2024-08-15T14:30:39-05:00 2023-09-30 621517792 PYA P C 2220 SUTHERLAND AVE KNOXVILLE TN 37919 990 2022-10-01 581828486 GWINNETT HOSPITAL SYSTEM FOUNDATION INC GWIN 6783125603 1755 NORTH BROWN ROAD 100 LAWRENCEVILLE GA 30043 JASON CHANDLER PRESIDENT 6783125603 2024-08-15 1 0 DEBORAH O ERNSBERGER P00364912 8656730844 2022 2024-08-08 14:25:15Z JASON CHANDLER 1755 NORTH BROWN ROAD 100 LAWRENCEVILLE GA 30043 4935634 0 X WWW.GMCGIVING.ORG X 1987 GA GWINNETT HOSPITAL SYSTEM FOUNDATION IS A NOT-FOR-PROFIT CHARITABLE ORGANIZATION WHOSE MISSION IS TO PROVIDE FINANCIAL SUPPORT TO NORTHSIDE HOSPITAL, INC. FOR PROJECTS WHICH MEET COMMUNITY NEEDS IN GWINNETT COUNTY. FOCUS IS PLACED ON PROGRAMS THAT ACCELERATE ACCESS TO HIGH QUALITY HEALTHCARE IN GWINNETT. 73 68 0 0 0 0 3668400 4465229 0 0 -61950 398405 -26365 -124327 3580085 4739307 1777656 599519 0 0 0 0 0 0 1051325 1484889 1582639 3262545 2182158 317540 2557149 15185226 18599038 2908561 2782488 12276665 15816550 X GWINNETT HOSPITAL SYSTEM FOUNDATION IS A NOT-FOR-PROFIT CHARITABLE ORGANIZATION WHOSE MISSION IS TO PROVIDE FINANCIAL SUPPORT TO NORTHSIDE HOSPITAL, INC. FOR PROJECTS WHICH MEET COMMUNITY NEEDS IN GWINNETT COUNTY. FOCUS IS PLACED ON PROGRAMS THAT ACCELERATE ACCESS TO HIGH QUALITY HEALTHCARE IN GWINNETT. 0 0 659449 599519 THE FOUNDATION RAISES FUNDS FOR THE PURPOSE OF IMPROVING THE QUALITY OF SERVICES PROVIDED BY NORTHSIDE HOSPITAL IN GWINNETT COUNTY. HISTORICALLY, THE FOUNDATION HAS SUPPORTED MANY OF THE HOSPITAL'S GWINNETT OPERATIONS AND PROGRAMS, INCLUDING NEONATAL INTENSIVE CARE, CANCER TREATMENT AND DETECTION, REHABILITATION SERVICES, MEDICAL RESIDENCY/EDUCATION, WOMEN'S PROGRAMS, SPORTS MEDICINE, CARDIOLOGY, AND SCHOLARSHIPS FOR NURSING AND VARIOUS ALLIED HEALTH SCIENCES. 659449 1 1 0 0 0 0 0 0 0 1 1 0 0 0 1 1 1 0 0 0 0 0 0 0 1 0 0 1 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 17 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 X 73 68 1 0 0 0 0 0 0 1 1 0 0 0 1 1 1 1 1 0 0 0 GA X SHANNON A BANNA 4048518000 1000 JOHNSON FERRY ROAD ATLANTA GA 30342 DENISE PECHT MD CHAIR 1.00 X 0 0 0 PAIGE HAVENS BOARD MEMBER 1.00 X 0 0 0 COLE HUDGENS BOARD MEMBER 1.00 X 0 0 0 DEBBIE MITCHAM BILBRO BOARD MEMBER, NORTHSIDE GWINNETT CEO 1.00 40.00 X 0 1032571 13063 JEFF WAGES BOARD MEMBER 1.00 X 0 0 0 JULIUS AJAYI MD BOARD MEMBER 1.00 X 0 0 0 MARY JO ALBERT MD BOARD MEMBER 1.00 X 0 0 0 ETHEL ANDERSEN BOARD MEMBER 1.00 X 0 0 0 TOM ANDERSEN BOARD MEMBER 1.00 X 0 0 0 KERRY ARMSTRONG BOARD MEMBER 1.00 X 0 0 0 MARVIN BARGE BOARD MEMBER 1.00 X 0 0 0 SHARON BARTELS BOARD MEMBER 1.00 X 0 0 0 JENNIFER BRIDWELL BOARD MEMBER 1.00 X 0 0 0 CARLTON BUCHANAN MD BOARD MEMBER 1.00 1.00 X 0 0 0 RENEE BYRD-LEWIS BOARD MEMBER 1.00 X 0 0 0 GREG CANTRELL BOARD MEMBER 1.00 X 0 0 0 BRUCE E CARTER DMD BOARD MEMBER 1.00 X 0 0 0 MURTAZA CASSOOBHOY MD BOARD MEMBER 1.00 X 0 328994 16662 ANNE CHANDLER BOARD MEMBER 1.00 X 0 0 0 CYNTHIA CHANDLER BOARD MEMBER 1.00 X 0 101314 20335 LISA CINK BOARD MEMBER 1.00 X 0 0 0 FRANK CIRCELLI BOARD MEMBER 1.00 X 0 0 0 CLIFF CLARK BOARD MEMBER 1.00 X 0 0 0 KRISTI ELLIS COHRON BOARD MEMBER 1.00 X 0 0 0 JULIA WEBB DAVIS BOARD MEMBER 1.00 X 0 0 0 DAN DUNWODY DDS BOARD MEMBER 1.00 X 0 0 0 TOM FERRIN BOARD MEMBER 1.00 X 0 0 0 WILL GRANT BOARD MEMBER 1.00 X 0 0 0 DAVID GREENE BOARD MEMBER 1.00 X 0 0 0 STAN HALL BOARD MEMBER 1.00 X 0 0 0 GREG HAYES BOARD MEMBER 1.00 X 0 0 0 JANNA HAYES BOARD MEMBER 1.00 X 0 0 0 BILL HEAD BOARD MEMBER 1.00 X 0 0 0 CAROLYN HILL BOARD MEMBER 1.00 X 0 0 0 STEPHEN K HILL BOARD MEMBER 1.00 X 0 0 0 STEPHANIE HUNT BOARD MEMBER 1.00 X 0 0 0 KIMBERLY HUTCHERSON MD BOARD MEMBER 1.00 X 0 0 0 LC JOHNSON BOARD MEMBER 1.00 X 0 0 0 TERRI JONDAHL BOARD MEMBER 1.00 1.00 X 0 0 0 MOHAN KRISHNAMACHARY MD BOARD MEMBER 1.00 X 0 0 0 LYNNE KYTLE-HENDERSON BOARD MEMBER 1.00 X 0 0 0 LESLIE LEIGH MD BOARD MEMBER 1.00 X 0 12000 0 GARY LEVENGOOD MD BOARD MEMBER 1.00 X 0 815401 0 BIN LIU BOARD MEMBER 1.00 X 0 0 0 NICK MASINO BOARD MEMBER 1.00 X 0 0 0 SUZANNE MASINO BOARD MEMBER 1.00 X 0 0 0 MILES H MASON MD BOARD MEMBER 1.00 X 0 0 0 WAYNE MASON BOARD MEMBER 1.00 X 0 0 0 DAVID MCCLESKEY BOARD MEMBER 1.00 X 0 0 0 ERIN O'DONNELL MCCORMICK BOARD MEMBER 1.00 X 0 0 0 CHUCK MOOMEY MD BOARD MEMBER 1.00 X 0 0 0 BARTOW MORGAN BOARD MEMBER 1.00 X 0 0 0 STACY PATTERSON BOARD MEMBER 1.00 X 0 0 0 SCOTT PHELAN BOARD MEMBER 1.00 X 0 0 0 BETH PHELPS BOARD MEMBER 1.00 X 0 0 0 DONNY PHILLIPS BOARD MEMBER 1.00 X 0 0 0 NORA ROZIN BOARD MEMBER 1.00 X 0 0 0 SPENCER ROZIN MD BOARD MEMBER 1.00 X 0 0 0 BILL RUSSELL PHD BOARD MEMBER 1.00 X 0 0 0 RAYMER SALE BOARD MEMBER 1.00 X 0 0 0 KRISTEN SAPP BOARD MEMBER 1.00 X 0 0 0 TAMMY SHUMATE BOARD MEMBER 1.00 X 0 0 0 BILL SMITH BOARD MEMBER 1.00 X 0 0 0 CHUCK SMITH BOARD MEMBER 1.00 X 0 0 0 DAVID SNELL BOARD MEMBER 1.00 X 0 0 0 DAVID STILL BOARD MEMBER 1.00 X 0 0 0 CLYDE STRICKLAND BOARD MEMBER 1.00 X 0 0 0 MIKE TENNANT BOARD MEMBER 1.00 X 0 0 0 MIKE TOWNSEND BOARD MEMBER 1.00 X 0 0 0 RICHARD TUCKER BOARD MEMBER 1.00 X 0 0 0 DEPRIEST WADDY BOARD MEMBER 1.00 X 0 0 0 KATHRYN PARSONS WILLIS BOARD MEMBER 1.00 X 0 0 0 TERRA WINTER BOARD MEMBER 1.00 X 0 0 0 JASON CHANDLER FOUNDATION PRESIDENT 40.00 X 0 422973 20309 0 2713253 70369 0 0 1 0 0 589803 25000 3850426 2902 4465229 398405 398405 72000 589803 196327 -124327 -124327 4739307 0 0 274078 599519 599519 977336 298337 678999 65417 6503 17984 40930 26973 8234 18739 135237 41282 93955 7061 2155 4906 887 887 BAD DEBT 53427 53427 BANK FEES 8568 8568 307733 93937 213796 2182158 659449 471384 1051325 3286368 3325932 250406 1669410 110120 103494 76511 75087 2311 1424 11536021 13498778 15185226 18599038 2884874 2751980 23687 30508 2908561 2782488 X 2406460 3584627 9870205 12231923 12276665 15816550 15185226 18599038 2557149 982736 0 X 0 1 X 1 0 X 512345 2685048 2614286 2665847 3875426 12352952 512345 2685048 2614286 2665847 3875426 12352952 12352952 65864 276009 302137 -61950 398405 980465 13333417 0.92650 0.91810 X SCHEDULE A, PART II GWINNETT HOSPITAL SYSTEM FOUNDATION HAD A CHANGE IN ACCOUNTING PERIOD WHEREBY THE PREVIOUS YEAR END WAS JUNE 30 AND IT WAS CHANGED TO A YEAR END OF SEPTEMBER 30. THIS RESULTED IN A SHORT PERIOD RETURN FOR THE PERIOD JULY 1, 2019 TO SEPTEMBER 30, 2019. ACCORDINGLY, THE FINANCIAL INFORMATION PRESENTED IN SCHEDULE A, PART II, COLUMN (A) WAS FOR THE SHORT PERIOD. RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 9870205 2760651 339964 738897 12231923 9560685 2303017 -430186 1563311 9870205 12036994 1439211 503479 4418999 9560685 10036513 1428934 631352 59805 12036994 9566302 486095 15884 10036513 0.41340 0.58660 0 0 76511 75087 1424 1424 DUE TO NORTHSIDE HOSPITAL, INC. 30508 30508 X 5911768 982736 196327 1179063 4732705 6602 6602 4739307 2371883 196327 196327 2175556 6602 6602 2182158 PART X, LINE 2: THE FOUNDATION HAS BEEN RECOGNIZED AS A PUBLIC CHARITY, EXEMPT FROM FEDERAL INCOME TAX UNDER INTERNAL REVENUE CODE SECTION 501(A) AS AN ORGANIZATION DESCRIBED IN SECTION 501(C)(3) AND, THEREFORE, RELATED INCOME IS GENERALLY NOT SUBJECT TO FEDERAL OR STATE INCOME TAX. PART XI, LINE 2D - OTHER ADJUSTMENTS: FUNDRAISING EXPENSES NETTED WITH REVENUES 196,327. PART XI, LINE 4B - OTHER ADJUSTMENTS: OTHER ADJUSTMENT 6,602. PART XII, LINE 2D - OTHER ADJUSTMENTS: FUNDRAISING EXPENSES NETTED WITH REVENUES 196,327. PART XII, LINE 4B - OTHER ADJUSTMENTS: OTHER ADJUSTMENT 6,602. PAINT GWINNETT PINK 565313 532088 33225 140643 GOLF 96490 57715 38775 55684 661803 589803 72000 196327 196327 -124327 1 NORTHSIDE HOSPITAL INC 1000 JOHNSON FERRY ROAD ATLANTA GA 30342 581954432 501(C)(3) 560519 0 ASSISTANCE TO FUND PROGRAM OPERATIONS. GEORGIA GWINNETT COLLEGE FOUNDATION INC 1000 UNIVERSITY CENTER LN LAWRENCEVILLE GA 30043 215107997 501(C)(3) 6750 0 TO FUND SCHOLARSHIP PROGRAMS. GEORGIA STATE UNIVERSITY FOUNDATION INC PO BOX 3963 ATLANTA GA 30302 586033185 501(C)(3) 6250 0 TO FUND SCHOLARSHIP PROGRAMS. 3 0 1 0 0 0 0 0 0 0 DEBBIE MITCHAM BILBRO BOARD MEMBER, NORTHSIDE GWINNETT CEO 0 753207 0 264968 0 14396 0 0 0 13063 0 1045634 0 0 MURTAZA CASSOOBHOY MD BOARD MEMBER 0 259949 0 17381 0 51664 0 0 0 16662 0 345656 0 0 GARY LEVENGOOD MD BOARD MEMBER 0 645744 0 151838 0 17819 0 0 0 0 0 815401 0 0 JASON CHANDLER FOUNDATION PRESIDENT 0 281242 0 87456 0 54275 0 0 0 20309 0 443282 0 0 PART I, LINE 4B DEBBIE (MITCHAM) BILBRO, BOARD MEMBER OF GWINNETT HOSPITAL SYSTEM FOUNDATION, RECEIVED COMPENSATION AND DEFERRED COMPENSATION FOR SERVICE TO NORTHSIDE GWINNETT HOSPITAL. FORM 990, PART VI, SECTION A, LINE 2 THE FOLLOWING BOARD MEMBERS HAVE A RELATIONSHIP WITH ANOTHER BOARD MEMBER: ETHEL ANDERSEN AND TOM ANDERSEN - FAMILY RELATIONSHIP NORA ROZIN AND SPENCER ROZIN - FAMILY RELATIONSHIP SUZANNE MASINO AND NICK MASINO - FAMILY RELATIONSHIP FORM 990, PART VI, SECTION B, LINE 11B INFORMATION FOR PREPARATION OF THIS RETURN WAS PROVIDED TO AN INDEPENDENT CERTIFIED PUBLIC ACCOUNTANT. AFTER THE RETURN WAS PREPARED AND PRIOR TO FILING, IT WAS REVIEWED IN DETAIL BY NORTHSIDE HOSPITAL, INC. SENIOR FINANCIAL MANAGEMENT. ALSO PRIOR TO FILING, A COPY OF THE RETURN WAS MADE AVAILABLE TO THE EXECUTIVE COMMITTEE, COMPRISED OF FOUR MEMBERS OF THE BOARD OF DIRECTORS. FORM 990 IS ALSO PRESENTED TO THE FULL BOARD AT THE BOARD MEETING FOLLOWING THE REVIEW BY THE EXECUTIVE COMMITTEE. THIS BOARD MEETING MAY FALL AFTER THE RETURN HAS BEEN FILED WITH THE IRS. FORM 990, PART VI, SECTION B, LINE 12C WHILE THE ORGANIZATION DOES NOT HAVE ITS OWN FORMAL CONFLICT OF INTEREST POLICY, IT ADHERES TO THE POLICIES OF NORTHSIDE HOSPITAL, INC. ANNUALLY, A CONFLICT OF INTEREST QUESTIONNAIRE IS DISTRIBUTED TO AND DISCUSSED WITH EACH MEMBER OF THE BOARD OF DIRECTORS. THE HOSPITAL'S LEGAL DEPARTMENT MONITORS ALL POTENTIAL TRANSACTIONS INVOLVING CONFLICTS OF INTEREST WITH BOARD MEMBERS. BOARD MEMBERS MUST DISCLOSE POTENTIAL CONFLICTS USING A REASONABLE BELIEF STANDARD; PLAY NO DIRECT OR INDIRECT PART IN DELIBERATIONS; AND ABSENT THEMSELVES FROM THE MEETING AT WHICH ANY POTENTIAL CONFLICT INVOLVING THE MEMBER IS DISCUSSED. ONLY NON-CONFLICTED MEMBERS MAY DECIDE TO PURSUE A TRANSACTION OR ARRANGEMENT INVOLVING A CONFLICT, IF A MAJORITY OF THE BOARD DETERMINES THE TRANSACTION OR ARRANGEMENT IS IN THE ORGANIZATION'S BEST INTEREST. VIOLATION OF THE CONFLICT OF INTEREST POLICY IS SUBJECT TO CORRECTIVE ACTION, INCLUDING EXONERATION, CENSURE AND/OR REQUESTING RESIGNATION OF THE MEMBER. IN ADDITION, THE HOSPITAL HUMAN RESOURCES DEPARTMENT SENDS OUT A CONFLICT OF INTEREST POLICY AND DISCLOSURE FORM TO OFFICERS AND KEY EMPLOYEES EVERY 3 - 5 YEARS. THESE OFFICERS AND KEY EMPLOYEES ARE REQUIRED TO DISCLOSE ANY POTENTIAL CONFLICTS THAT ARISE DURING THE FISCAL YEAR. FORM 990, PART VI, SECTION C, LINE 19 GOVERNING DOCUMENTS ARE FILED WITH AND AVAILABLE ON THE GEORGIA SECRETARY OF STATE WEBSITE OR THROUGH THAT OFFICE. CERTAIN DOCUMENTS ARE ALSO AVAILABLE UPON REQUEST AT THE FOUNDATION OFFICE. GWINNETT HOSPITAL SYSTEM AUXILIARY INC 1000 JOHNSON FERRY ROAD ATLANTA GA 30342 581713644 ADMINISTRATIVE SERVICES GA 501(C)(3) LINE 3 N/A 0 NORTHSIDE HEALTH SERVICES INC 1000 JOHNSON FERRY ROAD ATLANTA GA 30342 581917328 PARENT HOLDING COMPANY GA 501(C)(3) LINE 12C, III-FI N/A 0 NORTHSIDE HOSPITAL FOUNDATION INC 1000 JOHNSON FERRY ROAD ATLANTA GA 30342 581653541 RAISE FUNDS IN FURTHERANCE OF NORTHSIDE HOSPITAL'S EXEMPT PURPOSE GA 501(C)(3) LINE 7 NORTHSIDE HEALTH SERVICES INC 0 NORTHSIDE HOSPITAL INC 1000 JOHNSON FERRY ROAD ATLANTA GA 30342 581954432 HOSPITAL GA 501(C)(3) LINE 3 NORTHSIDE HEALTH SERVICES INC 0 NORTHSIDE SHARES HELP INC 1000 JOHNSON FERRY ROAD ATLANTA GA 30342 581458873 PUBLIC CHARITY, ORGANIZED EMPLOYEE RELIEF FUND GA 501(C)(3) LINE 7 NORTHSIDE HEALTH SERVICES INC 0 NORTHSIDE VENTURES INC 1000 JOHNSON FERRY ROAD ATLANTA GA 30342 581954456 LEASING COMPANY GA N/A C 0 GWINNETT MANAGED CARE INC 1000 JOHNSON FERRY ROAD ATLANTA GA 30342 582135759 PROFESSIONAL SERVICES GA N/A C 0 NORTHSIDE HEALTH NETWORK INC 1000 JOHNSON FERRY ROAD ATLANTA GA 30342 843655289 PROFESSIONAL SERVICES GA N/A C 0 SEQUENT HEALTH PHYSICIAN PARTNERS 1000 JOHNSON FERRY ROAD ATLANTA GA 30342 471511997 CLINICALLY INTEGRATED ORGANIZATION GA N/A C 0 0 1 1 0 0 0 0 0 0 0 0 1 0 1 1 0 1 1 0