2021-08-12T11:07:07-05:00 2020-09-30 560747981 DIXON HUGHES GOODMAN LLP 500 RIDGEFIELD COURT ASHEVILLE NC 28806 990 2019-10-01 271198701 HAMILTON PHYSICIAN GROUP INC HAMI 7068765000 PO BOX 1168 DALTON GA 307221168 JULIE A SOEKORO VP/CFO/ASST TREASURER 7068765000 2021-08-11 1 AMY BIBBY P00445891 8282542254 2021-08-11 2019 2022-09-23 18:48:47Z JEFFREY D MYERS PO BOX 1168 DALTON GA 307221168 21623197 0 X N/A X 2009 GA HAMILTON PHYSICIAN GROUP (HPG) PROVIDES VARIOUS PHYSICIAN SPECIALTY SERVICES TO THE CITY OF DALTON AND WHITFIELD COUNTY. DURING THE FISCAL YEAR ENDED SEPTEMBER 30, 2018, HPG HAD 111,186 OUTPATIENT VISITS. HPG'S VISION IS TO SERVE THE NEEDS OF AREA RESIDENTS WITHOUT DISCRIMINATION AND REGARDLESS OF ABILITY TO PAY. 5 2 252 0 0 0 0 491399 22266061 20499492 -176283 0 175055 632306 22264833 21623197 0 0 0 0 29238918 30858718 0 0 0 7363043 8785040 36601961 39643758 -14337128 -18020561 4922726 5421680 7603443 10218453 -2680717 -4796773 AS AN AFFILIATE OF HAMILTON HEALTH CARE SYSTEM, HAMILTON PHYSICIAN GROUP, 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 39153509 20499492 HAMILTON PHYSICIAN GROUP, INC. (HPG) PROVIDES SPECIALTY PHYSICIAN SERVICES TO THE CITY OF DALTON, WHITFIELD COUNTY, AND SURROUNDING AREAS OF NORTHWEST GEORGIA. DURING FISCAL YEAR 2020, HPG HAD 144,033 OUTPATIENT VISITS. HPG'S MISSION IS TO SERVE THE NEEDS OF AREA RESIDENTS WITHOUT DISCRIMINATION AND REGARDLESS OF ABILITY TO PAY. THUS, HPG PROVIDED $597,587 IN CHARITY CARE AT ESTABLISHED RATES FOR PATIENTS UNABLE TO PAY FOR THEIR HEALTH CARE SERVICES DURING THE YEAR. IN ADDITION, CHARGES OF $13,884,096 WERE NOT COLLECTED DUE TO SHORTFALLS FROM MEDICARE AND MEDICAID. 39153509 1 1 0 0 0 0 0 0 0 0 1 0 0 0 1 1 0 1 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 25 0 1 252 1 0 0 0 0 0 0 0 0 0 0 0 0 X 5 2 0 0 0 0 0 1 1 1 1 0 0 1 1 1 1 1 1 1 1 0 GA X JOSEPH L MCGUIRE 7062782105 1200 MEMORIAL DRIVE DALTON GA 30720 BRYAN D CHEEVER MD CHAIRMAN 40.00 X X 378256 0 39514 ROBERT M CHANDLER VICE CHAIRMAN 1.00 X X 0 0 0 JEFFREY D MYERS PRESIDENT/CEO/TREASURER 1.00 40.00 X X 0 1378962 119775 SANDRA D MCKENZIE SECRETARY / VP 1.00 40.00 X X 0 601763 62414 JOSHUA L HARE DO TRUSTEE 1.00 X 1306013 0 88890 RANDALL F FOSTER ASSISTANT SECRETARY 1.00 40.00 X 0 277862 35270 JULIE A SOEKORO ASSISTANT TREASURER 1.00 40.00 X 0 61103 6500 STEPHEN ROHN MD PHYSICIAN 40.00 X 617208 143330 78408 TOMMY BLEDSOE JR MD PHYSICIAN EXECUTIVE-POPULATION HEALTH 40.00 X 647876 0 98261 DANIEL MARCADIS MD PHYSICIAN 40.00 X 709481 0 73853 JUSTIN HARE DO PHYSICIAN 40.00 X 788151 0 23843 SAMUEL CRITIDES JR MD PHYSICIAN 40.00 X 1245218 0 26227 SYED AGHA MD PHYSICIAN 40.00 X 978604 0 32075 ERIC GUERRA MD PHYSICIAN 40.00 X 940654 0 92023 JOSEPH L MCGUIRE FORMER ASSISTANT TREASURER 0.00 0.00 X 0 327168 33533 7611461 2790188 810586 62 1 1 0 COMPHEALTH PO BOX 972651 DALLAS TX 75397 LOCUM TENENS 396181 HAMILTON MEDICAL CENTER INC PO BOX 1168 DALTON GA 30722 DIAGNOSTICS PURCHASED SERVICES 222463 TODD J BAKER 1015 N EDGEHILL CT PEORIA IL 61604 MANAGMENT CONSULTING 190613 WELLSTAR HEALTH SYSTEM INC 1800 PARKWAY PLACE STE 500 MARRIETTA GA 30067 PROFESSIONAL FEES 151490 HUNTER MACLEAN EXLEY & DUNN PC 200 EAST ST JULIEAN STREET SAVANNAH GA 31401 LEGAL FEES 103381 5 491399 491399 NET PATIENT SERVICE RE 621990 20499492 20499492 20499492 MISCELLANEOUS INCOME 900099 632306 632306 632306 21623197 20499492 0 632306 2949353 2949353 22666085 22666085 868458 868458 3129124 3129124 1245698 1245698 286000 286000 204249 204249 2468130 2468130 10073 10073 1965655 1965655 1785680 1785680 175067 175067 279170 279170 1609328 1609328 MISCELLANEOUS EXPENSE 1688 1688 39643758 39153509 490249 0 88773 269068 2646308 2644875 849894 765225 3248036 1505524 1337751 1742512 4922726 5421680 4119065 6392371 3484378 3826082 7603443 10218453 X -2680717 -4796773 -2680717 -4796773 4922726 5421680 X -18020561 15904505 X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 420976 51862 369114 2827060 1453662 1373398 1742512 NOTE TO HAMILTON MEDICAL CENTER 3826082 3826082 X PART X, LINE 2: THE SYSTEM HAS ADOPTED PROCEDURES FOR DETERMINING THE EXISTENCE OF UNCERTAIN TAX POSITIONS, AND THE RELATED TIMING AND AMOUNT OF THEIR IMPACT ON THE FINANCIAL STATEMENTS, AND DETERMINED THAT THERE ARE NO UNCERTAIN TAX POSITIONS AS OF SEPTEMBER 30, 2020. 0 1 0 0 0 0 0 0 0 BRYAN D CHEEVER MD CHAIRMAN 203732 0 127326 0 47198 0 15174 0 24340 0 417770 0 2563 0 JEFFREY D MYERS PRESIDENT/CEO/TREASURER 0 901149 0 308775 0 169038 0 52987 0 66788 0 1498737 0 38987 SANDRA D MCKENZIE SECRETARY / VP 0 364688 0 103179 0 133896 0 23884 0 38530 0 664177 0 9884 JOSHUA L HARE DO TRUSTEE 1013763 0 253237 0 39013 0 67416 0 21474 0 1394903 0 53416 0 RANDALL F FOSTER ASSISTANT SECRETARY 0 211299 0 19048 0 47515 0 11730 0 23540 0 313132 0 0 STEPHEN ROHN MD PHYSICIAN 467334 143330 106339 0 43535 0 26069 16666 24340 11333 667617 171329 12069 16666 TOMMY BLEDSOE JR MD PHYSICIAN EXECUTIVE-POPULATION HEALT 301906 0 238365 0 107605 0 28913 0 69348 0 746137 0 15692 0 DANIEL MARCADIS MD PHYSICIAN 473963 0 187871 0 47647 0 14000 0 59853 0 783334 0 0 0 JUSTIN HARE DO PHYSICIAN 427101 0 305988 0 55062 0 14000 0 9843 0 811994 0 0 0 SAMUEL CRITIDES JR MD PHYSICIAN 1208215 0 8134 0 28869 0 4537 0 21690 0 1271445 0 0 0 SYED AGHA MD PHYSICIAN 611406 0 348198 0 19000 0 14000 0 18075 0 1010679 0 0 0 ERIC GUERRA MD PHYSICIAN 646498 0 251508 0 42648 0 42146 0 49877 0 1032677 0 28146 0 JOSEPH L MCGUIRE FORMER ASSISTANT TREASURER 0 193982 0 0 0 133186 0 10073 0 23460 0 360701 0 101684 PART I, LINE 4B THE FOLLOWING PERSONS RECEIVED CURRENT YEAR DEFERRED COMPENSATION ACCRUALS FROM NON-QUALIFIED PLANS: - JEFFREY D. MYERS - $ 38,987 - SANDRA D. MCKENZIE - $ 9,884 - STEPHEN ROHN, MD - $ 28,735 - TOMMY BLEDSOE, JR. - $ 15,692 - JOSHUA L. HARE, DO - $ 53,416 - ERIC GUERRA, MD - $ 28,146 - BRYAN D. CHEEVER - $ 2,563 FORM 990, PART VI, SECTION A, LINE 7A THE REGULAR TRUSTEES OF THE ORGANIZATION ARE APPOINTED BY THE BOARD OF TRUSTEES OF HAMILTON MEDICAL CENTER, 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 FOLLOWING MANAGEMENT PREPARATION AND REVIEW, THE FORM 990 IS REVIEWED BY AN INDEPENDENT CPA FIRM. 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 BOARD 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 REQUIRES 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 ORGANIZATION'S COMPENSATION COMMITTEE HAS THE AUTHORITY TO TAKE ACTION ON BEHALF OF THE BOARD WITH RESPECT TO THE COMPENSATION OF OFFICERS AND KEY EMPLOYEES. THE COMPENSATION COMMITTEE MAINTAINS MINUTES OF ITS PROCEEDINGS. ON AN ANNUAL BASIS THE COMPENSATION COMMITTEE 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 XI, LINE 9: CHANGE IN ACCRUED LIABILITY CLAIMS 1,301,181. DISTRIBUTION FROM RELATED ENTITY EQUITY TRANSFER 14,603,324. 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 0 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 MEDICAL CENTER INC PO BOX 1168 DALTON GA 30722 581519911 HEALTHCARE GA 501(C)(3) LINE 3 HAMILTON HEALTH CARE SYSTEM INC 0 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 MURRAY MEDICAL CENTER INC PO BOX 1168 DALTON GA 30722 582373427 HOSPITAL CARE / SERVICES GA 501(C)(3) LINE 3 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 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 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 WHITFIELD HEALTHCARE FOUNDATION INC PO BOX 1900 DALTON GA 30722 510175056 FUNDS FOR HEALTHCARE GA 501(C)(3) LINE 12B, II HAMILTON HEALTH CARE SYSTEM INC 0 HAMILTON CHILDREN'S INSTITUTE INC PO BOX 1168 DALTON GA 30722 823312912 PEDIATRIC DEVELOPMENTAL/BEHAVIORAL TREATMENT GA 501(C)(3) LINE 10 HAMILTON HEALTH CARE SYSTEM INC 0 HAMILTON HEALTH FIRST INC PO BOX 1168 DALTON GA 30722 581694713 PREFERRED PROVIDER GA N/A C 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0