TY 2010 Form 990

(A) Name and Title	(B) Average hours per week (describe hours for related organizations in Schedule O)	(C) Position (check all that apply)	(E) Reportable compensation from related organizations (W- 2/1099-MISC)
(1) JERRY JARED CHAIRMAN	1.0	X	X	0	0
(2) ROBERT H BEZANSON VICE CHAIRMAN	1.0	X	X	798,234	177,729
(3) GENICE MAROC PRESIDENT/CEO BEGINNING 5/2011	50.0	X	X	0	0
(4) STEVE EDWARDS SECRETARY	1.0	X	X	438,428	103,076
(5) JACOB MCWAY TREASURER	1.0	X	X	400,669	97,001
(6) LOREN BROADDUS MD DIRECTOR ENDING 11/2010	1.0	X		94,706	0
(7) DONA K ELKINS DIRECTOR	1.0	X		0	0
(8) GRANT Q HADEN JD DIRECTOR	1.0	X		0	0
(9) JANICE K HARRIS DIRECTOR	1.0	X		0	0
(10) DENNIS J HEIM DIRECTOR	1.0	X		0	0
(11) JAMES W HUTCHESON DIRECTOR	1.0	X		0	0
(12) RICHARD W KISSELL MD DIRECTOR	1.0	X		172,019	20,831
(13) LARRY W LIPSCOMB DIRECTOR	1.0	X		0	0
(14) RONALD D PONDS DIRECTOR	1.0	X		0	0
(15) JOHN P SQUIRES DIRECTOR ENDING 11/2010	1.0	X		0	0
(16) JOSEPH W TURNER JD DIRECTOR	1.0	X		0	0
(17) DAVID ZOLFAGHARI MD DIRECTOR BEGINNING 11/2010	1.0	X		0	0

(A) Name and business address	(B) Description of services	(C) Compensation
EJW ANESTHESIA SERVICES	ANESTHESIA	676,000
BENJAMIN LEAVITT	HOSPITALIST	213,260
NUCLEAR DIAGNOSIS INC	IMAGING	209,592
MARTIN JONES	ER PHYSICIAN	127,105
BKD LLP	AUDIT/CONSULTING	125,768
2 Total number of independent contractors (including but not limited to those listed above) who received more than $100,000 in compensation from the organization 5

Do not include amounts reported on lines 6b, 7b, 8b, 9b, and 10b of Part VIII.	(A) Total expenses	(B) Program service expenses	(C) Management and general expenses	(D) Fundraising expenses
1	Grants and other assistance to governments and organizations in the U.S. See Part IV, line 21	103,225	103,225
2	Grants and other assistance to individuals in the U.S. See Part IV, line 22	0
3	Grants and other assistance to governments, organizations, and individuals outside the U.S. See Part IV, lines 15 and 16	0
4	Benefits paid to or for members	0
5	Compensation of current officers, directors, trustees, and key employees ....	109,774		109,774
6	Compensation not included above, to disqualified persons (as defined under section 4958(f)(1)) and persons described in section 4958(c)(3)(B) ....	0
7	Other salaries and wages	13,433,217	11,629,702	1,803,515
8	Pension plan contributions (include section 401(k) and section 403(b) employer contributions) ....	538,240	475,430	62,810
9	Other employee benefits .......	1,980,552	1,740,277	240,275
10	Payroll taxes ...........	919,153	804,202	114,951
11	Fees for services (non-employees):
a	Management ......	0
b	Legal .........	2,424		2,424
c	Accounting ...........	92,957		92,957
d	Lobbying ...........	0
e	Professional fundraising. See Part IV, line 17..	0
f	Investment management fees ......	0
g	Other ..........	4,446,825	2,744,391	1,702,434
12	Advertising and promotion ....	47,088	9,079	38,009
13	Office expenses .......	1,206,843	1,023,746	183,097
14	Information technology ......	696,989	654,882	42,107
15	Royalties ..	0
16	Occupancy ...........	437,021	388,622	48,399
17	Travel ............	62,272	29,950	32,322
18	Payments of travel or entertainment expenses for any federal, state, or local public officials ......	0
19	Conferences, conventions, and meetings ....	21,398	13,460	7,938
20	Interest ...........	6,251	5,573	678
21	Payments to affiliates .......	0
22	Depreciation, depletion, and amortization .....	1,116,766	995,583	121,183
23	Insurance ..............	594,508	14,796	579,712
24	Other expenses. Itemize expenses not covered above. (Expenses grouped together and labeled miscellaneous may not exceed 5% of total expenses shown on line 25 below.)
a	BAD DEBT	4,718,293	4,718,293
b	MEDICAL SUPPLIES & DRUGS	2,282,708	2,282,708
c	STATE PROVIDER TAX	1,778,797	1,778,797
d	LICENSES, DUES, SUBSCRIPTIONS	108,073	38,894	69,179
e	RECRUITING & RETENTION	105,493	674	104,819
f	All other expenses	42,346	32,256	10,090
25	Total functional expenses. Add lines 1 through 24f	34,851,213	29,484,540	5,366,673	0
26	Joint costs. Check here if following SOP 98-2 (ASC 958-720). Complete this line only if the organization reported in column (B) joint costs from a combined educational campaign and fundraising solicitation

Part X Balance Sheet
	1	Cashnon-interest-bearing ..........	314,625	1	22,633
2	Savings and temporary cash investments .......	483,817	2	684,358
3	Pledges and grants receivable, net .........	560,106	3	415,472
4	Accounts receivable, net .........	3,560,548	4	3,569,477
5	Receivables from current and former officers, directors, trustees, key employees, and highest compensated employees. Complete Part II of
	Schedule L ..........		5
6	Receivables from other disqualified persons (as defined under section 4958(f)(1)) and persons described in section 4958(c)(3)(B). Complete Part II of
	Schedule L ..........		6
7	Notes and loans receivable, net .............		7
8	Inventories for sale or use ..............	344,648	8	346,743
9	Prepaid expenses and deferred charges ............	62,830	9	46,365
10a	Land, buildings, and equipment: cost or other basis. Complete Part VI of Schedule D	10a	23,212,831
b	Less: accumulated depreciation. .....	10b	14,658,473	9,446,482	10c	8,554,358
11	Investments—publicly traded securities ..........		11
12	Investments—other securities. See Part IV, line 11 ......		12
13	Investments—program-related. See Part IV, line 11 ..		13
14	Intangible assets .........		14
15	Other assets. See Part IV, line 11 ...........	75,607	15	130,280
16	Total assets. Add lines 1 through 15 (must equal line 34)...	14,848,663	16	13,769,686
	17	Accounts payable and accrued expenses .	2,112,181	17	1,783,683
18	Grants payable ..........		18
19	Deferred revenue ..........		19
20	Tax-exempt bond liabilities ..........		20
21	Escrow or custodial account liability. Complete Part IV of Schedule D..		21
22	Payables to current and former officers, directors, trustees, key employees, highest compensated employees, and disqualified
	persons. Complete Part II of Schedule L..........		22
23	Secured mortgages and notes payable to unrelated third parties ..	150,467	23	101,921
24	Unsecured notes and loans payable to unrelated third parties ....		24
25	Other liabilities. Complete Part X of Schedule D.....	6,474,299	25	6,269,318
26	Total liabilities. Add lines 17 through 25.....	8,736,947	26	8,154,922
		Organizations that follow SFAS 117, check here and complete lines 27 through 29, and lines 33 and 34.
27	Unrestricted net assets .....	5,512,856	27	5,136,716
28	Temporarily restricted net assets .....	598,860	28	478,048
29	Permanently restricted net assets .....		29
	Organizations that do not follow SFAS 117, check here and complete lines 30 through 34.
30	Capital stock or trust principal, or current funds .....		30
31	Paid-in or capital surplus, or land, building or equipment fund .....		31
32	Retained earnings, endowment, accumulated income, or other funds		32
33	Total net assets or fund balances .....	6,111,716	33	5,614,764
34	Total liabilities and net assets/fund balances .....	14,848,663	34	13,769,686

- TIN:

SCHEDULE A
(Form 990 or 990EZ)

Department of the Treasury
Internal Revenue Service

Public Charity Status and Public Support

Complete if the organization is a section 501(c)(3) organization or a section
4947(a)(1) nonexempt charitable trust.

Attach to Form 990 or Form 990-EZ. right arrow

See separate instructions.

OMB No. 1545-0047

2010

Open to Public
Inspection

Name of the organization

COX-MONETT HOSPITAL INC

Employer identification number

43-1656689

Part I

Reason for Public Charity Status (All organizations must complete this part.) See instructions

The organization is not a private foundation because it is: (For lines 1 through 11, check only one box.)

A church, convention of churches, or association of churches. section 170(b)(1)(A)(i).

A school described in section 170(b)(1)(A)(ii). (Attach Schedule E.)

A hospital or a cooperative hospital service organization described in section 170(b)(1)(A)(iii).

A medical research organization operated in conjunction with a hospital described in section 170(b)(1)(A)(iii). Enter the hospital's name, city, and state:

An organization operated for the benefit of a college or university owned or operated by a governmental unit described in

section 170(b)(1)(A)(iv). (Complete Part II.)

A federal, state, or local government or governmental unit described in section 170(b)(1)(A)(v).

An organization that normally receives a substantial part of its support from a governmental unit or from the general public described in

section 170(b)(1)(A)(vi). (Complete Part II.)

A community trust described in section 170(b)(1)(A)(vi). (Complete Part II.)

An organization that normally receives: (1) more than 331/3% of its support from contributions, membership fees, and gross

receipts from activities related to its exempt functions—subject to certain exceptions, and (2) no more than 331/3% of

its support from gross investment income and unrelated business taxable income (less section 511 tax) from businesses

acquired by the organization after June 30, 1975. See section 509(a)(2). (Complete Part III.)

An organization organized and operated exclusively to test for public safety. Seesection 509(a)(4).

An organization organized and operated exclusively for the benefit of, to perform the functions of, or to carry out the purposes of one or more publicly supported organizations described in section 509(a)(1) or section 509(a)(2). See section 509(a)(3). Check the box that describes the type of supporting organization and complete lines 11e through 11h.

Type I

Type II

Type III - Functionally integrated

Type III - Other

By checking this box, I certify that the organization is not controlled directly or indirectly by one or more disqualified persons other than foundation managers and other than one or more publicly supported organizations described in section 509(a)(1) or section 509(a)(2).

If the organization received a written determination from the IRS that it is a Type I, Type II or Type III supporting organization, check this box ..................................................

Since August 17, 2006, has the organization accepted any gift or contribution from any of the
following persons?

(i) a person who directly or indirectly controls, either alone or together with persons described in (ii)

Yes

and (iii) below, the governing body of the the supported organization? ................

11g(i)

(ii) a family member of a person described in (i) above? ......................

11g(ii)

(iii) a 35% controlled entity of a person described in (i) or (ii) above? ................

11g(iii)

Provide the following information about the supported organization(s).

(i) Name of supported organization	(ii) EIN	(iv) Is the organization in col. (i) listed in your governing document?		(v) Did you notify the organization in col. (i) of your support?		(vi) Is the organization in col. (i) organized in the U.S.?		(vii) Amount of support?
(i) Name of supported organization	(ii) EIN	Yes	No	Yes	No	Yes	No	(vii) Amount of support?


Total

For Paperwork Reduction Act Notice, see the Instructions for Form 990.

Cat. No. 11285F

Schedule A (Form 990 or 990-EZ) 2010

Page 2

Part II

Support Schedule for Organizations Described in IRC 170(b)(1)(A)(iv) and 170(b)(1)(A)(vi)
(Complete only if you checked the box on line 5, 7, or 8 of Part I or if the organization failed to qualify under Part III. If the organization fails to qualify under the tests listed below, please complete Part III.)

Section A. Public Support

Calendar year(or fiscal year beginning in)		(a) 2006	(b) 2007	(c) 2008	(d) 2009	(e) 2010	(f) Total
1	Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grants.") ....
2	Tax revenues levied for the organization's benefit and either paid to or expended on its behalf.......
3	The value of services or facilities furnished by a governmental unit to the organization without charge..
4	Total. Add lines 1 through 3..
5	The portion of total contributions by each person (other than a governmental unit or publicly supported organization) included on line 1 that exceeds 2% of the amount shown on line 11, column (f)..
6	Public Support. Subtract line 5 from line 4.

Section B. Total Support

Calendar year(or fiscal year beginning in)		(a) 2006	(b) 2007	(c) 2008	(d) 2009	(e) 2010	(f) Total
7	Amounts from line 4..
8	Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources..
9	Net income from unrelated business activities, whether or not the business is regularly carried on..
10	Other income. (Explain in Part IV.) Do not include gain or loss from the sale of capital assets..
11	Total support (Add lines 7 through 10).

Gross receipts from related activities, etc. (See instructions.) ..................

First Five Years If the Form 990 is for the organization's first, second, third, fourth, or fifth tax year as a 501(c)(3) organization,
check this box and stop here.......................................... right arrow

Section C. Computation of Public Support Percentage

Public Support Percentage for 2010 (line 6 column (f) divided by line 11 column (f)) .........

Public Support Percentage for 2009 Schedule A, Part II, line 14 ...............

16a

33 1/3% support test—2010. If the organization did not check the box on line 13, and line 14 is 33 1/3% or more, check this box
and stop here. The organization qualifies as a publicly supported organization ...................... right arrow

33 1/3% support test—2009. If the organization did not check the box on line 13 or 16a, and line 15 is 33 1/3% or more, check this
box and stop here. The organization qualifies as a publicly supported organization ..................... right arrow

17a

10%-facts-and-circumstances test—2010. If the organization did not check a box on line 13, 16a, or 16b and line 14
is 10% or more, and if the organization meets the "facts and circumstances" test, check this box and stop here. Explain
in Part IV how the organization meets the "facts and circumstances" test. The organization qualifies as a publicly supported
organization .................................................. right arrow

10%-facts-and-circumstances test—2009. If the organization did not check a box on line 13, 16a, 16b, or 17a and line
15 is 10% or more, and if the organization meets the "facts and circumstances" test, check this box and stop here.
Explain in Part IV how the organization meets the "facts and circumstances" test. The organization qualifies as a publicly
supported organization .............................................. right arrow

Private Foundation If the organization did not check a box on line 13, 16a, 16b, 17a or 17b, check this box and see
instructions ................................................... right arrow

Schedule A (Form 990 or 990-EZ) 2010

Page 3

Part III

Support Schedule for Organizations Described in IRC 509(a)(2)
(Complete only if you checked the box on line 9 of Part I or if the organization failed to qualify under Part II. If the organization fails to qualify under the tests listed below, please complete Part II.)

Section A. Public Support

Calendar year(or fiscal year beginning in)		(a) 2006	(b) 2007	(c) 2008	(d) 2009	(e) 2010	(f) Total
1	Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grants.") .
2	Gross receipts from admissions, merchandise sold or services performed, or facilities furnished in any activity that is related to the organization's tax-exempt purpose......
3	Gross receipts from activities that are not an unrelated trade or business under section 513..
4	Tax revenues levied for the organization's benefit and either paid to or expended on its behalf...
5	The value of services or facilities furnished by a governmental unit to the organization without charge..
6	Total. Add lines 1 through 5.
7a	Amounts included on lines 1, 2, and 3 received from disqualified persons...
b	Amounts included on lines 2 and 3 received from other than disqualified persons that exceed the greater of $5,000 or 1% of the amount on line 13 for the year.
c	Add lines 7a and 7b..
8	Public Support (Subtract line 7c from line 6.)

Section B. Total Support

Calendar year (or fiscal year beginning in)		(a) 2006	(b) 2007	(c) 2008	(d) 2009	(e) 2010	(f) Total
9	Amounts from line 6...
10a	Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources..
b	Unrelated business taxable income (less section 511 taxes) from businesses acquired after June 30, 1975.
c	Add lines 10a and 10b.
11	Net income from unrelated business activities not included in line 10b, whether or not the business is regularly carried on.
12	Other income. Do not include gain or loss from the sale of capital assets (Explain in Part IV.)
13	Total support (Add lines 9, 10c, 11 and 12.).

Section C. Computation of Public Support Percentage

Public Support Percentage for 2010 (line 8 column (f) divided by line 13 column (f)) .........

Public support percentage from 2009 Schedule A, Part III, line 15 ...............

Section D. Computation of Investment Income Percentage

Investment income percentage for 2010 (line 10c column (f) divided by line 13 column (f)) ......

Investment income percentage from 2009 Schedule A, Part III, line 17 .............

19a

33 1/3% support tests—2010. If the organization did not check the box on line 14, and line 15 is more than 33 1/3% and line 17 is not more than 33 1/3%, check this box and stop here. The organization qualifies as a publicly supported organization .......... right arrow

33 1/3% support tests—2009. If the organization did not check a box on line 14 or line 19a, and line 16 is more than 33 1/3% and line 18 is not more than 33 1/3%, check this box and stop here. The organization qualifies as a publicly supported organization .... right arrow

Private Foundation If the organization did not check a box on line 14, 19a or 19b, check this box and see instructions ..... right arrow

Schedule A (Form 990 or 990-EZ) 2010

Page 4

Part IV

Supplemental Information. Supplemental Information. Complete this part to provide the explanation required by Part II, line 10; Part II, line 17a or 17b; or Part III, line 12. Also complete this part for any additional information. (See instructions).

Facts And Circumstances Test

Explanation

Schedule A (Form 990 or 990-EZ) 2010

Additional Data

Software ID:
Software Version:

- TIN:

Schedule B
(Form 990, 990-EZ,
or 990-PF)

Department of the Treasury
Internal Revenue Service

Schedule of Contributors

Attach to Form 990, 990-EZ, or 990-PF.

OMB No. 1545-0047

2010

Name of organization

COX-MONETT HOSPITAL INC

Employer identification number

43-1656689

Organization type (check one):

Filers of:

Section:

Form 990 or 990-EZ

501(c)( ) (enter number) organization

4947(a)(1) nonexempt charitable trust not treated as a private foundation

527 political organization

Form 990-PF

501(c)(3) exempt private foundation

4947(a)(1) nonexempt charitable trust treated as a private foundation

501(c)(3) taxable private foundation

Check if your organization is covered by the General Rule or a Special Rule.
Note. Only a section 501(c)(7), (8), or (10) organization can check boxes for both the General Rule and a Special Rule. See instructions.

General Rule

For an organization filing Form 990, 990-EZ, or 990-PF that received, during the year, $5,000 or more (in money or
property) from any one contributor. Complete Parts I and II.

Special Rules

For a section 501(c)(3) organization filing Form 990 or 990-EZ, that met the 33¹/3% support test of the regulations
under sections 509(a)(1) and 170(b)(1)(A)(vi), and received from any one contributor, during the year, a contribution of the
greater of (1) $5,000 or (2) 2% of the amount on (i) Form 990, Part VIII, line 1h, or (ii) Form 990-EZ, line 1. Complete Parts I and II.

For a section 501(c)(7), (8), or (10) organization filing Form 990, or 990-EZ, that received from any one contributor,
during the year, aggregate contributions of more than $1,000 for use exclusively for religious, charitable,
scientific, literary, or educational purposes, or the prevention of cruelty to children or animals. Complete Parts I, II, and
III.

For a section 501(c)(7), (8), or (10) organization filing Form 990, or 990-EZ, that received from any one contributor,
during the year, contributions for use exclusively for religious, charitable, etc., purposes, but these contributions did
not aggregate to more than $1,000. If this box is checked, enter here the total contributions that were received during
the year for an exclusively religious, charitable, etc., purpose. Do not complete any of the parts unless the General Rule
applies to this organization because it received nonexclusively religious, charitable, etc., contributions of $5,000 or more
during the year. ......................... Arrow Bullet

Caution. An Organization that is not covered by the General Rule and/or the Special Rules does not file Schedule B (Form 990,
990-EZ, or 990-PF), but it must answer “No” on Part IV, line 2 of its Form 990, or check the box in the heading of its
Form 990-EZ, or on line 2 of its Form 990-PF, to certify that it does not meet the filing requirements of Schedule B (Form 990,
990-EZ, or 990-PF).

For Paperwork Reduction Act Notice, see the Instructions
for Form 990, 990-EZ, or 990-PF.

Cat. No. 30613XSchedule B (Form 990, 990-EZ, or 990-PF) (2010)

Name of organization COX-MONETT HOSPITAL INC
Schedule B (Form 990, 990-EZ, or 990-PF) (2010) Page 1 of 1 of Part I
Part I	Contributors (see Instructions)
(a) No.	(b) Name, address, and ZIP + 4	(c) Aggregate contributions	(d) Type of contribution
RESTRICTED	RESTRICTED RESTRICTED RESTRICTED RESTRICTED, RESTRICTED RESTRICTED	$RESTRICTED	Person Payroll Noncash (Complete Part II if there is a noncash contribution.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Aggregate contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II if there is a noncash contribution.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Aggregate contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II if there is a noncash contribution.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Aggregate contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II if there is a noncash contribution.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Aggregate contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II if there is a noncash contribution.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Aggregate contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II if there is a noncash contribution.)
Schedule B (Form 990, 990-EZ, or 990-PF) (2010)

Name of organization COX-MONETT HOSPITAL INC
Schedule B (Form 990, 990-EZ, or 990-PF) (2010) Page 1 of 1 of Part II
Part II	Noncash Property (see Instructions)
(a) No. from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (see instructions)	(d) Date received
		$
(a) No. from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (see instructions)	(d) Date received
		$
(a) No. from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (see instructions)	(d) Date received
		$
(a) No. from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (see instructions)	(d) Date received
		$
(a) No. from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (see instructions)	(d) Date received
		$
(a) No. from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (see instructions)	(d) Date received
		$
Schedule B (Form 990, 990-EZ, or 990-PF) (2010)

Schedule B (Form 990, 990-EZ, or 990-PF) (2010)

Page 1 of 1 of Part III

Name of organization
COX-MONETT HOSPITAL INC

Employer identification number

43-1656689

Part III

Exclusively religious, charitable, etc., individual contributions to section 501(c)(7), (8), or (10) organizations
aggregating more than $1,000 for the year. (Complete columns (a) through (e) and the following line entry.)
For organizations completing Part III, enter the total of exclusively religious, charitable, etc.,
contributions of $1,000 or less for the year. (Enter this information once. See instructions.) Arrow Bullet

(a) No.
from
Part I

(b)
Purpose of gift

(d)
Description of how gift is held

(e) Transfer of gift
Transferee's name, address, and ZIP 4	Relationship of transferor to transferee

(a) No.
from
Part I

(b)
Purpose of gift

(d)
Description of how gift is held

(e) Transfer of gift
Transferee's name, address, and ZIP 4	Relationship of transferor to transferee

(a) No.
from
Part I

(b)
Purpose of gift

(d)
Description of how gift is held

(e) Transfer of gift
Transferee's name, address, and ZIP 4	Relationship of transferor to transferee

(a) No.
from
Part I

(b)
Purpose of gift

(d)
Description of how gift is held

(e) Transfer of gift
Transferee's name, address, and ZIP 4	Relationship of transferor to transferee

Schedule B (Form 990, 990-EZ, or 990-PF) (2010)

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE C
(Form 990 or 990-EZ)

Department of the Treasury
Internal Revenue Service

Political Campaign and Lobbying Activities

For Organizations Exempt From Income Tax Under section 501(c) and section 527
SchCMd Bullet

Complete if the organization is described below.
SchCMd Bullet

Attach to Form 990 or Form 990-EZ. SchCMd Bullet

See separate instructions.

OMB No. 1545-0047

2010

Open to Public
Inspection

If the organization answered “Yes,” to Form 990, Part IV, Line 3, or Form 990-EZ, Part V, line 46 (Political Campaign Activities), then
Round Bullet

Section 501(c)(3) organizations: Complete Parts I-A and B. Do not complete Part I-C.
Round Bullet

Section 501(c) (other than section 501(c)(3)) organizations: Complete Parts I-A and C below. Do not complete Part I-B.
Round Bullet

Section 527 organizations: Complete Part I-A only.
If the organization answered “Yes,” to Form 990, Part IV, Line 4, or Form 990-EZ, Part VI, line 47 (Lobbying Activities), then
Round Bullet

Section 501(c)(3) organizations that have filed Form 5768 (election under section 501(h)) Complete Part II-A. Do not complete Part II-B.
Round Bullet

Section 501(c)(3) organizations that have NOT filed Form 5768 (election under section 501(h)): Complete Part II-B. Do not complete Part II-A.
If the organization answered “Yes,” to Form 990, Part IV, Line 5 (Proxy Tax) or Form 990-EZ, Part V, line 35a (Proxy Tax), then
Round Bullet

Section 501(c)(4), (5), or (6) organizations: Complete Part III.

Name of the organization

COX-MONETT HOSPITAL INC

Employer identification number

43-1656689

Part I-A

Complete if the organization is exempt under section 501(c) or is a section 527 organization.

Provide a description of the organization's direct and indirect political campaign activities on behalf of or in opposition to candidates for public office in Part IV.

Political expenditures .................................... SchCMd Bullet

Volunteer hours ........................................

Part I-B

Complete if the organization is exempt under section 501(c)(3).

Enter the amount of any excise tax incurred by the organization under section 4955 ......... SchCMd Bullet

Enter the amount of any excise tax incurred by organization managers under section 4955 ...... SchCMd Bullet

If the organization incurred a section 4955 tax, did it file Form 4720 for this year? ..............

Yes No

Was a correction made? .........................................

Yes No

If "Yes," describe in Part IV.

Part I-C

Complete if the organization is exempt under section 501(c) except section 501(c)(3).

Enter the amount directly expended by the filing organization for section 527 exempt function activities SchCMd Bullet

Enter the amount of the filing organization's funds contributed to other organizations for section 527 exempt funtion activities .................................... SchCMd Bullet

Total exempt function expenditures. Add lines 1 and 2. Enter here and on Form 1120-POL, line 17b.. SchCMd Bullet

Did the filing organization file Form 1120-POL for this year? ..........................

Yes No

Enter the names, addresses and employer identification number (EIN) of all section 527 political organizations to which the filing
organization made payments. For each organization listed, enter the amount paid from the filing organization’s funds. Also enter the amount of political contributions received that were promptly and directly delivered to a separate political organization, such as a separate segregated fund or a political action committee (PAC). If additional space is needed, provide information in Part IV.

(a) Name	(b) Address	(c) EIN	(d) Amount paid from filing organization's funds. If none, enter -0-.	(e) Amount of political contributions received and promptly and directly delivered to a separate political organization. If none, enter -0-.

For Privacy Act and Paperwork Reduction Act Notice, see the instructions for Form 990.

Cat. No. 50084S

Schedule C (Form 990 or 990-EZ) 2010

Page 2

Part II-A

Complete if the organization is exempt under section 501(c)(3) and filed Form 5768 (election under section 501(h)).

A Check if the filing organization belongs to an affiliated group.
B Check if the filing organization checked box A and "limited control" provisions apply.

Limits on Lobbying Expenditures (The term "expenditures" means amounts paid or incurred.)		(b) Affiliated Group Totals
1a	Total lobbying expenditures to influence public opinion (grass roots lobbying) ......
b	Total lobbying expenditures to influence a legislative body (direct lobbying) .......
c	Total lobbying expenditures (add lines 1a and 1b) ...................
d	Other exempt purpose expenditures ........................
e	Total exempt purpose expenditures (add lines 1c and 1d) ...............
f	Lobbying nontaxable amount. Enter the amount from the following table in both columns.
	If the amount on line 1e, column (a) or (b) is:The lobbying nontaxable amount is:
	Not over $500,00020% of the amount on line 1e.
	Over $500,000 but not over $1,000,000$100,000 plus 15% of the excess over $500,000.
	Over $1,000,000 but not over $1,500,000$175,000 plus 10% of the excess over $1,000,000.
	Over $1,500,000 but not over $17,000,000$225,000 plus 5% of the excess over $1,500,000.
	Over $17,000,000$1,000,000.

g	Grassroots nontaxable amount (enter 25% of line 1f) .................
h	Subtract line 1g from line 1a. If zero or less, enter -0-. ................
i	Subtract line 1f from line 1c. If zero or less, enter -0-. ................
j	If there is an amount other than zero on either line 1h or line 1i, did the organization file Form 4720 reporting section 4911 tax for this year? ......................................	Yes No

4-Year Averaging Period Under Section 501(h) (Some organizations that made a section 501(h) election do not have to complete all of the five columns below. See the instructions for lines 2a through 2f on page 4.)
Lobbying Expenditures During 4-Year Averaging Period
	Calendar year (or fiscal year beginning in)	(a) 2007	(b) 2008	(c) 2009	(d) 2010	(e) Total

2a	Lobbying non-taxable amount

b	Lobbying ceiling amount (150% of line 2a, column(e))

c	Total lobbying expenditures

d	Grassroots non-taxable amount

e	Grassroots ceiling amount (150% of line 2d, column (e))

f	Grassroots lobbying expenditures

Schedule C (Form 990 or 990-EZ) 2010

Page 3

Part II-B

Complete if the organization is exempt under section 501(c)(3) and has NOT filed Form 5768 (election under section 501(h)).

(a)

Yes

(b)

Amount

During the year, did the filing organization attempt to influence foreign, national, state or local legislation, including any attempt to influence public opinion on a legislative matter or referendum, through the use of:

Volunteers? .........................................

Paid staff or management (include compensation in expenses reported on lines 1c through 1i)? ....

Media advertisements? ....................................

Mailings to members, legislators, or the public? .........................

Publications, or published or broadcast statements? .......................

Grants to other organizations for lobbying purposes? .......................

Direct contact with legislators, their staffs, government officials, or a legislative body? ........

Rallies, demonstrations, seminars, conventions, speeches, lectures, or any similar means? ......

Other activities? If "Yes," describe in Part IV ..........................

Yes

4,562

Total. lines 1c through 1i ...................................

4,562

Did the activities in line 1 cause the organization to be not described in section 501(c)(3)? .....

If "Yes," enter the amount of any tax incurred under section 4912 .................

If "Yes," enter the amount of any tax incurred by organization managers under section 4912 .....

If the filing organization incurred a section 4912 tax, did it file Form 4720 for this year? .......

Part III-A

Complete if the organization is exempt under section 501(c)(4), section 501(c)(5), or section 501(c)(6).

Yes

Were substantially all (90% or more) dues received nondeductible by members? ................

Did the organization make only in-house lobbying expenditures of $2,000 or less? ................

Did the organization agree to carryover lobbying and political expenditures from the prior year? ..........

Part III-B

Complete if the organization is exempt under section 501(c)(4), section 501(c)(5), or section 501(c)(6) if BOTH Part III-A, lines 1 and 2 are answered “No” OR if Part III-A, line 3 is answered “Yes”.

Dues, assessments and similar amounts from members .....................

Section 162(e) non-deductible lobbying and political expenditures (do not include amounts of political
expenses for which the section 527(f) tax was paid).

Current year .........................................

Carryover from last year ....................................

Total ...........................................

Aggregate amount reported in section 6033(e)(1)(A) notices of nondeductible section 162(e) dues .

If notices were sent and the amount on line 2c exceeds the amount on line 3, what portion of the excess does the organization agree to carryover to the reasonable estimate of nondeductible lobbying and political expenditure next year? ................................

Taxable amount of lobbying and political expenditures (see instructions) ..............

Part IV

Supplemental Information

Complete this part to provide the descriptions required for Part l-A, line 1; Part l-B, line 4; Part l-C, line 5; and Part ll-B, line 1i.
Also, complete this part for any additional information.

Identifier	Return Reference	Explanation
OTHER LOBBYING ACTIVITIES	SCHEDULE C, PART II-B, LINE 1I	A PORTION OF DUES PAID TO THE MISSOURI HOSPITAL ASSOCIATION AND MONETT CHAMBER OF COMMERCE IS USED FOR POLITICAL LOBBYING. IN FY 2011, THESE AMOUNTS WERE $4,512 AND $50, RESPECTIVELY.

Schedule C (Form 990 or 990EZ) 2010

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE D
(Form 990)

Department of the Treasury
Internal Revenue Service

Supplemental Financial Statements

Complete if the organization answered "Yes," to Form 990,
Part IV, line 6, 7, 8, 9, 10, 11, or 12.
SchDMd Bullet

Attach to Form 990. SchDMd Bullet

See separate instructions.

OMB No. 1545-0047

2010

Open to Public Inspection

Name of the organization

COX-MONETT HOSPITAL INC

Employer identification number

43-1656689

Part I

Organizations Maintaining Donor Advised Funds or Other Similar Funds or Accounts. Complete if the organization answered "Yes" to Form 990, Part IV, line 6.

		(a) Donor advised funds	(b) Funds and other accounts
1	Total number at end of year .......
2	Aggregate contributions to (during year) ...
3	Aggregate grants from (during year) ...
4	Aggregate value at end of year .......

Did the organization inform all donors and donor advisors in writing that the assets held in donor advised
funds are the organization's property, subject to the organization's exclusive legal control? ............

Yes No

Did the organization inform all grantees, donors, and donor advisors in writing that grant funds may be
used only for charitable purposes and not for the benefit of the donor or donor advisor, or for any other purpose conferring impermissible private benefit. ...................................

Yes No

Part II

Conservation Easements. Complete if the organization answered "Yes" to Form 990, Part IV, line 7.

Purpose(s) of conservation easements held by the organization (check all that apply).

Preservation of land for public use (e.g., recreation or pleasure) Preservation of an historically importantly land area

Protection of natural habitat Preservation of a certified historic structure

Preservation of open space

Complete lines 2a–2d if the organization held a qualified conservation contribution in the form of a conservation easement on the last day of the tax year.


a	Total number of conservation easements .......................	2a
b	Total acreage restricted by conservation easements ..................	2b
c	Number of conservation easements on a certified historic structure included in (a) .....	2c
d	Number of conservation easements included in (c) acquired after 8/17/06 ........	2d

Number of conservation easements modified, transferred, released, extinguished, or terminated by the organization during
the taxable year SchDMd Bullet

Number of states where property subject to conservation easement is located SchDMd Bullet

Does the organization have a written policy regarding the periodic monitoring, inspection, handling of violations, and
enforcement of the conservation easements it holds? .............................

Yes No

Staff and volunteer hours devoted to monitoring, inspecting and enforcing conservation easements during the year SchDMd Bullet

Amount of expenses incurred in monitoring, inspecting, and enforcing conservation easements during the year SchDMd Bullet

Does each conservation easement reported on line 2(d) above satisfy the requirements of section
170(h)(4)(B)(i) and 170(h)(4)(B)(ii)? ....................................

Yes No

In Part XIV, describe how the organization reports conservation easements in its revenue and expense statement, and
balance sheet, and include, if applicable, the text of the footnote to the organization’s financial statements that describes
the organization’s accounting for conservation easements.

Part III

Organizations Maintaining Collections of Art, Historical Treasures, or Other Similar Assets.
Complete if the organization answered "Yes" to Form 990, Part IV, line 8.

If the organization elected, as permitted under SFAS 116, not to report in its revenue statement and balance sheet works of
art, historical treasures, or other similar assets held for public exhibition, education or research in furtherance of public service,
provide, in Part XIV, the text of the footnote to its financial statements that describes these items.

If the organization elected, as permitted under SFAS 116, to report in its revenue statement and balance sheet works of art,
historical treasures, or other similar assets held for public exhibition, education, or research in furtherance of public service,
provide the following amounts relating to these items:

(i)

Revenues included in Form 990, Part VIII, line 1 ........................ SchDMd Bullet

(ii)

Assets included in Form 990, Part X .............................. SchDMd Bullet

If the organization received or held works of art, historical treasures, or other similar assets for financial gain, provide the
following amounts required to be reported under SFAS 116 relating to these items:

Revenues included in Form 990, Part VIII, line 1 .......................... SchDMd Bullet

Assets included in Form 990, Part X ............................... SchDMd Bullet

For Privacy Act and Paperwork Reduction Act Notice, see the Intructions for Form 990

Cat. No. 52283D

Schedule D (Form 990) 2010

Page 2

Part III

Organizations Maintaining Collections of Art, Historical Treasures, or Other Similar Assets (continued)

Using the organization’s accession and other records, check any of the following that are a significant use of its collection
items (check all that apply):

Public exhibition

Loan or exchange programs

Scholarly research

Other

Preservation for future generations

Provide a description of the organization’s collections and explain how they further the organization’s exempt purpose in
Part XIV.

During the year, did the organization solicit or receive donations of art, historical treasures or other similar
assets to be sold to raise funds rather than to be maintained as part of the organization’s collection?........

Yes No

Part IV

Escrow and Custodial Arrangements. Complete if the organization answered "Yes" to Form 990,
Part IV, line 9, or reported an amount on Form 990, Part X, line 21.

Is the organization an agent, trustee, custodian or other intermediary for contributions or other assets not
included on Form 990, Part X? ....................................

Yes No

If "Yes," explain the arrangement in Part XIV and complete the following table:


c	Beginning balance .................................	1c
d	Additions during the year ..............................	1d
e	Distributions during the year .............................	1e
f	Ending balance ...................................	1f

Did the organization include an amount on Form 990, Part X, line 21? .....................

Yes No

If “Yes,” explain the arrangement in Part XIV.

Part V

Endowment Funds. Complete if the organization answered "Yes" to Form 990, Part IV, line 10.

		(a)Current Year	(b)Prior Year	(c)Two Years Back	(d)Three Years Back	(e)Four Years Back
1a	Beginning of year balance ....
b	Contributions ........
c	Investment earnings or losses ...
d	Grants or scholarships .....
e	Other expenditures for facilities and programs ........
f	Administrative expenses ....
g	End of year balance ......

Provide the estimated percentage of the year end balance held as:

Board designated or quasi-endowment: SchDMd Bullet

Permanent endowment: SchDMd Bullet

Term endowment: SchDMd Bullet

Are there endowment funds not in the possession of the organization that are held and administered for the
organization by:

Yes

(i) unrelated organizations ........................

3a(i)

(ii) related organizations ........................

3a(ii)

If "Yes" to 3a(ii), are the related organizations listed as required on Schedule R? .........

Describe in Part XIV the intended uses of the organization's endowment funds.

Part VI

InvestmentsLand, Buildings, and Equipment. See Form 990, Part X, line 10.

Description of investment		(b)Cost or other basis (other)	(c) Accumulated depreciation	(d) Book value
1a	Land .................	149,856		149,856
b	Buildings ................	14,055,718	7,475,006	6,580,712
c	Leasehold improvements ............
d	Equipment ................	8,553,520	6,951,204	1,602,316
e	Other .................	453,737	232,263	221,474
Total. Add lines 1a-1e. (Column (d) should equal Form 990, Part X, column (B), line 10(c).)........				8,554,358

Schedule D (Form 990) 2010

Page 3

Part VII

InvestmentsOther Securities. See Form 990, Part X, line 12.

(a) Description of security or category (including name of security)		(b)Book value	(c) Method of valuation: Cost or end-of-year market value
(1)Financial derivatives
(2)Closely-held equity interests
Other








Total. (Column (b) should equal Form 990, Part X, col.(B) line 12.)

Part VIII

InvestmentsProgram Related. See Form 990, Part X, line 13.

(a) Description of investment type		(b) Book value	(c) Method of valuation: Cost or end-of-year market value









Total. (Column (b) should equal Form 990, Part X, col.(B) line 13.)

Part IX

Other Assets. See Form 990, Part X, line 15.

(a) Description				(b) Book value









Total. (Column (b) should equal Form 990, Part X, col.(B) line 15.)...........

Part X

Other Liabilities. See Form 990, Part X, line 25.

1.(a) Description of Liability		(b) Amount
Federal Income Taxes		0
EST AMT DUE TO 3RD PARTY		666,869
DUE TO AFFILIATE		5,602,449







Total. (Column (b) should equal Form 990, Part X, col.(B) line 25.)		6,269,318
2. Fin 48 (ASC 740) Footnote. In Part XIV, provide the text of the footnote to the organization's financial statements that reports the organization's liability for uncertain tax positions under FIN 48 (ASC740).

Schedule D (Form 990) 2010

Page 4

Part XI Reconciliation of Change in Net Assets from Form 990 to Financial Statements
1	Total revenue (Form 990, Part VIII, column (A), line 12) ....................	1	34,354,261
2	Total expenses (Form 990, Part IX, column (A), line 25) .....................	2	34,851,213
3	Excess or (deficit) for the year. Subtract line 2 from line 1 .............	3	-496,952
4	Net unrealized gains (losses) on investments ..........................	4
5	Donated services and use of facilities .............................	5
6	Investment expenses ...................................	6
7	Prior period adjustments ..................................	7
8	Other (Describe in Part XIV) .................................	8
9	Total adjustments (net). Add lines 4 - 8 .............................	9
10	Excess or (deficit) for the year per financial statements. Combine lines 3 and 9 .........	10	-496,952

Part XII Reconciliation of Revenue per Audited Financial Statements With Revenue per Return
1	Total revenue, gains, and other support per audited financial statements .......			1	34,494,273
2	Amounts included on line 1 but not on Form 990, Part VIII, line 12:
a	Net unrealized gains on investments ..........	2a
b	Donated services and use of facilities .........	2b
c	Recoveries of prior year grants ...........	2c
d	Other (Describe in Part XIV): ............	2d
e	Add lines 2a through 2d .....................			2e
3	Subtract line 2e from line 1.....................			3	34,494,273
4	Amounts included on Form 990, Part VIII, line 12, but not on line 1:
a	Investment expenses not included on Form 990, Part VIII, line 7b .	4a
b	Other (Describe in Part XIV): ...........	4b	-140,012
c	Add lines 4a and 4b.......................			4c	-140,012
5	Total Revenue. Add lines 3 and 4c. (This should equal Form 990, Part I, line 12.) ......			5	34,354,261

Part XIII Reconciliation of Expenses per Audited Financial Statements With Expenses per Return
1	Total expenses and losses per audited financial statements .............			1	34,991,225
2	Amounts included on line 1 but not on Form 990, Part IX, line 25:
a	Donated services and use of facilities ..........	2a
b	Prior year adjustments ..............	2b
c	Other losses ................	2c
d	Other (Describe in Part XIV): ............	2d	140,012
e	Add lines 2a through 2d......................			2e	140,012
3	Subtract line 2e from line 1.....................			3	34,851,213
4	Amounts included on Form 990, Part IX, line 25, but not on line 1:
a	Investment expenses not included on Form 990, Part VIII, line 7b ..	4a
b	Other (Describe in Part XIV): ............	4b
c	Add lines 4a and 4b.......................			4c
5	Total expenses. Add lines 3 and 4c. (This should equal Form 990, Part I, line 18.) ......			5	34,851,213

Part XIV

Supplemental Information

Complete this part to provide the descriptions required for Part II, lines 3, 5, and 9; Part III, lines 1a and 4; Part lV, lines 1b and 2b;
Part V, line 4; Part X; Part XI, line 8; Part XII, lines 2d and 4b; and Part XIII, lines 2d and 4b. Also complete this part to provide any additional information.

Identifier	Return Reference	Explanation
UNCERTAIN TAX POSITIONS	SCHEDULE D, PART X, LINE 2	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.
RECONCILING ITEMS	SCHEDULE D, PART XII, LINE 4B AND PART XIII, LINE 2D	$ 140,012 RENTAL EXPENSES RECLASSIFIED TO OFFSET RENTAL REVENUE

Schedule D (Form 990) 2010

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE H
(Form 990)

Department of the Treasury
Internal Revenue Service

Hospitals

Complete if the organization answered "Yes" to Form 990, Part IV, question 20.
MediumBullet

Attach to Form 990. MediumBullet

See separate instructions.

OMB No. 1545-0047

2010

Open to Public Inspection

Name of the organization

COX-MONETT HOSPITAL INC

Employer identification number

43-1656689

Part I

Charity Care and Certain Other Community Benefits at Cost

Yes

Does the organization have a charity care policy? If "No," skip to question 6a...........

Yes

If "Yes," is it a written policy? .......................

Yes

If the organization has multiple hospitals, indicate which of the following best describes application of the charity care policy to the various hospitals.

Applied uniformly to all hospitals Applied uniformly to most hospitals Generally tailored to individual hospitals

Answer the following based on the charity care eligibility criteria that applies to the largest number of the organization's patients.

Does the organization use Federal Poverty Guidelines (FPG) to determine eligibility for providing free care to low

income individuals? If "Yes," indicate which of the following is the FPG family income limit for eligibility for free care:

100% 150% 200% Other

Does the organization use FPG to determine eligibility for providing discounted care to low income individuals? If

"Yes," indicate which of the following is the family income limit for eligibility for discounted care: .....

Yes

200% 250% 300% 350% 400% Other

If the organization does not use FPG to determine eligibility, describe in Part VI the income based criteria for determining eligibility for free or discounted care. Include in the description whether the organization uses an asset test or other threshold, regardless of income, to determine eligibility for free or discounted care.

Does the organization's policy provide free or discounted care to the "medically indigent"? ......

Yes

Does the organization budget amounts for free or discounted care provided under its charity care policy? ...

Yes

If "Yes," did the organization's charity care expenses exceed the budgeted amount?.........

Yes

If "Yes" to line 5b, as a result of budget considerations, was the organization unable to provide free or discounted
care to a patient who was eligibile for free or discounted care?...............

Does the organization prepare an annual community benefit report?.............

Yes

If "Yes," does the organization make it available to the public? ..............

Yes

Complete the following table using the worksheets provided in the Schedule H instructions. Do not submit these worksheets with the Schedule H.

Charity Care and Certain Other Community Benefits at Cost

	(c) Total community benefit expense	(d) Direct offsetting revenue	(e) Net community benefit expense	(f) Percent of total expense
a Charity care at cost (from Worksheets 1 and 2) ..	1,094,467		1,094,467	3.620 %
b Unreimbursed Medicaid (from Worksheet 3, column a) .	7,338,922	6,256,866	1,082,056	3.580 %
c Unreimbursed costs—other means-tested government programs (from Worksheet 3, column b) ....
dTotal Charity Care and Means-Tested Government Programs .....	8,433,389	6,256,866	2,176,523	7.200 %
Other Benefits e Community health improvement services and community benefit operations (from (Worksheet 4) ....	311,611	86,416	225,195	0.740 %
f Health professions education (from Worksheet 5) ..
g Subsidized health services (from Worksheet 6) ..	2,460,233	1,484,020	976,213	3.230 %
h Research (from Worksheet 7)
i Cash and in-kind contributions to community groups (from Worksheet 8) ..	103,225		103,225	0.340 %
jTotal Other Benefits ...	2,875,069	1,570,436	1,304,633	4.310 %
kTotal. Add lines 7d and 7j. ..	11,308,458	7,827,302	3,481,156	11.510 %

For Privacy Act and Paperwork Reduction Act Notice, see the Instructions for Form 990. Cat. No. 50192T Schedule H (Form 990) 2010

Schedule H (Form 990) 2010

Page 2

Part II

Community Building Activities Complete this table if the organization conducted any community building activities.

		(a) Number of activities or programs (optional)	(b) Persons served (optional)	(c) Total community building expense	(d) Direct offsetting revenue	(e) Net community building expense	(f) Percent of total expense
1	Physical improvements and housing
2	Economic development
3	Community support
4	Environmental improvements
5	Leadership development and training for community members
6	Coalition building
7	Community health improvement advocacy
8	Workforce development
9	Other
10	Total

Part III

Bad Debt, Medicare, & Collection Practices

Section A. Bad Debt Expense

Yes

Does the organization report bad debt expense in accordance with Heathcare Financial Management Association Statement No. 15? ..........................

Enter the amount of the organization's bad debt expense (at cost).....

1,936,295

Enter the estimated amount of the organization's bad debt expense (at cost) attributable to patients eligible under the organization's charity care policy ..

333,043

Provide in Part VI the text of the footnote to the organization's financial statements that describes bad debt expense. In addition, describe the costing methodology used in determining the amounts reported on lines 2 and 3, and rationale for including a portion of bad debt amounts as community benefit.

Section B. Medicare

Enter total revenue received from Medicare (including DSH and IME).....

10,459,304

Enter Medicare allowable costs of care relating to payments on line 5.....

10,181,234

Subtract line 6 from line 5. This is the surplus or (shortfall)........

278,070

Describe in Part VI the extent to which any shortfall reported in line 7 should be treated as community benefit.
Also describe in Part VI the costing methodology or source used to determine the amount reported on line 6.
Check the box that describes the method used:

Cost accounting system Cost to charge ratio Other

Section C. Collection Practices

Does the organization have a written debt collection policy? ...............

Yes

If "Yes," does the organization's collection policy contain provisions on the collection practices to be followed for patients who are known to qualify for charity care or financial assistance? Describe in Part VI......

Yes

Part IV

Management Companies and Joint Ventures

(a) Name of entity	(b) Description of primary activity of entity	(c) Organization's profit % or stock ownership %	(d) Officers, directors, trustees, or key employees' profit % or stock ownership%	(e) Physicians' profit % or stock ownership %
1
2
3
4
5
6
7
8
9
10
11
12
13

Schedule H (Form 990) 2010

Page 3

Part VFacility Information

Section A. Hospital Facilities (list in order of size, measured by total revenue per facility, from largest to smallest) How many hospital facilities did the organization operate during the tax year?1 Name and address		Other (Describe)
1	COX-MONETT HOSPITAL INC 801 N LINCOLN AVE MONETT,MO65708	X	X	X	X

Schedule H (Form 990) 2010

Page 4

Part VFacility Information (continued)

Section B. Facility Policies and Practices.

(Complete a separate Section B for each of the hospital facilities listed in Part V, Section A)

Name of Hospital Facility:COX-MONETT HOSPITAL INC

Line Number of Hospital Facility (from Schedule H, Part V, Section A):1

				Yes	No
Community Health Needs Assessment (Lines 1 through 7 are optional for 2010)
1	During the tax year or any prior tax year, did the hospital facility conduct a community health needs assessment (“Needs Assessment”)? If “No,” skip to question 8. .....................		1
	If “Yes,” indicate what the Needs Assessment describes (check all that apply):
	a	A definition of the community served by the hospital facility
	b	Demographics of the community
	c	Existing health care facilities and resources within the community that are available to respond to the health needs of the community
	d	How data was obtained
	e	The health needs of the community
	f	Primary and chronic disease needs and other health issues of uninsured persons, low-income persons, and minority groups
	g	The process for identifying and prioritizing community health needs and services to meet those needs
	h	The process for consulting with persons representing the community’s interests
	i	Information gaps that limit the hospital facility’s ability to assess all of the community’s health needs
	j	Other (describe in Part VI)
2	Indicate the tax year the hospital facility last conducted a Needs Assessment: 20
3	In conducting its most recent Needs Assessment, did the hospital facility take into account input from persons who represent the community served by the hospital facility? If “Yes,” describe in Part VI how the hospital facility took into account input from persons who represent the community, and identify the persons the hospital facility consulted.		3
4	Was the hospital facility’s Needs Assessment conducted with one or more other hospital facilities? If “Yes,” list the other hospital facilities in Part VI............................		4
5	Did the hospital facility make its Needs Assessment widely available to the public? ...........		5
	If “Yes,” indicate how the Needs Assessment was made widely available (check all that apply):
	a	Hospital facility’s website
	b	Available upon request from the hospital facility
	c	Other (describe in Part VI)
6	If the hospital facility addressed needs identified in its most recently conducted Needs Assessment, indicate how (check all that apply):
	a	Adoption of an implementation strategy to address the health needs of the hospital facility’s community
	b	Execution of the implementation strategy
	c	Development of a community benefit plan for the facility
	d	Participation in community-wide community benefit plan
	e	Inclusion of a community benefit section in operational plans
	f	Adoption of a budget for provision of services that address the needs identified in the CHNA
	g	Prioritization of health needs in the community
	h	Prioritization of services that the hospital facility will undertake to meet health needs in its community
	i	Other (describe in Part VI)
7	Did the hospital facility address all of the needs identified in its most recently conducted Needs Assessment? If “No,” explain in Part VI which needs it has not addressed together with the reasons why it has not addressed such needs.		7
Financial Assistance Policy
	Did the hospital facility have in place during the tax year a written financial assistance policy that:
8	Explains eligibility criteria for financial assistance, and whether such assistance includes free or discounted care?		8
9	Used federal poverty guidelines (FPG) to determine eligibility for providing free care to low incomeindividuals?..		9
	If “Yes,” indicate the FPG family income limit for eligibility for free care: %

Schedule H (Form 990) 2010

Page 5

Part VFacility Information (continued)

				Yes	No
10	Used FPG to determine eligibility for providing discounted care to low income individuals?.........		10
	If “Yes,” indicate the FPG family income limit for eligibility for discounted care: %
11	Explained the basis for calculating amounts charged to patients?.................		11
	If “Yes,” indicate the factors used in determining such amounts (check all that apply):
	a	Income level
	b	Asset level
	c	Medical indigency
	d	Insurance status
	e	Uninsured discount
	f	Medicaid/Medicare
	g	State regulation
	h	Other (describe in Part VI)
12	Explained the method for applying for financial assistance?...................		12
13	Included measures to publicize the policy within the community served by the hospital facility?.......		13
	If “Yes,” indicate how the hospital facility publicized the policy (check all that apply):
	a	The policy was posted at all times on the hospital facility’s web site
	b	The policy was attached to all billing invoices
	c	The policy was posted in the hospital facility’s emergency rooms or waiting rooms
	d	The policy was posted in the hospital facility’s admissions offices
	e	The policy was provided, in writing, to patients upon admission to the hospital facility
	f	The policy was available upon request
	g	Other (describe in Part VI)
Billing and Collections
14	Did the hospital facility have in place during the tax year a separate billing and collections policy, or a written financial assistance policy that explained actions the hospital facility may take upon non-payment?........		14
15	Check all of the following collection actions against a patient that were permitted under the hospital facility's policies at any time during the tax year:
	a	Reporting to credit agency
	b	Lawsuits
	c	Liens on residences
	d	Body attachments or arrests
	e	Other (describe in Part VI)
16	Did the hospital facility engage in or authorize a third party to engage in any of the following collection actions during the tax year?...................................		16
	If “Yes,” check all collection actions in which the hospital facility or a third party engaged (check all that apply):
	a	Reporting to credit agency
	b	Lawsuits
	c	Liens on residences
	d	Body attachments
	e	Other (describe in Part VI)
17	Indicate which actions the hospital facility took before initiating any of the collection actions checked in question 16 (check all that apply):
	a	Notified patients of the financial assistance policy upon admission
	b	Notified patients of the financial assistance policy prior to discharge
	c	Notified patients of the financial assistance policy in communications with the patients regarding the patients’ bills
	d	Documented its determination of whether a patient who applied for financial assistance under the financial assistance policy qualified for financial assistance
	e	Other (describe in Part VI)

Schedule H (Form 990) 2010

Page 6

Part VFacility Information (continued)

Policy Relating to Emergency Medical Care
				Yes	No
18	Did the hospital facility have in place during the tax year a written policy relating to emergency medical care that requires the hospital facility to provide, without discrimination, care for emergency medical conditions to individuals regardless of their eligibility under the hospital facility’s financial assistance policy?..........		18
	If “No,” indicate the reasons why (check all that apply):
	a	The hospital facility did not provide care for any emergency medical conditions
	b	The hospital facility did not have a policy relating to emergency medical care
	c	The hospital facility limited who was eligible to receive care for emergency medical conditions (describe in Part VI)
	d	Other (describe in Part VI)
Charges for Medical Care
19	Indicate how the hospital facility determined the amounts generally billed to individuals who had insurance covering emergency or other medically necessary care (check all that apply):
	a	The hospital facility used the lowest negotiated commercial insurance rate for those services at the hospital facility
	b	The hospital facility used the average of the three lowest negotiated commercial insurance rates for those services at the hospital facility
	c	The hospital facility used the Medicare rate for those services
	d	Other (describe in Part VI)
20	Did the hospital facility charge any of its patients who were eligible for assistance under the hospital facility’s financial assistance policy, and to whom the hospital facility provided emergency or other medically necessary services, more than the amounts generally billed to individuals who had insurance covering such care?.........		20
	If “Yes,” explain in Part VI.
21	Did the hospital facility charge any of its patients an amount equal to the gross charge for services provided to that patient?...................................		21
	If “Yes,” explain in Part VI.

Schedule H (Form 990) 2010

Page 7

Part VFacility Information (continued)

Section C. Other Facilities That Are Not Licensed, Registered, or Similarly Recognized as a Hospital Facility (list in order of size, measured by total revenue per facility, from largest to smallest) How many non-hospital facilities did the organization operate during the tax year?3
Name and address		Type of Facility (Describe)
1	COX REHAB 700 E CLEVELAND AVE MONETT,MO65708	REHABILITATION
2	COX REHAB 700 E CLEVELAND AVE MONETT,MO65708	REHABILITATION
3	COX REHAB 700 E CLEVELAND AVE MONETT,MO65708	REHABILITATION
4
5
6
7
8
9
10

Schedule H (Form 990) 2010

Page 8

Part VI

Supplemental Information

Complete this part to provide the following information.

1	Required descriptions. Provide the description required for Part I, lines 3c, 6a, and 7; Part II; Part III, lines 4, 8, and 9b; and Part V, Section B, lines 1j, 2, 4c, 6i, 7, 11i, 13i, 17l, 18l, 19e, 21d, 25, and 26.
2	Community health needs assessment. Describe how the organization assesses the health care needs of the communities it serves, in addition to any community health needs assessments reported in Part V, Section B.
3	Patient education of eligibility for assistance. Describe how the organization informs and educates patients and persons who may be billed for patient care about their eligibility for assistance under federal, state, or local government programs or under the organization’s financial assistance policy.
4	Community information. Describe the community the organization serves, taking into account the geographic area and demographic constituents it serves.
5	Promotion of community health. Provide any other information important to describing how the organization’s hospital facilities or other health care facilities further its exempt purpose by promoting the health of the community (e.g., open medical staff, community board, use of surplus funds, etc.).
6	Affiliated health care system. If the organization is part of an affiliated health care system, describe the respective roles of the organization and its affiliates in promoting the health of the communities served.
7	State filing of community benefit report. If applicable, identify all states with which the organization, or a related organization, files a community benefit report.

Identifier	ReturnReference	Explanation
ELIGIBILITY FOR FREE CARE	SCHEDULE H, PART I, LINE 3C	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 THIS POLICY.
PERCENT OF TOTAL EXPENSE	SCHEDULE H, PART I, LINE 7, COLUMN F	TO ARRIVE AT THE PERCENT OF TOTAL EXPENSES, THE DENOMINATOR WHICH EQUALS TOTAL OPERATING EXPENSES PER PART IX, LINE 25, OF THE FORM 990 ($34,984,110) WAS REDUCED BY BAD DEBT EXPENSE ($4,718,293).
SUBSIDIZED SERVICES	SCHEDULE H, PART I, LINE 7G	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 $976,213. COX-MONETT HOSPITAL PROVIDES PRIMARY CARE SERVICES TO THE CASSVILLE COMMUNITY AT THE CENTER. THESE SERVICES ARE PROVIDED IN A RURAL AREA WHERE THERE WOULD BE A SHORTAGE OF QUALITY MEDICAL CARE WITHOUT THE SERVICES. THE ORGANIZATION CONTINUES TO PROVIDE THESE SERVICES AS A BENEFIT TO THE COMMUNITY DESPITE KNOWING THAT FINANCIAL SHORTFALLS WILL BE SUSTAINED.
COSTING METHODOLOGY	SCHEDULE H, PART I, LINE 7G	THE COST TO CHARGE RATIO CALCULATED ON IRS WORKSHEET 2 WAS USED IN THE CALCULATION OF COST ON WORKSHEET 1. ON OTHER IRS WORKSHEETS, A COSTING SYSTEM WAS USED USING ALL PATIENT SEGMENTS. COST COMPUTED ON IRS WORKSHEETS 3 AND 6 WERE COMPUTED FROM THE MEDICARE COST REPORT, INCLUDING DIRECT COSTS PLUS OVERHEAD ALLOCATIONS COMPUTED IN THE COST REPORT STEP-DOWN PROCESS.
BAD DEBT EXPENSE	SCHEDULE H, PART III, SECTION A, LINE 4	THE AUDITED FINANCIAL STATEMENTS DO NOT CONTAIN A FOOTNOTE THAT DESCRIBES BAD DEBT EXPENSE. THEY DO, HOWEVER, CONTAIN A FOOTNOTE THAT DESCRIBES PATIENT ACCOUNTS RECEIVABLE: THE HOSPITAL REPORTS PATIENT ACCOUNTS RECEIVABLE FOR SERVICES RENDERED AT NET REALIZABLE AMOUNTS FROM THIRD-PARTY PAYERS, PATIENTS AND OTHERS. THE HOSPITAL PROVIDES AN ALLOWANCE FOR UNCOLLECTIBLE ACCOUNTS BASED UPON A REVIEW OF OUTSTANDING RECEIVABLES, HISTORICAL COLLECTION INFORMATION AND EXISTING ECONOMIC CONDITIONS. AS A SERVICE TO THE PATIENT, THE HOSPITAL BILLS THIRD-PARTY PAYERS DIRECTLY AND BILLS THE PATIENT WHEN THE PATIENT'S LIABILITY IS DETERMINED. PATIENT ACCOUNTS RECEIVABLE ARE DUE IN FULL WHEN BILLED. ACCOUNTS ARE CONSIDERED DELINQUENT AND SUBSEQUENTLY WRITTEN OFF AS BAD DEBTS BASED ON INDIVIDUAL CREDIT EVALUATION AND SPECIFIC CIRCUMSTANCES OF THE ACCOUNT. THE ORGANIZATION CALCULATED BAD DEBT AT COST BY TAKING THE BAD DEBT ATTRIBUTABLE TO PATIENT ACCOUNTS TIMES THE RATIO OF PATIENT CARE COST TO CHARGES USED FOR SCHEDULE H, PART I CALCULATIONS. 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 2009, APPROXIMATELY 18.6 PERCENT OF THE POPULATION LIVING IN BARRY AND LAWRENCE COUNTIES WERE CONSIDERED TO LIVE IN POVERTY.
COMMUNITY BENEFIT	SCHEDULE H, PART III, SECTION B, LINE 8	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.
COLLECTION POLICY	SCHEDULE H, PART III, SECTION C, LINE 9B	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.
NEEDS ASSESSMENT		IN 2012, THE FIRST "COMMUNITY HEALTH NEEDS ASSESSMENT" AS REQUIRED BY THE IRS WAS PUT IN PROCESS, ALONG WITH A PUBLIC PERCEPTION STUDY OF AREA HEADS OF HOUSEHOLDS. THE MOST RECENT STUDY SURVEYED 876 HOUSEHOLDS IN THE COXHEALTH SERVICE AREA (119 RESPONDENTS FROM BARRY & LAWRENCE COUNTIES) 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, PUBLIC SCHOOLS THROUGHOUT THE TOTAL SERVICE AREA. COX MONETT REFERENCES "ASSESSING THE HEALTH OF THE COMMUNITY", WHICH IS AN ANALYSIS OF BEHAVIORS AND OUTCOMES FOR THE SPECIFIC COUNTIES OF COXHEALTH SERVICE AREA BY THE MISSOURI HOSPITAL ASSOCIATION. DEMOGRAPHIC AND ECONOMIC ANALYSIS IS PERFORMED FOR THE 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.
PATIENT EDUCATION OF ELIGIBILITY FOR ASSISTANCE		INDIVIDUALS RESIDING WITHIN THE COX MONETT SERVICE AREA WHO ARE UNINSURED OR MEDICALLY INDIGENT AND UNABLE TO PAY FOR MEDICALLY NECESSARY MEDICAL SERVICES MAY QUALIFY FOR A REDUCTION IN THEIR BILL, DEPENDING ON THEIR FINANCIAL STATUS. UNINSURED PATIENTS ARE PROVIDED A FINANCIAL ASSISTANCE PACKET AT THE TIME OF REGISTRATION. COX MONETT ALSO PROVIDES NOTIFICATION REGARDING FINANCIAL ASSISTANCE FOR ALL SELF-PAY PATIENTS ON THEIR BILLING STATEMENTS. HOSPITAL STAFF VISITS SELF-PAY PATIENTS DURING THEIR HOSPITALIZATION TO DETERMINE IF THEY MIGHT BE ELIGIBLE FOR MEDICAID COVERAGE, COBRA OR OTHER FEDERAL ASSISTANCE AND HELPS WITH THE APPLICATION PROCESS. PATIENTS WHO ARE NOT ELIGIBLE FOR THESE PROGRAMS ARE CONTACTED BY A FINANCIAL COUNSELOR WHO CAN PROVIDE ASSISTANCE IN COMPLETING THE HOSPITAL'S ASSISTANCE PROGRAM. ELIGIBILITY ASSISTANCE INFORMATION IS ALSO AVAILABLE AT THE COXHEALTH WEBSITE, WWW.COXHEALTH.COM.
COMMUNITY INFORMATION		THE PRIMARY SERVICE AREA ("PSA") COUNTIES SERVED BY COX MONETT INCLUDE: BARRY, LAWRENCE & NEWTON COUNTIES (ALL LOCATED IN MISSOURI). THE TOTAL POPULATION OF THE SERVICE AREA IS 129,639. THE AVERAGE HOUSEHOLD INCOME IS $37,677 COMPARED WITH $58,796 FOR THE STATE OF MISSOURI. 9% OF BARRY COUNTY IS HISPANIC OR LATINO, VERSUS 4% IN NEWTON AND 6% IN LAWRENCE. 50% OF THE MARKET IS FEMALE AND 14% OF THE PEOPLE WHO LIVE THE IN THE SERVICE AREA ARE BETWEEN THE AGES OF 45-54. THE SERVICE AREA IS ESTIMATED TO ONLY GROW 3-4% IN THE NEXT TEN YEARS. 66% OF PEOPLE LIVING IN OUR SERVICE AREA LIVE IN A RURAL AREA AND 4.1% OF PEOPLE WHO LIVE IN BARRY COUNTY ARE NOT PROFICIENT IN ENGLISH. THE UNINSURED ACCOUNT FOR 18.5% COMPARED WITH 15.2% FOR THE STATE OF MISSOURI.
PROMOTION OF COMMUNITY HEALTH		COX-MONETT HOSPITAL'S 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 (HOSPITAL IN MONETT AND PHYSICIAN CLINICS IN SIX LOCATIONS WITHIN OUR SERVICE AREA). OUR GOAL IS TO PROVIDE QUALITY, AFFORDABLE CARE TO THE COMMUNITIES WE SERVE. COMMUNITY INVOLVEMENT IS ACHIEVED IN A VARIETY OF WAYS INCLUDING: - THE AVERAGE OBESITY RATE IN OUR SERVICE AREA IS 30%, COMPARED TO THE STATE AVERAGE OF 31.1%. COX MONETT OFFERS A WIDE-RANGE OF WELLNESS CLASSES FOR THE ENTIRE FAMILY. JOURNEYS IS A 20-WEEK ADULT WEIGHT MANAGEMENT PROGRAM TAUGHT BY CERTIFIED FITNESS TRAINERS, A REGISTERED DIETITIAN A LICENSED PSYCHOLOGIST. - CARDIAC KIDS IS A FREE CARDIOVASCULAR SCREENING PROGRAM AVAILABLE TO ALL FIFTH GRADE CHILDREN LIVING IN THE SERVICE AREA AND BEYOND. PARTIALLY FUNDED THROUGH THE CHILDREN'S MIRACLE NETWORK, THIS PROGRAM SCREENS CHILDREN WHO MIGHT BE AT RISK FOR HEART DISEASE. SINCE STARTING THE PROGRAM IN 2003, OVER 40% OF CHILDREN WERE IDENTIFIED AT RISK. - COX MONETT PROVIDES EXTENSIVE OUTREACH THROUGH FREE OR LOW-COST HEALTH EDUCATION AND HEALTH SCREENINGS YEAR-ROUND. EXAMPLES INCLUDE A FREE HEART HEALTHY FAIR IN FEBRUARY AND A FREE DIABETES SCREENING IN NOVEMBER. - COXHEALTH.COM PROVIDES ONLINE HEALTH EDUCATION AND INCORPORATES PODCASTS, HEALTH SURVEYS AND QUIZZES, AS WELL AS A HEALTH LIBRARY. HEALTHSENSE MAGAZINE IS DISTRIBUTED EACH QUARTER TO OVER 160,000 SOUTHWEST MISSOURI RESIDENTS. - COX MONETT SPONSORS COMMUNITY EVENTS PROMOTING HEALTH MESSAGES AND RAISING FUNDS FOR NEEDED HEALTH SERVICES. - COX MONETT'S ADMINISTRATIVE LEADERS PARTICIPATE IN MANY CIVIC ORGANIZATIONS WHOSE PURPOSE IS TO IMPROVE THE LIVES OF COMMUNITY MEMBERS. EXAMPLES INCLUDE THE MONETT SCHOOL BOARD, MONETT MAIN STREET AND THE CHAMBER OF COMMERCE. - DINING FOR DIABETES IS A YEARLY EVENT THAT RAISES MONEY FOR THE COX MONETT DIABETES CENTER. LAST YEAR, THE EVENT RAISED OVER $42,000 TO HELP PEOPLE WHO CANNOT AFFORD THE COST OF THE DISEASE. - COX MONETT'S RESPONSE TO THE MAY 2011 JOPLIN TORNADO WAS SWIFT AND COMPREHENSIVE. WE IMMEDIATELY PROVIDED MANPOWER AND SUPPLIES TO THE JOPLIN HOSPITALS. IN 2011, COX MONETT WAS AWARDED A GRANT THAT PROVIDES CHILDREN DIAGNOSED WITH ASTHMA SUPPLIES, EDUCATIONAL MATERIALS AND COUNSELING WITH A CERTIFIED ASTHMA EDUCATOR. CHILDREN IDENTIFIED WITH ASTHMA THROUGH THE SCHOOL PROGRAM ARE THEN REFERRED TO A PEDIATRIC PULMONOLOGIST. THE PROGRAM IS OFFERED TO SCHOOL-AGE CHILDREN IN OUR SERVICE AREA AND AT NO CHARGE. GOALS OF THE PROGRAM INCLUDE: - SELF-MANAGEMENT SKILLS - PROPER MEDICATION/DELIVERY TECHNIQUES - DEVELOP PATIENT/FAMILY/PHYSICIAN PARTNERSHIPS - ASSESS, TREAT AND MONITOR ASTHMA - MANAGE ASTHMA EXACERBATIONS - HOME ENVIRONMENT CHECKS - HOW TO USE PEAK FLOW METER AND UNDERSTAND RESULTS ACCORDING TO THE MISSOURI HOSPITAL ASSOCIATION'S "ASSESSING THE HEALTH OF OUR COMMUNITIES" REPORT, ER VISITS RELATED TO ASTHMA ARE ON THE RISE. COX MONETT SUPPORTS THE AMERICAN CANCER SOCIETY'S RELAY FOR LIFE BY PROVIDING WHEELCHAIRS FOR THE "SURVIVOR'S" TO RIDE IN FOR THE FIRST LAP.
AFFILIATED HEALTH CARE SYSTEM		COXHEALTH'S HOME CARE SERVICES ARE PROVIDED BY OXFORD HEALTHCARE, HOME PARENTERAL SERVICES (INFUSION THERAPY) AND HOME SUPPORT (DURABLE MEDICAL EQUIPMENT). OXFORD HEALTHCARE SUPPORTED THE COMMUNITY THROUGH MONTHLY NUTRITION AND FALL PREVENTION SEMINARS AT 20 AREA SENIOR CENTERS THROUGHOUT SOUTHWEST MISSOURI. OXFORD ALSO PROVIDED FREE BONE DENSITY SCREENINGS AT 34 COMMUNITY EVENTS, AND VITAL SIGN SCREENINGS AT MANY MORE. THROUGH AN ANNUAL FAN DRIVE, OXFORD COLLECTED AND DISTRIBUTED MORE THAN 600 BOX FANS TO SENIORS AND THE DISABLED WHO LACK ADEQUATE ACCESS TO COOLING DURING THE SUMMER MONTHS. DURING THE JOPLIN TORNADO AFTERMATH, OXFORD STAFF SET UP AND MANNED FIRST AID TENTS IN THE AFFECTED AREAS FOR 2 WEEKS, TENDING TO SURVIVORS AND CLEAN-UP CREWS. IN ADDITION TO PROVIDING FREE TREATMENT FOR MINOR INJURIES, THESE VOLUNTEER STAFFED FACILITIES AND ADMINISTERED MORE THAN 1,000 TETANUS SHOTS. OXFORD EMPLOYEES ADDITIONALLY COLLECTED FOOD AND CLOTHING TO BE DISTRIBUTED IN THE AFFECTED AREAS. HOME PARENTERAL SERVICES RECEIVED A SECOND GRANT AWARD FROM THE MISSOURI FOUNDATION FOR HEALTH ORGANIZATION. THIS GRANT ALLOWS HPS TO SERVE PATIENTS THAT FALL THROUGH THE CRACKS DUE TO HAVING NO REIMBURSEMENT OF ANY KIND, SERVING PATIENTS THROUGHOUT SOUTHERN MISSOURI. COXHEALTH HOME CARE SERVICES OF THE MIDWEST SUPPORTS THE COMMUNITY BY PROVIDING IN-HOME PRIVATE DUTY SERVICES, HOME HEALTHCARE AND THERAPY SUPPORT SERVICES, ASSISTANCE TO COXHEALTH SYSTEM IN DEVELOPING AN INTEGRATED HEALTH SYSTEM, AND SERVICE TO MEDICAID PATIENTS. LESTER E. COX MEDICAL CENTERS (COXHEALTH) SUPPORTS THE SPRINGFIELD, MISSOURI AND THE SURROUNDING COMMUNITY BY PROVIDING A VARIETY OF SERVICES WHICH INCLUDE UROLOGY, ENT (EAR, NOSE & THROAT), PULMONOLOGY, ORTHOPEDICS, CARDIOLOGY, PODIATRY, OBSTETRICS, RADIOLOGY (CT, MRI, NUCLEAR MEDICINE & MAMMOGRAPHY), LABORATORY, 24-HOUR EMERGENCY CENTER, GENERAL SURGICAL SERVICES, SAME-DAY SURGERY, DIABETES CENTER, SLEEP CENTER, CARDIOPULMONARY REHAB, MEDICAL-SURGICAL UNIT, PHARMACY AND COMMUNITY WELLNESS. COXHEALTH FOUNDATION SUPPORTS THE COMMUNITY BY RAISES FUNDS TO DISPERSE TO PATIENTS FOR THOSE NEEDS FOR WHICH THEY HAVE NO RESOURCES OR FUNDING, BUT WHICH ARE CRITICAL TO THE PATIENTS HEALTH AND WELL BEING. COXHEALTH AUXILIARY SUPPORTS THE COMMUNITY THROUGH FINANCIAL AND NON-FINANCIAL MEANS. THE ORGANIZATION PROVIDES SCHOLARSHIPS TO NURSING AND MEDICAL TECHNOLOGY STUDENTS AT COX COLLEGE. IN ADDITION, THE AUXILIARY PROVIDES SLEEP SACKS TO ALL NEWBORNS BORN AT COXHEALTH AND CAR SEATS TO THOSE IN NEED TO ENSURE THE SAFETY OF ANY NEWBORN LEAVING COXHEALTH.

Schedule H (Form 990) 2010

Additional Data

Software ID:
Software Version:

- TIN:

Schedule I
(Form 990)

Department of the Treasury
Internal Revenue Service

Grants and Other Assistance to Organizations,
Governments and Individuals in the United States

Complete if the organization answered "Yes," to Form 990, Part IV, line 21 or 22.
lBullet

Attach to Form 990

OMB No. 1545-0047

2010

Open to Public
Inspection

Name of the organization
COX-MONETT HOSPITAL INC

Employer identification number
43-1656689

Part I

General Information on Grants and Assistance

Does the organization maintain records to substantiate the amount of the grants or assistance, the grantees' eligibility for the grants or assistance, and
the selection criteria used to award the grants or assistance? ....................................

Yes No

Describe in Part IV the organization's procedures for monitoring the use of grant funds in the United States.

Part II

Grants and Other Assistance to Governments and Organizations in the United States. Complete if the organization answered "Yes" to
Form 990, Part IV, line 21 for any recipient that received more than $5,000. Check this box if no one recipient received more than $5,000. Use
Part IV and Schedule I-1 (Form 990) if additional space is needed ......................... lBullet

(a) Name and address of organization or government	(b) EIN	(c) IRC Code section if applicable	(d) Amount of cash grant	(h) Purpose of grant or assistance
(1) OZARK REGIONAL YMCA417 S JEFFERSON SPRINGFIELD,MO65806	44-0545283	501(C)(3)	100,000	COMMUNITY BENEFIT

Enter total number of section 501(c)(3) and government organizations ......................... Bullet Image

Enter total number of other organizations ................................ . Bullet Image

For Privacy Act and Paperwork Reduction Act Notice, see the Instructions for Form 990.

Cat. No. 50055P

Schedule I (Form 990) 2010

Page 2

Part III

Grants and Other Assistance to Individuals in the United States. Complete if the organization answered "Yes" to Form 990, Part IV, line 22.
Use Schedule I-1 (Form 990) if additional space is needed.

(a)Type of grant or assistance	(b)Number of recipients	(c)Amount of cash grant	(d)Amount of non-cash assistance	(e)Method of valuation (book, FMV, appraisal, other)	(f)Description of non-cash assistance

Part IV

Supplemental Information. Complete this part to provide the information required in Part I, line 2, and any other additional information.

Identifier	Return Reference	Explanation
MONITORING USE OF GRANT FUNDS	SCHEDULE I, PART I, LINE 2	THE USE OF GRANT FUNDS TO THE YMCA IS ACTIVELY MONITORED BY COX-MONETT HOSPITAL THROUGH AN EMPLOYEE WHO IS A MEMBER OF THE YMCA'S BOARD OF DIRECTORS. THE USE OF GRANT FUNDS CAN ALSO BE VISUALLY MONITORED BY THE ORGANIZATION BY VISITING THE YMCA AND VERIFYING THAT SUBSTANTIAL PROGRESS IS BEING MADE AS THE CONTRACT STIPULATES.

Schedule I (Form 990) 2010

Additional Data

Software ID:
Software Version:

- TIN:

Schedule J
(Form 990)

Department of the Treasury
Internal Revenue Service

Compensation Information

For certain Officers, Directors, Trustees, Key Employees, and Highest
Compensated Employees
SchJMediumBullet

Complete if the organization answered "Yes" to Form 990,
Part IV, question 23.
SchJMediumBullet

Attach to Form 990. SchJMediumBullet

See separate instructions.

OMB No. 1545-0047

2010

Open to Public Inspection

Name of the organization

COX-MONETT HOSPITAL INC

Employer identification number

43-1656689

Part I

Questions Regarding Compensation

Yes

Check the appropiate box(es) if the organization provided any of the following to or for a person listed in Form
990, Part VII, Section A, line 1a. Complete Part III to provide any relevant information regarding these items.

First-class or charter travel Housing allowance or residence for personal use

Travel for companions Payments for business use of personal residence

Tax idemnification and gross-up payments Health or social club dues or initiation fees

Discretionary spending account Personal services (e.g., maid, chauffeur, chef)

If any of the boxes in line 1a are checked, did the organization follow a written policy regarding payment or reimbursement orprovision of all the expenses described above? If "No," complete Part III to explain....

Did the organization require substantiation prior to reimbursing or allowing expenses incurred by all
officers, directors, trustees, and the CEO/Executive Director, regarding the items checked in line 1a? ....

Indicate which, if any, of the following the organization uses to establish the compensation of the
organization's CEO/Executive Director. Check all that apply.

Compensation committee Written employment contract

Independent compensation consultant Compensation survey or study

Form 990 of other organizations Approval by the board or compensation committee

During the year, did any person listed in Form 990, Part VII, Section A, line 1a with respect to the filing organization or a related organization:

Receive a severance payment or change-of-control payment? ...............

Participate in, or receive payment from, a supplemental nonqualified retirement plan? ........

Yes

Participate in, or receive payment from, an equity-based compensation arrangement? ........

If "Yes" to any of lines 4a-c, list the persons and provide the applicable amounts for each item in Part III.

Only 501(c)(3) and 501(c)(4) organizations only must complete lines 5-9.

For persons listed in form 990, Part VII, Section A, line 1a, did the organization pay or accrue any
compensation contingent on the revenues of:

The organization? ...........................

Any related organization? .........................

If "Yes," to line 5a or 5b, describe in Part III.

For persons listed in form 990, Part VII, Section A, line 1a, did the organization pay or accrue any
compensation contingent on the net earnings of:

The organization? ...........................

Any related organization? .........................

If "Yes," to line 6a or 6b, describe in Part III.

For persons listed in Form 990, Part VII, Section A, line 1a, did the organization provide any non-fixed
payments not described in lines 5 and 6? If "Yes," describe in Part III ............

Were any amounts reported in Form 990, Part VII, paid or accured pursuant to a contract that was
subject to the initial contract exception described in Regs. section 53.4958-4(a)(3)? If "Yes," describe
in Part III .............................

If "Yes" to line 8, did the organization also follow the rebuttable presumption procedure described in Regulations section 53.4958-6(c)? .........................

For Privacy Act and Paperwork Reduction Act Notice, see the Intructions for Form 990

Cat. No. 50053T

Schedule J (Form 990) 2010

Page 2

Part II

Officers, Directors, Trustees, Key Employees, and Highest Compensated Employees. Use Schedule J-1 if additional space needed.

For each individual whose compensation must be reported in Schedule J, report compensation from the organization on row (i) and from related organizations, described in the
instructions on row (ii). Do not list any individuals that are not listed on Form 990, Part VII.

Note. The sum of columns (B)(i)-(iii) must equal the applicable column (D) or column (E) amounts on Form 990, Part VII, line 1a.

(A) Name		(B) Breakdown of W-2 and/or 1099-MISC compensation			(C) Retirement and other deferred compensation	(D) Nontaxable benefits	(E) Total of columns (B)(i)-(D)	(F) Compensation reported in prior Form 990 or Form 990-EZ
(A) Name		(i) Base compensation	(ii) Bonus & incentive compensation	(iii) Other reportable compensation	(C) Retirement and other deferred compensation	(D) Nontaxable benefits	(E) Total of columns (B)(i)-(D)
(1) ROBERT H BEZANSON	(i) (ii)	0 615,229	0 0	0 183,005	0 165,983	0 11,746	0 975,963	157,147
(2) STEVE EDWARDS	(i) (ii)	0 430,955	0 0	0 7,473	0 89,940	0 13,136	0 541,504
(3) JACOB MCWAY	(i) (ii)	0 336,651	0 0	0 64,018	0 83,890	0 13,111	0 497,670	41,228
(4) RICHARD W KISSELL MD	(i) (ii)	0 170,039	0 0	0 1,980	0 9,026	0 11,805	0 192,850
(5) LAURIE DUFF	(i) (ii)	0 152,787	0 0	0 690	0 7,851	0 9,503	0 170,831
(6) GREG D JOHNSON	(i) (ii)	0 143,508	0 0	0 1,992	0 7,104	0 9,688	0 162,292
(7) RYAN MILLER	(i) (ii)	144,138 0	0 0	259 0	7,377 0	8,282 0	160,056 0

Schedule J (Form 990) 2010

Page 3

Part III

Supplemental Information

Complete this part to provide the information, explanation, or descriptions required for Part I, lines 1a, 1b, 4c, 5a, 5b, 6a, 6b, 7, and 8. Also complete this part for any additional information.

Identifier	Return Reference	Explanation
SUPPLEMENTAL NONQUALIFIED RETIREMENT PLAN	SCHEDULE J, PART I, LINE 4B	ROBERT BEZANSON, STEVE EDWARDS, AND JACOB MCWAY PARTICIPATE IN A 457(F) NONQUALIFIED RETIREMENT PLAN THROUGH LESTER E. COX MEDICAL CENTERS. - ROBERT BEZANSON RECEIVED AN EXECUTIVE 457(F) CONTRIBUTION OF $153,733 - ROBERT BEZANSON RECEIVED A 457(F) DISTRIBUTION OF $157,147, WHICH WAS REPORTED AS DEFERRED COMPENSATION ON A PRIOR FORM 990. - STEVE EDWARDS RECEIVED AN EXECUTIVE 457(F) CONTRIBUTION OF $ 77,690 - JACOB MCWAY RECEIVED AN EXECUTIVE 457(F) CONTRIBUTION OF $71,640 - JACOB MCWAY RECEIVED A 457(F) DISTRIBUTION OF $ 41,228, WHICH WAS REPORTED AS DEFERRED COMPENSATION ON A PRIOR FORM 990.
BOARD MEMBER COMPENSATION	SCHEDULE J, PART II; AND FORM 990, PART VII	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.
COMPENSATION REPORTED IN PRIOR FORM 990	SCHEDULE J, PART II, COLUMN F	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.

Schedule J (Form 990) 2010

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE O
(Form 990 or 990-EZ)

Department of the Treasury
Internal Revenue Service

Supplemental Information to Form 990 or 990-EZ

Complete to provide information for responses to specific questions on
Form 990 or to provide any additional information.
MediumBullet

Attach to Form 990 or 990-EZ.

OMB No. 1545-0047

2010

Open to Public
Inspection

Name of the organization

COX-MONETT HOSPITAL INC

Employer identification number

43-1656689

Identifier	Return Reference	Explanation
TOTAL NUMBER OF VOLUNTEERS	FORM 990, PART I, LINE 6	THE TOTAL NUMBER OF VOLUNTEERS INCLUDES NON-COMPENSATED MEMBERS OF THE BOARD OF DIRECTORS.
EXEMPT PURPOSE ACHIEVEMENTS	FORM 990, PART III, LINE 4D	COX-MONETT HOSPITAL EMBRACES A MISSION STATEMENT AND BY-LAWS THAT REFLECT A COMMITMENT TO CHARITABLE PURPOSE AND COMMUNITY BENEFIT. COX-MONETT PROVIDES MANY SERVICES TO THE COMMUNITY FREE OF CHARGE OR WITH LITTLE FINANCIAL GAIN. OUR GOAL IS TO KEEP OUR COMMUNITY HEALTHY. THE FOLLOWING IS A LIST OF SERVICES PROVIDED TO THE MONETT COMMUNITY DURING THE FISCAL YEAR ENDING SEPTEMBER 30, 2011. ADDITIONALLY, THE SUBSIDIES NOTED BELOW ARE CALCULATED USING INTERNAL COST ACCOUNTING METHODS RATHER THAN THE IRS WORKSHEETS FOR SCHEDULE H. SEE SCHEDULE H FOR THE COMPUTATION OF THESE SUBSIDIES USING THE SCHEDULE H WORKSHEETS. PARTICIPATED IN THE MEDICAID PROGRAM WITH UNREIMBURSED COST OF CARING FOR PATIENTS AND PROVIDED CHARITY CARE AND OTHER UNCOMPENSATED CARE SERVICES. SEE SCHEDULE H FOR AMOUNTS RELATED TO THESE SERVICES. WORKED WITH THE CHILDREN'S MIRACLE NETWORK OF COXHEALTH TO PROVIDE IMMUNIZATIONS AND PRIMARY CARE SERVICES TO CHILDREN THROUGH THE C.A.R.E. MOBILE. THE MOBILE CLINIC VISITS COX MONETT ONE DAY A WEEK AND PARENTS WHO TAKE ADVANTAGE OF THIS FREE SERVICE DO NOT HAVE ACCESS TO CARE OR TRANSPORTATION. THE MOBILE PEDIATRIC CLINIC SEES AN AVERAGE OF 25-30 PATIENTS PER DAY IN MONETT. RENDERED HEALTH CARE SERVICES AND EDUCATIONAL SERVICES THAT ARE SPECIFICALLY DESIGNED TO IMPROVE COMMUNITY HEALTH ARE AS FOLLOWS: -COMMUNITY WELLNESS SERVICES. -TUITION REIMBURSEMENT FOR STAFF WANTING TO CONTINUE THEIR EDUCATION. ENCOURAGE AND PROVIDE OPPORTUNITIES FOR VOLUNTEER EFFORTS TO SERVE IN THE COMMUNITY. MANY EMPLOYEES SERVE ON LOCAL NOT-FOR-PROFIT BOARDS AND ARE INVOLVED IN VARIOUS COMMUNITY ORGANIZATIONS AND ARE ASKED OFTEN TO SPEAK ON HEALTH-RELATED TOPICS. OPERATE 24-HOUR EMERGENCY CENTER. ER VISITS TOTALED 14,167. PROVIDE MANY COMMUNITY HEALTH AND EDUCATION PROGRAMS AND PROJECT SPECIFICALLY DESIGNED TO IMPROVE THE HEALTH STATUS OF OUR COMMUNITY AT NO CHARGE OR AT A REDUCED RATE. -FREE DIABETES SCREENINGS/EDUCATION EVENTS (ALSO FOR HISPANIC COMMUNITY). -FREE ADVANCE DIRECTIVES CLINIC -FLU SHOTS FOR SENIORS, BUSINESSES AND COMMUNITY (DRIVE-THROUGH CLINIC) -MAMMOGRAPHY -CHOLESTEROL, BLOOD SUGAR AND BLOOD PRESSURE SCREENINGS -COMMUNITY HEALTH FAIR -OB CLASSES (PARENTS, SIBLINGS AND NEW PARENTS) -BREASTFEEDING/CHILDBIRTH CLASSES -PROVIDE SPACE IN HOSPITAL AT NO CHARGE FOR LOCAL SUPPORT GROUPS TO MEET (BREAST CANCER AND PARKINSON'S). IN FISCAL YEAR 2011, BIRTHS TOTALED 282. COMBINED RADIOLOGY TESTS TOTALED 16,078, INPATIENT AND OUTPATIENT SURGERIES TOTALED 1,111. THE HOSPITAL OWNS AND OPERATES A RURAL HEALTH CLINIC IN CASSVILLE AND PHYSICIAN OFFICE VISITS TOTALED 14,047 AND THEY ALSO SPONSOR A YEARLY FREE HEALTH FAIR. ALL RADIOLOGICAL SERVICES TOTALED 3,403. CASSVILLE REHAB HAD 3,331 VISITS AND PROCEDURES PERFORMED.
MEMBERS AND SHAREHOLDERS	FORM 990, PART VI, SECTION A, LINES 6, 7A & 7B	PER ARTICLE 1, SECTION 1 OF THE ORGANIZATION'S BYLAWS, THE BOARD OF DIRECTORS SHALL CONSIST OF THE LESTER E. COX MEDICAL CENTERS EXECUTIVE COMMITTEE, PLUS THE PRESIDENT AND CHIEF EXECUTIVE OFFICER, AND DIRECTORS SHALL BE CHOSEN BY THE EXECUTIVE COMMITTEE OF COX HEALTH SYSTEMS. ARTICLE 10 GIVES THE ORGANIZATION'S SOLE MEMBER, LESTER E. COX MEDICAL CENTERS, APPROVAL POWER OVER ANY AMENDMENTS TO THE CORPORATION'S BYLAWS AND/OR ARTICLES OF INCORPORATION, AND ANY ACTION THAT WOULD CAUSE A MERGER, CONSOLIDATION, OR VOLUNTARY DISSOLUTION OF THE CORPORATION.
MEETING DOCUMENTATION	FORM 990, PART VI, SECTION A, LINE 8B	THE ORGANIZATION'S GOVERNING BODY DOES NOT HAVE ANY COMMITTEES WITH THE AUTHORITY TO ACT ON BEHALF OF THE GOVERNING BODY.
990 REVIEW POLICY	FORM 990, PART VI, SECTION B, LINE 11B	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 PROVIDED TO THE BOARD OF DIRECTORS THROUGH THE ONLINE BOARD PORTAL.
CONFLICT OF INTEREST POLICY	FORM 990, PART VI, SECTION B, LINE 12C	COXHEALTH OFFICERS, DIRECTORS AND KEY EMPLOYEES, AS WELL AS OFFICERS, DIRECTORS, AND KEY EMPLOYEES OF THE COXHEALTH AFFILIATES, ARE ANNUALLY REQUIRED TO DISCLOSE POTENTIAL CONFLICTS OF INTEREST FOLLOWING THE CORPORATE COMPLIANCE POLICY, AS STATED BELOW: 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 EXECUTIVE OFFICE AND IS DEFINED IN THE BOARD BYLAWS. FOR VENDORS, THE POLICY IS DISTRIBUTED AT THEIR FIRST CONTRACT WITH COXHEALTH.
PRESIDENT'S COMPENSATION REVIEW	FORM 990, PART VI, LINE 15A	THE PRESIDENT'S COMPENSATION IS PERIODICALLY REVIEWED BY AN INDEPENDENT CONSULTANT USING COMPARABILITY DATA. THE CONSULTANT'S RECOMMENDATIONS ARE PRESENTED TO AND DISCUSSED WITH THE BOARD OF DIRECTORS. THIS REVIEW IS DOCUMENTED IN BOARD MINUTES.
DOCUMENT DISCLOSURE	FORM 990, PART VI, LINE 19	GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY AND FINANCIAL STATEMENTS ARE MADE AVAILABLE UPON WRITTEN REQUEST FOR A LEGITIMATE BUSINESS PURPOSE (AS DETERMINED BY TOP MANAGEMENT). APPROVED DOCUMENTS CAN BE VIEWED AT THE COX-MONETT HOSPITAL ADMINISTRATIVE OFFICES.
HOURS FOR RELATED ORGANIZATIONS	FORM 990, PART VII, SECTION A, COLUMN B	THE FOLLOWING DIRECTORS SERVE ON THE BOARD OF COXHEALTH FOUNDATION, A RELATED ORGANIZATION, AND AVERAGE ONE HOUR OF SERVICE PER WEEK: JOSEPH TURNER LARRY LIPSCOMB THE FOLLOWING OFFICERS AND DIRECTORS SERVE ON THE BOARD OF COXHEALTH AUXILIARY, A RELATED ORGANIZATION, AND AVERAGE ONE HOUR OF SERVICE PER WEEK: LAURIE DUFF JANICE HARRIS ROBERT BEZANSON THE FOLLOWING OFFICERS AND DIRECTORS SERVE ON THE BOARDS OF COX ALTERNATIVE CARE OF THE OZARKS, INC., COXHEALTH HOME CARE SERVICES OF THE MIDWEST, INC., HEALTHCARE SERVICES OF THE OZARKS, INC., COX HPS OF THE OZARKS, INC., EACH A RELATED ORGANIZATION. EACH INDIVIDUAL AVERAGES ONE HOUR OF SERVICE PER WEEK FOR EACH ORGANIZATION: LOREN BROADDUS JACOB MCWAY DONA ELKINS LARRY LIPSCOMB GRANT HADEN STEVE EDWARDS DENNIS HEIM JOSEPH TURNER JAMES HUTCHESON JANICE HARRIS JERRY JARED RONALD PONDS RICHARD KISSELL CHARLES CHALENDER JOHN SQUIRES DAVID ZOLFAGHARI ROBERT BEZANSON LAURIE DUFF (OFFICER ONLY) THE FOLLOWING OFFICERS AND DIRECTORS SERVE ON THE BOARD OF PRIMROSE PLACE, INC., A RELATED ORGANIZATION, AND AVERAGE ONE HOUR OF SERVICE PER WEEK: ROBERT BEZANSON STEVE EDWARDS JACOB MCWAY JERRY JARED LAURIE DUFF (OFFICER ONLY) THE FOLLOWING OFFICERS AND DIRECTORS SERVE ON THE BOARDS OF LESTER E. COX MEDICAL CENTERS, A RELATED ORGANIZATION. EACH DIRECTOR AVERAGES ONE HOUR OF SERVICE PER WEEK AND EACH OFFICER AVERAGES 40 HOURS OF SERVICE PER WEEK: DIRECTORS --------------------------------- LOREN BROADDUS LARRY LIPSCOMB DONA ELKINS GRANT HADEN DENNIS HEIM JAMES HUTCHESON JERRY JARED RICHARD KISSELL (AVERAGES 40 HRS AS A PHYSICIAN) JOHN SQUIRES DAVID ZOLFAGHARI CHARLES CHALENDER RONALD PONDS JANICE HARRIS JOSEPH TURNER OFFICERS --------------------------------- ROBERT BEZANSON STEVE EDWARDS JACOB MCWAY LAURIE DUFF

For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.

Cat. No. 51056K

Schedule O (Form 990 or 990-EZ) 2010

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE R
(Form 990)

Department of the Treasury
Internal Revenue Service

Related Organizations and Unrelated Partnerships

Complete if the organization answered "Yes" to Form 990, Part IV, line 33, 34, 35, 36, or 37.
MediumBullet

Attach to Form 990. MediumBullet

See separate instructions.

OMB No. 1545-0047

2010

Open to Public Inspection

Name of the organization

COX-MONETT HOSPITAL INC

Employer identification number

43-1656689

Part I

Identification of Disregarded Entities (Complete if the organization answered "Yes" on Form 990, Part IV, line 33.)

(a) Name, address, and EIN of disregarded entity	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Total income	(e) End-of-year assets	(f) Direct controlling entity

Part II

Identification of Related Tax-Exempt Organizations (Complete if the organization answered "Yes" on Form 990, Part IV, line 34 because it had one or more related tax-exempt organizations during the tax year.)

(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Exempt Code section	(e) Public charity status (if section 501(c)(3))	(f) Direct controlling entity	(g) Section 512(b)(13) controlled organization
(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Exempt Code section	(e) Public charity status (if section 501(c)(3))	(f) Direct controlling entity	Yes	No
(1) LESTER E COX MEDICAL CENTERS 1423 N JEFFERSON ST SPRINGFIELD,MO65802 44-0577118	HOSPITAL	MO	501(C)(3)	3	NA
(2) COX ALTERNATIVE CARE OF THE OZARKS INC PO BOX 10939 SPRINGFIELD,MO65808 43-1641925	HOME HEALTH	MO	501(C)(3)	9	NA
(3) COXHEALTH FOUNDATION 3525 S NATIONAL SUITE 204 SPRINGFIELD,MO65807 43-6810485	FUNDRAISING	MO	501(C)(3)	11A I	NA
(4) COXHEALTH HME CRE SVCS OF THE MDWST INC 3850 S NATIONAL SPRINGFIELD,MO65807 26-4781194	HOME HEALTH	MO	501(C)(3)	9	NA
(5) COX HPS OF THE OZARKS INC 2220 W SUNSET SPRINGFIELD,MO65807 43-1641927	HOME HEALTH	MO	501(C)(3)	9	NA
(6) COX-MONETT HOSPITAL AUXILIARY 801 N LINCOLN AVE MONETT,MO65708 43-1852817	FUNDRAISING	MO	501(C)(3)	9	NA
(7) HEALTH ENRICHMENT SERVICES INC 3801 S NATIONAL SPRINGFIELD,MO65807 36-3263313	MED SVC	MO	501(C)(3)	7	NA
(8) HEALTHCARE SERVICES OF THE OZARKS INC PO BOX 10939 SPRINGFIELD,MO65808 43-1641928	HOME HEALTH	MO	501(C)(3)	9	NA
(9) PRIMROSE PLACE INC 1115 E PRIMROSE SPRINGFIELD,MO65807 43-1183783	NURSING HOME	MO	501(C)(3)	11A I	NA
(10) COXHEALTH AUXILIARY 3801 S NATIONAL SPRINGFIELD,MO65807 43-1090590	SUPPORT	MO	501(C)(3)	9	NA
(11) COX MEDICAL CTR GENPROF LIAB LOSS FUND 1423 N JEFFERSON SPRINGFIELD,MO65802 36-6668576	SELF-INSURAN	MO	501(C)(3)	11A I	NA

For Privacy Act and Paperwork Reduction Act Notice, see the Instructions for Form 990.

Cat. No. 50135Y

Schedule R (Form 990) 2010

Page 2

Part III

Identification of Related Organizations Taxable as a Partnership (Complete if the organization answered "Yes" on Form 990, Part IV, line 34 because it had one or more related organizations treated as a partnership during the tax year.)

(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Direct controlling entity	(e) Predominant income(related, unrelated, excluded from tax under sections 512-514)	(f) Share of total income	(g) Share of end-of-year assets	(h) Disproprtionate allocations?		(i) Code VUBI amount in box 20 of Schedule K-1 (Form 1065)	(j) General or managing partner?
(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Direct controlling entity		(f) Share of total income	(g) Share of end-of-year assets	Yes	No	(i) Code VUBI amount in box 20 of Schedule K-1 (Form 1065)	Yes	No
(1) SKAGGS-COX HEALTH ALLIANCELLC SFD MO 65807 SPRINGFIELD,MO65807 27-1117343	HEALTHCARE	MO	NA	N/A
(2) PCRMC-COX HEALTH ALLIANCELLC SFD MO 65802 SPRINGFIELD,MO65802 30-0649009	HEALTHCARE	MO	NA	N/A

Part IV

Identification of Related Organizations Taxable as a Corporation or Trust (Complete if the organization answered "Yes" on Form 990, Part IV, line 34 because it had one or more related organizations treated as a corporation or trust during the tax year.)

(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Direct controlling entity	(e) Type of entity (C corp, S corp, or trust)
(1) COX HEALTH SYSTEMS HMO & SUBS PO BOX 5750 SPRINGFIELD,MO65801 43-1757075	HMO	MO	NA	C CORP
(2) COX HEALTH SYSTEMS INSURANCE COMPANY 3525 S NATIONAL SUITE 205 SPRINGFIELD,MO65807 43-1684044	INSURANCE	MO	NA	C CORP
(3) MEDICAL DEVELOPMENTS INC 1423 N JEFFERSON AVE SPRINGFIELD,MO65802 43-1622182	PHARMACY	MO	NA	C CORP
(4) INSURANCE COMPANY OF SPRINGFIELD INC GRAND PAVILION CORPORATE CENTRE GRAND CAYMAN, CJ KY1-1102 CJ	CAPTIVE INSUR	CJ	NA	C CORP

Schedule R (Form 990) 2010

Page 3

Part V

Transactions With Related Organizations (Complete if the organization answered "Yes" on Form 990, Part IV, line 34, 35, 35A, or 36.)

Note. Complete line 1 if any entity is listed in Parts II, III or IV.

Yes

1 During the tax year, did the orgranization engage in any of the following transactions with one or more related organizations listed in Parts II-IV?

a Receipt of (i) interest (ii) annuities (iii) royalties (iv) rent from a controlled entity . . . . . . . . . . . . . . . . . . . . . . .

b Gift, grant, or capital contribution to other organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

c Gift, grant, or capital contribution from other organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Yes

d Loans or loan guarantees to or for other organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

e Loans or loan guarantees by other organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

f Sale of assets to other organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

g Purchase of assets from other organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

h Exchange of assets . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

i Lease of facilities, equipment, or other assets to other organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Yes

j Lease of facilities, equipment, or other assets from other organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . .

k Performance of services or membership or fundraising solicitations for other organization(s) . . . . . . . . . . . . . . . . . . . . . .

Yes

l Performance of services or membership or fundraising solicitations by other organization(s) . . . . . . . . . . . . . . . . . . . . . .

Yes

m Sharing of facilities, equipment, mailing lists, or other assets . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Yes

n Sharing of paid employees . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Yes

o Reimbursement paid to other organization for expenses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Yes

p Reimbursement paid by other organization for expenses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Yes

q Other transfer of cash or property to other organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

r Other transfer of cash or property from other organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

If the answer to any of the above is "Yes," see the instructions for information on who must complete this line, including covered relationships and transaction thresholds.

(a) Name of other organization	(b) Transaction type(a-r)	(c) Amount involved	(d) Method of determining amount involved
(1)
(2)
(3)
(4)
(5)
(6)

Schedule R (Form 990) 2010

Page 4

Part VI

Unrelated Organizations Taxable as a Partnership (Complete if the organization answered "Yes" on Form 990, Part IV, line 37.)

Provide the following information for each entity taxed as a partnership through which the organization conducted more than five percent of its activities (measured by total assets or gross revenue) that was not a related organization. See instructions regarding exclusion for certain investment partnerships.

(a) Name, address, and EIN of entity	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Are all partners section 501(c)(3) organizations?		(e) Share of end-of-year assets	(f) Disproprtionate allocations?		(g) Code VUBI amount in box 20 of Schedule K-1 (Form 1065)	(h) General or managing partner?
(a) Name, address, and EIN of entity	(b) Primary activity	(c) Legal domicile (state or foreign country)	Yes	No	(e) Share of end-of-year assets	Yes	No	(g) Code VUBI amount in box 20 of Schedule K-1 (Form 1065)	Yes	No

Schedule R (Form 990) 2010

Page 5

Part VII

Supplemental Information

Complete this part to provide additional information for responses to questions on Schedule R (see instructions).

Identifier	Return Reference	Explanation

Additional Data

Software ID:
Software Version:

1	Briefly describe the organization’s mission or most significant activities: THE ORGANIZATION PROVIDES QUALITY HEALTH CARE, EDUCATION AND RESEARCH IN ORDER TO IMPROVE THE HEALTH OF THE COMMUNITIES IT SERVES.
2	Check this box
3	Number of voting members of the governing body (Part VI, line 1a) ....	3	16
4	Number of independent voting members of the governing body (Part VI, line 1b) ....	4	8
5	Total number of individuals employed in calendar year 2010 (Part V, line 2a) ...	5	354
6	Total number of volunteers (estimate if necessary) ....	6	18
7a	Total unrelated business revenue from Part VIII, column (C), line 12 ..	7a	211,156
b	Net unrelated business taxable income from Form 990-T, line 34 ..	7b	7,496

		Prior Year	Current Year
8	Contributions and grants (Part VIII, line 1h) .........	272,556	95,116
9	Program service revenue (Part VIII, line 2g) .........	34,018,683	34,286,626
10	Investment income (Part VIII, column (A), lines 3, 4, and 7d ) ....	26,096	3,458
11	Other revenue (Part VIII, column (A), lines 5, 6d, 8c, 9c, 10c, and 11e)	111,470	-30,939
12	Total revenue—add lines 8 through 11 (must equal Part VIII, column (A), line 12)...................	34,428,805	34,354,261
13	Grants and similar amounts paid (Part IX, column (A), lines 1–3 )...	70,417	103,225
14	Benefits paid to or for members (Part IX, column (A), line 4) ....	0	0
15	Salaries, other compensation, employee benefits (Part IX, column (A), lines 5–10)	17,538,983	16,980,936
16a	Professional fundraising fees (Part IX, column (A), line 11e)....	0	0
b	Total fundraising expenses (Part IX, column (D), line 25) 0
17	Other expenses (Part IX, column (A), lines 11a–11d, 11f–24f)....	17,477,533	17,767,052
18	Total expenses. Add lines 13–17 (must equal Part IX, column (A), line 25)	35,086,933	34,851,213
19	Revenue less expenses. Subtract line 18 from line 12......	-658,128	-496,952
		Beginning of Current Year	End of Year
20	Total assets (Part X, line 16)............	14,848,663	13,769,686
21	Total liabilities (Part X, line 26)............	8,736,947	8,154,922
22	Net assets or fund balances. Subtract line 21 from line 20 .....	6,111,716	5,614,764

Sign Here

	Signature of officer	Date

	Type or print name and title.

Paid Preparer's Use Only	Preparer's signature	Date	Check if self- employed	Preparer’s taxpayer identification number (see instructions)
	Firm’s name (or yours if self-employed), address, and ZIP + 4			EIN
				Phone no.


4a	(Code: ) (Expenses $ 13,782,736 including grants of $ ) (Revenue $ 15,928,795 )
	INPATIENT AND OUTPATIENT SERVICES PROVIDED AT THE MONETT FACILITY MAKE UP THE ORGANIZATION'S LARGEST PROGRAM SERVICE ACTIVITY. USERS ARE ABLE TO SAVE TIME AND MONEY BY SEEING SPECIALISTS IN THEIR COMMUNITY. SERVICES INCLUDE UROLOGY, ENT (EAR, NOSE & THROAT), PULMONOLOGY, ORTHOPEDICS, CARDIOLOGY, PODIATRY, OBSTETRICS, RADIOLOGY (CT, MRI, NUCLEAR MEDICINE & MAMMOGRAPHY), LABORATORY, 24-HOUR EMERGENCY CENTER, GENERAL SURGICAL SERVICES, SAME-DAY SURGERY, DIABETES CENTER, SLEEP CENTER, CARDIOPULMONARY REHAB, MEDICAL-SURGICAL UNIT, PHARMACY AND COMMUNITY WELLNESS.

4b	(Code: ) (Expenses $ 3,391,881 including grants of $ ) (Revenue $ 3,920,018 )
	SERVICES PROVIDED AT THE CASSVILLE CLINIC CREATE THE ORGANIZATION'S SECOND LARGEST PROGRAM SERVICE ACTIVITY. SERVICES INCLUDE FAMILY MEDICINE, LABORATORY, RADIOLOGY, (CT, MRI & MAMMOGRAPHY), AND REHAB SERVICES (PT, OT & SPEECH).

4c	(Code: ) (Expenses $ 1,079,500 including grants of $ ) (Revenue $ 1,247,585 )
	REHABILITATION SERVICES PROVIDED THROUGH COX-MONETT CREATE THE THIRD LARGEST PROGRAM SERVICE ACTIVITY. THE PHYSICIANS IN THIS PRACTICE ARE THE "EXPERTS IN HUMAN MOTION." SERVICES INCLUDE PHYSICAL THERAPY, OCCUPATIONAL THERAPY, SPEECH PATHOLOGY, ATHLETIC TRAINING AND SPORTS MEDICINE. WHETHER ONE IS SUFFERING FROM BACK PAIN OR RECOVERING FROM A TOTAL JOINT REPLACEMENT, THERE ARE SERVICES TO GET THE PATIENT BACK ON THEIR FEET QUICKLY.

4d	Other program services. (Describe in Schedule O.)
	(Expenses $ 11,230,423 including grants of $ 103,225 ) (Revenue $ 12,979,072 )
4e	Total program service expenses$ 29,484,540

(A) Name and Title	(B) Average hours per week (describe hours for related organizations in Schedule O)	(C) Position (check all that apply)			(D) Reportable compensation from the organization (W- 2/1099-MISC)	(E) Reportable compensation from related organizations (W- 2/1099-MISC)	(F) Estimated amount of other compensation from the organization and related organizations
(A) Name and Title
(18) CHARLES T CHALENDER DIRECTOR BEGINNING 11/2010	1.0	X			0	0	0
(19) LAURIE DUFF ASSISTANT SECRETARY	1.0		X		0	153,477	17,354
(20) MARTIN WILLIAMS CHIEF FINANCIAL OFFICER	40.0		X		96,004	0	13,770
(21) GREG D JOHNSON PRESIDENT/CEO ENDING 5/2011	50.0		X		0	145,500	16,792
(22) RYAN MILLER PHARMACIST	40.0			X	144,397	0	15,659
(23) JOSEPH BLAMEY DIRECTOR OF RADIOLOGY	40.0			X	102,126	0	15,660
(24) SANDRA JASTAL CHEIF NURSING OFFICER	40.0			X	102,798	0	11,339

1b	Sub-Total................
c	Total from continuation sheets to Part VII, Section A....
d	Total (add lines 1b and 1c)............	445,325	2,203,033	489,211

				(A) Total revenue	(B) Related or exempt function revenue	(C) Unrelated business revenue	(D) Revenue excluded from tax under sections 512, 513, or 514
1a	Federated campaigns..1a
b	Membership dues....1b
c	Fundraising events....1c
d	Related organizations...1d		75,695
e	Government grants (contributions)1e

f	All other contributions, gifts, grants, and similar amounts not included above1f		19,421
g	Noncash contributions included in lines 1a-1f:$ 5,507
h	Total. Add lines 1a-1f.......			95,116
			Business Code
2a	NET PATIENT SERVICE REVENUE		900,099	33,895,937	33,895,937
b	OTHER		900,099	75,183	75,183
c	RETAIL PHARMACY REVENUE		446,110	211,156		211,156
d	CAFETERIA REVENUE		722,210	104,350	104,350
e
f	All other program service revenue .
g	Total. Add lines 2a–2f........			34,286,626
3	Investment income (including dividends, interest
	and other similar amounts).....			3,158			3,158
4	Income from investment of tax-exempt bond proceeds..			0
5	Royalties............			0
		(i) Real	(ii) Personal
6a	Gross Rents	109,073
b	Less: rental expenses	140,012
c	Rental income or (loss)	-30,939
d	Net rental income or (loss).......			-30,939			-30,939
		(i) Securities	(ii) Other
7a	Gross amount from sales of assets other than inventory		300
b	Less: cost or other basis and sales expenses
c	Gain or (loss)		300
d	Net gain or (loss)..........			300			300
8a	Gross income from fundraising events (not including $ of contributions reported on line 1c). See Part IV, line 18 ...
	a
b	Less: direct expenses ...b
c	Net income or (loss) from fundraising events..			0
9a	Gross income from gaming activities. See Part IV, line 19 ...
	a
b	Less: direct expenses ...b
c	Net income or (loss) from gaming activities...			0
10a	Gross sales of inventory, less returns and allowances .
	a
b	Less: cost of goods sold ..b
c	Net income or (loss) from sales of inventory..			0
Miscellaneous Revenue			Business Code
11a
b
c
d	All other revenue ....
e	Total. Add lines 11a–11d ......			0
12	Total revenue. See Instructions....			34,354,261	34,075,470	211,156	-27,481


				(A) Beginning of year		(B) End of year
1	Cashnon-interest-bearing ..........			314,625	1	22,633
2	Savings and temporary cash investments .......			483,817	2	684,358
3	Pledges and grants receivable, net .........			560,106	3	415,472
4	Accounts receivable, net .........			3,560,548	4	3,569,477
5	Receivables from current and former officers, directors, trustees, key employees, and highest compensated employees. Complete Part II of
	Schedule L ..........				5
6	Receivables from other disqualified persons (as defined under section 4958(f)(1)) and persons described in section 4958(c)(3)(B). Complete Part II of
	Schedule L ..........				6
7	Notes and loans receivable, net .............				7
8	Inventories for sale or use ..............			344,648	8	346,743
9	Prepaid expenses and deferred charges ............			62,830	9	46,365
10a	Land, buildings, and equipment: cost or other basis. Complete Part VI of Schedule D	10a	23,212,831
b	Less: accumulated depreciation. .....	10b	14,658,473	9,446,482	10c	8,554,358
11	Investments—publicly traded securities ..........				11
12	Investments—other securities. See Part IV, line 11 ......				12
13	Investments—program-related. See Part IV, line 11 ..				13
14	Intangible assets .........				14
15	Other assets. See Part IV, line 11 ...........			75,607	15	130,280
16	Total assets. Add lines 1 through 15 (must equal line 34)...			14,848,663	16	13,769,686
17	Accounts payable and accrued expenses .			2,112,181	17	1,783,683
18	Grants payable ..........				18
19	Deferred revenue ..........				19
20	Tax-exempt bond liabilities ..........				20
21	Escrow or custodial account liability. Complete Part IV of Schedule D..				21
22	Payables to current and former officers, directors, trustees, key employees, highest compensated employees, and disqualified
	persons. Complete Part II of Schedule L..........				22
23	Secured mortgages and notes payable to unrelated third parties ..			150,467	23	101,921
24	Unsecured notes and loans payable to unrelated third parties ....				24
25	Other liabilities. Complete Part X of Schedule D.....			6,474,299	25	6,269,318
26	Total liabilities. Add lines 17 through 25.....			8,736,947	26	8,154,922
	Organizations that follow SFAS 117, check here and complete lines 27 through 29, and lines 33 and 34.
27	Unrestricted net assets .....			5,512,856	27	5,136,716
28	Temporarily restricted net assets .....			598,860	28	478,048
29	Permanently restricted net assets .....				29
	Organizations that do not follow SFAS 117, check here and complete lines 30 through 34.
30	Capital stock or trust principal, or current funds .....				30
31	Paid-in or capital surplus, or land, building or equipment fund .....				31
32	Retained earnings, endowment, accumulated income, or other funds				32
33	Total net assets or fund balances .....			6,111,716	33	5,614,764
34	Total liabilities and net assets/fund balances .....			14,848,663	34	13,769,686