2012-06-07T09:30:53-05:00 2011-09-30 DIXON HUGHES GOODMAN LLP 500 RIDGEFIELD COURT ASHEVILLE NC 28806 990 2010-10-01 581519911 HAMILTON MEDICAL CENTER INC HAMI 7062782105 PO BOX 1168 DALTON GA 307221168 GARY L HOWARD 7062782105 2012-05-30 MICHAEL RAUCHWARG 8282542254 2010 2016-02-24 21:20:13Z GARY L HOWARD PO BOX 1168 DALTON GA 307221168 278628223 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 09/30/2010, HAMILTON HAD 46,649 PATIENT DAYS AND 219,377 OUTPATIENT VISITS. HAMILTON'S VISION IS TO SERVE THE NEEDS OF AREA RESIDENTS WITHOUT DISCRIMINATION AND REGARDLESS OF ABILITY TO PAY. 9 7 1413 232 62100 -68114 5242969 2549849 209976010 207121057 10301464 9275930 4294616 3492459 229815059 222439295 0 0 0 0 87119602 82825518 0 0 0 120602339 118478988 207721941 201304506 22093118 21134789 298585609 306739010 131460852 127018132 167124757 179720878 WE EXIST TO SERVE PEOPLE THROUGH THE MINISTRY OF HEALTHCARE 0 0 172646477 208002920 HAMILTON MEDICAL CENTER OPERATES A 282 BED ACUTE CARE HOSPITAL INCLUDING A 24-HOUR EMERGENCY ROOM, IN DALTON, GA WHICH SERVES THE NEEDS OF RESIDENTS OF THE CITY OF DALTON, WHITFIELD COUNTY AND SURROUNDING AREAS OF NORTHWEST GEORGIA. DURING THE YEAR ENDED SEPTEMBER 30,2011 THE MEDICAL CENTER HAD 44,191 PATIENT DAYS AND 227,237 OUTPATIENT VISITS. HAMILTON SERVES THE NEEDS OF AREA RESIDENTS WITHOUT DISCRIMINATION AND REGARDLESS OF ABILTIY TO PAY. ACCORDINGLY, THE HOSPITAL PROVIDED $42,784,864 IN CHARITY CARE AT ESTABLISHED RATES TO PATIENTS UNABLE TO PAY FOR THEIR HEALTH CARE SERVICES. IN ADDITION, CAHRGES OF $224,051,490 WERE NOT COLLECTED DUE TO SHORTFALLS FROM MEDICARE AND MEDICAID. 172646477 1 1 0 0 0 0 0 0 0 1 1 0 1 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 1 0 0 1 193 0 1 1413 1 1 1 0 0 0 0 0 0 0 0 0 X 9 7 0 0 0 0 0 0 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 1.00 X X 0 0 0 ROBERT H BROOKER 1.00 X X 0 0 0 ROBERT B HUBBS 1.00 X X 0 0 0 ANGELA M GORDY 1.00 X 0 0 0 STEVEN W PAYNTER MD 1.00 X 0 0 0 STEPHEN H RYALS MD 1.00 X 0 0 0 W SCOTT SELLERS 1.00 X 0 0 0 MATHEW D SMITH MD 1.00 X 0 0 0 JEFFREY D MYERS 1.00 X X 0 378247 110947 EZAD N AHMAD MD 1.00 X 0 0 0 CAROLYN K TURNER 1.00 X 0 0 0 GARY L HOWARD 1.00 X 0 382983 120327 KAREN J WISDOM 40.00 X 403110 0 54241 JOSEPH MCGUIRE 1.00 X 0 172999 65820 RANDALL F FOSTER 40.00 X 189948 0 51260 JANICE C KEYS 40.00 X 205210 0 23774 SANDRA D MCKENZIE 40.00 X 175609 0 46031 T STEVEN POUND 40.00 X 197975 0 42747 SHAWN MOLSBERGER 40.00 X 200441 0 43651 CARLTON LANCASTER 40.00 X 337397 0 87769 TIMOTHY R BUNKER 40.00 X 268864 0 37895 MICHAEL HARTLEY 40.00 X 181253 0 2363 DC CLARK JR 40.00 X 169847 0 24529 JAMES PIRKLE JR 40.00 X 156317 0 22103 JOHN S BOWLING 1.00 X 0 270838 185612 2485971 1205067 919069 45 1 1 0 SODEXO OPERATIONS LLC 86 HOPEMEADOW STREET SIMSBURG CT 06089 FACILITY MANAGEMENT 5416880 SIEMENS MEDICAL SOLUTIONS PO BOX 40065 ATLANTA GA 31192 I.S. CONSULTING AND SUPPORT 3984643 ANESTHESIA ASSSOCIATES PC PO BOX 2563 DALTON GA 30720 ANESTHISIA SERVICES 2301649 SOUTHEASTERN PHYSICIANS ASSOCIATION PO BOX 634850 CINCINNATI OH 45263 ER PHYSICIANS 1157159 GASTROINTESTINAL SPECIALITSTS 302 POINT NORTH PLACE DALTON GA 30720 GASTROINTESTINAL SERVICES 797009 53 2549849 2549849 PATIENT SERVICE REVENU 900099 204213138 204213138 WELLNESS CENTER 713940 1872544 1872544 MANAGEMENT FEES 561000 973275 973275 ANSWERING SERVICE 517000 62100 62100 207121057 5194639 5194639 2050954 2050954 2050954 2050954 60091666 178553 56170125 18803 3921541 159750 4081291 4081291 WENDOR REBATES 900099 943963 943963 GIFT SHOP 453220 244960 244960 EDUCATION 611710 30425 30425 222157 222157 1441505 222439295 208002920 62100 11824426 1633997 1633997 63387875 61966876 1420999 2041559 2041559 11433126 11433126 4328961 4328961 35655 35655 376154 376154 83939 83939 469282 469282 19742849 19032845 710004 131926 131926 30141493 18350253 11791240 3789938 3789938 6182018 6182018 280572 280572 142355 142355 3852389 3852389 14263825 14263825 864997 864997 BAD DEBT 31444137 31444137 PROVIDER TAX 2329672 2329672 MISCELLANEOUS 2271263 2271263 MANAGEMENT FEE TO HHCS 1095000 1095000 CONSULTING FEES 981524 981524 201304506 172646477 28658029 0 3709458 3825866 2335685 3289907 22203734 26218202 1235933 2621556 3411759 2819204 7521327 6302842 244588697 129356093 118350281 115232604 98569329 102720094 29554384 31392182 9896958 10672319 1796761 1644234 298585609 306739010 19253156 17273748 111020000 108410000 1187696 1334384 131460852 127018132 X 167124757 179720878 167124757 179720878 298585609 306739010 X 21134789 -8538668 X 0 1 1 X 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 5937617 5937617 114792650 44150701 70641949 2808735 2023778 784957 119445785 83181614 36264171 1603910 1603910 115232604 US TREASURY 20143725 F INTEREST RECEIVABLE 751467 F TIMBERLAND INVESTMENTS 4308615 F REAL ESTATE 6188375 F 31392182 ASSET RETIREMENT OBLIGATION 1334384 1334384 222439295 201304506 21134789 -8726720 188052 -8538668 12596121 DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: PART X: 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, 2011. PART XI, LINE 8 - OTHER ADJUSTMENTS: CHANGE IN LIABILITY CLAIMS ACCRUAL 188,052. FORM 990 PART XI LINE 5 UNREALIZED LOSS ON TRADING SECURITIES ($8,726,720) OFFSET BY CHANGE IN LIABILITY CLAIMS ACCRUAL ($79,203), GAIN ON INVESTMENT IN HEALTH ONE ALLIANCE ($95,361) AND OTHER ADJUSTMENT ($13,488). 1 1 X 1 X 125.000000000000 1 X 1 1 1 0 1 1 14878147 2249849 12628298 0.07430 31725038 27149191 4575847 0.02690 46603185 29399040 17204145 0.10120 1002416 21124 981292 0.00580 24284819 18826759 5458060 0.03210 111000 111000 0.00070 25398235 18847883 6550352 0.03860 72001420 48246923 23754497 0.13980 1 10965832 2741458 52201254 55454336 -3253082 X 1 1 1 1 HAMILTON MEDICAL CENTER INC

1200 MEMORIAL DRIVE DALTON GA 30720

X X X NOT REQUIRED 1 9 HAMILTON DIAGNOSTIC CENTER

1407 NORTH THORNTON AVENUE DALTON GA 30720

DIAGNOSTIC IMAGING, SLEEP DISORDERS HAMILTON SPECIALTY IMAGING

1436 BROADRICK DRIVE DALTON GA 30720

DIAGNOSTIC IMAGING HAMILTON WOUND CARE

1109 BURLEYSON ROAD DALTON GA 30720

WOUND CARE ENDOVASCULAR SURGERY PRACTICE

1109 BURLEYSON ROAD DALTON GA 30720

ENDOVASCULAR SERVICES HAMILTON CONVENIENT CARE

1012 BURLEYSON ROAD DALTON GA 30720

URGENT CARE CLINIC, FAMILY PRACTICE HAMILTON SPINE CENTER

1107 MEMORIAL DRIVE DALTON GA 30720

SPINE CARE CLINIC BRADLEY WELLNESS CENTER

1250 BROADRICK DRIVE DALTON GA 30720

FITNESS, CARIAC REHAB, PHYS./OCC. THERAPY NEPHROLOGY PRACTICE

1506 BROADRICK DALTON GA 30720

NEPHROLOGY SERVICES DIABETES TREATMENT CENTER

1109 BURLEYSON ROAD DALTON GA 30720

DIABETES TREATMENT CENTER PART I, LINE 7, COLUMN (F): THE BAD DEBT EXPENSE INCLUDED ON FORM 990, PART IX, LINE 25, COLUMN (A), BUT SUBTRACTED FOR PURPOSES OF CALCULATING THE PERCENTAGE IN THIS COLUMN IS $ 31444137. 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 THE AMOUNTS REPORTED IN THE TABLE OF CHARITY CARE AND CERTAIN OTHER COMMUNITY BENEFITS WERE DERIVED FROM COST TO CHARGE RATIO. THE TOTAL EXPENSE FROM FORM 990, PART IX, LINE 25, COLUMN A WAS $201,304,506. THE BAD DEBT INCLUDED IN THIS AMOUNT WAS $31,444,137. AFTER BAD DEBT WAS DEDUCTED FROM THE TOTAL EXPENSES THE AMOUNT OF TOTAL EXPENSES USED TO CALCULATE THE PERCENT IN LINE 7, COLUMN F WAS $169,860,369. PART I LINE 7G IN FURTHERANCE OF ITS MISSION, HAMILTON MEDICAL CENTER PROVIDES CERTAIN SERVICES TO THE COMMUNITY AT A LOSS. THESE SERVICES INCLUDE OBSTETRICS, BEHAVIORAL HEALTH, HOME HEALTH, AND HOSPICE. 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 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 (HMC) 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 94% OF THE FACILITY'S VOLUME. THE SERVICE AREA HAS A POPULATION OF 142,227 CONSISTING OF 102,599 AND 39,628 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 6 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 7 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. X X 1 1 X X X 0 1 0 0 0 1 1 0 0 JEFFREY D MYERS 0 339225 0 0 0 39022 0 18825 0 92122 0 489194 0 0 GARY L HOWARD 0 271522 0 0 0 111461 0 19705 0 100622 0 503310 0 67350 KAREN J WISDOM 299198 0 0 0 103912 0 15992 0 38249 0 457351 0 58138 0 JOSEPH MCGUIRE 0 145733 0 0 0 27266 0 7787 0 58033 0 238819 0 17977 RANDALL F FOSTER 130976 0 0 0 58972 0 7506 0 43754 0 241208 0 41604 0 JANICE C KEYS 163024 0 0 0 42186 0 1203 0 22571 0 228984 0 40131 0 SANDRA D MCKENZIE 139476 0 0 0 36133 0 8004 0 38027 0 221640 0 18877 0 T STEVEN POUND 151600 0 0 0 46375 0 7758 0 34989 0 240722 0 29292 0 SHAWN MOLSBERGER 147656 0 0 0 52785 0 6687 0 36964 0 244092 0 45983 0 CARLTON LANCASTER 233735 0 0 0 103662 0 17209 0 70560 0 425166 0 61663 0 TIMOTHY R BUNKER 251122 0 0 0 17742 0 13614 0 24281 0 306759 0 0 0 MICHAEL HARTLEY 176474 0 0 0 4779 0 0 0 2363 0 183616 0 0 0 DC CLARK JR 150591 0 0 0 19256 0 7593 0 16936 0 194376 0 0 0 JAMES PIRKLE JR 139982 0 0 0 16335 0 0 0 22103 0 178420 0 0 0 JOHN S BOWLING 0 249055 0 0 0 21783 0 111463 0 74149 0 456450 0 104878 PART I, LINE 4B JOHN S. BOWLING - $110,520; GARY L. HOWARD - $4,038; JEFFREY D. MYERS - $3,741; CARLTON LANCASTER, M.D. - $3,617 PART I, LINE 6 THE 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. DEVELOPMENT AUTHORITY OF THE CITY OF DALTON 810614876 2003-06-02 1000000 REFUND BONDS ISSUED 12/18/96 0 0 0 DEVELOPMENT AUTHORITY OF THE CITY OF DALTON 810614876 235550EQ9 2003-09-04 55000000 EXPANSION AND IMPROVEMENTS TO HEALTH CARE FACILITY 0 0 0 1000000 2003 1 0 1 1 58599086 420450 58178636 2008 0 0 1 1 0 0 0 0 1 0.85000 0.85000 1 0 1 0 0 1 0.85000 0.85000 1 0 1 0 0 0 1 1 1 0 0 0 0 FORM 990 PART IV LINE 12 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 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 11 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 ORGANIZATIONS 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 CHANGES IN NET ASSETS OR FUND BALANCES: FORM 990, PART XI, LINE 5: NET UNREALIZED LOSSES ON INVESTMENTS: -8,726,720. CHANGE IN LIABILITY CLAIMS ACCRUAL 188,052. TOTAL TO FORM 990, PART XI, LINE 5: -8,538,668. DALTON SENIOR HOUSING INC 519 WEST HAWTHORNE STREET DALTON GA 30720 581518011 LOW-INCOME HOUSING GA 501(C)(3) LINE 9 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 11D, III-O 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 11A, I HAMILTON HEALTH CARE SYSTEM INC 0 DALTON-WHITFIELD INDIGENT CARE TRUST PO BOX 1168 DALTON GA 30722 586345011 FUNDS FOR INDIGENT CARE GA 501(C)(3) LINE 11A, I 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 9 HAMILTON HEALTH CARE SYSTEM INC 0 HAMILTON HEALTH CARE SYSTEM INC PO BOX 1900 DALTON GA 30722 581519913 SUPPORT RELATED ENTITIES GA 501(C)(3) LINE 11D, III-O N/A 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 9 HAMILTON HEALTH CARE SYSTEM INC 0 MURRAY MEDICAL CENTER INC PO BOX 1406 CHATSWORTH GA 30705 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 9 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 11A, I HAMILTON HEALTH CARE SYSTEM INC 0 WHITFIELD PLACE INC PO BOX 1168 DALTON GA 30722 582103085 LOW-INCOME HOUSING GA 501(C)(3) LINE 9 HAMILTON HEALTH CARE SYSTEM INC 0 HAMILTON HEALTH FIRST INC PO BOX 1168 DALTON GA 30722 581694713 PREFERRED PROVIDER GA N/A C 1 0 1 0 0 0 0 0 0 0 0 1 0 1 0 1 1 1 HAMILTON AMBULATORY SURGERY CENTER INC A 686500 FMV HAMILTON AMBULATORY SURGERY CENTER INC N 1425228 FMV HAMILTON AMBULATORY SURGERY CENTER INC P 909058 FMV HAMILTON PHYSICIANS GROUP INC D 2140000 FMV