2019-05-09T12:46:59-05:00 2018-06-30 PricewaterhouseCoopers LLP 2001 MARKET ST SUITE 1800 PHILADELPHIA PA 19103 990 2017-07-01 200936376 WEST GEORGIA HEALTH FOUNDATION % ANTHONY J BUDZINSKI WEST 7709567827 793 SAWYER ROAD Marietta GA 300622222 ANTHONY J BUDZINSKI EVP 7709567827 2019-05-09 true JOANNE KRUEGER P01235586 2673303000 155.201.188.33 23522320191295000011 2019-05-09 P 7C276736B1F8534619D83B6F2AADECD8007A5E58 7C276736B1F8534619D83B6F2AADECD8007A5E58 2017 2020-01-14 16:20:31Z CANDICE L SAUNDERS 793 SAWYER ROAD Marietta GA 300622222 1412776 false X www.wghealth.org X 2004 GA TO SUPPORT THE CHARITABLE ACTIVITIES OF WEST GEORGIA MEDICAL CENTER, INC. AND ITS AFFILIATES. 20 10 0 26 0 0 415813 470933 0 0 349989 806961 80137 71547 845939 1349441 128284 132716 0 0 0 0 0 0 0 50774 89557 179058 222273 666881 1127168 16362102 17672893 7035 0 16355067 17672893 THE FOUNDATION OPERATES EXCLUSIVELY FOR THE BENEFIT OF THE WEST GEORGIA MEDICAL CENTER, INC. AND ITS AFFILIATED ENTITIES. false false 51760 0 0 TO PROVIDE FUNDS FOR THE SUPPORT OF WEST GEORGIA MEDICAL CENTER, INC. AND ITS AFFILIATES. SUPPORT INCLUDES BEREAVEMENT SERVICES, HOSPITAL VOLUNTEER PROGRAM, AND CAMP DOGWOOD - A GRIEF CAMP FOR CHILDREN. 112075 112075 0 TO PROVIDE FINANCIAL SUPPORT TO WEST GEORGIA MEDICAL CENTER, INC. FOR THE OPERATION OF THE HOSPICE CENTER. 20641 20641 0 HELPING HANDS FAMILY ASSISTANCE PROGRAM- TO ASSIST PRESENT AND RETIRED WEST GEORGIA HEALTH SERVICES, INC. EMPLOYEES AND HOSPITAL AUXILIARY VOLUNTEERS WITH FINANCIAL SUPPORT IN TIMES OF CRISIS. QUALIFYING HARDSHIPS INCLUDE CATASTROPHIC ILLNESS OR ACCIDENT SUFFERED BY A RECIPIENT OR AN UNINSURED LOSS TO A PRIMARY RESIDENCE CAUSED BY FIRE OR OTHER MAJOR INCIDENT OF DISASTER. FROM JULY 1, 2017 TO JUNE 30, 2018, THE HELPING HANDS PROGRAM ASSISTED 40 WEST GEORGIA HEALTH SERVICES, INC. EMPLOYEES BY PROVIDING $20,641 IN MONETARY ASSISTANCE. 184476 true true false false false false false false true false false false false false true false true false false false false false false true false false true true true false false false false false false false false false false false false false true true false false false true 0 0 0 false false false false false false false false false false X 20 10 false false false false true true true true true false false true true true true true true true true false GA X ANTHONY J BUDZINSKI 7709567827 793 SAWYER ROAD Marietta GA 300622222 X AMBICA YADAV TRUSTEE 1.0 13.0 X 0 4284 0 AVRIL P BECKFORD MD TRUSTEE & CHIEF PEDIATRIC OFF. 1.0 49.0 X X 0 444016 30191 CHARLES J JONES TRUSTEE 1.0 13.0 X 0 6339 0 DAVID H HAFNER MD TRUSTEE 1.0 13.0 X 0 55331 0 FRANK ROS TRUSTEE 1.0 13.0 X 0 4959 0 GARY A MILLER TRUSTEE 1.0 13.0 X 0 3586 0 GREG MORGAN TRUSTEE 1.0 13.0 X 0 3104 0 H SPEER BURDETTE III TRUSTEE 1.0 13.0 X 0 3400 0 JEFFREY L THARP MD MPH TRUSTEE & CHIEF MEDICINE SRVS. 1.0 49.0 X X 0 522885 80666 MICHAEL B PATTON TRUSTEE 1.0 13.0 X 0 4011 0 MITZI MOORE TRUSTEE 1.0 13.0 X 0 9175 0 O SCOTT SWAYZE MD TRUSTEE 1.0 13.0 X 0 5724 0 OTIS A BRUMBY III TRUSTEE 1.0 13.0 X 0 48879 0 PAUL DOUGLASS MD TRUSTEE & PHYSICIAN 1.0 49.0 X 0 633707 41401 R RANDALL BENTLEY SR ESQ TRUSTEE 1.0 13.0 X 0 48405 0 ROBERT N CROSS MD TRUSTEE 1.0 13.0 X 0 15971 0 T FITZ JOHNSON TRUSTEE 1.0 15.0 X 0 40981 0 THOMAS M PHILLIPS TRUSTEE 1.0 13.0 X 0 2467 0 W CHARLES BROCK TRUSTEE 1.0 13.0 X 0 46215 0 WALTER G ROBINSON TRUSTEE 1.0 13.0 X 0 8062 0 ALAN R MUSTER MD SVP SPECIALTY DIVISION WMG 1.0 51.0 X 0 601443 82349 ALAN WILDE SVP SUPPLY CHAIN (BEG. 6/18) 1.0 49.0 X 0 0 0 ANDREW ALBERRY VP INFO TECHNOLOGY OPERATIONS 1.0 49.0 X 0 155877 9394 ANDREW LEE VP CHIEF DIV. OFF.(BEG. 10/17) 1.0 49.0 X 0 117476 2008 ANTHONY J BUDZINSKI EVP & CFO 1.0 51.0 X 0 1233070 71584 ANTHONY M TRUPIANO SVP SUPPLY CHAIN 1.0 49.0 X 0 397653 49512 BARBARA B COREY SVP MANAGED CARE 1.0 49.0 X 0 613339 50336 BETH KOST SVP COMPLIANCE CHF PRIVACY OFF 1.0 49.0 X 0 389392 43110 BETHANY ROBERTSON VP/CHIEF LEARN.OFF.(END.4/18) 1.0 49.0 X 0 279036 45924 BRADFORD B NEWTON VP INFO. TECHNOLOGY ADMIN. 1.0 49.0 X 0 278749 51740 CANDICE L SAUNDERS PRESIDENT & CEO 1.0 51.0 X 0 2121661 76327 CARRIE O PLIETZ EVP & COO HOSPITAL DIVISION 1.0 49.0 X 0 884677 67768 DAVID W ANDERSON EVP/HR/OL/CCO 1.0 49.0 X 0 804964 75727 DOUGLAS ARVIN CPA MBA SVP FINANCE 1.0 49.0 X 0 433489 29905 ELIZABETH H LOUDERMILK VP FINANCIAL PLANNING 1.0 49.0 X 0 304210 50851 ELIZABETH PAPETTI VP OPS HOSPITAL DIVISION 1.0 49.0 X 0 239000 6136 ELLEN LANGFORD SVP WMG AMB. TRANS. (END.4/18) 1.0 49.0 X 0 434986 69267 ELLEN WRIGHT VP HIM CDI & POLICIES 1.0 49.0 X 0 74286 4329 FREDA LYON VP SYSTEM EMERGENCY SERVICES 1.0 49.0 X 0 243482 45328 JAMES M SWARTZ VP ACCOUNTING 1.0 49.0 X 0 282924 47009 JASON STEVENS VP DEPUTY GENERAL COUNSEL 1.0 49.0 X 0 346099 42842 JENNIFER GIUSTI VP CLINICAL OUTCOMES 1.0 49.0 X 0 317295 32617 JILL M CASE-WIRTH SVP NURSING SERVICES 1.0 49.0 X 0 444154 59112 JOHN A BRENNAN EVP CHIEF CLIN. INTG. OFFICER 1.0 49.0 X 0 1091634 82415 JOSEPH L BRYWCZYNSKI SVP HEALTH PARKS DEVELOPMENT 1.0 49.0 X 0 442964 73625 KEITH BOWERMASTER VP COMMUNICATION 1.0 49.0 X 0 204567 38658 KEM M MULLINS EVP AMBULATORY & BUS. DEV. 1.0 49.0 X 0 677287 57343 KENT HAYTHORN VP CLNCL. NURSING (END. 10/17) 1.0 49.0 X 0 115180 20470 KEVIN SCHAEFFER MD VP ONCOLOGY 1.0 49.0 X 0 315346 37252 KIMBERLY W MENEFEE SVP STRAT. COMM.DEV.(END.4/18) 1.0 49.0 X 0 544245 51952 KIMBERLY TAACA VP OPS SPECIALTY DIVISION 1.0 49.0 X 0 227431 27644 KRISTEN S TRICE VP DIAGNOSTIC OUTREACH 1.0 49.0 X 0 219064 42667 LEO E REICHERT EVP & GENERAL COUNSEL 1.0 49.0 X 0 751320 66257 MARCUS P CHARLSON MD VP SURGERY 1.0 49.0 X 0 196376 34191 MARY L TAVERNARO VP HUMAN RESOURCES OPERATIONS 1.0 49.0 X 0 302766 52404 MAXWELL KAGAN VP FINANCE & CFO 1.0 49.0 X 0 205325 34929 MICHELLE M ROBINSON VP MARKETING (END. 4/2018) 1.0 49.0 X 0 269465 45021 PAUL MURPHREE VP MEDICAL OUTCOMES 1.0 49.0 X 0 206596 21621 PETER R JUNGBLUT MD MBA SVP & MEDICAL DIRECTOR 1.0 49.0 X 0 344227 78651 REBECCA L RUHL VP FACILITY COMPLIANCE OPS 1.0 49.0 X 0 191015 30545 RICHARD S SIEGEL VP CARDIOLOGY & CVM ADMIN. 1.0 49.0 X 0 420012 79761 ROB SCHREINER EVP & PRESIDENT MEDICAL GROUP 1.0 49.0 X 0 260724 3189 ROBERT J DECOUX VP CORPORATE MED STAFF SVCS 1.0 49.0 X 0 224236 53512 ROBIN G BOEHRINGER VP TOTAL REWARDS (END. 5/2018) 1.0 49.0 X 0 237763 28362 SANDRA LUCIUS VP INFO TECHNOLOGY APPS 1.0 49.0 X 0 285948 49910 SEAN P TURNER VP REVENUE CYCLE MANAGEMENT 1.0 49.0 X 0 368104 59488 SNEHAL H DOSHI VP SYSTEM PHARMACIST 1.0 49.0 X 0 239515 59995 SONYA E ALDY VP TALENT ACQUISITION 1.0 49.0 X 0 244723 40030 STEPHEN L BADGER VP WMG STRATEGIC SERVICES 1.0 49.0 X 0 820360 59117 STEPHEN VAULT VP BUSINESS DEVELOPMENT 1.0 49.0 X 0 215180 24026 TIMOTHY HANEY SVP R.E. FAC. & DEV. SRVS. 1.0 49.0 X 0 599548 54288 TOM BONIECKI VP MUSCUSKELETAL NEURO. 1.0 49.0 X 0 180342 75237 VALERY A AKOPOV MD SVP HOSPITAL DIVISION WMG 1.0 49.0 X 0 574337 56862 VARMA RAMESWAR MD VP PEDIATRIC OPERATIONS 1.0 49.0 X 0 225328 52564 YVETTE BREWER MD VP PRIMARY CARE MEDICINE 1.0 49.0 X 0 227494 54160 DOUGLAS S FOSTER FORMER VP FINANCIAL PLAN. 0.0 0.0 X 0 115794 24995 JONATHAN B MORRIS MD FORMER SVP CHIEF INFO. OFF. 0.0 0.0 X 0 233817 16019 0 24686796 2752593 0 true true false 0 X 19673 451260 470933 0 483484 483484 0 0 0 0 0 323477 323477 323477 323477 134882 19673 63335 71547 71547 0 0 0 0 0 0 0 1349441 878508 112075 112075 20641 20641 0 0 0 0 0 0 0 0 0 0 0 0 0 37797 0 37797 0 0 10732 10732 0 0 0 0 0 0 0 0 0 0 0 BEREAVEMENT SERVICES 1445 1445 MISCELLANEOUS EXPENSES 17264 17264 PATIENT SERVICE EXPENSES 11714 11714 SUPPLIES 10605 10605 222273 184476 37797 0 1065810 0 0 0 279825 136970 0 0 0 0 0 0 0 0 0 0 0 0 0 0 15016467 17535923 0 0 0 0 0 0 0 0 16362102 17672893 7035 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 7035 0 X 0 -500 15443067 16761393 912000 912000 16355067 17672893 16362102 17672893 X 1127168 -302273 492931 X false true X true false X X 1 WEST GEORGIA MEDICAL CENTER INC 205497506 3 true 112075 0 1 112075 0 true false false false false false false false false false false false false false false true 16332380 513548 1078160 93050 158146 17672892 14602355 550791 1387967 0 208235 0 16332878 11774139 2295910 781178 256371 14594856 10924729 1314581 -148912 316259 11774139 8583037 2385121 672169 715598 10924729 0.05000 0.95000 false false 0 0 X SCHEDULE D, PART V, LINE 4 USE OF ORGANIZATION'S ENDOWMENT FUNDS: NET ASSETS ARE RELEASED FROM RESTRICTIONS WHEN EXPENSES ARE INCURRED TO SATISFY THE RESTRICTED PURPOSES, BY PASSAGE OF TIME OR BY OCCURENCE OF SPECIFIC EVENTS. NET ASSETS RELEASED DURING THE YEAR WERE PRIMARILY FOR THE CONTRIBUTIONS AND SUPPORT OF CONSTRUCTION OF ADDITIONAL FACILITIES, SPECIFIC MEDICAL AND CANCER TREATMENT EQUIPMENT, AND THE HOSPICE PROGRAM OF LAGRANGE-TROUP COUNTY HOSPITAL AUTHORITY. SCHEDULE D, PART X, LINE 2 The following footnote is related to the organization's application of FIN 48 (ASC 740): "WELLSTAR AND 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, EXCEPT FOR CAC AND WGHP. 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 ENTITYS FINANCIAL STATEMENTS AND HOW THE VALUES OF THESE POSITIONS ARE DETERMINED. THERE IS NO IMPACT ON WELLSTARS COMBINED FINANCIAL STATEMENTS AS A RESULT OF THE APPLICATION OF ASC 740." GOLF TOURNAMENT 103555 19506 84049 12250 5319 16316 95 9171 POINSETTIA SALE 33015 33015 104 18041 4 17985 167 17818 37 125 118 1759 154555 19673 134882 12250 5356 16441 317 28971 63335 71547 true WEST GEORGIA MEDICAL CENTER INC 1514 VERNON ROAD LAGRANGE GA 30240 205497506 501(C)(3) 112075 FMV N/A PROGRAM SUPPORT 1 HELPING HANDS EMPLOYEE PROGRAM 40 20641 FMV N/A SCHEDULE I, PART I, LINE 2 PROCEDURE FOR MONITORING THE USE OF GRANTS/SCHOLARSHIP FUNDS: FUNDS WERE USED TO SUPPORT WEST GEORGIA MEDICAL CENTER, INC., A RELATED 501(C)(3) ORGANIZATION AND OTHER AFFILIATED HEALTHCARE PROVIDERS. THE HELPING HANDS FAMILY ASSISTANCE PROGRAM IS AN EMPLOYEE EMERGENCY ASSISTANCE PROGRAM. true true false false false false false true false ALAN R MUSTER MD SVP SPECIALTY DIVISION WMG 0 452852 0 127755 0 20836 0 47400 0 34949 0 683792 0 0 ANDREW ALBERRY VP INFO TECHNOLOGY OPERATIONS 0 115774 0 35000 0 5103 0 0 0 9394 0 165271 0 0 ANTHONY J BUDZINSKI EVP & CFO 0 647939 0 160698 0 424433 0 47400 0 24184 0 1304654 0 398890 ANTHONY M TRUPIANO SVP SUPPLY CHAIN 0 315664 0 63812 0 18177 0 47400 0 2112 0 447165 0 0 AVRIL P BECKFORD MD TRUSTEE & CHIEF PEDIATRIC OFF. 0 250218 0 190568 0 3230 0 28516 0 1675 0 474207 0 0 BARBARA B COREY SVP MANAGED CARE 0 351440 0 71045 0 190854 0 29398 0 20938 0 663675 0 177832 BETH KOST SVP COMPLIANCE CHF PRIVACY OFF 0 311960 0 65013 0 12419 0 21884 0 21226 0 432502 0 0 BETHANY ROBERTSON VP/CHIEF LEARN.OFF.(END.4/18) 0 206746 0 34469 0 37821 0 14995 0 30929 0 324960 0 28401 BRADFORD B NEWTON VP INFO. TECHNOLOGY ADMIN. 0 217246 0 52306 0 9197 0 22820 0 28920 0 330489 0 0 CANDICE L SAUNDERS PRESIDENT & CEO 0 1256117 0 524447 0 341097 0 44900 0 31427 0 2197988 0 324125 CARRIE O PLIETZ EVP & COO HOSPITAL DIVISION 0 669407 0 201166 0 14104 0 36400 0 31368 0 952445 0 0 DAVID W ANDERSON EVP/HR/OL/CCO 0 504065 0 151479 0 149420 0 47149 0 28578 0 880691 0 126016 DOUGLAS ARVIN CPA MBA SVP FINANCE 0 350002 0 68566 0 14921 0 4163 0 25742 0 463394 0 0 DOUGLAS S FOSTER FORMER VP FINANCIAL PLAN. 0 110776 0 0 0 5018 0 19582 0 5413 0 140789 0 0 ELIZABETH H LOUDERMILK VP FINANCIAL PLANNING 0 254861 0 39942 0 9407 0 23400 0 27451 0 355061 0 0 ELIZABETH PAPETTI VP OPS HOSPITAL DIVISION 0 203900 0 26222 0 8878 0 4776 0 1360 0 245136 0 0 ELLEN LANGFORD SVP WMG AMB. TRANS. (END.4/18) 0 272189 0 55024 0 107773 0 44200 0 25067 0 504253 0 95982 FREDA LYON VP SYSTEM EMERGENCY SERVICES 0 202524 0 30195 0 10763 0 15521 0 29807 0 288810 0 0 JAMES M SWARTZ VP ACCOUNTING 0 233763 0 40142 0 9019 0 19530 0 27479 0 329933 0 0 JASON STEVENS VP DEPUTY GENERAL COUNSEL 0 236931 0 99073 0 10095 0 23400 0 19442 0 388941 0 0 JEFFREY L THARP MD MPH TRUSTEE & CHIEF MEDICINE SRVS. 0 316299 0 201272 0 5314 0 46785 0 33881 0 603551 0 0 JENNIFER GIUSTI VP CLINICAL OUTCOMES 0 224713 0 85231 0 7351 0 26087 0 6530 0 349912 0 0 JILL M CASE-WIRTH SVP NURSING SERVICES 0 354247 0 73826 0 16081 0 47400 0 11712 0 503266 0 0 JOHN A BRENNAN EVP CHIEF CLIN. INTG. OFFICER 0 829182 0 246421 0 16031 0 47400 0 35015 0 1174049 0 0 JONATHAN B MORRIS MD FORMER SVP CHIEF INFO. OFF. 0 116457 0 0 0 117360 0 7164 0 8855 0 249836 0 0 JOSEPH L BRYWCZYNSKI SVP HEALTH PARKS DEVELOPMENT 0 302686 0 55514 0 84764 0 47400 0 26225 0 516589 0 60537 KEITH BOWERMASTER VP COMMUNICATION 0 185774 0 11074 0 7719 0 18383 0 20275 0 243225 0 0 KEM M MULLINS EVP AMBULATORY & BUS. DEV. 0 516012 0 146039 0 15236 0 23400 0 33943 0 734630 0 0 KEVIN SCHAEFFER MD VP ONCOLOGY 0 225000 0 81191 0 9155 0 28013 0 9239 0 352598 0 0 KIMBERLY W MENEFEE SVP STRAT. COMM.DEV.(END.4/18) 0 318585 0 68385 0 157275 0 29400 0 22552 0 596197 0 143040 KIMBERLY TAACA VP OPS SPECIALTY DIVISION 0 150000 0 70710 0 6721 0 14665 0 12979 0 255075 0 0 KRISTEN S TRICE VP DIAGNOSTIC OUTREACH 0 179395 0 30806 0 8863 0 15323 0 27344 0 261731 0 0 LEO E REICHERT EVP & GENERAL COUNSEL 0 570403 0 161432 0 19485 0 29400 0 36857 0 817577 0 0 MARCUS P CHARLSON MD VP SURGERY 0 160014 0 27478 0 8884 0 11772 0 22419 0 230567 0 0 MARY L TAVERNARO VP HUMAN RESOURCES OPERATIONS 0 249538 0 42851 0 10377 0 29400 0 23004 0 355170 0 0 MAXWELL KAGAN VP FINANCE & CFO 0 163472 0 36000 0 5853 0 19597 0 15332 0 240254 0 0 MICHELLE M ROBINSON VP MARKETING (END. 4/2018) 0 221433 0 38025 0 10007 0 16089 0 28932 0 314486 0 0 PAUL DOUGLASS MD TRUSTEE & PHYSICIAN 0 485040 0 144525 0 4142 0 32100 0 9301 0 675108 0 0 PAUL MURPHREE VP MEDICAL OUTCOMES 0 166080 0 35932 0 4584 0 13506 0 8115 0 228217 0 0 PETER R JUNGBLUT MD MBA SVP & MEDICAL DIRECTOR 0 328499 0 3000 0 12728 0 47400 0 31251 0 422878 0 0 REBECCA L RUHL VP FACILITY COMPLIANCE OPS 0 154856 0 26592 0 9567 0 3900 0 26645 0 221560 0 0 RICHARD S SIEGEL VP CARDIOLOGY & CVM ADMIN. 0 308998 0 53732 0 57282 0 45890 0 33871 0 499773 0 43143 ROB SCHREINER EVP & PRESIDENT MEDICAL GROUP 0 253846 0 0 0 6878 0 0 0 3189 0 263913 0 0 ROBERT J DECOUX VP CORPORATE MED STAFF SVCS 0 183688 0 30625 0 9923 0 27057 0 26455 0 277748 0 0 ROBIN G BOEHRINGER VP TOTAL REWARDS (END. 5/2018) 0 195243 0 33528 0 8992 0 18998 0 9364 0 266125 0 0 SANDRA LUCIUS VP INFO TECHNOLOGY APPS 0 224713 0 48688 0 12547 0 47260 0 2650 0 335858 0 0 SEAN P TURNER VP REVENUE CYCLE MANAGEMENT 0 301913 0 51845 0 14346 0 29175 0 30313 0 427592 0 0 SNEHAL H DOSHI VP SYSTEM PHARMACIST 0 196088 0 32692 0 10735 0 29119 0 30876 0 299510 0 0 SONYA E ALDY VP TALENT ACQUISITION 0 210000 0 24700 0 10023 0 11700 0 28330 0 284753 0 0 STEPHEN L BADGER VP WMG STRATEGIC SERVICES 0 569392 0 120638 0 130330 0 23400 0 35717 0 879477 0 112403 STEPHEN VAULT VP BUSINESS DEVELOPMENT 0 184999 0 21126 0 9055 0 12890 0 11136 0 239206 0 0 TIMOTHY HANEY SVP R.E. FAC. & DEV. SRVS. 0 334270 0 105128 0 160150 0 28630 0 25658 0 653836 0 143033 TOM BONIECKI VP MUSCUSKELETAL NEURO. 0 162078 0 15564 0 2700 0 39607 0 35630 0 255579 0 0 VALERY A AKOPOV MD SVP HOSPITAL DIVISION WMG 0 464408 0 88401 0 21528 0 29400 0 27462 0 631199 0 0 VARMA RAMESWAR MD VP PEDIATRIC OPERATIONS 0 188219 0 27320 0 9789 0 40496 0 12068 0 277892 0 0 YVETTE BREWER MD VP PRIMARY CARE MEDICINE 0 191006 0 24084 0 12404 0 33126 0 21034 0 281654 0 0 SCHEDULE J, PART I, LINE 4A SEVERANCE PAYMENTS: Pursuant to their respective employment agreements, the following groups of officers are entitled to severance payments based on their compensation at that time in the event of certain identified circumstances. The severance payment periods are 24 months for Executive Vice Presidents, 18 months for Senior Vice Presidents, and 12 months for Vice Presidents. The following officer received severance pay during the 2017 CALENDAR YEAR FROM EITHER THE ORGANIZATION OR A RELATED ORGANIZATION: JONATHAN B. MORRIS, MD $113,177 SCHEDULE J, PART I, LINE 4B PARTICIPATION IN A SUPPLEMENTAL NON-QUALIFIED RETIREMENT PLAN: During the year, Vice Presidents, Senior Vice Presidents, Executive Vice Presidents and certain physicians participated in a supplemental nonqualified retirement plan sponsored by WellStar Health System, Inc. The amounts related to this plan are included in Schedule J, Part II, Column (C). The following individuals received payments from the plan included in Schedule J, Part II, Column (B): ANTHONY J. BUDZINSKI $398,890 BARBARA B. COREY 177,832 BETHANY ROBERTSON 28,401 CANDICE L. SAUNDERS 324,125 DAVID W. ANDERSON 126,016 ELLEN LANGFORD 95,982 JOSEPH L. BRYWCZYNSKI 60,537 KIMBERLY W. MENEFEE 143,040 RICHARD S. SIEGEL 43,143 STEPHEN L. BADGER 112,403 TIMOTHY HANEY 143,033 SCHEDULE J, PART I, LINE 7 NON-FIXED PAYMENTS TO OFFICERS: 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.THOSE FACTORS ARE: (1) PEOPLE & CUSTOMER SERVICE GOAL FOR EMPLOYEE "TRUST INDEX (2) QUALITY & SAFETY GOAL FOR CLINICAL EXCELLENCE AND PATIENT SATISFACTION; AND (3) FINANCIAL GOAL FOR ATTAINING A POSITIVE OPERATING MARGIN. CONFIRMATION OF ACHIEVING THESE GOALS IS TYPICALLY RECEIVED THROUGH THE ANNUAL EXTERNAL AUDIT PROCESS AND APPROVED BY THE BOARD OF TRUSTEES AT THAT TIME. FORM 990, PART I, LINES 7A & 7B UNRELATED BUSINESS INCOME WEST GEORGIA HEALTH FOUNDATION, INC. GENERATED NO UNRELATED BUSINESS INCOME ("UBI") FOR THE REPORTING YEAR. AS A RESULT THE FILED 990-T 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, 2018. FORM 990, PART IV, LINE 12B AUDITED FINANCIAL STATEMENTS WEST GEORGIA HEALTH FOUNDATION 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 CONTROLLED AFFILIATES. THE INDEPENDENT AUDITORS REPORT INCLUDES THE ACCOUNTS OF WELLSTAR AND ITS CONTROLLED AFFILIATES, WELLSTAR KENNESTONE HOSPITAL, INC., WELLSTAR COBB HOSPITAL, INC., WELLSTAR DOUGLAS HOSPITAL, INC., WELLSTAR PAULDING MEDICAL CENTER, INC., WELLSTAR ATLANTA MEDICAL CENTER, INC., WELLSTAR NORTH FULTON HOSPITAL, INC., WELLSTAR SPALDING REGIONAL HOSPITAL, INC., WELLSTAR SYLVAN GROVE HOSPITAL, INC., WELLSTAR WEST GEORGIA HEALTH SERVICES, INC., WELLSTAR WEST GEORGIA MEDICAL CENTER, INC., WELLSTAR FOUNDATION, INC., WELLSTAR WEST GEORGIA FOUNDATION, INC., VERNON WOODS RETIREMENT COMMUNITY, 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 HEALTH SYSTEM, INC. HAS THE AUTHORITY TO APPROVE APPOINTMENTS OF THE MEMBERS OF THE BOARD OF TRUSTEES OF ALL AFFILIATE CORPORATIONS. FORM 990, PART VI, SECTION A, LINE 7B POWERS OF THE BOARD As per the Articles of Incorporation, the ultimate sole member of the organization is Wellstar Health System, Inc., a GEORGIA nonprofit corporation. As sole member, Wellstar Health System, Inc. holds certain powers of election and approval in connection with the governing body of the organization. These powers are presented in detail in the governing documents which the company makes available to the public upon request. FORM 990, PART B, SECTION B, LINE 11B BOARD REVIEW OF FORM 990 Internal staff prepareS the organization's Form 990. Before filing the return with the Internal Revenue Service an external accounting firm, PricewaterhouseCoopers LLP, 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. FORM 990, PART VI, SECTION B, LINE 12C CONFLICT OF INTEREST POLICY Our conflict of interest policy requires all covered persons to annually review the policy and then complete, sign and return the Conflicts of Interest Survey and Attestation to the Compliance Office. The Policy requires an on-going disclosure obligation in the event a conflict arises during the year. The following is our process to regularly and consistently monitor and enforce the policy: Compliance identifies all covered persons who must complete the Survey and Attestation. Compliance verifies that the Survey and Attestation is distributed to these persons. Compliance verifies that these persons return a fully completed and signed Survey and Attestation. Compliance reviews each completed and signed Survey and Attestation to identify all conflicts listed in the document. All conflicts, potential conflicts and incidences of non-compliance are referred to the Chief Compliance Officer. The CCO takes appropriate action to completely resolve all identified conflicts and incidences of non-compliance. FORM 990, PART VI, SECTION B, LINES 15A & 15B COMPENSATION OF OFFICERS WELLSTAR HEALTH SYSTEM, INC. HAS ENGAGED SULLIVAN COTTER 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 COMPENSATION COMMITTEE CONSISTS OF FIVE TRUSTEES AS WELL AS THE CEO IN AN ADVISORY ROLE AND NOT A VOTING MEMBER. FURTHER IN COMMITTEE DISCUSSIONS ABOUT THE COMPENSATION FOR THE CHIEF EXECUTIVE OFFICER, THE CEO WILL RECUSE HIM/HERSELF FROM THAT PROCESS AND 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 TRUSTEES 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. BASE COMPENSATION IS TARGETED AT THE MEDIAN BASE COMPENSATION PAID TO SIMILAR POSITIONS AT SIMILAR ORGANIZATIONS (THE MARKET). OFFICERS OF THE COMPANY ALSO RECEIVE VARIABLE COMPENSATION THAT IS DEPENDENT ON INDIVIDUAL AND ORGANIZATION PERFORMANCE. WHEN PERFORMANCE IS AT A PREDETERMINED TARGETED LEVEL, THE TOTAL COMPENSATION, BOTH BASE AND VARIABLE, IS INTENDED TO BE AT OR AROUND THE 75TH% OF COMPENSATION PAID TO SIMILAR POSITIONS AT SIMILAR ORGANIZATIONS. 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 SULLIVAN COTTER 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 PROVIDED TO THE FULL BOARD OF TRUSTEES FOR REVIEW. FORM 990, PART VI, SECTION C, LINE 19 DOCUMENTS MADE AVAILABLE TO THE PUBLIC The organization and its AFFILIATES 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. FORM 990, PART VII OFFICERS HOURS WORKED 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. FORM 990, PART VII & FORM 990, SCHEDULE J COMPENSATION 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). FORM 990, PART XI, LINE 9 OTHER CHANGES IN NET ASSETS: $ 492,931 CHS Foundation Inc 793 SAWYER ROAD Marietta GA 30062 581649540 Foundation GA 501(C)(3) 12 II WHS INC true Douglas Hospital Inc 793 SAWYER ROAD MARIETTA GA 30062 582026750 Healthcare GA 501(C)(3) 3 WHS INC true Kennestone Hospital Inc 793 SAWYER ROAD Marietta GA 30062 582032904 Healthcare GA 501(C)(3) 3 WHS INC true Paulding Medical Center Inc 793 SAWYER ROAD MARIETTA GA 30062 582095884 Healthcare GA 501(C)(3) 3 WHS INC true Wellstar Foundation Inc 793 SAWYER ROAD MARIETTA GA 30062 581627413 Foundation GA 501(C)(3) 12 II WHS INC true Wellstar Health System Inc 793 SAWYER ROAD MARIETTA GA 30062 581649541 Healthcare GA 501(C)(3) 12 II NA false WELLSTAR ATLANTA MEDICAL CENTER INC 793 SAWYER ROAD MARIETTA GA 30062 810837031 HEALTHCARE GA 501(C)(3) 3 WHS INC true WELLSTAR NORTH FULTON HOSPTIAL INC 793 SAWYER ROAD MARIETTA GA 30062 810851756 HEALTHCARE GA 501(C)(3) 3 WHS INC true WELLSTAR SPALDING REGIONAL HOSPITALINC 793 SAWYER ROAD MARIETTA GA 30062 810864789 HEALTHCARE GA 501(C)(3) 3 WHS INC true WELLSTAR SYLVAN GROVE HOSPITAL INC 793 SAWYER ROAD MARIETTA GA 30062 810875069 HEALTHCARE GA 501(C)(3) 3 WHS INC true WEST GEORGIA HEALTH SERVICES INC 793 SAWYER ROAD MARIETTA GA 30062 205497622 HEALTHCARE GA 501(C)(3) 12 II WHS INC true WEST GEORGIA MEDICAL CENTER INC 793 SAWYER ROAD MARIETTA GA 30062 205497506 HEALTHCARE GA 501(C)(3) 3 WGHS INC true VERNON WOODS RETIREMENT COMMUNITY INC 793 SAWYER ROAD MARIETTA GA 30062 582575049 HEALTHCARE GA 501(C)(3) 10 WGHS INC true MEDICAL PARK FOUNDATION INC 1514 VERNON ROAD LAGRANGE GA 30062 581303478 FOUNDATION GA 501(C)(3) 7 WGHS INC true COBB HOSPITAL INC 793 SAWYER ROAD MARIETTA GA 30062 580968382 HEALTHCARE GA 501(C)(3) 3 WHS INC true COBB SOUTH PARKING DECK 793 SAWYER ROAD MARIETTA GA 300622222 752999669 PARKING GA NA N/A KENNESTONE EAST PARKING DECK LLC 793 SAWYER ROAD MARIETTA GA 300622222 200537100 PARKING GA NA N/A GRIFFIN IMAGING LLC 793 SAWYER ROAD MARIETTA GA 300622222 IMAGING CENTER GA NA N/A TENET EMSSPALDING 911 LLC 793 SAWYER ROAD MARIETTA GA 300622222 OFF. BLDG/EMS CTR GA NA N/A NORTH FULTON PARKING DECK LP 793 SAWYER ROAD MARIETTA GA 300622222 PARKING GA NA N/A Community Assurance Co 3rd Fl Barclays Hse Shedden Rd George Town CJ 581649541 INSURANCE CJ WHS INC C CORP WEST GEORGIA HEALTH PHYSICIANS INC 793 SAWYER ROAD MARIETTA GA 300622222 275125341 PHYSICIAN PRAC GA WGHS INC C CORP false true true false false false false false false false false false true true true true false false false