2012-05-15T13:46:31-04:00 2011-06-30 PricewaterhouseCoopers LLP 2001 MARKET ST SUITE 1700 PHILADELPHIA PA 19103 990 2010-07-01 582032904 KENNESTONE HOSPITAL INC KENN 7707925023 805 Sandy Plains Road Marietta GA 300666340 JIMMY SWARTZ 2012-05-15 true 2673303000 2010 2016-02-24 21:20:13Z A JAMES BUDZINSKI 691051664 false X www.wellstar.org X 1993 GA To provide world class charitable healthcare to the community. 18 14 4953 410 1121667 0 0 0 772276284 683440836 18062619 32980 9993352 7577848 800332255 691051664 0 0 0 0 251480542 263582427 0 0 0 424967395 319303513 676447937 582885940 123884318 108165724 439160433 451489162 264068767 243296810 175091666 208192352 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 518740286 683440836 As discussed herein, Kennestone Hospital, Inc (an affiliate of Wellstar Health System, Inc.) operates as a charitable organization consistent with the requirements of Internal Revenue Code Section 501 (c) (3) and the "community benefit standard" of IRS Revenue Ruling 69-545. In this regard, the governing body of the organization and/or its parent is composed of prominent citizens in the community, medical staff privileges in the hospital are available to all qualified physicians in the area, consistent with the size and nature of the facility; one of the hospitals operates a full-time emergency room open to all regardless of the ability to pay; the hospital provides care to needy members of its community consistent with its charity care policy regardless of their ability to pay for these services and admits as patients those able to pay for care, either themselves or through third-party payers such as private health insurance or government programs such as Medicare and Medicaid; and the hospital's excess funds are generally applied to expansion and replacement of existing facilities and equipment, amortization of indebtedness, improvement in patient care, community benefit activities, and charity care. Kennestone Hospital, Inc. consists of two hospitals, Wellstar Kennestone and Wellstar Windy Hill. These hospitals combined to invest approximately $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 continued 518740286 true false false false false false false false false true false false false 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 false false false true 0 0 4953 true true true false false false false false false false false false false false false X 18 14 true false true false true true true true true false false true true true true true true true true false GA X JAMES M SWARTZ 7707925023 805 SANDY PLAINS ROAD Marietta GA 300666340 X Randall Bentley 1.0 X 0 17242 0 Robert N Cross MD 1.0 X 0 4678 0 T E Durham 1.0 X 0 31751 1255 Thomas E Gearhard MD 1.0 X 0 389972 28532 David Hafner MD 1.0 X 0 16011 0 Charles J Jones 1.0 X 0 13123 0 Connie Kirk 1.0 X 0 5044 0 Janie Maddox 1.0 X 0 14609 0 Gary A Miller 1.0 X 0 2721 0 Steven W Oweida MD 1.0 X 0 17242 0 Tom Phillips 1.0 X 0 2754 0 Walter G Robinson 1.0 X 0 7065 0 Otis Brumby III 1.0 X 0 1727 0 W Allen Separk 1.0 X 0 7984 0 T Fitz Johnson 1.0 X 0 1742 0 Jeffrey Tharp MD 1.0 X 0 446816 28567 Robert G Warner MD 1.0 X 0 3142 0 Charles Pete Wood 1.0 X 0 12872 0 A James Budzinski 2.0 X 0 585666 33803 Gregory L Simone MD 2.0 X 0 3972245 172966 Bonnie Wilson 2.0 X 0 1480015 71627 David W Anderson 2.0 X 0 512652 29200 Donald Campbell MD 2.0 X 0 392680 24541 Barbara B Corey 2.0 X 0 353270 21091 Bruce Dean 2.0 X 0 246466 19958 Marcia Delk MD 2.0 X 0 424456 33113 Darold Etheridge 2.0 X 0 231132 14571 Lee Evins 2.0 X 0 248506 18089 Mark Haney 2.0 X 0 331882 23979 Christopher M Kane 2.0 X 0 400365 26918 Kenneth C Kunze MD 2.0 X 0 687208 37043 Louis W Little 50.0 X 283210 0 24158 Kimberly W Menefee 2.0 X 0 330316 22272 Ronald J Strachan 2.0 X 0 417826 27923 Candice L Saunders 50.0 X 480497 0 29392 Martin L Gutkin 50.0 X 229191 0 10854 Amanda Trask 50.0 X 170450 0 18395 ROBERT HAMILTON 2.0 X 0 302937 24258 MICHAEL GRAUE 2.0 X 0 691292 44574 ROBERT JANSEN 2.0 X 0 368959 20365 ELLEN LANGFORD 2.0 X 0 228643 16661 ROBERT MANDLER 2.0 X 0 262785 18444 JERRY TILLERY 50.0 X 166204 0 10939 JONATHAN B MORRIS 2.0 X 0 334194 23933 ANTHONY M TRUPIANO 2.0 X 0 285303 16534 ROBIN WILSON MD 2.0 X 0 340020 24726 JOSEPH L BRYWCZYNSKI 2.0 X 0 216142 14427 ELIZABETH A HOFFMANN 2.0 X 0 230428 10860 RICHARD T LOPES MD 2.0 X 0 513606 28822 JAMES M SWARTZ 2.0 X 0 169532 9148 MARY L WESLEY 2.0 X 0 294140 14070 Patricia Ann Mayne 50.0 X 184757 0 22123 Barbara G Ballard 2.0 X 0 120827 7602 Carol S Edwards 2.0 X 0 117869 6022 Beth Kost 2.0 X 0 244509 16135 Adam C Thompson 2.0 X 0 176957 9710 Betty Ann Brakovich 50.0 X 0 0 0 Laura Caramanica 50.0 X 0 0 0 Leo E Reichert 2.0 X 0 0 0 Deborah Roegge De Vita 2.0 X 0 0 0 Mary L Tavernaro 2.0 X 0 0 C Brett Scullen 2.0 X 0 80312 3785 Dwight Still 50.0 X 172167 0 13148 Patricia Horton 50.0 X 195413 0 10882 Sherron Kurtz 50.0 X 163404 13878 Thomas Whittaker 50.0 X 156859 0 10327 William Gonzalez 50.0 X 160138 16234 Marsha Burke 1.0 X 0 190475 12395 Linda A Clark 1.0 X 0 255306 10595 Bruce Harrison 2.0 X 0 455869 22304 Diane C Swain 40.0 X 123022 0 5506 2485312 17491285 1176654 187 true true false Brasfield Gorrie 1990 Vaughn Rd NW Suite 100 KENNESAW GA 30144 General Contractor 3058778 Batchelor and Kimball Inc PO Box 70 LITHONIA GA 30058 Maintenance 2001762 Surgical Operational Services 506 Commerce Park Dr Suite G MARIETTA GA 30060 OR Consultant 3226408 QUEST DIAGNOSTICS PO BOX 740736 ATLANTA GA 303740736 MEDICAL LAB SERVICES 1539427 Emory Clinic Inc 101 W Ponce De Leon Ave Suite 400 DECATUR GA 30030 Med/Phys Services 1405510 37 0 PATIENT REVENUE 621990 677839999 677839999 MEDICAL RECORDS 621990 45 45 INDEPENDENT & ASSISTED LIVING REVENUE 623000 5542816 5542816 PATIENT EDUCATION 621990 57976 57976 683440836 0 0 131534 131534 131534 131534 32980 32980 32980 32980 0 0 0 PHARMACY/RETAIL PHARMACY 446199 1174664 1121667 52997 LAB OUTREACH 370043 370043 CAFETERIA 3426933 3426933 2474674 2474674 7446314 691051664 683440836 1121667 6489161 0 0 0 0 1792157 1610969 181188 0 213260348 191709773 21550575 15252988 13711250 1541738 17565788 15789462 1776326 15711146 14122709 1588437 0 116337 69802 46535 0 0 0 0 18215810 17834121 381689 127805 109199 18606 136197199 135403453 793746 0 0 10703302 4377886 6325416 228941 179723 49218 0 408621 373425 35196 154165 154165 113769763 102256263 11513500 27260115 13279186 13980929 2948115 2948115 REPAIRS & MAINTENANCE 9080584 7846676 1233908 OTHER OPERATING EXPENSE 92756 66389 26367 582885940 518740286 64145654 0 15725 16125 187438 206806 95126210 114295624 10083002 11939153 4491675 4737900 642368300 333498220 312562748 308870080 1280943 1280943 15412692 10142531 439160433 451489162 41644157 41846819 313562 151910 222111048 201298081 264068767 243296810 X 175091666 208192352 175091666 208192352 439160433 451489162 X 108165724 -75065038 X false true true X false X 40125004 40125004 309192769 129027028 180165741 12715070 6743174 5971896 266050294 197728018 68322276 14285163 14285163 308870080 0 ASSET RETIREMENT OBLIGATION LT 932913 TAX EXEMPT BOND LIAB-DUE TO WHS 200365168 201298081 true true X true X 125. true X true true true false true true 37174838 37174838 0.06350 56808802 49506145 7302657 0.01250 93983640 49506145 44477495 0.07600 1140568 1140568 0.00190 363176 363176 0.00070 1503744 1503744 0.00260 95487384 49506145 45981239 0.07860 true 28177622 5784191 218138580 243373542 -25234962 X true true 2 1 Kennestone Hospital

677 Church Street Marietta GA 30060

X X X 2 Windy Hill Hospital

2540 Windy Hill Road Marietta GA 30067

X X Long Term Acute Care Kennestone Hospital 1 Windy Hill Hospital 2 Publication of Community Benefit Report Schedule H Part I Line 6a Kennestone Hospital, Inc.(consisting of Kennestone Hospital and Windy Hill Hospital) is an affiliate of Wellstar Health System, Inc. which on an annual basis issues a community benefit report. This report is subsequently distributed in and around the five county service area of the health system. It is also annually filed with Cobb County and the state of Georgia Department of Community Health. Additionally the information on community benefit is included in aggregate for Wellstar Health System, Inc. and affiliated hospitals as part of the Georgia Hospital Association's annual report. Cost to Charge Ratio Schedule H Part I Line 7 For purposes of the IRS Form 990 Schedule H, Wellstar Health System and Affiliates (including Kennestone and Windy Hill Hospitals) have estimated the current year cost to charge ratio for each hospital as it is reported in the annual community benefit report and as it will be reported in the state's Annual Hospital Financial Survey. Footnote on Bad Debt and Rationale for Community Benefit Schedule H Part III Line 4 The following footnote is detailed in the Wellstar Health System, Inc. and Affiliates Combined Financial Statements related to bad debt or uncollectible accounts: "During 2011, Wellstar adopted the provisions of FASB Accounting Standards Update (2011-07), Healthcare Entities (Topic 954). ASU 2011-07 requires the reclassification of the provision for uncollectible accounts associated with patient service revenue from an operating expense to a deduction from patient service revenue (net of contractual allowances and discounts)." " Wellstar recognizes patient service revenue associated with services provided to patients with third-party payor coverage on the basis of contractual rates for the services rendered. For uninsured patients that do not qualify for community financial aid, Wellstar recognizes revenue on the basis of its discounted rates for services provided. On the basis of historical experience, a significant portion of Wellstar's uninsured patients are unable or unwilling to pay for the services provided. Thus, Wellstar records a significant provision for uncollectible accounts related to uninsured patients in the period the services are provided." Subsequent to the end of the reporting period a propensity to pay review of patient accounts often results in prior year bad debt accounts which are deemed eligible for the organization's financial assistance policy. Those bad debt accounts are reclassified as charity and thus our rationale for including in community benefit. Medicare Shortfalls Schedule H Part III Line 8 Kennestone and Windy Hill Hospitals are providers of inpatient and outpatient services to Medicare program beneficiaries at determined rates. Without the participation in the Medicare program these patients may not have had convenient access to those services. The Medicare shortfall on line 7 represents the uncompensated difference between the expected reimbursement and the Medicare charges for those services stated at cost. We determine a cost to charge ratio for Medicare patients as part of the annual filing of the Medicare cost report. Collection Practices Sch H Part III Sec C Line 9b The policy written for collection practices that applies to all Wellstar Health System entities incorporates guidelines for personnel in the admissions and patient access areas to be trained in identifying patients that might qualify for financial assistance. It is also the policy of all Wellstar facilities to have at least one employee or contractor available at all times, especially in the hospitals with emergency rooms, who can provide assistance with the paperwork necessary to help patients who would qualify for governmental and other assistance programs. Facility Descriptions-Kennestone and Windy Hill Schedule H Part V Kennestone Hospital ia a general acute care hospital providing a full range of services, is licensed to operate 633 beds, and is presently staffed to operate 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 Assessment Schedule H Part VI Line 2 Wellstar Health System (and affiliates) is a key stakeholder in MAPP, Mobilizing for Action through Planning and Partnerships. MAPP, developed by the National Association of County and City Health Officials (NACCHO) in collaboration with the CDC, provides a structured guidance on creating and implementing a community-wide strategic planning process focused on improving the health and safety of our population. Through MAPP, a broad collection of community partners and residents come together to identify and prioritize health and safety issues and to identify resources for addressing them. The process results in an actionable community health improvement plan (CHIP) for measurable improvements in the community's health and quality of life as well as a scorecard for implementation and evaluation. The resulting community plan does not focus on one agency or community health challenge; rather, MAPP provides a long-term strategy that addresses the multiple factors that affect health in the community. Community involvement throughout the creation and the implementation of a health improvement plan results in creative solutions to community health problems with an improved focus on priorities, reduced duplication of services, increased collaboration on projects and activities, and increased capacity to garner additional resources. Moreover, continous community involvement leads to community ownership of the process. Community ownership, in turn, increases the credibility and sustainability of the health improvement efforts. Patient Education of Eligibility for Assistance Schedule H Part VI Line 3 Kennestone and Windy Hill Hospitals provide its patients with hospital personnel or contracted personnel who are trained in all aspects of governmental programs, payments plans, charity discounts, and other financial assistance offered to assist them in their hospital bills. If the patient is eligible for federal or state assistance programs, a staff member is knowledgeable in the steps necessary to qualify those individuals. If a patient is indigent or charity eligible they will be offered assistance through the hospital's charity and indigent care policy including the state's indigent care trust fund. If the patient has no other insurance and fails to qualify for indigent care assistance, the financial counselor can then offer the patient an opportunity to accept a payment plan with discounted payment options based on their ability to pay immediately or over time. All patient are afforded these opportunities. Community Information Schedule H Part VI Line 4 Kennestone and Windy Hill Hospitals are two of five hospitals that are affiliated with Wellstar Health System. The primary service area of the system is located in the Northwest Georgia area and receives the majority of its patients from one of five counties (Cherokee, Cobb, Douglas, Bartow and Paulding). Generally about 85% to 90% of the patient volume comes from this service area although other health systems have a presence in the area as well. Demographically the region is one of the fastest growing in the state as well as the country and the expansion of the services for the patient population reflects a desire to offer healthcare "closer to home" since Wellstar is considered a part of a larger metropolitan Atlanta market. Economically the region is strong in per capita income but given recent trends a rise in the uninsured and indigent population has occured. Affiliated Health System Roles 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, 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. X X X X X X false true X X X X X true true false false false false false true false Thomas E Gearhard MD 0 242155 0 139755 0 8062 0 21262 0 7270 0 418504 0 0 Jeffrey Tharp MD 0 275580 0 119178 0 52058 0 23584 0 4983 0 475383 0 0 A James Budzinski 0 434410 0 138539 0 12717 0 29307 0 4496 0 619469 0 0 Marsha Burke 0 190475 0 0 0 10655 0 1740 0 202870 0 0 Linda A Clark 0 255306 0 0 0 10595 0 0 265901 0 0 Gregory L Simone MD 0 814552 0 372600 0 2785093 0 169533 0 3433 0 4145211 0 0 Bonnie Wilson 0 414885 0 126556 0 938574 0 66357 0 5270 0 1551642 0 0 David W Anderson 0 379036 0 118871 0 14745 0 25947 0 3253 0 541852 0 0 Donald Campbell MD 0 304092 0 77660 0 10928 0 21047 0 3494 0 417221 0 0 Barbara B Corey 0 271931 0 70439 0 10900 0 19591 0 1500 0 374361 0 0 Bruce Dean 0 197308 0 39928 0 9230 0 14509 0 5449 0 266424 0 0 Marcia Delk MD 0 326735 0 86581 0 11140 0 22854 0 10259 0 457569 0 0 Darold Etheridge 0 191995 0 30437 0 8700 0 13630 0 941 0 245703 0 0 Lee Evins 0 183954 0 36757 0 27795 0 14120 0 3969 0 266595 0 0 Mark Haney 0 250475 0 67625 0 13782 0 18815 0 5164 0 355861 0 0 Bruce Harrison 0 283156 0 4564 0 168149 0 20737 0 1567 0 478173 0 0 Christopher M Kane 0 308673 0 80630 0 11062 0 21648 0 5270 0 427283 0 0 Kenneth C Kunze MD 0 532359 0 142962 0 11887 0 33411 0 3632 0 724251 0 0 Louis W Little 219648 0 52762 0 10800 0 16822 0 7336 0 307368 0 0 0 Kimberly W Menefee 0 252707 0 66022 0 11587 0 18694 0 3578 0 352588 0 0 Ronald J Strachan 0 278129 0 73374 0 66323 0 21239 0 6684 0 445749 0 0 Candice L Saunders 343988 0 123656 0 12853 0 24895 0 4497 0 509889 0 0 0 Martin L Gutkin 176021 0 26914 0 26256 0 9372 0 1482 0 240045 0 0 0 Diane C Swain 118672 0 0 0 4350 0 5098 0 408 0 128528 0 0 0 Dwight Still 171667 0 500 0 0 0 10433 0 2715 0 185315 0 0 0 Patricia Horton 137615 0 19148 0 38650 0 10882 0 0 0 206295 0 0 0 Sherron Kurtz 150326 13078 0 9788 4090 177282 0 Thomas Whittaker 156359 0 500 0 0 0 9637 0 690 0 167186 0 164905 0 Amanda Trask 145340 0 18906 0 6204 0 10728 0 7667 0 188845 0 173301 0 ROBERT HAMILTON 0 253421 0 41150 0 8366 0 16009 0 8249 0 327195 0 0 MICHAEL GRAUE 0 513657 0 164927 0 12708 0 33859 0 10715 0 735866 0 0 ROBERT JANSEN 0 311389 0 48653 0 8917 0 15337 0 5028 0 389324 0 0 ELLEN LANGFORD 0 182066 0 37877 0 8700 0 14188 0 2473 0 245304 0 0 ROBERT MANDLER 0 195977 0 37704 0 29104 0 14866 0 3578 0 281229 0 0 JERRY TILLERY 145058 0 14811 0 6335 0 10249 0 690 0 177143 0 0 0 JONATHAN B MORRIS 0 256833 0 50211 0 27150 0 18905 0 5028 0 358127 0 0 ANTHONY M TRUPIANO 0 230311 0 45692 0 9300 0 16534 0 0 0 301837 0 0 ROBIN WILSON MD 0 277804 0 53016 0 9200 0 14456 0 10270 0 364746 0 0 JOSEPH L BRYWCZYNSKI 0 167838 0 0 0 48304 0 12397 0 2030 0 230569 0 0 ELIZABETH A HOFFMANN 0 171895 0 15669 0 42864 0 9605 0 1255 0 241288 0 0 RICHARD T LOPES MD 0 405473 0 0 0 108133 0 26209 0 2613 0 542428 0 0 JAMES M SWARTZ 0 147399 0 14973 0 7160 0 7113 0 2035 0 178680 0 0 MARY L WESLEY 0 214845 0 19059 0 60236 0 12190 0 1880 0 308210 0 0 Patricia Ann Mayne 151715 0 24342 0 8700 0 11853 0 10270 0 206880 0 0 0 Beth Kost 0 209311 0 30248 0 4950 0 14503 0 1632 0 260644 0 0 Adam C Thompson 0 148759 0 16996 0 11202 0 7351 0 2359 0 186667 0 0 William Gonzalez 154101 5957 80 9519 6715 176372 0 Non-Fixed Payments to Officers Form 990 Schedule J Line 7 Wellstar has instituted an annual incentive plan for key leaders in the company. On an annual basis performance measures are proposed by management and approved and recommended by the Compensation Committee of the Board. The plan is designed to retain and reward leaders with incentives that keep them competitive with the market and comparable health systems. The criteria used to measure the performance consists of weighted factors in the areas of financial performance, customer service, employee engagement and quality indicators. Upon successful acheivement in the targeted levels for each factor, a performance payout is recommended and approved by the Board after the annual financial audit is completed. Severance Benefits Schedule J Pursuant to their respective employment agreements, the following groups of officers are entitled to severance payments based on their base salary and wages at that time in the event of certain identified circumstances. The officers with a severance payment period of 24 months as per their contractual agreement are: David Anderson, 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 Compensation Form 990, Schedule J, Part I, Line 1b & 2 While Wellstar Health System and its affiliates do not have a written policy regarding payment or reimbursement for the items listed in Part 1 Line 1a, the organization follows IRS guidelines in the payment of any of these items to individuals listed in Form 990 Part VII Section A. These items are added as taxable wages on the individual's Form W-2 as appropriate. Compensation Exceptions The following individuals became officers of Wellstar Health System and Affiliates during the accounting period covered by this return but were not compensated during the calendar year for which salary and benefits are reported in the return: Leo E Reichert Mary L Tavernaro Deborah Roegge De Vita Betty Ann Brakovich Laura Caramanica Pamela Etheridge Wife of Officer 53737 Employee of Wellstar false Greg Fortgang Son-in-Law of Trustee 102382 Employee of Wellstar false Amy Simone Daughter of Officer 72052 Employee of Wellstar false George Fleming Brother of Officer 59478 Employee of Wellstar false Matthew Maddox Son of Trustee 38489 Employee of Wellstar false Bonnie Miller Wife of Trustee 28417 Employee of Wellstar false Greg Separk Son of Trustee 25847 Employee of Wellstar false Business Transactions with Interested Parties Form 990 Schedule L Part IV All transactions listed in Schedule L Part IV are for interested parties or in this case family members of either trustees or officers of Kennestone Hospital, Inc. or its related organizations. The transactions all represent payment of services as employees of Wellstar Health System. Compensation Form 990 Part V Line 2 All compensation amounts reported on Form 990 Part V, Part VII, and Part IX as well as Schedule J represent compensation provided to individuals that provide services to the organization. Likewise, the number of employees reported on Form 990 represent the number of individuals providing services to the organization. All Federal employment tax responsibilities for these individuals (including Federal Employment Tax reporting responsibilities) are handled by Wellstar Health System, Inc (EIN 58-1649541). Conflict of Interest Policy Form 990 Part VI Section B Line 12A, B, & C Our conflict of interest policy requires all covered persons to annually review the policy and then complete, sign and return the Conflicts of Interest Survey and Attestation to the Compliance Office. The Policy requires an on-going disclosure obligation in the event a conflict arises during the year. The following is our process to regularly and consistently monitor and enforce the policy: Compliance identifies all covered persons who must complete the Survey and Attestation. Compliance verifies that the Survey and Attestation is distributed to these persons. Compliance verifies that these persons return a fully completed and signed Survey and Attestation. Compliance reviews each completed and signed Survey and Attestation to identify all conflicts listed in the document. All conflicts, potential conflicts and incidences of non-compliance are referred to the Chief Compliance Officer. The CCO takes appropriate action to completely resolve all identified conflicts and incidences of non-compliance. Process of Determining Officer Comp Form 990 Part VI Line 15A & B Wellstar engages the Hay Group to work with the governing board to review and recommend executive compensation. The executive compensation process at Wellstar is overseen by a committee of independent trustees, which follows a board-approved executive compensation philosophy. The 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 Statements Form 990 Part IV Line 12 Kennestone Hospital, Inc. is audited on an annual basis by an outside auditing firm, KPMG, and as part of that audit a consolidated financial statement is issued for all of WellStar Health System, Inc and its Affiliates. "The independent auditors report includes the accounts of Wellstar and its controlled affiliates, Kennestone Hospital, Inc., Cobb Hospital, Inc., Douglas Hospital, Inc., Paulding Medical Center, Inc., Wellstar Foundation, Inc. CHS Foundation, Inc., Community Assurance Company, Ltd., various Wellstar owned physician practices, a hospice facility, a nursing facility, home health business, and entities for infusion therapy and durable medical equipment. All significant intercompany accounts and transactions have been eliminated in combination. The Board of Trustees of Wellstar has the authority to approve appointments of the members of the board of trustees of all affiliate corporations." Tax Exempt Bond Allocation Form 990 Part IV Line 24a & Part X For purposes of the Form 990 reporting, Wellstar Health System, Inc EIN 58-1649541 will list all tax-exempt bonds issued since January 1, 2003 on Schedule K as it typically allocates the proceeds of the bonds to members of the Obligated Group (including the hospitals and physician group). Kennestone Hospital, Inc. will report this tax exempt bond liability on Part X, Line 25 Other Liabilities-Due to WHS, Inc. Current Officers/Directors Relationships Form 990 Part VI, Section A Line 2 For 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 Structure Form 990 Part VI Section A Lines 6, 7a & 7b As per the Articles of Incorporation, the sole member of the organization is Wellstar Health System, Inc., a GA nonprofit corporation. As sole member, Wellstar Health System, Inc. holds certain powers of election and approval in connection with the governing body of the organization. These powers are presented in detail in the governing documents which the company makes available to the public upon request. Officers Hours Worked Form 990 General Statement The officers devote their time to all of the organizations within Wellstar Health System that are listed in Schedule R, Part II. As such, the total hours worked by the officers across all organizations exceeds 40 hours a week. 990 Board Review Form 990 Part VI Line 11A Internal staff prepare the organization's Form 990. Before filing the return with the Internal Revenue Service an external accounting firm, PricewaterhouseCoopers, reviews and sign-offs on the completed return of each organization. The current year Form 990 is then reviewed by the Finance Committee along with a question and answer session. A motion is then made by the Finance committee to approve the returns and present to the full board copies of the forms in an electronic (pdf. format) version as well as a hard copy . The organization's CFO or designee subsequently signs the return for either manual or electronic filing by the appropriate due date. Disclosure of Financial Documents FORM 990 PART VI SECTION C Line 19 The organization and its subsidiaries are subject to the Open Records Law in the State of Georgia. Therefore, by law, citizens are permitted to inspect and copy its governing documents, policies and financial statements as may be requested from time to time. Additionally, the organization's Form 990 is made readily available on the Guidestar website. Periodically, the organization publishes its financial performance in the local newspaper for citizens to review, and it also publishes a community benefit report once a year for distribution to the public. Bylaws Changes Form 990, Part VI, Line 4 In 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 Assets Form 990 Part XI Line 5 For 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 ORGANIZATION FORM 990 PART VII NAME:T. E. Durham TITLE:Board Member HOURS:10 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:Jeffrey Tharp, 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:Gregory L Simone, MD TITLE:President & CEO HOURS:50 HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:Bonnie Wilson TITLE:Exec VP and Gen Counsel 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 and Med Director 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 and Asst Gen Counsel 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:Darold Etheridge TITLE:VP Finance HOURS:50 HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:Lee Evins TITLE:VP Revenue Cycle Mgmt HOURS:50 HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:Mark Haney TITLE:Sr VP Business Development HOURS:50 HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:Christopher M Kane TITLE:Sr VP Strategic Planning HOURS:50 HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:Kenneth C Kunze, MD TITLE:Sr VP and Chief Med Officer 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 and CIO HOURS:50 HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:ROBERT HAMILTON TITLE:VP MED AFFAIRS HOURS:50 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:VP MED AFFAIRS HOURS:50 HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:ELLEN LANGFORD TITLE:VP & COO WELLSTAR PHYS 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:VP & Chief Med Info Officer HOURS:50 HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:ANTHONY M TRUPIANO TITLE:VP SUPPLY CHAIN HOURS:50 HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:ROBIN WILSON, MD TITLE:VP Medical Mgmt 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 AND ANALYSIS HOURS:50 HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:RICHARD T LOPES, MD TITLE:Sr VP & PRES WELLSTAR PHYS 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: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 Roegge De Vita TITLE:VP Women's & Newborns Serv 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:C Brett Scullen TITLE:VP Pulmonology Operations HOURS:50 CHS Foundation Inc 805 Sandy Plains Road Marietta GA 30066 581649540 Foundation GA 501 (c) (3) 11 WHS Inc true Cobb Hospital Inc 805 Sandy Plains Road Marietta GA 30066 580968382 Healthcare GA 501 (c) (3) 3 WHS Inc true Douglas Hospital Inc 805 Sandy Plains Road Marietta GA 30066 582026750 Healthcare GA 501 (c) (3) 3 WHS Inc true Paulding Medical Center Inc 805 Sandy Plains Road Marietta GA 30066 582095884 Healthcare GA 501 (c) (3) 3 WHS Inc true Wellstar Foundation Inc 805 Sandy Plains Road Marietta GA 30066 581627413 Foundation GA 501 (c) (3) 11 WHS Inc true Wellstar Health System Inc 805 Sandy Plains Road Marietta GA 30066 581649541 Healthcare GA 501 (c) (3) 11 NA false Cobb Hospital Parking Company LLC 805 Sandy Plains Road Marietta GA 300666340 752999669 Parking GA NA Investment 26313 808030 false false Kennestone East Parking Deck LLC 805 Sandy Plains Road Marietta GA 300666340 200537100 Parking GA NA Investment -64045 2719346 false false Community Assurance Co 3rd Fl Barclays House Shedden Rd George Town Grand Cayman, BWI CJ 581649541 Insurance GA WHS Inc C 58594426 1.00000 false false false false false false false false false false false false false false false false false false