Form990
Click to see attachment
Department of the Treasury
Internal Revenue Service
Return of Organization Exempt From Income Tax
Under section 501(c), 527, or 4947(a)(1) of the Internal Revenue Code (except black lung benefit trust or private foundation)

MediumBullet The organization may have to use a copy of this return to satisfy state reporting requirements.
OMB No. 1545-0047
2011
Open to Public Inspection
A For the calendar year, or tax year beginning 05-01-2011 and ending 04-30-2012
BCheck if applicable:
CName of organization
SKAGGS COMMUNITY HOSPITAL ASSOCIATION
 
Doing Business As
SKAGGS REGIONAL MEDICAL CENTER
 
Number and street (or P.O. box if mail is not delivered to street address)
251 SKAGGS ROAD
 
Room/suite
City or town, state or country, and ZIP + 4
BRANSON, MO65615
D Employer identification number

44-0584290
E Telephone number

G Gross receipts $ 185,238,539
F Name and address of principal officer:
MR WILLIAM MAHONEY
251 SKAGGS ROAD
BRANSON,MO65615
I
Tax-exempt status: (   ) LeftBullet (insert no.) or
J
Website:MediumBullet
WWW.SKAGGS.NET
H(a)
Is this a group return for
affiliates?
H(b)
Are all affiliates included?
If "No," attach a list. (see instructions)
H(c)
Group exemption number MediumBullet  
K Form of organization:
 
L Year of formation: 1950
M State of legal domicile: MO
Part I
Summary
Activities & Governance 1 Briefly describe the organization’s mission or most significant activities: THE HOSPITAL IMPROVES YOUR LIFE VIA EDUCATION, PREVENTION, AND ADVO- CACY; BY THE USE OF TECHNOLOGY; AND BY PROVIDING COMFORT AND PRIVACY WHILE PRESERVING DIGNITY. SEE SCHEDULE O FOR ADDITIONAL INFORMATION.
2 Check this box MediumBullet
3 Number of voting members of the governing body (Part VI, line 1a)..... 3 13
4 Number of independent voting members of the governing body (Part VI, line 1b) .... 4 9
5 Total number of individuals employed in calendar year 2011 (Part V, line 2a) ... 5 1,429
6 Total number of volunteers (estimate if necessary) .... 6 326
7a Total unrelated business revenue from Part VIII, column (C), line 12 .. 7a 9,000
b Net unrelated business taxable income from Form 990-T, line 34 .. 7b -22,476
Revenues; Prior Year Current Year
8 Contributions and grants (Part VIII, line 1h) ......... 815,832 587,515
9 Program service revenue (Part VIII, line 2g) ......... 180,655,469 181,820,734
10 Investment income (Part VIII, column (A), lines 3, 4, and 7d ) .... 275,234 422,840
11 Other revenue (Part VIII, column (A), lines 5, 6d, 8c, 9c, 10c, and 11e) 1,199,821 1,158,507
12 Total revenue—add lines 8 through 11 (must equal Part VIII, column (A), line 12)................... 182,946,356 183,989,596
Expenses; 13 Grants and similar amounts paid (Part IX, column (A), lines 1–3 )... 140,014 385,787
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) 70,944,852 67,610,329
16a Professional fundraising fees (Part IX, column (A), line 11e)..... 0 0
b Total fundraising expenses (Part IX, column (D), line 25) MediumBullet0    
17 Other expenses (Part IX, column (A), lines 11a–11d, 11f–24f).... 112,538,923 115,478,413
18 Total expenses. Add lines 13–17 (must equal Part IX, column (A), line 25) 183,623,789 183,474,529
19 Revenue less expenses. Subtract line 18 from line 12....... -677,433 515,067
Net Assets or Fund Balances; Beginning of Current Year End of Year
20 Total assets (Part X, line 16)............. 113,507,476 108,670,196
21 Total liabilities (Part X, line 26)............. 63,197,947 58,180,699
22 Net assets or fund balances. Subtract line 21 from line 20..... 50,309,529 50,489,497
Part II
Signature Block
Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief, it is true, correct, and complete. Declaration of preparer (other than officer) is based on all information of which preparer has any knowledge.
Sign Here
JumboBullet
Signature of officer Date
JumboBullet
Type or print name and title.
Paid preparer use only
Print/type preparer's name
 
Preparer's signature
Date
PTIN
Firm's name Right pointing arrowhead image

Firm's EIN Right pointing arrowhead image
Firm's address Right pointing arrowhead image



Phone no.
May the IRS discuss this return with the preparer shown above? See instructions .........bullet
For Paperwork Reduction Act Notice, see the separate instructions.
Cat. No. 11282Y
Form 990 (2011)
Form 990 (2011)
Page 2
Part III
Statement of Program Service Accomplishments
Check if Schedule O contains a response to any question in this Part III .........
1
Briefly describe the organization’s mission: THE MISSION OF SKAGGS COMMUNITY HOSPITAL ASSOCIATION IS IMPROVING YOUR LIFE THROUGH MEDICAL, HEALTH AND WELLNESS SERVICES.
2
Did the organization undertake any significant program services during the year which were not listed on
the prior Form 990 or 990-EZ? ....................
If “Yes,” describe these new services on Schedule O.
3
Did the organization cease conducting, or make significant changes in how it conducts, any program services? ..........................
If “Yes,” describe these changes on Schedule O.
4
Describe the organization’s program service accomplishments for each of its three largest program services, as measured by expenses. Section 501(c)(3) and 501(c)(4) organizations and section 4947(a)(1) trusts are required to report the amount of grants and allocations to others, the total expenses, and revenue, if any, for each program service reported.
4a (Code:   ) (Expenses $ 126,668,164 including grants of $ 149,818 ) (Revenue $ 153,412,912 )
HOSPITAL SERVICES - FOR THE FYE 4/30/2012 SKAGGS REGIONAL MEDICAL CENTER EXPERIENCED A 10.4 PERCENT DECREASE IN PATIENT ADMISSIONS FOR A TOTAL OF 6,366. OUTPATIENT VISITS SAW A 4.0 PERCENT DECLINE FOR A TOTAL OF 89,769 OUTPATIENT VISITS. THE EMERGENCY ROOM HAD A 4.7 PERCENT DECLINE IN VISITS FOR A TOTAL OF 38,503 VISITS. SEE SCHEDULE O FOR ADDITIONAL INFORMATION.
4b (Code:   ) (Expenses $ 33,368,699 including grants of $   ) (Revenue $ 26,601,804 )
CLINIC SERVICES - FYE 4/30/2012 SAW A 23.7 PERCENT DECREASE IN CLINIC VISITS WITH 101,443 VISITS FOR THE FISCAL YEAR. SKAGGS CLINICS HAVE FOCUSED ATTENTION TO INITIATIVES IN FISCAL YEAR 2012 THAT INCLUDED INCREASING FAMILY MEDICINE AVAILABILITY, EXPANDING OB-GYN SERVICES AT SKAGGS HEALTHCARE-248 FACILITY, WORKING IN COLLABORATION WITH SKAGGS MEDICAL HOME AND STRENGTHENING THE AREA OF ELECTRONIC MEDICAL RECORDS THROUGH MEANINGFUL USE AND COMPUTERIZED PHYSICIAN ORDER ENTRY (CPOE) AT CLINICS. SEE SCHEDULE O FOR ADDITIONAL INFORMATION.
4c (Code:   ) (Expenses $ 2,025,783 including grants of $ 80,819 ) (Revenue $ 1,797,018 )
HOME HEALTH SERVICES - FOR THE FYE 4/30/2012 THERE WERE 9,407 VISITS WHICH WAS A 9.5 PERCENT DECREASE OVER THE PRIOR YEAR. SKAGGS HOME HEALTH SERVICES INCLUDE SKILLED NURSING, PHYSICAL THERAPY, OCCUPATIONAL THERAPY, MEDICAL SOCIAL SERVICE, PERSONAL CARE ASSISTANCE, NUTRITIONAL CONSULTATION, AND RESPIRATORY CONSULTATION. SEE SCHEDULE O FOR ADDITIONAL INFORMATION.
4d Other program services (Describe in Schedule O.)
(Expenses $   including grants of $   ) (Revenue $   )
4e Total program service expensesMediumBullet$ 162,062,646
Form 990 (2011)
Form 990 (2011)
Page 3
Part IV
Checklist of Required Schedules
Yes
No
1
Is the organization described in section 501(c)(3) or 4947(a)(1) (other than a private foundation)? If “Yes,” complete Schedule AClick to see attachment.....................
1
Yes
 
2
Is the organization required to complete Schedule B, Schedule of Contributors? Click to see attachment........
2
Yes
 
3
Did the organization engage in direct or indirect political campaign activities on behalf of or in opposition to candidates for public office? If “Yes,” complete Schedule C, Part IClick to see attachment..........
3
 
No
4
Section 501(c)(3) organizations. Did the organization engage in lobbying activities? If “Yes,” complete Schedule C,
Part IIClick to see attachment.........................
4
Yes
 
5
Is the organization a section 501(c)(4), 501(c)(5), or 501(c)(6) organization that receives membership dues, assessments, or similar amounts as defined in Revenue Procedure 98-19? If “Yes,” complete Schedule C, Part IIIClick to see attachment........................
5
 
No
6
Did the organization maintain any donor advised funds or any similar funds or accounts for which donors have the right to provide advice on the distribution or investment of amounts in such funds or accounts? If “Yes,” complete Schedule D, Part IClick to see attachment....................
6
 
No
7
Did the organization receive or hold a conservation easement, including easements to preserve open space,
the environment, historic land areas or historic structures? If “Yes,” complete Schedule D, Part IIClick to see attachment...
7
 
No
8
Did the organization maintain collections of works of art, historical treasures, or other similar assets? If “Yes,” complete Schedule D, Part III Click to see attachment....................
8
 
No
9
Did the organization report an amount in Part X, line 21; serve as a custodian for amounts not listed in Part X; or provide credit counseling, debt management, credit repair, or debt negotiation services? If “Yes,”
complete Schedule D, Part IVClick to see attachment...................
9
 
No
10
Did the organization, directly or through a related organization, hold assets in temporarily restricted endowments, permanent endowments, or quasi-endowments? If “Yes,” complete Schedule D, Part VClick to see attachment
10
 
No
11
If the organization’s answer to any of the following questions is ‘Yes,’ then complete Schedule D, Parts VI, VII, VIII, IX, or X as applicable:
a
Did the organization report an amount for land, buildings, and equipment in Part X, line10? If “Yes,” complete Schedule D, Part VI.Click to see attachment
11a
Yes
 
b
Did the organization report an amount for investments—other securities in Part X, line 12 that is 5% or more of its total assets reported in Part X, line 16? If “Yes,” complete Schedule D, Part VII.Click to see attachment
11b
Yes
 
c
Did the organization report an amount for investments—program related in Part X, line 13 that is 5% or more of its total assets reported in Part X, line 16? If “Yes,” complete Schedule D, Part VIII.Click to see attachment
11c
 
No
d
Did the organization report an amount for other assets in Part X, line 15 that is 5% or more of its total assets reported in Part X, line 16? If “Yes,” complete Schedule D, Part IX.Click to see attachment
11d
 
No
e
Did the organization report an amount for other liabilities in Part X, line 25? If “Yes,” complete Schedule D, Part X.Click to see attachment
11e
 
No
f
Did the organization’s separate or consolidated financial statements for the tax year include a footnote that addresses the organization’s liability for uncertain tax positions under FIN 48 (ASC 740)? If “Yes,” complete Schedule D, Part X.Click to see attachment
11f
 
No
12a
Did the organization obtain separate, independent audited financial statements for the tax year?
If “Yes,” complete Schedule D, Parts XI, XII, and XIII Click to see attachment
12a
 
No
b
Was the organization included in consolidated, independent audited financial statements for the tax year? If “Yes,” and if the organization answered ‘No’ to line 12a, then completing Schedule D, Parts XI, XII, and XIII is optional Click to see attachment
12b
Yes
 
13
Is the organization a school described in section 170(b)(1)(A)(ii)? If “Yes,” complete Schedule E
13
 
No
14a
Did the organization maintain an office, employees, or agents outside of the United States?....
14a
 
No
b
Did the organization have aggregate revenues or expenses of more than $10,000 from grantmaking, fundraising, business, investment, and program service activities outside the United States or aggregate foreign investments valued at $100,000 or more? If “Yes,” complete Schedule F, Part I.........
14b
 
No
15
Did the organization report on Part IX, column (A), line 3, more than $5,000 of grants or assistance to any organization or entity located outside the U.S.? If “Yes,” complete Schedule F, Part II..
15
 
No
16
Did the organization report on Part IX, column (A), line 3, more than $5,000 of aggregate grants or assistance to individuals located outside the U.S.? If “Yes,” complete Schedule F, Part III..
16
 
No
17
Did the organization report a total of more than $15,000, of expenses for professional fundraising services on Part IX, column (A), lines 6 and 11e? If “Yes,” complete Schedule G, Part I
17
 
No
18
Did the organization report more than $15,000 total of fundraising event gross income and contributions on Part VIII, lines 1c and 8a? If “Yes,” complete Schedule G, Part II..........
18
 
No
19
Did the organization report more than $15,000 of gross income from gaming activities on Part VIII, line 9a? If “Yes,” complete Schedule G, Part III...................
19
 
No
20a
Did the organization operate one or more hospitals? If “Yes,” complete Schedule H..... Click to see attachment
20a
Yes
 
b
If “Yes” to line 20a, did the organization attach a copy of its audited financial statement to this return? Note. All Form 990 filers that operated one or more hospitals must attach audited financial statements. Click to see attachment
20b
Yes
 
Form 990 (2011)
Form 990 (2011)
Page 4
Part IV
Checklist of Required Schedules (continued)
21
Did the organization report more than $5,000 of grants and other assistance to any government or organization in the United States on Part IX, column (A), line 1? If “Yes,” complete Schedule I, Parts I and II.. Click to see attachment
21
Yes
 
22
Did the organization report more than $5,000 of grants and other assistance to individuals in the United States on Part IX, column (A), line 2? If “Yes,” complete Schedule I, Parts I and III..... Click to see attachment
22
Yes
 
23
Did the organization answer “Yes” to Part VII, Section A, questions 3, 4, or 5, about compensation of the organization’s current and former officers, directors, trustees, key employees, and highest compensated employees? If “Yes,” complete Schedule J................ Click to see attachment
23
Yes
 
24a
Did the organization have a tax-exempt bond issue with an outstanding principal amount of more than $100,000 as of the last day of the year, that was issued after December 31, 2002? If “Yes,” answer questions 24b–24d and complete Schedule K. If “No,” go to line 25................ Click to see attachment
24a
Yes
 
b
Did the organization invest any proceeds of tax-exempt bonds beyond a temporary period exception?...
24b
 
No
c
Did the organization maintain an escrow account other than a refunding escrow at any time during the year
to defease any tax-exempt bonds?......................
24c
 
No
d
Did the organization act as an “on behalf of” issuer for bonds outstanding at any time during the year?...
24d
 
No
25a
Section 501(c)(3) and 501(c)(4) organizations. Did the organization engage in an excess benefit transaction with a disqualified person during the year? If “Yes,” complete Schedule L, Part I...... Click to see attachment
25a
 
No
b
Is the organization aware that it engaged in an excess benefit transaction with a disqualified person in a prior year, and that the transaction has not been reported on any of the organization’s prior Forms 990 or 990-EZ? If “Yes,” complete Schedule L, Part I................ Click to see attachment
25b
 
No
26
Was a loan to or by a current or former officer, director, trustee, key employee, highly compensated employee, or disqualified person outstanding as of the end of the organization’s tax year? If “Yes,” complete Schedule L,
Part II......................... Click to see attachment
26
Yes
 
27
Did the organization provide a grant or other assistance to an officer, director, trustee, key employee, substantial contributor or employee thereof, a grant selection committee member, or to a 35% controlled entity or family member of any of these persons? If “Yes,” complete Schedule L, Part III......... Click to see attachment
27
 
No
28
Was the organization a party to a business transaction with one of the following parties? (see Schedule L, Part IV instructions for applicable filing thresholds, conditions, and exceptions):
a
A current or former officer, director, trustee, or key employee? If “Yes,” complete Schedule L, Part IV ......................... Click to see attachment
28a
 
No
b
A family member of a current or former officer, director, trustee, or key employee? If “Yes,”
complete Schedule L, Part IV................... Click to see attachment
28b
Yes
 
c
An entity of which a current or former officer, director, trustee, or key employee (or a family member thereof) was an officer, director, trustee, or owner? If “Yes,” complete Schedule L, Part IV.. Click to see attachment
28c
Yes
 
29
Did the organization receive more than $25,000 in non-cash contributions? If “Yes,” complete Schedule M
29
 
No
30
Did the organization receive contributions of art, historical treasures, or other similar assets, or qualified conservation contributions? If “Yes,” complete Schedule M............
30
 
No
31
Did the organization liquidate, terminate, or dissolve and cease operations? If “Yes,” complete Schedule N,
Part I...........................
31
 
No
32
Did the organization sell, exchange, dispose of, or transfer more than 25% of its net assets? If “Yes,” complete Schedule N, Part II.......................
32
 
No
33
Did the organization own 100% of an entity disregarded as separate from the organization under Regulations sections 301.7701-2 and 301.7701-3? If “Yes,” complete Schedule R, Part I........ Click to see attachment
33
Yes
 
34
Was the organization related to any tax-exempt or taxable entity? If “Yes,” complete Schedule R, Parts II, III, IV, and V, line 1..................... Click to see attachment
34
Yes
 
35a
Did the organization have a controlled entity within the meaning of section 512(b)(13)?
35a
Yes
 
b
If ‘Yes’ to line 35a, did the organization receive any payment from or engage in any transaction with a controlled entity within the meaning of section 512(b)(13)? If “Yes,” complete Schedule R, Part V, line 2... Click to see attachment
35b
Yes
 
36
Section 501(c)(3) organizations. Did the organization make any transfers to an exempt non-charitable related organization? If “Yes,” complete Schedule R, Part V, line 2........... Click to see attachment
36
 
No
37
Did the organization conduct more than 5% of its activities through an entity that is not a related organization and that is treated as a partnership for federal income tax purposes? If “Yes,” complete Schedule R, Part VIClick to see attachment
37
 
No
38
Did the organization complete Schedule O and provide explanations in Schedule O for Part VI, lines 11 and 19? Note. All Form 990 filers are required to complete Schedule O. ............
38
Yes
 
Form 990 (2011)
Form 990 (2011)
Page 5
Part V
Statements Regarding Other IRS Filings and Tax Compliance
Check if Schedule O contains a response to any question in this Part V .........
Yes
No
1a
Enter the number reported in Box 3 of Form 1096. Enter -0- if not applicable. .......
1a
161
b
Enter the number of Forms W-2G included in line 1a. Enter -0- if not applicable.
1b
0
c
Did the organization comply with backup withholding rules for reportable payments to vendors and reportable gaming (gambling) winnings to prize winners? ..................
1c
Yes
 
2a
Enter the number of employees reported on Form W-3, Transmittal of Wage and Tax Statements filed for the calendar year ending with or within the year covered by this return .....................
2a
1,429
b
If at least one is reported on line 2a, did the organization file all required federal employment tax returns?

Note. If the sum of lines 1a and 2a is greater than 250, you may be required to e-file. (see instructions)
2b
Yes
 
3a
Did the organization have unrelated business gross income of $1,000 or more during the year?.............................
3a
Yes
 
b
If “Yes,” has it filed a Form 990-T for this year? If “No,” provide an explanation in Schedule O.....
3b
Yes
 
4a
At any time during the calendar year, did the organization have an interest in, or a signature or other authority over, a financial account in a foreign country (such as a bank account or securities account)?.......................
4a
 
No
b
If "Yes," enter the name of the foreign country: MediumBullet
See instructions for filing requirements for Form TD F 90-22.1, Report of Foreign Bank and Financial Accounts.
5a
Was the organization a party to a prohibited tax shelter transaction at any time during the tax year?..
5a
 
No
b
Did any taxable party notify the organization that it was or is a party to a prohibited tax shelter transaction?
5b
 
No
c
If “Yes” to line 5a or 5b, did the organization file Form 8886-T? ........
5c
 
 
6a
Does the organization have annual gross receipts that are normally greater than $100,000, and did the organization solicit any contributions that were not tax deductible?..........
6a
 
No
b
If “Yes,” did the organization include with every solicitation an express statement that such contributions or gifts were not tax deductible?........................
6b
 
 
7
Organizations that may receive deductible contributions under section 170(c).
a
Did the organization receive a payment in excess of $75 made partly as a contribution and partly for goods and services provided to the payor?....................
7a
 
No
b
If “Yes,” did the organization notify the donor of the value of the goods or services provided?.....
7b
 
 
c
Did the organization sell, exchange, or otherwise dispose of tangible personal property for which it was required to file Form 8282?...........................
7c
 
No
d
If “Yes,” indicate the number of Forms 8282 filed during the year ....
7d
 
e
Did the organization receive any funds, directly or indirectly, to pay premiums on a personal benefit contract?..........................
7e
 
No
f
Did the organization, during the year, pay premiums, directly or indirectly, on a personal benefit contract?..
7f
 
No
g
If the organization received a contribution of qualified intellectual property, did the organization file Form 8899 as required?...................
7g
 
 
h
If the organization received a contribution of cars, boats, airplanes, or other vehicles, did the organization file a Form 1098-C?...............
7h
 
 
8
Sponsoring organizations maintaining donor advised funds and section 509(a)(3) supporting organizations. Did the supporting organization, or a donor advised fund maintained by a sponsoring organization, have excess business holdings at any time during the year?................
8
 
 
9
Sponsoring organizations maintaining donor advised funds.
a
Did the organization make any taxable distributions under section 4966?.........
9a
 
 
b
Did the organization make a distribution to a donor, donor advisor, or related person?......
9b
 
 
10
Section 501(c)(7) organizations. Enter:
a
Initiation fees and capital contributions included on Part VIII, line 12 ...
10a
 
b
Gross receipts, included on Form 990, Part VIII, line 12, for public use of club facilities
10b
 
11
Section 501(c)(12) organizations. Enter:
a
Gross income from members or shareholders .........
11a
 
b
Gross income from other sources (Do not net amounts due or paid to other sources against amounts due or received from them) ........
11b
 
12a
Section 4947(a)(1) non-exempt charitable trusts. Is the organization filing Form 990 in lieu of Form 1041?
12a
 
 
b
If “Yes,” enter the amount of tax-exempt interest received or accrued during the year.
12b
 
13
Section 501(c)(29) qualified nonprofit health insurance issuers.
a
Is the organization licensed to issue qualified health plans in more than one state?
Note. All 501(c)(29) organizations must list in Schedule O each state in which they are licensed to issue qualified health plans, the amount of reserves required by each state, and the amount of reserves the organization allocated to each state.
13a
 
 
b
Enter the aggregate amount of reserves the organization is required to maintain by the states in which the organization is licensed to issue qualified health plans.
13b
 
c
Enter the aggregate amount of reserves on hand.
13c
 
14a
Did the organization receive any payments for indoor tanning services during the tax year?.....
14a
 
 
b
If "Yes," has it filed a Form 720 to report these payments? If “No,” provide an explanation in Schedule O..
14b
 
 
Form 990 (2011)
Form 990 (2011)
Page 6
Part VI
Governance, Management, and Disclosure For each “Yes” response to lines 2 through 7b below, and for a “No” response to lines 8a, 8b, or 10b below, describe the circumstances, processes, or changes in Schedule O. See instructions.
Check if Schedule O contains a response to any question in this Part VI .........
Section A. Governing Body and Management
Yes
No
1a
Enter the number of voting members of the governing body at the end of the tax year
If the governing body delegated broad authority to an executive committee or similar committee, explain in Schedule O.
1a
13
b
Enter the number of voting members included in line 1a, above, who are independent .................
1b
9
2
Did any officer, director, trustee, or key employee have a family relationship or a business relationship with any other officer, director, trustee, or key employee? .................
2
 
No
3
Did the organization delegate control over management duties customarily performed by or under the direct supervision of officers, directors or trustees, or key employees to a management company or other person? .
3
 
No
4
Did the organization make any significant changes to its governing documents since the prior Form 990 was filed?
4
Yes
 
5
Did the organization become aware during the year of a significant diversion of the organization’s assets? .
5
 
No
6
Did the organization have members or stockholders? ................
6
Yes
 
7a
Did the organization have members, stockholders, or other persons who had the power to elect or appoint one or more members of the governing body? .................
7a
Yes
 
b
Are any governance decisions of the organization reserved to (or subject to approval by) members, stockholders, or persons other than the governing body? ............
7b
 
No
8
Did the organization contemporaneously document the meetings held or written actions undertaken during the year by the following:
a
The governing body? .........................
8a
Yes
 
b
Each committee with authority to act on behalf of the governing body? ..........
8b
Yes
 
9
Is there any officer, director, trustee, or key employee listed in Part VII, Section A, who cannot be reached at the organization’s mailing address? If “Yes,” provide the names and addresses in Schedule O .....
9
 
No
Section B. Policies (This Section B requests information about policies not required by the Internal
Revenue Code.)
Yes
No
10a
Did the organization have local chapters, branches, or affiliates? ............
10a
 
No
b
If “Yes,” did the organization have written policies and procedures governing the activities of such chapters, affiliates, and branches to ensure their operations are consistent with the organization's exempt purposes? ....
10b
 
 
11a
Has the organization provided a complete copy of this Form 990 to all members of its governing body before filing the form?
11a
Yes
 
b
Describe in Schedule O the process, if any, used by the organization to review the Form 990. .....
12a
Did the organization have a written conflict of interest policy? If “No,” go to line 13.......
12a
Yes
 
b
Were officers, directors or trustees, and key employees required to disclose annually interests that could give rise to conflicts? ........................
12b
Yes
 
c
Did the organization regularly and consistently monitor and enforce compliance with the policy? If “Yes,” describe in Schedule O how this was done ....................
12c
Yes
 
13
Did the organization have a written whistleblower policy? ...............
13
Yes
 
14
Did the organization have a written document retention and destruction policy? .........
14
Yes
 
15
Did the process for determining compensation of the following persons include a review and approval by independent persons, comparability data, and contemporaneous substantiation of the deliberation and decision?
a
The organization’s CEO, Executive Director, or top management official ...........
15a
Yes
 
b
Other officers or key employees of the organization ................
15b
Yes
 
If "Yes," to line 15a or 15b, describe the process in Schedule O (see instructions).
16a
Did the organization invest in, contribute assets to, or participate in a joint venture or similar arrangement with a taxable entity during the year? ......................
16a
Yes
 
b
If “Yes,” did the organization follow a written policy or procedure requiring the organization to evaluate its participation in joint venture arrangements under applicable federal tax law, and take steps to safeguard the organization’s exempt status with respect to such arrangements? ............
16b
 
No
Section C. Disclosure
17
List the States with which a copy of this Form 990 is required to be filedMediumBullet
18
Section 6104 requires an organization to make its Form 1023 (or 1024 if applicable), 990, and 990-T (501(c)(3)s only) available for public inspection. Indicate how you made these available. Check all that apply.
19
Describe in Schedule O whether (and if so, how), the organization made its governing documents, conflict of interest policy, and financial statements available to the public during the tax year.
20
State the name, physical address, and telephone number of the person who possesses the books and records of the organization: MediumBullet
DAVID STRONG
251 SKAGGS ROAD
BRANSON,MO65615
(417) 335-7789
Form 990 (2011)
Form 990 (2011)
Page 7
Part VII
Compensation of Officers, Directors,Trustees, Key Employees, Highest Compensated Employees, and Independent Contractors
Check if Schedule O contains a response to any question in this Part VII .........
Section A. Officers, Directors, Trustees, Key Employees, and Highest Compensated Employees
1a Complete this table for all persons required to be listed. Report compensation for the calendar year ending with or within the organization’s tax year.
RoundBullet List all of the organization’s current officers, directors, trustees (whether individuals or organizations), regardless of amount
of compensation, and current key employees. Enter -0- in columns (D), (E), and (F) if no compensation was paid.

RoundBullet List all of the organization’s current key employees, if any. See instructions for definition of "key employee."
RoundBullet List the organization’s five current highest compensated employees (other than an officer, director, trustee or key employee)
who received reportable compensation (Box 5 of Form W-2 and/or Box 7 of Form 1099-MISC) of more than $100,000 from the
organization and any related organizations.

RoundBullet List all of the organization’s former officers, key employees, or highest compensated employees who received more than $100,000
of reportable compensation from the organization and any related organizations.

RoundBullet List all of the organization’s former directors or trustees that received, in the capacity as a former director or trustee of the
organization, more than $10,000 of reportable compensation from the organization and any related organizations.

List persons in the following order: individual trustees or directors; institutional trustees; officers; key employees; highest
compensated employees; and former such persons.
Check this box if neither the organization nor any related organizations compensated any current or former officer, director, or trustee.
(A)
Name and Title 		(B)
Average hours per week (describe hours for related organizations in Schedule O) 		(C)
Position (do not check more than one box, unless person is both an officer and a director/trustee) 		(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
Individual Trustee or Director; Institutional Trustee; Officer; Key Employee; Highest compensated employee; Former;
(1) PHIL LOYD
SECRETARY
 3.0 X   X       0 0 0
(2) DENNIS NEWKIRK
TREASURER THROUGH 07/2011, DIR
 3.0 X   X       0 0 0
(3) DAVID SMITH
CHAIRMAN
 3.0 X   X       0 0 0
(4) BOB SIMMONS
DIRECTOR
 3.0 X           0 0 0
(5) JOHN ANGLUM
DIRECTOR THROUGH 08/2011
 3.0 X           0 0 0
(6) RAEANNE PRESLEY
DIRECTOR
 3.0 X           0 0 0
(7) JIM KANEASTER
VICE CHAIRMAN
 3.0 X   X       0 0 0
(8) LYNN ALLISON MD
DIRECTOR
 3.0 X           0 0 0
(9) JAMES BERRY
DIRECTOR
 3.0 X           0 0 0
(10) JANICE WILLIAMS
DIRECTOR
 3.0 X           0 0 0
(11) LARRY SCHMITT
TREASURER BEG. 08/2011
 3.0 X   X       0 0 0
(12) TONY WHEELER
DIRECTOR
 3.0 X           0 0 0
(13) RICHARD BLUBAUGH
DIRECTOR BEG. 08/2011
 3.0 X           0 0 0
(14) BOB MCDOWELL
DIRECTOR BEG. 08/2011
 3.0 X           0 0 0
(15) WILLIAM MAHONEY
CEO
 40.0     X       358,414 0 29,061
(16) DAVID STRONG
CFO
 40.0     X       206,102 0 27,781
(17) DIANE CORNELISON DO
PHYSICIAN
 40.0         X   539,133 0 24,409
Form 990 (2011)
Form 990 (2011)
Page 8
Part VII
Section A. Officers, Directors, Trustees, Key Employees, and Highest Compensated Employees (continued)
(A)
Name and Title 		(B)
Average hours per week (describe hours for related organizations in Schedule O) 		(C)
Position (do not check more than one box, unless person is both an officer and a director/trustee) 		(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
Individual Trustee or Director; Institutional Trustee; Officer; Key Employee; Highest compensated employee; Former;
(18) NARIN ARUNAKUL MD
PHYSICIAN
 40.0         X   871,341 0 31,852
(19) MITTIE M DRAGOSLJVICH MD
PHYSICIAN
 40.0         X   933,184 0 50,986
(20) JOHN W HUFFMAN DO
PHYSICIAN
 40.0         X   563,198 0 34,846
(21) CHRIS R REEVES DO
PHYSICIAN
 40.0         X   631,404 0 41,568
(22) PETER MARCELLUS MD
FORMER DIR. MEDICAL AFFAIRS
             X 220,003 0 27,950
















1b Sub-Total................MediumBullet
c Total from continuation sheets to Part VII, Section A....MediumBullet
d Total (add lines 1b and 1c)............MediumBullet 4,322,779 0 268,453
2
Total number of individuals (including but not limited to those listed above) who received more than $100,000 of reportable compensation from the organizationMediumBullet64
Yes
No
3
Did the organization list any former officer, director or trustee, key employee, or highest compensated employee on line 1a? If “Yes,” complete Schedule J for such individual .............
3
Yes
 
4
For any individual listed on line 1a, is the sum of reportable compensation and other compensation from the organization and related organizations greater than $150,000? If “Yes,” complete Schedule J for such individual...........................
4
Yes
 
5
Did any person listed on line 1a receive or accrue compensation from any unrelated organization or individual for services rendered to the organization? If “Yes,” complete Schedule J for such person .....
5
 
No
Section B. Independent Contractors
1
Complete this table for your five highest compensated independent contractors that received more than $100,000 of compensation from the organization. Report compensation for the calendar year ending with or within the organization’s tax year.
(A)
Name and business address 		(B)
Description of services 		(C)
Compensation
CORNERSTONE PHYSICIANS
 
  		CONTRACT PHYSICIANS 5,108,388
WHITE RIVER ANESTHESIA ASSOCIATION
 
  		CONTRACT PHYSICIANS 1,273,672
NUCLEAR DIAGNOSIS INC
 
  		NUC MED STUDIES 921,695
SOUND PHYSICIANS
 
  		HOSPITALIST SERVICES 560,128
PROVIDER SOLUTIONS LLC
 
  		CONTRACT PHYSICIANS 1,503,381
2
Total number of independent contractors (including but not limited to those listed above) who received more than $100,000 of compensation from the organization MediumBullet60
Form 990 (2011)
Form 990 (2011)
Page 9
Part VIII
Statement of Revenue
(A)
Total revenue 		(B)
Related or
exempt
function
revenue 		(C)
Unrelated
business
revenue 		(D)
Revenue
excluded from
tax under sections
512, 513, or 514
Contributions, Gifts, Grants and Other Similar Amounts 1a Federated campaigns..1a  
b Membership dues....1b  
c Fundraising events....1c  
d Related organizations...1d 221,137
e Government grants (contributions)1e 41,101
f All other contributions, gifts, grants, and
similar amounts not included above1f 		325,277
g Noncash contributions included in lines 1a-1f:$  
h Total. Add lines 1a-1f.......MediumBullet 587,515
Program Service Revenue Business Code
2a PATIENT SERVICES 624,100 178,100,762 178,100,762    
b CAFETERIA 722,210 757,558 757,558    
c GIFT SHOP 453,220 185,709 185,709    
d MANAGEMENT FEES 561,000 464,270 464,270    
e OTHER 900,099 2,312,435 2,303,435 9,000  
f All other program service revenue .        
g Total. Add lines 2a–2f........MediumBullet 181,820,734
Other Revenue 3 Investment income (including dividends, interest
and other similar amounts).....MediumBullet 323,544     323,544
4 Income from investment of tax-exempt bond proceeds..MediumBullet 0      
5 Royalties............MediumBullet 0      
(i) Real (ii) Personal
6a Gross rents 1,273,937  
b Less: rental expenses 148,079  
c Rental income or (loss) 1,125,858  
d Net rental income or (loss).......MediumBullet 1,125,858     1,125,858
(i) Securities (ii) Other
7a Gross amount from sales of assets other than inventory 1,179,071 21,089
b Less: cost or other basis and sales expenses 1,087,701 13,163
c Gain or (loss) 91,370 7,926
d Net gain or (loss)..........MediumBullet 99,296     99,296
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..MediumBullet 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...MediumBullet 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..MediumBullet 0      
Miscellaneous Revenue Business Code
11a INCOME FROM EQUITY INVESTEE 900,099 32,649     32,649
b            
c            
d All other revenue ....        
e Total. Add lines 11a–11d ......MediumBullet 32,649
12 Total revenue. See Instructions....MediumBullet 183,989,596 181,811,734 9,000 1,581,347
Form 990 (2011)
Form 990 (2011)
Page 10
Part IX
Statement of Functional Expenses
Section 501(c)(3) and 501(c)(4) organizations must complete all columns. All other organizations must complete column (A) but are not required to complete columns (B), (C), and (D).
Check if Schedule O contains a response to any question in this Part IX. .........
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 United States. See Part IV, line 21 304,968 304,968
2 Grants and other assistance to individuals in the United States. See Part IV, line 22 80,819 80,819
3 Grants and other assistance to governments, organizations, and individuals outside the United States. 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 .... 741,585   741,585  
6 Compensation not included above, to disqualified persons (as defined under section 4958(f)(1)) and persons described in section 4958(c)(3)(B) .... 284,802 284,802    
7 Other salaries and wages 55,547,051 48,835,839 6,711,212  
8 Pension plan accruals and contributions (include section 401(k) and 403(b) employer contributions) .... 1,231,122 1,099,639 131,483  
9 Other employee benefits ....... 5,824,150 5,218,170 605,980  
10 Payroll taxes ........... 3,981,619 3,493,272 488,347  
11 Fees for services (non-employees):        
a Management ...... 0      
b Legal ......... 60,840   60,840  
c Accounting ........... 181,759   181,759  
d Lobbying ........... 0      
e Professional fundraising. See Part IV, line 17.. 0  
f Investment management fees ...... 0      
g Other .......... 27,822,406 20,703,127 7,119,279  
12 Advertising and promotion .... 557,839 25,566 532,273  
13 Office expenses ....... 4,337,525 2,804,258 1,533,267  
14 Information technology ...... 49,439   49,439  
15 Royalties .. 0      
16 Occupancy ........... 4,196,467 3,595,430 601,037  
17 Travel ............ 125,496 96,126 29,370  
18 Payments of travel or entertainment expenses for any federal, state, or local public officials ...... 0      
19 Conferences, conventions, and meetings .... 358,724 201,198 157,526  
20 Interest ........... 2,359,232 2,138,788 220,444  
21 Payments to affiliates ....... 0      
22 Depreciation, depletion, and amortization ..... 9,161,919 8,305,838 856,081  
23 Insurance .............. 2,243,077 1,121,445 1,121,632  
24 Other expenses. Itemize expenses not covered above (List miscellaneous expenses in line 24f. If line 24f amount exceeds 10% of line 25, column (A) amount, list line 24f expenses on Schedule O.)
a BAD DEBT 33,428,840 33,428,840    
b LICENSES, DUES & SUBSCRIPTIONS 324,378 149,842 174,536  
c MEDICAL SUPPLIES & DRUGS 22,898,616 22,898,616    
d PROVIDER TAX 7,055,509 7,055,509    
e
f All other expenses 316,347 220,554 95,793  
25 Total functional expenses. Add lines 1 through 24f 183,474,529 162,062,646 21,411,883 0
26 Joint costs. Complete this line only if the organization reported in column (B) joint costs from a combined educational campaign and fundraising solicitation. Check here MediumBullet if following SOP 98-2 (ASC 958-720).        
Form 990 (2011)
Form 990 (2011)
Page 11
Part X Balance Sheet
(A)
Beginning of year 		(B)
End of year
Assets 1 Cash—non-interest-bearing .......... 1,320,177 1 1,833,191
2 Savings and temporary cash investments ....... 19,307,649 2 18,200,476
3 Pledges and grants receivable, net ......... 0 3 0
4 Accounts receivable, net ......... 18,827,506 4 16,689,828
5 Receivables from current and former officers, directors, trustees, key employees, and highest compensated employees. Complete Part II of
Schedule L .......... 189,333 5 130,750
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 .......... 0 6 0
7 Notes and loans receivable, net ............. 0 7 0
8 Inventories for sale or use .............. 2,224,258 8 2,387,964
9 Prepaid expenses and deferred charges ............ 2,062,302 9 2,112,085
10a Land, buildings, and equipment: cost or other basis. Complete Part VI of Schedule D 10a 154,485,778
b Less: accumulated depreciation. ..... 10b 109,851,192 49,238,005 10c 44,634,586
11 Investments—publicly traded securities .......... 11,130,143 11 11,226,233
12 Investments—other securities. See Part IV, line 11 ...... 7,723,830 12 7,729,508
13 Investments—program-related. See Part IV, line 11 .. 0 13 0
14 Intangible assets ......... 119,865 14 6,552
15 Other assets. See Part IV, line 11 ........... 1,364,408 15 3,719,023
16 Total assets. Add lines 1 through 15 (must equal line 34)... 113,507,476 16 108,670,196
Liabilities 17 Accounts payable and accrued expenses . 14,511,610 17 11,562,941
18 Grants payable .......... 0 18 0
19 Deferred revenue .......... 0 19 0
20 Tax-exempt bond liabilities .......... 37,120,000 20 35,845,000
21 Escrow or custodial account liability. Complete Part IV of Schedule D.. 0 21 0
22 Payables to current and former officers, directors, trustees, key
employees, highest compensated employees, and disqualified
persons. Complete Part II of Schedule L.......... 0 22 0
23 Secured mortgages and notes payable to unrelated third parties .. 11,566,337 23 10,772,758
24 Unsecured notes and loans payable to unrelated third parties .... 0 24 0
25 Other liabilities (including federal income tax, payables to related third parties, and other liabilities not included on lines 17-24). Complete Part X of Schedule D..... 0 25 0
26 Total liabilities. Add lines 17 through 25..... 63,197,947 26 58,180,699
Net Assets or Fund Balance Organizations that follow SFAS 117, check here MediumBullet and complete lines 27 through 29, and lines 33 and 34.
27 Unrestricted net assets ..... 42,898,017 27 43,207,357
28 Temporarily restricted net assets ..... 0 28 0
29 Permanently restricted net assets ..... 7,411,512 29 7,282,140
Organizations that do not follow SFAS 117, check here MediumBullet 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 ..... 50,309,529 33 50,489,497
34 Total liabilities and net assets/fund balances ..... 113,507,476 34 108,670,196
Form 990 (2011)
Form 990 (2011)
Page 12
Part XI
Reconcilliation of Net Assets
Check if Schedule O contains a response to any question in this Part XI .........
1
Total revenue (must equal Part VIII, column (A), line 12) ...
1
183,989,596
2
Total expenses (must equal Part IX, column (A), line 25) ....
2
183,474,529
3
Revenue less expenses. Subtract line 2 from line 1 ...
3
515,067
4
Net assets or fund balances at beginning of year (must equal Part X, line 33, column (A)) ..
4
50,309,529
5
Other changes in net assets or fund balances (explain in Schedule O) ...
5
-335,099
6
Net assets or fund balances at end of year. Combine lines 3, 4, and 5 (must equal Part X, line 33, column (B)) ....
6
50,489,497
Part XII
Financial Statements and Reporting
Check if Schedule O contains a response to any question in this Part XII .........
Yes
No
1
Accounting method used to prepare the Form 990:  
If the organization changed its method of accounting from a prior year or checked "Other," explain in
Schedule O.
2a
Were the organization’s financial statements compiled or reviewed by an independent accountant?....
2a
 
No
b
Were the organization’s financial statements audited by an independent accountant?........
2b
Yes
 
c
If “Yes,” to 2a or 2b, does the organization have a committee that assumes responsibility for oversight of the audit, review, or compilation of its financial statements and selection of an independent accountant? If the organization changed either its oversight process or selection process during the tax year, explain in Schedule O. ...........................
2c
Yes
 
d
If “Yes” to line 2a or 2b, check a box below to indicate whether the financial statements for the year were issued on a separate basis, consolidated basis, or both:
3a
As a result of a federal award, was the organization required to undergo an audit or audits as set forth in the Single Audit Act and OMB Circular A-133? ................
3a
 
No
b
If “Yes,” did the organization undergo the required audit or audits? If the organization did not undergo the required audit or audits, explain why in Schedule O and describe any steps taken to undergo such audits. ..
3b
 
 
Form 990 (2011)
Additional Data


Software ID:  
Software Version:  
Form 990, Special Condition Description:
Special Condition Description
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.
right arrow Attach to Form 990 or Form 990-EZ. right arrow See separate instructions.
OMB No. 1545-0047
2011
Open to Public
Inspection
Name of the organization
SKAGGS COMMUNITY HOSPITAL ASSOCIATION
 
Employer identification number

44-0584290
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.)
1
2
3
4
5
section 170(b)(1)(A)(iv). (Complete Part II.)
6
7
8
9
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.)
10
11
e
f
g
(i) a person who directly or indirectly controls, either alone or together with persons described in (ii)
Yes
No
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)
 
 
h
(i)
Name of supported organization 		(ii)
EIN 		(iii)
Type of organization (described on lines 1- 9 above or IRC section (see instructions)) 		(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?
Yes No Yes No Yes No
Total                  

For Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 11285F
Schedule A (Form 990 or 990-EZ) 2011
Schedule A (Form 990 or 990-EZ) 2011
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) 2007 (b) 2008 (c) 2009 (d) 2010 (e) 2011 (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) 2007 (b) 2008 (c) 2009 (d) 2010 (e) 2011 (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).            
12
12
 
13
Section C. Computation of Public Support Percentage
14
14
 
15
15
 
16a
b
17a
b
18
Schedule A (Form 990 or 990-EZ) 2011
Schedule A (Form 990 or 990-EZ) 2011
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) 2007 (b) 2008 (c) 2009 (d) 2010 (e) 2011 (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) 2007 (b) 2008 (c) 2009 (d) 2010 (e) 2011 (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.).            
14
Section C. Computation of Public Support Percentage
15
15
 
16
16
 
Section D. Computation of Investment Income Percentage
17
17
 
18
18
 
19a
b
20
Schedule A (Form 990 or 990-EZ) 2011
Schedule A (Form 990 or 990-EZ) 2011
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) 2011

Additional Data


Software ID:  
Software Version:  
Schedule B
(Form 990, 990-EZ,
or 990-PF)
Department of the Treasury
Internal Revenue Service
Schedule of Contributors
Arrow Bullet Attach to Form 990, 990-EZ, or 990-PF.
OMB No. 1545-0047
2011
Name of organization
SKAGGS COMMUNITY HOSPITAL ASSOCIATION
 
Employer identification number

44-0584290
Organization type (check one):
Filers of:
Section:
Form 990 or 990-EZ





Form 990-PF




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
Special Rules
......................... 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 on line H of its
Form 990-EZ or on Part I, 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) (2011)

Page 2
Schedule B (Form 990, 990-EZ, or 990-PF) (2011)
Name of organization
SKAGGS COMMUNITY HOSPITAL ASSOCIATION
  		Employer identification number

44-0584290
Part I
Contributors (see Instructions). Use duplicate copies of Part I if additional space is needed.
     
(a)
No.		 (b)
Name, address, and ZIP + 4		 (c)
Total contributions		 (d)
Type of contribution
RESTRICTED
RESTRICTED
 

     
RESTRICTED
RESTRICTED  
RESTRICTED, RESTRICTED   RESTRICTED

$RESTRICTED




(Complete Part II if there is a noncash contribution.)
(a)
No.		 (b)
Name, address, and ZIP + 4		 (c)
Total contributions		 (d)
Type of contribution
 
 
 

     
 
   

$  




(Complete Part II if there is a noncash contribution.)
(a)
No.		 (b)
Name, address, and ZIP + 4		 (c)
Total contributions		 (d)
Type of contribution
 
 
 

     
 
   

$  




(Complete Part II if there is a noncash contribution.)
(a)
No.		 (b)
Name, address, and ZIP + 4		 (c)
Total contributions		 (d)
Type of contribution
 
 
 

     
 
   

$  




(Complete Part II if there is a noncash contribution.)
(a)
No.		 (b)
Name, address, and ZIP + 4		 (c)
Total contributions		 (d)
Type of contribution
 
 
 

     
 
   

$  




(Complete Part II if there is a noncash contribution.)
(a)
No.		 (b)
Name, address, and ZIP + 4		 (c)
Total contributions		 (d)
Type of contribution
 
 
 

     
 
   

$  




(Complete Part II if there is a noncash contribution.)
Schedule B (Form 990, 990-EZ, or 990-PF) (2011)

Page 3
Schedule B (Form 990, 990-EZ, or 990-PF) (2011)
Name of organization
SKAGGS COMMUNITY HOSPITAL ASSOCIATION
  		Employer identification number

44-0584290
Part II
Noncash Property (see Instructions). Use duplicate copies of Part II if additional space is needed.
     
(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) (2011)

Page 4
Schedule B (Form 990, 990-EZ, or 990-PF) (2011)
Name of organization
SKAGGS COMMUNITY HOSPITAL ASSOCIATION
  		Employer identification number

44-0584290
Part III
Exclusively religious, charitable, etc., individual contributions to section 501(c)(7), (8), or (10) organizations
that total 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 $  
Use duplicate copies of Part III if additional space is needed
(a) No.
from
Part I		 (b)
Purpose of gift		 (c)
Use 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		 (c)
Use 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		 (c)
Use 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		 (c)
Use 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) (2011)

Additional Data


Software ID:  
Software Version:  
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
2011
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, line 35c (Proxy Tax), then
Round Bullet Section 501(c)(4), (5), or (6) organizations: Complete Part III.
Name of the organization
SKAGGS COMMUNITY HOSPITAL ASSOCIATION
 
Employer identification number

44-0584290
Part I-A
Complete if the organization is exempt under section 501(c) or is a section 527 organization.

1
Provide a description of the organization’s direct and indirect political campaign activities in Part IV.
2
Political expenditures ....................................SchCMd Bullet
$  
3
Volunteer hours ........................................
 

Part I-B
Complete if the organization is exempt under section 501(c)(3).
1
Enter the amount of any excise tax incurred by the organization under section 4955 .........SchCMd Bullet
$  
2
Enter the amount of any excise tax incurred by organization managers under section 4955 ......SchCMd Bullet
$  
3
If the organization incurred a section 4955 tax, did it file Form 4720 for this year? ..............
4a
Was a correction made? .........................................
b
If "Yes," describe in Part IV.
Part I-C
Complete if the organization is exempt under section 501(c) except section 501(c)(3).
1
Enter the amount directly expended by the filing organization for section 527 exempt function activities SchCMd Bullet
$  
2
Enter the amount of the filing organization's funds contributed to other organizations for section 527 exempt function activities ...................................SchCMd Bullet

$  
3
Total exempt function expenditures. Add lines 1 and 2. Enter here and on Form 1120-POL, line 17b..SchCMd Bullet

$  
4
Did the filing organization file Form 1120-POL for this year? ..........................
5
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) 2011

Schedule C (Form 990 or 990-EZ) 2011
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 expenses, and share of excess lobbying expenditures).
B Check
Limits on Lobbying Expenditures
(The term "expenditures" means amounts paid or incurred.) 		(a) Filing
organization's
totals 		(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? ......................................

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) 2008 (b) 2009 (c) 2010 (d) 2011 (e) Total
             
2a Lobbying non-taxable amount          
             
b Lobbying ceiling amount
(150% of line 2a, column(e)) 		         
             
c Total lobbying expenditures          
             
d Grassroots nontaxable amount          
             
e Grassroots ceiling amount
(150% of line 2d, column (e))		          
             
f Grassroots lobbying expenditures          
Schedule C (Form 990 or 990-EZ) 2011


Schedule C (Form 990 or 990-EZ) 2011
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)).
For each “Yes” response to lines 1a through 1i below, provide in Part IV a detailed description of the lobbying activity.
(a)
Yes
No
(b)
Amount
1
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:
a
Volunteers? .........................................
 
No
b
Paid staff or management (include compensation in expenses reported on lines 1c through 1i)? ....
 
No
c
Media advertisements? ....................................
 
No
 
d
Mailings to members, legislators, or the public? .........................
 
No
 
e
Publications, or published or broadcast statements? .......................
 
No
 
f
Grants to other organizations for lobbying purposes? .......................
 
No
 
g
Direct contact with legislators, their staffs, government officials, or a legislative body? ........
 
No
 
h
Rallies, demonstrations, seminars, conventions, speeches, lectures, or any similar means? ......
 
No
 
i
Other activities? ..........................
Yes
 
17,933
j
Total. Add lines 1c through 1i ...............................
17,933
2a
Did the activities in line 1 cause the organization to be not described in section 501(c)(3)? .....
 
No
b
If "Yes," enter the amount of any tax incurred under section 4912 .................
 
c
If "Yes," enter the amount of any tax incurred by organization managers under section 4912 .....
 
d
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
No
1
Were substantially all (90% or more) dues received nondeductible by members? ................
1
 
 
2
Did the organization make only in-house lobbying expenditures of $2,000 or less? ................
2
 
 
3
Did the organization agree to carry over lobbying and political expenditures from the prior year? ..........
3
 
 
Part III-B
Complete if the organization is exempt under section 501(c)(4), section 501(c)(5), or section 501(c)(6) and if either (a) BOTH Part III-A, lines 1 and 2 are answered “No” OR (b) Part III-A, line 3 is answered “Yes”.
1
Dues, assessments and similar amounts from members .....................
1
 
2
Section 162(e) nondeductible lobbying and political expenditures (do not include amounts of political
expenses for which the section 527(f) tax was paid).
a
Current year .........................................
2a
 
b
Carryover from last year ....................................
2b
 
c
Total ...........................................
2c
 
3
Aggregate amount reported in section 6033(e)(1)(A) notices of nondeductible section 162(e) dues .
3
 
4
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? ................................
4
 
5
Taxable amount of lobbying and political expenditures (see instructions) ..............
5
 
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, Part II-A; line 5; and Part ll-B, line 1.
Also, complete this part for any additional information.
Identifier Return Reference Explanation
OTHER LOBBYING ACTIVITIES SCHEDULE C, PART II-B, LINE 1(I) THE ORGANIZATION PAYS DUES TO THE MISSOURI HOSPITAL ASSOCIATION AND THE AMERICAN HOSPITAL ASSOCIATION. A PORTION OF THESE DUES ARE ATTRIBUTABLE TO LOBBYING PURPOSES.
Schedule C (Form 990 or 990EZ) 2011

Additional Data


Software ID:  
Software Version:  

SCHEDULE D
(Form 990)
Department of the Treasury
Internal Revenue Service
Supplemental Financial Statements
SchDMd Bullet Complete if the organization answered "Yes," to Form 990,
Part IV, line 6, 7, 8, 9, 10, 11a, 11b, 11c, 11d, 11e, 11f, 12a, or 12b
SchDMd Bullet Attach to Form 990. SchDMd Bullet See separate instructions.
OMB No. 1545-0047
2011
Open to Public Inspection
Name of the organization
SKAGGS COMMUNITY HOSPITAL ASSOCIATION
 
Employer identification number

44-0584290
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 .......    
5
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? ............
6
Did the organization inform all grantees, donors, and donor advisors in writing that grant funds can 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? ...................................
Part II
Conservation Easements. Complete if the organization answered "Yes" to Form 990, Part IV, line 7.
1
Purpose(s) of conservation easements held by the organization (check all that apply).
2
Complete lines 2a through 2d if the organization held a qualified conservation contribution in the form of a conservation easement on the last day of the tax year.
Held at the End of the 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, and not on a historic structure listed in the National Register .................... 2d  
3
Number of conservation easements modified, transferred, released, extinguished, or terminated by the organization during
the tax year SchDMd Bullet  
4
Number of states where property subject to conservation easement is located SchDMd Bullet  
5
Does the organization have a written policy regarding the periodic monitoring, inspection, handling of violations, and
enforcement of the conservation easements it holds? .............................
6
Staff and volunteer hours devoted to monitoring, inspecting and enforcing conservation easements during the year SchDMd Bullet  
7
Amount of expenses incurred in monitoring, inspecting, and enforcing conservation easements during the year
SchDMd Bullet $  
8
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)? ....................................
9
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.
1a
If the organization elected, as permitted under SFAS 116 (ASC 958), 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.
b
If the organization elected, as permitted under SFAS 116 (ASC 958), 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 $  
2
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 (ASC 958), relating to these items:
a
Revenues included in Form 990, Part VIII, line 1 ..........................SchDMd Bullet $  
b
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) 2011

Schedule D (Form 990) 2011
Page 2
Part III
Organizations Maintaining Collections of Art, Historical Treasures, or Other Similar Assets (continued)
3
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):
a
d
b
e
 
c
4
Provide a description of the organization’s collections and explain how they further the organization’s exempt purpose in
Part XIV.
5
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?........
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.
1a
Is the organization an agent, trustee, custodian or other intermediary for contributions or other assets not
included on Form 990, Part X? ....................................
b
If "Yes," explain the arrangement in Part XIV and complete the following table:
Amount
c Beginning balance ................................. 1c  
d Additions during the year .............................. 1d  
e Distributions during the year ............................. 1e  
f Ending balance ................................... 1f  
2a
Did the organization include an amount on Form 990, Part X, line 21? .....................
b
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 Net investment earnings, gains, and losses ...        
d Grants or scholarships .....        
e Other expenditures for facilities
and programs ........ 		       
f Administrative expenses ....        
g End of year balance ......        
2
Provide the estimated percentage of the year end balance (line 1g) held as:
a
Board designated or quasi-endowment SchDMd Bullet  
b
Permanent endowment SchDMd Bullet  
c
Temporarily restricted endowment SchDMd Bullet  
The percentages in lines 2a, 2b, and 2c should equal 100%.
3a
Are there endowment funds not in the possession of the organization that are held and administered for the
organization by:

Yes
No
(i) unrelated organizations ........................
3a(i)
 
 
(ii) related organizations ........................
3a(ii)
 
 
b
If "Yes" to 3a(ii), are the related organizations listed as required on Schedule R? .........
3b
 
 
4
Describe in Part XIV the intended uses of the organization's endowment funds.
Part VI
Land, Buildings, and Equipment. See Form 990, Part X, line 10.
Description of property (a) Cost or other basis (investment) (b)Cost or other basis (other) (c) Accumulated depreciation (d) Book value
1a Land .................   3,851,167 3,851,167
b Buildings ................   60,388,630 41,434,248 18,954,382
c Leasehold improvements ............   10,939,325 2,805,729 8,133,596
d Equipment ................   70,768,642 61,528,913 9,239,729
e Other .................   8,538,014 4,082,302 4,455,712
Total. Add lines 1a through 1e. (Column (d) must equal Form 990, Part X, column (B), line 10(c).).......SchDMdBullet 44,634,586
Schedule D (Form 990) 2011

Schedule D (Form 990) 2011
Page 3
Part VII
Investments—Other 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    
(3)Other
(A) BENEFICIAL INT IN TRUST 		7,282,140 C

(B) INV IN BRANSON ORTHO/NEURO CTR 		367,543 C

(C) INV IN SKAGGS HLTH SYSTEM PHO 		79,825 C






Total. (Column (b) must equal Form 990, Part X, col. (B) line 12.)Small Bullet 7,729,508
Part VIII
Investments—Program 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) must equal Form 990, Part X, col.(B) line 13.)Small Bullet  
Part IX
Other Assets. See Form 990, Part X, line 15.
(a) Description (b) Book value








Total. (Column (b) must equal Form 990, Part X, col.(B) line 15.)...........Small Bullet  
Part X
Other Liabilities. See Form 990, Part X, line 25.
1.(a) Description of Liability (b) Book value
Federal Income Taxes  








Total. (Column (b) must equal Form 990, Part X, col.(B) line 25.)Small Bullet  
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) 2011

Schedule D (Form 990) 2011
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) .................... 1 183,989,596
2 Total expenses (Form 990, Part IX, column (A), line 25) ..................... 2 183,474,529
3 Excess or (deficit) for the year. Subtract line 2 from line 1 ............. 3 515,067
4 Net unrealized gains (losses) on investments .......................... 4 -205,727
5 Donated services and use of facilities ............................. 5  
6 Investment expenses ................................... 6  
7 Prior period adjustments .................................. 7  
8 Other (Describe in Part XIV.) ................................. 8 -129,372
9 Total adjustments (net). Add lines 4 through 8 ......................... 9 -335,099
10 Excess or (deficit) for the year per financial statements. Combine lines 3 and 9 ......... 10 179,968
Part XII Reconciliation of Revenue per Audited Financial Statements With Revenue per Return
1 Total revenue, gains, and other support per audited financial statements ....... 1 150,332,689
2 Amounts included on line 1 but not on Form 990, Part VIII, line 12:
a Net unrealized gains on investments .......... 2a -205,727
b Donated services and use of facilities ......... 2b  
c Recoveries of prior year grants ........... 2c  
d Other (Describe in Part XIV.) ............ 2d -33,599,259
e Add lines 2a through 2d ..................... 2e -33,804,986
3 Subtract line 2e from line 1..................... 3 184,137,675
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 -148,079
c Add lines 4a and 4b....................... 4c -148,079
5 Total Revenue. Add lines 3 and 4c. (This must equal Form 990, Part I, line 12.) ...... 5 183,989,596
Part XIII Reconciliation of Expenses per Audited Financial Statements With Expenses per Return
1 Total expenses and losses per audited financial statements ............. 1 150,152,721
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 148,079
e Add lines 2a through 2d...................... 2e 148,079
3 Subtract line 2e from line 1..................... 3 150,004,642
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 33,469,887
c Add lines 4a and 4b....................... 4c 33,469,887
5 Total expenses. Add lines 3 and 4c. (This must equal Form 990, Part I, line 18.) ...... 5 183,474,529
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.
OTHER CHANGES IN NET ASSETS SCHEDULE D, PART XI, LINE 8 $(129,372) CHANGE IN BENEFICIAL INTEREST IN PERPETUAL TRUST
OTHER REVENUE INCLUDED ON LINE 1, BUT NOT ON FORM 990, PART VIII, LINE 12 SCHEDULE D, PART XII, LINE 2D $(33,428,840) BAD DEBT EXPENSE ( 129,372) CHANGE IN BENEFICIAL INTEREST IN PERPETUAL TRUST ( 41,047) OTHER CONTRACT FEES -------------- $(33,599,259)
OTHER REVENUE INCLUDED ON FORM 990, PART VIII, LINE 12, BUT NOT ON LINE 1 SCHEDULE D, PART XII, LINE 4B $(148,079) RENTAL EXPENSES
OTHER EXPENSE INCLUDED ON LINE 1, BUT NOT ON FORM 990, PART IX, LINE 25 SCHEDULE D, PART XIII, LINE 2D $ 148,079 RENTAL EXPENSES
OTHER EXPENSE INCLUDED ON FORM 990, PART IX, LINE 25, BUT NOT ON LINE 1 SCHEDULE D, PART XIII, LINE 4B $ 33,428,840 BAD DEBT EXPENSE 41,047 OTHER CONTRACT FEES -------------- $ 33,469,887
Schedule D (Form 990) 2011

Additional Data


Software ID:  
Software Version:  




SCHEDULE H (Form 990)
Department of the Treasury
Internal Revenue Service
Hospitals
MediumBullet 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
2011
Open to Public Inspection
Name of the organization
SKAGGS COMMUNITY HOSPITAL ASSOCIATION
 
Employer identification number

44-0584290
Part I
Charity Care and Certain Other Community Benefits at Cost
Yes
No
1a
Did the organization have a financial assistance policy during the tax year? If "No," skip to question 6a....
1a
Yes
 
b
If "Yes," was it a written policy? .......................
1b
Yes
 
2
If the organization had multiple hospital facilities, indicate which of the following best describes application of the financial assistance policy to its various hospital facilities during the tax year.
3
Answer the following based on the financial assistance eligibility criteria that applied to the largest number of the organization's patients during the tax year.
a
Did the organization use Federal Poverty Guidelines (FPG) to determine eligibility for providing free care?
If "Yes," indicate which of the following was the FPG family income limit for eligibility for free care:
3a
Yes
 
b
Did the organization use FPG to determine eligibility for providing discounted care? If "Yes," indicate which of the
following was the family income limit for eligibility for discounted care: ............
3b
Yes
 
c
If the organization did 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 used an asset test or other threshold, regardless of income, to determine eligibility for free or discounted care.
4
Did the organization's financial assistance policy that applied to the largest number of its patients during the tax year provide for free or discounted care to the "medically indigent"? ..............

4

Yes

 
5a
Did the organization budget amounts for free or discounted care provided under its financial assistance policy during the tax year? ............................

5a

Yes

 
b
If "Yes," did the organization's financial assistance expenses exceed the budgeted amount?......
5b
Yes
 
c
If "Yes" to line 5b, as a result of budget considerations, was the organization unable to provide free or discountedcare to a patient who was eligibile for free or discounted care?...............
5c
 
No
6a
Did the organization prepare a community benefit report during the tax year?...........
6a
Yes
 
b
If "Yes," did the organization make it available to the public? ...............
6b
Yes
 
Complete the following table using the worksheets provided in the Schedule H instructions. Do not submit these worksheets with the Schedule H.
7
Financial Assistance and Certain Other Community Benefits at Cost
Financial Assistance
and Means-Tested Government Programs		 (a) Number of activities or programs (optional) (b) Persons served (optional) (c) Total community benefit expense (d) Direct offsetting revenue (e) Net community benefit expense (f) Percent of total expense
a Financial Assistance at cost
(from Worksheet 1) .. 		    1,713,948   1,713,948 1.140 %
b Medicaid (from Worksheet 3, column a) .....     24,288,346 19,583,410 4,704,936 3.140 %
c Costs of other means-tested government programs (from Worksheet 3, column b) .            
dTotal Financial Assistance and
Means-Tested Government Programs ..... 		    26,002,294 19,583,410 6,418,884 4.280 %
Other Benefits
e Community health improvement
services and community
benefit operations (from
(Worksheet 4) .... 		    154,598 16,992 137,606 0.090 %
f Health professions education
(from Worksheet 5) .. 		    206,887   206,887 0.140 %
g Subsidized health services
(from Worksheet 6) .. 		    19,998,493 17,955,906 2,042,587 1.360 %
h Research (from Worksheet 7)     49,151 871 48,280 0.030 %
i Cash and in-kind contributions for community benefit (from Worksheet 8) ....     304,968   304,968 0.200 %
jTotal Other Benefits ...     20,714,097 17,973,769 2,740,328 1.820 %
kTotal. Add lines 7d and 7j. ..     46,716,391 37,557,179 9,159,212 6.100 %
For Paperwork Reduction Act Notice, see the Instructions for Form 990. Cat. No. 50192T Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
Part II
Community Building Activities Complete this table if the organization conducted any community building activities during the tax year, and describe in Part VI how its community building activities promoted the health of the communities it serves.
(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     3,480   3,480  
3 Community support     16,700   16,700  
4 Environmental improvements            
5 Leadership development and training for community members            
6 Coalition building            
7 Community health improvement advocacy     4,188   4,188  
8 Workforce development            
9 Other     8,860   8,860  
10 Total     33,228   33,228  
Part III
Bad Debt, Medicare, & Collection Practices
Section A. Bad Debt Expense
Yes
No
1
Did the organization report bad debt expense in accordance with Heathcare Financial Management Association Statement No. 15? ..........................
1
 
No
2
Enter the amount of the organization's bad debt expense........
2
33,428,840
3
Enter the estimated amount of the organization's bad debt expense attributable to patients eligible under the organization's financial assistance policy .....
3
5,148,041
4
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
5
Enter total revenue received from Medicare (including DSH and IME).....
5
44,725,559
6
Enter Medicare allowable costs of care relating to payments on line 5.....
6
46,057,342
7
Subtract line 6 from line 5. This is the surplus or (shortfall)........
7
-1,331,783
8
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:
Section C. Collection Practices
9a
Did the organization have a written debt collection policy during the tax year? ..........
9a
Yes
 
b
If "Yes," did the organization’s collection policy that applied to the largest number of its patients during the tax year contain provisions on the collection practices to be followed for patients who are known to qualify for financial assistance? Describe in Part VI.......................

9b

 

No
Part IV
Management Companies and Joint Ventures
(see instructions)
(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 %
1BRANSON ORTHONEURO
  		MEDICAL BUILDING 89.000 % 0 % 11.000 %
2SKAGGS HEALTH SYSTEM
  		MEDICAL SUPPORT 50.000 % 0 % 50.000 %
3
4
5
6
7
8
9
10
11
12
13
Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
Part VFacility Information
Section A. Hospital Facilities
(list in order of size from largest to smallest)
How many hospital facilities did the organization operate during the tax year?1
Name and address 		Licensed Hospital General-Medical-Surgical Children's Hospital Teaching Hospital Critical Hospital Research Facility ER-24Hours ER-Other Other (Describe)
1 SKAGGS COMMUNITY HEALTH CENTER
251 SKAGGS ROAD
BRANSON,MO65616 		X X         X    
Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
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)
SKAGGS COMMUNITY HEALTH CENTER
Name of Hospital Facility:  
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 2011)
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 the community health 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 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 Participation in the development of a community-wide community benefit plan
d Participation in the execution of a 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 Needs Assessment
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 and 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 Explained eligibility criteria for financial assistance, and whether such assistance includes free or discounted care? 8 Yes  
9 Used federal poverty guidelines (FPG) to determine eligibility for providing free care?........... 9 Yes  
If "Yes," indicate the FPG family income limit for eligibility for free care: 150.%
If "No," explain in Part VI the criteria the hospital facility used.
Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
Part VFacility Information (continued)

Yes No
10 Used FPG to determine eligibility for providing discounted care?................. 10 Yes  
If “Yes,” indicate the FPG family income limit for eligibility for discounted care: 225.%
If "No," explain in Part VI the criteria the hospital facility used.
11 Explained the basis for calculating amounts charged to patients?................. 11 Yes  
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 Yes  
13 Included measures to publicize the policy within the community served by the hospital facility?....... 13 Yes  
If “Yes,” indicate how the hospital facility publicized the policy (check all that apply):
a The policy was posted 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 (FAP) that explained actions the hospital facility may take upon non-payment?....... 14 Yes  
15 Check all of the following collection actions against an individual that were permitted under the hospital facility's policies during the tax year before making reasonable efforts to determine the patient’s eligibility under the facility’s FAP:
a Reporting to credit agency
b Lawsuits
c Liens on residences
d Body attachments
e Other similar actions (describe in Part VI)
16 Did the hospital facility or an authorized third party perform any of the following actions during the tax year before making reasonable efforts to determine the patient’s eligibility under the facility’s FAP?.......... 16   No
If “Yes,” check all actions in which the hospital facility or a third party engaged:
a Reporting to credit agency
b Lawsuits
c Liens on residences
d Body attachments
e Other similar actions (describe in Part VI)
17 Indicate which efforts the hospital facility made before initiating any of the actions checked in line 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 patients were eligible for financial assistance under the hospital facility’s financial assistance policy
e Other (describe in Part VI)
Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
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 Yes  
If “No,” indicate why:
a The hospital facility did not provide care for any emergency medical conditions
b The hospital facility’s policy was not in writing
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)
Individuals Eligible for Financial Assistance
19 Indicate how the hospital facility determined, during the tax year, the maximum amounts that can be charged to FAP-eligible individuals for emergency or other medically necessary care.
a The hospital facility used its lowest negotiated commercial insurance rate when calculating the maximum amounts that can be charged
b The hospital facility used the average of it's three lowest negotiated commercial insurance rates when calculating the maximum amounts that can be charged
c The hospital facility used the Medicare rates when calculating the maximum amounts that can be charged
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   No
If “Yes,” explain in Part VI.
21 Did the hospital facility charge any of its FAP-eligible patients an amount equal to the gross charge for any services provided to that patient?............................... 21   No
If “Yes,” explain in Part VI.
Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
Part VFacility Information (continued)

Section C. Other Health Care Facilities That Are Not Licensed, Registered, or Similarly Recognized as a Hospital Facility
(list in order of size, from largest to smallest)
How many non-hospital health care facilities did the organization operate during the tax year?9
Name and address Type of Facility (describe)
1 SKAGGS ORTHONEURO CENTER
101 CAHILL RD
BRANSON,MO65616 		OUTPATIENT DEPTS PHYSICIAN CLINICS
2 SKAGGS OUTPATIENT CENTER
545 N BRANSON LANDING BLVD
BRANSON,MO65616 		OUTPATIENT DEPTS PHYSICIAN CLINICS
3 SKAGGS SOUTHSIDE CLINICS
590 BIRCH ST
HOLLISTER,MO65672 		PHYSICIAN CLINIC
4 SKAGGS MEDICAL EAST
13852 ST HWY 160
FORSYTH,MO65653 		PHYSICIAN CLINIC
5 SKAGGS MEDICAL WEST
11863 ST HWY 13
KIMBERLING CITY,MO65686 		PHYSICIAN CLINIC
6 BRANSON WEST MEDICAL CAREREHAB
18452 ST HWY 13
BRANSON WEST,MO65737 		OUTPATIENT DEPTS PHYSICIAN CLINICS
7 STONE COUNTY PT DEPARTMENT
17565 ST HWY 13
REEDS SPRING,MO65737 		OUTPATIENT DEPTS
8 MARY'S WELL HOUSE
5136 HWY 265
BRANSON,MO65616 		PHYSICIAN CLINIC
9 FITNESS CENTER
1500 BRANSON HILLS PKWY
BRANSON,MO65616 		FITNESS CENTER
10
Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
Part VI
Supplemental Information
Complete this part to provide the following information.
1 Required descriptions. Provide the descriptions 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, 3, 4, 5c, 6i, 7, 9, 10, 11h, 13g, 15e, 16e, 17e, 18d, 19d, 20, and 21.
2 Needs assessment. Describe how the organization assesses the health care needs of the communities it serves, in addition to any 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 3A PATIENTS WHOSE FAMILY INCOME IS AT OR BELOW 150% OF THE FPL ARE ELIGIBLE TO RECEIVE NONELECTIVE/MEDICALLY NECESSARY CARE DISCOUNTED AT 100% AFTER A $20 ENCOUNTER PAYMENT.
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 FORM 990, PART IX, LINE 25 ($183,474,529) WAS REDUCED BY BAD DEBT EXPENSE ($33,428,840).
COST TO CHARGE RATIO SCHEDULE H, PART I, LINE 7 THE COST TO CHARGE RATIO COMPUTED ON IRS WORKSHEET 2 WAS USED IN THE CALCULATIONS ON IRS WORKSHEETS 1, 3, AND 6.
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. THAT FOOTNOTE READS AS FOLLOWS: 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 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 USING THE AMOUNTS CALCULATED IN THE ORGANIZATION'S AUDITED FINANCIAL STATEMENTS. BAD DEBT ATTRIBUTABLE TO PATIENTS ELIGIBLE UNDER THE ORGANIZATION'S CHARITY CARE POLICY WAS ESTIMATED USING THE PERCENTAGE OF THE POPULATION THAT IS BELOW THE POVERTY LINE IN THE HOSPITAL'S SERVICE AREA.
COMMUNITY BENEFIT RATIONALE SCHEDULE H, PART III, SECTION B, LINE 8 THE HOSPITAL IS DESIGNATED BY MEDICARE AS A SOLE COMMUNITY HOSPITAL AND AS SUCH, IS THE SOLE SOURCE OF HOSPITAL CARE WITHIN A 35-MILE RADIUS. AS A LARGE RURAL HOSPITAL, MINIMUM STAFFING MUST BE MAINTAINED REGARDLESS OF SWINGS IN PATIENT VOLUME. WITHOUT THE HOSPITAL, MEDICARE PATIENTS WOULD NEED TO TRAVEL SIGNIFICANT DISTANCES TO RECEIVE HOSPITAL CARE. 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.
JOINT VENTURE OWNERSHIP PERCENTAGE SCHEDULE H, PART IV, LINE 1, COLUMNS (C) & (E) THE BRANSON ORTHO/NEURO OWNERSHIP PERCENTAGES LISTED IN COLUMNS (C) AND (E) ARE AS OF BRANSON ORTHO/NEURO'S TAX YEAR END, 12/31/2011. IN FISCAL YEAR 2012, THE HOSPITAL PURCHASED THREE PHYSICIANS' MEMBERSHIP INTERESTS. THE HOSPITAL'S OWNERSHIP PERCENTAGES AS OF 4/30/2012 EQUALED 89 PERCENT AND THE PHYSICIANS' OWNERSHIP PERCENTAGES EQUALED 11 PERCENT.
DETERMINATION OF MAXIMUM AMOUNTS CHARGED SCHEDULE H, PART V, SECTION B, LINE 19 ALL UNINSURED PATIENTS RECEIVE A 30% DISCOUNT, THIS AMOUNT IS LESS THAN ANY OF OUR MANAGED CARE CONTRACTS. THE FINANCIAL ASSISTANCE PATIENTS WHO RECEIVE 100% CHARITY ARE REQUIRED TO PAY A $20 ENCOUNTER PAYMENT. PATIENTS APPROVED FOR 75% CHARITY CARE, WILL PAY 25% OF CHARGES, WITH A $40 ENCOUNTER PAYMENT. PATIENTS APPROVED FOR 50% CHARITY CARE ARE REQUIRED TO PAY 50% OF CHARGES WITH A $40 ENCOUNTER PAYMENT. THE ENCOUNTER PAYMENT AMOUNT IS BASED ON AVERAGE INSURANCE CO-PAYMENTS. THE MAXIMUM AMOUNT CHARGED TO OUR QUALIFYING PATIENTS, AS A PERCENTAGE OF GROSS CHARGES IS LESS THAN ANY OF OUR MANAGED CARE CONTRACTS.
NEEDS ASSESSMENT   SKAGGS REGIONAL MEDICAL CENTER WORKS CLOSELY WITH ITS COMMUNITY THROUGH ITS RELATIONSHIP WITH ITS 120-PLUS TRUSTEES WHO ARE COMMUNITY LEADERS FROM TANEY AND STONE COUNTIES. SKAGGS ALSO MAINTAINS A STRONG RELATIONSHIP WITH AREA HEALTH DEPARTMENTS MONITORING THE HEALTH CARE NEEDS OF OUR COMMUNITY.
PATIENT EDUCATION OF ELIGIBILITY FOR ASSISTANCE   SKAGGS REGIONAL MEDICAL CENTER SCREENS ALL SELF-PAY PATIENTS FOR MEDICAID BY OUTSOURCING SELF-PAY TO SEE IF PATIENTS QUALIFY FOR ENTITLEMENT. IF THEY DO NOT QUALIFY, THEY WILL TALK TO A FINANCIAL COUNSELOR, WHO WILL SCREEN THEM FOR CHARITY. WE ALSO HAVE SIGNS THAT INCLUDE "THIS HOSPITAL DOES PARTICIPATE IN THE MEDICAID PROGRAM."
COMMUNITY INFORMATION   SKAGGS REGIONAL MEDICAL CENTER CONSIDERS TANEY AND STONE COUNTIES AS ITS PRIMARY SERVICE AREA WITH CHRISTIAN COUNTY, BOONE COUNTY AND PARTS OF CARROLL COUNTY IN NORTHERN ARKANSAS AS ITS SECONDARY SERVICE AREA. THE TOTAL POPULATION OF ZIP CODES SERVED BY SRMC IS APPROXIMATELY 144,000. THE PROJECTED POPULATION GROWTH IN THESE AREAS, ESPECIALLY THE CONTINUING MIGRATION INTO THE AREA OF RETIREES, IS A SIGNIFICANT FACTOR IN THE EVER-INCREASING NEED FOR HIGH-TECH MEDICAL SERVICES. THE POPULATION AGE 65 YEARS OR OLDER IN TANEY COUNTY IS 17.71 PERCENT, WHILE STONE COUNTY IS 24.24 PERCENT. AS A TOURIST DESTINATION, THE BRANSON/LAKES AREA HAS A STRONG SERVICE INDUSTRY WORKFORCE WHO OFTEN DON'T HAVE HEALTHCARE BENEFITS. THE MEDIAN HOUSEHOLD INCOME IN TANEY COUNTY IS $39,026 AND $41,351 IN STONE COUNTY. TANEY AND STONE COUNTIES ARE PROJECTED TO GROW FROM A POPULATION OF 68,361 IN 2000 TO 108,387 BY 2030.
COMMUNITY BUILDING ACTIVITIES   SKAGGS REGIONAL MEDICAL CENTER CONTINUES TO PROVIDE MANY COMMUNITY OUTREACH PROGRAMS THROUGH ITS SPEAKERS' BUREAU, COMMUNITY SCREENINGS AND EDUCATION PROGRAMS. SKAGGS REACHES MORE THAN 12,000 INDIVIDUALS THROUGH THESE EFFORTS.
PROMOTION OF COMMUNITY HEALTH   SKAGGS REGIONAL MEDICAL CENTER HAS A 13-MEMBER BOARD OF DIRECTORS WHO ARE ELECTED FROM THE 120-PLUS TRUSTEES. SEVERAL THOUSANDS OF DOLLARS ARE SPENT EACH YEAR OFFERING FREE OR LOW-COST SCREENINGS TO THE COMMUNITY AND EDUCATIONAL PROGRAMS. SKAGGS PHYSICIANS AND STAFF ARE COMMITTED TO EDUCATING THE COMMUNITY TO HELP ENSURE A HEALTHIER FUTURE. CPR CLASSES, SMOKING CESSATION CLASSES, PRENATAL CLASSES, ETC. ARE ALL FOCUSED ON GIVING OUR COMMUNITY MEMBERS THE RESOURCES THEY NEED TO MAKE INFORMED DECISIONS.
AFFILIATED HEALTH CARE SYSTEM   THE SKAGGS HEALTH CARE SYSTEM INCLUDES THE SKAGGS COMMUNITY HOSPITAL ASSOCIATION, SKAGGS FOUNDATION, AND BRANSON ORTHO/NEURO CENTER, LLC. THE FOUNDATION IS A NOT-FOR-PROFIT ENTITY WHOSE PURPOSE IS TO RAISE FUNDS FOR THE BENEFIT OF THE HOSPITAL. ORTHO/NEURO IS A LIMITED LIABILITY CORPORATION THAT OWNS A BUILDING IN BRANSON, MISSOURI, AND LEASES SPACE TO HEALTH CARE PROFESSIONALS FOR OUTPATIENT SERVICES.
Schedule H (Form 990) 2011
Additional Data


Software ID:  
Software Version:  
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
2011
Open to Public
Inspection
Name of the organization
SKAGGS COMMUNITY HOSPITAL ASSOCIATION
 
Employer identification number
44-0584290
Part I
General Information on Grants and Assistance
1
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? ....................................
2
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 (e) Amount of non-cash
assistance		 (f) Method of valuation
(book, FMV, appraisal,
other)		 (g) Description of
non-cash assistance		 (h) Purpose of grant
or assistance
(1) JOHN Q HAMMONS FOUNDATION INC300 S J Q HMNS PKWY STE 900
SPRINGFIELD,MO65806 		43-1521852 501(C)(3) 7,500       SUPPORT
(2) COLLEGE OF THE OZARKSPO BOX 17
POINT LOOKOUT,MO65726 		44-0556862 501(C)(3) 102,000       SUPPORT
(3) SKAGGS FOUNDATIONPO BOX 650
BRANSON,MO65615 		30-0107007 501(C)(3) 155,150       SUPPORT


















2
Enter total number of section 501(c)(3) and government organizations listed in the line 1 table ................. Bullet Image
3
3
Enter total number of other organizations listed in the line 1 table ......................... . Bullet Image
0
For Privacy Act and Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 50055P
Schedule I (Form 990) 2011

Schedule I (Form 990) 2011
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
(1) TUITION ASSISTANCE 26 39,718      
(2) HOME HEALTH CARE 6 41,101      











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 HOSPITAL NURSING ADMINISTRATION IS IN CONTACT WITH THE NURSING SCHOOL ADMINISTRATION OF THE COLLEGE OF THE OZARKS REGARDING THE STATUS OF THE PROGRAM, FUTURE PLACEMENT OPPORTUNITIES, ETC. EMPLOYEES MUST MEET A NUMBER OF QUALIFICATIONS TO QUALIFY FOR TUITION ASSISTANCE. FOLLOWING COMPLETION OF THE COURSE, THE EMPLOYEE MUST SUBMIT, IN WRITING, A REQUEST FOR A CHECK NOT TO EXCEED $1,000. THE REQUEST MUST BE ACCOMPANIED WITH A STATEMENT FROM THE SCHOOL WITH A BREAKDOWN OF CHARGES AND GRADES ARE SUBMITTED TO THE HUMAN RESOURCE DIRECTOR. DURING THE FISCAL YEAR, THE HOSPITAL ALSO DONATED $102,000 TO THE COLLEGE. THE DONATION TO THE JOHN Q HAMMONS FOUNDATION WAS GIVEN FOR THE PRICE CUTTER CHARITY CHAMPIONSHIP, WHICH IS AN ANNUAL EVENT HELD TO RAISE MONEY FOR LOCAL CHILDREN'S CHARITIES. THE JOHN Q HAMMONS FOUNDATION DISTRIBUTED THE MONETARY GIFTS RAISED TO 43 CHILDREN'S CHARITIES IN THE OZARKS. SKAGGS FOUNDATION IS A RELATED ORGANIZATION OF SKAGGS COMMUNITY HOSPITAL ASSOCIATION AND HAS SHARED FINANCIALS WITH THE ORGANIZATION. AS A RESULT, IT IS ABLE TO MONITOR USE OF GRANT FUNDS. THE HOME HEALTH CARE PROGRAM RECEIVES GRANT MONEY FROM THE SOUTHWEST MO OFFICE ON AGING IN TANEY COUNTY FOR USE TO COVER EXPENSES RELATED TO THE HOMEMAKER PROGRAM. EMPLOYEES WHO INCUR EXPENSES RELATED TO THIS PROGRAM ARE REIMBURSED WITH THIS GRANT MONEY. THE HOSPITAL'S HOME HEALTH DEPARTMENT MONITORS THE USE OF THESE GRANT FUNDS.
Schedule I (Form 990) 2011


Additional Data


Software ID:  
Software Version:  


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
2011
Open to Public Inspection
Name of the organization
SKAGGS COMMUNITY HOSPITAL ASSOCIATION
 
Employer identification number

44-0584290
Part I
Questions Regarding Compensation
Yes
No
1a
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.
b
If any of the boxes in line 1a are checked, did the organization follow a written policy regarding payment or reimbursement or provision of all the expenses described above? If "No," complete Part III to explain....
1b
 
No
2
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? ....
2
Yes
 
3
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. Do not check any boxes for methods
used by a related organization to establish compensation of the CEO/Executive Director, but explain in Part III.
4
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:
a
Receive a severance payment or change-of-control payment? ...............
4a
 
No
b
Participate in, or receive payment from, a supplemental nonqualified retirement plan? ........
4b
 
No
c
Participate in, or receive payment from, an equity-based compensation arrangement? ........
4c
 
No
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.
5
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:
a
The organization? ...........................
5a
 
No
b
Any related organization? .........................
5b
 
No
If "Yes," to line 5a or 5b, describe in Part III.
6
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:
a
The organization? ...........................
6a
 
No
b
Any related organization? .........................
6b
 
No
If "Yes," to line 6a or 6b, describe in Part III.
7
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 ............
7
Yes
 
8
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 Regulations section 53.4958-4(a)(3)? If "Yes," describe
in Part III .............................
8
 
No
9
If "Yes" to line 8, did the organization also follow the rebuttable presumption procedure described in Regulations section 53.4958-6(c)? .........................
9
 
 
For Privacy Act and Paperwork Reduction Act Notice, see the Intructions for Form 990
Cat. No. 50053T
Schedule J (Form 990) 2011

Schedule J (Form 990) 2011
Page 2
Part II
Officers, Directors, Trustees, Key Employees, and Highest Compensated Employees. Use duplicate copies if additional space is 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) for each listed individual must equal the total amount of Form 990, Part VII, Section A, line 1a, applicable column (D) and column (E) for that individual.
(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 as deferred
in prior Form 990
(i) Base compensation (ii) Bonus & incentive compensation (iii) Other reportable compensation
(1) DIANE CORNELISON DO (i)
(ii)		 536,225
0 		0
0 		2,908
0 		14,532
0 		9,877
0 		563,542
0 		0
0
(2) PETER MARCELLUS MD (i)
(ii)		 219,140
0 		0
0 		863
0 		8,933
0 		19,017
0 		247,953
0 		0
0
(3) WILLIAM MAHONEY (i)
(ii)		 358,040
0 		0
0 		374
0 		4,900
0 		24,161
0 		387,475
0 		0
0
(4) DAVID STRONG (i)
(ii)		 203,443
0 		0
0 		2,659
0 		4,186
0 		23,595
0 		233,883
0 		0
0
(5) NARIN ARUNAKUL MD (i)
(ii)		 844,593
0 		0
0 		26,748
0 		10,500
0 		21,352
0 		903,193
0 		0
0
(6) MITTIE M DRAGOSLJVICH MD (i)
(ii)		 658,173
0 		263,127
0 		11,884
0 		27,000
0 		23,986
0 		984,170
0 		0
0
(7) JOHN W HUFFMAN DO (i)
(ii)		 563,192
0 		0
0 		6
0 		19,061
0 		15,785
0 		598,044
0 		0
0
(8) CHRIS R REEVES DO (i)
(ii)		 589,808
0 		0
0 		41,596
0 		20,126
0 		21,442
0 		672,972
0 		0
0








Schedule J (Form 990) 2011

Schedule J (Form 990) 2011
Page 3
Part III
Supplemental Information
Complete this part to provide the information, explanation, or descriptions required for Part I, lines 1a, 1b, 3, 4c, 5a, 5b, 6a, 6b, 7, and 8. Also complete this part for any additional information.
Identifier Return Reference Explanation
GROSS-UP PAYMENTS SCHEDULE J, PART I, LINE 1 DOCTORS ARUNAKUL, REEVES, AND DRAGOSLJVICH RECEIVED GROSS-UP PAYMENTS ON FORGIVEN PRINCIPAL AND INTEREST. ALL AMOUNTS WERE TREATED AS TAXABLE.
INCENTIVE PAYMENTS SCHEDULE J, PART I, LINE 7 THE PHYSICIANS ARE ELIGIBLE FOR AN INCENTIVE PAYMENT, BASED ON REACHING A THRESHOLD SET BY THE CEC. ONCE THE PHYSICIANS' WORK RELATIVE VALUE UNITS (WRVU) ARE IN EXCESS OF THIS THRESHOLD ON AN ANNUAL BASIS THE PHYSICIAN RECEIVES A INCENTIVE. THE INCENTIVE IS CALCULATED ON 15% OF THE PHYSICIANS WRVU BASE RATE MULTIPLIED BY THE NUMBER OF WRVU'S IN EXCESS OF THAT THRESHOLD. THIS INCENTIVE IS ONLY COMPENSATED ONCE A YEAR AND IS CALCULATED IN OCTOBER. PHYSICIANS WHO HAVE A GUARANTEE ARE NOT ELIGIBLE FOR THE INCENTIVE.
Schedule J (Form 990) 2011

Additional Data


Software ID:  
Software Version:  
Schedule K
(Form 990)
Department of the Treasury
Internal Revenue Service
Supplemental Information on Tax Exempt Bonds
SchKMediumBullet Complete if the organization answered "Yes" to Form 990, Part IV, line 24a. Provide descriptions,
explanations, and any additional information in Part VI.
SchKMediumBullet Attach to Form 990. SchKMediumBullet See separate instructions.
OMB No. 1545-0047
2011
Open to Public
Inspection
Name of the organization
SKAGGS COMMUNITY HOSPITAL ASSOCIATION
 
Employer identification number
44-0584290
Part I
Bond Issues
(a) Issuer Name (b) Issuer EIN (c) CUSIP # (d) Date Issued (e) Issue Price (f) Description of Purpose (g) Defeased (h) On
Behalf of
Issuer 		(i) Pool
financing
Yes No Yes No Yes No
A THE INDUSTRIAL DEVELOPMENT AUTHORITY OF TANEY CO
  		43-1288274 87539NBQ8 11-17-2005 17,635,000 CONSTRUCT AND EQUIP HOSPITAL FACIL   X   X   X
Part II
Proceeds
A B C D
1 Amount of bonds retired . . . . . . . . . . . . . 2,700,000      
2 Amount of bonds legally defeased . . . . . . . . . . 0      
3 Total proceeds of issue . . . . . . . . . . . . . 18,700,518      
4 Gross proceeds in reserve funds . . . . . . . . 1,227,527      
5 Capitalized interest from proceeds . . . . . . . . . . 562,209      
6 Proceeds in refunding escrows . . . . . . . . . . . 0      
7 Issuance costs from proceeds . . . . . . . . . . . 0      
8 Credit enhancement from proceeds . . . . . . . . . . 0      
9 Working capital expenditures from proceeds . . . . . . . 0      
10 Capital expenditures from proceeds . . . . . . . . . . 16,910,892      
11 Other spent proceeds . . . . . . . . . . . 0      
12 Other unspent proceeds . . . . . . . . . . . 0      
13 Year of substantial completion . . . . . . . . . . . 2009
Yes No Yes No Yes No Yes No
14 Were the bonds issued as part of a current refunding issue? . . . .   X            
15 Were the bonds issued as part of an advance refunding issue? . . . .   X            
16 Has the final allocation of proceeds been made? . . . . . . X              
17 Does the organization maintain adequate books and records to support the final allocation of proceeds? . . . . . . . . . . . . . X              
Part III
Private Business Use
A B C D
Yes No Yes No Yes No Yes No
1 Was the organization a partner in a partnership, or a member of an LLC, which owned property financed by tax-exempt bonds? . . . . . . .   X            
2 Are there any lease arrangements that may result in private business use of bond-financed property? . . . . . . . . . X              
For Privacy Act and Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 50193E
Schedule K (Form 990) 2011
Schedule K (Form 990) 2011
Page 2
Part III
Private Business Use (Continued)
A B C D
Yes No Yes No Yes No Yes No
3a Are there any management or service contracts that may result in private business use of bond-financed property? . . . . . . . . . X              
b If ‘Yes’ to line 3a, does the organization routinely engage bond counsel or other outside counsel to review any management or service contracts relating to the financed property? . . . . . X              
c Are there any research agreements that may result in private business use of bond-financed property? . . . . . . .   X            
d If ‘Yes’ to line 3c, does the organization routinely engage bond counsel or other outside counsel to review any research agreements relating to the financed property? .                
4 Enter the percentage of financed property used in a private business use by entities other than a section 501(c)(3) organization or a state or local government . . SchKMediumBullet 0.00000%   %   %   %
5 Enter the percentage of financed property used in a private business use as a result of unrelated trade or business activity carried on by your organization, another section 501(c)(3) organization, or a state or local government . . . . . . . SchKMediumBullet 0.00000%   %   %   %
6 Total of lines 4 and 5 . . .. . . . . . . . . 0.00000%   %   %   %
7 Does the bond issue meet the private security or payment test? . . . X              
8 Has the organization established written procedures to ensure that all nonqualified bonds of the issue are remediated in accordance with the requirements under
Regulations sections 1.141-12 and 1.145-2?
X              
Part IV
Arbitrage
A B C D
Yes No Yes No Yes No Yes No
1 Has a Form 8038-T, Arbitrage Rebate, Yield Reduction and Penalty in Lieu of Arbitrage Rebate, been filed with respect to the bond issue? . . .   X            
2 Is the bond issue a variable rate issue?   X            
3a Has the organization or the governmental issuer entered into a qualified hedge with respect to the bond issue?   X            
b Name of provider . . . . . . . . 0
  		 
  		 
  		 
 
c Term of hedge . . . . . . . .        
d Was the hedge superintegrated? . . . .                
e Was a hedge terminated? . . . . .                
4a Were gross proceeds invested in a guaranteed investment contract (GIC)? . . . . . . X              
b Name of provider . . . . . . AIG MATCHED FUNDING
  		 
  		 
  		 
 
c Term of GIC . . . . . . . 23.4      
d Was the regulatory safe harbor for establishing the fair market value of the GIC satisfied? . . . . . . X              
5 Were any gross proceeds invested beyond an available temporary period? . . . . . . X              
6 Did the bond issue qualify for an exception to rebate? .   X            
7 Has the organization established written procedures to monitor the requirements of section 148? . . .   X            
Schedule K (Form 990) 2011

Schedule K (Form 990) 2011
Page 3
Part V
Procedures To Undertake Corrective Action
Has the organization established written procedures to ensure that violations of federal tax requirements are timely identified and corrected through the voluntary closing agreement program if self-remediation is not available under applicable regulations? . . . . . . . . . . . . . .
Part VI
Supplemental Information
Complete this part to provide additional information for responses to questions on Schedule K (see instructions).
Identifier Return Reference Explanation
TAX EXEMPT BOND SCHEDULE K, PART II, LINE 3 THE AMOUNT ENTERED IN PART II, LINE 3 IS GREATER THAN THE "ISSUE PRICE" OF THE BONDS ENTERED ON PART I, COLUMN (E) BECAUSE OF INVESTMENT EARNINGS THAT WERE EARNED ON THE BOND PROCEEDS DEPOSITED IN THE PROJECT FUND AND DEBT SERVICE RESERVE FUND. INVESTMENT EARNINGS ON THE DEBT SERVICE RESERVE FUND WERE ONLY TAKEN INTO ACCOUNT THROUGH THE END OF THE "PROJECT PERIOD" IN 2009.
Schedule K (Form 990) 2011

Additional Data


Software ID:  
Software Version:  

Schedule L
(Form 990 or 990-EZ)
Department of the Treasury
Internal Revenue Service
Transactions with Interested Persons
MediumBullet Complete if the organization answered
"Yes" on Form 990, Part IV, lines 25a, 25b, 26, 27, 28a, 28b, or 28c,
or Form 990-EZ, Part V lines 38a or 40b.
MediumBullet Attach to Form 990 or Form 990-EZ. MediumBulletSee separate instructions.
OMB No. 1545-0047
2011
Open to Public Inspection
Name of the organization
SKAGGS COMMUNITY HOSPITAL ASSOCIATION
 
Employer identification number

44-0584290
Part I
Excess Benefit Transactions (section 501(c)(3) and section 501 (c)(4) organizations only).
Complete if the organization answered "Yes" on Form 990, Part IV, line 25a or 25b, or Form 990-EZ, Part V, line 40b.
1(a) Name of disqualified person (b) Description of transaction (c) Corrected?
Yes No





2
Enter the amount of tax imposed on the organization managers or disqualified persons during the year under section 4958. ......................... Bullet Image$
 
3
Enter the amount of tax, if any, on line 2, above, reimbursed by the organization ....... Bullet Image$
 

Part II
Loans to and/or From Interested Persons.
Complete if the organization answered "Yes" on Form 990, Part IV, line 26, or Form 990-EZ, Part V, line 38a.
(a) Name of interested person and purpose (b) Loan to or from the organization? (c)Original principal amount (d)Balance due (e) In default? (f) Approved by board or committee? (g)Written agreement?
To From Yes No Yes No Yes No
(1) DR NARIN ARUNAKUL
RELOCATION AGREEMENT 		  X 50,000 10,000   No   No Yes  
(2) DR REEVES
RETURN TO HOSP AREA 		  X 200,000 120,750 Yes   Yes   Yes  
Total ...............Small Bullet $ 130,750
Part III
Grants or Assistance Benefitting Interested Persons.
Complete if the organization answered "Yes" on Form 990, Part IV, line 27.
(a) Name of interested person (b)Relationship between interested person and the organization (c)Amount of grant or type of assistance
For Privacy Act and Paperwork Reduction Act Notice, see the
Instructions for Form 990 or 990-EZ.
Cat. No. 50056A
Schedule L (Form 990 or 990-EZ) 2011
Schedule L (Form 990 or 990-EZ) 2011
Page 2
Part IV
Business Transactions Involving Interested Persons.
Complete if the organization answered "Yes" on Form 990, Part IV, line 28a, 28b, or 28c.
(a) Name of interested person (b) Relationship between interested person and the organization (c) Amount of transaction (d) Description of transaction (e) Sharing of organization's revenues?
Yes No
(1) SKAGGS HEALTH SYSTEM SEE PART V. 105,567 PHO DUES & ADMIN FEES   No
(2) BRANSON ORTHONEURO LLC SEE PART V. 645,131 JOINT VENTURE INVESTMENT   No
(3) WHITE RIVER VALLEY ELECTRIC COOP SEE PART V. 169,441 ELECTRIC SERVICE   No
(4) CONNIE MARCELLUS SPOUSE OF PETER MARCELLUS 24,413 COMPENSATION   No
Part V
Supplemental Information
Complete this part to provide additional information for responses to questions on Schedule L (see instructions).
Identifier Return Reference Explanation
LOANS TO INTERESTED PERSONS SCHEDULE L, PART II, LINE 2, COLUMN E DR. REEVES IS NO LONGER EMPLOYED BY THE HOSPITAL. THE PHYSICIAN AND THE HOSPITAL ARE WORKING ON A LOAN RE-PAYMENT AGREEMENT.
TRANSACTIONS WITH INTERESTED PERSONS SCHEDULE L, PART IV, COLUMN B (1) SKAGGS HEALTH SYSTEM AND SKAGGS COMMUNITY HOSPITAL SHARE COMMON BOARD MEMBERS, INCLUDING: JAMES BERRY, PHIL LOYD, AND DENNIS NEWKIRK. ADDITIONALLY, CEO WILLIAM MAHONEY AND CFO DAVID STRONG SERVE ON THE BOARD OF SKAGGS HEALTH SYSTEM. (2) THE HOSPITAL IS A MEMBER OF A JOINT VENTURE, BRANSON ORTHO/NEURO, LLC, WITH VARIOUS PHYSICIANS. ONE OF THESE PHYSICIANS, DR. MARCELLUS, WAS A FORMER KEY EMPLOYEE. NONE OF THE OTHER PHYSICIAN MEMBERS WERE INTERESTED PERSONS DURING THE FISCAL YEAR ACCORDING TO THE SCHEDULE L, PART IV, FILING INSTRUCTIONS. (3) BOB SIMMONS, A BOARD MEMBER OF SKAGGS COMMUNITY HOSPITAL, IS ALSO A BOARD MEMBER OF WHITE RIVER VALLEY ELECTRIC COOP.
Schedule L (Form 990 or 990-EZ) 2011

Additional Data


Software ID:  
Software Version:  




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
2011
Open to Public
Inspection
Name of the organization
SKAGGS COMMUNITY HOSPITAL ASSOCIATION
 
Employer identification number

44-0584290
Identifier Return Reference Explanation
ORGANIZATION'S MISSION SUMMARY FORM 990, PART I, LINE 1 THE SKAGGS TEAM INCLUDES THE EMPLOYEES, PHYSICIANS, BOARD MEMBERS, TRUSTEES AND VOLUNTEERS OF SKAGGS REGIONAL MEDICAL CENTER. THE SKAGGS TEAM IS DEDICATED TO ACHIEVING THE ORGANIZATION'S MISSION BY TAKING A LEADERSHIP ROLE IN WELLNESS THROUGH EDUCATION, PREVENTION AND ADVOCACY; SERVING OUR PATIENTS THROUGH THE USE OF MODERN TECHNOLOGY BY SKILLED PROFESSIONALS AND PROVIDING COMFORT AND PRIVACY WHILE PRESERVING DIGNITY IN ASSISTING INDIVIDUALS TO REACH THEIR HIGHEST QUALITY OF LIFE. THE SKAGGS TEAM ACCOMPLISHES THIS BY PROVIDING THE CLEANEST, FRIENDLIEST AND SAFEST HEALTHCARE ENVIRONMENT YOU WILL EVER EXPERIENCE; WITH AN ORGANIZED, CARING, HONEST TEAM THAT TAKES PRIDE IN ITS WORK; BY PROVIDING OUR HEALTH SYSTEM SERVICES IN CONVENIENT, ACCESSIBLE FACILITIES; BY PROVIDING INDIVIDUALIZED CARE FOR PHYSICAL, EMOTIONAL AND SPIRITUAL NEEDS; BY TREATING EACH OTHER AS WE WOULD WANT TO BE TREATED; BY EMPOWERING OUR TEAM MEMBERS TO DO WHATEVER IT TAKES TO ANTICIPATE NEEDS AND SOLVE CHALLENGES AS THEY ARISE; BY ENCOURAGING OUR TEAM TO BE PROACTIVE IN PERSONAL HEALTH AND WELLNESS AND WITH FINANCIAL INTEGRITY AND STABILITY. THE SKAGGS TEAM STRIVES TO FULFILL THIS MISSION BY PARTNERING WITH THOSE WE SERVE TO ACHIEVE THE HIGHEST LEVEL OF SATISFACTION.
PROGRAM SERVICE ACHIEVEMENT #1 FORM 990, PART III, LINE 4A SKAGGS REGIONAL MEDICAL CENTER PROVIDES THE FOLLOWING AREAS OF SERVICE: CANCER, CARDIAC, DIABETES & ENDOCRINOLOGY, EAR NOSE & THROAT, EMERGENCY & URGENT CARE, FAMILY MEDICINE, HOME CARE, HOSPICE, IMAGING & RADIOLOGY, LABORATORY & PATHOLOGY, NEPHROLOGY & DIALYSIS, NEUROLOGY, OCCUPATIONAL HEALTH, ORTHOPEDICS, PEDIATRICS, PSYCHIATRY, PULMONOLOGY/CRITICAL CARE, REHABILITATION & THERAPY, RHEUMATOLOGY, SLEEP DISORDER CENTER, SOCIAL SERVICES, SURGERY, UROLOGY, WOMEN'S SERVICES AND WOUND CARE. IN MAY OF 2011 SKAGGS PHYSICIANS AND STAFF DONATED TIME TO PROVIDE STUDENT ATHLETIC PHYSICALS TO SEVERAL HUNDRED BRANSON JUNIOR HIGH AND HIGH SCHOOL STUDENTS. THIS WAS A FREE SERVICE PROVIDED BY SKAGGS. AS SUMMER KICKED OFF IN MAY 2011, SKAGGS TEAMED UP WITH AREA EMERGENCY RESPONSE AGENCIES TO PROVIDE SAFETY EDUCATION TO AREA YOUTH. THIS WAS AN OUTDOOR/INDOOR EVENT HELD AT THE BRANSON RECPLEX WITH BOOTHS AND PRIZES FOR ATTENDEES. ALSO IN MAY, SKAGGS TEAMED UP WITH TANEY COUNTY AMBULANCE DISTRICT TO PURCHASE EKG TRANSMITTING SYSTEMS, WHICH PROVIDE FASTER TREATMENT FOR CARDIAC PATIENTS. THE LIFENET SYSTEM IS USED ON AMBULANCE PATIENTS SUSPECTED OF SUFFERING A HEART ATTACK. AN EKG REPORT BEATS THE PATIENT TO THE HOSPITAL, WHERE IF DETERMINED A HEART ATTACK IN PROGRESS, PROVIDERS ARE PREPARED TO TREAT IMMEDIATELY. IN AUGUST 2011 SKAGGS INPATIENT HOSPITAL CARE WAS NAMED AMONG THE BEST IN THE NATION FOR 30-DAY MORTALITY RATES IN THE AREAS OF HEART ATTACK, HEART FAILURE, AND PNEUMONIA. THE CENTERS FOR MEDICARE & MEDICAID SERVICES REPORT ALSO SHOWED SKAGGS MORTALITY RATE OF 12.6%, WHICH IS LOWER THAN THE NATIONAL AVERAGE OF 15.9%. IN JANUARY OF 2012 SKAGGS REGIONAL MEDICAL CENTER ANNOUNCED THAT IT WAS SEEKING A STRATEGIC PARTNER TO PROVIDE STABILITY AND GROWTH OF HEALTHCARE SERVICES FOR THE BRANSON/TRI-LAKES REGION. IN SEPTEMBER OF 2012 THE BOARD OF TRUSTEES AGREED ON THE SKAGGS BOARD OF DIRECTORS RECOMMENDATION TO PARTNER WITH COXHEALTH, LOCATED IN SPRINGFIELD, MO. IN MARCH 2012 THE SKAGGS.NET WEBSITE WAS GIVEN A NEW AND IMPROVED DESIGN AND IS NOW MORE USER-FRIENDLY WITH STREAMLINED TAXONOMY. DURING FISCAL YEAR 2012 SKAGGS OPENED ITS JOINT AND SPINE CENTER. THIS HOSPITAL UNIT EXPANDS AND STREAMLINES ORTHOPEDIC SURGERIES THROUGH THE ADOPTION OF THE MARSHALL-STEELE MODEL OF PATIENT CARE THAT BLENDS THE NEEDS OF THE PATIENTS WITH A MULTI-DISCIPLINARY TEAM OF PROFESSIONALS. THE PROCESS IS PROVEN TO SHORTEN THE PATIENTS' RECOVERY TIME AND IMPROVE OUTCOMES. SKAGGS CANCER PATIENTS HAVE A NEW WAY TO CELEBRATE WHEN THEIR TREATMENT ENDS. THANKS TO A GENEROUS DONATION FROM A COMMUNITY MEMBER A CANCER BELL WAS HUNG IN THE LOBBY OF THE CANCER CENTER. PATIENTS WHO HAVE COMPLETED CANCER TREATMENT RING THE BELL TO CELEBRATE A NEW CHAPTER IN LIFE. IN FISCAL YEAR 2012 SKAGGS HIRED A WELLNESS SUPERVISOR. THIS ROLE ORGANIZES COMMUNITY SCREENINGS, WHICH PROVIDES LOW-COST HEALTH SCREENINGS TO THE COMMUNITY AT VARIOUS LOCATIONS THROUGHOUT THE YEAR; HEALTH RISK ASSESSMENTS FOR AREA BUSINESSES, INCLUDING SKAGGS EMPLOYEES; AND COORDINATES WELLNESS EVENTS IN THE COMMUNITY, INCLUDING THE ANNUAL SKAGGS 5K RUN (RUN FOR YOUR LIFE) AND MAINTAIN DON'T GAIN WEIGHT LOSS CHALLENGE FOR SKAGGS EMPLOYEES AND COMMUNITY MEMBERS. SKAGGS EMERGENCY DEPARTMENT UPDATED ITS PAYMENT POLICY IN FISCAL YEAR 2012. THE GOAL WAS TO LIMIT THE AMOUNT OF BAD DEBT THE EMERGENCY DEPARTMENT WAS INCURRING ANNUALLY. PAYMENT OF INSURANCE CO-PAYMENT OR A DEPOSIT TO BE APPLIED TOWARD THEIR BILL WAS REQUIRED AT TIME OF SERVICE. A NEW PROGRAM CALLED SKAGGS MEDICAL HOME WAS LAUNCHED. THE PROGRAM IS STAFFED WITH A NURSE THAT HELPS WITH CARE PLAN AND COORDINATION OF HEALTH RESOURCES, A BEHAVIORAL HEALTH CONSULTANT THAT COACHES INDIVIDUALS ON BEHAVIORS THAT AFFECT THEIR HEALTH, A DATA SPECIALIST, AND THEIR DIRECTOR. THEY WORK WITH INDIVIDUALS WHO ARE BEING ADMITTED INTO THE HOSPITAL OVER AND OVER OR WHO ARE FREQUENTLY BEING TAKEN TO THE EMERGENCY ROOM. THE GOAL OF MEDICAL HOME IS TO IMPROVE THE HEALTH OF THESE INDIVIDUALS THROUGH COORDINATED CARE. PLANNING IS CENTERED ON THE HEALTH GOALS OF THE INDIVIDUALS, NOT SOMEONE ELSE'S. THE ANNUAL HEALTH FAIR FOR THE BRANSON-TRI-LAKES COMMUNITY PROVIDED LOW-COST SCREENINGS, WEEKEND APPOINTMENT TIMES FOR MAMMOGRAMS AND SKIN CANCER CHECKS IN THE SKAGGS CANCER CENTER. ADDITIONAL FREE SCREENINGS OFFERED THROUGHOUT THE FAIR INCLUDED BLOOD PRESSURE, HEIGHT, WEIGHT & BODY FAT, BLOOD SUGAR FINGER STICKS, BREAST SCREENING, AND FOOT SCREENINGS.
PROGRAM SERVICE ACHIEVEMENT #2 FORM 990, PART III, LINE 4B IN FISCAL YEAR 2012 SKAGGS CLINIC ADMINISTRATION ADDED TWO NEW FAMILY MEDICINE PHYSICIANS FOR STONE COUNTY RESIDENTS, ONE IN BRANSON WEST AND ANOTHER IN KIMBERLING CITY. AN ADDITIONAL GENERAL SURGEON WAS HIRED, WHICH NOW MEANS SKAGGS HAS TWO GENERAL SURGEONS. THE INTERNAL MEDICINE CLINIC WAS REOPENED WITH THE HIRING OF AN INTERNAL MEDICINE AND INFECTIOUS DISEASE PHYSICIAN. A NEW PULMONOLOGIST WAS ALSO ADDED TO CLINIC STAFF. COORDINATION OF CARE AND PHYSICIAN RELATIONS WAS ENHANCED THROUGH THE HIRING OF A PHYSICIAN LIAISON. GOALS FOR FISCAL YEAR 2013 ARE TO INCREASE SERVICES IN PAIN AND NEUROLOGY, ADD AN ORTHOPEDIC SURGEON, INCREASED FOCUS ON CARE CONTINUITY INITIATIVES AND WORKING WITH COXHEALTH SERVICES TO STRENGTHEN CLINICAL SERVICES IN THE BRANSON/TRI-LAKES REGION.
PROGRAM SERVICE ACHIEVEMENT #3 FORM 990, PART III, LINE 4C OUR INTERDISCIPLINARY TEAM WORKS HARD TO PROVIDE THE FINEST IN HOME HEALTH CARE, ALLOWING THE PATIENT COMFORT AND PRIVACY IN HIS/HER OWN SURROUNDINGS. BY DELIVERING THIS TYPE OF APPROPRIATE CARE UNDER THE SUPERVISION OF A PHYSICIAN, WE CAN HELP PATIENTS AVOID HOSPITALIZATION. HOWEVER, IF HOSPITALIZATION DOES BECOME NECESSARY, WE CAN HELP PATIENTS RECUPERATE MORE QUICKLY.
SIGNIFICANT CHANGES TO ORGANIZATIONAL DOCUMENTS FORM 990, PART VI, SECTION A, LINE 4 THE ORGANIZATION AMENDED ITS BYLAWS IN OCTOBER 2011, AND AGAIN IN MARCH 2012. SIGNIFICANT CHANGES ARE AS FOLLOWS: -VOTES OF THE DIRECTORS MAY BE SUBMITTED IN WRITING, BY TELEPHONE, OR ELECTRONICALLY IF ANY ACTION IS TAKEN BY THE BOARD OF DIRECTORS WITHOUT A MEETING. -DIRECTORS MAY PARTICIPATE IN A MEETING THROUGH TELEPHONE CONFERENCE AT ANY TIME, AS LONG AS ALL PERSONS PARTICIPATING IN THE MEETING CAN HEAR EACH OTHER. PREVIOUSLY THIS PARTICIPATION WAS ONLY ALLOWED IF THE DIRECTOR WAS NEEDED TO MEET QUORUM, OR IF A MAJORITY OF THOSE DIRECTORS PERSONALLY IN ATTENDANCE ALLOWED IT. -THE CHIEF EXECUTIVE OFFICER'S DUTIES NO LONGER INCLUDE SERVING AS A MEMBER OF THE BOARD OF DIRECTORS. -IN THE EVENT THE CEO IS UNABLE TO DESIGNATE AUTHORITY FOR HOSPITAL OPERATIONS, THE FOLLOWING ORDER OF COMMAND WILL BE INITIATED: CHIEF FINANCIAL OFFICER, CHIEF NURSING OFFICER, VICE PRESIDENT BUSINESS DEVELOPMENT, VICE PRESIDENT CLINIC ADMINISTRATION, CHIEF INFORMATION OFFICER, CHAIRMAN OF THE BOARD OF DIRECTORS. THE PREVIOUS ORDER OF COMMAND WAS: CHIEF OPERATING OFFICER, CHIEF FINANCIAL OFFICER, CHIEF NURSING OFFICER, CHIEF MARKETING OFFICER, VICE PRESIDENT MEDICAL AFFAIRS, CHAIRMAN OF THE BOARD OF DIRECTORS. -THE CHIEF OF STAFF OF THE MEDICAL STAFF SHALL NOW BE AN EX OFFICIO, NON-VOTING MEMBER OF THE SKAGGS BOARD OF DIRECTORS. PREVIOUSLY, THE CHIEF OF STAFF WAS TO APPOINT A MEDICAL STAFF MEMBER TO ATTEND EACH OF SKAGGS' BOARD OF DIRECTORS MEETINGS. THE BOARD OF DIRECTORS ALSO PASSED A RESOLUTION IN APRIL 2012, AMENDING THE BYLAWS AS FOLLOWS: -FOR ANY DIRECTOR WHOSE TERM ENDS AT THE 2012 ANNUAL MEETING OF THE BOARD OF TRUSTEES, THEIR TERM IS TO BE EXTENDED UNTIL DECEMBER 31, 2012. -THE CURRENT OFFICERS OF THE BOARD OF DIRECTORS SHALL MAINTAIN THEIR CURRENT POSITIONS UNTIL DECEMBER 31, 2012.
MEMBERS, STOCKHOLDERS, OR OTHER PERSONS FORM 990, PART VI, SECTION A, LINES 6 & 7A THE MEMBERSHIP OF THIS ORGANIZATION SHALL BE LIMITED TO PERSONS WHO ARE SELECTED AS A TRUSTEE, BY THE TRUSTEES. MEMBERS OF THE ACTIVE MEDICAL STAFF SHALL BE CONSIDERED NON-VOTING TRUSTEES AS LONG AS THEY REMAIN IN GOOD STANDING ON THE MEDICAL STAFF. TRUSTEES, WHO ARE NOT MEMBERS OF THE MEDICAL STAFF, SHALL BE ENTITLED TO ONE (I) VOTE IN THE ELECTION OF DIRECTORS IN SAID CORPORATION; AND IN ALL MATTERS, THE MAJORITY OF THE VOTES CAST SHALL CONTROL. ACTIVE TRUSTEES SHALL HAVE ALL THE BENEFITS, DUTIES AND OBLIGATIONS OF TRUSTEES AS FURTHER DEFINED IN THESE BYLAWS WITHOUT QUALIFICATION. IF ANY TRUSTEE SHALL FAIL TO ATTEND FOUR (4) CONSECUTIVE ANNUAL TRUSTEES' MEETINGS, THEN SAID TRUSTEE SHALL AUTOMATICALLY BE REMOVED FROM TRUSTEE BOARD MEMBERSHIP. NON-MEDICAL TRUSTEES IN GOOD STANDING SHALL BE APPOINTED AND HOLD OFFICE FOR LIFE, OR UNTIL RESIGNATION OR FAILURE TO FUNCTION, OR THEY MOVE OUT OF HOSPITAL SERVICE AREA. UPON THE DEATH, RESIGNATION OR FAILURE TO FUNCTION OF ANY NON-MEDICAL TRUSTEE, A NEW TRUSTEE SHALL BE ELECTED BY A MAJORITY VOTE OF THE REMAINING TRUSTEES VOTING THEREON. NEW TRUSTEES SHALL BE ELECTED AT THE ANNUAL MEETING OF THE TRUSTEES BY MAJORITY VOTE OF THE TRUSTEES VOTING THEREON. MEMBERS OF THE ACTIVE MEDICAL STAFF SHALL HOLD OFFICE SO LONG AS THEY SHALL CONTINUE TO BE A MEMBER OF THE ACTIVE MEDICAL STAFF IN GOOD STANDING.
REVIEW OF FORM 990 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. A DRAFT VERSION OF THE FORM 990 IS PROVIDED TO THE BOARD OF DIRECTORS PRIOR TO SUBMISSION. WHILE THE DRAFT IS PROVIDED TO ALL BOARD MEMBERS, IT IS THE MEMBERS OF THE FINANCE COMMITTEE THAT GO THROUGH AND REVIEW THE RETURN IN DETAIL. UPON RECEIVING THE APPROVAL OF THE BOARD OF DIRECTORS, THE DRAFT IS THEN FINALIZED AND SUBMITTED TO THE IRS.
CONFLICT OF INTEREST POLICY FORM 990, PART VI, SECTION B, LINE 12C THE CONFLICT OF INTEREST POLICY APPLIES TO ALL EMPLOYEES, AGENTS, MEDICAL STAFF, OFFICERS AND DIRECTORS OF THE ORGANIZATION. IT IS MONITORED AND ENFORCED THROUGH THE THIRD PARTY COMPLIANCE HOTLINE, GLOBAL COMPLIANCE. WHEN A COMPLIANCE ISSUE IS RECEIVED, IT IS INVESTIGATED FOLLOWING POLICY GUIDELINES. PREVIOUSLY, THE POLICY WAS MONITORED INTERNALLY BY CALLING DIRECTLY TO THE COMPLIANCE OFFICER WHO INVESTIGATED AND FOLLOWED UP ON ALL CALLS.
COMPENSATION REVIEW FORM 990, PART VI, SECTION B, LINES 15A & 15B THE COMPENSATION AND BENEFITS COMMITTEE, COMPRISED OF INDEPENDENT DIRECTORS, MET ON 3/17/2012 TO REVIEW THE COMPENSATION AND BENEFITS FOR THE CEO OF THE HOSPITAL. THE CEO REVIEWS THE COMPENSATION OF THE VICE PRESIDENTS AND MAKES RECOMMENDATIONS TO THE COMPENSATION COMMITTEE WHO FORMALLY APPROVES THE COMPENSATION. THE COMMITTEE OBTAINED COMPARABILITY DATA OF TOTAL COMPENSATION AND BENEFITS FOR COMPARABLE POSITIONS FROM INTEGRATED HEALTHCARE STRATEGIES, MERCER AND SULLIVAN COTTER. AFTER CONSIDERING ALL DATA, COMPENSATION WAS DETERMINED TO BE REASONABLE AND WAS APPROVED. THIS PROCESS WAS DOCUMENTED IN THE MINUTES OF THE EXECUTIVE COMMITTEE MEETING.
DOCUMENT DISCLOSURE FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION'S GOVERNING DOCUMENTS, FINANCIAL STATEMENTS, AND CONFLICT OF INTEREST POLICY ARE NOT MADE AVAILABLE TO THE PUBLIC.
COMPENSATION FORM 990, PART V, LINE 2A AND PART IX, LINES 7, 8, 9, AND 10 SKAGGS FOUNDATION'S EXECUTIVE DIRECTOR IS PAID BY SKAGGS COMMUNITY HOSPITAL ASSOCIATION, A RELATED ORGANIZATION. SKAGGS FOUNDATION HAS NO EMPLOYEES; HOWEVER, CERTAIN EMPLOYEES OF THE SKAGGS COMMUNITY HOSPITAL DEVOTE A PORTION OF THEIR TIME TO THE SKAGGS FOUNDATION, AND AS SUCH, A PORTION OF THEIR SALARIES ARE ALLOCATED BY THE HOSPITAL TO THE FOUNDATION, AS SEEN ON THE STATEMENT OF FUNCTIONAL EXPENSES. THE HOSPITAL FILES ALL W-2'S AND PAYS ALL PAYROLL TAXES, BUT ALLOCATES PAYROLL TAXES AND BENEFITS TO THE FOUNDATION ON THE SAME BASIS.
OTHER CHANGES IN NET ASSETS FORM 990, PART XI, LINE 5 $(205,727) UNREALIZED LOSS ON INVESTMENTS (129,372) CHANGE IN BENEFICIAL INTEREST IN PERPETUAL TRUST ---------- $(335,099)
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.
Cat. No. 51056K
Schedule O (Form 990 or 990-EZ) 2011

Additional Data


Software ID:  
Software Version:  
SCHEDULE R
(Form 990)
Department of the Treasury
Internal Revenue Service
Related Organizations and Unrelated Partnerships
MediumBulletComplete if the organization answered "Yes" to Form 990, Part IV, line 33, 34, 35, 36, or 37.
MediumBulletAttach to Form 990. MediumBullet See separate instructions.

OMB No. 1545-0047
2011
Open to Public Inspection
Name of the organization
SKAGGS COMMUNITY HOSPITAL ASSOCIATION
 
Employer identification number

44-0584290
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







(1) SKAGGS EMERGENCY PHYSICIANS
PO BOX 650
BRANSON,MO65615
35-2275232 		BILLING MO 0 0 NA
 
(2) BRANSON HEART CENTER
PO BOX 650
BRANSON,MO65615
30-0497209 		BILLING MO 0 0 NA
 
(3) SKAGGS OCCUPATIONAL HEALTH
PO BOX 650
BRANSON,MO65615
38-3774737 		BILLING MO 0 0 NA
 
(4) BRANSON FAMILY MEDICINE CLINIC
PO BOX 650
BRANSON,MO65615
32-2331834 		BILLING MO 0 0 NA
 




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
Yes No
(1) SKAGGS FOUNDATION

PO BOX 650

BRANSON,MO65615
30-0107007 		FUNDRAISING MO 501(C)(3) 11 A I NA
 
Yes
 












For Privacy Act and Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 50135Y
Schedule R (Form 990) 2011
Schedule R (Form 990) 2011
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 V—UBI
amount in box 20 of
Schedule K-1
(Form 1065)
 		(j)
General or
managing
partner?



 		(k)
Percentage
ownership
Yes No Yes No
(1) BRANSON ORTHONEURO CENTER LLC

14-1952089
BRANSON,MO65616
14-1952089 		MED BLDG MO NA
  		RELATED 77,821 4,499,470   No 0   No 89.000 %












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)

 		(f)
Share of total income



 		(g)
Share of
end-of-year
assets

 		(h)
Percentage
ownership












Schedule R (Form 990) 2011
Schedule R (Form 990) 2011
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
No
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 . . . . . . . . . . . . . . . . . . . . . . .
1a
Yes
 
b Gift, grant, or capital contribution to related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1b
Yes
 
c Gift, grant, or capital contribution from related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1c
Yes
 
d Loans or loan guarantees to or for related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1d
 
No
e Loans or loan guarantees by related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1e
 
No
f Sale of assets to related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1f
 
No
g Purchase of assets from related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1g
 
No
h Exchange of assets with related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1h
 
No
i Lease of facilities, equipment, or other assets to related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1i
Yes
 
j Lease of facilities, equipment, or other assets from related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . .
1j
Yes
 
k Performance of services or membership or fundraising solicitations for related organization(s) . . . . . . . . . . . . . . . . . . . .
1k
Yes
 
l Performance of services or membership or fundraising solicitations by related organization(s) . . . . . . . . . . . . . . . . . . . .
1l
Yes
 
m Sharing of facilities, equipment, mailing lists, or other assets with related organization(s) . . . . . . . . . . . . . . . . . . . . .
1m
Yes
 
n Sharing of paid employees with related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1n
Yes
 
o Reimbursement paid to related organization(s) for expenses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1o
Yes
 
p Reimbursement paid by related organization(s) for expenses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1p
Yes
 
q Other transfer of cash or property to related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1q
 
No
r Other transfer of cash or property from related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1r
 
No
2
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) BRANSON ORTHONEURO CENTER LLC

 A 16,547 FMV
(2) SKAGGS FOUNDATION

 B 155,150 FMV
(3) SKAGGS FOUNDATION

 C 221,137 FMV
(4) BRANSON ORTHONEURO CENTER LLC

 J 628,584 FMV
(5) SKAGGS FOUNDATION

 P 339,612 FMV
(6)
Schedule R (Form 990) 2011
Schedule R (Form 990) 2011
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)
Predominant income(related, unrelated, excluded from tax under sections 512-514)

(e)
Are all
partners
section
501(c)(3)
organizations? 		(f)
Share of total income




 		(g)
Share of
end-of-year
assets 		(h)
Disproprtionate allocations? 		(i)
Code V—UBI
amount in box
20 of Schedule K-1
(Form 1065) 		(j)
General or
managing
partner? 		(k)
Percentage
ownership
Yes No Yes No Yes No






























Schedule R (Form 990) 2011
Schedule R (Form 990) 2011
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: