Truman Medical Center, Incorporated

Accountants Reports and Consolidated Financial Statements (Including Reports Required Under OMB A-133) June 30, 2011 and 2010

June 30, 2011 and 2010 Contents Independent Accountants Report on Financial Statements and Supplementary Information... 1 Consolidated Financial Statements Balance Sheets... 2 Statements of Operations... 3 Statements of Changes in Net Assets... 4 Statements of Cash Flows... 5 Notes to Financial Statements... 6 Supplementary Information Consolidating Schedules Balance Sheets Information... 29 Consolidating Schedules Statements of Operations Information... 33 Consolidating Schedules Statements of Changes in Net Assets Information... 35 Statements of Cash Flows Information Hospital Hill... 37 Schedule of Expenditures of Federal Awards... 38 Independent Accountants Report on Internal Control Over Financial Reporting and on Compliance and Other Matters Based on an Audit of the Financial Statements Performed in Accordance with Government Auditing Standards... 41 Independent Accountants Report on Compliance with Requirements That Could Have a Direct and Material Effect on Each Major Program and on Internal Control Over Compliance in Accordance with OMB Circular A-133... 43 Schedule of Findings and Questioned Costs... 45 Summary Schedule of Prior Audit Findings... 47

Independent Accountants Report on Financial Statements and Supplementary Information Board of Directors Truman Medical Center, Incorporated Kansas City, Missouri We have audited the accompanying consolidated balance sheets of Truman Medical Center, Incorporated as of June 30, 2011 and 2010, and the related consolidated statements of operations, changes in net assets and cash flows for the years then ended. These financial statements are the responsibility of the Medical Center s management. Our responsibility is to express an opinion on these financial statements based on our audits. We conducted our audits in accordance with auditing standards generally accepted in the United States of America and the standards applicable to financial audits contained in Government Auditing Standards, issued by the Comptroller General of the United States. Those standards require that we plan and perform the audit to obtain reasonable assurance about whether the financial statements are free of material misstatement. An audit includes examining, on a test basis, evidence supporting the amounts and disclosures in the financial statements. An audit also includes assessing the accounting principles used and significant estimates made by management, as well as evaluating the overall financial statement presentation. We believe that our audits provide a reasonable basis for our opinion. In our opinion, the consolidated financial statements referred to above present fairly, in all material respects, the financial position of Truman Medical Center, Incorporated as of June 30, 2011 and 2010, and the results of its operations, the changes in its net assets and its cash flows for the years then ended in conformity with accounting principles generally accepted in the United States of America. In accordance with Government Auditing Standards, we have also issued our report dated December 16, 2011, on our consideration of the Medical Center s internal control over financial reporting and our tests of its compliance with certain provisions of laws, regulations, contracts and grant agreements and other matters. The purpose of that report is to describe the scope of our testing of internal control over financial reporting and compliance and the results of that testing and not to provide an opinion on the internal control over financial reporting or on compliance. That report is an integral part of an audit performed in accordance with Government Auditing Standards and should be considered in assessing the results of our audits.

Board of Directors Truman Medical Center, Incorporated Page 2 Our audits were conducted for the purpose of forming an opinion on the basic consolidated financial statements taken as a whole. The accompanying supplementary information, including the consolidating information and the schedule of expenditures of federal awards required by U.S. Office of Management and Budget Circular A-133, Audits of States, Local Governments and Non-Profit Organizations, is presented for purposes of additional analysis and is not a required part of the basic consolidated financial statements. The consolidating information is presented for purposes of additional analysis of the basic consolidated financial statements rather than to present the financial position, results of operations, changes in net assets and cash flows of the individual organizations. Such information has been subjected to the procedures applied in the audits of the basic consolidated financial statements and, in our opinion, is fairly stated, in all material respects, in relation to the basic consolidated financial statements taken as a whole. Kansas City, Missouri December 16, 2011

Consolidated Balance Sheets June 30, 2011 and 2010 Assets 2011 2010 Current Assets Cash and cash equivalents $ 49,149 $ 136,713 Short-term investments - 500,000 Patient accounts receivable, net of allowance; 2011 - $50,749,000, 2010 - $47,949,000 49,687,245 49,334,720 Estimated amounts due from third-party payers 9,405,200 9,056,415 Medicaid incentive receivable 15,895,833 6,451,648 Other receivables 15,423,654 8,152,064 Recoverable grant expenditures 764,206 852,371 Supplies 3,219,159 2,750,763 Prepaid expenses and deposits 4,932,691 3,508,408 Assets limited as to use required for current liabilities 4,258,216 4,933,762 Total current assets 103,635,353 85,676,864 Assets Limited as to Use Designated for self-insured losses 24,527,876 22,398,746 Board designated for capital acquisitions and other uses 2,047,241 1,653,970 Held by Bond Trustee 10,524,943 - Advances to related parties - 11,563 Interest in net assets of Truman Medical Center Charitable Foundation 16,010,597 16,114,138 Externally restricted by donors 554,711 657,860 53,665,368 40,836,277 Less amount required to meet current obligations 4,258,216 4,933,762 Total assets limited as to use, net 49,407,152 35,902,515 Property and Equipment, Net 192,377,891 187,473,865 Deferred Financing Costs and Other Assets 12,441,849 12,056,756 Total Assets $ 357,862,245 $ 321,110,000 See Notes to Consolidated Financial Statements

Liabilities and Net Assets 2011 2010 Current Liabilities Current maturities of long-term debt $ 20,867,272 $ 13,786,722 Accounts payable 26,325,996 20,383,755 Accrued payroll and related liabilities 23,552,609 22,070,409 Accrued expenses 5,169,372 5,970,527 Other current liabilities 5,611,287 2,111,401 Total current liabilities 81,526,536 64,322,814 Long-term Debt 96,863,003 74,290,861 Accrued Self-Insured Losses 13,624,696 14,977,237 Accrued Pension Cost 37,586,078 41,990,672 Total liabilities 229,600,313 195,581,584 Net Assets Unrestricted 110,272,163 107,197,200 Temporarily restricted 14,921,871 15,268,518 Permanently restricted 3,067,898 3,062,698 Total net assets 128,261,932 125,528,416 Total Liabilities and Net Assets $ 357,862,245 $ 321,110,000 2

Consolidated Statements of Operations Years Ended June 30, 2011 and 2010 2011 2010 Unrestricted Revenues, Gains and Other Support Net patient service revenue $ 248,402,092 $ 236,677,635 Subsidies from Kansas City and Jackson County, Missouri 35,757,835 38,464,071 Medicaid enhancements 135,161,884 140,779,606 Reimbursement of expenses Salaries and special services 2,023,959 1,778,866 Grant expenditures 9,589,796 11,299,272 Other 19,897,794 4,399,945 Net assets released from restrictions used for operations 322,477 626,060 451,155,837 434,025,455 Expenses Salaries and wages 196,035,387 191,791,659 Employee benefits 46,854,931 40,921,336 Purchased services and professional fees 93,173,421 88,506,164 Depreciation and amortization 24,209,649 21,875,700 Interest 4,599,252 3,748,262 Provision for uncollectible accounts 18,281,297 17,279,942 Supplies and other 76,371,205 72,111,928 459,525,142 436,234,991 Operating Loss (8,369,305) (2,209,536) Non-operating Income Investment return 4,185,871 2,429,298 Other 53,923 52,673 4,239,794 2,481,971 Excess (Deficiency) of Revenues Over Expenses (4,129,511) 272,435 Net assets released from restrictions used for property acquisitions 204,727 1,695,273 Contributions for acquisition of property and equipment 2,008,060 6,142,925 Change in fair value of interest rate swap agreement - 40,160 Change in defined benefit pension plan gains and losses 4,991,687 (12,342,116) Increase (Decrease) in Unrestricted Net Assets $ 3,074,963 $ (4,191,323) See Notes to Consolidated Financial Statements 3

Consolidated Statements of Changes in Net Assets Years Ended June 30, 2011 and 2010 2011 2010 Unrestricted Net Assets Excess (deficiency) of revenues over expenses $ (4,129,511) $ 272,435 Net assets released from restrictions used for property acquisitions 204,727 1,695,273 Contributions for acquisition of property and equipment 2,008,060 6,142,925 Change in fair value of interest rate swap agreement - 40,160 Change in defined benefit pension plan gains and losses 4,991,687 (12,342,116) Increase (decrease) in unrestricted net assets 3,074,963 (4,191,323) Temporarily Restricted Net Assets Contributions and other increases 289,298 564,590 Net assets released from restrictions used for operations (322,477) (626,060) Net assets released from restrictions used for property acquisitions (204,727) (1,695,273) Change in interest in the net assets of Truman Medical Center Charitable Foundation (108,741) (7,740,500) Decrease in temporarily restricted net assets (346,647) (9,497,243) Permanently Restricted Net Assets Change in interest in the net assets of Truman Medical Center Charitable Foundation 5,200 - Increase in permanently restricted net assets 5,200 - Increase (Decrease) in Net Assets 2,733,516 (13,688,566) Net Assets, Beginning of Year 125,528,416 139,216,982 Net Assets, End of Year $ 128,261,932 $ 125,528,416 See Notes to Consolidated Financial Statements 4

Consolidated Statements of Cash Flows Years Ended June 30, 2011 and 2010 2011 2010 Operating Activities Increase (decrease) in net assets $ 2,733,516 $ (13,688,566) Adjustments to reconcile change in net assets to net cash provided by operating activities Depreciation and amortization 24,209,649 21,875,700 Contributions for acquisition of long-lived assets (2,008,060) (6,142,925) Loss on disposal of property and equipment 7,264 9,168 Unrealized gain on investments (2,389,380) (1,501,679) Change in interest in net assets of Truman Medical Center Charitable Foundation 103,541 7,740,500 Change in fair value of interest rate swap - (40,160) Changes in Net receivables (17,328,920) (5,881,515) Supplies (468,396) (16,265) Prepaid expenses and other assets (1,657,219) (137,627) Accounts payable and accrued expenses (740,069) 12,201,228 Other current liabilities 3,499,886 (217,592) Net cash provided by operating activities 5,961,812 14,200,267 Investing Activities Purchase of property and equipment (17,166,328) (27,900,590) Changes in investments and assets limited as to use (10,043,252) 1,524,579 Net cash used in investing activities (27,209,580) (26,376,011) Financing Activities Net proceeds on line of credit 5,678,218 - Proceeds from issuance of long-term debt 29,091,683 4,376,878 Principal payments on long-term debt (15,617,757) (9,507,634) Proceeds from contributions for acquisition of long-lived assets 2,008,060 6,142,925 Net cash provided by financing activities 21,160,204 1,012,169 Decrease in Cash and Cash Equivalents (87,564) (11,163,575) Cash and Cash Equivalents, Beginning of Year 136,713 11,300,288 Cash and Cash Equivalents, End of Year $ 49,149 $ 136,713 Additional Cash Flow Information Interest paid, net of capitalized interest $ 4,327,301 $ 3,570,019 Capital lease obligations incurred for property and equipment 10,417,265 2,796,918 Property and equipment purchases included in accounts payable 2,075,991 469,771 See Notes to Consolidated Financial Statements 5

Notes to Consolidated Financial Statements June 30, 2011 and 2010 Note 1: Nature of Operations and Summary of Significant Accounting Policies Nature of Operations Truman Medical Center, Incorporated (Medical Center) is a Missouri not-for-profit organization. Since its inception in 1962, the Medical Center has operated the Truman Medical Center Hospital Hill facility under various agreements with the City of Kansas City, Missouri; since 1973, pursuant to an agreement with Jackson County, Missouri, the Medical Center has operated the Truman Medical Center Lakewood facility; and since February 1, 1999, the Medical Center has operated TMC Behavioral Health, which results from TMC Behavioral Health merging with Network Rehabilitative Services for People with Mental Illness. The Medical Center leases, operates and manages the facilities under agreements with various political subdivisions that own the facilities. Principles of Consolidation The consolidated financial statements include the accounts of the Medical Center, Professional and General Liability Self-Insurance Trust (Self-Insurance Trust) and Truman Medical Center Finance Support Corporation (Finance Support Corporation). Although legally independent of the Medical Center, under accounting principles generally accepted in the United States of America the Self- Insurance Trust and Finance Support Corporation are considered controlled not-for-profit affiliates and are included in the consolidated financial statements. All significant inter-entity accounts and transactions have been eliminated in consolidation. Use of Estimates The preparation of financial statements in conformity with accounting principles generally accepted in the United States of America requires management to make estimates and assumptions that affect the reported amounts of assets and liabilities and disclosure of contingent assets and liabilities at the date of the financial statements and the reported amounts of revenues, expenses and other changes in net assets during the reporting period. Actual results could differ from those estimates. Cash Equivalents The Medical Center considers all liquid investments, other than those limited as to use, with original maturities of three months or less to be cash equivalents. At June 30, 2011 and 2010, cash equivalents consisted primarily of money market accounts. Pursuant to legislation enacted in 2010, the FDIC will fully insure all noninterest-bearing transaction accounts beginning December 31, 2010 through December 31, 2012, at all FDIC-insured institutions. Effective July 21, 2010, the FDIC s insurance limits were permanently increased to $250,000. At June 30, 2011, the Medical Center s cash accounts did not exceed federally insured limits. 6

Notes to Consolidated Financial Statements June 30, 2011 and 2010 Investments and Investment Return Investments in equity securities having a readily determinable fair value and in all debt securities are carried at fair value. Investment return includes dividend, interest and other investment income; and realized and unrealized gains and losses on investments carried at fair value. Investment return that is initially restricted by donor stipulation and for which the restriction will be satisfied in the same year is included in unrestricted net assets. Other investment return is reflected in the statements of operations and changes in net assets as unrestricted or temporarily restricted based upon the existence and nature of any donor or legally imposed restrictions. Patient Accounts Receivable The Medical Center reports patient accounts receivable for services rendered at net realizable amounts from third-party payers, patients and others. The Medical Center provides an allowance for doubtful accounts based upon a review of outstanding receivables, historical collection information and existing economic conditions. As a service to the patient, the Medical Center bills third-party payers directly and bills the patient when the patient s liability is determined. Patient accounts receivable are due in full when billed unless other payment arrangements are granted. Accounts are considered delinquent and subsequently written off as bad debts based on individual credit evaluation and specific circumstances of the account. Assets Limited as to Use Assets limited as to use include (1) assets held by bond trustees, (2) assets designated for self-insured losses, (3) advances to related parties, (4) assets restricted by donors, and (5) assets set aside by the Board of Directors for future capital improvements and other uses over which the Board retains control and may, at its discretion, subsequently use the assets for other purposes. Amounts required to meet current liabilities of the Medical Center are included in current assets. Supplies All supply inventories are stated at the lower of cost or market. Costs are determined using the first-in, first-out method. Property and Equipment and Depreciation Property and equipment acquisitions are recorded at cost and are depreciated using the straight-line method over the estimated useful life of each asset. Assets under capital lease obligations and leasehold improvements are amortized over the shorter of the lease term or their respective estimated useful lives. Amortization of assets subject to leases is reported as part of depreciation expense. The estimated useful lives for each major depreciable classification of property and equipment are as follows: Buildings and improvements Equipment 10-40 years 3-15 years 7

Notes to Consolidated Financial Statements June 30, 2011 and 2010 Donations of property and equipment are reported at fair value as an increase in unrestricted net assets unless use of the assets is restricted by the donor. Monetary gifts that must be used to acquire property and equipment are reported as restricted support. The expiration of such restrictions is reported as an increase in unrestricted net assets when the donated asset is placed in service. The Medical Center capitalizes interest costs as a component of construction in progress, based on interest costs of borrowing specifically for the project, net of interest earned on investments acquired with the proceeds of the borrowing. Total interest capitalized and incurred was: 2011 2010 Interest capitalized $ 122,868 $ - Interest charged to expense 4,599,252 3,748,262 Total interest incurred $ 4,722,120 $ 3,748,262 Long-lived Asset Impairment The Medical Center evaluates the recoverability of the carrying value of long-lived assets whenever events or circumstances indicate the carrying amount may not be recoverable. If a long-lived asset is tested for recoverability and the undiscounted estimate future cash flows expected to result from the use and eventual disposition of the asset is less than the carrying amount of the asset, the asset cost is adjusted to fair value and an impairment loss is recognized as the amount by which the carrying amount of a long-lived asset exceeds its fair value. No asset impairment was recognized during the years ended June 30, 2011 and 2010. Interest in Net Assets of Truman Medical Center Charitable Foundation Truman Medical Center Charitable Foundation (Foundation) and the Medical Center are financially interrelated organizations. The Foundation seeks private support for and holds net assets on behalf of the Medical Center. The Medical Center accounts for its interest in the net assets of the Foundation (Interest) in a manner similar to the equity method. Changes in the Interest are included in change in net assets. Transfers of assets between the Foundation and the Medical Center are recognized as increases or decreases in the Interest. Temporarily and Permanently Restricted Net Assets Temporarily restricted net assets are those whose use by the Medical Center has been limited by donors to a specific time period or purpose. Permanently restricted net assets have been restricted by donors to be maintained by the Medical Center in perpetuity. 8

Notes to Consolidated Financial Statements June 30, 2011 and 2010 Excess (Deficiency) of Revenues Over Expenses The consolidated statements of operations include excess (deficiency) of revenues over expenses. Changes in unrestricted net assets that are excluded from the excess (deficiency) of revenues over expenses, consistent with industry practice, include unrealized gains and losses on investments other than trading securities, changes in the fair value of the interest rate swap agreement, defined benefit pension plan unrecognized deferred items and contributions of long-lived assets, including assets acquired using contributions that, by donor restriction, were to be used for the purpose of acquiring such assets. Net Patient Service Revenue The Medical Center has agreements with third-party payers that provide for payments at amounts different from its established rates. Net patient service revenue is reported at the estimated net realizable amounts from patients, third-party payers and others for services rendered, including estimated retroactive adjustments under reimbursement agreements with third-party payers. Retroactive adjustments are accrued on an estimated basis in the period the related services are rendered and adjusted in future periods as final settlements are determined. Charity Care The Medical Center provides care without charge or at amounts less than its established rates to patients meeting certain criteria under its charity care policy. Gross patient charges are reduced by the amount of charity care provided. (See Note 2.) Contributions Unconditional promises to give cash and other assets are accrued at estimated fair value at the date each promise is received. The gifts are reported as either temporarily or permanently restricted support if they are received with donor stipulations that limit the use of the donated assets. When a donor restriction expires; that is, when a stipulated time restriction ends or purpose restriction is accomplished, temporarily restricted net assets are reclassified as unrestricted net assets and reported as an increase in unrestricted net assets. Receipts of contributions that are conditional are reported as liabilities until the condition is eliminated or the contributed assets are returned to the donor. Self-Insurance The Medical Center is self-insured with respect to medical and other professional liability, general liability, workers compensation claims and employee health insurance. The Professional and General Liability Self-Insurance Trust (Self-Insurance Trust), a separate legal entity, covers both the Medical Center and University Physicians Associates (UPA) for medical malpractice. It also covers the Medical Center for general liability. Estimated losses for both professional and general liability have been actuarially estimated and accrued on a discounted basis. This estimate and the estimates of workers compensation and employee health benefits liabilities are based on pending claims, the Medical Center s historical 9

Notes to Consolidated Financial Statements June 30, 2011 and 2010 claims experience and the experience of similar hospitals. Malpractice and general liability losses have been accrued at a discount rate of 5.00% and 6.00% for 2011 and 2010, respectively. The Medical Center, UPA and Truman Medical Center Charitable Foundation are the three participants of the Truman Medical Center Professional and General Liability Self-Insurance Trust (Self-Insurance Trust). The trust agreement defines each organization s responsibilities for participating in the program and defines the method in which funding contributions will be determined for the participants. Estimated losses are determined by an actuary. The Medical Center is a defendant in a number of malpractice and workers compensation lawsuits seeking damages. Management believes that the provision for malpractice, general liability and workers compensation losses is adequate to cover losses incurred to date, but the provisions are based on estimates and, therefore, the ultimate liability may be less or more than anticipated. Deferred Financing Costs Deferred financing costs are amortized over the term of the related indebtedness using the straight-line method. Income Tax Status The Medical Center, Self-Insurance Trust and Finance Support Corporation are not-for-profit organizations within the meaning of Section 501(c)(3) of the Internal Revenue Code and a similar provision of state law and are exempt from income taxes. However, the Medical Center, Self-Insurance Trust and Finance Support Corporation are subject to federal income tax on any unrelated business taxable income. There was no unrelated business taxable income for the years ended June 30, 2011 and 2010. With a few exceptions, the Medical Center is no longer subject to U.S. federal, state and local income tax examinations by tax authorities for years before 2008. Subsequent Events Subsequent events have been evaluated through December 16, 2011, which is the date the financial statements were issued. Reclassifications Certain reclassifications have been made to the 2010 financial statements to conform to the 2011 financial statement presentation. These reclassifications had no effect on the change in net assets. 10

Notes to Consolidated Financial Statements June 30, 2011 and 2010 Note 2: Net Patient Service Revenue and Patient Accounts Receivable The Medical Center has agreements with third-party payers that provide for payments to the Medical Center at amounts different from its established rates. These payment arrangements include: Medicare. Inpatient acute care services rendered to Medicare program beneficiaries are paid at prospectively determined rates per discharge. These rates vary according to a patient classification system that is based on clinical, diagnostic and other factors. Inpatient non-acute services, outpatient services and defined medical education costs related to Medicare beneficiaries are paid based on a combination of fee schedules and the outpatient prospective payment system. The Medical Center is reimbursed for certain services at tentative rates with final settlement determined after submission of annual cost reports by the Medical Center and audits thereof by the Medicare Administrative Contractor. Medicaid. Inpatient services rendered to Medicaid program beneficiaries are reimbursed based upon a prospectively determined per diem rate. Outpatient services are reimbursed based upon the defined allowable cost. The Medical Center is reimbursed at a tentative rate with final settlement determined after submission of annual cost reports by the Medical Center and audits thereof by the Medicaid program. The Medical Center is recognized as a nominal charge provider under the Medicare and Medicaid programs as the Medical Center s charges are lower than other facilities in relation to costs and services provided to patients regardless of their ability to pay. Approximately 60% and 61% of net patient service revenues are from participation in the Medicare and state-sponsored Medicaid programs for the years ended June 30, 2011 and 2010, respectively. The Medical Center has also entered into payment agreements with certain commercial insurance carriers, health maintenance organizations and preferred provider organizations. The basis for payment to the Medical Center under these agreements includes prospectively determined rates per discharge, discounts from established charges and prospectively determined daily rates. 11

Notes to Consolidated Financial Statements June 30, 2011 and 2010 Net patient service revenue as reflected in the accompanying consolidated statements of operations consists of the following: 2011 2010 Gross patient charges Inpatient $ 276,850,083 $ 269,200,837 Outpatient 332,600,134 310,015,079 Long-term care 10,141,733 9,704,905 619,591,950 588,920,821 Deductions from gross patient charges Contractual allowances Medicare 34,999,341 30,421,653 Medicaid 124,411,796 125,096,506 Other 61,746,379 61,925,482 Charity care 150,032,342 134,897,924 Prior years third-party settlements - (98,379) 371,189,858 352,243,186 Net patient service revenue $ 248,402,092 $ 236,677,635 Uncompensated care represents services provided to patients who are unable to pay. Uncompensated care includes charity care and provision for uncollectible accounts. The Medical Center measures these services at cost as follows: 2011 2010 Uncompensated care gross patient charges $168,313,639 $152,177,866 Cost-to-charge ratio 71.22% 71.16% Uncompensated care costs 119,864,949 108,295,574 The above table converts uncompensated patient charges to cost using a cost-to-charge ratio. The cost-to-charge ratio is calculated by dividing operating expenses excluding the provision for uncollectible accounts into gross patient charges. 12

Notes to Consolidated Financial Statements June 30, 2011 and 2010 Accounts Receivable Concentration of Credit Risk The Medical Center s facilities are located in Jackson County, Missouri. They grant credit without collateral to their patients, most of who are area residents and are insured under third-party payer agreements. The mix of net patient accounts receivable at June 30, 2011 and 2010 is as follows: 2011 2010 Medicaid 35% 36% Medicare 12% 15% Other third-party payers 44% 42% Uninsured patients 9% 7% 100% 100% Note 3: Property and Equipment As of June 30, 2011, the Medical Center has committed approximately $2,764,000 for costs related to various construction projects. A summary of property and equipment at June 30 is as follows: 2011 2010 Land $ 1,410,446 $ 1,015,174 Buildings and improvements 274,577,806 266,610,269 Equipment 151,259,667 129,395,234 427,247,919 397,020,677 Less accumulated depreciation 250,994,741 227,716,048 176,253,178 169,304,629 Construction in progress 16,124,713 18,169,236 $192,377,891 $187,473,865 13

Notes to Consolidated Financial Statements June 30, 2011 and 2010 Note 4: Assets Limited as to Use Assets limited as to use include the following: 2011 2010 Funds Funds Required Required for Current Long-term for Current Long-term Total Liabilities Portion Total Liabilities Portion Held by Bond Trustee Cash and cash equivalents $ 10,524,943 $ - $ 10,524,943 $ - $ - $ - Designated for Self-Insured Losses Cash and cash equivalents 606,347 606,347 434,581 434,581 Fixed income mutual funds 7,097,984 3,651,869 3,446,115 6,765,351 4,499,181 2,266,170 Equity mutual funds 7,489,038 7,489,038 6,599,024 6,599,024 Equity investments 2,378,938 2,378,938 2,160,144 2,160,144 Private investment funds 6,955,569 6,955,569 6,439,646 6,439,646 24,527,876 4,258,216 20,269,660 22,398,746 4,933,762 17,464,984 Designated for Capital Acquisitions and Other Uses Cash and cash equivalents 154,062 154,062 71,425 71,425 Fixed income mutual funds 1,100,421 1,100,421 931,430 931,430 Equity mutual funds 792,758 792,758 651,115 651,115 2,047,241 2,047,241 1,653,970 1,653,970 Advances to Related Party Charitable Foundation 11,563 11,563 Interest in Net Assets of Truman Medical Center Charitable Foundation 16,010,597 16,010,597 16,114,138 16,114,138 Externally Restricted by Donors Cash and cash equivalents 554,711 554,711 657,860 657,860 $ 53,665,368 $ 4,258,216 $ 49,407,152 $ 40,836,277 $ 4,933,762 $ 35,902,515 The total amount of assets held by the bond trustee is available for construction and the acquisition of property and equipment. 14

Notes to Consolidated Financial Statements June 30, 2011 and 2010 Private Investment Funds The Medical Center holds investments in certain entities that calculate net asset value per share or its equivalent. As of June 30, 2011 and 2010, the Medical Center was invested in $6,955,569 and $6,439,646, respectively, of multi-strategy hedge funds. These funds primarily utilize directional (long/short domestic and global equity), and absolute return strategies with the objective of protecting capital, providing returns uncorrelated to the broad United States equity market and earning attractive rates of return over time. The Medical Center s hedge funds require between 90 and 100 days of advance notice prior to redemption. Redemption payments may be delayed in the event of certain extraordinary circumstances including, but not limited to, an inability to liquidate existing positions or the default or delay in payments due the funds from brokers, banks or other persons, or when the disposal of part or all of the assets of the funds, or the determination of the net asset value of the shares, would not be reasonably practicable or would be seriously prejudicial to the non-redeeming shareholders. The Medical Center has elected to measure the private investment funds at fair value. Management has elected the fair value option for these items because it more accurately reflects the portfolio returns and financial position of the Medical Center. Changes in fair value for these items are reported in investment return in the accompanying consolidated statements of operations. Investment Return Total investment return is comprised of the following: 2011 2010 Interest and dividend income $ 1,518,421 $ 792,157 Realized gain on sales of securities 278,070 135,462 Unrealized gain on investments reported at fair value 2,389,380 1,501,679 $ 4,185,871 $ 2,429,298 15

Notes to Consolidated Financial Statements June 30, 2011 and 2010 Note 5: Temporarily and Permanently Restricted Net Assets Temporarily restricted net assets at June 30, 2011 and 2010 are available for the following purposes: 2011 2010 Health care services, research and education $ 1,979,172 $ 2,217,078 Interest in net assets of Truman Medical Center Charitable Foundation (see Note 8) 12,942,699 13,051,440 $ 14,921,871 $ 15,268,518 During 2011 and 2010, net assets were released from donor restrictions by incurring expenses satisfying the restricted purposes of health care services, research and education amounting to $322,477 and $626,060, respectively, and for property acquisitions amounting to $204,727 and $1,695,273, respectively. Permanently restricted net assets are restricted to: 2011 2010 Investments to be held in perpetuity at Truman Medical Center Charitable Foundation; the income is primarily restricted for the purpose of funding department chairman positions at The University of Missouri-Kansas City School of Medicine. (The Medical Center is the teaching facility for the UMKC School of Medicine.) $ 3,067,898 $ 3,062,698 16

Notes to Consolidated Financial Statements June 30, 2011 and 2010 Note 6: Long-term Debt 2011 2010 Leasehold Refunding and Improvement Revenue Bonds (A) $ 4,335,000 $ 5,580,000 Special Obligation Bonds (B) 24,485,000 - Health Facilities Revenue Bonds (C) - 4,365,000 Health Facilities Revenue Notes (D) 5,746,352 7,265,862 Special Obligation Bonds (E) 29,125,000 30,185,000 Special Obligation Bonds (F) 14,405,000 16,405,000 Note payable (G) 14,700,000 14,700,000 Revolving credit agreement (H) 5,678,218 - Other notes payable (I) 5,577,904 2,178,731 Capital lease obligations (J) 12,796,367 6,599,828 116,848,841 87,279,421 Plus unamortized premium 881,434 798,162 117,730,275 88,077,583 Less current maturities 20,867,272 13,786,722 $ 96,863,003 $ 74,290,861 (A) Leasehold Refunding and Improvement Revenue Bonds issued by the Jackson County, Missouri, Public Building Corporation, Series 2006, $4,335,000 maturing serially in varying amounts through 2016; semiannual interest payments at rates ranging from 4.5% to 5.0%. (B) Special Obligation Bonds issued by Jackson County, Missouri, Series 2011, $24,485,000 maturing serially in varying amounts through 2027; semiannual interest payments at rates ranging from 3.0% to 4.75%. (C) (D) Variable Rate Demand Health Facilities Revenue Bonds issued by the Health and Educational Facilities Authority of the State of Missouri, Series 2005, $4,365,000 of principal payments made in 2011 to redeem the bonds; monthly interest payments at variable rates as determined weekly by the remarketing agent. Health Facilities Revenue Notes issued by the Health and Educational Facilities Authority of the State of Missouri, Series 2006, due November 2018; $469,412 payable quarterly including interest at rates ranging from 5.20% to 5.435%. 17

Notes to Consolidated Financial Statements June 30, 2011 and 2010 (E) Special Obligation Bonds issued by the Jackson County, Missouri, Public Building Corporation, Series 2002, $1,990,000 maturing serially in varying amounts through 2017, $5,535,000 term bonds due December 1, 2015; $9,495,000 term bonds due December 1, 2022; $12,105,000 term bonds due December 1, 2027; semiannual interest payments at rates ranging from 5.0% to 5.5%; collateralized by real estate, including improvements thereon, together with all equipment purchased with proceeds of the bond issue. (F) Special Obligation Bonds issued by Jackson County, Missouri, Series 2001, $11,880,000 maturing serially in varying amounts through 2016; $2,525,000 term bonds maturing from 2011 through 2012; semiannual interest payments at rates ranging from 4.75% to 5.50%; collateralized by revenues of the County. (G) Notes payable, due January 2040; annual interest payments ranging from 1.95% to 2.65% through 2016 and annual principal and interest payments ranging from $170,885 to $752,711 beginning in 2017. (H) Revolving line of credit, provides for borrowing up to $10,500,000; monthly interest payments at 2% plus LIBOR; collateralized by property and equipment. In connection with the line of credit, the Medical Center is required, among other things, to comply with certain financial covenants, which include a minimum debt service coverage ratio and debt to EBIDA ratio. The Medical Center did not meet all of these covenants during 2011 and, as a result, any advances made under the line of credit would be due on demand. The bank waived the violations of these covenants through June 30, 2011. (I) Various notes due through January 2014; with interest rates ranging from 2.6% to 5.47%; collateralized by property and equipment. Included is a $3.6 million loan that requires the Medical Center, among other things, to comply with certain financial covenants, which include a minimum debt service coverage ratio and debt to EBIDA ratio. The Medical Center did not meet all of these covenants during 2011 and, as a result, the loan would be due on demand. The bank waived the violations of these covenants through June 30, 2011. (J) At varying rates of interest from 1.5% to 9.97%, due through February 2016; collateralized by buildings and equipment. 18

Notes to Consolidated Financial Statements June 30, 2011 and 2010 Aggregate annual maturities of the existing long-term debt and payments on capital lease obligations at June 30, 2011 are as follows: Year Ending June 30, Long-term Debt Capital Lease Obligations Total 2012 $ 15,659,617 $ 5,927,831 $ 21,587,448 2013 6,924,470 3,046,799 9,971,269 2014 6,425,607 2,064,169 8,489,776 2015 6,206,828 1,788,921 7,995,749 2016 6,514,665 923,681 7,438,346 Thereafter 62,321,287-62,321,287 $104,052,474 13,751,401 $117,803,875 Less amount representing interest 955,034 Present value of future minimum lease payments 12,796,367 Less current maturities 5,207,655 Noncurrent portion $ 7,588,712 Property and equipment include the following property under capital leases: 2011 2010 Building $ 3,620,446 $ 3,620,446 Equipment 18,370,866 6,868,209 21,991,312 10,488,655 Less accumulated depreciation 7,050,873 3,861,132 $ 14,940,439 $ 6,627,523 Note 7: Derivative Financial Instrument As a strategy to maintain acceptable levels of exposure to the risk of changes in future cash flows due to interest rate fluctuations, the Medical Center entered into an interest rate swap agreement to effectively convert the variable rate Series 2005 Bonds to bear interest at a fixed rate in September 2005. The agreement expired in September 2009. Under the agreement, the Medical Center pays or receives the net interest amount monthly, with the monthly settlements included in interest expense. 19

Notes to Consolidated Financial Statements June 30, 2011 and 2010 Management has designated the interest rate swap agreement as a cash flow hedging instrument. The derivative was evaluated for hedge ineffectiveness, noting it was effective; therefore, the Medical Center s derivative instrument is recorded at its fair value with subsequent changes in fair value included in unrestricted net assets. At June 30, 2010, a change in fair value of $40,160 was recorded for the derivative instrument. Note 8: Related Party Transactions Truman Medical Center Charitable Foundation The Medical Center receives contributions from the Truman Medical Center Charitable Foundation. The Foundation is authorized by the Medical Center to solicit contributions on its behalf. In the absence of donor restrictions, the Foundation has discretionary control over the amounts to be distributed, the timing of distributions and the purposes for which funds are to be used. The Medical Center received approximately $2,008,000 and $6,143,000 of contributions from the Foundation during the fiscal years ended June 30, 2011 and 2010, respectively. In December 1992, Truman Medical Center entered into a 20-year capital lease with the Foundation for space in the Hospital Hill Center Building. Monthly base rental payments are $25,939, with additional payments for the Medical Center s share of direct costs also due monthly. Note 9: Pension Plans Defined Contribution Plan The Medical Center has a defined contribution pension plan covering substantially all employees. The plan allows for employee contributions, subject to certain IRS contribution limits. The Medical Center matched 25% of the employee contributions up to 3% of compensation. Effective July 1, 2011, the match was suspended. Expense under this plan was $576,548 and $555,084 for 2011 and 2010, respectively. Defined Benefit Plan The Medical Center has a noncontributory defined benefit pension plan covering all employees who meet the eligibility requirements. The plan was amended and restated on January 1, 2009 to a cash balance pension plan. Plan participants who were age 55 with 15 years of vested services were grandfathered under the prior plan and will continue to earn benefits under that pension plan fo r- mula. Certain long-service participants who did not meet the grandfathering thresholds received a one-time transition credit contribution on January 1, 2009. The accrued benefit under the prior plan for non-grandfathered participants on January 1, 2009 was frozen and those plan participants as well as future plan participants will earn benefits under the cash balance plan formula. 20

Notes to Consolidated Financial Statements June 30, 2011 and 2010 The Medical Center s funding policy is to make the minimum annual contribution that is required by applicable regulations, plus such amounts as the Medical Center may determine to be appropriate from time to time. The Medical Center expects to contribute $8,897,000 to the plan in 2012. The Medical Center uses a June 30th measurement date for the plan. Significant balances, costs and assumptions are: 2011 2010 Change in Benefit Obligation Beginning of year $118,792,494 $ 98,875,409 Service cost 4,077,856 1,919,378 Interest cost 6,708,934 6,308,797 Actuarial loss 1,929,125 14,936,641 Benefits paid and expenses (3,781,250) (3,247,731) End of year 127,727,159 118,792,494 Change in Fair Value of Plan Assets Beginning of year 76,801,822 63,711,010 Actual return on plan assets 11,461,434 7,190,666 Employer contribution 5,659,075 9,147,877 Benefits paid and expenses (3,781,250) (3,247,731) End of year 90,141,081 76,801,822 Accrued pension cost $(37,586,078) $(41,990,672) 2011 2010 Weighted-average assumptions used to determine benefit obligations Discount rate 5.75% 5.75% Rate of compensation increase 2.00% 2.00% Weighted-average assumptions used to determine benefit costs Discount rate 5.75% 6.50% Expected return on plan assets 8.00% 8.00% Rate of compensation increase 2.00% 2.00% 21

Notes to Consolidated Financial Statements June 30, 2011 and 2010 The following table presents the components of net periodic pension cost as of June 30, 2011 and 2010: 2011 2010 Service cost $ 4,077,856 $ 1,919,378 Interest cost 6,708,934 6,308,797 Expected return on plan assets (6,241,688) (5,464,320) Amortization of actuarial loss 2,535,642 1,733,029 Amortization of prior service credit (834,576) (834,576) Net periodic pension expense $ 6,246,168 $ 3,662,308 The following amounts have been recognized in the consolidated statement of operations for the years ended June 30, 2011 and 2010: 2011 2010 Amounts arising during the period Net (gain) loss $ (3,290,621) $ 13,210,295 Amounts reclassifed as components of net periodic benefit cost of the period Net loss 2,535,642 1,733,029 Net prior service credit (834,576) (834,576) Amounts that have been recognized in unrestricted net assets but not yet recognized as components of net periodic benefit cost consist of: Amounts Expected to be Recognized Within One 2011 2010 Year Net loss $ 35,905,097 $ 41,731,360 $ 1,877,781 Net prior service credit (7,846,681) (8,681,257) (834,576) 22

Notes to Consolidated Financial Statements June 30, 2011 and 2010 The accumulated benefit obligation for the defined benefit pension plan was $126,531,824 and $116,988,817 at June 30, 2011 and 2010, respectively. The Medical Center has estimated the long-term rate of return on plan assets based primarily on historical returns on plan assets, adjusted for changes in target portfolio allocations and recent changes in long-term interest rates based on publicly available information. Plan assets are held by a bank-administered trust fund, which invests the plan assets in accordance with the provisions of the plan agreement. The plan agreement permits investment in common stocks, corporate bonds and debentures, U.S. Government securities, certain insurance contracts, real estate and other specified investments, based on certain target allocation percentages. The plan may invest in certain derivative securities, as long as the fair value of such instruments does not exceed 25% of plan assets. Asset allocation is primarily based on a strategy to provide stable earnings while still permitting the plan to recognize potentially higher returns through investment in equity securities. The target asset allocation percentages for 2011 and 2010 are as follows: Equity securities 40% - 70% Fixed income securities 15% - 25% Alternative investments 20% - 30% Defined Benefit Plan Assets Following is a description of the valuation methodologies used for pension plan assets measured at fair value on a recurring basis and recognized in the accompanying consolidated balance sheets, as well as the general classification of pension plan assets pursuant to the valuation hierarchy. Where quoted market prices are available in an active market, plan assets are classified within Level 1 of the valuation hierarchy. Level 1 plan assets include money market and mutual funds. If quoted market prices are not available, then fair values are estimated by using pricing models, quoted prices of plan assets with similar characteristics or discounted cash flows. For private investment funds, the net asset value reported by the funds was used to determine fair value. Level 2 investments include private investment funds measured at net asset value per share. In certain cases where Level 1 or Level 2 inputs are not available, plan assets are classified within Level 3. There were no Level 3 investments. 23

Notes to Consolidated Financial Statements June 30, 2011 and 2010 The fair values of Medical Center s pension plan assets at June 30, 2011 and 2010, by asset category are as follows: Fair Value Measurements Using Quoted Prices in Active Markets for Identical Assets Significant Other Observable Inputs Significant Unobservable Inputs (Level 1) (Level 2) (Level 3) Fair Value 2011 Money market funds $ 6,323,430 $ 6,323,430 $ - $ - Mutual funds 55,144,942 55,144,942 - - Private investment funds 28,672,709-28,672,709 - $ 90,141,081 $ 55,144,942 $ 28,672,709 $ - 2010 Money market funds $ 7,120,237 $ 7,120,237 $ - $ - Mutual funds 40,616,700 40,616,700 - - Private investment funds 29,064,885-29,064,885 - $ 76,801,822 $ 47,736,937 $ 29,064,885 $ - The following benefit payments, which reflect expected future service, as appropriate, are expected to be paid as of June 30, 2011: 2012 $ 4,863,749 2013 5,484,745 2014 6,007,184 2015 6,766,011 2016 7,601,010 2017-2021 50,150,704 Note 10: Medicaid Enhancements Medicaid enhancements represent supplemental funding received from Missouri s Medicaid program. These amounts include payments to reimburse the Medical Center for Medicaid costs not reimbursed through patient revenue as well as reimbursements for Medicaid s portion of the Medical Center s Graduate Medical Education cost. The Medicaid enhancements revenue reported in the consolidated statements of operations was $135,161,884 and $140,779,606 in fiscal years 2011 and 2010, respectively. 24

Notes to Consolidated Financial Statements June 30, 2011 and 2010 Note 11: Functional Expenses The Medical Center provides general health care services to residents within its geographic location. Expenses related to providing these services are as follows: 2011 2010 Health care services $ 372,674,890 $ 353,786,578 General and administrative 86,850,252 82,448,413 $ 459,525,142 $ 436,234,991 Note 12: Fair Value of Financial Instruments Accounting principles generally accepted in the United States of America define fair value as the price that would be received to sell an asset or paid to transfer a liability in an orderly transaction between market participants at the measurement date. They also specify a fair value hierarchy which requires an entity to maximize the use of observable inputs and minimize the use of unobservable inputs when measuring fair value and describe three levels of inputs that may be used to measure fair value: Level 1 Level 2 Level 3 Quoted prices in active markets for identical assets or liabilities Observable inputs other than Level 1 prices, such as quoted prices for similar assets or liabilities; quoted prices in markets that are not active; or other inputs that are observable or can be corroborated by observable market data for substantially the full term of the assets or liabilities Unobservable inputs that are supported by little or no market activity and that are significant to the fair value of the assets or liabilities Transfers in and out of Level 1 (quoted market prices), Level 2 (other significant observable inputs) and Level 3 (significant unobservable inputs) are recognized on the year ending date. Following is a description of the valuation methodologies used for assets and liabilities measured at fair value on a recurring basis and recognized in the accompanying consolidated balance sheets, as well as the general classification of such assets and liabilities pursuant to the valuation hierarchy. Investments Where quoted market prices are available in an active market, securities are classified within Level 1 of the valuation hierarchy. Level 1 securities include exchange traded equity securities, money market funds and mutual funds. Level 2 securities include private investment funds. For the private investment funds, the net asset value reported by the fund was used to determine fair value. In certain cases where Level 1 and Level 2 inputs are not available, securities are classified within Level 3 of the hierarchy. There were no Level 3 investments. 25