WEST GEORGIA HEALTH FOUNDATION INC: Form 990, tax year 2012

View the entire original 990 at ProPublica ↗

Organization
WEST GEORGIA HEALTH FOUNDATION INC (EIN 20-0936376)
Tax period
2012-10-01 to 2013-09-30
Filed
2014-08-08
IRS object ID
201432209349300613
Schema version
2012v2.1
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 ReturnHeader

FieldValueIRS element (for citing)
Timestamp2014-08-08T08:47:07-05:00Timestamp
Tax Period End Date2013-09-30TaxPeriodEndDate

Preparer Firm PreparerFirm

FieldValueIRS element (for citing)
EIN560747981EIN

Preparer Firm Business Name PreparerFirmBusinessName

FieldValueIRS element (for citing)
Business Name Line1DIXON HUGHES GOODMAN LLPBusinessNameLine1

Preparer Firm US Address PreparerFirmUSAddress

FieldValueIRS element (for citing)
Address Line1500 RIDGEFIELD COURTAddressLine1
CityASHEVILLECity
StateNCState
ZIP Code28806ZIPCode
FieldValueIRS element (for citing)
Return Type990ReturnType
Tax Period Begin Date2012-10-01TaxPeriodBeginDate

Filer Filer

FieldValueIRS element (for citing)
EIN200936376EIN

Name Name

FieldValueIRS element (for citing)
Business Name Line1WEST GEORGIA HEALTH FOUNDATION INCBusinessNameLine1
FieldValueIRS element (for citing)
Name ControlWESTNameControl
Phone7068821411Phone

US Address USAddress

FieldValueIRS element (for citing)
Address Line11514 VERNON ROADAddressLine1
CityLAGRANGECity
StateGAState
ZIP Code30240ZIPCode

Officer Officer

FieldValueIRS element (for citing)
NamePAUL PERROTTIName
TitleCFOTitle
Phone7068821411Phone
Date Signed2014-08-08DateSigned
Authorize Third Party1AuthorizeThirdParty

Preparer Preparer

FieldValueIRS element (for citing)
NameAMY BIBBYName
PTINP00445891PTIN
Phone8282542254Phone
FieldValueIRS element (for citing)
Tax Year2012TaxYear
Build TS2015-11-30 17:44:51ZBuildTS

Form 990 IRS990

FieldValueIRS element (for citing)
Name Of Principal Officer PersonPAUL PERROTTINameOfPrincipalOfficerPerson

Address Principal Officer US AddressPrincipalOfficerUS

FieldValueIRS element (for citing)
Address Line11514 VERNON ROADAddressLine1
CityLAGRANGECity
StateGAState
ZIP Code30240ZIPCode
FieldValueIRS element (for citing)
Gross Receipts2492727GrossReceipts
Group Return For Affiliates0GroupReturnForAffiliates
Organization501c3XOrganization501c3
Web SiteWWW.WGHEALTH.ORGWebSite
Type Of Organization CorporationXTypeOfOrganizationCorporation
Year Formation2004YearFormation
State Legal DomicileGAStateLegalDomicile
Activity Or Mission DescriptionTHE FOUNDATION OPERATES EXCLUSIVELY FOR THE BENEFIT OF THE WEST GEORGIA MEDICAL CENTER, INC. AND ITS AFFILIATED ENTITIES.ActivityOrMissionDescription
Nbr Voting Members Governing Body13NbrVotingMembersGoverningBody
Nbr Independent Voting Members9NbrIndependentVotingMembers
Total Nbr Employees3TotalNbrEmployees
Total Nbr Volunteers86TotalNbrVolunteers
Total Gross UBI0TotalGrossUBI
Net Unrelated Business Txbl Income0NetUnrelatedBusinessTxblIncome
Contributions Grants Prior Year452183ContributionsGrantsPriorYear
Contributions Grants Current Year1999511ContributionsGrantsCurrentYear
Program Service Revenue Prior Year0ProgramServiceRevenuePriorYear
Program Service Revenue CY0ProgramServiceRevenueCY
Investment Income Prior Year399495InvestmentIncomePriorYear
Investment Income Current Year439876InvestmentIncomeCurrentYear
Other Revenue Prior Year0OtherRevenuePriorYear
Other Revenue Current Year0OtherRevenueCurrentYear
Total Revenue Prior Year851678TotalRevenuePriorYear
Total Revenue Current Year2439387TotalRevenueCurrentYear
Grants And Similar Amnts Prior Year225436GrantsAndSimilarAmntsPriorYear
Grants And Similar Amnts CY144801GrantsAndSimilarAmntsCY
Benefits Paid To Members Prior Year0BenefitsPaidToMembersPriorYear
Benefits Paid To Members CY0BenefitsPaidToMembersCY
Salaries Etc Prior Year0SalariesEtcPriorYear
Salaries Etc Current Year0SalariesEtcCurrentYear
Total Prof Fundrsng Exp Prior Year0TotalProfFundrsngExpPriorYear
Total Prof Fundrsng Exp CY0TotalProfFundrsngExpCY
Total Fundrsng Exp Current Year0TotalFundrsngExpCurrentYear
Other Expense Prior Year153772OtherExpensePriorYear
Other Expenses Current Year91947OtherExpensesCurrentYear
Total Expenses Prior Year379208TotalExpensesPriorYear
Total Expenses Current Year236748TotalExpensesCurrentYear
Revenues Less Expenses Prior Year472470RevenuesLessExpensesPriorYear
Revenues Less Expenses CY2202639RevenuesLessExpensesCY
Total Assets BOY6337735TotalAssetsBOY
Total Assets EOY8583037TotalAssetsEOY
Total Liabilities BOY62899TotalLiabilitiesBOY
Total Liabilities EOY0TotalLiabilitiesEOY
Net Assets Or Fund Balances BOY6274836NetAssetsOrFundBalancesBOY
Net Assets Or Fund Balances EOY8583037NetAssetsOrFundBalancesEOY
Mission DescriptionTHE FOUNDATION OPERATES EXCLUSIVELY FOR THE BENEFIT OF THE WEST GEORGIA MEDICAL CENTER, INC. AND ITS AFFILIATED ENTITIES.MissionDescription
Significant New Program Services0SignificantNewProgramServices
Significant Change0SignificantChange
Expense110288Expense
Grants34958Grants
DescriptionTO PROVIDE FUNDS FOR SPECIFIC MEDICAL AND CANCER TREATING EQUIPMENT AND SUPPORT OF WEST GEORGIA MEDICAL CENTER.Description

Activity2 Activity2

FieldValueIRS element (for citing)
Expense90234Expense
Grants90234Grants
DescriptionTO PROVIDE FINANCIAL SUPPORT TO WEST GEORGIA MEDICAL CENTER, INC. FOR OPERATING THE HOSPICE CENTER.Description

Activity3 Activity3

FieldValueIRS element (for citing)
Expense19609Expense
Grants19609Grants
DescriptionHELPING 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, 2012 - SEPTEMBER 30, 2013, THE HELPING HANDS PROGRAMS ASSISTED 51 WEST GEORGIA HEALTH SYSTEM EMPLOYEES BY PROVIDING $19,609 IN MONETARY ASSISTANCE.Description
FieldValueIRS element (for citing)
Total Program Service Expense220131TotalProgramServiceExpense
Described In501 C31DescribedIn501C3
Schedule B Required1ScheduleBRequired
Political Activities0PoliticalActivities
Lobbying Activities0LobbyingActivities
Subject To Proxy Tax0SubjectToProxyTax
Donor Advised Funds0DonorAdvisedFunds
Conservation Easements0ConservationEasements
Collections Of Art0CollectionsOfArt
Credit Counseling0CreditCounseling
Term Or Permanent Endowments1TermOrPermanentEndowments
Report Land Bldg Equip1ReportLandBldgEquip
Report Invest Oth Securities0ReportInvestOthSecurities
Report Prog Rel Invest0ReportProgRelInvest
Report Other Assets0ReportOtherAssets
Report Other Liabilities0ReportOtherLiabilities
Report Fin48 Footnote1ReportFin48Footnote
Independent Audit Financial Stmt1IndependentAuditFinancialStmt
Consolidated Audit Financial Stmt1ConsolidatedAuditFinancialStmt
School0School
Foreign Office0ForeignOffice
Foreign Activities0ForeignActivities
More Than5000 K To Organizations0MoreThan5000KToOrganizations
More Than5000 K To Individuals0MoreThan5000KToIndividuals
Professional Fundraising0ProfessionalFundraising
Fundraising Activities1FundraisingActivities
Gaming0Gaming
Hospital0Hospital
Grants To Organizations1GrantsToOrganizations
Grants To Individuals1GrantsToIndividuals
Schedule J Required1ScheduleJRequired
Tax Exempt Bonds0TaxExemptBonds
Excess Benefit Transaction0ExcessBenefitTransaction
Prior Excess Benefit Transaction0PriorExcessBenefitTransaction
Loan To Officer Or DQP0LoanToOfficerOrDQP
Grant To Related Person0GrantToRelatedPerson
Bsnss Rltnshp With Organization0BsnssRltnshpWithOrganization
Bsnss Rltnshp Thru Family Member0BsnssRltnshpThruFamilyMember
Officer Entity With Bsnss Rltnshp0OfficerEntityWithBsnssRltnshp
Deductible Non Cash Contributions0DeductibleNonCashContributions
Deductible Contributions Of Art0DeductibleContributionsOfArt
Terminated0Terminated
Partial Liquidation0PartialLiquidation
Disregarded Entity0DisregardedEntity
Related Entity1RelatedEntity
Related Org Controlled Entity0RelatedOrgControlledEntity
Transfers To Exempt Non Chrtbl Org0TransfersToExemptNonChrtblOrg
Activities Conducted Partnership0ActivitiesConductedPartnership
Schedule O Required1ScheduleORequired
Number Forms Transmitted With10963NumberFormsTransmittedWith1096
Number W2 G Included0NumberW2GIncluded
Compliance With Backup Witholding1ComplianceWithBackupWitholding
Number Of Employees3NumberOfEmployees
Employment Tax Returns Filed1EmploymentTaxReturnsFiled
Unrelated Business Income0UnrelatedBusinessIncome
Foreign Financial Account0ForeignFinancialAccount
Prohibited Tax Shelter Trans0ProhibitedTaxShelterTrans
Taxable Party Notification0TaxablePartyNotification
Non Deductible Contributions0NonDeductibleContributions
Quid Pro Quo Contributions1QuidProQuoContributions
Quid Pro Quo Disclosure1QuidProQuoDisclosure
Form8282 Property Disposed Of0Form8282PropertyDisposedOf
Funds To Pay Premiums0FundsToPayPremiums
Premiums Paid0PremiumsPaid
Indoor Tanning Services0IndoorTanningServices
Info In Schedule O Part VIXInfoInScheduleOPartVI
Nbr Voting Governing Body Members13NbrVotingGoverningBodyMembers
Number Independent Voting Members9NumberIndependentVotingMembers
Family Or Business Relationship1FamilyOrBusinessRelationship
Delegation Of Management Duties0DelegationOfManagementDuties
Changes To Organizing Docs0ChangesToOrganizingDocs
Material Diversion Or Misuse0MaterialDiversionOrMisuse
Members Or Stockholders1MembersOrStockholders
Election Of Board Members1ElectionOfBoardMembers
Decisions Subject To Approval1DecisionsSubjectToApproval
Minutes Of Governing Body1MinutesOfGoverningBody
Minutes Of Committees1MinutesOfCommittees
Officer Mailing Address0OfficerMailingAddress
Local Chapters0LocalChapters
Form990 Provided To Governing Body1Form990ProvidedToGoverningBody
Conflict Of Interest Policy1ConflictOfInterestPolicy
Annual Disclosure Covered Persons1AnnualDisclosureCoveredPersons
Regular Monitoring Enforcement1RegularMonitoringEnforcement
Whistleblower Policy1WhistleblowerPolicy
Document Retention Policy1DocumentRetentionPolicy
Compensation Process CEO0CompensationProcessCEO
Compensation Process Other0CompensationProcessOther
Investment In Joint Venture0InvestmentInJointVenture
States Where Copy Of Return Is FiledGAStatesWhereCopyOfReturnIsFiled
Upon RequestXUponRequest

The Books Are In Care Of TheBooksAreInCareOf

Name Business NameBusiness

FieldValueIRS element (for citing)
Business Name Line1SHANNON DICKERSON WEST GEORGIA HEALTHBusinessNameLine1
FieldValueIRS element (for citing)
Telephone Number7068453157TelephoneNumber

Address US AddressUS

FieldValueIRS element (for citing)
Address Line11514 VERNON ROADAddressLine1
CityLAGRANGECity
StateGAState
ZIP Code30240ZIPCode

Form990 Part VII Section A Form990PartVIISectionA (16 entries)

TitleTitleAverage Hours Per WeekAverageHoursPerWeekIndividual Trustee Or DirectorIndividualTrusteeOrDirectorOfficerOfficerReportable Comp From OrganizationReportableCompFromOrganizationReportable Comp From Related OrgsReportableCompFromRelatedOrgsOther CompensationOtherCompensationAverage Hours Per Week RelatedAverageHoursPerWeekRelated
WESLEY SMITH
CHAIRMAN1.00XX000
DR RICHARD SANDY SIMMONS
VICE CHAIRMAN1.00XX02082191289140.00
WAYNE ABBOTT
TREASURER1.00XX000
BETTY DRINKARD
MEMBER1.00X000
RICK MALLORY
MEMBER1.00X000
AIMEE THOMPSON MADDOX
MEMBER1.00X0620502344240.00
CHARLES SMITH
MEMBER1.00X000
JOHN JACKSON
MEMBER1.00X000
DR ROBERT COGGINS
MEMBER1.00X000
BEVERLY LUNDBERG
MEMBER1.00X000
DR BRETT BOWIE
MEMBER THROUGH DECEMBER 20121.00X0180000
DR JULIAN DUTTERA
MEMBER1.00X0138750
ELLEN HARRIS
MEMBER1.00X0002.00
DR DAVID MARTIN
MEMBER1.00X0101575040.00
GERALD FULKS
SECRETARY1.00X019895389086743.00
PAUL PERROTTI
CFO AND VP OF WHGS1.00X02527244994442.00
FieldValueIRS element (for citing)
Total Reportable Comp From Org0TotalReportableCompFromOrg
Total Reportable Comp Frm Rltd Orgs2645981TotalReportableCompFrmRltdOrgs
Total Other Compensation177144TotalOtherCompensation
Number Individuals GT100 K0NumberIndividualsGT100K
Formers Listed0FormersListed
Total Comp GT150 K1TotalCompGT150K
Compensation From Other Sources0CompensationFromOtherSources
Number Of Contractors GT100 K0NumberOfContractorsGT100K
Fundraising Events63645FundraisingEvents
All Other Contributions1935866AllOtherContributions
Total Contributions1999511TotalContributions

Investment Income InvestmentIncome

FieldValueIRS element (for citing)
Total Revenue Column114173TotalRevenueColumn
Exclusion$114,173ExclusionAmount

Gross Amount Sales Assets GrossAmountSalesAssets

FieldValueIRS element (for citing)
Securities325703Securities

Less Cost Oth Basis Sales Expenses LessCostOthBasisSalesExpenses

FieldValueIRS element (for citing)
Securities0Securities

Gain Or Loss GainOrLoss

FieldValueIRS element (for citing)
Securities325703Securities

Net Gain Or Loss Investments NetGainOrLossInvestments

FieldValueIRS element (for citing)
Total Revenue Column325703TotalRevenueColumn
Exclusion$325,703ExclusionAmount
FieldValueIRS element (for citing)
Gross Income Fundraising Events53340GrossIncomeFundraisingEvents
Cntrbtns Rprtd Fundraising Events63645CntrbtnsRprtdFundraisingEvents
Fundraising Direct Expenses53340FundraisingDirectExpenses

Net Income From Fundraising Events NetIncomeFromFundraisingEvents

FieldValueIRS element (for citing)
Total Revenue Column0TotalRevenueColumn

Total Revenue TotalRevenue

FieldValueIRS element (for citing)
Total Revenue Column2439387TotalRevenueColumn
Related Or Exempt Function Income0RelatedOrExemptFunctionIncome
Unrelated Business Revenue0UnrelatedBusinessRevenue
Exclusion$439,876ExclusionAmount

Grants To Domestic Orgs GrantsToDomesticOrgs

FieldValueIRS element (for citing)
Total124957Total
Program Services124957ProgramServices

Grants To Domestic Individuals GrantsToDomesticIndividuals

FieldValueIRS element (for citing)
Total19844Total
Program Services19844ProgramServices

Fees For Services Invst Mgmnt Fees FeesForServicesInvstMgmntFees

FieldValueIRS element (for citing)
Total14077Total
Management And General14077ManagementAndGeneral

Office Expenses OfficeExpenses

FieldValueIRS element (for citing)
Total73381Total
Program Services70841ProgramServices
Management And General2540ManagementAndGeneral

Other Expenses OtherExpenses

FieldValueIRS element (for citing)
DescriptionCAMP DOGWOOD GRIEF CAMPDescription
Total4489Total
Program Services4489ProgramServices

Total Functional Expenses TotalFunctionalExpenses

FieldValueIRS element (for citing)
Total236748Total
Program Services220131ProgramServices
Management And General16617ManagementAndGeneral
Fundraising0Fundraising

Cash Non Interest Bearing CashNonInterestBearing

FieldValueIRS element (for citing)
BOY808218BOY
EOY1199961EOY

Pledges And Grants Receivable PledgesAndGrantsReceivable

FieldValueIRS element (for citing)
BOY219483BOY
EOY1569886EOY

Investments Pub Traded Securities InvestmentsPubTradedSecurities

FieldValueIRS element (for citing)
BOY5310034BOY
EOY5813190EOY

Total Assets TotalAssets

FieldValueIRS element (for citing)
BOY6337735BOY
EOY8583037EOY

Other Liabilities OtherLiabilities

FieldValueIRS element (for citing)
BOY62899BOY
EOY0EOY

Total Liabilities TotalLiabilities

FieldValueIRS element (for citing)
BOY62899BOY
EOY0EOY
FieldValueIRS element (for citing)
Follow SFAS117XFollowSFAS117

Temporarily Restricted Net Assets TemporarilyRestrictedNetAssets

FieldValueIRS element (for citing)
BOY5362836BOY
EOY7671037EOY

Permanently Restricted Net Assets PermanentlyRestrictedNetAssets

FieldValueIRS element (for citing)
BOY912000BOY
EOY912000EOY

Total Net Assets Fund Balances TotalNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY6274836BOY
EOY8583037EOY

Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY6337735BOY
EOY8583037EOY
FieldValueIRS element (for citing)
Reconcilation Revenue Expenses2202639ReconcilationRevenueExpenses
Reconciliation Unrealized Invest105562ReconciliationUnrealizedInvest
Reconcilation Other Changes0ReconcilationOtherChanges
Method Of Accounting AccrualXMethodOfAccountingAccrual
Accountant Compile Or Review0AccountantCompileOrReview
FS Audited1FSAudited

FS Audited Basis FSAuditedBasis

FieldValueIRS element (for citing)
Financial Statement BothXFinancialStatementBoth
FieldValueIRS element (for citing)
Audit Committee1AuditCommittee
Federal Grant Audit Required0FederalGrantAuditRequired

Schedule A IRS990ScheduleA

FieldValueIRS element (for citing)
Publicly Supported Org170b1 AviXPubliclySupportedOrg170b1Avi

Gifts Grants Contrib Received170 GiftsGrantsContribReceived170

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years748072CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years476864CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years1007236CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year452183CurrentTaxYearMinus1Year
Current Tax Year1999511CurrentTaxYear
Total4683866Total

Total170 Total170

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years748072CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years476864CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years1007236CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year452183CurrentTaxYearMinus1Year
Current Tax Year1999511CurrentTaxYear
Total4683866Total
FieldValueIRS element (for citing)
Amounts Subst Contributors Total1357398AmountsSubstContributorsTotal
Public Support Total1703326468PublicSupportTotal170

Gross Investment Income170 GrossInvestmentIncome170

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years219576CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years146610CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years136866CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year399495CurrentTaxYearMinus1Year
Current Tax Year439876CurrentTaxYear
Total1342423Total
FieldValueIRS element (for citing)
Total Support6026289TotalSupport
Public Support Pertcentage1700.55200PublicSupportPertcentage170
Public Support Pertcent Prior Year0.66890PublicSupportPertcentPriorYear
Thirty Three Percnt Tests CY170XThirtyThreePercntTestsCY170

Schedule B IRS990ScheduleB

Contributor Info ContributorInfo

FieldValueIRS element (for citing)
Contributor NumberRESTRICTEDContributorNumber

Contributor Name Business ContributorNameBusiness

FieldValueIRS element (for citing)
Business Name Line1RESTRICTEDBusinessNameLine1

Contributor Address US ContributorAddressUS

FieldValueIRS element (for citing)
Address Line1RESTRICTEDAddressLine1
Address Line2RESTRICTEDAddressLine2
CityRESTRICTEDCity
StateRESTRICTEDState
ZIP CodeRESTRICTEDZIPCode
FieldValueIRS element (for citing)
Aggregate ContributionsRESTRICTEDAggregateContributions

Schedule D IRS990ScheduleD

Current Year CurrentYear

FieldValueIRS element (for citing)
Beginning Of Year Balance6274836BeginningOfYearBalance
Contributions1933958Contributions
Investment Earnings Or Losses551364InvestmentEarningsOrLosses
Other Expenditures177121OtherExpenditures
End Of Year Balance8583037EndOfYearBalance

Current Year Minus1 Year CurrentYearMinus1Year

FieldValueIRS element (for citing)
Beginning Of Year Balance5489839BeginningOfYearBalance
Contributions451895Contributions
Investment Earnings Or Losses665832InvestmentEarningsOrLosses
Other Expenditures332730OtherExpenditures
End Of Year Balance6274836EndOfYearBalance

Current Year Minus2 Years CurrentYearMinus2Years

FieldValueIRS element (for citing)
Beginning Of Year Balance4800666BeginningOfYearBalance
Contributions945878Contributions
Investment Earnings Or Losses155841InvestmentEarningsOrLosses
Other Expenditures412546OtherExpenditures
End Of Year Balance5489839EndOfYearBalance

Current Year Minus3 Years CurrentYearMinus3Years

FieldValueIRS element (for citing)
Beginning Of Year Balance5264798BeginningOfYearBalance
Contributions523813Contributions
Investment Earnings Or Losses647124InvestmentEarningsOrLosses
Other Expenditures1635069OtherExpenditures
End Of Year Balance4800666EndOfYearBalance

Current Year Minus4 Years CurrentYearMinus4Years

FieldValueIRS element (for citing)
Beginning Of Year Balance12371256BeginningOfYearBalance
Contributions821933Contributions
Investment Earnings Or Losses-3776InvestmentEarningsOrLosses
Other Expenditures7924615OtherExpenditures
End Of Year Balance5264798EndOfYearBalance
FieldValueIRS element (for citing)
Permanent Endowment EOY Balance0.11000PermanentEndowmentEOYBalance
Term Endowment EOY Balance0.89000TermEndowmentEOYBalance
Endowments Held By Unrelated Orgs0EndowmentsHeldByUnrelatedOrgs
Endowments Held By Related Orgs0EndowmentsHeldByRelatedOrgs
Total Of Book Value Land Buildings0TotalOfBookValueLandBuildings
Footnote In Part XIIIXFootnoteInPartXIII
Tot Revenue Etc Audited Fincl Stmt2530977TotRevenueEtcAuditedFinclStmt
Net Unrealized Gains Investments105562NetUnrealizedGainsInvestments
Revenue Not Rptd F990105562RevenueNotRptdF990
Revenue Subtotal2425415RevenueSubtotal
Investment Expenses Not Included13972InvestmentExpensesNotIncluded
Revenue Not Rptd On Fin Stmt13972RevenueNotRptdOnFinStmt
Total Revenue Per Form9902439387TotalRevenuePerForm990
Tot Expenses Etc Audited Fincl Stmt222776TotExpensesEtcAuditedFinclStmt
Expenses Not Rptd F9900ExpensesNotRptdF990
Expenses Subtotal222776ExpensesSubtotal
Investment Expenses Not Included213972InvestmentExpensesNotIncluded2
Expenses Not Rptd On Fin Stmt13972ExpensesNotRptdOnFinStmt
Total Expenses Per Form990236748TotalExpensesPerForm990

Form990 Schedule D Part XIII Form990ScheduleDPartXIII (2 entries)

IdentifierIdentifierReturn ReferenceReturnReferenceExplanationExplanation
DESCRIPTION OF INTENDED USE OF ENDOWMENT FUNDS: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.
DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: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, 2013, AND 2012. FISCAL YEARS ENDING ON AND AFTER SEPTEMBER 30, 2010 REMAIN SUBJECT TO EXAMINATION BY FEDERAL AND STATE TAX AUTHORITIES.

Schedule G IRS990ScheduleG

Events Information EventsInformation

FieldValueIRS element (for citing)
Name Of Event1GOLF TOURNAMENTNameOfEvent1
Gross Receipts Event173210GrossReceiptsEvent1
Charitable Contributions Event139917CharitableContributionsEvent1
Gross Revenue Event133293GrossRevenueEvent1
Cash Prizes Event1240CashPrizesEvent1
Non Cash Prizes Event125011NonCashPrizesEvent1
Rent Facility Costs Event11814RentFacilityCostsEvent1
Food And Beverage Event1187FoodAndBeverageEvent1
Entertainment Event12415EntertainmentEvent1
Other Direct Expenses Event13626OtherDirectExpensesEvent1
Name Of Event2POINSETTIA SALENameOfEvent2
Gross Receipts Event225007GrossReceiptsEvent2
Charitable Contributions Event213906CharitableContributionsEvent2
Gross Revenue Event211101GrossRevenueEvent2
Other Direct Expenses Event211101OtherDirectExpensesEvent2
Total Number Of Other Events2TotalNumberOfOtherEvents
Gross Receipts Other Events18768GrossReceiptsOtherEvents
Charitable Contrib Other Events9822CharitableContribOtherEvents
Gross Revenue Other Events8946GrossRevenueOtherEvents
Non Cash Prizes Other Events250NonCashPrizesOtherEvents
Rent Facility Costs Other Events750RentFacilityCostsOtherEvents
Food And Beverage Other Events75FoodAndBeverageOtherEvents
Other Direct Expenses Other Events7871OtherDirectExpensesOtherEvents
Gross Receipts Total116985GrossReceiptsTotal
Charitable Contributions Total63645CharitableContributionsTotal
Gross Revenue Total Events53340GrossRevenueTotalEvents
Cash Prizes Total Events240CashPrizesTotalEvents
Non Cash Prizes Total Events25261NonCashPrizesTotalEvents
Rent Facility Costs Total Events2564RentFacilityCostsTotalEvents
Food And Beverage Total Events262FoodAndBeverageTotalEvents
Entertainment Total Events2415EntertainmentTotalEvents
Other Direct Expenses Total Events22598OtherDirectExpensesTotalEvents
Direct Expense Summary Events53340DirectExpenseSummaryEvents
Net Income Summary0NetIncomeSummary

Schedule I IRS990ScheduleI

FieldValueIRS element (for citing)
Records Maintained1RecordsMaintained

Recipient Table RecipientTable

Recipient Name Business RecipientNameBusiness

FieldValueIRS element (for citing)
Business Name Line1WEST GEORGIA MEDICAL CENTER INCBusinessNameLine1

Address US AddressUS

FieldValueIRS element (for citing)
Address Line11514 VERNON ROADAddressLine1
CityLAGRANGECity
StateGAState
ZIP Code30240ZIPCode
FieldValueIRS element (for citing)
EIN Of Recipient205497506EINOfRecipient
IRC Section501(C)(3)IRCSection
Amount Of Cash Grant100272AmountOfCashGrant
Amount Of Non Cash Assistance21708AmountOfNonCashAssistance
Method Of ValuationFMVMethodOfValuation
Description Of Non Cash AssistanceMEDICAL EQUIPMENT AND SUPPLIESDescriptionOfNonCashAssistance
Purpose Of GrantSUPPORT FOR VARIOUS BENEVOLENT PROGRAMS INCLUDING THE LIFELINE PROGRAM FOR HOSPICE PATIENTSPurposeOfGrant
FieldValueIRS element (for citing)
Total Nbr Of501 C3 And Govt Grants1TotalNbrOf501C3AndGovtGrants
Total Nbr Of Other Organizations0TotalNbrOfOtherOrganizations

Form990 Schedule I Part III Form990ScheduleIPartIII (2 entries)

Type Of GrantTypeOfGrantNumber Of RecipientsNumberOfRecipientsAmount Of Cash GrantAmountOfCashGrant
HELPING HANDS EMPLOYEE PROGRAM5119609
KISH SCHOLARSHIP1235

Form990 Schedule I Part IV Form990ScheduleIPartIV

FieldValueIRS element (for citing)
IdentifierPROCEDURE FOR MONITORING GRANTS IN THE U.S.:Identifier
Return ReferencePART I, LINE 2:ReturnReference
ExplanationSCHEDULE I, PART I, LINE 2: 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.Explanation

Schedule J IRS990ScheduleJ

FieldValueIRS element (for citing)
Substantiation Required1SubstantiationRequired
Severance Payment0SeverancePayment
Supplemental Nonqual Retire Plan1SupplementalNonqualRetirePlan
Equity Based Comp Arrangement0EquityBasedCompArrangement
Comp Based On Revenue Of Filing Org0CompBasedOnRevenueOfFilingOrg
Comp Based On Revenue Related Orgs0CompBasedOnRevenueRelatedOrgs
Comp Based Net Earnings Filing Org0CompBasedNetEarningsFilingOrg
Comp Based Net Earnings Relate Orgs0CompBasedNetEarningsRelateOrgs
Any Non Fixed Payments0AnyNonFixedPayments
Initial Contract Exception0InitialContractException

Form990 Schedule J Part II Form990ScheduleJPartII (3 entries)

TitleTitleBase Compensation Filing OrgBaseCompensationFilingOrgComp Based On Related OrgsCompBasedOnRelatedOrgsBonus Filing OrgBonusFilingOrgBonus Related OrgsBonusRelatedOrgsOther Compensation Filing OrgOtherCompensationFilingOrgOther Compensation Related OrgsOtherCompensationRelatedOrgsDeferred Comp Filing OrgDeferredCompFilingOrgDeferred Comp Related OrgsDeferredCompRelatedOrgsNontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgNontaxable Benefits Related OrgsNontaxableBenefitsRelatedOrgsTotal Compensation Filing OrgTotalCompensationFilingOrgTotal Compensation Related OrgsTotalCompensationRelatedOrgsComp Report Prior990 Filing OrgCompReportPrior990FilingOrgComp Report Prior990 Related OrgsCompReportPrior990RelatedOrgs
DR RICHARD SANDY SIMMONS
VICE CHAIRMAN0155759000524600399708894022111000
GERALD FULKS
SECRETARY037481200016147260744290164380208040501604903
PAUL PERROTTI
CFO AND VP OF WHGS02511340001590030039019905030266800

Form990 Schedule J Part III Form990ScheduleJPartIII

FieldValueIRS element (for citing)
Return ReferencePART I, LINE 4BReturnReference
ExplanationA RELATED ORGANIZATION, WGMC MADE EMPLOYER CONTRIBUTIONS TO THE 457(F) EXECUTIVE RETIREMENT BENEFIT PLAN INCLUDING $20,260 FOR PAUL PERROTTI, CFO AND $55,700 FOR GERALD FULKS, CEO. IN ADDITION, DURING THE YEAR GERALD FAULKS RECEIVED A PAYOUT FROM THE PLAN IN THE AMOUNT OF $1,604,903.Explanation

Schedule O IRS990ScheduleO

General Explanation GeneralExplanation (9 entries)

Return ReferenceReturnReferenceExplanationExplanation
FORM 990, PART VI, SECTION A, LINE 2BOARD MEMBERS WESLEY SMITH AND CHARLES SMITH HAVE A FAMILY RELATIONSHIP.
FORM 990, PART VI, SECTION A, LINE 6THE SOLE MEMBER OF THE ORGANIZATION IS WEST GEORGIA HEALTH SERVICES, INC. A RELATED 501(C)(3) ORGANIZATION.
FORM 990, PART VI, SECTION A, LINE 7AUPON 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 7BTHE 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 11THE 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 12CANY 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.
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 18THE ORGANIZATION MAKES ITS FORM 990 AVAILABLE TO THE PUBLIC UPON REQUEST.
FORM 990, PART VI, SECTION C, LINE 19THE ORGANIZATION MAKES ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UPON REQUEST.

Schedule R IRS990ScheduleR

Form990 Schedule R Part II Form990ScheduleRPartII (5 entries)

Address Line1AddressUS/AddressLine1CityAddressUS/CityStateAddressUS/StateZIP CodeAddressUS/ZIPCodeEINEINPrimary ActivitiesPrimaryActivitiesLegal Domicile StateLegalDomicileStateExempt Code SectionExemptCodeSectionPublic Charity StatusPublicCharityStatusDirect Controlling Entity NADirectControllingEntityNAControlled OrgControlledOrgBusiness Name Line1DirectControllingEntityName/BusinessNameLine1
LAGRANGE-TROUP COUNTY HOSPITAL AUTHORITY
1514 VERNON ROADLAGRANGEGA30240562609278HOSPITAL AUTHORITYGA501(C)(3)LINE 3N/A0
VERNON WOODS RETIREMENT COMMUNITY INC
1514 VERNON ROADLAGRANGEGA30240582575049ASSISTED LIVINGGA501(C)(3)LINE 90WEST GEORIGA HEALTH SERVICES INC
WEST GEORGIA HEALTH SERVICES INC
1514 VERNON ROADLAGRANGEGA30240205497622PARENT OF HEALTH SYSTEMGA501(C)(3)LINE 11C, III-FIN/A0
WEST GEORGIA MEDICAL CENTER INC
1514 VERNON ROADLAGRANGEGA30240205497506HOSPITALGA501(C)(3)LINE 30WEST GEORIGA HEALTH SERVICES INC
MEDICAL PARK FOUNDATION INC
209 BROOME STREETLAGRANGEGA30240581303478SUPPORTING ORGANIZATIONGA501(C)(3)LINE 11A, I0WEST GEORIGA HEALTH SERVICES INC

Form990 Schedule R Part IV Form990ScheduleRPartIV

Name Of Related Org NameOfRelatedOrg

FieldValueIRS element (for citing)
Business Name Line1WEST GEORGIA HEALTH PHYSICIANS INCBusinessNameLine1

Address US AddressUS

FieldValueIRS element (for citing)
Address Line11514 VERNON ROADAddressLine1
CityLAGRANGECity
StateGAState
ZIP Code30240ZIPCode
FieldValueIRS element (for citing)
EIN275125341EIN
Primary ActivityPHYSICIAN PRACTICEPrimaryActivity
Legal Domicile StateGALegalDomicileState

Direct Controlling Entity Name DirectControllingEntityName

FieldValueIRS element (for citing)
Business Name Line1WEST GEORIGA HEALTH SERVICES INCBusinessNameLine1
FieldValueIRS element (for citing)
Type Of EntityCTypeOfEntity
Controlled Org0ControlledOrg
FieldValueIRS element (for citing)
Receipt Of Int Ann Rents Royalties0ReceiptOfIntAnnRentsRoyalties
Gift Grant Or Cap Contr To Other Org1GiftGrantOrCapContrToOtherOrg
Gift Grant Or Cap Contr Fr Other Org0GiftGrantOrCapContrFrOtherOrg
Loans Or Guarantees To Other Org0LoansOrGuaranteesToOtherOrg
Loans Or Guarantees From Other Org0LoansOrGuaranteesFromOtherOrg
Dividends Related Organization0DividendsRelatedOrganization
Sale Of Assets To Other Org0SaleOfAssetsToOtherOrg
Purchase Of Assets From Other Org0PurchaseOfAssetsFromOtherOrg
Exchange Of Assets0ExchangeOfAssets
Rental Of Facilities To Other Orgs0RentalOfFacilitiesToOtherOrgs
Rental Of Facilities Fr Other Orgs0RentalOfFacilitiesFrOtherOrgs
Perform Of Services For Other Orgs0PerformOfServicesForOtherOrgs
Perform Of Services By Other Orgs1PerformOfServicesByOtherOrgs
Sharing Of Facilities1SharingOfFacilities
Sharing Of Paid Employees1SharingOfPaidEmployees
Reimbursement Paid To Other Org1ReimbursementPaidToOtherOrg
Reimbursement Paid By Other Org0ReimbursementPaidByOtherOrg
Other Transfer To Other Org0OtherTransferToOtherOrg
Other Transfer From Other Org0OtherTransferFromOtherOrg

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