TY 2017 Form 990

(A) Name and title	(B) Average hours per week (list any hours for related organizations below dotted line)	(C) Position (do not check more than one box, unless person is both an officer and a director/trustee)	(E) Reportable compensation from related organizations (W-2/1099-MISC)
(1) Elorine Sitka...................................................................... board member	1.0 ................. 0.0	X			0	0	0
(2) R Martin Lambert MD...................................................................... board member, Chief of Staff	40.0 ................. 0.0	X			231,598	0	4,814
(3) Tommy Pietsch...................................................................... Board Member	1.0 ................. 0.0	X			0	0	0
(4) Ronald Leck...................................................................... Board Member	1.0 ................. 0.0	X			0	0	0
(5) Clay B Hermann...................................................................... Board Member	1.0 ................. 0.0	X			0	0	0
(6) Saundra Anderson DO...................................................................... Board Member/Physician	40.0 ................. 0.0	X			244,939	0	24,000
(7) Larry M Leahy...................................................................... Board Member	1.0 ................. 0.0	X			0	0	0
(8) Suzanne Kennedy...................................................................... Board Member	1.0 ................. 0.0	X			0	0	0
(9) Randy Meyer...................................................................... Board Member	1.0 ................. 0.0	X			0	0	0
(10) David Kapavik...................................................................... Board Member	1.0 ................. 0.0	X			0	0	0
(11) Marvin Boedeker...................................................................... Director	1.0 ................. 0.0	X			0	0	0
(12) Craig Sims...................................................................... Board Member	1.0 ................. 39.0	X			0	326,433	36,199
(13) Jennifer Franklin RN...................................................................... CCO	40.0 ................. 0.0		X		0	133,668	30,679
(14) Karen Barber RN...................................................................... CEO/Pres.	40.0 ................. 0.0		X		0	222,127	28,398
(15) John Olivares...................................................................... CFO	40.0 ................. 0.0		X		0	122,683	28,694
(16) DAVID BUTLER...................................................................... ASSISTANT SECRETARY	1.0 ................. 39.0		X		0	382,510	31,287
(17) James E Drost MD...................................................................... Physician	40.0 ................. 0.0			X	297,236	0	0

(A) Name and business address	(B) Description of services	(C) Compensation
AM Anesthesia Services of South tex, 222 Thiele Road YOAKUM,TX77995	Anesthesia Services	374,808
MedHost of Tennessee Inc, 2739 Momentum Place Chicago,IL60689	Medical Software	918,951
Lone Star Emergency Associates LLC, 1900 Barton Springs Road 5030 Austin,TX78704	Healthcare Services	757,715
TLC Staffing LLC, 101 Palmwood Drive VICTORIA,TX77901	Contract Labor SVCS	294,054
GE Healthcare, PO Box 96483 Chicago,IL60693	Healthcare Services	454,066
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 10

- TIN:

SCHEDULE A
(Form 990 or 990EZ)

Department of the Treasury
Internal Revenue Service

Public Charity Status and Public Support

Complete if the organization is a section 501(c)(3) organization or a section 4947(a)(1) nonexempt charitable trust.
right arrow

Attach to Form 990 or Form 990-EZ.
right arrow

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

Yoakum Community Hospital

Employer identification number

74-2323822

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.)

A church, convention of churches, or association of churches described in section 170(b)(1)(A)(i).

A school described in section 170(b)(1)(A)(ii). (Attach Schedule E (Form 990 or 990-EZ).)

A hospital or a cooperative hospital service organization described in section 170(b)(1)(A)(iii).

A medical research organization operated in conjunction with a hospital described in section 170(b)(1)(A)(iii). Enter the hospital's name, city, and state:

An organization operated for the benefit of a college or university owned or operated by a governmental unit described in section 170(b)(1)(A)(iv). (Complete Part II.)

A federal, state, or local government or governmental unit described in section 170(b)(1)(A)(v).

An organization that normally receives a substantial part of its support from a governmental unit or from the general public described in section 170(b)(1)(A)(vi). (Complete Part II.)

A community trust described in section 170(b)(1)(A)(vi). (Complete Part II.)

An agricultural research organization described in 170(b)(1)(A)(ix) operated in conjunction with a land-grant college or university or a non-land grant college of agriculture. See instructions. Enter the name, city, and state of the college or university:

An organization that normally receives: (1) more than 331/3% of its support from contributions, membership fees, and gross receipts from activities related to its exempt functions—subject to certain exceptions, and (2) no more than 331/3% of its support from gross investment income and unrelated business taxable income (less section 511 tax) from businesses acquired by the organization after June 30, 1975. See section 509(a)(2). (Complete Part III.)

An organization organized and operated exclusively to test for public safety. See section 509(a)(4).

An organization organized and operated exclusively for the benefit of, to perform the functions of, or to carry out the purposes of one or more publicly supported organizations described in section 509(a)(1) or section 509(a)(2). See section 509(a)(3). Check the box in lines 12a through 12d that describes the type of supporting organization and complete lines 12e, 12f, and 12g.

Type I. A supporting organization operated, supervised, or controlled by its supported organization(s), typically by giving the supported organization(s) the power to regularly appoint or elect a majority of the directors or trustees of the supporting organization. You must complete Part IV, Sections A and B.

Type II. A supporting organization supervised or controlled in connection with its supported organization(s), by having control or management of the supporting organization vested in the same persons that control or manage the supported organization(s). You must complete Part IV, Sections A and C.

Type III functionally integrated. A supporting organization operated in connection with, and functionally integrated with, its supported organization(s) (see instructions). You must complete Part IV, Sections A, D, and E.

Type III non-functionally integrated. A supporting organization operated in connection with its supported organization(s) that is not functionally integrated. The organization generally must satisfy a distribution requirement and an attentiveness requirement (see instructions). You must complete Part IV, Sections A and D, and Part V.

Check this box if the organization received a written determination from the IRS that it is a Type I, Type II, Type III functionally integrated, or Type III non-functionally integrated supporting organization.

Enter the number of supported organizations ...............................

Provide the following information about the supported organization(s).

(i) Name of supported organization	(ii) EIN	(iv) Is the organization listed in your governing document?		(v) Amount of monetary support (see instructions)	(vi) Amount of other support (see instructions)
(i) Name of supported organization	(ii) EIN	Yes	No	(v) Amount of monetary support (see instructions)	(vi) Amount of other support (see instructions)


Total

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

Cat. No. 11285F

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

Gross receipts from related activities, etc. (see instructions) ..................

First five years. If the Form 990 is for the organization's first, second, third, fourth, or fifth tax year as a section 501(c)(3) organization, check this box and stop here........................................ right arrow

Section C. Computation of Public Support Percentage

Public support percentage for 2019 (line 6, column (f) divided by line 11, column (f)) .........

Public support percentage for 2018 Schedule A, Part II, line 14 ...............

16a

33 1/3% support test—2019. If the organization did not check the box on line 13, and line 14 is 33 1/3% or more, check this box
and stop here. The organization qualifies as a publicly supported organization ....................... right arrow

33 1/3% support test—2018. If the organization did not check a box on line 13 or 16a, and line 15 is 33 1/3% or more, check this
box and stop here. The organization qualifies as a publicly supported organization ..................... right arrow

17a

10%-facts-and-circumstances test—2019. If the organization did not check a box on line 13, 16a, or 16b, and line 14
is 10% or more, and if the organization meets the "facts-and-circumstances" test, check this box and stop here. Explain
in Part VI how the organization meets the "facts-and-circumstances" test. The organization qualifies as a publicly supported
organization ..................................................... right arrow

10%-facts-and-circumstances test—2018. If the organization did not check a box on line 13, 16a, 16b, or 17a, and line
15 is 10% or more, and if the organization meets the "facts-and-circumstances" test, check this box and stop here.
Explain in Part VI how the organization meets the "facts-and-circumstances" test. The organization qualifies as a publicly
supported organization ................................................ right arrow

Private foundation. If the organization did not check a box on line 13, 16a, 16b, 17a, or 17b, check this box and see
instructions ..................................................... right arrow

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

First five years. If the Form 990 is for the organization's first, second, third, fourth, or fifth tax year as a section 501(c)(3) organization,
check this box and stop here............................................. right arrow

Section C. Computation of Public Support Percentage

Public support percentage for 2019 (line 8, column (f) divided by line 13, column (f)) .........

Public support percentage from 2018 Schedule A, Part III, line 15 ...............

Section D. Computation of Investment Income Percentage

Investment income percentage for 2019 (line 10c, column (f) divided by line 13, column (f)) ......

Investment income percentage from 2018 Schedule A, Part III, line 17 .............

19a

331/3% support tests—2019. If the organization did not check the box on line 14, and line 15 is more than 33 1/3%, and line 17 is not more than 33 1/3%, check this box and stop here. The organization qualifies as a publicly supported organization ....... right arrow

33 1/3% support tests—2018. If the organization did not check a box on line 14 or line 19a, and line 16 is more than 33 1/3% and line 18 is not more than 33 1/3%, check this box and stop here. The organization qualifies as a publicly supported organization .... right arrow

Private foundation. If the organization did not check a box on line 14, 19a, or 19b, check this box and see instructions .... right arrow

Schedule A (Form 990 or 990-EZ) 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

Are all of the organization’s supported organizations listed by name in the organization’s governing documents?
If "No," describe in Part VI how the supported organizations are designated. If designated by class or purpose,
describe the designation. If historic and continuing relationship, explain.

Did the organization have any supported organization that does not have an IRS determination of status under section 509(a)(1) or (2)? If "Yes," explain in Part VI how the organization determined that the supported organization was described in section 509(a)(1) or (2).

Did the organization have a supported organization described in section 501(c)(4), (5), or (6)? If "Yes," answer (b) and (c) below.

Did the organization confirm that each supported organization qualified under section 501(c)(4), (5), or (6) and satisfied the public support tests under section 509(a)(2)? If "Yes," describe in Part VI when and how the organization made the determination.

Did the organization ensure that all support to such organizations was used exclusively for section 170(c)(2)(B) purposes? If "Yes," explain in Part VI what controls the organization put in place to ensure such use.

Was any supported organization not organized in the United States ("foreign supported organization")? If “Yes” and if you checked 12a or 12b in Part I, answer (b) and (c) below.

Did the organization have ultimate control and discretion in deciding whether to make grants to the foreign supported organization? If “Yes,” describe in Part VI how the organization had such control and discretion despite being controlled or supervised by or in connection with its supported organizations.

Did the organization support any foreign supported organization that does not have an IRS determination under sections 501(c)(3) and 509(a)(1) or (2)? If “Yes,” explain in Part VI what controls the organization used to ensure that all support to the foreign supported organization was used exclusively for section 170(c)(2)(B) purposes.

Did the organization add, substitute, or remove any supported organizations during the tax year? If “Yes,” answer (b) and (c) below (if applicable). Also, provide detail in Part VI, including (i) the names and EIN numbers of the supported organizations added, substituted, or removed; (ii) the reasons for each such action; (iii) the authority under the organization's organizing document authorizing such action; and (iv) how the action was accomplished (such as by amendment to the organizing document).

Type I or Type II only. Was any added or substituted supported organization part of a class already designated in the organization's organizing document?

Substitutions only. Was the substitution the result of an event beyond the organization's control?

Did the organization provide support (whether in the form of grants or the provision of services or facilities) to anyone other than (i) its supported organizations, (ii) individuals that are part of the charitable class benefited by one or more of its supported organizations, or (iii) other supporting organizations that also support or benefit one or more of the filing organization’s supported organizations? If “Yes,” provide detail in Part VI.

Did the organization provide a grant, loan, compensation, or other similar payment to a substantial contributor (defined in section 4958(c)(3)(C)), a family member of a substantial contributor, or a 35% controlled entity with regard to a substantial contributor? If “Yes,” complete Part I of Schedule L (Form 990 or 990-EZ) .

Did the organization make a loan to a disqualified person (as defined in section 4958) not described in line 7? If “Yes,” complete Part I of Schedule L (Form 990 or 990-EZ).

Was the organization controlled directly or indirectly at any time during the tax year by one or more disqualified persons as defined in section 4946 (other than foundation managers and organizations described in section 509(a)(1) or (2))? If “Yes,” provide detail in Part VI.

Did one or more disqualified persons (as defined in line 9a) hold a controlling interest in any entity in which the supporting organization had an interest? If “Yes,” provide detail in Part VI.

Did a disqualified person (as defined in line 9a) have an ownership interest in, or derive any personal benefit from, assets in which the supporting organization also had an interest? If “Yes,” provide detail in Part VI.

10a

Was the organization subject to the excess business holdings rules of section 4943 because of section 4943(f) (regarding certain Type II supporting organizations, and all Type III non-functionally integrated supporting organizations)? If “Yes,” answer line 10b below.

10a

Did the organization have any excess business holdings in the tax year? (Use Schedule C, Form 4720, to determine whether the organization had excess business holdings).

10b

Schedule A (Form 990 or 990-EZ) 2019

Page 5

Part IV

Supporting Organizations (continued)

Yes

Has the organization accepted a gift or contribution from any of the following persons?

A person who directly or indirectly controls, either alone or together with persons described in (b) and (c) below, the governing body of a supported organization?

11a

A family member of a person described in (a) above?

11b

A 35% controlled entity of a person described in (a) or (b) above? If “Yes” to a, b, or c, provide detail in Part VI.

11c

Section B. Type I Supporting Organizations

Yes

Did the directors, trustees, or membership of one or more supported organizations have the power to regularly appoint or elect at least a majority of the organization’s directors or trustees at all times during the tax year? If “No,” describe in Part VI how the supported organization(s) effectively operated, supervised, or controlled the organization’s activities. If the organization had more than one supported organization, describe how the powers to appoint and/or remove directors or trustees were allocated among the supported organizations and what conditions or restrictions, if any, applied to such powers during the tax year.

Did the organization operate for the benefit of any supported organization other than the supported organization(s) that operated, supervised, or controlled the supporting organization? If “Yes,” explain in Part VI how providing such benefit carried out the purposes of the supported organization(s) that operated, supervised or controlled the supporting organization.

Section C. Type II Supporting Organizations

Yes

Were a majority of the organization’s directors or trustees during the tax year also a majority of the directors or trustees of each of the organization’s supported organization(s)? If “No,” describe in Part VI how control or management of the supporting organization was vested in the same persons that controlled or managed the supported organization(s).

Section D. All Type III Supporting Organizations

Yes

Did the organization provide to each of its supported organizations, by the last day of the fifth month of the organization’s tax year, (i) a written notice describing the type and amount of support provided during the prior tax year, (ii) a copy of the Form 990 that was most recently filed as of the date of notification, and (iii) copies of the organization’s governing documents in effect on the date of notification, to the extent not previously provided?

Were any of the organization’s officers, directors, or trustees either (i) appointed or elected by the supported organization(s) or (ii) serving on the governing body of a supported organization? If "No," explain in Part VI how the organization maintained a close and continuous working relationship with the supported organization(s).

By reason of the relationship described in (2), did the organization’s supported organizations have a significant voice in the organization’s investment policies and in directing the use of the organization’s income or assets at all times during the tax year? If "Yes," describe in Part VI the role the organization’s supported organizations played in this regard.

Section E. Type III Functionally-Integrated Supporting Organizations

Check the box next to the method that the organization used to satisfy the Integral Part Test during the year (see instructions):

The organization satisfied the Activities Test. Complete line 2 below.

The organization is the parent of each of its supported organizations. Complete line 3 below.

The organization supported a governmental entity. Describe in Part VI how you supported a government entity (see instructions)

Activities Test. Answer (a) and (b) below.

Yes

Did substantially all of the organization’s activities during the tax year directly further the exempt purposes of the supported organization(s) to which the organization was responsive? If "Yes," then in Part VI identify those supported organizations and explain how these activities directly furthered their exempt purposes, how the organization was responsive to those supported organizations, and how the organization determined that these activities constituted substantially all of its activities.

Did the activities described in (a) constitute activities that, but for the organization’s involvement, one or more of the organization’s supported organization(s) would have been engaged in? If "Yes," explain in Part VI the reasons for the organization’s position that its supported organization(s) would have engaged in these activities but for the organization’s involvement.

Parent of Supported Organizations. Answer (a) and (b) below.

Did the organization have the power to regularly appoint or elect a majority of the officers, directors, or trustees of each of the supported organizations? Provide details in Part VI.

Did the organization exercise a substantial degree of direction over the policies, programs and activities of each of its supported organizations? If "Yes," describe in Part VI. the role played by the organization in this regard.

Schedule A (Form 990 or 990-EZ) 2019

Page 6

Part V

Type III Non-Functionally Integrated 509(a)(3) Supporting Organizations

Check here if the organization satisfied the Integral Part Test as a qualifying trust on Nov. 20, 1970 (explain in Part VI). See instructions. All other Type III non-functionally integrated supporting organizations must complete Sections A through E.

	Section A - Adjusted Net Income		(A) Prior Year	(B) Current Year (optional)
1	Net short-term capital gain	1
2	Recoveries of prior-year distributions	2
3	Other gross income (see instructions)	3
4	Add lines 1 through 3	4
5	Depreciation and depletion	5
6	Portion of operating expenses paid or incurred for production or collection of gross income or for management, conservation, or maintenance of property held for production of income (see instructions)	6
7	Other expenses (see instructions)	7
8	Adjusted Net Income (subtract lines 5, 6 and 7 from line 4)	8

	Section B - Minimum Asset Amount		(A) Prior Year	(B) Current Year (optional)
1	Aggregate fair market value of all non-exempt-use assets (see instructions for short tax year or assets held for part of year):	1
a	Average monthly value of securities	1a
b	Average monthly cash balances	1b
c	Fair market value of other non-exempt-use assets	1c
d	Total (add lines 1a, 1b, and 1c)	1d
e	Discount claimed for blockage or other factors (explain in detail in Part VI):
2	Acquisition indebtedness applicable to non-exempt use assets	2
3	Subtract line 2 from line 1d	3
4	Cash deemed held for exempt use. Enter 1-1/2% of line 3 (for greater amount, see instructions).	4
5	Net value of non-exempt-use assets (subtract line 4 from line 3)	5
6	Multiply line 5 by .035	6
7	Recoveries of prior-year distributions	7
8	Minimum Asset Amount (add line 7 to line 6)	8

	Section C - Distributable Amount		Current Year
1	Adjusted net income for prior year (from Section A, line 8, Column A)	1
2	Enter 85% of line 1	2
3	Minimum asset amount for prior year (from Section B, line 8, Column A)	3
4	Enter greater of line 2 or line 3	4
5	Income tax imposed in prior year	5
6	Distributable Amount. Subtract line 5 from line 4, unless subject to emergency temporary reduction (see instructions)	6

Check here if the current year is the organization's first as a non-functionally-integrated Type III supporting organization (see instructions)

Schedule A (Form 990 or 990-EZ) 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:

- TIN:

Schedule B
(Form 990, 990-EZ,
or 990-PF)

Department of the Treasury
Internal Revenue Service

Schedule of Contributors

Attach to Form 990, 990-EZ, or 990-PF.

Go to www.irs.gov/Form990 for the latest information.

OMB No. 1545-0047

2019

Name of the organization

Yoakum Community Hospital

Employer identification number

74-2323822

Organization type (check one):

Filers of:

Section:

Form 990 or 990-EZ

501(c)( ) (enter number) organization

4947(a)(1) nonexempt charitable trust not treated as a private foundation

527 political organization

Form 990-PF

501(c)(3) exempt private foundation

4947(a)(1) nonexempt charitable trust treated as a private foundation

501(c)(3) taxable private foundation

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

For an organization filing Form 990, 990-EZ, or 990-PF that received, during the year, contributions totaling $5,000 or more (in money or other property) from any one contributor. Complete Parts I and II. See instructions for determining a contributor's total contributions.

Special Rules

For an organization described in section 501(c)(3) filing Form 990 or 990-EZ that met the 33¹/3% support test of the regulations
under sections 509(a)(1) and 170(b)(1)(A)(vi), that checked Schedule A (Form 990 or 990-EZ), Part II, line 13, 16a, or 16b, and that received from any one contributor, during the year, total contributions of the greater of (1) $5,000 or (2) 2% of the amount on (i) Form 990, Part VIII, line 1h, or (ii) Form 990-EZ, line 1. Complete Parts I and II.

For an organization described in section 501(c)(7), (8), or (10) filing Form 990 or 990-EZ that received from any one contributor,
during the year, total contributions of more than $1,000 exclusively for religious, charitable, scientific, literary, or educational purposes, or for the prevention of cruelty to children or animals. Complete Parts I, II, and III.

For an organization described in section 501(c)(7), (8), or (10) filing Form 990 or 990-EZ that received from any one contributor,
during the year, contributions exclusively for religious, charitable, etc., purposes, but no such contributions totaled more than $1,000. If this box is checked, enter here the total contributions that were received during the year for an exclusively religious, charitable, etc., purpose. Don't complete any of the parts unless the General Rule applies to this organization because it received nonexclusively religious, charitable, etc., contributions totaling $5,000 or more during the year ......... 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 Yoakum Community Hospital

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
		$	Person Payroll Noncash (Complete Part II for noncash contributions.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II for noncash contributions.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II for noncash contributions.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II for noncash contributions.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II for noncash contributions.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (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 Yoakum Community Hospital		Employer identification number 74-2323822

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 Yoakum Community Hospital			Employer identification number 74-2323822
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.) $ Use duplicate copies of Part III if additional space is needed.

(a)
No. from Part I

(b) Purpose 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

(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

(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

(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:

- TIN:

SCHEDULE D
(Form 990)

Department of the Treasury
Internal Revenue Service

Supplemental Financial Statements

Complete if the organization answered "Yes," on Form 990,
Part IV, line 6, 7, 8, 9, 10, 11a, 11b, 11c, 11d, 11e, 11f, 12a, or 12b.
SchDMd Bullet

Attach to Form 990.
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

Yoakum Community Hospital

Employer identification number

74-2323822

Part I

Organizations Maintaining Donor Advised Funds or Other Similar Funds or Accounts. Complete if the organization answered "Yes" on Form 990, Part IV, line 6.

		(a) Donor advised funds	(b) Funds and other accounts
1	Total number at end of year .........
2	Aggregate value of contributions to (during year)
3	Aggregate value of grants from (during year)
4	Aggregate value at end of year ........

Did the organization inform all donors and donor advisors in writing that the assets held in donor advised funds are the organization’s property, subject to the organization’s exclusive legal control? ............

Yes No

Did the organization inform all grantees, donors, and donor advisors in writing that grant funds can be used only for charitable purposes and not for the benefit of the donor or donor advisor, or for any other purpose conferring impermissible private benefit? ...................................

Yes No

Part II

Conservation Easements.
Complete if the organization answered "Yes" on Form 990, Part IV, line 7.

Purpose(s) of conservation easements held by the organization (check all that apply).

Preservation of land for public use (e.g., recreation or education) Preservation of an historically important land area

Protection of natural habitat Preservation of a certified historic structure

Preservation of open space

Complete lines 2a through 2d if the organization held a qualified conservation contribution in the form of a conservation easement on the last day of the tax year.


a	Total number of conservation easements ......................	2a
b	Total acreage restricted by conservation easements ....................	2b
c	Number of conservation easements on a certified historic structure included in (a) .....	2c
d	Number of conservation easements included in (c) acquired after 7/25/06, and not on a historic structure listed in the National Register ...	2d

Number of conservation easements modified, transferred, released, extinguished, or terminated by the organization during the
tax year SchDMd Bullet

Number of states where property subject to conservation easement is located SchDMd Bullet

Does the organization have a written policy regarding the periodic monitoring, inspection, handling of violations, and enforcement of the conservation easements it holds? ............

Yes No

Staff and volunteer hours devoted to monitoring, inspecting, handling of violations, and enforcing conservation easements during the year
SchDMd Bullet

Amount of expenses incurred in monitoring, inspecting, handling of violations, and enforcing conservation easements during the year
SchDMd Bullet

Does each conservation easement reported on line 2(d) above satisfy the requirements of section 170(h)(4)(B)(i) and section 170(h)(4)(B)(ii)? .............................

Yes No

In Part XIII, describe how the organization reports conservation easements in its revenue and expense statement, and
balance sheet, and include, if applicable, the text of the footnote to the organization’s financial statements that describes
the organization’s accounting for conservation easements.

Part III

Organizations Maintaining Collections of Art, Historical Treasures, or Other Similar Assets.
Complete if the organization answered "Yes" on Form 990, Part IV, line 8.

If the organization elected, as permitted under 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.

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

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:

Revenue included on Form 990, Part VIII, line 1 .......................... SchDMd Bullet

Assets included in Form 990, Part X ............................... SchDMd Bullet

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

Cat. No. 52283D

Schedule D (Form 990) 2019

Page 2

Part III

Organizations Maintaining Collections of Art, Historical Treasures, or Other Similar Assets (continued)

Using the organization’s acquisition, accession, and other records, check any of the following that are a significant use of its collection items (check all that apply):

Public exhibition

Loan or exchange programs

Scholarly research

Other

Preservation for future generations

Provide a description of the organization’s collections and explain how they further the organization’s exempt purpose in
Part XIII.

During the year, did the organization solicit or receive donations of art, historical treasures or other similar
assets to be sold to raise funds rather than to be maintained as part of the organization’s collection?...

Yes No

Part IV

Escrow and Custodial Arrangements. Complete if the organization answered "Yes" on Form 990, Part IV, line 9, or reported an amount on Form 990, Part X, line 21.

Is the organization an agent, trustee, custodian or other intermediary for contributions or other assets not
included on Form 990, Part X? ....................................

Yes No


b	If "Yes," explain the arrangement in Part XIII and complete the following table:		Amount
c	Beginning balance .............................	1c
d	Additions during the year ............................	1d
e	Distributions during the year ..........................	1e
f	Ending balance ................................	1f

Did the organization include an amount on Form 990, Part X, line 21, for escrow or custodial account liability? ...

Yes No

If "Yes," explain the arrangement in Part XIII. Check here if the explanation has been provided in Part XIII ....

Part V

Endowment Funds.
Complete if the organization answered "Yes" on Form 990, Part IV, line 10.

		(a) Current year	(b) Prior year	(c) Two years back	(d) Three years back	(e) Four years back

1a	Beginning of year balance ....
b	Contributions ...
c	Net investment earnings, gains, and losses
d	Grants or scholarships ...
e	Other expenditures for facilities and programs ...
f	Administrative expenses ....
g	End of year balance ......

Provide the estimated percentage of the current year end balance (line 1g, column (a)) held as:

Board designated or quasi-endowment SchDMd Bullet

Permanent endowment SchDMd Bullet

Term endowment SchDMd Bullet

The percentages on lines 2a, 2b, and 2c should equal 100%.

Are there endowment funds not in the possession of the organization that are held and administered for the
organization by:

Yes

(i) Unrelated organizations .................

3a(i)

(ii) Related organizations .................

3a(ii)

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

Describe in Part XIII the intended uses of the organization's endowment funds.

Part VI

Land, Buildings, and Equipment.
Complete if the organization answered "Yes" on Form 990, Part IV, line 11a. See Form 990, Part X, line 10.

Description of property		(a) Cost or other basis (investment)	(b) Cost or other basis (other)	(c) Accumulated depreciation	(d) Book value

1a	Land .....	0	1,000		1,000
b	Buildings ....		7,147,000	971,000	6,176,000
c	Leasehold improvements
d	Equipment ....		11,813,000	9,569,000	2,244,000
e	Other .....
Total. Add lines 1a through 1e. (Column (d) must equal Form 990, Part X, column (B), line 10(c).)..					8,421,000

Schedule D (Form 990) 2019

Page 3

Part VII

InvestmentsOther Securities.
Complete if the organization answered "Yes" on Form 990, Part IV, line 11b. See Form 990, Part X, line 12.

(a) Description of security or category (including name of security)	(b) Book value	(c) Method of valuation: Cost or end-of-year market value
(1) Financial derivatives.........
(2) Closely-held equity interests........
(3)Other
(B)
(C)
(D)
(E)
(F)
(G)
(H)
(I)
Total. (Column (b) must equal Form 990, Part X, col. (B) line 12.)

Part VIII

InvestmentsProgram Related. Complete if the organization answered 'Yes' on Form 990, Part IV, line 11c. See Form 990, Part X, line 13.

(a) Description of investment	(b) Book value	(c) Method of valuation: Cost or end-of-year market value

(2)
(3)
(4)
(5)
(6)
(7)
(8)
(9)
(10)
Total. (Column (b) must equal Form 990, Part X, col.(B) line 13.)

Part IX

Other Assets.
Complete if the organization answered 'Yes' on Form 990, Part IV, line 11d. See Form 990, Part X, line 15.

(a) Description				(b) Book value

(2)
(3)
(4)
(5)
(6)
(7)
(8)
(9)
(10)
Total. (Column (b) must equal Form 990, Part X, col.(B) line 15.)...........

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
(2)
(3)
(4)
(5)
(6)
(7)
(8)
(9)
Total. (Column (b) must equal Form 990, Part X, col.(B) line 25.)	233,000
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

Page 4

Part XI Reconciliation of Revenue per Audited Financial Statements With Revenue per Return. Complete if the organization answered 'Yes' on Form 990, Part IV, line 12a.
1	Total revenue, gains, and other support per audited financial statements .......		1
2	Amounts included on line 1 but not on Form 990, Part VIII, line 12:
a	Net unrealized gains (losses) on investments ....	2a
b	Donated services and use of facilities .........	2b
c	Recoveries of prior year grants ...........	2c
d	Other (Describe in Part XIII.) ............	2d
e	Add lines 2a through 2d .....................		2e
3	Subtract line 2e from line 1..................		3
4	Amounts included on Form 990, Part VIII, line 12, but not on line 1:
a	Investment expenses not included on Form 990, Part VIII, line 7b .	4a
b	Other (Describe in Part XIII.) ...........	4b
c	Add lines 4a and 4b....................		4c
5	Total revenue. Add lines 3 and 4c. (This must equal Form 990, Part I, line 12.) ......		5

Part XII Reconciliation of Expenses per Audited Financial Statements With Expenses per Return. Complete if the organization answered 'Yes' on Form 990, Part IV, line 12a.
1	Total expenses and losses per audited financial statements ...........		1
2	Amounts included on line 1 but not on Form 990, Part IX, line 25:
a	Donated services and use of facilities .........	2a
b	Prior year adjustments ............	2b
c	Other losses ................	2c
d	Other (Describe in Part XIII.) ............	2d
e	Add lines 2a through 2d....................		2e
3	Subtract line 2e from line 1...................		3
4	Amounts included on Form 990, Part IX, line 25, but not on line 1:
a	Investment expenses not included on Form 990, Part VIII, line 7b ..	4a
b	Other (Describe in Part XIII.) ............	4b
c	Add lines 4a and 4b.....................		4c
5	Total expenses. Add lines 3 and 4c. (This must equal Form 990, Part I, line 18.) ......		5

Part XIII

Supplemental Information

Provide the descriptions required for Part II, lines 3, 5, and 9; Part III, lines 1a and 4; Part lV, lines 1b and 2b; Part V, line 4; Part X, line 2; Part XI, lines 2d and 4b; and Part XII, lines 2d and 4b. Also complete this part to provide any additional information.

Return Reference	Explanation

Schedule D (Form 990) 2019

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE H
(Form 990)

Department of the Treasury
Internal Revenue Service

Hospitals

Complete if the organization answered "Yes" on Form 990, Part IV, question 20.
MediumBullet

Attach to Form 990.
MediumBullet

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

Yoakum Community Hospital

Employer identification number

74-2323822

Part I

Financial Assistance and Certain Other Community Benefits at Cost

Yes

Did the organization have a financial assistance policy during the tax year? If "No," skip to question 6a . . . .

Yes

If "Yes," was it a written policy? ......................

Yes

If the organization had multiple hospital facilities, indicate which of the following best describes application of the financial assistance policy to its various hospital facilities during the tax year.

Applied uniformly to all hospital facilities Applied uniformly to most hospital facilities Generally tailored to individual hospital facilities

Answer the following based on the financial assistance eligibility criteria that applied to the largest number of the organization's patients during the tax year.

Did the organization use Federal Poverty Guidelines (FPG) as a factor in determining eligibility for providing free care?

If "Yes," indicate which of the following was the FPG family income limit for eligibility for free care:

Yes

100% 150% 200% Other %

Did the organization use FPG as a factor in determining eligibility for providing discounted care? If "Yes," indicate

which of the following was the family income limit for eligibility for discounted care: . . . . . . . .

Yes

200% 250% 300% 350% 400% Other %

If the organization used factors other than FPG in determining eligibility, describe in Part VI the criteria used for determining eligibility for free or discounted care. Include in the description whether the organization used an asset test or other threshold, regardless of income, as a factor in determining eligibility for free or discounted care.

Did the organization's financial assistance policy that applied to the largest number of its patients during the tax year provide for free or discounted care to the "medically indigent"? . . . . . . . . . . . . .

Yes

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

Yes

If "Yes," did the organization's financial assistance expenses exceed the budgeted amount? . . . . . .

Yes

If "Yes" to line 5b, as a result of budget considerations, was the organization unable to provide free or discountedcare to a patient who was eligibile for free or discounted care? . . . . . . . . . . . . .

Did the organization prepare a community benefit report during the tax year? . . . . . . . . .

Yes

If "Yes," did the organization make it available to the public? . . . . . . . . . . . . .

Yes

Complete the following table using the worksheets provided in the Schedule H instructions. Do not submit these worksheets with the Schedule H.

Financial Assistance and Certain Other Community Benefits at Cost

Financial Assistance and Means-Tested Government Programs		(c) Total community benefit expense	(d) Direct offsetting revenue	(e) Net community benefit expense	(f) Percent of total expense
a	Financial Assistance at cost (from Worksheet 1) . . .	880,095	6,885	873,210	3.880 %
b	Medicaid (from Worksheet 3, column a) . . . . .	2,531,926	874,412	1,657,514	7.370 %
c	Costs of other means-tested government programs (from Worksheet 3, column b) . .
d	Total Financial Assistance and Means-Tested Government Programs . . . . .	3,412,021	881,297	2,530,724	11.250 %
Other Benefits
e	Community health improvement services and community benefit operations (from Worksheet 4).	0	0
f	Health professions education (from Worksheet 5) . . .	0	0	0	0 %
g	Subsidized health services (from Worksheet 6) . . . .
h	Research (from Worksheet 7) .	0	0	0	0 %
i	Cash and in-kind contributions for community benefit (from Worksheet 8) . . . .
j	Total. Other Benefits . .	0	0	0	0 %
k	Total. Add lines 7d and 7j .	3,412,021	881,297	2,530,724	11.250 %

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
4	Environmental improvements
5	Leadership development and training for community members
6	Coalition building
7	Community health improvement advocacy
8	Workforce development
9	Other
10	Total

Part III

Bad Debt, Medicare, & Collection Practices

Section A. Bad Debt Expense

Yes

Did the organization report bad debt expense in accordance with Healthcare Financial Management Association Statement No. 15? ..........................

Yes

Enter the amount of the organization's bad debt expense. Explain in Part VI the methodology used by the organization to estimate this amount. ......

2,534,521

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. ......

50,700

Provide in Part VI the text of the footnote to the organization’s financial statements that describes bad debt expense or the page number on which this footnote is contained in the attached financial statements.

Section B. Medicare

Enter total revenue received from Medicare (including DSH and IME).....

9,632,535

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

8,565,350

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

1,067,185

Describe in Part VI the extent to which any shortfall reported in line 7 should be treated as community benefit.Also describe in Part VI the costing methodology or source used to determine the amount reported on line 6.Check the box that describes the method used:

Cost accounting system Cost to charge ratio Other

Section C. Collection Practices

Did the organization have a written debt collection policy during the tax year? ..........

Yes

If "Yes," did the organization’s collection policy that applied to the largest number of its patients during the tax year
contain provisions on the collection practices to be followed for patients who are known to qualify for financial assistance? Describe in Part VI .........................

Yes

Part IV

Management Companies and Joint Ventures(owned 10% or more by officers, directors, trustees, key employees, and physicians—see instructions)

(a) Name of entity	(b) Description of primary activity of entity	(c) Organization's profit % or stock ownership %	(d) Officers, directors, trustees, or key employees' profit % or stock ownership %	(e) Physicians' profit % or stock ownership %
1
2
3
4
5
6
7
8
9
10
11
12
13

Schedule H (Form 990) 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)
1	YOAKUM COMMUNITY HOSPITAL 1200 Carl Ramert Drive Yoakum,TX77995 https://yoakumhospital.org 000023	X	X	X	X

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)

	Yoakum Community 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):

Yes

Community Health Needs Assessment

Was the hospital facility first licensed, registered, or similarly recognized by a state as a hospital facility in the current tax year or the immediately preceding tax year?........................

Was the hospital facility acquired or placed into service as a tax-exempt hospital in the current tax year or the immediately preceding tax year? If “Yes,” provide details of the acquisition in Section C...............

During the tax year or either of the two immediately preceding tax years, did the hospital facility conduct a community health needs assessment (CHNA)? If "No," skip to line 12......................

Yes

If "Yes," indicate what the CHNA report describes (check all that apply):

A definition of the community served by the hospital facility

Demographics of the community

Existing health care facilities and resources within the community that are available to respond to the health needs of the community

How data was obtained

The significant health needs of the community

Primary and chronic disease needs and other health issues of uninsured persons, low-income persons, and minority groups

The process for identifying and prioritizing community health needs and services to meet the community health needs

The process for consulting with persons representing the community’s interests

The impact of any actions taken to address the significant health needs identified in the hospital facility's prior CHNA(s)

Other (describe in Section C)

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

In conducting its most recent CHNA, did the hospital facility take into account input from persons who represent the broad interests of the community served by the hospital facility, including those with special knowledge of or expertise in public health? If "Yes," describe in Section C how the hospital facility took into account input from persons who represent the community, and identify the persons the hospital facility consulted .................

Yes

6 a

Was the hospital facility’s CHNA conducted with one or more other hospital facilities? If "Yes," list the other hospital facilities in Section C..................................

Was the hospital facility’s CHNA conducted with one or more organizations other than hospital facilities?” If “Yes,” list the other organizations in Section C. ............................

Did the hospital facility make its CHNA report widely available to the public?..............

Yes

If "Yes," indicate how the CHNA report was made widely available (check all that apply):

Hospital facility’s website (list url): https://yoakumhospital.org/about/chna/

Other website (list url):

Made a paper copy available for public inspection without charge at the hospital facility

Other (describe in Section C)

Did the hospital facility adopt an implementation strategy to meet the significant community health needs
identified through its most recently conducted CHNA? If "No," skip to line 11. ..............

Yes

Indicate the tax year the hospital facility last adopted an implementation strategy: 20 15

Is the hospital facility's most recently adopted implementation strategy posted on a website?.........

Yes

If "Yes" (list url): https://yoakumhospital.org/about/chna/

If "No," is the hospital facility’s most recently adopted implementation strategy attached to this return? ......

10b

Describe in Section C how the hospital facility is addressing the significant needs identified in its most recently conducted CHNA and any such needs that are not being addressed together with the reasons why such needs are not being addressed.

12a

Did the organization incur an excise tax under section 4959 for the hospital facility's failure to conduct a CHNA as required by section 501(r)(3)?...............................

12a

If "Yes" on line 12a, did the organization file Form 4720 to report the section 4959 excise tax?........

12b

If "Yes" on line 12b, what is the total amount of section 4959 excise tax the organization reported on Form 4720 for all of its hospital facilities? $

Schedule H (Form 990) 2019

Page 5

Part VFacility Information (continued)

Financial Assistance Policy (FAP)

	Yoakum Community Hospital
Name of hospital facility or letter of facility reporting group

Yes

Did the hospital facility have in place during the tax year a written financial assistance policy that:

Explained eligibility criteria for financial assistance, and whether such assistance included free or discounted care?

Yes

If “Yes,” indicate the eligibility criteria explained in the FAP:

Federal poverty guidelines (FPG), with FPG family income limit for eligibility for free care of 200.%
and FPG family income limit for eligibility for discounted care of 400.%

Income level other than FPG (describe in Section C)

Asset level

Medical indigency

Insurance status

Underinsurance discount

Residency

Other (describe in Section C)

Explained the basis for calculating amounts charged to patients?.................

Yes

Explained the method for applying for financial assistance?...................

Yes

If “Yes,” indicate how the hospital facility’s FAP or FAP application form (including accompanying instructions) explained the method for applying for financial assistance (check all that apply):

Described the information the hospital facility may require an individual to provide as part of his or her application

Described the supporting documentation the hospital facility may require an individual to submit as part of his or
her application

Provided the contact information of hospital facility staff who can provide an individual with information about the
FAP and FAP application process

Provided the contact information of nonprofit organizations or government agencies that may be sources of
assistance with FAP applications

Other (describe in Section C)

Was widely publicized within the community served by the hospital facility?........

Yes

If "Yes," indicate how the hospital facility publicized the policy (check all that apply):

The FAP was widely available on a website (list url):

See Part V, Section C

The FAP application form was widely available on a website (list url):

See Part V, Section C

A plain language summary of the FAP was widely available on a website (list url):
See Part V, Section C

The FAP was available upon request and without charge (in public locations in the hospital facility and by mail)

The FAP application form was available upon request and without charge (in public locations in the hospital facility
and by mail)

A plain language summary of the FAP was available upon request and without charge (in public locations in the
hospital facility and by mail)

Individuals were notified about the FAP by being offered a paper copy of the plain language summary of the FAP, by
receiving a conspicuous written notice about the FAP on their billing statements, and via conspicuous public displays or
other measures reasonably calculated to attract patients' attention

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

The FAP, FAP application form, and plain language summary of the FAP were translated into the primary language(s)
spoken by LEP populations

Other (describe in Section C)

Schedule H (Form 990) 2019

Page 6

Part VFacility Information (continued)

Billing and Collections

	Yoakum Community Hospital
Name of hospital facility or letter of facility reporting group

Yes

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

Yes

Check all of the following actions against an individual that were permitted under the hospital facility's policies during the tax year before making reasonable efforts to determine the individual’s eligibility under the facility’s FAP:

Reporting to credit agency(ies)

Selling an individual’s debt to another party

Deferring, denying, or requiring a payment before providing medically necessary care due to nonpayment of a previous
bill for care covered under the hospital facility's FAP

Actions that require a legal or judicial process

Other similar actions (describe in Section C)

None of these actions or other similar actions were permitted

Did the hospital facility or other authorized party perform any of the following actions during the tax year before making reasonable efforts to determine the individual’s eligibility under the facility’s FAP?............

If "Yes," check all actions in which the hospital facility or a third party engaged:

Reporting to credit agency(ies)

Selling an individual’s debt to another party

Deferring , denying, or requiring a payment before providing medically necessary care due to nonpayment of a previous
bill for care covered under the hospital facility's FAP

Actions that require a legal or judicial process

Other similar actions (describe in Section C)

Indicate which efforts the hospital facility or other authorized party made before initiating any of the actions listed (whether or not checked) in line 19. (check all that apply):

Provided a written notice about upcoming ECAs (Extraordinary Collection Action) and a plain language summary of the
FAP at least 30 days before initiating those ECAs (if not, describe in Section C)

Made a reasonable effort to orally notify individuals about the FAP and FAP application process (if not, describe in
Section C)

Processed incomplete and complete FAP applications (if not, describe in Section C)

Made presumptive eligibility determinations (if not, describe in Section C)

Other (describe in Section C)

None of these efforts were made

Policy Relating to Emergency Medical Care

Did the hospital facility have in place during the tax year a written policy relating to emergency medical care that required the hospital facility to provide, without discrimination, care for emergency medical conditions to individuals regardless of their eligibility under the hospital facility’s financial assistance policy?..................

Yes

If "No," indicate why:

The hospital facility did not provide care for any emergency medical conditions

The hospital facility’s policy was not in writing

The hospital facility limited who was eligible to receive care for emergency medical conditions (describe in Section C)

Other (describe in Section C)

Schedule H (Form 990) 2019

Page 7

Part VFacility Information (continued)

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

	Yoakum Community Hospital
Name of hospital facility or letter of facility reporting group

Yes

Indicate how the hospital facility determined, during the tax year, the maximum amounts that can be charged to FAP-eligible individuals for emergency or other medically necessary care.

The hospital facility used a look-back method based on claims allowed by Medicare fee-for-service during a prior 12-month period

The hospital facility used a look-back method based on claims allowed by Medicare fee-for-service and all private health insurers that pay claims to the hospital facility during a prior 12-month period

The hospital facility used a look-back method based on claims allowed by Medicaid, either alone or in combination with
Medicare fee-for-service and all private health insurers that pay claims to the hospital facility during a prior 12-month
period

The hospital facility used a prospective Medicare or Medicaid method

During the tax year, did the hospital facility charge any FAP-eligible individual to whom the hospital facility provided emergency or other medically necessary services more than the amounts generally billed to individuals who had insurance covering such care? ...............................

If "Yes," explain in Section C.

During the tax year, did the hospital facility charge any FAP-eligible individual an amount equal to the gross charge for any service provided to that individual? ...........................

If "Yes," explain in Section C.

Schedule H (Form 990) 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
Part V, Line 3E	The significant health needs of the community identified in the CHNA are presented as a prioritized description. Part V, Line 5 YOAKUM COMMUNITY HOSPITAL WORKED WITH COMMUNITY HOSPITAL CORPORATION IN THE DEVELOPMENT OF ITS CHNA to identify the significant community health needs in Lavaca County, Texas. Lavaca County has a significantly older population (22.1%) as compared to the state of TX (11.7%) as of 2015. The majority of growth in Lavaca County is expected to come from the 65 and older population over the next five years. As of 2015, Lavaca County has a slightly lower median household income than Texas ($50,864 compared to $51,603). -Lavaca County has a much lower percent of residents with Bachelors or Advanced Degrees than Texas (14.6% compared to 26.6%). -Between 2010 and 2014, the percent of the population (all ages) in Lavaca County (16.4%) that were uninsured was slightly lower than the state (21.9%), but higher than the national (14.2%) rates. -Between 2010 and 2014, 16.7% of the insured population in Lavaca County was receiving Medicaid. Specific groups at risk for inadequate care are the elderly, low Income/uninsured or underinsured, Non-English speaking and Veterans. YOAKUM COMMUNITY HOSPITAL PROVIDED COMMUNITY HOSPITAL CORPORATION WITH A LIST OF PERSONS WITH SPECIAL KNOWLEDGE OF PUBLIC HEALTH IN LAVACA COUNTY INCLUDING PUBLIC HEALTH REPRESENTATIVES, NOT FOR PROFIT ORGANIZATION PROFESSIONALS, CHARITIES AND OTHER INDIVIDUALS WHO FOCUS SPECIFICALLY ON UNDERREPRESENTED GROUPS. FROM THAT LIST, TEN IN DEPTH INTERVIEWS WERE CONDUCTED from August 12, 2015 through August 25, 2015, USING A STRUCTURE INTERVIEW GUIDE. EXTENSIVE NOTES WERE TAKEN DURING EACH INTERVIEW AND THEN QUANTIFIED BASED ON RESPONSES, COMMUNITIES AND POPULATIONS (MINORITY, ELDERLY, UN/UNDERINSURED, ETC.) SERVED, AND PRIORITIES IDENTIFIED BY RESPONDENTS. QUALITATIVE DATA FROM THE INTERVIEWS WAS ALSO ANALYZED AND REPORTED. INDIVIDUALS INTERVIEWED: -DR. MARSHALL BISHOP: FAMILY PRACTICE PHYSICIAN, WAGNER MEDICAL CLINIC -TOM KELLEY: SUPERINTENDENT, YOAKUM INDEPENDENT SCHOOL DISTRICT -THERESA KOSTELNIK, RN: FAMILY AND COMMUNITY HEALTH MANAGER, TEXAS DEPARTMENT OF STATE HEALTH SERVICES REGION 8 -SHARLA POHL: EXECUTIVE DIRECTOR, YOAKUM HOUSING AUTHORITY -KIM REEVES: EXECUTIVE DIRECTOR, BLUEBONNET YOUTH RANCH -ANNIE RODRIGUEZ: MAYOR, CITY OF YOAKUM -LORENE ROZNOVSKY: PRESIDENT, YOAKUM COMMUNITY HOSPITAL AUXILIARY -KAY SCHAUER, LCSW: DIRECTOR, NEW HORIZONS GERIATRIC COUNSELING PROGRAM -KELLI SCHLEY: MANAGER, YOAKUM DISCOUNT PHARMACY -ELORINE SITKA: MEMBER, YOAKUM COMMUNITY HOSPITAL BOARD OF TRUSTEES; VICE PRESIDENT, YOAKUM NATIONAL BANK; AND MAYOR PRO-TEM, CITY OF YOAKUM -KAY SCHAUER, LCSW: DIRECTOR, NEW HORIZONS GERIATRIC COUNSELING PROGRAM -KELLI SCHLEY: MANAGER, YOAKUM DISCOUNT PHARMACY -ELORINE SITKA: MEMBER, YOAKUM COMMUNITY HOSPITAL BOARD OF TRUSTEES; VICE PRESIDENT, YOAKUM NATIONAL BANK; AND MAYOR PRO-TEM, CITY OF YOAKUM -ELORINE SITKA: MEMBER, YOAKUM COMMUNITY HOSPITAL BOARD OF TRUSTEES; VICE PRESIDENT, YOAKUM NATIONAL BANK; AND MAYOR PRO-TEM, CITY OF YOAKUM
Part V, Line 11	YOAKUM COMMUNITY HOSPITAL HAS DECIDED TO ADDRESS THE NEED FOR "SPONSORING HEALTH SCREENINGS FOR THE COMMUNITY" BY SPONSORING BLOOD DRIVES, AND PERFORMING GLUCOSE, BLOOD PRESSURE AND CHOLESTEROL SCREENINGS FOR THE PUBLIC. YOAKUM COMMUNITY HOSPITAL HAS DECIDED NOT TO SPECIFICALLY ADDRESS THE NEED FOR "INCREASED ACCESS TO AFFORDABLE DENTAL CARE" LARGELY DUE TO ITS POSITION (LAST) ON THE PRIORITIZED LIST AND THE HOSPITAL'S LACK OF CAPACITY TO ADDRESS THAT NEED. DENTAL SERVICES ARE NOT A CORE BUSINESS FUNCTION OF THE HOSPITAL AND THE LEADERSHIP TEAM FELT THAT LIMITED RESOURCES AND EFFORTS WOULD BE BETTER SPENT ADDRESSING THE FIRST FIVE PRIORITIZED NEEDS. Yoakum Hospital is also addessing the following needs identified in its most recently conducted CHNA: Elderly Care, Mental/Behavioral Health, Access to Affordable Care, Prevention, Education, Services for Chronic Diseases, Preventable Conditions, Unhealthy Lifestyles, and Access to Affordable Dental Care. Part V, Lines 16A-C https://yoakumhospital.org/about/financial-assistance/ PART V, LINE 16I The hospital made translated copies of its FAP available to the Limited English Proficient community available upon request throughout the tax year. Prior to the filing of this return, these translated copies have been added to the hospital's website as well.
Part V, Line 20e	Patients are notified upon admission, prior to discharge, and in communications regarding individual bills. The organization documented determination of eligibility in accordance with the hospital facility's financial assistance policy.

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?
Name and address		Type of Facility (describe)
1
2
3
4
5
6
7
8
9
10

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
PART I, LINE 3C	THE ASSETS TEST IS USED IN ORDER TO DETERMINE THE AMOUNT OF DISCOUNTED CARE. PAY STUBS FOR PATIENT & SPOUSE, LAST YEAR'S TAX RETURN, SOCIAL SECURITY AWARD LETTER ARE REQUIRED IF EMPLOYED. IF UNEMPLOYED, FOOD STAMP APPROVAL/DENIAL, UNEMPLOYMENT APPROVAL/DENIAL AND LAST YEAR'S TAX RETURN ARE REQUIRED. THE PATIENT IS ALSO REQUIRED TO SUBMIT A FINANCIAL INFORMATION FORM SHOWING BILLS, BANK ACCOUNTS, AND ANY OTHER SUPPORT THEY MAY BE RECEIVING TO DETERMINE IF THEY ARE ELIGIBLE FOR CHARITY CARE.
PART I, LINE 6A	THE COMMUNITY BENEFIT REPORT FOR FISCAL YEAR ENDING JUNE 30, 2018 WAS PREPARED BY OUR CORPORATE OFFICE, COMMUNITY HOSPITAL CORPORATION.
PART I, LINE 7, COLUMN (F)	OUR TOTAL EXPENSE FROM FORM 990, PART IX, LINE 25, COLUMN (A) WAS $25,024,604. THE BAD DEBT EXPENSE INCLUDED IN THIS AMOUNT WAS $2,534,521. THIS LEFT A TOTAL EXPENSE OF $22,490,083 FOR PURPOSES OF CALCULATING NET COMMUNITY BENEFIT EXPENSE TO TOTAL EXPENSE.
Part III, Line 2, 3, & 4	ACCOUNTS RECEIVABLE ARE REDUCED BY AN ALLOWANCE FOR DOUBTFUL 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 DOUBTFUL 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 DOUBTFUL 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 DOUBTFUL 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 AS PROVIDED BY THE HOSPITAL'S INTERNAL POLICY AND THE AMOUNTS ACTUALLY COLLECTED AFTER ALL REASONABLE COLLECTION EFFORTS HAVE BEEN EXHAUSTED IS CHARGED OFF AGAINST THE ALLOWANCE FOR DOUBTFUL ACCOUNTS. THE HOSPITAL'S ALLOWANCE FOR DOUBTFUL ACCOUNTS FOR SELF-PAY PATIENTS WAS 51% OF SELF-PAY ACCOUNTS RECEIVABLE AT JUNE 30, 2018.
Part III, Line 8	INPATIENT ACUTE CARE SERVICES AND SUBSTANTIALLY ALL OUTPATIENT SERVICES RENDERED TO MEDICARE PROGRAM BENEFICIARIES ARE PAID AT PROSPECTIVELY DETERMINED RATES. THESE RATES VARY ACCORDING TO A PATIENT CLASSIFICATION SYSTEM THAT IS BASED ON CLINICAL, DIAGNOSTIC AND OTHER FACTORS. THE HOSPITAL IS REIMBURSED FOR CERTAIN SERVICES AT TENTATIVE RATES WITH FINAL SETTLEMENT DETERMINED AFTER SUBMISSION OF ANNUAL COST REPORTS BY THE HOSPITAL AND AUDITS THEREOF BY THE MEDICARE ADMINISTRATIVE CONTRACTOR.
Part III, Line 9B	IF A PATIENT OF YOAKUM COMMUNITY HOSPITAL QUALIFIES FOR ITS CHARITY CARE POLICY THE PATIENT'S ACCOUNT IS ADJUSTED ACCORDINGLY. PATIENT ACCOUNTS WITH REMAINING BALANCES WILL BE REASSESSED TO DETERMINE THEIR ABILITY TO PAY AND WILL EITHER BE ELIGIBLE TO PARTICIPATE IN A PAYMENT PLAN OR THEIR ACCOUNT BALANCE WILL BE WRITTEN OFF.
Part VI, Question 2	NEEDS ASSESSMENT THE ORGANIZATION SPEAKS WITH MEMBERS OF THE COMMUNITY AND LOCAL LEADERS TO SEE WHAT THEY FEEL ARE MAJOR NEEDS OF THE COMMUNITY. THE MISSION OF THE YCH FAMILY IS TO PROVIDE COMPREHENSIVE HEALTHCARE WITH COMPASSION, DIGNITY AND RESPECT THROUGH OUR TRADITION OF QUALITY CARE AND SUPERIOR SERVICE TO OUR COMMUNITY. YCH'S VISION IS TO BE RECOGNIZED AS A SOURCE OF COMPASSIONATE, QUALITY HEALTHCARE FOR OUR REGION. YCH OPERATES UNDER THE VALUES OF "RISE," RESPECT, INTEGRITY, STEWARDSHIP, AND EXCELLENCE. AS STATED IN OUR FYE 2017 COMMUNITY BENEFITS PLAN, IT HAS BEEN DETERMINED THAT WE NEED TO FOCUS ON FOUR ISSUES. THESE ISSUES ARE 1) NEED FOR INCREASED EMPHASIS ON ELDERLY CARE, 2) ACCESS TO MENTAL HEALTH SERVICES AND PROVIDERS, 3) ACCESS TO AFFORDABLE CARE & REDUCING HEALTH DISPARITIES AMONG SPECIFIC POPULATIONS, & 4) PREVENTION, EDUCATION, & SERVICES TO ADDRESS HIGH MORTALITY RATES, CHRONIC DISEASES, PREVENTABLE CONDITIONS, & UNHEALTHY LIFESTYLES. YCH HAS ADDRESSED THESE NEEDS BY PROMOTING EDUCATION AMONG THE YOUTH POPULATION BY GIVING TOURS OF THE HOSPITAL TO DISCUSS APPROPRIATE SAFETY RELATED TOPICS. EMPLOYEES ARE DEDICATED TO ENHANCING COMMUNITY WELLNESS BY SPONSORING CLUB MED AND COMMUNITY ASSISTING WITH STUDENTS (CAWS) PROGRAMS. YCH IS WORKING ON DEVELOPING AND IMPLEMENTING PUBLIC SERVICE MATERIALS PERTAINING TO WELLNESS BENEFITS AND THE AFFORDABLE CARE ACT (ACA). THEY WILL ALSO PROVIDE TRAINING FOR AN ACA SPECIALIST. YCH HAS PROVIDED LUNCH & LEARN MEETINGS TO ADDRESS THE NEEDS OF EDUCATION FOR THE COMMUNITY. SEVERAL OF OUR STAFF HAVE GIVEN TALKS AT THE LOCAL LION'S CLUB, LUTHERAN WOMEN'S GROUPS, ROTARY CLUB, METHODIST WOMEN'S GROUP, AUSTIN STREET BAPTIST WOMEN'S GROUP, AND STARTED A "SEW HEALTHY CLUB." HOLIDAY OPEN HOUSES ARE HELD TO OFFER OPPORTUNITIES FOR THE COMMUNITY TO COME VISIT OUR FACILITY. OUR GERI PSYCH PROGRAM HAS OFFERED COOKING CLASSES FOR OVER 50 PARTICIPANTS. WE HAS ALSO SPONSORED BLOOD PRESSURE AND CHOLESTEROL SCREENS AS PART OF SELF LOVE DAY.
Part VI, Question 3	PATIENT EDUCATION OF ELIGIBILITY FOR ASSISTANCE WE HAVE A COPY OF OUR CHARITY CARE POLICY POSTED ON OUR HOSPITAL WEBSITE AND HAVE AN ELIGIBILITY CONSULTANT ON SITE WHO WILL SCREEN ALL CUSTOMERS WHO ARE SELF PAY FOR ALL PROGRAMS THEY MAY BE ELIGIBLE FOR. OUR INSURED CUSTOMERS ARE ALSO REFERRED TO THE ELIGIBILITY CONSULTANT IF THEY ARE NOT ABLE TO SET UP FINANCIAL ARRANGEMENTS AFTER THEY ARE MOVED TO BEING SELF PAY. WE HAVE SIGNS POSTED IN OUR REGISTRATION AREA STATING "YCH PROVIDES FINANCIAL ASSISTANCE THROUGH OUR CHARITY OR INDIGENT PROGRAMS TO THOSE WHO QUALIFY. SEE REGISTRATION CLERK FOR MORE INFORMATION." OUR BILLING STATEMENTS ALSO HAVE CONTACT INFORMATION FOR CUSTOMERS WHO CANNOT PAY THE CLAIM IN FULL TO CALL TO DISCUSS MORE PAYMENT OPTIONS.
Part VI, Question 4	Community Information YOAKUM COMMUNITY HOSPITAL IS CENTRALLY LOCATED APPROXIMATELY 200 MILES FROM SAN ANTONIO & HOUSTON. OUR SERVICE AREA COVERS APPROXIMATELY 2000 SQUARE MILES AND APPROXIMATELY 40,000 PEOPLE (DEWITT & LAVACA COUNTIES COMBINED). THE ENTIRE POPULATION OF LAVACA AND DEWITT COUNTIES IS CLASSIFIED AS MEDICALLY UNDERSERVED. YCH SERVES HEALTH SERVICE REGION 8 OF THE STATE OF TEXAS.
Part VI, Question 5	PROMOTION OF COMMUNITY HEALTH YCH HOLDS VARIOUS ACTIVITIES TO PROMOTE HEALTH CARE TO OUR COMMUNITY. WE HOLD HEALTH FAIRS, DONNA'S DAY (FREE HEALTH SCREENINGS FOR BLOOD PRESSURE, CHOLESTEROL, AND GLUCOSE LEVELS), AND WE HAVE A DIABETIC CLINIC AVAILABLE IN OUR OUTPATIENT CLINIC.
Part VI, Question 6	AFFILIATED HEALTH CARE SYSTEM YOAKUM COMMUNITY HOSPITAL IS NOT PART OF AN AFFILIATED HEALTH CARE SYSTEM. YOAKUM COMMUNITY HOSPITAL IS A 25 BED CRITICAL ACCESS HOSPITAL OFFERING GENERAL MEDICAL AND SURGICAL CARE TO THE CITIZENS OF YOAKUM AND THE SURROUNDING COMMUNITIES. ESTABLISHED IN 1922, YOAKUM COMMUNITY HOSPITAL HAS BEEN AN INTEGRAL PART OF THE COMMUNITY SINCE ITS INCEPTION AND CONTINUES TO SEARCH FOR WAYS TO BETTER SERVE OUR COMMUNITY.
Part VI, Question 7	STATE FILING OF COMMUNITY BENEFIT REPORT TX

Schedule H (Form 990) 2019

Additional Data

Software ID:
Software Version:

- TIN:

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

Yoakum Community Hospital

Employer identification number

74-2323822

Part I

Questions Regarding Compensation

Yes

Check the appropiate box(es) if the organization provided any of the following to or for a person listed on Form
990, Part VII, Section A, line 1a. Complete Part III to provide any relevant information regarding these items.

First-class or charter travel Housing allowance or residence for personal use

Travel for companions Payments for business use of personal residence

Tax idemnification and gross-up payments Health or social club dues or initiation fees

Discretionary spending account Personal services (e.g., maid, chauffeur, chef)

If any of the boxes 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 .........

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? ..

Indicate which, if any, of the following the filing organization used to establish the compensation of the
organization's CEO/Executive Director. Check all that apply. Do not check any boxes for methods
used by a related organization to establish compensation of the CEO/Executive Director, but explain in Part III.

Compensation committee Written employment contract

Independent compensation consultant Compensation survey or study

Form 990 of other organizations Approval by the board or compensation committee

During the year, did any person listed on Form 990, Part VII, Section A, line 1a, with respect to the filing organization or a related organization:

Receive a severance payment or change-of-control payment? .............

Participate in, or receive payment from, a supplemental nonqualified retirement plan? .........

Yes

Participate in, or receive payment from, an equity-based compensation arrangement? .........

If "Yes" to any of lines 4a-c, list the persons and provide the applicable amounts for each item in Part III.

Only 501(c)(3), 501(c)(4), and 501(c)(29) organizations must complete lines 5-9.

For persons listed on Form 990, Part VII, Section A, line 1a, did the organization pay or accrue any
compensation contingent on the revenues of:

The organization? ....................

Any related organization? .......................

If "Yes," on line 5a or 5b, describe in Part III.

For persons listed on Form 990, Part VII, Section A, line 1a, did the organization pay or accrue any
compensation contingent on the net earnings of:

The organization? ..................

Any related organization? ......................

If "Yes," on line 6a or 6b, describe in Part III.

For persons listed on Form 990, Part VII, Section A, line 1a, did the organization provide any nonfixed
payments not described in lines 5 and 6? If "Yes," describe in Part III ............

Yes

Were any amounts reported on Form 990, Part VII, paid or accured pursuant to a contract that was
subject to the initial contract exception described in Regulations section 53.4958-4(a)(3)? If "Yes," describe
in Part III ..........................

If "Yes" on line 8, did the organization also follow the rebuttable presumption procedure described in Regulations section 53.4958-6(c)? .........................

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

Cat. No. 50053T

Schedule J (Form 990) 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
(A) Name and Title		(i) Base compensation	(ii) Bonus & incentive compensation	(iii) Other reportable compensation	(C) Retirement and other deferred compensation	(D) Nontaxable benefits	(E) Total of columns (B)(i)-(D)
1Jennifer Franklin RN CCO	(i) (ii)	0 ------------- 113,674	0 ------------- 15,615	0 ------------- 4,379	0 ------------- 5,586	0 ------------- 25,093	0 ------------- 164,347	0 ------------- 0
2R Martin Lambert MD board member, Chief of Staff	(i) (ii)	231,598 ------------- 0	0 ------------- 0	0 ------------- 0	0 ------------- 4,814	0 ------------- 0	231,598 ------------- 4,814	0 ------------- 0
3Karen Barber RN CEO/Pres.	(i) (ii)	0 ------------- 185,301	0 ------------- 32,293	0 ------------- 4,533	0 ------------- 15,728	0 ------------- 12,670	0 ------------- 250,525	0 ------------- 0
4John Olivares CFO	(i) (ii)	0 ------------- 105,452	0 ------------- 14,525	0 ------------- 2,706	0 ------------- 9,079	0 ------------- 19,615	0 ------------- 151,377	0 ------------- 0
5Saundra Anderson DO Board Member/Physician	(i) (ii)	244,939 ------------- 0	0 ------------- 0	0 ------------- 0	0 ------------- 24,000	0 ------------- 0	244,939 ------------- 24,000	0 ------------- 0
6DAVID BUTLER ASSISTANT SECRETARY	(i) (ii)	0 ------------- 359,967	0 ------------- 0	0 ------------- 22,543	0 ------------- 5,505	0 ------------- 25,782	0 ------------- 413,797	0 ------------- 0
7James E Drost MD Physician	(i) (ii)	297,236 ------------- 0	0 ------------- 0	0 ------------- 0	0 ------------- 0	0 ------------- 0	297,236 ------------- 0	0 ------------- 0
8Trini J Garza MD Physician (Thru 4/2018)	(i) (ii)	424,433 ------------- 0	0 ------------- 0	0 ------------- 0	0 ------------- 0	0 ------------- 0	424,433 ------------- 0	0 ------------- 0
9Craig Sims Board Member	(i) (ii)	0 ------------- 259,127	0 ------------- 0	0 ------------- 67,306	0 ------------- 9,005	0 ------------- 27,194	0 ------------- 362,632	0 ------------- 10,380

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 3

COMPENSATION OF CEO/EXECUTIVE DIRECTOR THE ORGANIZATION EXECUTIVES ARE EMPLOYED BY THE PARENT ORGANIZATION, COMMUNITY HOSPITAL CORPORATION (CHC), AND THEREFORE FOLLOW THE COMPENSATION POLICY OF CHC. CHC ENGAGED SULLIVAN COTTER TO CONDUCT A COMPETITIVE MARKET ANALYSIS OF THE COMPENSATION OF CHC'S TOP MANAGEMENT OFFICIALS, OFFICERS, DIRECTORS AND KEY EMPLOYEES. SULLIVAN COTTER GATHERED DATA RELATED TO JOB DESCRIPTIONS, SCOPE OF RESPONSIBILITY, AND CURRENT INCUMBENTS' COMPENSATION. SULLIVAN COTTER RECOMMENDED APPROPRIATE COMPARISON DATA AND UTILIZED SURVEY DATA FROM FOUR MAJOR EXECUTIVE COMPENSATION SURVEY PROVIDERS TO PROVIDE MARKET DATA AND EXECUTIVE COMPENSATION RECOMMENDATIONS THAT MEET CHC'S COMPENSATION PHILOSOPHY. SULLIVAN COTTER'S RECOMMENDATIONS WERE PRESENTED TO THE CHC COMPENSATION COMMITTEE OF THE BOARD FOR REVIEW AND APPROVAL. CHC ALSO CONDUCTS PERIODIC REVIEWS OF COMPENSATION TO DETERMINE WHETHER COMPENSATION ARRANGEMENTS AND BENEFITS ARE REASONABLE, BASED ON COMPETENT SURVEY INFORMATION, AND THE RESULT OF ARM'S LENGTH BARGAINING. THE ORGANIZATION FOLLOWED THIS PROCESS FOR THE YEAR ENDED JUNE 30, 2018 FOR ITS OFFICERS, DIRECTORS, KEY EMPLOYEES AND OTHER MANAGEMENT OFFICIALS.

Schedule J, Part I, Line 4B

NONQUALIFIED RETIREMENT PLAN PARTICIPATION WAS PAID TO: DAVID BUTLER - $12,706 Craig Sims - $21,238 SCHEDULE J, PART I, LINE 7 NON-FIXED PAYMENTS A PORTION OF THE DISCETIONARY INCENTIVE COMPENSATION PROGRAM WAS BASED ON THE EBIDA OF YOAKUM COMMUNITY HOSPITAL.

Schedule J (Form 990) 2019

Additional Data

Software ID:
Software Version:

- TIN:

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

Yoakum Community Hospital

Employer identification number

74-2323822

Return Reference	Explanation
DESCRIPTION of change in program services	From 990, Part III, Question 3 Obsterical Services were discontinued as of January 2018. Delegation of control of management duties Form 990, Part VI, Question 3 COMMUNITY HOSPITAL CORPORATION ('CHC') PROVIDES CERTAIN FINANCIAL, TECHNICAL AND MANAGERIAL SUPPORT SERVICES TO THE HOSPITAL.
DESCRIPTION OF CLASSES OF MEMBERS OR STOCKHOLDERS	FORM 990, PART VI, QUESTION 6 CHC IS THE SOLE MEMBER OF YOAKUM COMMUNITY HOSPITAL ("YCH").
DESCRIPTION OF CLASSES OF PERSONS AND THE NATURE OF THEIR RIGHTS	FORM 990, PART VI, QUESTION 7A CHC AS THE SOLE MEMBER OF YCH ELECTS THE MEMBERS OF THE BOARD OF TRUSTEES OF YCH AND IS EMPOWERED WITH THE ABILITY TO REMOVE TRUSTEES, WITH OR WITHOUT CAUSE.
Descr Classes of persons, decisions requir appr & type of	Voting Rights FORM 990, PART VI, QUESTION 7B ARTICLES OF INCORPORATION - BOARD OF DIRECTORS SECTION 7.1 POWERS. THE AFFAIRS OF THIS CORPORATION SHALL BE MANAGED BY ITS BOARD OF TRUSTEES(HEREINAFTER SOMETIMES CALLED THE 'BOARD') PROVIDED THAT THE APPROVAL OF THE MEMBER OF THIS CORPORATION SHALL BE NECESSARY FOR EACH OF THE FOLLOWING MATTERS: A. THE ESTABLISHMENT OF OR ANY CHANGE IN THE ACTIVITIES, PHILOSOPHY, MISSION OR PURPOSE OF THE CORPORATION AS SET BY THE MEMBER; B. ANY AMENDMENTS OR REVISIONS TO THE ARTICLES OF INCORPORATION OR BYLAWS OF THE CORPORATION; C. ANY AMENDMENTS OR REVISIONS OF THE ARTICLES OF INCORPORATION OR BYLAWS OF ANY SUBSIDIARY CORPORATION OF THE CORPORATION; D. THE CREATION OF, OR INVESTMENT IN, ANY SUBSIDIARY ENTITY, PARTNERSHIP OR VENTURE; E. ANY AMENDMENT, REVISION OR TERMINATION OF THE PARTNERSHIP AGREEMENT OF ANY PARTNERSHIP OR REGULATIONS OF ANY LIMITED LIABILITY COMPANY, TO WHICH THE CORPORATION IS A PARTY; F. THE ANNUAL OPERATING AND CAPITAL BUDGETS OF THE CORPORATION; G. ALL MATERIAL EXPENDITURE DEVIATIONS ($25,000 IN ANY SINGLE OR SERIES OF TRANSACTIONS) FROM THE ANNUAL OPERATING BUDGET; H. ALL EXPENDITURE DEVIATIONS FROM THE ANNUAL CAPITAL BUDGET; I. THE PURCHASE OR ACQUISITION OF ANY REAL, PERSONAL, OR MIXED PROPERTY THE CORPORATION IN EXCESS OF $25,000 THAT IS NOT PROVIDED FOR IN THE CORPORATION'S ANNUAL OPERATING OR CAPITAL BUDGETS; J. THE SALE, MORTGAGE, ENCUMBRANCE, TRANSFER, LEASE, GIFT, OR OTHER DISPOSITION OF ANY REAL PROPERTY OF THE CORPORATION; K. ANY SALE, GIFT, EXCHANGE, LEASE, MORTGAGE OR OTHER TRANSFER OR ENCUMBRANCE (COLLECTIVELY 'TRANSFER') OF THE PERSONAL PROPERTY OF THE CORPORATION (TANGIBLE OR INTANGIBLE) IF THE SUM OF SUCH TRANSFER AND THE SUM OF ALL PRIOR TRANSFERS, PER FISCAL YEAR, EXCEED $50,000; L. ANY DEBT OR FINANCING ARRANGEMENT OF THIS CORPORATION, EXCEPT USUSAL AND CUSTOMARY TRADE DEBTS, WHICH IS INCURRED IN THE ORDINARY COURSE OF BUSINESS OF THE CORPORATION; M. SETTLEMENT OF ANY CLAIMS OR LITIGATION INVOLVING THE CORPORATION; N. THE MERGER, DISSOLUTION, OR CONSOLIDATION OF THE CORPORATION OR SUBSIDIARY CORPORATION; O. THE EXECUTION, REVISION, AMENDMENT, EXTENSION, NON-RENEWAL OR TERMINATION OF ANY MANAGEMENT, EMPLOYMENT, LEASE, OR SERVICE CONTRACT AN ANNUAL COMPENSATION IN EXCESS OF $30,000 OR AN AGGREGATE COMPENSATION IN EXCESS OF $50,000; P. ANY DEBTS, LOANS, GUARANTIES, OR GRANTS NOT INCLUDED AND APPROVED AS PART OF THE CORPORATION'S ANNUAL OPERATING AND CAPITAL BUDGETS; Q. THE ELECTION OF THE MEMBERS OF THE BOARD OF TRUSTEES OF THE CORPORATION OR THE REMOVAL OF SAID TRUSTEE, WHETHER WITH OR WITHOUT CAUSE; R. THE ENGAGEMENT OF OR REMOVAL OF THE HOSPITAL ADMINISTRATOR; S. THE APPROVAL OF THE EMPLOYEE POLICIES AND BENEFITS PROGRAMS OF THE CORPORATION; T. THE APPROVAL OF THE APPROVAL OF MAJOR DEVELOPMENT CAMPAIGNS AND FUND-RAISING; AND U. THE APPROVAL OF THE FINANCE MANAGEMENT SYSTEM OF THE CORPORATION.
Describe process used by management &/or governing body to review	990 FORM 990, PART VI, QUESTION 11B A REVIEW OF THE 990 FORM IS PERFORMED BY THE CFO OF THE HOSPITAL FOLLOWING FORM PREPARATION. ELECTRONIC COPIES ARE SENT TO EACH BOARD MEMBER VIA EMAIL UPON COMPLETION OF THE FORM. THE FORMS ARE THEN FILED WITH THE IRS.
DESCRIPTION OF PROCESS TO MONITOR TRANSACTIONS FOR CONFLICTS OF	Interest Form 990, Part VI, Question 12C CONFLICT OF INTEREST STATEMENTS ARE FILED OUT BY GOVERNING BOARD MEMBERS, ADMINISTRATIVE TEAM, AND OTHER KEY EMPLOYEES ON A YEARLY BASIS.IF A CONFLICT OF INTEREST IS DISCLOSED, IT IS REVIEWED BY MANAGEMENT PERSONNEL, CHIEF COMPLIANCE OFFICER, GENERAL COUNSEL, OR THE AUDIT AND COMMITTEE. THE INTERESTED PERSON IS ALLOWED TO MAKE A PRESENTATION, AND ANSWER QUESTIONS POSED BY THE GOVERNING BODY AT THE COMMITTEE MEETING BUT MUST LEAVE AFTER THE RESENTATION, DURING THE DISCUSSION OF AND VOTE ON THE TRANSACTION OR ARRANGEMENT INVOLVING THE POTENTIAL CONFLICT OF INTEREST. IF DEEMED NECESSARY, A DISINTERESTED PERSON CAN BE APPOINTED TO INVESTIGATE THE POTENTIAL CONFLICT OF INTEREST AND THE ALTERNATIVES TO THE APPLICABLE TRANSACTION OR ARRANGEMENT. IF A MORE ADVANTAGEOUS TRANSACTION/ARRANGEMENT IS NOT REASONABLE, THE GOVERNING BODY SHALL DETERMINE BY A MAJORITY VOTE OF THE DISINTERESTED DIRECTORS WHETHER THE TRANSACTION/ARRANGEMENT IS IN THE BEST INTEREST OF THE ORGANIZATION. THE COMPLIANCE OFFICER ALONG WITH THE CHIEF FINANCIAL OFFICER IS RESPONSIBLEFOR CONDUCTING AUDITS AND MONITORING REVIEWS OF INTERNAL CONTROLS TO MAKE SURE THEY ARE FREE FROM ANY CONFLICTS OF INTEREST/INFLUENCES THAT WOULD IMPAIR THEIR ABILITY TO OBJECTIVELY CARRY OUT THEIR WORK WITHOUT BIAS. IF FOR ANY REASON THERE IS BELIEF THAT A BOARD/COMMITTEE MEMBER/EMPLOYEE FAILED TO DISCLOSE ACTUAL OR POSSIBLE CONFLICTS OF INTEREST, THE MEMBER/EMPLOYEE WILL BE INFORMED AND GIVEN AN OPPORTUNITY TO EXPLAIN THE FAILURE TO DISCLOSE. IF AFTER HEARING THE RESPONSE AND MAKING FURTHER INVESTIGATION IT IS DETERMINED THERE WAS FAILURE TO DISCLOSE, THEN APPROPRIATE DISCIPLINARY ACTION IS TAKEN WHICH CAN INCLUDE WITHOUT LIMITATION, TERMINATION OF THE PERSON'S MEMBERSHIP, employment, or contract.
OFFICES & POSITIONS FOR WHICH PROCESS WAS USED, & YEAR PROCESS	WAS BEGUN FORM 990, PART VI, QUESTION 15A & 15B THE ORGANIZATION EXECUTIVES ARE EMPLOYED BY THE PARENT ORGANIZATION, CHC, AND THEREFORE FOLLOW THE COMPENSATION POLICY OF CHC AS ADOPTED BY YOAKUM COMMUNITY HOSPITAL. CHC ENGAGED SULLIVAN COTTER TO CONDUCT A COMPETITIVE MARKET ANALYSIS OF THE COMPENSATION OF CHC'S TOP MANAGEMENT OFFICIALS, OFFICERS, DIRECTORS AND KEY EMPLOYEES. SULLIVAN COTTER GATHERED DATA RELATED TO JOB DESCRIPTIONS, SCOPE OF RESPONSIBILITY, AND CURRENT INCUMBENTS' COMPENSATION. SULLIVAN COTTER RECOMMENDED APPROPRIATE COMPARISON DATA AND UTILIZED SURVEY DATA FROM FOUR MAJOR EXECUTIVE COMPENSATION SURVEY PROVIDERS TO PROVIDE MARKET DATA AND EXECUTIVE COMPENSATION RECOMMENDATIONS THAT MEET CHC'S COMPENSATION PHILOSOPHY. SULLIVAN COTTER'S RECOMMENDATIONS WERE PRESENTED TO THE CHC COMPENSATION COMMITTEE OF THE BOARD FOR REVIEW AND APPROVAL. CHC ALSO CONDUCTS PERIODIC REVIEWS OF COMPENSATION TO DETERMINE WHETHER COMPENSATION ARRANGEMENTS AND BENEFITS ARE REASONABLE, BASED ON COMPETENT SURVEY INFORMATION, AND THE RESULT OF ARM'S LENGTH BARGAINING. THE PROCESS IS PERFORMED EACH YEAR PRIOR TO THE ANNUAL EMPLOYEE EVALUATION PROCESS, WHICH ENDS ON JULY 1ST OF EACH year.
AVAIL GOV DOCS, CONFLICT OF INTEREST POLICY, & FIN STMTS TO GEN	PUBLIC FORM 990, PART VI, QUESTION 19 THE ORGANIZATION MAKES ITS GOVERNING DOCUMENTS, FINANCIAL STATEMENTS, AND CONFLICT OF INTEREST POLICY AVAILABLE AT ITS BUSINESS OFFICE UPON REQUEST. OTHER CHANGES IN NET ASSETS OR FUND BALANCES FORM 990, PART XI, LINE 9 ROOF REPLACEMENT FROM HOSPITAL DISTRICT $378,916 IGT WITH ST. MARK'S $120,000 OTHER RECONCILING ITEM $4,983 ------------ TOTAL $503,899
FORM 990 PART IX LINE 11G	DESCRIPTION:PURCHASED SERVICES - HOSPITAL TOTAL FEES:2358931
FORM 990 PART IX LINE 11G	DESCRIPTION:PROFESSIONAL FEES - HOSPITAL TOTAL FEES:847974
FORM 990 PART IX LINE 11G	DESCRIPTION:PURCHASED SERVICES - CLINIC TOTAL FEES:37051
FORM 990 PART IX LINE 11G	DESCRIPTION:OTHERS TOTAL FEES:278683

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

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE R
(Form 990)

Department of the Treasury
Internal Revenue Service

Related Organizations and Unrelated Partnerships

Complete if the organization answered "Yes" on Form 990, Part IV, line 33, 34, 35b, 36, or 37.
MediumBullet

Attach to Form 990.
MediumBullet

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

Yoakum Community Hospital

Employer identification number

74-2323822

Part I

Identification of Disregarded Entities. Complete if the organization answered "Yes" on Form 990, Part IV, line 33.

(a) Name, address, and EIN (if applicable) of disregarded entity	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Total income	(e) End-of-year assets	(f) Direct controlling entity

Part II

Identification of Related Tax-Exempt Organizations. Complete if the organization answered "Yes" on Form 990, Part IV, line 34 because it had one or more related tax-exempt organizations during the tax year.

(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Exempt Code section	(e) Public charity status (if section 501(c)(3))	(f) Direct controlling entity	(g) Section 512(b)(13) controlled entity?
(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Exempt Code section	(e) Public charity status (if section 501(c)(3))	(f) Direct controlling entity	Yes	No
(1)BAPTIST HOSPITALS OF SOUTHEAST TEXAS PO BOX 1591 BEAUMONT,TX77704 74-1303720	HOSPITAL	TX	501(c)(3)	3	SWCH INC		No
(2)BAPTIST PHYSICIAN NETWORK 3080 COLLEGE ST BEAUMONT,TX77701 76-0453250	PRIMARY CARE	TX	501(c)(3)	3	BHSET		No
(3)SOUTHWEST COMMUNITY HOSPITAL INC 7800 N DALLAS PKWY STE 200 PLANO,TX75024 75-2725353	SUPPORT ORG	TX	501(c)(3)	12C-III-FI	CHC		No
(4)CONTINUECARE HOSPITAL OF TYLER 800 E DAWSON ST TYLER,TX75701 20-0991990	HOSPITAL	DE	501(c)(3)	3	CCC		No
(5)CONTINUECARE HOSPITAL OF SOUTHEAST TEXAS 7800 N DALLAS PKWY STE 200 PLANO,TX75024 20-1150480	HOSPITAL	TX	501(c)(3)	3	CCC		No
(6)ST MARK'S MEDICAL CENTER ONE ST MARKS PLACE LA GRANGE,TX78945 74-3019849	HOSPITAL	TX	501(c)(3)	3	CHC		No
(7)CHC COMMUNITY CARE LLC 7800 N DALLAS PKWY STE 200 PLANO,TX75024 37-1485773	SUPPORT ORG	DE	501(c)(3)	12C-III-FI	CHC		No
(8)CONTINUECARE HOSPITAL OF MIDLAND 4214 ANDREWS HIGHWAY MIDLAND,TX79703 46-3053684	HOSPITAL	DE	501(c)(3)	3	CCC		No
(9)CONTINUECARE HOSP AT HENDRICK MED CTR 1900 PINE ST 5TH FL ABILENE,TX79601 46-3607347	HOSPITAL	DE	501(c)(3)	3	CCC		No
(10)CONTINUECARE HOSPITAL AT BAKERSFIELD 7800 N DALLAS PKWY STE 200 PLANO,TX75024 46-5236524	HOSPITAL	DE	501(c)(3)	3	CCC		No
(11)CONTINUECARE HOSP BPTST HLT MADISONVILLE 900 HOSPITAL DRIVE 4TH FL MADISONVILLE,KY42431 46-5033192	HOSPITAL	DE	501(c)(3)	3	CCC		No
(12)CONTINUECARE HOSP AT BAPTIST HLT PADUCAH 2501 KENTUCKY AVENUE 5TH FL PADUCAH,KY42003 46-5032999	HOSPITAL	DE	501(c)(3)	3	CCC		No
(13)CONTINUECARE HOSPITAL AT BAPTIST HEALTH 1 TRILLIUM WAY CORBIN,KY40701 20-0925675	HOSPITAL	KY	501(c)(3)	3	CCC		No
(14)CRAWLEY MEMORIAL HOSPITAL 706 KINGS STREET KINGS MOUNTAIN,NC28086 56-0691100	HOSPITAL	NC	501(c)(3)	3	CAR CC		No
(15)CAROLINAS COMMUNITY CARE LLC 7800 N DALLAS PKWY STE 200 PLANO,TX75024 46-5590355	SUPPORT ORG	DE	501(c)(3)	12B-II	CHC		No
(16)JELLICO COMMUNITY HOSPITAL INC 188 HOSPITAL LANE JELLICO,TN37762 62-0924706	HOSPITAL	TN	501(c)(3)	3	CHC		No
(17)CONTINUECARE HOSPITAL AT ODESSA INC 500 W 4TH STREET ODESSA,TX79761 47-3539943	HOSPITAL	DE	501(c)(3)	3	CCC		No
(18)COMMUNITY HOSPITAL CORPORATION 7800 N DALLAS PKWY STE 200 PLANO,TX75024 75-2638469	SUPPORT ORG	TX	501(C)(3)	12C-III-FI	NA		No
(19)YOAKUM COMMUNITY HOSPITAL FOUNDATION 1200 CARL RAMERT DRIVE YOAKUM,TX77995 45-3609830	SUPPORT ORG	TX	501(C)(3)	12A-1	YCH		No
(20)BHSETX FOUNDATION 810 HOSPITAL DRIVE 235 BEAUMONT,TX77701 61-1557670	SUPPORT ORG	TX	501(C)(3)	7	BHSET		No
(21)MERCY RESTORATIVE CARE HOSPITAL INC 10648 PARK ROAD CHARLOTTE,NC28210 75-3054855	HOSPITAL	NC	501(c)(3)	3	CAR CC		No
(22)RURAL AND COMMUNITY HEALTHCARE COLLABORA 7800 N DALLAS PKWY STE 200 PLANO,TX75024 81-4337246	SUPPORT ORG	TX	501(c)(3)	7	CHC		No
(23)CONTINUECARE HOSPITAL AT PALMETTO HEALTH 7800 N DALLAS PKWY STE 200 PLANO,TX75024 81-3048423	HOSPITAL	TX	501(c)(3)	3	CCC		No

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

Cat. No. 50135Y

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	(f) Share of total income	(g) Share of end-of-year assets	(h) Disproprtionate allocations?		(i) Code V-UBI amount in box 20 of Schedule K-1 (Form 1065)	(j) General or managing partner?
(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Direct controlling entity	(f) Share of total income	(g) Share of end-of-year assets	Yes	No	(i) Code V-UBI amount in box 20 of Schedule K-1 (Form 1065)	Yes	No
(1) Critical access Hosp Coalition 120 G ST NW WASHINGTON,DC20005 82-1088069	Hosp. Coaliti	DE	NA

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	(i) Section 512(b)(13) controlled entity?
(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Direct controlling entity	(e) Type of entity (C corp, S corp, or trust)	(f) Share of total income	(g) Share of end-of-year assets	Yes	No
(1) COMMUNITY HEALTH ASSURANCE SPC LTD POB 69GT GRAND CAYMAN CJ	captive insur	CJ	CHC	C Corp				No
(2) COMMUNITY HOSPITAL CONSULTING 7800 N DALLAS PARKWAY SUITE 200 PLANO,TX75024 20-4710183	MGMT CONSULTI	TX	CHC	C Corp				No

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

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

b Gift, grant, or capital contribution to related organization(s) ............................

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

Yes

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

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

Yes

f Dividends from related organization(s) ............................

g Sale of assets to related organization(s) ............................

h Purchase of assets from related organization(s) ............................

i Exchange of assets with related organization(s) ............................

j Lease of facilities, equipment, or other assets to related organization(s) .......................

k Lease of facilities, equipment, or other assets from related organization(s) ......................

l Performance of services or membership or fundraising solicitations for related organization(s) .....................

m Performance of services or membership or fundraising solicitations by related organization(s) .................

n Sharing of facilities, equipment, mailing lists, or other assets with related organization(s) ...................

o Sharing of paid employees with related organization(s) ............................

p Reimbursement paid to related organization(s) for expenses ............................

Yes

q Reimbursement paid by related organization(s) for expenses ............................

r Other transfer of cash or property to related organization(s) ............................

s Other transfer of cash or property from related organization(s) ............................

If the answer to any of the above is "Yes," see the instructions for information on who must complete this line, including covered relationships and transaction thresholds.

(a) Name of related organization	(b) Transaction type (a-s)	(c) Amount involved	(d) Method of determining amount involved
(1) Yoakum Community Hospital Foundation	c	401,150	Cost
(2) COMMUNITY HOSPITAL CORPORATION	P	3,791,231	COST
(3) COMMUNITY HOSPITAL CORPORATION	E	157,736	COST
(4) COMMUNITY HOSPITAL CORPORATION	E	57,707	COST

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)	(e) Are all partners section 501(c)(3) organizations?		(f) Share of total income	(g) Share of end-of-year assets	(h) Disproprtionate allocations?		(i) Code V-UBI amount in box 20 of Schedule K-1 (Form 1065)	(j) General or managing partner?
(a) Name, address, and EIN of entity	(b) Primary activity	(c) Legal domicile (state or foreign country)	Yes	No	(f) Share of total income	(g) Share of end-of-year assets	Yes	No	(i) Code V-UBI amount in box 20 of Schedule K-1 (Form 1065)	Yes	No

Schedule R (Form 990) 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

Additional Data

Software ID:
Software Version:

		Prior Year	Current Year
8	Contributions and grants (Part VIII, line 1h) .........	528,091	642,754
9	Program service revenue (Part VIII, line 2g) .........	23,961,000	22,839,000
10	Investment income (Part VIII, column (A), lines 3, 4, and 7d ) ....	11,885	9,880
11	Other revenue (Part VIII, column (A), lines 5, 6d, 8c, 9c, 10c, and 11e)	246,886	768,071
12	Total revenue—add lines 8 through 11 (must equal Part VIII, column (A), line 12)	24,747,862	24,259,705
13	Grants and similar amounts paid (Part IX, column (A), lines 1–3 )...	0	0
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)	12,411,679	12,875,067
16a	Professional fundraising fees (Part IX, column (A), line 11e) .....	0	0
b	Total fundraising expenses (Part IX, column (D), line 25) 0
17	Other expenses (Part IX, column (A), lines 11a–11d, 11f–24e)....	11,828,974	12,149,537
18	Total expenses. Add lines 13–17 (must equal Part IX, column (A), line 25)	24,240,653	25,024,604
19	Revenue less expenses. Subtract line 18 from line 12.......	507,209	-764,899
		Beginning of Current Year	End of Year
20	Total assets (Part X, line 16).............	15,031,000	14,896,000
21	Total liabilities (Part X, line 26).............	3,855,000	3,981,000
22	Net assets or fund balances. Subtract line 21 from line 20.....	11,176,000	10,915,000

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	Signature of officer	Date

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4a	(Code: ) (Expenses $ 22,150,288 including grants of $ 0 ) (Revenue $ 23,658,929 )
	YOAKUM COMMUNITY HOSPITAL (YCH) IS A NOT-FOR-PROFIT, CRITICAL-ACCESS HOSPITAL DELIVERING COMPREHENSIVE SERVICES WITH COMPASSION AND COMMITMENT. HOSPITAL LEADERSHIP AND PHYSICIANS WORK TOGETHER TO GUIDE THE DIRECTION OF THE FACILITY. THE BUSY, 25-BED COMMUNITY HOSPITAL HAS SERVED NEIGHBORS IN YOAKUM AND THE SURROUNDING AREA FOR 90 YEARS. THE YCH MEDICAL STAFF OF 23 PHYSICIANS INCLUDES NOT ONLY FAMILY PHYSICIANS BUT ALSO THOSE CERTIFIED IN A NUMBER OF MAJOR HEALTHCARE SPECIALTIES. MORE THAN 80 YCH STAFF NURSES PROVIDE SPECIAL EXPERTISE AND A COMPASSIONATE BEDSIDE MANNER. THE HOSPITAL PROVIDES A BROAD RANGE OF INPATIENT AND OUTPATIENT SERVICES TO MEET THE EVOLVING HEALTH CARE NEEDS OF OUR COMMUNITY, WHICH INCLUDE LABORATORY, REHABILITATION, IMAGING, EMERGENCY, GENERAL MEDICINE, DIABETES EDUCATION, SLEEP DISORDER TREATMENT, SURGERY AND THE MANY MEDICAL SPECIALISTS WHO SCHEDULE PATIENT APPOINTMENTS AT THE YCH OUTPATIENT CLINIC. THE YCH TEAM TAKES PRIDE IN THE FACILITY'S QUALITY OF CARE AND OUR ONGOING COMMITMENT TO PATIENTS IN YOAKUM AND THE SURROUNDING COMMUNITIES. ADDITIONAL INFORMATION REGARDING YCH FOR FISCAL YEAR ENDED JUNE 30, 2018: -THE HOSPITAL DELIVERED APPROXIMATELY 52 BABIES AND PERFORMED 532 LIFESAVING SURGERIES. - YCH ADMITTED 739 LOCAL PATIENTS IN THE ACUTE STATE OF ILLNESS AND MANAGED 6,485 EMERGENCY ROOM VISITS WITH THE RAPID, RELIABLE CARE OUR COMMUNITY DESERVES. - THE EMERGENCY SERVICES AT YCH HAVE EARNED THE HOSPITAL DISTINGUISHED RECOGNITION AS THE FIRST LEVEL IV TRAUMA CENTER IN THE AREA. - IN 2007, YOAKUM CHAMBER OF COMMERCE PRESENTED YCH WITH ITS BUSINESS OF THE YEAR AWARD, AND THE HOSPITAL ALSO RECEIVED THE 2007 TEXAS HEALTH CARE QUALITY IMPROVEMENT AWARD. - IN 2012, YOAKUM COMMUNITY HOSPITAL RECEIVED THE 2012 TEXAS HEALTH CARE QUALITY IMPROVEMENT BRONZE AWARD. HOSPITAL SERVICES: YCH PROVIDES A BROAD RANGE OF SERVICES TO MEET THE EVOLVING HEALTH CARE NEEDS OF OUR COMMUNITY, WHICH INCLUDE: - UP-TO-DATE LABORATORY, PHYSICAL THERAPY AND RADIOLOGY SERVICES-INCLUDING MRI, MAMMOGRAPHY, CT, RADIOGRAPHY/FLUOROSCOPY AND ULTRASOUND DIAGNOSTIC SERVICES. - EMCARE PHYSICIANS IN YOAKUM COMMUNITY HOSPITAL'S EMERGENCY ROOM TREAT TRAUMA PATIENTS AT ANY TIME OF DAY OR NIGHT, SEVEN DAYS A WEEK. - MEDICAL SPECIALISTS, INCLUDING CARDIOLOGY, EAR, NOSE AND THROAT, GASTROENTEROLOGY, GENERAL SURGERY, OPHTHALMOLOGY, ORTHOPEDICS, OB/GYN, PODIATRY AND UROLOGY PHYSICIANS WHO SCHEDULE PATIENT APPOINTMENTS AT THE YCH OUTPATIENT CLINIC ON A REGULAR BASIS. - SURGICAL SERVICES FOR MANY INPATIENT AND OUTPATIENT PROCEDURES IN OUR FULLY EQUIPPED OPERATING ROOMS. - CONVENIENT ACCESS TO NUMEROUS OUTPATIENT SERVICES FOR PATIENTS WITH SLEEP DISORDERS, DIABETES AND PULMONARY REHABILITATION NEEDS.

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












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












4d	Other program services (Describe in Schedule O.)
	(Expenses $ including grants of $ ) (Revenue $ )
4e	Total program service expenses22,150,288

1b	Sub-Total................
c	Total from continuation sheets to Part VII, Section A....
d	Total (add lines 1b and 1c)...........	1,407,457	1,187,421	184,071

		Business Code
2a	Net Patient Services Rev	622110	22,839,000	22,839,000	0	0
b
c
d
e
f	All other program service revenue.
g	Total. Add lines 2a–2f .....		22,839,000

1	Briefly describe the organization’s mission or most significant activities: To enhance our tradition of compassionate, quality, and cost effective services which results in measurable benefits to our patients, community, employees, and medical staff.
2	Check this box
3	Number of voting members of the governing body (Part VI, line 1a) ........	3	11
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	236
6	Total number of volunteers (estimate if necessary) .............	6	20
7a	Total unrelated business revenue from Part VIII, column (C), line 12 ........	7a	0
b	Net unrelated business taxable income from Form 990-T, line 39 .........	7b	0

(A) Name and title	(B) Average hours per week (list any hours for related organizations below dotted line)		(D) Reportable compensation from the organization (W-2/1099-MISC)	(E) Reportable compensation from related organizations (W-2/1099-MISC)	(F) Estimated amount of other compensation from the organization and related organizations
(A) Name and title
(18) Trini J Garza MD........................................................................ Physician (Thru 4/2018)	40.0 .......................0.0	X	424,433	0	0
(19) Kelly Keeble........................................................................ Registered Nurse	40.0 .......................0.0	X	104,628	0	0
(20) Frankie Simmons........................................................................ Registered Nurse	40.0 .......................0.0	X	104,623	0	0

1a	Federated campaigns..		1a
b	Membership dues..		1b
c	Fundraising events..		1c	0
d	Related organizations		1d	461,150
e	Government grants (contributions)		1e	81,604

f	All other contributions, gifts, grants, and similar amounts not included above		1f	100,000

g	Noncash contributions included in lines 1a - 1f:$		1g	0

h Total. Add lines 1a-1f.......		642,754

3 Investment income (including dividends, interest, and othersimilar amounts) ......			9,880			9,880
4 Income from investment of tax-exempt bond proceeds			0
5 Royalties...........			0
		(ii) Personal	(i) Real
6a	Gross rents		22,612	6a
b	Less: rental expenses		74,470	6b
c	Rental income or (loss)	0	-51,858	6c
d	Net rental income or (loss).......			-51,858			-51,858
		(ii) Other	(i) Securities
7a	Gross amount from sales of assets other than inventory			7a
b	Less: cost or other basis and sales expenses			7b
c	Gain or (loss)			7c
d	Net gain or (loss).........			0
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..			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..			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..			0
Business Code			Miscellaneous Revenue
11a	OUTPATIENT CLINIC USAGE FEES		621990	19,300	19,300	0	0
b	Med Rec Transcripts		900099	4,504	4,504	0	0
c	340B DISPENSED FEE - PHARMACY		900099	639,468	639,468
d	All other revenue ....			156,657	156,657	0	0
e	Total. Add lines 11a–11d ......			819,929
12	Total revenue. See instructions.....			24,259,705	23,658,929	0	-41,978

1	Grants and other assistance to domestic organizations and domestic governments. See Part IV, line 21 ....	0
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 ...........	0	0
6	Compensation not included above, to disqualified persons (as defined under section 4958(f)(1)) and persons described in section 4958(c)(3)(B) .........	0
7	Other salaries and wages........	10,258,393	9,745,473	512,920
8	Pension plan accruals and contributions (include section 401(k) and 403(b) employer contributions) ....	192,645	181,086	11,559
9	Other employee benefits .......	1,776,658	1,670,059	106,599
10	Payroll taxes ...........	647,371	517,897	129,474
11	Fees for services (non-employees):
a	Management ......	0
b	Legal .........	240,417	149,058	91,359
c	Accounting ...........	74,392	8,927	65,465
d	Lobbying ...........	0
e	Professional fundraising services. See Part IV, line 17	0
f	Investment management fees ......	0
g	Other (If line 11g amount exceeds 10% of line 25, column (A) amount, list line 11g expenses on Schedule O)	3,522,639	2,674,665	847,974	0
12	Advertising and promotion ....	32,268	32,268
13	Office expenses .......	1,126,658	1,002,726	123,932
14	Information technology ......	122,514	61,257	61,257
15	Royalties ..	0
16	Occupancy ...........	468,915	375,132	93,783
17	Travel ............	49,632	24,816	24,816
18	Payments of travel or entertainment expenses for any federal, state, or local public officials .	0
19	Conferences, conventions, and meetings ....	0
20	Interest ...........	129,265	103,412	25,853
21	Payments to affiliates .......	471,599	0	471,599
22	Depreciation, depletion, and amortization ..	721,993	577,594	144,399
23	Insurance ...	219,884	175,907	43,977
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	Bad Debt	2,534,521	2,534,521	0	0
b	Med/Pharm Supplies	987,170	987,170	0	0
c	Repair & Maintenance	179,701	179,701	0	0
d	RENT & LEASE	74,470	74,470
e	All other expenses	1,193,499	1,074,149	119,350
25	Total functional expenses. Add lines 1 through 24e	25,024,604	22,150,288	2,874,316	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 if following SOP 98-2 (ASC 958-720).	0

1	Cash–non-interest-bearing ........			502,000	1	521,000
2	Savings and temporary cash investments .........			2,775,000	2	2,826,000
3	Pledges and grants receivable, net ......			0	3	0
4	Accounts receivable, net .............			2,201,000	4	1,220,000
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 ...........			0	7	0
8	Inventories for sale or use ............			372,000	8	390,000
9	Prepaid expenses and deferred charges ......			1,319,000	9	1,518,000
10a	Land, buildings, and equipment: cost or other basis. Complete Part VI of Schedule D	10a	18,961,000
b	Less: accumulated depreciation	10b	10,540,000	7,862,000	10c	8,421,000
11	Investments—publicly traded securities .			0	11	0
12	Investments—other securities. See Part IV, line 11 .....			0	12	0
13	Investments—program-related. See Part IV, line 11 ..			0	13	0
14	Intangible assets ...............			0	14	0
15	Other assets. See Part IV, line 11 ...........			0	15	0
16	Total assets. Add lines 1 through 15 (must equal line 33)...			15,031,000	16	14,896,000

17	Accounts payable and accrued expenses .....	1,422,000	17	1,862,000
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 ..	1,956,000	23	1,886,000
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	477,000	25	233,000
26	Total liabilities. Add lines 17 through 25..	3,855,000	26	3,981,000

	Organizations that follow FASB ASC 958, check here 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 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 ...........	11,176,000	32	10,915,000
33	Total liabilities and net assets/fund balances ........	15,031,000	33	14,896,000