WEST GEORGIA HEALTH FOUNDATION INC: Form 990, tax year 2009
View the entire original 990 at ProPublica ↗
- Organization
- WEST GEORGIA HEALTH FOUNDATION INC (EIN 20-0936376)
- Tax period
- 2009-10-01 to 2010-09-30
- Filed
- 2011-08-14
- IRS object ID
- 201112269349301006
- Schema version
- 2009v1.7
- 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
- Form 990
- Schedule A
- Schedule B
- Schedule D
- Schedule G
- Schedule I
- Schedule J
- Schedule O
- Schedule R
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Timestamp | 2011-08-14T20:41:19-05:00 | Timestamp |
| Tax Period End Date | 2010-09-30 | TaxPeriodEndDate |
Preparer Firm PreparerFirm
Preparer Firm Business Name PreparerFirmBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Pershing Yoakley & Associates P C | BusinessNameLine1 |
Preparer Firm US Address PreparerFirmUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | One Cherokee Mills 2220 Sutherland | AddressLine1 |
| City | Knoxville | City |
| State | TN | State |
| ZIP Code | 379192363 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnType |
| Tax Period Begin Date | 2009-10-01 | TaxPeriodBeginDate |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 200936376 | EIN |
Name Name
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | WEST GEORGIA HEALTH FOUNDATION INC | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Control | WEST | NameControl |
| Phone | 7068821411 | Phone |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1514 VERNON ROAD | AddressLine1 |
| City | LAGRANGE | City |
| State | GA | State |
| ZIP Code | 30240 | ZIPCode |
Officer Officer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | Paul Perrottii | Name |
| Title | CFO | Title |
| Phone | 7068821411 | Phone |
| Date Signed | 2011-08-14 | DateSigned |
| Authorize Third Party | 1 | AuthorizeThirdParty |
Preparer Preparer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | W Edward Phillips | Name |
| Phone | 8656730844 | Phone |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax Year | 2009 | TaxYear |
| Build TS | 2016-02-24 21:20:13Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Of Principal Officer Person | Susan Ferguson | NameOfPrincipalOfficerPerson |
Address Principal Officer US AddressPrincipalOfficerUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1514 VERNON ROAD | AddressLine1 |
| City | LAGRANGE | City |
| State | GA | State |
| ZIP Code | 30240 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | 783489 | GrossReceipts |
| Group Return For Affiliates | 0 | GroupReturnForAffiliates |
| Organization501c | X | Organization501c |
| Web Site | www.wghealth.org | WebSite |
| Type Of Organization Corporation | X | TypeOfOrganizationCorporation |
| Year Formation | 2004 | YearFormation |
| State Legal Domicile | GA | StateLegalDomicile |
| Activity Or Mission Description | THE 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 Body | 14 | NbrVotingMembersGoverningBody |
| Nbr Independent Voting Members | 9 | NbrIndependentVotingMembers |
| Total Nbr Employees | 0 | TotalNbrEmployees |
| Total Nbr Volunteers | 130 | TotalNbrVolunteers |
| Total Gross UBI | 0 | TotalGrossUBI |
| Net Unrelated Business Txbl Income | 0 | NetUnrelatedBusinessTxblIncome |
| Contributions Grants Prior Year | 748072 | ContributionsGrantsPriorYear |
| Contributions Grants Current Year | 476864 | ContributionsGrantsCurrentYear |
| Program Service Revenue CY | 0 | ProgramServiceRevenueCY |
| Investment Income Prior Year | -345886 | InvestmentIncomePriorYear |
| Investment Income Current Year | 259676 | InvestmentIncomeCurrentYear |
| Other Revenue Current Year | 0 | OtherRevenueCurrentYear |
| Total Revenue Prior Year | 402186 | TotalRevenuePriorYear |
| Total Revenue Current Year | 736540 | TotalRevenueCurrentYear |
| Grants And Similar Amnts Prior Year | 7822560 | GrantsAndSimilarAmntsPriorYear |
| Grants And Similar Amnts CY | 1558369 | GrantsAndSimilarAmntsCY |
| Benefits Paid To Members CY | 0 | BenefitsPaidToMembersCY |
| Salaries Etc Current Year | 0 | SalariesEtcCurrentYear |
| Total Prof Fundrsng Exp CY | 0 | TotalProfFundrsngExpCY |
| Total Fundrsng Exp Current Year | 0 | TotalFundrsngExpCurrentYear |
| Other Expense Prior Year | 35161 | OtherExpensePriorYear |
| Other Expenses Current Year | 49342 | OtherExpensesCurrentYear |
| Total Expenses Prior Year | 7857721 | TotalExpensesPriorYear |
| Total Expenses Current Year | 1607711 | TotalExpensesCurrentYear |
| Revenues Less Expenses Prior Year | -7455535 | RevenuesLessExpensesPriorYear |
| Revenues Less Expenses CY | -871171 | RevenuesLessExpensesCY |
| Total Assets BOY | 12362766 | TotalAssetsBOY |
| Total Assets EOY | 9558422 | TotalAssetsEOY |
| Total Liabilities BOY | 7092701 | TotalLiabilitiesBOY |
| Total Liabilities EOY | 4757756 | TotalLiabilitiesEOY |
| Net Assets Or Fund Balances BOY | 5270065 | NetAssetsOrFundBalancesBOY |
| Net Assets Or Fund Balances EOY | 4800666 | NetAssetsOrFundBalancesEOY |
| Mission Description | THE FOUNDATION IS ORGANIZED AND SHALL BE OPERATED EXCLUSIVELY FOR THE BENEFIT OF West Georgia Medical Center, Inc. AND ITS AFFILIATED ENTITIES BY PROVIDING FUNDRAISING AND FINANCIAL SUPPORT. | MissionDescription |
| Significant New Program Services | 0 | SignificantNewProgramServices |
| Significant Change | 0 | SignificantChange |
| Expense | 1418847 | Expense |
| Grants | 1418847 | Grants |
| Description | West Georgia Medical Center, Inc. - To provide funds for specific medical and cancer treating equipment in support of West Georgia Medical Center. | Description |
Activity2 Activity2
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expense | 124088 | Expense |
| Grants | 124088 | Grants |
| Description | To provide support to West Georgia Medical Center, Inc. for operating Hospice Center. | Description |
Activity3 Activity3
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expense | 15434 | Expense |
| Grants | 15434 | Grants |
| Description | Helping Hands - The Helping Hands Family Assistance Program has been established to assist present and retired WGHS employees and Hospital Auxiliary volunteers with financial support in times of crisis. Qualifying hardships include a 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, 2009 through September 30, 2010 the Helping Hands program has helped 33 West Georgia Health System employees. | Description |
Activity Other ActivityOther (2 entries)
| ExpenseExpense | DescriptionDescription |
|---|---|
| 2951 | Camp Dogwood |
| 3875 | Lifeline |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Other Program Service Exp | 6826 | TotalOfOtherProgramServiceExp |
| Total Program Service Expense | 1565195 | TotalProgramServiceExpense |
| Described In501 C3 | 1 | DescribedIn501C3 |
| Schedule B Required | 1 | ScheduleBRequired |
| Political Activities | 0 | PoliticalActivities |
| Lobbying Activities | 0 | LobbyingActivities |
| Donor Advised Funds | 0 | DonorAdvisedFunds |
| Conservation Easements | 0 | ConservationEasements |
| Collections Of Art | 0 | CollectionsOfArt |
| Credit Counseling | 0 | CreditCounseling |
| Term Or Permanent Endowments | 1 | TermOrPermanentEndowments |
| Balance Sheet Amounts Reported | 1 | BalanceSheetAmountsReported |
| Independent Audit Financial Stmt | 1 | IndependentAuditFinancialStmt |
| Consolidated Audit Financial Stmt | 1 | ConsolidatedAuditFinancialStmt |
| School | 0 | School |
| Foreign Office | 0 | ForeignOffice |
| Foreign Activities | 0 | ForeignActivities |
| More Than5000 K To Organizations | 0 | MoreThan5000KToOrganizations |
| More Than5000 K To Individuals | 0 | MoreThan5000KToIndividuals |
| Professional Fundraising | 0 | ProfessionalFundraising |
| Fundraising Activities | 1 | FundraisingActivities |
| Gaming | 0 | Gaming |
| Hospital | 0 | Hospital |
| Grants To Organizations | 1 | GrantsToOrganizations |
| Grants To Individuals | 1 | GrantsToIndividuals |
| Schedule J Required | 1 | ScheduleJRequired |
| Tax Exempt Bonds | 0 | TaxExemptBonds |
| Excess Benefit Transaction | 0 | ExcessBenefitTransaction |
| Prior Excess Benefit Transaction | 0 | PriorExcessBenefitTransaction |
| Loan To Officer Or DQP | 0 | LoanToOfficerOrDQP |
| Grant To Related Person | 0 | GrantToRelatedPerson |
| Bsnss Rltnshp With Organization | 0 | BsnssRltnshpWithOrganization |
| Bsnss Rltnshp Thru Family Member | 0 | BsnssRltnshpThruFamilyMember |
| Officer Entity With Bsnss Rltnshp | 0 | OfficerEntityWithBsnssRltnshp |
| Deductible Non Cash Contributions | 0 | DeductibleNonCashContributions |
| Deductible Contributions Of Art | 0 | DeductibleContributionsOfArt |
| Terminated | 0 | Terminated |
| Partial Liquidation | 0 | PartialLiquidation |
| Disregarded Entity | 0 | DisregardedEntity |
| Related Entity | 1 | RelatedEntity |
| Related Org Controlled Entity | 0 | RelatedOrgControlledEntity |
| Transfers To Exempt Non Chrtbl Org | 0 | TransfersToExemptNonChrtblOrg |
| Activities Conducted Partnership | 0 | ActivitiesConductedPartnership |
| Schedule O Required | 1 | ScheduleORequired |
| Number Forms Transmitted With1096 | 0 | NumberFormsTransmittedWith1096 |
| Number W2 G Included | 0 | NumberW2GIncluded |
| Number Of Employees | 0 | NumberOfEmployees |
| Unrelated Business Income | 0 | UnrelatedBusinessIncome |
| Foreign Financial Account | 0 | ForeignFinancialAccount |
| Prohibited Tax Shelter Trans | 0 | ProhibitedTaxShelterTrans |
| Taxable Party Notification | 0 | TaxablePartyNotification |
| Non Deductible Contributions | 0 | NonDeductibleContributions |
| Quid Pro Quo Contributions | 1 | QuidProQuoContributions |
| Quid Pro Quo Disclosure | 1 | QuidProQuoDisclosure |
| Form8282 Property Disposed Of | 0 | Form8282PropertyDisposedOf |
| Funds To Pay Premiums | 0 | FundsToPayPremiums |
| Premiums Paid | 0 | PremiumsPaid |
| Nbr Voting Governing Body Members | 14 | NbrVotingGoverningBodyMembers |
| Number Independent Voting Members | 9 | NumberIndependentVotingMembers |
| Family Or Business Relationship | 0 | FamilyOrBusinessRelationship |
| Delegation Of Management Duties | 0 | DelegationOfManagementDuties |
| Changes To Organizing Docs | 0 | ChangesToOrganizingDocs |
| Material Diversion Or Misuse | 0 | MaterialDiversionOrMisuse |
| Members Or Stockholders | 1 | MembersOrStockholders |
| Election Of Board Members | 1 | ElectionOfBoardMembers |
| Decisions Subject To Approval | 1 | DecisionsSubjectToApproval |
| Minutes Of Governing Body | 1 | MinutesOfGoverningBody |
| Minutes Of Committees | 1 | MinutesOfCommittees |
| Officer Mailing Address | 0 | OfficerMailingAddress |
| Local Chapters | 0 | LocalChapters |
| Form990 Provided To Governing Body | 1 | Form990ProvidedToGoverningBody |
| Conflict Of Interest Policy | 1 | ConflictOfInterestPolicy |
| Annual Disclosure Covered Persons | 0 | AnnualDisclosureCoveredPersons |
| Regular Monitoring Enforcement | 1 | RegularMonitoringEnforcement |
| Whistleblower Policy | 1 | WhistleblowerPolicy |
| Document Retention Policy | 1 | DocumentRetentionPolicy |
| Compensation Process CEO | 1 | CompensationProcessCEO |
| Compensation Process Other | 1 | CompensationProcessOther |
| Investment In Joint Venture | 0 | InvestmentInJointVenture |
| States Where Copy Of Return Is Filed | GA | StatesWhereCopyOfReturnIsFiled |
| Upon Request | X | UponRequest |
The Books Are In Care Of TheBooksAreInCareOf
Name Business NameBusiness
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Chris Wingo West Georgia Health | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Telephone Number | 7068453940 | TelephoneNumber |
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1514 Vernon Road | AddressLine1 |
| City | LaGrange | City |
| State | GA | State |
| ZIP Code | 30240 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| No Listed Persons Compensated | X | NoListedPersonsCompensated |
Form990 Part VII Section A Form990PartVIISectionA (17 entries)
| TitleTitle | Average Hours Per WeekAverageHoursPerWeek | Individual Trustee Or DirectorIndividualTrusteeOrDirector | Reportable Comp From OrganizationReportableCompFromOrganization | Reportable Comp From Related OrgsReportableCompFromRelatedOrgs | Other CompensationOtherCompensation | OfficerOfficer |
|---|---|---|---|---|---|---|
| Wesley Smith | ||||||
| Chairman | 1.00 | X | 0 | 0 | 0 | |
| Patrick Crews | ||||||
| Vice Chairman | 1.00 | X | 0 | 0 | 0 | |
| Heather Graham | ||||||
| Member | 1.00 | X | 0 | 0 | 0 | |
| Joe Ragland | ||||||
| Member | 1.00 | X | 0 | 0 | 0 | |
| Kyle Crawford | ||||||
| Member | 1.00 | X | 0 | 0 | 0 | |
| Wayne Hunter | ||||||
| Member | 1.00 | X | 0 | 0 | 0 | |
| Beverly Lundberg | ||||||
| Member | 1.00 | X | 0 | 0 | 0 | |
| Dr Brett Bowie | ||||||
| Member | 1.00 | X | 0 | 8500 | 0 | |
| Dr Julian Duttera | ||||||
| Member | 1.00 | X | 0 | 14375 | 0 | |
| Ellen Harris | ||||||
| Member | 1.00 | X | 0 | 0 | 0 | |
| Dr David Martin | ||||||
| Member | 1.00 | X | 0 | 100000 | 0 | |
| Gerald Fulks | ||||||
| Member, Secretary of Fdn | 1.00 | X | 0 | 537826 | 74340 | X |
| Aimee Thompson | ||||||
| Member, Employee of WGHS | 1.00 | X | 0 | 50951 | 5876 | |
| Wayne Abbott | ||||||
| Treasurer | 1.00 | X | 0 | 0 | 0 | |
| Cathy Wiggins | ||||||
| Director of Hospice | 1.00 | X | 0 | 91685 | 11215 | |
| Paul Perrottii | ||||||
| CFO & VP of WGHS | 1.00 | X | 0 | 305117 | 34882 | X |
| Susan Ferguson | ||||||
| Director of Foundation | 40.00 | 0 | 0 | 0 | X | |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | 0 | TotalReportableCompFromOrg |
| Total Reportable Comp Frm Rltd Orgs | 1108454 | TotalReportableCompFrmRltdOrgs |
| Total Other Compensation | 126313 | TotalOtherCompensation |
| Number Individuals GT100 K | 0 | NumberIndividualsGT100K |
| Formers Listed | 0 | FormersListed |
| Total Comp GT150 K | 1 | TotalCompGT150K |
| Compensation From Other Sources | 0 | CompensationFromOtherSources |
| Number Of Contractors GT100 K | 0 | NumberOfContractorsGT100K |
| Fundraising Events | 59752 | FundraisingEvents |
| All Other Contributions | 417112 | AllOtherContributions |
| Total Contributions | 476864 | TotalContributions |
Investment Income InvestmentIncome
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 146610 | TotalRevenueColumn |
| Exclusion | $146,610 | ExclusionAmount |
Gross Amount Sales Assets GrossAmountSalesAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | 113066 | Securities |
Gain Or Loss GainOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | 113066 | Securities |
Net Gain Or Loss Investments NetGainOrLossInvestments
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 113066 | TotalRevenueColumn |
| Exclusion | $113,066 | ExclusionAmount |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Income Fundraising Events | 46949 | GrossIncomeFundraisingEvents |
| Cntrbtns Rprtd Fundraising Events | 59752 | CntrbtnsRprtdFundraisingEvents |
| Fundraising Direct Expenses | 46949 | FundraisingDirectExpenses |
Net Income From Fundraising Events NetIncomeFromFundraisingEvents
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 0 | TotalRevenueColumn |
Total Revenue TotalRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 736540 | TotalRevenueColumn |
| Related Or Exempt Function Income | 0 | RelatedOrExemptFunctionIncome |
| Unrelated Business Revenue | 0 | UnrelatedBusinessRevenue |
| Exclusion | $259,676 | ExclusionAmount |
Grants To Domestic Orgs GrantsToDomesticOrgs
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1542935 | Total |
| Program Services | 1542935 | ProgramServices |
Grants To Domestic Individuals GrantsToDomesticIndividuals
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 15434 | Total |
| Program Services | 15434 | ProgramServices |
Fees For Services Invst Mgmnt Fees FeesForServicesInvstMgmntFees
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 14323 | Total |
| Management And General | 14323 | ManagementAndGeneral |
Depreciation Depletion DepreciationDepletion
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 5267 | Total |
| Management And General | 5267 | ManagementAndGeneral |
Other Expenses OtherExpenses (5 entries)
| DescriptionDescription | TotalTotal | Management And GeneralManagementAndGeneral | Program ServicesProgramServices |
|---|---|---|---|
| Miscellaneous Expense | 14800 | 14800 | |
| Equipment Rental and Ma | 7497 | 7497 | |
| Life Line | 3875 | 3875 | |
| Camp Dogwood | 2951 | 2951 | |
| Bank Fees | 629 | 629 |
Total Functional Expenses TotalFunctionalExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1607711 | Total |
| Program Services | 1565195 | ProgramServices |
| Management And General | 42516 | ManagementAndGeneral |
| Fundraising | 0 | Fundraising |
Cash Non Interest Bearing CashNonInterestBearing
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 3729122 | BOY |
| EOY | 539077 | EOY |
Pledges And Grants Receivable PledgesAndGrantsReceivable
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 532870 | BOY |
| EOY | 288655 | EOY |
Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 5267 | BOY |
Investments Pub Traded Securities InvestmentsPubTradedSecurities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 8095507 | BOY |
| EOY | 8730690 | EOY |
Total Assets TotalAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 12362766 | BOY |
| EOY | 9558422 | EOY |
Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 8663 | BOY |
| EOY | 9186 | EOY |
Other Liabilities OtherLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 7084038 | BOY |
| EOY | 4748570 | EOY |
Total Liabilities TotalLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 7092701 | BOY |
| EOY | 4757756 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Follow SFAS117 | X | FollowSFAS117 |
Unrestricted Net Assets UnrestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 5266 | BOY |
| EOY | 0 | EOY |
Temporarily Restricted Net Assets TemporarilyRestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 4352799 | BOY |
| EOY | 3888666 | EOY |
Permanently Restricted Net Assets PermanentlyRestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 912000 | BOY |
| EOY | 912000 | EOY |
Total Net Assets Fund Balances TotalNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 5270065 | BOY |
| EOY | 4800666 | EOY |
Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 12362766 | BOY |
| EOY | 9558422 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Method Of Accounting Accrual | X | MethodOfAccountingAccrual |
| Accountant Compile Or Review | 0 | AccountantCompileOrReview |
| FS Audited | 1 | FSAudited |
| Audit Committee | 1 | AuditCommittee |
| Financial Statement Both | X | FinancialStatementBoth |
| Federal Grant Audit Required | 0 | FederalGrantAuditRequired |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Publicly Supported Org170b1 Avi | X | PubliclySupportedOrg170b1Avi |
Gifts Grants Contrib Received170 GiftsGrantsContribReceived170
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | 1211905 | CurrentTaxYearMinus4Years |
| Current Tax Year Minus3 Years | 1328051 | CurrentTaxYearMinus3Years |
| Current Tax Year Minus2 Years | 726312 | CurrentTaxYearMinus2Years |
| Current Tax Year Minus1 Year | 748072 | CurrentTaxYearMinus1Year |
| Current Tax Year | 476864 | CurrentTaxYear |
| Total | 4491204 | Total |
Total170 Total170
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | 1211905 | CurrentTaxYearMinus4Years |
| Current Tax Year Minus3 Years | 1328051 | CurrentTaxYearMinus3Years |
| Current Tax Year Minus2 Years | 726312 | CurrentTaxYearMinus2Years |
| Current Tax Year Minus1 Year | 748072 | CurrentTaxYearMinus1Year |
| Current Tax Year | 476864 | CurrentTaxYear |
| Total | 4491204 | Total |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Amounts Subst Contributors Total | 190815 | AmountsSubstContributorsTotal |
| Public Support Total170 | 4300389 | PublicSupportTotal170 |
Gross Investment Income170 GrossInvestmentIncome170
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | 12020 | CurrentTaxYearMinus4Years |
| Current Tax Year Minus3 Years | 454640 | CurrentTaxYearMinus3Years |
| Current Tax Year Minus2 Years | 322117 | CurrentTaxYearMinus2Years |
| Current Tax Year Minus1 Year | 219576 | CurrentTaxYearMinus1Year |
| Current Tax Year | 146610 | CurrentTaxYear |
| Total | 1154963 | Total |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Support | 5646167 | TotalSupport |
| Gross Receipts From Admissions Etc | 259295 | GrossReceiptsFromAdmissionsEtc |
| Public Support Pertcentage170 | 0.76160 | PublicSupportPertcentage170 |
| Public Support Pertcent Prior Year | 0.80990 | PublicSupportPertcentPriorYear |
| Thirty Three Percnt Tests CY170 | X | ThirtyThreePercntTestsCY170 |
Schedule B IRS990ScheduleB
Contributor Info ContributorInfo
| Field | Value | IRS element (for citing) |
|---|---|---|
| Contributor Number | RESTRICTED | ContributorNumber |
Contributor Name Business ContributorNameBusiness
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | RESTRICTED | BusinessNameLine1 |
Contributor Address US ContributorAddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | RESTRICTED | AddressLine1 |
| Address Line2 | RESTRICTED | AddressLine2 |
| City | RESTRICTED | City |
| State | RESTRICTED | State |
| ZIP Code | RESTRICTED | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Aggregate Contributions | RESTRICTED | AggregateContributions |
Schedule D IRS990ScheduleD
Current Year CurrentYear
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Of Year Balance | 5264798 | BeginningOfYearBalance |
| Contributions | 523813 | Contributions |
| Investment Earnings Or Losses | 647124 | InvestmentEarningsOrLosses |
| Other Expenditures | 1635069 | OtherExpenditures |
| End Of Year Balance | 4800666 | EndOfYearBalance |
Current Year Minus1 Year CurrentYearMinus1Year
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Of Year Balance | 12371256 | BeginningOfYearBalance |
| Contributions | 821933 | Contributions |
| Investment Earnings Or Losses | -3776 | InvestmentEarningsOrLosses |
| Other Expenditures | 7924615 | OtherExpenditures |
| End Of Year Balance | 5264798 | EndOfYearBalance |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Permanent Endowment EOY Balance | 0.19000 | PermanentEndowmentEOYBalance |
| Term Endowment EOY Balance | 0.81000 | TermEndowmentEOYBalance |
| Endowments Held By Unrelated Orgs | 0 | EndowmentsHeldByUnrelatedOrgs |
| Endowments Held By Related Orgs | 0 | EndowmentsHeldByRelatedOrgs |
| Total Of Book Value Land Buildings | 0 | TotalOfBookValueLandBuildings |
Other Liabilities OtherLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| Description | Due to Affiliate | Description |
| Amount | $4,748,570 | Amount |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Amounts | 4748570 | TotalOfAmounts |
| Total Revenue | 736540 | TotalRevenue |
| Total Expenses | 1607711 | TotalExpenses |
| Excess Or Deficit For Year | -871171 | ExcessOrDeficitForYear |
| Net Unrealized GL On Investments | 401772 | NetUnrealizedGLOnInvestments |
| Total Adjustments | 401772 | TotalAdjustments |
| Excess Or Deficit Per FS | -469399 | ExcessOrDeficitPerFS |
| Tot Revenue Etc Audited Fincl Stmt | 1635069 | TotRevenueEtcAuditedFinclStmt |
| Other Revenues | 1635069 | OtherRevenues |
| Revenue Not Rptd F990 | 1635069 | RevenueNotRptdF990 |
| Revenue Subtotal | 0 | RevenueSubtotal |
| Other Revenues Not Included | 736540 | OtherRevenuesNotIncluded |
| Revenue Not Rptd On Fin Stmt | 736540 | RevenueNotRptdOnFinStmt |
| Total Revenue Per Form990 | 736540 | TotalRevenuePerForm990 |
| Tot Expenses Etc Audited Fincl Stmt | 1640335 | TotExpensesEtcAuditedFinclStmt |
| Other Expenses Included | 32624 | OtherExpensesIncluded |
| Expenses Not Rptd F990 | 32624 | ExpensesNotRptdF990 |
| Expenses Subtotal | 1607711 | ExpensesSubtotal |
| Expenses Not Rptd On Fin Stmt | 0 | ExpensesNotRptdOnFinStmt |
| Total Expenses Per Form990 | 1607711 | TotalExpensesPerForm990 |
Form990 Schedule D Part XIV Form990ScheduleDPartXIV (5 entries)
| IdentifierIdentifier | Return ReferenceReturnReference | ExplanationExplanation |
|---|---|---|
| Part V, Line 4: | Description of Intended Use of Endowment Funds: | Net assets are released from restrictions when expenses are incurred to satisfy the restricted purposes, by passage of time or by occurrence 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. |
| Part X: | Description of Uncertain Tax Positions Under FIN 48: | 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 no significant uncertain tax positions at september 30,2010. |
| Part XII, Line 2d - Other Adjustments: | Net Assets released from Restriction: 1635069. | |
| Part XII, Line 4b - Other Adjustments: | Investment Income: 146610. Gain on sale of Investments: 113066. Contributions: 523813. Special Event Expenses: -46949. | |
| Part XIII, Line 2d - Other Adjustments: | FUNDRAISING EXPENSE: 46949. Investment Expenses: -14325. |
Schedule G IRS990ScheduleG
Events Information EventsInformation
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Of Event1 | Golf Tournament | NameOfEvent1 |
| Gross Receipts Event1 | 64639 | GrossReceiptsEvent1 |
| Charitable Contributions Event1 | 34596 | CharitableContributionsEvent1 |
| Gross Revenue Event1 | 30043 | GrossRevenueEvent1 |
| Non Cash Prizes Event1 | 23845 | NonCashPrizesEvent1 |
| Rent Facility Costs Event1 | 3349 | RentFacilityCostsEvent1 |
| Other Direct Expenses Event1 | 2849 | OtherDirectExpensesEvent1 |
| Name Of Event2 | Poinsettia Sale | NameOfEvent2 |
| Gross Receipts Event2 | 28606 | GrossReceiptsEvent2 |
| Charitable Contributions Event2 | 15968 | CharitableContributionsEvent2 |
| Gross Revenue Event2 | 12638 | GrossRevenueEvent2 |
| Other Direct Expenses Event2 | 12638 | OtherDirectExpensesEvent2 |
| Total Number Of Other Events | 2 | TotalNumberOfOtherEvents |
| Gross Receipts Other Events | 13456 | GrossReceiptsOtherEvents |
| Charitable Contrib Other Events | 9188 | CharitableContribOtherEvents |
| Gross Revenue Other Events | 4268 | GrossRevenueOtherEvents |
| Other Direct Expenses Other Events | 4268 | OtherDirectExpensesOtherEvents |
| Gross Receipts Total | 106701 | GrossReceiptsTotal |
| Charitable Contributions Total | 59752 | CharitableContributionsTotal |
| Gross Revenue Total Events | 46949 | GrossRevenueTotalEvents |
| Non Cash Prizes Total Events | 23845 | NonCashPrizesTotalEvents |
| Rent Facility Costs Total Events | 3349 | RentFacilityCostsTotalEvents |
| Other Direct Expenses Total Events | 19755 | OtherDirectExpensesTotalEvents |
| Direct Expense Summary Events | 46949 | DirectExpenseSummaryEvents |
| Net Income Summary | 0 | NetIncomeSummary |
Schedule I IRS990ScheduleI
| Field | Value | IRS element (for citing) |
|---|---|---|
| Records Maintained | 0 | RecordsMaintained |
Recipient Table RecipientTable (4 entries)
| Address Line1AddressUS/AddressLine1 | CityAddressUS/City | StateAddressUS/State | ZIP CodeAddressUS/ZIPCode | EIN Of RecipientEINOfRecipient | IRC SectionIRCSection | Amount Of Cash GrantAmountOfCashGrant | Purpose Of GrantPurposeOfGrant |
|---|---|---|---|---|---|---|---|
| West Georgia Medical Center Inc | |||||||
| 1514 Vernon Road | LaGrange | GA | 30240 | 205497506 | 501(c)(3) | 124088 | Funds Donated for Hospice Operations |
| West Georgia Medical Center Inc | |||||||
| 1514 Vernon Road | LaGrange | GA | 30240 | 205497506 | 501(c)(3) | 516021 | Funds Donated for ER - South Tower Project |
| West Georgia Medical Center Inc | |||||||
| 1514 Vernon Road | laGrange | GA | 30240 | 205497506 | 501(c)(3) | 898952 | Funds donated for specific Medical and Cancer Treatment Equipment |
| West Georgia Medical Center Inc | |||||||
| 1514 Vernon Road | LaGrange | GA | 30240 | 205497506 | 501(c)(3) | 3874 | Funds Donated for specific LTC Equipment |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Nbr Of501 C3 And Govt Grants | 1 | TotalNbrOf501C3AndGovtGrants |
Form990 Schedule I Part III Form990ScheduleIPartIII
| Field | Value | IRS element (for citing) |
|---|---|---|
| Type Of Grant | Helping Hands Family Assistance Program | TypeOfGrant |
| Number Of Recipients | 33 | NumberOfRecipients |
| Amount Of Cash Grant | 15434 | AmountOfCashGrant |
Form990 Schedule I Part IV Form990ScheduleIPartIV
| Field | Value | IRS element (for citing) |
|---|---|---|
| Identifier | Other Information: | Identifier |
| Return Reference | Part IV: | ReturnReference |
| Explanation | 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
| Field | Value | IRS element (for citing) |
|---|---|---|
| Severance Payment | 0 | SeverancePayment |
| Supplemental Nonqual Retire Plan | 1 | SupplementalNonqualRetirePlan |
| Equity Based Comp Arrangement | 0 | EquityBasedCompArrangement |
| Comp Based On Revenue Of Filing Org | 0 | CompBasedOnRevenueOfFilingOrg |
| Comp Based On Revenue Related Orgs | 0 | CompBasedOnRevenueRelatedOrgs |
| Comp Based Net Earnings Filing Org | 0 | CompBasedNetEarningsFilingOrg |
| Comp Based Net Earnings Relate Orgs | 0 | CompBasedNetEarningsRelateOrgs |
| Any Non Fixed Payments | 0 | AnyNonFixedPayments |
| Initial Contract Exception | 0 | InitialContractException |
Form990 Schedule J Part II Form990ScheduleJPartII (2 entries)
| Base Compensation Filing OrgBaseCompensationFilingOrg | Comp Based On Related OrgsCompBasedOnRelatedOrgs | Bonus Filing OrgBonusFilingOrg | Bonus Related OrgsBonusRelatedOrgs | Other Compensation Filing OrgOtherCompensationFilingOrg | Other Compensation Related OrgsOtherCompensationRelatedOrgs | Deferred Comp Filing OrgDeferredCompFilingOrg | Deferred Comp Related OrgsDeferredCompRelatedOrgs | Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrg | Nontaxable Benefits Related OrgsNontaxableBenefitsRelatedOrgs | Total Compensation Filing OrgTotalCompensationFilingOrg | Total Compensation Related OrgsTotalCompensationRelatedOrgs | Comp Report Prior990 Filing OrgCompReportPrior990FilingOrg | Comp Report Prior990 Related OrgsCompReportPrior990RelatedOrgs |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Gerald Fulks | |||||||||||||
| 0 | 376997 | 0 | 147411 | 0 | 13418 | 0 | 65500 | 0 | 8840 | 0 | 612166 | 0 | 0 |
| Paul Perrottii | |||||||||||||
| 0 | 228503 | 0 | 64536 | 0 | 12078 | 0 | 27533 | 0 | 7349 | 0 | 339999 | 0 | 0 |
Form990 Schedule J Part III Form990ScheduleJPartIII
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Reference | Part I, Line 4b: | ReturnReference |
| Explanation | Part I, Line 4b: employer contribution to 457(f) executive retirement benefit plan: Paul Perrotti $20,260 Gerald Fulks $55,700 | Explanation |
Schedule O IRS990ScheduleO
General Explanation GeneralExplanation (7 entries)
| IdentifierIdentifier | ExplanationExplanation |
|---|---|
| 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 | appointment to The Board of Directors is subject to approval by West Georgia Health Services, Inc., a related 501(c)(3) organization. |
| Form 990, Part VI, Section A, line 7b | Certain actions of the Board of Directors must be approved by West Georgia Health Services, Inc., a related 501(c)(3) organization. |
| Form 990, Part VI, Section B, line 11 | A copy of the reviewed and approved 990 will be distributed to each board member prior to submittal electronically via e-mail. The 990 will be reviewed and approved by the Controller and CFO of West Georgia Medical Center. |
| Form 990, Part VI, Section B, line 12c | The conflict of interest policy applies to all employees and directors of West Georgia. 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 15 | 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 19 | The organization makes its governing documents and policies available upon request. |
Schedule R IRS990ScheduleR
Form990 Schedule R Part II Form990ScheduleRPartII (4 entries)
| Address Line1AddressUS/AddressLine1 | CityAddressUS/City | StateAddressUS/State | ZIP CodeAddressUS/ZIPCode | EINEIN | Primary ActivitiesPrimaryActivities | Legal Domicile StateLegalDomicileState | Exempt Code SectionExemptCodeSection | Public Charity StatusPublicCharityStatus | Direct Controlling Entity NADirectControllingEntityNA |
|---|---|---|---|---|---|---|---|---|---|
| LaGrange - Troup County Hospital Authority | |||||||||
| 1514 Vernon Road | LaGrange | GA | 30240 | 562609278 | Hospital Authority | GA | 501(c)(3) | 3 | N/A |
| Vernon Woods Retirement Community Inc | |||||||||
| 1514 Vernon Road | LaGrange | GA | 30240 | 582575049 | Assisted Living | GA | 501(c)(3) | 9 | N/A |
| West Georgia Health Services Inc | |||||||||
| 1514 Vernon Road | LaGrange | GA | 30240 | 205497622 | Parent of Health System | GA | 501(c)(3) | 11 | N/A |
| West Georgia Medical Center Inc | |||||||||
| 1514 Vernon Road | laGrange | GA | 30240 | 205497506 | Hospital | GA | 501(c)(3) | 3 | N/A |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Ann Rents Royalties | 0 | ReceiptOfIntAnnRentsRoyalties |
| Gift Grant Or Cap Contr To Other Org | 1 | GiftGrantOrCapContrToOtherOrg |
| Gift Grant Or Cap Contr Fr Other Org | 1 | GiftGrantOrCapContrFrOtherOrg |
| Loans Or Guarantees To Other Org | 0 | LoansOrGuaranteesToOtherOrg |
| Loans Or Guarantees From Other Org | 1 | LoansOrGuaranteesFromOtherOrg |
| Sale Of Assets To Other Org | 0 | SaleOfAssetsToOtherOrg |
| Purchase Of Assets From Other Org | 0 | PurchaseOfAssetsFromOtherOrg |
| Exchange Of Assets | 0 | ExchangeOfAssets |
| Rental Of Facilities To Other Orgs | 0 | RentalOfFacilitiesToOtherOrgs |
| Rental Of Facilities Fr Other Orgs | 0 | RentalOfFacilitiesFrOtherOrgs |
| Perform Of Services For Other Orgs | 0 | PerformOfServicesForOtherOrgs |
| Perform Of Services By Other Orgs | 0 | PerformOfServicesByOtherOrgs |
| Sharing Of Facilities | 0 | SharingOfFacilities |
| Sharing Of Paid Employees | 1 | SharingOfPaidEmployees |
| Reimbursement Paid To Other Org | 0 | ReimbursementPaidToOtherOrg |
| Reimbursement Paid By Other Org | 0 | ReimbursementPaidByOtherOrg |
| Other Transfer To Other Org | 0 | OtherTransferToOtherOrg |
| Other Transfer From Other Org | 0 | OtherTransferFromOtherOrg |
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