TY 2014 Form 990

(A) Name and Title	(B) Average hours per week (list any hours for related organizations below dotted line)	(C) Position (do not check more than one box, unless person is both an officer and a director/trustee)	(E) Reportable compensation from related organizations (W- 2/1099-MISC)
(1) WILLIAM C DOVEY JR........................................................................ CHAIR	1.00 .......................	X	X		0	0
(2) JAMES A BOTHELL SR........................................................................ VICE CHAIR	1.00 .......................	X	X		0	0
(3) PENELOPE SHIVES........................................................................ SECRETARY	1.00 .......................	X	X		0	0
(4) TIMOTHY R MCGARVEY........................................................................ TREASURER	1.00 .......................	X	X		0	0
(5) DENNY L BUTERBAUGH........................................................................ DIRECTOR	1.00 .......................	X			0	0
(6) FRANK D'AMELIO MD........................................................................ DIRECTOR	1.00 .......................	X			59,700	8,179
(7) TIMOTHY HANN........................................................................ DIRECTOR	1.00 .......................	X			0	0
(8) TONYA K HOUSE........................................................................ DIRECTOR	1.00 .......................	X			0	0
(9) SANDRA H LAND........................................................................ DIRECTOR	1.00 .......................	X			0	0
(10) MICHAEL L CRAMPTON........................................................................ DIRECTOR	1.00 .......................	X			0	0
(11) LYNN H PALMER........................................................................ DIRECTOR	1.00 .......................	X			0	0
(12) C VIRGINIA PALMER........................................................................ DIRECTOR	1.00 .......................	X			0	0
(13) CLARENCE O WEICHT........................................................................ DIRECTOR	1.00 .......................	X			0	0
(14) JASON HAWKINS........................................................................ CEO	38.00 .......................2.00		X		168,751	19,695
(15) DEBORAH SHUGHART........................................................................ CFO	38.00 .......................2.00		X		117,384	19,695
(16) JAMES RINTOUL MD........................................................................ ER PHYSICIAN	50.00 .......................			X	460,814	15,164
(17) ALBERT IGUCHI MD........................................................................ ER PHYSICIAN	50.00 .......................			X	374,424	18,692

Do not include amounts reported on lines 6b, 7b, 8b, 9b, and 10b of Part VIII.	(A) Total expenses	(B) Program service expenses	(C) Management and general expenses	(D) Fundraising expenses
1	Grants and other assistance to domestic organizations and domestic governments. See Part IV, line 21 ....	386,151	386,151
2	Grants and other assistance to domestic individuals. See Part IV, line 22 ....
3	Grants and other assistance to foreign organizations, foreign governments, and foreign individuals. See Part IV, lines 15 and 16 ............
4	Benefits paid to or for members ....
5	Compensation of current officers, directors, trustees, and key employees ....	393,404		393,404
6	Compensation not included above, to disqualified persons (as defined under section 4958(f)(1)) and persons described in section 4958(c)(3)(B) ....
7	Other salaries and wages ....	20,555,944	19,150,574	1,405,370
8	Pension plan accruals and contributions (include section 401(k) and 403(b) employer contributions) ....	1,200,193	1,099,638	100,555
9	Other employee benefits .......	3,632,508	3,371,751	260,757
10	Payroll taxes ...........	1,486,278	1,361,754	124,524
11	Fees for services (non-employees):
a	Management ......
b	Legal .........
c	Accounting ...........
d	Lobbying ...........
e	Professional fundraising services. See Part IV, line 17
f	Investment management fees ......
g	Other (If line 11g amount exceeds 10% of line 25, column (A) amount, list line 11g expenses on Schedule O) ....	1,218,224	901,384	316,840
12	Advertising and promotion ....	182,951	90,215	92,736
13	Office expenses .......	548,790	337,795	210,995
14	Information technology ......	85,415		85,415
15	Royalties ..
16	Occupancy ...........	568,284	568,284
17	Travel ............	68,523	56,716	11,807
18	Payments of travel or entertainment expenses for any federal, state, or local public officials ......
19	Conferences, conventions, and meetings ....	157,296	149,840	7,456
20	Interest ...........	1,659,396	1,659,396
21	Payments to affiliates .......
22	Depreciation, depletion, and amortization .....	3,057,493	3,057,493
23	Insurance ..............	476,386	476,386
24	Other expenses. Itemize expenses not covered above (List miscellaneous expenses in line 24e. If line 24e amount exceeds 10% of line 25, column (A) amount, list line 24e expenses on Schedule O.)
a	PURCHASED SERVICES	3,669,893	2,840,602	829,291
b	MEDICAL SUPPLIES	3,298,999	3,298,999
c	BAD DEBT	2,606,180	2,606,180
d	DIETARY	342,886	342,886
e	All other expenses	377,912	242,356	135,556
25	Total functional expenses. Add lines 1 through 24e	45,973,106	41,998,400	3,974,706	0
26	Joint costs. Complete this line only if the organization reported in column (B) joint costs from a combined educational campaign and fundraising solicitation. Check here if following SOP 98-2 (ASC 958-720).

Part X Balance Sheet Check if Schedule O contains a response or note to any line in this Part X ..............
	1	Cash–non-interest-bearing .............	6,553,455	1	6,069,198
2	Savings and temporary cash investments .........	2,314,744	2	251,262
3	Pledges and grants receivable, net ...........	22,524	3	6,774
4	Accounts receivable, net .............	6,906,360	4	8,425,059
5	Loans and other receivables from current and former officers, directors, trustees, key employees, and highest compensated employees. Complete Part II of Schedule L ..................
			5
6	Loans and other receivables from other disqualified persons (as defined under section 4958(f)(1)), persons described in section 4958(c)(3)(B), and contributing employers and sponsoring organizations of section 501(c)(9) voluntary employees' beneficiary organizations (see instructions) Complete Part II of Schedule L
			6
7	Notes and loans receivable, net .............		7
8	Inventories for sale or use ..............	496,990	8	486,916
9	Prepaid expenses and deferred charges ..........	774,110	9	870,214
10a	Land, buildings, and equipment: cost or other basis. Complete Part VI of Schedule D	10a	46,185,035
b	Less: accumulated depreciation .....	10b	21,911,974	26,512,371	10c	24,273,061
11	Investments—publicly traded securities ..........	5,592,337	11	7,755,220
12	Investments—other securities. See Part IV, line 11 .....		12
13	Investments—program-related. See Part IV, line 11 .....		13
14	Intangible assets ...............	162,979	14	162,979
15	Other assets. See Part IV, line 11 ...........	7,574,512	15	6,614,220
16	Total assets. Add lines 1 through 15 (must equal line 34)......	56,910,382	16	54,914,903
	17	Accounts payable and accrued expenses .........	5,040,378	17	5,615,843
18	Grants payable .................		18
19	Deferred revenue ................		19
20	Tax-exempt bond liabilities .............	26,730,995	20	26,239,786
21	Escrow or custodial account liability. Complete Part IV of Schedule D..		21
22	Loans and other payables to current and former officers, directors, trustees, key employees, highest compensated employees, and disqualified
	persons. Complete Part II of Schedule L..........		22
23	Secured mortgages and notes payable to unrelated third parties ..	1,196,819	23	1,011,712
24	Unsecured notes and loans payable to unrelated third parties ....		24
25	Other liabilities (including federal income tax, payables to related third parties, and other liabilities not included on lines 17-24). Complete Part X of Schedule D....................	5,877,192	25	6,011,342
26	Total liabilities. Add lines 17 through 25.........	38,845,384	26	38,878,683
		Organizations that follow SFAS 117 (ASC 958), check here and complete lines 27 through 29, and lines 33 and 34.
27	Unrestricted net assets ..............	16,977,220	27	14,950,884
28	Temporarily restricted net assets ...........		28
29	Permanently restricted net assets ...........	1,087,778	29	1,085,336
	Organizations that do not follow SFAS 117 (ASC 958), check here and complete lines 30 through 34.
30	Capital stock or trust principal, or current funds ........		30
31	Paid-in or capital surplus, or land, building or equipment fund .....		31
32	Retained earnings, endowment, accumulated income, or other funds		32
33	Total net assets or fund balances ...........	18,064,998	33	16,036,220
34	Total liabilities and net assets/fund balances ........	56,910,382	34	54,914,903

- TIN:

SCHEDULE A
(Form 990 or 990EZ)

Department of the Treasury
Internal Revenue Service

Public Charity Status and Public Support

Complete if the organization is a section 501(c)(3) organization or a section 4947(a)(1) nonexempt charitable trust.
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Attach to Form 990 or Form 990-EZ.
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Information about Schedule A (Form 990 or 990-EZ) and its instructions is at www.irs.gov/form990.

OMB No. 1545-0047

2014

Open to Public
Inspection

Name of the organization

FULTON COUNTY MEDICAL CENTER

Employer identification number

23-1401561

Part I

Reason for Public Charity Status (All organizations must complete this part.) See instructions.

The organization is not a private foundation because it is: (For lines 1 through 11, check only one box.)

A church, convention of churches, or association of churches described in section 170(b)(1)(A)(i).

A school described in section 170(b)(1)(A)(ii). (Attach Schedule E.)

A hospital or a cooperative hospital service organization described in section 170(b)(1)(A)(iii).

A medical research organization operated in conjunction with a hospital described in section 170(b)(1)(A)(iii). Enter the hospital's name, city, and state:

An organization operated for the benefit of a college or university owned or operated by a governmental unit described in

section 170(b)(1)(A)(iv). (Complete Part II.)

A federal, state, or local government or governmental unit described in section 170(b)(1)(A)(v).

An organization that normally receives a substantial part of its support from a governmental unit or from the general public described in section 170(b)(1)(A)(vi). (Complete Part II.)

A community trust described in section 170(b)(1)(A)(vi). (Complete Part II.)

An organization that normally receives: (1) more than 331/3% of its support from contributions, membership fees, and gross

receipts from activities related to its exempt functions—subject to certain exceptions, and (2) no more than 331/3% of

its support from gross investment income and unrelated business taxable income (less section 511 tax) from businesses

acquired by the organization after June 30, 1975. See section 509(a)(2). (Complete Part III.)

An organization organized and operated exclusively to test for public safety. See section 509(a)(4).

An organization organized and operated exclusively for the benefit of, to perform the functions of, or to carry out the purposes of one or more publicly supported organizations described in section 509(a)(1) or section 509(a)(2). See section 509(a)(3). Check the box in lines 11a through 11d that describes the type of supporting organization and complete lines 11e, 11f, and 11g.

Type I. A supporting organization operated, supervised, or controlled by its supported organization(s), typically by giving the supported organization(s) the power to regularly appoint or elect a majority of the directors or trustees of the supporting organization. You must complete Part IV, Sections A and B.

Type II. A supporting organization supervised or controlled in connection with its supported organization(s), by having control or management of the supporting organization vested in the same persons that control or manage the supported organization(s). You must complete Part IV, Sections A and C.

Type III functionally integrated. A supporting organization operated in connection with, and functionally integrated with, its supported organization(s) (see instructions). You must complete Part IV, Sections A, D, and E.

Type III non-functionally integrated. A supporting organization operated in connection with its supported organization(s) that is not functionally integrated. The organization generally must satisfy a distribution requirement and an attentiveness requirement (see instructions). You must complete Part IV, Sections A and D, and Part V.

Check this box if the organization received a written determination from the IRS that it is a Type I, Type II, Type III functionally integrated, or Type III non-functionally integrated supporting organization.

Enter the number of supported organizations .............................

Provide the following information about the supported organization(s).

(i)Name of supported organization	(ii) EIN	(iv) Is the organization listed in your governing document?		(v) Amount of monetary support (see instructions)	(vi) Amount of other support (see instructions)
(i)Name of supported organization	(ii) EIN	Yes	No	(v) Amount of monetary support (see instructions)	(vi) Amount of other support (see instructions)


Total

For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990EZ.

Cat. No. 11285F

Schedule A (Form 990 or 990-EZ) 2014

Page 2

Part II

Support Schedule for Organizations Described in Sections 170(b)(1)(A)(iv) and 170(b)(1)(A)(vi)
(Complete only if you checked the box on line 5, 7, or 8 of Part I or if the organization failed to qualify under Part III. If the organization fails to qualify under the tests listed below, please complete Part III.)

Section A. Public Support

Calendar year (or fiscal year beginning in)		(a) 2010	(b) 2011	(c) 2012	(d) 2013	(e) 2014	(f) Total
1	Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grants.") ....
2	Tax revenues levied for the organization's benefit and either paid to or expended on its behalf.......
3	The value of services or facilities furnished by a governmental unit to the organization without charge..
4	Total. Add lines 1 through 3
5	The portion of total contributions by each person (other than a governmental unit or publicly supported organization) included on line 1 that exceeds 2% of the amount shown on line 11, column (f)..
6	Public support. Subtract line 5 from line 4.

Section B. Total Support

Calendar year (or fiscal year beginning in)		(a) 2010	(b) 2011	(c) 2012	(d) 2013	(e) 2014	(f) Total
7	Amounts from line 4..
8	Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources...
9	Net income from unrelated business activities, whether or not the business is regularly carried on..
10	Other income. Do not include gain or loss from the sale of capital assets (Explain in Part VI.)..
11	Total support Add lines 7 through 10.

Gross receipts from related activities, etc. (see instructions) ..................

First five years. If the Form 990 is for the organization's first, second, third, fourth, or fifth tax year as a section 501(c)(3) organization, check this box and stop here........................................ right arrow

Section C. Computation of Public Support Percentage

Public support percentage for 2014 (line 6, column (f) divided by line 11, column (f)) .........

Public support percentage for 2013 Schedule A, Part II, line 14 ...............

16a

33 1/3% support test—2014. If the organization did not check the box on line 13, and line 14 is 33 1/3% or more, check this box
and stop here. The organization qualifies as a publicly supported organization ....................... right arrow

33 1/3% support test—2013. If the organization did not check a box on line 13 or 16a, and line 15 is 33 1/3% or more, check this
box and stop here. The organization qualifies as a publicly supported organization ..................... right arrow

17a

10%-facts-and-circumstances test—2014. If the organization did not check a box on line 13, 16a, or 16b, and line 14
is 10% or more, and if the organization meets the "facts-and-circumstances" test, check this box and stop here. Explain
in Part VI how the organization meets the "facts-and-circumstances" test. The organization qualifies as a publicly supported
organization ..................................................... right arrow

10%-facts-and-circumstances test—2013. If the organization did not check a box on line 13, 16a, 16b, or 17a, and line
15 is 10% or more, and if the organization meets the "facts-and-circumstances" test, check this box and stop here.
Explain in Part VI how the organization meets the "facts-and-circumstances" test. The organization qualifies as a publicly
supported organization ................................................ right arrow

Private foundation. If the organization did not check a box on line 13, 16a, 16b, 17a, or 17b, check this box and see
instructions ..................................................... right arrow

Schedule A (Form 990 or 990-EZ) 2014

Page 3

Part III

Support Schedule for Organizations Described in Section 509(a)(2)
(Complete only if you checked the box on line 9 of Part I or if the organization failed to qualify under Part II. If the organization fails to qualify under the tests listed below, please complete Part II.)

Section A. Public Support

Calendar year (or fiscal year beginning in)		(a) 2010	(b) 2011	(c) 2012	(d) 2013	(e) 2014	(f) Total
1	Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grants.") .
2	Gross receipts from admissions, merchandise sold or services performed, or facilities furnished in any activity that is related to the organization's tax-exempt purpose......
3	Gross receipts from activities that are not an unrelated trade or business under section 513..
4	Tax revenues levied for the organization's benefit and either paid to or expended on its behalf...
5	The value of services or facilities furnished by a governmental unit to the organization without charge..
6	Total. Add lines 1 through 5.
7a	Amounts included on lines 1, 2, and 3 received from disqualified persons...
b	Amounts included on lines 2 and 3 received from other than disqualified persons that exceed the greater of $5,000 or 1% of the amount on line 13 for the year.
c	Add lines 7a and 7b..
8	Public support (Subtract line 7c from line 6.)

Section B. Total Support

Calendar year (or fiscal year beginning in)		(a) 2010	(b) 2011	(c) 2012	(d) 2013	(e) 2014	(f) Total
9	Amounts from line 6...
10a	Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources..
b	Unrelated business taxable income (less section 511 taxes) from businesses acquired after June 30, 1975.
c	Add lines 10a and 10b.
11	Net income from unrelated business activities not included in line 10b, whether or not the business is regularly carried on.
12	Other income. Do not include gain or loss from the sale of capital assets (Explain in Part VI.) ..
13	Total support. (Add lines 9, 10c, 11, and 12.)..

First five years. If the Form 990 is for the organization's first, second, third, fourth, or fifth tax year as a section 501(c)(3) organization,
check this box and stop here............................................. right arrow

Section C. Computation of Public Support Percentage

Public support percentage for 2014 (line 8, column (f) divided by line 13, column (f)) .........

Public support percentage from 2013 Schedule A, Part III, line 15 ...............

Section D. Computation of Investment Income Percentage

Investment income percentage for 2014 (line 10c, column (f) divided by line 13, column (f)) ......

Investment income percentage from 2013 Schedule A, Part III, line 17 .............

19a

33 1/3% support tests—2014. If the organization did not check the box on line 14, and line 15 is more than 33 1/3%, and line 17 is not more than 33 1/3%, check this box and stop here. The organization qualifies as a publicly supported organization ....... right arrow

33 1/3% support tests—2013. If the organization did not check a box on line 14 or line 19a, and line 16 is more than 33 1/3% and line 18 is not more than 33 1/3%, check this box and stop here. The organization qualifies as a publicly supported organization .... right arrow

Private foundation. If the organization did not check a box on line 14, 19a, or 19b, check this box and see instructions .... right arrow

Schedule A (Form 990 or 990-EZ) 2014

Page 4

Part IV

Supporting Organizations

(Complete only if you checked a box on line 11 of Part I. If you checked 11a of Part I, complete Sections A and B. If you checked 11b of Part I, complete Sections A and C. If you checked 11c of Part I, complete Sections A, D, and E. If you checked 11d of Part I, complete Sections A and D, and complete Part V.)

Section A. All Supporting Organizations

Yes

Are all of the organization’s supported organizations listed by name in the organization’s governing documents?
If "No," describe in Part VI how the supported organizations are designated. If designated by class or purpose,
describe the designation. If historic and continuing relationship, explain.

Did the organization have any supported organization that does not have an IRS determination of status under section 509(a)(1) or (2)? If "Yes," explain in Part VI how the organization determined that the supported organization was described in section 509(a)(1) or (2).

Did the organization have a supported organization described in section 501(c)(4), (5), or (6)? If "Yes," answer (b) and (c) below.

Did the organization confirm that each supported organization qualified under section 501(c)(4), (5), or (6) and satisfied the public support tests under section 509(a)(2)? If "Yes," describe in Part VI when and how the organization made the determination.

Did the organization ensure that all support to such organizations was used exclusively for section 170(c)(2)(B) purposes? If "Yes," explain in Part VI what controls the organization put in place to ensure such use.

Was any supported organization not organized in the United States ("foreign supported organization")? If “Yes” and if you checked 11a or 11b in Part I, answer (b) and (c) below.

Did the organization have ultimate control and discretion in deciding whether to make grants to the foreign supported organization? If “Yes,” describe in Part VI how the organization had such control and discretion despite being controlled or supervised by or in connection with its supported organizations....

Did the organization support any foreign supported organization that does not have an IRS determination under sections 501(c)(3) and 509(a)(1) or (2)? If “Yes,” explain in Part VI what controls the organization used to ensure that all support to the foreign supported organization was used exclusively for section 170(c)(2)(B) purposes.

Did the organization add, substitute, or remove any supported organizations during the tax year? If “Yes,” answer (b) and (c) below (if applicable). Also, provide detail in Part VI, including (i) the names and EIN numbers of the supported organizations added, substituted, or removed, (ii) the reasons for each such action, (iii) the authority under the organization's organizing document authorizing such action, and (iv) how the action was accomplished (such as by amendment to the organizing document).

Type I or Type II only. Was any added or substituted supported organization part of a class already designated in the organization's organizing document?

Substitutions only. Was the substitution the result of an event beyond the organization's control?

Did the organization provide support (whether in the form of grants or the provision of services or facilities) to anyone other than (a) its supported organizations; (b) individuals that are part of the charitable class benefited by one or more of its supported organizations; or (c) other supporting organizations that also support or benefit one or more of the filing organization’s supported organizations? If “Yes,” provide detail in Part VI.

Did the organization provide a grant, loan, compensation, or other similar payment to a substantial contributor (defined in IRC 4958(c)(3)(C)), a family member of a substantial contributor, or a 35-percent controlled entity with regard to a substantial contributor? If “Yes,” complete Part I of Schedule L (Form 990) .

Did the organization make a loan to a disqualified person (as defined in section 4958) not described in line 7? If “Yes,” complete Part II of Schedule L (Form 990).

Was the organization controlled directly or indirectly at any time during the tax year by one or more disqualified persons as defined in section 4946 (other than foundation managers and organizations described in section 509(a)(1) or (2))? If “Yes,” provide detail in Part VI.

Did one or more disqualified persons (as defined in line 9(a)) hold a controlling interest in any entity in which the supporting organization had an interest? If “Yes,” provide detail in Part VI.

Did a disqualified person (as defined in line 9(a)) have an ownership interest in, or derive any personal benefit from, assets in which the supporting organization also had an interest? If “Yes,” provide detail in Part VI.

10a

Was the organization subject to the excess business holdings rules of IRC 4943 because of IRC 4943(f) (regarding certain Type II supporting organizations, and all Type III non-functionally integrated supporting organizations)? If “Yes,” answer b below.

10a

Did the organization have any excess business holdings in the tax year? (Use Schedule C, Form 4720, to determine whether the organization had excess business holdings).

10b

Has the organization accepted a gift or contribution from any of the following persons?

A person who directly or indirectly controls, either alone or together with persons described in (b) and (c) below, the governing body of a supported organization?

11a

A family member of a person described in (a) above?

11b

A 35% controlled entity of a person described in (a) or (b) above? If “Yes” to a, b, or c, provide detail in Part VI.

11c

Schedule A (Form 990 or 990-EZ) 2014

Page 5

Part IV

Supporting Organizations (continued)

Section B. Type I Supporting Organizations

Yes

Did the directors, trustees, or membership of one or more supported organizations have the power to regularly appoint or elect at least a majority of the organization’s directors or trustees at all times during the tax year? If “No,” describe in Part VI how the supported organization(s) effectively operated, supervised, or controlled the organization’s activities. If the organization had more than one supported organization, describe how the powers to appoint and/or remove directors or trustees were allocated among the supported organizations and what conditions or restrictions, if any, applied to such powers during the tax year.

Did the organization operate for the benefit of any supported organization other than the supported organization(s) that operated, supervised, or controlled the supporting organization? If “Yes,” explain in Part VI how providing such benefit carried out the purposes of the supported organization(s) that operated, supervised or controlled the supporting organization.

Section C. Type II Supporting Organizations

Yes

Were a majority of the organization’s directors or trustees during the tax year also a majority of the directors or trustees of each of the organization’s supported organization(s)? If “No,” describe in Part VI how control or management of the supporting organization was vested in the same persons that controlled or managed the supported organization(s).

Section D. All Type III Supporting Organizations

Yes

Did the organization provide to each of its supported organizations, by the last day of the fifth month of the organization’s tax year, (1) a written notice describing the type and amount of support provided during the prior tax year, (2) a copy of the Form 990 that was most recently filed as of the date of notification, and (3) copies of the organization’s governing documents in effect on the date of notification, to the extent not previously provided?

Were any of the organization’s officers, directors, or trustees either (i) appointed or elected by the supported organization(s) or (ii) serving on the governing body of a supported organization? If "No," explain in Part VI how the organization maintained a close and continuous working relationship with the supported organization(s).

By reason of the relationship described in (2), did the organization’s supported organizations have a significant voice in the organization’s investment policies and in directing the use of the organization’s income or assets at all times during the tax year? If "Yes," describe in Part VI the role the organization’s supported organizations played in this regard.

Section E. Type III Functionally-Integrated Supporting Organizations

Check the box next to the method that the organization used to satisfy the Integral Part Test during the year (see instructions):

The organization satisfied the Activities Test. Complete line 2 below.

The organization is the parent of each of its supported organizations. Complete line 3 below.

The organization supported a governmental entity. Describe in Part VI how you supported a government entity (see instructions)

Activities Test. Answer (a) and (b) below.

Yes

Did substantially all of the organization’s activities during the tax year directly further the exempt purposes of the supported organization(s) to which the organization was responsive? If "Yes," then in Part VI identify those supported organizations and explain how these activities directly furthered their exempt purposes, how the organization was responsive to those supported organizations, and how the organization determined that these activities constituted substantially all of its activities.

Did the activities described in (a) constitute activities that, but for the organization’s involvement, one or more of the organization’s supported organization(s) would have been engaged in? If "Yes," explain in Part VI the reasons for the organization’s position that its supported organization(s) would have engaged in these activities but for the organization’s involvement.

Parent of Supported Organizations. Answer (a) and (b) below.

Did the organization have the power to regularly appoint or elect a majority of the officers, directors, or trustees of each of the supported organizations? Provide details in Part VI.

Did the organization exercise a substantial degree of direction over the policies, programs and activities of each of its supported organizations? If "Yes," describe in Part VI the role played by the organization in this regard.

Schedule A (Form 990 or 990-EZ) 2014

Page 6

Part V – Type III Non-Functionally Integrated 509(a)(3) Supporting Organizations

1. Check here if the organization satisfied the Integral Part Test as a qualifying trust on Nov. 20, 1970. See instructions. All other Type III non-functionally integrated supporting organizations must complete Sections A through E.

	Section A - Adjusted Net Income		(A) Prior Year	(B) Current Year (optional)
1	Net short-term capital gain	1
2	Recoveries of prior-year distributions	2
3	Other gross income (see instructions)	3
4	Add lines 1 through 3	4
5	Depreciation and depletion	5
6	Portion of operating expenses paid or incurred for production or collection of gross income or for management, conservation, or maintenance of property held for production of income (see instructions)	6
7	Other expenses (see instructions)	7
8	Adjusted Net Income (subtract lines 5, 6 and 7 from line 4)	8

	Section B - Minimum Asset Amount		(A) Prior Year	(B) Current Year (optional)
1	Aggregate fair market value of all non-exempt-use assets (see instructions for short tax year or assets held for part of year):	1
a	Average monthly value of securities	1a
b	Average monthly cash balances	1b
c	Fair market value of other non-exempt-use assets	1c
d	Total (add lines 1a, 1b, and 1c)	1d
e	Discount claimed for blockage or other factors (explain in detail in Part VI):
2	Acquisition indebtedness applicable to non-exempt use assets	2
3	Subtract line 2 from line 1d	3
4	Cash deemed held for exempt use. Enter 1-1/2% of line 3 (for greater amount, see instructions).	4
5	Net value of non-exempt-use assets (subtract line 4 from line 3)	5
6	Multiply line 5 by .035	6
7	Recoveries of prior-year distributions	7
8	Minimum Asset Amount (add line 7 to line 6)	8

	Section C - Distributable Amount		Current Year
1	Adjusted net income for prior year (from Section A, line 8, Column A)	1
2	Enter 85% of line 1	2
3	Minimum asset amount for prior year (from Section B, line 8, Column A)	3
4	Enter greater of line 2 or line 3	4
5	Income tax imposed in prior year	5
6	Distributable Amount. Subtract line 5 from line 4, unless subject to emergency temporary reduction (see instructions)	6
7	Check here if the current year is the organization's first as a non-functionally-integrated Type III supporting organization (see instructions)

Schedule A (Form 990 or 990-EZ) 2014

Page 7

Section D - Distributions		Current Year
1 Amounts paid to supported organizations to accomplish exempt purposes
2 Amounts paid to perform activity that directly furthers exempt purposes of supported organizations, in excess of income from activity
3 Administrative expenses paid to accomplish exempt purposes of supported organizations
4 Amounts paid to acquire exempt-use assets
5 Qualified set-aside amounts (prior IRS approval required)
6 Other distributions (describe in Part VI). See instructions
7Total annual distributions. Add lines 1 through 6.
8 Distributions to attentive supported organizations to which the organization is responsive (provide details in Part VI). See instructions
9 Distributable amount for 2014 from Section C, line 6
10 Line 8 amount divided by Line 9 amount

Section E - Distribution Allocations (see instructions)		(i) Excess Distributions	(ii) Underdistributions Pre-2014	(iii) Distributable Amount for 2014
1 Distributable amount for 2014 from Section C, line 6
2 Underdistributions, if any, for years prior to 2014 (reasonable cause required--see instructions)
3 Excess distributions carryover, if any, to 2014:
a From 2009.......X
b From 2010.......X
c From 2011.......X
d From 2012.......X
e From 2013.......
fTotal of lines 3a through e
g Applied to underdistributions of prior years
h Applied to 2014 distributable amount
i Carryover from 2009 not applied (see instructions)
j Remainder. Subtract lines 3g, 3h, and 3i from 3f.
4Distributions for 2014 from Section D, line 7:
$
a Applied to underdistributions of prior years
b Applied to 2014 distributable amount
c Remainder. Subtract lines 4a and 4b from 4.
5 Remaining underdistributions for years prior to 2014, if any. Subtract lines 3g and 4a from line 2 (if amount greater than zero, see instructions)
6 Remaining underdistributions for 2014. Subtract lines 3h and 4b from line 1 (if amount greater than zero, see instructions)
7 Excess distributions carryover to 2015. Add lines 3j and 4c.
8 Breakdown of line 7:
a From 2010.......X
b From 2011.......X
c From 2012.......X
d From 2013.......
e From 2014.......

Schedule A (Form 990 or 990-EZ) (2014)

Schedule A (Form 990 or 990-EZ) 2014

Page 8

Part VI

Supplemental Information. Provide the explanations required by Part II, line 10; Part II, line 17a or 17b; Part III, line 12; Part IV, Section A, lines 1, 2, 3b, 3c, 4b, 4c, 5a, 6, 9a, 9b, 9c, 11a, 11b, and 11c; Part IV, Section B, lines 1 and 2; Part IV, Section C, line 1; Part IV, Section D, lines 2 and 3; Part IV, Section E, lines 1c, 2a, 2b, 3a and 3b; Part V, line 1; Part V, Section B, line 1e; Part V Section D, lines 5, 6, and 8; and Part V, Section E, lines 2, 5, and 6. Also complete this part for any additional information. (See instructions).

Facts And Circumstances Test

Return Reference	Explanation

Schedule A (Form 990 or 990-EZ) 2014

Additional Data

Software ID:
Software Version:

- TIN:

Schedule B
(Form 990, 990-EZ,
or 990-PF)

Department of the Treasury
Internal Revenue Service

Schedule of Contributors

Attach to Form 990, 990-EZ, or 990-PF.

Information about Schedule B (Form 990, 990-EZ, or 990-PF) and its instructions is at www.irs.gov/form990.

OMB No. 1545-0047

2014

Name of the organization

FULTON COUNTY MEDICAL CENTER

Employer identification number

23-1401561

Organization type (check one):

Filers of:

Section:

Form 990 or 990-EZ

501(c)( ) (enter number) organization

4947(a)(1) nonexempt charitable trust not treated as a private foundation

527 political organization

Form 990-PF

501(c)(3) exempt private foundation

4947(a)(1) nonexempt charitable trust treated as a private foundation

501(c)(3) taxable private foundation

Check if your organization is covered by the General Rule or a Special Rule.
Note. Only a section 501(c)(7), (8), or (10) organization can check boxes for both the General Rule and a Special Rule. See instructions.

General Rule

For an organization filing Form 990, 990-EZ, or 990-PF that received, during the year, contributions totaling $5,000 or more (in money or
property) from any one contributor. Complete Parts I and II. See instructions for determining a contributor's total contributions.

Special Rules

For an organization described in section 501(c)(3) filing Form 990 or 990-EZ that met the 33¹/3% support test of the regulations
under sections 509(a)(1) and 170(b)(1)(A)(vi), that checked Schedule A (Form 990 or 990-EZ), Part II, line 13, 16a, or 16b, and that received from any one contributor, during the year, total contributions of the greater of (1) $5,000 or (2) 2% of the amount on (i) Form 990, Part VIII, line 1h, or (ii) Form 990-EZ, line 1. Complete Parts I and II.

For an organization described in section 501(c)(7), (8), or (10) filing Form 990 or 990-EZ that received from any one contributor,
during the year, total contributions of more than $1,000 exclusively for religious, charitable, scientific, literary, or educational purposes, or for the prevention of cruelty to children or animals. Complete Parts I, II, and III.

For an organization described in section 501(c)(7), (8), or (10) filing Form 990 or 990-EZ that received from any one contributor,
during the year, contributions exclusively for religious, charitable, etc., purposes, but no such contributions totaled more than $1,000. If this box is checked, enter here the total contributions that were received during the year for an exclusively religious, charitable, etc., purpose. Do not complete any of the parts unless the General Rule applies to this organization because it received nonexclusively religious, charitable, etc., contributions totaling $5,000 or more during the year ......... Arrow Bullet

Caution. An organization that is not covered by the General Rule and/or the Special Rules does not file Schedule B (Form 990,
990-EZ, or 990-PF), but it must answer “No” on Part IV, line 2, of its Form 990; or check the box on line H of its
Form 990-EZ or on its Form 990PF, Part I, line 2, to certify that it does not meet the filing requirements of Schedule B (Form 990,
990-EZ, or 990-PF).

For Paperwork Reduction Act Notice, see the Instructions
for Form 990, 990-EZ, or 990-PF.

Cat. No. 30613XSchedule B (Form 990, 990-EZ, or 990-PF) (2014)

Schedule B (Form 990, 990-EZ, or 990-PF) (2014)

Page 2

Name of organization FULTON COUNTY MEDICAL CENTER

Part I	Contributors (see instructions). Use duplicate copies of Part I if additional space is needed.
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
RESTRICTED	,	$RESTRICTED	Person Payroll Noncash (Complete Part II for noncash contributions.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II for noncash contributions.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II for noncash contributions.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II for noncash contributions.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II for noncash contributions.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II for noncash contributions.)
Schedule B (Form 990, 990-EZ, or 990-PF) (2014)

Schedule B (Form 990, 990-EZ, or 990-PF) (2014)

Page 3

Name of organization FULTON COUNTY MEDICAL CENTER

Part II	Noncash Property (see instructions). Use duplicate copies of Part II if additional space is needed.
(a) No. from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (see instructions)	(d) Date received
		$
(a) No. from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (see instructions)	(d) Date received
		$
(a) No. from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (see instructions)	(d) Date received
		$
(a) No. from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (see instructions)	(d) Date received
		$
(a) No. from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (see instructions)	(d) Date received
		$
(a) No. from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (see instructions)	(d) Date received
		$
Schedule B (Form 990, 990-EZ, or 990-PF) (2014)

Schedule B (Form 990, 990-EZ, or 990-PF) (2014)

Page 4

Name of organization
FULTON COUNTY MEDICAL CENTER

Employer identification number

23-1401561

Part III

Exclusively religious, charitable, etc., contributions to organizations described in section 501(c)(7), (8), or (10)
that total more than $1,000 for the year from any one contributor. Complete columns (a) through (e) and the following line entry. For organizations completing Part III, enter the total of exclusively religious, charitable, etc., contributions of $1,000 or less for the year. (Enter this information once. See instructions.) Arrow Bullet

$
Use duplicate copies of Part III if additional space is needed.

(a) No.
from
Part I

(b) Purpose of gift

(d) Description of how gift is held

(e) Transfer of gift
Transferee's name, address, and ZIP 4	Relationship of transferor to transferee

(a) No.
from
Part I

(b) Purpose of gift

(d) Description of how gift is held

(e) Transfer of gift
Transferee's name, address, and ZIP 4	Relationship of transferor to transferee

(a) No.
from
Part I

(b) Purpose of gift

(d) Description of how gift is held

(e) Transfer of gift
Transferee's name, address, and ZIP 4	Relationship of transferor to transferee

(a) No.
from
Part I

(b) Purpose of gift

(d) Description of how gift is held

(e) Transfer of gift
Transferee's name, address, and ZIP 4	Relationship of transferor to transferee

Schedule B (Form 990, 990-EZ, or 990-PF) (2014)

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE D
(Form 990)

Department of the Treasury
Internal Revenue Service

Supplemental Financial Statements

Complete if the organization answered "Yes," to Form 990,
Part IV, line 6, 7, 8, 9, 10, 11a, 11b, 11c, 11d, 11e, 11f, 12a, or 12b.
SchDMd Bullet

Attach to Form 990.
Information about Schedule D (Form 990) and its instructions is at www.irs.gov/form990.

OMB No. 1545-0047

2014

Open to Public Inspection

Name of the organization

FULTON COUNTY MEDICAL CENTER

Employer identification number

23-1401561

Part I

Organizations Maintaining Donor Advised Funds or Other Similar Funds or Accounts. Complete if the organization answered "Yes" to Form 990, Part IV, line 6.

		(a) Donor advised funds	(b) Funds and other accounts
1	Total number at end of year .........
2	Aggregate value of contributions to (during year)
3	Aggregate value of grants from (during year)
4	Aggregate value at end of year ........

Did the organization inform all donors and donor advisors in writing that the assets held in donor advised
funds are the organization's property, subject to the organization's exclusive legal control? ............

Yes No

Did the organization inform all grantees, donors, and donor advisors in writing that grant funds can be
used only for charitable purposes and not for the benefit of the donor or donor advisor, or for any other purpose conferring impermissible private benefit? ...................................

Yes No

Part II

Conservation Easements. Complete if the organization answered "Yes" to Form 990, Part IV, line 7.

Purpose(s) of conservation easements held by the organization (check all that apply).

Preservation of land for public use (e.g., recreation or education) Preservation of an historically important land area

Protection of natural habitat Preservation of a certified historic structure

Preservation of open space

Complete lines 2a through 2d if the organization held a qualified conservation contribution in the form of a conservation easement on the last day of the tax year.


a	Total number of conservation easements .......................	2a
b	Total acreage restricted by conservation easements ..................	2b
c	Number of conservation easements on a certified historic structure included in (a) .....	2c
d	Number of conservation easements included in (c) acquired after 8/17/06, and not on a historic structure listed in the National Register ....................	2d

Number of conservation easements modified, transferred, released, extinguished, or terminated by the organization during
the tax year SchDMd Bullet

Number of states where property subject to conservation easement is located SchDMd Bullet

Does the organization have a written policy regarding the periodic monitoring, inspection, handling of violations, and
enforcement of the conservation easements it holds? .............................

Yes No

Staff and volunteer hours devoted to monitoring, inspecting, and enforcing conservation easements during the year
SchDMd Bullet

Amount of expenses incurred in monitoring, inspecting, and enforcing conservation easements during the year
SchDMd Bullet

Does each conservation easement reported on line 2(d) above satisfy the requirements of section 170(h)(4)(B)(i) and section 170(h)(4)(B)(ii)? .......................................

Yes No

In Part XIII, describe how the organization reports conservation easements in its revenue and expense statement, and
balance sheet, and include, if applicable, the text of the footnote to the organization’s financial statements that describes
the organization’s accounting for conservation easements.

Part III

Organizations Maintaining Collections of Art, Historical Treasures, or Other Similar Assets.
Complete if the organization answered "Yes" to Form 990, Part IV, line 8.

If the organization elected, as permitted under SFAS 116 (ASC 958), not to report in its revenue statement and balance sheet works of art, historical treasures, or other similar assets held for public exhibition, education, or research in furtherance of public service, provide, in Part XIII, the text of the footnote to its financial statements that describes these items.

If the organization elected, as permitted under SFAS 116 (ASC 958), to report in its revenue statement and balance sheet works of art, historical treasures, or other similar assets held for public exhibition, education, or research in furtherance of public service, provide the following amounts relating to these items:

(i)

Revenue included in Form 990, Part VIII, line 1 ........................ SchDMd Bullet

(ii)

Assets included in Form 990, Part X .............................. SchDMd Bullet

If the organization received or held works of art, historical treasures, or other similar assets for financial gain, provide the
following amounts required to be reported under SFAS 116 (ASC 958) relating to these items:

Revenue included in Form 990, Part VIII, line 1 .......................... SchDMd Bullet

Assets included in Form 990, Part X ............................... SchDMd Bullet

For Paperwork Reduction Act Notice, see the Instructions for Form 990.

Cat. No. 52283D

Schedule D (Form 990) 2014

Page 2

Part III

Organizations Maintaining Collections of Art, Historical Treasures, or Other Similar Assets (continued)

Using the organization’s acquisition, accession, and other records, check any of the following that are a significant use of its collection items (check all that apply):

Public exhibition

Loan or exchange programs

Scholarly research

Other

Preservation for future generations

Provide a description of the organization’s collections and explain how they further the organization’s exempt purpose in
Part XIII.

During the year, did the organization solicit or receive donations of art, historical treasures or other similar
assets to be sold to raise funds rather than to be maintained as part of the organization’s collection?........

Yes No

Part IV

Escrow and Custodial Arrangements. Complete if the organization answered "Yes" to Form 990,
Part IV, line 9, or reported an amount on Form 990, Part X, line 21.

Is the organization an agent, trustee, custodian or other intermediary for contributions or other assets not
included on Form 990, Part X? ....................................

Yes No

If "Yes," explain the arrangement in Part XIII and complete the following table:


c	Beginning balance .................................	1c
d	Additions during the year ..............................	1d
e	Distributions during the year .............................	1e
f	Ending balance ...................................	1f

Did the organization include an amount on Form 990, Part X, line 21, for escrow or custodial account liability?

Yes No

If "Yes," explain the arrangement in Part XIII. Check here if the explanation has been provided in Part XIII .......

Part V

Endowment Funds. Complete if the organization answered "Yes" to Form 990, Part IV, line 10.

		(a)Current year	(b)Prior year	b (c)Two years back	(d)Three years back	(e)Four years back
1a	Beginning of year balance ....
b	Contributions ........
c	Net investment earnings, gains, and losses
d	Grants or scholarships .....
e	Other expenditures for facilities and programs ........
f	Administrative expenses ....
g	End of year balance ......

Provide the estimated percentage of the current year end balance (line 1g, column (a)) held as:

Board designated or quasi-endowment SchDMd Bullet

Permanent endowment SchDMd Bullet

Temporarily restricted endowment SchDMd Bullet

The percentages in lines 2a, 2b, and 2c should equal 100%.

Are there endowment funds not in the possession of the organization that are held and administered for the
organization by:

Yes

(i) unrelated organizations ........................

3a(i)

(ii) related organizations ........................

3a(ii)

If "Yes" to 3a(ii), are the related organizations listed as required on Schedule R? .........

Describe in Part XIII the intended uses of the organization's endowment funds.

Part VI

Land, Buildings, and Equipment. Complete if the organization answered 'Yes' to Form 990, Part IV, line 11a. See Form 990, Part X, line 10.

Description of property		(b)Cost or other basis (other)	(c) Accumulated depreciation	(d) Book value
1a	Land .................	556,178		556,178
b	Buildings ................	16,034,303	5,550,039	10,484,264
c	Leasehold improvements ............
d	Equipment ................	25,450,177	13,947,234	11,502,943
e	Other .................	4,144,377	2,414,701	1,729,676
Total. Add lines 1a through 1e. (Column (d) must equal Form 990, Part X, column (B), line 10(c).).......				24,273,061

Schedule D (Form 990) 2014

Page 3

Part VII

InvestmentsOther Securities. Complete if the organization answered 'Yes' to Form 990, Part IV, line 11b. See Form 990, Part X, line 12.

(a) Description of security or category (including name of security)		(b)Book value	(c) Method of valuation: Cost or end-of-year market value
(1)Financial derivatives
(2)Closely-held equity interests
Other








Total. (Column (b) must equal Form 990, Part X, col. (B) line 12.)

Part VIII

InvestmentsProgram Related. Complete if the organization answered 'Yes' to Form 990, Part IV, line 11c. See Form 990, Part X, line 13.

(a) Description of investment		(b) Book value	(c) Method of valuation: Cost or end-of-year market value









Total. (Column (b) must equal Form 990, Part X, col.(B) line 13.)

Part IX

Other Assets. Complete if the organization answered 'Yes' to Form 990, Part IV, line 11d. See Form 990, Part X, line 15.

(a) Description				(b) Book value
(1) DEBT SERVICE FUND				3,290,665
(2) ESTIMATED THIRD-PARTY PAYOR SETTLEMENTS				1,821,042
(3) DEFERRED FINANCING COSTS				317,177
(4) DUE FROM AFFILIATES				100,000
(5) BENEFICIAL INTEREST IN PERPETUAL TRUST				1,085,336




Total. (Column (b) must equal Form 990, Part X, col.(B) line 15.)...........				6,614,220

Part X

Other Liabilities. Complete if the organization answered 'Yes' to Form 990, Part IV, line 11e or 11f. See Form 990, Part X, line 25.

1.(a) Description of liability		(b) Book value
Federal income taxes
OBLIGATION UNDER INTEREST RATE SWAP		231,847
PENSION PLAN LIABILITY		5,427,775
ESTIMATED THIRD-PARTY PAYOR SETTLEMENTS		351,720






Total. (Column (b) must equal Form 990, Part X, col.(B) line 25.)		6,011,342
2. Liability for uncertain tax positions. In Part XIII, provide the text of the footnote to the organization's financial statements that reports the organization's liability for uncertain tax positions under FIN 48 (ASC 740). Check here if the text of the footnote has been provided in Part XIII

Schedule D (Form 990) 2014

Page 4

Part XI Reconciliation of Revenue per Audited Financial Statements With Revenue per Return Complete if the organization answered 'Yes' to Form 990, Part IV, line 12a.
1	Total revenue, gains, and other support per audited financial statements .......			1	42,029,268
2	Amounts included on line 1 but not on Form 990, Part VIII, line 12:
a	Net unrealized gains (losses) on investments ....	2a
b	Donated services and use of facilities .........	2b
c	Recoveries of prior year grants ...........	2c
d	Other (Describe in Part XIII.) ............	2d	394,469
e	Add lines 2a through 2d .....................			2e	394,469
3	Subtract line 2e from line 1.....................			3	41,634,799
4	Amounts included on Form 990, Part VIII, line 12, but not on line 1:
a	Investment expenses not included on Form 990, Part VIII, line 7b .	4a
b	Other (Describe in Part XIII.) ...........	4b	2,871,087
c	Add lines 4a and 4b.......................			4c	2,871,087
5	Total revenue. Add lines 3 and 4c. (This must equal Form 990, Part I, line 12.) ......			5	44,505,886

Part XII Reconciliation of Expenses per Audited Financial Statements With Expenses per Return. Complete if the organization answered 'Yes' to Form 990, Part IV, line 12a.
1	Total expenses and losses per audited financial statements ...........			1	43,372,308
2	Amounts included on line 1 but not on Form 990, Part IX, line 25:
a	Donated services and use of facilities ..........	2a
b	Prior year adjustments ..............	2b
c	Other losses ................	2c
d	Other (Describe in Part XIII.) ............	2d	394,469
e	Add lines 2a through 2d......................			2e	394,469
3	Subtract line 2e from line 1.....................			3	42,977,839
4	Amounts included on Form 990, Part IX, line 25, but not on line 1:
a	Investment expenses not included on Form 990, Part VIII, line 7b ..	4a
b	Other (Describe in Part XIII.) ............	4b	2,995,267
c	Add lines 4a and 4b.......................			4c	2,995,267
5	Total expenses. Add lines 3 and 4c. (This must equal Form 990, Part I, line 18.) ......			5	45,973,106

Part XIII

Supplemental Information

Provide the descriptions required for Part II, lines 3, 5, and 9; Part III, lines 1a and 4; Part lV, lines 1b and 2b;
Part V, line 4; Part X, line 2; Part XI, lines 2d and 4b; and Part XII, lines 2d and 4b. Also complete this part to provide any additional information.

Return Reference	Explanation
PART X, LINE 2:	THE MEDICAL CENTER FOLLOWS THE GUIDANCE FOR ACCOUNTING FOR UNCERTAINTY IN INCOME TAXES RECOGNIZED IN AN ORGANIZATION'S CONSOLIDATED FINANCIAL STATEMENTS THAT PRESCRIBES A RECOGNITION THRESHOLD OF MORE-LIKELY-THAN-NOT TO BE SUSTAINED UPON EXAMINATION BY THE APPROPRIATE TAXING AUTHORITY. MEASUREMENT OF THE TAX UNCERTAINTY OCCURS IF THE RECOGNITION THRESHOLD HAS BEEN MET. THE GUIDANCE ALSO ADDRESSES DERECOGNITION, CLASSIFICATION, INTEREST AND PENALTIES, ACCOUNTING IN INTERIM PERIODS, AND DISCLOSURE. MANAGEMENT HAS DETERMINED THAT THIS GUIDANCE HAD NO MATERIAL EFFECT ON THE CONSOLIDATED FINANCIAL STATEMENTS. THE MEDICAL CENTER'S POLICY IS TO RECOGNIZE INTEREST RELATED TO UNRECOGNIZED TAX BENEFITS IN INTEREST EXPENSE AND PENALTIES IN GENERAL AND ADMINISTRATION EXPENSES. THERE WERE NO INTEREST OR PENALTIES RECOGNIZED ON THE CONSOLIDATED STATEMENTS OF OPERATIONS AS A RESULT OF THIS GUIDANCE. GENERALLY, TAX RETURNS FOR YEARS ENDED JUNE 30, 2012, AND THEREAFTER REMAIN SUBJECT TO EXAMINATION BY FEDERAL AND STATE TAX AUTHORITIES.
PART XI, LINE 2D - OTHER ADJUSTMENTS:	RENTAL EXPENSES 394,469.
PART XI, LINE 4B - OTHER ADJUSTMENTS:	BAD DEBT EXPENSE 2,606,180. REALIZED GAIN (LOSS) ON SALE OF ASSETS 1,132. NET ASSETS RELEASED FROM RESTRICTIONS 208,484. AUXILIARY INCOME 55,291.
PART XII, LINE 2D - OTHER ADJUSTMENTS:	RENTAL EXPENSES 394,469.
PART XII, LINE 4B - OTHER ADJUSTMENTS:	BAD DEBT EXPENSE 2,606,180. TRANSFER OF ASSETS TO RELATED PARTY 324,051. AUXILIARY EXPENSES 65,036.

Schedule D (Form 990) 2014

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE H (Form 990)

Department of the TreasuryInternal Revenue Service

Hospitals

Complete if the organization answered "Yes" to Form 990, Part IV, question 20.
MediumBullet

Attach to Form 990.
MediumBullet

Information about Schedule H (Form 990) and its instructions is at www.irs.gov/form990.

OMB No. 1545-0047

2014

Open to Public Inspection

Name of the organization

FULTON COUNTY MEDICAL CENTER

Employer identification number

23-1401561

Part I

Financial Assistance and Certain Other Community Benefits at Cost

Yes

Did the organization have a financial assistance policy during the tax year? If "No," skip to question 6a ...

Yes

If "Yes," was it a written policy? .......................

Yes

If the organization had multiple hospital facilities, indicate which of the following best describes application of the financial assistance policy to its various hospital facilities during the tax year.

Applied uniformly to all hospital facilities Applied uniformly to most hospital facilities Generally tailored to individual hospital facilities

Answer the following based on the financial assistance eligibility criteria that applied to the largest number of the organization's patients during the tax year.

Did the organization use Federal Poverty Guidelines (FPG) as a factor in determining eligibility for providing free care?

If "Yes," indicate which of the following was the FPG family income limit for eligibility for free care:

Yes

100% 150% 200% Other %

Did the organization use FPG as a factor in determining eligibility for providing discounted care? If "Yes," indicate

which of the following was the family income limit for eligibility for discounted care: .........

Yes

200% 250% 300% 350% 400% Other %

If the organization used factors other than FPG in determining eligibility, describe in Part VI the criteria used for determining eligibility for free or discounted care. Include in the description whether the organization used an asset test or other threshold, regardless of income, as a factor in determining eligibility for free or discounted care.

Did the organization's financial assistance policy that applied to the largest number of its patients during the tax year provide for free or discounted care to the "medically indigent"? ..............

Yes

Did the organization budget amounts for free or discounted care provided under its financial assistance policy during the tax year? ............................

Yes

If "Yes," did the organization's financial assistance expenses exceed the budgeted amount? ......

Yes

If "Yes" to line 5b, as a result of budget considerations, was the organization unable to provide free or discountedcare to a patient who was eligibile for free or discounted care? ..............

Did the organization prepare a community benefit report during the tax year? ..........

Yes

If "Yes," did the organization make it available to the public? ..............

Yes

Complete the following table using the worksheets provided in the Schedule H instructions. Do not submit these worksheets with the Schedule H.

Financial Assistance and Certain Other Community Benefits at Cost

Financial Assistance and Means-Tested Government Programs		(c) Total community benefit expense	(d) Direct offsetting revenue	(e) Net community benefit expense	(f) Percent of total expense
a	Financial Assistance at cost (from Worksheet 1) ..	101,722		101,722	0.230 %
b	Medicaid (from Worksheet 3, column a) ....	7,762,481	8,009,952	-247,471	0 %
c	Costs of other means-tested government programs (from Worksheet 3, column b) .
d	Total Financial Assistance and Means-Tested Government Programs .	7,864,203	8,009,952	-145,749	0.230 %
Other Benefits		111,071	11,856	99,215	0.230 %
e	Community health improvement services and community benefit operations (from Worksheet 4) ..	111,071	11,856	99,215	0.230 %
f	Health professions education (from Worksheet 5) ..
g	Subsidized health services (from Worksheet 6) ..	7,393,606	2,892,869	4,500,737	10.380 %
h	Research (from Worksheet 7)
i	Cash and in-kind contributions for community benefit (from Worksheet 8)
j	Total. Other Benefits ..	7,504,677	2,904,725	4,599,952	10.610 %
k	Total. Add lines 7d and 7j .	15,368,880	10,914,677	4,454,203	10.840 %

For Paperwork Reduction Act Notice, see the Instructions for Form 990. Cat. No. 50192T Schedule H (Form 990) 2014

Schedule H (Form 990) 2014

Page

Part II

Community Building Activities Complete this table if the organization conducted any community building activities during the tax year, and describe in Part VI how its community building activities promoted the health of the communities it serves.

		(c) Total community building expense	(e) Net community building expense	(f) Percent of total expense
1	Physical improvements and housing
2	Economic development
3	Community support
4	Environmental improvements
5	Leadership development and training for community members
6	Coalition building
7	Community health improvement advocacy
8	Workforce development	77,045	77,045	0.180 %
9	Other	1,946	1,946	0 %
10	Total	78,991	78,991	0.180 %

Part III

Bad Debt, Medicare, & Collection Practices

Section A. Bad Debt Expense

Yes

Did the organization report bad debt expense in accordance with Heathcare Financial Management Association Statement No. 15? ..........................

Enter the amount of the organization's bad debt expense. Explain in Part VI the methodology used by the organization to estimate this amount. ......

2,606,180

Enter the estimated amount of the organization's bad debt expense attributable to patients eligible under the organization's financial assistance policy. Explain in Part VI the methodology used by the organization to estimate this amount and the rationale, if any, for including this portion of bad debt as community benefit. ......

104,247

Provide in Part VI the text of the footnote to the organization’s financial statements that describes bad debt expense or the page number on which this footnote is contained in the attached financial statements.

Section B. Medicare

Enter total revenue received from Medicare (including DSH and IME).....

12,434,768

Enter Medicare allowable costs of care relating to payments on line 5.....

13,403,972

Subtract line 6 from line 5. This is the surplus (or shortfall)........

-969,204

Describe in Part VI the extent to which any shortfall reported in line 7 should be treated as community benefit.Also describe in Part VI the costing methodology or source used to determine the amount reported on line 6.Check the box that describes the method used:

Cost accounting system Cost to charge ratio Other

Section C. Collection Practices

Did the organization have a written debt collection policy during the tax year? ..........

Yes

If "Yes," did the organization’s collection policy that applied to the largest number of its patients during the tax year contain provisions on the collection practices to be followed for patients who are known to qualify for financial assistance? Describe in Part VI.......................

Yes

Part IV

Management Companies and Joint Ventures(owned 10% or more by officers, directors, trustees, key employees, and physicians—see instructions)

(a) Name of entity	(b) Description of primary activity of entity	(c) Organization's profit % or stock ownership %	(d) Officers, directors, trustees, or key employees' profit % or stock ownership %	(e) Physicians' profit % or stock ownership %
1
2
3
4
5
6
7
8
9
10
11
12
13

Schedule H (Form 990) 2014

Page

Part VFacility Information

Section A. Hospital Facilities (list in order of size from largest to smallest—see instructions) How many hospital facilities did the organization operate during the tax year?1 Name, address, primary website address, and state license number (and if a group return, the name and EIN of the subordinate hospital organization that operates the hospital facility)
1	FULTON COUNTY MEDICAL CENTER 214 PEACH ORCHARD DRIVE MCCONNELLSBURGH,PA17233	X	X	X	X

Schedule H (Form 990) 2014

Page

Part VFacility Information (continued)

Section B. Facility Policies and Practices

(Complete a separate Section B for each of the hospital facilities or facility reporting groups listed in Part V, Section A)

	FULTON COUNTY MEDICAL CENTER
Name of hospital facility or letter of facility reporting group

Line number of hospital facility, or line numbers of hospital facilities in a facility
reporting group (from Part V, Section A):

Yes

Community Health Needs Assessment

Was the hospital facility first licensed, registered, or similarly recognized by a State as a hospital facility in the current tax year or the immediately preceding tax year?.......................

Was the hospital facility acquired or placed into service as a tax-exempt hospital in the current tax year or the immediately preceding tax year? If “Yes,” provide details of the acquisition in Section C..........

During the tax year or either of the two immediately preceding tax years, did the hospital facility conduct a community health needs assessment (CHNA)? If "No," skip to line 12....................

Yes

If "Yes," indicate what the CHNA report describes (check all that apply):

A definition of the community served by the hospital facility

Demographics of the community

Existing health care facilities and resources within the community that are available to respond to the health needs of the community

How data was obtained

The significant health needs of the community

Primary and chronic disease needs and other health issues of uninsured persons, low-income persons, and minority groups

The process for identifying and prioritizing community health needs and services to meet the community health needs

The process for consulting with persons representing the community’s interests

Information gaps that limit the hospital facility’s ability to assess the community’s health needs

Other (describe in Section C)

Indicate the tax year the hospital facility last conducted a CHNA: 20 12

In conducting its most recent CHNA, did the hospital facility take into account input from persons who represent the broad interests of the community served by the hospital facility, including those with special knowledge of or expertise in public health? If "Yes," describe in Section C how the hospital facility took into account input from persons who represent the community, and identify the persons the hospital facility consulted .................

Yes

Was the hospital facility’s CHNA conducted with one or more other hospital facilities? If "Yes," list the other hospital facilities in Section C................................

Was the hospital facility’s CHNA conducted with one or more organizations other than hospital facilities?” If “Yes,” list the other organizations in Section C. ............................

Yes

Did the hospital facility make its CHNA report widely available to the public? ..............

Yes

If "Yes," indicate how the CHNA report was made widely available (check all that apply):

Hospital facility’s website (list url): WWW.FCMCPA.ORG/COMMUNITY-RESOURCES

Other website (list url):

Made a paper copy available for public inspection without charge at the hospital facility

Other (describe in Section C)

Did the hospital facility adopt an implementation strategy to meet the significant community health needs
identified through its most recently conducted CHNA? If "No," skip to line 11. .............

Yes

Indicate the tax year the hospital facility last adopted an implementation strategy: 20 12

Is the hospital facility's most recently adopted implementation strategy posted on a website? ........

Yes

If "Yes" (list url): WWW.FCMCPA.ORG/COMMUNITY-RESOURCES

If "No," is the hospital facility’s most recently adopted implementation strategy attached to this return? ......

10b

Describe in Section C how the hospital facility is addressing the significant needs identified in its most recently conducted CHNA and any such needs that are not being addressed together with the reasons why such needs are not being addressed.

12a

Did the organization incur an excise tax under section 4959 for the hospital facility's failure to conduct a CHNA as required by section 501(r)(3)? ...........................

12a

If "Yes" to line 12a, did the organization file Form 4720 to report the section 4959 excise tax? ......

12b

If "Yes" to line 12b, what is the total amount of section 4959 excise tax the organization reported on Form 4720 for all of its hospital facilities? $

Schedule H (Form 990) 2014

Page

Part VFacility Information (continued)

	FULTON COUNTY MEDICAL CENTER
Name of hospital facility or letter of facility reporting group

Yes

Financial Assistance Policy (FAP)

Did the hospital facility have in place during the tax year a written financial assistance policy that:

Explained eligibility criteria for financial assistance, and whether such assistance included free or discounted care?

Yes

If “Yes,” indicate the eligibility criteria explained in the FAP:

Federal poverty guidelines (FPG), with FPG family income limit for eligibility for free care of 100.000000000000%
and FPG family income limit for eligibility for discounted care of 200.000000000000%

Income level other than FPG (describe in Section C)

Asset level

Medical indigency

Insurance status

Underinsurance discount

Residency

Other (describe in Section C)

Explained the basis for calculating amounts charged to patients?.................

Yes

Explained the method for applying for financial assistance?...................

Yes

If “Yes,” indicate how the hospital facility’s FAP or FAP application form (including accompanying instructions) explained the method for applying for financial assistance (check all that apply):

Described the information the hospital facility may require an individual to provide as part of his or her application.

Described the supporting documentation the hospital facility may require an individual to submit as part of his or
her application.

Provided the contact information of hospital facility staff who can provide an individual with information about the
FAP and FAP application process.

Provided the contact information of nonprofit organizations or government agencies that may be sources of
assistance with FAP applications.

Other (describe in Section C)

Included measures to publicize the policy within the community served by the hospital facility?.......

Yes

If "Yes," indicate how the hospital facility publicized the policy (check all that apply):

The FAP was widely available on a website (list url): WWW.FCMCPA.ORG

The FAP application form was widely available on a website (list url): WWW.FCMCPA.ORG

A plain language summary of the FAP was widely available on a website (list url):
WWW.FCMCPA.ORG

The FAP was available upon request and without charge (in public locations in the hospital facility and by mail)

The FAP application form was available upon request and without charge (in public locations in the hospital facility
and by mail)

A plain language summary of the FAP was available upon request and without charge (in public locations in the
hospital facility and by mail)

Notice of availability of the FAP was conspicuously displayed throughout the hospital facility

Notified members of the community who are most likely to require financial assistance about availability of the FAP

Other (describe in Section C)

Billing and Collections

Did the hospital facility have in place during the tax year a separate billing and collections policy, or a written financial assistance policy (FAP) that explained all of the actions the hospital facility or other authorized party may take upon non-payment?..................................

Yes

Check all of the following actions against an individual that were permitted under the hospital facility's policies during the tax year before making reasonable efforts to determine the individual’s eligibility under the facility’s FAP:

Reporting to credit agency(ies)

Selling an individual’s debt to another party

Actions that require a legal or judicial process

Other similar actions (describe in Section C)

None of these actions or other similar actions were permitted

Schedule H (Form 990) 2014

Page

Part VFacility Information (continued)

	FULTON COUNTY MEDICAL CENTER
Name of hospital facility or letter of facility reporting group

Yes

Did the hospital facility or other authorized third party perform any of the following actions during the tax year before making reasonable efforts to determine the individual’s eligibility under the facility’s FAP?.........

If "Yes," check all actions in which the hospital facility or a third party engaged:

Reporting to credit agency(ies)

Selling an individual’s debt to another party

Actions that require a legal or judicial process

Other similar actions (describe in Section C)

Indicate which efforts the hospital facility or other authorized party made before initiating any of the actions listed (whether or not checked) in line 18. (check all that apply):

Notified individuals of the financial assistance policy on admission

Notified individuals of the financial assistance policy prior to discharge

Notified individuals of the financial assistance policy in communications with the individuals regarding the individuals’ bills

Documented its determination of whether individuals were eligible for financial assistance under the hospital facility’s financial assistance policy

Other (describe in Section C)

None of these efforts were made

Policy Relating to Emergency Medical Care

Did the hospital facility have in place during the tax year a written policy relating to emergency medical care that required the hospital facility to provide, without discrimination, care for emergency medical conditions to individuals regardless of their eligibility under the hospital facility’s financial assistance policy?................

Yes

If "No," indicate why:

The hospital facility did not provide care for any emergency medical conditions

The hospital facility’s policy was not in writing

The hospital facility limited who was eligible to receive care for emergency medical conditions (describe in Section C)

Other (describe in Section C)

Charges to Individuals Eligible for Assistance Under the FAP (FAP-Eligible Individuals)

Indicate how the hospital facility determined, during the tax year, the maximum amounts that can be charged to FAP-eligible individuals for emergency or other medically necessary care.

The hospital facility used its lowest negotiated commercial insurance rate when calculating the maximum amounts that can be charged

The hospital facility used the average of its three lowest negotiated commercial insurance rates when calculating the maximum amounts that can be charged

The hospital facility used the Medicare rates when calculating the maximum amounts that can be charged

Other (describe in Section C)

During the tax year, did the hospital facility charge any FAP-eligible individual to whom the hospital facility provided emergency or other medically necessary services more than the amounts generally billed to individuals who had insurance covering such care? ................................

If "Yes," explain in Section C.

During the tax year, did the hospital facility charge any FAP-eligible individual an amount equal to the gross charge for any service provided to that individual? ...........................

If "Yes," explain in Section C.

Schedule H (Form 990) 2014

Page

Part V

Facility Information (continued)

Section C. Supplemental Information for Part V, Section B. Provide descriptions required for Part V, Section B, lines 2, 3j, 5, 6a, 6b, 7d, 11, 13b, 13h, 15e, 16i, 18d, 19d, 20e, 21c, 21d, 22d, 23, and 24. If applicable, provide separate descriptions for each hospital facility in a facility reporting group, designated by facility reporting group letter and hospital facility line number from Part V, Section A (“A, 1,” “A, 4,” “B, 2,” “B, 3,” etc.) and name of hospital facility.
Form and Line Reference	Explanation
FULTON COUNTY MEDICAL CENTER	PART V, SECTION B, LINE 5: TO LAUNCH ITS COMMUNITY HEALTH NEEDS ASSESSMENT, FULTON COUNTY MEDICAL CENTER CONTRACTED WITH AN ACCOUNTING FIRM TO FACILITATE THE PROCESS, AND ESTABLISHED A CORE TEAM TO GUIDE THE PROCESS. EIGHTY-FIVE COMMUNITY LEADERS AND REPRESENTATIVES WERE INVITED TO PARTICIPATE IN THE COMMUNITY HEALTH NEEDS ASSESSMENT AND 32 INDIVIDUALS ATTENDED COMMUNITY ADVISORY COMMITTEE MEETINGS. MEMBERS OF THE FULTON COUNTY PARTNERSHIP REVIEWED AND COMMENTED ON DRAFT FINDINGS AND FOCUSED CONVERSATIONS WERE HELD AT THE FLU SHOT CLINIC AT THE WARFORDSBURG SENIOR CENTER. ADDITIONAL INSIGHTS WERE GATHERED FROM THE ASSESSMENTS AND PLANS OF COUNTY AND STATE AGENCIES AND OFFICES.
FULTON COUNTY MEDICAL CENTER	PART V, SECTION B, LINE 6B: FCMC'S CHNA WAS CONDUCTED WITH THE FULTON COUNTY FAMILY PARTNERSHIP AND TRI-STATE COMMUNITY HEALTH CARE.
FULTON COUNTY MEDICAL CENTER	PART V, SECTION B, LINE 7D: IN MAY 2013, FCMC PUBLICALLY REPORTED THE CHNA AT THE FULTON COUNTY PARTNERSHIP MEETING THAT MEETS MONTHLY. IT IS COMPRISED OF MEMBERS OF THE HEALTH AND HUMAN SERVICES COMMUNITIES OF FRANKLIN, FULTON & BEDFORD COUNTIES.
FULTON COUNTY MEDICAL CENTER	PART V, SECTION B, LINE 11: THE FCMC CHNA DID NOT ADDRESS THE HIGH NUMBER OF ACCIDENTS AND RELATED DEATHS AND INJURIES - BOTH MOTOR VEHICLE AND NON-TRANSPORT. FCMC DID NOT FEEL THAT THEY WOULD HAVE ENOUGH DATA OR EXPERTISE TO TAKE ON THIS PRIORITY AT THIS TIME OR HAVE THE FINANCIAL RESOURCES. FCMC DID NOT HAVE ANYONE IN THE CORE TEAM OR ADVISORY PANELS THAT COULD ADDRESS THESE ISSUES. FCMC RANKED THE PRIORITIES AND DETERMINED THAT THIS ONE WAS NOT A HIGH PRIORITY AT THIS TIME.
FULTON COUNTY MEDICAL CENTER	PART V, SECTION B, LINE 22D: THE HOSPITAL CURRENTLY APPLIES A TWO-TIER SYSTEM TO FAP-ELIGIBLE INDIVIDUALS. INDIVIDUALS THAT ARE SELF-PAY RECEIVE AN INITIAL WRITE OFF BASED ON THE TYPE OF SERVICE PROVIDED, RESULTING IN DISCOUNTED CARE. THE CHARITY CARE DISCOUNT IS THEN APPLIED TO THIS AMOUNT. INDIVIDUALS THAT ARE DENIED MEDICAL ASSISTANCE DUE TO INCOME AND/OR ASSET LEVELS BEING TOO HIGH FOR MEDICAL ASSISTANCE MUST MEET THE INCOME AND LIQUID ASSETS GUIDELINES OF FCMC AND PROVIDE PROOF OF THE LAST THREE MONTHS OF INCOME TO BE APPROVED. APPROVED APPLICANTS ARE ELIGIBLE FOR CHARITY CARE FOR SIX MONTHS AT A TIME. BOTH OF THESE DISCOUNTS ARE APPLIED DIRECTLY TO GROSS CHARGES. THE FACILITY IS CURRENTLY REVIEWING THEIR POLICIES TO ADOPT ONE OF THE TWO METHODS FOR DETERMINING AMOUNTS GENERALLY BILLED.
PART V, SECTION B, LINE 2:	THE CHNA WAS LAST CONDUCTED DURING THE ORGANIZATION'S 2012 TAX YEAR, WHICH IS EQUVIALENT TO ITS FISCAL YEAR ENDED JUNE 30, 2013. THE IMPLEMENTATION STRATEGY WAS ALSO ADOPTED DURING THAT SAME FISCAL YEAR.
PART V, SECTION B, LINE 16	FINANCIAL ASSISTANCE POLICY WEBSITE AVAILABILITY
FULTON COUNTY MEDICAL CENTER PART V, SECTION B, LINE 16A WEBSITE:	WWW.FCMCPA.ORG
FULTON COUNTY MEDICAL CENTER PART V, SECTION B, LINE 16B WEBSITE:	WWW.FCMCPA.ORG
FULTON COUNTY MEDICAL CENTER PART V, SECTION B, LINE 16C WEBSITE:	WWW.FCMCPA.ORG

Schedule H (Form 990) 2014

Page

Part VFacility Information (continued)

Section D. Other Health Care Facilities That Are Not Licensed, Registered, or Similarly Recognized as a Hospital Facility (list in order of size, from largest to smallest) How many non-hospital health care facilities did the organization operate during the tax year?2
Name and address		Type of Facility (describe)
1	FULTON CO MEDICAL CENTER NURSING HOME 214 PEACH ORCHARD ROAD MCCONNELLSBURG,PA17233	HOSPITAL-BASED LONG TERM CARE FACILITY
2	DR MILROTH FAMILY PRACTICE 318 N 1ST STREET MCCONNELLSBURG,PA17233	PHYSICIAN PRACTICE
3
4
5
6
7
8
9
10

Schedule H (Form 990) 2014

Page

Part VI

Supplemental Information

Provide the following information.

1	Required descriptions. Provide the descriptions required for Part I, lines 3c, 6a, and 7; Part II and Part III, lines 2, 3, 4, 8 and 9b.
2	Needs assessment. Describe how the organization assesses the health care needs of the communities it serves, in addition to any CHNAs reported in Part V, Section B.
3	Patient education of eligibility for assistance. Describe how the organization informs and educates patients and persons who may be billed for patient care about their eligibility for assistance under federal, state, or local government programs or under the organization’s financial assistance policy.
4	Community information. Describe the community the organization serves, taking into account the geographic area and demographic constituents it serves.
5	Promotion of community health. Provide any other information important to describing how the organization’s hospital facilities or other health care facilities further its exempt purpose by promoting the health of the community (e.g., open medical staff, community board, use of surplus funds, etc.).
6	Affiliated health care system. If the organization is part of an affiliated health care system, describe the respective roles of the organization and its affiliates in promoting the health of the communities served.
7	State filing of community benefit report. If applicable, identify all states with which the organization, or a related organization, files a community benefit report.

Form and Line Reference	Explanation
PART I, LINE 3C:	PATIENTS WITH NO HEALTH INSURANCE, PRIVATE OR EMPLOYER-SPONSORED INSURANCE, OR VIA GOVERNMENTAL PROGRAMS, ARE AUTOMATICALLY ELIGIBLE FOR A FINANCIAL ASSISTANCE DISCOUNT IN THE FOLLOWING AMOUNTS: INPATIENT SERVICES - 30%OUTPATIENT SERVICES - 40%HOME HEALTH SERVICES - 20%SWING BED SERVICES - 30%ADDITIONAL FINANCIAL ASSISTANCE MAY BE MADE AVAILABLE TO THE PATIENT BASED ON A SLIDING FEE SCALE, IN ACCORDANCE WITH FINANCIAL NEED, AS DETERMINED BY REFERENCING FEDERAL POVERTY LEVELS (FPL) IN EFFECT AT THE TIME OF THE DETERMINATION. IN GENERAL, PEOPLE WHOSE HOUSEHOLD INCOME IS BELOW 200 PERCENT OF THE FEDERAL POVERTY LEVEL ARE ELIGIBLE FOR FINANCIAL ASSISTANCE. FAMILIES OR INDIVIDUALS WITH HIGHER INCOMES MAY QUALIFY ON A CASE-BY-CASE BASIS.
PART I, LINE 7:	CHARITY CARE WAS CONVERTED TO COST ON LINE 7A BASED ON AN OVERALL COST-TO-CHARGE RATIO ADDRESSING ALL PATIENT SEGMENTS. UNREIMBURSED MEDICAID ON LINE 7B WAS CALCULATED USING THE COST-TO-CHARGE RATIO DERIVED FROM WORKSHEET 2. COMMUNITY HEALTH IMPROVEMENT SERVICES, LINE 7E ARE REPORTED FROM THE COMMUNITY BENEFIT'S ANNUAL BOARD REPORT. LINE 7G WAS DETERMINED USING THE MEDICARE COST REPORT.
PART I, LINE 7G:	SUBSIDIZED HEALTH SERVICES INCLUDED IN FISCAL YEAR 2015 WERE: EMERGENCY ROOM AND HOME HEALTH
PART I, LN 7 COL(F):	THE AMOUNT OF BAD DEBT EXPENSE REMOVED FROM THE DENOMINATOR OF THE CALCULATIONS WAS $2,606,180.
PART I, LINE 6A:	FCMC'S 990 FILING IS AVAILABLE TO THE PUBLIC UPON REQUEST. A SUMMARY OF FCMC'S COMMUNITY BENEFIT IS DESCRIBED IN FCMC'S ANNUAL REPORT. THE ANNUAL REPORT IS AVAILABLE TO THE PUBLIC DURING THE ANNUAL MEETING, AT THE HOSPITAL, AS WELL AS ON THE HOSPITAL WEBSITE.
PART II, LINES 8 & 9:	PART II, LINE 8: THE AMOUNT REPORTED REPRESENTS THE EXPENSE RELATED TO RECRUITING HEALTHCARE PROFESSIONALS AND MANAGEMENT POSITIONS TO THE HOSPITAL.PART II, LINE 9: FULTON COUNTY MEDICAL CENTER DONATED 50 HAMS TO A LOCAL FOOD BANK DURING THE HOLIDAY SEASON. THIS DONATION IS ONE OF MANY WAYS THE MEDICAL CENTER GIVES BACK TO THE COMMUNITY.
PART III, LINE 4:	PRIOR TO ANY ACCOUNT BEING CLASSIFIED AS BAD DEBT, ALL PAYMENTS ARE APPLIED INCLUDING CONTRACTUAL ALLOWANCES AND DISCOUNTS, AND EVERY EFFORT IS MADE WITH THE PATIENT IN AN ATTEMPT TO COLLECT THE OUTSTANDING BALANCE. ACCOUNTS PLACED IN COLLECTION FOR A YEAR WITH NO PAYMENT BEING RECEIVED WITHIN 120 DAYS ARE WRITTEN OFF TO BAD DEBT. IF A PAYMENT IS RECEIVED ON AN AMOUNT PREVIOUSLY WRITTEN OFF TO BAD DEBT, THE AMOUNT WOULD REDUCE BAD DEBT EXPENSE. FULTON COUNTY MEDICAL CENTER DOES NOT REFUSE SERVICE TO PATIENTS THAT GENERATE BAD DEBT. THE ESTIMATED AMOUNT OF ORGANIZATION'S BAD DEBT EXPENSE ATTRIBUTABLE TO PATIENTS ELIGIBLE UNDER THE ORGANIZATION'S CHARITY CARE POLICY IS CALCULATED BASED ON AN ESTIMATE OF CHARITY CARE ACCOUNTS COMPARED TO TOTAL BAD DEBT ACCOUNTS. FOOTNOTE TO FINANCIAL STATEMENTS:THE ALLOWANCE FOR DOUBTFUL ACCOUNTS IS BASED ON HISTORICAL LOSSES AND AN ANALYSIS OF CURRENTLY OUTSTANDING AMOUNTS FOR ITS MAJOR PAYOR SOURCES. MANAGEMENT REGULARLY REVIEWS DATA ABOUT THESE MAJOR PAYOR SOURCES OF REVENUE IN EVALUATING THE SUFFICIENCY OF THE ALLOWANCE FOR DOUBTFUL ACCOUNTS. FOR RECEIVABLES ASSOCIATED WITH SERVICES PROVIDED TO PATIENTS AND RESIDENTS WHO HAVE THIRD-PARTY COVERAGE, THE MEDICAL CENTER ANALYZES CONTRACTUALLY DUE AMOUNTS AND PROVIDES AN ALLOWANCE FOR DOUBTFUL ACCOUNTS AND A PROVISION FOR BAD DEBTS, IF NECESSARY (FOR EXAMPLE, FOR EXPECTED UNCOLLECTABLE DEDUCTIBLES AND COPAYMENTS ON ACCOUNTS FOR WHICH THE THIRD-PARTY PAYOR HAS NOT YET PAID). FOR RECEIVABLES ASSOCIATED WITH SELF-PAY PATIENTS AND RESIDENTS (WHICH INCLUDES BOTH PATIENTS AND RESIDENTS WITHOUT INSURANCE AND PATIENTS WITH DEDUCTIBLE AND PAYMENT BALANCES DUE FOR WHICH THIRD-PARTY COVERAGE EXISTS FOR PART OF THE BILL), THE MEDICAL CENTER RECORDS A SIGNIFICANT PROVISION FOR BAD DEBTS IN THE PERIOD OF SERVICE ON THE BASIS OF ITS PAST EXPERIENCE, WHICH INDICATES THAT MANY PATIENTS AND RESIDENTS ARE UNABLE OR UNWILLING TO PAY THE PORTION OF THEIR BILL FOR WHICH THEY ARE FINANCIALLY RESPONSIBLE. THE DIFFERENCE BETWEEN THE STANDARD RATES (OR THE DISCOUNTED RATES IF NEGOTIATED) AND THE AMOUNTS ACTUALLY COLLECTED AFTER ALL REASONABLE COLLECTION EFFORTS HAVE BEEN EXHAUSTED IS CHARGED OFF AGAINST THE ALLOWANCE FOR DOUBTFUL ACCOUNTS.
PART III, LINE 8:	MEDICARE SERVICES ARE PROVIDED TO THE ELDERLY WHICH ARE CONSIDERED TO BE A CHARITABLE CLASS. AS SUCH, WE BELIEVE THE SHORTFALL SHOULD BE CONSIDERED AS A COMMUNITY BENEFIT.
PART III, LINE 9B:	PATIENTS APPLYING FOR CHARITY CARE OR FINANCIAL ASSISTANCE, OR PATIENTS WHO ARE KNOWN TO QUALIFY FOR FREE OR DISCOUNTED CARE WILL BE PROCESSED AS SUCH BEFORE COLLECTION EFFORTS START. ONCE A DETERMINATION IS MADE ON ELIGIBILITY, ANY PERSONAL PORTION DUE IS SUBJECT TO THE SAME COLLECTION POLICY AS OTHER ACCOUNTS. IF THE PATIENT DOES NOT HAVE A THIRD PARTY INSURANCE COVERAGE, THEY WILL BE INFORMED OF THE FREE CARE PROGRAM. ELIGIBILITY WILL BE DETERMINED USING THE DEPARTMENT OF HEALTH AND HUMAN SERVICES INCOME POVERTY GUIDELINES CATEGORY B WITH NO SLIDING SCALE. PATIENTS/GUARANTORS WHO HAVE NOT MET ARRANGEMENTS TO PAY OFF THEIR ACCOUNTS WITHIN THE ALLOTTED TIME WILL BE FORWARDED TO THE HOSPITAL'S COLLECTION AGENCY. ALL ACCOUNTS WILL BE REVIEWED BY THE FINANCIAL ADVOCATE PRIOR TO AGENCY REFERRAL.
PART VI, LINE 2:	HEALTH CARE NEEDS FOR FULTON COUNTY MEDICAL CENTER HAVE BEEN ASSESSED USING BOTH INTERNAL AND EXTERNAL MEANS. INTERNALLY RECOMMENDATIONS ARE RECEIVED FROM STAFF AND PHYSICIANS (BOTH HOSPITAL-BASED AND VISITING) OF POTENTIAL SERVICES PATIENTS MAY BE REQUESTING. OUR CUSTOMER SERVICE REPRESENTATIVES AT FULTON COUNTY MEDICAL CENTER ALSO RECEIVE RECOMMENDATIONS FROM PATIENTS. THE RECOMMENDATIONS FROM PATIENTS MAY COME VIA COMPLIMENTS OR COMPLAINTS RECEIVED AS WELL AS PATIENT SURVEYS THAT ARE UTILIZED THROUGH THE HOSPITAL AS PART OF OUR QUALITY PROGRAM. IN ADDITION, DURING THE DEVELOPMENT OF THE STRATEGIC PLAN CURRENT AND FUTURE SERVICES ARE DISCUSSED THAT WILL BENEFIT THE COMMUNITY.
PART VI, LINE 3:	THE FULTON COUNTY MEDICAL CENTER POSTS INFORMATION ABOUT THE FINANCIAL ASSISTANCE PROGRAM AND DISCOUNTS AT THE ADMISSIONS AREAS, EMERGENCY ROOM WAITING AREAS, AND FINANCIAL ADVOCATE' OFFICE. THE INFORMATION IS INCLUDED IN THE INPATIENT AND OUTPATIENT SURGERY PATIENT PACKETS. THE FINANCIAL ADVOCATE DISCUSSES WITH THE PATIENT THE AVAILABILITY OF FINANCIAL ASSISTANCE AS WELL AS VARIOUS GOVERNMENT BENEFITS SUCH AS MEDICAID, AND ASSISTS THE PATIENT WITH QUALIFICATION FOR SUCH PROGRAMS, WHERE APPLICABLE. IN ADDITION, PATIENT INVOICES FOR FULTON COUNTY MEDICAL CENTER INCLUDE A NUMBER TO CALL FOR HELP IN APPLYING FOR FINANCIAL ASSISTANCE. THE FINANCIAL ASSISTANCE APPLICATION IS ON THE BACK OF THE PATIENT INVOICE AS WELL. WHEN COLLECTION TELEPHONE CALLS ARE MADE TO PATIENTS WITH OUTSTANDING BALANCES THEY ARE REMINDED OF OUR FINANCIAL ASSISTANCE PROGRAM.
PART VI, LINE 4:	THE FULTON COUNTY MEDICAL CENTER IS IN FULTON COUNTY PENNSYLVANIA. THIS COUNTY IS IN RURAL SOUTH CENTRAL PENNSYLVANIA AND HAD AN ESTIMATED POPULATION IN 2014 OF 14,632 WITH 11.1% OF THE POPULATION BELOW THE POVERTY LEVEL (US CENSUS). THE FULTON COUNTY MEDICAL CENTER IS THE ONLY MEDICAL FACILITY IN THE COUNTY. THE CLOSEST HOSPITAL IS 19 MILES AWAY AND PATIENTS WOULD HAVE TO TRAVEL OVER MOUNTAINOUS RURAL TERRAIN. THE FULTON COUNTY MEDICAL CENTER IS A CRITICAL ACCESS HOSPITAL WITH OVER 50% OF ITS REVENUES RECEIVED FROM THE MEDICARE AND MEDICAID PROGRAMS.
PART VI, LINE 5:	FULTON COUNTY MEDICAL CENTER'S (FCMC) BOARD IS COMPRISED OF CITIZENS FROM THE COMMUNITIES AND SERVICE AREAS THAT BENEFIT FROM FCMC'S SERVICES. FCMC IS THE ONLY HOSPITAL AND SKILLED NURSING HOME IN THIS RURAL SERVICE AREA. IN ADDITION FCMC OFFERS HOME HEALTH SERVICES AND A SPECIALTY SERVICES CLINIC WHERE PHYSICIAN SPECIALISTS FROM OTHER GEOGRAPHICAL AREAS SEE PATIENTS. THIS ALLOWS RESIDENTS OF THE SURROUNDING AREAS TO RECEIVE MEDICAL CARE FROM MEDICAL PROFESSIONALS CLOSE TO HOME. PATIENTS WHO COME TO THE EMERGENCY ROOM ARE NOT DENIED TREATMENT BASED ON THE ABILITY TO PAY. FCMC OFFERS FINANCIAL ASSISTANCE DISCOUNTS AND CHARITY CARE FOR THOSE PATIENTS WHO HAVE A LIMITED OR NO MEANS TO PAY THEIR MEDICAL BILL. TO MEET THE NEEDS OF OUR COMMUNITY, THE HOSPITAL EXTENDS PRIVILEGES TO LICENSE MEDICAL STAFF. MEMBERS OF THE MEDICAL CENTER STAFF VISIT THE LOCAL SCHOOLS AND PARTICIPATE IN HEALTH FAIRS IN THE AREA TO REMIND CHILDREN OF HEALTHY HABITS THEY SHOULD PRACTICE. IN ADDITION, SEVERAL COMMUNITY HEALTH FAIRS ARE HELD SUCH AS A WOMEN'S HEALTH FAIR AND A HEALTH HUNTER'S HEALTH FAIR. SUPPORT GROUPS SUCH AS ALZHEIMER'S SUPPORT GROUP, SMOKING CESSATION, AND AA ARE ALSO OFFERED TO THE COMMUNITY. AS A CRITICAL ACCESS HOSPITAL AND RURAL HEALTHCARE PROVIDER, FCMC PROVIDES AN OPPORTUNITY TO ASSIST IN THE EDUCATION OF FUTURE HEALTH CARE WORKERS. AS PART OF THIS ENDEAVOR, NURSING STUDENTS FROM A LOCAL CAMPUS OF PENNSYLVANIA STATE UNIVERSITY COMPLETE A PORTION OF THEIR EDUCATION AT FCMC. ALSO, LAKE ERIE COLLEGE OF OSTEOPATHIC MEDICINE (LECOM) MEDICAL STUDENTS ROTATE TO FCMC AS PART OF THEIR EDUCATION. ALLIED HEALTH STUDENTS FROM THE SCHOOL DISTRICTS IN THE COUNTY SPEND A DAY TOURING THE DEPARTMENTS AT FCMC. IN ADDITION HIGH SCHOOL STUDENTS HAVE THE OPPORTUNITY TO VOLUNTEER WITHIN THE FACILITY OR JOB SHADOW A PROFESSIONAL AT THE HOSPITAL. FCMC PROVIDES NUMEROUS SERVICES IN THE COMMUNITY AT REDUCED OR NO COST TO ADDRESS UNMET HEALTHCARE NEEDS. THERE ARE THREE SCHOOL DISTRICTS AND A PRIVATE SCHOOL IN THE COUNTY, ALL OF WHICH ARE VISITED ONCE DURING EACH SCHOOL YEAR TO CONDUCT HEALTH SCREENINGS, ACCORDING TO HEALTH ISSUES ADDRESSED IN THE CHNA., ETC. SHADE GAP ELEMENTARY SCHOOL, LOCATED IN HUNTINGDON COUNTY, ALSO HOSTS AN ANNUAL HEALTH FAIR FOR ITS STUDENTS. DURING FISCAL YEAR 2015, THERE WERE A TOTAL OF 620 STUDENTS SERVED. FCMC ALSO OFFERS A REGULAR SCHEDULE OF MEDICAL SCREENINGS TO ADULTS AND SENIOR CITIZENS WITHIN THE COMMUNITY. THE MEDICAL SCREENINGS INCLUDE BLOOD PRESSURE READINGS. THE REHABILITATION SERVICES DEPARTMENT PROVIDED FREE EXERCISE CLASSES IN THE COMMUNITY. THE COUCH POTATO EXERCISE CLASS IS A FUN BUT LOW IMPACT WAY TO GET FOLKS MOVING. A TOTAL OF 718 PERSONS WERE SERVED THROUGH THE MEDICAL SCREENINGS & EXERCISE CLASSES DURING THE YEAR.FCMC HOLDS NUMEROUS COMMUNITY HEALTH FAIRS, BOTH ALONE AND IN CONJUNCTION WITH OTHER PROVIDERS IN THE AREA. FCMC KICKS OFF SUMMER BY HOSTING THE "KICK OFF YOUR DRUG FREE SUMMER" EVENT. THIS YEAR 307 PEOPLE ATTENDED AND OVER 20 DIFFERENT AGENCIES PROVIDED FREE SCREENINGS TO CHILDREN OF ALL AGES. THE MEDICAL CENTER COLLECTED 37 POUNDS OF MEDICATION AS PART OF THE DRUG TAKE BACK DAY. THE ARRIVAL OF AUTUMN SIGNALS THE ANNUAL "HEALTHY SPORTSMAN FAIR": WHICH WAS ATTENDED BY 200 PEOPLE FOR A WIDE VARIETY OF HEALTH SCREENINGS OFFERED AT NOMINAL OR NO COST. THROUGHOUT FISCAL YEAR 2015, THERE WERE 2 WOMEN'S HEALTH FAIRS HELD TO FOCUS THE SPECIFIC NEEDS OF FEMALES. IN FEBRUARY THE FOCUS WAS ON CONGESTIVE HEART FAILURE WITH STAFF CARDIOLOGIST JEFFREY MANDAK AND IT WAS ATTENDED BY 32 PERSONS. IN OCTOBER (TO COINCIDE WITH BREAST CANCER AWARENESS MONTH) FCMC HOSTED A LADIES NIGHT OUT TO BRING LADIES TO CAMPUS FOR FREE SCREENINGS, EDUCATION AND PAMPERING. LOCAL CRAFT AND HEALTH AND BEAUTY PRODUCT VENDORS WERE ON HAND FOR THE LADIES TO SHOP WHILE GETTING FREE SCREENINGS LIKE PULSE OXIMETRY, BMI, CHOLESTEROL, GLUCOSE, CARDIAC RISK ASSESSMENT, BLOOD PRESSURE, EKG, AND TRUNK FLEXIBILITY. THIS EVENT WAS WELL ATTENDED BY 145 WOMEN. FCMC ALSO PROVIDED A FREE PINK CARNATION FOR EACH WOMAN WHO RECEIVED HER MAMMOGRAM IN OCTOBER. FCMC PARTICIPATED IN PINK OUT GAMES AT THE LOCAL HIGH SCHOOLS TO RAISE AWARENESS OF THE FREE MAMMOGIFT PROGRAM PROVIDED FOR THE COMMUNITY. THEY PROVIDED ANNOUNCEMENTS AT HALF TIME ON THE IMPORTANCE OF MAMMOGRAMS AND EDUCATIONAL MATERIAL FOR WOMEN TO TAKE HOME.FCMC ALSO SPONSORED "GYM NIGHTS" AT THE LOCAL COMMUNITY GYM. 93 FOLKS ENJOYED ZUMBA FITNESS, AT A REDUCED COST. FCMC IS PRO-ACTIVE IN GETTING THE COMMUNITY UP & MOVING IN A SAFE AND FUN ENVIRONMENT. MARCH IS NATIONAL NUTRITION MONTH. FCMC ALONG WITH THE REGISTERED STAFF DIETICIAN PROVIDED EDUCATION IN THE MAIN LOBBY TO GUESTS AND VISITS DURING A ONE-DAY EVENT, "ENJOY THE TASTE OF EATING RIGHT." THIS EVENT ALLOWED FOLKS TO ASK QUESTIONS AND TRY NEW FOOD SAMPLES AND TREATS LIKE STEEL CUT OATS WHILE ALSO RECEIVING FREE SCREENINGS FOR BLOOD PRESSURE, CHOLESTEROL, AND GLUCOSE. FCMC ALSO PROVIDED STAFF FOR THE ANNUAL CAMP CADET HELD AT CAMP SINOQUIPE. STAFF PROVIDED EDUCATION ON BASIC FIRST AID. THE CAMP WAS ATTENDED BY 39 YOUTH. IN JULY 2013, FCMC PURCHASED HEALTHY COMMUNITIES SOFTWARE. THIS SOFTWARE IS HELPING TO MEASURE COMMUNITY HEALTH NEEDS, SHARE BEST PRACTICES, AND IDENTIFIED FUNDING SOURCES TO IMPROVE COMMUNITY HEALTH. THE SOFTWARE IS STILL BEING USED TO TRACK PROGRESS AND USED COMMUNITY WIDE FOR DATA MINING.FULTON COUNTY MEDICAL CENTER PURPOSEFULLY PROVIDES SERVICES AT A LOSS AS PART OF ITS MISSION TO MEET THE MEDICAL NEEDS OF THE COMMUNITY. THESE SERVICES INCLUDE DIABETES AND NUTRITIONAL EDUCATION, PULMONARY AND CARDIAC REHABILITATION SERVICES, WHICH ARE PROVIDED AT A LOSS SINCE MANY PATIENTS HAVE EXHAUSTED ANY AVAILABLE INSURANCE BENEFITS, AND TOBACCO CESSATION AND PREVENTION SERVICES, WHICH TRADITIONALLY HAVE BEEN PROVIDED BY A STATE-FUNDED GRANT. THESE SERVICES ARE NOW PROVIDED ON A FEE-FOR-SERVICE BASIS, AND FCMC HAS CONTINUED TO PROVIDE EXTENSIVE SERVICES EVEN THOUGH THE REVENUES RECEIVED NO LONGER COVER THE FULL COSTS OF PROVIDING THEM.FULTON COUNTY MEDICAL CENTER ALSO HOSTS A SPECIALTY CLINIC, WHERE A VARIETY OF PHYSICIAN AND MID-LEVEL SPECIALISTS SEE PATIENTS ON A ROTATING BASIS. THE COSTS OF OPERATING AND STAFFING THIS CLINIC ARE NOT MET BY REVENUES. LOCAL RESIDENTS, PARTICULARLY THE ELDERLY AND THOSE WITH CHRONIC MEDICAL CONDITIONS, ARE GRATEFUL FOR THE OPPORTUNITY TO SEE QUALIFIED SPECIALISTS WITHOUT TRAVELING OVER THE MOUNTAINOUS AREA FOR DISTANCES OF 30-50 MILES OR MORE FOR THESE SERVICES. CURRENTLY, THERE ARE 39 SPECIALISTS AVAILABLE IN THE SPECIALTY CLINIC.
PART VI, LINE 7, REPORTS FILED WITH STATES	PA

Schedule H (Form 990) 2014

Additional Data

Software ID:
Software Version:

- TIN:

Schedule I
(Form 990)

Department of the Treasury
Internal Revenue Service

Grants and Other Assistance to Organizations,
Governments and Individuals in the United States

Complete if the organization answered "Yes," to Form 990, Part IV, line 21 or 22.
lBullet

Attach to Form 990.
lBullet

Information about Schedule I (Form 990) and its instructions is at www.irs.gov/form990.

OMB No. 1545-0047

2014

Open to Public
Inspection

Name of the organization
FULTON COUNTY MEDICAL CENTER

Employer identification number
23-1401561

Part I

General Information on Grants and Assistance

Does the organization maintain records to substantiate the amount of the grants or assistance, the grantees' eligibility for the grants or assistance, and
the selection criteria used to award the grants or assistance? ....................................

Yes No

Describe in Part IV the organization's procedures for monitoring the use of grant funds in the United States.

Part II

Grants and Other Assistance to Domestic Organizations and Domestic Governments. Complete if the organization answered "Yes" to
Form 990, Part IV, line 21, for any recipient that received more than $5,000. Part II can be duplicated if additional space is needed.

(a) Name and address of organization or government	(b) EIN	(c) IRC section if applicable	(d) Amount of cash grant	(f) Method of valuation (book, FMV, appraisal, other)	(h) Purpose of grant or assistance
(1) FULTON COUNTY MEDICAL CENTER FOUNDATION 214 PEACH ORCHARD ROAD MCCONNELLSBURG,PA17233	51-0674514	501(C)(3)	386,151	COST	SPONSORSHIP OF FUNDRAISING EVENT & CONTRIBUTIONS TO FUNDRAISING CAMPAIGNS

Enter total number of section 501(c)(3) and government organizations listed in the line 1 table ................ Bullet Image

Enter total number of other organizations listed in the line 1 table ........................ . Bullet Image

For Paperwork Reduction Act Notice, see the Instructions for Form 990.

Cat. No. 50055P

Schedule I (Form 990) 2014

Page 2

Part III

Grants and Other Assistance to Domestic Individuals. Complete if the organization answered "Yes" to Form 990, Part IV, line 22.
Part III can be duplicated if additional space is needed.

(a)Type of grant or assistance	(b)Number of recipients	(c)Amount of cash grant	(d)Amount of non-cash assistance	(e)Method of valuation (book, FMV, appraisal, other)	(f)Description of non-cash assistance

Part IV

Supplemental Information. Provide the information required in Part I, line 2, Part III, column (b), and any other additional information.

Return Reference	Explanation
PART I, LINE 2:	THE ORGANIZATION'S ONLY DONATION WAS TO THE FULTON COUNTY MEDICAL CENTER FOUNDATION, A RELATED ORGANIZATION. THROUGH THIS RELATIONSHIP THE ORGANIZATION IS ABLE TO OBTAIN INFORMATION ON HOW THE FUNDS ARE SPENT AND IS ABLE TO MAKE SURE THE FUNDS ARE SPENT PROPERLY

Schedule I (Form 990) 2014

Additional Data

Software ID:
Software Version:

- TIN:

Schedule J
(Form 990)

Department of the Treasury
Internal Revenue Service

Compensation Information

For certain Officers, Directors, Trustees, Key Employees, and Highest
Compensated Employees
SchJMediumBullet

Complete if the organization answered "Yes" to Form 990, Part IV, line 23.
SchJMediumBullet

Attach to Form 990.
SchJMediumBullet

Information about Schedule J (Form 990) and its instructions is at www.irs.gov/form990.

OMB No. 1545-0047

2014

Open to Public Inspection

Name of the organization

FULTON COUNTY MEDICAL CENTER

Employer identification number

23-1401561

Part I

Questions Regarding Compensation

Yes

Check the appropiate box(es) if the organization provided any of the following to or for a person listed in Form
990, Part VII, Section A, line 1a. Complete Part III to provide any relevant information regarding these items.

First-class or charter travel Housing allowance or residence for personal use

Travel for companions Payments for business use of personal residence

Tax idemnification and gross-up payments Health or social club dues or initiation fees

Discretionary spending account Personal services (e.g., maid, chauffeur, chef)

If any of the boxes in line 1a are checked, did the organization follow a written policy regarding payment or reimbursement or provision of all of the expenses described above? If "No," complete Part III to explain....

Did the organization require substantiation prior to reimbursing or allowing expenses incurred by all
directors, trustees, officers, including the CEO/Executive Director, regarding the items checked in line 1a? ..

Indicate which, if any, of the following the filing organization used to establish the compensation of the
organization's CEO/Executive Director. Check all that apply. Do not check any boxes for methods
used by a related organization to establish compensation of the CEO/Executive Director, but explain in Part III.

Compensation committee Written employment contract

Independent compensation consultant Compensation survey or study

Form 990 of other organizations Approval by the board or compensation committee

During the year, did any person listed in Form 990, Part VII, Section A, line 1a with respect to the filing organization or a related organization:

Receive a severance payment or change-of-control payment? ................

Participate in, or receive payment from, a supplemental nonqualified retirement plan? .........

Participate in, or receive payment from, an equity-based compensation arrangement? .........

If "Yes" to any of lines 4a-c, list the persons and provide the applicable amounts for each item in Part III.

Only 501(c)(3), 501(c)(4), and 501(c)(29) organizations must complete lines 5-9.

For persons listed in Form 990, Part VII, Section A, line 1a, did the organization pay or accrue any
compensation contingent on the revenues of:

The organization? ...........................

Any related organization? .........................

If "Yes," to line 5a or 5b, describe in Part III.

For persons listed in Form 990, Part VII, Section A, line 1a, did the organization pay or accrue any
compensation contingent on the net earnings of:

The organization? ...........................

Any related organization? .........................

If "Yes," to line 6a or 6b, describe in Part III.

For persons listed in Form 990, Part VII, Section A, line 1a, did the organization provide any non-fixed
payments not described in lines 5 and 6? If "Yes," describe in Part III ............

Were any amounts reported in Form 990, Part VII, paid or accured pursuant to a contract that was
subject to the initial contract exception described in Regulations section 53.4958-4(a)(3)? If "Yes," describe
in Part III .............................

If "Yes" to line 8, did the organization also follow the rebuttable presumption procedure described in Regulations section 53.4958-6(c)? .........................

For Paperwork Reduction Act Notice, see the Instructions for Form 990.

Cat. No. 50053T

Schedule J (Form 990) 2014

Page 2

Part II

Officers, Directors, Trustees, Key Employees, and Highest Compensated Employees. Use duplicate copies if additional space is needed.

For each individual whose compensation must be reported in Schedule J, report compensation from the organization on row (i) and from related organizations, described in the
instructions, on row (ii). Do not list any individuals that are not listed on Form 990, Part VII.
Note. The sum of columns (B)(i)-(iii) for each listed individual must equal the total amount of Form 990, Part VII, Section A, line 1a, applicable column (D) and (E) amounts for that individual.

(A) Name and Title		(B) Breakdown of W-2 and/or 1099-MISC compensation			(C) Retirement and other deferred compensation	(D) Nontaxable benefits	(E) Total of columns (B)(i)-(D)	(F) Compensation in column(B) reported as deferred in prior Form 990
(A) Name and Title		(i) Base compensation	(ii) Bonus & incentive compensation	(iii) Other reportable compensation	(C) Retirement and other deferred compensation	(D) Nontaxable benefits	(E) Total of columns (B)(i)-(D)
1JASON HAWKINSCEO	(i) (ii)	168,751 ............................... 0	0 ............................... 0	0 ............................... 0	0 ............................... 0	19,695 ............................... 0	188,446 ............................... 0	0 ............................... 0
2JAMES RINTOUL MDER PHYSICIAN	(i) (ii)	460,814 ............................... 0	0 ............................... 0	0 ............................... 0	0 ............................... 0	15,164 ............................... 0	475,978 ............................... 0	0 ............................... 0
3ALBERT IGUCHI MDER PHYSICIAN	(i) (ii)	374,424 ............................... 0	0 ............................... 0	0 ............................... 0	0 ............................... 0	18,692 ............................... 0	393,116 ............................... 0	0 ............................... 0
4GERALD CELESTINE MDER PHYSICIAN	(i) (ii)	321,755 ............................... 0	0 ............................... 0	0 ............................... 0	0 ............................... 0	20,038 ............................... 0	341,793 ............................... 0	0 ............................... 0
5JAMES FREEMAN MDER PHYSICIAN	(i) (ii)	318,432 ............................... 0	0 ............................... 0	0 ............................... 0	0 ............................... 0	20,038 ............................... 0	338,470 ............................... 0	0 ............................... 0
6JEFFREY MANDAK MDCARDIOLOGIST	(i) (ii)	413,071 ............................... 0	0 ............................... 0	0 ............................... 0	0 ............................... 0	24,848 ............................... 0	437,919 ............................... 0	0 ............................... 0

Schedule J (Form 990) 2014

Page 3

Part III

Supplemental Information

Provide the information, explanation, or descriptions required for Part I, lines 1a, 1b, 3, 4a, 4b, 4c, 5a, 5b, 6a, 6b, 7, and 8, and for Part II.
Also complete this part for any additional information.

Return Reference	Explanation

Schedule J (Form 990) 2014

Additional Data

Software ID:
Software Version:

- TIN:

Schedule K
(Form 990)

Department of the Treasury
Internal Revenue Service

Supplemental Information on Tax Exempt Bonds

Complete if the organization answered "Yes" to Form 990, Part IV, line 24a. Provide descriptions,
explanations, and any additional information in Part VI.
SchKMediumBullet

Attach to Form 990.
SchKMediumBullet

Information about Schedule K (Form 990) and its instructions is at www.irs.gov/form990.

OMB No. 1545-0047

2014

Open to Public
Inspection

Name of the organization
FULTON COUNTY MEDICAL CENTER

Employer identification number
23-1401561

Part I

Bond Issues

(a) Issuer name		(b) Issuer EIN	(c) CUSIP #	(d) Date issued	(e) Issue price	(f) Description of purpose	(g) Defeased		(h) On behalf of issuer		(i) Pool financing
(a) Issuer name		(b) Issuer EIN	(c) CUSIP #	(d) Date issued	(e) Issue price	(f) Description of purpose	Yes	No	Yes	No	Yes	No
A	FULTON COUNTY INDUSTRIAL DEVELOPMENT AUTHORITY	23-2299855	36024LAJ8	04-27-2006	25,926,018	NEW BUILDING STRUCTURE/EQUIPMENT FOR NEW HOSPITAL/LONG-TERM CARE FACILITY		X		X		X
B	FULTON COUNTY INDUSTRIAL DEVELOPMENT AUTHORITY	23-2299855		06-19-2009	3,500,000	NEW BUILDING STRUCTURE/EQUIPMENT FOR NEW SPECIALTY CLINIC & PARKING LOT		X		X		X

Part II

Proceeds

	A		B		C		D
	1 Amount of bonds retired . . . . . . . . . . . . . .	2,340,000
2 Amount of bonds legally defeased . . . . . . . . . . .
3 Total proceeds of issue . . . . . . . . . . . . . .	27,787,272		3,500,000
4 Gross proceeds in reserve funds . . . . . . . . . . . .	1,820,273
5 Capitalized interest from proceeds . . . . . . . . . . .	2,446,749
6 Proceeds in refunding escrows . . . . . . . . . . . .
7 Issuance costs from proceeds . . . . . . . . . . . .	518,520
8 Credit enhancement from proceeds . . . . . . . . . . .
9 Working capital expenditures from proceeds . . . . . . . . .
10 Capital expenditures from proceeds . . . . . . . . . . .	23,587,225		3,500,000
11 Other spent proceeds . . . . . . . . . . . . . .
12 Other unspent proceeds . . . . . . . . . . . . . .
13 Year of substantial completion . . . . . . . . . . . .	2007		2010
	Yes	No	Yes	No	Yes	No	Yes	No
14 Were the bonds issued as part of a current refunding issue? . . . . .		X		X
15 Were the bonds issued as part of an advance refunding issue? . . . . .		X		X
16 Has the final allocation of proceeds been made? . . . . . . . .	X		X
17 Does the organization maintain adequate books and records to support the final allocation of proceeds? . . . . . . . . . . . . . .	X		X

Part III

Private Business Use

	A		B		C		D
	Yes	No	Yes	No	Yes	No	Yes	No
1 Was the organization a partner in a partnership, or a member of an LLC, which owned property financed by tax-exempt bonds? . . . . . . .		X		X
2 Are there any lease arrangements that may result in private business use of bond-financed property? . . . . . . . . .		X		X

For Paperwork Reduction Act Notice, see the Instructions for Form 990.

Cat. No. 50193E

Schedule K (Form 990) 2014

Page 2

Part III

Private Business Use (Continued)

	A		B		C		D
	Yes	No	Yes	No	Yes	No	Yes	No
3a Are there any management or service contracts that may result in private business use of bond-financed property? . . . . . . . . . . . .		X		X
b If "Yes" to line 3a, does the organization routinely engage bond counsel or other outside counsel to review any management or service contracts relating to the financed property?
c Are there any research agreements that may result in private business use of bond-financed property? . . . . . . . . . . . . . . .		X		X
d If "Yes" to line 3c, does the organization routinely engage bond counsel or other outside counsel to review any research agreements relating to the financed property?
4 Enter the percentage of financed property used in a private business use by entities other than a section 501(c)(3) organization or a state or local government . .	0 %		0 %
5 Enter the percentage of financed property used in a private business use as a result of unrelated trade or business activity carried on by your organization, another section 501(c)(3) organization, or a state or local government . . . . . . .	0 %		0 %
6 Total of lines 4 and 5 . . . . . . . . . . . . .	0 %		0 %
7 Does the bond issue meet the private security or payment test? . . . . .		X		X
8a Has there been a sale or disposition of any of the bond-financed property to a nongovernmental person other than a 501(c)(3) organization since the bonds were issued?. . . . . . . . . . . . . . . . .		X		X
b If "Yes" to line 8a, enter the percentage of bond-financed property sold or disposed of.
c If "Yes" to line 8a, was any remedial action taken pursuant to Regulations sections 1.141-12 and 1.145-2? . . . . . . . . . . . . .
9 Has the organization established written procedures to ensure that all nonqualified bonds of the issue are remediated in accordance with the requirements under Regulations sections 1.141-12 and 1.145-2? . . . . . . .		X		X

Part IV

Arbitrage

	A		B		C		D
	Yes	No	Yes	No	Yes	No	Yes	No
1 Has the issuer filed Form 8038-T, Arbitrage Rebate, Yield Reduction and Penalty in Lieu of Arbitrage Rebate? . .		X		X
2 If "No" to line 1, did the following apply? . . . .
a Rebate not due yet? . . . . . . . .		X		X
b Exception to rebate? . . . . . . . .		X		X
c No rebate due? . . . . . . . .	X		X
If "Yes" to line 2c, provide in Part VI the date the rebate computation was performed . . . . . .
3 Is the bond issue a variable rate issue? . . . .		X		X
4a Has the organization or the governmental issuer entered into a qualified hedge with respect to the bond issue?		X	X
b Name of provider . . . . . . . . .	BRANCH BANKING & TRUST CO		BRANCH BANKING & TRUST CO
c Term of hedge . . . . . . . . . .	10.000000000000		10.000000000000
d Was the hedge superintegrated? . . . .		X		X
e Was the hedge terminated? . . . . . .		X		X

Schedule K (Form 990) 2014

Page 3

Part IV

Arbitrage (Continued)

	A		B		C		D
	Yes	No	Yes	No	Yes	No	Yes	No
5a Were gross proceeds invested in a guaranteed investment contract (GIC)? . . . . . . . . .		X		X
b Name of provider . . . . . . . . .
c Term of GIC . . . . . . . . . .
d Was the regulatory safe harbor for establishing the fair market value of the GIC satisfied? . . . . .
6 Were any gross proceeds invested beyond an available temporary period? . . . . . . . .		X		X
7 Has the organization established written procedures to monitor the requirements of section 148? . . .		X		X

Part V

Procedures To Undertake Corrective Action

	A		B		C		D
	Yes	No	Yes	No	Yes	No	Yes	No
Has the organization established written procedures to ensure that violations of federal tax requirements are timely identified and corrected through the voluntary closing agreement program if self-remediation is not available under applicable regulations?		X		X

Part VI

Supplemental Information. Provide additional information for responses to questions on Schedule K (see instructions).

Return Reference	Explanation
DATE REBATE COMPUTATION PERFORMED	ISSUER NAME: FULTON COUNTY INDUSTRIAL DEVELOPMENT AUTHORITY DATE THE REBATE COMPUTATION WAS PERFORMED: 07/01/2013 ISSUER NAME: FULTON COUNTY INDUSTRIAL DEVELOPMENT AUTHORITY DATE THE REBATE COMPUTATION WAS PERFORMED: 06/19/2009
SCHEDULE K SUPPLENTAL INFORMATION	SCHEDULE K, PART II, LINE 3, TOTAL PROCEEDS: THE ISSUE PRICE REPORTED IN PART I, COLUMN E FOR BOND A DOES NOT MATCH THE TOTAL PROCEEDS OF ISSUE REPORTED IN PART II, LINE 3. THE DIFFERENCE IS $1,861,254 IN EARNINGS OVER THE LIFE OF THE BOND.

Schedule K (Form 990) 2014

Additional Data

Software ID:
Software Version:

- TIN:

Schedule L
(Form 990 or 990-EZ)

Department of the Treasury
Internal Revenue Service

Transactions with Interested Persons

Complete if the organization answered
"Yes" on Form 990, Part IV, lines 25a, 25b, 26, 27, 28a, 28b, or 28c,
or Form 990-EZ, Part V, line 38a or 40b.
MediumBullet

Attach to Form 990 or Form 990-EZ.
MediumBullet

Information about Schedule L (Form 990 or 990-EZ) and its instructions is at www.irs.gov/form990.

OMB No. 1545-0047

2014

Open to Public Inspection

Name of the organization

FULTON COUNTY MEDICAL CENTER

Employer identification number

23-1401561

Part I

Excess Benefit Transactions (section 501(c)(3), section 501(c)(4), and 501(c)(29) organizations only).
Complete if the organization answered "Yes" on Form 990, Part IV, line 25a or 25b, or Form 990-EZ, Part V, line 40b.

1(a) Name of disqualified person	(c) Description of transaction	(d) Corrected?
1(a) Name of disqualified person	(c) Description of transaction	Yes	No

Enter the amount of tax incurred by organization managers or disqualified persons during the year under section 4958. ........................... Bullet Image

Enter the amount of tax, if any, on line 2, above, reimbursed by the organization ....... Bullet Image

Part II

Loans to and/or From Interested Persons.
Complete if the organization answered "Yes" on Form 990-EZ, Part V, line 38a, or Form 990, Part IV, line 26; or if the organization reported an amount on Form 990, Part X, line 5, 6, or 22

(a) Name of interested person	(b) Relationship with organization	(c) Purpose of loan	(d) Loan to or from the organization?		(e)Original principal amount	(f)Balance due	(g) In default?		(h) Approved by board or committee?		(i)Written agreement?
(a) Name of interested person	(b) Relationship with organization	(c) Purpose of loan	To	From	(e)Original principal amount	(f)Balance due	Yes	No	Yes	No	Yes	No






Total ...... $

Part III

Grants or Assistance Benefiting Interested Persons.
Complete if the organization answered "Yes" on Form 990, Part IV, line 27.

(a) Name of interested person	(b) Relationship between interested person and the organization	(c) Amount of assistance	(d) Type of assistance	(e) Purpose of assistance

For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.

Cat. No. 50056A

Schedule L (Form 990 or 990-EZ) 2014

Page 2

Part IV

Business Transactions Involving Interested Persons.
Complete if the organization answered "Yes" on Form 990, Part IV, line 28a, 28b, or 28c.

(a) Name of interested person	(b) Relationship between interested person and the organization	(c) Amount of transaction	(d) Description of transaction	(e) Sharing of organization's revenues?
(a) Name of interested person		(c) Amount of transaction	(d) Description of transaction	Yes	No
(1) JAYNE BUTERBAUGH	SPOUSE OF DENNY BUTERBAUGH, BOARD DIRECTOR	67,049	COMPENSATION AND BENEFITS AS AN EMPLOYEE		No
(2) DEANN HAWKINS	SPOUSE OF JASON HAWKINS, CEO	102,701	COMPENSATION AND BENEFITS AS AN EMPLOYEE		No

Part V

Supplemental Information
Provide additional information for responses to questions on Schedule L (see instructions).

Return Reference	Explanation

Schedule L (Form 990 or 990-EZ) 2014

Additional Data

Software ID:
Software Version:

- TIN:

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

Information about Schedule O (Form 990 or 990-EZ) and its instructions is at
www.irs.gov/form990.

OMB No. 1545-0047

2014

Open to Public
Inspection

Name of the organization

FULTON COUNTY MEDICAL CENTER

Employer identification number

23-1401561

Return Reference	Explanation
FORM 990, PART III, LINE 2	1. TELEMEDICINE PROGRAM EXPANSION: A. AUGUST 2014 - TELE-TOXICOLOGY SERVICES B. OCTOBER 2014 - TELE-BURN SERVICES 2. JULY 2014 - DR. MILROTH FAMILY PRACTICE JOINS FCMC'S HEALTHCARE TEAM 3. OCTOBER 2014 - COMPLETED A THERAPY PLAYGROUND FOR OUR THERAPY AND BEHAVIORAL HEALTH PATIENTS 4. JANUARY 2015 - TRANSITION OF CARE NURSE HIRED TO FOLLOW UP WITH PATIENTS AFTER DISCHARGE AND TO DECREASE THE READMISSION RATE 5. JANUARY 2015 - EXPANDED ORTHOPEDIC SERVICES 6. FEBRUARY 2015 - HEMATOLOGY/ONCOLOGY SERVICES 7. APRIL 2015 - UROLOGY SERVICES 8. APRIL 2015 - OPENED A HOME HEALTH BRANCH OFFICE AT JC BLAIR MEMORIAL HOSPITAL IN HUNTINGDON, PA 9. MAY 2015 - EXPANDED CARDIOLOGY SERVICES TO THE SOUTHERN HUNTINGDON COUNTY MEDICAL CENTER IN ORBISONIA, PA 10. JUNE 2015 - NEPHROLOGIST SERVICES 11. JUNE 2015 - FCMC FARMER'S MARKET OPEN FOR BUSINESS ON FCMC'S CAMPUS
FORM 990, PART VI, SECTION A, LINE 1	THE EXECUTIVE COMMITTEE SHALL CONSIST OF THE BOARD OFFICERS AND EACH OF THE COMMITTEE CHAIRPERSONS. THE PRESIDENT/CEO SHALL BE AN EX-OFFICIO, NON-VOTING MEMBER OF THE EXECUTIVE COMMITTEE. THE CHAIRPERSON OF THE BOARD SHALL ACT AS THE CHAIRPERSON OF THE EXECUTIVE COMMITTEE. FROM TIME TO TIME THE EXECUTIVE COMMITTEE SHALL HAVE AND MAY EXERCISE, ALL OF THE POWERS OF THE BOARD OF DIRECTORS TO TRANSACT THE REGULAR BUSINESS OF THE MEDICAL CENTER TO THE EXTENT PERMITTED BY LAW, PROVIDED ANY ACTION TAKEN SHALL NOT CONFLICT WITH THE POLICIES AND EXPRESS WISHES OF THE BOARD OF DIRECTORS, AND IT SHALL REPORT ITS ACTIONS AT THE NEXT BOARD MEETING. THE COMMITTEE MAY ALSO ENSURE THAT THE BOARD OF DIRECTORS COMPLETES AN ANNUAL SELF-EVALUATION OF THE BOARD'S PERFORMANCE. THE COMMITTEE MAY ARRANGE FOR A REGULAR PROGRAM ON CONTINUING EDUCATION FOR ALL MEMBERS OF THE BOARD, AND ASSURE THAT A PROPER ORIENTATION PROGRAM IS PROVIDED FOR ALL NEW BOARD MEMBERS.
FORM 990, PART VI, SECTION B, LINE 11	FULTON COUNTY MEDICAL CENTER HAS A CPA FIRM PREPARE ITS FORM 990. THE RETURN IS COMPLETED IN DRAFT FORM AND REVIEWED BY THE CFO AND PRESENTED TO THE FINANCE COMMITTEE. THE RETURN IS ALSO PROVIDED TO THE FULL GOVERNING BOARD BEFORE FILING WITH THE IRS.
FORM 990, PART VI, SECTION B, LINE 12C	ANY POSSIBLE CONFLICT OF INTEREST ON THE PART OF A DIRECTOR MUST BE DISCLOSED TO THE BOARD. A CONFLICT OF INTEREST FORM IS COMPLETED ANNUALLY BY ALL OFFICERS, DIRECTORS, AND KEY EMPLOYEES. THE FORMS ARE REVIEWED BY THE CEO. WHEN ANY INTEREST BECOMES A MATTER OF BOARD ACTION, THE DIRECTOR IS NOT TO VOTE OR USE PERSONAL INFLUENCE ON THE MATTER, AND IS NOT COUNTED IN THE QUORUM FOR A MEETING AT WHICH BOARD ACTION IS TO BE TAKEN ON THE INTEREST. THE DIRECTOR MAY, HOWEVER, BRIEFLY STATE A POSITION ON THE MATTER AND ANSWER PERTINENT QUESTIONS OF BOARD MEMBERS. THE MINUTES OF ALL ACTIONS TAKEN ON SUCH MATTERS CLEARLY REFLECT THAT THESE REQUIREMENTS HAVE BEEN MET. IT IS THE OBLIGATION OF EACH BOARD MEMBER TO ACT IN THE BEST INTEREST OF THE MEDICAL CENTER. ALL BOARD INFORMATION IS CONFIDENTIAL, AND IS NOT TO BE USED OR DISCUSSED OTHER THAN FOR APPROPRIATE MEDICAL CENTER BUSINESS. FAILURE OF A DIRECTOR TO MAINTAIN THE CONFIDENTIALITY OF BOARD INFORMATION IS GROUNDS FOR REMOVAL.
FORM 990, PART VI, SECTION B, LINE 15	THE BOARD OF DIRECTORS SERVES AS A COMPENSATION COMMITTEE AND REVIEWS AND ADJUSTS THE COMPENSATION OF THE CEO BASED ON EVALUATIONS AND COMPARABILITY DATA. THE HUMAN RESOURCES DEPARTMENT CONDUCTS A SURVEY TO GATHER COMPARABILITY DATA AND GIVES THIS INFORMATION TO THE BOARD OF DIRECTORS WHEN REQUESTED BY THE BOARD. THE PROCESS IS DOCUMENTED AND WAS LAST COMPLETED IN DECEMBER FY 2014 FOR THE CEO. THE CFO RECEIVES COST OF LIVING ADJUSTMENTS AS APPROVED, THROUGH THE BUDGET PROCESS, BY THE BOARD OF DIRECTORS EACH FISCAL YEAR. THE CEO, IN COLLABORATION WITH THE HR DEPARTMENT, REVIEWS AND ADJUSTS THE COMPENSATION OF THE CFO BASED ON PERFORMANCE AND COMPARABILITY DATA IF NEEDED. THE HR DEPARTMENT CONDUCTS A SURVEY TO GATHER COMPARABILITY DATA AND GIVES THIS INFORMATION TO THE CEO WHEN REQUESTED BY THE CEO. THIS INFORMATION IS SHARED WITH THE BOARD OF DIRECTORS FOR INFORMATIONAL PURPOSES. THE PROCESS WAS LAST COMPLETED FOR FISCAL YEAR 2014.
FORM 990, PART VI, SECTION C, LINE 18	FULTON COUNTY MEDICAL CENTER MAKES ITS FORM 990 AND FORM 1023 AVAILABLE TO THE PUBLIC.
FORM 990, PART VI, SECTION C, LINE 19	THE ORGANIZATION MAKES ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS AVAILABLE UPON REQUEST AND THROUGH AN ANNUAL MEETING WHICH IS OPEN TO THE GENERAL PUBLIC.
FORM 990, PART XI, LINE 9:	MINIMUM PENSION LIABILITY ADJUSTMENT -228,939. CHANGE IN FAIR VALUE OF INTEREST RATE SWAP 37,829. PERMANENTLY RESTRICTED VALUATION GAIN IN ASSETS HELD IN TRUST -2,442.
FORM 990, PART XII, LINE 2C:	THE ORGANIZATION'S BOARD OF DIRECTORS ASSUME RESPONSIBILITY FOR OVERSIGHT OF THE AUDIT. THE PROCESS IS CONSISTENT WITH PRIOR YEARS AND HAS NOT CHANGED.
FORM 990, PART VII:	THE COMPENSATION PAID TO FRANK D'AMELIO, M.D. IS FOR SERVICES PROVIDED AS THE DIRECTOR OF RADIOLOGY. FRANK D'AMELIO, M.D. DID NOT RECEIVE COMPENSATION FOR SERVING ON THE BOARD OF DIRECTORS.

For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.

Cat. No. 51056K

Schedule O (Form 990 or 990-EZ) 2014

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE R
(Form 990)

Department of the Treasury
Internal Revenue Service

Related Organizations and Unrelated Partnerships

Complete if the organization answered "Yes" on Form 990, Part IV, line 33, 34, 35b, 36, or 37.
MediumBullet

Attach to Form 990.
MediumBullet

Information about Schedule R (Form 990) and its instructions is at www.irs.gov/form990.

OMB No. 1545-0047

2014

Open to Public Inspection

Name of the organization

FULTON COUNTY MEDICAL CENTER

Employer identification number

23-1401561

Part I

Identification of Disregarded Entities Complete if the organization answered "Yes" on Form 990, Part IV, line 33.

(a) Name, address, and EIN (if applicable) of disregarded entity	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Total income	(e) End-of-year assets	(f) Direct controlling entity

Part II

Identification of Related Tax-Exempt Organizations Complete if the organization answered "Yes" on Form 990, Part IV, line 34 because it had one or more related tax-exempt organizations during the tax year.

(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Exempt Code section	(e) Public charity status (if section 501(c)(3))	(f) Direct controlling entity	(g) Section 512(b)(13) controlled entity?
(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Exempt Code section	(e) Public charity status (if section 501(c)(3))	(f) Direct controlling entity	Yes	No
(1) FULTON COUNTY MEDICAL CENTER FOUNDATION 214 PEACH ORCHARD ROAD MCCONNELLSBURG,PA17233 51-0674514	PROVIDE SUPPORT TO FULTON COUNTY MEDICAL CENTER	PA	501(C)(3)	LINE 7	FULTON COUNTY MEDICAL CENTER	Yes

For Paperwork Reduction Act Notice, see the Instructions for Form 990.

Cat. No. 50135Y

Schedule R (Form 990) 2014

Page 2

Part III

Identification of Related Organizations Taxable as a Partnership Complete if the organization answered "Yes" on Form 990, Part IV, line 34 because it had one or more related organizations treated as a partnership during the tax year.

(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Direct controlling entity	(f) Share of total income	(g) Share of end-of-year assets	(h) Disproprtionate allocations?		(i) Code V-UBI amount in box 20 of Schedule K-1 (Form 1065)	(j) General or managing partner?
(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Direct controlling entity	(f) Share of total income	(g) Share of end-of-year assets	Yes	No	(i) Code V-UBI amount in box 20 of Schedule K-1 (Form 1065)	Yes	No

Part IV

Identification of Related Organizations Taxable as a Corporation or Trust Complete if the organization answered "Yes" on Form 990, Part IV, line 34 because it had one or more related organizations treated as a corporation or trust during the tax year.

(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Direct controlling entity	(e) Type of entity (C corp, S corp, or trust)	(f) Share of total income	(g) Share of end-of-year assets	(i) Section 512(b)(13) controlled entity?
(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Direct controlling entity	(e) Type of entity (C corp, S corp, or trust)	(f) Share of total income	(g) Share of end-of-year assets	Yes	No

Schedule R (Form 990) 2014

Page 3

Part V

Transactions With Related Organizations Complete if the organization answered "Yes" on Form 990, Part IV, line 34, 35b, or 36.

Note. Complete line 1 if any entity is listed in Parts II, III, or IV of this schedule.

Yes

1 During the tax year, did the orgranization engage in any of the following transactions with one or more related organizations listed in Parts II-IV?

a Receipt of (i) interest, (ii) annuities, (iii) royalties, or (iv) rent from a controlled entity . . . . . . . . . . . . . . . . . . . . . . .

b Gift, grant, or capital contribution to related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Yes

c Gift, grant, or capital contribution from related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Yes

d Loans or loan guarantees to or for related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

e Loans or loan guarantees by related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

f Dividends from related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

g Sale of assets to related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

h Purchase of assets from related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

i Exchange of assets with related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

j Lease of facilities, equipment, or other assets to related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . .

k Lease of facilities, equipment, or other assets from related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . .

l Performance of services or membership or fundraising solicitations for related organization(s) . . . . . . . . . . . . . . . . . . . .

m Performance of services or membership or fundraising solicitations by related organization(s) . . . . . . . . . . . . . . . . . . . .

n Sharing of facilities, equipment, mailing lists, or other assets with related organization(s) . . . . . . . . . . . . . . . . . . . . .

Yes

o Sharing of paid employees with related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

p Reimbursement paid to related organization(s) for expenses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

q Reimbursement paid by related organization(s) for expenses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

r Other transfer of cash or property to related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

s Other transfer of cash or property from related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

If the answer to any of the above is "Yes," see the instructions for information on who must complete this line, including covered relationships and transaction thresholds.

(a) Name of related organization	(b) Transaction type (a-s)	(c) Amount involved	(d) Method of determining amount involved
(1) FULTON COUNTY MEDICAL CENTER FOUNDATION	B	386,151	COST
(2) FULTON COUNTY MEDICAL CENTER FOUNDATION	C	208,484	COST
(3) FULTON COUNTY MEDICAL CENTER FOUNDATION	N	0

Schedule R (Form 990) 2014

Page 4

Part VI

Unrelated Organizations Taxable as a Partnership Complete if the organization answered "Yes" on Form 990, Part IV, line 37.

Provide the following information for each entity taxed as a partnership through which the organization conducted more than five percent of its activities (measured by total assets or gross revenue) that was not a related organization. See instructions regarding exclusion for certain investment partnerships.

(a) Name, address, and EIN of entity	(b) Primary activity	(c) Legal domicile (state or foreign country)	(e) Are all partners section 501(c)(3) organizations?		(f) Share of total income	(g) Share of end-of-year assets	(h) Disproprtionate allocations?		(i) Code V-UBI amount in box 20 of Schedule K-1 (Form 1065)	(j) General or managing partner?
(a) Name, address, and EIN of entity	(b) Primary activity	(c) Legal domicile (state or foreign country)	Yes	No	(f) Share of total income	(g) Share of end-of-year assets	Yes	No	(i) Code V-UBI amount in box 20 of Schedule K-1 (Form 1065)	Yes	No

Schedule R (Form 990) 2014

Page 5

Part VII

Supplemental Information

Provide additional information for responses to questions on Schedule R (see instructions).

Return Reference	Explanation

Schedule R (Form 990) 2014

Additional Data

Software ID:
Software Version:

1	Briefly describe the organization’s mission or most significant activities: HEALTHCARE SERVICES
2	Check this box
3	Number of voting members of the governing body (Part VI, line 1a) ........	3	13
4	Number of independent voting members of the governing body (Part VI, line 1b) .....	4	11
5	Total number of individuals employed in calendar year 2014 (Part V, line 2a) ......	5	544
6	Total number of volunteers (estimate if necessary) .............	6	61
7a	Total unrelated business revenue from Part VIII, column (C), line 12 ........	7a	0
b	Net unrelated business taxable income from Form 990-T, line 34 .........	7b	0

		Prior Year	Current Year
8	Contributions and grants (Part VIII, line 1h) .........	553,851	303,440
9	Program service revenue (Part VIII, line 2g) .........	41,201,940	42,880,354
10	Investment income (Part VIII, column (A), lines 3, 4, and 7d ) ....	390,285	641,972
11	Other revenue (Part VIII, column (A), lines 5, 6d, 8c, 9c, 10c, and 11e)	317,047	680,120
12	Total revenue—add lines 8 through 11 (must equal Part VIII, column (A), line 12)...................	42,463,123	44,505,886
13	Grants and similar amounts paid (Part IX, column (A), lines 1–3 )...	214,854	386,151
14	Benefits paid to or for members (Part IX, column (A), line 4).....	0	0
15	Salaries, other compensation, employee benefits (Part IX, column (A), lines 5–10)	24,293,089	27,268,327
16a	Professional fundraising fees (Part IX, column (A), line 11e).....	0	0
b	Total fundraising expenses (Part IX, column (D), line 25) 0
17	Other expenses (Part IX, column (A), lines 11a–11d, 11f–24e)....	16,034,434	18,318,628
18	Total expenses. Add lines 13–17 (must equal Part IX, column (A), line 25)	40,542,377	45,973,106
19	Revenue less expenses. Subtract line 18 from line 12.......	1,920,746	-1,467,220
		Beginning of Current Year	End of Year
20	Total assets (Part X, line 16).............	56,910,382	54,914,903
21	Total liabilities (Part X, line 26).............	38,845,384	38,878,683
22	Net assets or fund balances. Subtract line 21 from line 20.....	18,064,998	16,036,220

Sign Here

	Signature of officer	Date

	Type or print name and title


4a	(Code: ) (Expenses $ 39,300,129 including grants of $ 386,151 ) (Revenue $ 37,308,307 )
	FULTON COUNTY MEDICAL CENTER PROVIDES INPATIENT, OUTPATIENT, EMERGENCY CARE, SKILLED NURSING, AND HOME HEALTH SERVICES. SERVICES ARE PROVIDED TO ALL WHO NEED THEM, REGARDLESS OF ABILITY TO PAY. EMERGENCY SERVICES ARE PROVIDED 24/7, 365 DAYS A YEAR, WITHOUT INQUIRY INTO FINANCIAL MEANS OR INSURANCE STATUS. ELECTIVE SERVICES ARE PROVIDED WITH FINANCIAL ASSISTANCE OFFERED BASED UPON A STANDARD, OBJECTIVE APPLICATION TO DETERMINE FINANCIAL NEED. SERVICES MAY BE DISCOUNTED FROM ESTABLISHED RATES OR PROVIDED FREE OF CHARGE AFTER THE APPLICATION AND SUPPORTING DOCUMENTATION HAVE BEEN EVALUATED. DISCOUNTS AND ALLOWANCES OFFERED UNDER THE MEDICAL CENTER'S FINANCIAL ASSISTANCE PROGRAM TOTALED $173,000 BASED ON CHARGES FOREGONE DURING THE FISCAL YEAR ENDED JUNE 30, 2015. THE AMOUNT OF THE DISCOUNT IS DETERMINED BY THE TYPE OF SERVICE RECEIVED SUCH AS INPATIENT, OUTPATIENT, ETC. INTEREST-FREE PAYMENT PLANS ARE MADE AVAILABLE FOR PATIENTS WHO CANNOT PAY IN FULL AT THE TIME OF SERVICE.

4b	(Code: ) (Expenses $ 2,698,271 including grants of $ ) (Revenue $ 5,572,047 )
	FULTON COUNTY MEDICAL CENTER OPERATES A 67 BED HOSPITAL-BASED SKILLED NURSING FACILITY. THE NURSING HOME OFFERS QUALITY CARE IN A FRIENDLY HOME ENVIRONMENT. THE HOSPITAL-BASED NURSING HOME OFFERS DIRECT AVAILABILITY TO SERVICES SUCH AS LAB, X-RAY, EKG, RESPIRATORY THERAPY, REHAB SERVICES AND 24 HOUR PHYSICIAN AVAILABILITY FOR EMERGENCIES. TODAY, FCMC LONG TERM CARE IS VERY MUCH A VITAL PART OF THE ORGANIZATION. THIS IS THE ONLY NURSING HOME IN FULTON COUNTY. HEALTHCARE HAS DRAMATICALLY CHANGED SINCE 1970 WHEN THE LTC UNIT WAS BUILT, HOWEVER THE QUALITY OF CARE, COUPLED WITH THE FAMILY-LIKE ATMOSPHERE HAS REMAINED UNCHANGED. IF THE FACILITY DID NOT EXIST FAMILIES WOULD HAVE TRAVEL OVER MOUNTAINOUS TERRAIN TO RECEIVE LONG TERM CARE SERVICES. WHILE THE FACILITY ACCEPTS ALL MAJOR INSURANCES, PRIVATE PAY, MEDICARE AND MEDICAID, THE MAJORITY OF THE PATIENTS (APPROXIMATELY 70%) HAVE MEDICAL ASSISTANCE AS THE PAYER.

4c	(Code: ) (Expenses $ including grants of $ ) (Revenue $ )












4d	Other program services (Describe in Schedule O.)
	(Expenses $ including grants of $ ) (Revenue $ )
4e	Total program service expenses41,998,400

1b	Sub-Total................
c	Total from continuation sheets to Part VII, Section A....
d	Total (add lines 1b and 1c)............	2,234,331	0	146,349

(A) Name and Title	(B) Average hours per week (list any hours for related organizations below dotted line)		(D) Reportable compensation from the organization (W- 2/1099-MISC)	(E) Reportable compensation from related organizations (W- 2/1099-MISC)	(F) Estimated amount of other compensation from the organization and related organizations
(A) Name and Title
(18) GERALD CELESTINE MD........................................................................ ER PHYSICIAN	40.00 .......................	X	321,755	0	20,038
(19) JAMES FREEMAN MD........................................................................ ER PHYSICIAN	40.00 .......................	X	318,432	0	20,038
(20) JEFFREY MANDAK MD........................................................................ CARDIOLOGIST	40.00 .......................	X	413,071	0	24,848

(A) Name and business address	(B) Description of services	(C) Compensation





2 Total number of independent contractors (including but not limited to those listed above) who received more than $100,000 of compensation from the organization 0

				(A) Total revenue	(B) Related or exempt function revenue	(C) Unrelated business revenue	(D) Revenue excluded from tax under sections 512-514
1a	Federated campaigns..1a
b	Membership dues....1b
c	Fundraising events....1c
d	Related organizations...1d		208,484
e	Government grants (contributions)1e

f	All other contributions, gifts, grants, and similar amounts not included above1f		94,956

g	Noncash contributions included in lines 1a-1f:$
h	Total. Add lines 1a-1f.......			303,440
			Business Code
2a	NET PATIENT SERVICE REVENUE		621110	37,308,307	37,308,307
b	NET RESIDENT SERVICE REVENUE		623000	5,572,047	5,572,047
c
d
e
f	All other program service revenue .
g	Total. Add lines 2a–2f........			42,880,354
3	Investment income (including dividends, interest, and other similar amounts).......			642,440			642,440
4	Income from investment of tax-exempt bond proceeds..
5	Royalties...........
		(i) Real	(ii) Personal
6a	Gross rents	72,921
b	Less: rental expenses	394,469
c	Rental income or (loss)	-321,548
d	Net rental income or (loss).......			-321,548			-321,548
		(i) Securities	(ii) Other
7a	Gross amount from sales of assets other than inventory
b	Less: cost or other basis and sales expenses	468
c	Gain or (loss)	-468
d	Net gain or (loss)..........			-468			-468
8a	Gross income from fundraising events (not including $ of contributions reported on line 1c). See Part IV, line 18 ..
	a
b	Less: direct expenses ...b
c	Net income or (loss) from fundraising events..
9a	Gross income from gaming activities. See Part IV, line 19 ...
	a
b	Less: direct expenses ...b
c	Net income or (loss) from gaming activities...
10a	Gross sales of inventory, less returns and allowances .
	a		2,036
b	Less: cost of goods sold ..b		849
c	Net income or (loss) from sales of inventory..			1,187			1,187
Miscellaneous Revenue			Business Code
11a	OTHER REVENUE		900099	1,000,481			1,000,481
b
c
d	All other revenue ....
e	Total. Add lines 11a–11d ......			1,000,481
12	Total revenue. See Instructions......			44,505,886	42,880,354	0	1,322,092


				(A) Beginning of year		(B) End of year
1	Cash–non-interest-bearing .............			6,553,455	1	6,069,198
2	Savings and temporary cash investments .........			2,314,744	2	251,262
3	Pledges and grants receivable, net ...........			22,524	3	6,774
4	Accounts receivable, net .............			6,906,360	4	8,425,059
5	Loans and other receivables from current and former officers, directors, trustees, key employees, and highest compensated employees. Complete Part II of Schedule L ..................
					5
6	Loans and other receivables from other disqualified persons (as defined under section 4958(f)(1)), persons described in section 4958(c)(3)(B), and contributing employers and sponsoring organizations of section 501(c)(9) voluntary employees' beneficiary organizations (see instructions) Complete Part II of Schedule L
					6
7	Notes and loans receivable, net .............				7
8	Inventories for sale or use ..............			496,990	8	486,916
9	Prepaid expenses and deferred charges ..........			774,110	9	870,214
10a	Land, buildings, and equipment: cost or other basis. Complete Part VI of Schedule D	10a	46,185,035
b	Less: accumulated depreciation .....	10b	21,911,974	26,512,371	10c	24,273,061
11	Investments—publicly traded securities ..........			5,592,337	11	7,755,220
12	Investments—other securities. See Part IV, line 11 .....				12
13	Investments—program-related. See Part IV, line 11 .....				13
14	Intangible assets ...............			162,979	14	162,979
15	Other assets. See Part IV, line 11 ...........			7,574,512	15	6,614,220
16	Total assets. Add lines 1 through 15 (must equal line 34)......			56,910,382	16	54,914,903
17	Accounts payable and accrued expenses .........			5,040,378	17	5,615,843
18	Grants payable .................				18
19	Deferred revenue ................				19
20	Tax-exempt bond liabilities .............			26,730,995	20	26,239,786
21	Escrow or custodial account liability. Complete Part IV of Schedule D..				21
22	Loans and other payables to current and former officers, directors, trustees, key employees, highest compensated employees, and disqualified
	persons. Complete Part II of Schedule L..........				22
23	Secured mortgages and notes payable to unrelated third parties ..			1,196,819	23	1,011,712
24	Unsecured notes and loans payable to unrelated third parties ....				24
25	Other liabilities (including federal income tax, payables to related third parties, and other liabilities not included on lines 17-24). Complete Part X of Schedule D....................			5,877,192	25	6,011,342
26	Total liabilities. Add lines 17 through 25.........			38,845,384	26	38,878,683
	Organizations that follow SFAS 117 (ASC 958), check here and complete lines 27 through 29, and lines 33 and 34.
27	Unrestricted net assets ..............			16,977,220	27	14,950,884
28	Temporarily restricted net assets ...........				28
29	Permanently restricted net assets ...........			1,087,778	29	1,085,336
	Organizations that do not follow SFAS 117 (ASC 958), check here and complete lines 30 through 34.
30	Capital stock or trust principal, or current funds ........				30
31	Paid-in or capital surplus, or land, building or equipment fund .....				31
32	Retained earnings, endowment, accumulated income, or other funds				32
33	Total net assets or fund balances ...........			18,064,998	33	16,036,220
34	Total liabilities and net assets/fund balances ........			56,910,382	34	54,914,903