2014-08-08T08:47:07-05:00 2013-09-30 560747981 DIXON HUGHES GOODMAN LLP 500 RIDGEFIELD COURT ASHEVILLE NC 28806 990 2012-10-01 200936376 WEST GEORGIA HEALTH FOUNDATION INC WEST 7068821411 1514 VERNON ROAD LAGRANGE GA 30240 PAUL PERROTTI 7068821411 2014-08-08 1 AMY BIBBY P00445891 8282542254 2012 2015-11-30 17:44:51Z PAUL PERROTTI 1514 VERNON ROAD LAGRANGE GA 30240 2492727 0 X WWW.WGHEALTH.ORG X 2004 GA THE FOUNDATION OPERATES EXCLUSIVELY FOR THE BENEFIT OF THE WEST GEORGIA MEDICAL CENTER, INC. AND ITS AFFILIATED ENTITIES. 13 9 3 86 0 0 452183 1999511 0 0 399495 439876 0 0 851678 2439387 225436 144801 0 0 0 0 0 0 0 153772 91947 379208 236748 472470 2202639 6337735 8583037 62899 0 6274836 8583037 THE FOUNDATION OPERATES EXCLUSIVELY FOR THE BENEFIT OF THE WEST GEORGIA MEDICAL CENTER, INC. AND ITS AFFILIATED ENTITIES. 0 0 110288 34958 TO PROVIDE FUNDS FOR SPECIFIC MEDICAL AND CANCER TREATING EQUIPMENT AND SUPPORT OF WEST GEORGIA MEDICAL CENTER. 90234 90234 TO PROVIDE FINANCIAL SUPPORT TO WEST GEORGIA MEDICAL CENTER, INC. FOR OPERATING THE HOSPICE CENTER. 19609 19609 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, 2012 - SEPTEMBER 30, 2013, THE HELPING HANDS PROGRAMS ASSISTED 51 WEST GEORGIA HEALTH SYSTEM EMPLOYEES BY PROVIDING $19,609 IN MONETARY ASSISTANCE. 220131 1 1 0 0 0 0 0 0 0 1 1 0 0 0 0 1 1 1 0 0 0 0 0 0 1 0 0 1 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 3 0 1 3 1 0 0 0 0 0 1 1 0 0 0 0 X 13 9 1 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 0 0 0 GA X SHANNON DICKERSON WEST GEORGIA HEALTH 7068453157 1514 VERNON ROAD LAGRANGE GA 30240 WESLEY SMITH 1.00 X X 0 0 0 DR RICHARD SANDY SIMMONS 1.00 40.00 X X 0 208219 12891 WAYNE ABBOTT 1.00 X X 0 0 0 BETTY DRINKARD 1.00 X 0 0 0 RICK MALLORY 1.00 X 0 0 0 AIMEE THOMPSON MADDOX 1.00 40.00 X 0 62050 23442 CHARLES SMITH 1.00 X 0 0 0 JOHN JACKSON 1.00 X 0 0 0 DR ROBERT COGGINS 1.00 X 0 0 0 BEVERLY LUNDBERG 1.00 X 0 0 0 DR BRETT BOWIE 1.00 X 0 18000 0 DR JULIAN DUTTERA 1.00 X 0 13875 0 ELLEN HARRIS 1.00 2.00 X 0 0 0 DR DAVID MARTIN 1.00 40.00 X 0 101575 0 GERALD FULKS 1.00 43.00 X 0 1989538 90867 PAUL PERROTTI 1.00 42.00 X 0 252724 49944 0 2645981 177144 0 0 1 0 0 63645 1935866 1999511 114173 114173 325703 0 325703 325703 325703 53340 63645 53340 0 2439387 0 0 439876 124957 124957 19844 19844 14077 14077 73381 70841 2540 CAMP DOGWOOD GRIEF CAMP 4489 4489 236748 220131 16617 0 808218 1199961 219483 1569886 5310034 5813190 6337735 8583037 62899 0 62899 0 X 5362836 7671037 912000 912000 6274836 8583037 6337735 8583037 2202639 105562 0 X 0 1 X 1 0 X 748072 476864 1007236 452183 1999511 4683866 748072 476864 1007236 452183 1999511 4683866 1357398 3326468 219576 146610 136866 399495 439876 1342423 6026289 0.55200 0.66890 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 6274836 1933958 551364 177121 8583037 5489839 451895 665832 332730 6274836 4800666 945878 155841 412546 5489839 5264798 523813 647124 1635069 4800666 12371256 821933 -3776 7924615 5264798 0.11000 0.89000 0 0 0 X 2530977 105562 105562 2425415 13972 13972 2439387 222776 0 222776 13972 13972 236748 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. GOLF TOURNAMENT 73210 39917 33293 240 25011 1814 187 2415 3626 POINSETTIA SALE 25007 13906 11101 11101 2 18768 9822 8946 250 750 75 7871 116985 63645 53340 240 25261 2564 262 2415 22598 53340 0 1 WEST GEORGIA MEDICAL CENTER INC 1514 VERNON ROAD LAGRANGE GA 30240 205497506 501(C)(3) 100272 21708 FMV MEDICAL EQUIPMENT AND SUPPLIES SUPPORT FOR VARIOUS BENEVOLENT PROGRAMS INCLUDING THE LIFELINE PROGRAM FOR HOSPICE PATIENTS 1 0 HELPING HANDS EMPLOYEE PROGRAM 51 19609 KISH SCHOLARSHIP 1 235 PROCEDURE FOR MONITORING GRANTS IN THE U.S.: PART I, LINE 2: SCHEDULE 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. 1 0 1 0 0 0 0 0 0 0 DR RICHARD SANDY SIMMONS 0 155759 0 0 0 52460 0 3997 0 8894 0 221110 0 0 GERALD FULKS 0 374812 0 0 0 1614726 0 74429 0 16438 0 2080405 0 1604903 PAUL PERROTTI 0 251134 0 0 0 1590 0 30039 0 19905 0 302668 0 0 PART I, LINE 4B A 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. 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. 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. 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 WEST GEORIGA 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 WEST GEORGIA MEDICAL CENTER INC 1514 VERNON ROAD LAGRANGE GA 30240 205497506 HOSPITAL GA 501(C)(3) LINE 3 WEST GEORIGA HEALTH SERVICES INC 0 MEDICAL PARK FOUNDATION INC 209 BROOME STREET LAGRANGE GA 30240 581303478 SUPPORTING ORGANIZATION GA 501(C)(3) LINE 11A, I WEST GEORIGA HEALTH SERVICES INC 0 WEST GEORGIA HEALTH PHYSICIANS INC 1514 VERNON ROAD LAGRANGE GA 30240 275125341 PHYSICIAN PRACTICE GA WEST GEORIGA HEALTH SERVICES INC C 0 0 1 0 0 0 0 0 0 0 0 0 0 1 1 1 1 0 0 0