2020-08-14T15:10:50-05:00 2019-09-30 560747981 DIXON HUGHES GOODMAN LLP 500 RIDGEFIELD COURT ASHEVILLE NC 28806 990 2018-10-01 823312912 HAMILTON CHILDREN'S INSTITUTE INC HAMI 7062268900 PO BOX 1168 DALTON GA 307221168 JULIE A SOEKORO VP/CFO/TREASURER 7062726115 2020-08-14 1 AMY BIBBY P00445891 8282542254 2020-08-14 99.47.28.203 2020-08-14 14:31:35 ED P B6FD9AFAEFFBB4389B3F723AC8EEB9995B3F41FF 48FB394F9AA065459641371F168D9F2AFFFBB473 2018 2020-09-23 17:36:50Z ANNA SHAW CHILDREN'S INSTITUTE JEFFREY D MYERS PO BOX 1168 DALTON GA 307221168 2141366 0 X X 2017 GA CHAMPION CARE TO CHILDREN AND FAMILIES FOR HAPPY, HEALTHY LIVES. 8 5 3 0 0 0 320060 1863161 0 278205 0 0 0 0 320060 2141366 0 0 0 0 139313 1353568 0 0 0 180747 787798 320060 2141366 0 0 0 696044 0 336044 0 360000 CHAMPION CARE TO CHILDREN AND FAMILIES FOR HAPPY, HEALTHY LIVES. 0 0 2069988 278205 HAMILTON CHILDREN'S INSTITUTE, INC., D/B/A ANNA SHAW CHILDREN'S INSTITUTE OPENED ON APRIL 1,2019. SERVICES OFFERED IN THE FACILITY INCLUDE AUTISM EVALUATION AND ASSESSMENT AND REHABILITATION SERVICES WHICH INCLUDE PHYSICAL THERAPY, OCCUPATIONAL THERAPY, AND SPEECH THERAPY. TOTAL PATIENT VISITS WERE 1744. 2069988 1 1 0 0 0 0 0 0 0 0 1 0 0 0 0 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 0 0 3 1 0 0 0 0 0 0 0 0 0 0 0 0 X 8 5 0 0 0 0 0 1 1 1 1 0 0 1 1 1 1 1 1 0 0 0 GA X JULIE A SOEKORO 7062726000 PO BOX 1168 DALTON GA 307221168 ROBERT M CHANDLER CHAIRMAN 1.00 X X 0 0 0 W NORRIS LITTLE VICE CHAIRMAN 1.00 X X 0 0 0 GARY A MIDDLETON TRUSTEE 1.00 X 0 0 0 JOHN P NEAL III TRUSTEE 1.00 X 0 0 0 SUSAN S YOUNG TRUSTEE 1.00 X 0 0 0 JEFFREY D MYERS PRESIDENT/CEO 1.00 40.00 X X 0 1501927 122161 JOSEPH L MCGUIRE VP/CFO/TREASURER 1.00 40.00 X X 0 596639 62378 SANDRA D MCKENZIE EVP/COO/SECRETARY 1.00 40.00 X X 0 597255 56388 STEVEN P BRIDENSTINE ASSISTANT TREASURER 1.00 40.00 X 0 145612 17366 0 2841433 258293 0 0 1 0 0 1863161 1863161 NET PATIENT SERVICE RE 621300 278205 278205 278205 2141366 278205 0 0 1079143 1079143 5422 5422 189673 189673 79330 79330 49998 49998 2033 2033 123102 123102 3570 3570 29395 29395 543970 543970 3890 3890 19347 19347 PROFESSIONAL FEES 12465 12465 SALES TAX 28 28 2141366 2069988 71378 0 111941 203267 20836 360000 0 360000 0 696044 336044 0 336044 X 0 360000 0 360000 0 696044 X 0 360000 X 0 1 X 1 0 X 320060 1863161 2183221 278205 278205 320060 2141366 2461426 0 0 0 2461426 320060 2141366 2461426 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 360000 360000 360000 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, 2019. PART X, LINE 2: THE ORGANIZATION HAS ADOPTED PROCEDURES FOR DETERMINING THE EXISTENCE OF UNCERTAIN TAX POSITIONS, AN 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, 2019. 0 1 0 0 0 0 0 0 0 JEFFREY D MYERS PRESIDENT/CEO 0 943863 0 388206 0 169858 0 53955 0 68206 0 1624088 0 40205 JOSEPH L MCGUIRE VP/CFO/TREASURER 0 361906 0 114299 0 120434 0 13750 0 48628 0 659017 0 93758 SANDRA D MCKENZIE EVP/COO/SECRETARY 0 350423 0 114571 0 132261 0 19934 0 36454 0 653643 0 6184 STEVEN P BRIDENSTINE ASSISTANT TREASURER 0 124301 0 13760 0 7551 0 6402 0 10964 0 162978 0 0 PART I, LINE 4B THE FOLLOWING PERSONS RECEIVED CURRENT YEAR DEFERREED COMPENSATION ACCRUALS FROM NON-QUALIFIED PLANS: - JEFFREY D. MYERS - $40,205 - SANDRA D. MCKENZIE - $6,184 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 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. THE POLICY ALSO REQUIRES EACH TRUSTEE AND OFFICER OF THE ORGANIZATION TO ANNUALLY SIGN A STATEMENT ACKNOWLEDGING RECEIPT FOR THE CONFLICT OF INTEREST POLICY. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION MAKES ITS GOVERNING DOCUMENTS, CONFLICTS OF INTEREST POLICY AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UPON REQUEST. FORM 990, PART XI, LINE 9: DISTRIBUTION OF LAND FROM HAMILTON MEDICAL CENTER, INC. 360,000. 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 HAMILTON PHYSICIAN GROUP INC PO BOX 1168 DALTON GA 30722 271198701 PHYSICIAN PRACTICE GA 501(C)(3) LINE 3 HAMILTON MEDICAL CENTER 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 HLTC INC PO BOX 1168 DALTON GA 30722 582341574 LONG-TERM CARE GA 501(C)(3) LINE 10 HAMILTON HEALTH CARE SYSTEM INC 0 HAMILTON HEALTH FIRST INC PO BOX 1168 DALTON GA 307221168 581694713 PREFERRED PROVIDER ORGANIZATION GA N/A C 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0