2024-05-08T17:00:12+00:00 2023-06-30 420714325 RSM US LLP 4650 East 53rd Street Davenport IA 52807 990 2022-07-01 440580870 Northwest Medical Center Association Inc NORT 8162717070 5325 Faraon Street St Joseph MO 64506 Drew Keesbury Officer 8162717070 2024-05-08 true Drew Keesbury 999009999 Jenifer L Chase P01306883 5638884000 2022 2023-04-26 12:10:37Z Mosaic Medical Center - Albany Drew Keesbury 5325 Faraon Street St Joseph MO 64506 23340134 false X https://www.mymlc.com/Main/Location/albany-mo/mosaic-medical-center-albany/ X 1955 MO NORTHWEST MEDICAL CENTER SERVES AS A COMPASSIONATE, EFFICIENT HEALTH HOME THAT ENCOURAGES WELLNESS, RESTORES HEALTH, AND PROMOTES A SUPERIOR QUALITY OF LIFE. 5 2 164 18 535 0 1294943 1139977 21458941 21223973 198908 598380 777276 23352264 23340134 35420 7620 0 12299882 12860582 0 0 11325665 12845034 23660967 25713236 -308703 -2373102 21777916 19905412 12543616 12908694 9234300 6996718 WITH THE HELP OF TRUSTED, INTEGRATED PARTNERS, NORTHWEST MEDICAL CENTER SERVES AS A COMPASSIONATE, EFFICIENT HEALTH HOME THAT ENCOURAGES WELLNESS, RESTORES HEALTH AND PROMOTES A SUPERIOR QUALITY OF LIFE. false false 21999582 7620 22000714 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 2022 U.S. census estimates, the population in the two-county service area is approximately 8,208, 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 72.63% governmental or self-pay patients. 15.6% 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 536 patients were admitted to the hospital resulting in approximately 1,891 patient days. The emergency room served approximately 2,682 patients and approximately 12,663 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. 21999582 true true false true false false false false true true false false false 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 23 0 true 164 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 646385 15112 Thomas Bieterman Former Director/CFO 1.0 36.0 X X 0 167017 2972 Davin Turner DO Director 1.0 37.0 X 0 393638 20954 Gene A Claycomb Director 1.0 37.0 X 0 443355 46562 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 0 0 Katie Dias DO Administrator - MLC Albany 39.0 1.0 X 327416 0 28195 Michael R Rinard Secretary 1.0 37.0 X 0 273849 41666 Angelia Martin MD Staff Physician 37.0 3.0 X 271556 2500 37851 Evan R Slanczka Staff Physician 40.0 0 X 444063 0 20598 James Bartley DO Staff Physician 40.0 0 X 313151 0 40869 Lori L Bishop Director - Nursing Services - Albany 40.0 0 X 132930 0 22050 Renee L Ellis Inpatient RN - Albany 40.0 0 X 127143 0 12232 Dwain Stilson Former CFO/Treasurer 0.0 0.0 X 0 157969 5073 Karen S Miller Former Treasurer 0.0 0.0 X 0 179091 12749 Mark Laney MD Former Director/CEO 0.0 0.0 X 0 3032113 27536 Michael Pulido Former Secretary/Chair 0.0 0.0 X 0 1258302 34631 1616259 6559219 369050 16 true true false Missouri Network Alliance LLC 4215 Philips Farm Rd Ste 103 Columbia MO 65201 Telecommunications services 227545 1 1128566 11411 1139977 Net Patient Service Revenue 621110 19955527 19955527 340B Pharmacy Revenue 621110 1268446 1268446 0 0 0 0 21223973 195908 195908 1200 1200 0 1200 1200 3000 0 0 3000 3000 3000 Referral Lab Revenue 621511 88519 87984 535 Cafeteria 722514 87753 87753 Other Misc Revenue 900099 599804 599804 0 0 0 0 776076 23340134 22000714 535 198908 7620 7620 449605 121937 327668 0 9822096 9537177 284919 245473 239931 5542 1678168 1525340 152828 665240 627288 37952 8516 8516 1403248 1333618 69630 0 655 655 1732212 1697077 35135 480430 480430 356374 330142 26232 36878 33501 3377 4451 4451 145460 7585 137875 1682370 1119255 563115 191892 191892 Corporate Allocations From Mosaic Health System 3557909 1529901 2028008 Medical Supplies/Includes 340B 2480125 2480125 FRA Tax 711120 711120 Dues & Subscriptions 53394 21192 32202 0 0 0 0 25713236 21999582 3713654 0 9985 10691 2586459 3592142 0 0 0 0 191931 155020 290313 271516 16754689 5938426 11341062 10816263 4348971 4487443 0 0 117415 119689 2891780 452648 21777916 19905412 5520160 5614580 0 0 7023456 7294114 12543616 12908694 X 7597007 6487040 1637293 509678 9234300 6996718 21777916 19905412 -2373102 135520 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 8516 8516 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. 36.00% of the membership dues paid to the Missouri Hospital Association are used for lobbying activities. 27.29% of the membership dues paid to the American Hospital Association are used for lobbying activities. 104688 20306 20306 104688 132765 -28077 104688 132765 56522 56522 132765 132765 7096 7096 132765 132765 6890 6890 132765 0.0 1.0 0.0 false false 9916037 2279042 7636995 1352718 399681 953037 4834305 3154004 1680301 651629 105699 545930 10816263 Due to Northwest Medical Center Foundation 6577467 Other Long Term Liabilities 281366 Due to Mosaic Health System 435281 Checks in Excess of Cash 7294114 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 (MOSAIC-ALBANY) 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, 2023, 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 $10.6M 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 $1.5M 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, 2023 AND 2022, THERE WERE NO UNCERTAIN TAX POSITIONS IDENTIFIED AND RECORDED AS A LIABILITY. true true X true X true X true true false false 1455729 1455729 0.0566 4244343 2660329 1584014 0.0616 0 0.0 0 0 5700072 2660329 3039743 0.1183 69690 69690 0.0027 0 0.0 0 0.0 0 0.0 8561 8561 0.0003 0 0 78251 0 78251 0.0030 0 0 5778323 2660329 3117994 0.1213 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 0 0 7811517 8953436 -1141919 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/ 98-64 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 Not Applicable Schedule H, Part I, Line 6a Not Applicable Schedule H, Part I, Line 7f Northwest Medical Center Association (Mosaic-Albany) did not report bad debt expense as part of operating expenses for health professions education for year ended 06/30/23. 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 22.48%, AND THE PERCENTAGE INCREASES TO 57.31% IF MEDICARE ALLOWABLE COSTS (SCHEDULE H, PART III, SECTION B, LINE 6) ARE INCLUDED IN TOTAL COMMUNITY BENEFIT EXPENSE. Schedule H, Part I, Line 7b DURING THE YEAR-ENDED 06/30/2023, NORTHWEST MEDICAL CENTER ASSOCIATION (MOSAIC-ALBANY) reduced the estimated FEDERAL REIMBURSEMENT ALLOWANCE program liability related to prior program years by approximately $429,000 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. FINANCIAL ASSISTANCE AT COST WAS $1,456,000 AND $645,000 FOR YEARS ENDED 6/30/23 AND 6/30/22, RESPECTIVELY. MEDICAID NET COMMUNITY BENEFIT EXPENSE WAS $1,584,000 AND $470,000 FOR THE YEARS ENDED 6/30/23 AND 6/30/22, RESPECTIVELY. THE NORTHWEST MEDICAL CENTER ASSOCIATION (MOSAIC-ALBANY) 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 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 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-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 10 and 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 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. 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. 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 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 Northwest Medical Center Association (Mosaic-Albany) Financial Assistance Policy and the process for submitting an application. to determine if the patient or guarantor is eligible for financial assistance, Mosaic-Albany 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-Albany 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-Albany 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-Albany 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-Albany financial assistance application will be accepted. Information on the Mosaic-Albany 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-Albany 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-Albany will attempt to find a correct address. If the correct address cannot be found, Mosaic-Albany 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-Albany 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-Albany 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-Albany staff are expected to uphold the highest ethical standards. All business must be conducted in the name of the caller or Mosaic-Albany. 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-Albany, will uphold and adhere to the Fair Debt Collection Practices Act. 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 2022 U.S. CENSUS ESTIMATES, THE POPULATION IN THE TWO COUNTY SERVICE AREA IS APPROXIMATELY 8,208, WHICH INCLUDES A HIGH PERCENTAGE OF LOW INCOME FAMILIES. THE ORGANIZATION SUPPORTS A PAYOR MIX OF APPROXIMATELY 72.63% 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. 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 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. true true false false false false false false false John M Poore Director/CEO 0 630107 0 13827 0 2451 0 0 0 15112 0 661497 0 0 Thomas Bieterman Former Director/CFO 0 166756 0 261 0 0 0 0 0 2972 0 169989 0 0 Gene A Claycomb Director 0 344147 0 94682 0 4526 0 10588 0 35974 0 489917 0 0 Davin Turner DO Director 0 354867 0 35973 0 2798 0 8299 0 12655 0 414592 0 63730 Mark Laney MD Former Director/CEO 0 3027894 0 228 0 3991 0 8220 0 19316 0 3059649 0 1973799 Michael Pulido Former Secretary/Chair 0 1255487 0 0 0 2815 0 8102 0 26529 0 1292933 0 519516 Karen S Miller Former Treasurer 0 178284 0 0 0 807 0 7236 0 5513 0 191840 0 0 Dwain Stilson Former CFO/Treasurer 0 157169 0 550 0 250 0 0 0 5073 0 163042 0 74404 Katie Dias DO Administrator - MLC Albany 255779 0 70980 0 657 0 9648 0 18547 0 355611 0 0 0 Michael R Rinard Secretary 0 213676 0 58812 0 1361 0 9254 0 32412 0 315515 0 0 Evan R Slanczka Staff Physician 384160 0 58449 0 1454 0 8296 0 12302 0 464661 0 0 0 James Bartley DO Staff Physician 311243 0 0 0 1908 0 9657 0 31212 0 354020 0 0 0 Angelia Martin MD Staff Physician 268953 2500 36 0 2567 0 5627 0 32224 0 309407 2500 0 0 Lori L Bishop Director - Nursing Services - Albany 111507 0 20800 0 623 0 2734 0 19316 0 154980 0 0 0 Schedule J, Part I, Line 4a Severance or change-of-control payment Mosaic Health System, a related organization, paid Samuel Mark Laney, CEO, severance payments during calendar year 2022. This is reported on Form 990, Part VII and Schedule J, Part II as other reportable compensation. Mosaic Health System, a related organization, paid Michael Pulido, COO, severance payments during calendar year 2022. 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 $116,667 GENE A CLAYCOMB - VESTED $0; ACCRUED $50,400 DAVIN TURNER, DO - VESTED $0; ACCRUED $21,000 MICHAEL R RINARD - VESTED $0; ACCRUED $31,360 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 SEPARATIONFROM 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. Schedule J, Part I, Line 3 Compensation Plan COMPENSATION IS ESTABLISHED BY MOSAIC HEALTH SYSTEM, A RELATED ENTITY, USING THE FOLLOWING: 1. COMPENSATION COMMITTEE 2. INDEPENDENT COMPENSATION CONSULTANT 3. COMPENSATION SURVEYS OR STUDIES 4. APPROVAL BY THE BOARD OR COMPENSATION COMMITTEE Form 990, Part VI, Line 2 FAMILY/BUSINESS RELATIONSHIPS AMONGST INTERESTED PERSONS MICHAEL 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 MISSOURI NONPROFIT CORPORATION, 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 MOSAIC HEALTH SYSTEM, AS THE SOLE MEMBER OF NORTHWEST MEDICAL CENTER ASSOCIATION, INC. (MOSAIC-ALBANY) 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, AS 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. 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. Form 990, Part X, Column (A) Line 28 IN TAX YEAR 2022, NORTHWEST MEDICAL CENTER ASSOCIATION (MOSAIC-ALBANY) DETERMINED THAT IT WAS MORE APPROPRIATE TO INCLUDE IN COLUMN (B) (END OF YEAR) FOR LINE 28 (NET ASSETS WITH DONOR RESTRICTIONS) CERTAIN ITEMS INCLUDED IN PRIOR YEAR FORMS 990 IN LINE 27 (NET ASSETS WITHOUT DONOR RESTRICTIONS), RESPECTIVELY. CONFORMING ADJUSTMENTS HAVE BEEN MADE TO THE 2022 BEGINNING OF YEAR AMOUNTS LISTED IN COLUMN (A) OF PART X. 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, the parent corporation. FORM 990, PART VI, SECTION B, LINE 15 COMPENSATION IS ESTABLISHED BY MOSAIC HEALTH SYSTEM, A RELATED ENTITY. 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 ADMINISTRATORS. FOR EACH POSITION TO BE REVIEWED, THE FULL SCOPE OF DUTIES AND RESPONSIBILITIES, NUMBERS OF STAFF MANAGED, 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. 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