Form990
Click to see attachment
Department of the TreasuryInternal Revenue Service
Return of Organization Exempt From Income Tax
Under section 501(c), 527, or 4947(a)(1) of the Internal Revenue Code (except private foundations)
MediumBullet Do not enter social security numbers on this form as it may be made public.
MediumBullet Go to www.irs.gov/Form990 for instructions and the latest information.
OMB No. 1545-0047
2019
Open to Public Inspection
A For the 2019 calendar year, or tax year beginning 07-01-2017 , and ending 06-30-2018
BCheck if applicable:
CName of organization
ARMSTRONG COUNTY MEMORIAL HOSPITAL
 
% MATTHEW F KOCIOLA
Doing business as
ACMH HOSPITAL
 
Number and street (or P.O. box if mail is not delivered to street address)
ONE NOLTE DRIVE
 
Room/suite
City or town, state or province, country, and ZIP or foreign postal code
KITTANNING, PA162018808
D Employer identification number

25-0965237
E Telephone number

G Gross receipts $ 108,941,835
F Name and address of principal officer:
JOHN I LEWIS
ONE NOLTE DRIVE
KITTANNING,PA16201
I
Tax-exempt status: (   ) LeftBullet (insert no.) or
J
Website:MediumBullet
WWW.ACMH.ORG
H(a)
Is this a group return for
subordinates?
H(b)
Are all subordinates
included?
If "No," attach a list. (see instructions)
H(c)
Group exemption number MediumBullet  
K Form of organization:  
L Year of formation: 1874
M State of legal domicile: PA
Part I
Summary
Activities & Governance 1 Briefly describe the organization’s mission or most significant activities: THE MISSION OF ARMSTRONG MEMORIAL HOSPITAL IS TO IMPROVE THE HEALTH AND WELL-BEING OF THE RESIDENTS OF ARMSTRONG AND NEIGHBORING COUNTIES.
2 Check this box MediumBullet
3 Number of voting members of the governing body (Part VI, line 1a) ........ 3 12
4 Number of independent voting members of the governing body (Part VI, line 1b) ..... 4 9
5 Total number of individuals employed in calendar year 2019 (Part V, line 2a) ...... 5 1,114
6 Total number of volunteers (estimate if necessary) ............. 6 163
7a Total unrelated business revenue from Part VIII, column (C), line 12 ........ 7a 912,394
b Net unrelated business taxable income from Form 990-T, line 39 ......... 7b 73,365
Revenues Prior Year Current Year
8 Contributions and grants (Part VIII, line 1h) ......... 194,284 398,969
9 Program service revenue (Part VIII, line 2g) ......... 105,313,788 102,732,927
10 Investment income (Part VIII, column (A), lines 3, 4, and 7d ) .... 308,765 459,671
11 Other revenue (Part VIII, column (A), lines 5, 6d, 8c, 9c, 10c, and 11e) 1,695,849 1,506,445
12 Total revenue—add lines 8 through 11 (must equal Part VIII, column (A), line 12) 107,512,686 105,098,012
Expenses; 13 Grants and similar amounts paid (Part IX, column (A), lines 1–3 )... 16,830 15,260
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) 58,797,959 56,212,718
16a Professional fundraising fees (Part IX, column (A), line 11e) ..... 0 0
b Total fundraising expenses (Part IX, column (D), line 25) MediumBullet0    
17 Other expenses (Part IX, column (A), lines 11a–11d, 11f–24e).... 44,394,613 43,265,049
18 Total expenses. Add lines 13–17 (must equal Part IX, column (A), line 25) 103,209,402 99,493,027
19 Revenue less expenses. Subtract line 18 from line 12....... 4,303,284 5,604,985
Net Assets or Fund Balances; Beginning of Current Year End of Year
20 Total assets (Part X, line 16)............. 68,352,522 67,023,492
21 Total liabilities (Part X, line 26)............. 29,060,202 25,714,741
22 Net assets or fund balances. Subtract line 21 from line 20..... 39,292,320 41,308,751
Part II
Signature Block
Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief, it is true, correct, and complete. Declaration of preparer (other than officer) is based on all information of which preparer has any knowledge.
Sign Here
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Signature of officer Date
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Type or print name and title
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Print/Type preparer's name
Preparer's signature
Date
PTIN
Firm's name MediumBullet

Firm's EIN MediumBullet
Firm's address MediumBullet



Phone no.
May the IRS discuss this return with the preparer shown above? (see instructions) ..........
For Paperwork Reduction Act Notice, see the separate instructions.
Cat. No. 11282Y Form 990 (2019)
Form 990 (2019)
Page 2
Part III
Statement of Program Service Accomplishments
Check if Schedule O contains a response or note to any line in this Part III..............
1
Briefly describe the organization’s mission: ACMH IS COMMITTED TO IMPROVING THE EMOTIONAL AND PHYSICAL HEALTH OF ITS PATIENTS THROUGH SUPERIOR CLINICAL CARE AND THE COMPASSIONATE MANAGEMENT OF ILLNESS AND DISABILITY.
2
Did the organization undertake any significant program services during the year which were not listed on
the prior Form 990 or 990-EZ? .....................
If "Yes," describe these new services on Schedule O.
3
Did the organization cease conducting, or make significant changes in how it conducts, any program
services? ...........................
If "Yes," describe these changes on Schedule O.
4
Describe the organization’s program service accomplishments for each of its three largest program services, as measured by expenses. Section 501(c)(3) and 501(c)(4) organizations are required to report the amount of grants and allocations to others, the total expenses, and revenue, if any, for each program service reported.
4a (Code:   ) (Expenses $ 48,560,196 including grants of $   ) (Revenue $ 61,051,285 )
ACMH HOSPITAL PROVIDES OUTPATIENT SERVICES SUCH AS RADIOLOGY, LABORATORY, EMERGENCY VISITS, AMBULATORY SURGERY, AND OTHER VARIOUS SERVICES. DURING THE FISCAL YEAR, TOTAL OUTPATIENT REGISTRATIONS WERE 193,530.
4b (Code:   ) (Expenses $ 22,216,579 including grants of $   ) (Revenue $ 30,530,506 )
ACMH HOSPITAL PROVIDES INPATIENT SERVICES SUCH AS MEDICAL AND SURGICAL, ACUTE REHAB, SKILLED NURSING, OB/GYN, ICU/CCU, PSYCHIATRIC AND NURSERY. PERCUTANEOUS CORONARY INTERVENTION TO TREAT NARROWED CORONARY ARTERIES. DURING THE FISCAL YEAR, TOTAL ADMISSIONS WERE 5,170 AND PATIENT DAYS WERE 23,837.
4c (Code:   ) (Expenses $ 5,723,855 including grants of $   ) (Revenue $ 5,368,471 )
ACMH HOSPITAL PROVIDES RURAL HEALTH CLINICS AT SEVERAL SURROUNDING COMMUNITY LOCATIONS INCLUDING LEECHBURG, ELDERTON, RURAL VALLEY, KITTANNING, AND NEW BETHLEHEM. TOTAL VISITS FOR ALL PHYSICIAN CLINICS TOTALED 62,949. THE PHYSICIAN CLINICS ALSO OFFER CHARITY CARE UNDER THE SAME POLICY AS ACMH HOSPITAL. TOTAL CHARITY CARE RELATING TO THE PHYSICIAN CLINICS FOR THE CURRENT FISCAL YEAR WAS 1,311. SEE SCHEDULE O FOR MORE INFORMATION.
4d Other program services (Describe in Schedule O.)
(Expenses $ 718,398 including grants of $ 15,260 ) (Revenue $ 5,782,665 )
4e Total program service expensesMediumBullet77,219,028
Form 990 (2019)
Form 990 (2019)
Page 3
Part IV
Checklist of Required Schedules
Yes
No
1
Is the organization described in section 501(c)(3) or 4947(a)(1) (other than a private foundation)? If "Yes," complete Schedule AClick to see attachment.....................
1
Yes
 
2
Is the organization required to complete Schedule B, Schedule of Contributors (see instructions)? Click to see attachment...
2
Yes
 
3
Did the organization engage in direct or indirect political campaign activities on behalf of or in opposition to candidates for public office? If "Yes," complete Schedule C, Part IClick to see attachment.............
3
 
No
4
Section 501(c)(3) organizations. Did the organization engage in lobbying activities, or have a section 501(h) election in effect during the tax year? If "Yes," complete Schedule C, Part IIClick to see attachment.........
4
Yes
 
5
Is the organization a section 501(c)(4), 501(c)(5), or 501(c)(6) organization that receives membership dues, assessments, or similar amounts as defined in Revenue Procedure 98-19? If "Yes," complete Schedule C, Part IIIClick to see attachment..
5
 
No
6
Did the organization maintain any donor advised funds or any similar funds or accounts for which donors have the right to provide advice on the distribution or investment of amounts in such funds or accounts? If "Yes," complete Schedule D, Part IClick to see attachment.........................
6
 
No
7
Did the organization receive or hold a conservation easement, including easements to preserve open space,
the environment, historic land areas, or historic structures? If "Yes," complete Schedule D, Part IIClick to see attachment....
7
 
No
8
Did the organization maintain collections of works of art, historical treasures, or other similar assets? If "Yes,"
complete Schedule D, Part IIIClick to see attachment..............
8
 
No
9
Did the organization report an amount in Part X, line 21 for escrow or custodial account liability; serve as a custodian for amounts not listed in Part X; or provide credit counseling, debt management, credit repair, or debt negotiation services? If "Yes," complete Schedule D, Part IVClick to see attachment..............
9
 
No
10
Did the organization, directly or through a related organization, hold assets in temporarily restricted endowments, permanent endowments, or quasi endowments? If "Yes," complete Schedule D, Part V......
10
 
 
11
If the organization’s answer to any of the following questions is "Yes," then complete Schedule D, Parts VI, VII, VIII, IX, or X as applicable.
a
Did the organization report an amount for land, buildings, and equipment in Part X, line 10? If "Yes," complete
Schedule D, Part VI. Click to see attachment...................
11a
Yes
 
b
Did the organization report an amount for investments—other securities in Part X, line 12 that is 5% or more of its total assets reported in Part X, line 16? If "Yes," complete Schedule D, Part VIIClick to see attachment.......
11b
Yes
 
c
Did the organization report an amount for investments—program related in Part X, line 13 that is 5% or more of its total assets reported in Part X, line 16? If "Yes," complete Schedule D, Part VIIIClick to see attachment.......
11c
 
No
d
Did the organization report an amount for other assets in Part X, line 15 that is 5% or more of its total assets reported in Part X, line 16? If "Yes," complete Schedule D, Part IXClick to see attachment............
11d
Yes
 
e
Did the organization report an amount for other liabilities in Part X, line 25? If "Yes," complete Schedule D, Part XClick to see attachment
11e
Yes
 
f
Did the organization’s separate or consolidated financial statements for the tax year include a footnote that addresses the organization’s liability for uncertain tax positions under FIN 48 (ASC 740)? If "Yes," complete Schedule D, Part XClick to see attachment
11f
Yes
 
12a
Did the organization obtain separate, independent audited financial statements for the tax year? If "Yes," complete
Schedule D, Parts XI and XIIClick to see attachment......................
12a
Yes
 
b
Was the organization included in consolidated, independent audited financial statements for the tax year? If "Yes," and if the organization answered "No" to line 12a, then completing Schedule D, Parts XI and XII is optional Click to see attachment
12b
Yes
 
13
Is the organization a school described in section 170(b)(1)(A)(ii)? If "Yes," complete Schedule E
13
 
No
14a
Did the organization maintain an office, employees, or agents outside of the United States? .....
14a
 
No
b
Did the organization have aggregate revenues or expenses of more than $10,000 from grantmaking, fundraising, business, investment, and program service activities outside the United States, or aggregate foreign investments valued at $100,000 or more? If "Yes," complete Schedule F, Parts I and IV.........
14b
 
No
15
Did the organization report on Part IX, column (A), line 3, more than $5,000 of grants or other assistance to or for any foreign organization? If “Yes,” complete Schedule F, Parts II and IV.....
15
 
No
16
Did the organization report on Part IX, column (A), line 3, more than $5,000 of aggregate grants or other assistance to or for foreign individuals? If “Yes,” complete Schedule F, Parts III and IV...
16
 
No
17
Did the organization report a total of more than $15,000 of expenses for professional fundraising services on Part IX, column (A), lines 6 and 11e? If "Yes," complete Schedule G, Part I(see instructions) ....
17
 
No
18
Did the organization report more than $15,000 total of fundraising event gross income and contributions on Part VIII, lines 1c and 8a? If "Yes," complete Schedule G, Part II............
18
 
No
19
Did the organization report more than $15,000 of gross income from gaming activities on Part VIII, line 9a? If "Yes," complete Schedule G, Part III...................
19
 
No
20a
Did the organization operate one or more hospital facilities? If "Yes," complete Schedule H....Click to see attachment
20a
Yes
 
b
If "Yes" to line 20a, did the organization attach a copy of its audited financial statements to this return? Click to see attachment
20b
Yes
 
21
Did the organization report more than $5,000 of grants or other assistance to any domestic organization or domestic government on Part IX, column (A), line 1? If “Yes,” complete Schedule I, Parts I and II.....Click to see attachment
21
Yes
 
Form 990 (2019)
Form 990 (2019)
Page 4
Part IV
Checklist of Required Schedules (continued)
Yes
No
22
Did the organization report more than $5,000 of grants or other assistance to or for domestic individuals on Part IX, column (A), line 2? If “Yes,” complete Schedule I, Parts I and III........Click to see attachment
22
 
No
23
Did the organization answer "Yes" to Part VII, Section A, line 3, 4, or 5 about compensation of the organization’s current and former officers, directors, trustees, key employees, and highest compensated employees? If "Yes," complete Schedule J....................... Click to see attachment
23
Yes
 
24a
Did the organization have a tax-exempt bond issue with an outstanding principal amount of more than $100,000 as of the last day of the year, that was issued after December 31, 2002? If “Yes,” answer lines 24b through 24d and complete Schedule K. If “No,” go to line 25a...............
24a
 
No
b
Did the organization invest any proceeds of tax-exempt bonds beyond a temporary period exception?...
24b
 
 
c
Did the organization maintain an escrow account other than a refunding escrow at any time during the year
to defease any tax-exempt bonds? ...............
24c
 
 
d
Did the organization act as an "on behalf of" issuer for bonds outstanding at any time during the year?...
24d
 
 
25a
Section 501(c)(3), 501(c)(4), and 501(c)(29) organizations. Did the organization engage in an excess benefit transaction with a disqualified person during the year? If "Yes," complete Schedule L, Part I ....
25a
 
No
b
Is the organization aware that it engaged in an excess benefit transaction with a disqualified person in a prior year, and that the transaction has not been reported on any of the organization’s prior Forms 990 or 990-EZ? If "Yes," complete Schedule L, Part I.......................
25b
 
No
26
Did the organization report any amount on Part X, line 5 or 22 for receivables from or payables to any current or former officer, director, trustee, key employee, creator or founder, substantial contributor, or 35% controlled entity or family member of any of these persons? If "Yes," complete Schedule L, Part II...........
26
 
No
27
Did the organization provide a grant or other assistance to any current or former officer, director, trustee, key employee, creator or founder, substantial contributor, or employee thereof, a grant selection committee member, or to a 35% controlled entity (including an employee thereof) or family member of any of these persons?
If "Yes," complete
Schedule L, Part III.........................
27
 
No
28
Was the organization a party to a business transaction with one of the following parties (see Schedule L, Part IV instructions for applicable filing thresholds, conditions, and exceptions):
a
A current or former officer, director, trustee, key employee, creator or founder, or substantial contributor? If "Yes," complete Schedule L, Part IV......................
28a
 
No
b
A family member of any individual described in line 28a? If "Yes," complete Schedule L, Part IV.....
28b
 
No
c
A 35% controlled entity of one or more individuals and/or organizations described in lines 28a or 28b? If "Yes," complete Schedule L, Part IV.....................
28c
 
 
29
Did the organization receive more than $25,000 in non-cash contributions? If "Yes," complete Schedule M..Click to see attachment
29
Yes
 
30
Did the organization receive contributions of art, historical treasures, or other similar assets, or qualified conservation contributions? If "Yes," complete Schedule M .................Click to see attachment
30
 
No
31
Did the organization liquidate, terminate, or dissolve and cease operations? If "Yes," complete Schedule N, Part I
31
 
No
32
Did the organization sell, exchange, dispose of, or transfer more than 25% of its net assets? If "Yes," complete Schedule N, Part II........................
32
 
No
33
Did the organization own 100% of an entity disregarded as separate from the organization under Regulations sections 301.7701-2 and 301.7701-3? If "Yes," complete Schedule R, Part I............Click to see attachment
33
Yes
 
34
Was the organization related to any tax-exempt or taxable entity? If "Yes," complete Schedule R, Part II, III, or IV, and Part V, line 1.........................Click to see attachment
34
Yes
 
35a
Did the organization have a controlled entity within the meaning of section 512(b)(13)?
35a
 
No
b
If ‘Yes’ to line 35a, did the organization receive any payment from or engage in any transaction with a controlled entity within the meaning of section 512(b)(13)? If "Yes," complete Schedule R, Part V, line 2 ...
35b
 
 
36
Section 501(c)(3) organizations. Did the organization make any transfers to an exempt non-charitable related organization? If "Yes," complete Schedule R, Part V, line 2............. Click to see attachment
36
 
No
37
Did the organization conduct more than 5% of its activities through an entity that is not a related organization and that is treated as a partnership for federal income tax purposes? If "Yes," complete Schedule R, Part VIClick to see attachment
37
 
No
38
Did the organization complete Schedule O and provide explanations in Schedule O for Part VI, lines 11b and 19? Note. All Form 990 filers are required to complete Schedule O. ............
38
Yes
 
Part V
Statements Regarding Other IRS Filings and Tax Compliance
Check if Schedule O contains a response or note to any line in this Part V...........
Yes
No
1a
Enter the number reported in Box 3 of Form 1096. Enter -0- if not applicable ..
1a
76
b
Enter the number of Forms W-2G included in line 1a. Enter -0- if not applicable .
1b
0
c
Did the organization comply with backup withholding rules for reportable payments to vendors and reportable gaming (gambling) winnings to prize winners? ..................
1c
Yes
 
Form 990 (2019)
Form 990 (2019)
Page 5
Part V
Statements Regarding Other IRS Filings and Tax Compliance (continued)
2a
Enter the number of employees reported on Form W-3, Transmittal of Wage and
Tax Statements, filed for the calendar year ending with or within the year covered by this return ..................
2a
1,114
b
If at least one is reported on line 2a, did the organization file all required federal employment tax returns?
Note. If the sum of lines 1a and 2a is greater than 250, you may be required to e-file (see instructions)
2b
Yes
 
3a
Did the organization have unrelated business gross income of $1,000 or more during the year?...
3a
Yes
 
b
If “Yes,” has it filed a Form 990-T for this year? If “No” to line 3b, provide an explanation in Schedule O...
3b
Yes
 
4a
At any time during the calendar year, did the organization have an interest in, or a signature or other authority over, a financial account in a foreign country (such as a bank account, securities account, or other financial account)? ..
4a
 
No
b
If "Yes," enter the name of the foreign country: MediumBullet
See instructions for filing requirements for FinCEN Form 114, Report of Foreign Bank and Financial Accounts (FBAR).
5a
Was the organization a party to a prohibited tax shelter transaction at any time during the tax year? ..
5a
 
No
b
Did any taxable party notify the organization that it was or is a party to a prohibited tax shelter transaction?
5b
 
No
c
If "Yes," to line 5a or 5b, did the organization file Form 8886-T? ............
5c
 
 
6a
Does the organization have annual gross receipts that are normally greater than $100,000, and did the organization solicit any contributions that were not tax deductible as charitable contributions? ...
6a
 
No
b
If "Yes," did the organization include with every solicitation an express statement that such contributions or gifts were not tax deductible? ......................
6b
 
 
7
Organizations that may receive deductible contributions under section 170(c).
a
Did the organization receive a payment in excess of $75 made partly as a contribution and partly for goods and services provided to the payor? ....................
7a
 
No
b
If "Yes," did the organization notify the donor of the value of the goods or services provided? .....
7b
 
 
c
Did the organization sell, exchange, or otherwise dispose of tangible personal property for which it was required to file Form 8282? .........................
7c
 
No
d
If "Yes," indicate the number of Forms 8282 filed during the year ....
7d
 
e
Did the organization receive any funds, directly or indirectly, to pay premiums on a personal benefit contract?
7e
 
No
f
Did the organization, during the year, pay premiums, directly or indirectly, on a personal benefit contract? ..
7f
 
No
g
If the organization received a contribution of qualified intellectual property, did the organization file Form 8899 as required? ......................
7g
 
 
h
If the organization received a contribution of cars, boats, airplanes, or other vehicles, did the organization file a Form 1098-C? ..........................
7h
 
 
8
Sponsoring organizations maintaining donor advised funds. Did a donor advised fund maintained by the sponsoring organization have excess business holdings at any time during the year? ........
8
 
 
9
Sponsoring organizations maintaining donor advised funds.
a
Did the sponsoring organization make any taxable distributions under section 4966?........
9a
 
 
b
Did the sponsoring organization make a distribution to a donor, donor advisor, or related person?...
9b
 
 
10
Section 501(c)(7) organizations. Enter:
a
Initiation fees and capital contributions included on Part VIII, line 12 ...
10a
 
b
Gross receipts, included on Form 990, Part VIII, line 12, for public use of club facilities
10b
 
11
Section 501(c)(12) organizations. Enter:
a
Gross income from members or shareholders .........
11a
 
b
Gross income from other sources (Do not net amounts due or paid to other sources against amounts due or received from them.) ..........
11b
 
12a
Section 4947(a)(1) non-exempt charitable trusts. Is the organization filing Form 990 in lieu of Form 1041?
12a
 
 
b
If "Yes," enter the amount of tax-exempt interest received or accrued during the year.
12b
 
13
Section 501(c)(29) qualified nonprofit health insurance issuers.
a
Is the organization licensed to issue qualified health plans in more than one state? .........
Note. See the instructions for additional information the organization must report on Schedule O.
13a
 
 
b
Enter the amount of reserves the organization is required to maintain by the states in which the organization is licensed to issue qualified health plans ....
13b
 
c
Enter the amount of reserves on hand ............
13c
 
14a
Did the organization receive any payments for indoor tanning services during the tax year?.....
14a
 
No
b
If "Yes," has it filed a Form 720 to report these payments? If "No," provide an explanation in Schedule O..
14b
 
 
15
Is the organization subject to the section 4960 tax on payment(s) of more than $1,000,000 in remuneration or excess parachute payment(s) during the year? ....................
If "Yes," see instructions and file Form 4720, Schedule N.
15
 
 
16
Is the organization an educational institution subject to the section 4968 excise tax on net investment income? ..
If "Yes," complete Form 4720, Schedule O.
16
 
 
Form 990 (2019)
Form 990 (2019)
Page 6
Part VI
Governance, Management, and Disclosure For each "Yes" response to lines 2 through 7b below, and for a "No" response to lines 8a, 8b, or 10b below, describe the circumstances, processes, or changes in Schedule O. See instructions.
Check if Schedule O contains a response or note to any line in this Part VI..............
Section A. Governing Body and Management
Yes
No
1a
Enter the number of voting members of the governing body at the end of the tax year
1a
12
If there are material differences in voting rights among members of the governing body, or if the governing body delegated broad authority to an executive committee or similar committee, explain in Schedule O.
b
Enter the number of voting members included in line 1a, above, who are independent
1b
9
2
Did any officer, director, trustee, or key employee have a family relationship or a business relationship with any other officer, director, trustee, or key employee? .................
2
Yes
 
3
Did the organization delegate control over management duties customarily performed by or under the direct supervision of officers, directors or trustees, or key employees to a management company or other person? .
3
 
No
4
Did the organization make any significant changes to its governing documents since the prior Form 990 was filed? .
4
 
No
5
Did the organization become aware during the year of a significant diversion of the organization’s assets? .
5
 
No
6
Did the organization have members or stockholders? ................
6
Yes
 
7a
Did the organization have members, stockholders, or other persons who had the power to elect or appoint one or more members of the governing body? ....................
7a
Yes
 
b
Are any governance decisions of the organization reserved to (or subject to approval by) members, stockholders, or persons other than the governing body? ...................
7b
Yes
 
8
Did the organization contemporaneously document the meetings held or written actions undertaken during the year by the following:
a
The governing body? .......................
8a
Yes
 
b
Each committee with authority to act on behalf of the governing body? ............
8b
Yes
 
9
Is there any officer, director, trustee, or key employee listed in Part VII, Section A, who cannot be reached at the organization’s mailing address? If "Yes," provide the names and addresses in Schedule O.......
9
 
No
Section B. Policies (This Section B requests information about policies not required by the Internal Revenue Code.)
Yes
No
10a
Did the organization have local chapters, branches, or affiliates? ............
10a
 
No
b
If "Yes," did the organization have written policies and procedures governing the activities of such chapters, affiliates, and branches to ensure their operations are consistent with the organization's exempt purposes?
10b
 
 
11a
Has the organization provided a complete copy of this Form 990 to all members of its governing body before filing the form? ............................
11a
Yes
 
b
Describe in Schedule O the process, if any, used by the organization to review this Form 990. .....
12a
Did the organization have a written conflict of interest policy? If "No," go to line 13.......
12a
Yes
 
b
Were officers, directors, or trustees, and key employees required to disclose annually interests that could give rise to conflicts? ..........................
12b
Yes
 
c
Did the organization regularly and consistently monitor and enforce compliance with the policy? If "Yes," describe in Schedule O how this was done...................
12c
Yes
 
13
Did the organization have a written whistleblower policy? ...............
13
Yes
 
14
Did the organization have a written document retention and destruction policy? .........
14
Yes
 
15
Did the process for determining compensation of the following persons include a review and approval by independent persons, comparability data, and contemporaneous substantiation of the deliberation and decision?
a
The organization’s CEO, Executive Director, or top management official ...........
15a
Yes
 
b
Other officers or key employees of the organization ................
15b
Yes
 
If "Yes" to line 15a or 15b, describe the process in Schedule O (see instructions).
16a
Did the organization invest in, contribute assets to, or participate in a joint venture or similar arrangement with a taxable entity during the year? ......................
16a
 
No
b
If "Yes," did the organization follow a written policy or procedure requiring the organization to evaluate its participation in joint venture arrangements under applicable federal tax law, and take steps to safeguard the organization’s exempt status with respect to such arrangements? ............
16b
 
 
Section C. Disclosure
17
List the states with which a copy of this Form 990 is required to be filedMediumBullet
PA
18
Section 6104 requires an organization to make its Form 1023 (or 1024-A if applicable), 990, and 990-T (501(c)(3)s only) available for public inspection. Indicate how you made these available. Check all that apply.
19
Describe in Schedule O whether (and if so, how) the organization made its governing documents, conflict of interest policy, and financial statements available to the public during the tax year.
20
State the name, address, and telephone number of the person who possesses the organization's books and records:
MediumBulletMATTHEW F KOCIOLAONE NOLTE DRIVE   KITTANNING,PA16201 (724) 543-8618
Form 990 (2019)
Form 990 (2019)
Page 7
Part VII
Compensation of Officers, Directors,Trustees, Key Employees, Highest Compensated Employees, and Independent Contractors
Check if Schedule O contains a response or note to any line in this Part VII..............
Section A. Officers, Directors, Trustees, Key Employees, and Highest Compensated Employees
1a Complete this table for all persons required to be listed. Report compensation for the calendar year ending with or within the organization’s tax year.
RoundBullet List all of the organization’s current officers, directors, trustees (whether individuals or organizations), regardless of amount
of compensation. Enter -0- in columns (D), (E), and (F) if no compensation was paid.

RoundBullet List all of the organization’s current key employees, if any. See instructions for definition of "key employee."
RoundBullet List the organization’s five current highest compensated employees (other than an officer, director, trustee or key employee)
who received reportable compensation (Box 5 of Form W-2 and/or Box 7 of Form 1099-MISC) of more than $100,000 from the
organization and any related organizations.

RoundBullet List all of the organization’s former officers, key employees, or highest compensated employees who received more than $100,000
of reportable compensation from the organization and any related organizations.

RoundBullet List all of the organization’s former directors or trustees that received, in the capacity as a former director or trustee of the
organization, more than $10,000 of reportable compensation from the organization and any related organizations.

See instructions for the order in which to list the persons above.
Check this box if neither the organization nor any related organization compensated any current officer, director, or trustee.
(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) 		(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
Individual Trustee or Director; Institutional Trustee; OfficerInd; Key Employee; Highest compensated employee; FormerOfcrDirectorTrusteeInd;
(1) MEREDITH CHRISTY......................................................................
CHAIRMAN
 1.0
.................
1.0 		X   X       0 0 0
(2) ELIZABETH WHITE......................................................................
VICE CHAIRMAN
 1.0
.................
2.0 		X   X       0 0 0
(3) VOLKER ZAUN......................................................................
SECRETARY/TREASURER
 1.0
.................
1.0 		X   X       0 0 0
(4) HAROLD ALTMAN MD......................................................................
CHIEF MEDICAL OFFICER
 39.0
.................
1.0 		X   X       299,060 0 13,678
(5) JOHN I LEWIS......................................................................
PRESIDENT & CEO
 39.0
.................
1.0 		X   X       355,815 0 74,691
(6) CHASE MCCLISTER......................................................................
DIRECTOR
 1.0
.................
3.0 		X           0 0 0
(7) SAMUEL FRIEDE......................................................................
DIRECTOR
 1.0
.................
1.0 		X           0 0 0
(8) DONALD TYLINSKI EDD......................................................................
DIRECTOR
 1.0
.................
1.0 		X           0 0 0
(9) SANDY BRADIGAN......................................................................
DIRECTOR
 1.0
.................
1.0 		X           0 0 0
(10) KATIE CHARLTON......................................................................
DIRECTOR
 1.0
.................
1.0 		X           0 0 0
(11) W STEVEN DAVIS......................................................................
DIRECTOR
 1.0
.................
1.0 		X           0 0 0
(12) SARUN SUWAN MD......................................................................
PRESIDENT OF MEDICAL STAFF
 39.0
.................
1.0 		X           326,364 0 28,685
(13) PATRICK BURNS......................................................................
CFO, VP OF FINANCE
 39.0
.................
1.0 		    X       238,564 0 24,199
(14) MONA RUPERT......................................................................
VP OF CLINICAL SERVICES
 40.0
.................
0.0 		      X     155,457 0 13,032
(15) NICOLE GERACI......................................................................
VP OF PATIENT SRVC & OPERATION
 40.0
.................
0.0 		      X     150,136 0 10,165
(16) JOSEPH CIPPEL......................................................................
PHYSICIAN
 40.0
.................
0.0 		        X   208,579 0 30,362
(17) CHAD SHAFFER......................................................................
PHYSICIAN
 40.0
.................
0.0 		        X   228,604 0 24,995
Form 990 (2019)
Form 990 (2019)
Page 8
Part VII
Section A. Officers, Directors, Trustees, Key Employees, and Highest Compensated Employees (continued)
(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) 		(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
Individual Trustee or Director; Institutional Trustee; OfficerInd; Key Employee; Highest compensated employee; FormerOfcrDirectorTrusteeInd;
(18) KARLA D MCCANN........................................................................
PHYSICIAN
 40.0
.......................0.0 		        X   203,243 0 27,150
(19) VICKY LEO........................................................................
PHYSICIAN
 40.0
.......................0.0 		        X   240,040 0 11,077
(20) MICHAEL ONDICH........................................................................
PHYSICIAN
 40.0
.......................0.0 		        X   159,888 0 26,078




















1b Sub-Total................MediumBullet
c Total from continuation sheets to Part VII, Section A....MediumBullet
d Total (add lines 1b and 1c)...........MediumBullet 2,565,750 0 284,112
2
Total number of individuals (including but not limited to those listed above) who received more than $100,000 of reportable compensation from the organization MediumBullet38
Yes
No
3
Did the organization list any former officer, director or trustee, key employee, or highest compensated employee on line 1a? If "Yes," complete Schedule J for such individual ..............
3
 
No
4
For any individual listed on line 1a, is the sum of reportable compensation and other compensation from the organization and related organizations greater than $150,000? If "Yes," complete Schedule J for such
individual...........................
4
Yes
 
5
Did any person listed on line 1a receive or accrue compensation from any unrelated organization or individual for services rendered to the organization? If "Yes," complete Schedule J for such person ........
5
 
No
Section B. Independent Contractors
1
Complete this table for your five highest compensated independent contractors that received more than $100,000 of compensation from the organization. Report compensation for the calendar year ending with or within the organization’s tax year.
(A)
Name and business address 		(B)
Description of services 		(C)
Compensation
SIGNET HEALTH,
235 W HICKORY ST STE 201
DENTON,TX76201 		PSYCHIATRY 582,692
CHILDRENS COMMUNITY PEDIATRICS,
11279 PERRY HIGHWAY STE 450
WEXFORD,PA15090 		PEDIATRIC 462,990
HARI K VEMULAPALLI MD LLC,
145 TANGLEWOOD DR
WEXFORD,PA15090 		PSYCHIATRY 280,000
ADVANCED LITHO CARE LTD,
1305 SOUTH MAIN ST
MEADVILLE,PA16335 		RADIOLOGY 221,465
BKD LLP,
910 E ST LOUIS ST SUITE 200
SPRINGFIELD,MO65801 		AUDIT/TAX/CONSULTING 214,412
2
Total number of independent contractors (including but not limited to those listed above) who received more than $100,000 of compensation from the organization MediumBullet13
Form 990 (2019)
Form 990 (2019)
Page 9
Part VIII
Statement of Revenue
Check if Schedule O contains a response or note to any line in this Part VIII.............
(A)
Total revenue 		(B)
Related or
exempt
function
revenue 		(C)
Unrelated
business
revenue 		(D)
Revenue
excluded from
tax under sections
512 - 514
Contributions, Gifts, GrantAmt and OtherAmt Similar Amounts 1a Federated campaigns..1a  
b Membership dues..1b  
c Fundraising events..1c  
d Related organizations1d 107,851
e Government grants (contributions)1e  
f All other contributions, gifts, grants, and similar amounts not included above1f 291,118
g Noncash contributions included in lines 1a - 1f:$ 1g 79,435
h Total. Add lines 1a-1f.......MediumBullet 398,969
Program Service RevenueAmt Business Code
2a PATIENT SERVICES 621500 96,950,262 96,950,262    
b CAFETERIA 722210 587,905 587,905    
c RENT FROM AFFILIATES 623000 359,629 359,629    
d OTHER REVENUE 900099 4,195,409 3,923,088 272,321  
e UNRELATED LAB SERVICES 621500 639,722   639,722  
f All other program service revenue.        
g Total. Add lines 2a–2f .....MediumBullet 102,732,927
OtherAmtRevenueAmt 3 Investment income (including dividends, interest, and othersimilar amounts) ......MediumBullet 264,734     264,734
4 Income from investment of tax-exempt bond proceedsMediumBullet 0      
5 Royalties...........MediumBullet 0      
(ii) Personal (i) Real
6a Gross rents   535,330 6a
b Less: rental expenses     6b
c Rental income or (loss) 0 535,330 6c
d Net rental income or (loss).......MediumBullet 535,330     535,330
(ii) Other (i) Securities
7a Gross amount from sales of assets other than inventory 11,500 4,027,260 7a
b Less: cost or other basis and sales expenses 2,380 3,841,443 7b
c Gain or (loss) 9,120 185,817 7c
d Net gain or (loss).........MediumBullet 194,937     194,937
8a Gross income from fundraising events (not including $   of contributions reported on line 1c). See Part IV, line 18 ....
8a 0
b Less: direct expenses ... 8b 0
c Net income or (loss) from fundraising events..MediumBullet 0    
9a Gross income from gaming activities.
See Part IV, line 19 ...
9a 0
b Less: direct expenses ... 9b 0
c Net income or (loss) from gaming activities..MediumBullet 0      
10a Gross sales of inventory, less
returns and allowances ..
10a 0
b Less: cost of goods sold .. 10b 0
c Net income or (loss) from sales of inventory..MediumBullet 0      
Business Code Miscellaneous Revenue
11a GAIN ON EQUITY INVESTEES 900099 971,115   351 970,764
b            
c            
d All other revenue ....        
e Total. Add lines 11a–11d ...... MediumBullet 971,115
12 Total revenue. See instructions.....MediumBullet 105,098,012 101,820,884 912,394 1,965,765
Form 990 (2019)
Form 990 (2019)
Page 10
Part IX
Statement of Functional Expenses
Section 501(c)(3) and 501(c)(4) organizations must complete all columns. All other organizations must complete column (A).Check if Schedule O contains a response or note to any line in this Part IX..............
Do not include amounts reported on lines 6b,
7b, 8b, 9b, and 10b of Part VIII. 		(A)
Total expenses 		(B)
Program service expenses 		(C)
Management and general expenses 		(D)
Fundraising
expenses
1 Grants and other assistance to domestic organizations and domestic governments. See Part IV, line 21 .... 15,260 15,260
2 Grants and other assistance to domestic individuals. See Part IV, line 22 ........... 0  
3 Grants and other assistance to foreign organizations, foreign governments, and foreign individuals. 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 ........... 1,689,846 996,577 693,269  
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........ 41,318,552 31,253,047 10,065,505  
8 Pension plan accruals and contributions (include section 401(k) and 403(b) employer contributions) .... 2,142,047 1,553,829 588,218  
9 Other employee benefits ....... 7,383,161 5,380,565 2,002,596  
10 Payroll taxes ........... 3,679,112 2,620,549 1,058,563  
11 Fees for services (non-employees):        
a Management ...... 0      
b Legal ......... 366,149   366,149  
c Accounting ........... 130,100   130,100  
d Lobbying ........... 0      
e Professional fundraising services. See Part IV, line 17 0  
f Investment management fees ...... 21,405   21,405  
g Other (If line 11g amount exceeds 10% of line 25, column (A) amount, list line 11g expenses on Schedule O) 12,385,765 10,245,241 2,140,524 0
12 Advertising and promotion .... 377,676 2,520 375,156  
13 Office expenses ....... 4,849,866 3,493,335 1,356,531  
14 Information technology ...... 980,417 165,188 815,229  
15 Royalties .. 0      
16 Occupancy ........... 2,132,557 1,679,008 453,549  
17 Travel ............ 88,804 54,904 33,900  
18 Payments of travel or entertainment expenses for any federal, state, or local public officials . 0      
19 Conferences, conventions, and meetings .... 68,691 37,364 31,327  
20 Interest ........... 61,332 43,782 17,550  
21 Payments to affiliates ....... 0      
22 Depreciation, depletion, and amortization .. 4,074,613 2,908,656 1,165,957  
23 Insurance ... 714,179 98,297 615,882  
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 MEDICAL SUPPLIES & DRUGS 12,321,711 12,321,711    
b BAD DEBT 2,369,493 2,369,493    
c PROVIDER TAXES 1,242,533 1,242,533    
d FOOD EXPENSES 699,044 596,348 102,696  
e All other expenses 380,714 140,821 239,893  
25 Total functional expenses. Add lines 1 through 24e 99,493,027 77,219,028 22,273,999 0
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 MediumBullet if following SOP 98-2 (ASC 958-720).        
Form 990 (2019)
Form 990 (2019)
Page 11
Part X
Balance Sheet
Check if Schedule O contains a response or note to any line in this Part IX..............
(A)
Beginning of year 		(B)
End of year
Assets 1 Cash–non-interest-bearing ........ 223,510 1 229,236
2 Savings and temporary cash investments ......... 12,736,163 2 11,927,409
3 Pledges and grants receivable, net ...... 0 3 0
4 Accounts receivable, net ............. 8,409,651 4 7,812,414
5 Loans and other payables to any current or former officer, director, trustee, key employee, creator or founder, substantial contributor, or 35% controlled entity or family member of any of these persons .......
0 5 0
6 Loans and other receivables from other disqualified persons (as defined under section 4958(f)(1)), and persons described in section 4958(c)(3)(B) ...
0 6 0
7 Notes and loans receivable, net ........... 2,469 7 0
8 Inventories for sale or use ............ 1,085,641 8 1,136,691
9 Prepaid expenses and deferred charges ...... 1,411,774 9 1,416,988
10a Land, buildings, and equipment: cost or other basis. Complete Part VI of Schedule D 10a 133,931,124
b Less: accumulated depreciation 10b 110,115,488 24,412,987 10c 23,815,636
11 Investments—publicly traded securities . 7,135,513 11 7,434,506
12 Investments—other securities. See Part IV, line 11 ..... 4,410,505 12 5,143,631
13 Investments—program-related. See Part IV, line 11 .. 0 13 0
14 Intangible assets ............... 6,667 14 46,250
15 Other assets. See Part IV, line 11 ........... 8,517,642 15 8,060,731
16 Total assets. Add lines 1 through 15 (must equal line 33)... 68,352,522 16 67,023,492
Liabilities 17 Accounts payable and accrued expenses ..... 10,518,193 17 10,829,677
18 Grants payable ... 0 18 0
19 Deferred revenue ......... 0 19 0
20 Tax-exempt bond liabilities ......... 0 20 0
21 Escrow or custodial account liability. Complete Part IV of Schedule D 0 21 0
22 Loans and other payables to any current or former officer, director, trustee, key employee, creator or founder, substantial contributor, or 35% controlled entity or family member of any of these persons .........
0 22 0
23 Secured mortgages and notes payable to unrelated third parties .. 4,541,458 23 4,329,169
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 14,000,551 25 10,555,895
26 Total liabilities. Add lines 17 through 25.. 29,060,202 26 25,714,741
Net Assets or Fund Balance Organizations that follow FASB ASC 958, check here MediumBullet and complete lines 27, 28, 32, and 33.
27 Net assets without donor restrictions ..........   27  
28 Net assets with donor restrictions ...........   28  
Organizations that do not follow FASB ASC 958, check here MediumBullet and complete lines 29 through 33.
29 Capital stock or trust principal, or current funds .....   29  
30 Paid-in or capital surplus, or land, building or equipment fund ...   30  
31 Retained earnings, endowment, accumulated income, or other funds   31  
32 Total net assets or fund balances ........... 39,292,320 32 41,308,751
33 Total liabilities and net assets/fund balances ........ 68,352,522 33 67,023,492
Form 990 (2019)
Form 990 (2019)
Page 12
Part XI
Reconcilliation of Net Assets
Check if Schedule O contains a response or note to any line in this Part XI..............
1
Total revenue (must equal Part VIII, column (A), line 12) ............
1
105,098,012
2
Total expenses (must equal Part IX, column (A), line 25) ............
2
99,493,027
3
Revenue less expenses. Subtract line 2 from line 1 ..............
3
5,604,985
4
Net assets or fund balances at beginning of year (must equal Part X, line 32, column (A)) ..
4
39,292,320
5
Net unrealized gains (losses) on investments ...............
5
-25,764
6
Donated services and use of facilities .................
6
 
7
Investment expenses .....................
7
 
8
Prior period adjustments .....................
8
 
9
Other changes in net assets or fund balances (explain in Schedule O) ........
9
-3,562,790
10
Net assets or fund balances at end of year. Combine lines 3 through 9 (must equal Part X, line 32, column (B))
10
41,308,751
Part XII
Financial Statements and Reporting
Check if Schedule O contains a response or note to any line in this Part XII.............
Yes
No
1
Accounting method used to prepare the Form 990:  
If the organization changed its method of accounting from a prior year or checked "Other," explain in
Schedule O.
2a
Were the organization’s financial statements compiled or reviewed by an independent accountant?
2a
 
No
If ‘Yes,’ check a box below to indicate whether the financial statements for the year were compiled or reviewed on a separate basis, consolidated basis, or both:
b
Were the organization’s financial statements audited by an independent accountant?
2b
Yes
 
If ‘Yes,’ check a box below to indicate whether the financial statements for the year were audited on a separate basis, consolidated basis, or both:
c
If "Yes," to line 2a or 2b, does the organization have a committee that assumes responsibility for oversight of the audit, review, or compilation of its financial statements and selection of an independent accountant?
2c
Yes
 
If the organization changed either its oversight process or selection process during the tax year, explain in Schedule O.
3a
As a result of a federal award, was the organization required to undergo an audit or audits as set forth in the Single Audit Act and OMB Circular A-133?
3a
 
No
b
If "Yes," did the organization undergo the required audit or audits? If the organization did not undergo the required audit or audits, explain why in Schedule O and describe any steps taken to undergo such audits.
3b
 
 
Form 990 (2019)
Form 990 (2019)
Additional Data


Software ID:  
Software Version:  
Form 990, Special Condition Description:
Special Condition Description
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 Go to www.irs.gov/Form990 for instructions and the latest information.
OMB No. 1545-0047
2019
Open to Public
Inspection
Name of the organization
ARMSTRONG COUNTY MEMORIAL HOSPITAL
 
Employer identification number

25-0965237
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 12, check only one box.)
1
2
3
4
5
6
7
8
9
10
11
12
a
b
c
d
e
f
Enter the number of supported organizations ...............................  
g
Provide the following information about the supported organization(s).
(i) Name of supported organization (ii) EIN (iii) Type of organization (described on lines 1- 10 above (see instructions)) (iv) Is the organization listed in your governing document? (v) Amount of monetary support (see instructions) (vi) Amount of other support (see instructions)
Yes No
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) 2019

Schedule A (Form 990 or 990-EZ) 2019
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 failed to qualify under the tests listed below, please complete Part III.)
Section A. Public Support
Calendar year (or fiscal year beginning in) right arrow (a) 2015 (b) 2016 (c) 2017 (d) 2018 (e) 2019 (f) Total
1 Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grant.") ..            
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) right arrow (a) 2015 (b) 2016 (c) 2017 (d) 2018 (e) 2019 (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  
12
12
 
13
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
14
14
 
15
15
 
16a
b
17a
b
18
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) 2019

Schedule A (Form 990 or 990-EZ) 2019
Page 3
Part III
Support Schedule for Organizations Described in Section 509(a)(2)
(Complete only if you checked the box on line 10 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) right arrow (a) 2015 (b) 2016 (c) 2017 (d) 2018 (e) 2019 (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) right arrow (a) 2015 (b) 2016 (c) 2017 (d) 2018 (e) 2019 (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.)..            
14
Section C. Computation of Public Support Percentage
15
15
 
16
16
 
Section D. Computation of Investment Income Percentage
17
17
 
18
18
 
19a
b
20
Schedule A (Form 990 or 990-EZ) 2019

Schedule A (Form 990 or 990-EZ) 2019
Page 4
Part IV
Supporting Organizations
(Complete only if you checked a box on line 12 of Part I. If you checked 12a of Part I, complete Sections A and B. If you checked 12b of Part I, complete Sections A and C. If you checked 12c of Part I, complete Sections A, D, and E. If you checked 12d of Part I, complete Sections A and D, and complete Part V.)
Section A. All Supporting Organizations
Yes
No
1
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.
1
 
 
2
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).
2
 
 
3a
Did the organization have a supported organization described in section 501(c)(4), (5), or (6)? If "Yes," answer (b) and (c) below.
3a
 
 
b
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.
3b
 
 
c
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.
3c
 
 
4a
Was any supported organization not organized in the United States ("foreign supported organization")? If “Yes” and if you checked 12a or 12b in Part I, answer (b) and (c) below.
4a
 
 
b
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.
4b
 
 
c
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.
4c
 
 
5a
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).
5a
 
 
b
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?
5b
 
 
c
Substitutions only. Was the substitution the result of an event beyond the organization's control?
5c
 
 
6
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.
6
 
 
7
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) .
7
 
 
8
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).
8
 
 
9a
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.
9a
 
 
b
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.
9b
 
 
c
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.
9c
 
 
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
 
 
b
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) 2019

Schedule A (Form 990 or 990-EZ) 2019
Page 5
Part IV
Supporting Organizations (continued)
Yes
No
11
Has the organization accepted a gift or contribution from any of the following persons?
a
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
 
 
b
A family member of a person described in (a) above?
11b
 
 
c
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
No
1
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.
1
 
 
2
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.
2
 
 
Section C. Type II Supporting Organizations
Yes
No
1
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).
1
 
 
Section D. All Type III Supporting Organizations
Yes
No
1
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?
1
 
 
2
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).
2
 
 
3
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.
3
 
 
Section E. Type III Functionally-Integrated Supporting Organizations
1
Check the box next to the method that the organization used to satisfy the Integral Part Test during the year (see instructions):
a
b
c
2
Activities Test. Answer (a) and (b) below.
Yes
No
a
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.
2a
 
 
b
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.
2b
 
 
3
Parent of Supported Organizations. Answer (a) and (b) below.
a
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.
3a
 
 
b
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.
3b
 
 
Schedule A (Form 990 or 990-EZ) 2019

Schedule A (Form 990 or 990-EZ) 2019
Page 6
Part V
Type III Non-Functionally Integrated 509(a)(3) Supporting Organizations
1
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  
7
Schedule A (Form 990 or 990-EZ) 2019

Schedule A (Form 990 or 990-EZ) 2019
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 2019 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-2019 		(iii)
Distributable
Amount for 2019
1 Distributable amount for 2019 from Section C, line 6  
2 Underdistributions, if any, for years prior to 2019 (reasonable cause required-- explain in Part VI).
See instructions.		  
3 Excess distributions carryover, if any, to 2019:
a From 2014.......  
b From 2015.......  
c From 2016.......  
d From 2017.......  
e From 2018.......  
fTotal of lines 3a through e  
g Applied to underdistributions of prior years  
h Applied to 2019 distributable amount  
i Carryover from 2014 not applied (see
instructions) 		 
j Remainder. Subtract lines 3g, 3h, and 3i from 3f.  
4Distributions for 2019 from Section D, line 7:
$  
a Applied to underdistributions of prior years  
b Applied to 2019 distributable amount  
c Remainder. Subtract lines 4a and 4b from 4.  
5 Remaining underdistributions for years prior to
2019, if any. Subtract lines 3g and 4a from line 2.
If the amount is greater than zero, explain in Part VI.
See instructions.		  
6 Remaining underdistributions for 2019. Subtract
lines 3h and 4b from line 1. If the amount is greater
than zero, explain in Part VI. See instructions.		  
7 Excess distributions carryover to 2020. Add lines
3j and 4c.		  
8 Breakdown of line 7:
a Excess from 2015.....  
b Excess from 2016.....  
c Excess from 2017.....  
d Excess from 2018.....  
e Excess from 2019.....  
Schedule A (Form 990 or 990-EZ) (2019)

Schedule A (Form 990 or 990-EZ) 2019
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) 2019


Additional Data


Software ID:  
Software Version:  
Schedule B
(Form 990, 990-EZ,
or 990-PF)
Department of the Treasury
Internal Revenue Service
Schedule of Contributors

Arrow Bullet Attach to Form 990, 990-EZ, or 990-PF.
Arrow Bullet Go to www.irs.gov/Form990 for the latest information.
OMB No. 1545-0047
2019
Name of the organization
ARMSTRONG COUNTY MEMORIAL HOSPITAL
 
Employer identification number

25-0965237
Organization type (check one):
Filers of:
Section:
Form 990 or 990-EZ






Form 990-PF




Check if your organization is covered by the General Rule or a Special Rule.  
Note: Only a section 501(c)(7), (8), or (10) organization can check boxes for both the General Rule and a Special Rule. See instructions.
General Rule
Special Rules
......... Arrow Bullet $  
Caution: An organization that isn't covered by the General Rule and/or the Special Rules doesn't file Schedule B (Form 990,
990-EZ, or 990-PF), but it must answer “No” on Part IV, line 2, of its Form 990; or check the box on line H of its Form 990-EZ
or on its Form 990PF, Part I, line 2, to certify that it doesn't meet the filing requirements of Schedule B (Form 990,
990-EZ, or 990-PF).
For Paperwork Reduction Act Notice, see the Instructions
for Form 990, 990-EZ, or 990-PF.
Cat. No. 30613XSchedule B (Form 990, 990-EZ, or 990-PF) (2019)
Schedule B (Form 990, 990-EZ, or 990-PF) (2019) Page 2
Name of organization
ARMSTRONG COUNTY MEMORIAL HOSPITAL
  		Employer identification number
25-0965237
Part I
Contributors
Contributors (see instructions). Use duplicate copies of Part I if additional space is needed.
(a)
No.		 (b)
Name, address, and ZIP + 4		 (c)
Total contributions		 (d)
Type of contribution
 
 
 
 

$  


(Complete Part II for noncash contributions.)
(a)
No.		 (b)
Name, address, and ZIP + 4		 (c)
Total contributions		 (d)
Type of contribution
 
 
 
 

$  


(Complete Part II for noncash contributions.)
(a)
No.		 (b)
Name, address, and ZIP + 4		 (c)
Total contributions		 (d)
Type of contribution
 
 
 
 

$  


(Complete Part II for noncash contributions.)
(a)
No.		 (b)
Name, address, and ZIP + 4		 (c)
Total contributions		 (d)
Type of contribution
 
 
 
 

$  


(Complete Part II for noncash contributions.)
(a)
No.		 (b)
Name, address, and ZIP + 4		 (c)
Total contributions		 (d)
Type of contribution
 
 
 
 

$  


(Complete Part II for noncash contributions.)
(a)
No.		 (b)
Name, address, and ZIP + 4		 (c)
Total contributions		 (d)
Type of contribution
 
 
 
 

$  


(Complete Part II for noncash contributions.)
Schedule B (Form 990, 990-EZ, or 990-PF) (2019)
Schedule B (Form 990, 990-EZ, or 990-PF) (2019)
Page 3
Name of organization
ARMSTRONG COUNTY MEMORIAL HOSPITAL
  		Employer identification number

25-0965237
Part II
Noncash Property (see instructions). Use duplicate copies of Part II if additional space is needed.
(a)
No. from Part I		 (b)
Description of noncash property given		 (c)
FMV (or estimate)
(See instructions) 		(d)
Date received
 
$    
(a)
No. from Part I		 (b)
Description of noncash property given		 (c)
FMV (or estimate)
(See instructions) 		(d)
Date received
 
$    
(a)
No. from Part I		 (b)
Description of noncash property given		 (c)
FMV (or estimate)
(See instructions) 		(d)
Date received
 
$    
(a)
No. from Part I		 (b)
Description of noncash property given		 (c)
FMV (or estimate)
(See instructions) 		(d)
Date received
 
$    
(a)
No. from Part I		 (b)
Description of noncash property given		 (c)
FMV (or estimate)
(See instructions) 		(d)
Date received
 
$    
(a)
No. from Part I		 (b)
Description of noncash property given		 (c)
FMV (or estimate)
(See instructions) 		(d)
Date received
 
$    
Schedule B (Form 990, 990-EZ, or 990-PF) (2019)
Schedule B (Form 990, 990-EZ, or 990-PF) (2019)
Page 4
Name of organization
ARMSTRONG COUNTY MEMORIAL HOSPITAL
  		Employer identification number

25-0965237
Part III
Exclusively religious, charitable, etc., contributions to organizations described in section 501(c)(7), (8), or (10) that total more than $1,000 for the year from any one contributor. Complete columns (a) through (e) and the following line entry. For organizations completing Part III, enter the total of exclusively religious, charitable, etc., contributions of $1,000 or less for the year. (Enter this information once. See instructions.) Arrow Bullet$  
Use duplicate copies of Part III if additional space is needed.
(a)
No. from Part I		 (b) Purpose of gift (c) Use of gift (d) Description of how gift is held
 
(e) Transfer of gift
Transferee's name, address, and ZIP 4 Relationship of transferor to transferee
 
 
     
 
(a)
No. from Part I		 (b) Purpose of gift (c) Use of gift (d) Description of how gift is held
 
(e) Transfer of gift
Transferee's name, address, and ZIP 4 Relationship of transferor to transferee
 
 
     
 
(a)
No. from Part I		 (b) Purpose of gift (c) Use of gift (d) Description of how gift is held
 
(e) Transfer of gift
Transferee's name, address, and ZIP 4 Relationship of transferor to transferee
 
 
     
 
(a)
No. from Part I		 (b) Purpose of gift (c) Use of gift (d) Description of how gift is held
 
(e) Transfer of gift
Transferee's name, address, and ZIP 4 Relationship of transferor to transferee
 
 
     
 
Schedule B (Form 990, 990-EZ, or 990-PF) (2019)

Additional Data


Software ID:  
Software Version:  
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 BulletGo to www.irs.gov/Form990 for instructions and the latest information.
OMB No. 1545-0047
2019
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
ARMSTRONG COUNTY MEMORIAL HOSPITAL
 
Employer identification number

25-0965237
Part I-A
Complete if the organization is exempt under section 501(c) or is a section 527 organization.

1
Provide a description of the organization’s direct and indirect political campaign activities in Part IV (see instructions for definition of “political campaign activities")

2
Political campaign activity expenditures (see instructions) ....................................................................SchCMd Bullet
$  
3
Volunteer hours for political campaign activities (see instructions) ..................................................................
 

Part I-B
Complete if the organization is exempt under section 501(c)(3).
1
Enter the amount of any excise tax incurred by the organization under section 4955 ................................SchCMd Bullet
$  
2
Enter the amount of any excise tax incurred by organization managers under section 4955 .......................SchCMd Bullet
$  
3
If the organization incurred a section 4955 tax, did it file Form 4720 for this year? .........................................
4a
Was a correction made? ......................................................................................................................
b
If "Yes," describe in Part IV.
Part I-C
Complete if the organization is exempt under section 501(c), except section 501(c)(3).
1
Enter the amount directly expended by the filing organization for section 527 exempt function activities ..... SchCMd Bullet
$  
2
Enter the amount of the filing organization's funds contributed to other organizations for section 527 exempt function activities ............................................................................................................................SchCMd Bullet

$  
3
Total exempt function expenditures. Add lines 1 and 2. Enter here and on Form 1120-POL, line 17b...........SchCMd Bullet

$  
4
Did the filing organization file Form 1120-POL for this year? ...................................................................
5
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) 2019

Schedule C (Form 990 or 990-EZ) 2019
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 Bulletexpenses, and share of excess lobbying expenditures).
B Check SchCMd Bullet
Limits on Lobbying Expenditures
(The term "expenditures" means amounts paid or incurred.) 		(a) Filing
organization's
totals 		(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? ...................................................................................................................

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) 2016 (b) 2017 (c) 2018 (d) 2019 (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) 2019


Schedule C (Form 990 or 990-EZ) 2019
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|No
(b)
Amount
1
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:
a
Volunteers? ...........................................................................................................
 
No
b
Paid staff or management (include compensation in expenses reported on lines 1c through 1i)? ........
 
No
c
Media advertisements? ...................................................................................................
 
No
 
d
Mailings to members, legislators, or the public? .............................................................................
 
No
 
e
Publications, or published or broadcast statements? ...........................................................
 
No
 
f
Grants to other organizations for lobbying purposes? ..........................................................
 
No
 
g
Direct contact with legislators, their staffs, government officials, or a legislative body? .......................
 
No
 
h
Rallies, demonstrations, seminars, conventions, speeches, lectures, or any similar means? ..................
 
No
 
i
Other activities? ...................................................................................................................
Yes
 
9,518
j
Total. Add lines 1c through 1i ....................................................................................................
9,518
2a
Did the activities in line 1 cause the organization to be not described in section 501(c)(3)? .....
 
No
b
If "Yes," enter the amount of any tax incurred under section 4912 ...........................................
 
c
If "Yes," enter the amount of any tax incurred by organization managers under section 4912 ...................
 
d
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
No
1
Were substantially all (90% or more) dues received nondeductible by members? ...............................................
1
 
 
2
Did the organization make only in-house lobbying expenditures of $2,000 or less? ............................................
2
 
 
3
Did the organization agree to carry over lobbying and political expenditures from the prior year? .................................
3
 
 
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."
1
Dues, assessments and similar amounts from members ......................................................................
1
 
2
Section 162(e) nondeductible lobbying and political expenditures (do not include amounts of political expenses for which the section 527(f) tax was paid).
a
Current year .............................................................................................................................
2a
 
b
Carryover from last year ............................................................................................................
2b
 
c
Total ...........................................................................................................................................
2c
 
3
Aggregate amount reported in section 6033(e)(1)(A) notices of nondeductible section 162(e) dues .
3
 
4
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? ......................................................................................................................
4
 
5
Taxable amount of lobbying and political expenditures (see instructions) .........................................
5
 
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
SCHEDULE C, PART II-B, LINE 1(I) OTHER LOBBYING ACTIVITIES: THE HOSPITAL HOLDS MEMBERSHIP IN THE HOSPITAL & HEALTH SYSTEM ASSOCIATION OF PENNSYLVANIA (HAP) AND THE HEALTHCARE COUNCIL OF WESTERN PENNSYLVANIA (HCWP) WHICH ENGAGE IN LOBBYING AS PART OF THEIR MISSION TO REPRESENT THE INTEREST OF HOSPITALS AT BOTH THE FEDERAL AND STATE LEVELS.
Schedule C (Form 990 or 990EZ) 2019


Additional Data


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Software Version:  

SCHEDULE D
(Form 990)
Department of the Treasury
Internal Revenue Service
Supplemental Financial Statements
SchDMd Bullet 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.
SchDMd Bullet Go to www.irs.gov/Form990 for instructions and the latest information.
OMB No. 1545-0047
2019
Open to Public Inspection
Name of the organization
ARMSTRONG COUNTY MEMORIAL HOSPITAL
 
Employer identification number

25-0965237
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 ........    
5
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? ............
6
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? ...................................
Part II
Conservation Easements.
Complete if the organization answered "Yes" on Form 990, Part IV, line 7.
1
Purpose(s) of conservation easements held by the organization (check all that apply).
2
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.
Held at the End of the 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 7/25/06, and not on a historic structure listed in the National Register ... 2d  
3
Number of conservation easements modified, transferred, released, extinguished, or terminated by the organization during the
tax year SchDMd Bullet  
4
Number of states where property subject to conservation easement is located SchDMd Bullet  
5
Does the organization have a written policy regarding the periodic monitoring, inspection, handling of violations, and enforcement of the conservation easements it holds? ............
6
Staff and volunteer hours devoted to monitoring, inspecting, handling of violations, and enforcing conservation easements during the year
SchDMd Bullet  
7
Amount of expenses incurred in monitoring, inspecting, handling of violations, and enforcing conservation easements during the year
SchDMd Bullet $  
8
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)? .............................
9
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.
1a
If the organization elected, as permitted under FASB 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.
b
If the organization elected, as permitted under FASB 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 $  
2
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 FASB ASC 958 relating to these items:
a
Revenue included on Form 990, Part VIII, line 1 ..........................SchDMd Bullet $  
b
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) 2019

Schedule D (Form 990) 2019
Page 2
Part III
Organizations Maintaining Collections of Art, Historical Treasures, or Other Similar Assets (continued)
3
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):
a
d
b
e
 
c
4
Provide a description of the organization’s collections and explain how they further the organization’s exempt purpose in
Part XIII.
5
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?...
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.
1a
Is the organization an agent, trustee, custodian or other intermediary for contributions or other assets not
included on Form 990, Part X? ....................................
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  
2a
Did the organization include an amount on Form 990, Part X, line 21, for escrow or custodial account liability? ...
b
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 ......          
2
Provide the estimated percentage of the current year end balance (line 1g, column (a)) held as:
a
Board designated or quasi-endowment SchDMd Bullet  
b
Permanent endowment SchDMd Bullet  
c
Term endowment SchDMd Bullet  
The percentages on lines 2a, 2b, and 2c should equal 100%.
3a
Are there endowment funds not in the possession of the organization that are held and administered for the
organization by:

Yes
No
(i) Unrelated organizations .................
3a(i)
 
 
(ii) Related organizations .................
3a(ii)
 
 
b
If "Yes" on 3a(ii), are the related organizations listed as required on Schedule R? .........
3b
 
 
4
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 .....   297,281 297,281
b Buildings ....   48,170,205 34,297,797 13,872,408
c Leasehold improvements        
d Equipment ....   82,253,367 72,880,904 9,372,463
e Other .....   3,210,271 2,936,787 273,484
Total. Add lines 1a through 1e. (Column (d) must equal Form 990, Part X, column (B), line 10(c).)..SchDMdBullet 23,815,636
Schedule D (Form 990) 2019

Schedule D (Form 990) 2019
Page 3
Part VII
Investments—Other 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........ 244,306 C
(3) Other
(A) CHART		 3,986,362 C

(B) VANTAGE		 912,963 C
(C)
(D)
(E)
(F)
(G)
(H)
(I)
Total. (Column (b) must equal Form 990, Part X, col. (B) line 12.)Small Bullet 5,143,631
Part VIII
Investments—Program 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
(2)
(3)
(4)
(5)
(6)
(7)
(8)
(9)
(10)
Total. (Column (b) must equal Form 990, Part X, col.(B) line 13.)Small Bullet  
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)OTHER RECEIVABLES 7,048,785
(2)DUE FROM 3RD PARTY PAYERS 273,489
(3)ACCRUED INTEREST 16,415
(4)DUE FROM AFFILIATES 722,042
(5)
(6)
(7)
(8)
(9)
(10)
Total. (Column (b) must equal Form 990, Part X, col.(B) line 15.)...........Small Bullet 8,060,731
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
(4)
(5)
(6)
(7)
(8)
(9)
Total. (Column (b) must equal Form 990, Part X, col.(B) line 25.)Small Bullet 10,555,895
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) 2019

Schedule D (Form 990) 2019
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 ....... 1 102,310,469
2 Amounts included on line 1 but not on Form 990, Part VIII, line 12:
a Net unrealized gains (losses) on investments .... 2a -25,764
b Donated services and use of facilities ......... 2b  
c Recoveries of prior year grants ........... 2c  
d Other (Describe in Part XIII.) ............ 2d -2,369,493
e Add lines 2a through 2d ..................... 2e -2,395,257
3 Subtract line 2e from line 1.................. 3 104,705,726
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 392,286
c Add lines 4a and 4b.................... 4c 392,286
5 Total revenue. Add lines 3 and 4c. (This must equal Form 990, Part I, line 12.) ...... 5 105,098,012
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 97,123,534
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 97,123,534
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 2,369,493
c Add lines 4a and 4b..................... 4c 2,369,493
5 Total expenses. Add lines 3 and 4c. (This must equal Form 990, Part I, line 18.) ...... 5 99,493,027
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, PART X, LINE 2 UNCERTAIN TAX POSITIONS: MANAGEMENT HAS EVALUATED THEIR INCOME TAX POSITIONS UNDER THE GUIDANCE INCLUDED IN ASC 740. BASED ON THEIR REVIEW, MANAGEMENT HAS NOT IDENTIFIED ANY MATERIAL UNCERTAIN TAX POSITIONS TO BE RECORDED OR DISCLOSED IN THE FINANCIAL STATEMENTS.
SCHEDULE D, PART XI, LINE 2D AMOUNTS INCLUDED ON LINE 1 BUT NOT ON FORM 990, PART VIII, LINE 12: $ (2,369,493) BAD DEBT EXPENSE
SCHEDULE D, PART XI, LINE 4B AMOUNTS INCLUDED ON FORM 990, PART VIII, LINE 12, BUT NOT ON LINE 1: $ 392,286 GRANTS FOR PROPERTY AND EQUIPMENT ACQUISITION
SCHEDULE D, PART XII, LINE 4B AMOUNTS INCLUDED ON FORM 990, PART IX, LINE 25, BUT NOT ON LINE 1: $ 2,369,493 BAD DEBT EXPENSE
Schedule D (Form 990) 2019


Additional Data


Software ID:  
Software Version:  




SCHEDULE H
(Form 990)
Department of the Treasury
Internal Revenue Service
Hospitals
MediumBullet Complete if the organization answered "Yes" on Form 990, Part IV, question 20.
MediumBullet Attach to Form 990.
MediumBullet Go to www.irs.gov/Form990EZ for instructions and the latest information.
OMB No. 1545-0047
2019
Open to Public Inspection
Name of the organization
ARMSTRONG COUNTY MEMORIAL HOSPITAL
 
Employer identification number

25-0965237
Part I
Financial Assistance and Certain Other Community Benefits at Cost
Yes
No
1a
Did the organization have a financial assistance policy during the tax year? If "No," skip to question 6a . . . .
1a
Yes
 
b
If "Yes," was it a written policy? ......................
1b
Yes
 
2
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.
3
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.
a
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:
3a
Yes
 
%
b
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: . . . . . . . .
3b
Yes
 
%
c
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.
4
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"? . . . . . . . . . . . . .

4

Yes

 
5a
Did the organization budget amounts for free or discounted care provided under its financial assistance policy during
the tax year? . . . . . . . . . . . . . . . . . . . . . . .

5a

Yes

 
b
If "Yes," did the organization's financial assistance expenses exceed the budgeted amount? . . . . . .
5b
 
No
c
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? . . . . . . . . . . . . .
5c
 
 
6a
Did the organization prepare a community benefit report during the tax year? . . . . . . . . .
6a
 
No
b
If "Yes," did the organization make it available to the public? . . . . . . . . . . . . .
6b
 
 
Complete the following table using the worksheets provided in the Schedule H instructions. Do not submit these worksheets with the Schedule H.
7
Financial Assistance and Certain Other Community Benefits at Cost
Financial Assistance and
Means-Tested
Government Programs
 (a) Number of activities or programs (optional) (b) Persons served (optional) (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) . . . 		    460,192   460,192 0.470 %
b Medicaid (from Worksheet 3, column a) . . . . .     15,886,922 11,794,095 4,092,827 4.210 %
c Costs of other means-tested government programs (from Worksheet 3, column b) . .            
d Total Financial Assistance and Means-Tested Government Programs . . . . .     16,347,114 11,794,095 4,553,019 4.680 %
Other Benefits
e Community health improvement services and community benefit operations (from Worksheet 4).     94,156   94,156 0.100 %
f Health professions education (from Worksheet 5) . . .     309,251 70,140 239,111 0.250 %
g Subsidized health services (from Worksheet 6) . . . .     4,439,464 3,379,021 1,060,443 1.100 %
h Research (from Worksheet 7) .            
i Cash and in-kind contributions for community benefit (from Worksheet 8) . . . .     15,260   15,260 0.020 %
j Total. Other Benefits . .     4,858,131 3,449,161 1,408,970 1.470 %
k Total. Add lines 7d and 7j .     21,205,245 15,243,256 5,961,989 6.150 %
For Paperwork Reduction Act Notice, see the Instructions for Form 990. Cat. No. 50192T Schedule H (Form 990) 2019
Schedule H (Form 990) 2019
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     2,818   2,818  
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     2,818   2,818  
Part III
Bad Debt, Medicare, & Collection Practices
Section A. Bad Debt Expense
Yes
No
1
Did the organization report bad debt expense in accordance with Healthcare Financial Management Association Statement No. 15? ..........................
1
 
No
2
Enter the amount of the organization's bad debt expense. Explain in Part VI the methodology used by the organization to estimate this amount. ......
2
2,369,493
3
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. ......
3
305,665
4
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
5
Enter total revenue received from Medicare (including DSH and IME).....
5
13,567,773
6
Enter Medicare allowable costs of care relating to payments on line 5.....
6
14,211,992
7
Subtract line 6 from line 5. This is the surplus (or shortfall)........
7
-644,219
8
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:
Section C. Collection Practices
9a
Did the organization have a written debt collection policy during the tax year? ..........
9a
Yes
 
b
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 .........................

9b

 

No
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) 2019
Schedule H (Form 990) 2019
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?1Name, 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) 		Licensed Hospital General-Medical-Surgical Children's Hospital Teaching Hospital Critical Hospital ResearchGrp Facility ER-24Hours ER-Other Other (describe) Facility reporting group
1 ARMSTRONG COUNTY MEMORIAL HOSPITAL
ONE NOLTE DRIVE
KITTANNING,PA16201
WWW.ACMH.ORG
270901 		X X         X   SNU, REHAB & PSYCHIATRIC UNITS  
Schedule H (Form 990) 2019
Schedule H (Form 990) 2019
Page 4
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)
ARMSTRONG COUNTY MEMORIAL HOSPITAL
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): 		1
Yes No
Community Health Needs Assessment
1 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?........................ 1   No
2 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............... 2   No
3 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...................... 3 Yes  
If "Yes," indicate what the CHNA report describes (check all that apply):
a
b
c
d
e
f
g
h
i
j
4 Indicate the tax year the hospital facility last conducted a CHNA: 20 17
5 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 ................. 5 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.................................. 6a   No
b 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. ............................ 6b   No
7 Did the hospital facility make its CHNA report widely available to the public?.............. 7 Yes  
If "Yes," indicate how the CHNA report was made widely available (check all that apply):
a
b
c
d
8 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. .............. 		8 Yes  
9 Indicate the tax year the hospital facility last adopted an implementation strategy: 20 17
10 Is the hospital facility's most recently adopted implementation strategy posted on a website?......... 10 Yes  
a If "Yes" (list url): SEE PART V, SECTION C
b If "No," is the hospital facility’s most recently adopted implementation strategy attached to this return? ...... 10b    
11 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   No
b If "Yes" on line 12a, did the organization file Form 4720 to report the section 4959 excise tax?........ 12b    
c 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) 2019
Schedule H (Form 990) 2019
Page 5
Part VFacility Information (continued)

Financial Assistance Policy (FAP)
ARMSTRONG COUNTY MEMORIAL HOSPITAL
Name of hospital facility or letter of facility reporting group  
Yes No
Did the hospital facility have in place during the tax year a written financial assistance policy that:
13 Explained eligibility criteria for financial assistance, and whether such assistance included free or discounted care? 13 Yes  
If “Yes,” indicate the eligibility criteria explained in the FAP:
a
b
c
d
e
f
g
h
14 Explained the basis for calculating amounts charged to patients?................. 14 Yes  
15 Explained the method for applying for financial assistance?................... 15 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):
a
b
c
d
e
16 Was widely publicized within the community served by the hospital facility?........ 16 Yes  
If "Yes," indicate how the hospital facility publicized the policy (check all that apply):
a
SEE PART V, SECTION C
b
SEE PART V, SECTION C
c
d
e
f
g
h
i
j
Schedule H (Form 990) 2019
Schedule H (Form 990) 2019
Page 6
Part VFacility Information (continued)

Billing and Collections
ARMSTRONG COUNTY MEMORIAL HOSPITAL
Name of hospital facility or letter of facility reporting group  
Yes No
17 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 nonpayment?.................................. 17 Yes  
18 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:
a
b
c
d
e
f
19 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?............ 19   No
If "Yes," check all actions in which the hospital facility or a third party engaged:
a
b
c
d
e
20 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):
a
b
c
d
e
f
Policy Relating to Emergency Medical Care
21 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?.................. 21 Yes  
If "No," indicate why:
a
b
c
d
Schedule H (Form 990) 2019
Schedule H (Form 990) 2019
Page 7
Part VFacility Information (continued)

Charges to Individuals Eligible for Assistance Under the FAP (FAP-Eligible Individuals)
ARMSTRONG COUNTY MEMORIAL HOSPITAL
Name of hospital facility or letter of facility reporting group  
Yes No
22 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.
a
b
c
d
23 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? ............................... 23   No
If "Yes," explain in Section C.
24 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? ........................... 24   No
If "Yes," explain in Section C.
Schedule H (Form 990) 2019
Schedule H (Form 990) 2019
Page 8
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, 16j, 18e, 19e, 20a, 20b, 20c, 20d, 20e, 21c, 21d, 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 COMMUNITY INPUT: THE COMMUNITY STAKEHOLDERS WHO PARTICIPATED IN THIS COMMUNITY HEALTH NEEDS ASSESSMENT REPRESENTED A CROSS-SECTION OF THE HEALTH AND HUMAN SERVICES AGENCIES IN ARMSTRONG COUNTY. SOME PARTICIPANTS WERE SPECIFICALLY CHOSEN BECAUSE OF THEIR PUBLIC HEALTH KNOWLEDGE AND EXPERIENCE. OTHERS WERE CHOSEN BECAUSE OF THEIR EXPERTISE IN: - CHRONIC HEALTH CONDITIONS IN ARMSTRONG COUNTY - BARRIERS TO HEALTHCARE - KNOWLEDGE OF UNDERSERVED GROUPS OF POPULATION IN ARMSTRONG COUNTY - FORMING ORGANIZATIONAL COLLABORATIONS WITH ACMH HOSPITAL TO MEET HEALTH NEEDS - AN AWARENESS OF THE HEALTH CONCERNS OF THE PEOPLE UTILIZING HEALTHCARE SERVICES - WHERE RESIDENTS OF THE COUNTY ARE GOING FOR HEALTH AND WELLNESS SERVICES -RELIABLE SOURCES OF HEALTH INFORMATION INTERVIEWS WITH THESE STAKEHOLDERS REVEALED CERTAIN BARRIERS TO HEALTH SERVICES AND UNDERSERVED GROUPS OF THE POPULATION IN ARMSTRONG COUNTY WHERE PRIORITY COMMUNITY NEEDS.
SCHEDULE H, PART V, SECTION B, LINE 7A CHNA URL: HTTPS://WWW.ACMH.ORG/CHNA
SCHEDULE H, PART V, SECTION B, LINE 10A IMPLEMENTATION STRATEGY URL: HTTPS://WWW.ACMH.ORG/CHNA
SCHEDULE H, PART V, SECTION B, LINE 11 ADDRESSING IDENTIFIED NEEDS: ACMH IS ADDRESSING THE SIGNIFICANT NEEDS IDENTIFIES IN OUR MOST RECENT CHNA AS FOLLOWS: 1. EDUCATION OF COMMUNITY MEMBERS REGARDING THEIR HEALTHCARE NEEDS AND PREVENTIVE CARE SERVICES THEY SHOULD BE EMPLOYING. ACMH PURCHASED A NEW DEXA, BONE DENSITY SCANNER TO DIAGNOSIS OSTEOPOROSIS. OSTEOPOROSIS IS A GROWING HEALTHCARE CRISIS AFFECTING MILLIONS OF MEN AND WOMEN. OSTEOPOROSIS IS DETECTABLE AND TREATABLE. THIS SYSTEM WILL HELP IDENTIFY PATIENTS AT RISK FOR OSTEOPOROSIS AND FRACTURES. THIS PARTICULAR SCANNER ALSO HAS THE ABILITY TO MEASURE BODY COMPOSITION. REGULARLY SCHEDULED BODY COMPOSITION SCANS DURING THE COURSE OF A PATIENT'S WEIGHT MANAGEMENT PROGRAM WILL SHOW IF THE WEIGHT LOSS IS FROM FAT STORES OR FROM MUSCLE. WHEN USED IN CONJUNCTION WITH WEIGHT MANAGEMENT PROGRAMS IT CAN BE USED TO HELP PATIENTS LOSE BODY FAT, NOT MUSCLE MASS, FOR A MORE SUCCESSFUL AND HEALTHIER LONG TERM WEIGHT LOSS. ACMH OPENED A CONCUSSION CARE CLINIC IN DECEMBER 2015 IN THE SNYDER INSTITUTE. ACMH USES THE C3 LOGIX APPLICATION THAT WAS DEVELOPED AT CLEVELAND CLINIC AND ACQUIRED BY ALLEGHENY HEALTH NETWORK FOR THEIR SPORTS MEDICINE PROGRAM. WITH THE RECENT FOCUS ON CHRONIC TRAUMATIC ENCEPHALOPATHY (CTE) AND CONCUSSIONS, AHN SHARED THEIR KNOWLEDGE WITH ACMH. THE FOCUS OF THE PROGRAM CONTINUES TO BE MANAGING PEOPLE SUFFERING FROM ACUTE CONCUSSIONS OR ACUTE POST-CONCUSSION SYMPTOMS. CONCUSSION CARE IS SEEING APPROXIMATELY 35 PATIENTS EACH MONTH WITH MOST OF THE VOLUME BEING ATTRIBUTED TO ATHLETES. 2. EDUCATION OF COMMUNITY MEMBERS, HEALTH CARE ORGANIZATIONS AND HEALTH AND HUMAN SERVICE ORGANIZATIONS AS TO WHAT SERVICES ARE AVAILABLE WITHIN THE COUNTY. THE PLANNING COMMITTEE BELIEVES THAT THE DEVELOPMENT AND PUBLICATION OF A CATALOG OF ORGANIZATIONS WITHIN THE COMMUNITY WITH EXPLANATORY INFORMATION ABOUT THE SERVICES EACH OFFERS ALONG WITH RELEVANT CONTACTS WOULD BE A HELPFUL AND WORKABLE SOLUTION. A STAT MEDEVAC REPRESENTATIVE PROVIDES EDUCATION TO EMTS AND PARAMEDICS USING A QA COMMITTEE TO DETERMINE WHICH CLASSES TO PROVIDE. EDUCATION THAT HAS BEEN PROVIDED INCLUDES: NARCAM, DON'T DELAY- CALL 911, USE OF SIMULATED PATIENTS TO PROVIDE TRAINING AND WHAT NURSES IN THE ED DO. HE HAS ALSO ARRANGED FOR FOLLOW-UP INFORMATION TO BE PROVIDED BACK TO THE PARAMEDICS AFTER THE PATIENT HAS BEEN SEEN IN THE ED. 3. OBESITY ACMH CONTINUES TO WORK THROUGH THE HEALTHY ARMSTRONG PROGRAM TO ADDRESS OBESITY WITHIN THE COMMUNITY. ACMH IS INVESTIGATING THE FEASIBILITY OF DEVELOPING A MEDICAL WEIGHT LOSS CLINIC THAT WOULD INCLUDE A CLINICIAN (A CERTIFIED AS A FELLOW IN WEIGHT LOSS), DIETITIANS, A PROGRAM OF PHYSICAL EXERCISE, A PSYCHOLOGIST OR PSYCHIATRIST, AND A SURGEON WHO WOULD PERFORM GASTRIC SLEEVE SURGERY. 4. DIABETES THE PLANNING COMMITTEE BELIEVES THAT ENHANCED EDUCATION FOR NEWLY DIAGNOSED PATIENTS WILL HAVE THE GREATEST IMPACT IN NEGATING FUTURE PROBLEMS FOR THOSE PATIENTS. ACMH IS IN THE MIDDLE OF THE 2ND RECERTIFICATION BY THE AMERICAN DIABETES ASSOCIATION FOR DIABETES EDUCATION. THE CERTIFICATION PROVIDES A FORMAL STRUCTURE TO TEACH THE USE OF A SELF-MANAGEMENT SURVEY. OUR DIABETES NURSE NAVIGATOR GOES TO ACMH PHYSICIAN-OWNED PRACTICES IN LEECHBURG, RURAL VALLEY AND DOWNTOWN KITTANNING. PROVIDERS IN THOSE PRACTICES REFER PATIENTS BELIEVED TO BE AT HIGH RISK. MEETINGS WITH PATIENTS LAST FROM 1.5 TO 2 HOURS. ABOUT 60% OF REFERRED PATIENTS PARTICIPATE. EDUCATIONAL CLASSES ARE ALSO BEING CONDUCTED AT THE ENDOCRINOLOGY OFFICE TOGETHER WITH THE CRNP THERE. THESE CLASSES PROVIDE EDUCATION ON NEW TECHNOLOGY FOR DIABETES MANAGEMENT, CONTINUOUS GLUCOSE TESTING AND TYPE 1 EQUIPMENT THAT CAN BE OBTAINED THROUGH LOCAL PHARMACIES. THE NURSE NAVIGATOR IS ALSO WORKING ON A PRE-DIABETES PROGRAM FOR INDIVIDUALS AT RISK AND WITH THE LOCAL YMCA IN THEIR PROGRAMS TO ADDRESS PRE-DIABETES. THE YMCA PROGRAM CONSISTS OF NUTRITION COUNSELOR WEIGHT LOSS COUNSELOR, AND PERSONAL EXERCISE PROGRAM. SHE ALSO SPEAKS TO DIFFERENT GROUPS IN THE COMMUNITY. 5. CANCER RATES AND SCREENINGS THE HIGH CANCER RATES IN ARMSTRONG COUNTY ARE MAINLY COLORECTAL, ESOPHAGEAL, LUNG AND BREAST. A SUBCOMMITTEE WILL ATTEMPT TO CORRELATE SCREENING NEEDS, EDUCATION PROGRAMS AND APPROPRIATE CLINICAL INTERVENTIONS NEEDS RELATIVE TO CANCER RATES. A MITIGATION BEING CONSIDERED IS TO ENGAGE SPECIALISTS IN ESOPHAGEAL DISORDERS FOR ENHANCED SCREENINGS AND INTERVENTIONS. SUBSEQUENT PLANS OF ACTION FOR OTHER HIGH RATE CANCERS WILL ALSO BE DEVELOPED. ACMH HAS ACQUIRED MEDICAL STAFF TO ADDRESS ESOPHAGEAL DISEASE, TREATING GERO FOR INDIVIDUALS WHO PRESENT WITH A BMI OF 35 OR LESS. ACMH BEGAN OFFERING LOW DOSE CT (LDCT) FOR LUNG CANCER SCREENING IN 2013. AT THAT TIME IT WAS NOT PAID FOR BY MOST INSURANCES. IN FEBRUARY 2015, MEDICARE ISSUED A FINAL DECISION TO PAY FOR THE LOW DOSE CT BECAUSE OF THE SIGNIFICANT NUMBER OF PREMATURE DEATHS THAT COULD BE PREVENTED. LDCT IS THE ONLY SCREENING TEST SHOWN TO LOWER THE CHANCE OF DYING FROM LUNG CANCER. POSITIVE PATIENT CASES ARE REVIEWED AND FOLLOWED BY A MULTIDISCIPLINARY TEAM THAT IS TRAINED AND EXPERIENCED IN PROVIDING THE CONTINUUM OF CARE FOR LUNG CANCER SCREENING, INCLUDING IMAGE INTERPRETATION, DIAGNOSTIC PROCEDURES, PATHOLOGY SPECIMEN, TREATMENT, AND FOLLOW-UP BASED UPON BEST PRACTICES ESTABLISHED IN THE NATIONAL LUNG SCREENING TRIAL. ACMH BEGAN OFFERING DIGITAL BREAST TOMOGRAPHY (DBT) IN SEPTEMBER OF 2016. AS WITH ANY DIAGNOSTIC SCREENING, EARLY DETECTION SAVES LIVES. ANOTHER ADVANTAGE OF DBT IS THAT IT DETECTS ONE TO TWO ADDITIONAL CANCERS PER THOUSAND WOMEN SCREENED AND REDUCES THE NEED FOR RECALL FOR ADDITIONAL IMAGING FOR FINDINGS THAT ARE NOT CANCER. 6. TRANSPORTATION ACMH IS CONSIDERING AN OUTSIDE REVIEW OR USING OUTSIDE SUPPORT TO ANALYZE TRANSPORTATION NEEDS AND TO IDENTIFY ALL ALTERNATIVE TRANSPORTATION SYSTEMS AVAILABLE WITHIN ARMSTRONG COUNTY. TRANSPORTATION CONTINUES TO BE A PROBLEM WITHIN ARMSTRONG COUNTY. TRANSPORTATION IS PROVIDED FOR PATIENTS OF LIFE ARMSTRONG. HOSE COMPANY #6 PROVIDES MUCH TRANSPORTATION FOR PATIENTS WHO USE WHEELCHAIRS. ACMH COVERS THE COST OF TAXI FARES FOR DISCHARGED PATIENTS WHO DO NOT HAVE TRANSPORTATION HOME. 7. SUBSTANCE ABUSE AND ADDICTION ACMH WILL CONTINUE TO SUPPORT "DRUGS KILL DREAMSITS "JAIL EXPERIENCE" PROGRAM. ACMH WILL CONTINUE THE EDUCATIONAL PROGRAM IT BEGAN IN 2014 ADDRESSING YOUTH ACCESS TO FAMILY MEMBERS' PRESCRIPTION MEDICATIONS. ACMH WILL WORK WITH ARC MANOR (ADDICTION RECOVERY CENTER) TO ADDRESS DUAL DIAGNOSIS ISSUES AND IS IMPLEMENTING A HOSPITAL-BASED DETOXIFICATION UNIT. THE COMMONWEALTH OFFICE OF MENTAL HEALTH PROVIDED $250,000 REINVESTMENT MONIES TO OPEN A 4 BED HOSPITAL-BASED DETOX PROGRAM. THE PROGRAM WILL BE CLASSIFIED AS A LEVEL 4A MEANING PATIENT MUST HAVE SUBSTANCE USE DISORDER AND BE IN ACUTE WITHDRAWAL. ADMISSION IS VOLUNTARY FOR THE PATIENT AND THE AVERAGE LENGTH OF STAY WILL BE 3-5 DAYS. STAFFING WILL CONSIST OF ONE RN, A NURSE'S AIDE AND A THERAPIST AND MAY WORK IN CONJUNCTION WITH THE BEHAVIORAL HEALTH ASSESSMENT TEAM. PHYSICIAN AND MID-LEVELS WILL BE ON SITE AND ON CALL. REFERRALS WILL ORIGINATE PRIMARILY FROM THE ED. THE PROGRAM IS TENTATIVELY SCHEDULED TO OPEN IN APRIL 2018. NARCAM EDUCATION IS BEING PROVIDED TO AREA EMTS AND PARAMEDICS. 8. RESOURCES AVAILABLE FOR UNDER- AND UN-INSURED INDIVIDUALS A COMMITTEE WAS FORMED IN FISCAL YEAR 2016 TO ADDRESS THIS NEED. THE PLANNING COMMITTEE BELIEVES THAT A FEASIBLE SOLUTION WOULD BE THE DEVELOPMENT OF A CONCIERGE/NAVIGATOR SERVICE, WHICH WOULD INDIVIDUALLY GUIDE PATIENTS THROUGH THE HEALTHCARE SYSTEM AND DETERMINE/ACCESS AVAILABLE RESOURCES. NEARLY 100 PATIENTS PER MONTH SEEK FINANCIAL COUNSELING FOR HELP PAYING FOR THEIR HEALTH CARE SERVICES AT ACMH HOSPITAL AND AT PROVIDER OFFICES. 9. PROVIDER SHORTAGES ACMH HAS RECENTLY HIRED A PSYCHIATRIST, WHICH SOMEWHAT REDUCES THE MENTAL HEALTH CARE PROVIDER SHORTAGE IN ARMSTRONG COUNTY. ACMH IS TAKING STEPS TO RECRUIT UROLOGISTS AND NEUROLOGISTS INTO ARMSTRONG COUNTY. A NEUROLOGIST HAS BEEN HIRED AND WILL BE SUPPORTED BY A NEUROLOGIST FROM PUNXSUTAWNEY WHO WILL PROVIDE TELENEUROLOGY SERVICES DURING DAYLIGHT HOURS. UPMC IS PROVIDING TELENEUROLOGY SERVICES DURING NIGHTS AND ON WEEKENDS. ACMH CONTINUES TO PURSUE UROLOGISTS, PSYCHIATRISTS AND GENERAL SURGEONS.
SCHEDULE H, PART V, SECTION B, LINES 16A-C FAP, APPLICATION, AND PLS URL: HTTP://ACMH.ORG/BILLING-AND-INSURANCE#FINANCIALASSISTANCE
SCHEDULE H, PART V, SECTION B, LINE 16J THE FINANCIAL ASSISTANCE POLICY INDICATES: INDIVIDUAL NOTICES INFORMING PATIENTS ABOUT FINANCIAL ASSISTANCE/DISCOUNT WILL BE OFFERED AT THE TIME OF REGISTRATION. SIGNS WILL BE POSTED IN REGISTRATION AREAS OF THE HOSPITAL AND ITS AFFILIATED CLINICS AND PHYSICIAN OFFICES.
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
Schedule H (Form 990) 2019
Schedule H (Form 990) 2019
Page 9
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?10
Name and address Type of Facility (describe)
1 ARMSTRONG PRIMARY CARE CENTER LEECHBURG
116 MAIN ST
LEECHBURG,PA15656 		PRIMARY CARE, LAB DRAW, RADIOLOGY, PHYSICAL THERAPY
2 ACMH HEALTH PAVILION
202 5TH AVENUE
FORD CITY,PA16226 		OUTPATIENT PHYSICAL THERAPY, LAB DRAW
3 ARMSTRONG PRIMARY CARE CENTEER ELDERTON
116 MAIN ST
ELDERTON,PA15736 		PRIMARY CARE, LAB DRAW, RADIOLOGY
4 ARMSTRONG PRIMARY CARE CTR S BETHLEHEM
102 SOUTH ST
NEW BETHLEHEM,PA16242 		PRIMARY CARE, LAB DRAW
5 ARMSTRONG PRIMARY CARE CTR RURAL VALLEY
10261 ST RT 85
KITTANNING,PA16201 		PRIMARY CARE, LAB DRAW
6 ARMSTRONG PRIMARY CARE CENTER KITTANNING
260 SOUTH JEFFERSON ST
KITTANNING,PA16201 		PRIMARY CARE, LAB DRAW
7 ARMSTRONG OUTPATIENT IMAGING CENTER
87 GLADE DRIVE
KITTANNING,PA16201 		OUTPATIENT RADIOLOGY CENTER
8 COWANSVILLE HEALTH CENTER
882 EAST BRADY ROAD
COWANSVILLE,PA16218 		LAB DRAW
9 WORTHINGTON FAMILY PRACTICE
1482 BUTLER RD
WORTHINGTON,PA16262 		LAB DRAW
10 ENDOCRINOLOGY ASSOCIATES
600 MEDICAL ARTS BUILDING SUITE 64
KITTANNING,PA16201 		ENDOCRINOLOGY CLINIC
Schedule H (Form 990) 2019
Schedule H (Form 990) 2019
Page 10
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, LINE 7: COSTING METHODOLOGY: THE COST TO CHARGE RATIO COMPUTED ON IRS WORKSHEET 2 WAS USED IN THE CALCULATION ON IRS WORKSHEETS 1 AND 3.
SCHEDULE H, PART I, LINE 7G SUBSIDIZED HEALTH SERVICES: ARMSTRONG COUNTY MEMORIAL HOSPITAL REPORTS FIVE RHC FACILITIES AS SUBSIDIZED HEALTH SERVICES. WHEN THESE CLINICS WERE ESTABLISHED, THE AREAS IN WHICH THEY ARE LOCATED WERE IN MEDICALLY UNDERSERVED AREAS OR PHYSICIAN SHORTAGE AREAS. ACMH HOSPITAL ALSO REPORTS INPATIENT PSYCH AND SKILLED NURSING UNITS AS SUBSIDIZED HEALTH SERVICES. THE IRS DEFINITION OF A SUBSIDIZED HEALTH SERVICE MEANS CLINICAL SERVICES PROVIDED DESPITE A FINANCIAL LOSS TO THE ORGANIZATION.
SCHEDULE H, PART I, LINE 7, COLUMN F PERCENT OF TOTAL EXPENSE: TO ARRIVE AT THE PERCENT OF TOTAL EXPENSES, THE DENOMINATOR WHICH EQUALS TOTAL OPERATING EXPENSES PER FORM 990, PART IX, LINE 25, WAS REDUCED BY BAD DEBT EXPENSE OF $2,369,493.
SCHEDULE H, PART II COMMUNITY BUILDING ACTIVITIES: THE PRIMARY COMMUNITY BUILDING ACTIVITIES ARE STAFF INVOLVEMENT WITH HEALTHY ARMSTRONG WHICH IS A COLLABORATIVE EFFORT TO IMPROVE THE HEALTH OF FAMILIES AND HELP CHILDREN MAINTAIN A HEALTHY WEIGHT THROUGH IMPROVED NUTRITION AND INCREASED PHYSICAL ACTIVITY. HOSPITAL REPRESENTATIVES ALSO ATTEND CAREER DAYS AT LOCAL SCHOOLS AND PROVIDE TOURS OF THE FACILITY TO EDUCATE STUDENTS ABOUT CAREERS IN HEALTH CARE.
SCHEDULE H, PART III, SECTION A, LINE 2 BAD DEBT EXPENSE: THIS IS THE AMOUNT REPORTED AS BAD DEBT ON THE HOSPITAL'S AUDITED FINANCIAL STATEMENTS.
SCHEDULE H, PART III, SECTION A, LINE 3 BAD DEBT EXPENSE ATTRIBUTABLE TO CHARITY CARE: THIS AMOUNT WAS ESTIMATED BY MULTIPLYING THE TOTAL BAD DEBT EXPENSE ON THE AUDITED FINANCIAL STATEMENTS BY THE POVERTY PERCENTAGE FOR ARMSTRONG COUNTY REPORTED ON WWW.CENSUS.GOV.
SCHEDULE H, PART III, SECTION A, LINE 4 BAD DEBT EXPENSE AUDIT FOOTNOTE: THE AUDITED FINANCIAL STATEMENTS DO NOT CONTAIN A FOOTNOTE THAT DESCRIBES BAD DEBT EXPENSE. THEY DO, HOWEVER, CONTAIN A FOOTNOTE THAT DESCRIBES PATIENT ACCOUNTS RECEIVABLE. THAT FOOTNOTE READS AS FOLLOWS: ACCOUNTS RECEIVABLE ARE REDUCED BY AN ALLOWANCE FOR UNCOLLECTIBLE ACCOUNTS. IN EVALUATING THE COLLECTABILITY OF ACCOUNTS RECEIVABLE, THE HOSPITAL ANALYZES ITS PAST HISTORY AND IDENTIFIES TRENDS FOR EACH OF ITS MAJOR PAYER SOURCES OF REVENUE TO ESTIMATE THE APPROPRIATE ALLOWANCE FOR UNCOLLECTIBLE ACCOUNTS AND PROVISION FOR UNCOLLECTIBLE ACCOUNTS. MANAGEMENT REGULARLY REVIEWS DATA ABOUT THESE MAJOR PAYER SOURCES OF REVENUE IN EVALUATING THE SUFFICIENCY OF THE ALLOWANCE FOR UNCOLLECTIBLE ACCOUNTS. FOR RECEIVABLES ASSOCIATED WITH SERVICES PROVIDED TO PATIENTS WHO HAVE THIRD-PARTY COVERAGE, THE HOSPITAL ANALYZES CONTRACTUALLY DUE AMOUNTS AND PROVIDES AN ALLOWANCE FOR UNCOLLECTIBLE ACCOUNTS AND A PROVISION FOR UNCOLLECTIBLE ACCOUNTS, IF NECESSARY (FOR EXAMPLE, FOR EXPECTED UNCOLLECTIBLE DEDUCTIBLES AND COPAYMENTS ON ACCOUNTS FOR WHICH THE THIRD-PARTY PAYER HAS NOT YET PAID, OR FOR PAYERS WHO ARE KNOWN TO BE HAVING FINANCIAL DIFFICULTIES THAT MAKE THE REALIZATION OF AMOUNTS DUE UNLIKELY). FOR RECEIVABLES ASSOCIATED WITH SELF-PAY PATIENTS (WHICH INCLUDES BOTH PATIENTS WITHOUT INSURANCE AND PATIENTS WITH DEDUCTIBLE AND COPAYMENT BALANCES DUE FOR WHICH THIRD-PARTY COVERAGE EXISTS FOR PART OF THE BILL), THE HOSPITAL RECORDS A SIGNIFICANT PROVISION FOR UNCOLLECTIBLE ACCOUNTS IN THE PERIOD OF SERVICE ON THE BASIS OF ITS PAST EXPERIENCE, WHICH INDICATES THAT MANY PATIENTS ARE UNABLE OR UNWILLING TO PAY THE PORTION OF THEIR BILL FOR WHICH THEY ARE FINANCIALLY RESPONSIBLE. THE DIFFERENCE BETWEEN THE STANDARD RATES (OR THE DISCOUNTED RATES IF NEGOTIATED OR PROVIDED BY POLICY) AND THE AMOUNTS ACTUALLY COLLECTED AFTER ALL REASONABLE COLLECTION EFFORTS HAVE BEEN EXHAUSTED IS CHARGED OFF AGAINST THE ALLOWANCE FOR UNCOLLECTIBLE ACCOUNTS.
SCHEDULE H, PART III, SECTION B, LINE 8 COMMUNITY BENEFIT: SERVING PATIENTS WITH GOVERNMENT HEALTH BENEFITS, SUCH AS MEDICARE, IS A COMPONENT OF THE COMMUNITY BENEFIT STANDARD THAT TAX-EXEMPT HOSPITALS ARE HELD TO. THIS IMPLIES THAT SERVING MEDICARE PATIENTS IS A COMMUNITY BENEFIT AND THAT THE HOSPITAL OPERATES TO PROMOTE THE HEALTH OF THE COMMUNITY. THE MEDICARE COST REPORT WAS USED TO DETERMINE THE AMOUNTS REPORTED ON LINES 5 AND 6.
SCHEDULE H, PART III, SECTION C, LINE 9B COLLECTION POLICY: PATIENTS RECEIVE CORRESPONDENCE GIVING THEM THE OPPORTUNITY TO CONTACT THE ORGANIZATION TO QUESTION THEIR STATEMENTS AND/OR ESTABLISH PAYMENT ARRANGEMENTS. IF A PATIENT CONTACTS THE ORGANIZATION, IT IS FIRST DETERMINED WHETHER OR NOT THEY MAY BE ELIGIBLE FOR ASSISTANCE THROUGH MEDICAID OR FINANCIAL ASSISTANCE. IF THE PATIENT IS NOT ELIGIBLE FOR ANY OF THE ASSISTANCE LISTED, THEN THE ORGANIZATION WORKS WITH THE PATIENT TO ESTABLISH A PAYMENT PLAN, USUALLY FOR UP TO 12 MONTHS BUT EXTENSION IS ALLOWED FOR EXTENUATING CIRCUMSTANCES. IF AN ACCOUNT IS DETERMINED TO BE UNCOLLECTIBLE AND NO REQUEST FOR ASSISTANCE OR PAYMENT ARRANGEMENTS IS RECEIVED, THE ACCOUNT IS REFERRED TO AN OUTSIDE COLLECTION AGENCY.
SCHEDULE H, PART VI, LINE 2 NEEDS ASSESSMENT: ACMH REGULARLY USES RELIABLE DATA AVAILABLE ON THE INTERNET TO DETERMINE THE NEEDS OF OUR COMMUNITY. COUNTY HEALTH RANKINGS PULL FROM VARIOUS RELIABLE DATABASES TO PROVIDE INFORMATION ABOUT OUTCOMES, HEALTH FACTORS, ENVIRONMENTAL FACTORS, AND COMMUNITY HEALTH STATUS INDICATORS. WE USE INFORMATION FROM THE DEPARTMENT OF HEALTH REGARDING HEALTH BEHAVIORS. WE ALSO COLLABORATE WITH THE LOCAL SCHOOL DISTRICT AND OTHER COMMUNITY ORGANIZATIONS AND EMPLOYERS TO DETERMINE OUR ROLE IN THE DEVELOPMENT OF HEALTHY FACILITIES, PROGRAMS, AND BEHAVIORS IN ARMSTRONG COUNTY. IN FY2018 ACMH CONDUCTED A COMMUNITY HEALTH NEEDS ASSESSMENT AND PUBLISHED THE FINDINGS ON OUR WEBPAGE. THE NEEDS ASSESSMENT TOOK INTO ACCOUNT INFORMATION FROM PRIMARY DATA AS WELL AS SECONDARY DATA.
SCHEDULE H, PART VI, LINE 3 PATIENT EDUCATION OF ELIGIBILITY FOR ASSISTANCE: EACH PATIENT IS ASKED THE QUESTION, "DO YOU NEED HELP WITH YOUR MEDICAL BILLS?" AT THE POINT OF REGISTRATION. FOR EVERY PATIENT THAT ANSWERS YES, WE SEND THE PATIENT A COVER LETTER EXPLAINING OUR FINANCIAL ASSISTANCE PROGRAM, AN APPLICATION, AND BASIC GUIDELINES IDENTIFYING INFORMATION NEEDED TO PROCESS THE APPLICATION. ONCE THE PATIENT RECEIVES THE APPLICATION AND COMPLETES THE INFORMATION, THE APPLICATION IS REVIEWED FOR ACCURACY AND POTENTIAL APPROVAL. IF THE PATIENT HAS SUPPLIED ALL THE NECESSARY INFORMATION AND A DECISION IS MADE, AN APPROVED OR DENIED LETTER IS SENT TO THE PATIENT. IF THE PATIENT HAS NOT SUPPLIED ENOUGH INFORMATION TO MAKE A PROPER DECISION, A LETTER DETAILING THE MISSING INFORMATION IS SENT TO THE PATIENT ALONG WITH A FOLLOW UP PHONE CALL. THE APPLICATION IS PRINTED ON THE BACK OF EVERY STATEMENT SENT TO PATIENTS CONCERNING THEIR OUT OF POCKET EXPENSE. WE UTILIZE AN EARLY OUT SELF-PAY VENDOR THAT HAS BEEN TRAINED ON OUR FINANCIAL ASSISTANCE POLICY AND WHEN THEY HAVE CONTACT WITH OUR PATIENTS, THEY ADVISE THEM OF THE PROGRAM AND INITIATE THE APPLICATION PROGRAM WHEN THE PATIENT REQUESTS THEIR ASSISTANCE. THIS VENDOR OFFERS THE FINANCIAL ASSISTANCE APPLICATION ON THEIR WEBSITE LISTED UNDER THE OPTIONS FOR RESOLUTION OF THE OUTSTANDING BALANCE(S). THE HOSPITAL HAS FINANCIAL ASSISTANCE POSTERS PLACED IN STRATEGIC LOCATIONS THROUGHOUT THE FACILITY TO INFORM THEM OF THE PROGRAM OFFERED. WE ARE PARTICIPATING IN HEALTH FAIRS THROUGHOUT THE COUNTY BY ATTENDING AND OFFERING ASSISTANCE WITH THE APPLICATION PROCESS FOR FINANCIAL ASSISTANCE.
SCHEDULE H, PART VI, LINE 4 COMMUNITY INFORMATION: WE CONSIDER ALL OF ARMSTRONG COUNTY TO BE INCLUDED IN OUR SERVICE AREA AS WE ARE THE ONLY HOSPITAL AND THE ONLY PROVIDER OF EMERGENCY SERVICES. ARMSTRONG COUNTY LIES IN THE RURAL APPALACHIAN REGION AND IS MADE UP OF 45 MINOR CIVIL DIVISIONS. THE MAJORITY OF THESE MUNICIPALITIES ARE DESIGNATED AS EITHER MEDICALLY UNDERSERVED AREAS OR HEALTH PROFESSIONAL SHORTAGE AREAS, OR BOTH, BY THE UNITED STATES DEPARTMENT OF HEALTH AND HUMAN SERVICES. THERE IS NO PUBLIC TRANSPORTATION SYSTEM FOR MOST OF THE AREA. SOCIOECONOMIC DATA FOR THE REGION SHOWS THAT THE PER CAPITA INCOME OF ARMSTRONG COUNTY IS LOWER THAN THE AVERAGE OF THE UNITED STATES, THE COMMONWEALTH OF PENNSYLVANIA AND THE OVERALL APPALACHIAN REGION. ARMSTRONG COUNTY RESIDENTS ARE OLDER THAN THE AVERAGE RESIDENT OF PENNSYLVANIA AS A WHOLE. A DISPROPORTIONATELY LARGER PERCENTAGE OF OUR POPULATION RESIDES IN RURAL AREAS.
SCHEDULE H, PART VI, LINE 5 PROMOTION OF COMMUNITY HEALTH: ACMH IS A FOUNDING MEMBER OF THE ARMSTRONG COUNTY COALITION FOR HEALTH AND WELLNESS WHICH EXISTS TO PROMOTE PHYSICAL ACTIVITY AND HEALTHIER FAMILIES THROUGH COMMUNITY DESIGN AND SUPPORT. COALITION MEMBERS CURRENTLY INCLUDE, ELECTED ARMSTRONG COUNTY OFFICIALS, ACMH HOSPITAL PERSONNEL, AND OTHER COMMUNITY LEADERS. THE GOAL OF THE COALITION IS TO REVERSE THREATS TO THE HEALTH AND WELL-BEING OF ARMSTRONG COUNTY CITIZENS WHICH INCLUDE POOR NUTRITION, SEDENTARY LIFESTYLES, AND LIMITED PHYSICAL ACTIVITY BY PROVIDING LEADERSHIP, FUNDING AND TECHNICAL ASSISTANCE IN ORDER TO PROMOTE THE USE OF EXISTING TRAILS AND PARKS, TO OPTIMIZE COMMUNITY DESIGN, TO INCREASE ACCESS TO RECREATIONAL RESOURCES, TO ENHANCE EXISTING FITNESS FACILITIES AND TO PROMOTE EDUCATIONAL PROGRAMS THAT FOCUS ON HEALTHIER LIFESTYLES. ACMH ALSO PARTICIPATES IN HEALTHY ARMSTRONG, A COALITION OF A LARGE NUMBER OF STAKEHOLDERS THAT MEETS MONTHLY TO COMBAT CHILDHOOD OBESITY. HEALTHY ARMSTRONG HAS BEEN AWARDED SEVERAL GRANTS AND HAS ACHIEVED NATIONAL RECOGNITION THROUGH ITS PROGRAM OF USING THE SCHOOL SYSTEM TO PROMOTE INCREASED PHYSICAL ACTIVITY AND NUTRITIONAL EDUCATION. ACMH PARTICIPATES IN ECONOMIC DEVELOPMENT MEETINGS. THE MAJORITY OF BOARD MEMBERS ARE ARMSTRONG COUNTY RESIDENTS AND WERE SELECTED TO REPRESENT THE COMMUNITIES SERVED. ACMH MANAGERS ARE ENCOURAGED TO PARTICIPATE ON THE BOARDS OF OTHER NON-PROFIT HEALTH AND HUMAN SERVICES ORGANIZATIONS. ACMH PROVIDES STRATEGIC PLANNING LEADERSHIP AND FACILITATION TO SMALLER ORGANIZATIONS IN THE COMMUNITY. ACMH WIDELY ADVERTISES ITS FINANCIAL ASSISTANCE/FREE CARE PROGRAMS WHICH ARE INCOME BASED. SINCE ACMH OWNS SEVERAL RURAL HEALTH CLINICS LOCATED IN MEDICALLY UNDERSERVED AREAS IT OFFERS FINANCIAL ASSISTANCE TO LOW INCOME INDIVIDUALS AND FAMILIES FOR ALL TYPES OF HEALTHCARE SERVICES.
SCHEDULE H, PART VI, LINE 6 AFFILIATED HEALTH CARE SYSTEM: THE ORGANIZATION IS A MEMBER OF A CONSOLIDATED GROUP, AND THE GROUP'S CONSOLIDATED FINANCIAL STATEMENTS INCLUDE THE ACCOUNTS OF ARMSTRONG COUNTY MEMORIAL HOSPITAL, ARMSCARE, INC., ARMSTRONG HEALTH AND EDUCATION FOUNDATION, ACMH ANESTHESIA SERVICES, ACMH PHYSICIAN SERVICES, GLADE RUN MEDICAL ASSOCIATES INC., AND ARMSTRONG CENTER FOR MEDICINE AND HEALTH, INC. (ACMH, INC.), COLLECTIVELY REFERRED TO AS THE HEALTH SYSTEM. THE HOSPITAL IS A NOT-FOR-PROFIT ENTITY, WHOLLY OWNED BY ACMH, INC. THE HOSPITAL PROVIDES INPATIENT, OUTPATIENT, AND EMERGENCY CARE SERVICES IN THE ARMSTRONG COUNTY, PENNSYLVANIA AREA. ACMH, INC. IS A NOT-FOR-PROFIT CORPORATION FORMED TO SUPPORT AND FURTHER THE CHARITABLE ACTIVITIES OF ARMSTRONG COUNTY MEMORIAL HOSPITAL AS WELL AS ANY OTHER SUBSIDIARY ORGANIZATION AND IS THE PARENT ORGANIZATION. ARMSCARE, INC. IS A 95%-OWNED, FOR-PROFIT ENTITY ENGAGED PRINCIPALLY IN THE RENTAL AND SALE OF DURABLE MEDICAL EQUIPMENT AND SUPPLIES. THE FOUNDATION IS A NOT-FOR-PROFIT ENTITY WHOSE PURPOSE IS TO RAISE FUNDS FOR THE BENEFIT OF THE HOSPITAL AND WELLNESS OF THE COMMUNITY. THE HEALTH SYSTEM FORMED ACMH ANESTHESIA SERVICES AND ACMH PHYSICIAN SERVICES IN 2006. THESE ENTITIES WERE ESTABLISHED TO PROVIDE ANESTHESIA AND PHYSICIAN SERVICES TO THE HEALTH SYSTEM. THE HEALTH SYSTEM FORMED GLADE RUN MEDICAL ASSOCIATES, INC. (GLADE RUN) IN 2009, AND IT BEGAN OPERATIONS IN 2010. GLADE RUN IS A NOT-FOR-PROFIT ENTITY ESTABLISHED TO PROVIDE PHYSICIAN SERVICES TO THE HEALTH SYSTEM.
Schedule H (Form 990) 2019
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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 Go to www.irs.gov/Form990 for the latest information.
OMB No. 1545-0047
2019
Open to Public
Inspection
Name of the organization
ARMSTRONG COUNTY MEMORIAL HOSPITAL
 
Employer identification number
25-0965237
Part I
General Information on Grants and Assistance
1
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? ........................
2
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
noncash assistance		 (h) Purpose of grant
or assistance
(1) HOUSTON FOOD BANK
535 PORTWALL ST
HOUSTON,TX77029 		74-2181456 501(C)(3) 9,220       DONOR SRVCS
2
Enter total number of section 501(c)(3) and government organizations listed in the line 1 table ................. Bullet Image
1
3
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) 2019

Schedule I (Form 990) 2019
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
noncash assistance		 (e) Method of valuation (book,
FMV, appraisal, other)		 (f) Description of noncash 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 MONITORING GRANT FUNDS: BEFORE PROVIDING GRANT FUNDS TO OTHER ORGANIZATIONS, ARMSTRONG COUNTY MEMORIAL HOSPITAL LOOKS AT THE HISTORY OF THE ORGANIZATION THEY ARE CONSIDERING DONATING TO AND ASKS THE ORGANIZATION TO PROVIDE THEM WITH DETAIL REGARDING WHAT THE MONEY WILL BE SPENT ON.
Schedule I (Form 990) 2019



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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 Go to www.irs.gov/Form990 for instructions and the latest information.
OMB No. 1545-0047
2019
Open to Public Inspection
Name of the organization
ARMSTRONG COUNTY MEMORIAL HOSPITAL
 
Employer identification number

25-0965237
Part I
Questions Regarding Compensation
Yes
No
1a
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.
b
If any of the boxes on 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 .........
1b
 
 
2
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 on Line 1a? ..
2
 
 
3
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.
4
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:
a
Receive a severance payment or change-of-control payment? .............
4a
 
No
b
Participate in, or receive payment from, a supplemental nonqualified retirement plan? .........
4b
Yes
 
c
Participate in, or receive payment from, an equity-based compensation arrangement? .........
4c
 
No
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.
5
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:
a
The organization? ....................
5a
Yes
 
b
Any related organization? .......................
5b
 
No
If "Yes," on line 5a or 5b, describe in Part III.
6
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:
a
The organization? ..................
6a
Yes
 
b
Any related organization? ......................
6b
 
No
If "Yes," on line 6a or 6b, describe in Part III.
7
For persons listed on Form 990, Part VII, Section A, line 1a, did the organization provide any nonfixed
payments not described in lines 5 and 6? If "Yes," describe in Part III ............
7
 
No
8
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 ..........................
8
 
No
9
If "Yes" on line 8, did the organization also follow the rebuttable presumption procedure described in Regulations section 53.4958-6(c)? .........................
9
 
 
For Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 50053T
Schedule J (Form 990) 2019

Schedule J (Form 990) 2019
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
(i) Base
compensation 		(ii) Bonus & incentive
compensation 		(iii) Other reportable compensation
1HAROLD ALTMAN MD
CHIEF MEDICAL OFFICER 		(i)

(ii)		 281,267
-------------
0 		0
-------------
0 		17,793
-------------
0 		2,625
-------------
0 		11,053
-------------
0 		312,738
-------------
0 		0
-------------
0
2JOHN I LEWIS
PRESIDENT & CEO 		(i)

(ii)		 335,482
-------------
0 		0
-------------
0 		20,333
-------------
0 		52,486
-------------
0 		22,205
-------------
0 		430,506
-------------
0 		0
-------------
0
3SARUN SUWAN MD
PRESIDENT OF MEDICAL STAFF 		(i)

(ii)		 321,381
-------------
0 		4,983
-------------
0 		0
-------------
0 		1,875
-------------
0 		26,810
-------------
0 		355,049
-------------
0 		0
-------------
0
4PATRICK BURNS
CFO, VP OF FINANCE 		(i)

(ii)		 224,955
-------------
0 		300
-------------
0 		13,309
-------------
0 		2,625
-------------
0 		21,574
-------------
0 		262,763
-------------
0 		0
-------------
0
5JOSEPH CIPPEL
PHYSICIAN 		(i)

(ii)		 173,506
-------------
0 		35,073
-------------
0 		0
-------------
0 		1,875
-------------
0 		28,487
-------------
0 		238,941
-------------
0 		0
-------------
0
6CHAD SHAFFER
PHYSICIAN 		(i)

(ii)		 211,848
-------------
0 		16,756
-------------
0 		0
-------------
0 		1,875
-------------
0 		23,120
-------------
0 		253,599
-------------
0 		0
-------------
0
7KARLA D MCCANN
PHYSICIAN 		(i)

(ii)		 170,055
-------------
0 		33,188
-------------
0 		0
-------------
0 		1,875
-------------
0 		25,275
-------------
0 		230,393
-------------
0 		0
-------------
0
8VICKY LEO
PHYSICIAN 		(i)

(ii)		 190,250
-------------
0 		49,790
-------------
0 		0
-------------
0 		2,625
-------------
0 		8,452
-------------
0 		251,117
-------------
0 		0
-------------
0
9MICHAEL ONDICH
PHYSICIAN 		(i)

(ii)		 146,528
-------------
0 		13,360
-------------
0 		0
-------------
0 		1,872
-------------
0 		24,206
-------------
0 		185,966
-------------
0 		0
-------------
0
10MONA RUPERT
VP OF CLINICAL SERVICES 		(i)

(ii)		 145,668
-------------
0 		150
-------------
0 		9,639
-------------
0 		2,399
-------------
0 		10,633
-------------
0 		168,489
-------------
0 		0
-------------
0
11NICOLE GERACI
VP OF PATIENT SRVC & OPERATION 		(i)

(ii)		 145,566
-------------
0 		150
-------------
0 		4,420
-------------
0 		1,632
-------------
0 		8,533
-------------
0 		160,301
-------------
0 		0
-------------
0
Schedule J (Form 990) 2019

Schedule J (Form 990) 2019
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 PARTICIPATE IN A 457(F) NONQUALIFIED RETIREMENT PLAN AND RECEIVED THE FOLLOWING 457(F) PAYMENTS: $49,861 JOHN I. LEWIS (CONTRIBUTION) THE 457(F) PLAN THAT ARMSTRONG COUNTY MEMORIAL HOSPITAL ESTABLISHED FOR A SELECT GROUP OF MANAGEMENT INCLUDES THE FOLLOWING TERMS: A PARTICIPANT SHALL BECOME FULLY VESTED IN HIS DEFERRED COMPENSATION ACCOUNT, AND INCOME, GAINS AND LOSSES ATTRIBUTABLE THERETO, IF HE REMAINS IN SERVICE WITH THE EMPLOYER UNTIL THE FIRST OF THE FOLLOWING EVENTS OCCUR: (A) THE DEATH OF THE PARTICIPANT; (B) THE DISABILITY OF THE PARTICIPANT; (C) THE DATE THE PARTICIPANT ATTAINS AGE 65; 0R (D) THE DATE A PARTICIPANT IS TERMINATED FROM EMPLOYMENT WITH THE EMPLOYER DUE TO A CHANGE OF CONTROL EVENT. UPON VESTING, THE DEFERRED COMPENSATION ACCOUNT WILL BE INCLUDIBLE IN THE GROSS INCOME OF THE PARTICIPANT PURSUANT TO CODE SECTION 457(F).
SCHEDULE J, PART I, LINES 5A & 6A CONTINGENT COMPENSATION: MANAGEMENT USES MGMA PUBLISHED STANDARDS TO ESTABLISH A BASE SALARY FOR PROVIDERS. IN ADDITION TO THE BASE SALARY, PROVIDERS HAVE THE ABILITY TO EARN INCENTIVES BASED UPON THEIR PRODUCTIVITY AS REFLECTED IN WORK RVU MEASURES. IN ADDITION, THE CEO PRESENTS GOALS TO THE EXECUTIVE COMMITTEE OF THE BOARD OF DIRECTORS OF WHAT THE ORGANIZATION HOPES TO ACHIEVE DURING EACH FISCAL YEAR. THESE GOALS ARE BASED ON REVENUES, NET EARNINGS, AND OTHER MEASURES. DEPENDING ON THE RESULTS, THE EXECUTIVE COMMITTEE OF THE BOARD, WITH INPUT FROM THE CEO, DETERMINES WHAT AMOUNT OF BONUSES (IF ANY) WILL BE PAID.
Schedule J (Form 990) 2019

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SCHEDULE M
(Form 990)

Department of the Treasury
Internal Revenue Service
Noncash Contributions
Right pointing arrow large imageComplete if the organizations answered "Yes" on Form 990, Part IV, lines 29 or 30.
Right pointing arrow large image Attach to Form 990.
Right pointing arrow large imageGo to www.irs.gov/Form990 for the latest information.
OMB No. 1545-0047
2019
Open to Public Inspection
Name of the organization
ARMSTRONG COUNTY MEMORIAL HOSPITAL
 
Employer identification number

25-0965237
Part I
Types of Property
(a)
Check if applicable 		(b)
Number of contributions or items contributed 		(c)
Noncash contribution amounts reported on
Form 990, Part VIII, line 1g 		(d)
Method of determining
noncash contribution amounts
1 Art—Works of art ....        
2 Art—Historical treasures .        
3 Art—Fractional interests ..        
4 Books and publications ..      
5 Clothing and household
goods ....... 		     
6 Cars and other vehicles ..        
7 Boats and planes ....        
8 Intellectual property ...        
9 Securities—Publicly traded .        
10 Securities—Closely held stock .        
11 Securities—Partnership, LLC,
or trust interests .... 		       
12 Securities—Miscellaneous ..        
13 Qualified conservation
contribution—Historic
structures ..... 		       
14 Qualified conservation
contribution—Other ... 		       
15 Real estate—Residential .        
16 Real estate—Commercial ..        
17 Real estate—Other ...        
18 Collectibles .....        
19 Food inventory ...        
20 Drugs and medical supplies . X 9 79,435 FMV
21 Taxidermy ......        
22 Historical artifacts ....        
23 Scientific specimens ..        
24 Archeological artifacts ...        
25 Other Right pointing arrow large image ( )
26 Other Right pointing arrow large image ( )
27 Other Right pointing arrow large image ( )
28 Other Right pointing arrow large image ( )
29
Number of Forms 8283 received by the organization during the tax year for contributions
for which the organization completed Form 8283, Part IV, Donee Acknowledgement
29
 
Yes
No
30a
During the year, did the organization receive by contribution any property reported in Part I, lines 1 through 28, that it must hold for at least three years from the date of the initial contribution, and which isn't required to be used for exempt purposes for the entire holding period? ...................
30a
 
No
b
If "Yes," describe the arrangement in Part II.
31
Does the organization have a gift acceptance policy that requires the review of any nonstandard contributions?
31
 
No
32a
Does the organization hire or use third parties or related organizations to solicit, process, or sell noncash
contributions? ..........................
32a
 
No
b
If "Yes," describe in Part II.
33
If the organization didn't report an amount in column (c) for a type of property for which column (a) is checked,
describe in Part II.
For Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 51227J
Schedule M (Form 990) (2019)
Schedule M (Form 990) (2019)
Page 2
Part IISupplemental Information. Provide the information required by Part I, lines 30b, 32b, and 33, and whether the organization is reporting in Part I, column (b), the number of contributions, the number of items received, or a combination of both. Also complete this part for any additional information.
Return Reference Explanation
SCHEDULE M, PART I, COLUMN (B) NUMBER OF CONTRIBUTIONS: THE NUMBER IN COLUMN B REFLECTS THE NUMBER OF CONTRIBUTIONS.
Schedule M (Form 990) (2019)

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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 Go to www.irs.gov/Form990 for the latest information.
OMB No. 1545-0047
2019
Open to Public
Inspection
Name of the organization
ARMSTRONG COUNTY MEMORIAL HOSPITAL
 
Employer identification number

25-0965237
Return Reference Explanation
FORM 990, PART I, LINE 1 ORGANIZATION'S MISSION: THE HOSPITAL WILL: FOCUS ON PATIENT AND FAMILY CENTERED SERVICES; CONTINUE TO DEVELOP THOSE SPECIALTY SERVICES THAT MEET THE CHANGING NEEDS OF THE COMMUNITY; DELIVER HIGH QUALITY, COST-EFFECTIVE CARE; AND PROMOTE HEALTH EDUCATION AND WELLNESS.
FORM 990, PART III, LINE 4 PROGRAM SERVICES: ARMSTRONG COUNTY MEMORIAL HOSPITAL IS A 168 BED COMMUNITY HOSPITAL WHICH PROVIDES INPATIENT & OUTPATIENT MEDICAL SERVICES TO ALL COUNTY RESIDENTS WITHOUT DISCRIMINATION. THE HOSPITAL HAS CONTRACTS WITH THIRD-PARTY PAYERS TO PROVIDE CARE FOR MEDICARE, MEDICAID, BLUE CROSS AND OTHER COMMERCIAL PAYER PATIENTS. THE HOSPITAL PROVIDES EMERGENCY CARE REGARDLESS OF A PATIENTS ABILITY TO PAY. PURSUANT TO THE HOSPITAL'S CHARITY CARE POLICY, CHARGES ARE FULLY OR PARTIALLY WRITTEN OFF FOR PATIENTS MEETING THE CRITERIA SPECIFIED IN THE POLICY. CHARGES EXCLUDED UNDER THE HOSPITAL'S CHARITY CARE POLICY WERE APPROXIMATELY $1,485,000 FOR THE FISCAL YEAR. THE AMOUNTS REPORTED AS EXPENSE FOR LINES 4A, 4B AND 4C REPRESENT ONLY THE PORTION OF EXPENSES THAT RELATE TO THE GENERATION OF REVENUE FOR THESE PROGRAMS. ADDITIONALLY, MANAGEMENT AND GENERAL EXPENSE IS ASSOCIATED WITH THESE PROGRAMS AND IS INCLUDED IN PART IX STATEMENT OF FUNCTIONAL EXPENSES COLUMN C. DUE TO FOLLOWING THE IRS INSTRUCTIONS FOR REPORTING EXPENSES UNDER THIS SECTION, THE NET PROFIT (LOSS) OF THESE PROGRAMS IS NOT COMPLETELY DISCLOSED UNDER LINES 4A, 4B AND 4C. FORM 990, PART III, LINE 4D, OTHER PROGRAM SERVICES: THESE ARE ITEMS THAT HELP SUPPORT THE MEDICAL SERVICES OUR PATIENTS RECEIVE AT ACMH HOSPITAL. ITEMS INCLUDE CAFETERIA AND VENDING, COMMUNITY BENEFITS, INVESTMENT FEES, PREVENTATIVE HEALTH, XRAY TECHNOLOGY AND THE 340B DRUG PROGRAM.
FORM 990, PART VI, SECTION A, LINE 2 BUSINESS RELATIONSHIP: JOHN LEWIS AND PATRICK BURNS ARE BOARD MEMBERS OF ARMSCARE, INC. A RELATED TAXABLE CORPORATION. SEE SCHEDULE R, PART IV.
FORM 990, PART VI, SECTION A, LINES 6, 7A & 7B MEMBERS/STOCKHOLDERS: THE ORGANIZATION IS A SUBSIDIARY OF ARMSTRONG CENTER FOR MEDICINE & HEALTH, INC. (ACMH), ANOTHER TAX EXEMPT ENTITY. ACCORDING TO THE BYLAWS, ARTICLE II, ACMH, A PENNSYLVANIA NONPROFIT CORPORATION, SHALL HAVE CERTAIN RIGHTS WITH RESPECT TO THE GOVERNANCE OF THIS CORPORATION AS MAY BE SPECIFIED IN THESE BYLAWS IN THE CAPACITY OF ANOTHER BODY AS THAT TERM IS DEFINED IN THE PENNSYLVANIA NONPROFIT CORPORATION LAW, SPECIFICALLY 15 PA C.S. SECTION 7103. THE BYLAWS OF ACMH DESCRIBE SEVEN SITUATIONS IN WHICH APPROVAL IS NEEDED BY THE PARENT CORPORATION. 1) AMENDMENT OF THE ARTICLES OF INCORPORATION OF THIS CORPORATION OR OF THESE BYLAWS; 2) THE SALE, LEASE OR EXCHANGE OF ALL OR SUBSTANTIALLY ALL OF THE PROPERTY OR ASSETS OF THIS CORPORATION; 3) MERGER OR CONSOLIDATION WITH ANY OTHER CORPORATION; 4) DISSOLUTION OF THE CORPORATION AND DISTRIBUTION OF ASSETS PURSUANT THERETO; 5) APPROVAL OF THE ANNUAL BUDGET AND LONG-RANGE PLAN FOR THIS CORPORATION; 7) ANY OTHER MATTER THAT BYLAWS REQUIRE THE APPROVAL OF THE MEMBERS OF THE CORPORATION. ALSO, THE PARENT CORPORATION HAS THE AUTHORITY TO SELECT THE BOARD MEMBERS OF THE HOSPITAL'S BOARD OF DIRECTORS (ARTICLE 3, SECTION 3 (B)).
FORM 990, PART VI, SECTION B, LINE 11B REVIEW OF FORM 990: THE FORM 990 IS PREPARED BY AN INDEPENDENT ACCOUNTING FIRM BASED ON THE AUDITED FINANCIAL STATEMENTS AND INFORMATION PROVIDED BY THE ACCOUNTING DEPARTMENT OF THE ORGANIZATION. PRIOR TO FILING, A TENTATIVE DRAFT OF THE 990 IS REVIEWED BY THE DIRECTOR OF FINANCE, THE VICE PRESIDENT OF FINANCE, AND THE PRESIDENT/CEO BEFORE BEING PRESENTED TO THE BOARD OF DIRECTORS. THE 990 IS REVIEWED AND APPROVED AT THE BOARD MEETING AND FINAL REPORTS ARE PLACED ON THE BOARD OF DIRECTORS PORTAL ONCE OFFICIALLY FILED.
FORM 990, PART VI, SECTION B, LINE 12C CONFLICT OF INTEREST POLICY: THE ORGANIZATION MONITORS COMPLIANCE WITH ITS CONFLICT OF INTEREST POLICY BY REQUESTING ON AN ANNUAL BASIS THAT MEMBERS OF THE BOARD OF DIRECTORS, ALL CORPORATE OFFICERS, AND ALL KEY EMPLOYEES COMPLETE A QUESTIONNAIRE LISTING ALL ORGANIZATIONS WITH WHICH THEY HAVE AN AFFILIATION. THE POLICY OF THE ORGANIZATION DESCRIBES HOW ANY CONFLICTS OF INTEREST ARE TO BE ADDRESSED. THE CHAIRMAN OF THE BOARD SHALL BECOME FAMILIAR WITH ALL SUCH DISCLOSURE STATEMENTS IN CASE A CONFLICT ARISES. THE VICE-CHAIRMAN OF THE BOARD SHALL BE FAMILIAR WITH THE STATEMENT FILED BY THE CHAIRMAN. IF A CONFLICT OF INTEREST SHOULD ARISE, THE MEMBERS ABSTAIN FROM THE VOTE RELATING TO THAT MATTER.
FORM 990 PART VI, SECTION B, LINES 15A & 15B COMPENSATION REVIEW: THE PROCESS ACMH HOSPITAL USES TO DETERMINE IF THE OFFICERS OF THE ORGANIZATION ARE TO RECEIVE A WAGE ADJUSTMENT IS AS FOLLOWS: 1) A SALARY COMPARISON PREPARED BY SURVEY DATA OBTAINED FROM YAFFE, WATSON WYATT AND SULLIVAN COTTON; 2) THE INFORMATION IS COMPILED BY THE VP OF HUMAN RESOURCES AND GIVEN TO THE EXECUTIVE COMMITTEE OF THE BOARD OF DIRECTORS FOR THEIR CONSIDERATION AND INPUT; 3) CHANGES TO EXECUTIVE COMPENSATION REQUIRE A SIGNED DOCUMENT FROM THE CHAIR OF THE HOSPITAL BOARD OF DIRECTORS. EXECUTIVE COMPENSATION IS REVIEWED AS DESCRIBED ABOVE, ON AN AS NEEDED BASIS AND WAS LAST COMPLETED IN FEBRUARY 2018.
FORM 990, PART VI, SECTION C, LINE 19 DOCUMENT DISCLOSURE: THE ORGANIZATION TAKES THE FOLLOWING ACTIONS RELEASING INFORMATION REGARDING ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, OR FINANCIAL STATEMENTS: IF A REQUEST IS MADE TO REVIEW THE UNAUDITED FINANCIAL STATEMENTS, IT IS DISCUSSED AND DETERMINED ON A CASE BY CASE BASIS AS TO WHETHER THE INFORMATION WILL BE RELEASED. THE AUDITED FINANCIAL STATEMENTS ARE MADE AVAILABLE TO THE ORGANIZATIONS THAT REQUEST THEM. A CODE OF CONDUCT FOR THE ORGANIZATION IS AVAILABLE TO THE PUBLIC ON ITS WEBSITE AT WWW.ACMH.ORG. THE CORPORATION'S GOVERNING DOCUMENTS ARE KEPT IN THE ADMINISTRATIVE DEPARTMENT OF THE HOSPITAL. THESE DOCUMENTS CAN BE VIEWED UPON REQUEST, BUT THEY ARE NOT ALLOWED TO BE TAKEN FROM THEIR DESIGNATED AREA OR HAVE COPIES MADE WITHOUT PERMISSION.
FORM 990, PART VII, SECTION A BOARD MEMBER COMPENSATION: NO BOARD MEMBERS RECEIVE ANY COMPENSATION FOR THEIR DIRECTOR DUTIES. JOHN I. LEWIS IS COMPENSATED AS PRESIDENT/CEO. HAROLD ALTMAN, MD, IS COMPENSATED AS CHIEF MEDICAL OFFICER. SARUN SUWAN, MD, IS COMPENSATED AS MEDICAL STAFF PRESIDENT.
FORM 990, PART VIII, LINE 6A RENTAL INCOME: ACMH HOSPITAL PROVIDES RENTAL LOCATIONS TO AREA PHYSICIANS AND OTHER HEALTHCARE RELATED ENTITIES IN ORDER TO PROMOTE ACCESSIBLE HEALTHCARE OPTIONS CLOSE TO HOME FOR THE LOCAL COMMUNITY. THE RENTAL INCOME CHARGED TO EACH LOCATION IS BASED ON PREVAILING RENTAL RATES PER SQUARE FOOT, THE AMOUNT OF SPACE, THE CONDITION OF THE OFFICE SPACE AND THE AMOUNT OF TIME THE OFFICE SPACE IS USED EACH MONTH.
FORM 990, PART XI, LINE 9 OTHER CHANGES IN NET ASSETS: $ 1,260,574 CHANGE IN DEFINED BENEFIT PENSION PLAN (4,823,364) TRANSFER TO AFFILIATES ------------ $(3,562,790)
FORM 990 PART IX LINE 11G DESCRIPTION:OUTSIDE SERVICES TOTAL FEES:6835511
FORM 990 PART IX LINE 11G DESCRIPTION:MAINTENANCE & SRVC CONTRACTS TOTAL FEES:2275038
FORM 990 PART IX LINE 11G DESCRIPTION:PURCHASED PHYSICIAN SERVICES TOTAL FEES:2150102
FORM 990 PART IX LINE 11G DESCRIPTION:COLLECTION SERVICES TOTAL FEES:439354
FORM 990 PART IX LINE 11G DESCRIPTION:MEDICAL DIRECTOR FEES TOTAL FEES:434233
FORM 990 PART IX LINE 11G DESCRIPTION:CONSULTING SERVICES TOTAL FEES:251527
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.
Cat. No. 51056K
Schedule O (Form 990 or 990-EZ) 2019


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SCHEDULE R
(Form 990)
Department of the Treasury
Internal Revenue Service
Related Organizations and Unrelated Partnerships
MediumBulletComplete if the organization answered "Yes" on Form 990, Part IV, line 33, 34, 35b, 36, or 37.
MediumBulletAttach to Form 990.
MediumBullet Go to www.irs.gov/Form990 for instructions and the latest information.

OMB No. 1545-0047
2019
Open to Public Inspection
Name of the organization
ARMSTRONG COUNTY MEMORIAL HOSPITAL
 
Employer identification number

25-0965237
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
(1) ARMSTRONG OUTPATIENT IMAGING LLC
87 GLADE PARK EAST
KITTANNING,PA16201
03-0492975 		RADIOLOGY PA 0 0 ACMH HOSP
 










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?
Yes No
(1)ACMH PHYSICIAN SERVICES
ONE NOLTE DRIVE

KITTANNING,PA16201
20-4648195 		PRIMARY CARE PA 501(C)(3) 3 ACMH
 
 
No
(2)ARMSTRONG HEALTH & EDUCATION FOUNDATION
ONE NOLTE DRIVE

KITTANNING,PA16201
25-1655867 		FOUNDATION PA 501(C)(3) 12A I ACMH
 
 
No
(3)ARMSTRONG CENTER FOR MEDICINE & HEALTH
ONE NOLTE DRIVE

KITTANNING,PA16201
20-4648477 		PARENT CORP PA 501(C)(3) 10 NA
 
 
No
(4)GLADE RUN MEDICAL ASSOCIATES INC
ONE NOLTE DRIVE

KITTANNING,PA16201
26-4750523 		PHYSICIAN PRA PA 501(C)(3) 12A I ACMH
 
 
No






For Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 50135Y
Schedule R (Form 990) 2019
Schedule R (Form 990) 2019
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?



 		(k)
Percentage
ownership
Yes No Yes No












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?
Yes No
(1) ARMSCAREINC

ONE NOLTE DRIVE
KITTANNING,PA16201
25-1495691 		DURABLE MED EQUIP PA ACMH
  		C CORP         No












Schedule R (Form 990) 2019
Schedule R (Form 990) 2019
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
No
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 .....................
1a
 
No
b Gift, grant, or capital contribution to related organization(s) ............................
1b
 
No
c Gift, grant, or capital contribution from related organization(s) ............................
1c
Yes
 
d Loans or loan guarantees to or for related organization(s) ............................
1d
 
No
e Loans or loan guarantees by related organization(s) ............................
1e
 
No
f Dividends from related organization(s) ............................
1f
 
No
g Sale of assets to related organization(s) ............................
1g
 
No
h Purchase of assets from related organization(s) ............................
1h
 
No
i Exchange of assets with related organization(s) ............................
1i
 
No
j Lease of facilities, equipment, or other assets to related organization(s) .......................
1j
Yes
 
k Lease of facilities, equipment, or other assets from related organization(s) ......................
1k
 
No
l Performance of services or membership or fundraising solicitations for related organization(s) .....................
1l
 
No
m Performance of services or membership or fundraising solicitations by related organization(s) .................
1m
Yes
 
n Sharing of facilities, equipment, mailing lists, or other assets with related organization(s) ...................
1n
Yes
 
o Sharing of paid employees with related organization(s) ............................
1o
Yes
 
p Reimbursement paid to related organization(s) for expenses ............................
1p
Yes
 
q Reimbursement paid by related organization(s) for expenses ............................
1q
Yes
 
r Other transfer of cash or property to related organization(s) ............................
1r
Yes
 
s Other transfer of cash or property from related organization(s) ............................
1s
Yes
 
2
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





Schedule R (Form 990) 2019
Schedule R (Form 990) 2019
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) 		(d)
Predominant income (related, unrelated, excluded from tax under sections 512-514)

(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? 		(k)
Percentage
ownership
Yes No Yes No Yes No






























Schedule R (Form 990) 2019
Schedule R (Form 990) 2019
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) 2019

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