TY 2018 Form 990

- 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 the latest information.

OMB No. 1545-0047

2018

Open to Public
Inspection

Name of the organization

JOHN ED CHAMBERS MEMORIAL HOSPITAL INC

Employer identification number

71-6044543

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) 2018

Page 2

Part II

Support Schedule for Organizations Described in Sections 170(b)(1)(A)(iv), 170(b)(1)(A)(vi), and 170(b)(1)(A)(ix)
(Complete only if you checked the box on line 5, 7, 8, or 9 of Part I or if the organization failed to qualify under Part III. If the organization fails to qualify under the tests listed below, please complete Part III.)

Section A. Public Support

Calendar year (or fiscal year beginning in)		(a) 2014	(b) 2015	(c) 2016	(d) 2017	(e) 2018	(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) 2014	(b) 2015	(c) 2016	(d) 2017	(e) 2018	(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 2018 (line 6, column (f) divided by line 11, column (f)) .........

Public support percentage for 2017 Schedule A, Part II, line 14 ...............

16a

33 1/3% support test—2018. 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—2017. 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—2018. 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—2017. 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) 2018

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) 2014	(b) 2015	(c) 2016	(d) 2017	(e) 2018	(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) 2014	(b) 2015	(c) 2016	(d) 2017	(e) 2018	(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 2018 (line 8, column (f) divided by line 13, column (f)) .........

Public support percentage from 2017 Schedule A, Part III, line 15 ...............

Section D. Computation of Investment Income Percentage

Investment income percentage for 2018 (line 10c, column (f) divided by line 13, column (f)) ......

Investment income percentage from 2017 Schedule A, Part III, line 17 .............

19a

331/3% support tests—2018. 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—2017. 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) 2018

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) 2018

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) 2018

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) 2018

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 2018 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-2018	(iii) Distributable Amount for 2018
1 Distributable amount for 2018 from Section C, line 6
2 Underdistributions, if any, for years prior to 2018 (reasonable cause required-- explain in Part VI). See instructions.
3 Excess distributions carryover, if any, to 2018:
a From 2013.......
b From 2014.......
c From 2015.......
d From 2016.......
e From 2017.......
fTotal of lines 3a through e
g Applied to underdistributions of prior years
h Applied to 2018 distributable amount
i Carryover from 2013 not applied (see instructions)
j Remainder. Subtract lines 3g, 3h, and 3i from 3f.
4Distributions for 2018 from Section D, line 7:
$
a Applied to underdistributions of prior years
b Applied to 2018 distributable amount
c Remainder. Subtract lines 4a and 4b from 4.
5 Remaining underdistributions for years prior to 2018, 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 2018. 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 2019. Add lines 3j and 4c.
8 Breakdown of line 7:
a Excess from 2014......
b Excess from 2015.....
c Excess from 2016.....
d Excess from 2017.....
e Excess from 2018.....

Schedule A (Form 990 or 990-EZ) (2018)

Schedule A (Form 990 or 990-EZ) 2018

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) 2018

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

2018

Name of the organization

JOHN ED CHAMBERS MEMORIAL HOSPITAL INC

Employer identification number

71-6044543

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) (2018)

Schedule B (Form 990, 990-EZ, or 990-PF) (2018) Page 2

Name of organization JOHN ED CHAMBERS MEMORIAL HOSPITAL INC

Part I	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
RESTRICTED	,	$ RESTRICTED	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) (2018)

Schedule B (Form 990, 990-EZ, or 990-PF) (2018)

Page 3

Name of organization JOHN ED CHAMBERS MEMORIAL HOSPITAL INC		Employer identification number 71-6044543

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) (2018)

Schedule B (Form 990, 990-EZ, or 990-PF) (2018)

Page 4


Name of organization JOHN ED CHAMBERS MEMORIAL HOSPITAL INC			Employer identification number 71-6044543
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) (2018)

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 the latest information.

OMB No. 1545-0047

2018

Open to Public Inspection

Name of the organization

JOHN ED CHAMBERS MEMORIAL HOSPITAL INC

Employer identification number

71-6044543

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 SFAS 116 (ASC 958), not to report in its revenue statement and balance sheet works of art, historical treasures, or other similar assets held for public exhibition, education, or research in furtherance of public service, provide, in Part XIII, the text of the footnote to its financial statements that describes these items.

If the organization elected, as permitted under SFAS 116 (ASC 958), to report in its revenue statement and balance sheet works of art, historical treasures, or other similar assets held for public exhibition, education, or research in furtherance of public service, provide the following amounts relating to these items:

(i)

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

(ii)

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

If the organization received or held works of art, historical treasures, or other similar assets for financial gain, provide the
following amounts required to be reported under SFAS 116 (ASC 958) relating to these items:

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

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

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

Cat. No. 52283D

Schedule D (Form 990) 2018

Page 2

Part III

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

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

Public exhibition

Loan or exchange programs

Scholarly research

Other

Preservation for future generations

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

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

Yes No

Part IV

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

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

Yes No


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

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

Yes No

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

Part V

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

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

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

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

Board designated or quasi-endowment SchDMd Bullet

Permanent endowment SchDMd Bullet

Temporarily restricted endowment SchDMd Bullet

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

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

Yes

(i) unrelated organizations .................

3a(i)

(ii) related organizations .................

3a(ii)

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

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

Part VI

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

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

1a	Land .....	1,229,124		1,229,124
b	Buildings ....	21,470,299	11,569,993	9,900,306
c	Leasehold improvements
d	Equipment ....	10,841,433	7,510,074	3,331,359
e	Other .....	488,821	228,297	260,524
Total. Add lines 1a through 1e. (Column (d) must equal Form 990, Part X, column (B), line 10(c).)..				14,721,313

Schedule D (Form 990) 2018

Page 3

Part VII

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

(a) Description of security or category (including name of security)	(b) Book value	(c) Method of valuation: Cost or end-of-year market value
(1) Financial derivatives.........
(2) Closely-held equity interests........
(3)Other
(A)
(B)
(C)
(D)
(E)
(F)
(G)
(H)
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

(1)
(2)
(3)
(4)
(5)
(6)
(7)
(8)
(9)
Total. (Column (b) must equal Form 990, Part X, col.(B) line 13.)

Part IX

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

(a) Description				(b) Book value

(1)
(2)
(3)
(4)
(5)
(6)
(7)
(8)
(9)
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
(2)
(3)
(4)
(5)
(6)
(7)
(8)
(9)
Total. (Column (b) must equal Form 990, Part X, col.(B) line 25.)
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) 2018

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	19,415,475
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	14,668
e	Add lines 2a through 2d .....................			2e	14,668
3	Subtract line 2e from line 1..................			3	19,400,807
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	1,239,654
c	Add lines 4a and 4b....................			4c	1,239,654
5	Total revenue. Add lines 3 and 4c. (This must equal Form 990, Part I, line 12.) ......			5	20,640,461

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	20,609,459
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	14,668
e	Add lines 2a through 2d....................			2e	14,668
3	Subtract line 2e from line 1...................			3	20,594,791
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	1,239,654
c	Add lines 4a and 4b.....................			4c	1,239,654
5	Total expenses. Add lines 3 and 4c. (This must equal Form 990, Part I, line 18.) ......			5	21,834,445

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
FORM 990, SCHEDULE D, PART X, LINE 2	MANAGEMENT HAS EVALUATED THEIR INCOME TAX POSITIONS UNDER THE GUIDANCE INCLUDED IN ASC 740. BASED ON THEIR REVIEW, MANAGEMENT HAS NOT IDENTIFIED ANY MATERIAL INCOME TAX POSITIONS TO BE RECORDED OR DISCLOSED IN THE FINANCIAL STATEMENTS.
FORM 990, SCHEDULE D, PART XI, LINE 2D	FUNDRAISING EXPENSE $14,668
FORM 990, SCHEDULE D, PART XI, LINE 4B	BAD DEBT EXPENSE $1,148,551 GAIN ON SALE $91,103 ------------------------------------- TOTAL $1,239,654
FORM 990, SCHEDULE D, PART XII, LINE 2D	FUNDRAISING EXPENSE $14,668
FORM 990, SCHEDULE D, PART XII, LINE 4B	BAD DEBT EXPENSE $1,148,551 GAIN ON SALE $91,103 ------------------------------------- TOTAL $1,239,654

Schedule D (Form 990) 2018

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE G (Form 990 or 990-EZ)

Department of the Treasury
Internal Revenue Service

Supplemental Information Regarding
Fundraising or Gaming Activities

Complete if the organization answered "Yes" on Form 990, Part IV, lines 17, 18, or 19, or if the organization entered more than $15,000 on Form 990-EZ, line 6a. 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

2018

Open to Public Inspection

Name of the organization
JOHN ED CHAMBERS MEMORIAL HOSPITAL INC

Employer identification number

71-6044543

Part I

Fundraising Activities. Complete if the organization answered "Yes" on Form 990, Part IV, line 17.

Form 990-EZ filers are not required to complete this part.

Indicate whether the organization raised funds through any of the following activities. Check all that apply.

a	Mail solicitations	e	Solicitation of non-government grants
b	Internet and email solicitations	f	Solicitation of government grants
c	Phone solicitations	g	Special fundraising events
d	In-person solicitations

Did the organization have a written or oral agreement with any individual (including officers, directors, trustees

or key employees listed in Form 990, Part VII) or entity in connection with professional fundraising services?

YesNo

If "Yes," list the ten highest paid individuals or entities (fundraisers) pursuant to agreements under which the fundraiser is
to be compensated at least $5,000 by the organization.

(i) Name and address of individual or entity (fundraiser)	(iii) Did fundraiser have custody or control of contributions?
	Yes	No










Total . . . . . . . . . . . . . . . . . . . .

List all states in which the organization is registered or licensed to solicit contributions or has been notified it is exempt from registration or licensing.

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

Cat. No. 50083H

Schedule G (Form 990 or 990-EZ) 2018

Page 2

Part II

Fundraising Events. Complete if the organization answered "Yes" on Form 990, Part IV, line 18, or reported more than $15,000 of fundraising event contributions and gross income on Form 990-EZ, lines 1 and 6b. List events with gross receipts greater than $5,000.

		(a) Event #1 GOLF TOURNAMENT (event type)	(d) Total events (add col. (a) through col. (c))
1	Gross receipts . . . . .	39,150	39,150
2	Less: Contributions . . . .	25,120	25,120
3	Gross income (line 1 minus line 2) . . . . . .	14,030	14,030

4	Cash prizes . . . . .
5	Noncash prizes . . . .	11,960	11,960
6	Rent/facility costs . . . .	1,910	1,910
7	Food and beverages . . .	598	598
8	Entertainment . . . .
9	Other direct expenses . . .	200	200
10	Direct expense summary. Add lines 4 through 9 in column (d) . . . . . . . . . .		14,668
11	Net income summary. Subtract line 10 from line 3, column (d). . . . . . . . . .		-638

Part III

Gaming. Complete if the organization answered "Yes" on Form 990, Part IV, line 19, or reported more than $15,000 on Form 990-EZ, line 6a.

		(a) Bingo	(b) Pull tabs/Instant bingo/progressive bingo	(c) Other gaming	(d) Total gaming (add col.(a) through col.(c))
1	Gross revenue . . . . .

2	Cash prizes . . . . .
3	Noncash prizes . . . .
4	Rent/facility costs . . . .
5	Other direct expenses . . .

Volunteer labor . . . .

	Yes %
	No

	Yes %
	No

	Yes %
	No

Direct expense summary. Add lines 2 through 5 in column (d) . . . . . . . . . . right arrow

Net gaming income summary. Subtract line 7 from line 1, column (d). . . . . . . . . right arrow

Enter the state(s) in which the organization conducts gaming activities:

Is the organization licensed to conduct gaming activities in each of these states? . . . . . . . .

YesNo

If "No," explain:

10a

Were any of the organization's gaming licenses revoked, suspended or terminated during the tax year? . . .

YesNo

If "Yes," explain:

Schedule G (Form 990 or 990-EZ) 2018

Page 3

Does the organization conduct gaming activities with nonmembers? . . . . . . . . . . .

YesNo

Is the organization a grantor, beneficiary or trustee of a trust or a member of a partnership or other entity

formed to administer charitable gaming? . . . . . . . . . . . . . . . . .

YesNo

Indicate the percentage of gaming activity conducted in:

The organization's facility . . . . . . . . . . . . . . . . . .

13a

An outside facility . . . . . . . . . . . . . . . . . . . .

13b

Enter the name and address of the person who prepares the organization's gaming/special events books and records:

Name

Address

15a

Does the organization have a contract with a third party from whom the organization receives gaming

revenue? . . . . . . . . . . . . . . . . . . . . . . . .

YesNo

If "Yes," enter the amount of gaming revenue received by the organization right arrow

$ and the

amount of gaming revenue retained by the third party right arrow

$ .

If "Yes," enter name and address of the third party:

Name

Address

Gaming manager information:

Name

Gaming manager compensation right arrow

Description of services provided right arrow

Director/officer Employee Independent contractor

Mandatory distributions:

Is the organization required under state law to make charitable distributions from the gaming proceeds to

retain the state gaming license? . . . . . . . . . . . . . . . . . . .

YesNo

Enter the amount of distributions required under state law distributed to other exempt organizations or spent

in the organization's own exempt activities during the tax year right arrow

Part IV

Supplemental Information. Provide the explanations required by Part I, line 2b, columns (iii) and (v); and Part III, lines 9, 9b, 10b, 15b, 15c, 16, and 17b, as applicable. Also provide any additional information. See instructions.

Return Reference	Explanation

Schedule G (Form 990 or 990-EZ) 2018

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

2018

Open to Public Inspection

Name of the organization

JOHN ED CHAMBERS MEMORIAL HOSPITAL INC

Employer identification number

71-6044543

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 110 %

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) . . .	570,742		570,742	2.760 %
b	Medicaid (from Worksheet 3, column a) . . . . .	2,183,187	1,566,443	616,744	2.980 %
c	Costs of other means-tested government programs (from Worksheet 3, column b) . .
d	Total Financial Assistance and Means-Tested Government Programs . . . . .	2,753,929	1,566,443	1,187,486	5.740 %
Other Benefits
e	Community health improvement services and community benefit operations (from Worksheet 4).
f	Health professions education (from Worksheet 5) . . .
g	Subsidized health services (from Worksheet 6) . . . .	2,662,720	1,067,857	1,594,863	7.710 %
h	Research (from Worksheet 7) .
i	Cash and in-kind contributions for community benefit (from Worksheet 8) . . . .
j	Total. Other Benefits . .	2,662,720	1,067,857	1,594,863	7.710 %
k	Total. Add lines 7d and 7j .	5,416,649	2,634,300	2,782,349	13.450 %

For Paperwork Reduction Act Notice, see the Instructions for Form 990. Cat. No. 50192T Schedule H (Form 990) 2018

Schedule H (Form 990) 2018

Page

Part II

Community Building Activities Complete this table if the organization conducted any community building activities during the tax year, and describe in Part VI how its community building activities promoted the health of the communities it serves.

		(a) Number of activities or programs (optional)	(b) Persons served (optional)	(c) Total community building expense	(d) Direct offsetting revenue	(e) Net community building expense	(f) Percent of total expense
1	Physical improvements and housing
2	Economic development
3	Community support
4	Environmental improvements
5	Leadership development and training for community members
6	Coalition building
7	Community health improvement advocacy
8	Workforce development
9	Other
10	Total

Part III

Bad Debt, Medicare, & Collection Practices

Section A. Bad Debt Expense

Yes

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

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. ......

1,148,551

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. ......

631,703

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).....

7,081,844

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

4,218,535

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

2,863,309

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) 2018

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	CHAMBERS MEMORIAL HOSPITAL 719 DETROIT STREET DANVILLE,AR728330639 WWW.CHAMBERSHOSPITAL.COM AR4825	X	X	X

Schedule H (Form 990) 2018

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)

	CHAMBERS MEMORIAL HOSPITAL
Name of hospital facility or letter of facility reporting group

Line number of hospital facility, or line numbers of hospital facilities in a facility
reporting group (from Part V, Section A):

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 18

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): WWW.CHAMBERSHOSPITAL.COM

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 19

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

Yes

If "Yes" (list url): WWW.CHAMBERSHOSPITAL.COM

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) 2018

Page 5

Part VFacility Information (continued)

Financial Assistance Policy (FAP)

	CHAMBERS MEMORIAL 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 110.% and FPG family income limit for eligibility for discounted care of 200.%

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):

WWW.CHAMBERSHOSPITAL.COM

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

WWW.CHAMBERSHOSPITAL.COM

A plain language summary of the FAP was widely available on a website (list url):
WWW.CHAMBERSHOSPITAL.COM

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) 2018

Page 6

Part VFacility Information (continued)

Billing and Collections

	CHAMBERS MEMORIAL 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

Made a reasonable effort to orally notify individuals about the FAP and FAP application process

Processed incomplete and complete FAP applications

Made presumptive eligibility determinations

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) 2018

Page 7

Part VFacility Information (continued)

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

	CHAMBERS MEMORIAL 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) 2018

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, 20e, 21c, 21d, 23, and 24. If applicable, provide separate descriptions for each hospital facility in a facility reporting group, designated by facility reporting group letter and hospital facility line number from Part V, Section A (“A, 1,” “A, 4,” “B, 2,” “B, 3,” etc.) and name of hospital facility.
Form and Line Reference	Explanation
SCHEDULE H, PART V, SECTION B, LINE 5	THE HOSPITAL CALCULATED THE COMMUNITY HEALTH INPUT QUESTIONNAIRES IN ORDER TO GATHER BROAD COMMUNITY INPUT REGARDING HEALTH ISSUES. THE HOSPITAL ENGAGED BKD, LLP TO ASSIST IN CONDUCTING A FORMAL COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA). KEY INTERVIEWEES INCLUDED COMMUNITY STAKEHOLDERS THAT REPRESENT THE BROAD INTEREST OF THE COMMUNITY WITH KNOWLEDGE OF OR EXPERTISE IN PUBLIC HEALTH. DIAGLOGUES WITH KEY INTERVIEWEES WERE CONDUCTED. INTERVIEWEES WERE DETERMINED BASED ON THEIR SPECIALIZED KNOWLEDGE OR EXPERTISE IN PUBLIC HEALTH OR THEIR INVOLVEMENT WITH UNDERSERVED AND MINORITY POPULATIONS. ALL INTERVIEWS WERE CONDUCTED BY BKD PERSONNEL USING A STANDARD QUESTIONNAIRE. A SUMMARY OF THEIR OPINIONS IS REPORTED WITHOUT JUDGING THE TRUTHFULNESS OR ACCURACY OF THEIR REMARKS. INTERVIEW DATA WAS INITIALLY RECORDED IN BOTH WRITTEN AND NARRATIVE FORM. INTERVIEWEES WERE ASSURED THAT PERSONAL IDENTIFIERS SUCH AS NAME OR ORGANIZATIONAL AFFILIATIONS WOULD NOT BE CONNECTED IN ANY WAY TO THE INFORMATION PRESENTED IN THE CHNA.
SCHEDULE H, PART V, SECTION B, LINE 11	THE NEEDS THAT WILL BE ADDRESSED IN THE MOST CURRENTLY ADOPTED CHNA INCLUDE THE FOLLOWING ISSUES CONSISTENTLY RAISED DURING INTERVIEWS: 1. OBESITY OBESITY INCREASES RISKS FOR MORBIDITY AND MORTALITY OF NUMEROUS MEDICAL CONDITIONS. YELL COUNTY HAS A 14% HIGHER INCIDENT OF OBESITY THAN THE NATIONAL BENCHMARK AND 5% HIGHER THAN THE STATE OF ARKANSAS AS A WHOLE. WE FEEL IT IS VERY IMPORTANT TO BRING THIS KNOWLEDGE TO THE COMMUNITY WHEN PERFORMING SURVEYS AND ASKING ABOUT OBESITY IN YELL COUNTY AS A LARGE PERCENTAGE OF YELL COUNTY PARTICIPANTS DID NOT THINK YELL COUNTY HAD AN OBESITY PROBLEM. WE WILL CONTINUE TO PARTNER WITH AND HELP SPONSOR HEALTHY ACTIVE YELL WHICH MEETS WITH MEMBERS OF THE COMMUNITY MONTHLY TO CONTINUE TO INCREASE AWARENESS OF THIS GROWING PROBLEM AND WORK TOGETHER TO CONTINUE TO EDUCATE AND HELP YELL COUNTY TO BECOME HEALTHIER AND MORE ACTIVE. WE HAVE REPRESENTATION FROM ALL SCHOOLS (STUDENTS, TEACHER AND NURSES) IN YELL COUNTY ALONG WITH THE ARKANSAS DEPT. OF HEALTH AND COUNTY EXTENSION SERVICES. OUR GROUP CONTINUES TO BE PART OF ARCOPS WHICH IS THE ARKANSAS COALITION FOR OBESITY PREVENTION. THIS PARTNERSHIP WITH ARCOPS HELPS US TO ASSIST RESIDENTS OF YELL COUNTY. WE WILL ALSO CONTINUE TO PARTNER WITH OUR SCHOOLS, ADH, ARCOPS, COUNTY EXTENSION AND THE SENIOR CITIZEN CENTER TO CONTINUE TO BUILD A HEALTHIER AND MORE ACTIVE COMMUNITY. 2. HEALTH KNOWLEDGE AND EDUCATION KNOWLEDGE IS CRUCIAL TO CREATING A HEALTHIER COMMUNITY. WE HAVE DISCOVERED THROUGH INTERVIEWS AND SURVEYS THAT WE HAVE NOT BEEN COMPLETELY SUCCESSFUL IN GETTING THE INFORMATION TO THE CITIZENS OF YELL COUNTY. WE FEEL IT IS NECESSARY TO DIRECT THE COMMUNITIES' ATTENTION TO IMPORTANT HEALTHCARE TOPICS IN ORDER TO BRING AWARENESS OF CHRONIC ILLNESSES THAT AFFECT OUR HEALTH AND THE HEALTH OF OUR LOVED ONES. WE PLAN TO CONTINUE TO GET KNOWLEDGE AND EDUCATION OUT BY UTILIZING OUR LOCAL NEWSPAPER, BY ASSIGNING NURSE EDUCATOR TO UPDATE AND KEEP EDUCATIONAL MATERIAL CURRENT ON OUR FACILITY WEBSITE, THROUGH HEALTH FAIRS, THE SENIOR CITIZEN CENTER, AND THROUGH OUR SCHOOLS AND OUR LOCAL FAITH-BASED ORGANIZATIONS. WE PLAN TO PROVIDE EDUCATION AND MATERIAL ON TOPICS SUCH AS FAMILY HEALTH, CHRONIC DISEASES, PREVENTATIVE HEALTH, HEALTHY EATING THROUGH NUTRITION EDUCATION, PROMOTION OF INCREASED ACTIVITY, AND SMOKING CESSATION. WE ALSO PLAN TO PROVIDE EDUCATION AND INFORMATION ON DRUG AND ALCOHOL ABUSE AND TREATMENT OPTIONS. INFORMATION AND EDUCATION WILL BE PROVIDED BY NURSING EDUCATOR, DON, HOSPITAL NURSING STAFF, HOME HEALTH NURSING STAFF AND OUR STAFF PHYSICIANS. OUR NURSE PRACTITIONERS WILL ALSO BE PART OF GETTING THIS KNOWLEDGE AND EDUCATION TO OUR COMMUNITY. 3. MENTAL HEALTH SERVICES CHAMBERS MEMORIAL HOSPITAL RECOGNIZED THE NEED FOR MENTAL HEALTH SERVICES THROUGH OUR INPATIENT AND CLINICS. AS A RESULT, CHAMBERS OPENED A 12 BED ADULT BEHAVIOR UNIT, RESTORATIONS, IN JULY 2018. WHEN THE UNIT OPENED IT WAS FOCUSED ON ADULTS 60 AND GREATER BUT DUE TO THE NEED NOTED, THE AGE LIMITED WAS LOWERED IN RECENT MONTHS. RESTORATIONS HAS ADDED A SOCIAL WORKER ON STAFF FOR THE UNIT AS WELL AS A PSYCHIATRIST VIA TELE MED. RESTORATIONS IS IN THE PROCESS OF HIRING A FULL TIME APRN WITH A SPECIALTY IN PSYCH. THIS APRN WILL BE IN HOUSE TO ROUND ON PATIENTS AND MEET WITH THE ADMITTING PHYSICIANS AND THE PSYCHIATRIST. THIS SHOULD BE A GREAT ADDITION TO THE UNIT FOR OUR PATIENTS AND EMPLOYEES. THE UNIT HAS ADDED A COMMUNITY EDUCATION EMPLOYEE THAT VISITS NURSING HOMES, HOSPITALS, CLINICS AND SCHOOLS TO GET INFORMATION AND EDUCATION OUT REGARDING MENTAL HEALTH AS WELL AS TO TELL THESE AGENCIES ABOUT OUR FACILITY. THE ADDITION OF THE APRN WILL ALLOW US TO EXPLORE OPPORTUNITIES TO IMPROVE OUTPATIENT PSYCHIATRIC SERVICES. 4. SERVICES TO TREAT DRUG AND ALCOHOL ABUSE SOME OF THE ISSUES FOR PATIENTS WITH DRUG AND ALCOHOL ABUSE MAY BE HANDLED BY BEHAVIORAL HEALTH AS DRUG AND ALCOHOL ABUSE GO HAND IN HAND WITH MENTAL HEALTH ISSUES. WE REALIZE THAT IT IS IMPORTANT TO EDUCATE THE PUBLIC AS WELL AS EMPLOYEES REGARDING SIGNS AND SYMPTOMS OF DRUG AND/OR ALCOHOL ABUSE. WE FEEL IT IS ALSO IMPORTANT TO EDUCATE THE COMMUNITY REGARDING PRESCRIPTION DRUGS AND HOW THEY CAN BECOME ADDICTED TO THEM. WE ARE ALWAYS TAUGHT TO FINISH TAKING OUR PRESCRIPTIONS AS PRESCRIBED BUT WE FEEL EDUCATION NEEDS TO BE IMPROVED CONCERNING PRESCRIPTION NARCOTICS. WE INTEND TO USE THE LOCAL DRUG STORES TO HELP GET THIS INFORMATION OUT TO THE PUBLIC AND TO BE SURE AND HAND OUT INFORMATION REGARDING THESE TYPES OF PRESCRIPTIONS WITH THE PRESCRIPTION DURING OFFICE VISITS OR WHEN BEING DISCHARGED FORM HOSPITAL OR EMERGENCY ROOM. WE ALSO DISCUSSED LOOKING AT THE FREQUENCY OF CERTAIN DRUGS BEING PRESCRIBED AS THE GOVERNMENT IS LOOKING INTO THIS TO SOME DEGREE DUE TO THE OPIOID CRISIS. WE FEEL IT IS IMPORTANT TO LOOK AT ALTERNATIVES TO DRUG USE. YELL COUNTY HAS A DRUG COURT WHICH HAS HELPED SOME STAY OFF OF DRUGS. PLANS TO UTILIZE LOCAL POLICE FOR TRAINING AS WELL AS DRUG COURT FOR TRAINING ON WHAT HAPPENS WHEN YOU ARE ASSIGNED TO DRUG COURT. YELL COUNTY ALSO HAS AT LEAST ONE AA MEETING PLACE. WE BELIEVE INCREASING AWARENESS TO DRUG AND ALCOHOL ABUSE AND BEING AWARE OF WHAT AGENCY OR FACILITY TO REFER PATIENTS TOO AS WELL AS STAYING ON TOP OF WHAT WE AND THE STATE AND GOVERNMENT ARE DOING TO HELP CONTROL THE OPIOID CRISIS WILL HELP TO HAVE A HEALTHIER COMMUNITY WITH REGARDS TO SERVICES FOR DRUG AND ALCOHOL ABUSE. 5. CHILDREN'S HEALTH SERVICES CHILDREN ARE THE FUTURE OF OUR COMMUNITY AND IT IS IMPORTANT THAT OUR FACILITY PLAYS AN ACTIVE ROLE IN CHILDREN'S HEALTH SERVICES. CHILDREN'S HEALTH SERVICES IS VERY IMPORTANT TO THE HEALTH OF THE CHILDREN OF OUR COMMUNITY. WE HAVE WORKED ON THIS FOR THE PAST 3 YEARS AND PLAN TO CONTINUE AND INCREASE OUR EFFORTS IN THIS. OUR FACILITY CONTINUES TO PROVIDE FREE PHYSICALS TO ALL CHILDREN INVOLVED IN ANY TYPE OF SPORTS FOR ALL SCHOOLS ON THE WEST SIDE OF YELL COUNTY WHICH ENCOMPASSES THREE SCHOOLS. WE STILL HAVE ONE CAR SEAT INSTRUCTOR WORKING FOR OUR FACILITY AND PLAN TO SCHEDULE A CLASS TO EDUCATE FAMILIES ON CAR SEAT SAFETY AND WILL LOOK INTO GETTING AT LEAST ONE MORE INSTRUCTOR ON BOARD. WE WILL ALSO LOOK INTO FINDING WAYS OF RECEIVING CAR SEATS TO GIVE TO FAMILIES IN NEED UPON COMPLETION OF THE CAR SEAT SAFETY COURSE. THE FACILITY CONTINUES TO BE INVOLVED IN FARM SAFETY PROGRAM THAT IS HELD IN MAY OF EACH YEAR AND PLAN TO CONTINUE TO DO THIS. THIS IS AIMED AT 5TH GRADE STUDENTS FROM SCHOOLS ALL OVER THE COUNTY AND HOSPITAL EMPLOYEES SPEAK ON FIRST AIDE AND PROVIDE EACH 5TH GRADER WITH A FIRST AID PACKAGE AS WELL AS TEACHING MATERIAL ON SAFETY. WE REALIZE THAT WE HAVE NOT MET OUR GOALS ON CHILDREN'S HEALTH SERVICES AND PLAN TO STEP UP OUR EDUCATION TO FAMILIES ON THE IMPORTANCE OF PREVENTATIVE MEDICINE. THIS WILL BE DONE THROUGH THE SCHOOLS AS WELL AS ON AN INPATIENT AND OUTPATIENT LEVEL. OUR PARTNERSHIP WITH HEALTHY ACTIVE YELL BRINGS US TOGETHER WITH MEMBERS FROM EVERY SCHOOL IN YELL COUNTY AND GIVES US OPPORTUNITY TO REACH STUDENTS OF ALL AGES AS WELL AS PARENTS THROUGH THIS EFFORT. WE CONTINUE TO BELIEVE THAT BY HELPING TO INCREASE CHILDREN'S HEALTH SERVICES AND EDUCATING FAMILIES IN THIS REGARD WE WILL HAVE A HEALTHIER COMMUNITY OF TOMORROW.
FORM 990, SCHEDULE H, PART V, LINE 16J	ALL PATIENTS WILL BE OFFERED, AS PART OF THE REGISTRATION AND/OR DISCHARGE PROCESS, A COPY OF THE PLAIN LANGUAGE SUMMARY OF THIS POLICY. ADDITIONALLY, ALL PATIENTS IDENTIFIED AS POTENTIAL FINANCIAL ASSISTANCE RECIPIENTS OR ANYONE REQUESTING FINANCIAL ASSISTANCE WILL BE OFFERED THE OPPORTUNITY TO APPLY FOR FINANCIAL ASSISTANCE. IF THIS EVALUATION IS NOT CONDUCTED UNTIL AFTER THE PATIENT LEAVES THE FACILITY, OR IN CASE OF OUTPATIENTS OR EMERGENCY PATIENTS, THE FINANCIAL COUNSELOR WILL MAIL A FINANCIAL ASSISTANCE APPLICATION TO THE PATIENT FOR COMPLETION. IN ADDITION, THE HOSPITAL WILL PROVIDE A PLAIN LANGUAGE SUMMARY OF THE FINANCIAL ASSISTANCE POLICY TO THE PATIENT WITH ALL BILLING STATEMENTS AND COMMUNICATIONS WITHIN THE FIRST 120 DAYS FOLLOWING THE FIRST BILLING STATEMENT.
FORM 990, SCHEDULE H, PART V, LINE 20E	INFORMATION REGARDING THE FINANCIAL ASSISTANCE POLICY WILL BE PROVIDED ON MONTHLY BILLING STATEMENTS AS WELL AS EFFORTS TO CONTACT THE PATIENT OR RESPONSIBLE PARTY VIA TELEPHONE. CHAMBERS MEMORIAL HOSPITAL WILL PROVIDE PATIENTS OR OTHER PARTIES RESPONSIBLE FOR PAYMENT OF THE ACCOUNT WITH A NOTICE, A MINIMUM OF 30 DAYS IN ADVANCE OF INITIATING ANY EXTRAORDINARY COLLECTION ACTIVITIES.

Schedule H (Form 990) 2018

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?5
Name and address		Type of Facility (describe)
1	CHAMBERS MEMORIAL CLINIC 719 DETROIT AVENUE DANVILLE,AR72833	FAMILY CLINIC
2	SCENIC 7 MEDICAL CLINIC 402 SOUTH SCENIC 7 DRIVE OLA,AR72853	FAMILY CLINIC
3	WESTERN YELL COUNTY MEDICAL CLINIC 301 WEST BROADWAY HAVANA,AR72842	FAMILY CLINIC
4	PLAINVIEW MEDICAL CLINIC 102 NORTH GARFIELD AVENUE PLAINVIEW,AR72857	FAMILY CLINIC
5	CHAMBERS MEMORIAL HOME HEALTH AGENCY 719 DETROIT AVENUE DANVILLE,AR72833	HOME HEALTH
6
7
8
9
10

Schedule H (Form 990) 2018

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
FORM 990, SCHEDULE H, PART I, LINE 3C	PLEASE REFER TO THE FINANCIAL ASSISTANCE POLICY OR SCHEDULE H, PART V, LINES 13 THROUGH 16 FOR ADDITIONAL INFORMATION ON THE FAP.
FORM 990, SCHEDULE H, PART I, LINE 7, COLUMN F	BAD DEBT EXPENSE IN THE AMOUNT OF $1,148,551 IS INCLUDED ON FORM 990 PART IX, LINE 25, COLUMN (A) ("TOTAL FUNCTIONAL EXPENSES"), BUT IS SUBTRACTED FOR PURPOSES OF CALCULATING THE PERCENTAGES IN THIS COLUMN.
FORM 990, SCHEDULE H, PART I, LINE 7	CHAMBERS MEMORIAL HOSPITAL USES THE MEDICARE COST REPORT COST TO CHARGE RATIO METHODOLOGY.
FORM 990, SCHEDULE H, PART III, LINE 4	PLEASE SEE ATTACHED AUDIT REPORT NOTE 1.
FORM 990, SCHEDULE H, PART III, LINE 9B	PATIENTS ARE INFORMED OF CHARITY CARE PROGRAM UPON ADMISSION AND DISCHARGE. THE PLAIN LANGUAGE SUMMARY OF THE FAP IS INCLUDED IN THE REGISTRATION PACKET. ALL PATIENTS IDENTIFIED AS POTENTIAL FINANCIAL ASSISTANCE RECIPIENTS OR ANYONE REQUESTING FINANCIAL ASSISTANCE WILL BE OFFERED THE OPPORTUNITY TO APPLY FOR FINANCIAL ASSISTANCE. THE FINANCIAL COUNSELOR WILL MAIL A FINANCIAL ASSISTANCE APPLICATION TO THE PATIENT AND INFORMATION REGARDING THE FAP WILL BE MADE AVAILABLE WITH ALL BILLING STATEMENTS AND COMMUNICATIONS WITHIN THE FIRST 120 DAYS FOLLOWING THE FIRST BILLING STATEMENT.
FORM 990, SCHEDULE H, PART VI, LINE 2	IN ADDITION TO ANY HEALTH NEEDS REPORTED ON PART V, SECTION B, THE HOSPITAL UTILIZES THE 'COUNTY HEALTH RANKINGS' MODEL TO WEIGH THE HEALTH FACTORS NEEDS TO THE COMMUNITIES IT SERVES. THE MODEL PROVIDES A RANKING METHOD THAT RANKS ALL 50 STATES AND THE COUNTIES WITHIN EACH STATE BASED ON TWO TYPES OF HEALTH OUTCOMES FOR EACH COUNTY: MORTALITY AND MORBIDITY. COUNTIES ARE RANKED RELATIVE TO THE HEALTH OF OTHER COUNTIES IN THE STATES. AS PART OF THE ANALYSIS OF THE CHNA FOR THE COMMUNITY, THE RELATIVE HEALTH STATUS FOR YELL COUNTY WILL BE COMPARED TO THE STATE OF ARKANSAS AS WELL AS TO THE NATIONAL BENCHMARK. A BETTER UNDERSTANDING OF THE FACTORS THAT AFFECT THE HEALTH OF THE COMMUNITY WILL ASSIST WITH HOW TO IMPROVE THE COMMUNITYS HABITS, CULTURE, AND ENVIRONMENT. YELL COUNTY FELL WITHIN THE LOWER 50TH PERCENTILE OF THE 75 COUNTIES IN ARKANSAS. THE HEALTH NEEDS ARE SIMILAR TO THE NEEDS ADDRESSED IN THE CHNA AND VOICED BY THE INTERVIEWS CONDUCTED.
FORM 990, SCHEDULE H, PART VI, LINE 3	ALL PATIENTS WILL BE OFFERED, AS PART OF THE REGISTRATION AND/OR DISCHARGE PROCESS, A COPY OF THE PLAIN LANGUAGE SUMMARY OF THIS POLICY. ADDITIONALLY, ALL PATIENTS IDENTIFIED AS POTENTIAL FINANCIAL ASSISTANCE RECIPIENTS OR ANYONE REQUESTING FINANCIAL ASSISTANCE WILL BE OFFERED THE OPPORTUNITY TO APPLY FOR FINANCIAL ASSISTANCE. IF THIS EVALUATION IS NOT CONDUCTED UNTIL AFTER THE PATIENT LEAVES THE FACILITY, OR IN CASE OF OUTPATIENTS OR EMERGENCY PATIENTS, THE FINANCIAL COUNSELOR WILL MAIL A FINANCIAL ASSISTANCE APPLICATION TO THE PATIENT FOR COMPLETION. IN ADDITION, THE HOSPITAL WILL PROVIDE A PLAIN LANGUAGE SUMMARY OF THE FINANCIAL ASSISTANCE POLICY TO THE PATIENT WITH ALL BILLING STATEMENTS AND COMMUNICATIONS WITHIN THE FIRST 120 DAYS FOLLOWING THE FIRST BILLING STATEMENT. IN ADDITION, PATIENTS WILL BE CONTACTED VIA TELEPHONE.
FORM 990, SCHEDULE H, PART VI, LINE 4	THE COMMUNITY SERVED BY THE HOSPITAL IS A RURAL AREA IN CENTRAL WESTERN ARKANSAS. THE HOSPITAL IS LOCATED IN DANVILLE, ARKANSAS, WHICH IS THE SECOND LARGEST TOWN IN THE COMMUNITY WITH A POPULATION OF AROUND 2,350 PEOPLE. THE POPULATION IS ABOUT 75% CAUCASIAN, MAKING IT MUCH MORE RACIALLY HOMOGENOUS THAN EITHER THE STATE OF ARKANSAS OR THE UNITED STATES AS A WHOLE. MOST OF THE REMAINING POPULATION IS HISPANIC OR LATINO. ACCORDING TO THE U.S. CENSUS BUREAU, ABOUT 16% OF THE COMMUNITY'S POPULATION IS OVER AGE 65, WHICH IS HIGHER THAN ARKANSAS (15%). THIS AGE GROUP USES MORE HEALTH SERVICES THAN ANY OTHER SO THE HOSPITAL SHOULD BE PREPARED FOR AN INCREASE IN PATIENT VOLUME IN THE FUTURE. ADDITIONALLY, THE PERCENTAGE OF THE COMMUNITY POPULATION AGED 15 TO 44 IS EXPECTED TO DECREASE OVER THE NEXT TWO YEARS, WHICH COULD CONTRIBUTE TO DIFFICULTIES IN RECRUITING PHYSICIANS TO CARE FOR THE AGING POPULATION. FACTORS SUCH AS EDUCATIONAL, ATTAINMENT, POVERTY LEVELS, UNEMPLOYMENT RATES AND INSURANCE COVERAGE LEVELS CONTRIBUTE SIGNIFICANTLY TO THE HEALTH STATUS OF A COMMUNITY. APPROXIMATELY 14% OF THE COMMUNITY'S POPULATION AGE 25 YEARS OR OLDER HAS OBTAINED AN BACHELOR'S DEGREE OR HIGHER, COMPARED TO ABOUT 31% OF THE UNITED STATES. ABOUT 21% OF THE POPULATION DOES NOT HAVE A HIGH SCHOOL DIPOLMA COMPARED TO ABOUT 13% OF THE COUNTRY AS A WHOLE. LOWER LEVELS OF EDUCATIONAL ATTAINMENT HAVE BEEN LINKED TO NEGATIVE HEALTH OUTCOMES, SO THIS IS RELEVANT TO THE CONSIDERATION OF THE HEALTH NEEDS OF THE COMMUNITY. THE INCOME LEVELS OF INDIVIDUALS WITHIN THE COMMUNITY ALSO HAVE A SIGNIFICANT EFFECT ON THEIR ABILITY TO ACCESS HEALTH SERVICES. THE MEDIAN HOUSEHOLD INCOME IN YELL COUNTY IS $39,696, COMPARED TO $43,813 FOR THE STATE OF ARKANSAS AND $57,652 FOR THE UNITED STATES. LOWER THAN MEDIAN HOUSEHOLD INCOME SUGGESTS THAT MANY MEMBERS OF THE COMMUNITY MAY HAVE DIFFICULTY OBTAINING HEALTH CARE, ESPECIALLY PREVENTATIVE CARE. ADDITIONALLY, WHILE SIMILAR TO THE STATE OF ARKANSAS, THE LEVELS OF POVERTY IN YELL COUNTY ARE SIGNIFICANTLY HIGHER THAN THE RATES IN THE UNITED STATES.
FORM 990, SCHEDULE H, PART VI, LINE 5	THE HOSPITAL AND OTHER HEALTH CARE FACILITIES FURTHER THEIR EXEMPT PURPOSE BY PROMOTING HEALTH CARE INITIATIVES IN THE COMMUNITIES SERVED. THE HOSPITAL IS INVOLVED WITH LOCAL SCHOOL DISTRICTS, HEALTH DEPARTMENTS, CHURCHES AND FAITH-BASED ORGANIZATIONS, SENIOR CITIZEN CENTERS, AND OTHER ORGANIZATIONS TO HELP PROMOTE HEALTH EDUCATION. A FEW EVENTS IN WHICH THE HOSPITAL IS INVOLVED IN INCLUDES CAR SEAT SAFETY, HEALTH FAIRS, YELL COUNTY FAIR, FARM SAFETY, AND OTHER LOCAL EVENTS THAT WILL HELP THE HOSPITAL DISTRIBUTE HEALTH KNOWLEDGE.

Schedule H (Form 990) 2018

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

2018

Open to Public Inspection

Name of the organization

JOHN ED CHAMBERS MEMORIAL HOSPITAL INC

Employer identification number

71-6044543

Part I

Questions Regarding Compensation

Yes

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

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

Travel for companions Payments for business use of personal residence

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

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

If any of the boxes in line 1a are checked, did the organization follow a written policy regarding payment or reimbursement or provision of all of the expenses described above? If "No," complete Part III to explain .........

Did the organization require substantiation prior to reimbursing or allowing expenses incurred by all
directors, trustees, officers, including the CEO/Executive Director, regarding the items checked in line 1a? ..

Yes

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? .........

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

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) 2018

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)
1MIKE MCCOY CEO	(i) (ii)	257,817 ------------- 0	0 ------------- 0	0 ------------- 0	10,684 ------------- 0	5,387 ------------- 0	273,888 ------------- 0	0 ------------- 0
2THOMAS TINNESZ MD PHYSICIAN	(i) (ii)	377,157 ------------- 0	0 ------------- 0	0 ------------- 0	11,400 ------------- 0	4,943 ------------- 0	393,500 ------------- 0	0 ------------- 0
3JOHN WESTWOOD MD PYSICIAN	(i) (ii)	223,810 ------------- 0	0 ------------- 0	0 ------------- 0	9,000 ------------- 0	1,196 ------------- 0	234,006 ------------- 0	0 ------------- 0
4WILLIAM BERRY MD PHYSICIAN	(i) (ii)	211,181 ------------- 0	0 ------------- 0	0 ------------- 0	8,986 ------------- 0	7,764 ------------- 0	227,931 ------------- 0	0 ------------- 0
5TIMMY KAY MD PHYSICIAN	(i) (ii)	223,150 ------------- 0	0 ------------- 0	0 ------------- 0	8,986 ------------- 0	1,490 ------------- 0	233,626 ------------- 0	0 ------------- 0
6KARL SANDBERG MD PHYSICIAN	(i) (ii)	173,248 ------------- 0	0 ------------- 0	0 ------------- 0	7,254 ------------- 0	8,098 ------------- 0	188,600 ------------- 0	0 ------------- 0

Schedule J (Form 990) 2018

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 1A	ALL MONTHLY DUES FOR CHAMBERLYNE COUNTRY CLUB ARE PAID FOR MIKE MCCOY. FOR WILLIAM BERRY, THOMAS TINNESZ, TIMMY KAY WE PAY HALF AND THEY PAYROLL DEDUCT THE OTHER HALF BASED ON THE TYPE OF MEMBERSHIP THEY HAVE.

Schedule J (Form 990) 2018

Additional Data

Software ID:
Software Version:

- TIN:

Note: To capture the full content of this document, please select landscape mode (11" x 8.5") when printing.

Schedule K
(Form 990)

Department of the Treasury
Internal Revenue Service

Supplemental Information on Tax-Exempt Bonds

Complete if the organization answered "Yes" to Form 990, Part Ⅵ, line 24a. Provide descriptions,
explanations, and any additional information in Part Ⅵ.
SchKMediumBullet

Attach to Form 990.
SchKMediumBullet

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

OMB No. 1545-0047

2018

Open to Public
Inspection

Name of the organization
JOHN ED CHAMBERS MEMORIAL HOSPITAL INC

Employer identification number
71-6044543

Part Ⅰ

Bond Issues

(a) Issuer name		(b) Issuer EIN	(c) CUSIP #	(d) Date issued	(e) Issue price	(f) Description of purpose	(g) Defeased		(h) On behalf of issuer		(i) Pool financing
(a) Issuer name		(b) Issuer EIN	(c) CUSIP #	(d) Date issued	(e) Issue price	(f) Description of purpose	Yes	No	Yes	No	Yes	No
A	YELL COUNTY ARKANSAS	71-0420105	98544NAA4	11-14-2006	8,100,000	CONSTRUCTION & IMPROVEMENT BONDS		X		X		X
B	YELL COUNTY ARKANSAS	71-0420105	98544NAB2	01-02-2007	1,800,000	CONSTRUCTION & IMPROVEMENT BONDS		X		X		X

Part Ⅱ

Proceeds

	A		B		C		D
	1 Amount of bonds retired ..................	2,327,549		517,233
2 Amount of bonds legally defeased ..............	0		0
3 Total proceeds of issue ..................	8,100,000		1,800,000
4 Gross proceeds in reserve funds .............	0		0
5 Capitalized interest from proceeds .............	0		0
6 Proceeds in refunding escrows ...............	0		0
7 Issuance costs from proceeds ...............	55,514		12,336
8 Credit enhancement from proceeds .............	0		0
9 Working capital expenditures from proceeds .............	0		0
10 Capital expenditures from proceeds .............	0		0
11 Other spent proceeds .............	8,100,000		1,800,000
12 Other unspent proceeds .............	0		0
13 Year of substantial completion .............	2009		2009
	Yes	No	Yes	No	Yes	No	Yes	No
14 Were the bonds issued as part of a current refunding issue? ....		X		X
15 Were the bonds issued as part of an advance refunding issue? .....		X		X
16 Has the final allocation of proceeds been made? ..........	X		X
17 Does the organization maintain adequate books and records to support the final allocation of proceeds? ..................	X		X

Part Ⅲ

Private Business Use

	A		B		C		D
	Yes	No	Yes	No	Yes	No	Yes	No
1 Was the organization a partner in a partnership, or a member of an LLC, which owned property financed by tax-exempt bonds? .............		X		X
2 Are there any lease arrangements that may result in private business use of bond-financed property? ...............		X		X

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

Cat. No. 50193E

Schedule K (Form 990) 2018

Page 2

Part Ⅲ

Private Business Use (Continued)

	A		B		C		D
	Yes	No	Yes	No	Yes	No	Yes	No
3a Are there any management or service contracts that may result in private business use of bond-financed property? .............		X		X
b If "Yes" to line 3a, does the organization routinely engage bond counsel or other outside counsel to review any management or service contracts relating to the financed property?
c Are there any research agreements that may result in private business use of bond-financed property? .............		X		X
d If "Yes" to line 3c, does the organization routinely engage bond counsel or other outside counsel to review any research agreements relating to the financed property?
4 Enter the percentage of financed property used in a private business use by entities other than a section 501(c)(3) organization or a state or local government ....	0 %		0 %
5 Enter the percentage of financed property used in a private business use as a result of unrelated trade or business activity carried on by your organization, another section 501(c)(3) organization, or a state or local government .........
6 Total of lines 4 and 5 .............
7 Does the bond issue meet the private security or payment test? ...		X		X
8a Has there been a sale or disposition of any of the bond-financed property to a nongovernmental person other than a 501(c)(3) organization since the bonds were issued?.............		X		X
b If "Yes" to line 8a, enter the percentage of bond-financed property sold or disposed of. ..
c If "Yes" to line 8a, was any remedial action taken pursuant to Regulations sections 1.141-12 and 1.145-2? .............		X		X
9 Has the organization established written procedures to ensure that all nonqualified bonds of the issue are remediated in accordance with the requirements under Regulations sections 1.141-12 and 1.145-2? ........		X		X

Part Ⅳ

Arbitrage

	A		B		C		D
	Yes	No	Yes	No	Yes	No	Yes	No
1 Has the issuer filed Form 8038-T, Arbitrage Rebate, Yield Reduction and Penalty in Lieu of Arbitrage Rebate? ...		X		X
2 If "No" to line 1, did the following apply? ....
a Rebate not due yet? .......		X		X
b Exception to rebate? ........		X		X
c No rebate due? .........	X		X
If "Yes" to line 2c, provide in Part Ⅵ the date the rebate computation was performed ......
3 Is the bond issue a variable rate issue? .....		X		X
4a Has the organization or the governmental issuer entered into a qualified hedge with respect to the bond issue?		X		X
b Name of provider ..........	0		0
c Term of hedge .........
d Was the hedge superintegrated? ......
e Was the hedge terminated? ........

Schedule K (Form 990) 2018

Page 3

Part Ⅳ

Arbitrage (Continued)

	A		B		C		D
	Yes	No	Yes	No	Yes	No	Yes	No
5a Were gross proceeds invested in a guaranteed investment contract (GIC)?		X		X
b Name of provider ..........	0		0
c Term of GIC .........
d Was the regulatory safe harbor for establishing the fair market value of the GIC satisfied? ........
6 Were any gross proceeds invested beyond an available temporary period?		X		X
7 Has the organization established written procedures to monitor the requirements of section 148? ...		X		X

Part Ⅴ

Procedures To Undertake Corrective Action

---------------------------------------------------------------------------------------------------------------	A		B		C		D
	Yes	No	Yes	No	Yes	No	Yes	No
Has the organization established written procedures to ensure that violations of federal tax requirements are timely identified and corrected through the voluntary closing agreement program if self-remediation is not available under applicable regulations?		X		X

Part Ⅵ

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

Return Reference	Explanation
FORM 990, SCHEDULE K, PART IV, LINE 2C	FOR BOND SERIES 2006A, THE LAST REBATE COMPUTATION DATE WAS 10/31/2016. FOR BOND SERIES 2006B, THE LAST REBATE COMPUTATION DATE WAS 10/31/2016.
FORM 990, SCHEDULE K, PART IV, LINE 2C	A - COMPLETED ON BOND YEAR OF 10/31/2018 B - COMPLETED ON BOND YEAR OF 10/31/2018
FORM 990, SCHEDULE K, PART III, LINE 9 & PART IV, LINE 7 & PART V	THE ORGANIZATION IS IN THE PROCESS OF DRAFTING THESE POLICIES.

Schedule K (Form 990) 2018

Additional Data

Software ID:
Software Version:

1	Briefly describe the organization’s mission or most significant activities: IT IS THE GOAL OF CHAMBERS MEMORIAL HOSPITAL TO PROVIDE QUALITY HEALTHCARE SERVICES IN A COST EFFECTIVE MANNER THAT MEETS THE NEEDS & EXPECTATIONS OF PATIENTS & COMMUNITIES.
2	Check this box
3	Number of voting members of the governing body (Part VI, line 1a) ........	3	7
4	Number of independent voting members of the governing body (Part VI, line 1b) .....	4	5
5	Total number of individuals employed in calendar year 2018 (Part V, line 2a) ......	5	307
6	Total number of volunteers (estimate if necessary) .............	6	10
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 34 .........	7b	0

		Prior Year	Current Year
8	Contributions and grants (Part VIII, line 1h) .........	71,063	120,261
9	Program service revenue (Part VIII, line 2g) .........	18,438,966	19,260,203
10	Investment income (Part VIII, column (A), lines 3, 4, and 7d ) ....	54,335	125,753
11	Other revenue (Part VIII, column (A), lines 5, 6d, 8c, 9c, 10c, and 11e)	1,123,962	1,134,244
12	Total revenue—add lines 8 through 11 (must equal Part VIII, column (A), line 12)	19,688,326	20,640,461
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)	11,049,355	11,828,867
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)....	9,144,970	10,005,578
18	Total expenses. Add lines 13–17 (must equal Part IX, column (A), line 25)	20,194,325	21,834,445
19	Revenue less expenses. Subtract line 18 from line 12.......	-505,999	-1,193,984
		Beginning of Current Year	End of Year
20	Total assets (Part X, line 16).............	27,705,165	25,721,042
21	Total liabilities (Part X, line 26).............	12,482,421	11,692,282
22	Net assets or fund balances. Subtract line 21 from line 20.....	15,222,744	14,028,760

Sign Here

	Signature of officer	Date

	Type or print name and title


4a	(Code: ) (Expenses $ 18,394,363 including grants of $ 0 ) (Revenue $ 19,260,203 )
	IT IS THE GOAL OF CHAMBERS MEMORIAL HOSPITAL TO PROVIDE QUALITY HEALTHCARE SERVICES IN A COST EFFECTIVE MANNER THAT MEETS THE NEEDS AND EXPECTATIONS OF PATIENTS AND THE COMMUNITITES SERVED.

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 expenses18,394,363

(A) Name and Title	(B) Average hours per week (list any hours for related organizations below dotted line)	(C) Position (do not check more than one box, unless person is both an officer and a director/trustee)			(D) Reportable compensation from the organization (W- 2/1099-MISC)	(E) Reportable compensation from related organizations (W- 2/1099-MISC)	(F) Estimated amount of other compensation from the organization and related organizations
(A) Name and Title
(1) JOHNNY CHAMBERS...................................................................... CHAIRMAN	1.0 ................. 0.0	X	X		0	0	0
(2) DAVID FISHER...................................................................... VICE CHAIRMAN	1.0 ................. 0.0	X	X		0	0	0
(3) ROBERT REDFERN...................................................................... SECRETARY	1.0 ................. 0.0	X	X		0	0	0
(4) TODD SANDERS...................................................................... DIRECTOR	1.0 ................. 0.0	X			0	0	0
(5) TOMMY PAPASAN...................................................................... DIRECTOR	1.0 ................. 0.0	X			0	0	0
(6) RITCHIE TIPPIN...................................................................... DIRECTOR	1.0 ................. 0.0	X			0	0	0
(7) PHILIP ALEXANDER...................................................................... DIRECTOR	1.0 ................. 0.0	X			0	0	0
(8) MIKE MCCOY...................................................................... CEO	40.0 ................. 0.0		X		257,817	0	16,071
(9) THOMAS TINNESZ MD...................................................................... PHYSICIAN	40.0 ................. 0.0			X	377,157	0	16,343
(10) JOHN WESTWOOD MD...................................................................... PYSICIAN	32.0 ................. 0.0			X	223,810	0	10,196
(11) WILLIAM BERRY MD...................................................................... PHYSICIAN	32.0 ................. 0.0			X	211,181	0	16,750
(12) TIMMY KAY MD...................................................................... PHYSICIAN	32.0 ................. 0.0			X	223,150	0	10,476
(13) KARL SANDBERG MD...................................................................... PHYSICIAN	32.0 ................. 0.0			X	173,248	0	15,352

1b	Sub-Total................
c	Total from continuation sheets to Part VII, Section A....
d	Total (add lines 1b and 1c)...........	1,466,363	0	85,188

(A) Name and business address	(B) Description of services	(C) Compensation
RIVER RIDGE RX INC, PO BOX 394 DANVILLE,AR728330394	PHARMACY SERVICES	324,250
ANESTHESIA SPECIALISTS PA, PO BOX 20343 HOT SPRINGS,AR71903	ANESTHESIA SERVICES	279,000



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 2

1a	Federated campaigns..		1a
b	Membership dues..		1b
c	Fundraising events..		1c	25,120
d	Related organizations		1d
e	Government grants (contributions)		1e	57,400

f	All other contributions, gifts, grants, and similar amounts not included above		1f	37,741

g	Noncash contributions included in lines 1a - 1f:$
h Total. Add lines 1a-1f.......		120,261

		Business Code
2a	PATIENT SERVICES	622110	19,260,203	19,260,203
b
c
d
e
f	All other program service revenue.
g	Total. Add lines 2a–2f ....		19,260,203

3 Investment income (including dividends, interest, and othersimilar amounts) ......			34,650			34,650
4 Income from investment of tax-exempt bond proceeds			0
5 Royalties...........			0
		(ii) Personal	(i) Real
6a	Gross rents		21,685
b	Less: rental expenses
c	Rental income or (loss)	0	21,685
d	Net rental income or (loss)......			21,685			21,685
		(ii) Other	(i) Securities
7a	Gross amount from sales of assets other than inventory	166,000
b	Less: cost or other basis and sales expenses	74,897
c	Gain or (loss)	91,103
d	Net gain or (loss).....			91,103			91,103
8a	Gross income from fundraising events (not including $ 25,120of contributions reported on line 1c). See Part IV, line 18 ....
	a		14,030
b	Less: direct expenses ...b		14,668
c	Net income or (loss) from fundraising events..			-638			-638
9a	Gross income from gaming activities. See Part IV, line 19 ...
	a		0
b	Less: direct expenses ...b		0
c	Net income or (loss) from gaming activities..			0
10a	Gross sales of inventory, less returns and allowances ..
	a		0
b	Less: cost of goods sold ..b		0
c	Net income or (loss) from sales of inventory..			0
Business Code			Miscellaneous Revenue
11a	340B REVENUE		900099	728,232			728,232
b	CAFETERIA REVENUE		900099	125,576			125,576
c	MANAGED CARE FEES		900099	189,354			189,354
d	All other revenue ....			70,035			70,035
e	Total. Add lines 11a–11d ......			1,113,197
12	Total revenue. See Instructions......			20,640,461	19,260,203		1,259,997

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, line 15 and 16.	0
4	Benefits paid to or for members	0
5	Compensation of current officers, directors, trustees, and key employees ....	273,888		273,888	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			0
7	Other salaries and wages	9,860,835	8,331,278	1,529,557	0
8	Pension plan accruals and contributions (include section 401(k) and 403(b) employer contributions) ....	283,896	239,860	44,036	0
9	Other employee benefits .......	711,241	600,917	110,324	0
10	Payroll taxes ...........	699,007	590,581	108,426
11	Fees for services (non-employees):
a	Management ......	0
b	Legal .........	0
c	Accounting ...........	61,713	52,140	9,573
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)	3,824,465	3,231,236	593,229
12	Advertising and promotion ....	41,222	34,828	6,394
13	Office expenses .......	287,089	242,557	44,532
14	Information technology ......	0
15	Royalties ..	0
16	Occupancy ...........	286,591	242,137	44,454
17	Travel ............	141,202	119,300	21,902
18	Payments of travel or entertainment expenses for any federal, state, or local public officials .	0
19	Conferences, conventions, and meetings ....	0
20	Interest ...........	588,954	497,599	91,355
21	Payments to affiliates .......	0
22	Depreciation, depletion, and amortization ..	937,747	792,289	145,458
23	Insurance ...	302,871	255,891	46,980
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 EXPENSE	1,148,551	1,148,551
b	OPERATING SUPPLIES	1,397,706	1,180,902	216,804
c	EQUIPMENT EXPENSE	361,582	305,495	56,087
d	REPAIRS & MAINTENANCE	300,113	253,561	46,552
e	All other expenses	325,772	275,241	50,531
25	Total functional expenses. Add lines 1 through 24e	21,834,445	18,394,363	3,440,082	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).

1	Cash–non-interest-bearing ........			332,104	1	1,800
2	Savings and temporary cash investments .........			7,386,093	2	6,650,486
3	Pledges and grants receivable, net ......			0	3	0
4	Accounts receivable, net .............			3,516,088	4	3,329,728
5	Loans and other receivables from current and former officers, directors, trustees, key employees, and highest compensated employees. Complete Part II of Schedule L .............
				0	5	0
6	Loans and other receivables from other disqualified persons (as defined under section 4958(f)(1)), persons described in section 4958(c)(3)(B), and contributing employers and sponsoring organizations of section 501(c)(9) voluntary employees' beneficiary organizations (see instructions) Complete Part II of Schedule L ..............
				0	6	0
7	Notes and loans receivable, net ....			0	7	0
8	Inventories for sale or use ........			361,892	8	332,461
9	Prepaid expenses and deferred charges ......			370,362	9	232,580
10a	Land, buildings, and equipment: cost or other basis. Complete Part VI of Schedule D	10a	34,029,677
b	Less: accumulated depreciation	10b	19,308,364	15,315,754	10c	14,721,313
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 ...........			422,872	15	452,674
16	Total assets. Add lines 1 through 15 (must equal line 34)...			27,705,165	16	25,721,042

17	Accounts payable and accrued expenses .....	1,466,638	17	1,211,063
18	Grants payable ...	0	18	0
19	Deferred revenue .........	0	19	0
20	Tax-exempt bond liabilities .........	10,849,549	20	10,172,868
21	Escrow or custodial account liability. Complete Part IV of Schedule D	0	21	0
22	Loans and other payables to current and former officers, directors, trustees, key employees, highest compensated employees, and disqualified
	persons. Complete Part II of Schedule L..	166,234	22	90,944
23	Secured mortgages and notes payable to unrelated third parties ..	0	23	217,407
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	0	25	0
26	Total liabilities. Add lines 17 through 25..	12,482,421	26	11,692,282

	Organizations that follow SFAS 117 (ASC 958), check here and complete lines 27 through 29, and lines 33 and 34.
27	Unrestricted net assets	15,222,744	27	14,028,760
28	Temporarily restricted net assets ...........	0	28	0
29	Permanently restricted net assets	0	29	0
	Organizations that do not follow SFAS 117 (ASC 958), check here and complete lines 30 through 34.
30	Capital stock or trust principal, or current funds .....		30
31	Paid-in or capital surplus, or land, building or equipment fund ...		31
32	Retained earnings, endowment, accumulated income, or other funds		32
33	Total net assets or fund balances ...........	15,222,744	33	14,028,760
34	Total liabilities and net assets/fund balances ........	27,705,165	34	25,721,042

1(a) Name of disqualified person	(c) Description of transaction	(d) Corrected?
1(a) Name of disqualified person	(c) Description of transaction	Yes	No

(a) Name of interested person	(b) Relationship with organization	(c) Purpose of loan	(d) Loan to or from the organization?		(e)Original principal amount	(f)Balance due	(g) In default?		(h) Approved by board or committee?		(i)Written agreement?
(a) Name of interested person	(b) Relationship with organization	(c) Purpose of loan	To	From	(e)Original principal amount	(f)Balance due	Yes	No	Yes	No	Yes	No
(1) CHAMBERS BANK	JOHNNY CHAMBERS - BOD	EQUIPMENT		X	153,586	90,944		No	Yes		Yes





Total ............... $						90,944

(a) Name of interested person	(b) Relationship between interested person and the organization	(c) Amount of transaction	(d) Description of transaction	(e) Sharing of organization's revenues?
(a) Name of interested person		(c) Amount of transaction	(d) Description of transaction	Yes	No
(1) CHAMBERS BANK	JOHNNY CHAMBERS - BOD	606,012	INVESTMENT INTEREST INC AND EX		No

Return Reference	Explanation
FORM 990, PART VI, SECTION B, LINE 11B	THE CEO REVIEWS AND ALSO PRESENTS TO THE BOARD OF DIRECTORS FOR APPROVAL.
FORM 990, PART VI, SECTION B, LINE 12C	THE HOSPITAL HAS A COMPLIANCE COMMITTEE THAT MONITORS FOR POLICY COMPLIANCE AND RECOMMENDS CHANGES OR NEW POLICIES TO THE CEO FOR APPROVAL. THE HOSPITAL HAS INSTITUTED A NEW POLICY FOR EMPLOYEES THAT WILL BE USED FOR BOARD MEMBERS GOING FORWARD. THE BOARD MEMBERS WILL SIGN THE AGREEMENT AND BE WITHDRAWN FROM VOTING DECISIONS AS CONFLICTS ARISE.
FORM 990, PART VI, SECTION B, LINE 15A & 15B	THIS REVIEW IS DONE ANNUALLY AT THE CEO'S ANNIVERSARY DATE BY THE BOARD OF DIRECTORS. THIS WOULD HAVE BEEN DONE IN MAY OF 2018. THE CEO PERFORMS EVALUATIONS AND COMPENSATION REVIEWS AT THE ANNIVERSARY DATE OF EACH DEPARTMENT HEAD. THEY ARE PERFORMED YEARLY.
FORM 990, PART VI, SECTION C, LINE 19	NO DOCUMENTS ARE AVAILABLE TO THE PUBLIC.
FORM 990 PART IX LINE 11G	DESCRIPTION:EMERGENCY ROOM SERVICES TOTAL FEES:1816680
FORM 990 PART IX LINE 11G	DESCRIPTION:PSYCH TOTAL FEES:549165
FORM 990 PART IX LINE 11G	DESCRIPTION:PHARMACY SERVICES TOTAL FEES:306000
FORM 990 PART IX LINE 11G	DESCRIPTION:ANESTHESIOLOGY SERVICES TOTAL FEES:285000
FORM 990 PART IX LINE 11G	DESCRIPTION:ADMIN & OFFICE SERVICES TOTAL FEES:217804
FORM 990 PART IX LINE 11G	DESCRIPTION:SPEECH THERAPY SERVICES TOTAL FEES:156214
FORM 990 PART IX LINE 11G	DESCRIPTION:OCCUPATIONAL THERAPY TOTAL FEES:149512
FORM 990 PART IX LINE 11G	DESCRIPTION:PHYSICIAL THERAPY TOTAL FEES:126549
FORM 990 PART IX LINE 11G	DESCRIPTION:LAB & X-RAY TOTAL FEES:117831
FORM 990 PART IX LINE 11G	DESCRIPTION:RESPIRATORY CARE TOTAL FEES:73650
FORM 990 PART IX LINE 11G	DESCRIPTION:NURSING TOTAL FEES:15488
FORM 990 PART IX LINE 11G	DESCRIPTION:OTHER PURCHASED SERVICES TOTAL FEES:10572