4A (Expenses $ 990823007 including grants of $ 1322069) (Revenue $ 1231730984)
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 $1,223,983,404 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. THE HOSPITAL ALSO OPERATES COX COLLEGE, A PRIVATE, NON-PROFIT SINGLE PURPOSE COLLEGE ACCREDITED TO PROVIDE ACADEMIC PROGRAMMING IN A VARIETY OF ALLIED HEALTH FIELDS.

4B (Expenses $ 272601020 including grants of $ 0) (Revenue $ 216156722)
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 10.7% AND 36.2% PERCENT OF TOTAL PATIENTS SEEN IN THE CLINIC RESPECTIVELY. AFFORDABLE, CONVENIENT CARE IS ALSO PROVIDED IN OUR RETAIL CLINICS. LESTER E. COX MEDICAL CENTERS CONTINUES TO ADD SUPER CLINICS BRINGING ADVANCED CARE TO THE PATIENT INCLUDING PHYSICAL THERAPY, IMAGING AND PHARMACY SERVICES WITHIN THE CLINIC. COXHEALTH HAS ALSO INVESTED IN TELEMEDICINE INFRASTRUCTURE TO FURTHER EXPAND ITS ABILITY TO OFFER COST EFFECTIVE AND CONVENIENT CARE TO OUR COMMUNITY. ADDITIONALLY COXHEALTH HAS 29 VIRTUAL SCHOOL CLINICS ENABLING STUDENTS TO BE SEEN ON SITE AND PARENTS TO PARTICIPATE IN THE CLINICAL VISIT WITHOUT LEAVING WORK.

Schedule H, Part V, Section B, Line 5 Facility 1, 1
"Facility 1, 1 - MERCY HOSPITAL. Mercy Hospital system serves millions each year. Mercy is a cutting-edge healthcare provider that is charged with ""providing the region with high-quality care and an experience that is easier and more personal."" Mercy Hospital Springfield houses 886 beds that serve people throughout Southwest Missouri and Northwest Arkansas."

Schedule H, Part V, Section B, Line 5 Facility 1, 2
Facility 1, 2 - BURRELL BEHAVIORAL HEALTH. Burrell Behavioral Health is the third largest Certified Community Behavioral Health Center in the nation with multiple locations throughout Springfield and surrounding areas. Burrell has more than 400 licensed providers offering a full continuum of care through their integrated network. Burrell has continued to expand their reach and partnerships in the community through offering community-based services in coordination with schools and other organizations, such as Boys & Girls Clubs Springfield to meet the behavioral health needs of the community.

Schedule H, Part V, Section B, Line 5 Facility 1, 3
Facility 1, 3 - JORDAN VALLEY COMMUNITY HEALTH CENTER. Jordan Valley Community Health Center is Missouri's largest Federally Qualified Health Center serving 75,000 patients in the Ozarks each year. Founded in 2003, their mission to improve the community's health through access and relationships has driven their growth from their first medical clinic located in a strip mall to nine clinics, three school-based clinics and a fleet of mobile units that visit schools and organizations providing medical, dental, vision and behavioral health care services in southwest Missouri. Jordan Valley Community Health Center provides an integrated model of care, simplifying healthcare by giving access to a multitude of services in each clinic

Schedule H, Part V, Section B, Line 5 Facility 1, 4
Facility 1, 4 - OZARKS HEALTH COMMISSION. Building upon the success of the 2016 and 2019 regional health assessments, in 2021 partners again sought to better understand the health status, behaviors and needs of the populations served. The resulting 2022 Regional Health Assessment (RHA) combines more than 200 hospital and community indicators, including feedback from stakeholders and citizens, across a 30-county region that includes southwest Missouri, southeast Kansas and northeast Oklahoma. The full Ozarks Health Commission RHA can be found at http://ozarkshealthcommission.org/.

Schedule H, Part V, Section B, Line 5 Facility 1, 5
Facility 1, 5 - CHRISTIAN COUNTY HEALTH DEPARTMENT. In 1968 a public health office was established in Ozark, Missouri, under the auspices of the Ozarks Area Community Action Agency Corporation, with funding shared by the federal government and the Missouri Department of Health. Two years later the Christian County Health Department (CCHD) was created by a vote of the residents of the county. CCHD's mission is to serve and protect the county citizens by promoting healthy behaviors, increasing understanding of health issues and improving the quality of the environment. The department offers a variety of programs to serve the needs of Christian County residents.

Schedule H, Part V, Section B, Line 5 Facility 1, 6
Facility 1, 6 - WEBSTER COUNTY HEALTH DEPARTMENT. The Webster County Health Department (WCHD) was established in 1957 in order to preserve and protect public health of the community. WCHD's focus is on teaching, protecting and empowering people so that they don't get sick. By providing vaccinations, offering nutrition education, ensuring clean water and safe food, and providing screening and testing services, WCHD protects individual and community health.

Schedule H, Part V, Section B, Line 5 Facility 1, 7
Facility 1, 7 - SPRINGFIELD-GREENE COUNTY HEALTH (SGCHD). Springfield-Greene County Health (SGCHD) was established by the City of Springfield in 1873 as the Springfield Department of Health. The name was changed, and services were expanded to the entire county in 1976. The mission of SCGHD is to protect and improve community health through education, collaboration and prevention. Through chronic disease prevention, community health & epidemiology, environmental health and other programs, SGCHD can help the citizens of Greene County live longer, happier and healthier lives.

Schedule H, Part V, Section B, Line 6a Facility 1, 1
Facility 1, 1 - REPORTING GROUP #1. 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 MERCY HEALTH. 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 Facility 1, 1
Facility 1, 1 - REPORTING GROUP #1. THE CHNA WAS ALSO CONDUCTED WITH THE FOLLOWING OTHER NON-HOSPITAL ORGANIZATIONS: -CHRISTIAN COUNTY HEALTH DEPARTMENT -SPRINGFIELD-GREENE COUNTY HEALTH DEPARTMENT - WEBSTER COUNTY HEALTH DEPARTMENT

Schedule H, Part V, Section B, Line 7 Facility 1, 1
Facility 1, 1 - REPORTING GROUP #1. 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 7 Facility 1, 2
Facility 1, 2 - REPORTING GROUP #1. 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 11 Facility 1, 1
Facility 1, 1 - REPORTING GROUP #1. (1) SPECIAL HEALTH ISSUE - COVID 19 (A) DECREASE HOSPITALIZATION RELATED TO COVID 19 (i) PROPOSED TACTIC - SUPPORT COMMUNITY INITIATIVES, INCLUDING INCREASE PERCENT OF FULLY VACCINATED INDIVIDUALS AS RECOMMENDED BY CDC (2) SUBSTANCE USE AND RECOVERY (A) DECREASE TOBACCO AND VAPE USE RATES (i) INCREASE ACCESS TO CLINICAL EDUCATION AND TRAINING RELATED TO TOBACCO AND VAPE CESSATION (B) INCREASE AWARENESS OF SUBSTANCE USE PREVENTION AND TREATMENT RESOURCES (i) PROMOTE EDUCATION AND TRAIING RELATED TO SUBSTANCE USE (EXAMPLES: HARM REDUCTION, NALOXONE, MENTAL HEALTH FIRST AID) (3) MENTAL HEALTH (A) INCREASE AWARENESS OF MENTAL HEALTH SERVICES (i) INCREASE ACCESS THROUGH ALTERNATIVE CARE MODELS (II) IMPLEMENT TRAUMA INFORMED CARE TRAINING AND EDUCATION (4) DIABETES (A) IMPROVE CHRONIC DISEASE SELF MANAGEMENT (i) INCREASE ENROLLMENT IN CARE MANAGEMENT PROGRAMS (ii) PROMOTE ACCESS TO SCHOOL-AGE PREVENTION EDUCATION AND CARE PROGRAMS (ALL) (A) ENGAGE IN MULTI-SECTOR CARE COORDINATION TO REDUCE HEALTH DISPARITIES AND IMPROVE HEALTH OUTCOMES (i) IMPLEMENT COMMUNITY INFORMATION EXCHANGE (CIE)

Schedule H, Part V, Section B, Line 13 Facility 1, 1
Facility 1, 1 - REPORTING GROUP #1. 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 13 Facility 1, 1
Facility 1, 1 - REPORTING GROUP #1. 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 16 Facility 1, 1
Facility 1, 1 - REPORTING GROUP #1. 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, 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 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 $2,783,162. 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, Line 2 Bad debt expense - methodology used to estimate amount
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, 2022. 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, Line 3 Bad Debt Expense Methodology
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 2017-2021, APPROXIMATELY 13.2 PERCENT OF GREENE COUNTY WAS CONSIDERED TO LIVE IN POVERTY.

Schedule H, Part III, Line 4 Bad debt expense - financial statement footnote
"THE AUDIT FOOTNOTE ADDRESSING BAD DEBT EXPENSE AND PATIENT ACCOUNTS RECEIVABLE IS FOUNDION THE AUDITED FINANCIAL STATEMENTS UNDER NOTE 1, SUBTITLED ""PATIENT ACCOUNTS RECEIVABLE."""

Schedule H, Part III, Line 8 Community benefit & methodology for determining medicare costs
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, Line 9b Collection practices for patients eligible for financial assistance
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 V, Section B, Line 16a FAP website
1 - FACILITY REPORTING GROUP #1: Line 16a URL: HTTPS://WWW.COXHEALTH.COM/PATIENTS-AND-VISITORS/FINANCIAL-ASSISTANCE/;

Schedule H, Part V, Section B, Line 16b FAP Application website
1 - FACILITY REPORTING GROUP #1: Line 16b URL: HHTTPS://WWW.COXHEALTH.COM/PATIENTS-AND-VISITORS/FINANCIAL-ASSISTANCE/;

Schedule H, Part V, Section B, Line 16c FAP plain language summary website
1 - FACILITY REPORTING GROUP #1: Line 16c URL: HTTPS://WWW.COXHEALTH.COM/PATIENTS-AND-VISITORS/FINANCIAL-ASSISTANCE/;

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 2022. OHC Region stakeholders began the RHA process with analysis of publicly available health data (secondary data) and participating health systems' emergency department utilization data (primary data) to identify health issues of greatest concern across the region. The result was a ranked list of eight Ozarks Health Commission Region health issues. A full description of the health issues and indicators used can be found in the OHC Regional Health Assessment. To represent diverse views from across the region and population, qualitative data was collected between September and October 2021. Across the OHC Region these viewpoints were solicited via 75 individual interviews, 10 focus groups and 2,638 surveys. Specifically in the Springfield Community, 20 individual interviews were held with stakeholders and 3 virtual focus groups were held with local health system leaders, community outreach organizations, and a local drug task force as well as other sectors of the Springfield Community to allow voices to highlight challenges that they see as the biggest health related needs. Further, approximately 31% of regional survey respondents were from the Springfield Community. Methodologies used for the initial scoring/ranking of the health issues and the full report of the qualitative work can be found in the OHC Regional Health Assessment. This prioritization information can be used by organizations to develop community health improvement plans, guide decision making, foster collaboration across initiatives for collective community impact and increase funding by using evidence to describe issues and propose solutions.

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 and/or controlled 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.