2016-05-13T13:20:49-05:00 2015-06-30 PricewaterhouseCoopers LLP 2001 MARKET ST SUITE 1800 PHILADELPHIA PA 19103 990 2014-07-01 580968382 COBB HOSPITAL INC % JAMES M SWARTZ COBB 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 300666340 339620313 false X www.wellstar.org X 1984 GA TO PROVIDE WORLD-CLASS CHARITABLE HEALTHCARE TO THE COMMUNITY. 18 9 2567 225 0 0 0 0 324507645 331306932 247125 -187198 6966308 8313381 331721078 339433115 3000 11200 0 0 136619685 145975592 0 0 0 181261779 184182283 317884464 330169075 13836614 9264040 212397174 189509262 115259589 109315901 97137585 80193361 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 276541830 11200 331306932 SEE SCHEDULE O 276541830 true false false false false false false false false true false false true 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 true false false true 0 0 2567 true 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 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 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 Kevin W Deter VP Operations & COO 50.0 0.0 X 318639 0 58603 Nancy R Doelling VP Pediatric SRVS.(BEGIN. 8/4) 2.0 48.0 X 0 141009 11811 Kenneth D Etheridge VP Finance & Hospital CFO 50.0 0.0 X 250590 0 39241 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 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 48.0 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 Elizabeth H Loudermilk VP Ent Intelligence & Intgrtn 2.0 48.0 X 0 308160 25651 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 Veronica Martin VP CNO Patient Care Services 50.0 0.0 X 269445 0 17716 Patricia A Mayne VP Emergency Services 2.0 48.0 X 0 311329 50119 Thomas W McNamara VP Medical Affairs 50.0 0.0 X 373293 0 51861 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 Kem M Mullins SVP & Hospital President 50.0 0.0 X 477879 0 50745 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 Robin Wilson MD SVP Chief Hlth Innov Officer 2.0 48.0 X 0 637993 22144 Chester A Zborowski VP Health Parks Operations 2.0 48.0 X 0 223151 24265 JOSEPH W HERZBERG AVP Human Resources 50.0 0.0 X 215130 0 40922 YONA D ROBERTS Mgr Pharmacy 50.0 0.0 X 195512 0 31349 CHRISTOPHER A BRIDGERS Dir Pharmacy 50.0 0.0 X 170434 0 26152 HEATHER S ROCHFORD Mgr Pharmacy 50.0 0.0 X 157104 0 36271 GLORIA NWAGBARA RN Charge Nurse 50.0 0.0 X 154892 0 40488 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 Ilona L Wozniak FORMER VP Operations & COO 0.0 0.0 X 403746 0 474 2986664 22289637 2661140 116 true true false Martin General Contracting Inc 3633 Ivy Gulledge Rd DALLAS GA 30132 General Contracting 1827034 Quest Diagnostics PO BOX 740736 ATLANTA GA 30384 MEDICAL SERVICEs 1064928 INGLETT AND STUBBS LLC PO BOX 932506 ATLANTA GA 311932506 GENERAL CONTRACTOR 1075440 FRESENIUS MEDICAL CARE DBA RCC MARI PO BOX 101518 ATLANTA GA 303921518 MEDICAL SERVICEs 974300 BRASFIELD AND GORRIE 1990 VAUGH RD SUITE 100 KENNESAW GA 30144 GENERAL CONTRACTING 2768784 24 0 PATIENT REVENUE 621990 331253985 331253985 PATIENT EDUCATION 621990 52757 52757 MEDICAL RECORDS 621990 190 190 331306932 0 0 0 28720 0 28720 28720 0 28720 0 187198 -187198 -187198 0 -187198 0 0 0 CAFETERIA 621990 1776279 1776279 PARKING 621990 882754 882754 PHARMACY REVENUE 621990 3369787 3369787 2255841 2255841 8284661 339433115 331306932 0 8126183 0 11200 11200 0 0 1625902 1403433 222469 0 278936 245464 33472 114024695 98385271 15639424 5599876 4832064 767812 16103693 13895678 2208015 8342490 7198632 1143858 0 16290 16290 0 0 0 0 17974212 16426553 1547659 17968 13952 4016 12280805 9907743 2373062 0 0 3809149 343256 3465893 102952 71235 31717 0 76632 59583 17049 4037431 4037431 67219348 58002748 9216600 13179467 5443813 7735654 3109372 3109372 REPAIRS & MAINTENANCE 5509643 3493299 2016344 MEDICAL SUPPLIES 56573227 56549956 23271 OTHER EXPENSES 275787 257950 17837 330169075 276541830 53627245 0 11850 333961 12877 0 0 0 79669445 57685075 0 0 0 0 0 0 7048020 7411096 1752510 593402 295503484 181991863 115957825 113511621 0 0 0 0 0 0 0 0 7944647 9974107 212397174 189509262 15519950 11989141 0 0 0 0 0 0 0 0 0 0 0 0 0 0 99739639 97326760 115259589 109315901 X 97137585 80193361 0 0 0 0 97137585 80193361 212397174 189509262 X 9264040 -26208264 X false true X true false X 4336556 4336556 145101445 79089032 66012413 4523425 2975351 1548074 138404659 99460965 38943694 3137399 466515 2670884 113511621 C&E MEDICAID PENDING REC. 2562704 OTHER RECEIVABLES (CORP ALLOC) 7411403 9974107 0 ASSET RETIREMENT-OTHER LT LIAB 620325 TAX EXEMPT BOND LIAB-DUE TO WH 96693679 OTHER LIABILITIES 12756 97326760 X SCHEDULE D, PART X, LINE 2 The following footnote is related to the organization's application of FIN 48 (ASC 740): Wellstar (including COBB HOSPITAL, INC.) 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 35583316 35583316 0.10780 53972374 47108736 6863638 0.02080 89555690 47108736 42446954 0.12860 613524 613524 0.00190 613524 613524 0.00190 90169214 47108736 43060478 0.13050 true 12711147 2019674 111236737 128576842 -17340105 X true true 1 1 COBB HOSPITAL 3950 AUSTELL ROAD AUSTELL GA 30106 www.wellstar.org 033-432 X X X COBB 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 SCHEDULE H, PART V, SECTION B, LINE 3J OTHER DESCRIPTIONS FROM THE COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA): The Community Health Needs Assessment for COBB HOSPITAL, INC. 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: COBB HOSPITAL, INC. 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, COBB HOSPITAL, INC. partnered with CDPH and formed a 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 report 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. Behavioral Risk Factor Surveillance System (BRFSS) 11. WellStar Health System - COBB Hospital, INC.'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 COBB HOSPITAL, INC. conducted 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 COBB HOSPITAL, INC. CHNA CAN BE FOUND at the following websites: COBB HOSPITAL, INC. WEBSITE: http://www.wellstar.org/about-us/documents/chna/cobb_chna_06172013.pdf AND WELLSTAR HEALTH SYSTEM WEBSITE: http://www.wellstar.org/pages/default.aspx SCHEDULE H, PART V, SECTION B, LINE 10A COBB HOSPITAL's MOST RECENTLY ADOPTED IMPLEMENTATION STRATEGY CAN BE FOUND ON its WEBSITE AT: http://www.wellstar.org/about-us/Documents/Implementation_Strategy/cobb_im plementation_strategy_11112013.pdf SCHEDULE H, PART V, SECTION B, LINE 11 PROGRAMS & STRATEGIES TO ADDRESS THE NEEDS OF THE COMMUNITY: COBB 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. - 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) - 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 being assessed) - 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. (initiative 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. - Increase cancer prevention and education community outreach (including smoking cessation program) utilizing WellStar Cancer Program team. (In progress) - Improve prevention-based educational resources and the referral process to free or low-cost healthcare clinics for continuity of care within the Emergency Department (including nurse navigator training and bi-lingual materials). UNADDRESSED CHNA NEEDS - Selection criteria for COBB 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, SCHEDULE H, PART I, LINE 6A PUBLICATION OF COMMUNITY BENEFIT REPORT: COBB Hospital, Inc. is an affiliate of Wellstar Health System, Inc. which on an annual basis issues a community benefit report. This report is subsequently distributed in and around the five county service 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 ON THE WELLSTAR WEBSITE AT: http://www.wellstar.org/about-us/documents/chna/cobb_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 COBB HOSPITAL) 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 charge 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: COBB HOSPITAL IS A provider of inpatient and outpatient services to Medicare program beneficiaries at determined rates. Without the participation in the Medicare program these patients may not have had convenient access to those services. 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., AND COBB 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 ELIGIBILITY 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 COBB Hospital 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 patie 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 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 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 Kevin W Deter VP Operations & COO 223662 0 86191 0 8786 0 38507 0 20096 0 377242 0 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 Kenneth D Etheridge VP Finance & Hospital CFO 206502 0 33072 0 11016 0 27569 0 11672 0 289831 0 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 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 Elizabeth H Loudermilk VP Ent Intelligence & Intgrtn 0 225680 0 73283 0 9197 0 6309 0 19342 0 333811 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 Veronica Martin VP CNO Patient Care Services 225493 0 35099 0 8853 0 0 0 17716 0 287161 0 0 0 Patricia A Mayne VP Emergency Services 0 177986 0 122895 0 10448 0 26305 0 23814 0 361448 0 0 Thomas W McNamara VP Medical Affairs 316722 0 42173 0 14398 0 28200 0 23661 0 425154 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 Kem M Mullins SVP & Hospital President 380078 0 85723 0 12078 0 22700 0 28045 0 528624 0 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 Robin Wilson MD SVP Chief Hlth Innov Officer 0 395907 0 232368 0 9718 0 0 0 22144 0 660137 0 0 Ilona L Wozniak FORMER VP Operations & COO 244818 0 0 0 158928 0 474 0 0 0 404220 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 JOSEPH W HERZBERG AVP Human Resources 185203 0 22132 0 7795 0 15038 0 25884 0 256052 0 0 0 YONA D ROBERTS Mgr Pharmacy 194770 0 66 0 676 0 20480 0 10869 0 226861 0 0 0 CHRISTOPHER A BRIDGERS Dir Pharmacy 150010 0 20000 0 424 0 12478 0 13674 0 196586 0 0 0 HEATHER S ROCHFORD Mgr Pharmacy 148054 0 8584 0 466 0 20639 0 15632 0 193375 0 0 0 GLORIA NWAGBARA RN Charge Nurse 154658 0 66 0 168 0 18567 0 21921 0 195380 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 James Clements BARBARA B. COREY BRUCE ALAN DEAN Sarath Degala Marcia Delk-Payne KENNETH D. ETHERIDGE JIMMY E. FRANCIS KRISTYN M. GREIFER ROBERT D. JANSEN PETER R. JUNGBLUT CHRISTOPHER MICHAEL KANE Beth Kost Ellen Langford LEE R. COOK Elizabeth Loudermilk Veronica Martin PATRICIA A. MAYNE Thomas McNamara KIMBERLY W. MENEFEE JONATHAN B. MORRIS Kem Mullins Bradford Newton Leo Reichert Bethany Robertson Michelle Robinson CANDICE LYNN SAUNDERS CHRISTOPHER B. SCULLEN Richard Siegel Jeffery Stanley Daniel Styf JAMES M. SWARTZ MARY LOUISE TAVERNARO Adam Thompson ANTHONY MICHAEL TRUPIANO Robin Wilson ILONA L. WOZNIAK DONALD CAMPBELL ROBERT MANDLER DEBORAH ROEGGE DE VITA DAVID W. ANDERSON CHESTER ZBOROWSKI BARBARA BALLARD 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, Cobb Hospital, Inc. (an affiliate of Wellstar Health System, Inc.) operates as a charitable organization consistent with the requirements of Internal Revenue Code Section 501(c)(3) and the "community benefit standard" of IRS Revenue Ruling 69-545. In this regard, the governing body of the organization and/or its parent is composed of prominent citizens in the community, medical staff privileges in the hospital are available to all qualified physicians in the area consistent with the size and nature of the facility; the hospital operates a full-time emergency room open to all regardless of ability to pay; the hospital provides care to the needy members of the community consistent with its charity care policy regardless of their ability to pay for these services. The hospital's excess funds are generally applied to expansion and replacement of existing facilities and equipment, amortization of indebtedness, improvement of patient care, community benefits activity, and charity care. Cobb Hospital reinvested a total of approximately $13.0 million in capital expenditures for equipment upgrades and other capital improvements to better serve the community. Cobb Hospital was organized in 1984. The hospital affiliated with the Northwest Georgia Health System in 1993. In 1994, Northwest Georgia Health System helped form the PROMINA Health System and changed its name to Promina Northwest Health System. In 1998 Promina Northwest changed its name to Wellstar Health System and is now totally independent of Promina. Cobb Hospital is subordinate to, and subject to the authority of Wellstar Health System and its governing boards including the Hospital Authority of Cobb County. Cobb Hospital provides a full range of inpatient and outpatient services characteristic of a community hospital. The hospital is licensed to operate 382 beds and is presently staffed to operate 370 beds. The original hospital was constructed in 1968 and several major structural additions have happened since that time. The following stats constitute the overall program services provided during the reporting period ended June 30, 2015: Adult Discharges - 20,557 Newborn Discharges - 3,647 Med & Surgical Short Stay Cases - 15 Emergency Room Visits - 99,443 Total Surgical Cases - 11,825 Outpatient Procedures Non-ED OP Radiology - 57,237 GI Laboratory - 824 Cath Lab Procedures - 1,962 Total FTEs Paid - 1,965 Community Benefit Reporting Community Outreach - $ 613,524 Unreimbursed Charity Care (at cost) - $ 35,583,316 Medicaid Shortfalls (at cost) - $ 6,863,638 Total Community Benefit - $ 43,060,478 As an affiliate of Wellstar Health System, Cobb Hospital participates in many community and educational programs for the overall health and benefit of the area that they serve. Some examples of those programs are: Community Health/Education - Screenings and educational opportunities such as defensive driving for teens (offered at a minimal cost or at no cost), smoking cessation, heart smart school, CPR and others. System-wide over 54,000 residents from the community participated in these various screenings. More than 65,000 students learned about important health topics through our elementary and adolescent school health programs. The Public Relations department notifies the public of these offerings by publishing a quarterly mailer to community residents which costs the system over $80,000. Community Activities - Sponsors blood drives, provides funding to school health programs for medical and dental preventive care. Community Events - Wellstar has an annual day for the Latino community geared at screenings and educational activities on a variety of health issues specifically for the Hispanic community. Sponsorships A group of employees also participated in the annual "Relay for Life" an event to raise funds and awareness for cancer research and prevention (held in conjunction with the American Cancer Society). System-wide a total of $22,000 was raised to support cancer research, education and patient services. Efforts are planned to expand this support in the coming years. Recognition and Accomplishments - Cobb Hospital and Kennestone Hospital operate full-service clinics on the respective campuses to provide health related services to uninsured and underinsured who might not otherwise receive care. In FY2013 the clinics served a combined 8,000 patient visitors at a cost of almost $2.8 million. A clinic for senior wellness also opened in Cobb County. WellStar Cobb Hospital is ranked in the US News and World Report's Best Hospitals in Atlanta. The hospital was ranked as ninth in Atlanta and 15th in the state of Georgia in this annual report. Only nine hospitals were chosen from Atlanta's 60 institutions WellStar Cobb and Kennestone Hospitals received the United Total Joint Replacement Specialty Center Designation in recognition of the quality care in their respective units. Both hospitals received three-star ratings which is the highest possible. The hospitals met extensive quality and outcomes criteria based on nationally recognized medical standards and expert advice. In addition the total hip and knee joint replacement programs are certified by the Joint Commission. In October 2012 WellStar completed the system wide implementation of a new cleaning process called Xenex. The process use ultraviolet light technology/machines to decontaminate rooms in five to 12 minutes. This includes patient rooms, emergency departments, public restrooms, supply rooms and nursing stations. Independent studies and lab samples have shown that the system is 20 times more effective than regular cleaning protocols for eliminating bacteria and many other organisms. All hospitals have a least one machine in operation. WellStar Cobb Hospital received four Joint Commission Disease-Specific Certifications (some mentioned previously). The hospital was recertified for hip replacement, knee replacement and primary stroke and received an initial certification for spinal surgery. The hospital has to demonstrate compliance with consensus-based national standards, effective use of appropriate, evidence-based clinical practice guidelines and collection and analysis of a minimum of four performance measures specific to the specialty care provided. WellStar Cobb expanded the innovative STAT Cancer Clinic concept that previously was only available at Kennestone Hospital. In this clinic patients see all members of the treatment and support team in one place and in one afternoon for an initial diagnosis. These clinics are the only true multidisciplinary services of their kind in metro Atlanta. With specialists in thoracic surgery, pulmonary, medical and radiation oncology the patient is guided through a treatment protocol that happens in days, not weeks or months. WellStar Cobb Hospital experienced such great success with the daVinci surgical system that it was able to add a second system during the reporting period. The state of the art minimally invasive technology is used by gynecologic, urologic, thoracic, colorectal and general surgeons. The surgeons are able to work through smaller incisions, less pain for the patient, and faster recoveries with this technology. The Partnership for Health and Accountability of the Georgia Hospital Association presented two of its prestigious Quality and Patient Safety Awards to WellStar Cobb Hospital. One award relates to the timely and appropriate administration of antibiotics and the second relates to re-engineering discharge. Cobb Hospital also was presented with the Circle of Excellence Award for hospitals that demonstrate a sustained commitment to quality and safety having won multiple awards over the previous five years. To better serve behavioral health patients who visit WellStar Douglas Hospital's Emergency Department, the system began using an innovative technology to offer telemedicine. The technology is provided in a partnership with TeleHealth and allow psychiatrists at WellStar Cobb Hospital to securely and conveniently evaluate Douglas patients and expedite their discharge. With the success of the pilot program the system plans to expand to Paulding Hospital, which, like Douglas Hospital does not have on-site psychiatrists. WellStar Kennestone Hospital launched an initiative called Best In Georgia (BIG) with a goal to improve patient safety and well-being across the system. A multidisciplinary team of physicians and other team members meets on a monthly basis to elevate performance measures at the hospital. As many consumers research healthcare performance measures in sources such as Health Grades, and US News and World Report it is important to focus on raising the hospitals position in the public. Cobb, Douglas, Paulding and Windy Hill hospitals have also joined in this initiative. Cobb Hospital has instituted an inpatient medical stabilization service called New Vision. This service for adults with drug, alcohol a FORM 990, PART I, LINES 7A & 7B UNRELATED BUSINESS INCOME COBB Hospital, INC. generated no unrelated business income for the reporting period. As a result the attached 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, 2015. FORM 990, PART IV, LINE 12B AUDITED FINANCIAL STATEMENTS COBB 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). COBB 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 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 VII, 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 COBB Hospital, Inc. had a change in net assets of ($26,208,264) related to transfers to affiliates as part of the allocation of income statement and balance sheet transactions over the year. 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