2018-05-15T16:18:16-05:00 2017-06-30 PricewaterhouseCoopers LLP 2001 MARKET ST SUITE 1800 PHILADELPHIA PA 19103 990 2016-07-01 200936376 WEST GEORGIA HEALTH FOUNDATION % JAMES M SWARTZ WEST 7709567827 793 SAWYER ROAD Marietta GA 300622222 JAMES M SWARTZ VP, ACCOUNTING 7709567827 2018-05-15 true JOANNE KRUEGER P01235586 2673303000 2018-05-10 2016 2022-09-23 18:48:47Z X CANDICE L SAUNDERS 793 SAWYER ROAD Marietta GA 300622222 906041 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 45 0 0 2508076 415813 0 0 221478 349989 0 80137 2729554 845939 232207 128284 0 0 0 0 0 0 0 33732 50774 265939 179058 2463615 666881 14602356 16362102 0 7035 14602356 16355067 X THE FOUNDATION OPERATES EXCLUSIVELY FOR THE BENEFIT OF THE WEST GEORGIA MEDICAL CENTER, INC. AND ITS AFFILIATED ENTITIES. false false 19846 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. 111911 111911 0 TO PROVIDE FINANCIAL SUPPORT TO WEST GEORGIA MEDICAL CENTER, INC. FOR THE OPERATION OF THE HOSPICE CENTER. 16373 16373 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, 2016 TO JUNE 30, 2017, THE HELPING HANDS PROGRAM ASSISTED 34 WEST GEORGIA HEALTH SERVICES, INC. EMPLOYEES BY PROVIDING $16,373 IN MONETARY ASSISTANCE. 148130 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 JAMES M SWARTZ 7709567827 793 SAWYER ROAD Marietta GA 300622222 X AMBICA YADAV TRUSTEE 1.0 13.0 X 0 0 0 AVRIL P BECKFORD MD TRUSTEE & CHIEF PEDIATRIC OFF. 1.0 49.0 X X 0 501784 30198 CHARLES J JONES TRUSTEE 1.0 13.0 X 0 8672 0 DAVID H HAFNER MD TRUSTEE 1.0 13.0 X 0 48713 0 FRANK ROS TRUSTEE 1.0 13.0 X 0 4406 0 GARY A MILLER TRUSTEE 1.0 13.0 X 0 5340 0 GREG MORGAN TRUSTEE 1.0 13.0 X 0 3063 0 H SPEER BURDETTE III TRUSTEE 1.0 13.0 X 0 1906 0 JEFFREY L THARP MD MPH TRUSTEE & CHIEF MEDICNE SRVS 1.0 49.0 X X 0 493911 79677 MICHAEL B PATTON TRUSTEE 1.0 13.0 X 0 1563 0 MITZI MOORE TRUSTEE 1.0 13.0 X 0 13175 0 O SCOTT SWAYZE MD TRUSTEE 1.0 13.0 X 0 6445 0 OTIS A BRUMBY III TRUSTEE 1.0 13.0 X 0 40016 0 PAUL DOUGLASS MD TRUSTEE & PHYSICIAN 1.0 49.0 X 0 329713 20355 R RANDALL BENTLEY SR ESQ TRUSTEE 1.0 13.0 X 0 41484 0 ROBERT N CROSS MD TRUSTEE 1.0 13.0 X 0 24103 0 T FITZ JOHNSON TRUSTEE 1.0 15.0 X 0 35232 0 THOMAS M PHILLIPS TRUSTEE 1.0 13.0 X 0 2518 0 W CHARLES BROCK TRUSTEE 1.0 13.0 X 0 42532 0 WALTER G ROBINSON TRUSTEE 1.0 13.0 X 0 6071 0 ALAN R MUSTER MD SVP SPECIALTY DIVISION WMG 1.0 51.0 X 0 633636 80751 ANDREW ALBERRY VP INFO TECH OPS (BEG. 6/2017) 1.0 49.0 X 0 0 0 ANTHONY J BUDZINSKI EVP & CFO 1.0 51.0 X 0 914834 76606 ANTHONY M TRUPIANO SVP SUPPLY CHAIN 1.0 49.0 X 0 388370 49435 BARBARA B COREY SVP MANAGED CARE 1.0 49.0 X 0 420994 41706 BETH KOST SVP COMPLIANCE CHF PRIVACY OFF 1.0 49.0 X 0 363421 37830 BETHANY ROBERTSON VP & CHIEF LEARNING OFFICER 1.0 49.0 X 0 246707 44872 BRADFORD B NEWTON VP INFO. TECHNOLOGY ADMIN. 1.0 49.0 X 0 286933 50759 BRUCE A DEAN VP R.E.DEP.GEN CNSL(END.1/17) 1.0 49.0 X 0 577268 72918 CANDICE L SAUNDERS PRESIDENT & CEO 1.0 51.0 X 0 2113106 77581 CARRIE O PLIETZ EVP & COO HOSPITAL DIVISION 1.0 49.0 X 0 697120 43856 DAVID W ANDERSON EVP/HR/OL/COO 1.0 49.0 X 0 849012 74463 DONALD CAMPBELL MD SVP PE & STUDENT AFF(END 4/17) 1.0 49.0 X 0 72782 0 DOUGLAS ARVIN CPA MBA SVP FINANCE (BEG. 4/2016) 1.0 49.0 X 0 318704 14600 DOUGLAS S FOSTER VP FINANCIAL PLAN. (END. 6/17) 1.0 49.0 X 0 178547 5853 ELIZABETH H LOUDERMILK VP ENT INTELLIGENCE & INTGRTN 1.0 49.0 X 0 294876 47586 ELIZABETH PAPETTI VP OPS HOSP. DIV.(BEG.12/2016) 1.0 49.0 X 0 202923 1985 ELLEN LANGFORD SVP & COO 1.0 49.0 X 0 335511 75412 FREDA LYON VP SYSTEM EMERGENCY SERVICES 1.0 49.0 X 0 221587 35147 JAMES M SWARTZ VP ACCOUNTING 1.0 49.0 X 0 274133 45700 JASON STEVENS VP DEPUTY GEN CNSL (BEG. 2/17) 1.0 49.0 X 0 0 0 JENNIFER GIUSTI VP CLNCL. OUTCOMES(BEG.3/2017) 1.0 49.0 X 0 0 0 JENNIFER GARBER VP HR (BEG. 5/2017) 1.0 49.0 X 0 0 0 JILL M CASE-WIRTH SVP NURSING SERVICES 1.0 49.0 X 0 435891 58077 JIMMY E FRANCIS VP INFO TECH. OPS (END. 12/16) 1.0 49.0 X 0 272960 40309 JOHN A BRENNAN EVP CHIEF CLNC. INTG. OFFICER 1.0 49.0 X 0 893160 23360 JONATHAN B MORRIS MD SVP CHIEF INFO. OFF.(END 3/17) 1.0 49.0 X 0 882549 54516 JOSEPH L BRYWCZYNSKI SVP HEALTH PARKS DEVELOPMENT 1.0 49.0 X 0 434177 72826 KEITH BOWERMASTER VP COMMUNICATIONS (BEG.2/2017) 1.0 49.0 X 0 0 0 KEM M MULLINS EVP AMBULATORY & BUS. DEV. 1.0 49.0 X 0 840741 54100 KENT HAYTHORN VP CLNCL. NURSING (BEG.4/2017) 1.0 49.0 X 0 0 0 KEVIN SCHAEFFER MD VP ONCOLOGY (BEG. 12/2016) 1.0 49.0 X 0 0 0 KIMBERLY TAACA VP OPS SPEC. DIV. (BEG.3/2017) 1.0 49.0 X 0 0 0 KIMBERLY W MENEFEE SVP STRATEGIC COMM. DEVELOP. 1.0 51.0 X 0 394712 51363 KRISTEN S TRICE VP DIAGNOSTIC OUTREACH 1.0 49.0 X 0 205555 36989 KRISTYN M GREIFER MD VP POP. MGMT. (END. 6/2016) 1.0 49.0 X 0 177787 7297 LEO E REICHERT EVP & GENERAL COUNSEL 1.0 49.0 X 0 808514 64680 MARCUS P CHARLSON MD VP SURGERY 1.0 49.0 X 0 136340 13465 MARY L TAVERNARO VP HUMAN RESOURCES OPERATIONS 1.0 49.0 X 0 291022 51368 MAXWELL KAGAN VP FINANCE & CFO (BEG. 4/2017) 1.0 49.0 X 0 0 0 MICHELLE M ROBINSON VP MKTNG./PR/INTERNAL COMM. 1.0 49.0 X 0 291537 43884 PETER R JUNGBLUT MD MBA SVP & MEDICAL DIRECTOR 1.0 49.0 X 0 537169 77857 REBECCA L RUHL VP FACILITY COMPLIANCE OPS 1.0 49.0 X 0 110585 18603 REYNOLD J JENNINGS MD CHIEF STRATEGY OFF.(END. 1/17) 1.0 49.0 X 0 288675 79 RICHARD S SIEGEL VP CARDIOLOGY & CVM ADMIN. 1.0 49.0 X 0 372323 58796 ROBERT J DECOUX VP CORPORATE MED STAFF SVCS 1.0 49.0 X 0 224102 47704 ROBERT MANDLER VP DIAG. OUTREACH (END. 1/17) 1.0 49.0 X 0 307320 63818 ROBIN G BOEHRINGER VP TOTAL REWARDS 1.0 49.0 X 0 215659 25819 SANDRA LUCIUS VP INFO TECHNOLOGY APPS 1.0 49.0 X 0 270147 49145 SEAN P TURNER VP REVENUE CYCLE MANAGEMENT 1.0 49.0 X 0 341777 51093 SNEHAL H DOSHI VP SYSTEM PHARMACIST 1.0 49.0 X 0 237787 46552 SONYA E ALDY VP TALENT ACQ. (BEG. 10/2016) 1.0 49.0 X 0 94689 3035 STEPHEN L BADGER SVP CHIEF ADMIN. OFFICER 1.0 49.0 X 0 747938 70962 STEPHEN VAULT VP BUSINESS DEV. (BEG.10/2016) 1.0 49.0 X 0 59811 1661 TIMOTHY L MASEK VP FINANCE & CFO(END. 8/2016) 1.0 49.0 X 0 7149 0 TOM BONIECKI VP MUSCULSKELETAL NEURO. 1.0 49.0 X 0 164617 64340 VALERY A AKOPOV MD SVP HOSPITAL DIVISION WMG 1.0 49.0 X 0 630442 56054 VARMA RAMESWAR MD VP PEDIATRIC OPS.(BEG.10/2016) 1.0 49.0 X 0 197012 51337 YVETTE BREWER MD VP PRIMARY CARE (BEG. 12/2016) 1.0 49.0 X 0 192442 51446 JANIE MADDOX FORMER TRUSTEE 0.0 0.0 X 0 10379 0 WANDA Y ROBINSON FORMER VP COMPLIANCE 0.0 0.0 X 0 130109 10837 0 22206188 2328662 0 true true false 0 X 0 0 415813 415813 0 362837 362837 0 0 0 0 0 -12848 -12848 -12848 -12848 140239 60102 80137 80137 0 0 0 0 0 0 0 845939 430126 111911 111911 16373 16373 0 0 0 0 0 0 0 0 0 0 0 0 0 30928 30928 0 0 0 0 0 0 0 0 0 0 0 0 0 0 BEREAVEMENT SERVICES 6160 6160 0 MISCELLANEOUS EXPENSES 7499 7499 PATIENT SERVICE EXPENSES 3921 3921 VOLUNTEER SERVICE EXPENSES 2266 2266 179058 148130 30928 0 3587492 1065810 0 0 399958 279825 0 0 0 0 0 0 0 0 0 0 0 0 0 0 10614906 15016467 0 0 0 0 0 0 0 0 14602356 16362102 0 7035 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 7035 X 0 0 13690356 15443067 912000 912000 14602356 16355067 14602356 16362102 X 666881 1068906 16924 X false true X true false X X 1 WEST GEORGIA MEDICAL CENTER INC 205497506 3 true 111911 0 1 111911 0 true false false false false false false false false false false false false false false true RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 14602355 550791 1387967 0 208235 0 16332878 11774139 2295910 781178 256371 14594856 10924729 1314581 -148912 316259 11774139 8583037 2385121 672169 715598 10924729 6274836 1933958 551364 177121 8583037 0.00000 0.06000 0.94000 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, A TAXABLE NOT-FOR-PROFIT. 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 96460 96460 44471 POINSETTIA SALE 28638 28638 13548 1 15141 15141 2083 140239 140239 60102 60102 80137 true WEST GEORGIA MEDICAL CENTER INC 793 SAWYER ROAD MARIETTA GA 300622222 205497506 501(C)(3) 111911 FMV N/A PROGRAM SUPPORT 1 0 HELPING HANDS EMPLOYEE PROGRAM 34 16373 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 245820 0 368505 0 19311 0 47300 0 33451 0 714387 0 0 ANTHONY J BUDZINSKI EVP & CFO 0 627848 0 261647 0 25339 0 47300 0 29306 0 991440 0 0 ANTHONY M TRUPIANO SVP SUPPLY CHAIN 0 301350 0 69055 0 17965 0 47300 0 2135 0 437805 0 0 AVRIL P BECKFORD MD TRUSTEE & CHIEF PEDIATRIC OFF. 0 251638 0 281281 0 -31135 0 28416 0 1782 0 531982 0 0 BARBARA B COREY SVP MANAGED CARE 0 335504 0 72393 0 13097 0 21392 0 20314 0 462700 0 0 BETH KOST SVP COMPLIANCE CHF PRIVACY OFF 0 295632 0 55726 0 12063 0 22418 0 15412 0 401251 0 0 BETHANY ROBERTSON VP & CHIEF LEARNING OFFICER 0 197371 0 35029 0 14307 0 14762 0 30110 0 291579 0 0 BRADFORD B NEWTON VP INFO. TECHNOLOGY ADMIN. 0 209394 0 39846 0 37693 0 22512 0 28247 0 337692 0 28517 BRUCE A DEAN VP R.E.DEP.GEN CNSL(END.1/17) 0 251077 0 46286 0 279905 0 47300 0 25618 0 650186 0 264569 CANDICE L SAUNDERS PRESIDENT & CEO 0 1202152 0 584908 0 326046 0 46319 0 31262 0 2190687 0 305375 CARRIE O PLIETZ EVP & COO HOSPITAL DIVISION 0 537130 0 148556 0 11434 0 19240 0 24616 0 740976 0 0 DAVID W ANDERSON EVP/HR/OL/COO 0 481208 0 223893 0 143911 0 47300 0 27163 0 923475 0 120302 DOUGLAS ARVIN CPA MBA SVP FINANCE (BEG. 4/2016) 0 240963 0 68000 0 9741 0 0 0 14600 0 333304 0 0 DOUGLAS S FOSTER VP FINANCIAL PLAN. (END. 6/17) 0 147125 0 25000 0 6422 0 0 0 5853 0 184400 0 0 ELIZABETH H LOUDERMILK VP ENT INTELLIGENCE & INTGRTN 0 246958 0 38241 0 9677 0 21739 0 25847 0 342462 0 0 ELIZABETH PAPETTI VP OPS HOSP. DIV.(BEG.12/2016) 0 171398 0 30184 0 1341 0 0 0 1985 0 204908 0 0 ELLEN LANGFORD SVP & COO 0 262350 0 61413 0 11748 0 44900 0 30512 0 410923 0 0 FREDA LYON VP SYSTEM EMERGENCY SERVICES 0 180001 0 31256 0 10330 0 13259 0 21888 0 256734 0 0 JAMES M SWARTZ VP ACCOUNTING 0 223163 0 41974 0 8996 0 18992 0 26708 0 319833 0 0 JANIE MADDOX FORMER TRUSTEE 0 10379 0 0 0 0 0 0 0 0 0 10379 0 0 JEFFREY L THARP MD MPH TRUSTEE & CHIEF MEDICNE SRVS 0 317599 0 266590 0 -90278 0 46626 0 33051 0 573588 0 0 JILL M CASE-WIRTH SVP NURSING SERVICES 0 343262 0 77269 0 15360 0 46830 0 11247 0 493968 0 0 JIMMY E FRANCIS VP INFO TECH. OPS (END. 12/16) 0 222789 0 40245 0 9926 0 37002 0 3307 0 313269 0 0 JOHN A BRENNAN EVP CHIEF CLNC. INTG. OFFICER 0 674922 0 204891 0 13347 0 0 0 23360 0 916520 0 0 JONATHAN B MORRIS MD SVP CHIEF INFO. OFF.(END 3/17) 0 411050 0 94664 0 376835 0 25934 0 28582 0 937065 0 362682 JOSEPH L BRYWCZYNSKI SVP HEALTH PARKS DEVELOPMENT 0 293301 0 64545 0 76331 0 47300 0 25526 0 507003 0 58660 KEM M MULLINS EVP AMBULATORY & BUS. DEV. 0 500011 0 223894 0 116836 0 23300 0 30800 0 894841 0 101800 KIMBERLY W MENEFEE SVP STRATEGIC COMM. DEVELOP. 0 307070 0 73247 0 14395 0 29300 0 22063 0 446075 0 0 KRISTEN S TRICE VP DIAGNOSTIC OUTREACH 0 171400 0 25582 0 8573 0 10179 0 26810 0 242544 0 0 KRISTYN M GREIFER MD VP POP. MGMT. (END. 6/2016) 0 164970 0 7500 0 5317 0 2100 0 5197 0 185084 0 0 LEO E REICHERT EVP & GENERAL COUNSEL 0 549786 0 241549 0 17179 0 29300 0 35380 0 873194 0 0 MARY L TAVERNARO VP HUMAN RESOURCES OPERATIONS 0 238222 0 42513 0 10287 0 28907 0 22461 0 342390 0 0 MICHELLE M ROBINSON VP MKTNG./PR/INTERNAL COMM. 0 213429 0 40470 0 37638 0 15756 0 28128 0 335421 0 27733 PAUL DOUGLASS MD TRUSTEE & PHYSICIAN 0 317284 0 9755 0 2674 0 14135 0 6220 0 350068 0 0 PETER R JUNGBLUT MD MBA SVP & MEDICAL DIRECTOR 0 332259 0 50250 0 154660 0 47300 0 30557 0 615026 0 141932 REYNOLD J JENNINGS MD CHIEF STRATEGY OFF.(END. 1/17) 0 37500 0 250415 0 760 0 0 0 79 0 288754 0 0 RICHARD S SIEGEL VP CARDIOLOGY & CVM ADMIN. 0 299416 0 60155 0 12752 0 44675 0 14121 0 431119 0 0 ROBERT J DECOUX VP CORPORATE MED STAFF SVCS 0 180086 0 34799 0 9217 0 22036 0 25668 0 271806 0 0 ROBERT MANDLER VP DIAG. OUTREACH (END. 1/17) 0 223912 0 38881 0 44527 0 46646 0 17172 0 371138 0 22391 ROBIN G BOEHRINGER VP TOTAL REWARDS 0 185699 0 22056 0 7904 0 16979 0 8840 0 241478 0 0 SANDRA LUCIUS VP INFO TECHNOLOGY APPS 0 216590 0 40958 0 12599 0 46550 0 2595 0 319292 0 0 SEAN P TURNER VP REVENUE CYCLE MANAGEMENT 0 269888 0 62153 0 9736 0 21724 0 29369 0 392870 0 0 SNEHAL H DOSHI VP SYSTEM PHARMACIST 0 190008 0 36852 0 10927 0 22230 0 24322 0 284339 0 0 STEPHEN L BADGER SVP CHIEF ADMIN. OFFICER 0 464744 0 157297 0 125897 0 47300 0 23662 0 818900 0 112403 TOM BONIECKI VP MUSCULSKELETAL NEURO. 0 153941 0 8391 0 2285 0 30397 0 33943 0 228957 0 0 VALERY A AKOPOV MD SVP HOSPITAL DIVISION WMG 0 433132 0 115323 0 81987 0 29300 0 26754 0 686496 0 59811 VARMA RAMESWAR MD VP PEDIATRIC OPS.(BEG.10/2016) 0 175485 0 17885 0 3642 0 39573 0 11764 0 248349 0 0 WANDA Y ROBINSON FORMER VP COMPLIANCE 0 82021 0 42652 0 5436 0 3867 0 6970 0 140946 0 0 YVETTE BREWER MD VP PRIMARY CARE (BEG. 12/2016) 0 165601 0 24319 0 2522 0 31192 0 20254 0 243888 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 2016 CALENDAR YEAR FROM EITHER THE ORGANIZATION OR A RELATED ORGANIZATION: DONALD CAMPBELL, MD $ 69,282 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): JONATHAN B. MORRIS, MD $362,682 CANDICE L. SAUNDERS 305,375 BRUCE A. DEAN 264,569 PETER R. JUNGBLUT, MD, MBA 141,932 DAVID W. ANDERSON 120,302 STEPHEN L. BADGER 112,403 KEM M. MULLINS 101,800 VALERY A. AKOPOV, MD 59,811 JOSEPH L. BRYWCZYNSKI 58,660 BRADFORD B. NEWTON 28,517 MICHELLE M. ROBINSON 27,733 ROBERT MANDLER 22,391 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, 2017. 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. 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 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 trustee of Wellstar; provided, however, the full Board of Trustees evaluates and approves the compensation of the Chief Executive Officer. The philosophy requires annual disclosure of the committee's actions and decisions to the full board, which it has done. The committee is guided by the board-approved philosophy. Overall, the philosophy is intended to reward for organizational and individual performance. When performance is at a predetermined targeted level, the compensation is intended to be at or around the median of compensation paid to similar positions at similar organizations (the "market"). Wellstar's executive compensation philosophy defines the market as being comprised of comparable not-for-profit health care delivery systems, i.e., not-for-profit organizations similar in complexity and scale to Wellstar. To assist the committee in fulfilling its duties, the committee engaged the Hay Group to provide market compensation data to compare to the Wellstar positions whose compensation the committee oversees. The committee uses this data to provide context when making decisions in administering the compensation program. Accurate minutes of the committee's discussion and decisions are recorded during each committee meeting, and reviewed and approved by the full Board of Trustees at its next scheduled meeting. 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: $ 16,924 CHS Foundation Inc 793 SAWYER ROAD Marietta GA 300622222 581649540 Foundation GA 501(C)(3) 12 II WHS INC true Douglas Hospital Inc 793 SAWYER ROAD MARIETTA GA 300622222 582026750 Healthcare GA 501(C)(3) 3 WHS INC true Kennestone Hospital Inc 793 SAWYER ROAD Marietta GA 300622222 582032904 Healthcare GA 501(C)(3) 3 WHS INC true Paulding Medical Center Inc 793 SAWYER ROAD MARIETTA GA 300622222 582095884 Healthcare GA 501(C)(3) 3 WHS INC true Wellstar Foundation Inc 793 SAWYER ROAD MARIETTA GA 300622222 581627413 Foundation GA 501(C)(3) 12 II WHS INC true Wellstar Health System Inc 793 SAWYER ROAD MARIETTA GA 300622222 581649541 Healthcare GA 501(C)(3) 12 II NA false WELLSTAR ATLANTA MEDICAL CENTER INC 793 SAWYER ROAD MARIETTA GA 300622222 810837031 HEALTHCARE GA 501(C)(3) 3 WHS INC true WELLSTAR NORTH FULTON HOSPTIAL INC 793 SAWYER ROAD MARIETTA GA 300622222 810851756 HEALTHCARE GA 501(C)(3) 3 WHS INC true WELLSTAR SPALDING REGIONAL HOSPITALINC 793 SAWYER ROAD MARIETTA GA 300622222 810864789 HEALTHCARE GA 501(C)(3) 3 WHS INC true WELLSTAR SYLVAN GROVE HOSPITAL INC 793 SAWYER ROAD MARIETTA GA 300622222 810875069 HEALTHCARE GA 501(C)(3) 3 WHS INC true WEST GEORGIA HEALTH SERVICES INC 793 SAWYER ROAD MARIETTA GA 300622222 205497622 HEALTHCARE GA 501(C)(3) 12 II WHS INC true WEST GEORGIA MEDICAL CENTER INC 793 SAWYER ROAD MARIETTA GA 300622222 205497506 HEALTHCARE GA 501(C)(3) 3 WGHS INC true VERNON WOODS RETIREMENT COMMUNITY INC 793 SAWYER ROAD MARIETTA GA 300622222 582575049 HEALTHCARE GA 501(C)(3) 10 WGHS INC true MEDICAL PARK FOUNDATION INC 1514 VERNON ROAD LAGRANGE GA 300622222 581303478 FOUNDATION GA 501(C)(3) 7 WGHS INC true COBB HOSPITAL INC 793 SAWYER ROAD MARIETTA GA 300622222 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