TY 2015 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) CHASE PALMER...................................................................... BOARD TREASURER	1.0 ................. 0.0	X	X		0	0	0
(2) DEAN SEARLE...................................................................... BOARD SECRETARY	1.0 ................. 0.0	X	X		0	0	0
(3) R BLAIR ABNEY...................................................................... BOARD CHAIRMAN	1.0 ................. 0.0	X	X		0	0	0
(4) RUSSELL J COLLIER...................................................................... PRESIDENT/CEO	40.0 ................. 1.0	X	X		0	315,969	48,178
(5) STEVE ALTMILLER...................................................................... GSHS PRESIDENT/CEO	1.0 ................. 50.0	X	X		0	650,200	87,557
(6) LUIS BALBUENA MD...................................................................... MEDICAL STAFF REP TO BOARD	1.0 ................. 40.0	X	X		0	444,707	24,732
(7) ALBERTO SUMMERHALDERS...................................................................... MEDICAL STAFF VP	1.0 ................. 0.0	X	X		0	0	0
(8) JEFF BEATY...................................................................... MEDICAL STAFF PRESIDENT	1.0 ................. 0.0	X	X		0	0	0
(9) ALLEN STAGGERS...................................................................... DIRECTOR	1.0 ................. 0.0	X			0	0	0
(10) BUCK BIRDSONG...................................................................... DESIGNATED SYSTEM REP	1.0 ................. 0.0	X			0	0	0
(11) GEORGE MEISENHEIMER...................................................................... DIRECTOR	1.0 ................. 0.0	X			0	0	0
(12) JULIE SIMMONS...................................................................... DIRECTOR	1.0 ................. 0.0	X			0	0	0
(13) LEROY FISHER...................................................................... DIRECTOR	1.0 ................. 0.0	X			0	0	0
(14) TED HUFFHINES...................................................................... BOARD VICE CHAIRMAN	1.0 ................. 0.0	X	X		0	0	0
(15) MITTIE HUTCHINS...................................................................... DIRECTOR	1.0 ................. 0.0	X			0	0	0
(16) TIM PILEGGI...................................................................... INTERIM CFO	1.0 ................. 50.0		X		0	583,683	0
(17) OLUWOLE O PETERS...................................................................... PHARMICIST	40.0 ................. 0.0			X	144,923	0	3,914

(A) Name and business address	(B) Description of services	(C) Compensation
MORRIS AND DICKSON CO LLC, PO BOX 51367 SHREVEPORT,LA71135	PHARMACY MANAGEMENT	2,291,532
MEDEFIS INC, 10826 OLD MILL RD SUITE 101 OMAHA,NE68154	MEDICAL SERVICES	515,088
ALLEGIANCE HEALTH MANAGEMENT INC, 504 TEXAS STREET SHREVEPORT,LA71101	MENTAL HEALTH	464,725
EAST TEXAS PULMONARY ASSOCIATES, 703 E MARSHALL AVE SUITE 3008 LONGVIEW,TX75601	MEDICAL SERVICES	334,000
NUMED INC, PO BOX 1098 DENTON,TX76202	MEDICAL SERVICES	264,542
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 17

- 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

Information about Schedule A (Form 990 or 990-EZ) and its instructions is at www.irs.gov/form990.

OMB No. 1545-0047

2015

Open to Public
Inspection

Name of the organization

Harrison County Hospital Association

Employer identification number

75-0974351

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 11, 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 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 11a through 11d that describes the type of supporting organization and complete lines 11e, 11f, and 11g.

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) 2015

Page 2

Part II

Support Schedule for Organizations Described in Sections 170(b)(1)(A)(iv) and 170(b)(1)(A)(vi)
(Complete only if you checked the box on line 5, 7, or 8 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) 2011	(b) 2012	(c) 2013	(d) 2014	(e) 2015	(f) Total
1	Gifts, grants, contributions, and membership fees received. (Do not include any unusual grants.) ....
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) 2011	(b) 2012	(c) 2013	(d) 2014	(e) 2015	(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 2015 (line 6, column (f) divided by line 11, column (f)) .........

Public support percentage for 2014 Schedule A, Part II, line 14 ...............

16a

33 1/3% support test—2015. 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—2014. 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—2015. 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—2014. 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) 2015

Page 3

Part III

Support Schedule for Organizations Described in Section 509(a)(2)
(Complete only if you checked the box on line 9 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) 2011	(b) 2012	(c) 2013	(d) 2014	(e) 2015	(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) 2011	(b) 2012	(c) 2013	(d) 2014	(e) 2015	(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 2015 (line 8, column (f) divided by line 13, column (f)) .........

Public support percentage from 2014 Schedule A, Part III, line 15 ...............

Section D. Computation of Investment Income Percentage

Investment income percentage for 2015 (line 10c, column (f) divided by line 13, column (f)) ......

Investment income percentage from 2014 Schedule A, Part III, line 17 .............

19a

331/3% support tests—2015. 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—2014. 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) 2015

Page 4

Part IV

Supporting Organizations

(Complete only if you checked a box on line 11 of Part I. If you checked 11a of Part I, complete Sections A and B. If you checked 11b of Part I, complete Sections A and C. If you checked 11c of Part I, complete Sections A, D, and E. If you checked 11d 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 11a or 11b 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) 2015

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) 2015

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. 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) 2015

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 2015 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-2015	(iii) Distributable Amount for 2015
1 Distributable amount for 2015 from Section C, line 6
2 Underdistributions, if any, for years prior to 2015 (reasonable cause required--see instructions)
3 Excess distributions carryover, if any, to 2015:
a
b
c
d From 2013.......
e From 2014.......
fTotal of lines 3a through e
g Applied to underdistributions of prior years
h Applied to 2015 distributable amount
i Carryover from 2010 not applied (see instructions)
j Remainder. Subtract lines 3g, 3h, and 3i from 3f.
4Distributions for 2015 from Section D, line 7:
$
a Applied to underdistributions of prior years
b Applied to 2015 distributable amount
c Remainder. Subtract lines 4a and 4b from 4.
5 Remaining underdistributions for years prior to 2015, if any. Subtract lines 3g and 4a from line 2 (if amount greater than zero, see instructions)
6 Remaining underdistributions for 2015. Subtract lines 3h and 4b from line 1 (if amount greater than zero, see instructions)
7 Excess distributions carryover to 2016. Add lines 3j and 4c.
8 Breakdown of line 7:
a
b
c Excess from 2013.......
d From 2014.......
e From 2015.......

Schedule A (Form 990 or 990-EZ) (2015)

Schedule A (Form 990 or 990-EZ) 2015

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) 2015

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

Information about Schedule C (Form 990 or 990-EZ) and its instructions is at www.irs.gov/form990.

OMB No. 1545-0047

2015

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

Harrison County Hospital Association

Employer identification number

75-0974351

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.

Political expenditures ...................................................................................................................... SchCMd Bullet

Volunteer hours .............................................................................................................................

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) 2015

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) 2012	(b) 2013	(c) 2014	(d) 2015	(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) 2015

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

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

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

Yes

15,867

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

15,867

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
PART II-B, LINE 1	LOBBYING ACTIVITIES: THE AMOUNT REPRESENTS THE PERCENTAGE OF DUES PAID TO THE AMERICAN HOSPITAL ASSOCIATION THAT THE AHA DETERMINED WAS FOR LOBBYING EXPENSES.

Schedule C (Form 990 or 990EZ) 2015

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.
Information about Schedule D (Form 990) and its instructions is at www.irs.gov/form990.

OMB No. 1545-0047

2015

Open to Public Inspection

Name of the organization

Harrison County Hospital Association

Employer identification number

75-0974351

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 8/17/06, 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) 2015

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 ....
b	Contributions ...
c	Net investment earnings, gains, and losses
d	Grants or scholarships ...
e	Other expenditures for facilities and programs ...
f	Administrative expenses ....
g	End of year balance ......

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

Temporarily restricted endowment SchDMd Bullet

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)

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

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 ...	601,681		601,681
b	Buildings	43,881,154	31,109,789	12,771,365
c	Leasehold improvements	428,467	418,530	9,937
d	Equipment ...	22,970,094	18,641,884	4,328,210
e	Other ...	3,536,560	2,976,674	559,886
Total. Add lines 1a through 1e. (Column (d) must equal Form 990, Part X, column (B), line 10(c).)..				18,271,079

Schedule D (Form 990) 2015

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) INVESTMENT IN HOME HEALTH	987,406	F
(B) INVESTMENT IN SERVICE ORG	572,800	F
(C) INVESTMENT IN FOUNDATION	484,132	F
(D) INVESTMENT IN PHYS HOSP ORG	11,630	F
(D)
(E)
(F)
(G)
(H)
Total. (Column (b) must equal Form 990, Part X, col. (B) line 12.)	2,055,968

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)
(2)
(3)
(4)
(5)
(6)
(7)
(8)
(9)
Total. (Column (b) must equal Form 990, Part X, col.(B) line 13.)

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) INTERCOMPANY				6,302,582
(2) OTHER NON CURRENT ASSETS				18,273
(2)
(3)
(4)
(5)
(6)
(7)
(8)
(9)
Total. (Column (b) must equal Form 990, Part X, col.(B) line 15.)...........				6,320,855

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
Intercompany Payables	2,305,917
Other Non Current Liabilities	38,000
(3)
(4)
(5)
(6)
(7)
(8)
(9)
Total. (Column (b) must equal Form 990, Part X, col.(B) line 25.)	2,343,917
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) 2015

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 (Form 990) 2015

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

Information about Schedule H (Form 990) and its instructions is at www.irs.gov/form990.

OMB No. 1545-0047

2015

Open to Public Inspection

Name of the organization

Harrison County Hospital Association

Employer identification number

75-0974351

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:

Yes

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 500 %

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) . . .	1,346,816	708,710	638,106	0.990 %
b	Medicaid (from Worksheet 3, column a) . . . . .	10,522,953	8,316,813	2,206,140	3.430 %
c	Costs of other means-tested government programs (from Worksheet 3, column b) . .	92,127	29,847	62,280	0.100 %
d	Total Financial Assistance and Means-Tested Government Programs . . . . .	11,961,896	9,055,370	2,906,526	4.520 %
Other Benefits
e	Community health improvement services and community benefit operations (from Worksheet 4).	112,000		112,000	0.170 %
f	Health professions education (from Worksheet 5) . . .	300,000		300,000	0.470 %
g	Subsidized health services (from Worksheet 6) . . . .
h	Research (from Worksheet 7) .
i	Cash and in-kind contributions for community benefit (from Worksheet 8) . . . .	2,788,568		2,788,568	4.330 %
j	Total. Other Benefits . .	3,200,568		3,200,568	4.970 %
k	Total. Add lines 7d and 7j .	15,162,464	9,055,370	6,107,094	9.490 %

For Paperwork Reduction Act Notice, see the Instructions for Form 990. Cat. No. 50192T Schedule H (Form 990) 2015

Schedule H (Form 990) 2015

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. ......

37,791,757

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. ......

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).....

18,739,949

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

18,530,525

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

209,424

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) 2015

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?1 Name, 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)
1	HARRISON COUNTY HOSPITAL ASSOCIATION 811 SOUTH WASHINGTON AVE MARSHALL,TX75670 WWW.GSMCMARSHALL.ORG 000020	X	X	X

Schedule H (Form 990) 2015

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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)

	HARRISON COUNTY HOSPITAL ASSOCIATION
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

Information gaps that limit the hospital facility’s ability to assess the community’s health needs

Other (describe in Section C)

Indicate the tax year the hospital facility last conducted a CHNA: 20 15

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

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

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):

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 15

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) 2015

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Part VFacility Information (continued)

Financial Assistance Policy (FAP)

	HARRISON COUNTY HOSPITAL ASSOCIATION
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 100% and FPG family income limit for eligibility for discounted care of 500.%

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)

Included measures to publicize the policy 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)

Notice of availability of the FAP was conspicuously displayed throughout the hospital facility

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

Other (describe in Section C)

Billing and Collections

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 non-payment?..................................

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

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

Schedule H (Form 990) 2015

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Part VFacility Information (continued)

	HARRISON COUNTY HOSPITAL ASSOCIATION
Name of hospital facility or letter of facility reporting group

Yes

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

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):

Notified individuals of the financial assistance policy on admission

Notified individuals of the financial assistance policy prior to discharge

Notified individuals of the financial assistance policy in communications with the individuals regarding the individuals’ bills

Documented its determination of whether individuals were eligible for financial assistance under the hospital facility’s financial assistance policy

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)

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

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 its lowest negotiated commercial insurance rate when calculating the maximum amounts that
can be charged

The hospital facility used the average of its three lowest negotiated commercial insurance rates when calculating the maximum amounts that can be charged

The hospital facility used the Medicare rates when calculating the maximum amounts that can be charged

Other (describe in Section C)

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) 2015

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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, 16i, 18d, 19d, 20e, 21c, 21d, 22d, 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	REPRESENTATIVES FROM THE COMMUNITY: HARRISON COUNTY HOSPITAL ASSOCIATION (DBA, GOOD SHEPHERD MEDICAL CENTER - MARSHALL) RECEIVED INPUT FROM REPRESENTATIVES OF THE COMMUNITY WHICH INCLUDES THE FOLLOWING INDIVIDUALS WITH; A) SPECIALIZED KNOWLEDGE OR EXPERTISE IN PUBLIC HEALTH B) AFFILIATION WITH LOCAL GOVERNMENT, SCHOOL AND INDUSTRY C) INVOLVEMENT WITH UNDERSERVED AND MINORITY POPULATIONS. ALL INTERVIEWS WERE CONDUCTED USING A STANDARD QUESTIONAIRE DEVELOPED BY BKD, LLP, A NATIONAL CPA FIRM THAT PROVIDES TAX AND OTHER ADVISORY SERVICES. THE FOLLOWING INDIVIDUALS PARTICIPATED IN OUR KEY INFORMANT QUESTIONAIRE PROCESS: GOOD SHEPHERD MEDICAL CENTER, CLINICAL DIRECTOR OF EMERGENCY SERVICES - LONGVIEW GOOD SHEPHERD MEDICAL CENTER, CLINICAL DIRECTOR GOOD SHEPHERD MEDICAL ASSOCIATES, GASTROENTEROLOGIST GOOD SHEPHERD MEDICAL CENTER, PHARMACY DIRECTOR GOOD SHEPHERD MEDICAL CENTER, DIRECTOR OF REIMBURSEMENT GOOD SHEPHERD MEDICAL CENTER, CLINICAL DIRECTOR - MEDICAL/SURGICAL GOOD SHEPHERD HEALTH SYSTEM, DIRECTOR OF PATIENT ACCESS GOOD SHEPHERD HEALTH SYSTEM, DIRECTOR OF INFECTION CONTROL GOOD SHEPHERD HEALTH SYSTEM, CHIEF INFORMATION OFFICER GOOD SHEPHERD MEDICAL CENTER, DIRECTOR OF EMERGENCY SERVICES (KILGORE) GOOD SHEPHERD HEALTH SYSTEM, EDUCATIONAL SERVICES DIRECTOR GOOD SHEPHERD HEALTH SYSTEM, EMPLOYEE HEALTH DIRECTOR LONGVIEW CITY COUNCILMAN, DISTRICT 5 GOOD SHEPHERD MEDICAL ASSOCIATES, FAMILY NURSE PRACTITIONER GOOD SHEPHERD HEALTH SYSTEM, PHYSICIAN SERVICES DIRECTOR GOOD SHEPHERD MEDICAL CENTER, INTERNAL MEDICINE RESIDENCY PROGRAM DIRECTOR GREGG COUNTY HEALTH DEPARTMENT AIR LIFETEAM AIRE RESCUE GOOD SHEPHERD HEALTH SYSTEM, VICE PRESIDENT OF HUMAN RESOURCES COMMUNITY HEALTHCORE, EXECUTIVE DIRECTOR CITY OF LONGIVEW, FIRE CHIEF GOOD SHEPHERD MEDICAL CENTER, IMAGING SERVICES DIRECTOR GOOD SHEPHERD MEDICAL CENTER, LAB SUPERVISOR GOOD SHEPHERD HEALTH SYSTEM, DIRECTOR OF MARKETING COMMUNITY HEALTHCORE, EMPLOYEE RUSK COUNTY HEALTH DISTRICT GOOD SHEPHERD MEDICAL CENTER, PHYSICIAN DIRECTOR OF EMERGENCY SERVICES GOOD SHEPHERD MEDICAL CENTER, INPATIENT REHAB SERVICES DIRECTOR GOOD SHEPHERD MEDICAL ASSOCIATES, PHYSICIAN DIRECTOR - INTERNAL MEDICINE CLINIC GOOD SHEPHERD MEDICAL ASSOCIATES, NURSE PRACTITIONER LONGVIEW CITY COUNCIL WOMAN, DISTRICT 3 GOOD SHEPHERD MEDICAL CENTER, VICE PRESIDENT - ANCILLARY SERVICES (MARSHALL) GOOD SHEPHERD MEDICAL CENTER, CHIEF NURSING OFFICER (MARSHALL) LONGVIEW CHAMBER OF COMMERCE, CHIEF EXECUTIVE OFFICER MARSHALL/HARRISON COUNTY HEALTH DISTRICT, EMPLOYEE GOOD SHEPHERD MEDICAL ASSOCIATES, PHYSICIAN LONGVIEW CITY COUNCIL WOMAN, DISTRICT 4 GOOD SHEPHERD MEDICAL ASSOCIATES, EXECUTIVE VICE PRESIDENT/COO GOOD SHEPHERD MEDICAL CENTER, COMPLIANCE SPECIALIST - QUALITY GOOD SHEPHERD HEALTH SYSTEM, EXECUTIVE DIRECTOR - HEALTH & PREVENTION COMMUNITY HEALTHCORE, EMPLOYEE GOOD SHEPHERD MEDICAL CENTER, CHIEF NURSING OFFICER (LONGVIEW) GOOD SHEPHERD MEDICAL CENTER, MEDICAL DIRECTOR - SURGICAL SERVICES COMMUNITY HEALTHCORE, EMPLOYEE GOOD SHEPHERD HEALTH SYSTEM, PATIENT EXPERIENCE DIRECTOR GOOD SHEPHERD MEDICAL CENTER, CLINICAL DIRECTOR - ORTHO/NEURO UNIT GOOD SHEPHERD MEDICAL CENTER, CLINICAL DIRECTOR - ONCOLOGY UNIT GOOD SHEPHERD MEDICAL CENTER, CLINICAL DIRECTOR - ANTEPARTUM/MOTHER-BABY UNIT HARRISON COUNTY UNITED WAY GOOD SHEPHERD HEALTH SYSTEM, SENIOR VICE PRESIDENT - INTEGRATION & BUSINESS DEVELOPMENT CUMBERLAND PRESBYTERIAN CHURCH OF MARSHALL, REVEREND COMMUNITY HEALTHCORE, EMPLOYEE GOOD SHEPHERD MEDICAL ASSOCIATES, PEDIATRICIAN GOOD SHEPHERD MEDICAL ASSOCIATES, CLINIC DIRECTOR OF OPERATIONS (PRIMARY CARE) GOOD SHEPHERD MEDICAL ASSOCIATES, GASTROENTEROLOGIST GOOD SHEPHERD MEDICAL CENTER, DIRECTOR OF EMERGENCY SERVICES (NORTHPARK) GOOD SHEPHERD MEDICAL CENTER, EMERGENCY MEDICINE PHYSICIAN GOOD SHEPHERD MEDICAL ASSOCIATES, CLINIC DIRECTOR OF OPERATIONS (SPECIALTY CARE) GOOD SHEPHERD MEDICAL CENTER, CLINICAL DIRECTOR - LABOR & DELIVERY PINE TREE SCHOOL DISTRICT, SUPERINTENDENT GOOD SHEPHERD HEALTH SYSTEM, CHIEF FINANCIAL OFFICER GOOD SHEPHERD HEALTH SYSTEM, DIRECTOR - GOVERNMENT & COMMUNITY RELATIONS GOOD SHEPHERD MEDICAL CENTER, DIRECTOR OF EMERGENCY SERVICES (LONGVIEW) RUSK COUNTY UNITED WAY GOOD SHEPHERD MEDICAL ASSOCIATES, PEDIATRICIAN THE FOLLOWING COMMUNITY NEEDS WERE IDENTIFIED: 1) LACK OF MENTAL HEALTH PROVIDERS/SERVICES 2) OBESITY, DIABETES, HEART DISEASE AND OTHER CHRONIC DISEASES 3) AFFORDABLE PRIMARY AND PREVENTATIVE CARE OPTIONS 4) UNEMPLOYMENT AND DECREASE IN INCOME IN THE COMMUNITY DUE TO ECONOMIC DOWNTURN 5) HEALTHY BEHAVIORS/LIFESTYLE CHOICES 6) SUBSTANCE ABUSE 7) LACK OF HEALTH KNOWLEDGE/EDUCATION 8) LACK OF COMMUNITY RESOURCES TO PROMOTE HEALTH (FACILITIES, OUTDOOR SPACES) 9) POOR NUTRITION/LIMITED ACCESS TO HEALTHY FOOD OPTIONS 10) UNINSURED/LIMITED INSURANCE DUE TO LACK OF MEDICAID EXPANSION OR HIGH DEDUCTIBLE PLANS 11) ADULT SMOKING/TOBACCO USE 12) CRIME AND VIOLENCE
SCHEDULE H, PART V, SECTION B, LINE 22D	DETERMINATION OF AMOUNTS BILLED: THE FINANCIAL ASSISTANCE ELIGIBILITY DISCOUNT GUIDELINES IN PLACE DURING TAX YEAR 2015 STATED, "ALL UNINSURED PATIENTS WHO QUALIFY FOR LESS THAN 68% FINANCIAL ASSISTANCE AND COMPLETE THE NECESSARY APPLICATION PROCESS, WILL RECEIVE THE DISCOUNT UNDER THE UNINSURED ADJUSTMENT. THIS AMOUNT IS BASED ON AN AVERAGE OF GSHS MANAGED CARE CONTRACTS DEEPEST DISCOUNTS." (BEGINNING IN TAX YEAR 2016, THE HOSPITAL CHANGED TO USING MEDICARE RATES TO CALCULATE MAXIMUM AMOUNTS THAT CAN BE CHARGED.)
SCHEDULE H, PART V, SECTION B, LINE 11	IDENTIFIED NEEDS ADDRESSED AND NOT ADDRESSED: IN RESPONSE TO THE RESULTS OF THE 2016 CHNA, THE HOSPITAL'S BOARD OF DIRECTORS AND MANAGEMENT TEAM DEVELOPED A CHNA IMPLEMENTATION PLAN IN ORDER TO PRIORITIZE AND ADDRESS THE MAJOR COMMUNITY NEEDS. IN REGARDS TO THE #1 COMMUNITY NEED IDENTIFIED IN THE CHNA (LACK OF MENTAL HEALTH PROVIDERS/SERVICES), WE TOOK SEVERAL ACTIONS DURING THE TAX YEAR AND PLAN TO CONTINUE BUILDING UPON THESE STEPS IN THE FUTURE. THESE ACTIONS ARE PRIMARILY TO ADDRESS THE ONGOING ISSUE OF TREATING BEHAVIORAL HEALTH PATIENTS IN OUR EMERGENCY DEPARTMENT AND REFERRING THESE PATIENTS TO OTHER PSYCHIATRIC PROVIDERS. OUR GOAL IS TO BOTH IMPROVE CARE AND PROVIDE SERVICES IN A MORE APPROPRIATE TREATMENT SETTING. ACTIONS TAKEN TOWARDS ADDRESSING THE #1 NEED INCLUDED: - ENGAGED A TELE-PSYCHIATRY PROVIDER TO PROVIDE BEHAVIORAL HEALTH SCREENINGS AND EVALUATIONS. - PROVIDED SAMA DE-ESCALATION TRAINING TO HEALP PREVENT PSYCHIATRIC PATIENT AGGRESSION FROM BEING PHYSICALLY HARMFUL. - WORKED WITH COMMUNITY HEALTHCORE, THE REGIONAL MENTAL HEALTH AUTHORITY, TO IMPROVE PSYCHIATRIC PATIENT SCREENING AND DISPOSITION PROCESSES, INCLUDING USE OF TELEMEDICINE. - EVALUATING AND PLANNING FOR REMODELING THE EMERGENCY DEPARTMENT TO INCLUDE PATIENT CARE DESIGNED SPECIFICALLY FOR PSYCHIATRIC PATIENTS. THE AFOREMENTIONED ACTIONS WILL ALSO ADDRESS COMMUNITY NEED #6 (SUBSTANCE ABUSE) AND INDIRECTLY CONTRIBUTE TO A REDUCTION IN NEED #12 (CRIME AND VIOLENCE) DUE TO HIGH CRIME AND VIOLENCE RECIDIVISM OF UNTREATED PSYCHIATRIC AND SUBSTANCE ABUSE PATIENTS. IN REGARDS TO THE REMAINING COMMUNITY NEEDS, THE HOSPITAL WILL CONTINUE TO OFFER A WIDE RANGE OF SERVICES, PROGRAMS, EDUCATION AND TRAINING TO ADDRESS NEED #'S 2,5,7, AND 11. ISSUE #8 IS PARTIALLY ADDRESSED THROUGH THE HOSPITAL FITNESS CENTER FACILITIES AND PROGRAMS. NEED #'S 3 AND 10 ARE ADDRESSED BY SPECIAL IN-HOUSE PROGRAMS TO ASSIST THE UNINSURED, INCLUDING PAYMENT DISCOUNT PROGRAMS, CERTIFIED APPLICATION COUNSELORS TO ASSIST PATIENTS WITH ACCESS TO THE FEDERAL HEALTH INSURANCE MARKETPLACE, CHARITY POLICIES AND REFERRALS TO LOCAL FEDERALLY QUALIFIED HEALTH CENTERS (FQHCS). MORE DETAILS REGARDING OUR CHNA IMPLEMENATION STRATEGY MAY BE FOUND AT WWW.GSMC.ORG/MARSHALL/ABOUT-US/COMMUNITY-HEALTH-NEEDS-ASSESSMENT. COMMUNITY NEEDS NOT ADDRESSED: AREAS OF NEED NOT SPECIFICALLY ADDRESSED BY THE HOSPITAL INCLUDE NEED #4 (UNEMPLOYMENT AND DECREASE IN INCOME DUE TO ECONOMIC DOWNTURN), #9 (POOR NUTRITION/LIMITED ACCESS TO HEALTHY FOODS) AND DIRECT ACTION TO MEET #12 (CRIME AND VIOLENCE). WHILE MEMBERS OF HOSPITAL MANAGEMENT PARTICIPATE IN LOCAL GROUPS AND COMMITTEES FORMED TO PROMOTE ECONOMIC GROWTH AND JOBS, THE HOSPITAL DOES NOT CHOOSE TO DIRECTLY ADDRESS ECONOMIC MATTERS OF THE COMMUNITY DUE TO OUR FINANCIAL LIMITATIONS. ALSO, WHILE THE HOSPITAL PROVIDES SOME EDUCATION TO PATIENTS REGARDING PROPER DIET, WE DO NOT HAVE THE RESOURCES OR ABILITY TO ENSURE THAT IMPOVERISHED POPULATIONS ENJOY NUTRITIONAL AND VARIED FOOD OPTIONS DELIVERED TO FOOD DESERTS. FINALLY, IT IS NOT CONSIDERED A HOSPITAL ROLE TO CONFRONT RISING CRIME AND VIOLENCE THROUGH DIRECT ENFORCEMENT ACTIONS.
SCHEDULE H, PART V, SECTION B, LINES 7 & 10A	CHNA & IMPLEMENTATION STRATEGY: THE HOSPITAL'S COMMUNITY HEALTH NEEDS ASSESSMENT AND IMPLEMENTATION STRATEGY ARE AVAILABLE UPON REQUEST AND AT THE FOLLOWING WEBSITE: WWW.GSMC.ORG/MARSHALL/ABOUT-US/COMMUNITY-HEALTH-NEEDS-ASSESSMENT
SCHEDULE H, PART V, SECTION B, LINE 16A, 16B & 16C	FAP DOCUMENTS AVAILABLE TO THE PUBLIC: THE FINANCIAL ASSISTANCE POLICY, APPLICATION AND PLAIN LANGUAGE SUMMARY ARE AVAILABLE UPON REQUEST AND AT THE FOLLOWING WEBSITE: www.gsmc.org/patients-visitors/financial-assistance-2

Schedule H (Form 990) 2015

Page 8

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?4
Name and address		Type of Facility (describe)
1	MARSHALL HEALTH CINIC 805 LINDSEY DRIVE MARSHALL,TX75670	HEALTH CLINIC
2	EAST TEXAS PEDIATRICS 618 S GROVE STREET STE 100 MARSHALL,TX75670	HEALTH CLINIC
3	MARSHALL PEDIATRIC CLINIC 707 S GROVE STREET MARSHALL,TX75670	HEALTH CLINIC
4	FIRST IN PEDIATRICS 304 UNIVERSITY SUITE 105 MARSHALL,TX75670	HEALTH CLINIC
5
6
7
8
9
10

Schedule H (Form 990) 2015

Page 9

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, LINES 7A & 7B	ALLOCATION OF MEDICAID SUPPLEMENTAL PAYMENTS: DURING THE CURRENT REPORTING PERIOD, THE STATE OF TEXAS PARTICIPATED IN A SPECIAL 1115 MEDICAID WAIVER WITH THE CENTERS FOR MEDICARE AND MEDICAID SERVICES (CMS). VARIOUS SUPPLEMENTAL PAYMENTS UNDER THE WAIVER ARE INTENDED TO HELP HOSPITALS OFFSET MEDICAID AND UNINSURED LOSSES AND/OR CREATE NEW PROGRAMS DESIGNED TO IMPROVE THE PATIENT CARE EXPERIENCE, ENHANCE HEALTH OUTCOMES AND REDUCE COSTS FOR THESE SAME PATIENT POPULATIONS. SUPPLEMENTAL PAYMENTS ARE CAPPED BY MEDICAID AND UNINSURED LOSSES DETERMINED FROM A SPECIAL UNCOMPENSATED CARE (UC) TOOL DESIGNED BY THE TEXAS HEALTH AND HUMAN SERVICES COMMISSION (HHSC). IN FISCAL YEAR 2016, THE HOSPITAL RECOGNIZED $6,374,714 OF SUPPLEMENTAL PAYMENT INCOME UNDER THE MEDICAID WAIVER. FOR PURPOSES OF IRS FORM 990 SCHEDULE H REPORTING, MEDICAID SUPPLEMENTAL PAYMENTS AND TAX ASSESSMENTS HAVE BEEN ALLOCATED BETWEEN FINACIAL ASSISTANCE (CHARITY), MEDICAID AND BAD DEBT USING RATIOS DERIVED FROM THE UC TOOL AND OTHER INTERNAL DOCUMENTS USED FOR PURPOSES OF PREPARING MEDICARE COST REPORT WORKSHEET S-10 "HOSPITAL UNCOMPENSATED AND INDIGENT CARE DATA". MORE INFORMATION ON THE MEDICAID WAIVER MAY BE FOUND AT HTTP://WWW.HHSC.STATE.TX.US/1115WAIVER-SHTML.
SCHEDULE H, PART III, LINE 2 & 3	BAD DEBT EXPENSE: THE BAD DEBT EXPENSE INCLUDED ON FORM 990, PART IX, LINE 24(A) OF $41,145,508 HAS BEEN REDUCED BY ALLOCATED MEDICAID SUPPLEMENTAL PAYMENTS OF $3,353,751. WE DID NOT INCLUDE ANY BAD DEBT AMOUNTS IN COMMUNITY BENEFITS.
SCHEDULE H, PART III, LINE 4	BAD DEBT FOOTNOTE: THE INFORMATION IS PROVIDED IN THE ATTACHED AUDITED FINANCIAL STATEMENT ON PAGES 10 AND 11 TITLED "PATIENT ACCOUNTS RECEIVABLE".
SCHEDULE H, PART III, LINE 8	COSTING METHODOLOGY: SOURCE OF INFORMATION ON LINE 6 IS THE FYE 09/30/16 MEDICARE COST REPORT. THE SUM OF MEDICARE PART A ALLOWABLE COSTS REPORTED ON WORKSHEET D-1 PART II (FOR BOTH INPATIENT ACUTE PPS AND INPATIENT REHAB FACILITY) AND WORKSHEET DV, COLUMN 9.01 FOR MEDICARE OUTPATIENT PPS SERVICES. SINCE ALLOWABLE COSTS ARE NOT DETERMINED FOR SERVICES RENDERED TO MEDICARE PATIENTS ENROLLED IN MEDICARE ADVANTAGE (MEDICARE PART C) OR FOR PHYSICIAN SERVICES BILLED UNDER MEDICARE PART B, NEITHER THE REVENUES OR COSTS RELATED TO THESE SERVICES HAVE BEEN INCLUDED ON LINES 5 OR 6. MEDICARE ALLOWABLE COSTS WERE DERIVED FROM THE FYE 09/30/16 MEDICARE COST REPORT. THE COST REPORT USES FINANCIAL AND STATISTICAL DATA TO DEVELOP PER DIEMS AND COST TO CHARGE RATIOS THAT ULTIMATELY DETERMINE ALLOWABLE MEDICARE INPATIENT AND OUTPATIENT COSTS.
SCHEDULE H, PART III, LINE 9B	PROVISIONS ON COLLECTION PRACTICES: ALL PATIENTS WHO ARE UNDERINSURED OR UNINSURED WILL BE EVALUATED FOR GOVERNMENT PROGRAMS, PAYMENT PLANS AND FINANCIAL ASSISTANCE. IF ALL ATTEMPTS FAIL, WE WILL CONSIDER EACH ACCOUNT MEETING CERTAIN CRITERIA FOR FINANCIAL ASSISTANCE. ANY ACCOUNT THAT HAS A BALANCE GREATER THAN $10,000 AND HAS NOT QUALIFIED FOR MEDICAID OR COUNTY CHARITY PROGRAMS WILL BE REVIEWED ON A CASE BY CASE BASIS FOR CHARITY CONSIDERATION. CREDIT REPORTS MAY BE RUN AND SUBMITTED FOR REVIEW. WRITE OFFS WILL BE MONITORED THROUGH A SPECIFIC CODE, TO MONITOR AND EVALUATE, AS NEEDED, FOR CHANGES OR UPDATES. IF AT ANYTIME RECOVERIES OBTAINED AFTER WRITE-OFF, THE CHARITY ADJUSTMENT WILL BE REVERSED AND ADDITIONAL REVIEW OF THE ACCOUNT WILL BE REQUIRED. GOOD SHEPHERD MEDICAL CENTER - MARSHALL DOES NOT CONDUCT, OR PERMIT COLLECTION AGENCIES TO CONDUCT ON ITS BEHALF, EXTRAORDINARY COLLECTION ACTIONS, AGAINST INDIVIDUALS BEFORE REASONABLE EFFORTS HAVE BEEN MADE TO DETERMINE WHETHER THE PATIENT IS ELIGIBLE FOR THE FINANCIAL ASSISTANCE PROGRAM. IF AT ANY TIME IT IS DETERMINED THAT AN INDIVIDUAL IS ELIGIBLE FOR FINANCIAL ASSISTANCE, ALL COLLECTION ATTEMPTS ARE STOPPED.
SCHEDULE H, PART VI, LINE 2	NEEDS ASSESSMENT: THE BOARD OF DIRECTORS IS A NON-PAID COMMUNITY BASED BOARD WHO REPRESENT A BROAD SPECTRUM OF OUR COMMUNITY. THEY GUIDE THE DIRECTION OF THE ORGANIZATION BASED ON THE INFORMATION THEY RECEIVE FROM THEIR CONSTITUENTS, THE PROGRAM CAPABILITIES OF THE ORGANIZATION, AVAILABILITY OF PHYSICIANS AND THE PERFORMANCE OUTCOMES OF THE ORGANIZATION. IN ADDITION, THE HOSPITAL EXECUTIVES AND MID-LEVEL MANAGERS LIVE AND WORK IN THIS COMMUNITY, SURROUNDING COMMUNITIES AND ALL THREE COUNTIES WHICH WE SERVE, AS WELL AS PARTICIPATE IN COMMUNITY EDUCATION AT ALL LEVELS. GOOD SHEPHERD MEDICAL CENTER - MARSHALL EXECUTIVES AND MID-LEVEL MANAGERS LIVE AND WORK IN THIS COMMUNITY, SURROUNDING COMMUNITIES AND ALL THREE COUNTIES WHICH WE SERVE, AS WELL AS, PARTICIPATE IN COMMUNITY ORGANIZATIONS. GOOD SHEPHERD MEDICAL CENTER - MARSHALL HAS A GROUP OF OVER 1,100 SENIORS WHO ARE A PART OF OUR EXTRA STEPS PROGRAM WHICH PROVIDE US FEEDBACK AT MONTHLY MEETINGS ATTENDED BY OVER 500 SENIORS. IN ADDITION, GOOD SHEPHERD MEDICAL CENTER - MARSHALL HAS A FITNESS/WELLNESS CENTER THAT SERVES 2,300 MEMBERS OF ALL AGES. THE CENTER HAS A SUGGESTION BOX FOR IDEAS REGARDING IMPROVEMENTS AND PROGRAMS. IN ADDITION, LOCAL AND INDIVIDUAL MEETINGS ARE HELD WITH LOCAL BUSINESSES WITH AN OPEN FORUM/FOCUS GROUP THAT SHARES INFORMATION REGARDING IMPROVEMENTS AND PROGRAMS THEY WOULD LIKE THE ORGANIZATION TO OFFER FOR PURPOSES OF MEETING THEIR EMPLOYEE'S HEALTH NEEDS. THE CEO ALSO PARTICPATES IN A TASK FORCE TO ENCOURAGE GROWTH AND DEVELOPMENT OF OUR COMMUNITY.
SCHEDULE H, PART VI, LINE 3	PATIENT EDUCATION OF ELIGIBILITY FOR ASSISTANCE: AS PATIENTS ENTER OUR FACILITY, SIGNAGE IS POSTED IN DESIGNATED AREAS WHICH STATE OUR POLICY TO PROVIDE CHARITY CARE TO THOSE PATIENTS WHO MEET ELIGIBILITY REQUIREMENTS. BUSINESS OFFICE AND REGISTRATION STAFF DISCUSS PAYMENT OPTIONS AND FINANCIAL ASSITANCE AVAILABLE TO PATIENTS USING VERBAL AND WRITTEN COMMUNICATION. PATIENTS ARE CONTACTED PRIOR TO SERVICES WITH AN ESTIMATED COST AND OUT OF POCKET EXPENSES. CASH PRICES AND PAYMENT OPTIONS ARE DISCUSSED AND A FINANCIAL ASSISTANCE SCREENING IS AVAILABLE UPON REQUEST. GOOD SHEPHERD MEDICAL CENTER EVALUATES PATIENT APPLICATIONS AND UTILIZES A SLIDING SCALE TO QUALIFY PATIENTS BASED ON GOVERNMENT POVERTY GUIDELINES. ADDITIONALLY, OUR ELIGIBILITY VENDOR SCREENS FOR GOVERNMENT AGENCY PROGRAMS AND OFFERS FINANCIAL ASSISTANCE APPLICATIONS TO THOSE WHO DO NOT QUALIFY FOR GOVERNMENT PROGRAMS. BUSINESS OFFICE AND REGISTRATION PERSONNEL ARE AVAILABLE TO ANSWER ANY FINANCIAL QUESTIONS AND ASSIST THE PUBLIC WITH THEIR FINANCIAL OBLIGATIONS.
SCHEDULE H, PART VI, LINE 4	COMMUNITY INFORMATION: GOOD SHEPHERD MEDICAL CENTER - MARSHALL IS LOCATED IN THE PINEY WOODS OF EAST TEXAS AND SERVICES A RURAL COMMUNITY WHICH INCLUDES HARRISON, NORTHERN PANALO AND SOUTHERN MARION COUNTIES. THE POPULATION IN EACH OF THESE COUNTIES IS DIVERSE IN INCOME AND ETHNICITY. HARRISON COUNTY, ESTABLISHED IN 1839, IS LOCATED IN NORTHEASTERN TEXAS ALONG THE LOUISIANA BORDER AND COMPRISES 984 SQUARE MILES. MARSHALL, THE COUNTY SEAT, 152 MILES EAST OF DALLAS AND 39 MILES WEST OF SHREVEPORT. ACCORDING TO THE 2016 CENSUS ESTIMATES, 18.5% OF HARRISON COUNTY POPULATION LIVES IN POVERTY. 15.9% OF HARRISON COUNTY RESIDENTS ARE AGE 65 OR OLDER. THE CENSUS BUREAU REPORTS THAT ONLY 19.1% OF ADULTS HOLD A COLLEGE DEGREE OR HIGHER LEVEL OF EDUCATION. EDUCATION LEVEL IMPACTS THE TYPES OF AVAILABLE JOBS AND BENEFIT LEVELS, INCLUDING HEALTHCARE COVERAGE. IN OTHER SERVICE LOCATIONS, MARION COUNTY HAS A MEDIAN ANNUAL INCOME OF $34,175 AND 23.4% OF ITS RESIDENTS LIVE IN POVERTY. PANOLA COUNTY HAS A MEDIAN ANNUAL HOUSEHOLD INCOME OF $50,119 AND 15.1% OF ITS RESIDENTS LIVE IN POVERTY. UNEMPLOYMENT IN HARRISON, PANOLA AND MARION COUNTIES IS CURRENTLY BETWEEN 6.1% TO 7.4%. IT IS CLEAR THAT WITHIN THE AREA SERVED THERE ARE MANY OBSTACLES TO OVERCOME REGARDING HEALTH CARE COVERAGE. MANY FIND IT DIFFICULT TO AFFORD THE COST OF HEALTHCARE BOTH IN BASIC PREVENTION AND IN TREATMENT OF EXISTING CONDITIONS. (SOURCE: U.S. CENSUS BUREAU)
SCHEDULE H, PART VI, LINE 5	PROMOTION OF COMMUNITY HEALTH: THE COMMUNITY BUILDING ACTIVITIES INCLUDE OUR WELLNESS CENTER AND THE PROGRAMS WE OFFER IN AN ATTEMPT TO KEEP OUR COMMUNITY HEALTHY. THE WELLNESS CENTER IS THE HUB OF OUR PROGRAM OFFERING FITNESS AND WELLNESS PROGRAMS FOR INDIVIDUALS, FAMILIES AND BUSINESSES IN OUR COMMUNITY, INCLUDING HOSPITAL EMPLOYEES AND THEIR FAMILIES. WE ALSO OFFER A VARIETY OF WATER AEROBICS, ADULT AEROBIC CLASSES, SENIOR EXERCISE CLASSES, SPECIALTY CLASSES SUCH AS ZUMBA, CARDIAC REHAB, ETC. WE ALSO OFFER ACUTE, CHRONIC AND PREVENTATIVE EDUCATIONAL PROGRAMS TO OUR COMMUNITY. WE ARE INVOLVED IN THE SCHOOLS WITH PRENATAL CLASSES FOR PREGNANT TEENS AND ALSO WORK WITH THE SCHOOLS ON OBESITY PROGRAMS. IN ADDITION, WE PROVIDE COMMUNITY EDUCATIONAL SERVICES AND PROGRAMS, SUCH AS CPR, CERTIFIED DIABETIC EDUCATION PROGRAMS, WOUND CARE EDUCATION AND PREVENTION, SEATBELT AWARENESS, HARD HATS FOR LITTLE HEADS BICYCLE RODEO AND SHOPPING CLASSES FOR PERSONS TRYING TO MODIFY DIET FOR CARDIAC REASONS OR WEIGHT LOSS. FURTHERMORE, WE OFFER HEALTH FAIRS THAT PROVIDE BASIC SCREENING EXAMS AT NO COST TO OUR COMMUNITY. OUR CASE MANAGEMENT AND SOCIAL SERVICES PROGRAM OFFERS THE AVAILABILITY OF EXTERNAL SOURCES AND PROGRAMS TO ASSIST PATIENTS AND THEIR FAMILIES, SUCH AS WIC AND OTHER GOVERNMENT AND PRIVATE PROGRAMS.
SCHEDULE H, PART VI, LINE 6	AFFILIATED HEALTH CARE SYSTEM: THE HOSPITAL IS PART OF GOOD SHEPHERD HEALTH SYSTEM WHICH ALLOWS US TO BETTER REACH OUT AND SERVE OUR CATCHMENT AREA.
SCHEDULE H, PART VI, LINE 7	STATE FILING OF COMMUNITY BENEFIT REPORT: TEXAS SCHEDULE H, PART I, LINE 3B PROCESS FOR DETERMINING ELIGIBILITY FOR DISCOUNTED CARE: POLICY IN TAX YEAR 2015 ALLOWED FOR FINANCIAL ASSISTANCE FOR PERSONS UP TO 500% OF FEDERAL POVERTY GUIDELINES (FPG). BEGINNING IN TAX YEAR 2016, THE QUALIFICATION THRESHOLD WAS LOWERED TO 400% OF FPG.
SCHEDULE H, PART I, LINE 3C	FACTORS TO DETERMINE FREE OR DISCOUNTED CARE: TO QUALIFY UNDER THE FINANCIAL ASSISTANCE POLICY THE FOLLOWING MUST BE MET: (1) A RATIO IS DEVELOPED BY DIVIDING THE PATIENT'S INCOME BY THE FEDERAL POVERTY GUIDELINES. (2) THIS RATIO IS MATCHED TO THE FOLLOWING CHART TO DETERMINE AMOUNT ELIGIBLE FOR FINANCIAL ASSISTANCE. RATIO ASSISTANCE 0% - 100% 100% 101% - 200% 80% 201% - 300% 60% 301% - 400% 40% 401% - 500% 20% 501% - 1000% 0% FACTORS OTHER THAN FPG DETERMINING FREE OR DISCOUNTED CARE: THE HOSPITAL USES THE FOLLOWING CRITERIA TO DETERMINE ELIGIBILITY FOR FREE OR DISCOUNTED CARE: - ASSET LEVEL - MEDICAL INDIGENCY - INSURANCE STATUS - UNDERINSURANCE STATUS
SCHEDULE H, PART I, LINE 7, COL(F)	BAD DEBT EXPENSE: BAD DEBT EXPENSE IN THE AMOUNT OF $41,145,508, WAS NOT INCLUDED IN TOTAL EXPENSE USED TO COMPUTE THE PERCENTAGE REPORTED IN PART I, LINE 7, COL(F).

Schedule H (Form 990) 2015

Additional Data

Software ID:
Software Version:

- TIN:

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

Information about Schedule I (Form 990) and its instructions is at www.irs.gov/form990.

OMB No. 1545-0047

2015

Open to Public
Inspection

Name of the organization
Harrison County Hospital Association

Employer identification number
75-0974351

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	(e) Amount of non-cash assistance	(f) Method of valuation (book, FMV, appraisal, other)	(g) Description of non-cash assistance	(h) Purpose of grant or assistance

(1) SERVICE ORGANIZATION OF GOOD SHEPHERD
2950 50TH STREET
LUBBOCK,TX79413

38-3914883

501(C)(3)

2,788,568

HEALTHCARE SERVICES

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) 2015

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 non-cash assistance	(e) Method of valuation (book, FMV, appraisal, other)	(f) Description of non-cash assistance

(1)
(2)
(3)
(4)
(5)
(6)
(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	AFTER A NEED IS DETERMINED FOR ASSISTANCE, A REQUEST FROM THE SERVICE ORGANIZATION OF GOOD SHEPHERD IS SUBMITTED, IDENTIFYING THE FUNDS NEEDED FOR THE PROGRAM AND/OR PATIENT. THE REQUEST IS REVIEWED AND APPROVED BY THE CFO BEFORE FUNDS ARE TRANSFERRED. A SERVICE LOG IS SUBMITTED TO THE CFO TO DOCUMENT HOURS INCURRED ON PROJECTS AND SUPPORT USE OF FUNDS.

Schedule I (Form 990) 2015

Additional Data

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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

Information about Schedule J (Form 990) and its instructions is at www.irs.gov/form990.

OMB No. 1545-0047

2015

Open to Public Inspection

Name of the organization

Harrison County Hospital Association

Employer identification number

75-0974351

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 .........

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? ..

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?

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 non-fixed
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) 2015

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)
1RUSSELL J COLLIERPRESIDENT/CEO	(i) (ii)	0 ------------- 315,969	0 ------------- 0	0 ------------- 0	0 ------------- 34,484	0 ------------- 13,694	0 ------------- 364,147	-------------
2STEVE ALTMILLERGSHS PRESIDENT/CEO	(i) (ii)	0 ------------- 650,200	0 ------------- 0	0 ------------- 0	0 ------------- 75,600	0 ------------- 11,957	0 ------------- 737,757	-------------
3LUIS BALBUENA MDMEDICAL STAFF REP TO BOARD	(i) (ii)	0 ------------- 429,959	0 ------------- 14,748	0 ------------- 0	0 ------------- 10,600	0 ------------- 14,132	0 ------------- 469,439	-------------
4TIM PILEGGIINTERIM CFO	(i) (ii)	0 ------------- 583,683	0 ------------- 0	0 ------------- 0	0 ------------- 0	0 ------------- 0	0 ------------- 583,683	-------------
5THOMAS SMOLENSKIPHYSICIAN	(i) (ii)	165,163 ------------- 0	2,500 ------------- 0	0 ------------- 0	0 ------------- 0	3,679 ------------- 0	171,342 ------------- 0	-------------
6JOYCE EGLICHARGE NURSE	(i) (ii)	166,607 ------------- 0	0 ------------- 0	0 ------------- 0	6,715 ------------- 0	5,672 ------------- 0	178,994 ------------- 0	-------------
7KEITH KIRBOWCHIEF NURSING OFFICER	(i) (ii)	148,760 ------------- 0	0 ------------- 0	0 ------------- 0	13,377 ------------- 0	17,920 ------------- 0	180,057 ------------- 0	-------------
8RICKY PAULFORMER PRES OF MEDICAL STAFF	(i) (ii)	0 ------------- 556,806	0 ------------- 0	0 ------------- 0	0 ------------- 10,600	0 ------------- 18,266	0 ------------- 585,672	-------------
9JOHN MCDONALD DOFORMER MEDICAL STAFF	(i) (ii)	0 ------------- 205,162	0 ------------- 12,132	0 ------------- 0	0 ------------- 8,825	0 ------------- 5,092	0 ------------- 231,211	-------------
10VALARIE ALLMAN MDFORMER VP MEDICAL STAFF	(i) (ii)	0 ------------- 303,082	0 ------------- 333	0 ------------- 0	0 ------------- 10,600	0 ------------- 11,854	0 ------------- 325,869	-------------
11RAY DELKFORMER VP OPERATIONS	(i) (ii)	0 ------------- 231,767	0 ------------- 0	0 ------------- 0	0 ------------- 23,735	0 ------------- 13,554	0 ------------- 269,056	-------------

Schedule J (Form 990) 2015

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 4B	SUPPLEMENTAL NONQUALIFIED RETIREMENT PLAN: THE FOLLOWING INDIVIDUALS PARTICIPATED IN A SUPPLEMENTAL NONQUALIFIED RETIREMENT PLAN DESCRIBED IN 457(F): INDIVIDUALS: PAYMENT IN W-2: DEFERRED COMPENSATION: STEVE ALTMILLER NONE $ 65,000 RUSSELL J COLLIER NONE $ 23,884 KEITH KIRBOW NONE $ 7,285 RAY DELK NONE $ 14,375

Schedule J (Form 990) 2015

Additional Data

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- TIN:

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 IV, line 24a. Provide descriptions,
explanations, and any additional information in Part VI.
SchKMediumBullet

Attach to Form 990.
SchKMediumBullet

Information about Schedule K (Form 990) and its instructions is at www.irs.gov/form990.

OMB No. 1545-0047

2015

Open to Public
Inspection

Name of the organization
Harrison County Hospital Association

Employer identification number
75-0974351

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	HARRISON COUNTY HEALTH FACILITIES DEVELOPMENT	75-2740093	415221AW0	09-22-2010	43,980,049	REFUND ESCROWS, CAPITAL PROJECTS		X		X		X

Part II

Proceeds

	A		B		C		D
	1 Amount of bonds retired ..................	2,005,000
2 Amount of bonds legally defeased ..............	0
3 Total proceeds of issue ..................	43,980,049
4 Gross proceeds in reserve funds .............	3,077,293
5 Capitalized interest from proceeds .............	0
6 Proceeds in refunding escrows ...............	31,331,629
7 Issuance costs from proceeds ...............	879,600
8 Credit enhancement from proceeds .............	0
9 Working capital expenditures from proceeds .............	0
10 Capital expenditures from proceeds .............	8,691,527
11 Other spent proceeds .............	0
12 Other unspent proceeds .............	0
13 Year of substantial completion .............	2013
	Yes	No	Yes	No	Yes	No	Yes	No
14 Were the bonds issued as part of a current refunding issue? ....	X
15 Were the bonds issued as part of an advance refunding issue? .....		X
16 Has the final allocation of proceeds been made? ..........		X
17 Does the organization maintain adequate books and records to support the final allocation of proceeds? ..................	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
2 Are there any lease arrangements that may result in private business use of bond-financed property? ...............		X

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

Cat. No. 50193E

Schedule K (Form 990) 2015

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
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
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 %
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 .............
7 Does the bond issue meet the private security or payment test? ...		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
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
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

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
2 If "No" to line 1, did the following apply? ....
a Rebate not due yet? .......		X
b Exception to rebate? ........		X
c No rebate due? .........	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
4a Has the organization or the governmental issuer entered into a qualified hedge with respect to the bond issue?		X
b Name of provider ..........	0
c Term of hedge .........
d Was the hedge superintegrated? ......
e Was the hedge terminated? ........

Schedule K (Form 990) 2015

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
b Name of provider ..........	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
7 Has the organization established written procedures to monitor the requirements of section 148? ...		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

Part VI

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

Return Reference	Explanation
SCHEDULE K, PART I, BOND ISSUES:	(A) THE ISSUER NAME: HARRISON COUNTY HEALTH FACILITIES DEVELOPMENT CORPORATION (F) DESCRIPTION OF PURPOSE: REFUND ESCROWS, CAPITAL PROJECTS AND IMPROVEMENTS
SCHEDULE K, PART IV, ARBITRAGE, LINE 2C:	(A) ISSUER NAME: HARRISON COUNTY HEALTH FACILITIES DEVELOPMENT CORPORATION DATE THE REBATE COMPUTATION WAS PERFORMED: 08/01/2015

Schedule K (Form 990) 2015

Additional Data

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Software Version:

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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

Information about Schedule O (Form 990 or 990-EZ) and its instructions is at
www.irs.gov/form990.

OMB No. 1545-0047

2015

Open to Public
Inspection

Name of the organization

Harrison County Hospital Association

Employer identification number

75-0974351

Return Reference	Explanation
FORM 990, PART VI, SECTION A, LINE 1A	DELEGATION OF AUTHORITY: THE EXECUTIVE COMMITTEE SHALL HAVE THE AUTHORITY OF THE BOARD TO TRANSACT ALL REGULAR BUSINESS BETWEEN MEETINGS OF THE BOARD.
FORM 990, PART VI, SECTION A, LINE 6	MEMBERS OF THE ORGANIZATION: GSHS, INC. IS THE SOLE MEMBER.
FORM 990, PART VI, SECTION A, LINE 7A	ELECTION OF MEMBERS AND THE BOARD OF DIRECTORS: AS THE SOLE MEMBER, GSHS, INC. HAS THE POWER TO APPOINT ONE MEMBER TO THE CORPORATION'S BOARD OF DIRECTORS AND THE POWER TO APPROVE THE REMAINING DIRECTORS NOMINATED TO THE BOARD.
FORM 990, PART VI, SECTION A, LINE 7B	GOVERNING DECISIONS OF THE ORGANIZATION: A NUMBER OF DECISIONS OF THE ORGANIZATION ARE SUBJECT TO APPROVAL OF THE MEMBER OF THE ORGANIZATION. THESE RESERVED POWERS ARE STATED BELOW: A) THE APPOINTMENT OF ONE MEMBER OF THE ORGANIZATION'S BOARD OF DIRECTORS, AND THE APPROVAL OF THE REMAINING DIRECTORS FOLLOWING THE NOMINATION PROCESS AND SUBJECT TO THE PROVISIONS GOVERNING STAFF DIRECTORS; B) THE REMOVAL OF A MEMBER OF THE ORGANIZATION'S BOARD AND ALSO THE APPROVAL OF REMOVAL AND APPOINTMENTS TO FILL VACANCIES ON THE BOARD AND SET THE SIZE OF THE BOARD; C) APPROVE ELECTION AND REMOVAL OF OFFICERS OF THE ORGANIZATION AND ESTABLISH, TERMINATE, AND/OR REVISE ALL EMPLOYMENT CONTRACTS, COMPENSATION, AND BENEFIT PACKAGES OF THE OFFICERS OF THE ORGANIZATION REGARDLESS OF WHICH ENTITY ACTUALLY PAYS SUCH COMPENSATION OR BENEFITS; D) DESIGNATE THE FISCAL YEAR; E) APPROVE THE SELECTION AND REMOVAL OF INDEPENDENT AUDITORS, OUTSIDE GENERAL LEGAL COUNSEL, AND OUTSIDE INVESTMENT ADVISORS; F) AMEND THE ARTICLES OF INCORPORATION; G) APPROVE ALL MERGERS, ACQUISITIONS, CONSOLIDATIONS, OR AFFILIATIONS WITH OTHER ENTITIES, THE SALE OF ALL OR SUBSTANTIALLY ALL OF THE ASSETS OF THE ORGANIZATION, OR THE SALE, MORTGAGE, OR ENCUMBRANCE OF ANY PROPERTY OWNED BY THE ORGANIZATION; H) APPROVE THE DISSOLUTION OR LIQUIDATION OF THE ORGANIZATION; I) APPROVE CAPITAL PLANS, STRATEGIC PLANS, AND ANNUAL OPERATING AND CAPITAL BUDGETS; J) APPROVE ANY EXCEPTION TO THE CAPITAL BUDGET FOR A SINGLE ITEM OR RELATED ITEM THAT EXCEEDS $100,000 AND/OR APPROVE ANY AGGREGATE ANNUAL EXPENDITURES THAT EXCEED THE BUDGET BY $50,000; K) SELECT OFFICIAL DEPOSITORIES FOR THE ORGANIZATION'S FUNDS; L) CREATE OR INVEST IN ANY SUBSIDIARY ENTITY OR ENTER INTO ANY PARTNERSHIP OR JOINT VENTURE; M) AUTHORIZE ANY LOANS, GUARANTEES, OR INCURRENCE OF DEBT; N) AUTHORIZE THE COMMENCEMENT OF ANY LITIGATION OR OTHER LEGAL PROCEEDING, OR THE SETTLEMENT, DISPOSITION, OR TERMINATION OF ANY SUCH LITIGATION OR OTHER LEGAL PROCEEDING OR OF ANY CLAIM OR THREAT OF LITIGATION OR OTHER LEGAL PROCEEDING NOT FULLY COVERED BY INSURANCE; AND O) APPROVE THE ADMISSION OF ADDITIONAL MEMBERS OF THE ORGANIZATION.
FORM 990, PART VI, SECTION B, LINE 11B	PROCESS OF REVIEWING FORM 990: THE ORGANIZATION HAS AN EXTERNAL ACCOUNTING FIRM AUDIT ON A CONSOLIDATED BASIS. THE 990 IS PREPARED BY AN EXTERNAL ACCOUNTING FIRM. THE RETURN IS THEN REVIEWED BY INTERNAL ACCOUNTANTS AND EXECUTIVES PRIOR TO FILING.
FORM 990, PART VI, SECTION B, LINE 12C	MONITOR AND ENFORCE COMPLIANCE WITH CONFLICT OF INTEREST POLICY: DISCLOSURES ARE OBTAINED ANNUALLY. THE BOARD REVIEWS AND APPROVES THE BOARD MEMBERS' DISCLOSURES, AND THE CEO REVIEWS AND APPROVES THE EMPLOYEES' DISCLOSURES. BOARD MINUTES REFLECT WHEN A BOARD MEMBER DECLARES A CONFLICT AND DOES NOT VOTE.
FORM 990, PART VI, SECTION B, LINE 15	PROCESS OF DETERMINING COMPENSATION: A COMPENSATION SUBCOMMITTEE OF THE BOARD NEGOTIATES CONTRACTS WITH EXECUTIVES THROUGH LONGNECKER & ASSOCIATES. THIS SUBCOMMITTEE OF THE BOARD REVIEWS AND APPROVES COMPENSATION AND BONUSES ANNUALLY.
FORM 990, PART VI, SECTION C, LINE 19	AVAILABILITY OF DOCUMENTS: THE ORGANIZATION DOES NOT MAKE ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC.
FORM 990, PART I, LINE 1	CONTINUATION OF THE ORGANIZATION'S MISSION STATEMENT: ...AGE, OR ABILITY TO PAY.
FORM 990, PART I	DOING BUSINESS AS: GOOD SHEPHERD MEDICAL CENTER - MARSHALL
FORM 990, PART IV, LINE 12 & PART XII, LINE 2	AUDITED FINANCIAL STATEMENTS: THE ORGANIZATION HAS ANSWERED "NO" TO THE QUESTIONS REGARDING AN AUDIT IN PART IV, LINE 12 AND PART XII. THE ORGANIZATION ONLY RECEIVED AN AUDIT OF ITS BALANCE SHEET FOR THE YEAR ENDED SEPTEMBER 30, 2016. THEREFORE, SINCE THE ORGANIZATION DID NOT HAVE AN AUDITED INCOME STATEMENT FOR THE PERIOD COVERED BY THIS RETURN, THE ORGANIZATION DOES NOT HAVE AUDITED FINANCIAL STATEMENTS ACCORDING TO THE IRS INSTRUCTIONS. THE ORGANIZATION HAS ATTACHED A COPY OF ITS MOST RECENT AUDITED FINANCIAL STATEMENTS FOR THE YEAR ENDED SEPTEMBER 30, 2015 AND SEPTEMBER 30, 2014 TO THE FORM 990 AND ANSWERED "YES" TO PART IV, LINE 20B.

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

Cat. No. 51056K

Schedule O (Form 990 or 990-EZ) 2015

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

Information about Schedule R (Form 990) and its instructions is at www.irs.gov/form990.

OMB No. 1545-0047

2015

Open to Public Inspection

Name of the organization

Harrison County Hospital Association

Employer identification number

75-0974351

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)	(d) Total income	(e) End-of-year assets	(f) Direct controlling entity

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)GSHS INC 700 E MARSHALL AVE LONGVIEW,TX75601 75-2027157	SUPPORT GSMC	TX	501(C)(3)	11, TYPE II	NA		No
(2)MARSHALL HEALTH SERVICES INC 811 SOUTH WASHINGTON AVE MARSHALL,TX75670 75-2580686	HEALTHCARE	TX	501(C)(3)	3	GSMC MARSH	Yes
(3)MARSHALL HOSPITAL FOUNDATION INC 811 SOUTH WASHINGTON AVE MARSHALL,TX75670 75-2605699	SUPPORT	TX	501(C)(3)	7	GSMC MARSH	Yes
(4)THE GOOD SHEPHERD HOSPITAL INC 700 E MARSHALL AVE LONGVIEW,TX75601 75-1041154	HEALTHCARE	TX	501(C)(3)	3	GSHS INC	Yes
(5)GSHS ADMINISTRATIVE SERVICES ORG INC 700 E MARSHALL AVE LONGVIEW,TX75601 86-1132471	ADMIN SUPPORT	TX	501(C)(3)	11, TYPE I	GSHS INC	Yes
(6)GOOD SHEPHERD MEDICAL CENTER - LINDEN 404 N KAUFMAN ST LINDEN,TX75563 01-0829282	HEALTHCARE	TX	501(C)(3)	3	GSHS INC	Yes
(7)GSMC - LINDEN FOUNDATION INC 404 N KAUFMAN ST LINDEN,TX75563 20-0845127	SUPPORT	TX	501(C)(3)	11, TYPE I	GSMC LINDEN	Yes
(8)GOOD SHEPHERD HOSPITAL AUXILIARY 700 E MARSHALL AVE LONGVIEW,TX75601 23-7203364	SUPPORT	TX	501(C)(3)	9	GSMC	Yes
(9)GOOD SHEPHERD FOUNDATION INC 700 E MARSHALL AVE LONGVIEW,TX75601 75-2056700	SUPPORT	TX	501(C)(3)	11, TYPE I	GSMC	Yes
(10)MEMORIAL HOSPITAL AUXILIARY 811 S WASHINGTON AVE MARSHALL,TX75670 51-0151805	SUPPORT	TX	501(C)(3)	3	GSMC MARSH	Yes

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

Cat. No. 50135Y

Schedule R (Form 990) 2015

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	(e) Predominant income(related, unrelated, excluded from tax under sections 512-514)	(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
(1) GOOD SHEPHERD AMBULATORY SURGICAL CENTER 700 E MARSHALL AVE LONGVIEW,TX75601 90-0259782	SURGERY	TX	NA	N/A

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) GSHS ENTERPRISES INC 700 E MARSHALL AVE LONGVIEW,TX75601 75-2027162	HEALTHCARE	TX	GSHS INC	C CORP				Yes
(2) GOOD SHEPHERD HEALTH NETWORK 700 E MARSHALL AVE LONGVIEW,TX75601 75-2554695	INACTIVE	TX	GSMC	C CORP				Yes
(3) NORTHEAST TEXAS PHYSICIAN SERVICES 700 E MARSHALL AVE LONGVIEW,TX75601 75-2712245	MGMT SERVICES	TX	GSHS ENTERPRISE	C CORP				Yes
(4) GOOD SHEPHERD PHYSICIAN SERVICES INC 700 E MARSHALL AVE LONGVIEW,TX75601 75-2762417	MEDICAL SERVICES	TX	GSHS ENTERPRISE	C CORP				Yes
(5) GSHS ENTERPRISES HOLDING INC 700 E MARSHALL AVE LONGVIEW,TX75601 51-0412465	HOLDING COMPANY	DE	GSHS ENTERPRISE	C CORP				Yes
(6) GSHS ENTERPRISES OPERATING 1 700 E MARSHALL AVE LONGVIEW,TX75601 75-2954772	HEALTHCARE	DE	GSHS ENTERPRISE	C CORP				Yes
(7) GSHS ENTERPRISES OPERATING 2 700 E MARSHALL AVE LONGVIEW,TX75601 75-2954777	HEALTHCARE	DE	GSHS ENTERPRISE	C CORP				Yes
(8) MARSHALL PHYSICIAN HOSPITAL ORGANIZATION 700 E MARSHALL AVE LONGVIEW,TX75601 75-2580689	INACTIVE	TX	GSMC MARSHALL	C CORP	0	0	100.000 %	Yes

Schedule R (Form 990) 2015

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) ............................

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

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

Yes

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

Yes

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) .................

Yes

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) ............................

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) MARSHALL HEALTH SERVICES	M	884,295	CASH PAID
(2) MARSHALL HEALTH SERVICES	A	620,911	CASH PAID
(3) MARSHALL HEALTH SERVICES	K	308,370	CASH PAID

Schedule R (Form 990) 2015

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) 2015

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) 2015

Additional Data

Software ID:
Software Version:

1	Briefly describe the organization’s mission or most significant activities: TO SERVE THE COMMUNITY WITH RESPECT TO PROVIDING HEALTHCARE SERVICES AND HEALTHCARE EDUCATION REGARDLESS OF RACE, SEX, CREED, NATIONAL ORIGIN, HANDICAP, (SEE SCHEDULE O)...
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	12
5	Total number of individuals employed in calendar year 2015 (Part V, line 2a) ......	5	581
6	Total number of volunteers (estimate if necessary) .............	6	75
7a	Total unrelated business revenue from Part VIII, column (C), line 12 ........	7a	109,487
b	Net unrelated business taxable income from Form 990-T, line 34 .........	7b

		Prior Year	Current Year
8	Contributions and grants (Part VIII, line 1h) .........	0	0
9	Program service revenue (Part VIII, line 2g) .........	92,097,973	109,635,284
10	Investment income (Part VIII, column (A), lines 3, 4, and 7d ) ....	27,603	119,899
11	Other revenue (Part VIII, column (A), lines 5, 6d, 8c, 9c, 10c, and 11e)	710,610	715,605
12	Total revenue—add lines 8 through 11 (must equal Part VIII, column (A), line 12)	92,836,186	110,470,788
13	Grants and similar amounts paid (Part IX, column (A), lines 1–3 )...	225,000	2,788,568
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)	26,870,360	28,184,977
16a	Professional fundraising fees (Part IX, column (A), line 11e) .....	0	0
b	Total fundraising expenses (Part IX, column (D), line 25) 62,596
17	Other expenses (Part IX, column (A), lines 11a–11d, 11f–24e)....	62,668,290	76,341,652
18	Total expenses. Add lines 13–17 (must equal Part IX, column (A), line 25)	89,763,650	107,315,197
19	Revenue less expenses. Subtract line 18 from line 12.......	3,072,536	3,155,591
		Beginning of Current Year	End of Year
20	Total assets (Part X, line 16).............	36,863,188	39,838,169
21	Total liabilities (Part X, line 26).............	41,520,670	41,282,557
22	Net assets or fund balances. Subtract line 21 from line 20.....	-4,657,482	-1,444,388

Sign Here

	Signature of officer	Date

	Type or print name and title


4a	(Code: ) (Expenses $ 95,075,412 including grants of $ 2,788,568 ) (Revenue $ 109,635,284 )
	GOOD SHEPHERD MEDICAL CENTER - MARSHALL EXISTS TO IDENTIFY AND DELIVER QUALITY HEALTHCARE SERVICES IN A SAFE & CARING ENVIRONMENT TO THE PEOPLE OF THIS REGION. GOOD SHEPHERD MEDICAL CENTER - MARSHALL IS A NON-FOR-PROFIT FACILITY LOCATED NORTHEAST TEXAS, APPROXIMATELY 150 MILES EAST OF DALLAS, TEXAS AND 35 MILES WEST OF SHREVEPORT, LOUISIANA. GOOD SHEPHERD MEDICAL CENTER - MARSHALL IS THE ONLY HOSPITAL LOCATED IN HARRISON AND MARION COUNTIES. ESTABLISHED IN 1954 BY SEVERAL HARRISON COUNTY PHYSICIANS, GOOD SHEPHERD MEDICAL CENTER - MARSHALL HAS GROWN TO A 149 BED FACILITY WITH AN INTENSIVE CARE UNIT AND A 24-HOUR LEVEL III TRAUMA CENTER. GOOD SHEPHERD MEDICAL CENTER - MARSHALL IS ACCREDITED BY THE JOINT COMMISSION ON ACCREDITATION FOR HEALTHCARE ORGANIZATIONS.

4b	(Code: ) (Expenses $ including grants of $ ) (Revenue $ )












4c	(Code: ) (Expenses $ including grants of $ ) (Revenue $ )












4d	Other program services (Describe in Schedule O.)
	(Expenses $ including grants of $ ) (Revenue $ )
4e	Total program service expenses95,075,412

(A) Name and Title	(B) Average hours per week (list any hours for related organizations below dotted line)			(D) Reportable compensation from the organization (W- 2/1099-MISC)	(E) Reportable compensation from related organizations (W- 2/1099-MISC)	(F) Estimated amount of other compensation from the organization and related organizations
(A) Name and Title
(18) THOMAS SMOLENSKI........................................................................ PHYSICIAN	40.0 .......................0.0	X		167,663	0	3,679
(19) JOYCE EGLI........................................................................ CHARGE NURSE	40.0 .......................0.0	X		166,607	0	12,387
(20) REMONA WATSON........................................................................ CHARGE NURSE	40.0 .......................0.0	X		140,086	0	6,059
(21) KEITH KIRBOW........................................................................ CHIEF NURSING OFFICER	40.0 .......................0.0	X		148,760	0	31,297
(22) RICKY PAUL........................................................................ FORMER PRES OF MEDICAL STAFF	0.0 .......................40.0		X	0	556,806	28,866
(23) JOHN MCDONALD DO........................................................................ FORMER MEDICAL STAFF	0.0 .......................40.0		X	0	217,294	13,917
(24) VALARIE ALLMAN MD........................................................................ FORMER VP MEDICAL STAFF	0.0 .......................40.0		X	0	303,415	22,454
(25) RAY DELK........................................................................ FORMER VP OPERATIONS	0.0 .......................40.0		X	0	231,767	37,289

1b	Sub-Total................
c	Total from continuation sheets to Part VII, Section A....
d	Total (add lines 1b and 1c)...........	768,039	3,303,841	320,329

1a	Federated campaigns..		1a
b	Membership dues..		1b
c	Fundraising events..		1c
d	Related organizations		1d
e	Government grants (contributions)		1e

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

g	Noncash contributions included in lines 1a-1f:$
h Total.Add lines 1a-1f.......		0

		Business Code
2a	Net Patient Revenues	621110	99,488,976	99,488,976
b	Government Funds - Trauma	624200	31,214	31,214
c	PHARMACY REVENUE	446110	2,406,142	2,406,142
d	Life Wellness Center	624200	509,663	509,663
e	.
f	All other program service revenue.			7,199,289	7,199,289
g Total.Add lines 2a–2f.....			109,635,284

3 Investment income (including dividends, interest, and othersimilar amounts) ..........			120,995		109,487	11,508
4 Income from investment of tax-exempt bond proceeds			0
5 Royalties...........			0
		(ii) Personal	(i) Real
6a	Gross rents		729,948
b	Less: rental expenses		34,528
c	Rental income or (loss)	0	695,420
d	Net rental income or (loss)......			695,420			695,420
		(ii) Other	(i) Securities
7a	Gross amount from sales of assets other than inventory		27,484
b	Less: cost or other basis and sales expenses	3,801	24,779
c	Gain or (loss)	-3,801	2,705
d	Net gain or (loss).....			-1,096			-1,096
8a	Gross income from fundraising events (not including $ of contributions reported on line 1c). See Part IV, line 18 ....
	a
b	Less: direct expenses ...b
c	Net income or (loss) from fundraising events..			0
9a	Gross income from gaming activities. See Part IV, line 19 ...
	a
b	Less: direct expenses ...b
c	Net income or (loss) from gaming activities..			0
10a	Gross sales of inventory, less returns and allowances ..
	a
b	Less: cost of goods sold ..b
c	Net income or (loss) from sales of inventory..			0
Business Code			Miscellaneous Revenue
11a	Vending Machines		722210	20,185			20,185
b
c
d	All other revenue ....
e	Total. Add lines 11a–11d ......			20,185
12	Total revenue. See Instructions......			110,470,788	109,635,284	109,487	726,017

1	Grants and other assistance to domestic organizations and domestic governments. See Part IV, line 21	2,788,568	2,788,568
2	Grants and other assistance to individuals in the United States. See Part IV, line 22	0
3	Grants and other assistance to governments, organizations, and individuals outside the United States. See Part IV, lines 15 and 16	0
4	Benefits paid to or for members	0
5	Compensation of current officers, directors, trustees, and key employees ....	0
6	Compensation not included above, to disqualified persons (as defined under section 4958(f)(1)) and persons described in section 4958(c)(3)(B) ....	0
7	Other salaries and wages	22,625,480	18,315,344	4,284,442	25,694
8	Pension plan accruals and contributions (include section 401(k) and 403(b) employer contributions) ....	475,822	385,179	90,103	540
9	Other employee benefits .......	3,399,629	2,752,002	643,766	3,861
10	Payroll taxes ...........	1,684,046	1,363,237	318,897	1,912
11	Fees for services (non-employees):
a	Management ......	4,357,960	3,527,772	825,239	4,949
b	Legal .........	12,930	10,467	2,448	15
c	Accounting ...........	404,575	327,504	76,612	459
d	Lobbying ...........	0
e	Professional fundraising services. See Part IV, line 17	0
f	Investment management fees ......	0
g	Other (If line 11g amount exceeds 10% of line 25, column (A) amount, list line 11g expenses on Schedule O)	6,602,757	5,344,936	1,250,322	7,499
12	Advertising and promotion ....	235	190	45
13	Office expenses .......	967,641	783,306	183,236	1,099
14	Information technology ......	13,942	11,286	2,640	16
15	Royalties ..	0
16	Occupancy ...........	1,608,006	1,301,682	304,498	1,826
17	Travel ............	127,260	103,017	24,098	145
18	Payments of travel or entertainment expenses for any federal, state, or local public officials .	0
19	Conferences, conventions, and meetings ....	32,795	26,548	6,210	37
20	Interest ...........	1,739,484		1,739,484
21	Payments to affiliates .......	0
22	Depreciation, depletion, and amortization ..	2,611,793	2,114,249	494,578	2,966
23	Insurance ...	388,819	314,749	73,628	442
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	ASO SYSTEM	7,223,570	5,847,486	1,367,881	8,203
b	MEDICAL SUPPLIES	6,521,716	6,521,716
c	BAD DEBT	41,145,508	41,145,508
d	REPAIRS AND MAINTENANCE	1,216,644	984,874	230,388	1,382
e	All other expenses	1,366,017	1,105,792	258,674	1,551
25	Total functional expenses. Add lines 1 through 24e	107,315,197	95,075,412	12,177,189	62,596
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 ........			1,097	1	0
2	Savings and temporary cash investments .........			5,264,728	2	3,923,607
3	Pledges and grants receivable, net ......			0	3	0
4	Accounts receivable, net .............			9,719,204	4	6,260,209
5	Loans and other receivables from current and former officers, directors, trustees, key employees, and highest compensated employees. Complete Part II of Schedule L
				0	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 ....			0	7	0
8	Inventories for sale or use ........			1,461,946	8	1,702,879
9	Prepaid expenses and deferred charges ......			234,088	9	270,992
10a	Land, buildings, and equipment: cost or other basis. Complete Part VI of Schedule D	10a	71,417,956
b	Less: accumulated depreciation	10b	53,146,877	18,033,898	10c	18,271,079
11	Investments—publicly traded securities .			0	11	0
12	Investments—other securities. See Part IV, line 11 .....			535,569	12	2,055,968
13	Investments—program-related. See Part IV, line 11 ..			0	13	0
14	Intangible assets ...............			1,116,393	14	1,032,580
15	Other assets. See Part IV, line 11 ...........			496,265	15	6,320,855
16	Total assets. Add lines 1 through 15 (must equal line 34)...			36,863,188	16	39,838,169

17	Accounts payable and accrued expenses .....	4,607,729	17	5,495,771
18	Grants payable ...	0	18	0
19	Deferred revenue .........	0	19	0
20	Tax-exempt bond liabilities .........	35,023,084	20	33,442,869
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 ..	0	23	0
24	Unsecured notes and loans payable to unrelated third parties ..	0	24	0
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	1,889,857	25	2,343,917
26	Total liabilities. Add lines 17 through 25..	41,520,670	26	41,282,557

	Organizations that follow SFAS 117 (ASC 958), check here and complete lines 27 through 29, and lines 33 and 34.
27	Unrestricted net assets	-5,096,168	27	-1,852,990
28	Temporarily restricted net assets ...........	438,686	28	408,602
29	Permanently restricted net assets	0	29	0
	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 ...........	-4,657,482	33	-1,444,388
34	Total liabilities and net assets/fund balances ........	36,863,188	34	39,838,169