Heartland Regional Medical Center ("Heartland") has developed an accountable care organization (ACO), is participating in the Medicare Shared Savings Program and may enter into other similar shared savings arrangements with commercial, self-insured, or other third-party payers. In connection with its ACO activities, Heartland has or shall enter into various arrangements with providers, specifically related to the purposes of the Medicare Shared Savings Program or similar shared savings arrangements in which Heartland participates. In that respect, Heartland has developed certain financial incentive programs to encourage its employed providers and certain independent providers that have contracts to provide clinical services to Heartland's patients (physicians, advanced practice registered nurses, care managers) to adhere to certain quality assurance initiatives and programs, improve patient satisfaction and help reduce the cost of providing quality health care, all of which supports the organizations aim of better care for individuals, better health for populations and lower growth in health care expenditures. The financial incentive programs were effective July 1, 2012 and are between Heartland, all of its employed providers and the following independent providers: St. Joseph Oncology, Inc. and St. Joseph Urology, and covers all medical services provided. In addition, Heartland has entered into a services agreement with Gates Hospitalists, LLC ("Gates"), effective September 1, 2012, for the purpose of securing the commitment of hospitalists to care for Heartland patients admitted to hospitals in the North Kansas City community and a commitment of such hospitalists to adhere to the quality assurance and improvement program and evidenced-based clinical guidelines associated with Heartland’s ACO.