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KENNESTONE HOSPITAL INC: Form 990, tax year 2010

View the entire original 990 at ProPublica ↗

Organization
KENNESTONE HOSPITAL INC (EIN 58-2032904)
Tax period
2010-07-01 to 2011-06-30
Filed
2012-05-15
IRS object ID
201221369349304962
Schema version
2010v3.7
Source
Download XML · Original 990 at ProPublica

Every field in the e-filed return. Faint text is the IRS element name, for citing.

Return header ReturnHeader

FieldValueIRS element (for citing)
Timestamp2012-05-15T13:46:31-04:00Timestamp
Tax Period End Date2011-06-30TaxPeriodEndDate

Preparer Firm PreparerFirm

Preparer Firm Business Name PreparerFirmBusinessName

FieldValueIRS element (for citing)
Business Name Line1PricewaterhouseCoopers LLPBusinessNameLine1

Preparer Firm US Address PreparerFirmUSAddress

FieldValueIRS element (for citing)
Address Line12001 MARKET ST SUITE 1700AddressLine1
CityPHILADELPHIACity
StatePAState
ZIP Code19103ZIPCode
FieldValueIRS element (for citing)
Return Type990ReturnType
Tax Period Begin Date2010-07-01TaxPeriodBeginDate

Filer Filer

FieldValueIRS element (for citing)
EIN582032904EIN

Name Name

FieldValueIRS element (for citing)
Business Name Line1KENNESTONE HOSPITAL INCBusinessNameLine1
FieldValueIRS element (for citing)
Name ControlKENNNameControl
Phone7707925023Phone

US Address USAddress

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

Officer Officer

FieldValueIRS element (for citing)
NameJIMMY SWARTZName
TitleVP, ACCOUNTINGTitle
Date Signed2012-05-15DateSigned
Authorize Third PartytrueAuthorizeThirdParty

Preparer Preparer

FieldValueIRS element (for citing)
Phone2673303000Phone
FieldValueIRS element (for citing)
Tax Year2010TaxYear
Build TS2016-02-24 21:20:13ZBuildTS

Form 990 IRS990

FieldValueIRS element (for citing)
Name Of Principal Officer PersonA JAMES BUDZINSKINameOfPrincipalOfficerPerson
Gross Receipts691051664GrossReceipts
Group Return For AffiliatesfalseGroupReturnForAffiliates
Organization501c3XOrganization501c3
Web Sitewww.wellstar.orgWebSite
Type Of Organization CorporationXTypeOfOrganizationCorporation
Year Formation1993YearFormation
State Legal DomicileGAStateLegalDomicile
Activity Or Mission DescriptionTo provide world class charitable healthcare to the community.ActivityOrMissionDescription
Nbr Voting Members Governing Body18NbrVotingMembersGoverningBody
Nbr Independent Voting Members14NbrIndependentVotingMembers
Total Nbr Employees4953TotalNbrEmployees
Total Nbr Volunteers410TotalNbrVolunteers
Total Gross UBI1121667TotalGrossUBI
Net Unrelated Business Txbl Income0NetUnrelatedBusinessTxblIncome
Contributions Grants Prior Year0ContributionsGrantsPriorYear
Contributions Grants Current Year0ContributionsGrantsCurrentYear
Program Service Revenue Prior Year772276284ProgramServiceRevenuePriorYear
Program Service Revenue CY683440836ProgramServiceRevenueCY
Investment Income Prior Year18062619InvestmentIncomePriorYear
Investment Income Current Year32980InvestmentIncomeCurrentYear
Other Revenue Prior Year9993352OtherRevenuePriorYear
Other Revenue Current Year7577848OtherRevenueCurrentYear
Total Revenue Prior Year800332255TotalRevenuePriorYear
Total Revenue Current Year691051664TotalRevenueCurrentYear
Grants And Similar Amnts Prior Year0GrantsAndSimilarAmntsPriorYear
Grants And Similar Amnts CY0GrantsAndSimilarAmntsCY
Benefits Paid To Members Prior Year0BenefitsPaidToMembersPriorYear
Benefits Paid To Members CY0BenefitsPaidToMembersCY
Salaries Etc Prior Year251480542SalariesEtcPriorYear
Salaries Etc Current Year263582427SalariesEtcCurrentYear
Total Prof Fundrsng Exp Prior Year0TotalProfFundrsngExpPriorYear
Total Prof Fundrsng Exp CY0TotalProfFundrsngExpCY
Total Fundrsng Exp Current Year0TotalFundrsngExpCurrentYear
Other Expense Prior Year424967395OtherExpensePriorYear
Other Expenses Current Year319303513OtherExpensesCurrentYear
Total Expenses Prior Year676447937TotalExpensesPriorYear
Total Expenses Current Year582885940TotalExpensesCurrentYear
Revenues Less Expenses Prior Year123884318RevenuesLessExpensesPriorYear
Revenues Less Expenses CY108165724RevenuesLessExpensesCY
Total Assets BOY439160433TotalAssetsBOY
Total Assets EOY451489162TotalAssetsEOY
Total Liabilities BOY264068767TotalLiabilitiesBOY
Total Liabilities EOY243296810TotalLiabilitiesEOY
Net Assets Or Fund Balances BOY175091666NetAssetsOrFundBalancesBOY
Net Assets Or Fund Balances EOY208192352NetAssetsOrFundBalancesEOY
Mission DescriptionTO CREATE AND DELIVER HIGH QUALITY HOSPITAL, PHYSICIAN AND OTHER HEALTHCARE RELATED SERVICES THAT IMPROVE THE HEALTH AND WELL-BEING OF THE INDIVIDUALS AND COMMUNITIES WE SERVE.MissionDescription
Significant New Program ServicesfalseSignificantNewProgramServices
Significant ChangefalseSignificantChange
Expense518740286Expense
Revenue683440836Revenue
DescriptionAs discussed herein, Kennestone Hospital, Inc (an affiliate of Wellstar Health System, Inc.) operates as a charitable organization consistent with the requirements of Internal Revenue Code Section 501 (c) (3) and the "community benefit standard" of IRS Revenue Ruling 69-545. In this regard, the governing body of the organization and/or its parent is composed of prominent citizens in the community, medical staff privileges in the hospital are available to all qualified physicians in the area, consistent with the size and nature of the facility; one of the hospitals operates a full-time emergency room open to all regardless of the ability to pay; the hospital provides care to needy members of its community consistent with its charity care policy regardless of their ability to pay for these services and admits as patients those able to pay for care, either themselves or through third-party payers such as private health insurance or government programs such as Medicare and Medicaid; and the hospital's excess funds are generally applied to expansion and replacement of existing facilities and equipment, amortization of indebtedness, improvement in patient care, community benefit activities, and charity care. Kennestone Hospital, Inc. consists of two hospitals, Wellstar Kennestone and Wellstar Windy Hill. These hospitals combined to invest approximately $20.2 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 583 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. (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). A recent addition included a women's imaging department. The following stats constitute the overall program services for the period ended June 30, 2011: Kennestone Windy Hill Total Total Adult Discharges 36,149 417 36,566 Med/Surg Short StayCases 2,229 4 2,233 Newborn Discharges 5,475 5,475 Emergency Room Visits 92,686 0 92,686 Pediatric ER Visits 23,939 23,939 Outpatient Surgical Cases 11,026 3,187 14,213 Inpatient Surgical Cases 9,104 115 9,219 Open Heart Cases 655 655 Outpatient Procedures Non ED OP Radiology 137,158 9,989 147,147 Cath Lab/Pacers/EP 8,935 0 8,935 GI Lab 4,596 208 4,804 Total FTEs (Paid) 3,520 270 3,790 Community Benefit Reporting Community Outreach (incl system alloc) $ 2,563,784 Unreimbursed Charity Care (at cost) $37,174,838 Based on Charity/Indigent charges of $114.6 million Medicaid Shortfall (at cost) $ 7,302,656 Totals $47,041,278 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 (and the program's value if known): 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. The hospitals also help sponsor an annual "Latino" health fair to reach out to the ever expanding Hispanic community that it serves. 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. Women's and Children's Resource Center The Women's and Children Resource Center of Kennestone had unreimbursed costs of approximately $185,000. This program provides much needed support for mothers and their newborn babies. The program demonstrates our commitment to the health and well-being of new mothers and babies in our community. Approximately 2000 parents attended prenatal and childbirth classes sponsored by the Women's Center. Other Programs Kennestone Hospital and Wellstar sponsor several other programs which may not have a specific value associated with them but offer health and education to the community. 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. Wellstar offers a Disease Management program in which five chronic diseases are monitored for patients through periodic updates by a Wellstar clinician (via phone). This program helped reduce both hospital admissions and ER visits for those patients in the program. Sponsorships and Community Activities. Employees participated in the Heart Walk in support of those suffering from heart disease. The system is a major sponsor (the Wellstar Cardiac Network) in this American Heart Association initiative by contributing $100,000 and donating staff time to this worthwhile cause. A group of Kennestone Hospital employees also volunteered to participate in the "Relay for Life" event to raise funds and awareness of cancer treatment and prevention. The event benefited the American Cancer Society. A portion of the Kennestone Hospital community is beneficiary of some of Wellstar's sponsorships and contributions including $10,000 raised system-wide. Additionally Wellstar donated $10,000 to support the March of Dimes and employees raised an additional $8,000 for this worthwhile cause. 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. Kennestone Hospital is the first in the metro Atlanta area to install the CAREpoint Workstation which helps save lives threatened by cardiac emergencies. This is in addition to the system's continuedDescription
Total Program Service Expense518740286TotalProgramServiceExpense
Described In501 C3trueDescribedIn501C3
Schedule B RequiredfalseScheduleBRequired
Political ActivitiesfalsePoliticalActivities
Lobbying ActivitiesfalseLobbyingActivities
Donor Advised FundsfalseDonorAdvisedFunds
Conservation EasementsfalseConservationEasements
Collections Of ArtfalseCollectionsOfArt
Credit CounselingfalseCreditCounseling
Term Or Permanent EndowmentsfalseTermOrPermanentEndowments
Report Land Bldg EquiptrueReportLandBldgEquip
Report Invest Oth SecuritiesfalseReportInvestOthSecurities
Report Prog Rel InvestfalseReportProgRelInvest
Report Other AssetsfalseReportOtherAssets
Report Other LiabilitiestrueReportOtherLiabilities
Report Fin48 FootnotefalseReportFin48Footnote
Independent Audit Financial StmtfalseIndependentAuditFinancialStmt
Consolidated Audit Financial StmttrueConsolidatedAuditFinancialStmt
SchoolfalseSchool
Foreign OfficefalseForeignOffice
Foreign ActivitiesfalseForeignActivities
More Than5000 K To OrganizationsfalseMoreThan5000KToOrganizations
More Than5000 K To IndividualsfalseMoreThan5000KToIndividuals
Professional FundraisingfalseProfessionalFundraising
Fundraising ActivitiesfalseFundraisingActivities
GamingfalseGaming
HospitaltrueHospital
Financial Stmt AttachedtrueFinancialStmtAttached
Grants To OrganizationsfalseGrantsToOrganizations
Grants To IndividualsfalseGrantsToIndividuals
Schedule J RequiredtrueScheduleJRequired
Tax Exempt BondsfalseTaxExemptBonds
Excess Benefit TransactionfalseExcessBenefitTransaction
Prior Excess Benefit TransactionfalsePriorExcessBenefitTransaction
Loan To Officer Or DQPfalseLoanToOfficerOrDQP
Grant To Related PersonfalseGrantToRelatedPerson
Bsnss Rltnshp With OrganizationfalseBsnssRltnshpWithOrganization
Bsnss Rltnshp Thru Family MembertrueBsnssRltnshpThruFamilyMember
Officer Entity With Bsnss RltnshpfalseOfficerEntityWithBsnssRltnshp
Deductible Non Cash ContributionsfalseDeductibleNonCashContributions
Deductible Contributions Of ArtfalseDeductibleContributionsOfArt
TerminatedfalseTerminated
Partial LiquidationfalsePartialLiquidation
Disregarded EntityfalseDisregardedEntity
Related EntitytrueRelatedEntity
Related Org Controlled EntitytrueRelatedOrgControlledEntity
Transaction Related EntityfalseTransactionRelatedEntity
Transfers To Exempt Non Chrtbl OrgfalseTransfersToExemptNonChrtblOrg
Activities Conducted PartnershipfalseActivitiesConductedPartnership
Schedule O RequiredtrueScheduleORequired
Number Forms Transmitted With10960NumberFormsTransmittedWith1096
Number W2 G Included0NumberW2GIncluded
Number Of Employees4953NumberOfEmployees
Employment Tax Returns FiledtrueEmploymentTaxReturnsFiled
Unrelated Business IncometrueUnrelatedBusinessIncome
Form990-T FiledtrueForm990-TFiled
Foreign Financial AccountfalseForeignFinancialAccount
Prohibited Tax Shelter TransfalseProhibitedTaxShelterTrans
Taxable Party NotificationfalseTaxablePartyNotification
Non Deductible ContributionsfalseNonDeductibleContributions
Quid Pro Quo ContributionsfalseQuidProQuoContributions
Form8282 Property Disposed OffalseForm8282PropertyDisposedOf
Funds To Pay PremiumsfalseFundsToPayPremiums
Premiums PaidfalsePremiumsPaid
Excess Business HoldingsfalseExcessBusinessHoldings
Taxable DistributionsfalseTaxableDistributions
Distribution To DonorfalseDistributionToDonor
Indoor Tanning ServicesfalseIndoorTanningServices
Info In Schedule O Part VIXInfoInScheduleOPartVI
Nbr Voting Governing Body Members18NbrVotingGoverningBodyMembers
Number Independent Voting Members14NumberIndependentVotingMembers
Family Or Business RelationshiptrueFamilyOrBusinessRelationship
Delegation Of Management DutiesfalseDelegationOfManagementDuties
Changes To Organizing DocstrueChangesToOrganizingDocs
Material Diversion Or MisusefalseMaterialDiversionOrMisuse
Members Or StockholderstrueMembersOrStockholders
Election Of Board MemberstrueElectionOfBoardMembers
Decisions Subject To ApprovaltrueDecisionsSubjectToApproval
Minutes Of Governing BodytrueMinutesOfGoverningBody
Minutes Of CommitteestrueMinutesOfCommittees
Officer Mailing AddressfalseOfficerMailingAddress
Local ChaptersfalseLocalChapters
Form990 Provided To Governing BodytrueForm990ProvidedToGoverningBody
Conflict Of Interest PolicytrueConflictOfInterestPolicy
Annual Disclosure Covered PersonstrueAnnualDisclosureCoveredPersons
Regular Monitoring EnforcementtrueRegularMonitoringEnforcement
Whistleblower PolicytrueWhistleblowerPolicy
Document Retention PolicytrueDocumentRetentionPolicy
Compensation Process CEOtrueCompensationProcessCEO
Compensation Process OthertrueCompensationProcessOther
Investment In Joint VenturefalseInvestmentInJointVenture
States Where Copy Of Return Is FiledGAStatesWhereCopyOfReturnIsFiled
Upon RequestXUponRequest

The Books Are In Care Of TheBooksAreInCareOf

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

Address US AddressUS

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

Form990 Part VII Section A Form990PartVIISectionA (71 entries)

TitleTitleAverage Hours Per WeekAverageHoursPerWeekIndividual Trustee Or DirectorIndividualTrusteeOrDirectorReportable Comp From OrganizationReportableCompFromOrganizationReportable Comp From Related OrgsReportableCompFromRelatedOrgsOther CompensationOtherCompensationOfficerOfficerHighest Compensated EmployeeHighestCompensatedEmployeeFormerFormer
Randall Bentley
Board Member Chairman1.0X0172420
Robert N Cross MD
Board Member1.0X046780
T E Durham
Board Member1.0X0317511255
Thomas E Gearhard MD
Board Member1.0X038997228532
David Hafner MD
Board Member1.0X0160110
Charles J Jones
Board Member1.0X0131230
Connie Kirk
Board Member1.0X050440
Janie Maddox
Board Member Vice Chair1.0X0146090
Gary A Miller
Board Member1.0X027210
Steven W Oweida MD
Board Member1.0X0172420
Tom Phillips
Board Member1.0X027540
Walter G Robinson
Board Member1.0X070650
Otis Brumby III
Board Member1.0X017270
W Allen Separk
Board Member1.0X079840
T Fitz Johnson
Board Member1.0X017420
Jeffrey Tharp MD
Board Member1.0X044681628567
Robert G Warner MD
Board Member1.0X031420
Charles Pete Wood
Board Member1.0X0128720
A James Budzinski
Exec VP and CFO2.0058566633803X
Gregory L Simone MD
President & CEO2.003972245172966X
Bonnie Wilson
Exec VP and Gen Counsel2.00148001571627X
David W Anderson
Exec VP HR/OL/CCO2.0051265229200X
Donald Campbell MD
Sr VP and Med Director2.0039268024541X
Barbara B Corey
Sr VP Managed Care2.0035327021091X
Bruce Dean
VP and Asst Gen Counsel2.0024646619958X
Marcia Delk MD
Sr VP Med Affairs & CQO2.0042445633113X
Darold Etheridge
VP Finance2.0023113214571X
Lee Evins
VP Revenue Cycle Mgmt2.0024850618089X
Mark Haney
Sr VP Business Development2.0033188223979X
Christopher M Kane
Sr VP Strategic Planning2.0040036526918X
Kenneth C Kunze MD
Sr VP and Chief Med Officer2.0068720837043X
Louis W Little
Sr VP Post Acute & Hosp Admin50.0283210024158X
Kimberly W Menefee
Sr VP Public & Govt Affairs2.0033031622272X
Ronald J Strachan
Sr VP and CIO2.0041782627923X
Candice L Saunders
Exec VP & Adminstrator50.0480497029392X
Martin L Gutkin
VP Finance & Hospital CFO50.0229191010854X
Amanda Trask
VP Prof & Support Services50.0170450018395X
ROBERT HAMILTON
VP MED AFFAIRS2.0030293724258X
MICHAEL GRAUE
EXEC VP & COO2.0069129244574X
ROBERT JANSEN
VP MED AFFAIRS2.0036895920365X
ELLEN LANGFORD
VP & COO WELLSTAR PHYS GRP2.0022864316661X
ROBERT MANDLER
VP Diagnostic Outreach2.0026278518444X
JERRY TILLERY
VP OPERATIONS50.0166204010939X
JONATHAN B MORRIS
VP & Chief Med Info Officer2.0033419423933X
ANTHONY M TRUPIANO
VP SUPPLY CHAIN2.0028530316534X
ROBIN WILSON MD
VP Medical Mgmt2.0034002024726X
JOSEPH L BRYWCZYNSKI
Sr VP HEALTH PARKS ADMIN2.0021614214427X
ELIZABETH A HOFFMANN
VP BUDGET AND ANALYSIS2.0023042810860X
RICHARD T LOPES MD
Sr VP & PRES WELLSTAR PHYS GRP2.0051360628822X
JAMES M SWARTZ
VP ACCOUNTING2.001695329148X
MARY L WESLEY
Sr VP NURSING SERVICES & CNE2.0029414014070X
Patricia Ann Mayne
VP Emergency Services50.0184757022123X
Barbara G Ballard
VP Homecare & Hospice2.001208277602X
Carol S Edwards
VP Cardiac Services2.001178696022X
Beth Kost
VP Compliance/Ch Privacy Offr2.0024450916135X
Adam C Thompson
VP Surgery2.001769579710X
Betty Ann Brakovich
VP/CNO Pat Care Serv W Hill50.0000X
Laura Caramanica
VP/CNO Pt Care Serv KH50.0000X
Leo E Reichert
Exec VP & General Counsel2.0000X
Deborah Roegge De Vita
VP Women's & Newborns Serv2.0000X
Mary L Tavernaro
VP Human Resources Operations2.000X
C Brett Scullen
VP Pulmonology Operations2.00803123785X
Dwight Still
Radition Oncology Physicist50.0172167013148X
Patricia Horton
Asst VP Nursing50.0195413010882X
Sherron Kurtz
Exec Dir Surgical Srv KH50.016340413878X
Thomas Whittaker
Radiation Oncology Physicist50.0156859010327X
William Gonzalez
Manager Pharmacy50.016013816234X
Marsha Burke
Former Exec VP and CFO1.0019047512395X
Linda A Clark
Exec VP and COO1.0025530610595X
Bruce Harrison
Sr VP and CAO Phys Group2.0045586922304X
Diane C Swain
VP & COO Kenn Hospital40.012302205506X
FieldValueIRS element (for citing)
Total Reportable Comp From Org2485312TotalReportableCompFromOrg
Total Reportable Comp Frm Rltd Orgs17491285TotalReportableCompFrmRltdOrgs
Total Other Compensation1176654TotalOtherCompensation
Number Individuals GT100 K187NumberIndividualsGT100K
Formers ListedtrueFormersListed
Total Comp GT150 KtrueTotalCompGT150K
Compensation From Other SourcesfalseCompensationFromOtherSources

Contractor Compensation ContractorCompensation (5 entries)

Address Line1AddressOfContractor/AddressUS/AddressLine1CityAddressOfContractor/AddressUS/CityStateAddressOfContractor/AddressUS/StateZIP CodeAddressOfContractor/AddressUS/ZIPCodeDescription Of ServicesDescriptionOfServicesCompensationCompensation
Brasfield Gorrie
1990 Vaughn Rd NW Suite 100KENNESAWGA30144General Contractor3058778
Batchelor and Kimball Inc
PO Box 70LITHONIAGA30058Maintenance2001762
Surgical Operational Services
506 Commerce Park Dr Suite GMARIETTAGA30060OR Consultant3226408
QUEST DIAGNOSTICS
PO BOX 740736ATLANTAGA303740736MEDICAL LAB SERVICES1539427
Emory Clinic Inc
101 W Ponce De Leon Ave Suite 400DECATURGA30030Med/Phys Services1405510
FieldValueIRS element (for citing)
Number Of Contractors GT100 K37NumberOfContractorsGT100K
Total Contributions0TotalContributions

Program Service Revenue ProgramServiceRevenue (4 entries)

DescriptionDescriptionBusiness CodeBusinessCodeTotal Revenue ColumnTotalRevenueColumnRelated Or Exempt Function IncomeRelatedOrExemptFunctionIncome
PATIENT REVENUE621990677839999677839999
MEDICAL RECORDS6219904545
INDEPENDENT & ASSISTED LIVING REVENUE62300055428165542816
PATIENT EDUCATION6219905797657976
FieldValueIRS element (for citing)
Total Program Service Revenue683440836TotalProgramServiceRevenue

Income From Invest Bond Proceeds IncomeFromInvestBondProceeds

FieldValueIRS element (for citing)
Total Revenue Column0TotalRevenueColumn

Royalties Revenue RoyaltiesRevenue

FieldValueIRS element (for citing)
Total Revenue Column0TotalRevenueColumn

Gross Rents GrossRents

FieldValueIRS element (for citing)
Real131534Real

Rental Income Or Loss RentalIncomeOrLoss

FieldValueIRS element (for citing)
Real131534Real

Net Rental Income Or Loss NetRentalIncomeOrLoss

FieldValueIRS element (for citing)
Total Revenue Column131534TotalRevenueColumn
Exclusion$131,534ExclusionAmount

Gross Amount Sales Assets GrossAmountSalesAssets

FieldValueIRS element (for citing)
Other32980Other

Gain Or Loss GainOrLoss

FieldValueIRS element (for citing)
Other32980Other

Net Gain Or Loss Investments NetGainOrLossInvestments

FieldValueIRS element (for citing)
Total Revenue Column32980TotalRevenueColumn
Exclusion$32,980ExclusionAmount

Net Income From Fundraising Events NetIncomeFromFundraisingEvents

FieldValueIRS element (for citing)
Total Revenue Column0TotalRevenueColumn

Net Income From Gaming NetIncomeFromGaming

FieldValueIRS element (for citing)
Total Revenue Column0TotalRevenueColumn

Net Income Or Loss NetIncomeOrLoss

FieldValueIRS element (for citing)
Total Revenue Column0TotalRevenueColumn

Other Revenue Misc OtherRevenueMisc (3 entries)

DescriptionDescriptionBusiness CodeBusinessCodeTotal Revenue ColumnTotalRevenueColumnUnrelated Business RevenueUnrelatedBusinessRevenueExclusionExclusionAmount
PHARMACY/RETAIL PHARMACY44619911746641121667$52,997
LAB OUTREACH370043$370,043
CAFETERIA3426933$3,426,933

Miscellaneous Revenue MiscellaneousRevenue

FieldValueIRS element (for citing)
Total Revenue Column2474674TotalRevenueColumn
Exclusion$2,474,674ExclusionAmount
FieldValueIRS element (for citing)
Total Other Revenue7446314TotalOtherRevenue

Total Revenue TotalRevenue

FieldValueIRS element (for citing)
Total Revenue Column691051664TotalRevenueColumn
Related Or Exempt Function Income683440836RelatedOrExemptFunctionIncome
Unrelated Business Revenue1121667UnrelatedBusinessRevenue
Exclusion$6,489,161ExclusionAmount

Grants To Domestic Orgs GrantsToDomesticOrgs

FieldValueIRS element (for citing)
Total0Total

Grants To Domestic Individuals GrantsToDomesticIndividuals

FieldValueIRS element (for citing)
Total0Total

Foreign Grants ForeignGrants

FieldValueIRS element (for citing)
Total0Total

Benefits To Members BenefitsToMembers

FieldValueIRS element (for citing)
Total0Total

Comp Current Officers Directors CompCurrentOfficersDirectors

FieldValueIRS element (for citing)
Total1792157Total
Program Services1610969ProgramServices
Management And General181188ManagementAndGeneral

Comp Disqual Persons CompDisqualPersons

FieldValueIRS element (for citing)
Total0Total

Other Salaries And Wages OtherSalariesAndWages

FieldValueIRS element (for citing)
Total213260348Total
Program Services191709773ProgramServices
Management And General21550575ManagementAndGeneral

Pension Plan Contributions PensionPlanContributions

FieldValueIRS element (for citing)
Total15252988Total
Program Services13711250ProgramServices
Management And General1541738ManagementAndGeneral

Other Employee Benefits OtherEmployeeBenefits

FieldValueIRS element (for citing)
Total17565788Total
Program Services15789462ProgramServices
Management And General1776326ManagementAndGeneral

Payroll Taxes PayrollTaxes

FieldValueIRS element (for citing)
Total15711146Total
Program Services14122709ProgramServices
Management And General1588437ManagementAndGeneral

Fees For Services Management FeesForServicesManagement

FieldValueIRS element (for citing)
Total0Total

Fees For Services Legal FeesForServicesLegal

FieldValueIRS element (for citing)
Total116337Total
Program Services69802ProgramServices
Management And General46535ManagementAndGeneral

Fees For Services Accounting FeesForServicesAccounting

FieldValueIRS element (for citing)
Total0Total

Fees For Services Lobbying FeesForServicesLobbying

FieldValueIRS element (for citing)
Total0Total

Fees For Services Prof Fundraising FeesForServicesProfFundraising

FieldValueIRS element (for citing)
Total0Total

Fees For Services Invst Mgmnt Fees FeesForServicesInvstMgmntFees

FieldValueIRS element (for citing)
Total0Total

Fees For Services Other FeesForServicesOther

FieldValueIRS element (for citing)
Total18215810Total
Program Services17834121ProgramServices
Management And General381689ManagementAndGeneral

Advertising Advertising

FieldValueIRS element (for citing)
Total127805Total
Program Services109199ProgramServices
Management And General18606ManagementAndGeneral

Office Expenses OfficeExpenses

FieldValueIRS element (for citing)
Total136197199Total
Program Services135403453ProgramServices
Management And General793746ManagementAndGeneral

Information Technology InformationTechnology

FieldValueIRS element (for citing)
Total0Total

Royalties Royalties

FieldValueIRS element (for citing)
Total0Total

Occupancy Occupancy

FieldValueIRS element (for citing)
Total10703302Total
Program Services4377886ProgramServices
Management And General6325416ManagementAndGeneral

Travel Travel

FieldValueIRS element (for citing)
Total228941Total
Program Services179723ProgramServices
Management And General49218ManagementAndGeneral

Travel Entrtnmnt Public Officials TravelEntrtnmntPublicOfficials

FieldValueIRS element (for citing)
Total0Total

Conferences Meetings ConferencesMeetings

FieldValueIRS element (for citing)
Total408621Total
Program Services373425ProgramServices
Management And General35196ManagementAndGeneral

Interest Interest

FieldValueIRS element (for citing)
Total154165Total
Management And General154165ManagementAndGeneral

Payments To Affiliates PaymentsToAffiliates

FieldValueIRS element (for citing)
Total113769763Total
Program Services102256263ProgramServices
Management And General11513500ManagementAndGeneral

Depreciation Depletion DepreciationDepletion

FieldValueIRS element (for citing)
Total27260115Total
Program Services13279186ProgramServices
Management And General13980929ManagementAndGeneral

Insurance Insurance

FieldValueIRS element (for citing)
Total2948115Total
Management And General2948115ManagementAndGeneral

Other Expenses OtherExpenses (2 entries)

DescriptionDescriptionTotalTotalProgram ServicesProgramServicesManagement And GeneralManagementAndGeneral
REPAIRS & MAINTENANCE908058478466761233908
OTHER OPERATING EXPENSE927566638926367

Total Functional Expenses TotalFunctionalExpenses

FieldValueIRS element (for citing)
Total582885940Total
Program Services518740286ProgramServices
Management And General64145654ManagementAndGeneral
Fundraising0Fundraising

Cash Non Interest Bearing CashNonInterestBearing

FieldValueIRS element (for citing)
BOY15725BOY
EOY16125EOY

Savings And Temp Cash Investments SavingsAndTempCashInvestments

FieldValueIRS element (for citing)
BOY187438BOY
EOY206806EOY

Accounts Receivable AccountsReceivable

FieldValueIRS element (for citing)
BOY95126210BOY
EOY114295624EOY

Inventories For Sale Or Use InventoriesForSaleOrUse

FieldValueIRS element (for citing)
BOY10083002BOY
EOY11939153EOY

Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges

FieldValueIRS element (for citing)
BOY4491675BOY
EOY4737900EOY
FieldValueIRS element (for citing)
Land Buildings Equipment Basis642368300LandBuildingsEquipmentBasis
Land Bldg Equipment Accum Deprec333498220LandBldgEquipmentAccumDeprec

Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet

FieldValueIRS element (for citing)
BOY312562748BOY
EOY308870080EOY

Intangible Assets IntangibleAssets

FieldValueIRS element (for citing)
BOY1280943BOY
EOY1280943EOY

Other Assets Total OtherAssetsTotal

FieldValueIRS element (for citing)
BOY15412692BOY
EOY10142531EOY

Total Assets TotalAssets

FieldValueIRS element (for citing)
BOY439160433BOY
EOY451489162EOY

Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses

FieldValueIRS element (for citing)
BOY41644157BOY
EOY41846819EOY

Mort Notes Pybl Secured Invest Prop MortNotesPyblSecuredInvestProp

FieldValueIRS element (for citing)
BOY313562BOY
EOY151910EOY

Other Liabilities OtherLiabilities

FieldValueIRS element (for citing)
BOY222111048BOY
EOY201298081EOY

Total Liabilities TotalLiabilities

FieldValueIRS element (for citing)
BOY264068767BOY
EOY243296810EOY
FieldValueIRS element (for citing)
Follow SFAS117XFollowSFAS117

Unrestricted Net Assets UnrestrictedNetAssets

FieldValueIRS element (for citing)
BOY175091666BOY
EOY208192352EOY

Total Net Assets Fund Balances TotalNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY175091666BOY
EOY208192352EOY

Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY439160433BOY
EOY451489162EOY
FieldValueIRS element (for citing)
Info In Schedule O Part XIXInfoInScheduleOPartXI
Reconcilation Revenue Expenses108165724ReconcilationRevenueExpenses
Reconcilation Other Changes-75065038ReconcilationOtherChanges
Method Of Accounting AccrualXMethodOfAccountingAccrual
Accountant Compile Or ReviewfalseAccountantCompileOrReview
FS AuditedtrueFSAudited
Audit CommitteetrueAuditCommittee
Financial Statement ConsolidatedXFinancialStatementConsolidated
Federal Grant Audit RequiredfalseFederalGrantAuditRequired

Schedule A IRS990ScheduleA

FieldValueIRS element (for citing)
Hospital170b1 AiiiXHospital170b1Aiii

Schedule D IRS990ScheduleD

FieldValueIRS element (for citing)
Art Public Exhibition AmtsArtPublicExhibitionAmts
Held Works Of Art AmtsHeldWorksOfArtAmts

Land Land

FieldValueIRS element (for citing)
Other Cost Or Other Basis40125004OtherCostOrOtherBasis
Book Value40125004BookValue

Buildings Buildings

FieldValueIRS element (for citing)
Other Cost Or Other Basis309192769OtherCostOrOtherBasis
Depreciation129027028Depreciation
Book Value180165741BookValue

Leasehold Improvements LeaseholdImprovements

FieldValueIRS element (for citing)
Other Cost Or Other Basis12715070OtherCostOrOtherBasis
Depreciation6743174Depreciation
Book Value5971896BookValue

Equipment Equipment

FieldValueIRS element (for citing)
Other Cost Or Other Basis266050294OtherCostOrOtherBasis
Depreciation197728018Depreciation
Book Value68322276BookValue

Other Land Buildings OtherLandBuildings

FieldValueIRS element (for citing)
Other Cost Or Other Basis14285163OtherCostOrOtherBasis
Book Value14285163BookValue
FieldValueIRS element (for citing)
Total Of Book Value Land Buildings308870080TotalOfBookValueLandBuildings
Federal Income Tax Liability0FederalIncomeTaxLiability

Other Liabilities OtherLiabilities (2 entries)

DescriptionDescriptionAmountAmount
ASSET RETIREMENT OBLIGATION LT$932,913
TAX EXEMPT BOND LIAB-DUE TO WHS$200,365,168
FieldValueIRS element (for citing)
Total Of Amounts201298081TotalOfAmounts

Schedule H IRS990ScheduleH

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

Other Percentage OtherPercentage

FieldValueIRS element (for citing)
OtherXOther
Free Other Percentage125.FreeOtherPercentage
FieldValueIRS element (for citing)
FPG Reference Discounted CaretrueFPGReferenceDiscountedCare
Pcent200 DXPcent200D
Free Disc Care Medically IndigenttrueFreeDiscCareMedicallyIndigent
Amounts Budgeted For Charity CaretrueAmountsBudgetedForCharityCare
Expenses Exceeded BudgettrueExpensesExceededBudget
Unable To Provide CarefalseUnableToProvideCare
Annual Community Benefit ReporttrueAnnualCommunityBenefitReport
Report Publically AvailabletrueReportPublicallyAvailable

Charity Care At Cost CharityCareAtCost

FieldValueIRS element (for citing)
Total Community Benefit Expense37174838TotalCommunityBenefitExpense
Net Community Benefit Expense37174838NetCommunityBenefitExpense
Percent Of Total Expense0.06350PercentOfTotalExpense

Unreimbursed Medicaid UnreimbursedMedicaid

FieldValueIRS element (for citing)
Total Community Benefit Expense56808802TotalCommunityBenefitExpense
Direct Offsetting Revenue49506145DirectOffsettingRevenue
Net Community Benefit Expense7302657NetCommunityBenefitExpense
Percent Of Total Expense0.01250PercentOfTotalExpense

Total Charity Care TotalCharityCare

FieldValueIRS element (for citing)
Total Community Benefit Expense93983640TotalCommunityBenefitExpense
Direct Offsetting Revenue49506145DirectOffsettingRevenue
Net Community Benefit Expense44477495NetCommunityBenefitExpense
Percent Of Total Expense0.07600PercentOfTotalExpense

Community Health Services CommunityHealthServices

FieldValueIRS element (for citing)
Total Community Benefit Expense1140568TotalCommunityBenefitExpense
Net Community Benefit Expense1140568NetCommunityBenefitExpense
Percent Of Total Expense0.00190PercentOfTotalExpense

Health Professions Education HealthProfessionsEducation

FieldValueIRS element (for citing)
Total Community Benefit Expense363176TotalCommunityBenefitExpense
Net Community Benefit Expense363176NetCommunityBenefitExpense
Percent Of Total Expense0.00070PercentOfTotalExpense

Total Other Benefits TotalOtherBenefits

FieldValueIRS element (for citing)
Total Community Benefit Expense1503744TotalCommunityBenefitExpense
Net Community Benefit Expense1503744NetCommunityBenefitExpense
Percent Of Total Expense0.00260PercentOfTotalExpense

Total Community Benefits TotalCommunityBenefits

FieldValueIRS element (for citing)
Total Community Benefit Expense95487384TotalCommunityBenefitExpense
Direct Offsetting Revenue49506145DirectOffsettingRevenue
Net Community Benefit Expense45981239NetCommunityBenefitExpense
Percent Of Total Expense0.07860PercentOfTotalExpense
FieldValueIRS element (for citing)
Bad Debt Expense ReportedtrueBadDebtExpenseReported
Bad Debt Expense$28,177,622BadDebtExpenseAmount
Amount Attributable To5784191AmountAttributableTo
Amount Reimbursed By Medicare218138580AmountReimbursedByMedicare
Cost Of Care Reimbursed By Medicare243373542CostOfCareReimbursedByMedicare
Medicare Surplus Or Shortfall-25234962MedicareSurplusOrShortfall

Costing Methodology Used CostingMethodologyUsed

FieldValueIRS element (for citing)
Cost To Charge RatioXCostToChargeRatio
FieldValueIRS element (for citing)
Written Debt Collection PolicytrueWrittenDebtCollectionPolicy
Provision For Charity CaretrueProvisionForCharityCare
Number Of Hospital Facilities2NumberOfHospitalFacilities

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

Facility NumberFacilityNumberAddress Line1Address/AddressLine1CityAddress/CityStateAddress/StateZIP CodeAddress/ZIPCodeLicensed HospitalLicensedHospitalGeneral Medical And SurgicalGeneralMedicalAndSurgicalEr24 HoursEr24HoursOtherOther
Kennestone Hospital
1677 Church StreetMariettaGA30060XXX
Windy Hill Hospital
22540 Windy Hill RoadMariettaGA30067XXLong Term Acute Care

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

Hospital Facility NumberHospitalFacilityNumber
Kennestone Hospital
1
Windy Hill Hospital
2

Form990 Schedule H Part VI Form990ScheduleHPartVI (10 entries)

IdentifierIdentifierReturn ReferenceReturnReferenceExplanationExplanation
Publication of Community Benefit ReportSchedule H Part I Line 6aKennestone Hospital, Inc.(consisting of Kennestone Hospital and Windy Hill Hospital) is an affiliate of Wellstar Health System, Inc. which on an annual basis issues a community benefit report. This report is subsequently distributed in and around the five county service area of the health system. It is also annually filed with Cobb County and the state of Georgia Department of Community Health. Additionally the information on community benefit is included in aggregate for Wellstar Health System, Inc. and affiliated hospitals as part of the Georgia Hospital Association's annual report.
Cost to Charge RatioSchedule H Part I Line 7For purposes of the IRS Form 990 Schedule H, Wellstar Health System and Affiliates (including Kennestone and Windy Hill Hospitals) have estimated the current year cost to charge ratio for each hospital as it is reported in the annual community benefit report and as it will be reported in the state's Annual Hospital Financial Survey.
Footnote on Bad Debt and Rationale for Community BenefitSchedule H Part III Line 4The following footnote is detailed in the Wellstar Health System, Inc. and Affiliates Combined Financial Statements related to bad debt or uncollectible accounts: "During 2011, Wellstar adopted the provisions of FASB Accounting Standards Update (2011-07), Healthcare Entities (Topic 954). ASU 2011-07 requires the reclassification of the provision for uncollectible accounts associated with patient service revenue from an operating expense to a deduction from patient service revenue (net of contractual allowances and discounts)." " Wellstar recognizes patient service revenue associated with services provided to patients with third-party payor coverage on the basis of contractual rates for the services rendered. For uninsured patients that do not qualify for community financial aid, Wellstar recognizes revenue on the basis of its discounted rates for services provided. On the basis of historical experience, a significant portion of Wellstar's uninsured patients are unable or unwilling to pay for the services provided. Thus, Wellstar records a significant provision for uncollectible accounts related to uninsured patients in the period the services are provided." Subsequent to the end of the reporting period a propensity to pay review of patient accounts often results in prior year bad debt accounts which are deemed eligible for the organization's financial assistance policy. Those bad debt accounts are reclassified as charity and thus our rationale for including in community benefit.
Medicare ShortfallsSchedule H Part III Line 8Kennestone and Windy Hill Hospitals are providers of inpatient and outpatient services to Medicare program beneficiaries at determined rates. Without the participation in the Medicare program these patients may not have had convenient access to those services. The Medicare shortfall on line 7 represents the uncompensated difference between the expected reimbursement and the Medicare charges for those services stated at cost. We determine a cost to charge ratio for Medicare patients as part of the annual filing of the Medicare cost report.
Collection PracticesSch H Part III Sec C Line 9bThe policy written for collection practices that applies to all Wellstar Health System entities incorporates guidelines for personnel in the admissions and patient access areas to be trained in identifying patients that might qualify for financial assistance. It is also the policy of all Wellstar facilities to have at least one employee or contractor available at all times, especially in the hospitals with emergency rooms, who can provide assistance with the paperwork necessary to help patients who would qualify for governmental and other assistance programs.
Facility Descriptions-Kennestone and Windy HillSchedule H Part VKennestone Hospital ia a general acute care hospital providing a full range of services, is licensed to operate 633 beds, and is presently staffed to operate 583 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 750,000 square feet. The original hospital was constructed in 1950, major structural additions were made during the 1960s and 1970s, and the present main entrance was constructed in the last few years. A new patient tower was completed in 2005 and greatly expanded the cardiac services capabilities of the hospital. Additionally another patient tower is being built 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. 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.
Needs AssessmentSchedule H Part VI Line 2Wellstar Health System (and affiliates) is a key stakeholder in MAPP, Mobilizing for Action through Planning and Partnerships. MAPP, developed by the National Association of County and City Health Officials (NACCHO) in collaboration with the CDC, provides a structured guidance on creating and implementing a community-wide strategic planning process focused on improving the health and safety of our population. Through MAPP, a broad collection of community partners and residents come together to identify and prioritize health and safety issues and to identify resources for addressing them. The process results in an actionable community health improvement plan (CHIP) for measurable improvements in the community's health and quality of life as well as a scorecard for implementation and evaluation. The resulting community plan does not focus on one agency or community health challenge; rather, MAPP provides a long-term strategy that addresses the multiple factors that affect health in the community. Community involvement throughout the creation and the implementation of a health improvement plan results in creative solutions to community health problems with an improved focus on priorities, reduced duplication of services, increased collaboration on projects and activities, and increased capacity to garner additional resources. Moreover, continous community involvement leads to community ownership of the process. Community ownership, in turn, increases the credibility and sustainability of the health improvement efforts.
Patient Education of Eligibility for AssistanceSchedule H Part VI Line 3Kennestone and Windy Hill Hospitals provide its patients with hospital personnel or contracted personnel who are trained in all aspects of governmental programs, payments plans, charity discounts, and other financial assistance offered to assist them in their hospital bills. If the patient is eligible for federal or state assistance programs, a staff member is knowledgeable in the steps necessary to qualify those individuals. If a patient is indigent or charity eligible they will be offered assistance through the hospital's charity and indigent care policy including the state's indigent care trust fund. If the patient has no other insurance and fails to qualify for indigent care assistance, the financial counselor can then offer the patient an opportunity to accept a payment plan with discounted payment options based on their ability to pay immediately or over time. All patient are afforded these opportunities.
Community InformationSchedule H Part VI Line 4Kennestone and Windy Hill Hospitals are two of five hospitals that are affiliated with Wellstar Health System. The primary service area of the system is located in the Northwest Georgia area and receives the majority of its patients from one of five counties (Cherokee, Cobb, Douglas, Bartow and Paulding). Generally about 85% to 90% of the patient volume comes from this service area although other health systems have a presence in the area as well. Demographically the region is one of the fastest growing in the state as well as the country and the expansion of the services for the patient population reflects a desire to offer healthcare "closer to home" since Wellstar is considered a part of a larger metropolitan Atlanta market. Economically the region is strong in per capita income but given recent trends a rise in the uninsured and indigent population has occured.
Affiliated Health System RolesSchedule H Part VI Line 7As stated in the Wellstar Health System, Inc and Affiliates audited financial statments for the period ended June 30, 2011, 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 $17.4 million and Windy Hill Hospital committed approximately $2.8 million in capital expenditures for the year to meet those needs.

Schedule J IRS990ScheduleJ

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

Form990 Schedule J Part II Form990ScheduleJPartII (47 entries)

Base Compensation Filing OrgBaseCompensationFilingOrgComp Based On Related OrgsCompBasedOnRelatedOrgsBonus Filing OrgBonusFilingOrgBonus Related OrgsBonusRelatedOrgsOther Compensation Filing OrgOtherCompensationFilingOrgOther Compensation Related OrgsOtherCompensationRelatedOrgsDeferred Comp Filing OrgDeferredCompFilingOrgDeferred Comp Related OrgsDeferredCompRelatedOrgsNontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgNontaxable Benefits Related OrgsNontaxableBenefitsRelatedOrgsTotal Compensation Filing OrgTotalCompensationFilingOrgTotal Compensation Related OrgsTotalCompensationRelatedOrgsComp Report Prior990 Filing OrgCompReportPrior990FilingOrgComp Report Prior990 Related OrgsCompReportPrior990RelatedOrgs
Thomas E Gearhard MD
024215501397550806202126207270041850400
Jeffrey Tharp MD
0275580011917805205802358404983047538300
A James Budzinski
0434410013853901271702930704496061946900
Marsha Burke
01904750001065501740020287000
Linda A Clark
0255306000105950026590100
Gregory L Simone MD
08145520372600027850930169533034330414521100
Bonnie Wilson
041488501265560938574066357052700155164200
David W Anderson
0379036011887101474502594703253054185200
Donald Campbell MD
030409207766001092802104703494041722100
Barbara B Corey
027193107043901090001959101500037436100
Bruce Dean
01973080399280923001450905449026642400
Marcia Delk MD
0326735086581011140022854010259045756900
Darold Etheridge
0191995030437087000136300941024570300
Lee Evins
018395403675702779501412003969026659500
Mark Haney
025047506762501378201881505164035586100
Bruce Harrison
028315604564016814902073701567047817300
Christopher M Kane
030867308063001106202164805270042728300
Kenneth C Kunze MD
0532359014296201188703341103632072425100
Louis W Little
219648052762010800016822073360307368000
Kimberly W Menefee
025270706602201158701869403578035258800
Ronald J Strachan
027812907337406632302123906684044574900
Candice L Saunders
3439880123656012853024895044970509889000
Martin L Gutkin
17602102691402625609372014820240045000
Diane C Swain
11867200043500509804080128528000
Dwight Still
171667050000010433027150185315000
Patricia Horton
137615019148038650010882000206295000
Sherron Kurtz
150326130780978840901772820
Thomas Whittaker
156359050000096370690016718601649050
Amanda Trask
1453400189060620401072807667018884501733010
ROBERT HAMILTON
02534210411500836601600908249032719500
MICHAEL GRAUE
05136570164927012708033859010715073586600
ROBERT JANSEN
03113890486530891701533705028038932400
ELLEN LANGFORD
01820660378770870001418802473024530400
ROBERT MANDLER
019597703770402910401486603578028122900
JERRY TILLERY
1450580148110633501024906900177143000
JONATHAN B MORRIS
025683305021102715001890505028035812700
ANTHONY M TRUPIANO
02303110456920930001653400030183700
ROBIN WILSON MD
027780405301609200014456010270036474600
JOSEPH L BRYWCZYNSKI
01678380004830401239702030023056900
ELIZABETH A HOFFMANN
01718950156690428640960501255024128800
RICHARD T LOPES MD
040547300010813302620902613054242800
JAMES M SWARTZ
0147399014973071600711302035017868000
MARY L WESLEY
021484501905906023601219001880030821000
Patricia Ann Mayne
151715024342087000118530102700206880000
Beth Kost
02093110302480495001450301632026064400
Adam C Thompson
01487590169960112020735102359018666700
William Gonzalez
154101595780951967151763720

Form990 Schedule J Part III Form990ScheduleJPartIII (4 entries)

IdentifierIdentifierReturn ReferenceReturnReferenceExplanationExplanation
Non-Fixed Payments to OfficersForm 990 Schedule J Line 7Wellstar has instituted an annual incentive plan for key leaders in the company. On an annual basis performance measures are proposed by management and approved and recommended by the Compensation Committee of the Board. The plan is designed to retain and reward leaders with incentives that keep them competitive with the market and comparable health systems. The criteria used to measure the performance consists of weighted factors in the areas of financial performance, customer service, employee engagement and quality indicators. Upon successful acheivement in the targeted levels for each factor, a performance payout is recommended and approved by the Board after the annual financial audit is completed.
Severance BenefitsSchedule JPursuant to their respective employment agreements, the following groups of officers are entitled to severance payments based on their base salary and wages at that time in the event of certain identified circumstances. The officers with a severance payment period of 24 months as per their contractual agreement are: David Anderson, Marsha Burke, Linda Clark, Gregory Simone MD, and Bonnie Wilson. 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, Bruce Harrison, Robert Jansen MD, Christopher Kane, Kenneth Kunze MD, Lou Little, Richard Lopes MD, Kimberly Menefee, Craig Owens, Tarey Ray, Leo E Reichert, Candice Saunders, Ron Strachan, Mary L Wesley The officers with a severance payment period of 12 months as per their agreement: Barbara Ballard, Betty A Brakovich, Laura Caramanica, Bruce Dean, Carol Edwards, Darold Etheridge, Lee Evins, Martin Gutkin, Robert Hamilton, Elizabeth Hoffmann, Beth Kost, Ellen Langford, Robert Mandler, Jonathan Morris MD, Deborah Roegge DeVita, C Brett Scullen, James Swartz, Mary L Tavernaro, Adam Thompson, Jerry Tillery, Amanda Trask, Anthony Trupiano, Robin Wilson MD During the calendar year, the following individuals received a payout in the amounts listed in accordance with their severance agreements as set forth above: Marsha Burke $ 190,475 Linda Clark $ 255,306 Teresa Ray $ 99,120 Bruce Harrison $ 455,868 Gregory L Simone $3,518,524 Bonnie Wilson $1,124,436 Deborah Pasch $ 35,140
Other CompensationForm 990, Schedule J, Part I, Line 1b & 2While Wellstar Health System and its affiliates do not have a written policy regarding payment or reimbursement for the items listed in Part 1 Line 1a, the organization follows IRS guidelines in the payment of any of these items to individuals listed in Form 990 Part VII Section A. These items are added as taxable wages on the individual's Form W-2 as appropriate.
Compensation ExceptionsThe following individuals became officers of Wellstar Health System and Affiliates during the accounting period covered by this return but were not compensated during the calendar year for which salary and benefits are reported in the return: Leo E Reichert Mary L Tavernaro Deborah Roegge De Vita Betty Ann Brakovich Laura Caramanica

Schedule L IRS990ScheduleL

Form990 Schedule L Part IV Form990ScheduleLPartIV (7 entries)

RelationshipRelationshipAmount Of TransactionAmountOfTransactionDescription Of TransactionDescriptionOfTransactionSharing Of RevenuesSharingOfRevenues
Pamela Etheridge
Wife of Officer53737Employee of Wellstarfalse
Greg Fortgang
Son-in-Law of Trustee102382Employee of Wellstarfalse
Amy Simone
Daughter of Officer72052Employee of Wellstarfalse
George Fleming
Brother of Officer59478Employee of Wellstarfalse
Matthew Maddox
Son of Trustee38489Employee of Wellstarfalse
Bonnie Miller
Wife of Trustee28417Employee of Wellstarfalse
Greg Separk
Son of Trustee25847Employee of Wellstarfalse

Form990 Schedule L Part V Form990ScheduleLPartV

FieldValueIRS element (for citing)
IdentifierBusiness Transactions with Interested PartiesIdentifier
Return ReferenceForm 990 Schedule L Part IVReturnReference
ExplanationAll transactions listed in Schedule L Part IV are for interested parties or in this case family members of either trustees or officers of Kennestone Hospital, Inc. or its related organizations. The transactions all represent payment of services as employees of Wellstar Health System.Explanation

Schedule O IRS990ScheduleO

General Explanation GeneralExplanation (51 entries)

IdentifierIdentifierReturn ReferenceReturnReferenceExplanationExplanation
CompensationForm 990 Part V Line 2All compensation amounts reported on Form 990 Part V, Part VII, and Part IX as well as Schedule J represent compensation provided to individuals that provide services to the organization. Likewise, the number of employees reported on Form 990 represent the number of individuals providing services to the organization. All Federal employment tax responsibilities for these individuals (including Federal Employment Tax reporting responsibilities) are handled by Wellstar Health System, Inc (EIN 58-1649541).
Conflict of Interest PolicyForm 990 Part VI Section B Line 12A, B, & COur conflict of interest policy requires all covered persons to annually review the policy and then complete, sign and return the Conflicts of Interest Survey and Attestation to the Compliance Office. The Policy requires an on-going disclosure obligation in the event a conflict arises during the year. The following is our process to regularly and consistently monitor and enforce the policy: Compliance identifies all covered persons who must complete the Survey and Attestation. Compliance verifies that the Survey and Attestation is distributed to these persons. Compliance verifies that these persons return a fully completed and signed Survey and Attestation. Compliance reviews each completed and signed Survey and Attestation to identify all conflicts listed in the document. All conflicts, potential conflicts and incidences of non-compliance are referred to the Chief Compliance Officer. The CCO takes appropriate action to completely resolve all identified conflicts and incidences of non-compliance.
Process of Determining Officer CompForm 990 Part VI Line 15A & BWellstar engages the Hay Group to work with the governing board to review and recommend executive compensation. The executive compensation process at Wellstar is overseen by a committee of independent trustees, which follows a board-approved executive compensation philosophy. The current members of the Wellstar committee are: Pete Wood Janie Maddox Al Separk Board Chairman--Ex Officio Wellstar CEO--Ex Officio In committtee discussions about the compensation for the Chief Executive Officer, The CEO will recuse himself/herself from that process but is a non-voting committee member for discussions on all other officers. The executive compensation philosophy empowers the committee to oversee the executive compensation process and administer the executive compensation program on behalf of the full board of trustee of Wellstar; provided, however, the full Board of Trustees evaluates and approves the compensation of the Chief Executive Officer. The philosophy requires annual disclosure of the committee's actions and decisions to the full board, which it has done. The committee is guided by the board-approved philosophy. Overall, the philosophy is intended to reward for organizational and individual performance. When performance is at a predetermined targeted level, the compensation is intended to be at or around the median of compensation paid to similar positions at similar organizations (the "market"). Wellstar's executive compensation philosophy defines the market as being comprised of comparable not-for-profit health care delivery systems, i.e., not-for-profit organizations similar in complexity and scale to Wellstar. To assist the committee in fulfilling its duties, the committee engaged the Hay Group to provide market compensation data to compare to the Wellstar positions whose compensation the committee oversees. The committee uses this data to provide context when making decisions in administering the compensation program. Accurate minutes of the committee's discussion and decisions are recorded during each committee meeting, and reviewed and approved by the full Board of Trustees at its next scheduled meeting.
Audited Financial StatementsForm 990 Part IV Line 12Kennestone Hospital, Inc. is audited on an annual basis by an outside auditing firm, KPMG, and as part of that audit a consolidated financial statement is issued for all of WellStar Health System, Inc and its Affiliates. "The independent auditors report includes the accounts of Wellstar and its controlled affiliates, Kennestone Hospital, Inc., Cobb Hospital, Inc., Douglas Hospital, Inc., Paulding Medical Center, Inc., Wellstar Foundation, Inc. CHS Foundation, Inc., Community Assurance Company, Ltd., various Wellstar owned physician practices, a hospice facility, a nursing facility, home health business, and entities for infusion therapy and durable medical equipment. All significant intercompany accounts and transactions have been eliminated in combination. The Board of Trustees of Wellstar has the authority to approve appointments of the members of the board of trustees of all affiliate corporations."
Tax Exempt Bond AllocationForm 990 Part IV Line 24a & Part XFor purposes of the Form 990 reporting, Wellstar Health System, Inc EIN 58-1649541 will list all tax-exempt bonds issued since January 1, 2003 on Schedule K as it typically allocates the proceeds of the bonds to members of the Obligated Group (including the hospitals and physician group). Kennestone Hospital, Inc. will report this tax exempt bond liability on Part X, Line 25 Other Liabilities-Due to WHS, Inc.
Current Officers/Directors RelationshipsForm 990 Part VI, Section A Line 2For a portion of the tax year two 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.
Organization StructureForm 990 Part VI Section A Lines 6, 7a & 7bAs per the Articles of Incorporation, the sole member of the organization is Wellstar Health System, Inc., a GA nonprofit corporation. As sole member, Wellstar Health System, Inc. holds certain powers of election and approval in connection with the governing body of the organization. These powers are presented in detail in the governing documents which the company makes available to the public upon request.
Officers Hours WorkedForm 990 General StatementThe officers devote their time to all of the organizations within Wellstar Health System that are listed in Schedule R, Part II. As such, the total hours worked by the officers across all organizations exceeds 40 hours a week.
990 Board ReviewForm 990 Part VI Line 11AInternal staff prepare the organization's Form 990. Before filing the return with the Internal Revenue Service an external accounting firm, PricewaterhouseCoopers, reviews and sign-offs on the completed return of each organization. The current year Form 990 is then reviewed by the Finance Committee along with a question and answer session. A motion is then made by the Finance committee to approve the returns and present to the full board copies of the forms in an electronic (pdf. format) version as well as a hard copy . The organization's CFO or designee subsequently signs the return for either manual or electronic filing by the appropriate due date.
Disclosure of Financial DocumentsFORM 990 PART VI SECTION C Line 19The organization and its subsidiaries are subject to the Open Records Law in the State of Georgia. Therefore, by law, citizens are permitted to inspect and copy its governing documents, policies and financial statements as may be requested from time to time. Additionally, the organization's Form 990 is made readily available on the Guidestar website. Periodically, the organization publishes its financial performance in the local newspaper for citizens to review, and it also publishes a community benefit report once a year for distribution to the public.
Bylaws ChangesForm 990, Part VI, Line 4In November 2010 the bylaws of Wellstar Health System were amended to reflect that any retired trustees be provided benefits upon their retirement from service on the Board.
Changes in Net AssetsForm 990 Part XI Line 5For the reporting period Kennestone Hospital, Inc. had a change in net assets of ($75,065,038) related to transfers to affiliates as part of the allocation of income statement and balance sheet transactions over the year.
HOURS DEVOTED FOR RELATED ORGANIZATIONFORM 990 PART VIINAME:T. E. Durham TITLE:Board Member HOURS:10
HOURS DEVOTED FOR RELATED ORGANIZATIONFORM 990 PART VIINAME:Thomas E. Gearhard, MD TITLE:Board Member HOURS:50
HOURS DEVOTED FOR RELATED ORGANIZATIONFORM 990 PART VIINAME:Jeffrey Tharp, MD TITLE:Board Member HOURS:50
HOURS DEVOTED FOR RELATED ORGANIZATIONFORM 990 PART VIINAME:A James Budzinski TITLE:Exec VP and CFO HOURS:50
HOURS DEVOTED FOR RELATED ORGANIZATIONFORM 990 PART VIINAME:Gregory L Simone, MD TITLE:President & CEO HOURS:50
HOURS DEVOTED FOR RELATED ORGANIZATIONFORM 990 PART VIINAME:Bonnie Wilson TITLE:Exec VP and Gen Counsel HOURS:50
HOURS DEVOTED FOR RELATED ORGANIZATIONFORM 990 PART VIINAME:David W. Anderson TITLE:Exec VP HR/OL/CCO HOURS:50
HOURS DEVOTED FOR RELATED ORGANIZATIONFORM 990 PART VIINAME:Donald Campbell, MD TITLE:Sr VP and Med Director HOURS:50
HOURS DEVOTED FOR RELATED ORGANIZATIONFORM 990 PART VIINAME:Barbara B Corey TITLE:Sr VP Managed Care HOURS:50
HOURS DEVOTED FOR RELATED ORGANIZATIONFORM 990 PART VIINAME:Bruce Dean TITLE:VP and Asst Gen Counsel HOURS:50
HOURS DEVOTED FOR RELATED ORGANIZATIONFORM 990 PART VIINAME:Marcia Delk, MD TITLE:Sr VP Med Affairs & CQO HOURS:50
HOURS DEVOTED FOR RELATED ORGANIZATIONFORM 990 PART VIINAME:Darold Etheridge TITLE:VP Finance HOURS:50
HOURS DEVOTED FOR RELATED ORGANIZATIONFORM 990 PART VIINAME:Lee Evins TITLE:VP Revenue Cycle Mgmt HOURS:50
HOURS DEVOTED FOR RELATED ORGANIZATIONFORM 990 PART VIINAME:Mark Haney TITLE:Sr VP Business Development HOURS:50
HOURS DEVOTED FOR RELATED ORGANIZATIONFORM 990 PART VIINAME:Christopher M Kane TITLE:Sr VP Strategic Planning HOURS:50
HOURS DEVOTED FOR RELATED ORGANIZATIONFORM 990 PART VIINAME:Kenneth C Kunze, MD TITLE:Sr VP and Chief Med Officer HOURS:50
HOURS DEVOTED FOR RELATED ORGANIZATIONFORM 990 PART VIINAME:Kimberly W. Menefee TITLE:Sr VP Public & Govt Affairs HOURS:50
HOURS DEVOTED FOR RELATED ORGANIZATIONFORM 990 PART VIINAME:Ronald J Strachan TITLE:Sr VP and CIO HOURS:50
HOURS DEVOTED FOR RELATED ORGANIZATIONFORM 990 PART VIINAME:ROBERT HAMILTON TITLE:VP MED AFFAIRS HOURS:50
HOURS DEVOTED FOR RELATED ORGANIZATIONFORM 990 PART VIINAME:MICHAEL GRAUE TITLE:EXEC VP & COO HOURS:50
HOURS DEVOTED FOR RELATED ORGANIZATIONFORM 990 PART VIINAME:ROBERT JANSEN TITLE:VP MED AFFAIRS HOURS:50
HOURS DEVOTED FOR RELATED ORGANIZATIONFORM 990 PART VIINAME:ELLEN LANGFORD TITLE:VP & COO WELLSTAR PHYS GRP HOURS:50
HOURS DEVOTED FOR RELATED ORGANIZATIONFORM 990 PART VIINAME:ROBERT MANDLER TITLE:VP Diagnostic Outreach HOURS:50
HOURS DEVOTED FOR RELATED ORGANIZATIONFORM 990 PART VIINAME:JONATHAN B MORRIS TITLE:VP & Chief Med Info Officer HOURS:50
HOURS DEVOTED FOR RELATED ORGANIZATIONFORM 990 PART VIINAME:ANTHONY M TRUPIANO TITLE:VP SUPPLY CHAIN HOURS:50
HOURS DEVOTED FOR RELATED ORGANIZATIONFORM 990 PART VIINAME:ROBIN WILSON, MD TITLE:VP Medical Mgmt HOURS:50
HOURS DEVOTED FOR RELATED ORGANIZATIONFORM 990 PART VIINAME:JOSEPH L BRYWCZYNSKI TITLE:Sr VP HEALTH PARKS ADMIN HOURS:50
HOURS DEVOTED FOR RELATED ORGANIZATIONFORM 990 PART VIINAME:ELIZABETH A HOFFMANN TITLE:VP BUDGET AND ANALYSIS HOURS:50
HOURS DEVOTED FOR RELATED ORGANIZATIONFORM 990 PART VIINAME:RICHARD T LOPES, MD TITLE:Sr VP & PRES WELLSTAR PHYS GRP HOURS:50
HOURS DEVOTED FOR RELATED ORGANIZATIONFORM 990 PART VIINAME:JAMES M SWARTZ TITLE:VP ACCOUNTING HOURS:50
HOURS DEVOTED FOR RELATED ORGANIZATIONFORM 990 PART VIINAME:MARY L WESLEY TITLE:Sr VP NURSING SERVICES & CNE HOURS:50
HOURS DEVOTED FOR RELATED ORGANIZATIONFORM 990 PART VIINAME:Barbara G Ballard TITLE:VP Homecare & Hospice HOURS:50
HOURS DEVOTED FOR RELATED ORGANIZATIONFORM 990 PART VIINAME:Carol S Edwards TITLE:VP Cardiac Services HOURS:50
HOURS DEVOTED FOR RELATED ORGANIZATIONFORM 990 PART VIINAME:Beth Kost TITLE:VP Compliance/Ch Privacy Offr HOURS:50
HOURS DEVOTED FOR RELATED ORGANIZATIONFORM 990 PART VIINAME:Adam C Thompson TITLE:VP Surgery HOURS:50
HOURS DEVOTED FOR RELATED ORGANIZATIONFORM 990 PART VIINAME:Leo E Reichert TITLE:Exec VP & General Counsel HOURS:50
HOURS DEVOTED FOR RELATED ORGANIZATIONFORM 990 PART VIINAME:Deborah Roegge De Vita TITLE:VP Women's & Newborns Serv HOURS:50
HOURS DEVOTED FOR RELATED ORGANIZATIONFORM 990 PART VIINAME:Mary L Tavernaro TITLE:VP Human Resources Operations HOURS:50
HOURS DEVOTED FOR RELATED ORGANIZATIONFORM 990 PART VIINAME:C Brett Scullen TITLE:VP Pulmonology Operations HOURS:50

Schedule R IRS990ScheduleR

Form990 Schedule R Part II Form990ScheduleRPartII (6 entries)

Address Line1AddressUS/AddressLine1CityAddressUS/CityStateAddressUS/StateZIP CodeAddressUS/ZIPCodeEINEINPrimary ActivitiesPrimaryActivitiesLegal Domicile StateLegalDomicileStateExempt Code SectionExemptCodeSectionPublic Charity StatusPublicCharityStatusBusiness Name Line1DirectControllingEntityName/BusinessNameLine1Controlled OrgControlledOrg
CHS Foundation Inc
805 Sandy Plains RoadMariettaGA30066581649540FoundationGA501 (c) (3)11WHS Inctrue
Cobb Hospital Inc
805 Sandy Plains RoadMariettaGA30066580968382HealthcareGA501 (c) (3)3WHS Inctrue
Douglas Hospital Inc
805 Sandy Plains RoadMariettaGA30066582026750HealthcareGA501 (c) (3)3WHS Inctrue
Paulding Medical Center Inc
805 Sandy Plains RoadMariettaGA30066582095884HealthcareGA501 (c) (3)3WHS Inctrue
Wellstar Foundation Inc
805 Sandy Plains RoadMariettaGA30066581627413FoundationGA501 (c) (3)11WHS Inctrue
Wellstar Health System Inc
805 Sandy Plains RoadMariettaGA30066581649541HealthcareGA501 (c) (3)11NAfalse

Form990 Schedule R Part III Form990ScheduleRPartIII (2 entries)

Address Line1AddressUS/AddressLine1CityAddressUS/CityStateAddressUS/StateZIP CodeAddressUS/ZIPCodeEINEINPrimary ActivityPrimaryActivityLegal Domicile StateLegalDomicileStateBusiness Name Line1DirectControllingEntityName/BusinessNameLine1Predominant Income TypePredominantIncomeTypeShare Of Total IncomeShareOfTotalIncomeShare Of EOY AssetsShareOfEOYAssetsDisproportionate AllocationsDisproportionateAllocationsGeneral Or Managing PartnerGeneralOrManagingPartner
Cobb Hospital Parking Company LLC
805 Sandy Plains RoadMariettaGA300666340752999669ParkingGANAInvestment26313808030falsefalse
Kennestone East Parking Deck LLC
805 Sandy Plains RoadMariettaGA300666340200537100ParkingGANAInvestment-640452719346falsefalse

Form990 Schedule R Part IV Form990ScheduleRPartIV

Name Of Related Org NameOfRelatedOrg

FieldValueIRS element (for citing)
Business Name Line1Community Assurance CoBusinessNameLine1

Address Foreign AddressForeign

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

Direct Controlling Entity Name DirectControllingEntityName

FieldValueIRS element (for citing)
Business Name Line1WHS IncBusinessNameLine1
FieldValueIRS element (for citing)
Type Of EntityCTypeOfEntity
Share Of EOY Assets58594426ShareOfEOYAssets
Percentage Ownership1.00000PercentageOwnership
FieldValueIRS element (for citing)
Receipt Of Int Ann Rents RoyaltiesfalseReceiptOfIntAnnRentsRoyalties
Gift Grant Or Cap Contr To Other OrgfalseGiftGrantOrCapContrToOtherOrg
Gift Grant Or Cap Contr Fr Other OrgfalseGiftGrantOrCapContrFrOtherOrg
Loans Or Guarantees To Other OrgfalseLoansOrGuaranteesToOtherOrg
Loans Or Guarantees From Other OrgfalseLoansOrGuaranteesFromOtherOrg
Sale Of Assets To Other OrgfalseSaleOfAssetsToOtherOrg
Purchase Of Assets From Other OrgfalsePurchaseOfAssetsFromOtherOrg
Exchange Of AssetsfalseExchangeOfAssets
Rental Of Facilities To Other OrgsfalseRentalOfFacilitiesToOtherOrgs
Rental Of Facilities Fr Other OrgsfalseRentalOfFacilitiesFrOtherOrgs
Perform Of Services For Other OrgsfalsePerformOfServicesForOtherOrgs
Perform Of Services By Other OrgsfalsePerformOfServicesByOtherOrgs
Sharing Of FacilitiesfalseSharingOfFacilities
Sharing Of Paid EmployeesfalseSharingOfPaidEmployees
Reimbursement Paid To Other OrgfalseReimbursementPaidToOtherOrg
Reimbursement Paid By Other OrgfalseReimbursementPaidByOtherOrg
Other Transfer To Other OrgfalseOtherTransferToOtherOrg
Other Transfer From Other OrgfalseOtherTransferFromOtherOrg