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COBB HOSPITAL: Form 990, tax year 2012

View the entire original 990 at ProPublica ↗

Organization
COBB HOSPITAL (EIN 58-0968382)
Tax period
2012-07-01 to 2013-06-30
Filed
2014-05-14
IRS object ID
201401349349304850
Schema version
2012v2.3
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

FieldValueIRS element (for citing)
Timestamp2014-05-14T13:19:24-05:00Timestamp
Tax Period End Date2013-06-30TaxPeriodEndDate

Preparer Firm PreparerFirm

Preparer Firm Business Name PreparerFirmBusinessName

FieldValueIRS element (for citing)
Business Name Line1PricewaterhouseCoopers LLPBusinessNameLine1

Preparer Firm US Address PreparerFirmUSAddress

FieldValueIRS element (for citing)
Address Line12001 MARKET ST SUITE 1700AddressLine1
CityPHILADELPHIACity
StatePAState
ZIP Code19103ZIPCode
FieldValueIRS element (for citing)
Return Type990ReturnType
Tax Period Begin Date2012-07-01TaxPeriodBeginDate

Filer Filer

FieldValueIRS element (for citing)
EIN580968382EIN

Name Name

FieldValueIRS element (for citing)
Business Name Line1COBB HOSPITAL INCBusinessNameLine1
FieldValueIRS element (for citing)
In Care Of Name% JAMES M SWARTZInCareOfName
Name ControlCOBBNameControl
Phone7707925023Phone

US Address USAddress

FieldValueIRS element (for citing)
Address Line1805 Sandy Plains RoadAddressLine1
Address Line2SuiteAddressLine2
CityMariettaCity
StateGAState
ZIP Code300666340ZIPCode

Officer Officer

FieldValueIRS element (for citing)
NameJAMES M SWARTZName
TitleVP ACCOUNTINGTitle
Phone7707925023Phone
Date Signed2014-05-14DateSigned
Authorize Third PartytrueAuthorizeThirdParty

Preparer Preparer

FieldValueIRS element (for citing)
Phone2673303000Phone
FieldValueIRS element (for citing)
Tax Year2012TaxYear
Build TS2015-11-30 17:44:51ZBuildTS

Form 990 IRS990

FieldValueIRS element (for citing)
Name Of Principal Officer PersonREYNOLD J JENNINGSNameOfPrincipalOfficerPerson

Address Principal Officer US AddressPrincipalOfficerUS

FieldValueIRS element (for citing)
Address Line1805 Sandy Plains RoadAddressLine1
CityMariettaCity
StateGAState
ZIP Code300666340ZIPCode
FieldValueIRS element (for citing)
Gross Receipts317624894GrossReceipts
Group Return For AffiliatesfalseGroupReturnForAffiliates
Organization501c3XOrganization501c3
Web Sitewww.wellstar.orgWebSite
Type Of Organization CorporationXTypeOfOrganizationCorporation
Year Formation1984YearFormation
State Legal DomicileGAStateLegalDomicile
Activity Or Mission DescriptionTo provide world-class charitable healthcare to the communityActivityOrMissionDescription
Nbr Voting Members Governing Body18NbrVotingMembersGoverningBody
Nbr Independent Voting Members14NbrIndependentVotingMembers
Total Nbr Employees2565TotalNbrEmployees
Total Nbr Volunteers200TotalNbrVolunteers
Total Gross UBI0TotalGrossUBI
Net Unrelated Business Txbl Income0NetUnrelatedBusinessTxblIncome
Contributions Grants Prior Year0ContributionsGrantsPriorYear
Contributions Grants Current Year0ContributionsGrantsCurrentYear
Program Service Revenue Prior Year312941906ProgramServiceRevenuePriorYear
Program Service Revenue CY311114035ProgramServiceRevenueCY
Investment Income Prior Year13150InvestmentIncomePriorYear
Investment Income Current Year-367715InvestmentIncomeCurrentYear
Other Revenue Prior Year5625666OtherRevenuePriorYear
Other Revenue Current Year6510859OtherRevenueCurrentYear
Total Revenue Prior Year318580722TotalRevenuePriorYear
Total Revenue Current Year317257179TotalRevenueCurrentYear
Grants And Similar Amnts Prior Year0GrantsAndSimilarAmntsPriorYear
Grants And Similar Amnts CY0GrantsAndSimilarAmntsCY
Benefits Paid To Members Prior Year0BenefitsPaidToMembersPriorYear
Benefits Paid To Members CY0BenefitsPaidToMembersCY
Salaries Etc Prior Year136487616SalariesEtcPriorYear
Salaries Etc Current Year137373481SalariesEtcCurrentYear
Total Prof Fundrsng Exp Prior Year0TotalProfFundrsngExpPriorYear
Total Prof Fundrsng Exp CY0TotalProfFundrsngExpCY
Total Fundrsng Exp Current Year0TotalFundrsngExpCurrentYear
Other Expense Prior Year151642508OtherExpensePriorYear
Other Expenses Current Year154174207OtherExpensesCurrentYear
Total Expenses Prior Year288130124TotalExpensesPriorYear
Total Expenses Current Year291547688TotalExpensesCurrentYear
Revenues Less Expenses Prior Year30450598RevenuesLessExpensesPriorYear
Revenues Less Expenses CY25709491RevenuesLessExpensesCY
Total Assets BOY188291475TotalAssetsBOY
Total Assets EOY198251107TotalAssetsEOY
Total Liabilities BOY126800535TotalLiabilitiesBOY
Total Liabilities EOY120234733TotalLiabilitiesEOY
Net Assets Or Fund Balances BOY61490940NetAssetsOrFundBalancesBOY
Net Assets Or Fund Balances EOY78016374NetAssetsOrFundBalancesEOY
Mission DescriptionTO 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.MissionDescription
Significant New Program ServicesfalseSignificantNewProgramServices
Significant ChangefalseSignificantChange
Expense250900375Expense
Revenue311114035Revenue
DescriptionAs discussed herein, Cobb Hospital, Inc (an affiliate of Wellstar Health System, Inc.) operates as a charitable organization consistent with the requirements of Internal Revenue Code Section 501(c)(3) and the "community benefit standard" of IRS Revenue Ruling 69-545. In this regard, the governing body of the organization and/or its parent is composed of prominent citizens in the community, medical staff privileges in the hospital are available to all qualified physicians in the area consistent with the size and nature of the facility; the hospital operates a full-time emergency room open to all regardless of ability to pay; the hospital provides care to the needy members of the community consistent with its charity care policy regardless of their ability to pay for these services. The hospital's excess funds are generally applied to expansion and replacement of existing facilities and equipment, amortization of indebtedness, improvement of patient care, community benefits activity, and charity care. Cobb Hospital reinvested a total of approximately $13.0 million in capital expenditures for equipment upgrades and other capital improvements to better serve the community. Cobb Hospital was organized in 1984. The hospital affiliated with the Northwest Georgia Health System in 1993. In 1994, Northwest Georgia Health System helped form the PROMINA Health System and changed its name to Promina Northwest Health System. In 1998 Promina Northwest changed its name to Wellstar Health System and is now totally independent of Promina. Cobb Hospital is subordinate to, and subject to the authority of Wellstar Health System and its governing boards including the Hospital Authority of Cobb County. Cobb Hospital provides a full range of inpatient and outpatient services characteristic of a community hospital. The hospital is licensed to operate 382 beds and is presently staffed to operate 370 beds. The original hospital was constucted in 1968 and several major structural additions have happened since that time. The following stats constitute the overall program services provided during the reporting period ended June 30, 2013: Adult Discharges-19,523 Med/Surg Short Stay days-5,526 Emergency Room Visits (incl pediatric ER)-105,234 Outpatient Surgical Cases-7,163 Inpatient Surgical Cases-3,899 Outpatient Procedures Non-ED OP Radiology-54,351 GI Laboratory-1,528 Total FTEs (paid)-1,932 Community Benefit Reporting Community Outreach-$1,019,877 Unreimbursed Charity Care (at cost)-$25,599,335 Medicaid Shortfalls (at cost)-$8,093,370 Total-$33,692,705 As an affiliate of Wellstar Health System, Cobb Hospital participates in many community and educational programs for the overall health and benefit of the area that they serve. Some examples of those programs are: Community Health/Education--screenings and educational opportunities such as denfensive driving for teens (offered at a minimal cost or at no cost), smoking cessation, heart smart school, CPR and others. System-wide over 54,000 residents from the community participated in these various screenings. More than 65,000 students learned about important health topics through our elementary and adolescent school health programs. The Public Relations department notifies the public of these offerings by publishing a quarterly mailer to community residents which costs the system over $80,000. Community Activities--sponsors blood drives, provides funding to school health programs for medical and dental preventive care. Community Events--Wellstar has an annual day for the Latino community geared at screenings and educational activities on a variety of health issues specifically for the Hispanic community. Sponsorships A group of employees also participated in the annual "Relay for Life" an event to raise funds and awareness for cancer research and prevention (held in conjunction with the American Cancer Society). System-wide a total of $22,000 was raised to support cancer research, education and patient services. Efforts are planned to expand this support in the coming years. Recognition and Accomplishments Cobb Hospital and Kennestone Hospital operate full-service clinics on the respective campuses to provide health related services to uninsured and underinsured who might not otherwise receive care. In FY2013 the clinics served a combined 8,000 patient visitors at a cost of almost $2.8 million. A clinic for senior wellness also opened in Cobb County. WellStar Cobb Hospital is ranked in the US News and World Report's Best Hospitals in Atlanta. The hospital was ranked as ninth in Atlanta and 15th in the state of Georgia in this annual report. Only nine hospitals were chosen from Atlanta's 60 institutions WellStar Cobb and Kennestone Hospitals received the United Total Joint Replacement Specialty Center Designation in recognition of the quality care in their repective units. Both hospitals received three-star ratings which is the highest possible. The hospitals met extensive quality and outcomes criteria based on nationally recognized medical standards and expert advice. In addition the total hip and knee joint replacement programs are certified by the Joint Commission. In October 2012 WellStar completed the systemwide implementation of a new cleaning process called Xenex. The process use 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 bacteria and many other organisms. All hospitals have a least one machine in operation. WellStar Cobb Hospital received four Joint Commission Disease-Specific Certifications (some mentioned previously). The hospital was recertified for hip replacement, knee replacement and primary stroke and received an initial certification for spinal surgery. The hospital has to demonstrate compliance with consensus-based national standards, effective use of appropriate, evidence-based clinical practice guidelines and collection and analysis of a minimum of four performance measures specific to the specialty care provided. WellStar Cobb expanded the innovative STAT Cancer Clinic concept that previously was only available at Kennestone Hospital. In this clinic patients see all members of the treatment and support team in one place and in one afternoon for an initial diagnosis. These clinics are the only true multidisciplinary services of their kind in metro Atlanta. With specialists in thoracic surgery, pulmonary, medical and radiation oncology the patient is guided through a treatment protocol that happens in days, not weeks or months. WellStar Cobb Hospital experienced such great success with the daVinci Surgical system that it was able to add a second system during the reporting period. The state of the art minimally invasive technology is used by gynecologic, urologic, thoracic, colorectal and general surgeons. The surgeons are able to work through smaller incisions, less pain for the patient, and faster recoveries with this technology. The Partnership for Health and Accountability of the Georgia Hospital Association presented two of its prestigious Quality and Patient Safety Awards to WellStar Cobb Hospital. One award relates to the timely and appropriate administration of antibiotics and the second relates to re-engineering discharge. Cobb Hospital also was presented with the Circle of Excellence Award for hospitals that demonstrate a sustained commitment to quality and safety having won multiple awards over the previous five years. To better serve behavioral health patients who visit WellStar Douglas Hospital's Emergency Department, the system began using an innovative technology to offer telemedicine. The technology is provided in a partnership with TeleHealth and allow psychiatrists at WellStar Cobb Hospital to securely and conveniently evaluate Douglas patients and expedite their discharge. With the success of the pilot program the system plans to expand to Paulding Hospital, which, like Douglas Hospital does not have on-site psychiatrists. 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 monthly basis to elevate performance measures at the hospital. As many consumers research healthcare performance measures in sources such as Health Grades, and US News and World Report it is important to focus on raising the hospitals position in the public. Cobb, Douglas, Paulding and Windy Hill hospitals have also joined in this initiative. Cobb Hospital has instituted an inpatient medical stablization service called New Vision. This service for adults with drug, alcohol and related health issues is a medically supervised, three-day hospital stay whichDescription
Total Program Service Expense250900375TotalProgramServiceExpense
Described In501 C3trueDescribedIn501C3
Schedule B RequiredfalseScheduleBRequired
Political ActivitiesfalsePoliticalActivities
Lobbying ActivitiesfalseLobbyingActivities
Donor Advised FundsfalseDonorAdvisedFunds
Conservation EasementsfalseConservationEasements
Collections Of ArtfalseCollectionsOfArt
Credit CounselingfalseCreditCounseling
Term Or Permanent EndowmentsfalseTermOrPermanentEndowments
Report Land Bldg EquiptrueReportLandBldgEquip
Report Invest Oth SecuritiesfalseReportInvestOthSecurities
Report Prog Rel InvestfalseReportProgRelInvest
Report Other AssetsfalseReportOtherAssets
Report Other LiabilitiestrueReportOtherLiabilities
Report Fin48 FootnotetrueReportFin48Footnote
Independent Audit Financial StmtfalseIndependentAuditFinancialStmt
Consolidated Audit Financial StmttrueConsolidatedAuditFinancialStmt
SchoolfalseSchool
Foreign OfficefalseForeignOffice
Foreign ActivitiesfalseForeignActivities
More Than5000 K To OrganizationsfalseMoreThan5000KToOrganizations
More Than5000 K To IndividualsfalseMoreThan5000KToIndividuals
Professional FundraisingfalseProfessionalFundraising
Fundraising ActivitiesfalseFundraisingActivities
GamingfalseGaming
HospitaltrueHospital
Financial Stmt AttachedtrueFinancialStmtAttached
Grants To OrganizationsfalseGrantsToOrganizations
Grants To IndividualsfalseGrantsToIndividuals
Schedule J RequiredtrueScheduleJRequired
Tax Exempt BondsfalseTaxExemptBonds
Excess Benefit TransactionfalseExcessBenefitTransaction
Prior Excess Benefit TransactionfalsePriorExcessBenefitTransaction
Loan To Officer Or DQPfalseLoanToOfficerOrDQP
Grant To Related PersonfalseGrantToRelatedPerson
Bsnss Rltnshp With OrganizationfalseBsnssRltnshpWithOrganization
Bsnss Rltnshp Thru Family MembertrueBsnssRltnshpThruFamilyMember
Officer Entity With Bsnss RltnshpfalseOfficerEntityWithBsnssRltnshp
Deductible Non Cash ContributionsfalseDeductibleNonCashContributions
Deductible Contributions Of ArtfalseDeductibleContributionsOfArt
TerminatedfalseTerminated
Partial LiquidationfalsePartialLiquidation
Disregarded EntityfalseDisregardedEntity
Related EntitytrueRelatedEntity
Related Org Controlled EntitytrueRelatedOrgControlledEntity
Transaction Related EntitytrueTransactionRelatedEntity
Transfers To Exempt Non Chrtbl OrgfalseTransfersToExemptNonChrtblOrg
Activities Conducted PartnershipfalseActivitiesConductedPartnership
Schedule O RequiredtrueScheduleORequired
Number Forms Transmitted With10960NumberFormsTransmittedWith1096
Number W2 G Included0NumberW2GIncluded
Number Of Employees2565NumberOfEmployees
Employment Tax Returns FiledtrueEmploymentTaxReturnsFiled
Unrelated Business IncomefalseUnrelatedBusinessIncome
Foreign Financial AccountfalseForeignFinancialAccount
Prohibited Tax Shelter TransfalseProhibitedTaxShelterTrans
Taxable Party NotificationfalseTaxablePartyNotification
Non Deductible ContributionsfalseNonDeductibleContributions
Quid Pro Quo ContributionsfalseQuidProQuoContributions
Form8282 Property Disposed OffalseForm8282PropertyDisposedOf
Funds To Pay PremiumsfalseFundsToPayPremiums
Premiums PaidfalsePremiumsPaid
Indoor Tanning ServicesfalseIndoorTanningServices
Info In Schedule O Part VIXInfoInScheduleOPartVI
Nbr Voting Governing Body Members18NbrVotingGoverningBodyMembers
Number Independent Voting Members14NumberIndependentVotingMembers
Family Or Business RelationshipfalseFamilyOrBusinessRelationship
Delegation Of Management DutiesfalseDelegationOfManagementDuties
Changes To Organizing DocstrueChangesToOrganizingDocs
Material Diversion Or MisusefalseMaterialDiversionOrMisuse
Members Or StockholderstrueMembersOrStockholders
Election Of Board MemberstrueElectionOfBoardMembers
Decisions Subject To ApprovaltrueDecisionsSubjectToApproval
Minutes Of Governing BodytrueMinutesOfGoverningBody
Minutes Of CommitteestrueMinutesOfCommittees
Officer Mailing AddressfalseOfficerMailingAddress
Local ChaptersfalseLocalChapters
Form990 Provided To Governing BodytrueForm990ProvidedToGoverningBody
Conflict Of Interest PolicytrueConflictOfInterestPolicy
Annual Disclosure Covered PersonstrueAnnualDisclosureCoveredPersons
Regular Monitoring EnforcementtrueRegularMonitoringEnforcement
Whistleblower PolicytrueWhistleblowerPolicy
Document Retention PolicytrueDocumentRetentionPolicy
Compensation Process CEOtrueCompensationProcessCEO
Compensation Process OthertrueCompensationProcessOther
Investment In Joint VenturefalseInvestmentInJointVenture
States Where Copy Of Return Is FiledGAStatesWhereCopyOfReturnIsFiled
Upon RequestXUponRequest

The Books Are In Care Of TheBooksAreInCareOf

FieldValueIRS element (for citing)
Name PersonJAMES M SWARTZNamePerson
Telephone Number7707925023TelephoneNumber

Address US AddressUS

FieldValueIRS element (for citing)
Address Line1805 SANDY PLAINS ROADAddressLine1
CityMariettaCity
StateGAState
ZIP Code300666340ZIPCode
FieldValueIRS element (for citing)
Info In Schedule O Part VIIXInfoInScheduleOPartVII

Form990 Part VII Section A Form990PartVIISectionA (77 entries)

TitleTitleAverage Hours Per WeekAverageHoursPerWeekAverage Hours Per Week RelatedAverageHoursPerWeekRelatedIndividual Trustee Or DirectorIndividualTrusteeOrDirectorReportable Comp From OrganizationReportableCompFromOrganizationReportable Comp From Related OrgsReportableCompFromRelatedOrgsOther CompensationOtherCompensationOfficerOfficerHighest Compensated EmployeeHighestCompensatedEmployeeFormerFormer
AVRIL P BECKFORD MD
TRUSTEE2.048.0X043348322804
RANDALL BENTLEY JR
TRUSTEE1.05.0X0191220
OTIS BRUMBY III
TRUSTEE1.07.0X041200
SHAN COOPER
TRUSTEE1.05.0X04680
ROBERT N CROSS MD
TRUSTEE1.05.0X051660
T E RUSTY DURHAM
TRUSTEE1.014.0X0372011410
THOMAS GEARHARD MD
TRUSTEE2.048.0X053332470106
DAVID HAFNER MD
TRUSTEE1.05.0X0213140
T FITZ JOHNSON
TRUSTEE1.05.0X0105510
CHARLES J JONES
TRUSTEE1.05.0X0158870
JANIE MADDOX
TRUSTEE CHAIR1.05.0X0168290
GARY A MILLER
TRUSTEE VICE CHAIR1.05.0X031400
STEVEN W OWEIDA MD
TRUSTEE1.05.0X0190410
TOM PHILLIPS
TRUSTEE1.05.0X025990
WALTER G ROBINSON
TRUSTEE1.05.0X096840
FRANK ROS
TRUSTEE1.05.0X09270
W ALLEN SEPARK
TRUSTEE1.07.0X091680
JEFFERY THARP MD
TRUSTEE2.048.0X060990965330
VALERY A AKOPOV MD
VP & CHIEF HOSPITALISTS2.048.0036929230115X
DAVID W ANDERSON
EXEC VP HR/OL/CCO2.048.00100911377916X
NICOLE V ASHE
VP FINANCE & CFO WMG2.048.0022920434796X
BARBARA G BALLARD
VP HOMECARE & HOSPICE2.048.0026923741328X
JOSEPH L BRYWCZYNSKI
SR VP HEALTH PARKS DEVELOPMENT2.048.0032140248393X
A JAMES BUDZINSKI
EXEC VP and CFO2.050.0081145272350X
DONALD CAMPBELL MD
SR VP PHYS EDUC & STUDENT AFF2.048.0044199754362X
LEE RANDOLPH COOK
VP MEDICINE & BEHAVIORAL HLTH2.048.0037858954807X
BARBARA B COREY
SR VP MANAGED CARE2.048.0043737649536X
BRUCE A DEAN
VP REAL ESTATE & DEP GEN COUNS2.048.0028950948725X
SARATH DEGALA
VP REVENUE CYCLE MANAGEMENT2.048.0012435410914X
MARCIA DELK-PAYNE MD
SR VP MED AFFAIRS & CQO2.048.0053713947333X
CAROL S EDWARDS
VP CARDIAC SERVICES2.048.0017250127149X
KENNETH D ETHERIDGE
VP FINANCE & HOSPITAL CFO50.00.0255939025385X
CLARENCE HARLEE EVINS JR
VP REVENUE CYCLE2.048.0019880122150X
MICHAEL L GRAUE
EXEC VP & COO2.048.0070441282434X
ELIZABETH A HOFFMANN
VP BUDGET & ANALYSIS2.048.0024263716592X
ROBERT D JANSEN
EXEC VP & PRES MEDICAL GROUP2.048.0065119166994X
REYNOLD J JENNINGS
PRESIDENT & CEO2.050.00157172664901X
CHRISTOPHER M KANE
SR VP STRATEGIC PLAN & BUS DEV2.048.0047849345700X
BETH KOST
VP COMPLIANCE/CHIEF PRIV OFCR2.048.0027921524478X
KENNETH C KUNZE MD
SR VP CHIEF MEDICAL OFFICER2.048.00112571676665X
ELLEN LANGFORD
VP & COO MED GRP2.048.0031239939496X
LOUIS W LITTLE
SR VP POST ACUTE & HOSP PRES2.048.0035695640332X
ROBERT MANDLER
VP DIAGNOSTIC OUTREACH2.048.0027334447743X
CAROL B MAXWELL
VP TALENT ACQUISTION2.048.0023946820708X
THOMAS W McNAMARA MD
VP MEDICAL AFFAIRS50.00.0324339029155X
KIMBERLY W MENEFEE
SR VP MARKETING & GOV AFFAIRS2.048.0039628153325X
JONATHAN B MORRIS MD
SR VP & CIO2.048.0042758843417X
KEM M MULLINS
SR VP & HOSPITAL PRESIDENT48.02.0471889033388X
BRADFORD B NEWTON
VP INFO TECH ADMIN2.048.00578543589X
ELIZABETH PERSON
VP & CNO PATIENT CARE SRVCS50.00.0253305029392X
LEO E REICHERT
EXEC VP & GENERAL COUNSEL2.048.0061166248028X
MICHELLE M ROBINSON
VP MARKETING/PR/INT COMMUNICAT2.048.0020121328691X
DEBORAH ROEGGE DE VITA
VP WOMEN & NEWBORN SERVICES2.048.0026696918003X
CHRISTOPHER B SCULLEN
VP PULMONARY OPERATIONS2.048.0020004910678X
JEFFERY D STANLEY
VP PHARMACY & SYSTEM COORD2.048.00606715109X
MICHAEL R STREETMAN
VP INFO TECH OPERATIONS2.048.00762436493X
JAMES M SWARTZ
VP ACCOUNTING2.048.0022625630541X
MARY L TAVERNARO
VP HUMAN RESOURCES OPERATIONS2.048.0024313524803X
ADAM C THOMPSON
VP SURGERY2.048.0019182822669X
ANTHONY M TRUPIANO
SR VP SUPPLY CHAIN2.048.0032732835439X
MARY L WESLEY
SR VP NURSING SRVCS & CNE2.048.0038349437702X
ROBIN WILSON MD
SR VP CHIEF INNOVATION OFFICER2.048.0046285543631X
ILONA L WOZNIAK
VP OPERATIONS & HOSP COO50.00.0285491013867X
CHESTER A ZBOROWSKI
VP HEALTH PARKS OPERATIONS2.048.0013771115717X
PETER JUNGBLUT MD
SR VP & MEDICAL DIRECTOR2.048.0000X
VERONICA MARTIN
VP & CHIEF NURSING OFFICER50.00.0000X
RICK SIEGEL
VP CARDIO SERVICE LINE2.048.0000X
KRISTYN GREIFER MD
VP POPULATION HLTH MGMT2.048.0000X
JOSEPH W HERZBERG
AVP HUMAN RESOURCES50.00.0192859033608X
ALLAN M HOFFMAN MD
EXEC DIR COMMUNITY CLINICS50.00.0184892025334X
BILLY A REID
DIR PHARMACY50.00.0163653021514X
TERRY L PALMISANO
EXEC DIR NURSING50.00.0155175020929X
WILLIAM GONZALEZ
MANAGER PHARMACY50.00.0146528028514X
CHARLES 'PETE' WOOD
FORMER TRUSTEE0.00.00130910X
RICHARD T LOPES MD
FORMER SR VP & PRES WMG0.00.0048042619938X
GREGORY L SIMONE MD
FORMER PRES & CEO0.00.0022676323597X
BONNIE L WILSON
FORMER EXEC VP & GEN COUNSEL0.00.0022723713210X
FieldValueIRS element (for citing)
Total Reportable Comp From Org2434070TotalReportableCompFromOrg
Total Reportable Comp Frm Rltd Orgs18796110TotalReportableCompFrmRltdOrgs
Total Other Compensation2051233TotalOtherCompensation
Number Individuals GT100 K92NumberIndividualsGT100K
Formers ListedtrueFormersListed
Total Comp GT150 KtrueTotalCompGT150K
Compensation From Other SourcesfalseCompensationFromOtherSources

Contractor Compensation ContractorCompensation (5 entries)

Address Line1AddressOfContractor/AddressUS/AddressLine1CityAddressOfContractor/AddressUS/CityStateAddressOfContractor/AddressUS/StateZIP CodeAddressOfContractor/AddressUS/ZIPCodeDescription Of ServicesDescriptionOfServicesCompensationCompensation
Martin General Contracting Inc
3633 Ivy Gulledge RdDALLASGA30132General Contracting1694699
Quest Diagnostics
PO BOX 740736ATLANTAGA30384LAB SERVICES922620
Batchelor and Kimball Inc
PO Box 70LITHONIAGA30058MAINTENANCE1261317
NATIONAL MEDICAL CARE DBA RCC MARIE
PO Box 101518ATLANTAGA303921518Medical Services924000
Quantum Radiology
598 Nancy Street Suite 100MARIETTAGA30060Diagnostic Services541229
FieldValueIRS element (for citing)
Number Of Contractors GT100 K26NumberOfContractorsGT100K
Total Contributions0TotalContributions

Program Service Revenue ProgramServiceRevenue (3 entries)

DescriptionDescriptionBusiness CodeBusinessCodeTotal Revenue ColumnTotalRevenueColumnRelated Or Exempt Function IncomeRelatedOrExemptFunctionIncome
PATIENT REVENUE621990311087064311087064
PATIENT EDUCATION6219902675526755
MEDICAL RECORDS621990216216
FieldValueIRS element (for citing)
Total Program Service Revenue311114035TotalProgramServiceRevenue

Investment Income InvestmentIncome

FieldValueIRS element (for citing)
Total Revenue Column0TotalRevenueColumn

Income From Invest Bond Proceeds IncomeFromInvestBondProceeds

FieldValueIRS element (for citing)
Total Revenue Column0TotalRevenueColumn

Royalties Revenue RoyaltiesRevenue

FieldValueIRS element (for citing)
Total Revenue Column0TotalRevenueColumn

Gross Rents GrossRents

FieldValueIRS element (for citing)
Real27605Real

Rental Income Or Loss RentalIncomeOrLoss

FieldValueIRS element (for citing)
Real27605Real
Personal0Personal

Net Rental Income Or Loss NetRentalIncomeOrLoss

FieldValueIRS element (for citing)
Total Revenue Column27605TotalRevenueColumn
Exclusion$27,605ExclusionAmount

Less Cost Oth Basis Sales Expenses LessCostOthBasisSalesExpenses

FieldValueIRS element (for citing)
Other367715Other

Gain Or Loss GainOrLoss

FieldValueIRS element (for citing)
Other-367715Other

Net Gain Or Loss Investments NetGainOrLossInvestments

FieldValueIRS element (for citing)
Total Revenue Column-367715TotalRevenueColumn
Exclusion-$367,715ExclusionAmount

Net Income From Fundraising Events NetIncomeFromFundraisingEvents

FieldValueIRS element (for citing)
Total Revenue Column0TotalRevenueColumn

Net Income From Gaming NetIncomeFromGaming

FieldValueIRS element (for citing)
Total Revenue Column0TotalRevenueColumn

Net Income Or Loss NetIncomeOrLoss

FieldValueIRS element (for citing)
Total Revenue Column0TotalRevenueColumn

Other Revenue Misc OtherRevenueMisc (3 entries)

DescriptionDescriptionTotal Revenue ColumnTotalRevenueColumnExclusionExclusionAmount
CAFETERIA1964015$1,964,015
PARKING769540$769,540
PHARMACY REVENUE3259437$3,259,437

Miscellaneous Revenue MiscellaneousRevenue

FieldValueIRS element (for citing)
Total Revenue Column490262TotalRevenueColumn
Exclusion$490,262ExclusionAmount
FieldValueIRS element (for citing)
Total Other Revenue6483254TotalOtherRevenue

Total Revenue TotalRevenue

FieldValueIRS element (for citing)
Total Revenue Column317257179TotalRevenueColumn
Related Or Exempt Function Income311114035RelatedOrExemptFunctionIncome
Exclusion$6,143,144ExclusionAmount

Grants To Domestic Orgs GrantsToDomesticOrgs

FieldValueIRS element (for citing)
Total0Total

Grants To Domestic Individuals GrantsToDomesticIndividuals

FieldValueIRS element (for citing)
Total0Total

Foreign Grants ForeignGrants

FieldValueIRS element (for citing)
Total0Total

Benefits To Members BenefitsToMembers

FieldValueIRS element (for citing)
Total0Total

Comp Current Officers Directors CompCurrentOfficersDirectors

FieldValueIRS element (for citing)
Total1722150Total
Program Services1508259ProgramServices
Management And General213891ManagementAndGeneral

Comp Disqual Persons CompDisqualPersons

FieldValueIRS element (for citing)
Total0Total

Other Salaries And Wages OtherSalariesAndWages

FieldValueIRS element (for citing)
Total108468492Total
Program Services94992735ProgramServices
Management And General13475757ManagementAndGeneral

Pension Plan Contributions PensionPlanContributions

FieldValueIRS element (for citing)
Total8896606Total
Program Services7791648ProgramServices
Management And General1104958ManagementAndGeneral

Other Employee Benefits OtherEmployeeBenefits

FieldValueIRS element (for citing)
Total10334591Total
Program Services9051035ProgramServices
Management And General1283556ManagementAndGeneral

Payroll Taxes PayrollTaxes

FieldValueIRS element (for citing)
Total7951642Total
Program Services6964048ProgramServices
Management And General987594ManagementAndGeneral

Fees For Services Management FeesForServicesManagement

FieldValueIRS element (for citing)
Total0Total

Fees For Services Legal FeesForServicesLegal

FieldValueIRS element (for citing)
Total10623Total
Management And General10623ManagementAndGeneral

Fees For Services Accounting FeesForServicesAccounting

FieldValueIRS element (for citing)
Total0Total

Fees For Services Lobbying FeesForServicesLobbying

FieldValueIRS element (for citing)
Total0Total

Fees For Services Prof Fundraising FeesForServicesProfFundraising

FieldValueIRS element (for citing)
Total0Total

Fees For Services Invst Mgmnt Fees FeesForServicesInvstMgmntFees

FieldValueIRS element (for citing)
Total0Total

Fees For Services Other FeesForServicesOther

FieldValueIRS element (for citing)
Total12399434Total
Program Services11656129ProgramServices
Management And General743305ManagementAndGeneral

Advertising Advertising

FieldValueIRS element (for citing)
Total45995Total
Program Services35269ProgramServices
Management And General10726ManagementAndGeneral

Office Expenses OfficeExpenses

FieldValueIRS element (for citing)
Total13287234Total
Program Services12703261ProgramServices
Management And General583973ManagementAndGeneral

Information Technology InformationTechnology

FieldValueIRS element (for citing)
Total0Total

Royalties Royalties

FieldValueIRS element (for citing)
Total0Total

Occupancy Occupancy

FieldValueIRS element (for citing)
Total3625906Total
Program Services339274ProgramServices
Management And General3286632ManagementAndGeneral

Travel Travel

FieldValueIRS element (for citing)
Total90957Total
Program Services58296ProgramServices
Management And General32661ManagementAndGeneral

Travel Entrtnmnt Public Officials TravelEntrtnmntPublicOfficials

FieldValueIRS element (for citing)
Total0Total

Conferences Meetings ConferencesMeetings

FieldValueIRS element (for citing)
Total60454Total
Program Services37579ProgramServices
Management And General22875ManagementAndGeneral

Interest Interest

FieldValueIRS element (for citing)
Total21526Total
Management And General21526ManagementAndGeneral

Payments To Affiliates PaymentsToAffiliates

FieldValueIRS element (for citing)
Total55787428Total
Program Services48858629ProgramServices
Management And General6928799ManagementAndGeneral

Depreciation Depletion DepreciationDepletion

FieldValueIRS element (for citing)
Total13376809Total
Program Services5196862ProgramServices
Management And General8179947ManagementAndGeneral

Insurance Insurance

FieldValueIRS element (for citing)
Total2492479Total
Management And General2492479ManagementAndGeneral

Other Expenses OtherExpenses (3 entries)

DescriptionDescriptionTotalTotalProgram ServicesProgramServicesManagement And GeneralManagementAndGeneral
REPAIRS & MAINTENANCE501931238503631168949
MEDICAL SUPPLIES477539574767410479853
OTHER EXPENSES20209318288419209

Total Functional Expenses TotalFunctionalExpenses

FieldValueIRS element (for citing)
Total291547688Total
Program Services250900375ProgramServices
Management And General40647313ManagementAndGeneral
Fundraising0Fundraising

Cash Non Interest Bearing CashNonInterestBearing

FieldValueIRS element (for citing)
BOY7025BOY
EOY6125EOY

Savings And Temp Cash Investments SavingsAndTempCashInvestments

FieldValueIRS element (for citing)
BOY27596BOY
EOY39723EOY

Pledges And Grants Receivable PledgesAndGrantsReceivable

FieldValueIRS element (for citing)
BOY0BOY
EOY0EOY

Accounts Receivable AccountsReceivable

FieldValueIRS element (for citing)
BOY51290559BOY
EOY59767668EOY

Receivables From Officers Etc ReceivablesFromOfficersEtc

FieldValueIRS element (for citing)
BOY0BOY
EOY0EOY

Receivables From Disqual Persons ReceivablesFromDisqualPersons

FieldValueIRS element (for citing)
BOY0BOY
EOY0EOY

Other Notes Loans Receivable Net OtherNotesLoansReceivableNet

FieldValueIRS element (for citing)
BOY0BOY
EOY0EOY

Inventories For Sale Or Use InventoriesForSaleOrUse

FieldValueIRS element (for citing)
BOY6174822BOY
EOY6632769EOY

Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges

FieldValueIRS element (for citing)
BOY1576039BOY
EOY3737204EOY
FieldValueIRS element (for citing)
Land Buildings Equipment Basis274639211LandBuildingsEquipmentBasis
Land Bldg Equipment Accum Deprec155852814LandBldgEquipmentAccumDeprec

Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet

FieldValueIRS element (for citing)
BOY119382073BOY
EOY118786397EOY

Investments Pub Traded Securities InvestmentsPubTradedSecurities

FieldValueIRS element (for citing)
BOY0BOY
EOY0EOY

Investments Other Securities InvestmentsOtherSecurities

FieldValueIRS element (for citing)
BOY0BOY
EOY0EOY

Investments Program Related InvestmentsProgramRelated

FieldValueIRS element (for citing)
BOY0BOY
EOY0EOY

Intangible Assets IntangibleAssets

FieldValueIRS element (for citing)
BOY0BOY
EOY0EOY

Other Assets Total OtherAssetsTotal

FieldValueIRS element (for citing)
BOY9833361BOY
EOY9281221EOY

Total Assets TotalAssets

FieldValueIRS element (for citing)
BOY188291475BOY
EOY198251107EOY

Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses

FieldValueIRS element (for citing)
BOY19872593BOY
EOY15299565EOY

Grants Payable GrantsPayable

FieldValueIRS element (for citing)
BOY0BOY
EOY0EOY

Deferred Revenue DeferredRevenue

FieldValueIRS element (for citing)
BOY0BOY
EOY0EOY

Tax Exempt Bond Liabilities TaxExemptBondLiabilities

FieldValueIRS element (for citing)
BOY0BOY
EOY0EOY

Escrow Account Liability EscrowAccountLiability

FieldValueIRS element (for citing)
BOY0BOY
EOY0EOY

Loans From Officers Directors LoansFromOfficersDirectors

FieldValueIRS element (for citing)
BOY0BOY
EOY0EOY

Mort Notes Pybl Secured Invest Prop MortNotesPyblSecuredInvestProp

FieldValueIRS element (for citing)
BOY29459BOY
EOY27748EOY

Unsecured Notes Loans Payable UnsecuredNotesLoansPayable

FieldValueIRS element (for citing)
BOY0BOY
EOY0EOY

Other Liabilities OtherLiabilities

FieldValueIRS element (for citing)
BOY106898483BOY
EOY104907420EOY

Total Liabilities TotalLiabilities

FieldValueIRS element (for citing)
BOY126800535BOY
EOY120234733EOY
FieldValueIRS element (for citing)
Follow SFAS117XFollowSFAS117

Unrestricted Net Assets UnrestrictedNetAssets

FieldValueIRS element (for citing)
BOY61490940BOY
EOY78016374EOY

Temporarily Restricted Net Assets TemporarilyRestrictedNetAssets

FieldValueIRS element (for citing)
BOY0BOY
EOY0EOY

Permanently Restricted Net Assets PermanentlyRestrictedNetAssets

FieldValueIRS element (for citing)
BOY0BOY
EOY0EOY

Total Net Assets Fund Balances TotalNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY61490940BOY
EOY78016374EOY

Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY188291475BOY
EOY198251107EOY
FieldValueIRS element (for citing)
Info In Schedule O Part XIXInfoInScheduleOPartXI
Reconcilation Revenue Expenses25709491ReconcilationRevenueExpenses
Reconcilation Other Changes-9184057ReconcilationOtherChanges
Method Of Accounting AccrualXMethodOfAccountingAccrual
Accountant Compile Or ReviewfalseAccountantCompileOrReview
FS AuditedtrueFSAudited

FS Audited Basis FSAuditedBasis

FieldValueIRS element (for citing)
Financial Statement ConsolidatedXFinancialStatementConsolidated
FieldValueIRS element (for citing)
Audit CommitteetrueAuditCommittee
Federal Grant Audit RequiredfalseFederalGrantAuditRequired

Schedule A IRS990ScheduleA

FieldValueIRS element (for citing)
Hospital170b1 AiiiXHospital170b1Aiii

Schedule D IRS990ScheduleD

FieldValueIRS element (for citing)
Art Public Exhibition AmtsArtPublicExhibitionAmts
Held Works Of Art AmtsHeldWorksOfArtAmts
Current Year Minus3 YearsCurrentYearMinus3Years
Current Year Minus4 YearsCurrentYearMinus4Years

Land Land

FieldValueIRS element (for citing)
Other Cost Or Other Basis4336556OtherCostOrOtherBasis
Book Value4336556BookValue

Buildings Buildings

FieldValueIRS element (for citing)
Other Cost Or Other Basis135682842OtherCostOrOtherBasis
Depreciation67739134Depreciation
Book Value67943708BookValue

Leasehold Improvements LeaseholdImprovements

FieldValueIRS element (for citing)
Other Cost Or Other Basis4462326OtherCostOrOtherBasis
Depreciation2632292Depreciation
Book Value1830034BookValue

Equipment Equipment

FieldValueIRS element (for citing)
Other Cost Or Other Basis129313869OtherCostOrOtherBasis
Depreciation85481388Depreciation
Book Value43832481BookValue

Other Land Buildings OtherLandBuildings

FieldValueIRS element (for citing)
Other Cost Or Other Basis843618OtherCostOrOtherBasis
Book Value843618BookValue
FieldValueIRS element (for citing)
Total Of Book Value Land Buildings118786397TotalOfBookValueLandBuildings
Federal Income Tax Liability0FederalIncomeTaxLiability

Other Liabilities OtherLiabilities (3 entries)

DescriptionDescriptionAmountAmount
ASSET RETIREMENT-OTHER LT LIAB$554,254
TAX EXEMPT BOND LIAB-DUE TO WH$104,351,392
OTHER LIABILITIES$1,774
FieldValueIRS element (for citing)
Total Of Amounts104907420TotalOfAmounts
Footnote In Part XIIIXFootnoteInPartXIII

Form990 Schedule D Part XIII Form990ScheduleDPartXIII

FieldValueIRS element (for citing)
IdentifierUncertain Tax PositionIdentifier
Return ReferenceSCHEDULE D PART X Line 2ReturnReference
ExplanationThe following is a footnote from the combined financial statements of Wellstar Health System, Inc. and Affiliates related to the reporting of the organization's liability for uncertain tax positions under FIN 48. "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 tax. Community Assurance Corportion 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."Explanation

Schedule H IRS990ScheduleH

FieldValueIRS element (for citing)
Charity Care PolicytrueCharityCarePolicy
Written PolicytrueWrittenPolicy
Policy Applied To All HospitalsXPolicyAppliedToAllHospitals
FPG Reference Free CaretrueFPGReferenceFreeCare

Other Percentage OtherPercentage

FieldValueIRS element (for citing)
OtherXOther
Free Other Percentage125.FreeOtherPercentage
FieldValueIRS element (for citing)
FPG Reference Discounted CaretrueFPGReferenceDiscountedCare
Pcent300XPcent300
Free Disc Care Medically IndigenttrueFreeDiscCareMedicallyIndigent
Amounts Budgeted For Charity CaretrueAmountsBudgetedForCharityCare
Expenses Exceeded BudgettrueExpensesExceededBudget
Unable To Provide CarefalseUnableToProvideCare
Annual Community Benefit ReporttrueAnnualCommunityBenefitReport
Report Publically AvailabletrueReportPublicallyAvailable

Charity Care At Cost CharityCareAtCost

FieldValueIRS element (for citing)
Total Community Benefit Expense25499335TotalCommunityBenefitExpense
Net Community Benefit Expense25499335NetCommunityBenefitExpense
Percent Of Total Expense0.08750PercentOfTotalExpense

Unreimbursed Medicaid UnreimbursedMedicaid

FieldValueIRS element (for citing)
Total Community Benefit Expense54229296TotalCommunityBenefitExpense
Direct Offsetting Revenue46135926DirectOffsettingRevenue
Net Community Benefit Expense8093370NetCommunityBenefitExpense
Percent Of Total Expense0.02780PercentOfTotalExpense

Total Charity Care TotalCharityCare

FieldValueIRS element (for citing)
Total Community Benefit Expense79728631TotalCommunityBenefitExpense
Direct Offsetting Revenue46135926DirectOffsettingRevenue
Net Community Benefit Expense33592705NetCommunityBenefitExpense
Percent Of Total Expense0.11530PercentOfTotalExpense

Community Health Services CommunityHealthServices

FieldValueIRS element (for citing)
Total Community Benefit Expense1019877TotalCommunityBenefitExpense
Net Community Benefit Expense1019877NetCommunityBenefitExpense
Percent Of Total Expense0.00350PercentOfTotalExpense

Total Other Benefits TotalOtherBenefits

FieldValueIRS element (for citing)
Total Community Benefit Expense1019877TotalCommunityBenefitExpense
Net Community Benefit Expense1019877NetCommunityBenefitExpense
Percent Of Total Expense0.00350PercentOfTotalExpense

Total Community Benefits TotalCommunityBenefits

FieldValueIRS element (for citing)
Total Community Benefit Expense80748508TotalCommunityBenefitExpense
Direct Offsetting Revenue46135926DirectOffsettingRevenue
Net Community Benefit Expense34612582NetCommunityBenefitExpense
Percent Of Total Expense0.11880PercentOfTotalExpense
FieldValueIRS element (for citing)
Bad Debt Expense ReportedtrueBadDebtExpenseReported
Bad Debt Expense$16,099,452BadDebtExpenseAmount
Amount Attributable To2173297AmountAttributableTo
Amount Reimbursed By Medicare99986470AmountReimbursedByMedicare
Cost Of Care Reimbursed By Medicare111071421CostOfCareReimbursedByMedicare
Medicare Surplus Or Shortfall-11084951MedicareSurplusOrShortfall

Costing Methodology Used CostingMethodologyUsed

FieldValueIRS element (for citing)
Cost To Charge RatioXCostToChargeRatio
FieldValueIRS element (for citing)
Written Debt Collection PolicytrueWrittenDebtCollectionPolicy
Provision For Charity CaretrueProvisionForCharityCare
Number Of Hospital Facilities1NumberOfHospitalFacilities

Form990 Schedule H Part V Section A Form990ScheduleHPartVSectionA

FieldValueIRS element (for citing)
Facility Number1FacilityNumber

Name Name

FieldValueIRS element (for citing)
Business Name Line1COBB HOSPITALBusinessNameLine1

Address Address

FieldValueIRS element (for citing)
Address Line13950 AUSTELL ROADAddressLine1
CityAUSTELLCity
StateGAState
ZIP Code30106ZIPCode
FieldValueIRS element (for citing)
Licensed HospitalXLicensedHospital
General Medical And SurgicalXGeneralMedicalAndSurgical
Er24 HoursXEr24Hours

Form990 Schedule H Part V Section B Form990ScheduleHPartVSectionB

Hospital Facility Name HospitalFacilityName

FieldValueIRS element (for citing)
Business Name Line1COBB HOSPITALBusinessNameLine1
FieldValueIRS element (for citing)
CHNA ConductedtrueCHNAConducted
Community DefinitionXCommunityDefinition
Community DemographicsXCommunityDemographics
Existing ResourcesXExistingResources
How Data ObtainedXHowDataObtained
Community Health NeedsXCommunityHealthNeeds
Other Health IssuesXOtherHealthIssues
Identifying ProcessXIdentifyingProcess
Consulting ProcessXConsultingProcess
Information GapsXInformationGaps
OtherXOther
Needs Assessment Conducted12NeedsAssessmentConducted
Take Into AccounttrueTakeIntoAccount
Other FacilitiesfalseOtherFacilities
CHNA Widely AvailabletrueCHNAWidelyAvailable
Own WebsiteXOwnWebsite
Adopt Implement StrategyXAdoptImplementStrategy
Develop Community PlanXDevelopCommunityPlan
Include Operational PlansXIncludeOperationalPlans
Prioritize Health NeedsXPrioritizeHealthNeeds
All Needs AddressedfalseAllNeedsAddressed
Organization Incur Excise TaxfalseOrganizationIncurExciseTax
Eligibility Criteria ExplainedtrueEligibilityCriteriaExplained
Uses FPG FreetrueUsesFPGFree
FPG Free Percent125.FPGFreePercent
Uses FPG DiscountedtrueUsesFPGDiscounted
FPG Discount Percent300.FPGDiscountPercent
Explains BasistrueExplainsBasis
Income LevelXIncomeLevel
Medical IndigencyXMedicalIndigency
Insurance StatusXInsuranceStatus
Uninsured DiscountXUninsuredDiscount
Medicaid MedicareXMedicaidMedicare
State RegulationXStateRegulation
Explains Application MethodtrueExplainsApplicationMethod
Includes Publicity MeasurestrueIncludesPublicityMeasures
Posted On WebsiteXPostedOnWebsite
Attached To InvoicesXAttachedToInvoices
Posted In Emergency RoomXPostedInEmergencyRoom
Posted In Admission OfficeXPostedInAdmissionOffice
Provided On AdmissionXProvidedOnAdmission
Available On RequestXAvailableOnRequest
Other PublicityXOtherPublicity
Actions On NonpaymenttrueActionsOnNonpayment
Collection ActivitiesfalseCollectionActivities
Notify Upon AdmissionXNotifyUponAdmission
Notify Before DischargeXNotifyBeforeDischarge
Notified All PatientsXNotifiedAllPatients
Documented DeterminationXDocumentedDetermination
Nondiscrim Emergency Care PolicytrueNondiscrimEmergencyCarePolicy
Average Negotiated RatesXAverageNegotiatedRates
Amounts Generally BilledfalseAmountsGenerallyBilled
Gross ChargesfalseGrossCharges

Form990 Schedule H Part VI Form990ScheduleHPartVI (17 entries)

IdentifierIdentifierReturn ReferenceReturnReferenceExplanationExplanation
Publication of Community Benefit ReportSch H Part I Line 6aCobb Hospital, Inc. 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.
Cost to Charge RatioSch H Part I Line 7For purposes of the IRS Form 990 Schedule H, Wellstar Health System and Affiliates (including Cobb 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.
Footnote on Bad Debt and Rationale for Community BenefitSch H Part III Line 4The following footnote is detailed in the Wellstar Health System, Inc. and Affiliates 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.
Medicare ShortfallsSchedule H Part III Line 8Cobb 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 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.
Collection PracticesSchedule H Part III Sec C Line 9bThe 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.
Hospital DescriptionSchedule H Part VCobb Hospital is a general acute care hospital providing a full range of services, is licensed to operate 382 beds, and is presently staffed to operate 370 beds. It is located on an approximately 55-acre campus in Austell, Georgia and is housed within a complex of connected buildings containing a total square footage in excess of 599,000 square feet. The original hospital was constructed in 1968 and major structural additions have been made in several phases since that time. The hospital provides medical, surgical, obstetrical, pediatric, rehabilitative, and psychiatric inpatient care and outpatient care, including emergency services. The Cobb Hospital Women's Center operates 20 labor and delivery rooms, 40 post partum rooms, 6 antipartum rooms and a resource center and classrooms offering educational opportunities.
Needs AssessmentSchedule H Part VI Line 2Wellstar Health System (and affiliates) is a key stakeholder in MAPP, Mobilizing for Action through Planning and Partnerships. 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, continous community involvement leads to community ownership of the process. Community ownership, in turn, increases the credibility and sustainability of the health improvement efforts.
Patient Education of Eligibility for AssistanceSch H Part VI Line 3Cobb Hospital provides its patients with hospital personnel or contracted personnel who are trained in all aspects of governmental programs, payments plans, charity discounts, and other financial assistance offered to assist them in their hospital bills. If the patient is eligible for federal or state assistance programs, a staff member is knowledgeable in the steps necessary to qualify those individuals. If a patient is indigent or charity eligible they will be offered assistance through the hospital's charity and indigent care policy including the state's indigent care trust fund. If the patient has no other insurance and fails to qualify for indigent care assistance, the financial counselor can then offer the patient an opportunity to accept a payment plan with discounted payment options based on their ability to pay immediately or over time. All patient are afforded these opportunities.
Community InformationSch H Part VI Line 4Cobb Hospital is one of five hospitals that are affiliated with the parent corporation, Wellstar Health System. The primary service area of the system is located in the Northwest Georgia area and receives the majority of its patients from one of five counties (Cherokee, Cobb, Douglas, Bartow and Paulding). Generally about 85% to 90% of the patient volume comes from this service area although other health systems have a presence in the area as well. Demographically the region is one of the fastest growing in the state as well as the country and the expansion of the services for the patient population reflects a desire to offer healthcare "closer to home" since Wellstar is considered a part of a larger metropolitan Atlanta market. Economically the region is strong in per capita income but given recent trends a rise in the uninsured and indigent population has occured.
Promotion of Community HealthSchedule H Part VI Line 5As stated in the Wellstar Health System, Inc and Affiliates audited financial statments for the period ended June 30, 2013, Cobb Hospital (an affiliate of Wellstar Health System, Inc.) operates as a charitable organization consistent with the requirements of Internal Revenue Code Sect 501 (c) (3) and the "community benefit standard" of IRS 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 qualifed 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; and the hospital provides care to the needy members of the community consistent with its charity care policy. The hospital's excess funds are genrally applied to expansion and replacement of existing facilities and equipment, amortization of indebtedness, improvement fo patient care, community benefit activities, and charity care. Cobb Hospital committed approximately $13.3 million in capital expenditures for the year to meet those needs.
Publication of Fin Assistance PolicySch H Part V Line 13gIn addition to the other methods of posting the financial assistance policy, the hospital makes available for patients in admissions and outpatient registration areas a brochure including frequently asked questions.
Other Info for Community Health Needs AssessmentPart V Section B Line 1jThe Community Health Needs Assessment also provides a list of WellStar Health System CHNA collaborators including individuals, organizations and governmental agencies consulted that contributed special knowledge of medically underserved and low income populations and/or expertise in public health.
CHNA Input from Community SourcesPart V Section B Line 3WellStar Cobb 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 and City Health Officials, the hospital leveraged the findings from community health needs assessments conducted for Tax Year 2012. Through a grant by the Centers for Disease Control and Prevention, WellStar Cobb 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 Include: 1. Georgia Department of Public Health, OASIS 2. Centers for Disease Control and Prevention-National Vital Stats 3. Agency for Healthcare Research and Quality (AHRQ) 4. US Census Bureau 5. US Department of Health and Human Services 6. Kaiser Permanente Web-Based CHNA Platform 7. Catholic Health Association CHNA resources 8. County Health Rankings and Roadmaps (Univ of Wisconsin) 9. Healthy People 2020 10.Behavorial Risk Factor Surveillance System (BRFSS) 11.Internal data showing service area zip codes for admission Qualitative Data Sources Include: 1. Cobb County Focus Group Report (based on various demographic groups of the zip codes represented) This includes two groups conducted in Spanish and reflecting 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. 3. Cobb key informant interview report--this included 20 participants identified by Cobb 2020's Community Strengths and Themes Workgroup to represent different sectors of the community who possessed above average knowledge of the healthcare issues, healthcare system or the community. 4. Cobb MAPP Community Survey Report--44 question telephone surveys of 1,233 adults 18-94 performed by the A.L. Burruss Institute for Public Service and Research at Kennesaw State University (university in the community served by the hospital) 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.
Facility Community Needs AssessmentPart V Section B Line 4While WellStar Cobb Hospital conducts its own community health needs assessment there may be some overlap with other hospitals in the healthcare system simply because of the geographic constraints and structure of the organization. The community served therefore will have common boundaries.
Explanation of Unaddressed NeedsPart V Section B Line 7Selection criteria for WellStar Cobb 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 the local school system, family and churches since the health needs are more cultural and societal. Improvement to health needs stemming from socioeconomic and physical environmental 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 governemental agencies to drive these types of health improvements. Key questions when addressing health needs are, do we have existing facilities and resources dedicated to the health needs showing clear disparities and poor performance? And 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? WellStar Health System will continue to address these and other questions.
Affiliated Health Care SystemPart VI Line 6WellStar Health System, Inc., as the parent corporation, and Cobb Hospital, Douglas Hospital, Kennestone Hospital, Paulding Medical Center and Windy Hill Hospital provide a variety of health care and related services to the community. In addition a nursing home, two residential hospice facilities, an assisted living facility and a group of mulitiple physicians provide a full continuum of care to the area we serve.
CHNA Implementation StrategySchedule H Part VI Item 2In order to access the proposed Community Health Needs Assessment Implementation Strategy for Cobb Hospital, Inc., a link has been established at www.wellstar.org under the "about us" tab of the website.

Schedule J IRS990ScheduleJ

FieldValueIRS element (for citing)
First Class Or Charter TravelXFirstClassOrCharterTravel
Travel For CompanionsXTravelForCompanions
Idemnification Gross Up PaymentsXIdemnificationGrossUpPayments
Discretionary Spending AccountXDiscretionarySpendingAccount
Housing Allowance Or ResidenceXHousingAllowanceOrResidence
Club Dues Or FeesXClubDuesOrFees
Written Policy Re T And E ExpensesfalseWrittenPolicyReTAndEExpenses
Substantiation RequiredtrueSubstantiationRequired
Compensation CommitteeXCompensationCommittee
Independent ConsultantXIndependentConsultant
Form990 Of Other OrganizationsXForm990OfOtherOrganizations
Written Employment ContractXWrittenEmploymentContract
Compensation SurveyXCompensationSurvey
Board Or Committee ApprovalXBoardOrCommitteeApproval
Severance PaymenttrueSeverancePayment
Supplemental Nonqual Retire PlantrueSupplementalNonqualRetirePlan
Equity Based Comp ArrangementfalseEquityBasedCompArrangement
Comp Based On Revenue Of Filing OrgfalseCompBasedOnRevenueOfFilingOrg
Comp Based On Revenue Related OrgsfalseCompBasedOnRevenueRelatedOrgs
Comp Based Net Earnings Filing OrgfalseCompBasedNetEarningsFilingOrg
Comp Based Net Earnings Relate OrgsfalseCompBasedNetEarningsRelateOrgs
Any Non Fixed PaymentstrueAnyNonFixedPayments
Initial Contract ExceptionfalseInitialContractException

Form990 Schedule J Part II Form990ScheduleJPartII (54 entries)

TitleTitleBase Compensation Filing OrgBaseCompensationFilingOrgComp Based On Related OrgsCompBasedOnRelatedOrgsBonus Filing OrgBonusFilingOrgBonus Related OrgsBonusRelatedOrgsOther Compensation Filing OrgOtherCompensationFilingOrgOther Compensation Related OrgsOtherCompensationRelatedOrgsDeferred Comp Filing OrgDeferredCompFilingOrgDeferred Comp Related OrgsDeferredCompRelatedOrgsNontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgNontaxable Benefits Related OrgsNontaxableBenefitsRelatedOrgsTotal Compensation Filing OrgTotalCompensationFilingOrgTotal Compensation Related OrgsTotalCompensationRelatedOrgsComp Report Prior990 Filing OrgCompReportPrior990FilingOrgComp Report Prior990 Related OrgsCompReportPrior990RelatedOrgs
AVRIL P BECKFORD MD
TRUSTEE03910980346820770302280400045628700
THOMAS GEARHARD MD
TRUSTEE0374127014989609301044344025762060343000
JEFFERY THARP MD
TRUSTEE04530520144219012638047325018005067523900
CHARLES 'PETE' WOOD
FORMER TRUSTEE0000013091000001309100
VALERY A AKOPOV MD
VP & CHIEF HOSPITALISTS028932004981903015302053009585039940700
DAVID W ANDERSON
EXEC VP HR/OL/CCO0396057011325604998000636750142410108702900
NICOLE V ASHE
VP FINANCE & CFO WMG019765502486806681014552020244026400000
BARBARA G BALLARD
VP HOMECARE & HOSPICE022140003913708700016066025262031056500
JOSEPH L BRYWCZYNSKI
SR VP HEALTH PARKS DEVELOPMENT0252245058357010800032749015644036979500
A JAMES BUDZINSKI
EXEC VP and CFO050765801473710156423054844017506088380200
DONALD CAMPBELL MD
SR VP PHYS EDUC & STUDENT AFF0313078071586057333040224014138049635900
LEE RANDOLPH COOK
VP MEDICINE & BEHAVIORAL HLTH0253643053103071843037847016960043339600
BARBARA B COREY
SR VP MANAGED CARE0280236080891076249034459015077048691200
BRUCE A DEAN
VP REAL ESTATE & DEP GEN COUNS0210603037339041567033613015112033823400
MARCIA DELK-PAYNE MD
SR VP MED AFFAIRS & CQO035228209099009386704413103202058447200
CAROL S EDWARDS
VP CARDIAC SERVICES0166152000634902261704532019965000
KENNETH D ETHERIDGE
VP FINANCE & HOSPITAL CFO1909390264450385550149010104840281324000
CLARENCE HARLEE EVINS JR
VP REVENUE CYCLE015771403337107716011150011000022095100
MICHAEL L GRAUE
EXEC VP & COO05326190157139014654051672030762078684600
ELIZABETH A HOFFMANN
VP BUDGET & ANALYSIS01992870346500870001010806484025922900
ROBERT D JANSEN
EXEC VP & PRES MEDICAL GROUP05199080118865012418046463020531071818500
REYNOLD J JENNINGS
PRESIDENT & CEO09818580562478027390064901000163662700
CHRISTOPHER M KANE
SR VP STRATEGIC PLAN & BUS DEV0321428074695082370024938020762052419300
BETH KOST
VP COMPLIANCE/CHIEF PRIV OFCR02303960401190870001645608022030369300
KENNETH C KUNZE MD
SR VP CHIEF MEDICAL OFFICER058115601004350444125068643080220120238100
ELLEN LANGFORD
VP & COO MED GRP019374203339408526303485404642035189500
LOUIS W LITTLE
SR VP POST ACUTE & HOSP PRES0233362058935064659024451015881039728800
RICHARD T LOPES MD
FORMER SR VP & PRES WMG0480426000001993800050036400
ROBERT MANDLER
VP DIAGNOSTIC OUTREACH0208264035125029955033059014684032108700
CAROL B MAXWELL
VP TALENT ACQUISTION02090710283970200001417706531026017600
THOMAS W McNAMARA MD
VP MEDICAL AFFAIRS279016036623087000185110106440353494000
KIMBERLY W MENEFEE
SR VP MARKETING & GOV AFFAIRS0264110090000123171036736016589044960600
JONATHAN B MORRIS MD
SR VP & CIO034623907228609063022886020531047100500
KEM M MULLINS
SR VP & HOSPITAL PRESIDENT23970601000000132183023951094370505277000
ELIZABETH PERSON
VP & CNO PATIENT CARE SRVCS215622028981087020150220143700282697000
LEO E REICHERT
EXEC VP & GENERAL COUNSEL04566290133697021336025403022625065969000
MICHELLE M ROBINSON
VP MARKETING/PR/INT COMMUNICAT017213902426804806012162016529022990400
DEBORAH ROEGGE DE VITA
VP WOMEN & NEWBORN SERVICES018595903208704892301169806305028497200
CHRISTOPHER B SCULLEN
VP PULMONARY OPERATIONS0163084028265087000102960382021072700
GREGORY L SIMONE MD
FORMER PRES & CEO0226763000009581014016025036000
JAMES M SWARTZ
VP ACCOUNTING018473003282608700013409017132025679700
MARY L TAVERNARO
VP HUMAN RESOURCES OPERATIONS019967403476108700014330010473026793800
ADAM C THOMPSON
VP SURGERY01552250273530925008055014614021449700
ANTHONY M TRUPIANO
SR VP SUPPLY CHAIN025370606261201101003543900036276700
MARY L WESLEY
SR VP NURSING SRVCS & CNE0302455069297011742027058010644042119600
BONNIE L WILSON
FORMER EXEC VP & GEN COUNSEL022723700000958103629024044700
ROBIN WILSON MD
SR VP CHIEF INNOVATION OFFICER02955610155781011513019506024125050648600
ILONA L WOZNIAK
VP OPERATIONS & HOSP COO24369403251709280011792020750299358000
CHESTER A ZBOROWSKI
VP HEALTH PARKS OPERATIONS0113075023010223350578409933015342800
JOSEPH W HERZBERG
AVP HUMAN RESOURCES171777019567015150115770220310226467000
ALLAN M HOFFMAN MD
EXEC DIR COMMUNITY CLINICS16915401453801200079220174120210226000
BILLY A REID
DIR PHARMACY1633030350000100500114640185167000
TERRY L PALMISANO
EXEC DIR NURSING1469940818100065170144120176104000
WILLIAM GONZALEZ
MANAGER PHARMACY1408710565700093230191910175042000

Form990 Schedule J Part III Form990ScheduleJPartIII (4 entries)

IdentifierIdentifierReturn ReferenceReturnReferenceExplanationExplanation
Non-Fixed PaymentsForm 990 Schedule J Part 1 Line 7As 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 (manager level employees and above). Those factors are: People goal for employee turnover Customer Service goal for employee engagement Quality & Safety goal for clinical excellence and patient satisfaction Financial goal for attaining a positive operating margin Confirmation of achieving these payout triggers is typically received through the annual external audit process and approved by the Board of Trustees at that time. In addition the incentive program has now been extended to all WellStar team members (non-manager level)on a somewhat smaller scale.
Severance BenefitsPursuant to their respective employment agreements, the following groups of officers are entitled to severance payments based on their base salary and wages at that time in the event of certain identified circumstances. The officers with a severance payment period of 24 months as per their contractual agreement are: David Anderson Reynold Jennings The officers with a severance payment period of 18 months as per their respective agreements are: Joseph Brywczynski; A James Budzinski; Donald Campbell MD; Barbara Corey; Marcia Delk MD; Michael Graue; T Mark Haney; Robert Jansen MD; Peter Jungblut MD; Christopher Kane; Kenneth Kunze MD; Lou Little; Richard Lopes MD; Kimberly Menefee; Jonathan Morris MD; Leo E Reichert; Ron Strachan; Anthony Trupiano; Mary L Wesley; Robin Wilson MD The officers with a severance payment period of 12 months as per their agreement: Valery Akopov; Nicole Ashe; Barbara Ballard; Randy Cook; Bruce Dean; Sarath Degala; Carol Edwards; Kenneth D Etheridge; Lee Evins; Kristyn Greifer, MD; Elizabeth Hoffmann; Beth Kost; Ellen Langford; Robert Mandler; Carol Maxwell; Veronica Martin; Thomas W McNamara, MD; Bradford Newton; Elizabeth Person; Michelle M Robinson; Deborah Roegge deVita; Christopher Scullen; Rick Siegel; Jeffery Stanley; Michael Streetman; James M Swartz; Mary L Tavernaro; Adam C Thompson; Ilona L Wozniak; Chester Zborowski. The following officers received severance pay during the period: Gregory L Simone $250,360; Bonnie Wilson $240,446; Richard T Lopes, MD $500,363 and Ronald Strachan $104,106
Other CompensationForm 990 Schedule J Part 1 Line 1b and 2While 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.
Compensation ExceptionsOn Schedule J of IRS Form 990 the following individuals were employed as officers of Wellstar Health System and its Affiliates during the reporting period but did not have salary and benefits in the calendar year for which this schedule applies: Peter Jungblut, MD; Guillermo Pierluisi, MD; Veronica Martin; Rick Siegel; and Kristyn Greifer, MD

Schedule L IRS990ScheduleL

Form990 Schedule L Part IV Form990ScheduleLPartIV (9 entries)

RelationshipRelationshipAmount Of TransactionAmountOfTransactionDescription Of TransactionDescriptionOfTransactionSharing Of RevenuesSharingOfRevenues
Pamela Etheridge
Wife of Officer60897Employee of Wellstarfalse
Greg Fortgang
Son-in-law of Trustee99034Employee of Wellstarfalse
Greg Separk
Son of Trustee23420Employee of Wellstarfalse
George Fleming
Brother of Officer65701Employee of Wellstarfalse
Matthew Maddox
Son of Trustee67037Employee of Wellstarfalse
Bonnie Miller
Wife of Trustee35100Employee of Wellstarfalse
Jessica Haney
Daughter of Officer57127Employee of Wellstarfalse
Greg Kost
Brother-in-law of Officer47539Employee of Wellstarfalse
Jennifer Haney
Daughter-in-law of Offcer77821Employee of Wellstarfalse

Form990 Schedule L Part V Form990ScheduleLPartV

FieldValueIRS element (for citing)
IdentifierBUSINESS TRANSACTIONS WITH INTERESTED PARTIESIdentifier
Return ReferenceSCHEDULE L PART IVReturnReference
ExplanationALL TRANSACTIONS LISTED ON SCHEDULE L PART IV ARE INDIVIDUALS RELATED TO EITHER BOARD MEMBERS OR OFFICERS WHO ARE ALSO EMPLOYEES OF WELLSTAR HEALTH SYSTEM, INC. - EIN 58-1649541. ALL SERVICES OR TRANSACTIONS ARE IN THE NORMAL COURSE OF BUSINESS WITHIN THE SYSTEM.Explanation

Schedule O IRS990ScheduleO

General Explanation GeneralExplanation (12 entries)

IdentifierIdentifierReturn ReferenceReturnReferenceExplanationExplanation
990 T Explanation of FilingForm 990 Part V Line 3Cobb Hospital generated no unrelated business income for the reporting period. As a result the attached 990T 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, 2013.
Form 990 Copy to Board of DirectorsForm 990 Part VI Line 11AInternal 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. 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.
Conflict of Interest PolicyForm 990 Part VI Section B Line 12 a-cOur 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 this 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 for determining Exec CompensationForm 990 Part VI Section B Line 15A & BWellstar 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 board members and the CEO for the system. In discussions about the compensation for the Chief Executive Officer, the acting 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 DOCUMENTSForm 990 Part VI Section C Line 19The 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.
CompensationForm 990 Part V Line 2All 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).
Organizational StructureForm 990 Part VI Line 6 & 7As per the articles of Incorporation, the sole member of the organization is Wellstar Health System, Inc., a GA nonprofit corporation. As sole member, Wellstar Health System holds certain powers of election and approval in connection with the governing body of the organization. These powers are presented in detail in the company's governing documents which the company makes available to the public upon request.
Officer's HoursForm 990 General StatementThe 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 of the organizations exceeds 40 hours per week.
AUDITED FINANCIAL STATEMENTSForm 990 Part IV Line 12 and Part XIWellStar 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."
Tax-Exempt Bonds AllocationForm 990 Part IV Line 24a & Part XFor 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). Cobb Hospital, Inc. will report this tax exempt bond liability on Part X, Line 25 Other Liabilities.
Other Changes in Net AssetsForm 990 Part XI Line 5For the reporting period Cobb Hospital, Inc. had a change in net assets of ($9,184,057) related to transfers to affiliates as part of the allocation of income statement and balance sheet transactions over the year.
Bylaws AmendmentsPart VI Line 4During the reporting period the Board of Trustees voted to amend the bylaws for WellStar Health System, Inc. to add an Audit Committee and a Compensation Committee as additional named board committees with authority to act on behalf of the governing body.

Schedule R IRS990ScheduleR

Form990 Schedule R Part II Form990ScheduleRPartII (6 entries)

Address Line1AddressUS/AddressLine1CityAddressUS/CityStateAddressUS/StateZIP CodeAddressUS/ZIPCodeEINEINPrimary ActivitiesPrimaryActivitiesLegal Domicile StateLegalDomicileStateExempt Code SectionExemptCodeSectionPublic Charity StatusPublicCharityStatusBusiness Name Line1DirectControllingEntityName/BusinessNameLine1Controlled OrgControlledOrg
CHS Foundation
805 Sandy Plains RoadMariettaGA30066581649540FoundationGA501 (C) 311 TYPE 2WHStrue
Douglas Hospital Inc
805 Sandy Plains RoadMariettaGA30066582026750HealthcareGA501 (C) 33WHStrue
Kennestone Hospital Inc
805 Sandy Plains RoadMariettaGA30066582032904HealthcareGA501 (C) 33WHStrue
Paulding Medical Center Inc
805 Sandy Plains RoadMariettaGA30066582095884HealthcareGA501 (C) 33WHStrue
Wellstar Foundation
805 Sandy Plains RoadMariettaGA30066581627413FoundationGA501 (C) 311 Type 2WHStrue
Wellstar Health System
805 Sandy Plains RoadMariettaGA30066581649541HealthcareGA501 (C) 311 Type 2NAfalse

Form990 Schedule R Part III Form990ScheduleRPartIII (2 entries)

Address Line1AddressUS/AddressLine1CityAddressUS/CityStateAddressUS/StateZIP CodeAddressUS/ZIPCodeEINEINPrimary ActivityPrimaryActivityLegal Domicile StateLegalDomicileStateBusiness Name Line1DirectControllingEntityName/BusinessNameLine1Predominant Income TypePredominantIncomeTypeDisproportionate AllocationsDisproportionateAllocationsGeneral Or Managing PartnerGeneralOrManagingPartner
Kennestone South Parking Deck
805 Sandy Plains RoadMariettaGA300666340582429775PARKINGGANAN/Afalsefalse
Cobb Hospital Parking Company LLC
805 Sandy Plains RoadMariettaGA300666340752999669PARKINGGANAN/Afalsefalse

Form990 Schedule R Part IV Form990ScheduleRPartIV

Name Of Related Org NameOfRelatedOrg

FieldValueIRS element (for citing)
Business Name Line1Community Assurance CoBusinessNameLine1

Address Foreign AddressForeign

FieldValueIRS element (for citing)
Address Line13rd Fl Barclays House Shedden RdAddressLine1
CityGeorge TownCity
Province Or StateGrand Cayman, BWIProvinceOrState
CountryCJCountry
FieldValueIRS element (for citing)
EIN581649541EIN
Primary ActivityINSURANCEPrimaryActivity
Legal Domicile Foreign CountryCJLegalDomicileForeignCountry

Direct Controlling Entity Name DirectControllingEntityName

FieldValueIRS element (for citing)
Business Name Line1WHS INCBusinessNameLine1
FieldValueIRS element (for citing)
Type Of EntityCTypeOfEntity
Controlled OrgtrueControlledOrg
FieldValueIRS element (for citing)
Receipt Of Int Ann Rents RoyaltiesfalseReceiptOfIntAnnRentsRoyalties
Gift Grant Or Cap Contr To Other OrgfalseGiftGrantOrCapContrToOtherOrg
Gift Grant Or Cap Contr Fr Other OrgfalseGiftGrantOrCapContrFrOtherOrg
Loans Or Guarantees To Other OrgfalseLoansOrGuaranteesToOtherOrg
Loans Or Guarantees From Other OrgfalseLoansOrGuaranteesFromOtherOrg
Sale Of Assets To Other OrgfalseSaleOfAssetsToOtherOrg
Purchase Of Assets From Other OrgfalsePurchaseOfAssetsFromOtherOrg
Exchange Of AssetsfalseExchangeOfAssets
Rental Of Facilities To Other OrgsfalseRentalOfFacilitiesToOtherOrgs
Rental Of Facilities Fr Other OrgstrueRentalOfFacilitiesFrOtherOrgs
Perform Of Services For Other OrgsfalsePerformOfServicesForOtherOrgs
Perform Of Services By Other OrgsfalsePerformOfServicesByOtherOrgs
Sharing Of FacilitiesfalseSharingOfFacilities
Sharing Of Paid EmployeesfalseSharingOfPaidEmployees
Reimbursement Paid To Other OrgfalseReimbursementPaidToOtherOrg
Reimbursement Paid By Other OrgfalseReimbursementPaidByOtherOrg
Other Transfer To Other OrgfalseOtherTransferToOtherOrg
Other Transfer From Other OrgfalseOtherTransferFromOtherOrg

Transactions Related Orgs Table TransactionsRelatedOrgsTable

Name Of Other Organization NameOfOtherOrganization

FieldValueIRS element (for citing)
Business Name Line1CHS Foundation IncBusinessNameLine1
FieldValueIRS element (for citing)
Transaction TypeKTransactionType
Amount Involved207861AmountInvolved
Method Of Amt DeterminationFMVMethodOfAmtDetermination