2013-05-13T11:30:45-05:00 2012-06-30 PricewaterhouseCoopers LLP 2001 MARKET ST SUITE 1700 PHILADELPHIA PA 19103 990 2011-07-01 580968382 COBB HOSPITAL INC % JAMES M SWARTZ COBB 7707925023 805 Sandy Plains Road Marietta GA 300666340 James M Swartz 2013-05-13 true 2673303000 2011 2016-02-24 21:20:13Z REYNOLD J JENNINGS 805 Sandy Plains Road Marietta GA 300666340 318580722 false X www.wellstar.org X 1984 GA To provide world-class charitable healthcare to the community 18 14 2630 200 0 0 0 0 305272543 312941906 0 13150 3163632 5625666 308436175 318580722 0 0 0 0 137566556 136487616 0 0 0 145373579 151642508 282940135 288130124 25496040 30450598 187247660 188291475 120452266 126800535 66795394 61490940 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 247764948 312941906 As discussed herein, Cobb Hospital, Inc (an affiliate of Wellstar Health System, Inc.) operates as a charitable organization consistent with the requirements of Internal Revenue Code Section 501(c)(3) and the "community benefit standard" of IRS Revenue Ruling 69-545. In this regard, the governing body of the organization and/or its parent is composed of prominent citizens in the community, medical staff privileges in the hospital are available to all qualified physicians in the area consistent with the size and nature of the facility; the hospital operates a full-time emergency room open to all regardless of ability to pay; the hospital provides care to the needy members of the community consistent with its charity care policy regardless of their ability to pay for these services. The hospital's excess funds are generally applied to expansion and replacement of existing facilities and equipment, amortization of indebtedness, improvement of patient care, community benefits activity, and charity care. Cobb Hospital reinvested a total of approximately $18.0 million in capital expenditures for equipment upgrades and other capital improvements to better serve the community. Cobb Hospital was organized in 1984. The hospital affiliated with the Northwest Georgia Health System in 1993. In 1994, Northwest Georgia Health System helped form the PROMINA Health System and changed its name to Promina Northwest Health System. In 1998 Promina Northwest changed its name to Wellstar Health System and is now totally independent of Promina. Cobb Hospital is subordinate to, and subject to the authority of Wellstar Health System and its governing boards including the Hospital Authority of Cobb County. Cobb Hospital provides a full range of inpatient and outpatient services characteristic of a community hospital. The hospital is licensed to operate 382 beds and is presently staffed to operate 370 beds. The original hospital was constucted in 1968 and several major structural additions have happened since that time. The following stats constitute the overall program services provided during the reporting period ended June 30, 2012: Adult Discharges 20,882 Med/Surg Short Stay days 5,804 Emergency Room Visits (incl pediatric ER) 99,207 Outpatient Surgical Cases 7,423 Inpatient Surgical Cases 3,791 Outpatient Procedures Non-ED OP Radiology 62,944 GI Laboratory 1,773 Total FTEs (paid) 1,957 Community Benefit Reporting Community Outreach (incl system-wide alloc) $147,904 Unreimbursed Charity Care (at cost) $29,218,662 Medicaid Shortfalls (at cost) $ 8,204,712 Total $37,571,278. As an affiliate of Wellstar Health System, Cobb Hospital participates in many community and educational programs for the overall health and benefit of the area that they serve. Some examples of those programs are: Community Health/Education--screenings and educational opportunities such as denfensive driving for teens (offered at a minimal cost or at no cost), smoking cessation, heart smart school, CPR and others. System-wide over 200,000 residents from the community participated in these various screenings. The Public Relations department notifies the public of these offerings by publishing a quarterly mailer to community residents which costs the system over $80,000. Community Activities--sponsors blood drives, provides funding to school health programs for medical and dental preventive care. Community Events--Wellstar has an annual day for the Latino community geared at screenings and educational activities on a variety of health issues specifically for the Hispanic community. Sponsorships A group of employees also participated in the annual "Relay for Life: an event to raise funds and awareness for cancer research and prevention (held in conjunction with the American Cancer Society). System-wide a total of $10,000 was raised to support cancer research, education and patient services. Efforts are planned to expand this support in the coming years. Recognition and Accomplishments Cobb Hospital and Kennestone Hospital operate full-service clinics on the respective campuses to provide health related services to uninsured and underinsured who might not otherwise receive care. In FY2012 the clinics served a combined 9,000 patient visitors at a cost of almost $3 million. A clinic for senior wellness also opened in Cobb County. The system partnered with the local school systems to provide free health and safety education to nearly 50,000 area elementary students and approximately 8,000 adolescent students. In partnership with Cobb County law enforcement and YWCA, Wellstar started a program called Sexual Assault Nurse Examiner (SANE) for confidential and secure treatment of sexual assault victims. Approximately 100 patients were treated in the program. Cobb Hospital continued to serve as a Partner in Education site for mentoring South Cobb High School students with interest in pursuing healthcare professions. Thirty students participate in the program each year. Wellstar and the Cobb County Board of Education have partnered to provide student athletes with concussion testing in all sports related programs offered in the schools. This testing is provided free of charge to the student athletes as a proactive and preventive measure before participation is granted. Wellstar and Cobb Hospital again received the designation as a "Company that Cares" for its caring about patients, communities and team members. It is one of only seven health care systems and the only local system to achieve that distinction. Cobb Hospital and other Wellstar facilities continued to invest in state of the art cancer treatment with its Wellstar Cancer Program. More than 3,000 patients were treated in the system; 917 cyberknife radiosurgeries were performed; and almost 21,000 radiation therapy treatments were provided. Cobb, Douglas, Kennestone and Paulding hospitals continue to meet the Appropriate Care Measures (ACM) 93 percent threshold in quality for the Presidential Level of the Quality Honor Roll as reported by Georgia Hospital Association. Wellstar has seen its percentages move from a rating of 81.4 percent to a current rate of 94.6 percent. Cobb Hospital was named one of the Top 10 Best Hospitals in metro Atlanta by the US News and World Report magazine. Wellstar received a 3 STAR rating from the Society of Thoracic Surgeons for the quality of its cardiac surgery program. Only 12-15 percent of hospitals across the country receive this 3 Star rating, which denotes the highest category of quality for clinical excellence based on national standards. Kennestone Hospital specifically was in the top tier of cardiac programs across the country. This ranking helps to validate the addition of the cardiac surgery services several years ago as a product line to provide these services "closer to home". WellStar Cobb, Douglas and Kennestone are all accredited chest pain centers. All WellStar hospitals, physician offices, and administrative offices implemented a policy of a Tobacco-Free Environment on January 1, 2012. This initiative makes our campuses better equipped to institute tobacco cessation programs and to provide leadership in this area. It further meets the challenge of our credo which states that "at WellStar we believe in life well-lived". All five of WellStar's hospitals have earned Quality Respiratory Care Recognition (QRCR) for the ninth year in a row under a national program that attempts to help patients make informed decisions about quality respiratory services available in hospitals. Only about 15 percent of hospitals have applied and received this recognition. The designation ensures patient safety by agreeing to adhere to a strict set of criteria for quality respiratory services. WellStar implemented a new Enterprise Master Patient Index (EMPI) during the year. The project was activated at all of the system hospitals as well as the physician offices in an effort to enhance the patient experience and improve safety. The system provides more patient-centered care and helps eliminate duplicate medical records as the information gathered at registration is shared throughout WellStar. Wellstar Health System donated approximately $1.0 million in funds to the Georgia Highlands College Nursing program. The funds to be disbursed over two years will support the college's new Bachelor of Science in nursing as well as onsite programs for WellStar team members. It is the largest single contribution the college has ever received. The agreement expands the bridge program for licensed practical nurses who want to become registered nurses with an associate's degree. The program is available at GHC to students in Cobb, Douglas and Paulding counties. This will also help meet the educational needs of WellStar team members who are students at GHC. Having onsite access to learning opportunites so that nurses can learn and grow is critical to WellStar hiring and retaining nurses for the system. WellStar Cobb Hospital receive 247764948 true false false false false false false false false true false false true true false 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 true false false true 0 0 2630 true false false false false false false false false false false X 18 14 true false false 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 Randall Bentley 1.0 X 0 16769 0 Robert N Cross MD 1.0 X 0 4272 0 TE Durham 1.0 X 0 36443 1430 Thomas E Gearhard MD 1.0 X 0 441387 30593 David Hafner MD 1.0 X 0 17769 0 Charles J Jones 1.0 X 0 12580 0 Connie Kirk 1.0 X 0 4675 0 Janie Maddox 1.0 X 0 15634 0 Gary A Miller 1.0 X 0 1742 0 Steven W Oweida MD 1.0 X 0 16946 0 Tom Phillips 1.0 X 0 6165 0 Walter G Robinson 1.0 X 0 3954 0 Otis Brumby III 1.0 X 0 2374 0 W Allen Separk 1.0 X 0 8095 0 T Fitz Johnson 1.0 X 0 3730 0 Jeffrey Tharp MD 1.0 X 0 508542 31417 Charles Pete Wood 1.0 X 0 13025 0 Avril Beckford MD 1.0 X 0 398842 21377 A James Budzinski 2.0 X 0 932621 48453 Reynold J Jennings 2.0 X 0 348685 14385 David W Anderson 2.0 X 0 503600 29075 Donald Campbell MD 2.0 X 0 599439 33540 Barbara B Corey 2.0 X 0 345736 22861 Bruce Dean 2.0 X 0 282753 22320 Marcia Delk MD 2.0 X 0 420637 32831 Clarence H Evins 2.0 X 0 250193 18352 Christopher M Kane 2.0 X 0 396107 27207 Kenneth C Kunze MD 2.0 X 0 698966 35591 Louis W Little 2.0 X 0 286719 24608 Kimberly W Menefee 2.0 X 0 325382 22343 Ronald J Strachan 2.0 X 0 492358 24507 Lee Randolph Cook 50.0 X 336765 0 23660 MICHAEL GRAUE 2.0 X 0 680247 43271 ROBERT JANSEN 2.0 X 0 509124 26667 ELLEN LANGFORD 2.0 X 0 275321 14655 Robert Mandler 2.0 X 0 266979 18768 Jonathan B Morris 2.0 X 0 416394 27823 Anthony M Trupiano 2.0 X 0 284073 16516 Robin Wilson MD 2.0 X 0 506787 32116 Ilona L Wozniak 50.0 X 278506 0 18289 Joseph L Brywczynski 2.0 X 0 311785 19612 Elizabeth A Hoffmann 2.0 X 0 233775 11530 Richard T Lopes MD 2.0 X 0 757815 36938 James M Swartz 2.0 X 0 217871 14937 Mary L Wesley 2.0 X 0 457717 21831 Barbara G Ballard 2.0 X 0 259113 22697 Carol S Edwards 2.0 X 0 325593 20146 Beth Kost 2.0 X 0 269763 17725 Elizabeth Person 50.0 X 243848 0 17231 Chris Brett Scullen 2.0 X 0 188627 8053 Adam C Thompson 2.0 X 0 185584 10535 Leo E Reichert 2.0 X 0 623353 36099 Deborah DeVita Roegge 2.0 X 0 170369 7541 Mary L Tavernaro 2.0 X 0 224515 15552 Carol B Maxwell 2.0 X 0 86518 4350 Kenneth D Etheridge 50.0 X 345123 0 19449 Thomas W McNamara MD 50.0 X 203605 0 12415 Kem Mullins 50.0 X 0 0 0 Chester Zborowski 2.0 X 0 0 0 Valery Akopov 2.0 X 0 0 0 Allen Hoffman MD 50.0 X 179664 0 15136 Billy A Reid 50.0 X 165084 0 12300 William Gonzalez 50.0 X 143053 0 16734 Timothy Fullard 50.0 X 142296 0 14271 Tawana Moses 50.0 X 169442 0 10714 Gregory L Simone MD X 0 248936 13892 Bonnie Wilson X 0 244138 13763 2207386 15140537 1056106 86 true true false Martin General Contracting Inc 3633 Ivy Gulledge Rd DALLAS GA 30132 General Contracting 713967 Quest Diagnostics PO BOX 740736 ATLANTA GA 30384 LAB SERVICES 855526 Surgical Operational Services Inc 505 Commerce Park Dr Suite G MARIETTA GA 30060 Consultant OR 842949 RCC Marietta PO Box 101518 ATLANTA GA 303921518 Medical Services 1095400 Cork-Howard Construction Inc 2121 New Market Pkwy Suite 118 MARIETTA GA 30067 GENERAL CONTRACTOR 6519672 22 0 PATIENT REVENUE 621990 311646354 311646354 PATIENT EDUCATION 621990 27374 27374 MEDICAL RECORDS 621990 537 537 MEDICAID REIMB (MEANINGFUL USE) 621990 1267641 1267641 312941906 0 0 0 27065 27065 27065 27065 13150 13150 13150 13150 0 0 0 CAFETERIA 1929193 1929193 PARKING 962725 962725 PHARMACY REVENUE 2282185 2282185 424498 424498 5598601 318580722 312941906 5638816 0 0 0 0 1407848 1238202 169646 0 111913433 98426889 13486544 5744330 5052138 692192 9199257 8090747 1108510 8222748 7231907 990841 0 35491 35491 0 0 0 0 9976613 9711804 264809 19299 17872 1427 13602659 11708299 1894360 0 0 3655533 330334 3325199 87577 49525 38052 0 52067 28474 23593 49308 49308 57415395 50496840 6918555 13306141 5367873 7938268 2395508 2395508 REPAIRS & MAINTENANCE 4463346 3480446 982900 MEDICAL SUPPLIES 46157603 46157149 454 OTHER EXPENSES 425968 376449 49519 288130124 247764948 40365176 0 6825 7025 37865 27596 0 0 48302664 51290559 0 0 0 0 0 0 5078180 6174822 1753680 1576039 306813156 187431083 121765354 119382073 0 0 0 0 0 0 0 0 10303092 9833361 187247660 188291475 20393695 19872593 0 0 0 0 0 0 0 0 0 0 57208 29459 0 0 100001363 106898483 120452266 126800535 X 66795394 61490940 0 0 0 0 66795394 61490940 187247660 188291475 X 30450598 -35755052 X false true true X false X 4336556 4336556 147916047 75230009 72686038 4870974 3576407 1294567 147751189 108624667 39126522 1938390 1938390 119382073 DUE TO AFFILIATES 4774742 C&E MEDICAID PENDING 5058619 9833361 0 ASSET RETIREMENT-OTHER LT LIAB 602705 TAX EXEMPT BOND LIAB-DUE TO WH 106295778 106898483 Uncertain Tax Position SCHEDULE D PART X Line 2 The following is a footnote from the combined financial statements of Wellstar Health System, Inc. and Affiliates related to the reporting of the organization's liability for uncertain tax positions under FIN 48. "Wellstar and all but one of its affiliates have been recognized as exempt from Federal income tax under Internal Revenue Code Section 501 (a) as organizations described in Section 501 (c) (3) and therefore, related income is generally not subject to Federal or state income tax. Community Assurance Corportion is a controlled foreign corporation not subject to Federal tax. Wellstar applies FASB ASC 740, Income Taxes, which addresses accounting for uncertainties in income tax positions. It also provides guidance on when tax positions are recognized in an entity's financial statements and how the values of these positions are determined. There is no impact on Wellstar's combined financial statements as a result of the application of ASC 740." true true X true X 125. true X true true true false true true 29218662 29218662 0.10140 56149808 47945096 8204712 0.02850 85368470 47945096 37423374 0.12990 1024029 1024029 0.00360 1024029 1024029 0.00360 86392499 47945096 38447403 0.13350 true 13485901 3101264 102875402 112965790 -10090388 X true true 1 1 Cobb Hospital

3950 Austell Road Austell GA 300666340

X X X Cobb Hospital 1 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 Sch H Part I Line 6a Cobb Hospital, Inc. is an affiliate of Wellstar Health System, Inc. which on an annual basis issues a community benefit report. This report is subsequently distributed in and around the five county service area of the health system. Cost to Charge Ratio Sch H Part I Line 7 For purposes of the IRS Form 990 Schedule H, Wellstar Health System and Affiliates (including Cobb Hospital) have estimated the current year cost to charge ratio for each hospital as it is reported in the annual community benefit report and as it will be reported in the state's Annual Hospital Financial Survey. Footnote on Bad Debt and Rationale for Community Benefit Sch H Part III Line 4 The following footnote is detailed in the Wellstar Health System, Inc. and Affiliates Financial Statements related to bad debt or uncollectible accounts: "During 2011, Wellstar adopted the provisions of FASB Accounting Standards Update (2011-07), Healthcare Entities (Topic 954). ASU 2011-07 requires the reclassification of the provision for uncollectible accounts associated with patient service revenue from an operating expense to a deduction from patient service revenue (net of contractual allowances and discounts)." "Wellstar recognizes patient service revenue associated with services provided to patients with third-party payor coverage on the basis of contractual rates for the services rendered. For uninsured patients that do not qualify for community financial aid, Wellstar recognizes revenue on the basis of its discounted rates for services provided. On the basis of historical experience, a significant portion of Wellstar's uninsured patients are unable or unwilling to pay for the services provided. Thus, Wellstar records a significant provision for uncollectible accounts related to uninsured patients in the period the services are provided." Subsequent to the end of the reporting period a propensity to pay review of patient accounts often results in prior year bad debt accounts which are deemed eligible for the organization's financial assistance policy. Those bad debt accounts are reclassified as charity and thus our rationale for including in community benefit. Medicare Shortfalls Schedule H Part III Line 8 Cobb Hospital is a provider of inpatient and outpatient services to Medicare program beneficiaries at determined rates. Without the participation in the Medicare program these patients may not have had convenient access to those services. The Medicare shortfall on line 7 represents the uncompensated difference between the expected reimbursement and the Medicare charges for those services stated at cost. We determine a cost to charge ratio for Medicare patients as part of the annual filing of the Medicare cost report. Collection Practices Schedule 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. Hospital Description Schedule H Part V Cobb Hospital is a general acute care hospital providing a full range of services, is licensed to operate 382 beds, and is presently staffed to operate 370 beds. It is located on an approximately 55-acre campus in Austell, Georgia and is housed within a complex of connected buildings containing a total square footage in excess of 599,000 square feet. The original hospital was constructed in 1968 and major structural additions have been made in several phases since that time. The hospital provides medical, surgical, obstetrical, pediatric, rehabilitative, and psychiatric inpatient care and outpatient care, including emergency services. The Cobb Hospital Women's Center operates 20 labor and delivery rooms, 40 post partum rooms, 6 antipartum rooms and a resource center and classrooms offering educational opportunities. Needs 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 Sch H Part VI Line 3 Cobb Hospital provides its patients with hospital personnel or contracted personnel who are trained in all aspects of governmental programs, payments plans, charity discounts, and other financial assistance offered to assist them in their hospital bills. If the patient is eligible for federal or state assistance programs, a staff member is knowledgeable in the steps necessary to qualify those individuals. If a patient is indigent or charity eligible they will be offered assistance through the hospital's charity and indigent care policy including the state's indigent care trust fund. If the patient has no other insurance and fails to qualify for indigent care assistance, the financial counselor can then offer the patient an opportunity to accept a payment plan with discounted payment options based on their ability to pay immediately or over time. All patient are afforded these opportunities. Community Information Sch H Part VI Line 4 Cobb Hospital is one of five hospitals that are affiliated with the parent corporation, Wellstar Health System. The primary service area of the system is located in the Northwest Georgia area and receives the majority of its patients from one of five counties (Cherokee, Cobb, Douglas, Bartow and Paulding). Generally about 85% to 90% of the patient volume comes from this service area although other health systems have a presence in the area as well. Demographically the region is one of the fastest growing in the state as well as the country and the expansion of the services for the patient population reflects a desire to offer healthcare "closer to home" since Wellstar is considered a part of a larger metropolitan Atlanta market. Economically the region is strong in per capita income but given recent trends a rise in the uninsured and indigent population has occured. Affiliated Health System Role Schedule H Part VI Line 7 As stated in the Wellstar Health System, Inc and Affiliates audited financial statments for the period ended June 30, 2012, Cobb Hospital (an affiliate of Wellstar Health System, Inc.) operates as a charitable organization consistent with the requirements of Internal Revenue Code Sect 501 (c) (3) and the "community benefit standard" of IRS Ruling 69-545. In this regard the governing body of the organization and/or its parent is composed of prominent citizens in the community, medical staff privileges in the hospital are available to all qualifed physicians in the area consistent with the size and nature of the facility; the hospital operates a full-time emergency room open to all regardless of ability to pay; and the hospital provides care to the needy members of the community consistent with its charity care policy. The hospital's excess funds are genrally applied to expansion and replacement of existing facilities and equipment, amortization of indebtedness, improvement fo patient care, community benefit activities, and charity care. Cobb Hospital committed approximately $21.2 million in capital expenditures for the year to meet those needs. Publication of Fin 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. X X X X X X false true X X X X X true false false false false false false true false Thomas E Gearhard MD 0 249303 0 184230 0 7854 0 23371 0 7222 0 471980 0 0 Jeffrey Tharp MD 0 308337 0 89305 0 110900 0 26140 0 5277 0 539959 0 0 A James Budzinski 0 464491 0 454394 0 13736 0 43675 0 4778 0 981074 0 0 Avril Beckford MD 0 261712 0 49363 0 87767 0 21377 0 0 420219 0 0 Reynold J Jennings 0 339346 0 0 9339 0 14385 0 0 363070 0 0 Gregory L Simone MD 0 248936 0 0 0 10168 0 3724 0 262828 0 0 Bonnie Wilson 0 244138 0 0 0 10168 0 3595 0 257901 0 0 David W Anderson 0 388078 0 100027 0 15495 0 25522 0 3553 0 532675 0 0 Donald Campbell MD 0 314601 0 64127 0 220711 0 29646 0 3894 0 632979 0 0 Barbara B Corey 0 276741 0 58195 0 10800 0 19361 0 3500 0 368597 0 0 Bruce Dean 0 201641 0 72017 0 9095 0 16148 0 6172 0 305073 0 0 Marcia Delk MD 0 337360 0 71529 0 11748 0 22572 0 10259 0 453468 0 0 Clarence H Evins 0 191938 0 29473 0 28782 0 14197 0 4155 0 268545 0 0 Christopher M Kane 0 318290 0 66617 0 11200 0 21485 0 5722 0 423314 0 0 Kenneth C Kunze MD 0 569002 0 118114 0 11850 0 33824 0 1767 0 734557 0 0 Louis W Little 0 224975 0 50944 0 10800 0 16978 0 7630 0 311327 0 0 Kimberly W Menefee 0 258803 0 54544 0 12035 0 18482 0 3861 0 347725 0 0 Ronald J Strachan 0 287145 0 49464 0 155749 0 22279 0 2228 0 516865 0 0 Lee Randolph Cook 276688 0 48026 0 12051 0 18980 0 4680 0 360425 0 0 0 Allen Hoffman MD 164352 0 14112 0 1200 0 7412 0 7724 0 194800 0 0 0 Billy A Reid 155703 0 9381 0 0 9945 0 2355 0 177384 0 0 0 William Gonzalez 137338 0 5715 0 0 8823 0 7911 0 159787 0 0 0 Timothy Fullard 142023 0 273 0 0 8494 0 5777 0 156567 0 0 0 Tawana Moses 151889 0 16353 0 1200 0 10082 0 632 0 180156 0 0 0 MICHAEL GRAUE 0 527427 0 138784 0 14036 0 33360 0 9911 0 723518 0 0 ROBERT JANSEN 0 346951 0 98895 0 63278 0 21176 0 5491 0 535791 0 0 ELLEN LANGFORD 0 186452 0 80169 0 8700 0 11975 0 2680 0 289976 0 0 Robert Mandler 0 206312 0 31122 0 29545 0 14907 0 3861 0 285747 0 0 Jonathan B Morris 0 267997 0 136358 0 12039 0 22332 0 5491 0 444217 0 0 Anthony M Trupiano 0 237972 0 36641 0 9460 0 16516 0 0 300589 0 0 Robin Wilson MD 0 290890 0 205797 0 10100 0 21394 0 10722 0 538903 0 0 Ilona L Wozniak 238675 0 30571 0 9260 0 16396 0 1893 0 296795 0 0 0 Joseph L Brywczynski 0 249445 0 51540 0 10800 0 17759 0 1853 0 331397 0 0 Elizabeth A Hoffmann 0 194472 0 30603 0 8700 0 9763 0 1767 0 245305 0 0 Richard T Lopes MD 0 563490 0 98330 0 95995 0 35223 0 1715 0 794753 0 0 James M Swartz 0 180180 0 28991 0 8700 0 9268 0 5669 0 232808 0 0 Mary L Wesley 0 295174 0 151203 0 11340 0 18920 0 2911 0 479548 0 0 Barbara G Ballard 0 218870 0 31523 0 8720 0 14225 0 8472 0 281810 0 0 Carol S Edwards 0 260780 0 29770 0 35043 0 18289 0 1857 0 345739 0 0 Beth Kost 0 225630 0 35433 0 8700 0 15958 0 1767 0 287488 0 0 Elizabeth Person 209838 0 24323 0 9687 0 14587 0 2644 0 261079 0 0 0 Chris Brett Scullen 0 159623 0 20304 0 8700 0 7837 0 216 0 196680 0 0 Adam C Thompson 0 152126 0 24158 0 9300 0 7783 0 2752 0 196119 0 0 Leo E Reichert 0 438716 0 168080 0 16557 0 28317 0 7782 0 659452 0 0 Deborah DeVita Roegge 0 119681 0 0 50688 0 7048 0 493 0 177910 0 0 Mary L Tavernaro 0 191015 0 27108 0 6392 0 13871 0 1681 0 240067 0 0 Kenneth D Etheridge 201008 0 135415 0 8700 0 18428 0 1021 0 364572 0 0 0 Thomas W McNamara MD 153493 0 0 0 50112 0 11251 0 1164 0 216020 0 0 0 Non-Fixed Payments Form 990 Schedule J Part 1 Line 7 As part of the Wellstar Executive Compensation Philosophy a performance pay plan was instituted several years ago whereby the Wellstar Board of Trustees approves an annual incentive plan which consists of several performance goals or factors that upon attainment will result in payouts to eligible plan participants (manager level employees and above). Those factors are: People goal for employee turnover Customer Service goal for employee engagement Quality & Safety goal for clinical excellence and patient satisfaction Financial goal for attaining a positive operating margin Confirmation of achieving these payout triggers is typically received through the annual external audit process and approved by the Board of Trustees at that time. In addition the incentive program has now been extended to all WellStar team members (non-manager level)on a somewhat smaller scale. Severance Benefits 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 Randy Cook Barbara Corey Marcia Delk MD Michael Graue T Mark Haney Bruce Harrison Robert Jansen MD Christopher Kane Kenneth Kunze MD Lou Little Richard Lopes MD Kimberly Menefee Jonathan Morris MD Leo E Reichert Ron Strachan Anthony Trupiano Mary L Wesley Robin Wilson MD The officers with a severance payment period of 12 months as per their agreement: Barbara Ballard Bruce Dean Carol Edwards Darold Etheridge Lee Evins Robert Hamilton Elizabeth Hoffmann Beth Kost Ellen Langford Robert Mandler Carol Maxwell Elizabeth Person Deborah Roegge DeVita C Brett Scullen James Swartz Mary L Tavernaro Adam Thompson Ilona Wozniak During the calendar year, the following individuals received a payout in the amounts listed in accordance with their severance agreements as set forth above: Bruce Harrison $21,897 Gregory L Simone $248,936 Bonnie Wilson $244,138 Other Compensation Form 990 Schedule J Part 1 Line 1b and 2 While Wellstar Health System and its affiliates do not have a written policy regarding payment or reimbursement fo 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 On Schedule J of IRS Form 990 the following individuals were employed as officers of Wellstar Health System and its Affiliates during the reporting period but did not have salary and benefits in the calendar year for which this schedule applies: Kem Mullins, Chester Zborowski and Valery Akopov Pamela Etheridge Wife of Officer 55003 Employee of Wellstar false Greg Fortgang Son-in-law of Trustee 92895 Employee of Wellstar false Greg Separk Son of Trustee 59724 Employee of Wellstar false George Fleming Brother of Officer 60969 Employee of Wellstar false Matthew Maddox Son of Trustee 39776 Employee of Wellstar false Bonnie Miller Wife of Trustee 31510 Employee of Wellstar false Jessica Haney Daughter of Officer 54545 Employee of Wellstar false Greg Kost Brother-in-law of Officer 25034 Employee of Wellstar false 990 T Explanation of Filing Form 990 Part V Line 3 Cobb Hospital generated no unrelated business income for the reporting period. As a result the attached 990T shows no activity. If subsequent review of the books reveals any unreported UBI we will file an amended return for the tax period ended June 30, 2012. Form 990 Copy to Board of Directors 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. The current year Form 990 is then reviewed by the Finance Committee along with a question and answer session. A motion is then made by the Finance committee to approve the returns and present to the full board copies of the forms in an electronic (pdf. format) version as well as a hard copy. The organization's CFO or designee subsequently signs the return for either manual or electronic filing by the appropriate due date. Conflict of Interest Policy Form 990 Part VI Section B Line 12 a-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 this policy: Compliance identifies all covered persons who must complete the survey and attestation. Compliance verifies that the survey and attestation is distributed to these persons. Compliance verifies that these persons return a fully completed and signed survey and attestation. Compliance reviews each completed and signed survey and attestation to identify all conflicts listed in the document. All conflicts, potential conflicts and incidences of non-compliance are referred to the Chief Compliance Officer. The CCO takes appropriate action to completely resolve all identified conflicts and incidences of non-compliance. Process for determining Exec Compensation Form 990 Part VI Section B 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 consists of three board members and the CEO for the system. In discussions about the compensation for the Chief Executive Officer, the acting CEO will recuse himself from that process but is a non-voting committee member for discussions on all other officers. The executive compensation philosophy empowers the committee to oversee the executive compensation process and administer the executive compensation program on behalf of the full board of trustee of Wellstar; provided, however, the full Board of Trustees evaluates and approves the compensation of the Chief Executive Officer. The philosophy requires annual disclosure of the committee's actions and decisions to the full board, which it has done. The committee is guided by the board-approved philosophy. Overall, the philosophy is intended to reward for organizational and individual performance. When performance is at a predetermined targeted level, the compensation is intended to be at or around the median of compensation paid to similar positions at similar organizations (the "market"). Wellstar's executive compensation philosophy defines the market as being comprised of comparable not-for-profit health care delivery systems, i.e., not-for-profit organizations similar in complexity and scale to Wellstar. To assist the committee in fulfilling its duties, the committee engaged the Hay Group to provide market compensation data to compare to the Wellstar positions whose compensation the committee oversees. The committee uses this data to provide context when making decisions in administering the compensation program. Accurate minutes of the committee's discussion and decisions are recorded during each committee meeting, and reviewed and approved at the following committee meeting. DISCLOSURE OF FINANCIAL DOCUMENTS Form 990 Part VI Section C Line 19 The organization and its subsidiaries are subject to the Open Records Law in the State of Georgia. Therefore, by law, citizens are permitted to inspect and copy its governing documents, policies and financial statements as may be requested from time to time. Additionally, the organization's Form 990 is made readily available on the Guidestar website. Periodically, the organization publishes its financial performance in the local newspaper for citizens to review, and it also publishes a community benefit report once a year for distribution to the public. Compensation 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). Organizational Structure Form 990 Part VI Line 6 & 7 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 holds certain powers of election and approval in connection with the governing body of the organization. These powers are presented in detail in the company's governing documents which the company makes available to the public upon request. Officer's Hours 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 of the organizations exceeds 40 hours per week. AUDITED FINANCIAL STATEMENTS Form 990 Part IV Line 12 and Part XI WellStar Health System, Inc. is audited on an annual basis by an outside auditing firm, KPMG, and as part of that audit a consolidated financial statement is issued for all of WellStar Health System, Inc and its Affiliates. "The independent auditors report includes the accounts of Wellstar and its controlled affiliates, Kennestone Hospital, Inc., Cobb Hospital, Inc., Douglas Hospital, Inc., Paulding Medical Center, Inc., Wellstar Foundation, Inc. CHS Foundation, Inc., Community Assurance Company, Ltd., various Wellstar owned physician practices, a hospice facility, a nursing facility, home health business, and entities for infusion therapy and durable medical equipment. All significant intercompany accounts and transactions have been eliminated in combination. The Board of Trustees of Wellstar has the authority to approve appointments of the members of the board of trustees of all affiliate corporations." CURRENT OFFICERS/DIRECTORS RELATIONSHIPS FORM 990 PART VI, SECTION A LINE 2 Two of the current officers and directors for Wellstar Health System, Inc. --EIN 58-1649541 are related to each other through family. Lou Little, Sr VP Post Acute Services and Administrator of Windy Hill Hospital is the brother-in-law of Gregory Simone, former President and CEO for the system. Tax-Exempt Bonds 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). Cobb Hospital, Inc. will report this tax exempt bond liability on Part X, Line 25 Other Liabilities. Cobb Hospital, Inc. has also restated its beginning balance sheet with respect to tax exempt bond liabilities as the amounts allocated to tax exempt bond liabilities are now included on Line 25. Other Changes in Net Assets Form 990 Part XI Line 5 For the reporting period Cobb Hospital, Inc. had a change in net assets of ($44,175,628) related to transfers to affiliates as part of the allocation of income statement and balance sheet transactions over the year. HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:Randall Bentley TITLE:Board Member Chair HOURS:1 HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:Robert N Cross MD TITLE:Board Member HOURS:1 HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:TE Durham TITLE:Board Member HOURS:5 HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:Thomas E Gearhard MD TITLE:Board Member HOURS:50 HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:David Hafner MD TITLE:Board Member HOURS:1 HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:Charles J Jones TITLE:Board Member HOURS:1 HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:Connie Kirk TITLE:Board Member HOURS:1 HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:Janie Maddox TITLE:Board Member-Vice Chair HOURS:1 HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:Gary A Miller TITLE:Board Member HOURS:1 HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:Steven W Oweida MD TITLE:Board Member HOURS:1 HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:Tom Phillips TITLE:Board Member HOURS:1 HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:Walter G Robinson TITLE:Board Member HOURS:1 HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:Otis Brumby III TITLE:Board Member HOURS:1 HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:W. Allen Separk TITLE:Board Member HOURS:1 HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:T. Fitz Johnson TITLE:Board Member HOURS:1 HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:Jeffrey Tharp MD TITLE:Board Member HOURS:50 HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:Charles "Pete" Wood TITLE:Board Member HOURS:1 HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:Avril Beckford MD TITLE:Board Member HOURS:50 HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:A James Budzinski TITLE:Exec VP and CFO HOURS:50 HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:Reynold J Jennings TITLE:President & CEO HOURS:50 HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:David W Anderson TITLE:Exec VP HR/OL/CCO HOURS:50 HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:Donald Campbell MD TITLE:Sr VP Physician Education HOURS:50 HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:Barbara B Corey TITLE:Sr VP Managed Care HOURS:50 HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:Bruce Dean TITLE:VP Real Estate & Dep Gen Consl HOURS:50 HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:Marcia Delk MD TITLE:Sr VP Med Affairs & CQO HOURS:50 HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:Clarence H Evins TITLE:VP Revenue Cycle Mgmt HOURS:50 HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:Christopher M Kane TITLE:Sr VP Strategic Plan&Bus Devlp HOURS:50 HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:Kenneth C Kunze MD TITLE:Sr VP Chief Med Officer HOURS:50 HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:Louis W Little TITLE:Sr VP Post Acute & Hosp Admin HOURS:50 HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:Kimberly W. Menefee TITLE:Sr VP Public & Govt Affairs HOURS:50 HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:Ronald J Strachan TITLE:Sr VP & CIO HOURS:50 HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:Lee Randolph Cook TITLE:Sr VP & Administrator HOURS:2 HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:MICHAEL GRAUE TITLE:EXEC VP COO HOURS:50 HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:ROBERT JANSEN TITLE:Exec VP & Pres Med Group HOURS:50 HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:ELLEN LANGFORD TITLE:VP & COO PHY GRP HOURS:50 HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:Robert Mandler TITLE:VP Diagnostic Outreach HOURS:50 HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:Jonathan B Morris TITLE:Sr VP and CIO HOURS:50 HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:Anthony M Trupiano TITLE:Sr VP Supply Chain HOURS:50 HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:Robin Wilson, MD TITLE:Sr VP Performance Innovation HOURS:50 HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:Joseph L Brywczynski TITLE:Sr VP Health Parks Admin HOURS:50 HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:Elizabeth A Hoffmann TITLE:VP Budget & Analysis HOURS:50 HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:Richard T Lopes, MD TITLE:Sr VP & Pres Wellstar Phy Grp HOURS:50 HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:James M Swartz TITLE:VP Accounting HOURS:50 HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:Mary L Wesley TITLE:Sr VP Nursing Services & CNE HOURS:50 HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:Barbara G Ballard TITLE:VP Homecare & Hospice HOURS:50 HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:Carol S Edwards TITLE:VP Cardiac Services HOURS:50 HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:Beth Kost TITLE:VP Compliance/Ch Privacy Offr HOURS:50 HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:Chris Brett Scullen TITLE:VP Pulmonology Operations HOURS:50 HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:Adam C Thompson TITLE:VP Surgery HOURS:50 HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:Leo E Reichert TITLE:Exec VP & General Counsel HOURS:50 HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:Deborah DeVita Roegge TITLE:VP Women's & Newborn Srv Line HOURS:50 HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:Mary L Tavernaro TITLE:VP Human Resources Operations HOURS:50 HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:Carol B Maxwell TITLE:VP Human Resources HOURS:50 HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:Kenneth D Etheridge TITLE:VP Finance and Hospital CFO HOURS:2 HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:Chester Zborowski TITLE:VP Health Park Operations HOURS:50 HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:Valery Akopov TITLE:VP Chief Hospitalists Services HOURS:50 CHS Foundation 805 Sandy Plains Road Marietta GA 30066 581649540 Foundation GA 501 (c) (3) 11 WHS true Douglas Hospital Inc 805 Sandy Plains Road Marietta GA 30066 582026750 Healthcare GA 501 (c) (3) 3 NA true Kennestone Hospital Inc 805 Sandy Plains Road Marietta GA 30066 582032904 Healthcare GA 501 (c) (3) 3 WHS true Paulding Medical Center Inc 805 Sandy Plains Road Marietta GA 30066 582095884 Healthcare GA 501 (c) (3) 3 WHS true Wellstar Foundation 805 Sandy Plains Road Marietta GA 30066 581627413 Foundation GA 501 (c) (3) 11 Type 2 WHS true Wellstar Health System 805 Sandy Plains Road Marietta GA 30066 581649541 Healthcare GA 501 (c) (3) 11 Type 2 NA false Kennestone South Parking Deck 805 Sandy Plains Road Marietta GA 300666340 582429775 PARKING GA NA Investment 208549 1796385 false false Cobb Hospital Parking Company LLC 805 Sandy Plains Road Marietta GA 300666340 752999669 PARKING GA NA Investment 75069 783098 false false Community Assurance Co 3rd Fl Barclays House Shedden Rd George Town Grand Cayman, BWI CJ 581649541 INSURANCE CJ WHS INC C 59852977 1.00000 false false false false false false false false false true false false false false false false false false CHS Foundation Inc J 223225 FMV