2016-08-12T09:26:37-05:00 2015-09-30 560747981 DIXON HUGHES GOODMAN LLP 500 RIDGEFIELD COURT ASHEVILLE NC 28806 990 2014-10-01 205497506 WEST GEORGIA MEDICAL CENTER INC WEST 7068821411 1514 VERNON ROAD LAGRANGE GA 30240 PAUL PERROTTI CFO/SENIOR VICE PRESIDENT 7068821411 2016-08-11 1 AMY BIBBY P00445891 8282542254 2014 2016-09-27 15:27:22Z GERALD FULKS 1514 VERNON ROAD LAGRANGE GA 30240 211540322 0 X WWW.WGHEALTH.ORG X 2006 GA THE PRIMARY MISSION OF WEST GEORGIA MEDICAL CENTER IS TO PROVIDE ACCESS TO QUALITY, COST-EFFECTIVE COMMUNITY-BASED HEALTHCARE SERVICES TO RESIDENTS OF COUNTIES IN WESTERN GEORGIA AND EASTERN ALABAMA. 9 8 1538 148 215450 88712 749267 332841 204325789 205916717 2875989 1455454 3251797 3387987 211202842 211092999 258304 244873 0 0 77273624 77164525 0 0 0 126730463 121364535 204262391 198773933 6940451 12319066 185495578 187302342 95650747 147120743 89844831 40181599 X WEST GEORGIA HEALTH SERVES THE HEALTH CARE NEEDS OF PEOPLE WITHIN OUR REGION THROUGH PROFESSIONAL SERVICE, COMPASSIONATE TREATMENT AND A SAFE ENVIRONMENT, WHILE COLLABORATING WITH COMMUNITY LEADERS TO PRODUCE BETTER HEALTH FOR OUR CITIZENS. 0 0 154796552 244873 182214982 THE HOSPITAL SERVICES PROGRAMS' GOAL IS TO PROVIDE THE BEST POSSIBLE HEALTH CARE SERVICES TO MEET THE NEEDS OF THE PEOPLE IN TROUP AND OTHER COUNTIES IN THE GEOGRAPHICAL AREA. THE PROGRAM HAD 8,438 ADMISSIONS, 30,599 INPATIENT DAYS, 55,969 OUTPATIENT EMERGENCY ROOM VISITS, 5,425 INPATIENT EMERGENCY ROOM VISITS, 1,843 INPATIENT SURGERIES, 4,202 OUTPATIENT SURGERIES, 664 INPATIENT ENDOSCOPIES, 3,710 OUTPATIENT ENDOSCOPIES,AND 1,106 DELIVERIES. 9587246 16982293 LONG TERM CARE INCLUDES TWO NURSING HOMES. THIS PROGRAM PROVIDED 87,737 INPATIENT DAYS IN SKILLED NURSING CARE. 3329235 4163894 HOSPICE PROGRAM PROVIDED 4,041 INPATIENT DAYS OF HOSPICE CARE AND 12,883 DAYS OF HOSPICE HOME CARE 4486719 2754029 ADDITIONAL EXEMPT ACTIVITY PROGRAMS INCLUDING HOME HEALTH, DIALYSIS, PHYSICIAN PRACTICES, OCCUPATIONAL EXPENSES, OCCUPATIONAL HEALTH, SCHOLARSHIPS, ETC. IN ADDITION ALL FY 2015 PROFITS FROM SALES AT THE GIFT SHOP WERE DONATED TO THE FOUNDATION TO SUPPORT THE UPCOMING CANCER PROGRAM. 4486719 2754029 172199752 1 1 0 1 0 0 0 1 1 1 1 0 0 0 1 1 0 1 0 0 0 0 0 0 0 0 1 1 1 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 375 0 1 1538 1 1 1 0 0 0 0 0 0 0 0 0 X 9 8 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 1 1 GA X X PAUL PERROTTI SR VPCFO 7068453934 1514 VERNON ROAD LAGRANGE GA 30240 MIKE PATTON CHAIR 1.00 1.00 X X 0 0 0 JOHN MCKIBBEN VICE CHAIR 1.00 2.00 X X 0 0 0 SPEER BURDETTE TREASURER 1.00 1.00 X X 0 0 0 ANIL MODI MD SECRETARY 1.00 X X 19956 0 0 BOBBY CARMICHAEL BOARD MEMBER 1.00 X 0 0 0 NANCY DURAND BOARD MEMBER 1.00 3.00 X 0 0 0 RANDY COMERFORD MD BOARD MEMBER 1.00 1.00 X 0 0 0 KENNETH MCCAMEY BOARD MEMBER 1.00 1.00 X 0 0 0 GEORGE STEFENELLI MD BOARD MEMBER 1.00 X 6000 0 0 GERALD N FULKS PRESIDENT/CEO 40.00 2.00 X 472740 0 92545 PAUL R PERROTTI SENIOR VP FINANCE/CFO 40.00 3.00 X 318015 0 52549 CHARIS ACREE SENIOR VP OPERATIONS 40.00 X 268720 0 84769 TRIPP PENN VP SUPPORT SERVICES 40.00 X 182275 0 32903 DEBORAH W BURTON VP/CHIEF NURSING OFFICER 40.00 X 188277 0 64332 TOMMY BRITT VP HUMAN RESOURCES 40.00 X 160689 0 28183 LIZA FRITCHLEY VP SENIOR SERVICES 40.00 X 160584 0 27927 MARY SPARROW PHARMACIST 40.00 X 138646 0 42410 DON DAVIS DIRECTOR, PHARMACY 40.00 X 165979 0 44932 ALFRED MCNAIR PHARMACIST 40.00 X 151397 0 71488 CAROL TODD GENERAL COUNSEL 40.00 X 177806 0 30025 JANICE PAGE PHARMACIST 40.00 X 131989 0 28278 2543073 0 600341 49 0 1 0 CONIFER HEALTH SOLUTIONS LLC 1500 S DOUGLASS RD ANAHEIM CA 92806 MANAGEMENT 5327196 GEORGIA RADIOLOGY SERVICES LLC 5665 NEW NORTHSIDE DR ATLANTA GA 30328 OUTSIDE RADIOLOGY 3135663 SOUTHERN CRESCENT ANESTHESIOLOGY 80 NEWNAN STATION DRIVE NEWNAN GA 30265 ANESTHESIOLOGY SERVICES 1056865 MICROSOFT LICENSING GP 1950 N STEMMONS FWY DALLAS TX 75207 SOFTWARE 525745 HSS INC 900 SOUTH BROADWAY SUITE A DENVER CO 80209 SECURITY SERVICES 484981 114 325141 7700 332841 PATIENT SERVICE REVENUE 621400 204161527 204161527 PREMIER PSHP INCOME 900099 942140 942140 PHARMACY 621400 529882 529882 EHR INCENTIVE PROGRAM REVENUE 621400 227402 227402 LIFELINE 621400 55766 55766 205916717 1473564 1473564 36251 395139 0 0 36251 395139 431390 36251 395139 31084 46642 2552 -46642 28532 -18110 -18110 596610 398129 198481 198481 MANAGEMENT FEES 900099 1297453 1297453 CAFETERIA AND VENDING 900099 797171 797171 MISCELLANEOUS 621400 344812 179199 165613 318680 318680 2758116 211092999 206115198 215450 4429510 X 244873 244873 2084923 662265 1422658 57627120 51423584 6203536 4066680 3547647 519033 9216036 8039787 1176249 4169766 3637576 532190 334845 247250 87595 1560845 1560845 254591 254591 134463 134463 28065851 25721956 2343895 655702 35933 619769 10268071 7691045 2577026 4852691 631397 4221294 2303556 2101796 201760 603445 373759 229686 193136 115212 77924 3379411 3379411 11486538 10568489 918049 825052 742458 82594 BAD DEBT 33914141 33914141 MEDICAL SUPPLIES 22486049 22486049 UBI TAX 31613 31613 MED STAFF DEVELOPMENT D 14535 14535 198773933 172199752 26574181 0 11669888 11667455 376039 778382 24541252 24076144 3018100 3078360 2335772 1584213 255014263 164132943 98173524 90881320 39009726 49676517 130115 192100 6241162 5367851 185495578 187302342 16716701 19009682 67734565 65465835 70022 54049 11129459 62591177 95650747 147120743 X 82512313 33072301 7332518 7109298 89844831 40181599 185495578 187302342 X 12319066 -1856310 -60125988 X X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 42420 42420 0 PART II-B, LINE 1: WEST GEORGIA MEDICAL CENTER, INC. PAYS ANNUAL MEMBERSHIP DUES TO GEORGIA ALLIANCE OF COMMUNITY HOSPITALS, GEORGIA HOSPITAL ASSOCIATION, GEORGIA HEALTH CARE ASSOCIATION, AND THE AMERICAN HOSPITAL ASSOCIATION. A PORTION OF THESE DUES ARE DESIGNATED BY THESE ORGANIZATIONS FOR LOBBYING ACTIVITIES. 2355189 X X 0 1 70022 15973 54049 1 7332518 223220 7109298 7563602 231084 7332518 9277918 1714316 7563602 9327227 695000 11142 486291 269160 9277918 9660005 600000 363 637675 295466 9327227 1.00000 0 0 3695649 3695649 110438540 49151664 61286876 9681153 5823600 3857553 129506817 109157679 20349138 1692104 1692104 90881320 INSURANCE LIABILITY 1200000 PENSION PAYABLE 61308464 WGHS COVENANT NOT TO COMPETE 73803 DUE TO AFFILIATES 8910 62591177 X 114518086 -1856310 398129 -1458181 115976267 134463 94982269 95116732 211092999 164181318 398129 398129 163783189 134463 34856281 34990744 198773933 PART III, LINE 4: THE ORGANIZATION HOLDS ART COLLECTIONS AND EXIBITS THEM IN PUBLIC AREAS. THE EXHIBITS ENHANCE THE HEALTH CARE EXPERIENCES FOR PATIENTS, PATIENT'S FAMILIES, AND VISITORS. PART V, LINE 4: TERM ENDOWMENT FUNDS ARE TO BE USED FOR NURSING SCHOLARSHIPS. PERMANENT ENDOWMENT FUNDS ARE TO BE USED FOR PROPERTY AND IMPROVEMENTS FOR HOSPITAL PURPOSES. PART X, LINE 2: THE ORGANIZATION IS EXEMPT FROM INCOME TAX PURSUANT TO INTERNAL REVENUE CODE SECTION 501(A), AS AN ORGANIZATION DESCRIBED IN SECTION 501(C)(3). RELATED INCOME IS GENERALLY NOT SUBJECT TO FEDERAL AND STATE INCOME TAXES. THE ORGANIZATION HAS EVALUATED ITS TAX POSITION 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: AUXILIARY COST OF GOODS SOLD FOR GIFT SHOP 398,129. PART XI, LINE 4B - OTHER ADJUSTMENTS: PREMIER HEALTH ALLIANCE REVENUE INCLUDED IN EXPENSES 942,140. PROVISION FOR BAD DEBT 33,914,141. PENSION LIABILITY ADJUSTMENT 15,597,680. EQUITY TRANSFER TO AFFILIATE PSO 9,172,315. RESTATED ASC 715 NET PENSION OBLIGATION 35,355,993. PART XII, LINE 2D - OTHER ADJUSTMENTS: AUXILIARY COST OF GOODS SOLD FOR GIFT SHOP 398,129. PART XII, LINE 4B - OTHER ADJUSTMENTS: PROVISION FOR BAD DEBT 33,914,141. PREMIER HEALTH ALLIANCE REVENUE INCLUDED IN EXPENSES 942,140. 1 1 1 X 125.000000000000 1 X 375.000000000000 1 1 1 0 1 1 7439091 7439091 0.04510 30083196 24481784 5601412 0.03400 403280 180597 222683 0.00140 37925567 24662381 13263186 0.08050 59863 59863 0.00040 1031396 1031396 0.00630 151258 151258 0.00090 1242517 1242517 0.00760 39168084 24662381 14505703 0.08810 2356 2356 0.00000 2356 2356 0 11132143 0 36160454 34525247 1635207 X 1 1 1 1 WEST GEORGIA MEDICAL CENTER INC 1514 VERNON ROAD LAGRANGE GA 30240 X X X WEST GEORGIA MEDICAL CENTER 1 0 0 1 X X X X X X X 12 1 0 0 1 X SEE DISCLOSURE X 1 12 1 SEE DISCLOSURE 0 0 1 X 125.000000000000 375.000000000000 X X X 1 1 X X X 1 X SEE DISCLOSURE X SEE DISCLOSURE X SEE DISCLOSURE X X X X X 1 0 X X X X 1 X 0 0 WEST GEORGIA MEDICAL CENTER PART V, SECTION B, LINE 5: THE WEST GEORGIA HEALTH COMMUNITY HEALTH NEEDS ASSESSMENT STEERING COMMITTEE IDENTIFIED COMMUNITY LEADERS, PARTNERS, AND REPRESENTATIVES TO INCLUDE IN THE CHNA PROCESS. REPRESENTATIVES OF GROUPS, OR INDIVIDUALS, WHO REPRESENT MEDICALLY UNDERSERVED POPULATIONS, LOW INCOME POPULATIONS, MINORITY POPULATIONS, AND POPULATIONS WITH CHRONIC DISEASES WERE INCLUDED.WEST GEORGIA HEALTH IDENTIFIED OVER 120 COMMUNITY MEMBERS TO PARTICIPATE IN THE CHNA PROCESS. KEY COMMUNITY STAKEHOLDERS WHO WERE INTERVIEWED INCLUDED:BART MCFADDEN OF THE BOYS AND GIRLS CLUB OF WEST GEORGIA; CARL VON EPPS OF THE GEORGIA HOUSE OF REPRESENTATIVES; DEBBIE BURDETTE FROM TROUP COUNTY SCHOOLS; ELIA BALTES OF THE DASH PROGRAM AND CHILI PROGRAM; JACK EATMON OF THE TROUP FAMILY CONNECTION; JUDY WRIGHT FROM WGH SOCIAL SERVICES; KAY DURAND OF THE TROUP COUNTY CENTER FOR STRATEGIC PLANNING, INC.; LARRY ASPLUND, THE PASTOR OF NEW COMMUNITY CHURCH; MELODY WEGIENKA, A PUBLIC HEALTH NURSE OF THE DISTRICT 4 PUBLIC HEALTH DEPARTMENT; MICHELE BEDINGFIELD FROM THE HARMONY HOUSE; MICHELE THOMPSON FROM WOMEN'S FIRST CHOICE; NORMA TUCKER, A CITY COUNCIL MEMBER, FROM FIRST STEPS PROGRAM; PAT ROBINSON FROM THE SENIOR CORP CENTER; SHAY THORNTON FROM THE DEPARTMENT OF FAMILY AND CHILDREN SERVICES; VALERIE WEST, A BOARD MEMBER FROM NATIONAL ALLIANCE ON MENTAL ILLNESS, SERVING ON THE TROUP COUNTY MENTAL HEALTH TASK FORCE; WANDA SCARBOROUGH FROM TROUP TRANSFORMATION.COMMUNITY FOCUS GROUP PARTICIPANTS INCLUDED:ALISHA SCOTT, A COURT PUBLIC DEFENDER; ALTON WEST FROM THE CITY OF LAGRANGE COMMUNITY DEVELOPMENT; BUCK DAVIS FROM THE TROUP COUNTY COMMISSION; CANDACE WORTHAM FROM TROUP CARES; CARL VON EPPS, A STATE REPRESENTATIVE; CARRIE BKRICH FROMTROUP CO. STRATEGIC PLANNING; CATHY SMITH FROM DASH; CHARLENE MCCLANAHAN FROM WEST GEORGIA HEALTH ONCOLOGY DEPARTMENT; CHRIS POWELL FROM THE SALVATION ARMY; DAN WOOTEN FROM ACTIVE LIFE SENIORS; DAVE MILLER FROM NEW VENTURES; DEBBIE BURDETTE, ALITERACY VOLUNTEER/ACTIVIST; DEBORAH BURTON FROM WEST GEORGIA HEALTH; DIANE HARRELL FROM THE CENTER FOR COMMUNITY STUDIES; DONA CHERRY FROM TROUP CARES NETWORK; DR. JAY GIESLER A PHYSICIAN; DR. SANDY SIMMONS A PHYSICIAN; GAIL GORDON FROM SUCCESS BY SIX; JACK EATMON FROM TROUP FAMILY CONNECTION; JACK LEIDNER FROM HOGANSVILLE CITY COUNCIL; JANICE HETHCOX FROM TROUP BELL; JEAN CROCKER FROM HOGANSVILLE CITY COUNCIL; JEANNETTE LITTLE STATE FROM COURT JUDGE; JEFF LUKKEN, MAYOR OF THE CITY OF LAGRANGE; JUDY WRIGHT, WGH SOCIAL SERVICES; KAREN CAGLE FROM TROUP COUNTY SCHOOLS; KEN SMITH FROM TROUP CO. COMMISSION; MANDY HILL FROM TWIN CEDARS YOUTH COUNCIL; MELODY WEGIENKA, A PUBLIC HEALTH NURSE FROM THE DISTRICT 4 PUBLIC HEALTH DEPARTMENT; MICHELE THOMPSON FROM WOMEN'S FIRST CHOICE; MIKE ANGSTADT FROM TWIN CEDARS YOUTH & FAMILY SERVICES; MORRIS JONES FROM TROUP COUNTY COMMISSIONER; NORMA TUCKER FROM FIRST STEPS & CITY COUNCIL; PASTOR HUGO OROPEZA FROM HISPANIC CHURCH; PATRICIA ROBINSON FROM SENIOR CORP; PATTI YOUNGBLOOD FROM THE UNITED WAY OF W. GEORGIA, INC.; RANDY NIX, A GEORGIA STATE REPRESENTATIVE; RICHARD ENGLISH FROM THE TROUP COUNTY COMMISSION; SPEER BURDETTE FROM THE CALLAWAY FOUNDATION; TRIPP PENN FROM WEST GEORGIA HEALTH; VALERIE WEST, A BOARD MEMBER AT THE NATIONAL ALLIANCE ON MENTAL ILLNESS, AND FROM THE TROUP COUNTY MENTAL HEALTHTASK FORCE; WANDA SCARBOROUGH FROM TROUP TRANSFORMATION WEST GEORGIA MEDICAL CENTER PART V, SECTION B, LINE 11: DURING OCTOBER AND NOVEMBER 2015, WEST GEORGIA HEALTH COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA) STEERING COMMITTEE CONDUCTED AN EVALUATION OF ITS IMPLEMENTATION STRATEGIES FOR THE 2014-2015 FISCAL YEAR ENDING SEPTEMBER 30, 2015. THE EVALUATION PROCESS INCLUDED: STATUS REPORT OF ACTIVITIES AND COMPILING YEAR-END OUTCOME AND IMPACT METRICS.STEERING COMMITTEE MEETING TO RATE THE ACCOMPLISHMENTS OF EACH GOAL AND DETERMINE IF THE CURRENT IMPLEMENTATION STRATEGIES SHOULD BE CONTINUED, DISCONTINUED OR MODIFIED.ACTION PLAN UPDATE FOR THE UPCOMING FISCAL YEAR. THE STEERING COMMITTEE MET ON NOVEMBER 3, 2015 TO REVIEW THE STATUS, OUTCOMES AND IMPACT OF THE VARIOUS IMPLEMENTATION STRATEGIES ACCOMPLISHED THROUGHOUT THE PREVIOUS FISCAL YEAR. SOME HIGHLIGHTS OF THE OUTCOMES/IMPACT DATA INCLUDED: GOAL 1: ACCESS THREE (3) SPECIALIST PHYSICIANS HAVE BEEN RECRUITED (PULMONOLOGIST, RADIATION ONCOLOGIST AND ENT), UROLOGY SEARCH STILL ACTIVE; OTHER RECRUITMENT EFFORTS ON HOLD UNTIL PHYSICIAN NEEDS ASSESSMENT IS UPDATED.OVER $21 MILLION WAS PROVIDED IN CHARITY CARE AND BAD DEBT; EMERGENCY DEPARTMENT VISITS ACTUALLY INCREASED THIS PAST YEAR, AS DID THE PERCENTAGE THAT WAS AMBULATORY CARE SENSITIVE CONDITIONS (28%).THE COMMUNITY RESOURCE GUIDE IS UNDERWAY AND IS EXPECTED TO BE COMPLETED BY DECEMBER 31, 2015.1,078 WGH EMPLOYEES AND SPOUSES PARTICIPATED IN THE EMPLOYEE WELLNESS PROGRAMS; 618 EMPLOYEES PARTICIPATED IN THE WEIGHT LOSS CHALLENGE AND LOST A TOTAL OF 2,343 POUNDS.TROUP COUNTY WELLNESS AT WORK INITIATIVE EXPANDED TO ONLY ONE EMPLOYER; THE CHAMBER IS LOOKING AT STRATEGIES TO EXPAND PARTICIPATION. GOAL 2: CHRONIC DISEASE PREVENTION AND MANAGEMENT 800 PEOPLE PARTICIPATED IN THE "PAINT THE TOWN PINK" EVENT; 12 LOW INCOME WOMEN WERE SCREENED AND 11 WERE GIVEN PAYMENT VOUCHERS AND SCHEDULED FOR MAMMOGRAMS. 113 PEOPLE WALKED IN THE "HOPE FOR A DAY" WALK, RAISING MORE THAN $80,000 FOR BREAST CANCER SCREENINGS, AWARENESS, PATIENT SUPPORT, ETC.INITIATED LUNG CT SCREENING FOR LUNG CANCER; 12 PATIENTS STAGE 1; 4 PATIENTS STAGE 2; 23 PATIENTS STAGE 3; AND 33 PATIENTS STAGE 4 LUNG CANCER DIAGNOSES REPORTED.ZERO PARTICIPANTS IN SMOKING CESSATION PROGRAM; ENCOURAGING PHYSICIANS TO REFER. COLON CANCER DIAGNOSES: STAGE 1 - 5 PATIENTS; STAGE 2 - 7 PATIENTS; STAGE 3 -6 PATIENTS; AND STAGE 4 - 8 PATIENTS.178 MEN SCREENED DURING PROSTATE CANCER EVENT; 12 REFERRED FOR FOLLOW UP; STAGE 1 - 19 PATIENTS; STAGE 2 - 29 PATIENTS; STAGE 3 - 0 PATIENTS; AND STAGE 4 - 3 PATIENTS DIAGNOSED.TWO 2-DAY HEALTH FAIRS ATTRACTED OVER 400 PARTICIPANTS.84 PEOPLE PARTICIPATED IN WEIGHT MANAGEMENT CLASSES WITH WGH DIETITIANS. PROJECT RED 30-DAY, ALL CAUSE READMISSION RATE FOR FY 2015 TD=4.69%; OVERALL WGH 30-DAY, ALL-CAUSE HEART FAILURE READMISSION RATE FOR FY 2015 TD = 13.78%. GOAL 3: HEALTHY YOUTH NO TEEN PREGNANCY CLASSES WERE OFFERED DUE TO A LACK OF PARTICIPATION. TEEN BIRTHS AT WGH INCREASED 149% IN 2015. THE TROUP COUNTY SCHOOL DISTRICT IS ADDING A 7TH GRADE CURRICULUM.SEX, TRUTH AND CONSEQUENCES CLASS HELD IN JANUARY 2015 WITH 80 PARTICIPANTS, POST-TESTS SHOWED 80% (COMBINED PARENTS AND STUDENTS) REPORTED INCREASED KNOWLEDGE OF THE TOPICS. TEEN MAZE EVENT HELD IN NOVEMBER 2014 WITH 900 PARTICIPANTS. PROVIDED FINANCIAL SUPPORT TO LOCAL BOYS AND GIRLS CLUB EVENTS: 67% OF LOCAL CLUB MEMBERS REPORTED PARTICIPATING IN PHYSICAL ACTIVITY FOR 7 DAYS/WEEK VS. 33% OF YOUTH NATIONWIDE; 63% OF CLUB MEMBERS REPORTED CONSUMING AT LEAST 2 FRUITS/3 VEGETABLES EACH DAY VS. 43% CONSUMPTION AMONG U.S. YOUTH; 91.5% OF YOUTH PARTICIPATING IN THE CLUBS' SUMMER PROGRAM DEMONSTRATED IMPROVED FITNESS FROM JUNE TO JULY.555 PARENTS WERE SCREENED IN THE FIRST STEPS PROGRAM TO PREVENT SHAKEN BABY SYNDROME; 2 CASES WERE REPORTED, UP FROM ZERO IN 2014. UPON RESEARCH AND REVIEW, THE FOLLOWING IMPLEMENTATION STRATEGY OBJECTIVES (BY GOALS) ARE NOT BEING PURSUED BY WEST GEORGIA HEALTH: GOAL 1: DECREASE INAPPROPRIATE ER UTILIZATION AND ADMISSIONS BY IMPROVING ACCESS TO PREVENTION, PRIMARY CARE AND CHRONIC DISEASE MANAGEMENT IN UNDERSERVED AREASOBJECTIVE A: IMPLEMENT A MOBILE HEALTH CLINIC - DURING THE COURSE OF THIS EVALUATION, IT WAS DETERMINED THAT IMPLEMENTING A MOBILE HEALTH CLINIC WAS NOT FINANCIALLY FEASIBLE AND WILL NOT BE PURSUED FURTHER. GOAL 2: REDUCE INCIDENCE AND PREVALENCE OF CHRONIC DISEASES AND IMPROVE CHRONIC DISEASE MANAGEMENT OF OBESITY, HEART DISEASE, CANCER, STROKE AND DIABETESOBJECTIVE C: EVALUATE BREAST CANCER RISK ASSESSMENT PRODUCTS AND SEEK FUNDING OPTIONS FOR IMPLEMENTATION - DURING THE COURSE OF THIS EVALUATION, IT WAS DETERMINED THAT EVALUATING AND IMPLEMENTING BREAST CANCER RISK ASSESSMENT PRODUCTS WAS NOT FINANCIALLY FEASIBLE AND WILL NOT BE PURSUED FURTHER.OBJECTIVE E: EVALUATE COLON CANCER RISK ASSESSMENT PRODUCTS AND SEEK FUNDING OPTIONS FOR IMPLEMENTATION - DURING THE COURSE OF THIS EVALUATION, IT WAS DETERMINED THAT EVALUATING AND IMPLEMENTING COLON CANCER RISK ASSESSMENT PRODUCTS WAS NOT FINANCIALLY FEASIBLE AND WILL NOT BE PURSUED FURTHER.OBJECTIVE F: EVALUATE PROSTATE CANCER RISK ASSESSMENT PRODUCTS AND SEEK FUNDING OPTIONS FOR IMPLEMENTATION - DURING THE COURSE OF THIS EVALUATION, IT WAS DETERMINED THAT EVALUATING AND IMPLEMENTING PROSTATE CANCER RISK ASSESSMENT PRODUCTS WAS NOT FINANCIALLY FEASIBLE AND WILL NOT BE PURSUED FURTHER.OBJECTIVE H: IF WGH MOBILE VAN CLINICS ARE DEEMED FEASIBLE, OFFER EDUCATIONAL SESSIONS IN CONJUNCTION WITH WGH MOBILE VAN CLINICS - DURING THE COURSE OF THIS EVALUATION, IT WAS DETERMINED THAT IMPLEMENTING A MOBILE HEALTH CLINIC WAS NOT FINANCIALLY FEASIBLE AND WILL NOT BE PURSUED FURTHER.OBJECTIVE H: EVALUATE DIABETES RISK ASSESSMENT PRODUCTS AND SEEK FUNDING OPTIONS FOR IMPLEMENTATION - DURING THE COURSE OF THIS EVALUATION, IT WAS DETERMINED THAT EVALUATING AND IMPLEMENTING DIABETES RISK ASSESSMENT PRODUCTS WAS NOT FINANCIALLY FEASIBLE AND WILL NOT BE PURSUED FURTHER.OBJECTIVE J: EVALUATE STROKE RISK ASSESSMENT PRODUCTS AND SEEK FUNDING OPTIONS FOR IMPLEMENTATION - DURING THE COURSE OF THIS EVALUATION, IT WAS DETERMINED THAT EVALUATING AND IMPLEMENTING STROKE RISK ASSESSMENT PRODUCTS WAS NOT FINANCIALLY FEASIBLE AND WILL NOT BE PURSUED FURTHER.OBJECTIVE K: EVALUATE HEART RISK ASSESSMENT PRODUCTS AND SEEK FUNDING OPTIONS FOR IMPLEMENTATION - DURING THE COURSE OF THIS EVALUATION, IT WAS DETERMINED THAT EVALUATING AND IMPLEMENTING HEART RISK ASSESSMENT PRODUCTS WAS NOT FINANCIALLY FEASIBLE AND WILL NOT BE PURSUED FURTHER. WEST GEORGIA MEDICAL CENTER PART V, SECTION B, LINE 16I: ANNUAL NOTIFICATION IN LOCAL GENERAL CIRCULATION NEWSPAPER. ALSO, INDIVIDUAL NOTIFICATION OF THE POLICY IS GIVEN AT REGISTRATION TO ALL PATIENTS. WEST GEORGIA MEDICAL CENTER PART V, SECTION B, LINE 19D: WE PROACTIVELY COMMUNICATE THE FACILITY'S PARTICIPATION IN THE INDIGENT PROGRAM. WEST GEORGIA MEDICAL CENTER PART V, SECTION B, LINE 22D: THE ORGANIZATION USES THE LOOK-BACK AGB METHOD AS DESCRIBED IN TREASURY REGULATIONS. THE LOOKBACK IS BASED ON A RETROSPECTIVE 12-MONTH MEASUREMENT PERIOD AND IS BASED ON ACTUAL PAST CLAIMS PAID TO THE HOSPITAL FACILITY BY MEDICARE FEE-FOR-SERVICE TOGETHER WITH ALL PRIVATE HEALTH INSURERS. WEST GEORGIA MEDICAL CENTER PART V, SECTION B, LINE 24: ALL PATIENTS ARE CHARGED THE SAME CDM PRICING. ADJUSTMENTS ARE LATER MADE BASED ON THE INVIDUALS APPLICATION FOR FINANCIAL ASSISTANCE AS COMPARED TO THE FPL GUIDELINES. PART V, SECTION B, LINE 7A: HTTP://WWW.WGHEALTH.ORG/ABOUT-US/COMMUNITY-NEEDS-ASSESSMENT/ PART V, SECTION B, LINE 10A: HTTP://WWW.WGHEALTH.ORG/IMAGES/UPLOADS/WGH_REPORT_FINAL.PDF PART V, SECTION B, LINE 16: HTTP://WWW.WELLSTAR.ORG/ABOUT-US/POLICIES-PROCEDURES/PAGES/COMMUNITY-FINANCIAL-ASSISTANCE-POLICY.ASPX PART V, SECTION B, LINE 16 FINANCIAL ASSISTANCE POLICY WEBSITE AVAILABILITY WEST GEORGIA MEDICAL CENTER PART V, SECTION B, LINE 16A WEBSITE: SEE DISCLOSURE WEST GEORGIA MEDICAL CENTER PART V, SECTION B, LINE 16B WEBSITE: SEE DISCLOSURE WEST GEORGIA MEDICAL CENTER PART V, SECTION B, LINE 16C WEBSITE: SEE DISCLOSURE 6 FLORENCE HAND HOME 200 MEDICAL DRIVE LAGRANGE GA 30240 LONG TERM CARE TWIN FOUNTAINS HOME 1400 HOGANSVILLE ROAD LAGRANGE GA 30240 LONG TERM CARE HOSPICE LAGRANGE 1510 VERNON ROAD LAGRANGE GA 30240 HOSPICE WEST GEORGIA WOUND CARE 1600 VERNON RD SUITE G LAGRANGE GA 30240 WOUND CARE WEST GEORGIA HOME CARE 120 GLEN BASE ROAD LAGRANGE GA 30240 HOME HEALTH; SKILLED NURSING WOMEN'S HEALTH CENTER 1420 VERNON ROAD LAGRANGE GA 30240 WOMEN'S CENTER PART I, LINE 7, COLUMN (F): THE BAD DEBT EXPENSE INCLUDED ON FORM 990, PART IX, LINE 25, COLUMN (A), BUT SUBTRACTED FOR PURPOSES OF CALCULATING THE PERCENTAGE IN THIS COLUMN IS $ 33,914,141. PART I, LINE 6B: PLEASE SEE THE ORGANIZATION'S COMMUNITY BENEFIT REPORT FOR FY'15 AT THE WEB ADDRESS BELOW:HTTP://WWW.WGHEALTH.ORG/IMAGES/UPLOADS/WGH_YEAR_2_EVALUATION_FINAL_REPORT_05-02-16_2.PDF PART II, COMMUNITY BUILDING ACTIVITIES: WEST GEORGIA HEALTH HAS BEEN THE COMMUNITY HOSPITAL FOR LAGRANGE AND THE WEST CENTRAL AREA OF GEORGIA FOR OVER SEVENTY YEARS, ALWAYS STRIVING TO PROVIDE EXCELLENT SERVICE TO OUR PATIENTS. IT IS THE ONLY HOSPITAL WITHIN A 35 MILES RADIUS FOR MANY COMMUNITY MEMBERS IN THE SERVICE AREA. WEST GEORGIA MEDICAL CENTER AND ITS EMPLOYEES SUPPORTS THEIR COMMUNITY THROUGH A VARIETY OF WAYS. IN TERMS OF SPONSORSHIPS, WGMC HAS PROVIDED SPONSOR FUNDING TO SEVERAL ORGANIZATIONS THAT FOCUS ON HEALTH-RELATED EVENTS THAT BENEFIT OUR LOCAL COMMUNITY INCLUDING: THE AMERICAN CANCER SOCIETY RELAY FOR LIFE, MARCH OF DIMES MARCH FOR BABIES, HEART OF WEST GEORGIA GOLF TOURNAMENT, WALK TO END ALZHEIMER'S, AMONG OTHERS. IN ADDITION, WGMC COORDINATES TWO MAJOR COMMUNITY EVENTS EACH YEAR: PAINT THE TOWN PINK BREAST CANCER AWARENESS EVENT AND THE HEART TRUTH FOR WOMEN LUNCHEON. IN ADDITION, WGMC SUPPORTS THE LAGRANGE-TROUP COUNTY CHAMBER OF COMMERCE AND ITS MISSION OF IMPROVING ECONOMIC DEVELOPMENT FOR THE COUNTY WITH A CHAIRMAN'S LEVEL SPONSORSHIP EACH YEAR. IN TERMS OF HEALTH PROMOTION, WGMC PARTICIPATES IN COMMUNITY HEALTH FAIRS, OFFERING A VARIETY OF SCREENINGS (BLOOD PRESSURE, GLUCOSE, CLINICAL BREAST EXAMS, FLU CLINICS) AND INFORMATION REGARDING PREVENTION AND AWARENESS OF NUMEROUS DISEASES PREVALENT IN OUR COMMUNITY (STROKE, DIABETES, HYPERTENSION, HEART DISEASE, CANCER, COPD, SMOKING). FOR THE PAST 5 YEARS, WGMC HAS PROVIDED MANPOWER AND PLANNING EXPERTISE TO TEEN MAZE, A TROUP COUNTY HEALTH DEPARTMENT INITIATIVE DESIGNED TO LOWER TEEN PREGNANCY RATES, PROVIDE INFORMATION ON DISTRACTED AND/OR DRUNK DRIVING, STDS, AND RISKY BEHAVIORS AND TO RAISE TROUP COUNTY GRADUATION RATES. WGMC ALSO OFFERS LOW-COST ($5) PROSTATE CANCER SCREENINGS EACH YEAR AND PARTNERS WITH THE WEST CENTRAL GEORGIA CANCER COALITION TO OFFER VOUCHERS FOR MAMMOGRAMS FOR UNDERSERVED WOMEN WHO QUALIFY. WGMC ALSO HOSTED SIX BLOOD DRIVES IN 2015, DURING WHICH 293 UNITS WERE DONATED PRIMARILY BY WGMC EMPLOYEES. FOR MORE THAN 40 YEARS, WGMC EMPLOYEES AND PHYSICIANS HAVE VOLUNTEERED THEIR TIME TO CONDUCT FREE ATHLETIC PHYSICALS FOR ALL MIDDLE AND HIGH SCHOOL ATHLETES WITHIN THE TROUP COUNTY SCHOOL DISTRICT. WGMC HOSTS A VARIETY OF MONTHLY OR QUARTERLY SUPPORT GROUPS INCLUDING THOSE FOR PATIENTS AND/OR FAMILIES WITH CANCER, BREAST CANCER, ALZHEIMER'S AND PARKINSON'S DISEASES. THEY ALSO OFFER A BREASTFEEDING SUPPORT GROUP FOR MOTHERS WITH INFANTS.WGMC STAFF ROUTINELY OFFER COMMUNITY CLASSES FOR CHILDBIRTH PREPARATION, BREASTFEEDING, INFANT CPR AND SAFETY, HEARTSAVER CPR, SAFE BABYSITTERS, PRE-TEEN CLASSES ON BODY CHANGES AND BLS FOR HEALTHCARE PROVIDERS.IN ADDITION TO ITS LIFESAVING TECHNOLOGY AND TREATMENTS, WGMC'S CANCER PROGRAM OFFERS NUMEROUS COMPLEMENTARY THERAPIES INCLUDING ART THERAPY, CURVY YOGA, NUTRITION CLASSES FOR CANCER PATIENTS AND THEIR FAMILIES, AS WELL AS THE AMERICAN CANCER SOCIETY PROGRAMS LOOK GOOD, FEEL BETTER AND ROAD TO RECOVERY PROGRAMS. SINCE 1996, WEST GEORGIA HOSPICE, A DIVISION OF WGMC, HAS HOSTED A GOLF TOURNAMENT EACH YEAR TO BENEFIT THE WEST GEORGIA HOSPICE CHARITABLE FUND. THE MONEY IN THIS FUND HELP ENSURE THAT ALL FAMILIES IN NEED HAVE ACCESS TO COMPREHENSIVE AND COMPASSIONATE HOSPICE CARE, REGARDLESS OF THEIR ABILITY TO PAY. IN ADDITION, WEST GEORGIA HOSPICE HOSTS CAMP DOGWOOD, A FREE, THREE-DAY GRIEF CAMP FOR 125 CHILDREN IN KINDERGARTEN THROUGH 8TH GRADE WHO HAVE EXPERIENCED THE LOSS OF A CLOSE LOVED ONE. THIS PROGRAM BEGAN IN 1997.IN ADDITION TO RAISING FUNDS TO SUPPORT FOR A RENOVATION/EXPANSION OF WGMC'S CANCER CENTER, THE WEST GEORGIA FOUNDATION COORDINATES THE WEST GEORGIA INSIDERS PROGRAM. THIS PROGRAM, WHICH LAUNCHED IN 2013, HOSTS EIGHT SESSIONS EACH YEAR FOR A CLASS THAT IS COMPOSED OF 20 BUSINESS AND COMMUNITY LEADERS REPRESENTING A GOOD CROSS SECTION OF OUR COMMUNITY. ITS PURPOSE IS TO EDUCATE COMMUNITY LEADERS ABOUT THE HEALTHCARE SERVICES AVAILABLE IN TROUP COUNTY, AS WELL AS THE CHANGES IN HEALTHCARE POLICY THAT COULD AFFECT LOCAL FAMILIES AND BUSINESSES. PART III, LINE 4: FOOTNOTE: BAD DEBT EXPENSE WAS COMPUTED SO AS TO REFLECT THE ESTIMATED NET REALIZABLE AMOUNTS RECEIVABLE FROM PATIENTS, THIRD-PARTY PAYORS AND OTHERS FOR SERVICES RENDERED. FOR RECEIVABLES ASSOCIATED WITH SERVICES PROVIDED TO PATIENTS WHO HAVE THIRD-PARTY COVERAGE, THE HOSPITAL ANALYZES ITS PAST HISTORY AND IDENTIFIES TRENDS FOR EACH OF ITS MAJOR PAYOR SOURCES OF REVENUE TO ESTIMATE A PROVISION FOR BAD DEBT IF NECESSARY. FOR RECEIVABLES ASSOCIATED WITH SELF-PAY PATIENTS (WHICH INCLUDES BOTH PATIENTS WITHOUT INSURANCE AND PATIENTS WITH DEDUCTIBLE AND COPAYMENT BALANCES DUE FOR WHICH THIRD-PARTY COVERAGE EXISTS FOR PART OF THE BILL), THE HOSPITAL RECORDS A PROVISION FOR BAD DEBTS IN THE PERIOD OF SERVICE ON THE BASIS OF ITS PAST EXPERIENCE, WHICH INDICATES THAT MANY PATIENTS ARE UNABLE OR UNWILLING TO PAY THE PORTION OF THEIR BILL FOR WHICH THEY ARE FINANCIALLY RESPONSIBLE. RECOVERIES OF ACCOUNTS PREVIOUSLY WRITTEN OFF ARE RECORDED AS A REDUCTION TO THE PROVISION FOR BAD DEBT EXPENSE. BAD DEBT EXPENSE WAS COMPUTED USING THE COST TO CHARGE RATIO. PART III, LINE 8: MEDICARE ALLOWABLE COSTS WERE CALCULATED USING MEDICARE COST REPORTS. PART III, LINE 9B: THE ORGANIZATION HAS A FINANCIAL ASSISTANCE POLICY WHICH GOVERNS ELIGIBILITY CRITERIA AND COLLECTON PRACTICES FOR ALL PATIENTS AND PATIENTS KNOWN TO QUALIFY FOR CHARITY AND OTHER FINANCIAL ASSISTANCE. ONCE A PATIENT IS DETERMINED TO QUALIFY FOR CHARITY CARE, IT IS NOTED IN THE PATIENT'S FINANCIAL CHART AND ANY COLLECTON EFFORTS CEASE. PART VI, LINE 2: WEST GEORGIA MEDICAL CENTER IDENTIFIED AND ASSESSED THE HEALTH NEEDS OF THE COMMUNITY THROUGH THE FOLLOWING STEPS. 1) THE HOSPITAL'S CEO DEVELOPED AN INTERNAL STEERING COMMITTEE 2) THE COMMITTEE DEFINED THE COMMUNITY AS ITS PRIMARY SERVICE AREA - TROUP COUNTY, GA. 3) THE COMMITTEE IDENTIFIED AND ENGAGED COMMUNITY LEADERS AND STAKEHOLDERS. 4) WGMC WORKED WITH DRAFFIN & TUCKER, LLP TO CREATE A COMMUNITY HEALTH PROFILE WHICH ADDRESSED ACCESS TO PREVENTIVE HEALTH SERVICES, UNDERLYING CAUSES OF HEALTH PROBLEMS, AND MAJOR CHRONIC DISEASES OF THE POPULATION. SECONDARY DATA CAME FROM A VARIETY OF SOURCES INCLUDING VITAL RECORDS, STATE AND NATIONAL HEALTH STATUS DATA AND HOSPITAL UTILIZATION DATA. 5) THE TEAM GAINED COMMUNITY INPUT VIA MEETINGS WITH COMMUNITY LEADERS AND STAKEHOLDERS. 6) THE TEAM DEVELOPED A PRIORITIZATION OF NEEDS TO ADDRESS. 7) THE TEAM DEVELOPED IMPLEMENTATION STRATEGIES TO ADDRESS THE IDENTIFIED NEEDS. PART VI, LINE 3: THE ORGANIZATION NOTIFIES PATIENTS (OR THEIR REPRESENTATIVES) OF THIS POLICY AT REGISTRATION. SIGNAGE IS POSTED IN BOTH ENGLISH AND SPANISH. INFORMATION AND APPLICATIONS FOR FINANCIAL ASSISTANCE ARE AVAILABLE IN THE ADMISSIONS OFFICE AND EMERGENCY DEPARTMENT. WEST GEORGIA HEALTH COMMUNICATES THE AVAILABLITY OF FINANCIAL ASSISTANCE TO THE COMMUNITY BY COMMUNICATION ON THE HOSPITAL INTERNET SITE, AND VIA POSTINGS IN INTAKE AREAS. WGH ASSURES THE LATEST UPDATES ARE AVAILABLE FOR PUBLIC COMMUNICATIONS ANNUALLY. PART VI, LINE 4: WEST GEORGIA HEALTH SERVICES, INC. (WGHS) IS A 558-BED FACILITY LOCATED IN LAGRANGE, GEORGIA, APPROXIMATELY 70 MILES SOUTH OF ATLANTA. WGHS PRIMARY SERVICE AREA IS TROUP COUNTY WITH A POPULATION OF APPROXIMATELY 68,000, BUT IT ALSO SERVES OTHER COUNTIES IN THE WEST CENTRAL GEORGIA AND EAST CENTRAL ALABAMA. APPROXIMATELY 19.5% OF THE POPULATION IN THE SERVICE AREA IS LIVING AT OR BELOW POVERTY LEVEL. ALMOST 25% OF THE POPULATION IS UNDER 18 YEARS AND ONLY ABOUT 14% OF THE POPULATION IN THE SERVICE AREA IS OVER THE AGE OF 65. THE MEDIAN HOUSEHOLD INCOME IN THE PRIMARY SERVICE AREA IS APPROXIMATELY $42,000. PART VI, LINE 5: THE ORGANIZATION'S BOARD IS COMPRISED PRIMARILY OF RESIDENTS OF THE PRIMARY SERVICE AREA. MEDICAL STAFF PRIVILEGES ARE EXTENDED TO ALL QUALIFIED PHYSICIANS IN SELECT DEPARTMENTS. ALL SURPLUS FUNDS ARE REINVESTED INTO HEALTHCARE SERVICES FOR THE COMMUNITY. IN ADDITION TO OPERATING A 276-BED HOSPITAL, WGMC ALSO OPERATES A 16-BED HOSPICE FACILITY AND TWO NURSING HOMES (265-BEDS).WEST GEORGIA MEDICAL CENTER AND ITS EMPLOYEES SERVE OUR COMMUNITY THROUGH A VARIETY OF SCREENING EVENTS, HEALTH FAIRS, EDUCATIONAL SESSIONS AND SERVICE CLINICS. SUCH SCREENING EVENTS INCLUDE - PAINT THE TOWN PINK BREAST CANCER AWARENESS EVENT, TROUP FAMILY EXPO, THE ANNUAL SUPERSTAR FOOTBALL CAMP, ANNUAL $5 PROSTATE SCREENINGS, CLINICAL BREAST EXAMS/VOUCHERS FOR FREE MAMMOGRAM FOR WOMEN WHO QUALIFY (A PARTNERSHIP WITH WEST GEORGIA CANCER COALITION) AND THE BRINGING THE AGES TOGETHER HEALTH EXPO, AMONG OTHERS. PART VI, LINE 6: THE ORGANIZATION (WGMC) IS PART OF WEST GEORGIA HEALTH SERVICES, INC., A MULTI-ENTITY HEALTHCARE SYSTEM. THE ORGANIZATIONS IN THE SYSTEM INCLUDE: (1) WEST GEORGIA HEALTH SERVICES, INC. - WGHS SERVES AS THE PARENT ORGANIZATION OF THE SYSTEM AND PROVIDES STRATEGIC DIRECTION FOR THE SYSTEM. (2) WEST GEORGIA MEDICAL CENTER, INC. (WGMC)-- OPERATES A 276-BED ACUTE CARE HOSPITAL; A 150-BED SKILLED NURSING HOME (FLORENCE HAND HOME); A 112- BED SKILLED NURSING HOME (TWIN FOUNTAINS HOME); WEST GEORGIA HOSPICE (A HOME HOSPICE AGENCY) PLUS A 16-BED INPATIENT FACILITY); AND WEST GEORGIA HOME CARE WHICH PROVIDES HOME CARE SERVICES TO TROUP, HEARD, HARRIS, MERIWETHER COUNTIES. (3) VERNON WOODS RETIREMENT COMMUNITY, INC. - VERNON WOODS OPERATES A RETIREMENT COMMUNITY OFFERING BOTH ASSISTED AND INDEPENDENT LIVING. (4) WEST GEORGIA HEALTH FOUNDATION, INC. - THE FOUNDATION PROVIDES FUNDRAISING AND SUPPORT FOR WEST GEORGIA HEALTH SERVICES, INC. AND ITS AFFILIATES. (5) WEST GEORGIA HEALTH PHYSICIANS INC. - THIS IS A PHYSICIAN SERVICE ORGANIZATION WHICH PROVIDES SPECIALIZED MEDICAL SERVICES TO THE COMMUNITY. PART VI, LINE 7, REPORTS FILED WITH STATES GA 1 TROUP CARES 301 MEDICAL DRIVE 501 LAGRANGE GA 30240 208176300 501(C)(3) 60000 SUPPLEMENTAL SUPPORT BOYS AND GIRLS CLUB OF WEST GEORGIA PO BOX 1328 LAGRANGE GA 30241 581998988 501(C)(3) 10000 2015 SPONSORSHIP TROUP COUNTY CENTER FOR STRATEGIC PLANNING 100 RIDLEY AVENUE STE 2200 LAGRANGE GA 30240 270863139 501(C)(3) 10000 OPERATIONAL SUPPORT CIRCLES OF TROUP COUNTY 1220 LAFAYETTE PARKWAY LAGRANGE GA 30241 270863139 501(C)(3) 25000 RELAY FOR LIFE SPONSORSHIP WEST GEORGIA HEALTH FOUNDATION 1514 VERNON ROAD LAGRANGE GA 30240 200936376 501(C)(3) 85000 SUPPORT FOR UPCOMING CANCER PROGRAM AMERICAN CANCER SOCITY 233 12TH STREET SUITE 710 COLUMBUS GA 31901 131788491 501(C)(3) 10000 RELAY FOR LIFE SPONSORSHIP LAGRANGE-TROUP COUNTY CHAMBER OF COMMERCE PO BOX 636 LAGRANGE GA 30241 580318810 501(C)(6) 10000 OPERATIONAL SUPPORT 6 1 PART I, LINE 2: GRANTS MADE TO INDIVIDUALS ARE NOT PAID DIRECTLY TO THE INDIVIDUAL UNLESS SUBSTANTIATED BY RECEIPTS. MOST PAYMENTS ARE MADE DIRECTLY TO THE EDUCATIONAL INSTITUTION FOR THE GRANT RECIPIENT'S TUITION AND BOOKS. GRANTS MADE TO GOVERNMENTS AND ORGANIZATIONS ARE NOT MONITORED. X 1 1 X X X 0 1 0 0 0 0 0 0 0 GERALD N FULKS PRESIDENT/CEO 398304 0 64000 0 10436 0 76565 0 15980 0 565285 0 0 0 PAUL R PERROTTI SENIOR VP FINANCE/CFO 275838 0 32907 0 9270 0 30660 0 21889 0 370564 0 0 0 CHARIS ACREE SENIOR VP OPERATIONS 228713 0 24234 0 15773 0 62969 0 21800 0 353489 0 0 0 TRIPP PENN VP SUPPORT SERVICES 156115 0 22199 0 3961 0 7929 0 24974 0 215178 0 0 0 DEBORAH W BURTON VP/CHIEF NURSING OFFICER 161382 0 23555 0 3340 0 50020 0 14312 0 252609 0 0 0 TOMMY BRITT VP HUMAN RESOURCES 134950 0 19426 0 6313 0 6614 0 21569 0 188872 0 0 0 LIZA FRITCHLEY VP SENIOR SERVICES 133762 0 17326 0 9496 0 5263 0 22664 0 188511 0 0 0 MARY SPARROW PHARMACIST 132109 0 450 0 6087 0 35291 0 7119 0 181056 0 0 0 DON DAVIS DIRECTOR, PHARMACY 147929 0 11143 0 6907 0 44176 0 756 0 210911 0 0 0 ALFRED MCNAIR PHARMACIST 131341 0 13688 0 6368 0 50794 0 20694 0 222885 0 0 0 CAROL TODD GENERAL COUNSEL 155494 0 15661 0 6651 0 27531 0 2494 0 207831 0 0 0 JANICE PAGE PHARMACIST 131414 0 450 0 125 0 5577 0 22701 0 160267 0 0 0 PART I, LINE 1A THE ORGANIZATION PAYS COUNTRY CLUB DUES FOR THE CEO ONLY. THESE ARE ADDED TO HIS TAXABLE COMPENSATION. PART I, LINE 4B 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. A LAGRANGE-TROUP COUNTY HOSPITAL AUTHORITY 562609278 507154AF9 2008-07-31 45434268 CONSTRUCTION 0 0 0 B LAGRANGE-TROUP COUNTY HOSPITAL AUTHORITY 562609278 NONEAVAIL 2014-08-15 22389764 REFUNDING 0 0 0 A 4875000 46001275 4619242 900528 45782302 2011 0 0 1 1 B 678494 22389764 164498 22240003 2014 1 0 1 1 A 0 0 0 0 0.00000 0.00000 0 0 0 B 0 0 0 0 0.00000 0.00000 0.00000 0 0 0 A 0 0 1 0 0 0 0 0 1 B 0 0 1 0 0 0 0 0 1 A 0 B 0 SCH K, PART I, COLUMN (F) PROCEEDS FOR ALL BONDS LISTED ARE FOR THE PURPOSE OF FINANCING HEALTHCARE FACILITIES OF A 501(C)(3) ORGANIZATION. SERIES 2008A WAS ISSUED FOR THE FOLLOWING PURPOSE: (1) TO FINANCE OR REFINANCE A PORTION OF THE COSTS OF CERTAIN FACILITIES INCLUDING THE ACQUISITION AND CONSTRUCTION OF ADDITIONAL HEALTHCARE FACILITIES AND THE RENOVATION OF EXISTING HEALTHCARE FACILITIES OF THE AUTHORITY IN TROUP COUNTY, GEORGIA, WHICH ARE PART OF WEST GEORGIA MEDICAL CENTER, (2) TO PAY CAPITALIZED INTEREST DURING THE CONSTRUCTION PERIOD OF THE PROJECT, AND (3) TO PAY COSTS OF ISSUANCE OF THE SERIES 2008A CERTIFICATES SERIES 2014 WAS ISSUED FOR THE FOLLOWING PURPOSE: (1) TO REFUND THE OUTSTANDING SERIES 2010 CERTIFICATES, AND (2) TO PAY ALL OR A PORTION OF THE COST OF ISSUING THE CERTIFICATES. 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 ACCORDING TO THE CORPORATE BYLAWS OF WEST GEORGIA MEDICAL CENTER - THE BOARD OF DIRECTORS OF THE CORPORATION SHALL BE APPOINTED BY THE PARENT BOARD OF THE CORPORATION'S SOLE MEMBER, WEST GEORGIA HEALTH SERVICES, INC. PER ARTICLE III SECTION 2 THE BOARD OF DIRECTORS OF THE CORPORATION SHALL CONSIST OF BETWEEN NINE (9) AND SEVENTEEN (17), WITH AN EXACT NUMBER OF MEMBERS TO BE SET BY RESOLUTION OF THE BOARD OF DIRECTORS ("THE PARENT BOARD") OF THE CORPORATION'S SOLE MEMBER, WEST GEORGIA HEALTH SERVICES, INC. THE BOARD OF DIRECTORS SHALL BE APPOINTED BY THE PARENT BOARD. AS OF THE COMMENCEMENT DATE OF THE LEASE AND TRANSFER AGREEMENT, THE CRITERIA FOR THE SELECTION OF THE MEMBERS OF THE BOARD OF DIRECTORS SHALL BE AS FOLLOWS: (A) FIVE (5) OF THE MEMBERS SHALL BE THE MEMBERS OF THE PARENT BOARD ("PARENT BOARD MEMBERS"); (B) ONE (1) MEMBER SHALL BE THE COUNTY AUTHORITY MEMBER NOT SERVING ON THE PARENT BOARD; (C) ONE (1) MEMBER SHALL BE THE CITY AUTHORITY MEMBER NOT SERVING ON THE PARENT BOARD; (D) TWO (2) OF THE MEMBERS SHALL BE PHYSICIANS NOMINATED BY THE TROUP COUNTY MEDICAL SOCIETY ("MEDICAL SOCIETY MEMBER (S)") AND APPOINTED BY A MAJORITY VOTE OF THE PARENT BOARD FORM 990, PART VI, SECTION A, LINE 7B PER ARTICLE IX OF ARTICLES OF INCORPORATION, NOTWITHSTANDING ANY OTHER PROVISIONS OF THESE ARTICLES OF INCORPORATION OR THE CORPORATION'S BYLAWS, THE CORPORATION MAY NOT TAKE ANY OF THE FOLLOWING ACTIONS WITHOUT THE APPROVAL OF ITS SOLE MEMBER, WEST GEORGIA HEALTH SERVICES, INC.: (I) AMEND OR RESTATE THE ARTICLES OF INCORPORATION OR THE BYLAWS OF THE CORPORATION; (II) APPOINT OR REMOVE A DIRECTOR OR THE PRESIDENT AND CHIEF EXECUTIVE OFFICER OF THE CORPORATION; (III) ORGANIZE ANY SUBSIDIARY CORPORATION OR ENTER INTO ANY JOINT VENTURE OR PARTNERSHIP; (IV) ADOPT A PLAN OF LIQUIDATION OR DISSOLUTION (V) ENTER INTO ANY TRANSACTION PROVIDING FOR THE SALE, MORTGAGE OR OTHER DISPOSITION OF ALL OR SUBSTANTIALLY ALL OF THE ASSETS OF THE CORPORATION, OR PROVIDING FOR A CHANGE IN CONTROL OVER THE CORPORATION; (VI) ADOPT A PLAN OF MERGER OR CONSOLIDATION WITH ANOTHER CORPORATION; (VII) ADOPT OR AMEND AN ANNUAL OPERATING BUDGET OR CAPITAL BUDGET OR MAKE ANY EXPENDITURE IN EXCESS OF $50,000 EXCEPT PURSUANT TO A BUDGET OR EXPENDITURE POLICIES APPROVED BY WEST GEORGIA HEALTH SERVICES, INC.; OR (VII) AMEND OR TERMINATE ANY LEASE OF A HOSPITAL FACILITY TO WHICH THE CORPORATION IS A PARTY. FORM 990, PART VI, SECTION B, LINE 11 THE RETURN WAS PREPARED BY AN INDEPENDENT ACCOUNTING FIRM WITH ASSISTANCE AND OVERSIGHT BY MANAGEMENT. THE 990 WILL BE REVIEWED AND APPROVED BY THE CONTROLLER AND CFO OF WEST GEORGIA HEALTH. A COPY OF THE REVIEWED AND APPROVED 990 WILL BE DISTRIBUTED TO EACH BOARD MEMBER PRIOR TO SUBMITTAL ELECTRONICALLY VIA E-MAIL. FORM 990, PART VI, SECTION B, LINE 12C THE CONFLICT OF INTEREST POLICY APPLIES TO ALL EMPLOYEES AND DIRECTORS OF WEST GEORGIA HEALTH. 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 THE 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 CORPOATION. FORM 990, PART VI, SECTION B, LINE 15 HUMAN RESOURCES MAKES COMPENSATION RECOMMENDATIONS BASED ON COMPARATIVE MARKET ANALYSIS. THE DATA 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 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. IN ADDITION, AS A HOSPITAL AUTHORITY BOND ISSUER, ANNUAL FINANCIALS ARE REPORTED ON EMMA_ELECTRONIC MUNICIPAL MARKET ACCESS WEBSITE FOR PUBLIC INSPECTION. FORM 990, PART IX, LINE 11G CONTRACT LABOR: PROGRAM SERVICE EXPENSES 4,835,070. MANAGEMENT AND GENERAL EXPENSES 50,459. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 4,885,529. PROFESSIONAL FEES AND SERVICES: PROGRAM SERVICE EXPENSES 19,792,370. MANAGEMENT AND GENERAL EXPENSES 460,890. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 20,253,260. CONSULTING: PROGRAM SERVICE EXPENSES 1,094,516. MANAGEMENT AND GENERAL EXPENSES 1,832,546. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 2,927,062. FORM 990, PART XI, LINE 9: PENSION LIABILITY ADJUSTMENT -15,597,680. EQUITY TRANSFER TO AFFILIATE PSO -9,172,315. ASC 715 RESTATEMENT OF NET PENSION OBLIGATIONS -35,355,993. PART XII, LINE 2C THIS PROCESS HAS NOT CHANGED FROM THE PRIOR YEAR. WEST GEORGIA HEALTH FOUNDATION INC 1514 VERNON ROAD LAGRANGE GA 30240 200936376 FUNDRAISING GA 501(C)(3) LINE 7 WEST GEORGIA HEALTH SERVICES INC 0 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 VERNON WOODS RETIREMENT COMMUNITY INC 1514 VERNON ROAD LAGRANGE GA 30240 582575049 ASSISTED LIVING GA 501(C)(3) LINE 9 WEST GEORGIA HEALTH SERVICES INC 0 LAGRANGE-TROUP COUNTY HOSPITAL AUTHORITY 1514 VERNON ROAD LAGRANGE GA 30240 562609278 HOSPITAL AUTHORITY GA 501(C)(3) LINE 3 N/A 0 MEDICAL PARK FOUNDATION INC 209 BROOME STREET LAGRANGE GA 30240 581303478 SUPPORTING ORGANIZATION GA 501(C)(3) LINE 11A, I WEST GEORGIA HEALTH SERVICES INC 0 WEST GEORGIA HEALTH PHYSICIANS INC 1514 VERNON ROAD LAGRANGE GA 30240 275125341 PHYSICIAN PRACTICE GA N/A C 0 0 1 1 0 0 0 0 0 0 1 1 1 1 1 1 0 1 0 0