TY 2018 Form 990

- TIN:

Form990

Department of the TreasuryInternal Revenue Service

Return of Organization Exempt From Income Tax

Under section 501(c), 527, or 4947(a)(1) of the Internal Revenue Code (except private foundations)

Do not enter social security numbers on this form as it may be made public.

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

OMB No. 1545-0047

2018

Open to Public Inspection

A For the 2019 calendar year, or tax year beginning 10-01-2018 , and ending 09-30-2019

BCheck if applicable: Address change Name change Initial return Final return/terminated Amended return Application pending

CName of organization
JAMES B HAGGIN MEMORIAL HOSPITAL INC

% WILLIAM SNAPP III

Doing business as

Number and street (or P.O. box if mail is not delivered to street address)
464 LINDEN AVENUE

Room/suite

City or town, state or province, country, and ZIP or foreign postal code
HARRODSBURG, KY40330

D Employer identification number

61-0510934

E Telephone number

G Gross receipts $ 24,124,784

F Name and address of principal officer:
DANIEL MCKAY
217 S 3RD STREET
DANVILLE,KY40422

Tax-exempt status: 501(c)(3) 501(c) ( ) LeftBullet

(insert no.) 4947(a)(1) or 527

Website:

WWW.EMHEALTH.ORG

H(a)

Is this a group return for
subordinates? Yes No

H(b)

Are all subordinates
included?

Yes No

If "No," attach a list. (see instructions)

H(c)

Group exemption number MediumBullet

K Form of organization: Corporation Trust Association Other MediumBullet

L Year of formation: 1913

M State of legal domicile: KY

Part I

Summary

1	Briefly describe the organization’s mission or most significant activities: TO PROVIDE ACUTE HOSPITAL CARE TO INDIVIDUALS RESIDING WITHIN A PRIMARY SERVICE AREA OF MERCER AND SURROUNDING COUNTIES.
2	Check this box
3	Number of voting members of the governing body (Part VI, line 1a) ........	3	13
4	Number of independent voting members of the governing body (Part VI, line 1b) .....	4	10
5	Total number of individuals employed in calendar year 2018 (Part V, line 2a) ......	5	117
6	Total number of volunteers (estimate if necessary) .............	6	26
7a	Total unrelated business revenue from Part VIII, column (C), line 12 ........	7a	353
b	Net unrelated business taxable income from Form 990-T, line 34 .........	7b	-149,341

		Prior Year	Current Year
8	Contributions and grants (Part VIII, line 1h) .........	246,378	243,439
9	Program service revenue (Part VIII, line 2g) .........	19,703,321	23,721,380
10	Investment income (Part VIII, column (A), lines 3, 4, and 7d ) ....	12,371	12,623
11	Other revenue (Part VIII, column (A), lines 5, 6d, 8c, 9c, 10c, and 11e)	579,314	140,155
12	Total revenue—add lines 8 through 11 (must equal Part VIII, column (A), line 12)	20,541,384	24,117,597
13	Grants and similar amounts paid (Part IX, column (A), lines 1–3 )...	0	0
14	Benefits paid to or for members (Part IX, column (A), line 4).....	0	0
15	Salaries, other compensation, employee benefits (Part IX, column (A), lines 5–10)	12,147,123	13,830,869
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)....	12,073,307	11,336,554
18	Total expenses. Add lines 13–17 (must equal Part IX, column (A), line 25)	24,220,430	25,167,423
19	Revenue less expenses. Subtract line 18 from line 12.......	-3,679,046	-1,049,826
		Beginning of Current Year	End of Year
20	Total assets (Part X, line 16).............	13,134,230	12,993,552
21	Total liabilities (Part X, line 26).............	21,782,308	22,691,456
22	Net assets or fund balances. Subtract line 21 from line 20.....	-8,648,078	-9,697,904

Part II

Signature Block

Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief, it is true, correct, and complete. Declaration of preparer (other than officer) is based on all information of which preparer has any knowledge.

Sign Here

	Signature of officer	Date

	Type or print name and title

Paid Preparer Use Only

Print/Type preparer's name

Preparer's signature

Date

Check if
self-employed

PTIN

Firm's name MediumBullet

Firm's EIN MediumBullet

Firm's address MediumBullet

Phone no.

May the IRS discuss this return with the preparer shown above? (see instructions) ..........YesNo

For Paperwork Reduction Act Notice, see the separate instructions.

Cat. No. 11282Y Form 990 (2018)

Form 990 (2018)

Page 2

Part III

Statement of Program Service Accomplishments

Check if Schedule O contains a response or note to any line in this Part III..............

Briefly describe the organization’s mission: THE JAMES B HAGGIN MEMORIAL HOSPITAL WILL MAINTAIN A LEADERSHIP POSITION IN EFFICIENTLY PROVIDING QUALITY MEDICAL CARE AND HEALTH CARE SERVICES TO THE RESIDENTS OF MERCER AND SURROUNDING COUNTIES. SEE SCHEDULE O FOR CONTINUATION.

Did the organization undertake any significant program services during the year which were not listed on
the prior Form 990 or 990-EZ? ..................... Yes No

If "Yes," describe these new services on Schedule O.

Did the organization cease conducting, or make significant changes in how it conducts, any program
services? ........................... Yes No

If "Yes," describe these changes on Schedule O.

Describe the organization’s program service accomplishments for each of its three largest program services, as measured by expenses. Section 501(c)(3) and 501(c)(4) organizations are required to report the amount of grants and allocations to others, the total expenses, and revenue, if any, for each program service reported.


4a	(Code: ) (Expenses $ 22,203,776 including grants of $ ) (Revenue $ 23,721,380 )
	SEE SCHEDULE O.

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












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












4d	Other program services (Describe in Schedule O.)
	(Expenses $ including grants of $ ) (Revenue $ )
4e	Total program service expenses22,203,776

Form 990 (2018)

Page 3

Part IV

Checklist of Required Schedules

Yes

Is the organization described in section 501(c)(3) or 4947(a)(1) (other than a private foundation)? If "Yes," complete Schedule A Click to see attachment

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

Yes

Is the organization required to complete Schedule B, Schedule of Contributors (see instructions)? Click to see attachment

...

Yes

Did the organization engage in direct or indirect political campaign activities on behalf of or in opposition to candidates for public office? If "Yes," complete Schedule C, Part I Click to see attachment

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

Section 501(c)(3) organizations. Did the organization engage in lobbying activities, or have a section 501(h) election in effect during the tax year? If "Yes," complete Schedule C, Part II Click to see attachment

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

Yes

Is the organization a section 501(c)(4), 501(c)(5), or 501(c)(6) organization that receives membership dues, assessments, or similar amounts as defined in Revenue Procedure 98-19? If "Yes," complete Schedule C, Part III.................

Did the organization maintain any donor advised funds or any similar funds or accounts for which donors have the right to provide advice on the distribution or investment of amounts in such funds or accounts? If "Yes," complete Schedule D, Part I Click to see attachment

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

Did the organization receive or hold a conservation easement, including easements to preserve open space,
the environment, historic land areas, or historic structures? If "Yes," complete Schedule D, Part II Click to see attachment

...

Did the organization maintain collections of works of art, historical treasures, or other similar assets? If "Yes," complete Schedule D, Part III Click to see attachment

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

Did the organization report an amount in Part X, line 21 for escrow or custodial account liability; serve as a custodian for amounts not listed in Part X; or provide credit counseling, debt management, credit repair, or debt negotiation services? If "Yes," complete Schedule D, Part IV Click to see attachment

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

Did the organization, directly or through a related organization, hold assets in temporarily restricted endowments, permanent endowments, or quasi-endowments? If "Yes," complete Schedule D, Part V Click to see attachment

......

If the organization’s answer to any of the following questions is "Yes," then complete Schedule D, Parts VI, VII, VIII, IX, or X as applicable.

Did the organization report an amount for land, buildings, and equipment in Part X, line 10?
If "Yes," complete Schedule D, Part VI. Click to see attachment

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

11a

Yes

Did the organization report an amount for investments—other securities in Part X, line 12 that is 5% or more of its total assets reported in Part X, line 16? If "Yes," complete Schedule D, Part VII Click to see attachment

.......

11b

Did the organization report an amount for investments—program related in Part X, line 13 that is 5% or more of its total assets reported in Part X, line 16? If "Yes," complete Schedule D, Part VIII Click to see attachment

.......

11c

Did the organization report an amount for other assets in Part X, line 15 that is 5% or more of its total assets reported in Part X, line 16? If "Yes," complete Schedule D, Part IX Click to see attachment

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

11d

Did the organization report an amount for other liabilities in Part X, line 25? If "Yes," complete Schedule D, Part X Click to see attachment

11e

Yes

Did the organization’s separate or consolidated financial statements for the tax year include a footnote that addresses the organization’s liability for uncertain tax positions under FIN 48 (ASC 740)? If "Yes," complete Schedule D, Part X Click to see attachment

11f

12a

Did the organization obtain separate, independent audited financial statements for the tax year?
If "Yes," complete Schedule D, Parts XI and XII Click to see attachment

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

12a

Was the organization included in consolidated, independent audited financial statements for the tax year? If "Yes," and if the organization answered "No" to line 12a, then completing Schedule D, Parts XI and XII is optional Click to see attachment

12b

Yes

Is the organization a school described in section 170(b)(1)(A)(ii)? If "Yes," complete Schedule E

14a

Did the organization maintain an office, employees, or agents outside of the United States? .....

14a

Did the organization have aggregate revenues or expenses of more than $10,000 from grantmaking, fundraising, business, investment, and program service activities outside the United States, or aggregate foreign investments valued at $100,000 or more? If "Yes," complete Schedule F, Parts I and IV.........

14b

Did the organization report on Part IX, column (A), line 3, more than $5,000 of grants or other assistance to or for any foreign organization? If “Yes,” complete Schedule F, Parts II and IV.....

Did the organization report on Part IX, column (A), line 3, more than $5,000 of aggregate grants or other assistance to or for foreign individuals? If “Yes,” complete Schedule F, Parts III and IV...

Did the organization report a total of more than $15,000 of expenses for professional fundraising services on Part IX, column (A), lines 6 and 11e? If "Yes," complete Schedule G, Part I(see instructions) ....

Did the organization report more than $15,000 total of fundraising event gross income and contributions on Part VIII, lines 1c and 8a? If "Yes," complete Schedule G, Part II............

Did the organization report more than $15,000 of gross income from gaming activities on Part VIII, line 9a? If "Yes," complete Schedule G, Part III...................

20a

Did the organization operate one or more hospital facilities? If "Yes," complete Schedule H.... Click to see attachment

20a

Yes

If "Yes" to line 20a, did the organization attach a copy of its audited financial statements to this return? Click to see attachment

20b

Yes

Did the organization report more than $5,000 of grants or other assistance to any domestic organization or domestic government on Part IX, column (A), line 1? If “Yes,” complete Schedule I, Parts I and II.....

Did the organization report more than $5,000 of grants or other assistance to or for domestic individuals on Part IX, column (A), line 2? If “Yes,” complete Schedule I, Parts I and III........

Form 990 (2018)

Page 4

Part IV

Checklist of Required Schedules (continued)

Yes

Did the organization answer "Yes" to Part VII, Section A, line 3, 4, or 5 about compensation of the organization’s current and former officers, directors, trustees, key employees, and highest compensated employees? If "Yes," complete Schedule J....................... Click to see attachment

Yes

24a

Did the organization have a tax-exempt bond issue with an outstanding principal amount of more than $100,000 as of the last day of the year, that was issued after December 31, 2002? If “Yes,” answer lines 24b through 24d and complete Schedule K. If “No,” go to line 25a...............

24a

Did the organization invest any proceeds of tax-exempt bonds beyond a temporary period exception?...

24b

Did the organization maintain an escrow account other than a refunding escrow at any time during the year
to defease any tax-exempt bonds? ...............

24c

Did the organization act as an "on behalf of" issuer for bonds outstanding at any time during the year?...

24d

25a

Section 501(c)(3), 501(c)(4), and 501(c)(29) organizations. Did the organization engage in an excess benefit transaction with a disqualified person during the year? If "Yes," complete Schedule L, Part I............

25a

Is the organization aware that it engaged in an excess benefit transaction with a disqualified person in a prior year, and that the transaction has not been reported on any of the organization’s prior Forms 990 or 990-EZ? If "Yes," complete Schedule L, Part I...................

25b

Did the organization report any amount on Part X, line 5, 6, or 22 for receivables from or payables to any current or former officers, directors, trustees, key employees, highest compensated employees, or disqualified persons? If "Yes," complete Schedule L, Part II................

Did the organization provide a grant or other assistance to an officer, director, trustee, key employee, substantial contributor or employee thereof, a grant selection committee member, or to a 35% controlled entity or family member of any of these persons? If "Yes," complete Schedule L, Part III.........

Was the organization a party to a business transaction with one of the following parties (see Schedule L, Part IV instructions for applicable filing thresholds, conditions, and exceptions):

A current or former officer, director, trustee, or key employee? If "Yes," complete Schedule L,
Part IV........................

28a

A family member of a current or former officer, director, trustee, or key employee? If "Yes," complete Schedule L, Part IV.....................

28b

An entity of which a current or former officer, director, trustee, or key employee (or a family member thereof) was an officer, director, trustee, or direct or indirect owner? If "Yes," complete Schedule L, Part IV...

28c

Did the organization receive more than $25,000 in non-cash contributions? If "Yes," complete Schedule M..

Did the organization receive contributions of art, historical treasures, or other similar assets, or qualified conservation contributions? If "Yes," complete Schedule M .............

Did the organization liquidate, terminate, or dissolve and cease operations? If "Yes," complete Schedule N, Part I.

Did the organization sell, exchange, dispose of, or transfer more than 25% of its net assets? If "Yes," complete Schedule N, Part II...........

Did the organization own 100% of an entity disregarded as separate from the organization under Regulations sections 301.7701-2 and 301.7701-3? If "Yes," complete Schedule R, Part I........ Click to see attachment

Was the organization related to any tax-exempt or taxable entity? If "Yes," complete Schedule R, Part II, III, or IV, and Part V, line 1......................... Click to see attachment

Yes

35a

Did the organization have a controlled entity within the meaning of section 512(b)(13)?

35a

Yes

If ‘Yes’ to line 35a, did the organization receive any payment from or engage in any transaction with a controlled entity within the meaning of section 512(b)(13)? If "Yes," complete Schedule R, Part V, line 2 ... Click to see attachment

35b

Yes

Section 501(c)(3) organizations. Did the organization make any transfers to an exempt non-charitable related organization? If "Yes," complete Schedule R, Part V, line 2............. Click to see attachment

Did the organization conduct more than 5% of its activities through an entity that is not a related organization and that is treated as a partnership for federal income tax purposes? If "Yes," complete Schedule R, Part VI Click to see attachment

Did the organization complete Schedule O and provide explanations in Schedule O for Part VI, lines 11b and 19? Note. All Form 990 filers are required to complete Schedule O. ............

Yes

Part V

Statements Regarding Other IRS Filings and Tax Compliance
Check if Schedule O contains a response or note to any line in this Part V...........

Yes

Enter the number reported in Box 3 of Form 1096 Enter -0- if not applicable ..

Enter the number of Forms W-2G included in line 1a. Enter -0- if not applicable .

Did the organization comply with backup withholding rules for reportable payments to vendors and reportable gaming (gambling) winnings to prize winners? ..................

Yes

Form 990 (2018)

Page 5

Enter the number of employees reported on Form W-3, Transmittal of Wage and
Tax Statements, filed for the calendar year ending with or within the year covered by this return ..................

117

If at least one is reported on line 2a, did the organization file all required federal employment tax returns?
Note. If the sum of lines 1a and 2a is greater than 250, you may be required to e-file (see instructions)

Yes

Did the organization have unrelated business gross income of $1,000 or more during the year?...

Yes

If “Yes,” has it filed a Form 990-T for this year? If “No” to line 3b, provide an explanation in Schedule O...

Yes

At any time during the calendar year, did the organization have an interest in, or a signature or other authority over, a financial account in a foreign country (such as a bank account, securities account, or other financial account)? ..

If "Yes," enter the name of the foreign country: MediumBullet

See instructions for filing requirements for FinCEN Form 114, Report of Foreign Bank and Financial Accounts (FBAR).

Was the organization a party to a prohibited tax shelter transaction at any time during the tax year? ..

Did any taxable party notify the organization that it was or is a party to a prohibited tax shelter transaction?

If "Yes," to line 5a or 5b, did the organization file Form 8886-T? ............

Does the organization have annual gross receipts that are normally greater than $100,000, and did the organization solicit any contributions that were not tax deductible as charitable contributions? ...

If "Yes," did the organization include with every solicitation an express statement that such contributions or gifts were not tax deductible? ......................

Organizations that may receive deductible contributions under section 170(c).

Did the organization receive a payment in excess of $75 made partly as a contribution and partly for goods and services provided to the payor? ....................

If "Yes," did the organization notify the donor of the value of the goods or services provided? .....

Did the organization sell, exchange, or otherwise dispose of tangible personal property for which it was required to file Form 8282? .........................

If "Yes," indicate the number of Forms 8282 filed during the year ....

Did the organization receive any funds, directly or indirectly, to pay premiums on a personal benefit contract?

Did the organization, during the year, pay premiums, directly or indirectly, on a personal benefit contract? ..

If the organization received a contribution of qualified intellectual property, did the organization file Form 8899 as required? ......................

If the organization received a contribution of cars, boats, airplanes, or other vehicles, did the organization file a Form 1098-C? ..........................

Sponsoring organizations maintaining donor advised funds.
Did a donor advised fund maintained by the sponsoring organization have excess business holdings at any time during the year? .........................

Did the sponsoring organization make any taxable distributions under section 4966?...

Did the sponsoring organization make a distribution to a donor, donor advisor, or related person?...

Section 501(c)(7) organizations. Enter:

Initiation fees and capital contributions included on Part VIII, line 12 ...

10a

Gross receipts, included on Form 990, Part VIII, line 12, for public use of club facilities

10b

Section 501(c)(12) organizations. Enter:

Gross income from members or shareholders .........

11a

Gross income from other sources (Do not net amounts due or paid to other sources against amounts due or received from them.) ..........

11b

12a

Section 4947(a)(1) non-exempt charitable trusts. Is the organization filing Form 990 in lieu of Form 1041?

12a

If "Yes," enter the amount of tax-exempt interest received or accrued during the year.

12b

Section 501(c)(29) qualified nonprofit health insurance issuers.

Is the organization licensed to issue qualified health plans in more than one state?
Note. See the instructions for additional information the organization must report on Schedule O.

13a

Enter the amount of reserves the organization is required to maintain by the states in which the organization is licensed to issue qualified health plans ....

13b

Enter the amount of reserves on hand ............

13c

14a

Did the organization receive any payments for indoor tanning services during the tax year?.....

14a

If "Yes," has it filed a Form 720 to report these payments? If "No," provide an explanation in Schedule O..

14b

Is the organization subject to the section 4960 tax on payment(s) of more than $1,000,000 in remuneration or excess parachute payment(s) during the year? If "Yes," see instructions and file Form 4720, Schedule N .....

Is the organization an educational institution subject to the section 4968 excise tax on net investment income?
If "Yes," complete Form 4720, Schedule O ................

Form 990 (2018)

Page 6

Part VI

Governance, Management, and Disclosure For each "Yes" response to lines 2 through 7b below, and for a "No" response to lines 8a, 8b, or 10b below, describe the circumstances, processes, or changes in Schedule O. See instructions.

Check if Schedule O contains a response or note to any line in this Part VI..............

Section A. Governing Body and Management

Yes

Enter the number of voting members of the governing body at the end of the tax year

If there are material differences in voting rights among members of the governing body, or if the governing body delegated broad authority to an executive committee or similar committee, explain in Schedule O.

Enter the number of voting members included in line 1a, above, who are independent

Did any officer, director, trustee, or key employee have a family relationship or a business relationship with any other officer, director, trustee, or key employee? .................

Did the organization delegate control over management duties customarily performed by or under the direct supervision of officers, directors or trustees, or key employees to a management company or other person? .

Did the organization make any significant changes to its governing documents since the prior Form 990 was filed? .

Did the organization become aware during the year of a significant diversion of the organization’s assets? .

Did the organization have members or stockholders? ................

Yes

Did the organization have members, stockholders, or other persons who had the power to elect or appoint one or more members of the governing body? ....................

Yes

Are any governance decisions of the organization reserved to (or subject to approval by) members, stockholders, or persons other than the governing body? ...................

Yes

Did the organization contemporaneously document the meetings held or written actions undertaken during the year by the following:

The governing body? .......................

Yes

Each committee with authority to act on behalf of the governing body? ............

Yes

Is there any officer, director, trustee, or key employee listed in Part VII, Section A, who cannot be reached at the organization’s mailing address? If "Yes," provide the names and addresses in Schedule O.......

Section B. Policies (This Section B requests information about policies not required by the Internal Revenue Code.)

Yes

10a

Did the organization have local chapters, branches, or affiliates? ............

10a

If "Yes," did the organization have written policies and procedures governing the activities of such chapters, affiliates, and branches to ensure their operations are consistent with the organization's exempt purposes?

10b

11a

Has the organization provided a complete copy of this Form 990 to all members of its governing body before filing the form? ............................

11a

Yes

Describe in Schedule O the process, if any, used by the organization to review this Form 990. .....

12a

Did the organization have a written conflict of interest policy? If "No," go to line 13.......

12a

Yes

Were officers, directors, or trustees, and key employees required to disclose annually interests that could give rise to conflicts? ..........................

12b

Yes

Did the organization regularly and consistently monitor and enforce compliance with the policy? If "Yes," describe in Schedule O how this was done...................

12c

Yes

Did the organization have a written whistleblower policy? ...............

Yes

Did the organization have a written document retention and destruction policy? .........

Yes

Did the process for determining compensation of the following persons include a review and approval by independent persons, comparability data, and contemporaneous substantiation of the deliberation and decision?

The organization’s CEO, Executive Director, or top management official ...........

15a

Other officers or key employees of the organization ................

15b

If "Yes" to line 15a or 15b, describe the process in Schedule O (see instructions).

16a

Did the organization invest in, contribute assets to, or participate in a joint venture or similar arrangement with a taxable entity during the year? ......................

16a

If "Yes," did the organization follow a written policy or procedure requiring the organization to evaluate its participation in joint venture arrangements under applicable federal tax law, and take steps to safeguard the organization’s exempt status with respect to such arrangements? ............

16b

Section C. Disclosure

List the States with which a copy of this Form 990 is required to be filed MediumBullet

Section 6104 requires an organization to make its Form 1023 (or 1024-A if applicable), 990, and 990-T (501(c)(3)s only) available for public inspection. Indicate how you made these available. Check all that apply.

Own website Another's website Upon request Other (explain in Schedule O)

Describe in Schedule O whether (and if so, how) the organization made its governing documents, conflict of interest policy, and financial statements available to the public during the tax year.

State the name, address, and telephone number of the person who possesses the organization's books and records:
MediumBullet

WILLIAM SNAPP III217 S 3RD STREET DANVILLE,KY40422 (859) 239-2424

Form 990 (2018)

Page 7

Part VII

Compensation of Officers, Directors,Trustees, Key Employees, Highest Compensated Employees, and Independent Contractors

Check if Schedule O contains a response or note to any line in this Part VII..............

Section A. Officers, Directors, Trustees, Key Employees, and Highest Compensated Employees

1a Complete this table for all persons required to be listed. Report compensation for the calendar year ending with or within the organization’s tax year.
RoundBullet

List all of the organization’s current officers, directors, trustees (whether individuals or organizations), regardless of amount
of compensation. Enter -0- in columns (D), (E), and (F) if no compensation was paid.

List all of the organization’s current key employees, if any. See instructions for definition of "key employee."

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

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

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

List persons in the following order: individual trustees or directors; institutional trustees; officers; key employees; highest
compensated employees; and former such persons.

Check this box if neither the organization nor any related organization compensated any current officer, director, or trustee.

(A) Name and Title	(B) Average hours per week (list any hours for related organizations below dotted line)	(C) Position (do not check more than one box, unless person is both an officer and a director/trustee)			(D) Reportable compensation from the organization (W- 2/1099-MISC)	(E) Reportable compensation from related organizations (W- 2/1099-MISC)	(F) Estimated amount of other compensation from the organization and related organizations
(A) Name and Title
(1) DOUGLAS GREENBURG...................................................................... BOARD CHAIRMAN	10.0 ................. 0.0	X	X		0	4,950	0
(2) JOETTA WICKLIFFE...................................................................... VICE-CHAIR	10.0 ................. 0.0	X	X		0	1,650	0
(3) GREG COBETTO...................................................................... TREASURER	10.0 ................. 0.0	X	X		0	1,650	0
(4) KAY RICHARDSON...................................................................... SECRETARY	10.0 ................. 0.0	X	X		0	1,650	0
(5) PAMELA JOHNSON MD...................................................................... BOARD MEMBER / CHIEF OF STAFF	40.0 ................. 0.0	X			183,249	0	12,537
(6) THOMAS C JACKSON MD...................................................................... BOARD MEM/VICE CHIEF OF STAFF	40.0 ................. 0.0	X			0	1,050	0
(7) DENNIS DAVIS...................................................................... BOARD MEMBER	4.5 ................. 0.0	X			0	600	0
(8) JAMES W DUNN...................................................................... BOARD MEMBER	4.5 ................. 0.0	X			0	5,100	0
(9) JOHN A SETTLES...................................................................... BOARD MEMBER	4.5 ................. 0.0	X			0	300	0
(10) DANIEL MCKAY...................................................................... PRESIDENT & CEO	2.5 ................. 57.5	X	X		0	283,332	25,260
(11) LYNNE WARNER-LYNN...................................................................... VP OF CLINICAL EFFECTIVENESS	20.0 ................. 20.0	X	X		109,065	109,065	40,146
(12) AMY PORTER...................................................................... BOARD MEMBER	4.5 ................. 0.0	X			300	0	0
(13) JOHN D TRISLER...................................................................... BOARD MEMBER	4.5 ................. 0.0	X			0	0	0
(14) WILLIAM SNAPP III...................................................................... EXECUTIVE VP & CFO	2.5 ................. 57.5		X		0	390,340	61,492
(15) BURT PIPER...................................................................... EXECUTIVE VP & COO	3.0 ................. 57.0		X		0	348,622	58,955
(16) LYDIA TIMS...................................................................... CNO	40.0 ................. 0.0		X		113,169	0	20,399
(17) JOAN DELAHOUSEY...................................................................... CRNA	40.0 ................. 0.0			X	213,753	0	42,224

Form 990 (2018)

Page 8

Part VII

Section A. Officers, Directors, Trustees, Key Employees, and Highest Compensated Employees (continued)

(A) Name and Title	(B) Average hours per week (list any hours for related organizations below dotted line)			(D) Reportable compensation from the organization (W- 2/1099-MISC)	(E) Reportable compensation from related organizations (W- 2/1099-MISC)	(F) Estimated amount of other compensation from the organization and related organizations
(A) Name and Title
(18) MICHELLE PINKSTON........................................................................ PHARMACIST	40.0 .......................0.0	X		140,796	0	11,393
(19) SUSAN WHEELER........................................................................ PHARMACIST	40.0 .......................0.0	X		109,774	0	46,109
(20) STACEY RIDER........................................................................ PHARMACIST	40.0 .......................0.0	X		115,718	0	9,872
(21) SALLY DAVENPORT........................................................................ FORMER CEO	0.0 .......................0.0		X	0	490,876	36,704

1b	Sub-Total................
c	Total from continuation sheets to Part VII, Section A....
d	Total (add lines 1b and 1c)...........	985,824	1,639,185	365,091

Total number of individuals (including but not limited to those listed above) who received more than $100,000 of reportable compensation from the organization MediumBullet

Yes

Did the organization list any former officer, director or trustee, key employee, or highest compensated employee on line 1a? If "Yes," complete Schedule J for such individual ..............

Yes

For any individual listed on line 1a, is the sum of reportable compensation and other compensation from the organization and related organizations greater than $150,000? If "Yes," complete Schedule J for such
individual...........................

Yes

Did any person listed on line 1a receive or accrue compensation from any unrelated organization or individual for services rendered to the organization? If "Yes," complete Schedule J for such person ........

Section B. Independent Contractors

Complete this table for your five highest compensated independent contractors that received more than $100,000 of compensation from the organization. Report compensation for the calendar year ending with or within the organization’s tax year.

(A) Name and business address	(B) Description of services	(C) Compensation
HOSPITAL MD, 400 WESTPARK COURT STE 230 PEACHTREE CITY,GA30269	PHYSICIAN SERVICES	1,195,212




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 1

Form 990 (2018)

Page 9

Part VIII

Statement of Revenue

Check if Schedule O contains a response or note to any line in this Part VIII.............

(A)
Total revenue

(B)
Related or
exempt
function
revenue

(D)
Revenue
excluded from
tax under sections
512 - 514

1a	Federated campaigns..		1a
b	Membership dues..		1b
c	Fundraising events..		1c
d	Related organizations		1d	5,170
e	Government grants (contributions)		1e

f	All other contributions, gifts, grants, and similar amounts not included above		1f	238,269

g	Noncash contributions included in lines 1a - 1f:$
h Total. Add lines 1a-1f.......		243,439

		Business Code
2a	PATIENT SERVICES	621400	23,721,380	23,721,027	353
b
c
d
e
f	All other program service revenue.
g	Total. Add lines 2a–2f ....		23,721,380

3 Investment income (including dividends, interest, and othersimilar amounts) ......			19,810			19,810
4 Income from investment of tax-exempt bond proceeds			0
5 Royalties...........			0
		(ii) Personal	(i) Real
6a	Gross rents		5,445
b	Less: rental expenses
c	Rental income or (loss)	0	5,445
d	Net rental income or (loss)......			5,445			5,445
		(ii) Other	(i) Securities
7a	Gross amount from sales of assets other than inventory
b	Less: cost or other basis and sales expenses		7,187
c	Gain or (loss)		-7,187
d	Net gain or (loss).....			-7,187			-7,187
8a	Gross income from fundraising events (not including $ of contributions reported on line 1c). See Part IV, line 18 ....
	a		0
b	Less: direct expenses ...b		0
c	Net income or (loss) from fundraising events..			0
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	CAFETERIA		722514	73,126			73,126
b	MISCELLANEOUS REVENUES		900099	61,584			61,584
c
d	All other revenue ....
e	Total. Add lines 11a–11d ......			134,710
12	Total revenue. See Instructions......			24,117,597	23,721,027	353	152,778

Form 990 (2018)

Page 10

Part IX

Statement of Functional Expenses

Section 501(c)(3) and 501(c)(4) organizations must complete all columns. All other organizations must complete column (A).Check if Schedule O contains a response or note to any line in this Part IX..............

Do not include amounts reported on lines 6b, 7b, 8b, 9b, and 10b of Part VIII.		(A) Total expenses	(B) Program service expenses	(C) Management and general expenses	(D) Fundraising expenses

1	Grants and other assistance to domestic organizations and domestic governments. See Part IV, line 21	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 ....	327,869	327,869
6	Compensation not included above, to disqualified persons (as defined under section 4958(f)(1)) and persons described in section 4958(c)(3)(B) ....	0
7	Other salaries and wages	10,889,755	9,892,237	997,518
8	Pension plan accruals and contributions (include section 401(k) and 403(b) employer contributions) ....	0
9	Other employee benefits .......	1,811,212	1,811,212
10	Payroll taxes ...........	802,033	782,497	19,536
11	Fees for services (non-employees):
a	Management ......	0
b	Legal .........	12,642		12,642
c	Accounting ...........	36,201		36,201
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)	2,501,585	1,741,622	759,963
12	Advertising and promotion ....	8,246	5,332	2,914
13	Office expenses .......	851,980	672,252	179,728
14	Information technology ......	0
15	Royalties ..	0
16	Occupancy ...........	825,249	318,943	506,306
17	Travel ............	20,033	18,806	1,227
18	Payments of travel or entertainment expenses for any federal, state, or local public officials .	0
19	Conferences, conventions, and meetings ....	39,401	37,851	1,550
20	Interest ...........	201,240	201,240
21	Payments to affiliates .......	0
22	Depreciation, depletion, and amortization ..	1,346,776	1,346,776
23	Insurance ...	223,033	32,573	190,460
24	Other expenses. Itemize expenses not covered above (List miscellaneous expenses in line 24e. If line 24e amount exceeds 10% of line 25, column (A) amount, list line 24e expenses on Schedule O.)
a	MEDICAL SUPPLIES	1,608,016	1,608,016
b	REPAIR & MAINTENANCE	595,295	404,353	190,942
c	SHARED RESOURCE ALLOCATION	2,580,868	2,580,868
d	PROVIDER TAXES	340,524	340,524
e	All other expenses	145,465	80,805	64,660
25	Total functional expenses. Add lines 1 through 24e	25,167,423	22,203,776	2,963,647	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).

Form 990 (2018)

Page 11

Part X

Balance Sheet

Check if Schedule O contains a response or note to any line in this Part IX..............

				(A) Beginning of year		(B) End of year

1	Cash–non-interest-bearing ........			180,553	1	161,533
2	Savings and temporary cash investments .........			264,827	2	321,547
3	Pledges and grants receivable, net ......			0	3	0
4	Accounts receivable, net .............			3,776,720	4	3,378,985
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 ........			462,764	8	497,960
9	Prepaid expenses and deferred charges ......			135,483	9	225,884
10a	Land, buildings, and equipment: cost or other basis. Complete Part VI of Schedule D	10a	11,662,340
b	Less: accumulated depreciation	10b	3,342,832	8,313,883	10c	8,319,508
11	Investments—publicly traded securities .			0	11	0
12	Investments—other securities. See Part IV, line 11 .....			0	12	0
13	Investments—program-related. See Part IV, line 11 ..			0	13	0
14	Intangible assets ...............			0	14	0
15	Other assets. See Part IV, line 11 ...........			0	15	88,135
16	Total assets. Add lines 1 through 15 (must equal line 34)...			13,134,230	16	12,993,552

17	Accounts payable and accrued expenses .....	1,474,974	17	1,833,927
18	Grants payable ...	0	18	0
19	Deferred revenue .........	0	19	0
20	Tax-exempt bond liabilities .........	0	20	0
21	Escrow or custodial account liability. Complete Part IV of Schedule D	0	21	0
22	Loans and other payables to current and former officers, directors, trustees, key employees, highest compensated employees, and disqualified
	persons. Complete Part II of Schedule L..	0	22	0
23	Secured mortgages and notes payable to unrelated third parties ..	4,536,913	23	4,099,399
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	15,770,421	25	16,758,130
26	Total liabilities. Add lines 17 through 25..	21,782,308	26	22,691,456

	Organizations that follow SFAS 117 (ASC 958), check here and complete lines 27 through 29, and lines 33 and 34.
27	Unrestricted net assets	-8,648,078	27	-9,697,904
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 ...........	-8,648,078	33	-9,697,904
34	Total liabilities and net assets/fund balances ........	13,134,230	34	12,993,552

Form 990 (2018)

Page 12

Part XI

Reconcilliation of Net Assets

Check if Schedule O contains a response or note to any line in this Part XI..............

Total revenue (must equal Part VIII, column (A), line 12) ............

24,117,597

Total expenses (must equal Part IX, column (A), line 25) ............

25,167,423

Revenue less expenses. Subtract line 2 from line 1 ..............

-1,049,826

Net assets or fund balances at beginning of year (must equal Part X, line 33, column (A)) ..

-8,648,078

Net unrealized gains (losses) on investments ...............

Donated services and use of facilities .................

Investment expenses .....................

Prior period adjustments .....................

Other changes in net assets or fund balances (explain in Schedule O) ........

Net assets or fund balances at end of year. Combine lines 3 through 9 (must equal Part X, line 33, column (B))

-9,697,904

Part XII

Financial Statements and Reporting

Check if Schedule O contains a response or note to any line in this Part XII.............

Yes

Accounting method used to prepare the Form 990: Cash Accrual Other
If the organization changed its method of accounting from a prior year or checked "Other," explain in
Schedule O.

Were the organization’s financial statements compiled or reviewed by an independent accountant?

If ‘Yes,’ check a box below to indicate whether the financial statements for the year were compiled or reviewed on a separate basis, consolidated basis, or both:

Separate basis Consolidated basis Both consolidated and separate basis

Were the organization’s financial statements audited by an independent accountant?

Yes

If ‘Yes,’ check a box below to indicate whether the financial statements for the year were audited on a separate basis, consolidated basis, or both:

Separate basis Consolidated basis Both consolidated and separate basis

If "Yes," to line 2a or 2b, does the organization have a committee that assumes responsibility for oversight of the audit, review, or compilation of its financial statements and selection of an independent accountant?

Yes

If the organization changed either its oversight process or selection process during the tax year, explain in Schedule O.

As a result of a federal award, was the organization required to undergo an audit or audits as set forth in the Single Audit Act and OMB Circular A-133?

If "Yes," did the organization undergo the required audit or audits? If the organization did not undergo the required audit or audits, explain why in Schedule O and describe any steps taken to undergo such audits.

Form 990 (2018)

Additional Data

Software ID:
Software Version:

Form 990, Special Condition Description:

Special Condition Description

- 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

JAMES B HAGGIN MEMORIAL HOSPITAL INC

Employer identification number

61-0510934

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

JAMES B HAGGIN MEMORIAL HOSPITAL INC

Employer identification number

61-0510934

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 JAMES B HAGGIN 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 JAMES B HAGGIN MEMORIAL HOSPITAL INC		Employer identification number 61-0510934

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 JAMES B HAGGIN MEMORIAL HOSPITAL INC			Employer identification number 61-0510934
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 C
(Form 990 or 990-EZ)

Department of the Treasury
Internal Revenue Service

Political Campaign and Lobbying Activities

For Organizations Exempt From Income Tax Under section 501(c) and section 527

SchCMd Bullet

Complete if the organization is described below. SchCMd Bullet

Attach to Form 990 or Form 990-EZ.
SchCMd Bullet

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

OMB No. 1545-0047

2018

Open to Public
Inspection

If the organization answered "Yes" on Form 990, Part IV, Line 3, or Form 990-EZ, Part V, line 46 (Political Campaign Activities), then
Round Bullet

Section 501(c)(3) organizations: Complete Parts I-A and B. Do not complete Part I-C.
Round Bullet

Section 501(c) (other than section 501(c)(3)) organizations: Complete Parts I-A and C below. Do not complete Part I-B.
Round Bullet

Section 527 organizations: Complete Part I-A only.
If the organization answered "Yes" on Form 990, Part IV, Line 4, or Form 990-EZ, Part VI, line 47 (Lobbying Activities), then
Round Bullet

Section 501(c)(3) organizations that have filed Form 5768 (election under section 501(h)): Complete Part II-A. Do not complete Part II-B.
Round Bullet

Section 501(c)(3) organizations that have NOT filed Form 5768 (election under section 501(h)): Complete Part II-B. Do not complete Part II-A.
If the organization answered "Yes" on Form 990, Part IV, Line 5 (Proxy Tax) (see separate instructions) or Form 990-EZ, Part V, line 35c (Proxy Tax) (see separate instructions), then
Round Bullet

Section 501(c)(4), (5), or (6) organizations: Complete Part III.

Name of the organization

JAMES B HAGGIN MEMORIAL HOSPITAL INC

Employer identification number

61-0510934

Part I-A

Complete if the organization is exempt under section 501(c) or is a section 527 organization.

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

Political campaign activity expenditures (see instructions) .................................................................... SchCMd Bullet

Volunteer hours for political campaign activities (see instructions) ..................................................................

Part I-B

Complete if the organization is exempt under section 501(c)(3).

Enter the amount of any excise tax incurred by the organization under section 4955 ................................ SchCMd Bullet

Enter the amount of any excise tax incurred by organization managers under section 4955 ....................... SchCMd Bullet

If the organization incurred a section 4955 tax, did it file Form 4720 for this year? .........................................

Yes No

Was a correction made? ......................................................................................................................

Yes No

If "Yes," describe in Part IV.

Part I-C

Complete if the organization is exempt under section 501(c), except section 501(c)(3).

Enter the amount directly expended by the filing organization for section 527 exempt function activities ..... SchCMd Bullet

Enter the amount of the filing organization's funds contributed to other organizations for section 527 exempt function activities ............................................................................................................................ SchCMd Bullet

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

Did the filing organization file Form 1120-POL for this year? ...................................................................

Yes No

Enter the names, addresses and employer identification number (EIN) of all section 527 political organizations to which the filing
organization made payments. For each organization listed, enter the amount paid from the filing organization’s funds. Also enter the amount of political contributions received that were promptly and directly delivered to a separate political organization, such as a separate segregated fund or a political action committee (PAC). If additional space is needed, provide information in Part IV.

(a) Name	(b) Address	(c) EIN	(d) Amount paid from filing organization's funds. If none, enter -0-.	(e) Amount of political contributions received and promptly and directly delivered to a separate political organization. If none, enter -0-.
1
2
3
4
5
6

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

Cat. No. 50084S

Schedule C (Form 990 or 990-EZ) 2018

Page 2

Part II-A

Complete if the organization is exempt under section 501(c)(3) and filed Form 5768 (election under section 501(h)).

A Check SchCMd Bullet

if the filing organization belongs to an affiliated group (and list in Part IV each affiliated group member's name, address, EIN, expenses, and share of excess lobbying expenditures).
B Check SchCMd Bullet

if the filing organization checked box A and "limited control" provisions apply.

Limits on Lobbying Expenditures (The term "expenditures" means amounts paid or incurred.)		(b) Affiliated group totals
1a	Total lobbying expenditures to influence public opinion (grass roots lobbying) ......................
b	Total lobbying expenditures to influence a legislative body (direct lobbying) ...............................
c	Total lobbying expenditures (add lines 1a and 1b) ...................................................................
d	Other exempt purpose expenditures ........................................................................
e	Total exempt purpose expenditures (add lines 1c and 1d) ...............................................
f	Lobbying nontaxable amount. Enter the amount from the following table in both columns.
	If the amount on line 1e, column (a) or (b) is:The lobbying nontaxable amount is:
	Not over $500,00020% of the amount on line 1e.
	Over $500,000 but not over $1,000,000$100,000 plus 15% of the excess over $500,000.
	Over $1,000,000 but not over $1,500,000$175,000 plus 10% of the excess over $1,000,000.
	Over $1,500,000 but not over $17,000,000$225,000 plus 5% of the excess over $1,500,000.
	Over $17,000,000$1,000,000.

g	Grassroots nontaxable amount (enter 25% of line 1f) .................................................
h	Subtract line 1g from line 1a. If zero or less, enter -0-. ................................................
i	Subtract line 1f from line 1c. If zero or less, enter -0-. ................................................
j	If there is an amount other than zero on either line 1h or line 1i, did the organization file Form 4720 reporting section 4911 tax for this year? ...................................................................................................................	Yes No

4-Year Averaging Period Under section 501(h) (Some organizations that made a section 501(h) election do not have to complete all of the five columns below. See the separate instructions for lines 2a through 2f.)
Lobbying Expenditures During 4-Year Averaging Period
	Calendar year (or fiscal year beginning in)	(a) 2015	(b) 2016	(c) 2017	(d) 2018	(e) Total

2a	Lobbying nontaxable amount

b	Lobbying ceiling amount (150% of line 2a, column(e))

c	Total lobbying expenditures

d	Grassroots nontaxable amount

e	Grassroots ceiling amount (150% of line 2d, column (e))

f	Grassroots lobbying expenditures

Schedule C (Form 990 or 990-EZ) 2018

Page 3

Part II-B

Complete if the organization is exempt under section 501(c)(3) and has NOT filed Form 5768 (election under section 501(h)).

For each "Yes" response on lines 1a through 1i below, provide in Part IV a detailed description of the lobbying activity.

(a)

Yes

(b)

Amount

During the year, did the filing organization attempt to influence foreign, national, state or local legislation, including any attempt to influence public opinion on a legislative matter or referendum, through the use of:

Volunteers? ...........................................................................................................

Paid staff or management (include compensation in expenses reported on lines 1c through 1i)? ........

Media advertisements? ...................................................................................................

Mailings to members, legislators, or the public? .............................................................................

Publications, or published or broadcast statements? ...........................................................

Grants to other organizations for lobbying purposes? ..........................................................

Direct contact with legislators, their staffs, government officials, or a legislative body? .......................

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

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

Yes

920

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

920

Did the activities in line 1 cause the organization to be not described in section 501(c)(3)? .....

If "Yes," enter the amount of any tax incurred under section 4912 ...........................................

If "Yes," enter the amount of any tax incurred by organization managers under section 4912 ...................

If the filing organization incurred a section 4912 tax, did it file Form 4720 for this year? ........................

Part III-A

Complete if the organization is exempt under section 501(c)(4), section 501(c)(5), or section 501(c)(6).

Yes

Were substantially all (90% or more) dues received nondeductible by members? ...............................................

Did the organization make only in-house lobbying expenditures of $2,000 or less? ............................................

Did the organization agree to carry over lobbying and political expenditures from the prior year? .................................

Part III-B

Complete if the organization is exempt under section 501(c)(4), section 501(c)(5), or section 501(c)(6) and if either (a) BOTH Part III-A, lines 1 and 2, are answered "No" OR (b) Part III-A, line 3, is answered “Yes."

Dues, assessments and similar amounts from members ......................................................................

Section 162(e) nondeductible lobbying and political expenditures (do not include amounts of political expenses for which the section 527(f) tax was paid).

Current year .............................................................................................................................

Carryover from last year ............................................................................................................

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

Aggregate amount reported in section 6033(e)(1)(A) notices of nondeductible section 162(e) dues .

If notices were sent and the amount on line 2c exceeds the amount on line 3, what portion of the excess does the organization agree to carryover to the reasonable estimate of nondeductible lobbying and political expenditure next year? ......................................................................................................................

Taxable amount of lobbying and political expenditures (see instructions) .........................................

Part IV

Supplemental Information

Provide the descriptions required for Part l-A, line 1; Part l-B, line 4; Part l-C, line 5; Part II-A (affiliated group list); Part II-A, lines 1 and 2 (see instructions), and Part ll-B, line 1. Also, complete this part for any additional information.

Return Reference	Explanation
SCHEDULE C, PART 11-B, LINE 1	LOBBYING EXPENDITURES ------------------------- A PORTION OF DUES PAID TO THE KENTUCKY HOSPITAL ASSOCIATION (KHA) ARE USED FOR LOBBYING.

Schedule C (Form 990 or 990EZ) 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

JAMES B HAGGIN MEMORIAL HOSPITAL INC

Employer identification number

61-0510934

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 .....	826,709		826,709
b	Buildings ....	6,391,253	1,357,507	5,033,746
c	Leasehold improvements	52,453	52,453	0
d	Equipment ....	4,267,529	1,884,574	2,382,955
e	Other .....	124,396	48,298	76,098
Total. Add lines 1a through 1e. (Column (d) must equal Form 990, Part X, column (B), line 10(c).)..				8,319,508

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	0
DUE TO RELATED PARTY	14,295,220
DUE TO THIRD PARTY	2,462,910
(3)
(4)
(5)
(6)
(7)
(8)
(9)
Total. (Column (b) must equal Form 990, Part X, col.(B) line 25.)	16,758,130
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	24,119,314
2	Amounts included on line 1 but not on Form 990, Part VIII, line 12:
a	Net unrealized gains (losses) on investments ....	2a
b	Donated services and use of facilities .........	2b
c	Recoveries of prior year grants ...........	2c
d	Other (Describe in Part XIII.) ............	2d
e	Add lines 2a through 2d .....................			2e
3	Subtract line 2e from line 1..................			3	24,119,314
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	-1,717
c	Add lines 4a and 4b....................			4c	-1,717
5	Total revenue. Add lines 3 and 4c. (This must equal Form 990, Part I, line 12.) ......			5	24,117,597

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	25,169,155
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	1,732
e	Add lines 2a through 2d....................			2e	1,732
3	Subtract line 2e from line 1...................			3	25,167,423
4	Amounts included on Form 990, Part IX, line 25, but not on line 1:
a	Investment expenses not included on Form 990, Part VIII, line 7b ..	4a
b	Other (Describe in Part XIII.) ............	4b
c	Add lines 4a and 4b.....................			4c
5	Total expenses. Add lines 3 and 4c. (This must equal Form 990, Part I, line 18.) ......			5	25,167,423

Part XIII

Supplemental Information

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

Return Reference	Explanation
SCHEDULE D, PART X, LINE 2	INCOME TAXES ----------- THE ORGANIZATION'S AUDITED FINANCIAL STATEMENTS DID NOT INCLUDE A FOOTNOTE THAT ADDRESSED THE ORGANIZATION'S LIABILITY FOR UNCERTAIN TAX POSITIONS UNDER FIN 48 (ASC 740). MANAGEMENT HAS EVALUATED THEIR INCOME TAX POSITIONS UNDER THE GUIDANCE INCLUDED IN ASC 740. BASED ON THEIR REVIEW, MANAGEMENT HAS NOT IDENTIFIED ANY MATERIAL UNCERTAIN TAX POSITIONS TO BE RECORDED OR DISCLOSED IN THE FINANCIAL STATEMENTS.
SCHEDULE D, PART XI, LINE 4B	AMOUNTS INCLUDED ON FORM 990, PART VIII BUT NOT ON LINE 1 ---------------------------------------------------------- LOSS ON ASSET DISPOSAL INCLUDED IN EXPENSE PER AUDIT $(7,187) CONTRIBUTION REVENUE INCLUDED IN EXPENSE PER AUDIT 5,470 --------- $(1,717)
SCHEDULE D, PART XII, LINE 2D	AMOUNTS INCLUDED ON LINE 1 BUT NOT ON FORM 990, PART XI --------------------------------------------------------- LOSS ON ASSET DISPOSAL INCLUDED IN EXPENSE PER AUDIT $ 7,187 CONTRIBUTION REVENUE INCLUDED IN EXPENSE PER AUDIT (5,470) ROUNDING 15 ---------- 1,732

Schedule D (Form 990) 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

JAMES B HAGGIN MEMORIAL HOSPITAL INC

Employer identification number

61-0510934

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 125 %

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? . . . . . .

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) . . .	107,184		107,184	0.430 %
b	Medicaid (from Worksheet 3, column a) . . . . .	5,707,750	4,468,327	1,239,423	4.930 %
c	Costs of other means-tested government programs (from Worksheet 3, column b) . .
d	Total Financial Assistance and Means-Tested Government Programs . . . . .	5,814,934	4,468,327	1,346,607	5.360 %
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) . . . .
h	Research (from Worksheet 7) .
i	Cash and in-kind contributions for community benefit (from Worksheet 8) . . . .
j	Total. Other Benefits . .
k	Total. Add lines 7d and 7j .	5,814,934	4,468,327	1,346,607	5.360 %

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. ......

2,666,843

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. ......

983,706

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).....

6,568,793

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

5,811,200

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

757,593

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	THE JAMES B HAGGIN MEMORIAL HOSPITAL 464 LINDEN AVENUE HARRODSBURG,KY40330 WWW.EMHEALTH.ORG 600053	X	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)

	THE JAMES B HAGGIN 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 17

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

Yes

6 a

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

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

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

Yes

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

Hospital facility’s website (list url): SEE PART V, SECTION C

Other website (list url):

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

Other (describe in Section C)

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

Yes

Indicate the tax year the hospital facility last adopted an implementation strategy: 20 17

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

Yes

If "Yes" (list url): SEE PART V, SECTION C

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

10b

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

12a

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

12a

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

12b

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

Schedule H (Form 990) 2018

Page 5

Part VFacility Information (continued)

Financial Assistance Policy (FAP)

	THE JAMES B HAGGIN 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 125.% and FPG family income limit for eligibility for discounted care of 300.%

Income level other than FPG (describe in Section C)

Asset level

Medical indigency

Insurance status

Underinsurance discount

Residency

Other (describe in Section C)

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

Yes

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

Yes

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

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

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

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

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

Other (describe in Section C)

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

Yes

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

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

SEE PART V, SECTION C

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

SEE PART V, SECTION C

A plain language summary of the FAP was widely available on a website (list url):
SEE PART V, SECTION C

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

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

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

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

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

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

Other (describe in Section C)

Schedule H (Form 990) 2018

Page 6

Part VFacility Information (continued)

Billing and Collections

	THE JAMES B HAGGIN 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)

	THE JAMES B HAGGIN 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	COMMUNITY INPUT ----------------- THROUGH THE FOCUS GROUP AND ONLINE SURVEY, PARTICIPATION AND INPUT WAS GATHERED FROM REPRESENTATIVES OF PUBLIC HEALTH, AS WELL AS SEVERAL INDIVIDUALS WHOSE ORGANIZATIONS WORK WITH LOW-INCOME, MINORITY (INCLUDING HISPANIC, AFRICAN AMERICA), OR OTHER MEDICALLY UNDERSERVED POPULATIONS (SPECIFICALLY, THE ELDERLY, DISABLED, YOUNG ADULTS, LGBT COMMUNITY, THE MENTALLY ILL, INMATES, HEARING IMPAIRED, MEDICAID RECIPIENTS, AND THE UNINSURED).
SCHEDULE H, PART V, SECTION B, LINE 7A & LINE 10A	CHNA REPORT & IMPLEMENTATION STRATEGY ---------------------------------------- THE HOSPITAL'S CHNA REPORT AND IMPLEMENTATION STRATEGY CAN BE FOUND AT: HTTP://WWW.EMHEALTH.ORG/SERVICES/COMMUNITY-HEALTH
SCHEDULE H, PART V, SECTION B, LINE 11	ASSESSING THE NEEDS OF THE COMMUNITY ----------------------------------------- THE INTERNAL STAKEHOLDERS OF JAMES B. HAGGIN MEMORIAL HOSPTIAL DETERMINED THE FOLLOWING TO BE THE TOP HEALTH PRIORITIES FOR THE HOSPITAL TO ADDRESS IN THE COMMUNITY FOR THE COMING YEARS: - DIABETES - ACCESS TO HEALTHCARE SERVICES - CANCER - EARLY DETECTION AND PREVENTION - CARDIOVASCULAR DISEASE & RELATED RISK FACTORS - NUTRITION, PHYSICAL ACTIVITY, & WEIGHT - INJURY & VIOLENCE - SUBSTANCE ABUSE THESE PRIORITY AREAS, AND PLANS TO ADDRESS THESE, WILL BE INTEGRATED INTO THE HOSPITAL'S IMPLEMENTATION STRATEGY. THE RATIONALE FOR SELECTING THESE AREAS IS AN UNDERSTANDING THAT IMPACTING THESE WOULD ALSO IMPACT MANY OTHER AREAS OF NEED IDENTIFIED IN THE ASSESSMENT, SUCH AS DEMENTIA, MENTAL HEALTH, SEXUALLY TRANSMITTED DISEASES, & HIV/AIDS, ORAL HEALTH, INFANT HEALTH & FAMILY PLANNING, RESPIRATORY DISEASES, TOBACCO USE, AND CHRONIC KIDNEY DISEASE. THESE AREAS ALSO REPRESENT A CONTINUATION OF EXISTING WORK AND ALLOW THE HOSPITAL TO BUILD ON PAST SUCCESSES. THERE ARE ADDITIONAL NEEDS IDENTIFIED WITHIN THE CHNA REPORT THAT ARE NOT SPECIFICALLY ADDRESSED BY HAGGIN MEMORIAL HOSPITAL, DUE TO NO EXPERTISE OR LIMITED RESOURCES, BUT ARE BEING ADDRESSED BY OTHER AGENCIES WITHIN THE COMMUNITY.
SCHEDULE H, PART V, SECTION B, LINE 16A, 16B, AND 16C	FINANCIAL ASSISTANCE POLICY WEBSITE ------------------------------------- THE HOSPITAL'S FAP, FAP APPLICATION FORM, AND PLAIN LANGUAGE SUMMARY ARE AVAILABLE AT: HTTP://WWW.EMHEALTH.ORG/FOR-PATIENTS/GOING-HOME/BILLING-INSURANCE/

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?1
Name and address		Type of Facility (describe)
1	MEDSOURCE HOME MEDICAL 470 LINDEN AVENUE STE 1 HARRODSBURG,KY40330	DURABLE MEDICAL EQUIPMENT
2
3
4
5
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
SCHEDULE H, PART II	COMMUNITY BUILDING ACTIVITIES ----------------------------------------- OFFICERS AND STAFF OF THE HOSPITAL ARE ENGAGED IN LEADERSHIP POSITIONS WITHIN SEVERAL ORGANIZATIONS IN THE LOCAL COMMUNITY.
SCHEDULE H, PART III, LINE 2	BAD DEBT EXPENSE ------------------ THE HOSPITAL HAS ADOPTED THE NEW REVENUE RECOGNITION STANDARD ASU 2014-09. UNDER ASU 2014-09, THE ESTIMATED AMOUNTS DUE FROM PATIENTS FOR WHICH THE HOSPITAL DOES NOT EXPECT TO BE ENTITLED OR COLLECT FROM THE PATIENTS ARE CONSIDERED IMPLICIT PRICE CONCESSIONS AND EXCLUDED FROM THE HOSPITAL'S ESTIMATION OF THE TRANSACTION PRICE OR REVENUE RECORDED. BAD DEBT EXPENSE WAS NOT SIGNIFICANT TO THE AUDITED FINANCIAL STATEMENTS FOR THE YEAR ENDED SEPTEMBER 30, 2019. HOWEVER, THE HOSPITAL INTERNALLY TRACKS BAD DEBT EXPENSE CONSISTENT WITH HISTORICAL PRACTICES AND THAT AMOUNT HAS BEEN REPORTED ON SCHEDULE H, PART III, SECTION A, LINE 2. THIS AMOUNT IS DIRECTLY FROM THE FINANCIAL STATEMENTS AND INCLUDES ESTIMATES AND ACCRUALS OF BAD DEBT EXPENSE AND DOES NOT NECESSARILY REFLECT ACTUAL WRITE-OFFS DURING THE PERIOD.
SCHEDULE H, PART III, LINE 3	BAD DEBT EXPENSE ATTRIBUTABLE TO CHAIRTY CARE ------------------------------------------- BAD DEBT EXPENSE ATTRIBUTABLE TO PATIENTS ELIGIBLE UNDER THE ORGANIZATION'S CHARITY CARE POLICY IS REPORTED PER THE MEDICARE COST REPORT WORKSHEET S-10.
SCHEDULE H, PART III, LINE 4	BAD DEBT EXPENSE ----------------- THE CORPORATION REPORTS PATIENT ACCOUNTS RECEIVABLE FOR SERVICES RENDERED AT NET REALIZABLE AMOUNTS FROM THIRD-PARTY PAYERS, PATIENTS, AND OTHERS. THE CORPORATION PROVIDES AN ALLOWANCE FOR UNCOLLECTIBLE ACCOUNTS BASED UPON A REVIEW OF OUTSTANDING RECEIVABLES, HISTORICAL COLLECTION INFORMATION, AND EXISTING ECONOMIC CONDITIONS. AS A SERVICE TO THE PATIENT, THE CORPORATION BILLS THIRD-PARTY PAYERS DIRECTLY AND BILLS THE PATIENT WHEN THE PATIENT'S LIABILITY IS DETERMINED. PATIENT ACCOUNTS RECEIVABLE ARE DUE IN FULL WHEN BILLED. ACCOUNTS ARE CONSIDERED DELINQUENT AND SUBSEQUENTLY WRITTEN OFF AS BAD DEBTS AND BASED ON INDIVIDUAL CREDIT EVALUATION AND SPECIFIC CIRCUMSTANCES OF THE ACCOUNT.
SCHEDULE H, PART III, LINE 8	MEDICARE SURPLUS / SHORTFALL ---------------------------- AMOUNTS REPORTED ON LINES 5 AND 6 WERE BASED ON THE CORPORATION'S MEDICARE COST REPORT.
SCHEDULE H, PART III, LINE 9B	WRITTEN DEBT COLLECTION POLICY AND FINANCIAL ASSISTANCE -------------------------------------------------- IF IT IS DETERMINED THAT A PATIENT OR RESPONSIBLE PARTY IS ELIGIBLE FOR FINANCIAL ASSISTANCE, EMH WILL: - SEND WRITTEN NOTIFICATION TO THE RESPONSIBLE INDIVIDUAL OF THE ASSISTANCE DETERMINATION AND - IF THE DISCOUNT IS LESS THAN 100%, EMH WILL: * PROVIDE THE RESPONSIBLE INDIVIDUAL WITH A BILLING STATEMENT SHOWING THE AMOUNT OWED, HOW THE AMOUNT WAS DETERMINED, AND DESCRIBE HOW THE INDIVIDUAL CAN LEARN MORE ABOUT HOW THE HOSPITAL CALCULATES AGB; * ISSUE REFUNDS TO THE RESPONSIBLE INDIVIDUAL IF HE OR SHE PREVIOUSLY PAID AN AMOUNT TO EMH EXCEEDING WHAT HE OR SHE IS PERSONALLY RESPONSIBLE TO PAY; AND * TAKE ALL REASONABLE MEASURES TO REVERSE ANY ECAS (WITH THE EXCEPTION OF A SALE OF A DEBT OR DEFERRING OR DENYING CARE FOR NON-PAYMENT OF AMOUNTS FOR PREVIOUS CARE) TAKEN AGAINST THE RESPONSIBLE INDIVIDUAL TO THE EXTENT POSSIBLE.
SCHEDULE H, PART VI, LINE 2	NEEDS ASSESSMENT ------------------ IN 2017, PROFESSIONAL RESEARCH CONSULTANTS (PRC) WAS ENGAGED TO CONDUCT A NEEDS ASSESSMENT OF EMJBH'S COMMUNITY, WHICH IS DEFINED AS THE PRICIPAL RESIDENTIAL ZIP CODES IN BOYLE, GARRARD, MERCER, AND WASHINGTON COUNTIES IN KENTUCKY. A SURVEY AND A COMMUNITY FOCUS GROUP WERE COMPLETED TO OBTAIN PRIMARY DATA FROM INDIVIDUALS WITHIN THE COMMUNITY. THE FOCUS GROUP WAS COMPRISED OF REPRESENTATIVES FROM PUBLIC HEALTH, SOCIAL SERVICE PROVIDERS, EMPLOYERS, AND OTHER COMMUNITY LEADERS, SELF REPORT DATA, MORTALITY, MORIDITY, LIFESTYLE, INCIDENCE OF CHRONIC DISEASE, INJURY DATA AND DISABILITY DATA ARE PART OF THE ASSESSMENT PROCESS. THE BENCH MARK IS ESTABLISHED USING HEALTHY PEOPLE 2020 DATA.
SCHEDULE H, PART VI, LINE 3	PATIENT EDUCATION OF ELIGIBILITY FOR ASSISTANCE ------------------------------------ THE JAMES B. HAGGIN HOSPITAL (JBH) CHARITY CARE POLICY IS POSTED ON THE WWW.EMHEALTH.ORG WEBSITE. AT REGISTRATION OF SELF-PAY CLIENTS, INFORMATION IS GIVEN ON A REDUCED FEE, CHARITY APPLICATION, AND A REFERRAL TO A FINANCIAL COUNSELOR. THE FREE COMMUNITY SCREENINGS ARE POSTED ON THE WEBSITE AND IN AREA NEWSPAPERS IF THE HOSTING ORGANIZATION INVITES COMMUNITY PARTICIPATION. SOME EVENTS ARE DISCUSSED ON LOCAL RADIO. INFORMATION REGARDING THE FREE CLINIC IS ALSO GIVEN BY HEALTHCARE PROVIDERS, FAITH COMMUNITY NURSES, CASE WORKERS, AND OTHER MEDICAL PROFESSIONALS.
SCHEDULE H, PART VI, LINE 4	COMMUNITY INFORMATION ----------------------- THE COMMUNITY DEFINED FOR THE CHNA REPORT INCLUDES THE PRINCIPAL RESIDENTIAL ZIP CODES IN BOYLE, GARRARD, MERCER, AND WASHINGTON COUNTIES IN KENTUCKY, COMPRISING THE SERVICE AREA OF EPHRAIM MCDOWELL JAMES B. HAGGIN HOSPITAL. THE HEALTH SYSTEM SERVES BOYLE, MERCER, CASEY, LINCOLN, GARRARD, AND WASHINGTON COUNTIES, WHICH HAVE A RURAL POPULATION OF APPROXIMATELY 113,000. ACCESS IS AN ISSUE, DUE TO TRAVEL BARRIERS SUCH AS AN OUT-OF-DATE HIGHWAYS AND LACK OF PUBLIC TRANSPORTATION. THESE ACCESS ISSUES INFLUENCED THE DECISION TO SERVE WITH FREE SCREENINGS AT KEY GATHERING PLACES SUCH AS CHURCHES AND SCHOOLS, ETC. INSURANCE COVERAGE IS ANOTHER ISSUE. THE NUMBERS OF UNINSURED CONTINUES TO EXCEED THE NATIONAL AVERAGE AND THE UNDERINSURED IN THIS SERVICE AREA CONTINUES TO EXCEED POST ACA.
SCHEDULE H, PART VI, LINE 5	PROMOTION OF COMMUNITY HEALTH --------------------------------- OFFICERS AND STAFF OF EMJBH ARE ENGAGED IN LEADERSHIP POSITIONS WITHIN SEVERAL ORGANIZATIONS IN THE LOCAL COMMUNITY. EMJBH IS THE ONLY ACUTE CARE HOSPITAL OPERATING IN MERCER COUNTY AND PROVIDES EMERGENCY TREATMENT TO LOCAL RESIDENTS WHO WOULD OTHERWISE HAVE TO TRAVEL OUT OF THE COUNTY TO RECEIVE EMERGENCY MEDICAL TREATMENT. EMJBH ALSO PROVIDES A WEEKEND AND AFTER HOURS WALK-IN CLINIC TO PROVIDE A BETTER (MORE APPROPRIATE) OPTION THAN THE ER TO OUR RESIDENTS WHO REQUIRE BASIC HEALTHCARE NEEDS AFTER HOURS AND ON THE WEEKEND. EMJBH, ALONG WITH THE LOCAL HEALTH DEPARTMENT, IS RESPONSIBLE FOR EDUCATION AND PROVIDING THE MEDICAL CARE TO ITS LOCAL AND SURROUNDING RESIDENTS. THE HOSPITAL PROVIDES FREE COMMUNITY HEALTH FORUMS MONTHLY TO THE COMMUNITY AT THE PUBLIC LIBRARY EDUCATING THEM ON HEALTH RELATED ISSUES (HOW TO IMPROVE THEIR MENTAL HEALTH, HOW TO KEEP UP WITH THEIR MEDICATIONS, BIKE SAFETY, HOW TO MAINTAIN A WALKING PROGRAM, HEALTHY EATING, BREAST SCREENING AND EARLY DETECTION EDUCATION). WE ALSO PROVIDE NUMEROUS HEALTH FAIRS TO LOCAL COMPANIES FOR A NOMINAL CHARGE. STAFF HAS ALSO GIVEN TESTIMONY AT LOCAL, STATE, AND FEDERAL LEVELS RELATED TO OUR SERVICE AREA'S HEALTH, EDUCATION AND ECONOMIC ISSUES. EMJBH AND EMH SYSTEM BOARDS ARE COMPRISED OF COMMUNITY MEMBERS WITH REPRESENTATION FROM THE MEDICAL STAFF AND SENIOR LEADERSHIP AND THE JAMES B. HAGGIN HOSPITAL BOARD. THE GOVERNING BOARD APPROVED THE ESTABLISHMENT AND FUNDING OF THE COMMUNITY SERVICE DEPARTMENT AND THE FUNDING OF THE HEALTH RISK BEHAVIOR ASSESSMENT OF BOYLE COUNTY. THEY ALSO APPROVED THE CHARITY CARE POLICY. THERE IS NEVER A FEE FOR SERVICES PROVIDED BY THE COMMUNITY SERVICE DEPARTMENT. WE ALSO APPROACHED CHURCHES IN THE SIX-COUNTY AREA WITH HEALTH SCREENINGS. PREVENTATIVE CARE, SUCH AS FLU SHOTS, ARE TAKEN TO THE COMMUNITY. SO, TOO, ARE ANNUAL SKIN CANCER CHECKS, MONTHLY BLOOD PRESSURE CHECKS, SEMIANNUAL GLUCOSE AND CHOLESTEROL CHECKS, ALONG WITH NURSE CONSULTS. SUCH SERVICES ARE OFFERED IN SCHOOLS, CHURCHES, AND OTHER PUBLIC ENTITIES IN THE REGION.
SCHEDULE H, PART VI, LINE 6	AFFILIATED HEALTH CARE SYSTEM -------------------------------- JAMES B. HAGGIN HOSPITAL IS A CRITICAL ACCESS HOSPITAL LOCATED IN MERCER COUNTY. ON DECEMBER 1, 2017, THE HOSPITAL WAS ACQUIRED BY EPHRAIM MCDOWELL HEALTH (EMH). EMH IS A COMPREHENSIVE, INTEGRATED HEALTHCARE DELIVERY SYSTEM THAT SERVES 113,000 RESIDENTS FROM SIX COUNTIES IN SOUTH CENTRAL KENTUCKY. THE EMH BOARD IS COMPRISED OF COMMUNITY MEMBERS AND REPRESENTATION FROM FT LOGAN HOSPITAL, JAMES B. HAGGIN MEMORIAL HOSPITAL, MEDICAL STAFF, AND EMRMC LEADERSHIP. FT LOGAN HOSPITAL IS A CRITICAL ACCESS HOSPITAL LOCATED IN LINCOLN COUNTY. HEALTH RESOURCE IS COMPRISED OF CLINICS, AN EARLY CHILDHOOD DEVELOPMENT CENTER, ASSISTED LIVING FACULTY, AND DURABLE MEDICAL EQUIPMENT OUTLETS. THERE ARE REPRESENTATIVES FROM OUR SIX COUNTIES, MEDICAL STAFF, AND LEADERSHIP ON THE COMMUNITY BOARD THAT OVERSEES AND COORDINATES THE SERVICES OF EPHRAIM MCDOWELL HEALTH.
SCHEDULE H, PART I, LINE 7, COLUMN F	PERCENT OF TOTAL EXPENSE ----------------------- TO ARRIVE AT THE PERCENT OF TOTAL EXPENSES, THE DENOMINATOR EQUALS TOTAL OPERATING EXPENSES PER PART IX, LINE 25, OF THE FORM 990.
SCHEDULE H, PART I, LINE 7	COSTING METHODOLOGY -------------------- THE COST TO CHARGE RATIO CALCULATED ON IRS WORKSHEET 2 WAS USED IN THE CALCULATION OF COST ON IRS WORKSHEET 1. COST COMPUTED ON IRS WORKSHEET 3 WAS COMPUTED FROM THE MEDICARE COST REPORT, INCLUDING DIRECT COSTS PLUS OVERHEAD ALLOCATIONS COMPUTED IN THE COST REPORT STEP-DOWN PROCESS.

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

JAMES B HAGGIN MEMORIAL HOSPITAL INC

Employer identification number

61-0510934

Part I

Questions Regarding Compensation

Yes

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

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

Travel for companions Payments for business use of personal residence

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

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

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

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

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

Compensation committee Written employment contract

Independent compensation consultant Compensation survey or study

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

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

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

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

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

Yes

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)
1PAMELA JOHNSON MD BOARD MEMBER / CHIEF OF STAFF	(i) (ii)	174,552 ------------- 0	0 ------------- 0	8,697 ------------- 0	12,098 ------------- 0	439 ------------- 0	195,786 ------------- 0	0 ------------- 0
2DANIEL MCKAY PRESIDENT & CEO	(i) (ii)	0 ------------- 239,534	0 ------------- 30,000	0 ------------- 13,798	0 ------------- 9,268	0 ------------- 15,992	0 ------------- 308,592	0 ------------- 0
3SALLY DAVENPORT FORMER CEO	(i) (ii)	0 ------------- 380,644	0 ------------- 85,212	0 ------------- 25,020	0 ------------- 22,000	0 ------------- 14,704	0 ------------- 527,580	0 ------------- 0
4WILLIAM SNAPP III EXECUTIVE VP & CFO	(i) (ii)	0 ------------- 311,436	0 ------------- 67,319	0 ------------- 11,585	0 ------------- 22,000	0 ------------- 39,492	0 ------------- 451,832	0 ------------- 0
5BURT PIPER EXECUTIVE VP & COO	(i) (ii)	0 ------------- 279,736	0 ------------- 58,510	0 ------------- 10,376	0 ------------- 22,000	0 ------------- 36,955	0 ------------- 407,577	0 ------------- 0
6LYNNE WARNER-LYNN VP OF CLINICAL EFFECTIVENESS	(i) (ii)	88,521 ------------- 88,521	10,639 ------------- 10,639	9,905 ------------- 9,905	8,920 ------------- 8,920	11,153 ------------- 11,153	129,138 ------------- 129,138	0 ------------- 0
7JOAN DELAHOUSEY CRNA	(i) (ii)	211,947 ------------- 0	0 ------------- 0	1,806 ------------- 0	17,410 ------------- 0	24,814 ------------- 0	255,977 ------------- 0	0 ------------- 0
8MICHELLE PINKSTON PHARMACIST	(i) (ii)	140,507 ------------- 0	0 ------------- 0	289 ------------- 0	11,241 ------------- 0	152 ------------- 0	152,189 ------------- 0	0 ------------- 0
9SUSAN WHEELER PHARMACIST	(i) (ii)	108,967 ------------- 0	0 ------------- 0	807 ------------- 0	9,322 ------------- 0	36,787 ------------- 0	155,883 ------------- 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 3

ESTABLISHING CEO COMPENSATION ------------------------------------ THE CEO IS COMPENSATED BY EPHRAIM MCDOWELL HEALTH, INC. (EMH), A RELATED ORGANIZATION. EMH USES THE FOLLOWING METHODS TO ESTABLISH THE COMPENSATION OF THE CEO: - COMPENSATION COMMITTEE - INDEPENDENT COMPENSATION CONSULTANT - WRITTEN EMPLOYMENT CONTRACT - COMPENSATION SURVEY OR STUDY - APPROVAL BY THE BOARD OR COMPENSATION COMMITTEE

SCHEDULE J, PART I, LINE 6A & 6B

MANAGEMENT INCENTIVE PLAN ------------------------------- EPHRAIM MCDOWELL HEALTH, INC. AND ITS AFFILIATES HAVE MANAGEMENT INCENTIVE PLANS FOR CORPORATE OFFICERS, SENIOR VICE-PRESIDENTS, VICE-PRESIDENTS, AND DIRECTORS. ANNUAL PAYOUTS RELATED TO THESE INCENTIVE PLANS HAVE TWO COMPONENTS. 30% OF THE ANNUAL PAYOUT IS BASED ON NET OPERATING INCOME GOALS COMPARED TO BUDGET. THE OTHER 70% IS BASED ON QUALITY MEASURES, PATIENT SATISFACTION GOALS, ASSOCIATE SATISFACTION GOALS, AND SAFETY MEASURES.

Schedule J (Form 990) 2018

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE O
(Form 990 or 990-EZ)

Department of the Treasury
Internal Revenue Service

Supplemental Information to Form 990 or 990-EZ

Complete to provide information for responses to specific questions on
Form 990 or 990-EZ or to provide any additional information.
MediumBullet

Attach to Form 990 or 990-EZ.
MediumBullet

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

OMB No. 1545-0047

2018

Open to Public
Inspection

Name of the organization

JAMES B HAGGIN MEMORIAL HOSPITAL INC

Employer identification number

61-0510934

Return Reference	Explanation
FORM 990, PART I, LINE 1	ORGANIZATION'S MISSION ------------------------------- SERVICES WILL MEET IDENTIFIED COMMUNITY NEEDS AND SHALL BE PROVIDED WITH THE HIGHEST CONCERN FOR OUR PATIENTS AND THEIR FAMILIES. THESE SERVICES WILL BE PROVIDED AT THE LOWEST POSSIBLE COST. THE HOSPTIAL WILL PROVIDE ADEQUATE FACILITIES, MODERN EQUIPMENT, A PROFESSIONALLY TRAINED STAFF, AND A QUALIFIED MEDICAL STAFF. THE HEALTH CARE SERVICES MAY INCLUDE ACUTE MEDICAL AND SURGICAL INPATIENT, OUTPATIENT, EMERGENCY, HEALTH EDUCATION, HEALTH SCREENING, WELLNESS, AND REHABILITATION. ALL SERVICES WILL BE PROVIDED WITHOUT REGARD TO RACE, COLOR, CREED, RELIGION, AGE, SEX, DISABILITY, SOCIAL, OR ECONOMIC STATUS.
FORM 990, PART III, LINE 4	PROGRAM SERVICE ACCOMPLISHMENTS ------------------------------------ EPHRAIM MCDOWELL JAMES B. HAGGIN HOSPITAL (EMJBHH), LOCATED IN HARRODSBURG, KENTUCKY, IS A 25-BED CRITICAL ACCESS HOSPITAL OFFERING QUALITY HEALTH CARE AND LEVEL IV TRAUMA CERTIFIED EMERGENCY SERVICES. THE FACILITY IS JOINT COMMISSION ACCREDITED. EMJBHH OFFERS A VARIETY OF EPHRAIM MCDOWELL HEALTH SYSTEM SERVICES LOCALLY THROUGH THE FACILITY, INCLUDING CARDIOPULMONARY, DIAGNOSTIC, DIETARY, SWING BEDS, LABORATORY, REHABILITATION, SURGICAL SERVICES, 24-HOUR EMERGENCY CARE, AND DURABLE MEDICAL EQUIPMENT. IN FISCAL YEAR 2019, OUTPATIENT REGISTRATIONS, INCLUDING EMERGENCY SERVICES WERE 30,698; THERE WERE 342 SURGICAL PROCEDURES, 440 ADMISSIONS (INCLUDING SWING), AND THE FACILITY RECORDED 2,545 TOTAL PATIENT DAYS (INCLUDING OBSERVATION AND SWING). COMMUNITY HEALTH EDUCATION - GENERAL ----------------------------------------------- HEALTH FAIRS - A REGISTERED NURSE (RN) MET WITH EACH CLIENT TO DEVELOP A WRITTEN PLAN TO DECREASE THEIR LIFESTYLE ASSOCIATED HEALTH RISK FACTORS. SERVICES WERE OFFERED AT 3 SITES (5 EVENTS) IN WASHINGTON AND MERCER COUNTIES WITH A FOCUS ON REACHING AT RISK AND VULNERABLE POPULATIONS. EIGHTY-EIGHT INDIVIDUALS WERE SERVED. OVER FIFTY THREE PERCENT HAD A HOUSEHOLD INCOME BELOW $35,000; COMPARED 59% IN 2018 AND 38% IN 2017. IN CLIENTS SEEN, UNEMPLOYMENT INCREASED FROM 4 % IN 2017; 7 % IN FY 2018 TO 14% IN 2019. FOR CONTEXT, IT SHOULD BE NOTED THAT ONE OF THE SITES IS AN ADDICTION PROGRAM, BUT THIS SITE WAS SCREENED ALL THREE YEARS. FORTY FIVE PERCENT OF CLIENTS WERE RETIRED; UP 9% FROM 2018 AND 12% FROM 2017. IN FISCAL YEAR (FY) 2019, ELEVEN PERCENT REPORTED HAVING NO PRIMARY CARE PROVIDER (PCP) COMPARED WITH FY 2018, TWENTY-NINE PERCENT AND FY 2017 WHEN TWENTY FOUR PERCENT REPORTED NOT HAVING A PRIMARY CARE PROVIDER. REFERRAL OPTIONS WERE PROVIDED, INCLUDING HOPE CLINIC, REDUCED FEE PROGRAM, AND A PRIMARY CARE PROVIDER LISTING FOR THE REGION. THE DECREASE IN THOSE LACKING A PRIMARY CARE PROVIDER MAY BE DUE TO THE AFFORDABLE CARE ACT AND THE TREATMENT CENTER'S EFFORTS TO ASSIST CLIENTS IN OBTAINING CARE. NO AFRICAN AMERICAN CLIENTS WERE SERVED IN FY 2019, WHILE 3% SERVED WERE CATEGORIZED AS OTHER AND 97% SERVED WERE CAUCASIAN CLIENTS, COMPARED TO THOSE SERVED IN FY 2018 WHO WERE 5% AFRICAN AMERICAN, 95 PERCENT CAUCASIAN, AND IN FY 2017 NINE PERCENT WERE AFRICAN AMERICAN, 89% CAUCASIAN, AND 2% HISPANIC. THE AFRICAN AMERICAN AND HISPANIC POPULATION REPRESENTS A HIGH-RISK GROUP DUE TO POVERTY, DIABETES, HIGH BLOOD PRESSURE, HIGH BODY MASS INDEX AND OTHER FACTORS, AND WAS A FOCUS FOR SERVICES. THE ETHNICITY PERCENTAGES ARE REPRESENTATIVE OF THE REGIONAL DEMOGRAPHICS. SCREENING TEST RESULTS SHOWED THAT 50% WERE OUT OF NORMAL RANGE COMPARED TO 58 PERCENT WERE OUT OF NORMAL RANGE IN 2018, AND 50 PERCENT IN FY 2017. TWENTY TWO PERCENT OF PARTICIPANTS WITH ABNORMAL TEST RESULTS WERE REFERRED TO A PRIMARY CARE PROVIDER FOR FOLLOW-UP CARE COMPARED TO 15% IN 2018 AND TWENTY PERCENT IN FY 2017. FIFTY-NINE PERCENT OF CLIENTS WERE FEMALE; FORTY-ONE PERCENT WERE MALE IN FY 2019 COMPARED TO 44% FEMALE AND 56% MALE IN FY 2018, AND 51% FEMALE AND 49% MALE IN FY 2017. THE HIGHER NUMBERS OF MALE POPULATION PROBABLY REFLECT THE POPULATION OF THE ADDICTION TREATMENT FACILITY IN 2018 AND 2019. THE ADDITION OF ADDITIONAL EVENTS IN FY 2019 INCREASED THE NUMBER OF FEMALES SCREENED. A TOTAL OF FORTY-ONE INDIVIDUALS WERE SEEN IN FY 2018 COMPARED TO 45 INDIVIDUALS IN FY 2017. FEWER CLIENTS WERE SEEN IN 2018 AND 2017 DUE TO STAFF AND DEPARTMENT REDUCTIONS. IT SHOULD BE NOTED THAT SCREENINGS DURING THE SPRING OF 2018 WERE CANCELLED DUE TO BUDGET CONSTRAINTS. THE CONCLUSION IS THAT HIGH RISK INDIVIDUALS CONTINUED TO BE SERVED BY THE SCREENING PROGRAMS IN SPITE OF THE DECLINE IN NUMBERS BUT CONTINUED EFFORTS TO REACH HIGH RISK CLIENTS ARE EVIDENCE BY THE INCREASE IN NUMBERS DURING FY 2019. COMMUNITY HEALTH EDUCATION - SUPPORT GROUP ------------------------------------------------------ CLIENTS AT SCREENINGS WERE REFERRED TO HERITAGE HOSPICE FOR GRIEF COUNSELING, TO THE MONTHLY ALZHEIMER'S SUPPORT GROUP, AND TO THE DIABETES SUPPORT GROUP THAT MEETS AT THE MCDOWELL WELLNESS CENTER ALL BASED IN BOYLE COUNTY. TOBACCO CESSATION AND SOME NUTRITION COUNSELING ARE ALSO AVAILABLE THROUGH THE LOCAL HEALTH DEPARTMENTS. COMMUNITY-BASED CLINICAL SERVICES - HEALTH SCREENINGS ----------------------------------------------------------------- HEALTH FAIRS WERE CONDUCTED IN MERCER AND WASHINGTON COUNTIES IN COLLABORATION WITH COUNTY EXTENSION OFFICES, DRUG ADDICTION PROGRAMS AND CHURCHES. SERVICES OFFERED WERE BASED UPON THE 2017 CHNA COMMUNITY FEEDBACK AND IMPLEMENTATION PLAN THAT WAS APPROVED BY THE EMJBHH GOVERNING BOARD AND THE EPHRAIM MCDOWELL HEALTH (EMH) GOVERNING BOARD. SERVICES INCLUDED CARDIOVASCULAR DISEASE (CVD) RISK FACTORS REDUCTION (BOTH STROKE AND HEART ATTACK). CVD RISK SCREENINGS INCLUDED CHOLESTEROL, GLUCOSE, BODY MASS INDEX (BMI), BLOOD PRESSURE, TOBACCO USE, FAMILY HISTORY, PULSE REGULARITY, ACTIVITY INTENSITY, RISK SCORE CARD, AND CONSULTATION WITH AN RN TO DEVELOP GOAL(S) FOR HEALTH RISK REDUCTION. EARLY DETECTION/PREVENTION OF CANCER INCLUDES TOBACCO USE CESSATION REFERRALS, AND DISTRIBUTION OF COLORECTAL CANCER SCREENING KITS. BLOOD PRESSURE SCREENING ------------------------ DURING FY 2019, 78% OF 86 BLOOD PRESSURE ASSESSMENTS IN MERCER AND WASHINGTON COUNTIES EXCEEDED THE RECOMMENDED RANGE AS ESTABLISHED BY THE AMERICAN HEART ASSOCIATION (AHA) COMPARED TO FY 2018, 88 PERCENT OF 41 BLOOD PRESSURE AND IN FY 2017, 75 PERCENT OF 45 ABNORMAL BLOOD PRESSURE READINGS. THIS IS A 13% INCREASE FROM FY 2017 TO FY 2018 AND A 10% DECREASE FROM 2018 TO 2019. DIETARY INFORMATION WAS PROVIDED. INSTRUCTIONS FOR MONITORING AND RECORDING BLOOD PRESSURE, AND THE SIGNIFICANCE OF BLOOD PRESSURE CONTROL IN THE PREVENTION OF HEART ATTACK AND STROKE WERE KEY ELEMENTS IN CLIENT EDUCATION FOR THOSE WITH PRE-HYPERTENSION AND STAGE I HYPERTENSION. STAGE II HYPERTENSION AND ABOVE CLIENTS WERE REFERRED FOR PRIMARY CARE FOLLOW-UP AND EVALUATION. CANCER - COLORECTAL SCREENING ----------------------------- TWENTY-TWO (FY 2019) COMPARED TO THIRTY-FOUR (FY 2018) COLORECTAL CANCER SCREENING KITS WERE DISTRIBUTED THROUGH SCREENINGS, AND 10 THRU (2019) CLINICS, AND THE HOSPITAL DURING THE MARCH COLORECTAL SCREENING DRIVE. TWENTY WERE RETURNED FOR INTERPRETATION AND NONE WERE POSITIVE FOR OCCULT BLOOD IN FY 2019 COMPARED TO FOUR OF 22 OR 18% POSITIVE IN FY 2018. THESE INDIVIDUALS WERE REFERRED TO THEIR PRIMARY CARE PROVIDERS FOR FURTHER TESTING AND THE PCP WAS NOTIFIED OF THE INDIVIDUAL'S RESULTS. THIS PROJECT WAS FUNDED BY THE EPHRAIM MCDOWELL HEALTH CARE FOUNDATION (EMHCF). CANCER SKIN SCREENING --------------------- IN BOTH FY 2019 AND FY 2018 THERE WAS NOT A SKIN CANCER SCREENING OFFERED IN MERCER AND WASHINGTON COUNTIES DUE TO THE LACK OF A COMMUNITY PARTNER AND LIMITED LICENSED INDEPENDENT PRACTITIONER COVERAGE. CHOLESTEROL TESTING ------------------- IN FY2019, 45% OF 86 INDIVIDUALS COMPARED TO FY2018, WHERE THIRTY-NINE PERCENT OF 41 INDIVIDUALS AND TO FY2017, TWENTY-SEVEN PERCENT OF 45 (AN INCREASE OF 12%) TOTAL CHOLESTEROL TESTS EXCEEDED THE RECOMMENDED RANGE AS ESTABLISHED BY THE AMERICAN HEART ASSOCIATION (AHA). THIS IS AN INCREASING TREND CONSISTENT WITH THE STATE AND NATIONAL TRENDS. OF THE LIPID PANEL FOR BOTH YEARS, THE LDL WAS THE MOST ELEVATED. DIABETES SCREENING ------------------ IN 2019 TWENTY ONE PERCENT OF 87 INDIVIDUALS TOTAL BLOOD SUGARS (GLUCOSE) TESTS COMPARED TO 2018, WHERE TWELVE PERCENT OR 41 INDIVIDUALS AND 20 PERCENT OF 45 INDIVIDUALS TOTAL BLOOD SUGAR (GLUCOSE) TESTS IN FY 2017 EXCEEDED THE RECOMMENDED RANGE AS ESTABLISHED BY THE AMERICAN DIABETIC ASSOCIATION (ADA). IN FY 2016 AN A1C MACHINE WAS PROVIDED BY THE EPHRAIM MCDOWELL HEALTH CARE FOUNDATION AND A1C TESTING WAS IMPLEMENTED AT THE SCREENING SITES FOR THOSE WHO MET THE FOLLOWING HIGH RISK CRITERIA: . KNOWN DIABETIC OR PRE-DIABETIC . FASTING BLOOD SUGAR ABOVE 111 WITH UNKNOWN DIAGNOSIS . EXTENDED FAMILY MEMBER WITH DIAGNOSIS AND NOT DONE BEFORE . HAS NOT HAD A1C TAKEN WITHIN THE LAST 3 MONTHS USING THESE CRITERIA, FOURTEEN INDIVIDUALS WERE SCREENED IN FY 2019 COMPARE TO 10 IN FY 2018 AND 7 IN FY 2017, RESULTING IN 71% IN 2019, 40% IN 2018, AND 71% IN 2017 OF THOSE INDIVIDUALS HAVING ABNORMAL A1C RESULTS. DIET AND LIFESTYLE CHANGES WERE A SIGNIFICANT PART OF THE EDUCATION PROVIDED TO TRY TO REDUCE THESE NUMBERS, WHICH REFLECT THE GROWING TREND NATIONALLY.
FORM 990, PART III, LINE 4 (CONT)	NUTRITION/OBESITY SCREENING --------------------------- SIXTY SEVEN PERCENT OF 83 ADULTS SCREENED FOR BODY MASS INDEX COMPARED TO EIGHTY-SEVEN PERCENT OF 41 ADULTS SCREENED IN 2018 AND SEVENTY-ONE PERCENT IN FY 2017 EXCEEDED THE NATIONAL HEALTH RECOMMENDATIONS. (4% OF INDIVIDUALS WERE IN THE EXTREME OBESITY CATEGORY COMPARED TO 4.8% IN 2018.) THIS ALSO REFLECTS THE HEALTH TREND IN THE COMMONWEALTH OF KENTUCKY. EDUCATION WAS OFFERED RELATED TO PORTION CONTROL AND GLYCEMIC INDEX FOR ALL CLIENTS EXCEEDING THE RECOMMENDED RANGE. REFERRAL TO A DIETITIAN, COUNTY HEALTH DEPARTMENT NUTRITION CLASSES OR PRIMARY CARE PROVIDER WAS MADE FOR THOSE IN THE HIGH-RISK GROUP DUE TO THE RELATIONSHIP BETWEEN OBESITY AND SOME FORMS OF CANCER, DIABETES, MOBILITY ISSUES, GERD, HEART ATTACK AND STROKE. STROKE SCREENING ------------------ STROKE SCREENINGS WAS PROVIDED AT THE ADDICTION TREATMENT FACILITY AND MERCER COUNTY EXTENSION OFFICE, AND COUNTY SEAT CHURCH USING THE AMERICAN STROKE ASSOCIATION SCORECARD TO RECORD THE CLIENT'S RISK FACTORS AS HIGH (RED), MEDIUM (YELLOW) OR LOW (GREEN) FOR PURPOSES OF EDUCATION AND GOAL SETTING TO REDUCE MODIFIABLE LIFESTYLE RELATED CVD RISK FACTORS. INDIVIDUALS WITH THREE OR MORE RISK FACTORS IN THE HIGH-RISK RANGE WERE REFERRED FOR PCP FOLLOW-UP. TWENTY THREE PERCENT OF INDIVIDUALS FELL WITHIN THE RED CATEGORY, OR HIGH RISK, FOR HAVING A STROKE DURING THE FY 2019 SCREENINGS COMPARED 18% IN FY 2018 AND NINE PERCENT IN FY 2017. THE SERVICE AREA IS THE HEART OF THE "STROKE BELT". THE SITES PROVIDED A VARIATION IN RURAL VERSUS TOWN COMMUNITIES AND VARYING AREAS OF THE TWO COUNTIES. COMMUNITY-BASED CLINICAL SERVICES - IMMUNIZATIONS ------------------------------------------------- FLU SHOTS - FORTY-SEVEN FLU SHOTS WERE ADMINISTERED TO INDIVIDUALS FROM THE ADDICTION FACILITY DURING SCREENING EVENTS. FLU CLINICS WERE HELD IN AREA CHURCHES AND SEVENTY-SEVEN ADDITIONAL FLU VACCINES WERE ADMINISTERED IN BOTH 2019 AND 2018 FOR A TOTAL OF 124 VACCINES GIVEN IN 2019 IN WASHINGTON AND MERCER COUNTIES AND 107 GIVEN DURING FY 2018. THIS COMPARES TO A TOTAL OF 146 FLU SHOTS GIVEN IN FY 2017. FINANCIAL DONATIONS FOR THE COMMUNITY - COST OF FUND RAISING ----------------------------------------------------------------- COST OF FUND RAISING - PROJECTS IN THIS CATEGORY INCLUDED THE ROTARY PANCAKE BREAKFAST FUND RAISER. EMJBHH STAFF WORKED THE EVENT TO ASSIST IN MEETING IDENTIFIED COMMUNITY NEEDS. OTHER EVENTS ALSO INCLUDE PROJECT GRADUATION: MERCER AND BURGIN SCHOOL SYSTEMS, COMMUNITY THEATRE - RAGGED EDGE THEATRE, AND THE MERCER COUNTY CHAMBER OF COMMERCE. FINANCIAL DONATIONS FOR THE COMMUNITY-IN-KIND ----------------------------------------------- MEDICAL SUPPORT --------------- AREA RESIDENTS WERE SERVED THROUGH MEDICAL SUPPORT SERVICES AT THE PIONEER DAYS EVENT IN MERCER COUNTY. SERVICES INCLUDED BLOOD PRESSURE CHECKS AND FIRST AID SERVICES. EMJBHH PERSONNEL HELPED PLAN, SET UP AND PROVIDE HEALTH SERVICES AT THE EVENT. EMJBHH PARTICIPATES AND PROVIDES REGULAR MEETING SPACE FOR THE WEIGHT WATCHERS PROGRAM IN OUR COMMUNITY. SENIOR LEADERS PARTICIPATE IN THE KODA FUNDRAISER/AWARENESS THROUGH EDUCATION TO OUR COMMUNITY. PERSONNEL/ADMINISTRATIVE SUPPORT -------------------------------- EMJBHH LEADERS SERVED AS TEAM CAPTAINS FOR THE AMERICAN CANCER SOCIETY RELAY FOR LIFE IN MERCER COUNTY. THIS IS THE MAJOR FUND-RAISER FOR THE AMERICAN CANCER ASSOCIATION. EMJBHH LEADERS AND ASSOCIATES PARTICIPATED IN THE DAY OF CARING AND DAY OF ACTION TO IMPROVE OUR COMMUNITY THROUGH SERVICE PROJECTS THROUGH THE HEART OF KENTUCKY UNITED WAY. EMJBHH LEADERS AND ASSOCIATES PARTICIPATED IN THE SALVATION ARMY (TSA) KETTLE DRIVE TO PROVIDE FOOD AND NECESSITIES FOR THOSE IN NEED IN THE COMMUNITY. EMJBHH PARTICIPATES IN THE SOUTHERN KENTUCKY AHEC (AREA HEALTH EDUCATION CENTER) FUTURE DOCS PROGRAM. THIS PROGRAM GIVES A BOOST TO PRE-MED STUDENTS IN THE REGION TO LEARN MORE ABOUT THE MEDICAL SCHOOL APPLICATION PROCESS, PRACTICE INTERVIEW SKILLS, INTERACT WITH MEDICAL STUDENTS AND PHYSICIANS. EMJBHH LEADERS HOLD BOTH MEMBERSHIP AND LEADERSHIP POSITIONS WITHIN VARIOUS SERVICE ORGANIZATIONS IN THE COMMUNITY, ROLE MODELING GOOD CITIZENSHIP. COMMUNITY-BUILDING ACTIVITIES ------------------------------- COMMUNITY HEALTH IMPROVEMENT ADVOCACY ------------------------------------- COALITION BUILDING ACTIVITIES INCLUDED WORKING WITH MERCER COUNTY YOUTH LEADERSHIP; SERVICE ON ROTARY; HEART OF KENTUCKY UNITED WAY; AND AMERICAN CANCER RELAY FOR LIFE. EPHRAIM MCDOWELL JAMES B. HAGGIN HOSPITAL WAS PART OF A VERY SUCCESSFUL HKUW FUND RAISING CAMPAIGN WITHIN THE EPHRAIM MCDOWELL HEALTH CARE SYSTEM. ASSOCIATES WERE ALSO ENGAGED IN THE DAY OF ACTION. STAFF SERVED ON COMMITTEES, TEAMS, AND CONTRIBUTED TO MAKE THIS A PROJECT FOR THEIR COMMUNITY AND THOSE THEY SERVE A SUCCESS. IN ADDITION TO MAINTAINING MEETING PARTICIPATION IN THE HARRODSBURG ROTARY CLUB, STAFF MEMBERS ENGAGED IN FUNDRAISERS, AND EXEMPLIFIED THE ROTARY MOTTO OF SERVICE ABOVE SELF IN THEIR LEADERSHIP ROLE WITHIN THE COMMUNITY. THE AMERICAN CANCER SOCIETY STRIVES TO PROVIDE EDUCATION TO THE PUBLIC REGARDING CANCER AND RAISE FUNDS FOR RESEARCH SURROUNDING CURE AND TREATMENT. EMJBHH STAFF PARTICIPATED AT ALL LEVELS-COMMITTEE MEETINGS, TEAM CAPTAINS, EVENT PARTICIPATION AND FUND-RAISING. EMJBHH PARTICIPATED IN AN AREA WIDE ACTIVE SHOOTER DRILL AT BURGIN INDEPENDENT SCHOOLS WITH MULTIPLE AGENCIES PARTICIPATING, AS WELL AS A TOUR BUS ACCIDENT DRILL WITH MULTIPLE AGENCIES PARTICIPATING. WORKFORCE DEVELOPMENT --------------------- SENIOR LEADERS PARTICIPATED IN THE MERCER COUNTY YOUTH LEADERSHIP PROGRAM. LEADERS AND STAFF HOSTED MERCER COUNTY SCHOOLS AND BURGIN INDEPENDENT SCHOOLS FRESHMAN CLASSES, WHERE THEY TOURED THE HOSPITAL AND LEARNED ABOUT DIFFERENT CAREER OPPORTUNITIES IN HEALTHCARE. HAGGIN LEADERS AND STAFF PROVIDED WORKFORCE TESTING FOR CORNING, INC., WHICH INCLUDES PULMONARY FUNCTION TESTING AND TB SKIN TESTING. COMMUNITY SUPPORT ------------------ HAGGIN LEADERS AND STAFF RANG THE BELL FOR THE SALVATION ARMY (TSA) DURING THE CHRISTMAS HOLIDAY SEASON; THEREBY ASSISTING TSA IN ATTAINING THEIR GOAL. THE AIM WAS TO FEED THE HUNGRY AND PROVIDE CHRISTMAS FOR NEEDY FAMILIES. TSA'S PLEDGE IS TO DO THE MOST GOOD WITH CONTRIBUTIONS. EMJBHH LEADERS SERVE ON THE MERCER COUNTY COMMUNITY ENDOWMENT COMMITTEE THAT RELIES ON THE CITIZENS OF MERCER COUNTY AS ITS PRIMARY FUNDING SOURCE TO SUPPORT COMMUNITY EFFORTS. HAGGIN STAFF PLANNED, ORGANIZED AND PARTICIPATED IN THE ANNUAL JULY 4 FOOD DRIVE WHICH PROVIDES FOOD FOR THE CHRISTIAN LIFE CENTER LOCATED IN HARRODSBURG. THIS FOOD DRIVE TYPICALLY PROVIDES ENOUGH FOOD TO RESTOCK THE CENTER FOR THE REMAINDER OF THE SUMMER SEASON, TO HELP THOSE IN NEED IN THE COMMUNITY. HAGGIN LEADERS AND STAFF PARTICIPATE IN THE MERCER COUNTY BACKPACK PROGRAM. THIS IS A MERCER COUNTY SCHOOLS PROGRAM WHICH PROVIDES FOOD ITEMS THAT ARE SENT HOME WITH CHILDREN WEEKLY THROUGH THE BACKPACK SERVICE. HAGGIN LEADERS AND STAFF PROVIDED THE ANNUAL BICYCLE SAFETY PROGRAM AT THE MERCER COUNTY PUBLIC LIBRARY. THIS PROGRAM PROVIDES BICYCLE SAFETY INFORMATION AND HELMETS TO EACH CHILD IN ATTENDANCE. THERE WERE 30 CHILDREN IN ATTENDANCE AND 22 BICYCLES WERE GIVEN AWAY. UNASSIGNED PROGRAM --------------------- ADDITIONAL COMMUNITY INVOLVEMENT THAT ENHANCED THE LIVES OF THE CITIZENS OF MERCER COUNTY AND THE SURROUNDING COUNTIES INCLUDED INVOLVEMENT IN LAY HEALTH/FAITH COMMUNITY NURSING MINISTRIES WITHIN THE CONGREGATIONS. FULL CONGREGATIONAL IMPACT WAS GENERATED BY LEADERSHIP POSITIONS WITHIN THE VARIOUS CHURCH COMMITTEES. SERVICES PROVIDED INCLUDED, BUT WERE NOT LIMITED TO, SERVING ON BOARDS/COMMITTEES, TEACHING, MEAL PREPARATION, MUSIC AND WORSHIP LEADERSHIP, CHOIR PARTICIPATION AND HOME VISITS/CALLS. THE JOURNAL OF CHRISTIAN NURSING REPORTS THAT CHRISTIAN FAITH AND PRACTICE SUPPORTS BETTER MENTAL, PHYSICAL AND SPIRITUAL HEALTH (MARCH 2013). COMMUNITY INVOLVEMENT IN CHILDREN'S PROGRAMS THROUGH THE AREA CHURCHES RESULTED IN OVER 1,000 CHILDREN BEING SERVED.
FORM 990, PART III, LINE 4 (CONT)	IN FY 2019, JAMES B. HAGGIN HOSPITAL INVESTED $1,346,607 IN COMMUNITY BENEFITS INCLUDING FINANCIAL ASSISTANCE AND MEANS-TESTED PROGRAMS. THIS IS ABOVE AND BEYOND THE HOURS OF VOLUNTEER TIME IN LEADERSHIP ROLES BY EMJBHH STAFF AT THE LOCAL, REGIONAL, STATE AND NATIONAL LEVEL.
FORM 990, PART VI, SECTION A, LINE 6	MEMBERS OF THE ORGANIZATION ----------------------------- EPHRAIM MCDOWELL HEALTH, INC. IS THE SOLE CORPORATE MEMBER OF JAMES B. HAGGIN MEMORIAL HOSPITAL. EPHRIAM MCDOWELL HEALTH, INC., A RELATED 501(C)(3) ENTITY, IS THE PARENT ORGANIZATION OF AN INTEGRATED HEALTCARE DELIVERY SYSTEM. EPHRAIM MCDOWELL HEALTH, INC. ELECTS BOARD MEMBERS OF JAMES B. HAGGIN MEMORIAL HOSPITAL ON AN ANNUAL BASIS. THE BYLAWS OF JAMES B. HAGGIN MEMORIAL HOSPITAL REQUIRE APPROVAL OF CERTAIN TRANSACTIONS BY ITS SOLE CORPORATE MEMBER, EPHRAIM MCDOWELL HEALTH, INC.
FORM 990, PART VI, SECTION B, LINE 11	PROCESS TO REVIEW FORM 990 ----------------------------------- COPIES OF THE FORM 990 ARE SUBMITTED TO THE FULL BOARD VIA EMAIL PRIOR TO FILING.
FORM 990, PART VI, SECTION B, LINE 12B AND 12C	MONITORING THE CONFLICT OF INTEREST POLICY ------------------------------------------ ANNUALLY, BOARD OF DIRECTORS, SENIOR LEADERSHIP, AND MEDICAL STAFF LEADERS COMPLETE A CONFLICT OF INTEREST QUESTIONNAIRE. COMPLETION OF THE ANNUAL QUESTIONNAIRE IS COORDINATED BY GENERAL COUNSEL AND EPHRAIM MCDOWELL'S CORPORATE COMPLIANCE OFFICER. THE COMPLETED QUESTIONNAIRES ARE REVIEWED BY THE SENIOR LEADERSHIP AND THE CORPORATE COMPLIANCE OFFICER. THE CHAIRMAN OF THE BOARD OF DIRECTORS IS MADE AWARE OF CONFLICTS WHICH HAVE BEEN DISCLOSED ON ANNUAL STATEMENTS. IF CONFLICTS EXIST, THE CONFLICT IS DISCLOSED AND THE INDIVIDUAL WITH THE CONFLICT DOES NOT PARTICIPATE OR VOTE ON ACTIVITIES WHERE A CONFLICT OF INTEREST IS PRESENT.
FORM 990, PART VI, SECTION B, LINE 15	PROCESS FOR DETERMINING COMPENSATION ------------------------------------------ JAMES B. HAGGIN MEMORIAL HOSPITAL IS PART OF AN INTEGRATED HEALTHCARE DELIVERY SYSTEM WHOSE PARENT IS EPHRAIM MCDOWELL HEALTH, INC. COMPENSATION FOR ALL AFFILIATES IS OVERSEEN AND COORDINATED THROUGH EPHRAIM MCDOWELL HEALTH, INC. THE MERCER GROUP, INDEPENDENT CONSULTANTS, CONDUCTED A REVIEW AND PROVIDED MARKET DATA IN 2018 FOR ESTABLISHING REASONABLE COMPENSATION OF THE CEO. FOR OTHER OFFICERS AND KEY EMPLOYEES FOR THE SYSTEM, THE ORGANIZATION ALSO UTILIZED COMPENSATION STUDIES. THE COMPENSATION IS APPROVED BY THE COMPENSATION COMMITTEE OF THE EPHRAIM MCDOWELL HEALTH, INC. BOARD OF DIRECTORS. THE DECISION AND PROCESS IS DOCUMENTED BY THE COMMITTEE.
FORM 990, PART VI, SECTION C, LINE 19	MAKING FORMS AVAILABLE TO THE PUBLIC ---------------------------------------- THE ORGANIZATION MAKES ITS FINANCIAL STATEMENTS, GOVERNING DOCUMENTS, AND CONFLICT OF INTEREST POLICY AVAILABLE TO THE PUBLIC UPON REQUEST.

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

Cat. No. 51056K

Schedule O (Form 990 or 990-EZ) 2018

Additional Data

Software ID:
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- TIN:

SCHEDULE R
(Form 990)

Department of the Treasury
Internal Revenue Service

Related Organizations and Unrelated Partnerships

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

Attach to Form 990.
MediumBullet

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

OMB No. 1545-0047

2018

Open to Public Inspection

Name of the organization

JAMES B HAGGIN MEMORIAL HOSPITAL INC

Employer identification number

61-0510934

Part I

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

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

Part II

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

(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Exempt Code section	(e) Public charity status (if section 501(c)(3))	(f) Direct controlling entity	(g) Section 512(b)(13) controlled entity?
(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Exempt Code section	(e) Public charity status (if section 501(c)(3))	(f) Direct controlling entity	Yes	No
(1)HAGGIN MEMORIAL HOSPITAL FOUNDATION INC 464 LINDEN AVENUE HARRODSBURG,KY40330 31-0995840	SUPPORT	KY	501(C)(3)	12B-II	JBH	Yes
(2)JOHN HILL BAILEY CHILDREN'S LEARNING CTR 217 S THIRD STREET DANVILLE,KY40422 61-1186005	DAYCARE CTR	KY	501(C)(3)	2	EM HEALTH		No
(3)EMHFL INC 217 S THIRD STREET DANVILLE,KY40422 61-1388556	CRITICAL HOSP	KY	501(C)(3)	3	EM HEALTH		No
(4)EPHRAIM MCDOWELL HEALTH RESOURCE INC 217 S THIRD STREET DANVILLE,KY40422 31-1545520	HEALTHCARE	KY	501(C)(3)	3	EM HEALTH		No
(5)EPHRAIM MCDOWELL REGIONAL MEDICAL CENTER 217 S THIRD STREET DANVILLE,KY40422 61-0492356	CRITCAL HOSP	KY	501(C)(3)	3	EM HEALTH		No
(6)EPHRAIM MCDOWELL HEALTH INC 217 S THIRD STREET DANVILLE,KY40422 61-1324736	MGT SERVICES	KY	501(C)(3)	12B-II	NA		No
(7)MCDOWELL HOME HEALTH AGENCY INC 217 S THIRD STREET DANVILLE,KY40422 61-0715227	HOME HEALTH	KY	501(C)(3)	3	EM HEALTH		No
(8)EPHRAIM MCDOWELL HEALTH CARE FOUNDATION 217 S THIRD STREET DANVILLE,KY40422 61-1229333	FUNDRAISING	KY	501(C)(3)	12B-II	EM HEALTH		No

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

Cat. No. 50135Y

Schedule R (Form 990) 2018

Page 2

Part III

Identification of Related Organizations Taxable as a Partnership Complete if the organization answered "Yes" on Form 990, Part IV, line 34 because it had one or more related organizations treated as a partnership during the tax year.

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

Part IV

Identification of Related Organizations Taxable as a Corporation or Trust Complete if the organization answered "Yes" on Form 990, Part IV, line 34 because it had one or more related organizations treated as a corporation or trust during the tax year.

(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Direct controlling entity	(e) Type of entity (C corp, S corp, or trust)	(f) Share of total income	(g) Share of end-of-year assets	(h) Percentage ownership	(i) Section 512(b)(13) controlled entity?
(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Direct controlling entity	(e) Type of entity (C corp, S corp, or trust)	(f) Share of total income	(g) Share of end-of-year assets		Yes	No
(1) COOPERATIVE CARE INC 217 S THIRD STREET DANVILLE,KY40422 61-1265715	CONTRACTING SVCS	KY	NA	C	0	0	0 %		No

Schedule R (Form 990) 2018

Page 3

Part V

Transactions With Related Organizations Complete if the organization answered "Yes" on Form 990, Part IV, line 34, 35b, or 36.

Note. Complete line 1 if any entity is listed in Parts II, III, or IV of this schedule.

Yes

1 During the tax year, did the orgranization engage in any of the following transactions with one or more related organizations listed in Parts II-IV?

a Receipt of (i) interest, (ii) annuities, (iii) royalties, or (iv) rent from a controlled entity .....................

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

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

Yes

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Yes

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

Yes

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

(a) Name of related organization	(b) Transaction type (a-s)	(c) Amount involved	(d) Method of determining amount involved

Schedule R (Form 990) 2018

Page 4

Part VI

Unrelated Organizations Taxable as a Partnership Complete if the organization answered "Yes" on Form 990, Part IV, line 37.

Provide the following information for each entity taxed as a partnership through which the organization conducted more than five percent of its activities (measured by total assets or gross revenue) that was not a related organization. See instructions regarding exclusion for certain investment partnerships.

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

Schedule R (Form 990) 2018

Page 5

Part VII

Supplemental Information

Provide additional information for responses to questions on Schedule R (see instructions).

Return Reference	Explanation

Schedule R (Form 990) 2018

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