2022-11-11T17:11:55-06:00 2021-12-31 FORVIS LLP 910 E ST LOUIS 200/PO BOX 1190 SPRINGFIELD MO 658062523 990 2021-01-01 431684044 COX HEALTH SYSTEMS INSURANCE COMPANY % LISA ODOM CFO COXH 4172692900 PO BOX 5750 SPRINGFIELD MO 65801 LISA ODOM CFO 4172693000 2022-04-27 true LISA ODOM 999009999 Brian D Todd P00422601 4178658701 3 2021 2022-09-23 18:48:47Z MATTHEW AUG PO BOX 5750 SPRINGFIELD MO 65801 149493194 false X WWW.COXHEALTHPLANS.COM X 1994 MO ENGAGED IN PROMOTING THE COMMON GOOD AND GENERAL WELFARE OF THE PEOPLE OF THE COMMUNITY BY PROVIDING LOW-COST, HIGH-QUALITY HEALTH PLANS TO AN UNDERSERVED POPULATION. 8 4 0 4 0 0 0 0 143169831 137385478 722454 519249 0 0 143892285 137904727 0 0 127313415 127312178 0 0 0 0 0 12701224 12006631 140014639 139318809 3877646 -1414082 54553162 52773938 30091106 29724487 24462056 23049451 TO SUPPORT HEALTH IMPROVEMENT IN THE COMMUNITIES WE SERVE BY OFFERING COMPETITIVE INSURANCE PRODUCTS BASED ON QUALITY OUTCOMES AND EVIDENCED BASED HEALTHCARE. false false 131446934 137385478 THE COMPANY (CHSIC) PROVIDES GROUP AND INDIVIDUAL HEALTH INSURANCE POLICIES. IT HAS BEEN ARRANGING HEALTH CARE SERVICES THROUGH THE OPERATION OF HEALTH PLANS SINCE ITS INCEPTION IN 1994. CHSIC SERVES APPROXIMATELY 27,000 PEOPLE ACROSS THE STATE OF MISSOURI AND MOST ARE IN ITS PRIMARY SERVICE AREA, WHICH CONSISTS OF THE 26 COUNTIES IN SOUTHWEST MISSOURI. CHSIC'S HEALTH PLANS ARE EPO AND PPO PLANS, AND THEY PROVIDE A COMMUNITY BENEFIT DUE TO THEIR LOW COST, THEIR AVAILABILITY TO ALL IN THE COMMUNITY AND THEIR ROLE IN COX HEALTH SYSTEM'S IMPROVING OF THE HEALTH OF THE COMMUNITY. 131446934 false false false false false false false false false false false false false true true true true false false false false false false false false false false false true false false false false false false false false false false false false false true false false true 0 0 0 false false false false false false false false X 8 4 true false false false true true true true true false false true true true true true true false false false X LISA ODOM CFO 4172692900 PO BOX 5750 SPRINGFIELD MO 65801 MR STEVEN D EDWARDS VICE CHAIRMAN/DIRECTOR 1.0 39.0 X X 0 1973321 323705 DR TIMOTHY JONES DIRECTOR 1.0 39.0 X 0 562697 93303 MR MATTHEW AUG CHIEF EXECUTIVE OFFICER 20.0 20.0 X 0 394021 23101 DR NORMAN J MECHLIN DIRECTOR 1.0 39.0 X 0 372407 16468 MRS LISA ODOM CHIEF FINANCIAL OFFICER 20.0 20.0 X 0 178173 25004 MS SUSAN BUTTS CHIEF INFORMATION OFFICER 20.0 20.0 X 0 157453 9123 MS LOREE LINES SECRETARY 20.0 20.0 X 0 57752 10492 DR MARK COSTLEY CHAIRMAN/DIRCTOR 1.0 1.0 X X 0 47018 20219 MR JERRY G JARED DIRECTOR 1.0 1.0 X 0 0 0 MR JOHN BRENT SINGLETON DIRECTOR 1.0 1.0 X 0 0 0 MR ROBERT MCDOWELL DIRECTOR 1.0 1.0 X 0 0 0 MS RITA M NEEDHAM DIRECTOR 1.0 1.0 X 0 0 0 0 3742842 521415 0 false true false CONNELL INSURANCE 511 BEE CREEK RD BRANSON MO 65616 BROKER COMMISSIONS 806207 MULTIPLAN 115 FIFTH AVENUE NEW YORK NY 10003 NEGOTIATING SAVINGS 777160 BARKER PHILLIPS JACKSON PO BOX 4207 SPRINGFIELD MO 65808 BROKER COMMISSIONS 702578 FIRST HEALTH 3200 HIGHLAND AVE DOWNERS GROVE IL 60515 SAVINGS FEES 624439 OLLIS AND COMPANY PO BOX 10346 SPRINGFIELD MO 65808 BROKER COMMISSIONS 409614 7 0 PREMIUM INCOME 524114 137385478 137385478 137385478 515087 515087 0 0 0 0 0 11592629 11588467 4162 4162 4162 0 0 0 0 0 0 0 0 0 0 137904727 137385478 519249 0 0 0 127312178 127312178 0 0 0 0 0 0 7868923 7868923 0 0 0 0 0 3522560 3522560 0 0 0 0 0 0 0 0 2952 2952 0 0 0 PREMIUM TAX 535577 535577 PCORI FEE 76619 76619 139318809 131446934 7871875 0 859 202 28219216 26959382 0 0 5176893 3576103 0 0 0 0 0 0 0 0 0 0 0 0 21156194 22238251 0 0 0 0 0 0 0 0 54553162 52773938 427587 295088 0 0 3274279 2928965 0 0 0 0 0 0 0 0 0 0 26389240 26500434 30091106 29724487 X 800000 800000 39189682 39189682 -15527626 -16940231 24462056 23049451 54553162 52773938 X -1414082 1477 X false true X true false 0 CLAIMS AND CLAIMS PAYABLE 25290739 DUE TO RELATED PARTIES 1209695 26500434 137904727 137904727 137904727 139318809 139318809 139318809 SCHEDULE D, PART X, LINE 2 UNCERTAIN TAX POSITIONS: EFFECTIVE JANUARY 1, 2015, THE COMPANY ELECTED 501(C) NONPROFIT TAX-EXEMPT STATUS. AS A RESULT OF THIS ELECTION, THE COMPANY IS NO LONGER SUBJECT TO INCOME TAXES AT THE ENTITY LEVEL. THE COMPANY IS NOT AWARE OF ANY UNCERTAIN TAX POSITIONS AT DECEMBER 31, 2021 AND 2020. false true false false false false false false false DR NORMAN J MECHLIN DIRECTOR 0 372407 0 0 0 0 0 0 0 16468 0 388875 0 0 DR TIMOTHY JONES DIRECTOR 0 526181 0 35826 0 690 0 75750 0 17553 0 656000 0 0 MR MATTHEW AUG CHIEF EXECUTIVE OFFICER 0 319654 0 73917 0 450 0 14100 0 9001 0 417122 0 0 MR STEVEN D EDWARDS VICE CHAIRMAN/DIRECTOR 0 1232639 0 441501 0 299181 0 301267 0 22438 0 2297026 0 284930 MRS LISA ODOM CHIEF FINANCIAL OFFICER 0 144540 0 32943 0 690 0 9580 0 15424 0 203177 0 0 MS SUSAN BUTTS CHIEF INFORMATION OFFICER 0 156163 0 0 0 1290 0 0 0 9123 0 166576 0 0 SCHEDULE J, PART I, LINE 3 ESTABLISHMENT OF TOP MANAGEMENT OFFICIAL COMPENSATION: LESTER E. COX MEDICAL CENTERS, A RELATED PARTY OF THE ORGANIZATION, USES THE FOLLOWING TO ESTABLISH THE COMPENSATION OF THE COX HEALTH SYSTEMS INSURANCE COMPANY TOP MANAGEMENT OFFICIAL: COMPENSATION COMMITTEE, INDEPENDENT COMPENSATION CONSULTANT, WRITTEN EMPLOYMENT CONTRACT, COMPENSATION SURVEY OR STUDY, AND APPROVAL BY THE BOARD OR COMPENSATION COMMITTEE. SCHEDULE J, PART I, LINE 4B SUPPLEMENTAL NONQUALIFIED RETIREMENT PLAN: STEVE EDWARDS PARTICIPATES IN A 457(F) NONQUALIFIED RETIREMENT PLAN WITH LESTER E. COX MEDICAL CENTERS ("COX"). HE RECEIVED AN EXECUTIVE 457(F) CONTRIBUTION OF $286,767, AND AN EXECUTIVE DISTRIBUTION OF $284,930, WHICH WAS REPORTED AS DEFERRED COMPENSATION ON A PRIOR FORM 990. SCHEDULE J, PART II, COLUMN F COMPENSATION REPORTED ON PRIOR FORM 990: AMOUNTS REPORTED IN SCHEDULE J, PART II, COLUMN F, WERE REPORTED ON A PRIOR FORM 990 OF LESTER E. COX MEDICAL CENTERS, A RELATED ORGANIZATION. 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. DURING CALENDAR YEAR 2021, THERE WERE NO AMOUNTS REQUIRED TO BE REPORTED. FORM 990, PART VI, SECTION A, LINE 2 FAMILY AND BUSINESS RELATIONSHIPS: STEVEN EDWARDS SERVES AS THE PRESIDENT AND CEO, AND MARK COSTLEY, LOREE LINES, MATTHEW AUG, LISA ODOM, SUSAN BUTTS, NORMAN MECHLIN, AND TIMOTHY JONES ARE ALL EMPLOYED BY LESTER E. COX MEDICAL CENTERS, A RELATED ORGANIZATION. NO COMPENSATION WAS PROVIDED FOR RESPONSIBILITIES ASSOCIATED WITH BEING A BOARD DIRECTOR. COMPENSATION REPORTED FOR BOARD MEMBERS LISTED ON FORM 990, PART VII, AND SCHEDULE J REPRESENTS EMPLOYEE OR INDEPENDENT CONTRACTOR COMPENSATION UNRELATED TO SERVICE AS A BOARD MEMBER. FORM 990, PART VI, SECTION A, LINE 6 STOCKHOLDERS: THE STOCKHOLDER IS COX HEALTH SYSTEMS HMO, INC., A RELATED ORGANIZATION. FORM 990, PART VI, SECTION A, LINE 7A ELECTION/APPOINTMENT OF BOARD MEMBERS: THE BOARD SHALL CONSIST OF NO LESS THAN EIGHT (8) AND NO MORE THAN TWENTY-ONE (21) DIRECTORS, WHO SHALL BE ELECTED AT THE ANNUAL MEETING OF THE STOCKHOLDER, COX HEALTH SYSTEMS HMO, INC. ONE (1) DIRECTOR SHALL RESIDE IN THE BRANSON, MISSOURI AREA, WHICH IS DEFINED AS THE SKAGGS COMMUNITY HOSPITAL ASSOCIATION D/B/A COX MEDICAL CENTER BRANSON (CMCB) SERVICE AREA INCLUDING STONE AND TANEY COUNTIES (CMCB DIRECTOR). THE BOARD SHALL RECEIVE NOMINATIONS FROM THE CMCB BOARD PRIOR TO THE ANNUAL MEETING FOR ELECTION AS DIRECTOR. THE BOARD OF DIRECTORS OF COX MEDICAL GROUP (CMG) SHALL NOMINATE TWO (2) PHYSICIANS TO SERVE ON THE BOARD (EACH A CMG DIRECTOR). ONE CMG DIRECTOR SHALL BE EMPLOYED BY FERRELL-DUNCAN CLINIC, INC. AND THE OTHER SHALL BE EMPLOYED BY LESTER E. COX MEDICAL CENTERS (MEMBER), EMPLOYED BY CMG, OR EMPLOYED BY MEMBER AND LEASED TO CMG. THE BOARD SHALL RECEIVE NOMINATIONS FROM THE CMG BOARD PRIOR TO THE ANNUAL MEETING AT WHICH DIRECTORS ARE ELECTED. FORM 990, PART VI, SECTION A, LINE 7B STOCKHOLDER POWERS: ALTERATIONS, AMENDMENTS, OR REPEALS OF THE BYLAWS MAY BE MADE BY A MAJORITY OF THE STOCKHOLDERS ENTITLED TO VOTE AT ANY MEETING. FORM 990, PART VI, SECTION B, LINE 11B FORM 990 REVIEW: THE FORM 990 IS PREPARED BY AN INDEPENDENT ACCOUNTING FIRM BASED ON THE AUDITED FINANCIAL STATEMENTS AND INFORMATION PROVIDED BY THE ORGANIZATION. THE FORM 990 IS PROVIDED TO THE DIRECTOR OF ACCOUNTING AND CFO FOR A DETAILED REVIEW TO ENSURE ACCURACY. A COPY IS THEN PROVIDED TO THE CEO AND GOVERNING BODY FOR REVIEW PRIOR TO FILING. FORM 990, PART VI, SECTION B, LINE 12C 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 THE BOARD 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 COXHEALTH. FORM 990, PART VI, SECTION B, LINES 15A & 15B COMPENSATION REVIEW: 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 ASSESSMENTS 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: COX HEALTH SYSTEMS INSURANCE COMPANY'S GOVERNING DOCUMENTS AND CONFLICT OF INTEREST POLICY ARE AVAILABLE FOR PUBLIC INSPECTION AS AN ATTACHMENT TO THE APPLICATION FOR RECOGNITION OF EXEMPTION. FORM 990, PART XI, LINE 9 OTHER CHANGES IN NET ASSETS: $ 1,477 CHANGE IN NONADMITTED ASSETS COX HEALTH SYSTEMS HMO INC PO BOX 5750 SPRINGFIELD MO 65801 431757075 INSURANCE MO 501(C)4 COXHEALTH false LESTER E COX MEDICAL CENTERS 1423 N JEFFERSON SPRINGFIELD MO 65802 440577118 HOSPITAL MO 501(C)3 3 COXHEALTH false COXHEALTH FOUNDATION 3525 S NATIONAL SUITE 204 SPRINGFIELD MO 65807 436810485 FUNDRAISING MO 501(C)(3) 12AI LESTER E COX false COX HPS OF THE OZARKS INC 2220 W SUNSET SPRINGFIELD MO 65807 431641927 HOME HEALTH MO 501(C)(3) 10 LESTER E COX false COX-MONETT HOSPITAL INC 801 N LINCOLN AVE MONETT MO 65708 431656689 HOSPITAL MO 501(C)(3) 3 LESTER E COX false HEALTH ENRICHMENT SERVICERS INC 3801 S NATIONAL SPRINGFIELD MO 65807 363263313 MED SERVICES MO 501(C)(3) 7 LESTER E COX false HC SVCS OZARKS INC DBA COXHEALTH AT HOME PO BOX 10939 SPRINGFIELD MO 65808 431641928 HOME HEALTH MO 501(C)(3) 10 LESTER E COX false PRIMROSE PLACE 1115 E PRIMROSE SPRINGFIELD MO 65807 431641928 SUPPORT MO 501 (C)(3) 12AI LESTER E COX false COX MEDICAL CTR GENPROF LIAB LOSS FUND 1423 N JEFFERSON SPRINGFIELD MO 65802 366668576 SELF-INSURANC MO 501(C)(3) 12AI LESTER E COX false SKAGGS COMM HOSP ASSOC (COX MC BRANSON) 525 BRANSON LANDING BLVD BRANSON MO 65616 440584290 HOSPITAL MO 501(C)(3) 3 LESTER E COX false COX COLLEGE 1423 N JEFFERSON SPRINGFIELD MO 65802 475148345 EDUCATION MO 501(C)(3) 2 LESTER E COX false COXHEALTH 1423 N JEFFERSON SPRINGFIELD MO 65802 471087427 HOLDING CO MO 501(C)(3) 12B NA false COX MEDICAL GROUP 1423 N JEFFERSON SPRINGFIELD MO 65802 471087566 PHYSCIANS MO 501(C)(3) 10 COXHEALTH false COX MEDICAL GROUP CLINICS 3801 S NATIONAL SPRINGFIELD MO 65807 371830627 HEALTHCARE MO 501(C)(3) 10 COXHEALTH false COX BARTON COUNTY HOSPITAL 1423 N JEFFERSON SPRINGFIELD MO 65802 823300758 HOSPITAL MO 501(C)(3) 3 COXHEALTH false MEDICAL DEVELOPMENTS 1423 N JEFFERSON AVE SPRINGFIELD MO 65802 431622182 PHARMACY MO LESTER E COX C CORP false INSURANCE COMPANY OF SPRINGFIELD INC GRAND PAVILLION CORPORATE CENTRE GRAND CAYMAN CJ KY1-11 CAPTIVE INSUR CJ LESTER E COX C CORP false COX TAXABLE CLOSE CORPORATION 1423 N JEFFERSON AVE SPRINGFIELD MO 65802 472573263 MEDICAL CLINI MO COX MED GROUP C CORP false FERRELL-DUNCAN CLINIC INC 1001 E PRIMROSE SPRINGFIELD MO 65808 430991578 PHYSICIANS MO CTCC C CORP false false false true true true false false false false false false false true true true true false false false