2016-11-14T12:10:07-06:00 2015-12-31 BKD LLP 200 E Main St Suite 700 Fort Wayne IN 46802 990 2015-01-01 431757075 COX HEALTH SYSTEMS HMO INC % LISA ODOM CFO COXH 4172692900 PO BOX 5750 SPRINGFIELD MO 65801 MATTHEW AUG PRESIDENT 4172693000 2016-11-15 true Joyce A Dulworth P00151125 2604604000 2015 2017-02-10 21:41:12Z X MATTHEW AUG PO BOX 5750 SPRINGFIELD MO 65807 14273719 false X WWW.COXHEALTHPLANS.COM X 1996 MO ENGAGED IN PROMOTING THE COMMON GOOD AND GENERAL WELFARE OF THE COMMUNITY BY PROVIDING A LOW-COST, HIGH-QUALITY HMO OPTION TO ALL INDIVIDUALS, INCLUDING AN UNDERSERVED POPULATION. 9 6 0 6 0 0 0 0 0 14243941 0 29778 0 0 0 14273719 0 0 0 1319013 0 5105229 0 0 0 0 4607581 0 11031823 0 3241896 28622694 31495025 1864609 1758822 26758085 29736203 X TO SUPPORT HEALTH IMPROVEMENT IN THE COMMUNITIES WE SERVE BY OFFERING COMPETITIVE INSURANCE PRODUCTS BASED ON QUALITY OUTCOMES AND EVIDENCED BASED HEALTHCARE. false true 1170055 1503163 COX HMO'S PRIMARY ACTIVITY HAS BEEN ARRANGING HEALTH CARE SERVICES THROUGH THE OPERATION OF AN HMO SINCE 1997. COX HMO HAS SERVED UP TO 400 PEOPLE IN ITS SERVICE AREA WHICH CONSISTS OF 26 COUNTIES IN THE STATE OF MISSOURI. COX HMO IS NO LONGER WRITING BUSINESS AND ALL ACTIVITIES AND PLAN OFFERINGS WILL BE CONDUCTED OUT OF THE RELATED COMPANY, COX HEALTH SYSTEMS INSURANCE COMPANY (CHSIC). AS OF DECEMBER 2015, MEMBERSHIP CONSISTED OF 88 PEOPLE. 5157547 9700139 COX HMO PROVIDES OPERATIONAL SUPPORT SERVICES TO ITS WHOLLY OWNED SUBSIDIARY CHSIC. SUCH ADMINISTRATIVE SERVICES PROVIDED TO CHSIC INCLUDE COMPREHENSIVE ADMINISTRATIVE SERVICES, FINANCIAL AND MANAGERIAL SERVICES, PREMIUM PROCESSING, CLAIMS MANAGEMENT AND PROVIDER NETWORK ADMINISTRATION. 2015377 3040639 COX HMO SERVES AS THE THIRD PARTY ADMINISTRATOR (TPA) FOR COX HEALTH SYSTEMS HOSPITALS' SELF-FUNDED EMPLOYEE HEALTH PLAN. THE CHS HOSPITALS' SELF-FUNDED PLAN COVERS APPROXIMATELY 12,500 MEMBERS INCLUDING EMPLOYEES AND DEPENDENTS. 8342979 false false false false false false false false false true true 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 true true true true false true 1757 0 true 0 false false false false false false X 9 6 false false false false true false false true true false false true true true true true true true true false MO X LISA ODOM CFO 4172692900 3200 S NATIONAL BUILDING B SPRINGFIELD MO 65807 MR STEVEN D EDWARDS VICE CHAIRMAN/DIRECTOR 1.0 39.0 X 0 1355943 259919 DR JAMES H CEASER DIRECTOR 1.0 39.0 X 0 380008 14153 DR MARK COSTLEY CHAIRMAN/DIRECTOR 1.0 39.0 X 0 293850 45753 MS RITA M NEEDHAM DIRECTOR 1.0 1.0 X 0 0 0 MR JOSEPH W TURNER DIRECTOR 1.0 5.0 X 0 0 0 MR JERRY G JARED DIRECTOR 1.0 2.0 X 0 0 0 MR KENNETH E MEYER DIRECTOR 1.0 1.0 X 0 0 0 MR CHRIS W NATTINGER DIRECTOR 1.0 1.0 X 0 0 0 MR LARRY SCHMITT DIRECTOR 1.0 1.0 X 0 0 0 MATTHEW AUG CHIEF EXECUTIVE OFFICER 20.0 20.0 X 0 307936 19979 JOHN D GAMBLE CHIEF FINANCIAL OFFICER 20.0 20.0 X 0 155258 17501 SUSAN BUTTS CHIEF INFORMATION OFFICER 20.0 20.0 X 0 132145 7171 DANIEL O'CONNELL DIRECTOR OF MEDICAL MANAGEMENT 20.0 20.0 X 0 91924 17178 JEFF BOND RETIRED CEO 1.0 0.0 X 0 127708 6493 0 2844772 388147 0 true true false TRIZETTO GROUP INC 12250 WEBER HILL ROAD SUITE 100 ST LOUIS MO 63127 HEALTHCARE IT SVC 409549 CATAMARAN 1600 MCCONNOR PARKWAY FLOOR 1 SCHAUMBURG IL 60173 PHARMACY SERVICES 379601 MILLIMAN 500 NORTH BROADWAY SUITE 1750 ST LOUIS MO 63102 CONSULTING 232643 ERNST YOUNG US LLP 190 CARONDELET PLAZA DRIVE ST LOUIS MO 63105 TAX CONSULTING 171385 OZARK MAILING SERVICE LLC 2804 NORTH OAK GROVE AVENUE SPRINGFIELD MO 65803 MAILING 251143 9 0 PREMIUM REVENUE 524114 1718311 1718311 ADMINISTRATIVE SERVICES 561000 12525630 12525630 14243941 29778 29778 0 0 0 0 0 0 0 0 0 0 14273719 14243941 29778 0 0 0 1319013 1319013 0 0 3941709 3153367 788342 0 1163520 930816 232704 0 0 53084 53084 375724 375724 0 0 0 681347 52131 629216 161138 128910 32228 604810 483848 120962 1030501 824401 206100 0 360589 288471 72118 40752 32602 8150 0 8256 6605 1651 2059 2059 0 368412 294730 73682 398794 319035 79759 FEDERAL INCOME TAXES 455380 455380 OTHER EXPENSES 1406 1406 PROPERTY TAXES 7827 6262 1565 SALES TAXES 2130 1704 426 55372 44298 11074 11031823 8342979 2688844 0 X 6940857 5659068 4568275 5568674 0 0 1361885 1651895 0 0 0 0 0 0 0 0 528058 529283 7362045 6774010 589279 588035 0 0 14634340 17498070 0 0 0 0 0 0 28622694 31495025 1381914 1536644 0 0 67767 439 0 0 0 0 0 0 0 0 0 0 414928 221739 1864609 1758822 X 13421532 14063160 1356113 20605010 11980440 -4931967 26758085 29736203 28622694 31495025 X 3241896 -263778 X false true X true false 139203 139203 7222842 6774010 448832 588035 INVESTMENTS IN AFFILIATES 17498070 C 17498070 0 CLAIMS AND CLAIMS PAYABLE 221739 221739 14271696 14271696 2023 2023 14273719 11029800 11029800 2023 2023 11031823 ASC 740 FOOTNOTE 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. PART XI, LINE 4B INTEREST EXPENSE $ 2,023 PART XII, LINE 4B INTEREST EXPENSE $ 2,023 false true false false false false false false false MATTHEW AUG CHIEF EXECUTIVE OFFICER 0 256424 0 44970 0 6542 0 12985 0 6994 0 327915 0 0 JOHN D GAMBLE CHIEF FINANCIAL OFFICER 0 131612 0 19463 0 4183 0 3305 0 14196 0 172759 0 0 JEFF BOND RETIRED CEO 0 61098 0 66262 0 348 0 3756 0 2737 0 134201 0 0 MR STEVEN D EDWARDS VICE CHAIRMAN/DIRECTOR 0 936242 0 265782 0 153919 0 245648 0 14271 0 1615862 0 147034 DR JAMES H CEASER DIRECTOR 0 360683 0 0 0 19325 0 0 0 14153 0 394161 0 0 DR MARK COSTLEY CHAIRMAN/DIRECTOR 0 291794 0 0 0 2056 0 31250 0 14503 0 339603 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 HMO 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, QUESTION 4B SUPPLEMENTAL NONQUALIFIED RETIREMENT PLAN: STEVE EDWARDS PARTICIPATES IN A 457(F) NONQUALIFIED RETIREMENT PLAN WITH LESTER E. COX MEDICAL CENTERS. HE RECEIVED AN EXECUTIVE 457(F) CONTRIBUTION OF $232,398 AND A 457(F) DISTRIBUTION OF $147,034, WHICH WAS REPORTED AS DEFERRED COMPENSATION ON A PRIOR FORM 990 OF THE PARENT. 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 ON PRIOR FORM 990 OF THE PARENT: 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. FORM 990, PART III, LINE 3 INSURED LIVES WITH HMO PLANS WERE TRANSFERRED THROUGHOUT THE YEAR UPON CONTRACT RENEWAL TO CHSIC PLANS TO CLOSE DOWN THE HMO PLANS. AS OF 1/1/16 ALL REMAINING MEMBERS WITH HMO PLANS WERE TRANSFERRED TO NEW PLANS IN CHSIC. FORM 990, PART VI, SECTION A, LINE 6 2000 SHARES CLASS H COMMON STOCK - ONE MEMBER WHICH IS COX HEALTH SYSTEMS FORM 990, PART VI, SECTION B, LINE 11B THE FORM 990 IS PROVIDED TO THE DIRECTOR OF ACCOUNTING AND CFO FOR A DETAILED REVIEW. THE FORM INFORMATION IS CROSS-CHECKED WITH COMPANY FINANCIAL RECORDS TO ENSURE ACCURACY. A COPY IS ALSO PROVIDED TO THE CEO AND GOVERNING BODY FOR REVIEW PRIOR TO FILING. FORM 990, PART VI, SECTION B, LINE 12C ALL OFFICERS AND BOARD MEMBERS ARE REQUIRED ANNUALLY TO REVIEW AND SIGN CONFLICT OF INTEREST DISCLOSURES. FORM 990, PART VI, SECTION B, LINE 15A REVIEWED BY THE CFO OF COX HEALTH SYSTEMS ANNUALLY. FORM 990, PART VI, SECTION B, LINE 15B REVIEWED BY THE PRESIDENT OF COX HEALTHPLANS ANNUALLY. FORM 990, PART VI, SECTION C, LINE 18 THESE DOCUMENTS WILL BE AVAILABLE UPON REQUEST. FORM 990, PART VI, SECTION C, LINE 19 COX HEALTH SYSTEMS HMO'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 X Effective January 1, 2015, the Company elected 501(c) nonprofit tax-exempt status. The balance sheet is being presented with the amounts that would have been entered on the 2014 Form 990 according to the IRS instructions. FORM 990, PART XI, LINE 9 ISSUANCE OF SHARES $ 641,628 CHANGES IN DEFERRED TAXES $ (5,731) CHANGES IN NONADMITTED ASSETS $(949,217) CHANGES IN EQUITY OF AFFILIATES $ 628,276 DIVIDENDS PAID $(114,586) DIFFERENCE IN ELIMINATION ENTRIES $(464,148) TOTAL $(263,778) COX HEALTHPLANS LLC 3200 S NATIONAL BLDG B SPRINGFIELD MO 65807 431754751 MANAGEMENT MO 3469855 11528528 COX HMO FERRELL-DUNCAN CLINIC 1001 E PRIMROSE SPRINGFIELD MO 65807 542183221 PHYSICIANS MO COXHEALTH REGIONAL SERVICES 3800 S NATIONAL SUITE 540 SPRINGFIELD MO 65807 542183222 HEALTHCARE MO COXHEALTH OXFORD HEALTHCARE HOME HEALTH AGENCY 3550 S NATIONAL SPRINGFIELD MO 65807 770700975 HOME HEALTH MO COXHEALTH COXHEALTH HOME SUPPORT SYSTEMS 2224 W SUNSET SPRINGFIELD MO 65807 542183216 HOME HEALTH MO COXHEALTH OB GYN FERRELL-DUNCAN CLINIC 1000 E PRIMROSE SPRINGFIELD MO 65807 431878984 PHYSICIANS MO COXHEALTH COXHEALTH ALLIANCE LLC 3850 S NATIONAL AVE SPRINGFIELD MO 65807 271117213 MANAGEMENT MO COXHEALTH SPRINGFIELD NEUROLOGICAL AND SPINE INSTI 2900 S NATIONAL AVE SPRINGFIELD MO 65807 274296628 PHYSICIANS MO COXHEALTH COX HEALTH SYSTEMS INSURANCE COMPANY 3200 S NATIONAL BLDG B SPRINGFIELD MO 65807 431684044 INSURANCE MO 501(C)(4) COX HMO true LESTER E COX MEDICAL CENTERS 1423 N JEFFERSON SPRINGFIELD MO 65802 440577118 HOSPITAL MO 501(C)(3) 3 NA false COX ALTERNATIVE CARE OF THE OZARKS INC PO BOX 10939 SPRINGFIELD MO 65808 431641925 HOME HEALTH MO 501(C)(3) 9 COXHEALTH false COXHEALTH FOUNDATION 3525 S NATIONAL SUITE 204 SPRINGFIELD MO 65807 436810485 FUNDRAISING MO 501(C)(3) 11AI COXHEALTH false COXHEALTH HME CRE SVCS OF THE MDWST INC 3850 S NATIONAL SPRINGFIELD MO 65807 264781194 HOME HEALTH MO 501(C)(3) 9 COXHEALTH false COX HPS OF THE OZARKS INC 2220 W SUNSET SPRINGFIELD MO 65807 431641927 HOME HEALTH MO 501(C)(3) 9 COXHEALTH false COX-MONETT HOSPITAL INC 801 N LINCOLN AVE MONETT MO 65708 431656689 HOSPITAL MO 501(C)(3) 3 COXHEALTH false COX-MONETT HOSPITAL AUXILIARY 801 N LINCOLN AVE MONETT MO 65708 431852817 SUPPORT MO 501(C)(3) 9 COXHEALTH false HEALTH ENRICHMENT SERVICES INC 3801 S NATIONAL SPRINGFIELD MO 65807 363263313 MED SVC MO 501(C)(3) 7 COXHEALTH false HEALTHCARE SERVICES OF THE OZARKS INC PO BOX 10939 SPRINGFIELD MO 65808 431641928 HOME HEALTH MO 501(C)(3) 9 COXHEALTH false PRIMROSE PLACE INC 1115 E PRIMROSE SPRINGFIELD MO 65807 431183783 NURSING HOME MO 501(C)(3) 11AI COXHEALTH false COXHEALTH AUXILIARY 3801 S NATIONAL SPRINGFIELD MO 65807 431090590 SUPPORT MO 501(C)(3) 9 COXHEALTH false COX MEDICAL CTR GENPROF LIAB LOSS FUND 1423 N JEFFERSON SPRINGFIELD MO 65802 366668576 SELF-INSURANC MO 501(C)(3) 11AI COXHEALTH false SKAGGS REGIONAL MEDICAL CENTER D/B/A COX MEDICAL CTR BRANSON BRANSON MO 65616 440584290 HOSPITAL MO 501(C)(3) 3 COXHEALTH false COX COLLEGE 1423 NORTH JEFFERSON SPRINGFIELD MO 65802 475148345 EDUCATION MO 501(C)(3) 2 COXHEALTH false SKAGGS-COXHEALTH ALLIANCE LLC SFD MO 65807 SPRINGFIELD MO 65807 271117343 HEALTHCARE MO COXHLTH ALLI RELATED false false 0.00000 PCRMC-COXHEALTH ALLIANCE LLC SFD MO 65807 SPRINGFIELD MO 65807 300649009 HEALTHCARE MO COXHLTH ALLI RELATED false false 0.00000 MEDICAL DEVELOPMENTS 1423 N JEFFERSON AVE SPRINGFIELD MO 65802 431622182 PHARMACY MO COXHEALTH C CORP 0 0 0.00000 false INSURANCE COMPANY OF SPRINGFIELD INC GRAND PAVILLION CORPORATE CENTRE GRAND CAYMAN CJ KY1-110 INSURANCE CJ COXHEALTH C CORP 0 0 0.00000 false false true true false false false false false false false false true false true true true false false false LESTER E COX MEDICAL CENTERS C 641628 COST COX HEALTH SYSTEMS INSURANCE COMPANY N 196258 COST COX HEALTHPLANS LLC P 118029 COST