TY 2018 Form 990

(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)	(E) Reportable compensation from related organizations (W- 2/1099-MISC)
(1) CHARLES CHUCK CHALENDER...................................................................... 1ST VICE CHAIR	1.0 ................. 1.0	X	X	0	0	0
(2) PATRICIA DIX MD...................................................................... BOARD MEMBER	40.0 ................. 1.0	X		363,260	0	41,496
(3) DENNIS HEIM...................................................................... CHAIR OF THE BOARD	1.0 ................. 1.0	X	X	0	0	0
(4) ROBERT MCDOWELL...................................................................... BOARD MEMBER	1.0 ................. 1.0	X		0	0	0
(5) JAN BAUMGARTNER...................................................................... BOARD MEMBER	1.0 ................. 1.0	X		0	0	0
(6) HAL HIGDON...................................................................... 3RD VICE CHAIR	1.0 ................. 1.0	X	X	0	0	0
(7) JAMES HUTCHESON...................................................................... BOARD MEMBER	1.0 ................. 1.0	X		0	0	0
(8) BRIAN JARED...................................................................... BOARD MEMBER	1.0 ................. 1.0	X		0	0	0
(9) DAVID ZOLFAGHARI MD...................................................................... BOARD MEMBER	1.0 ................. 40.0	X		0	1,125,716	16,320
(10) ROBERT FULP...................................................................... 2ND VICE CHAIR OF THE BOARD	1.0 ................. 1.0	X	X	0	0	0
(11) JANICE HARRIS...................................................................... BOARD MEMBER	1.0 ................. 1.0	X		0	0	0
(12) JOHN JACK PRIM...................................................................... BOARD MEMBER	1.0 ................. 1.0	X		0	0	0
(13) JOSEPH TURNER...................................................................... BOARD MEMBER	1.0 ................. 1.0	X		0	0	0
(14) IBRAHIM ABE ABDALLA MD...................................................................... BOARD MEMBER	40.0 ................. 1.0	X		0	983,315	16,320
(15) STACI NIEMOTH MD...................................................................... BOARD MEMBER	1.0 ................. 40.0	X		0	571,029	16,320
(16) STEVE EDWARDS...................................................................... PRESIDENT AND CEO COXHEALTH	5.0 ................. 40.0		X	0	1,501,873	295,293
(17) JACOB MCWAY...................................................................... SR VP AND CFO COXHEALTH	5.0 ................. 40.0		X	0	891,941	168,179

(A) Name and Title	(B) Average hours per week (list any hours for related organizations below dotted line)	(E) Reportable compensation from related organizations (W- 2/1099-MISC)	(F) Estimated amount of other compensation from the organization and related organizations
(18) VICKIE NELSON........................................................................ SECRETARY TO THE BOARD	5.0 .......................40.0	X			0	65,580	10,981
(19) DAVID STRONG........................................................................ VP HOSPITAL REVENUE & CFO CMCB	20.0 .......................20.0		X		179,197	179,199	58,885
(20) RON PRENGER........................................................................ SR VP, CHIEF HOSPITAL OFFICER	40.0 .......................0.0		X		466,289	0	46,352
(21) GENICE MAROC........................................................................ VP CLINICAL SERVICES	40.0 .......................0.0		X		218,559	0	15,338
(22) MAX BUETOW........................................................................ VP REGIONAL SERVICES	40.0 .......................0.0		X		234,492	0	30,217
(23) JEFF HAWKINS........................................................................ VP CLINICAL SERVICES	40.0 .......................0.0		X		192,346	0	17,781
(24) FRANK ROMERO........................................................................ VP MEDICAL AFFAIRS	40.0 .......................0.0		X		437,331	0	30,400
(25) ROBERT FERGUSON........................................................................ VP FERRELL DUNCAN CLINIC	40.0 .......................0.0		X		314,343	0	25,232
(26) KAREN KRAMER........................................................................ VP, CHIEF NURSING OFFICER	40.0 .......................0.0		X		300,728	0	46,229
(27) AMANDA HEDGPETH........................................................................ VP CLINICAL SERVICES	40.0 .......................0.0		X		188,271	0	17,303
(28) LOUIS KRENN MD........................................................................ PHYSICIAN	40.0 .......................0.0			X	633,710	0	29,735
(29) ARMIN KAMYAB MD........................................................................ PHYSICIAN	40.0 .......................0.0			X	1,127,346	0	39,688
(30) NAGIB CHOWDHURY MD........................................................................ PHYSICIAN	40.0 .......................0.0			X	533,874	0	39,688
(31) GREGORY STAMPS MD........................................................................ PHYSICIAN	40.0 .......................0.0			X	671,374	0	48,685
(32) ARJIT CHOWDHURY MD........................................................................ PHYSICIAN	40.0 .......................0.0			X	593,202	0	29,735

(A) Name and business address	(B) Description of services	(C) Compensation
SPRINGFIELD NEUROLOGICAL INSTITUTE, 3801 S NATIONAL AVE SPRINGFIELD,MO65804	PHYS REMUNERATION	16,688,149
OZARK ANESTHESIA ASSOCIATES, 1000 E PRIMROSE ST 520 SPRINGFIELD,MO65807	ANESTHESIA SERVICES	9,680,954
360 DEGREE MEDICINE, 108 SUNNY LANE BRANSON WEST,MO65737	PHYSICIAN SERVICES	6,498,213
GE PRECISION HEALTHCARE LLC, PO BOX 843553 DALLAS,TX75284	EQUIP MAINTENANCE	5,102,564
FERRELL DUNCAN BUILDING CO, 1001 E PRIMROSE AVE SPRINGFIELD,MO65737	RENTAL SPACE	3,469,220
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 95

- TIN:

SCHEDULE A
(Form 990 or 990EZ)

Department of the Treasury
Internal Revenue Service

Public Charity Status and Public Support

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

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

Go to www.irs.gov/Form990 for the latest information.

OMB No. 1545-0047

2018

Open to Public
Inspection

Name of the organization

LESTER E COX MEDICAL CENTERS

Employer identification number

44-0577118

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 12, check only one box.)

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

A school described in section 170(b)(1)(A)(ii). (Attach Schedule E (Form 990 or 990-EZ).)

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

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

An organization operated for the benefit of a college or university owned or operated by a governmental unit described in section 170(b)(1)(A)(iv). (Complete Part II.)

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

An organization that normally receives a substantial part of its support from a governmental unit or from the general public described in section 170(b)(1)(A)(vi). (Complete Part II.)

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

An agricultural research organization described in 170(b)(1)(A)(ix) operated in conjunction with a land-grant college or university or a non-land grant college of agriculture. See instructions. Enter the name, city, and state of the college or university:

An organization that normally receives: (1) more than 331/3% of its support from contributions, membership fees, and gross receipts from activities related to its exempt functions—subject to certain exceptions, and (2) no more than 331/3% of its support from gross investment income and unrelated business taxable income (less section 511 tax) from businesses acquired by the organization after June 30, 1975. See section 509(a)(2). (Complete Part III.)

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

An organization organized and operated exclusively for the benefit of, to perform the functions of, or to carry out the purposes of one or more publicly supported organizations described in section 509(a)(1) or section 509(a)(2). See section 509(a)(3). Check the box in lines 12a through 12d that describes the type of supporting organization and complete lines 12e, 12f, and 12g.

Type I. A supporting organization operated, supervised, or controlled by its supported organization(s), typically by giving the supported organization(s) the power to regularly appoint or elect a majority of the directors or trustees of the supporting organization. You must complete Part IV, Sections A and B.

Type II. A supporting organization supervised or controlled in connection with its supported organization(s), by having control or management of the supporting organization vested in the same persons that control or manage the supported organization(s). You must complete Part IV, Sections A and C.

Type III functionally integrated. A supporting organization operated in connection with, and functionally integrated with, its supported organization(s) (see instructions). You must complete Part IV, Sections A, D, and E.

Type III non-functionally integrated. A supporting organization operated in connection with its supported organization(s) that is not functionally integrated. The organization generally must satisfy a distribution requirement and an attentiveness requirement (see instructions). You must complete Part IV, Sections A and D, and Part V.

Check this box if the organization received a written determination from the IRS that it is a Type I, Type II, Type III functionally integrated, or Type III non-functionally integrated supporting organization.

Enter the number of supported organizations ...............................

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

(i) Name of supported organization	(ii) EIN	(iv) Is the organization listed in your governing document?		(v) Amount of monetary support (see instructions)	(vi) Amount of other support (see instructions)
(i) Name of supported organization	(ii) EIN	Yes	No	(v) Amount of monetary support (see instructions)	(vi) Amount of other support (see instructions)


Total

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

Cat. No. 11285F

Schedule A (Form 990 or 990-EZ) 2018

Page 2

Part II

Support Schedule for Organizations Described in Sections 170(b)(1)(A)(iv), 170(b)(1)(A)(vi), and 170(b)(1)(A)(ix)
(Complete only if you checked the box on line 5, 7, 8, or 9 of Part I or if the organization failed to qualify under Part III. If the organization fails to qualify under the tests listed below, please complete Part III.)

Section A. Public Support

Calendar year (or fiscal year beginning in)		(a) 2014	(b) 2015	(c) 2016	(d) 2017	(e) 2018	(f) Total
1	Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grant.") ..
2	Tax revenues levied for the organization's benefit and either paid to or expended on its behalf....
3	The value of services or facilities furnished by a governmental unit to the organization without charge..
4	Total. Add lines 1 through 3
5	The portion of total contributions by each person (other than a governmental unit or publicly supported organization) included on line 1 that exceeds 2% of the amount shown on line 11, column (f)..
6	Public support. Subtract line 5 from line 4.

Section B. Total Support

Calendar year (or fiscal year beginning in)		(a) 2014	(b) 2015	(c) 2016	(d) 2017	(e) 2018	(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 VI.)..
11	Total support. Add lines 7 through 10

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

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

Section C. Computation of Public Support Percentage

Public support percentage for 2018 (line 6, column (f) divided by line 11, column (f)) .........

Public support percentage for 2017 Schedule A, Part II, line 14 ...............

16a

33 1/3% support test—2018. If the organization did not check the box on line 13, and line 14 is 33 1/3% or more, check this box
and stop here. The organization qualifies as a publicly supported organization ....................... right arrow

33 1/3% support test—2017. If the organization did not check a box on line 13 or 16a, and line 15 is 33 1/3% or more, check this
box and stop here. The organization qualifies as a publicly supported organization ..................... right arrow

17a

10%-facts-and-circumstances test—2018. If the organization did not check a box on line 13, 16a, or 16b, and line 14
is 10% or more, and if the organization meets the "facts-and-circumstances" test, check this box and stop here. Explain
in Part VI how the organization meets the "facts-and-circumstances" test. The organization qualifies as a publicly supported
organization ..................................................... right arrow

10%-facts-and-circumstances test—2017. If the organization did not check a box on line 13, 16a, 16b, or 17a, and line
15 is 10% or more, and if the organization meets the "facts-and-circumstances" test, check this box and stop here.
Explain in Part VI how the organization meets the "facts-and-circumstances" test. The organization qualifies as a publicly
supported organization ................................................ right arrow

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

Schedule A (Form 990 or 990-EZ) 2018

Page 3

Part III

Support Schedule for Organizations Described in Section 509(a)(2)
(Complete only if you checked the box on line 10 of Part I or if the organization failed to qualify under Part II. If the organization fails to qualify under the tests listed below, please complete Part II.)

Section A. Public Support

Calendar year (or fiscal year beginning in)		(a) 2014	(b) 2015	(c) 2016	(d) 2017	(e) 2018	(f) Total
1	Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grants.") .
2	Gross receipts from admissions, merchandise sold or services performed, or facilities furnished in any activity that is related to the organization's tax-exempt purpose
3	Gross receipts from activities that are not an unrelated trade or business under section 513 .....
4	Tax revenues levied for the organization's benefit and either paid to or expended on its behalf...
5	The value of services or facilities furnished by a governmental unit to the organization without charge
6	Total. Add lines 1 through 5
7a	Amounts included on lines 1, 2, and 3 received from disqualified persons
b	Amounts included on lines 2 and 3 received from other than disqualified persons that exceed the greater of $5,000 or 1% of the amount on line 13 for the year.
c	Add lines 7a and 7b..
8	Public support. (Subtract line 7c from line 6.)

Section B. Total Support

Calendar year (or fiscal year beginning in)		(a) 2014	(b) 2015	(c) 2016	(d) 2017	(e) 2018	(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 VI.) ..
13	Total support. (Add lines 9, 10c, 11, and 12.)..

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

Section C. Computation of Public Support Percentage

Public support percentage for 2018 (line 8, column (f) divided by line 13, column (f)) .........

Public support percentage from 2017 Schedule A, Part III, line 15 ...............

Section D. Computation of Investment Income Percentage

Investment income percentage for 2018 (line 10c, column (f) divided by line 13, column (f)) ......

Investment income percentage from 2017 Schedule A, Part III, line 17 .............

19a

331/3% support tests—2018. If the organization did not check the box on line 14, and line 15 is more than 33 1/3%, and line 17 is not more than 33 1/3%, check this box and stop here. The organization qualifies as a publicly supported organization ....... right arrow

33 1/3% support tests—2017. If the organization did not check a box on line 14 or line 19a, and line 16 is more than 33 1/3% and line 18 is not more than 33 1/3%, check this box and stop here. The organization qualifies as a publicly supported organization .... right arrow

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

Schedule A (Form 990 or 990-EZ) 2018

Page 4

Part IV

Supporting Organizations

(Complete only if you checked a box on line 12 of Part I. If you checked 12a of Part I, complete Sections A and B. If you checked 12b of Part I, complete Sections A and C. If you checked 12c of Part I, complete Sections A, D, and E. If you checked 12d of Part I, complete Sections A and D, and complete Part V.)

Section A. All Supporting Organizations

Yes

Are all of the organization’s supported organizations listed by name in the organization’s governing documents?
If "No," describe in Part VI how the supported organizations are designated. If designated by class or purpose,
describe the designation. If historic and continuing relationship, explain.

Did the organization have any supported organization that does not have an IRS determination of status under section 509(a)(1) or (2)? If "Yes," explain in Part VI how the organization determined that the supported organization was described in section 509(a)(1) or (2).

Did the organization have a supported organization described in section 501(c)(4), (5), or (6)? If "Yes," answer (b) and (c) below.

Did the organization confirm that each supported organization qualified under section 501(c)(4), (5), or (6) and satisfied the public support tests under section 509(a)(2)? If "Yes," describe in Part VI when and how the organization made the determination.

Did the organization ensure that all support to such organizations was used exclusively for section 170(c)(2)(B) purposes? If "Yes," explain in Part VI what controls the organization put in place to ensure such use.

Was any supported organization not organized in the United States ("foreign supported organization")? If “Yes” and if you checked 12a or 12b in Part I, answer (b) and (c) below.

Did the organization have ultimate control and discretion in deciding whether to make grants to the foreign supported organization? If “Yes,” describe in Part VI how the organization had such control and discretion despite being controlled or supervised by or in connection with its supported organizations.

Did the organization support any foreign supported organization that does not have an IRS determination under sections 501(c)(3) and 509(a)(1) or (2)? If “Yes,” explain in Part VI what controls the organization used to ensure that all support to the foreign supported organization was used exclusively for section 170(c)(2)(B) purposes.

Did the organization add, substitute, or remove any supported organizations during the tax year? If “Yes,” answer (b) and (c) below (if applicable). Also, provide detail in Part VI, including (i) the names and EIN numbers of the supported organizations added, substituted, or removed; (ii) the reasons for each such action; (iii) the authority under the organization's organizing document authorizing such action; and (iv) how the action was accomplished (such as by amendment to the organizing document).

Type I or Type II only. Was any added or substituted supported organization part of a class already designated in the organization's organizing document?

Substitutions only. Was the substitution the result of an event beyond the organization's control?

Did the organization provide support (whether in the form of grants or the provision of services or facilities) to anyone other than (i) its supported organizations, (ii) individuals that are part of the charitable class benefited by one or more of its supported organizations, or (iii) other supporting organizations that also support or benefit one or more of the filing organization’s supported organizations? If “Yes,” provide detail in Part VI.

Did the organization provide a grant, loan, compensation, or other similar payment to a substantial contributor (defined in section 4958(c)(3)(C)), a family member of a substantial contributor, or a 35% controlled entity with regard to a substantial contributor? If “Yes,” complete Part I of Schedule L (Form 990 or 990-EZ) .

Did the organization make a loan to a disqualified person (as defined in section 4958) not described in line 7? If “Yes,” complete Part I of Schedule L (Form 990 or 990-EZ).

Was the organization controlled directly or indirectly at any time during the tax year by one or more disqualified persons as defined in section 4946 (other than foundation managers and organizations described in section 509(a)(1) or (2))? If “Yes,” provide detail in Part VI.

Did one or more disqualified persons (as defined in line 9a) hold a controlling interest in any entity in which the supporting organization had an interest? If “Yes,” provide detail in Part VI.

Did a disqualified person (as defined in line 9a) have an ownership interest in, or derive any personal benefit from, assets in which the supporting organization also had an interest? If “Yes,” provide detail in Part VI.

10a

Was the organization subject to the excess business holdings rules of section 4943 because of section 4943(f) (regarding certain Type II supporting organizations, and all Type III non-functionally integrated supporting organizations)? If “Yes,” answer line 10b below.

10a

Did the organization have any excess business holdings in the tax year? (Use Schedule C, Form 4720, to determine whether the organization had excess business holdings).

10b

Schedule A (Form 990 or 990-EZ) 2018

Page 5

Part IV

Supporting Organizations (continued)

Yes

Has the organization accepted a gift or contribution from any of the following persons?

A person who directly or indirectly controls, either alone or together with persons described in (b) and (c) below, the governing body of a supported organization?

11a

A family member of a person described in (a) above?

11b

A 35% controlled entity of a person described in (a) or (b) above? If “Yes” to a, b, or c, provide detail in Part VI.

11c

Section B. Type I Supporting Organizations

Yes

Did the directors, trustees, or membership of one or more supported organizations have the power to regularly appoint or elect at least a majority of the organization’s directors or trustees at all times during the tax year? If “No,” describe in Part VI how the supported organization(s) effectively operated, supervised, or controlled the organization’s activities. If the organization had more than one supported organization, describe how the powers to appoint and/or remove directors or trustees were allocated among the supported organizations and what conditions or restrictions, if any, applied to such powers during the tax year.

Did the organization operate for the benefit of any supported organization other than the supported organization(s) that operated, supervised, or controlled the supporting organization? If “Yes,” explain in Part VI how providing such benefit carried out the purposes of the supported organization(s) that operated, supervised or controlled the supporting organization.

Section C. Type II Supporting Organizations

Yes

Were a majority of the organization’s directors or trustees during the tax year also a majority of the directors or trustees of each of the organization’s supported organization(s)? If “No,” describe in Part VI how control or management of the supporting organization was vested in the same persons that controlled or managed the supported organization(s).

Section D. All Type III Supporting Organizations

Yes

Did the organization provide to each of its supported organizations, by the last day of the fifth month of the organization’s tax year, (i) a written notice describing the type and amount of support provided during the prior tax year, (ii) a copy of the Form 990 that was most recently filed as of the date of notification, and (iii) copies of the organization’s governing documents in effect on the date of notification, to the extent not previously provided?

Were any of the organization’s officers, directors, or trustees either (i) appointed or elected by the supported organization(s) or (ii) serving on the governing body of a supported organization? If "No," explain in Part VI how the organization maintained a close and continuous working relationship with the supported organization(s).

By reason of the relationship described in (2), did the organization’s supported organizations have a significant voice in the organization’s investment policies and in directing the use of the organization’s income or assets at all times during the tax year? If "Yes," describe in Part VI the role the organization’s supported organizations played in this regard.

Section E. Type III Functionally-Integrated Supporting Organizations

Check the box next to the method that the organization used to satisfy the Integral Part Test during the year (see instructions):

The organization satisfied the Activities Test. Complete line 2 below.

The organization is the parent of each of its supported organizations. Complete line 3 below.

The organization supported a governmental entity. Describe in Part VI how you supported a government entity (see instructions)

Activities Test. Answer (a) and (b) below.

Yes

Did substantially all of the organization’s activities during the tax year directly further the exempt purposes of the supported organization(s) to which the organization was responsive? If "Yes," then in Part VI identify those supported organizations and explain how these activities directly furthered their exempt purposes, how the organization was responsive to those supported organizations, and how the organization determined that these activities constituted substantially all of its activities.

Did the activities described in (a) constitute activities that, but for the organization’s involvement, one or more of the organization’s supported organization(s) would have been engaged in? If "Yes," explain in Part VI the reasons for the organization’s position that its supported organization(s) would have engaged in these activities but for the organization’s involvement.

Parent of Supported Organizations. Answer (a) and (b) below.

Did the organization have the power to regularly appoint or elect a majority of the officers, directors, or trustees of each of the supported organizations? Provide details in Part VI.

Did the organization exercise a substantial degree of direction over the policies, programs and activities of each of its supported organizations? If "Yes," describe in Part VI. the role played by the organization in this regard.

Schedule A (Form 990 or 990-EZ) 2018

Page 6

Part V

Type III Non-Functionally Integrated 509(a)(3) Supporting Organizations

Check here if the organization satisfied the Integral Part Test as a qualifying trust on Nov. 20, 1970 (explain in Part VI). See instructions. All other Type III non-functionally integrated supporting organizations must complete Sections A through E.

	Section A - Adjusted Net Income		(A) Prior Year	(B) Current Year (optional)
1	Net short-term capital gain	1
2	Recoveries of prior-year distributions	2
3	Other gross income (see instructions)	3
4	Add lines 1 through 3	4
5	Depreciation and depletion	5
6	Portion of operating expenses paid or incurred for production or collection of gross income or for management, conservation, or maintenance of property held for production of income (see instructions)	6
7	Other expenses (see instructions)	7
8	Adjusted Net Income (subtract lines 5, 6 and 7 from line 4)	8

	Section B - Minimum Asset Amount		(A) Prior Year	(B) Current Year (optional)
1	Aggregate fair market value of all non-exempt-use assets (see instructions for short tax year or assets held for part of year):	1
a	Average monthly value of securities	1a
b	Average monthly cash balances	1b
c	Fair market value of other non-exempt-use assets	1c
d	Total (add lines 1a, 1b, and 1c)	1d
e	Discount claimed for blockage or other factors (explain in detail in Part VI):
2	Acquisition indebtedness applicable to non-exempt use assets	2
3	Subtract line 2 from line 1d	3
4	Cash deemed held for exempt use. Enter 1-1/2% of line 3 (for greater amount, see instructions).	4
5	Net value of non-exempt-use assets (subtract line 4 from line 3)	5
6	Multiply line 5 by .035	6
7	Recoveries of prior-year distributions	7
8	Minimum Asset Amount (add line 7 to line 6)	8

	Section C - Distributable Amount		Current Year
1	Adjusted net income for prior year (from Section A, line 8, Column A)	1
2	Enter 85% of line 1	2
3	Minimum asset amount for prior year (from Section B, line 8, Column A)	3
4	Enter greater of line 2 or line 3	4
5	Income tax imposed in prior year	5
6	Distributable Amount. Subtract line 5 from line 4, unless subject to emergency temporary reduction (see instructions)	6

Check here if the current year is the organization's first as a non-functionally-integrated Type III supporting organization (see instructions)

Schedule A (Form 990 or 990-EZ) 2018

Page 7

Part V

Type III Non-Functionally Integrated 509(a)(3) Supporting Organizations (continued)

Section D - Distributions		Current Year
1 Amounts paid to supported organizations to accomplish exempt purposes
2 Amounts paid to perform activity that directly furthers exempt purposes of supported organizations, in excess of income from activity
3 Administrative expenses paid to accomplish exempt purposes of supported organizations
4 Amounts paid to acquire exempt-use assets
5 Qualified set-aside amounts (prior IRS approval required)
6 Other distributions (describe in Part VI). See instructions
7Total annual distributions. Add lines 1 through 6.
8 Distributions to attentive supported organizations to which the organization is responsive (provide details in Part VI). See instructions
9 Distributable amount for 2018 from Section C, line 6
10 Line 8 amount divided by Line 9 amount

Section E - Distribution Allocations (see instructions)		(i) Excess Distributions	(ii) Underdistributions Pre-2018	(iii) Distributable Amount for 2018
1 Distributable amount for 2018 from Section C, line 6
2 Underdistributions, if any, for years prior to 2018 (reasonable cause required-- explain in Part VI). See instructions.
3 Excess distributions carryover, if any, to 2018:
a From 2013.......
b From 2014.......
c From 2015.......
d From 2016.......
e From 2017.......
fTotal of lines 3a through e
g Applied to underdistributions of prior years
h Applied to 2018 distributable amount
i Carryover from 2013 not applied (see instructions)
j Remainder. Subtract lines 3g, 3h, and 3i from 3f.
4Distributions for 2018 from Section D, line 7:
$
a Applied to underdistributions of prior years
b Applied to 2018 distributable amount
c Remainder. Subtract lines 4a and 4b from 4.
5 Remaining underdistributions for years prior to 2018, if any. Subtract lines 3g and 4a from line 2. If the amount is greater than zero, explain in Part VI. See instructions.
6 Remaining underdistributions for 2018. Subtract lines 3h and 4b from line 1. If the amount is greater than zero, explain in Part VI. See instructions.
7 Excess distributions carryover to 2019. Add lines 3j and 4c.
8 Breakdown of line 7:
a Excess from 2014......
b Excess from 2015.....
c Excess from 2016.....
d Excess from 2017.....
e Excess from 2018.....

Schedule A (Form 990 or 990-EZ) (2018)

Schedule A (Form 990 or 990-EZ) 2018

Page 8

Part VI

Supplemental Information. Provide the explanations required by Part II, line 10; Part II, line 17a or 17b; Part III, line 12; Part IV, Section A, lines 1, 2, 3b, 3c, 4b, 4c, 5a, 6, 9a, 9b, 9c, 11a, 11b, and 11c; Part IV, Section B, lines 1 and 2; Part IV, Section C, line 1; Part IV, Section D, lines 2 and 3; Part IV, Section E, lines 1c, 2a, 2b, 3a and 3b; Part V, line 1; Part V, Section B, line 1e; Part V Section D, lines 5, 6, and 8; and Part V, Section E, lines 2, 5, and 6. Also complete this part for any additional information. (See instructions).

Facts And Circumstances Test

Return Reference	Explanation

Schedule A (Form 990 or 990-EZ) 2018

Additional Data

Software ID:
Software Version:

- TIN:

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

Department of the Treasury
Internal Revenue Service

Schedule of Contributors

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

Go to www.irs.gov/Form990 for the latest information.

OMB No. 1545-0047

2018

Name of the organization

LESTER E COX MEDICAL CENTERS

Employer identification number

44-0577118

Organization type (check one):

Filers of:

Section:

Form 990 or 990-EZ

501(c)( ) (enter number) organization

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

527 political organization

Form 990-PF

501(c)(3) exempt private foundation

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

501(c)(3) taxable private foundation

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

General Rule

For an organization filing Form 990, 990-EZ, or 990-PF that received, during the year, contributions totaling $5,000 or more (in money or other property) from any one contributor. Complete Parts I and II. See instructions for determining a contributor's total contributions.

Special Rules

For an organization described in section 501(c)(3) filing Form 990 or 990-EZ that met the 33¹/3% support test of the regulations
under sections 509(a)(1) and 170(b)(1)(A)(vi), that checked Schedule A (Form 990 or 990-EZ), Part II, line 13, 16a, or 16b, and that received from any one contributor, during the year, total contributions of the greater of (1) $5,000 or (2) 2% of the amount on (i) Form 990, Part VIII, line 1h, or (ii) Form 990-EZ, line 1. Complete Parts I and II.

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

For an organization described in section 501(c)(7), (8), or (10) filing Form 990 or 990-EZ that received from any one contributor,
during the year, contributions exclusively for religious, charitable, etc., purposes, but no such contributions totaled more than $1,000. If this box is checked, enter here the total contributions that were received during the year for an exclusively religious, charitable, etc., purpose. Don't complete any of the parts unless the General Rule applies to this organization because it received nonexclusively religious, charitable, etc., contributions totaling $5,000 or more during the year ......... Arrow Bullet

Caution. An organization that isn't covered by the General Rule and/or the Special Rules doesn't 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 its Form 990PF, Part I, line 2, to certify that it doesn't 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) (2018)

Schedule B (Form 990, 990-EZ, or 990-PF) (2018) Page 2

Name of organization LESTER E COX MEDICAL CENTERS

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	Person Payroll Noncash (Complete Part II for noncash contributions.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II for noncash contributions.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II for noncash contributions.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II for noncash contributions.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II for noncash contributions.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II for noncash contributions.)
Schedule B (Form 990, 990-EZ, or 990-PF) (2018)

Schedule B (Form 990, 990-EZ, or 990-PF) (2018)

Page 3

Name of organization LESTER E COX MEDICAL CENTERS		Employer identification number 44-0577118

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) (2018)

Schedule B (Form 990, 990-EZ, or 990-PF) (2018)

Page 4


Name of organization LESTER E COX MEDICAL CENTERS			Employer identification number 44-0577118
Part III Exclusively religious, charitable, etc., contributions to organizations described in section 501(c)(7), (8), or (10) that total more than $1,000 for the year from any one contributor. 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.) $ Use duplicate copies of Part III if additional space is needed.

(a)
No. from Part I

(b) Purpose of gift

(d) Description of how gift is held

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

(a)
No. from Part I

(b) Purpose of gift

(d) Description of how gift is held

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

(a)
No. from Part I

(b) Purpose of gift

(d) Description of how gift is held

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

(a)
No. from Part I

(b) Purpose of gift

(d) Description of how gift is held

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

Schedule B (Form 990, 990-EZ, or 990-PF) (2018)

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE C
(Form 990 or 990-EZ)

Department of the Treasury
Internal Revenue Service

Political Campaign and Lobbying Activities

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

SchCMd Bullet

Complete if the organization is described below. SchCMd Bullet

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

Go to www.irs.gov/Form990 for instructions and the latest information.

OMB No. 1545-0047

2018

Open to Public
Inspection

If the organization answered "Yes" on 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" on 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" on Form 990, Part IV, Line 5 (Proxy Tax) (see separate instructions) or Form 990-EZ, Part V, line 35c (Proxy Tax) (see separate instructions), then
Round Bullet

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

Name of the organization

LESTER E COX MEDICAL CENTERS

Employer identification number

44-0577118

Part I-A

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

Provide a description of the organization’s direct and indirect political campaign activities in Part IV (see instructions for definition of “political campaign activities")

Political campaign activity expenditures (see instructions) .................................................................... SchCMd Bullet

Volunteer hours for political campaign activities (see instructions) ..................................................................

Part I-B

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

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

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

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

Yes No

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

Yes No

If "Yes," describe in Part IV.

Part I-C

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

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

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

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

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

Yes No

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

(a) Name	(b) Address	(c) EIN	(d) Amount paid from filing organization's funds. If none, enter -0-.	(e) Amount of political contributions received and promptly and directly delivered to a separate political organization. If none, enter -0-.
1
2
3
4
5
6

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

Cat. No. 50084S

Schedule C (Form 990 or 990-EZ) 2018

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 Bullet

if the filing organization belongs to an affiliated group (and list in Part IV each affiliated group member's name, address, EIN, expenses, and share of excess lobbying expenditures).
B Check SchCMd Bullet

if the filing organization checked box A and "limited control" provisions apply.

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

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

4-Year Averaging Period Under section 501(h) (Some organizations that made a section 501(h) election do not have to complete all of the five columns below. See the separate instructions for lines 2a through 2f.)
Lobbying Expenditures During 4-Year Averaging Period
	Calendar year (or fiscal year beginning in)	(a) 2015	(b) 2016	(c) 2017	(d) 2018	(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) 2018

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 on lines 1a through 1i below, provide in Part IV a detailed description of the lobbying activity.

(a)

Yes

(b)

Amount

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

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

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

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

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

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

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

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

Yes

116,024

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

Other activities? ...................................................................................................................

Yes

45,601

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

161,625

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

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

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

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

Part III-A

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

Yes

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

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

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

Part III-B

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

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

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

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

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

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

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

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

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

Part IV

Supplemental Information

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, lines 1 and 2 (see instructions), and Part ll-B, line 1. Also, complete this part for any additional information.

Return Reference	Explanation
SCHEDULE C, PART II-B, LINE 1G	DIRECT CONTACT WITH LEGISLATORS, ETC: THE ORGANIZATION CONTRACTED WINTON POLICY GROUP AND KELLER MCINTYRE & ASSOCIATES, LOBBYING AND ASSOCIATION MANAGEMENT FIRMS, TO LOBBY ISSUES THAT BENEFIT THE INTERESTS OF THE COMMUNITY, COXHEALTH AND ITS AFFILIATES.
SCHEDULE C, PART II-B, LINE 1I	OTHER LOBBYING ACTIVITIES: MEMBERS OF THE ADMINISTRATIVE STAFF CONTACT LEGISLATORS REGARDING KEY HEALTHCARE ISSUES. ALSO, PORTIONS OF DUES PAID TO THE MISSOURI HOSPITAL ASSOCIATION (MHA) AND THE AMERICAN HOSPITAL ASSOCIATION (AHA) ARE USED FOR LOBBYING PURPOSES. IN FISCAL YEAR 2019, THE AMOUNT ATTRIBUTABLE TO LOBBYING WAS $31,160 FOR MHA AND $14,441 FOR AHA.

Schedule C (Form 990 or 990EZ) 2018

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE D
(Form 990)

Department of the Treasury
Internal Revenue Service

Supplemental Financial Statements

Complete if the organization answered "Yes," on 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

Go to www.irs.gov/Form990 for the latest information.

OMB No. 1545-0047

2018

Open to Public Inspection

Name of the organization

LESTER E COX MEDICAL CENTERS

Employer identification number

44-0577118

Part I

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

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

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

Yes No

Did the organization inform all grantees, donors, and donor advisors in writing that grant funds 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? ...................................

Yes No

Part II

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

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

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

Protection of natural habitat Preservation of a certified historic structure

Preservation of open space

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.


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 7/25/06, and not on a historic structure listed in the National Register ...	2d

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

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

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

Yes No

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

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

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

Yes No

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" on Form 990, Part IV, line 8.

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.

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)

Revenue included on Form 990, Part VIII, line 1 ......................... SchDMd Bullet

(ii)

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

If the organization received or held works of art, historical treasures, or other similar assets for financial gain, provide the
following amounts required to be reported under SFAS 116 (ASC 958) relating to these items:

Revenue included on Form 990, Part VIII, line 1 .......................... SchDMd Bullet

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) 2018

Page 2

Part III

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

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):

Public exhibition

Loan or exchange programs

Scholarly research

Other

Preservation for future generations

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

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

Yes No

Part IV

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

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

Yes No


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

Did the organization include an amount on Form 990, Part X, line 21, for escrow or custodial account liability? ...

Yes No

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" on Form 990, Part IV, line 10.

		(a)Current year	(b)Prior year	(c)Two years back	(d)Three years back	(e)Four years back

1a	Beginning of year balance ....	4,225,941	4,044,690	3,820,777	5,111,030	4,800,435
b	Contributions ...	394,384	418,547	426,535	653,117	486,859
c	Net investment earnings, gains, and losses	99,139	101,204	107,185	107,994	149,724
d	Grants or scholarships ...					22,800
e	Other expenditures for facilities and programs ...	404,311	338,500	309,807	2,051,364	303,188
f	Administrative expenses ....
g	End of year balance ......	4,315,153	4,225,941	4,044,690	3,820,777	5,111,030

Provide the estimated percentage of the current year end balance (line 1g, column (a)) held as:

Board designated or quasi-endowment SchDMd Bullet

Permanent endowment SchDMd Bullet

45.990 %

Temporarily restricted endowment SchDMd Bullet

54.010 %

The percentages on lines 2a, 2b, and 2c should equal 100%.

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

Yes

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

3a(i)

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

3a(ii)

Yes

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

Yes

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

Part VI

Land, Buildings, and Equipment.
Complete if the organization answered "Yes" on Form 990, Part IV, line 11a. 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 .....	27,397,064		27,397,064
b	Buildings ....	400,842,465	208,752,301	192,090,164
c	Leasehold improvements	4,770,006	4,252,114	517,892
d	Equipment ....	714,641,146	523,631,950	191,009,196
e	Other .....	30,505,384	14,691,972	15,813,412
Total. Add lines 1a through 1e. (Column (d) must equal Form 990, Part X, column (B), line 10(c).)..				426,827,728

Schedule D (Form 990) 2018

Page 3

Part VII

InvestmentsOther Securities. Complete if the organization answered "Yes" on Form 990, Part IV, line 11b. 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)
(B)
(C)
(D)
(E)
(F)
(G)
(H)
Total. (Column (b) must equal Form 990, Part X, col. (B) line 12.)

Part VIII

InvestmentsProgram Related. Complete if the organization answered 'Yes' on Form 990, Part IV, line 11c. See Form 990, Part X, line 13.

(a) Description of investment	(b) Book value	(c) Method of valuation: Cost or end-of-year market value
(1)INT IN NA OF TAX EXEMPT SUBS	274,546,314	C
(1)
(2)
(3)
(4)
(5)
(6)
(7)
(8)
(9)
Total. (Column (b) must equal Form 990, Part X, col.(B) line 13.)	274,546,314

Part IX

Other Assets. Complete if the organization answered 'Yes' on Form 990, Part IV, line 11d. See Form 990, Part X, line 15.

(a) Description				(b) Book value

(1)
(2)
(3)
(4)
(5)
(6)
(7)
(8)
(9)
Total. (Column (b) must equal Form 990, Part X, col.(B) line 15.)...........

Part X

Other Liabilities. Complete if the organization answered 'Yes' on Form 990, Part IV, line 11e or 11f. See Form 990, Part X, line 25.

1.(a) Description of liability	(b) Book value
(1) Federal income taxes	0
COXHEALTH AUXILIARY LIABILITIES	55,005
EST AMT DUE TO 3RD PARTIES	6,751,073
DUE TO AFFILIATES	18,467,000
SELF INSURANCE CLAIMS PAYABLE	37,165,053
(5)
(6)
(7)
(8)
(9)
Total. (Column (b) must equal Form 990, Part X, col.(B) line 25.)	62,438,131
2. Liability for uncertain tax positions. 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) 2018

Page 4

Part XI Reconciliation of Revenue per Audited Financial Statements With Revenue per Return Complete if the organization answered 'Yes' on Form 990, Part IV, line 12a.
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 (losses) 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. Complete if the organization answered 'Yes' on Form 990, Part IV, line 12a.
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

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.

Return Reference

Explanation

SCHEDULE D, PART V, LINE 4

INTENDED USE OF ENDOWMENTS: COXHEALTH FOUNDATION, A RELATED ORGANIZATION, HOLDS 19 ENDOWMENT FUNDS WHICH INCLUDE MONIES DONATED TO BE USED FOR SPECIFIC EXPENSES, AND THE INCOME FROM EACH FUND IS TO BE SPENT ON SPECIFIC SERVICES AND PROGRAM FUNCTIONS ON A FUND-BY-FUND BASIS. ENDOWMENT FUNDS HELD BY THE FOUNDATION ARE INTENDED FOR BUT NOT LIMITED TO EXPENDITURES RELATING TO CANCER SERVICES, HEALTH EDUCATION, PURCHASE OF EQUIPMENT AND INDIGENT CARE. THESE SERVICES AND FUNCTIONS BENEFIT COXHEALTH AND ITS AFFILIATES. SCHEDULE D, PART V, LINE 1E, COLUMN C INCLUDES AN AMOUNT REPRESENTING THE BALANCE OF FUNDS THAT ARE HELD FOR THE BENEFIT OF COX COLLEGE, A RELATED ENTITY. THESE FUNDS WERE PREVIOUSLY HELD FOR THE BENEFIT OF LESTER E. COX MEDICAL CENTERS. IN FYE 9/30/16, COX COLLEGE WAS CREATED AND THESE FUNDS WERE DEEMED HELD FOR THE BENEFIT OF COX COLLEGE.

SCHEDULE D, PART X, LINE 2

UNCERTAIN TAX POSITIONS: MANAGEMENT HAS EVALUATED THEIR INCOME TAX POSITIONS UNDER THE GUIDANCE INCLUDED IN ASC 740. BASED ON THEIR REVIEW, MANAGEMENT HAS NOT IDENTIFIED ANY MATERIAL UNCERTAIN TAX POSITIONS TO BE RECORDED OR DISCLOSED IN THE FINANCIAL STATEMENTS.

Schedule D (Form 990) 2018

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE F(Form 990)

Department of the Treasury
Internal Revenue Service

Statement of Activities Outside the United States

Complete if the organization answered "Yes" to Form 990, Part IV, line 14b, 15, or 16. Right pointing arrow large image

Attach to Form 990. Right pointing arrow large image

Go to www.irs.gov/Form990 for instructions and the latest information.

OMB No. 1545-0047

2018

Open to Public Inspection

Name of the organization
LESTER E COX MEDICAL CENTERS

Employer identification number

44-0577118

Part I

General Information on Activities Outside the United States. Complete if the organization answered "Yes" to Form 990, Part IV, line 14b.

For grantmakers. Does the organization maintain records to substantiate the amount of its grants and

other assistance, the grantees’ eligibility for the grants or assistance, and the selection criteria used

to award the grants or assistance? . . . . . . . . . . . . . . . . . . . . . . . . .

Yes

For grantmakers. Describe in Part V the organization’s procedures for monitoring the use of its grants and other assistance outside the United States.

Activites per Region. (The following Part I, line 3 table can be duplicated if additional space is needed.)

(a) Region		(b) Number of offices in the region	(c) Number of employees, agents, and independent contractors in region	(d) Activities conducted in region (by type) (e.g., fundraising, program services, investments, grants to recipients located in the region)	(e) If activity listed in (d) is a program service, describe specific type of service(s) in region	(f) Total expenditures for and investments in region
	Central America and the Caribbean	0	1	Investments	CAPTIVE INSURANCE	1,161,995
	Central America and the Caribbean	0		Investments		113,219,299















3a	Sub-total .....	0	1			114,381,294
b	Total from continuation sheets to Part I ...
c	Totals (add lines 3a and 3b)	0	1			114,381,294

For Paperwork Reduction Act Notice, see the Instructions for Form 990.Cat. No. 50082W Schedule F (Form 990) 2018

Schedule F (Form 990) 2018

Page 2

Part II

Grants and Other Assistance to Organizations or Entities Outside the United States. Complete if the organization answered "Yes" to Form 990, Part IV, line 15, for any recipient who received more than $5,000. Part II can be duplicated if additional space is needed.

1 (a) Name of organization		(b) IRS code section and EIN (if applicable)	(c) Region	(d) Purpose of grant	(e) Amount of cash grant	(f) Manner of cash disbursement	(g) Amount of non-cash assistance	(h) Description of non-cash assistance	(i) Method of valuation (book, FMV, appraisal, other)

2	Enter total number of recipient organizations listed above that are recognized as charities by the foreign country, recognized as tax-exempt by the IRS, or for which the grantee or counsel has provided a section 501(c)(3) equivalency letter .......
3	Enter total number of other organizations or entities .......................

Schedule F (Form 990) 2018

Schedule F (Form 990) 2018Page 3

Part III

Grants and Other Assistance to Individuals Outside the United States. Complete if the organization answered "Yes" to Form 990, Part IV, line 16.

Part III can be duplicated if additional space is needed.

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

Schedule F (Form 990) 2018

Page 4

Part IV

Foreign Forms

Schedule F (Form 990) 2018

Page 5

Part V

Supplemental Information
Provide the information required by Part I, line 2 (monitoring of funds); Part I, line 3, column (f) (accounting method; amounts of investments vs. expenditures per region); Part II, line 1 (accounting method); Part III (accounting method); and Part III, column (c) (estimated number of recipients), as applicable. Also complete this part to provide any additional information (see instructions).

ReturnReference	Explanation
SCHEDULE F, PART I, LINE 3, COLUMN F	ACCOUNTING METHOD: THE AMOUNT OF PROGRAM SERVICE EXPENDITURES REPORTED ON LINE 1 ARE REPORTED BASED ON THE AMOUNTS INCLUDED IN THE AUDITED FINANCIAL STATEMENTS OF THE INSURANCE COMPANY OF SPRINGFIELD, INC., THE CAPTIVE INSURANCE COMPANY. THESE AUDITED FINANCIAL STATEMENTS USED GENERALLY ACCEPTED ACCOUNTING PRINCIPLES ESTABLISHED BY THE FINANCIAL ACCOUNTING STANDARDS BOARD.

Schedule F (Form 990) 2018

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE G (Form 990 or 990-EZ)

Department of the Treasury
Internal Revenue Service

Supplemental Information Regarding
Fundraising or Gaming Activities

Complete if the organization answered "Yes" on Form 990, Part IV, lines 17, 18, or 19, or if the organization entered more than $15,000 on Form 990-EZ, line 6a. right arrow

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

Go to www.irs.gov/Form990 for instructions and the latest information.

OMB No. 1545-0047

2018

Open to Public Inspection

Name of the organization
LESTER E COX MEDICAL CENTERS

Employer identification number

44-0577118

Part I

Fundraising Activities. Complete if the organization answered "Yes" on Form 990, Part IV, line 17.

Form 990-EZ filers are not required to complete this part.

Indicate whether the organization raised funds through any of the following activities. Check all that apply.

a	Mail solicitations	e	Solicitation of non-government grants
b	Internet and email solicitations	f	Solicitation of government grants
c	Phone solicitations	g	Special fundraising events
d	In-person solicitations

Did the organization have a written or oral agreement with any individual (including officers, directors, trustees

or key employees listed in Form 990, Part VII) or entity in connection with professional fundraising services?

YesNo

If "Yes," list the ten highest paid individuals or entities (fundraisers) pursuant to agreements under which the fundraiser is
to be compensated at least $5,000 by the organization.

(i) Name and address of individual or entity (fundraiser)	(iii) Did fundraiser have custody or control of contributions?
	Yes	No










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

List all states in which the organization is registered or licensed to solicit contributions or has been notified it is exempt from registration or licensing.

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

Cat. No. 50083H

Schedule G (Form 990 or 990-EZ) 2018

Page 2

Part II

Fundraising Events. Complete if the organization answered "Yes" on Form 990, Part IV, line 18, or reported more than $15,000 of fundraising event contributions and gross income on Form 990-EZ, lines 1 and 6b. List events with gross receipts greater than $5,000.

		(a) Event #1 SCRAMBLE FOR MI (event type)	(b) Event #2 WRAP IT UP (event type)	(d) Total events (add col. (a) through col. (c))
1	Gross receipts . . . . .	46,706	20,643	67,349
2	Less: Contributions . . . .	31,911	15,969	47,880
3	Gross income (line 1 minus line 2) . . . . . .	14,795	4,674	19,469

4	Cash prizes . . . . .	1,248		1,248
5	Noncash prizes . . . .
6	Rent/facility costs . . . .	15,674	4,674	20,348
7	Food and beverages . . .
8	Entertainment . . . .		300	300
9	Other direct expenses . . .	557	1,737	2,294
10	Direct expense summary. Add lines 4 through 9 in column (d) . . . . . . . . . .			24,190
11	Net income summary. Subtract line 10 from line 3, column (d). . . . . . . . . .			-4,721

Part III

Gaming. Complete if the organization answered "Yes" on Form 990, Part IV, line 19, or reported more than $15,000 on Form 990-EZ, line 6a.

		(a) Bingo	(b) Pull tabs/Instant bingo/progressive bingo	(c) Other gaming	(d) Total gaming (add col.(a) through col.(c))
1	Gross revenue . . . . .

2	Cash prizes . . . . .
3	Noncash prizes . . . .
4	Rent/facility costs . . . .
5	Other direct expenses . . .

Volunteer labor . . . .

	Yes %
	No

	Yes %
	No

	Yes %
	No

Direct expense summary. Add lines 2 through 5 in column (d) . . . . . . . . . . right arrow

Net gaming income summary. Subtract line 7 from line 1, column (d). . . . . . . . . right arrow

Enter the state(s) in which the organization conducts gaming activities:

Is the organization licensed to conduct gaming activities in each of these states? . . . . . . . .

YesNo

If "No," explain:

10a

Were any of the organization's gaming licenses revoked, suspended or terminated during the tax year? . . .

YesNo

If "Yes," explain:

Schedule G (Form 990 or 990-EZ) 2018

Page 3

Does the organization conduct gaming activities with nonmembers? . . . . . . . . . . .

YesNo

Is the organization a grantor, beneficiary or trustee of a trust or a member of a partnership or other entity

formed to administer charitable gaming? . . . . . . . . . . . . . . . . .

YesNo

Indicate the percentage of gaming activity conducted in:

The organization's facility . . . . . . . . . . . . . . . . . .

13a

An outside facility . . . . . . . . . . . . . . . . . . . .

13b

Enter the name and address of the person who prepares the organization's gaming/special events books and records:

Name

Address

15a

Does the organization have a contract with a third party from whom the organization receives gaming

revenue? . . . . . . . . . . . . . . . . . . . . . . . .

YesNo

If "Yes," enter the amount of gaming revenue received by the organization right arrow

$ and the

amount of gaming revenue retained by the third party right arrow

$ .

If "Yes," enter name and address of the third party:

Name

Address

Gaming manager information:

Name

Gaming manager compensation right arrow

Description of services provided right arrow

Director/officer Employee Independent contractor

Mandatory distributions:

Is the organization required under state law to make charitable distributions from the gaming proceeds to

retain the state gaming license? . . . . . . . . . . . . . . . . . . .

YesNo

Enter the amount of distributions required under state law distributed to other exempt organizations or spent

in the organization's own exempt activities during the tax year right arrow

Part IV

Supplemental Information. Provide the explanations required by Part I, line 2b, columns (iii) and (v); and Part III, lines 9, 9b, 10b, 15b, 15c, 16, and 17b, as applicable. Also provide any additional information. See instructions.

Return Reference	Explanation

Schedule G (Form 990 or 990-EZ) 2018

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE H
(Form 990)

Department of the Treasury
Internal Revenue Service

Hospitals

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

Attach to Form 990.
MediumBullet

Go to www.irs.gov/Form990EZ for instructions and the latest information.

OMB No. 1545-0047

2018

Open to Public Inspection

Name of the organization

LESTER E COX MEDICAL CENTERS

Employer identification number

44-0577118

Part I

Financial Assistance and Certain Other Community Benefits at Cost

Yes

Did the organization have a financial assistance policy during the tax year? If "No," skip to question 6a . . . .

Yes

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

Yes

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.

Applied uniformly to all hospital facilities Applied uniformly to most hospital facilities Generally tailored to individual hospital facilities

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.

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:

100% 150% 200% Other %

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: . . . . . . . .

Yes

200% 250% 300% 350% 400% Other %

If the organization used factors other than FPG in determining eligibility, describe in Part VI the criteria used 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.

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"? . . . . . . . . . . . . .

Yes

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

Yes

If "Yes," did the organization's financial assistance expenses exceed the budgeted amount? . . . . . .

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? . . . . . . . . . . . . .

Did the organization prepare a community benefit report during the tax year? . . . . . . . . .

Yes

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

Yes

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

Financial Assistance and Certain Other Community Benefits at Cost

Financial Assistance and Means-Tested Government Programs		(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) . . .	43,296,516		43,296,516	3.750 %
b	Medicaid (from Worksheet 3, column a) . . . . .	159,807,372	140,552,948	19,254,424	1.670 %
c	Costs of other means-tested government programs (from Worksheet 3, column b) . .
d	Total Financial Assistance and Means-Tested Government Programs . . . . .	203,103,888	140,552,948	62,550,940	5.420 %
Other Benefits
e	Community health improvement services and community benefit operations (from Worksheet 4).	135,406		135,406	0.010 %
f	Health professions education (from Worksheet 5) . . .	22,392,815	13,986,397	8,406,418	0.730 %
g	Subsidized health services (from Worksheet 6) . . . .	10,811,400	6,635,406	4,175,994	0.360 %
h	Research (from Worksheet 7) .
i	Cash and in-kind contributions for community benefit (from Worksheet 8) . . . .	2,046,727		2,046,727	0.180 %
j	Total. Other Benefits . .	35,386,348	20,621,803	14,764,545	1.280 %
k	Total. Add lines 7d and 7j .	238,490,236	161,174,751	77,315,485	6.700 %

For Paperwork Reduction Act Notice, see the Instructions for Form 990. Cat. No. 50192T Schedule H (Form 990) 2018

Schedule H (Form 990) 2018

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

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

Enter the amount of the organization's bad debt expense. Explain in Part VI the methodology used by the organization to estimate this amount. ......

91,301,578

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. ......

14,151,745

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

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

389,781,583

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

509,256,732

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

-119,475,149

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

Cost accounting system Cost to charge ratio Other

Section C. Collection Practices

Did the organization have a written debt collection policy during the tax year? ..........

Yes

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 .........................

Yes

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 %
1
2
3
4
5
6
7
8
9
10
11
12
13

Schedule H (Form 990) 2018

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?3Name, address, primary website address, and state license number (and if a group return, the name and EIN of the subordinate hospital organization that operates the hospital facility)							Facility reporting group
1	LESTER E COX MEDICAL CENTERS - SOUTH 3801 S NATIONAL AVE SPRINGFIELD,MO65807 WWW.COXHEALTH.COM 500	X	X	X	X	X	1
2	LESTER E COX MEDICAL CENTERS - NORTH 1423 N JEFFERSON ST SPRINGFIELD,MO65802 WWW.COXHEALTH.COM 500	X			X	X	1
3	MEYER ORTHOPEDIC HOSPITAL 1000 E WALNUT LAWN SPRINGFIELD,MO65807 WWW.COXHEALTH.COM 500	X			X		1

Schedule H (Form 990) 2018

Page 4

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)

	FACILITY REPORTING GROUP #1
Name of hospital facility or letter of facility reporting group

Line number of hospital facility, or line numbers of hospital facilities in a facility
reporting group (from Part V, Section A):

Yes

Community Health Needs Assessment

Was the hospital facility first licensed, registered, or similarly recognized by a state as a hospital facility in the current tax year or the immediately preceding tax year?........................

Was the hospital facility acquired or placed into service as a tax-exempt hospital in the current tax year or the immediately preceding tax year? If “Yes,” provide details of the acquisition in Section C...............

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 12......................

Yes

If "Yes," indicate what the CHNA report describes (check all that apply):

A definition of the community served by the hospital facility

Demographics of the community

Existing health care facilities and resources within the community that are available to respond to the health needs of the community

How data was obtained

The significant health needs of the community

Primary and chronic disease needs and other health issues of uninsured persons, low-income persons, and minority groups

The process for identifying and prioritizing community health needs and services to meet the community health needs

The process for consulting with persons representing the community’s interests

The impact of any actions taken to address the significant health needs identified in the hospital facility's prior CHNA(s)

Other (describe in Section C)

Indicate the tax year the hospital facility last conducted a CHNA: 20 18

In conducting its most recent CHNA, did the hospital facility take into account input from persons who represent the broad interests of the community served by the hospital facility, including those with special knowledge of or expertise in public health? If "Yes," describe in Section C how the hospital facility took into account input from persons who represent the community, and identify the persons the hospital facility consulted .................

Yes

6 a

Was the hospital facility’s CHNA conducted with one or more other hospital facilities? If "Yes," list the other hospital facilities in Section C..................................

Yes

Was the hospital facility’s CHNA conducted with one or more organizations other than hospital facilities?” If “Yes,” list the other organizations in Section C. ............................

Yes

Did the hospital facility make its CHNA report widely available to the public?..............

Yes

If "Yes," indicate how the CHNA report was made widely available (check all that apply):

Hospital facility’s website (list url): SEE PART V, SECTION C

Other website (list url): SEE PART V, SECTION C

Made a paper copy available for public inspection without charge at the hospital facility

Other (describe in Section C)

Did the hospital facility adopt an implementation strategy to meet the significant community health needs
identified through its most recently conducted CHNA? If "No," skip to line 11. ..............

Yes

Indicate the tax year the hospital facility last adopted an implementation strategy: 20 18

Is the hospital facility's most recently adopted implementation strategy posted on a website?.........

Yes

If "Yes" (list url): SEE PART V, SECTION C

If "No," is the hospital facility’s most recently adopted implementation strategy attached to this return? ......

10b

Describe in Section C how the hospital facility is addressing the significant needs identified in its most recently conducted CHNA and any such needs that are not being addressed together with the reasons why such needs are not being addressed.

12a

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)?...............................

12a

If "Yes" on line 12a, did the organization file Form 4720 to report the section 4959 excise tax?........

12b

If "Yes" on line 12b, 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) 2018

Page 5

Part VFacility Information (continued)

Financial Assistance Policy (FAP)

	FACILITY REPORTING GROUP #1
Name of hospital facility or letter of facility reporting group

Yes

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 included free or discounted care?

Yes

If “Yes,” indicate the eligibility criteria explained in the FAP:

Federal poverty guidelines (FPG), with FPG family income limit for eligibility for free care of 0.% and FPG family income limit for eligibility for discounted care of 300.%

Income level other than FPG (describe in Section C)

Asset level

Medical indigency

Insurance status

Underinsurance discount

Residency

Other (describe in Section C)

Explained the basis for calculating amounts charged to patients?.................

Yes

Explained the method for applying for financial assistance?...................

Yes

If “Yes,” indicate how the hospital facility’s FAP or FAP application form (including accompanying instructions) explained the method for applying for financial assistance (check all that apply):

Described the information the hospital facility may require an individual to provide as part of his or her application

Described the supporting documentation the hospital facility may require an individual to submit as part of his or
her application

Provided the contact information of hospital facility staff who can provide an individual with information about the
FAP and FAP application process

Provided the contact information of nonprofit organizations or government agencies that may be sources of
assistance with FAP applications

Other (describe in Section C)

Was widely publicized within the community served by the hospital facility?........

Yes

If "Yes," indicate how the hospital facility publicized the policy (check all that apply):

The FAP was widely available on a website (list url):

SEE PART V, SECTION C

The FAP application form was widely available on a website (list url):

SEE PART V, SECTION C

A plain language summary of the FAP was widely available on a website (list url):
SEE PART V, SECTION C

The FAP was available upon request and without charge (in public locations in the hospital facility and by mail)

The FAP application form was available upon request and without charge (in public locations in the hospital facility
and by mail)

A plain language summary of the FAP was available upon request and without charge (in public locations in the
hospital facility and by mail)

Individuals were notified about the FAP by being offered a paper copy of the plain language summary of the FAP, by
receiving a conspicuous written notice about the FAP on their billing statements, and via conspicuous public displays or
other measures reasonably calculated to attract patients' attention

Notified members of the community who are most likely to require financial assistance about availability of the FAP

The FAP, FAP application form, and plain language summary of the FAP were translated into the primary language(s)
spoken by LEP populations

Other (describe in Section C)

Schedule H (Form 990) 2018

Page 6

Part VFacility Information (continued)

Billing and Collections

	FACILITY REPORTING GROUP #1
Name of hospital facility or letter of facility reporting group

Yes

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 all of the actions the hospital facility or other authorized party may take upon nonpayment?..................................

Yes

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 individual’s eligibility under the facility’s FAP:

Reporting to credit agency(ies)

Selling an individual’s debt to another party

Deferring, denying, or requiring a payment before providing medically necessary care due to nonpayment of a previous
bill for care covered under the hospital facility's FAP

Actions that require a legal or judicial process

Other similar actions (describe in Section C)

None of these actions or other similar actions were permitted

Did the hospital facility or other authorized party perform any of the following actions during the tax year before making reasonable efforts to determine the individual’s eligibility under the facility’s FAP?............

If "Yes," check all actions in which the hospital facility or a third party engaged:

Reporting to credit agency(ies)

Selling an individual’s debt to another party

Deferring , denying, or requiring a payment before providing medically necessary care due to nonpayment of a previous
bill for care covered under the hospital facility's FAP

Actions that require a legal or judicial process

Other similar actions (describe in Section C)

Indicate which efforts the hospital facility or other authorized party made before initiating any of the actions listed (whether or not checked) in line 19. (check all that apply):

Provided a written notice about upcoming ECAs (Extraordinary Collection Action) and a plain language summary of the
FAP at least 30 days before initiating those ECAs

Made a reasonable effort to orally notify individuals about the FAP and FAP application process

Processed incomplete and complete FAP applications

Made presumptive eligibility determinations

Other (describe in Section C)

None of these efforts were made

Policy Relating to Emergency Medical Care

Did the hospital facility have in place during the tax year a written policy relating to emergency medical care that required 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?..................

Yes

If "No," indicate why:

The hospital facility did not provide care for any emergency medical conditions

The hospital facility’s policy was not in writing

The hospital facility limited who was eligible to receive care for emergency medical conditions (describe in Section C)

Other (describe in Section C)

Schedule H (Form 990) 2018

Page 7

Part VFacility Information (continued)

Charges to Individuals Eligible for Assistance Under the FAP (FAP-Eligible Individuals)

	FACILITY REPORTING GROUP #1
Name of hospital facility or letter of facility reporting group

Yes

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.

The hospital facility used a look-back method based on claims allowed by Medicare fee-for-service during a prior 12-month period

The hospital facility used a look-back method based on claims allowed by Medicare fee-for-service and all private health insurers that pay claims to the hospital facility during a prior 12-month period

The hospital facility used a look-back method based on claims allowed by Medicaid, either alone or in combination with
Medicare fee-for-service and all private health insurers that pay claims to the hospital facility during a prior 12-month
period

The hospital facility used a prospective Medicare or Medicaid method

During the tax year, did the hospital facility charge any FAP-eligible individual 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? ...............................

If "Yes," explain in Section C.

During the tax year, did the hospital facility charge any FAP-eligible individual an amount equal to the gross charge for any service provided to that individual? ...........................

If "Yes," explain in Section C.

Schedule H (Form 990) 2018

Page 8

Part V

Facility Information (continued)

Section C. Supplemental Information for Part V, Section B. Provide descriptions required for Part V, Section B, lines 2, 3j, 5, 6a, 6b, 7d, 11, 13b, 13h, 15e, 16j, 18e, 19e, 20e, 21c, 21d, 23, and 24. If applicable, provide separate descriptions for each hospital facility in a facility reporting group, designated by facility reporting group letter and hospital facility line number from Part V, Section A (“A, 1,” “A, 4,” “B, 2,” “B, 3,” etc.) and name of hospital facility.
Form and Line Reference	Explanation
SCHEDULE H, PART V, SECTION B, LINE 5	COMMUNITY INPUT: IN 2017, A VARIETY OF ORGANIZATIONS ACROSS THE OZARKS RECONVENED UNDER THE UMBRELLA OF THE OZARKS HEALTH COMMISSION TO ASSESS THE HEALTH NEEDS OF OUR REGION. BUILDING UPON THE SUCCESS OF THE 2016 REGIONAL HEALTH ASSESSMENT, PARTNERS AGAIN SOUGHT TO BETTER UNDERSTAND THE HEALTH STATUS, BEHAVIORS AND NEEDS OF THE POPULATIONS THEY SERVE. THIS 2019 ASSESSMENT COMBINES MORE THAN 140 HOSPITAL AND COMMUNITY DATA INDICATORS AS WELL AS FEEDBACK FROM STAKEHOLDERS AND THE BROADER COMMUNITY. THIS PROCESS RESULTED IN THREE PRIORITIES: LUNG DISEASE, CARDIOVASCULAR DISEASE AND MENTAL HEALTH. WEAVING AMONG THE ISSUES IDENTIFIED WERE FIVE COMMON THREADS: ACCESS TO HEALTH CARE, MENTAL HEALTH, PHYSICAL ACTIVITY, SOCIAL DETERMINANTS OF HEALTH AND TOBACCO USE. ADDITIONALLY, THE HEALTH STATUS OF POPULATIONS OF INTEREST - SUCH AS PEOPLE IN POVERTY, MINORITIES AND THE ELDERLY--WERE ALSO ANALYZED. RECOGNIZING THE VALUE OF ASSESSING AND ACTING TOGETHER ON LOCAL HEALTH ISSUES, KEY PLAYERS FROM LOCAL HOSPITAL SYSTEMS, PUBLIC HEALTH ENTITIES, AND OTHERS FORMED A WORKING GROUP TO BEGIN THE TASK OF A REGIONAL HEALTH ASSESSMENT. THIS GROUP GREW UNDER THE UMBRELLA OF THE LOCAL OZARKS HEALTH COMMISSION (OHC) AND PUBLISHED THE FIRST ASSESSMENTS IN 2016. SINCE THAT TIME, THE PROCESS HAS BEEN RECOGNIZED AT THE ANNUAL MEETING OF THE AMERICAN PUBLIC HEALTH ASSOCIATION, HONORED AS A PROMISING PRACTICE BY THE NATIONAL ASSOCIATION OF COUNTY AND CITY HEALTH OFFICIALS, AND AWARDED THE GROUP MERIT AWARD FROM THE MISSOURI PUBLIC HEALTH ASSOCIATION. COLLECTIVELY, THE ASSESSMENTS SPAN FOUR STATES - MISSOURI, OKLAHOMA, ARKANSAS, AND KANSAS, 29 COUNTIES AND THREE HOSPITAL SYSTEMS. THIS FOOTPRINT WILL BE REFERRED TO THROUGHOUT THE REPORT AS THE OHC REGION. PRIORITIZATION PROCESS INCLUDED THE FOLLOWING STAKEHOLDERS: CITY OF SPRINGFIELD - PLANNING DEPARTMENT -COMMUNITY PARTNERSHIP OF THE OZARKS -COXHEALTH -DREW LEWIS FOUNDATION -MERCY -MISSOURI ALLIANCE OF YMCA -MISSOURI STATE UNIVERSITY -MISSOURI JOB CENTER -OZARKS FOOD HARVEST -OZARK GREENWAYS -SPRINGFIELD AREA CHAMBER OF COMMERCE -SPRINGFIELD-GREENE COUNTY HEALTH DEPARTMENT -SPRINGFIELD-GREENE COUNTY PARKS
SCHEDULE H, PART V, SECTION B, LINE 6A	CHNA CONDUCTED WITH OTHER HOSPITALS: THE CHNA WAS CONDUCTED FOR THE ENTIRE REPORTING GROUP #1, AS REPORTED ON SCHEDULE H, PART V, SECTION A, INCLUDING LESTER E. COX MEDICAL CENTERS - SOUTH, LESTER E. COX MEDICAL CENTERS - NORTH, AND MEYER ORTHOPEDIC HOSPITAL. OTHER HOSPITAL FACILITY PARTNERS INCLUDED FREEMAN HEALTH SYSTEM, AND MERCY. THE CHNA WAS ALSO CONDUCTED WITH RELATED ORGANIZATIONS COX MEDICAL CENTER BRANSON, COX BARTON COUNTY HOSPITAL AND COX-MONETT HOSPITAL.
SCHEDULE H, PART V, SECTION B, LINE 6B	CHNA CONDUCTED WITH OTHER ORGANIZATIONS: THE CHNA WAS ALSO CONDUCTED WITH THE FOLLOWING OTHER NON-HOSPITAL ORGANIZATIONS: -JASPER COUNTY HEALTH DEPARTMENT -JOPLIN HEALTH DEPARTMENT -SPRINGFIELD-GREENE COUNTY HEALTH DEPARTMENT -TANEY COUNTY HEALTH DEPARTMENT
SCHEDULE H, PART V, SECTION B, LINE 7A	CHNA HOSPITAL FACILITY'S WEBSITE: HTTPS://WWW.COXHEALTH.COM/ABOUT-US/COMMUNITY-HEALTH-NEEDS-ASSESSMENTS/
SCHEDULE H, PART V, SECTION B, LINE 7B	CHNA OTHER WEBSITES: HTTP://WWW.OZARKSHEALTHCOMMISSION.ORG HTTP://WWW.MERCY.NET HTTP://WWW.COXHEALTH.COM HTTP://WWW.FREEMANHEALTH.COM
SCHEDULE H, PART V, SECTION B, LINE 7D	OTHER METHODS TO MAKE THE CHNA REPORT AVAILABLE TO THE PUBLIC: PRINTED COPIES ARE AVAILABLE BY REQUEST THROUGH HOSPITAL OR PUBLIC HEALTH PARTNERS OR AT OZARKSHEALTHCOMMISSION.ORG AND NEWS RELEASE WAS SENT OUT TO ENCOURAGE MEDIA COVERAGE WITH LINKS TO THE REPORT AND KEY MESSAGES FOR THE PUBLIC.
SCHEDULE H, PART V, SECTION B, LINE 10A	IMPLEMENTATION STRATEGY WEBSITE: HTTPS://WWW.COXHEALTH.COM/ABOUT-US/COMMUNITY-HEALTH-NEEDS-ASSESSMENTS/
SCHEDULE H, PART V, SECTION B, LINE 11	ADDRESSING IDENTIFIED NEEDS: 1. INCREASE PATIENT ENGAGEMENT IN CHRONIC CONDITION SELF-MANAGEMENT -THE CENTER FOR HEALTH IMPROVEMENT EMPLOYS A SKILLED TEAM OF HEALTHCARE PROFESSIONALS WHO DELIVER SUPPORT AND EDUCATION FOR CHRONIC DISEASE MANAGEMENT, MEDICAL NUTRITION THERAPY, AND ADVANCE CARE PLANNING. THEY PROVIDE TOOLS DESIGNED TO INCREASE SELF- MANAGEMENT OF CHRONIC CONDITIONS INCLUDING DIABETES, AUTOIMMUNE DISORDERS, METABOLIC SYNDROME, AND MORE. -IN THE FIRST QUARTER CALENDAR YEAR 2018, A CURRENT STATE ASSESSMENT OF THE CENTER FOR HEALTH IMPROVEMENT WAS CONDUCTED TO DETERMINE THE EFFICACY OF VARIOUS PROGRAMS. AS A RESULT OF THE ASSESSMENT, THE TEAM REFINED THE SCOPE OF OFFERINGS TO AN EVIDENCE-BASED, TARGETED PROGRAM SUITE THAT FOCUSES HEAVILY ON IMPROVING CHRONIC CONDITION MANAGEMENT OF PATIENTS. -IN ADDITION TO THE PROGRAMS ALREADY OFFERED, THE CENTER FOR HEALTH IMPROVEMENT ADDED A NEW SIX-WEEK, EVIDENCE-BASED COURSE FOCUSED ON CHRONIC PAIN CONDITIONS. -THE NURSING EDUCATION DEPARTMENT AND THE JOINT REPLACEMENT EDUCATORS AT MEYER ORTHOPEDIC CENTER DEVELOPED A PROCESS TO INCREASE TIGR VIDEO EDUCATION VIEWS. MANDATORY EDUCATION WAS EXPANDED TO INCLUDE ALL ADULT PATIENTS WITH A DIAGNOSIS OF PNEUMONIA, HEART FAILURE, ACUTE MI, TOTAL HIP/KNEE REPLACEMENT, OR COPD TO HELP ACHIEVE BEST OUTCOMES WHILE REDUCING READMISSIONS. -TIGR VIDEO VIEWS INCREASED FROM 4,694 VIEWS IN MAY 2018 TO 6,284 IN MAY 2019. 2. REDUCE AVOIDABLE HOSPITAL READMISSIONS - COXHEALTH NURSING ADMINISTRATION BEGAN TRAINING NURSES ON LIGHT DUTY TO COMPLETE PATIENT READMISSION INTERVIEW FORMS IN 2018. WHEN A PATIENT IS READMITTED WITHIN THIRTY DAYS, A CASE MANAGER MEETS WITH THE PATIENT TO DISCUSS THE READMISSION. TOPICS COVERED IN THE INTERVIEW INCLUDE: >FREQUENCY OF GOOD COMMUNICATION IN THE HOSPITAL REGARDING DIAGNOSIS AND MEDICATIONS. >COMMUNICATION ABOUT DISCHARGE INSTRUCTIONS AND ABILITY TO UNDERSTAND INSTRUCTIONS. >MEDICATION COMPLIANCE AND REASONS FOR ANY DIFFICULTY REMAINING COMPLIANT. >FOLLOW UP APPOINTMENTS WITH A PCP BEING SCHEDULED AND ATTENDED. >REASONS FOR READMISSION, FROM THE PATIENTS PERSPECTIVE. >>THE INFORMATION GATHERED BY THE CASE MANAGER COMES DIRECTLY FROM THE PATIENT AND IS ENTERED INTO REPORTABLE FIELDS THAT ALLOW FOR DATA COLLECTION. COMMON THEMES FOR AVOIDABLE READMISSIONS WILL BE EASIER TO IDENTIFY AND PREVENT THROUGH THIS PROCESS. -EVIDENCE-BASED BEST PRACTICES TO REDUCE AVOIDABLE READMISSIONS HAVE BEEN IMPLEMENTED AND CONTINUE TO EXPAND. >COXHEALTH HIRED TRANSITIONAL CARE PHARMACISTS WHO DEDICATE THEIR TIME WORKING WITH PATIENTS BEING DISCHARGED TO ENSURE THE PATIENT LEAVES THE HOSPITAL WITH THEIR MEDICATIONS. >NEW EFFORTS ARE IN PLACE TO INCREASE THE NUMBER OF PATIENTS WHO LEAVE THE HOSPITAL WITH THEIR MEDICATIONS THROUGH THE USE OF A FOCUSED, FAST-PACED I-90 PROJECT. >THE CLINIC SUPPORT TEAM HAS BEEN INSTRUMENTAL IN SCHEDULING FOLLOW-UP APPOINTMENTS WITH PATIENTS. THE MAJORITY OF INPATIENT UNITS ARE COVERED BY THE CLINIC SUPPORT TEAM, WHICH MEANS MOST PATIENTS HAVE A FOLLOW UP APPOINTMENT SCHEDULED PRIOR TO LEAVING THE HOSPITAL. >A SUBGROUP COMPRISED OF FRONTLINE STAFF, LEADERS, AND QUALITY IMPROVEMENT EXPERTS HAS BEEN FORMED TO FOCUS SPECIFICALLY ON REDUCING HEART FAILURE READMISSIONS. THE GROUP WILL USE DATA TO INFORM DECISIONS ON HOW TO BEST MANAGE OUR PATIENTS WITH FREQUENT INPATIENT STAYS DUE TO HEART FAILURE. 3. INCREASE ACCESS TO TOBACCO CESSATION RESOURCES FOR PATIENTS AND FAMILIES PRESENTING TO OUR HOSPITALS AND CLINICS -AN ASSET ASSESSMENT AND GAP ANALYSIS OF THE SYSTEMS TOBACCO TREATMENT OFFERINGS WAS CONDUCTED. RECOMMENDATIONS FROM THAT ASSESSMENT INCLUDED CREATION AND IMPLEMENTATION OF A CLEARLY OUTLINED REFERRAL PROCESS AND DEFINED RESOURCES AND PROMOTION OF THE ASK, ADVISE, ACT/REFER MODEL TO INITIATE INTERVENTION. -IN MAY 2018, WE PROVIDED TRAINING TO 12 KEY COXHEALTH STAFF MEMBERS AND 3 COMMUNITY EDUCATORS. COMPLETION OF THE UMASS MEDICAL SCHOOL EDUCATION CURRICULUM, REQUIRED EXAMS, AND PRACTICE HOURS MADE CLASS PARTICIPANTS ELIGIBLE FOR CERTIFICATION AS TOBACCO TREATMENT SPECIALISTS. AS A RESULT OF THIS EDUCATION, THE NUMBER OF CESSATION RESOURCES AVAILABLE WITHIN THE SYSTEM INCREASED. THE TRAINING WILL BE OFFERED AGAIN IN OCTOBER 2019 TO FURTHER INCREASE RESOURCES. -THE QUIT RATE FOR OUR TOBACCO CESSATION PROGRAM HAS CONTINUED TO SHOW POSITIVE RESULTS SINCE ITS INCEPTION IN 2013, WITH THE CURRENT QUIT RATE FOR 2019 TO DATE AT 64%. AVERAGING ACROSS THE HISTORY OF THE PROGRAM, THE AGGREGATED QUIT RATE IS 55%. -DUE TO THE SUCCESS OF THIS PROGRAM, FOLLOWING THE STONE AND TANEY COUNTY MFH TOBACCO GRANTS END ON MAY 31, 2018, WE WERE ABLE TO HIRE A FULL TIME TOBACCO CESSATION COORDINATOR WHO IS RESPONSIBLE FOR COORDINATING SYSTEM EFFORTS TO STANDARDIZE POLICIES AND REFERRAL PROCESSES ACROSS ALL CAMPUSES AND SETTINGS. 4. DECREASE CHILDHOOD OBESITY -THE CARDIAC KIDS PROGRAM IS IMPLEMENTED IN 13 RURAL SCHOOLS IN THE COXHEALTH SERVICE AREA. ITS MAIN OBJECTIVE IS TO SCREEN 5TH GRADE STUDENTS FOR HEALTH INDICATORS THAT PUT THEM AT HIGH RISK FOR DEVELOPING CARDIAC DISEASE. SCREENING BY COXHEALTH STAFF INCLUDES HEIGHT AND WEIGHT MEASUREMENT, BMI CONSULT, AND HEALTH/NUTRITION EDUCATION. -APPROXIMATELY 400 CHILDREN ARE SCREENED ANNUALLY. THOSE WHO ARE DEEMED HIGH RISK ARE REFERRED TO THE COMMITTED TO KIDS PROGRAM. THIS 8-WEEK PROGRAM IS AN INTENSIVE INTERVENTION FOR AT-RISK CHILDREN AND THEIR FAMILIES FOCUSING ON HEATHY BEHAVIOR AND NUTRITION EDUCATION. 5. INCREASE THE NUMBER OF WOMEN WHO BREASTFEED THEIR INFANTS AFTER DELIVERY -COXHEALTH AND THE SPRINGFIELD-GREENE COUNTY HEALTH DEPARTMENT ARE CURRENTLY ENGAGED IN A COMMUNITY BREASTFEEDING COALITION WITH THE GOAL OF STRATEGICALLY ALIGNING EFFORTS TO HELP MOVE THE CHIP INITIATIVE FORWARD. -IN ADDITION TO EDUCATION PRESENTED IN OUR GENERAL PRENATAL CLASSES, THE COXHEALTH LACTATION CONSULTANTS FACILITATE A MONTHLY BREAST FEEDING SUPPORT GROUP CALLED THE LACTATION CLUB. -THE ANNUAL COXHEALTH BABY FAIR IS A FREE EVENT THAT FEATURES VENDOR DISPLAYS, DEMONSTRATIONS, DOOR PRIZES, AND CLASSES WITH A VARIETY OF TOPICS INCLUDING BREASTFEEDING. 6. INCREASE DETECTION AND TREATMENT OF THE EARLIEST STAGES OF LUNG CANCER NODULES -COXHEALTH OFFERS LOW-DOSE CT SCANS AS A DIAGNOSTIC SCREENING FOR LUNG CANCER. LOW-DOSE CT SCANS USE LOWER AMOUNTS OF RADIATION TO HELP IDENTIFY LUNG NODULES IN THE EARLIEST STAGES OF LUNG CANCER WHEN IT IS MOST TREATABLE. STUDIES HAVE SHOWN THAT PATIENTS WHO PARTICIPATE IN A LOW-DOSE CT LUNG CANCER PROGRAM ARE 20% LESS LIKELY TO DIE FROM LUNG CANCER THAN THOSE WHO WERE NOT SCREENED WHEN APPROPRIATE. -SINCE THE PROGRAM BEGAN, THE NUMBER OF INDIVIDUALS WHO HAD A LOW-DOSE CT SCAN COMPLETED HAS CONTINUED TO INCREASE. 7. INCREASE REFERRALS TO COMMUNITY ORAL HEALTH RESOURCES FOR PATIENTS PRESENTING TO THE ED FOR DENTAL ISSUES -COMMUNITY PARTNERSHIPS WITH LOCAL RESOURCES HAVE BEEN STRENGTHENED AND REFINED TO ENSURE STAFF FEEL EMPOWERED TO REFER PATIENTS TO FACILITIES LIKE THE JORDAN VALLEY COMMUNITY HEALTH CENTER (JVCHC) FOR THE APPROPRIATE LEVEL OF CARE FOR ORAL HEALTH ISSUES. -WHEN EVALUATING THE CHIEF COMPLAINTS OF PATIENTS THAT PRESENTED TO THE EMERGENCY DEPARTMENT (ED) FIVE OR MORE TIMES IN A 12-MONTH PERIOD FOR NON-EMERGENT CARE, DENTAL COMPLAINTS RANKED AMONG THE HIGHEST. -PROTOCOLS WERE DEVELOPED FOR PATIENTS THAT PRESENT WITH TOOTH PAIN IN THE ED. AFTER THE MEDICAL SCREENING EXAM COMPLETION, THE PATIENT IS TRANSITIONED TO JVCHC FOR IMMEDIATE DENTAL CARE. -COXHEALTH WORKED IN COLLABORATION WITH JVCHC TO APPLY FOR A GRANT THAT ALLOWED FOR THE HIRE OF ADDITIONAL DENTISTS. TO ENSURE SAME-DAY OR NEXT DAY APPOINTMENTS, THE DENTAL CLINIC EXPANDED TO ADD SATURDAY HOURS. -QUICK ACCESS TO THE DENTAL CLINIC ALLOWED COXHEALTH ED PHYSICIANS TO DISCONTINUE PRESCRIBING NARCOTICS TO PATIENTS WHO PRESENTED WITH TOOTH PAIN.
SCHEDULE H, PART V, SECTION B, LINE 13A	ELIGIBILITY FOR FREE CARE: IN GENERAL, THE ORGANIZATION'S CHARITY CARE POLICY DOES NOT PROVIDE FOR DISCOUNTS OF 100%. THEREFORE, IT IS EXPECTED THAT THE PATIENT OR GUARANTOR WILL HOLD A RESPONSIBILITY FOR PAYMENT OF AT LEAST A PORTION OF THE SERVICES, REGARDLESS OF THE LEVEL OF ELIGIBILITY. IT IS OUR INTENTION TO WORK WITH INDIVIDUALS ON THEIR OUT-OF-POCKET RESPONSIBILITY TO ESTABLISH FEASIBLE MONTHLY PAYMENTS WHEN NECESSARY. IN THE EVENT THAT A PATIENT OR GUARANTOR IS DETERMINED TO HAVE NO MEANS OF PAYING THE AMOUNT INDICATED AS THEIR RESPONSIBILITY DUE TO EXTENUATING CIRCUMSTANCES, CONSIDERATION MAY BE GIVEN TO WAIVING DEDUCTIBLES AND/OR INCREASING THE DISCOUNT AMOUNT UP TO A 100% DISCOUNT OF THE PATIENT PORTION. THESE EXTENUATING CASES ARE SUBJECT TO THE DISCRETION AND APPROVAL OF THE PFS DIRECTOR AND/OR THE CHIEF FINANCIAL OFFICER WITHIN THE APPROVAL LIMITS DEFINED AT THE END OF THE POLICY.
SCHEDULE H, PART V, SECTION B, LINE 13H	OTHER CRITERIA USED TO DETERMINE FINANCIAL ASSISTANCE ELIGIBILITY: MEDICAL HARDSHIP MAY ALSO BE USED TO DETERMINE FINANCIAL ELIGIBILITY. COXHEALTH SHALL MAKE A DECISION ABOUT A PATIENT/GUARANTOR'S MEDICAL HARDSHIP BY REVIEWING THE FINANCIAL ASSISTANCE APPLICATION, INCLUDING ACCOMPANYING FINANCIAL DOCUMENTATION, IN ADDITION TO OTHER RELEVANT DOCUMENTATION THAT SUPPORTS THE MEDICAL HARDSHIP OF THE PATIENT.
SCHEDULE H, PART V, SECTION B, LINE 16A	FINANCIAL ASSISTANCE POLICY WEBSITE: HTTPS://WWW.COXHEALTH.COM/PATIENTS-AND-VISITORS/FINANCIAL-ASSISTANCE/
SCHEDULE H, PART V, SECTION B, LINE 16B	FINANCIAL ASSISTANCE POLICY APPLICATION WEBSITE: HTTPS://WWW.COXHEALTH.COM/PATIENTS-AND-VISITORS/FINANCIAL-ASSISTANCE/
SCHEDULE H, PART V, SECTION B, LINE 16C	PLAIN LANGUAGE SUMMARY WEBSITE: HTTPS://WWW.COXHEALTH.COM/PATIENTS-AND-VISITORS/FINANCIAL-ASSISTANCE/
SCHEDULE H, PART V, SECTION B, LINE 16J	MEASURES TO PUBLICIZE THE POLICY: FINANCIAL ASSISTANCE AVAILABILITY IS PROACTIVELY COMMUNICATED TO UNINSURED PATIENTS BY CUSTOMER SERVICE STAFF AND BY OUR EARLY OUT AND BAD DEBT VENDORS; ANYONE RECOGNIZED AS UNINSURED IS TOLD ABOUT THE FA AVAILABILITY AND ENCOURAGED TO PARTICIPATE.

Schedule H (Form 990) 2018

Page 9

Part VFacility Information (continued)

Section D. 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?77
Name and address		Type of Facility (describe)
1	SPRINGFIELD INPATIENT PHYSICIANS 3801 S NATIONAL AVE 5TH FL SPRINGFIELD,MO65807	MEDICAL OFFICES
2	ADULT MEDICINE AND ENDOCRINOLOGY SPECLST 960 E WALNUT LAWN SUITE 201 SPRINGFIELD,MO65807	CLINIC
3	FAMILY MEDICAL CARE CENTER 1423 N JEFFERSON ST B-100 SPRINGFIELD,MO65802	CLINIC
4	PHYSICIANS FOR WOMEN 3850 S NATIONAL AVE 400 SPRINGFIELD,MO65807	CLINIC
5	COXHEALTH CENTER STEEPLECHASE 1530 E REPUBLIC RD SPRINGFIELD,MO65804	CLINIC
6	PEDIATRIC CENTER 3443 S NATIONAL AVE SPRINGFIELD,MO65807	CLINIC
7	REGIONAL PERINATAL CENTER 1000 E PRIMROSE 360 SPRINGFIELD,MO65807	CLINIC
8	COXHEALTH CENTER NIXA 411 N MCCROSKEY NIXA,MO65714	CLINIC
9	NORTHSIDE PEDIATRICS AND ADOLESCENTS 1443 N ROBBERSON 200 SPRINGFIELD,MO65802	CLINIC
10	COXHEALTH NEWBORN MEDICINE SPECIALISTS 3801 S NATIONAL AVE SPRINGFIELD,MO65807	CLINIC
11	COXHEALTH CENTER WILLOW SPRINGS 816 E MAIN WILLOW SPRINGS,MO65793	CLINIC
12	SUN RIVER ORTHOPAEDICS 3800 S NATIONAL AVE 700 SPRINGFIELD,MO65807	CLINIC
13	COXHEALTH CENTER ELFINDALE 1429 W SUNSHINE SPRINGFIELD,MO65807	CLINIC
14	COXHEALTH PEDIATRICS 1000 E PRIMROSE 300 SPRINGFIELD,MO65807	CLINIC
15	COXHEALTH CENTER LEBANON 510 E HWY 32 LEBANON,MO65536	CLINIC
16	COXHEALTH CENTER CHESTERFIELD 3805 S KANSAS EXPRESSWAY STE B SPRINGFIELD,MO65807	CLINIC
17	COXHEALTH CENTER WILLARD 304 E JACKSON 5H WILLARD,MO65781	CLINIC
18	COXHEALTH CENTER MOUNTAIN GROVE 1602-A N MAIN ST MOUNTAIN GROVE,MO65711	CLINIC
19	COX SENIOR HEALTH CENTER 1423 N JEFFERSON ST SPRINGFIELD,MO65802	CLINIC
20	COX SENIOR HEALTH CENTER SOUTH 3525 S NATIONAL 207 SPRINGFIELD,MO65807	CLINIC
21	COXHEALTH CENTER MARSHFIELD 1245 BANNING ST MARSHFIELD,MO65706	CLINIC
22	COXHEALTH CENTER OZARK 5548 N FARMER BRANCH RD OZARK,MO65721	CLINIC
23	COXHEALTH CENTER REPUBLIC 820 ILLINOIS AVE REPUBLIC,MO65738	CLINIC
24	COXHEALTH SURGERY MONETT 801 N LINCOLN MONETT,MO65708	CLINIC
25	COXHEALTH CENTER AVA 806 SW COLLINS AVE AVA,MO65608	CLINIC
26	COXHEALTH INPATIENT PSYCHIATRY 1423 N JEFFERSON ST SPRINGFIELD,MO65802	CLINIC
27	COXHEALTH CENTER BUFFALO 119 N ASH BUFFALO,MO65622	CLINIC
28	COXHEALTH CENTER ROGERSVILLE 151 JOHNSTOWN DR ROGERSVILLE,MO65742	CLINIC
29	COXHEALTH CENTER FOR ADDICTIONS 1423 N JEFFERSON ST SPRINGFIELD,MO65802	CLINIC
30	THE CLINIC AT WALMART #0444 3315 S CAMPBELL SPRINGFIELD,MO65807	CLINIC
31	COXHEALTH PEDIATRIC SPECIALTIES TURNER 1000 E PRIMROSE 200 SPRINGFIELD,MO65807	CLINIC
32	COXHEALTH CENTER SEYMOUR 202 COMMERCIAL SEYMOUR,MO65746	CLINIC
33	THE CLINIC AT WALMART #0379 2004 W MARLER LANE OZARK,MO65721	CLINIC
34	THE CLINIC AT WALMART #2221 2021 E INDEPENDENCE SPRINGFIELD,MO65804	CLINIC
35	THE CLINIC AT WALMART #1009 1150 US HWY 60 EAST REPUBLIC,MO65738	CLINIC
36	COXHEALTH CENTER CAMPBELL 2750 S CAMPBELL SPRINGFIELD,MO65807	CLINIC
37	PEDIATRIC HOSPITAL AFFILIATES 3801 S NATIONAL AVE 7TH FL SPRINGFIELD,MO65807	CLINIC
38	SPRINGFIELD NEUROLOGICAL AND SPINE 3801 S NATIONAL SPRINGFIELD,MO65804	CLINIC
39	COXHEALTH PSYCHOLOGICAL SERVICES 3800 S NATIONAL 770 SPRINGFIELD,MO65807	CLINIC
40	MARTIN CENTER 3901 S FREMONT SPRINGFIELD,MO65807	CLINIC
41	OZARK HEALTH VENTURES 3550 S NATIONAL AVE SPRINGFIELD,MO65807	CLINIC
42	BONE AND JOINT CENTER 3555 S NATIONAL AVE SPRINGFIELD,MO65807	CLINIC
43	FERRELL-DUNCAN CLINIC 1000 E PRIMROSE SPRINGFIELD,MO65807	MEDICAL OFFICES
44	MEYER CENTER FITNESS AND REHAB 3545 S NATIONAL AVE SPRINGFIELD,MO65807	FITNESS AND REHAB CENTER
45	COX HYPERBARIC MEDICINE AND WOUND CARE 3525 S NATIONAL AVE 101 SPRINGFIELD,MO65807	CLINIC
46	MEDICAL OFFICE BUILDING-COX WALNUT LAWN 3525 S NATIONAL AVE SPRINGFIELD,MO65807	MEDICAL OFFICES
47	TURNER WOMEN AND CHILDREN'S CENTER 1000 E PRIMROSE SPRINGFIELD,MO65807	MEDICAL OFFICES
48	WHEELER HEART AND VASCULAR 3800 S NATIONAL AVE 700 SPRINGFIELD,MO65807	MEDICAL OFFICES
49	HULSTON CANCER CENTER 3850 S NATIONAL AVE SPRINGFIELD,MO65807	MEDICAL OFFICES
50	MEDICAL TOWERS 1443 N ROBBERSON SPRINGFIELD,MO65802	MEDICAL OFFICES
51	COXHEALTH INFECTIOUS DISEASES SPECIALTY 3800 S NATIONAL LL100 SPRINGFIELD,MO65807	CLINIC
52	COX CARE MOBILE 3525 S NATIONAL AVE 105 SPRINGFIELD,MO65807	CLINIC
53	THE CLINIC AT WALMART #86 2825 N KANSAS EXPWAY SPRINGFIELD,MO65803	CLINIC
54	SENIOR ADVANTAGE 1000 E WALNUT LAWN SPRINGFIELD,MO65807	CLINIC
55	COXHEALTH SPECIALTY CLINIC 1001 E PRIMROSE STREET SPRINGFIELD,MO65807	CLINIC
56	PANTHER CLINIC OPERATED BY COXHEALTH 900 N BENTON AVENUE SPRINGFIELD,MO65802	CLINIC
57	COXHEALTH ADULT & PEDIATRIC URGENT CARE 1000 E PRIMROSE SPRINGFIELD,MO65807	URGENT CARE CLINIC
58	COXHEALTH VIRTUAL VISITS 1423 N JEFFERSON SPRINGFIELD,MO65802	CLINIC
59	COXHEALTH NEUROPSYCHOLOGY 3801 S NATIONAL AVE SUITE 900 SPRINGFIELD,MO65807	CLINIC
60	COXHEALTH OCCUPATIONAL MEDICINE 1499 N ROBBERSON SPRINGFIELD,MO65802	CLINIC
61	COXHEALTH PEDIATRIC PLACE 3800 S NATIONAL AVE SUITE 730 SPRINGFIELD,MO65807	CLINIC
62	COXHEALTH PEDIATRIC SURGICAL SPECIALTIES 1000 E PRIMROSE SUITE 300 SPRINGFIELD,MO65807	CLINIC
63	COXHEALTH PRIMROSE OBGYN 1000 E PRIMROSE SUITE 270 SPRINGFIELD,MO65807	CLINIC
64	COXHEALTH QUICK CARE HYVEE 1720 W BATTLEFIELD SPRINGFIELD,MO65807	CLINIC
65	COXHEALTH SKIN CARE 1925 CHESTERFIELD BLVD SPRINGFIELD,MO65807	CLINIC
66	COXHEALTH WELCOME CLINIC 2900 S NATIONAL BLDG A SPRINGFIELD,MO65804	CLINIC
67	COXHEALTH CENTER OZARK 5548 N FARNER BRANCH RD OZARK,MO65721	CLINIC
68	PALLIATIVE CARE 3801 S NATIONAL AVE SPRINGFIELD,MO65807	CLINIC
69	COXHEALTH OZARK PEDIATRICS 1741 SOUTH 15TH ST OZARK,MO65721	CLINIC
70	COXHEALTH MEDICAL MILE CLINIC 2900 S NATIONAL AVE SPRINGFIELD,MO65807	CLINIC
71	COXHEALTH CENTER SOUTHERN HILLS 2702 E SUNSHINE SPRINGFIELD,MO65804	CLINIC
72	COXHEALTH CONSULTING SERV AND AVIATION M 3555 S NATIONAL AVE SUITE 104 SPRINGFIELD,MO65807	CLINIC
73	COXHEALTH INTEGRATED BEHAVIORAL HEALTHCA 3800 S NATIONAL LL100 SPRINGFIELD,MO65807	CLINIC
74	COXHEALTH OBSTETRICS AND GYNECOLOGY 3525 S NATIONAL AVE 210 SPRINGFIELD,MO65807	CLINIC
75	COXHEALTH PEDIATRIC SPECIALTIES MED SOUT 3525 S NATIONAL AVE SUITE 210 SPRINGFIELD,MO65807	CLINIC
76	GLYCEMIC MANAGEMENT SERVICES 3801 S NATIONAL AVE SPRINGFIELD,MO65807	CLINIC
77	COXHEALTH CENTER BRANSON 890 HWY 248 BRANSON,MO65616	CLINIC

Schedule H (Form 990) 2018

Page 10

Part VI

Supplemental Information

Provide the following information.

1	Required descriptions. Provide the descriptions required for Part I, lines 3c, 6a, and 7; Part II and Part III, lines 2, 3, 4, 8 and 9b.
2	Needs assessment. Describe how the organization assesses the health care needs of the communities it serves, in addition to any CHNAs 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.

Form and Line Reference	Explanation
SCHEDULE H, PART I, LINE 3C	ELIGIBILITY FOR FREE CARE: IN GENERAL, THE ORGANIZATION'S CHARITY CARE POLICY DOES NOT PROVIDE FOR DISCOUNTS OF 100%. THEREFORE, IT IS EXPECTED THAT THE PATIENT OR GUARANTOR WILL HOLD A RESPONSIBILITY FOR PAYMENT OF AT LEAST A PORTION OF THE SERVICES, REGARDLESS OF THE LEVEL OF ELIGIBILITY. IT IS OUR INTENTION TO WORK WITH INDIVIDUALS ON THEIR OUT-OF-POCKET RESPONSIBILITY TO ESTABLISH FEASIBLE MONTHLY PAYMENTS WHEN NECESSARY. IN THE EVENT THAT A PATIENT OR GUARANTOR IS DETERMINED TO HAVE NO MEANS OF PAYING THE AMOUNT INDICATED AS THEIR RESPONSIBILITY DUE TO EXTENUATING CIRCUMSTANCES, CONSIDERATION MAY BE GIVEN TO WAIVING DEDUCTIBLES AND/OR INCREASING THE DISCOUNT AMOUNT UP TO A 100% DISCOUNT OF THE PATIENT PORTION. THESE EXTENUATING CASES ARE SUBJECT TO THE DISCRETION AND APPROVAL OF THE PFS DIRECTOR AND/OR THE CHIEF FINANCIAL OFFICER WITHIN THE APPROVAL LIMITS DEFINED AT THE END OF THE POLICY.
SCHEDULE H, PART I, LINE 7, COLUMN F	PERCENT OF TOTAL EXPENSE: TO ARRIVE AT THE PERCENT OF TOTAL EXPENSES, THE DENOMINATOR EQUALS TOTAL OPERATING EXPENSES PER PART IX, LINE 25, OF THE FORM 990.
SCHEDULE H, PART I, LINE 7G	SUBSIDIZED SERVICES: THE ORGANIZATION HAS INCLUDED COSTS ASSOCIATED WITH RURAL HEALTH CENTERS (RHC) IN THE CALCULATION OF SUBSIDIZED SERVICES ON LINE 7G, WITH A NET SUBSIDY FROM RHCS OF $4,175,994. LESTER E. COX MEDICAL CENTERS PROVIDES PRIMARY CARE SERVICES TO THE SURROUNDING COMMUNITIES AT THE CENTERS. THESE SERVICES ARE PROVIDED IN RURAL AREAS WHERE THERE WOULD BE A SHORTAGE OF QUALITY MEDICAL CARE WITHOUT THE SERVICES. LESTER E. COX MEDICAL CENTERS CONTINUES TO PROVIDE THESE SERVICES AS A BENEFIT TO THE COMMUNITY DESPITE KNOWING THAT FINANCIAL SHORTFALLS WILL BE SUSTAINED.
SCHEDULE H, PART I, LINE 7	COSTING METHODOLOGY: THE COST TO CHARGE RATIO CALCULATED ON IRS WORKSHEET 2 WAS USED IN THE CALCULATION OF COST ON IRS WORKSHEETS 1 AND 3. COST COMPUTED ON IRS WORKSHEETS 5 AND 6 WERE COMPUTED FROM THE MEDICARE COST REPORT, INCLUDING DIRECT COSTS PLUS OVERHEAD ALLOCATIONS COMPUTED IN THE COST REPORT STEP-DOWN PROCESS.
SCHEDULE H, PART III, SECTION A, LINE 2	BAD DEBT EXPENSE: THE HOSPITAL HAS ADOPTED THE NEW REVENUE RECOGNITION STANDARD ASU 2014-09. UNDER ASU 2014-09, THE ESTIMATED AMOUNTS DUE FROM PATIENTS FOR WHICH THE HOSPITAL DOES NOT EXPECT TO BE ENTITLED OR COLLECT FROM THE PATIENTS ARE CONSIDERED IMPLICIT PRICE CONCESSIONS AND EXCLUDED FROM THE HOSPITAL'S ESTIMATION OF THE TRANSACTION PRICE OR REVENUE RECORDED. BAD DEBT EXPENSE WAS NOT SIGNIFICANT TO THE AUDITED FINANCIAL STATEMENTS FOR THE YEAR ENDED SEPTEMBER 30, 2019. HOWEVER, THE HOSPITAL INTERNALLY TRACKS BAD DEBT EXPENSE CONSISTENT WITH HISTORICAL PRACTICES AND THAT AMOUNT HAS BEEN REPORTED ON SCHEDULE H, PART III, SECTION A, LINE 2.
SCHEDULE H, PART III, SECTION A, LINE 3	BAD DEBT EXPENSE ATTRIBUTABLE TO CHARITY CARE: THE BAD DEBT ATTRIBUTABLE TO PATIENTS ELIGIBLE UNDER THE ORGANIZATION'S CHARITY CARE POLICY WAS DETERMINED USING POVERTY LIMIT DEMOGRAPHIC INFORMATION OBTAINED THROUGH THE US CENSUS BUREAU. USING DATA FROM 2014-2018, APPROXIMATELY 15.5 PERCENT OF GREENE COUNTY WAS CONSIDERED TO LIVE IN POVERTY.
SCHEDULE H, PART III, SECTION A, LINE 4	BAD DEBT EXPENSE FOOTNOTE: THE AUDIT FOOTNOTE ADDRESSING BAD DEBT EXPENSE AND PATIENT ACCOUNTS RECEIVABLE IS FOUND ON PAGE 11 OF THE AUDITED FINANCIAL STATEMENTS UNDER NOTE 1, SUBTITLED "PATIENT ACCOUNTS RECEIVABLE."
SCHEDULE H, PART III, SECTION B, LINE 8	COMMUNITY BENEFIT: SERVING PATIENTS WITH GOVERNMENT HEALTH BENEFITS, SUCH AS MEDICARE, IS A COMPONENT OF THE COMMUNITY BENEFIT STANDARD THAT TAX-EXEMPT HOSPITALS ARE HELD TO. THIS IMPLIES THAT SERVING MEDICARE PATIENTS IS A COMMUNITY BENEFIT AND THAT THE HOSPITAL OPERATES TO PROMOTE THE HEALTH OF THE COMMUNITY.
SCHEDULE H, PART III, SECTION C, LINE 9B	COLLECTION POLICY: THE ORGANIZATION WILL NOT PURSUE LEGAL ACTION FOR NONPAYMENT OF ANY AMOUNTS DISCOUNTED AS A RESULT OF AN APPROVED OR PARTIALLY APPROVED REQUEST FOR FINANCIAL ASSISTANCE. BALANCES REMAINING AFTER SUCH DISCOUNTS ARE APPLIED WILL, HOWEVER, BE SUBJECT TO COLLECTION ACTIVITY, INCLUDING LEGAL ACTION. IN ADDITION, THE ORGANIZATION WILL NOT CHARGE INTEREST ON THE BALANCE REMAINING AFTER APPLYING THE FINANCIAL ASSISTANCE DISCOUNT. HOWEVER, THE ORGANIZATION MAY, IN ITS SOLE DISCRETION, CHARGE INTEREST ON THE BALANCE OWED IF 1) THE GUARANTOR DEFAULTS ON HIS OR HER PAYMENT AGREEMENT OR 2) THE BALANCE IS REFERRED TO THE COLLECTION AGENCY FOR COLLECTION.
SCHEDULE H, PART VI, LINE 2	NEEDS ASSESSMENT: LESTER E. COX MEDICAL CENTERS HAS PERFORMED AN ENVIRONMENTAL SCAN ANNUALLY SINCE 2006. COMMUNITY HEALTH NEEDS ASSESSMENTS AS REQUIRED BY THE IRS WERE COMPLETED IN EARLY 2016. A PUBLIC PERCEPTION STUDY OF AREA HEADS OF HOUSEHOLDS IS CONDUCTED ANNUALLY. THE MOST RECENT STUDY SURVEYED 876 HOUSEHOLDS IN OUR SERVICE AREA TO DETERMINE WHAT SERVICES ARE NEEDED. WE ALSO PERFORM A PUBLIC HEALTH SURVEY, WHICH ASKS COMMUNITY LEADERS AND HEALTH PROFESSIONALS WHAT THEIR PRIORITIES ARE AND WHAT HEALTH SERVICES ARE LACKING IN THEIR COMMUNITY. THE PUBLIC HEALTH SURVEY IS SENT TO COUNTY PUBLIC HEALTH DEPARTMENTS, LOCAL AGENCIES, REGIONAL SERVICES CLINICS, MENTAL HEALTH FACILITIES, AND PUBLIC SCHOOLS THROUGHOUT THE TOTAL SERVICE AREA. LESTER E. COX MEDICAL CENTERS REFERENCES UNITED HEALTH FOUNDATION STATE-BY-STATE HEALTH RANKINGS AS WELL AS ROBERT WOOD JOHNSON AND UNIVERSITY OF WISCONSIN POPULATION HEALTH INSTITUTE COUNTY HEALTH RANK FOR HEALTH OUTCOMES AND HEALTH FACTORS. COXHEALTH ALSO REFERENCES "ASSESSING THE HEALTH OF THE COMMUNITY", WHICH IS AN ANALYSIS OF BEHAVIORS AND OUTCOMES FOR THE SPECIFIC COUNTIES OF THE SERVICE AREA BY THE MISSOURI HOSPITAL ASSOCIATION. DEMOGRAPHIC AND ECONOMIC ANALYSIS IS PERFORMED FOR THE 22-COUNTY SERVICE AREA. NIELSEN CLARITAS DEMOGRAPHIC ESTIMATES AND PROJECTIONS ARE USED TO EVALUATE THE CHANGE IN POPULATION CHARACTERISTICS. UNEMPLOYMENT, HOME FORECLOSURE, AND INPATIENT PAYER DATA IS ALSO ASSESSED. IN 2016, COXHEALTH PERFORMED A COMMUNITY HEALTH NEEDS ASSESSMENT AS PART OF A COLLABORATIVE EFFORT, CONSISTING OF A VARIETY OF ORGANIZATIONS ACROSS THE OZARKS, TO BETTER UNDERSTAND THE HEALTH STATUS, BEHAVIORS, AND NEEDS OF THE POPULATIONS WE SERVE. UNDER THE UMBRELLA OF THE LOCAL OZARKS HEALTH COMMISSION, THIS FIRST-TIME COLLABORATION WAS THE LARGEST IN THE REGION SPANNING FOUR STATES-MISSOURI, OKLAHOMA, ARKANSAS AND KANSAS-29 COUNTIES AND THREE HOSPITAL SYSTEMS. THE WORKING GROUP SAW THE VALUE OF USING A SYSTEMATIC, DATA-DRIVEN ASSESSMENT TO INFORM DECISIONS AND GUIDE EFFORTS TO IMPROVE COMMUNITY HEALTH AND WELLNESS ON A REGIONAL LEVEL. THIS LARGER, CONCERTED APPROACH WILL LEVERAGE COMMON STRENGTHS AND STRATEGIES TO MOVE IN THE SAME DIRECTION ON SIGNIFICANT HEALTH CONCERNS. THE 2019 ASSESSMENT PROCESS BUILDS ON THE METHODOLOGY DEVELOPED DURING THE 2016 COMMUNITY HEALTH NEEDS ASSESSMENT. IT INCLUDES MORE THAN 140 HOSPITAL AND COMMUNITY DATA INDICATORS. THIS DATA WAS COMPARED TO THE NATION AND PAST PERFORMANCE AND USED TO IDENTIFY THE SIX ASSESSED HEALTH ISSUES (AHI): CANCER, LUNG DISEASE, CARDIOVASCULAR DISEASE, MENTAL HEALTH, DIABETES, AND ORAL HEALTH. LOCAL STAKEHOLDERS UTILIZED A COMBINATION OF PUBLIC HEALTH AND HOSPITAL DATA, ALONG WITH A COMMUNITY SURVEY DATA, TO PRIORITIZE THE AHI BASED ON FEASIBILITY AND COMMUNITY READINESS. THIS PRIORITIZATION PROCESS RESULTED IN THREE PRIORITIES FOR THE SPRINGFIELD COMMUNITY: LUNG DISEASE, CARDIOVASCULAR DISEASE AND MENTAL HEALTH. ALTHOUGH OTHER AHI WERE IDENTIFIED AS HEALTH ISSUES FOR THE SPRINGFIELD COMMUNITY, RESOURCES WOULD BE DILUTED IN AN EFFORT TO ADDRESS SEVERAL HEALTH ISSUES, THUS MINIMIZING THE ABILITY TO CREATE MEANINGFUL IMPACT. BY PRIORITIZING THE AHI BY FEASIBILITY AND COMMUNITY READINESS, THE COMMUNITY WILL BE ABLE TO HAVE A GREATER IMPACT ON OVERALL COMMUNITY HEALTH THROUGH EFFICIENT AND EFFECTIVE RESOURCE ALLOCATION.
SCHEDULE H, PART VI, LINE 3	PATIENT EDUCATION OF ELIGIBILITY FOR ASSISTANCE: LESTER E. COX MEDICAL CENTERS USES A VARIETY OF METHODS TO INFORM AND EDUCATE PATIENTS ABOUT THEIR ELIGIBILITY FOR ASSISTANCE UNDER FEDERAL, STATE PROGRAMS OR UNDER THE ORGANIZATION'S POLICY: - AVAILABILITY OF FINANCIAL ASSISTANCE THROUGH THE ORGANIZATION IS COMMUNICATED TO PATIENTS THROUGH THE USE OF SIGNAGE AND BROCHURES/INFORMATION PACKETS AVAILABLE AT CHECK-IN LOCATIONS. - LESTER E. COX MEDICAL CENTERS ALSO PROACTIVELY COMMUNICATES THE AVAILABILITY OF FINANCIAL ASSISTANCE ON PATIENT BILLS AND STATEMENTS; AND ITS EARLY-OUT VENDOR RESPONSIBLE FOR PATIENT BALANCE COLLECTIONS IS EXPECTED TO PROACTIVELY INFORM SELF PAY PATIENTS OF THE AVAILABILITY WHEN SPEAKING TO THEM ON THE PHONE. - FOR ASSISTANCE UNDER FEDERAL AND STATE PROGRAMS LESTER E. COX MEDICAL CENTERS UTILIZES AN OUTSOURCE ELIGIBILITY VENDOR WHO MEETS WITH SELF PAY INPATIENTS AT THE BEDSIDE TO COMPLETE AN ELIGIBILITY SCREENING, INFORM THE PATIENTS OF POTENTIAL AVAILABILITY, AND WILL WORK WITH THE PATIENT TO HELP THEM THROUGH THE PROCESS. OUTPATIENTS ARE REFERRED TO THE VENDOR AFTER CARE AND THOSE ARE WORKED IN A SIMILAR FASHION WITH THE EXPECTATION THAT THE FIRST CONTACT IS THROUGH MAIL OR PHONE RATHER THAN AT THE BEDSIDE.
SCHEDULE H, PART VI, LINE 4	COMMUNITY INFORMATION: THE PRIMARY SERVICE AREA (PSA) COUNTIES SERVED BY LESTER E. COX MEDICAL CENTERS INCLUDE: BARRY, CHRISTIAN, GREENE, LAWRENCE, STONE, TANEY, AND WEBSTER (ALL PSA COUNTIES ARE LOCATED IN MISSOURI). THE SECONDARY SERVICE AREA (SSA) COUNTIES SERVED BY LESTER E. COX MEDICAL CENTERS INCLUDE: BARTON, BAXTER - AR, BOONE - AR, CARROLL - AR, CEDAR, DADE, DALLAS, DOUGLAS, HICKORY, HOWELL, LACLEDE, MARION - AR, OREGON, OZARK, POLK, PULASKI, TEXAS, AND WRIGHT (ALL SSA COUNTIES ARE LOCATED IN MISSOURI EXCEPT BAXTER, BOONE, CARROLL, AND MARION COUNTIES IN ARKANSAS). THE TOTAL POPULATION IN THE SERVICE AREA IS OVER ONE MILLION AND APPROXIMATELY 58% OF THE TOTAL 25-COUNTY POPULATION IS IN THE SEVEN COUNTY PRIMARY SERVICE AREA. SLIGHTLY MORE THAN 50% OF THE MARKET IS FEMALE AND SLIGHTLY MORE THAN 18% OF THE SERVICE AREA IS FEMALE BETWEEN THE AGES OF 15 AND 44. THE SEGMENT OF THE POPULATION OVER THE AGE OF 65 IS ALMOST 20% OF THE TOTAL POPULATION AND IS PROJECTED TO INCREASE 12% BETWEEN 2020 AND 2025. THE AVERAGE HOUSEHOLD INCOME IS $64,665 IN THE TOTAL 25-COUNTY SERVICE AREA COMPARED WITH $79,915 FOR THE STATE OF MISSOURI. DIVERSITY IS VERY LOW IN THE 25-COUNTY SERVICE AREA AS 91% OF THE POPULATION IS WHITE ALONE.
SCHEDULE H, PART VI, LINE 5	PROMOTION OF COMMUNITY HEALTH: LESTER E. COX MEDICAL CENTERS' MISSION IS TO IMPROVE THE HEALTH OF THE COMMUNITIES WE SERVE THROUGH QUALITY HEALTH CARE, EDUCATION AND RESEARCH. WE ACTIVELY LIVE THIS MISSION BY PROVIDING QUALITY HEALTH CARE WITH MULTIPLE ACCESS POINTS FOR CARE INCLUDING THREE HOSPITALS AND MORE THAN 60 PHYSICIAN CLINICS (INCLUDING RETAIL CLINICS). THE ORGANIZATION PROMOTES THE HEALTH OF THE COMMUNITY THROUGH A COMMUNITY BOARD, HEALTH RELATED AD CAMPAIGNS, PROVISION OF WELLNESS SERVICES AND VACCINATIONS, PROVISION OF CARE FOR INDIGENT SEGMENTS OF THE POPULATION, FUNDING OF CARE QUALIFIED COMMUNITY MEMBERS THROUGH A NOT-FOR-PROFIT FOUNDATION, COMMUNITY EDUCATION CLASSES RELATED TO HEALTH AND WELLNESS, COMMUNITY ADVISORY COUNCILS AND HEALTH IMPROVEMENT EFFORTS IN PARTNERSHIP WITH PUBLIC HEALTH DEPARTMENTS, SCHOOL SYSTEMS AND OTHER REGIONAL HEALTH CARE PROVIDERS. A MAJORITY OF LESTER E. COX MEDICAL CENTERS' BOARD IS COMPRISED OF INDIVIDUALS WHO RESIDE IN THE ORGANIZATION'S PRIMARY SERVICE AREA, WHO ARE NEITHER EMPLOYEES NOR INDEPENDENT CONTRACTORS. THE ORGANIZATION EXTENDS MEDICAL STAFF PRIVILEGES TO PHYSICIANS IN THE COMMUNITY IF THEY QUALIFY.
SCHEDULE H, PART VI, LINE 6	AFFILIATED HEALTH CARE SYSTEM: COXHEALTH IS THE PARENT OF LESTER E. COX MEDICAL CENTERS AND ITS WHOLLY OWNED SUBSIDIARIES PLUS CERTAIN AFFILIATED NOT-FOR-PROFIT ENTITIES AND IS COLLECTIVELY REFERRED TO AS COXHEALTH. COXHEALTH (THE HEALTH SYSTEM) OPERATES AS AN INTEGRATED DELIVERY SYSTEM INCLUDING FOUR HOSPITALS, A SURGICAL CENTER, AN INPATIENT REHABILITATION FACILITY, HOME CARE COMPANIES, PHYSICIAN SERVICES, MENTAL HEALTH SERVICES, INSURANCE COMPANIES AND A FOUNDATION. COXHEALTH'S HOME CARE SERVICES ARE PROVIDED BY COXHEALTH AT HOME AND INCLUDE HOME HEALTH SERVICES, INFUSION THERAPY AND DURABLE MEDICAL EQUIPMENT. COXHEALTH AT HOME SUPPORTED THE COMMUNITY THROUGH MONTHLY NUTRITION AND FALL PREVENTION SEMINARS AT 20 AREA SENIOR CENTERS THROUGHOUT SOUTHWEST MISSOURI. THEY ALSO PROVIDED FREE BONE DENSITY SCREENINGS AT 34 COMMUNITY EVENTS, AND VITAL SIGN SCREENINGS AT MANY MORE. THROUGH AN ANNUAL FAN DRIVE, COXHEALTH AT HOME COLLECTED AND DISTRIBUTED BOX FANS TO SENIORS AND THE DISABLED WHO LACK ADEQUATE ACCESS TO COOLING DURING THE SUMMER MONTHS. INFUSION THERAPY RECEIVED A SECOND GRANT AWARD FROM THE MISSOURI FOUNDATION FOR HEALTH ORGANIZATION. THIS GRANT ALLOWS US TO SERVE PATIENTS THAT FALL THROUGH THE CRACKS DUE TO HAVING NO REIMBURSEMENT OF ANY KIND, SERVING PATIENTS THROUGHOUT SOUTHERN MISSOURI. ASSISTANCE TO COXHEALTH SYSTEM IN DEVELOPING AN INTEGRATED HEALTH SYSTEM, AND SERVICE TO MEDICAID PATIENTS. COX-MONETT HOSPITAL SUPPORTS THE MONETT, MISSOURI AND SURROUNDING COMMUNITY BY PROVIDING A VARIETY OF SERVICES WHICH INCLUDE UROLOGY, ENT (EAR, NOSE AND THROAT), PULMONOLOGY, ORTHOPEDICS, CARDIOLOGY, PODIATRY, OBSTETRICS, RADIOLOGY (CT, MRI, NUCLEAR MEDICINE AND MAMMOGRAPHY), LABORATORY, 24-HOUR EMERGENCY CENTER, GENERAL SURGICAL SERVICES, SAME-DAY SURGERY, DIABETES CENTER, SLEEP CENTER, CARDIOPULMONARY REHAB, MEDICAL-SURGICAL UNIT, URGENT CARE, PHARMACY AND COMMUNITY WELLNESS. COXHEALTH FOUNDATION SUPPORTS THE COMMUNITY BY RAISING FUNDS TO DISPERSE TO PATIENTS FOR THOSE NEEDS FOR WHICH THEY HAVE NO RESOURCES OR FUNDING, BUT WHICH ARE CRITICAL TO THE PATIENT'S HEALTH AND WELL BEING. SKAGGS COMMUNITY HOSPITAL ASSOCIATION D/B/A COX MEDICAL CENTER BRANSON (CMCB) HAS BEEN SERVING SOUTHWEST MISSOURI RESIDENTS FOR MORE THAN 63 YEARS AND OFFERS OVER 25 MAJOR SERVICE AREAS. THE HOSPITAL'S AVERAGE DAILY PATIENT CENSUS EXCEEDS 85 WITH 165 LICENSED HOSPITAL BEDS. A STAFF OF OVER 1,100 PERSONNEL IS REQUIRED TO OPERATE THE HOSPITAL AND ITS NUMEROUS CLINICS. COXHEALTH ADDED A FOURTH HOSPITAL IN 2018, COX BARTON COUNTY HOSPITAL (COX BARTON COUNTY). THE FACILITY WAS A COUNTY HOSPITAL OWNED AND OPERATED BY BARTON COUNTY MEMORIAL HOSPITAL (BCMH). IT WAS BUILT IN 2007 AND IS A 25-BED CRITICAL ACCESS HOSPITAL IN LAMAR, MISSOURI OFFERING AN EMERGENCY DEPARTMENT, AS WELL AS SPECIALIZED CARE IN DIABETES, CARDIOLOGY, ORTHOPEDICS AND SPORTS MEDICINE, NEUROLOGY, WOMEN'S HEALTH AND MORE. IN OCTOBER 2017, COXHEALTH SIGNED A LETTER OF INTENT WITH BCMH TO ACQUIRE ITS OPERATION AND TO LEASE ITS PROPERTY. BCMH WAS STRUGGLING AS A RURAL HOSPITAL TO KEEP UP WITH DECLINING REVENUE. COXHEALTH'S ACQUISITION ALLOWS FOR THE PATIENTS PREVIOUSLY SERVED BY BCMH TO BECOME A PART OF THE COXHEALTH SYSTEM. COX BARTON COUNTY WILL CONTINUE THE SERVICES PREVIOUSLY PROVIDED BY BCMH AND INTENDS TO EXPAND THESE SERVICES FURTHER IN THE FUTURE AS WELL. TO COMPLETE THE TRANSACTION, COXHEALTH FORMED TWO ENTITIES, COX BARTON COUNTY HOSPITAL, A MISSOURI NONPROFIT CORPORTATION, AND CBCH, LLC, A MISSOURI LIMITED LIABILITY COMPANY. BOTH ENTITIES HAVE THE SAME CORPORATE PARENT, COXHEALTH, WHICH IS A MISSOURI NONPROFIT CORPORATION. THE OPERATION AND ASSETS OF THE HOSPITAL HAVE BEEN HELD BY CBCH, LLC SINCE JANUARY 1, 2018 AND WILL BE TRANSFERRED TO COX BARTON COUNTY HOSPITAL EFFECTIVE OCTOBER 1, 2019.

Schedule H (Form 990) 2018

Additional Data

Software ID:
Software Version:

- TIN:

Note: To capture the full content of this document, please select landscape mode (11" x 8.5") when printing.

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," on Form 990, Part IV, line 21 or 22.
lBullet

Attach to Form 990.
lBullet

Go to www.irs.gov/Form990 for the latest information.

OMB No. 1545-0047

2018

Open to Public
Inspection

Name of the organization
LESTER E COX MEDICAL CENTERS

Employer identification number
44-0577118

Part I

General Information on Grants and Assistance

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

Yes No

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

Part II

Grants and Other Assistance to Domestic Organizations and Domestic Governments. Complete if the organization answered "Yes" on 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 section (if applicable)	(d) Amount of cash grant	(h) Purpose of grant or assistance
(1) MHA CENTER FOR EDUCATION PO BOX 60 JEFFERSON CITY,MO65102	43-0898947	501(C)(3)	93,312	COMM BENEFIT
(2) COXHEALTH COXHEALTH SPRINGFIELD,MO65802	47-1087427	501(C)(3)	47,599	COMM BENEFIT
(3) COXHEALTH FOUNDATION 3525 S NATIONAL STE 204 SPRINGFIELD,MO65807	43-6810485	501(C)(3)	9,693	COMM BENEFIT

Enter total number of section 501(c)(3) and government organizations listed in the line 1 table ................. Bullet Image

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) 2018

Page 2

Part III

Grants and Other Assistance to Domestic Individuals. Complete if the organization answered "Yes" on 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 noncash assistance	(e) Method of valuation (book, FMV, appraisal, other)	(f) Description of noncash assistance

(1) CHILDREN'S MIRACLE NETWORK -SPECIAL NEEDS GRANT	2341	188,223
(2) CHILDREN'S MIRACLE NETWORK -FAMILY CARE GRANTS	78	182,675
(3) CHILDREN'S MIRACLE NETWORK -COMMUNITY OUTREACH GRA	38063	59,610
(4) CHILDREN'S MIRACLE NETWORK -LESTER E COX MC GRANTS	63524	525,581
(5) CHILDREN'S MIRACLE NETWORK -OTHER GRANTS	18912	434,902
(6) TUITION ASSISTANCE PROGRAMS	10	97,710
(7) CAR SEAT/SLEEP SACK	3729	24,359
(7)

Part IV

Supplemental Information. Provide the information required in Part I, line 2; Part III, column (b); and any other additional information.

Return Reference

Explanation

SCHEDULE I, PART I, LINE 2

PROCEDURES FOR MONITORING THE USE OF GRANT FUNDS IN THE U.S.: THROUGH THE CHILDREN'S MIRACLE NETWORK, LESTER E. COX MEDICAL CENTERS DISTRIBUTES FUNDS TO INDIVIDUALS THROUGHOUT THE COMMUNITY. SEE BELOW FOR A SUMMARY OF PROGRAMS THROUGH WHICH FUNDS ARE DISTRIBUTED. DURING FISCAL YEAR 2019, NEARLY 123,000 CHILDREN WERE SERVED: SPECIAL NEEDS FUND - $188,223 - DIRECT FINANCIAL ASSISTANCE TO FAMILIES, WHICH INCLUDES: *KIDS CHECKS - $90,639 *MEAL TRAYS - $61,072 *MEAL VOUCHERS - $3,872 *GIFT CARDS - $32,640 FAMILY CARE GRANTS - $182,675 - DIRECT FINANCIAL ASSISTANCE TO FAMILIES, WHICH INCLUDES: SPEECH, OCCUPATIONAL AND PHYSICAL THERAPY BILLS, HOSPITAL BILLS, ETC. COMMUNITY GUARANTEED GRANTS - $59,610 TOTAL *CARDIAC PROGRAM (A PORTION TO COX- MONETT HOSPITAL, INC.) - $26,610 *"NEVER SHAKE A BABY" PROGRAM - $15,000 *BICYCLE SAFETY PROGRAM - $ 7,000 *WASTED PROGRAM - $3,000 *WATER SAFETY PROGRAM - $2,000 *CAR SEAT SAFETY PROGRAM - $6,000 LESTER E. COX MEDICAL CENTERS GUARANTEED GRANTS - $525,581 TOTAL *CHILD LIFE PROGRAM - $147,210 *C.A.R.E. MOBILE - $378,371 DISCRETIONARY AND OPEN FUNDS - $434,902 - THESE ARE FUNDS THAT DO NOT FALL INTO ONE OF THE ABOVE CATEGORIES AND INCLUDES FUNDS TO DEPARTMENTS FOR EQUIPMENT AND OTHER THERAPEUTIC ITEMS FOR CHILDREN. THE FUNDS ARE AS FOLLOWS: *SURGICAL SERVICES - $22,109 *MONETT L & D - $15,167 *LABOR & DELIVERY - $41,187 *RESPIRATORY CARE - $77,332 *PEDIATRICS/PICU - $4,982 *BRANSON PEDIATRICS - $20,605 *BRANSON MATERNITY - $15,977 *BRANSON THERAPY SERVICES - $5,000 *CHILD/ADOLESCENT PSYCH - $22,495 *WOMEN/NEWBORN - $20,521 *CASE MANAGEMENT - $5,998 *OP NEURO-THERAPY - $7,690 *ACUTE CARE THERAPY - $21,900 *REHAB THERAPY MORH - $5,203 *LABORATORY SERVICES - $4,962 *BARTON COUNTY ER - $23,774 *GI ENDOSCOPE & TOWER - $120,000 THE ORGANIZATION ALSO PROVIDED SUPPORT OF OTHER LOCAL ORGANIZATIONS THROUGH SPONSORSHIPS AS PART OF THEIR COMMUNITY BUILDING ACTIVITIES. THE USE OF THE FUNDS CAN BE SEEN AT EVENTS AND IN COMMUNITY PROJECTS.

Schedule I (Form 990) 2018

Additional Data

Software ID:
Software Version:

- TIN:

Schedule J
(Form 990)

Department of the Treasury
Internal Revenue Service

Compensation Information

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

Complete if the organization answered "Yes" on Form 990, Part IV, line 23.
SchJMediumBullet

Attach to Form 990.
SchJMediumBullet

Go to www.irs.gov/Form990 for instructions and the latest information.

OMB No. 1545-0047

2018

Open to Public Inspection

Name of the organization

LESTER E COX MEDICAL CENTERS

Employer identification number

44-0577118

Part I

Questions Regarding Compensation

Yes

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

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

Travel for companions Payments for business use of personal residence

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

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

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

Yes

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

Yes

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.

Compensation committee Written employment contract

Independent compensation consultant Compensation survey or study

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

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

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

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

Yes

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

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

Only 501(c)(3), 501(c)(4), and 501(c)(29) organizations must complete lines 5-9.

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

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

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

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

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

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

Yes

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

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

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

Were any amounts reported on 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 ..........................

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

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

Cat. No. 50053T

Schedule J (Form 990) 2018

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 on 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 in column (B) reported as deferred on prior Form 990
(A) Name and Title		(i) Base compensation	(ii) Bonus & incentive compensation	(iii) Other reportable compensation	(C) Retirement and other deferred compensation	(D) Nontaxable benefits	(E) Total of columns (B)(i)-(D)
1PATRICIA DIX MD BOARD MEMBER	(i) (ii)	360,417 ------------- 0	0 ------------- 0	2,843 ------------- 0	26,750 ------------- 0	14,746 ------------- 0	404,756 ------------- 0	0 ------------- 0
2DAVID ZOLFAGHARI MD BOARD MEMBER	(i) (ii)	0 ------------- 1,125,716	0 ------------- 0	0 ------------- 0	0 ------------- 0	0 ------------- 16,320	0 ------------- 1,142,036	0 ------------- 0
3STEVE EDWARDS PRESIDENT AND CEO COXHEALTH	(i) (ii)	0 ------------- 1,113,707	0 ------------- 377,807	0 ------------- 10,359	0 ------------- 269,727	0 ------------- 25,566	0 ------------- 1,797,166	0 ------------- 0
4JACOB MCWAY SR VP AND CFO COXHEALTH	(i) (ii)	0 ------------- 605,649	0 ------------- 148,486	0 ------------- 137,806	0 ------------- 144,963	0 ------------- 23,216	0 ------------- 1,060,120	0 ------------- 126,919
5IBRAHIM ABE ABDALLA MD BOARD MEMBER	(i) (ii)	0 ------------- 983,315	0 ------------- 0	0 ------------- 0	0 ------------- 0	0 ------------- 16,320	0 ------------- 999,635	0 ------------- 0
6LOUIS KRENN MD PHYSICIAN	(i) (ii)	633,410 ------------- 0	0 ------------- 0	300 ------------- 0	13,365 ------------- 0	16,370 ------------- 0	663,445 ------------- 0	0 ------------- 0
7ARMIN KAMYAB MD PHYSICIAN	(i) (ii)	1,127,076 ------------- 0	0 ------------- 0	270 ------------- 0	31,865 ------------- 0	7,823 ------------- 0	1,167,034 ------------- 0	0 ------------- 0
8NAGIB CHOWDHURY MD PHYSICIAN	(i) (ii)	533,604 ------------- 0	0 ------------- 0	270 ------------- 0	31,865 ------------- 0	7,823 ------------- 0	573,562 ------------- 0	0 ------------- 0
9GREGORY STAMPS MD PHYSICIAN	(i) (ii)	670,684 ------------- 0	0 ------------- 0	690 ------------- 0	32,250 ------------- 0	16,435 ------------- 0	720,059 ------------- 0	0 ------------- 0
10ARJIT CHOWDHURY MD PHYSICIAN	(i) (ii)	592,902 ------------- 0	0 ------------- 0	300 ------------- 0	13,365 ------------- 0	16,370 ------------- 0	622,937 ------------- 0	0 ------------- 0
11DAVID STRONG VP HOSPITAL REVENUE & CFO CMCB	(i) (ii)	139,122 ------------- 139,123	19,251 ------------- 19,251	20,824 ------------- 20,825	21,175 ------------- 21,175	8,267 ------------- 8,268	208,639 ------------- 208,642	17,179 ------------- 17,180
12RON PRENGER SR VP, CHIEF HOSPITAL OFFICER	(i) (ii)	409,424 ------------- 0	54,885 ------------- 0	1,980 ------------- 0	31,750 ------------- 0	14,602 ------------- 0	512,641 ------------- 0	0 ------------- 0
13GENICE MAROC VP CLINICAL SERVICES	(i) (ii)	203,657 ------------- 0	12,922 ------------- 0	1,980 ------------- 0	7,107 ------------- 0	8,231 ------------- 0	233,897 ------------- 0	0 ------------- 0
14MAX BUETOW VP REGIONAL SERVICES	(i) (ii)	218,301 ------------- 0	15,501 ------------- 0	690 ------------- 0	13,750 ------------- 0	16,467 ------------- 0	264,709 ------------- 0	0 ------------- 0
15JEFF HAWKINS VP CLINICAL SERVICES	(i) (ii)	180,008 ------------- 0	11,048 ------------- 0	1,290 ------------- 0	9,749 ------------- 0	8,032 ------------- 0	210,127 ------------- 0	0 ------------- 0
16FRANK ROMERO VP MEDICAL AFFAIRS	(i) (ii)	412,948 ------------- 0	22,403 ------------- 0	1,980 ------------- 0	13,750 ------------- 0	16,650 ------------- 0	467,731 ------------- 0	0 ------------- 0
17ROBERT FERGUSON VP FERRELL DUNCAN CLINIC	(i) (ii)	292,839 ------------- 0	19,524 ------------- 0	1,980 ------------- 0	13,750 ------------- 0	11,482 ------------- 0	339,575 ------------- 0	0 ------------- 0
18KAREN KRAMER VP, CHIEF NURSING OFFICER	(i) (ii)	281,120 ------------- 0	18,318 ------------- 0	1,290 ------------- 0	31,742 ------------- 0	14,487 ------------- 0	346,957 ------------- 0	0 ------------- 0
19AMANDA HEDGPETH VP CLINICAL SERVICES	(i) (ii)	177,541 ------------- 0	10,460 ------------- 0	270 ------------- 0	9,555 ------------- 0	7,748 ------------- 0	205,574 ------------- 0	0 ------------- 0
20STACI NIEMOTH MD BOARD MEMBER	(i) (ii)	0 ------------- 571,029	0 ------------- 0	0 ------------- 0	0 ------------- 0	0 ------------- 16,320	0 ------------- 587,349	0 ------------- 0

Schedule J (Form 990) 2018

Page 3

Part III

Supplemental Information

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.

Return Reference	Explanation
SCHEDULE J, PART I, LINE 1A	INFORMATION REGARDING BENEFITS PROVIDED: MONTHLY SOCIAL CLUB DUES ARE INCLUDED IN THE TAXABLE COMPENSATION OF STEVE EDWARDS, CEO. CHARTER TRAVEL IS PROVIDED FOR STEVE EDWARDS, JACOB MCWAY AND DENNIS HEIM FOR TRAVEL TO COLLABORATIVE MEETINGS REPRESENTING COXHEALTH FOR EXPEDIENCY. AS THERE WAS NO PERSONAL USE PORTION OF THIS BENEFIT, NONE WAS INCLUDED IN TAXABLE WAGES.
SCHEDULE J, PART I, LINE 4B	SUPPLEMENTAL NONQUALIFIED RETIREMENT PLAN: STEVE EDWARDS AND JACOB MCWAY PARTICIPATE IN A 457(F) NONQUALIFIED RETIREMENT PLAN WITH LESTER E. COX MEDICAL CENTERS: - STEVE EDWARDS RECEIVED AN EXECUTIVE 457(F) CONTRIBUTION OF $255,977. - JACOB MCWAY RECEIVED AN EXECUTIVE 457(F) CONTRIBUTION OF $113,098. - JACOB MCWAY RECEIVED A 457(F) DISTRIBUTION OF $126,919, WHICH WAS REPORTED AS DEFERRED COMPENSATION ON A PRIOR FORM 990. - DAVID STRONG RECEIVED AN EXECUTIVE 457(F) CONTRIBUTION OF $28,600. - DAVID STRONG RECEIVED A 457(F) DISTRIBUTION OF $34,359, WHICH WAS REPORTED AS DEFERRED COMPENSATION ON A PRIOR FORM 990.
SCHEDULE J, PART I, LINE 6A	COMPENSATION CONTINGENT ON THE NET EARNINGS OF THE ORGANIZATION: KEY EMPLOYEES HAVE NET EARNINGS AS ONE COMPONENT OF A BALANCED SCORECARD METRIC CONTAINED WITHIN A BONUS PROGRAM. EMPLOYED PHYSICIANS ARE PAID BASED ON A SALARY, A FORMULA USING COLLECTIONS AND EXPENSES, AN AMOUNT PER RVU, OR A COMBINATION OF THESE. PHYSICIANS LISTED ON PART VII THAT ARE SUBJECT TO THESE COMPENSATION ARRANGEMENTS ARE MARTIN JONES, ARIJIT CHOWDHURY, CARY MARQUIS, TOMMY TRENT, AND BOYD CROCKETT. EXECUTIVE LEVEL STAFF ARE ELIGIBLE FOR ADDITIONAL COMPENSATION BASED ON A VARIETY OF PERFORMANCE INDICATORS IN QUALITY, CUSTOMER AND EMPLOYEE SATISFACTION AND BUSINESS PERFORMANCE MEASURES.
SCHEDULE J, PART II; AND FORM 990, PART VII	BOARD MEMBER COMPENSATION: NO COMPENSATION WAS PROVIDED FOR RESPONSIBILITIES ASSOCIATED WITH BEING A BOARD DIRECTOR. COMPENSATION REPORTED FOR SEVERAL BOARD MEMBERS LISTED ON SCHEDULE J REPRESENTS EMPLOYEE OR INDEPENDENT CONTRACTOR COMPENSATION UNRELATED TO SERVICE AS A BOARD MEMBER.
SCHEDULE J, PART II, COLUMN F	COMPENSATION REPORTED IN PRIOR FORM 990: COMPENSATION IS REPORTED ON THE FORM 990 IN THE YEAR THAT THE COMPENSATION IS EARNED BY OR AWARDED TO AN INDIVIDUAL, EVEN IF THE COMPENSATION IS NOT PAID TO THE INDIVIDUAL, IS NOT FULLY VESTED, OR IS SUBJECT TO SUBSTANTIAL RISK OF FORFEITURE. IF COMPENSATION IS EARNED OR AWARDED IN ONE YEAR BUT PAID IN A LATER YEAR, THEN THE COMPENSATION IS REPORTED A SECOND TIME ON THE FORM 990 IN THE YEAR THE COMPENSATION IS VESTED OR PAID TO THE INDIVIDUAL.

Schedule J (Form 990) 2018

Additional Data

Software ID:
Software Version:

- TIN:

Note: To capture the full content of this document, please select landscape mode (11" x 8.5") when printing.

Schedule K
(Form 990)

Department of the Treasury
Internal Revenue Service

Supplemental Information on Tax-Exempt Bonds

Complete if the organization answered "Yes" to Form 990, Part Ⅵ, line 24a. Provide descriptions,
explanations, and any additional information in Part Ⅵ.
SchKMediumBullet

Attach to Form 990.
SchKMediumBullet

Go to www.irs.gov/Form990 for the latest information.

OMB No. 1545-0047

2018

Open to Public
Inspection

Name of the organization
LESTER E COX MEDICAL CENTERS

Employer identification number
44-0577118

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
(a) Issuer name		(b) Issuer EIN	(c) CUSIP #	(d) Date issued	(e) Issue price	(f) Description of purpose	Yes	No	Yes	No	Yes	No
A	HEALTH & EDUCATIONAL FACILITIES AUTH - STATE OF MO	43-1178966	60637AEA6	04-17-2013	215,764,775	NEW INFRASTRUCTURE/CURRENT REFUND		X		X		X
B	HEALTH & EDUCATIONAL FACILITIES AUTH - STATE OF MO	43-1178966		10-15-2008	70,000,000	NEW INFRASTRUCTURE & EQUIPMENT		X		X		X
C	HEALTH & EDUCATIONAL FACILITIES AUTH - STATE OF MO	43-1178966	60635R427	09-25-2008	157,078,759	'97 & '02 REFUND & NEW INFRSTRCTRE	X			X		X
D	HEALTH & EDUCATIONAL FACILITIES AUTH - STATE OF MO	43-1178966		10-15-2008	35,000,000	NEW INFRASTRUCTURE & EQUIPMENT		X		X		X
	HEALTH & EDUCATIONAL FACILITIES AUTH - STATE OF MO	43-1178966		08-29-2017	4,692,000	CAPITAL EQUIPMENT FINANCING		X		X		X
	HEALTH & EDUCATIONAL FACILITIES AUTH - STATE OF MO	43-1178966		04-22-2015	142,209,927	REFINANCE 80% 2008A		X		X		X
	HEALTH & EDUCATIONAL FACILITIES AUTH - STATE OF MO	43-1178966	60637ANY4	04-17-2019	120,260,000	NEW INFRASTRUCURE & EQUIPMENT		X		X		X

Part Ⅱ

Proceeds

	A		B		C		D
	1 Amount of bonds retired ..................	3,515,000		0		24,530,872		560,000
2 Amount of bonds legally defeased ..............	0		0		130,000,000		0
3 Total proceeds of issue ..................	216,278,348		70,469,521		158,302,381		35,028,548
4 Gross proceeds in reserve funds .............	0		0		3,102,979		0
5 Capitalized interest from proceeds .............	16,377,190		783,050		1,387,574		421,299
6 Proceeds in refunding escrows ...............	0		0		0		0
7 Issuance costs from proceeds ...............	2,222,341		501,052		1,448,413		271,929
8 Credit enhancement from proceeds .............	0		2,121,540		0		803,381
9 Working capital expenditures from proceeds .............	0		0		0		0
10 Capital expenditures from proceeds .............	167,958,089		67,063,879		66,262,892		33,531,939
11 Other spent proceeds .............	29,720,728		0		73,174,648		0
12 Other unspent proceeds .............	0		0		0		0
13 Year of substantial completion .............	2015		2012		2012		2012
	Yes	No	Yes	No	Yes	No	Yes	No
14 Were the bonds issued as part of a current refunding issue? ....	X			X	X			X
15 Were the bonds issued as part of an advance refunding issue? .....		X		X		X		X
16 Has the final allocation of proceeds been made? ..........	X		X		X		X
17 Does the organization maintain adequate books and records to support the final allocation of proceeds? ..................	X		X		X		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		X		X		X
2 Are there any lease arrangements that may result in private business use of bond-financed property? ...............	X			X	X			X

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

Cat. No. 50193E

Schedule K (Form 990) 2018

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		X		X		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?
c Are there any research agreements that may result in private business use of bond-financed property? .............		X		X		X		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 ....	0 %		0.830 %		0.930 %		0.830 %
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 .........
6 Total of lines 4 and 5 .............			0.830 %		0.930 %		0.830 %
7 Does the bond issue meet the private security or payment test? ...		X		X		X		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		X		X		X
b If "Yes" to line 8a, enter the percentage of bond-financed property sold or disposed of. ..
c If "Yes" to line 8a, was any remedial action taken pursuant to Regulations sections 1.141-12 and 1.145-2? .............		X		X		X		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		X		X		X

Part Ⅳ

Arbitrage

	A		B		C		D
	Yes	No	Yes	No	Yes	No	Yes	No
1 Has the issuer filed Form 8038-T, Arbitrage Rebate, Yield Reduction and Penalty in Lieu of Arbitrage Rebate? ...		X		X		X		X
2 If "No" to line 1, did the following apply? ....
a Rebate not due yet? .......		X		X		X		X
b Exception to rebate? ........		X		X		X		X
c No rebate due? .........	X		X		X		X
If "Yes" to line 2c, provide in Part Ⅵ the date the rebate computation was performed ......
3 Is the bond issue a variable rate issue? .....		X	X			X	X
4a Has the organization or the governmental issuer entered into a qualified hedge with respect to the bond issue?		X		X		X		X
b Name of provider ..........	0		0		0		0
c Term of hedge .........
d Was the hedge superintegrated? ......
e Was the hedge terminated? ........

Schedule K (Form 990) 2018

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		X		X		X
b Name of provider ..........	0		0		0		0
c Term of GIC .........
d Was the regulatory safe harbor for establishing the fair market value of the GIC satisfied? ........
6 Were any gross proceeds invested beyond an available temporary period?		X		X		X		X
7 Has the organization established written procedures to monitor the requirements of section 148? ...	X		X		X		X

Part Ⅴ

Procedures To Undertake Corrective Action

---------------------------------------------------------------------------------------------------------------	A		B		C		D
	Yes	No	Yes	No	Yes	No	Yes	No
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		X		X		X

Part Ⅵ

Supplemental Information. Provide additional information for responses to questions on Schedule K (see instructions).

Return Reference	Explanation
SCHEDULE K, GROUP 1, PART II, LINE 3, COLUMNS A, B, C, D	TOTAL PROCEEDS OF ISSUE: THE TOTAL PROCEEDS OF THE ISSUE EXCEEDED THE ISSUE PRICE BY THE INVESTMENT EARNINGS AS OF 09/30/2019.
SCHEDULE K, GROUP 1, PART II, LINE 11, COLUMNS A, C	OTHER PROCEEDS SPENT: THE OTHER SPENT PROCEEDS RELATE TO THE CURRENT REFUNDING PROCEEDS OF THE ISSUE.
SCHEDULE K, GROUP 1, PART IV, LINE 2C, COLUMNS A, B, C, D	DATE REBATE COMPUTATION WAS PERFORMED: REBATE CALCULATION/ANALYSIS WERE COMPLETED AS FOLLOWS: -BOND SERIES ISSUE A ON 03/20/2018 -BOND SERIES ISSUE B ON 11/19/2018 -BOND SERIES ISSUE C ON 10/17/2018 -BOND SERIES ISSUE D ON 11/20/2018
SCHEDULE K, GROUP 2, PART II, LINE 3, COLUMN B	TOTAL PROCEEDS OF ISSUE: THE TOTAL PROCEEDS OF THE ISSUE EXCEEDED THE ISSUE PRICE BY THE INVESTMENT EARNINGS AS OF 09/30/2019.
SCHEDULE K, GROUP 2, PART II, LINE 11, COLUMN B	OTHER PROCEEDS SPENT: THE OTHER SPENT PROCEEDS RELATE TO THE ADVANCE REFUNDING PROCEEDS OF THE ISSUE.

Schedule K (Form 990) 2018

Additional Data

Software ID:
Software Version:

- TIN:

Note: To capture the full content of this document, please select landscape mode (11" x 8.5") when printing.

Schedule K
(Form 990)

Department of the Treasury
Internal Revenue Service

Supplemental Information on Tax-Exempt Bonds

Complete if the organization answered "Yes" to Form 990, Part Ⅵ, line 24a. Provide descriptions,
explanations, and any additional information in Part Ⅵ.
SchKMediumBullet

Attach to Form 990.
SchKMediumBullet

Go to www.irs.gov/Form990 for the latest information.

OMB No. 1545-0047

2018

Open to Public
Inspection

Name of the organization
LESTER E COX MEDICAL CENTERS

Employer identification number
44-0577118

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
(a) Issuer name		(b) Issuer EIN	(c) CUSIP #	(d) Date issued	(e) Issue price	(f) Description of purpose	Yes	No	Yes	No	Yes	No
A	HEALTH & EDUCATIONAL FACILITIES AUTH - STATE OF MO	43-1178966	60637AEA6	04-17-2013	215,764,775	NEW INFRASTRUCTURE/CURRENT REFUND		X		X		X
B	HEALTH & EDUCATIONAL FACILITIES AUTH - STATE OF MO	43-1178966		10-15-2008	70,000,000	NEW INFRASTRUCTURE & EQUIPMENT		X		X		X
C	HEALTH & EDUCATIONAL FACILITIES AUTH - STATE OF MO	43-1178966	60635R427	09-25-2008	157,078,759	'97 & '02 REFUND & NEW INFRSTRCTRE	X			X		X
D	HEALTH & EDUCATIONAL FACILITIES AUTH - STATE OF MO	43-1178966		10-15-2008	35,000,000	NEW INFRASTRUCTURE & EQUIPMENT		X		X		X
	HEALTH & EDUCATIONAL FACILITIES AUTH - STATE OF MO	43-1178966		08-29-2017	4,692,000	CAPITAL EQUIPMENT FINANCING		X		X		X
	HEALTH & EDUCATIONAL FACILITIES AUTH - STATE OF MO	43-1178966		04-22-2015	142,209,927	REFINANCE 80% 2008A		X		X		X
	HEALTH & EDUCATIONAL FACILITIES AUTH - STATE OF MO	43-1178966	60637ANY4	04-17-2019	120,260,000	NEW INFRASTRUCURE & EQUIPMENT		X		X		X

Part Ⅱ

Proceeds

	A		B		C		D
	1 Amount of bonds retired ..................	3,515,000		0		24,530,872		560,000
2 Amount of bonds legally defeased ..............	0		0		130,000,000		0
3 Total proceeds of issue ..................	216,278,348		70,469,521		158,302,381		35,028,548
4 Gross proceeds in reserve funds .............	0		0		3,102,979		0
5 Capitalized interest from proceeds .............	16,377,190		783,050		1,387,574		421,299
6 Proceeds in refunding escrows ...............	0		0		0		0
7 Issuance costs from proceeds ...............	2,222,341		501,052		1,448,413		271,929
8 Credit enhancement from proceeds .............	0		2,121,540		0		803,381
9 Working capital expenditures from proceeds .............	0		0		0		0
10 Capital expenditures from proceeds .............	167,958,089		67,063,879		66,262,892		33,531,939
11 Other spent proceeds .............	29,720,728		0		73,174,648		0
12 Other unspent proceeds .............	0		0		0		0
13 Year of substantial completion .............	2015		2012		2012		2012
	Yes	No	Yes	No	Yes	No	Yes	No
14 Were the bonds issued as part of a current refunding issue? ....	X			X	X			X
15 Were the bonds issued as part of an advance refunding issue? .....		X		X		X		X
16 Has the final allocation of proceeds been made? ..........	X		X		X		X
17 Does the organization maintain adequate books and records to support the final allocation of proceeds? ..................	X		X		X		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		X		X		X
2 Are there any lease arrangements that may result in private business use of bond-financed property? ...............	X			X	X			X

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

Cat. No. 50193E

Schedule K (Form 990) 2018

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		X		X		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?
c Are there any research agreements that may result in private business use of bond-financed property? .............		X		X		X		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 ....	0 %		0.830 %		0.930 %		0.830 %
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 .........
6 Total of lines 4 and 5 .............			0.830 %		0.930 %		0.830 %
7 Does the bond issue meet the private security or payment test? ...		X		X		X		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		X		X		X
b If "Yes" to line 8a, enter the percentage of bond-financed property sold or disposed of. ..
c If "Yes" to line 8a, was any remedial action taken pursuant to Regulations sections 1.141-12 and 1.145-2? .............		X		X		X		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		X		X		X

Part Ⅳ

Arbitrage

	A		B		C		D
	Yes	No	Yes	No	Yes	No	Yes	No
1 Has the issuer filed Form 8038-T, Arbitrage Rebate, Yield Reduction and Penalty in Lieu of Arbitrage Rebate? ...		X		X		X		X
2 If "No" to line 1, did the following apply? ....
a Rebate not due yet? .......		X		X		X		X
b Exception to rebate? ........		X		X		X		X
c No rebate due? .........	X		X		X		X
If "Yes" to line 2c, provide in Part Ⅵ the date the rebate computation was performed ......
3 Is the bond issue a variable rate issue? .....		X	X			X	X
4a Has the organization or the governmental issuer entered into a qualified hedge with respect to the bond issue?		X		X		X		X
b Name of provider ..........	0		0		0		0
c Term of hedge .........
d Was the hedge superintegrated? ......
e Was the hedge terminated? ........

Schedule K (Form 990) 2018

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		X		X		X
b Name of provider ..........	0		0		0		0
c Term of GIC .........
d Was the regulatory safe harbor for establishing the fair market value of the GIC satisfied? ........
6 Were any gross proceeds invested beyond an available temporary period?		X		X		X		X
7 Has the organization established written procedures to monitor the requirements of section 148? ...	X		X		X		X

Part Ⅴ

Procedures To Undertake Corrective Action

---------------------------------------------------------------------------------------------------------------	A		B		C		D
	Yes	No	Yes	No	Yes	No	Yes	No
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		X		X		X

Part Ⅵ

Supplemental Information. Provide additional information for responses to questions on Schedule K (see instructions).

Return Reference	Explanation
SCHEDULE K, GROUP 1, PART II, LINE 3, COLUMNS A, B, C, D	TOTAL PROCEEDS OF ISSUE: THE TOTAL PROCEEDS OF THE ISSUE EXCEEDED THE ISSUE PRICE BY THE INVESTMENT EARNINGS AS OF 09/30/2019.
SCHEDULE K, GROUP 1, PART II, LINE 11, COLUMNS A, C	OTHER PROCEEDS SPENT: THE OTHER SPENT PROCEEDS RELATE TO THE CURRENT REFUNDING PROCEEDS OF THE ISSUE.
SCHEDULE K, GROUP 1, PART IV, LINE 2C, COLUMNS A, B, C, D	DATE REBATE COMPUTATION WAS PERFORMED: REBATE CALCULATION/ANALYSIS WERE COMPLETED AS FOLLOWS: -BOND SERIES ISSUE A ON 03/20/2018 -BOND SERIES ISSUE B ON 11/19/2018 -BOND SERIES ISSUE C ON 10/17/2018 -BOND SERIES ISSUE D ON 11/20/2018
SCHEDULE K, GROUP 2, PART II, LINE 3, COLUMN B	TOTAL PROCEEDS OF ISSUE: THE TOTAL PROCEEDS OF THE ISSUE EXCEEDED THE ISSUE PRICE BY THE INVESTMENT EARNINGS AS OF 09/30/2019.
SCHEDULE K, GROUP 2, PART II, LINE 11, COLUMN B	OTHER PROCEEDS SPENT: THE OTHER SPENT PROCEEDS RELATE TO THE ADVANCE REFUNDING PROCEEDS OF THE ISSUE.

Schedule K (Form 990) 2018

Additional Data

Software ID:
Software Version:

- TIN:

Schedule L
(Form 990 or 990-EZ)

Department of the Treasury
Internal Revenue Service

Transactions with Interested Persons

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

Go to www.irs.gov/Form990 for the latest information.

OMB No. 1545-0047

2018

Open to Public Inspection

Name of the organization

LESTER E COX MEDICAL CENTERS

Employer identification number

44-0577118

Part I

Excess Benefit Transactions (section 501(c)(3), section 501(c)(4), and 501(c)(29) 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	(c) Description of transaction	(d) Corrected?
1(a) Name of disqualified person	(c) Description of transaction	Yes	No

Enter the amount of tax incurred by organization managers or disqualified persons during the year under section 4958. ........................... Bullet Image

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?
(a) Name of interested person	(b) Relationship with organization	(c) Purpose of loan	To	From	(e)Original principal amount	(f)Balance due	Yes	No	Yes	No	Yes	No






Total ............... $						0

Part III

Grants or Assistance Benefiting 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) 2018

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?
(a) Name of interested person		(c) Amount of transaction	(d) Description of transaction	Yes	No
(1) VICKI HOCKENSMITH	S EDWARDS - SEE PART V	112,718	WAGES AND BENEFITS		No
(2) TERRY HAMMER	S EDWARDS - SEE PART V	110,997	WAGES AND BENEFITS		No
(3) LISA ESPY	K KRAMER - SEE PART V	38,490	WAGES		No
(4) JASON PRENGER	R PRENGER - SEE PART V	24,727	WAGES AND BENEFITS		No
(5) BETTY EDWARDS	S EDWARDS - SEE PART V	23,953	RETIREMENT BENEFITS		No
(6) CONNIE ROMERO	F ROMERO - SEE PART V	105,520	WAGES AND BENEFITS		No
(7) ANDREW HEDGPETH	A HEDGPETH - SEE PART V	253,420	WAGES AND BENEFITS		No
(8) JEFF HAWKINS	A HEDGPETH - SEE PART V	202,096	WAGES AND BENEFITS		No
(9) AMANDA HEDGPETH	J HAWKINS - SEE PART V	197,826	WAGES AND BENEFITS		No
(10) LISA HEDGPETH	A HEDGPETH - SEE PART V	30,375	WAGES AND BENEFITS		No
(11) SCOTT ROGERS	S NIEMOTH - SEE PART V	114,254	WAGES AND BENEFITS		No

Part V

Supplemental Information
Provide additional information for responses to questions on Schedule L (see instructions).

Return Reference

Explanation

SCHEDULE L, PART IV

BUSINESS TRANSACTIONS INVOLVING INTERESTED PERSONS: (1,2,5)STEVE EDWARDS, CEO, HAS THREE FAMILY MEMBERS WHO WORK FOR OR RECEIVE RETIREMENT BENEFITS FROM LESTER E. COX MEDICAL CENTERS. VICKI HOCKENSMITH IS HIS SISTER, TERRY HAMMER IS HIS BROTHER-IN-LAW, AND BETTY B. EDWARDS IS HIS MOTHER. (3)KAREN KRAMER'S SISTER, LISA ESPY, IS AN EMPLOYEE AT LESTER E. COX MEDICAL CENTERS, AND KAREN IS VICE PRESIDENT AND CHIEF NURSING OFFICER. (4)RON PRENGER'S SON, JASON PRENGER, IS AN EMPLOYEE AT LESTER E. COX MEDICAL CENTERS, AND RON IS A SENIOR VICE PRESIDENT AND CHIEF HOSPITAL OFFICER. (6)FRANK ROMERO'S WIFE, CONNIE ROMERO, IS AN EMPLOYEE OF LESTER E. COX MEDICAL CENTERS AND FRANK IS VICE PRESIDENT OF MEDICAL AFFAIRS. (7,8,9,10) ANDREW HEDGPETH IS AN EMPLOYEE OF LESTER E. COX MEDICAL CENTERS AND AMANDA HEDGPETH IS AN EMPLOYEE OF LESTER E. COX MEDICAL CENTERS AND ARE MARRIED. THERE ARE TWO ADDITIONAL FAMILY MEMBERS WHO ARE EMPLOYEES OF LESTER E. COX MEDICAL CENTERS. JEFF HAWKINS, VICE PRESIDENT OF CLINICAL SERVICES, IS AMANDA HEDGPETH'S UNCLE. LISA HEDGPETH, AN EMPLOYEE OF LESTER E. COX MEDICAL CENTERS, IS ANDREW HEDGPETH'S MOTHER. (11) STACI NIEMOTH'S HUSBAND, SCOTT ROGERS, IS AN EMPLOYEE OF LESTER E. COX MEDICAL CENTERS AND STACI IS JOC CHAIR OF MEDICAL AFFAIRS.

Schedule L (Form 990 or 990-EZ) 2018

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE O
(Form 990 or 990-EZ)

Department of the Treasury
Internal Revenue Service

Supplemental Information to Form 990 or 990-EZ

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

Attach to Form 990 or 990-EZ.
MediumBullet

Go to www.irs.gov/Form990 for the latest information.

OMB No. 1545-0047

2018

Open to Public
Inspection

Name of the organization

LESTER E COX MEDICAL CENTERS

Employer identification number

44-0577118

Return Reference	Explanation
FORM 990, PART III, LINE 4B	ADDITIONAL INFORMATION ABOUT PHYSICIAN CARE: AFFORDABLE, CONVENIENT CARE IS ALSO PROVIDED IN OUR RETAIL CLINICS. LESTER E. COX MEDICAL CENTERS CONTINUES TO PARTNER WITH WAL-MART AND HYVEE AND CURRENTLY HAS 6 PARTNERSHIP CLINICS. COXHEALTH HAS ALSO INVESTED IN TELEMEDICINE INFRASTRUCTURE TO FURTHER EXPAND ITS ABILITY TO OFFER COST EFFECTIVE AND CONVENIENT CARE TO OUR COMMUNITY.
FORM 990, PART III, LINE 4C	EXEMPT PURPOSE ACHIEVEMENTS - ADDITIONAL INFORMATION ABOUT HOME CARE: OXFORD SUPPORTS THE COMMUNITY THROUGH THEIR ASSOCIATION SUPPORT (I.E. ALZHEIMER'S ASSOCIATION, DIABETES ASSOCIATION, HEART ASSOCIATION, ETC,) THEY WORK DILIGENTLY TO RAISE FUNDS FOR PATIENTS THROUGH DONATIONS FROM THEIR EMPLOYEES AND A COMMUNITY WIDE FAN DRIVE FOR PATIENTS WITHOUT AIR CONDITIONING. HOME SUPPORT HAS PROVIDED DURABLE MEDICAL EQUIPMENT AND SERVICES TO PATIENTS IN SOUTHWEST MISSOURI FOR OVER 30 YEARS AND AS THE COMPANY HAS GROWN IT HAS STEADILY BECOME MORE INVOLVED IN AN EFFORT TO BETTER MEET THE NEEDS OF THE COMMUNITY AS A WHOLE. THE STAFF SUPPORT THEIR PATIENTS AND FAMILIES IN MANY WAYS BY CONTACTING HOME HEALTH CARE AGENCIES, DIVISION OF AGING AND OTHER LOCAL CHARITIES. THEY REGULARLY DONATE MEDICAL EQUIPMENT TO CONVOY OF HOPE AND OTHER AGENCIES THAT SUPPORT DISASTER AND RELIEF EFFORTS BOTH LOCALLY AND ABROAD. COMMUNITY BENEFIT ACTIVITIES INCLUDE DONATED EMPLOYEE TIME AND PARTS TO INSTALL AN OVERHEAD LIFT FOR AN ORGANIZATION CALLED "HORSES OF HOPE" THAT AIDS IN HELPING DISABLED PATIENTS RIDE HORSES.
FORM 990, PART III, LINES 4A-4D	EXEMPT PURPOSE ACHIEVEMENTS - COMMUNITY BENEFIT REPORT: LESTER E. COX MEDICAL CENTERS IS PROUD TO OFFER NATIONALLY RECOGNIZED QUALITY CARE AND THE LATEST IN MEDICAL TECHNOLOGY AND SERVICES TO IMPROVE OUR COMMUNITY'S HEALTH. DESPITE INNOVATION AND QUALITY, THERE ARE STILL COMMUNITY NEEDS THAT ARE NOT MET THROUGH REGULAR COURSE OF CARE. THAT IS WHY AS A COMMUNITY-OWNED, NOT-FOR-PROFIT HOSPITAL SYSTEM, WE PROVIDE THE KIND OF CARE AND PROGRAMS THAT ARE NEEDED TO SERVE ALL IN OUR COMMUNITIES, INCLUDING SOME OF THE MOST VULNERABLE - THE UNDERINSURED AND UNINSURED. PROGRAMS THAT HELP THE INDIVIDUALS AND FAMILIES OF OUR COMMUNITY ARE AN INVESTMENT IN FRIENDS, FAMILY, AND NEIGHBORS. LESTER E. COX MEDICAL CENTERS DOES THIS THROUGH INITIATIVES LIKE KOHL'S CARDIAC KIDS AND HEALTHY FOOD PANTRY COLLABORATIVE, BUT IS ALSO EVIDENT IN COMMUNITY AND HEALTH CARE EDUCATION, SUPPORT GROUPS, PREVENTIVE SCREENINGS, SPONSORSHIPS, AND DONATIONS. COMMUNITY BENEFIT MEDICARE, MEDICAID AND UNINSURED SUBSIDIES $ 202,640,317 CMC $ 232,818,665 SYSTEM-WIDE THIS FIGURE INCLUDES THE ESTIMATED UNPAID COSTS OF PROVIDING CARE TO MEDICARE AND MEDICAID PATIENTS AND REPRESENTS THE SHORTFALL BETWEEN THE COST OF PROVIDING CARE AND THE PAYMENTS RECEIVED BY THE GOVERNMENT AND COVERED INDIVIDUALS. ALSO, IT INCLUDES THE ESTIMATED UNPAID COST OF PROVIDING FREE OR DISCOUNTED CARE TO PERSONS WHO CANNOT AFFORD TO PAY FOR ANY OR ALL OF THE SERVICES THEY RECEIVE AND WHO ARE NOT ELIGIBLE FOR PUBLIC PROGRAMS. COMMUNITY OUTREACH SERVICES $ 284,811 CMC $ 300,760 SYSTEM-WIDE INCLUDES ACTIVITIES CARRIED OUT TO IMPROVE COMMUNITY HEALTH AND SERVICES THAT ARE SUBSIDIZED BECAUSE THEY ARE NEEDED IN THE COMMUNITY. EXAMPLES ARE COMMUNITY EDUCATION, HEALTH SCREENINGS, SUPPORT GROUPS, IMMUNIZATIONS, COALITION BUILDING AND SUBSIDY OF HEALTH CARE SERVICES. HEALTH PROFESSIONALS EDUCATION AND RESEARCH $ 4,409,860 CMC $ 5,639,606 SYSTEM-WIDE THIS FIGURE IS THE COST OF PROVIDING CLINICAL PLACEMENTS FOR PHYSICIANS AND OTHER HEALTH PROFESSIONALS PLUS THE UN-REIMBURSED COST OF COX FAMILY MEDICINE RESIDENCY AND SCHOOLS OF ALLIED HEALTH PROFESSIONS. IT INCLUDES THE UN-REIMBURSED EXPENSE OF STUDIES ON THERAPEUTIC PROTOCOLS AND RESEARCH. FOUNDATION GRANTS, FINANCIAL CONTRIBUTIONS AND IN-KIND DONATIONS $ 2,046,727 CMC $ 2,217,966 SYSTEM-WIDE THIS FIGURE INCLUDES CASH AND IN-KIND DONATIONS TO SUPPORT COMMUNITY ORGANIZATIONS, PATIENT ADVOCACY AND EDUCATION, AS WELL AS CONTRIBUTIONS FOR NOT-FOR-PROFIT COMMUNITY ORGANIZATIONS AND EVENT SPONSORSHIPS. TOTAL COMMUNITY BENEFIT: $ 209,381,715 CMC $ 240,976,997 SYSTEM-WIDE ECONOMIC IMPACT REAL ESTATE AND PROPERTY TAXES $ 967,646 CMC $ 1,308,834 SYSTEM-WIDE TOTAL REAL ESTATE AND PROPERTY TAXES PAID BY LESTER E. COX MEDICAL CENTERS FOR MEDICAL OFFICE BUILDINGS AND PHYSICIAN OFFICES AND CLINIC. CAPITAL INVESTMENTS $ 63,630,558 CMC $ 90,110,325 SYSTEM-WIDE AS A NON-PROFIT ORGANIZATION, LESTER E. COX MEDICAL CENTERS REINVESTS ITS REVENUE IN THE SERVICES IT PROVIDES TO THE COMMUNITY, INCLUDING THE COST OF MEDICAL TECHNOLOGY, EQUIPMENT AND SERVICES. THIS AMOUNT INCLUDES THE TOTAL INVESTMENT MADE THROUGH PURCHASING AND LEASING OF MEDICAL EQUIPMENT AND TECHNOLOGY, AS WELL AS RENTAL FACILITIES, SUCH AS MEDICAL OFFICES. PAYROLL & BENEFITS $ 475,149,361 CMC $ 818,309,350 SYSTEM-WIDE THE COXHEALTH SYSTEM IS ONE OF THE LARGEST EMPLOYERS IN SOUTHWEST MISSOURI. IN CALENDAR YEAR 2015, LESTER E. COX MEDICAL CENTERS ALONE EMPLOYED NEARLY 9,400 PEOPLE, AND THE REMAINING COXHEALTH SYSTEM AFFILIATES CARRY THE TOTAL EMPLOYED FIGURE TO OVER 10,000 PEOPLE. THIS DOLLAR AMOUNT INCLUDES THE COST OF PAYROLL AND BENEFITS OF OUR DEDICATED TEAM FOR LESTER E. COX MEDICAL CENTERS. IT ALSO INCLUDES A SIGNIFICANT INVESTMENT ON CONTRACT PERSONNEL IN VARIOUS MEDICAL SPECIALTIES AS WELL AS MONIES TO OTHER PROFESSIONALS WHO RESIDE LOCALLY. TOTAL ECONOMIC IMPACT: $ 544,560,492 CMC $ 915,324,430 SYSTEM-WIDE TOTAL CONTRIBUTIONS TO THE COMMUNITY: $ 753,942,207 CMC $ 1,156,301,427 SYSTEM-WIDE
FORM 990, PART VI, SECTION A, LINE 2	BUSINESS RELATIONSHIPS: BOARD MEMBERS JAN BAUMGARTNER AND ROBERT FULP HAVE A BUSINESS RELATIONSHIP. BOARD MEMBERS WHO RECEIVE COMPENSATION, OFFICERS, AND KEY EMPLOYEES ARE EMPLOYED BY COXHEALTH AND ITS AFFILIATES AND THEREFORE SHARE A BUSINESS RELATIONSHIP.
FORM 990, PART VI, SECTION A, LINE 6, 7A & 7B	MEMBERS, STOCKHOLDERS, OR OTHER PERSONS: THE FOLLOWING CORPORATE POWERS AND RESPONSIBILITIES SHALL BE SOLELY & SPECIFICALLY RESERVED TO THE MEMBER; (A) TO ESTABLISH AND CHANGE THE BUSINESS PURPOSES, MISSION, VISION OR VALUES OF CMC; (B) TO APPROVE AMENDMENTS TO THE ARTICLES OF INCORPORATION OF CMC AS PROVIDED THEREIN; (C) TO APPROVE AMENDMENTS TO THE BYLAWS OF CMC; (D) TO APPROVE THE ADOPTION OF AND ANY REVISION TO THE CHARTERS FOR ALL COMMITTEES ESTABLISHED BY THE BOARD; (E) TO APPOINT AND REMOVE THE DIRECTORS OF CMC, SUBJECT TO THE REQUIREMENTS OF ARTICLE FIVE, SECTION 1 AND TO APPOINT AND REMOVE THE OFFICERS OF THE BOARD AND CMC; (F) AFTER CONSULTATION WITH THE BOARD, TO APPROVE THE APPOINTMENT AND REMOVAL OF THE PRESIDENT AND CEO OF CMC; (G) TO APPOINT THE AUDITOR AND THE CORPORATE COUNSEL FOR CMC AND ITS CONTROLLED SUBSIDIARIES OR REMOTELY CONTROLLED SUBSIDIARIES; (H) TO ESTABLISH CENTRALIZED EMPLOYEE BENEFIT, INSURANCE, INVESTMENT, FINANCING, MARKETING, LEGAL, CORPORATE, COMPLIANCE, PERFORMANCE ASSESSMENT AND IMPROVEMENT AND OTHER OPERATIONAL AND SUPPORT PROGRAMS; TO REQUIRE THE PARTICIPATION OF CMC IN SUCH PROGRAMS; AND TO AUTHORIZE THE OPENING AND CLOSING OF BANK ACCOUNTS AND INVESTMENT ACCOUNTS IN THE NAME OF CMC; (I) TO APPROVE THE MERGER, CONSOLIDATION OR DISSOLUTION OF CMC OR THE SALE OF ALL OR SUBSTANTIALLY ALL OF THE ASSETS OF CMC; (J) TO APPROVE THE FORMATION OF A CONTROLLED SUBSIDIARY OR A REMOTELY SUBSIDIARY; (K) TO APPROVE THE ACQUISITION OR DISPOSITION BY CMC OF ANOTHER LEGAL ENTITY OR AN INTEREST IN ANOTHER LEGAL ENTITY; (L) AFTER RECEIVING INPUT FROM THE BOARD, TO APPROVE THE STRATEGIC PLAN AND THE OPERATING AND CAPITAL BUDGETS OF CMC; (M) APPROVAL OF CMC'S UNBUDGETED DEBT AND CAPITAL EXPENDITURES OF ONE HUNDRED THOUSAND DOLLARS ($100,000) OR GREATER; (N) TO AUTHORIZE OR APPROVE THE ACQUISITION OR DISPOSITION BY CMC OF REAL PROPERTY OR ANY INTEREST IN REAL PROPERTY HAVING A VALUE OF ONE HUNDRED THOUSAND DOLLARS ($100,000) OR GREATER; (O) TO APPROVE THE SALE OR PURCHASE OF ANY PROPERTY OF CMC HAVING A VALUE OF ONE HUNDRED THOUSAND DOLLARS ($100,000) OR GREATER; (P) TO AUTHORIZE AND APPROVE BORROWING MONEY OR ENTERING INTO FINANCIAL GUARANTIES BY CMC, INCLUDING ACTIONS RELATING TO THE FORMATION, JOINING, OPERATION, WITHDRAWAL FROM AND TERMINATION OF A CREDIT GROUP OR AN OBLIGATED GROUP AND THE GRANTING OF SECURITY INTERESTS IN THE PROPERTY OF CMC; (Q) TO REQUIRE CMC TO TRANSFER ASSETS, INCLUDING BUT NOT LIMITED TO CASH, TO THE MEMBER; (R) TO APPROVE THE TRANSFER OF ASSETS BY CMC TO ANY ENTITY OTHER THAN THE MEMBER, OTHER THAN TRANSFERS MADE IN THE ORDINARY COURSE OF OPERATIONS OF CMC WHICH WILL NOT REQUIRE APPROVAL OF THE MEMBER; (S) TO APPROVE THE RATE OF PAYMENT, COMPENSATION OR RENT AND/OR ANY PROVISIONS CONCERNING EXCLUSIVITY WITH RESPECT TO ANY CONTRACT FOR PHYSICIAN SERVICES AND ANY LEASE/TIMESHARE AGREEMENT BETWEEN ANY PHYSICIAN OR PHYSICIAN GROUP, ON THE ONE HAND, AND CMC OR ANY CONTROLLED SUBSIDIARY OR REMOTELY CONTROLLED SUBSIDIARY, ON THE OTHER HAND, ALL IN ACCORDANCE WITH SUCH POLICIES AND PROCESSES WHICH MAY BE PROMULGATED FROM TIME TO TIME BY THE MEMBER; (T) TO APPROVE CHANGES TO THE TYPE OF OR RELOCATION OF PHYSICIAN PROFESSIONAL MEDICAL SERVICES OFFERED BY CMC, WHERE THE CHANGE INVOLVES (A) SERVICES OFFERED OR PROVIDED BY CMG PHYSICIANS AND (B) (I) A CHANGE IN VENUE OR PROVIDER STATUS OF THE MEDICAL SERVICE, (II) THE CESSATION OF A PRE-EXISTING MEDICAL SERVICE, OR (III) THE OFFERING OF A NEW MEDICAL SERVICE; (U) TO ENGAGE, APPROVE, AND TO FINALIZE ANY AND ALL CONTRACTS OR AGREEMENTS WITH ANY THIRD PARTY HOSPITAL-BASED PHYSICIAN GROUPS (ANESTHESIOLOGISTS, PATHOLOGISTS, RADIOLOGISTS, OR EMERGENCY MEDICINE PHYSICIANS) THAT WILL RENDER PROFESSIONAL SERVICES TO CMC; (V) TO OVERRIDE AND REVERSE ANY DECISION MADE OR ACTION AUTHORIZED BY THE CMC BOARD TO THE EXTENT THAT SUCH DECISION OR ACTION CONFLICTS WITH A DECISION MADE OR ACTION AUTHORIZED BY THE JOINT OPERATIONS COMMITTEE OF THE MEMBER; (W) TO DETERMINE THE EXTENT TO WHICH AND THE MANNER IN WHICH THE POWERS DESCRIBED IN THIS SECTION WHICH ARE RESERVED TO THE MEMBER WITH RESPECT TO CMC ARE TO BE INCLUDED IN THE GOVERNING DOCUMENTS OF ANY CONTROLLED SUBSIDIARY OR REMOTELY CONTROLLED SUBSIDIARY AND EXERCISED WITH RESPECT TO ANY CONTROLLED SUBSIDIARY OR ANY REMOTELY CONTROLLED SUBSIDIARY. THE BOARD SHALL BE ELECTED BY THE MEMBER. PRIOR TO THE ANNUAL MEETING, THE BOARD SHALL NOMINATE A SLATE OF PERSONS FOR ELECTION AS CMC DIRECTORS AND OFFICERS TO SUBMIT TO COXHEALTH FOR APPOINTMENT. COXHEALTH WILL ACT IN GOOD FAITH AND NOT UNREASONABLY WITHHOLD APPOINTMENT.
FORM 990, PART VI, SECTION B, LINE 11B	990 REVIEW POLICY: THE FORM 990 IS PREPARED BY AN INDEPENDENT ACCOUNTING FIRM BASED ON THE AUDITED FINANCIAL STATEMENTS AND INFORMATION PROVIDED BY THE ACCOUNTING DEPARTMENT OF THE ORGANIZATION. PRIOR TO FILING, FORM 990 IS FIRST REVIEWED BY MEMBERS OF TOP MANAGEMENT. ONCE THEY HAVE APPROVED THE DRAFT, A FINAL COPY IS PRESENTED TO THE AUDIT COMMITTEE OF THE BOARD OF DIRECTORS. IN ADDITION, A FINAL COPY IS PROVIDED TO THE BOARD OF DIRECTORS THROUGH THE ONLINE BOARD PORTAL PRIOR TO FILING.
FORM 990, PART VI, SECTION B, LINE 12C	MONITORING COMPLIANCE WITH CONFLICT OF INTEREST POLICY: COXHEALTH OFFICERS, DIRECTORS AND KEY EMPLOYEES, AS WELL AS OFFICERS, DIRECTORS AND KEY EMPLOYEES OF THE COXHEALTH AFFILIATES AND/OR COMMITTEES WITH DELEGATED AUTHORITY TO MAKE DECISIONS, ARE ANNUALLY REQUIRED TO DISCLOSE POTENTIAL CONFLICTS OF INTEREST FOLLOWING THE POLICY, SET FORTH BELOW. THE POLICY REQUIRES THAT BOARD MEMBERS MAKE DECISIONS THAT ARE CONFLICT FREE, OR IF A CONFLICT IS PRESENT, THAT IT IS FULLY DISCLOSED FOR THE BOARD'S CONSIDERATION. COXHEALTH'S EMPLOYEES AND BOARD MEMBERS MUST AVOID ALL ACTIVITIES, ASSOCIATIONS OR INTERESTS THAT CREATE A CONFLICT OF INTEREST. CONFLICTS OF INTEREST FOR EMPLOYEES MUST BE REPORTED TO THE CORPORATE INTEGRITY DEPARTMENT. A FILE WILL BE MAINTAINED OF ALL REPORTED CONFLICTS OF INTEREST. FOR MEDICAL STAFF MEMBERS, THE CONFLICT OF INTEREST PROCESS MAY BE ACCESSED THROUGH THE MEDICAL STAFF OFFICE. FOR BOARD MEMBERS, THE CONFLICT OF INTEREST PROCESS IS HANDLED THROUGH THE GOVERNANCE SUB-COMMITTEE OF COXHEALTH WITH THE ASSISTANCE OF THE EXECUTIVE OFFICE AND IS DEFINED IN THE CHARTER OF THE GOVERNANCE SUB-COMMITTEE. IF ANY OFFICER OR DIRECTOR IS FOUND TO HAVE A CONFLICT OF INTEREST, SUCH PERSON SHALL NEITHER VOTE NOR USE HIS OR HER INFLUENCE TO AFFECT ANY DECISION RELATING TO THE CONFLICT, AND SUCH PERSON SHOULD NOT BE INCLUDED IN DETERMINING WHETHER A QUORUM PARTICIPATED IN THE DECISION. SUCH PERSON IS PERMITTED TO BRIEFLY STATE HIS OR HER POSITION ON THE MATTER, AND ANSWER PERTINENT QUESTIONS ABOUT IT, IF HIS OR HER KNOWLEDGE OR EXPERTISE COULD ASSIST THOSE PARTICIPATING IN THE DECISION. FOR VENDORS, THE POLICY IS DISTRIBUTED WITH THEIR INITIAL CONTRACT WITH LESTER E. COX MEDICAL CENTERS.
FORM 990, PART VI, SECTION B, LINES 15A & 15B	COMPENSATION REVIEW POLICY: COXHEALTH EMPLOYS A DEFINED GOVERNANCE STRUCTURE AROUND EXECUTIVE COMPENSATION. THE BOARD OF DIRECTORS MAINTAINS A COMPENSATION COMMITTEE THAT IS CHARGED WITH CARRYING OUT THE FUNCTIONS OF EVALUATING AND SETTING EXECUTIVE COMPENSATION THROUGH FORMAL DOCUMENTED MEETINGS THAT OCCUR SEVERAL TIMES DURING THE YEAR. THE COMPENSATION COMMITTEE UTILIZES A WELL RESPECTED INDEPENDENT EXTERNAL ADVISOR TO PROVIDE THIRD PARTY ASSESSMENT AND RECOMMENDATIONS REGARDING COMPENSATION LEVELS AND BENEFIT PROGRAMS FOR THE TOP EXECUTIVES OF THE ORGANIZATION TO ENSURE THE COMPENSATION PROGRAM IS COMPETITIVE AND WITHIN FAIR MARKET VALUE. AFTER A FULL REVIEW OF THE DATA AND THOROUGH DISCUSSION THE COMMITTEE MAKES A SELF DETERMINATION OF COMPENSATION LEVELS SET JANUARY 1 OF EACH YEAR. ANNUALLY THE STEPS NECESSARY TO DOCUMENT REBUTTABLE PRESUMPTION ARE TAKEN AND RECORDED. ADDITIONALLY, COMPENSATION LEVELS FOR THE VICE PRESIDENT TIER OF MANAGEMENT IS OVERSEEN BY THE CEO USING EXTERNAL COMPARABLE DATA FOR ASSESSMENT AND IS PROVIDED TO THE COMPENSATION COMMITTEE FOR REVIEW ON AN ANNUAL BASIS.
FORM 990, PART VI, SECTION C, LINE 19	DOCUMENT DISCLOSURE: LESTER E. COX MEDICAL CENTERS MAKES AVAILABLE ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY AND FINANCIAL STATEMENTS AVAILABLE FOR ALL LEGITIMATE BUSINESS PURPOSES AS DETERMINED BY MANAGEMENT. IN ADDITION, AS A CONTINUING DISCLOSURE REQUIREMENT OF CERTAIN DEBT COVENANTS THE ORGANIZATION PROVIDES ITS AUDITED FINANCIAL STATEMENTS AND SPECIFIC QUARTERLY FINANCIAL INFORMATION TO DEFINED REPOSITORIES FOR REVIEW BY PARTIES OR INDIVIDUALS INTERESTED IN THE INFORMATION.
FORM 990, PART VII, SECTION A	BOARD MEMBER COMPENSATION: DRS. DIX, NIEMOTH, ZOLFAGHARI, AND ABDALLA ARE RECEIVING COMPENSATION RELATED TO THEIR ROLES AS EMPLOYEES UNDER COXHEALTH AND RELATED AFFILIATES. NO BOARD MEMBERS RECEIVE COMPENSATION FOR THEIR DUTIES AS BOARD MEMBERS.
FORM 990, PART XI, LINE 9	OTHER CHANGES TO NET ASSETS: $ (49,603,336) DEFINED BENEFIT PENSION PLAN LOSS & SETTLEMENT (13,398) CHANGE IN BENEFICIAL INTEREST IN TRUST 2,516,324 TRANSFER FROM AFFILIATES 661,589 TRANSFER OF COXHEALTH AUXILIARY NET ASSETS ------------- $ (46,438,821)
FORM 990 PART IX LINE 11G	DESCRIPTION:PURCHASED AFFILIATE SERVICES TOTAL FEES:XXX-XX-XXXX
FORM 990 PART IX LINE 11G	DESCRIPTION:PHYSICAL REMUNERATION TOTAL FEES:XXX-XX-XXXX
FORM 990 PART IX LINE 11G	DESCRIPTION:CONTRACT LABOR TOTAL FEES:9752028
FORM 990 PART IX LINE 11G	DESCRIPTION:ANESTHESIA SERVICES TOTAL FEES:8504500
FORM 990 PART IX LINE 11G	DESCRIPTION:REPAIRS & MAINTENANCE TOTAL FEES:6957396
FORM 990 PART IX LINE 11G	DESCRIPTION:BILLING/COLLECTIONS SERVICES TOTAL FEES:6068549
FORM 990 PART IX LINE 11G	DESCRIPTION:PURCHASED LAB SERVICES TOTAL FEES:5891147
FORM 990 PART IX LINE 11G	DESCRIPTION:OTHER PURCHASED SERVICES TOTAL FEES:5130474
FORM 990 PART IX LINE 11G	DESCRIPTION:CONSULTING TOTAL FEES:3027427
FORM 990 PART IX LINE 11G	DESCRIPTION:HOUSEKEEPING/LAUNDRY TOTAL FEES:2438542
FORM 990 PART IX LINE 11G	DESCRIPTION:MEDICAL DIRECTOR TOTAL FEES:1714896
FORM 990 PART IX LINE 11G	DESCRIPTION:PURCHASED MANAGEMENT SERVICES TOTAL FEES:730875
FORM 990 PART IX LINE 11G	DESCRIPTION:PHARMACY FEES TOTAL FEES:688239
FORM 990 PART IX LINE 11G	DESCRIPTION:OCCUPATIONAL THERAPY TOTAL FEES:366757
FORM 990 PART IX LINE 11G	DESCRIPTION:COURIER SERVICES TOTAL FEES:357663
FORM 990 PART IX LINE 11G	DESCRIPTION:PROFESSIONAL FEES TOTAL FEES:346368
FORM 990 PART IX LINE 11G	DESCRIPTION:SPECIAL SERVICES TOTAL FEES:114919
FORM 990 PART IX LINE 11G	DESCRIPTION:RADIOLOGY TOTAL FEES:91198

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

Cat. No. 51056K

Schedule O (Form 990 or 990-EZ) 2018

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE R
(Form 990)

Department of the Treasury
Internal Revenue Service

Related Organizations and Unrelated Partnerships

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

Attach to Form 990.
MediumBullet

Go to www.irs.gov/Form990 for instructions and the latest information.

OMB No. 1545-0047

2018

Open to Public Inspection

Name of the organization

LESTER E COX MEDICAL CENTERS

Employer identification number

44-0577118

Part I

Identification of Disregarded Entities Complete if the organization answered "Yes" on 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)	(f) Direct controlling entity
(1) FERRELL DUNCAN CLINIC 1001 E PRIMROSE SPRINGFIELD,MO65807 54-2183221	PHYSICIANS	MO	LESTER E COX
(2) REGIONAL SERVICES 3800 S NATIONAL SUITE 540 SPRINGFIELD,MO65807 54-2183222	HEALTHCARE	MO	LESTER E COX
(3) OXFORD HEALTHCARE HOME HEALTH AGENCY 3550 S NATIONAL SPRINGFIELD,MO65807 77-0700975	HOME HEALTH	MO	LESTER E COX
(4) COXHEALTH HOME SUPPORT SYSTEMS 2224 W SUNSET SPRINGFIELD,MO65807 54-2183216	HOME HEALTH	MO	LESTER E COX
(5) OB GYN FERRELL DUNCAN CLINIC 1000 E PRIMROSE SPRINGFIELD,MO65807 43-1878984	PHYSICIANS	MO	LESTER E COX
(6) COXHEALTH INNOVATIONS LLC 3850 S NATIONAL SPRINGFIELD,MO65807 27-1117213	MANAGEMENT	MO	LESTER E COX
(7) SPRINGFIELD NEUROLOGICAL AND SPINE INSTI 2900 S NATIONAL AVE SPRINGFIELD,MO65807 27-4296628	PHYSICIANS	MO	LESTER E COX
(8) FERRELL DUNCAN CLINIC BRANSON 251 SKAGGS ROAD BRANSON,MO65616 46-4039135	PHYSICIANS	MO	LESTER E COX
(9) TRIPLE STARS PROPERTIES LLC 901 ST LOUIS STREET SUITE 600 SPRINGFIELD,MO65806	REAL ESTATE	MO	COXHLTH INNV

Part II

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

(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Exempt Code section	(e) Public charity status (if section 501(c)(3))	(f) Direct controlling entity	(g) Section 512(b)(13) controlled entity?
(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Exempt Code section	(e) Public charity status (if section 501(c)(3))	(f) Direct controlling entity	Yes	No
(1)COX ALTERNATIVE CARE OF THE OZARKS INC PO BOX 10939 SPRINGFIELD,MO65808 43-1641925	HOME HEALTH	MO	501(C)(3)	10	LESTER E COX	Yes
(2)COXHEALTH FOUNDATION 3525 S NATIONAL SUITE 204 SPRINGFIELD,MO65807 43-6810485	FUNDRAISING	MO	501(C)(3)	12A I	LESTER E COX	Yes
(3)COXHEALTH HOME CARE SVCS OF THE MIDWEST PO BOX 10939 SPRINGFIELD,MO65808 26-4781194	HOME HEALTH	MO	501(C)(3)	10	LESTER E COX	Yes
(4)COX HPS OF THE OZARKS INC 2220 W SUNSET SPRINGFIELD,MO65807 43-1641927	HOME HEALTH	MO	501(C)(3)	10	LESTER E COX	Yes
(5)COX-MONETT HOSPITAL INC 801 N LINCOLN MONETT,MO65708 43-1656689	HOSPITAL	MO	501(C)(3)	3	LESTER E COX	Yes
(6)HEALTH ENRICHMENT SERVICES INC 3801 S NATIONAL SPRINGFIELD,MO65807 36-3263313	MED SERVICES	MO	501(C)(3)	7	LESTER E COX	Yes
(7)HEALTHCARE SERVICES OF THE OZARKS INC PO BOX 10939 SPRINGFIELD,MO65808 43-1641928	HOME HEALTH	MO	501(C)(3)	10	LESTER E COX	Yes
(8)PRIMROSE PLACE INC 1115 E PRIMROSE SPRINGFIELD,MO65807 43-1183783	SUPPORT	MO	501(C)(3)	12A I	LESTER E COX	Yes
(9)LESTER E COX MED CTRPROF LIAB LOSS FUND 1423 N JEFFERSON SPRINGFIELD,MO65802 36-6668576	SELF INSURANC	MO	501(C)(3)	12A I	LESTER E COX	Yes
(10)COXHEALTH 1423 N JEFFERSON SPRINGFIELD,MO65802 47-1087427	HOLDING CO	MO	501(C)(3)	12 B II	NA		No
(11)COX MEDICAL GROUP 1423 N JEFFERSON SPRINGFIELD,MO65802 47-1087566	PHYSICIANS	MO	501(C)(3)	10	COXHEALTH		No
(12)SKAGGS COMM HOSP ASSOC (COX MC BRANSON) 525 BRANSON LANDING BOULEVARD BRANSON,MO65616 44-0584290	HOSPITAL	MO	501(C)(3)	3	LESTER E COX	Yes
(13)COXHEALTH SYSTEMS HMO INC PO BOX 5750 SPRINGFIELD,MO658015750 43-1757075	HMO	MO	501(C)(4)		LESTER E COX	Yes
(14)COX COLLEGE 1423 N JEFFERSON SPRINGFIELD,MO65802 47-5148345	EDUCATION	MO	501(C)(3)	2	LESTER E COX	Yes
(15)COX MEDICAL GROUP CLINICS 3801 S NATIONAL SPRINGFIELD,MO65807 37-1830627	HEALTHCARE	MO	501(C)(3)	10	COXHEALTH		No
(16)COX HEALTH SYSTEMS INSURANCE COMPANY PO BOX 5750 SPRINGFIELD,MO65801 43-1684044	INSURANCE	MO	501(C)(4)		LESTER E COX	Yes
(17)COX BARTON COUNTY HOSPITAL 1423 N JEFFERSON SPRINGFIELD,MO65802 82-3300758	HOSPITAL	MO	501(C)(3)	3	COXHEALTH		No

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

Cat. No. 50135Y

Schedule R (Form 990) 2018

Page 2

Part III

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

(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Direct controlling entity	(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?
(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Direct controlling entity	(f) Share of total income	(g) Share of end-of-year assets	Yes	No	(i) Code V-UBI amount in box 20 of Schedule K-1 (Form 1065)	Yes	No

Part IV

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

(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Direct controlling entity	(e) Type of entity (C corp, S corp, or trust)	(f) Share of total income	(g) Share of end-of-year assets	(h) Percentage ownership	(i) Section 512(b)(13) controlled entity?
(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		Yes	No
(1) MEDICAL DEVELOPMENTS INC 1423 N JEFFERSON SPRINGFIELD,MO65802 43-1622182	PHARMACY	MO	LESTER E COX	C CORP	3,361,540	6,051,476	100.000 %	Yes
(2) COX TAXABLE CLOSE CORPORATION 1423 N JEFFERSON AVE SPRINGFIELD,MO65802 47-2573263	MEDICAL CLINIC	MO	COX MED GROUP	C CORP	0	0			No
(3) FERRELL-DUNCAN CLINIC INC 1001 E PRIMROSE SPRINGFIELD,MO65808 43-0991578	PHYSICIANS	MO	CTCC	C CORP	0	0			No
(4) INSURANCE CO OF SPRINGFIELD INC GRAND PAVILLION CORPORATE CENTRE KY GRAND CAYMAN GRAND CAYMAN CJ	CAPTIVE INSURANCE	CJ	LESTER E COX	C CORP	1,138,370	582,460	100.000 %	Yes

Schedule R (Form 990) 2018

Page 3

Part V

Transactions With Related Organizations Complete if the organization answered "Yes" on 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

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 .....................

Yes

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

Yes

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

Yes

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

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

f Dividends from related organization(s) ............................

g Sale of assets to related organization(s) ............................

h Purchase of assets from related organization(s) ............................

i Exchange of assets with related organization(s) ............................

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

Yes

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

Yes

l Performance of services or membership or fundraising solicitations for related organization(s) .....................

m Performance of services or membership or fundraising solicitations by related organization(s) .................

n Sharing of facilities, equipment, mailing lists, or other assets with related organization(s) ...................

o Sharing of paid employees with related organization(s) ............................

p Reimbursement paid to related organization(s) for expenses ............................

Yes

q Reimbursement paid by related organization(s) for expenses ............................

Yes

r Other transfer of cash or property to related organization(s) ............................

Yes

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

Yes

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 related organization	(b) Transaction type (a-s)	(c) Amount involved	(d) Method of determining amount involved
(1) SKAGGS COMM HOSP ASSOC DBA COX MED CTR BRNSN	A/J	7,230	COST
(2) COXHEALTH FOUNDATION	C	2,769,003	COST
(3) COX COLLEGE	K	533,457	COST
(4) COX-MONETT HOSPITAL INC	K	154,536	COST
(5) MEDICAL DEVELOPMENTS INC	K	183,059	COST
(6) COX HPS OF THE OZARKS INC	K	220,920	COST
(7) SKAGGS COMM HOSP ASSOC DBA COX MED CTR BRNSN	P	3,089,467	COST
(8) COX COLLEGE	P	144,008	COST
(9) COX-MONETT HOSPITAL INC	P	755,096	COST
(10) COX HPS OF THE OZARKS INC	P	658,665	COST
(11) COXHEALTH SYSTEMS HMO INC	P	3,316,619	COST
(12) SKAGGS COMM HOSP ASSOC DBA COX MED CTR BRNSN	Q	84,608,687	COST
(13) COX COLLEGE	Q	10,824,367	COST
(14) COX-MONETT HOSPITAL INC	Q	22,697,659	COST
(15) MEDICAL DEVELOPMENTS INC	Q	2,757,085	COST
(16) COX BARTON COUNTY HOSPITAL	Q	6,637,510	COST
(17) COX HPS OF THE OZARKS INC	Q	2,891,191	COST
(18) HEALTHCARE SERVICES OF THE OZARKS INC	Q	932,535	COST
(19) COXHEALTH SYSTEMS HMO INC	Q	5,671,194	COST
(20) COX MEDICAL GROUP	Q	354,308	COST
(21) FERRELL-DUNCAN CLINIC INC	Q	6,401,888	COST
(22) SKAGGS COMM HOSP ASSOC DBA COX MED CTR BRNSN	R	362,667	COST
(23) COX-MONETT HOSPITAL INC	R	55,084	COST
(24) MEDICAL DEVELOPMENTS INC	R	298,681	COST
(25) SKAGGS COMM HOSP ASSOC DBA MED CTR BRNSN	S	183,450	COST
(26) MEDICAL DEVELOPMENTS INC	S	8,334,215	COST

Schedule R (Form 990) 2018

Page 4

Part VI

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

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

(a) Name, address, and EIN of entity	(b) Primary activity	(c) Legal domicile (state or foreign country)	(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?
(a) Name, address, and EIN of entity	(b) Primary activity	(c) Legal domicile (state or foreign country)	Yes	No	(f) Share of total income	(g) Share of end-of-year assets	Yes	No	(i) Code V-UBI amount in box 20 of Schedule K-1 (Form 1065)	Yes	No

Schedule R (Form 990) 2018

Page 5

Part VII

Supplemental Information

Provide additional information for responses to questions on Schedule R (see instructions).

Return Reference	Explanation

Schedule R (Form 990) 2018

Additional Data

Software ID:
Software Version:

1	Briefly describe the organization’s mission or most significant activities: THE ORGANIZATION PROVIDES QUALITY HEALTH CARE, EDUCATION AND RESEARCH IN ORDER TO IMPROVE THE HEALTH OF THE COMMUNITIES IT SERVES.
2	Check this box
3	Number of voting members of the governing body (Part VI, line 1a) ........	3	15
4	Number of independent voting members of the governing body (Part VI, line 1b) .....	4	11
5	Total number of individuals employed in calendar year 2018 (Part V, line 2a) ......	5	11,422
6	Total number of volunteers (estimate if necessary) .............	6	15
7a	Total unrelated business revenue from Part VIII, column (C), line 12 ........	7a	906,278
b	Net unrelated business taxable income from Form 990-T, line 34 .........	7b	248,684

		Prior Year	Current Year
8	Contributions and grants (Part VIII, line 1h) .........	3,707,224	4,177,936
9	Program service revenue (Part VIII, line 2g) .........	1,198,109,827	1,195,207,493
10	Investment income (Part VIII, column (A), lines 3, 4, and 7d ) ....	19,931,522	8,415,557
11	Other revenue (Part VIII, column (A), lines 5, 6d, 8c, 9c, 10c, and 11e)	17,836,092	25,329,726
12	Total revenue—add lines 8 through 11 (must equal Part VIII, column (A), line 12)	1,239,584,665	1,233,130,712
13	Grants and similar amounts paid (Part IX, column (A), lines 1–3 )...	1,188,060	1,673,310
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)	438,017,467	473,182,944
16a	Professional fundraising fees (Part IX, column (A), line 11e) .....	0	0
b	Total fundraising expenses (Part IX, column (D), line 25) 796,788
17	Other expenses (Part IX, column (A), lines 11a–11d, 11f–24e)....	735,504,839	680,366,111
18	Total expenses. Add lines 13–17 (must equal Part IX, column (A), line 25)	1,174,710,366	1,155,222,365
19	Revenue less expenses. Subtract line 18 from line 12.......	64,874,299	77,908,347
		Beginning of Current Year	End of Year
20	Total assets (Part X, line 16).............	1,621,399,974	1,753,434,894
21	Total liabilities (Part X, line 26).............	711,853,525	803,578,470
22	Net assets or fund balances. Subtract line 21 from line 20.....	909,546,449	949,856,424

Sign Here

	Signature of officer	Date

	Type or print name and title


4a	(Code: ) (Expenses $ 699,445,008 including grants of $ ) (Revenue $ 942,656,136 )
	HOSPITAL SERVICES: AS A COMMUNITY OWNED, NON-PROFIT HOSPITAL, LESTER E. COX MEDICAL CENTERS PROVIDES THE KIND OF CARE AND PROGRAMS THAT ARE NEEDED TO SERVE MANY OF THE MOST VULNERABLE IN OUR COMMUNITIES - THE UNDERINSURED AND UNINSURED. COMMUNITY BENEFIT TOTALED $240,976,997 SYSTEM-WIDE IN THESE CATEGORIES: SHORT-FALLS IN REIMBURSEMENT AND CHARITY CARE; COMMUNITY OUTREACH SERVICES INCLUDING COMMUNITY EDUCATION, HEALTH SCREENINGS, SUPPORT GROUPS AND IMMUNIZATIONS; HEALTH PROFESSIONALS EDUCATION AND RESEARCH, INCLUDING THE UN-REIMBURSED COST OF COX FAMILY MEDICINE RESIDENCY AND SCHOOLS OF ALLIED HEALTH PROFESSIONS; AND FOUNDATION GRANTS, FINANCIAL CONTRIBUTIONS AND IN-KIND DONATIONS.

4b	(Code: ) (Expenses $ 196,102,444 including grants of $ ) (Revenue $ 203,092,124 )
	PHYSICIAN CARE: EMPLOYED PHYSICIANS AT LESTER E. COX MEDICAL CENTER PLAY AN IMPORTANT ROLE IN ACCESS TO MEDICAL CARE THROUGH THEIR PRACTICE AT RURAL HEALTH CLINICS IN UNDER-SERVED AREAS OF SOUTHWEST MISSOURI. PHYSICIANS WITH COX FAMILY MEDICINE RESIDENCY ARE MAKING A VISIBLE DIFFERENCE IN CARE FOR UNINSURED PATIENTS AS WELL AS PATIENTS COVERED BY MEDICAID. THESE PATIENTS REPRESENT 36.9 PERCENT OF TOTAL PATIENTS SEEN IN THE CLINIC. SEE SCHEDULE O FOR ADDITIONAL INFORMATION.

4c	(Code: ) (Expenses $ 30,498,094 including grants of $ ) (Revenue $ 33,837,780 )
	HOME CARE: LESTER E. COX MEDICAL CENTERS' HOME CARE SERVICES, HOSPICE AND DURABLE MEDICAL EQUIPMENT ARE PROVIDED BY COXHEALTH AT HOME. COXHEALTH AT HOME STRIVES TO MEET THE HOME CARE AND HOSPICE NEEDS FOR CLIENTS OF ALL AGES. THEIR SERVICES INCLUDE NURSING CARE, MEDICATION SUPERVISION, IV THERAPY, PERSONAL CARE, HOUSEKEEPING, LAUNDRY, MEAL PREPARATION, SHOPPING, ERRANDS, TRANSPORTATION, COMPANIONSHIP, TELEMONITORING AND LIFELINE PERSONAL EMERGENCY RESPONSE SYSTEM. SEE SCHEDULE O FOR ADDITIONAL INFORMATION.

4d	Other program services (Describe in Schedule O.)
	(Expenses $ 20,408,302 including grants of $ 1,673,310 ) (Revenue $ 15,621,453 )
4e	Total program service expenses946,453,848

1b	Sub-Total................
c	Total from continuation sheets to Part VII, Section A....
d	Total (add lines 1b and 1c)...........	6,454,322	5,318,653	1,040,177

1a	Federated campaigns..		1a
b	Membership dues..		1b	1,920
c	Fundraising events..		1c	47,880
d	Related organizations		1d	2,769,003
e	Government grants (contributions)		1e

f	All other contributions, gifts, grants, and similar amounts not included above		1f	1,359,133

g	Noncash contributions included in lines 1a - 1f:$
h Total. Add lines 1a-1f.......		4,177,936

		Business Code
2a	NET PATIENT SERVICE REVENUE	900099	1,169,746,295	1,169,746,295
b	NET PATIENT SERVICE - UNRELATED LAB	621500	292,265		292,265
c	NET PATIENT SERVICE - UNRELATED RETAIL DME	446199	614,013		614,013
d	CAFETERIA, MEALS & VENDING	722514	5,551,998	5,551,998
e	FITNESS CENTERS	713940	3,092,747	3,092,747
f	All other program service revenue.		15,910,175	15,910,175
g	Total. Add lines 2a–2f ....		1,195,207,493

3 Investment income (including dividends, interest, and othersimilar amounts) ......			11,100,596			11,100,596
4 Income from investment of tax-exempt bond proceeds			48,278			48,278
5 Royalties...........			0
		(ii) Personal	(i) Real
6a	Gross rents		1,830,700
b	Less: rental expenses		1,342,489
c	Rental income or (loss)	0	488,211
d	Net rental income or (loss)......			488,211			488,211
		(ii) Other	(i) Securities
7a	Gross amount from sales of assets other than inventory	65,322	277,739,077
b	Less: cost or other basis and sales expenses	412,323	280,125,393
c	Gain or (loss)	-347,001	-2,386,316
d	Net gain or (loss).....			-2,733,317			-2,733,317
8a	Gross income from fundraising events (not including $ 47,880of contributions reported on line 1c). See Part IV, line 18 ....
	a		19,469
b	Less: direct expenses ...b		24,190
c	Net income or (loss) from fundraising events..			-4,721			-4,721
9a	Gross income from gaming activities. See Part IV, line 19 ...
	a		0
b	Less: direct expenses ...b		0
c	Net income or (loss) from gaming activities..			0
10a	Gross sales of inventory, less returns and allowances ..
	a		535,978
b	Less: cost of goods sold ..b		268,809
c	Net income or (loss) from sales of inventory..			267,169			267,169
Business Code			Miscellaneous Revenue
11a	GAIN ON INVESTMENT IN EQUITY INVESTEE		900099	322,534			322,534
b	CHANGE IN INTEREST IN NET ASSETS OF SUBS		900099	25,104,615			25,104,615
c	LOSS ON EXTINGUISHMENT OF DEBT		900099	-848,082			-848,082
d	All other revenue ....
e	Total. Add lines 11a–11d ......			24,579,067
12	Total revenue. See Instructions......			1,233,130,712	1,194,301,215	906,278	33,745,283

1	Grants and other assistance to domestic organizations and domestic governments. See Part IV, line 21	160,250	160,250
2	Grants and other assistance to domestic individuals. See Part IV, line 22	1,513,060	1,513,060
3	Grants and other assistance to foreign organizations, foreign governments, and foreign individuals. See Part IV, line 15 and 16.	0
4	Benefits paid to or for members	0
5	Compensation of current officers, directors, trustees, and key employees ....	3,988,669	2,663,103	1,325,566
6	Compensation not included above, to disqualified persons (as defined under section 4958(f)(1)) and persons described in section 4958(c)(3)(B) ....	814,454	455,514	358,940
7	Other salaries and wages	371,949,637	275,088,011	96,579,300	282,326
8	Pension plan accruals and contributions (include section 401(k) and 403(b) employer contributions) ....	19,026,702	18,367,642	652,721	6,339
9	Other employee benefits .......	48,514,498	46,721,634	1,792,764	100
10	Payroll taxes ...........	28,888,984	27,771,354	1,099,793	17,837
11	Fees for services (non-employees):
a	Management ......	0
b	Legal .........	35,000		35,000
c	Accounting ...........	299,359		299,359
d	Lobbying ...........	161,625		161,625
e	Professional fundraising services. See Part IV, line 17	0
f	Investment management fees ......	1,134,635		1,134,635
g	Other (If line 11g amount exceeds 10% of line 25, column (A) amount, list line 11g expenses on Schedule O)	318,004,531	235,156,205	82,833,786	14,540
12	Advertising and promotion ....	174,254	126,639	44,695	2,920
13	Office expenses .......	20,783,827	15,255,169	5,385,533	143,125
14	Information technology ......	6,774,999	5,006,425	1,766,954	1,620
15	Royalties ..	0
16	Occupancy ...........	20,400,869	16,045,832	4,320,684	34,353
17	Travel ............	2,191,959	1,617,470	570,865	3,624
18	Payments of travel or entertainment expenses for any federal, state, or local public officials .	0
19	Conferences, conventions, and meetings ....	2,204,917	1,623,220	572,895	8,802
20	Interest ...........	17,622,962	16,076,874	1,546,088
21	Payments to affiliates .......	0
22	Depreciation, depletion, and amortization ..	38,397,602	35,027,151	3,368,507	1,944
23	Insurance ...	5,008,470	3,701,923	1,306,547
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	MEDICAL SUPPLIES & DRUGS	193,368,541	193,368,541
b	STATE PROVIDER TAX	44,145,756	44,145,756
c	LICENSES, DUES, SUBSCRIPTIONS	1,519,320	1,122,979	396,341
d	MISCELLANEOUS	8,137,485	5,439,096	2,419,131	279,258
e	All other expenses
25	Total functional expenses. Add lines 1 through 24e	1,155,222,365	946,453,848	207,971,729	796,788
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 if following SOP 98-2 (ASC 958-720).

1	Cash–non-interest-bearing ........			5,847,089	1	3,052,465
2	Savings and temporary cash investments .........			180,125,784	2	233,751,408
3	Pledges and grants receivable, net ......			0	3	0
4	Accounts receivable, net .............			150,412,515	4	157,985,142
5	Loans and other receivables from current and former officers, directors, trustees, key employees, and highest compensated employees. Complete Part II of Schedule L .............
				726,662	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 ....			10,019,995	7	11,214,893
8	Inventories for sale or use ........			13,736,953	8	12,891,454
9	Prepaid expenses and deferred charges ......			11,733,114	9	10,072,476
10a	Land, buildings, and equipment: cost or other basis. Complete Part VI of Schedule D	10a	1,178,156,065
b	Less: accumulated depreciation	10b	751,328,337	436,420,088	10c	426,827,728
11	Investments—publicly traded securities .			407,434,678	11	483,926,814
12	Investments—other securities. See Part IV, line 11 .....			107,389,119	12	81,981,906
13	Investments—program-related. See Part IV, line 11 ..			248,352,878	13	274,546,314
14	Intangible assets ...............			25,263,742	14	25,263,742
15	Other assets. See Part IV, line 11 ...........			23,937,357	15	31,920,552
16	Total assets. Add lines 1 through 15 (must equal line 34)...			1,621,399,974	16	1,753,434,894

17	Accounts payable and accrued expenses .....	180,320,066	17	226,888,481
18	Grants payable ...	0	18	0
19	Deferred revenue .........	4,469,935	19	6,236,004
20	Tax-exempt bond liabilities .........	447,791,927	20	489,782,673
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 ..	15,346,290	23	10,929,954
24	Unsecured notes and loans payable to unrelated third parties ..	7,455,266	24	7,303,227
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	56,470,041	25	62,438,131
26	Total liabilities. Add lines 17 through 25..	711,853,525	26	803,578,470

	Organizations that follow SFAS 117 (ASC 958), check here and complete lines 27 through 29, and lines 33 and 34.
27	Unrestricted net assets	866,288,448	27	902,288,994
28	Temporarily restricted net assets ...........	22,758,349	28	26,942,077
29	Permanently restricted net assets	20,499,652	29	20,625,353
	Organizations that do not follow SFAS 117 (ASC 958), check here and complete lines 30 through 34.
30	Capital stock or trust principal, or current funds .....		30
31	Paid-in or capital surplus, or land, building or equipment fund ...		31
32	Retained earnings, endowment, accumulated income, or other funds		32
33	Total net assets or fund balances ...........	909,546,449	33	949,856,424
34	Total liabilities and net assets/fund balances ........	1,621,399,974	34	1,753,434,894

1	Was the organization a U.S. transferor of property to a foreign corporation during the tax year? If "Yes,"the organization may be required to file Form 926, Return by a U.S. Transferor of Property to a Foreign Corporation (see Instructions for Form 926). . . . . . . . . . . . . . . . . . . . . . . . . . . . . .	Yes	No
2	Did the organization have an interest in a foreign trust during the tax year? If "Yes," the organization may be required to separately file Form 3520, Annual Return to Report Transactions with Foreign Trusts and Receipt of Certain Foreign Gifts, and/or Form 3520-A, Annual Information Return of Foreign Trust With a U.S. Owner (see Instructions for Forms 3520 and 3520-A; don't file with Form 990). . . . . . . . . . . . . . . . . . . . . . . .	Yes	No
3	Did the organization have an ownership interest in a foreign corporation during the tax year? If "Yes," the organization may be required to file Form 5471, Information Return of U.S. Persons with Respect to Certain Foreign Corporations. (see Instructions for Form 5471). . . . . . . . . . . . . . . . . . . . . . . . . . . .	Yes	No
4	Was the organization a direct or indirect shareholder of a passive foreign investment company or a qualified electing fund during the tax year? If “Yes,” the organization may be required to file Form 8621, Information Return by a Shareholder of a Passive Foreign Investment Company or Qualified Electing Fund. (see Instructions for Form 8621) .	Yes	No
5	Did the organization have an ownership interest in a foreign partnership during the tax year? If "Yes," the organization may be required to file Form 8865, Return of U.S. Persons with Respect to Certain Foreign Partnerships (see Instructions for Form 8865). . . . . . . . . . . . . . . . . . . . . . . . . . . . . .	Yes	No
6	Did the organization have any operations in or related to any boycotting countries during the tax year? If "Yes," the organization may be required to separately file Form 5713, International Boycott Report (see Instructions for Form 5713; don't file with Form 990).. . . . . . . . . . . . . . . . . . . . . . . . . . . .	Yes	No