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KENNESTONE HOSPITAL INC: Form 990, tax year 2012

View the entire original 990 at ProPublica ↗

Organization
KENNESTONE HOSPITAL INC (EIN 58-2032904)
Tax period
2012-07-01 to 2013-06-30
Filed
2014-05-14
IRS object ID
201401349349304990
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)
Timestamp2014-05-14T13:29:52-05:00Timestamp
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)
EIN582032904EIN

Name Name

FieldValueIRS element (for citing)
Business Name Line1KENNESTONE HOSPITAL INCBusinessNameLine1
FieldValueIRS element (for citing)
In Care Of Name% JAMES M SWARTZInCareOfName
Name ControlKENNNameControl
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 Code30066ZIPCode
FieldValueIRS element (for citing)
Gross Receipts791485576GrossReceipts
Group Return For AffiliatesfalseGroupReturnForAffiliates
Organization501c3XOrganization501c3
Web Sitewww.wellstar.orgWebSite
Type Of Organization CorporationXTypeOfOrganizationCorporation
Year Formation1993YearFormation
State Legal DomicileGAStateLegalDomicile
Activity Or Mission DescriptionTo provide world-class charitable healthcare to the community.ActivityOrMissionDescription
Nbr Voting Members Governing Body18NbrVotingMembersGoverningBody
Nbr Independent Voting Members14NbrIndependentVotingMembers
Total Nbr Employees5336TotalNbrEmployees
Total Nbr Volunteers410TotalNbrVolunteers
Total Gross UBI586179TotalGrossUBI
Contributions Grants Prior Year0ContributionsGrantsPriorYear
Contributions Grants Current Year0ContributionsGrantsCurrentYear
Program Service Revenue Prior Year725011981ProgramServiceRevenuePriorYear
Program Service Revenue CY772656090ProgramServiceRevenueCY
Investment Income Prior Year32955InvestmentIncomePriorYear
Investment Income Current Year-468013InvestmentIncomeCurrentYear
Other Revenue Prior Year14573763OtherRevenuePriorYear
Other Revenue Current Year18814851OtherRevenueCurrentYear
Total Revenue Prior Year739618699TotalRevenuePriorYear
Total Revenue Current Year791002928TotalRevenueCurrentYear
Grants And Similar Amnts Prior Year2150GrantsAndSimilarAmntsPriorYear
Grants And Similar Amnts CY890GrantsAndSimilarAmntsCY
Benefits Paid To Members Prior Year0BenefitsPaidToMembersPriorYear
Benefits Paid To Members CY0BenefitsPaidToMembersCY
Salaries Etc Prior Year272571926SalariesEtcPriorYear
Salaries Etc Current Year289902566SalariesEtcCurrentYear
Total Prof Fundrsng Exp Prior Year0TotalProfFundrsngExpPriorYear
Total Prof Fundrsng Exp CY0TotalProfFundrsngExpCY
Total Fundrsng Exp Current Year0TotalFundrsngExpCurrentYear
Other Expense Prior Year350085746OtherExpensePriorYear
Other Expenses Current Year377828313OtherExpensesCurrentYear
Total Expenses Prior Year622659822TotalExpensesPriorYear
Total Expenses Current Year667731769TotalExpensesCurrentYear
Revenues Less Expenses Prior Year116958877RevenuesLessExpensesPriorYear
Revenues Less Expenses CY123271159RevenuesLessExpensesCY
Total Assets BOY529669305TotalAssetsBOY
Total Assets EOY571422413TotalAssetsEOY
Total Liabilities BOY292181675TotalLiabilitiesBOY
Total Liabilities EOY279660854TotalLiabilitiesEOY
Net Assets Or Fund Balances BOY237487630NetAssetsOrFundBalancesBOY
Net Assets Or Fund Balances EOY291761559NetAssetsOrFundBalancesEOY
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
Expense593708685Expense
Grants890Grants
Revenue772656090Revenue
DescriptionAs discussed herein, Kennestone 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; one of the hospitals operates a full-time emergency room open to all regardless of the ability to pay; the hospital provides care to needy members of its community consistent with its charity care policy regardless of their ability to pay for these services and admits as patients those able to pay for care, either themselves or through third-party payers such as private health insurance or government programs such as Medicare and Medicaid; and the hospital's excess funds are generally applied to expansion and replacement of existing facilities and equipment, amortization of indebtedness, improvement in patient care, community benefit activities, and charity care. Kennestone Hospital, Inc. consists of two hospitals, Wellstar Kennestone and Wellstar Windy Hill. These hospitals combined to invest approximately $101.4 million in capital expenditures for the fiscal period. Wellstar Kennestone Hospital is a general acute hospital which provides a full range of inpatient and outpatient services for the overall health of the community. The hospital is located in Marietta, Georgia. The original hospital was constructed in 1950. The present main building was constructed in 1975. Kennestone is licensed to operate 633 beds and is currently staffed to operate 588 beds. Wellstar Windy Hill Hospital is located in the unincorporated area of Cobb County in northwest metropolitan Atlanta. It is an acute care hospital concentrating at the present time on long term care inpatient and outpatient services. The original structure was built in 1973 and renovated in 1987. The beds at Windy Hill serve medically complex patients whose average stay is approximately 30 days. Kennestone Hospital, Inc. affiliated with 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. Wellstar became totally independent of Promina in 2000. Kennestone Hospital, Inc. was organized in 1993 and is subordinate to, and subject to the authority of, Wellstar Health System and its governing board. Kennestone offers most major inpatient clinical services, a variety of outpatient services, women's services and open heart surgery. It is one of the largest hospitals in the state of Georgia. Kennestone is also home to a variety of state-of-the-art procedures and equipment not offered elsewhere in the larger Atlanta metro service area. The hospital has also opened several satellite outpatient imaging centers to provide easier access to our patient population. One additional service offered on the campus of Kennestone is called Atherton Place. This residential facility provides independent housing as well as assisted living to residents needing these services--especially the elderly. Kennestone also now operates a residential hospice facility at Kennesaw Mountain near the Kennestone campus. Windy Hill has transitioned its focus to long-term inpatient and outpatient services. These services include a concentration in geriatrics, rehabilitation, orthopedics and senior care. An additional service offered at Windy Hill Hospital includes a women's imaging department. The following stats constitute the overall program services for the period ended June 30, 2013: Kennestone Hospital Total Adult Discharges-35,895 Med/Surg Short StayCases-1,073 Newborn Discharges-5,418 Emergency Room Visits-122,883 Total surgery cases-22,736 Non ED OP Radiology Procedures-151,685 Cath Lab Procedures-6,754 GI Lab Procedures-3,509 Radiology Oncology procedures-16,145 Total FTEs (Paid)-3,880 Windy Hill Hospital Total Adult Discharges-379 Total Surgery Cases-2,200 Non ED OP Radiology Procedures-10,205 GI Lab Procedures-312 Sleep Lab Procedures-1,928 Total FTEs (Paid)-248 Community Benefit Reporting Community Outreach and Health Improvements-$1,566,595 Unreimbursed Charity Care (at cost)-$44,751,019 (based on charges of $159.5 million) Health professions education-$221,678 Medicaid Shortfalls(at cost)-$5,664,727 Total community benefit expense for the two hospitals was $52,204,019. Community Benefits Detail Kennestone and Windy Hill, affiliates of Wellstar Health System, participate in many community and educational programs for the overall health and benefit of the area that it serves. The following are examples of programs or services that are provided by Kennestone Hospital, Inc. for the charitable benefit of the community: Community Health/Education Wellstar's Marketing and Public Relations department provides free brochures on a variety of health-related topics such as blood pressure, diabetes, cholesterol, osteoporosis, and nutrition. Kennestone Hospital specifically offers the community the space and instructors for many support groups and educational opportunities--some free of charge and others at a nominal fee (examples of the offerings are women's health, palliative care, birthing classes, etc.) Kennestone and Windy Hill also offer free and/or low cost screenings for health issues such as blood pressure, cholesterol, flu shots, and others. System-wide for the reporting period over 200,000 area residents were seen at either the screenings or health fairs. School Health Program--This program is operated in conjunction with area school systems and seeks to teach school-aged children about health and safety topics such as dental health, water safety, seat belt safety and others. Safe Kids-Cobb/Cherokee Wellstar and the Cobb Public Health Department sponsor safety education events on an annual basis to the community, specifically the Cobb County area. The safety initiatives are centered around car seat checks, bike helmets, water safety and other preventive initiatives. The mission is to reduce the number of accidental injuries for children ages 14 and under. The SafeKids Cobb program provided 1,700 car seat checks with a number of car seats distributed to families in need. The Partner-in-Education program provides health-related supplies and support to area elementary and middle schools. Through the "Partners in Ministry" program, the Pastoral Care Department leads a partnership between the health system and local area congregations to link between the spiritual and clinical community needs. Sponsorships and Community Activities As part of the October Breast Cancer Awareness Month WellStar and the WellStar Cancer Network has partnered with a local television station to sponsor "Buddy Check 11", an 11Alive program designed to encourage breast self exam. The participants choose a buddy and subsequently remind their buddy to perform a monthly self exam. The program is now in its third year. WellStar Health System was the only Atlanta health system honored with a "Celebrating Our Heritage" Award by Renovacion Conyugal, a nonprofit organization dedicated to strengthening, supporting and empowering Latino youth. WellStar has a 10-year partnership with the organization to provide financial and facility support. Team members from the Acworth Health Park participated in the building of a Habitat for Humanity home in Acworth, Georgia. The home was built on property donated to Northwest Atlanta Habitat by a retired Army Lt Col Ashley Ivey before his passing. He had stipulated that a home be built and presented to a disabled veteran. Accomplishments and Recognition Kennestone and Windy Hill Hospitals are accredited by the Joint Commission. Wellstar was granted accreditation by the Intersocietal Commission for the Accreditation of Echocardiography Labs after rigorous testing and quality outcomes for diagnosis of heart disease. All five Wellstar hospital labs earned "Accreditation with Distinction" from the College of American Pathologists (CAP), recognized as one of the most stringent in laboratory quality assurance. Wellstar's labs are part of the 6,000 CAP-accredited laboratories nationwide. Wellstar Sleep Disorders Center at Windy Hill Hospital offers world class care as one of the 10 largest sleep centers nationwide. The center consists of 12 rooms with more board-certified sleep specialists on staff than any sleep center in the southeast US. The program is accredited by the American Academy of Sleep Medicine. As affiliates of Wellstar Health System, Kennestone and Windy Hill are part of a system that is ranked in the Top 100 in the nation according to Verispan's annual listing of the Top 100 InDescription
Total Program Service Expense593708685TotalProgramServiceExpense
Described In501 C3trueDescribedIn501C3
Schedule B RequiredfalseScheduleBRequired
Political ActivitiesfalsePoliticalActivities
Lobbying ActivitiesfalseLobbyingActivities
Subject To Proxy TaxfalseSubjectToProxyTax
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 EntityfalseTransactionRelatedEntity
Transfers To Exempt Non Chrtbl OrgfalseTransfersToExemptNonChrtblOrg
Activities Conducted PartnershipfalseActivitiesConductedPartnership
Schedule O RequiredtrueScheduleORequired
Number Forms Transmitted With10960NumberFormsTransmittedWith1096
Number W2 G Included0NumberW2GIncluded
Number Of Employees5336NumberOfEmployees
Employment Tax Returns FiledtrueEmploymentTaxReturnsFiled
Unrelated Business IncometrueUnrelatedBusinessIncome
Form990-T FiledtrueForm990-TFiled
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
Excess Business HoldingsfalseExcessBusinessHoldings
Taxable DistributionsfalseTaxableDistributions
Distribution To DonorfalseDistributionToDonor
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 (80 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
TE 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
BETTY ANN BRAKOVICH
VP/CNO PATIENT CARE SRVCS WH50.00.0187026021552X
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
LAURA CARAMANICA
VP/CNO PATIENT CARE SRV KENN50.00.0300131043634X
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 COUN2.048.0028950948725X
SARATH DEGALA
VP REVENUE CYCLE MGMT2.048.0012435410914X
MARCIA DELK-PAYNE MD
SR VP MED AFFAIRS & CQO2.048.0053713947333X
CAROL S EDWARDS
VP CARDIAC SERVICES2.048.0017250127149X
CLARENCE HARLEE EVINS JR
VP REVENUE CYCLE2.048.0019880122150X
MICHAEL L GRAUE
EXEC VP & COO2.048.0070441282434X
MARTIN L GUTKIN
VP FINANCE & HOSPITAL CFO50.00.0239282017552X
ELIZABETH A HOFFMANN
VP BUDGET & ANALYSIS2.048.0024263716592X
ROBERT D JANSEN MD
EXEC VP & PRES WMG2.048.0065119166994X
REYNOLD J JENNINGS
PRESIDENT & CEO2.050.00157172664901X
CHRISTOPHER M KANE
SR VP STRATEGIC PLAN & BUS DEV2.048.0047849345700X
BETH KOST
VP COMPLIANCE & CHIEF PRIVACY2.048.0027921524478X
KENNETH C KUNZE MD
SR VP & CHIEF MEDICAL OFFICER2.048.00112571676665X
ELLEN LANGFORD
VP & COO WELLSTAR PHYS GRP2.048.0031239939496X
LOUIS W LITTLE
SR VP POST ACUTE & HOSP PRES40.010.0356956040332X
ROBERT M LUBITZ MD
VP MEDICAL AFFAIRS KH50.00.07673103673X
ROBERT MANDLER
VP DIAGNOSTIC OUTREACH2.048.0027334447743X
CAROL B MAXWELL
VP TALENT ACQUISTION2.048.0023946820708X
PATRICIA A MAYNE
VP EMERGENCY SERVICES50.00.0202664036387X
KIMBERLY W MENEFEE
SR VP MARKETING & GOV AFFAIRS2.048.0039628153325X
JONATHAN B MORRIS MD
SR VP & CIO2.048.0042758843417X
BRADFORD B NEWTON
VP INFO TECHNOLOGY ADMIN2.048.00578543589X
LEO E REICHERT
EXEC VP & GENERAL COUNSEL2.048.0061156248028X
MICHELLE M ROBINSON
VP MARKETING, PR INTERNAL COMM2.048.0020121328691X
DEBORAH ROEGGE DE VITA
VP WOMEN & NEWBORN2.048.0026696915303X
CANDICE L SAUNDERS
EXEC VP & HOSP PRESIDENT48.02.0554816060784X
CHRISTOPHER B SCULLEN
VP PULMONARY OPERATIONS2.048.0020004910678X
JEFFERY D STANLEY
VP PHARMACY & SYS COORDINATOR2.048.00606715109X
MICHAEL R STREETMAN
VP INFO TECHNOLOGY 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
JERRY TILLERY
VP OPERATIONS KENNESTONE50.00.0205990018045X
AMANDA ELIZ T TRASK
VP PROF & SUPPORT SRVCS KH50.00.0184767032597X
ANOTHONY M TRUPIANO
SR VP SUPPLY CHAIN2.048.0032732835439X
MARY L WESLEY
SR VP NURSING SERVICES CNE2.048.0038349437702X
ROBIN WILSON MD
SR VP CHIEF INNOVATION OFFICER2.048.0046285543631X
DANIEL J WOODS
SR VP & COO KENN HOSPITAL50.00.0299410026380X
CHESTER A ZBOROWSKI
VP HEALTH PARK OPERATIONS2.048.0013771115717X
KRISTYN GREIFER MD
VP POPULATION HLTH MGMT2.048.0000X
PETER JUNGBLUT MD
SR VP & MEDICAL DIRECTOR2.048.0000X
RICK SEIGEL
VP CARDIO SRVC & MED ADMIN2.048.0000X
JYOTSNA R VANAPALLI
RADIATION ONCOLOGY PHYSICIST50.00.0170876021070X
MARK G VAN EWYK
PHARMACIST SPECIALTY50.00.0168535016196X
ROBERT J DeCOUX
AVP HUMAN RESOURCES50.00.0163878026571X
HEATHER S ROCHFORD
MANAGER PHARMACY50.00.0164331021162X
DONNA H THOMAS
AVP QUALITY SRV & PATIENT SAFE50.00.016762207423X
CHARLES 'PETE WOOD
TRUSTEE0.00.00130910X
RICHARD T LOPES MD
FORMER SR VP & PRES WMG0.00.0048042619938X
GREGORY L SIMONE
FORMER PRES & CEO0.00.0022676323597X
BONNIE L WILSON
FORMER EXEC VP & GEN COUNSEL0.00.0022723713210X
FieldValueIRS element (for citing)
Total Reportable Comp From Org3443015TotalReportableCompFromOrg
Total Reportable Comp Frm Rltd Orgs18439054TotalReportableCompFrmRltdOrgs
Total Other Compensation2140473TotalOtherCompensation
Number Individuals GT100 K165NumberIndividualsGT100K
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
Brasfield Gorrie
1990 Vaughn Rd NW Suite 100KENNESAWGA30144General Contractor39917793
CDH Partners
675 Tower RoadMARIETTAGA30060General Contractor2821887
Cork-Howard Construction Inc
2121 New Market Pkwy Suite 118MARIETTAGA30067General Contractor2505234
Inglett and Stubbs LLC
PO Box 932506ATLANTAGA311932506General Contractor2343913
Quest Diagnostics
PO Box 740736ATLANTAGA303740736Lab Services1709380
FieldValueIRS element (for citing)
Number Of Contractors GT100 K50NumberOfContractorsGT100K
Total Contributions0TotalContributions

Program Service Revenue ProgramServiceRevenue (4 entries)

DescriptionDescriptionBusiness CodeBusinessCodeTotal Revenue ColumnTotalRevenueColumnRelated Or Exempt Function IncomeRelatedOrExemptFunctionIncome
PATIENT REVENUE621990766791529766791529
MEDICAL RECORDS621990744744
INDEPENDENT & ASSISTED LIVING REVENUE62300057506665750666
PATIENT EDUCATION621990113151113151
FieldValueIRS element (for citing)
Total Program Service Revenue772656090TotalProgramServiceRevenue

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)
Real1406644Real

Rental Income Or Loss RentalIncomeOrLoss

FieldValueIRS element (for citing)
Real1406644Real
Personal0Personal

Net Rental Income Or Loss NetRentalIncomeOrLoss

FieldValueIRS element (for citing)
Total Revenue Column1406644TotalRevenueColumn
Exclusion$1,406,644ExclusionAmount

Gross Amount Sales Assets GrossAmountSalesAssets

FieldValueIRS element (for citing)
Other14635Other

Less Cost Oth Basis Sales Expenses LessCostOthBasisSalesExpenses

FieldValueIRS element (for citing)
Other482648Other

Gain Or Loss GainOrLoss

FieldValueIRS element (for citing)
Other-468013Other

Net Gain Or Loss Investments NetGainOrLossInvestments

FieldValueIRS element (for citing)
Total Revenue Column-468013TotalRevenueColumn
Exclusion-$468,013ExclusionAmount

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)

DescriptionDescriptionBusiness CodeBusinessCodeTotal Revenue ColumnTotalRevenueColumnUnrelated Business RevenueUnrelatedBusinessRevenueExclusionExclusionAmount
PHARMACY/RETAIL PHARMACY4461999144667586179$8,558,488
LAB OUTREACH588357$588,357
CAFETERIA4612314$4,612,314

Miscellaneous Revenue MiscellaneousRevenue

FieldValueIRS element (for citing)
Total Revenue Column3062869TotalRevenueColumn
Exclusion$3,062,869ExclusionAmount
FieldValueIRS element (for citing)
Total Other Revenue17408207TotalOtherRevenue

Total Revenue TotalRevenue

FieldValueIRS element (for citing)
Total Revenue Column791002928TotalRevenueColumn
Related Or Exempt Function Income772656090RelatedOrExemptFunctionIncome
Unrelated Business Revenue586179UnrelatedBusinessRevenue
Exclusion$17,760,659ExclusionAmount

Grants To Domestic Orgs GrantsToDomesticOrgs

FieldValueIRS element (for citing)
Total0Total

Grants To Domestic Individuals GrantsToDomesticIndividuals

FieldValueIRS element (for citing)
Total890Total
Program Services890ProgramServices

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)
Total2908711Total
Program Services2618955ProgramServices
Management And General289756ManagementAndGeneral

Comp Disqual Persons CompDisqualPersons

FieldValueIRS element (for citing)
Total0Total

Other Salaries And Wages OtherSalariesAndWages

FieldValueIRS element (for citing)
Total230261062Total
Program Services208002543ProgramServices
Management And General22258519ManagementAndGeneral

Pension Plan Contributions PensionPlanContributions

FieldValueIRS element (for citing)
Total18219674Total
Program Services16452635ProgramServices
Management And General1767039ManagementAndGeneral

Other Employee Benefits OtherEmployeeBenefits

FieldValueIRS element (for citing)
Total21606326Total
Program Services19513937ProgramServices
Management And General2092389ManagementAndGeneral

Payroll Taxes PayrollTaxes

FieldValueIRS element (for citing)
Total16906793Total
Program Services15273300ProgramServices
Management And General1633493ManagementAndGeneral

Fees For Services Management FeesForServicesManagement

FieldValueIRS element (for citing)
Total0Total

Fees For Services Legal FeesForServicesLegal

FieldValueIRS element (for citing)
Total24744Total
Management And General24744ManagementAndGeneral

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)
Total27588819Total
Program Services26988228ProgramServices
Management And General600591ManagementAndGeneral

Advertising Advertising

FieldValueIRS element (for citing)
Total405459Total
Program Services110259ProgramServices
Management And General295200ManagementAndGeneral

Office Expenses OfficeExpenses

FieldValueIRS element (for citing)
Total27143362Total
Program Services25755703ProgramServices
Management And General1387659ManagementAndGeneral

Information Technology InformationTechnology

FieldValueIRS element (for citing)
Total0Total

Royalties Royalties

FieldValueIRS element (for citing)
Total0Total

Occupancy Occupancy

FieldValueIRS element (for citing)
Total11899810Total
Program Services5022483ProgramServices
Management And General6877327ManagementAndGeneral

Travel Travel

FieldValueIRS element (for citing)
Total261816Total
Program Services221172ProgramServices
Management And General40644ManagementAndGeneral

Travel Entrtnmnt Public Officials TravelEntrtnmntPublicOfficials

FieldValueIRS element (for citing)
Total0Total

Conferences Meetings ConferencesMeetings

FieldValueIRS element (for citing)
Total292779Total
Program Services231666ProgramServices
Management And General61113ManagementAndGeneral

Interest Interest

FieldValueIRS element (for citing)
Total39751Total
Management And General39751ManagementAndGeneral

Payments To Affiliates PaymentsToAffiliates

FieldValueIRS element (for citing)
Total124548708Total
Program Services112556127ProgramServices
Management And General11992581ManagementAndGeneral

Depreciation Depletion DepreciationDepletion

FieldValueIRS element (for citing)
Total33546479Total
Program Services17370743ProgramServices
Management And General16175736ManagementAndGeneral

Insurance Insurance

FieldValueIRS element (for citing)
Total5743140Total
Management And General5743140ManagementAndGeneral

Other Expenses OtherExpenses (3 entries)

DescriptionDescriptionTotalTotalProgram ServicesProgramServicesManagement And GeneralManagementAndGeneral
REPAIRS & MAINTENANCE1170532791093302595997
MEDICAL SUPPLIES13448322513442211161114
OTHER OPERATING EXPENSES1448945860386291

Total Functional Expenses TotalFunctionalExpenses

FieldValueIRS element (for citing)
Total667731769Total
Program Services593708685ProgramServices
Management And General74023084ManagementAndGeneral
Fundraising0Fundraising

Cash Non Interest Bearing CashNonInterestBearing

FieldValueIRS element (for citing)
BOY20200BOY
EOY21975EOY

Savings And Temp Cash Investments SavingsAndTempCashInvestments

FieldValueIRS element (for citing)
BOY4146714BOY
EOY-17973EOY

Pledges And Grants Receivable PledgesAndGrantsReceivable

FieldValueIRS element (for citing)
BOY0BOY
EOY0EOY

Accounts Receivable AccountsReceivable

FieldValueIRS element (for citing)
BOY121621833BOY
EOY147987765EOY

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)
BOY14584035BOY
EOY13895896EOY

Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges

FieldValueIRS element (for citing)
BOY4743978BOY
EOY6697514EOY
FieldValueIRS element (for citing)
Land Buildings Equipment Basis691829446LandBuildingsEquipmentBasis
Land Bldg Equipment Accum Deprec297515503LandBldgEquipmentAccumDeprec

Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet

FieldValueIRS element (for citing)
BOY376326779BOY
EOY394313943EOY

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)
BOY1280943BOY
EOY1280943EOY

Other Assets Total OtherAssetsTotal

FieldValueIRS element (for citing)
BOY6944823BOY
EOY7242350EOY

Total Assets TotalAssets

FieldValueIRS element (for citing)
BOY529669305BOY
EOY571422413EOY

Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses

FieldValueIRS element (for citing)
BOY51064914BOY
EOY32046308EOY

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)
BOY67814BOY
EOY18178EOY

Unsecured Notes Loans Payable UnsecuredNotesLoansPayable

FieldValueIRS element (for citing)
BOY0BOY
EOY0EOY

Other Liabilities OtherLiabilities

FieldValueIRS element (for citing)
BOY241048947BOY
EOY247596368EOY

Total Liabilities TotalLiabilities

FieldValueIRS element (for citing)
BOY292181675BOY
EOY279660854EOY
FieldValueIRS element (for citing)
Follow SFAS117XFollowSFAS117

Unrestricted Net Assets UnrestrictedNetAssets

FieldValueIRS element (for citing)
BOY237487630BOY
EOY291761559EOY

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)
BOY237487630BOY
EOY291761559EOY

Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY529669305BOY
EOY571422413EOY
FieldValueIRS element (for citing)
Info In Schedule O Part XIXInfoInScheduleOPartXI
Reconcilation Revenue Expenses123271159ReconcilationRevenueExpenses
Reconcilation Other Changes-68997230ReconcilationOtherChanges
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 Basis44606550OtherCostOrOtherBasis
Book Value44606550BookValue

Buildings Buildings

FieldValueIRS element (for citing)
Other Cost Or Other Basis352824098OtherCostOrOtherBasis
Depreciation127503366Depreciation
Book Value225320732BookValue

Leasehold Improvements LeaseholdImprovements

FieldValueIRS element (for citing)
Other Cost Or Other Basis15567618OtherCostOrOtherBasis
Depreciation4483152Depreciation
Book Value11084466BookValue

Equipment Equipment

FieldValueIRS element (for citing)
Other Cost Or Other Basis266003266OtherCostOrOtherBasis
Depreciation165528985Depreciation
Book Value100474281BookValue

Other Land Buildings OtherLandBuildings

FieldValueIRS element (for citing)
Other Cost Or Other Basis12827914OtherCostOrOtherBasis
Book Value12827914BookValue
FieldValueIRS element (for citing)
Total Of Book Value Land Buildings394313943TotalOfBookValueLandBuildings
Federal Income Tax Liability0FederalIncomeTaxLiability

Other Liabilities OtherLiabilities (2 entries)

DescriptionDescriptionAmountAmount
ASSET RETIREMENT OBLIGATION LT$1,076,104
TAX EXEMPT BOND LIAB-DUE TO WH$246,520,264
FieldValueIRS element (for citing)
Total Of Amounts247596368TotalOfAmounts
Footnote In Part XIIIXFootnoteInPartXIII

Form990 Schedule D Part XIII Form990ScheduleDPartXIII

FieldValueIRS element (for citing)
IdentifierSCHEDULE D Part X Line 2 FIN 48 FOOTNOTEIdentifier
ExplanationThe following footnote is related to the organization's application of FIN 48 (ASC 740). "Wellstar (including Douglas Hospital) and all but one of its affiliates have been recognized as exempt from Federal income tax under Internal Revenue Code Section 501 (a) as organizations described in Section 501 (c)(3) and, therefore, related income is generally not subject to Federal or state income taxes. Community Assurance Corporation is a controlled foreign corporation not subject to Federal tax. Wellstar applies FASB ASC 740, Income Taxes, which addresses accounting for uncertainties in income tax positions. It also provides guidance on when tax positions are recognized in an entity's financial statements and how the values of these positions are determined. There is no impact on Wellstar's combined financial statements as a result of the application of ASC 740."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 Expense44751019TotalCommunityBenefitExpense
Net Community Benefit Expense44751019NetCommunityBenefitExpense
Percent Of Total Expense0.06330PercentOfTotalExpense

Unreimbursed Medicaid UnreimbursedMedicaid

FieldValueIRS element (for citing)
Total Community Benefit Expense64994047TotalCommunityBenefitExpense
Direct Offsetting Revenue59329319DirectOffsettingRevenue
Net Community Benefit Expense5664728NetCommunityBenefitExpense
Percent Of Total Expense0.00800PercentOfTotalExpense

Total Charity Care TotalCharityCare

FieldValueIRS element (for citing)
Total Community Benefit Expense109745066TotalCommunityBenefitExpense
Direct Offsetting Revenue59329319DirectOffsettingRevenue
Net Community Benefit Expense50415747NetCommunityBenefitExpense
Percent Of Total Expense0.07130PercentOfTotalExpense

Community Health Services CommunityHealthServices

FieldValueIRS element (for citing)
Total Community Benefit Expense1566595TotalCommunityBenefitExpense
Net Community Benefit Expense1566595NetCommunityBenefitExpense
Percent Of Total Expense0.00220PercentOfTotalExpense

Health Professions Education HealthProfessionsEducation

FieldValueIRS element (for citing)
Total Community Benefit Expense221678TotalCommunityBenefitExpense
Net Community Benefit Expense221678NetCommunityBenefitExpense
Percent Of Total Expense0.00030PercentOfTotalExpense

Total Other Benefits TotalOtherBenefits

FieldValueIRS element (for citing)
Total Community Benefit Expense1788273TotalCommunityBenefitExpense
Net Community Benefit Expense1788273NetCommunityBenefitExpense
Percent Of Total Expense0.00250PercentOfTotalExpense

Total Community Benefits TotalCommunityBenefits

FieldValueIRS element (for citing)
Total Community Benefit Expense111533339TotalCommunityBenefitExpense
Direct Offsetting Revenue59329319DirectOffsettingRevenue
Net Community Benefit Expense52204020NetCommunityBenefitExpense
Percent Of Total Expense0.07380PercentOfTotalExpense
FieldValueIRS element (for citing)
Bad Debt Expense ReportedtrueBadDebtExpenseReported
Bad Debt Expense$26,975,579BadDebtExpenseAmount
Amount Attributable To3870962AmountAttributableTo
Amount Reimbursed By Medicare229172493AmountReimbursedByMedicare
Cost Of Care Reimbursed By Medicare265018225CostOfCareReimbursedByMedicare
Medicare Surplus Or Shortfall-35845732MedicareSurplusOrShortfall

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 Facilities2NumberOfHospitalFacilities

Form990 Schedule H Part V Section A Form990ScheduleHPartVSectionA (2 entries)

Facility NumberFacilityNumberAddress Line1Address/AddressLine1CityAddress/CityStateAddress/StateZIP CodeAddress/ZIPCodeWebsite AddressWebsiteAddressLicensed HospitalLicensedHospitalGeneral Medical And SurgicalGeneralMedicalAndSurgicalEr24 HoursEr24HoursOtherOther
KENNESTONE HOSPITAL
1677 CHURCH STREETMARIETTAGA30060www.wellstar.orgXXXHEALTH PARK INPATIENT HOSPICE
WINDY HILL HOSPITAL
22540 WINDY HILL ROADMARIETTAGA30067www.wellstar.orgXXLONG TERM ACUTE CARE

Form990 Schedule H Part V Section B Form990ScheduleHPartVSectionB (2 entries)

Hospital Facility NumberHospitalFacilityNumberCHNA ConductedCHNAConductedCommunity DefinitionCommunityDefinitionCommunity DemographicsCommunityDemographicsExisting ResourcesExistingResourcesHow Data ObtainedHowDataObtainedCommunity Health NeedsCommunityHealthNeedsOther Health IssuesOtherHealthIssuesIdentifying ProcessIdentifyingProcessConsulting ProcessConsultingProcessInformation GapsInformationGapsOtherOtherNeeds Assessment ConductedNeedsAssessmentConductedTake Into AccountTakeIntoAccountOther FacilitiesOtherFacilitiesCHNA Widely AvailableCHNAWidelyAvailableOwn WebsiteOwnWebsiteOn RequestOnRequestAdopt Implement StrategyAdoptImplementStrategyDevelop Community PlanDevelopCommunityPlanInclude Operational PlansIncludeOperationalPlansPrioritize Health NeedsPrioritizeHealthNeedsAll Needs AddressedAllNeedsAddressedOrganization Incur Excise TaxOrganizationIncurExciseTaxEligibility Criteria ExplainedEligibilityCriteriaExplainedUses FPG FreeUsesFPGFreeFPG Free PercentFPGFreePercentUses FPG DiscountedUsesFPGDiscountedFPG Discount PercentFPGDiscountPercentExplains BasisExplainsBasisIncome LevelIncomeLevelMedical IndigencyMedicalIndigencyInsurance StatusInsuranceStatusUninsured DiscountUninsuredDiscountMedicaid MedicareMedicaidMedicareState RegulationStateRegulationExplains Application MethodExplainsApplicationMethodIncludes Publicity MeasuresIncludesPublicityMeasuresPosted On WebsitePostedOnWebsiteAttached To InvoicesAttachedToInvoicesPosted In Emergency RoomPostedInEmergencyRoomPosted In Admission OfficePostedInAdmissionOfficeProvided On AdmissionProvidedOnAdmissionAvailable On RequestAvailableOnRequestOther PublicityOtherPublicityActions On NonpaymentActionsOnNonpaymentCollection ActivitiesCollectionActivitiesNotify Upon AdmissionNotifyUponAdmissionNotify Before DischargeNotifyBeforeDischargeNotified All PatientsNotifiedAllPatientsDocumented DeterminationDocumentedDeterminationNondiscrim Emergency Care PolicyNondiscrimEmergencyCarePolicyAverage Negotiated RatesAverageNegotiatedRatesAmounts Generally BilledAmountsGenerallyBilledGross ChargesGrossCharges
KENNESTONE HOSPITAL
1trueXXXXXXXXXX12truefalsetrueXXXXXXfalsefalsetruetrue125.true300.trueXXXXXXtruetrueXXXXXXXtruefalseXXXXtrueXfalsefalse
WINDY HILL HOSPITAL
trueXXXXXXXXXX12truefalseXXXXXXfalsefalsetruetrue125.true300.trueXXXXXXtruetrueXXXXXXXtruefalseXXXXtrueXfalsefalse

Form990 Schedule H Part VI Form990ScheduleHPartVI (17 entries)

IdentifierIdentifierReturn ReferenceReturnReferenceExplanationExplanation
Publication of Community Benefit ReportSchedule H Part I Line 6aKennestone Hospital, Inc.(consisting of Kennestone Hospital and Windy Hill Hospital) is an affiliate of Wellstar Health System, Inc. which on an annual basis issues a community benefit report. This report is subsequently distributed in and around the five county service area of the health system. It is also annually filed with Cobb County and the state of Georgia Department of Community Health. Additionally the information on community benefit is included in aggregate for Wellstar Health System, Inc. and affiliated hospitals as part of the Georgia Hospital Association's annual report.
Cost to Charge RatioSchedule H Part I Line 7For purposes of the IRS Form 990 Schedule H, Wellstar Health System and Affiliates (including Kennestone and Windy Hill Hospitals) 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 BenefitSchedule H Part III Line 4The following footnote is detailed in the Wellstar Health System, Inc. and Affiliates Combined Financial Statements related to bad debt or uncollectible accounts: "During 2011, Wellstar adopted the provisions of FASB Accounting Standards Update (2011-07), Healthcare Entities (Topic 954). ASU 2011-07 requires the reclassification of the provision for uncollectible accounts associated with patient service revenue from an operating expense to a deduction from patient service revenue (net of contractual allowances and discounts)." " Wellstar recognizes patient service revenue associated with services provided to patients with third-party payor coverage on the basis of contractual rates for the services rendered. For uninsured patients that do not qualify for community financial aid, Wellstar recognizes revenue on the basis of its discounted rates for services provided. On the basis of historical experience, a significant portion of Wellstar's uninsured patients are unable or unwilling to pay for the services provided. Thus, Wellstar records a significant provision for uncollectible accounts related to uninsured patients in the period the services are provided." Subsequent to the end of the reporting period a propensity to pay review of patient accounts often results in prior year bad debt accounts which are deemed eligible for the organization's financial assistance policy. Those bad debt accounts are reclassified as charity and thus our rationale for including in community benefit.
Medicare ShortfallsSchedule H Part III Line 8Kennestone and Windy Hill Hospitals are providers 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 Part III Section B line 7 represents the uncompensated difference between the expected reimbursement and the Medicare charges for those services stated at cost. We determine a cost to charge ratio for Medicare patients as part of the annual filing of the Medicare cost report.
Collection PracticesSch 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.
Facility Descriptions-Kennestone and Windy HillSchedule H Part VKennestone Hospital ia a general acute care hospital providing a full range of services, is licensed to operate 633 beds, and is presently staffed to operate 588 beds. It is located on an approximately 41-acre campus in Marietta, Georgia and is housed within a complex of connected buildings containing a total square footage in excess of 1,112,000 square feet. The original hospital was constructed in 1950, major structural additions were made during the 1960s, 1975, 1998, and 2006. A new patient tower was completed in 2005 and greatly expanded the cardiac services capabilities of the hospital. Additionally a fourth patient tower recently opened to transition the hospital to private rooms from the current semi-private bed methodology. Kennestone Hospital provides medical, surgical, obstetrical, and rehabilitative inpatient care and outpatient care, including one of the busiest emergency rooms in the state of Georgia--recently designated a level II Trauma center for the service area. The hospital experiences over 300,000 annual visits in its adult and pediatric emergency room facilities. With its full range of inpatient and outpatient services the hospital has expanded programs in open-heart surgery and services including a Congestive Heart Failure Clinic which opened in February of 2012; ambulatory surgery; oncology services and surgery including cyberknife technology; radiology services and surgery; and women's and children's services. In May of 2012, Kennestone began performing Transcatheter Aortic Valve Replacement surgery (TAVR). Windy Hill Hospital, located in the unincorporated area of Cobb County in northwest metropolitan Atlanta, is an acute care hospital concentrating on long-term acute inpatient and outpatient services. It is licensed to operate 115 beds, is presently staffed to operate 55 beds, is located on an approximately 15-acre campus, and contains total square footage of approximately 100,000 square feet. A twelve bed sleep disorder center is located at Windy Hill. Windy Hill was originally constructed in 1973 and renovated in 1987. The main areas of focus for Windy Hill Hospital include long-term acute care, rehabilitation, orthopedics, and diagnostics. Windy Hill also offers a service in the treatment of sleep disorders.
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 AssistanceSchedule H Part VI Line 3Kennestone and Windy Hill Hospitals provide its patients with hospital personnel or contracted personnel who are trained in all aspects of governmental programs, payments plans, charity discounts, and other financial assistance offered to assist them in their hospital bills. If the patient is eligible for federal or state assistance programs, a staff member is knowledgeable in the steps necessary to qualify those 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 InformationSchedule H Part VI Line 4Kennestone and Windy Hill Hospitals are two of five hospitals that are affiliated with 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, Kennestone and Windy Hill Hospitals (affiliates of Wellstar Health System, Inc.) operate as charitable organizations 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; Kennestone Hospital operates a full-time emergency room open to all regardless of ability to pay; and the hospitals (Kennestone and Windy Hill) provide 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. Kennestone Hospital committed approximately $91.6 million and Windy Hill Hospital committed approximately $9.8 million in capital expenditures for the year to meet those needs.
Publication of Financial 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 Descriptions from the CHNAPart V Section B Line 1jThe Community Health Needs Assessment for both Kennestone and Windy Hill also provide 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 Representative and SourcesPart V Section B Line 3WellStar Kennestone and Windy Hill Hospitals integrated multiple sources of data from national and state web-based data platforms with multiple primary data gathering methods (see list below). As a partner in the strategic planning process utilized by Cobb & Douglas Public Health (CDPH) called Mobilizing for Action through Planning and Partners (MAPP) from the National Association of County & City Health Officials, the hospital leveraged the findings from community health needs assessments conducted in tax year 2012. Through a grant by the Centers for Disease Control and Prevention, WellStar Kennestone and Windy Hill 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 both of the hospital facility's CHNA reports publicly available at wellstar.org. Quantitative Data Sources Including: 1. Georgia Department of Public Health, OASIS 2. Centers for Disease Control and Prevention (CDC) Vital Statistics 3. Agency for Healthcare Research and Quality (AHRQ) 4. U. S. Census Bureau 5. U.S. Department of Health and Human Services 6. Kaiser Permanente Web-Based CHNA Platform 7. Catholic Health Association CHNA resources 8. County Health Rankings & Roadmaps, University of Wisconsin 9. Healthy People 2020 10.Behavorial Risk Factor Surveillance System (BRFSS) 11.WellStar Health System - WellStar Kennestone & Windy Hill Hospital's FY2012 utilization data to assess service area zip codes accounting for 90 percent of hospital admissions and visits and primary service areas. Qualitative Data Sources Including: 1. Cobb County Focus Group Report-58 people participated in six focus group representing 14 zip codes. Demographics varied among the groups indicative of the zip codes represented. Two groups were conducted in Spanish and reflected low-income, low education attainment and medically underserved populations. 2. MAPP Assessment Workgroups with representatives from Douglas and Cobb counties conducted four community assessments which helped develop the Cobb2020 Community Health Improvement Plan. This included the 2011 Field Test Local Public Health System Assessment by the National Public Health Performance Standards Program (NPHPSP) 3. Cobb Key Informant Interview Report-20 participants identified by Cobb 2020's Community Strengths and Themes Workgroup to represent different sectors of the Cobb community who possessed above average knowledge of the healthcare issues, healthcare system or the community. 4. Cobb MAPP Community Survey Report-44-question telephone surveys of 1,244 adults ages 18-94 performed by the A.L. Burruss Institute for Public Service and Research, Kennesaw State University. 5. Cobb County 2010 - How Healthy Are We? 6. Cobb County MAPP Forces of Change Assessment Summary Report 7. Bartow, Cherokee and Paulding County Key Informant interviews of community stakeholders led by Ron Chapman, Principal, Magnetic North, LLC, a third-party consultant LLC, a third-party consultant
Facility Community Needs AssessmentPart V Section B Line 4While both WellStar Kennestone and WellStar Windy Hill each conduct its own community health needs assessment there may be some overlap with the other hospitals in WellStar Health System simply because of the geographic constraints and structure of the organization. The community served therefore is defined by similar zip codes and areas of services.
Explanation of Unaddressed CHNA NeedsPart V Section B Line 7Selection criteria for WellStar Kennestone and Windy Hill Hospital's prioritized health needs were primarily based upon the bandwidth to build a sustainable community benefit model focused on preventable health behaviors and access to care. Sexually transmitted infections and teen pregnancy are not addressed leaving awareness education with schools, family and churches since the health needs are more cultural and societal. Improvement to health needs stemming from socioeconomic and physical environmental such as air quality and transportation, gain traction from public policy and education. A health system can complement efforts to impact policy, but has to rely on public health, state and local municipalities and federal governmental agencies to drive these types of health improvements. Key questions when addressing health needs are 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, Inc. and its affiliates 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 and retirement facility as well as a group of 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 Kennestone Hospital Inc. (Kennestone and Windy Hill Hospitals), 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 (57 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
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
BETTY ANN BRAKOVICH
VP/CNO PATIENT CARE SRVCS WH1480960283550105750109080106440208578000
JOSEPH L BRYWCZYNSKI
SR VP HEALTH PARKS DEVELOPMENT0252245058357010800032749015644036979500
A JAMES BUDZINSKI
EXEC VP and CFO050765801473710156423054844017506088380200
DONALD CAMPBELL MD
SR VP PHYS EDUC & STUDENT AFF0313078071586057333040224014138049635900
LAURA CARAMANICA
VP/CNO PATIENT CARE SRV KENN25708203434908700034473091610343765000
LEE RANDOLPH COOK
VP MEDICINE & BEHAVIORAL HLTH0253643053103071843037847016960043339600
BARBARA B COREY
SR VP MANAGED CARE0280236080891076249034459015077048691200
BRUCE A DEAN
VP REAL ESTATE & DEP GEN COUN0210603037339041567033613015112033823400
MARCIA DELK-PAYNE MD
SR VP MED AFFAIRS & CQO035228209099009386704413103202058447200
CAROL S EDWARDS
VP CARDIAC SERVICES0166152000634902261704532019965000
CLARENCE HARLEE EVINS JR
VP REVENUE CYCLE015771403337107716011150011000022095100
MICHAEL L GRAUE
EXEC VP & COO05326190157139014654051672030762078684600
MARTIN L GUTKIN
VP FINANCE & HOSPITAL CFO18838002412002678209616079360256834000
ELIZABETH A HOFFMANN
VP BUDGET & ANALYSIS01992870346500870001010806484025922900
ROBERT D JANSEN MD
EXEC VP & PRES WMG05199080118865012418046463020531071818500
REYNOLD J JENNINGS
PRESIDENT & CEO09818580562478027390064901000163662700
CHRISTOPHER M KANE
SR VP STRATEGIC PLAN & BUS DEV0321428074695082370024938020762052419300
BETH KOST
VP COMPLIANCE & CHIEF PRIVACY02303960401190870001645608022030369300
KENNETH C KUNZE MD
SR VP & CHIEF MEDICAL OFFICER058115601004350444125068643080220120238100
ELLEN LANGFORD
VP & COO WELLSTAR PHYS GRP019374203339408526303485404642035189500
LOUIS W LITTLE
SR VP POST ACUTE & HOSP PRES2333620589350646590244510158810397288000
RICHARD T LOPES MD
FORMER SR VP & PRES WMG0480426000001993800050036400
ROBERT MANDLER
VP DIAGNOSTIC OUTREACH0208264035125029955033059014684032108700
CAROL B MAXWELL
VP TALENT ACQUISTION02090710283970200001417706531026017600
PATRICIA A MAYNE
VP EMERGENCY SERVICES1594750224890207000123340240530239051000
KIMBERLY W MENEFEE
SR VP MARKETING & GOV AFFAIRS0264110090000123171036736016589044960600
JONATHAN B MORRIS MD
SR VP & CIO034623907228609063022886020531047100500
LEO E REICHERT
EXEC VP & GENERAL COUNSEL04565290133697021336025403022625065959000
MICHELLE M ROBINSON
VP MARKETING, PR INTERNAL COMM017213902426804806012162016529022990400
DEBORAH ROEGGE DE VITA
VP WOMEN & NEWBORN018595903208704892301169803605028227200
CANDICE L SAUNDERS
EXEC VP & HOSP PRESIDENT36529908199201075250446580161260615600000
CHRISTOPHER B SCULLEN
VP PULMONARY OPERATIONS0163084028265087000102960382021072700
GREGORY L SIMONE
FORMER PRES & CEO0226763000009581014016025036000
JAMES M SWARTZ
VP ACCOUNTING018473003282608700013409017132025679700
MARY L TAVERNARO
VP HUMAN RESOURCES OPERATIONs019967403476108700014330010473026793800
ADAM C THOMPSON
VP SURGERY01552250273530925008055014614021449700
JERRY TILLERY
VP OPERATIONS KENNESTONE168921022677014392012114059310224035000
AMANDA ELIZ T TRASK
VP PROF & SUPPORT SRVCS KH154196021871087000117830208140217364000
ANOTHONY M TRUPIANO
SR VP SUPPLY CHAIN025370606261201101003543900036276700
MARY L WESLEY
SR VP NURSING SERVICES CNE0302455069297011742027058010644042119600
BONNIE L WILSON
FORMER EXEC VP & GEN COUNSEL022723700000958103629024044700
ROBIN WILSON MD
SR VP CHIEF INNOVATION OFFICER02955610155781011513019506024125050648600
DANIEL J WOODS
SR VP & COO KENN HOSPITAL1745560118000068540152400111400325790000
CHESTER A ZBOROWSKI
VP HEALTH PARK OPERATIONS0113075023010223350578409933015342800
JYOTSNA R VANAPALLI
RADIATION ONCOLOGY PHYSICIST1706690207000104260106440191946000
MARK G VAN EWYK
PHARMACIST SPECIALTY168328020700010351058450184731000
ROBERT J DeCOUX
AVP HUMAN RESOURCES14601901665901200099820165890190449000
HEATHER S ROCHFORD
MANAGER PHARMACY1612290310200097390114230185493000
DONNA H THOMAS
AVP QUALITY SRV & PATIENT SAFE150194016228012000688805350175045000

Form990 Schedule J Part III Form990ScheduleJPartIII (4 entries)

IdentifierIdentifierReturn ReferenceReturnReferenceExplanationExplanation
Non-Fixed Payments to OfficersForm 990 Schedule J Line 7Wellstar has instituted an annual incentive plan for key leaders in the company. On an annual basis performance measures are proposed by management and approved and recommended by the Compensation Committee of the Board. The plan is designed to retain and reward leaders with incentives that keep them competitive with the market and comparable health systems. The criteria used to measure the performance consists of weighted factors in the areas of financial performance, customer service, employee engagement and quality indicators. Upon successful acheivement in the targeted levels for each factor, a performance payout is recommended and approved by the Board after the annual financial audit is completed. Last year the board and senior management extended the incentive program to include all team members or non-management personnel. The performance pay plan for this group of employees is based on successful attainment of various system and facility goals and the fixed dollar awarded for that achievement.
Severance BenefitsSchedule JPursuant 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; Candice Saunders; 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 MD; Nicole Ashe; Barbara Ballard; Betty A Brakovich; Laura Caramanica; Bruce Dean; Carol Edwards; Lee Evins; Kristyn Greifer, MD; Martin Gutkin; Elizabeth Hoffmann; Beth Kost; Ellen Langford; Robert Mandler; Patricia Mayne; Carol Maxwell; Deborah Roegge DeVita; C Brett Scullen; Rick Siegel; James Swartz; Mary L Tavernaro; Adam Thompson; Jerry Tillery; Amanda Trask; and Chester Zborowski. During the calendar year, the following individuals received a payout in the amounts listed in accordance with their severance agreements as set forth above: 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 I, Line 1b & 2While Wellstar Health System and its affiliates do not have a written policy regarding payment or reimbursement for 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 ExceptionsThe following individuals became officers of Wellstar Health System and Affiliates during the accounting period covered by this return but were not compensated during the calendar year for which salary and benefits are reported in the return: Kristyn Greifer, MD; Peter Jungblut MD; and Rick Siegel.

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 ReferenceForm 990 Schedule L Part IVReturnReference
ExplanationAll transactions listed in Schedule L Part IV are for interested parties or in this case family members of either trustees or officers of Kennestone Hospital, Inc. or its related organizations. The transactions all represent payment of services as employees of Wellstar Health System.Explanation

Schedule O IRS990ScheduleO

General Explanation GeneralExplanation (11 entries)

IdentifierIdentifierReturn ReferenceReturnReferenceExplanationExplanation
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).
Conflict of Interest PolicyForm 990 Part VI Section B Line 12A, B, & 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 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 Determining Officer CompForm 990 Part VI 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 consist of five trustees as well as the CEO in an advisory role and not a voting member. Further in committtee discussions about the compensation for the Chief Executive Officer, The CEO will recuse himself/herself 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 by the full Board of Trustees at its next scheduled meeting.
Audited Financial StatementsForm 990 Part IV Line 12 & Part IXKennestone Hospital, Inc. is audited on an annual basis by an outside auditing firm, KPMG, and as part of that audit a consolidated financial statement is issued for all of WellStar Health System, Inc and its Affiliates. "The independent auditors report includes the accounts of Wellstar and its controlled affiliates, Kennestone Hospital, Inc., Cobb Hospital, Inc., Douglas Hospital, Inc., Paulding Medical Center, Inc., Wellstar Foundation, Inc. CHS Foundation, Inc., Community Assurance Company, Ltd., various Wellstar owned physician practices, a hospice facility, a nursing facility, home health business, and entities for infusion therapy and durable medical equipment. All significant intercompany accounts and transactions have been eliminated in combination. The Board of Trustees of Wellstar has the authority to approve appointments of the members of the board of trustees of all affiliate corporations."
Tax Exempt Bond 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). Kennestone Hospital, Inc. will report this tax exempt bond liability on Part X, Line 25 Other Liabilities-Due to WHS, Inc.
Organization StructureForm 990 Part VI Section A Lines 6, 7a & 7bAs 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, Inc. holds certain powers of election and approval in connection with the governing body of the organization. These powers are presented in detail in the governing documents which the company makes available to the public upon request.
Officers Hours WorkedForm 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 organizations exceeds 40 hours a week.
990 Board ReviewForm 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 of each organization. The current year Form 990 is then reviewed by the Finance Committee along with a question and answer session. A motion is then made by the Finance committee to approve the returns and present to the full board copies of the forms in an electronic (pdf. format) version as well as a hard copy . The organization's CFO or designee subsequently signs the return for either manual or electronic filing by the appropriate due date.
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.
Changes in Net AssetsForm 990 Part XI Line 5For the reporting period Kennestone Hospital, Inc. had a change in net assets of ($68,997,230) 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 hehalf 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 Inc
805 Sandy Plains RoadMariettaGA30066581649540FoundationGA501 (C) 311 Type 2WHS Inctrue
Cobb Hospital Inc
805 Sandy Plains RoadMariettaGA30066580968382HealthcareGA501 (C) 33WHS Inctrue
Douglas Hospital Inc
805 Sandy Plains RoadMariettaGA30066582026750HealthcareGA501 (C) 33WHS Inctrue
Paulding Medical Center Inc
805 Sandy Plains RoadMariettaGA30066582095884HealthcareGA501 (C) 33WHS Inctrue
Wellstar Foundation Inc
805 Sandy Plains RoadMariettaGA30066581627413FoundationGA501 (C) 311 Type 2WHS Inctrue
Wellstar Health System Inc
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 TypePredominantIncomeType
Cobb Hospital Parking Company LLC
805 Sandy Plains RoadMariettaGA300666340752999669ParkingGANAN/A
Kennestone East Parking Deck LLC
805 Sandy Plains RoadMariettaGA300666340200537100ParkingGANAN/A

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 NAN/ADirectControllingEntityNA
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 OrgsfalseRentalOfFacilitiesFrOtherOrgs
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