2011-08-14T20:41:19-05:00 2010-09-30 Pershing Yoakley & Associates P C One Cherokee Mills 2220 Sutherland Knoxville TN 379192363 990 2009-10-01 200936376 WEST GEORGIA HEALTH FOUNDATION INC WEST 7068821411 1514 VERNON ROAD LAGRANGE GA 30240 Paul Perrottii 7068821411 2011-08-14 1 W Edward Phillips 8656730844 2009 2016-02-24 21:20:13Z Susan Ferguson 1514 VERNON ROAD LAGRANGE GA 30240 783489 0 X www.wghealth.org X 2004 GA THE FOUNDATION IS ORGANIZED AND SHALL BE OPERATED EXCLUSIVELY FOR THE BENEFIT OF THE West Georgia Medical Center, Inc. AND ITS AFFILIATED ENTITIES. 14 9 0 130 0 0 748072 476864 0 -345886 259676 0 402186 736540 7822560 1558369 0 0 0 0 35161 49342 7857721 1607711 -7455535 -871171 12362766 9558422 7092701 4757756 5270065 4800666 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. 0 0 1418847 1418847 West Georgia Medical Center, Inc. - To provide funds for specific medical and cancer treating equipment in support of West Georgia Medical Center. 124088 124088 To provide support to West Georgia Medical Center, Inc. for operating Hospice Center. 15434 15434 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. 2951 Camp Dogwood 3875 Lifeline 6826 1565195 1 1 0 0 0 0 0 0 1 1 1 1 0 0 0 0 0 0 1 0 0 1 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 0 0 0 0 0 0 0 0 1 1 0 0 0 14 9 0 0 0 0 1 1 1 1 1 0 0 1 1 0 1 1 1 1 1 0 GA X Chris Wingo West Georgia Health 7068453940 1514 Vernon Road LaGrange GA 30240 X Wesley Smith 1.00 X 0 0 0 Patrick Crews 1.00 X 0 0 0 Heather Graham 1.00 X 0 0 0 Joe Ragland 1.00 X 0 0 0 Kyle Crawford 1.00 X 0 0 0 Wayne Hunter 1.00 X 0 0 0 Beverly Lundberg 1.00 X 0 0 0 Dr Brett Bowie 1.00 X 0 8500 0 Dr Julian Duttera 1.00 X 0 14375 0 Ellen Harris 1.00 X 0 0 0 Dr David Martin 1.00 X 0 100000 0 Gerald Fulks 1.00 X X 0 537826 74340 Aimee Thompson 1.00 X 0 50951 5876 Wayne Abbott 1.00 X 0 0 0 Cathy Wiggins 1.00 X 0 91685 11215 Paul Perrottii 1.00 X X 0 305117 34882 Susan Ferguson 40.00 X 0 0 0 0 1108454 126313 0 0 1 0 0 59752 417112 476864 146610 146610 113066 113066 113066 113066 46949 59752 46949 0 736540 0 0 259676 1542935 1542935 15434 15434 14323 14323 5267 5267 Miscellaneous Expense 14800 14800 Equipment Rental and Ma 7497 7497 Life Line 3875 3875 Camp Dogwood 2951 2951 Bank Fees 629 629 1607711 1565195 42516 0 3729122 539077 532870 288655 5267 8095507 8730690 12362766 9558422 8663 9186 7084038 4748570 7092701 4757756 X 5266 0 4352799 3888666 912000 912000 5270065 4800666 12362766 9558422 X 0 1 1 X 0 X 1211905 1328051 726312 748072 476864 4491204 1211905 1328051 726312 748072 476864 4491204 190815 4300389 12020 454640 322117 219576 146610 1154963 5646167 259295 0.76160 0.80990 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 5264798 523813 647124 1635069 4800666 12371256 821933 -3776 7924615 5264798 0.19000 0.81000 0 0 0 Due to Affiliate 4748570 4748570 736540 1607711 -871171 401772 401772 -469399 1635069 1635069 1635069 0 736540 736540 736540 1640335 32624 32624 1607711 0 1607711 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. Golf Tournament 64639 34596 30043 23845 3349 2849 Poinsettia Sale 28606 15968 12638 12638 2 13456 9188 4268 4268 106701 59752 46949 23845 3349 19755 46949 0 0 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 1 Helping Hands Family Assistance Program 33 15434 Other Information: Part IV: 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. 0 1 0 0 0 0 0 0 0 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 Part I, Line 4b: Part I, Line 4b: employer contribution to 457(f) executive retirement benefit plan: Paul Perrotti $20,260 Gerald Fulks $55,700 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. 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 0 1 1 0 1 0 0 0 0 0 0 0 0 1 0 0 0 0