NORTHWEST GEORGIA MEDICAL FOUNDATION INC: Form 990EZ, tax year 2016

View the entire original 990 at ProPublica ↗

Organization: NORTHWEST GEORGIA MEDICAL FOUNDATION INC (EIN 45-3907541)
Tax period: 2016-01-01 to 2016-12-31
Filed: 2017-11-15
IRS object ID: 201713199349204741
Schema version: 2016v3.0
Source: Download XML · Original 990 at ProPublica

Every field in the e-filed return. Faint text is the IRS element name, for citing.

Return header
Form 990-EZ
Schedule A
Schedule B
Schedule O
Transfer Prsnl Bnft Contracts Decl

Return header ReturnHeader

Field	Value	IRS element (for citing)
Return	2017-11-15T14:19:26-06:00	ReturnTs
Tax Period End	2016-12-31	TaxPeriodEndDt

Preparer Firm PreparerFirmGrp

Field	Value	IRS element (for citing)
Preparer Firm EIN	461381910	PreparerFirmEIN

Preparer Firm Name PreparerFirmName

Field	Value	IRS element (for citing)
Business Name Line1	WHITTINGTON JONES & RUDERT CPAS LLC	BusinessNameLine1Txt

Preparer US Address PreparerUSAddress

Field	Value	IRS element (for citing)
Address Line1	PO BOX 1264	AddressLine1Txt
City	ROME	CityNm
State Abbreviation	GA	StateAbbreviationCd
ZIP	301621264	ZIPCd

Field	Value	IRS element (for citing)
Return Type	990EZ	ReturnTypeCd
Tax Period Begin	2016-01-01	TaxPeriodBeginDt

Filer Filer

Field	Value	IRS element (for citing)
EIN	453907541	EIN

Business Name BusinessName

Field	Value	IRS element (for citing)
Business Name Line1	NORTHWEST GEORGIA MEDICAL FOUNDATION	BusinessNameLine1Txt
Business Name Line2	INC	BusinessNameLine2Txt

Field	Value	IRS element (for citing)
Business Name Control	NORT	BusinessNameControlTxt
Phone	7062956325	PhoneNum

US Address USAddress

Field	Value	IRS element (for citing)
Address Line1	415 EAST THIRD AVE	AddressLine1Txt
City	ROME	CityNm
State Abbreviation	GA	StateAbbreviationCd
ZIP	30161	ZIPCd

Business Officer BusinessOfficerGrp

Field	Value	IRS element (for citing)
Person	DR AL DIAZ	PersonNm
Person Title	CHAIRMAN	PersonTitleTxt
Phone	7062956325	PhoneNum
Signature	2017-11-08	SignatureDt
Discuss With Paid Preparer	Yes (1)	DiscussWithPaidPreparerInd

Preparer Person PreparerPersonGrp

Field	Value	IRS element (for citing)
Preparer Person	JILL MASLANKA	PreparerPersonNm
PTIN	P01035911	PTIN
Phone	7062347571	PhoneNum
Preparation	2017-11-08	PreparationDt

Filing Security Information FilingSecurityInformation

IP Address IPAddress

Field	Value	IRS element (for citing)
I Pv4 Address	173.165.188.56	IPv4AddressTxt

Field	Value	IRS element (for citing)
IP	2017-11-08	IPDt
IP Tm	14:59:57	IPTm
IP Timezone	ES	IPTimezoneCd
Filing License Type	P	FilingLicenseTypeCd
At Submission Creation Device Id	DB44125E40327351D88FFC540CC22E114B941245	AtSubmissionCreationDeviceId
At Submission Filing Device Id	D9094F4A93F35951889CFE9FF5346C5D03989576	AtSubmissionFilingDeviceId

Field	Value	IRS element (for citing)
Tax	2016	TaxYr
Build TS	2017-02-10 21:41:12Z	BuildTS

Form 990-EZ IRS990EZ

Field	Value	IRS element (for citing)
Method Of Accounting Cash	Yes (X)	MethodOfAccountingCashInd
Website Address	N/A	WebsiteAddressTxt
Organization501c3	Yes (X)	Organization501c3Ind
Type Of Organization Other	Yes (X)	TypeOfOrganizationOtherInd
Type Of Organization Other	TAX-EXEMPT	TypeOfOrganizationOtherDesc
Gross Receipts	$6,864	GrossReceiptsAmt
Info In Schedule O Part I	Yes (X)	InfoInScheduleOPartIInd
Contributions Gifts Grants Etc	$6,864	ContributionsGiftsGrantsEtcAmt
Total Revenue	$6,864	TotalRevenueAmt
Fees And Other Pymt To Ind Cntrct	$1,003	FeesAndOtherPymtToIndCntrctAmt
Occupancy Rent Utlts And Maint	$1,961	OccupancyRentUtltsAndMaintAmt
Other Expenses Total	$6,144	OtherExpensesTotalAmt
Total Expenses	$9,108	TotalExpensesAmt
Excess Or Deficit For Year	-$2,244	ExcessOrDeficitForYearAmt
Net Assets Or Fund Balances BOY	$128,082	NetAssetsOrFundBalancesBOYAmt
Other Changes In Net Assets	$0	OtherChangesInNetAssetsAmt
Net Assets Or Fund Balances EOY	$125,838	NetAssetsOrFundBalancesEOYAmt
Info In Schedule O Part II	Yes (X)	InfoInScheduleOPartIIInd

Cash Savings And Investments CashSavingsAndInvestmentsGrp

Field	Value	IRS element (for citing)
BOY	$123,005	BOYAmt
EOY	$119,843	EOYAmt

Other Assets Total Detail OtherAssetsTotalDetail

Field	Value	IRS element (for citing)
BOY	$5,077	BOYAmt
EOY	$5,995	EOYAmt

Form990 Total Assets Form990TotalAssetsGrp

Field	Value	IRS element (for citing)
BOY	$128,082	BOYAmt
EOY	$125,838	EOYAmt

Sum Of Total Liabilities SumOfTotalLiabilitiesGrp

Field	Value	IRS element (for citing)
BOY	$0	BOYAmt
EOY	$0	EOYAmt

Net Assets Or Fund Balances NetAssetsOrFundBalancesGrp

Field	Value	IRS element (for citing)
BOY	$128,082	BOYAmt
EOY	$125,838	EOYAmt

Field	Value	IRS element (for citing)
Info In Schedule O Part III	Yes (X)	InfoInScheduleOPartIIIInd
Primary Exempt Purpose	THE PRIMARY PURPOSE OF THE CORPORATION IS THE SOLICITATION OF CONTRIBUTIONS, GIFTS, BEQUESTS AND CONVEYANCES OF REAL AND PERSONAL PROPERTY, INCLUDING MONEY, TO BE USED FOR THE BENEFIT OF AND TO CARRY OUT THE MISSION AND PURPOSE OF EDUCATING STUDENTS OF THE GEORGIA HEALTH SCIENCES UNIVERSITY AT ITS ROME, GEORGIA CAMPUS.	PrimaryExemptPurposeTxt

Program Srvc Accomplishment ProgramSrvcAccomplishmentGrp

Field	Value	IRS element (for citing)
Description Program Srvc Accom	TO PROVIDE SUPPORT TO THE NORTHWEST GEORGIA CLINICAL CAMPUS OF THE MEDICAL COLLEGE OF GEORGIA.	DescriptionProgramSrvcAccomTxt
Grants And Allocations	$0	GrantsAndAllocationsAmt
Program Service Expenses	$4,448	ProgramServiceExpensesAmt

Field	Value	IRS element (for citing)
Total Program Service Expenses	$4,448	TotalProgramServiceExpensesAmt

Officer Director Trustee Empl OfficerDirectorTrusteeEmplGrp (9 entries)

TitleTitleTxt	Average Hrs Per Wk Devoted To PosAverageHrsPerWkDevotedToPosRt	CompensationCompensationAmt	Employee Benefit ProgramEmployeeBenefitProgramAmt	Expense Account Other AllwncExpenseAccountOtherAllwncAmt
DR JULIE BARNES
CHAIRMAN	1.00	$0	$0	$0
DR JOE BURCH
SECRETARY	1.00	$0	$0	$0
DR ED MCBRIDE
TREASURER	1.00	$0	$0	$0
KENNA STOCK
DIRECTOR	1.00	$0	$0	$0
JOHN QUINLIVAN
DIRECTOR	1.00	$0	$0	$0
DR SIDNEY BELL
DIRECTOR	1.00	$0	$0	$0
DR JOHN DESMOND
DIRECTOR	1.00	$0	$0	$0
DR JOE BIUSO
DIRECTOR	1.00	$0	$0	$0
BILL TEMPLE
DIRECTOR	1.00	$0	$0	$0

Field	Value	IRS element (for citing)
Info In Schedule O Part V	Yes (X)	InfoInScheduleOPartVInd
Activities Not Previously Rpt	0	ActivitiesNotPreviouslyRptInd
Chg Made To Orgnzng Doc Not Rpt	0	ChgMadeToOrgnzngDocNotRptInd
Organization Had UBI	0	OrganizationHadUBIInd
Subject To Proxy Tax	0	SubjectToProxyTaxInd
Organization Dissolved Etc	0	OrganizationDissolvedEtcInd
Direct Indirect Pltcl Expend	$0	DirectIndirectPltclExpendAmt
Made Loans To From Officers	0	MadeLoansToFromOfficersInd
Tax Imposed Under IRC4911	$0	TaxImposedUnderIRC4911Amt
Tax Imposed Under IRC4912	$0	TaxImposedUnderIRC4912Amt
Tax Imposed Under IRC4955	$0	TaxImposedUnderIRC4955Amt
Engaged In Excess Benefit Trans	0	EngagedInExcessBenefitTransInd
Tax Imposed On Organization Mgr	$0	TaxImposedOnOrganizationMgrAmt
Tax Reimbursed By Organization	$0	TaxReimbursedByOrganizationAmt
Prohibited Tax Shelter Trans	0	ProhibitedTaxShelterTransInd
States Where Copy Of Return Is Fld	GA	StatesWhereCopyOfReturnIsFldCd

Books In Care Of Detail BooksInCareOfDetail

Business Name BusinessName

Field	Value	IRS element (for citing)
Business Name Line1	DR JULIE BARNES	BusinessNameLine1Txt

US Address USAddress

Field	Value	IRS element (for citing)
Address Line1	415 E 3RD AVENUE	AddressLine1Txt
City	ROME	CityNm
State Abbreviation	GA	StateAbbreviationCd
ZIP	30161	ZIPCd

Field	Value	IRS element (for citing)
Phone	7062918853	PhoneNum

Field	Value	IRS element (for citing)
Foreign Financial Account	0	ForeignFinancialAccountInd
Foreign Office	0	ForeignOfficeInd
Donor Advised Fnds	0	DonorAdvisedFndsInd
Operate Hospital	0	OperateHospitalInd
Tanning Services Provided	0	TanningServicesProvidedInd
Related Organization Ctrl Ent	0	RelatedOrganizationCtrlEntInd
Political Campaign Acty	0	PoliticalCampaignActyInd
Lobbying Activities	0	LobbyingActivitiesInd
School Operating	0	SchoolOperatingInd
Trnsfr Exmpt Non Chrtbl Rltd Org	0	TrnsfrExmptNonChrtblRltdOrgInd
Part VI Of Comp Of Hghst Pd Empl	NONE	PartVIOfCompOfHghstPdEmplTxt
Part VI Hghst Pd Cntrct Prof Srvc	NONE	PartVIHghstPdCntrctProfSrvcTxt
Filed Schedule A	Yes (1)	FiledScheduleAInd

Schedule A IRS990ScheduleA

Field	Value	IRS element (for citing)
College Organization	Yes (X)	CollegeOrganizationInd

Gifts Grants Contri Rcvd170 GiftsGrantsContriRcvd170Grp

Field	Value	IRS element (for citing)
Current Tax Year Minus3 Years	$27,000	CurrentTaxYearMinus3YearsAmt
Current Tax Year Minus2 Years	$58,500	CurrentTaxYearMinus2YearsAmt
Current Tax Year Minus1 Year	$52,000	CurrentTaxYearMinus1YearAmt
Current Tax Year	$6,864	CurrentTaxYearAmt
Total	$144,364	TotalAmt

Total Calendar Year170 TotalCalendarYear170Grp

Field	Value	IRS element (for citing)
Current Tax Year Minus3 Years	$27,000	CurrentTaxYearMinus3YearsAmt
Current Tax Year Minus2 Years	$58,500	CurrentTaxYearMinus2YearsAmt
Current Tax Year Minus1 Year	$52,000	CurrentTaxYearMinus1YearAmt
Current Tax Year	$6,864	CurrentTaxYearAmt
Total	$144,364	TotalAmt

Field	Value	IRS element (for citing)
Public Support Total170	$144,364	PublicSupportTotal170Amt
Total Support	$144,364	TotalSupportAmt
Public Support CY170	1.00000	PublicSupportCY170Pct
Public Support PY170	1.00000	PublicSupportPY170Pct
Thirty Thr Pct Suprt Tests CY170	Yes (X)	ThirtyThrPctSuprtTestsCY170Ind

Schedule B IRS990ScheduleB

Contributor Information ContributorInformationGrp

Field	Value	IRS element (for citing)
Contributor	RESTRICTED	ContributorNum

Contributor Business Name ContributorBusinessName

Field	Value	IRS element (for citing)
Business Name Line1	RESTRICTED	BusinessNameLine1

Contributor US Address ContributorUSAddress

Field	Value	IRS element (for citing)
Address Line1	RESTRICTED	AddressLine1
Address Line2	RESTRICTED	AddressLine2
City	RESTRICTED	City
State	RESTRICTED	State
ZIP Code	RESTRICTED	ZIPCode

Field	Value	IRS element (for citing)
Total Contributions	RESTRICTED	TotalContributionsAmt

Schedule O IRS990ScheduleO

Supplemental Information Detail SupplementalInformationDetail (3 entries)

Form And Line ReferenceFormAndLineReferenceDesc	ExplanationExplanationTxt
FORM 990-EZ, PART I, LINE 14	DESCRIPTION: DEPRECIATION. AMOUNT: 1,961.
FORM 990-EZ, PART I, LINE 16 - OTHER EXPENSES	DESCRIPTION: SPECIAL EVENTS. AMOUNT: 4,222. DESCRIPTION: MISCELLANEOUS. AMOUNT: 566. DESCRIPTION: MEALS & EVENTS. AMOUNT: 1,356. TOTAL TO FORM 990-EZ, LINE 16: 6,144.
FORM 990-EZ, PART II, LINE 24 - OTHER ASSETS	DESCRIPTION: OTHER DEPRECIABLE ASSETS. BEG. OF YEAR AMOUNT: 5,077. END OF YEAR AMOUNT: 5,995.

Transfer Prsnl Bnft Contracts Decl TransferPrsnlBnftContractsDecl

Field	Value	IRS element (for citing)
Declaration	THE ORGANIZATION DID NOT, DURING THE YEAR, RECEIVE ANY FUNDS, DIRECTLY,OR INDIRECTLY, TO PAY PREMIUMS ON A PERSONAL BENEFIT CONTRACT.THE ORGANIZATION, DID NOT, DURING THE YEAR, PAY ANY PREMIUMS, DIRECTLY,OR INDIRECTLY, ON A PERSONAL BENEFIT CONTRACT.	DeclarationDesc

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