2016-05-13T14:17:57-05:00 2015-06-30 PricewaterhouseCoopers LLP 2001 MARKET ST SUITE 1800 PHILADELPHIA PA 19103 990 2014-07-01 582026750 DOUGLAS HOSPITAL INC % JAMES M SWARTZ DOUG 7707925023 805 Sandy Plains Road Marietta GA 300666340 JAMES M SWARTZ VP, ACCOUNTING 2673303000 2016-05-12 true JOANNE KRUEGER P01235586 2673303000 2014 2016-08-17 19:52:53Z CANDICE L SAUNDERS 805 Sandy Plains Road Marietta GA 300666340 126230204 false X www.wellstar.org X 1992 GA TO PROVIDE WORLD-CLASS CHARITABLE HEALTHCARE TO THE COMMUNITY. 18 9 948 84 0 0 0 0 113708367 125072565 2572 -15260 748373 1172899 114459312 126230204 600 600 0 0 51017344 54806920 0 0 0 58826338 62714137 109844282 117521657 4615030 8708547 84136160 78146264 42108389 39670447 42027771 38475817 X TO CREATE AND DELIVER HIGH QUALITY HOSPITAL, PHYSICIAN AND OTHER HEALTHCARE RELATED SERVICES THAT IMPROVE THE HEALTH AND WELL-BEING OF THE INDIVIDUALS AND COMMUNITIES WE SERVE. false false 95822644 600 125072565 SEE SCHEDULE O 95822644 true false false false false false false false false true false false false true true false true false false false false false false false false true true false false true false false false false false false false false false false false false false true true false false false true 0 0 948 true false false false false false false false false false false X 18 9 false false false false true true true true true false false true true true true true true true true false GA X JAMES M SWARTZ 7707925023 805 SANDY PLAINS ROAD Marietta GA 300666340 X Avril P Beckford MD TRUSTEE 2.0 48.0 X 0 484008 29400 Jeffrey L Tharp MD TRUSTEE 2.0 48.0 X 0 630869 74725 RANDALL BENTLEY SR TRUSTEE 1.0 5.0 X 0 19268 0 OTIS A BRUMBY III TRUSTEE 1.0 5.0 X 0 14475 0 ROBERT N CROSS MD TRUSTEE 1.0 5.0 X 0 14446 0 TE RUSTY DURHAM TRUSTEE emeritus 1.0 5.0 X 0 661 0 THOMAS E GEARHARD MD TRUSTEE 2.0 48.0 X 0 347375 73211 DAVID H HAFNER MD TRUSTEE 1.0 5.0 X 0 26233 0 T FITZ JOHNSON TRUSTEE 1.0 7.0 X 0 20712 0 CHARLES J JONES TRUSTEE 1.0 5.0 X 0 4075 0 JANIE MADDOX TRUSTEE - CHAIR 1.0 5.0 X 0 8850 0 GARY A MILLER TRUSTEE - VICE CHAIR 1.0 5.0 X 0 4387 0 MITZI MOORE TRUSTEE 1.0 5.0 X 0 1730 0 TOM PHILLIPS TRUSTEE 1.0 5.0 X 0 2903 0 WALTER ROBINSON TRUSTEE 1.0 5.0 X 0 4672 0 FRANK ROS TRUSTEE 1.0 5.0 X 0 2820 0 ORIN SWAYZE MD TRUSTEE 1.0 5.0 X 0 4624 0 GREG MORGAN TRUSTEE 1.0 5.0 X 0 1624 0 WILLIAM C BROCK TRUSTEE 1.0 5.0 X 0 20247 0 STEVEN W OWEIDA MD TRUSTEE EMERITUS 1.0 5.0 X 0 31409 0 W ALLEN SEPARK TRUSTEE EMERITUS 1.0 7.0 X 0 8177 0 Valery A Akopov VP & Chief of Hospitalist Svcs 2.0 48.0 X 0 399745 53663 David W Anderson EVP HR OL CCO 2.0 48.0 X 0 648929 70290 Nicole V Ashe VP Finance & CFO WMG 2.0 48.0 X 0 262185 45885 Barbara G Ballard VP Homecare & Hospice 2.0 48.0 X 0 282836 64915 Melissa L Box VP CNO Patient Care Services 50.0 0.0 X 216527 0 38260 Joseph L Brywczynski SVP Health Parks Development 2.0 48.0 X 0 570096 70144 Anthony J Budzinski EVP & CFO 2.0 50.0 X 0 689236 71096 Donald Campbell MD SVP Phys Educ & Student Aff 2.0 48.0 X 0 513317 62483 Jill M Case-Wirth VP Pediatric SRVS.(BEGIN. 8/4) 2.0 46.0 X 0 72410 4759 James E Clements VP Bus Dev & Strategic Prtnrsp 2.0 48.0 X 0 264016 17453 Lee R Cook VP Med & Behavioral Health 2.0 48.0 X 0 592708 45052 Barbara B Corey SVP Managed Care 2.0 48.0 X 0 379163 48129 Bruce A Dean VP Real Estate Deputy Gen Cnsl 2.0 48.0 X 0 282461 69841 Sarath Degala VP Revenue Cycle Management 2.0 48.0 X 0 19850 2923 Marcia Delk-Payne MD SVP Med Affair & Chf Qlty Ofcr 2.0 48.0 X 0 925812 49890 Nancy R Doelling VP Pediatric SRVS.(BEGIN. 8/4) 2.0 48.0 X 0 141009 11811 Jimmy E Francis VP Info Technology Operations 2.0 48.0 X 0 257027 36192 Steven L Grace VP Talent Acquisition 2.0 48.0 X 0 266953 32731 Kristyn M Greifer MD VP Population Management 2.0 48.0 X 0 369983 28680 Joel W Helmke VP Oncology (BEGIN. 7/21) 2.0 48.0 X 0 165514 28875 Robert D Jansen md EVP & Pres Medical Group 2.0 48.0 X 0 782540 75243 Reynold J Jennings president & ceo 2.0 50.0 X 0 1701981 2056 Peter R Jungblut MD SVP & Medical Dir WMG 2.0 48.0 X 0 398803 69399 Christopher M Kane SVP Strategic Plan & Bus Dev 2.0 48.0 X 0 806400 42332 Beth Kost VP Compliance Chf Privacy Ofcr 2.0 48.0 X 0 331700 34022 Ellen Langford SVP & COO WellStar Med Group 2.0 48.0 X 0 279307 58966 Elizabeth H Loudermilk VP Ent Intelligence & Intgrtn 2.0 48.0 X 0 308160 25651 Sandra Lucius VP Info Technology Apps 2.0 48.0 X 0 224424 46993 Robert Mandler VP Diagnostic Outreach 2.0 48.0 X 0 290840 61524 Patricia A Mayne VP Emergency Services 2.0 48.0 X 0 311329 50119 Kimberly W Menefee SVP Strategic Community Dev 2.0 48.0 X 0 362955 46026 Christopher L Morgan VP & Admin. CLIO (BEGIN. 7/7) 2.0 48.0 X 0 168139 21747 Jonathan B Morris MD SVP Chief Info Officer 2.0 48.0 X 0 462389 50258 Bradford B Newton VP Information Technology Admi 2.0 48.0 X 0 232340 47711 Craig Owens SVP & Hospital President 48.0 2.0 X 344496 0 67184 Michael G Paul VP Facilities Eng Support Svcs 2.0 48.0 X 0 220953 24150 Leo E Reichert EVP & General Counsel 2.0 48.0 X 0 752077 29200 Bethany Robertson VP & Chief Learning Officer 2.0 48.0 X 0 218673 41608 Michelle M Robinson VP Mktng/PR/Internal Comm 2.0 48.0 X 0 238847 40651 Wanda Y Robinson VP Compliance PWHP(BEGIN.9/15) 2.0 48.0 X 0 82927 2538 Deborah Roegge De Vita VP Women & Newborn Svc Line 2.0 48.0 X 0 231925 31900 Candice L Saunders President & CEO 2.0 48.0 X 0 812226 72916 Christopher B Scullen VP Pulmonology Operations 2.0 48.0 X 0 292246 17839 Richard S Siegel VP Cardiology & CVM Admin 2.0 48.0 X 0 323664 70462 Jeffery D Stanley VP Pharmacy & System Coor 2.0 48.0 X 0 216271 30238 Daniel J Styf SVP PW Health Plan 2.0 48.0 X 0 337033 27733 James M Swartz VP Accounting 2.0 48.0 X 0 272353 42262 Mary L Tavernaro VP Human Resources Operations 2.0 48.0 X 0 259157 49126 Adam C Thompson VP Surgery 2.0 48.0 X 0 228073 21830 Anthony M Trupiano SVP Supply Chain 2.0 48.0 X 0 345219 47596 Sean P Turner VP Rev.Cycle MGMT (BEGIN.9/28) 2.0 48.0 X 0 273082 46665 Robin Wilson MD SVP Chief Hlth Innov Officer 2.0 48.0 X 0 637993 22144 Chester A Zborowski VP Health Parks Operations 2.0 48.0 X 0 223151 24265 MARGARET W CHASTAIN Dir Pharmacy 50.0 0.0 X 178420 0 28299 CHRISTOPHER S GREENE Exec Dir Finance & Hosp Ops 50.0 0.0 X 168972 0 21764 STEVEN W HARRIS Pharmacist Specialty 50.0 0.0 X 150471 0 11495 BEVERLY M BATES RN Charge Nurse 50.0 0.0 X 149018 0 40806 KAREN Y BEARD DIR SURGICAL SVS DH/WH 50.0 0.0 X 142303 0 25301 Kenneth C Kunze MD FMR. SVP Chief Medical Officer 0.0 0.0 X 0 383389 0 MICHAEL L GRAUE FRMR. EBP & CHIEF OP. OFFICER 0.0 0.0 X 0 522266 0 1350207 22289647 2500427 56 true true false Inglett and Stubbs LLC PO Box 932506 ATLANTA GA 311932506 CONSTRUCTION 476980 QUEST DIAGNOSTICS PO BOX 740736 ATLANTA GA 303740736 MEDICAL 403233 ALLIANCE HEALTHCARE SERVICES PO BOX 6600 NEWPORT BEACH CA 92658 MEDICAL 289545 FRESENIUS MEDICAL CARE PO BOX 101518 ATLANTA GA 30392 MEDICAL 265000 BATSON-COOK COMPANY 200 GALLERIA PARKWAY ATLANTA GA 30399 CONSTRUCTION 7528931 15 0 HOSPITAL PATIENT REVENUE 621990 125053336 125053336 0 MEDICAL RECORDS REVENUE 621990 156 156 PATIENT EDUCATION 621990 19073 19073 125072565 0 0 0 116585 0 116585 0 116585 0 116585 -15260 0 -15260 -15260 -15260 0 0 0 GROUND LEASE REVENUE 621990 428105 428105 CAFETERIA SALES 621990 523956 523956 LACTATION/IMMUNIZATIONS 621990 532 532 103721 103721 1056314 126230204 125072565 0 1157639 0 600 600 0 0 681560 592957 88603 0 0 43043336 37240309 5803027 2161840 2161840 5767146 4990063 777083 3153038 2728188 424850 0 1341 1341 0 0 0 0 6197279 5957475 239804 2884 3605 -721 4196186 3317685 878501 0 0 1626961 123158 1503803 37215 19834 17381 0 151366 13196 138170 1107616 1107616 25904584 22414119 3490465 5843577 2643587 3199990 1215665 1215665 REPAIRS & MAINT 2244013 1699768 544245 MEDICAL SUPPLIES 14086602 14069743 16859 OTHER EXPENSES 98848 8357 90491 117521657 95822644 21699013 0 6375 41756 18779 0 0 0 24829187 19173914 0 0 0 0 0 0 1863146 1930520 325205 63384 118002750 62394564 55761421 55608186 0 0 0 0 0 0 0 0 1332047 1328504 84136160 78146264 7055125 5199612 0 0 0 0 0 0 0 0 0 0 0 0 0 0 35053264 34470835 42108389 39670447 X 42027771 38475817 0 0 0 0 42027771 38475817 84136160 78146264 X 8708547 -12260501 X false true X true false X 59570 59570 56425656 23547556 32878100 1121454 722701 398753 58540763 37800056 20740707 1855307 324251 1531056 55608186 0 OTHER LT LIABILITIES 14646 ASSET RETIREMENT OBLIGATION LT 631969 TAX EXEMPT BOND LIAB.DUE TO WHS 33824220 34470835 X SCHEDULE D, PART X, LINE 2 The following footnote is related to the organization's application of FIN 48 (ASC 740): Wellstar (including DOUGLAS Hospital) and all but one of its affiliates have been recognized as exempt from Federal income tax under Internal Revenue Code Section 501(a) as organizations described in Section 501(C)(3) and, therefore, related income is generally not subject to Federal or state income taxes. Community Assurance Corporation is a controlled foreign corporation not subject to Federal tax. Wellstar applies FASB ASC 740, Income Taxes, which addresses accounting for uncertainties in income tax positions. It also provides guidance on when tax positions are recognized in an entity's financial statements and how the values of these positions are determined. There is no impact on Wellstar's combined financial statements as a result of the application of ASC 740. true true X true X 125. true X true true true false true true 11958733 11958733 0.10890 16141233 15000647 1140586 0.00970 28099966 15000647 13099319 0.11860 242966 242966 0.00220 242966 242966 0.00220 28342932 15000647 13342285 0.12080 true 5169760 630171 45335585 50735806 -5400221 X true true 1 1 DOUGLAS HOSPITAL 8954 HOSPITAL DRIVE DOUGLASVILLE GA 30134 www.wellstar.org 048-548 X X X DOUGLAS HOSPITAL 1 false false true X X X X X X X X X X 12 true false false true X SEE PART V, SECTION C X SEE PART V, SECTION C X true 12 true SEE PART V, SECTION C false false true X 125. 300. X X X X X X true true X X X X X true X SEE PART V, SECTION C X SEE PART V, SECTION C X X X X X X true X false X X X X true X false false SCHEDULE H, PART V, SECTION B, LINE 3J OTHER DESCRIPTIONS FROM THE COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA): The Community Health Needs Assessment for DOUGLAS HOSPITAL provideS a list of WellStar Health System CHNA collaborators including individuals, organizations, and governmental agencies THAT WERE consulted AND contributed special knowledge of medically underserved and low income populations and/or expertise in public health. SCHEDULE H, PART V, SECTION B, LINE 5 INPUT FROM COMMUNITY REPRESENTATIVES & COMMUNITY SOURCES: DOUGLAS HOSPITAL integrated multiple sources of data from national and state web-based data platforms with multiple primary data gathering methods (see list below). As a partner in the strategic planning process utilized by Cobb & Douglas Public Health (CDPH) called Mobilizing for Action through Planning and Partners (MAPP) from the National Association of County & City Health Officials, the hospital leveraged the findings from THE community health needs assessments conducted in tax year 2012. Through a grant by the Centers for Disease Control and Prevention, DOUGLAS HOSPITAL partnered with CDPH and formed a coalition, Cobb 2020, to conduct its needs assessment via multiple modalities: MAPP workgroups, focus groups, surveys, Key Informant interviews, and implementation teams to act upon identified strategic issues in the community. To collect robust data for counties WellStar serves outside of Cobb, WellStar enlisted expertise of county and regional public health officials, independent consultants, and other Key Informants. A listing of collaborators can be found in the Appendix of the hospital facility's CHNA reports publicly available at wellstar.org. Quantitative Data Sources Including: 1. Georgia Department of Public Health, OASIS 2. Centers for Disease Control and Prevention (CDC) Vital Statistics 3. Agency for Healthcare Research and Quality (AHRQ) 4. U.S. Census Bureau 5. U.S. Department of Health and Human Services 6. Kaiser Permanente Web - Based CHNA Platform 7. Catholic Health Association CHNA resources 8. County Health Rankings & Roadmaps, University of Wisconsin 9. Healthy People 2020 10. Behavioral Risk Factor Surveillance System (BRFSS) 11. WellStar Health System - DOUGLAS Hospital's FY2012 utilization data to assess service area zip codes accounting for 90 percent of hospital admissions and visits and primary service areas. Qualitative Data Sources Including: 1. Cobb County Focus Group Report - 58 people participated in six focus group representing 14 zip codes. Demographics varied among the groups indicative of the zip codes represented. Two groups were conducted in Spanish and reflected low-income, low education attainment and medically underserved populations. 2. MAPP Assessment Workgroups with representatives from Douglas and Cobb counties conducted four community assessments which helped develop the Cobb 2020 Community Health Improvement Plan. This included the 2011 Field Test Local Public Health System Assessment by the National Public Health Performance Standards Program (NPHPSP). 3. Cobb Key Informant Interview Report - 20 participants identified by Cobb 2020's Community Strengths and Themes Workgroup to represent different sectors of the Cobb community who possessed above average knowledge of the healthcare issues, healthcare system or the community. 4. Cobb MAPP Community Survey Report - A 44 question telephone survey of 1,244 adults ages 18-94 performed by the A.L. Burruss Institute for Public Service and Research, Kennesaw State University. 5. Cobb County 2010 - How Healthy Are We? 6. Cobb County MAPP Forces of Change Assessment Summary Report 7. Bartow, Cherokee and Paulding County Key Informant interviews of community stakeholders led by Ron Chapman, Principal, Magnetic North, LLC, a third-party consultanT. SCHEDULE H, PART V, SECTION B, LINE 6A ORGANIZATIONS INCLUDED IN COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA): While DOUGLAS HOSPITAL conducted its own community health needs assessment there may be some overlap with the other hospitals in WellStar Health System simply because of the geographic constraints and structure of the organization. The community served therefore is defined by similar zip codes and areas of services. SCHEDULE H, PART V, SECTION B, LINES 7A & 7B THE DOUGLAS HOSPITAL CHNA CAN BE FOUND AT THE FOLLOWING: DOUGLAS HOSPITAL WEBSITE: Http://www.wellstar.org/about-us/documents/chna/douglas_chna_06172013.pdf AND WELLSTAR HEALTH SYSTEM WEBSITE: http://www.wellstar.org/pages/default.aspx SCHEDULE H, PART V, SECTION B, LINE 10A DOUGLAS HOSPITAL'S MOST RECENTLY ADOPTED IMPLEMENTATION STRATEGY CAN BE FOUND ON ITS WEBSITE at: http://www.wellstar.org/about-us/documents/implementation_strategy/douglas _implementation_strategy_11112013.pdf SCHEDULE H, PART V, SECTION B, LINE 11 PROGRAMS & STRATEGIES TO ADDRESS THE NEEDS OF THE COMMUNITY: DOUGLAS HOSPITAL Based on the prioritized health needs, WellStar will implement a five-year, two-phased Community Benefit program that is sustainable and strategically aligned with the WellStar Health System mission and vision to address the prioritized health needs of the uninsured and low-income populations. This is accomplished through expanding provider participation, education, outreach and prevention activities/programs to promote healthy lifestyles and access to care (Phase 1) and creating a collaborative safety net organization for shared accountability to leverage and maximize complementary skills and capacity building (Phase 2). Currently, Phase 2 has shifted from creating an organization to integrating this type of care delivery into the community benefit services WellStar delivers at a health system-level across all hospitals. Progress ongoing in Phase 2: Strategy: Improve access to care to vulnerable populations - Strengthen collaborative partnerships with community stakeholders to increase access to preventative and primary care, improve quality and reduce costs. - Reduce preventable hospital admissions, re-admissions and Emergency Department visits by redirecting care to community clinics and primary care via the hospital-based care management program. - Increase the number of hospital-affiliated/WellStar Physicians Group primary care providers and specialists providing free or low-cost healthcare programs/clinics via a Graduate Medical Education program. (Commences in 2017) - Develop a more collaborative delivery system for behavioral health services/resources through partnerships. (in process) - Improve medication access through centralized reduced cost Pharmaceutical Patient Access Programs and the Federal 340B Drug Pricing Program for the management of chronic disease and to reduce complications. (currently being assessed) - Evaluate hospital-based subsidized health services to more effectively and efficiently allocate assets addressing prioritized needs of the medically underserved and uninsured. STRATEGY: Promote healthy lifestyles via preventative care, programs and activities - Engage faith-based organizations in coordination and provision of care (MEMPHIS Model). (Pilot to be conducted at WellStar Paulding Hospital.) - Expand free health screenings to the underserved and uninsured through WellStar Corporate & Community Health. - Improve prevention-based educational resources and the referral process to free or low-cost healthcare clinics for continuity of care within the Emergency Department. - Provide community benefit leadership/consultation for the prevention and management of pulmonary diseases (asthma, lung cancer, chronic obstructive pulmonary disease) and cardiovascular disease. UNADDRESSED CHNA NEEDS - Selection criteria for DOUGLAS HOSPITAL'S prioritized health needs were primarily based upon the bandwidth to build a sustainable community benefit model focused on preventable health behaviors and access to care. Sexually transmitted infections and teen pregnancy are not addressed leaving awareness education with schools, family and churches since the health needs are more cultural and societal. Improvement to health needs stemming from socioeconomic and physical environmental FACTORS such as air quality and transportation, gain traction from public policy and education. A health system can complement efforts to impact policy, but has to rely on public health, state and local municipalities and federal governmental agencies to drive these types of health improvements. Key questions when addressing health needs are: 1.) Do we have existing facilities and resources dedicated to the health needs showing clear disparities and poor performance? And, 2.) Do we have effective and feasible interventions, a successful solution that has the potential to solve multiple problems, and the opportunity to intervene at the prevention level? Other needs not addressed are either beyond the scope or expertise of DOUGLAS Hospital, not being addressed at this time or are being addressed by WellStar on a system level or via other partners in public health. SCHEDULE H, PA SCHEDULE H, PART I, LINE 6A PUBLICATION OF COMMUNITY BENEFIT REPORT: DOUGLAS HOSPITAL is an affiliate of Wellstar Health System, Inc. which on an annual basis issues a community benefit report. This report is subsequently distributed in and around the five county service area of the health system. It is also annually filed with Cobb County and the state of Georgia Department of Community Health. Additionally the information on community benefit is included in aggregate for Wellstar Health System, Inc. and affiliated hospitals as part of the Georgia Hospital Association's annual report. On an annual basis the hospital reports its community health benefits report to the Georgia Hospital Association (GHA). GHA aggregates the hospital specific reports into a statewide community health benefit report. The State of Georgia also requires hospitals to file the Hospital Financial Survey and the Indigent Care Trust Fund Survey so that it can collect information on hospital financial class categories and also to determine the amount of uncompensated care by hospital. THE COMMUNITY BENEFIT REPORT CAN BE FOUND ON THE WELLSTAR WEBSITE AT: http://www.wellstar.org/about-us/documents/chna/douglas_chna_06172013.pdf Schedule H, Part I, Line 7 COST TO CHARGE RATIO: For purposes of the IRS Form 990 Schedule H, Wellstar Health System and Affiliates (including DOUGLAS HOSPITAL) have estimated the current year cost to charge ratio for each hospital as it is reported in the annual community benefit report and as it will be reported in the state's Annual Hospital Financial Survey. Schedule H, Part III, Section A, Line 2 METHODOLOGY USED TO ESTIMATE BAD DEBT: The reported bad debt charges is derived from the unpaid balances of patient accounts that are deemed uncollectible after 120 days of collection effort by the hospital's patient financial services staff. The unpaid patient accounts are then sent to collection agencies and any collected amount is deemed as bad debt recovery. The source of this data is the hospital's detailed financial trial balance. The net reported bad debt charges are then multiplied by the Hospital Financial Survey calculated cost to charge ratio to arrive at the estimated bad debt expense. Schedule H, Part III, Section A, Line 3 METHOLODOGY & RATIONALE USED TO DETERMINE BAD DEBT ATTRIBUTABLE TO PATIENT'S ELIGIBLE UNDER ORGANIZATION'S FAP: The bad debt attributable to patients eligible under the hospital's financial assistance program is determined using a weekly bad debt conversion report for a period of twelve months. The conversion rate for this period is used to determine this bad debt category. The total reported conversion charges is multiplied by a calculated cost to charge ratio to arrive at the cost of bad debt attributable to patient's eligible under the hospital's FAP. Schedule H, Part III, Section A, Line 4 FOOTNOTE ON BAD DEBT & RATIONALE FOR COMMUNITY BENEFIT: The following footnote is detailed in the Wellstar Health System, Inc. and Affiliates Combined Financial Statements related to bad debt or uncollectible accounts: "During 2011, Wellstar adopted the provisions of FASB Accounting Standards Update (2011-07), Healthcare Entities (Topic 954). ASU 2011-07 requires the reclassification of the provision for uncollectible accounts associated with patient service revenue from an operating expense to a deduction from patient service revenue (net of contractual allowances and discounts)." "Wellstar recognizes patient service revenue associated with services provided to patients with third-party payor coverage on the basis of contractual rates for the services rendered. For uninsured patients that do not qualify for community financial aid, Wellstar recognizes revenue on the basis of its discounted rates for services provided. On the basis of historical experience, a significant portion of Wellstar's uninsured patients are unable or unwilling to pay for the services provided. Thus, Wellstar records a significant provision for uncollectible accounts related to uninsured patients in the period the services are provided." Subsequent to the end of the reporting period a propensity to pay review of patient accounts often results in prior year bad debt accounts which are deemed eligible for the organization's financial assistance policy. Those bad debt accounts are reclassified as charity and thus our rationale for including in community benefit. Schedule H, Part III, Section B, Line 8 MEDICARE SHORTFALLS: DOUGLAS HOSPITAL IS A provider of inpatient and outpatient services to Medicare program beneficiaries at determined rates. Without the participation in the Medicare program these patients may not have had convenient access to those services. The Medicare shortfall on SCHEDULE H, Part III, Section B, line 7 represents the uncompensated difference between the expected reimbursement and the Medicare charges for those services stated at cost. We determine a cost to charge ratio for Medicare patients as part of the annual filing of the Medicare cost report. Schedule H, Part III, Section C, Line 9B COLLECTION PRACTICES: The policy written for collection practices that applies to all Wellstar Health System entities incorporates guidelines for personnel in the admissions and patient access areas to be trained in identifying patients that might qualify for financial assistance. It is also the policy of all Wellstar facilities to have at least one employee or contractor available at all times, especially in the hospitals with emergency rooms, who can provide assistance with the paperwork necessary to help patients who would qualify for governmental and other assistance programs. SCHEDULE H, PART VI, LINE 2 NEEDS ASSESSMENT: To assess the current health and well-being of the community served, WELLSTAR HEALTH SYSTEM, INC., AND DOUGLAS HOSPITAL conducted a Community Health Needs Assessment (CHNA), a collaborative effort involving hospital leadership, public health agencies, Cobb2020, and a diverse coalition of community stakeholders. Partners represented a broad knowledge base of the hospital's primary service area comprising Bartow, Douglas, Cherokee, Cobb, and Paulding counties and some outlying zip codes determined by utilization. To assess the current community health status and capture a broad base of input, collaborators engaged IN a strategic process called Mobilizing for Action Through Planning and Partnerships (MAPP) launched by Cobb & Douglas Public Health (CDPH). MAPP provides the framework for creating a community-driven health improvement plan through different assessments to evaluate: - Prevalent health issues - Health issues that are important to the community members - Availability of health services - Forces that impact community health Wellstar Health System (and affiliates) is a key stakeholder in MOBLIZING FOR ACTION THROUGH PLANNING AND PARTNERSHIPS ("MAPP"). MAPP, developed by the National Association of County and City Health Officials ("NACCHO") in collaboration with the CDC, provides a structured guidance on creating and implementing a community-wide strategic planning process focused on improving the health and safety of our population. Through MAPP, a broad collection of community partners and residents come together to identify and prioritize health and safety issues and to identify resources for addressing them. The process results in an actionable community health improvement plan (CHIP) for measurable improvements in the community's health and quality of life as well as a scorecard for implementation and evaluation. The resulting community plan does not focus on one agency or community health challenge; rather, MAPP provides a long-term strategy that addresses the multiple factors that affect health in the community. Community involvement throughout the creation and the implementation of a health improvement plan results in creative solutions to community health problems with an improved focus on priorities, reduced duplication of services, increased collaboration on projects and activities, and increased capacity to garner additional resources. Moreover, continuous community involvement leads to community ownership of the process. Community ownership, in turn, increases the credibility and sustainability of the health improvement efforts. SCHEDULE H, PART VI, LINE 3 PATIENT EDUCATION OF ELIGIBILITY FOR ASSISTANCE: The hospital provides notice of the availability of community financial Assistance via: - Signage - Patient Brochure - Billing Statement - Collection Action Letter - Online at http://www.wellstar.org/pages/online-bill-pay.aspx DOUGLAS Hospital provide its patients with hospital personnel or contracted personnel who are trained in all aspects of governmental programs, payments plans, charity discounts, and other financial assistance offered to assist them in their hospital bills. If the patient is eligible for federal or state assistance programs, a staff member is knowledgeable in the steps necessary to qualify those individual X X X X X X false true X X X X X X true true false false false false false true false Valery A Akopov VP & Chief of Hospitalist Svcs 0 329534 0 59170 0 11041 0 28200 0 25463 0 453408 0 0 David W Anderson EVP HR OL CCO 0 414523 0 205272 0 29134 0 45700 0 24590 0 719219 0 0 Nicole V Ashe VP Finance & CFO WMG 0 219898 0 32783 0 9504 0 22403 0 23482 0 308070 0 0 Barbara G Ballard VP Homecare & Hospice 0 238742 0 33691 0 10403 0 43913 0 21002 0 347751 0 0 Melissa L Box VP CNO Patient Care Services 175219 0 29684 0 11624 0 12816 0 25444 0 254787 0 0 0 Joseph L Brywczynski SVP Health Parks Development 0 266989 0 285443 0 17664 0 45700 0 24444 0 640240 0 0 Anthony J Budzinski EVP & CFO 0 539386 0 134954 0 14896 0 45700 0 25396 0 760332 0 0 Donald Campbell MD SVP Phys Educ & Student Aff 0 327517 0 167537 0 18263 0 45700 0 16783 0 575800 0 0 James E Clements VP Bus Dev & Strategic Prtnrsp 0 207563 0 49762 0 6691 0 0 0 17453 0 281469 0 0 Lee R Cook VP Med & Behavioral Health 0 256547 0 327425 0 8736 0 27624 0 17428 0 637760 0 0 Barbara B Corey SVP Managed Care 0 301454 0 65765 0 11944 0 21292 0 26837 0 427292 0 0 Bruce A Dean VP Real Estate Deputy Gen Cnsl 0 227781 0 40345 0 14335 0 45675 0 24166 0 352302 0 0 Marcia Delk-Payne MD SVP Med Affair & Chf Qlty Ofcr 0 370531 0 544886 0 10395 0 45700 0 4190 0 975702 0 0 Nancy R Doelling VP Pediatric SRVS.(BEGIN. 8/4) 0 117427 0 16910 0 6672 0 11120 0 691 0 152820 0 0 Jimmy E Francis VP Info Technology Operations 0 205005 0 42280 0 9742 0 33822 0 2370 0 293219 0 0 Steven L Grace VP Talent Acquisition 0 200013 0 52892 0 14048 0 14653 0 18078 0 299684 0 0 Kristyn M Greifer MD VP Population Management 0 307528 0 52230 0 10225 0 18722 0 9958 0 398663 0 0 Joel W Helmke VP Oncology (BEGIN. 7/21) 0 110000 0 51610 0 3904 0 20081 0 8794 0 194389 0 0 Robert D Jansen md EVP & Pres Medical Group 0 591219 0 170344 0 20977 0 45700 0 29543 0 857783 0 0 Reynold J Jennings president & ceo 0 975000 0 708390 0 18591 0 0 0 2056 0 1704037 0 0 Peter R Jungblut MD SVP & Medical Dir WMG 0 307528 0 78959 0 12316 0 40200 0 29199 0 468202 0 0 Christopher M Kane SVP Strategic Plan & Bus Dev 0 341744 0 454243 0 10413 0 21954 0 20378 0 848732 0 0 Beth Kost VP Compliance Chf Privacy Ofcr 0 244733 0 77006 0 9961 0 22318 0 11704 0 365722 0 0 Kenneth C Kunze MD FMR. SVP Chief Medical Officer 0 0 0 0 0 383389 0 0 0 0 0 383389 0 0 Ellen Langford SVP & COO WellStar Med Group 0 220376 0 46995 0 11936 0 36643 0 22323 0 338273 0 0 Elizabeth H Loudermilk VP Ent Intelligence & Intgrtn 0 225680 0 73283 0 9197 0 6309 0 19342 0 333811 0 0 Sandra Lucius VP Info Technology Apps 0 185834 0 30026 0 8564 0 44758 0 2235 0 271417 0 0 Robert Mandler VP Diagnostic Outreach 0 214261 0 58412 0 18167 0 45249 0 16275 0 352364 0 0 Patricia A Mayne VP Emergency Services 0 177986 0 122895 0 10448 0 26305 0 23814 0 361448 0 0 Kimberly W Menefee SVP Strategic Community Dev 0 282547 0 66726 0 13682 0 28200 0 17826 0 408981 0 0 Christopher L Morgan VP & Admin. CLIO (BEGIN. 7/7) 0 110770 0 52731 0 4638 0 20102 0 1645 0 189886 0 0 Jonathan B Morris MD SVP Chief Info Officer 0 369512 0 80613 0 12264 0 23553 0 26705 0 512647 0 0 Bradford B Newton VP Information Technology Admi 0 192691 0 30661 0 8988 0 20598 0 27113 0 280051 0 0 Craig Owens SVP & Hospital President 270317 0 60546 0 13633 0 45700 0 21484 0 411680 0 0 0 Michael G Paul VP Facilities Eng Support Svcs 0 181401 0 27532 0 12020 0 0 0 24150 0 245103 0 0 Leo E Reichert EVP & General Counsel 0 489341 0 247184 0 15552 0 0 0 29200 0 781277 0 0 Bethany Robertson VP & Chief Learning Officer 0 178067 0 31215 0 9391 0 13097 0 28511 0 260281 0 0 Michelle M Robinson VP Mktng/PR/Internal Comm 0 196373 0 33264 0 9210 0 14300 0 26351 0 279498 0 0 Deborah Roegge De Vita VP Women & Newborn Svc Line 0 195728 0 27621 0 8576 0 25759 0 6141 0 263825 0 0 Candice L Saunders President & CEO 0 621461 0 174240 0 16525 0 45334 0 27582 0 885142 0 0 Christopher B Scullen VP Pulmonology Operations 0 172411 0 112906 0 6929 0 0 0 17839 0 310085 0 0 Richard S Siegel VP Cardiology & CVM Admin 0 271627 0 40496 0 11541 0 45700 0 24762 0 394126 0 0 Jeffery D Stanley VP Pharmacy & System Coor 0 176156 0 30945 0 9170 0 21580 0 8658 0 246509 0 0 Daniel J Styf SVP PW Health Plan 0 281902 0 39983 0 15148 0 18663 0 9070 0 364766 0 0 James M Swartz VP Accounting 0 200242 0 63140 0 8971 0 16856 0 25406 0 314615 0 0 Mary L Tavernaro VP Human Resources Operations 0 212056 0 37659 0 9442 0 27690 0 21436 0 308283 0 0 Adam C Thompson VP Surgery 0 166858 0 51698 0 9517 0 0 0 21830 0 249903 0 0 Anthony M Trupiano SVP Supply Chain 0 268258 0 61742 0 15219 0 45700 0 1896 0 392815 0 0 Sean P Turner VP Rev.Cycle MGMT (BEGIN.9/28) 0 233395 0 36468 0 3219 0 20091 0 26574 0 319747 0 0 Robin Wilson MD SVP Chief Hlth Innov Officer 0 395907 0 232368 0 9718 0 0 0 22144 0 660137 0 0 Chester A Zborowski VP Health Parks Operations 0 165755 0 45188 0 12208 0 0 0 24265 0 247416 0 0 Avril P Beckford MD TRUSTEE 0 395084 0 86393 0 2531 0 27460 0 1940 0 513408 0 0 Jeffrey L Tharp MD TRUSTEE 0 480597 0 147676 0 2596 0 45700 0 29025 0 705594 0 0 THOMAS E GEARHARD MD TRUSTEE 0 293273 0 48916 0 5186 0 42668 0 30543 0 420586 0 0 MARGARET W CHASTAIN Dir Pharmacy 165194 0 11263 0 1963 0 26298 0 2001 0 206719 0 0 0 CHRISTOPHER S GREENE Exec Dir Finance & Hosp Ops 154253 0 14273 0 446 0 11521 0 10243 0 190736 0 0 0 STEVEN W HARRIS Pharmacist Specialty 143980 0 1250 0 5241 0 0 11495 0 161966 0 0 0 BEVERLY M BATES RN Charge Nurse 144424 0 3750 0 844 0 13363 0 27443 0 189824 0 0 0 KAREN Y BEARD DIR SURGICAL SVS DH/WH 132933 0 8817 0 553 0 14175 0 11126 0 167604 0 0 0 MICHAEL L GRAUE FRMR. EBP & CHIEF OP. OFFICER 0 0 0 0 0 522266 0 0 0 0 0 522266 0 0 SCHEDULE J, PART I, LINE 1B REIMBURSEMENT POLICY While WellStar Health System and its affiliates do not have a written policy regarding payment or reimbursement of the items listed in Part I Line 1a, the organization follows IRS guidelines in the payment of any of these items to individuals listed in Form 990 Part VII Section A. These items are added as taxable wages on the individual's Form W-2 as appropriate. SCHEDULE J, PART I, LINE 4A SEVERANCE PAYMENTS Pursuant to their respective employment agreements, the following groups of officers are entitled to severance payments based on their compensation at that time in the event of certain identified circumstances. The severance payment periods are 24 months for Executive Vice Presidents, 18 months for Senior Vice Presidents, and 12 months for Vice Presidents. The following officerS/KEY EMPLOYEES received severance pay during the 2014 CALENDAR YEAR FROM EITHER THE ORGANIZATION OR A RELATED ORGANIZATION: KENNETH C. KUNZE, MD $ 383,389 MICHAEL L. GRAUE, MD 522,266 SCHEDULE J, PART I, LINE 4B The following officers/KEY EMPLOYEES PARTICIPATED IN A SUPPLEMENTAL NON-QUALIFIED RETIREMENT PLAN DURING THE YEAR. Valery Akopov Nicole Ashe Melissa Box Craig Owens JOSEPH L. BRYWCZYNSKI ANTHONY J. BUDZINSKI James Clements LEE R. COOK BARBARA B. COREY BRUCE ALAN DEAN Sarath Degala Marcia Delk-Payne JIMMY E. FRANCIS KRISTYN M. GREIFER ROBERT D. JANSEN PETER R. JUNGBLUT CHRISTOPHER MICHAEL KANE Beth Kost Ellen Langford Elizabeth Loudermilk PATRICIA A. MAYNE KIMBERLY W. MENEFEE JONATHAN B. MORRIS Bradford Newton Leo Reichert Bethany Robertson Michelle Robinson CANDICE LYNN SAUNDERS Richard Siegel CHRISTOPHER B. SCULLEN Jeffery Stanley Daniel Styf JAMES M. SWARTZ MARY LOUISE TAVERNARO Adam Thompson ANTHONY MICHAEL TRUPIANO Robin Wilson DONALD CAMPBELL ROBERT MANDLER DEBORAH ROEGGE DE VITA DAVID W. ANDERSON CHESTER ZBOROWSKI BARBARA BALLARD SCHEDULE J, PART I, LINE 7B NON-FIXED PAYMENTS TO OFFICERS As part of the WellStar Executive Compensation Philosophy a performance pay plan was instituted several years ago whereby the WellStar Board of Trustees approves an annual incentive plan which consists of several performance goals or factors that upon attainment will result in payouts to eligible plan participants. Those factors are: People & Customer Service goal for employee "Trust Index", Quality & Safety goal for clinical excellence and patient satisfaction, Financial goal for attaining a positive operating margin. Confirmation of achieving these goals is typically received through the annual external audit process and approved by the Board of Trustees at that time. FORM 990, PART III, LINE 4A PROGRAM SERVICE ACCOMPLISHMENTS As discussed herein, Douglas Hospital, Inc. (an affiliate of Wellstar Health System, Inc.) operates as a charitable organization consistent with the requirements of Internal Revenue Code section 501(c)(3) and the "community benefit standard" of IRS Revenue Ruling 69-545. In this regard, the governing body of the organization and/or its parent is composed of prominent citizens in the community, medical staff privileges in the hospital are available to all qualified physicians in the area consistent with the size and nature of the facility; the hospital operates a full-time emergency room open to all regardless of ability to pay; the hospital provides care to the needy members of the community consistent with its charity care policy regardless of their ability to pay for these services. The hospital's excess funds are generally applied to expansion and replacement of existing facilities and equipment, amortization of indebtedness, improvement of patient care, community benefit activities, and charity care. Douglas Hospital committed approximately $15.3 million in capital expenditures for the year to meet the technology and program needs of the community we serve. Douglas Hospital, Inc. was organized in 1992. The hospital affiliated with the Northwest Georgia Health System in 1993. In 1994 Northwest Georgia Health System helped form the PROMINA Health System and changed its name to Promina Northwest Health System. In 1998 Promina Northwest changed its name to Wellstar Health System and is now totally independent of PROMINA. Douglas Hospital is subordinate to, and subject to the authority of Wellstar Health System and its governing boards including the Hospital Authority of Douglas County. Wellstar Douglas provides a full range of inpatient and outpatient services characteristic of a community hospital. The hospital is licensed to operate 108 beds and is presently staffed to operate 102 beds. The original hospital was constructed in 1974 and has had three major structural additions since 1985. The following stats constitute the overall program services provided during the reporting period ended June 30, 2015: Adult Discharges - 6,914 Newborn Discharges - 464 Med & Surgical Short Stay Cases - 6 Emergency Room Visits - 66,753 Total Surgical Cases - 3,996 Outpatient Procedures Non-ED OP Radiology - 39,023 GI Laboratory - 1,072 Cath Lab Procedures - 972 Total FTEs Paid - 732 Community Benefit Reporting Community Outreach - $ 242,966 Unreimbursed Charity Care (at cost) - $ 11,958,733 Medicaid Shortfalls (at cost) - $ 1,140,586 Total Community Benefit - $ 13,342,285 As an affiliate of Wellstar Health System, Douglas Hospital participates in many community and educational programs for the overall health and benefit of the area that we serve. Some examples of those programs are: Community Health/Education Screenings and educational opportunities such as defensive driving for teens (offered at a minimal cost), smoking cessation, heart smart school, CPR and others. Community Activities--sponsors blood drives, provides funding to school health programs for medical and dental care for the underserved population. Community Events Latino Day for the community Hispanics to have a variety of screenings for health related issues. In all a total of over 200,000 area residents participated in some type of education or screening in health issues. Over 2,000 couples participated in prenatal educational offerings sponsored by WellStar. Sponorships-- Wellstar's Laundry services Department partnered with a local homeless shelter, MUST Ministries, to donate retired and faded scrubs to new arrivals at the shelter. MUST have integrated housing programs in Cobb, Cherokee, and Douglas counties (the heart of Wellstar"s service area). Recognition and Accomplishments Douglas Hospital continues to be accredited by the Joint Commission on Accreditation of Healthcare Organizations (JCAHO). All of the Wellstar system hospitals (including Douglas) have been awarded "Accreditation with Distinction" by the Commission on Laboratory Accreditation of the College of American Pathologists (CAP). CAP awards are considered one of the most stringent in laboratory quality assurance in the industry. The Wellstar Cancer Program is accredited by the American College of Surgeons. The expansion of the cancer program has resulted in an increase in the services provided for cancer patients at both Douglas and Paulding Hospitals. The Wellstar Respiratory Care is accredited by the American Association for Respiratory Care with its "Recognition for Quality". Wellstar Health System is number five in the Top 100 Integrated Healthcare Networks as published by SDI. It is also the highest ranked integrated network in the state. Wellstar is named in the 100 Best Companies List by "Working Mothers" magazine and as a National Employer Team Member by AARP for its work on behalf of more mature workers within the organization. Wellstar was also named for a sixth year in a row to the Companies that Care Honor Roll. This distinction represents employers who create positive work environments for its employees and who are also active community partners. WellStar Douglas Hospital was awarded the Business Beautification Award for the month of July 2012 by Keep Douglasville Beautiful. The Keep Douglasville Beautiful Board of Directors presents the award to a local business each quarter throughtout the year for their efforts in community growth. In October WellStar completed the system-wide implementation of a new cleaning process called Xenex. The process uses ultraviolet light technology/machines to decontaminate rooms in five to 12 minutes. This includes patient rooms, emergency departments, public restrooms, supply rooms and nursing stations. Independent studies and lab samples have shown that the system is 20 times more effective than regular cleaning protocols for eliminating harmful bacteria and many other organisms. All hospitals have a least one machine in operation. WellStar Douglas Hospital's Neurodiagnostic/Electroencephalography (EEG) Laboratory was granted a five-year accreditation by the Laboratory Accreditation Board of the American Board of Registration of Electroencephalographic and Evoked Potential Technologists. The accreditation was based on an evaluation of the quality of the EEGs performed in the lab and on a review of the labs policy and procedures manual. To better serve behavioral health patients who visit WellStar Douglas Hospital's Emergency Department, the system began using an innovative technology to offer telemedicine. The technology is provided in a partnership with TeleHealth and allows psychiatrists at WellStar Cobb Hospital to securely and conveniently evaluate Douglas patients and expedite their discharge. With the success of the pilot program the system plans to expand to Paulding Hospital, which, like Douglas does not have an on-site psychiatrist. WellStar Kennestone Hospital launched an initiative called Best In Georgia (BIG) with a goal to improve patient safety and well-being across the system. A multidisciplinary team of physicians and other team members meet on a monthly basis to evaluate performance measures at the hospital. As many consumers research healthcare performance measures in sources such as Health Grades and US News and World Report as well as other online sites it is important to focus on improving the hospitals position in the public. Cobb, Douglas, Paulding and Windy Hill hospitals have also joined in this initiative at their respective hospitals. Douglas Hospital began construction during the reporting period on its Intensive Care Unit expansion and the Emergency Department renovation. The $18 million project is projected to be completed in late 2014 and will double the number of ICU beds. Plans also include relocating the cafeteria and new triage/treatment rooms in the Emergency Department. The project will add an additional 43,270 square feet to the campus and 10,702 square feet will be renovated. FORM 990, PART I, LINES 7A & 7B UNRELATED BUSINESS INCOME DOUGLAS HOSPITAL, INC. GENERATED NO UNRELATED BUSINESS INCOME FOR THE REPORTING YEAR. AS A RESULT THE ATTACHED 990-T SHOWS NO ACTIVITY. IF SUBSEQUENT REVIEW OF THE BOOKS REVEALS ANY UNREPORTED UBI WE WILL FILE AN AMENDED RETURN FOR THE TAX PERIOD ENDED JUNE 30, 2015. FORM 990, PART IV, LINE 12B AUDITED FINANCIAL STATEMENTS DOUGLAS HOSPITAL, Inc. is audited on an annual basis by an outside auditing firm, KPMG, and as part of that audit a consolidated financial statement is issued for all of WellStar Health System, Inc. and its Affiliates. "The independent auditors report includes the accounts of WellStar and its controlled affiliates, Kennestone Hospital, Inc., Cobb Hospital, Inc., Douglas Hospital, Inc., Paulding Medical Center, Inc., WellStar Foundation, Inc. CHS Foundation, Inc., Community Assurance Company, Ltd., various WellStar owned physician practices, a hospice facility, a nursing facility, home health business, and entities for infusion therapy and durable medical equipment. All significant intercompany accounts and transactions have been eliminated in combination. The Board of Trustees of WellStar has the authority to approve appointments of the members of the board of trustees of all affiliate corporations." FORM 990, PART IV, LINE 24A TAX EXEMPT BOND REPORTING For purposes of the Form 990 reporting, WellStar Health System, Inc. (EIN 58-1649541) will list all tax-exempt bonds issued since January 1, 2003 on Schedule K as it typically allocates the proceeds of the bonds to members of the Obligated Group (including the hospitals and physician group). Douglas Hospital, Inc. will report this tax exempt bond liability on Part X, Line 25 Other Liabilities. Paulding Medical Center, Inc. has also restated its beginning balance sheet with respect to tax exempt bond liabilities as the amounts allocated to tax exempt bond liabilities are now included on Line 25. FORM 990, PART VI, SECTION A, LINE 7B POWERS OF THE BOARD AS PER THE ARTICLES OF INCORPORATION, THE SOLE MEMBER OF THE ORGANIZATION IS WELLSTAR HEALTH SYSTEM, INC., A GEORGIA NONPROFIT CORPORATION. AS SOLE MEMBER, WELLSTAR HEALTH SYSTEM, INC. HOLDS CERTAIN POWERS OF ELECTION AND APPROVAL IN CONNECTION WITH THE GOVERNING BODY OF THE ORGANIZATION. THESE POWERS ARE PRESENTED IN DETAIL IN THE GOVERNING DOCUMENTS WHICH THE COMPANY MAKES AVAILABLE TO THE PUBLIC UPON REQUEST. FORM 990, PART B, SECTION B, LINE 11B BOARD REVIEW OF FORM 990 Internal staff prepareS the organization's Form 990. Before filing the return with the Internal Revenue Service an external accounting firm, PricewaterhouseCoopers LLP, reviews and sign-offs on the completed return of each organization. The current year Form 990 is then reviewed by the Finance Committee along with a question and answer session. A motion is then made by the Finance committee to approve the returns and present to the full board copies of the forms in an electronic (pdf. format) version as well as a hard copy. The organization's CFO or designee subsequently signs the return for either manual or electronic filing by the appropriate due date. FORM 990, PART VI, SECTION B, LINE 12C CONFLICT OF INTEREST POLICY Our conflict of interest policy requires all covered persons to annually review the policy and then complete, sign and return the Conflicts of Interest Survey and Attestation to the Compliance Office. The Policy requires an on-going disclosure obligation in the event a conflict arises during the year. The following is our process to regularly and consistently monitor and enforce the policy: Compliance identifies all covered persons who must complete the Survey and Attestation. Compliance verifies that the Survey and Attestation is distributed to these persons. Compliance verifies that these persons return a fully completed and signed Survey and Attestation. Compliance reviews each completed and signed Survey and Attestation to identify all conflicts listed in the document. All conflicts, potential conflicts and incidences of non-compliance are referred to the Chief Compliance Officer. The CCO takes appropriate action to completely resolve all identified conflicts and incidences of non-compliance. FORM 990, PART VII, SECTION B, LINES 15A & 15B COMPENSATION OF OFFICERS Wellstar engages the Hay Group to work with the governing board to review and recommend executive compensation. The executive compensation process at Wellstar is overseen by a committee of independent trustees, which follows a board-approved executive compensation philosophy. The compensation committee consists of five trustees as well as the CEO in an advisory role and not a voting member. Further in committee discussions about the compensation for the Chief Executive Officer, The CEO will recuse him/herself from that process and is a non-voting committee member for discussions on all other officers. The executive compensation philosophy empowers the committee to oversee the executive compensation process and administer the executive compensation program on behalf of the full board of trustee of Wellstar; provided, however, the full Board of Trustees evaluates and approves the compensation of the Chief Executive Officer. The philosophy requires annual disclosure of the committee's actions and decisions to the full board, which it has done. The committee is guided by the board-approved philosophy. Overall, the philosophy is intended to reward for organizational and individual performance. When performance is at a predetermined targeted level, the compensation is intended to be at or around the median of compensation paid to similar positions at similar organizations (the "market"). Wellstar's executive compensation philosophy defines the market as being comprised of comparable not-for-profit health care delivery systems, i.e., not-for-profit organizations similar in complexity and scale to Wellstar. To assist the committee in fulfilling its duties, the committee engaged the Hay Group to provide market compensation data to compare to the Wellstar positions whose compensation the committee oversees. The committee uses this data to provide context when making decisions in administering the compensation program. Accurate minutes of the committee's discussion and decisions are recorded during each committee meeting, and reviewed and approved by the full Board of Trustees at its next scheduled meeting. FORM 990, PART VI, SECTION C, LINE 19 DOCUMENTS MADE AVAILABLE TO THE PUBLIC The organization and its subsidiaries are subject to the Open Records Law in the State of Georgia. Therefore, by law, citizens are permitted to inspect and copy its governing documents, policies and financial statements as may be requested from time to time. Additionally, the organization's Form 990 is made readily available on the Guidestar website. Periodically, the organization publishes its financial performance in the local newspaper for citizens to review, and it also publishes a community benefit report once a year for distribution to the public. FORM 990, PART VII OFFICERS HOURS WORKED The officers devote their time to all of the organizations within Wellstar Health System that are listed in Schedule R, Part II. As such, the total hours worked by the officers across all organizations exceeds 40 hours a week. FORM 990, PART VII & FORM 990, SCHEDULE J COMPENSATION All compensation amounts reported on Form 990 Part V, Part VII, and Part IX as well as Schedule J represent compensation provided to individuals that provide services to the organization. Likewise, the number of employees reported on Form 990 represent the number of individuals providing services to the organization. All Federal employment tax responsibilities for these individuals (including Federal Employment Tax reporting responsibilities) are handled by Wellstar Health System, Inc. (EIN 58-1649541). FORM 990, PART XI, LINE 9 OTHER CHANGES IN NET ASSETS Form 990 Part XI Line 9 For the reporting period DOUGLAS HOSPITAL, Inc. had a change in net assets of ($12,260,501) related to transfers to affiliates as part of the allocation of income statement and balance sheet transactions over the year. 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