2012-06-07T09:30:53-05:00 2011-09-30 DIXON HUGHES GOODMAN LLP 500 RIDGEFIELD COURT ASHEVILLE NC 28806 990 2010-10-01 582373427 MURRAY MEDICAL CENTER INC MURR 7066954564 PO BOX 1406 CHATSWORTH GA 30705 JOSEPH L MCGUIRE 7066954564 2012-05-30 MICHAEL RAUCHWARG 8282542254 2010 2016-02-24 21:20:13Z JEFFREY D MYERS PO BOX 1168 DALTON GA 307221168 19921206 0 X N/A X 1998 GA MURRAY MEDICAL CENTER OPERATES A 42 BED ACUTE CARE HOSPITAL IN CHATSWORTH, GA. DURING THE FISCAL YEAR ENDED 9/30/11 THE ORGANIZAZION HAD 2,265 INPATIENT DAYS AND 28,090 OUTPATIENT VISITS. THE ORGANIZATIONS MISSION IS TO SERVE THE NEEDS OF THE AREA RESIDENTS WITHOUT DISCRIMINATION AND REGARDLESS OF ABILTIY TO PAY. 10 8 147 8 0 0 753252 537925 18475081 19086624 24912 10627 237944 286030 19491189 19921206 0 0 0 0 10083540 9099000 0 0 0 10779125 11021474 20862665 20120474 -1371476 -199268 4365938 4283766 10037693 10116789 -5671755 -5833023 TO PROVIDE FRIENDLY CARING SERVICE THAT SHOWS RESPECT FOR THE PATIENTS, FAMILITES, CUSTOMERS, AND EACH OTHER, THAT MEETS THEIR NEEDS AND EXCEEDS THEIR EXPECTATIONS. 0 0 17253859 19280394 MURRAY MEDICAL CENTER OPERATES A 42 BED ACUTE CARE HOSPITAL IN CHATSWORTH, GA. DURING THE FISCAL YEAR ENDED 9/30/11 THE ORGANIZAZION HAD 2,265 INPATIENT DAYS AND 28,090 OUTPATIENT VISITS. THE ORGANIZATIONS MISSION IS TO SERVE THE NEEDS OF THE AREA RESIDENTS WITHOUT DISCRIMINATION AND REGARDLESS OF ABILTIY TO PAY. CHARITY CARE PROVIDED BY THE ORGANIZATION WAS $5,353,847 FOR THE FISCAL YEAR. IN ADDITION, CHARGES OF $25,044,615 WERE NOT COLLECTED DUE TO SHORTFALLS FROM MEDICARE AND MEDICAID. 17253859 1 1 0 0 0 0 0 0 0 1 0 0 0 0 1 0 1 0 0 0 0 0 0 0 0 1 1 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 1 45 0 1 147 1 0 0 0 0 0 0 0 0 0 0 X 10 8 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 GARY A MIDDLETON 1.00 X X 0 0 0 ROBERT T COOK MD 1.00 X X 0 0 0 BERNITA P COFIELD 1.00 X X 0 0 0 RICHARD BAGLEY 1.00 X 0 0 0 BILL KEITH 1.00 X 0 0 0 JAMES B MCCRANEY 1.00 X 0 0 0 R BLAINE MINOR MD 1.00 X 0 0 0 TRUDY SWILLING 1.00 X 0 0 0 MICHAEL A WITT MD 1.00 X 0 0 0 JEFFREY D MYERS 1.00 X X 0 378247 110947 GARY L HOWARD 1.00 X 0 382983 120327 JAMES C HAZEL 1.00 X 220961 0 730497 JOSEPH L MCGUIRE 1.00 X 0 172999 65820 DANNY WRIGHT 40.00 X 79737 0 26852 BRENDA GUINN 40.00 X 100665 0 21895 JOHN S BOWLING 1.00 X 0 270838 185612 401363 1205067 1261950 2 1 1 0 SENTINAL PHARMACY SOLUTONS 3195 EAGLE WATCH DRIVE WOODSTOCK GA 30189 PHARMACY 164018 SIEMENS MEDICAL SOLUTIONS INC PO BOX 120001 DEPT 0733 DALLAS TX 75312 I.S. CONSULTING & SUPPORT 145594 SUMMIT MOBILE IMAGING INC PO BOX 200096 CARTERSVILLE GA 30120 DIAGNOSTIC IMAGING 145560 HAMILTON MEDICAL CENTER INC PO BOX 1168 DALTON GA 30722 LAB AND SLEEP STUDIES 106860 NATIONWIDE RECOVERY SERVICES PO BOX 56346 ATLANTA GA 30343 COLLECTION SERVICES 105169 5 537925 537925 PATIENT SERVICES 900099 19086624 19086624 19086624 9877 9877 68397 68397 68397 68397 750 750 750 750 MISCELLANEOUS 900099 97927 97927 VENDOR REBATES 900099 95843 95843 CAFETERIA SALES 722210 23863 23863 217633 19921206 19280394 0 102887 1058047 1058047 5696114 5696114 156345 156345 1723225 1723225 465269 465269 21906 21906 126 126 1462636 1170636 292000 14994 14994 2233159 1424107 809052 150324 150324 715263 715263 4924 4924 350000 350000 191209 191209 70767 70767 BAD DEBTS 5147308 5147308 PROVIDER TAX 235159 235159 MISCELLANEOUS 163906 163906 MANAGEMENT FEE TO HAMIL 160000 160000 COLLECTIONS FEES 99793 99793 20120474 17253859 2866615 0 11222 598317 2484481 1753673 394311 369289 72725 51662 7000362 5489537 1068250 1510825 327970 6979 4365938 4283766 3037693 3116789 7000000 7000000 10037693 10116789 X -5671755 -5833023 -5671755 -5833023 4365938 4283766 X -199268 38000 X 0 1 1 X 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 1441479 1035912 405567 357724 188091 169633 5201159 4265534 935625 1510825 DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: PART X: 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, 2011. 1 1 X 1 X 125.000000000000 1 X 1 1 1 0 1 1 1919347 1919347 0.12820 3273948 1992390 1281558 0.08560 5193295 1992390 3200905 0.21380 5193295 1992390 3200905 0.21380 1 1845304 461326 4233173 6042105 -1808932 X 1 1 1 1 MURRAY MEDICAL CENTER INC

PO BOX 1406 CHATSWORTH GA 30705

X X X MURRAY MEDICAL CENTER INC 1 0 0 0 0 0 0 0 0 0 0 0 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 $ 5147308. PART I LINE 6A MURRAY 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 $20,120,474. THE BAD DEBT EXPENSE INCLUDED IN THIS AMOUNT WAS $5,147,308. AFTER BAD DEBT EXPENSE WAS DEDUCTED FROM THE TOTAL EXPENSES THE AMOUNT OF TOTAL EXPENSES USED TO CALCULATE THE PERCENT IN LINE 7, COLUMN F WAS $14,973,166. PART III LINE 4 MURRAY 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 MURRAY 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 MURRAY 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 MURRAY 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 COST TO CHARGE RATIOS IN ACCORDANCE WITH WORKSHEET 2 INSTRUCTIONS. PART III, LINE 9B MURRAY MEDICAL CENTER'S COLLECTIONS POLICY CONTAINS PROVISIONS RELATED TO THE MEDICALLY INDIGENT. PATIENTS WHO STATE 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 MURRAY 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 MURRAY MEDICAL CENTER (MMC) PROVIDES CARE REGARDLESS OF ABILITY TO PAY. THE PATIENT ACCESS COORDINATOR AND ADMISSIONS SUPERVISOR ARE RESPONSIBLE FOR EDUCATING PATIENTS AND RESPONSIBLE PARTIES OF POTENTIAL PAYMENT OPTIONS AS WELL AS THE ORGANIZATION'S FINANCIAL ASSISTANCE PROGRAM. THESE INDIVIDUAL 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 MURRAY MEDICAL CENTER'S PRIMARY SERVICE AREA CONSISTS OF MURRAY COUNTY IN NORTHWEST GEORGIA AND REPRESENTS 100% OF THE FACILITY'S VOLUME. THE SERVICE AREA HAS A POPULATION OF 39,628. MINORITY POPULATIONS CONSIST OF HISPANIC (13%) AND AFRICAN-AMERICAN (1%). APPROXIMATELY 21% OF THE POPULATION LIVE BELOW THE POVERTY LEVEL. PART VI LINE 6 MURRAY MEDICAL CENTER (MMC), INCLUDING ITS RELATED AFFILIATES, IS ORGANIZED AND OPERATED FOR CHARITABLE PURPOSES WITH THE GOAL OF PROMOTING THE HEALTH OF THE COMMUNITIES IT SERVES. MMC 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 AVAILABLE FUNDS IN FURTHERANCE OF THE HOSPITAL'S CHARITABLE PURPOSE. PART VI LINE 7 MURRAY MEDICAL CENTER, INC. (MMC) 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; HAMILTON 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 HAMILTON MEDICAL CENTER. 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 JAMES C HAZEL 167038 0 0 0 53923 0 682022 0 48475 0 951458 0 1642156 0 JOSEPH L MCGUIRE 0 145733 0 0 0 27266 0 7787 0 58033 0 238819 0 17977 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 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. 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 CPA 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 MEMBER OF THE BOARD OF TRUSTEES PRIOR TO FILING WITH THE INTERNAL REVENUE SERVICE. FORM 990, PART VI, SECTION B, LINE 12C THE ORGANIZATION HAS A CLEAR AND DETAILED CONFLICT OF INTEREST POLICY WHICH ESTABLISHES A PROCEDURE FOR IDENTIFYING, REVIEWING AND ADDRESSING CONFLICTS OF INTEREST. THIS POLICY ALSO REQUIRES EACH TRUSTEE AND OFFICER OF THE ORGANIZATION TO ANNUALLY SIGN A STATEMENT ACKNOWLEDGING RECEIPT OF THE CONFLICT OF INTEREST POLICY. FORM 990, PART VI, SECTION B, LINE 15 UNDER A BOARD RESOLUTION, THE ORGANIZATION'S COMPENSATION COMMITTEE HAS THE AUTHORITY TO TAKE ACTION ON BEHALF OF THE BOARD WITH RESPECT TO THE COMPENSATION OF OFFICERS AND KEY EMPLOYEES. THE COMPENSATION COMMITTEE MAINTAINS MINUTES OF ITS PROCEEDINGS. ON AN ANNUAL BASIS THE COMPENSATION COMMITTEE WILL MEET TO SET THE ANNUAL COMPENSATION OF THE PRESIDENT/CEO. THIS ACTION IS BASED ON CONSULTATION WITH A THIRD PARTY CONSULTING FIRM TO REVIEW THE TOTAL COMPENSATION OF THE CEO AND KEY EMPLOYEES SUCH THAT TOTAL COMPENSATION PACKAGES ARE CONSIDERED FAIR MARKET AND NOT EXCESSIVE. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION MAKES ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UPON REQUEST. CHANGES IN NET ASSETS OR FUND BALANCES: FORM 990, PART XI, LINE 5: NET UNREALIZED LOSSES ON INVESTMENTS: -2,568. DIVESTITURE OF LIABILTIY CLAIMS INVESTMENT 150,000. CHANGE IN ACCRUED LIABILITIES CLAIMS -109,432. TOTAL TO FORM 990, PART XI, LINE 5: 38,000. 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 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 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 HAMILTON MEDICAL CENTER INC PO BOX 1168 DALTON GA 30722 581519911 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 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 0 0 0