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 990-EZ or to provide any additional information.
MediumBullet Attach to Form 990 or 990-EZ.
MediumBullet Go to www.irs.gov/Form990 for the latest information.
OMB No. 1545-0047
2019
Open to Public
Inspection
Name of the organization
Minnie Hamilton Health Care Center Inc
 
Employer identification number

55-0629032
Return Reference Explanation
Form 990, Part VI, Section B, line 11b Form 990 is reviewed by Executive Management, the Finance Committee and the Board of Directors.
Form 990, Part VI, Section B, line 12c The Board of Directors sign the statement annually. Individual members are excused from decision making on issues where conflicts may arise. Board of Director members recuse themselves from voting on issues where a conflict may exist.
Form 990, Part VI, Section B, line 15 A survey of like facilities in the state, utilizing the Health Care Authority information that is available, to compare salaries of top executives, as well as looking at job responsibilities and years of experience. The CEO is a contracted position and approved by the Board of Directors. Executive management is approved by the CEO.
Form 990, Part VI, Section C, line 19 Audited Financial Statements are available upon request to the public. Annually the audited balance sheet and income statement are published in the local newspaper as per the Health Care Authority financial disclosure requirements.
Form 990, Part IX, line 11g Physician Fees: Program service expenses 9,811. Management and general expenses 1,999. Fundraising expenses 0. Total expenses 11,810. Other Purchased Services: Program service expenses 1,940,782. Management and general expenses 395,539. Fundraising expenses 0. Total expenses 2,336,321.
Form 990, Page 1, Line 6 Volunteers of the organization include members of the hospital auxiliary and teenagers involved in a volunteer program.
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.
Cat. No. 51056K
Schedule O (Form 990 or 990-EZ) 2019


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