4A (Expenses $ 180720335 including grants of $ 34500) (Revenue $ 203477775)
HOSPITAL SERVICES - COX MEDICAL CENTER BRANSON PROVIDES THE FOLLOWING AREAS OF SERVICE: CANCER, CARDIAC, DIABETES AND ENDOCRINOLOGY, EAR NOSE AND THROAT, EMERGENCY, URGENT CARE, FAMILY MEDICINE, IMAGING AND RADIOLOGY, LABORATORY AND PATHOLOGY, NEPHROLOGY AND DIALYSIS, NEUROLOGY, OCCUPATIONAL HEALTH, ORTHOPEDICS, PEDIATRICS, PSYCHIATRY, PULMONOLOGY/CRITICAL CARE, REHABILITATION AND THERAPY, RHEUMATOLOGY, SLEEP DISORDER CENTER, SOCIAL SERVICES, SURGERY, UROLOGY, WOMEN'S SERVICES AND WOUND CARE. IVANTAGE HEALTH ANALYTICS RECOGNIZED COX MEDICAL CENTER BRANSON FOR OVERALL EXCELLENCE IN OUTCOMES AMONG ALL ACUTE CARE HOSPITALS IN THE NATION, AND AS ONE OF SEVEN RURAL MISSOURI HOSPITALS FOR EXCELLENCE IN QUALITY, ACCORDING TO ITS HOSPITAL STRENGTH INDEX. COX MEDICAL CENTER BRANSON EACH RECEIVED A 4-STAR RATING FROM HOSPITAL COMPARE STAR RATINGS, AS DETERMINED BY QUALITY, SAFETY AND PATIENT EXPERIENCE DATA REPORTED TO THE CENTERS FOR MEDICARE; MEDICAID SERVICES. COX MEDICAL CENTER BRANSON RECEIVED HIGH PATIENT SAFETY AND PATIENT OUTCOMES SCORES FROM CONSUMER REPORTS. COX MEDICAL CENTER BRANSON IS AMONG A SELECT FEW HEALTH SYSTEMS IN THE NATION TO RECEIVE THE AMERICAN HEART ASSOCIATION/AMERICAN STROKE ASSOCIATION'S GET WITH THE GUIDELINES - STROKE GOLD PLUS PERFORMANCE ACHIEVEMENT AWARD. COX MEDICAL CENTER BRANSON HAS BEEN NAMED TO THE TARGET: STROKE HONOR ROLL ELITE LIST. COX MEDICAL CENTER BRANSON IS A LEVEL 2 STROKE CENTER. COX MEDICAL CENTER BRANSON'S IMPLEMENTED CENTERING PREGNANCY -A PILOT GROUP PROGRAM FOR PRENATAL CARE. THE NATIONAL PROGRAM CAME TO BRANSON IN JUNE 2016 THROUGH FUNDING FROM THE MARCH OF DIMES AND SKAGGS FOUNDATION. THE CONCEPT OF CENTERING PREGNANCY IS A MODEL OF CARE THAT LOOKS A LOT DIFFERENT FROM TRADITIONAL PRENATAL VISITS, WHICH ARE OFTEN BRIEF AND ONE-ON-ONE WITH A WOMAN'S HEALTHCARE PROVIDER. IN THE NEW PROGRAM, EXPECTANT MOMS SKIP THE WAITING ROOM AND HAVE APPOINTMENTS THE SAME DAY AND TIME EACH MONTH IN SUPPORT-GROUP STYLE. THE OPEN FORUM ALLOWS MOMS TO SUPPORT EACH OTHER BY SHARING THEIR PREGNANCY WORRIES AND EXCITEMENT.

4B (Expenses $ 20061621 including grants of $ 0) (Revenue $ 16556028)
CLINIC SERVICES - CLINIC SERVICES INCLUDE FAMILY MEDICINE, OB-GYN SERVICES, GENERAL SURGERY, INTERNAL MEDICINE, INFECTIOUS DISEASE TREATMENT AND PULMONOLOGY. COORDINATION OF CARE IS ENHANCED BY A PHYSICIAN LIAISON.

Schedule H, Part V, Section B, Line 5 Facility , 1
Facility , 1 - SKAGGS COMMUNITY HOSPITAL ASSOCIATION. COMMUNITY INPUT: IN 2021, ORGANIZATIONS ACROSS THE OZARKS RECONVENED UNDER THE UMBRELLA OF THE OZARKS HEALTH COMMISSION (OHC) TO ASSESS THE HEALTH NEEDS OF OUR REGION. THE OHC REGION INCLUDES 30 COUNTIES LOCATED WITHIN THE STATES OF MISSOURI, KANSAS AND OKLAHOMA. IT IS CENTERED IN SOUTHWEST MISSOURI, AND REPRESENTS THE COMBINED SERVICE AREAS OF OHC REGION HEALTHCARE PARTNERS COXHEALTH, FREEMAN HEALTH SYSTEM, AND MERCY HOSPITALS. SEVEN MULTI-COUNTY COMMUNITIES WERE DEFINED BASED ON HOSPITAL SERVICE AREAS AND NAMED FOR A MAJOR CITY WITHIN THE COMMUNITY: BOLIVAR, BRANSON, JOPLIN, LEBANON, MONETT, MOUNTAIN VIEW, AND SPRINGFIELD. THE 2022 REGIONAL HEALTH ASSESSMENT (RHA) BUILDS UPON THE SUCCESS OF THE 2016 AND 2019 RHAS TO BETTER UNDERSTAND THE HEALTH STATUS, BEHAVIORS AND NEEDS OF THE POPULATIONS AND COMMUNITIES SERVED. THIS ASSESSMENT TAKES A COMPREHENSIVE, DATA-DRIVEN APPROACH TO LOOK AT THE HEALTH CHARACTERISTICS AND BEHAVIORS OF RESIDENTS IN THE OHC REGION BY PRESENTING MORE THAN 200 PUBLIC HEALTH AND EMERGENCY ROOM UTILIZATION DATA INDICATORS INCLUDING DEMOGRAPHICS, HEALTH MORBIDITY AND MORTALITY, HEALTH STATUS AND BEHAVIORS, AND SOCIAL DETERMINANTS OF HEALTH. THE OHC STEERING COMMITTEE ELECTED TO UTILIZE CONSULTATIVE SERVICES TO ACQUIRE RELIABLE AND REPRESENTATIVE INPUT FROM THE 30-COUNTY OHC REGION. TO THAT END, A CONSULTING FIRM WAS HIRED TO GATHER BOTH QUANTITATIVE AND QUALITATIVE DATA THROUGH 3 AVENUES: COMMUNITY SURVEYS, FOCUS GROUPS AND INTERVIEWS. THE PROCESS RESULTED IN THE IDENTIFICATION OF THE FOLLOWING HEALTH PRIORITIES: JOPLIN COMMUNITY (ENCOMPASSES COX BARTON COUNTY HOSPITAL SERVICE AREA): MENTAL HEALTH, DIABETES, LUNG DISEASE, HEART DISEASE; SPRINGFIELD, BRANSON AND MONETT COMMUNITIES: MENTAL HEALTH, SUBSTANCE USE AND RECOVERY, DIABETES. ALL COMMUNITIES IDENTIFIED COVID-19 AS A SPECIAL HEALTH ISSUE. ADDITIONALLY, INDICATORS THAT COULD IMPACT MULTIPLE ASSESSED HEALTH ISSUES, REFERRED TO HERE AS SOCIAL DETERMINANTS OF HEALTH, WERE NOTED IN EVERY COMMUNITY. BROADLY, THESE SOCIAL DETERMINANTS OF HEALTH FALL INTO SIX CATEGORIES: ECONOMIC STABILITY, EDUCATION ACCESS AND QUALITY, HEALTHCARE ACCESS AND QUALITY, NEIGHBORHOOD AND BUILT ENVIRONMENT, SOCIAL AND COMMUNITY CONTEXT, AND HEALTH BEHAVIORS. THE OHC HIGHLIGHTED KEY FACTORS AND POPULATIONS OF INTEREST WITH DISPARATE NEEDS, CHALLENGES AND GREATER VULNERABILITY THAN COMPARABLE AREAS WITH THE SAME POPULATION IN OTHER COUNTIES. HISTORICALLY DISENFRANCHISED POPULATIONS, SUCH AS PEOPLE IN POVERTY, MINORITIES AND THE ELDERLY, OFTEN EXPERIENCE HIGHER RATES OF CHRONIC ILLNESS AND WORSE HEALTH OUTCOMES, DUE TO A MULTITUDE OF STRUCTURAL AND ENVIRONMENTAL FACTORS. THIS CAN LEAD TO HEALTH DISPARITIES BETWEEN VARIOUS SOCIOECONOMIC CLASSES AND/OR DEMOGRAPHIC GROUPS. THE PRIORITIZATION OF ASSESSED HEALTH ISSUES PROCESS INCLUDED THE FOLLOWING COMMUNITY STAKEHOLDERS. BRANSON COMMUNITY: -COXHEALTH -COX MEDICAL CENTER BRANSON -SKAGGS FOUNDATION -TANEY COUNTY AMBULANCE DISTRICT -TANEY COUNTY HEALTH DEPARTMENT -GIFT OF HOPE -FAITH COMMUNITY HEALTH -TABLE ROCK LAKE CHAMBER OF COMMERCE -STONE COUNTY HEALTH DEPARTMENT -CHRISTIAN ACTION MINISTRIES

Schedule H, Part V, Section B, Line 6a Facility , 1
Facility , 1 - SKAGGS COMMUNITY HOSPITAL ASSOCIATION. 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 HOSPITALS. 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
Facility , 1 - SKAGGS COMMUNITY HOSPITAL ASSOCIATION. THE CHNA WAS ALSO CONDUCTED WITH THE FOLLOWING OTHER NON-HOSPITAL ORGANIZATIONS: -BURRELL BEHAVIORAL HEALTH -CHRISTIAN COUNTY HEALTH DEPARTMENT -CITY OF JOPLIN HEALTH DEPARTMENT -JASPER COUNTY HEALTH DEPARTMENT -LAWRENCE COUNTY HEALTH DEPARTMENT -SPRINGFIELD-GREENE COUNTY HEALTH DEPARTMENT -TANEY COUNTY HEALTH DEPARTMENT -VERNON COUNTY HEALTH DEPARTMENT

Schedule H, Part V, Section B, Line 7 Facility , 1
Facility , 1 - SKAGGS COMMUNITY HOSPITAL ASSOCIATION. PRINTED COPIES ARE AVAILABLE BY REQUEST THROUGH HOSPITAL AND PUBLIC HEALTH PARTNERS. ELECTRONIC AND PRINTABLE VERSIONS ARE AVAILABLE AT COXHEALTH.COM AND OZARKSHEALTHCOMMISSION.ORG. NEWS RELEASE WAS HELD TO ENCOURAGE MEDIA COVERAGE WITH LINKS TO THE REPORT AND KEY MESSAGES FOR THE PUBLIC.

Schedule H, Part V, Section B, Line 7 Facility , 2
Facility , 2 - SKAGGS COMMUNITY HOSPITAL ASSOCIATION. 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
Facility , 1 - SKAGGS COMMUNITY HOSPITAL ASSOCIATION. 1. DECREASE HOSPITALIZATIONS RELATED TO COVID-19 -SUPPORT COMMUNITY INITIATIVES, INCLUDING INCREASE PERCENT OF FULLY VACCINATED INDIVIDUALS AS RECOMMENDED BY THE CDC 2. DECREASE TOBACCO AND VAPE USE RATES -INCREASE ACCESS TO CLINICAL EDUCATION AND TRAINING RELATED TO TOBACCO AND VAPE CESSATION 3. INCREASE AWARENESS OF SUBSTANCE USE PREVENTION AND TREATMENT RESOURCES -PROMOTE EDUCATION AND TRAINING RELATED TO SUBSTANCE USE (EXAMPLES: HARM REDUCTION, NALOXONE, MENTAL HEALTH FIRST AID) 4. INCREASE AWARENESS OF MENTAL HEALTH SERVICES -INCREASE ACCESS THROUGH ALTERNATIVE CARE MODELS -IMPLEMENT TRAUMA INFORMED CARE TRAINING AND EDUCATION 5. IMPROVE CHRONIC DISEASE SELF-MANAGEMENT -INCREASE REFERRALS TO SELF-MANAGEMENT EDUCATION -INCREASE ENROLLMENT IN CARE MANAGEMENT PROGRAMS -PROMOTE ACCESS TO SCHOOL-AGE PREVENTION EDUCATION AND CARE PROGRAMS 6. ENGAGE IN MULTI-SECTOR CARE COORDINATION TO REDUCE HEALTH DISPARITIES AND IMPROVE HEALTH OUTCOMES -IMPLEMENT COMMUNITY INFORMATION EXCHANGE PLATFORM

Schedule H, Part V, Section B, Line 13 Facility , 1
Facility , 1 - SKAGGS COMMUNITY HOSPITAL ASSOCIATION. 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 13 Facility , 2
Facility , 2 - SKAGGS COMMUNITY HOSPITAL ASSOCIATION. 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 16 Facility , 1
Facility , 1 - SKAGGS COMMUNITY HOSPITAL ASSOCIATION. 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 THIS 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 FORM 990, PART IX, LINE 25.

Schedule H, Part I, Line 7 COST TO CHARGE RATIO
THE COST TO CHARGE RATIO COMPUTED ON IRS WORKSHEET 2 WAS USED IN THE CALCULATIONS ON IRS WORKSHEET 1 AND 3. WORKSHEET 6 USED INTERNAL COST CALCULATIONS.

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 $X,XXX,XXX.XX. COX MEDICAL CENTER BRANSON 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. COX MEDICAL CENTER BRANSON CONTINUES TO PROVIDE THESE SERVICES AS A BENEFIT TO THE COMMUNITY DESPITE KNOWING THAT FINANCIAL SHORTFALLS WILL BE SUSTAINED.

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
BAD DEBT ATTRIBUTABLE TO PATIENTS ELIGIBLE UNDER THE ORGANIZATION'S CHARITY CARE POLICY WAS ESTIMATED USING THE PERCENTAGE OF THE POPULATION THAT IS BELOW THE POVERTY LINE IN THE HOSPITAL'S SERVICE AREA.

Schedule H, Part III, Line 4 Bad debt expense - financial statement footnote
"THE AUDIT FOOTNOTE ADDRESSING BAD DEBT EXPENSE AND PATIENT ACCOUNTS RECEIVABLE IS FOUND ON PAGE 15 OF THE AUDITED FINANCIAL STATEMENTS UNDER NOTE 1, SUBTITLED ""PATIENT ACCOUNTS RECEIVABLE."""

Schedule H, Part III, Line 8 Community benefit & methodology for determining medicare costs
THE HOSPITAL IS DESIGNATED BY MEDICARE AS A SOLE COMMUNITY HOSPITAL AND AS SUCH, IS THE SOLE SOURCE OF HOSPITAL CARE WITHIN A 35-MILE RADIUS. AS A LARGE RURAL HOSPITAL, MINIMUM STAFFING MUST BE MAINTAINED REGARDLESS OF SWINGS IN PATIENT VOLUME. WITHOUT THE HOSPITAL, MEDICARE PATIENTS WOULD NEED TO TRAVEL SIGNIFICANT DISTANCES TO RECEIVE HOSPITAL CARE. SERVING PATIENTS WITH GOVERNMENT HEALTH BENEFITS, SUCH AS MEDICARE, IS A COMPONENT OF THE COMMUNITY BENEFIT STANDARD THAT TAX-EXEMPT HOSPITALS ARE HELD TO. THIS IMPLIES THAT SERVING MEDICARE PATIENTS IS A COMMUNITY BENEFIT AND THAT THE HOSPITAL OPERATES TO PROMOTE THE HEALTH OF THE COMMUNITY.

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
- SKAGGS COMMUNITY HEALTH CENTER: Line 16a URL: HTTPS://WWW.COXHEALTH.COM/PATIENTS-AND-VISITORS/FINANCIAL-ASSISTANCE/;

Schedule H, Part V, Section B, Line 16b FAP Application website
- SKAGGS COMMUNITY HEALTH CENTER: Line 16b URL: HTTPS://WWW.COXHEALTH.COM/PATIENTS-AND-VISITORS/FINANCIAL-ASSISTANCE/;

Schedule H, Part V, Section B, Line 16c FAP plain language summary website
- SKAGGS COMMUNITY HEALTH CENTER: Line 16c URL: HTTPS://WWW.COXHEALTH.COM/PATIENTS-AND-VISITORS/FINANCIAL-ASSISTANCE/;

Schedule H, Part VI, Line 4 Community information
CMCB CONSIDERS TANEY AND STONE COUNTIES AS ITS PRIMARY SERVICE AREA WITH CHRISTIAN COUNTY, BOONE COUNTY AND PARTS OF CARROLL COUNTY IN NORTHERN ARKANSAS AS ITS SECONDARY SERVICE AREA. THE TOTAL POPULATION OF ZIP CODES SERVED BY CMCB IS APPROXIMITELY 144,000. THE PROJECTED POPULATION gROWTH IN THESE AREAS, ESPECIALLY THE CONTINUING MIGRATION INTO THE AREA OF RETIREES, IS A SIGNIFICANT FACTOR IN THE EVER-INCREASING NEED FOR HIGH-TECH MEDICAL SERVICES.

Schedule H, Part VI, Line 5 Promotion of community health
CMCB HAS A 15-MEMBER BOARD OF DIRECTORS. SEVERAL THOUSANDS OF DOLLARS ARE SPENT EACH YEAR OFFERING FREE LOW-COST SCREENINGS TO THE COMMUNITY AND EDUCATIONAL PROGRAMS. CMCB PHYSICIANS AND STAFF ARE COMMITTED TO EDUCATING THE COMMUNITY TO HELP ENSURE A HEALTHIER FUTURE. CPR CLASSES, SMOKING CESSATION CLASSES, PRENATAL CLASSES, ETC. ARE ALL FOCUSED ON GIVING OUR COMMUNITY MEMBERS THE RESOURCES THEY NEED TO MAKE INFORMED DECISIONS.

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. Commission stakeholders began the RHA process with analysis of publicly available health data (secondary data) and participating health systems' emergency room 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 garnered. During September and October 2021, 7 individual interviews, in addition to virtual focus group discussions in both Taney and Stone Counties were completed. Those interviewed represented health and social service organizations, education and community collaboratives. Of the 2,628 survey respondents from the OHC Region, 3.99% indicated they lived in the Branson Community. Respondents were asked to rank perceived community needs. Stakeholders, education and community individual interviews and focus groups agreed that a top challenge was affordable housing. In contrast to survey participants, affordable and quality childcare did not hold as high a spot as access to healthcare. Also of high priority was lack of mental health options for children and free or low-cost treatment for substance use, which is a significant need in this community. This information was considered during the process of establishing health priorities for the Branson 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 Report. This prioritization information can be used by organizations to develop community health improvement plans, guide decision-making, and foster collaboration across initiatives.

Schedule H, Part VI, Line 3 Patient education of eligibility for assistance
LESTER E. COX MEDICAL CENTERS, PARENT ORGANIZATION, 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 6 Affiliated health care system
CMCB IS PART OF THE COXHEALTH SYSTEM, WHICH INCLUDES THE FOLLOWING: LESTER E. COX MEDICAL CENTERS, WHICH 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. THE HEALTH SYSTEM PRIMARILY EARNS REVENUES BY PROVIDING INPATIENT, OUTPATIENT, EMERGENCY CARE, INPATIENT REHABILITATION, HOME CARE, PHYSICIAN SERVICES AND HEALTH INSURANCE PRODUCTS TO PATIENTS AND EMPLOYERS IN SPRINGFIELD, MISSOURI, AND THE SURROUNDING SOUTHWEST MISSOURI AREA. 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.