2017-11-13T17:03:05-06:00 2016-12-31 BKD LLP 910 E ST LOUIS 200/PO BOX 1190 SPRINGFIELD MO 658062523 990 2016-01-01 431757075 COX HEALTH SYSTEMS HMO INC % LISA ODOM CFO COXH 4172692900 PO BOX 5750 SPRINGFIELD MO 65801 MATTHEW AUG PRESIDENT 4172693000 2017-11-15 true Brian D Todd P00422601 4178658701 2017-11-15 167.68.126.162 43032920173175000013 2017-11-13 P 91A381FB5BD85776892F90E6573D95955D41CA23 7481C238FC3ED1336C3827CC9EE40AED1E8819AA 2016 2017-02-10 21:41:12Z MATTHEW AUG PO BOX 5750 SPRINGFIELD MO 65801 13463453 false X WWW.COXHEALTHPLANS.COM X 1996 MO ENGAGED IN PROMOTING THE COMMON GOOD AND GENERAL WELFARE OF THE COMMUNITY BY PROVIDING A LOW-COST, HIGH-QUALITY HMO OPTION TO ALL INDIVIDUALS, INCLUDING AN UNDERSERVED POPULATION. 9 6 0 6 0 0 0 0 14243941 13421169 29778 42284 0 0 14273719 13463453 0 0 1319013 0 5105229 5351451 0 0 0 4607581 3982853 11031823 9334304 3241896 4129149 31495025 29821851 1758822 1708742 29736203 28113109 X TO SUPPORT HEALTH IMPROVEMENT IN THE COMMUNITIES WE SERVE BY OFFERING COMPETITIVE INSURANCE PRODUCTS BASED ON QUALITY OUTCOMES AND EVIDENCED BASED HEALTHCARE. false true 4998843 10315961 COX HMO PROVIDES OPERATIONAL SUPPORT SERVICES TO ITS WHOLLY OWNED SUBSIDIARY CHSIC. SUCH ADMINISTRATIVE SERVICES PROVIDED TO CHSIC INCLUDE COMPREHENSIVE ADMINISTRATIVE SERVICES, FINANCIAL AND MANAGERIAL SERVICES, PREMIUM PROCESSING, CLAIMS MANAGEMENT AND PROVIDER NETWORK ADMINISTRATION. 1871146 3105208 COX HMO SERVES AS THE THIRD PARTY ADMINISTRATOR (TPA) FOR COX HEALTH SYSTEMS HOSPITALS' SELF-FUNDED EMPLOYEE HEALTH PLAN. THE CHS HOSPITALS' SELF-FUNDED PLAN COVERS APPROXIMATELY 13,300 MEMBERS INCLUDING EMPLOYEES AND DEPENDENTS. 6869989 false false false false false false false false false true true false false true true true true false false false false false false false false false false false true false false false false false false false false false false false false true true true true false true 1649 0 true 0 false false false false false false X 9 6 true false false false true true true true true false false true true true true true true false false false X LISA ODOM CFO 4172692900 PO BOX 5750 SPRINGFIELD MO 65801 DR JAMES H CEASER DIRECTOR 1.0 39.0 X 0 631168 14784 DR MARK COSTLEY CHAIRMAN/DIRECTOR 1.0 39.0 X X 0 217591 25992 MR CHRIS W NATTINGER DIRECTOR 1.0 1.0 X 0 0 0 MR JERRY G JARED DIRECTOR 1.0 2.0 X 0 0 0 MR JOSEPH W TURNER DIRECTOR 1.0 5.0 X 0 0 0 MR KENNETH E MEYER DIRECTOR 1.0 1.0 X 0 0 0 MR LARRY SCHMITT DIRECTOR 1.0 1.0 X 0 0 0 MR STEVEN D EDWARDS VICE CHAIRMAN/DIRECTOR 1.0 39.0 X X 0 1532608 276827 MS RITA M NEEDHAM DIRECTOR 1.0 1.0 X 0 0 0 JOHN D GAMBLE CFO ENDING 7/2016 20.0 20.0 X 0 109283 10341 MATTHEW AUG CHIEF EXECUTIVE OFFICER 20.0 20.0 X 0 328984 20129 SUSAN BUTTS CHIEF INFORMATION OFFICER 20.0 20.0 X 0 132189 7014 LISA ODOM CFO BEGINNING 7/2016 20.0 20.0 X 0 50612 4447 0 3002435 359534 0 false true false TRIZETTO GROUP INC 12250 WEBER HILL ROAD SUITE 100 ST LOUIS MO 63127 HEALTHCARE IT SVC 331620 ENVISION PHARMACEUTICAL SOLUTIONS 2181 E AURORA RD SUITE 201 TWINSBURG OH 44087 PHARM. BENEFITS MGR 317531 MILLIMAN 500 NORTH BROADWAY SUITE 1750 ST LOUIS MO 63102 CONSULTING 280545 BKD LLP 200 E MAIN ST SUITE 700 FORT WAYNE IN 468021900 AUDIT/TAX/CONSULTING 175518 OZARK MAILING SERVICE LLC 2804 NORTH OAK GROVE AVENUE SPRINGFIELD MO 65803 MAILING 252611 8 0 ADMINISTRATIVE SERVICES 561000 13225335 13225335 HEALTH CLAIMS REIMBURSEMENT 524114 187231 187231 PREMIUM INCOME 524114 8603 8603 13421169 42284 42284 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 13463453 13421169 42284 0 0 0 0 0 0 3979794 2910395 1069399 120781 88326 32455 978190 715344 262846 272686 199413 73273 0 5143 5143 175518 175518 0 0 320106 320106 785614 647676 137938 181393 132651 48742 691020 519442 171578 943221 689771 253450 0 294906 215663 79243 28478 20826 7652 0 5885 4304 1581 625 457 168 0 372519 272421 100098 57501 42050 15451 LICENSES, DUES & SUBSCRIPTIONS 57251 41867 15384 CLAIMS FEES 10096 10096 MISCELLANEOUS 53577 39181 14396 9334304 6869989 2464315 0 5659068 1699938 5568674 10603227 0 0 1651895 858727 0 0 0 0 0 0 0 0 529283 587108 7562641 7146529 588035 416112 0 0 17498070 14716588 0 0 0 0 0 940151 31495025 29821851 1536644 881781 0 0 439 0 0 0 0 0 0 0 0 0 0 0 221739 826961 1758822 1708742 X 14063160 14092409 20605010 8268000 -4931967 5752700 29736203 28113109 31495025 29821851 X 4129149 -5752243 X false true X true false 144031 126744 17287 7418610 7019785 398825 416112 INVESTMENTS IN CHSIC 14716588 C 14716588 0 CLAIMS PAYABLE 5000 DUE TO RELATED PARTIES 821961 826961 X 8603 8603 13454850 13454850 13463453 60848 60000 60000 848 9333456 9333456 9334304 SCHEDULE D, PART X, LINE 2 UNCERTAIN TAX POSITIONS: EFFECTIVE JANUARY 1, 2015, THE COMPANY ELECTED 501(C) NONPROFIT TAX-EXEMPT STATUS. AS A RESULT OF THIS ELECTION, THE COMPANY IS NO LONGER SUBJECT TO INCOME TAXES AT THE ENTITY LEVEL. THE COMPANY FILES A CONSOLIDATED INFORMATIONAL TAX RETURN (990) WITH ITS SUBSIDIARY, COX HEALTHPLANS, LLC. THE COMPANY IS NOT AWARE OF ANY UNCERTAIN TAX POSITIONS AT DECEMBER 31, 2016 OR 2015. SCHEDULE D, PART XI, LINE 4B OTHER AMOUNTS INCLUDED ON FORM 990, PART VIII, LINE 12, BUT NOT LINE 1: $ 13,264,833 COXHEALTH PLANS, LLC REVENUE 187,231 HEALTH CLAIMS REVENUE 2,786 INTEREST INCOME ----------- $ 13,454,850 SCHEDULE D, PART XII, LINE 2D OTHER AMOUNTS INCLUDED ON LINE 1, BUT NOT FORM 990, PART IX, LINE 25: $ 60,000 ELIMINATED FEES PAID TO LLC FROM HMO SCHEDULE D, PART XII, LINE 4B OTHER AMOUNTS INCLUDED ON FORM 990, PART IX, LINE 25, BUT NOT LINE 1: $ 9,322,735 COXHEALTH PLANS, LLC EXPENSES 625 INTEREST EXPENSE 10,096 CLAIMS FEES ----------- $ 9,333,456 false true false false false false false false false DR JAMES H CEASER DIRECTOR 0 586138 0 45030 0 0 0 0 0 14784 0 645952 0 0 DR MARK COSTLEY CHAIRMAN/DIRECTOR 0 215916 0 0 0 1675 0 11190 0 14802 0 243583 0 0 MATTHEW AUG CHIEF EXECUTIVE OFFICER 0 264001 0 58683 0 6300 0 12985 0 7144 0 349113 0 0 MR STEVEN D EDWARDS VICE CHAIRMAN/DIRECTOR 0 948127 0 331733 0 252748 0 253616 0 23211 0 1809435 0 238103 SCHEDULE J, PART I, LINE 3 ESTABLISHMENT OF TOP MANAGEMENT OFFICIAL COMPENSATION: LESTER E. COX MEDICAL CENTERS, A RELATED ORGANIZATION, USES THE FOLLOWING TO ESTABLISH THE COMPENSATION OF THE COX HEALTH SYSTEMS HMO TOP MANAGEMENT OFFICIAL: COMPENSATION COMMITTEE, INDEPENDENT COMPENSATION CONSULTANT, WRITTEN EMPLOYMENT CONTRACT, COMPENSATION SURVEY OR STUDY, AND APPROVAL BY THE BOARD OR COMPENSATION COMMITTEE. SCHEDULE J, PART I, LINE 4B SUPPLEMENTAL NONQUALIFIED RETIREMENT PLAN: STEVE EDWARDS PARTICIPATES IN A 457(F) NONQUALIFIED RETIREMENT PLAN WITH LESTER E. COX MEDICAL CENTERS ("COX"). HE RECEIVED AN EXECUTIVE 457(F) CONTRIBUTION OF $240,366 AND A 457(F) DISTRIBUTION OF $238,103, WHICH WAS REPORTED AS DEFERRED COMPENSATION ON A PRIOR FORM 990 OF COX. SCHEDULE J, PART II, COLUMN F COMPENSATION REPORTED ON PRIOR FORM 990: THE AMOUNT REPORTED IN SCHEDULE J, PART II, COLUMN F, WAS REPORTED ON A PRIOR FORM 990 OF LESTER E. COX MEDICAL CENTERS, A RELATED ORGANIZATION. 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. FORM 990, PART III, LINE 3 SIGNIFICANT CHANGES IN PROGRAM SERVICES: AS OF 1/1/16, ALL REMAINING MEMBERS WITH HMO PLANS WERE TRANSFERRED TO NEW PLANS IN COX HEALTH SYSTEMS INSURANCE COMPANY, A RELATED ORGANIZATION. FORM 990, PART VI, SECTION A, LINE 2 FAMILY & BUSINESS RELATIONSHIPS: STEVEN EDWARDS SERVES AS THE PRESIDENT & CEO, AND JAMES CEASER, MARK COSTLEY, MATTHEW AUG, JOHN GAMBLE, LISA ODOM, AND SUSAN BUTTS ARE ALL EMPLOYED BY LESTER E. COX MEDICAL CENTERS, A RELATED ORGANIZATION. NO COMPENSATION WAS PROVIDED FOR RESPONSIBILITIES ASSOCIATED WITH BEING A BOARD DIRECTOR. COMPENSATION REPORTED FOR BOARD MEMBERS LISTED ON FORM 990, PART VII, AND SCHEDULE J REPRESENTS EMPLOYEE OR INDEPENDENT CONTRACTOR COMPENSATION UNRELATED TO SERVICE AS A BOARD MEMBER. FORM 990, PART VI, SECTION A, LINE 6 MEMBERS: THE MEMBER IS LESTER E. COX MEDICAL CENTERS ("MEMBER"), A RELATED ORGANIZATION AND SUBSIDIARY OF COXHEALTH ("PARENT"), ANOTHER RELATED ORGANIZATION. FORM 990, PART VI, SECTION A, LINE 7A ELECTION/APPOINTMENT OF BOARD MEMBERS: THE BOARD SHALL CONSIST OF NO LESS THAN EIGHT (8) AND NO MORE THAN TWENTY-ONE (21) DIRECTORS, EACH OF WHOM SHALL BE APPOINTED BY COXHEALTH ("PARENT"). ONE (1) DIRECTOR SHALL RESIDE IN THE BRANSON, MISSOURI AREA, WHICH IS DEFINED AS THE SKAGGS COMMUNITY HOSPITAL ASSOCIATION D/B/A COX MEDICAL CENTER BRANSON ("CMCB") SERVICE AREA INCLUDING STONE AND TANEY COUNTIES ("CMCB DIRECTOR"). THE BOARD SHALL RECEIVE NOMINATIONS FROM THE CMCB BOARD PRIOR TO THE ANNUAL MEETING FOR ELECTION AS DIRECTOR. THE BOARD OF DIRECTORS OF COX MEDICAL GROUP ("CMG") SHALL NOMINATE TWO (2) PHYSICIANS TO SERVE ON THE BOARD (EACH A "CMG DIRECTOR"). ONE CMG DIRECTOR SHALL BE EMPLOYED BY FERRELL-DUNCAN CLINIC, INC. AND THE OTHER SHALL BE EMPLOYED BY LESTER E. COX MEDICAL CENTERS ("MEMBER"), EMPLOYED BY CMG, OR EMPLOYED BY MEMBER AND LEASED TO CMG. THE PARENT SHALL RECEIVE NOMINATIONS FROM THE CMG BOARD PRIOR TO THE ANNUAL MEETING AT WHICH DIRECTORS ARE ELECTED. FORM 990, PART VI, SECTION A, LINE 7B MEMBER POWERS: THE BYLAWS ARE REVIEWED BY THE PRESIDENT AND CEO OF COXHEALTH ("PARENT") OR HIS/HER DESIGNEE TOGETHER WITH THE GENERAL COUNSEL, AT LEAST EVERY THREE (3) YEARS. THE PARENT MAY ADOPT, AMEND AND REPEAL THE BYLAWS, SUBJECT TO ANY LIMITATIONS SET FORTH IN THE BYLAWS, AT ANY MEETING, PROVIDED THAT A COPY OF THE BYLAWS TO BE CONSIDERED AT THE MEETING ACCOMPANIES THE NOTICE THEREOF. EXCEPT AS SPECIFIED BELOW OR AS SET FORTH ELSEWHERE IN THE BYLAWS, THE FOLLOWING RESERVED POWERS MAY BE EXERCISED BY THE PARENT WITHOUT PRIOR ACTION BY THE BOARD. SAID RESERVED POWERS ARE: (A) TO ESTABLISH AND CHANGE THE BUSINESS PURPOSES, MISSION, VISION OR VALUES OF THE CORPORATION; (B) TO APPROVE AMENDMENTS TO THE ARTICLES OF ACCEPTANCE OF THE CORPORATION AS PROVIDED THEREIN; (C) TO APPROVE AMENDMENTS TO THE BYLAWS OF THE CORPORATION; (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 THE CORPORATION, SUBJECT TO THE REQUIREMENTS OF ARTICLE FIVE, AND TO APPOINT AND REMOVE THE OFFICERS OF THE BOARD AND THE CORPORATION; (F) TO APPROVE THE APPOINTMENT AND REMOVAL OF THE PRESIDENT OF THE CORPORATION; (G) TO APPOINT THE AUDITOR AND THE CORPORATE COUNSEL FOR THE CORPORATION AND ITS CONTROLLED SUBSIDIARIES OR REMOTELY CONTROLLED SUBSIDIARIES SO LONG AS SUCH APPOINTMENT IS CONSISTENT WITH ALL APPLICABLE LAWS AND REGULATIONS, INCLUDING MISSOURI DEPARTMENT OF INSURANCE REGULATIONS AND GUIDELINES; (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 THE CORPORATION IN SUCH PROGRAMS; AND TO AUTHORIZE THE OPENING AND CLOSING OF BANK ACCOUNTS AND INVESTMENT ACCOUNTS IN THE NAME OF THE CORPORATION; (I) TO APPROVE THE MERGER, CONSOLIDATION OR DISSOLUTION OF THE CORPORATION OR THE SALE OF ALL OR SUBSTANTIALLY ALL OF THE ASSETS OF THE CORPORATION; TI) TO APPROVE THE FORMATION OF A CONTROLLED SUBSIDIARY OR A REMOTELY CONTROLLED SUBSIDIARY; (K) TO APPROVE THE ACQUISITION OR DISPOSITION BY THE CORPORATION OF ANOTHER LEGAL ENTITY OR AN INTEREST IN ANOTHER LEGAL ENTITY; (1) TO APPROVE THE STRATEGIC PLAN AND THE OPERATING AND CAPITAL BUDGETS OF THE CORPORATION; (M) APPROVAL OF THE CORPORATION'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 THE CORPORATION 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 THE CORPORATION 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 THE CORPORATION, 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 THE CORPORATION; (Q) TO APPROVE THE TRANSFER OF ASSETS BY THE CORPORATION TO ANY ENTITY OTHER THAN THE MEMBER AND/ OR PARENT, OTHER THAN TRANSFERS MADE IN THE ORDINARY COURSE OF OPERATIONS OF THE CORPORATION WHICH WILL NOT REQUIRE APPROVAL OF THE PARENT; (R) TO DETERMINE THE EXTENT TO WHICH AND THE MANNER IN WHICH THE POWERS DESCRIBED IN THIS SECTION WHICH ARE RESERVED TO THE PARENT WITH RESPECT TO THE CORPORATION 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. FORM 990, PART VI, SECTION B, LINE 11B FORM 990 REVIEW: THE FORM 990 IS PREPARED BY AN INDEPENDENT ACCOUNTING FIRM BASED ON THE AUDITED FINANCIAL STATEMENTS AND INFORMATION PROVIDED BY THE ORGANIZATION. THE FORM 990 IS PROVIDED TO THE DIRECTOR OF ACCOUNTING AND CFO FOR A DETAILED REVIEW TO ENSURE ACCURACY. A COPY IS THEN PROVIDED TO THE CEO AND GOVERNING BODY FOR REVIEW PRIOR TO FILING. FORM 990, PART VI, SECTION B, LINE 12C 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 THE BOARD 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 COXHEALTH. FORM 990, PART VI, SECTION B, LINES 15A & 15B COMPENSATION REVIEW: 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: COX HEALTH SYSTEMS HMO'S GOVERNING DOCUMENTS AND CONFLICT OF INTEREST POLICY ARE AVAILABLE FOR PUBLIC INSPECTION AS AN ATTACHMENT TO THE APPLICATION FOR RECOGNITION OF EXEMPTION. FORM 990, PART XI, LINE 9 OTHER CHANGES IN NET ASSETS: $ 29,249 CAPITAL CONTRIBUTIONS 383,955 CHANGE IN NONADMITTED ASSETS (6,165,447) CHANGE IN EQUITY OF AFFILIATES ----------- $(5,752,243) COX HEALTHPLANS LLC 3200 S NATIONAL BLDG B SPRINGFIELD MO 65807 431754751 MANAGEMENT MO 13285335 12709777 COX HMO COX HEALTH SYSTEMS INSURANCE COMPANY 3200 S NATIONAL BLDG B SPRINGFIELD MO 65807 431684044 INSURANCE MO 501(C)(4) COX HMO true LESTER E COX MEDICAL CENTERS 1423 N JEFFERSON SPRINGFIELD MO 65802 440577118 HOSPITAL MO 501(C)(3) 3 COXHEALTH false COX ALTERNATIVE CARE OF THE OZARKS INC PO BOX 10939 SPRINGFIELD MO 65808 431641925 HOME HEALTH MO 501(C)(3) 10 LESTER E COX false COXHEALTH FOUNDATION 3525 S NATIONAL SUITE 204 SPRINGFIELD MO 65807 436810485 FUNDRAISING MO 501(C)(3) 12 A I LESTER E COX false COXHEALTH HME CRE SVCS OF THE MDWST INC 3850 S NATIONAL SPRINGFIELD MO 65807 264781194 HOME HEALTH MO 501(C)(3) 10 LESTER E COX false COX HPS OF THE OZARKS INC 2220 W SUNSET SPRINGFIELD MO 65807 431641927 HOME HEALTH MO 501(C)(3) 10 LESTER E COX false COX-MONETT HOSPITAL INC 801 N LINCOLN AVE MONETT MO 65708 431656689 HOSPITAL MO 501(C)(3) 3 LESTER E COX false COX-MONETT HOSPITAL AUXILIARY 801 N LINCOLN AVE MONETT MO 65708 431852817 SUPPORT MO 501(C)(3) 10 LESTER E COX false HEALTH ENRICHMENT SERVICES INC 3801 S NATIONAL SPRINGFIELD MO 65807 363263313 MED SERVICES MO 501(C)(3) 7 LESTER E COX false HEALTHCARE SERVICES OF THE OZARKS INC PO BOX 10939 SPRINGFIELD MO 65808 431641928 HOME HEALTH MO 501(C)(3) 10 LESTER E COX false PRIMROSE PLACE INC 1115 E PRIMROSE SPRINGFIELD MO 65807 431183783 SUPPORT MO 501(C)(3) 12 A I LESTER E COX false COXHEALTH AUXILIARY 3801 S NATIONAL SPRINGFIELD MO 65807 431090590 SUPPORT MO 501(C)(3) 10 LESTER E COX false COX MEDICAL CTR GENPROF LIAB LOSS FUND 1423 N JEFFERSON SPRINGFIELD MO 65802 366668576 SELF-INSURANC MO 501(C)(3) 12 A I LESTER E COX false SKAGGS COMM HOSP ASSOC (COX MC BRANSON) 525 BRANSON LANDING BOULEVARD BRANSON MO 65616 440584290 HOSPITAL MO 501(C)(3) 3 LESTER E COX false COX COLLEGE 1423 NORTH JEFFERSON SPRINGFIELD MO 65802 475148345 EDUCATION MO 501(C)(3) 2 LESTER E COX false COXHEALTH 1423 N JEFFERSON SPRINGFIELD MO 65802 471087427 HOLDING CO MO 501(C)(3) 12 B II NA false COX MEDICAL GROUP 1423 N JEFFERSON SPRINGFIELD MO 65802 471087566 PHYSICIANS MO 501(C)(3) 10 COXHEALTH false COX MEDICAL GROUP CLINICS 3801 S NATIONAL SPRINGFIELD MO 65807 371830627 HEALTHCARE MO 501(C)(3) 10 COXHEALTH false MEDICAL DEVELOPMENTS 1423 N JEFFERSON AVE SPRINGFIELD MO 65802 431622182 PHARMACY MO LESTER E COX C CORP 0.00000 false INSURANCE COMPANY OF SPRINGFIELD INC GRAND PAVILLION CORPORATE CENTRE GRAND CAYMAN CJ KY1-110 CAPTIVE INSURANCE CJ LESTER E COX C CORP 0.00000 false COX TAXABLE CLOSE CORPORATION 1423 N JEFFERSON AVE SPRINGFIELD MO 65802 472573263 MEDICAL CLINIC MO COX MED GROUP C CORP 0.00000 false FERRELL-DUNCAN CLINIC INC 1001 E PRIMROSE SPRINGFIELD MO 65808 430991578 PHYSICIANS MO CTCC C CORP 0.00000 false false true false true true false false false false false false true false true true true false false false COX HEALTH SYSTEMS INSURANCE COMPANY B 3000000 FMV COX HEALTH SYSTEMS INSURANCE COMPANY D 65897 FMV COX HEALTH SYSTEMS INSURANCE COMPANY E 87726 FMV COX HEALTH SYSTEMS INSURANCE COMPANY L 10115537 FMV