2016-05-13T13:20:58-05:00 2015-06-30 PricewaterhouseCoopers LLP 2001 MARKET ST SUITE 1800 PHILADELPHIA PA 19103 990 2014-07-01 582032904 KENNESTONE HOSPITAL INC % JAMES M SWARTZ KENN 7707925023 805 Sandy Plains Road Marietta GA 300666340 JAMES M SWARTZ VP, ACCOUNTING 2673303000 2016-05-12 true JOANNE KRUEGER P01235586 2673303000 2014 2016-08-17 19:52:53Z CANDICE L SAUNDERS 805 SANDY PLAINS ROAD MARIETTA GA 30066 948418808 false X www.wellstar.org X 1993 GA To provide world-class charitable healthcare to the community. 18 9 5481 381 115636 0 0 0 816044685 922320839 242878 199405 20151284 25898564 836438847 948418808 500 16550 0 0 291503229 312606840 0 0 0 431687279 453460066 723191008 766083456 113247839 182335352 650984427 628535643 265817652 252608997 385166775 375926646 X 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 666449587 16550 922320839 SEE SCHEDULE O 666449587 true false false false false false false false false true false false false true true false true false false false false false false false false true true false false true false false false false false false false false false false false false false true true false false false true 0 0 5481 true true true false false false false false false false false false false false false X 18 9 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 7707925023 805 SANDY PLAINS ROAD Marietta GA 300666340 X Avril P Beckford MD TRUSTEE 2.0 48.0 X 0 484008 29400 Jeffrey L Tharp MD TRUSTEE 2.0 48.0 X 0 630869 74725 RANDALL BENTLEY SR TRUSTEE 1.0 5.0 X 0 19268 0 OTIS A BRUMBY III TRUSTEE 1.0 5.0 X 0 14475 0 ROBERT N CROSS MD TRUSTEE 1.0 5.0 X 0 14446 0 TE RUSTY DURHAM TRUSTEE EMERITUS 1.0 5.0 X 0 661 0 THOMAS E GEARHARD MD TRUSTEE 2.0 48.0 X 0 347375 73211 DAVID H HAFNER MD TRUSTEE 1.0 5.0 X 0 26223 0 T FITZ JOHNSON TRUSTEE 1.0 7.0 X 0 20712 0 CHARLES J JONES TRUSTEE 1.0 5.0 X 0 4075 0 JANIE MADDOX TRUSTEE - CHAIR 1.0 5.0 X 0 8850 0 GARY A MILLER TRUSTEE - VICE CHAIR 1.0 5.0 X 0 4387 0 MITZI MOORE TRUSTEE 1.0 5.0 X 0 1730 0 TOM PHILLIPS TRUSTEE 1.0 5.0 X 0 2903 0 WALTER ROBINSON TRUSTEE 1.0 5.0 X 0 4672 0 FRANK ROS TRUSTEE 1.0 5.0 X 0 2820 0 ORIN SWAYZE MD TRUSTEE 1.0 5.0 X 0 4624 0 GREG MORGAN TRUSTEE 1.0 5.0 X 0 1624 0 WILLIAM C BROCK TRUSTEE 1.0 5.0 X 0 20247 0 STEVEN W OWEIDA MD TRUSTEE EMERITUS 1.0 5.0 X 0 31409 0 W ALLEN SEPARK TRUSTEE EMERITUS 1.0 7.0 X 0 8177 0 Valery A Akopov MD VP & Chief of Hospitalist Svcs 2.0 48.0 X 0 399745 53663 David W Anderson EVP HR OL CCO 2.0 48.0 X 0 648929 70290 Nicole V Ashe VP Finance & CFO WMG 2.0 48.0 X 0 262185 45885 Barbara G Ballard VP Homecare & Hospice 2.0 48.0 X 0 282836 64915 Betty A Brakovich VP CNO Patient Care Services 50.0 0.0 X 196569 0 35792 Joseph L Brywczynski SVP Health Parks Development 2.0 48.0 X 0 570096 70144 Anthony J Budzinski EVP & CFO 2.0 50.0 X 0 689236 71096 Donald Campbell MD SVP Phys Educ & Student Aff 2.0 48.0 X 0 513317 62483 Laura Caramanica VP CNO Patient Care Services 50.0 0.0 X 454652 0 55534 Jill M Case-Wirth SVP Nursing SRVS.(BEGIN. 12/1) 2.0 48.0 X 0 72410 4759 James E Clements VP Bus Dev & Strategic Prtnrsp 2.0 48.0 X 0 264016 17453 Lee R Cook VP Med & Behavioral Health 2.0 48.0 X 0 592708 45052 Barbara B Corey SVP Managed Care 2.0 48.0 X 0 379163 48129 Bruce A Dean VP Real Estate Deputy Gen Cnsl 2.0 48.0 X 0 282461 69841 Sarath Degala VP Revenue Cycle Management 2.0 48.0 X 0 19850 2923 Marcia Delk-Payne MD SVP Med Affair & Chf Qlty Ofcr 2.0 48.0 X 0 925812 49890 Nancy R Doelling VP Pediatric SRVS.(BEGIN. 8/4) 2.0 48.0 X 0 141009 11811 Jimmy E Francis VP Info Technology Operations 2.0 48.0 X 0 257027 36192 Steven L Grace VP Talent Acquisition 2.0 48.0 X 0 266953 32731 Kristyn M Greifer MD VP Population Management 2.0 48.0 X 0 369983 28680 Martin L Gutkin VP Finance & Hospital CFO 50.0 0.0 X 258323 0 9294 Joel W Helmke VP Oncology (BEGIN. 7/21) 2.0 48.0 X 0 165514 28875 Robert D Jansen MD EVP & Pres Medical Group 2.0 48.0 X 0 782540 75243 Reynold J Jennings PRESIDENT & CEO 2.0 50.0 X 0 1701981 2056 Peter R Jungblut MD SVP & Medical Dir WMG 2.0 48.0 X 0 398803 69399 Christopher M Kane SVP Strategic Plan & Bus Dev 2.0 48.0 X 0 806400 42332 Beth Kost VP Compliance Chf Privacy Ofcr 2.0 48.0 X 0 331700 34022 Ellen Langford SVP & COO WellStar Med Group 2.0 48.0 X 0 279307 58966 Louis W Little SVP Post Acute Svc & Hosp Pres 40.0 10.0 X 579061 0 66520 Elizabeth H Loudermilk VP Ent Intelligence & Intgrtn 2.0 48.0 X 0 308160 25651 Robert M Lubitz MD VP Medical Affairs 50.0 0.0 X 421782 0 50548 Sandra Lucius VP Info Technology Apps 2.0 48.0 X 0 224424 46993 Robert Mandler VP Diagnostic Outreach 2.0 48.0 X 0 290840 61524 Patricia A Mayne VP Emergency Services 40.0 10.0 X 311329 0 50119 Kimberly W Menefee SVP Strategic Community Dev 2.0 48.0 X 0 362955 46026 Christopher L Morgan VP & Admin. CLIO (BEGIN. 7/7) 2.0 48.0 X 0 168139 21747 Jonathan B Morris MD SVP Chief Info Officer 2.0 48.0 X 0 462389 50258 Bradford B Newton VP Information Technology Admi 2.0 48.0 X 0 232340 47711 Michael G Paul VP Facilities Eng Support Svcs 2.0 48.0 X 0 220953 24150 Leo E Reichert EVP & General Counsel 2.0 48.0 X 0 752077 29200 Bethany Robertson VP & Chief Learning Officer 2.0 48.0 X 0 218673 41608 Michelle M Robinson VP Mktng/PR/Internal Comm 2.0 48.0 X 0 238847 40651 Wanda Y Robinson VP Compliance PWHP(BEGIN.9/15) 2.0 48.0 X 0 82927 2538 Deborah Roegge De Vita VP Women & Newborn Svc Line 2.0 48.0 X 0 231925 31900 Candice L Saunders President & CEO 2.0 48.0 X 0 812226 72916 Christopher B Scullen VP Pulmonology Operations 2.0 48.0 X 0 292246 17839 Richard S Siegel VP Cardiology & CVM Admin 2.0 48.0 X 0 323664 70462 Jeffery D Stanley VP Pharmacy & System Coor 2.0 48.0 X 0 216271 30238 Daniel J Styf SVP PW Health Plan 2.0 48.0 X 0 337033 27733 James M Swartz VP Accounting 2.0 48.0 X 0 272353 42262 Mary L Tavernaro VP Human Resources Operations 2.0 48.0 X 0 259157 49126 Adam C Thompson VP Surgery 2.0 48.0 X 0 228073 21830 Anthony M Trupiano SVP Supply Chain 2.0 48.0 X 0 345219 47596 Sean P Turner VP Rev.Cycle MGMT (BEGIN.9/28) 2.0 48.0 X 0 273082 46665 Monte A Wilson VP & COO Kennestone Hospital 50.0 0.0 X 346226 0 26235 Robin Wilson MD SVP Chief Hlth Innov Officer 2.0 48.0 X 0 637993 22144 Daniel J Woods SVP & Hospital President 48.0 2.0 X 482590 0 70359 Chester A Zborowski VP Health Parks Operations 2.0 48.0 X 0 223151 24265 LOUIS LOVETT AVP GME/DIO 50.0 0.0 X 288896 0 65491 JYOTSNA R VANAPALLI Rad Oncology Chief Physicist 50.0 0.0 X 199632 0 42396 SHERRON KURTZ Exec Dir Surgical Svcs KH/CH 50.0 0.0 X 184199 0 14981 JANET P MEMARK MD Physician Group 50.0 0.0 X 176192 0 20499 CAROLE J HARMAN Exec Dir Women's Nursing 50.0 0.0 X 168894 0 33082 Michael L Graue FORMER EVP & COO 0.0 0.0 X 0 522266 0 Kenneth C Kunze MD FRMR SVP CHIEF MEDICAL OFFICER 0.0 0.0 X 0 383389 0 4068345 21978308 2758049 255 true true false BRASSFIELD AND GORRIE 1990 Vaughn Rd NW STE 100 KENNESAW GA 30144 General Contractor 25880985 CDH Partners Inc 675 Tower Road MARIETTA GA 30060 General Contractor 1566417 FRESENIUS MEDICAL CARE- DBA RCC MAR PO BOX 101518 ATLANTA GA 303921518 Medical Services 1150750 Quest Diagnostics PO Box 740736 ATLANTA GA 303740736 Medical Services 2060831 SOUTHERN PRESCRIPTION SERVICE PO BOX 888387 ATLANTA GA 30356 TRANSCRIPTION SRVS 994489 44 0 PATIENT REVENUE 621990 915965098 915965098 MEDICAL RECORDS 621990 845 845 INDEPENDENT & ASSISTED LIVING REVENUE 623000 6319865 6319865 PATIENT EDUCATION 621990 35031 35031 922320839 0 0 0 3128387 0 3128387 0 3128387 3128387 199405 0 199405 199405 199405 0 0 0 PHARMACY/RETAIL PHARMACY 446199 10224480 115636 10108844 LAB OUTREACH 621990 340497 340497 CAFETERIA 621990 4888670 4888670 7316530 7316530 22770177 948418808 922320839 115636 25982333 0 16550 16550 0 0 3049198 2687378 361820 0 243623727 220409473 23214254 0 12043902 10895245 1148657 36119704 32677042 3442662 17770309 16072149 1698160 0 66243 66243 0 0 0 0 38744360 36092951 2651409 630949 172643 458306 24150658 16689057 7461601 0 0 12937187 5636580 7300607 250025 101856 148169 0 338459 127386 211073 9121505 9121505 146797654 132776768 14020886 35249651 16190772 19058879 6143685 6143685 REPAIRS & MAINTENANCE 12530921 9488209 3042712 0 MEDICAL SUPPLIES 165791728 165683853 107875 OTHER OPERATING EXPENSES 707041 731675 -24634 766083456 666449587 99633869 0 32275 0 104910 896320 0 0 193622402 164823168 0 0 0 0 0 0 15840014 16375511 4384708 1378887 810762526 370965818 432526642 439796708 0 0 0 0 0 0 0 0 4473476 5265049 650984427 628535643 29668001 21282581 0 0 0 0 0 0 0 0 0 0 0 0 0 0 236149651 231326416 265817652 252608997 X 385166775 375926646 0 0 0 0 385166775 375926646 650984427 628535643 X 182335352 -191575481 X false true X true false X 44606550 44606550 434179416 152148081 282031335 16143183 6148551 9994632 304437750 211062951 93374799 11395627 1606235 9789392 439796708 0 ASSET RETIREMENT - OTHER LT 1909185 TAX EXEMPT BOND LIAB-DUE TO WH 229417231 231326416 X SCHEDULE D, PART X, LINE 2 The following footnote is related to the organization's application of FIN 48 (ASC 740): "Wellstar (including KENNESTONE Hospital) and all but one of its affiliates have been recognized as exempt from Federal income tax under Internal Revenue Code Section 501(a) as organizations described in Section 501(C)(3) and, therefore, related income is generally not subject to Federal or state income taxes. Community Assurance Corporation 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 60436392 60436392 0.07890 61648929 54261148 7387781 0.00960 122085321 54261148 67824173 0.08850 1480786 1480786 0.00190 264354 264354 0.00040 1745140 1745140 0.00230 123830461 54261148 69569313 0.09080 true 24248000 2481868 281631693 321956762 -40325069 X true true 2 1 KENNESTONE HOSPITAL 677 CHURCH STREET MARIETTA GA 30060 www.wellstar.org 033-548 X X X HEALTH PARK INPATIENT HOSPICE 2 WINDY HILL HOSPITAL 2540 WINDY HILL ROAD MARIETTA GA 30067 www.wellstar.org 033-545 X X LONG TERM ACUTE CARE KENNESTONE HOSPITAL 1 false false true X X X X X X X X X X 12 true false false true X SEE PART V, SECTION C X SEE PART V, SECTION C X true 12 true SEE PART V, SECTION C false false true X 125. 300. X X X X X X true true X X X X X true X SEE PART V, SECTION C X SEE PART V, SECTION C X X X X X X true X false X X X X true X false false WINDY HILL HOSPITAL 2 false false true X X X X X X X X X X 12 true false false true X SEE PART V, SECTION C X SEE PART V, SECTION C X true 12 true SEE PART V, SECTION C false false true X 125. 300. X X X X X X true true X X X X X true X SEE PART V, SECTION C X SEE PART V, SECTION C X X X X X X true X false X X X X true X false false SCHEDULE H, PART V, SECTION, LINE 3J OTHER DESCRIPTIONS FROM THE COMMUNITY HEALTH NEEDS ASSSESSMENT (CHNA): The Community Health Needs Assessment for Kennestone hospital and Windy Hill HOSPITAL, provides a list of WellStar Health System CHNA collaborators including individuals, organizations, and governmental agencies that were consulted and contributed special knowledge of medically underserved and low income populations and/or expertise in public health. SCHEDULE H, PART V, SECTION B, LINE 5 INPUT FROM COMMUNITY REPRESENTATIVES & COMMUNITY SOURCES: Kennestone and Windy Hill Hospitals integrated multiple sources of data from national and state web-based data platforms with multiple primary data gathering methods (see list below). As a partner in the strategic planning process utilized by Cobb & Douglas Public Health (CDPH) called Mobilizing for Action through Planning and Partners (MAPP) from the National Association of County & City Health Officials, the hospital leveraged the findings from the community health needs assessments conducted in tax year 2012. Through a grant by the Centers for Disease Control and Prevention, Kennestone and Windy Hill hospitals partnered with CDPH and formed coalition, Cobb 2020, to conduct its needs assessment via multiple modalities: MAPP workgroups, focus groups, surveys, Key Informant interviews, and implementation teams to act upon identified strategic issues in the community. To collect robust data for counties WellStar serves outside of Cobb, WellStar enlisted expertise of county and regional public health officials, independent consultants, and other Key Informants. A listing of collaborators can be found in the Appendix of the hospital facility's CHNA reports publicly available at wellstar.org. Quantitative Data Sources Including: 1. Georgia Department of Public Health, OASIS 2. Centers for Disease Control and Prevention (CDC) Vital Statistics 3. Agency for Healthcare Research and Quality (AHRQ) 4. U.S. Census Bureau 5. U.S. Department of Health and Human Services 6. Kaiser Permanente Web-Based CHNA Platform 7. Catholic Health Association CHNA resources 8. County Health Rankings & Roadmaps, University of Wisconsin 9. Healthy People 2020 10. Behavorial Risk Factor Surveillance System (BRFSS) 11. WellStar Health System - Kennestone & Windy Hill Hospital's FY2012 utilization data to assess service area zip codes accounting for 90 percent of hospital admissions and visits and primary service areas. Qualitative Data Sources Including: 1. Cobb County Focus Group Report - 58 people participated in six focus group representing 14 zip codes. Demographics varied among the groups indicative of the zip codes represented. Two groups were conducted in Spanish and reflected low-income, low education attainment and medically underserved populations. 2. MAPP Assessment Workgroups with representatives from Douglas and Cobb counties conducted four community assessments which helped develop the Cobb 2020 Community Health Improvement Plan. This included the 2011 Field Test Local Public Health System Assessment by the National Public Health Performance Standards Program (NPHPSP). 3. Cobb Key Informant Interview Report - 20 participants identified by Cobb 2020's Community Strengths and Themes Workgroup to represent different sectors of the Cobb community who possessed above average knowledge of the healthcare issues, healthcare system or the community. 4. Cobb MAPP Community Survey Report - A 44 question telephone survey of 1,244 adults ages 18-94 performed by the A.L. Burruss Institute for Public Service and Research, Kennesaw State University. 5. Cobb County 2010 - How Healthy Are We? 6. Cobb County MAPP Forces of Change Assessment Summary Report 7. Bartow, Cherokee and Paulding County Key Informant interviews of community stakeholders led by Ron Chapman, Principal, Magnetic North, LLC, a third-party consultanT. SCHEDULE H, PART V, SECTION B, LINE 6A ORGANIZATIONS INCLUDED IN COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA): While both Kennestone and Windy Hill HOSPITALs each conduct its own community health needs assessment there may be some overlap with the other hospitals in WellStar Health System simply because of the geographic constraints and structure of the organization. The community served therefore is defined by similar zip codes and areas of services. SCHEDULE H, PART V, SECTION B, LINES 7A & 7B THE KENNESTONE HOSPITAL, INC. CHNA / WINDY HILL HOSPITAL CHNA CAN BE FOUND ONLINE AT THE FOLLOWING: KENNESTONE HOSPITAL,INC. WEBSITE: http://www.wellstar.org/locations/pages/wellstar-kennestone-hospital.aspx AND WELLSTAR HEALTH SYSTEM WEBSITE: http://www.wellstar.org/pages/default.aspx SCHEDULE H, PART V, SECTION B, LINE 10A KENNESTONE HOSPITAL'S MOST RECENTLY ADOPTED IMPLEMENTATION STRATEGY CAN BE found ON ITS WEBSITE AT: http://www.wellstar.org/aboutus/documents/implementation_strategy/kennesT one_implementation_strategy_11112013.pdf AND WINDY HILL HOSPITAL'S MOST RECENTLY ADOPTED IMPLEMENTATION STRATEGY CAN BE found ON ITS WEBSITE AT: http://www.wellstar.org/aboutus/Documents/ImplEMentation_Strategy/windyhil l_implementation_strategy_11112013.pdf SCHEDULE H, PART V, SECTION B, LINE 11 PROGRAMS & STRATEGIES TO ADDRESS THE NEEDS OF THE COMMUNITY: KENNESTONE / WINDY HILL HOSPITAL Based on the prioritized health needs, WellStar will implement a five-year, two-phased Community Benefit program that is sustainable and strategically aligned with the WellStar Health System mission and vision to address the prioritized health needs of the uninsured and low-income populations. This is accomplished through expanding provider participation, education, outreach and prevention activities/programs to promote healthy lifestyles and access to care (Phase 1) and creating a collaborative safety net organization for shared accountability to leverage and maximize complementary skills and capacity building (Phase 2). Currently, Phase 2 has shifted from creating an organization to integrating this type of care delivery into the community benefit services WellStar delivers at a health system-level across all hospitals. Progress ongoing in Phase 2: Strategy: Improve access to care to vulnerable populations - Strengthen collaborative partnerships with community stakeholders to increase access to preventative and primary care, improve quality and reduce costs. - Reduce preventable hospital admissions, re-admissions and Emergency Department visits by redirecting care to community clinics and primary care via the hospital-based care management program. - Increase the number of hospital-affiliated/WellStar Physicians Group primary care providers and specialists providing free or low-cost healthcare programs/clinics via a Graduate Medical Education program. (Commences in 2017) - Participate as a Cobb Access Health integrator/partner to build a low-income healthcare delivery system in Cobb County. (not being pursued as a separate entity, but as a part of community benefit services delivered by WellStar.) - Improve medication access through centralized reduced cost Pharmaceutical Patient Access Programs and the Federal 340B Drug Pricing Program for the management of chronic disease and to reduce complications. (Currently assessing the program) - Evaluate hospital-based subsidized health services to more effectively and efficiently allocate assets addressing prioritized needs of the medically underserved and uninsured. STRATEGY: Promote healthy lifestyles via preventative care, programs and activities - Engage faith-based organizations in coordination and provision of care (MEMPHIS Model). (Pilot to be conducted at WellStar Paulding Hospital.) - Expand free health screenings to the underserved and uninsured through WellStar Corporate & Community Health. - Provide at-risk, low income first time moms with care and education for healthy pregnancies via nurse home visiting program. (Not being pursued at this time.) - Collaborate with Cobb2020 Healthy Lifestyle initiatives (including physical activity, healthy eating, and obesity). - Provide community benefit leadership/consultation for the prevention and management of diabetes, cancer and cardiovascular disease. (Being delivered on a System-wide level.) - Increase cancer prevention and education community outreach (including smoking cessation program) utilizing WellStar Cancer Program team. (Underway) - Improve prevention-based educational resources and the referral process to free or low-cost healthcare clinics for continuity of care within the Emergency Department. UNADDRESSED CHNA NEEDS - Selection criteria for KENNESTONE HOSPITAL'S prioritized health needs were primarily based upon the bandwidth to build a sustainable community benefit model focused on preventable health behaviors and access to care. Sexually transmitted infections and teen pregnancy are not addressed leaving awareness education with schools, family and churches since the health needs are more cultural and societal. Improvement to health needs stemming from socioeconomic and physical environmental FACTORS such as air quality and transportation, gain traction from public policy and education. A health system can complement efforts to impact policy, but has to rely on public health, state and local municipalities and federal governmental agencies to drive these types of health improvements. Key questions when addressing health needs are: 1.) Do we have existing facilities and resources dedicated to the health needs showing clear disparities and poor performance? And, 2.) do we have effective and feasible interventions, a successful solution that has the potential to solve multiple problems, and the opportunity to intervene at the prevention level? Other needs not addressed are either beyond the scope or expertise of KENnESTONE Hospital, not being addressed at this time or are being addressed by WellStar on a system level or via other partners in public health. SCHEDULE H, PART V, SECTION B, LINE 13B FAP ELIGBILITY CRITERIA - INCOME LEVEL OTHER THAN FPG: The hospital abides by the financial assistance requirements under IRC 501(R)(5). IRC 501(R)(5) requires health care facilities to limit the amounts charged for emergency and other medically necessary care that is provided to individuals eligible for assistance under the health care facilities financial assistance policy to not more than the amounts generally billed to individuals who have insurance. The hospital extends its sliding scale for Community Financial Aid eligibility well beyond the minimum government levels to 300% of FPG. WellStar has chosen to use the average of the three best negotiated commercial rates as the trigger to not exceed in the application of the discounts/amounts charged to patients, on our sliding scale. SCHEDULE H, PART V, SECTION B, LINE 13H FAP ELIGBILITY CRITERIA - OTHER CRITERIA: Other special circumstances may qualify a patient for full indigent or sliding scAle Charity benefits. Special circumstances may include but not limited to: - Patient deceased, with verification that there is no estate. - Unable to contact patient but Propensity to Pay software returns a low ability/low propensity designation. SCHEDULE H, PART V, SECTION B, LINE 15 METHOD FOR APPLYING FOR FINANCIAL ASSISTANCE: In order to qualify for Financial Assistance, cooperation with WellStar Health System hospital Community Financial Assistance staff is necessary in identifying and determining alternative sources of payment or coverage from public and private payment programs. For qualification of financial assistance under the hospital's policy, a patient (or his or her guardian or family member) must: - Submit a true, accurate, signed and completed application for financial assistance; - Provide a copy of the prior year Federal Income Tax Return and W2/1099 (including all schedules); or Provide two of the following if unable to provide a copy of the most recent Federal Income Tax Return: - Provide THREE months of the most recent pay stubs (or certification of unemployment) or; - Separation Notice or unemployment claim if unemployed; or - Provide THREE current bank statements for all checking and savings accounts; or - Provide award letter from social Security Office; or - Provide Current Profit and Loss report for all self-employed applicants; or - Current CD, 401k, 403b, IRA and other investment statements; or - Provide Asset Statement, with equity adjustments (Rental property, land second houses). Community Financial Assistance eligibility will be determined based on a thorough review of the submitted information. SCHEDULE H, PART V, SECTION B, LINE 16A THE WELLSTAR HEALTH SYSTEM COMMUNITY FINANCIAL ASSISTANCE POLICY CAN BE FOUND ON ITS WEBSITE: http://www.wellstar.org/about-us/policies-procedures/pages/community-finan cial-assistance-policy.aspx SCHEDULE H, PART V, SECTION B, LINE 16B THE WELLSTAR HEALTH SYSTEM FINANCIAL ASSISTANCE APPLICATION CAN BE FOUND ON ITS WEBSITE: http://www.wellstar.org/about-us/policies-procedures/documents/community-f inancial-aid-application.pdf SCHEDULE H, PART V, SECTION B, LINE 16I PUBLICATION OF THE FINANCIAL ASSISTANCE POLICY (FAP): In addition to the other methods of posting the financial assistance policy, the hospital makes available for patients in admissions and outpatient registration areas a brochure including frequently asked questions. SCHEDULE H, PART V, SECTION B, LINE 20E ADDITIONAL EFFORTS MADE BEFORE COLLECTIONS ACTION INITIATED: The hospital facility also notified individuals of the financial assistance policy online at http://www.wellstar.org/pages/online-bill-pay.aspx. Furthermore, the hospital facility utilizes a propensity to pay software. Individuals with a low ability/low propensity designation may qualify for full indigent or sliding scale charity benefits. SCHEDULE H, PART I, LINE 6A PUBLICATION OF COMMUNITY BENEFIT REPORT: Kennestone Hospital, Inc.(consisting of Kennestone Hospital and Windy Hill Hospital) is an affiliate of Wellstar Health System, Inc. which on an annual basis issues a community benefit report. This report is subsequently distributed in and around the five county service area of the health system. It is also annually filed with Cobb County and the state of Georgia Department of Community Health. Additionally the information on community benefit is included in aggregate for Wellstar Health System, Inc. and affiliated hospitals as part of the Georgia Hospital Association's annual report. On an annual basis the hospital reports its community health benefits report to the Georgia Hospital Association (GHA). GHA aggregates the hospital specific reports into a statewide community health benefit report. The State of Georgia also requires hospitals to file the Hospital Financial Survey and the Indigent Care Trust Fund Survey so that it can collect information on hospital financial class categories and also to determine the amount of uncompensated care by hospital. THE COMMUNITY BENEFIT REPORT CAN BE FOUND AT THE FOLLOWING WEBSITES: Kennestone HOSPITAL: http://www.wellstar.org/ about-Us/documents/chna/kennestone_chna_06172013.PDF Windy Hill HOSPITAL: http://www.wellstar.org/ about-us/documents/chna/windyhill_chna_06172013.PDF SCHEDULE H, PART I, LINE 7 COST TO CHARGE RATIO: For purposes of the IRS Form 990 Schedule H, Wellstar Health System and Affiliates (including Kennestone and Windy Hill Hospitals) have estimated the current year cost to charge ratio for each hospital as it is reported in the annual community benefit report and as it will be reported in the state's Annual Hospital Financial Survey. SCHEDULE H, PART III, SECTION A, LINE 2 METHODOLOGY USED TO ESTIMATE BAD DEBT: The reported bad debt charges is derived from the unpaid balances of patient accounts that are deemed uncollectible after 120 days of collection effort by the hospital's patient financial services staff. The unpaid patient accounts are then sent to collection agencies and any collected amount is deemed as bad debt recovery. The source of this data is the hospital's detailed financial trial balance. The net reported bad debt charges are then multiplied by the Hospital Financial Survey calculated cost to charge ratio to arrive at the estimated bad debt expense. SCHEDULE H, PART III, SECTION A, LINE 3 METHOLODOGY & RATIONALE USED TO DETERMINE BAD DEBT ATTRIBUTABLE TO PATIENT'S ELIGIBLE UNDER ORGANIZATION'S FAP: The bad debt attributable to patients eligible under the hospital's financial assistance program is determined using a weekly bad debt conversion report for a period of twelve months. The conversion rate for this period is used to determine this bad debt category. The total reported conversion charges is multiplied by a calculated cost to charge ratio to arrive at the cost of bad debt attributable to patient's eligible under the hospital's FAP. SCHEDULE H, PART III, SECTION A, LINE 4 FOOTNOTE ON BAD DEBT & RATIONALE FOR COMMUNITY BENEFIT: The following footnote is detailed in the Wellstar Health System, Inc. and Affiliates Combined Financial Statements related to bad debt or uncollectible accounts: "During 2011, Wellstar adopted the provisions of FASB Accounting Standards Update (2011-07), Healthcare Entities (Topic 954). ASU 2011-07 requires the reclassification of the provision for uncollectible accounts associated with patient service revenue from an operating expense to a deduction from patient service revenue (net of contractual allowances and discounts)." "Wellstar recognizes patient service revenue associated with services provided to patients with third-party payor coverage on the basis of contractual rates for the services rendered. For uninsured patients that do not qualify for community financial aid, Wellstar recognizes revenue on the basis of its discounted rates for services provided. On the basis of historical experience, a significant portion of Wellstar's uninsured patients are unable or unwilling to pay for the services provided. Thus, Wellstar records a significant provision for uncollectible accounts related to uninsured patients in the period the services are provided." Subsequent to the end of the reporting period a propensity to pay review of patient accounts often results in prior year bad debt accounts which are deemed eligible for the organization's financial assistance policy. Those bad debt accounts are reclassified as charity and thus our rationale for including in community benefit. SCHEDULE H, PART III, SECTION B, LINE 8 MEDICARE SHORTFALLS: Kennestone and Windy Hill Hospitals are providers of inpatient and outpatient services to Medicare program beneficiaries at determined rates. Without the participation in the Medicare program these patients may not have had convenient access to those services. The Medicare shortfall on SCHEDULE H, Part III, Section B, line 7 represents the uncompensated difference between the expected reimbursement and the Medicare charges for those services stated at cost. We determine a cost to charge ratio for Medicare patients as part of the annual filing of the Medicare cost report. SCHEDULE H, PART III, SECTION C, LINE 9B COLLECTION PRACTICES: The policy written for collection practices that applies to all Wellstar Health System entities incorporates guidelines for personnel in the admissions and patient access areas to be trained in identifying patients that might qualify for financial assistance. It is also the policy of all Wellstar facilities to have at least one employee or contractor available at all times, especially in the hospitals with emergency rooms, who can provide assistance with the paperwork necessary to help patients who would qualify for governmental and other assistance programs. SCHEDULE H, PART VI, LINE 2 NEEDS ASSESSMENT: To assess the current health and well-being of the community served, WELLSTAR HEALTH SYSTEM, INC., KENNESTONE HOSPITAL, AND WINDY HILL HOSPITAL, conducted a Community Health Needs Assessment (CHNA), a collaborative effort involving hospital leadership, public health agencies, Cobb2020, and a diverse coalition of community stakeholders. Partners represented a broad knowledge base of the hospital's primary service area comprising Bartow, Douglas, Cherokee, Cobb, and Paulding counties and some outlying zip codes determined by utilization. To assess the current community health status and capture a broad base of input, collaborators engaged IN a strategic process called Mobilizing for Action Through Planning and Partnerships (MAPP) Launched by Cobb & Douglas Public Health (CDPH). MAPP provides the framework for creating a community-driven health improvement plan through different assessments to evaluate: - Prevalent health issues - Health issues that are important to the community members - Availability of health services - Forces that impact community health WellStar Health System (and affiliates) is a key stakeholder in MOBLIZING FOR ACTION THROUGH PLANNING AND PARTNERSHIPS ("MAPP"). MAPP, developed by the National Association of County and City Health Officials ("NACCHO") in collaboration with the CDC, provides a structured guidance on creating and implementing a community-wide strategic planning process focused on improving the health and safety of our population. Through MAPP, a broad collection of community partners and residents come together to identify and prioritize health and safety issues and to identify resources for addressing them. The process results in an actionable community health improvement plan (CHIP) for measurable improvements in the community's health and quality of life as well as a scorecard for implementation and evaluation. The resulting community plan does not focus on one agency or community health challenge; rather, MAPP provides a long-term strategy that addresses the multiple factors that affect health in the community. Community involvement throughout the creation and the implementation of a health improvement plan results in creative solutions to community health problems with an improved focus on priorities, reduced duplication of services, increased collaboration on projects and activities, and increased capacity to garner additional resources. Moreover, continuous community involvement leads to community ownership of the process. Community ownership, in turn, increases the credibility and sustainability of the health improvement efforts. SCHEDULE H, PART VI, LINE 3 PATIENT EDUCATION OF ELIGIBLITY FOR ASSISTANCE: The hospital provides notice of the availability of community financial Assistance via: - Signage - Patient Brochure - Billing Statement - Collection Action Letter - Online at http://www.wellstar.org/pages/online-bill-pay.aspx Kennestone and Windy Hill Hospitals provide its patients with hospital personnel or contracted personnel who are trained in all aspects of governmental programs, payments plans, charity discounts, and other financial assistance offered to assist them in their hospital bills. If the patient is eligible for federal or state assistance programs, a staff member is knowledgeable in the steps necessary to qualify those individuals. If a patient is indigent or charity eligible they will be offered assistance through the hospital's charity and indigent care policy including the state's indigent care trust fund. If the patient has no other insurance and fails to qualify for indigent care assistance, the financial counselor can then offer the patient an opportunity to accept a payment plan with discounted payment options based on their ability to pay immediately or over time. All patient are afforded these opportunities. SCHEDULE H, PART VI, LINE 4 COMMUNITY INFORMATION: As part of an integrated health system, WellStar Health system, inc. and Kennestone and Windy Hill hospitals' service area overlaps with the other three WellStar hospitals. This intersecting impact across WellStar's five-county primary service area of approximately 1.3 million residents in Bartow, Cherokee, Cobb, Douglas, and Paulding counties is not easily determined by a county by county analysis. The majority of patient volume comes from this service area although other health systems have a presence in the area as well. Demographically, the region is one of the fastest growing in the state as well as the country and the expansion of the services for the patient population reflects a desire to offer healthcare "closer to home" since WellStar is considered a part of a larger metropolitan Atlanta MARKET. ECONOMICALLY, the region is strong in per capita income but given recent trends a rise in the uninsured and indigent population has occurred. Kennestone and Windy Hill Hospitals are two of five hospitals that are affiliated with Wellstar Health System. the primary service area of the system is located in the Northwest Georgia area and receives the majority of its patients from one of five counties (Cherokee, Cobb, Douglas, Bartow and Paulding). Generally about 85% to 90% of the patient volume comes from this service area although other health systems have a presence in the area as well. SCHEDULE H, PART VI, LINE 5 PROMOTION OF COMMUNITY HEALTH: As stated in the Wellstar Health System, Inc and Affiliates audited financial statements for the period ended 6/30/2015, Kennestone and Windy Hill Hospitals (affiliates of Wellstar Health System, Inc.) operate as charitable organizations 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; Kennestone Hospital operates a full-time emergency room open to all regardless of ability to pay; and the hospitals (Kennestone and Windy Hill) provide care to the needy members of the community consistent with its charity care policy. The hospital's excess funds are generally applied to expansion and replacement of existing facilities and equipment, amortization of indebtedness, improvement of patient care, community benefit activities including health education, preventive screenings and health fairs, research, subsidized health services, and charity care. Kennestone Hospital committed approximately $ 19.7 million and Windy Hill Hospital committed approximately $ 67.4 million in capital expenditures for the year to meet those needs. SCHEDULE H, PART VI, LINE 6 AFFILIATED HEALTH CARE SYSTEM: Recognized as the fifth most integrated healthcare delivery system in the country, WellStar Health System is one of the largest not-for-profit health systems in Georgia and serves a population of nearly 1.3 million residents in five counties. The vision of WellStar is to deliver world-class healthcare. WellStar includes WellStar Kennestone Regional Medical Center (anchored by WellStar Kennestone Hospital) and WellStar Cobb, Douglas, Paulding and Windy Hill hospitals; the WellStar Medical Group; Urgent Care Centers; Acworth Health Park; Health Place; Homecare; Hospice; Atherton Place; Paulding Nursing Center; and the WellStar Foundation. SCHEDULE H, PART VI, LINE 7 STATE FILING OF COMMUNITY HEALTH BENEFIT REPORT: On an annual basis the hospital reports its community health benefits report to the Georgia Hospital Association (GHA). GHA aggregates the hospital specific reports into a statewide community health benefit report. The State of Georgia also requires hospitals to file the Hospital Financial Survey and the Indigent Care Trust Fund Survey so that it can collect information on hospital financial class categories and also to determine the amount of uncompensated care by hospital. X X X X X X false true X X X X X X true true false false false false false true false Valery A Akopov MD VP & Chief of Hospitalist Svcs 0 329534 0 59170 0 11041 0 28200 0 25463 0 453408 0 0 David W Anderson EVP HR OL CCO 0 414523 0 205272 0 29134 0 45700 0 24590 0 719219 0 0 Nicole V Ashe VP Finance & CFO WMG 0 219898 0 32783 0 9504 0 22403 0 23482 0 308070 0 0 Barbara G Ballard VP Homecare & Hospice 0 238742 0 33691 0 10403 0 43913 0 21002 0 347751 0 0 Betty A Brakovich VP CNO Patient Care Services 157685 0 28582 0 10302 0 23465 0 12327 0 232361 0 0 0 Joseph L Brywczynski SVP Health Parks Development 0 266989 0 285443 0 17664 0 45700 0 24444 0 640240 0 0 Anthony J Budzinski EVP & CFO 0 539386 0 134954 0 14896 0 45700 0 25396 0 760332 0 0 Donald Campbell MD SVP Phys Educ & Student Aff 0 327517 0 167537 0 18263 0 45700 0 16783 0 575800 0 0 Laura Caramanica VP CNO Patient Care Services 271856 0 171232 0 11564 0 45700 0 9834 0 510186 0 0 0 James E Clements VP Bus Dev & Strategic Prtnrsp 0 207563 0 49762 0 6691 0 0 0 17453 0 281469 0 0 Lee R Cook VP Med & Behavioral Health 0 256547 0 327425 0 8736 0 27624 0 17428 0 637760 0 0 Barbara B Corey SVP Managed Care 0 301454 0 65765 0 11944 0 21292 0 26837 0 427292 0 0 Bruce A Dean VP Real Estate Deputy Gen Cnsl 0 227781 0 40345 0 14335 0 45675 0 24166 0 352302 0 0 Marcia Delk-Payne MD SVP Med Affair & Chf Qlty Ofcr 0 370531 0 544886 0 10395 0 45700 0 4190 0 975702 0 0 Nancy R Doelling VP Pediatric SRVS.(BEGIN. 8/4) 0 117427 0 16910 0 6672 0 11120 0 691 0 152820 0 0 Jimmy E Francis VP Info Technology Operations 0 205005 0 42280 0 9742 0 33822 0 2370 0 293219 0 0 Steven L Grace VP Talent Acquisition 0 200013 0 52892 0 14048 0 14653 0 18078 0 299684 0 0 Michael L Graue FORMER EVP & COO 0 0 0 0 0 522266 0 0 0 0 0 522266 0 0 Kristyn M Greifer MD VP Population Management 0 307528 0 52230 0 10225 0 18722 0 9958 0 398663 0 0 Martin L Gutkin VP Finance & Hospital CFO 190902 0 52190 0 15231 0 0 0 9294 0 267617 0 0 0 Joel W Helmke VP Oncology (BEGIN. 7/21) 0 110000 0 51610 0 3904 0 20081 0 8794 0 194389 0 0 Robert D Jansen MD EVP & Pres Medical Group 0 591219 0 170344 0 20977 0 45700 0 29543 0 857783 0 0 Reynold J Jennings PRESIDENT & CEO 0 975000 0 708390 0 18591 0 0 0 2056 0 1704037 0 0 Peter R Jungblut MD SVP & Medical Dir WMG 0 307528 0 78959 0 12316 0 40200 0 29199 0 468202 0 0 Christopher M Kane SVP Strategic Plan & Bus Dev 0 341744 0 454243 0 10413 0 21954 0 20378 0 848732 0 0 Beth Kost VP Compliance Chf Privacy Ofcr 0 244733 0 77006 0 9961 0 22318 0 11704 0 365722 0 0 Kenneth C Kunze MD FRMR SVP CHIEF MEDICAL OFFICER 0 0 0 0 0 383389 0 0 0 0 0 383389 0 0 Ellen Langford SVP & COO WellStar Med Group 0 220376 0 46995 0 11936 0 36643 0 22323 0 338273 0 0 Louis W Little SVP Post Acute Svc & Hosp Pres 247333 0 321759 0 9969 0 44057 0 22463 0 645581 0 0 0 Elizabeth H Loudermilk VP Ent Intelligence & Intgrtn 0 225680 0 73283 0 9197 0 6309 0 19342 0 333811 0 0 Robert M Lubitz MD VP Medical Affairs 348421 0 62338 0 11023 0 45700 0 4848 0 472330 0 0 0 Sandra Lucius VP Info Technology Apps 0 185834 0 30026 0 8564 0 44758 0 2235 0 271417 0 0 Robert Mandler VP Diagnostic Outreach 0 214261 0 58412 0 18167 0 45249 0 16275 0 352364 0 0 Patricia A Mayne VP Emergency Services 177986 0 122895 0 10448 0 26305 0 23814 0 361448 0 0 0 Kimberly W Menefee SVP Strategic Community Dev 0 282547 0 66726 0 13682 0 28200 0 17826 0 408981 0 0 Christopher L Morgan VP & Admin. CLIO (BEGIN. 7/7) 0 110770 0 52731 0 4638 0 20102 0 1645 0 189886 0 0 Jonathan B Morris MD SVP Chief Info Officer 0 369512 0 80613 0 12264 0 23553 0 26705 0 512647 0 0 Bradford B Newton VP Information Technology Admi 0 192691 0 30661 0 8988 0 20598 0 27113 0 280051 0 0 Michael G Paul VP Facilities Eng Support Svcs 0 181401 0 27532 0 12020 0 0 0 24150 0 245103 0 0 Leo E Reichert EVP & General Counsel 0 489341 0 247184 0 15552 0 0 0 29200 0 781277 0 0 Bethany Robertson VP & Chief Learning Officer 0 178067 0 31215 0 9391 0 13097 0 28511 0 260281 0 0 Michelle M Robinson VP Mktng/PR/Internal Comm 0 196373 0 33264 0 9210 0 14300 0 26351 0 279498 0 0 Deborah Roegge De Vita VP Women & Newborn Svc Line 0 195728 0 27621 0 8576 0 25759 0 6141 0 263825 0 0 Candice L Saunders President & CEO 0 621461 0 174240 0 16525 0 45334 0 27582 0 885142 0 0 Christopher B Scullen VP Pulmonology Operations 0 172411 0 112906 0 6929 0 0 0 17839 0 310085 0 0 Richard S Siegel VP Cardiology & CVM Admin 0 271627 0 40496 0 11541 0 45700 0 24762 0 394126 0 0 Jeffery D Stanley VP Pharmacy & System Coor 0 176156 0 30945 0 9170 0 21580 0 8658 0 246509 0 0 Daniel J Styf SVP PW Health Plan 0 281902 0 39983 0 15148 0 18663 0 9070 0 364766 0 0 James M Swartz VP Accounting 0 200242 0 63140 0 8971 0 16856 0 25406 0 314615 0 0 Mary L Tavernaro VP Human Resources Operations 0 212056 0 37659 0 9442 0 27690 0 21436 0 308283 0 0 Adam C Thompson VP Surgery 0 166858 0 51698 0 9517 0 0 0 21830 0 249903 0 0 Anthony M Trupiano SVP Supply Chain 0 268258 0 61742 0 15219 0 45700 0 1896 0 392815 0 0 Sean P Turner VP Rev.Cycle MGMT (BEGIN.9/28) 0 233395 0 36468 0 3219 0 20091 0 26574 0 319747 0 0 Monte A Wilson VP & COO Kennestone Hospital 287019 0 48986 0 10221 0 0 0 26235 0 372461 0 0 0 Robin Wilson MD SVP Chief Hlth Innov Officer 0 395907 0 232368 0 9718 0 0 0 22144 0 660137 0 0 Daniel J Woods SVP & Hospital President 379267 0 87679 0 15644 0 45700 0 24659 0 552949 0 0 0 Chester A Zborowski VP Health Parks Operations 0 165755 0 45188 0 12208 0 0 0 24265 0 247416 0 0 Avril P Beckford MD TRUSTEE 0 395084 0 86393 0 2531 0 27460 0 1940 0 513408 0 0 Jeffrey L Tharp MD TRUSTEE 0 480597 0 147676 0 2596 0 45700 0 29025 0 705594 0 0 THOMAS E GEARHARD MD TRUSTEE 0 293273 0 48916 0 5186 0 42668 0 30543 0 420586 0 0 LOUIS LOVETT AVP GME/DIO 245575 0 39483 0 3838 0 42138 0 23353 0 354387 0 0 0 JYOTSNA R VANAPALLI Rad Oncology Chief Physicist 198869 0 315 0 448 0 21484 0 20912 0 242028 0 0 0 SHERRON KURTZ Exec Dir Surgical Svcs KH/CH 160326 0 18484 0 5389 0 11459 0 3522 0 199180 0 0 0 JANET P MEMARK MD Physician Group 160000 0 14344 0 1848 0 19367 0 1132 0 196691 0 0 0 CAROLE J HARMAN Exec Dir Women's Nursing 149760 0 17172 0 1962 0 11615 0 21467 0 201976 0 0 0 SCHEDULE J, PART I, LINE 1B REIMBURSEMENT POLICY While WellStar Health System and its affiliates do not have a written policy regarding payment or reimbursement of the items listed in Part I 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. These items are added as taxable wages on the individual's Form W-2 as appropriate. 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 officerS/KEY EMPLOYEES received severance pay during the 2014 CALENDAR YEAR FROM EITHER THE ORGANIZATION OR A RELATED ORGANIZATION: KENNETH C. KUNZE, MD $ 383,389 MICHAEL L. GRAUE, MD 522,266 SCHEDULE J, PART I, LINE 4B The following officers/KEY EMPLOYEES PARTICIPATED IN A SUPPLEMENTAL NON-QUALIFIED RETIREMENT PLAN DURING THE YEAR. Valery Akopov Nicole Ashe JOSEPH L. BRYWCZYNSKI ANTHONY J. BUDZINSKI Laura Caramanica James Clements BARBARA B. COREY BRUCE ALAN DEAN Sarath Degala Marcia Delk-Payne JIMMY E. FRANCIS KRISTYN M. GREIFER ROBERT D. JANSEN PETER R. JUNGBLUT CHRISTOPHER MICHAEL KANE Beth Kost Ellen Langford Elizabeth Loudermilk PATRICIA A. MAYNE KIMBERLY W. MENEFEE JONATHAN B. MORRIS Bradford Newton Leo Reichert Bethany Robertson Michelle Robinson CANDICE LYNN SAUNDERS Richard Siegel CHRISTOPHER B. SCULLEN Jeffery Stanley Daniel Styf JAMES M. SWARTZ MARY LOUISE TAVERNARO Adam Thompson ANTHONY MICHAEL TRUPIANO Monte Wilson Robin Wilson DANIEL WOODS DONALD CAMPBELL ROBERT MANDLER DEBORAH ROEGGE DE VITA DAVID W. ANDERSON CHESTER ZBOROWSKI BARBARA BALLARD Betty Brakovich Lee R. Cook Louis Little Robert Lubitz Martin Gutkin SCHEDULE J, PART I, LINE 7B 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: People & Customer Service goal for employee "Trust Index", Quality & Safety goal for clinical excellence and patient satisfaction, 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 III, LINE 4A PROGRAM SERVICE ACCOMPLISHMENTS As discussed herein, Kennestone 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; one of the hospitals operates a full-time emergency room open to all regardless of the ability to pay; the hospital provides care to needy members of its community consistent with its charity care policy regardless of their ability to pay for these services and admits as patients those able to pay for care, either themselves or through third-party payers such as private health insurance or government programs such as Medicare and Medicaid; and the hospital's excess funds are generally applied to expansion and replacement of existing facilities and equipment, amortization of indebtedness, improvement in patient care, community benefit activities, and charity care. Kennestone Hospital, Inc. consists of two hospitals, Wellstar Kennestone and Wellstar Windy Hill. These hospitals combined to invest approximately $101.4 million in capital expenditures for the fiscal period. Wellstar Kennestone Hospital is a general acute hospital which provides a full range of inpatient and outpatient services for the overall health of the community. The hospital is located in Marietta, Georgia. The original hospital was constructed in 1950. The present main building was constructed in 1975. Kennestone is licensed to operate 633 beds and is currently staffed to operate 588 beds. Wellstar Windy Hill Hospital is located in the unincorporated area of Cobb County in northwest metropolitan Atlanta. It is an acute care hospital concentrating at the present time on long term care inpatient and outpatient services. The original structure was built in 1973 and renovated in 1987. The beds at Windy Hill serve medically complex patients whose average stay is approximately 30 days. Kennestone Hospital, Inc. affiliated with 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. Wellstar became totally independent of Promina in 2000. Kennestone Hospital, Inc. was organized in 1993 and is subordinate to, and subject to the authority of, Wellstar Health System and its governing board. Kennestone offers most major inpatient clinical services, a variety of outpatient services, women's services and open heart surgery. It is one of the largest hospitals in the state of Georgia. Kennestone is also home to a variety of state-of-the-art procedures and equipment not offered elsewhere in the larger Atlanta metro service area. The hospital has also opened several satellite outpatient imaging centers to provide easier access to our patient population. One additional service offered on the campus of Kennestone is called Atherton Place. This residential facility provides independent housing as well as assisted living to residents needing these services--especially the elderly. Kennestone also now operates a residential hospice facility at Kennesaw Mountain near the Kennestone campus. Windy Hill has transitioned its focus to long-term inpatient and outpatient services. These services include a concentration in geriatrics, rehabilitation, orthopedics and senior care. An additional service offered at Windy Hill Hospital includes a women's imaging department. Kennestone Hospital, Inc. operates two brand new health parks in Acworth and East Cobb. These facilities bring physician, outpatient surgery, diagnostic, laboratory and therapy services under one roof. The following stats constitute the overall program services for the period ended June 30, 2015: Kennestone Hospital Total Adult Discharges - 37,360 Med/Surg. Short Stay Cases - 10 Newborn Discharges - 5,506 Emergency Room Visits - 132,581 Total surgery cases - 24,859 Non ED OP Radiology Procedures - 156,163 Cath Lab Procedures - 6,464 GI Lab Procedures - 2,093 Radiology Oncology procedures - 15,772 Total FTEs (Paid) - 3,891 Windy Hill Hospital Total Adult Discharges - 344 Med/Surg. Short Stay Cases - 1 Total Surgery Cases - 1,553 Non ED OP Radiology Procedures - 29,570 GI Lab Procedures - 159 Total FTEs (Paid) - 297 Community Benefit Reporting Community Outreach and Health Improvements - $ 1,480,786 Unreimbursed Charity Care (at cost) - $ 60,436,392 Health professions education - $ 264,354 Medicaid Shortfalls (at cost) - $ 8,887,054 Total community benefit expense for the two hospitals - $ 70,804,232 Community Benefits Detail Kennestone and Windy Hill, affiliates of Wellstar Health System, participate in many community and educational programs for the overall health and benefit of the area that it serves. The following are examples of programs or services that are provided by Kennestone Hospital, Inc. for the charitable benefit of the community: Community Health/Education Wellstar's Marketing and Public Relations department provides free brochures on a variety of health-related topics such as blood pressure, diabetes, cholesterol, osteoporosis, and nutrition. Kennestone Hospital specifically offers the community the space and instructors for many support groups and educational opportunities--some free of charge and others at a nominal fee (examples of the offerings are women's health, palliative care, birthing classes, etc.) Kennestone and Windy Hill also offer free and/or low cost screenings for health issues such as blood pressure, cholesterol, flu shots, and others. System-wide for the reporting period over 200,000 area residents were seen at either the screenings or health fairs. School Health Program This program is operated in conjunction with area school systems and seeks to teach school-aged children about health and safety topics such as dental health, water safety, seat belt safety and others. Safe Kids-Cobb/Cherokee Wellstar and the Cobb Public Health Department sponsor safety education events on an annual basis to the community, specifically the Cobb County area. The safety initiatives are centered around car seat checks, bike helmets, water safety and other preventive initiatives. The mission is to reduce the number of accidental injuries for children ages 14 and under. The SafeKids Cobb program provided 1,500 car seat checks with a number of car seats distributed to families in need. The Partner-in-Education program provides health-related supplies and support to area elementary and middle schools. Through the "Partners in Ministry" program, the Pastoral Care Department leads a partnership between the health system and local area congregations to link between the spiritual and clinical community needs. Sponsorships and Community Activities As part of the October Breast Cancer Awareness Month WellStar and the WellStar Cancer Network has partnered with a local television station to sponsor "Buddy Check 11", an 11Alive program designed to encourage breast self-exam. The participants choose a buddy and subsequently remind their buddy to perform a monthly self-exam. The program is now in its third year. WellStar Health System was the only Atlanta health system honored with a "Celebrating Our Heritage" Award by Renovacion Conyugal, a nonprofit organization dedicated to strengthening, supporting and empowering Latino youth. WellStar has a 10-year partnership with the organization to provide financial and facility support. Team members from the Acworth Health Park participated in the building of a Habitat for Humanity home in Acworth, Georgia. The home was built on property donated to Northwest Atlanta Habitat by a retired Army Lt Col Ashley Ivey before his passing. He had stipulated that a home be built and presented to a disabled veteran. Accomplishments and Recognition Kennestone and Windy Hill Hospitals are accredited by the Joint Commission. Wellstar was granted accreditation by the Intersocietal Commission for the Accreditation of Echocardiography Labs after rigorous testing and quality outcomes for diagnosis of heart disease. All five Wellstar hospital labs earned "Accreditation with Distinction" from the College of American Pathologists (CAP), recognized as one of the most stringent in laboratory quality assurance. Wellstar's labs are part of the 6,000 CAP-accredited laboratories nationwide. Wellstar Sleep Disorders Center at Windy Hill Hospital offers world class care as one of the 10 largest sleep centers nationwide. The center consists of 12 rooms with more board-certified sleep specialists on staff than any sleep center in the southeast US. The program is ac FORM 990, PART IV, LINE 12B AUDITED FINANCIAL STATEMENTS Kennestone Hospital, Inc. is audited on an annual basis by an outside auditing firm, KPMG, and as part of that audit a consolidated financial statement is issued for all of WellStar Health System, Inc. and its Affiliates. "The independent auditors report includes the accounts of Wellstar and its controlled affiliates, Kennestone Hospital, Inc., Cobb Hospital, Inc., Douglas Hospital, Inc., Paulding Medical Center, Inc., Wellstar Foundation, Inc. CHS Foundation, Inc., Community Assurance Company, Ltd., various Wellstar owned physician practices, a hospice facility, a nursing facility, home health business, and entities for infusion therapy and durable medical equipment. All significant intercompany accounts and transactions have been eliminated in combination. The Board of Trustees of Wellstar has the authority to approve appointments of the members of the board of trustees of all affiliate corporations." FORM 990, PART IV, LINE 24A TAX EXEMPT BOND REPORTING 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). Kennestone Hospital, Inc. will report this tax exempt bond liability on Part X, Line 25 Other Liabilities-Due to WHS, Inc. FORM 990, PART VI, SECTION A, LINE 7B POWERS OF THE BOARD As per the Articles of Incorporation, the 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 VI, 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 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 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. 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 For the reporting period Kennestone Hospital, Inc. had a change in net assets of ($191,575,481) related to transfers to affiliates as part of the allocation of income statement and balance sheet transactions over the year. CHS Foundation Inc 805 Sandy Plains Road Marietta GA 30066 581649540 Foundation GA 501(C)(3) 11 Type 2 WHS Inc true Cobb Hospital Inc 805 Sandy Plains Road Marietta GA 30066 580968382 Healthcare GA 501(C)(3) 3 WHS Inc true Douglas Hospital Inc 805 Sandy Plains Road Marietta GA 30066 582026750 Healthcare GA 501(C)(3) 3 WHS Inc true Paulding Medical Center Inc 805 Sandy Plains Road Marietta GA 30066 582095884 Healthcare GA 501(C)(3) 3 WHS Inc true Wellstar Foundation Inc 805 Sandy Plains Road Marietta GA 30066 581627413 Foundation GA 501(C)(3) 11 Type 2 WHS Inc true Wellstar Health System Inc 805 Sandy Plains Road Marietta GA 30066 581649541 Healthcare GA 501(C)(3) 11 Type 2 NA false Cobb Hospital Parking Company LLC 805 Sandy Plains Road Marietta GA 300666340 752999669 Parking GA WHS N/A 0 0 0 KENNESTONE EAST PARKING DECK LLC 793 SAWYER ROAD MARIETTA GA 30060 200537100 PARKING GA WHS N/A 0 0 0 Community Assurance Co 3rd Fl Barclays House Shedden Rd George Town Grand Cayman CJ 581649541 Insurance CJ C-CORP false false false false false false false false false false false false false false false true false false false