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HAMILTON MEDICAL CENTER INC: Form 990, tax year 2011

View the entire original 990 at ProPublica ↗

Organization
HAMILTON MEDICAL CENTER INC (EIN 58-1519911)
Tax period
2011-10-01 to 2012-09-30
Filed
2013-05-14
IRS object ID
201311349349307416
Schema version
2011v1.5
Source
Download XML · Original 990 at ProPublica

Every field in the e-filed return. Faint text is the IRS element name, for citing.

Return header ReturnHeader

FieldValueIRS element (for citing)
Timestamp2013-05-14T17:29:30-05:00Timestamp
Tax Period End Date2012-09-30TaxPeriodEndDate

Preparer Firm PreparerFirm

FieldValueIRS element (for citing)
EIN560747981EIN

Preparer Firm Business Name PreparerFirmBusinessName

FieldValueIRS element (for citing)
Business Name Line1DIXON HUGHES GOODMAN LLPBusinessNameLine1

Preparer Firm US Address PreparerFirmUSAddress

FieldValueIRS element (for citing)
Address Line1500 RIDGEFIELD COURTAddressLine1
CityASHEVILLECity
StateNCState
ZIP Code28806ZIPCode
FieldValueIRS element (for citing)
Return Type990ReturnType
Tax Period Begin Date2011-10-01TaxPeriodBeginDate

Filer Filer

FieldValueIRS element (for citing)
EIN581519911EIN

Name Name

FieldValueIRS element (for citing)
Business Name Line1HAMILTON MEDICAL CENTER INCBusinessNameLine1
FieldValueIRS element (for citing)
Name ControlHAMINameControl
Phone7062782105Phone

US Address USAddress

FieldValueIRS element (for citing)
Address Line1PO BOX 1168AddressLine1
CityDALTONCity
StateGAState
ZIP Code307221168ZIPCode

Officer Officer

FieldValueIRS element (for citing)
NameGARY L HOWARDName
TitleVP/CFO/ASSIST SECRETARY/TREASTitle
Phone7062782105Phone
Date Signed2013-05-14DateSigned
Authorize Third Party1AuthorizeThirdParty

Preparer Preparer

FieldValueIRS element (for citing)
NameAMY BIBBYName
PTINP00445891PTIN
Phone8282542254Phone
FieldValueIRS element (for citing)
Tax Year2011TaxYear
Build TS2016-02-25 16:41:14ZBuildTS

Form 990 IRS990

FieldValueIRS element (for citing)
Name Of Principal Officer PersonJEFFREY D MYERSNameOfPrincipalOfficerPerson

Address Principal Officer US AddressPrincipalOfficerUS

FieldValueIRS element (for citing)
Address Line1PO BOX 1168AddressLine1
CityDALTONCity
StateGAState
ZIP Code307221168ZIPCode
FieldValueIRS element (for citing)
Gross Receipts275803502GrossReceipts
Group Return For Affiliates0GroupReturnForAffiliates
Organization501c3XOrganization501c3
Web SiteHAMILTONHEALTH.COMWebSite
Type Of Organization CorporationXTypeOfOrganizationCorporation
Year Formation1983YearFormation
State Legal DomicileGAStateLegalDomicile
Activity Or Mission DescriptionHAMILTON MEDICAL CENTER, INC. OPERATES A 282-BED, ACUTE CARE HOSPITAL, INCLUDING A 24-HOUR EMERGENCY ROOM IN DALTON, GA. DURING THE FISCAL YEAR ENDED 09/30/2012, THE MEDICAL CENTER HAD 43,817 PATIENT DAYS AND 252,954 OUTPATIENT VISITS. HAMILTON SERVES THE NEEDS OF AREA RESIDENTS WITHOUT DISCRIMINATION AND REGARDLESS OF ABILITY TO PAY.ActivityOrMissionDescription
Nbr Voting Members Governing Body9NbrVotingMembersGoverningBody
Nbr Independent Voting Members7NbrIndependentVotingMembers
Total Nbr Employees1427TotalNbrEmployees
Total Nbr Volunteers209TotalNbrVolunteers
Total Gross UBI63938TotalGrossUBI
Net Unrelated Business Txbl Income-65267NetUnrelatedBusinessTxblIncome
Contributions Grants Prior Year2549849ContributionsGrantsPriorYear
Contributions Grants Current Year3775000ContributionsGrantsCurrentYear
Program Service Revenue Prior Year207121057ProgramServiceRevenuePriorYear
Program Service Revenue CY178050848ProgramServiceRevenueCY
Investment Income Prior Year9275930InvestmentIncomePriorYear
Investment Income Current Year7346073InvestmentIncomeCurrentYear
Other Revenue Prior Year3492459OtherRevenuePriorYear
Other Revenue Current Year7223106OtherRevenueCurrentYear
Total Revenue Prior Year222439295TotalRevenuePriorYear
Total Revenue Current Year196395027TotalRevenueCurrentYear
Grants And Similar Amnts Prior Year0GrantsAndSimilarAmntsPriorYear
Grants And Similar Amnts CY0GrantsAndSimilarAmntsCY
Benefits Paid To Members Prior Year0BenefitsPaidToMembersPriorYear
Benefits Paid To Members CY0BenefitsPaidToMembersCY
Salaries Etc Prior Year82825518SalariesEtcPriorYear
Salaries Etc Current Year87608689SalariesEtcCurrentYear
Total Prof Fundrsng Exp Prior Year0TotalProfFundrsngExpPriorYear
Total Prof Fundrsng Exp CY0TotalProfFundrsngExpCY
Total Fundrsng Exp Current Year0TotalFundrsngExpCurrentYear
Other Expense Prior Year118478988OtherExpensePriorYear
Other Expenses Current Year86681807OtherExpensesCurrentYear
Total Expenses Prior Year201304506TotalExpensesPriorYear
Total Expenses Current Year174290496TotalExpensesCurrentYear
Revenues Less Expenses Prior Year21134789RevenuesLessExpensesPriorYear
Revenues Less Expenses CY22104531RevenuesLessExpensesCY
Total Assets BOY306739010TotalAssetsBOY
Total Assets EOY339939496TotalAssetsEOY
Total Liabilities BOY127018132TotalLiabilitiesBOY
Total Liabilities EOY127145738TotalLiabilitiesEOY
Net Assets Or Fund Balances BOY179720878NetAssetsOrFundBalancesBOY
Net Assets Or Fund Balances EOY212793758NetAssetsOrFundBalancesEOY
Mission DescriptionWE EXIST TO SERVE PEOPLE THROUGH THE MINISTRY OF HEALTHCAREMissionDescription
Significant New Program Services0SignificantNewProgramServices
Significant Change0SignificantChange
Expense152488227Expense
Grants0Grants
Revenue179112697Revenue
DescriptionHAMILTON 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 09/30/2012, THE MEDICAL CENTER HAD 43,817 PATIENT DAYS AND 252,954 OUTPATIENT VISITS. HAMILTON SERVES THE NEEDS OF AREA RESIDENTS WITHOUT DISCRIMINATION AND REGARDLESS OF ABILITY TO PAY. ACCORDINGLY, THE HOSPITAL PROVIDED $43,850,956 IN CHARITY CARE AT ESTABLISHED RATES TO PATIENTS UNABLE TO PAY FOR THEIR HEALTH CARE SERVICES THIS FISCAL YEAR. IN ADDITION, CAHRGES OF $245,422,638 WERE NOT COLLECTED DUE TO SHORTFALLS FROM MEDICARE AND MEDICAID.Description
Total Program Service Expense152488227TotalProgramServiceExpense
Described In501 C31DescribedIn501C3
Schedule B Required1ScheduleBRequired
Political Activities0PoliticalActivities
Lobbying Activities0LobbyingActivities
Subject To Proxy Tax0SubjectToProxyTax
Donor Advised Funds0DonorAdvisedFunds
Conservation Easements0ConservationEasements
Collections Of Art0CollectionsOfArt
Credit Counseling0CreditCounseling
Term Or Permanent Endowments0TermOrPermanentEndowments
Report Land Bldg Equip1ReportLandBldgEquip
Report Invest Oth Securities0ReportInvestOthSecurities
Report Prog Rel Invest0ReportProgRelInvest
Report Other Assets0ReportOtherAssets
Report Other Liabilities1ReportOtherLiabilities
Report Fin48 Footnote1ReportFin48Footnote
Independent Audit Financial Stmt0IndependentAuditFinancialStmt
Consolidated Audit Financial Stmt1ConsolidatedAuditFinancialStmt
School0School
Foreign Office0ForeignOffice
Foreign Activities0ForeignActivities
More Than5000 K To Organizations0MoreThan5000KToOrganizations
More Than5000 K To Individuals0MoreThan5000KToIndividuals
Professional Fundraising0ProfessionalFundraising
Fundraising Activities0FundraisingActivities
Gaming0Gaming
Hospital1Hospital
Financial Stmt Attached1FinancialStmtAttached
Grants To Organizations0GrantsToOrganizations
Grants To Individuals0GrantsToIndividuals
Schedule J Required1ScheduleJRequired
Tax Exempt Bonds1TaxExemptBonds
Invest Tax Exempt Bonds0InvestTaxExemptBonds
Escrow Account0EscrowAccount
On Behalf Of Issuer0OnBehalfOfIssuer
Excess Benefit Transaction0ExcessBenefitTransaction
Prior Excess Benefit Transaction0PriorExcessBenefitTransaction
Loan To Officer Or DQP0LoanToOfficerOrDQP
Grant To Related Person0GrantToRelatedPerson
Bsnss Rltnshp With Organization0BsnssRltnshpWithOrganization
Bsnss Rltnshp Thru Family Member0BsnssRltnshpThruFamilyMember
Officer Entity With Bsnss Rltnshp0OfficerEntityWithBsnssRltnshp
Deductible Non Cash Contributions0DeductibleNonCashContributions
Deductible Contributions Of Art0DeductibleContributionsOfArt
Terminated0Terminated
Partial Liquidation0PartialLiquidation
Disregarded Entity0DisregardedEntity
Related Entity1RelatedEntity
Related Org Controlled Entity1RelatedOrgControlledEntity
Transaction Related Entity1TransactionRelatedEntity
Transfers To Exempt Non Chrtbl Org0TransfersToExemptNonChrtblOrg
Activities Conducted Partnership0ActivitiesConductedPartnership
Schedule O Required1ScheduleORequired
Number Forms Transmitted With1096194NumberFormsTransmittedWith1096
Number W2 G Included0NumberW2GIncluded
Compliance With Backup Witholding1ComplianceWithBackupWitholding
Number Of Employees1427NumberOfEmployees
Employment Tax Returns Filed1EmploymentTaxReturnsFiled
Unrelated Business Income1UnrelatedBusinessIncome
Form990-T Filed1Form990-TFiled
Foreign Financial Account0ForeignFinancialAccount
Prohibited Tax Shelter Trans0ProhibitedTaxShelterTrans
Taxable Party Notification0TaxablePartyNotification
Non Deductible Contributions0NonDeductibleContributions
Quid Pro Quo Contributions0QuidProQuoContributions
Form8282 Property Disposed Of0Form8282PropertyDisposedOf
Funds To Pay Premiums0FundsToPayPremiums
Premiums Paid0PremiumsPaid
Indoor Tanning Services0IndoorTanningServices
Info In Schedule O Part VIXInfoInScheduleOPartVI
Nbr Voting Governing Body Members9NbrVotingGoverningBodyMembers
Number Independent Voting Members7NumberIndependentVotingMembers
Family Or Business Relationship0FamilyOrBusinessRelationship
Delegation Of Management Duties0DelegationOfManagementDuties
Changes To Organizing Docs0ChangesToOrganizingDocs
Material Diversion Or Misuse0MaterialDiversionOrMisuse
Members Or Stockholders0MembersOrStockholders
Election Of Board Members1ElectionOfBoardMembers
Decisions Subject To Approval1DecisionsSubjectToApproval
Minutes Of Governing Body1MinutesOfGoverningBody
Minutes Of Committees1MinutesOfCommittees
Officer Mailing Address0OfficerMailingAddress
Local Chapters0LocalChapters
Form990 Provided To Governing Body1Form990ProvidedToGoverningBody
Conflict Of Interest Policy1ConflictOfInterestPolicy
Annual Disclosure Covered Persons1AnnualDisclosureCoveredPersons
Regular Monitoring Enforcement1RegularMonitoringEnforcement
Whistleblower Policy1WhistleblowerPolicy
Document Retention Policy1DocumentRetentionPolicy
Compensation Process CEO1CompensationProcessCEO
Compensation Process Other1CompensationProcessOther
Investment In Joint Venture0InvestmentInJointVenture
States Where Copy Of Return Is FiledGAStatesWhereCopyOfReturnIsFiled
Upon RequestXUponRequest

The Books Are In Care Of TheBooksAreInCareOf

FieldValueIRS element (for citing)
Name PersonJOSEPH L MCGUIRENamePerson
Telephone Number7062782105TelephoneNumber

Address US AddressUS

FieldValueIRS element (for citing)
Address Line11200 MEMORIAL DRIVEAddressLine1
CityDALTONCity
StateGAState
ZIP Code30720ZIPCode

Form990 Part VII Section A Form990PartVIISectionA (25 entries)

TitleTitleAverage Hours Per WeekAverageHoursPerWeekIndividual Trustee Or DirectorIndividualTrusteeOrDirectorOfficerOfficerReportable Comp From OrganizationReportableCompFromOrganizationReportable Comp From Related OrgsReportableCompFromRelatedOrgsOther CompensationOtherCompensationKey EmployeeKeyEmployeeHighest Compensated EmployeeHighestCompensatedEmployeeFormerFormer
ROBERT M CHANDLER
CHAIRMAN1.00XX000
ROBERT H BROOKER
VICE CHAIRMAN1.00XX000
ROBERT B HUBBS
SECRETARY/TREASURER1.00XX000
ANGELA M GORDY
TRUSTEE1.00X000
STEVEN W PAYNTER MD
TRUSTEE1.00X000
STEPHEN H RYALS MD
TRUSTEE1.00X000
W SCOTT SELLERS
TRUSTEE1.00X000
MATHEW D SMITH MD
TRUSTEE1.00X000
EZAD N AHMAD MD
TRUSTEE1.00X000
CAROLYN K TURNER
TRUSTEE1.00X000
JEFFREY D MYERS
PRESIDENT/CEO1.00XX0562536129255
GARY L HOWARD
VP/CFO/ASST. SECRETARY/TREASURER1.00X041698294021
JOSEPH L MCGUIRE
VP/CONTROLLER/ASST TREASUR1.00X019403953427
SANDRA D MCKENZIE
VICE PRESIDENT40.00193959046658X
CATHY L FERGUSON
VICE PRESIDENT40.00151228035389X
STEPHEN G ROHN
PHYSICIAN40.00649287055503X
SHAWN C MOLSBERGER
VICE PRESIDENT40.00172223049028X
MICHAEL HARTLEY MD
PHYSICIAN40.0046356506594X
CARLTON LANCASTER MD
PHYSICIAN/ MED STAFF CONSULTANT40.00301700086692X
TIMOTHY R BUNKER MD
PHYSICIAN40.00294882037607X
DC CLARK JR
PHARMACIST40.00172655015458X
HENRIETTA S PLANZER
PHARMACIST40.0016556909810X
KAREN J WISDOM
FORMER COO/VP0.00393384085592X
JANICE C KEYS
FORMER VP0.0017168605816X
T STEVEN POUND
FORMER VP0.00167003027106X
FieldValueIRS element (for citing)
Total Reportable Comp From Org3297141TotalReportableCompFromOrg
Total Reportable Comp Frm Rltd Orgs1173557TotalReportableCompFrmRltdOrgs
Total Other Compensation737956TotalOtherCompensation
Number Individuals GT100 K12NumberIndividualsGT100K
Formers Listed1FormersListed
Total Comp GT150 K1TotalCompGT150K
Compensation From Other Sources0CompensationFromOtherSources

Contractor Compensation ContractorCompensation (5 entries)

Address Line1AddressOfContractor/AddressUS/AddressLine1CityAddressOfContractor/AddressUS/CityStateAddressOfContractor/AddressUS/StateZIP CodeAddressOfContractor/AddressUS/ZIPCodeDescription Of ServicesDescriptionOfServicesCompensationCompensation
SODEXO OPERATIONS LLC
86 HOPEMEADOW STREETSIMSBURGCT06089FACILITY MANAGEMENT5109189
SIEMENS MEDICAL SOLUTIONS
PO BOX 40065ATLANTAGA31192I.S. CONSULTING AND SUPPORT4562900
SOUTHEASTERN PHYSICIAN ASSOCIATES
PO BOX 634850CINCINNATIOH45263ER PHYSICIANS1399268
ANESTHESIA ASSOCIATES PC
PO BOX 2563DALTONGA30720ANESTHESIA SERVICES1234133
GASTROINTESTINAL SPECIALISTS
302 POINT NORTH PLACEDALTONGA30720GASTROINTESTINAL SERVICES735944
FieldValueIRS element (for citing)
Number Of Contractors GT100 K64NumberOfContractorsGT100K
Related Organizations3775000RelatedOrganizations
Total Contributions3775000TotalContributions

Program Service Revenue ProgramServiceRevenue (3 entries)

DescriptionDescriptionBusiness CodeBusinessCodeTotal Revenue ColumnTotalRevenueColumnRelated Or Exempt Function IncomeRelatedOrExemptFunctionIncome
NET PATIENT SERVICE RE900099175149721175149721
WELLNESS CENTER71394019286411928641
MANAGEMENT FEES561000972486972486
FieldValueIRS element (for citing)
Total Program Service Revenue178050848TotalProgramServiceRevenue

Investment Income InvestmentIncome

FieldValueIRS element (for citing)
Total Revenue Column3637902TotalRevenueColumn
Exclusion$3,637,902ExclusionAmount

Gross Rents GrossRents

FieldValueIRS element (for citing)
Real2000433Real

Less Rental Expenses LessRentalExpenses

FieldValueIRS element (for citing)
Real0Real

Rental Income Or Loss RentalIncomeOrLoss

FieldValueIRS element (for citing)
Real2000433Real

Net Rental Income Or Loss NetRentalIncomeOrLoss

FieldValueIRS element (for citing)
Total Revenue Column2000433TotalRevenueColumn
Exclusion$2,000,433ExclusionAmount

Gross Amount Sales Assets GrossAmountSalesAssets

FieldValueIRS element (for citing)
Securities82984760Securities
Other131886Other

Less Cost Oth Basis Sales Expenses LessCostOthBasisSalesExpenses

FieldValueIRS element (for citing)
Securities79401359Securities
Other7116Other

Gain Or Loss GainOrLoss

FieldValueIRS element (for citing)
Securities3583401Securities
Other124770Other

Net Gain Or Loss Investments NetGainOrLossInvestments

FieldValueIRS element (for citing)
Total Revenue Column3708171TotalRevenueColumn
Exclusion$3,708,171ExclusionAmount

Other Revenue Misc OtherRevenueMisc (3 entries)

DescriptionDescriptionBusiness CodeBusinessCodeTotal Revenue ColumnTotalRevenueColumnRelated Or Exempt Function IncomeRelatedOrExemptFunctionIncomeExclusionExclusionAmount
VENDOR REBATES90009910618491061849
GIFT SHOP453220242156$242,156
EDUCATION61171020985$20,985

Miscellaneous Revenue MiscellaneousRevenue

FieldValueIRS element (for citing)
Total Revenue Column3897683TotalRevenueColumn
Unrelated Business Revenue63938UnrelatedBusinessRevenue
Exclusion$3,833,745ExclusionAmount
FieldValueIRS element (for citing)
Total Other Revenue5222673TotalOtherRevenue

Total Revenue TotalRevenue

FieldValueIRS element (for citing)
Total Revenue Column196395027TotalRevenueColumn
Related Or Exempt Function Income179112697RelatedOrExemptFunctionIncome
Unrelated Business Revenue63938UnrelatedBusinessRevenue
Exclusion$13,443,392ExclusionAmount

Comp Current Officers Directors CompCurrentOfficersDirectors

FieldValueIRS element (for citing)
Total1166697Total
Management And General1166697ManagementAndGeneral

Other Salaries And Wages OtherSalariesAndWages

FieldValueIRS element (for citing)
Total66899600Total
Program Services64611293ProgramServices
Management And General2288307ManagementAndGeneral

Pension Plan Contributions PensionPlanContributions

FieldValueIRS element (for citing)
Total2027259Total
Program Services2027259ProgramServices

Other Employee Benefits OtherEmployeeBenefits

FieldValueIRS element (for citing)
Total12996378Total
Program Services12996378ProgramServices

Payroll Taxes PayrollTaxes

FieldValueIRS element (for citing)
Total4518755Total
Program Services4518755ProgramServices

Fees For Services Management FeesForServicesManagement

FieldValueIRS element (for citing)
Total1136442Total
Management And General1136442ManagementAndGeneral

Fees For Services Legal FeesForServicesLegal

FieldValueIRS element (for citing)
Total552460Total
Management And General552460ManagementAndGeneral

Fees For Services Accounting FeesForServicesAccounting

FieldValueIRS element (for citing)
Total98948Total
Management And General98948ManagementAndGeneral

Fees For Services Invst Mgmnt Fees FeesForServicesInvstMgmntFees

FieldValueIRS element (for citing)
Total501670Total
Management And General501670ManagementAndGeneral

Fees For Services Other FeesForServicesOther

FieldValueIRS element (for citing)
Total20658197Total
Program Services19948193ProgramServices
Management And General710004ManagementAndGeneral

Advertising Advertising

FieldValueIRS element (for citing)
Total110267Total
Program Services110267ProgramServices

Office Expenses OfficeExpenses

FieldValueIRS element (for citing)
Total13998895Total
Program Services2946004ProgramServices
Management And General11052891ManagementAndGeneral

Information Technology InformationTechnology

FieldValueIRS element (for citing)
Total4648093Total
Program Services4648093ProgramServices

Occupancy Occupancy

FieldValueIRS element (for citing)
Total6158015Total
Program Services6158015ProgramServices

Travel Travel

FieldValueIRS element (for citing)
Total272204Total
Program Services272204ProgramServices

Conferences Meetings ConferencesMeetings

FieldValueIRS element (for citing)
Total206200Total
Management And General206200ManagementAndGeneral

Interest Interest

FieldValueIRS element (for citing)
Total3778691Total
Management And General3778691ManagementAndGeneral

Depreciation Depletion DepreciationDepletion

FieldValueIRS element (for citing)
Total14385872Total
Program Services14385872ProgramServices

Insurance Insurance

FieldValueIRS element (for citing)
Total309959Total
Management And General309959ManagementAndGeneral

Other Expenses OtherExpenses (3 entries)

DescriptionDescriptionTotalTotalProgram ServicesProgramServices
MEDICAL SUPPLIES1626967016269670
PROVIDER TAX22753312275331
MISCELLANEOUS13208931320893

Total Functional Expenses TotalFunctionalExpenses

FieldValueIRS element (for citing)
Total174290496Total
Program Services152488227ProgramServices
Management And General21802269ManagementAndGeneral
Fundraising0Fundraising

Cash Non Interest Bearing CashNonInterestBearing

FieldValueIRS element (for citing)
BOY3825866BOY
EOY9097659EOY

Savings And Temp Cash Investments SavingsAndTempCashInvestments

FieldValueIRS element (for citing)
BOY3289907BOY
EOY7879267EOY

Accounts Receivable AccountsReceivable

FieldValueIRS element (for citing)
BOY26218202BOY
EOY27382143EOY

Other Notes Loans Receivable Net OtherNotesLoansReceivableNet

FieldValueIRS element (for citing)
BOY2621556BOY
EOY4072967EOY

Inventories For Sale Or Use InventoriesForSaleOrUse

FieldValueIRS element (for citing)
BOY2819204BOY
EOY3198740EOY

Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges

FieldValueIRS element (for citing)
BOY6302842BOY
EOY6570766EOY
FieldValueIRS element (for citing)
Land Buildings Equipment Basis260577687LandBuildingsEquipmentBasis
Land Bldg Equipment Accum Deprec143661606LandBldgEquipmentAccumDeprec

Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet

FieldValueIRS element (for citing)
BOY115232604BOY
EOY116916081EOY

Investments Pub Traded Securities InvestmentsPubTradedSecurities

FieldValueIRS element (for citing)
BOY102720094BOY
EOY141889817EOY

Investments Other Securities InvestmentsOtherSecurities

FieldValueIRS element (for citing)
BOY31392182BOY
EOY10781586EOY

Investments Program Related InvestmentsProgramRelated

FieldValueIRS element (for citing)
BOY10672319BOY
EOY10654008EOY

Other Assets Total OtherAssetsTotal

FieldValueIRS element (for citing)
BOY1644234BOY
EOY1496462EOY

Total Assets TotalAssets

FieldValueIRS element (for citing)
BOY306739010BOY
EOY339939496EOY

Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses

FieldValueIRS element (for citing)
BOY17273748BOY
EOY20128210EOY

Tax Exempt Bond Liabilities TaxExemptBondLiabilities

FieldValueIRS element (for citing)
BOY108410000BOY
EOY105675000EOY

Other Liabilities OtherLiabilities

FieldValueIRS element (for citing)
BOY1334384BOY
EOY1342528EOY

Total Liabilities TotalLiabilities

FieldValueIRS element (for citing)
BOY127018132BOY
EOY127145738EOY
FieldValueIRS element (for citing)
Follow SFAS117XFollowSFAS117

Unrestricted Net Assets UnrestrictedNetAssets

FieldValueIRS element (for citing)
BOY179720878BOY
EOY212793758EOY

Total Net Assets Fund Balances TotalNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY179720878BOY
EOY212793758EOY

Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY306739010BOY
EOY339939496EOY
FieldValueIRS element (for citing)
Info In Schedule O Part XIXInfoInScheduleOPartXI
Reconcilation Revenue Expenses22104531ReconcilationRevenueExpenses
Reconcilation Other Changes10968349ReconcilationOtherChanges
Info In Schedule O Part XIIXInfoInScheduleOPartXII
Method Of Accounting AccrualXMethodOfAccountingAccrual
Accountant Compile Or Review0AccountantCompileOrReview
FS Audited1FSAudited
Audit Committee1AuditCommittee
Financial Statement ConsolidatedXFinancialStatementConsolidated
Federal Grant Audit Required0FederalGrantAuditRequired

Schedule A IRS990ScheduleA

FieldValueIRS element (for citing)
Hospital170b1 AiiiXHospital170b1Aiii

Schedule B IRS990ScheduleB

Contributor Info ContributorInfo

FieldValueIRS element (for citing)
Contributor NumberRESTRICTEDContributorNumber

Contributor Name Business ContributorNameBusiness

FieldValueIRS element (for citing)
Business Name Line1RESTRICTEDBusinessNameLine1

Contributor Address US ContributorAddressUS

FieldValueIRS element (for citing)
Address Line1RESTRICTEDAddressLine1
Address Line2RESTRICTEDAddressLine2
CityRESTRICTEDCity
StateRESTRICTEDState
ZIP CodeRESTRICTEDZIPCode
FieldValueIRS element (for citing)
Aggregate ContributionsRESTRICTEDAggregateContributions

Schedule D IRS990ScheduleD

Land Land

FieldValueIRS element (for citing)
Other Cost Or Other Basis5937617OtherCostOrOtherBasis
Book Value5937617BookValue

Buildings Buildings

FieldValueIRS element (for citing)
Other Cost Or Other Basis120406726OtherCostOrOtherBasis
Depreciation48179677Depreciation
Book Value72227049BookValue

Equipment Equipment

FieldValueIRS element (for citing)
Other Cost Or Other Basis128770494OtherCostOrOtherBasis
Depreciation92979567Depreciation
Book Value35790927BookValue

Other Land Buildings OtherLandBuildings

FieldValueIRS element (for citing)
Other Cost Or Other Basis5462850OtherCostOrOtherBasis
Depreciation2502362Depreciation
Book Value2960488BookValue
FieldValueIRS element (for citing)
Total Of Book Value Land Buildings116916081TotalOfBookValueLandBuildings

Other Liabilities OtherLiabilities

FieldValueIRS element (for citing)
DescriptionASSET RETIREMENT OBLIGATIONDescription
Amount$1,342,528Amount
FieldValueIRS element (for citing)
Total Of Amounts1342528TotalOfAmounts

Form990 Schedule D Part XIV Form990ScheduleDPartXIV

FieldValueIRS element (for citing)
IdentifierDESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48:Identifier
Return ReferencePART X:ReturnReference
ExplanationTHE 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, 2012.Explanation

Schedule H IRS990ScheduleH

FieldValueIRS element (for citing)
Charity Care Policy1CharityCarePolicy
Written Policy1WrittenPolicy
Policy Applied To All HospitalsXPolicyAppliedToAllHospitals
FPG Reference Free Care1FPGReferenceFreeCare

Other Percentage OtherPercentage

FieldValueIRS element (for citing)
OtherXOther
Free Other Percentage125.000000000000FreeOtherPercentage
FieldValueIRS element (for citing)
FPG Reference Discounted Care1FPGReferenceDiscountedCare
Pcent250XPcent250
Free Disc Care Medically Indigent1FreeDiscCareMedicallyIndigent
Amounts Budgeted For Charity Care1AmountsBudgetedForCharityCare
Expenses Exceeded Budget1ExpensesExceededBudget
Unable To Provide Care0UnableToProvideCare
Annual Community Benefit Report1AnnualCommunityBenefitReport
Report Publically Available1ReportPublicallyAvailable

Charity Care At Cost CharityCareAtCost

FieldValueIRS element (for citing)
Total Community Benefit Expense14113785TotalCommunityBenefitExpense
Direct Offsetting Revenue3500000DirectOffsettingRevenue
Net Community Benefit Expense10613785NetCommunityBenefitExpense
Percent Of Total Expense0.06090PercentOfTotalExpense

Unreimbursed Medicaid UnreimbursedMedicaid

FieldValueIRS element (for citing)
Total Community Benefit Expense33128694TotalCommunityBenefitExpense
Direct Offsetting Revenue28021657DirectOffsettingRevenue
Net Community Benefit Expense5107037NetCommunityBenefitExpense
Percent Of Total Expense0.02930PercentOfTotalExpense

Total Charity Care TotalCharityCare

FieldValueIRS element (for citing)
Total Community Benefit Expense47242479TotalCommunityBenefitExpense
Direct Offsetting Revenue31521657DirectOffsettingRevenue
Net Community Benefit Expense15720822NetCommunityBenefitExpense
Percent Of Total Expense0.09020PercentOfTotalExpense

Community Health Services CommunityHealthServices

FieldValueIRS element (for citing)
Total Community Benefit Expense678285TotalCommunityBenefitExpense
Direct Offsetting Revenue29614DirectOffsettingRevenue
Net Community Benefit Expense648671NetCommunityBenefitExpense
Percent Of Total Expense0.00370PercentOfTotalExpense

Subsidized Health Services SubsidizedHealthServices

FieldValueIRS element (for citing)
Total Community Benefit Expense25603911TotalCommunityBenefitExpense
Direct Offsetting Revenue18311043DirectOffsettingRevenue
Net Community Benefit Expense7292868NetCommunityBenefitExpense
Percent Of Total Expense0.04180PercentOfTotalExpense

Cash And In Kind Contributions CashAndInKindContributions

FieldValueIRS element (for citing)
Total Community Benefit Expense103059TotalCommunityBenefitExpense
Direct Offsetting Revenue0DirectOffsettingRevenue
Net Community Benefit Expense103059NetCommunityBenefitExpense
Percent Of Total Expense0.00060PercentOfTotalExpense

Total Other Benefits TotalOtherBenefits

FieldValueIRS element (for citing)
Total Community Benefit Expense26385255TotalCommunityBenefitExpense
Direct Offsetting Revenue18340657DirectOffsettingRevenue
Net Community Benefit Expense8044598NetCommunityBenefitExpense
Percent Of Total Expense0.04610PercentOfTotalExpense

Total Community Benefits TotalCommunityBenefits

FieldValueIRS element (for citing)
Total Community Benefit Expense73627734TotalCommunityBenefitExpense
Direct Offsetting Revenue49862314DirectOffsettingRevenue
Net Community Benefit Expense23765420NetCommunityBenefitExpense
Percent Of Total Expense0.13630PercentOfTotalExpense
FieldValueIRS element (for citing)
Bad Debt Expense Reported1BadDebtExpenseReported
Bad Debt Expense$10,431,537BadDebtExpenseAmount
Amount Attributable To2607884AmountAttributableTo
Amount Reimbursed By Medicare53029263AmountReimbursedByMedicare
Cost Of Care Reimbursed By Medicare60770776CostOfCareReimbursedByMedicare
Medicare Surplus Or Shortfall-7741513MedicareSurplusOrShortfall

Costing Methodology Used CostingMethodologyUsed

FieldValueIRS element (for citing)
Cost Accounting SystemXCostAccountingSystem
FieldValueIRS element (for citing)
Written Debt Collection Policy1WrittenDebtCollectionPolicy
Provision For Charity Care1ProvisionForCharityCare
Number Of Hospital Facilities1NumberOfHospitalFacilities

Form990 Schedule H Part V Section A Form990ScheduleHPartVSectionA

FieldValueIRS element (for citing)
Facility Number1FacilityNumber

Name Name

FieldValueIRS element (for citing)
Business Name Line1HAMILTON MEDICAL CENTERBusinessNameLine1

Address Address

FieldValueIRS element (for citing)
Address Line11200 MEMORIAL DRIVEAddressLine1
CityDALTONCity
StateGAState
ZIP Code30720ZIPCode
FieldValueIRS element (for citing)
Licensed HospitalXLicensedHospital
General Medical And SurgicalXGeneralMedicalAndSurgical
Er24 HoursXEr24Hours

Form990 Schedule H Part V Section B Form990ScheduleHPartVSectionB

Hospital Facility Name HospitalFacilityName

FieldValueIRS element (for citing)
Business Name Line1HAMILTON MEDICAL CENTERBusinessNameLine1
FieldValueIRS element (for citing)
Hospital Facility Number1HospitalFacilityNumber
Eligibility Criteria Explained1EligibilityCriteriaExplained
Uses FPG Free1UsesFPGFree
FPG Free Percent125.000000000000FPGFreePercent
Uses FPG Discounted1UsesFPGDiscounted
FPG Discount Percent250.000000000000FPGDiscountPercent
Explains Basis1ExplainsBasis
Income LevelXIncomeLevel
Insurance StatusXInsuranceStatus
Explains Application Method1ExplainsApplicationMethod
Includes Publicity Measures1IncludesPublicityMeasures
Available On RequestXAvailableOnRequest
Other PublicityXOtherPublicity
Actions On Nonpayment1ActionsOnNonpayment
Collection Activities0CollectionActivities
Nondiscrim Emergency Care Policy1NondiscrimEmergencyCarePolicy
Used Other MethodXUsedOtherMethod
Amounts Generally Billed0AmountsGenerallyBilled
Gross Charges0GrossCharges

Form990 Schedule H Part V Section C Form990ScheduleHPartVSectionC

FieldValueIRS element (for citing)
Number Of Other Facilities9NumberOfOtherFacilities

Other Facilities OtherFacilities (9 entries)

Address Line1Address/AddressLine1CityAddress/CityStateAddress/StateZIP CodeAddress/ZIPCodeFacility TypeFacilityType
HAMILTON DIAGNOSTIC CENTER
1407 NORTH THORNTON AVENUEDALTONGA30720DIAGNOSTIC IMAGING, SLEEP DISORDERS
HAMILTON SPECIALTY IMAGING
1436 BROADRICK DRIVEDALTONGA30720DIAGNOSTIC IMAGING
HAMILTON WOUND CARE
1109 BURLEYSON ROADDALTONGA30720WOUND CARE
ENDOVASCULAR SURGERY PRACTICE
1109 BURLEYSON ROADDALTONGA30720ENDOVASCULAR SERVICES
HAMILTON CONVENIENT CARE
1012 BURLEYSON ROADDALTONGA30720URGENT CARE CLINIC, FAMILY PRACTICE
HAMILTON SPINE CENTER
1107 MEMORIAL DRIVEDALTONGA30720SPINE CARE CLINIC
BRADLEY WELLNESS CENTER
1250 BROADRICK DRIVEDALTONGA30720FITNESS, CARIAC REHAB, PHYS./OCC. THERAPY
NEPHROLOGY PRACTICE
1506 BROADRICK DRIVEDALTONGA30720NEPHROLOGY SERVICES
DIABETES TREATMENT CENTER
1109 BURLEYSON ROADDALTONGA30720DIABETES TREATMENT CENTER

Form990 Schedule H Part VI Form990ScheduleHPartVI (13 entries)

ExplanationExplanationIdentifierIdentifier
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: - OBSTETRICS SERVICES $ 1,172,543 - BEHAVIORAL HEALTH SERVICES 941,383 - HOME HEALTH SERVICES 1,613,418 - HOSPICE CARE 968,045 - ADULT DAY CARE SERVICES 100,000 - CARDIOLOGY SERVICES 1,727,897 - CONVENIENT CARE SERVICES 769,591 TOTAL TO PART I, LINE 7G, COL (E): $ 7,292,868
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: "THE PROVISION FOR DOUBTFUL ACCOUNTS IS BASED UPON MANAGEMENT'S ASSESSMENT OF HISTORICAL AND EXPECTED NET COLLECTIONS CONSIDERING BUSINESS AND ECONOMIC CONDITIONS, TRENDS IN HEALTH CARE COVERAGE, AND OTHER COLLECTION INDICATORS. PERIODICALLY, MANAGEMENT ASSESSES THE ADEQUACY OF THE ALLOWANCE FOR DOUBTFUL ACCOUNTS BASED UPON HISTORICAL WRITE-OFF EXPERIENCE AND OTHER COLLECTION TRENDS. THE RESULTS OF THIS REVIEW ARE THEN USED TO MAKE ANY MODIFICATIONS TO THE PROVISION FOR DOUBTFUL ACCOUNTS TO ESTABLISH AN APPROPRIATE ALLOWANCE FOR UNCOLLECTIBLE RECEIVABLES." 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 V, SECTION B, LINE 13G: 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.HAMILTON MEDICAL CENTER
PART V, SECTION B, LINE 19D: THE ORGANIZATION IS IN THE PROCESS OF ADOPTING A METHOD FOR CALCULATING AMOUNTS GENERALLY BILLED THAT WILL COMPLY WITH THE REGULATIONS UNDER SECTION 1.501(R)-5 WHEN FINAL GUIDANCE IS AVAILABLE.HAMILTON MEDICAL CENTER
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 COMMUNITY NEEDS. IN ORDER TO ASSESS UNMET PHYSICIAN NEEDS OF WHITFIELD AND MURRAY COUNTIES, PHYSICIAN NEEDS ASSESSMENTS ARE PERIODICALLY CONDUCTED, MOST RECENTLY IN MAY, 2010.
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 89% OF THE FACILITY'S VOLUME. THE SERVICE AREA HAS A POPULATION OF 142,741 CONSISTING OF 103,184 AND 39,557 IN WHITFIELD AND MURRAY COUNTIES, RESPECTIVELY. MINORITY POPULATIONS IN WHITFIELD COUNTY CONSIST OF HISPANIC (32%) AND AFRICAN AMERICAN (4%). APPROXIMATELY 23% OF THE POPULATION LIVE BELOW THE POVERTY LEVEL. MINORITY POPULATIONS IN MURRAY COUNTY CONSIST OF HISPANIC (13%) AND AFRICAN AMERICAN (1%). APPROXIMATELY 21% 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; AND WHITFIELD HEALTHCARE FOUNDATION, INC., A PHILANTHROPIC ORGANIZATION. HAMILTON AMBULATORY SURGERY CENTER, INC., A MULTI-SPECIALTY SURGERY CENTER, AND HAMILTON PHYSICIAN GROUP, INC., A CARDIOLOGY PRACTICE EMPLOYING FOUR CARDIOLOGISTS, ARE CONTROLLED AFFILIATES OF HMC.

Schedule J IRS990ScheduleJ

FieldValueIRS element (for citing)
Travel For CompanionsXTravelForCompanions
Club Dues Or FeesXClubDuesOrFees
Written Policy Re T And E Expenses1WrittenPolicyReTAndEExpenses
Substantiation Required1SubstantiationRequired
Compensation CommitteeXCompensationCommittee
Independent ConsultantXIndependentConsultant
Board Or Committee ApprovalXBoardOrCommitteeApproval
Severance Payment0SeverancePayment
Supplemental Nonqual Retire Plan1SupplementalNonqualRetirePlan
Equity Based Comp Arrangement0EquityBasedCompArrangement
Comp Based On Revenue Of Filing Org0CompBasedOnRevenueOfFilingOrg
Comp Based On Revenue Related Orgs0CompBasedOnRevenueRelatedOrgs
Comp Based Net Earnings Filing Org1CompBasedNetEarningsFilingOrg
Comp Based Net Earnings Relate Orgs1CompBasedNetEarningsRelateOrgs
Any Non Fixed Payments0AnyNonFixedPayments
Initial Contract Exception0InitialContractException

Form990 Schedule J Part II Form990ScheduleJPartII (15 entries)

Base Compensation Filing OrgBaseCompensationFilingOrgComp Based On Related OrgsCompBasedOnRelatedOrgsBonus Filing OrgBonusFilingOrgBonus Related OrgsBonusRelatedOrgsOther Compensation Filing OrgOtherCompensationFilingOrgOther Compensation Related OrgsOtherCompensationRelatedOrgsDeferred Comp Filing OrgDeferredCompFilingOrgDeferred Comp Related OrgsDeferredCompRelatedOrgsNontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgNontaxable Benefits Related OrgsNontaxableBenefitsRelatedOrgsTotal Compensation Filing OrgTotalCompensationFilingOrgTotal Compensation Related OrgsTotalCompensationRelatedOrgsComp Report Prior990 Filing OrgCompReportPrior990FilingOrgComp Report Prior990 Related OrgsCompReportPrior990RelatedOrgs
JEFFREY D MYERS
039580001204880462480197690109486069179100
GARY L HOWARD
02749970455080964770128240811970511003046989
JOSEPH L MCGUIRE
0147536022827023676097300436970247466011773
SANDRA D MCKENZIE
1426690186880326020934903730902406170153090
CATHY L FERGUSON
13519504665011368078530275360186617000
STEPHEN G ROHN
5610200708530174140169430385600704790000
SHAWN C MOLSBERGER
14943401529407495070430419850221251000
MICHAEL HARTLEY MD
4511640001240100065940470159000
CARLTON LANCASTER MD
2336910006800901433207236003883920216070
TIMOTHY R BUNKER MD
2554280250770143770123020253050332489000
DC CLARK JR
1471480622601928107572078860188113000
HENRIETTA S PLANZER
158277000729206447033630175379000
KAREN J WISDOM
00003933840532670323250478976000
JANICE C KEYS
000017168600058160177502000
T STEVEN POUND
0000167003000271060194109000

Form990 Schedule J Part III Form990ScheduleJPartIII (2 entries)

Return ReferenceReturnReferenceExplanationExplanation
PART I, LINE 4BTHE FOLLOWING PERSONS RECEIVED CURRENT YEAR DEFERRED COMPENSATION ACCRUALS FROM NON-QUALIFIED PLANS: - JEFFREY D. MYERS - $ 6,500 - CARLTON LANCASTER - $ 1,425 - KAREN J. WISDOM - $ 53,267 - STEPHEN ROHN - $ 443 - TIMOTHY R. BUNKER - $ 1,356
PART I, LINE 6THE ORGANIZATION HAS A MANAGEMENT PERFORMANCE INCENTIVE PLAN FOR ELIGIBLE PARTICIPANTS TO FOCUS ON SPECIFIC STRATEGIC, ORGANIZATIONAL AND FINANCIAL GOALS. THE TOTAL AWARDS UNDER THE PLAN CANNOT EXCEED TEN PERCENT OF THE HAMILTON HEALTH CARE SYSTEM COMBINED EXCESS OF REVENUES OVER EXPENSES EXCLUDING INVESTMENT INCOME. INDIVIDUAL INCENTIVES ARE BASED UPON ACHIEVING CERTAIN ORGANIZATIONAL AND INDIVIDUAL SERVICE QUALITY, FINANCIAL RESULTS AND CUSTOMER SATISFACTION GOALS.

Schedule K IRS990ScheduleK

Form990 Schedule K Part I Form990ScheduleKPartI (2 entries)

Issuer EINIssuerEINDate IssuedDateIssuedIssue PriceIssuePriceDescription Of PurposeDescriptionOfPurposeDefeasedDefeasedOn Behalf Of IssuerOnBehalfOfIssuerPool FinancingPoolFinancingCUSIP NumberCUSIPNumber
DEVELOPMENT AUTHORITY OF THE CITY OF DALTON
8106148762003-06-021000000REFUND BONDS ISSUED 12/18/96000
DEVELOPMENT AUTHORITY OF THE CITY OF DALTON
8106148762003-09-0455000000EXPANSION AND IMPROVEMENTS TO HEALTH CARE FACILITY000235550EQ9

Form990 Schedule K Part II Form990ScheduleKPartII (2 entries)

Total ProceedsTotalProceedsOther Spent ProceedsOtherSpentProceedsYear Of Subst CompletionYearOfSubstCompletionCurrent RefundingCurrentRefundingAdvance RefundingAdvanceRefundingFinal Allocation MadeFinalAllocationMadeAdequate Books And Recds MaintaindAdequateBooksAndRecdsMaintaindAmount RetiredAmountRetiredIssuance Costs From ProceedsIssuanceCostsFromProceedsCapital ExpendituresCapitalExpenditures
1000000100000020031011
5859908620080011161500042045058178636

Form990 Schedule K Part III Form990ScheduleKPartIII

FieldValueIRS element (for citing)
Owning Bond Financed Property0OwningBondFinancedProperty
Any Lease Arrangements1AnyLeaseArrangements
Mngment Cntrct Bond Financd Prprty0MngmentCntrctBondFinancdPrprty
Any Research Agreements0AnyResearchAgreements
Prcntge Prvt Business Use By Others0.00000PrcntgePrvtBusinessUseByOthers
Percentage Of Prvt Business Re UBI0.00860PercentageOfPrvtBusinessReUBI
Total Private Business Use0.00860TotalPrivateBusinessUse
Post Issuance Compliance Procdrs1PostIssuanceComplianceProcdrs

Form990 Schedule K Part IV Form990ScheduleKPartIV (2 entries)

Form8038 T FiledForm8038TFiledVariable Rate IssueVariableRateIssueHedge Identified In Books And RecdsHedgeIdentifiedInBooksAndRecdsGross Proceeds Invested In GICGrossProceedsInvestedInGICGross Proceeds InvestedGrossProceedsInvestedException To RebateExceptionToRebate
010001
110000
FieldValueIRS element (for citing)
Fed Tax Requirements ComplianceXFedTaxRequirementsCompliance

Form990 Schedule K Part VI Form990ScheduleKPartVI (3 entries)

IdentifierIdentifierExplanationExplanation
SCHEDULE K, PART II, LINE 3; TOTAL PROCEEDS:THE AMOUNT PRESENTED ON PART II, LINE 3, COLUMN (B) INCLUDES INVESTMENT EARNINGS OF $ 3,599,086 CUMULATIVE OVER THE INVESTMENT LIFE OF THE ISSUE. AS OF THE FILING OF THIS RETURN, ALL INVESTED AMOUNTS HAVE BEEN ALLOCATED TO CAPITAL EXPENDITURES.
SCHEDULE K, PART II, LINE 11; OTHER SPENT PROCEEDS:THE AMOUNTS PRESENT ON PART II, LINE 11, BOND (A) REPRESENT AMOUNTS USED TO REFUND A PRIOR ISSUED DATED DECEMBER 18, 1996.
SCHEDULE K, PART III, BOND (A):ALL OF THE PROCEEDS FROM THE ISSUE LISTED IN COLUMN (A) WERE USED TO CURRENTLY REFUND AN ISSUE DATED PRIOR TO JANUARY 1, 2003. SCHEDULE K, PART III IS NOT APPLICABLE TO BOND (A).

Schedule O IRS990ScheduleO

General Explanation GeneralExplanation (7 entries)

Return ReferenceReturnReferenceExplanationExplanationIdentifierIdentifier
FORM 990, PART VI, SECTION A, LINE 7ATHE REGULAR TRUSTEES OF THE ORGANIZATION ARE APPOINTED BY THE BOARD OF TRUSTEES OF HAMILTON MEDICAL CENTER, INC.
FORM 990, PART VI, SECTION A, LINE 7BCERTAIN 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 11FOLLOWING 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 12CTHE 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 15UNDER 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 19THE ORGANIZATION MAKES ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UPON REQUEST
FORM 990, PART XI, LINE 5:NET UNREALIZED GAINS ON INVESTMENTS: 11,448,200. CHANGE IN LIABILITY CLAIMS ACCRUAL -479,851. TOTAL TO FORM 990, PART XI, LINE 5: 10,968,349.CHANGES IN NET ASSETS OR FUND BALANCES:

Schedule R IRS990ScheduleR

Form990 Schedule R Part II Form990ScheduleRPartII (13 entries)

Address Line1AddressUS/AddressLine1CityAddressUS/CityStateAddressUS/StateZIP CodeAddressUS/ZIPCodeEINEINPrimary ActivitiesPrimaryActivitiesLegal Domicile StateLegalDomicileStateExempt Code SectionExemptCodeSectionPublic Charity StatusPublicCharityStatusDirect Controlling Entity NADirectControllingEntityNAControlled OrgControlledOrgBusiness Name Line1DirectControllingEntityName/BusinessNameLine1
HAMILTON HEALTH CARE SYSTEM INC
PO BOX 1168DALTONGA30722581519913SUPPORT RELATED ENTITIESGA501(C)(3)LINE 11D, III-ON/A0
DALTON SENIOR HOUSING INC
519 WEST HAWTHORNE STREETDALTONGA30720581518011LOW-INCOME HOUSINGGA501(C)(3)LINE 91HAMILTON HEALTH CARE SYSTEM INC
HAMILTON AMBULATORY SURGERY CENTER INC
PO BOX 1168DALTONGA30722582654791SURGICAL SERVICESGA501(C)(3)LINE 31HAMILTON MEDICAL CENTER INC
HAMILTON EMERGENCY MEDICAL SERVICES INC
PO BOX 1168DALTONGA30722581651002EMERGENCY MEDICALGA501(C)(3)LINE 91HAMILTON HEALTH CARE SYSTEM INC
HAMILTON PHYSICIAN GROUP INC
PO BOX 1168DALTONGA30722271198701PHYSICIAN PRACTICEGA501(C)(3)LINE 31HAMILTON MEDICAL CENTER INC
HLTC INC
PO BOX 1168DALTONGA30722582341574LONG TERM ELDERLY CAREGA501(C)(3)LINE 91HAMILTON HEALTH CARE SYSTEM INC
MURRAY MEDICAL CENTER INC
PO BOX 1406CHATSWORTHGA30705582373427HOSPITAL CARE / SERVICESGA501(C)(3)LINE 31HAMILTON HEALTH CARE SYSTEM INC
ROYAL OAK COMMUNITY LTD
PO BOX 1900DALTONGA30722581970228SENIOR LIVING SERVICESGA501(C)(3)LINE 91HAMILTON HEALTH CARE SYSTEM INC
WHITFIELD PLACE INC
PO BOX 1168DALTONGA30722582103085LOW-INCOME HOUSINGGA501(C)(3)LINE 91HAMILTON HEALTH CARE SYSTEM INC
DALTON-WHITFIELD COUNTY HOSPITAL LIABILITY TRUST
PO BOX 1168DALTONGA30722581331514LIABILITY CLAIMS COVERAGEGA501(C)(3)LINE 11D, III-O1HAMILTON HEALTH CARE SYSTEM INC
DALTON-WHITFIELD ADDITIONAL TRUST
PO BOX 1168DALTONGA30722586345013FUNDS FOR INDIGENT CAREGA501(C)(3)LINE 11A, I1HAMILTON HEALTH CARE SYSTEM INC
DALTON-WHITFIELD INDIGENT CARE TRUST
PO BOX 1168DALTONGA30722586345011FUNDS FOR INDIGENT CAREGA501(C)(3)LINE 11A, I1HAMILTON HEALTH CARE SYSTEM INC
WHITFIELD HEALTHCARE FOUNDATION INC
PO BOX 1900DALTONGA30722510175056FUNDS FOR HEALTHCAREGA501(C)(3)LINE 11A, I1HAMILTON HEALTH CARE SYSTEM INC

Form990 Schedule R Part IV Form990ScheduleRPartIV

Name Of Related Org NameOfRelatedOrg

FieldValueIRS element (for citing)
Business Name Line1HAMILTON HEALTH FIRST INCBusinessNameLine1

Address US AddressUS

FieldValueIRS element (for citing)
Address Line1PO BOX 1168AddressLine1
CityDALTONCity
StateGAState
ZIP Code30722ZIPCode
FieldValueIRS element (for citing)
EIN581694713EIN
Primary ActivityPREFERRED PROVIDERPrimaryActivity
Legal Domicile StateGALegalDomicileState
Direct Controlling Entity NAN/ADirectControllingEntityNA
Type Of EntityCTypeOfEntity
FieldValueIRS element (for citing)
Receipt Of Int Ann Rents Royalties1ReceiptOfIntAnnRentsRoyalties
Gift Grant Or Cap Contr To Other Org0GiftGrantOrCapContrToOtherOrg
Gift Grant Or Cap Contr Fr Other Org1GiftGrantOrCapContrFrOtherOrg
Loans Or Guarantees To Other Org1LoansOrGuaranteesToOtherOrg
Loans Or Guarantees From Other Org0LoansOrGuaranteesFromOtherOrg
Sale Of Assets To Other Org0SaleOfAssetsToOtherOrg
Purchase Of Assets From Other Org0PurchaseOfAssetsFromOtherOrg
Exchange Of Assets0ExchangeOfAssets
Rental Of Facilities To Other Orgs0RentalOfFacilitiesToOtherOrgs
Rental Of Facilities Fr Other Orgs0RentalOfFacilitiesFrOtherOrgs
Perform Of Services For Other Orgs0PerformOfServicesForOtherOrgs
Perform Of Services By Other Orgs1PerformOfServicesByOtherOrgs
Sharing Of Facilities0SharingOfFacilities
Sharing Of Paid Employees1SharingOfPaidEmployees
Reimbursement Paid To Other Org0ReimbursementPaidToOtherOrg
Reimbursement Paid By Other Org1ReimbursementPaidByOtherOrg
Other Transfer To Other Org1OtherTransferToOtherOrg
Other Transfer From Other Org1OtherTransferFromOtherOrg

Transactions Related Orgs Table TransactionsRelatedOrgsTable (4 entries)

Transaction TypeTransactionTypeAmount InvolvedAmountInvolvedMethod Of Amt DeterminationMethodOfAmtDetermination
HAMILTON AMBULATORY SURGERY CENTER INC
A686500FMV
HAMILTON AMBULATORY SURGERY CENTER INC
N856021FMV
HAMILTON AMBULATORY SURGERY CENTER INC
P1421690FMV
HAMILTON PHYSICIANS GROUP INC
D1932967INCR. IN LOAN BAL