2015-05-15T09:01:38-05:00 2014-06-30 PricewaterhouseCoopers LLP 2001 MARKET ST SUITE 1700 PHILADELPHIA PA 19103 990 2013-07-01 581649541 WELLSTAR HEALTH SYSTEM INC % JAMES M SWARTZ WELL 7707925023 805 SANDY PLAINS ROAD Suite MARIETTA GA 300666340 JAMES SWARTZ VP ACCOUNTING 7709567827 2015-05-08 true MATTHEW D PETROSKI P00853132 7709567827 2013 2016-03-07 17:11:31Z REYNOLD J JENNINGS 805 Sandy Plains Road Marietta GA 300666340 747040515 false X www.wellstar.org X 1994 GA TO DELIVER WORLD-CLASS CHARITABLE HEALTHCARE TO THE COMMUNITY. 17 9 5817 275210 0 0 653903471 664865794 28077016 54674985 21014857 26362125 702995344 745902904 1518880 1167763 0 0 397394838 420122898 0 0 1899305 215783890 239109495 614697608 660400156 88297736 85502748 2074237739 2289388627 830212494 1012073035 1244025245 1277315592 X TO CREATE AND DELIVER HIGH QUALITY HOSPITAL, PHYSICIAN AND OTHER HEALTHCARE RELATED SERVICES THAT IMPROVE THE HEALTH AND WELL-BEING OF THE INDIVIDUALS AND COMMUNITIES THAT WE SERVE. false false 443966825 1167763 664865794 WELLSTAR HEALTH SYSTEM IS A VERTICALLY INTEGRATED HEALTH CARE DELIVERY SYSTEM WHICH PROVIDES THROUGH AFFILIATED BUSINESS ORGANIZATIONS A FULL SPECTRUM OF HEALTH SERVICES, INCLUDING WELLNESS PROGRAMS, PHYSICIAN OFFICE VISITS, OUTPATIENT CARE, INPATIENT CARE, AND POST-ACUTE SERVICES SUCH AS HOME HEALTH AND LONG TERM NURSING CARE. THE SYSTEM THROUGH ITS AFFILIATED BUSINESS ORGANIZATIONS OPERATES FIVE HOSPITALS(KENNESTONE, COBB, PAULDING MEDICAL, DOUGLAS AND WINDY HILL), MULTIPLE PHYSICIAN OFFICES, PRIMARY CARE CENTERS, OUTPATIENT CARE FACILITIES, A NURSING HOME AND OTHER HEALTH RELATED SERVICES INCLUDING TWO INPATIENT HOSPICE FACILITIES. THE SYSTEM IS SUPPORTED FINANCIALLY BY A FUND-RAISING ORGANIZATION, WELLSTAR FOUNDATION, INC. THE SERVICE AREA FOR THE SYSTEM ENCOMPASSES PARTS OF THE NORTHWESTERN SECTION OF THE STATE OF GEORGIA - THE PRIMARY AREA BEING IN BARTOW, CHEROKEE, COBB, DOUGLAS AND PAULDING COUNTIES. APPROXIMATELY 90% OF INPATIENT DISCHARGES AND OUTPATIENTS SERVED ARE FROM THE AFOREMENTIONED COUNTIES. THE WELLSTAR VISION IS TO DELIVER WORLD CLASS HEALTHCARE. OUR MISSION IS 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. HISTORY ------- IN 1993, WHAT WAS THEN KNOWN AS THE COBB HEALTH SYSTEM, THE KENNESTONE REGIONAL HEALTH CARE SYSTEM, AND THE DOUGLAS GENERAL HOSPITAL AFFILIATED TO FORM THE NORTHWEST GEORGIA HEALTH SYSTEM. PAULDING MEMORIAL MEDICAL CENTER AFFILIATED WITH NORTHWEST GEORGIA HEALTH SYSTEM IN 1994. IN 1994, THE NORTHWEST GEORGIA HEALTH SYSTEM HELPED FORM THE PROMINA HEALTH SYSTEM AND CHANGED ITS NAME TO PROMINA NORTHWEST HEALTH SYSTEM. IN 1998, PROMINA NORTHWEST HEALTH SYSTEM CHANGED ITS NAME TO WELLSTAR HEALTH SYSTEM. WELLSTAR DISASSOCIATED FROM AND BECAME TOTALLY INDEPENDENT OF PROMINA IN 1999. WELLSTAR HEALTH SYSTEM IS A PARENT CORPORATION WHICH PROVIDES OVERALL COORDINATION INCLUDING GOVERNING BODY TO ITS SEVEN SUBORDINATE AFFILIATES: 1) COBB HOSPITAL, INC; 2) CHS FOUNDATION, INC (INVESTMENT MANAGEMENT); 3) DOUGLAS HOSPITAL INC; 4) KENNESTONE HOSPITAL, INC; 5) PAULDING MEDICAL CENTER, INC; 6) WELLSTAR FOUNDATION INC. AND 7)COMMUNITY ASSURANCE COMPANY, LTD. (A CAPTIVE SELF-INSURANCE ORGANIZATION). SERVICES -------- WELLSTAR HEALTH SYSTEM IS ABLE TO OFFER A FULL RANGE OF HEALTHCARE SERVICES THROUGH ITS AFFILIATES. THE SERVICES OFFERED INCLUDE BUT ARE NOT LIMITED TO: MOST MAJOR INPATIENT CLINICAL SERVICES, OUTPATIENT SERVICES, DIAGNOSTIC AND THERAPEUTIC SERVICES, ANCILLIARY AND SUPPORT SERVICES, URGENT CARE SERVICES AND HOME HEALTH SERVICES. THE SYSTEM INCLUDES A RESIDENTIAL FACILITY ON THE KENNESTONE HOSPITAL CAMPUS, CALLED ATHERTON PLACE. ARTHERTON PLACE ALSO HOUSES AN ASSISTED LIVING UNIT AS AN ADDITIONAL LEVEL OF CARE. THE FIVE HOSPITALS ARE ACUTE CARE FACILITIES WITH INPATIENT, OUTPATIENT, AND EMERGENCY SERVICES. PAULDING MEDICAL CENTER IS HOME TO A FULL CARE NURSING HOME, PAULDING NURSING CENTER. COBB HOSPITAL IS HOME TO A HOME HEALTH AGENCY AND A RESIDENTIAL HOSPICE FACILITY CALLED TRANQUILITY FOR THOSE PATIENTS IN THE END STAGES OF LIFE. KENNESTONE HOSPITAL ALSO OPENED A RESIDENTIAL HOSPICE FACILITY NOT FAR FROM ITS MAIN CAMPUS. THE SYSTEM IS COMPLIMENTED WITH APPROXIMATELY 85 PHYSICIAN PRACTICES AND SEVERAL URGENT CARE CENTERS. THE SYSTEM IS THUS ABLE TO PROVIDE A COMPLETE CONTINUUM OF CARE FOR THE COMMUNITY ITS SERVES. The following statements of community benefit and program service accomplishments represent system-wide activity for Wellstar Health System, Inc. (the "System") - EIN 58-1649541. All affiliated entities of the system except the Physician Hospital Organization (EIN 58-2116179) operate as charitable organizations consistent with the requirements of Internal Revenue Code Section 501(c)(3) and the "Community Benefit Standard" of IRS Revenue Ruling 69-545. The following excerpt from the audited financial statements identifies a broad overview of the charitable purpose for the System. "The System maintains records to identify and monitor the level of charity care it provides through its affiliates. These records include the amount of charges foregone for services and supplies furnished under its charity care policy. Charges foregone, based on established rates, totaled approximately $343.8 million and $314.8 million in 2012 and 2013 respectively. In fiscal 2013, Wellstar affiliate hospitals made $15.5 million in provider payments and recognized such payments as a reduction in net patient service revenue in the accompanying combined financial statements. The System also participates in certain governmental insurance programs, including Medicare and Medicaid. Under these programs, the System provides care to patients at payment rates which are determined by the Federal and State governments, regardless of the System's actual charges. In most cases, these programs pay the System at amounts which are less than its cost of providing services. The System offers many wellness and educational services at little or no cost to the community. Health fairs are held throughout the year at convenient locations, providing various health screenings, such as mammograms, blood pressure and cholesterol checks. A large number of educational programs are offered for all ages. These programs include bicycle safety, car seat safety, defensive driving, CPR and first-aid classes. Flu shots are available to the community during flu season. Health screenings, medical supplies, and immunizations are provided to children through local health departments and health fairs with System sponsorship in many cases. The costs of these services are included in operating expenses. The System promotes health education and activities for students, parents, and teachers through its Partner-in-Education programs. The physicians of the System make significant contributions to improve the health status of the community, including involvement in many community activities promoting health awareness and improvement, emergency room care, and delivery of care to the indigent population of the System's service area. The System also made significant contributions to the nursing program at a local university. This financial support has helped to grow the program, which benefits the System as well as the community. The System and all but one of its affiliates have been recognized as organizations 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. One of the System's affiliates is a controlled foreign corporation not subject to Federal income tax. The Physician Hospital Organization (EIN 58-2116179) is a taxable affiliate of the System and files IRS Form 1120 US Corporation Income Tax Return." Financial Data and Statistics (Services Provided System-Wide) Licensed Beds-1,321 Discharges-64,376 Newborn Deliveries-9,560 Emergency Room Visits-322,082 Behavioral ER Visits-8,598 Surgeries-43,030 Cath Lab/Pacemakers/EP-9,741 Non-ED O/P Radiology Procedures-285,677 Medical Group Visits-1,433,816 COMMUNITY BENEFITS ------------------ Wellstar Health System participates and collaborates with patients and residents in meeting health needs and improving the overall quality of life in the community. This is especially important in responding to the needs of the underserved regardless of the system's ability to generate a positive margin. Some services would possibly be discontinued if based on a purely financial basis. The following are some examples of the system's services that provide community benefits (and a monetary value of those benefits if known). Clinics Wellstar is affiliated with several clinics which provide free or discounted health services to persons who cannot afford to pay or those who are not expected to pay. During FY2013 as in the prior year the clinics at Kennestone and Cobb Hospitals experienced a combined total of 8,000 patient visits at a cost of $2.8 million. Community Health/Education Wellstar's Marketing and Public Relations department provides free brochures on a variety of health-related issues. On a quarterly basis Wellstar sends out a wellness magazine entitled "Health and You" to 180,000 homes in the community/service area. The magazine provides information on health issues and a schedule of health related classes/seminars available throughout the system. While the magazine is an excellent referral source for Wellstar's varied services, it provides free medical information to the households receiving the publication. Wellstar provides support groups and educational opportunities to the community on a variety of topics (examples-- men's and women's health issues, palliative care, mental health, birthing classes, etc.) Some of these opportunities are provided free of charge or at a minimal fee. Wellstar also provides free or low cost screen 443966825 true false false true false false false false true true false false true true true false true false true false false false false false false false true true true true false false false false false false false true true true false false false false true true true true false false true 0 0 5817 true true true true CJ false false false false false false false false false X 17 9 false false false false false false false true true false false true true true true true true true true true true GA X JAMES M SWARTZ 7707925023 805 SANDY PLAINS ROAD MARIETTA GA 300666340 X AVRIL P BECKFORD MD TRUSTEE 40.0 10.0 X 456909 0 29970 RANDALL BENTLEY JR TRUSTEE 1.0 5.0 X 20619 0 0 OTIS BRUMBY III TRUSTEE 1.0 5.0 X 3687 0 0 SHAN COOPER TRUSTEE 1.0 5.0 X 1218 0 0 ROBERT CROSS MD TRUSTEE 1.0 5.0 X 5266 0 0 T E RUSTY DURHAM TRUSTEE 10.0 5.0 X 37928 0 13445 THOMAS GEARHARD MD TRUSTEE 40.0 10.0 X 484242 0 72307 DAVID HAFNER MD TRUSTEE 1.0 5.0 X 24386 0 0 T FITZ JOHNSON TRUSTEE 1.0 5.0 X 18008 0 0 CHARLES J JONES TRUSTEE 1.0 5.0 X 17308 0 0 JANIE MADDOX TRUSTEE - CHAIR 1.0 5.0 X 19581 0 0 GARY MILLER TRUSTEE - VICE CHAIR 1.0 5.0 X 4249 0 0 STEVEN W OWEIDA MD TRUSTEE 1.0 5.0 X 21472 0 0 TOM PHILLIPS TRUSTEE 1.0 5.0 X 2734 0 0 WALTER G ROBINSON TRUSTEE 1.0 5.0 X 10640 0 0 FRANK ROS TRUSTEE 1.0 5.0 X 3747 0 0 W ALLEN SEPARK TRUSTEE 1.0 7.0 X 9844 0 0 JEFFERY THARP MD TRUSTEE 40.0 10.0 X 566320 0 72948 VALERY A AKOPOV MD VP & CHIEF OF HOSPITALISTS 40.0 10.0 X 394355 0 53783 DAVID W ANDERSON EXEC VP HR/OL/CCO 40.0 10.0 X 590159 0 64119 NICOLE ASHE VP FINANCE & CFO WMG 40.0 10.0 X 256832 0 46130 TRACEY ATWATER VP & FOUNDATION PRESIDENT 48.0 2.0 X 264868 0 48197 BARBARA BALLARD VP HOMECARE & HOSPICE 40.0 10.0 X 376870 0 73407 JOSEPH L BRYWCZYNSKI SVP HEALTH PARKS DEVELOPMENT 40.0 10.0 X 319737 0 59522 A JAMES BUDZINSKI EXEC VP & CFO 40.0 12.0 X 645375 0 67649 DONALD CAMPBELL MD SVP PHYS EDUC & STUDENT AFF 40.0 10.0 X 437419 0 45134 LEE RANDOLPH COOK VP MEDICINE & BEHAVIORAL HLTH 40.0 10.0 X 292193 0 48389 BARBARA B COREY SVP MANAGED CARE 40.0 10.0 X 353009 0 44619 BRUCE A DEAN VP REAL ESTATE & DEP GEN COUN 40.0 10.0 X 260414 0 64294 SARATH DEGALA VP REVENUE CYCLE MGMT 40.0 10.0 X 289953 0 34966 MARCIA DELK-PAYNE MD SVP MED AFFAIRS & CQO 40.0 10.0 X 434313 0 51552 T MARK HANEY SVP & HOSPITAL PRESIDENT 2.0 48.0 X 0 334058 46179 ROBERT D JANSEN MD EXEC VP & PRES MEDICAL GROUP 40.0 10.0 X 791804 0 71531 REYNOLD J JENNINGS PRESIDENT & CEO 40.0 12.0 X 1389700 0 2200 CHRISTOPHER M KANE SVP STRATEGIC PLAN & BUS DEV 40.0 10.0 X 403363 0 54031 BETH KOST VP Compliance/Chf Privacy Ofcr 40.0 10.0 X 278339 0 37798 ELLEN LANGFORD VP & COO WMG 40.0 10.0 X 251119 0 36691 LOUIS W LITTLE SVP POST ACUTE/HOSP PRES 2.0 48.0 X 0 303532 53864 ROBERT MANDLER VP DIAGNOSTIC OUTREACH 40.0 10.0 X 274343 0 59721 CAROL B MAXWELL VP TALENT ACQUISTION 40.0 10.0 X 128331 0 12302 KIMBERLY W MENEFEE SVP MARKETING & GOV AFFAIRS 40.0 10.0 X 334382 0 49550 JONATHAN B MORRIS MD SVP CHIEF INFORMATION OFFICR 40.0 10.0 X 479551 0 47874 KEM M MULLINS SVP & HOSP PRESIDENT 2.0 48.0 X 0 429024 43672 BRADFORD B NEWTON VP INFORMATION TECH ADMIN 40.0 10.0 X 215090 0 38727 CRAIG OWENS SVP & HOSP PRESIDENT 2.0 48.0 X 0 382729 40702 LEO E REICHERT EXEC VP & GENERAL COUNSEL 40.0 10.0 X 595331 0 27431 MICHELLE M ROBINSON VP MARKETING/PR/INTERNAL COMM 40.0 10.0 X 230978 0 33982 DEBORAH ROEGGE DE VITA VP WOMEN & NEWBORN SVC LINE 40.0 10.0 X 243970 0 8440 CANDICE L SAUNDERS EXEC VP & COO 40.0 10.0 X 539392 108137 65639 CHRISTOPHER B SCULLEN VP PULMONARY OPERATIONS 40.0 10.0 X 196607 0 2497 JEFFERY D STANLEY VP PHARMACY & SYS COORD 40.0 10.0 X 200737 0 27947 JAMES M SWARTZ VP ACCOUNTING 40.0 10.0 X 228870 0 36502 MARY TAVERNARO VP HUMAN RESOURCES OPERATIONS 40.0 10.0 X 241535 0 41187 ADAM C THOMPSON VP SURGERY 40.0 10.0 X 202684 0 17822 ANTHONY M TRUPIANO SVP SUPPLY CHAIN 40.0 10.0 X 361685 0 47393 MARY L WESLEY SVP NURSING SERVICES CNE 40.0 10.0 X 349633 0 56860 ROBIN WILSON MD SVP CHIEF INNOVATION OFFICER 40.0 10.0 X 510364 0 28431 CHESTER ZBOROWSKI VP Health Park Operations 40.0 10.0 X 207340 0 18413 PETER JUNGBLUT MD SVP & MEDICAL DIRECTOR 40.0 10.0 X 358267 0 56395 KRISTYN GREIFER MD VP POPULATION HEALTH MGMT 40.0 10.0 X 263708 0 10138 JIMMY FRANCIS VP INFO TECHNOLOGY OPERATIONS 40.0 10.0 X 150343 0 580 STEVEN GRACE VP TALENT ACQUISITION 40.0 10.0 X 144341 0 4206 ELIZABETH LOUDERMILK VP ENT INTELLIGENCE & INTGRTN 40.0 10.0 X 240446 0 11978 SANDRA LUCIUS VP INFO TECHNOLOGY APPS 40.0 10.0 X 177459 0 26570 MICHAEL PAUL VP FACILITIES ENG SUIPPORT SVC 40.0 10.0 X 86864 0 1985 BETHANY ROBERTSON VP & CHIEF LEARNING OFFICER 40.0 10.0 X 200645 0 39317 RICHARD SIEGEL VP CARDIOLOGY & CVM ADMIN 40.0 10.0 X 337829 0 62810 JAMES CLEMENTS VP BUS DEV & STRATEGIC PRTNRSP 40.0 10.0 X 131463 0 11124 DANIEL WOODS SVP & HOSPITAL PRESIDENT 2.0 48.0 X 0 425017 69627 DANIEL STYF SVP PW HEALTH PLAN 40.0 10.0 X 185654 0 13376 BARRY MANGEL MD CHIEF CARDIAC SERVICES 50.0 0.0 X 700647 0 68531 WILLIAM R MAYFIELD MD CHIEF OF SURGERY SERVICES 50.0 0.0 X 582666 0 61457 ALAN R MUSTER MD CHIEF PULMONARY SERVICES 50.0 0.0 X 543103 0 65674 PERRY G BUSBEE MD CHIEF WOMENS SERVICES 50.0 0.0 X 348382 0 52931 SAID ELAHIHABI MD MD 50.0 0.0 X 1438817 0 66685 AHMAD KHALDI MD MD 50.0 0.0 X 906068 0 48531 WILLIAM BENEDICT JR MD MD 50.0 0.0 X 951179 0 53791 MARK MCLAUGHLIN MD MD 50.0 0.0 X 1014877 0 8705 SALVATORE MANNINO MD 50.0 0.0 X 780635 0 67506 MICHAEL L GRAUE FMR EXEC VP & COO 0.0 0.0 X 1166074 0 36144 KENNETH C KUNZE MD FMR SVP CHIEF MED OFFICER 0.0 0.0 X 665985 0 26607 26654255 1982497 2762485 595 true true false EPIC SYSTEMS CORPORATION POBOX 88314 MILWAUKEE WI 532880314 INFORMATION TECH SRV 14148735 IMPACT ADVISORS LLC 931 W 75TH STREET SUITE 137-304 NAPERVILLE IL 60565 CONSULTING 7641896 PRESIDIO NETWORKED SOLUTIONS PO BOX 822169 PHILADELPHIA PA 191822169 IS 15300075 INGLETT AND STUBBS INC PO BOX 932506 ATLANTA GA 311932506 GENERAL CONTRACTOR 7305643 BRASFIELD AND GORRIE LLC 1190 VAUGHN RD NW SUITE 100 KENNESAW GA 30144 GENERAL CONTRACTOR 5247939 5 0 PATIENT REVENUE 621990 264493282 264493282 COBB COUNTY DETENTION CENTER 621990 5324465 5324465 EQUITY IN EARNINGS OF HOSP AFFILIATES 621990 136583663 136583663 SHARED SERVICES COSTS RECOUPMENT 621990 233018502 233018502 WELLNESS CENTER 621400 2292478 2292478 23153404 23153404 664865794 55812596 55812596 0 0 1349416 1349416 0 1349416 1349416 1137611 -1137611 -1137611 -1137611 0 0 0 LAUNDRY 812300 275210 275210 CHILDCARE REVENUE 621990 1387060 1387060 OTHER REVENUE 621990 23350439 23350439 25012709 745902904 664865794 275210 80761900 339155 339155 828608 828608 0 0 22812505 18009223 4491508 311774 0 323807851 252426836 70633972 747043 28140705 20819535 7213514 107656 20989839 9932618 10915783 141438 24371998 17152410 7110705 108883 0 1453940 1453940 477157 477157 0 0 0 81232735 45233289 35726416 273030 8246585 1403010 6778728 64847 8155453 7849492 216480 89481 0 0 24740298 16641484 8096311 2503 2088805 1036870 1041199 10736 0 2696371 1093453 1591769 11149 11545875 11545875 233340 203193 30147 0 32743635 12344727 20385353 13555 22990883 6336766 16654117 REPAIRS & MAINTENANCE 29401164 20375373 9025791 MEDICAL SUPPLIES 11349481 11349481 OTHER OPERATING EXPENSES 1753773 591302 1145261 17210 660400156 443966825 214534026 1899305 28636 65044 16858777 33898944 0 0 23238153 32995490 0 0 0 0 0 0 6024689 8096858 40502038 34888229 630949041 274611543 260732010 356337498 786154750 675250308 0 0 0 0 39437459 0 901261227 1147856256 2074237739 2289388627 106542553 227603596 0 0 0 0 515306698 516089829 0 0 0 0 0 0 94088 0 208269155 268379610 830212494 1012073035 X 1233913516 1262583371 6144876 9983343 3966853 4748878 1244025245 1277315592 2074237739 2289388627 X 85502748 5844055 -58056456 X false true X true false X X X false false false COBB HOSPITAL INC 580968382 03 true true true 62612216 PAULDING MEDICAL CENTER INC 582095884 03 true true true 13508132 KENNESTONE HOSPITAL INC 582032904 03 true true true 134780804 DOUGLAS HOSPITAL INC 582026750 03 true true true 22125350 4 233026502 true true true 5300 true 2549 true 2322 true 190000 true 211772 true 6541 true 144207 562691 false Form 990 Schedule C Part IV During the reporting period Wellstar Health System, Inc. held a retainer for a local firm to provide professional services for community related activities including support in community benefit reporting and legislative healthcare initiatives affecting the system hospitals. Wellstar is also a party to several healthcare related coalitions that protect the interests of all member hospitals. 4915000 771000 799000 6485000 4286000 162000 467000 4915000 4416000 75000 -37000 168000 4286000 3810000 24000 -70000 652000 3112000 3578000 19000 -8000 221000 3368000 0.73000 0.27000 false true true 45066660 45066660 163176432 47178681 115997751 12292883 7744590 4548293 408700403 219326850 189373553 1712663 361422 1351241 356337498 UNAMORTIZED BORROWING COSTS 2461381 OTHER RECEIVABLES 1032674 OTHER PREPAIDS 743322 EQUITY IN AFFILIATES 1138322600 OTHER LT ASSETS 5296279 1147856256 0 ACCRUED PENSION LIABILITY 163476178 OTHER LONG TERM LIABILITIES 26620171 INSURANCE RESERVES 78283261 268379610 Form 990 Schedule D Part V Line 4 The endowment funds held on Wellstar Health System are intended to be held in perpetuity and the earnings thereon are to be used for financial assistance for patients in the Wellstar Hospice Program. All funds were expended during the fiscal year for the Wellstar Hospice Program and a new inpatient Hospice facility at Kennestone Hospital. SCHEDULE D PART X, LINE 2 TAX LIABILITY The following footnote from the WellStar Health System and Affiliates audited financial statements details the income tax position for the reporting period: "WellStar 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. CAC is a controlled foreign corporation not subject to Federal Tax. WellStar applies FASB ASC 740, Income Taxes, which addresses accounting for uncertainties in income tax positions. It also provides guidance on when tax positions are recognized in an entity's financial statements and how the values of these positions are determined. There is no impact on WellStar's combined financial statements as a result of the application of ASC 740." true American Cancer Society 1825 Barrett Lakes Blvd Suite 280 Kennesaw GA 30144 131623888 501 (c) (3) 86000 Sponsor Fundraiser American Heart Association 1101 Northchase Parkway Suite 1 Marietta GA 30067 580198114 501 (c) (3) 40000 Sponsor Fundraiser Cherokee County Chamber of Commerce PO Box 4998 Canton GA 30114 582487501 501 (c) (6) 10590 Sponsor Fundraiser Cobb Chamber of Commerce PO Box 671868 Marietta GA 30006 582487501 501 (c) (6) 12225 Sponsor Fundaraiser March of Dimes 1775 The Exchange Suite 515 Atlanta GA 30339 131846366 501 (c) (3) 15000 Sponsor Fundraiser Paulding County Chamber of Commerce 455 Jimmy Campbell Pkwy Dallas GA 30132 5540 Sponsor Fundraiser YWCA of Northwest Georgia 48 Henderson St Marietta GA 30064 580617782 501 (c) (3) 25000 Sponsor Fundraiser Rotary Club of East Cobb PO Box 72081 Marietta GA 30007 581654204 501 (c) (3) 7500 Sponsorship Colon Cancer Alliance 1025 Vermont Ave NW Washington DC 20005 860947831 501 (c) (3) 6000 Sponsor Fundraiser Towne Center at Cobb 400 Barrett Pkwy Kennesaw GA 30144 743214411 501 (c) (3) 5250 Sponsor Fundraiser The Salvation Army 740 Marietta St NW Atlanta GA 30318 580660606 501 (c) (3) 6000 Sponsor Fundraiser The Careplace 1707 N Blairs Bridge Rd Austell GA 30168 270070164 501 (c) (3) 7500 Sponsor Fundraiser Sope Creek Foundation P O Box 681691 Marietta GA 30068 582266191 501 (c) (6) 10000 Sponsor Fundraiser Lung Cancer Alliance 888 16th St NW Suite 150 Washington DC 20006 911821040 501 (c) (3) 10000 Sponsor Fundraiser Georgia Museums Inc P O Box 3248 Caterville GA 30120 201234015 501 (c) (3) 10000 Sponsor Fundraising WFSH - FM 2970 Peachtree Rd NW Suite 700 Atlanta GA 30305 770388924 501 (c) (6) 11000 Sponsor Fundraiser City of Kennesaw 2529 J O Stephenson Ave NW Kennesaw GA 30144 586010582 16550 Contribution Goshen Vallley 387 Gosgen Church Way Waleska GA 30183 582361483 501 (c) (3) 25000 Sponsor Fundraiser 12 6 SCHEDULE I PART I LINE 2 WELLSTAR HEALTH SYSTEM, INC. AND ITS AFFILIATES HAVE SET ASIDE FUNDS FOR CONTRIYUTIONS AND SPONSORSHIPS ON AN ANNUAL BASIS THAT PROVIDE ASSISTANCE TO NATIONAL AND LOCAL TAX EXEMPT ORGANIZATIONS IN THE FURTHERANCE OF THE COMMUNITY NEEDS. WELLSTAR ALSO HAS SEVERAL AGREEMENTS WITH AREA COLLEGES AND UNIVERSITIES TO PROMOTE HEALTHCARE RELATED CAREER OPPORTUNITIES. WELLSTAR PROVIDES SCHOLARSHIPS TO LOCAL STUDENTS FOR HEALTHCARE COURSES OF STUDY. ALL SPONSORSHIPS AND SCHOLARSHIPS ARE AWARD BASED ON SPECIFIC QUALIFICATIONS WITHOUT REGARD TO AGE, GENDER, OR ETHNICITY. X X X X X X false true X X X X X X true true false false false false false true false AVRIL P BECKFORD MD TRUSTEE 389384 0 60399 0 7126 0 28100 0 1870 0 486879 0 0 0 THOMAS GEARHARD MD TRUSTEE 384953 0 90185 0 9104 0 43876 0 28431 0 556549 0 0 0 JEFFERY THARP MD TRUSTEE 468886 0 90202 0 7232 0 45600 0 27348 0 639268 0 0 0 VALERY A AKOPOV MD VP & CHIEF OF HOSPITALISTS 310404 0 70715 0 13236 0 28100 0 25683 0 448138 0 0 0 DAVID W ANDERSON EXEC VP HR/OL/CCO 404417 0 159785 0 25957 0 45600 0 18519 0 654278 0 0 0 NICOLE ASHE VP FINANCE & CFO WMG 214535 0 31427 0 10870 0 22501 0 23629 0 302962 0 0 0 TRACEY ATWATER VP & FOUNDATION PRESIDENT 225168 0 26358 0 13342 0 22353 0 25844 0 313065 0 0 0 BARBARA BALLARD VP HOMECARE & HOSPICE 232916 0 126392 0 17562 0 45600 0 27807 0 450277 0 0 0 JOSEPH L BRYWCZYNSKI SVP HEALTH PARKS DEVELOPMENT 260476 0 40655 0 18606 0 45600 0 13922 0 379259 0 0 0 A JAMES BUDZINSKI EXEC VP & CFO 526234 0 102668 0 16473 0 45600 0 22049 0 713024 0 0 0 DONALD CAMPBELL MD SVP PHYS EDUC & STUDENT AFF 319526 0 97801 0 20092 0 26376 0 18758 0 482553 0 0 0 LEE RANDOLPH COOK VP MEDICINE & BEHAVIORAL HLTH 250291 0 29549 0 12353 0 28100 0 20289 0 340582 0 0 0 BARBARA B COREY SVP MANAGED CARE 294105 0 45904 0 13000 0 21192 0 23427 0 397628 0 0 0 BRUCE A DEAN VP REAL ESTATE & DEP GEN COUN 222219 0 26013 0 12182 0 45600 0 18694 0 324708 0 0 0 SARATH DEGALA VP REVENUE CYCLE MGMT 256000 0 24631 0 9322 0 14300 0 20666 0 324919 0 0 0 MARCIA DELK-PAYNE MD SVP MED AFFAIRS & CQO 361498 0 56423 0 16392 0 45600 0 5952 0 485865 0 0 0 MICHAEL L GRAUE FMR EXEC VP & COO 539531 0 596480 0 30063 0 22000 0 14144 0 1202218 0 0 0 T MARK HANEY SVP & HOSPITAL PRESIDENT 0 266032 0 49532 0 18494 0 28100 0 18079 0 380237 0 0 ROBERT D JANSEN MD EXEC VP & PRES MEDICAL GROUP 576801 0 191534 0 23469 0 45600 0 25931 0 863335 0 0 0 REYNOLD J JENNINGS PRESIDENT & CEO 975000 0 392445 0 22255 0 0 0 2200 0 1391900 0 0 0 CHRISTOPHER M KANE SVP STRATEGIC PLAN & BUS DEV 333404 0 52038 0 17921 0 28100 0 25931 0 457394 0 0 0 BETH KOST VP Compliance/Chf Privacy Ofcr 238762 0 27950 0 11627 0 22218 0 15580 0 316137 0 0 0 KENNETH C KUNZE MD FMR SVP CHIEF MED OFFICER 557251 0 79798 0 28936 0 21789 0 4818 0 692592 0 0 0 ELLEN LANGFORD VP & COO WMG 215010 0 25595 0 10514 0 17494 0 19197 0 287810 0 0 0 LOUIS W LITTLE SVP POST ACUTE/HOSP PRES 0 241301 0 46915 0 15316 0 30800 0 23064 0 357396 0 0 ROBERT MANDLER VP DIAGNOSTIC OUTREACH 209039 0 45374 0 19930 0 45168 0 14553 0 334064 0 0 0 KIMBERLY W MENEFEE SVP MARKETING & GOV AFFAIRS 275658 0 43175 0 15549 0 28100 0 21450 0 383932 0 0 0 JONATHAN B MORRIS MD SVP CHIEF INFORMATION OFFICR 360500 0 104879 0 14172 0 22174 0 25700 0 527425 0 0 0 KEM M MULLINS SVP & HOSP PRESIDENT 0 370800 0 36921 0 21303 0 22600 0 21072 0 472696 0 0 BRADFORD B NEWTON VP INFORMATION TECH ADMIN 187990 0 17821 0 9279 0 20733 0 17994 0 253817 0 0 0 CRAIG OWENS SVP & HOSP PRESIDENT 0 263719 0 105293 0 13717 0 19770 0 20932 0 423431 0 0 LEO E REICHERT EXEC VP & GENERAL COUNSEL 477407 0 93142 0 24782 0 0 0 27431 0 622762 0 0 0 MICHELLE M ROBINSON VP MARKETING/PR/INTERNAL COMM 191580 0 29902 0 9496 0 13817 0 20165 0 264960 0 0 0 DEBORAH ROEGGE DE VITA VP WOMEN & NEWBORN SVC LINE 190963 0 41450 0 11557 0 0 0 8440 0 252410 0 0 0 CANDICE L SAUNDERS EXEC VP & COO 442689 88750 80407 16120 16296 3267 37680 7554 16997 3408 594069 119099 0 0 CHRISTOPHER B SCULLEN VP PULMONARY OPERATIONS 168216 0 19691 0 8700 0 953 0 1544 0 199104 0 0 0 JEFFERY D STANLEY VP PHARMACY & SYS COORD 172016 0 19203 0 9518 0 20004 0 7943 0 228684 0 0 0 JAMES M SWARTZ VP ACCOUNTING 195357 0 22869 0 10644 0 15918 0 20584 0 265372 0 0 0 MARY TAVERNARO VP HUMAN RESOURCES OPERATIONS 206877 0 24217 0 10441 0 27803 0 13384 0 282722 0 0 0 ADAM C THOMPSON VP SURGERY 162787 0 19056 0 20841 0 0 0 17822 0 220506 0 0 0 ANTHONY M TRUPIANO SVP SUPPLY CHAIN 261720 0 84521 0 15444 0 45600 0 1793 0 409078 0 0 0 MARY L WESLEY SVP NURSING SERVICES CNE 285516 0 48277 0 15840 0 43701 0 13159 0 406493 0 0 0 ROBIN WILSON MD SVP CHIEF INNOVATION OFFICER 386250 0 107359 0 16755 0 0 0 28431 0 538795 0 0 0 CHESTER ZBOROWSKI VP Health Park Operations 161710 0 35101 0 10529 0 0 0 18413 0 225753 0 0 0 BARRY MANGEL MD CHIEF CARDIAC SERVICES 618839 0 76084 0 5724 0 40100 0 28431 0 769178 0 0 0 WILLIAM R MAYFIELD MD CHIEF OF SURGERY SERVICES 527869 0 51034 0 3763 0 40100 0 21357 0 644123 0 0 0 ALAN R MUSTER MD CHIEF PULMONARY SERVICES 483374 0 56536 0 3193 0 40794 0 24880 0 608777 0 0 0 PERRY G BUSBEE MD CHIEF WOMENS SERVICES 307297 0 35403 0 5682 0 27946 0 24985 0 401313 0 0 0 SAID ELAHIHABI MD MD 998529 0 435634 0 4654 0 40100 0 26585 0 1505502 0 0 0 AHMAD KHALDI MD MD 875300 0 25728 0 5040 0 22600 0 25931 0 954599 0 0 0 WILLIAM BENEDICT JR MD MD 698798 0 249220 0 3161 0 34267 0 19524 0 1004970 0 0 0 MARK MCLAUGHLIN MD MD 640389 0 371218 0 3270 0 0 0 8705 0 1023582 0 0 0 PETER JUNGBLUT MD SVP & MEDICAL DIRECTOR 288480 0 47451 0 22336 0 40100 0 16295 0 414662 0 0 0 KRISTYN GREIFER MD VP POPULATION HEALTH MGMT 219245 0 36675 0 7788 0 0 0 10138 0 273846 0 0 0 JIMMY FRANCIS VP INFO TECHNOLOGY OPERATIONS 96160 0 39913 0 14270 0 0 0 580 0 150923 0 0 0 ELIZABETH LOUDERMILK VP ENT INTELLIGENCE & INTGRTN 206215 0 24140 0 10091 0 0 0 11978 0 252424 0 0 0 SANDRA LUCIUS VP INFO TECHNOLOGY APPS 161658 0 12427 0 3374 0 23999 0 2571 0 204029 0 0 0 BETHANY ROBERTSON VP & CHIEF LEARNING OFFICER 177162 0 16307 0 7176 0 11898 0 27419 0 239962 0 0 0 RICHARD SIEGEL VP CARDIOLOGY & CVM ADMIN 266559 0 59361 0 11909 0 40777 0 22033 0 400639 0 0 0 SALVATORE MANNINO MD 412489 0 363106 0 5040 0 40100 0 27406 0 848141 0 0 0 DANIEL WOODS SVP & HOSPITAL PRESIDENT 0 357456 0 49403 0 18158 0 44249 0 25378 0 494644 0 0 DANIEL STYF SVP PW HEALTH PLAN 148086 0 30000 0 7568 0 9327 0 4049 0 199030 0 0 0 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. 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 received severance pay during the period: Michael Graue $323,718; Kenneth Kunze, MD $334,351; and Elizabeth Person $41,928. OTHER COMPENSATION While WellStar Health System and its affiliates do not have a written policy regarding payment or reimbursement of the items listed in Part 1 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 III On Schedule J of IRS Form 990 the following individual was employed as an officer of WellStar Health System and/or its Affiliates during the reporting period but did not have salary and benefits in the calendar year for which this schedule applies: Kevin Deter. B HOSPITAL AUTHORITY OF COBB COUNTY 582464600 19081PEM4 2004-04-30 25000000 EQUIPMENT POOL false false false C COBB COUNTY KENNESTONE HOSPITAL AUTHORITY 581147004 190813LN3 2005-10-31 120000000 CAPITAL IMPROVEMENTS (Series A & B false false false D HOSPITAL AUTHORITY OF COBB COUNTY 582464600 19081PEN2 2006-06-30 25000000 EQUIPMENT POOL false false false B 0 0 25000000 0 0 0 0 0 0 25000000 0 0 2004 false false true true C 3875000 0 120000000 0 0 0 1167300 0 0 116948276 1884424 0 2007 false false true true D 0 0 25000000 0 0 0 0 0 0 25000000 0 0 2006 B false false false false 0 C false false false false 0.00020 0.00020 0.00040 D false false false 0 B false true true false 0 false 0 false C false true 0 false 0 false D false true 0 false 0 false B true C true D true SCH K PART V POST ISSUANCE TAX COMPLIANCE FOR TAX EXEMPT BONDS WELLSTAR HEALTH SYSTEM, INC (THE BORROWER ON TAX EXEMPT BONDS) HAS ESTABLISHED POLICIES AND PROCEDURES THAT WILL MAXIMIZE THE LIKELIHOOD THAT ALL APPLICABLE POST-ISSUANCE REQUIREMENTS OF FEDERAL INCOME TAX LAW NEEDED TO PRESERVE THE TAX-EXEMPT STATUS OF THE BONDS ARE MET. THE PROCEDURES INCLUDE EXTERNAL ADVISORS SUCH AS BOND COUNSEL AND OTHER LEGAL COUNSEL WHO ASSIST THE BORROWER IN MAINTAINING THE TAX-EXEMPT STATUS OF ALL BONDS; ARBITRAGE REBATE CALCULATIONS THAT NEED TO BE MADE FOR EACH BOND ISSUE; DOCUMENTATION OF THE USE OF BOND PROCEEDS INCLUDING POTENTIAL PRIVATE BUSINESS USE APPLICABLE TO THE BONDS AFTER AN ANNUAL INTERNAL REVIEW OF THOSE USES; AND PROPER RECORD KEEPING OF ALL DOCUMENTS RELATED TO THE ISSUANCE OF TAX-EXEMPT BONDS. THESE PROCEDURES APPLY TO ALL LISTED TAX-EXEMPT BONDS. A COBB COUNTY KENNESTONE HOSPITAL AUTHORITY 581147004 190813NM3 2011-11-01 127345930 CONSTRUCTION false false false B PAULDING COUNTY HOSPITAL AUTHORITY 586011214 703596DH6 2012-06-28 32711016 CONSTRUCTION SERIES A false false false C PAULDING COUNTY HOSPITAL AUTHORITY 586011214 703596DK9 2012-06-28 68750000 CONSTRUCTION SERIES B false false false D COBB COUNTY KENNESTONE HOSPITAL AUTHORITY 581147004 190813PH2 2012-11-15 122366879 ADVANCED REFUNDING CONSTRUCTION false false A 4205000 0 127345930 0 0 50962739 1383191 0 0 75000000 0 0 2011 true true false true B 0 0 32711016 14896852 446282 0 437500 0 0 17151433 0 0 false false false true C 0 0 68750000 27382125 1945963 0 471875 0 0 39576733 0 0 false false false true D 0 0 122366879 0 0 121287509 1079370 0 0 0 0 0 true true true A false false false 0 false false false B false false false 0 false false false C false false 0 D 0 A false true 0 false 0 false B false true false 0 false 0 false C false true true 0 false 0 false D false true false 0 false 0 false A true B true C true D true PAMELA ETHERIDGE WIFE OF OFFICER 61285 EMPLOYEE OF WELLSTAR false GREG FORTGANG SON-IN-LAW OF TRUSTEE 100521 EMPLOYEE OF WELLSTAR false JESSICA HANEY DAUGHTER OF OFFICER 62455 EMPLOYEE OF WELLSTAR false GEORGE FLEMING BROTHER OF OFFICER 66332 EMPLOYEE OF WELLSTAR/COBB false GREYSTONE POWER BOARD MEMBER 911408 EXPLANATION IN PART V false MATTHEW MADDOX SON OF BOARD MEMBER 78440 EMPLOYEE OF WELLSTAR false PUCKETT EMS AMBULANCE SERVICE BROTHER-IN-LAW OF OFFICER 168934 EXPLANATION IN PART V false BONNIE MILLER WIFE OF BOARD MEMBER 34394 EMPLOYEE OF WELLSTAR false GREG KOST BROTHER-IN-LAW OF OFFICER 49327 EMPLOYEE OF WELLSTAR false BRIAN BUSBEE SON OF KEY EMPLOYEE 84069 EMPLOYEE OF WELLSTAR false JENNIFER HANEY DAUGHTER-IN-LAW OF OFFCER 79812 EMPLOYEE OF WELLSTAR false SCH L PART IV TRANSACTIONS WITH INTERESTED PARTIES On Schedule L Part IV we have several interested parties that require additional explanation for the transactions: Board Trustee Gary Miller is President of Greystone Power which provides electric service to certain Wellstar Hospitals and Physician practices in the normal course of business. The total amount of the transactions with Greystone is $911,408--$601,917 related to Douglas Hospital, $163,626 and $145,865 related to Wellstar Medical Group. Steve Puckett is the brother-in-law of Ellen Langford, an officer with Wellstar Health System. Mr. Puckett is the President of Puckett EMS Ambulance Service which provides ambulance services to several Wellstar Health System affiliates. Individually all of the entity specific transactions are less than $100,000 but in aggregate total $168,934. All of these services or transactions are in the normal course of business within the system. VOLUNTEERS Form 990 Part I General Information WellStar Health System, Inc. through its affiliated business organizations operates five hospitals and throughout the system there are approximately 800 volunteers who make up the network of people who donate their time to serving our healthcare community. Kennestone Hospital, Inc. has approximately 400 volunteers between Kennestone and Windy Hill. The Cobb Auxiliary has approximately 200 volunteers. Douglas Hospital and Paulding Hospital have approximately 100 volunteers each in their respective auxiliaries. AUDITED FINANCIAL STATEMENTS Form 990 Part IV Line 12 and Part XI WellStar Health System, 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." PROCESS OF 990 BOARD REVIEW Form 990 PART VI LINE 11A Internal staff prepare the organization's Form 990. Before filing the return with the Internal Revenue Service an external accounting firm, PricewaterhouseCoopers, reviews and sign-offs on the completed return of each organization. Generally, 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. CONFLICT OF INTEREST POLICY FORM 990 PART VI SECTION B Line 12 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. PROCESS OF EXEC COMPENSATION FORM 990 PART VI SECTION B Lines 15a & 15b 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. Currently the executive compensation committee consists of five members of the Board of Trustees as well as the CEO. In committee discussions about the compensation for the Chief Executive Officer, the CEO will recuse himself from that process but 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 at the following committee meeting. DISCLOSURE OF FINANCIAL DOCUMENTS FORM 990 PART VI SECTION C Line 19 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. COMPENSATION INFORMATION ON FORM 990 FORM 990 PART VII COMPENSATION, PART IX LINES 5-7 & SCHEDULE J & J-1 ALL COMPENSATION AMOUNTS REPORTED ON FORM 990, PART VII, PART IX, LINES 5-7, AND SCHEDULE J REPRESENT COMPENSATION PROVIDED TO INDIVIDUALS THAT PROVIDE SERVICES TO THE ORGANIZATION. LIKEWISE, THE NUMBER OF EMPLOYEES REPORTED ON PART V, LINE 2A REPRESENTS 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). OFFICERS HOURS WORKED FORM 990 GENERAL STATEMENT & SCHEDULE J The officers devote their time to all of the organizations with WellStar Health System that are listed in Schedule R, Part II. As such, the total hours worked by the officers across all of the organizations exceeds 40 hours per week. Other Changes In Net Assets FORM 990 PART XI LINE 9 The other changes in net assets for Wellstar Health System, Inc. are as result of pension adjustments, assets released from restriction, and other changes in net assets, totaling ($58,056,456). Transactions with Related Organizations Form 990 Schedule R Part V Line 2 The dollar amounts reported on Form 990 Schedule R Part V Line 2 for WellStar Health System, Inc. include the overhead allocations to affiliates and consists of the following types of transactions as listed in Line 1 (a-r): h) Exchange of Assets, i) Lease of facilities, equipment, or other assets to other organizations, j) Lease of facilities, equipment, or other assets from other organizations, n) Sharing of paid employees, o) Reimbursement paid to other organizations, q) Other transfers of cash or property to other organizations, r) Other transfers of cash or property from other organizations. Wellstar Medical Group LLC 805 Sandy Plains Road Marietta GA 30066 273818647 Healthcare GA 62621914 WHS Inc Cobb Gynecologists 2 LLC 805 Sandy Plains Road Marietta GA 30066 020808099 Healthcare GA 0 NA South Cobb OB-GYN 2 LLC 805 Sandy Plains Road Marietta GA 30066 020808071 Healthcare GA 0 NA WellStar Acworth Family Practice LLC 805 Sandy Plains Road Marietta GA 30066 412243451 Healthcare GA 0 NA WellStar Atlanta General Surgery LLC 805 Sandy Plains Road Marietta GA 30066 264271578 Healthcare GA 0 NA WellStar Behavioral Health LLC 805 Sandy Plains Road Marietta GA 30066 582500211 Healthcare GA 0 NA Wellstar Cardiovascular Medicine LLC 805 Sandy Plains Road Marietta GA 30066 263557639 Healthcare GA 0 NA WellStar Cherokee Street Internal and Pr 805 Sandy Plains Road Marietta GA 30066 161735178 Healthcare GA 0 NA WellStar Cobb Family Medicine LLC 805 Sandy Plains Road Marietta GA 30066 582560699 Healthcare GA 0 NA WellStar Cobb Gynecologists LLC 805 Sandy Plains Road Marietta GA 30066 582502440 Healthcare GA 0 NA WellStar Cobb Hospitalists LLC 805 Sandy Plains Road Marietta GA 30066 753140245 Healthcare GA 0 NA WellStar Cobb Medical Group LLC 805 Sandy Plains Road Marietta GA 30066 582586050 Healthcare GA 0 NA WellStar Cobb Rehabilitation Medicine L 805 Sandy Plains Road Marietta GA 30066 582587322 Healthcare GA 0 NA WellStar Cobb Surgical Associates LLC 805 Sandy Plains Road Marietta GA 30066 562469675 Healthcare GA 0 NA WellStar Cooper Lake Family Medicine LL 805 Sandy Plains Road Marietta GA 30066 264295540 Healthcare GA 0 NA WellStar Cornerstone Family Medicine LL 805 Sandy Plains Road Marietta GA 30066 061745258 Healthcare GA 0 NA WellStar Cousins and Cantrell LLC 805 Sandy Plains Road Marietta GA 30066 582586291 Healthcare GA 0 NA WellStar Creekside Pediatrics LLC 805 Sandy Plains Road Marietta GA 30066 582499179 Healthcare GA 0 NA WellStar Douglas Surgical Associates LL 805 Sandy Plains Road Marietta GA 30066 300364595 Healthcare GA 0 NA WellStar Douglasville Medical Center at 805 Sandy Plains Road Marietta GA 30066 753245214 Healthcare GA 0 NA WellStar Douglasville Medical Center LL 805 Sandy Plains Road Marietta GA 30066 582577971 Healthcare GA 0 NA WellStar East Cobb Medical Center LLC 805 Sandy Plains Road Marietta GA 30066 582598851 Healthcare GA 0 NA WellStar East Paulding Pediatric Center 805 Sandy Plains Road Marietta GA 30066 582598855 Healthcare GA 0 NA WellStar East Paulding Primary Care Cent 805 Sandy Plains Road Marietta GA 30066 582598856 Healthcare GA 0 NA WellStar Infectious Disease LLC 805 Sandy Plains Road Marietta GA 30066 582502436 Healthcare GA 0 NA WellStar Internal Medicine Associates of 805 Sandy Plains Road Marietta GA 30066 582586054 Healthcare GA 0 NA WellStar Internal Medicine at Douglasvil 805 Sandy Plains Road Marietta GA 30066 582598842 Healthcare GA 0 NA WellStar Internal Medicine at Paulding 805 Sandy Plains Road Marietta GA 30066 300355547 Healthcare GA 0 NA WellStar Internal Medicine of Cobb LLC 805 Sandy 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NA WellStar Marietta Primary Care LLC 805 Sandy Plains Road Marietta GA 30066 582577979 Healthcare GA 0 NA WellStar Marietta Pulmonary Medicine LL 805 Sandy Plains Road Marietta GA 30066 582586292 Healthcare GA 0 NA WellStar Medical Specialists 2 LLC 805 Sandy Plains Road Marietta GA 30066 753261729 Healthcare GA 0 NA WellStar Medical Specialists LLC 805 Sandy Plains Road Marietta GA 30066 582586293 Healthcare GA 0 NA WellStar Midani Pediatric Practice LLC 805 Sandy Plains Road Marietta GA 30066 582598853 Healthcare GA 0 NA WellStar Neurosurgery LLC 805 Sandy Plains Road Marietta GA 30066 300067488 Healthcare GA 0 NA WellStar North Cobb Pediatrics LLC 805 Sandy Plains Road Marietta GA 30066 582518119 Healthcare GA 0 NA WellStar North Cobb Women's Health 2 LL 805 Sandy Plains Road Marietta GA 30066 412243450 Healthcare GA 0 NA WellStar North Cobb Women's Health LLC 805 Sandy Plains Road Marietta GA 30066 582499178 Healthcare GA 0 NA WellStar North Douglas OBGYN LLC 805 Sandy Plains Road Marietta GA 30066 582598852 Healthcare GA 0 NA WellStar Northwest Women's Care LLC 805 Sandy Plains Road Marietta GA 30066 582499181 Healthcare GA 0 NA WellStar Occupational Health LLC 805 Sandy Plains Road Marietta GA 30066 582510194 Healthcare GA 0 NA WellStar Palliative Medicine LLC 805 Sandy Plains Road Marietta GA 30066 223972021 Healthcare GA 0 NA WellStar Paulding Surgical Associates L 805 Sandy Plains Road Marietta GA 30066 743130874 Healthcare GA 0 NA WellStar Pediatric & Adolescent Center 805 Sandy Plains Road Marietta GA 30066 582570392 Healthcare GA 0 NA WellStar Pediatric & Family Wellness Cen 805 Sandy Plains Road Marietta GA 30066 264687089 Healthcare GA 0 NA WellStar Pediatric Professionals LLC 805 Sandy Plains Road Marietta GA 30066 320093335 Healthcare GA 0 NA WellStar Pediatrics at Brookstone LLC 805 Sandy Plains Road Marietta GA 30066 582598844 Healthcare GA 0 NA WellStar Phillips Women's Care LLC 805 Sandy Plains Road Marietta GA 30066 582586058 Healthcare GA 0 NA WellStar Physicians Group Douglas Hospit 805 Sandy Plains Road Marietta GA 30066 161735192 Healthcare GA 0 NA WellStar Physicians Group ENT LLC 805 Sandy Plains Road Marietta GA 30066 582473668 Healthcare GA 0 NA WellStar Physicians Group Hospitalists 805 Sandy Plains Road Marietta GA 30066 582461494 Healthcare GA 0 NA WellStar Physicians Group Pathologists 805 Sandy Plains Road Marietta GA 30066 582461493 Healthcare GA 0 NA WellStar Powder Springs Medical Center 805 Sandy Plains Road Marietta GA 30066 582586052 Healthcare GA 0 NA WellStar Rehab Medicine LLC 805 Sandy Plains Road Marietta GA 30066 582532917 Healthcare GA 0 NA WellStar Rheumatology Associates of Mari 805 Sandy Plains Road Marietta GA 30066 450559274 Healthcare GA 0 NA WellStar Shallowford Medical Center LLC 805 Sandy Plains Road Marietta GA 30066 582598849 Healthcare GA 0 NA WellStar Smyrna Primary Care Center LLC 805 Sandy Plains Road Marietta GA 30066 582598843 Healthcare GA 0 NA WellStar South Cobb Primary Care LLC 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GA 30066 582577976 Healthcare GA 0 NA WellStar Urgent Care on Sandy Plains Roa 805 Sandy Plains Road Marietta GA 30066 582598845 Healthcare GA 0 NA WellStar West Cobb Medical Center LLC 805 Sandy Plains Road Marietta GA 30066 582586288 Healthcare GA 0 NA WellStar Woodlawn Commons Family Practic 805 Sandy Plains Road Marietta GA 30066 582586053 Healthcare GA 0 NA Homecare Billing Services LLC 805 Sandy Plains Road Marietta GA 30066 582479534 Healthcare GA 2994511 NA Wellstar Windy Hill Apothecary LLC 805 Sandy Plains Road Marietta GA 30066 562511925 Healthcare GA 1102029 NA Wellstar Bi-County ENT LLC 805 Sandy Plains Road Marietta GA 30066 272258194 Healthcare GA 0 NA Wellstar Comprehensive Bariatric Srv LLC 805 Sandy Plains Road Marietta GA 30066 271716783 Healthcare GA 0 NA Wellstar Family Medicine LLC 805 Sandy Plains Road Marietta GA 30066 273565358 Healthcare GA 0 NA Wellstar Home Health LLC 805 Sandy Plains Road Marietta GA 30066 270277843 Healthcare GA 5812873 WHS Inc Wellstar Health Network LLC 805 Sandy Plains Road Marietta GA 30066 273870970 Healthcare GA WHS Inc Wellstar Health Ventures LLC 805 Sandy Plains Road Marietta GA 30066 453754932 Healthcare GA 883513 WHS Inc Wellstar IPA LLC 805 Sandy Plains Road Marietta GA 30066 581649541 Insurance GA 0 NA Wellstar Community Hospice LLC 805 Sandy Plains Road Marietta GA 30066 134350580 Healthcare GA 8807384 NA Center for Health Transformation 805 Sandy Plains Road Marietta GA 30066 581649541 Healthcare GA 0 NA CHS Foundation Inc 805 Sandy Plains Road Marietta GA 30066 581649540 Foundation GA 501(C)(3) 11 Type 2 WHS true Cobb Hospital Inc 805 Sandy Plains Road Marietta GA 30066 580968382 Healthcare GA 501(C)(3) 3 WHS true Douglas Hospital Inc 805 Sandy Plains Road Marietta GA 30066 582026750 Healthcare GA 501(C)(3) 3 WHS true Kennestone Hospital Inc 805 Sandy Plains Road Marietta GA 30066 582032904 Healthcare GA 501(C)(3) 3 WHS true Paulding Medical Center Inc 805 Sandy Plains Road Marietta GA 30066 582095884 Healthcare GA 501(C)(3) 3 WHS true Wellstar Foundation Inc 805 Sandy Plains Road Marietta GA 30066 581627413 Foundation GA 501(C)(3) 11 Type 2 WHS true Kennestone South Parking Deck 805 Sandy Plains Road Marietta GA 300666340 581649541 PARKING GA NA INVESTMENT 108373 1673218 false false 0.45000 Cobb Hospital Parking Company LLC 805 Sandy Plains Road Marietta GA 300666340 752999669 PARKING GA NA INVESTMENT 32610 727353 false false 0.62500 Community Assurance Co 3rd Fl Barclays Hse Shedden Rd George Town Cayman Islands CJ 581649541 INSURANCE CJ WHS INC C-CORP 64703036 1.00000 true false false false false false false false true true true false false false true true false true true Cobb Hospital Inc q 62612216 actual cost Douglas Hospital Inc q 22125350 actual cost Kennestone Hospital Inc q 134780804 actual cost Paulding Medical Center Inc q 13500132 actual cost