SC-2026-00028 - Albedo Holdings, LLC. v. REBECCA K CHAMBERLAIN and ROBERT JAMES CHAMBERLAIN

What's This Case About?

Let’s get one thing straight: a hospital is being sued for $1,456.13. Not the other way around. You read that right. The hospital — or at least the ghost of its billing department — is the one getting dragged into court. But here’s the twist: the hospital isn’t even the one suing. Oh no. It sold the debt. And now, a shadowy entity called Albedo Holdings, LLC — which sounds less like a medical billing company and more like a cryptocurrency startup run out of a basement in Tulsa — is demanding payment like it personally delivered IV fluids and moral support at 3 a.m. in Coalgate, Oklahoma.

So who are these people? On one side, we’ve got Rebecca K. Chamberlain and Robert James Chamberlain, a married couple from Tupelo, Oklahoma — population: tiny, vibes: “we know everyone’s business.” Rebecca appears to be the patient in question, with multiple ER visits recorded between 2020 and 2021 at Coal County General Hospital, which, based on the name, probably has one elevator and a nurse who also runs the gift shop. The hospital, for its part, seems like your average rural medical facility — doing its best, billing its hardest, and, according to its CEO Chris Martin, fully compliant with “all applicable state and federal hospital price transparency laws,” which is a sentence that sounds like it was written while sobbing into a W-2.

Now, what actually happened? Over the course of several emergency room visits in 2020 and 2021, Rebecca Chamberlain received care — vitals checked, labs drawn, radiology performed, medications dispensed, all the usual ER jazz. Each visit generated a bill. And each bill, according to the hospital’s own records, was partially paid by Blue Cross Blue Shield, with the remainder either written off, adjusted, or marked as a “small balance.” In accounting terms, that usually means: “we’re not chasing this.” But in debt collection terms, it means: “aha — fresh meat.”

The hospital’s internal ledgers show six separate accounts tied to the Chamberlains, totaling exactly $1,456.13 — $300 here, $295.75 there, a cool $197.50 for an ER visit in November 2021. Some of these balances were already marked as “bad debt write off” or “small balance,” suggesting the hospital had given up on collecting. But instead of tossing them in the shredder, they did what hospitals in rural Oklahoma do: they sold the debt to a third party. On July 2, 2025 — a date suspiciously close to when CEO Chris Martin certified the hospital’s price transparency compliance — Coal County General Hospital, Inc. signed a “Conveyance and Bill of Sale” transferring all rights to these accounts to Albedo Holdings, LLC. No explanation. No apology. Just a cold, legal handoff of unpaid medical bills, like passing a hot potato before it explodes.

And boom — fast-forward to March 2, 2026. Albedo Holdings, LLC, now the proud owner of six dusty medical accounts, files a petition in Coal County District Court demanding $1,456.13 from the Chamberlains. No interest. No late fees. Just the principal, plus the cost of the lawsuit, because apparently, even $1,456.13 is worth a trip to small claims court when you’re in the business of buying other people’s grudges.

So why are they in court? Legally, this is a straightforward debt collection case. Albedo Holdings claims it’s owed money for “services performed” — a phrase so bland it could be the title of a corporate training video. They’re not suing for malpractice, breach of contract, or emotional distress. They’re not even alleging fraud. They’re just saying: “We bought this debt. You owe it. Pay up.” And under Oklahoma law, when a debt is legally assigned, the new owner can sue just like the original creditor. It’s like if your friend sells your IOU for a $20 loan to a stranger — suddenly, you owe the stranger, not your buddy.

But here’s where it gets deliciously absurd. The original hospital appears to have already written off these debts. Look at the account summaries: “Bad Debt Write Off,” “Small Balance,” “Adjustment -$166.88.” These aren’t typos. These are accounting decisions. They mean the hospital internally decided not to pursue collection. So when they turned around and sold those debts anyway, it’s like donating your old couch to Goodwill and then suing the new owner for not paying you $300 for it. The optics are… questionable.

Now, what do they want? Albedo Holdings is asking for exactly $1,456.13 — not a penny more, not a penny less. In the grand scheme of medical debt, that’s not a fortune. It’s less than a month’s rent in most cities, less than a decent used car down payment. But for a couple in rural Oklahoma, it’s still a chunk of change — especially when you consider that some of these charges go back four years, and the hospital already treated them as uncollectible. And let’s not forget: Albedo Holdings didn’t provide any care. They didn’t draw blood, interpret X-rays, or hold Rebecca’s hand during a panic attack. They just bought a spreadsheet.

And yet, here we are. A trial date is set for April 21, 2026, at 9:00 a.m. in the Coal County Courthouse — a building that probably has more history than Wi-Fi. The Chamberlains have been ordered to show up with “all books, papers, and witnesses needed to establish your defense,” which, given the circumstances, might just be a stack of old insurance statements and a very tired sigh.

Our take? The most absurd part isn’t that a hospital sold its debt. That happens every day. It’s not even that a shell company is now suing for less than $1,500. No — the real comedy gold is the sheer bureaucratic audacity of it all. The hospital certified its compliance with price transparency laws the same month it sold off a bundle of old medical debts, some of which were already written off. It’s like putting up a “We Care About Our Patients” banner while quietly auctioning off their financial guilt to the highest bidder.

We’re not rooting for medical debt collectors. We’re not rooting for hospitals that play accounting games. But if we had to pick a side? We’re rooting for the Chamberlains to walk into that courtroom, hand over $1,456.13 in pennies, and make Albedo Holdings count every single one. Because sometimes, justice isn’t about winning. It’s about making the machine work just hard enough to feel ridiculous.

Case Overview

$1,456 Demand Petition

Jurisdiction

District Court of Coal County, Oklahoma

Filing Attorney

MATT YEAGER

Relief Sought

$1,456 Monetary

Plaintiffs

Albedo Holdings, LLC. business
Rep: MATT YEAGER

Defendants

REBECCA K CHAMBERLAIN and ROBERT JAMES CHAMBERLAIN individual

Claims

#	Cause of Action	Description
1	unpaid bill for services performed	collection of $1,456.13 for services performed

Petition Text

3,552 words

IN THE DISTRICT COURT OF COAL COUNTY STATE OF OKLAHOMA Albedo Holdings, LLC. ) vs. ) REBECCA K CHAMBERLAIN and ROBERT JAMES ) CHAMBERLAIN ) XXX-XX-6358 ) Plaintiff, Defendant(s) CASE NO.: SC-26-28 AFFIDAVIT Albedo Holdings, LLC., being sworn, deposes and states: That the defendant resides at 213 N 4TH AVE, TUPELO, OK 74572. If the Defendant’s residence is not in COAL county, this action is brought to collect an open account, note, or other instrument of indebtedness contracted or given in COAL; or COAL County is otherwise the proper venue for collection of such open account, note, or instrument of indebtedness. Plaintiff acknowledges and disclaims jury trial. (see Oklahoma Statutes, Title 12, Sections 1751, 1752, 134, 135, 139 and 142, Oklahoma Constitution, Article 2.) The Defendant owes the Plaintiff $1,456.13 for: Unpaid bill for services performed. The Plaintiff has demanded payment, but the defendant has refused to pay, and no part of the amount sued for has been paid. THE MAILING ADDRESS OF THE PLAINTIFF IS: Albedo Holdings, LLC. PO BOX 3280 BROKEN ARROW, OK 74013 (918) 615-0014 MATT YEAGER Subscribed before me this 2nd day of March, 2026. My Commission Expires: ________________ Notary Public (or Clerk or Judge) ____________________________ ORDER THE STATE OF OKLAHOMA TO THE DEFENDANT: You are hereby directed to appear and answer to the above claim at the time set below, and to have with you at the time, all books, papers, and witnesses needed to establish your defense. This matter shall be heard on the 21 day of April, 2026 at 9:00 o’clock AM. in Room ____ of the COAL County Courthouse, 4 N MAIN ST, in COALGATE, COAL County, Oklahoma. YOU ARE FURTHER NOTIFIED THAT IF YOU DO NOT ALSO APPEAR JUDGMENT WILL BE GIVEN AGAINST YOU for the amount of the claim as stated in the above affidavit and, in addition, for costs of the action (including attorney fees where provided by law) and costs of service of the order .Dated this 3rd day of March, 2026 CONVEYANCE AND BILL OF SALE Coal County General Hospital, Inc., an Oklahoma corporation, as Assignor, for valuable consideration, the receipt and sufficiency of which are hereby acknowledged, does hereby grant, bargain, convey, transfer and assign to Albedo Holdings, LLC, an Oklahoma limited liability company, as Assignee, all of Assignor’s right, title and interest in and to all of the accounts of the Assignor identified in the document attached hereto as Exhibit 1 which exhibit is by this reference made a part hereof (the “Transferred Accounts"). Assignor hereby represents and warrants to Assignee that (i) Assignor is the sole beneficial owner of the Transferred Accounts, (ii) Assignor has good title to the Transferred Accounts free and clear of all claims, charges, liens and encumbrances, (iii) Assignor has full power and authority to convey, transfer and assign the Transferred Accounts and no approval of any person or authority is required to transfer and convey the Transferred Accounts to Assignee, and (iv) the Transferred Accounts are hereby conveyed, transferred and assigned to Assignee free and clear of all liens and encumbrances, without any warranty as to the value or collectability of the Transferred Accounts or any other warranty whatsoever. Assignor agrees to execute such other and further documents as may be necessary to effect the intent and purposes of this Conveyance and Bill of Sale. COAL COUNTY GENERAL HOSPITAL, INC. By: [signature] Chris Martin, CEO ACKNOWLEDGMENT BEFORE ME, a Notary Public in and for the State of Oklahoma, on [July 2], 2025, appeared Chris Martin, CEO of Coal County General Hospital, Inc., an Oklahoma corporation, and acknowledged that he executed the above and foregoing document as his free and voluntary act and as the act of said corporation for the uses and purposes set forth therein. SEAL NOTARY PUBLIC Rachel Washington AcctID AcctNum Lname Balance 2074335 1002189 CHAMBERLAIN 196.50 2074336 C1043339 CHAMBERLAIN 300.00 2089491 1003195 CHAMBERLAIN 316.88 2089492 1005468 CHAMBERLAIN 295.75 2089493 1005694 CHAMBERLAIN 149.50 2089494 1005859 CHAMBERLAIN 197.50 COAL COUNTY GENERAL HOSPITAL 6 N COVINGTON ST COALGATE OK 74538 STAY TYPE SUB TYPE SERVICE EXPECT DATE CITIZENSHIP RECORD OF ADMISSION E/R BR PATIENT NAME: CHAMBERLAIN REBECCA K ROOM NO.: C1043339 HOSP. NO.: PO BOX 105 ADDRESS LINE - 1: 213 W OLIVE ST ADDRESS LINE - 2: STATE: OK ZIP CODE: 74572 COUNTY CODE: CITY: TUPELO STATE: OK ZIP CODE: 74572 COUNTY CODE: CITY: TUPELO STATE: OK ZIP CODE: 74572 COUNTY CODE: AGE: 41 BIRTHDATE: 1979 SEX: F NATIONALITY: W CIVIL STATUE: M MILITARY: RELIGION: CHURCH: PATIENT TELEPHONE NUMBER: 580-235-1085 NAME OF HUSBAND OR NAME OF WIFE: SPOUSE BIRTHPLACE: SPOUSE EMPLOYER NAME: SPOUSE ADDRESS: SPOUSE EMPLOYER ADDRESS: NAME OF FATHER: BIRTHPLACE: NAME OF MOTHER: BIRTHPLACE: NAME: RELATIONSHIP: ADDRESS: TELEPHONE: GUARANTOR ADDRESS - 1: STATE: OK ZIP CODE: 74572 DATE: TIME: PLACED BY: EVENT: SIGNATURE: PRINCIPAL DIAGNOSIS: SECONDARY DIAGNOSIS: PRINCIPAL OPERATION/DATE: SECONDARY OPERATIONS: Consultation With ____________________________ Results: ☐ Recovered ☐ Improved ☐ Not Improved ☐ Not Treated ☐ Diagnosis Only ☐ Died ☐ Released Against Advice Cause of Death ____________________________ Autopsy: ☐ Yes ☐ No I have examined and approved this complete medical record on _______________ 30 ________ Signed ________________________________________ Attending Physician ADMISSION - SUMMARY SHEET 4/22/86 11:19 AM Coal County General Hospital Patient Account Detail 0 Account Patient Info Demographics Guarantor Info C1043739 CHAMBERLAIN REBECCA K PO BOX 105 CHAMBERLAIN REBECCA K PO BOX 105 PO BOX 105 213 W OLIVE ST TUPELO, OK 74572 TUPELO, OK 74572 TUPelo, OK 74572 SSN Phone Phone Cell 580-235-1085 580-235-1085 MMN-MMN-MMN Sex MS Sex MS F M Admit Date Admit Code Stay Type Service Disch Date Disch Code DOB Physician 09/17/2020 E 11/EMER 3 ER 09/17/2020 H HOME 7/1979 0 Cycle Code Coll Code Coll Sw 1 R Primary Sw Ins Description Y BB BLUE CROSS OUTPATIENT CHAMBERLAIN REBECCA K <table> <tr> <th>AR Date</th> <th>Service Type</th> <th>Date</th> <th>Chrg/Rec</th> <th>CPT</th> <th>NDC</th> <th>Med</th> <th>Nac</th> <th>Charge</th> <th>Credit</th> </tr> <tr> <td>02/19/2021</td> <td></td> <td></td> <td>BB BLUE CROSS OUTPATIENT</td> <td></td> <td></td> <td></td> <td></td> <td>0.00</td> <td></td> </tr> <tr> <td>07/17/2021</td> <td></td> <td></td> <td></td> <td></td> <td></td> <td></td> <td></td> <td>0.00</td> <td></td> </tr> <tr> <td>05/31/2022</td> <td></td> <td></td> <td></td> <td></td> <td></td> <td></td> <td></td> <td>0.00</td> <td></td> </tr> <tr> <td>10/16/2025</td> <td></td> <td></td> <td></td> <td></td> <td></td> <td></td> <td></td> <td>0.00</td> <td></td> </tr> <tr> <td>10/16/2025</td> <td></td> <td></td> <td></td> <td></td> <td></td> <td></td> <td></td> <td>0.00</td> <td></td> </tr> </table> Summary Code Revenue Code Description BB 0 BEGINNING BALANCE SB 0 SMALL BALANCE WO 0 BAD DEBT WRITE OFF Charge Summary <table> <tr> <th>Amount</th> <th>Days</th> <th>Days Med Nec</th> <th>Units</th> </tr> <tr> <td>300.00</td> <td>0</td> <td>0</td> <td>0</td> </tr> <tr> <td>-300.00</td> <td>1</td> <td>1</td> <td>1</td> </tr> <tr> <td>0.00</td> <td>2</td> <td>2</td> <td>2</td> </tr> </table> Hospital Information Name: COAL COUNTY GENERAL HOSPITAL Address: 6 N COVINGTON ST COAL GATE, OK 74538-2002 Phone#: 731236968 Tax ID#: COAL COUNTY GENERAL HOSPITAL 6 N COVINGTON ST COALGATE OK 74538 STAY TYPE: B/R SUB TYPE: ER SERVICE: ER EXPECTED DATE: 7/18/21 RECORD OF ADMISSION PATIENT NAME: CHAMBERLAIN REBECCA K ROOM NO.: HD-2 HOSP. NO.: 1003195 ADDRESS LINE - 1: PO BOX 105 AGE: 42 BIRTHDATE: 1/979 SEX: F BIRTHPLACE: TUPELO CITY: TUPELO STATE: OK ZIP CODE: 74572 COUNTY CODE: PATIENT TELEPHONE: 580-235-1085 NATIONALITY: W Civil St.: M MILITARY: RELIGION: CHURCH: SPONSOR EMPLOYER NAME: SPONSOR EMPLOYER ADDRESS: NAME OF FATHER: BIRTHPLACE: NAME OF MOTHER: BIRTHPLACE: NAME: CHAMBERLAIN REBECCA K RELATIONSHIP: ADDRESS: PO BOX 105 TUPELO OK TELEPHONE: 580-235-1085 ALLERGIES: No Kn DATE LAST ASM.: 6/01/21 PREV. ADM. NO.: 1002189 ADMISSION DATE: 7/18/21 TIME OF ADMISSION: 9:40 AM FINANCIAL CLASS: BB MEDICAL RECORD NUMBER: 31925 ADMISSION CODE: 11/EMER BONE: SHORT TERM HOSPITAL: INTERMEDIATE CARE FACILITY: CANCER/CHILD. HOSP? HOME HEALTH: LEFT AMA: EXP OTHER: TIME: ADVANCE DIRECTIVE: N CODE: SECONDARY DIAGNOSIS: PRINCIPAL OPERATION/DATE: SECONDARY OPERATIONS: Consultation With ____________________________ Results: □ Recovered □ Improved □ Not Improved □ Not Treated □ Diagnosis Only □ Died □ Released Against Advice Cause of Death ___________________________________________ Autopsy: □ Yes □ No I have examined and approved this complete medical record on ________________ 20 ________ Signed _______________________________________________________________________________________ Attending Physician ____________________________ Signature ____________________________ Date ___________ ADMISSION SUMMARY SHEET Cost County General Hospital Patient Account Detail Account Patient Info 0 1003195 CHAMBERLAIN REBECCA.K PO BOX 105 Demographics Guarantor Info CHAMBERLAIN REBECCA.K PO BOX 105 TUPelo, OK 74572 SSN Phone Cell 580-235-1065 Stay Information Admit Date Admit Code Stay Type Service Disch Date Disch Code DOB Physician 07/18/2021 E 11/EMER 3 ER ER 07/14/2021 H HOME # 1979 DOOD KANDRA BILL INFORMATION Billing Information Cycle Code Coll Code Bill Sw 3 R Cred Sw Insurance Information Subscriber CHAMBERLAIN REBECCA.K Computed DRG Receipited DRG 5656 Group YUH823637407 YUH823637407 AR Service Type Date Tran Code ST SC LC Number Qty Description Cpt Mod Description Chg/Rec NDC Ndc Charge Credit Date Credit 07/18/2021 ER BP 07/18/2021 Pay ER 11043 88 BLUE CROSS OUTPATIENT $75.00 $250.00 07/18/2021 07/18/2021 07/18/2021 07/18/2021 07/18/2021 11/15/2021 ER Pay 11/15/2021 Pay ER 12243 88 BLUE CROSS OUTPATIENT $17.00 $247.12 12/01/2021 ER Pay 12/01/2021 Pay ER 12243 88 BLUE CROSS OUTPATIENT $0.00 12/22/2021 IN Pay 12/22/2021 Pay IN 0 BP BLUE CROSS PHYSICIAN FEE $0.00 01/14/2022 ER Pay 01/14/2022 Pay ER 14454 BP BLUE CROSS PHYSICIAN FEE $0.00 11/03/2022 10/27/2025 IN Pay 10/27/2025 Pay IN 0 BP BLUE CROSS PHYSICIAN FEE $0.00 10/27/2025 IN Pay 10/27/2025 Pay IN 0 BP BLUE CROSS PHYSICIAN FEE $0.00 10/27/2025 IN Pay 10/27/2025 Pay IN 0 BP BLUE CROSS PHYSICIAN FEE $0.00 Total Charges: $94.00 Total Adjustment: -$166.88 Less Payments: $247.12 AR Balance: $0.00 <table> <tr> <th>Summary Code</th> <th>Revenue Code</th> <th>Description</th> <th>Charge Summary</th> <th>Bed Debt Balance</th> <th>Amount</th> <th>Days Med Nec</th> <th>Units</th> </tr> <tr> <td>36</td> <td>450</td> <td>EMERG ROOM</td> <td></td> <td></td> <td>130.00</td> <td></td> <td>1</td> </tr> <tr> <td>77</td> <td>320</td> <td>RADIOLOGY</td> <td></td> <td></td> <td>250.00</td> <td></td> <td>1</td> </tr> <tr> <td>78</td> <td>250</td> <td>PHARMACY</td> <td></td> <td></td> <td>109.00</td> <td></td> <td>2</td> </tr> <tr> <td>SB</td> <td>0</td> <td>SMALL BALANCE</td> <td></td> <td></td> <td>$16.88</td> <td></td> <td>1</td> </tr> <tr> <td>SL</td> <td>961</td> <td>PROF FEES-ER</td> <td></td> <td></td> <td>75.00</td> <td></td> <td>1</td> </tr> <tr> <td>WO</td> <td>0</td> <td>BAD DEBT WRITE OFF</td> <td></td> <td></td> <td>0.00</td> <td></td> <td>3</td> </tr> </table> Name: COAL COUNTY GENERAL HOSPITAL Address: 6 N COVINGTON ST COALGATE, OK 74539-2002 Phone#: Tax ID#: 731235988 COAL COUNTY GENERAL HOSPITAL 6 N COVINGTON ST COALGATE OK 74538 RECORD OF ADMISSION STAY TYPE: E/R SUB TYPE: ER SERVICE: ER EXPECT DATE: 10/20/21 CITIZENSHIP: PATIENT NAME: CHAMBERLAIN REBECCA K ROOM NO.: ED-2 BED NO.: 1005468 ADDRESS LINE - 1: PO BOX 105 ADDRESS LINE - 2: AGE: 42 BIRTHDATE: 1979 SEX: F BIRTHPLACE: TUPELO CITY: TUPELO STATE: OK ZIP CODE: 74572 COUNTY CODE: PATIENT TELEPHONE: 580-235-1085 EDUCATION: NATIONALITY: W CIVIL STATUE: M MILITARY: RELIGION: CHURCH: SPOUSE EMPLOYER NAME: NAME OF HUSBAND OR NAME OF WIFE: SPOUSE BIRTHPLACE: SPOUSE ADDRESS: SPOUSE EMPLOYER ADDRESS NAME OF FATHER: SPOUSE BIRTHPLACE: NAME OF MOTHER: SPOUSE BIRTHPLACE ADDRESS: PO BOX 105 TELEPHONE: 580-235-1085 FINANCIAL CLASS: BB MEDICAL RECORDS NUMBER: 31925 ADMISSION CODE: 11/EMER HOME SHORT TERM HOSPITAL INTRAVENOUS INFUSION SKILLED NURSING FACILITY INTERMITTENT I.V. CARE CANCER FACILITY CHILDREN'S HOSPITAL DIYNAGE/OTHER HEALTH LEFT ANA EXP OTHER TIME AM PM PRINCIPAL DIAGNOSIS: ADVANCE DIRECTIVE = N CODE: SECONDARY DIAGNOSIS: PRINCIPAL OPERATION/DATE: SECONDARY OPERATIONS: Consultation With _______________________ Results: ☐ Recovered ☐ Improved ☐ Not Improved ☐ Not Treated ☐ Diagnosis Only ☐ Died ☐ Released Against Advice Cause of Death: ____________________________________________ Autopsy: ☐ Yes ☐ No I have examined and approved this complete medical record on ___________________________ 20 ______ Signed ________________________________ Attending Physician ADMISSION - SUMMARY SHEET Coal County General Hospital Patient Account Detail Account Patient Info Guarantor Info 1005488 CHAMBERLAIN REBECCA K CHAMBERLAIN REBECCA K PO BOX 105 PO BOX 105 TUPelo, OK 74572 SSN Phone Cell 580-235-1085 580-235-1086 Demographics Stay Information Admit Date Admit Code Stay Type Service Disch Date Disch Code DOB Physician 10/20/2021 E 11/EMER 3 ER ER 10/20/2021 H HOME /1979 16 BULLARD BRETT Billing Information Cycle Code Call Code Bill Sw Cred Sw Comp DRG Received DRG 2 R R Insurance Information Primary Sw Ins Description Y BB BLUE CROSS OUTPATIENT Y BP BLUE CROSS PHYSICIAN FEE CHAMBERLAIN REBECCA K CHAMBERLAIN REBECCA K <table> <tr> <th>Date</th> <th>Type</th> <th>Code</th> <th>Chrg/Rec</th> <th>STS CLC Number</th> <th>Cty Description</th> <th>CPT</th> <th>NDC</th> <th>Nec</th> <th>Med</th> <th>Charge</th> <th>Credit</th> </tr> <tr> <td>10/20/2021</td><td>PAY</td><td>IN</td><td>13374</td><td></td><td>BP BLUE CROSS PHYSICIAN FEE</td><td>$125.00</td><td></td><td></td><td></td><td>$125.00</td><td></td> </tr> <tr> <td></td><td>PAY</td><td>ER</td><td>14248</td><td></td><td>BB BLUE CROSS OUTPATIENT</td><td></td><td></td><td></td><td></td><td>$125.00</td><td></td> </tr> <tr> <td></td><td>PAY</td><td>IN</td><td>15432</td><td></td><td>BB BLUE CROSS OUTPATIENT</td><td></td><td></td><td></td><td></td><td>$125.00</td><td></td> </tr> <tr> <td>10/20/2021</td><td>PAY</td><td>IN</td><td>13374</td><td></td><td>BP BLUE CROSS PHYSICIAN FEE</td><td>$125.00</td><td></td><td></td><td></td><td>$125.00</td><td></td> </tr> <tr> <td>10/20/2021</td><td>PAY</td><td>ER</td><td>14248</td><td></td><td>BB BLUE CROSS OUTPATIENT</td><td></td><td></td><td></td><td></td><td>$125.00</td><td></td> </tr> <tr> <td>10/20/2021</td><td>PAY</td><td>IN</td><td>15432</td><td></td><td>BB BLUE CROSS OUTPATIENT</td><td></td><td></td><td></td><td></td><td>$125.00</td><td></td> </tr> <tr> <td>12/23/2021</td><td>PAY</td><td>IN</td><td>13374</td><td></td><td>BP BLUE CROSS PHYSICIAN FEE</td><td>$125.00</td><td></td><td></td><td></td><td>$125.00</td><td></td> </tr> <tr> <td>01/10/2022</td><td>PAY</td><td>ER</td><td>14248</td><td></td><td>BB BLUE CROSS OUTPATIENT</td><td></td><td></td><td></td><td></td><td>$295.75</td><td></td> </tr> <tr> <td>01/28/2022</td><td>PAY</td><td>IN</td><td>15432</td><td></td><td>BB BLUE CROSS OUTPATIENT</td><td></td><td></td><td></td><td></td><td>$295.75</td><td></td> </tr> <tr> <td>11/30/2022</td><td>PAY</td><td>IN</td><td>15432</td><td></td><td>BB BLUE CROSS OUTPATIENT</td><td></td><td></td><td></td><td></td><td>$295.75</td><td></td> </tr> <tr> <td>10/27/2025</td><td>PAY</td><td>IN</td><td>15432</td><td></td><td>BB BLUE CROSS OUTPATIENT</td><td></td><td></td><td></td><td></td><td>$295.75</td><td></td> </tr> <tr> <td>10/27/2025</td><td>PAY</td><td>IN</td><td>15432</td><td></td><td>BB BLUE CROSS OUTPATIENT</td><td></td><td></td><td></td><td></td><td>$295.75</td><td></td> </tr> </table> Total Charges: $718.50 Total Adjustment: -$295.75 Less Payments: $295.75 AR Balance: $0.00 <table> <tr> <th>Summary Code</th> <th>Revenue Code</th> <th>Description</th> <th>Charge Summary</th> <th>Bad Debt Balance</th> <th>Amount</th> <th>Days</th> <th>Days Med Nec</th> <th>Units</th> </tr> <tr> <td>36</td> <td>450</td> <td>EMERG ROOM</td> <td></td> <td>0.00</td> <td>130.00</td> <td></td> <td></td> <td>1</td> </tr> <tr> <td>55</td> <td>300</td> <td>Laboratory (Lab)</td> <td></td> <td></td> <td>149.50</td> <td></td> <td></td> <td>3</td> </tr> <tr> <td>77</td> <td>320</td> <td>RADIOLOGY</td> <td></td> <td></td> <td>300.00</td> <td></td> <td></td> <td>1</td> </tr> <tr> <td>78</td> <td>250</td> <td>PHARMACY</td> <td></td> <td></td> <td>12.00</td> <td></td> <td></td> <td>1</td> </tr> <tr> <td>S8</td> <td>0</td> <td>SMALL BALANCE</td> <td></td> <td></td> <td>285.75</td> <td></td> <td></td> <td>1</td> </tr> <tr> <td>SL</td> <td>961</td> <td>PROF FEES-ER</td> <td></td> <td></td> <td>125.00</td> <td></td> <td></td> <td>1</td> </tr> <tr> <td>WO</td> <td>0</td> <td>BAD DEBT WRITE OFF</td> <td></td> <td></td> <td>0.00</td> <td></td> <td></td> <td>2</td> </tr> </table> Name: COAL COUNTY GENERAL HOSPITAL Address: 6 N COVINGTON ST Phone#: COALGATE, OK 74538-2002 Tax ID#: 731235996 Hospital Information COAL COUNTY GENERAL HOSPITAL 6 N COVINGTON ST COALGATE OK 74538 RECORD OF ADMISSION STAY TYPE: H/R SUB TYPE: MR SERVICE: ED-2 EFFECT DATE: 10/31/21 CIVILIAN? PATIENT NAME: CHAMBERLAIN REBECCA K ROOM NO.: 1005694 PHONE NO.: PO BOX 105 ADDRESS LINE - 1 ADDRESS LINE - 3 CITY: TUPELO STATE: OK ZIP CODE: 74572 PATIENT TELEPHONE: 580-235-1085 AGE: 42 SEX: F BIRTHPLACE: NATIONALLITY: W CIVIL ST: MILITARY RELATION: OTHER: HOUSE EMPLOYER NAME: HOUSE EMPLOYER ADDRESSES: HOUSE ADDRESS: NAME OF FATHER: (blacked out) BIRTHPLACE: (blacked out) NAME OF MOTHER: (blacked out) BIRTHPLACE: (blacked out) FINANCIAL CODE: BB MEDICAL RECORD NUMBER: 31925 ADMISSION CODE: 11/EMER HOME TYPE: HOSPITAL POLICY: INTERMEDIATE CARE FACILITY OUTPATIENT CLINIC CHILD DOCT HEALTH DEATH LEFT AMA HELP OTHER TIME AM PM: 10:00 PRINCIPAL DIAGNOSIS: ADVANCE DIRECTIVE = N CODE: SECONDARY DIAGNOSIS: PRINCIPAL OPERATION/DATES: SECONDARY OPERATIONS: Consultation With __________________________ Results: □ Recovered □ Improved □ Not Improved □ Not Treated □ Diagnosis Only □ Died □ Released Against Advice Causes of Death ___________________________ Autopsy: □ Yes □ No I have examined and approved this complete medical record on ___________________________ Signed ___________________________ Attending Physician ADMISSION SUMMARY SHEET Coal County General Hospital Patient Account Detail Account 1005694 Patient info CHAMBERLAIN REBECCA K PO BOX 105 Demographics Guarantor info CHAMBERLAIN REBECCA K PO BOX 105 TUPELO, OK 74572 Phone 580-235-1085 Cell 580-235-1085 Stay Information Physician DODD KANDRA Billing Information Primary Sw Ins Description Y BB BLUE CROSS OUTPATIENT Y BP BLUE CROSS PHYSICIAN FEE CPT NDC Med Charge 00091362511 $19.00 $130.00 $75.00 $74.50 $0.00 $149.50 $149.50 $148.50 Total Charges: 224.00 Total Adjustment: -448.50 Less Payments: 74.50 AR Balance: 0.00 Bad Debt Balanc: 0.00 Charge Summary Summary Code Revenue Code Description Amount 36 450 EMERG ROOM 130.00 78 250 PHARMACY 19.00 3/2/26, 11:20 AM SB 0 SMALL BALANCE -149.50 1 SL 881 PROF FEES-ER 75.00 1 WO 0 BAD DEBT WRITE OFF 0.00 2 Hospital Information Name: COAL COUNTY GENERAL HOSPITAL Address: 6 N COVINGTON ST COALGATE, OK 74538-2002 Phone: Tax ID# : 731235896 COAL COUNTY GENERAL HOSPITAL 6 N COVINGTON ST COALGATE OK 74538 RECORD OF ADMISSION STAY TYPE: REGULAR ROOM #1772 SERVICE: ER EFFECT DATE: 11/07/21 PATIENT INFORMATION: LAST NAME: CHAMBERLAIN FIRST NAME: REBECCA K MIDDLE NAME: K ROOM NO.: RD-1 HOSP. NO.: 1005859 PO BOX: 105 AGE: 42 SEX: F BIRTHPLACE: TUPELO CITY: TUPELO STATE: OK ZIP CODE: 74572 COUNTRY CODE: PATIENT TELEPHONE: 580-235-1065 ADMISSION RECORD: MEDICAL RECORD NUMBER: 31925 ADMISSION CODE: 11/EMER. PRINCIPAL DIAGNOSIS: ADVANCE DIRECTIVE: N SECONDARY DIAGNOSIS: PRINCIPAL OPERATION/DATES: SECONDARY OPERATIONS: Consultation With ____________________________ Results: □ Recovered □ Improved □ Not Improved □ Not Treated □ Diagnosis Only □ Died □ Released Against Advice Cause of Death ____________________________ Autopsy: □ Yes □ No I have examined and approved this complete medical record on ____________________________ Signed ____________________________ Attending Physician ____________________________ ADMISSION - SUMMARY SHEET Coal County General Hospital Patient Account Detail Account 10059859 CHAMBERLAIN REBECCA K PO BOX 105 Demographics Guarantor Info CHAMBERLAIN REBECCA K PO BOX 105 TUPELO, OK 74572 TUPELO, OK 74572 Phone SSN SSN Stay Information Stay Code DOB Physician Billing Information Contract Number Group Received DRG 063 Cycle Code 2 Primary Sw Ins Y Y Description BLUE CROSS OUTPATIENT BLUE CROSS PHYSICIAN FEE <table> <tr> <th>AR</th> <th>Service Date</th> <th>Type</th> <th>Tran Code</th> <th>CPT</th> <th>NDC</th> <th>Med</th> <th>Nac</th> <th>Charge</th> <th>Credit</th> </tr> <tr> <td></td> <td>11/10/2021</td> <td>Pay ER</td> <td>14248</td> <td>B8 BLUE CROSS OUTPATIENT</td> <td></td> <td></td> <td>$58.09</td> <td></td> <td></td> </tr> <tr> <td></td> <td>11/07/2021</td> <td>Pay ER</td> <td>14026</td> <td>BP BLUE CROSS PHYSICIAN FEE</td> <td></td> <td></td> <td>$670.00</td> <td></td> <td></td> </tr> <tr> <td></td> <td>11/07/2021</td> <td>Pay IN</td> <td>15432</td> <td>B8 BLUE CROSS OUTPATIENT</td> <td></td> <td></td> <td>$133.00</td> <td></td> <td></td> </tr> <tr> <td></td> <td>11/18/2021</td> <td>Pay IN</td> <td>15432</td> <td>B8 BLUE CROSS OUTPATIENT</td> <td></td> <td></td> <td>$48.00</td> <td></td> <td></td> </tr> <tr> <td></td> <td>11/18/2021</td> <td>Pay ER</td> <td>14026</td> <td>BP BLUE CROSS PHYSICIAN FEE</td> <td></td> <td></td> <td>$51.00</td> <td></td> <td></td> </tr> <tr> <td></td> <td>10/27/2022</td> <td>Pay IN</td> <td>15432</td> <td>B8 BLUE CROSS OUTPATIENT</td> <td></td> <td></td> <td>$48.00</td> <td></td> <td></td> </tr> <tr> <td></td> <td>10/27/2022</td> <td>Pay IN</td> <td>15432</td> <td>B8 BLUE CROSS OUTPATIENT</td> <td></td> <td></td> <td>$90.00</td> <td></td> <td></td> </tr> <tr> <td></td> <td>10/27/2022</td> <td>Pay IN</td> <td>15432</td> <td>B8 BLUE CROSS OUTPATIENT</td> <td></td> <td></td> <td>$197.50</td> <td></td> <td></td> </tr> </table> Total Charges: $98.09 Total Adjustment: -$187.50 Less Payments: 762.59 AR Balance: $197.50 Bad Debt Balanc: $0.00 Charge Summary <table> <tr> <th>Summary Code</th> <th>Revenue Code</th> <th>Description</th> <th>Amount</th> <th>Days</th> <th>Days Med Nec</th> <th>Units</th> </tr> <tr> <td>36</td> <td>450</td> <td>EMERG ROOM</td> <td>670.00</td> <td></td> <td></td> <td>1</td> </tr> <tr> <td>55</td> <td>300</td> <td>Laboratory (Lab)</td> <td>157.09</td> <td></td> <td></td> <td>3</td> </tr> <tr> <td>SB</td> <td>0</td> <td>SMALL BALANCE</td> <td>-197.50</td> <td></td> <td></td> <td>1</td> </tr> <tr> <td>SL</td> <td>981</td> <td>PROF FEES-ER</td> <td>133.00</td> <td></td> <td></td> <td>1</td> </tr> <tr> <td>WO</td> <td>0</td> <td>BAD DEBT WRITE OFF</td> <td>0.00</td> <td></td> <td></td> <td>2</td> </tr> </table> Name: COAL COUNTY GENERAL HOSPITAL Address: 6 N COVINGTON ST Phone#: COALGATE, OK 74538-2002 Tax ID#: 731235996 Hospital Information Coal County General Hospital 6 N. Covington St Coalgate, OK 74538 (580) 927-2327 July 2nd, 2025 To Whom it May Concern: As Chief Executive Officer of Coal County General Hospital, Inc., I hereby certify that Coal County General Hospital is in full compliance with all applicable state and federal hospital price transparency laws, including but not limited to the Oklahoma Transparency in Health Care Prices Act, Title 63, section 1-725.1 et seq. of the Oklahoma Statutes. This certification is intended to meet the requirements of Title 12, section 193(B)(2) of the Oklahoma Statutes. Sincerely, Chris Martin, CEO Coal County General Hospital, Inc. Payment History by Account Number After Statement AcctID AcctNum Payment Date Payment Type