2014-05-14T13:29:52-05:00 2013-06-30 PricewaterhouseCoopers LLP 2001 MARKET ST SUITE 1700 PHILADELPHIA PA 19103 990 2012-07-01 582032904 KENNESTONE HOSPITAL INC % JAMES M SWARTZ KENN 7707925023 805 Sandy Plains Road Suite Marietta GA 300666340 JAMES M SWARTZ 7707925023 2014-05-14 true 2673303000 2012 2015-11-30 17:44:51Z REYNOLD J JENNINGS 805 SANDY PLAINS ROAD MARIETTA GA 30066 791485576 false X www.wellstar.org X 1993 GA To provide world-class charitable healthcare to the community. 18 14 5336 410 586179 0 0 725011981 772656090 32955 -468013 14573763 18814851 739618699 791002928 2150 890 0 0 272571926 289902566 0 0 0 350085746 377828313 622659822 667731769 116958877 123271159 529669305 571422413 292181675 279660854 237487630 291761559 TO CREATE AND DELIVER HIGH QUALITY HOSPITAL, PHYSICIAN AND OTHER HEALTHCARE RELATED SERVICES THAT IMPROVE THE HEALTH AND WELL-BEING OF THE INDIVIDUALS AND COMMUNITIES WE SERVE. false false 593708685 890 772656090 As 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 In 593708685 true false false false false false false false false false true false false false true true false true false false false false false false false false true true false false true false false false false false false true false false false false false false true true false false false true 0 0 5336 true true true false false false false false false false false false false false false X 18 14 false false true false true true true true true false false true true true true true true true true false GA X JAMES M SWARTZ 7707925023 805 SANDY PLAINS ROAD Marietta GA 300666340 X AVRIL P BECKFORD MD 2.0 48.0 X 0 433483 22804 RANDALL BENTLEY JR 1.0 5.0 X 0 19122 0 OTIS BRUMBY III 1.0 7.0 X 0 4120 0 SHAN COOPER 1.0 5.0 X 0 468 0 ROBERT N CROSS MD 1.0 5.0 X 0 5166 0 TE RUSTY DURHAM 1.0 14.0 X 0 37201 1410 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480426 19938 GREGORY L SIMONE 0.0 0.0 X 0 226763 23597 BONNIE L WILSON 0.0 0.0 X 0 227237 13210 3443015 18439054 2140473 165 true true false Brasfield Gorrie 1990 Vaughn Rd NW Suite 100 KENNESAW GA 30144 General Contractor 39917793 CDH Partners 675 Tower Road MARIETTA GA 30060 General Contractor 2821887 Cork-Howard Construction Inc 2121 New Market Pkwy Suite 118 MARIETTA GA 30067 General Contractor 2505234 Inglett and Stubbs LLC PO Box 932506 ATLANTA GA 311932506 General Contractor 2343913 Quest Diagnostics PO Box 740736 ATLANTA GA 303740736 Lab Services 1709380 50 0 PATIENT REVENUE 621990 766791529 766791529 MEDICAL RECORDS 621990 744 744 INDEPENDENT & ASSISTED LIVING REVENUE 623000 5750666 5750666 PATIENT EDUCATION 621990 113151 113151 772656090 0 0 0 1406644 1406644 0 1406644 1406644 14635 482648 -468013 -468013 -468013 0 0 0 PHARMACY/RETAIL PHARMACY 446199 9144667 586179 8558488 LAB OUTREACH 588357 588357 CAFETERIA 4612314 4612314 3062869 3062869 17408207 791002928 772656090 586179 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44606550 352824098 127503366 225320732 15567618 4483152 11084466 266003266 165528985 100474281 12827914 12827914 394313943 0 ASSET RETIREMENT OBLIGATION LT 1076104 TAX EXEMPT BOND LIAB-DUE TO WH 246520264 247596368 X SCHEDULE D Part X Line 2 FIN 48 FOOTNOTE The following footnote is related to the organization's application of FIN 48 (ASC 740). "Wellstar (including Douglas Hospital) and all but one of its affiliates have been recognized as exempt from Federal income tax under Internal Revenue Code Section 501 (a) as organizations described in Section 501 (c)(3) and, therefore, related income is generally not subject to Federal or state income taxes. Community Assurance Corporation is a controlled foreign corporation not subject to Federal tax. Wellstar applies FASB ASC 740, Income Taxes, which addresses accounting for uncertainties in income tax positions. It also provides guidance on when tax positions are recognized in an entity's financial statements and how the values of these positions are determined. There is no impact on Wellstar's combined financial statements as a result of the application of ASC 740." true true X true X 125. true X true true true false true true 44751019 44751019 0.06330 64994047 59329319 5664728 0.00800 109745066 59329319 50415747 0.07130 1566595 1566595 0.00220 221678 221678 0.00030 1788273 1788273 0.00250 111533339 59329319 52204020 0.07380 true 26975579 3870962 229172493 265018225 -35845732 X true true 2 1 KENNESTONE HOSPITAL

677 CHURCH STREET MARIETTA GA 30060

www.wellstar.org X X X HEALTH PARK INPATIENT HOSPICE 2 WINDY HILL HOSPITAL

2540 WINDY HILL ROAD MARIETTA GA 30067

www.wellstar.org X X LONG TERM ACUTE CARE KENNESTONE HOSPITAL 1 true X X X X X X X X X X 12 true false true X X X X X X false false true true 125. true 300. true X X X X X X true true X X X X X X X true false X X X X true X false false WINDY HILL HOSPITAL true X X X X X X X X X X 12 true false X X X X X X false false true true 125. true 300. true X X X X X X true true X X X X X X X true false X X X X true X false false Publication of Community Benefit Report Schedule H Part I Line 6a Kennestone 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 Ratio Schedule H Part I Line 7 For 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 Benefit Schedule H Part III Line 4 The following footnote is detailed in the Wellstar Health System, Inc. and Affiliates Combined Financial Statements related to bad debt or uncollectible accounts: "During 2011, Wellstar adopted the provisions of FASB Accounting Standards Update (2011-07), Healthcare Entities (Topic 954). ASU 2011-07 requires the reclassification of the provision for uncollectible accounts associated with patient service revenue from an operating expense to a deduction from patient service revenue (net of contractual allowances and discounts)." " Wellstar recognizes patient service revenue associated with services provided to patients with third-party payor coverage on the basis of contractual rates for the services rendered. For uninsured patients that do not qualify for community financial aid, Wellstar recognizes revenue on the basis of its discounted rates for services provided. On the basis of historical experience, a significant portion of Wellstar's uninsured patients are unable or unwilling to pay for the services provided. Thus, Wellstar records a significant provision for uncollectible accounts related to uninsured patients in the period the services are provided." Subsequent to the end of the reporting period a propensity to pay review of patient accounts often results in prior year bad debt accounts which are deemed eligible for the organization's financial assistance policy. Those bad debt accounts are reclassified as charity and thus our rationale for including in community benefit. Medicare Shortfalls Schedule H Part III Line 8 Kennestone 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 Practices Sch H Part III Sec C Line 9b The policy written for collection practices that applies to all Wellstar Health System entities incorporates guidelines for personnel in the admissions and patient access areas to be trained in identifying patients that might qualify for financial assistance. It is also the policy of all Wellstar facilities to have at least one employee or contractor available at all times, especially in the hospitals with emergency rooms, who can provide assistance with the paperwork necessary to help patients who would qualify for governmental and other assistance programs. Facility Descriptions-Kennestone and Windy Hill Schedule H Part V Kennestone 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 Assessment Schedule H Part VI Line 2 Wellstar 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 Assistance Schedule H Part VI Line 3 Kennestone 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 Information Schedule H Part VI Line 4 Kennestone 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 Health Schedule H Part VI Line 5 As 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 Policy Sch H Part V Line 13g In 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 CHNA Part V Section B Line 1j The 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 Sources Part V Section B Line 3 WellStar 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 Assessment Part V Section B Line 4 While 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 Needs Part V Section B Line 7 Selection 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 System Part VI Line 6 WellStar 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 Strategy Schedule H Part VI Item 2 In 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. X X X X X X false true X X X X X X true true false false false false false true false AVRIL P BECKFORD MD 0 391098 0 34682 0 7703 0 22804 0 0 0 456287 0 0 THOMAS GEARHARD MD 0 374127 0 149896 0 9301 0 44344 0 25762 0 603430 0 0 JEFFERY THARP MD 0 453052 0 144219 0 12638 0 47325 0 18005 0 675239 0 0 CHARLES 'PETE WOOD 0 0 0 0 0 13091 0 0 0 0 0 13091 0 0 VALERY A AKOPOV MD 0 289320 0 49819 0 30153 0 20530 0 9585 0 399407 0 0 DAVID W ANDERSON 0 396057 0 113256 0 499800 0 63675 0 14241 0 1087029 0 0 NICOLE V ASHE 0 197655 0 24868 0 6681 0 14552 0 20244 0 264000 0 0 BARBARA G BALLARD 0 221400 0 39137 0 8700 0 16066 0 25262 0 310565 0 0 BETTY ANN BRAKOVICH 148096 0 28355 0 10575 0 10908 0 10644 0 208578 0 0 0 JOSEPH L BRYWCZYNSKI 0 252245 0 58357 0 10800 0 32749 0 15644 0 369795 0 0 A JAMES BUDZINSKI 0 507658 0 147371 0 156423 0 54844 0 17506 0 883802 0 0 DONALD CAMPBELL MD 0 313078 0 71586 0 57333 0 40224 0 14138 0 496359 0 0 LAURA CARAMANICA 257082 0 34349 0 8700 0 34473 0 9161 0 343765 0 0 0 LEE RANDOLPH COOK 0 253643 0 53103 0 71843 0 37847 0 16960 0 433396 0 0 BARBARA B COREY 0 280236 0 80891 0 76249 0 34459 0 15077 0 486912 0 0 BRUCE A DEAN 0 210603 0 37339 0 41567 0 33613 0 15112 0 338234 0 0 MARCIA DELK-PAYNE MD 0 352282 0 90990 0 93867 0 44131 0 3202 0 584472 0 0 CAROL S EDWARDS 0 166152 0 0 0 6349 0 22617 0 4532 0 199650 0 0 CLARENCE HARLEE EVINS JR 0 157714 0 33371 0 7716 0 11150 0 11000 0 220951 0 0 MICHAEL L GRAUE 0 532619 0 157139 0 14654 0 51672 0 30762 0 786846 0 0 MARTIN L GUTKIN 188380 0 24120 0 26782 0 9616 0 7936 0 256834 0 0 0 ELIZABETH A HOFFMANN 0 199287 0 34650 0 8700 0 10108 0 6484 0 259229 0 0 ROBERT D JANSEN MD 0 519908 0 118865 0 12418 0 46463 0 20531 0 718185 0 0 REYNOLD J JENNINGS 0 981858 0 562478 0 27390 0 64901 0 0 0 1636627 0 0 CHRISTOPHER M KANE 0 321428 0 74695 0 82370 0 24938 0 20762 0 524193 0 0 BETH KOST 0 230396 0 40119 0 8700 0 16456 0 8022 0 303693 0 0 KENNETH C KUNZE MD 0 581156 0 100435 0 444125 0 68643 0 8022 0 1202381 0 0 ELLEN LANGFORD 0 193742 0 33394 0 85263 0 34854 0 4642 0 351895 0 0 LOUIS W LITTLE 233362 0 58935 0 64659 0 24451 0 15881 0 397288 0 0 0 RICHARD T LOPES MD 0 480426 0 0 0 0 0 19938 0 0 0 500364 0 0 ROBERT MANDLER 0 208264 0 35125 0 29955 0 33059 0 14684 0 321087 0 0 CAROL B MAXWELL 0 209071 0 28397 0 2000 0 14177 0 6531 0 260176 0 0 PATRICIA A MAYNE 159475 0 22489 0 20700 0 12334 0 24053 0 239051 0 0 0 KIMBERLY W MENEFEE 0 264110 0 9000 0 123171 0 36736 0 16589 0 449606 0 0 JONATHAN B MORRIS MD 0 346239 0 72286 0 9063 0 22886 0 20531 0 471005 0 0 LEO E REICHERT 0 456529 0 133697 0 21336 0 25403 0 22625 0 659590 0 0 MICHELLE M ROBINSON 0 172139 0 24268 0 4806 0 12162 0 16529 0 229904 0 0 DEBORAH ROEGGE DE VITA 0 185959 0 32087 0 48923 0 11698 0 3605 0 282272 0 0 CANDICE L SAUNDERS 365299 0 81992 0 107525 0 44658 0 16126 0 615600 0 0 0 CHRISTOPHER B SCULLEN 0 163084 0 28265 0 8700 0 10296 0 382 0 210727 0 0 GREGORY L SIMONE 0 226763 0 0 0 0 0 9581 0 14016 0 250360 0 0 JAMES M SWARTZ 0 184730 0 32826 0 8700 0 13409 0 17132 0 256797 0 0 MARY L TAVERNARO 0 199674 0 34761 0 8700 0 14330 0 10473 0 267938 0 0 ADAM C THOMPSON 0 155225 0 27353 0 9250 0 8055 0 14614 0 214497 0 0 JERRY TILLERY 168921 0 22677 0 14392 0 12114 0 5931 0 224035 0 0 0 AMANDA ELIZ T TRASK 154196 0 21871 0 8700 0 11783 0 20814 0 217364 0 0 0 ANOTHONY M TRUPIANO 0 253706 0 62612 0 11010 0 35439 0 0 0 362767 0 0 MARY L WESLEY 0 302455 0 69297 0 11742 0 27058 0 10644 0 421196 0 0 BONNIE L WILSON 0 227237 0 0 0 0 0 9581 0 3629 0 240447 0 0 ROBIN WILSON MD 0 295561 0 155781 0 11513 0 19506 0 24125 0 506486 0 0 DANIEL J WOODS 174556 0 118000 0 6854 0 15240 0 11140 0 325790 0 0 0 CHESTER A ZBOROWSKI 0 113075 0 2301 0 22335 0 5784 0 9933 0 153428 0 0 JYOTSNA R VANAPALLI 170669 0 207 0 0 0 10426 0 10644 0 191946 0 0 0 MARK G VAN EWYK 168328 0 207 0 0 0 10351 0 5845 0 184731 0 0 0 ROBERT J DeCOUX 146019 0 16659 0 1200 0 9982 0 16589 0 190449 0 0 0 HEATHER S ROCHFORD 161229 0 3102 0 0 0 9739 0 11423 0 185493 0 0 0 DONNA H THOMAS 150194 0 16228 0 1200 0 6888 0 535 0 175045 0 0 0 Non-Fixed Payments to Officers Form 990 Schedule J Line 7 Wellstar 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 Benefits Schedule J Pursuant 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 Compensation Form 990, Schedule J, Part I, Line 1b & 2 While 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 Exceptions The 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. Pamela Etheridge Wife of Officer 60897 Employee of Wellstar false Greg Fortgang Son-in-Law of Trustee 99034 Employee of Wellstar false Greg Separk Son of Trustee 23420 Employee of Wellstar false George Fleming Brother of Officer 65701 Employee of Wellstar false Matthew Maddox Son of Trustee 67037 Employee of Wellstar false Bonnie Miller Wife of Trustee 35100 Employee of Wellstar false Jessica Haney Daughter of Officer 57127 Employee of Wellstar false Greg Kost Brother-in-law of officer 47539 Employee of Wellstar false Jennifer Haney Daughter-in-law of offcer 77821 Employee of Wellstar false Business Transactions with Interested Parties Form 990 Schedule L Part IV All 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. Compensation Form 990 Part V Line 2 All compensation amounts reported on Form 990 Part V, Part VII, and Part IX as well as Schedule J represent compensation provided to individuals that provide services to the organization. Likewise, the number of employees reported on Form 990 represent the number of individuals providing services to the organization. All Federal employment tax responsibilities for these individuals (including Federal Employment Tax reporting responsibilities) are handled by Wellstar Health System, Inc (EIN 58-1649541). Conflict of Interest Policy Form 990 Part VI Section B Line 12A, B, & C Our conflict of interest policy requires all covered persons to annually review the policy and then complete, sign and return the Conflicts of Interest Survey and Attestation to the Compliance Office. The Policy requires an on-going disclosure obligation in the event a conflict arises during the year. The following is our process to regularly and consistently monitor and enforce the policy: Compliance identifies all covered persons who must complete the Survey and Attestation. Compliance verifies that the Survey and Attestation is distributed to these persons. Compliance verifies that these persons return a fully completed and signed Survey and Attestation. Compliance reviews each completed and signed Survey and Attestation to identify all conflicts listed in the document. All conflicts, potential conflicts and incidences of non-compliance are referred to the Chief Compliance Officer. The CCO takes appropriate action to completely resolve all identified conflicts and incidences of non-compliance. Process of Determining Officer Comp Form 990 Part VI Line 15A & B Wellstar engages the Hay Group to work with the governing board to review and recommend executive compensation. The executive compensation process at Wellstar is overseen by a committee of independent trustees, which follows a board-approved executive compensation philosophy. The compensation committee 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 Statements Form 990 Part IV Line 12 & Part IX Kennestone 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 Allocation Form 990 Part IV Line 24a & Part X For purposes of the Form 990 reporting, Wellstar Health System, Inc EIN 58-1649541 will list all tax-exempt bonds issued since January 1, 2003 on Schedule K as it typically allocates the proceeds of the bonds to members of the Obligated Group (including the hospitals and physician group). Kennestone Hospital, Inc. will report this tax exempt bond liability on Part X, Line 25 Other Liabilities-Due to WHS, Inc. Organization Structure Form 990 Part VI Section A Lines 6, 7a & 7b As 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 Worked Form 990 General Statement The officers devote their time to all of the organizations within Wellstar Health System that are listed in Schedule R, Part II. As such, the total hours worked by the officers across all organizations exceeds 40 hours a week. 990 Board Review Form 990 Part VI Line 11A Internal staff prepare the organization's Form 990. Before filing the return with the Internal Revenue Service an external accounting firm, PricewaterhouseCoopers, reviews and sign-offs on the completed return of each organization. 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 Documents FORM 990 PART VI SECTION C Line 19 The organization and its subsidiaries are subject to the Open Records Law in the State of Georgia. Therefore, by law, citizens are permitted to inspect and copy its governing documents, policies and financial statements as may be requested from time to time. Additionally, the organization's Form 990 is made readily available on the Guidestar website. Periodically, the organization publishes its financial performance in the local newspaper for citizens to review, and it also publishes a community benefit report once a year for distribution to the public. Changes in Net Assets Form 990 Part XI Line 5 For 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 Amendments Part VI Line 4 During 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. CHS Foundation Inc 805 Sandy Plains Road Marietta GA 30066 581649540 Foundation GA 501 (C) 3 11 Type 2 WHS Inc true Cobb Hospital Inc 805 Sandy Plains Road Marietta GA 30066 580968382 Healthcare GA 501 (C) 3 3 WHS Inc true Douglas Hospital Inc 805 Sandy Plains Road Marietta GA 30066 582026750 Healthcare GA 501 (C) 3 3 WHS Inc true Paulding Medical Center Inc 805 Sandy Plains Road Marietta GA 30066 582095884 Healthcare GA 501 (C) 3 3 WHS Inc true Wellstar Foundation Inc 805 Sandy Plains Road Marietta GA 30066 581627413 Foundation GA 501 (C) 3 11 Type 2 WHS Inc true Wellstar Health System Inc 805 Sandy Plains Road Marietta GA 30066 581649541 Healthcare GA 501 (C) 3 11 Type 2 NA false Cobb Hospital Parking Company LLC 805 Sandy Plains Road Marietta GA 300666340 752999669 Parking GA NA N/A Kennestone East Parking Deck LLC 805 Sandy Plains Road Marietta GA 300666340 200537100 Parking GA NA N/A Community Assurance Co 3rd Fl Barclays House Shedden Rd George Town Grand Cayman, BWI CJ 581649541 Insurance CJ N/A true false false false false false false false false false false false false false false false false false false