2011-05-16T16:22:58-05:00 2010-06-30 PricewaterhouseCoopers LLP 2001 MARKET ST SUITE 1700 PHILADELPHIA PA 19103 990 2009-07-01 580968382 COBB HOSPITAL INC COBB 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 516452745 false X www.wellstar.org X 1984 GA To provide world-class charitable healthcare to the community 18 14 2615 200 0 0 0 0 341890379 364184219 -3734742 8787865 4104469 4181245 342260106 377153329 0 0 0 0 121633094 132712984 0 0 0 212216401 213852673 333849495 346565657 8410611 30587672 365362133 393363223 149978621 162688578 215383512 230674645 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 312472213 364184219 As discussed herein, Cobb Hospital, Inc (an affiliate of Wellstar Health System, Inc.) operates as a charitable organization consistent with the requirements of Internal Revenue Code Section 501 (c) (3) and the "community benefit standard" of IRS Revenue Ruling 69-545. In this regard, the governing body of the organization and/or its parent is composed of prominent citizens in the community, medical staff privileges in the hospital are available to all qualified physicians in the area consistent with the size and nature of the facility; the hospital operates a full-time emergency room open to all regardless of ability to pay; the hospital provides care to the needy members of the community consistent with its charity care policy regardless of their ability to pay for these services. The hospital's excess funds are generally applied to expansion and replacement of existing facilities and equipment, amortization of indebtedness, improvement of patient care, community benefits activity, and charity care. Cobb Hospital reinvested a total of approximately $7.0 million in capital expenditures for equipment upgrades and other capital improvements to better serve the community. Cobb Hospital was organized in 1984. The hospital affiliated with the Northwest Georgia Health System in 1993. In 1994, Northwest Georgia Health System helped form the PROMINA Health System and changed its name to Promina Northwest Health System. In 1998 Promina Northwest changed its name to Wellstar Health System and is now totally independent of Promina. Cobb Hospital is subordinate to, and subject to the authority of Wellstar Health System and its governing boards including the Hospital Authority of Cobb County. Cobb Hospital provides a full range of inpatient and outpatient services characteristic of a community hospital. The hospital is licensed to operate 382 beds and is presently staffed to operate 366 beds. The original hospital was constucted in 1968 and several major structural additions have happened since that time. The following stats constitute the overall program services provided during the reporting period ended June 30, 2010: Adult Discharges 22,328 Med/Surg Short Stay Days 4,293 Emergency Room Visits (incl pediatric ER) 92,353 Outpatient Surgical Cases 7,774 Inpatient Surgical Cases 4,047 Outpatient Procedures Non-ED OP Radiology 72,943 GI Laboratory 1,522 Total FTEs (paid) 1,903 Community Benefit Reporting Community Outreach (incl system-wide alloc) $1,350,341 Unreimbursed Charity Care (at cost) $14,600,927 Medicaid Shortfalls (at cost) $10,884,335 Total $26,835,603 The Georgia Hospital Association has estimated that Cobb Hospital has had an economic impact of approximately $743 million and is responsible for creating over 4,500 jobs for the local and state economy. As an affiliate of Wellstar Health System, Cobb Hospital participates in many community and educational programs for the overall health and benefit of the area that they serve. Some examples of those programs are: Community Health/Education--screenings and educational opportunities such as denfensive driving for teens (offered at a minimal cost or at no cost), smoking cessation, heart smart school, CPR and others. System-wide over 200,000 residents from the community participated in these various screenings. The Public Relations department notifies the public of these offerings by publishing a quarterly mailer to community residents which costs the system over $100,000. Community Activities--sponsors blood drives, provides funding to school health programs for medical and dental preventive care. Community Events--Wellstar has an annual day for the Latino community geared at screenings and educational activities on a variety of health issues specifically for the Hispanic community. Wellstar Cobb Hospital had the most blood donors in a year for a hospital its size (over 1000+ employees)as recognized by the American Red Cross. These blood drives help not only patients but provide the system with significant cost savings in blood supplies. On an more international scale Wellstar Cobb, Kennestone, and Windy Hill Hospitals played a supportive role in the disaster relief related to the January 2010 earthquake in Haiti. Food, water, shelter and medical assistance were needs that Wellstar helped provide to the residents of Haiti. Several Wellstar physicians went directly to the devastated area to provide onsite medical assistance. Additionally several Haitian victims were airlifted and received medical help at Wellstar Cobb, Kennestone and Windy Hill Hospitals for more critical injuries sustained in the earthquake. These efforts were part of the National Disaster Management Service (NDMS). Wellstar supported its own Haitian team members/employees with resources and counseling. Sponsorships--Employees of Cobb Hospital participated in "Go Red for Women Day" program designed to raise awareness of heart disease in women (in conjunction with the American Heart Association). A group of employees also participated in the annual "Relay for Life: an event to raise funds and awareness for cancer research and prevention (held in conjunction with the American Cancer Society). Recognition and Accomplishments Cobb Hospital and Kennestone Hospital operate full-service clinics on the respective campuses to provide health related services to uninsured and underinsured who might not otherwise receive care. In FY2010 the clinics served a combined 8,000 patient visitors at a cost of almost $3.1 million. The system partnered with the local school systems to provide free health and safety education to nearly 50,000 area elementary students and approximately 8,000 adolescent students. In partnership with Cobb County law enforcement and YWCA, Wellstar started a program called Sexual Assault Nurse Examiner (SANE) for confidential and secure treatment of sexual assault victims. Approximately 100 patients were treated in the program. Cobb Hospital continued to serve as a Partner in Education site for mentoring South Cobb High School students with interest in pursuing healthcare professions. Thirty students participate in the program each year. Wellstar and Cobb Hospital received the designation as a "Company that Cares" for its caring about patients, communities and team members. It is one of only seven health care systems and the only local system to achieve that distinction. Wellstar Health System and affiliates remained strong financially with a 5.9% operating margin. The system also initiated an internal program to identify costs savings and revenue enhancements which produced an additional $75 million in company-wide savings and efficiencies. These initiatives made it possible to continue to reinvest funds into improvement and purchase of state of the art facilities and equipment ($81 million was spent in FY10 for total system-wide capital expenditures). Wellstar made an important investment in the area of clinical excellence by adding the Cardiovascular Medicine physician practice to the system. The physician practice is recognized by the Medical Group Management Associates as one of the top performers in the country. The result is the Wellstar Cardiac Network which makes Wellstar one of the leading cardiac health systems in Georgia. Cobb Hospital and other Wellstar facilities continued to invest in state of the art cancer treatment with its Wellstar Cancer Program. More than 3,000 patients were treated in the system representing approximately 8.4% of cancer cases in Georgia. Awards American College of Radiology-recognized for the Ultrasound and Nuclear Medicine product lines Quality Respiratory Care by the American Association of Respiratory Care Accredited Chest Pain Clinics at all hospitals by the Society of Chest Pain Centers Accredited Breast Health Center by the National Accreditation Program for Breast Centers JCAHO-Disease Specific Certification and Certified Primary Stroke Center American Diabetes Association recognized Wellstar for meeting national standards for diabetes self-management Wellstar Cobb and Douglas Hospitals received a Partnership for Health Accountability Quality and Patient Safety Awards from Georgia Hospital Association for 2009 Wellstar's Cobb Hospital's NICU received the Georgia VHA Leadership Award for Clinical Excellence. Wellstar Cobb, Douglas and 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. 312472213 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 2615 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 TE Durham 1.0 X 0 34715 2135 Thomas E Gearhard MD 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 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 W 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 Darold Etheridge 50.0 X 257321 0 24944 Lee Evins 2.0 X 0 237160 22440 Mark Haney 2.0 X 0 348007 32214 Patrick 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 Randy Cook 50.0 X 349808 0 33957 ROBERT HAMILTON 40.0 X 280941 0 22888 MICHAEL GRAUE 2.0 X 0 658068 49874 ROBERT JANSEN 2.0 X 0 207504 15763 ELLEN LANGFORD 2.0 X 0 188974 17817 Robert Mandler 2.0 X 0 235075 21295 Jonathan B Morris 2.0 X 0 148980 12644 Anthony M Trupiano 2.0 X 0 233753 17874 Robin Wilson MD 2.0 X 0 154726 13389 Ilona L Wozniak 50.0 X 64265 0 5012 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 Wylene Watts 50.0 X 141357 0 11302 Billy A Reid 50.0 X 153549 0 14370 Nancy Craney 50.0 X 149776 0 13625 Alma Stanfield 50.0 X 137502 0 11842 Tawana Moses 50.0 X 156876 0 13023 Marsha Burke 1.0 X 0 550796 43614 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 Ray 1.0 X 0 322133 19811 Andrew W Tatnall 1.0 X 0 187893 11548 Ellena Ann Evans 2.0 X 255439 0 18327 1946834 11577068 1097076 68 true true false Martin General Contracting Inc 3633 Ivy Gulledge Rd DALLAS GA 30132 General Contracting 1118178 Quest Diagnostics PO BOX 740736 ATLANTA GA 30384 LAB SERVICES 871667 Surgical Operational Services Inc 505 Commerce Park Dr Suite G MARIETTA GA 30060 Consultant OR 1225082 RCC Marietta PO Box 101518 ATLANTA GA 303921518 Medical Services 844262 Progressive Transcription 2674 Bomar Road DOUGLASVILLE GA 30135 TRANSCRIPTION SRVCS 343232 18 0 PATIENT REVENUE 621990 364071499 364071499 PATIENT EDUCATION 621990 9522 9522 WELLNESS CENTER 713940 101869 101869 MEDICAL RECORDS 621990 1329 1329 364184219 3823859 3823859 0 0 120570 120570 120570 120570 144263422 139299029 387 4964393 -387 4964006 4964006 0 0 0 CAFETERIA 1605154 1605154 PARKING 878155 878155 CHILD CARE 572349 572349 1005017 0 1005017 4060675 377153329 364184219 0 12969110 0 0 0 0 1312902 1037848 275054 0 0 106960022 96428726 10531296 7506105 6756995 749110 8896970 8009052 887918 8036985 7234894 802091 0 2339 2339 0 0 0 0 8040669 7160784 879885 28092 21267 6825 57678645 55504073 2174572 0 0 3982509 2220130 1762379 75121 45284 29837 0 109335 100710 8625 96532 96532 57846815 45727907 12118908 13443548 11281737 2161811 3019666 2387046 632620 REPAIRS & MAINTENANCE 3922114 3018615 903499 BAD DEBT 65475729 65475729 OTHER OPER EXPENSE 131559 61416 70143 346565657 312472213 34093444 0 5150 5150 15308004 12743930 41558127 43440759 5467600 5949935 3946068 6842302 338924894 205682306 137017152 133242588 126978367 154129717 35081665 37008842 365362133 393363223 30336276 34026954 1357548 1025938 118284797 127635686 149978621 162688578 X 215383512 230674645 215383512 230674645 365362133 393363223 X false true true X false X 4336556 4336556 135253381 63893782 71359599 4445450 3396294 1049156 192472354 138392230 54080124 2417153 2417153 133242588 INVESTMENT IN PHYSICIAN GROUP 14917014 INTANGIBLE ASSETS-KSU ALLOC 1493847 GOODWILL (CORP ALLOC) 5775768 ISSUANCE COSTS (CORP ALLOC) 1563769 GA HIGHLANDS COLLEGE LT ASSET 26355 CHATTAHOOCHEE TECH LT ASSET 47259 INVESTMENT IN COBB PARKING 840467 DUE FROM AFFILIATES 4774742 C&E M'CAID PENDING REC 6854135 OTHER RECEIVABLES (CORP ALLOC) 715486 37008842 0 ACCRUED PENSION LIABILITY 34674025 UNCLAIMED PROPERTY RESERVES (A 274319 ASSET RETIREMENT-OTHER LONG TE 1591378 INSURANCE RESERVE (ALLOCATED) 3267398 OTHER LONG TERM LIABILITIES (A 3543330 TAX EXEMPT BOND LIAB-DUE TO WHS 84285236 127635686 Uncertain Tax Position SCHEDULE D PART X Line 2 The following is a footnote from the combined financial statements of Wellstar Health System, Inc. and Affiliates related to the reporting of the organization's liability for uncertain tax positions under FIN 48. "Wellstar and all but one of its affiliates have been recognized as exempt from Federal income tax under Internal Revenue Code Section 501 (a) as organizations described in Section 501 (c) (3) and therefore, related income is generally not subject to Federal or state income tax. Community Assurance Corportion is a controlled foreign corporation not subject to Federal tax. Wellstar applies FASB ASC 740, Income Taxes, which addresses accounting for uncertainties in income tax positions. It also provides guidance on when tax positions are recognized in an entity's financial statements and how the values of these positions are determined. There is no impact on Wellstar's combined financial statements as a result of the application of ASC 740." true true X true X 125. true X true true true false true true 14600927 14600927 0.05250 52265519 41966116 10299403 0.03700 66866446 41966116 24900330 0.08950 940034 64357 875677 0.00310 940034 64357 875677 0.00310 67806480 42030473 25776007 0.09260 true 19489795 233877 97435402 114319737 -16884335 X true true Cobb Hospital

3950 Austell Road Austell GA 300666340

X X X Cobb Hospital, Inc. is an affiliate of Wellstar Health System, Inc. which on an annual basis issues a community benefit report. This report is subsequently distributed in and around the five county service areas of the health system. The Charity and other Community Benefit at Cost calculations on Part I, Line 7 of Schedule H are determined by comparing the cost to charge ratio from the hospital's Medicare cost report and other governmental reports to the expected reimbursement (if any) of those charges. The net community benefit expense or shortfall is then compared to the total hospital functional expense less bad debt (as mentioned previously). The resulting percentage of net community benefit expense to total expense is approximately 7% for the reporting period. The percentage of net community benefit expense to the total functional expense found on Form 990 Part IX, Line 25, column (A) is calculated by reducing the total expense ($346,565,657) by the amount of bad debt expense ($65,475,729) on Line 24b of Form 990, Part IX. The patient accounts generated by the hospital are analyzed for their propensity to pay any amounts not covered by insurance. After a period of attempting to collect outstanding balances, the accounts that are deemed uncollectible are written off to bad debt. Some patient accounts that are classified as bad debts are subsequently determined to qualify for charity and indigent care adjustments. This determination can occur due to inadequate information being available at the time services were provided as well as throughout the collection cycle as the patient's financial status may periodically change. Accounts for undocumented aliens and crime victims are sometimes written off because the patients do not allow follow-up in the collection process and thus never become eligible for charity or governmental funding. Generally speaking however, Wellstar and Cobb Hospital do not treat bad debt as uncompensated care. The Medicare shortfall on line 7 generally represents the uncompensated difference between the expected Medicare reimbursement and the Medicare charges stated at cost. The costing methodology to determine the amount reported on line 6 for Medicare allowable costs is basically a cost to charge ratio determined from data in the annual Medicare cost report. The policy written for collection practices at all Wellstar Health System entities incorporates guideline for personnel in the admissions and patient access registration 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 hospitals to have at least one employee or contractor available 24 hours a day and seven days a week (especially in hospitals with emergency rooms) on duty to provide assistance for the paperwork necessary to qualify for charity care or governmental assistance programs. Wellstar 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 measureable 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 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, continuous community involvement leads to community ownership of the process. Community ownership, in turn, increases the credibility and sustainability of the health improvement efforts. Cobb Hospital provides patients with cashiers and financial counselors who are trained in all of the uncompensation program requirements, payment plans, charity discounts, and other programs that are offered by the hospital. This includes at least one cashier in the emergency room on duty at all times. These financial counselors are well versed in the eligibilty requirements for Medicare and Medicaid if applicable for the patient which includes in some instances SSI Disablilty through the Medicare program. If a patient is pregnant and not covered by insurance or another government program the counselors can assist the patient in obtaining Medicaid eligibility (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. 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. Cobb Hospital is one of five hospitals that are affiliated with the parent corporation, Wellstar Health System. The primary service area of the system is located in the Northwest Georgia area and receives the majority and is expected to receive the majority of its patients from one of the following five counties--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 conunty. The system has therefore expanded to bring many services to the geographic area that previously were not available except in the "downtown" 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, Cobb Hospital (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; 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 indebtness, improvement of patient care, community benefit activities, and charity care. Cobb Hospital committed approximately $7.0 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 false false false false false false true false Thomas E Gearhard MD 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 Marsha Burke 0 550796 0 0 0 0 0 39033 0 4581 0 594410 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 W 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 Darold Etheridge 186959 0 55161 0 15201 0 20084 0 4860 0 282265 0 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 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 Ray 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 Randy Cook 258850 0 78550 0 12408 0 26698 0 7259 0 383765 0 0 0 Wylene Watts 128170 0 12987 0 200 0 9975 0 1327 0 152659 0 0 0 Billy A Reid 143290 0 10259 0 0 0 12309 0 2061 0 167919 0 0 0 Nancy Craney 136119 0 13632 0 25 0 12207 0 1418 0 163401 0 0 0 Tawana Moses 140848 0 15197 0 831 0 12481 0 542 0 169899 0 0 0 Ellena Ann Evans 193812 0 29637 0 31990 0 18327 0 0 0 273766 0 0 0 ROBERT HAMILTON 250665 0 21576 0 8700 0 19613 0 3275 0 303829 0 0 0 MICHAEL GRAUE 0 492184 0 88589 0 77295 0 45369 0 4505 0 707942 0 0 ROBERT JANSEN 0 149454 0 0 0 58050 0 12822 0 2941 0 223267 0 0 ELLEN LANGFORD 0 153885 0 26364 0 8725 0 15558 0 2259 0 206791 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 Anthony M Trupiano 0 185075 0 11541 0 37137 0 17874 0 0 0 251627 0 0 Robin Wilson MD 0 120878 0 0 0 33848 0 9717 0 3672 0 168115 0 0 Non-Fixed Payments Form 990 Schedule J Part 1 Line 7 As part of the Wellstar Executive Compensation Philosophy a performance pay plan was instituted several years ago whereby the Wellstar Board of Trustees approves an annual incentive plan which consists of several performance goals or factors that upon attainment will result in payouts to eligible plan participants (manager level employees and above). Those factors are: People goal for employee turnover Customer Service goal for employee engagement Quality & Safety goal for clinical excellence and patient satisfaction Financial goal for attaining a positive operating margin Confirmation of achieving these payout triggers is typically received through the annual external audit process and approved by the Board of Trustees at that time. Severance Benefits PURSUANT TO THEIR RESPECTIVE EMPLOYMENT AGREEMENTS, THE FOLLOWING OFFICERS ARE ENTITLED TO SEVERANCE 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 $378,334 ANDREW TATNALL $187,892 Other Compensation Form 990 Schedule J Part 1 Line 1b and 2 While Wellstar Health System and its affiliates do not have a written policy regarding payment or reimbursement fo the items listed in Part 1 Line 1a, the organization follows IRS guidelines in the payment of any of these items to individuals listed in Form 990 Part VII Section A. Compensation Exceptions On Schedule J of IRS Form 990 the following individuals were employed as officers of Wellstar Health System and its Affiliates during the reporting period but did not have salary and benefits in the calendar year for which this schedule applies: 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 Matthew Maddox Son of Trustee 36500 Employee of Wellstar false Bonnie Miller Wife of Trustee 26996 Employee of Wellstar false 990 T Explanation of Filing Form 990 Part V Line 3 Cobb Hospital generated no unrelated business income for the reporting period. As a result the attached 990T shows no activity. If subsequent review of the books reveals any unreported UBI we will file an amended return for the tax period ended June 30, 2010. Form 990 Copy to Board of Directors Form 990 Part VI Line 11A Internal staff prepare the organization's Form 990. Before filing the return with the Internal Revenue Service an external accounting firm, PricewaterhouseCoopers reviews and sign-offs on the completed return. This reviewed form is then made available to both the organization's Finance committee of the Board of Directors 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. Conflict of Interest Policy Form 990 Part VI Section B Line 12 a-c Our conflict of interest policy requires all covered persons to annually review the policy and then complete, sign and return the Conflicts of Interest Survey and Attestation to the Compliance Office. The policy requires an on-going disclosure obligation in the event a conflict arises during the year. The following is our process to regularly and consistently monitor and enforce this policy: Compliance identifies all covered persons who must complete the survey and attestation. Compliance verifies that the survey and attestation is distributed to these persons. Compliance verifies that these persons return a fully completed and signed survey and attestation. Compliance reviews each completed and signed survey and attestation to identify all conflicts listed in teh document. All conflicts, potential conflicts and incidences of non-compliance are referred to the Chief Compliance Officer. The CCO takes appropriate action to completely resolve all identified conflicts and incidences of non-compliance. Process for determining Exec Compensation Form 990 Part VI Section B Line 15A & B Wellstar engages the Hay Group to work with the governing board to review and recommend executive compensation. The executive compensation process at Wellstar is overseen by a committee of independent trustees, which follows a board-approved executive compensation philosophy. The 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 acting CEO will recuse himself from that process but is a non-voting committee member for discussions on all other officers. The executive compensation philosophy empowers the committee to oversee the executive compensation process and administer the executive compensation program on behalf of the full board of trustee of Wellstar; provided, however, the full Board of Trustees evaluates and approves the compensation of the Chief Executive Officer. The philosophy requires annual disclosure of the committee's actions and decisions to the full board, which it has done. The committee is guided by the board-approved philosophy. Overall, the philosophy is intended to reward for organizational and individual performance. When performance is at a predetermined targeted level, the compensation is intended to be at or around the median of compensation paid to similar positions at similar organizations (the "market"). Wellstar's executive compensation philosophy defines the market as being comprised of comparable not-for-profit health care delivery systems, i.e., not-for-profit organizations similar in complexity and scale to Wellstar. To assist the committee in fulfilling its duties, the committee engaged the Hay Group to provide market compensation data to compare to the Wellstar positions whose compensation the committee oversees. The committee uses this data to provide context when making decisions in administering the compensation program. Accurate minutes of the committee's discussion and decisions are recorded during each committee meeting, and reviewed and approved at the following committee meeting. DISCLOSURE OF FINANCIAL DOCUMENTS Form 990 Part VI Section C Line 19 The organization and its subsidiaries are subject to the Open Records Law in the State of Georgia. Therefore, by law, citizens are permitted to inspect and copy its governing documents, policies and financial statements as may be requested from time to time. Additionally, the organization's Form 990 is made readily available on the Guidestar website. Periodically, the organization publishes its financial performance in the local newspaper for citizens to review, and it also publishes a community benefit report once a year for distribution to the public. Compensation Form 990 Part V Line 2 All compensation amounts reported on Form 990 Part V, Part VII, and Part IX as well as Schedule J represent compensation provided to individuals that provide services to the organization. Likewise, the number of employees reported on Form 990 represent the number of individuals providing services to the organization. All Federal employment tax responsibilities for these individuals (including Federal Employment Tax reporting responsibilities) are handled by Wellstar Health System, Inc (EIN 58-1649541). Bylaw 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 recommending nominations to the Board. Nominations are voted upon by the full Board and each 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 each of the 18 existing Trustees effective June 30, 2010. One Trustee will rotate off the Board in year one; two will rotate off 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 from the Board. Organizational Structure Form 990 Part VI Line 6 & 7 As per the articles of Incorporation, the sole member of the organization is Wellstar Health System, Inc., a GA nonprofit corporation. As sole member, Wellstar Health System holds certain powers of election and approval in connection with the governing body of the organization. These powers are presented in detail in the company's governing documents which the company makes available to the public upon request. Officer's Hours Form 990 General Statement The officers devote their time to all of the organizations within Wellstar Health System that are listed in Schedule R, Part II. As such, the total hours worked by the officers across all of the organizations exceeds 40 hours per week. AUDITED FINANCIAL STATEMENTS Form 990 Part IV Line 12 and Part XI Wellstar Health System, Inc. is audited on an annual basis by an outside auditing firm and as part of that audit a consolidated financial statement is issued for all of Wellstar Health System, Inc and its Affiliates'. CURRENT OFFICERS/DIRECTORS RELATIONSHIPS FORM 990 PART VI, SECTION A LINE 2 Two of the current officers and directors for Wellstar Health System, Inc. --EIN 58-1649541 are related to each other through family. Lou Little, Sr VP Post Acute Services and Administrator of Windy Hill Hospital is the brother-in-law of Gregory Simone, Former President and CEO for the system. Tax-Exempt Bonds Allocation Form 990 Part IV Line 24a & Part X For purposes of the Form 990 reporting, Wellstar Health System, Inc EIN 58-1649541 will list all tax-exempt bonds issued since January 1, 2003 on Schedule K as it typically allocates the proceeds of the bonds to members of the Obligated Group (including the hospitals and physician group). Cobb Hospital, Inc. will report this tax exempt bond liability on Part X, Line 25 Other Liabilities. Cobb Hospital, Inc. has also restated its beginning balance sheet with respect to tax exempt bond liabilities as the amounts allocated to tax exempt bond liabilities are now included on Line 25. CHS Foundation 805 Sandy Plains Road Marietta GA 30066 581649540 Foundation GA 501 (c) (3) 11 NA Douglas Hospital Inc 805 Sandy Plains Road Marietta GA 30066 582026750 Healthcare GA 501 (c) (3) 3 NA Kennestone Hospital Inc 805 Sandy Plains Road Marietta GA 30066 582032904 Healthcare GA 501 (c) (3) 3 NA Paulding Medical Center Inc 805 Sandy Plains Road Marietta GA 30066 582095884 Healthcare GA 501 (c) (3) 3 NA Wellstar Foundation 805 Sandy Plains Road Marietta GA 30066 581627413 Foundation GA 501 (c) (3) 11 NA Wellstar Health System 805 Sandy Plains Road Marietta GA 30066 581649541 Healthcare GA 501(c) (3) 11 NA Kennestone South Parking Deck 805 Sandy Plains Road Marietta GA 300666340 582429775 PARKING GA NA INVESTMENT 193986 1887789 false false Cobb Hospital Parking Company LLC 805 Sandy Plains Road Marietta GA 300666340 752999669 PARKING GA NA INVESTMENT 41418 840467 false false Community Assurance Co 3rd Fl Barclays House Shedden Rd George Town Grand Cayman, BWI CJ 581649541 INSURANCE CJ WHS INC C 0 71561974 1.00000 false false false false false false false false false true false false false false false false false false CHS Foundation Inc j 331812