LOCAL HIGH SCHOOLS IN ADDITION TO PROVIDING FUNDS TO ASSIST LOUISBURG, PAOLA AND OSAWATOMIE SCHOOLS WITH ADDITIONAL HEALTHCARE ITEMS. FOR ALL SCHOLARSHIPS, THE ORGANIZATION CAREFULLY SELECTS THE RECIPIENTS OF THE FUNDS AND A CHECK IS WRITTEN DIRECTLY TO THE UNIVERSITY ON BEHALF OF THE INDIVIDUAL SELECTED.

Schedule I (Form 990) 2022

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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

2022

Open to Public Inspection

Name of the organization

MIAMI COUNTY MEDICAL CENTER INC

Employer identification number

48-1155548

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 on 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 on 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? ..................

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) 2022

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, 1099-MISC compensation, and/or 1099-NEC			(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)
1PAUL LUCE VICE PRESIDENT/COO - MCMC	(i) (ii)	333,100 ------------- 0	0 ------------- 0	5,051 ------------- 0	7,333 ------------- 0	16,098 ------------- 0	361,582 ------------- 0	0 ------------- 0
2STANLEY HOLM PRESIDENT/CEO	(i) (ii)	0 ------------- 951,080	0 ------------- 430,222	0 ------------- 18,363	0 ------------- 232,884	0 ------------- 25,800	0 ------------- 1,658,349	0 ------------- 0
3TERESA KELLER SECY/ASSISTANT GENERAL COUNSEL	(i) (ii)	0 ------------- 261,723	0 ------------- 171,146	0 ------------- 1,958	0 ------------- 11,941	0 ------------- 25,695	0 ------------- 472,463	0 ------------- 0
4KRYSTAL CLAYMORE TREASURER/CFO	(i) (ii)	0 ------------- 478,752	0 ------------- 670,166	0 ------------- 2,405	0 ------------- 116,357	0 ------------- 22,442	0 ------------- 1,290,122	0 ------------- 0
5JEFF DOSSETT CHIEF OPERATING OFFICER	(i) (ii)	0 ------------- 383,369	0 ------------- 538,364	0 ------------- 6,194	0 ------------- 84,223	0 ------------- 25,342	0 ------------- 1,037,492	0 ------------- 0
6JASON HANNAGAN SECRETARY/CHIEF LEGAL OFFICER	(i) (ii)	0 ------------- 521,334	0 ------------- 685,208	0 ------------- 1,088	0 ------------- 129,090	0 ------------- 25,627	0 ------------- 1,362,347	0 ------------- 0
7ELIZABETH LONG CHIEF MEDICAL OFFICER	(i) (ii)	0 ------------- 569,304	0 ------------- 0	0 ------------- 1,965	0 ------------- 0	0 ------------- 25,188	0 ------------- 596,457	0 ------------- 0
8JONATHAN NEWKIRK PHYSICIAN	(i) (ii)	332,205 ------------- 0	0 ------------- 0	12,996 ------------- 0	26,314 ------------- 0	12,443 ------------- 0	383,958 ------------- 0	6,104 ------------- 0
9NATALIE HAGMAN PHYSICIAN	(i) (ii)	251,088 ------------- 0	0 ------------- 0	465 ------------- 0	8,687 ------------- 0	15,183 ------------- 0	275,423 ------------- 0	0 ------------- 0
10SARA COBINE PHYSICIAN	(i) (ii)	248,687 ------------- 0	0 ------------- 0	573 ------------- 0	10,209 ------------- 0	21,183 ------------- 0	280,652 ------------- 0	0 ------------- 0
11BRIAN COOKE PHYSICIAN	(i) (ii)	289,363 ------------- 0	0 ------------- 0	7,529 ------------- 0	14,584 ------------- 0	25,158 ------------- 0	336,634 ------------- 0	5,670 ------------- 0
12GEORGINA GREEN PHYSICIAN	(i) (ii)	242,193 ------------- 0	0 ------------- 0	843 ------------- 0	8,562 ------------- 0	20,017 ------------- 0	271,615 ------------- 0	0 ------------- 0

Schedule J (Form 990) 2022

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

THE FOLLOWING AMOUNTS WERE ACCRUED IN 2022 TO A 457(F) PLAN FOR THE BENEFIT OF THE SENIOR EXECUTIVE LEADERSHIP AND WERE INCLUDED AS DEFERRED INCOME ON SCHEDULE J FOR THE FOLLOWING: STANLEY HOLM, PRESIDENT AND CHIEF EXECUTIVE OFFICER, $199,268; KRYSTAL CLAYMORE, CHIEF FINANCIAL OFFICER, $85,538; JEFF DOSSETT, CHIEF OPERATING OFFICER, $59,431; AND JASON HANNAGAN, CHIEF LEGAL COUNSEL, $92,861. A SELECT GROUP OF PHYSICIANS ALSO PARTICIPATE IN A SUPPLEMENTAL EXECUTIVE RETIREMENT PLAN (SERP). IN 2022 THERE WERE PAYOUTS OF $6,104 TO DR. JONATHAN NEWKIRK AND $5,670 TO BRIAN COOKE. THESE AMOUNTS ARE REPORTED AS TAXABLE COMPENSATION AND INCLUDED ON THEIR RESPECTIVE W-2S. THE FOLLOWING AMOUNTS WERE ACCRUED IN 2022 FOR A 457(F) PLAN AND INCLUDED AS DEFERRED INCOME ON SCHEDULE J FOR THE BENEFIT OF DRS. JONATHAN NEWKIRK, $6,518; SARA COBINE, $2,487; GEORGINA GREEN, $1,271; BRIAN COOKE, $5,580 AND NATALIE HAGMAN, $1,164. $5,580 AND NATALIE HAGMAN, $1,164.

Schedule J (Form 990) 2022

Additional Data

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Schedule L
(Form 990)

Department of the Treasury
Internal Revenue Service

Transactions with Interested Persons

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

Attach to Form 990 or Form 990-EZ.
MediumBullet

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

OMB No. 1545-0047

2021

Open to Public Inspection

Name of the organization

MIAMI COUNTY MEDICAL CENTER INC

Employer identification number

48-1155548

Part I

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

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

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

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

Part II

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

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






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

Part III

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

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

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

Cat. No. 50056A

Schedule L (Form 990) 2021

Page 2

Part IV

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

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

Part V

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

Return Reference	Explanation
SCHEDULE L, PART IV	(A) PATRICIA DIEHM (B) PATIRICIA DIEHM IS THE SISTER-IN-LAW OF PAUL LUCE, AN OFFICER OF MIAMI COUNTY MEDICAL CENTER, INC. (C) $105,842 (D) Patricia Diehm is an employee of Miami County Medical Center, Inc. (E) NO

Schedule L (Form 990) 2021

Additional Data

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SCHEDULE O
(Form 990)

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

2021

Open to Public
Inspection

Name of the organization

MIAMI COUNTY MEDICAL CENTER INC

Employer identification number

48-1155548

Return Reference	Explanation
FORM 990, PART III, LINE 4A	MIAMI COUNTY MEDICAL CENTER, INC. OPERATES AN ACUTE CARE HOSPITAL IN PAOLA, KANSAS. MIAMI COUNTY MEDICAL CENTER, INC. CARRIES OUT ITS MISSION BY HELPING PEOPLE THROUGH HEALING, HEALTH AND HAPPINESS IN MIAMI COUNTY, KANSAS AND THE SURROUNDING AREA. MIAMI COUNTY MEDICAL CENTER, INC. IS A JOINT COMMISSION ACCREDITED HOSPITAL AND IS LICENSED FOR 39 BEDS AND CURRENTLY STAFFS 18 INPATIENT BEDS. PROGRAM SERVICES EXPENSES ARE ALL RELATED TO THE PROVISION OF HEALTHCARE SERVICES. IN 2022, MIAMI COUNTY MEDICAL CENTER, INC. PROVIDED 1,076 DAYS OF INPATIENT CARE, PROVIDED 135,951 OUTPATIENT PROCEDURES, AND 8,634 EMERGENCY VISITS TO THE COMMUNITY. MIAMI COUNTY MEDICAL CENTER'S RURAL HEALTH CLINICS OPERATE IN AREAS DESIGNATED AS MEDICALLY UNDERSERVED. THESE CLINICS HELP MEET THE NEEDS OF THEIR RESPECTIVE COMMUNITIES BY PROVIDING PRIMARY CARE PHYSICIANS AND MID-LEVEL PROVIDERS, LAB SERVICES AND X-RAY SERVICES. THE RURAL HEALTH CARE CLINICS COST IN EXCESS OF PAYMENTS WAS $1,092,383. EDUCATIONAL SUPPORT IN ADDITION TO PROVIDING UNCOMPENSATED CARE FOR PATIENTS IN NEED, THE MEDICAL CENTER PROVIDES OTHER HEALTH CARE RELATED BENEFITS TO THE COMMUNITIES IT SERVES BY PROVIDING 24-HOUR EMEGENCY CARE TO THE PUBLIC REGARDLESS OF ABILITY TO PAY. THE MEDICAL CENTER ALSO PROVIDES EDUCATION FOR A VARIETY OF MEDICAL PROFESSIONALS, HEALTH CARE SCREENINGS AND EDUCATION PROGRAMS FOR THE GENERAL PUBLIC AND SUPPORT GROUP SPONSORSHIPS. SPORTS NET MIAMI COUNTY MEDICAL CENTER PROVIDES ATHLETIC TRAINING STAFF FOR AREA HIGH SCHOOLS AND JUNIOR HIGH SCHOOOLS DURING THE SCHOOL YEAR THROUGH ITS SPORTS NET PROGRAM. IN 2022 $162,764 OF ATHLETIC TRAINER SERVICES WAS PROVIDED TO THE SCHOOLS IN THE MIAMI COUNTY MEDICAL CENTER'S SERVICE AREA. CONTRIBUTIONS MIAMI COUNTY MEDICAL CENTER SUPPORTS A VARIETY OF SOCIAL, EDUCATION AND CIVIC HEALTHCARE RELATED ORGANIZATIONS WITHIN ITS SERVICE AREA. IN 2022, $170,265 WAS CONTRIBUTED TO VARIOUS AGENCIES AND CHARITABLE ORGANIZATIONS AND $5,000 IN SCHOLARSHIPS TO STUDENTS INTERESTED IN PURSUING HEALTHCARE EDUCATION.
FORM 990, PART IV, LINE 20B	AS OF JANUARY 1, 2023, A MEMBER SUBSTITUTION OCCURRED MAKING THE UNIVERSITY OF KANSAS HEALTH SYSTEM (TUKHS) THE SOLE MEMBER OF OLATHE HEALTH SYSTEM, INC. AND ALL OF ITS SUPPORTED ORGANIZATIONS, INCLUDING MIAMI COUNTY MEDICAL CENTER, INC. TUKHS OPERATES ON A FYE OF 6.30.2023, THEREFORE IT WAS DETERMINED OLATHE HEALTH SYSTEM, INC. WOULD NOT AUDIT THE FINANCIAL REPORTS AS OF 12.31.22 BUT WOULD BE INCLUDED IN THE UKHS FINANCIAL REPORTING AUDIT OF 6.30.2023.
FORM 990, PART VI, SECTION A, LINE 2	STANLEY HOLM, KRYSTAL CLAYMORE AND JEFF DOSSETT HAVE A BUSINESS RELATIONSHIP WITH EACH OTHER. THEY SERVED AS AN OFFICER OR DIRECTOR FOR OLATHE HEALTH DEVELOPMENT CORPORATION AND OLATHE MEDICAL CENTER DOCTOR'S BUILDING CONDOMINIUM OWNERS ASSOCIATION, INC. WHICH ARE RELATED FOR PROFIT COMPANIES. STANLEY HOLM, KRYSTAL CLAYMORE, JEFF DOSSETT, JASON HANNAGAN, ELIZABETH LONG AND TERESA KELLER WERE OR ARE EMPLOYED BY OLATHE HEALTH SYSTEM INC. WHICH IS THE SOLE MEMBER OF MIAMI COUNTY MEDICAL CENTER, INC.
FORM 990, PART VI, SECTION B, LINE 6	OLATHE HEALTH SYSTEM, INC., A NOT-FOR-PROFIT, 501(C)(3) ORGANIZATION, IS THE SOLE MEMBER OF MIAMI COUNTY MEDICAL CENTER, INC.
FORM 990, PART VI, SECTION B, LINE 7A	OLATHE HEALTH SYSTEM, INC. IS THE SOLE MEMBER OF MIAMI COUNTY MEDICAL CENTER, INC. AND HAS THE RIGHT TO ELECT ALL THE BOARD OF DIRECTORS.
FORM 990, PART VI, SECTION A, LINE 7B	OLATHE HEALTH SYSTEM, INC. IS THE SOLE MEMBER, AND HAS THE RIGHTS TO APPROVE MIAMI COUNTY MEDICAL CENTER, INC.'S BYLAWS AND ARTICLES OF INCORPORATION AND ALSO APPROVE MIAMI COUNTY MEDICAL CENTER'S BOARD MEMBERS AND HAVE AUTHORITY OVER CERTAIN TRANSACTIONS.
FORM 990, PART VI, SECTION B, LINE 11B	AN INDEPENDENT ACCOUNTING FIRM PREPARES AND REVIEWS THE 990. THE 990 IS THEN REVIEWED BY THE ORGANIZATION'S MANAGEMENT PERSONNEL. ANY QUESTIONS AND CONCERNS MANAGEMENT HAS ARE ADDRESSED AND ANY CORRECTIONS OR CLARIFICATIONS ARE MADE. THE UNIVERSITY OF KANSAS HEALTH SYSTEM BECAME THE SOLE MEMBER OF OLATHE HEALTH SYSTEM, INC. AND ALL OF ITS ENTITIES, INCLUDING MIAMI COUNTY MEDICAL CENTER, INC., ON JANUARY 1, 2023. THE PARENT COMPANY, OLATHE HEALTH SYSTEM, INC. WAS DISSOLVED IN JUNE 2023. THE BOARD AND ITS AUDIT AND COMPLIANCE COMMITTEE USED TO REVIEW AND APPROVE THE FORM 990 PRIOR TO SUBMISSION TO THE IRS. THE 2022 FORM 990 WILL BE REVIEWED AND APPROVED BY THE UNIVERSITY OF KANSAS HEALTH SYSTEM BOARD OF DIRECTORS PRIOR TO SUBMISSION TO THE IRS.
FORM 990, PART VI, SECTION B, LINE 12C	THE PURPOSE OF THE ORGANIZATION'S CONFLICT OF INTEREST POLICY IS TO PROTECT THE ORGANIZATION'S INTEREST WHEN IT IS CONTEMPLATING A DECISION OR ENTERING INTO A TRANSACTION OR ARRANGEMENT THAT MIGHT BENEFIT THE PRIVATE INTEREST OF ANY PERSON IN A POSITION OF AUTHORITY OVER THE ORGANIZATION, OR MIGHT RESULT IN A POSSIBLE EXCESS BENEFIT TRANSACTION. CORPORATE OFFICERS AND MEMBERS OF THE BOARD OF DIRECTORS REVIEW THE CONFLICT OF INTEREST POLICY AND COMPLETE A DISCLOSURE OF INFORMATION FORM ANNUALLY. A SUMMARY OF THE ANNUAL DISCLOSURES OF INFORMATION IS PROVIDED TO THE FULL BOARD FOR REVIEW AT LEAST ONE TIME PER YEAR. THE CONFLICT OF INTEREST POLICY CALLS FOR ANY INTERESTED PERSON TO DISCLOSE THE EXISTENCE OF A FINANCIAL RELATIONSHIP OR COMPETITIVE INTEREST IN CONNECTION WITH ANY PENDING TRANSACTION OR ARRANGEMENT. THE INDIVIDUAL IS GIVEN THE OPPORTUNITY TO DISCLOSE ALL MATERIAL FACTS TO THE DIRECTORS CONSIDERING THE PROPOSED TRANSACTION OR ARRANGEMENT THAT GAVE RISE TO THE DISCLOSURE. WHEN A TRANSACTION INVOLVES AN INTERESTED PARTY, THE FOLLOWING PROCEDURES ARE FOLLOWED: 1. THE INTERESTED PARTY LEAVES THE MEETING AFTER PROVIDING ANY MATERIAL FACTS OR DISCUSSION REGARDING THE MATTER THAT GIVES RISE TO THE INTEREST UNLESS REQUESTED TO STAY BY THE REMAINING BOARD OR COMMITTEE MEMBERS. 2. IF APPROPRIATE, THE BOARD MAY APPOINT A NON-INTERESTED PERSON OR COMMITTEE TO INVESTIGATE ALTERNATIVES TO THE PROPOSED TRANSACTION. 3. THE INTERESTED DIRECTORS MAY NOT VOTE ON THE MATTER THAT GIVES RISE TO THE INTEREST. 4. IN ORDER TO APPROVE THE TRANSACTION, THE BOARD MUST FIRST FIND, BY A MAJORITY VOTE OF THE DIRECTORS THEN IN OFFICE, WITHOUT COUNTING THE VOTE OF THE INTERESTED DIRECTORS, a. THAT THE PROPOSED TRANSACTION IS IN THE ORGANIZATION'S BEST INTERESTS AND FOR ITS OWN BENEFIT, AND b. THAT, AFTER REASONABLE INVESTIGATION, THE BOARD HAS DETERMINED THAT THE ORGANIZATION CANNOT OBTAIN A MORE ADVANTAGEOUS TRANSACTION WITH EFFORTS UNDER THE CIRCUMSTANCES.
FORM 990, PART VI, SECTION B, LINE 15A & 15B	ANNUALLY, THE PERSONNEL AND COMPENSATION COMMITTEE OF THE OLATHE HEALTH SYSTEM, INC. BOARD, WHICH IS COMPRISED OF INDEPENDENT MEMBERS OF THE BOARD OF OLATHE HEALTH SYSTEM, INC., REVIEWS AND APPROVES THE CEO AND OTHER OFFICERS AND KEY EMPLOYEES OF THE CORPORATION'S COMPENSATION IN ACCORDANCE WITH THEIR COMPENSATION POLICY. THE COMPENSATION COMMITTEE REVIEWS THIRD PARTY SALARY SURVEYS AND ALSO UTILIZES WRITTEN CONTRACTS FOR THE CEO TO DETERMINE THE FAIR MARKET VALUE OF THE CURRENT COMPENSATION SALARY RANGES AND BENEFITS. COMPENSATION FOR SUCH OFFICERS IS APPROVED BY THE COMMITTEE AND INFORMATION OF THEIR FINDINGS IS AVAILABLE TO ALL BOARD MEMBERS AT THEIR REQUEST.
FORM 990, PART VI, SECTION C, LINE 19	THE ORGANIZATION'S GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY AND FINANCIAL STATEMENT ARE NOT AVAILABLE TO THE PUBLIC.
FORM 990, PART XI, LINE 9	CHANGES IN RESTRICTED ASSETS $ (65,566)
FORM 990, PART XII, LINE 2C & 3B	THE AUDIT AND COMPLIANCE COMMITTEE OF THE BOARD WAS ESTABLISHED AND HAS OVERSIGHT OF THE AUDIT PROCESS, INCLUDING SELECTION OF THE INDEPENDENT ACCOUNTANT. AS OF JANURY 1, 2023, A MEMBER SUBSTITUTION OCCURRED MAKING THE UNIVERSITY OF KANSAS HEALTH SYSTEM (TUKHS) THE SOLE MEMBER OF OLATHE HEALTH SYSTEM, INC. AND ALL OF ITS SUPPORTED ORGANIZATIONS, INCLUDING OLATHE MEDICAL CENTER, INC. TUKHS OPERATES ON A FYE OF 6.30.2023, THEREFORE IT WAS DETERMINED OLATHE HEALTH SYSTEM, INC. WOULD NOT AUDIT THE FINANCIAL REPORTS AS OF 12.31.22 BUT WOULD BE INCLUDED IN THE AUDIT OF TUKHS FINANCIAL REPORTING AUDIT OF 6.30.2023. OLATHE HEALTH SYSTEM, INC. COMPLIED WITH THE SINGLE AUDIT PROVISIONS THROUGH INCLUSION IN TUKHS SINGLE AUDIT TO INCLUDE OHSI CALENDAR YEAR 2022.
FORM 990 PART IX LINE 11G	DESCRIPTION:MEDICAL PROFESSIONAL FEES TOTAL FEES:2372029
FORM 990 PART IX LINE 11G	DESCRIPTION:OUTSIDE SERVICES TOTAL FEES:1688681
FORM 990 PART IX LINE 11G	DESCRIPTION:OTHER FEES FOR SERVICE TOTAL FEES:700850

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

Cat. No. 51056K

Schedule O (Form 990) 2021

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

2021

Open to Public Inspection

Name of the organization

MIAMI COUNTY MEDICAL CENTER INC

Employer identification number

48-1155548

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)OLATHE MEDICAL CENTER INC 20333 W 151ST ST OLATHE,KS66061 48-0577664	HOSPITAL	KS	501(C)(3)	3	OHSI	Yes
(2)OLATHE HEALTH SYSTEM INC 20333 W 151ST ST OLATHE,KS66061 48-0979845	SUPPORT ORG	KS	501(C)(3)	12C	NA		No
(3)OLATHE HEALTH PHYSICIANS INC 20333 W 151ST ST OLATHE,KS66061 48-1088982	CLINICS	KS	501(C)(3)	10	OHSI	Yes
(4)OLATHE HEALTH CHARITABLE FOUNDATION 20333 W 151ST ST OLATHE,KS66061 48-1136010	FUNDRAISING	KS	501(C)(3)	12A	OMCI	Yes

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

Cat. No. 50135Y

Schedule R (Form 990) 2021

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?		(k) Percentage ownership
(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Direct controlling entity	(f) Share of total income	(g) Share of end-of-year assets	Yes	No	(i) Code V-UBI amount in box 20 of Schedule K-1 (Form 1065)	Yes	No	(k) Percentage ownership

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	(h) Percentage ownership	(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	(h) Percentage ownership	Yes	No
(1) OMC DOCTOR'S BLDG CONDO OWNERS ASSOC 20333 W 151ST ST OLATHE,KS66061 48-1244766	REAL ESTATE	KS	OMCI	C CORPORATION	0	0		Yes
(2) OLATHE HEALTH DEVELOPMENT CORPORATION 20333 W 151ST ST OLATHE,KS66061 36-3445097	MEDICAL SERVICES	KS	OHSI	C CORPORATION	0	0		Yes

Schedule R (Form 990) 2021

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) ............................

Yes

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

Yes

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

Yes

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

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

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

(a) Name of related organization	(b) Transaction type (a-s)	(c) Amount involved	(d) Method of determining amount involved
(1) OLATHE MEDICAL CENTER INC	M	303,041	COST
(2) OLATHE MEDICAL CENTER INC	N	250,556	COST
(3) OLATHE MEDICAL CENTER INC	O	1,229,371	COST
(4) OLATHE HEALTH PHYSICIANS INC	O	1,042,309	COST
(5) OLATHE MEDICAL CENTER INC	P	8,061,689	COST
(6) OLATHE HEALTH PHYSICIANS INC	P	119,922	COST
(7) OLATHE MEDICAL CENTER INC	Q	16,241,996	COST
(8) OLATHE HEALTH PHYSICIANS INC	Q	1,091,768	COST
(9) OLATHE HEALTH CHARITABLE FOUNDATION	C	206,300	COST

Schedule R (Form 990) 2021

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?		(k) Percentage ownership
(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	(k) Percentage ownership

Schedule R (Form 990) 2021

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) 2021

Additional Data

Software ID:
Software Version:

1	Briefly describe the organization’s mission or most significant activities: TO HELP PEOPLE THROUGH HEALING, HEALTH, AND HAPPINESS.
2	Check this box
3	Number of voting members of the governing body (Part VI, line 1a) ........	3	5
4	Number of independent voting members of the governing body (Part VI, line 1b) .....	4	5
5	Total number of individuals employed in calendar year 2021 (Part V, line 2a) ......	5	213
6	Total number of volunteers (estimate if necessary) .............	6	25
7a	Total unrelated business revenue from Part VIII, column (C), line 12 ........	7a	5,343
b	Net unrelated business taxable income from Form 990-T, Part I, line 11 .........	7b	0

		Prior Year	Current Year
8	Contributions and grants (Part VIII, line 1h) .........	101,811	410,976
9	Program service revenue (Part VIII, line 2g) .........	32,043,764	31,918,568
10	Investment income (Part VIII, column (A), lines 3, 4, and 7d ) ....	3,014,147	4,920,780
11	Other revenue (Part VIII, column (A), lines 5, 6d, 8c, 9c, 10c, and 11e)	303,550	74,246
12	Total revenue—add lines 8 through 11 (must equal Part VIII, column (A), line 12)	35,463,272	37,324,570
13	Grants and similar amounts paid (Part IX, column (A), lines 1–3 )...	142,972	175,265
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)	17,420,540	18,125,235
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)....	16,297,431	17,539,223
18	Total expenses. Add lines 13–17 (must equal Part IX, column (A), line 25)	33,860,943	35,839,723
19	Revenue less expenses. Subtract line 18 from line 12.......	1,602,329	1,484,847
		Beginning of Current Year	End of Year
20	Total assets (Part X, line 16).............	90,050,134	79,492,613
21	Total liabilities (Part X, line 26).............	14,197,151	12,677,812
22	Net assets or fund balances. Subtract line 21 from line 20.....	75,852,983	66,814,801

Sign Here

	Signature of officer	Date

	Type or print name and title


4a	(Code: ) (Expenses $ 31,679,906 including grants of $ 175,265 ) (Revenue $ 31,918,568 )
	SEE SCHEDULE O

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












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












4d	Other program services (Describe in Schedule O.)
	(Expenses $ including grants of $ ) (Revenue $ )
4e	Total program service expenses31,679,906

1b	Sub-Total................
c	Total from continuation sheets to Part VII, Section A....
d	Total (add lines 1b and 1c)...........	1,724,093	5,692,641	910,360

1a	Federated campaigns..		1a
b	Membership dues..		1b
c	Fundraising events..		1c
d	Related organizations		1d	206,300
e	Government grants (contributions)		1e	204,676

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

g	Noncash contributions included in lines 1a - 1f:$		1g

h Total. Add lines 1a-1f.......		410,976

		Business Code
2a	PATIENT CARE SERVICE REVENUE	621110	31,072,942	31,072,942
b	PROVIDER RELIEF FUNDS	621110	845,626	845,626
c
d
e
f	All other program service revenue.
g	Total. Add lines 2a–2f .....		31,918,568

3 Investment income (including dividends, interest, and othersimilar amounts) ......			1,426,186			1,426,186
4 Income from investment of tax-exempt bond proceeds			0
5 Royalties...........			0
		(ii) Personal	(i) Real
6a	Gross rents		57,534	6a
b	Less: rental expenses		56,527	6b
c	Rental income or (loss)	0	1,007	6c
d	Net rental income or (loss).......			1,007			1,007
		(ii) Other	(i) Securities
7a	Gross amount from sales of assets other than inventory		6,656,746	7a
b	Less: cost or other basis and sales expenses		3,162,152	7b
c	Gain or (loss)		3,494,594	7c
d	Net gain or (loss).........			3,494,594			3,494,594
8a	Gross income from fundraising events (not including $ of contributions reported on line 1c). See Part IV, line 18 ....
			8a	0
b	Less: direct expenses ...		8b	0
c	Net income or (loss) from fundraising events..			0
9a	Gross income from gaming activities. See Part IV, line 19 ...
			9a	0
b	Less: direct expenses ...		9b	0
c	Net income or (loss) from gaming activities..			0
10a	Gross sales of inventory, less returns and allowances ..
			10a	0
b	Less: cost of goods sold ..		10b	0
c	Net income or (loss) from sales of inventory..			0
Business Code			Miscellaneous Revenue
11a	REBATES		900099	474			474
b	CAFETERIA SALES		722514	164			164
c	All Other Misc Revenue		900099	72,601		5,343	67,258
d	All other revenue ....			72,601		5,343	67,258
e	Total. Add lines 11a–11d ......			73,239
12	Total revenue. See instructions.....			37,324,570	31,918,568	5,343	4,989,683

1	Grants and other assistance to domestic organizations and domestic governments. See Part IV, line 21 ....	170,265	170,265
2	Grants and other assistance to domestic individuals. See Part IV, line 22 ...........	5,000	5,000
3	Grants and other assistance to foreign organizations, foreign governments, and foreign individuals. See Part IV, lines 15 and 16. .............	0
4	Benefits paid to or for members .......	0
5	Compensation of current officers, directors, trustees, and key employees ...........	361,582		361,582
6	Compensation not included above, to disqualified persons (as defined under section 4958(f)(1)) and persons described in section 4958(c)(3)(B) .........	105,842	105,842
7	Other salaries and wages........	14,603,043	13,643,636	959,407
8	Pension plan accruals and contributions (include section 401(k) and 403(b) employer contributions) ....	269,672	229,648	40,024
9	Other employee benefits .......	1,858,131	1,409,725	448,406
10	Payroll taxes ...........	926,965	813,914	113,051
11	Fees for services (non-employees):
a	Management ......	690,875		690,875
b	Legal .........	44,620		44,620
c	Accounting ...........	28,569		28,569
d	Lobbying ...........	0
e	Professional fundraising services. See Part IV, line 17	0
f	Investment management fees ......	7,337		7,337
g	Other (If line 11g amount exceeds 10% of line 25, column (A) amount, list line 11g expenses on Schedule O)	4,761,560	4,223,931	537,629
12	Advertising and promotion ....	54,087		54,087
13	Office expenses .......	291,870	130,235	161,635
14	Information technology ......	1,100,977	924,121	176,856
15	Royalties ..	0
16	Occupancy ...........	2,326,356	2,117,381	208,975
17	Travel ............	14,743	12,794	1,949
18	Payments of travel or entertainment expenses for any federal, state, or local public officials .	0
19	Conferences, conventions, and meetings ....	0
20	Interest ...........	0
21	Payments to affiliates .......	0
22	Depreciation, depletion, and amortization ..	1,516,624	1,307,707	208,917
23	Insurance ...	213,505	138,120	75,385
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	Bad Debt Expense	3,081,212	3,081,212
b	Medical Supplies	3,187,290	3,187,290
c	Repairs & Maintenance	74,059	74,059
d	Medicaid Assessment	98,767	98,767
e	All other expenses	46,772	6,259	40,513
25	Total functional expenses. Add lines 1 through 24e	35,839,723	31,679,906	4,159,817	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 ........			11,812	1	12,287
2	Savings and temporary cash investments .........			1,699,905	2	1,987,052
3	Pledges and grants receivable, net ......			0	3	0
4	Accounts receivable, net .............			4,420,306	4	3,143,216
5	Loans and other receivables from any current or former officer, director, trustee, key employee, creator or founder, substantial contributor, or 35% controlled entity or family member of any of these persons .......
				0	5	0
6	Loans and other receivables from other disqualified persons (as defined under section 4958(f)(1)), and persons described in section 4958(c)(3)(B) ...
				0	6	0
7	Notes and loans receivable, net ...........			0	7	0
8	Inventories for sale or use ............			830,529	8	901,897
9	Prepaid expenses and deferred charges ......			153,954	9	105,494
10a	Land, buildings, and equipment: cost or other basis. Complete Part VI of Schedule D	10a	40,208,970
b	Less: accumulated depreciation	10b	27,395,840	13,573,228	10c	12,813,130
11	Investments—publicly traded securities .			45,844,083	11	39,744,772
12	Investments—other securities. See Part IV, line 11 .....			11,380,752	12	9,757,825
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 ...........			12,135,565	15	11,026,940
16	Total assets. Add lines 1 through 15 (must equal line 33)...			90,050,134	16	79,492,613

17	Accounts payable and accrued expenses .....	2,542,467	17	2,149,874
18	Grants payable ...	0	18	0
19	Deferred revenue .........	1,050,302	19	0
20	Tax-exempt bond liabilities .........	0	20	0
21	Escrow or custodial account liability. Complete Part IV of Schedule D	0	21	0
22	Loans and other payables to any current or former officer, director, trustee, key employee, creator or founder, substantial contributor, or 35% controlled entity or family member of any of these persons .........
		0	22	0
23	Secured mortgages and notes payable to unrelated third parties ..	0	23	0
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	10,604,382	25	10,527,938
26	Total liabilities. Add lines 17 through 25..	14,197,151	26	12,677,812

	Organizations that follow FASB ASC 958, check here and complete lines 27, 28, 32, and 33.
27	Net assets without donor restrictions ..........	75,787,417	27	66,814,801
28	Net assets with donor restrictions ...........	65,566	28	0
	Organizations that do not follow FASB ASC 958, check here and complete lines 29 through 33.
29	Capital stock or trust principal, or current funds .....		29
30	Paid-in or capital surplus, or land, building or equipment fund ...		30
31	Retained earnings, endowment, accumulated income, or other funds		31
32	Total net assets or fund balances ...........	75,852,983	32	66,814,801
33	Total liabilities and net assets/fund balances ........	90,050,134	33	79,492,613