2012-05-15T13:56:56-04:00 2011-06-30 PricewaterhouseCoopers LLP 2001 MARKET ST SUITE 1700 PHILADELPHIA PA 19103 990 2010-07-01 581649541 WELLSTAR HEALTH SYSTEM INC WELL 7707925023 805 SANDY PLAINS ROADS MARIETTA GA 300666340 JAMES M SWARTZ 2012-05-15 true 2673303000 2010 2016-02-24 21:20:13Z X A JAMES BUDZINSKI 805 Sandy Plains Road Marietta GA 300666340 1139975867 false X www.wellstar.org X 1994 GA TO PROVIDE CHARITABLE HEALTHCARE TO THE COMMUNITY 18 14 4294 800 415054 0 0 0 409133863 551662318 67685 41013220 1826536 2990869 411028084 595666407 422143 831081 0 0 291538491 303447688 0 0 1477655 155395659 154842868 447356293 459121637 -36328209 136544770 1456919936 1617727279 670003978 592743679 786915958 1024983600 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 THAT WE SERVE. false false 382035475 552561352 WELLSTAR HEALTH SYSTEM IS A VERTICALLY INTEGRATED HEALTH CARE DELIVERY SYSTEM WHICH PROVIDES THROUGH AFFILIATED BUSINESS ORGANIZATIONS A FULL SPECTRUM OF HEALTH SERVICES, INCLUDING WELLNESS PROGRAMS, PHYSICIAN OFFICE VISITS, OUTPATIENT CARE, INPATIENT CARE, AND POST-ACUTE SERVICES SUCH AS HOME HEALTH AND LONG TERM NURSING CARE. THE SYSTEM THROUGH ITS AFFILIATED BUSINESS ORGANIZATIONS OPERATES FIVE HOSPITALS(KENNESTONE, COBB, PAULDING MEDICAL, DOUGLAS AND WINDY HILL), MULTIPLE PHYSICIAN OFFICES, PRIMARY CARE CENTERS, OUTPATIENT CARE FACILITIES, A NURSING HOME AND OTHER HEALTH RELATED SERVICES. THE SYSTEM IS SUPPORTED FINANCIALLY BY A FUND-RAISING ORGANIZATION, WELLSTAR FOUNDATION, INC. THE SERVICE AREA FOR THE SYSTEM ENCOMPASSES PARTS OF THE NORTHWESTERN SECTION OF THE STATE OF GEORGIA - THE PRIMARY AREA BEING IN BARTOW, CHEROKEE, COBB, DOUGLAS AND PAULDING COUNTIES. APPROXIMATELY 90% OF INPATIENT DISCHARGES AND OUTPATIENTS SERVED ARE FROM THE AFOREMENTIONED COUNTIES. THE WELLSTAR VISION IS TO DELIVER WORLD CLASS HEALTHCARE. OUR MISSION IS 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. HISTORY ------- IN 1993, WHAT WAS THEN KNOWN AS THE COBB HEALTH SYSTEM, THE KENNESTONE REGIONAL HEALTH CARE SYSTEM, AND THE DOUGLAS GENERAL HOSPITAL AFFILIATED TO FORM THE NORTHWEST GEORGIA HEALTH SYSTEM. PAULDING MEMORIAL MEDICAL CENTER AFFILIATED WITH NORTHWEST GEORGIA HEALTH SYSTEM IN 1994. IN 1994, THE NORTHWEST GEORGIA HEALTH SYSTEM HELPED FORM THE PROMINA HEALTH SYSTEM AND CHANGED ITS NAME TO PROMINA NORTHWEST HEALTH SYSTEM. IN 1998, PROMINA NORTHWEST HEALTH SYSTEM CHANGED ITS NAME TO WELLSTAR HEALTH SYSTEM. WELLSTAR DISASSOCIATED FROM AND BECAME TOTALLY INDEPENDENT OF PROMINA IN 1999. WELLSTAR HEALTH SYSTEM IS A PARENT CORPORATION WHICH PROVIDES OVERALL COORDINATION INCLUDING GOVERNING BODY TO ITS SEVEN SUBORDINATE AFFILIATES: 1) COBB HOSPITAL, INC; 2) CHS FOUNDATION, INC (INVESTMENT MANAGEMENT); 3) DOUGLAS HOSPITAL INC; 4) KENNESTONE HOSPITAL, INC; 5) PAULDING MEDICAL CENTER, INC; 6) WELLSTAR FOUNDATION INC. AND 7)COMMUNITY ASSURANCE COMPANY, LTD. (A CAPTIVE SELF-INSURANCE ORGANIZATION). SERVICES -------- WELLSTAR HEALTH SYSTEM IS ABLE TO OFFER A FULL RANGE OF HEALTHCARE SERVICES THROUGH ITS AFFILIATES. THE SERVICES OFFERED INCLUDE BUT ARE NOT LIMITED TO: MOST MAJOR INPATIENT CLINICAL SERVICES, OUTPATIENT SERVICES, DIAGNOSTIC AND THERAPEUTIC SERVICES, ANCILLIARY AND SUPPORT SERVICES, URGENT CARE SERVICES AND HOME HEALTH SERVICES. THE SYSTEM INCLUDES A RESIDENTIAL FACILITY ON THE KENNESTONE HOSPITAL CAMPUS, CALLED ATHERTON PLACE. ARTHERTON PLACE ALSO HOUSES AN ASSISTED LIVING UNIT AS AN ADDITIONAL LEVEL OF CARE. THE FIVE HOSPITALS ARE ACUTE CARE FACILITIES WITH INPATIENT, OUTPATIENT, AND EMERGENCY SERVICES. PAULDING MEDICAL CENTER IS HOME TO A FULL CARE NURSING HOME, PAULDING NURSING CENTER. COBB HOSPITAL IS HOME TO A HOME HEALTH AGENCY AND A RESIDENTIAL HOSPICE FACILITY CALLED TRANQUILITY FOR THOSE PATIENTS IN THE END STAGES OF LIFE. THE SYSTEM IS COMPLIMENTED WITH APPROXIMATELY 85 PHYSICIAN PRACTICES AND SEVERAL URGENT CARE CENTERS. THE SYSTEM IS THUS ABLE TO PROVIDE A COMPLETE CONTINUUM OF CARE FOR THE COMMUNITY ITS SERVES. The following statements of community benefit and program service accomplishments represent system-wide activity for Wellstar Health System, Inc. (the "System") - EIN 58-1649541. All affiliated entities of the system except the Physician Hospital Organization (EIN 58-2116179) operate as charitable organizations consistent with the requirements of Internal Revenue Code Section 501(c)(3) and the "Community Benefit Standard" of IRS Revenue Ruling 69-545. The following excerpt from the audited financial statements identifies a broad overview of the charitable purpose for the System. "The System maintains records to identify and monitor the level of charity care it provides through its affiliates. These records include the amount of charges foregone for services and supplies furnished under its charity care policy. Charges foregone, based on established rates, totaled approximately $170.3 million and $222.8 million in 2010 and 2011 respectively. During 2010, the State of Georgia adopted into law the Provider Payment Agreement Act. The Act provides that each hospital shall be assessed a provider payment in the amount of 1.45% of net patient service revenue of the hospital based on the annual financial survey filed with the State of Georgia Department of Community Health and such payments be recognized as a community benefit. In fiscal 2011, Wellstar affiliate hospitals made $14.0 million in provider payments and recognized such payments as a reduction in net patient service revenue in the accompanying combined financial statements. The System also participates in certain governmental insurance programs, including Medicare and Medicaid. Under these programs, the System provides care to patients at payment rates which are determined by the Federal and State governments, regardless of the System's actual charges. In some cases, these programs pay the System at amounts which are less than its cost of providing services. The System offers many wellness and educational services at little or no cost to the community. Health fairs are held throughout the year at convenient locations, providing various health screenings, such as mammograms, blood pressure and cholesterol checks. A large number of educational programs are offered for all ages. These programs include bicycle safety, car seat safety, defensive driving, CPR and first-aid classes. Flu shots are available to the community during flu season. Health screenings, medical supplies, and immunizations are provided to children through local health departments and health fairs with System sponsorship in many cases. The costs of these services are included in operating expenses. The System promotes health education and activities for students, parents, and teachers through its Partner-in-Education programs. The physicians of the System make significant contributions to improve the health status of the community, including involvement in many community activities promoting health awareness and improvement, emergency room care, and delivery of care to the indigent population of the System's service area. The System also made significant contributions to the nursing program at a local university. This financial support has helped to grow the program, which benefits the System as well as the community. The System and all but one of its affiliates have been recognized as organizations 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. One of the System's affiliates is a controlled foreign corporation not subject to Federal income tax. The Physician Hospital Organization (EIN 58-2116179) is a taxable affiliate of the System and files IRS Form 1120 US Corporation Income Tax Return." Financial Data and Statistics (Services Provided System-Wide) Prior Year Staffed Beds 1,144 1,143 Licensed Beds 1,321 1,321 Discharges 66,585 64,667 Newborn Deliveries 10,117 10,646 Emergency Room Visits 255,077 242,890 Pediatric ER Visits 51,269 49,714 Surgeries 42,328 42,804 Cath Lab/Pacemakers/EP 11,231 12,001 Non-ED O/P Radiology Procedures 285,318 311,003 Medical Group Visits 1,101,530 1,105,303 COMMUNITY BENEFITS ------------------ Wellstar Health System participates and collaborates with patients and residents in meeting health needs and improving the overall quality of life in the community. This is especially important in responding to the needs of the underserved regardless of the system's ability to generate a positive margin. Some services would possibly be discontinued if based on a purely financial basis. The following are some examples of the system's services that provide community benefits (and a monetary value of those benefits if known). Clinics Wellstar is affiliated with several clinics which provide free or discounted health services to persons who cannot afford to pay or those who are not expected to pay. During FY2011 the clinics at Kennestone and Cobb Hospitals experienced a combined total of 9,000 patient visits at a cost of $3.2 million. Some of the Wellstar physicians provide services in these clinics. One of Wellstar's own physicians, Dr Jose Rodriquez of the Wellstar Kennestone Pediatrics Associates, was recognized by a local business periodical for his volunteer work outside his normal work with Wellstar. He worked with a local organization to strengthen Hispanic families; taught a 10-week parenting class for the Hispanic community; and coordinated an annual meningococal vaccination program for over 600 area Hispanic high school seniors. Community Health/Education Wellstar's Marketing and Pub 382035475 true false false true false false false false true true false false true true true false true false true false false false false false false false true true true true false false false false false false false true true true false false false false true true true true false false true 0 0 4294 true true true true CJ false false false true false false false false false X 18 14 true false true false false false false true true false false true true true true true true true true true true GA X JAMES M SWARTZ 7707925023 805 SANDY PLAINS ROAD MARIETTA GA 300666340 X RANDALL BENTLEY SR 1.0 X 17242 0 0 ROBERT N CROSS MD 1.0 X 4678 0 0 TE RUSTY DURHAM 10.0 X 31751 0 1255 DAVID HAFNER MD 1.0 X 16011 0 0 THOMAS E GEARHARD MD 50.0 X 389972 0 28532 OTIS BRUMBY III 1.0 X 1727 0 0 JANIE MADDDOX 1.0 X 14609 0 0 STEVEN W OWEIDA MD 1.0 X 17242 0 0 TOM PHILLIPS 1.0 X 2754 0 0 WALTER G ROBINSON 1.0 X 7065 0 0 CONNIE KIRK 1.0 X 5044 0 0 W ALLEN SEPARK 1.0 X 7984 0 0 T FITZ JOHNSON 1.0 X 1742 0 0 GARY A MILLER 1.0 X 2721 0 0 JEFFREY THARP MD 50.0 X 446816 0 28567 CHARLES WOOD 1.0 X 12872 0 0 ROBERT WARNER MD 1.0 X 3142 0 0 CHARLES JONES 1.0 X 13123 0 0 GREGORY L SIMONE MD 50.0 X 3972245 0 172966 RONALD J STRACHAN 50.0 X 417826 0 27923 BARBARA COREY 50.0 X 353270 0 21091 DAVID ANDERSON X 512652 0 29200 KIMBERLY MENEFEE 50.0 X 330316 0 22272 LOU LITTLE 2.0 X 0 283210 24158 T MARK HANEY 50.0 X 331882 0 23979 DAROLD ETHERIDGE 50.0 X 231132 0 14571 LEE EVINS 50.0 X 248506 0 18089 CHRISTOPHER KANE 50.0 X 400365 0 26918 RANDY COOK 2.0 X 0 337679 23480 ROBERT MANDLER 50.0 X 262785 0 18444 CANDICE L SAUNDERS 2.0 X 0 480497 29392 PATRICK JANSEN 2.0 X 52225 0 3163 TRACEY ATWATER 50.0 X 254974 0 20336 DON CAMPBELL 50.0 X 392680 0 24541 MARCIA DELK 50.0 X 424457 0 33113 BONNIE WILSON 50.0 X 1480015 0 71627 KENNETH C KUNZE MD 50.0 X 687208 0 37043 BRUCE DEAN 50.0 X 246466 0 19958 A JAMES BUDZINSKI 50.0 X 585666 0 33803 JONATHAN B MORRIS MD 50.0 X 334194 0 23933 MICHAEL GRAUE 50.0 X 691292 0 44574 ANTHONY M TRUPIANO 50.0 X 285303 0 16534 ELLEN LANGFORD 50.0 X 228643 0 16661 CRAIG OWENS 2.0 X 0 311694 21752 ROBIN WILSON MD 50.0 X 340020 0 24726 JOSEPH L BRYWCZYNSKI 50.0 X 216142 0 14427 ELIZABETH A HOFFMANN 50.0 X 230428 0 10860 RICHARD T LOPES MD 50.0 X 513606 0 28822 JAMES M SWARTZ 50.0 X 169532 0 9148 MARY L WESLEY 50.0 X 294140 0 14070 BARBARA G BALLARD 50.0 X 120827 0 7602 CAROL S EDWARDS 50.0 X 117869 0 6022 ROBERT D JANSEN MD 50.0 X 368959 0 20365 BETH KOST 50.0 X 244509 0 16135 C BRETT SCULLEN 50.0 X 80312 0 3785 ADAM C THOMPSON 50.0 X 176957 0 9710 LEO E REICHERT 50.0 X 0 0 0 DEBORAH ROEGGE DE VITA 50.0 X 0 0 0 MARY L TAVERNARO 50.0 X 202544 0 12732 BARRY MANGEL MD 50.0 X 723993 0 45611 WILLIAM MAYFIELD MD 50.0 X 898604 0 43544 AVRIL BECKFORD MD 50.0 X 403675 0 21616 PERRY BUSBEE MD 50.0 X 350280 0 26981 ALAN MUSTER MD 50.0 X 587153 0 34062 Stephen J Odom MD 50.0 X 788831 0 40192 Nydia Bladuell 50.0 X 788508 0 37623 Amar Patel 50.0 X 760002 0 51468 Donald A Page Jr MD 50.0 X 765451 0 41639 Howard Snapper 50.0 X 755752 0 51292 MARSHA BURKE 1.0 X 190475 0 12395 LINDA CLARK 1.0 X 255306 0 10595 BRUCE HARRISON 50.0 X 455869 0 22304 24520341 1413080 1495601 840 true true false McKESSON INFORMATION SOLUTIONS POBOX 98347 CHICAGO IL 606938347 INFORMATION TECH SRV 8784605 MINDPOWER INC 337 GEORGIA AVENUE ATLANTA GA 30312 MARKETING 3155143 WEBMEDX INC 5901 C PEACHTREE DUNWOODY ROAD STE ATLANTA GA 30328 TRANSCRIPTION SRV 2048409 CHAMBERLIN EDMONDS AND ASSOCIATES PO BOX 572490 MURRAY UT 841572490 COLLECTION SERVICE 2319655 HARKINS AND HENRY LAW OFFICES 4901 OLDE TOWNE PKWY 300 MARIETTA GA 30068 LEGAL SERVICES 1904389 109 0 PATIENT REVENUE 621910 191509212 191509212 EQUITY IN EARNINGS OF HOSP AFFILIATES 621990 145142086 145142086 COBB COUNTY DETENTION CENTER 621990 1339919 1339919 SHARED SERVICES COSTS RECOUPMENT 621990 202449451 202449451 WELLNESS CENTER 621400 2262898 2262898 8958752 8958752 551662318 13001840 33 13001807 0 0 453522 453522 453522 453522 571884485 543873105 28011380 28011380 28011380 0 0 1335389 436355 899034 899034 LAUNDRY 812300 262366 262366 DISTRIBUTION FEES 493000 152655 152655 SEMINAR REVENUE 103795 103795 1119497 1119497 1638313 595666407 552561352 415054 42690001 761321 761321 69760 69760 0 0 20497549 18058101 2227678 211770 0 227887940 203289394 23941357 657189 21777783 18965890 2713771 98122 18362659 15738043 2530041 94575 14921757 12955511 1904441 61805 0 625657 495462 130195 301640 301640 0 0 0 48703521 42126049 6439731 137741 7539472 4686745 2800624 52103 16912719 16028920 767107 116692 0 0 15361576 13575061 1776998 9517 1770946 1123555 640139 7252 0 2876810 2232721 632321 11768 15091750 15091750 0 22602426 14332071 8251371 18984 6734428 6200744 533684 REPAIRS & MAINTENANCE 15740919 10975801 4765118 OTHER OPERATING EXPENSE 581004 420326 160541 137 459121637 382035475 75608507 1477655 47641 47641 44866668 21586577 20819336 29736597 5248530 5048749 15335657 20755113 326516304 213392313 98370551 113123991 606426626 725275891 28909277 29719477 636895650 672433243 1456919936 1617727279 69899306 63043520 347069865 339767680 3040626 1707717 249994181 188224762 670003978 592743679 X 778199385 1013738745 5023769 7544640 3692804 3700215 786915958 1024983600 1456919936 1617727279 X 136544770 101522872 X false true true X false X X X false false false COBB HOSPITALINC 580968382 03 true true true 58012343 PAULDING MEDICAL CENTER INC 582095884 03 true true true 11090682 KENNESTONE HOSPITAL INC 582032904 03 true true true 113769696 DOUGLAS HOSPITALINC 582026750 03 true true true 19686730 4 202559451 true true true 8000 true 3000 true 383 true 268629 true 146921 true 90 true 122196 549219 false Other Lobbying Expenses Form 990 Schedule C Part IV During the reporting period Wellstar Health System, Inc. held a retainer for a local firm to provide professional services for community related activities including support in community benefit reporting and legislative healthcare initiatives affecting the system hospitals. Wellstar is also a party to several healthcare related coalitions that protect the interests of all member hospitals. 3810000 24000 -70000 652000 4416000 3578000 19000 -8000 221000 3810000 3013000 615000 20000 -70000 3578000 0.84000 0.16000 false true true 21399555 21399555 73625361 39896149 33729212 9208492 6775038 2433454 219462130 166721126 52741004 2820766 2820766 113123991 UNAMORTIZED BORROWING COSTS 5563950 OTHER RECEIVABLES 7604675 OTHER PREPAIDS 406610 EQUITY IN AFFILIATES 658858008 672433243 0 ACCRUED PENSION LIABILITY 102379847 OTHER LONG TERM LIABILITIES 19413160 INSURANCE RESERVES 64932787 UNCLAIMED PROPERTY (ALLOCATED) 1124119 ASSET RETIREMENT OBLIGATION LT 374849 188224762 Endowment Funds Form 990 Schedule D Part V Line 4 The endowment funds held on Wellstar Health System are intended to be held in perpetuity and the earnings thereon are to be used for financial assistance for patients in the Wellstar Hospice Program. All funds were expended during the fiscal year for the Wellstar Hospice Program and a new inpatient Hospice facility at Kennestone Hospital SCHEDULE D PART X, LINE 2 TAX LIABILITY The following footnote from the WellStar Health System and Affiliates audited financial statements details the income tax position for the reporting period: "WellStar and all but one of its affiliates have been recognized as exempt from Federal income tax under Internal Revenue Code Section 501 (a) as organizations described in Section 501 (c)(3) and, therefore, related income is generally not subject to Federal or state income taxes. CAC 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." false American Cancer Society 1825 Barrett Lakes Blvd Suite 280 Kennesaw GA 30144 131623888 501 (c) (3) 15345 Sponsor Fundraiser American Heart Association 1101 Northchase Parkway Suite 1 Marietta GA 30067 580198114 501 (c) (3) 50000 Sponsor Fundraiser Foundation of North Metro Technical College 5198 Ross Road Acworth GA 30102 581920498 501 (c) (3) 128477 Student Affliation Agree/PT March of Dimes 1775 The Exchange Suite 515 Atlanta GA 30339 131846366 501 (c) (3) 15000 Sponsor Fundraiser MUST Ministries PO Box 1717 Marietta GA 30061 582034725 501 (c) (3) 30500 Sponsor Fundraiser The Center for Family Resources 995 Roswell St Suite 100 Marietta GA 30060 580876634 501 (c) (3) 25000 Sponsor Fundraiser Tommy Nobis Center 1480 Bells Ferry Rd Marietta GA 30060 582080817 501 (c) (3) 7500 Sponsor Fundraiser YMCA of Northwest Georgia 48 Henderson St Marietta GA 30064 580617782 501 (c) (3) 20000 Sponsor Fundraiser Chattahoochee Tech College Foundation 980 South Cobb Drive Marietta GA 30060 581684206 501 (c) (3) 15867 Grant for Agreement with school United Way Cobb County 995 Roswell Rd Suite 338 Marietta GA 30060 501 (c) (3) 44000 Contribution Rotary Club of East Cobb PO Box 72081 Marietta GA 30007 581654204 501 (c) (3) 7500 Sponsorship Yes 2 Save Lives 805 SANDY PLAINS ROAD MARIETTA GA 30066 273310216 501 (c) (4) 125000 State Trauma Program Coalition Susan G Komen for the Cure Atlanta 4840 Roswell Road Bldg D Suite 100 Atlanta GA 30342 581959763 501 (c) (3) 7500 Sponsorship of Race for Cure 51 2 X X X X X X false true X X X X X true true false false false false false true false THOMAS E GEARHARD MD 242155 0 139755 0 8062 0 21262 0 7270 0 418504 0 0 0 JEFFREY THARP MD 275580 0 119178 0 52058 0 23584 0 4983 0 475383 0 0 0 GREGORY L SIMONE MD 814552 0 372600 0 2785093 0 169533 0 3433 0 4145211 0 0 0 MARSHA BURKE 190475 0 0 0 10655 0 1740 0 202870 0 0 0 RONALD J STRACHAN 278129 0 73374 0 66323 0 21239 0 6684 0 445749 0 0 0 BARBARA COREY 271931 0 70439 0 10900 0 19591 0 1500 0 374361 0 0 0 DAVID ANDERSON 379036 0 118871 0 14745 0 25947 0 3253 0 541852 0 0 0 KIMBERLY MENEFEE 252707 0 66022 0 11587 0 18694 0 3578 0 352588 0 0 0 LOU LITTLE 0 219648 0 52762 0 10800 0 16822 0 7336 0 307368 0 0 T MARK HANEY 250475 0 67625 0 13782 0 18815 0 5164 0 355861 0 0 0 DAROLD ETHERIDGE 191995 0 30437 0 8700 0 13630 0 941 0 245703 0 0 0 LEE EVINS 183954 0 36757 0 27795 0 14120 0 3969 0 266595 0 0 0 CHRISTOPHER KANE 308673 0 80630 0 11062 0 21648 0 5270 0 427283 0 0 0 LINDA CLARK 255306 0 0 0 10595 0 0 265901 0 0 0 RANDY COOK 0 269236 0 55827 0 12616 0 19007 0 4473 0 361159 0 0 ROBERT MANDLER 195977 0 37704 0 29104 0 14866 0 3578 0 281229 0 0 0 CANDICE L SAUNDERS 0 343988 0 123656 0 12853 0 24895 0 4497 0 509889 0 0 TRACEY ATWATER 203872 0 41673 0 9429 0 15128 0 5208 0 275310 0 0 0 DON CAMPBELL 304092 0 77660 0 10928 0 21047 0 3494 0 417221 0 0 0 MARCIA DELK 326736 0 86581 0 11140 0 22854 0 10259 0 457570 0 0 0 BRUCE HARRISON 283156 0 4564 0 168149 0 20737 0 1567 0 478173 0 0 0 BONNIE WILSON 414885 0 126556 0 938574 0 66357 0 5270 0 1551642 0 0 0 KENNETH C KUNZE MD 532359 0 142962 0 11887 0 33411 0 3632 0 724251 0 0 0 BRUCE DEAN 197308 0 39928 0 9230 0 14509 0 5449 0 266424 0 0 0 A JAMES BUDZINSKI 434410 0 138539 0 12717 0 29307 0 4496 0 619469 0 0 0 Stephen J Odom MD 378275 0 330179 0 80377 0 37636 0 2556 0 829023 0 0 0 Nydia Bladuell 435862 0 351496 0 1150 0 37623 0 0 826131 0 0 0 Amar Patel 406085 0 348917 0 5000 0 36440 0 15028 0 811470 0 0 0 Donald A Page Jr MD 408325 0 354187 0 2939 0 36666 0 4973 0 807090 0 0 0 Howard Snapper 409316 0 341436 0 5000 0 36264 0 15028 0 807044 0 0 0 JONATHAN B MORRIS MD 256833 0 50211 0 27150 0 18905 0 5028 0 358127 0 0 0 MICHAEL GRAUE 513657 0 164927 0 12708 0 33859 0 10715 0 735866 0 0 0 ANTHONY M TRUPIANO 230311 0 45692 0 9300 0 16534 0 0 301837 0 0 0 ELLEN LANGFORD 182066 0 37877 0 8700 0 14188 0 2473 0 245304 0 0 0 CRAIG OWENS 0 241388 0 58911 0 11395 0 17960 0 3792 0 333446 0 0 ROBIN WILSON MD 277804 0 53016 0 9200 0 14456 0 10270 0 364746 0 0 0 BARRY MANGEL MD 295863 0 118405 0 309725 0 35341 0 10270 0 769604 0 0 0 WILLIAM MAYFIELD MD 478087 0 64108 0 356409 0 40550 0 2994 0 942148 0 0 0 JOSEPH L BRYWCZYNSKI 167838 0 0 48304 0 12397 0 2030 0 230569 0 0 0 ELIZABETH A HOFFMANN 171895 0 15669 0 42864 0 9605 0 1255 0 241288 0 0 0 RICHARD T LOPES MD 405473 0 0 108133 0 26209 0 2613 0 542428 0 0 0 JAMES M SWARTZ 147399 0 14973 0 7160 0 7113 0 2035 0 178680 0 0 0 MARY L WESLEY 214845 0 19059 0 60236 0 12190 0 1880 0 308210 0 0 0 ROBERT D JANSEN MD 311389 0 48653 0 8917 0 15337 0 5028 0 389324 0 0 0 BETH KOST 209311 0 30248 0 4950 0 14503 0 1632 0 260644 0 0 0 ADAM C THOMPSON 148759 0 16996 0 11202 0 7351 0 2359 0 186667 0 0 0 AVRIL BECKFORD MD 248228 0 80334 0 75113 0 21616 0 0 425291 0 0 0 PERRY BUSBEE MD 186037 0 58392 0 105851 0 19711 0 7270 0 377261 0 0 0 ALAN MUSTER MD 286004 0 78006 0 223143 0 29426 0 4636 0 621215 0 0 0 MARY L TAVERNARO 174839 0 26505 0 1200 0 11180 0 1552 0 215276 0 0 0 NON-FIXED PAYMENTS TO OFFICERS FORM 990 SCHEDULE J LINE 7 Wellstar has instituted an annual incentive plan for key leaders in the company. On an annual basis performance measures are proposed by management and recommended and approved by the compensation committee of the Board. The plan is designed to retain and reward leaders with incentives that keep them competitive with the market and comparable health systems. The criteria used to measure the performance consists of weighted factors in the areas of financial performance, customer service, employee engagement and quality indicatiors. Upon successful acheivement at various targeted levels for each factor an overall performance payout is recommended and approved by the Board after the annual financial audit is completed. SEVERANCE PAYMENTS Pursuant to their respective employment agreements, the following groups of officers are entitled to severance payments based on their base salary and wages at that time in the event of certain identified circumstances. The officers with a severance payment period of 24 months as per their contractual agreement are: David Anderson, Marsha Burke, Linda Clark, Gregory Simone MD, and Bonnie Wilson. The officers with a severance payment period of 18 months as per their respective agreements are: Joseph Brywczynski, A James Budzinski, Donald Campbell MD, Barbara Corey, Marcia Delk MD, Michael Graue, T Mark Haney, Bruce Harrison, Robert Jansen MD, Christopher Kane, Kenneth Kunze MD, Lou Little, Richard Lopes MD, Kimberly Menefee, Craig Owens, Tarey Ray, Leo E Reichert, Ron Strachan, Mary L Wesley The officers with a severance payment period of 12 months as per their agreement: Barbara Ballard, Bruce Dean, Carol Edwards, Darold Etheridge, Lee Evins, Robert Hamilton, Elizabeth Hoffmann, Beth Kost, Ellen Langford, Robert Mandler, Jonathan Morris MD, Deborah Roegge DeVita, C Brett Scullen, James Swartz, Mary L Tavernaro, Adam Thompson, Anthony Trupiano, Robin Wilson MD During the calendar year, the following individuals received a payout in the amounts listed in accordance with their severance agreements as set forth above: Marsha Burke $ 190,475 Linda Clark $ 255,306 Teresa Ray $ 99,120 Bruce Harrison $ 455,868 Gregory L Simone $3,518,524 Bonnie Wilson $1,124,436 OTHER COMPENSATION Form 990, Schedule J, Part I, Line 1b & 2 While Wellstar Health System and its affiliates do not have a written policy regarding payment or reimbursement for the items listed in Part 1 Line 1a, the organization follows IRS guidelines in the payment of any of these items to individuals listed in Form 990 Part VII Section A. These items are added as taxable wages on the individual's Form W-2 as appropriate. Hospital Authority of Cobb County 582464600 19081PDR4 2003-04-30 132210370 Construction false false false Hospital Authority of Cobb County 582464600 19081PEM4 2004-04-30 25000000 Equipment Pool false false false Cobb County Kennestone Hospital Authority 581147004 190813LN3 2005-10-31 60000000 Capital Improvements (Series A false false false Cobb County Kennestone Hospital Authority 581147004 190813LM5 2005-10-31 60000000 Capital Improvements (Series B false false false 9280000 132210370 53163166 1566767 74573976 2906461 2005 true true true true 25000000 25000000 2004 false false true true 60000000 583650 58474137 942212 2007 false false true true 60000000 583650 58474138 942212 2007 false false true true false false false false true 0.00020 0.00020 true false false false false true true false false false false true 0.00020 0.00020 true false false false false true 0.00020 0.00020 true false false false false false true false true false false false true false true true UBS false false true false true false false false true PAMELA ETHERIDGE WIFE OF OFFICER 53737 EMPLOYEE OF WELLSTAR false GREG FORTGANG SON-IN-LAW OF TRUSTEE 102382 EMPLOYEE OF WELLSTAR false AMY SIMONE DAUGHTER OF OFFICER 72052 EMPLOYEE OF WELLSTAR false GEORGE FLEMING BROTHER OF OFFICER 59478 EMPLOYEE OF WELLSTAR/COBB false THOMAS E GEARHARD MD BOARD MEMBER 135874 BUILDING LEASE false GREYSTONE POWER BOARD MEMBER 952578 EXPLANATION IN SCH O false MATTHEW MADDOX SON OF BOARD MEMBER 38489 EMPLOYEE OF WELLSTAR false PUCKETT EMS AMBULANCE SERVICE BROTHER-IN-LAW OF OFFICER 316544 EXPLANATION IN SCH O false H S I FINANCIAL SERVICES OFFICER IS DIR OF AGENCY 442799 EXPLANATION IN SCH O false BONNIE MILLER WIFE OF BOARD MEMBER 28417 EMPLOYEE OF WELLSTAR false GREG SEPARK SON OF BOARD MEMBER 25847 EMPLOYEE OF WELLSTAR false COMPENSATION INFORMATION ON FORM 990 FORM 990 PART VII COMPENSATION, PART IX LINES 5-7 & SCHEDULE J & J-1 ALL COMPENSATION AMOUNTS REPORTED ON FORM 990, PART VII; PART IX, LINES 5-7; AND SCHEDULE J REPRESENT COMPENSATION PROVIDED TO INDIVIDUALS THAT PROVIDE SERVICES TO THE ORGANIZATION. LIKEWISE, THE NUMBER OF EMPLOYEES REPORTED ON PART V, LINE 2A REPRESENTS 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). CONFLICT OF INTEREST POLICY FORM 990 PART VI SECTION B Line 12 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. PROCESS OF EXEC COMPENSATION FORM 990 PART VI SECTION B Line 15a & b WellStar engages the Hay Group to work with the governing board to review and recommend executive compensation. The executive compensation process at WellStar is overseen by a committee of independent trustees, which follows a board-approved executive compensation philosophy. The current members of the WellStar committee are: Pete Wood Janie Maddox Al Separk Wellstar Board Chair Ex Officio CEO--Ex Officio In committtee discussions about the compensation for the Chief Executive Officer, the CEO will recuse himself from that process but is a non-voting committee member for discussions on all other officers. The executive compensation philosophy empowers the committee to oversee the executive compensation process and administer the executive compensation program on behalf of the full board of trustee of WellStar; provided, however, the full Board of Trustees evaluates and approves the compensation of the Chief Executive Officer. The philosophy requires annual disclosure of the committee's actions and decisions to the full board, which it has done. The committee is guided by the board-approved philosophy. Overall, the philosophy is intended to reward for organizational and individual performance. When performance is at a predetermined targeted level, the compensation is intended to be at or around the median of compensation paid to similar positions at similar organizations (the "market"). WellStar's executive compensation philosophy defines the market as being comprised of comparable not-for-profit health care delivery systems, i.e., not-for-profit organizations similar in complexity and scale to Wellstar. To assist the committee in fulfilling its duties, the committee engaged the Hay Group to provide market compensation data to compare to the Wellstar positions whose compensation the committee oversees. The committee uses this data to provide context when making decisions in administering the compensation program. Accurate minutes of the committee's discussion and decisions are recorded during each committee meeting, and reviewed and approved at the following committee meeting. DISCLOSURE OF FINANCIAL DOCUMENTS FORM 990 PART VI SECTION C Line 19 The organization and its subsidiaries are subject to the Open Records Law in the State of Georgia. Therefore, by law, citizens are permitted to inspect and copy its governing documents, policies and financial statements as may be requested from time to time. Additionally, the organization's Form 990 is made readily available on the Guidestar website. Periodically, the organization publishes its financial performance in the local newspaper for citizens to review, and it also publishes a community benefit report once a year for distribution to the public. VOLUNTEERS Form 990 Part I General Information WellStar Health System, Inc. through its affiliated business organizations operates five hospitals and throughout the system there are approximately 800 volunteers who make up the network of people who donate their time to serving our healthcare community. Kennestone Hospital, Inc. has approximately 400 volunteers between Kennestone and Windy Hill. The Cobb Auxiliary has approximately 200 volunteers. Douglas Hospital and Paulding Hospital have approximately 100 volunteers each in their respective auxiliaries. AUDITED FINANCIAL STATEMENTS Form 990 Part IV Line 12 and Part XI WellStar Health System, Inc. is audited on an annual basis by an outside auditing firm, 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." PROCESS OF 990 BOARD REVIEW Form 990 PART VI LINE 11A Internal staff prepare the organization's Form 990. Before filing the return with the Internal Revenue Service an external accounting firm, PricewaterhouseCoopers, reviews and sign-offs on the completed return of each organization. Generally, 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. CURRENT OFFICERS/DIRECTORS RELATIONSHIPS FORM 990 PART VI, SECTION A LINE 2 For a portion of the tax year two officers and directors for WellStar Health System, Inc. --EIN 58-1649541 are related to each other through family. Lou Little, Sr VP Post Acute Services and Administrator of Windy Hill Hospital is the brother-in-law of Gregory Simone, former President and CEO for the system. OFFICERS HOURS WORKED FORM 990 GENERAL STATEMENT & SCHEDULE J The officers devote their time to all of the organizations with WellStar Health System that are listed in Schedule R, Part II. As such, the total hours worked by the officers across all of the organizations exceeds 40 hours per week. BYLAWS CHANGES FORM 990, PART VI, LINE 4 In November 2010 the bylaws of Wellstar Health System were amended to reflect that any retired trustees be provided benefits upon their retirement from service on the Board. Transactions with Related Organizations Form 990 Schedule R Part V Line 2 The dollar amounts reported on Form 990 Schedule R Part V Line 2 for WellStar Health System, Inc. include the overhead allocations to affiliates and consists of the following types of transactions as listed in Line 1 (a-r): h) Exchange of Assets i) Lease of facilities, equipment, or other assets to other organizations j) Lease of facilities, equipment, or other assets from other organizations n) Sharing of paid employees o) Reimbursement paid to other organizations q) Other transfers of cash or property to other organizations r) Other transfers of cash or property from other organizations SCH L PART IV EXPLANATIONS On Schedule L Part IV we have several interested parties that require additional explanation for the transactions: Board Trustee Gary Miller is President of Greystone Power which provides electric service to certain Wellstar Hospitals and Physician practices in the normal course of business. The total amount of the transactions with Greystone is $952,500 with $65,000 related to Paulding Hospital; $739,000 related to Douglas Hospital and $148,000 related to Wellstar Medical Group. Steve Puckett is the brother-in-law of Ellen Langford, an officer with Wellstar Health System. Mr. Puckett is the President of Puckett EMS Ambulance Service which provides ambulance services to several Wellstar Health System affiliates. Individually all of the entity specific transactions are less than $100,000 but in aggregate total $316,544. These services are in the normal course of business with our hospitals. H.S.I. Financial Services is a local billing agency which provides services to Wellstar Health System in the form of routine collection services of outstanding patient balances. Lee Evins, an officer of Wellstar Health System is also a director on the H.S.I. board. The total amount of the transactions with H.S.I. equal $442,799 for the reporting period. Changes In Net Assets Form 990 Part XI Line 5 The changes in net assets for Wellstar Health System, Inc are as follows: Unrealized Gains $42,201,705 Pension Adjustment 58,562,000 Other Changes 759,168 Total $101,522,873 HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:LOU LITTLE TITLE:VP POST ACUTE SRVCS & HOSP ADM HOURS:50 HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:RANDY COOK TITLE:SR VP & ADMINISTRATOR HOURS:50 HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:CANDICE L SAUNDERS TITLE:SR VP ADMINISTRATOR HOURS:50 HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:CRAIG OWENS TITLE:SR VP & ADMIN HOURS:50 Wellstar Medical Group LLC 805 Sandy Plains Road Marietta GA 30066 273818647 Healthcare GA 165901127 53375066 WHS Inc Cobb Gynecologists 2 LLC 805 Sandy Plains Road Marietta GA 30066 020808099 Healthcare GA 0 NA South Cobb OB-GYN 2 LLC 805 Sandy Plains Road Marietta GA 30066 020808071 Healthcare GA 0 NA WellStar Acworth Family 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