2013-10-07T08:48:44-05:00 2012-12-31 621142155 PUGH & COMPANY PC 315 N CEDAR BLUFF RD SUITE 200 KNOXVILLE TN 37923 990 2012-01-01 204901729 LAFOLLETTE MEDICAL FOUNDATION INC LAFO 4239126963 PO BOX 128 JACKSBORO TN 37757 JUDGE SHAYNE SEXTON 4239126963 2013-08-29 1 RE FOUST P00745365 8657690660 2012 2016-02-25 16:41:14Z JUDGE SHAYNE SEXTON PO BOX 128 JACKSBORO TN 37757 2725295 0 X WWW.LAFOLLETTEMEDICALFOUNDATION.ORG X 2006 TN THE FOUNDATION IS ORGANIZED AS A PUBLIC BENEFIT CORPORATION FOR THE CHARITABLE PURPOSE OF MAKING DISTRIBUTIONS TO QUALIFYING 501(C)(3) ORGANIZATIONS THAT PROVIDE FOR THE HEALTHCARE OF THE RESIDENTS OF LAFOLLETTE COMMUNITY, WHICH INCLUDES ALL OF CAMPBELL COUNTY. 7 7 0 0 0 0 1498158 0 0 0 418638 393937 0 0 1916796 393937 549175 602253 0 0 0 0 0 0 0 145134 134606 694309 736859 1222487 -342922 10050850 10129485 31800 0 10019050 10129485 X THE FOUNDATION IS ORGANIZED AS A PUBLIC BENEFIT CORPORATION FOR THE CHARITABLE PURPOSE OF MAKING DISTRIBUTIONS TO QUALIFYING 501(C)(3) ORGANIZATIONS THAT PROVIDE FOR THE HEALTHCARE OF THE RESIDENTS OF LAFOLLETTE COMMUNITY, WHICH INCLUDES ALL OF CAMPBELL COUNTY. 0 0 602253 602253 THE FOUNDATION IS ORGANIZED AS A PUBLIC BENEFIT CORPORATION FOR THE CHARITABLE PURPOSE OF MAKING DISTRIBUTIONS TO QUALIFYING 501(C)(3) ORGANIZATIONS THAT PROVIDE FOR THE HEALTHCARE OF THE RESIDENTS OF LAFOLLETTE COMMUNITY, WHICH INCLUDES ALL OF CAMPBELL COUNTY. THE FOUNDATION IS ORGANIZED AS A PUBLIC BENEFIT CORPORATION FOR THE CHARITABLE PURPOSE OF MAKING DISTRIBUTIONS TO QUALIFYING 501(C)(3) ORGANIZATIONS THAT PROVIDE FOR THE HEALTHCARE OF THE RESIDENTS OF THE LAFOLLETTE,TN COMMUNITY. 602253 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 0 1 0 0 0 0 0 0 0 0 0 0 0 X 7 7 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 0 0 0 0 0 TN X JUNE WILBURN 4239126963 PO BOX 128 JACKSBORO TN 37757 X BRENDA ROBARDS 1.00 X 0 0 0 MIKE STANFIELD 1.00 X 0 0 0 LUCY LOBERTINI 1.00 X 0 0 0 KATHY MYERS 1.00 X 0 0 0 JUDGE SHAYNE SEXTON 1.00 X 0 0 0 ELIZABETH ASBURY 1.00 X 0 0 0 DR JAMES FARRIS 1.00 X 0 0 0 0 0 0 0 0 0 0 0 279611 279611 2445684 2331358 114326 114326 114326 393937 114326 0 279611 602253 602253 3938 3938 11200 11200 100002 100002 14940 14940 2687 2687 1839 1839 736859 602253 134606 0 649003 478280 9401847 9651205 10050850 10129485 11050 0 20750 0 31800 0 X 10019050 10129485 10019050 10129485 10050850 10129485 X -342922 453035 322 X 0 1 X 0 0 X 1498158 1498158 1498158 1498158 1498158 328328 231982 251778 260522 393937 1466547 2964705 0.50530 0.43720 X 0 846972 453035 453035 393937 0 393937 736537 0 736537 322 322 736859 PART XI, LINE 2D - OTHER ADJUSTMENTS: UNREALIZED GAINS ON INVESTMENTS 453,035. PART XII, LINE 4B - OTHER ADJUSTMENTS: RECOVERIES OF PRIOR YEAR GRANTS 322. 1 THE SHEPHERD'S HOME INC P O BOX 707 JACKSBORO TN 37757 270988603 501(C)(3) 70727 CASH GRANT HEALTH CARE FOOD LIFE SERVICES OF CAMPBELL COUNTY 206 S INDIANA AVE LAFOLLETTE TN 37766 621812105 501(C)(3) 60000 CASH GRANT HEALTH CARE CAMPBELL COUNTY SENIOR CITIZENS 102 8TH STREET LAFOLLETTE TN 37766 620988347 501(C)(3) 59520 CASH GRANT HEALTH CARE CAMPBELL COUNTY CHILDREN'S CENTER 2315 JACKSBORO PIKE JACKSBORO TN 37766 780251005 501(C)(3) 99594 CASH GRANT HEALTH CARE EAST TENNESSEE HUMAN RESOURCE AGENCY INC 9111 CROSS PARK DRIVE D-100 KNOXVILLE TN 37923 621493851 501(C)(3) 22000 CASH GRANT HEALTH CARE CHET - COMMUNITY HEALTH OF EAST TN P O BOX 209 507 MAIN ST JACKSBORO TN 37757 581470587 501(C)(3) 125912 CASH GRANT HEALTH CARE TN BAPTIST ADULT HOMES PO BOX 728 BRENTWOOD TN 37024 620934533 501(C)(3) 20000 CASH GRANT HEALTH CARE CASA OF CAMPBELL COUNTY PO BOX 1054 JACKSBORO TN 37757 205755609 501(C)(3) 21000 CASH GRANT HEALTH CARE LAFOLLETTE UNITED METHODIST CHURCH 808 E CENTRAL AVENUE LAFOLLETTE TN 37766 626043365 501(C)(3) 16500 CASH GRANT HEALTH CARE JELLICO COMMUNITY HOSPITAL 188 HOSPITAL LANE JELLICO TN 37762 620924706 501(C)(3) 7000 CASH GRANT HEALTH CARE WYNN HABERSHAM COMMUNITY HEALTH CLINIC 1037 STINKING CREEK ROAD LA FOLLETTE TN 37766 311548496 501(C)(3) 100000 CASH GRANT HEALTH CARE 11 FORM 990; SCHEDULE I; PART I; LINE 2 THE ORGANIZATION SELECTS ORGANIZATIONS THAT ENGAGE IN ACTIVITIES AND MAKE DISTRIBUTIONS THAT PROVIDE FOR THE HEALTHCARE OF THE RESIDENTS OF THE LAFOLLETTE. THE PROPERTY, AFFAIRS AND BUSINESS OF THE FOUNDATION ARE TO BE MANAGED BY A BOARD OF DIRECTORS, WHOSE OPERATIONS IN GOVERNING THE FOUNDATION ARE DEFINED BY TENNESSEE STATUTE AND THE FOUNDATIONS BYLAWS. FORM 990, PART VI, SECTION B, LINE 11 THE ORGANIZATION'S CONFLICT OF INTEREST POLICY CALLS FOR ANNUAL STATEMENTS TO BE SIGNED EACH YEAR. ARTICLE VII CALLS FOR PERIODIC REVIEWS OF COMPENSATION ISSUES AND RELATED PARTY AFFILIATIONS. FORM 990, PART VI, SECTION B, LINE 11 THE 990 IS PRESENTED TO EACH BOARD MEMBER PRIOR TO THE MEETING FOR MEMBERS TO VIEW PRIOR TO THE FILING. FORM 990, PART VI, SECTION B, LINE 12C THE ORGANIZATION'S CONFLICT OF INTEREST POLICY CALLS FOR ANNUAL STATEMENTS SHALL BE SIGNED EACH YEAR. ARTICLE VII CALLS FOR PERIODIC REVIEWS OF COMPENSATION ISSUES AND RELATED PARTY AFFILIATIONS. FORM 990, PART VI, SECTION C, LINE 19 AVAILABLE UPON REQUEST CHANGES IN NET ASSETS OR FUND BALANCES: FORM 990, PART XI, LINE 9: RECOVERIES OF PRIOR YEARS GRANTS 322.