2019-06-28T10:45:33-05:00 2018-09-30 560747981 DIXON HUGHES GOODMAN LLP 500 RIDGEFIELD COURT ASHEVILLE NC 28806 990 2017-10-01 581519911 HAMILTON MEDICAL CENTER INC HAMI 7062782105 PO BOX 1168 DALTON GA 307221168 JOSEPH L MCGUIRE VP/CFO 7062782105 2019-06-28 1 AMY BIBBY P00445891 8282542254 2019-06-28 24.241.144.70 2019-06-28 10:34:35 ED P 6DA4B0C79C306AA0BD087F1CE311720CD318C7AF 3C4A73C7F70BFF54BAAC11A85090BDFB39FC8B01 2017 2020-03-31 21:24:44Z JEFFREY D MYERS PO BOX 1168 DALTON GA 307221168 409045109 0 X HAMILTONHEALTH.COM X 1983 GA HAMILTON MEDICAL CENTER, INC. OPERATES A 282-BED, ACUTE CARE HOSPITAL, INCLUDING A 24-HOUR EMERGENCY ROOM IN DALTON, GA. DURING THE FISCAL YEAR ENDED 09/30/2018, THE MEDICAL CENTER HAD 46,313 PATIENT DAYS AND 233,322 OUTPATIENT VISITS. HAMILTON SERVES THE NEEDS OF AREA RESIDENTS WITHOUT DISCRIMINATION AND REGARDLESS OF ABILITY TO PAY. 9 8 1438 175 45540 -93230 4500000 4500000 240735511 258742484 8062740 10676277 5742866 6023348 259041117 279942109 0 0 0 0 117291577 122368706 0 0 0 102918708 112415103 220210285 234783809 38830832 45158300 512136692 665966221 150254139 243458563 361882553 422507658 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 191758033 260173625 HAMILTON MEDICAL CENTER, INC. OPERATES A 282-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 09/30/2018, THE MEDICAL CENTER HAD 46,313 PATIENT DAYS AND 233,322 OUTPATIENT VISITS. HAMILTON SERVES THE NEEDS OF AREA RESIDENTS WITHOUT DISCRIMINATION AND REGARDLESS OF ABILITY TO PAY. ACCORDINGLY, THE HOSPITAL PROVIDED $47,944,674 IN CHARITY CARE AT ESTABLISHED RATES TO PATIENTS UNABLE TO PAY FOR THEIR HEALTH CARE SERVICES THIS FISCAL YEAR. IN ADDITION, CAHRGES OF $533,719,128 WERE NOT COLLECTED DUE TO SHORTFALLS FROM MEDICARE AND MEDICAID. 191758033 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 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 1 221 0 1 1438 1 1 1 0 0 0 0 0 0 0 0 0 X 9 8 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 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 S CRAIG TIDWELL MD TRUSTEE 1.00 X 0 0 0 WALLACE R WEEKS MD TRUSTEE 1.00 X 0 0 0 JEFFREY D MYERS PRESIDENT/CEO 1.00 40.00 X X 0 1176982 114023 JOSEPH L MCGUIRE VP/CFO/ASST. TREASURER 1.00 40.00 X 0 585223 55902 RANDALL F FOSTER ASSISTANT TREASURER 40.00 X 192722 0 30788 SANDRA D MCKENZIE EXECUTIVE VP/COO 40.00 X 554469 0 75758 ALFRED D WRIGHT VICE PRESIDENT 40.00 X 273949 0 45729 CATHY L FERGUSON VICE PRESIDENT 40.00 X 350359 0 99369 STEPHEN G ROHN MD VP/PHYSICIAN 40.00 X 535780 431155 145260 ERNALDO ELEMENTO VICE PRESIDENT 40.00 X 293378 0 56610 JOHN FORRESTER VICE PRESIDENT 40.00 X 318693 0 18447 TODD HARRISON VICE PRESIDENT 40.00 X 257226 0 55401 MICHAEL HARTLEY MD PHYSICIAN 40.00 X 605581 0 58145 WINDSOR PAMPHILE MD PHYSICIAN 40.00 X 425091 0 32933 HARVEER MANN MD PHYSICIAN 40.00 X 372523 0 19011 ATRAC KAY MD PHYSICIAN 40.00 X 350015 0 0 JEFFREY BOUADOU MD PHYSICIAN 40.00 X 346871 0 14575 4876657 2193360 821951 114 0 1 0 BRASFIELD & GORRIE LLC PO BOX 11407 BIRMINGHAM AL 35246 GENERAL CONTRACTOR 8066323 LAYTON CONSTRUCTION COMPANY LLC 9090 SOUTH SANDY PARKWAY SANDY UT 84070 GENERAL CONTRACTOR 6965461 CERNER HEALTH SERVICES INC PO BOX 40065 ATLANTA GA 31192 I.S. CONSULTING AND SUPPORT 6673344 TU PARKS CONSTRUCTION CO 711 E MAIN ST CHATTANOOGA TN 37408 GENERAL CONTRACTOR 5961484 DALTON ANESTHESIA ASSOCIATES PC PO BOX 789 DALTON GA 30722 PROFESSIONAL SERVICES 2158416 88 4500000 4500000 NET PATIENT SERVICE RE 900099 255474674 255474674 WELLNESS CENTER 713940 2074192 2074192 MANAGEMENT FEES 561000 1193618 1193618 258742484 6627305 6627305 3017481 0 3017481 3017481 3017481 133010590 141382 129091653 11347 3918937 130035 4048972 4048972 VENDOR REBATES 900099 1031241 1031241 GIFT SHOP 453220 345398 345398 EDUCATION 611710 54502 54502 1574726 45540 1529186 3005867 279942109 260173625 45540 15222944 X 2776576 2776576 91000106 87721710 3278396 3186342 2980606 205736 19643894 18375527 1268367 5761788 5389761 372027 2148183 2148183 1064269 1064269 134608 134608 1139476 1139476 26425133 25525133 900000 341120 341120 17469418 3018645 14450773 6123766 6123766 8541817 8541817 246595 246595 362423 362423 5599235 5599235 13463228 13463228 442770 442770 MEDICAL SUPPLIES 24529440 24529440 PROVIDER TAX 2872751 2872751 MISCELLANEOUS 1510871 1510871 234783809 191758033 43025776 0 12038875 12683504 5222352 3142064 23232673 25833315 17522987 16175044 3590178 4151750 9840264 13649504 410550386 222670259 149642462 187880127 262168204 351615130 18305874 18248381 10572823 32587402 512136692 665966221 25979492 31495456 122913166 210468733 1361481 1494374 150254139 243458563 X 361882553 422507658 361882553 422507658 512136692 665966221 X 45158300 28489626 -13022821 X X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 22185274 22185274 181501180 76912236 104588944 173040898 143352056 29688842 33823034 2405967 31417067 187880127 ASSET RETIREMENT OBLIGATION 1494374 1494374 X PART X, LINE 2: THE ORGANIZATION 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, 2018. 1 1 X 1 X 125.000000000000 1 X 1 1 1 0 1 1 10049573 4000000 6049573 0.02580 32530678 25617415 6913263 0.02940 42580251 29617415 12962836 0.05520 1361874 113163 1248711 0.00530 14537836 7653145 6884691 0.02930 477668 477668 0.00200 16377378 7766308 8611070 0.03660 58957629 37383723 21573906 0.09180 1 14844849 3711212 61939482 66803354 -4863872 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 15 1 0 0 1 X HTTPS://WWW.HAMILTONHEALTH.COM/ABOUT/CHNA-IMPLEMENTATION-STRATEGY/ X 1 15 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 HTTPS://WWW.HAMILTONHEALTH.COM/PATIENTS-VISITORS/PATIENT-RESOURCES/BILL-PAY X HTTPS://WWW.HAMILTONHEALTH.COM/PATIENTS-VISITORS/PATIENT-RESOURCES/BILL-PAY X HTTPS://WWW.HAMILTONHEALTH.COM/PATIENTS-VISITORS/PATIENT-RESOURCES/BILL-PAY X X X X X X 1 X 0 X X X X 1 X 0 0 HAMILTON MEDICAL CENTER PART V, SECTION B, LINE 11: HAMILTON MEDICAL CENTER, INC. IDENTIFIED THE SEVEN TOP AREAS TO FOCUS ON OUT OF ALL NEEDS IDENTIFIED BY THE ASSESSMENT. THESE SEVEN 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, CARIAC 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 ANNUAL COMMUNITY BENEFIT INFORMATION IS INCLUDED IN A SPECIAL SECTION OF HAMILTONHEALTH, A MAGAZINE PUBLISHED QUARTERLY BY HAMILTON HEALTH CARE SYSTEM (HHCS). HAMILTONHEALTH IS MADE AVAILABLE BY DIRECT MAIL TO HOUSEHOLDS IN THE PRIMARY SERVICE AREA; WAITING AREAS AROUND THE CAMPUS; IN WAITING AREAS OF PHYSICIAN OFFICES IN THE PRIMARY SERVICE AREA; AND ON THE HHCS WEBSITE, WWW.HAMILTONHEALTH.COM. 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 FOLLOWING DEPARTMENTS AND SERVICES: - BEHAVIORAL HEALTH SERVICES $ 1,478,244 - HOME HEALTH SERVICES 4,631,276 - HOSPICE CARE 775,189 TOTAL TO PART I, LINE 7G, COL (E): $ 6,884,691 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 2 AND 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: "FOR UNINSURED AND UNDERINSURED PATIENTS THAT DO NOT QUALIFY FOR FINANCIAL ASSISTANCE, HMC RECOGNIZES REVENUE ON THE BASIS OF ESTABLISHED RATES, DISCOUNTED ACCORDING TO POLICY FOR SERVICES RENDERED. HISTORICAL EXPERIENCE HAS SHOWN A SIGNIFICANT PROPORTION OF HMC'S UNINSURED PATIENTS, IN ADDITION TO A GROWING PROPORTION OF HMC'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 ACCOUNTS RECEIVABLE ASSOCIATED WITH THIRD-PARTY PAYORS AND UNINSURED PATIENTS, MANAGEMENT REGULARLY ASSESSES THE ADEQUACY OF THE ALLOWANCE AND PROVISION FOR DOUBTFUL ACCOUNTS BASED UPON BUSINESS AND ECONOMIC CONSIDERATIONS, TRENDS IN HEALTHCARE COVERAGE, HISTORICAL WRITE-OFF EXPERIENCE AND OTHER COLLECTION TRENDS. BASED ON THESE HISTORICAL ANALYSES, HMC RECORDS A PROVISION AND ALLOWANCE FOR DOUBTFUL ACCOUNTS FOR THIRD-PARTY AND UNINSURED PATIENT ACCOUNTS RECEIVABLEBALANCES FOR WHICH THE PATIENT IS RESPONSIBLE." 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 MEDICARE ALLOWABLE COSTS REPORTED ON LINE 6 WERE DERIVED FROM THE MEDICARE COST REPORT UTILIZING ALLOWABLE METHODS UNDER MEDICARE GUIDELINES. 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 AUGUST 2016. IN ORDER TO ASSESS THE UNMET PHYSICIAN NEEDS OF WHITFIELD AND MURRAY COUNTIES, PHYSICIAN NEEDS ASSESSMENTS ARE PERIODICALLY CONDUCTED, MOST RECENTLY IN AUGUST 2016. PART VI, LINE 3: HAMILTON MEDICAL CENTER PROVIDES CARE REGARDLESS OF ABILITY TO PAY. HMC EMPLOYS TWO FULL TIME FINANCIAL COUNSELORS WHO ARE RESPONSIBLE FOR EDUCATING PATIENTS AND RESPONSIBLE PARTIES OF POTENTIAL PAYMENT OPTIONS AS WELL AS THE ORGANIZATION'S FINANCIAL ASSISTANCE PROGRAM. THE FINANCIAL COUNSELORS ASSIST PATIENTS WITH THE COMPLETION OF THE FINANCIAL ASSISTANCE APPLICATION AND PROCESS THE APPLICATION FOR APPROVAL. HMC ALSO EMPLOYS 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 88% OF THE FACILITY'S VOLUME. THE SERVICE AREA HAS A POPULATION OF 143,983 CONSISTING OF 104,062 AND 39,921 IN WHITFIELD AND MURRAY COUNTIES, RESPECTIVELY. MINORITY POPULATIONS IN WHITFIELD COUNTY CONSIST OF HISPANIC (36%) AND AFRICAN AMERICAN (4%). APPROXIMATELY 17% OF THE POPULATION LIVE BELOW THE POVERTY LEVEL. MINORITY POPULATIONS IN MURRAY COUNTY CONSIST OF HISPANIC (15%) AND AFRICAN AMERICAN (1%). APPROXIMATELY 17% 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 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; WHITFIELD HEALTHCARE FOUNDATION, INC., A PHILANTHROPIC ORGANIZATION; AND HAMILTON CHILDREN'S INSTITUTE, INC., A PROVIDER OF PEDIATRIC DEVELOPMENTAL AND BEHAVIORAL TREATMENT. HAMILTON AMBULATORY SURGERY CENTER, INC., A MULTI-SPECIALTY SURGERY CENTER, AND HAMILTON PHYSICIAN GROUP, INC., A MULTI-SPECIALTY ORGANIZATION OF PHYSICIAN PRACTICES, 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 673911 0 299431 0 203640 0 46385 0 67638 0 1291005 0 32885 JOSEPH L MCGUIRE VP/CFO/ASST. TREASURER 0 307121 0 160703 0 117399 0 13500 0 42402 0 641125 0 92522 RANDALL F FOSTER ASSISTANT TREASURER 151067 0 15341 0 26314 0 9234 0 21554 0 223510 0 0 0 SANDRA D MCKENZIE EXECUTIVE VP/COO 310467 0 107152 0 136850 0 16129 0 59629 0 630227 0 3967 0 ALFRED D WRIGHT VICE PRESIDENT 162101 0 51053 0 60795 0 11789 0 33940 0 319678 0 0 0 CATHY L FERGUSON VICE PRESIDENT 212049 0 75731 0 62579 0 10273 0 89096 0 449728 0 0 0 STEPHEN G ROHN MD VP/PHYSICIAN 358313 321395 93509 91725 83958 18035 29109 12479 103672 0 668561 443634 15609 12479 ERNALDO ELEMENTO VICE PRESIDENT 175747 0 56625 0 61006 0 9607 0 47003 0 349988 0 0 0 JOHN FORRESTER VICE PRESIDENT 183824 0 58410 0 76459 0 10075 0 8372 0 337140 0 0 0 TODD HARRISON VICE PRESIDENT 126673 0 43320 0 87233 0 9384 0 46017 0 312627 0 0 0 MICHAEL HARTLEY MD PHYSICIAN 381278 0 205215 0 19088 0 33712 0 24433 0 663726 0 20212 0 WINDSOR PAMPHILE MD PHYSICIAN 399007 0 6944 0 19140 0 13500 0 19433 0 458024 0 0 0 HARVEER MANN MD PHYSICIAN 361696 0 8194 0 2633 0 0 0 19011 0 391534 0 0 0 ATRAC KAY MD PHYSICIAN 332015 0 0 0 18000 0 0 0 0 0 350015 0 0 0 JEFFREY BOUADOU MD PHYSICIAN 323944 0 4139 0 18788 0 0 0 14575 0 361446 0 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 - $ 32,885 - MICHAEL HARTLEY - $ 20,212 - STEPHEN ROHN - $ 28,088 - SANDRA D. MCKENZIE - $3,967 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 A 55334834 734527 54600306 2012 1 0 1 1 B 60203454 200700 20057259 34044631 2016 1 0 1 1 C 95318444 1260588 22501276 71556580 0 0 0 1 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 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 A 0 B 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 FOLLOWING MANAGEMENT PREPARATION AND REVIEW, THE FORM 990 IS REVIEWED BY AN INDEPENDENT PUBLIC ACCOUNTING FIRM. SUBSEQUENTLY, A DRAFT 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 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 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 PROCEDURES. 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 THRID 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 25,525,133. MANAGEMENT AND GENERAL EXPENSES 900,000. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 26,425,133. FORM 990, PART XI, LINE 9: CHANGE IN LIABILITY CLAIMS ACCRUAL 8,686. DISTRIBUTION TO RELATED ENTITY -13,031,507. 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