2021 William Jewell College ANNUAL REPORT THE AUTHORITY MISSION STATEMENT e The Mission of the Health and Educational Facili- g e ties Authority of the State of Missouri is to pro- l l o vide access to the capital markets in an effort to C l a lower the cost of health and educational services c i n in Missouri by providing high quality, readily h c available, low cost financing alternatives for e T Missouri public and private, nonprofit health and e t a educational institutions. t S The Health and Educational Facilities retirement and nursing homes, The validity of the Authority’s Act was Authority of the State of Missouri, specialized care centers and alcoholic upheld by the Missouri Supreme Court in created by an Act of the Missouri rehabilitation treatment centers. Menorah Medical Center vs. Health and General Assembly and operational in Educational financings include public Educational Facilities Authority of the State 1979, is empowered to make loans to universities, liberal arts colleges, major of Missouri 584 S. W. 2d 73 (MO 1979). any participating health or research universities and medical educational institution and to refund schools, institutions of specialized outstanding obligations, mortgages instruction, public school districts, or advances issued, made or given for private elementary and secondary the cost of facilities. schools and charter schools. AUTHORITY MEMBERSHIP The Act provides for seven members The Authority is self-funded, has no During 1995, the Authority was appointed by the Governor of the taxing power and receives no charged with developing guidelines State of Missouri, with the advice financial support or appropriations for, and the administration of, the and consent of the Senate. Each from the State. Direct Deposit Program, which member must be a resident of the provides strong credit ratings for State and no more than four The Authority assists not-for-profit Missouri school districts. The Authority members may be of the same institutions in borrowing funds at the also developed the HELP Program, political party. Members are lowest possible cost to provide which provides low interest loans to appointed for five year terms. quality medical and educational small and/or rural health care and Members continue to serve after services to Missouri residents. Interest educational facilities. expiration of their term until a paid on Authority bonds and notes is successor is appointed or they are exempt from federal and Missouri The Authority’s bonds and notes do reappointed. state income taxation, resulting in not constitute a debt or liability of the materially lower interest rates for State of Missouri or of any political AUTHORITY REPRESENTATIVES substantial savings on financing cost. subdivision thereof, within the Michael J. Stanard meaning of any State constitutional Executive Director Many types of health care and provision or statutory limitation. The Vincent M. Loretta educational institutions across the Authority has no taxing power. The Assistant Director state receive financing assistance credit supporting any Authority note Antoinette M. Wilcox from the Authority. Health care or bond issue is the credit of the Administrative Assistant financings have been arranged for individual borrowing institutions. The Thompson Coburn LLP health facilities ranging from fewer bonds and notes are limited General Counsel than 100 to over 1,000 beds, obligations of the Authority payable Columbia Capital Management, LLC including acute and primary care solely from payments made by the Financial Advisor facilities, teaching and research borrowing institution. centers, osteopathic hospitals, 1 TABLE OF CONTENTS THE AUTHORITY 1 CHAIR’S LETTER (BY MICHAEL E. HENZE) 3 AUTHORITY MEMBERS 4-5 FINANCING OPTIONS 6 PROGRAMS AND IMPACT ON MISSOURI ECONOMY 7 CITIES AND INSTITUTIONS 8-10 CUMULATIVE SUMMARY OF FINANCINGS 11-12 PROJECTS FINANCED 13-19 HELP! PROGRAM - DIRECT LOANS 20 s e c i v r e S r o i n e S n a r e h t u L 2 CHAIR LETTER As Chair of the Missouri Health and Educa(cid:31)onal Facili(cid:31)es Authority (MoHEFA) and on behalf of the Members and staff, I am proud to submit this Annual Report of the Authority for 2021. Once again it was a year full of uncertainty and we hope our borrowers and professional partners fared as well as possible. As 2022 progresses, the promise of more normalcy will be a welcome relief. Calendar year 2021 marked 43 years of capital financing ac(cid:31)vi(cid:31)es on behalf of Missouri’s numerous health and educa(cid:31)on- al ins(cid:31)tu(cid:31)ons. For over four decades, MoHEFA has provided lower-cost, readily accessible funding op(cid:31)ons for health and educa(cid:31)onal providers of all sizes and purposes represen(cid:31)ng all geographic areas of Missouri. MoHEFA ac(cid:31)vity since 1979 includes over 570 bond and note issues, over 65 direct loans to smaller borrowers and serving as program administrator on over 3000 public school district bond issues. More historic detail is included in this report. 2021 was a slighter slower year than typical in terms of number of transac(cid:31)ons with many ins(cid:31)tu(cid:31)ons s(cid:31)ll struggling to recover from pandemic-related shutdowns and restric(cid:31)ons, reduced enrollment, the demands of virtual educa(cid:31)on and health care, staffing shortages and so many other factors. However, the low interest rate environment provided very a(cid:27)rac(cid:31)ve terms for borrowers able to move forward with projects or refinancings. Several bond issues were ini(cid:31)ated late in 2021 and indicate more confident (cid:31)mes are ahead. The Authority adjusted several policies in recent years and remains dedicated to providing the best possible services for the wide range of health and educa(cid:31)onal ins(cid:31)tu(cid:31)ons in Missouri. One such change was the revised HELP! Program for small loans with a lower interest rate, more a(cid:27)rac(cid:31)ve terms and addi(cid:31)onal available funds. The Missouri School District Direct Deposit Program con(cid:31)nues to serve Missouri public school districts and now is in its 27th year of providing school bond credit enhancement. The Members of the Authority, and its staff and advisors, are honored to serve the State of Missouri and specifically the dozens of fine health care and educa(cid:31)onal ins(cid:31)tu(cid:31)ons in all corners of the State. As we move into 2022 early signs point to more op(cid:31)mism. Our Members, staff and advisors look forward to another year of providing capital financing opportu- ni(cid:31)es for our state’s world-class ins(cid:31)tu(cid:31)ons and helping to reduce the cost of health care and educa(cid:31)on for the ci(cid:31)zens of our State. m Michael E. Henze e t Chair of the Authority s y S h t l a e H l a n o i g e R e k a L 3 !"#$%&'()*(+&,-&( .$%"/(01(2$&(342$0/"(25 ! AUTHORITY MEMBERS R Mr. Henze, a resident of and Nursing Home in Yellville, Ark., and Hot Spring County AI Osage Beach, is the re(cid:14)red Memorial Hospital in Malvern, Ark., before being named H C chief execu(cid:14)ve officer of Lake administrator of Hot Spring County Memorial in 1981. He -Regional Health System in joined Lake Regional Health System as CEO in 1990. Mr. Henze E ZOsage Beach, Mo. He joined and his wife, Gerri, have three children and six grandchildren. N Ethe hospital in April 1990, and They enjoy spending (cid:14)me with their family, fishing the White Hoversaw a drama(cid:14)c expansion River in Arkansas and spending (cid:14)me on their farm in Macks E.of services and capital Creek, Mo. Term as a Member expires July 30, 2024. Limprovements. During his E RMr. Cavato, a resident of Univer- Atenure, three major AIsity City, Missouri is the principal H H Cexpansion/renova(cid:14)on projects Cand owner of JAC Consul(cid:14)ng, MIwere completed that shaped the current LRHS campus. This E LLC, providing consul(cid:14)ng and C included adding a heart program, oncology services and a VIadvisory services to local govern- three-story pa(cid:14)ent tower to house intensive care, cardiac - ments, non-profit agencies and O care and observa(cid:14)on units. The clinic system also was real estate development en(cid:14)(cid:14)es. T developed to improve access to care. Mr. Henze served on AServices include program V the board of the Missouri Hospital Associa(cid:14)on (MHA), Amanagement, real estate and serving as chair of the Board of Trustees (2007), and on Cdevelopment planning, project mul(cid:14)ple MHA board commi‹ees, including the Federal A.management, financial advisory Reimbursement Allowance, and Finance and Budget H and intergovernmental rela(cid:14)ons. PIn addi(cid:14)on to his long professional career in government and commi‹ees. He received MHA’s highest honor, the E Sfinance, Mr. Cavato has been very ac(cid:14)ve in the community as Dis(cid:14)nguished Service Award, in 2013 and its Visionary O an advisor, volunteer and board member of a number of Leadership Award in 2004. He also served as a delegate to J educa(cid:14)onal, non-profit, religious and governmental en(cid:14)(cid:14)es. the American Hospital Associa(cid:14)on Regional Policy Board and He has served as a board member of Cardinal Ri‹er College as a member of the board of Healthcare Services Group, a Prep High School, Barat Academy, Beyond Housing, the medical malprac(cid:14)ce carrier, serving as chair (2005-2008). Missouri Workforce Housing Associa(cid:14)on and the Saint Louis Originally from Conway, Ark., Henze earned a bachelor’s University Urban Planning and Real Estate Development degree in business and economics from Hendrix College in Program. Term as a Member expired July 30, 2013. Conway, Ark., in 1976, and a master’s degree in business administra(cid:14)on from the University of Central Arkansas in 1979. He served as controller at Marion County Hospital (continued on next column) R Mr. George, a resident of St. Louis, Missouri is the re(cid:14)red President of the Interna(cid:14)onal Brotherhood of Electrical Workers E R (IBEW) Local One in St. Louis. Prior to serving as President since 1998 he served various other roles for Local One including U S Registrar, Instructor, Business Agent, Organizer and as Trustee for several different funds. He is a lifelong Journeyman Wireman. A E In addi(cid:14)on to his professional career, Mr. George was elected to four terms as a Member of the Missouri House of R T Representa(cid:14)ves from the 74th district represen(cid:14)ng a por(cid:14)on of north St. Louis County. He was - E Chairman or Vice Chairman of the Labor Commi‹ee, Workforce Development and Workplace Safety G Commi‹ee and the Municipal Corpora(cid:14)on Commi‹ee. His other commi‹ee memberships included R O Missouri Job Training Legisla(cid:14)ve Oversight; Local Government; Appropria(cid:14)on - Natural and E Economic Resources; Insurance; Communica(cid:14)ons, Energy and Technology; and Employment G Security and Unemployment Benefits Workers Compensa(cid:14)on. He has been honored as the Thomas . E F. Eagleton Grassroots Democrat of the Year. Mr. George also served six years with the 138th S Infantry of the Missouri Na(cid:14)onal Guard. Term as a Member expired July 30, 2015. A M O H T 4 AUTHORITY MEMBERS RMrs. Sco(cid:23), a resident of Poplar RMs. Maguffee,of Colum- E E BBluff, Missouri, is the Execu(cid:8)ve Bbia, Missouri, is an a orney M M EDirector of the Three Rivers Eand clerk to Judge Karen M M T - SChoem mis uan itgyr aCdoullaetgee oFfo uSntedpah(cid:8)eonns. E - oKifn Agp Mpeitaclhse, lWl, eMsitsesronu Drii sCtoriucrtt. E TCollege and The University of FShe is a former partner at O F CMissouri and earned a Masters UHusch Blackwell, LLP, in Jeffer- Sof Arts in English from Southeast Gson City, Missouri, where she A W.Missouri State University. Mrs. Mprac(cid:8)ced law from 1996 to Sco has more than 50 years of 2009, when she le˜ to become H . R Texperience as a college educator a stay-at-home mother. At H I Dand administrator having served many roles at Three Rivers AHusch, Ms. Maguffee successfully counseled clients from U R Community College including English instructor, Chair of such diverse industries as banking and finance, construc- J A the English Department, Chair of the Humani(cid:8)es Division, S(cid:8)on and land development, and manufacturing, regarding Vice President for College Advancement and her current federal, state, and local environmental, health, and safety posi(cid:8)on with the Founda(cid:8)on. Mrs. Sco received the compliance, audits, self-repor(cid:8)ng of viola(cid:8)ons, and Governor's Award for Excellence in Teaching, was awarded enforcement ac(cid:8)ons. She also advised clients regarding the Dis(cid:8)nguished Alumni Award from the College of Arts environmental issues that arise in commercial transac- and Sciences at The University of Missouri and received (cid:8)ons, including real estate deals and bankruptcy. Prior to the Faculty-Alumni Award from the MU Alumni joining Husch, Ms. Maguffee prac(cid:8)ced law in Washington, Associa(cid:8)on. She is a charter member of the Griffiths D.C., where she represented chemical manufacturers and Leadership Society for Women at The University of transporters on a variety of legisla(cid:8)ve, regulatory, and Missouri, and in 2006 received the Na(cid:8)onal Ins(cid:8)tute for enforcement issues. Staff and Organiza(cid:8)on Development (NISOD) Excellence A graduate of Bates College and the University of Michigan Award. She has been appointed to serve on several Law School, Ms. Maguffee served on the Board of statewide boards, including an appointment by Governor Directors of the Food Bank for Central & Northeast John Ashcro˜ to the Missouri Lo ery Commission, a Missouri for 9 years, the last 2 as Board President. She is posi(cid:8)on she held from 1991-96. Governor Christopher currently President of the Board of Directors of the Mary Bond appointed Mrs. Sco to the Missouri Health and Lee Johnston Community Learning Center in Columbia. Educa(cid:8)onal Facili(cid:8)es Authority (MoHEFA) where she She is ac(cid:8)ve in King's Daughters and several other civic and served from 1984-1991. In 2007 Governor Ma Blunt charitable organiza(cid:8)ons. Governor Jay Nixon appointed appointed her to her current MoHEFA term. Mrs. Sco is Ms. Maguffee to the Missouri Health and Educa(cid:8)onal ac(cid:8)ve in various community organiza(cid:8)ons including the Facili(cid:8)es Authority. Term as a Member expired July 30, Poplar Bluff Public Library Board of Trustees, Chamber of 2013. Commerce, University of Missouri Alumni Associa(cid:8)on, P.E.O., Southeast Missouri Kappa Alpha Theta Rush, Rotary Interna(cid:8)onal and Poplar Bluff’s First United Methodist e Church. Term as a Member expired July 30, 2011. g e l l o C l l e w e J m a i l l i W 5 FINANCING OPTIONS The Authority assists health care and educational institutions in financing equipment purchases and capital projects at the lowest possible cost. Financing options that the Authority offers to Missouri institutions consist of the following debt instruments: VARIABLE FLOATING RATE BONDS REFUNDING OF PRIOR DEBT While these instruments have a nominal long-term Health care and educa(cid:127)onal ins(cid:127)tu(cid:127)ons oˆen refinance to maturity, the interest rate is adjusted periodically (usually take advantage of lower interest rates in the market place daily or weekly). The borrower is able to take advantage of than existed at the (cid:127)me of prior financing. Similarly, such low short-term rates, but also, if condi(cid:127)ons warrant, to ins(cid:127)tu(cid:127)ons oˆen wish to avoid restric(cid:127)ve covenants or lock in a fixed interest rate without many of the costs collateral requirements contained in a prior financing that associated with a new issuance of bonds. would no longer be necessary in a new financing. The Authority has the ability to issue “current refunding FIXED RATE SHORT TO INTERMEDIATE bonds” which can accomplish these goals. Such bonds oˆen can be issued to refund the ins(cid:127)tu(cid:127)on’s obliga(cid:127)ons TERM BONDS A varia(cid:127)on of tradi(cid:127)onal fixed rate long-term bonds, these even if the Authority was not involved in the original fully amor(cid:127)zed bonds are for borrowers who desire shorter financing. Current refunding depends on the terms of the prepayment provisions and can generate sufficient prior financing, current market condi(cid:127)ons, exis(cid:127)ng bond revenues to re(cid:127)re the principal over a shorter maturity. The holders and (cid:127)ming, and require that the prior bonds be bonds are generally issued for periods ranging from 10-15 redeemed within 90 days of issuance of the new bonds. years, with a 5-8 year prepayment provision. FIXED RATE LONG-TERM BONDS These tradi(cid:127)onal 20 to 60 year fully amor(cid:127)zed term bonds are issued at prevailing market rates. This type of instrument offers the security of fixed rates and the alm ne opportunity to stabilize interest costs in a vola(cid:127)le market ot s while matching a longer term liability with the expected giy useful life of the asset. eS Rh t el ka FLOATING OR FIXED RATE NOTES ae The interest rate on these one to two year notes either LH floats, with the rate adjusted periodically, or is fixed for its term. The borrower is able to take advantage of lower interest rates while planning long-term financing according to projected needs. 6 PROGRAMS MISSOURI SCHOOL DISTRICT DIRECT DEPOSIT PROGRAM ADVANCE FUNDING PROGRAM In 1995, the Missouri Legislature adopted Senate Bill No. 301 which sets forth the In 1985 the Authority and the Missouri development of a program to assist Missouri school districts with their financing School Boards Associaƒon established the needs. The Direct Deposit Program, administered by the Authority, provides a Missouri School District Advance Funding major benefit to school districts issuing general obligaƒon bonds. Program to provide the lowest cost financ- In an effort to improve the credit quality of all school districts in Missouri, the ing available for Missouri school districts Program, effecƒvely, provides for credit enhancement by authorizing the direct and public community junior colleges to deposit, by the State of Missouri to a bank serving as trustee, of a porƒon of state fund any cash flow deficits that might occur aid payments that would otherwise be paid directly to the involved school in their various funds during the fiscal year. district. The direct deposit amount is equal to debt service on the school district Some of the advantages of parƒcipaƒng in bonds. This procedure results in a credit raƒng in the second highest raƒng the program include low borrowing rates, category (i.e. “AA+”), resulƒng in aŽracƒve interest rates on the bonds at no high investment rates, costs of issuance addiƒonal cost to the parƒcipaƒng district. shared by all parƒcipants and easy access to funds. Since 1985, almost $1.18 billion As of June 30, 2021, a total of 2,961 financings have been processed through the program, represen(cid:1)ng $17.8 billion of bonds issued benefi(cid:1)ng school districts in all has been loaned to parƒcipants under the Missouri coun(cid:1)es and the City of St. Louis. Advance Funding Program. HELP! PROGRAM IMPACT ON MISSOURI ECONOMY The Authority, recognizing the difficulty that small providers of health care and A Study recently was completed by IHS Markit Economics as to the economic impact of educaƒonal services experience obtaining MoHEFA's bonds on Missouri's economy in terms of jobs, construction, purchasing, adequate financing for their capital needs, utilities and other matters. The Study considered the recent ten year period and deter in 1995 created the HELP! Program to mined the following: provide these organizaƒons access to low MoHEFA issued $5.62 billion ($562 million annually) in new financing for cost loans. Through the HELP! Program, the construction and capital projects for health and educational facilities throughout Authority loans up to $500,000 for a maxi- Missouri mum of ten years at aŽracƒve interest rates to small health care and educaƒonal These financings boosted the labor market growth and supported 6691 jobs providers. 53 insƒtuƒons have taken annually with wages above the State average advantage of the benefits of this program Similarly, MoHEFA financings in that period supported $362 million in labor and for a total of over $16,824,389 in loans. $473 million in GDP annually Additionally, during MoHEFA's early history, 1979-2006, bond issuance supported HIGHER EDUCATION WORKING CAPITAL LOAN PROGRAM annual totals of 5916 jobs, $412 million of GDP and $339 million of labor income During 1997, the Authority established the The projects financed create long term economic value through the health and Higher Educaƒon Working Capital Loan educational services provided by the institutions thereby increasing the quality of Program to help alleviate cash flow difficul- life in Missouri and the competitiveness of the State ƒes that are typically experienced during Health and education is the second largest part of each fiscal year by higher educa- employment sector in Missouri accounting for ƒonal insƒtuƒons. The Program allows 16% of the State's employment parƒcipaƒng insƒtuƒons to borrow money under an advance funding agreement to Had these financings not been completed over provide funds during that porƒon of its the last ten years, Missouri could have lost another 2967 construction jobs current fiscal year when funds are not yet on hand to pay expenses as incurred. MoHEFA's financing options provide low-cost financing for capital projects when needed As of December 31, 2021, $243.2 million of most and even in challenging economic times notes have been issued under this program. 7 CCCIIITTTIIIEEESSS AAANNNDDD IIINNNSSSTTTIIITTTUUUTTTIIIOOONNNSSS CCCIIITTTIIIEEESSS AAANNNDDD IIINNNSSSTTTIIITTTUUUTTTIIIOOONNNSSS Aurora Columbia Kohoka Linn St. Louis Area • Lutheran H.S. of St. Charles County • Mercy Hospital • Burrell Behavioral Health • Preferred Family Healthcare • State Technical College of Missouri • Ascension Health • Preferred Family Healthcare • Preferred Family Healthcare • Tolton Regional Catholic High School Kansas City Area Louisiana • Anheuser Busch Eye Ins†tute St. Robert Ava • Family Health Center • Academie Lafaye‹e • Dialysis Clinic, Inc. • ARCH - Area Rescue Consor†um of Hospitals • Preferred Family Healthcare • Deaconess Long Term Care • Lenoir Re(cid:4)rement Community • Avila University Macon • A.T. S†ll University of Health Sciences Sedalia • Preferred Family Healthcare • Preferred Family Healthcare • Bap(cid:4)st Medical Center • Dialysis Clinic, Inc. • BJC - Barnes-Jewish Hospital • Katy Trail Community Health Belleview • Woodhaven Learning Center • The Barstow School • Macon County Samaritan Memorial Hospital • BJC - Barnes-Jewish West • Preferred Family Healthcare • Deaconess Long Term Care • Stephens College • Children’s Mercy Hospital Marshall • Bethesda Barclay House Sikeston • The University of Missouri • Compass Health • Bethesda Gardens Belton • John Fitzgibbon Memorial Hospital • Missouri Delta Medical Center Crystal City • Coordinated Professional Services • Bethesda Health Group • Dialysis Clinic, Inc. • Missouri Valley College Smithville • Mercy Jefferson Regional Medical Center • Crossroads Charter Schools • Bethesda West Blue Springs Desloge • Deaconess Long Term Care Maryville • BJC - Health Care • Saint Luke’s Northland Hospital • St. Mary’s Medical Center • Preferred Family Healthcare • Dialysis Clinic, Inc. • SSM - St. Francis Hospital • BJC - Missouri Bap†st Medical Center Springfield • Saint Luke’s Health System • Health Midwest Marshfield • John Burroughs School • Advocates for a Healthy Community Edina Bolivar • Kansas City Academy • Deaconess Long Term Care • SSM - Cardinal Glennon Children’s Hospital • Assemblies of God Financial Services • Preferred Family Healthcare • Ci(cid:143)zens Memorial Healthcare • Kansas City Art Ins(cid:4)tute • Advocates for a Healthy Community • Central Ins†tute for the Deaf Group • CoxHealth Eldorado Springs • Kansas City Univ. of Medicine & Biosciences Mexico • Chris†an Brothers College High School • Burrell Behavioral Health • Preferred Family Healthcare • Preferred Family Healthcare • LifeFlight Eagle • Audrain Medical Center • Chris†an Horizons, Inc. • CoxHealth • Southwest Bap(cid:143)st University Ellington • Menorah Medical Center Moberly • BJC - Chris†an Hospitals • Drury University Bonne Terre • Reynolds County Memorial Hospital • Mosaic Life Care • Preferred Family Healthcare • City Academy • Evangel University • BJC-Parkland Health Center Fairfax • The Pembroke Hill School • Dialysis Clinic, Inc. • Clayton Academy • Forest Ins†tute of Professional Boonville • Community Hospital Associa(cid:4)on • Preferred Family Healthcare Monett • The Community School Psychology • Dialysis Clinic, Inc. Farmington • Rockhurst High School • Cox Health • Deaconess Health Services • Mercy Hospital • Rockhurst University • SSM-DePaul Health Center • Missouri State University • Family Health Center • Mineral Area Regional Medical Center • Deaconess Long Term Care • Saint Luke’s Hospital • DeSmet Jesuit High School • Preferred Family Healthcare • Kemper Military School and College • BJC - Parkland Health Center • Saint Luke’s Northland Hospital Montgomery City • Family Care Health Centers Sweet Springs • Valley Hope Associa(cid:143)on Fayette • Saint Luke’s Health System • Preferred Family Healthcare • Fontbonne University • I-70 Community Hospital Branson • Central Methodist University • Sherwood Au(cid:4)sm Center Mountain View • Forsyth School Sullivan • Preferred Family Healthcare Forsyth • St. Joseph Health Center • Mercy St. Francis Hospital • Incarnate Word Hospital • BJC - Missouri Bap†st Hospital • CoxHealth - Skaggs • Preferred Family Healthcare • St. Pius X High School Neosho • KIPP-St. Louis Trenton Brookfield Fulton • Stowers Ins(cid:4)tute for Medical Research • Freeman Neosho Hospital • Lutheran Church Extension Fund • LifeFlight Eagle • Preferred Family Healthcare • Westminster College • Swope Parkway Health Center • Preferred Family Healthcare • Lutheran High School Associa†on • North Central Missouri College Buffalo • William Woods University • Trinity Lutheran Hospital • Lutheran Senior Services Nevada • Preferred Family Healthcare • Deaconess Long Term Care Hannibal • Truman Medical Centers • Preferred Family Healthcare • Mary Ins†tute & St. Louis Country Day Sch. • Saint Luke’s Wright Memorial Hospital Camdenton • Hannibal - LaGrange College • The University of Missouri - Kansas City • Maryville University • Preferred Family Healthcare • Preferred Family Healthcare • YMCA of Greater Kansas City O’Fallon • Mercy Health Troy • BJC - Progress West Health Center • Mercy Hospital • Preferred Family Healthcare Canton Harrisonville Kingsville • Living Word Chris(cid:4)an School • Mercy South Union • Culver-Stockton College • Deaconess Long Term Care • Western Johnson County Health Clinic Osage Beach • Miriam School and Founda†on • Preferred Family Healthcare Cape Girardeau • LifeFlight Eagle Kirksville • Dialysis Clinic, Inc. • Missouri Bap†st University Unionville • Preferred Family Healthcare • Preferred Family Healthcare • Dialysis Clinic, Inc. • Lake Regional Health System • Mother of Good Counsel Home • Putnam County Memorial Hospital • Saint Francis Medical Center Hayti • A.T. S(cid:4)ll University of Health Sciences Parkville • Na†onal Benevolent Associa†on • Southeast Health • Pemiscot County Health System • Northeast Missouri Health Council • Park University • Preferred Family Healthcare Versailles • Southeast Missouri State University Hermitage • Preferred Family Healthcare • Ranken Technical College • Katy Trail Community Health Poplar Bluff Carthage • Ozarks Community Health Center Lake St. Louis • Saint Louis Priory School Warrensburg • Preferred Family Healthcare • Mercy Hospital Hollister • Preferred Family Healthcare • Saint Louis University • University of Central Missouri Cassville • Advocates for a Healthy Community • SSM - St. Joseph Hospital West Potosi • St. Alexius Hospital Warrenton • Deaconess Long Term Care Lebanon • St. Anthony’s Medical Center • Preferred Family Healthcare • Deaconess Long Term Care Humansville • Preferred Family Healthcare • Mercy Hospital • Deaconess Long Term Care • Laclede County Healthcare Consor(cid:4)um • SSM-St. Clare Health Center Washington Chesterfield Independence •• MPreefrecyrr Hedo sFpaimtailly Healthcare R• Molilsasouri University of Science & •• SSSt.M Lo-Suti.s J Cohseaprthe rK Sirckhwoooold • Mercy Hospital •• LBoagraatn A Ccoaldleegme yof Chiroprac(cid:4)c • Children’s Mercy Hospital Lee’s Summit Technology • BJC-St. Louis Children’s Hospital W• Leutldheorann SCphurrinchg Esxtension Fund Jefferson City • Preferred Family Healthcare • St. Louis University High School • Preferred Family Healthcare • John Knox Village • Messiah Lutheran School • St. Luke’s Episcopal - Presbyterian • Capital Region Medical Center • Preferred Family Healthcare Salisbury • St. Luke’s Episcopal - Presbyterian South Wentzville Hospitals • Dialysis Clinic, Inc. • Saint Luke’s East Hospital • Family Health Center • SSM - St. Mary’s Health Center • Compass Health • Preferred Family Healthcare • St. Michael the Archangel H.S. St. Charles • SSM Health Care Chillicothe • SSM - St. Mary’s Health Center • The University of Missouri - St. Louis • Preferred Family Healthcare • Summit Chris(cid:4)an Academy • Campbell Montessori School • Hedrick Medical Center Joplin Lewistown • Parkside Meadows • The Visita†on Academy • SSM - St. Joseph Health Center • Preferred Family Healthcare • Chris(cid:4)an Horizons, Inc. • Deaconess Long Term Care • Preferred Family Healthcare • The Washington University West Plains Clinton • Freeman Health System • SSM-St. Joseph’s Medical Center • University of Health Sciences & Pharmacy • Dialysis Clinic, Inc. • Compass Health • Mercy Hospital Liberty in St. Louis • Preferred Family Healthcare • Dialysis Clinic, Inc. • Missouri Southern State University • Preferred Family Healthcare St. Joseph • Webster University • Missouri State University • LifeFlight Eagle • Preferred Family Healthcare • William Jewell College • Mosaic Life Care St. Peters Winfield • Northwest Missouri Health Services • Preferred Family Healthcare • BJC-Barnes-Jewish St. Peters • Preferred Family Healthcare • Preferred Family Healthcare • Compass Health 8 CCCIIITTTIIIEEESSSC AAAITNNNIEDDDS III NNNASSSNTTTDIIITTT IUUUNTTTSIIIOOOTINNNTSSSUTIONS CCCIIITTTIIIEEESSSC AAAITNNNIEDDDS III NNNASSSNTTTDIIITTT IUUUNTTTSIIIOOOTINNNTUSSS TIONS Aurora Aurora Columbia Columbia Kohoka Kohoka Linn Linn St. Louis Area St. Louis Area • Lutheran H.S. of St. •C hLaurtlhees rCaonu Hn.tSy. of St. Charles County • Mercy Hospital • Mercy Hospital • Burrell Behavioral H•e aBluthrrell Behavioral Health • Preferred Family He•a lPthrecafererred Family Healthcare • State Technical Colle•g Set oatf eM Tiescshonuircial College of Mi•ss Aosucreinsion Health • Ascension Health • Preferred Family He•a lPthrecafererred Family Healthcare • Preferred Family He•a lPthrecafererred Family Healthcare• Tolton Regional Cath•o Tliocl tHoing hR eSgchioonoall Catholic HigKh aScnhsoaosl City AreKaansas City Area Louisiana Louisiana • Anheuser Busch Eye• I nAsn†hteuuteser Busch Eye Ins(cid:14)tute St. Robert St. Robert Ava Ava • Family Health Cente•r Family Health Center • Academie Lafaye‹e• Academie LafayeŠe • Dialysis Clinic, Inc. • Dialysis Clinic, Inc. • ARCH - Area Rescue• C AoRnsCoHr †- uAmre ao fR Heoscsupeit aClosnsor(cid:14)u•m P oref fHeorrsepdit Faalsmily He•a lPthrecafererred Family Healthcare • Deaconess Long Term• D Ceaarceoness Long Term Care• Lenoir Re(cid:4)rement C•o mLemnouinr iRtye(cid:1)rement Commun•it yAvila University • Avila University Macon Macon • A.T. S†ll University o•f HA.eTa. lSt(cid:14)hl lS Ucineinvceerssity of Health SScieendcaeslia Sedalia • Preferred Family He•a lPthrecafererred Family Healthcare• Preferred Family He•a lPthrecafererred Family Healthcare• Bap(cid:4)st Medical Cen•te Brap(cid:14)st Medical Center • Dialysis Clinic, Inc. • Dialysis Clinic, Inc. • BJC - Barnes-Jewish •H BoJsCp i-t aBlarnes-Jewish Hospital • Katy Trail Communit•y KHaetayl tThrail Community Health Belleview Belleview • Woodhaven Learnin•g WCeonotdehraven Learning Cente•r The Barstow School• The Barstow School • Macon County Sama•r iMtaanc Mone Cmoourniatly H Soasmpaitraitlan Me•m BoJrCi a-l BHaorsnpeist-aJlewish •W BeJsCt - Barnes-Jewish West • Preferred Family He•a lPthrecafererred Family Healthcare ••B•B•B• SDDSCelouatiei(cid:143)ll.ai tieanMzlvoycte so aSannLinrsurspy e kCM’rseslsii ’enMns Lm iHcoge,oned sIragincil acTtalh.el H rCSmBBB•••••eey aDDSSCsn eloCtultaiteite(cid:143)ll.aaeih tieanmMrzlrvocycete aso aSannLirnrsursepy e kCM’rseslsii ’enMns Lm iHcoge,oned sIraginci lacTtalh.el H rCSmeeyans CtltteaehmrrceaC•D•E•••re dMPPSTrethrryieseeenespffrl eecoaUthyrraengrr Jeelnieve ddsCeff CFFreisaaotrimmsytllyoeii nllgoyy efR HHMeeegiC•D•E•••aaiso llsdMPPSTttrenohhthrryiaueseeeccneslaaprffrl eeMicoaUtrrhyeerraengrre Jeelnideve ddsCieffc CFFreaisaaotlri mmsytlClyoeeii nllgonyy eftR HHeMereegiaaisollsttnohhaucclaar Mirree•••••••••e dCCDCCDHKKioaaorhcieeaonnmaoiaallslssdyrcl sptaadCsorhraessiieonsn snMnCC aesaC’tdiis stttliHes iedsyyMnr edw LCiAAaco ehePcr,lnrt tasraIch gotnrdIyn tfcT eeeHs.emrs(cid:4)or sSt•m••••••••ysiuco pCDCCCHKKD htnCieoaaorhtieeoaaaoannmoiaaollrlls ssdyrclelSsptaadssorehraessiionsrn snMCC vaesaC’idiis stcttliHs iedsyyeMn edw LsCiAAaco ehePcr,lnrt tasraIch gotnrdIyn tfcT eeeHs.emrs(cid:14)or sStmysiucop htnCietoaaaolrl elSservices M••M•M•• AJMSDoaaaSdehiMrrrsvansyssoc o -hhovcF uaSniiafitrtlteziel.le gs elVsFsil abr fdLaolbloneron cyanig s CH M THoeeleoarlemms•M••M•M•ltgp hoAJMSD eiCoaaaytSrdeaaih iMrrraCsvalrnsyssoleco o H-hhovcFm uaSnioiafitrmtltesziel.le pgs elVusFsiil abnrt fdLaaolbilotnleroyn cyanig s CH M THoeeleoarlemmsltgpho eiCytraai aClrleo Hmo•••••••••ms pCBBBBBBJSuoSieeeeeJJnthCCMnattttinhhhh tlt--y r eeee -BHMa ssssCuledddd iaIrsaaaaanrrsl odstWBGHo†huiuanea tegrCrraauschidall ttlt BseaerGh eanyS lfpG ecsoHh†nrroo ons•••••••••tutuo ho CBBBBBBJSsMpleonSeeeeeeJJ h CCMnDtttteCnhhhh tdh--e r eeee -iBiaHMa clssssCdfulaedddd iarIrlsaaaaan errsCl odsntWBGHoe(cid:14)hui’uaneasn tegr CrraautHschideall ttlt BosearerGh easnyS lfppG ecsoHih(cid:14)nrtrooa onstutluoho sMplene DeCdheiiacldfarlSSS•••• eC nGAMSAimpek’adsrsnriieos isvtinHtensueosthoomrp cgtLsuavobupfirtilkieinli teeeDlsae’s lslef do olNtrfa o aG rM toHhedeld aaFiSSS•••• nlcitn dahGAMSAimpak lyadHs rrnCi ioesisvCinocteensuosoitshomnap cpgmtLultav iobueStfirtmilakrieenli eeelDlsure’sv lsnef dio olicNttrefay o saG rM toH hedeld aaFinlcitndaha lyH nC Coceoisnapmlt ieStmarelurvniicteys • CoxHealth • CoxHealth Eldorado SpringEsldorado Springs • Kansas City Univ. of •M Keadnicsianse C &it yB Uionsicvi.e onfc eMsedicine & Biosciences Mexico Mexico • Chris†an Brothers C•o lClehgreis (cid:14)Haignh B Srcohtohoelrs College Hig•h BScuhrroeolll Behavioral H•e aBluthrrell Behavioral Health • Preferred Family He•a lPthrecafererred Family Healthcare• Preferred Family He•a lPthrecafererred Family Healthcare• LifeFlight Eagle • LifeFlight Eagle • Audrain Medical Cen•t eArudrain Medical Center • Chris†an Horizons, I•n cC.hris(cid:14)an Horizons, Inc. • CoxHealth • CoxHealth • Southwest Bap(cid:143)st U•n Sivoeurtshitwyest Bap(cid:143)st UniversitEyllington Ellington • Menorah Medical Ce•n Mteernorah Medical Center Moberly Moberly • BJC - Chris†an Hosp•it aBlJsC - Chris(cid:21)an Hospitals • Drury University • Drury University Bonne Terre Bonne Terre • Reynolds County Me•m Roeryinaol Hldoss Cpoituanlty Memorial •H oMsopsitaailc Life Care • Mosaic Life Care • Preferred Family Hea•l tPhrceafererred Family 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Compass Health 9