2011-05-16T16:26:06-05:00 2010-06-30 PricewaterhouseCoopers LLP 2001 MARKET ST SUITE 1700 PHILADELPHIA PA 19103 990 2009-07-01 582026750 DOUGLAS HOSPITAL INC DOUG 7707925023 805 Sandy Plains Road Marietta GA 300666340 JAMES M SWARTZ 2011-05-16 true 2673303000 2009 2016-02-24 21:20:13Z A JAMES BUDZINSKI 805 Sandy Plains Road Marietta GA 300666340 170195799 false X www.wellstar.org X 1992 GA To provide world class charitable healthcare to the community 18 14 777 100 0 0 0 0 111595641 117086651 -1281892 3090172 868806 1037909 111182555 121214732 0 0 0 0 34893580 40571998 0 0 0 67486340 71803866 102379920 112375864 8802635 8838868 103250816 109077912 52978838 58175975 50271978 50901937 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 100662697 117096651 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 $1.9 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, 2010: Adult Discharges 6,329 Med & Surgical Short Stay Days 1,679 Emergency Room Visits 53,487 Outpatient Surgical Cases 4,475 Inpatient Surgical Cases 1,344 Outpatient Procedures Non-ED OP Radiology 45,011 GI Laboratory 1,385 Total FTEs Paid 576 Community Benefit Reporting Community Outreach $ 437,885 incl system generated allocated benefits Unreimbursed Charity Care (at cost) $4,176,502 Medicaid Shortfalls (at cost) $1,786,789 Total $6,401,176 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). 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 program has grown system-wide more than 43% in the last five or six years. This expansion 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 eleven in the Top 100 Integrated Healthcare Network as published by SDI. It is also the highest ranked integrated networks 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 third 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. Douglas exceeded 700 days without a case of ventilator-associated pneumonia (VAP) and central line associated bloodstream infections (CLBSI). Cleverly & Associates, a leading healthcare financial consulting firm, recognized Douglas Hospital as a "Five Star" hospital in their annual Top 100 Community Value Hospitals in the US in 2009. Wellstar Cobb, Douglas & Kennestone Hospitals each received the American College of Cardiology Foundation Action Registry Gold Performance Achievement Award for 2009. The hospitals were three of only 121 hospitals nationwide to do so. The award recognizes Wellstar's commitment and success in implementing a higher standard of care for heart attack patients. 100662697 true false false false false false false false false true false true false false false false false false false false true false false true false false false false false false true false false false false false false true true false false true 0 0 777 true false false false false false false false false false 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 7707925393 805 SANDY PLAINS ROAD Marietta GA 300666340 Randall Bentley 1.0 X 0 16471 0 Robert N Cross MD 1.0 X 0 4767 0 T E Durham 1.0 X 0 34715 2135 Thomas E Gearhard 1.0 X 0 320690 31087 David Hafner MD 1.0 X 0 15651 0 Charles J Jones 1.0 X 0 12635 0 Connie Kirk 1.0 X 0 4195 0 Janie Maddox 1.0 X 0 4884 0 Gary A Miller 1.0 X 0 2609 0 Steven W Oweida MD 1.0 X 0 17488 0 Tom Phillips 1.0 X 0 2774 0 Walter G Robinson 1.0 X 0 3372 0 Ronald P Roper MD 1.0 X 0 9713 0 W Allen Separk 1.0 X 0 7230 0 Kessel D Stelling 1.0 X 0 1252 0 Jeffrey Tharp MD 1.0 X 0 374975 32823 Ken Thigpen 1.0 X 0 10151 0 Robert G Warner MD 1.0 X 0 3581 0 Charles Pete Wood 1.0 X 0 12025 0 A James Budzinski 2.0 X 0 542322 42617 Gregory L Simone MD 2.0 X 0 1127407 76939 Bonnie Wilson 2.0 X 0 564617 45500 David Anderson 2.0 X 0 500879 38389 Donald Campbell MD 2.0 X 0 392181 31906 Barbara B Corey 2.0 X 0 354487 28277 Bruce Dean 2.0 X 0 231199 23450 Marcia Delk MD 2.0 X 0 420898 41645 K Darold Etheridge 2.0 X 0 257321 24944 Lee Evins 2.0 X 0 237160 22440 Mark Haney 2.0 X 0 348007 32214 Patrick M Jansen 2.0 X 0 233543 19687 Christopher M Kane 2.0 X 0 361179 32046 Kenneth C Kunze MD 2.0 X 0 497872 35952 Louis W Little 2.0 X 0 290248 31176 Kimberly W Menefee 2.0 X 0 322123 28095 Ronald J Strachan 2.0 X 0 398320 34634 Robert Mandler 2.0 X 0 235075 21295 Jonathan B Morris 2.0 X 0 148980 12644 MICHAEL GRAUE 2.0 X 0 658068 49874 Robin Wilson MD 2.0 X 0 154726 13389 ELLEN LANGFORD 2.0 X 0 188974 17817 CRAIG OWENS 50.0 X 221639 0 18157 Anthony M Trupiano 2.0 X 0 233753 17874 Joseph L Brywczynski 2.0 X 0 0 0 Elizabeth A Hoffmann 2.0 X 0 0 0 Richard T Lopes MD 2.0 X 0 0 0 James M Swartz 2.0 X 0 0 0 Mary L Wesley 2.0 X 0 0 0 Martha Seahorn 50.0 X 171728 0 14486 Margaret W Chastain 50.0 X 143436 0 12048 Rosalyn H Cranford 50.0 X 128816 0 37063 Steven W Harris 50.0 X 120036 0 14037 Peggy Tyndall 50.0 X 123776 0 14848 Linda A Clark 1.0 X 0 402300 24741 Bruce Harrison 1.0 X 0 378334 34449 Nancy Kemp 1.0 X 0 226912 13955 Teresa M Rae 1.0 X 0 322133 19811 Andrew W Tatnall 1.0 X 0 187893 11548 Marsha L Burke 1.0 X 0 550796 43614 909431 11626885 1047606 29 true true false Batchelor Kimball PO Box 70 LITHONIA GA 30058 Maintenance 701222 Cork-Howard Construction 2121 New Market Parkway Suite 118 MARIETTA GA 30067 General Contractor 325699 RCC Marietta PO Box 101518 ATLANTA GA 303921518 Medical 952668 Quest Diagnostics PO Box 740736 ATLANTA GA 303740736 Medical Lab 290907 Progressive Transcription Services PO Box 1357 BLUERIDGE GA 30513 Transcription 200578 13 0 HOSPITAL PATIENT REVENUE 621990 117086625 117086625 MEDICAL RECORDS REVENUE 621990 26 26 117086651 1344566 1344566 0 0 204089 204089 204089 204089 50726673 48981067 1745606 1745606 1745606 0 0 0 GROUND LEASE REVENUE 79403 79403 CAFETERIA SALES 406291 406291 LACTATION/IMMUNIZATIONS 30818 30818 317308 317308 833820 121214732 117086651 0 4128081 0 0 0 0 252447 225612 26835 0 32701978 29225798 3476180 0 2489950 2225269 264681 0 2716716 2427930 288786 0 2410907 2154627 256280 0 0 0 0 0 0 0 1852498 1835727 16771 0 620 620 0 0 12158989 11626828 532161 0 0 0 1576993 327213 1249780 0 30903 22428 8475 0 0 27061 17564 9497 0 64071 0 64071 0 20134939 18030112 2104827 5427793 2961701 2466092 0 775945 0 775945 0 REPAIRS & MAINT 1471539 1298753 172786 BAD DEBT 28282102 28282102 OTHER OPERATING EXPENSE 413 413 112375864 100662697 11713167 0 2150 2150 4283092 3356412 13031096 12584352 1565884 1867831 1004457 1718772 102264340 57659004 47200436 44605336 32486656 40553709 3677045 4389350 103250816 109077912 8406361 10109567 5385922 5109211 39186555 42957197 52978838 58175975 X 50271978 50901937 50271978 50901937 103250816 109077912 X false true true X false X 59570 59570 41212192 17041511 24170681 846414 450217 396197 59461016 40167275 19293741 685147 685147 44605336 0 ACCRUED PENSION LIABILITY 10553396 INSURANCE RESERVE 858551 UNCLAIMED PROPERTY 77126 ASSET RETIREMENT OBLIGATION LT 570873 OTHER LONG TERM LIABILITIES 1726689 TAX EXEMPT BOND LIAB-DUE TO WHS 29170562 42957197 SCHEDULE D PART X, LINE 2 FIN 48 FOOTNOTE The following footnote is related to the organization's application of FIN 48 (ASC 740). "Wellstar (including Douglas Hospital) and all but one of its affiliates have been recognized as exempt from Federal income tax under Internal Revenue Code Section 501 (a) as organizations described in Section 501 (c)(3) and, therefore, related income is generally not subject to Federal or state income taxes. 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." true true true true X true true true false true true 4176502 4176502 0.05030 11335976 9549187 1786789 0.02150 15512478 9549187 5963291 0.07180 292859 292859 0.00350 292859 292859 0.00350 15805337 9549187 6256150 0.07530 true 7136191 85167 29745701 31519244 -1773543 X true true Douglas Hospital Inc

8954 Hospital Drive Douglasville GA 30134

X X X 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 areas of the health system. Wellstar Health System (including Douglas Hospital) has elected to use the cost to charge ratio from our FY2009 Hospital Financial Survey filed with the state of Georgia. This cost to charge ratio reconciles with the community benefit reporting done both internally in the system and with our annual published community benefit report which is distributed to the Wellstar service areas as well as reported to the Georgia Hospital Association. The percent of net community benefit expense to the total expense for the hospital ($328,236,934 from Form 990 Part IX line 25) is the calculation of Sch H Part 1 Line 7 column (f). For purposes of calculating this ratio we subtract the amount of bad debt expense ($28,282,102) from the total expense in order to determine the percentage for the amount in column (f) The footnote to the Wellstar Health System and Affiliates' financial statments describes net patient service revenue as: " Net patient service revenue is reported at the estimated net realizable amounts from patients, third-party payors, and others for services rendered". While this footnote does not specifically describe bad debts, it can be implied that those accounts written off to bad debt have been deemed unrealizable for collection by the organization. In estimating the bad debt amounts to be counted as community benefit for this reporting period we considered that some patient accounts were classified as bad debt and subsequently determined to have qualified for charity or indigent care adjustments. This determination can occur due to inadequate information being available at the time the services were provided as well as throughout the collection cycle as the patient's financial status may periodically change. Wellstar has participated in the Section 1011 program for undocumented aliens and determined that while a portion of the patients that are eligible to be paid from the program exist, there is another portion who are not eligible because they did not provide the necessary documentation to qualify. Those patients and others in similar circumstances which subsequently became bad debt accounts would have qualified under the organization's charity care policy had they furnished the necessary information to be considered. While this portion of the patient population may be small we have made a determination that 1.2% of the bad debt expense (at cost) is attributable to charity care and community benefit. Generally speaking, however, Wellstar (and Douglas Hospital) does not treat bad debt as uncompensated care. 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 or possibly access at all. The Medicare shortfall on line 7 represents the uncompensated difference between the expected reimbursement and the Medicare charges for those services stated at cost. The costing methodology to determine the amount listed on line 6 ($31,519,244) for allowable costs is basically a cost to charge ratio determined from the annual Medicare cost report. 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 charity care or other 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 in the paperwork necessary to qualify for charity care or governmental assistance programs. 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. -- 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 priortize 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 activites, 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. Douglas Hospital provides its patients with hospital personnel who are trained in all of the uncompensation program requirements, payment plans, charity discounts, and other programs offered to assist them in paying their bills. This includes at least one financial counselor in the emergency room on duty at all times. These financial counselors are well versed in the eligibility for Medicare and Medicaid if applicable for the patient (including in some instances SSI Disability through the Medicare program). If a patient is pregnant and presents for service without insurance or other government assistance, the counselors can assist the patient in obtaining Medicaid (based on the income level) regardless of the patient's citizenship. If the 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 (set aside for that exact purpose). If the patient has no other insurance and fails to qualify for indigent care 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 patients are afforded these opportunities. 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 and is expected to receive the majority of its patients from one of the following counties in Georgia--Bartow, Cherokee, Cobb, Douglas and Paulding--generally about 85% to 90%. While these five counties are in the metropolitan Atlanta area (or border on the metro area) they are in some of the fastest growing areas in the entire country. The system has therefore expanded to bring many services to the geographic area that previously were not available except in the Atlanta community. Economically the region is strong in per capita income but as in many areas of the country the system has seen an increase in the unemployment numbers and thus an increase in the uninsured and indigent population for the patients it serves. As stated in the Wellstar Health System and Affiliates Audited Financial Statements for the period ending June 30,2010, Douglas Hosptial (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 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; and 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 $1.9 million in capital expenditures for the year to meet technology and program needs of the community it serves. 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 0 277416 0 0 0 43274 0 24774 0 6313 0 351777 0 0 Jeffrey Tharp MD 0 252457 0 0 0 122518 0 28132 0 4691 0 407798 0 0 A James Budzinski 0 420659 0 108651 0 13012 0 38425 0 4192 0 584939 0 0 Linda A Clark 0 402300 0 0 0 0 0 24741 0 0 0 427041 0 0 Gregory L Simone MD 0 809466 0 302279 0 15662 0 73802 0 3137 0 1204346 0 0 Bonnie Wilson 0 417321 0 134446 0 12850 0 39687 0 5813 0 610117 0 0 David Anderson 0 368147 0 120049 0 12683 0 35424 0 2965 0 539268 0 0 Donald Campbell MD 0 295414 0 85967 0 10800 0 28784 0 3122 0 424087 0 0 Barbara B Corey 0 263238 0 80299 0 10950 0 26777 0 1500 0 382764 0 0 Bruce Dean 0 191680 0 30424 0 9095 0 18417 0 5033 0 254649 0 0 Marcia Delk MD 0 316598 0 92972 0 11328 0 31275 0 10370 0 462543 0 0 K Darold Etheridge 0 186959 0 55161 0 15201 0 20084 0 4860 0 282265 0 0 Lee Evins 0 171405 0 39268 0 26487 0 18665 0 3775 0 259600 0 0 Mark Haney 0 242031 0 91501 0 14475 0 26541 0 5673 0 380221 0 0 Bruce Harrison 0 278872 0 87392 0 12070 0 28459 0 5990 0 412783 0 0 Patrick M Jansen 0 178558 0 27979 0 27006 0 18097 0 1590 0 253230 0 0 Christopher M Kane 0 288428 0 60926 0 11825 0 27233 0 4813 0 393225 0 0 Nancy Kemp 0 166656 0 11166 0 49090 0 13955 0 0 0 240867 0 0 Kenneth C Kunze MD 0 405444 0 80238 0 12190 0 35410 0 542 0 533824 0 0 Louis W Little 0 210372 0 68687 0 11189 0 23133 0 8043 0 321424 0 0 Kimberly W Menefee 0 235766 0 74822 0 11535 0 24820 0 3275 0 350218 0 0 Teresa M Rae 0 218400 0 18610 0 85123 0 19811 0 0 0 341944 0 0 Ronald J Strachan 0 270123 0 57603 0 70594 0 28407 0 6227 0 432954 0 0 Andrew W Tatnall 0 147670 0 11584 0 28639 0 11548 0 0 0 199441 0 0 Marsha L Burke 0 550796 0 0 0 0 0 39033 0 4581 0 594410 0 0 Martha Seahorn 151520 0 19008 0 1200 0 11211 0 3275 0 186214 0 0 0 Margaret W Chastain 132117 0 11319 0 0 0 11464 0 584 0 155484 0 0 0 Rosalyn H Cranford 119577 0 0 0 9239 0 33617 0 3446 0 165879 0 0 0 Robert Mandler 0 183917 0 27811 0 23347 0 18020 0 3275 0 256370 0 0 Jonathan B Morris 0 116750 0 25000 0 7230 0 11056 0 1588 0 161624 0 0 MICHAEL GRAUE 0 492184 0 88589 0 77295 0 45369 0 4505 0 707942 0 0 Robin Wilson MD 0 120878 0 0 0 33848 0 9717 0 3672 0 168115 0 0 ELLEN LANGFORD 0 153885 0 26364 0 8725 0 15558 0 2259 0 206791 0 0 CRAIG OWENS 154421 0 0 0 67218 0 16396 0 1761 0 239796 0 0 0 Anthony M Trupiano 0 185075 0 11541 0 37137 0 17874 0 0 0 251627 0 0 Severance Benefits Schedule J PURSUANT TO THEIR RESPECTIVE EMPLOYMENT AGREEMENTS, THE FOLLOWING OFFICERS ARE ENTITLED TO SERVERANCE PAYMENTS BASED ON THEIR BASE SALARY AND WAGES AT THAT TIME IN THE EVENT OF CERTAIN IDENTIFIED CIRCUMSTANCES. OFFICER SEVERENCE BENEFIT PERIOD DAVID W. ANDERSON 24 MONTHS DONALD H. CAMPBELL 18 MONTHS LINDA C. CLARK 24 MONTHS RANDY COOK 12 MONTHS BARBARA B. COREY 18 MONTHS MARCIA L. DELK, M.D. 18 MONTHS DAROLD ETHERIDGE 12 MONTHS LEE EVINS 12 MONTHS T. MARK HANEY 18 MONTHS BRUCE HARRISON 12 MONTHS NANCY KEMP 12 MONTHS JOHN LAW 12 MONTHS LOU LITTLE 18 MONTHS KIMBERLY W. MENEFEE 18 MONTHS TAREY RAY 18 MONTHS ANDY TATNALL 18 MONTHS LEIGH COX 12 MONTHS BONNIE L. WILSON 24 MONTHS MARSHA BURKE 24 MONTHS GREGORY L. SIMONE 24 MONTHS CHRISTOPHER KANE 18 MONTHS RON STRACHAN 12 MONTHS CANDICE SAUNDERS 18 MONTHS JIM BUDZINSKI 18 MONTHS MIKE GRAUE 18 MONTHS ROBERT HAMILTON 12 MONTHS ROBERT JANSEN 12 MONTHS ELLEN LANGFORD 12 MONTHS KENNETH KUNZE, MD 18 MONTHS ROBERT MANDLER 12 MONTHS JONATHAN MORRIS 12 MONTHS ANTHONY TRUPIANO 12 MONTHS ROBIN WILSON, MD 12 MONTHS JOSEPH BRYWCZYNSKI 18 MONTHS ELIZABETH HOFFMANN 12 MONTHS RICHARD LOPES, MD 18 MONTHS JAMES SWARTZ 12 MONTHS MARY WESLEY 18 MONTHS During the year, the following individuals received a payout in the amounts listed in accordance with their severance agreements as set forth above: MARSHA BURKE $550,796 LINDA CLARK $402,300 LEIGH COX $ 34,560 NANCY KEMP $226,912 TERESA RAY $322,133 BRUCE HARRISON $141,995 ANDREW TATNALL $187,892 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 2009 for which salary and benefits totals apply: Joseph L Brywczynski Elizabeth A Hoffmann Richard T Lopes, MD James M Swartz Mary L Wesley Pamela Etheridge Wife of Officer 51723 Employee of Wellstar false Greg Fortgang Son-in-Law of Trustee 86813 Employee of Wellstar false Amy Simone Daughter of Officer 88061 Employee of Wellstar false George Fleming Brother of Officer 56575 Employee of Wellstar false Greystone Power Board Member - Pres of Co 721298 Electric Services false Bonnie Miller Wife of Board Member 26996 Employee of Wellstar false Matthew Maddox Son of Board Member 36500 Employee of Wellstar false 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: Kessel Stelling Chair Pete Wood Janie Maddox Al Separk Board Chairman 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. was audited for the reporting period ended June 30, 2010 as part of the consolidated financial statement audit of the Wellstar Health System, Inc. and Affiliates. 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. Douglas Hospital, Inc. has also restated its beginning balance sheet with respect to tax exempt bond liabilities as the amounts allocated to tax exempt bond liabilities are now included on Line 25. Current Officers/Directors Relationships Form 990 Part 6 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. This reviewed form is then made available to both the organization's Finance committee of the Board of Trustees as well as the full board in the form of an electronic (pdf. format) version and hard copy of the return. The organization's CFO subsequently signs the return for either manual or electronic filing by the appropriate due date. Bylaws Changes Form 990, Part VI, Line 4 On June 17, 2010, Wellstar Health System and its affiliates amended its bylaws to address the manner of election and terms of office for members of the Board of Trustees. The Chair appoints a Governance Committee consisting of three (3) or more Trustees for purposes of recommeding nominations. Nominations are voted upon by the full Board and each new Trustee is appointed to serve terms of three years, although the Board can establish a shorter term at the time of election. Each Trustee may serve a "term limit" of not more than four (4) consecutive terms of three years. To provide continuity on the Board, there is established a methodology of rotation off the Board for the 18 existing Trustees effective June 30, 2010. One Trustee will rotate off the Board in year one; two Trustees will rotate off the Board in year two; one Trustee will rotate off the Board in year three; and continuing for all remaining positions until all Trustees have expired terms or elect to leave the Board. At the end of the "term limit" the Trustee may be re-elected after a one year absence. 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