PAULDING MEDICAL CENTER INC: Form 990, tax year 2014
View the entire original 990 at ProPublica ↗
- Organization
- PAULDING MEDICAL CENTER INC (EIN 58-2095884)
- Tax period
- 2014-07-01 to 2015-06-30
- Filed
- 2016-05-13
- IRS object ID
- 201621349349304807
- Schema version
- 2014v6.0
- 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 ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return | 2016-05-13T13:12:50-05:00 | ReturnTs |
| Tax Period End | 2015-06-30 | TaxPeriodEndDt |
Preparer Firm PreparerFirmGrp
Preparer Firm Name PreparerFirmName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | PricewaterhouseCoopers LLP | BusinessNameLine1Txt |
Preparer US Address PreparerUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 2001 MARKET ST SUITE 1800 | AddressLine1Txt |
| City | PHILADELPHIA | CityNm |
| State Abbreviation | PA | StateAbbreviationCd |
| ZIP | 19103 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnTypeCd |
| Tax Period Begin | 2014-07-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 582095884 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | PAULDING MEDICAL CENTER INC | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| In Care Of | % JAMES M SWARTZ | InCareOfNm |
| Business Name Control | PAUL | BusinessNameControlTxt |
| Phone | 7707925023 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 805 Sandy Plains Road | AddressLine1Txt |
| City | Marietta | CityNm |
| State Abbreviation | GA | StateAbbreviationCd |
| ZIP | 300666340 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | JAMES SWARTZ | PersonNm |
| Person Title | VP ACCOUNTING | PersonTitleTxt |
| Phone | 2673303000 | PhoneNum |
| Signature | 2016-05-12 | SignatureDt |
| Discuss With Paid Preparer | Yes (true) | DiscussWithPaidPreparerInd |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | JOANNE KRUEGER | PreparerPersonNm |
| PTIN | P01235586 | PTIN |
| Phone | 2673303000 | PhoneNum |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2014 | TaxYr |
| Build TS | 2016-08-17 19:52:53Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Principal Officer | CANDICE L SAUNDERS | PrincipalOfficerNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 805 Sandy Plains Road | AddressLine1Txt |
| City | Marietta | CityNm |
| State Abbreviation | GA | StateAbbreviationCd |
| ZIP | 300666340 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $110,633,578 | GrossReceiptsAmt |
| Group Return For Affiliates | false | GroupReturnForAffiliatesInd |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | www.wellstar.org | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 1993 | FormationYr |
| Legal Domicile State | GA | LegalDomicileStateCd |
| Activity Or Mission | To deliver world-class charitable healthcare. | ActivityOrMissionDesc |
| Voting Members Governing Body | 18 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 9 | VotingMembersIndependentCnt |
| Total Employee | 876 | TotalEmployeeCnt |
| Total Volunteers | 105 | TotalVolunteersCnt |
| Total Gross UBI | $0 | TotalGrossUBIAmt |
| Net Unrelated Bus Txbl Incm | $0 | NetUnrelatedBusTxblIncmAmt |
| PY Contributions Grants | $0 | PYContributionsGrantsAmt |
| CY Contributions Grants | $0 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $75,573,580 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $109,637,767 | CYProgramServiceRevenueAmt |
| PY Investment Income | $1,894 | PYInvestmentIncomeAmt |
| CY Investment Income | $81,500 | CYInvestmentIncomeAmt |
| PY Other Revenue | $355,951 | PYOtherRevenueAmt |
| CY Other Revenue | $914,311 | CYOtherRevenueAmt |
| PY Total Revenue | $75,931,425 | PYTotalRevenueAmt |
| CY Total Revenue | $110,633,578 | CYTotalRevenueAmt |
| PY Grants And Similar Paid | $0 | PYGrantsAndSimilarPaidAmt |
| CY Grants And Similar Paid | $1,000 | CYGrantsAndSimilarPaidAmt |
| PY Benefits Paid To Members | $0 | PYBenefitsPaidToMembersAmt |
| CY Benefits Paid To Members | $0 | CYBenefitsPaidToMembersAmt |
| PY Salaries Comp Emp Bnft Paid | $34,868,051 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $46,964,890 | CYSalariesCompEmpBnftPaidAmt |
| PY Total Prof Fndrsng Expns | $0 | PYTotalProfFndrsngExpnsAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $0 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $36,003,218 | PYOtherExpensesAmt |
| CY Other Expenses | $56,515,927 | CYOtherExpensesAmt |
| PY Total Expenses | $70,871,269 | PYTotalExpensesAmt |
| CY Total Expenses | $103,481,817 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | $5,060,156 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | $7,151,761 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $177,640,983 | TotalAssetsBOYAmt |
| Total Assets EOY | $167,442,391 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $111,994,863 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $114,552,195 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $65,646,120 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $52,890,196 | NetAssetsOrFundBalancesEOYAmt |
| Info In Schedule O Part III | Yes (X) | InfoInScheduleOPartIIIInd |
| Mission | 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. | MissionDesc |
| Significant New Program Srvc | false | SignificantNewProgramSrvcInd |
| Significant Change | false | SignificantChangeInd |
| Expense | $81,969,940 | ExpenseAmt |
| Grant | $1,000 | GrantAmt |
| Revenue | $109,637,767 | RevenueAmt |
| Desc | SEE SCHEDULE O | Desc |
| Total Program Service Expenses | $81,969,940 | TotalProgramServiceExpensesAmt |
| Described In Section501c3 | Yes (true) | DescribedInSection501c3Ind |
| Schedule B Required | false | ScheduleBRequiredInd |
| Political Campaign Acty | false | PoliticalCampaignActyInd |
| Lobbying Activities | false | LobbyingActivitiesInd |
| Donor Advised Fund | false | DonorAdvisedFundInd |
| Conservation Easements | false | ConservationEasementsInd |
| Collections Of Art | false | CollectionsOfArtInd |
| Credit Counseling | false | CreditCounselingInd |
| Temp Or Permanent Endowments | false | TempOrPermanentEndowmentsInd |
| Report Land Building Equipment | Yes (true) | ReportLandBuildingEquipmentInd |
| Report Investments Other Sec | false | ReportInvestmentsOtherSecInd |
| Report Program Related Invst | false | ReportProgramRelatedInvstInd |
| Report Other Assets | false | ReportOtherAssetsInd |
| Report Other Liabilities | Yes (true) | ReportOtherLiabilitiesInd |
| Include FIN48 Footnote | Yes (true) | IncludeFIN48FootnoteInd |
| Independent Audit Fincl Stmt | false | IndependentAuditFinclStmtInd |
| Consolidated Audit Fincl Stmt | Yes (true) | ConsolidatedAuditFinclStmtInd |
| School Operating | false | SchoolOperatingInd |
| Foreign Office | false | ForeignOfficeInd |
| Foreign Activities | false | ForeignActivitiesInd |
| More Than5000 K To Org | false | MoreThan5000KToOrgInd |
| More Than5000 K To Individuals | false | MoreThan5000KToIndividualsInd |
| Professional Fundraising | false | ProfessionalFundraisingInd |
| Fundraising Activities | false | FundraisingActivitiesInd |
| Gaming Activities | false | GamingActivitiesInd |
| Operate Hospital | Yes (true) | OperateHospitalInd |
| Audited Financial Stmt Att | Yes (true) | AuditedFinancialStmtAttInd |
| Grants To Organizations | false | GrantsToOrganizationsInd |
| Grants To Individuals | false | GrantsToIndividualsInd |
| Schedule J Required | Yes (true) | ScheduleJRequiredInd |
| Tax Exempt Bonds | false | TaxExemptBondsInd |
| Engaged In Excess Benefit Trans | false | EngagedInExcessBenefitTransInd |
| PY Excess Benefit Trans | false | PYExcessBenefitTransInd |
| Loan Outstanding | false | LoanOutstandingInd |
| Grant To Related Person | false | GrantToRelatedPersonInd |
| Business Rln With Org Mem | false | BusinessRlnWithOrgMemInd |
| Business Rln With Fam Mem | false | BusinessRlnWithFamMemInd |
| Business Rln With Officer Ent | false | BusinessRlnWithOfficerEntInd |
| Deductible Non Cash Contri | false | DeductibleNonCashContriInd |
| Deductible Art Contribution | false | DeductibleArtContributionInd |
| Terminate Operations | false | TerminateOperationsInd |
| Partial Liquidation | false | PartialLiquidationInd |
| Disregarded Entity | false | DisregardedEntityInd |
| Related Entity | Yes (true) | RelatedEntityInd |
| Related Organization Ctrl Ent | Yes (true) | RelatedOrganizationCtrlEntInd |
| Transaction With Control Ent | false | TransactionWithControlEntInd |
| Trnsfr Exmpt Non Chrtbl Rltd Org | false | TrnsfrExmptNonChrtblRltdOrgInd |
| Activities Conducted Prtshp | false | ActivitiesConductedPrtshpInd |
| Schedule O Required | Yes (true) | ScheduleORequiredInd |
| IRP Document | 0 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Employee | 876 | EmployeeCnt |
| Employment Tax Returns Filed | Yes (true) | EmploymentTaxReturnsFiledInd |
| Unrelated Bus Incm Over Limit | false | UnrelatedBusIncmOverLimitInd |
| Foreign Financial Account | false | ForeignFinancialAccountInd |
| Prohibited Tax Shelter Trans | false | ProhibitedTaxShelterTransInd |
| Taxable Party Notification | false | TaxablePartyNotificationInd |
| Nondeductible Contributions | false | NondeductibleContributionsInd |
| Quid Pro Quo Contributions | false | QuidProQuoContributionsInd |
| Form8282 Property Disposed Of | false | Form8282PropertyDisposedOfInd |
| Rcv Fnds To Pay Prsnl Bnft Cntrct | false | RcvFndsToPayPrsnlBnftCntrctInd |
| Pay Premiums Prsnl Bnft Cntrct | false | PayPremiumsPrsnlBnftCntrctInd |
| Indoor Tanning Services | false | IndoorTanningServicesInd |
| Info In Schedule O Part VI | Yes (X) | InfoInScheduleOPartVIInd |
| Governing Body Voting Members | 18 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 9 | IndependentVotingMemberCnt |
| Family Or Business Rln | false | FamilyOrBusinessRlnInd |
| Delegation Of Mgmt Duties | false | DelegationOfMgmtDutiesInd |
| Change To Org Documents | false | ChangeToOrgDocumentsInd |
| Material Diversion Or Misuse | false | MaterialDiversionOrMisuseInd |
| Members Or Stockholders | Yes (true) | MembersOrStockholdersInd |
| Election Of Board Members | Yes (true) | ElectionOfBoardMembersInd |
| Decisions Subject To Approva | Yes (true) | DecisionsSubjectToApprovaInd |
| Minutes Of Governing Body | Yes (true) | MinutesOfGoverningBodyInd |
| Minutes Of Committees | Yes (true) | MinutesOfCommitteesInd |
| Officer Mailing Address | false | OfficerMailingAddressInd |
| Local Chapters | false | LocalChaptersInd |
| Form990 Provided To Gvrn Body | Yes (true) | Form990ProvidedToGvrnBodyInd |
| Conflict Of Interest Policy | Yes (true) | ConflictOfInterestPolicyInd |
| Annual Disclosure Covered Prsn | Yes (true) | AnnualDisclosureCoveredPrsnInd |
| Regular Monitoring Enfrc | Yes (true) | RegularMonitoringEnfrcInd |
| Whistleblower Policy | Yes (true) | WhistleblowerPolicyInd |
| Document Retention Policy | Yes (true) | DocumentRetentionPolicyInd |
| Compensation Process CEO | Yes (true) | CompensationProcessCEOInd |
| Compensation Process Other | Yes (true) | CompensationProcessOtherInd |
| Investment In Joint Venture | false | InvestmentInJointVentureInd |
| States Where Copy Of Return Is Fld | GA | StatesWhereCopyOfReturnIsFldCd |
| Upon Request | Yes (X) | UponRequestInd |
Books In Care Of Detail BooksInCareOfDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | JAMES M SWARTZ | PersonNm |
| Phone | 7707925023 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 805 SANDY PLAINS ROAD | AddressLine1Txt |
| City | Marietta | CityNm |
| State Abbreviation | GA | StateAbbreviationCd |
| ZIP | 300666340 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part VII | Yes (X) | InfoInScheduleOPartVIIInd |
Form990 Part VII Section A Form990PartVIISectionAGrp (82 entries)
| TitleTitleTxt | Average Hours Per WeekAverageHoursPerWeekRt | Average Hours Per Week Rltd OrgAverageHoursPerWeekRltdOrgRt | Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd | Reportable Comp From OrgReportableCompFromOrgAmt | Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt | Other CompensationOtherCompensationAmt | OfficerOfficerInd | Highest Compensated EmployeeHighestCompensatedEmployeeInd | Former Ofcr Director TrusteeFormerOfcrDirectorTrusteeInd |
|---|---|---|---|---|---|---|---|---|---|
| Avril P Beckford MD | |||||||||
| TRUSTEE | 2.0 | 48.0 | Yes (X) | $0 | $484,008 | $29,400 | |||
| Jeffrey L Tharp MD | |||||||||
| TRUSTEE | 2.0 | 48.0 | Yes (X) | $0 | $630,869 | $74,725 | |||
| RANDALL BENTLEY SR | |||||||||
| TRUSTEE | 1.0 | 5.0 | Yes (X) | $0 | $19,268 | $0 | |||
| OTIS A BRUMBY III | |||||||||
| TRUSTEE | 1.0 | 5.0 | Yes (X) | $0 | $14,475 | $0 | |||
| ROBERT N CROSS MD | |||||||||
| TRUSTEE | 1.0 | 5.0 | Yes (X) | $0 | $14,446 | $0 | |||
| TE RUSTY DURHAM | |||||||||
| TRUSTEE EMERITUS | 1.0 | 5.0 | Yes (X) | $0 | $661 | $0 | |||
| THOMAS E GEARHARD MD | |||||||||
| TRUSTEE | 2.0 | 48.0 | Yes (X) | $0 | $347,375 | $73,211 | |||
| DAVID H HAFNER MD | |||||||||
| TRUSTEE | 1.0 | 5.0 | Yes (X) | $0 | $26,233 | $0 | |||
| T FITZ JOHNSON | |||||||||
| TRUSTEE | 1.0 | 7.0 | Yes (X) | $0 | $20,712 | $0 | |||
| CHARLES J JONES | |||||||||
| TRUSTEE | 1.0 | 5.0 | Yes (X) | $0 | $4,075 | $0 | |||
| JANIE MADDOX | |||||||||
| TRUSTEE - CHAIR | 1.0 | 5.0 | Yes (X) | $0 | $8,850 | $0 | |||
| GARY A MILLER | |||||||||
| TRUSTEE - VICE CHAIR | 1.0 | 5.0 | Yes (X) | $0 | $4,387 | $0 | |||
| MITZI MOORE | |||||||||
| TRUSTEE | 1.0 | 5.0 | Yes (X) | $0 | $1,730 | $0 | |||
| TOM PHILLIPS | |||||||||
| TRUSTEE | 1.0 | 5.0 | Yes (X) | $0 | $2,903 | $0 | |||
| WALTER ROBINSON | |||||||||
| TRUSTEE | 1.0 | 5.0 | Yes (X) | $0 | $4,672 | $0 | |||
| FRANK ROS | |||||||||
| TRUSTEE | 1.0 | 5.0 | Yes (X) | $0 | $2,820 | $0 | |||
| ORIN SWAYZE MD | |||||||||
| TRUSTEE | 1.0 | 5.0 | Yes (X) | $0 | $4,624 | $0 | |||
| GREG MORGAN | |||||||||
| TRUSTEE | 1.0 | 5.0 | Yes (X) | $0 | $1,624 | $0 | |||
| WILLIAM C BROCK | |||||||||
| TRUSTEE | 1.0 | 5.0 | Yes (X) | $0 | $20,247 | $0 | |||
| STEVEN W OWEIDA | |||||||||
| TRUSTEE EMERITUS | 1.0 | 5.0 | Yes (X) | $0 | $31,409 | $0 | |||
| W ALLEN SEPARK | |||||||||
| TRUSTEE EMERITUS | 1.0 | 7.0 | Yes (X) | $0 | $8,177 | $0 | |||
| Valery A Akopov MD | |||||||||
| VP & Chief of Hospitalist Svcs | 2.0 | 48.0 | $0 | $399,745 | $53,663 | Yes (X) | |||
| David W Anderson | |||||||||
| EVP HR OL CCO | 2.0 | 48.0 | $0 | $648,929 | $70,290 | Yes (X) | |||
| Nicole V Ashe | |||||||||
| VP Finance & CFO WMG | 2.0 | 48.0 | $0 | $262,185 | $45,885 | Yes (X) | |||
| Barbara G Ballard | |||||||||
| VP Homecare & Hospice | 2.0 | 48.0 | $0 | $282,836 | $64,915 | Yes (X) | |||
| Joseph L Brywczynski | |||||||||
| SVP Health Parks Development | 2.0 | 48.0 | $0 | $570,096 | $70,144 | Yes (X) | |||
| Anthony J Budzinski | |||||||||
| EVP & CFO | 2.0 | 50.0 | $0 | $689,236 | $71,096 | Yes (X) | |||
| Donald Campbell MD | |||||||||
| SVP Phys Educ & Student Aff | 2.0 | 48.0 | $0 | $513,317 | $62,483 | Yes (X) | |||
| Jill M Case-Wirth | |||||||||
| SVP Nursing SRVS.(BEGIN. 12/1) | 2.0 | 48.0 | $0 | $72,410 | $4,759 | Yes (X) | |||
| James E Clements | |||||||||
| VP Bus Dev & Strategic Prtnrsp | 2.0 | 48.0 | $0 | $264,016 | $17,453 | Yes (X) | |||
| Lee R Cook | |||||||||
| VP Med & Behavioral Health | 2.0 | 48.0 | $0 | $592,708 | $45,052 | Yes (X) | |||
| Barbara B Corey | |||||||||
| SVP Managed Care | 2.0 | 48.0 | $0 | $379,163 | $48,129 | Yes (X) | |||
| Bruce A Dean | |||||||||
| VP Real Estate Deputy Gen Cnsl | 2.0 | 48.0 | $0 | $282,461 | $69,841 | Yes (X) | |||
| Sarath Degala | |||||||||
| VP Revenue Cycle Management | 2.0 | 48.0 | $0 | $19,850 | $2,923 | Yes (X) | |||
| Marcia Delk-Payne MD | |||||||||
| SVP Med Affair & Chf Qlty Ofcr | 2.0 | 48.0 | $0 | $925,812 | $49,890 | Yes (X) | |||
| Nancy R Doelling | |||||||||
| VP Pediatric SRVS.(BEGIN. 8/4) | 2.0 | 48.0 | $0 | $141,009 | $11,811 | Yes (X) | |||
| Jimmy E Francis | |||||||||
| VP Info Technology Operations | 2.0 | 48.0 | $0 | $257,027 | $36,192 | Yes (X) | |||
| Steven L Grace | |||||||||
| VP Talent Acquisition | 2.0 | 48.0 | $0 | $266,953 | $32,731 | Yes (X) | |||
| Kristyn M Greifer MD | |||||||||
| VP Population Management | 2.0 | 48.0 | $0 | $369,983 | $28,680 | Yes (X) | |||
| Timothy Haney | |||||||||
| SVP & Hospital President | 48.0 | 2.0 | $354,817 | $0 | $41,580 | Yes (X) | |||
| Joel W Helmke | |||||||||
| VP Oncology (BEGIN. 7/21) | 2.0 | 48.0 | $0 | $165,514 | $28,875 | Yes (X) | |||
| Vicky L Hogue | |||||||||
| VP CNO Patient Care Services | 50.0 | 0.0 | $223,394 | $0 | $53,690 | Yes (X) | |||
| Robert D Jansen MD | |||||||||
| EVP & Pres Medical Group | 2.0 | 48.0 | $0 | $782,540 | $75,243 | Yes (X) | |||
| Reynold J Jennings | |||||||||
| president & ceo | 2.0 | 50.0 | $0 | $1,701,981 | $2,056 | Yes (X) | |||
| Peter R Jungblut MD | |||||||||
| SVP & Medical Dir WMG | 2.0 | 48.0 | $0 | $398,803 | $69,399 | Yes (X) | |||
| Christopher M Kane | |||||||||
| SVP Strategic Plan & Bus Dev | 2.0 | 48.0 | $0 | $806,400 | $42,332 | Yes (X) | |||
| Beth Kost | |||||||||
| VP Compliance Chf Privacy Ofcr | 2.0 | 48.0 | $0 | $331,700 | $34,022 | Yes (X) | |||
| Ellen Langford | |||||||||
| SVP & COO WellStar Med Group | 2.0 | 48.0 | $0 | $279,307 | $58,966 | Yes (X) | |||
| Elizabeth H Loudermilk | |||||||||
| VP Ent Intelligence & Intgrtn | 2.0 | 48.0 | $0 | $308,160 | $25,651 | Yes (X) | |||
| Sandra Lucius | |||||||||
| VP Info Technology Apps | 2.0 | 48.0 | $0 | $224,424 | $46,993 | Yes (X) | |||
| Robert Mandler | |||||||||
| VP Diagnostic Outreach | 2.0 | 48.0 | $0 | $290,840 | $61,524 | Yes (X) | |||
| Patricia A Mayne | |||||||||
| VP Emergency Services | 2.0 | 48.0 | $0 | $311,329 | $50,119 | Yes (X) | |||
| Kimberly W Menefee | |||||||||
| SVP Strategic Community Dev | 2.0 | 48.0 | $0 | $362,955 | $46,026 | Yes (X) | |||
| Christopher L Morgan | |||||||||
| VP & Admin. CLIO (BEGIN. 7/7) | 2.0 | 48.0 | $0 | $168,139 | $21,747 | Yes (X) | |||
| Jonathan B Morris MD | |||||||||
| SVP Chief Info Officer | 2.0 | 48.0 | $0 | $462,389 | $50,258 | Yes (X) | |||
| Bradford B Newton | |||||||||
| VP Information Technology Admi | 2.0 | 48.0 | $0 | $232,340 | $47,711 | Yes (X) | |||
| Michael G Paul | |||||||||
| VP Facilities Eng Support Svcs | 2.0 | 48.0 | $0 | $220,953 | $24,150 | Yes (X) | |||
| Guillermo J Pierluisi MD MPH MB | |||||||||
| VP Medical Affairs | 50.0 | 0.0 | $322,661 | $0 | $63,680 | Yes (X) | |||
| Leo E Reichert | |||||||||
| EVP & General Counsel | 2.0 | 48.0 | $0 | $752,077 | $29,200 | Yes (X) | |||
| Bethany Robertson | |||||||||
| VP & Chief Learning Officer | 2.0 | 48.0 | $0 | $218,673 | $41,608 | Yes (X) | |||
| Michelle M Robinson | |||||||||
| VP Mktng/PR/Internal Comm | 2.0 | 48.0 | $0 | $238,847 | $40,651 | Yes (X) | |||
| Wanda Y Robinson | |||||||||
| VP Compliance PWHP(BEGIN.9/15) | 2.0 | 48.0 | $0 | $82,927 | $2,538 | Yes (X) | |||
| Deborah Roegge De Vita | |||||||||
| VP Women & Newborn Svc Line | 2.0 | 48.0 | $0 | $231,925 | $31,900 | Yes (X) | |||
| Candice L Saunders | |||||||||
| President & CEO | 2.0 | 48.0 | $0 | $812,226 | $72,916 | Yes (X) | |||
| Christopher B Scullen | |||||||||
| VP Pulmonology Operations | 2.0 | 48.0 | $0 | $292,246 | $17,839 | Yes (X) | |||
| Richard S Siegel | |||||||||
| VP Cardiology & CVM Admin | 2.0 | 48.0 | $0 | $323,664 | $70,462 | Yes (X) | |||
| Jeffery D Stanley | |||||||||
| VP Pharmacy & System Coor | 2.0 | 48.0 | $0 | $216,271 | $30,238 | Yes (X) | |||
| Daniel J Styf | |||||||||
| SVP PW Health Plan | 2.0 | 48.0 | $0 | $337,033 | $27,733 | Yes (X) | |||
| James M Swartz | |||||||||
| VP Accounting | 2.0 | 48.0 | $0 | $272,353 | $42,262 | Yes (X) | |||
| Mary L Tavernaro | |||||||||
| VP Human Resources Operations | 2.0 | 48.0 | $0 | $259,157 | $49,126 | Yes (X) | |||
| Adam C Thompson | |||||||||
| VP Surgery | 2.0 | 48.0 | $0 | $228,073 | $21,830 | Yes (X) | |||
| Anthony M Trupiano | |||||||||
| SVP Supply Chain | 2.0 | 48.0 | $0 | $345,219 | $47,596 | Yes (X) | |||
| Sean P Turner | |||||||||
| VP Rev.Cycle MGMT (BEGIN.9/28) | 2.0 | 48.0 | $0 | $273,082 | $46,665 | Yes (X) | |||
| ROBIN WILSON MD | |||||||||
| SVP Chief Hlth Innov Officer | 2.0 | 48.0 | $0 | $637,993 | $22,144 | Yes (X) | |||
| CHESTER A ZBOROWSKI | |||||||||
| VP Health Parks Operations | 2.0 | 48.0 | $0 | $223,151 | $24,265 | Yes (X) | |||
| DWIGHT T STILL | |||||||||
| Radiation Oncology Physicist | 50.0 | 0.0 | $178,226 | $0 | $27,533 | Yes (X) | |||
| WILLIAM S GONZALEZ | |||||||||
| Mgr Pharmacy | 50.0 | 0.0 | $165,800 | $0 | $50,049 | Yes (X) | |||
| CAROL S O'CONNEL | |||||||||
| AVP Supp Svcs & Long Term Care | 50.0 | 0.0 | $163,829 | $0 | $26,719 | Yes (X) | |||
| ANDREA M PARSON | |||||||||
| Dir Pharmacy | 50.0 | 0.0 | $160,658 | $0 | $48,751 | Yes (X) | |||
| JULIE KRAFTZENK | |||||||||
| Coor Patient Flow | 50.0 | 0.0 | $152,200 | $0 | $26,602 | Yes (X) | |||
| Michael L Graue | |||||||||
| FORMER EVP & COO | 0.0 | 0.0 | $0 | $522,266 | $0 | Yes (X) | |||
| Kenneth C Kunze MD | |||||||||
| FRMR SVP CHIEF MEDICAL OFFICER | 0.0 | 0.0 | $0 | $383,389 | $0 | Yes (X) | |||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $1,721,585 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $22,289,647 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $2,605,922 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 50 | IndivRcvdGreaterThan100KCnt |
| Former Ofcr Employees Listed | Yes (true) | FormerOfcrEmployeesListedInd |
| Total Comp Greater Than150 K | Yes (true) | TotalCompGreaterThan150KInd |
| Compensation From Other Srcs | false | CompensationFromOtherSrcsInd |
Contractor Compensation ContractorCompensationGrp (5 entries)
| Address Line1ContractorAddress/USAddress/AddressLine1Txt | CityContractorAddress/USAddress/CityNm | State AbbreviationContractorAddress/USAddress/StateAbbreviationCd | ZIPContractorAddress/USAddress/ZIPCd | ServicesServicesDesc | CompensationCompensationAmt |
|---|---|---|---|---|---|
| Brasfield Gorrie LLC | |||||
| 1990 Vaughn Rd NWSTE 100 | KENNESAW | GA | 30144 | CONSTRUCTION | $12,479,929 |
| CDH PARTNERS INC | |||||
| 675 TOWER RD | MARIETTA | GA | 30060 | CONSTRUCTION | $666,001 |
| INGLETT AND STUBBS LLC | |||||
| PO BOX 932506 | ATLANTA | GA | 311932506 | CONSTRUCTION | $1,433,219 |
| ELEKTA INC | |||||
| PO BOX 404199 | ATLANTA | GA | 303844199 | MEDICAL | $748,762 |
| SHARED SOLUTIONS AND SERVICES | |||||
| 2425 GATEWAY DR | IRVING | TX | 75063 | INTERNAL SUPPORT | $630,579 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cntrct Rcvd Greater Than100 K | 16 | CntrctRcvdGreaterThan100KCnt |
| Total Contributions | $0 | TotalContributionsAmt |
Program Service Revenue ProgramServiceRevenueGrp (2 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt |
|---|---|---|---|
| HOSPITAL PATIENT REVENUE | 621990 | $109,637,521 | $109,637,521 |
| MEDICAL RECORDS | 621990 | $246 | $246 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $109,637,767 | TotalProgramServiceRevenueAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $0 | TotalRevenueColumnAmt |
Incm From Invest Bond Proceeds IncmFromInvestBondProceedsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $0 | TotalRevenueColumnAmt |
Royalties Revenue RoyaltiesRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $0 | TotalRevenueColumnAmt |
Gross Rents GrossRentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $77,982 | RealAmt |
| Personal | $0 | PersonalAmt |
Less Rental Expenses LessRentalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $0 | RealAmt |
| Personal | $0 | PersonalAmt |
Rental Income Or Loss RentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $77,982 | RealAmt |
| Personal | $0 | PersonalAmt |
Net Rental Income Or Loss NetRentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $77,982 | TotalRevenueColumnAmt |
| Exclusion | $77,982 | ExclusionAmt |
Gross Amount Sales Assets GrossAmountSalesAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | $81,500 | OtherAmt |
Less Cost Oth Basis Sales Expnss LessCostOthBasisSalesExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | $0 | OtherAmt |
Gain Or Loss GainOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | $81,500 | OtherAmt |
Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $81,500 | TotalRevenueColumnAmt |
| Unrelated Business Revenue | $0 | UnrelatedBusinessRevenueAmt |
| Exclusion | $81,500 | ExclusionAmt |
Net Incm From Fundraising Evt NetIncmFromFundraisingEvtGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $0 | TotalRevenueColumnAmt |
Net Income From Gaming NetIncomeFromGamingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $0 | TotalRevenueColumnAmt |
Net Income Or Loss NetIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $0 | TotalRevenueColumnAmt |
Other Revenue Misc OtherRevenueMiscGrp (3 entries)
| DescDesc | Total Revenue ColumnTotalRevenueColumnAmt | ExclusionExclusionAmt | BusinessBusinessCd |
|---|---|---|---|
| CAFETERIA | $477,571 | $477,571 | |
| IMMUNIZATIONS | $134 | $134 | 621990 |
| OTHER INCOME | $358,624 | $358,624 | 621990 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Revenue Total | $836,329 | OtherRevenueTotalAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $110,633,578 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $109,637,767 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $0 | UnrelatedBusinessRevenueAmt |
| Exclusion | $995,811 | ExclusionAmt |
Grants To Domestic Orgs GrantsToDomesticOrgsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Grants To Domestic Individuals GrantsToDomesticIndividualsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,000 | TotalAmt |
| Program Services | $1,000 | ProgramServicesAmt |
Foreign Grants ForeignGrantsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Benefits To Members BenefitsToMembersGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,081,685 | TotalAmt |
| Program Services | $906,129 | ProgramServicesAmt |
| Management And General | $175,556 | ManagementAndGeneralAmt |
Comp Disqual Persons CompDisqualPersonsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $37,472,798 | TotalAmt |
| Program Services | $31,891,972 | ProgramServicesAmt |
| Management And General | $5,580,826 | ManagementAndGeneralAmt |
Pension Plan Contributions PensionPlanContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,450,598 | TotalAmt |
| Program Services | $1,234,016 | ProgramServicesAmt |
| Management And General | $216,582 | ManagementAndGeneralAmt |
Other Employee Benefits OtherEmployeeBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $4,211,785 | TotalAmt |
| Program Services | $3,582,944 | ProgramServicesAmt |
| Management And General | $628,841 | ManagementAndGeneralAmt |
Payroll Taxes PayrollTaxesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,748,024 | TotalAmt |
| Program Services | $2,337,730 | ProgramServicesAmt |
| Management And General | $410,294 | ManagementAndGeneralAmt |
Fees For Services Management FeesForServicesManagementGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Fees For Services Legal FeesForServicesLegalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Fees For Services Accounting FeesForServicesAccountingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Fees For Services Lobbying FeesForServicesLobbyingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Fees For Services Prof Fundraising FeesForServicesProfFundraising
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Fees For Srvc Invst Mgmnt Fees FeesForSrvcInvstMgmntFeesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Fees For Services Other FeesForServicesOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $3,155,244 | TotalAmt |
| Program Services | $3,275,135 | ProgramServicesAmt |
| Management And General | -$119,891 | ManagementAndGeneralAmt |
Advertising AdvertisingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $3,223 | TotalAmt |
| Program Services | $3,223 | ProgramServicesAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $4,414,691 | TotalAmt |
| Program Services | $2,967,146 | ProgramServicesAmt |
| Management And General | $1,447,545 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Information Technology InformationTechnologyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Royalties RoyaltiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Occupancy OccupancyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,850,390 | TotalAmt |
| Program Services | $640,052 | ProgramServicesAmt |
| Management And General | $2,210,338 | ManagementAndGeneralAmt |
Travel TravelGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $50,228 | TotalAmt |
| Program Services | $36,350 | ProgramServicesAmt |
| Management And General | $13,878 | ManagementAndGeneralAmt |
Pymt Travel Entrtnmnt Pub Ofcl PymtTravelEntrtnmntPubOfclGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Conferences Meetings ConferencesMeetingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $56,026 | TotalAmt |
| Program Services | $32,591 | ProgramServicesAmt |
| Management And General | $23,435 | ManagementAndGeneralAmt |
Interest InterestGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,757,629 | TotalAmt |
| Management And General | $1,757,629 | ManagementAndGeneralAmt |
Payments To Affiliates PaymentsToAffiliatesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $21,975,864 | TotalAmt |
| Program Services | $18,694,755 | ProgramServicesAmt |
| Management And General | $3,281,109 | ManagementAndGeneralAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $9,102,196 | TotalAmt |
| Program Services | $4,472,935 | ProgramServicesAmt |
| Management And General | $4,629,261 | ManagementAndGeneralAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $676,912 | TotalAmt |
| Management And General | $676,912 | ManagementAndGeneralAmt |
Other Expenses OtherExpensesGrp (3 entries)
| DescDesc | TotalTotalAmt | Program ServicesProgramServicesAmt | Management And GeneralManagementAndGeneralAmt |
|---|---|---|---|
| REPAIRS & MAINTENANCE | $1,757,337 | $1,130,104 | $627,233 |
| MEDICAL SUPPLIES | $10,707,199 | $10,756,782 | -$49,583 |
| OTHER OPERATING EXPENSES | $8,988 | $7,076 | $1,912 |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $103,481,817 | TotalAmt |
| Program Services | $81,969,940 | ProgramServicesAmt |
| Management And General | $21,511,877 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Cash Non Interest Bearing CashNonInterestBearingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $5,400 | BOYAmt |
| EOY | $0 | EOYAmt |
Savings And Temp Cash Invst SavingsAndTempCashInvstGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $75,049 | BOYAmt |
| EOY | $93,503 | EOYAmt |
Pledges And Grants Receivable PledgesAndGrantsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $18,673,393 | BOYAmt |
| EOY | $15,550,129 | EOYAmt |
Receivables From Officers Etc ReceivablesFromOfficersEtcGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Rcvbl From Disqualified Prsn RcvblFromDisqualifiedPrsnGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Oth Notes Loans Receivable Net OthNotesLoansReceivableNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Inventories For Sale Or Use InventoriesForSaleOrUseGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,598,812 | BOYAmt |
| EOY | $1,548,027 | EOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,014,410 | BOYAmt |
| EOY | $259,900 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $190,118,485 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $40,621,705 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $155,905,445 | BOYAmt |
| EOY | $149,496,780 | EOYAmt |
Investments Pub Traded Sec InvestmentsPubTradedSecGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $38,324 | BOYAmt |
| EOY | $38,324 | EOYAmt |
Investments Other Securities InvestmentsOtherSecuritiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Investments Program Related InvestmentsProgramRelatedGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Intangible Assets IntangibleAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Other Assets Total OtherAssetsTotalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $330,150 | BOYAmt |
| EOY | $455,728 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $177,640,983 | BOYAmt |
| EOY | $167,442,391 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $5,020,344 | BOYAmt |
| EOY | $3,870,789 | EOYAmt |
Grants Payable GrantsPayableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Deferred Revenue DeferredRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Tax Exempt Bond Liabilities TaxExemptBondLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Escrow Account Liability EscrowAccountLiabilityGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Loans From Officers Directors LoansFromOfficersDirectorsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Mortg Notes Pybl Scrd Invst Prop MortgNotesPyblScrdInvstPropGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Unsecured Notes Loans Payable UnsecuredNotesLoansPayableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Other Liabilities OtherLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $106,974,519 | BOYAmt |
| EOY | $110,681,406 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $111,994,863 | BOYAmt |
| EOY | $114,552,195 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Organization Follows SFAS117 | Yes (X) | OrganizationFollowsSFAS117Ind |
Unrestricted Net Assets UnrestrictedNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $65,646,120 | BOYAmt |
| EOY | $52,890,196 | EOYAmt |
Temporarily Rstr Net Assets TemporarilyRstrNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Permanently Rstr Net Assets PermanentlyRstrNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $65,646,120 | BOYAmt |
| EOY | $52,890,196 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $177,640,983 | BOYAmt |
| EOY | $167,442,391 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part XI | Yes (X) | InfoInScheduleOPartXIInd |
| Reconcilation Revenue Expnss | $7,151,761 | ReconcilationRevenueExpnssAmt |
| Other Changes In Net Assets | -$19,907,685 | OtherChangesInNetAssetsAmt |
| Method Of Accounting Accrual | Yes (X) | MethodOfAccountingAccrualInd |
| Accountant Compile Or Review | false | AccountantCompileOrReviewInd |
| FS Audited | Yes (true) | FSAuditedInd |
FS Audited Basis FSAuditedBasisGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Consolidated Basis Fincl Stmt | Yes (X) | ConsolidatedBasisFinclStmtInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Audit Committee | Yes (true) | AuditCommitteeInd |
| Federal Grant Audit Required | false | FederalGrantAuditRequiredInd |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital | Yes (X) | HospitalInd |
Schedule D IRS990ScheduleD
| Field | Value | IRS element (for citing) |
|---|---|---|
| Art Public Exhibition Amounts | ArtPublicExhibitionAmountsGrp | |
| Held Works Art | HeldWorksArtGrp | |
| CY Minus3 Yr Endwmt Fund | CYMinus3YrEndwmtFundGrp | |
| CY Minus4 Yr Endwmt Fund | CYMinus4YrEndwmtFundGrp |
Land LandGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $3,170,973 | OtherCostOrOtherBasisAmt |
| Book Value | $3,170,973 | BookValueAmt |
Buildings BuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $129,439,519 | OtherCostOrOtherBasisAmt |
| Depreciation | $16,612,195 | DepreciationAmt |
| Book Value | $112,827,324 | BookValueAmt |
Leasehold Improvements LeaseholdImprovementsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $5,176,019 | OtherCostOrOtherBasisAmt |
| Depreciation | $387,416 | DepreciationAmt |
| Book Value | $4,788,603 | BookValueAmt |
Equipment EquipmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $46,045,826 | OtherCostOrOtherBasisAmt |
| Depreciation | $22,486,865 | DepreciationAmt |
| Book Value | $23,558,961 | BookValueAmt |
Other Land Buildings OtherLandBuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $6,286,148 | OtherCostOrOtherBasisAmt |
| Depreciation | $1,135,229 | DepreciationAmt |
| Book Value | $5,150,919 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $149,496,780 | TotalBookValueLandBuildingsAmt |
| Federal Income Tax Liability | $0 | FederalIncomeTaxLiabilityAmt |
Other Liabilities Org OtherLiabilitiesOrgGrp (2 entries)
| DescDesc | AmtAmt |
|---|---|
| ASSET RETIREMENT - OTHER LT | $926,920 |
| TAX EXEMPT BOND LIAB-DUE TO WH | $109,754,486 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Liability | $110,681,406 | TotalLiabilityAmt |
| Footnote Text | Yes (X) | FootnoteTextInd |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | SCHEDULE D, PART X, LINE 2 | FormAndLineReferenceDesc |
| Explanation | The following footnote is related to the organization's application of FIN 48 (ASC 740): Wellstar (including PAULDING MEDICAL CENTER, INC.) 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. | ExplanationTxt |
Schedule H IRS990ScheduleH
| Field | Value | IRS element (for citing) |
|---|---|---|
| Financial Assistance Policy | Yes (true) | FinancialAssistancePolicyInd |
| Written Policy | Yes (true) | WrittenPolicyInd |
| All Hospitals Policy | Yes (X) | AllHospitalsPolicyInd |
| FPG Reference Free Care | Yes (true) | FPGReferenceFreeCareInd |
Free Care Oth Percentage FreeCareOthPercentageGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | Yes (X) | OtherInd |
| Free Care Other | 125. | FreeCareOtherPct |
| Field | Value | IRS element (for citing) |
|---|---|---|
| FPG Reference Discounted Care | Yes (true) | FPGReferenceDiscountedCareInd |
| Percent300 | Yes (X) | Percent300Ind |
| Free Care Medically Indigent | Yes (true) | FreeCareMedicallyIndigentInd |
| Financial Assistance Budget | Yes (true) | FinancialAssistanceBudgetInd |
| Expenses Exceed Budget | Yes (true) | ExpensesExceedBudgetInd |
| Unable To Provide Care | false | UnableToProvideCareInd |
| Annual Community Bnft Report | Yes (true) | AnnualCommunityBnftReportInd |
| Report Publically Available | Yes (true) | ReportPublicallyAvailableInd |
Financial Assistance At Cost Typ FinancialAssistanceAtCostTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $9,195,872 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $9,195,872 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.08480 | TotalExpensePct |
Unreimbursed Medicaid UnreimbursedMedicaidGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $11,541,903 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $8,522,029 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $3,019,874 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.02780 | TotalExpensePct |
Total Financial Assistance Typ TotalFinancialAssistanceTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $20,737,775 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $8,522,029 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $12,215,746 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.11260 | TotalExpensePct |
Community Health Services CommunityHealthServicesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $190,129 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $190,129 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00270 | TotalExpensePct |
Total Other Benefits TotalOtherBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $190,129 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $190,129 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00270 | TotalExpensePct |
Total Community Benefits TotalCommunityBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $20,927,904 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $8,522,029 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $12,405,875 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.11530 | TotalExpensePct |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | Yes (true) | BadDebtExpenseReportedInd |
| Bad Debt Expense | $5,285,665 | BadDebtExpenseAmt |
| Bad Debt Expense Attributable | $445,317 | BadDebtExpenseAttributableAmt |
| Reimbursed By Medicare | $29,633,190 | ReimbursedByMedicareAmt |
| Cost Of Care Reimbursed By Medcr | $39,368,231 | CostOfCareReimbursedByMedcrAmt |
| Medicare Surplus Or Shortfall | -$9,735,041 | MedicareSurplusOrShortfallAmt |
Costing Methodology Used CostingMethodologyUsedGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cost To Charge Ratio | Yes (X) | CostToChargeRatioInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Written Debt Collection Policy | Yes (true) | WrittenDebtCollectionPolicyInd |
| Financial Assistance Prvsn | Yes (true) | FinancialAssistancePrvsnInd |
| Hospital Facilities | 1 | HospitalFacilitiesCnt |
Hospital Facilities HospitalFacilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 1 | FacilityNum |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | WELLSTAR PAULDING HOSPITAL | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 600 WEST MEMORIAL DRIVE | AddressLine1Txt |
| City | DALLAS | CityNm |
| State Abbreviation | GA | StateAbbreviationCd |
| ZIP | 30132 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Website Address | www.wellstar.org | WebsiteAddressTxt |
| State License | 110-547 | StateLicenseNum |
| Licensed Hospital | Yes (X) | LicensedHospitalInd |
| General Medical And Surgical | Yes (X) | GeneralMedicalAndSurgicalInd |
| Emergency Room24 Hrs | Yes (X) | EmergencyRoom24HrsInd |
| Other | SKILLED NURSING HOME | OtherDesc |
Hospital Fclty Policies Prctc HospitalFcltyPoliciesPrctcGrp
Hospital Facility Name HospitalFacilityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | WELLSTAR PAULDING HOSPITAL | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 1 | FacilityNum |
| First Licensed CY Or PY | false | FirstLicensedCYOrPYInd |
| Tax Exempt Hospital CY Or PY | false | TaxExemptHospitalCYOrPYInd |
| CHNA Conducted | Yes (true) | CHNAConductedInd |
| Community Definition | Yes (X) | CommunityDefinitionInd |
| Community Demographics | Yes (X) | CommunityDemographicsInd |
| Existing Resources | Yes (X) | ExistingResourcesInd |
| How Data Obtained | Yes (X) | HowDataObtainedInd |
| Community Health Needs | Yes (X) | CommunityHealthNeedsInd |
| Other Health Issues | Yes (X) | OtherHealthIssuesInd |
| Community Hlth Needs Id Process | Yes (X) | CommunityHlthNeedsIdProcessInd |
| Consulting Process | Yes (X) | ConsultingProcessInd |
| Information Gaps | Yes (X) | InformationGapsInd |
| Other | Yes (X) | OtherInd |
| CHNA Conducted | 12 | CHNAConductedYr |
| Take Into Account Others Input | Yes (true) | TakeIntoAccountOthersInputInd |
| CHNA Conducted With Other Fclts | false | CHNAConductedWithOtherFcltsInd |
| CHNA Conducted With Non Fclts | false | CHNAConductedWithNonFcltsInd |
| CHNA Report Widely Available | Yes (true) | CHNAReportWidelyAvailableInd |
| Rpt Available On Own Website | Yes (X) | RptAvailableOnOwnWebsiteInd |
| Own Website URL | SEE PART V, SECTION C | OwnWebsiteURLTxt |
| Other Website | Yes (X) | OtherWebsiteInd |
| Other Website URL | SEE PART V, SECTION C | OtherWebsiteURLTxt |
| Paper Copy Public Inspection | Yes (X) | PaperCopyPublicInspectionInd |
| Implementation Strategy Adopt | Yes (true) | ImplementationStrategyAdoptInd |
| Implementation Strategy Adpt | 12 | ImplementationStrategyAdptYr |
| Strategy Posted Website | Yes (true) | StrategyPostedWebsiteInd |
| Strategy Website URL | SEE PART V, SECTION C | StrategyWebsiteURLTxt |
| Strategy Attached | false | StrategyAttachedInd |
| Organization Incur Excise Tax | false | OrganizationIncurExciseTaxInd |
| Elig Criteria Explained | Yes (true) | EligCriteriaExplainedInd |
| FPG Family Incm Lmt Free Dscnt | Yes (X) | FPGFamilyIncmLmtFreeDscntInd |
| FPG Family Incm Lmt Free Care | 125. | FPGFamilyIncmLmtFreeCarePct |
| FPG Family Incm Lmt Dscnt Care | 300. | FPGFamilyIncmLmtDscntCarePct |
| Income Level Criteria | Yes (X) | IncomeLevelCriteriaInd |
| Asset Level Criteria | Yes (X) | AssetLevelCriteriaInd |
| Medical Indigency Criteria | Yes (X) | MedicalIndigencyCriteriaInd |
| Insurance Status Criteria | Yes (X) | InsuranceStatusCriteriaInd |
| Underinsurance Stat Criteria | Yes (X) | UnderinsuranceStatCriteriaInd |
| Other Criteria | Yes (X) | OtherCriteriaInd |
| Explained Basis | Yes (true) | ExplainedBasisInd |
| App Financial Asst Expln | Yes (true) | AppFinancialAsstExplnInd |
| Described Info | Yes (X) | DescribedInfoInd |
| Described Suprt Doc | Yes (X) | DescribedSuprtDocInd |
| Provided Hospital Contact | Yes (X) | ProvidedHospitalContactInd |
| Provided Nonprofit Contact | Yes (X) | ProvidedNonprofitContactInd |
| Other Method | Yes (X) | OtherMethodInd |
| Includes Publicity Measures | Yes (true) | IncludesPublicityMeasuresInd |
| FAP Available On Website | Yes (X) | FAPAvailableOnWebsiteInd |
| FAP Available On Website URL | SEE PART V, SECTION C | FAPAvailableOnWebsiteURLTxt |
| FAP App Available On Website | Yes (X) | FAPAppAvailableOnWebsiteInd |
| FAP App Available On Website URL | SEE PART V, SECTION C | FAPAppAvailableOnWebsiteURLTxt |
| FAP Avlbl On Request No Charge | Yes (X) | FAPAvlblOnRequestNoChargeInd |
| FAP App Avlbl On Request No Chrg | Yes (X) | FAPAppAvlblOnRequestNoChrgInd |
| FAP Sum Avlbl On Request No Chrg | Yes (X) | FAPSumAvlblOnRequestNoChrgInd |
| FAP Notice Displayed | Yes (X) | FAPNoticeDisplayedInd |
| Communtity Notified FAP | Yes (X) | CommuntityNotifiedFAPInd |
| Other Publicity | Yes (X) | OtherPublicityInd |
| FAP Actions On Nonpayment | Yes (true) | FAPActionsOnNonpaymentInd |
| Permit No Actions | Yes (X) | PermitNoActionsInd |
| Collection Activities | false | CollectionActivitiesInd |
| FAP Notified Upon Admission | Yes (X) | FAPNotifiedUponAdmissionInd |
| FAP Notified Before Discharge | Yes (X) | FAPNotifiedBeforeDischargeInd |
| Documented Elig Determination | Yes (X) | DocumentedEligDeterminationInd |
| Other Actions Taken | Yes (X) | OtherActionsTakenInd |
| Nondis Emergency Care Policy | Yes (true) | NondisEmergencyCarePolicyInd |
| Average Negotiated Rates | Yes (X) | AverageNegotiatedRatesInd |
| Amounts Generally Billed | false | AmountsGenerallyBilledInd |
| Gross Charges | false | GrossChargesInd |
Supplemental Information SupplementalInformationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | SCHEDULE H, PART V, SECTION B, LINE 3J | FormAndLineReferenceDesc |
| Explanation | OTHER DESCRIPTIONS FROM THE COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA): The Community Health Needs Assessment for WELLSTAR PAULDING 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: WELLSTAR PAULDING 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, WELLSTAR PAULDING 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 report 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 - WELLSTAR PAULDING 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 WELLSTAR PAULDING 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 WELLSTAR PAULDING HOSPITAL CHNA CAN BE FOUND AT THE FOLLOWING: PAULDING MEDICAL CENTER WEBSITE:http://www.wellstar.org/about-us/documents/chna/paulding_chna_0617 2013.pdf AND WELLSTAR HEALTH SYSTEM WEBSITE: HTTP://WWW.WELLSTAR.ORG/PAGES/DEFAULT.ASPX SCHEDULE H, PART V, SECTION B, LINE 10A WELLSTAR PAULDING HOSPITAL'S MOST RECENTLY ADOPTED IMPLEMENTATION STRATEGY CAN BE FOUND ON ITS WEBSITE AT: http://www.wellstar.org/about-us/Documents/Implementation_Strategy/pauldin g_implementation_strategy_11112013.pdf SCHEDULE H, PART V, SECTION B, LINE 11 PROGRAMS & STRATEGIES TO ADDRESS THE NEEDS OF THE COMMUNITY: 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 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. - 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) - Reduce preventable hospitalizations, re-admissions and Emergency Department visits via hospital-based care management program. - Improve medication access through a centralized reduced cost Pharmaceutical Patient Access Program 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). (Paulding Hospital is the location of the pilot.) - Provide assistance with the school-based health center pilot in Acworth School District. (Pilot is not being pursued, but school-based health education is being provided.) - 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. - Improve education and referral system within the Emergency Department for chronic disease management and preventative care. UNADDRESSED CHNA NEEDS - Selection criteria for WELLSTAR PAUDLING 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 WELLSTAR PAUDLING 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, PART V, LINE 13 | ExplanationTxt |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | SCHEDULE H, PART I, LINE 6A | FormAndLineReferenceDesc |
| Explanation | PUBLICATION OF COMMUNITY BENEFIT REPORT: WELLSTAR PAULDING 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/paulding_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 WELLSTAR PAULDING 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 chargeD IS 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: WELLSTAR PAULDING 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 WELLSTAR PAULDING 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 WELLSTAR PAULDING 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 | ExplanationTxt |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| First Class Or Charter Travel | Yes (X) | FirstClassOrCharterTravelInd |
| Travel For Companions | Yes (X) | TravelForCompanionsInd |
| Idemnification Gross Up Pmts | Yes (X) | IdemnificationGrossUpPmtsInd |
| Discretionary Spending Acct | Yes (X) | DiscretionarySpendingAcctInd |
| Housing Allowance Or Residence | Yes (X) | HousingAllowanceOrResidenceInd |
| Club Dues Or Fees | Yes (X) | ClubDuesOrFeesInd |
| Written Policy Ref T And E Expnss | false | WrittenPolicyRefTAndEExpnssInd |
| Substantiation Required | Yes (true) | SubstantiationRequiredInd |
| Compensation Committee | Yes (X) | CompensationCommitteeInd |
| Independent Consultant | Yes (X) | IndependentConsultantInd |
| Form990 Of Other Organizations | Yes (X) | Form990OfOtherOrganizationsInd |
| Written Employment Contract | Yes (X) | WrittenEmploymentContractInd |
| Compensation Survey | Yes (X) | CompensationSurveyInd |
| Board Or Committee Approval | Yes (X) | BoardOrCommitteeApprovalInd |
| Severance Payment | Yes (true) | SeverancePaymentInd |
| Supplemental Nonqual Rtr Plan | Yes (true) | SupplementalNonqualRtrPlanInd |
| Equity Based Comp Arrngm | false | EquityBasedCompArrngmInd |
| Comp Based On Revenue Of Flng Org | false | CompBasedOnRevenueOfFlngOrgInd |
| Comp Bsd On Rev Related Orgs | false | CompBsdOnRevRelatedOrgsInd |
| Comp Bsd Net Earns Flng Org | false | CompBsdNetEarnsFlngOrgInd |
| Comp Bsd Net Earns Rltd Orgs | false | CompBsdNetEarnsRltdOrgsInd |
| Any Non Fixed Payments | Yes (true) | AnyNonFixedPaymentsInd |
| Initial Contract Exception | false | InitialContractExceptionInd |
Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp (61 entries)
| TitleTitleTxt | Base Compensation Filing OrgBaseCompensationFilingOrgAmt | Compensation Based On Rltd OrgsCompensationBasedOnRltdOrgsAmt | Bonus Filing OrganizationBonusFilingOrganizationAmount | Bonus Related OrganizationsBonusRelatedOrganizationsAmt | Other Compensation Filing OrgOtherCompensationFilingOrgAmt | Other Compensation Rltd OrgsOtherCompensationRltdOrgsAmt | Deferred Compensation Flng OrgDeferredCompensationFlngOrgAmt | Deferred Comp Rltd OrgsDeferredCompRltdOrgsAmt | Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgAmt | Nontaxable Benefits Rltd OrgsNontaxableBenefitsRltdOrgsAmt | Total Compensation Filing OrgTotalCompensationFilingOrgAmt | Total Compensation Rltd OrgsTotalCompensationRltdOrgsAmt | Comp Report Prior990 Filing OrgCompReportPrior990FilingOrgAmt | Comp Report Prior990 Rltd OrgsCompReportPrior990RltdOrgsAmt |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Valery A Akopov MD | ||||||||||||||
| VP & Chief of Hospitalist Svcs | $0 | $329,534 | $0 | $59,170 | $0 | $11,041 | $0 | $28,200 | $0 | $25,463 | $0 | $453,408 | $0 | $0 |
| David W Anderson | ||||||||||||||
| EVP HR OL CCO | $0 | $414,523 | $0 | $205,272 | $0 | $29,134 | $0 | $45,700 | $0 | $24,590 | $0 | $719,219 | $0 | $0 |
| Nicole V Ashe | ||||||||||||||
| VP Finance & CFO WMG | $0 | $219,898 | $0 | $32,783 | $0 | $9,504 | $0 | $22,403 | $0 | $23,482 | $0 | $308,070 | $0 | $0 |
| Barbara G Ballard | ||||||||||||||
| VP Homecare & Hospice | $0 | $238,742 | $0 | $33,691 | $0 | $10,403 | $0 | $43,913 | $0 | $21,002 | $0 | $347,751 | $0 | $0 |
| Joseph L Brywczynski | ||||||||||||||
| SVP Health Parks Development | $0 | $266,989 | $0 | $285,443 | $0 | $17,664 | $0 | $45,700 | $0 | $24,444 | $0 | $640,240 | $0 | $0 |
| Anthony J Budzinski | ||||||||||||||
| EVP & CFO | $0 | $539,386 | $0 | $134,954 | $0 | $14,896 | $0 | $45,700 | $0 | $25,396 | $0 | $760,332 | $0 | $0 |
| Donald Campbell MD | ||||||||||||||
| SVP Phys Educ & Student Aff | $0 | $327,517 | $0 | $167,537 | $0 | $18,263 | $0 | $45,700 | $0 | $16,783 | $0 | $575,800 | $0 | $0 |
| James E Clements | ||||||||||||||
| VP Bus Dev & Strategic Prtnrsp | $0 | $207,563 | $0 | $49,762 | $0 | $6,691 | $0 | $0 | $0 | $17,453 | $0 | $281,469 | $0 | $0 |
| Lee R Cook | ||||||||||||||
| VP Med & Behavioral Health | $0 | $256,547 | $0 | $327,425 | $0 | $8,736 | $0 | $27,624 | $0 | $17,428 | $0 | $637,760 | $0 | $0 |
| Barbara B Corey | ||||||||||||||
| SVP Managed Care | $0 | $301,454 | $0 | $65,765 | $0 | $11,944 | $0 | $21,292 | $0 | $26,837 | $0 | $427,292 | $0 | $0 |
| Bruce A Dean | ||||||||||||||
| VP Real Estate Deputy Gen Cnsl | $0 | $227,781 | $0 | $40,345 | $0 | $14,335 | $0 | $45,675 | $0 | $24,166 | $0 | $352,302 | $0 | $0 |
| Marcia Delk-Payne MD | ||||||||||||||
| SVP Med Affair & Chf Qlty Ofcr | $0 | $370,531 | $0 | $544,886 | $0 | $10,395 | $0 | $45,700 | $0 | $4,190 | $0 | $975,702 | $0 | $0 |
| Nancy R Doelling | ||||||||||||||
| VP Pediatric SRVS.(BEGIN. 8/4) | $0 | $117,427 | $0 | $16,910 | $0 | $6,672 | $0 | $11,120 | $0 | $691 | $0 | $152,820 | $0 | $0 |
| Jimmy E Francis | ||||||||||||||
| VP Info Technology Operations | $0 | $205,005 | $0 | $42,280 | $0 | $9,742 | $0 | $33,822 | $0 | $2,370 | $0 | $293,219 | $0 | $0 |
| Steven L Grace | ||||||||||||||
| VP Talent Acquisition | $0 | $200,013 | $0 | $52,892 | $0 | $14,048 | $0 | $14,653 | $0 | $18,078 | $0 | $299,684 | $0 | $0 |
| Michael L Graue | ||||||||||||||
| FORMER EVP & COO | $0 | $0 | $0 | $0 | $0 | $522,266 | $0 | $0 | $0 | $0 | $0 | $522,266 | $0 | $0 |
| Kristyn M Greifer MD | ||||||||||||||
| VP Population Management | $0 | $307,528 | $0 | $52,230 | $0 | $10,225 | $0 | $18,722 | $0 | $9,958 | $0 | $398,663 | $0 | $0 |
| Timothy Haney | ||||||||||||||
| SVP & Hospital President | $272,688 | $0 | $64,247 | $0 | $17,882 | $0 | $28,200 | $0 | $13,380 | $0 | $396,397 | $0 | $0 | $0 |
| Joel W Helmke | ||||||||||||||
| VP Oncology (BEGIN. 7/21) | $0 | $110,000 | $0 | $51,610 | $0 | $3,904 | $0 | $20,081 | $0 | $8,794 | $0 | $194,389 | $0 | $0 |
| Vicky L Hogue | ||||||||||||||
| VP CNO Patient Care Services | $179,421 | $0 | $31,709 | $0 | $12,264 | $0 | $25,321 | $0 | $28,369 | $0 | $277,084 | $0 | $0 | $0 |
| Robert D Jansen MD | ||||||||||||||
| EVP & Pres Medical Group | $0 | $591,219 | $0 | $170,344 | $0 | $20,977 | $0 | $45,700 | $0 | $29,543 | $0 | $857,783 | $0 | $0 |
| Reynold J Jennings | ||||||||||||||
| president & ceo | $0 | $975,000 | $0 | $708,390 | $0 | $18,591 | $0 | $0 | $0 | $2,056 | $0 | $1,704,037 | $0 | $0 |
| Peter R Jungblut MD | ||||||||||||||
| SVP & Medical Dir WMG | $0 | $307,528 | $0 | $78,959 | $0 | $12,316 | $0 | $40,200 | $0 | $29,199 | $0 | $468,202 | $0 | $0 |
| Christopher M Kane | ||||||||||||||
| SVP Strategic Plan & Bus Dev | $0 | $341,744 | $0 | $454,243 | $0 | $10,413 | $0 | $21,954 | $0 | $20,378 | $0 | $848,732 | $0 | $0 |
| Beth Kost | ||||||||||||||
| VP Compliance Chf Privacy Ofcr | $0 | $244,733 | $0 | $77,006 | $0 | $9,961 | $0 | $22,318 | $0 | $11,704 | $0 | $365,722 | $0 | $0 |
| Kenneth C Kunze MD | ||||||||||||||
| FRMR SVP CHIEF MEDICAL OFFICER | $0 | $0 | $0 | $0 | $0 | $383,389 | $0 | $0 | $0 | $0 | $0 | $383,389 | $0 | $0 |
| Ellen Langford | ||||||||||||||
| SVP & COO WellStar Med Group | $0 | $220,376 | $0 | $46,995 | $0 | $11,936 | $0 | $36,643 | $0 | $22,323 | $0 | $338,273 | $0 | $0 |
| Elizabeth H Loudermilk | ||||||||||||||
| VP Ent Intelligence & Intgrtn | $0 | $225,680 | $0 | $73,283 | $0 | $9,197 | $0 | $6,309 | $0 | $19,342 | $0 | $333,811 | $0 | $0 |
| Sandra Lucius | ||||||||||||||
| VP Info Technology Apps | $0 | $185,834 | $0 | $30,026 | $0 | $8,564 | $0 | $44,758 | $0 | $2,235 | $0 | $271,417 | $0 | $0 |
| Robert Mandler | ||||||||||||||
| VP Diagnostic Outreach | $0 | $214,261 | $0 | $58,412 | $0 | $18,167 | $0 | $45,249 | $0 | $16,275 | $0 | $352,364 | $0 | $0 |
| Patricia A Mayne | ||||||||||||||
| VP Emergency Services | $0 | $177,986 | $0 | $122,895 | $0 | $10,448 | $0 | $26,305 | $0 | $23,814 | $0 | $361,448 | $0 | $0 |
| Kimberly W Menefee | ||||||||||||||
| SVP Strategic Community Dev | $0 | $282,547 | $0 | $66,726 | $0 | $13,682 | $0 | $28,200 | $0 | $17,826 | $0 | $408,981 | $0 | $0 |
| Christopher L Morgan | ||||||||||||||
| VP & Admin. CLIO (BEGIN. 7/7) | $0 | $110,770 | $0 | $52,731 | $0 | $4,638 | $0 | $20,102 | $0 | $1,645 | $0 | $189,886 | $0 | $0 |
| Jonathan B Morris MD | ||||||||||||||
| SVP Chief Info Officer | $0 | $369,512 | $0 | $80,613 | $0 | $12,264 | $0 | $23,553 | $0 | $26,705 | $0 | $512,647 | $0 | $0 |
| Bradford B Newton | ||||||||||||||
| VP Information Technology Admi | $0 | $192,691 | $0 | $30,661 | $0 | $8,988 | $0 | $20,598 | $0 | $27,113 | $0 | $280,051 | $0 | $0 |
| Michael G Paul | ||||||||||||||
| VP Facilities Eng Support Svcs | $0 | $181,401 | $0 | $27,532 | $0 | $12,020 | $0 | $0 | $0 | $24,150 | $0 | $245,103 | $0 | $0 |
| Guillermo J Pierluisi MD MPH | ||||||||||||||
| VP Medical Affairs | $266,510 | $0 | $44,770 | $0 | $11,381 | $0 | $40,200 | $0 | $23,480 | $0 | $386,341 | $0 | $0 | $0 |
| Leo E Reichert | ||||||||||||||
| EVP & General Counsel | $0 | $489,341 | $0 | $247,184 | $0 | $15,552 | $0 | $0 | $0 | $29,200 | $0 | $781,277 | $0 | $0 |
| Bethany Robertson | ||||||||||||||
| VP & Chief Learning Officer | $0 | $178,067 | $0 | $31,215 | $0 | $9,391 | $0 | $13,097 | $0 | $28,511 | $0 | $260,281 | $0 | $0 |
| Michelle M Robinson | ||||||||||||||
| VP Mktng/PR/Internal Comm | $0 | $196,373 | $0 | $33,264 | $0 | $9,210 | $0 | $14,300 | $0 | $26,351 | $0 | $279,498 | $0 | $0 |
| Deborah Roegge De Vita | ||||||||||||||
| VP Women & Newborn Svc Line | $0 | $195,728 | $0 | $27,621 | $0 | $8,576 | $0 | $25,759 | $0 | $6,141 | $0 | $263,825 | $0 | $0 |
| Candice L Saunders | ||||||||||||||
| President & CEO | $0 | $621,461 | $0 | $174,240 | $0 | $16,525 | $0 | $45,334 | $0 | $27,582 | $0 | $885,142 | $0 | $0 |
| Christopher B Scullen | ||||||||||||||
| VP Pulmonology Operations | $0 | $172,411 | $0 | $112,906 | $0 | $6,929 | $0 | $0 | $0 | $17,839 | $0 | $310,085 | $0 | $0 |
| Richard S Siegel | ||||||||||||||
| VP Cardiology & CVM Admin | $0 | $271,627 | $0 | $40,496 | $0 | $11,541 | $0 | $45,700 | $0 | $24,762 | $0 | $394,126 | $0 | $0 |
| Jeffery D Stanley | ||||||||||||||
| VP Pharmacy & System Coor | $0 | $176,156 | $0 | $30,945 | $0 | $9,170 | $0 | $21,580 | $0 | $8,658 | $0 | $246,509 | $0 | $0 |
| Daniel J Styf | ||||||||||||||
| SVP PW Health Plan | $0 | $281,902 | $0 | $39,983 | $0 | $15,148 | $0 | $18,663 | $0 | $9,070 | $0 | $364,766 | $0 | $0 |
| James M Swartz | ||||||||||||||
| VP Accounting | $0 | $200,242 | $0 | $63,140 | $0 | $8,971 | $0 | $16,856 | $0 | $25,406 | $0 | $314,615 | $0 | $0 |
| Mary L Tavernaro | ||||||||||||||
| VP Human Resources Operations | $0 | $212,056 | $0 | $37,659 | $0 | $9,442 | $0 | $27,690 | $0 | $21,436 | $0 | $308,283 | $0 | $0 |
| Adam C Thompson | ||||||||||||||
| VP Surgery | $0 | $166,858 | $0 | $51,698 | $0 | $9,517 | $0 | $0 | $0 | $21,830 | $0 | $249,903 | $0 | $0 |
| Anthony M Trupiano | ||||||||||||||
| SVP Supply Chain | $0 | $268,258 | $0 | $61,742 | $0 | $15,219 | $0 | $45,700 | $0 | $1,896 | $0 | $392,815 | $0 | $0 |
| Sean P Turner | ||||||||||||||
| VP Rev.Cycle MGMT (BEGIN.9/28) | $0 | $233,395 | $0 | $36,468 | $0 | $3,219 | $0 | $20,091 | $0 | $26,574 | $0 | $319,747 | $0 | $0 |
| Avril P Beckford MD | ||||||||||||||
| TRUSTEE | $0 | $395,084 | $0 | $86,393 | $0 | $2,531 | $0 | $27,460 | $0 | $1,940 | $0 | $513,408 | $0 | $0 |
| Jeffrey L Tharp MD | ||||||||||||||
| TRUSTEE | $0 | $480,597 | $0 | $147,676 | $0 | $2,596 | $0 | $45,700 | $0 | $29,025 | $0 | $705,594 | $0 | $0 |
| THOMAS E GEARHARD MD | ||||||||||||||
| TRUSTEE | $0 | $293,273 | $0 | $48,916 | $0 | $5,186 | $0 | $42,668 | $0 | $30,543 | $0 | $420,586 | $0 | $0 |
| DWIGHT T STILL | ||||||||||||||
| Radiation Oncology Physicist | $173,298 | $0 | $541 | $0 | $4,387 | $0 | $9,732 | $0 | $17,801 | $0 | $205,759 | $0 | $0 | $0 |
| WILLIAM S GONZALEZ | ||||||||||||||
| Mgr Pharmacy | $157,934 | $0 | $7,051 | $0 | $815 | $0 | $24,702 | $0 | $25,347 | $0 | $215,849 | $0 | $0 | $0 |
| CAROL S O'CONNEL | ||||||||||||||
| AVP Supp Svcs & Long Term Care | $142,917 | $0 | $18,720 | $0 | $2,192 | $0 | $7,302 | $0 | $19,417 | $0 | $190,548 | $0 | $0 | $0 |
| ANDREA M PARSON | ||||||||||||||
| Dir Pharmacy | $148,762 | $0 | $11,596 | $0 | $300 | $0 | $20,493 | $0 | $28,258 | $0 | $209,409 | $0 | $0 | $0 |
| JULIE KRAFTZENK | ||||||||||||||
| Coor Patient Flow | $150,404 | $0 | $66 | $0 | $1,730 | $0 | $18,056 | $0 | $8,546 | $0 | $178,802 | $0 | $0 | $0 |
| ROBIN WILSON MD | ||||||||||||||
| SVP Chief Hlth Innov Officer | $0 | $395,907 | $0 | $232,368 | $0 | $9,718 | $0 | $0 | $0 | $22,144 | $0 | $660,137 | $0 | $0 |
| CHESTER A ZBOROWSKI | ||||||||||||||
| VP Health Parks Operations | $0 | $165,755 | $0 | $45,188 | $0 | $12,208 | $0 | $0 | $0 | $24,265 | $0 | $247,416 | $0 | $0 |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | SCHEDULE J, PART I, LINE 1B | FormAndLineReferenceDesc |
| Explanation | 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 JOSEPH L. BRYWCZYNSKI ANTHONY J. BUDZINSKI James Clements 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 Vicky Hogue Elizabeth Loudermilk PATRICIA A. MAYNE KIMBERLY W. MENEFEE JONATHAN B. MORRIS Bradford Newton Guillermo Pierluisi 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 Lee R. Cook Timothy M. Haney 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. approved by the Board of Trustees at that time. | ExplanationTxt |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (2 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| FORM 990, PART III, LINE 4A | PROGRAM SERVICE ACCOMPLISHMENTS Paulding Medical Center, Inc. (an affiliate of Wellstar Health System, Inc.) operates as a charitable organization consistent with the requirements of IRS 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 needy members of its community consistent with its charity care policy regardless of their ability to pay for these services; and the hospitals excess funds are generally applied to expansion and replacement of existing facilities and equipment, amortization of indebtedness, improvement in patient care, community benefit activities, and charity care. Paulding had $107.6 million in capital expenditures disbursed during the tax period reviewed with the construction of a new replacement hospital contributing to a majority of that total. Wellstar Paulding Hospital is a general acute care hospital providing a full range of services to the community. The hospital is licensed to operate 83 beds and is presently staffed to operate 34 beds. The existing hospital will be replaced by a 253,000 square foot, 112-bed replacement acute care hospital in the spring of 2014. Paulding Medical Center, Inc. was organized in 1994. 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. Paulding Medical Center is subject to the authority and governing board of Wellstar Health System and the Paulding County Hospital Authority. Paulding Hospital provides a full range of inpatient and outpatient services characteristic of a community hospital. Paulding Nursing Home is located on the campus of the hospital and functions as part of the full range of health services provided to the community. The nursing home provides skilled long-term nursing care to persons requiring those services by reason of age or physical impairment. The nursing home is the only such facility in the Wellstar system. The following stats constitute the overall program services provided during the reporting period ended June 30, 2015: Adult Discharges - 4,546 Med & Surgical Short Stay Cases - 27 Emergency Room Visits - 64,170 Total Surgical Cases - 2,745 Outpatient Procedures Non-ED OP Radiology - 33,788 GI Laboratory - 281 Cath Lab Procedures - 297 Radiology Oncology Procedures - 5,380 Total FTEs Paid - 682 Community Benefit Reporting Community Outreach - $ 190,129 Unreimbursed Charity Care (at cost) - $ 9,195,872 Medicaid Shortfalls (at cost) - $ 3,019,874 Total Community Benefit - $ 12,405,875 Accomplishments and Awards - As an affiliate of Wellstar Health System, Paulding Hospital participates in many community and educational programs for the overall health and benefit of the area that they serve. The Paulding Nursing Home provides both subacute and long term care services to patients in the community. Since the nursing home is one of very few in the area and located on the medical complex campus it is very crucial to an ever expanding service area. Paulding Hospital is accredited by the Joint Commission on Accreditation of Healthcare Organizations (JCAHO). The parent company, Wellstar Health System, was again honored as one of the top 100 health systems in the country by Verispan. The system was ranked at #5 as listed in the magazine, "Modern Healthcare", and is the highest ranked system in the state. All of Wellstar hospital laboratories including Paulding were 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. Wellstar Health System ranks as the top company in the Working Mother 100 Best Companies List. Wellstar ranked seventh in the large company category in Atlanta's Top 25 Employers by the publication "Atlanta Business Chronicle". Wellstar was recognized as a "Company that Cares" for 2013 which was the sixth year in a row the system was honored. The system began participating in Terrific Tales, a Company that Cares sponsored literacy project. Several Wellstar hospitals took on the challenge of purchasing quality books for local elementary school libraries in underserved areas. Paulding Hospital adopted a local school (Poole Elementary) and helped the system raise funds to purchase books for that and other local schools. WellStar Health System received two national work-life distinctions during the year. The National Association of Female Executives honored the system for the fourth year as one of the Top 10 Nonprofit Companies for female executives. Eighty-two percent of the WellStar workforce are women. In 2012, 80 percent of promotions to manager and above went to women and of the 13 employees promoted to executive positions there were six that were for females. WellStar is also one of the 54 organizations nationwide to earn the Alliance for Work-Life Progress Seal of Distinction. This award identifies organizational success in the area of work-life effectiveness. WellStar was one of only two Georgia organizations to be honored. In October of the reporting period 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 Paulding Nursing Center received two national Excellence in Action Awards from the National Research Corporation. The nursing center received the awards for customer and employee satisfaction. The Nursing Center ranked in the top 10 percent of a field of more than 5,000 surveyed facilities. Paulding Nursing Center is one of only 83 facilities in the country and one of 17 in Georgia to receive both awards. Orthosport WellStar opened a new orthopedic and sports physical therapy clinic in the Paulding Physicians Center and very near the new replacement hospital for Paulding Hospital in Hiram, Georgia. Orthosport became a part of WellStar in January of 2012 and has locations in Marietta, Kennesaw, Woodstock, Austell and Douglasville which are all in the communities it serves. Orthosport is the only physical therapy provider in the area to offer aquatic therapy at each location allowing patients with acute and chronic injuries to heal much faster and with less pain. 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 meets on a periodic basis to evaluate performance measures at the hospital. As many consumers become more savvy and research healthcare performance in sources such as Health Grades, and US News and World Report as well as other computer websites, it is important for hospitals to focus on raising their standing in the community and public in general. Cobb, Douglas, Paulding and Windy Hill hospitals have also joined in this initiative. The Paulding Hospital Surgical Services Team raised more than $600 to purchase a new computer, desk and chair for the WellStar Paulding Nursing Center. The department hopes that the internet access will help the nursing home residents keep in better touch with family and friends and improve their quality of life. The new Paulding replacement hospital is scheduled to open in April of 2014. The new hospital will be a state-of-the-art facility with eight floors and over 250,000 square feet of space. It will include a 40-room emergency department which greatly enhances that service for the Paulding County community. Over 100 new jobs will be added to the workforce. The hospital will also have a glass atrium that will connect it to an 82,200 square-foot existing medical office complex. Paulding Nursing Center received a five-star rating from the Centers for Medicare and Medicaid Services (CMS) for its overall performance in health inspections, nurse staffing and quality of medical care. Only 10 percent of nursing homes in the country earn this top rating, and only about 17 percent of more than 350 homes in Georgia earned an overall five-star rating. Approximately 150 team members serve the 182 residents of Pauldin |
| FORM 990, PART I, LINES 7A & 7B | UNRELATED BUSINESS INCOME PAULDING MEDICAL CENTER, 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 Paulding Medical Center, 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). Paulding Medical Center, 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 VI, 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 Paulding Medical Center, Inc. had a change in net assets of ($19,907,685) related to transfers to affiliates as part of the allocation of income statement and balance sheet transactions over the year. |
Schedule R IRS990ScheduleR
Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp (6 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | EINEIN | Primary ActivitiesPrimaryActivitiesTxt | Legal Domicile StateLegalDomicileStateCd | Exempt Code SectionExemptCodeSectionTxt | Public Charity StatusPublicCharityStatusTxt | Business Name Line1DirectControllingEntityName/BusinessNameLine1Txt | Controlled OrganizationControlledOrganizationInd |
|---|---|---|---|---|---|---|---|---|---|---|
| CHS Foundation Inc | ||||||||||
| 805 Sandy Plains Road | Marietta | GA | 30066 | 581649540 | Foundation | GA | 501(C)(3) | 11 Type 2 | WHS | Yes (true) |
| Cobb Hospital Inc | ||||||||||
| 805 Sandy Plains Road | Marietta | GA | 30066 | 580968382 | Healthcare | GA | 501(C)(3) | 3 | WHS | Yes (true) |
| Douglas Hospital Inc | ||||||||||
| 805 Sandy Plains Road | Marietta | GA | 30066 | 582026750 | Healthcare | GA | 501(C)(3) | 3 | WHS | Yes (true) |
| Kennestone Hospital Inc | ||||||||||
| 805 Sandy Plains Road | Marietta | GA | 30066 | 582032904 | Healthcare | GA | 501(C)(3) | 3 | WHS | Yes (true) |
| Wellstar Foundation Inc | ||||||||||
| 805 Sandy Plains Road | Marietta | GA | 30066 | 581627413 | Foundation | GA | 501(C)(3) | 11 Type 2 | WHS | Yes (true) |
| Wellstar Health System Inc | ||||||||||
| 805 Sandy Plains Road | Marietta | GA | 30066 | 581649541 | Healthcare | GA | 501(C)(3) | 11 Type 2 | WHS | false |
Id Related Org Txbl Partnership IdRelatedOrgTxblPartnershipGrp (2 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | EINEIN | Primary ActivitiesPrimaryActivitiesTxt | Legal Domicile StateLegalDomicileStateCd | Business Name Line1DirectControllingEntityName/BusinessNameLine1Txt | Predominant Income TypePredominantIncomeTypeTxt | Share Of Total IncomeShareOfTotalIncomeAmt | Share Of EOY AssetsShareOfEOYAssetsAmt | UBI Code VUBICodeVAmt |
|---|---|---|---|---|---|---|---|---|---|---|---|
| Cobb Hospital Parking Company LLC | |||||||||||
| 805 Sandy Plains Road | Marietta | GA | 300666340 | 752999669 | Parking | GA | WHS | N/A | $0 | $0 | $0 |
| KENNESTONE EAST PARKING DECK LLC | |||||||||||
| 793 SAWYER ROAD | MARIETTA | GA | 30060 | 200537100 | PARKING | GA | WHS | N/A | $0 | $0 | $0 |
Id Related Org Txbl Corp Tr IdRelatedOrgTxblCorpTrGrp
Related Organization Name RelatedOrganizationName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Community Assurance Co | BusinessNameLine1Txt |
Foreign Address ForeignAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 3rd Fl Barclays Hse Shedden Rd | AddressLine1Txt |
| City | George Town | CityNm |
| Province Or State | Grand Cayman | ProvinceOrStateNm |
| Country | CJ | CountryCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 581649541 | EIN |
| Primary Activities | Insurance | PrimaryActivitiesTxt |
| Legal Domicile Foreign Country | CJ | LegalDomicileForeignCountryCd |
| Entity Type | C-CORP | EntityTypeTxt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Annts Rnts Rylts | false | ReceiptOfIntAnntsRntsRyltsInd |
| Gift Grnt Or Cap Contri To Oth Org | false | GiftGrntOrCapContriToOthOrgInd |
| Gift Grnt Cap Contri From Oth Org | false | GiftGrntCapContriFromOthOrgInd |
| Loans Or Guarantees To Other Org | false | LoansOrGuaranteesToOtherOrgInd |
| Loans Or Guarantees From Oth Org | false | LoansOrGuaranteesFromOthOrgInd |
| Div Related Organization | false | DivRelatedOrganizationInd |
| Asset Sale To Other Org | false | AssetSaleToOtherOrgInd |
| Asset Purchase From Other Org | false | AssetPurchaseFromOtherOrgInd |
| Asset Exchange | false | AssetExchangeInd |
| Rental Of Facilities To Oth Org | false | RentalOfFacilitiesToOthOrgInd |
| Rental Of Fclts From Oth Org | false | RentalOfFcltsFromOthOrgInd |
| Perform Of Services For Oth Org | false | PerformOfServicesForOthOrgInd |
| Perform Of Services By Other Org | false | PerformOfServicesByOtherOrgInd |
| Sharing Of Facilities | false | SharingOfFacilitiesInd |
| Paid Employees Sharing | false | PaidEmployeesSharingInd |
| Reimbursement Paid To Other Org | Yes (true) | ReimbursementPaidToOtherOrgInd |
| Reimbursement Paid By Other Org | false | ReimbursementPaidByOtherOrgInd |
| Transfer To Other Org | false | TransferToOtherOrgInd |
| Transfer From Other Org | false | TransferFromOtherOrgInd |