2025-05-12T10:15:42+00:00 2024-06-30 420714325 RSM US LLP 4650 East 53rd Street Davenport IA 52807 990 2023-07-01 440580870 Northwest Medical Center Association Inc NORT 8162717070 5325 Faraon Street St Joseph MO 64506 Drew Keesbury Officer 8162717070 2025-05-12 true true Jenifer L Chase P01306883 5638884000 2025-05-12 2023 2025-03-06 01:10:19Z Mosaic Medical Center - Albany Drew Keesbury 5325 Faraon Street St Joseph MO 64506 28364842 false X https://www.mymlc.com/Main/Location/albany-mo/mosaic-medical-center-albany/ X 1955 MO NORTHWEST MEDICAL CENTER ASSOCIATION, INC. SERVES AS A COMPASSIONATE, EFFICIENT HEALTH HOME THAT ENCOURAGES WELLNESS, RESTORES HEALTH, AND PROMOTES A SUPERIOR QUALITY OF LIFE. 5 2 167 17 2708 2708 1139977 738322 21223973 27361728 198908 79180 777276 178712 23340134 28357942 7620 5099 0 12860582 13670317 0 0 12845034 12193579 25713236 25868995 -2373102 2488947 19905412 21267347 12908694 11179085 6996718 10088262 WITH THE HELP OF TRUSTED, INTEGRATED PARTNERS, NORTHWEST MEDICAL CENTER ASSOCIATION, INC. SERVES AS A COMPASSIONATE, EFFICIENT HEALTH HOME THAT ENCOURAGES WELLNESS, RESTORES HEALTH AND PROMOTES A SUPERIOR QUALITY OF LIFE. false false 21457781 5099 27537732 Northwest Medical Center Association (Mosaic-Albany) is a critical access hospital located in Albany, Missouri, and operates clinics in Albany, Grant City, New Hampton, and Stanberry. Its primary service area is predominantly rural and includes Gentry and Worth counties located in northwest Missouri. According to the 2023 U.S. census estimates, the population in the two-county service area is approximately 8,194, which includes a high percentage of low-income families. The economy of the region is based on agriculture, minor manufacturing and small businesses resulting in a payor mix for Mosaic-Albany approximately 74.53% governmental or self-pay patients. 13.95% of the population have an income that is below the federal poverty level. Mosaic-Albany offers both inpatient and outpatient services including emergency care, plus convenient clinics, and specialty care services. During the year, approximately 408 patients were admitted to the hospital resulting in approximately 1,836 patient days. The emergency room served approximately 2,540 patients and approximately 17,316 clinic visits were generated. We seek to improve the health of area individuals and communities. The Organization is a member of the Mayo Network for clinical consultations. 21457781 true true false true false false false false true true false false true true true false true false false false false false false false false true true false false true false false false false false false false false false false false false false true true true false false true 21 0 true 167 true false false false false false true true false false false false false X 5 2 true false false false true true true true true false false true true true true true true false false false X Drew Keesbury 8162717070 5325 Faraon Street St Joseph MO 64506 John M Poore Director/CEO 1.0 37.0 X X 0 1136919 39911 Davin Turner DO Director 1.0 37.0 X 0 645499 43162 Gene A Claycomb Director 1.0 38.0 X 0 418503 44902 Matt Baker Director/Vice Chair 1.0 3.0 X 0 2500 0 Serena Naylor Director/Chair 1.0 4.0 X 0 2500 0 Drew Keesbury CFO/Treasurer 1.0 36.0 X 0 459172 17432 Katie Dias DO President - Mosaic Life Care Albany 39.0 1.0 X 295975 0 23654 Michael R Rinard Secretary 1.0 36.0 X 0 281508 44915 Angelia Martin MD Staff Physician 37.0 3.0 X 273421 2500 37656 Callie Hunter APRN - Albany 40.0 0 X 116312 0 22426 James Bartley DO Staff Physician 40.0 0 X 315154 0 41775 Lori L Bishop Director - Nursing Services - Albany 40.0 0 X 121513 0 22389 Stacey Karns Physician Assistant 40.0 0 X 125941 0 5454 Mark Laney MD Former Director/CEO 0.0 0.0 X 0 1061154 0 Michael Pulido Former Secretary/Chair 0.0 0.0 X 0 590338 20738 Thomas Bieterman Former Director/CFO 0.0 0.0 X 0 185860 12817 1248316 4786453 377231 14 true true false Missouri Network Alliance LLC 4215 Philips Farm Rd Ste 103 Columbia MO 65201 Telecommunications services 105786 Have a Nice Day Anesthesia LLC 2106 Woodcrest Drive Chillicothe MO 64601 Medical Services 104912 2 323782 269309 145231 9392 738322 Net Patient Service Revenue 621110 26373931 26373931 340B Pharmacy Revenue 621110 987797 987797 0 0 0 0 27361728 86080 86080 1200 1200 0 1200 1200 0 6900 0 -6900 -6900 -6900 Cafeteria 722514 89196 89196 Other Misc Revenue 900099 84752 84752 Referral Lab Revenue 621511 3564 856 2708 0 0 0 0 177512 28357942 27537732 2708 79180 5099 5099 405141 138617 266524 0 10469497 10163761 305736 272156 264886 7270 1791018 1641188 149830 732505 694295 38210 8375 8375 1093885 1018612 75273 0 605 355 250 1222291 1191130 31161 405522 388938 16584 354236 320051 34185 39666 36004 3662 7244 3703 3541 136019 6517 129502 1688118 1125194 562924 285030 285030 Corporate Allocations From Mosaic Health System 3923391 1177017 2746374 Medical Supplies/Includes 340B 2212034 2212034 FRA Tax 718824 718824 Dues & Subscriptions 98339 66526 31813 0 0 0 0 25868995 21457781 4411214 0 10691 12940 3592142 3435588 0 0 0 0 155020 316594 271516 220910 17254179 6859285 10816263 10394894 4487443 5091474 0 0 119689 239746 452648 1555201 19905412 21267347 5614580 4607906 0 0 7294114 6571179 12908694 11179085 X 6487040 9111735 509678 976527 6996718 10088262 19905412 21267347 2488947 602597 0 X false true X true false X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED false false false false false false false false true 8375 8375 false Schedule C, Part II-B, Line 1 DETAILED DESCRIPTION OF THE LOBBYING ACTIVITY PORTION OF DUES PAID TO HOSPITAL ASSOCIATIONS THAT ARE USED FOR LOBBYING PURPOSES BY THE HOSPITAL ASSOCIATIONS. 32.40% of the membership dues paid to the Missouri Hospital Association are used for lobbying activities. 32.00% of the membership dues paid to the American Hospital Association are used for lobbying activities. 104688 28077 132765 104688 20306 20306 104688 132765 -28077 104688 132765 56522 56522 132765 132765 7096 7096 132765 0.0 1.0 0.0 false false 10858055 2917673 7940382 980795 471270 509525 4928168 3333935 1594233 487161 136407 350754 10394894 Due From Mosaic Health System 1072548 Medicaid Receivable 429653 LT Prepaid 53000 1555201 Due to Northwest Medical Center Foundation 6406304 Other Long Term Liabilities 164875 Due to Mosaic Health System 0 Checks in Excess of Cash 6571179 X Schedule D, Part V, Line 4 Intended uses of endowment funds The earnings from the endowment fund can be used for any and all expenses needed to support the Northwest Medical Center Association, Inc (Mosaic-Albany). Schedule D, Part X, Line 2 FIN 48 (ASC 740) footnote MOSAIC HEALTH SYSTEM, HEARTLAND REGIONAL MEDICAL CENTER (MOSAIC-ST. JOSEPH), MOSAIC MEDICAL CENTER-MARYVILLE (MOSAIC-MARYVILLE), NORTHWEST MEDICAL CENTER ASSOCIATION, INC. (MOSAIC-ALBANY), HEARTLAND LONG-TERM ACUTE CARE HOSPITAL (HLTACH), MOSAIC LIFE CARE FOUNDATION, AND NORTHWEST MEDICAL CENTER FOUNDATION (ALBANY FOUNDATION) ARE NONPROFIT CORPORATIONS DESCRIBED IN SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE AND ARE EXEMPT FROM FEDERAL INCOME TAXES ON RELATED INCOME PURSUANT TO SECTION 501(A) OF THE INTERNAL REVENUE CODE. HOWEVER, THEY ARE SUBJECT TO FEDERAL INCOME TAX ON ANY UNRELATED BUSINESS TAXABLE INCOME. MIDWESTERN AND HHS PROPERTIES, INC. ARE SUBJECT TO INCOME TAXATION. WITH A FEW EXCEPTIONS, Mosaic's tax returns are generally subject to U.S. federal examinations by tax authorities for a period up to three years from the extended due date of return. AT JUNE 30, 2024, NET OPERATING LOSS CARRYFORWARDS GENERATED IN FISCAL YEARS ENDING JUNE 30, 2018 AND PRIOR ARE AVAILABLE TO OFFSET FUTURE TAXABLE INCOME FOR THESE ENTITIES AGGREGATED APPROXIMATELY $7.2M AND EXPIRE THROUGH 2038. FOR NET OPERATING LOSS CARRYFORWARDS GENERATED IN FISCAL YEAR-ENDED JUNE 30, 2019 AND FORWARD WILL BE AVAILABLE TO OFFSET FUTURE TAXABLE INCOME FOR THESE ENTITIES IN THE AMOUNT OF $1.8M AND ARE CARRIED FORWARD INDEFINITELY. SEPARATE RETURN LIMITATION RESTRICTIONS APPLY TO A PORTION OF THESE NET OPERATING LOSS CARRYFORWARDS. TAX POSITIONS ARE NOT OFFSET OR AGGREGATED WITH OTHER POSITIONS. TAX POSITIONS THAT MEET THE MORE-LIKELY-THAN-NOT RECOGNITION THRESHOLD ARE MEASURED AS THE LARGEST AMOUNT OF TAX BENEFIT THAT IS MORE THAN 50% LIKELY TO BE REALIZED ON SETTLEMENT WITH THE APPLICABLE TAXING AUTHORITY. THE PORTION OF THE BENEFITS ASSOCIATED WITH TAX POSITIONS TAKEN THAT EXCEEDS THE AMOUNT MEASURED AS DESCRIBED ABOVE IS REFLECTED AS A LIABILITY FOR UNCERTAIN TAX BENEFITS IN THE ACCOMPANYING BALANCE SHEET ALONG WITH ANY ASSOCIATED INTEREST AND PENALTIES THAT WOULD BE PAYABLE TO THE TAXING AUTHORITIES UPON EXAMINATION. AS OF JUNE 30, 2024 AND 2023, THERE WERE NO UNCERTAIN TAX POSITIONS IDENTIFIED AND RECORDED AS A LIABILITY. true true X true X true X true true false false 847164 847164 0.0328 3674945 3468458 206487 0.0080 0 0.0 0 0 4522109 3468458 1053651 0.0407 82336 82336 0.0032 0 0.0 0 0.0 0 0.0 6040 6040 0.0002 0 0 88376 0 88376 0.0034 0 0 4610485 3468458 1142027 0.0442 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0 0 0 0 0.0 false 453883 0 8260291 9618420 -1358129 X true true 1 1 Northwest Medical Center (Mosaic-Albany) 705 North College Street Albany MO 64402 www.mymlc.com/MAIN/LOCATION/ALBANY-MO/mosaic-medical-center-albany/ 98-65 X X X X Northwest Medical Center (Mosaic-Albany) 1 false false true X X X X X X X X X 21 true false false true X https://www.mymlc.com/General/Community-Health-Needs-Assessment/albany-community-health-needs-assess X true 21 true https://www.mymlc.com/General/Community-Health-Needs-Assessment/albany-community-health-needs-assess false true X 200.0 300.0 X true true X X X X true X SEE SCHEDULE O X SEE SCHEDULE O X SEE SCHEDULE O X X X X X X true X false X X X X X true X false false Schedule H, Part V, Section B, Line 3E The significant health needs of the community are a prioritized description of various factors including: - Mental Health; - Poverty; AND - Obesity These significant health needs are identified through The Community Health Needs Assessment (CHNA). Schedule H, Part V, Section B, Line 5 Facility , 1 Facility , 1 - Northwest Medical Center Association (Mosaic-Albany). Northwest Medical Center Association (Mosaic-Albany) conducted a Community Health Needs Assessment (CHNA) during tax year 2021 TO DETERMINE SERVICES NEEDED BY THE MEDICALLY UNDERSERVED, LOW INCOME OR MINORITY POPULATIONS. TO ENSURE INPUT WAS TAKEN INTO ACCOUNT FROM PERSONS WHO REPRESENT THE COMMUNITY, Mosaic-Albany UTILIZED AN INDEPENDENT CONSULTING FIRM NAMED CROWE, LLP. THIS FIRM CONDUCTED the key stakeholder interviews. THE FOLLOWING THREE NEEDS WERE CHOSEN TO BE addressed over the next three years. - MENTAL HEALTH - POVERTY - OBESITY Key Stakeholder Interviews: Community input was obtained through one-on-one key stakeholder interviews that were performed with community leaders from eight community organizations/agencies representing public health, senior living facilities, social service organizations and government agencies. To assure the medically underserved were represented in this CHNA, interviews were conducted with representatives from the following organizations: Albany Chamber of Commerce, City of Albany, Missouri, City of Grant City, Missouri, Grand River Regional Ambulance District, Northwest Medical Center, Northwest Medical Center Foundation, Pine View Manor Skilled Nursing and Assisted Living and Tri County Health Department. The key stakeholder Interviews were conducted between November 4th and 5th of 2021. To ensure consistency in the topics covered a semi-structured interview guide was used. All interviews were conducted by Crowe, LLP. Feedback was gathered on pressing health care concerns, access challenges and identification of populations with serious unmet health care needs. Approaches to improve the community's health were also solicited to ensure community benefit programs and resources are focused on significant health needs as perceived by the community at large. This alignment Mosaic-Albany's mission, services and strategic priorities. Schedule H, Part V, Section B, Line 11 Facility , 1 Facility , 1 - Northwest Medical Center Association (Mosaic-Albany). THE COMMUNITY HEALTH NEEDS ASSESSMENT WAS CONDUCTED AND AN IMPLEMENTATION PLAN FOR ADDRESSING THE IDENTIFIED NEEDS WAS ADOPTED IN THE 2021 TAX YEAR. THE THREE PRIMARY HEALTH ISSUES IDENTIFIED WERE: 1) Mental Health; 2) Poverty; AND 3) Obesity TO ADDRESS THE TOP THREE NEEDS IDENTIFIED BY THE COMMUNITY HEALTH NEEDS ASSESSMENT, Northwest Medical Center Association (Mosaic-Albany) ADOPTED THE FOLLOWING ACTION PLAN FOR TAX YEARS 2022, 2023, AND 2024. SIGNIFICANT NEED #1 Mental Health: A) Working to get more mental health providers hired to meet the needs of the region, since there is a significant shortage of providers available to serve this population. B) Collaborate with the Northwest Missouri Cooperative Mental Health Board. C) Expand telehealth visits in the Emergency Department to provide mental health services. D) Work with local schools to have school assemblies and programs to promote mental health, healthy living and healthy family relationships. KEY PARTNERS: - TRI-COUNTY HEALTH DEPARTMENT - MOSAIC LIFE CARE (ST. JOSEPH, MO) - AREA SCHOOLS (ALBANY, WORTH COUNTY, STANBERRY, KING CITY, JEFFERSON) - Northwest Missouri Cooperative Mental Health Board SIGNIFICANT NEED #2 Poverty: A) Provide financial counselors to assist the public in understanding and navigating their coverage options, applying for Medicare or Medicaid if applicable. B) Provide elder fraud education. KEY PARTNERS: - TRI-COUNTY HEALTH DEPARTMENT - BTC Bank SIGNIFICANT NEED #3 Obesity: A) WELLNESS FAIRS/EDUCATION EVENTS FOR PATIENTS WITH DIABETES AND OTHER CHRONIC CONDITIONS. B) HOST ON-SITE WELLNESS PROGRAM IN OUR ON-SITE HOSPITAL FITNESS GYM IN ADDITION TO CARDIOPULMONARY REHAB SERVICES. C) Walk with a Doc with didactic health education session. KEY HEALTH PARTNERS: - MOSAIC LIFE CARE (ST. JOSEPH, MO) - City of Albany THE COMPLETE CHNA WITH IMPLEMENTATION STRATEGY CAN BE FOUND AT: https://www.mymlc.com/General/Community-Health-Needs-Assessment/albany-community-health-needs-assessment/ Schedule H, Part V, Section B, Line 20 Facility , 1 Facility , 1 - Northwest Medical Center Association (Mosaic-Albany). FINANCIAL COUNSELORS ARE AVAILABLE ONSITE TO EXPLAIN AND HELP PATIENTS AND RESPONSIBLE PARTIES WITH THE FINANCIAL ASSISTANCE POLICY. SEE FINANCIAL ASSISTANCE POLICY FOR COMPLETE DESCRIPTION OF EFFORTS MADE BEFORE INITIATING COLLECTION ACTIONS. 4 Mosaic Family Care-Albany East 1607 East HWY 136 Albany MO 64402 Family Care Mosaic Family Care- Grant City 307 East 2nd Street Grant City MO 64456 Family Care Mosaic Family Care-Stanberry 202 East Main Street Stanberry MO 64489 Family Care Mosaic Family Care- New Hampton 304 Lincoln Way New Hampton MO 64471 Family Care Schedule H, Part I, Line 3c In FY2024, Northwest Medical Center Association (Mosaic-Albany) modified the Financial Assistance Policy (FAP) eligibility criteria to include an asset test. Includable assets, which are assets identified in the FAP, are combined with gross household income and compared to the Federal Poverty Guidelines threshold previously established by Mosaic-Albany for free or discounted care. Schedule H, Part I, Line 6a Not Applicable Schedule H, Part I, Line 7 Column F NO BAD DEBT EXPENSE IS REPORTED ON FORM 990, PART IX, LINE 25, AS IT IS REPORTED ON FORM 990, PART VIII, LINE 2A IN NET PATIENT SERVICE REVENUE. Schedule H, Part I, Line 7b DURING THE YEAR-ENDED 06/30/2024, NORTHWEST MEDICAL CENTER ASSOCIATION (MOSAIC-ALBANY) reduced the estimated FEDERAL REIMBURSEMENT ALLOWANCE program liability related to prior program years by approximately $441,000 thereby increasing patient service revenue by the same amount. This change in estimate was the result of the state of Missouri providing NORTHWEST MEDICAL CENTER ASSOCIATION (MOSAIC-ALBANY) final settlement notifications during the year ended June 30, 2023. Due to the subjectivity involved in making these estimates due to the lack of historical precedence with respect to how the state administers the program, there is at least a reasonable possibility that recorded estimates will change by a material amount in the near term. Schedule H, Part VI, Line 7 NOT APPLICABLE Schedule H, Part I, Line 7 Costing Methodology used to calculate financial assistance THE COSTING METHODOLOGY USED TO CALCULATE THE AMOUNTS REPORTED IN THE TABLE WAS THE COST TO CHARGE RATIO DERIVED FROM WORKSHEET 2. Schedule H, Part II Community Building Activities NOT APPLICABLE Schedule H, Part III, Line 2 Bad debt expense - methodology used to estimate amount Northwest Medical Center Association (Mosaic-Albany), calculates bad debt expense at the established rate as reported in patient service revenue in the audited financial statements. Discounts provided by third-party payors on patient accounts are written off as contractual allowances. Payments received on an account previously written off to bad debt expense are credited to a bad debt recovery account. Schedule H, Part III, Line 3 Bad Debt Expense Methodology NORTHWEST MEDICAL CENTER ASSOCIATION (MOSAIC-ALBANY) uses a third party to electronically review a patient's or the guarantor's information to assess financial need. This review utilizes a healthcare industry-recognized, predictive model that is based on public record databases and does not access the patient's or guarantor's credit file. The model's rule set is designed to assess each patient based upon the same standards and is calibrated against historical Financial Assistance approvals by Mosaic-Albany. This enables Mosaic-Albany to assess whether a patient is characteristic of other patients who have historically qualified for Financial Assistance under the traditional application process. When the model is utilized, it will be deployed prior to bad debt assignment or after all other eligibility and payment sources have been exhausted. This allows Mosaic-Albany to screen all patients for Financial Assistance prior to pursuing any extraordinary collection actions. As a result, Mosaic-Albany reported zero dollars for the estimated amount of the organization's bad debt expense attributable to patients eligible under the organization's FINANCIAL ASSISTANCE POLICY. Schedule H, Part III, Line 4 Bad debt expense - financial statement footnote Please see THE ACCOUNTS RECEIVABLE FOOTNOTE ON PAGE 11 and the Patient Service revenue Footnote regarding implicit price concessions on page 18 OF The ATTACHED AUDITED FINANCIAL STATEMENTS. SEE ALSO THE PARAGRAPH IN THE CHARITY CARE FOOTNOTE ON PAGE 19. Schedule H, Part III, Line 8 Community benefit & methodology for determining medicare costs THE MEDICARE ALLOWABLE COSTS WERE CALCULATED USING A COST TO CHARGE RATIO DIRECTLY FROM THE MEDICARE COST REPORT WHICH RESULTS IN A SHORTFALL OF COVERING THE NORTHWEST MEDICAL CENTER ASSOCIATION'S COST OF TREATING MEDICARE PATIENTS. THIS SHORTFALL, IN ADDITION TO NON-PAYMENT BY MEDICARE RECIPIENTS FOR THEIR DEDUCTIBLE AND COINSURANCE AMOUNT INCREASES FINANCIAL ASSISTANCE AND BAD DEBT. Northwest Medical Center Association (Mosaic-Albany) PROVIDES SERVICES TO ALL MEDICARE PATIENTS WITH THE KNOWLEDGE THAT THE COST OF PROVIDING CARE TO THEM MAY EXCEED THE REIMBURSEMENT FROM MEDICARE FOR THE SERVICES PROVIDED. THE SHORTFALL OF COSTS, FINANCIAL ASSISTANCE AND BAD DEBT IS CONSIDERED TO BE A COMMUNITY BENEFIT BECAUSE THE Mosaic-Albany IS ABSORBING THE ADDITIONAL COST OF PROVIDING CARE TO THE ELDERLY AND DISABLED IN THE COMMUNITY. NORTHWEST MEDICAL CENTER ASSOCIATION'S net community benefit expense (Schedule H, Part I, line 7, column (e)) as a percentage is 4.42%, and the percentage increases to 9.67% if Medicare shortfalls (SCHEDULE H, PART III, SECTION B, LINE 7) are included in net community benefit expense. IN ADDITION, THIS COINCIDES WITH THE IRS REVENUE RULING 69-545, WHICH provides general requirements for tax exemption, along with section 501(c)(3) and 501(r). Schedule H, Part III, Line 9b Collection practices for patients eligible for financial assistance Northwest Medical Center Association (Mosaic-Albany) FINANCIAL ASSISTANCE POLICY CONTAINS THE ACTIONS Mosaic- Albany MAY TAKE IN THE EVENT OF A PATIENT'S NON-PAYMENT, INCLUDING COLLECTION ACTIONS AND REPORTING TO CREDIT AGENCIES. THESE ACTIONS APPLY BROADLY TO Mosaic- Albany PATIENTS, INCLUDING THOSE PATIENTS Mosaic- Albany KNOWS QUALIFY FOR FINANCIAL ASSISTANCE UNDER ITS FINANCIAL ASSISTANCE POLICY (FAP). UNDER Mosaic- Albany FAP, PATIENTS MAY RECEIVE FREE OR DISCOUNTED CARE, DEPENDING ON THEIR FINANCIAL QUALIFICATIONS. FOR FAP-ELIGIBLE PATIENTS WITH BALANCES REMAINING AFTER DISCOUNTS, COLLECTION ACTIONS WILL NOT BE TAKEN WITHIN 120 DAYS OF ISSUING THE FIRST POST-DISCHARGE STATEMENT(S). DURING THIS 120-DAY PERIOD, PATIENTS WILL RECEIVE FOUR WRITTEN STATEMENTS. IF FOR SOME REASON A MONTHLY STATEMENT IS RETURNED AS UNDELIVERABLE, Mosaic- Albany WILL ATTEMPT TO OBTAIN A CORRECT ADDRESS OR REACH THE PATIENT BY TELEPHONE. IF, AFTER 120 DAYS, THE PATIENT HAS NOT REMITTED PAYMENT OR AGREED TO A PAYMENT PLAN WITH Mosaic- Albany, THE PATIENT ACCOUNT WILL BE TURNED OVER TO A THIRD-PARTY COLLECTION AGENCY. Schedule H, Part V, Section B, Line 16a FAP website - Northwest Medical Center (Mosaic-Albany): Line 16a URL: SEE SCHEDULE O; Schedule H, Part V, Section B, Line 16b FAP Application website - Northwest Medical Center (Mosaic-Albany): Line 16b URL: SEE SCHEDULE O; Schedule H, Part V, Section B, Line 16c FAP plain language summary website - Northwest Medical Center (Mosaic-Albany): Line 16c URL: SEE SCHEDULE O; Schedule H, Part VI, Line 2 Needs assessment Northwest Medical Center Association (Mosaic-Albany) HAS A ROBUST APPROACH FOR ASSESSING THE NEEDS OF THE COMMUNITIES IT SERVES. THIS ONGOING COMMITMENT INCLUDES COLLABORATING WITH LOCAL GROUPS, SCHOOL DISTRICTS AND CITY AND COUNTY AGENCIES TO IDENTIFY NEEDS, PROMOTE HEALTHY LIVING, ASSURE THAT AFFORDABLE MEDICAL SERVICES ARE AVAILABLE, DEVELOP STRATEGIES FOR IMPROVING EDUCATION AND ECONOMIC STRENGTH, AND PROVIDING ONGOING SUPPORT. Schedule H, Part VI, Line 3 Patient education of eligibility for assistance Northwest Medical Center Association (Mosaic-Albany) INFORMS AND EDUCATES PATIENTS AND GUARANTORS WHO MAY BE BILLED FOR PATIENT CARE ABOUT THEIR ELIGIBILITY FOR FINANCIAL ASSISTANCE BEGINNING AT THE REGISTRATION DESK AND CONTINUING WITH FINANCIAL ASSISTANCE INFORMATION BEING INCLUDED ON EVERY BILLING STATEMENT A PATIENT OR GUARANTOR RECEIVES FROM MOSAIC-ALBANY. GUIDELINES FOR THE PROGRAM ARE AVAILABLE AT EACH REGISTRATION DESK AND ARE INCLUDED IN ALL ADMISSION PACKETS. PATIENTS ARE CONTACTED IF THE PATIENT IS EXPECTED TO HAVE A FINANCIAL RESPONSIBILITY FOR THE VISIT. A FINANCIAL COUNSELOR ATTEMPTS TO VISIT THE ROOM OF EVERY UNINSURED PATIENT THAT IS ADMITTED TO OUR FACILITY FOR OBSERVATION OR INPATIENT CARE. THE COUNSELOR DISCUSSES PAYMENT OPTIONS WITH THE PATIENT AND CAN ASSIST THEM WITH VARIOUS OPTIONS THAT INCLUDE, BUT ARE NOT LIMITED TO, MEDICAID APPLICATION, HEALTH CARE EXCHANGE ELIGIBILITY AND ELIGIBILITY UNDER THE ORGANIZATION'S FINANCIAL ASSISTANCE POLICY. COUNSELORS ALSO WORK WITH OUR CARE MANAGEMENT STAFF TO SUPPORT THE DISCHARGE PROCESSES SO THAT FINANCIAL HARDSHIP DOES NOT KEEP THE PATIENT FROM RECEIVING THE APPROPRIATE FOLLOW-UP CARE. THIS ASSISTANCE INCLUDES INSTRUCTIONS FOR SCHEDULING AN APPOINTMENT WITH A FINANCIAL COUNSELOR WHO CAN ASSIST THEM IN COMPLETING THE FINANCIAL ASSISTANCE APPLICATION. Schedule H, Part VI, Line 4 Community information Northwest Medical Center Association (Mosaic-Albany) IS A CRITICAL ACCESS HOSPITAL LOCATED IN ALBANY, MISSOURI, AND OPERATES CLINICS IN ALBANY, GRANT CITY, NEW HAMPTON AND STANBERRY. ITS PRIMARY SERVICE AREA IS PRIMARILY RURAL AND INCLUDES GENTRY AND WORTH COUNTIES LOCATED IN NORTHWEST MISSOURI. ACCORDING TO THE 2023 U.S. CENSUS ESTIMATES, THE POPULATION IN THE TWO COUNTY SERVICE AREA IS APPROXIMATELY 8,194, WHICH INCLUDES A HIGH PERCENTAGE OF LOW INCOME FAMILIES. THE ORGANIZATION SUPPORTS A PAYOR MIX OF APPROXIMATELY 74.53% GOVERNMENTAL OR SELF-PAY PATIENTS. Schedule H, Part VI, Line 5 Promotion of community health NORTHWEST MEDICAL CENTER ASSOCIATION (MOSAIC-ALBANY) IS A NONPROFIT CRITICAL ACCESS HOSPITAL OPERATING TO SERVE A PUBLIC RATHER THAN A PRIVATE INTEREST AND MEETING THE REQUIREMENTS OF REVENUE RULING 69-545. CONTROL OF THE MOSAIC-ALBANY RESTS WITH ITS BOARD, WHICH IS PRIMARILY COMPOSED OF MEMBERS OF THE COMMUNITY, IN ADDITION TO A FEW SELECT EMPLOYEES OF MOSAIC-ALBANY. MOSAIC-ALBANY ACCEPTS PATIENTS PAYING WITH MEDICAID AND MEDICARE AND OPERATES AN ACTIVE AND GENERALLY ACCESSIBLE EMERGENCY ROOM OPEN TO ALL PATIENTS WITHOUT REGARD TO ABILITY TO PAY. MOSAIC-ALBANY USES SURPLUS FUNDS TO IMPROVE THE QUALITY OF PATIENT CARE, MAINTAIN AND IMPROVE EQUIPMENT AND FACILITIES, EXTEND SERVICE OFFERINGS TO NEW AREAS AND PROVIDE SUPPORT TO THE COMMUNITIES IT SERVICES. MOSAIC-ALBANY PROMOTES HEALTH IN THE ALBANY REGION IN NUMEROUS WAYS. MOSAIC-ALBANY PROVIDED DIRECT FUNDING SUPPORT TO THE COMMUNITY ORGANIZATIONS WITH LIKE MISSIONS INCLUDING COMMUNITY EVENTS AND ACTIVITIES OF LOCAL SCHOOLS AND NURSING HOMES. MOSAIC-ALBANY extends medical staff privileges to all qualified physicians in its community for some or all of its departments or specialties. THE ORGANIZATION OFFERS MANY EDUCATIONAL PROGRAMS THROUGHOUT THE YEAR TO HELP MAINTAIN A HEALTHY LIFESTYLE. SOME OF THE PROGRAMS PROMOTE HEALTH EDUCATION AND PREVENTATIVE CARE AWARENESS AND RESOURCES TO THE COMMUNITY. THIS INCLUDES PROGRAMS ABOUT BREAST CANCER, PROSTATE CANCER, DIABETES, PARKINSON'S DISEASE, AND STROKE AWARENESS WITHIN THE COMMUNITY. THE PROGRAMS ARE WELL-ADVERTISED AND MOST OF THEM ARE FREE OF CHARGE. ONE PROGRAM THAT MOSAIC-ALBANY PROVIDES TO THE COMMUNITY IS TRANSPORTATION FOR PATIENTS TO THE HOSPITALS AND PRIMARY CARE CLINICS FOR THE EXISTING PATIENTS THROUGHOUT THE REGION. IN ADDITION, THIS TRANSPORTATION HAS BEEN USED FOR OTHER COMMUNITY NEEDS BY TAKING AREA RESIDENTS TO OTHER APPOINTMENTS AT OTHER FACILITIES NOT RELATED TO THE ORGANIZATION. ALSO MOSAIC-ALBANY OPERATES A CARE MANAGEMENT PROGRAM THROUGH WHICH A NURSE VISITS PATIENTS WITH CHRONIC CONDITIONS AND/OR SIGNIFICANT BARRIERS TO HEALTH AND WELLNESS. THE CARE MANAGEMENT NURSE ASSISTS WITH COORDINATION OF CARE, ACCESS TO CARE AND PROPER NUTRITION, AMONG OTHER FACTORS. THE 340B DRUG PRICING PROGRAM ("340B PROGRAM") ENABLES SAFETY NET HEALTHCARE ORGANIZATIONS SERVING UNINSURED, VULNERABLE AND INDIGENT POPULATIONS TO PURCHASE OUTPATIENT PRESCRIPTION DRUGS AT A DISCOUNT. MOSAIC-ALBANY HAS PARTICIPATED IN THIS PROGRAM SINCE 2011. THIS PARTICIPATION HAS GENERATED REVENUE FROM THE CONTRACTED RETAIL PHARMACY RELATIONSHIPS AND HAS REDUCED DRUG PRICING FOR OUTPATIENT MEDICATIONS. THE PROGRAM IS CURRENTLY THREATENED BY LEGISLATIVE CHALLENGES. Schedule H, Part VI, Line 6 Affiliated health care system MOSAIC HEALTH SYSTEM (PARENT) IS A MISSOURI NONPROFIT CORPORATION LOCATED IN ST. JOSEPH, MISSOURI, THAT PROVIDES, THROUGH ITS VARIOUS SUBSIDIARIES AND AFFILIATES, AN INTEGRATED HEALTH CARE DELIVERY SYSTEM, INCLUDING INPATIENT AND OUTPATIENT CARE AND PHYSICIAN SERVICES TO RESIDENTS OF NORTHWEST MISSOURI AND ADJACENT AREAS IN IOWA, KANSAS AND NEBRASKA. AS THE SYSTEM MANAGER, THE PARENT'S MISSION IS TO MANAGE THE EXEMPT PUBLIC CHARITIES IN ITS HEALTH CARE SYSTEM AS A "SUPPORTING ORGANIZATION" WITHIN THE MEANING OF SECTIONS 501(C)(3) AND 509(A)(3) OF THE INTERNAL REVENUE CODE (IRC). THE PARENT HAS OWNERSHIP INTEREST IN THE FOLLOWING RELATED ORGANIZATIONS: HEARTLAND REGIONAL MEDICAL CENTER DBA MOSAIC LIFE CARE (MOSAIC-ST. JOSEPH) IS A MISSOURI NONPROFIT CORPORATION LOCATED IN ST. JOSEPH, MISSOURI, THAT OPERATES A GENERAL MEDICAL AND SURGICAL HOSPITAL WITH 348 LICENSED BEDS AND EMPLOYS BOTH PRIMARY AND SPECIALTY PHYSICIANS. THE PARENT IS THE SOLE CORPORATE MEMBER OF MOSAIC-ST. JOSEPH. MOSAIC MEDICAL CENTER-MARYVILLE (MOSAIC-MARYVILLE) IS A MISSOURI NONPROFIT CORPORATION LOCATED IN MARYVILLE, MISSOURI, THAT OPERATES A GENERAL MEDICAL AND SURGICAL HOSPITAL WITH 81 LICENSED BEDS AND EMPLOYS BOTH PRIMARY AND SPECIALTY PHYSICIANS. THE PARENT IS THE SOLE CORPORATE MEMBER OF MOSAIC-MARYVILLE. OBLIGATED GROUP: THE PARENT, MOSAIC-ST. JOSEPH AND MOSAIC-MARYVILLE ARE MEMBERS OF THE OBLIGATED GROUP, WHICH IS LIABLE FOR CERTAIN LONG-TERM DEBT OUTSTANDING UNDER A MASTER TRUST INDENTURE (SEE NOTE 5). THE PARENT ALSO HAS OWNERSHIP INTEREST IN THE FOLLOWING RELATED ORGANIZATIONS: NORTHWEST MEDICAL CENTER ASSOCIATION, INC. DBA MOSAIC MEDICAL CENTER-ALBANY (MOSAICALBANY) IS A MISSOURI NONPROFIT CORPORATION LOCATED IN ALBANY, MISSOURI, THAT PROVIDES INPATIENT, OUTPATIENT AND EMERGENCY CARE SERVICES AS A CRITICAL ACCESS HOSPITAL WITH 25 LICENSED BEDS. THE PARENT IS THE SOLE CORPORATE MEMBER OF MOSAIC-ALBANY. HEARTLAND LONG-TERM ACUTE CARE HOSPITAL (LTACH) IS A MISSOURI NONPROFIT CORPORATION THAT OPERATES A LONG-TERM ACUTE CARE HOSPITAL WITH 41 LICENSED BEDS IN SPACE LEASED FROM MOSAIC-ST. JOSEPH. THE PARENT IS THE SOLE CORPORATE MEMBER OF LTACH. HEARTLAND FOUNDATION DBA MOSAIC LIFE CARE FOUNDATION IS A MISSOURI NONPROFIT CORPORATION WHOSE MISSION AND PRINCIPAL ACTIVITIES ARE TO EMPOWER CHILDREN AND ADULTS TO BUILD HEALTHIER, MORE LIVABLE COMMUNITIES, PRIMARILY IN NORTHWEST MISSOURI AND NEIGHBORING COUNTIES IN IOWA, KANSAS AND NEBRASKA. THE PARENT IS THE SOLE CORPORATE MEMBER OF MOSAIC LIFE CARE FOUNDATION. NORTHWEST MEDICAL CENTER FOUNDATION (ALBANY FOUNDATION) IS A MISSOURI NONPROFIT CORPORATION OPERATED TO PERFORM THE FUNCTIONS OF, AND/OR TO CARRY OUT THE PURPOSES OF MOSAIC-ALBANY AND OTHER CHARITABLE HEALTH CARE ORGANIZATIONS LOCATED IN MOSAIC-ALBANY'S SERVICE AREA. ALBANY FOUNDATION'S PURPOSES SHALL INCLUDE, BUT NOT BE LIMITED TO, OWNING PROPERTY, FUNDRAISING AND MAKING GRANTS FROM ITS FUNDS FOR THE BENEFIT OF THE MOSAICALBANY AND THE OTHER ORGANIZATIONS IT SUPPORTS. MOSAIC-ALBANY IS THE SOLE CORPORATE MEMBER OF ALBANY FOUNDATION. true true false false false false false false false John M Poore Director/CEO 0 995932 0 135653 0 5334 0 13200 0 26711 0 1176830 0 0 Davin Turner DO Director 0 594549 0 45616 0 5334 0 12413 0 30749 0 688661 0 0 Gene A Claycomb Director 0 376783 0 35458 0 6262 0 10991 0 33911 0 463405 0 0 Mark Laney MD Former Director/CEO 0 0 0 0 0 1061154 0 0 0 0 0 1061154 0 0 Michael Pulido Former Secretary/Chair 0 0 0 0 0 590338 0 0 0 20738 0 611076 0 0 Thomas Bieterman Former Director/CFO 0 185573 0 287 0 0 0 2890 0 9927 0 198677 0 0 Drew Keesbury CFO/Treasurer 0 445072 0 13200 0 900 0 0 0 17432 0 476604 0 0 Katie Dias DO President - Mosaic Life Care Albany 263107 0 32136 0 732 0 4588 0 19066 0 319629 0 0 0 Michael R Rinard Secretary 0 255214 0 24256 0 2038 0 11666 0 33249 0 326423 0 0 James Bartley DO Staff Physician 313246 0 0 0 1908 0 9726 0 32049 0 356929 0 0 0 Angelia Martin MD Staff Physician 268850 2500 2000 0 2571 0 5595 0 32061 0 311077 2500 0 0 Schedule J, Part I, Line 3 Arrangement used to establish the top management official's compensation COMPENSATION IS ESTABLISHED BY MOSAIC HEALTH SYSTEM, a related tax-exempt organization, USING THE FOLLOWING: 1. COMPENSATION COMMITTEE 2. INDEPENDENT COMPENSATION CONSULTANT 3. COMPENSATION SURVEYS OR STUDIES 4. APPROVAL BY THE BOARD OR COMPENSATION COMMITTEE Schedule J, Part I, Line 4a Severance or change-of-control payment Mosaic Health System, a related tax-exempt organization, paid Samuel Mark Laney, CEO, severance payments during calendar year 2023. This is reported on Form 990, Part VII and Schedule J, Part II as other reportable compensation. Mosaic Health System, a related tax-exempt organization, paid Michael Pulido, COO, severance payments during calendar year 2023. This is reported on Form 990, Part VII and Schedule J, Part II as other reportable compensation. Schedule J, Part I, Line 4b Supplemental nonqualified retirement plan JOHN M POORE - VESTED $0; ACCRUED $200,000 GENE A CLAYCOMB - VESTED $0; ACCRUED $54,431 DAVIN TURNER, DO - VESTED $0; ACCRUED $84,000 MICHAEL R RINARD - VESTED $0; ACCRUED $31,360 DREW KEESBURY - VESTED $0; ACCRUED $53,667 KATIE DIAS, DO - VESTED $0; ACCRUED $20,085 THOSE LISTED ABOVE HAVE SIGNED A SUPPLEMENTAL EXECUTIVE RETIREMENT PLAN WHICH RECOGNIZES THE VALUE OF THE INDIVIDUAL AND THE MUTUAL BENEFIT OF CONTINUED EMPLOYMENT FOR AN EXTENDED PERIOD OF TIME BY ESTABLISHING A 457F PLAN. THE FOLLOWING ARE THE GENERAL STIPULATIONS OF THE AGREEMENT: 1. THE PLAN IS FUNDED YEARLY AS THE RESULT OF A CALCULATION DESCRIBED IN THE AGREEMENT, WHICH WILL REWARD THE INDIVIDUAL WITH 100% VESTING BASED ON A 5-YEAR CLIFF VESTING SCHEDULE. 2. FOR SERP PARTICIPANTS PRIOR TO 2019, DISTRIBUTION WILL OCCUR UPON DEATH OR UPON SEPARATION FROM SERVICE DUE TO DISABILITY OR UPON INVOLUNTARY SEPARATION FROM SERVICE WITHOUT CAUSE. THEN A LUMP SUM PAYMENT WILL BE DISBURSED WITHIN 90 DAYS OF EACH SITUATION TAKING INTO CONSIDERATION A NON-COMPETE COVENANT. 3. FOR SERP PARTICIPANTES AFTER 2019, DISTRIBUTION WILL OCCUR UPON DEATH OR UPON SEPARATION FROM SERVICE DUE TO DISABILITY OR UPON INVOLUNTARY SEPARATION FROM SERVICE WITHOUT CAUSE. THEN A LUMP SUM PAYMENT DISTRIBUTES WITHIN 60 DAYS AND DOESN'T TAKE INTO ACCOUNT NON-COMPETE COVENANT. 4. SEPARATION WITH CAUSE MAKES THE SUPPLEMENTAL EXECUTIVE RETIREMENT AGREEMENT NULL AND VOID. Form 990, Part VI, Line 2 FAMILY/BUSINESS RELATIONSHIPS AMONGST INTERESTED PERSONS MICHAEL R RINARD, DREW KEESBURY, AND JOHN M. POORE HAVE A BUSINESS RELATIONSHIP. Form 990, Part VI, Line 6 Classes of members or stockholders MOSAIC HEALTH SYSTEM, a related tax-exempt organization, IS THE SOLE MEMBER OF NORTHWEST MEDICAL CENTER ASSOCIATION, INC (Mosaic-Albany). Form 990, Part VI, Line 7a Members or stockholders electing members of governing body AS THE SOLE MEMBER OF NORTHWEST MEDICAL CENTER ASSOCIATION, INC. (MOSAIC-ALBANY), MOSAIC HEALTH SYSTEM, a related tax-exempt organization, HAS THE RIGHT TO ELECT ALL THE BOARD OF DIRECTORS. Form 990, Part VI, Line 7b Decisions requiring approval by members or stockholders MOSAIC HEALTH SYSTEM, a related tax-exempt organization and THE SOLE MEMBER, SHALL HAVE THE FOLLOWING POWERS: OVERALL STRATEGIC DIRECTION, NUMBER AND ELECTION OF BOARD MEMBERS, APPOINTMENT OF AUDITORS AND LEGAL COUNSEL, ESTABLISHMENT OF BANKING RELATIONSHIPS AND MANAGEMENT OF CASH AND OTHER ASSETS, APPROVAL OF CHANGES TO THE ARTICLES OF INCORPORATION AND BYLAWS, LONG-RANGE PLANNING, ADOPTION OF ANNUAL OPERATING PLANS AND APPLICATION FOR CERTIFICATES OF NEED. Form 990, Part VI, Line 11b Review of form 990 by governing body THE ACCOUNTING STAFF OF THE ORGANIZATION PREPARES THE FORM 990 AND SUBMITS A DRAFT TO AN INDEPENDENT ACCOUNTING FIRM. THE INDEPENDENT ACCOUNTING FIRM REVIEWS THE FORM 990 WITH INFORMATION PROVIDED FROM THE ORGANIZATION'S ACCOUNTING STAFF. THE DRAFT FORM 990 IS REVISED FOR ANY CORRECTIONS OR CLARIFICATIONS BASED ON THE REVIEW BY THE INDEPENDENT ACCOUNTING FIRM. THEN THE FORM 990 IS REVIEWED BY THE ORGANIZATIONS LEADERSHIP FOR ANY QUESTIONS AND CONCERNS. AFTER RESOLVING QUESTIONS AND CONCERNS WITH LEADERSHIP AND THE ACCOUNTING FIRM, THE FINAL FORM 990 WITH ALL REQUIRED SCHEDULES IS THEN PRESENTED TO BOARD FOR APPROVAL. ONCE APPROVED THEN THE 990 TAX RETURN IS ELECTRONICALLY FILED with the Internal Revenue Service. Form 990, Part VI, Line 12c Conflict of interest policy THIS CONFLICTS OF INTEREST AND DOCUMENTATION POLICY ("POLICY") APPLIES TO ALL DIRECTORS AND OFFICERS OF THE ORGANIZATION AND ANY OTHER PERSON WHO IS IN A POSITION TO EXERCISE SUBSTANTIAL INFLUENCE OVER THE DECISIONS AND AFFAIRS OF THE ORGANIZATION (COLLECTIVELY, "COVERED PERSONS"). DUTY TO DISCLOSE IF AN INTERESTED PERSON HAS A POSITION OR FINANCIAL INTEREST IN ANY BUSINESS OR OTHER ENTITY WITH WHICH THE ORGANIZATION IS CONSIDERING ENTERING INTO AN ARRANGEMENT OR TRANSACTION, THE INTERESTED PERSON MUST DISCLOSE THE EXISTENCE OF HIS OR HER POSITION OR FINANCIAL INTEREST AND ALL MATERIAL FACTS RELATED THERETO TO THE ORGANIZATION'S BOARD OF DIRECTORS (THE "BOARD") OR EXECUTIVE COMMITTEE AS SOON AS THE INTERESTED PERSON HAS KNOWLEDGE OF THE POTENTIAL ARRANGEMENT OR TRANSACTION, AND WHENEVER REQUESTED BY THE BOARD OR THE EXECUTIVE COMMITTEE. DETERMINING WHETHER A CONFLICT OF INTEREST EXISTS AFTER DISCLOSURE OF A POSITION OR A FINANCIAL INTEREST BY AN INTERESTED PERSON, AND AFTER ANY DISCUSSION WITH THE INTERESTED PERSON, THE INTERESTED PERSON (INCLUDING THOSE INTERESTED PERSONS WHO ARE MEMBERS OF THE BOARD OR EXECUTIVE COMMITTEE) WILL LEAVE THE BOARD MEETING WHILE THE DETERMINATION OF WHETHER A CONFLICT OF INTEREST EXISTS IN CONNECTION WITH THE PROPOSED TRANSACTION IS DISCUSSED BY THE BOARD OR THE EXECUTIVE COMMITTEE AND VOTED UPON. A POSITION OR A FINANCIAL INTEREST WILL BE CONSIDERED A CONFLICT OF INTEREST ONLY IF THE BOARD OR THE EXECUTIVE COMMITTEE MAKES SUCH DETERMINATION. AN INTERESTED PERSON IS CONSIDERED TO HAVE A CONFLICT OF INTEREST WITH RESPECT TO HIS OR HER COMPENSATION IF THE PERSON RECEIVES COMPENSATION FROM THE ORGANIZATION AND THE PERSON'S COMPENSATION IS BEING DISCUSSED OR REVIEWED BY THE BOARD OR ANY COMMITTEE THEREOF. PROCEDURES FOR ADDRESSING THE CONFLICT OF INTEREST *BEFORE ANY DISCUSSION AND VOTE ON WHETHER A CONFLICT OF INTEREST EXISTS, AN INTERESTED PERSON MAY MAKE A PRESENTATION TO THE BOARD OR THE EXECUTIVE COMMITTEE REGARDING THE INTERESTED PERSON'S POSITION OR FINANCIAL INTEREST. AFTER SUCH PRESENTATION, THE INTERESTED PERSON WILL LEAVE THE MEETING DURING THE DISCUSSION OF, AND THE VOTE ON, THE PROPOSED TRANSACTION. *THE BOARD OR THE EXECUTIVE COMMITTEE WILL UNDERTAKE APPROPRIATE DUE DILIGENCE AND INFORM ITSELF OF ALL MATERIAL INFORMATION REASONABLY AVAILABLE TO IT AND EXPLORE ALL REASONABLE ALTERNATIVES TO THE PROPOSED TRANSACTION THAT WOULD NOT INVOLVE THE CONFLICT OF INTEREST. *IF A MORE ADVANTAGEOUS TRANSACTION OR ARRANGEMENT IS NOT REASONABLY POSSIBLE UNDER CIRCUMSTANCES NOT PRODUCING A CONFLICT OF INTEREST, THE BOARD OR THE EXECUTIVE COMMITTEE WILL DETERMINE BY A MAJORITY VOTE OF THE DISINTERESTED DIRECTORS WHETHER THE PROPOSED TRANSACTION IS (I) IN THE ORGANIZATION'S BEST INTEREST, (II) FOR THE ORGANIZATION'S OWN BENEFIT, AND (III) FAIR AND REASONABLE TO THE ORGANIZATION. IN CONFORMITY WITH THIS DETERMINATION, THE BOARD WILL MAKE ITS DECISION AS TO WHETHER THE ORGANIZATION MAY ENTER INTO THE PROPOSED TRANSACTION. QUORUM FOR BOARD OR EXECUTIVE COMMITTEE ACTION FOR PURPOSES OF THE BOARD OR EXECUTIVE COMMITTEE ACTIONS TO BE TAKEN UNDER THESE PROCEDURES, INCLUDING THE DETERMINATION WHETHER A CONFLICT OF INTEREST EXISTS, A MAJORITY OF THE DISINTERESTED DIRECTORS ON THE BOARD OR THE EXECUTIVE COMMITTEE WILL CONSTITUTE A QUORUM. HOWEVER, IN NO CASE WILL A SINGLE DISINTERESTED DIRECTOR TAKE ANY SUCH ACTION. VIOLATIONS OF THE CONFLICTS OF INTEREST POLICY IF THE BOARD OR THE EXECUTIVE COMMITTEE HAS REASONABLE CAUSE TO BELIEVE THAT A COVERED PERSON HAS FAILED TO DISCLOSE A POSITION OR A FINANCIAL INTEREST, IT WILL INFORM THE COVERED PERSON OF THE BASIS FOR SUCH BELIEF AND AFFORD THE COVERED PERSON AN OPPORTUNITY TO EXPLAIN THE ALLEGED FAILURE TO DISCLOSE. IF, AFTER HEARING THE RESPONSE OF THE COVERED PERSON AND MAKING SUCH FURTHER INVESTIGATION AS MAY BE WARRANTED UNDER THE CIRCUMSTANCES, THE BOARD OR THE EXECUTIVE COMMITTEE DETERMINES THAT THE COVERED PERSON HAS IN FACT FAILED TO DISCLOSE A POSITION OR A FINANCIAL INTEREST, THE BOARD OR THE EXECUTIVE COMMITTEE WILL TAKE APPROPRIATE DISCIPLINARY AND CORRECTIVE ACTION. DOCUMENTATION IN MINUTES THE MINUTES OF THE BOARD OR THE EXECUTIVE COMMITTEE WILL CONTAIN: *WITH RESPECT TO THE DETERMINATION OF WHETHER A CONFLICT OF INTEREST EXISTS, THE NAME OF THE INTERESTED PERSON WHO DISCLOSED OR WAS OTHERWISE FOUND TO HAVE A POSITION OR FINANCIAL INTEREST IN CONNECTION WITH AN ACTUAL OR POTENTIAL CONFLICT OF INTEREST; THE NATURE OF THE POSITION OR FINANCIAL INTEREST; ANY ACTION TAKEN TO DETERMINE WHETHER A CONFLICT OF INTEREST WAS PRESENT; AND THE BOARD OR THE EXECUTIVE COMMITTEE'S DECISION AS TO WHETHER A CONFLICT OF INTEREST IN FACT EXISTED. *WITH RESPECT TO WHETHER OR NOT THE CONFLICT OF INTEREST TRANSACTION IS APPROVED, THE NAMES OF THE PERSONS PRESENT FOR THE DISCUSSIONS AND VOTE RELATED TO THE PROPOSED TRANSACTION; THE CONTENT OF THE DISCUSSION; WHETHER ALTERNATIVES WERE DISCUSSED THAT DID NOT INVOLVE A CONFLICT OF INTEREST; THE BASIS FOR THE DETERMINATION THAT THE PROPOSED TRANSACTION WAS (I) IN THE ORGANIZATION'S BEST INTEREST, (II) FOR THE ORGANIZATION'S OWN BENEFIT, AND (III) FAIR AND REASONABLE TO THE ORGANIZATION; AND THE RECORD OF THE VOTE TAKEN IN CONNECTION WITH THE PROCEEDINGS. ANNUAL STATEMENTS EACH COVERED PERSON WILL ANNUALLY SIGN A STATEMENT THAT AFFIRMS SUCH PERSON: *HAS RECEIVED A COPY OF THIS POLICY; *HAS READ AND UNDERSTANDS THE POLICY; *HAS AGREED TO COMPLY WITH THE POLICY; AND *UNDERSTANDS THE ORGANIZATION IS EXEMPT FROM FEDERAL INCOME TAX AND TO MAINTAIN ITS FEDERAL TAX EXEMPTION THE ORGANIZATION MUST ENGAGE PRIMARILY IN ACTIVITIES THAT ACCOMPLISH ONE OR MORE OF ITS TAX-EXEMPT PURPOSES. IN ADDITION, EACH COVERED PERSON WILL ANNUALLY COMPLETE, SIGN AND PROMPTLY RETURN TO THE BOARD A QUESTIONNAIRE AND DISCLOSURE STATEMENT SUBSTANTIALLY IN THE FORM ATTACHED HERETO. A COVERED PERSON NEED NOT DISCLOSE COMPENSATION PAID TO THE COVERED PERSON BY ORGANIZATION PURSUANT TO A RESOLUTION OF THE BOARD. Form 990, Part VI, Line 19 Required documents available to the public THE ORGANIZATION MAKES ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UPON REQUEST. ALL OF THESE DOCUMENTS ARE LOCATED IN ADMINISTRATION. Schedule H, Part V, Section B, Line 16a FAP Website URL https://www.mymlc.com/Main/Location/st-joseph-mo/mosaic-life-care-at-st.-joseph-medical-center/main-medical-center/medical-bills-made-easy/financial-assistance/ Schedule H, Part V, Section B, Line 16b FAP Application Form https://www.mymlc.com/Main/Location/st-joseph-mo/mosaic-life-care-at-st.-joseph-medical-center/main-medical-center/medical-bills-made-easy/financial-assistance/ Schedule H, Part V, Section B, Line 16c FAP Plain Language Summary https://www.mymlc.com/Main/Location/st-joseph-mo/mosaic-life-care-at-st.-joseph-medical-center/main-medical-center/medical-bills-made-easy/financial-assistance/ Form 990, Part XII, Line 2C Financial Statements and Reporting The results of the consolidated audit are reviewed by the Mosaic Health System Board, a related tax-exempt organization and the sole member of NORTHWEST MEDICAL CENTER ASSOCIATION, INC. FORM 990, PART VI, SECTION B, LINE 15 COMPENSATION IS ESTABLISHED BY MOSAIC HEALTH SYSTEM, A RELATED tax-exempt organization. AN ANNUAL REVIEW WAS PERFORMED DURING THE PRIOR FISCAL YEAR. MARKET DATA WAS PROVIDED BY A THIRD PARTY COMPENSATION CONSULTANT THAT SPECIALIZES IN MARKET SALARY DATA. A COMPENSATION COMMITTEE COMPRISED OF MOSAIC HEALTH SYSTEM BOARD CHAIR, MOSAIC HEALTH SYSTEM BOARD VICE-CHAIR AND THREE ADDITIONAL MOSAIC HEALTH SYSTEM BOARD MEMBERS AND INDEPENDENT LEGAL COUNSEL, AS SCRIBE, OVERSAW AN ANNUAL SALARY REVIEW PROCESS FOR OFFICERS AND Presidents. For each position to be reviewed, the full scope of duties and responsibilities, processes managed, approximate revenue, expense, or capital dollars managed were provided to the third-party consultant. Facility size, not-for- profit status and the scope of each job position were compared to like facilities to determine base compensation and incentive compensation for each position. The data gathered by the third-party consultant was reviewed by the compensation committee, outlier issues were resolved and based upon present financial indicators, the committee made its determination of compensation levels for the next pay year on 9/19/2023 as documented in the meeting minutes. Mosaic Health System (MHS) 5325 Faraon Street St Joseph MO 64506 431283316 Healthcare MO 501(c)(3) Type II NA false Heartland Foundation (MOSAIC LIFE CARE FOUNDATION) 5325 Faraon Street St Joseph MO 64506 431262768 Support MO 501(c)(3) 7 Mosaic Health System true Heartland Long Term Acute Care Hospital (HLTACH) 5325 Faraon Street St Joseph MO 64506 261972987 Healthcare MO 501(c)(3) 3 Mosaic Health System true Heartland Regional Medical Center (MOSAIC-ST JOSEPH) 5325 Faraon Street St Joseph MO 64506 440545289 Healthcare MO 501(c)(3) 3 Mosaic Health System true Northwest Medical Center Foundation Inc (NMC FOUNDATION) 705 North College Street Albany MO 64402 473694893 Support MO 501(c)(3) Type I Northwest Medical Center Association Inc true Mosaic Medical Center-Maryville (MOSAIC-MARYVILLE) 5325 Faraon Street St Joseph MO 64506 832249459 Healthcare MO 501(c)(3) 3 Mosaic Health System true Midwestern Health Management Inc 5325 Faraon Street St Joseph MO 64506 431264358 Healthcare MO NA C Corporation true HHS Properties Inc 5325 Faraon Street St Joseph MO 64506 431593799 Investment MO NA C Corporation true Uptown Housing Inc 5325 Faraon Street St Joseph MO 64506 261416252 Redevelopment MO NA C Corporation true Uptown St Joseph Redevelopment Corp 5325 Faraon Street St Joseph MO 64506 201742813 Redevelopment MO NA C Corporation true false true true false true false false false false false true false true true true true true true true HEARTLAND REGIONAL MEDICAL CENTER (MOSAIC-ST JOSEPH) Q 2262862 FMV MOSAIC HEALTH SYSTEM (MHS) M 3923391 FMV MOSAIC HEALTH SYSTEM (MHS) P 6726861 FMV NORTHWEST MEDICAL CENTER FOUNDATION INC C 310057 FMV