4A (Expenses $ 636853040 including grants of $ 1338498) (Revenue $ 704061263)
HEARTLAND REGIONAL MEDICAL CENTER (Mosaic-St. Joseph) IS A 352-BED MEDICAL SURGICAL HOSPITAL LOCATED IN ST. JOSEPH, MISSOURI. IT SERVES A COMMUNITY OF 85,000 RESIDENTS. BECAUSE ST. JOSEPH IS A BORDER CITY, IT ALSO PROVIDES SERVICES TO THOSE LIVING IN THE ADJACENT STATES OF KANSAS, NEBRASKA AND IOWA. THE ECONOMY OF THE REGION IS BASED ON AGRICULTURE, MINOR MANUFACTURING AND SMALL BUSINESSES RESULTING IN A PAYOR MIX FOR MOSAIC-ST. JOSEPH APPROXIMATELY 70.59% GOVERNMENTAL OR Self-PAY PATIENTS. 15.6% OF THE POPULATION HAVE INCOME THAT IS BELOW THE FEDERAL POVERTY LEVEL. MOSAIC-ST. JOSEPH PROVIDES A WIDE RANGE OF INPATIENT AND OUTPATIENT SERVICES INCLUDING CARDIO-THORACIC, VASCULAR, ORTHOPEDIC AND GENERAL SURGERIES, MENTAL HEALTH SERVICES, ALONG WITH A FULL ARRAY OF DIAGNOSTIC AND THERAPEUTIC SERVICES. IT OPERATES A 24-HOUR EMERGENCY ROOM DESIGNATED AS A TRAUMA II CENTER BY THE STATE OF MISSOURI. MOSAIC-ST. JOSEPH'S OBSTETRICS DEPARTMENT PROVIDES 18 LABOR, DELIVERY, RECOVERY AND POST-PARTUM BEDS WHICH ARE ALSO DESIGNATED AS A LEVEL II CENTER. THE HOSPITAL PROVIDES RADIATION ONCOLOGY SERVICES, HOME HEALTH VISITS AND HOSPICE CARE. THE ORGANIZATION IS A MEMBER OF THE MAYO NETWORK FOR CLINICAL CONSULTATIONS. DURING THE YEAR, APPROXIMATELY 13,900 PATIENTS WERE ADMITTED TO THE HOSPITAL RESULTING IN APPROXIMATELY 70,400 PATIENT DAYS. A TOTAL OF APPROXIMATELY 9,500 SURGERIES WERE PERFORMED, THE EMERGENCY ROOM SERVED APPROXIMATELY 48,700 PATIENTS AND APPROXIMATELY 163,100 VISITS WERE GENERATED BY OUTPATIENTS. MOSAIC-ST. JOSEPH EMPLOYS APPROXIMATELY 3,800 FULL-TIME EQUIVALENT CARE GIVERS. THE MEDICAL STAFF INCLUDES APPROXIMATELY 289 PHYSICIANS COVERING PRIMARY CARE AND SPECIALTY CLINICS FOR APPROXIMATELY 25 LOCATIONS THROUGHOUT THE REGION. THERE WERE APPROXIMATELY 617,800 CLINIC PATIENT VISITS DURING THE YEAR. OTHER PROGRAM SERVICES: MOSAIC-ST. JOSEPH HAS A 340B DESIGNATION FROM HEALTH RESOURCES AND SERVICES ADMINISTRATION (FEDERAL GOVERNMENT). THIS ALLOWS THE MEDICAL CENTER TO RECEIVE OUTPATIENT DRUGS AT REDUCED PRICES FROM THE DRUG MANUFACTURERS. THE 340B PROGRAM ENABLES COVERED ENTITIES TO STRETCH SCARCE FEDERAL RESOURCES AS FAR AS POSSIBLE, REACHING MORE ELIGIBLE PATIENTS AND PROVIDING MORE COMPREHENSIVE SERVICES. THE PROGRAM IS AVAILABLE TO HOSPITALS THAT PROVIDE CARE FOR A DISPROPORTIONATE NUMBER OF PATIENTS THAT RANGE FROM NO INCOME TO LOW INCOME.

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/Substance Abuse: - Access and Cost of Health Care; - Obesity: and - important health issues. 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 - HEARTLAND REGIONAL MEDICAL CENTER (Mosaic-St. Joseph). The Community Health Needs Assessment (CHNA) was jointly prepared by Mosaic-St. Joseph and Heartland Long Term Acute Care Hospital. THE CHNA WAS CONDUCTED DURING TAX YEAR 2021 TO DETERMINE SERVICES NEEDED BY THE MEDICALLY UNDERSERVED. The following three needs were chosen to be addressed over the next three years: - Mental Health/Substance Abuse, - Access to and Cost of Health Care, - Obesity TO ENSURE INPUT WAS TAKEN INTO ACCOUNT FROM PERSONS WHO REPRESENT THE COMMUNITY, Mosaic-St. Joseph and HLTACH UTILIZED AN INDEPENDENT CONSULTING FIRM NAMED CROWE, LLP. THIS FIRM helped CONDUCT key stakeholder interviews and a community survey. Key Stakeholder Interviews: COMMUNITY INPUT WAS OBTAINED THROUGH KEY STAKEHOLDER INTERVIEWS PERFORMED WITH LEADERS FROM TWENTY-THREE COMMUNITY ORGANIZATIONS REPRESENTING PUBLIC HEALTH, PUBLIC SCHOOLS, 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; BIG BROTHERS BIG SISTERS, BUCHANAN COUNTY SHERIFF'S DEPARTMENT, COMMUNITY ACTION PARTNERSHIP, COMMUNITY MISSIONS CORPORATION, CATHOLIC CHARITIES, FAMILY GUIDANCE CENTER, INTERSERV, MIDLAND EMPIRE RESOURCES FOR INDEPENDENT LIVING, NORTHWEST HEALTH SERVICES, PIVOTAL POINT TRANSITIONAL HOUSING, PROGRESSIVE COMMUNITY SERVICES, SECOND HARVEST COMMUNITY FOOD BANK, SOCIAL WELFARE BOARD, ST. JOSEPH HABITAT FOR HUMANITY, ST. JOSEPH HEALTH DEPARTMENT, ST. JOSEPH POLICE DEPARTMENT, ST. JOSEPH SCHOOL DISTRICT, ST. JOSEPH UNITED WAY, ST. JOSEPH YOUTH ALLIANCE, ST. JOSEPH YMCA, ST. JOSEPH YWCA, UNTITED CEREBRAL PALSY, VOICES OF COURAGE CHILD ADVOCACY CENTER. These key stakeholder interviews were conducted between October 25th and 27th, 2021. To assure that medically underserved were included in this CHNA, interviews were conducted with agencies serving neighborhoods where median household incomes are very low or unemployed, as well as agencies providing services related to mental health, persons who are homeless, victims of domestic violence, elderly and persons with disabilities. Community Health Survey: In order to develop a broad understanding of community health needs, Mosaic-St. Joseph and HLTACH conducted a community survey in January 2022. A link to the survey was distributed via e-mail, social media and word of mouth to the community at-large. A total of 258 surveys were completed. The majority of respondents were White/Caucasian (96%), 1% of the respondents identified as Black or African American and 1% identified as Hispanic or Latino. The remaining 2% identified with other racial or ethnic identities. THE SAMPLE INCLUDED MEN AND WOMEN, 18 AND OVER.

Schedule H, Part V, Section B, Line 6a Facility , 1
Facility , 1 - Heartland Long Term Acute Care Hospital (HLTACH). Heartland Regional Medical Center (Mosaic-St. Joseph) CONDUCTED A COMMUNITY HEALTH NEEDS ASSESSMENT AND ADOPTED AN IMPLEMENTATION STRATEGY WITH Heartland Long Term Acute Care Hospital (HLTACH), A RELATED ORGANIZATION.

Schedule H, Part V, Section B, Line 11 Facility , 1
Facility , 1 - HEARTLAND REGIONAL MEDICAL CENTER (Mosaic-St. Joseph):. FACILITY NAME: HEARTLAND REGIONAL MEDICAL CENTER (MOSAIC-ST. JOSEPH): DESCRIPTION: THE COMMUNITY HEALTH NEEDS ASSESSMENT WAS CONDUCTED AND AN IMPLEMENTATION PLAN FOR ADDRESSING THE IDENTIFIED NEEDS WAS ADOPTED IN THE 2021 TAX YEAR. THE TOP THREE SIGNIFICANT NEEDS IDENTIFIED WERE: 1) MENTAL HEATLTH/SUBSTANCE ABUSE; 2) ACCESS AND COST OF HEALTH CARE; AND 3) OBESITY. MOSAIC-ST. JOSEPH'S ROLE IS MUCH MORE THAN BEING A HOSPITAL. IT IS A FULLY ENGAGED COMMUNITY PARTNER STRIVING TO ADDRESS THE UNIQUE HEALTH AND SOCIAL ISSUES THAT CHALLENGE THE REGION. MANAGEMENT RECOGNIZES THAT THE COMMUNITY'S MAJOR HEALTH PROBLEMS STEM, IN LARGE PART, FROM SOCIAL DETERMINANTS OF HEALTH. SOCIAL DETERMINANTS THAT AFFECT ACCESS TO HEALTH CARE (HEALTHY PEOPLE 2020 FRAMEWORK) INCLUDE: ECONOMIC STABILITY, POVERTY, EMPLOYMENT, FOOD SECURITY, HOUSING STABILITY, EDUCATION, HIGH SCHOOL GRADUATION, ENROLLMENT IN HIGHER EDUCATION, LANGUAGE AND LITERACY, EARLY CHILDHOOD, NEIGHBORHOOD AND BUILT ENVIRONMENT, ACCESS TO HEALTHY FOOD, QUALITY OF HOUSING, CRIME AND VIOLENCE, ENVIRONMENTAL CONDITIONS, CIVIC PARTICIPATION, PERCEPTIONS OF DISCRIMINATION/EQUITY, AND INCARCERATION/INSTITUTIONALIZATION. TO FULLY MEET THE NEEDS IDENTIFIED BY THE COMMUNITY HEALTH NEEDS ASSESSMENT, MOSAIC-ST. JOSEPH IMPLEMENTED A THREE-YEAR ACTION PLAN FOR THE TAX YEARS 2022, 2023, AND 2024 COMPRISED OF THE FOLLOWING COMPONENTS. SIGNIFICANT NEED #1: MENTAL HEALTH/SUBSTANCE ABUSE: A)CONTINUE WORK OF BEHAVIORAL HEALTH ALLIANCE. B)CONTINUE TO FINANCIALLY SUPPORT AGENCIES THAT PROVIDE MENTAL HEALTH SERVICES. C)CONTINUE AND EXPAND THE MOSAIC ART EXPERIENCE. D)PROVIDE THE 4TH GRADE CHALLENGE IN ELEMENTARY SCHOOLS WITH EMPHASIS ON MENTAL HEALTH. E) THE ORGANIZATION'S SPIRITUAL HEALTH DEPARTMENT WILL PROVIDE ONGOING EDUCATION ON TRAUMA TO THE COMMUNITY. THIS EVENT WILL BE PRESENTED YEARLY AND IS OPEN TO THE PUBLIC. MOSAIC CHAPLAINS ALSO PROVIDE ADVANCED DIRECTIVE AND DURABLE POWER OF ATTORNEY EDUCATION FOR ANYONE IN THE HOSPITAL, AND TO CHURCHES AN OTHER COMMUNITY GROUPS WHEN THEY REQUEST. IN ADDITION, SPIRITUAL HEALTH PROVIDES A PULPIT SUPPLY IN AREA CHURCHES WHEN NEEDED AND GIVE PRESENTATIONS ON THE ROLE OF THE CHAPLAIN IN HEALTH CARE. SIGNIFICANT NEED #2: ACCESS TO AND COST OF CARE: A) THE ORGANIZATION WILL PROVIDE FINANCIAL SUPPORT TO ORGANIZATIONS PROVIDING ACCESS SUPPORT TO THE COMMUNITY, SUCH AS FAITH IN ACTION TRANSPORTATION MINISTRY B) THE ORGANIZATION WILL CONTINUE TO SUPPORT SOCIAL WELFARE BOARD. SIGNIFICANT NEED #3: OBESITY: A) THE ORGANIZATION WILL AGAIN OFFER 4TH GRADE CHALLENGE IN ELEMENTARY SCHOOLS, PROVIDING PHYSICAL ACTIVITY AND EDUCATION ON HEALTHY EATING AND EXERCISE. B) THE ORGANIZATION WILL ONCE AGAIN PROVIDE KIDS IN THE KITCHEN HEALTHY COOKING CLASS. C) THE ORGANIZATION WILL PROVIDE AN ADULT HEALTHY LIFESYTLE PROGRAM. D) THE ORGANIZATION WILL ALSO SUPPORT SECOND HARVEST COMMUNITY FOOD BANK IN PROVIDING HEALTHY FOOD CHOICES. THE COMPLETE CHNA WITH IMPLEMENTATION STRATEGY CAN BE FOUND AT: HTTPS://WWW.MYMLC.COM/GENERAL/COMMUNITY-HEALTH-NEEDS-ASSESSMENT/ST-JOSEPH-CHNA/

Schedule H, Part V, Section B, Line 20 Facility , 1
Facility , 1 - Heartland Regional Medical Center (Mosaic-St. Joseph):. FINANCIAL COUNSELORS ARE AVAILABLE ONSITE TO EXPLAIN AND HELP PATIENTS AND GUARANTORS WITH THE FINANCIAL ASSISTANCE POLICY. SEE FINANCIAL ASSISTANCE POLICY FOR A COMPLETE DESCRIPTION OF EFFORTS MADE BEFORE INITIATING COLLECTION ACTIONS.

Schedule H, Part I, Line 7f
Heartland Regional Medical Center (Mosaic-St. Joseph) did not report bad debt expense as part of operating expenses for health professions education for year ended 06/30/22. 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. THE ORGANIZATION'S TOTAL COMMUNITY BENEFIT EXPENSE (SCHEDULE H, PART I, LINE 7, COLUMN (C)) AS A PERCENTAGE OF TOTAL EXPENSES IS 25.93%, AND THE PERCENTAGE INCREASES TO 55.29% IF MEDICARE ALLOWABLE COSTS (SCHEDULE H, PART III, SECTION B, LINE 6) ARE INCLUDED IN TOTAL COMMUNITY BENEFIT EXPENSE.

Schedule H, Part I, Line 3c
Not Applicable

Schedule H, Part I, Line 6a
Not applicable

Schedule H, Part I, Line 7b
During the year-ended 06/30/2022, Heartland Regional Medical Center (Mosaic-St Joseph) increased the estimated Medicaid Federal Reimbursement Allowance program liability related to prior program years by approximately $1,500,000, thereby decreasing patient service revenue by the same amount. This change in estimate was the result of the state of Missouri providing Mosaic final settlement notifications during the year ended June 30, 2022. 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 I, Line 7g
On March 11, 2020, the World Health Organization (WHO) declared the novel coronavirus disease (COVID-19) a pandemic. The Center for Disease Control (CDC) confirmed its spread to the United States and it was declared a national public health emergency, followed by state of emergency declarations (including by the Governor of Missouri), and the Centers for Medicare and Medicaid Services (CMS) issuing guidance regarding elective procedures. The COVID-19 pandemic has caused significant disruption to the national economy as well as Mosaic's operations. In 2022, the COVID-19 pandemic continued to impact Mosaic's business as well as patients, communities and employees. With the COVID-19 pandemic Mosaic-St Joseph has incurred significant increase in expenses related to the following items: 1. Personal Protective Equipment (PPE) 2. Pharmacy Expenses 3. Temporary Testing Sites 4. Temporary Vaccination Clinics 5. Labor Costs 6. Supplies and various other expenses Due to the significant increase in expenses from the Covid-19 pandemic, Mosaic-St Joseph temporarily scaled back community benefit programs. During FY22, Heartland Regional Medical Center (Mosaic-St Joseph) experienced a net expense of $36,759,000 in Covid-19 expenses, which is reflected in Part I, Line 7g.

Schedule H, Part III, Line 2 Adoption of Charity Care Assessment System
Heartland Regional Medical Center (Mosaic-St. Joseph) reported a slight decrease in bad debt expense, from $26,128,238 for fiscal year-ended June 30, 2021 to $23,614,137 for fiscal year-ended June 30, 2022.

Schedule H, Part I, Line 7g Subsidized Health Services
CERTAIN COVID-19 COSTS WERE SUBSIDIZED WITH PROVIDER RELIEF FUNDS AND OTHER GRANT FUNDING.

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 THE CALCULATIONS FROM WORKSHEET 2. FINANCIAL ASSISTANCE AT COST WAS $22,000,000 AND $29,500,000 FOR YEARS ENDED 6/30/22 AND 6/30/21. MEDICAID NET COMMUNITY BENEFIT SURPLUS WAS $20,254,000 FOR THE YEAR ENDED 6/30/22 WHILE MEDICAID NET COMMUNITY BENEFIT EXPENSE WAS $253,000 FOR YEAR ENDED 6/30/21, RESPECTIVELY. THE HEARTLAND REGIONAL MEDICAL CENTER (MOSAIC-ST. JOSEPH) RECEIVES REIMBURSEMENT FROM THE MEDICAID PROGRAM IN RELATION TO THE PERCENTAGE OF MEDICAID AND INDIGENT POPULATION THEY SERVE.

Schedule H, Part II Community Building Activities
Heartland Regional Medical Center (Mosaic-St. Joseph) COMMUNITY BUILDING ACTIVITIES PROMOTED THE HEALTH OF THE COMMUNITIES SERVED BY PROVIDING ECONOMIC SUPPORT TO HELP RE-VITALIZE THE DOWNTOWN ST JOSEPH AREA AND FACILITATE JOB GROWTH THROUGHOUT THE GREATER ST JOSEPH AREA. AMONG OTHER COMMUNITY BUILDING ACTIVITIES, Mosaic-St. Joseph FUNDS AND MAINTAINS A TEAM FOCUSED ON DISASTER READINESS, COORDINATION AND RELIEF.

Schedule H, Part III, Line 2 Bad debt expense - methodology used to estimate amount
Heartland Regional Medical Center (Mosaic-St. Joseph) 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 4 Bad debt expense - financial statement footnote
PLEASE SEE THE ACCOUNTS RECEIVABLE FOOTNOTE ON PAGE 10 AND THE PATIENT SERVICE REVENUE FOOTNOTE REGARDING IMPLICIT PRICE CONCESSIONS ON PAGE 17 OF THE ATTACHED AUDITED FINANCIAL STATEMENTS. SEE ALSO THE PARAGRAPH IN THE CHARITY CARE FOOTNOTE ON PAGE 18.

Schedule H, Part V, Section B, Line 16a FAP website
- Heartland Regional Medical Center: Line 16a URL: SEE SCHEDULE O;

Schedule H, Part V, Section B, Line 16b FAP Application website
- Heartland Regional Medical Center: Line 16b URL: SEE SCHEDULE O;

Schedule H, Part V, Section B, Line 16c FAP plain language summary website
- Heartland Regional Medical Center: Line 16c URL: SEE SCHEDULE O;

Schedule H, Part VI, Line 2 Needs assessment
Heartland Regional Medical Center (Mosaic-St. Joseph) 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 4 Community information
THE ORGANIZATION'S PRIMARY AND SECONDARY SERVICE AREA IS AN 18 COUNTY URBAN/RURAL REGION LOCATED IN NORTHWEST MISSOURI AND NORTHEAST KANSAS. THE POPULATION IS ELDERLY AND UNDERINSURED. THE LOCAL ECONOMY CONSISTS OF AGRICULTURAL, SMALL MANUFACTURING AND SELFEMPLOYED BUSINESSES, PRIMARILY BLUE-COLLAR WORKERS. THE ORGANIZATION SUPPORTS A PAYOR MIX OF APPROXIMATELY 70.59% GOVERNMENTAL OR SELF-PAY PATIENTS. 17.2% OF THE POPULATION IS BELOW THE POVERTY LEVEL; 23.6% OF THE POPULATION SMOKES; AND 38.3% HAVE A BODY MASS INDEX GREATER THAN 30. MORE THAN 70% OF THE ELEMENTARY AGE STUDENTS RECEIVE FREE OR REDUCED-COST LUNCHES.

Schedule H, Part III, Line 3 Bad Debt Expense Methodology
HEARTLAND REGIONAL MEDICAL CENTER (MOSAIC-ST. JOSEPH) uses a third party to electronically review a patient or the patient's Guarantor 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 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-St. Joesph. This enables Mosaic-St. Joesph 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-St. Joesph to screen all patients for Financial Assistance prior to pursuing any extraordinary collection actions. AS A RESULT, MOSAIC-ST. JOSEPH 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 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 HOSPITAL'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. Mosaic-St. Joseph 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 HOSPITAL IS ABSORBING THE COST OF PROVIDING CARE TO THE ELDERLY AND DISABLED IN THE COMMUNITY. IN ADDITION, THIS COINCIDES WITH THE IRS REVENUE RULING 69-545, WHICH provides general requirements for tax exemption, along with section 501(c)(3).

Schedule H, Part III, Line 9b Collection practices for patients eligible for financial assistance
"Heartland Regional Medical Center's (Mosaic-St. Joseph) FINANCIAL ASSISTANCE POLICY CONTAINS PROVISIONS ON COLLECTION PRACTICES TO BE FOLLOWED FOR PATIENTS WHO QUALIFY FOR FINANCIAL ASSISTANCE ONLY. ACCORDING TO THIS POLICY, FINANCIAL ASSISTANCE ELIGIBILITY CRITERIA ARE BASED ON RESIDENCY, GROSS HOUSEHOLD INCOME & HOUSEHOLD SIZE. APPLYING FOR FINANCIAL ASSISTANCE Patients will be informed of the Mosaic-St. Joseph Financial Assistance Policy and the process for submitting an application to determine if the patient or guarantor is eligible for financial assistance, Mosaic-St. Joseph asks for the necessary information and documents to prove household size, income, and residency. A completed application for financial assistance should be submitted within 240 days from the date of the first post-discharge billing statement. Mosaic-St. Joseph will make reasonable efforts to explain the Medicaid benefits, the health insurance exchange and coverage, and other public and private coverage that may apply. Mosaic-St. Joseph will also provide the details of these programs and offer to help patients and guarantors apply for them as well as, private programs and COBRA coverage. Once the patient or guarantor is screened to be potentially eligible for any of these programs, public or private, Mosaic-St. Joseph expects him or her to apply. If a patient or guarantor chooses not to apply, he or she may be denied financial assistance. If the patient or guarantor is potentially eligible for any third-party coverage, he or she must provide documentation of approval or denial of that third-party coverage before a Mosaic-St. Joseph financial assistance application will be accepted. Information on the Mosaic-St. Joseph Financial Assistance Policy will be communicated to patients in a culturally appropriate language. Information about the policy will be translated in the most prevalent languages in the Mosaic-St. Joseph primary service area. COLLECTION ACTIONS TAKEN IN EVENT OF NON-PAYMENT No account will be subject to collection actions within 120 days of issuing the first post-discharge statement and without first making reasonable efforts to determine whether the patient is eligible for financial assistance. No extraordinary collection actions will be pursued against a patient if the patient or guarantor has provided documentation showing that an application has been submitted for Medicaid or other publicly sponsored health programs, and that an eligibility determination is still pending. If a statement is sent to a patient or guarantor, and mail is returned as undeliverable, Mosaic-St. Joseph will attempt to find a correct address. If the correct address cannot be found, Mosaic-St. Joseph will attempt to contact the patient or guarantor by telephone at the number listed by the patient or guarantor. If efforts to communicate with the patient or guarantor fail, accounts will be sent to a collection agency. Reasonable efforts to inform patient of financial assistance Prior to sending an account to a collection agency, the patient or guarantor will generally receive a minimum of four written statements (includes the first post-discharge statement and three subsequent statements). These statements will include a telephone number for information on paying patient balances and a notice about financial assistance. If an agreement has not been made to resolve the account, the fourth and final statement will be sent to the patient or guarantor. This statement acts as a notice to the account owner of the amount owed to Mosaic-St. Joseph and that the account will be placed with a third-party collection agency in 30 days. This statement will include a plain language summary and will outline any collection actions that may be taken if a plan is not put in place to settle the account. There are other times when accounts may be placed in collections including when: 1. The patient or guarantor has not made timely payments according to the agreed-upon payment plan 2. The patient or guarantor has received a financial assistance discount but is no longer working with Mosaic-St. Joseph in good faith to pay off the remaining amount owed. Extraordinary collection activities Once an account is with the collection agency, the following actions may be taken to make sure debt for services and care is paid. They are ""Extraordinary Collection Activities:"" 1. Seizing the patient's or guarantor's bank account 2. Civil actions 3. Property liens 4. Garnishing of wages 5. Reporting adverse information to credit bureaus Before ""Extraordinary Collection Activities"" can begin, the account must be reviewed, and approval must be given by Mosaic-St. Joseph Patient Billing Leadership. When one of these actions is to be taken against a patient or guarantor, the patient or guarantor will be given a 30-day written notice of the action to be taken. The patient or guarantor will also be informed of the Mosaic-St. Joseph Financial Assistance Policy and how to apply for it. A plain language summary of the Financial Assistance Policy will be included with the notice. ENFORCEMENT Mosaic-St. Joseph staff are expected to uphold the highest ethical standards. All business must be conducted in the name of the caller or Mosaic-St. Joseph. Everything a staff member says must be true and correct using a professional approach. The staff as well as, all third-party vendors working on behalf of Mosaic-St. Joseph, will uphold and adhere to the Fair Debt Collection Practices Act."

Schedule H, Part VI, Line 3 Patient education of eligibility for assistance
Heartland Regional Medical Center (Mosaic-St. Joseph) 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-St. Joseph. 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 5 Promotion of community health
"HEARTLAND REGIONAL MEDICAL CENTER (MOSAIC-ST. JOSEPH) IS A NONPROFIT HOSPITAL OPERATING TO SERVE A PUBLIC RATHER THAN A PRIVATE INTEREST AND MEETING THE REQUIREMENTS OF REVENUE RULING 69-545. CONTROL OF MOSAIC-ST. JOSEPH RESTS WITH ITS BOARD, WHICH IS PRIMARILY COMPOSED OF MEMBERS OF THE COMMUNITY, IN ADDITION TO A FEW SELECT EMPLOYEES OF MOSAIC-ST. JOSEPH. MOSAIC-ST. JOSEPH 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-ST. JOSEPH 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 SERVES. MOSAIC-ST. JOSEPH PROMOTES HEALTH IN THE ST. JOSEPH REGION IN NUMEROUS WAYS. HIGHLIGHTED BELOW ARE EXAMPLES IN WHICH MOSAIC-ST. JOSEPH PROVIDED DIRECT FUNDING SUPPORT TO THE COMMUNITY ORGANIZATIONS WITH LIKE MISSIONS. IN FY22, MOSAIC-ST. JOSEPH MAINTAINED A POST NATAL PROGRAM IN WHICH A NURSE WILL MAKE FOLLOW UP PHONE CALLS FOR EVERY PATIENT TO ARRANGE FOLLOW UP CARE FOR THE BABIES AND SETUP CAR SEAT CHECKS FOR EACH INFANT IF DESIRED. IN ADDITION, THIS DEPARTMENT PROVIDES TWO HOURS OF SUPPORT TO THE BREASTFEEDING GROUP TWICE A WEEK. THIS IS DONE AT NO EXPENSE TO THE PATIENT AND IS A NON-BILLABLE SERVICE THAT IS PROVIDED AS A COMMUNITY BENEFIT. IN FY22, DUE TO CONTINUED EFFECTS OF THE COVID 19 PANDEMIC MANY COMMUNITY HEALTH IMPROVEMENT PROGRAMS WERE NOT ABLE TO BE OFFERED. PROGRAMMING TYPICALLY HELD FOR THE COMMUNITY INCLUDED: 1. 4TH GRADE HEALTH CHALLENGE 2. POUND PLUNGE 3. FIT-TASTIC FAMILY FUN DAY 4. KIDS IN THE KITCHEN HEALTH COOKING CLASSES 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-ST. JOSEPH 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
THE ORGANIZATION IS AFFILIATED, THROUGH A PARENT BOARD, WITH A REGIONAL Medical CENTER Hospital, A COMMUNITY FOUNDATION, A LONG-TERM ACUTE CARE HOSPITAL, A CRITICAL ACCESS RURAL HOSPITAL, A RURAL COMMUNITY FOUNDATION AND A GENERAL MEDICAL AND Surgical HOSPITAL. ALL OF WHICH COLLABORATE WITH EDUCATIONAL, GOVERNMENTAL AND LOCAL BUSINESS LEADERS TO IMPLEMENT PROGRAMS TO HELP IMPROVE HEALTH HABITS AND, IN THE LONG-TERM, THE HEALTH OF THE COMMUNITIES SERVED BY THE ORGANIZATION. These affiliations include the hospital reported on this tax return. THE PARENT BOARD IS COMPRISED OF COMMUNITY LEADERS WHO REPRESENT THE EDUCATIONAL, MEDICAL, GOVERNMENTAL AND BUSINESS SECTORS IN THE COMMUNITY. THE COMMUNITY FOUNDATION OVERSEES A NUMBER OF PROGRAMS WORKING TO IMPROVE HEALTH and Educational needs IN THE COMMUNITY. The Regional Medical center hospital provides general medical and surgical needs to patients and provides both primary and specialty physicians, in addition to providing emergent and outpatient clinic care for all. The Long-term acute care hospital IS A FACILITY DEDICATED TO THE CARE OF PATIENTS WHO HAVE CHRONIC CONDITIONS REQUIRING A LONGER LENGTH OF STAY THAN IS NORMALLY PROVIDED IN AN ACUTE CARE HOSPITAL. THE GENERAL MEDICAL and Surgical CARE HOSPITAL PROVIDES ACUTE, EMERGENT AND OUTPATIENT CLINIC CARE FOR ALL. THE CRITICAL ACCESS RURAL HOSPITAL PROVIDES ACUTE, EMERGENT AND OUTPATIENT CLINICS ARE FOR THOSE IN THE RURAL COMMUNITY AREA. THE RURAL COMMUNITY FOUNDATION SUPPORTS THE CRITICAL ACCESS RURAL HOSPITAL. ALL HOSPITAL FACILITIES PROVIDE CARE FOR ALL PATIENTS REGARDLESS OF THEIR ABILITY TO PAY. ALL THE HOSPITAL Organizations MAINTAIN AN ONGOING COMMITMENT TO PROVIDE SUPPORT FOR THE BETTERMENT OF THE COMMUNITY.