WEST GEORGIA HEALTH FOUNDATION INC: Form 990, tax year 2014
View the entire original 990 at ProPublica ↗
- Organization
- WEST GEORGIA HEALTH FOUNDATION INC (EIN 20-0936376)
- Tax period
- 2014-10-01 to 2015-09-30
- Filed
- 2016-08-12
- IRS object ID
- 201602259349301620
- Schema version
- 2014v6.0
- 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
- Schedule A
- Schedule B
- Schedule D
- Schedule G
- Schedule I
- Schedule J
- Schedule O
- Schedule R
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return | 2016-08-12T09:26:37-05:00 | ReturnTs |
| Tax Period End | 2015-09-30 | TaxPeriodEndDt |
Preparer Firm PreparerFirmGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Firm EIN | 560747981 | PreparerFirmEIN |
Preparer Firm Name PreparerFirmName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | DIXON HUGHES GOODMAN LLP | BusinessNameLine1Txt |
Preparer US Address PreparerUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 500 RIDGEFIELD COURT | AddressLine1Txt |
| City | ASHEVILLE | CityNm |
| State Abbreviation | NC | StateAbbreviationCd |
| ZIP | 28806 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnTypeCd |
| Tax Period Begin | 2014-10-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 200936376 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | WEST GEORGIA HEALTH FOUNDATION INC | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | WEST | BusinessNameControlTxt |
| Phone | 7068821411 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1514 VERNON ROAD | AddressLine1Txt |
| City | LAGRANGE | CityNm |
| State Abbreviation | GA | StateAbbreviationCd |
| ZIP | 30240 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | PAUL PERROTTI | PersonNm |
| Person Title | CFO | PersonTitleTxt |
| Phone | 7068821411 | PhoneNum |
| Signature | 2016-08-11 | SignatureDt |
| Discuss With Paid Preparer | Yes (1) | DiscussWithPaidPreparerInd |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | AMY BIBBY | PreparerPersonNm |
| PTIN | P00445891 | PTIN |
| Phone | 8282542254 | PhoneNum |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2014 | TaxYr |
| Build TS | 2016-09-27 15:27:22Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Principal Officer | PAUL PERROTTI | PrincipalOfficerNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1514 VERNON ROAD | AddressLine1Txt |
| City | LAGRANGE | CityNm |
| State Abbreviation | GA | StateAbbreviationCd |
| ZIP | 30240 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $1,553,772 | GrossReceiptsAmt |
| Group Return For Affiliates | 0 | GroupReturnForAffiliatesInd |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | WWW.WGHEALTH.ORG | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 2004 | FormationYr |
| Legal Domicile State | GA | LegalDomicileStateCd |
| Activity Or Mission | THE FOUNDATION OPERATES EXCLUSIVELY FOR THE BENEFIT OF THE WEST GEORGIA MEDICAL CENTER, INC. AND ITS AFFILIATED ENTITIES. | ActivityOrMissionDesc |
| Voting Members Governing Body | 14 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 10 | VotingMembersIndependentCnt |
| Total Employee | 3 | TotalEmployeeCnt |
| Total Volunteers | 72 | TotalVolunteersCnt |
| Total Gross UBI | $0 | TotalGrossUBIAmt |
| Net Unrelated Bus Txbl Incm | $0 | NetUnrelatedBusTxblIncmAmt |
| PY Contributions Grants | $2,326,527 | PYContributionsGrantsAmt |
| CY Contributions Grants | $1,293,169 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $0 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $0 | CYProgramServiceRevenueAmt |
| PY Investment Income | $437,337 | PYInvestmentIncomeAmt |
| CY Investment Income | $180,189 | CYInvestmentIncomeAmt |
| PY Other Revenue | $0 | PYOtherRevenueAmt |
| CY Other Revenue | $0 | CYOtherRevenueAmt |
| PY Total Revenue | $2,763,864 | PYTotalRevenueAmt |
| CY Total Revenue | $1,473,358 | CYTotalRevenueAmt |
| PY Grants And Similar Paid | $517,809 | PYGrantsAndSimilarPaidAmt |
| CY Grants And Similar Paid | $246,666 | CYGrantsAndSimilarPaidAmt |
| PY Benefits Paid To Members | $0 | PYBenefitsPaidToMembersAmt |
| CY Benefits Paid To Members | $0 | CYBenefitsPaidToMembersAmt |
| PY Salaries Comp Emp Bnft Paid | $0 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $0 | CYSalariesCompEmpBnftPaidAmt |
| PY Total Prof Fndrsng Expns | $0 | PYTotalProfFndrsngExpnsAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $0 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $139,191 | PYOtherExpensesAmt |
| CY Other Expenses | $48,182 | CYOtherExpensesAmt |
| PY Total Expenses | $657,000 | PYTotalExpensesAmt |
| CY Total Expenses | $294,848 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | $2,106,864 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | $1,178,510 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $11,224,768 | TotalAssetsBOYAmt |
| Total Assets EOY | $11,796,819 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $300,035 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $22,680 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $10,924,733 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $11,774,139 | NetAssetsOrFundBalancesEOYAmt |
| Mission | THE FOUNDATION OPERATES EXCLUSIVELY FOR THE BENEFIT OF THE WEST GEORGIA MEDICAL CENTER, INC. AND ITS AFFILIATED ENTITIES. | MissionDesc |
| Significant New Program Srvc | 0 | SignificantNewProgramSrvcInd |
| Significant Change | 0 | SignificantChangeInd |
| Expense | $34,867 | ExpenseAmt |
| Grant | $10,355 | GrantAmt |
| Desc | TO PROVIDE FUNDS FOR SPECIFIC MEDICAL AND CANCER TREATING EQUIPMENT AND SUPPORT OF WEST GEORGIA MEDICAL CENTER. | Desc |
Prog Srvc Accom Acty2 ProgSrvcAccomActy2Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expense | $225,141 | ExpenseAmt |
| Grant | $225,141 | GrantAmt |
| Desc | TO PROVIDE FINANCIAL SUPPORT TO WEST GEORGIA MEDICAL CENTER, INC. FOR OPERATING THE HOSPICE CENTER. | Desc |
Prog Srvc Accom Acty3 ProgSrvcAccomActy3Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expense | $11,170 | ExpenseAmt |
| Grant | $11,170 | GrantAmt |
| Desc | HELPING HANDS FAMILY ASSISTANCE PROGRAM - TO ASSIST PRESENT AND RETIRED WGHS EMPLOYEES AND HOSPITAL AUXILIARY VOLUNTEERS WITH FINANCIAL SUPPORT IN TIMES OF CRISIS. QUALIFYING HARDSHIPS INCLUDE CATASTROPHIC ILLNESS OR ACCIDENT SUFFERED BY A RECIPIENT OR AN UNINSURED LOSS TO A PRIMARY RESIDENCE CAUSED BY FIRE OR OTHER MAJOR ACCIDENT OR DISASTER. FROM OCTOBER 1, 2014 - SEPTEMBER 30, 2015, THE HELPING HANDS PROGRAMS ASSISTED 23 WEST GEORGIA HEALTH SYSTEM EMPLOYEES BY PROVIDING $11,170 IN MONETARY ASSISTANCE. | Desc |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Expenses | $271,178 | TotalProgramServiceExpensesAmt |
| Described In Section501c3 | Yes (1) | DescribedInSection501c3Ind |
| Schedule B Required | Yes (1) | ScheduleBRequiredInd |
| Political Campaign Acty | 0 | PoliticalCampaignActyInd |
| Lobbying Activities | 0 | LobbyingActivitiesInd |
| Subject To Proxy Tax | 0 | SubjectToProxyTaxInd |
| Donor Advised Fund | 0 | DonorAdvisedFundInd |
| Conservation Easements | 0 | ConservationEasementsInd |
| Collections Of Art | 0 | CollectionsOfArtInd |
| Credit Counseling | 0 | CreditCounselingInd |
| Temp Or Permanent Endowments | Yes (1) | TempOrPermanentEndowmentsInd |
| Report Land Building Equipment | 0 | ReportLandBuildingEquipmentInd |
| Report Investments Other Sec | 0 | ReportInvestmentsOtherSecInd |
| Report Program Related Invst | 0 | ReportProgramRelatedInvstInd |
| Report Other Assets | 0 | ReportOtherAssetsInd |
| Report Other Liabilities | Yes (1) | ReportOtherLiabilitiesInd |
| Include FIN48 Footnote | Yes (1) | IncludeFIN48FootnoteInd |
| Independent Audit Fincl Stmt | Yes (1) | IndependentAuditFinclStmtInd |
| Consolidated Audit Fincl Stmt | Yes (1) | ConsolidatedAuditFinclStmtInd |
| School Operating | 0 | SchoolOperatingInd |
| Foreign Office | 0 | ForeignOfficeInd |
| Foreign Activities | 0 | ForeignActivitiesInd |
| More Than5000 K To Org | 0 | MoreThan5000KToOrgInd |
| More Than5000 K To Individuals | 0 | MoreThan5000KToIndividualsInd |
| Professional Fundraising | 0 | ProfessionalFundraisingInd |
| Fundraising Activities | Yes (1) | FundraisingActivitiesInd |
| Gaming Activities | 0 | GamingActivitiesInd |
| Operate Hospital | 0 | OperateHospitalInd |
| Grants To Organizations | Yes (1) | GrantsToOrganizationsInd |
| Grants To Individuals | Yes (1) | GrantsToIndividualsInd |
| Schedule J Required | Yes (1) | ScheduleJRequiredInd |
| Tax Exempt Bonds | 0 | TaxExemptBondsInd |
| Engaged In Excess Benefit Trans | 0 | EngagedInExcessBenefitTransInd |
| PY Excess Benefit Trans | 0 | PYExcessBenefitTransInd |
| Loan Outstanding | 0 | LoanOutstandingInd |
| Grant To Related Person | 0 | GrantToRelatedPersonInd |
| Business Rln With Org Mem | 0 | BusinessRlnWithOrgMemInd |
| Business Rln With Fam Mem | 0 | BusinessRlnWithFamMemInd |
| Business Rln With Officer Ent | 0 | BusinessRlnWithOfficerEntInd |
| Deductible Non Cash Contri | 0 | DeductibleNonCashContriInd |
| Deductible Art Contribution | 0 | DeductibleArtContributionInd |
| Terminate Operations | 0 | TerminateOperationsInd |
| Partial Liquidation | 0 | PartialLiquidationInd |
| Disregarded Entity | 0 | DisregardedEntityInd |
| Related Entity | Yes (1) | RelatedEntityInd |
| Related Organization Ctrl Ent | 0 | RelatedOrganizationCtrlEntInd |
| Trnsfr Exmpt Non Chrtbl Rltd Org | 0 | TrnsfrExmptNonChrtblRltdOrgInd |
| Activities Conducted Prtshp | 0 | ActivitiesConductedPrtshpInd |
| Schedule O Required | Yes (1) | ScheduleORequiredInd |
| IRP Document | 0 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Backup Wthld Compliance | Yes (1) | BackupWthldComplianceInd |
| Employee | 3 | EmployeeCnt |
| Employment Tax Returns Filed | Yes (1) | EmploymentTaxReturnsFiledInd |
| Unrelated Bus Incm Over Limit | 0 | UnrelatedBusIncmOverLimitInd |
| Foreign Financial Account | 0 | ForeignFinancialAccountInd |
| Prohibited Tax Shelter Trans | 0 | ProhibitedTaxShelterTransInd |
| Taxable Party Notification | 0 | TaxablePartyNotificationInd |
| Nondeductible Contributions | 0 | NondeductibleContributionsInd |
| Quid Pro Quo Contributions | 0 | QuidProQuoContributionsInd |
| Form8282 Property Disposed Of | 0 | Form8282PropertyDisposedOfInd |
| Rcv Fnds To Pay Prsnl Bnft Cntrct | 0 | RcvFndsToPayPrsnlBnftCntrctInd |
| Pay Premiums Prsnl Bnft Cntrct | 0 | PayPremiumsPrsnlBnftCntrctInd |
| Indoor Tanning Services | 0 | IndoorTanningServicesInd |
| Info In Schedule O Part VI | Yes (X) | InfoInScheduleOPartVIInd |
| Governing Body Voting Members | 14 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 10 | IndependentVotingMemberCnt |
| Family Or Business Rln | Yes (1) | FamilyOrBusinessRlnInd |
| Delegation Of Mgmt Duties | 0 | DelegationOfMgmtDutiesInd |
| Change To Org Documents | 0 | ChangeToOrgDocumentsInd |
| Material Diversion Or Misuse | 0 | MaterialDiversionOrMisuseInd |
| Members Or Stockholders | Yes (1) | MembersOrStockholdersInd |
| Election Of Board Members | Yes (1) | ElectionOfBoardMembersInd |
| Decisions Subject To Approva | Yes (1) | DecisionsSubjectToApprovaInd |
| Minutes Of Governing Body | Yes (1) | MinutesOfGoverningBodyInd |
| Minutes Of Committees | Yes (1) | MinutesOfCommitteesInd |
| Officer Mailing Address | 0 | OfficerMailingAddressInd |
| Local Chapters | 0 | LocalChaptersInd |
| Form990 Provided To Gvrn Body | Yes (1) | Form990ProvidedToGvrnBodyInd |
| Conflict Of Interest Policy | Yes (1) | ConflictOfInterestPolicyInd |
| Annual Disclosure Covered Prsn | Yes (1) | AnnualDisclosureCoveredPrsnInd |
| Regular Monitoring Enfrc | Yes (1) | RegularMonitoringEnfrcInd |
| Whistleblower Policy | Yes (1) | WhistleblowerPolicyInd |
| Document Retention Policy | Yes (1) | DocumentRetentionPolicyInd |
| Compensation Process CEO | 0 | CompensationProcessCEOInd |
| Compensation Process Other | 0 | CompensationProcessOtherInd |
| Investment In Joint Venture | 0 | InvestmentInJointVentureInd |
| States Where Copy Of Return Is Fld | GA | StatesWhereCopyOfReturnIsFldCd |
| Upon Request | Yes (X) | UponRequestInd |
Books In Care Of Detail BooksInCareOfDetail
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | PAUL PERROTTI | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Phone | 7068453934 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1514 VERNON ROAD | AddressLine1Txt |
| City | LAGRANGE | CityNm |
| State Abbreviation | GA | StateAbbreviationCd |
| ZIP | 30240 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part VII | Yes (X) | InfoInScheduleOPartVIIInd |
Form990 Part VII Section A Form990PartVIISectionAGrp (15 entries)
| TitleTitleTxt | Average Hours Per WeekAverageHoursPerWeekRt | Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd | OfficerOfficerInd | Reportable Comp From OrgReportableCompFromOrgAmt | Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt | Other CompensationOtherCompensationAmt | Average Hours Per Week Rltd OrgAverageHoursPerWeekRltdOrgRt |
|---|---|---|---|---|---|---|---|
| WESLEY SMITH | |||||||
| CHAIRMAN | 1.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | |
| DR RICHARD SANDY SIMMONS | |||||||
| VICE CHAIRMAN | 1.00 | Yes (X) | Yes (X) | $0 | $426,139 | $31,681 | 40.00 |
| WAYNE ABBOTT | |||||||
| TREASURER | 1.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | |
| GERALD FULKS | |||||||
| SECRETARY | 1.00 | Yes (X) | Yes (X) | $0 | $472,740 | $92,545 | 41.00 |
| DR ROBERT COGGINS | |||||||
| MEMBER | 1.00 | Yes (X) | $0 | $42,750 | $0 | ||
| NANCY DURAND | |||||||
| MEMBER | 1.00 | Yes (X) | $0 | $0 | $0 | 3.00 | |
| DR JULIAN DUTTERA | |||||||
| MEMBER | 1.00 | Yes (X) | $0 | $1,500 | $0 | ||
| DR JOHN JACKSON | |||||||
| MEMBER | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| ELLEN HARRIS | |||||||
| MEMBER | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| BEVERLY LUNDBERG | |||||||
| MEMBER | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| ROBBY BURCH | |||||||
| MEMBER | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| RICK MALLORY | |||||||
| MEMBER | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| MICHAEL LAMB | |||||||
| MEMBER | 1.00 | Yes (X) | $0 | $55,972 | $23,740 | 40.00 | |
| CHARLES SMITH | |||||||
| MEMBER | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| PAUL PERROTTI | |||||||
| CFO | 1.00 | Yes (X) | $0 | $318,015 | $52,549 | 42.00 | |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $0 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $1,317,116 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $200,515 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 0 | IndivRcvdGreaterThan100KCnt |
| Former Ofcr Employees Listed | 0 | FormerOfcrEmployeesListedInd |
| Total Comp Greater Than150 K | Yes (1) | TotalCompGreaterThan150KInd |
| Compensation From Other Srcs | 0 | CompensationFromOtherSrcsInd |
| Cntrct Rcvd Greater Than100 K | 0 | CntrctRcvdGreaterThan100KCnt |
| Fundraising | $77,120 | FundraisingAmt |
| Related Organizations | $85,000 | RelatedOrganizationsAmt |
| All Other Contributions | $1,131,049 | AllOtherContributionsAmt |
| Total Contributions | $1,293,169 | TotalContributionsAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $206,467 | TotalRevenueColumnAmt |
| Exclusion | $206,467 | ExclusionAmt |
Less Cost Oth Basis Sales Expnss LessCostOthBasisSalesExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $26,278 | SecuritiesAmt |
Gain Or Loss GainOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | -$26,278 | SecuritiesAmt |
Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | -$26,278 | TotalRevenueColumnAmt |
| Exclusion | -$26,278 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Fundraising Gross Income | $54,136 | FundraisingGrossIncomeAmt |
| Contri Rpt Fundraising Event | $77,120 | ContriRptFundraisingEventAmt |
| Fundraising Direct Expenses | $54,136 | FundraisingDirectExpensesAmt |
Net Incm From Fundraising Evt NetIncmFromFundraisingEvtGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $0 | TotalRevenueColumnAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $1,473,358 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $0 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $0 | UnrelatedBusinessRevenueAmt |
| Exclusion | $180,189 | ExclusionAmt |
Grants To Domestic Orgs GrantsToDomesticOrgsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $235,123 | TotalAmt |
| Program Services | $235,123 | ProgramServicesAmt |
Grants To Domestic Individuals GrantsToDomesticIndividualsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $11,543 | TotalAmt |
| Program Services | $11,543 | ProgramServicesAmt |
Fees For Srvc Invst Mgmnt Fees FeesForSrvcInvstMgmntFeesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $21,015 | TotalAmt |
| Management And General | $21,015 | ManagementAndGeneralAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $23,564 | TotalAmt |
| Program Services | $20,909 | ProgramServicesAmt |
| Management And General | $2,655 | ManagementAndGeneralAmt |
Other Expenses OtherExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | CAMP DOGWOOD GRIEF CAMP | Desc |
| Total | $3,603 | TotalAmt |
| Program Services | $3,603 | ProgramServicesAmt |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $294,848 | TotalAmt |
| Program Services | $271,178 | ProgramServicesAmt |
| Management And General | $23,670 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Cash Non Interest Bearing CashNonInterestBearingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $3,987,030 | BOYAmt |
| EOY | $1,169,565 | EOYAmt |
Pledges And Grants Receivable PledgesAndGrantsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $767,427 | BOYAmt |
| EOY | $578,324 | EOYAmt |
Investments Pub Traded Sec InvestmentsPubTradedSecGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $6,470,311 | BOYAmt |
| EOY | $10,048,930 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $11,224,768 | BOYAmt |
| EOY | $11,796,819 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | $22,317 | EOYAmt |
Other Liabilities OtherLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $300,035 | BOYAmt |
| EOY | $363 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $300,035 | BOYAmt |
| EOY | $22,680 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Organization Follows SFAS117 | Yes (X) | OrganizationFollowsSFAS117Ind |
Temporarily Rstr Net Assets TemporarilyRstrNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $10,012,733 | BOYAmt |
| EOY | $10,862,139 | EOYAmt |
Permanently Rstr Net Assets PermanentlyRstrNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $912,000 | BOYAmt |
| EOY | $912,000 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $10,924,733 | BOYAmt |
| EOY | $11,774,139 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $11,224,768 | BOYAmt |
| EOY | $11,796,819 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Reconcilation Revenue Expnss | $1,178,510 | ReconcilationRevenueExpnssAmt |
| Net Unrlzd Gains Losses Invst | -$329,104 | NetUnrlzdGainsLossesInvstAmt |
| Other Changes In Net Assets | $0 | OtherChangesInNetAssetsAmt |
| Info In Schedule O Part XII | Yes (X) | InfoInScheduleOPartXIIInd |
| Method Of Accounting Accrual | Yes (X) | MethodOfAccountingAccrualInd |
| Accountant Compile Or Review | 0 | AccountantCompileOrReviewInd |
| FS Audited | Yes (1) | FSAuditedInd |
FS Audited Basis FSAuditedBasisGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Consol And Sep Basis Fincl Stmt | Yes (X) | ConsolAndSepBasisFinclStmtInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Audit Committee | Yes (1) | AuditCommitteeInd |
| Federal Grant Audit Required | 0 | FederalGrantAuditRequiredInd |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Public Organization170 | Yes (X) | PublicOrganization170Ind |
Gifts Grants Contri Rcvd170 GiftsGrantsContriRcvd170Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $1,007,236 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $452,183 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $1,999,511 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $2,330,235 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $1,293,169 | CurrentTaxYearAmt |
| Total | $7,082,334 | TotalAmt |
Total Calendar Year170 TotalCalendarYear170Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $1,007,236 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $452,183 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $1,999,511 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $2,330,235 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $1,293,169 | CurrentTaxYearAmt |
| Total | $7,082,334 | TotalAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Substantial Contributors Tot | $2,903,407 | SubstantialContributorsTotAmt |
| Public Support Total170 | $4,178,927 | PublicSupportTotal170Amt |
Gross Investment Income170 GrossInvestmentIncome170Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $136,866 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $399,495 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $439,876 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $437,337 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $206,467 | CurrentTaxYearAmt |
| Total | $1,620,041 | TotalAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Support | $8,702,375 | TotalSupportAmt |
| Public Support CY170 | 0.48020 | PublicSupportCY170Pct |
| Public Support PY170 | 0.50910 | 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 D IRS990ScheduleD
CY Endwmt Fund CYEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $10,924,729 | BeginningYearBalanceAmt |
| Contributions | $1,314,581 | ContributionsAmt |
| Investment Earnings Or Losses | -$148,912 | InvestmentEarningsOrLossesAmt |
| Other Expenditures | $316,259 | OtherExpendituresAmt |
| End Year Balance | $11,774,139 | EndYearBalanceAmt |
CY Minus1 Yr Endwmt Fund CYMinus1YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $8,583,037 | BeginningYearBalanceAmt |
| Contributions | $2,385,121 | ContributionsAmt |
| Investment Earnings Or Losses | $672,169 | InvestmentEarningsOrLossesAmt |
| Other Expenditures | $715,598 | OtherExpendituresAmt |
| End Year Balance | $10,924,729 | EndYearBalanceAmt |
CY Minus2 Yr Endwmt Fund CYMinus2YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $6,274,836 | BeginningYearBalanceAmt |
| Contributions | $1,933,958 | ContributionsAmt |
| Investment Earnings Or Losses | $551,364 | InvestmentEarningsOrLossesAmt |
| Other Expenditures | $177,121 | OtherExpendituresAmt |
| End Year Balance | $8,583,037 | EndYearBalanceAmt |
CY Minus3 Yr Endwmt Fund CYMinus3YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $5,489,839 | BeginningYearBalanceAmt |
| Contributions | $451,895 | ContributionsAmt |
| Investment Earnings Or Losses | $665,832 | InvestmentEarningsOrLossesAmt |
| Other Expenditures | $332,730 | OtherExpendituresAmt |
| End Year Balance | $6,274,836 | EndYearBalanceAmt |
CY Minus4 Yr Endwmt Fund CYMinus4YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $4,800,666 | BeginningYearBalanceAmt |
| Contributions | $945,878 | ContributionsAmt |
| Investment Earnings Or Losses | $155,841 | InvestmentEarningsOrLossesAmt |
| Other Expenditures | $412,546 | OtherExpendituresAmt |
| End Year Balance | $5,489,839 | EndYearBalanceAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Board Designated Balance EOY | 0.00000 | BoardDesignatedBalanceEOYPct |
| Prmnnt Endowment Balance EOY | 0.11370 | PrmnntEndowmentBalanceEOYPct |
| Term Endowment Balance EOY | 0.88630 | TermEndowmentBalanceEOYPct |
| Endowments Held Unrelated Org | 0 | EndowmentsHeldUnrelatedOrgInd |
| Endowments Held Related Org | 0 | EndowmentsHeldRelatedOrgInd |
| Total Book Value Land Buildings | $0 | TotalBookValueLandBuildingsAmt |
Other Liabilities Org OtherLiabilitiesOrgGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | INTERCOMPANY PAYABLES | Desc |
| Amt | $363 | Amt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Liability | $363 | TotalLiabilityAmt |
| Footnote Text | Yes (X) | FootnoteTextInd |
| Total Rev Etc Audited Fincl Stmt | $1,177,375 | TotalRevEtcAuditedFinclStmtAmt |
| Net Unrealized Gains Invst | -$329,104 | NetUnrealizedGainsInvstAmt |
| Other Revenue | $54,136 | OtherRevenueAmt |
| Revenue Not Reported | -$274,968 | RevenueNotReportedAmt |
| Revenue Subtotal | $1,452,343 | RevenueSubtotalAmt |
| Investment Expenses Not Incld | $21,015 | InvestmentExpensesNotIncldAmt |
| Revenue Not Reported Fincl Stmt | $21,015 | RevenueNotReportedFinclStmtAmt |
| Total Revenue Per Form990 | $1,473,358 | TotalRevenuePerForm990Amt |
| Tot Expns Etc Audited Fincl Stmt | $327,969 | TotExpnsEtcAuditedFinclStmtAmt |
| Other Expenses Included | $54,136 | OtherExpensesIncludedAmt |
| Expenses Not Reported | $54,136 | ExpensesNotReportedAmt |
| Expenses Subtotal | $273,833 | ExpensesSubtotalAmt |
| Investment Expenses Not Incld2 | $21,015 | InvestmentExpensesNotIncld2Amt |
| Expenses Not Rpt Fincl Stmt | $21,015 | ExpensesNotRptFinclStmtAmt |
| Total Expenses Per Form990 | $294,848 | TotalExpensesPerForm990Amt |
Supplemental Information Detail SupplementalInformationDetail (4 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| PART V, LINE 4: | NET ASSETS ARE RELEASED FROM RESTRICTIONS WHEN EXPENSES ARE INCURRED TO SATISFY THE RESTRICTED PURPOSES, BY PASSAGE OF TIME OR BY OCCURENCE OF SPECIFIC EVENTS. NET ASSETS RELEASED DURING THE YEAR WERE PRIMARILY FOR THE CONTRIBUTIONS AND SUPPORT OF CONSTRUCTION OF ADDITIONAL FACILITIES, SPECIFIC MEDICAL AND CANCER TREATMENT EQUIPMENT, AND THE HOSPICE PROGRAM OF LAGRANGE-TROUP COUNTY HOSPITAL AUTHORITY. |
| PART X, LINE 2: | THE FOUNDATION HAS BEEN CLASSIFIED AS AN ORGANIZATION EXEMPT FROM FEDERAL INCOME TAXES UNDER INTERNAL REVENUE CODE SECTION 501(C)(3) AND HAS BEEN DETERMINED NOT TO BE A PRIVATE FOUNDATION UNDER SECTION 509(A). ACCORDINGLY, NO PROVISION FOR INCOME TAXES HAS BEEN MADE. THE FOUNDATION HAS EVALUATED ITS TAX POSITIONS AND HAS DETERMINED THAT IT DOES NOT HAVE ANY MATERIAL UNRECOGNIZED TAX BENEFITS OR OBLIGATIONS AS OF SEPTEMBER 30, 2015, AND 2014. FISCAL YEARS ENDING ON AND AFTER SEPTEMBER 30, 2012 REMAIN SUBJECT TO EXAMINATION BY FEDERAL AND STATE TAX AUTHORITIES. |
| PART XI, LINE 2D - OTHER ADJUSTMENTS: | SPECIAL EVENT EXPENSE 54,136. |
| PART XII, LINE 2D - OTHER ADJUSTMENTS: | SPECIAL EVENT EXPENSE 54,136. |
Schedule G IRS990ScheduleG
Fundraising Event Information FundraisingEventInformationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Event1 | GOLF TOURNAMENT | Event1Nm |
| Gross Receipts Event1 | $86,690 | GrossReceiptsEvent1Amt |
| Charitable Contri Event1 | $49,367 | CharitableContriEvent1Amt |
| Gross Revenue Event1 | $37,323 | GrossRevenueEvent1Amt |
| Cash Prizes Event1 | $10,700 | CashPrizesEvent1Amt |
| Non Cash Prizes Event1 | $15,277 | NonCashPrizesEvent1Amt |
| Food And Beverage Event1 | $7,040 | FoodAndBeverageEvent1Amt |
| Other Direct Expenses Event1 | $4,305 | OtherDirectExpensesEvent1Amt |
| Event2 | POINSETTIA SALE | Event2Nm |
| Gross Receipts Event2 | $25,140 | GrossReceiptsEvent2Amt |
| Charitable Contri Event2 | $13,984 | CharitableContriEvent2Amt |
| Gross Revenue Event2 | $11,156 | GrossRevenueEvent2Amt |
| Other Direct Expenses Event2 | $11,156 | OtherDirectExpensesEvent2Amt |
| Other Events Total | 2 | OtherEventsTotalCnt |
| Gross Receipts Other Events | $19,426 | GrossReceiptsOtherEventsAmt |
| Charitable Contri Other Events | $13,769 | CharitableContriOtherEventsAmt |
| Gross Revenue Other Events | $5,657 | GrossRevenueOtherEventsAmt |
| Non Cash Prizes Other Events | $53 | NonCashPrizesOtherEventsAmt |
| Oth Direct Expnss Other Events | $5,605 | OthDirectExpnssOtherEventsAmt |
| Gross Receipts Total | $131,256 | GrossReceiptsTotalAmt |
| Charitable Contributions Tot | $77,120 | CharitableContributionsTotAmt |
| Gross Revenue Total Events | $54,136 | GrossRevenueTotalEventsAmt |
| Cash Prizes Total Events | $10,700 | CashPrizesTotalEventsAmt |
| Non Cash Prizes Total Events | $15,330 | NonCashPrizesTotalEventsAmt |
| Food And Beverage Total Events | $7,040 | FoodAndBeverageTotalEventsAmt |
| Oth Direct Expnss Total Events | $21,066 | OthDirectExpnssTotalEventsAmt |
| Direct Expense Summary Events | $54,136 | DirectExpenseSummaryEventsAmt |
| Net Income Summary | $0 | NetIncomeSummaryAmt |
Schedule I IRS990ScheduleI
| Field | Value | IRS element (for citing) |
|---|---|---|
| Grant Records Maintained | Yes (1) | GrantRecordsMaintainedInd |
Recipient Table RecipientTable
Recipient Business Name RecipientBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | WEST GEORGIA MEDICAL CENTER INC | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1514 VERNON ROAD | AddressLine1Txt |
| City | LAGRANGE | CityNm |
| State Abbreviation | GA | StateAbbreviationCd |
| ZIP | 30240 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Recipient EIN | 205497506 | RecipientEIN |
| IRC Section | 501(C)(3) | IRCSectionDesc |
| Cash Grant | $225,141 | CashGrantAmt |
| Purpose Of Grant | SUPPORT FOR VARIUS BENEVOLENT PROGRAMS INCLUDING THE LIFELINE PROGRAM FOR HOSPICE PATIENTS | PurposeOfGrantTxt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total501c3 Org | 1 | Total501c3OrgCnt |
Grants Other Asst To Indiv In US GrantsOtherAsstToIndivInUSGrp (2 entries)
| Grant TypeGrantTypeTxt | RecipientRecipientCnt | Cash GrantCashGrantAmt |
|---|---|---|
| HELPING HANDS EMPLOYEE PROGRAM | 23 | $11,170 |
| GEORGE KISH SCHOLARSHIP | 1 | $373 |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | PART I, LINE 2: | FormAndLineReferenceDesc |
| Explanation | FUNDS WERE USED TO SUPPORT WEST GEORGIA MEDICAL CENTER, INC., A RELATED 501(C)(3) ORGANIZATION AND OTHER AFFILIATED HEALTHCARE PROVIDERS. THE HELPING HANDS FAMILY ASSISTANCE PROGRAM IS AN EMPLOYEE EMERGENCY ASSISTANCE PROGRAM. | ExplanationTxt |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Substantiation Required | Yes (1) | SubstantiationRequiredInd |
| Severance Payment | 0 | SeverancePaymentInd |
| Supplemental Nonqual Rtr Plan | Yes (1) | SupplementalNonqualRtrPlanInd |
| Equity Based Comp Arrngm | 0 | EquityBasedCompArrngmInd |
| Comp Based On Revenue Of Flng Org | 0 | CompBasedOnRevenueOfFlngOrgInd |
| Comp Bsd On Rev Related Orgs | 0 | CompBsdOnRevRelatedOrgsInd |
| Comp Bsd Net Earns Flng Org | 0 | CompBsdNetEarnsFlngOrgInd |
| Comp Bsd Net Earns Rltd Orgs | 0 | CompBsdNetEarnsRltdOrgsInd |
| Any Non Fixed Payments | 0 | AnyNonFixedPaymentsInd |
| Initial Contract Exception | 0 | InitialContractExceptionInd |
Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp (3 entries)
| TitleTitleTxt | Base Compensation Filing OrgBaseCompensationFilingOrgAmt | Compensation Based On Rltd OrgsCompensationBasedOnRltdOrgsAmt | Bonus Filing OrganizationBonusFilingOrganizationAmount | Bonus Related OrganizationsBonusRelatedOrganizationsAmt | Other Compensation Filing OrgOtherCompensationFilingOrgAmt | Other Compensation Rltd OrgsOtherCompensationRltdOrgsAmt | Deferred Compensation Flng OrgDeferredCompensationFlngOrgAmt | Deferred Comp Rltd OrgsDeferredCompRltdOrgsAmt | Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgAmt | Nontaxable Benefits Rltd OrgsNontaxableBenefitsRltdOrgsAmt | Total Compensation Filing OrgTotalCompensationFilingOrgAmt | Total Compensation Rltd OrgsTotalCompensationRltdOrgsAmt | Comp Report Prior990 Filing OrgCompReportPrior990FilingOrgAmt | Comp Report Prior990 Rltd OrgsCompReportPrior990RltdOrgsAmt |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| DR RICHARD SANDY SIMMONS | ||||||||||||||
| VICE CHAIRMAN | $0 | $373,683 | $0 | $46,440 | $0 | $6,016 | $0 | $10,400 | $0 | $21,281 | $0 | $457,820 | $0 | $0 |
| GERALD FULKS | ||||||||||||||
| SECRETARY | $0 | $398,304 | $0 | $64,000 | $0 | $10,436 | $0 | $76,565 | $0 | $15,980 | $0 | $565,285 | $0 | $0 |
| PAUL PERROTTI | ||||||||||||||
| CFO | $0 | $275,838 | $0 | $32,907 | $0 | $9,270 | $0 | $30,660 | $0 | $21,889 | $0 | $370,564 | $0 | $0 |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | PART I, LINE 4B | FormAndLineReferenceDesc |
| Explanation | EMPLOYER CONTRIBUTIONS TO THE 457(F) SUPPLEMENTAL EXECUTIVE RETIREMENT BENEFIT PLAN (SERP) INCLUDE $20,260 FOR PAUL PERROTTI, CFO AND $55,700 FOR GERALD FULKS, CEO. IN ACCORDANCE WITH 457(F) REGULATIONS THESE AMOUNTS WERE VESTED DURING THE YEAR, HOWEVER, THEY WERE NOT RECEIVED BY THE EMPLOYEE. | ExplanationTxt |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (11 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| FORM 990, PART VI, SECTION A, LINE 2 | BOARD MEMBERS WESLEY SMITH AND CHARLES SMITH HAVE A FAMILY RELATIONSHIP. |
| FORM 990, PART VI, SECTION A, LINE 6 | THE SOLE MEMBER OF THE ORGANIZATION IS WEST GEORGIA HEALTH SERVICES, INC. A RELATED 501(C)(3) ORGANIZATION. |
| FORM 990, PART VI, SECTION A, LINE 7A | UPON A VACANCY, THE MEMBERS OF THE BOARD OF DIRECTORS SHALL BE APPOINTED BY THE BOARD OF DIRECTORS OF W. GA HEALTH SERVICES, INC. TO SERVE A TERM OF 4 YEARS AND UNTIL A SUCCESSOR HAS BEEN APPOINTED, OR UNTIL THE MEMBER'S EARLIER DEATH, RESIGNATION, OR REMOVAL. A DIRECTOR MAY SERVE UP TO TWO 4 YEAR SUCCESSIVE TERMS. ANY DIRECTOR MAY BE REMOVED, EITHER FOR OR WITHOUT CAUSE, BY THE BOARD OF DIRECTORS OF W. GA HEALTH SERVICES, INC. |
| FORM 990, PART VI, SECTION A, LINE 7B | THE DECISIONS OF THE GOVERNING BODY ARE SUBJECT TO THE APPROVAL OF THE ORGANIZATION'S SOLE MEMBER THROUGH THE SELECTION AND OVERSIGHT OF THE BOARD OF DIRECTORS. |
| FORM 990, PART VI, SECTION B, LINE 11 | THE RETURN WAS PREPARED BY AN INDEPENDENT ACCOUNTING FIRM WITH ASSISTANCE AND OVERSIGHT BY MANAGEMENT. UPON COMPLETION AND REVIEW BY MANAGEMENT, A COPY OF THE 990 WAS PROVIDED TO EACH BOARD MEMBER VIA E-MAIL PRIOR TO FILING WITH THE IRS. |
| FORM 990, PART VI, SECTION B, LINE 12C | ANY DIRECTOR OF THE CORPORATION HAVING ANY POTENTIAL FINANCIAL INTEREST IN THE OUTCOME OF ANY DECISION THAT IS BEFORE THE BOARD OF DIRECTORS SHALL MAKE SUCH INTEREST APPARENT PRIOR TO THE DELIBERATIONS OR VOTE OF THE BOARD OF DIRECTORS ON THIS ISSUE, AND SAID DIRECTOR SHALL ABSTAIN FROM VOTING ON THIS ISSUE, AND ABSENT HIMSELF/HERSELF FROM THIS MEETING DURING DELIBERATIONS ON THIS ISSUE. THE NATURE OF ANY DIRECTOR'S POTENTIAL FINANCIAL INTEREST IN THE OUTCOME OF ANY BOARD DECISION SHALL BE DISCLOSED IN THE MINUTE BOOK OF THE CORPORATION. |
| FORM 990, PART VI, SECTION B, LINE 15 | HUMAN RESOURCES MAKES COMPENSATION RECOMMENDATIONS BASED ON COMPARATIVE MARKET ANALYSIS WHICH IS THEN REVIEWED AND APPROVED BY THE BOARD OF DIRECTORS. |
| FORM 990, PART VI, SECTION C, LINE 18 | THE ORGANIZATION MAKES ITS FORM 990 AVAILABLE TO THE PUBLIC UPON REQUEST. |
| FORM 990, PART VI, SECTION C, LINE 19 | THE ORGANIZATION MAKES ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UPON REQUEST. |
| PART VII | BOARD MEMBER COMPENSATION: BOARD MEMBERS DR. ROBERT COGGINS AND DR. JULIAN DUTTERA RECEIVED COMPENSATION FROM RELATED ORGANIZATION WEST GEORGIA MEDICA CENTER FOR MEDICAL SERVICES RENDERED TO THAT ORGANIZATION. BOARD MEMBER DR. SANDY SIMMONS SERVES AS THE CHIEF MEDICAL DIRECTOR AND AS A PULMONOLOGIST FOR RELATED ORGANIZATION WEST GEORGIA HEALTH PHYSICIAN. HE ALSO SERVES AS THE MEDICAL DIRECTOR FOR SLEEP CLINIC FOR WEST GEORGIA MEDICA CENTER. DR. SANDY SIMMONS RECEIVES COMPENSATION FROM THESE RELATED ORGANIZATONS FOR MEDICAL SERVICES RENDERED. |
| FORM 990, PART XII, LINE 2C: | THIS PROCESS HAS NOT CHANGED FROM THE PRIOR YEAR. |
Schedule R IRS990ScheduleR
Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp (5 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | EINEIN | Primary ActivitiesPrimaryActivitiesTxt | Legal Domicile StateLegalDomicileStateCd | Exempt Code SectionExemptCodeSectionTxt | Public Charity StatusPublicCharityStatusTxt | Direct Controlling NADirectControllingNACd | Controlled OrganizationControlledOrganizationInd | Business Name Line1DirectControllingEntityName/BusinessNameLine1Txt |
|---|---|---|---|---|---|---|---|---|---|---|---|
| LAGRANGE-TROUP COUNTY HOSPITAL AUTHORITY | |||||||||||
| 1514 VERNON ROAD | LAGRANGE | GA | 30240 | 562609278 | HOSPITAL AUTHORITY | GA | 501(C)(3) | LINE 3 | N/A | 0 | |
| VERNON WOODS RETIREMENT COMMUNITY INC | |||||||||||
| 1514 VERNON ROAD | LAGRANGE | GA | 30240 | 582575049 | ASSISTED LIVING | GA | 501(C)(3) | LINE 9 | 0 | WEST GEORIGA HEALTH SERVICES INC | |
| WEST GEORGIA HEALTH SERVICES INC | |||||||||||
| 1514 VERNON ROAD | LAGRANGE | GA | 30240 | 205497622 | PARENT OF HEALTH SYSTEM | GA | 501(C)(3) | LINE 11C, III-FI | N/A | 0 | |
| WEST GEORGIA MEDICAL CENTER INC | |||||||||||
| 1514 VERNON ROAD | LAGRANGE | GA | 30240 | 205497506 | HOSPITAL | GA | 501(C)(3) | LINE 3 | 0 | WEST GEORIGA HEALTH SERVICES INC | |
| MEDICAL PARK FOUNDATION INC | |||||||||||
| 209 BROOME STREET | LAGRANGE | GA | 30240 | 581303478 | SUPPORTING ORGANIZATION | GA | 501(C)(3) | LINE 11A, I | 0 | WEST GEORIGA HEALTH SERVICES INC | |
Id Related Org Txbl Corp Tr IdRelatedOrgTxblCorpTrGrp
Related Organization Name RelatedOrganizationName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | WEST GEORGIA HEALTH PHYSICIANS INC | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1514 VERNON ROAD | AddressLine1Txt |
| City | LAGRANGE | CityNm |
| State Abbreviation | GA | StateAbbreviationCd |
| ZIP | 30240 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 275125341 | EIN |
| Primary Activities | PHYSICIAN PRACTICE | PrimaryActivitiesTxt |
| Legal Domicile State | GA | LegalDomicileStateCd |
| Direct Controlling NA | N/A | DirectControllingNACd |
| Entity Type | C | EntityTypeTxt |
| Controlled Organization | 0 | ControlledOrganizationInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Annts Rnts Rylts | 0 | ReceiptOfIntAnntsRntsRyltsInd |
| Gift Grnt Or Cap Contri To Oth Org | Yes (1) | GiftGrntOrCapContriToOthOrgInd |
| Gift Grnt Cap Contri From Oth Org | Yes (1) | GiftGrntCapContriFromOthOrgInd |
| Loans Or Guarantees To Other Org | 0 | LoansOrGuaranteesToOtherOrgInd |
| Loans Or Guarantees From Oth Org | 0 | LoansOrGuaranteesFromOthOrgInd |
| Div Related Organization | 0 | DivRelatedOrganizationInd |
| Asset Sale To Other Org | 0 | AssetSaleToOtherOrgInd |
| Asset Purchase From Other Org | 0 | AssetPurchaseFromOtherOrgInd |
| Asset Exchange | 0 | AssetExchangeInd |
| Rental Of Facilities To Oth Org | 0 | RentalOfFacilitiesToOthOrgInd |
| Rental Of Fclts From Oth Org | 0 | RentalOfFcltsFromOthOrgInd |
| Perform Of Services For Oth Org | 0 | PerformOfServicesForOthOrgInd |
| Perform Of Services By Other Org | Yes (1) | PerformOfServicesByOtherOrgInd |
| Sharing Of Facilities | Yes (1) | SharingOfFacilitiesInd |
| Paid Employees Sharing | Yes (1) | PaidEmployeesSharingInd |
| Reimbursement Paid To Other Org | Yes (1) | ReimbursementPaidToOtherOrgInd |
| Reimbursement Paid By Other Org | 0 | ReimbursementPaidByOtherOrgInd |
| Transfer To Other Org | 0 | TransferToOtherOrgInd |
| Transfer From Other Org | 0 | TransferFromOtherOrgInd |
Comments