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
2012
Open to Public Inspection
A For the 2012 calendar year, or tax year beginning 05-01-2012 , 2012, and ending 04-30-2013
BCheck if applicable:
CName of organization
SKAGGS COMMUNITY HOSPITAL ASSOCIATION
 
Doing Business As
COX MEDICAL CENTER BRANSON
 
Number and street (or P.O. box if mail is not delivered to street address)
251 SKAGGS ROAD
Suite
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 $ 189,162,153
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 14
4 Number of independent voting members of the governing body (Part VI, line 1b) ..... 4 6
5 Total number of individuals employed in calendar year 2011 (Part V, line 2a) ...... 5 1,423
6 Total number of volunteers (estimate if necessary) ............. 6 275
7a Total unrelated business revenue from Part VIII, column (C), line 12 ........ 7a 0
b Net unrelated business taxable income from Form 990-T, line 34 ......... 7b 0
Revenues Prior Year Current Year
8 Contributions and grants (Part VIII, line 1h) ......... 587,515 745,045
9 Program service revenue (Part VIII, line 2g) ......... 181,820,734 186,099,475
10 Investment income (Part VIII, column (A), lines 3, 4, and 7d ) .... 422,840 517,611
11 Other revenue (Part VIII, column (A), lines 5, 6d, 8c, 9c, 10c, and 11e) 1,158,507 1,057,748
12 Total revenue—add lines 8 through 11 (must equal Part VIII, column (A), line 12)................... 183,989,596 188,419,879
Expenses; 13 Grants and similar amounts paid (Part IX, column (A), lines 1–3 )... 385,787 372,526
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) 67,610,329 72,562,875
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–24e).... 115,478,413 109,029,820
18 Total expenses. Add lines 13–17 (must equal Part IX, column (A), line 25) 183,474,529 181,965,221
19 Revenue less expenses. Subtract line 18 from line 12....... 515,067 6,454,658
Net Assets or Fund Balances; Beginning of Current Year End of Year
20 Total assets (Part X, line 16)............. 108,670,196 152,039,918
21 Total liabilities (Part X, line 26)............. 58,180,699 61,582,892
22 Net assets or fund balances. Subtract line 21 from line 20..... 50,489,497 90,457,026
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 MediumBullet

Firm's EIN MediumBullet
Firm's address MediumBullet



Phone no.
May the IRS discuss this return with the preparer shown above? (see instructions) ............
For Paperwork Reduction Act Notice, see the separate instructions.
Cat. No. 11282Y
Form 990 (2012)
Form 990 (2012)
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 HOSPITAL'S MISSION IS TO IMPROVE THE HEALTH OF THE COMMUNITIES WE SERVE THROUGH QUALITY HEALTH CARE, EDUCATION AND RESEARCH.
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 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 $ 128,272,172 including grants of $ 184,185 ) (Revenue $ 158,289,235 )
HOSPITAL SERVICES - DURING THE FISCAL YEAR THE HOSPITAL EXPERIENCED A 9.46% DECREASE IN PATIENT ADMISSION WITH A TOTAL OF 6,267. EMERGENCY ROOM VISITS ALSO SAW A DECREASE OF 6.57% FOR A TOTAL OF 36,128 FOR THE FISCAL YEAR. OUTPATIENT VISITS INCREASED BY LESS THAN 1% TO 90,060 FOR THE FISCAL YEAR. THE HOSPITAL ALSO EXPERIENCED A DECREASE IN ITS AVERAGE OCCUPANCY RATE FROM 43.43% FOR FISCAL YEAR 2012 TO 41.62% FOR FISCAL YEAR 2013. SEE SCHEDULE O FOR ADDITIONAL INFORMATION.
4b (Code:   ) (Expenses $ 32,565,842 including grants of $   ) (Revenue $ 24,686,025 )
CLINIC SERVICES - DURING THE FISCAL YEAR THE HOSPITAL HAD 112,952 TOTAL CLINIC VISITS, AN INCREASE OF 10.19% COMPARED TO THE PRIOR FISCAL YEAR.
4c (Code:   ) (Expenses $ 1,863,804 including grants of $ 188,341 ) (Revenue $ 3,124,215 )
HOME HEALTH SERVICES - HOME HEALTH AND HOSPICE VISITS TOTALED 12,071 FOR THE FISCAL YEAR ENDED 4/30/13. THIS IS A DECREASE OF 23.38% AS COMPARED TO THE PREVIOUS FISCAL YEAR. HOME HEALTH SERVICES INCLUDE SKILLED NURSING, PHYSICAL THERAPY, OCCUPATIONAL THERAPY, MEDICAL SOCIAL SERVICE, PERSONAL CARE ASSISTANCE, NUTRITIONAL CONSULTATIONS 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 expensesMediumBullet162,701,818
Form 990 (2012)
Form 990 (2012)
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 (see instructions)? 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, or have a section 501(h) election in effect during the tax year? 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 for escrow or custodial account liability; 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, line 10?
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 VIIClick 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 VIIIClick 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 IXClick 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 XClick to see attachment
11e
Yes
 
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 XClick 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 and XII 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 and XII is optional Click to see attachment
12b
 
No
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, Parts I and IV.........
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 United States? If “Yes,” complete Schedule F, Parts II and IV
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 United States? If “Yes,” complete Schedule F, Parts III and IV...
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 (see instructions)....
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 hospital facilities? 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 statements to this return? Click to see attachment
20b
Yes
 
Form 990 (2012)
Form 990 (2012)
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, line 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 lines 24b through 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, highest 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
 
No
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 direct or indirect 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, Part II, III, or IV, and Part 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
 
No
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...
35b
 
 
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 11b and 19? Note. All Form 990 filers are required to complete Schedule O. ............
38
Yes
 
Form 990 (2012)
Form 990 (2012)
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
150
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
1,423
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
 
No
b
If “Yes,” has it filed a Form 990-T for this year? If “No,” provide an explanation in Schedule O.....
3b
 
 
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, securities account, or other financial 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 as charitable contributions?...
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. See the instructions for additional information the organization must report on Schedule O.
13a
 
 
b
Enter the 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 amount of reserves on hand ............
13c
 
14a
Did the organization receive any payments for indoor tanning services during the tax year?.....
14a
 
No
b
If "Yes," has it filed a Form 720 to report these payments? If “No,” provide an explanation in Schedule O..
14b
 
 
Form 990 (2012)
Form 990 (2012)
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 .....................
1a
14
If there are material differences in voting rights among members of the governing body, or if the governing body delegated broad authority to an executive committee or similar committee, explain in Schedule O.
b
Enter the number of voting members included in line 1a, above, who are independent ...................
1b
6
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
Yes
 
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 this 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:
MediumBulletDAVID STRONG251 SKAGGS ROADBRANSONMO65615 (417) 335-7789
Form 990 (2012)
Form 990 (2012)
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. 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 organization compensated any current officer, director, or trustee.
(A)
Name and Title 		(B)
Average hours per week (list any hours for related organizations below dotted line) 		(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) BOB MCDOWELL........................................................................
SECRETARY
 3.0
.......................0.0 		X   X       0 0 0
(2) TONY WHEELER........................................................................
DIRECTOR
 3.0
.......................0.0 		X           0 0 0
(3) JIM KANEASTER........................................................................
CHAIRMAN
 3.0
.......................0.0 		X   X       0 0 0
(4) BOB SIMMONS........................................................................
DIRECTOR
 3.0
.......................0.0 		X           0 0 0
(5) DENNIS NEWKIRK........................................................................
DIRECTOR
 3.0
.......................1.0 		X           0 0 0
(6) PHILLIP LOYD........................................................................
VICE CHAIRMAN
 3.0
.......................1.0 		X   X       0 0 0
(7) JAKE MCWAY........................................................................
DIRECTOR BEGINNING 1/2013
 3.0
.......................45.0 		X           0 635,317 107,846
(8) JAMES BERRY........................................................................
DIRECTOR
 3.0
.......................1.0 		X           0 0 0
(9) JANICE WILLIAMS........................................................................
DIRECTOR
 3.0
.......................0.0 		X           0 0 0
(10) LARRY SCHMITT........................................................................
TREASURER
 3.0
.......................0.0 		X   X       0 0 0
(11) JOHN DUFF........................................................................
DIRECTOR BEGINNING 1/2013
 3.0
.......................40.0 		X           0 493,575 139,088
(12) RAEANNE PRESLEY........................................................................
DIRECTOR
 3.0
.......................0.0 		X           0 0 0
(13) RICHARD BLUBAUGH........................................................................
DIRECTOR
 3.0
.......................0.0 		X           0 0 0
(14) STEVE EDWARDS........................................................................
DIRECTOR BEGINNING 1/2013
 3.0
.......................46.0 		X           0 901,555 143,128
(15) LYNN ALLISON........................................................................
DIRECTOR ENDING 12/2012
 3.0
.......................0.0 		X           0 0 0
(16) DAVID SMITH........................................................................
CHAIRMAN ENDING 12/2012
 3.0
.......................0.0 		X   X       0 0 0
(17) WILLIAM MAHONEY........................................................................
CEO
 40.0
.......................1.0 		    X       429,118 0 32,290
Form 990 (2012)
Form 990 (2012)
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 (list any hours for related organizations below dotted line) 		(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) DAVID STRONG........................................................................
CFO
 40.0
.......................1.0 		    X       227,339 0 30,459
(19) SHERYL TILUS........................................................................
CNO ENDING 4/2013
 40.0
.......................0.0 		      X     173,696 0 27,544
(20) CAROL MURROW........................................................................
VP BUSINESS DEVELOPMENT
 40.0
.......................0.0 		      X     166,201 0 16,859
(21) DIANE CORNELISON........................................................................
PHYSICIAN
 40.0
.......................0.0 		        X   519,493 0 26,107
(22) JOHN HUFFMAN........................................................................
PHYSICIAN
 40.0
.......................0.0 		        X   527,931 0 32,607
(23) MITTIE DRAGOSLJVICH........................................................................
PHYSICIAN
 40.0
.......................0.0 		        X   647,794 0 43,280
(24) NARIN ARUNAKUL........................................................................
PHYSICIAN
 40.0
.......................0.0 		        X   797,073 0 33,622
(25) PRASERT VIJITBENJARONK........................................................................
PHYSICIAN
 40.0
.......................0.0 		        X   550,667 0 28,272
(26) PETER MARCELLUS........................................................................
FORMER DIR. MEDICAL AFFAIRS
 0.0
.......................0.0 		          X 173,794 0 28,078








1b Sub-Total................MediumBullet
c Total from continuation sheets to Part VII, Section A....MediumBullet
d Total (add lines 1b and 1c)............MediumBullet 4,213,106 2,030,447 689,180
2
Total number of individuals (including but not limited to those listed above) who received more than $100,000 of reportable compensation from the organizationMediumBullet65
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
360 DEGREE MEDICINE,   CONTRACT PHYSICIANS 4,886,184
WHITE RIVER ANESTHESIA ASSOCIATION,   CONTRACT PHYSICIANS 1,404,318
PROVIDER SOLUTIONS LLC,   CONTRACT PHYSICIANS 1,001,633
NUCLEAR DIAGNOSIS INC,   NUC MED STUDIES 852,587
SOUND PHYSICIANS,   HOSPITALIST SERVICES 769,836
2
Total number of independent contractors (including but not limited to those listed above) who received more than $100,000 of compensation from the organization MediumBullet100
Form 990 (2012)
Form 990 (2012)
Page 9
Part VIII
Statement of Revenue
Check if Schedule O contains a response to any question in this Part VIII ..............
(A)
Total revenue 		(B)
Related or
exempt
function
revenue 		(C)
Unrelated
business
revenue 		(D)
Revenue
excluded from
tax under sections
512, 513, or 514
Contributions, Gifts, Grants and Other Similar Amounts 1a Federated campaigns..1a  
b Membership dues....1b  
c Fundraising events....1c  
d Related organizations...1d 48,491
e Government grants (contributions)1e 30,000
f All other contributions, gifts, grants, and
similar amounts not included above1f 		666,554
g Noncash contributions included in lines
1a-1f:$ 		 
h Total. Add lines 1a-1f.......MediumBullet 745,045
Program Service Revenue Business Code
2a PATIENT SERVICE REVENUE 624100 176,343,852 176,343,852    
b EHR REVENUE 624100 2,299,206 2,299,206    
c CAFETERIA 722514 742,122 742,122    
d MANAGEMENT FEES 453220 476,769 476,769    
e GIFT SHOP 561000 221,012 221,012    
f All other program service revenue . 6,016,514 6,016,514    
g Total. Add lines 2a–2f........MediumBullet 186,099,475
Other Revenue 3 Investment income (including dividends, interest, and other similar amounts).......MediumBullet 335,571     335,571
4 Income from investment of tax-exempt bond proceeds..MediumBullet 0      
5 Royalties...........MediumBullet 0      
(i) Real (ii) Personal
6a Gross rents 1,278,697  
b Less: rental expenses 94,979  
c Rental income or (loss) 1,183,718 0
d Net rental income or (loss).......MediumBullet 1,183,718     1,183,718
(i) Securities (ii) Other
7a Gross amount from sales of assets other than inventory 754,879 74,456
b Less: cost or other basis and sales expenses 631,136 16,159
c Gain or (loss) 123,743 58,297
d Net gain or (loss)..........MediumBullet 182,040     182,040
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 900099 -125,970     -125,970
b            
c            
d All other revenue ....        
e Total. Add lines 11a–11d ...... MediumBullet -125,970
12 Total revenue. See Instructions......MediumBullet 188,419,879 186,099,475   1,575,359
Form 990 (2012)
Form 990 (2012)
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).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 21 125,526 125,526
2 Grants and other assistance to individuals in the United States. See Part IV, line 22 247,000 247,000
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 .... 1,205,944 390,995 814,949  
6 Compensation not included above, to disqualified persons (as defined under section 4958(f)(1)) and persons described in section 4958(c)(3)(B) .... 239,654 239,654    
7 Other salaries and wages 57,590,888 50,810,329 6,780,559  
8 Pension plan accruals and contributions (include section 401(k) and 403(b) employer contributions) .... 1,618,618 1,427,022 191,596  
9 Other employee benefits ....... 7,725,727 6,888,735 836,992  
10 Payroll taxes ........... 4,182,044 3,668,907 513,137  
11 Fees for services (non-employees):        
a Management ...... 0      
b Legal ......... 191,294   191,294 0
c Accounting ........... 199,100   199,100  
d Lobbying ........... 0      
e Professional fundraising services. See Part IV, line 17 0  
f Investment management fees ...... 0      
g Other (If line 11g amount exceeds 10% of line 25, column (A) amount, list line 11g expenses on Schedule O) ........ 24,958,390 20,590,339 4,368,051  
12 Advertising and promotion .... 646,323 24,604 621,719  
13 Office expenses ....... 4,099,293 2,699,668 1,399,625  
14 Information technology ...... 2,096,114 1,883,701 212,413  
15 Royalties .. 0      
16 Occupancy ........... 3,520,468 2,976,163 544,305  
17 Travel ............ 157,171 115,064 42,107  
18 Payments of travel or entertainment expenses for any federal, state, or local public officials ...... 0      
19 Conferences, conventions, and meetings .... 468,444 220,447 247,997  
20 Interest ........... 2,350,627 2,131,078 219,549  
21 Payments to affiliates ....... 0      
22 Depreciation, depletion, and amortization ..... 7,896,540 7,159,003 737,537  
23 Insurance .............. 1,900,078 786,788 1,113,290  
24 Other expenses. Itemize expenses not covered above (List miscellaneous expenses in line 24e. If line 24e amount exceeds 10% of line 25, column (A) amount, list line 24e expenses on Schedule O.)
a BAD DEBT 29,236,303 29,236,303    
b MEDICAL SUPPLIES & DRUGS 22,486,632 22,486,632    
c PROVIDER TAX 8,284,824 8,284,824    
d LICENSES, DUES, SUBSCRIPTIONS 391,620 162,512 229,108  
e All other expenses 146,599 146,524 75  
25 Total functional expenses. Add lines 1 through 24e 181,965,221 162,701,818 19,263,403 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 (2012)
Form 990 (2012)
Page 11
Part X Balance Sheet Check if Schedule O contains a response to any question in this Part X ...............
(A)
Beginning of year 		(B)
End of year
Assets 1 Cash—non-interest-bearing ............. 1,833,191 1 6,234,707
2 Savings and temporary cash investments ......... 18,200,476 2 20,507,318
3 Pledges and grants receivable, net ........... 0 3 0
4 Accounts receivable, net ............. 16,689,828 4 18,459,913
5 Loans and other receivables from current and former officers, directors, trustees, key employees, and highest compensated employees. Complete Part II of
Schedule L ..................
130,750 5 0
6 Loans and other receivables from other disqualified persons (as defined under section 4958(f)(1)), persons described in section 4958(c)(3)(B), and contributing employers and sponsoring organizations of section 501(c)(9) voluntary employees' beneficiary organizations (see instructions) Complete Part II of Schedule L
0 6 0
7 Notes and loans receivable, net ............. 0 7 0
8 Inventories for sale or use .............. 2,387,964 8 2,195,639
9 Prepaid expenses and deferred charges .......... 2,112,085 9 1,279,879
10a Land, buildings, and equipment: cost or other basis. Complete Part VI of Schedule D 10a 77,121,252
b Less: accumulated depreciation ..... 10b 2,181,904 44,634,586 10c 74,939,348
11 Investments—publicly traded securities .......... 11,226,233 11 13,890,288
12 Investments—other securities. See Part IV, line 11 ..... 7,729,508 12 8,006,679
13 Investments—program-related. See Part IV, line 11 ..... 0 13 1,494,580
14 Intangible assets ............... 6,552 14 1,468,164
15 Other assets. See Part IV, line 11 ........... 3,719,023 15 3,563,403
16 Total assets. Add lines 1 through 15 (must equal line 34)...... 108,670,196 16 152,039,918
Liabilities 17 Accounts payable and accrued expenses ......... 11,562,941 17 10,550,126
18 Grants payable ................. 0 18 0
19 Deferred revenue ................ 0 19 40,036
20 Tax-exempt bond liabilities ............. 35,845,000 20 34,505,000
21 Escrow or custodial account liability. Complete Part IV of Schedule D.. 0 21 0
22 Loans and other 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 .. 10,772,758 23 14,930,581
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 1,557,149
26 Total liabilities. Add lines 17 through 25......... 58,180,699 26 61,582,892
Net Assets or Fund Balance Organizations that follow SFAS 117 (ASC 958), check here MediumBullet and complete lines 27 through 29, and lines 33 and 34.
27 Unrestricted net assets .............. 43,207,357 27 81,050,076
28 Temporarily restricted net assets ........... 0 28 1,494,580
29 Permanently restricted net assets ........... 7,282,140 29 7,912,370
Organizations that do not follow SFAS 117 (ASC 958), 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 ........... 50,489,497 33 90,457,026
34 Total liabilities and net assets/fund balances ........ 108,670,196 34 152,039,918
Form 990 (2012)
Form 990 (2012)
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
188,419,879
2
Total expenses (must equal Part IX, column (A), line 25) ............
2
181,965,221
3
Revenue less expenses. Subtract line 2 from line 1 ..............
3
6,454,658
4
Net assets or fund balances at beginning of year (must equal Part X, line 33, column (A)) ..
4
50,489,497
5
Net unrealized gains (losses) on investments ...............
5
1,053,535
6
Donated services and use of facilities .................
6
 
7
Investment expenses .....................
7
 
8
Prior period adjustments .....................
8
 
9
Other changes in net assets or fund balances (explain in Schedule O) ........
9
32,459,336
10
Net assets or fund balances at end of year. Combine lines 3 through 9 (must equal Part X, line 33, column (B))
10
90,457,026
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
If ‘Yes,’ check a box below to indicate whether the financial statements for the year were compiled or reviewed on a separate basis, consolidated basis, or both:
b
Were the organization’s financial statements audited by an independent accountant?
2b
 
No
If ‘Yes,’ check a box below to indicate whether the financial statements for the year were audited on a separate basis, consolidated basis, or both:
c
If “Yes,” to line 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?
2c
 
 
If the organization changed either its oversight process or selection process during the tax year, explain in Schedule O.
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 (2012)
Form 990, Special Condition Description:
Special Condition Description
Additional Data


Software ID:  
Software Version:  
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
2012
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 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
Provide the following information about the supported organization(s).
(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 monetary support
Yes No Yes No Yes No
Total                  

For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990EZ.
Cat. No. 11285F
Schedule A (Form 990 or 990-EZ) 2012
Schedule A (Form 990 or 990-EZ) 2012
Page 2
Part II
Support Schedule for Organizations Described in Sections 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) right arrow (a) 2008 (b) 2009 (c) 2010 (d) 2011 (e) 2012 (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) right arrow (a) 2008 (b) 2009 (c) 2010 (d) 2011 (e) 2012 (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. Do not include gain or loss from the sale of capital assets (Explain in Part IV.)..            
11 Total support (Add lines 7 through 10).            
12
12
 
13
First five years. If the Form 990 is for the organization's first, second, third, fourth, or fifth tax year as a 501(c)(3) organization, check this box and stop here........................................right arrow
Section C. Computation of Public Support Percentage
14
14
 
15
15
 
16a
b
17a
b
18
Private foundation. If the organization did not check a box on line 13, 16a, 16b, 17a, or 17b, check this box and see
instructions ..................................................... right arrow
Schedule A (Form 990 or 990-EZ) 2012
Schedule A (Form 990 or 990-EZ) 2012
Page 3
Part III
Support Schedule for Organizations Described in Section 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) right arrow (a) 2008 (b) 2009 (c) 2010 (d) 2011 (e) 2012 (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) right arrow (a) 2008 (b) 2009 (c) 2010 (d) 2011 (e) 2012 (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) 2012
Schedule A (Form 990 or 990-EZ) 2012
Page 4
Part IV
Supplemental Information. Complete this part to provide the explanations required by Part II, line 10; Part II, line 17a or 17b; and 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) 2012

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
2012
Name of the 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) (2012)

Schedule B (Form 990, 990-EZ, or 990-PF) (2012)
Page 2
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) (2012)

Schedule B (Form 990, 990-EZ, or 990-PF) (2012)
Page 3
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) (2012)

Schedule B (Form 990, 990-EZ, or 990-PF) (2012)
Page 4
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) (2012)

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
2012
Open to Public
Inspection
If the organization answered “Yes” to Form 990, Part IV, Line 3, or Form 990-EZ, Part V, line 46 (Political Campaign Activities), then
Round Bullet Section 501(c)(3) organizations: Complete Parts I-A and B. Do not complete Part I-C.
Round Bullet Section 501(c) (other than section 501(c)(3)) organizations: Complete Parts I-A and C below. Do not complete Part I-B.
Round Bullet Section 527 organizations: Complete Part I-A only.
If the organization answered “Yes” to Form 990, Part IV, Line 4, or Form 990-EZ, Part VI, line 47 (Lobbying Activities), then
Round Bullet Section 501(c)(3) organizations that have filed Form 5768 (election under section 501(h)): Complete Part II-A. Do not complete Part II-B.
Round Bullet Section 501(c)(3) organizations that have NOT filed Form 5768 (election under section 501(h)): Complete Part II-B. Do not complete Part II-A.
If the organization answered “Yes” to Form 990, Part IV, Line 5 (Proxy Tax) or Form 990-EZ, Part V, line 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 Paperwork Reduction Act Notice, see the instructions for Form 990 or 990-EZ.
Cat. No. 50084S
Schedule C (Form 990 or 990-EZ) 2012

Schedule C (Form 990 or 990-EZ) 2012
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 SchCMd Bulletexpenses, and share of excess lobbying expenditures).
B Check SchCMd Bullet
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) 2009 (b) 2010 (c) 2011 (d) 2012 (e) Total
             
2a Lobbying nontaxable 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) 2012


Schedule C (Form 990 or 990-EZ) 2012
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)
No
Yes
(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
 
13,025
j
Total. Add lines 1c through 1i ...............................
13,025
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, line 5; Part II-A (affiliated group list); Part II-A, line 2; 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) 2012

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
2012
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 section 170(h)(4)(B)(ii)? .......................................
9
In Part XIII, 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 XIII, 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 Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 52283D
Schedule D (Form 990) 2012

Schedule D (Form 990) 2012
Page 2
Part III
Organizations Maintaining Collections of Art, Historical Treasures, or Other Similar Assets (continued)
3
Using the organization’s acquisition, 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 XIII.
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 XIII 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 XIII. Check here if the explanation has been provided in Part XIII ........
Part V
Endowment Funds. Complete if the organization answered "Yes" to Form 990, Part IV, line 10.
(a)Current year (b)Prior year b (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 current year end balance (line 1g, column (a)) 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 XIII 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 .................   1,136,152 1,136,152
b Buildings ................   19,328,860 584,838 18,744,022
c Leasehold improvements ............   2,194,789 34,762 2,160,027
d Equipment ................   50,487,318 1,350,379 49,136,939
e Other .................   3,974,133 211,925 3,762,208
Total. Add lines 1a through 1e. (Column (d) must equal Form 990, Part X, column (B), line 10(c).).......SchDMdBullet 74,939,348
Schedule D (Form 990) 2012

Schedule D (Form 990) 2012
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 		7,912,370 F

(B) INV IN SKAGGS HLTH SYSTEM PHO 		94,309 F







Total. (Column (b) must equal Form 990, Part X, col. (B) line 12.)Small Bullet 8,006,679
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 0
LEGAL LIABILITY 1,118,099
DUE TO RELATED PARTY 149,262
DUE TO 3rd PARTY 289,788






Total. (Column (b) must equal Form 990, Part X, col.(B) line 25.)Small Bullet 1,557,149
2. Fin 48 (ASC 740) Footnote. In Part XIII, 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 (ASC 740). Check here if the text of the footnote has been provided in Part XIII .....................................................
Schedule D (Form 990) 2012

Schedule D (Form 990) 2012
Page 4
Part XI Reconciliation of Revenue per Audited Financial Statements With Revenue per Return
1 Total revenue, gains, and other support per audited financial statements ....... 1  
2 Amounts included on line 1 but not on Form 990, Part VIII, line 12:
a Net unrealized gains on investments .......... 2a  
b Donated services and use of facilities ......... 2b  
c Recoveries of prior year grants ........... 2c  
d Other (Describe in Part XIII.) ............ 2d  
e Add lines 2a through 2d ..................... 2e  
3 Subtract line 2e from line 1..................... 3  
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 XIII.) ........... 4b  
c Add lines 4a and 4b....................... 4c  
5 Total revenue. Add lines 3 and 4c. (This must equal Form 990, Part I, line 12.) ...... 5  
Part XII Reconciliation of Expenses per Audited Financial Statements With Expenses per Return
1 Total expenses and losses per audited financial statements ........... 1  
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 XIII.) ............ 2d  
e Add lines 2a through 2d...................... 2e  
3 Subtract line 2e from line 1..................... 3  
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 XIII.) ............ 4b  
c Add lines 4a and 4b....................... 4c  
5 Total expenses. Add lines 3 and 4c. (This must equal Form 990, Part I, line 18.) ...... 5  
Part XIII
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, line 2; Part XI, lines 2d and 4b; and Part XII, lines 2d and 4b. Also complete this part to provide any additional information.
Identifier Return Reference Explanation
Schedule D (Form 990) 2012

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
2012
Open to Public Inspection
Name of the organization
SKAGGS COMMUNITY HOSPITAL ASSOCIATION
 
Employer identification number

44-0584290
Part I
Financial Assistance 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) as a factor in determining 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 as a factor in determining 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 used factors other than FPG in determining 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, as a factor in determining 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) .. 		    1,337,186   1,337,186 0.880 %
b Medicaid (from Worksheet 3,
column a) .... 		    21,941,248 18,535,404 3,405,844 2.230 %
c Costs of other means-tested
government programs (from
Worksheet 3, column b) . 		           
d Total Financial Assistance
and Means-Tested
Government Programs . 		    23,278,434 18,535,404 4,743,030 3.110 %
Other Benefits
     149,017 150 148,867 0.100 %
e Community health
improvement services and
community benefit operations
(from Worksheet 4) ..
f Health professions education
(from Worksheet 5) .. 		    207,019   207,019 0.140 %
g Subsidized health services
(from Worksheet 6) .. 		    22,322,236 18,662,284 3,659,952 2.390 %
h Research (from Worksheet 7)     2,694   2,694  
i Cash and in-kind
contributions for community
benefit (from Worksheet 8) 		    380,770   380,770 0.250 %
j Total. Other Benefits ..     23,061,736 18,662,434 4,399,302 2.880 %
k Total. Add lines 7d and 7j .     46,340,170 37,197,838 9,142,332 5.990 %
For Paperwork Reduction Act Notice, see the Instructions for Form 990. Cat. No. 50192T Schedule H (Form 990) 2012
Schedule H (Form 990) 2012
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 Community support            
4 Environmental improvements            
5 Leadership development and training for community members            
6 Coalition building            
7 Community health improvement advocacy            
8 Workforce development            
9 Other            
10 Total            
Part III
Bad Debt, Medicare, & Collection Practices
Section A. Bad Debt Expense
Yes
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. Explain in Part VI the methodology used by the organization to estimate this amount. ......
2
29,236,303
3
Enter the estimated amount of the organization's bad debt expense attributable to patients eligible under the organization's financial assistance policy. Explain in Part VI the methodology used by the organization to estimate this amount and the rationale, if any, for including this portion of bad debt as community benefit. ......
3
5,262,534
4
Provide in Part VI the text of the footnote to the organization’s financial statements that describes bad debt expense or the page number on which this footnote is contained in the attached financial statements.
Section B. Medicare
5
Enter total revenue received from Medicare (including DSH and IME).....
5
43,269,540
6
Enter Medicare allowable costs of care relating to payments on line 5.....
6
47,894,190
7
Subtract line 6 from line 5. This is the surplus (or shortfall)........
7
-4,624,650
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(owned 10% or more by officers, directors, trustees, key employees, and physicians—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 %
1SKAGGS HEALTH SYSTEM
  		MEDICAL SUPPORT 50.000 % 0 % 50.000 %
2
3
4
5
6
7
8
9
10
11
12
13
Schedule H (Form 990) 2012
Schedule H (Form 990) 2012
Page
Part VFacility Information
Section A. Hospital Facilities
(list in order of size from largest to smallest—see instructions)
How many hospital facilities did the organization operate during the tax year?1
Name, address, and primary website address 		Licensed Hospital General-Medical-Surgical Children's Hospital Teaching Hospital Critical Hospital Research Facility ER-24Hours ER-Other Other (Describe) Facility reporting group
1 SKAGGS COMMUNITY HEALTH CENTER
251 SKAGGS ROAD
BRANSON,MO65616
WWW.SKAGGS.NET 		X X         X      
Schedule H (Form 990) 2012
Schedule H (Form 990) 2012
Page
Part VFacility Information (continued)

Section B. Facility Policies and Practices

(Complete a separate Section B for each of the hospital facilities or facility reporting groups listed in Part V, Section A)
SKAGGS COMMUNITY HEALTH CENTER
Name of hospital facility or facility reporting group  
For single facility filers only: line Number of Hospital Facility (from Schedule H, Part V, Section A) 1
Yes No
Community Health Needs Assessment (Lines 1 through 8c are optional for tax years begining on or before March 23, 2012)
1 During the tax year or either of the two immediately preceding tax years, did the hospital facility conduct a community health needs assessment (CHNA)? If "No," skip to line 9.................... 1 Yes  
If “Yes,” indicate what the CHNA report describes (check all that apply):
a
b
c
d
e
f
g
h
i
j
2 Indicate the tax year the hospital facility last conducted a CHNA: 20 12
3 In conducting its most recent CHNA, did the hospital facility take into account input from representatives of the community served by the hospital facility, including those with special knowledge of or expertise in public health? 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 Yes  
4 Was the hospital facility’s CHNA conducted with one or more other hospital facilities? If “Yes,” list the other hospital facilities in Part VI................................ 4   No
5 Did the hospital facility make its CHNA report widely available to the public? ............. 5 Yes  
If “Yes,” indicate how the CHNA report was made widely available (check all that apply):
a
b
c
6 If the hospital facility addressed needs identified in its most recently conducted CHNA, indicate how (check all that apply to date):
a
b
c
d
e
f
g
h
i
7 Did the hospital facility address all of the needs identified in its most recently conducted CHNA? If “No,” explain in Part VI which needs it has not addressed and the reasons why it has not addressed such needs ........ 7   No
8a Did the organization incur an excise tax under section 4959 for the hospital facility's failure to conduct a CHNA as required by section 501(r)(3)? ........................... 8a   No
b If "Yes" to line 8a, did the organization file Form 4720 to report the section 4959 excise tax? ...... 8b    
c If "Yes" to line 8b, what is the total amount of section 4959 excise tax the organization reported on Form 4720 for all of its hospital facilities? $  

Schedule H (Form 990) 2012
Schedule H (Form 990) 2012
Page
Part VFacility Information (continued)

Financial Assistance Policy Yes No
9 Did the hospital facility have in place during the tax year a written financial assistance policy that:
Explained eligibility criteria for financial assistance, and whether such assistance includes free or discounted care? 9 Yes  
10 Used federal poverty guidelines (FPG) to determine eligibility for providing free care?........... 10 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.
11 Used FPG to determine eligibility for providing discounted care?................. 11 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.
12 Explained the basis for calculating amounts charged to patients?................. 12 Yes  
If “Yes,” indicate the factors used in determining such amounts (check all that apply):
a
b
c
d
e
f
g
h
13 Explained the method for applying for financial assistance?................... 13 Yes  
14 Included measures to publicize the policy within the community served by the hospital facility?....... 14 Yes  
If “Yes,” indicate how the hospital facility publicized the policy (check all that apply):
a
b
c
d
e
f
g
Billing and Collections
15 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?....... 15 Yes  
16 Check all of the following 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
b
c
d
e
17 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?.......... 17   No
If “Yes,” check all actions in which the hospital facility or a third party engaged:
a
b
c
d
e
Schedule H (Form 990) 2012
Schedule H (Form 990) 2012
Page
Part VFacility Information (continued)

18 Indicate which efforts the hospital facility made before initiating any of the actions listed in line 17 (check all that apply):
a
b
c
d
e
Policy Relating to Emergency Medical Care
Yes No
19 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?.......... 19 Yes  
If “No,” indicate why:
a
b
c
d
Charges to Individuals Eligible for Assistance under the FAP (FAP-Eligible Individuals)
20 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
b
c
d
21 During the tax year, did the hospital facility charge any FAP-eligible individuals 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? ............................ 21   No
If “Yes,” explain in Part VI.
22 During the tax year, did the hospital facility charge any FAP-eligible individuals an amount equal to the gross charge for any service provided to that individual? ......................... 22   No
If “Yes,” explain in Part VI.
Schedule H (Form 990) 2012
Schedule H (Form 990) 2012
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 CMCB OUTPATIENT CENTER
545 N BRANSON LANDING BLVD
BRANSON,MO65616 		OUTPATIENT DEPTS PHYSICIAN CLINICS
3 CMCB SOUTHSIDE FAMILY CLINIC
590 BIRCH ST
HOLLISTER,MO65672 		PHYSICIAN CLINIC
4 CMCB MEDICAL EAST
13852 ST HWY 160
FORSYTH,MO65653 		PHYSICIAN CLINIC
5 CMCB MEDICAL WEST
11863 ST HWY 13
KIMBERLING CITY,MO65686 		PHYSICIAN CLINIC
6 CMCB BRANSON WEST MEDICAL CAREREHAB
18452 ST HWY 13
BRANSON WEST,MO65737 		OUTPATIENT DEPTS PHYSICIAN CLINICS
7 STONE COUNTY OUTREACH THERAPY
17565 ST HWY 13
REEDS SPRING,MO65737 		OUTPATIENT DEPTS
8 MARY'S WELL HOUSE
5136 HWY 265
BRANSON,MO65616 		PHYSICIAN CLINIC
9 FITNESS CENTER BRANSON
1500 BRANSON HILLS PKWY
BRANSON,MO65616 		FITNESS CENTER
10
Schedule H (Form 990) 2012
Schedule H (Form 990) 2012
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; Part V, Section A; and Part V, Section B, lines 1j, 3, 4, 5c, 6i, 7, 10, 11, 12h, 14g, 16e, 17e, 18e, 19c, 19d, 20d, 21, and 22.
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.
8 Facility reporting group(s). If applicable, for each hospital facility in a facility reporting group provide the descriptions required for Part V, Section B, lines 1j, 3, 4, 5c, 6i, 7, 10, 11, 12h, 14g, 16e, 17e, 18e, 19c, 19d, 20d, 21, and 22.
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 ($181,965,221) WAS REDUCED BY BAD DEBT EXPENSE ($29,236,303).
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 DUE TO THE AFFILIATION WITH COXHEALTH THE HOSPITAL DID NOT HAVE AN AUDIT FOR THE FISCAL YEAR ENDED 4/30/13. THE ORGANIZATION CALCULATED BAD DEBT USING THE AMOUNTS CALCULATED IN THE ORGANIZATION'S INTERNAL 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.
COMMUNITY INPUT SCHEDULE H, PART V, SECTION B, LINE 3 THE CHNA PROCESS INVOLVED: - COLLECTION AND ANALYSIS OF A LARGE RANGE OF DATA, INCLUDING DEMOGRAPHIC, SOCIOECONOMIC AND HEALTH STATISTICS, HEALTH CARE RESOURCES AND PATIENT USE RATES. - INTERVIEWS WITH KEY INFORMANTS WHO REPRESENT A) BROAD INTERESTS OF THE COMMUNITY, B) POPULATIONS OF NEED OR C) PERSONS WITH SPECIALIZED KNOWLEDGE IN PUBLIC HEALTH. - CIRCULATION OF A COMMUNITY HEALTH INPUT QUESTIONNAIRE THAT GATHERED A WIDE RANGE OF INFORMATION WHICH WAS WIDELY DISTRIBUTED TO MEMBERS OF THE COMMUNITY. THE FOLLOWING STEPS WERE CONDUCTED AS PART OF HOSPITAL'S COMMUNITY HEALTH NEEDS ASSESSMENT: - THE "COMMUNITY" SERVED BY THE HOSPITAL WAS DEFINED BY UTILIZING INPATIENT AND OUTPATIENT DATA REGARDING PATIENT ORIGIN. THIS PROCESS IS FURTHER DESCRIBED IN COMMUNITY SERVED BY THE HOSPITAL. - POPULATION DEMOGRAPHICS AND SOCIOECONOMIC CHARACTERISTICS OF THE COMMUNITY WERE GATHERED AND REPORTED UTILIZING VARIOUS THIRD PARTIES (SEE REFERENCES IN APPENDICES). THE HEALTH STATUS OF THE COMMUNITY WAS THEN REVIEWED. INFORMATION ON THE LEADING CAUSES OF DEATH AND MORBIDITY INFORMATION WAS ANALYZED IN CONJUNCTION WITH HEALTH OUTCOMES AND FACTORS REPORTED FOR THE COMMUNITY BY COUNTYHEALTHRANKINGS.ORG. HEALTH FACTORS WITH SIGNIFICANT OPPORTUNITY FOR IMPROVEMENT WERE NOTED. - AN INVENTORY OF HEALTH CARE FACILITIES AND RESOURCES WAS PREPARED AND ESTIMATED A DEMAND FOR PHYSICIAN AND HOSPITAL SERVICES WAS ESTIMATED. BOTH WERE EVALUATED FOR UNMET NEEDS. - COMMUNITY INPUT WAS PROVIDED THROUGH KEY INFORMANT INTERVIEWS OF 15 STAKEHOLDERS AND A COMMUNITY HEALTH INPUT QUESTIONNAIRE WAS WIDELY DISTRIBUTED. THE COMMUNITY HEALTH INPUT QUESTIONNAIRE WAS COMPLETED BY 547 INDIVIDUALS. RESULTS AND FINDINGS ARE DESCRIBED IN THE KEY INFORMANT AND COMMUNITY HEALTH INPUT QUESTIONNAIRE SECTIONS OF THE CHNA REPORT. - INFORMATION GATHERED IN THE ABOVE STEPS WAS ANALYZED AND REVIEWED TO IDENTIFY HEALTH ISSUES OF UNINSURED PERSONS, LOW-INCOME PERSONS AND MINORITY GROUPS AND THE COMMUNITY AS A WHOLE. HEALTH NEEDS WERE RANKED UTILIZING A WEIGHTING METHOD THAT CONSIDERS 1) THE ABILITY OF THE HOSPITAL TO IMPACT CHANGE, 2) THE SIZE OF THE PROBLEM, 3) THE SERIOUSNESS OF THE PROBLEM AND 4) THE PREVALENCE OF COMMON THEMES. - HEALTH NEEDS WERE THEN PRIORITIZED TAKING INTO ACCOUNT THE PERCEIVED DEGREE OF INFLUENCE THE HOSPITAL HAS TO IMPACT THE NEED AND THE HEALTH NEEDS IMPACT ON THE OVERALL HEALTH OF THE COMMUNITY. INFORMATION GAPS WERE IDENTIFIED DURING THE PRIORITIZATION PROCESS AND ARE ALSO REPORTED. - RECOMMENDATIONS BASED ON THIS ASSESSMENT HAVE BEEN COMMUNICATED TO HOSPITAL MANAGEMENT.
IMPLEMENTATION STRATEGY SCHEDULE H, PART V, SECTION B, LINE 6 IN RESPONSE TO THE RESULTS OF THE MOST RECENTLY CONDUCTED COMMUNITY HEALTH NEEDS ASSESSMENT, THE ORGANIZATION ADOPTED AN IMPLEMENTATION STRATEGY. THE IMPLEMENTATION CAN BE FOUND AT THE FOLLOWING URL: HTTP://WWW.SKAGGS.NET/UPLOADS/PUBLIC/IMPLEMENTATION%20PLAN-FINAL%20VERSION %204%2030%2013.PDF
ADDRESSING IDENTIFIED NEEDS SCHEDULE H, PART V, SECTION B, LINE 7 THE 2012 COMMUNITY HEALTH NEEDS ASSESSMENT IDENTIFIES A NUMBER OF UNMET OR PARTIALLY MET HEALTH NEEDS THROUGHOUT THE SERVICE AREA. ANALYSIS OF THE COMMUNITY HEALTH NEEDS ASSESSMENT DATA PROVIDED A MEANS TO EVALUATE AND PRIORITIZE AREAS OF GREATEST NEED. HEALTH NEEDS WERE RANKED ON A SCALE OF ONE TO FIVE WITH A FIVE MEANING THAT THE HOSPITAL COULD HAVE THE GREATEST IMPACT ON THAT NEED, WHILE A ONE DENOTES THE LEAST IMPACT. THESE HEALTH WERE FURTHER RANKED ON FOUR FACTORS: - THE ABILITY OF COX MEDICAL CENTER BRANSON TO EVALUATE AND MEASURE OUTCOMES. - HOW MANY PEOPLE ARE AFFECTED BY THE ISSUE OR SIZE OF THE PROBLEM? - WHAT ARE THE CONSEQUENCES OF NOT ADDRESSING THE PROBLEM? - PREVALENCE OF COMMON THEMES. BY ADDRESSING THESE NEEDS, COMMUNITY HEALTH WILL LIKELY IMPROVE. THEY HAVE THE GREATEST IMPACT ON OVERALL COMMUNITY HEALTH AND THE HOSPITAL HAS THE ABILITY TO MAKE AN IMPACT. OVER THE LAST YEAR, THE HOSPITAL HAS BEGUN TO DEVELOP TOOLS FOR INTERVENTION, AND THROUGH THIS PLAN, CURRENT INTERVENTIONS WILL BE EXPANDED UPON AND NEW INTERVENTIONS WILL BE CREATED AND IMPLEMENTED IN ORDER TO IMPACT THE GREATEST NUMBER OF RESIDENTS. AS A RESULT OF THE ANALYSIS, AFFORDABLE CARE, UNINSURED RESIDENTS, DISEASES OF THE HEART, ACCESS TO SPECIALISTS, SHORTAGE OF PHYSICIANS, ACCESS TO RECREATIONAL FACILITIES, ADULT SMOKING AND TRANSPORTATION WERE IDENTIFIED AS THE PRIORITY AREAS ON WHICH WE WILL FOCUS. THERE WERE OTHER AREAS OF NEED IDENTIFIED THROUGH THE ASSESSMENT THAT ARE CLEARLY IMPORTANT TO IMPROVING THE HEALTH OF THE COMMUNITY. WHILE THEY ARE DEEMED TO HAVE A LESS IMMEDIATE IMPACT, IF OPPORTUNITY ARISES, THEY WILL BE INTEGRATED INTO THIS PLAN AS A SUB-OBJECTIVE ACTIVITY. UNFORTUNATELY, AS WITH MOST OF RURAL AMERICA, COX MEDICAL CENTER BRANSON IS WITHOUT THE NECESSARY RESOURCES TO ADEQUATELY ADDRESS THE PANDEMIC INCREASE IN PEOPLE WHO ARE IMPACTED BY MENTAL HEALTH AND SUBSTANCE ABUSE ISSUES.
DETERMINATION OF MAXIMUM AMOUNTS CHARGED SCHEDULE H, PART V, SECTION B, LINE 20 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   COX MEDICAL CENTER BRANSON (CMCB) WORKS CLOSELY WITH ITS COMMUNITY THROUGH ITS RELATIONSHIP WITH COXHEALTH. IN THE FISCAL YEAR CMCB TOOK THE LEAD IN BRINGING TOGETHER AREA ORGANIZATIONS WITH THE SIMILAR GOAL OF ADDRESSING THE HEALTHCARE NEEDS OF THE COMMUNITY, AS IDENTIFIED BY THE COMMUNITY NEEDS ASSESSMENT: UNHEALTHY BODY WEIGHT, ACCESS TO CARE, MENTAL HEALTH, AND SUBSTANCE ABUSE - INCLUDING TOBACCO, AND CHILD AND FAMILY SAFETY. THE COALITION IS NAMED OWNIT AND IS LED BY A STEERING COMMITTEE AND MEMBERS MAKE UP SUCH AGENCIES AND ORGANIZATIONS AS THE TANEY AND STONE COUNTY HEALTH DEPARTMENTS AND MORE.
PATIENT EDUCATION OF ELIGIBILITY FOR ASSISTANCE   CMCB 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   CMCB 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 CMCB 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.
PROMOTION OF COMMUNITY HEALTH   CMCB HAS A 14-MEMBER BOARD OF DIRECTORS. SEVERAL THOUSANDS OF DOLLARS ARE SPENT EACH YEAR OFFERING FREE OR LOW-COST SCREENINGS TO THE COMMUNITY AND EDUCATIONAL PROGRAMS. CMCB 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   EFFECTIVE 1/1/2013, COX BRANSON BECAME A SUBSIDIARY OF COXHEALTH. COXHEALTH PROVIDES QUALITY HEALTH CARE, EDUCATION, AND RESEARCH IN ORDER TO IMPROVE THE HEALTH OF THE COMMUNITIES IT SERVES, INCLUDING SPRINGFIELD AND SURROUNDING AREAS. THE FOLLOWING ACTIVITIES RELATE TO ACTIVITIES PROVIDED THROUGH COXHEALTH'S AFFILIATED HEALTH CARE SYSTEM: COXHEALTH'S HOME CARE SERVICES ARE PROVIDED BY OXFORD HEALTHCARE, HOME PARENTERAL SERVICES (INFUSION THERAPY) AND HOME SUPPORT (DURABLE MEDICAL EQUIPMENT). OXFORD HEALTHCARE SUPPORTED THE COMMUNITY THROUGH MONTHLY NUTRITION AND FALL PREVENTION SEMINARS AT 20 AREA SENIOR CENTERS THROUGHOUT SOUTHWEST MISSOURI. OXFORD ALSO PROVIDED FREE BONE DENSITY SCREENINGS AT 34 COMMUNITY EVENTS, AND VITAL SIGN SCREENINGS AT MANY MORE. THROUGH AN ANNUAL FAN DRIVE, OXFORD COLLECTED AND DISTRIBUTED MORE THAN 600 BOX FANS TO SENIORS AND THE DISABLED WHO LACK ADEQUATE ACCESS TO COOLING DURING THE SUMMER MONTHS. HOME PARENTERAL SERVICES RECEIVED A SECOND GRANT AWARD FROM THE MISSOURI FOUNDATION FOR HEALTH ORGANIZATION. THIS GRANT ALLOWS HPS TO SERVE PATIENTS THAT FALL THROUGH THE CRACKS DUE TO HAVING NO REIMBURSEMENT OF ANY KIND, SERVING PATIENTS THROUGHOUT SOUTHERN MISSOURI. COXHEALTH HOME CARE SERVICES OF THE MIDWEST SUPPORTS THE COMMUNITY BY PROVIDING IN-HOME PRIVATE DUTY SERVICES, HOME HEALTHCARE AND THERAPY SUPPORT SERVICES, ASSISTANCE TO COXHEALTH SYSTEM IN DEVELOPING AN INTEGRATED HEALTH SYSTEM, AND SERVICE TO MEDICAID PATIENTS. COX-MONETT HOSPITAL SUPPORTS THE MONETT, MISSOURI AND THE SURROUNDING COMMUNITY BY PROVIDING A VARIETY OF SERVICES WHICH INCLUDE UROLOGY, ENT (EAR, NOSE & THROAT), PULMONOLOGY, ORTHOPEDICS, CARDIOLOGY, PODIATRY, OBSTETRICS, RADIOLOGY (CT, MRI, NUCLEAR MEDICINE & MAMMOGRAPHY), LABORATORY, 24-HOUR EMERGENCY CENTER, GENERAL SURGICAL SERVICES, SAME-DAY SURGERY, DIABETES CENTER, SLEEP CENTER, CARDIOPULMONARY REHAB, MEDICAL-SURGICAL UNIT, PHARMACY AND COMMUNITY WELLNESS. COXHEALTH FOUNDATION SUPPORTS THE COMMUNITY BY RAISING FUNDS TO DISPERSE TO PATIENTS FOR THOSE NEEDS FOR WHICH THEY HAVE NO RESOURCES OR FUNDING, BUT WHICH ARE CRITICAL TO THE PATIENT'S HEALTH AND WELL BEING. COXHEALTH AUXILIARY SUPPORTS THE COMMUNITY THROUGH FINANCIAL AND NON-FINANCIAL MEANS. THE ORGANIZATION PROVIDES SCHOLARSHIPS TO NURSING AND MEDICAL TECHNOLOGY STUDENTS AT COX COLLEGE. IN ADDITION, THE AUXILIARY PROVIDES SLEEP SACKS TO ALL NEWBORNS BORN AT COXHEALTH AND CAR SEATS TO THOSE IN NEED TO ENSURE THE SAFETY OF ANY NEWBORN LEAVING COXHEALTH.
Schedule H (Form 990) 2012
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
2012
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. Part II can be duplicated if additional space is needed.
(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) SKAGGS FOUNDATION
PO BOX 650
BRANSON,MO65615 		30-0107007 501(C)(3) 70,157       SUPPORT
(2) BRANSON CBMC
PO BOX 1246
BRANSON,MO65615 		62-1841451 501(C)(3) 10,000       SUPPORT




















2
Enter total number of section 501(c)(3) and government organizations listed in the line 1 table ................ Bullet Image
2
3
Enter total number of other organizations listed in the line 1 table ........................ . Bullet Image
 
For Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 50055P
Schedule I (Form 990) 2012

Schedule I (Form 990) 2012
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.
Part III can be duplicated 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 25 39,717      
(2) HOME HEALTH CARE 8 188,341      
(3) TOBACCO CESSATIION 3   13,046 FMV SUPPLIES
(4) CAREERS IN HEALTH 24   5,896 FMV SUPPLIES






Part IV
Supplemental Information.
Complete this part to provide the information required in Part I, line 2, Part III, column (b), and any other additional information.
Identifier Return Reference Explanation
PROCEDURES FOR MONITORING THE USE OF GRANT FUNDS IN THE U.S. PART I, LINE 2 SKAGGS FOUNDATION FILED WITH THE INTERNAL REVENUE SERVICE TO BECOME A COMMUNITY FOUNDATION EFFECTIVE JANUARY 1, 2013. PRIOR TO THIS, SKAGGS FOUNDATION WAS A RELATED ORGANIZATION WHICH SHARED FINANCIALS WITH COX MEDICAL CENTER BRANSON. AS A RESULT, COX BRANSON WAS ABLE TO MONITOR THE USE OF GRANT FUNDS. FUNDS PAID TO CBMC WERE FOR A ONE-TIME SPONSORSHIP OF THE MAYOR'S PRAYER BREAKFAST. THE FUNDS DONATED WERE USED IMMEDIATELY TO SUPPORT THE EVENT. FOLLOWING COMPLETION OF THE COURSE(S), IT IS THE GRANTEE'S RESPONSIBILITY TO REQUEST, IN WRITING, A REIMBURSEMENT REQUEST FOR THE SEMESTER'S TUITION FEES NOT TO EXCEED $1,000 PER SEMESTER AND NO MORE THAN $2,000 PER YEAR. THE REQUEST MUST BE ACCOMPANIED WITH A STATEMENT FROM THE SCHOOL WITH A BREAKDOWN OF CHARGES ALONG WITH A COPY OF THE GRADES FOR THE COURSES BEING REIMBURSED. ALL DOCUMENTS SHOULD THEN BE SUBMITTED FOR REVIEW AND APPROVAL. 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. THE TOBACCO CESSATION PROGRAM AND THE CAREERS IN HEALTH CLUB WERE FUNDED FROM DONATIONS RECEIVED FROM THE MISSOURI FOUNDATION FOR HEALTH. THE TOBACCO CESSATION PROGRAM OFFERS CLASSES AND SUPPLIES TO MEMBERS OF THE COMMUNITY/EMPLOYEES TO ASSIST THEM WITH SMOKING CESSATION. THIS PROGRAM IS MONITORED BY THE HEALTH AND WELLNESS DEPARTMENT. THE CAREERS IN HEALTH CLUB WAS SET-UP TO ENCOURAGE AND EXPOSE STUDENTS TO CONSIDER HEALTHCARE AS A CAREER CHOICE. THIS PROGRAM IS MONITORED BY THE HEALTH AND WELLNESS DEPARTMENT AND BRANSON SCHOOLS.
Schedule I (Form 990) 2012


Additional Data


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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
2012
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 of 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 filing organization used 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
Yes
 
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 Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 50053T
Schedule J (Form 990) 2012

Schedule J (Form 990) 2012
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 (E) amounts for that individual.
(A) Name and Title (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)JAKE MCWAYDIRECTOR BEGINNING 1/2013 (i)
(ii)		 0
417,213 		0
110,374 		0
107,730 		0
89,979 		0
17,867 		0
743,163 		0
85,023
(2)JOHN DUFFDIRECTOR BEGINNING 1/2013 (i)
(ii)		 0
333,629 		0
90,783 		0
69,163 		0
117,838 		0
21,250 		0
632,663 		0
34,836
(3)STEVE EDWARDSDIRECTOR BEGINNING 1/2013 (i)
(ii)		 0
630,893 		0
120,585 		0
150,077 		0
123,397 		0
19,731 		0
1,044,683 		0
139,676
(4)WILLIAM MAHONEYCEO (i)
(ii)		 396,030
0 		32,725
0 		363
0 		5,000
0 		27,290
0 		461,408
0 		0
0
(5)DAVID STRONGCFO (i)
(ii)		 220,190
0 		0
0 		7,149
0 		4,699
0 		25,760
0 		257,798
0 		0
0
(6)DIANE CORNELISONPHYSICIAN (i)
(ii)		 515,928
0 		1,800
0 		1,765
0 		15,411
0 		10,696
0 		545,600
0 		0
0
(7)JOHN HUFFMANPHYSICIAN (i)
(ii)		 527,931
0 		0
0 		0
0 		15,636
0 		16,971
0 		560,538
0 		0
0
(8)MITTIE DRAGOSLJVICHPHYSICIAN (i)
(ii)		 645,850
0 		0
0 		1,944
0 		18,131
0 		25,149
0 		691,074
0 		0
0
(9)NARIN ARUNAKULPHYSICIAN (i)
(ii)		 768,110
0 		1,800
0 		27,163
0 		10,500
0 		23,122
0 		830,695
0 		0
0
(10)PRASERT VIJITBENJARONKPHYSICIAN (i)
(ii)		 531,851
0 		1,800
0 		17,016
0 		5,000
0 		23,272
0 		578,939
0 		0
0
(11)SHERYL TILUSCNO ENDING 4/2013 (i)
(ii)		 173,679
0 		0
0 		17
0 		3,597
0 		23,947
0 		201,240
0 		0
0
(12)CAROL MURROWVP BUSINESS DEVELOPMENT (i)
(ii)		 149,127
0 		0
0 		17,074
0 		6,047
0 		10,812
0 		183,060
0 		0
0
(13)PETER MARCELLUSFORMER DIR. MEDICAL AFFAIRS (i)
(ii)		 172,931
0 		0
0 		863
0 		7,273
0 		20,805
0 		201,872
0 		0
0
Schedule J (Form 990) 2012

Schedule J (Form 990) 2012
Page 3
Part III
Supplemental Information
Complete this part to provide the information, explanation, or descriptions required for Part I, lines 1a, 1b, 3, 4a, 4b, 4c, 5a, 5b, 6a, 6b, 7, and 8, and for Part II.
Also complete this part for any additional information.
Identifier Return Reference Explanation
GROSS-UP PAYMENTS SCHEDULE J, PART I, LINE 1 DOCTOR ARUNAKUL RECEIVED GROSS-UP PAYMENTS ON FORGIVEN PRINCIPAL AND INTEREST. STRONG, MURROW, TILUS AND VIJITBENJARONK RECEIVED GROSS-UP PAYMENTS ON GIFT CARDS. ALL AMOUNTS WERE TREATED AS TAXABLE.
SUPPLEMENTAL NONQUALIFIED RETIREMENT PLAN SCHEDULE J, PART I, LINE 4B STEVE EDWARDS, JACOB MCWAY, AND JOHN DUFF PARTICIPATE IN A 457(F) NONQUALIFIED RETIREMENT PLAN THROUGH LESTER E. COX MEDICAL CENTERS, A RELATED ORGANIZATION. - STEVE EDWARDS RECEIVED AN EXECUTIVE 457(F) CONTRIBUTION OF $110,897. - STEVE EDWARDS RECEIVED A 457(F) DISTRIBUTION OF $139,676, WHICH WAS REPORTED AS DEFERRED COMPENSATION ON A PRIOR FORM 990. - JACOB MCWAY RECEIVED AN EXECUTIVE 457(F) CONTRIBUTION OF $77,479. - JACOB MCWAY RECEIVED A 457(F) DISTRIBUTION OF $85,023, WHICH WAS REPORTED AS DEFERRED COMPENSATION ON A PRIOR FORM 990. - JOHN DUFF RECEIVED AN EXECUTIVE 457(F) CONTRIBUTION OF $105,338. - JOHN DUFF RECEIVED A 457(F) DISTRIBUTION OF $34,836, WHICH WAS REPORTED AS DEFERRED COMPENSATION ON A PRIOR FORM 990.
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) 2012

Additional Data


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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
2012
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 . . . . . . . . . . . . . . 3,745,000      
2 Amount of bonds legally defeased . . . . . . . . . . . 13,890,000      
3 Total proceeds of issue . . . . . . . . . . . . . . 18,700,518      
4 Gross proceeds in reserve funds . . . . . . . . . . . . 0      
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 Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 50193E
Schedule K (Form 990) 2012
Schedule K (Form 990) 2012
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            
8a Has there been a sale or disposition of any of the bond financed property to a nongovernmental person other than a 501(c)(3) organization since the bonds were issued?. . . . . . . . . . . . . . . . .   X            
b If “Yes” to line 8a, enter the percentage of bond-financed property sold or disposed of. 0.00000%   %   %   %
c If “Yes” to line 8a, was any remedial action taken pursuant to Regulations sections 1.141-12 and 1.145-2? . . . . . . . . . . . . .   X            
9 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 the issuer filed Form 8038-T? . . . . .   X            
2 If "No" to line 1, did the following apply? . . . .
a Rebate not due yet? . . . . . . . .                
b Exception to rebate? . . . . . . . .                
c No rebate due? . . . . . . . . . .
X              
If you checked "No rebate due" in line 2c, provide in Part VI the date the rebate computation was performed
3 Is the bond issue a variable rate issue? . . . .   X            
4a 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? . . . . . . .                
Schedule K (Form 990) 2012
Schedule K (Form 990) 2012
Page 3
Part IV
Arbitrage (Continued)
A B C D
Yes No Yes No Yes No Yes No
5a Were gross proceeds invested in a guaranteed investment contract (GIC)? . . . . . . . . . X              
b Name of provider . . . . . . . . . AIG MATCHED FUND CO
  		 
  		 
  		 
 
c Term of GIC . . . . . . . . . . 23.4      
d Was the regulatory safe harbor for establishing the fair market value of the GIC satisfied? . . . . . X              
6 Were any gross proceeds invested beyond an available temporary period? . . . . . . . . X              
7 Has the organization established written procedures to monitor the requirements of section 148? . . . X              
Part V
Procedures To Undertake Corrective Action
A B C D
Yes No Yes No Yes No Yes No
1 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? X              
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, COLUMN A THE AMOUNT ENTERED IN PART II, LINE 3, COLUMN A IS GREATER THAN THE "ISSUE PRICE" OF THE BONDS ENTERED ON PART I, LINE A, 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."
GROSS PROCEEDS IN RESERVE FUNDS SCHEDULE K, PART II, LINE 4, COLUMN A THE BONDS ARE NO LONGER OUTSTANDING. ALL AMOUNTS IN THE DEBT SERVICE RESERVE FUND WERE USED TO REDEEM THE BONDS ON MAY 6, 2013.
NO REBATE DUE SCHEDULE K, PART IV, LINE 2(C), COLUMN A THE FINAL REBATE COMPUTATION WAS PERFORMED AS OF MAY 6, 2013.
Schedule K (Form 990) 2012

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, line 38a or 40b.
MediumBullet Attach to Form 990 or Form 990-EZ. MediumBullet See separate instructions.
OMB No. 1545-0047
2012
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) Relationship between disqualified person and organization (c) Description of transaction (d) Corrected?
Yes No





2
Enter the amount of tax incurred by 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-EZ, Part V, line 38a, or Form 990, Part IV, line 26; or if the organization reported an amount on Form 990, Part X, line 5, 6, or 22
(a) Name of interested person (b) Relationship with organization (c) Purpose of loan (d) Loan to or from the organization? (e)Original principal amount (f)Balance due (g) In default? (h) Approved by board or committee? (i)Written agreement?
To From Yes No Yes No Yes No
Total ......Small Bullet $ 0
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 assistance (d) Type of assistance (e) Purpose of assistance
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.
Cat. No. 50056A
Schedule L (Form 990 or 990-EZ) 2012
Schedule L (Form 990 or 990-EZ) 2012
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 SYSTEMS SEE PART V. 175,800 PHO DUES & ADMIN FEES   No
(2) WHITE RIVER VALLEY ELECTRIC COOP SEE PART V. 156,479 LOAN REPAYMENT & ELECTRIC SVC   No
(3) CONNIE MARCELLUS SPOUSE OF PETER MARCELLUS 19,444 COMPENSATION   No
(4) 360 DEGREE MEDICINE SEE PART V 4,706,184 CONTRACTED PHYSICIANS   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
TRANSACTIONS WITH INTERESTED PERSONS SCHEDULE L, PART IV, COLUMN B (1) SKAGGS HEALTH SYSTEMS AND COX MEDICAL CENTER BRANSON 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 SYSTEMS. (2) BOB SIMMONS, A BOARD MEMBER OF COX MEDICAL CENTER BRANSON, IS ALSO A BOARD MEMBER OF WHITE RIVER VALLEY ELECTRIC COOP. (4) RICHARD BLUBAUGH, A BOARD MEMBER OF COX MEDICAL CENTER BRANSON, IS ALSO A BOARD MEMBER AND MANAGING PARTNER OF 360 DEGREE MEDICINE.
Schedule L (Form 990 or 990-EZ) 2012

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
2012
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 VISION: THE HOSPITAL'S VISION IS TO BE THE BEST FOR THOSE WHO NEED US. WE VALUE SAFETY, COMPASSION, RESPECT AND INTEGRITY. THE HOSPITAL HAS BEEN SERVING SOUTHWEST MISSOURI RESIDENTS FOR MORE THAN 62 YEARS AND OFFERS OVER 25 MAJOR SERVICE AREAS. THE HOSPITAL'S AVERAGE DAILY PATIENT CENSUS EXCEEDS 90 WITH 165 LICENSED HOSPITAL BEDS. A STAFF OF OVER 1,000 PERSONNEL IS REQUIRED TO OPERATE THE HOSPITAL AND ITS NUMEROUS CLINICS. ON JUNE 28, 2012, THE HOSPITAL SIGNED A NONBINDING LETTER OF INTENT WITH LESTER E. COX MEDICAL CENTERS (COXHEALTH) TO EXCLUSIVELY NEGOTIATE A DEFINITIVE AGREEMENT WHEREBY COXHEALTH REPLACES THE TRUSTEES OF THE HOSPITAL TO BECOME THE SOLE MEMBER AND OWNER. THE LETTER OF INTENT WAS THE RESULT OF A FOUR MONTH PROCESS WHICH BEGAN IN FEBRUARY 2012 WITH THE HOSPITAL ISSUING A REQUEST FOR PROPOSAL. COXHEALTH AND ONE OTHER FINALIST WERE SELECTED TO UNDERGO THE INITIAL DUE DILIGENCE PROCESS AND NEGOTIATE A LETTER OF INTENT. COXHEALTH WAS SELECTED AS THE FINALISTS BY THE HOSPITAL'S BOARD. UNDER THE AGREEMENT, A MEMBER SUBSTITUTION MODEL, THE HOSPITAL CONTINUES TO MAINTAIN ITS OWN HOSPITAL BOARD WHILE BECOMING A SUBSIDIARY OF COXHEALTH. COXHEALTH, AS THE PARENT COMPANY, ASSUMES THE RESPONSIBILITIES PREVIOUSLY HELD BY THE SKAGGS BOARD OF TRUSTEES. ADDITIONALLY, COXHEALTH WILL HAVE REPRESENTATION ON THE SKAGGS BOARD AND SKAGGS WILL HAVE REPRESENTATION ON THE COXHEALTH BOARD. THIS ALLOWS BOTH PARTIES TO ACT TOGETHER AS ONE ENTITY FOR THE PURPOSES OF CONTRACTING, RECRUITMENT AND GROWTH. IN JANUARY 2013 THE HOSPITAL BECAME A PART OF THE COXHEALTH NETWORK, DOING BUSINESS AS COX MEDICAL CENTER BRANSON.
PROGRAM SERVICE ACHIEVEMENT #1 FORM 990, PART III, LINE 4A COX MEDICAL CENTER BRANSON PROVIDES THE FOLLOWING AREAS OF SERVICE: CANCER, CARDIAC, DIABETES & ENDOCRINOLOGY, EAR NOSE & THROAT, EMERGENCY, URGENT CARE, FAMILY MEDICINE, 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 THE FISCAL YEAR COX BRANSON BEGAN PROVIDING THE FULLTIME SERVICES OF A PHYSICIAN'S ASSISTANT AT FAITH COMMUNITY HEALTH CLINIC, WHICH PROVIDES TREATMENT AND PREVENTATIVE HEALTHCARE FOR THE UNINSURED AND UNDERINSURED MEMBERS OF THE COMMUNITY. ADDITIONALLY, MARKETING AND COMMUNICATIONS EFFORTS WERE PROVIDED TO THE CLINIC BY COX BRANSON. IN THE FISCAL YEAR COX BRANSON TOOK THE LEAD IN BRINGING TOGETHER AREA ORGANIZATIONS WITH THE SIMILAR GOAL OF ADDRESSING THE HEALTHCARE NEEDS OF THE COMMUNITY, AS IDENTIFIED BY THE COMMUNITY NEEDS ASSESSMENT: UNHEALTHY BODY WEIGHT, ACCESS TO CARE, MENTAL HEALTH, AND SUBSTANCE ABUSE - INCLUDING TOBACCO, AND CHILD AND FAMILY SAFETY. THE COALITION IS NAMED OWNIT AND IS LED BY A STEERING COMMITTEE AND MEMBERS MAKE UP SUCH AGENCIES AND ORGANIZATIONS AS THE TANEY AND STONE COUNTY HEALTH DEPARTMENTS AND MORE. INITIATIVES THAT HAVE BEEN CREATED AS A RESULT OF THIS COALITION ARE: - "STAYING FIT" - A GRANT FUNDED PROGRAM THAT TARGETS AREA YOUTH AND OBESITY. - "TRI-LAKES CLEAN AIR ALLIANCE" - A GRANT FUNDED PROGRAM THAT EDUCATES THE COMMUNITY OF THE DANGERS OF TOBACCO USE AND DRIVES AN INITIATIVE TO CHANGE POLICY. IN FEBRUARY OF 2013, COX BRANSON PRESENTED A ONE DAY HEALTH FAIR. THE EVENT INCLUDED LOW-COST AND FREE HEALTH SCREENINGS, FREE HEALTH PRESENTATIONS AND FREE FITNESS CLASSES. APPROXIMATELY 500 PEOPLE ATTENDED WITH 250 PARTICIPATING IN THE LOW-COST SCREENINGS. IN APRIL OF 2013, THANKS IN PART TO GRANT FUNDING SECURED BY SKAGGS FOUNDATION, COX BRANSON BEGAN PROVIDING TOBACCO CESSATION CLASSES, LED BY AN INSTRUCTOR WHO IS A CERTIFIED TOBACCO TREATMENT SPECIALIST THROUGH THE MAYO CLINIC AND CERTIFIED THROUGH THE ALA AS A FREEDOM FROM SMOKING FACILITATOR. SUBSTANCE ABUSE, INCLUDING TOBACCO USE, IS IDENTIFIED AS A HEALTHCARE NEED IN THE COMMUNITY HEALTH ASSESSMENT. IN APRIL OF 2013, COX BRANSON PRESENTED THE SAFE SUMMER INJURY PREVENTION EXPO FOR KIDS AND FAMILIES. THE FREE, ONE DAY EVENT HIGHLIGHTED THE COMMON INJURIES CHILDREN SUFFER DURING THE SUMMER MONTHS: WATER-RELATED, BICYCLE AND OTHER WHEELED SPORTS, AND PEDESTRIAN INJURIES. THROUGH FISCAL YEAR 2013 A TOTAL OF TWO COMMUNITY SCREENINGS WERE HELD AT COX MEDICAL CENTER BRANSON'S MAIN CAMPUS AND A SATELLITE CLINIC IN KIMBERLING CITY. A TOTAL OF 50 PEOPLE TOOK PART IN THE LOW-COST AND FREE SCREENINGS PROVIDED. LOW-COST SCREENINGS INCLUDE: CHOLESTEROL, A1C AND PSA AND A COMPLETE LIPID PANEL. FREE SCREENINGS INCLUDE: BMI, BODY FAT, HEIGHT, WEIGHT, BLOOD PRESSURE. NEW EQUIPMENT/SERVICES IN FISCAL YEAR 2013 COX BRANSON PURCHASED THE BECKMAN COULTER POWER PROCESSOR SAMPLE HANDLING SYSTEM AND CLINICAL CHEMISTRY SYSTEM, WHICH UPDATES EQUIPMENT THAT WAS EIGHT YEARS OLD. THIS ELECTRONIC, AUTOMATED ASSEMBLY LINE READS BAR-CODED TUBES OF BLOOD AND MUCH MORE. THE OUTCOME IS PATIENTS' LAB RESULTS BEING PROCESSED FASTER - MORE THAN 300 SAMPLES PER HOUR. THE COST OF THE NEW EQUIPMENT IS $1 MILLION DOLLARS, TO BE PAID FOR OVER THE NEXT SEVEN YEARS. INTERVENTIONAL CARDIOLOGISTS AT COXHEALTH CARDIOLOGY BRANSON ARE ON THE CUTTING EDGE OF CARDIAC CATHETERIZATION, INTRODUCING IN FISCAL YEAR 2013, A NEW ACCESS POINT, THE RADIAL ARTERY, TO REDUCE RECOVERY TIME, BLEEDING AND SAVE MONEY. ADDITIONAL PROGRAMS WITH A FOCUS ON ADDRESSING THE COMMUNITY'S UNHEALTHY BODY WEIGHT, AS IDENTIFIED BY THE COMMUNITY NEEDS ASSESSMENT, THE FOLLOWING PROGRAMS WERE OFFERED BY COXHEALTH FITNESS CENTER BRANSON IN FISCAL YEAR 2013: "THE 101 DAY WEIGHT LOSS CHALLENGE" AND "MAINTAIN DON'T GAIN." THESE PROGRAMS PROVIDED A DISCOUNT TO ACCESS THE FITNESS CENTER AND ATTEND UNLIMITED BOOT CAMPS WITH CERTIFIED PERSONAL TRAINERS.
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.
AUDITED FINANCIAL STATEMENTS FORM 990, PART IV, LINE 20B THE ORGANIZATION DID NOT RECEIVE AN AUDIT FOR THE FISCAL YEAR ENDING APRIL 30, 2013. IN ACCORDANCE WITH THE BYLAWS, WHICH WERE UPDATED AS A RESULT OF THE AGREEMENT WITH COXHEALTH, THE ORGANIZATION HAS ADOPTED A NEW FISCAL YEAR, ENDING SEPTEMBER 3O. COX MEDICAL CENTER BRANSON IS INCLUDED IN THE CONSOLIDATED AUDIT OF THE COXHEALTH SYSTEM FOR THE YEAR ENDED SEPTEMBER 30, 2013, WHICH IS ATTACHED TO THIS RETURN.
SIGNIFICANT CHANGES TO ORGANIZATIONAL DOCUMENTS FORM 990, PART VI, SECTION A, LINE 4 ON JUNE 28, 2012, THE HOSPITAL SIGNED A NONBINDING LETTER OF INTENT WITH LESTER E. COX MEDICAL CENTERS (COXHEALTH) TO EXCLUSIVELY NEGOTIATE A DEFINITIVE AGREEMENT WHEREBY COXHEALTH REPLACES THE TRUSTEES OF THE HOSPITAL TO BECOME THE SOLE MEMBER AND OWNER. UNDER THE AGREEMENT, A MEMBER SUBSTITUTION MODEL, THE HOSPITAL CONTINUES TO MAINTAIN ITS OWN HOSPITAL BOARD WHILE BECOMING A SUBSIDIARY OF COXHEALTH. COXHEALTH, AS THE PARENT COMPANY, ASSUMES THE RESPONSIBILITIES PREVIOUSLY HELD BY THE SKAGGS BOARD OF TRUSTEES. ADDITIONALLY, COXHEALTH WILL HAVE REPRESENTATION ON THE SKAGGS BOARD AND SKAGGS WILL HAVE REPRESENTATION ON THE COXHEALTH BOARD. THIS ALLOWS BOTH PARTIES TO ACT TOGETHER AS ONE ENTITY FOR THE PURPOSES OF CONTRACTING, RECRUITMENT AND GROWTH. AS PART OF THE AGREEMENT, SKAGGS COMMUNITY HOSPITAL ASSOCIATION, DOING BUSINESS AS COX MEDICAL CENTER BRANSON, AMENDED ITS BYLAWS. SIGNIFICANT CHANGES RELATED TO THE AGREEMENT ARE AS FOLLOWS: - IN JANUARY 2013 THE HOSPITAL BECAME A PART OF THE COXHEALTH NETWORK, DOING BUSINESS AS COX MEDICAL CENTER BRANSON. - COX BRANSON SHALL HAVE ONE MEMBER WHICH SHALL BE LESTER E. COX MEDICAL CENTERS (COXHEALTH). THE POWERS AND DUTIES OF THE MEMBER WERE ALSO UPDATED. SEE NARRATIVE FOR FORM 990, PART VI, LINES 6, 7A & 7B FOR ADDITIONAL DETAILS. - THE AFFAIRS OF COX BRANSON SHALL BE MANAGED, SUPERVISED AND CONTROLLED BY A BOARD CONSISTING OF AT LEAST ELEVEN (11), BUT NOT MORE THAN FIFTEEN (15) MEMBERS. THE BOARD SHALL CONSIST OF THE FOLLOWING REPRESENTATIVES OF THE MEMBER: PRESIDENT AND CEO OF THE MEMBER; A MEMBER DESIGNATED BY THE PRESIDENT AND CEO OF THE MEMBER AND THE CHO OF THE MEMBER ("MEMBER DIRECTORS"). THREE (3) DIRECTORS SHALL BE FROM THE ACTIVE COX BRANSON MEDICAL STAFF. THESE NON-MEMBER REPRESENTATIVE DIRECTORS SHALL HAVE THEIR PRIMARY RESIDENCE IN THE BRANSON, MISSOURI AREA UNLESS A MAJORITY OF THE APPROVES OTHERWISE. - THE FISCAL YEAR OF COX BRANSON SHALL BEGIN OCTOBER 1 AND END SEPTEMBER 30.
MEMBERS, STOCKHOLDERS, OR OTHER PERSONS FORM 990, PART VI, SECTION A, LINES 6, 7A & 7B THE ORGANIZATION HAS ONLY ONE MEMBER - LESTER E COX MEDICAL CENTERS (COXHEALTH). THE FOLLOWING CORPORATE POWERS AND RESPONSIBILITIES SHALL BE SOLELY AND SPECIFICALLY RESERVED TO THE MEMBER; A. ELECTION, APPOINTMENT AND REMOVAL OF COX BRANSON BOARD OF DIRECTORS ("BOARD") AFTER NOMINATION BY THE BOARD; B. APPOINTMENT AND REMOVAL OF THE PRESIDENT AND CHIEF EXECUTIVE OFFICER OF COX BRANSON ("PRESIDENT AND CEO OF COX BRANSON") AFTER RECOMMENDATION BY/CONSULTATION WITH THE BOARD; C. APPROVAL OF COX BRANSON'S UNBUDGETED DEBT AND CAPITAL EXPENDITURES EXCEEDING $250,000; D. APPROVAL OF COX BRANSON'S OPERATING AND CAPITAL BUDGETS AND FINANCIAL REPORTS, MERGERS, CONSOLIDATIONS, ACQUISITIONS, AFFILIATIONS, AND REORGANIZATION OR DISPOSITION OF ASSETS EXCEEDING THE THEN FAIR VALUE OF $250,000; E. AMENDMENT, REPEAL OR ADOPTION OF COX BRANSON'S ARTICLES OF INCORPORATION AND BYLAWS EXCEPT AS OTHERWISE PROVIDED IN THE BYLAWS. THE BOARD SHALL BE ELECTED BY THE MEMBER. NO LATER THAN SEPTEMBER 1 OF EACH YEAR, THE BOARD SHALL NOMINATE A SLATE OF PERSONS FOR ELECTION AS COX BRANSON DIRECTORS AND OFFICERS TO SUBMIT TO THE COXHEALTH BOARD FOR APPOINTMENT. THE COXHEALTH BOARD WILL ACT IN GOOD FAITH AND NOT UNREASONABLY WITHHOLD APPOINTMENT. IF FOR ANY REASON A NOMINATED PERSON IS NOT APPOINTED BY THE COXHEALTH BOARD, THE BOARD HAS THE RIGHT TO NOMINATE ANOTHER PERSON FOR CONSIDERATION. FINAL DECISIONS MADE BY THE BOARD OF THE DIRECTORS MUST ALSO BE APPROVED BY THE COXHEALTH BOARD AS WELL. THE MEMBER SHALL NOT EXERCISE ITS POWERS WITHOUT FIRST OBTAINING APPROVAL FROM TWO-THIRDS (2/3) MAJORITY OF THE BOARD IN THE FOLLOWING CIRCUMSTANCES: A. TRANSFER ANY OF ITS COX BRANSON MEMBERSHIP TO ANY OTHER ENTITY; B. SELL OR LEASE ALL OR SUBSTANTIALLY ALL OF COX BRANSON'S ASSETS; AND C. ENTER INTO A MANAGEMENT AGREEMENT FOR ALL OR SUBSTANTIALLY ALL OF COX BRANSON'S OPERATION. THE MEMBER MAY NOT TERMINATE OR SUBSTANTIALLY LIMIT THE FOLLOWING COX BRANSON SERVICE LINES WITHOUT FIRST OBTAINING APPROVAL FROM TWO-THIRDS (2/3) MAJORITY OF THE BOARD: EMERGENCY DEPARTMENT, CARDIOLOGY, ORTHOPEDICS, PRIMARY CARE, RADIATION AND MEDICAL ONCOLOGY, RADIOLOGY, PATHOLOGY, ANESTHESIA, GENERAL SURGERY, ICU, MEDICAL/SURGICAL SERVICES, ACUTE REHABILITATION SERVICES, WOMEN'S HEALTH SERVICES, GERIATRICS, NEUROSCIENCES, PAIN MANAGEMENT, PSYCHIATRY, UROLOGY AND ENDOCRINOLOGY NOTWITHSTANDING THE ABOVEMENTIONED LIMITATION, THESE SERVICE LINES MAY BE TERMINATED OR SUBSTANTIALLY LIMITED BY THE MEMBER WITHOUT TWO-THIRDS (2/3) MAJORITY OF THE COX BRANSON BOARD IF (I) THERE IS A LOSS OF A LICENSE OR ACCREDITATION REQUIRED TO MAINTAIN SUCH SERVICE, OR A LOSS OF MEDICARE OR MEDICAID CERTIFICATION REQUIRED FOR SUCH SERVICE, IN EACH CASE, OTHER THAN DUE TO THE ACTIONS OR INACTIONS OF THE MEMBER OR COX BRANSON OR (II) THERE IS DESTRUCTION OR MATERIAL DAMAGE TO A FACILITY (PENDING THE PERFORMANCE OR REPAIR OR REPLACEMENT EFFORTS).
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 DIRECTORS AND COMMITTEE MEMBERS SHALL FILE A DISCLOSURE STATEMENT ANNUALLY WITH THE PRESIDENT AND CEO OF COX BRANSON OR HIS/HER DESIGNEE, WHICH DOCUMENT SHALL BE DISCLOSED TO THE BOARD AND THE AUDIT AND COMPLIANCE COMMITTEE OF THE MEMBER. DIRECTORS AND COMMITTEE MEMBERS SHALL INFORM THE BOARD OR COMMITTEE, AS THE CASE MAY BE, OF ANY DUALITY OF INTEREST OR ACTUAL OR POTENTIAL CONFLICT OF INTEREST IN ANY MATTER UNDER CONSIDERATION. SUCH PERSON SHALL NEITHER VOTE NOR USE HIS/HER INFLUENCE TO AFFECT THE DECISION ON THE MATTER, AND SHALL NOT BE COUNTED IN DETERMINING WHETHER A QUORUM PARTICIPATED IN THE DECISION, EVEN WHEN PERMITTED BY LAW. THE MINUTES OF THE MEETING SHALL REFLECT THE DISCLOSURE, ABSTENTION FROM VOTING, AND QUORUM STATUS. NOTHING HEREIN PREVENTS THE BOARD FROM AUTHORIZING, APPROVING OR RATIFYING A BUSINESS RELATIONSHIP OR REACHING A CONCLUSION ON AN ISSUE DESPITE A CONFLICT OF INTEREST OR DUALITY OF INTEREST, SO LONG AS THE PROCEDURES DESCRIBED IN THE BYLAWS ARE FOLLOWED. DISCUSSION: THE PROCEDURES ABOVE SHALL NOT PREVENT THE DIRECTOR OR COMMITTEE MEMBER FROM BRIEFLY STATING HIS/HER POSITION ON THE MATTER, OR FROM ANSWERING PERTINENT QUESTIONS ABOUT IT, IF THE DUTIES SET FORTH HEREIN ARE SUBJECT TO THE RESERVED POWERS OF THE MEMBER'S KNOWLEDGE OR EXPERTISE COULD ASSIST THOSE PARTICIPATING IN THE DECISION. ALL DIRECTORS SHALL BE INFORMED OF THIS ARTICLE BY THE PRESIDENT AND CEO OF COX BRANSON UPON TAKING OFFICE. VOTING: DIRECTORS AND COMMITTEE MEMBERS SHALL INFORM THE BOARD OR COMMITTEE, AS THE CASE MAY BE, OF ANY DUALITY OF INTEREST OR ACTUAL OR POTENTIAL CONFLICT OF INTEREST IN ANY MATTER UNDER CONSIDERATION. SUCH PERSON SHALL NEITHER VOTE NOR USE HIS/HER INFLUENCE TO AFFECT THE DECISION ON THE MATTER, AND SHALL NOT BE COUNTED IN DETERMINING WHETHER A QUORUM PARTICIPATED IN THE DECISION, EVEN WHEN PERMITTED BY LAW. THE MINUTES OF THE MEETING SHALL REFLECT THE DISCLOSURE, ABSTENTION FROM VOTING, AND QUORUM STATUS. NOTHING HEREIN PREVENTS THE BOARD FROM AUTHORIZING, APPROVING OR RATIFYING A BUSINESS RELATIONSHIP OR REACHING A CONCLUSION ON AN ISSUE DESPITE A CONFLICT OF INTEREST OR DUALITY OF INTEREST, SO LONG AS THE PROCEDURES DESCRIBED IN THIS ARTICLE ARE FOLLOWED. THE POLICY ABOVE SHALL NOT PREVENT THE DIRECTOR OR COMMITTEE MEMBER FROM BRIEFLY STATING HIS/HER POSITION ON THE MATTER, OR FROM ANSWERING PERTINENT QUESTIONS ABOUT IT, IF THE DUTIES SET FORTH HEREIN ARE SUBJECT TO THE RESERVED POWERS OF THE MEMBER'S KNOWLEDGE OR EXPERTISE COULD ASSIST THOSE PARTICIPATING IN THE DECISION. NOTICE: ALL DIRECTORS SHALL BE INFORMED OF THIS ARTICLE BY THE PRESIDENT AND CEO OF COX BRANSON UPON TAKING OFFICE.
COMPENSATION REVIEW FORM 990, PART VI, SECTION B, LINES 15A & 15B THE COMPENSATION AND BENEFITS COMMITTEE, COMPRISED OF INDEPENDENT DIRECTORS, MET ON 10/23/2012 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.
OTHER FEES FOR SERVICES FORM 990, PART IX, LINE 11G OTHER FEES FOR SERVICES ARE COMPRISED OF THE FOLLOWING CATEGORIES: $ 6,642,284 CONTRACT SERVICES 4,074,111 OTHER CONTRACTS 4,080,277 NON-LABOR CONTRACTED SERVICES 4,124,251 PHYSICIAN CONTRACT LABOR 3,043,297 CONTRACTED LAB SERVICES 1,131,186 NON-PHYSICIAN CONTRACT LABOR 763,180 CONTRACTED COLLECTION AGENCY 689,518 CONTRACTED CONSULTING SERVICES 306,269 CONTRACTED TRANSCRIPTION SERVICES 104,017 CONTRACTED X-RAY SERVICES ---------- $24,958,390 TOTAL
OTHER CHANGES IN NET ASSETS FORM 990, PART XI, LINE 9 $30,334,482 ASSET FAIR VALUE ADJUSTMENT 1,494,623 CHANGE IN INVESTMENT IN SKAGGS FOUNDATION 630,231 CHANGE IN BENEFICIAL INTEREST IN PERPETUAL TRUST ---------- $32,459,336 TOTAL
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.
Cat. No. 51056K
Schedule O (Form 990 or 990-EZ) 2012

Additional Data


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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
2012
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" to Form 990, Part IV, line 33.)
(a)
Name, address, and EIN (if applicable) 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 CMCB
 
(2) BRANSON HEART CENTER
PO BOX 650
BRANSON,MO65615
30-0497209 		BILLING MO 0 0 CMCB
 
(3) SKAGGS OCCUPATIONAL HEALTH
PO BOX 650
BRANSON,MO65615
38-3774737 		BILLING MO 0 0 CMCB
 
(4) BRANSON FAMILY MEDICINE CLINIC
PO BOX 650
BRANSON,MO65615
32-2331834 		BILLING MO 0 0 CMCB
 
(5) BRANSON ORTHONEURO CENTER LLC
PO BOX 650
BRANSON,MO65615
17-1952089 		MED BLDG MO 641,636 8,189,932 CMCB
 


Part II
Identification of Related Tax-Exempt Organizations (Complete if the organization answered "Yes" to 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 entity?
Yes No
(1) COX ALTERNATIVE CARE OF THE OZARKS INC

PO BOX 10939

SPRINGFIELD,MO65808
43-1641925 		HOME HEALTH MO 501(C)(3) 9 COXHEALTH
 
 
No
(2) COXHEALTH FOUNDATION

3525 S NATIONAL SUITE 204

SPRINGFIELD,MO65807
43-6810485 		FUNDRAISING MO 501(C)(3) 11 A I COXHEALTH
 
 
No
(3) COXHEALTH HME CRE SVCS OF THE MDWST INC

3850 S NATIONAL

SPRINGFIELD,MO65807
26-4781194 		HOME HEALTH MO 501(C)(3) 9 COXHEALTH
 
 
No
(4) COX HPS OF THE OZARKS INC

2220 W SUNSET

SPRINGFIELD,MO65807
43-1641927 		HOME HEALTH MO 501(C)(3) 9 COXHEALTH
 
 
No
(5) COX-MONETT HOSPITAL INC

801 LINCOLN AVE

MONETT,MO65708
43-1656689 		HOSPITAL MO 501(C)(3) 3 COXHEALTH
 
 
No
(6) COX-MONETT HOSPITAL AUXILIARY

801 LINCOLN AVE

MONETT,MO65708
43-1852817 		FUNDRAISING MO 501(C)(3) 9 COXHEALTH
 
 
No
(7) HEALTH ENRICHMENT SERVICES INC

3801 S NATIONAL

SPRINGFIELD,MO65807
36-3263313 		MED SVC MO 501(C)(3) 7 COXHEALTH
 
 
No
(8) HEALTHCARE SERVICES OF THE OZARKS INC

PO BOX 10939

SPRINGFIELD,MO65808
43-1641928 		HOME HEALTH MO 501(C)(3) 9 COXHEALTH
 
 
No
(9) PRIMROSE PLACE INC

1115 E PRIMROSE

SPRINGFIELD,MO65807
43-1183783 		NURSING HOME MO 501(C)(3) 11 a i COXHEALTH
 
 
No
(10) COXHEALTH AUXILIARY

3801 S NATIONAL

SPRINGFIELD,MO65807
43-1090590 		SUPPORT MO 501(C)(3) 9 COXHEALTH
 
 
No
(11) COX MEDICAL CTR GENPROF LIAB LOSS FUND

1423 N JEFFERSON

SPRINGFIELD,MO65802
36-6668576 		SELF-INSURAN MO 501(C)(3) 11 a i COXHEALTH
 
 
No
(12) LESTER E COX MEDICAL CENTERS

1423 N JEFFERSON ST

SPRINGFIELD,MO65802
44-0577118 		HOSPITAL MO 501(C)(3) 3 NA
 
 
No
For Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 50135Y
Schedule R (Form 990) 2012
Schedule R (Form 990) 2012
Page 2
Part III
Identification of Related Organizations Taxable as a Partnership (Complete if the organization answered "Yes" to 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) SKAGGS-COX HEALTH ALLIANCE LL

1423 N JEFFERSON AVENUE
SPRINGFIELD,MO65807
27-1117343 		HEALTHCARE MO COXHEALTH
  		RELATED 0 -64,196   No 0   No 40.000 %
(2) PCRMC-COX HEALTH ALLIANCE LLC

1423 N JEFFERSON AVENUE
SPRINGFIELD,MO65807
30-0649009 		HEALTHCARE MO NA
  		                 










Part IV
Identification of Related Organizations Taxable as a Corporation or Trust (Complete if the organization answered "Yes" to 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
 		(i)
Section 512(b)(13) controlled entity?
Yes No
(1) COX HEALTH SYSTEMS HMO INC

PO BOX 5750
SPRINGFIELD,MO658015750
43-1757075 		HMO MO NA
  		C CORP         No
(2) COX HEALTH SYSTEMS INSURANCE COMPANY

3525 S NATIONAL SUITE 205
SPRINGFIELD,MO65807
43-1684044 		INSURANCE MO NA
  		C CORP         No
(3) MEDICAL DEVELOPMENTS INC

1423 N JEFFERSON AVE
SPRINGFIELD,MO65802
43-1622182 		PHARMACY MO NA
  		C CORP     0 %   No
(4) INSURANCE COMPANY OF SPRINGFIELD INC

GRAND PAVILION CORPORATE CENTRE
GRAND CAYMAN,CJ  
CJ
CAPTIVE INSUR MO NA
  		C CORP     0 %   No






Schedule R (Form 990) 2012
Schedule R (Form 990) 2012
Page 3
Part V
Transactions With Related Organizations (Complete if the organization answered "Yes" to Form 990, Part IV, line 34, 35b, or 36.)
Note. Complete line 1 if any entity is listed in Parts II, III, or IV of this schedule.
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 or (iv) rent from a controlled entity . . . . . . . . . . . . . . . . . . . . . . .
1a
 
No
b Gift, grant, or capital contribution to related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1b
 
No
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 Dividends from related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1f
 
No
g Sale of assets to related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1g
 
No
h Purchase of assets from related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1h
 
No
i Exchange of assets with related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1i
 
No
j Lease of facilities, equipment, or other assets to related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1j
 
No
k Lease of facilities, equipment, or other assets from related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . .
1k
 
No
l Performance of services or membership or fundraising solicitations for related organization(s) . . . . . . . . . . . . . . . . . . . .
1l
 
No
m Performance of services or membership or fundraising solicitations by related organization(s) . . . . . . . . . . . . . . . . . . . .
1m
 
No
n Sharing of facilities, equipment, mailing lists, or other assets with related organization(s) . . . . . . . . . . . . . . . . . . . . .
1n
 
No
o Sharing of paid employees with related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1o
 
No
p Reimbursement paid to related organization(s) for expenses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1p
 
No
q Reimbursement paid by related organization(s) for expenses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1q
 
No
r Other transfer of cash or property to related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1r
 
No
s Other transfer of cash or property from related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1s
 
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-s) 		(c)
Amount involved 		(d)
Method of determining amount involved





Schedule R (Form 990) 2012
Schedule R (Form 990) 2012
Page 4
Part VI
Unrelated Organizations Taxable as a Partnership (Complete if the organization answered "Yes" to 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 section 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) 2012
Schedule R (Form 990) 2012
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


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