2012-08-15T08:47:16-05:00 2011-12-31 621142155 PUGH & COMPANY PC 315 N CEDAR BLUFF RD KNOXVILLE TN 37923 990 2011-01-01 204901729 LAFOLLETTE MEDICAL FOUNDATION INC LAFO 4239126963 PO BOX 128 JACKSBORO TN 37757 JUDGE SHAYNE SEXTON 4239126963 2012-08-09 1 RE FOUST P00745365 8657690660 2011 2016-02-24 21:20:13Z JUDGE SHAYNE SEXTON PO BOX 128 JACKSBORO TN 37757 4492143 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 THE LAFOLLETTE COMMUNITY, WHICH INCLUDES ALL OF CAMPBELL COUNTY. 6 6 0 0 0 0 0 1498158 0 0 903294 418638 32977 0 936271 1916796 537490 549175 0 0 0 0 0 0 0 124867 145134 662357 694309 273914 1222487 9099360 10050850 133387 31800 8965973 10019050 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 THE LAFOLLETTE COMMUNITY, WHICH INCLUDES ALL OF CAMPBELL COUNTY. 0 0 549175 549175 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 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. 549175 1 1 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 0 1 1 0 1 0 0 0 0 0 0 0 0 0 0 0 X 6 6 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 0 0 0 0 0 0 0 0 1498158 1498158 260522 260522 2733463 2575347 158116 158116 158116 1916796 158116 0 260522 549175 549175 23163 23163 103134 103134 15000 15000 2272 2272 1565 1565 694309 549175 145134 0 588835 649003 8510525 9401847 9099360 10050850 3387 11050 130000 20750 133387 31800 X 8965973 10019050 8965973 10019050 9099360 10050850 X 1222487 -169410 X 0 1 0 X 0 X 1498158 1498158 1498158 1498158 1498158 855727 328328 231982 251778 260522 1928337 3426495 0.43720 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 1916796 694309 1222487 -186436 17026 -169410 1053077 1730360 0 1730360 186436 186436 1916796 677283 0 677283 17026 17026 694309 PART XI, LINE 8 - OTHER ADJUSTMENTS: RECOVERIES OF PRIOR YEARS GRANTS 17,026. PART XII, LINE 4B - OTHER ADJUSTMENTS: UNREALIZED LOSSES ON INVESTMENTS 186,436. PART XIII, LINE 4B - OTHER ADJUSTMENTS: RECOVERIES OF PRIOR YEAR GRANTS 17,026. 1 THE SHEPHERD'S HOME INC P O BOX 707 JACKSBORO TN 37757 270988603 501(C)(3) 70743 CASH GRANT HEALTH CARE ST MARY'S MEDICAL CENTER OF CAMPBELL COUNTY 923 E CENTRAL AVE LAFOLLETTE TN 37766 621817376 501(C)(3) 70009 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) 50400 CASH GRANT HEALTH CARE CATHOLIC CHARITIES OF EAST TENNESSEE 250 WEST BEACH STREET LAFOLLETTE TN 37757 100229692 501(C)(3) 20750 CASH GRANT HEALTH CARE CAMPBELL COUNTY CHILDREN'S CENTER 2315 JACKSBORO PIKE JACKSBORO TN 37766 780251005 501(C)(3) 108950 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) 43823 CASH GRANT HEALTH CARE TN BAPTIST ADULT HOMES PO BOX 728 BRENTWOOD TN 37024 620934533 501(C)(3) 7500 CASH GRANT HEALTH CARE HELEN ROSS MCNABB CENTER 201 W SPRINGDALE AVENUE KNOXVILLE TN 37917 620548914 501(C)(3) 75000 CASH GRANT HEALTH CARE CASA OF CAMPBELL COUNTY PO BOX 1054 JACKSBORO TN 37757 205755609 501(C)(3) 20000 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 5: NET UNREALIZED LOSSES ON INVESTMENTS: -186,436. RECOVERIES OF PRIOR YEARS GRANTS 17,026. TOTAL TO FORM 990, PART XI, LINE 5: -169,410.