4A (Expenses $ 76460339 including grants of $ 33343) (Revenue $ 81543832)
MOSAIC MEDICAL CENTER-MARYVILLE (MOSAIC-MARYVILLE) IS A 81-BED MEDICAL SURGICAL HOSPITAL LOCATED IN MARYVILLE, MISSOURI. IT SERVES A COMMUNITY OF 12,000 RESIDENTS. BECAUSE MARYVILLE 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-MARYVILLE OF APPROXIMATELY 62.11% GOVERNMENTAL OR NO-PAY PATIENTS. MOSAIC-MARYVILLE PROVIDES A WIDE RANGE OF INPATIENT AND OUTPATIENT SERVICES INCLUDING VASCULAR, ORTHOPEDIC AND GENERAL SURGERIES, AND MENTAL HEALTH SERVICES. IT OPERATES A 24-HOUR EMERGENCY ROOM, AND AN OBSTETRICS DEPARTMENT PROVIDES 9 LABOR/DELIVERY/RECOVERY/POST-PARTUM BEDS. DURING FY22, APPROXIMATELY 1,600 PATIENTS WERE ADMITTED TO MOSAIC-MARYVILLE RESULTING IN APPROXIMATELY 7,422 PATIENT DAYS. A TOTAL OF APPROXIMATELY 1,705 SURGERIES WERE PERFORMED, THE EMERGENCY ROOM SERVED APPROXIMATELY 8,572 PATIENTS AND APPROXIMATELY 99,700 VISITS WERE GENERATED BY OUTPATIENTS. THERE WERE APPROXIMATELY 112,200 PATIENT VISITS DURING THE YEAR. OTHER PROGRAM SERVICES: THE MOSAIC MEDICAL CENTER-MARYVILLE HAS A 340B DESIGNATION FROM HEALTH RESOURCES AND SERVICES ADMINISTRATION (FEDERAL GOVERNMENT). THIS ALLOWS MOSAIC-MARYVILLE 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; AND - ADULT AND CHILDHOOD OBESITY THESE SIGNIFICANT HEALTH NEEDS ARE IDENTIFIED THROUGH THE COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA). Interviews were performed with leaders from nine community organizations/agencies representing public health, public schools, social service organizations and government agencies as part of the 2021 CHNA for Mosaic-Maryville. Mosaic- Maryville conducted another CHNA during its fiscal year ending June 30, 2022 to align timing for its CHNA cycle with other hospitals in Mosaic Life Care.

Schedule H, Part V, Section B, Line 5 Facility , 1
Facility , 1 - MOSAIC MEDICAL CENTER MARYVILLE (MOSAIC-MARYVILLE). Mosaic Medical Center - Maryville (MOSAIC-MARYVILLE) offers both inpatient and outpatient services including Emergency Care, plus convenient clinics and specialty care services. We seek to improve the health of area individuals and communities and to provide the right care, at the right time, in the right place, at the right cost with outcomes second to none. THE COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA) WAS PREPARED BY MOSAIC-MARYVILLE. THE CHNA WAS CONDUCTED DURING TAX YEAR 2021, TO DETERMINE SERVICES NEEDED BY THE MEDICALLY UNDERSERVED. THE FOLLOWING TWO NEEDS WERE CHOSEN TO BE ADDRESSED OVER THE NEXT THREE YEARS: - MENTAL HEALTH, - ADULT AND CHILDHOOD OBESITY TO ENSURE INPUT WAS TAKEN INTO ACCOUNT FROM PERSONS WHO REPRESENT THE COMMUNITY, MOSAIC-MARYVILLE UTILIZED AN INDEPENDENT CONSULTING FIRM NAMED CROWE, LLP. THIS FIRM HELPED CONDUCT KEY STAKEHOLDER INTERVIEWS AND A COMMUNITY HEALTH SURVEY. KEY STAKEHOLDER INTERVIEWS: COMMUNITY INPUT WAS OBTAINED THROUGH KEY STAKEHOLDER INTERVIEWS PERFORMED WITH LEADERS FROM NINE COMMUNITY ORGANIZATIONS REPRESENTING PUBLIC HEALTH, PUBLIC SCHOOLS, LOCAL GOVERNMENT OFFICIALS, SOCIAL SERVICE ORGANIZATIONS AND NON-PROFIT ORGANIZATIONS. TO ASSURE THE MEDICALLY UNDERSERVED WERE REPRESENTED IN THIS CHNA, INTERVIEWS WERE CONDUCTED WITH REPRESENTATIVES FROM THE FOLLOWING ORGANIZATIONS: 1ST UNITED METHODIST CHURCH, BIG BROTHERS/BIG SISTERS OF NODAWAY COUNTY, COMMUNITY SERVICES INC., MARYVILLE R-II SCHOOL DISTRICT, NODAWAY COUNTY ECONOMIC DEVELOPMENT, NODAWAY COUNTY HEALTH DEPARTMENT, NODAWAY COUNTY SENIOR CENTER, NORTHWEST MISSOURI REGIONAL COUNCIL OF GOVERNMENTS, AND NORTHWEST MISSOURI STATE UNIVERSITY. THESE KEY STAKEHOLDER INTERVIEWS WERE CONDUCTED BETWEEN October 2021 to February 2022. TO ASSURE THAT MEDICALLY UNDERSERVED WERE INCLUDED IN THIS CHNA, INTERVIEWS WERE CONDUCTED WITH AGENCIES SERVING PERSONS WHO ARE HOMELESS, DISABLED, VICTIMS OF DOMESTIC VIOLENCE, UNEMPLOYED AND/OR PERSONS WITH LOW INCOME. COMMUNITY HEALTH SURVEY: MOSAIC-MARYVILLE's most recent CHNA was conducted during its fiscal year ending June 30, 2022 to be on the same CHNA cycle as the other related hospitals in Mosaic Life Care. The majority of respondents were White/Caucasian (99%). The remaining 1% identified with other racial or ethnic identities. THE SAMPLE INCLUDED MEN AND WOMEN, 18 AND OVER.

Schedule H, Part V, Section B, Line 11 Facility , 1
Facility , 1 - MOSAIC MEDICAL CENTER-MARYVILLE (MOSAIC-MARYVILLE). 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 TWO SIGNIFICANT NEEDS IDENTIFIED WERE: 1) MENTAL HEALTH; AND 2) ADULT AND CHILDHOOD OBESITY MOSAIC-MARYVILLE'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 POSITIVELY IMPACT THE SOCIAL DETERMINANTS OF HEALTH, MOSAIC-MARYVILLE CREATED THE FOLLOWING ACTION PLAN FOR POPULATION HEALTH: SIGNIFICANT NEED #1: MENTAL HEALTH PLAN: A) THE ORGANIZATION WILL EXPAND AND CONTINUE CLINIC BEHAVIORAL HEALTH OFFERINGS. B) THE ORGANIZATION WILL CONTINE TO provide support to organizations providing mental health programs to the community. C) THE ORGANIZATION will enhance relationship with Northwest Missouri State University's wellness center regarding behavioral/mental health concerns D) THE ORGANIZATION will work with area schools to raise awareness and provide resources for child and adolescent mental health. E) THE ORGANIZATION will work with area mental health providers and collaborators to identify ways to reduce the stigma of mental illness. F) THE ORGANIZATION will identify and work together with funding sources to support mental health initiatives. SIGNIFICANT NEED #2: ADULT AND CHILDHOOD OBESITY: A) THE ORGANIZATION will continue Healthy Lifestyles and Commit to Be Fit. B) THE ORGANIZATION will continue diabetes education programs and support group. C) THE ORGANIZATION will expand and continue the 4th Grade Challenge programs into all county schools and encourage caregivers to volunteer to participate in this program. D) THE ORGANIZATION will continue health screenings. E) THE ORGANIZATION will increase community education regarding obesity. THE COMPLETE CHNA WITH IMPLEMENTATION STRATEGY CAN BE FOUND AT: HTTPS://www.mymlc.com/General/Community-Health-Needs-Assessment/maryville-community-health-needs-assessment/

Schedule H, Part V, Section B, Line 20 Facility , 1
Facility , 1 - Mosaic Medical Center - Maryville (Mosaic-Maryville). 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 3c
Not Applicable

Schedule H, Part I, Line 6a
Not Applicable

Schedule H, Part I, Line 7f
MOSAIC MEDICAL CENTER MARYVILLE (MOSAIC-MARYVILLE) 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 18.91%, AND THE PERCENTAGE INCREASES TO 38.59% IF MEDICARE ALLOWABLE COSTS (SCHEDULE H, PART III, SECTION B, LINE 6) ARE INCLUDED IN TOTAL COMMUNITY BENEFIT EXPENSE.

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-MARYVILLE HAS INCURRED AN INCREASE IN EXPENSES RELATED TO THE FOLLOWING ITEMS: 1.PERSONAL PROTECTIVE EQUIPMENT (PPE) 2.PHARMACY EXPENSES 3.LABOR COSTS 4.SUPPLIES AND VARIOUS OTHER EXPENSES DURING FY22, MOSAIC-MARYVILLE EXPERIENCED A NET INCREASE OF $501,000 IN COVID-19 EXPENSES, WHICH IS REFLECTED IN PART I, LINE 7G.

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

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. FINANCIAL ASSISTANCE AT COST WAS $3,362,000 AND $4,263,000 FOR YEARS ENDED 6/30/22 AND 6/30/21, RESPECTIVELY. MEDICAID NET COMMUNITY BENEFIT EXPENSE WAS $46,000 AND $2,776,000 FOR THE YEARS ENDED 6/30/22 AND 6/30/21, RESPECTIVELY. MOSAIC MEDICAL-MARYVILLE 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
MOSAIC MEDICAL CENTER-Maryville (MOSAIC-Maryville) COMMUNITY BUILDING ACTIVITIES PROMOTED THE HEALTH OF THE COMMUNITIES SERVED BY PROVIDING MANY EDUCATIONAL PROGRAMS TO HELP MAINTAIN A HEALTHY LIFESTYLE. THESE ARE WELL-ADVERTISED AND MOST OF THEM ARE FREE OF CHARGE. IN REGARDS TO THE MENTAL HEALTH SERVICES PROVIDED TO THE COMMUNITY, MOSAIC-MARYVILLE WORKS WITH NORTHWEST MISSOURI STATE UNIVERSITY'S WELLNESS CENTER TO PROVIDE ASSISTANCE AND EDUCATION WITH BEHAVIORAL/MENTAL HEALTH CONCERNS. IN ADDITION, THE ORGANIZATION WORKS WITH AREA SCHOOLS TO RAISE AWARENESS AND PROVIDE RESOURCES FOR CHILD AND ADOLESCENT MENTAL HEALTH. MOSAIC-MARYVILLE HAS PROGRAMS LIKE HEALTHY LIFESTYLES AND COMMIT TO BE FIT TO HELP REDUCE ADULT AND CHILDHOOD OBESITY. ANOTHER PROGRAM IS HEALTH 4 LIFE WHICH PARTICIPATES WITH LOCAL SCHOOLS TO HELP REDUCE OBESITY.

Schedule H, Part III, Line 2 Bad debt expense - methodology used to estimate amount
Mosaic Medical Center-Maryville (Mosaic-Maryville) 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
MOSAIC MEDICAL CENTER-MARYVILLE (MOSAIC-MARYVILLE) 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-Maryville. This enables Mosaic-Maryville 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-Maryville to screen all patients for Financial Assistance prior to pursuing any extraordinary collection actions. AS A RESULT, MOSAIC-MARYVILLE 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 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
- Mosaic Medical Center-Maryville: Line 16a URL: SEE SCHEDULE O;

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

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

Schedule H, Part VI, Line 2 Needs assessment
MOSAIC MEDICAL CENTER-Maryville (MOSAIC-Maryville) 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
Mosaic Medical Center - Maryville (Mosaic - Maryville) IS A not-for-profit hospital LOCATED IN Maryville, MISSOURI, AND OPERATES CLINICS IN Maryville, Savannah AND Bedford, IA. ITS PRIMARY SERVICE AREA IS PRIMARILY RURAL AND INCLUDES Nodaway COUNTY LOCATED IN NORTHWEST MISSOURI. ACCORDING TO THE 2019 U.S. CENSUS ESTIMATES, THE POPULATION IN THE NODAWAY COUNTY SERVICE AREA IS APPROXIMATELY 22,359, WHICH INCLUDES A HIGH PERCENTAGE OF LOW INCOME FAMILIES. THE ORGANIZATION SUPPORTS A PAYOR MIX OF APPROXIMATELY 62.11% GOVERNMENTAL OR SELF-PAY PATIENTS.

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 Medical Center - Maryville (Mosaic-Maryville) 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-Maryville IS ABSORBING THE ADDITIONAL 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 VI, Line 3 Patient education of eligibility for assistance
Mosaic Medical Center-Maryville (Mosaic-Maryville) INFORMS AND EDUCATES PATIENTS AND PERSONS 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 THE Mosaic-Maryville. 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
"Mosaic MEDICAL CENTER - Maryville (MOSAIC-Maryville) 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 THE MOSAIC-Maryville RESTS WITH ITS BOARD, WHICH IS PRIMARILY COMPOSED OF MEMBERS OF THE COMMUNITY, IN ADDITION TO A FEW SELECT EMPLOYEES OF MOSAIC-Maryville. MOSAIC-Maryville 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-Maryville 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-Maryville PROMOTES HEALTH IN THE Maryville REGION IN NUMEROUS WAYS. MOSAIC-Maryville PROVIDED DIRECT FUNDING SUPPORT TO THE COMMUNITY ORGANIZATIONS WITH LIKE MISSIONS INCLUDING COMMUNITY EVENTS AND ACTIVITIES OF LOCAL SCHOOLS AND NURSING HOMES. THE ORGANIZATION OFFERS MANY EDUCATIONAL PROGRAMS TO HELP MAINTAIN A HEALTHY LIFESTYLE. THESE ARE WELL-ADVERTISED AND MOST OF THEM ARE FREE OF CHARGE. In regards to the mental health services provided to the community, Mosaic-Maryville works with Northwest Missouri State University's wellness center to provide assistance and education with behavioral/mental health concerns. In addition, the organization works with area schools to raise awareness and provide resources for child and adolescent mental health. Mosaic-Maryville has programs like Healthy Lifestyles and Commit to be Fit to help reduce adult and childhood obesity. Another program is Health 4 Life which participates with local schools to help reduce obesity. 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-Maryville HAS PARTICIPATED IN THIS PROGRAM SINCE 2019. 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.

Schedule H, Part III, Line 9b Collection practices for patients eligible for financial assistance
"Mosaic Medical Center-Maryville is committed to continuing the rich 125 year tradition of serving Maryville and surrounding communities. Maintaining continuity with Franciscan Sisters of Mary and the SSM St. Francis organization, Mosaic Medical Center-Maryville is pleased to continue supporting vulnerable community member needs with a generous charity policy. THE 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 Mosaic Medical Center-Maryville's (Mosaic-Maryville) Financial Assistance Policy and the process for submitting an application. to determine if the patient or guarantor is eligible for financial assistance, Mosaic-Maryville 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-Maryville 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-Maryville 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-Maryville 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-Maryville financial assistance application will be accepted. Information on the Mosaic-Maryville 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-Maryville 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-Maryville will attempt to find a correct address. If the correct address cannot be found, Mosaic-Maryville 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-Maryville 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-Maryville 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 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 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-Maryville staff are expected to uphold the highest ethical standards. All business must be conducted in the name of the caller or Mosaic-Maryville. 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-Maryville, will uphold and adhere to the Fair Debt Collection Practices Act."