2024-08-14T13:10:20-05:00 2023-09-30 621517792 PYA P C 2220 SUTHERLAND AVE KNOXVILLE TN 37919 990 2022-10-01 581519911 HAMILTON MEDICAL CENTER INC HAMI 7062726115 PO BOX 1168 DALTON GA 307221168 JULIE A SOEKORO VP/CFO/ASST TREASURER 7062726115 2024-08-14 1 0 DEBORAH O ERNSBERGER P00364912 8656730844 2022 2024-08-08 14:25:15Z JEFFREY D MYERS PO BOX 1168 DALTON GA 307221168 695115491 0 X WWW.HAMILTONHEALTH.COM X 1983 GA HAMILTON MEDICAL CENTER, INC. OPERATES A 255-BED, ACUTE CARE HOSPITAL, INCLUDING A 24-HOUR EMERGENCY ROOM IN DALTON, GA. DURING THE FISCAL YEAR ENDED 09/30/2023, THE MEDICAL CENTER HAD 46,915 PATIENT DAYS AND 211,102 OUTPATIENT VISITS. HAMILTON SERVES THE NEEDS OF AREA RESIDENTS WITHOUT DISCRIMINATION AND REGARDLESS OF ABILITY TO PAY. 11 10 2294 80 37960 0 9787857 8709364 358210535 382719955 8340134 14079640 7398556 7345636 383737082 412854595 0 0 0 0 158524191 177589504 0 0 0 174277550 182265187 332801741 359854691 50935341 52999904 791470584 845414203 214228846 220994595 577241738 624419608 AS AN AFFILIATE OF HAMILTON HEALTH CARE SYSTEM, HAMILTON MEDICAL CENTER, INC. SUPPORTS THE SYSTEM MISSION OF PROVIDING LEADERSHIP, PARTNERSHIPS AND SEAMLESS RESOURCE COORDINATION TO MEET HEALTH CARE NEEDS THAT ADVANCE THE QUALITY AND DIGNITY OF LIFE. 0 0 296060393 382719955 HAMILTON MEDICAL CENTER, INC. OPERATES A 255-BED, ACUTE CARE HOSPITAL, INCLUDING A 24-HOUR EMERGENCY ROOM, WHICH SERVES THE NEEDS OF RESIDENTS OF THE CITY OF DALTON, WHITFIELD COUNTY AND SURROUNDING AREAS OF NORTHWEST GEORGIA. DURING THE FISCAL YEAR ENDED 09/30/2023, THE MEDICAL CENTER HAD 46,915 PATIENT DAYS AND 211,102 OUTPATIENT VISITS. HAMILTON SERVES THE NEEDS OF AREA RESIDENTS WITHOUT DISCRIMINATION AND REGARDLESS OF ABILITY TO PAY. ACCORDINGLY, THE HOSPITAL PROVIDED $78,787,254 IN CHARITY CARE AT ESTABLISHED RATES TO PATIENTS UNABLE TO PAY FOR THEIR HEALTH CARE SERVICES THIS FISCAL YEAR. IN ADDITION, CHARGES OF $785,327,839 WERE NOT COLLECTED DUE TO SHORTFALLS FROM MEDICARE AND MEDICAID. 296060393 1 1 0 0 0 0 0 0 0 0 1 0 1 0 1 1 0 1 0 0 0 0 0 0 0 0 1 1 0 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 0 0 0 1 362 0 1 2294 1 1 1 0 0 0 0 0 0 0 0 0 X 11 10 0 0 0 0 0 1 1 1 1 0 0 1 1 1 1 1 1 1 1 0 GA X JULIE A SOEKORO 7062782105 1200 MEMORIAL DRIVE DALTON GA 30720 JEFFREY D MYERS PRESIDENT/CEO 1.00 40.00 X X 0 1609084 135112 ROBERT M CHANDLER CHAIRMAN 1.00 X X 0 0 0 ROBERT H BROOKER VICE CHAIRMAN 1.00 X X 0 0 0 ROBERT B HUBBS SECRETARY/TREASURER 1.00 X X 0 0 0 J DAVID GREGG TRUSTEE 1.00 X 0 0 0 AYMAN RIFAI MD TRUSTEE 1.00 X 0 0 0 W SCOTT SELLERS TRUSTEE 1.00 X 0 0 0 OLIVER F COBB TRUSTEE 1.00 X 0 0 0 ZABDIEL MENDEZ TRUSTEE 1.00 X 0 0 0 MICHAEL D WILSON MD TRUSTEE 1.00 X 0 0 0 MATHEW D SMITH MD TRUSTEE 1.00 X 0 0 0 JULIE A SOEKORO CFO/TREASURER 1.00 40.00 X 0 721943 112436 RANDALL F FOSTER ASSISTANT TREASURER 40.00 X 0 246469 12592 CHRISTOPHER DELASHMITT MD VP & CMO 40.00 X 635589 0 32107 ERNALDO ELEMENTO VICE PRESIDENT 40.00 X 371867 0 52682 ALFRED D WRIGHT VICE PRESIDENT 40.00 X 343390 0 28914 BRYAN CHEEVER RESIDENCY DIRECTOR 40.00 X 309210 0 3773 JUDEAN GUINN VICE PRESIDENT 40.00 X 374769 0 38210 KRISTINE GODFREY VICE PRESIDENT 40.00 X 144227 63080 3730 NED WIGGS VICE PRESIDENT 40.00 X 257441 0 12722 MICHAEL HARTLEY MD PHYSICIAN 40.00 X 771363 0 42320 HECTOR DOURRON MD PHYSICIAN 40.00 X 702210 0 33714 TOMMY BLEDSOE JR PHY. EXEC. POPULATION HEALTH 40.00 X 481952 0 75419 WINDSOR PAMPHILE MD PHYSICIAN 40.00 X 492562 0 26390 MAHESHKUMAR DESAI MD PHYSICIAN 40.00 X 517469 0 23664 CATHY L FERGUSON FORMER VICE PRESIDENT 40.00 X 330431 0 41122 5732480 2640576 674907 261 1 1 0 TU PARKS CONSTRUCTION CO 711 E MAIN ST CHATTANOOGA TN 37408 GENERAL CONTRACTOR 13334964 EPIC SYSTEMS CORPORATION 1979 MILKY WAY VERONA WI 53593 EMR 7293017 NORTH GEORGIA ANETHESIA SERVICES PC 1200 MEMORIAL DR DALTON GA 307202529 PROFESSIONAL SERVICES 6170093 BRASSFIELD & GORRIE LLC PO BOX 11407 BIRMINGHAM AL 35246 GENERAL CONTRACTOR 4962598 MEDIX STAFFING SOLUTIONS 222 S RIVERSIDE PLAZA SUITE 2120 CHICAGO IL 60606 STAFFING SERVICES 3858777 125 6897097 1812267 8709364 NET PATIENT SERVICE REVENUE 900099 379581888 379581888 WELLNESS CENTER 713940 1697428 1697428 MANAGEMENT FEES 561000 1440639 1440639 382719955 9340569 9340569 3800716 0 3800716 3800716 3800716 286611792 388175 282260896 0 4350896 388175 4739071 4739071 VENDOR REBATES 900099 1682671 1682671 GIFT SHOP 459420 598744 598744 EDUCATION 611710 92302 92302 1171203 37960 1133243 3544920 412854595 382719955 37960 21387316 X 2766924 2766924 141981264 133717188 8264076 4293514 3966313 327201 19643844 18146822 1497022 8903958 8225403 678555 3486563 3486563 840100 840100 37006 37006 1106335 1106335 37267371 34447371 2820000 112152 112152 24296064 3627945 20668119 7562805 7562805 11386249 11386249 158371 158371 696088 696088 7353030 7353030 24808483 24808483 1754878 1754878 MEDICAL SUPPLIES 56625397 56625397 PROVIDER TAX 3815028 3815028 MISCELLANEOUS 959267 959267 359854691 296060393 63794298 0 14236187 15947996 6835582 8661045 42983280 40071832 17418287 14691246 5853533 6872885 12389900 22852804 645857907 316352574 290909191 329505333 314786587 322138260 26837283 24897855 59220754 59524947 250000 791470584 845414203 26165450 38119831 186591517 181596267 1471879 1278497 214228846 220994595 X 577241738 624419608 577241738 624419608 791470584 845414203 X 52999904 14708165 -20530199 X X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 35992614 35992614 300028931 118469084 181559847 249395406 194512724 54882682 60440956 3370766 57070190 329505333 PROGRAM RELATED INVESTMENTS 59524947 C 59524947 ASSET RETIREMENT OBLIGATION 1278497 1278497 X PART X, LINE 2: HMC HAS ADOPTED PROCEDURES FOR DETERMINING THE EXISTENCE OF UNCERTAIN TAX POSITIONS, AND THE RELATED TIMING AND AMOUNT OF THEIR IMPACT ON THE CONSOLIDATED FINANCIAL STATEMENTS, AND DETERMINED THAT THERE ARE NO UNCERTAIN TAX POSITIONS AS OF SEPTEMBER 30, 2023 AND 2022. 1 1 X 1 X 125.000000000000 1 X 1 1 1 0 1 1 16904149 16904149 0.04700 42854983 37450539 5404444 0.01500 59759132 37450539 22308593 0.06200 1962316 105229 1857087 0.00520 7817151 7552102 265049 0.00070 173500 173500 0.00050 9952967 7657331 2295636 0.00640 69712099 45107870 24604229 0.06840 1 24904915 6226229 76384115 86606444 -10222329 X 1 1 1 1 HAMILTON MEDICAL CENTER 1200 MEMORIAL DRIVE DALTON GA 30720 X X X HAMILTON MEDICAL CENTER 1 0 0 1 X X X X X X X X X 21 1 0 0 1 X HTTPS://WWW.HAMILTONHEALTH.COM/ABOUT/CHNA-IMPLEMENTATION-STRATEGY/ X 1 21 1 HTTPS://WWW.HAMILTONHEALTH.COM/ABOUT/CHNA-IMPLEMENTATION-STRATEGY/ 0 1 X 125.000000000000 250.000000000000 X X X 1 1 X X X X 1 X WWW.HAMILTONHEALTHCARE.COM/PATIENTS-VISITORS/PATIENT-RESOURCES/BILL-PAY X WWW.HAMILTONHEALTHCARE.COM/PATIENTS-VISITORS/PATIENT-RESOURCES/BILL-PAY X WWW.HAMILTONHEALTHCARE.COM/PATIENTS-VISITORS/PATIENT-RESOURCES/BILL-PAY X X X X X X 1 X 0 X X X 1 X 0 0 HAMILTON MEDICAL CENTER PART V, SECTION B, LINE 11: HAMILTON MEDICAL CENTER, INC. IDENTIFIED THE TOP SIX AREAS TO FOCUS ON OUT OF ALL NEEDS IDENTIFIED BY THE ASSESSMENT. THESE SIX ARE CONSIDERED THE MOST SIGNIFICANT HEALTH NEEDS IN THE COMMUNITY AND WILL BE COVERED BY THE IMPACT INITIATIVES. OTHER HEALTH NEEDS IDENTIFIED IN THE ASSESSMENT BUT NOT DEEMED SIGNIFICANT MAY BE INDIRECTLY IMPACTED BY THE INITIATIVES, BUT RESOURSE CONSTRAINTS PREVENT THE NEEDS FROM BEING ADDRESSED DIRECTLY. HAMILTON MEDICAL CENTER PART V, SECTION B, LINE 16J: UPON CONSULTATION WITH THE FINANCIAL COUNSELORS, THE FINANCIAL ASSISTANCE POLICY IS PRESENTED AND EXPLAINED. ASSISTANCE IS ALSO OFFERED FOR COMPLETION OF THE APPLICATION FOR FINANCIAL ASSISTANCE. 9 1 - HAMILTON DIAGNOSTIC CENTER 1407 NORTH THORNTON AVENUE DALTON GA 30720 DIAGNOSTIC IMAGING, SLEEP DISORDERS 2 - HAMILTON SPECIALTY IMAGING 1436 BROADRICK DRIVE DALTON GA 30720 DIAGNOSTIC IMAGING 3 - HAMILTON WOUND CARE 1109 BURLEYSON ROAD DALTON GA 30720 WOUND CARE 4 - ENDOVASCULAR SURGERY PRACTICE 1109 BURLEYSON ROAD DALTON GA 30720 ENDOVASCULAR SERVICES 5 - HAMILTON CONVENIENT CARE 1012 BURLEYSON ROAD DALTON GA 30720 URGENT CARE CLINIC, FAMILY PRACTICE 6 - HAMILTON SPINE CENTER 1107 MEMORIAL DRIVE DALTON GA 30720 SPINE CARE CLINIC 7 - BRADLEY WELLNESS CENTER 1250 BROADRICK DRIVE DALTON GA 30720 FITNESS, CARDIAC REHAB, PHYS./OCC. THERAPY 8 - NEPHROLOGY PRACTICE 1506 BROADRICK DRIVE DALTON GA 30720 NEPHROLOGY SERVICES 9 - DIABETES TREATMENT CENTER 1109 BURLEYSON ROAD DALTON GA 30720 DIABETES TREATMENT CENTER PART I, LINE 6A: HAMILTON MEDICAL CENTER'S COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA) AND CORRESPONDING IMPLEMENTATION STRATEGY ARE COMPLETED EVERY THREE YEARS AND ARE PUBLICLY AVAILABLE ON THE ORGANIZATION'S WEBSITE: WWW.HAMILTONHEALTH.COM/ABOUT/CHNA-IMPLEMENTATION-STRATEGY/. A PAPER COPY IS ALSO AVAILABLE FREE OF CHARGE BY REQUEST. PART I, LINE 7: COSTS FOR THE PURPOSE OF PART I, LINE 7 ARE COMPUTED USING A COST-TO-CHARGES RATIO. PART I, LINE 7G: SUBSIDIZED HEALTH SERVICES PRESENTED ON PART I, LINE 7 INCLUDE THE DEPARTMENTS AND SERVICES: HOME HEALTH SERVICES & HOSPICE CARE PART III, LINE 2: THE ORGANIZATION UTILIZES A COST TO CHARGE RATIO PART III, LINE 3: THE ORGANIZATION ESTIMATES THAT 25% OF THOSE REPORTED AS BAD DEBT WOULD QUALIFY FOR FINANCIAL ASSISTANCE IF THE INDIVIDUAL APPLIED FOR ASSISTANCE. PART III, LINE 4: HAMILTON MEDICAL CENTER 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, THIRD-PARTY PAYORS ARE BILLED DIRECTLY AND THE PATIENT'S PORTION IS DETERMINED AND BILLED SUBSEQUENTLY. ACCOUNTS NOT MEETING CHARITY ASSISTANCE GUIDELINES AND UNPAID AFTER CERTAIN COLLECTION EFFORTS ARE CONSIDERED DELINQUENT AND WRITTEN OFF AS BAD DEBTS.THE COSTING METHODOLOGY USED TO DETERMINE THE AMOUNT REPORTED ON LINES 2AND 3 IS COST TO CHARGE RATIO.THE AUDITED FINANCIAL STATEMENT FOR HAMILTON HEALTH CARE SYSTEM, INC, WHICH INCLUDES HAMILTON MEDICAL CENTER, REPORTS THE PROVISION FOR DOUBTFUL ACCOUNTS AT ESTABLISHED RATES AND CONTAINS THE FOLLOWING FOOTNOTE: HAMILTON MEDICAL CENTER, INC. 58-1519911 "IMPLICIT PRICE CONCESSIONS FOR UNINSURED AND UNDERINSURED PATIENTS THAT DO NOT QUALIFY FOR FINANCIAL ASSISTANCE ARE ESTIMATED BASED ON HISTORICAL COLLECTION EXPERIENCE WITH THIS CLASS OF PATIENTS USING A PORTFOLIO APPROACH AS A PRACTICAL EXPEDIENT. FOR UNINSURED AND UNDERINSURED PATIENTS THAT DO NOT QUALIFY FOR FINANCIAL ASSISTANCE, THE SYSTEM RECOGNIZES REVENUE ON THE BASIS OF ESTABLISHED RATES, DISCOUNTED ACCORDING TO POLICY FOR SERVICES RENDERED. HISTORICAL EXPERIENCE HAS SHOWN A SIGNIFICANT PROPORTION OF THE SYSTEM'S UNINSURED PATIENTS, IN ADDITION TO A GROWING PROPORTION OF THE SYSTEM'S INSURED PATIENTS, WILL BE UNABLE OR UNWILLING TO PAY FOR THEIR RESPONSIBLE AMOUNTS FOR THE SERVICES PROVIDED. IN ORDER TO ESTIMATE THE NET REALIZABLE VALUE OF THE REVENUES AND ACCOUNTSRECEIVABLE ASSOCIATED WITH THIRD-PARTY PAYORS AND UNINSURED PATIENTS, MANAGEMENT REGULARLY ASSESSES THEIR VALUATION BASED UPON BUSINESS AND ECONOMIC CONSIDERATIONS, TRENDS IN HEALTHCARE COVERAGE, HISTORICAL WRITE-OFF EXPERIENCE AND OTHER COLLECTION TRENDS."SINCE HAMILTON MEDICAL CENTER PROVIDES CARE REGARDLESS OF ABILITY TO PAY, A PORTION OF THE PROVISION FOR DOUBTFUL ACCOUNTS SHOULD BE INCLUDED IN COMMUNITY BENEFIT. PART III, LINE 8: HAMILTON MEDICAL CENTER BELIEVES THAT THE ENTIRE AMOUNT OF MEDICARE SHORTFALL SHOULD BE CONSIDERED COMMUNITY BENEFIT. IT IS LIKELY THAT MANY OF THE INDIVIDUALS WOULD QUALIFY FOR CHARITY CARE OR OTHER NEEDS-BASED GOVERNMENT PROGRAMS AND THE BURDENS OF GOVERNMENT ARE RELIEVED UPON ACCEPTANCE OF PAYMENT LESS THAN COST. THE AMOUNT REPORTED WAS DERIVED FROM A COST ACCOUNTING SYSTEM THAT INCLUDES ALL SERVICE LINES AND PAYORS. PART III, LINE 9B: HAMILTON MEDICAL CENTER'S COLLECTIONS POLICY CONTAINS PROVISIONS RELATED TO THE MEDICALLY INDIGENT. PATIENTS WHO STATE THAT THEY HAVE LIMITED RESOURCES OR AN INABILITY TO PAY ARE SCREENED FOR ELIGIBILITY FOR CHARITY ASSISTANCE UNDER THE MEDICAL CENTER'S POLICY. QUALIFYING PATIENTS' ACCOUNTS ARE PARTIALLY OR FULLY WRITTEN-OFF UNDER POLICY PROVISIONS. UPON DETERMINATION OF PATIENT RESPONSIBILITY, BALANCES NOT QUALIFYING FOR ASSISTANCE ARE SUBJECTED TO A COLLECTION CYCLE WITH REGULAR NOTICES AND STATEMENTS. IF PAYMENT ARRANGEMENTS HAVE NOT BEEN MADE UPON COMPLETION OF THE COLLECTION CYCLE, THE ACCOUNT IS WRITTEN-OFF AND REFERRED FOR EXTERNAL COLLECTION FOLLOW-UP. PART VI, LINE 2: HAMILTON MEDICAL CENTER, IN CONJUNCTION WITH HAMILTON HEALTH CARE SYSTEM AND OTHER AFFILIATES, WORKS CLOSELY WITH LOCAL GOVERNMENT AND NOT-FOR-PROFIT AGENCIES TO ASSESS AND MEET THE COMMUNITY NEEDS IDENTIFIED IN THE COMMUNITY HEALTH NEEDS ASSESSMENT. THE LATEST CHNA WAS COMPLETED BY HAMILTON MEDICAL CENTER IN 2022. IN ORDER TO ASSESS THE UNMET PHYSICIAN NEEDS OF WHITFIELD AND MURRAY COUNTIES, PHYSICIAN NEEDS ASSESSMENTS ARE PERIODICALLY CONDUCTED, MOST RECENTLY IN 2018. PART VI, LINE 3: HAMILTON MEDICAL CENTER PROVIDES CARE REGARDLESS OF ABILITY TO PAY. HMC EMPLOYS TWO FULL TIME PATIENT ACCOUNT LIAISONS WHO ARE RESPONSIBLE FOR EDUCATING PATIENTS AND RESPONSIBLE PARTIES OF POTENTIAL PAYMENT OPTIONS AS WELL AS THE ORGANIZATION'S FINANCIAL ASSISTANCE PROGRAM. THE PATIENT ACCOUNT LIAISONS ASSIST PATIENTS WITH THE COMPLETION OF THE FINANCIAL ASSISTANCE APPLICATION AND PROCESS THE APPLICATION FOR APPROVAL. HMC ALSO EMPLOYS HAMILTON MEDICAL CENTER, INC. 58-1519911 THE SERVICES OF A MEDICAID ELIGIBILITY SERVICE TO ASSIST ELIGIBLE PATIENTS WITH OBTAINING MEDICAID COVERAGE. PART VI, LINE 4: HAMILTON MEDICAL CENTER'S PRIMARY SERVICE AREA CONSISTS OF WHITFIELD AND MURRAY COUNTIES IN NORTHWEST GEORGIA AND REPRESENTS 89% OF THE FACILITY'S VOLUME. THE SERVICE AREA HAS A POPULATION OF 144,722 CONSISTING OF 103,687 AND 41,035 IN WHITFIELD AND MURRAY COUNTIES, RESPECTIVELY. MINORITY POPULATIONS IN WHITFIELD COUNTY CONSIST OF HISPANIC (37.5%) AND AFRICAN AMERICAN (4.5%). APPROXIMATELY 12.9% OF THE POPULATION LIVE BELOW THE POVERTY LEVEL. MINORITY POPULATIONS IN MURRAY COUNTY CONSIST OF HISPANIC (16.7%) AND AFRICAN AMERICAN (1.7%). APPROXIMATELY 13.3% OF THE POPULATION LIVE BELOW THE POVERTY LEVEL. PART VI, LINE 5: HAMILTON MEDICAL CENTER (HMC), INCLUDING ITS RELATED AFFILIATES, IS ORGANIZED AND OPERATED FOR CHARITABLE PURPOSES WITH THE GOAL OF PROMOTING THE HEALTH OF THE COMMUNITIES IT SERVES. HMC SUPPORTS THIS MISSION WITH A COMMUNITY BOARD, OPEN MEDICAL STAFF AND AN EMERGENCY ROOM AVAILABLE TO PATIENTS REGARDLESS OF ABILITY TO PAY. THE BOARD IS COMPOSED OF CIVIC LEADERS AND PHYSICIANS WHO RESIDE IN THE HOSPITAL'S SERVICE AREA. THE BOARD SETS POLICY AND STRATEGIC DIRECTION AND DETERMINES THE USE OF SURPLUS FUNDS IN FURTHERANCE OF THE HOSPITAL'S CHARITABLE PURPOSE. PART VI, LINE 6: HAMILTON MEDICAL CENTER, INC. (HMC) IS A CONTROLLED AFFILIATE OF HAMILTON HEALTH CARE SYSTEM, INC. (SYSTEM), WHEREBY THE TRUSTEES AND OFFICERS ARE ELECTED AND APPOINTED BY THE BOARD OF TRUSTEES OF SYSTEM. OTHER HAMILTON MEDICAL CENTER, INC. 58-1519911 CONTROLLED AFFILIATES INCLUDE: DALTON SENIOR HOUSING, INC. AND WHITFIELD PLACE, INC., PROVIDERS OF HOUSING TO LOW INCOME SENIORS AND HANDICAPPED INDIVIDUALS; HAMILTON EMERGENCY MEDICAL SERVICES, INC., WHICH OPERATES WHITFIELD EMERGENCY MEDICAL SERVICES; HLTC, INC., A LONG-TERM CARE SERVICES PROVIDER; MURRAY MEDICAL CENTER, INC.; ROYAL OAK COMMUNITY, LTD., A RETIREMENT COMMUNITY; AND WHITFIELD HEALTHCARE FOUNDATION, INC., A PHILANTHROPIC ORGANIZATION. HAMILTON AMBULATORY SURGERY CENTER, INC., A MULTI-SPECIALTY SURGERY CENTER, AND HAMILTON PHYSICIAN GROUP, INC., A MULTI-SPECIALTY ORGANIZATION OF PHYSICIAN PRACTICES, AND HAMILTON CHILDREN'S INSTITUTE ARE CONTROLLED AFFILIATES OF HMC. X X 1 1 X X X 0 1 0 0 0 0 0 0 0 JEFFREY D MYERS PRESIDENT/CEO 0 955987 0 479272 0 173825 0 59300 0 75812 0 1744196 0 44050 JULIE A SOEKORO CFO/TREASURER 0 391721 0 188023 0 142199 0 31097 0 81339 0 834379 0 15593 MICHAEL HARTLEY MD PHYSICIAN 487717 0 261675 0 21971 0 36014 0 6306 0 813683 0 20764 0 HECTOR DOURRON MD PHYSICIAN 466435 0 205393 0 30382 0 32408 0 1306 0 735924 0 17158 0 CHRISTOPHER DELASHMITT MD VP & CMO 373740 0 154946 0 106903 0 15250 0 16857 0 667696 0 0 0 TOMMY BLEDSOE JR PHY. EXEC. POPULATION HEALTH 351783 0 7556 0 122613 0 23469 0 51950 0 557371 0 9875 0 MAHESHKUMAR DESAI MD PHYSICIAN 457648 0 18222 0 41599 0 22358 0 1306 0 541133 0 7593 0 WINDSOR PAMPHILE MD PHYSICIAN 427005 0 18222 0 47335 0 25084 0 1306 0 518952 0 11427 0 ERNALDO ELEMENTO VICE PRESIDENT 204443 0 91086 0 76338 0 12562 0 40120 0 424549 0 0 0 JUDEAN GUINN VICE PRESIDENT 206301 0 95964 0 72504 0 11442 0 26768 0 412979 0 0 0 ALFRED D WRIGHT VICE PRESIDENT 194141 0 80170 0 69079 0 10426 0 18488 0 372304 0 0 0 CATHY L FERGUSON FORMER VICE PRESIDENT 269523 0 0 0 60908 0 17130 0 23992 0 371553 0 3593 0 BRYAN CHEEVER RESIDENCY DIRECTOR 250682 0 6795 0 51733 0 0 0 3773 0 312983 0 2598 0 NED WIGGS VICE PRESIDENT 204574 0 31650 0 21217 0 10827 0 1895 0 270163 0 0 0 RANDALL F FOSTER ASSISTANT TREASURER 0 185361 0 31063 0 30045 0 11569 0 1023 0 259061 0 0 KRISTINE GODFREY VICE PRESIDENT 142267 30008 0 32293 1960 779 593 631 1511 995 146331 64706 0 0 PART I, LINE 1A THE PERSONAL USE PORTION OF BOTH SPOUSAL TRAVEL AND SOCIAL CLUB DUES ARE INCLUDED IN THE RECIPIENTS TAXABLE WAGES. PART I, LINE 4B THE FOLLOWING PERSONS RECEIVED CURRENT YEAR DEFERRED COMPENSATION ACCRUALS FROM NON-QUALIFIED PLANS: - JEFFREY D. MYERS - $44,050 - JULIE A. SOEKORO - $15,593 - MICHAEL HARTLEY, MD - $20,764 - CATHY FERGUSON - $3,593 - TOMMY BLEDSOE, JR. - $9,875 - HECTOR DOURRON, MD - $17,158 - MAHESHKUMAR DESAI, MD - $7,593 - WINDSOR PHAMPILE, MD - $11,427 - BRYAN CHEEVER - $2,598 THE FOLLOWING PERSONS RECEIVED CURRENT YEAR DEFERRED COMPENSATION ACCRUALS FROM NON-QUALIFIED SERP PLANS: - JEFFREY D. MYERS - $405,000 - SANDRA D. MCKENZIE - $75,000 A DEVELOPMENT AUTHORITY OF THE CITY OF DALTON 581519911 235550FGO 2012-12-05 55334800 REFUND BONDS ISSUED 12/18/96, 04/01/98, & 09/04/03 0 0 0 B DEVELOPMENT AUTHORITY OF THE CITY OF DALTON 581519911 NONEAVAIL 2012-12-05 60200000 REFUND BONDS ISSUED 11/18/92 & 09/04/03, IMPROVEMENTS TO MEDICAL CENTER 0 0 0 C DALTON-WHITFIELD COUNTY JOINT DEVELOPMENT AUTHORITY 581519911 235641AM9 2017-12-21 90000000 ACQUIRE, CONSTRUCT, RENOVATE AND EQUIP HEALTHCARE FACILITIES 0 0 0 D DEVELOPMENT AUTHORITY OF THE CITY OF DALTON 581519911 NONEAVAIL 2022-06-09 31165000 REFUND BONDS ISSUED 12/5/12 0 0 0 A 31165000 55334834 734527 54600306 2012 1 0 1 1 B 60203454 200700 20057259 34044631 2016 1 0 1 1 C 96897633 1260588 96897633 0 0 1 1 D 31165000 31165000 1 0 1 0 A 0 0 0 0 0.01500 0.01500 0 0 0 B 0 0 0 0 0.00610 0.00610 0 0 0 C 0 0 0 0 0 0 0 D 0 0 0 0 0 0 0 A 0 1 0 0 0 0 0 0 1 B 0 1 0 0 1 0 0 0 1 C 0 1 0 0 0 0 0 0 1 D 0 1 0 0 0 0 0 0 0 FORM 990, PART VI, SECTION A, LINE 7A THE REGULAR TRUSTEES OF THE ORGANIZATION ARE APPOINTED BY THE BOARD OF TRUSTEES OF HAMILTON HEALTH CARE SYSTEM, INC. FORM 990, PART VI, SECTION A, LINE 7B CERTAIN CAPITAL EXPENDITURE AND CONTRACTUAL COMMITMENT DECISIONS MUST BE SUBSEQUENTLY APPROVED BY THE HAMILTON HEALTH CARE SYSTEM BOARD OF TRUSTEES. FORM 990, PART VI, SECTION B, LINE 11B THE FORM 990 IS PREPARED BY AN INDEPENDENT CPA FIRM AND REVIEWED BY EXECUTIVE MANAGEMENT. SUBSEQUENTLY, A DRAFT COPY OF THE UNFILED FORM 990 IS POSTED TO A SECURE PAGE ON THE HAMILTON HEALTH CARE SYSTEM WEBSITE FOR REVIEW AND COMMENT BY ALL MEMBERS OF THE BOAD OF TRUSTEES PRIOR TO FILING WITH THE INTERNAL REVENUE SERVICE. FORM 990, PART VI, SECTION B, LINE 12C THE ORGANIZATION HAS A CLEAR AND DETAILED CONFLICT OF INTEREST POLICY WHICH ESTABLISHES A PROCEDURE FOR IDENTIFYING, REVIEWING AND ADDRESSING CONFLICTS OF INTEREST. THIS POLICY ALSO REQUIRED EACH TRUSTEE AND OFFICER OF THE ORGANIZATION TO ANNUALLY SIGN A STATEMENT ACKNOWLEDGING RECEIPT OF THE CONFLICT OF INTEREST POLICY. FORM 990, PART VI, SECTION B, LINE 15 UNDER A BOARD RESOLUTION, THE FINANCE & AUDIT COMMITTEE OF HAMILTON HEALTH CARE SYSTEM HAS THE AUTHORITY TO TAKE ACTION ON BEHALF OF THE BOARD WITH RESPECT TO THE COMPENSATION OF OFFICERS AND KEY EMPLOYEES. THE FINANCE & AUDIT COMMITTEE OF HAMILTON HEALTH CARE SYSTEM MAINTAINS MINUTES OF ITS PROCEDURES. ON AN ANNUAL BASIS THE FINANCE & AUDIT COMMITTEE OF HAMILTON HEALTH CARE SYSTEM WILL MEET TO SET THE ANNUAL COMPENSATION OF THE PRESIDENT/CEO. THIS ACTION IS BASED ON CONSULTATION WITH A THIRD PARTY CONSULTING FIRM TO REVIEW THE TOTAL COMPENSATION OF THE CEO AND KEY EMPLOYEES SUCH THAT TOTAL COMPENSATION PACKAGES ARE CONSIDERED FAIR MARKET AND NOT EXCESSIVE. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION MAKES ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UPON REQUEST FORM 990, PART IX, LINE 11G OTHER: PROGRAM SERVICE EXPENSES 34,447,371. MANAGEMENT AND GENERAL EXPENSES 2,820,000. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 37,267,371. FORM 990, PART XI, LINE 9: DISTRIBUTION TO RELATED ENTITY (HPG) -20,888,514. CHANGE IN LIABILITY CLAIMS ACCRUAL -669,340. TRANSFER OF INVESTMENT TO(FROM) LIABILITY CLAIMS TRUST 1,027,655. FORM 990, PART XII, LINE 2: FINANCIAL STATEMENTS OF HAMILTON MEDICAL CENTER, INC ARE AUDITED ON A CONSOLIDATED BASIS TO INCLUDE HAMILTON AMBULATORY SURGERY CENTER, INC. AND HAMILTON PHYSICIAN GROUP, INC, BOTH OF WHICH ARE WHOLLY-OWNED SUBSIDIARIES EXEMPT UNDER SECTION 501(C)(3). HAMILTON HEALTH CARE SYSTEM INC PO BOX 1168 DALTON GA 30722 581519913 SUPPORT RELATED ENTITIES GA 501(C)(3) LINE 12B, II N/A 0 DALTON SENIOR HOUSING INC 519 WEST HAWTHORNE STREET DALTON GA 30720 581518011 LOW-INCOME HOUSING GA 501(C)(3) LINE 10 HAMILTON HEALTH CARE SYSTEM INC 0 HAMILTON AMBULATORY SURGERY CENTER INC PO BOX 1168 DALTON GA 30722 582654791 SURGICAL SERVICES GA 501(C)(3) LINE 3 HAMILTON MEDICAL CENTER INC 1 HAMILTON EMERGENCY MEDICAL SERVICES INC PO BOX 1168 DALTON GA 30722 581651002 EMERGENCY MEDICAL GA 501(C)(3) LINE 10 HAMILTON HEALTH CARE SYSTEM INC 0 HAMILTON PHYSICIAN GROUP INC PO BOX 1168 DALTON GA 30722 271198701 PHYSICIAN PRACTICE GA 501(C)(3) LINE 3 HAMILTON MEDICAL CENTER INC 1 HLTC INC PO BOX 1168 DALTON GA 30722 582341574 LONG TERM ELDERLY CARE GA 501(C)(3) LINE 10 HAMILTON HEALTH CARE SYSTEM INC 0 ROYAL OAK COMMUNITY LTD PO BOX 1900 DALTON GA 30722 581970228 SENIOR LIVING SERVICES GA 501(C)(3) LINE 10 HAMILTON HEALTH CARE SYSTEM INC 0 DALTON-WHITFIELD COUNTY HOSPITAL LIABILITY TRUST PO BOX 1168 DALTON GA 30722 581331514 LIABILITY CLAIMS COVERAGE GA 501(C)(3) LINE 12C, III-FI HAMILTON HEALTH CARE SYSTEM INC 0 HAMILTON CHILDREN'S INSTITUTE PO BOX 1168 DALTON GA 30722 823312912 PEDIATRIC DEVELOPMENTAL/BEHAVIORAL HEALTH TREATMENT GA 501(C)(3) LINE 10 HAMILTON HEALTH CARE SYSTEM INC 0 WHITFIELD HEALTHCARE FOUNDATION INC PO BOX 1168 DALTON GA 30722 510175056 FUNDS FOR HEALTHCARE GA 501(C)(3) LINE 12B, II HAMILTON HEALTH CARE SYSTEM INC 0 WHITFIELD PLACE INC PO BOX 1168 DALTON GA 30722 582103085 LOW-INCOME HOUSING GA 501(C)(3) LINE 10 HAMILTON HEALTH CARE SYSTEM INC 0 DALTON-WHITFIELD ADDITIONAL TRUST PO BOX 1168 DALTON GA 30722 586345013 FUNDS FOR INDIGENT CARE GA 501(C)(3) LINE 12C, III-FI N/A 0 DALTON-WHITFIELD INDIGENT CARE TRUST PO BOX 1168 DALTON GA 30722 586345011 FUNDS FOR INDIGENT CARE GA 501(C)(3) LINE 12C, III-FI N/A 0 HAMILTON ORTHOPEDIC SURGERY CENTER PO BOX 1168 DALTON GA 30722 873430438 ORTHOPEDIC SURGERY CENTER GA N/A 0 0 HAMILTON HEALTH FIRST INC PO BOX 1168 DALTON GA 307221168 581694713 PREFERRED PROVIDER ORGANIZATION GA HAMILTON MEDICAL CENTER INC C 1.00000 0 HMC HOLDINGS INC PO BOX 1168 DALTON GA 307221168 TITLE HOLDING GA HAMILTON MEDICAL CENTER INC C 1.00000 0 1 0 1 1 0 0 0 0 0 0 0 0 1 0 1 0 1 1 1 HAMILTON AMBULATORY SURGERY CENTER INC A 686496 FMV HAMILTON AMBULATORY SURGERY CENTER INC O 1803715 FMV HAMILTON AMBULATORY SURGERY CENTER INC P -1240166 FMV HAMILTON AMBULATORY SURGERY CENTER INC Q 1490060 FMV HAMILTON PHYSICIAN GROUP INC D 20365965 INCR. 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