SCHEDULE O
(Form 990 or 990-EZ)

Department of the Treasury
Internal Revenue Service
Supplemental Information to Form 990 or 990-EZ

Complete to provide information for responses to specific questions on
Form 990 or to provide any additional information.
MediumBullet Attach to Form 990 or 990-EZ.
MediumBullet Information about Schedule O (Form 990 or 990-EZ) and its instructions is at
www.irs.gov/form990.
OMB No. 1545-0047
2013
Open to Public
Inspection
Name of the organization
DALTON-WHITFIELD COUNTY HOSPITAL LIABILITY TRUST
 
Employer identification number

58-1331514
Return Reference Explanation
FORM 990, PART VI, SECTION A, LINE 7A HAMILTON MEDICAL CENTER, INC. MAY REMOVE THE TRUSTEE WITH OR WITHOUT CAUSE UPON 30 DAYS WRITTEN NOTICE. UPON NOTICE, HAMILTON SHALL APPOINT A QUALIFIED SUCCESSOR TRUSTEE. HAMILTON MEDICAL CENTER, INC. IS A RELATED 501(C)(3) ORGANIZATION.
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 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. 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 C, LINE 19 THE ORGANIZATION MAKES ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UPON REQUEST.
FORM 990, PART XI, LINE 9: WITHDRAWAL OF INVESTMENTS -4,510,235. INCREASE (DECREASE) IN LIABILITY ACCRUAL -286,078.
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.
Cat. No. 51056K
Schedule O (Form 990 or 990-EZ) 2013

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