2012-08-14T13:33:15-05:00 2011-09-30 DIXON HUGHES GOODMAN LLP 500 RIDGEFIELD COURT ASHEVILLE NC 28806 990 2010-10-01 205497506 WEST GEORGIA MEDICAL CENTER INC WEST 7068821411 1514 VERNON ROAD LAGRANGE GA 30240 PAUL PERROTTI 7068821411 2012-08-14 AMY BIBBY 8282542254 2010 2016-02-24 21:20:13Z GERALD FULKS 1514 VERNON ROAD LAGRANGE GA 30240 165152046 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 7 1593 198 199259 71933 2224756 1077589 147296939 159517973 -599113 1415064 1346128 3063468 150268710 165074094 875250 711932 0 0 72215370 80903371 0 0 0 81101450 86031869 154192070 167647172 -3923360 -2573078 209247988 196195159 105043598 99551264 104204390 96643895 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 122281093 133962677 THE HOSPITAL SERVICES PROGRAM GOAL IS TO PROVIDE VERY HIGH QUALITY PATIENT CARE FOR ALL INDIVIDUALS IN TROUP AND OTHER COUNTIES IN THE GEOGRAPHICAL AREA. THE PROGRAM HAD 9,149 ADMISSIONS, 31,993 INPATIENT DAYS, 56,687 OUTPATIENT EMERGENCY ROOM VISITS, 5,483 INPATIENT EMERGENCY ROOM VISITS, 1,535 INPATIENT SURGERIES, 5,801 OUTPATIENT SURGERIES, AND 984 DELIVERIES. 11465786 16082801 LONG TERM CARE INCLUDES TWO NURSING HOMES. THIS PROGRAM PROVIDED 87,320 INPATIENT DAYS OF SKILLED NURSING CARE. 3147212 3843266 HOSPICE PROGRAM PROVIDED 4,300 INPATIENT DAYS OF HOSPICE CARE AND 13,605 HOSPICE VISITS. 8133937 6141174 ADDITIONAL EXEMPT ACTIVITY PROGRAMS INCLUDING HOME HEALTH, DIALYSIS, PHYSICIAN PRACTICES, OCCUPATIONAL EXPENSES, OCCUPATIONAL HEALTH, SCHOLARSHIPS, ETC. 8133937 6141174 145028028 1 1 0 1 0 0 1 0 1 1 0 0 0 1 1 0 1 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 1 184 0 1 1593 1 1 1 0 0 0 0 0 0 0 0 0 X 9 7 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 1 1 GA X PAUL PERROTTI SR VPCFO 7068453934 1514 VERNON ROAD LAGRANGE GA 30240 SPEER BURDETTE 1.00 X X 0 0 0 ELLEN HARRIS 1.00 X X 0 0 0 ROD DURASKI MD 1.00 X X 0 0 0 JOHN MCKIBBEN 1.00 X X 0 0 0 KENNETH MCCAMEY 1.00 X 0 0 0 C PAUL MAJOR MD 1.00 X 57900 0 0 CONNOR SMITH MD 1.00 X 76500 0 0 MIKE PATTON 1.00 X 0 0 0 CHARLES WARDLAW 1.00 X 0 0 0 ANIL MODI MD 1.00 X 0 0 0 GERALD FULKS 40.00 X 470814 0 86210 PAUL PERROTTI 40.00 X 423168 0 40390 LIZA FRITCHLEY 40.00 X 126972 0 18258 SUSAN BURDICK 40.00 X 0 78370 21241 TRIPP PENN PAUL PENN III 40.00 X 142716 0 23729 CATHERINE WIGGINS 40.00 X 90568 0 44544 CHARIS ACREE 40.00 X 232452 0 79237 DEBORAH BURTON 40.00 X 174276 0 76168 ANGAMPALLY RAJEEV 40.00 X 687390 0 18686 WILLIAM TURTON 40.00 X 360436 0 15487 NICK A VLACHOS 40.00 X 239920 0 10488 MICHAEL MYERS 40.00 X 165568 0 17438 DON DAVIS 40.00 X 147482 0 31330 JAMES BRENNAN 40.00 X 102425 0 0 3498587 78370 483206 33 1 1 0 MORRIS & DICKSON PO BOX 51367 SHREVEPORT LA 711351367 PHARMACY - DRUGS 6247785 MICROSOFT LICENSING 6100 NELL ROAD RENO NV 89511 SOFTWARE LICENSE 570443 SLEEPMED 1333 TAYLOR STREET COLUMBIA SC 29201 SLEEP STUDIES 454100 SOUTHERN CARDIOPULMONARY ASSOCIATES 1551 DOCTORS DRIVE LAGRANGE GA 30240 HEART DOCTOR SERVICES 316808 LAGRANGE EMERGENCY PHYSICIANS 5665 NEW NORTHSIDE DRIVE ATLANTA GA 30328 ER DOCTORS 282734 22 333783 36590 707216 1077589 PATIENT SERVICE REVENU 621400 158293046 158293046 OCCUPATIONAL HEALTH 621400 1058032 1058032 LIFELINE 621400 111611 111611 PHARMACY 621400 55284 55284 159517973 547 547 27780 18633 27780 18633 46413 18633 27780 1438127 54342 77952 1438127 -23610 1414517 1414517 465532 465532 465532 VENDOR REBATES 621400 689745 689745 INCENTIVE REVENUE 900099 645090 645090 CAFETERIA AND VENDING 900099 569798 25358 544440 646890 146121 500769 2551523 165074094 160002138 199259 3795108 74486 74486 637446 637446 2095002 710743 1384259 60751120 55029685 5721435 3235584 2869753 365831 10551542 9358532 1193010 4270123 3850976 419147 111216 111216 549031 549031 274768 274768 114381 114381 22171314 19988147 2183167 358559 59882 298677 31808017 30359271 1448746 2732236 323 2731913 2419000 2262670 156330 620297 390682 229615 198149 104728 93421 3817804 3817804 11438123 10236541 1201582 734452 468086 266366 BAD DEBT 8320407 8320407 COST OF GOODS SOLD 305670 305670 UBI TAX 33445 33445 CASUALTY LOSS 25000 25000 167647172 145028028 22619144 0 6627623 5119171 27943958 30604915 3325039 2997008 3243892 3251023 2713024 239719791 122975751 120394563 116744040 35877177 28636371 1621217 302950 8528647 7512529 209247988 196195159 15238679 15484282 72639796 71131593 17165123 12935389 105043598 99551264 X 94544385 87316668 1287835 1249530 8372170 8077697 104204390 96643895 209247988 196195159 X -2573078 -4987417 X 0 1 1 X 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 36355 36355 0 EXPLANATION OF OTHER LOBBYING ACTIVITIES: PART II-B, LINE 1I: WEST GEORGIA MEDICAL CENTER, INC. PAYS ANNUAL MEMBERSHIP DUES TO BOTH GEORGIA ALLIANCE OF COMMUNITY HOSPITALS AND GEORGIA HOSPITAL ASSOCIATION. A PORTION OF THESE DUES ARE DESIGNATED BY THESE ORGANIZATIONS FOR LOBBYING ACTIVITIES. 0 2352189 0 0 X X 0 9660005 600000 363 637675 294473 9328220 11684884 1595 801505 1224969 9660005 0.86600 0.13400 0 0 3645649 3645649 106348059 57370075 48977984 121562410 65605676 55956734 8163673 8163673 116744040 INSURANCE LIABILITY 350001 DUE TO THIRD PARTY PAYORS 3481259 PENSION PAYABLE 9104129 12935389 PART III, LINE 4: THE ORGANIZATION HODLS ART COLLECTIONS AND EXIBITS THEM IN PUBLIC AREAS. THE EXHIBITS ENHANCE THE HEALTH CARE EXPERIENCES FOR PATIENTS, PATIENT'S FAMILIES, AND VISITORS. DESCRIPTION OF INTENDED USE OF ENDOWMENT FUNDS: 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. DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: PART X: WGMC AND THE FOUNDATION ARE ORGANIZATIONS EXEMPT FROM INCOME TAX PURSUANT TO INTERNAL REVENUE CODE SECTION 501(A), AS ORGANIZATIONS DESCRIBED IN SECTION 501(C)(3). RELATED INCOME IS GENERALLY NOT SUBJECT TO FEDERAL AND STATE INCOME TAXES. THE PSO WAS ORGANIZED IN THE STATE OF GEORGIA AS A NONPROFIT ORGANIZATION. HOWEVER, THE PSO HAS NOT FILED FOR TAX EXEMPT STATUS WITH THE INTERNAL REVENUE SERVICE. AS SUCH, THE ENTITY IS CONSIDERED A FOR PROFIT ENTITY AND SUBJECT TO TAXATION. THE PSO THEREFORE ACCOUNTS FOR INCOME TAXES IN ACCORDANCE WITH THE LIABILITY METHOD UNDER WHICH DEFERRED TAX ASSETS AND LIABILITIES ARE DETERMINED BASED ON THE DIFFERENCES BETWEEN THE FINANCIAL ACCOUNTING AND TAX BASES OF ASSETS AND LIABILITIES. DEFERRED TAX ASSETS OR LIABILITIES AT THE END OF EACH PERIOD ARE DETERMINED USING THE CURRENTLY ENACTED TAX RATE EXPECTED TO APPLY TO TAXABLE INCOME IN THE PERIODS THAT THE DEFERRED TAX ASSET OR LIABILITY IS EXPECTED TO BE REALIZED OR SETTLED. AT SEPTEMBER 30, 2011, THE PSO HAD APPROXIMATELY $1,408,000 IN NET OPERATING LOSS CARRY FORWARDS ("NOLS"). THESE NOLS RESULT IN APPROXIMATELY $493,000 IN DEFERRED TAX ASSETS, WHICH ARE OFF-SET BY AN EQUAL AMOUNT OF VALUATION ALLOWANCE. THE GROUP 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. 1 1 1 X 125.000000000000 1 X 375.000000000000 1 1 1 0 1 1 8508323 8508323 0.05340 27244088 17566349 9677739 0.06070 1031775 620406 411369 0.00260 36784186 18186755 18597431 0.11670 338327 338327 0.00210 1036002 1036002 0.00650 175333 175333 0.00110 328370 328370 0.00210 1878032 1878032 0.01180 38662218 18186755 20475463 0.12850 5 72 10133 10133 0.00010 4 2175 2175 0.00000 3 60 18063 18063 0.00010 12 132 30371 30371 0.00020 0 3526735 35607602 36839187 -1231585 X 1 1 1 1 WEST GEORGIA MEDICAL CENTER INC

1514 VERNON ROAD LAGRANGE GA 30240

X X X WEST GEORGIA MEDICAL CENTER 1 7 ENOCH CALLAWAY MEDICAL CENTER

111 MEDICAL DRIVE LAGRANGE GA 30240

CANCER CLINIC HOSPICE LAGRANGE

1510 VERNON ROAD LAGRANGE GA 30240

HOSPICE FLORENCE HAND HOME

200 MEDICAL DRIVE LAGRANGE GA 30240

LONG TERM CARE TWIN FOUNTAINS HOME

1400 HOGANSVILLE ROAD LAGRANGE GA 30240

LONG TERM 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 WEST GEORGIA HEART CLINIC

1514 VERNON ROAD LAGRANGE GA 30240

HEART CLINIC 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 $ 8320407. PART II: 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. THE LEADERSHIP AND STAFF OF WGH PARTICIPATE IN MANY GROUP EVENTS AND ACTIVITIES THROUGHOUT THE YEAR. IN FY 2011, SEVERAL MEMBERS OF OUR LEADERSHIP TEAM SAT ON COMMITTEES AND THE BOARD OF THE LAGRANGE-TROUP COUNTY CHAMBER OF COMMERCE. MANY OTHERS HAVE SERVED IN THE CHAIRPERSON ROLE IN PREVIOUS YEARS. OTHER COMMUNITY ORGANIZATIONS SUPPORTED BY WEST GEORGIA HEALTH INCLUDE: CERTIFIED LITERATE COMMUNITY PROGRAM (CLCP), JUNIOR VOLUNTEER PROGRAM, KIWANIS CLUB, LIONS CLUB, CB&T BOARD, THE DEVELOPMENT AUTHORITY, TROUP COUNTY CENTER FOR STRATEGIC PLANNING, AND TROUP COUNTY SCHOOL SYSTEM FOR HEALTH CAREERS. WGH IS AN EMPLOYMENT ENGINE FOR THE BUSINESS COMMUNITY HAVING CONTINUOUS INVOLVEMENT IN MUCH OF WHAT THE CHAMBER DOES EVERY DAY.WGH PERFORMS PERIODIC EMERGENCY RESPONSE DRILLS TO ASSIST IN PREPARING THE COMMUNITY AND TO CONTINUOUSLY IMPROVE RESPONSE AND COMMUNICATION IN CASE OF A COMMUNITY-WIDE EMERGENCY. TEAM MEMBERS OF THE HOSPITAL SERVE ON BOARDS OF SEVERAL AGENCIES, WORKING IN AND WITH ALL LEVELS OF THE EDUCATION SYSTEM, AS WELL AS THE SENIOR POPULATION IN THE SERVICE AREA. WGH CONSTANTLY LISTENS TO THE COMMUNITY REGARDING HEALTHCARE NEEDS AND PERFORMS SURVEYS TO GET A MORE IN-DEPTH UNDERSTANDING OF THE NEEDS OF THE COMMUNITY. WGH RECRUITS SPECIALTY PHYSICIANS TO MEET IDENTIFIED NEEDS; (CARDIOLOGY, NEUROLOGY, RADIOLOGY, ONCOLOGY JUST TO MENTION A FEW), ALONG WITH GENERAL PRACTITIONERS, OB-GYNS, ETC. OUR NEW SOUTH TOWER WAS OFFICIALLY OPENED IN JUNE, 2010, WITH STATE OF THE ART FACILITY AND EQUIPMENT TO PROVIDE EXCELLENT SERVICE AND CARE IN THE AREAS OF EMERGENCY CARE, CARDIOLOGY, ICU, AND LABOR & DELIVERY. WGH WELCOMED TO OUR COMMUNITY THE NEW WOMEN'S CENTER IN LATE 2010, WHICH PROVIDE MANY OF THE SERVICES WOMEN OF ALL AGES NEED AND HAVE ASKED FOR IN THE COMMUNITY. PART III, LINE 4: FOOTNOTE: PERIODICALLY, MANAGEMENT ASSESSES THE ADEQUACY OF THE ALLOWANCE FOR UNCOLLECTIBLE ACCOUNTS BASED UPON HISTORICAL WRITE-OFF EXPERIENCE BY PAYOR CATEGORY. THE RESULTS OF THIS REVIEW ARE THEN USED TO MAKE ANY MODIFICATIONS TO THE PROVISION OF BAD DEBTS TO ESTABLISH AN APPROPRIATE ALLOWANCE FOR UNCOLLECTABLE ACCOUNTS. BAD DEBT EXPENSE WAS COMPUTED USING THE COST TO CHARGE RATIO. PART III, LINE 8: MEDICARE ALLOWABLE COSTS WERE CALCULATED USING MEDICARE COST REPORTS. THE ORGANIZATION HAS NOT ESTIMATED WHAT PORTION OF THE MEDICARE SHORTFALL IS ATTRIBUTED TO PATIENTS WHO QUALIFY FOR FINANCIAL ASSISTANCE DUE TO LACK OF CLEAR ESTIMATE. 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: WGH ENGAGED AN OUTSIDE CONSULTANT TO SURVEY COMMUNITY HEALTH STATUS, BEHAVIORS, AND NEEDS. THIS SURVEY IDENTIFIED OPPORTUNITIES FOR HEALTH IMPROVEMENT IN THE ORGANIZATION'S PRIMARY AND SECONDARY SERVICE AREAS. THE SURVEY CONSISTED OF A RADOM SAMPLE OF 500 INDIVIDUALS (AGE 18 OR OLDER) INTERVIEWED BY TELEPHONE. THE RESULTS OF THE SURVEY ARE AVAILABLE UPON REQUEST. 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 550-BED FACILITY LOCATED IN LAGRANGE, GEORGIA, APPROXIMATELY 70 MILES SOUTH OF ATLANTA. WGH'S PRIMARY SERVICE AREA IS TROUP COUNTY WITH A POPULATION OF APPROXIMATELY 67,000, BUT IT ALSO SERVES OTHER COUNTIES IN THE WEST CENTRAL GEORGIA AND EAST CENTRAL ALABAMA. APROXIMATELY 20% OF THE POPULATION IN THE SERVICE AREA IS LIVING AT OR BELOW POVERTY LEVEL. ALMOST 61% OF THE POPULATION IS BETWEEN THE AGES OF 18 AND 64. ONLY ABOUT 12% 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 6: 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 HOSPICE FACILITY AND TWO NURSING HOMES. PART VI, LINE 7: THE ORGANIZATION (WGMC) IS PART OF WEST GEORGIA HEALTH SERVICES, INC., A MULTI-ENTITY HEALTHCARE SYSTEM. OTHER 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) VERNON WOODS RETIREMENT COMMUNITY, INC. - VERNON WOODS OPERATES A RETIREMENT COMMUNITY OFFERING BOTH ASSISTED AND INDEPENDENT LIVING. (3) WEST GEORGIA HEALTH FOUNDATION, INC. - THE FOUNDATION PROVIDES FUNDRAISING AND SUPPORT FOR WEST GEORGIA HEALTH SERVICES, INC. AND ITS AFFILIATES. (4) WEST GEORGIA HEALTH PHYSICIANS INC. - THIS IS A PHYSICIAN SERVICE ORGANIZATION WHICH PROVIDES SPECIALIZED MEDICAL SERVICES TO THE COMMUNITY. REPORTS FILED WITH STATES PART VI, LINE 7 GA 1 WEST GEORGIA HEALTH FOUNDATION INC 1514 VERNON ROAD LAGRANGE GA 30240 205497506 501(C)(3) 53000 OPERATIONAL SUPPORT 1 NURSING SCHOLARSHIPS (TUITION AND BOOKS) 18 637446 PROCEDURE FOR MONITORING GRANTS IN THE U.S.: PART I, LINE 2: SCHEDULE I, 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 X 1 1 X X X X 0 1 0 0 0 0 0 0 0 GERALD FULKS 374356 0 96458 0 0 0 72819 0 13391 0 557024 0 0 0 PAUL PERROTTI 232685 0 42188 0 148295 0 29724 0 10666 0 463558 0 148295 0 TRIPP PENN PAUL PENN III 120216 0 22500 0 0 0 6522 0 17207 0 166445 0 0 0 CHARIS ACREE 196825 0 35627 0 0 0 65321 0 13916 0 311689 0 0 0 DEBORAH BURTON 147561 0 26715 0 0 0 66027 0 10141 0 250444 0 0 0 ANGAMPALLY RAJEEV 687390 0 0 0 0 0 6720 0 11966 0 706076 0 0 0 WILLIAM TURTON 360436 0 0 0 0 0 5476 0 10011 0 375923 0 0 0 NICK A VLACHOS 222320 0 17600 0 0 0 2031 0 8457 0 250408 0 0 0 MICHAEL MYERS 165568 0 0 0 0 0 4021 0 13417 0 183006 0 0 0 DON DAVIS 137584 0 9898 0 0 0 30275 0 1055 0 178812 0 0 0 JAMES BRENNAN 102425 0 0 0 0 0 0 0 0 0 102425 0 0 0 PART I, LINE 1A THE ORGANIZATION PAYS MINOR SPOUSAL TRAVEL AND COUNTRY CLUB DUES FOR THE CEO ONLY. THESE ARE ADDED TO HIS TAXABLE COMPENSATION. PART I, LINE 4B EMPLOYER CONTRIBUTIONS TO THE 457(F) EXECUTIVE RETIREMENT BENEFIT PLAN INCLUDE $20,260 FOR PAUL PERROTTI AND $55,700 FOR GERALD FULKS. LAGRANGE-TROUP COUNTY HOSPITAL AUTHORITY 562609278 507154AF9 2008-07-31 45434268 CONSTRUCTION 0 0 0 LAGRANGE-TROUP COUNTY HOSPITAL AUTHORITY 562609278 NONEAVAIL 2010-01-15 24000000 CONSTRUCTION/ REFUNDING 0 0 0 LAGRANGE-TROUP COUNTY HOSPITAL AUTHORITY 562609278 NONEAVAIL 2010-06-22 4000000 CAPITAL ACQUISITION 0 0 0 1470000 46349309 4619242 900528 45782302 2011 0 0 1 1 210803 24000000 463425 132338 23404237 2011 1 0 1 1 721769 4003301 75509 2809994 1193307 2012 0 0 0 1 0 0 0 0 1 0.00000 0.00000 0.00000 1 0 0 0 0 1 0.00000 0.00000 0.00000 1 0 0 0 0 1 0.00000 0.00000 0.00000 1 0 0 0 0 0 1 0 0 0 0 0 1 0 0 0 0 0 1 SCH K, PART I, COLUMN (F) DESCRIPTION OF PURPOSE: 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 2010 WAS ISSUED FOR THE FOLLOWING PURPOSE: (1) TO FINANCE OR REFINANCE ALL OR A PORTION OF THE COST OF THE ACQUISITION, CONSTRUCTION, RENOVATION, EQUIPPING AND INSTALLING OF CERTAIN ADDITIONS, EXTENSIONS, AND IMPROVEMENTS TO WEST GEORGIA MEDICAL CENTER, (2) TO PAY OFF A PROMISSORY NOTE ISSUED TO THE PURCHASER IN CONNECTION WITH A LOAN MADE TO WEST GEORGIA MEDICAL CENTER, AND (3) TO PAY OFF ALL OR A PORTION OF THE COST OF ISSUANCE OF THE SERIES 2010 CERTIFICATES. SERIES 2010B WAS ISSUED FOR THE FOLLOWING PURPOSE: (1) TO FINANCE OR REFINANCE ALL OR A PORTION OF THE COST OF THE ACQUISITION AND INSTALLATION OF CERTAIN HEALTHCARE EQUIPMENT AND OTHER EQUIPMENT AT WEST GEORGIA MEDICAL CENTER, AND (2) TO PAY ALL OR A PORTION OF THE COSTS OF ISSUANCE OF THE SERIES 2010B 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 THE CORPORATION MAY NOT APPOINT OR REMOVE A DIRECTOR OR THE PRESIDENT AND THE CHIEF EXECUTIVE OFFICER OF THE CORPORATION WITHOUT THE APPROVAL OF ITS SOLE MEMBER, WEST GEORGIA HEALTH SERVICES, INC. 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 A COPY OF THE REVIEWED AND APPROVED 990 WAS DISTRIBUTED TO EACH BOARD MEMBER VIA E-MAIL PRIOR TO ELECTRONIC FILING OF THE RETURN. THE 990 WAS ALSO REVIEWED AND APPROVED BY THE CONTROLLER AND CFO OF WEST GEORGIA HEALTH. 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. CHANGES IN NET ASSETS OR FUND BALANCES: FORM 990, PART XI, LINE 5: NET UNREALIZED LOSSES ON INVESTMENTS: -1,027,222. PRIOR PERIOD ADJUSTMENTS: -818,651. PENSION LIABILITY ADJUSTMENT -1,141,544. TRANSFER TO AFFILIATE -2,000,000. TOTAL TO FORM 990, PART XI, LINE 5: -4,987,417. 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 WEST GEORGIA HEALTH PHYSICIANS INC 1514 VERNON ROAD LAGRANGE GA 30240 275125341 PHYSICIAN PRACTICE GA WEST GEORIGA HEALTH SERVICES INC C 1 1 0 1 1 0 0 1 1 1 0 1 0 1 0 1 0 0