2012-05-15T13:42:48-04:00 2011-06-30 PricewaterhouseCoopers LLP 2001 MARKET ST SUITE 1700 PHILADELPHIA PA 19103 990 2010-07-01 580968382 COBB HOSPITAL INC COBB 7707925023 805 Sandy Plains Road Marietta GA 300666340 JIMMY SWARTZ 2012-05-15 true 2673303000 2010 2016-02-24 21:20:13Z A JAMES BUDZINSKI 805 Sandy Plains Road Marietta GA 300666340 308436175 false X www.wellstar.org X 1984 GA To provide world-class charitable healthcare to the community 18 14 2598 200 0 0 0 0 364184219 305272543 8787865 0 4181245 3163632 377153329 308436175 0 0 0 0 132712984 137566556 0 0 0 213852673 145373579 346565657 282940135 30587672 25496040 171591044 187247660 105672681 120452266 65918363 66795394 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 244039192 305272543 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 $21.2 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 constucted 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, 2011: Adult Discharges 21,513 Med/Surg Short Stay days 4,529 Emergency Room Visits (incl pediatric ER) 94,953 Outpatient Surgical Cases 7,652 Inpatient Surgical Cases 3,878 Outpatient Procedures Non-ED OP Radiology 63,044 GI Laboratory 1,555 Total FTEs (paid) 1,952 Community Benefit Reporting Community Outreach (incl system-wide alloc) $1,394,265 Unreimbursed Charity Care (at cost) $19,519,332 Medicaid Shortfalls (at cost) $ 7,780,976 Total $28,694,573 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 denfensive driving for teens (offered at a minimal cost or at no cost), smoking cessation, heart smart school, CPR and others. System-wide over 200,000 residents from the community participated in these various screenings. 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 $10,000 was raised to support cancer research, education and patient services. 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 FY2011 the clinics served a combined 9,000 patient visitors at a cost of almost $3.2 million. The system partnered with the local school systems to provide free health and safety education to nearly 50,000 area elementary students and approximately 8,000 adolescent students. In partnership with Cobb County law enforcement and YWCA, Wellstar started a program called Sexual Assault Nurse Examiner (SANE) for confidential and secure treatment of sexual assault victims. Approximately 100 patients were treated in the program. Cobb Hospital continued to serve as a Partner in Education site for mentoring South Cobb High School students with interest in pursuing healthcare professions. Thirty students participate in the program each year. Wellstar and the Cobb County Board of Education have partnered to provide student athletes with concussion testing in all sports related programs offered in the schools. This testing is provided free of charge to the student athletes as a proactive and preventive measure before participation is granted. Wellstar and Cobb Hospital again received the designation as a "Company that Cares" for its caring about patients, communities and team members. It is one of only seven health care systems and the only local system to achieve that distinction. Wellstar Health System and affiliates remained strong financially with a 6.0% operating margin. The system also initiated an internal program to identify costs savings and revenue enhancements which produced an additional $75 million in company-wide savings and efficiencies and continues to identify additional costs savings program each year. These initiatives made it possible to continue to reinvest funds into improvement and purchase of state of the art facilities and equipment ($55 million was spent in FY11 for total system-wide capital expenditures). Wellstar made an important investment in the area of clinical excellence by adding additional physicians and practitioners to the system and a total of 66 new physicians to the Wellstar Medical Group. Additional cardiology doctors have helped to make Wellstar one of the leading cardiac health systems in Georgia. Cobb Hospital and other Wellstar facilities continued to invest in state of the art cancer treatment with its Wellstar Cancer Program. More than 3,000 patients were treated in the system; 847 cyberknife radiosurgeries were performed; and almost 17,000 radiation therapy treatments were provided. Cobb Hospital has initiated a new voluntary service called "New Vision". This service offers adults treatment for alcohol and drug rehab and help with withdrawal symptons often associated with the treatment. The service has helped over 300 patients since inception with specialized care to provide medical stabilization and continued rehabilitation. Cobb, Douglas, Kennestone and Paulding hospitals continue to meet the Appropriate Care Measures (ACM) 93 percent threshold in quality for the Presidential Level of the Quality Honor Roll as reported by Georgia Hospital Association. Wellstar has seen its percentages move from a rating of 81.4 percent to a current rate of 94.6 percent. Awards American College of Radiology-recognized for the Ultrasound and Nuclear Medicine product lines Quality Respiratory Care by the American Association of Respiratory Care Accredited Chest Pain Clinics at all hospitals by the Society of Chest Pain Centers Accredited Breast Health Center by the National Accreditation Program for Breast Centers JCAHO-Disease Specific Certification and Certified Primary Stroke Center. Two Wellstar Cobb Hospital nurses were awarded DAISY Awards from UnitedHealthcare and the Daisy Foundation to recognize the extraordinary work that nurses do every day. The award was established by the DAISY Foundation, an organization to seek a cure for Diseases Attacking the Immune SYstem. Wellstar's hospitals received the GHA and Partnership for Health and Accontability Circle of Excellence Award, an honor given to hospitals and health systems that have demonstrated a sustained commitment to quality and patient safety over an extended period of time. Wellstar has greatly improved its quality and patient safety statistics over the last three years. Wellstar Community Hospice as named a national partner of "We Honor Veterans". This recognition is for organizations that make a systematic commitment to improving care for veterans including those facing life-limiting illnesses. Wellstar Cobb Hospital's NICU received a VHA award in clinical excellence for its work on ventilator-associated pneumonia prevention in neonates. Wellstar received a "3 STAR " rating from the Society of Thoracic Surgeons (STS) for the quality of it's cardiace surgery program throughout the system. Cobb Hospital was named one of the Top 10 Best Hospitals in metro Atlanta by the US News and World Repor 244039192 true false false false false false false false false true false false true true false false true false false false false false false false false true true false false true false false false false false false true false false false false false false true true true false false true 0 0 2598 true false false false false false false false false false false X 18 14 true false true 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 Randall Bentley 1.0 X 0 17242 0 Robert N Cross MD 1.0 X 0 4678 0 TE Durham 1.0 X 0 31751 1255 Thomas E Gearhard MD 1.0 X 0 389972 28532 David Hafner MD 1.0 X 0 16011 0 Charles J Jones 1.0 X 0 13123 0 Connie Kirk 1.0 X 0 5044 0 Janie Maddox 1.0 X 0 14609 0 Gary A Miller 1.0 X 0 2721 0 Steven W Oweida MD 1.0 X 0 17242 0 Tom Phillips 1.0 X 0 2754 0 Walter G Robinson 1.0 X 0 7065 0 Otis Brumby III 1.0 X 0 1727 0 W Allen Separk 1.0 X 0 7984 0 T Fitz Johnson 1.0 X 0 1742 0 Jeffrey Tharp MD 1.0 X 0 446816 28567 Robert G Warner MD 1.0 X 0 3142 0 Charles Pete Wood 1.0 X 0 12872 0 A James Budzinski 2.0 X 0 585666 33803 Gregory L Simone MD 2.0 X 0 3972245 172966 Bonnie Wilson 2.0 X 0 1480015 71627 David W Anderson 2.0 X 0 512652 29200 Donald Campbell MD 2.0 X 0 392680 24541 Barbara B Corey 2.0 X 0 353270 21091 Bruce Dean 2.0 X 0 246536 19958 Marcia Delk MD 2.0 X 0 424456 33113 Darold Etheridge 50.0 X 231132 0 14571 Lee Evins 2.0 X 0 248506 18089 Mark Haney 2.0 X 0 331882 23979 Christopher M Kane 2.0 X 0 400365 26918 Kenneth C Kunze MD 2.0 X 0 687207 37043 Louis W Little 2.0 X 0 283210 24158 Kimberly W Menefee 2.0 X 0 330316 22272 Ronald J Strachan 2.0 X 0 417826 27923 Randy Cook 50.0 X 337679 0 23480 ROBERT HAMILTON 50.0 X 302937 0 24258 MICHAEL GRAUE 2.0 X 0 691292 44574 ROBERT JANSEN 2.0 X 0 368959 20365 ELLEN LANGFORD 2.0 X 0 228643 16661 Robert Mandler 2.0 X 0 262785 18444 Jonathan B Morris 2.0 X 0 334194 23933 Anthony M Trupiano 2.0 X 0 285303 16534 Robin Wilson MD 2.0 X 0 340020 24726 Ilona L Wozniak 50.0 X 268174 0 17704 Joseph L Brywczynski 2.0 X 0 216142 14427 Elizabeth A Hoffmann 2.0 X 0 230428 10860 Richard T Lopes MD 2.0 X 0 513606 28822 James M Swartz 2.0 X 0 169532 9148 Mary L Wesley 2.0 X 0 294140 14070 Barbara G Ballard 2.0 X 0 120827 7602 Carol S Edwards 2.0 X 0 117869 6022 Beth Kost 2.0 X 0 244509 16135 Elizabeth Person 50.0 X 113994 0 6671 Chris Brett Scullen 2.0 X 0 80312 3785 Adam C Thompson 2.0 X 0 176957 9710 Leo E Reichert 2.0 X 0 0 0 Deborah DeVita Roegge 2.0 X 0 0 0 Allen Hoffman MD 50.0 X 181500 0 12194 Billy A Reid 50.0 X 157674 0 11673 Nancy Craney 50.0 X 164910 0 11694 Sheila Baker 50.0 X 158949 0 10230 Tawana Moses 50.0 X 166785 0 10502 Marsha Burke 1.0 X 0 190475 12395 Linda A Clark 1.0 X 0 255306 10595 Bruce Harrison 1.0 X 0 455869 22304 Ellena Ann Evans 5.0 X 133080 0 5523 2216814 17240495 1124647 98 true true false Martin General Contracting Inc 3633 Ivy Gulledge Rd DALLAS GA 30132 General Contracting 792127 Quest Diagnostics PO BOX 740736 ATLANTA GA 30384 LAB SERVICES 744918 Surgical Operational Services Inc 505 Commerce Park Dr Suite G MARIETTA GA 30060 Consultant OR 1072276 RCC Marietta PO Box 101518 ATLANTA GA 303921518 Medical Services 914889 Cork-Howard Construction Inc 2121 New Market Pkwy Suite 118 MARIETTA GA 30067 GENERAL CONTRACTOR 8117380 18 0 PATIENT REVENUE 621990 305251778 305251778 PATIENT EDUCATION 621990 20689 20689 MEDICAL RECORDS 621990 76 76 305272543 0 0 0 140324 140324 140324 140324 0 0 0 0 CAFETERIA 1817737 1817737 PARKING 819452 819452 LACTATION REVENUE 19633 19633 366486 366486 3023308 308436175 305272543 0 3163632 0 0 0 0 1253914 1116862 137052 0 110754276 98654374 12099902 7945106 6971036 974070 9412602 8258617 1153985 8200658 7195257 1005401 0 25906 25906 0 0 0 0 11215206 9828329 1386877 22977 18690 4287 51910847 50986505 924342 0 0 4567832 1201335 3366497 75132 54236 20896 0 64657 57272 7385 75815 75815 58012360 50900045 7112315 12803102 5350881 7452221 1839242 1839242 REPAIRS & MAINTENANCE 4489701 3178010 1311691 OTHER OPER EXPENSE 270802 267743 3059 282940135 244039192 38900943 0 5150 6825 37356 37865 41091463 48302664 4318299 5078180 2833116 1753680 298816465 177051111 111669270 121765354 11636390 10303092 171591044 187247660 20490640 20393695 83344 57208 85098697 100001363 105672681 120452266 X 65918363 66795394 65918363 66795394 171591044 187247660 X 25496040 -24619009 X false true true X false X 4336556 4336556 138938732 69413004 69525728 4639332 3481825 1157507 138876409 104156283 34720126 12025437 12025437 121765354 LONG TERM PORTION OF PREPAIDS 3593 DUE TO AFFILIATES 4774742 C&E MEDICAID PENDING 5524757 10303092 0 ASSET RETIREMENT-OTHER LT LIAB 668324 TAX EXEMPT BOND LIAB-DUE TO WHS 99333039 100001363 Uncertain Tax Position SCHEDULE D PART X Line 2 The following is a footnote from the combined financial statements of Wellstar Health System, Inc. and Affiliates related to the reporting of the organization's liability for uncertain tax positions under FIN 48. "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 tax. Community Assurance Corportion 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 19519332 19519332 0.06860 52745014 44964038 7780976 0.02730 72264346 44964038 27300308 0.09590 780023 780023 0.00270 780023 780023 0.00270 73044369 44964038 28080331 0.09860 true 17528086 3726288 97410972 105768025 -8357053 X true true 1 1 Cobb Hospital

3950 Austell Road Austell GA 300666340

X X X Cobb Hospital 1 true Publication of Community Benefit Report Sch H Part I Line 6a 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. Cost to Charge Ratio Sch H Part I Line 7 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. Footnote on Bad Debt and Rationale for Community Benefit Sch H Part III Line 4 The following footnote is detailed in the Wellstar Health System, Inc. and Affiliates 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. Medicare Shortfalls Schedule H Part III Line 8 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 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. Collection Practices Schedule H Part III Sec C Line 9b 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. Hospital Description Schedule H Part V Cobb Hospital is a general acute care hospital providing a full range of services, is licensed to operate 382 beds, and is presently staffed to operate 370 beds. It is located on an approximately 55-acre campus in Austell, Georgia and is housed within a complex of connected buildings containing a total square footage in excess of 450,000 square feet. The original hospital was constructed in 1968 and major structural additions have been made in several phases since that time. The hospital provides medical, surgical, obstetrical, pediatric, rehabilitative, and psychiatric inpatient care and outpatient care, including emergency services. The Cobb Hospital Women's Center operates 20 labor and delivery rooms, 40 post partum rooms, 6 antipartum rooms and a resource center and classrooms offering educational opportunities. Needs Assessment Schedule H Part VI Line 2 Wellstar Health System (and affiliates) is a key stakeholder in MAPP, Mobilizing for Action through Planning and Partnerships. 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, continous community involvement leads to community ownership of the process. Community ownership, in turn, increases the credibility and sustainability of the health improvement efforts. Patient Education of Eligibility for Assistance Sch H Part VI Line 3 Cobb Hospital provides its patients with hospital personnel or contracted personnel who are trained in all aspects of governmental programs, payments plans, charity discounts, and other financial assistance offered to assist them in their hospital bills. If the patient is eligible for federal or state assistance programs, a staff member is knowledgeable in the steps necessary to qualify those individuals. If a patient is indigent or charity eligible they will be offered assistance through the hospital's charity and indigent care policy including the state's indigent care trust fund. If the patient has no other insurance and fails to qualify for indigent care assistance, the financial counselor can then offer the patient an opportunity to accept a payment plan with discounted payment options based on their ability to pay immediately or over time. All patient are afforded these opportunities. Community Information Sch H Part VI Line 4 Cobb Hospital is one of five hospitals that are affiliated with the parent corporation, Wellstar Health System. The primary service area of the system is located in the Northwest Georgia area and receives the majority of its patients from one of five counties (Cherokee, Cobb, Douglas, Bartow and Paulding). Generally about 85% to 90% of the patient volume comes from this service area although other health systems have a presence in the area as well. Demographically the region is one of the fastest growing in the state as well as the country and the expansion of the services for the patient population reflects a desire to offer healthcare "closer to home" since Wellstar is considered a part of a larger metropolitan Atlanta market. Economically the region is strong in per capita income but given recent trends a rise in the uninsured and indigent population has occured. Affiliated Health System Role Schedule H Part VI Line 7 As stated in the Wellstar Health System, Inc and Affiliates audited financial statments for the period ended June 30, 2011, Cobb Hospital (an affiliate of Wellstar Health System, Inc.) operates as a charitable organization consistent with the requirements of Internal Revenue Code Sect 501 (c) (3) and the "community benefit standard" of IRS Ruling 69-545. In this regard the governing body of the organization and/or its parent is composed of prominent citizens in the community, medical staff privileges in the hospital are available to all qualifed 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; and the hospital provides care to the needy members of the community consistent with its charity care policy. The hospital's excess funds are genrally applied to expansion and replacement of existing facilities and equipment, amortization of indebtedness, improvement fo patient care, community benefit activities, and charity care. Cobb Hospital committed approximately $21.2 million in capital expenditures for the year to meet those needs. X X X X X X false true X X X X X true false false false false false false true false Thomas E Gearhard MD 0 242155 0 139755 0 8062 0 21262 0 7270 0 418504 0 0 Jeffrey Tharp MD 0 275580 0 119178 0 52058 0 23584 0 4983 0 475383 0 0 A James Budzinski 0 434410 0 138539 0 12717 0 29307 0 4496 0 619469 0 0 Marsha Burke 0 190475 0 0 0 10655 0 1740 0 202870 0 0 Linda A Clark 0 255306 0 0 0 10595 0 0 265901 0 0 Gregory L Simone MD 0 814552 0 372600 0 2785093 0 169533 0 3433 0 4145211 0 0 Bonnie Wilson 0 414885 0 126556 0 938574 0 66357 0 5270 0 1551642 0 0 David W Anderson 0 379036 0 118871 0 14745 0 25947 0 3253 0 541852 0 0 Donald Campbell MD 0 304092 0 77660 0 10928 0 21047 0 3494 0 417221 0 0 Barbara B Corey 0 271931 0 70439 0 10900 0 19591 0 1500 0 374361 0 0 Bruce Dean 0 197308 0 39928 0 9300 0 14509 0 5449 0 266494 0 0 Marcia Delk MD 0 326735 0 86581 0 11140 0 22854 0 10259 0 457569 0 0 Darold Etheridge 191995 0 30437 0 8700 0 13630 0 941 0 245703 0 0 0 Lee Evins 0 183954 0 36757 0 27795 0 14120 0 3969 0 266595 0 0 Mark Haney 0 250475 0 67625 0 13782 0 18815 0 5164 0 355861 0 0 Bruce Harrison 0 283156 0 4564 0 168149 0 20737 0 1567 0 478173 0 0 Christopher M Kane 0 308673 0 80630 0 11062 0 21648 0 5270 0 427283 0 0 Kenneth C Kunze MD 0 532358 0 142962 0 11887 0 33411 0 3632 0 724250 0 0 Louis W Little 0 219648 0 52762 0 10800 0 16822 0 7336 0 307368 0 0 Kimberly W Menefee 0 252707 0 66022 0 11587 0 18694 0 3578 0 352588 0 0 Ronald J Strachan 0 278129 0 73374 0 66323 0 21239 0 6684 0 445749 0 0 Randy Cook 269236 0 55827 0 12616 0 19007 0 4473 0 361159 0 0 0 Allen Hoffman MD 166206 0 14278 0 1016 0 7532 0 4662 0 193694 0 0 0 Billy A Reid 148236 0 0 9438 0 9508 0 2165 0 169347 0 0 0 Nancy Craney 150203 0 14707 0 0 10142 0 1552 0 176604 0 0 0 Sheila Baker 153667 0 5282 0 0 9250 0 980 0 169179 0 0 0 Tawana Moses 148338 0 17247 0 1200 0 9912 0 590 0 177287 0 0 0 Ellena Ann Evans 132405 0 0 675 0 5523 0 0 138603 0 0 0 ROBERT HAMILTON 253421 0 41150 0 8366 0 16009 0 8249 0 327195 0 0 0 MICHAEL GRAUE 0 513657 0 164927 0 12708 0 33859 0 10715 0 735866 0 0 ROBERT JANSEN 0 311389 0 48653 0 8917 0 15337 0 5028 0 389324 0 0 ELLEN LANGFORD 0 182066 0 37877 0 8700 0 14188 0 2473 0 245304 0 0 Robert Mandler 0 195977 0 37704 0 29104 0 14866 0 3578 0 281229 0 0 Jonathan B Morris 0 256833 0 50211 0 27150 0 18905 0 5028 0 358127 0 0 Anthony M Trupiano 0 230311 0 45692 0 9300 0 16534 0 0 301837 0 0 Robin Wilson MD 0 277804 0 53016 0 9200 0 14456 0 10270 0 364746 0 0 Ilona L Wozniak 231088 0 28386 0 8700 0 15946 0 1758 0 285878 0 0 0 Joseph L Brywczynski 0 167838 0 0 48304 0 12397 0 2030 0 230569 0 0 Elizabeth A Hoffmann 0 171895 0 15669 0 42864 0 9605 0 1255 0 241288 0 0 Richard T Lopes MD 0 405473 0 0 108133 0 26209 0 2613 0 542428 0 0 James M Swartz 0 147399 0 14973 0 7160 0 7113 0 2035 0 178680 0 0 Mary L Wesley 0 214845 0 19059 0 60236 0 12190 0 1880 0 308210 0 0 Beth Kost 0 209311 0 30248 0 4950 0 14503 0 1632 0 260644 0 0 Adam C Thompson 0 148759 0 16996 0 11202 0 7351 0 2359 0 186667 0 0 Non-Fixed Payments Form 990 Schedule J Part 1 Line 7 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 (manager level employees and above). Those factors are: People goal for employee turnover Customer Service goal for employee engagement Quality & Safety goal for clinical excellence and patient satisfaction Financial goal for attaining a positive operating margin Confirmation of achieving these payout triggers is typically received through the annual external audit process and approved by the Board of Trustees at that time. Severance Benefits 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, Randy Cook, 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, 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, Ilona Wozniak 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 Ellena Evans $ 133,080 Other Compensation Form 990 Schedule J Part 1 Line 1b and 2 While Wellstar Health System and its affiliates do not have a written policy regarding payment or reimbursement fo 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. Compensation Exceptions On Schedule J of IRS Form 990 the following individuals were employed as officers of Wellstar Health System and its Affiliates during the reporting period but did not have salary and benefits in the calendar year for which this schedule applies: Leo Reichert Deborah Roegge DeVita Pamela Etheridge Wife of Officer 53737 Employee of Wellstar 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 false Matthew Maddox Son of Trustee 38489 Employee of Wellstar false Bonnie Miller Wife of Trustee 28417 Employee of Wellstar false Greg Separk Son of Trustee 25847 Employee of Wellstar false 990 T Explanation of Filing Form 990 Part V Line 3 Cobb Hospital generated no unrelated business income for the reporting period. As a result the attached 990T 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, 2011. Form 990 Copy to Board of Directors 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. 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. Conflict of Interest Policy Form 990 Part VI Section B Line 12 a-c 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 this 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 for determining 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 Board Chairman--Ex Officio CEO--Ex Officio In committtee discussions about the compensation for the Chief Executive Officer, the acting 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. Compensation Form 990 Part V Line 2 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). Bylaw Changes Form 990 Part VI Line 4 In November 2010 the bylaws of Wellstar Health System, Inc. were amended to state that benefits would be provided for trustees upon their retirement from the Board. Organizational Structure Form 990 Part VI Line 6 & 7 As per the articles of Incorporation, the sole member of the organization is Wellstar Health System, Inc., a GA nonprofit corporation. As sole member, Wellstar Health System holds certain powers of election and approval in connection with the governing body of the organization. These powers are presented in detail in the company's governing documents which the company makes available to the public upon request. Officer's Hours Form 990 General Statement 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 of the organizations exceeds 40 hours per week. 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." CURRENT OFFICERS/DIRECTORS RELATIONSHIPS FORM 990 PART VI, SECTION A LINE 2 Two of the current 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, President and CEO for the system. Tax-Exempt Bonds Allocation Form 990 Part IV Line 24a & Part X 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. Cobb Hospital, Inc. has also restated its beginning balance sheet with respect to tax exempt bond liabilities as the amounts allocated to tax exempt bond liabilities are now included on Line 25. Other Changes in Net Assets Form 990 Part XI Line 5 For the reporting period Cobb Hospital, Inc. had a change in net assets of ($24,619,009) related to transfers to affiliates as part of the allocation of income statement and balance sheet transactions over the year. HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:TE Durham TITLE:Board Member HOURS:10 HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:Thomas E Gearhard MD TITLE:Board Member HOURS:50 HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:Jeffrey Tharp MD TITLE:Board Member HOURS:50 HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:A James Budzinski TITLE:Exec VP and CFO HOURS:50 HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:Gregory L Simone MD TITLE:President & CEO HOURS:50 HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:Bonnie Wilson TITLE:Exec VP and Gen Counsel HOURS:50 HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:David W Anderson TITLE:Exec VP HR/OL/CCO HOURS:50 HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:Donald Campbell MD TITLE:Sr VP and Medical Director HOURS:50 HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:Barbara B Corey TITLE:Sr VP Managed Care HOURS:50 HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:Bruce Dean TITLE:VP & Asst Gen Counsel HOURS:50 HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:Marcia Delk MD TITLE:Sr VP Med Affairs & CQO HOURS:50 HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:Lee Evins TITLE:VP Revenue Cycle Mgmt HOURS:50 HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:Mark Haney TITLE:Sr VP Business Development HOURS:50 HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:Christopher M Kane TITLE:Sr VP Strategic Planning HOURS:50 HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:Kenneth C Kunze MD TITLE:Sr VP Chief Med Officer HOURS:50 HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:Louis W Little TITLE:Sr VP Post Acute & Hosp Admin HOURS:50 HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:Kimberly W. Menefee TITLE:Sr VP Public & Govt Affairs HOURS:50 HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:Ronald J Strachan TITLE:Sr VP & CIO HOURS:50 HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:MICHAEL GRAUE TITLE:EXEC VP COO HOURS:50 HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:ROBERT JANSEN TITLE:VP MED AFFAIRS HOURS:50 HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:ELLEN LANGFORD TITLE:VP & COO PHY GRP HOURS:50 HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:Robert Mandler TITLE:VP Diagnostic Outreach HOURS:50 HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:Jonathan B Morris TITLE:VP & Chief Med Info Officer HOURS:50 HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:Anthony M Trupiano TITLE:VP Supply Chain HOURS:50 HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:Robin Wilson, MD TITLE:VP Medical Management HOURS:50 HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:Joseph L Brywczynski TITLE:Sr VP Health Parks Admin HOURS:50 HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:Elizabeth A Hoffmann TITLE:VP Budget Analysis HOURS:50 HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:Richard T Lopes, MD TITLE:Sr VP & Pres Wellstar Phy Grp HOURS:50 HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:James M Swartz TITLE:VP Accounting HOURS:50 HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:Mary L Wesley TITLE:Sr VP Nursing Services & CNE HOURS:50 HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:Barbara G Ballard TITLE:VP Homecare & Hospice HOURS:50 HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:Carol S Edwards TITLE:VP Cardiac Services HOURS:50 HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:Beth Kost TITLE:VP Compliance/Ch Privacy Offr HOURS:50 HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:Chris Brett Scullen TITLE:VP Pulmonology Operations HOURS:50 HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:Adam C Thompson TITLE:VP Surgery HOURS:50 HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:Leo E Reichert TITLE:Exec VP & General Counsel HOURS:50 HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:Deborah DeVita Roegge TITLE:VP Women's & Newborn Srv Line HOURS:50 CHS Foundation 805 Sandy Plains Road Marietta GA 30066 581649540 Foundation GA 501 (c) (3) 11 WHS true Douglas Hospital Inc 805 Sandy Plains Road Marietta GA 30066 582026750 Healthcare GA 501 (c) (3) 3 NA true Kennestone Hospital Inc 805 Sandy Plains Road Marietta GA 30066 582032904 Healthcare GA 501 (c) (3) 3 WHS true Paulding Medical Center Inc 805 Sandy Plains Road Marietta GA 30066 582095884 Healthcare GA 501 (c) (3) 3 WHS true Wellstar Foundation 805 Sandy Plains Road Marietta GA 30066 581627413 Foundation GA 501 (c) (3) 11 WHS true Wellstar Health System 805 Sandy Plains Road Marietta GA 30066 581649541 Healthcare GA 501 (c) (3) 11 NA false Kennestone South Parking Deck 805 Sandy Plains Road Marietta GA 300666340 582429775 PARKING GA NA INVESTMENT 105048 1853336 false false Cobb Hospital Parking Company LLC 805 Sandy Plains Road Marietta GA 300666340 752999669 PARKING GA NA INVESTMENT 26313 808030 false false Community Assurance Co 3rd Fl Barclays House Shedden Rd George Town Grand Cayman, BWI CJ 581649541 INSURANCE CJ WHS INC C 58594426 1.00000 false false false false false false false false false true false false false false false false false false CHS Foundation Inc J 264550 FMV