2020-08-11T16:50:11-05:00 2019-09-30 BKD LLP 910 E ST LOUIS 200/PO BOX 1190 SPRINGFIELD MO 658062523 990 2018-10-01 440577118 LESTER E COX MEDICAL CENTERS % JACOB M MCWAY LEST 4172693000 1423 N JEFFERSON ST SPRINGFIELD MO 65802 JAKE MCWAY EXECUTIVE VP & CFO 4172698811 2020-08-15 true Brian D Todd P00422601 4178658701 167.68.126.162 43032920202245000029 2020-08-11 P 74C51B083D6172D3D43AC87F1A33B4712A418457 707D1959215E1734E70291BECA2AB3AECE192F1C 2018 2020-09-23 17:36:50Z STEVE EDWARDS 1423 N JEFFERSON ST SPRINGFIELD MO 65802 1515303916 false X WWW.COXHEALTH.COM X 1923 MO THE ORGANIZATION PROVIDES QUALITY HEALTH CARE, EDUCATION AND RESEARCH IN ORDER TO IMPROVE THE HEALTH OF THE COMMUNITIES IT SERVES. 15 11 11422 15 906278 248684 3707224 4177936 1198109827 1195207493 19931522 8415557 17836092 25329726 1239584665 1233130712 1188060 1673310 0 0 438017467 473182944 0 0 796788 735504839 680366111 1174710366 1155222365 64874299 77908347 1621399974 1753434894 711853525 803578470 909546449 949856424 X MISSION: TO IMPROVE THE HEALTH OF THE COMMUNITIES WE SERVE THROUGH QUALITY HEALTH CARE, EDUCATION AND RESEARCH. false false 699445008 942656136 HOSPITAL SERVICES: AS A COMMUNITY OWNED, NON-PROFIT HOSPITAL, LESTER E. COX MEDICAL CENTERS PROVIDES THE KIND OF CARE AND PROGRAMS THAT ARE NEEDED TO SERVE MANY OF THE MOST VULNERABLE IN OUR COMMUNITIES - THE UNDERINSURED AND UNINSURED. COMMUNITY BENEFIT TOTALED $240,976,997 SYSTEM-WIDE IN THESE CATEGORIES: SHORT-FALLS IN REIMBURSEMENT AND CHARITY CARE; COMMUNITY OUTREACH SERVICES INCLUDING COMMUNITY EDUCATION, HEALTH SCREENINGS, SUPPORT GROUPS AND IMMUNIZATIONS; HEALTH PROFESSIONALS EDUCATION AND RESEARCH, INCLUDING THE UN-REIMBURSED COST OF COX FAMILY MEDICINE RESIDENCY AND SCHOOLS OF ALLIED HEALTH PROFESSIONS; AND FOUNDATION GRANTS, FINANCIAL CONTRIBUTIONS AND IN-KIND DONATIONS. 196102444 203092124 PHYSICIAN CARE: EMPLOYED PHYSICIANS AT LESTER E. COX MEDICAL CENTER PLAY AN IMPORTANT ROLE IN ACCESS TO MEDICAL CARE THROUGH THEIR PRACTICE AT RURAL HEALTH CLINICS IN UNDER-SERVED AREAS OF SOUTHWEST MISSOURI. PHYSICIANS WITH COX FAMILY MEDICINE RESIDENCY ARE MAKING A VISIBLE DIFFERENCE IN CARE FOR UNINSURED PATIENTS AS WELL AS PATIENTS COVERED BY MEDICAID. THESE PATIENTS REPRESENT 36.9 PERCENT OF TOTAL PATIENTS SEEN IN THE CLINIC. SEE SCHEDULE O FOR ADDITIONAL INFORMATION. 30498094 33837780 HOME CARE: LESTER E. COX MEDICAL CENTERS' HOME CARE SERVICES, HOSPICE AND DURABLE MEDICAL EQUIPMENT ARE PROVIDED BY COXHEALTH AT HOME. COXHEALTH AT HOME STRIVES TO MEET THE HOME CARE AND HOSPICE NEEDS FOR CLIENTS OF ALL AGES. THEIR SERVICES INCLUDE NURSING CARE, MEDICATION SUPERVISION, IV THERAPY, PERSONAL CARE, HOUSEKEEPING, LAUNDRY, MEAL PREPARATION, SHOPPING, ERRANDS, TRANSPORTATION, COMPANIONSHIP, TELEMONITORING AND LIFELINE PERSONAL EMERGENCY RESPONSE SYSTEM. SEE SCHEDULE O FOR ADDITIONAL INFORMATION. 20408302 1673310 15621453 946453848 true true false true false false false false false true true false true false true false false true false false true false false false true false true true true true true true false false false false false false false false true false false false false false true true true true true false true 519 0 true 11422 true true true true CJ false false false true true false false false false false false X 15 11 true false false false true true true true true false false true true true true true true true true false X JACOB M MCWAY 4172698811 3800 S NATIONAL SPRINGFIELD MO 65807 X CHARLES CHUCK CHALENDER 1ST VICE CHAIR 1.0 1.0 X X 0 0 0 PATRICIA DIX MD BOARD MEMBER 40.0 1.0 X 363260 0 41496 DENNIS HEIM CHAIR OF THE BOARD 1.0 1.0 X X 0 0 0 ROBERT MCDOWELL BOARD MEMBER 1.0 1.0 X 0 0 0 JAN BAUMGARTNER BOARD MEMBER 1.0 1.0 X 0 0 0 HAL HIGDON 3RD VICE CHAIR 1.0 1.0 X X 0 0 0 JAMES HUTCHESON BOARD MEMBER 1.0 1.0 X 0 0 0 BRIAN JARED BOARD MEMBER 1.0 1.0 X 0 0 0 DAVID ZOLFAGHARI MD BOARD MEMBER 1.0 40.0 X 0 1125716 16320 ROBERT FULP 2ND VICE CHAIR OF THE BOARD 1.0 1.0 X X 0 0 0 JANICE HARRIS BOARD MEMBER 1.0 1.0 X 0 0 0 JOHN JACK PRIM BOARD MEMBER 1.0 1.0 X 0 0 0 JOSEPH TURNER BOARD MEMBER 1.0 1.0 X 0 0 0 IBRAHIM ABE ABDALLA MD BOARD MEMBER 40.0 1.0 X 0 983315 16320 STACI NIEMOTH MD BOARD MEMBER 1.0 40.0 X 0 571029 16320 STEVE EDWARDS PRESIDENT AND CEO COXHEALTH 5.0 40.0 X 0 1501873 295293 JACOB MCWAY SR VP AND CFO COXHEALTH 5.0 40.0 X 0 891941 168179 VICKIE NELSON SECRETARY TO THE BOARD 5.0 40.0 X 0 65580 10981 DAVID STRONG VP HOSPITAL REVENUE & CFO CMCB 20.0 20.0 X 179197 179199 58885 RON PRENGER SR VP, CHIEF HOSPITAL OFFICER 40.0 0.0 X 466289 0 46352 GENICE MAROC VP CLINICAL SERVICES 40.0 0.0 X 218559 0 15338 MAX BUETOW VP REGIONAL SERVICES 40.0 0.0 X 234492 0 30217 JEFF HAWKINS VP CLINICAL SERVICES 40.0 0.0 X 192346 0 17781 FRANK ROMERO VP MEDICAL AFFAIRS 40.0 0.0 X 437331 0 30400 ROBERT FERGUSON VP FERRELL DUNCAN CLINIC 40.0 0.0 X 314343 0 25232 KAREN KRAMER VP, CHIEF NURSING OFFICER 40.0 0.0 X 300728 0 46229 AMANDA HEDGPETH VP CLINICAL SERVICES 40.0 0.0 X 188271 0 17303 LOUIS KRENN MD PHYSICIAN 40.0 0.0 X 633710 0 29735 ARMIN KAMYAB MD PHYSICIAN 40.0 0.0 X 1127346 0 39688 NAGIB CHOWDHURY MD PHYSICIAN 40.0 0.0 X 533874 0 39688 GREGORY STAMPS MD PHYSICIAN 40.0 0.0 X 671374 0 48685 ARJIT CHOWDHURY MD PHYSICIAN 40.0 0.0 X 593202 0 29735 6454322 5318653 1040177 531 false true false SPRINGFIELD NEUROLOGICAL INSTITUTE 3801 S NATIONAL AVE SPRINGFIELD MO 65804 PHYS REMUNERATION 16688149 OZARK ANESTHESIA ASSOCIATES 1000 E PRIMROSE ST 520 SPRINGFIELD MO 65807 ANESTHESIA SERVICES 9680954 360 DEGREE MEDICINE 108 SUNNY LANE BRANSON WEST MO 65737 PHYSICIAN SERVICES 6498213 GE PRECISION HEALTHCARE LLC PO BOX 843553 DALLAS TX 75284 EQUIP MAINTENANCE 5102564 FERRELL DUNCAN BUILDING CO 1001 E PRIMROSE AVE SPRINGFIELD MO 65737 RENTAL SPACE 3469220 95 1920 47880 2769003 1359133 4177936 NET PATIENT SERVICE REVENUE 900099 1169746295 1169746295 NET PATIENT SERVICE - UNRELATED LAB 621500 292265 292265 NET PATIENT SERVICE - UNRELATED RETAIL DME 446199 614013 614013 CAFETERIA, MEALS & VENDING 722514 5551998 5551998 FITNESS CENTERS 713940 3092747 3092747 15910175 15910175 1195207493 11100596 11100596 48278 48278 0 1830700 1342489 488211 0 488211 488211 277739077 65322 280125393 412323 -2386316 -347001 -2733317 -2733317 19469 47880 24190 -4721 -4721 0 0 0 535978 268809 267169 267169 GAIN ON INVESTMENT IN EQUITY INVESTEE 900099 322534 322534 CHANGE IN INTEREST IN NET ASSETS OF SUBS 900099 25104615 25104615 LOSS ON EXTINGUISHMENT OF DEBT 900099 -848082 -848082 24579067 1233130712 1194301215 906278 33745283 X 160250 160250 1513060 1513060 0 0 3988669 2663103 1325566 814454 455514 358940 371949637 275088011 96579300 282326 19026702 18367642 652721 6339 48514498 46721634 1792764 100 28888984 27771354 1099793 17837 0 35000 35000 299359 299359 161625 161625 0 1134635 1134635 318004531 235156205 82833786 14540 174254 126639 44695 2920 20783827 15255169 5385533 143125 6774999 5006425 1766954 1620 0 20400869 16045832 4320684 34353 2191959 1617470 570865 3624 0 2204917 1623220 572895 8802 17622962 16076874 1546088 0 38397602 35027151 3368507 1944 5008470 3701923 1306547 MEDICAL SUPPLIES & DRUGS 193368541 193368541 STATE PROVIDER TAX 44145756 44145756 LICENSES, DUES, SUBSCRIPTIONS 1519320 1122979 396341 MISCELLANEOUS 8137485 5439096 2419131 279258 1155222365 946453848 207971729 796788 5847089 3052465 180125784 233751408 0 0 150412515 157985142 726662 0 0 0 10019995 11214893 13736953 12891454 11733114 10072476 1178156065 751328337 436420088 426827728 407434678 483926814 107389119 81981906 248352878 274546314 25263742 25263742 23937357 31920552 1621399974 1753434894 180320066 226888481 0 0 4469935 6236004 447791927 489782673 0 0 0 0 15346290 10929954 7455266 7303227 56470041 62438131 711853525 803578470 X 866288448 902288994 22758349 26942077 20499652 20625353 909546449 949856424 1621399974 1753434894 X 77908347 8840449 -46438821 X false true X true true true X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED false false false false false false true 116024 false true 45601 161625 false SCHEDULE C, PART II-B, LINE 1G DIRECT CONTACT WITH LEGISLATORS, ETC: THE ORGANIZATION CONTRACTED WINTON POLICY GROUP AND KELLER MCINTYRE & ASSOCIATES, LOBBYING AND ASSOCIATION MANAGEMENT FIRMS, TO LOBBY ISSUES THAT BENEFIT THE INTERESTS OF THE COMMUNITY, COXHEALTH AND ITS AFFILIATES. SCHEDULE C, PART II-B, LINE 1I OTHER LOBBYING ACTIVITIES: MEMBERS OF THE ADMINISTRATIVE STAFF CONTACT LEGISLATORS REGARDING KEY HEALTHCARE ISSUES. ALSO, PORTIONS OF DUES PAID TO THE MISSOURI HOSPITAL ASSOCIATION (MHA) AND THE AMERICAN HOSPITAL ASSOCIATION (AHA) ARE USED FOR LOBBYING PURPOSES. IN FISCAL YEAR 2019, THE AMOUNT ATTRIBUTABLE TO LOBBYING WAS $31,160 FOR MHA AND $14,441 FOR AHA. 4225941 394384 99139 404311 4315153 4044690 418547 101204 338500 4225941 3820777 426535 107185 309807 4044690 5111030 653117 107994 2051364 3820777 4800435 486859 149724 22800 303188 5111030 0.45990 0.54010 false true true 27397064 27397064 400842465 208752301 192090164 4770006 4252114 517892 714641146 523631950 191009196 30505384 14691972 15813412 426827728 INT IN NA OF TAX EXEMPT SUBS 274546314 C 274546314 0 COXHEALTH AUXILIARY LIABILITIES 55005 EST AMT DUE TO 3RD PARTIES 6751073 DUE TO AFFILIATES 18467000 SELF INSURANCE CLAIMS PAYABLE 37165053 62438131 SCHEDULE D, PART V, LINE 4 INTENDED USE OF ENDOWMENTS: COXHEALTH FOUNDATION, A RELATED ORGANIZATION, HOLDS 19 ENDOWMENT FUNDS WHICH INCLUDE MONIES DONATED TO BE USED FOR SPECIFIC EXPENSES, AND THE INCOME FROM EACH FUND IS TO BE SPENT ON SPECIFIC SERVICES AND PROGRAM FUNCTIONS ON A FUND-BY-FUND BASIS. ENDOWMENT FUNDS HELD BY THE FOUNDATION ARE INTENDED FOR BUT NOT LIMITED TO EXPENDITURES RELATING TO CANCER SERVICES, HEALTH EDUCATION, PURCHASE OF EQUIPMENT AND INDIGENT CARE. THESE SERVICES AND FUNCTIONS BENEFIT COXHEALTH AND ITS AFFILIATES. SCHEDULE D, PART V, LINE 1E, COLUMN C INCLUDES AN AMOUNT REPRESENTING THE BALANCE OF FUNDS THAT ARE HELD FOR THE BENEFIT OF COX COLLEGE, A RELATED ENTITY. THESE FUNDS WERE PREVIOUSLY HELD FOR THE BENEFIT OF LESTER E. COX MEDICAL CENTERS. IN FYE 9/30/16, COX COLLEGE WAS CREATED AND THESE FUNDS WERE DEEMED HELD FOR THE BENEFIT OF COX COLLEGE. SCHEDULE D, PART X, LINE 2 UNCERTAIN TAX POSITIONS: MANAGEMENT HAS EVALUATED THEIR INCOME TAX POSITIONS UNDER THE GUIDANCE INCLUDED IN ASC 740. BASED ON THEIR REVIEW, MANAGEMENT HAS NOT IDENTIFIED ANY MATERIAL UNCERTAIN TAX POSITIONS TO BE RECORDED OR DISCLOSED IN THE FINANCIAL STATEMENTS. Central America and the Caribbean 0 1 Investments CAPTIVE INSURANCE 1161995 Central America and the Caribbean 0 Investments 113219299 0 1 0 1 114381294 114381294 true false true true false false SCHEDULE F, PART I, LINE 3, COLUMN F ACCOUNTING METHOD: THE AMOUNT OF PROGRAM SERVICE EXPENDITURES REPORTED ON LINE 1 ARE REPORTED BASED ON THE AMOUNTS INCLUDED IN THE AUDITED FINANCIAL STATEMENTS OF THE INSURANCE COMPANY OF SPRINGFIELD, INC., THE CAPTIVE INSURANCE COMPANY. THESE AUDITED FINANCIAL STATEMENTS USED GENERALLY ACCEPTED ACCOUNTING PRINCIPLES ESTABLISHED BY THE FINANCIAL ACCOUNTING STANDARDS BOARD. SCRAMBLE FOR MI 46706 31911 14795 1248 15674 557 WRAP IT UP 20643 15969 4674 4674 300 1737 0 67349 47880 19469 1248 20348 300 2294 24190 -4721 true true X false true X true true false true true 43296516 43296516 0.03750 159807372 140552948 19254424 0.01670 203103888 140552948 62550940 0.05420 135406 135406 0.00010 22392815 13986397 8406418 0.00730 10811400 6635406 4175994 0.00360 2046727 2046727 0.00180 35386348 20621803 14764545 0.01280 238490236 161174751 77315485 0.06700 false 91301578 14151745 389781583 509256732 -119475149 X true true 3 1 LESTER E COX MEDICAL CENTERS - SOUTH 3801 S NATIONAL AVE SPRINGFIELD MO 65807 WWW.COXHEALTH.COM 500 X X X X X 1 2 LESTER E COX MEDICAL CENTERS - NORTH 1423 N JEFFERSON ST SPRINGFIELD MO 65802 WWW.COXHEALTH.COM 500 X X X 1 3 MEYER ORTHOPEDIC HOSPITAL 1000 E WALNUT LAWN SPRINGFIELD MO 65807 WWW.COXHEALTH.COM 500 X X 1 FACILITY REPORTING GROUP #1 13 false false true X X X X X X X X X 18 true true true true X SEE PART V, SECTION C X SEE PART V, SECTION C X X true 18 true SEE PART V, SECTION C false true X 0. 300. X X X X X X true true X X X true X SEE PART V, SECTION C X SEE PART V, SECTION C X SEE PART V, SECTION C X X X X X X X true X false X X X X true X false false SCHEDULE H, PART V, SECTION B, LINE 5 COMMUNITY INPUT: IN 2017, A VARIETY OF ORGANIZATIONS ACROSS THE OZARKS RECONVENED UNDER THE UMBRELLA OF THE OZARKS HEALTH COMMISSION TO ASSESS THE HEALTH NEEDS OF OUR REGION. BUILDING UPON THE SUCCESS OF THE 2016 REGIONAL HEALTH ASSESSMENT, PARTNERS AGAIN SOUGHT TO BETTER UNDERSTAND THE HEALTH STATUS, BEHAVIORS AND NEEDS OF THE POPULATIONS THEY SERVE. THIS 2019 ASSESSMENT COMBINES MORE THAN 140 HOSPITAL AND COMMUNITY DATA INDICATORS AS WELL AS FEEDBACK FROM STAKEHOLDERS AND THE BROADER COMMUNITY. THIS PROCESS RESULTED IN THREE PRIORITIES: LUNG DISEASE, CARDIOVASCULAR DISEASE AND MENTAL HEALTH. WEAVING AMONG THE ISSUES IDENTIFIED WERE FIVE COMMON THREADS: ACCESS TO HEALTH CARE, MENTAL HEALTH, PHYSICAL ACTIVITY, SOCIAL DETERMINANTS OF HEALTH AND TOBACCO USE. ADDITIONALLY, THE HEALTH STATUS OF POPULATIONS OF INTEREST - SUCH AS PEOPLE IN POVERTY, MINORITIES AND THE ELDERLY--WERE ALSO ANALYZED. RECOGNIZING THE VALUE OF ASSESSING AND ACTING TOGETHER ON LOCAL HEALTH ISSUES, KEY PLAYERS FROM LOCAL HOSPITAL SYSTEMS, PUBLIC HEALTH ENTITIES, AND OTHERS FORMED A WORKING GROUP TO BEGIN THE TASK OF A REGIONAL HEALTH ASSESSMENT. THIS GROUP GREW UNDER THE UMBRELLA OF THE LOCAL OZARKS HEALTH COMMISSION (OHC) AND PUBLISHED THE FIRST ASSESSMENTS IN 2016. SINCE THAT TIME, THE PROCESS HAS BEEN RECOGNIZED AT THE ANNUAL MEETING OF THE AMERICAN PUBLIC HEALTH ASSOCIATION, HONORED AS A PROMISING PRACTICE BY THE NATIONAL ASSOCIATION OF COUNTY AND CITY HEALTH OFFICIALS, AND AWARDED THE GROUP MERIT AWARD FROM THE MISSOURI PUBLIC HEALTH ASSOCIATION. COLLECTIVELY, THE ASSESSMENTS SPAN FOUR STATES - MISSOURI, OKLAHOMA, ARKANSAS, AND KANSAS, 29 COUNTIES AND THREE HOSPITAL SYSTEMS. THIS FOOTPRINT WILL BE REFERRED TO THROUGHOUT THE REPORT AS THE OHC REGION. PRIORITIZATION PROCESS INCLUDED THE FOLLOWING STAKEHOLDERS: CITY OF SPRINGFIELD - PLANNING DEPARTMENT -COMMUNITY PARTNERSHIP OF THE OZARKS -COXHEALTH -DREW LEWIS FOUNDATION -MERCY -MISSOURI ALLIANCE OF YMCA -MISSOURI STATE UNIVERSITY -MISSOURI JOB CENTER -OZARKS FOOD HARVEST -OZARK GREENWAYS -SPRINGFIELD AREA CHAMBER OF COMMERCE -SPRINGFIELD-GREENE COUNTY HEALTH DEPARTMENT -SPRINGFIELD-GREENE COUNTY PARKS SCHEDULE H, PART V, SECTION B, LINE 6A CHNA CONDUCTED WITH OTHER HOSPITALS: THE CHNA WAS CONDUCTED FOR THE ENTIRE REPORTING GROUP #1, AS REPORTED ON SCHEDULE H, PART V, SECTION A, INCLUDING LESTER E. COX MEDICAL CENTERS - SOUTH, LESTER E. COX MEDICAL CENTERS - NORTH, AND MEYER ORTHOPEDIC HOSPITAL. OTHER HOSPITAL FACILITY PARTNERS INCLUDED FREEMAN HEALTH SYSTEM, AND MERCY. THE CHNA WAS ALSO CONDUCTED WITH RELATED ORGANIZATIONS COX MEDICAL CENTER BRANSON, COX BARTON COUNTY HOSPITAL AND COX-MONETT HOSPITAL. SCHEDULE H, PART V, SECTION B, LINE 6B CHNA CONDUCTED WITH OTHER ORGANIZATIONS: THE CHNA WAS ALSO CONDUCTED WITH THE FOLLOWING OTHER NON-HOSPITAL ORGANIZATIONS: -JASPER COUNTY HEALTH DEPARTMENT -JOPLIN HEALTH DEPARTMENT -SPRINGFIELD-GREENE COUNTY HEALTH DEPARTMENT -TANEY COUNTY HEALTH DEPARTMENT SCHEDULE H, PART V, SECTION B, LINE 7A CHNA HOSPITAL FACILITY'S WEBSITE: HTTPS://WWW.COXHEALTH.COM/ABOUT-US/COMMUNITY-HEALTH-NEEDS-ASSESSMENTS/ SCHEDULE H, PART V, SECTION B, LINE 7B CHNA OTHER WEBSITES: HTTP://WWW.OZARKSHEALTHCOMMISSION.ORG HTTP://WWW.MERCY.NET HTTP://WWW.COXHEALTH.COM HTTP://WWW.FREEMANHEALTH.COM SCHEDULE H, PART V, SECTION B, LINE 7D OTHER METHODS TO MAKE THE CHNA REPORT AVAILABLE TO THE PUBLIC: PRINTED COPIES ARE AVAILABLE BY REQUEST THROUGH HOSPITAL OR PUBLIC HEALTH PARTNERS OR AT OZARKSHEALTHCOMMISSION.ORG AND NEWS RELEASE WAS SENT OUT TO ENCOURAGE MEDIA COVERAGE WITH LINKS TO THE REPORT AND KEY MESSAGES FOR THE PUBLIC. SCHEDULE H, PART V, SECTION B, LINE 10A IMPLEMENTATION STRATEGY WEBSITE: HTTPS://WWW.COXHEALTH.COM/ABOUT-US/COMMUNITY-HEALTH-NEEDS-ASSESSMENTS/ SCHEDULE H, PART V, SECTION B, LINE 11 ADDRESSING IDENTIFIED NEEDS: 1. INCREASE PATIENT ENGAGEMENT IN CHRONIC CONDITION SELF-MANAGEMENT -THE CENTER FOR HEALTH IMPROVEMENT EMPLOYS A SKILLED TEAM OF HEALTHCARE PROFESSIONALS WHO DELIVER SUPPORT AND EDUCATION FOR CHRONIC DISEASE MANAGEMENT, MEDICAL NUTRITION THERAPY, AND ADVANCE CARE PLANNING. THEY PROVIDE TOOLS DESIGNED TO INCREASE SELF- MANAGEMENT OF CHRONIC CONDITIONS INCLUDING DIABETES, AUTOIMMUNE DISORDERS, METABOLIC SYNDROME, AND MORE. -IN THE FIRST QUARTER CALENDAR YEAR 2018, A CURRENT STATE ASSESSMENT OF THE CENTER FOR HEALTH IMPROVEMENT WAS CONDUCTED TO DETERMINE THE EFFICACY OF VARIOUS PROGRAMS. AS A RESULT OF THE ASSESSMENT, THE TEAM REFINED THE SCOPE OF OFFERINGS TO AN EVIDENCE-BASED, TARGETED PROGRAM SUITE THAT FOCUSES HEAVILY ON IMPROVING CHRONIC CONDITION MANAGEMENT OF PATIENTS. -IN ADDITION TO THE PROGRAMS ALREADY OFFERED, THE CENTER FOR HEALTH IMPROVEMENT ADDED A NEW SIX-WEEK, EVIDENCE-BASED COURSE FOCUSED ON CHRONIC PAIN CONDITIONS. -THE NURSING EDUCATION DEPARTMENT AND THE JOINT REPLACEMENT EDUCATORS AT MEYER ORTHOPEDIC CENTER DEVELOPED A PROCESS TO INCREASE TIGR VIDEO EDUCATION VIEWS. MANDATORY EDUCATION WAS EXPANDED TO INCLUDE ALL ADULT PATIENTS WITH A DIAGNOSIS OF PNEUMONIA, HEART FAILURE, ACUTE MI, TOTAL HIP/KNEE REPLACEMENT, OR COPD TO HELP ACHIEVE BEST OUTCOMES WHILE REDUCING READMISSIONS. -TIGR VIDEO VIEWS INCREASED FROM 4,694 VIEWS IN MAY 2018 TO 6,284 IN MAY 2019. 2. REDUCE AVOIDABLE HOSPITAL READMISSIONS - COXHEALTH NURSING ADMINISTRATION BEGAN TRAINING NURSES ON LIGHT DUTY TO COMPLETE PATIENT READMISSION INTERVIEW FORMS IN 2018. WHEN A PATIENT IS READMITTED WITHIN THIRTY DAYS, A CASE MANAGER MEETS WITH THE PATIENT TO DISCUSS THE READMISSION. TOPICS COVERED IN THE INTERVIEW INCLUDE: >FREQUENCY OF GOOD COMMUNICATION IN THE HOSPITAL REGARDING DIAGNOSIS AND MEDICATIONS. >COMMUNICATION ABOUT DISCHARGE INSTRUCTIONS AND ABILITY TO UNDERSTAND INSTRUCTIONS. >MEDICATION COMPLIANCE AND REASONS FOR ANY DIFFICULTY REMAINING COMPLIANT. >FOLLOW UP APPOINTMENTS WITH A PCP BEING SCHEDULED AND ATTENDED. >REASONS FOR READMISSION, FROM THE PATIENTS PERSPECTIVE. >>THE INFORMATION GATHERED BY THE CASE MANAGER COMES DIRECTLY FROM THE PATIENT AND IS ENTERED INTO REPORTABLE FIELDS THAT ALLOW FOR DATA COLLECTION. COMMON THEMES FOR AVOIDABLE READMISSIONS WILL BE EASIER TO IDENTIFY AND PREVENT THROUGH THIS PROCESS. -EVIDENCE-BASED BEST PRACTICES TO REDUCE AVOIDABLE READMISSIONS HAVE BEEN IMPLEMENTED AND CONTINUE TO EXPAND. >COXHEALTH HIRED TRANSITIONAL CARE PHARMACISTS WHO DEDICATE THEIR TIME WORKING WITH PATIENTS BEING DISCHARGED TO ENSURE THE PATIENT LEAVES THE HOSPITAL WITH THEIR MEDICATIONS. >NEW EFFORTS ARE IN PLACE TO INCREASE THE NUMBER OF PATIENTS WHO LEAVE THE HOSPITAL WITH THEIR MEDICATIONS THROUGH THE USE OF A FOCUSED, FAST-PACED I-90 PROJECT. >THE CLINIC SUPPORT TEAM HAS BEEN INSTRUMENTAL IN SCHEDULING FOLLOW-UP APPOINTMENTS WITH PATIENTS. THE MAJORITY OF INPATIENT UNITS ARE COVERED BY THE CLINIC SUPPORT TEAM, WHICH MEANS MOST PATIENTS HAVE A FOLLOW UP APPOINTMENT SCHEDULED PRIOR TO LEAVING THE HOSPITAL. >A SUBGROUP COMPRISED OF FRONTLINE STAFF, LEADERS, AND QUALITY IMPROVEMENT EXPERTS HAS BEEN FORMED TO FOCUS SPECIFICALLY ON REDUCING HEART FAILURE READMISSIONS. THE GROUP WILL USE DATA TO INFORM DECISIONS ON HOW TO BEST MANAGE OUR PATIENTS WITH FREQUENT INPATIENT STAYS DUE TO HEART FAILURE. 3. INCREASE ACCESS TO TOBACCO CESSATION RESOURCES FOR PATIENTS AND FAMILIES PRESENTING TO OUR HOSPITALS AND CLINICS -AN ASSET ASSESSMENT AND GAP ANALYSIS OF THE SYSTEMS TOBACCO TREATMENT OFFERINGS WAS CONDUCTED. RECOMMENDATIONS FROM THAT ASSESSMENT INCLUDED CREATION AND IMPLEMENTATION OF A CLEARLY OUTLINED REFERRAL PROCESS AND DEFINED RESOURCES AND PROMOTION OF THE ASK, ADVISE, ACT/REFER MODEL TO INITIATE INTERVENTION. -IN MAY 2018, WE PROVIDED TRAINING TO 12 KEY COXHEALTH STAFF MEMBERS AND 3 COMMUNITY EDUCATORS. COMPLETION OF THE UMASS MEDICAL SCHOOL EDUCATION CURRICULUM, REQUIRED EXAMS, AND PRACTICE HOURS MADE CLASS PARTICIPANTS ELIGIBLE FOR CERTIFICATION AS TOBACCO TREATMENT SPECIALISTS. AS A RESULT OF THIS EDUCATION, THE NUMBER OF CESSATION RESOURCES AVAILABLE WITHIN THE SYSTEM INCREASED. THE TRAINING WILL BE OFFERED AGAIN IN OCTOBER 2019 TO FURTHER INCREASE RESOURCES. -THE QUIT RATE FOR OUR TOBACCO CESSATION PROGRAM HAS CONTINUED TO SHOW POSITIVE RESULTS SINCE ITS INCEPTION IN 2013, WITH THE CURRENT QUIT RATE FOR 2019 TO DATE AT 64%. AVERAGING ACROSS THE HISTORY OF THE PROGRAM, THE AGGREGATED QUIT RATE IS 55%. -DUE TO THE SUCCESS OF THIS PROGRAM, FOLLOWING THE STONE AND TANEY COUNTY MFH TOBACCO GRANTS END ON MAY 31, 2018, WE WERE ABLE TO HIRE A FULL TIME TOBACCO CESSATION COORDINATOR WHO IS RESPONSIBLE FOR COORDINATING SYSTEM EFFORTS TO STANDARDIZE POLICIES AND REFERRAL PROCESSES ACROSS ALL CAMPUSES AND SETTINGS. 4. DECREASE CHILDHOOD OBESITY -THE CARDIAC KIDS PROGRAM IS IMPLEMENTED IN 13 RURAL SCHOOLS IN THE COXHEALTH SERVICE AREA. ITS MAIN OBJECTIVE IS TO SCREEN 5TH GRADE STUDENTS FOR HEALTH INDICATORS THAT PUT THEM AT HIGH RISK FOR DEVELOPING CARDIAC DISEASE. SCREENING BY COXHEALTH STAFF INCLUDES HEIGHT AND WEIGHT MEASUREMENT, BMI CONSULT, AND HEALTH/NUTRITION EDUCATION. -APPROXIMATELY 400 CHILDREN ARE SCREENED ANNUALLY. THOSE WHO ARE DEEMED HIGH RISK ARE REFERRED TO THE COMMITTED TO KIDS PROGRAM. THIS 8-WEEK PROGRAM IS AN INTENSIVE INTERVENTION FOR AT-RISK CHILDREN AND THEIR FAMILIES FOCUSING ON HEATHY BEHAVIOR AND NUTRITION EDUCATION. 5. INCREASE THE NUMBER OF WOMEN WHO BREASTFEED THEIR INFANTS AFTER DELIVERY -COXHEALTH AND THE SPRINGFIELD-GREENE COUNTY HEALTH DEPARTMENT ARE CURRENTLY ENGAGED IN A COMMUNITY BREASTFEEDING COALITION WITH THE GOAL OF STRATEGICALLY ALIGNING EFFORTS TO HELP MOVE THE CHIP INITIATIVE FORWARD. -IN ADDITION TO EDUCATION PRESENTED IN OUR GENERAL PRENATAL CLASSES, THE COXHEALTH LACTATION CONSULTANTS FACILITATE A MONTHLY BREAST FEEDING SUPPORT GROUP CALLED THE LACTATION CLUB. -THE ANNUAL COXHEALTH BABY FAIR IS A FREE EVENT THAT FEATURES VENDOR DISPLAYS, DEMONSTRATIONS, DOOR PRIZES, AND CLASSES WITH A VARIETY OF TOPICS INCLUDING BREASTFEEDING. 6. INCREASE DETECTION AND TREATMENT OF THE EARLIEST STAGES OF LUNG CANCER NODULES -COXHEALTH OFFERS LOW-DOSE CT SCANS AS A DIAGNOSTIC SCREENING FOR LUNG CANCER. LOW-DOSE CT SCANS USE LOWER AMOUNTS OF RADIATION TO HELP IDENTIFY LUNG NODULES IN THE EARLIEST STAGES OF LUNG CANCER WHEN IT IS MOST TREATABLE. STUDIES HAVE SHOWN THAT PATIENTS WHO PARTICIPATE IN A LOW-DOSE CT LUNG CANCER PROGRAM ARE 20% LESS LIKELY TO DIE FROM LUNG CANCER THAN THOSE WHO WERE NOT SCREENED WHEN APPROPRIATE. -SINCE THE PROGRAM BEGAN, THE NUMBER OF INDIVIDUALS WHO HAD A LOW-DOSE CT SCAN COMPLETED HAS CONTINUED TO INCREASE. 7. INCREASE REFERRALS TO COMMUNITY ORAL HEALTH RESOURCES FOR PATIENTS PRESENTING TO THE ED FOR DENTAL ISSUES -COMMUNITY PARTNERSHIPS WITH LOCAL RESOURCES HAVE BEEN STRENGTHENED AND REFINED TO ENSURE STAFF FEEL EMPOWERED TO REFER PATIENTS TO FACILITIES LIKE THE JORDAN VALLEY COMMUNITY HEALTH CENTER (JVCHC) FOR THE APPROPRIATE LEVEL OF CARE FOR ORAL HEALTH ISSUES. -WHEN EVALUATING THE CHIEF COMPLAINTS OF PATIENTS THAT PRESENTED TO THE EMERGENCY DEPARTMENT (ED) FIVE OR MORE TIMES IN A 12-MONTH PERIOD FOR NON-EMERGENT CARE, DENTAL COMPLAINTS RANKED AMONG THE HIGHEST. -PROTOCOLS WERE DEVELOPED FOR PATIENTS THAT PRESENT WITH TOOTH PAIN IN THE ED. AFTER THE MEDICAL SCREENING EXAM COMPLETION, THE PATIENT IS TRANSITIONED TO JVCHC FOR IMMEDIATE DENTAL CARE. -COXHEALTH WORKED IN COLLABORATION WITH JVCHC TO APPLY FOR A GRANT THAT ALLOWED FOR THE HIRE OF ADDITIONAL DENTISTS. TO ENSURE SAME-DAY OR NEXT DAY APPOINTMENTS, THE DENTAL CLINIC EXPANDED TO ADD SATURDAY HOURS. -QUICK ACCESS TO THE DENTAL CLINIC ALLOWED COXHEALTH ED PHYSICIANS TO DISCONTINUE PRESCRIBING NARCOTICS TO PATIENTS WHO PRESENTED WITH TOOTH PAIN. SCHEDULE H, PART V, SECTION B, LINE 13A ELIGIBILITY FOR FREE CARE: IN GENERAL, THE ORGANIZATION'S CHARITY CARE POLICY DOES NOT PROVIDE FOR DISCOUNTS OF 100%. THEREFORE, IT IS EXPECTED THAT THE PATIENT OR GUARANTOR WILL HOLD A RESPONSIBILITY FOR PAYMENT OF AT LEAST A PORTION OF THE SERVICES, REGARDLESS OF THE LEVEL OF ELIGIBILITY. IT IS OUR INTENTION TO WORK WITH INDIVIDUALS ON THEIR OUT-OF-POCKET RESPONSIBILITY TO ESTABLISH FEASIBLE MONTHLY PAYMENTS WHEN NECESSARY. IN THE EVENT THAT A PATIENT OR GUARANTOR IS DETERMINED TO HAVE NO MEANS OF PAYING THE AMOUNT INDICATED AS THEIR RESPONSIBILITY DUE TO EXTENUATING CIRCUMSTANCES, CONSIDERATION MAY BE GIVEN TO WAIVING DEDUCTIBLES AND/OR INCREASING THE DISCOUNT AMOUNT UP TO A 100% DISCOUNT OF THE PATIENT PORTION. THESE EXTENUATING CASES ARE SUBJECT TO THE DISCRETION AND APPROVAL OF THE PFS DIRECTOR AND/OR THE CHIEF FINANCIAL OFFICER WITHIN THE APPROVAL LIMITS DEFINED AT THE END OF THE POLICY. SCHEDULE H, PART V, SECTION B, LINE 13H OTHER CRITERIA USED TO DETERMINE FINANCIAL ASSISTANCE ELIGIBILITY: MEDICAL HARDSHIP MAY ALSO BE USED TO DETERMINE FINANCIAL ELIGIBILITY. COXHEALTH SHALL MAKE A DECISION ABOUT A PATIENT/GUARANTOR'S MEDICAL HARDSHIP BY REVIEWING THE FINANCIAL ASSISTANCE APPLICATION, INCLUDING ACCOMPANYING FINANCIAL DOCUMENTATION, IN ADDITION TO OTHER RELEVANT DOCUMENTATION THAT SUPPORTS THE MEDICAL HARDSHIP OF THE PATIENT. SCHEDULE H, PART V, SECTION B, LINE 16A FINANCIAL ASSISTANCE POLICY WEBSITE: HTTPS://WWW.COXHEALTH.COM/PATIENTS-AND-VISITORS/FINANCIAL-ASSISTANCE/ SCHEDULE H, PART V, SECTION B, LINE 16B FINANCIAL ASSISTANCE POLICY APPLICATION WEBSITE: HTTPS://WWW.COXHEALTH.COM/PATIENTS-AND-VISITORS/FINANCIAL-ASSISTANCE/ SCHEDULE H, PART V, SECTION B, LINE 16C PLAIN LANGUAGE SUMMARY WEBSITE: HTTPS://WWW.COXHEALTH.COM/PATIENTS-AND-VISITORS/FINANCIAL-ASSISTANCE/ SCHEDULE H, PART V, SECTION B, LINE 16J MEASURES TO PUBLICIZE THE POLICY: FINANCIAL ASSISTANCE AVAILABILITY IS PROACTIVELY COMMUNICATED TO UNINSURED PATIENTS BY CUSTOMER SERVICE STAFF AND BY OUR EARLY OUT AND BAD DEBT VENDORS; ANYONE RECOGNIZED AS UNINSURED IS TOLD ABOUT THE FA AVAILABILITY AND ENCOURAGED TO PARTICIPATE. 77 SPRINGFIELD INPATIENT PHYSICIANS 3801 S NATIONAL AVE 5TH FL SPRINGFIELD MO 65807 MEDICAL OFFICES ADULT MEDICINE AND ENDOCRINOLOGY SPECLST 960 E WALNUT LAWN SUITE 201 SPRINGFIELD MO 65807 CLINIC FAMILY MEDICAL CARE CENTER 1423 N JEFFERSON ST B-100 SPRINGFIELD MO 65802 CLINIC PHYSICIANS FOR WOMEN 3850 S NATIONAL AVE 400 SPRINGFIELD MO 65807 CLINIC COXHEALTH CENTER STEEPLECHASE 1530 E REPUBLIC RD SPRINGFIELD MO 65804 CLINIC PEDIATRIC CENTER 3443 S NATIONAL AVE SPRINGFIELD MO 65807 CLINIC REGIONAL PERINATAL CENTER 1000 E PRIMROSE 360 SPRINGFIELD MO 65807 CLINIC COXHEALTH CENTER NIXA 411 N MCCROSKEY NIXA MO 65714 CLINIC NORTHSIDE PEDIATRICS AND ADOLESCENTS 1443 N ROBBERSON 200 SPRINGFIELD MO 65802 CLINIC COXHEALTH NEWBORN MEDICINE SPECIALISTS 3801 S NATIONAL AVE SPRINGFIELD MO 65807 CLINIC COXHEALTH CENTER WILLOW SPRINGS 816 E MAIN WILLOW SPRINGS MO 65793 CLINIC SUN RIVER ORTHOPAEDICS 3800 S NATIONAL AVE 700 SPRINGFIELD MO 65807 CLINIC COXHEALTH CENTER ELFINDALE 1429 W SUNSHINE SPRINGFIELD MO 65807 CLINIC COXHEALTH PEDIATRICS 1000 E PRIMROSE 300 SPRINGFIELD MO 65807 CLINIC COXHEALTH CENTER LEBANON 510 E HWY 32 LEBANON MO 65536 CLINIC COXHEALTH CENTER CHESTERFIELD 3805 S KANSAS EXPRESSWAY STE B SPRINGFIELD MO 65807 CLINIC COXHEALTH CENTER WILLARD 304 E JACKSON 5H WILLARD MO 65781 CLINIC COXHEALTH CENTER MOUNTAIN GROVE 1602-A N MAIN ST MOUNTAIN GROVE MO 65711 CLINIC COX SENIOR HEALTH CENTER 1423 N JEFFERSON ST SPRINGFIELD MO 65802 CLINIC COX SENIOR HEALTH CENTER SOUTH 3525 S NATIONAL 207 SPRINGFIELD MO 65807 CLINIC COXHEALTH CENTER MARSHFIELD 1245 BANNING ST MARSHFIELD MO 65706 CLINIC COXHEALTH CENTER OZARK 5548 N FARMER BRANCH RD OZARK MO 65721 CLINIC COXHEALTH CENTER REPUBLIC 820 ILLINOIS AVE REPUBLIC MO 65738 CLINIC COXHEALTH SURGERY MONETT 801 N LINCOLN MONETT MO 65708 CLINIC COXHEALTH CENTER AVA 806 SW COLLINS AVE AVA MO 65608 CLINIC COXHEALTH INPATIENT PSYCHIATRY 1423 N JEFFERSON ST SPRINGFIELD MO 65802 CLINIC COXHEALTH CENTER BUFFALO 119 N ASH BUFFALO MO 65622 CLINIC COXHEALTH CENTER ROGERSVILLE 151 JOHNSTOWN DR ROGERSVILLE MO 65742 CLINIC COXHEALTH CENTER FOR ADDICTIONS 1423 N JEFFERSON ST SPRINGFIELD MO 65802 CLINIC THE CLINIC AT WALMART #0444 3315 S CAMPBELL SPRINGFIELD MO 65807 CLINIC COXHEALTH PEDIATRIC SPECIALTIES TURNER 1000 E PRIMROSE 200 SPRINGFIELD MO 65807 CLINIC COXHEALTH CENTER SEYMOUR 202 COMMERCIAL SEYMOUR MO 65746 CLINIC THE CLINIC AT WALMART #0379 2004 W MARLER LANE OZARK MO 65721 CLINIC THE CLINIC AT WALMART #2221 2021 E INDEPENDENCE SPRINGFIELD MO 65804 CLINIC THE CLINIC AT WALMART #1009 1150 US HWY 60 EAST REPUBLIC MO 65738 CLINIC COXHEALTH CENTER CAMPBELL 2750 S CAMPBELL SPRINGFIELD MO 65807 CLINIC PEDIATRIC HOSPITAL AFFILIATES 3801 S NATIONAL AVE 7TH FL SPRINGFIELD MO 65807 CLINIC SPRINGFIELD NEUROLOGICAL AND SPINE 3801 S NATIONAL SPRINGFIELD MO 65804 CLINIC COXHEALTH PSYCHOLOGICAL SERVICES 3800 S NATIONAL 770 SPRINGFIELD MO 65807 CLINIC MARTIN CENTER 3901 S FREMONT SPRINGFIELD MO 65807 CLINIC OZARK HEALTH VENTURES 3550 S NATIONAL AVE SPRINGFIELD MO 65807 CLINIC BONE AND JOINT CENTER 3555 S NATIONAL AVE SPRINGFIELD MO 65807 CLINIC FERRELL-DUNCAN CLINIC 1000 E PRIMROSE SPRINGFIELD MO 65807 MEDICAL OFFICES MEYER CENTER FITNESS AND REHAB 3545 S NATIONAL AVE SPRINGFIELD MO 65807 FITNESS AND REHAB CENTER COX HYPERBARIC MEDICINE AND WOUND CARE 3525 S NATIONAL AVE 101 SPRINGFIELD MO 65807 CLINIC MEDICAL OFFICE BUILDING-COX WALNUT LAWN 3525 S NATIONAL AVE SPRINGFIELD MO 65807 MEDICAL OFFICES TURNER WOMEN AND CHILDREN'S CENTER 1000 E PRIMROSE SPRINGFIELD MO 65807 MEDICAL OFFICES WHEELER HEART AND VASCULAR 3800 S NATIONAL AVE 700 SPRINGFIELD MO 65807 MEDICAL OFFICES HULSTON CANCER CENTER 3850 S NATIONAL AVE SPRINGFIELD MO 65807 MEDICAL OFFICES MEDICAL TOWERS 1443 N ROBBERSON SPRINGFIELD MO 65802 MEDICAL OFFICES COXHEALTH INFECTIOUS DISEASES SPECIALTY 3800 S NATIONAL LL100 SPRINGFIELD MO 65807 CLINIC COX CARE MOBILE 3525 S NATIONAL AVE 105 SPRINGFIELD MO 65807 CLINIC THE CLINIC AT WALMART #86 2825 N KANSAS EXPWAY SPRINGFIELD MO 65803 CLINIC SENIOR ADVANTAGE 1000 E WALNUT LAWN SPRINGFIELD MO 65807 CLINIC COXHEALTH SPECIALTY CLINIC 1001 E PRIMROSE STREET SPRINGFIELD MO 65807 CLINIC PANTHER CLINIC OPERATED BY COXHEALTH 900 N BENTON AVENUE SPRINGFIELD MO 65802 CLINIC COXHEALTH ADULT & PEDIATRIC URGENT CARE 1000 E PRIMROSE SPRINGFIELD MO 65807 URGENT CARE CLINIC COXHEALTH VIRTUAL VISITS 1423 N JEFFERSON SPRINGFIELD MO 65802 CLINIC COXHEALTH NEUROPSYCHOLOGY 3801 S NATIONAL AVE SUITE 900 SPRINGFIELD MO 65807 CLINIC COXHEALTH OCCUPATIONAL MEDICINE 1499 N ROBBERSON SPRINGFIELD MO 65802 CLINIC COXHEALTH PEDIATRIC PLACE 3800 S NATIONAL AVE SUITE 730 SPRINGFIELD MO 65807 CLINIC COXHEALTH PEDIATRIC SURGICAL SPECIALTIES 1000 E PRIMROSE SUITE 300 SPRINGFIELD MO 65807 CLINIC COXHEALTH PRIMROSE OBGYN 1000 E PRIMROSE SUITE 270 SPRINGFIELD MO 65807 CLINIC COXHEALTH QUICK CARE HYVEE 1720 W BATTLEFIELD SPRINGFIELD MO 65807 CLINIC COXHEALTH SKIN CARE 1925 CHESTERFIELD BLVD SPRINGFIELD MO 65807 CLINIC COXHEALTH WELCOME CLINIC 2900 S NATIONAL BLDG A SPRINGFIELD MO 65804 CLINIC COXHEALTH CENTER OZARK 5548 N FARNER BRANCH RD OZARK MO 65721 CLINIC PALLIATIVE CARE 3801 S NATIONAL AVE SPRINGFIELD MO 65807 CLINIC COXHEALTH OZARK PEDIATRICS 1741 SOUTH 15TH ST OZARK MO 65721 CLINIC COXHEALTH MEDICAL MILE CLINIC 2900 S NATIONAL AVE SPRINGFIELD MO 65807 CLINIC COXHEALTH CENTER SOUTHERN HILLS 2702 E SUNSHINE SPRINGFIELD MO 65804 CLINIC COXHEALTH CONSULTING SERV AND AVIATION M 3555 S NATIONAL AVE SUITE 104 SPRINGFIELD MO 65807 CLINIC COXHEALTH INTEGRATED BEHAVIORAL HEALTHCA 3800 S NATIONAL LL100 SPRINGFIELD MO 65807 CLINIC COXHEALTH OBSTETRICS AND GYNECOLOGY 3525 S NATIONAL AVE 210 SPRINGFIELD MO 65807 CLINIC COXHEALTH PEDIATRIC SPECIALTIES MED SOUT 3525 S NATIONAL AVE SUITE 210 SPRINGFIELD MO 65807 CLINIC GLYCEMIC MANAGEMENT SERVICES 3801 S NATIONAL AVE SPRINGFIELD MO 65807 CLINIC COXHEALTH CENTER BRANSON 890 HWY 248 BRANSON MO 65616 CLINIC SCHEDULE H, PART I, LINE 3C ELIGIBILITY FOR FREE CARE: IN GENERAL, THE ORGANIZATION'S CHARITY CARE POLICY DOES NOT PROVIDE FOR DISCOUNTS OF 100%. THEREFORE, IT IS EXPECTED THAT THE PATIENT OR GUARANTOR WILL HOLD A RESPONSIBILITY FOR PAYMENT OF AT LEAST A PORTION OF THE SERVICES, REGARDLESS OF THE LEVEL OF ELIGIBILITY. IT IS OUR INTENTION TO WORK WITH INDIVIDUALS ON THEIR OUT-OF-POCKET RESPONSIBILITY TO ESTABLISH FEASIBLE MONTHLY PAYMENTS WHEN NECESSARY. IN THE EVENT THAT A PATIENT OR GUARANTOR IS DETERMINED TO HAVE NO MEANS OF PAYING THE AMOUNT INDICATED AS THEIR RESPONSIBILITY DUE TO EXTENUATING CIRCUMSTANCES, CONSIDERATION MAY BE GIVEN TO WAIVING DEDUCTIBLES AND/OR INCREASING THE DISCOUNT AMOUNT UP TO A 100% DISCOUNT OF THE PATIENT PORTION. THESE EXTENUATING CASES ARE SUBJECT TO THE DISCRETION AND APPROVAL OF THE PFS DIRECTOR AND/OR THE CHIEF FINANCIAL OFFICER WITHIN THE APPROVAL LIMITS DEFINED AT THE END OF THE POLICY. SCHEDULE H, PART I, LINE 7, COLUMN F PERCENT OF TOTAL EXPENSE: TO ARRIVE AT THE PERCENT OF TOTAL EXPENSES, THE DENOMINATOR EQUALS TOTAL OPERATING EXPENSES PER PART IX, LINE 25, OF THE FORM 990. SCHEDULE H, PART I, LINE 7G SUBSIDIZED SERVICES: THE ORGANIZATION HAS INCLUDED COSTS ASSOCIATED WITH RURAL HEALTH CENTERS (RHC) IN THE CALCULATION OF SUBSIDIZED SERVICES ON LINE 7G, WITH A NET SUBSIDY FROM RHCS OF $4,175,994. LESTER E. COX MEDICAL CENTERS PROVIDES PRIMARY CARE SERVICES TO THE SURROUNDING COMMUNITIES AT THE CENTERS. THESE SERVICES ARE PROVIDED IN RURAL AREAS WHERE THERE WOULD BE A SHORTAGE OF QUALITY MEDICAL CARE WITHOUT THE SERVICES. LESTER E. COX MEDICAL CENTERS CONTINUES TO PROVIDE THESE SERVICES AS A BENEFIT TO THE COMMUNITY DESPITE KNOWING THAT FINANCIAL SHORTFALLS WILL BE SUSTAINED. SCHEDULE H, PART I, LINE 7 COSTING METHODOLOGY: THE COST TO CHARGE RATIO CALCULATED ON IRS WORKSHEET 2 WAS USED IN THE CALCULATION OF COST ON IRS WORKSHEETS 1 AND 3. COST COMPUTED ON IRS WORKSHEETS 5 AND 6 WERE COMPUTED FROM THE MEDICARE COST REPORT, INCLUDING DIRECT COSTS PLUS OVERHEAD ALLOCATIONS COMPUTED IN THE COST REPORT STEP-DOWN PROCESS. SCHEDULE H, PART III, SECTION A, LINE 2 BAD DEBT EXPENSE: THE HOSPITAL HAS ADOPTED THE NEW REVENUE RECOGNITION STANDARD ASU 2014-09. UNDER ASU 2014-09, THE ESTIMATED AMOUNTS DUE FROM PATIENTS FOR WHICH THE HOSPITAL DOES NOT EXPECT TO BE ENTITLED OR COLLECT FROM THE PATIENTS ARE CONSIDERED IMPLICIT PRICE CONCESSIONS AND EXCLUDED FROM THE HOSPITAL'S ESTIMATION OF THE TRANSACTION PRICE OR REVENUE RECORDED. BAD DEBT EXPENSE WAS NOT SIGNIFICANT TO THE AUDITED FINANCIAL STATEMENTS FOR THE YEAR ENDED SEPTEMBER 30, 2019. HOWEVER, THE HOSPITAL INTERNALLY TRACKS BAD DEBT EXPENSE CONSISTENT WITH HISTORICAL PRACTICES AND THAT AMOUNT HAS BEEN REPORTED ON SCHEDULE H, PART III, SECTION A, LINE 2. SCHEDULE H, PART III, SECTION A, LINE 3 BAD DEBT EXPENSE ATTRIBUTABLE TO CHARITY CARE: THE BAD DEBT ATTRIBUTABLE TO PATIENTS ELIGIBLE UNDER THE ORGANIZATION'S CHARITY CARE POLICY WAS DETERMINED USING POVERTY LIMIT DEMOGRAPHIC INFORMATION OBTAINED THROUGH THE US CENSUS BUREAU. USING DATA FROM 2014-2018, APPROXIMATELY 15.5 PERCENT OF GREENE COUNTY WAS CONSIDERED TO LIVE IN POVERTY. SCHEDULE H, PART III, SECTION A, LINE 4 BAD DEBT EXPENSE FOOTNOTE: THE AUDIT FOOTNOTE ADDRESSING BAD DEBT EXPENSE AND PATIENT ACCOUNTS RECEIVABLE IS FOUND ON PAGE 11 OF THE AUDITED FINANCIAL STATEMENTS UNDER NOTE 1, SUBTITLED "PATIENT ACCOUNTS RECEIVABLE." SCHEDULE H, PART III, SECTION B, LINE 8 COMMUNITY BENEFIT: SERVING PATIENTS WITH GOVERNMENT HEALTH BENEFITS, SUCH AS MEDICARE, IS A COMPONENT OF THE COMMUNITY BENEFIT STANDARD THAT TAX-EXEMPT HOSPITALS ARE HELD TO. THIS IMPLIES THAT SERVING MEDICARE PATIENTS IS A COMMUNITY BENEFIT AND THAT THE HOSPITAL OPERATES TO PROMOTE THE HEALTH OF THE COMMUNITY. SCHEDULE H, PART III, SECTION C, LINE 9B COLLECTION POLICY: THE ORGANIZATION WILL NOT PURSUE LEGAL ACTION FOR NONPAYMENT OF ANY AMOUNTS DISCOUNTED AS A RESULT OF AN APPROVED OR PARTIALLY APPROVED REQUEST FOR FINANCIAL ASSISTANCE. BALANCES REMAINING AFTER SUCH DISCOUNTS ARE APPLIED WILL, HOWEVER, BE SUBJECT TO COLLECTION ACTIVITY, INCLUDING LEGAL ACTION. IN ADDITION, THE ORGANIZATION WILL NOT CHARGE INTEREST ON THE BALANCE REMAINING AFTER APPLYING THE FINANCIAL ASSISTANCE DISCOUNT. HOWEVER, THE ORGANIZATION MAY, IN ITS SOLE DISCRETION, CHARGE INTEREST ON THE BALANCE OWED IF 1) THE GUARANTOR DEFAULTS ON HIS OR HER PAYMENT AGREEMENT OR 2) THE BALANCE IS REFERRED TO THE COLLECTION AGENCY FOR COLLECTION. SCHEDULE H, PART VI, LINE 2 NEEDS ASSESSMENT: LESTER E. COX MEDICAL CENTERS HAS PERFORMED AN ENVIRONMENTAL SCAN ANNUALLY SINCE 2006. COMMUNITY HEALTH NEEDS ASSESSMENTS AS REQUIRED BY THE IRS WERE COMPLETED IN EARLY 2016. A PUBLIC PERCEPTION STUDY OF AREA HEADS OF HOUSEHOLDS IS CONDUCTED ANNUALLY. THE MOST RECENT STUDY SURVEYED 876 HOUSEHOLDS IN OUR SERVICE AREA TO DETERMINE WHAT SERVICES ARE NEEDED. WE ALSO PERFORM A PUBLIC HEALTH SURVEY, WHICH ASKS COMMUNITY LEADERS AND HEALTH PROFESSIONALS WHAT THEIR PRIORITIES ARE AND WHAT HEALTH SERVICES ARE LACKING IN THEIR COMMUNITY. THE PUBLIC HEALTH SURVEY IS SENT TO COUNTY PUBLIC HEALTH DEPARTMENTS, LOCAL AGENCIES, REGIONAL SERVICES CLINICS, MENTAL HEALTH FACILITIES, AND PUBLIC SCHOOLS THROUGHOUT THE TOTAL SERVICE AREA. LESTER E. COX MEDICAL CENTERS REFERENCES UNITED HEALTH FOUNDATION STATE-BY-STATE HEALTH RANKINGS AS WELL AS ROBERT WOOD JOHNSON AND UNIVERSITY OF WISCONSIN POPULATION HEALTH INSTITUTE COUNTY HEALTH RANK FOR HEALTH OUTCOMES AND HEALTH FACTORS. COXHEALTH ALSO REFERENCES "ASSESSING THE HEALTH OF THE COMMUNITY", WHICH IS AN ANALYSIS OF BEHAVIORS AND OUTCOMES FOR THE SPECIFIC COUNTIES OF THE SERVICE AREA BY THE MISSOURI HOSPITAL ASSOCIATION. DEMOGRAPHIC AND ECONOMIC ANALYSIS IS PERFORMED FOR THE 22-COUNTY SERVICE AREA. NIELSEN CLARITAS DEMOGRAPHIC ESTIMATES AND PROJECTIONS ARE USED TO EVALUATE THE CHANGE IN POPULATION CHARACTERISTICS. UNEMPLOYMENT, HOME FORECLOSURE, AND INPATIENT PAYER DATA IS ALSO ASSESSED. IN 2016, COXHEALTH PERFORMED A COMMUNITY HEALTH NEEDS ASSESSMENT AS PART OF A COLLABORATIVE EFFORT, CONSISTING OF A VARIETY OF ORGANIZATIONS ACROSS THE OZARKS, TO BETTER UNDERSTAND THE HEALTH STATUS, BEHAVIORS, AND NEEDS OF THE POPULATIONS WE SERVE. UNDER THE UMBRELLA OF THE LOCAL OZARKS HEALTH COMMISSION, THIS FIRST-TIME COLLABORATION WAS THE LARGEST IN THE REGION SPANNING FOUR STATES-MISSOURI, OKLAHOMA, ARKANSAS AND KANSAS-29 COUNTIES AND THREE HOSPITAL SYSTEMS. THE WORKING GROUP SAW THE VALUE OF USING A SYSTEMATIC, DATA-DRIVEN ASSESSMENT TO INFORM DECISIONS AND GUIDE EFFORTS TO IMPROVE COMMUNITY HEALTH AND WELLNESS ON A REGIONAL LEVEL. THIS LARGER, CONCERTED APPROACH WILL LEVERAGE COMMON STRENGTHS AND STRATEGIES TO MOVE IN THE SAME DIRECTION ON SIGNIFICANT HEALTH CONCERNS. THE 2019 ASSESSMENT PROCESS BUILDS ON THE METHODOLOGY DEVELOPED DURING THE 2016 COMMUNITY HEALTH NEEDS ASSESSMENT. IT INCLUDES MORE THAN 140 HOSPITAL AND COMMUNITY DATA INDICATORS. THIS DATA WAS COMPARED TO THE NATION AND PAST PERFORMANCE AND USED TO IDENTIFY THE SIX ASSESSED HEALTH ISSUES (AHI): CANCER, LUNG DISEASE, CARDIOVASCULAR DISEASE, MENTAL HEALTH, DIABETES, AND ORAL HEALTH. LOCAL STAKEHOLDERS UTILIZED A COMBINATION OF PUBLIC HEALTH AND HOSPITAL DATA, ALONG WITH A COMMUNITY SURVEY DATA, TO PRIORITIZE THE AHI BASED ON FEASIBILITY AND COMMUNITY READINESS. THIS PRIORITIZATION PROCESS RESULTED IN THREE PRIORITIES FOR THE SPRINGFIELD COMMUNITY: LUNG DISEASE, CARDIOVASCULAR DISEASE AND MENTAL HEALTH. ALTHOUGH OTHER AHI WERE IDENTIFIED AS HEALTH ISSUES FOR THE SPRINGFIELD COMMUNITY, RESOURCES WOULD BE DILUTED IN AN EFFORT TO ADDRESS SEVERAL HEALTH ISSUES, THUS MINIMIZING THE ABILITY TO CREATE MEANINGFUL IMPACT. BY PRIORITIZING THE AHI BY FEASIBILITY AND COMMUNITY READINESS, THE COMMUNITY WILL BE ABLE TO HAVE A GREATER IMPACT ON OVERALL COMMUNITY HEALTH THROUGH EFFICIENT AND EFFECTIVE RESOURCE ALLOCATION. SCHEDULE H, PART VI, LINE 3 PATIENT EDUCATION OF ELIGIBILITY FOR ASSISTANCE: LESTER E. COX MEDICAL CENTERS USES A VARIETY OF METHODS TO INFORM AND EDUCATE PATIENTS ABOUT THEIR ELIGIBILITY FOR ASSISTANCE UNDER FEDERAL, STATE PROGRAMS OR UNDER THE ORGANIZATION'S POLICY: - AVAILABILITY OF FINANCIAL ASSISTANCE THROUGH THE ORGANIZATION IS COMMUNICATED TO PATIENTS THROUGH THE USE OF SIGNAGE AND BROCHURES/INFORMATION PACKETS AVAILABLE AT CHECK-IN LOCATIONS. - LESTER E. COX MEDICAL CENTERS ALSO PROACTIVELY COMMUNICATES THE AVAILABILITY OF FINANCIAL ASSISTANCE ON PATIENT BILLS AND STATEMENTS; AND ITS EARLY-OUT VENDOR RESPONSIBLE FOR PATIENT BALANCE COLLECTIONS IS EXPECTED TO PROACTIVELY INFORM SELF PAY PATIENTS OF THE AVAILABILITY WHEN SPEAKING TO THEM ON THE PHONE. - FOR ASSISTANCE UNDER FEDERAL AND STATE PROGRAMS LESTER E. COX MEDICAL CENTERS UTILIZES AN OUTSOURCE ELIGIBILITY VENDOR WHO MEETS WITH SELF PAY INPATIENTS AT THE BEDSIDE TO COMPLETE AN ELIGIBILITY SCREENING, INFORM THE PATIENTS OF POTENTIAL AVAILABILITY, AND WILL WORK WITH THE PATIENT TO HELP THEM THROUGH THE PROCESS. OUTPATIENTS ARE REFERRED TO THE VENDOR AFTER CARE AND THOSE ARE WORKED IN A SIMILAR FASHION WITH THE EXPECTATION THAT THE FIRST CONTACT IS THROUGH MAIL OR PHONE RATHER THAN AT THE BEDSIDE. SCHEDULE H, PART VI, LINE 4 COMMUNITY INFORMATION: THE PRIMARY SERVICE AREA (PSA) COUNTIES SERVED BY LESTER E. COX MEDICAL CENTERS INCLUDE: BARRY, CHRISTIAN, GREENE, LAWRENCE, STONE, TANEY, AND WEBSTER (ALL PSA COUNTIES ARE LOCATED IN MISSOURI). THE SECONDARY SERVICE AREA (SSA) COUNTIES SERVED BY LESTER E. COX MEDICAL CENTERS INCLUDE: BARTON, BAXTER - AR, BOONE - AR, CARROLL - AR, CEDAR, DADE, DALLAS, DOUGLAS, HICKORY, HOWELL, LACLEDE, MARION - AR, OREGON, OZARK, POLK, PULASKI, TEXAS, AND WRIGHT (ALL SSA COUNTIES ARE LOCATED IN MISSOURI EXCEPT BAXTER, BOONE, CARROLL, AND MARION COUNTIES IN ARKANSAS). THE TOTAL POPULATION IN THE SERVICE AREA IS OVER ONE MILLION AND APPROXIMATELY 58% OF THE TOTAL 25-COUNTY POPULATION IS IN THE SEVEN COUNTY PRIMARY SERVICE AREA. SLIGHTLY MORE THAN 50% OF THE MARKET IS FEMALE AND SLIGHTLY MORE THAN 18% OF THE SERVICE AREA IS FEMALE BETWEEN THE AGES OF 15 AND 44. THE SEGMENT OF THE POPULATION OVER THE AGE OF 65 IS ALMOST 20% OF THE TOTAL POPULATION AND IS PROJECTED TO INCREASE 12% BETWEEN 2020 AND 2025. THE AVERAGE HOUSEHOLD INCOME IS $64,665 IN THE TOTAL 25-COUNTY SERVICE AREA COMPARED WITH $79,915 FOR THE STATE OF MISSOURI. DIVERSITY IS VERY LOW IN THE 25-COUNTY SERVICE AREA AS 91% OF THE POPULATION IS WHITE ALONE. SCHEDULE H, PART VI, LINE 5 PROMOTION OF COMMUNITY HEALTH: LESTER E. COX MEDICAL CENTERS' MISSION IS TO IMPROVE THE HEALTH OF THE COMMUNITIES WE SERVE THROUGH QUALITY HEALTH CARE, EDUCATION AND RESEARCH. WE ACTIVELY LIVE THIS MISSION BY PROVIDING QUALITY HEALTH CARE WITH MULTIPLE ACCESS POINTS FOR CARE INCLUDING THREE HOSPITALS AND MORE THAN 60 PHYSICIAN CLINICS (INCLUDING RETAIL CLINICS). THE ORGANIZATION PROMOTES THE HEALTH OF THE COMMUNITY THROUGH A COMMUNITY BOARD, HEALTH RELATED AD CAMPAIGNS, PROVISION OF WELLNESS SERVICES AND VACCINATIONS, PROVISION OF CARE FOR INDIGENT SEGMENTS OF THE POPULATION, FUNDING OF CARE QUALIFIED COMMUNITY MEMBERS THROUGH A NOT-FOR-PROFIT FOUNDATION, COMMUNITY EDUCATION CLASSES RELATED TO HEALTH AND WELLNESS, COMMUNITY ADVISORY COUNCILS AND HEALTH IMPROVEMENT EFFORTS IN PARTNERSHIP WITH PUBLIC HEALTH DEPARTMENTS, SCHOOL SYSTEMS AND OTHER REGIONAL HEALTH CARE PROVIDERS. A MAJORITY OF LESTER E. COX MEDICAL CENTERS' BOARD IS COMPRISED OF INDIVIDUALS WHO RESIDE IN THE ORGANIZATION'S PRIMARY SERVICE AREA, WHO ARE NEITHER EMPLOYEES NOR INDEPENDENT CONTRACTORS. THE ORGANIZATION EXTENDS MEDICAL STAFF PRIVILEGES TO PHYSICIANS IN THE COMMUNITY IF THEY QUALIFY. SCHEDULE H, PART VI, LINE 6 AFFILIATED HEALTH CARE SYSTEM: COXHEALTH IS THE PARENT OF LESTER E. COX MEDICAL CENTERS AND ITS WHOLLY OWNED SUBSIDIARIES PLUS CERTAIN AFFILIATED NOT-FOR-PROFIT ENTITIES AND IS COLLECTIVELY REFERRED TO AS COXHEALTH. COXHEALTH (THE HEALTH SYSTEM) OPERATES AS AN INTEGRATED DELIVERY SYSTEM INCLUDING FOUR HOSPITALS, A SURGICAL CENTER, AN INPATIENT REHABILITATION FACILITY, HOME CARE COMPANIES, PHYSICIAN SERVICES, MENTAL HEALTH SERVICES, INSURANCE COMPANIES AND A FOUNDATION. COXHEALTH'S HOME CARE SERVICES ARE PROVIDED BY COXHEALTH AT HOME AND INCLUDE HOME HEALTH SERVICES, INFUSION THERAPY AND DURABLE MEDICAL EQUIPMENT. COXHEALTH AT HOME SUPPORTED THE COMMUNITY THROUGH MONTHLY NUTRITION AND FALL PREVENTION SEMINARS AT 20 AREA SENIOR CENTERS THROUGHOUT SOUTHWEST MISSOURI. THEY ALSO PROVIDED FREE BONE DENSITY SCREENINGS AT 34 COMMUNITY EVENTS, AND VITAL SIGN SCREENINGS AT MANY MORE. THROUGH AN ANNUAL FAN DRIVE, COXHEALTH AT HOME COLLECTED AND DISTRIBUTED BOX FANS TO SENIORS AND THE DISABLED WHO LACK ADEQUATE ACCESS TO COOLING DURING THE SUMMER MONTHS. INFUSION THERAPY RECEIVED A SECOND GRANT AWARD FROM THE MISSOURI FOUNDATION FOR HEALTH ORGANIZATION. THIS GRANT ALLOWS US TO SERVE PATIENTS THAT FALL THROUGH THE CRACKS DUE TO HAVING NO REIMBURSEMENT OF ANY KIND, SERVING PATIENTS THROUGHOUT SOUTHERN MISSOURI. ASSISTANCE TO COXHEALTH SYSTEM IN DEVELOPING AN INTEGRATED HEALTH SYSTEM, AND SERVICE TO MEDICAID PATIENTS. COX-MONETT HOSPITAL SUPPORTS THE MONETT, MISSOURI AND SURROUNDING COMMUNITY BY PROVIDING A VARIETY OF SERVICES WHICH INCLUDE UROLOGY, ENT (EAR, NOSE AND THROAT), PULMONOLOGY, ORTHOPEDICS, CARDIOLOGY, PODIATRY, OBSTETRICS, RADIOLOGY (CT, MRI, NUCLEAR MEDICINE AND MAMMOGRAPHY), LABORATORY, 24-HOUR EMERGENCY CENTER, GENERAL SURGICAL SERVICES, SAME-DAY SURGERY, DIABETES CENTER, SLEEP CENTER, CARDIOPULMONARY REHAB, MEDICAL-SURGICAL UNIT, URGENT CARE, PHARMACY AND COMMUNITY WELLNESS. COXHEALTH FOUNDATION SUPPORTS THE COMMUNITY BY RAISING FUNDS TO DISPERSE TO PATIENTS FOR THOSE NEEDS FOR WHICH THEY HAVE NO RESOURCES OR FUNDING, BUT WHICH ARE CRITICAL TO THE PATIENT'S HEALTH AND WELL BEING. SKAGGS COMMUNITY HOSPITAL ASSOCIATION D/B/A COX MEDICAL CENTER BRANSON (CMCB) HAS BEEN SERVING SOUTHWEST MISSOURI RESIDENTS FOR MORE THAN 63 YEARS AND OFFERS OVER 25 MAJOR SERVICE AREAS. THE HOSPITAL'S AVERAGE DAILY PATIENT CENSUS EXCEEDS 85 WITH 165 LICENSED HOSPITAL BEDS. A STAFF OF OVER 1,100 PERSONNEL IS REQUIRED TO OPERATE THE HOSPITAL AND ITS NUMEROUS CLINICS. COXHEALTH ADDED A FOURTH HOSPITAL IN 2018, COX BARTON COUNTY HOSPITAL (COX BARTON COUNTY). THE FACILITY WAS A COUNTY HOSPITAL OWNED AND OPERATED BY BARTON COUNTY MEMORIAL HOSPITAL (BCMH). IT WAS BUILT IN 2007 AND IS A 25-BED CRITICAL ACCESS HOSPITAL IN LAMAR, MISSOURI OFFERING AN EMERGENCY DEPARTMENT, AS WELL AS SPECIALIZED CARE IN DIABETES, CARDIOLOGY, ORTHOPEDICS AND SPORTS MEDICINE, NEUROLOGY, WOMEN'S HEALTH AND MORE. IN OCTOBER 2017, COXHEALTH SIGNED A LETTER OF INTENT WITH BCMH TO ACQUIRE ITS OPERATION AND TO LEASE ITS PROPERTY. BCMH WAS STRUGGLING AS A RURAL HOSPITAL TO KEEP UP WITH DECLINING REVENUE. COXHEALTH'S ACQUISITION ALLOWS FOR THE PATIENTS PREVIOUSLY SERVED BY BCMH TO BECOME A PART OF THE COXHEALTH SYSTEM. COX BARTON COUNTY WILL CONTINUE THE SERVICES PREVIOUSLY PROVIDED BY BCMH AND INTENDS TO EXPAND THESE SERVICES FURTHER IN THE FUTURE AS WELL. TO COMPLETE THE TRANSACTION, COXHEALTH FORMED TWO ENTITIES, COX BARTON COUNTY HOSPITAL, A MISSOURI NONPROFIT CORPORTATION, AND CBCH, LLC, A MISSOURI LIMITED LIABILITY COMPANY. BOTH ENTITIES HAVE THE SAME CORPORATE PARENT, COXHEALTH, WHICH IS A MISSOURI NONPROFIT CORPORATION. THE OPERATION AND ASSETS OF THE HOSPITAL HAVE BEEN HELD BY CBCH, LLC SINCE JANUARY 1, 2018 AND WILL BE TRANSFERRED TO COX BARTON COUNTY HOSPITAL EFFECTIVE OCTOBER 1, 2019. true MHA CENTER FOR EDUCATION PO BOX 60 JEFFERSON CITY MO 65102 430898947 501(C)(3) 93312 COMM BENEFIT COXHEALTH COXHEALTH SPRINGFIELD MO 65802 471087427 501(C)(3) 47599 COMM BENEFIT COXHEALTH FOUNDATION 3525 S NATIONAL STE 204 SPRINGFIELD MO 65807 436810485 501(C)(3) 9693 COMM BENEFIT 3 CHILDREN'S MIRACLE NETWORK -SPECIAL NEEDS GRANT 2341 188223 CHILDREN'S MIRACLE NETWORK -FAMILY CARE GRANTS 78 182675 CHILDREN'S MIRACLE NETWORK -COMMUNITY OUTREACH GRA 38063 59610 CHILDREN'S MIRACLE NETWORK -LESTER E COX MC GRANTS 63524 525581 CHILDREN'S MIRACLE NETWORK -OTHER GRANTS 18912 434902 TUITION ASSISTANCE PROGRAMS 10 97710 CAR SEAT/SLEEP SACK 3729 24359 SCHEDULE I, PART I, LINE 2 PROCEDURES FOR MONITORING THE USE OF GRANT FUNDS IN THE U.S.: THROUGH THE CHILDREN'S MIRACLE NETWORK, LESTER E. COX MEDICAL CENTERS DISTRIBUTES FUNDS TO INDIVIDUALS THROUGHOUT THE COMMUNITY. SEE BELOW FOR A SUMMARY OF PROGRAMS THROUGH WHICH FUNDS ARE DISTRIBUTED. DURING FISCAL YEAR 2019, NEARLY 123,000 CHILDREN WERE SERVED: SPECIAL NEEDS FUND - $188,223 - DIRECT FINANCIAL ASSISTANCE TO FAMILIES, WHICH INCLUDES: *KIDS CHECKS - $90,639 *MEAL TRAYS - $61,072 *MEAL VOUCHERS - $3,872 *GIFT CARDS - $32,640 FAMILY CARE GRANTS - $182,675 - DIRECT FINANCIAL ASSISTANCE TO FAMILIES, WHICH INCLUDES: SPEECH, OCCUPATIONAL AND PHYSICAL THERAPY BILLS, HOSPITAL BILLS, ETC. COMMUNITY GUARANTEED GRANTS - $59,610 TOTAL *CARDIAC PROGRAM (A PORTION TO COX- MONETT HOSPITAL, INC.) - $26,610 *"NEVER SHAKE A BABY" PROGRAM - $15,000 *BICYCLE SAFETY PROGRAM - $ 7,000 *WASTED PROGRAM - $3,000 *WATER SAFETY PROGRAM - $2,000 *CAR SEAT SAFETY PROGRAM - $6,000 LESTER E. COX MEDICAL CENTERS GUARANTEED GRANTS - $525,581 TOTAL *CHILD LIFE PROGRAM - $147,210 *C.A.R.E. MOBILE - $378,371 DISCRETIONARY AND OPEN FUNDS - $434,902 - THESE ARE FUNDS THAT DO NOT FALL INTO ONE OF THE ABOVE CATEGORIES AND INCLUDES FUNDS TO DEPARTMENTS FOR EQUIPMENT AND OTHER THERAPEUTIC ITEMS FOR CHILDREN. THE FUNDS ARE AS FOLLOWS: *SURGICAL SERVICES - $22,109 *MONETT L & D - $15,167 *LABOR & DELIVERY - $41,187 *RESPIRATORY CARE - $77,332 *PEDIATRICS/PICU - $4,982 *BRANSON PEDIATRICS - $20,605 *BRANSON MATERNITY - $15,977 *BRANSON THERAPY SERVICES - $5,000 *CHILD/ADOLESCENT PSYCH - $22,495 *WOMEN/NEWBORN - $20,521 *CASE MANAGEMENT - $5,998 *OP NEURO-THERAPY - $7,690 *ACUTE CARE THERAPY - $21,900 *REHAB THERAPY MORH - $5,203 *LABORATORY SERVICES - $4,962 *BARTON COUNTY ER - $23,774 *GI ENDOSCOPE & TOWER - $120,000 THE ORGANIZATION ALSO PROVIDED SUPPORT OF OTHER LOCAL ORGANIZATIONS THROUGH SPONSORSHIPS AS PART OF THEIR COMMUNITY BUILDING ACTIVITIES. THE USE OF THE FUNDS CAN BE SEEN AT EVENTS AND IN COMMUNITY PROJECTS. X X true true X X X X X false true false false false true false false false PATRICIA DIX MD BOARD MEMBER 360417 0 0 0 2843 0 26750 0 14746 0 404756 0 0 0 DAVID ZOLFAGHARI MD BOARD MEMBER 0 1125716 0 0 0 0 0 0 0 16320 0 1142036 0 0 STEVE EDWARDS PRESIDENT AND CEO COXHEALTH 0 1113707 0 377807 0 10359 0 269727 0 25566 0 1797166 0 0 JACOB MCWAY SR VP AND CFO COXHEALTH 0 605649 0 148486 0 137806 0 144963 0 23216 0 1060120 0 126919 IBRAHIM ABE ABDALLA MD BOARD MEMBER 0 983315 0 0 0 0 0 0 0 16320 0 999635 0 0 LOUIS KRENN MD PHYSICIAN 633410 0 0 0 300 0 13365 0 16370 0 663445 0 0 0 ARMIN KAMYAB MD PHYSICIAN 1127076 0 0 0 270 0 31865 0 7823 0 1167034 0 0 0 NAGIB CHOWDHURY MD PHYSICIAN 533604 0 0 0 270 0 31865 0 7823 0 573562 0 0 0 GREGORY STAMPS MD PHYSICIAN 670684 0 0 0 690 0 32250 0 16435 0 720059 0 0 0 ARJIT CHOWDHURY MD PHYSICIAN 592902 0 0 0 300 0 13365 0 16370 0 622937 0 0 0 DAVID STRONG VP HOSPITAL REVENUE & CFO CMCB 139122 139123 19251 19251 20824 20825 21175 21175 8267 8268 208639 208642 17179 17180 RON PRENGER SR VP, CHIEF HOSPITAL OFFICER 409424 0 54885 0 1980 0 31750 0 14602 0 512641 0 0 0 GENICE MAROC VP CLINICAL SERVICES 203657 0 12922 0 1980 0 7107 0 8231 0 233897 0 0 0 MAX BUETOW VP REGIONAL SERVICES 218301 0 15501 0 690 0 13750 0 16467 0 264709 0 0 0 JEFF HAWKINS VP CLINICAL SERVICES 180008 0 11048 0 1290 0 9749 0 8032 0 210127 0 0 0 FRANK ROMERO VP MEDICAL AFFAIRS 412948 0 22403 0 1980 0 13750 0 16650 0 467731 0 0 0 ROBERT FERGUSON VP FERRELL DUNCAN CLINIC 292839 0 19524 0 1980 0 13750 0 11482 0 339575 0 0 0 KAREN KRAMER VP, CHIEF NURSING OFFICER 281120 0 18318 0 1290 0 31742 0 14487 0 346957 0 0 0 AMANDA HEDGPETH VP CLINICAL SERVICES 177541 0 10460 0 270 0 9555 0 7748 0 205574 0 0 0 STACI NIEMOTH MD BOARD MEMBER 0 571029 0 0 0 0 0 0 0 16320 0 587349 0 0 SCHEDULE J, PART I, LINE 1A INFORMATION REGARDING BENEFITS PROVIDED: MONTHLY SOCIAL CLUB DUES ARE INCLUDED IN THE TAXABLE COMPENSATION OF STEVE EDWARDS, CEO. CHARTER TRAVEL IS PROVIDED FOR STEVE EDWARDS, JACOB MCWAY AND DENNIS HEIM FOR TRAVEL TO COLLABORATIVE MEETINGS REPRESENTING COXHEALTH FOR EXPEDIENCY. AS THERE WAS NO PERSONAL USE PORTION OF THIS BENEFIT, NONE WAS INCLUDED IN TAXABLE WAGES. SCHEDULE J, PART I, LINE 4B SUPPLEMENTAL NONQUALIFIED RETIREMENT PLAN: STEVE EDWARDS AND JACOB MCWAY PARTICIPATE IN A 457(F) NONQUALIFIED RETIREMENT PLAN WITH LESTER E. COX MEDICAL CENTERS: - STEVE EDWARDS RECEIVED AN EXECUTIVE 457(F) CONTRIBUTION OF $255,977. - JACOB MCWAY RECEIVED AN EXECUTIVE 457(F) CONTRIBUTION OF $113,098. - JACOB MCWAY RECEIVED A 457(F) DISTRIBUTION OF $126,919, WHICH WAS REPORTED AS DEFERRED COMPENSATION ON A PRIOR FORM 990. - DAVID STRONG RECEIVED AN EXECUTIVE 457(F) CONTRIBUTION OF $28,600. - DAVID STRONG RECEIVED A 457(F) DISTRIBUTION OF $34,359, WHICH WAS REPORTED AS DEFERRED COMPENSATION ON A PRIOR FORM 990. SCHEDULE J, PART I, LINE 6A COMPENSATION CONTINGENT ON THE NET EARNINGS OF THE ORGANIZATION: KEY EMPLOYEES HAVE NET EARNINGS AS ONE COMPONENT OF A BALANCED SCORECARD METRIC CONTAINED WITHIN A BONUS PROGRAM. EMPLOYED PHYSICIANS ARE PAID BASED ON A SALARY, A FORMULA USING COLLECTIONS AND EXPENSES, AN AMOUNT PER RVU, OR A COMBINATION OF THESE. PHYSICIANS LISTED ON PART VII THAT ARE SUBJECT TO THESE COMPENSATION ARRANGEMENTS ARE MARTIN JONES, ARIJIT CHOWDHURY, CARY MARQUIS, TOMMY TRENT, AND BOYD CROCKETT. EXECUTIVE LEVEL STAFF ARE ELIGIBLE FOR ADDITIONAL COMPENSATION BASED ON A VARIETY OF PERFORMANCE INDICATORS IN QUALITY, CUSTOMER AND EMPLOYEE SATISFACTION AND BUSINESS PERFORMANCE MEASURES. SCHEDULE J, PART II; AND FORM 990, PART VII BOARD MEMBER COMPENSATION: NO COMPENSATION WAS PROVIDED FOR RESPONSIBILITIES ASSOCIATED WITH BEING A BOARD DIRECTOR. COMPENSATION REPORTED FOR SEVERAL BOARD MEMBERS LISTED ON SCHEDULE J REPRESENTS EMPLOYEE OR INDEPENDENT CONTRACTOR COMPENSATION UNRELATED TO SERVICE AS A BOARD MEMBER. SCHEDULE J, PART II, COLUMN F COMPENSATION REPORTED IN PRIOR FORM 990: COMPENSATION IS REPORTED ON THE FORM 990 IN THE YEAR THAT THE COMPENSATION IS EARNED BY OR AWARDED TO AN INDIVIDUAL, EVEN IF THE COMPENSATION IS NOT PAID TO THE INDIVIDUAL, IS NOT FULLY VESTED, OR IS SUBJECT TO SUBSTANTIAL RISK OF FORFEITURE. IF COMPENSATION IS EARNED OR AWARDED IN ONE YEAR BUT PAID IN A LATER YEAR, THEN THE COMPENSATION IS REPORTED A SECOND TIME ON THE FORM 990 IN THE YEAR THE COMPENSATION IS VESTED OR PAID TO THE INDIVIDUAL. A HEALTH & EDUCATIONAL FACILITIES AUTH - STATE OF MO 431178966 60637AEA6 2013-04-17 215764775 NEW INFRASTRUCTURE/CURRENT REFUND false false false B HEALTH & EDUCATIONAL FACILITIES AUTH - STATE OF MO 431178966 2008-10-15 70000000 NEW INFRASTRUCTURE & EQUIPMENT false false false C HEALTH & EDUCATIONAL FACILITIES AUTH - STATE OF MO 431178966 60635R427 2008-09-25 157078759 '97 & '02 REFUND & NEW INFRSTRCTRE true false false D HEALTH & EDUCATIONAL FACILITIES AUTH - STATE OF MO 431178966 2008-10-15 35000000 NEW INFRASTRUCTURE & EQUIPMENT false false false A 3515000 0 216278348 0 16377190 0 2222341 0 0 167958089 29720728 0 2015 true false true true B 0 0 70469521 0 783050 0 501052 2121540 0 67063879 0 0 2012 false false true true C 24530872 130000000 158302381 3102979 1387574 0 1448413 0 0 66262892 73174648 0 2012 true false true true D 560000 0 35028548 0 421299 0 271929 803381 0 33531939 0 0 2012 false false true true A false true false false 0 false false false true B false false false false 0.00830 0.00830 false false false true C false true false false 0.00930 0.00930 false false false true D false false false false 0.00830 0.00830 false false false true A false false false true false false 0 false 0 false true B false false false true true false 0 false 0 false true C false false false true false false 0 false 0 false true D false false false true true false 0 false 0 false true A true B true C true D true SCHEDULE K, GROUP 1, PART II, LINE 3, COLUMNS A, B, C, D TOTAL PROCEEDS OF ISSUE: THE TOTAL PROCEEDS OF THE ISSUE EXCEEDED THE ISSUE PRICE BY THE INVESTMENT EARNINGS AS OF 09/30/2019. SCHEDULE K, GROUP 1, PART II, LINE 11, COLUMNS A, C OTHER PROCEEDS SPENT: THE OTHER SPENT PROCEEDS RELATE TO THE CURRENT REFUNDING PROCEEDS OF THE ISSUE. SCHEDULE K, GROUP 1, PART IV, LINE 2C, COLUMNS A, B, C, D DATE REBATE COMPUTATION WAS PERFORMED: REBATE CALCULATION/ANALYSIS WERE COMPLETED AS FOLLOWS: -BOND SERIES ISSUE A ON 03/20/2018 -BOND SERIES ISSUE B ON 11/19/2018 -BOND SERIES ISSUE C ON 10/17/2018 -BOND SERIES ISSUE D ON 11/20/2018 A HEALTH & EDUCATIONAL FACILITIES AUTH - STATE OF MO 431178966 2017-08-29 4692000 CAPITAL EQUIPMENT FINANCING false false false B HEALTH & EDUCATIONAL FACILITIES AUTH - STATE OF MO 431178966 2015-04-22 142209927 REFINANCE 80% 2008A false false false C HEALTH & EDUCATIONAL FACILITIES AUTH - STATE OF MO 431178966 60637ANY4 2019-04-17 120260000 NEW INFRASTRUCURE & EQUIPMENT false false false A 1274240 0 4692000 0 0 0 90350 0 0 4601650 0 0 2017 false false true true B 0 0 142215222 0 0 0 1326793 0 0 140826285 62144 0 2015 false true false true C 0 0 120308278 0 0 0 716079 0 0 28984699 0 90607500 false false false true A false false false false 0 false false false true B false false false false 0 false false false true C false false false false 0 false false false false A false true false false false false 0 false 0 false true B false true false false false false 0 false 0 false true C false true false false false false 0 false 0 false true A true B true C true SCHEDULE K, GROUP 2, PART II, LINE 3, COLUMN B TOTAL PROCEEDS OF ISSUE: THE TOTAL PROCEEDS OF THE ISSUE EXCEEDED THE ISSUE PRICE BY THE INVESTMENT EARNINGS AS OF 09/30/2019. SCHEDULE K, GROUP 2, PART II, LINE 11, COLUMN B OTHER PROCEEDS SPENT: THE OTHER SPENT PROCEEDS RELATE TO THE ADVANCE REFUNDING PROCEEDS OF THE ISSUE. 0 VICKI HOCKENSMITH S EDWARDS - SEE PART V 112718 WAGES AND BENEFITS false TERRY HAMMER S EDWARDS - SEE PART V 110997 WAGES AND BENEFITS false LISA ESPY K KRAMER - SEE PART V 38490 WAGES false JASON PRENGER R PRENGER - SEE PART V 24727 WAGES AND BENEFITS false BETTY EDWARDS S EDWARDS - SEE PART V 23953 RETIREMENT BENEFITS false CONNIE ROMERO F ROMERO - SEE PART V 105520 WAGES AND BENEFITS false ANDREW HEDGPETH A HEDGPETH - SEE PART V 253420 WAGES AND BENEFITS false JEFF HAWKINS A HEDGPETH - SEE PART V 202096 WAGES AND BENEFITS false AMANDA HEDGPETH J HAWKINS - SEE PART V 197826 WAGES AND BENEFITS false LISA HEDGPETH A HEDGPETH - SEE PART V 30375 WAGES AND BENEFITS false SCOTT ROGERS S NIEMOTH - SEE PART V 114254 WAGES AND BENEFITS false SCHEDULE L, PART IV BUSINESS TRANSACTIONS INVOLVING INTERESTED PERSONS: (1,2,5)STEVE EDWARDS, CEO, HAS THREE FAMILY MEMBERS WHO WORK FOR OR RECEIVE RETIREMENT BENEFITS FROM LESTER E. COX MEDICAL CENTERS. VICKI HOCKENSMITH IS HIS SISTER, TERRY HAMMER IS HIS BROTHER-IN-LAW, AND BETTY B. EDWARDS IS HIS MOTHER. (3)KAREN KRAMER'S SISTER, LISA ESPY, IS AN EMPLOYEE AT LESTER E. COX MEDICAL CENTERS, AND KAREN IS VICE PRESIDENT AND CHIEF NURSING OFFICER. (4)RON PRENGER'S SON, JASON PRENGER, IS AN EMPLOYEE AT LESTER E. COX MEDICAL CENTERS, AND RON IS A SENIOR VICE PRESIDENT AND CHIEF HOSPITAL OFFICER. (6)FRANK ROMERO'S WIFE, CONNIE ROMERO, IS AN EMPLOYEE OF LESTER E. COX MEDICAL CENTERS AND FRANK IS VICE PRESIDENT OF MEDICAL AFFAIRS. (7,8,9,10) ANDREW HEDGPETH IS AN EMPLOYEE OF LESTER E. COX MEDICAL CENTERS AND AMANDA HEDGPETH IS AN EMPLOYEE OF LESTER E. COX MEDICAL CENTERS AND ARE MARRIED. THERE ARE TWO ADDITIONAL FAMILY MEMBERS WHO ARE EMPLOYEES OF LESTER E. COX MEDICAL CENTERS. JEFF HAWKINS, VICE PRESIDENT OF CLINICAL SERVICES, IS AMANDA HEDGPETH'S UNCLE. LISA HEDGPETH, AN EMPLOYEE OF LESTER E. COX MEDICAL CENTERS, IS ANDREW HEDGPETH'S MOTHER. (11) STACI NIEMOTH'S HUSBAND, SCOTT ROGERS, IS AN EMPLOYEE OF LESTER E. COX MEDICAL CENTERS AND STACI IS JOC CHAIR OF MEDICAL AFFAIRS. FORM 990, PART III, LINE 4B ADDITIONAL INFORMATION ABOUT PHYSICIAN CARE: AFFORDABLE, CONVENIENT CARE IS ALSO PROVIDED IN OUR RETAIL CLINICS. LESTER E. COX MEDICAL CENTERS CONTINUES TO PARTNER WITH WAL-MART AND HYVEE AND CURRENTLY HAS 6 PARTNERSHIP CLINICS. COXHEALTH HAS ALSO INVESTED IN TELEMEDICINE INFRASTRUCTURE TO FURTHER EXPAND ITS ABILITY TO OFFER COST EFFECTIVE AND CONVENIENT CARE TO OUR COMMUNITY. FORM 990, PART III, LINE 4C EXEMPT PURPOSE ACHIEVEMENTS - ADDITIONAL INFORMATION ABOUT HOME CARE: OXFORD SUPPORTS THE COMMUNITY THROUGH THEIR ASSOCIATION SUPPORT (I.E. ALZHEIMER'S ASSOCIATION, DIABETES ASSOCIATION, HEART ASSOCIATION, ETC,) THEY WORK DILIGENTLY TO RAISE FUNDS FOR PATIENTS THROUGH DONATIONS FROM THEIR EMPLOYEES AND A COMMUNITY WIDE FAN DRIVE FOR PATIENTS WITHOUT AIR CONDITIONING. HOME SUPPORT HAS PROVIDED DURABLE MEDICAL EQUIPMENT AND SERVICES TO PATIENTS IN SOUTHWEST MISSOURI FOR OVER 30 YEARS AND AS THE COMPANY HAS GROWN IT HAS STEADILY BECOME MORE INVOLVED IN AN EFFORT TO BETTER MEET THE NEEDS OF THE COMMUNITY AS A WHOLE. THE STAFF SUPPORT THEIR PATIENTS AND FAMILIES IN MANY WAYS BY CONTACTING HOME HEALTH CARE AGENCIES, DIVISION OF AGING AND OTHER LOCAL CHARITIES. THEY REGULARLY DONATE MEDICAL EQUIPMENT TO CONVOY OF HOPE AND OTHER AGENCIES THAT SUPPORT DISASTER AND RELIEF EFFORTS BOTH LOCALLY AND ABROAD. COMMUNITY BENEFIT ACTIVITIES INCLUDE DONATED EMPLOYEE TIME AND PARTS TO INSTALL AN OVERHEAD LIFT FOR AN ORGANIZATION CALLED "HORSES OF HOPE" THAT AIDS IN HELPING DISABLED PATIENTS RIDE HORSES. FORM 990, PART III, LINES 4A-4D EXEMPT PURPOSE ACHIEVEMENTS - COMMUNITY BENEFIT REPORT: LESTER E. COX MEDICAL CENTERS IS PROUD TO OFFER NATIONALLY RECOGNIZED QUALITY CARE AND THE LATEST IN MEDICAL TECHNOLOGY AND SERVICES TO IMPROVE OUR COMMUNITY'S HEALTH. DESPITE INNOVATION AND QUALITY, THERE ARE STILL COMMUNITY NEEDS THAT ARE NOT MET THROUGH REGULAR COURSE OF CARE. THAT IS WHY AS A COMMUNITY-OWNED, NOT-FOR-PROFIT HOSPITAL SYSTEM, WE PROVIDE THE KIND OF CARE AND PROGRAMS THAT ARE NEEDED TO SERVE ALL IN OUR COMMUNITIES, INCLUDING SOME OF THE MOST VULNERABLE - THE UNDERINSURED AND UNINSURED. PROGRAMS THAT HELP THE INDIVIDUALS AND FAMILIES OF OUR COMMUNITY ARE AN INVESTMENT IN FRIENDS, FAMILY, AND NEIGHBORS. LESTER E. COX MEDICAL CENTERS DOES THIS THROUGH INITIATIVES LIKE KOHL'S CARDIAC KIDS AND HEALTHY FOOD PANTRY COLLABORATIVE, BUT IS ALSO EVIDENT IN COMMUNITY AND HEALTH CARE EDUCATION, SUPPORT GROUPS, PREVENTIVE SCREENINGS, SPONSORSHIPS, AND DONATIONS. COMMUNITY BENEFIT MEDICARE, MEDICAID AND UNINSURED SUBSIDIES $ 202,640,317 CMC $ 232,818,665 SYSTEM-WIDE THIS FIGURE INCLUDES THE ESTIMATED UNPAID COSTS OF PROVIDING CARE TO MEDICARE AND MEDICAID PATIENTS AND REPRESENTS THE SHORTFALL BETWEEN THE COST OF PROVIDING CARE AND THE PAYMENTS RECEIVED BY THE GOVERNMENT AND COVERED INDIVIDUALS. ALSO, IT INCLUDES THE ESTIMATED UNPAID COST OF PROVIDING FREE OR DISCOUNTED CARE TO PERSONS WHO CANNOT AFFORD TO PAY FOR ANY OR ALL OF THE SERVICES THEY RECEIVE AND WHO ARE NOT ELIGIBLE FOR PUBLIC PROGRAMS. COMMUNITY OUTREACH SERVICES $ 284,811 CMC $ 300,760 SYSTEM-WIDE INCLUDES ACTIVITIES CARRIED OUT TO IMPROVE COMMUNITY HEALTH AND SERVICES THAT ARE SUBSIDIZED BECAUSE THEY ARE NEEDED IN THE COMMUNITY. EXAMPLES ARE COMMUNITY EDUCATION, HEALTH SCREENINGS, SUPPORT GROUPS, IMMUNIZATIONS, COALITION BUILDING AND SUBSIDY OF HEALTH CARE SERVICES. HEALTH PROFESSIONALS EDUCATION AND RESEARCH $ 4,409,860 CMC $ 5,639,606 SYSTEM-WIDE THIS FIGURE IS THE COST OF PROVIDING CLINICAL PLACEMENTS FOR PHYSICIANS AND OTHER HEALTH PROFESSIONALS PLUS THE UN-REIMBURSED COST OF COX FAMILY MEDICINE RESIDENCY AND SCHOOLS OF ALLIED HEALTH PROFESSIONS. IT INCLUDES THE UN-REIMBURSED EXPENSE OF STUDIES ON THERAPEUTIC PROTOCOLS AND RESEARCH. FOUNDATION GRANTS, FINANCIAL CONTRIBUTIONS AND IN-KIND DONATIONS $ 2,046,727 CMC $ 2,217,966 SYSTEM-WIDE THIS FIGURE INCLUDES CASH AND IN-KIND DONATIONS TO SUPPORT COMMUNITY ORGANIZATIONS, PATIENT ADVOCACY AND EDUCATION, AS WELL AS CONTRIBUTIONS FOR NOT-FOR-PROFIT COMMUNITY ORGANIZATIONS AND EVENT SPONSORSHIPS. TOTAL COMMUNITY BENEFIT: $ 209,381,715 CMC $ 240,976,997 SYSTEM-WIDE ECONOMIC IMPACT REAL ESTATE AND PROPERTY TAXES $ 967,646 CMC $ 1,308,834 SYSTEM-WIDE TOTAL REAL ESTATE AND PROPERTY TAXES PAID BY LESTER E. COX MEDICAL CENTERS FOR MEDICAL OFFICE BUILDINGS AND PHYSICIAN OFFICES AND CLINIC. CAPITAL INVESTMENTS $ 63,630,558 CMC $ 90,110,325 SYSTEM-WIDE AS A NON-PROFIT ORGANIZATION, LESTER E. COX MEDICAL CENTERS REINVESTS ITS REVENUE IN THE SERVICES IT PROVIDES TO THE COMMUNITY, INCLUDING THE COST OF MEDICAL TECHNOLOGY, EQUIPMENT AND SERVICES. THIS AMOUNT INCLUDES THE TOTAL INVESTMENT MADE THROUGH PURCHASING AND LEASING OF MEDICAL EQUIPMENT AND TECHNOLOGY, AS WELL AS RENTAL FACILITIES, SUCH AS MEDICAL OFFICES. PAYROLL & BENEFITS $ 475,149,361 CMC $ 818,309,350 SYSTEM-WIDE THE COXHEALTH SYSTEM IS ONE OF THE LARGEST EMPLOYERS IN SOUTHWEST MISSOURI. IN CALENDAR YEAR 2015, LESTER E. COX MEDICAL CENTERS ALONE EMPLOYED NEARLY 9,400 PEOPLE, AND THE REMAINING COXHEALTH SYSTEM AFFILIATES CARRY THE TOTAL EMPLOYED FIGURE TO OVER 10,000 PEOPLE. THIS DOLLAR AMOUNT INCLUDES THE COST OF PAYROLL AND BENEFITS OF OUR DEDICATED TEAM FOR LESTER E. COX MEDICAL CENTERS. IT ALSO INCLUDES A SIGNIFICANT INVESTMENT ON CONTRACT PERSONNEL IN VARIOUS MEDICAL SPECIALTIES AS WELL AS MONIES TO OTHER PROFESSIONALS WHO RESIDE LOCALLY. TOTAL ECONOMIC IMPACT: $ 544,560,492 CMC $ 915,324,430 SYSTEM-WIDE TOTAL CONTRIBUTIONS TO THE COMMUNITY: $ 753,942,207 CMC $ 1,156,301,427 SYSTEM-WIDE FORM 990, PART VI, SECTION A, LINE 2 BUSINESS RELATIONSHIPS: BOARD MEMBERS JAN BAUMGARTNER AND ROBERT FULP HAVE A BUSINESS RELATIONSHIP. BOARD MEMBERS WHO RECEIVE COMPENSATION, OFFICERS, AND KEY EMPLOYEES ARE EMPLOYED BY COXHEALTH AND ITS AFFILIATES AND THEREFORE SHARE A BUSINESS RELATIONSHIP. FORM 990, PART VI, SECTION A, LINE 6, 7A & 7B MEMBERS, STOCKHOLDERS, OR OTHER PERSONS: THE FOLLOWING CORPORATE POWERS AND RESPONSIBILITIES SHALL BE SOLELY & SPECIFICALLY RESERVED TO THE MEMBER; (A) TO ESTABLISH AND CHANGE THE BUSINESS PURPOSES, MISSION, VISION OR VALUES OF CMC; (B) TO APPROVE AMENDMENTS TO THE ARTICLES OF INCORPORATION OF CMC AS PROVIDED THEREIN; (C) TO APPROVE AMENDMENTS TO THE BYLAWS OF CMC; (D) TO APPROVE THE ADOPTION OF AND ANY REVISION TO THE CHARTERS FOR ALL COMMITTEES ESTABLISHED BY THE BOARD; (E) TO APPOINT AND REMOVE THE DIRECTORS OF CMC, SUBJECT TO THE REQUIREMENTS OF ARTICLE FIVE, SECTION 1 AND TO APPOINT AND REMOVE THE OFFICERS OF THE BOARD AND CMC; (F) AFTER CONSULTATION WITH THE BOARD, TO APPROVE THE APPOINTMENT AND REMOVAL OF THE PRESIDENT AND CEO OF CMC; (G) TO APPOINT THE AUDITOR AND THE CORPORATE COUNSEL FOR CMC AND ITS CONTROLLED SUBSIDIARIES OR REMOTELY CONTROLLED SUBSIDIARIES; (H) TO ESTABLISH CENTRALIZED EMPLOYEE BENEFIT, INSURANCE, INVESTMENT, FINANCING, MARKETING, LEGAL, CORPORATE, COMPLIANCE, PERFORMANCE ASSESSMENT AND IMPROVEMENT AND OTHER OPERATIONAL AND SUPPORT PROGRAMS; TO REQUIRE THE PARTICIPATION OF CMC IN SUCH PROGRAMS; AND TO AUTHORIZE THE OPENING AND CLOSING OF BANK ACCOUNTS AND INVESTMENT ACCOUNTS IN THE NAME OF CMC; (I) TO APPROVE THE MERGER, CONSOLIDATION OR DISSOLUTION OF CMC OR THE SALE OF ALL OR SUBSTANTIALLY ALL OF THE ASSETS OF CMC; (J) TO APPROVE THE FORMATION OF A CONTROLLED SUBSIDIARY OR A REMOTELY SUBSIDIARY; (K) TO APPROVE THE ACQUISITION OR DISPOSITION BY CMC OF ANOTHER LEGAL ENTITY OR AN INTEREST IN ANOTHER LEGAL ENTITY; (L) AFTER RECEIVING INPUT FROM THE BOARD, TO APPROVE THE STRATEGIC PLAN AND THE OPERATING AND CAPITAL BUDGETS OF CMC; (M) APPROVAL OF CMC'S UNBUDGETED DEBT AND CAPITAL EXPENDITURES OF ONE HUNDRED THOUSAND DOLLARS ($100,000) OR GREATER; (N) TO AUTHORIZE OR APPROVE THE ACQUISITION OR DISPOSITION BY CMC OF REAL PROPERTY OR ANY INTEREST IN REAL PROPERTY HAVING A VALUE OF ONE HUNDRED THOUSAND DOLLARS ($100,000) OR GREATER; (O) TO APPROVE THE SALE OR PURCHASE OF ANY PROPERTY OF CMC HAVING A VALUE OF ONE HUNDRED THOUSAND DOLLARS ($100,000) OR GREATER; (P) TO AUTHORIZE AND APPROVE BORROWING MONEY OR ENTERING INTO FINANCIAL GUARANTIES BY CMC, INCLUDING ACTIONS RELATING TO THE FORMATION, JOINING, OPERATION, WITHDRAWAL FROM AND TERMINATION OF A CREDIT GROUP OR AN OBLIGATED GROUP AND THE GRANTING OF SECURITY INTERESTS IN THE PROPERTY OF CMC; (Q) TO REQUIRE CMC TO TRANSFER ASSETS, INCLUDING BUT NOT LIMITED TO CASH, TO THE MEMBER; (R) TO APPROVE THE TRANSFER OF ASSETS BY CMC TO ANY ENTITY OTHER THAN THE MEMBER, OTHER THAN TRANSFERS MADE IN THE ORDINARY COURSE OF OPERATIONS OF CMC WHICH WILL NOT REQUIRE APPROVAL OF THE MEMBER; (S) TO APPROVE THE RATE OF PAYMENT, COMPENSATION OR RENT AND/OR ANY PROVISIONS CONCERNING EXCLUSIVITY WITH RESPECT TO ANY CONTRACT FOR PHYSICIAN SERVICES AND ANY LEASE/TIMESHARE AGREEMENT BETWEEN ANY PHYSICIAN OR PHYSICIAN GROUP, ON THE ONE HAND, AND CMC OR ANY CONTROLLED SUBSIDIARY OR REMOTELY CONTROLLED SUBSIDIARY, ON THE OTHER HAND, ALL IN ACCORDANCE WITH SUCH POLICIES AND PROCESSES WHICH MAY BE PROMULGATED FROM TIME TO TIME BY THE MEMBER; (T) TO APPROVE CHANGES TO THE TYPE OF OR RELOCATION OF PHYSICIAN PROFESSIONAL MEDICAL SERVICES OFFERED BY CMC, WHERE THE CHANGE INVOLVES (A) SERVICES OFFERED OR PROVIDED BY CMG PHYSICIANS AND (B) (I) A CHANGE IN VENUE OR PROVIDER STATUS OF THE MEDICAL SERVICE, (II) THE CESSATION OF A PRE-EXISTING MEDICAL SERVICE, OR (III) THE OFFERING OF A NEW MEDICAL SERVICE; (U) TO ENGAGE, APPROVE, AND TO FINALIZE ANY AND ALL CONTRACTS OR AGREEMENTS WITH ANY THIRD PARTY HOSPITAL-BASED PHYSICIAN GROUPS (ANESTHESIOLOGISTS, PATHOLOGISTS, RADIOLOGISTS, OR EMERGENCY MEDICINE PHYSICIANS) THAT WILL RENDER PROFESSIONAL SERVICES TO CMC; (V) TO OVERRIDE AND REVERSE ANY DECISION MADE OR ACTION AUTHORIZED BY THE CMC BOARD TO THE EXTENT THAT SUCH DECISION OR ACTION CONFLICTS WITH A DECISION MADE OR ACTION AUTHORIZED BY THE JOINT OPERATIONS COMMITTEE OF THE MEMBER; (W) TO DETERMINE THE EXTENT TO WHICH AND THE MANNER IN WHICH THE POWERS DESCRIBED IN THIS SECTION WHICH ARE RESERVED TO THE MEMBER WITH RESPECT TO CMC ARE TO BE INCLUDED IN THE GOVERNING DOCUMENTS OF ANY CONTROLLED SUBSIDIARY OR REMOTELY CONTROLLED SUBSIDIARY AND EXERCISED WITH RESPECT TO ANY CONTROLLED SUBSIDIARY OR ANY REMOTELY CONTROLLED SUBSIDIARY. THE BOARD SHALL BE ELECTED BY THE MEMBER. PRIOR TO THE ANNUAL MEETING, THE BOARD SHALL NOMINATE A SLATE OF PERSONS FOR ELECTION AS CMC DIRECTORS AND OFFICERS TO SUBMIT TO COXHEALTH FOR APPOINTMENT. COXHEALTH WILL ACT IN GOOD FAITH AND NOT UNREASONABLY WITHHOLD APPOINTMENT. FORM 990, PART VI, SECTION B, LINE 11B 990 REVIEW POLICY: THE FORM 990 IS PREPARED BY AN INDEPENDENT ACCOUNTING FIRM BASED ON THE AUDITED FINANCIAL STATEMENTS AND INFORMATION PROVIDED BY THE ACCOUNTING DEPARTMENT OF THE ORGANIZATION. PRIOR TO FILING, FORM 990 IS FIRST REVIEWED BY MEMBERS OF TOP MANAGEMENT. ONCE THEY HAVE APPROVED THE DRAFT, A FINAL COPY IS PRESENTED TO THE AUDIT COMMITTEE OF THE BOARD OF DIRECTORS. IN ADDITION, A FINAL COPY IS PROVIDED TO THE BOARD OF DIRECTORS THROUGH THE ONLINE BOARD PORTAL PRIOR TO FILING. FORM 990, PART VI, SECTION B, LINE 12C MONITORING COMPLIANCE WITH CONFLICT OF INTEREST POLICY: COXHEALTH OFFICERS, DIRECTORS AND KEY EMPLOYEES, AS WELL AS OFFICERS, DIRECTORS AND KEY EMPLOYEES OF THE COXHEALTH AFFILIATES AND/OR COMMITTEES WITH DELEGATED AUTHORITY TO MAKE DECISIONS, ARE ANNUALLY REQUIRED TO DISCLOSE POTENTIAL CONFLICTS OF INTEREST FOLLOWING THE POLICY, SET FORTH BELOW. THE POLICY REQUIRES THAT BOARD MEMBERS MAKE DECISIONS THAT ARE CONFLICT FREE, OR IF A CONFLICT IS PRESENT, THAT IT IS FULLY DISCLOSED FOR THE BOARD'S CONSIDERATION. COXHEALTH'S EMPLOYEES AND BOARD MEMBERS MUST AVOID ALL ACTIVITIES, ASSOCIATIONS OR INTERESTS THAT CREATE A CONFLICT OF INTEREST. CONFLICTS OF INTEREST FOR EMPLOYEES MUST BE REPORTED TO THE CORPORATE INTEGRITY DEPARTMENT. A FILE WILL BE MAINTAINED OF ALL REPORTED CONFLICTS OF INTEREST. FOR MEDICAL STAFF MEMBERS, THE CONFLICT OF INTEREST PROCESS MAY BE ACCESSED THROUGH THE MEDICAL STAFF OFFICE. FOR BOARD MEMBERS, THE CONFLICT OF INTEREST PROCESS IS HANDLED THROUGH THE GOVERNANCE SUB-COMMITTEE OF COXHEALTH WITH THE ASSISTANCE OF THE EXECUTIVE OFFICE AND IS DEFINED IN THE CHARTER OF THE GOVERNANCE SUB-COMMITTEE. IF ANY OFFICER OR DIRECTOR IS FOUND TO HAVE A CONFLICT OF INTEREST, SUCH PERSON SHALL NEITHER VOTE NOR USE HIS OR HER INFLUENCE TO AFFECT ANY DECISION RELATING TO THE CONFLICT, AND SUCH PERSON SHOULD NOT BE INCLUDED IN DETERMINING WHETHER A QUORUM PARTICIPATED IN THE DECISION. SUCH PERSON IS PERMITTED TO BRIEFLY STATE HIS OR HER POSITION ON THE MATTER, AND ANSWER PERTINENT QUESTIONS ABOUT IT, IF HIS OR HER KNOWLEDGE OR EXPERTISE COULD ASSIST THOSE PARTICIPATING IN THE DECISION. FOR VENDORS, THE POLICY IS DISTRIBUTED WITH THEIR INITIAL CONTRACT WITH LESTER E. COX MEDICAL CENTERS. FORM 990, PART VI, SECTION B, LINES 15A & 15B COMPENSATION REVIEW POLICY: COXHEALTH EMPLOYS A DEFINED GOVERNANCE STRUCTURE AROUND EXECUTIVE COMPENSATION. THE BOARD OF DIRECTORS MAINTAINS A COMPENSATION COMMITTEE THAT IS CHARGED WITH CARRYING OUT THE FUNCTIONS OF EVALUATING AND SETTING EXECUTIVE COMPENSATION THROUGH FORMAL DOCUMENTED MEETINGS THAT OCCUR SEVERAL TIMES DURING THE YEAR. THE COMPENSATION COMMITTEE UTILIZES A WELL RESPECTED INDEPENDENT EXTERNAL ADVISOR TO PROVIDE THIRD PARTY ASSESSMENT AND RECOMMENDATIONS REGARDING COMPENSATION LEVELS AND BENEFIT PROGRAMS FOR THE TOP EXECUTIVES OF THE ORGANIZATION TO ENSURE THE COMPENSATION PROGRAM IS COMPETITIVE AND WITHIN FAIR MARKET VALUE. AFTER A FULL REVIEW OF THE DATA AND THOROUGH DISCUSSION THE COMMITTEE MAKES A SELF DETERMINATION OF COMPENSATION LEVELS SET JANUARY 1 OF EACH YEAR. ANNUALLY THE STEPS NECESSARY TO DOCUMENT REBUTTABLE PRESUMPTION ARE TAKEN AND RECORDED. ADDITIONALLY, COMPENSATION LEVELS FOR THE VICE PRESIDENT TIER OF MANAGEMENT IS OVERSEEN BY THE CEO USING EXTERNAL COMPARABLE DATA FOR ASSESSMENT AND IS PROVIDED TO THE COMPENSATION COMMITTEE FOR REVIEW ON AN ANNUAL BASIS. FORM 990, PART VI, SECTION C, LINE 19 DOCUMENT DISCLOSURE: LESTER E. COX MEDICAL CENTERS MAKES AVAILABLE ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY AND FINANCIAL STATEMENTS AVAILABLE FOR ALL LEGITIMATE BUSINESS PURPOSES AS DETERMINED BY MANAGEMENT. IN ADDITION, AS A CONTINUING DISCLOSURE REQUIREMENT OF CERTAIN DEBT COVENANTS THE ORGANIZATION PROVIDES ITS AUDITED FINANCIAL STATEMENTS AND SPECIFIC QUARTERLY FINANCIAL INFORMATION TO DEFINED REPOSITORIES FOR REVIEW BY PARTIES OR INDIVIDUALS INTERESTED IN THE INFORMATION. FORM 990, PART VII, SECTION A BOARD MEMBER COMPENSATION: DRS. DIX, NIEMOTH, ZOLFAGHARI, AND ABDALLA ARE RECEIVING COMPENSATION RELATED TO THEIR ROLES AS EMPLOYEES UNDER COXHEALTH AND RELATED AFFILIATES. NO BOARD MEMBERS RECEIVE COMPENSATION FOR THEIR DUTIES AS BOARD MEMBERS. FORM 990, PART XI, LINE 9 OTHER CHANGES TO NET ASSETS: $ (49,603,336) DEFINED BENEFIT PENSION PLAN LOSS & SETTLEMENT (13,398) CHANGE IN BENEFICIAL INTEREST IN TRUST 2,516,324 TRANSFER FROM AFFILIATES 661,589 TRANSFER OF COXHEALTH AUXILIARY NET ASSETS ------------- $ (46,438,821) FORM 990 PART IX LINE 11G DESCRIPTION:PURCHASED AFFILIATE SERVICES TOTAL FEES:XXX-XX-XXXX FORM 990 PART IX LINE 11G DESCRIPTION:PHYSICAL REMUNERATION TOTAL FEES:XXX-XX-XXXX FORM 990 PART IX LINE 11G DESCRIPTION:CONTRACT LABOR TOTAL FEES:9752028 FORM 990 PART IX LINE 11G DESCRIPTION:ANESTHESIA SERVICES TOTAL FEES:8504500 FORM 990 PART IX LINE 11G DESCRIPTION:REPAIRS & MAINTENANCE TOTAL FEES:6957396 FORM 990 PART IX LINE 11G DESCRIPTION:BILLING/COLLECTIONS SERVICES TOTAL FEES:6068549 FORM 990 PART IX LINE 11G DESCRIPTION:PURCHASED LAB SERVICES TOTAL FEES:5891147 FORM 990 PART IX LINE 11G DESCRIPTION:OTHER PURCHASED SERVICES TOTAL FEES:5130474 FORM 990 PART IX LINE 11G DESCRIPTION:CONSULTING TOTAL FEES:3027427 FORM 990 PART IX LINE 11G DESCRIPTION:HOUSEKEEPING/LAUNDRY TOTAL FEES:2438542 FORM 990 PART IX LINE 11G DESCRIPTION:MEDICAL DIRECTOR TOTAL FEES:1714896 FORM 990 PART IX LINE 11G DESCRIPTION:PURCHASED MANAGEMENT SERVICES TOTAL FEES:730875 FORM 990 PART IX LINE 11G DESCRIPTION:PHARMACY FEES TOTAL FEES:688239 FORM 990 PART IX LINE 11G DESCRIPTION:OCCUPATIONAL THERAPY TOTAL FEES:366757 FORM 990 PART IX LINE 11G DESCRIPTION:COURIER SERVICES TOTAL FEES:357663 FORM 990 PART IX LINE 11G DESCRIPTION:PROFESSIONAL FEES TOTAL FEES:346368 FORM 990 PART IX LINE 11G DESCRIPTION:SPECIAL SERVICES TOTAL FEES:114919 FORM 990 PART IX LINE 11G DESCRIPTION:RADIOLOGY TOTAL FEES:91198 FERRELL DUNCAN CLINIC 1001 E PRIMROSE SPRINGFIELD MO 65807 542183221 PHYSICIANS MO 0 0 LESTER E COX REGIONAL SERVICES 3800 S NATIONAL SUITE 540 SPRINGFIELD MO 65807 542183222 HEALTHCARE MO 0 0 LESTER E COX OXFORD HEALTHCARE HOME HEALTH AGENCY 3550 S NATIONAL SPRINGFIELD MO 65807 770700975 HOME HEALTH MO 0 0 LESTER E COX 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