DOUGLAS HOSPITAL INC: Form 990, tax year 2010
View the entire original 990 at ProPublica ↗
- Organization
- DOUGLAS HOSPITAL INC (EIN 58-2026750)
- Tax period
- 2010-07-01 to 2011-06-30
- Filed
- 2012-05-15
- IRS object ID
- 201241369349304649
- 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
| Field | Value | IRS element (for citing) |
|---|---|---|
| Timestamp | 2012-05-15T13:41:03-04:00 | Timestamp |
| Tax Period End Date | 2011-06-30 | TaxPeriodEndDate |
Preparer Firm PreparerFirm
Preparer Firm Business Name PreparerFirmBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | PricewaterhouseCoopers LLP | BusinessNameLine1 |
Preparer Firm US Address PreparerFirmUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 2001 MARKET ST SUITE 1700 | AddressLine1 |
| City | PHILADELPHIA | City |
| State | PA | State |
| ZIP Code | 19103 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnType |
| Tax Period Begin Date | 2010-07-01 | TaxPeriodBeginDate |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 582026750 | EIN |
Name Name
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | DOUGLAS HOSPITAL INC | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Control | DOUG | NameControl |
| Phone | 7707925023 | Phone |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 805 Sandy Plains Road | AddressLine1 |
| City | Marietta | City |
| State | GA | State |
| ZIP Code | 300666340 | ZIPCode |
Officer Officer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | JIMMY SWARTZ | Name |
| Title | VP, ACCOUNTING | Title |
| Date Signed | 2012-05-15 | DateSigned |
| Authorize Third Party | true | AuthorizeThirdParty |
Preparer Preparer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Phone | 2673303000 | Phone |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax Year | 2010 | TaxYear |
| Build TS | 2016-02-24 21:20:13Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Of Principal Officer Person | A JAMES BUDZINSKI | NameOfPrincipalOfficerPerson |
Address Principal Officer US AddressPrincipalOfficerUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 805 Sandy Plains Road | AddressLine1 |
| City | Marietta | City |
| State | GA | State |
| ZIP Code | 300666340 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | 95592032 | GrossReceipts |
| Group Return For Affiliates | false | GroupReturnForAffiliates |
| Organization501c3 | X | Organization501c3 |
| Web Site | www.wellstar.org | WebSite |
| Type Of Organization Corporation | X | TypeOfOrganizationCorporation |
| Year Formation | 1992 | YearFormation |
| State Legal Domicile | GA | StateLegalDomicile |
| Activity Or Mission Description | To provide world class charitable healthcare to the community | ActivityOrMissionDescription |
| Nbr Voting Members Governing Body | 18 | NbrVotingMembersGoverningBody |
| Nbr Independent Voting Members | 14 | NbrIndependentVotingMembers |
| Total Nbr Employees | 776 | TotalNbrEmployees |
| Total Nbr Volunteers | 100 | TotalNbrVolunteers |
| Total Gross UBI | 0 | TotalGrossUBI |
| Net Unrelated Business Txbl Income | 0 | NetUnrelatedBusinessTxblIncome |
| Contributions Grants Prior Year | 0 | ContributionsGrantsPriorYear |
| Contributions Grants Current Year | 0 | ContributionsGrantsCurrentYear |
| Program Service Revenue Prior Year | 117086651 | ProgramServiceRevenuePriorYear |
| Program Service Revenue CY | 94854673 | ProgramServiceRevenueCY |
| Investment Income Prior Year | 3090172 | InvestmentIncomePriorYear |
| Investment Income Current Year | 0 | InvestmentIncomeCurrentYear |
| Other Revenue Prior Year | 1037909 | OtherRevenuePriorYear |
| Other Revenue Current Year | 737359 | OtherRevenueCurrentYear |
| Total Revenue Prior Year | 121214732 | TotalRevenuePriorYear |
| Total Revenue Current Year | 95592032 | TotalRevenueCurrentYear |
| Grants And Similar Amnts Prior Year | 0 | GrantsAndSimilarAmntsPriorYear |
| Grants And Similar Amnts CY | 0 | GrantsAndSimilarAmntsCY |
| Benefits Paid To Members Prior Year | 0 | BenefitsPaidToMembersPriorYear |
| Benefits Paid To Members CY | 0 | BenefitsPaidToMembersCY |
| Salaries Etc Prior Year | 40571998 | SalariesEtcPriorYear |
| Salaries Etc Current Year | 43038270 | SalariesEtcCurrentYear |
| Total Prof Fundrsng Exp Prior Year | 0 | TotalProfFundrsngExpPriorYear |
| Total Prof Fundrsng Exp CY | 0 | TotalProfFundrsngExpCY |
| Total Fundrsng Exp Current Year | 0 | TotalFundrsngExpCurrentYear |
| Other Expense Prior Year | 71803866 | OtherExpensePriorYear |
| Other Expenses Current Year | 43492307 | OtherExpensesCurrentYear |
| Total Expenses Prior Year | 112375864 | TotalExpensesPriorYear |
| Total Expenses Current Year | 86530577 | TotalExpensesCurrentYear |
| Revenues Less Expenses Prior Year | 8838868 | RevenuesLessExpensesPriorYear |
| Revenues Less Expenses CY | 9061455 | RevenuesLessExpensesCY |
| Total Assets BOY | 56518043 | TotalAssetsBOY |
| Total Assets EOY | 58798093 | TotalAssetsEOY |
| Total Liabilities BOY | 40741478 | TotalLiabilitiesBOY |
| Total Liabilities EOY | 45809603 | TotalLiabilitiesEOY |
| Net Assets Or Fund Balances BOY | 15776565 | NetAssetsOrFundBalancesBOY |
| Net Assets Or Fund Balances EOY | 12988490 | NetAssetsOrFundBalancesEOY |
| Mission Description | 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 | MissionDescription |
| Significant New Program Services | false | SignificantNewProgramServices |
| Significant Change | false | SignificantChange |
| Expense | 73853046 | Expense |
| Revenue | 94854673 | Revenue |
| Description | As discussed herein, Douglas Hospital, Inc (an affiliate of Wellstar Health System, Inc.) operates as a charitable organization consistent with the requirements of Internal Revenue Code section 501 (c) (3) and the "community benefit standard" of IRS Revenue Ruling 69-545. In this regard, the governing body of the organization and/or its parent is composed of prominent citizens in the community, medical staff privileges in the hospital are available to all qualified physicians in the area consistent with the size and nature of the facility; the hospital operates a full-time emergency room open to all regardless of ability to pay; the hospital provides care to the needy members of the community consistent with its charity care policy regardless of their ability to pay for these services. The hospital's excess funds are generally applied to expansion and replacement of existing facilities and equipment, amortization of indebtedness, improvement of patient care, community benefit activities, and charity care. Douglas Hospital committed approximately $4 million in capital expenditures for the year to meet the technology and program needs of the community we serve. Douglas Hospital, Inc. was organized in 1992. The hospital affiliated with the Northwest Georgia Health System in 1993. In 1994 Northwest Georgia Health System helped form the PROMINA Health System and changed its name to Promina Northwest Health System. In 1998 Promina Northwest changed its name to Wellstar Health System and is now totally independent of PROMINA. Douglas Hospital is subordinate to, and subject to the authority of Wellstar Health System and its governing boards including the Hospital Authority of Douglas County. Wellstar Douglas provides a full range of inpatient and outpatient services characteristic of a community hospital. The hospital is licensed to operate 108 beds and is presently staffed to operate 102 beds. The original hospital was constructed in 1974 and had one major structural addition in 1985. The following stats constitute the overall program services provided during the reporting period ended June 30, 2011: Adult Discharges 6,696 Med & Surgical Short Stay Cases 106 Emergency Room Visits 54,596 Outpatient Surgical Cases 4,384 Inpatient Surgical Cases 1,284 Outpatient Procedures Non-ED OP Radiology 43,629 GI Laboratory 1,314 Total FTEs Paid 602 Community Benefit Reporting Community Outreach $ 401,114 incl system generated allocated benefits Unreimbursed Charity Care (at cost)$7,723,889 Medicaid Shortfalls (at cost) $141,999 Total $8,267,002 As an affiliate of Wellstar Health System, Douglas Hospital participates in many community and educational programs for the overall health and benefit of the area that we serve. Some examples of those programs are: Community Health/Education--screenings and educational opportunities such as defensive driving for teens (offered at a minimal cost), smoking cessation, heart smart school, CPR and others. Community Activities--sponsors blood drives, provides funding to school health programs for medical and dental care for the underserved population. Community Events--Latino Day for the community Hispanics to have a variety of screenings for health related issues. In all a total of over 200,000 area residents participated in some type of education or screening in health issues. Sponorships--A group of employees participated in the annual "Relay for Life event to locally raise funds and awareness for cancer research and prevention (held in conjunction with the American Cancer Society). System-wide a total of $10,000 was raised for this important cancer prevention and treatment program. Wellstar's Laundry services Department partnered with a local homeless shelter, MUST Ministries, to donate retired and faded scrubs to new arrivals at the shelter. MUST has integrated housing programs in Cobb, Cherokee, and Douglas counties (the heart of Wellstar"s service area) Recognition and Accomplishments Douglas Hospital continues to be accredited by the Joint Commission on Accreditation of Healthcare Organizations (JCAHO). All of the Wellstar system hospitals (including Douglas) have been awarded "Accreditation with Distinction" by the Commission on Laboratory Accreditation of the College of American Pathologists (CAP). CAP awards are considered one of the most stringent in laboratory quality assurance in the industry. The Wellstar Cancer Program is accredited by the American College of Surgeons. The expansion of the cancer program has resulted in an increase in the services provided for cancer patients at both Douglas and Paulding Hospitals. The Wellstar Respiratory Care is accredited by the American Association for Respiratory Care with its "Recognition for Quality". Wellstar Health System is number nine in the Top 100 Integrated Healthcare Networks as published by SDI. It is also the highest ranked integrated network in the state. Wellstar is named in the 100 Best Companies List by "Working Mothers" magazine and as a National Employer Team Member by AARP for its work on behalf of more mature workers within the organization. Wellstar was also named for a fourth year in a row to the Companies that Care Honor Roll. This distinction represents employers who create positive work environments for its employees and who are also active community partners. Douglas Hospital's Ambulatory Surgery Department was selected by a national customer service company, the Studer Group, for its Fire Starter Award. The department is in the 90th percentile in patient satisfaction and customer service and has been above the 90th percentile for the past three or four years. Douglas Hospital received a Partnership for Health and Accountability Quality and Patient Safety Award from Georgia Hospital Association related to the reduction of healthcare associated infections. For the last several years Wellstar Douglas Hospital has sponsored a joint class for patients who are scheduled to have some type of joint replacement surgery. These twice a month classes prepar the patients for not only surgery and the risk involved but post-operative realities and their new "pain free" activities and rehabilitation that is involved. This program has educated approximately 250 patients over a four year period. Wellstar continues to expand its participation in the annual American Heart Association-Heart Walk as a major sponsor (the Wellstar Cardiac Network). For the past several years Wellstar has participated with walkers and donations now totalling more than $100,000 per year. Wellstar was named one of America's Best Adoption-Friendly Workplaces on a list released by the Dave Thomas Foundation for Adoption. Wellstar ranked fifth in the hospital and health industry. The rankings are based on a survey of companies to analyze their adoption benefits. Wellstar's policy includes a $5,000 per finalized adoption (and a $10,000 lifetime maximum) for employees with at least six months of continuous employment to assist in the adoption process. Douglas Hospital initiated a new patient experience called "Zero Sleepless Nights" in its Diagnostic services department for mammography patients. The service is intended to provide screening results to patients within 24 hours of their procedure to reduce and hopefully eliminate the stress associated with unknown diagnoses. As a system Wellstar performs more than 73,000 mammograms each year and this new service has proven to be very well received by those patients. Cobb, Douglas, Kennestone, and Paulding hospitals continue to meet the Appropriate Care Measures (ACM) of 93 percent thresholds in quality for the Presidental Level of Quality Honor Roll as reported by the Georgia Hospital Association. Wellstar has progressed in this area from an 81.4 percent threshold to 94.6 percent. Wellstar (including Cobb, Douglas, and Kennestone hospitals) received a "3 STAR" rating from the Society of Thoracic Surgeons (STS) for the quality of its cardiac surgery (only 12-15 percent of hospitals across the country receive this rating). This rating helps validate that quality cardiovascular care will remain a priority of the system's program. | Description |
| Total Program Service Expense | 73853046 | TotalProgramServiceExpense |
| Described In501 C3 | true | DescribedIn501C3 |
| Schedule B Required | false | ScheduleBRequired |
| Political Activities | false | PoliticalActivities |
| Lobbying Activities | false | LobbyingActivities |
| Donor Advised Funds | false | DonorAdvisedFunds |
| Conservation Easements | false | ConservationEasements |
| Collections Of Art | false | CollectionsOfArt |
| Credit Counseling | false | CreditCounseling |
| Term Or Permanent Endowments | false | TermOrPermanentEndowments |
| Report Land Bldg Equip | true | ReportLandBldgEquip |
| Report Invest Oth Securities | false | ReportInvestOthSecurities |
| Report Prog Rel Invest | false | ReportProgRelInvest |
| Report Other Assets | false | ReportOtherAssets |
| Report Other Liabilities | true | ReportOtherLiabilities |
| Report Fin48 Footnote | false | ReportFin48Footnote |
| Independent Audit Financial Stmt | true | IndependentAuditFinancialStmt |
| Consolidated Audit Financial Stmt | false | ConsolidatedAuditFinancialStmt |
| School | false | School |
| Foreign Office | false | ForeignOffice |
| Foreign Activities | false | ForeignActivities |
| More Than5000 K To Organizations | false | MoreThan5000KToOrganizations |
| More Than5000 K To Individuals | false | MoreThan5000KToIndividuals |
| Professional Fundraising | false | ProfessionalFundraising |
| Fundraising Activities | false | FundraisingActivities |
| Gaming | false | Gaming |
| Hospital | true | Hospital |
| Financial Stmt Attached | true | FinancialStmtAttached |
| Grants To Organizations | false | GrantsToOrganizations |
| Grants To Individuals | false | GrantsToIndividuals |
| Schedule J Required | true | ScheduleJRequired |
| Tax Exempt Bonds | false | TaxExemptBonds |
| Excess Benefit Transaction | false | ExcessBenefitTransaction |
| Prior Excess Benefit Transaction | false | PriorExcessBenefitTransaction |
| Loan To Officer Or DQP | false | LoanToOfficerOrDQP |
| Grant To Related Person | false | GrantToRelatedPerson |
| Bsnss Rltnshp With Organization | false | BsnssRltnshpWithOrganization |
| Bsnss Rltnshp Thru Family Member | true | BsnssRltnshpThruFamilyMember |
| Officer Entity With Bsnss Rltnshp | false | OfficerEntityWithBsnssRltnshp |
| Deductible Non Cash Contributions | false | DeductibleNonCashContributions |
| Deductible Contributions Of Art | false | DeductibleContributionsOfArt |
| Terminated | false | Terminated |
| Partial Liquidation | false | PartialLiquidation |
| Disregarded Entity | false | DisregardedEntity |
| Related Entity | true | RelatedEntity |
| Related Org Controlled Entity | true | RelatedOrgControlledEntity |
| Transaction Related Entity | false | TransactionRelatedEntity |
| Transfers To Exempt Non Chrtbl Org | false | TransfersToExemptNonChrtblOrg |
| Activities Conducted Partnership | false | ActivitiesConductedPartnership |
| Schedule O Required | true | ScheduleORequired |
| Number Forms Transmitted With1096 | 0 | NumberFormsTransmittedWith1096 |
| Number W2 G Included | 0 | NumberW2GIncluded |
| Number Of Employees | 776 | NumberOfEmployees |
| Employment Tax Returns Filed | true | EmploymentTaxReturnsFiled |
| Unrelated Business Income | false | UnrelatedBusinessIncome |
| Foreign Financial Account | false | ForeignFinancialAccount |
| Prohibited Tax Shelter Trans | false | ProhibitedTaxShelterTrans |
| Taxable Party Notification | false | TaxablePartyNotification |
| Non Deductible Contributions | false | NonDeductibleContributions |
| Quid Pro Quo Contributions | false | QuidProQuoContributions |
| Form8282 Property Disposed Of | false | Form8282PropertyDisposedOf |
| Funds To Pay Premiums | false | FundsToPayPremiums |
| Premiums Paid | false | PremiumsPaid |
| Indoor Tanning Services | false | IndoorTanningServices |
| Info In Schedule O Part VI | X | InfoInScheduleOPartVI |
| Nbr Voting Governing Body Members | 18 | NbrVotingGoverningBodyMembers |
| Number Independent Voting Members | 14 | NumberIndependentVotingMembers |
| Family Or Business Relationship | true | FamilyOrBusinessRelationship |
| Delegation Of Management Duties | false | DelegationOfManagementDuties |
| Changes To Organizing Docs | true | ChangesToOrganizingDocs |
| Material Diversion Or Misuse | false | MaterialDiversionOrMisuse |
| Members Or Stockholders | true | MembersOrStockholders |
| Election Of Board Members | true | ElectionOfBoardMembers |
| Decisions Subject To Approval | true | DecisionsSubjectToApproval |
| Minutes Of Governing Body | true | MinutesOfGoverningBody |
| Minutes Of Committees | true | MinutesOfCommittees |
| Officer Mailing Address | false | OfficerMailingAddress |
| Local Chapters | false | LocalChapters |
| Form990 Provided To Governing Body | true | Form990ProvidedToGoverningBody |
| Conflict Of Interest Policy | true | ConflictOfInterestPolicy |
| Annual Disclosure Covered Persons | true | AnnualDisclosureCoveredPersons |
| Regular Monitoring Enforcement | true | RegularMonitoringEnforcement |
| Whistleblower Policy | true | WhistleblowerPolicy |
| Document Retention Policy | true | DocumentRetentionPolicy |
| Compensation Process CEO | true | CompensationProcessCEO |
| Compensation Process Other | true | CompensationProcessOther |
| Investment In Joint Venture | false | InvestmentInJointVenture |
| States Where Copy Of Return Is Filed | GA | StatesWhereCopyOfReturnIsFiled |
| Upon Request | X | UponRequest |
The Books Are In Care Of TheBooksAreInCareOf
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Person | JAMES M SWARTZ | NamePerson |
| Telephone Number | 7707925023 | TelephoneNumber |
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 805 SANDY PLAINS ROAD | AddressLine1 |
| City | Marietta | City |
| State | GA | State |
| ZIP Code | 300666340 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part VII | X | InfoInScheduleOPartVII |
Form990 Part VII Section A Form990PartVIISectionA (64 entries)
| TitleTitle | Average Hours Per WeekAverageHoursPerWeek | Individual Trustee Or DirectorIndividualTrusteeOrDirector | Reportable Comp From OrganizationReportableCompFromOrganization | Reportable Comp From Related OrgsReportableCompFromRelatedOrgs | Other CompensationOtherCompensation | OfficerOfficer | Highest Compensated EmployeeHighestCompensatedEmployee | FormerFormer |
|---|---|---|---|---|---|---|---|---|
| Randall Bentley | ||||||||
| Board Member-Chairman | 1.0 | X | 0 | 17242 | 0 | |||
| Robert N Cross MD | ||||||||
| Board Member | 1.0 | X | 0 | 4678 | 0 | |||
| T E Durham | ||||||||
| Board Member | 1.0 | X | 0 | 31751 | 1255 | |||
| Thomas E Gearhard | ||||||||
| Board Member | 1.0 | X | 0 | 389972 | 28532 | |||
| David Hafner MD | ||||||||
| Board Member | 1.0 | X | 0 | 16011 | 0 | |||
| Charles J Jones | ||||||||
| Board Member | 1.0 | X | 0 | 13123 | 0 | |||
| Connie Kirk | ||||||||
| Board Member | 1.0 | X | 0 | 5044 | 0 | |||
| Janie Maddox | ||||||||
| Board Member- Vice Chair | 1.0 | X | 0 | 14609 | 0 | |||
| Gary A Miller | ||||||||
| Board Member | 1.0 | X | 0 | 2721 | 0 | |||
| Steven W Oweida MD | ||||||||
| Board Member | 1.0 | X | 0 | 17242 | 0 | |||
| Tom Phillips | ||||||||
| Board Member | 1.0 | X | 0 | 2754 | 0 | |||
| Walter G Robinson | ||||||||
| Board Member | 1.0 | X | 0 | 7065 | 0 | |||
| Otis Brumby III | ||||||||
| Board Member | 1.0 | X | 0 | 1727 | 0 | |||
| W Allen Separk | ||||||||
| Board Member | 1.0 | X | 0 | 7984 | 0 | |||
| T Fitz Johnson | ||||||||
| Board Member | 1.0 | X | 0 | 1742 | 0 | |||
| Jeffrey Tharp MD | ||||||||
| Board Member | 1.0 | X | 0 | 446816 | 28567 | |||
| Robert G Warner MD | ||||||||
| Board Member | 1.0 | X | 0 | 3142 | 0 | |||
| Charles Pete Wood | ||||||||
| Board Member | 1.0 | X | 0 | 12872 | 0 | |||
| A James Budzinski | ||||||||
| Exec VP and CFO & Acting CEO | 2.0 | 0 | 585666 | 33803 | X | |||
| Gregory L Simone MD | ||||||||
| President & CEO | 2.0 | 0 | 3972245 | 172966 | X | |||
| Bonnie Wilson | ||||||||
| Exec VP & Gen Counsel | 2.0 | 0 | 1480015 | 71627 | X | |||
| David Anderson | ||||||||
| Exec VP HR/OL/CCO | 2.0 | 0 | 512652 | 29200 | X | |||
| Donald Campbell MD | ||||||||
| Sr VP & Medical Director | 2.0 | 0 | 392680 | 24541 | X | |||
| Barbara B Corey | ||||||||
| Sr VP Managed Care | 2.0 | 0 | 353270 | 21091 | X | |||
| Bruce Dean | ||||||||
| VP & Asst Gen Counsel | 2.0 | 0 | 246466 | 19958 | X | |||
| Marcia Delk MD | ||||||||
| Sr VP Med Affairs & CQO | 2.0 | 0 | 424456 | 33113 | X | |||
| K Darold Etheridge | ||||||||
| VP Finance | 2.0 | 0 | 231132 | 14571 | X | |||
| Lee Evins | ||||||||
| VP Revenue Cycle Mgmt | 2.0 | 0 | 248506 | 18089 | X | |||
| Mark Haney | ||||||||
| Sr VP Business Development | 2.0 | 0 | 331882 | 23979 | X | |||
| Christopher M Kane | ||||||||
| Sr VP Strategic Planning | 2.0 | 0 | 400365 | 26918 | X | |||
| Kenneth C Kunze MD | ||||||||
| Sr VP Chief Med Officer | 2.0 | 0 | 687208 | 37043 | X | |||
| Louis W Little | ||||||||
| Sr VP Post Acute Srv & Admin | 2.0 | 0 | 283210 | 24158 | X | |||
| Kimberly W Menefee | ||||||||
| Sr VP Public & Govt Affairs | 2.0 | 0 | 330316 | 22272 | X | |||
| Ronald J Strachan | ||||||||
| Sr VP Chief Info Officer | 2.0 | 0 | 417826 | 27923 | X | |||
| Robert Mandler | ||||||||
| VP Diagnostic Outreach | 2.0 | 0 | 262785 | 18444 | X | |||
| Jonathan B Morris | ||||||||
| VP & Chief Med Info Officer | 2.0 | 0 | 334194 | 23933 | X | |||
| MICHAEL GRAUE | ||||||||
| EXEC VP COO | 2.0 | 0 | 691292 | 44574 | X | |||
| Robin Wilson MD | ||||||||
| VP Medical Management | 2.0 | 0 | 340020 | 24726 | X | |||
| ELLEN LANGFORD | ||||||||
| VP & COO MED GROUP | 2.0 | 0 | 228643 | 16661 | X | |||
| CRAIG OWENS | ||||||||
| SR VP & ADMIN | 50.0 | 311694 | 0 | 21752 | X | |||
| Anthony M Trupiano | ||||||||
| VP Supply Chain | 2.0 | 0 | 285303 | 16534 | X | |||
| Joseph L Brywczynski | ||||||||
| Sr VP Health Parks Admin | 2.0 | 0 | 216142 | 14427 | X | |||
| Elizabeth A Hoffmann | ||||||||
| VP Budget & Anaysis | 2.0 | 0 | 230428 | 10860 | X | |||
| Richard T Lopes MD | ||||||||
| Sr VP & Pres Wellstar Phy Grp | 2.0 | 0 | 513606 | 28822 | X | |||
| James M Swartz | ||||||||
| VP Accounting | 2.0 | 0 | 169532 | 9148 | X | |||
| Mary L Wesley | ||||||||
| Sr VP Nursing Srvcs & CNE | 2.0 | 0 | 294140 | 14070 | X | |||
| Barbara Ballard | ||||||||
| VP Homecare and Hospice | 2.0 | 0 | 120827 | 7602 | X | |||
| Robert Jansen MD | ||||||||
| VP Medical Affairs | 2.0 | 0 | 368959 | 20365 | X | |||
| Beth Kost | ||||||||
| VP Compliance/Chief Privacy Of | 2.0 | 0 | 244509 | 16135 | X | |||
| Carol S Edwards | ||||||||
| VP Cardiac Services | 2.0 | 0 | 117869 | 6022 | X | |||
| C Brett Scullen | ||||||||
| VP Pulmonology Operations | 2.0 | 0 | 80312 | 3785 | X | |||
| Adam C Thompson | ||||||||
| VP Surgery | 2.0 | 0 | 176957 | 9710 | X | |||
| Leo E Reichert | ||||||||
| Exec VP General Counsel | 2.0 | 0 | 0 | 0 | X | |||
| Deborah DeVita Roegge | ||||||||
| VP Women's and Newborn Srvs | 2.0 | 0 | 0 | 0 | X | |||
| Betty Ann Brakovich | ||||||||
| VP/CNO Pat Care Srv W Hill | 50.0 | 0 | 0 | 0 | X | |||
| Laura Caramanica | ||||||||
| VP/CNO Pat Care Srv Kennestone | 50.0 | 0 | 0 | 0 | X | |||
| Martha Seahorn | ||||||||
| Asst VP & CNO Patient Services | 50.0 | 179779 | 0 | 14189 | X | |||
| Margaret W Chastain | ||||||||
| Dir Pharmacy | 50.0 | 148957 | 0 | 9542 | X | |||
| Beverly Bates | ||||||||
| RN | 50.0 | 130411 | 0 | 13953 | X | |||
| Steven W Harris | ||||||||
| Pharmacist | 50.0 | 126342 | 0 | 12423 | X | |||
| Peggy Tyndall | ||||||||
| Dir Nursing | 50.0 | 133422 | 13587 | X | ||||
| Linda A Clark | ||||||||
| Exec VP and COO | 1.0 | 0 | 255306 | 10595 | X | |||
| Bruce Harrison | ||||||||
| Sr VP and CAO Phys Group | 1.0 | 0 | 455869 | 22304 | X | |||
| Marsha L Burke | ||||||||
| Former Exec VP & CFO | 1.0 | 0 | 190475 | 12395 | X | |||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | 1030605 | TotalReportableCompFromOrg |
| Total Reportable Comp Frm Rltd Orgs | 17471558 | TotalReportableCompFrmRltdOrgs |
| Total Other Compensation | 1076164 | TotalOtherCompensation |
| Number Individuals GT100 K | 27 | NumberIndividualsGT100K |
| Formers Listed | true | FormersListed |
| Total Comp GT150 K | true | TotalCompGT150K |
| Compensation From Other Sources | false | CompensationFromOtherSources |
Contractor Compensation ContractorCompensation (5 entries)
| Address Line1AddressOfContractor/AddressUS/AddressLine1 | CityAddressOfContractor/AddressUS/City | StateAddressOfContractor/AddressUS/State | ZIP CodeAddressOfContractor/AddressUS/ZIPCode | Description Of ServicesDescriptionOfServices | CompensationCompensation |
|---|---|---|---|---|---|
| Batchelor Kimball | |||||
| PO Box 70 | LITHONIA | GA | 30058 | Maintenance | 771036 |
| Martin General Contracting Inc | |||||
| 3633 Ivy Gulledge Road | DALLAS | GA | 30132 | General Contractor | 337202 |
| RCC Marietta | |||||
| PO Box 101518 | ATLANTA | GA | 303921518 | Medical | 915495 |
| Quest Diagnostics | |||||
| PO Box 740736 | ATLANTA | GA | 303740736 | Medical Lab | 220095 |
| Urology Associates Lithrotripsy LLC | |||||
| 9825 Spectrum Drive Bldg 3 | AUSTIN | TX | 78717 | Medical | 312400 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Contractors GT100 K | 8 | NumberOfContractorsGT100K |
| Total Contributions | 0 | TotalContributions |
Program Service Revenue ProgramServiceRevenue (2 entries)
| DescriptionDescription | Business CodeBusinessCode | Total Revenue ColumnTotalRevenueColumn | Related Or Exempt Function IncomeRelatedOrExemptFunctionIncome |
|---|---|---|---|
| HOSPITAL PATIENT REVENUE | 621990 | 94854613 | 94854613 |
| MEDICAL RECORDS REVENUE | 621990 | 60 | 60 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | 94854673 | TotalProgramServiceRevenue |
Investment Income InvestmentIncome
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 0 | TotalRevenueColumn |
Income From Invest Bond Proceeds IncomeFromInvestBondProceeds
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 0 | TotalRevenueColumn |
Royalties Revenue RoyaltiesRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 0 | TotalRevenueColumn |
Gross Rents GrossRents
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | 111296 | Real |
Rental Income Or Loss RentalIncomeOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | 111296 | Real |
Net Rental Income Or Loss NetRentalIncomeOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 111296 | TotalRevenueColumn |
| Exclusion | $111,296 | ExclusionAmount |
Net Gain Or Loss Investments NetGainOrLossInvestments
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 0 | TotalRevenueColumn |
Net Income From Fundraising Events NetIncomeFromFundraisingEvents
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 0 | TotalRevenueColumn |
Net Income From Gaming NetIncomeFromGaming
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 0 | TotalRevenueColumn |
Net Income Or Loss NetIncomeOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 0 | TotalRevenueColumn |
Other Revenue Misc OtherRevenueMisc (3 entries)
| DescriptionDescription | Total Revenue ColumnTotalRevenueColumn | ExclusionExclusionAmount |
|---|---|---|
| GROUND LEASE REVENUE | 84328 | $84,328 |
| CAFETERIA SALES | 425009 | $425,009 |
| LACTATION/IMMUNIZATIONS | 21970 | $21,970 |
Miscellaneous Revenue MiscellaneousRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 94756 | TotalRevenueColumn |
| Exclusion | $94,756 | ExclusionAmount |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Other Revenue | 626063 | TotalOtherRevenue |
Total Revenue TotalRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 95592032 | TotalRevenueColumn |
| Related Or Exempt Function Income | 94854673 | RelatedOrExemptFunctionIncome |
| Unrelated Business Revenue | 0 | UnrelatedBusinessRevenue |
| Exclusion | $737,359 | ExclusionAmount |
Grants To Domestic Orgs GrantsToDomesticOrgs
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Grants To Domestic Individuals GrantsToDomesticIndividuals
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Foreign Grants ForeignGrants
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Benefits To Members BenefitsToMembers
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Comp Current Officers Directors CompCurrentOfficersDirectors
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 311693 | Total |
| Program Services | 276254 | ProgramServices |
| Management And General | 35439 | ManagementAndGeneral |
Comp Disqual Persons CompDisqualPersons
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Other Salaries And Wages OtherSalariesAndWages
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 34939044 | Total |
| Program Services | 30967173 | ProgramServices |
| Management And General | 3971871 | ManagementAndGeneral |
Pension Plan Contributions PensionPlanContributions
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 2560257 | Total |
| Program Services | 2269156 | ProgramServices |
| Management And General | 291101 | ManagementAndGeneral |
Other Employee Benefits OtherEmployeeBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 2691983 | Total |
| Program Services | 2385905 | ProgramServices |
| Management And General | 306078 | ManagementAndGeneral |
Payroll Taxes PayrollTaxes
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 2535293 | Total |
| Program Services | 2247030 | ProgramServices |
| Management And General | 288263 | ManagementAndGeneral |
Fees For Services Management FeesForServicesManagement
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Fees For Services Legal FeesForServicesLegal
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1502 | Total |
| Management And General | 1502 | ManagementAndGeneral |
Fees For Services Accounting FeesForServicesAccounting
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Fees For Services Lobbying FeesForServicesLobbying
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Fees For Services Prof Fundraising FeesForServicesProfFundraising
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Fees For Services Invst Mgmnt Fees FeesForServicesInvstMgmntFees
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Fees For Services Other FeesForServicesOther
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1330857 | Total |
| Program Services | 1106825 | ProgramServices |
| Management And General | 224032 | ManagementAndGeneral |
Advertising Advertising
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Office Expenses OfficeExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 13168122 | Total |
| Program Services | 12558024 | ProgramServices |
| Management And General | 610098 | ManagementAndGeneral |
Information Technology InformationTechnology
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Royalties Royalties
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Occupancy Occupancy
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 2275676 | Total |
| Program Services | 1048079 | ProgramServices |
| Management And General | 1227597 | ManagementAndGeneral |
Travel Travel
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 35848 | Total |
| Program Services | 21352 | ProgramServices |
| Management And General | 14496 | ManagementAndGeneral |
Travel Entrtnmnt Public Officials TravelEntrtnmntPublicOfficials
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Conferences Meetings ConferencesMeetings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 36223 | Total |
| Program Services | 31966 | ProgramServices |
| Management And General | 4257 | ManagementAndGeneral |
Interest Interest
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 26749 | Total |
| Management And General | 26749 | ManagementAndGeneral |
Payments To Affiliates PaymentsToAffiliates
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 19686790 | Total |
| Program Services | 17448409 | ProgramServices |
| Management And General | 2238381 | ManagementAndGeneral |
Depreciation Depletion DepreciationDepletion
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 4514733 | Total |
| Program Services | 2117855 | ProgramServices |
| Management And General | 2396878 | ManagementAndGeneral |
Insurance Insurance
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 703840 | Total |
| Management And General | 703840 | ManagementAndGeneral |
Other Expenses OtherExpenses (2 entries)
| DescriptionDescription | TotalTotal | Program ServicesProgramServices | Management And GeneralManagementAndGeneral |
|---|---|---|---|
| REPAIRS & MAINT | 1699382 | 1370296 | 329086 |
| OTHER OPERATING EXPENSE | 12585 | 4722 | 7863 |
Total Functional Expenses TotalFunctionalExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 86530577 | Total |
| Program Services | 73853046 | ProgramServices |
| Management And General | 12677531 | ManagementAndGeneral |
| Fundraising | 0 | Fundraising |
Cash Non Interest Bearing CashNonInterestBearing
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 2150 | BOY |
| EOY | 2150 | EOY |
Savings And Temp Cash Investments SavingsAndTempCashInvestments
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 16919 | BOY |
| EOY | 6294 | EOY |
Accounts Receivable AccountsReceivable
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 12584352 | BOY |
| EOY | 16052926 | EOY |
Inventories For Sale Or Use InventoriesForSaleOrUse
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1494690 | BOY |
| EOY | 1609493 | EOY |
Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 600343 | BOY |
| EOY | 371288 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Buildings Equipment Basis | 90028560 | LandBuildingsEquipmentBasis |
| Land Bldg Equipment Accum Deprec | 51243996 | LandBldgEquipmentAccumDeprec |
Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 38935519 | BOY |
| EOY | 38784564 | EOY |
Other Assets Total OtherAssetsTotal
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 2884070 | BOY |
| EOY | 1971378 | EOY |
Total Assets TotalAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 56518043 | BOY |
| EOY | 58798093 | EOY |
Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 6143371 | BOY |
| EOY | 6303534 | EOY |
Other Liabilities OtherLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 34598107 | BOY |
| EOY | 39506069 | EOY |
Total Liabilities TotalLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 40741478 | BOY |
| EOY | 45809603 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Follow SFAS117 | X | FollowSFAS117 |
Unrestricted Net Assets UnrestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 15776565 | BOY |
| EOY | 12988490 | EOY |
Total Net Assets Fund Balances TotalNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 15776565 | BOY |
| EOY | 12988490 | EOY |
Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 56518043 | BOY |
| EOY | 58798093 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part XI | X | InfoInScheduleOPartXI |
| Reconcilation Revenue Expenses | 9061455 | ReconcilationRevenueExpenses |
| Reconcilation Other Changes | -11849530 | ReconcilationOtherChanges |
| Method Of Accounting Accrual | X | MethodOfAccountingAccrual |
| Accountant Compile Or Review | false | AccountantCompileOrReview |
| FS Audited | true | FSAudited |
| Audit Committee | true | AuditCommittee |
| Financial Statement Consolidated | X | FinancialStatementConsolidated |
| Federal Grant Audit Required | false | FederalGrantAuditRequired |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital170b1 Aiii | X | Hospital170b1Aiii |
Schedule D IRS990ScheduleD
| Field | Value | IRS element (for citing) |
|---|---|---|
| Art Public Exhibition Amts | ArtPublicExhibitionAmts | |
| Held Works Of Art Amts | HeldWorksOfArtAmts |
Land Land
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 59570 | OtherCostOrOtherBasis |
| Book Value | 59570 | BookValue |
Buildings Buildings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 41546798 | OtherCostOrOtherBasis |
| Depreciation | 18415375 | Depreciation |
| Book Value | 23131423 | BookValue |
Leasehold Improvements LeaseholdImprovements
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 1127482 | OtherCostOrOtherBasis |
| Depreciation | 489472 | Depreciation |
| Book Value | 638010 | BookValue |
Equipment Equipment
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 46366881 | OtherCostOrOtherBasis |
| Depreciation | 32339149 | Depreciation |
| Book Value | 14027732 | BookValue |
Other Land Buildings OtherLandBuildings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 927829 | OtherCostOrOtherBasis |
| Book Value | 927829 | BookValue |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Book Value Land Buildings | 38784564 | TotalOfBookValueLandBuildings |
| Federal Income Tax Liability | 0 | FederalIncomeTaxLiability |
Other Liabilities OtherLiabilities (3 entries)
| DescriptionDescription | AmountAmount |
|---|---|
| DUE FROM AFFILIATIES | $4,774,742 |
| ASSET RETIREMENT OBLIGATION LT | $576,803 |
| TAX EXEMPT BOND LIAB-DUE TO WHS | $34,154,524 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Amounts | 39506069 | TotalOfAmounts |
| Total Revenue | 95592032 | TotalRevenue |
| Total Expenses | 86530577 | TotalExpenses |
| Excess Or Deficit For Year | 9061455 | ExcessOrDeficitForYear |
| Excess Or Deficit Per FS | 9061455 | ExcessOrDeficitPerFS |
Form990 Schedule D Part XIV Form990ScheduleDPartXIV
| Field | Value | IRS element (for citing) |
|---|---|---|
| Identifier | SCHEDULE D PART X, LINE 2 FIN 48 FOOTNOTE | Identifier |
| Explanation | The following footnote is related to the organization's application of FIN 48 (ASC 740). "Wellstar (including Douglas Hospital) and all but one of its affiliates have been recognized as exempt from Federal income tax under Internal Revenue Code Section 501 (a) as organizations described in Section 501 (c)(3) and, therefore, related income is generally not subject to Federal or state income taxes. CAC is a controlled foreign corporation not subject to Federal tax. Wellstar applies FASB ASC 740, Income Taxes, which addresses accounting for uncertainties in income tax positions. It also provides guidance on when tax positions are recognized in an entity's financial statements and how the values of these positions are determined. There is no impact on Wellstar's combined financial statements as a result of the application of ASC 740." | Explanation |
Schedule H IRS990ScheduleH
| Field | Value | IRS element (for citing) |
|---|---|---|
| Charity Care Policy | true | CharityCarePolicy |
| Written Policy | true | WrittenPolicy |
| FPG Reference Free Care | true | FPGReferenceFreeCare |
Other Percentage OtherPercentage
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | X | Other |
| Free Other Percentage | 125. | FreeOtherPercentage |
| Field | Value | IRS element (for citing) |
|---|---|---|
| FPG Reference Discounted Care | true | FPGReferenceDiscountedCare |
| Pcent200 D | X | Pcent200D |
| Free Disc Care Medically Indigent | true | FreeDiscCareMedicallyIndigent |
| Amounts Budgeted For Charity Care | true | AmountsBudgetedForCharityCare |
| Expenses Exceeded Budget | true | ExpensesExceededBudget |
| Unable To Provide Care | false | UnableToProvideCare |
| Annual Community Benefit Report | true | AnnualCommunityBenefitReport |
| Report Publically Available | true | ReportPublicallyAvailable |
Charity Care At Cost CharityCareAtCost
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 7723889 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 7723889 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.08890 | PercentOfTotalExpense |
Unreimbursed Medicaid UnreimbursedMedicaid
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 12384648 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 12242649 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 141999 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00160 | PercentOfTotalExpense |
Total Charity Care TotalCharityCare
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 20108537 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 12242649 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 7865888 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.09050 | PercentOfTotalExpense |
Community Health Services CommunityHealthServices
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 318140 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 318140 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00370 | PercentOfTotalExpense |
Total Other Benefits TotalOtherBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 318140 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 318140 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00370 | PercentOfTotalExpense |
Total Community Benefits TotalCommunityBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 20426677 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 12242649 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 8184028 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.09420 | PercentOfTotalExpense |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | true | BadDebtExpenseReported |
| Bad Debt Expense | $5,078,038 | BadDebtExpenseAmount |
| Amount Attributable To | 940920 | AmountAttributableTo |
| Amount Reimbursed By Medicare | 31314387 | AmountReimbursedByMedicare |
| Cost Of Care Reimbursed By Medicare | 33692688 | CostOfCareReimbursedByMedicare |
| Medicare Surplus Or Shortfall | -2378301 | MedicareSurplusOrShortfall |
Costing Methodology Used CostingMethodologyUsed
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cost To Charge Ratio | X | CostToChargeRatio |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Hospital Facilities | 1 | NumberOfHospitalFacilities |
Form990 Schedule H Part V Section A Form990ScheduleHPartVSectionA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility Number | 1 | FacilityNumber |
Name Name
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Douglas Hospital Inc | BusinessNameLine1 |
Address Address
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 8954 Hospital Drive | AddressLine1 |
| City | Douglasville | City |
| State | GA | State |
| ZIP Code | 30134 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Licensed Hospital | X | LicensedHospital |
| General Medical And Surgical | X | GeneralMedicalAndSurgical |
| Er24 Hours | X | Er24Hours |
Form990 Schedule H Part V Section B Form990ScheduleHPartVSectionB
Hospital Facility Name HospitalFacilityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Douglas Hospital Inc | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital Facility Number | 1 | HospitalFacilityNumber |
Form990 Schedule H Part VI Form990ScheduleHPartVI (10 entries)
| IdentifierIdentifier | Return ReferenceReturnReference | ExplanationExplanation |
|---|---|---|
| Publication of Annual Community Benefit Report | Part I Line 6a | Douglas Hospital, Inc. is an affiliate of Wellstar Health System, Inc. which on an annual basis issues a community benefit report. This report is subsequently distributed in and around the five county service area of the health system. |
| Cost to Charge Ratio | Schedule H Part 1 Line 7 | For purposes of the IRS Form 990 Schedule H, Wellstar Health System and Affiliates (including Douglas Hospital) have estimated the current year cost to charge ratio for each hospital as it is reported in the annual community benefit report and as it will be reported in the state's Annual Hospital Financial Survey. |
| Footnote on Bad Debts and Rationale for Community Benefit | Schedule H Part III Line 4 | The following footnote is detailed in the Wellstar Health System, Inc. and Affiliates Financial Statementsrelated 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 as community benefit. |
| Medicare Shortfalls | Part III Line 8 | Douglas Hospital is a provider of inpatient and outpatient services to Medicare program beneficiaries at determined rates. Without the participation in the Medicare program these patients may not have had convenient access to those services. The Medicare shortfall on line 7 represents the uncompensated difference between the expected reimbursement and the Medicare charges for those services stated at cost. We determine a cost to charge ratio for Medicare patients as part of the annual filing of the Medicare cost report. |
| Collection Practices | Part III Sec C Line 9b | The policy written for collection practices that applies to all Wellstar Health System entities incorporates guidelines for personnel in the admissions and patient access areas to be trained in identifying patients that might qualify for financial assistance. It is also the policy of all Wellstar facilities to have at least one employee or contractor available at all times, especially in the hospitals with emergency rooms, who can provide assistance with the paperwork necessary to help patients who would qualify for governmental and other assistance programs. |
| Hospital Description | Schedule H Part V | Douglas Hospital is a general acute care hospital providing a full range of services, is licensed to operate 108 beds, and is presently staffed to operate 102 beds. It is located on an approximately 50-acre campus in Douglasville, Georgia and is housed within a complex of connected buildings which contain a total square footage of over 98,000 square feet. The original hospital was constructed in 1974 and has had several additions and improvements which represent the current structure. |
| 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 | Part VI Line 3 | Douglas Hospital provides its patients with hospital personnel or contracted personnel who are trained in all aspects of governmental programs, payments plans, charity discounts, and other financial assistance offered to assist them in their hospital bills. If the patient is eligible for federal or state assistance programs, a staff member is knowledgeable in the steps necessary to qualify those individuals. If a patient is indigent or charity eligible they will be offered assistance through the hospital's charity and indigent care policy including the state's indigent care trust fund. If the patient has no other insurance and fails to qualify for indigent care assistance, the financial counselor can then offer the patient an opportunity to accept a payment plan with discounted payment options based on their ability to pay immediately or over time. All patient are afforded these opportunities. |
| Community Information | Part VI Line 4 | Douglas Hospital is one of five hospitals that are affiliated with the parent corporation, Wellstar Health System. The primary service area of the system is located in the Northwest Georgia area and receives the majority of its patients from one of five counties (Cherokee, Cobb, Douglas, Bartow and Paulding). Generally about 85% to 90% of the patient volume comes from this service area although other health systems have a presence in the area as well. Demographically the region is one of the fastest growing in the state as well as the country and the expansion of the services for the patient population reflects a desire to offer healthcare "closer to home" since Wellstar is considered a part of a larger metropolitan Atlanta market. Economically the region is strong in per capita income but given recent trends a rise in the uninsured and indigent population has occured. |
| Affiliated Health Care System Roles | Part VI Line 7 | As stated in the Wellstar Health System, Inc and Affiliates audited financial statments for the period ended June 30, 2011, Douglas Hospital (an affiliate of Wellstar Health System, Inc.) operates as a charitable organization consistent with the requirements of Internal Revenue Code Sect 501 (c) (3) and the "community benefit standard" of IRS Ruling 69-545. In this regard the governing body of the organization and/or its parent is composed of prominent citizens in the community, medical staff privileges in the hospital are available to all qualifed physicians in the area consistent with the size and nature of the facility; the hospital operates a full-time emergency room open to all regardless of ability to pay; and the hospital provides care to the needy members of the community consistent with its charity care policy. The hospital's excess funds are genrally applied to expansion and replacement of existing facilities and equipment, amortization of indebtedness, improvement fo patient care, community benefit activities, and charity care. Douglas Hospital committed approximately $4.1 million in capital expenditures for the year to meet those needs. |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| First Class Or Charter Travel | X | FirstClassOrCharterTravel |
| Travel For Companions | X | TravelForCompanions |
| Idemnification Gross Up Payments | X | IdemnificationGrossUpPayments |
| Discretionary Spending Account | X | DiscretionarySpendingAccount |
| Housing Allowance Or Residence | X | HousingAllowanceOrResidence |
| Club Dues Or Fees | X | ClubDuesOrFees |
| Written Policy Re T And E Expenses | false | WrittenPolicyReTAndEExpenses |
| Substantiation Required | true | SubstantiationRequired |
| Compensation Committee | X | CompensationCommittee |
| Independent Consultant | X | IndependentConsultant |
| Written Employment Contract | X | WrittenEmploymentContract |
| Compensation Survey | X | CompensationSurvey |
| Board Or Committee Approval | X | BoardOrCommitteeApproval |
| Severance Payment | true | SeverancePayment |
| Supplemental Nonqual Retire Plan | true | SupplementalNonqualRetirePlan |
| Equity Based Comp Arrangement | false | EquityBasedCompArrangement |
| Comp Based On Revenue Of Filing Org | false | CompBasedOnRevenueOfFilingOrg |
| Comp Based On Revenue Related Orgs | false | CompBasedOnRevenueRelatedOrgs |
| Comp Based Net Earnings Filing Org | false | CompBasedNetEarningsFilingOrg |
| Comp Based Net Earnings Relate Orgs | false | CompBasedNetEarningsRelateOrgs |
| Any Non Fixed Payments | true | AnyNonFixedPayments |
| Initial Contract Exception | false | InitialContractException |
Form990 Schedule J Part II Form990ScheduleJPartII (38 entries)
| Base Compensation Filing OrgBaseCompensationFilingOrg | Comp Based On Related OrgsCompBasedOnRelatedOrgs | Bonus Filing OrgBonusFilingOrg | Bonus Related OrgsBonusRelatedOrgs | Other Compensation Filing OrgOtherCompensationFilingOrg | Other Compensation Related OrgsOtherCompensationRelatedOrgs | Deferred Comp Filing OrgDeferredCompFilingOrg | Deferred Comp Related OrgsDeferredCompRelatedOrgs | Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrg | Nontaxable Benefits Related OrgsNontaxableBenefitsRelatedOrgs | Total Compensation Filing OrgTotalCompensationFilingOrg | Total Compensation Related OrgsTotalCompensationRelatedOrgs | Comp Report Prior990 Filing OrgCompReportPrior990FilingOrg | Comp Report Prior990 Related OrgsCompReportPrior990RelatedOrgs |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Thomas E Gearhard | |||||||||||||
| 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 |
| Linda A Clark | |||||||||||||
| 0 | 255306 | 0 | 0 | 0 | 0 | 0 | 10595 | 0 | 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 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 |
| K 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 | |||||||||||||
| 0 | 219648 | 0 | 52762 | 0 | 10800 | 0 | 16822 | 0 | 7336 | 0 | 307368 | 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 |
| Marsha L Burke | |||||||||||||
| 0 | 190475 | 0 | 0 | 0 | 0 | 0 | 10655 | 0 | 1740 | 0 | 202870 | 0 | 0 |
| Martha Seahorn | |||||||||||||
| 157114 | 0 | 21440 | 0 | 1225 | 0 | 8111 | 0 | 6078 | 0 | 193968 | 0 | 0 | 0 |
| Margaret W Chastain | |||||||||||||
| 137564 | 0 | 11243 | 0 | 150 | 0 | 8933 | 0 | 609 | 0 | 158499 | 0 | 0 | 0 |
| Robert Mandler | |||||||||||||
| 0 | 195977 | 0 | 37704 | 0 | 29104 | 0 | 14866 | 0 | 3578 | 0 | 281229 | 0 | 0 |
| Jonathan B Morris | |||||||||||||
| 0 | 256833 | 0 | 50211 | 0 | 27150 | 0 | 18905 | 0 | 5028 | 0 | 358127 | 0 | 0 |
| MICHAEL GRAUE | |||||||||||||
| 0 | 513657 | 0 | 164927 | 0 | 12708 | 0 | 33859 | 0 | 10715 | 0 | 735866 | 0 | 0 |
| Robin Wilson MD | |||||||||||||
| 0 | 277804 | 0 | 53016 | 0 | 9200 | 0 | 14456 | 0 | 10270 | 0 | 364746 | 0 | 0 |
| ELLEN LANGFORD | |||||||||||||
| 0 | 182066 | 0 | 37877 | 0 | 8700 | 0 | 14188 | 0 | 2473 | 0 | 245304 | 0 | 0 |
| CRAIG OWENS | |||||||||||||
| 241388 | 0 | 58911 | 0 | 11395 | 0 | 17960 | 0 | 3792 | 0 | 333446 | 0 | 0 | 0 |
| Anthony M Trupiano | |||||||||||||
| 0 | 230311 | 0 | 45692 | 0 | 9300 | 0 | 16534 | 0 | 0 | 0 | 301837 | 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 |
| Robert Jansen MD | |||||||||||||
| 0 | 311389 | 0 | 48653 | 0 | 8917 | 0 | 15337 | 0 | 5028 | 0 | 389324 | 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 | |
Form990 Schedule J Part III Form990ScheduleJPartIII (4 entries)
| IdentifierIdentifier | Return ReferenceReturnReference | ExplanationExplanation |
|---|---|---|
| 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, Ron Strachan, Mary L Wesley The officers with a severance payment period of 12 months as per their agreement: Barbara Ballard, Bruce Dean, Carol Edwards, Darold Etheridge, Lee Evins, Robert Hamilton, Elizabeth Hoffmann, Beth Kost, Ellen Langford, Robert Mandler, Jonathan Morris MD, Deborah Roegge DeVita, C Brett Scullen, James Swartz, Mary L Tavernaro, Adam Thompson, 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 |
| Non-Fixed Payments to Officers | Form 990 Schedule J Part 1 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 subsequently approved 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 comparably sized 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 and growth indicators. Upon successful achievement up to various targeted levels for each factor the performance payout is recommended and approved by the board after the annual financial audit is finalized and approved. |
| Other Compensation | Form 990 Schedule J Part 1 Line 1b and 2 | While Wellstar Health System does not have a written policy regarding payment or reimbursement of the items listed in Part 1 Line 1a, the organization follows IRS guidelines in the payment of any items to individuals listed in Form 990 Part VII Section A. All of these items are added as taxable wages on the individual's W-2. |
| Compensation Exceptions | On Schedule J of Form 990 the following individuals were employed as officers with Wellstar Health System Inc. during the reporting period but did not have compensation during the calendar year for which salary and benefits totals apply: LEO E REICHERT DEBORAH ROEGGE DE VITA BETTY ANN BRAKOVICH LAURA CARAMANICA |
Schedule L IRS990ScheduleL
Form990 Schedule L Part IV Form990ScheduleLPartIV (8 entries)
| RelationshipRelationship | Amount Of TransactionAmountOfTransaction | Description Of TransactionDescriptionOfTransaction | Sharing Of RevenuesSharingOfRevenues |
|---|---|---|---|
| Pamela Etheridge | |||
| Wife of Officer | 53737 | Employee of Wellstar | |
| Greg Fortgang | |||
| Son-in-Law of Trustee | 102382 | Employee of Wellstar | |
| Amy Simone | |||
| Daughter of Officer | 72052 | Employee of Wellstar | false |
| George Fleming | |||
| Brother of Officer | 59478 | Employee of Wellstar | false |
| Greystone Power | |||
| Board Member - Pres of Co | 739493 | Electric Services | false |
| Bonnie Miller | |||
| Wife of Board Member | 28417 | Employee of Wellstar | false |
| Matthew Maddox | |||
| Son of Board Member | 38489 | Employee of Wellstar | false |
| Greg Separk | |||
| Son of Board Member | 25847 | Employee of Wellstar | false |
Form990 Schedule L Part V Form990ScheduleLPartV
| Field | Value | IRS element (for citing) |
|---|---|---|
| Identifier | Business Transactions with Interested Parties | Identifier |
| Return Reference | Form 990 Sch L Part | ReturnReference |
| Explanation | The business transactions listed on Schedule L Part IV are for interested parties (family members) of either a trustee or officer of Douglas Hospital or a related organization. All transaction with the exception of Greystone Power are for employment services with Wellstar Health System and its Affiliates. The transaction with Greystone Power is for utility services provided to Douglas Hospital by a company whose CEO is also a trustee of Wellstar Health System | Explanation |
Schedule O IRS990ScheduleO
General Explanation GeneralExplanation (53 entries)
| IdentifierIdentifier | Return ReferenceReturnReference | ExplanationExplanation |
|---|---|---|
| Filing of 990 T | Part V Line 3 a & b | Douglas Hospital, Inc. has elected to file a blank 990-T for the reporting period as there is no known unrelated business income. However in the event a subsequent disclosure of any unrelated business income is made we will amend the currently filed return. |
| Conflict of Interest Policy | Form 990 Part VI Section B Line 12 | 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 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 annually. Compliance verifies that the Survey and Attestation is distributed to these persons. Compliance verifies that these persons return a fully completed and signed Survey and Attestation. Compliance reviews each completed and signed Survey and Attestation to identify all conflicts listed in the document. All conflicts, potential conflicts and incidences of non-compliance are referred to the Chief Compliance Officer. The CCO takes appropriate action to completely resolve all identified conflicts and incidences of non-compliance. |
| Process for Determining Compensation for Top Execs | Form 990 Part VI Section B Line 15 | 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 Randall Bentley Ex Officio CEO Ex Officio In committtee discussions about the compensation for the Chief Executive Officer, the CEO will recuse himself from that process but is a non-voting committee member for discussions on all other officers. The executive compensation philosophy empowers the committee to oversee the executive compensation process and administer the executive compensation program on behalf of the full board of trustee of Wellstar; provided, however, the full Board of Trustees evaluates and approves the compensation of the Chief Executive Officer. The philosophy requires annual disclosure of the committee's actions and decisions to the full board, which it has done. The committee is guided by the board-approved philosophy. Overall, the philosophy is intended to reward for organizational and individual performance. When performance is at a predetermined targeted level, the compensation is intended to be at or around the median of compensation paid to similar positions at similar organizations (the "market"). Wellstar's executive compensation philosophy defines the market as being comprised of comparable not-for-profit health care delivery systems, i.e., not-for-profit organizations similar in complexity and scale to Wellstar. To assist the committee in fulfilling its duties, the committee engaged the Hay Group to provide market compensation data to compare to the Wellstar positions whose compensation the committee oversees. The committee uses this data to provide context when making decisions in administering the compensation program. Accurate minutes of the committee's discussion and decisions are recorded during each committee meeting, and reviewed and approved at the following committee meeting. |
| Process for Public Disclosure of Important 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 for charitable organizations. 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. |
| Audited Financial Statements | Form 990 Part IV Line 12 | Douglas 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 Reporting | Form 990 Part IV Line 24a | 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). Douglas Hospital, Inc. will report this tax exempt bond liability on Part X, Line 25 Other Liabilities. |
| Current Officers/Directors Relationships | Form 990 Part VI Section A Line 2 | Two of the current officers and trustees for Wellstar Health System, Inc. --EIN 58-1649541 are related to each other through family. Gregory Simone, President and CEO is the brother-in-law of Lou Little, Sr VP Post Acute Services and Administrator of Windy Hill Hospital. |
| Organizational 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 holds certain powers of elections 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 and Schedule J | 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. |
| Compensation | Schedule J, Part II | 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). |
| 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. |
| Bylaws Changes | Form 990, Part VI, Line 4 | In November 2010 the bylaws of Wellstar Health System, Inc. were amended to state that benefits would be provided for trustees upon their retirement from the Board. |
| Changes in Net Assets | Form 990 Part XI Line 5 | For the reporting period Douglas Hospital, Inc. had a change in net assets of ($11,849,530) 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:Thomas E Gearhard 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 & Acting CEO 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 & Gen Counsel HOURS:50 |
| HOURS DEVOTED FOR RELATED ORGANIZATION | FORM 990 PART VII | NAME:David 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 & Medical 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 & 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:K. 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 Chief Med Officer HOURS:50 |
| HOURS DEVOTED FOR RELATED ORGANIZATION | FORM 990 PART VII | NAME:Louis W. Little TITLE:Sr VP Post Acute Srv & Admin HOURS:50 |
| HOURS DEVOTED FOR RELATED ORGANIZATION | FORM 990 PART VII | NAME:Kimberly W. Menefee TITLE:Sr VP Public & Govt Affairs HOURS:50 |
| HOURS DEVOTED FOR RELATED ORGANIZATION | FORM 990 PART VII | NAME:Ronald J Strachan TITLE:Sr VP Chief Info Officer 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:MICHAEL GRAUE TITLE:EXEC VP COO HOURS:50 |
| HOURS DEVOTED FOR RELATED ORGANIZATION | FORM 990 PART VII | NAME:Robin Wilson MD TITLE:VP Medical Management HOURS:50 |
| HOURS DEVOTED FOR RELATED ORGANIZATION | FORM 990 PART VII | NAME:ELLEN LANGFORD TITLE:VP & COO MED GROUP 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: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 & Anaysis HOURS:50 |
| HOURS DEVOTED FOR RELATED ORGANIZATION | FORM 990 PART VII | NAME:Richard T Lopes, MD TITLE:Sr VP & Pres Wellstar Phy Grp HOURS:50 |
| HOURS DEVOTED FOR RELATED ORGANIZATION | FORM 990 PART VII | NAME:James M Swartz TITLE:VP Accounting HOURS:50 |
| HOURS DEVOTED FOR RELATED ORGANIZATION | FORM 990 PART VII | NAME:Mary L Wesley TITLE:Sr VP Nursing Srvcs & CNE HOURS:50 |
| HOURS DEVOTED FOR RELATED ORGANIZATION | FORM 990 PART VII | NAME:Barbara Ballard TITLE:VP Homecare and Hospice HOURS:50 |
| HOURS DEVOTED FOR RELATED ORGANIZATION | FORM 990 PART VII | NAME:Robert Jansen, MD TITLE:VP Medical Affairs HOURS:50 |
| HOURS DEVOTED FOR RELATED ORGANIZATION | FORM 990 PART VII | NAME:Beth Kost TITLE:VP Compliance/Chief Privacy Of 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:C Brett Scullen TITLE:VP Pulmonology Operations HOURS:50 |
| HOURS DEVOTED FOR RELATED ORGANIZATION | FORM 990 PART VII | NAME:Adam C Thompson TITLE:VP Surgery HOURS:50 |
| HOURS DEVOTED FOR RELATED ORGANIZATION | FORM 990 PART VII | NAME:Leo E Reichert TITLE:Exec VP General Counsel HOURS:50 |
| HOURS DEVOTED FOR RELATED ORGANIZATION | FORM 990 PART VII | NAME:Deborah DeVita Roegge TITLE:VP Women's and Newborn Srvs HOURS:50 |
| HOURS DEVOTED FOR RELATED ORGANIZATION | FORM 990 PART VII | NAME:Linda A Clark TITLE:Exec VP and COO HOURS:1 |
| HOURS DEVOTED FOR RELATED ORGANIZATION | FORM 990 PART VII | NAME:Bruce Harrison TITLE:Sr VP and CAO Phys Group HOURS:1 |
| HOURS DEVOTED FOR RELATED ORGANIZATION | FORM 990 PART VII | NAME:Marsha L. Burke TITLE:Former Exec VP & CFO HOURS:1 |
Schedule R IRS990ScheduleR
Form990 Schedule R Part II Form990ScheduleRPartII (6 entries)
| Address Line1AddressUS/AddressLine1 | CityAddressUS/City | StateAddressUS/State | ZIP CodeAddressUS/ZIPCode | EINEIN | Primary ActivitiesPrimaryActivities | Legal Domicile StateLegalDomicileState | Exempt Code SectionExemptCodeSection | Public Charity StatusPublicCharityStatus | Business Name Line1DirectControllingEntityName/BusinessNameLine1 | Controlled OrgControlledOrg |
|---|---|---|---|---|---|---|---|---|---|---|
| CHS Foundation | ||||||||||
| 805 Sandy Plains Road | Marietta | GA | 30066 | 581649540 | Foundation | GA | 501 (c) (3) | 11 | WHS | true |
| Cobb Hospital Inc | ||||||||||
| 805 Sandy Plains Road | Marietta | GA | 30066 | 580968382 | Healthcare | GA | 501 (c) (3) | 3 | WHS | true |
| Kennestone Hospital Inc | ||||||||||
| 805 Sandy Plains Road | Marietta | GA | 30066 | 582032904 | Healthcare | GA | 501 (c) (3) | 3 | WHS | true |
| Paulding Medical Center Inc | ||||||||||
| 805 Sandy Plains Road | Marietta | GA | 30066 | 582095884 | Healthcare | GA | 501 (c) (3) | 3 | WHS | true |
| Wellstar Foundation | ||||||||||
| 805 Sandy Plains Road | Marietta | GA | 30066 | 581627413 | Foundation | GA | 501 (c) (3) | 11 | WHS | true |
| Wellstar Health System | ||||||||||
| 805 Sandy Plains Road | Marietta | GA | 30066 | 581649541 | Healthcare | GA | 501 (c) (3) | 11 | NA | false |
Form990 Schedule R Part III Form990ScheduleRPartIII (2 entries)
| Address Line1AddressUS/AddressLine1 | CityAddressUS/City | StateAddressUS/State | ZIP CodeAddressUS/ZIPCode | EINEIN | Primary ActivityPrimaryActivity | Legal Domicile StateLegalDomicileState | Business Name Line1DirectControllingEntityName/BusinessNameLine1 | Predominant Income TypePredominantIncomeType | Share Of Total IncomeShareOfTotalIncome | Share Of EOY AssetsShareOfEOYAssets | Disproportionate AllocationsDisproportionateAllocations | General Or Managing PartnerGeneralOrManagingPartner |
|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 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 |
Form990 Schedule R Part IV Form990ScheduleRPartIV
Name Of Related Org NameOfRelatedOrg
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Community Assurance Co | BusinessNameLine1 |
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 805 Sandy Plains Road | AddressLine1 |
| City | Marietta | City |
| State | GA | State |
| ZIP Code | 300666340 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 581649541 | EIN |
| Primary Activity | Insurance | PrimaryActivity |
| Legal Domicile Foreign Country | CJ | LegalDomicileForeignCountry |
Direct Controlling Entity Name DirectControllingEntityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | WHS Inc | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Type Of Entity | C | TypeOfEntity |
| Share Of EOY Assets | 58594426 | ShareOfEOYAssets |
| Percentage Ownership | 1.00000 | PercentageOwnership |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Ann Rents Royalties | false | ReceiptOfIntAnnRentsRoyalties |
| Gift Grant Or Cap Contr To Other Org | false | GiftGrantOrCapContrToOtherOrg |
| Gift Grant Or Cap Contr Fr Other Org | false | GiftGrantOrCapContrFrOtherOrg |
| Loans Or Guarantees To Other Org | false | LoansOrGuaranteesToOtherOrg |
| Loans Or Guarantees From Other Org | false | LoansOrGuaranteesFromOtherOrg |
| Sale Of Assets To Other Org | false | SaleOfAssetsToOtherOrg |
| Purchase Of Assets From Other Org | false | PurchaseOfAssetsFromOtherOrg |
| Exchange Of Assets | false | ExchangeOfAssets |
| Rental Of Facilities To Other Orgs | false | RentalOfFacilitiesToOtherOrgs |
| Rental Of Facilities Fr Other Orgs | false | RentalOfFacilitiesFrOtherOrgs |
| Perform Of Services For Other Orgs | false | PerformOfServicesForOtherOrgs |
| Perform Of Services By Other Orgs | false | PerformOfServicesByOtherOrgs |
| Sharing Of Facilities | false | SharingOfFacilities |
| Sharing Of Paid Employees | false | SharingOfPaidEmployees |
| Reimbursement Paid To Other Org | false | ReimbursementPaidToOtherOrg |
| Reimbursement Paid By Other Org | false | ReimbursementPaidByOtherOrg |
| Other Transfer To Other Org | false | OtherTransferToOtherOrg |
| Other Transfer From Other Org | false | OtherTransferFromOtherOrg |