WEST GEORGIA HEALTH FOUNDATION INC: Form 990, tax year 2010

View the entire original 990 at ProPublica ↗

Organization
WEST GEORGIA HEALTH FOUNDATION INC (EIN 20-0936376)
Tax period
2010-10-01 to 2011-09-30
Filed
2012-08-14
IRS object ID
201202279349302805
Schema version
2010v3.4
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)
Timestamp2012-08-14T13:33:15-05:00Timestamp
Tax Period End Date2011-09-30TaxPeriodEndDate

Preparer Firm PreparerFirm

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 Date2010-10-01TaxPeriodBeginDate

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 Signed2012-08-14DateSigned

Preparer Preparer

FieldValueIRS element (for citing)
NameAMY BIBBYName
Phone8282542254Phone
FieldValueIRS element (for citing)
Tax Year2010TaxYear
Build TS2016-02-24 21:20:13ZBuildTS

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 Receipts1176733GrossReceipts
Group Return For Affiliates0GroupReturnForAffiliates
Organization501c3XOrganization501c3
Web SiteWWW.WGHEALTH.ORGWebSite
Type Of Organization CorporationXTypeOfOrganizationCorporation
Year Formation2004YearFormation
State Legal DomicileGAStateLegalDomicile
Activity Or Mission DescriptionTHE FOUNDATION IS ORGANIZED AND SHALL BE OPERATED EXCLUSIVELY FOR THE BENEFIT OF THE WEST GEORGIA MEDICAL CENTER, INC. AND ITS AFFILIATED ENTITIES.ActivityOrMissionDescription
Nbr Voting Members Governing Body14NbrVotingMembersGoverningBody
Nbr Independent Voting Members8NbrIndependentVotingMembers
Total Nbr Employees3TotalNbrEmployees
Total Nbr Volunteers87TotalNbrVolunteers
Total Gross UBI0TotalGrossUBI
Net Unrelated Business Txbl Income0NetUnrelatedBusinessTxblIncome
Contributions Grants Prior Year476864ContributionsGrantsPriorYear
Contributions Grants Current Year942399ContributionsGrantsCurrentYear
Program Service Revenue Prior Year0ProgramServiceRevenuePriorYear
Program Service Revenue CY0ProgramServiceRevenueCY
Investment Income Prior Year259676InvestmentIncomePriorYear
Investment Income Current Year136866InvestmentIncomeCurrentYear
Other Revenue Prior Year0OtherRevenuePriorYear
Other Revenue Current Year9214OtherRevenueCurrentYear
Total Revenue Prior Year736540TotalRevenuePriorYear
Total Revenue Current Year1088479TotalRevenueCurrentYear
Grants And Similar Amnts Prior Year1558369GrantsAndSimilarAmntsPriorYear
Grants And Similar Amnts CY351073GrantsAndSimilarAmntsCY
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 Year49342OtherExpensePriorYear
Other Expenses Current Year80669OtherExpensesCurrentYear
Total Expenses Prior Year1607711TotalExpensesPriorYear
Total Expenses Current Year431742TotalExpensesCurrentYear
Revenues Less Expenses Prior Year-871171RevenuesLessExpensesPriorYear
Revenues Less Expenses CY656737RevenuesLessExpensesCY
Total Assets BOY9558422TotalAssetsBOY
Total Assets EOY5721672TotalAssetsEOY
Total Liabilities BOY4757756TotalLiabilitiesBOY
Total Liabilities EOY231833TotalLiabilitiesEOY
Net Assets Or Fund Balances BOY4800666NetAssetsOrFundBalancesBOY
Net Assets Or Fund Balances EOY5489839NetAssetsOrFundBalancesEOY
Mission DescriptionNONEMissionDescription
Significant New Program Services0SignificantNewProgramServices
Significant Change0SignificantChange
Expense304183Expense
Grants243783Grants
DescriptionTO PROVIDE FUNDS FOR SPECIFIC MEDICAL AND CANCER TREATING EQUIPMENT AND SUPPORT OF WEST GEORGIA MEDICAL CENTER.Description

Activity2 Activity2

FieldValueIRS element (for citing)
Expense90000Expense
Grants90000Grants
DescriptionTO PROVIDE SUPPORT TO WEST GEORGIA MEDICAL CENTER, INC. FOR OPERATING THE HOSPICE CENTER.Description

Activity3 Activity3

FieldValueIRS element (for citing)
Expense16290Expense
Grants16290Grants
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, 2010 - SEPTEMBER 30, 2011, THE HELPING HANDS PROGRAMS HAS PROVIDED $16,290 IN ASSISTANCE TO 32 WEST GEORGIA HEALTH SYSTEM EMPLOYEES.Description

Activity Other ActivityOther

FieldValueIRS element (for citing)
Expense6040Expense
Grants1000Grants
FieldValueIRS element (for citing)
Total Of Other Program Service Exp6040TotalOfOtherProgramServiceExp
Total Of Other Program Service Grnt1000TotalOfOtherProgramServiceGrnt
Total Program Service Expense416513TotalProgramServiceExpense
Described In501 C31DescribedIn501C3
Schedule B Required1ScheduleBRequired
Political Activities0PoliticalActivities
Lobbying Activities0LobbyingActivities
Donor Advised Funds0DonorAdvisedFunds
Conservation Easements0ConservationEasements
Collections Of Art0CollectionsOfArt
Credit Counseling0CreditCounseling
Term Or Permanent Endowments1TermOrPermanentEndowments
Report Land Bldg Equip0ReportLandBldgEquip
Report Invest Oth Securities0ReportInvestOthSecurities
Report Prog Rel Invest0ReportProgRelInvest
Report Other Assets0ReportOtherAssets
Report Other Liabilities1ReportOtherLiabilities
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
Transaction Related Entity0TransactionRelatedEntity
Transfers To Exempt Non Chrtbl Org0TransfersToExemptNonChrtblOrg
Activities Conducted Partnership0ActivitiesConductedPartnership
Schedule O Required1ScheduleORequired
Number Forms Transmitted With10962NumberFormsTransmittedWith1096
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 Members14NbrVotingGoverningBodyMembers
Number Independent Voting Members8NumberIndependentVotingMembers
Family Or Business Relationship0FamilyOrBusinessRelationship
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 CEO1CompensationProcessCEO
Compensation Process Other1CompensationProcessOther
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 Line1JENNY MYHAND 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 (20 entries)

TitleTitleAverage Hours Per WeekAverageHoursPerWeekIndividual Trustee Or DirectorIndividualTrusteeOrDirectorOfficerOfficerReportable Comp From OrganizationReportableCompFromOrganizationReportable Comp From Related OrgsReportableCompFromRelatedOrgsOther CompensationOtherCompensation
WESLEY SMITH
CHAIRMAN1.00XX000
PATRICK CREWS 1010-211
VICE CHAIRMAN1.00XX000
SANDY SIMMONS 211-911
VICE CHAIRMAN1.00XX000
WAYNE ABBOTT
TREASURER1.00XX000
GERALD FULKS
SECRETARY1.00XX047081486210
HEATHER GRAHAM
MEMBER1.00X000
RICK MALLORY 042011-092011
MEMBER1.00X000
AIMEE THOMPSON MADDOX
MEMBER1.00X05283813390
KYLE CRAWFORD
MEMBER1.00X000
WAYNE HUNTER
MEMBER1.00X000
TERRY MCMILLAN
MEMBER1.00X000
BEVERLY LUNDBERG
MEMBER1.00X000
DR BRETT BOWIE
MEMBER1.00X0191500
DR JULIAN DUTTERA
MEMBER1.00X0201880
ELLEN HARRIS
MEMBER1.00X000
DR DAVID MARTIN
MEMBER1.00X01000000
SUSAN FERGUSON
DIRECTOR OF DEVELOPMENT40.00XX0526154842
CATHERINE WIGGINS
DIRECTOR - HOSPICE1.00X09056844544
PAUL PERROTTI
CFO AND VP OF WHGS1.00XX042316840390
JOE RAGLAND 102010-042011
MEMBER1.00X000
FieldValueIRS element (for citing)
Total Reportable Comp From Org0TotalReportableCompFromOrg
Total Reportable Comp Frm Rltd Orgs1229341TotalReportableCompFrmRltdOrgs
Total Other Compensation189376TotalOtherCompensation
Number Individuals GT100 K0NumberIndividualsGT100K
Formers Listed0FormersListed
Total Comp GT150 K1TotalCompGT150K
Compensation From Other Sources0CompensationFromOtherSources
Number Of Contractors GT100 K0NumberOfContractorsGT100K
Fundraising Events101490FundraisingEvents
Related Organizations74486RelatedOrganizations
All Other Contributions766423AllOtherContributions
Total Contributions942399TotalContributions

Investment Income InvestmentIncome

FieldValueIRS element (for citing)
Total Revenue Column169497TotalRevenueColumn
Exclusion$169,497ExclusionAmount

Less Cost Oth Basis Sales Expenses LessCostOthBasisSalesExpenses

FieldValueIRS element (for citing)
Securities32631Securities

Gain Or Loss GainOrLoss

FieldValueIRS element (for citing)
Securities-32631Securities

Net Gain Or Loss Investments NetGainOrLossInvestments

FieldValueIRS element (for citing)
Total Revenue Column-32631TotalRevenueColumn
Exclusion-$32,631ExclusionAmount
FieldValueIRS element (for citing)
Gross Income Fundraising Events58922GrossIncomeFundraisingEvents
Cntrbtns Rprtd Fundraising Events101490CntrbtnsRprtdFundraisingEvents
Fundraising Direct Expenses55623FundraisingDirectExpenses

Net Income From Fundraising Events NetIncomeFromFundraisingEvents

FieldValueIRS element (for citing)
Total Revenue Column3299TotalRevenueColumn
Exclusion$3,299ExclusionAmount

Other Revenue Misc OtherRevenueMisc

FieldValueIRS element (for citing)
DescriptionMISCELLANEOUSDescription
Business Code900099BusinessCode
Total Revenue Column5915TotalRevenueColumn
Exclusion$5,915ExclusionAmount
FieldValueIRS element (for citing)
Total Other Revenue5915TotalOtherRevenue

Total Revenue TotalRevenue

FieldValueIRS element (for citing)
Total Revenue Column1088479TotalRevenueColumn
Related Or Exempt Function Income0RelatedOrExemptFunctionIncome
Unrelated Business Revenue0UnrelatedBusinessRevenue
Exclusion$146,080ExclusionAmount

Grants To Domestic Orgs GrantsToDomesticOrgs

FieldValueIRS element (for citing)
Total333783Total
Program Services333783ProgramServices

Grants To Domestic Individuals GrantsToDomesticIndividuals

FieldValueIRS element (for citing)
Total17290Total
Program Services17290ProgramServices

Fees For Services Invst Mgmnt Fees FeesForServicesInvstMgmntFees

FieldValueIRS element (for citing)
Total13461Total
Management And General13461ManagementAndGeneral

Advertising Advertising

FieldValueIRS element (for citing)
Total1000Total
Management And General1000ManagementAndGeneral

Office Expenses OfficeExpenses

FieldValueIRS element (for citing)
Total952Total
Program Services184ProgramServices
Management And General768ManagementAndGeneral

Other Expenses OtherExpenses (2 entries)

DescriptionDescriptionTotalTotalProgram ServicesProgramServices
BAD DEBT6252462524
CAMP DOGWOOD GRIEF CAMP27322732

Total Functional Expenses TotalFunctionalExpenses

FieldValueIRS element (for citing)
Total431742Total
Program Services416513ProgramServices
Management And General15229ManagementAndGeneral
Fundraising0Fundraising

Cash Non Interest Bearing CashNonInterestBearing

FieldValueIRS element (for citing)
BOY539077BOY
EOY729236EOY

Pledges And Grants Receivable PledgesAndGrantsReceivable

FieldValueIRS element (for citing)
BOY288655BOY
EOY379291EOY

Investments Pub Traded Securities InvestmentsPubTradedSecurities

FieldValueIRS element (for citing)
BOY8730690BOY
EOY4613145EOY

Total Assets TotalAssets

FieldValueIRS element (for citing)
BOY9558422BOY
EOY5721672EOY

Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses

FieldValueIRS element (for citing)
BOY9186BOY
EOY389EOY

Other Liabilities OtherLiabilities

FieldValueIRS element (for citing)
BOY4748570BOY
EOY231444EOY

Total Liabilities TotalLiabilities

FieldValueIRS element (for citing)
BOY4757756BOY
EOY231833EOY
FieldValueIRS element (for citing)
Follow SFAS117XFollowSFAS117

Temporarily Restricted Net Assets TemporarilyRestrictedNetAssets

FieldValueIRS element (for citing)
BOY3888666BOY
EOY4577839EOY

Permanently Restricted Net Assets PermanentlyRestrictedNetAssets

FieldValueIRS element (for citing)
BOY912000BOY
EOY912000EOY

Total Net Assets Fund Balances TotalNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY4800666BOY
EOY5489839EOY

Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY9558422BOY
EOY5721672EOY
FieldValueIRS element (for citing)
Info In Schedule O Part XIXInfoInScheduleOPartXI
Reconcilation Revenue Expenses656737ReconcilationRevenueExpenses
Reconcilation Other Changes32436ReconcilationOtherChanges
Method Of Accounting AccrualXMethodOfAccountingAccrual
Accountant Compile Or Review0AccountantCompileOrReview
FS Audited1FSAudited
Audit Committee1AuditCommittee
Financial Statement BothXFinancialStatementBoth
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 Years1328051CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years726312CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years748072CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year476864CurrentTaxYearMinus1Year
Current Tax Year1007236CurrentTaxYear
Total4286535Total

Total170 Total170

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years1328051CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years726312CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years748072CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year476864CurrentTaxYearMinus1Year
Current Tax Year1007236CurrentTaxYear
Total4286535Total
FieldValueIRS element (for citing)
Amounts Subst Contributors Total193822AmountsSubstContributorsTotal
Public Support Total1704092713PublicSupportTotal170

Gross Investment Income170 GrossInvestmentIncome170

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years454640CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years322117CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years219576CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year146610CurrentTaxYearMinus1Year
Current Tax Year136866CurrentTaxYear
Total1279809Total
FieldValueIRS element (for citing)
Total Support5566344TotalSupport
Public Support Pertcentage1700.73530PublicSupportPertcentage170
Public Support Pertcent Prior Year0.76160PublicSupportPertcentPriorYear
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 Balance4800666BeginningOfYearBalance
Contributions945878Contributions
Investment Earnings Or Losses155841InvestmentEarningsOrLosses
Other Expenditures412546OtherExpenditures
End Of Year Balance5489839EndOfYearBalance

Current Year Minus1 Year CurrentYearMinus1Year

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

Current Year Minus2 Years CurrentYearMinus2Years

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 Balance0.19000PermanentEndowmentEOYBalance
Term Endowment EOY Balance0.81000TermEndowmentEOYBalance
Endowments Held By Unrelated Orgs0EndowmentsHeldByUnrelatedOrgs
Endowments Held By Related Orgs0EndowmentsHeldByRelatedOrgs
Total Of Book Value Land Buildings0TotalOfBookValueLandBuildings

Other Liabilities OtherLiabilities

FieldValueIRS element (for citing)
DescriptionDUE TO AFFILIATEDescription
Amount$231,444Amount
FieldValueIRS element (for citing)
Total Of Amounts231444TotalOfAmounts
Total Revenue1088479TotalRevenue
Total Expenses431742TotalExpenses
Excess Or Deficit For Year656737ExcessOrDeficitForYear
Net Unrealized GL On Investments32436NetUnrealizedGLOnInvestments
Total Adjustments32436TotalAdjustments
Excess Or Deficit Per FS689173ExcessOrDeficitPerFS
Tot Revenue Etc Audited Fincl Stmt1101719TotRevenueEtcAuditedFinclStmt
Net Unrealized Gains Investments32436NetUnrealizedGainsInvestments
Other Revenues56789OtherRevenues
Revenue Not Rptd F99089225RevenueNotRptdF990
Revenue Subtotal1012494RevenueSubtotal
Other Revenues Not Included75985OtherRevenuesNotIncluded
Revenue Not Rptd On Fin Stmt75985RevenueNotRptdOnFinStmt
Total Revenue Per Form9901088479TotalRevenuePerForm990
Tot Expenses Etc Audited Fincl Stmt412546TotExpensesEtcAuditedFinclStmt
Other Expenses Included56789OtherExpensesIncluded
Expenses Not Rptd F99056789ExpensesNotRptdF990
Expenses Subtotal355757ExpensesSubtotal
Other Expenses Not Included75985OtherExpensesNotIncluded
Expenses Not Rptd On Fin Stmt75985ExpensesNotRptdOnFinStmt
Total Expenses Per Form990431742TotalExpensesPerForm990

Form990 Schedule D Part XIV Form990ScheduleDPartXIV (6 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: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 INCLUDED IN THE ACCOMPANYING FINANCIAL STATEMENTS. 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, 2011, AND 2010. FISCAL YEARS ENDING ON AND AFTER SEPTEMBER 30, 2008 REMAIN SUBJECT TO EXAMINATION BY FEDERAL AND STATE TAX AUTHORITIES.
PART XII, LINE 2D - OTHER ADJUSTMENTS:SPECIAL EVENT EXPENSES 55,623. DISCOUNT ON PLEDGES RECEIVABLE 1,166.
PART XII, LINE 4B - OTHER ADJUSTMENTS:INVESTMENT FEES 13,461. BAD DEBT 62,524.
PART XIII, LINE 2D - OTHER ADJUSTMENTS:SPECIAL EVENT EXPENSES 55,623. DISCOUNT ON PLEDGES RECEVIABLE 1,166.
PART XIII, LINE 4B - OTHER ADJUSTMENTS:INVESTMENT EXPENSES 13,461. BAD DEBT 62,524.

Schedule G IRS990ScheduleG

Events Information EventsInformation

FieldValueIRS element (for citing)
Name Of Event1GOLF TOURNAMENTNameOfEvent1
Gross Receipts Event1122781GrossReceiptsEvent1
Charitable Contributions Event183284CharitableContributionsEvent1
Gross Revenue Event139497GrossRevenueEvent1
Cash Prizes Event19100CashPrizesEvent1
Non Cash Prizes Event124208NonCashPrizesEvent1
Rent Facility Costs Event12549RentFacilityCostsEvent1
Other Direct Expenses Event13639OtherDirectExpensesEvent1
Name Of Event2POINSETTIA SALENameOfEvent2
Gross Receipts Event222649GrossReceiptsEvent2
Charitable Contributions Event212674CharitableContributionsEvent2
Gross Revenue Event29975GrossRevenueEvent2
Other Direct Expenses Event29975OtherDirectExpensesEvent2
Total Number Of Other Events2TotalNumberOfOtherEvents
Gross Receipts Other Events14982GrossReceiptsOtherEvents
Charitable Contrib Other Events5532CharitableContribOtherEvents
Gross Revenue Other Events9450GrossRevenueOtherEvents
Rent Facility Costs Other Events2350RentFacilityCostsOtherEvents
Food And Beverage Other Events594FoodAndBeverageOtherEvents
Other Direct Expenses Other Events3208OtherDirectExpensesOtherEvents
Gross Receipts Total160412GrossReceiptsTotal
Charitable Contributions Total101490CharitableContributionsTotal
Gross Revenue Total Events58922GrossRevenueTotalEvents
Cash Prizes Total Events9100CashPrizesTotalEvents
Non Cash Prizes Total Events24208NonCashPrizesTotalEvents
Rent Facility Costs Total Events4899RentFacilityCostsTotalEvents
Food And Beverage Total Events594FoodAndBeverageTotalEvents
Other Direct Expenses Total Events16822OtherDirectExpensesTotalEvents
Direct Expense Summary Events55623DirectExpenseSummaryEvents
Net Income Summary3299NetIncomeSummary

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 Grant333783AmountOfCashGrant
Purpose Of GrantHOSPITAL OPERATIONSPurposeOfGrant
FieldValueIRS element (for citing)
Total Nbr Of501 C3 And Govt Grants1TotalNbrOf501C3AndGovtGrants

Form990 Schedule I Part III Form990ScheduleIPartIII (2 entries)

Type Of GrantTypeOfGrantNumber Of RecipientsNumberOfRecipientsAmount Of Cash GrantAmountOfCashGrant
HELPING HANDS EMPLOYEE PROGRAM3216290
TUITION REIMBURSEMENT11000

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)
Travel For CompanionsXTravelForCompanions
Club Dues Or FeesXClubDuesOrFees
Written Policy Re T And E Expenses1WrittenPolicyReTAndEExpenses
Substantiation Required1SubstantiationRequired
Independent ConsultantXIndependentConsultant
Written Employment ContractXWrittenEmploymentContract
Compensation SurveyXCompensationSurvey
Board Or Committee ApprovalXBoardOrCommitteeApproval
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 (2 entries)

Base 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
GERALD FULKS
037435609645800072819013391055702400
PAUL PERROTTI
0232685042188014829502972401066604635580148295

Form990 Schedule J Part III Form990ScheduleJPartIII (2 entries)

Return ReferenceReturnReferenceExplanationExplanation
PART I, LINE 1ATHE ORGANIZATION PAYS MINOR SPOUSAL TRAVEL AND COUNTRY CLUB DUES FOR THE CEO ONLY. THESE ARE ADDED TO HIS TAXABLE COMPENSATION.
PART I, LINE 4BEMPLOYER CONTRIBUTIONS TO THE 457(F) EXECUTIVE RETIREMENT PLAN INCLUDE $20,260 FOR PAUL PERROTTI AND $55,700 FOR GERALD FULKS.

Schedule O IRS990ScheduleO

General Explanation GeneralExplanation (9 entries)

IdentifierIdentifierExplanationExplanationReturn ReferenceReturnReference
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 ORGANIZATIONS MEMBER THROUGH THE SELECTION AND OVERSIGHT OF THE BOARD OF DIRECTORS.
FORM 990, PART VI, SECTION B, LINE 11A COPY OF THE 990 WAS PROVIDED TO EACH BOARD MEMBER VIA E-MAIL PRIOR TO FILING WITH THE IRS.
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 12C
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 B, LINE 15
THE ORGANIZATION MAKES ITS FORM 990 AVAILABLE TO THE PUBLIC UPON REQUEST.FORM 990, PART VI, SECTION C, LINE 18
THE ORGANIZATION MAKES ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UPON REQUEST.FORM 990, PART VI, SECTION C, LINE 19
CHANGES IN NET ASSETS OR FUND BALANCES:NET UNREALIZED GAINS ON INVESTMENTS: 32,436.FORM 990, PART XI, LINE 5:

Schedule R IRS990ScheduleR

Form990 Schedule R Part II Form990ScheduleRPartII (4 entries)

Address Line1AddressUS/AddressLine1CityAddressUS/CityStateAddressUS/StateZIP CodeAddressUS/ZIPCodeEINEINPrimary ActivitiesPrimaryActivitiesLegal Domicile StateLegalDomicileStateExempt Code SectionExemptCodeSectionPublic Charity StatusPublicCharityStatusDirect Controlling Entity NADirectControllingEntityNAControlled OrgControlledOrg
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 9N/A0
WEST GEORGIA HEALTH SERVICES INC
1514 VERNON ROADLAGRANGEGA30240205497622PARENT OF HEALTH SYSTEMGA501(C)(3)LINE 11A, IN/A0
WEST GEORGIA MEDICAL CENTER INC
1514 VERNON ROADLAGRANGEGA30240205497506HOSPITALGA501(C)(3)LINE 3N/A0

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
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 Org1GiftGrantOrCapContrFrOtherOrg
Loans Or Guarantees To Other Org0LoansOrGuaranteesToOtherOrg
Loans Or Guarantees From Other Org0LoansOrGuaranteesFromOtherOrg
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 Org0ReimbursementPaidToOtherOrg
Reimbursement Paid By Other Org0ReimbursementPaidByOtherOrg
Other Transfer To Other Org0OtherTransferToOtherOrg
Other Transfer From Other Org0OtherTransferFromOtherOrg

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