PAULDING MEDICAL CENTER INC: Form 990, tax year 2009
View the entire original 990 at ProPublica ↗
- Organization
- PAULDING MEDICAL CENTER INC (EIN 58-2095884)
- Tax period
- 2009-07-01 to 2010-06-30
- Filed
- 2011-05-16
- IRS object ID
- 201141369349306274
- Schema version
- 2009v1.7
- Source
- Download XML · Original 990 at ProPublica
Every field in the e-filed return. Faint text is the IRS element name, for citing.
- Return header
- Form 990
- Schedule A
- Schedule B
- Schedule D
- Schedule H
- Schedule J
- Schedule L
- Schedule O
- Schedule R
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Timestamp | 2011-05-16T16:33:23-05:00 | Timestamp |
| Tax Period End Date | 2010-06-30 | TaxPeriodEndDate |
Preparer Firm PreparerFirm
Preparer Firm Business Name PreparerFirmBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | PricewaterhouseCoopers LLP | BusinessNameLine1 |
Preparer Firm US Address PreparerFirmUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 2001 MARKET ST SUITE 1700 | AddressLine1 |
| City | PHILADELPHIA | City |
| State | PA | State |
| ZIP Code | 19103 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnType |
| Tax Period Begin Date | 2009-07-01 | TaxPeriodBeginDate |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 582095884 | EIN |
Name Name
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | PAULDING MEDICAL CENTER INC | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Control | PAUL | NameControl |
| Phone | 7707925023 | Phone |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 805 Sandy Plains Road | AddressLine1 |
| City | Marietta | City |
| State | GA | State |
| ZIP Code | 300666340 | ZIPCode |
Officer Officer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | JAMES M SWARTZ | Name |
| Title | VP, ACCOUNTING & TREASURY | Title |
| Date Signed | 2011-05-16 | DateSigned |
| Authorize Third Party | true | AuthorizeThirdParty |
Preparer Preparer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Phone | 2673303000 | Phone |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax Year | 2009 | TaxYear |
| Build TS | 2016-02-24 21:20:13Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Of Principal Officer Person | A JAMES BUDZINSKI | NameOfPrincipalOfficerPerson |
Address Principal Officer US AddressPrincipalOfficerUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 805 Sandy Plains Road | AddressLine1 |
| City | Marietta | City |
| State | GA | State |
| ZIP Code | 300666340 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | 75885244 | GrossReceipts |
| Group Return For Affiliates | false | GroupReturnForAffiliates |
| Organization501c | X | Organization501c |
| Web Site | www.wellstar.org | WebSite |
| Type Of Organization Corporation | X | TypeOfOrganizationCorporation |
| Year Formation | 1993 | YearFormation |
| State Legal Domicile | GA | StateLegalDomicile |
| Activity Or Mission Description | To deliver world-class charitable healthcare | ActivityOrMissionDescription |
| Nbr Voting Members Governing Body | 18 | NbrVotingMembersGoverningBody |
| Nbr Independent Voting Members | 14 | NbrIndependentVotingMembers |
| Total Nbr Employees | 535 | TotalNbrEmployees |
| Total Nbr Volunteers | 85 | TotalNbrVolunteers |
| Total Gross UBI | 0 | TotalGrossUBI |
| Net Unrelated Business Txbl Income | 0 | NetUnrelatedBusinessTxblIncome |
| Contributions Grants Prior Year | 671615 | ContributionsGrantsPriorYear |
| Contributions Grants Current Year | 889511 | ContributionsGrantsCurrentYear |
| Program Service Revenue Prior Year | 54664190 | ProgramServiceRevenuePriorYear |
| Program Service Revenue CY | 64682449 | ProgramServiceRevenueCY |
| Investment Income Prior Year | -355158 | InvestmentIncomePriorYear |
| Investment Income Current Year | 1182350 | InvestmentIncomeCurrentYear |
| Other Revenue Prior Year | 380177 | OtherRevenuePriorYear |
| Other Revenue Current Year | 389982 | OtherRevenueCurrentYear |
| Total Revenue Prior Year | 55360824 | TotalRevenuePriorYear |
| Total Revenue Current Year | 67144292 | TotalRevenueCurrentYear |
| Grants And Similar Amnts Prior Year | 0 | GrantsAndSimilarAmntsPriorYear |
| Grants And Similar Amnts CY | 0 | GrantsAndSimilarAmntsCY |
| Benefits Paid To Members Prior Year | 0 | BenefitsPaidToMembersPriorYear |
| Benefits Paid To Members CY | 0 | BenefitsPaidToMembersCY |
| Salaries Etc Prior Year | 20517980 | SalariesEtcPriorYear |
| Salaries Etc Current Year | 25156709 | SalariesEtcCurrentYear |
| Total Prof Fundrsng Exp Prior Year | 0 | TotalProfFundrsngExpPriorYear |
| Total Prof Fundrsng Exp CY | 0 | TotalProfFundrsngExpCY |
| Total Fundrsng Exp Current Year | 0 | TotalFundrsngExpCurrentYear |
| Other Expense Prior Year | 35057477 | OtherExpensePriorYear |
| Other Expenses Current Year | 39837899 | OtherExpensesCurrentYear |
| Total Expenses Prior Year | 55575457 | TotalExpensesPriorYear |
| Total Expenses Current Year | 64994608 | TotalExpensesCurrentYear |
| Revenues Less Expenses Prior Year | -214633 | RevenuesLessExpensesPriorYear |
| Revenues Less Expenses CY | 2149684 | RevenuesLessExpensesCY |
| Total Assets BOY | 37627994 | TotalAssetsBOY |
| Total Assets EOY | 41006415 | TotalAssetsEOY |
| Total Liabilities BOY | 20244938 | TotalLiabilitiesBOY |
| Total Liabilities EOY | 21345031 | TotalLiabilitiesEOY |
| Net Assets Or Fund Balances BOY | 17383056 | NetAssetsOrFundBalancesBOY |
| Net Assets Or Fund Balances EOY | 19661384 | NetAssetsOrFundBalancesEOY |
| Mission Description | 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 | MissionDescription |
| Significant New Program Services | false | SignificantNewProgramServices |
| Significant Change | false | SignificantChange |
| Expense | 56408776 | Expense |
| Revenue | 64682449 | Revenue |
| Description | Paulding Medical Center, Inc. (an affiliate of Wellstar Health System, Inc.) operates as a charitable organization consistent with the requirements of IRS 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 needy members of its community consistent with its charity care policy regardless of their ability to pay for these services; and the hospitals excess funds are generally applied to expansion and replacement of existing facilities and equipment, amortization of indebtedness, improvement in patient care, community benefit activities, and charity care. Paulding had $6.0 million in capital expenditures disbursed during the tax period reviewed. Wellstar Paulding Hospital is a general acute care hospital providing a full range of services to the community. The hospital is licensed to operate 83 beds and is presently staffed to operate 34 beds. Paulding Medical Center, Inc. was organized in 1994. 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. Paulding Medical Center is subject to the authority and governing board of Wellstar Health System and the Paulding County Hospital Authority. Paulding Hospital provides a full range of inpatient and outpatient services characteristic of a community hospital. Paulding Nursing Home is located on the campus of the hospital and functions as part of the full range of health services provided to the community. The nursing home provides skilled long-term nursing care to persons requiring those services by reason of age or physical impairment. The nursing home is the only such facility in the Wellstar system. The following stats consitute the overall program services provided for the period ended June 30, 2010: Adult Discharges 1,951 Nursing Facility Days 64,255 Medical & Surgical Short Stay Days 604 Emergency Room Visits- 36,755 Outpatient Surgical Cases - 1,290 Inpatient Surgical Cases - 235 Outpatient Procedures Non ED OP Radiology 25,975 (35% increase from prior year) GI Laboratory - 465 Total FTEs Paid - 416 Community Benefit Reporting Community Outreach (incl system generated allocation) $218,162 Unreimbursed Charity Care (at cost) $2,242,963 Medical Shortfalls (at cost) $1,442,942 As an affiliate of Wellstar Health System, Paulding Hospital participates in many community and educational programs for the overall health and benefit of the area that they serve. Accomplishments and Awards The Paulding Nursing Home provides both subacute and long term care services to patients in the community. Since the nursing home is one of very few in the area and located on the medical complex campus it is very crucial to an ever expanding service area. Paulding Hospital is accredited by the Joint Commission on Accreditation of Healthcare Organizations (JCAHO). The parent company, Wellstar Health System, was again honored as one of the top 100 health systems in the country by Verispan. The system was ranked at #9 as listed in the magazine, "Modern Healthcare", and is the highest ranked system in the state. All of Wellstar hospital laboratories including Paulding were awarded "Accreditation with Distinction" by the Commission on Laboratory Accreditation of the College of American Pathologists (CAP). CAP awards are considered one of the most stringent in laboratory quality assurance in the industry. Wellstar Health System ranks in the Top 20 of the Working Mother 100 Best Companies List. Wellstar Paulding Imaging Center opened in November 2008 with the first truly high-field open MRI in Georgia. This system allows clinical excellence and comfort for all patients especially the elderly. This center allows local residents a more convenient location for physician and imaging procedures. The new imaging center later won an award at the Annual American Society of Interior Designers. Wellstar ranked number 13 in Atlanta's Top 25 Employers by the publication "Atlanta Business Chronicle". Wellstar was recognized as a "Company that Cares" for 2009-2010 which was the third year in a row the system was honored. The system began participating in Terrific Tales, a Company that Cares sponsored literacy project. Several Wellstar hospitals took on the challenge of purchasing quality books for local elementary school libraries in underserved areas. Paulding Hospital adopted a local school(Poole Elementary) and helped the system raise funds to purchase books for that and other local schools. Paulding Hospital and Nursing Home embraced the senior community it serves by celebrating National Older People's Month. The hospital had activities that helped honor the seniors with events and educational sessions. More than 100 people attended Wellstar East Paulding Primary Care's Diabetes Community Health Fair during the year. This fair attempted to identify local residents at risk for this disease. Wellstar Health System was named to the AARP National Employer Team for its commitment to recruiting older employees. Wellstar also has several partnerships with local colleges to provide clinical training for nursing and therapy students to compliment their classroom curriculum in those areas. One of Wellstar's own, Cecilia Byers, was honored by the Governor of Georgia as the Biomedical Engineer of the Year. The award recognized her commitment to education, professional integrity and community involvement. Ms Byers serves the biomedical needs at Paulding, Douglas, Cobb and Windy Hill hospitals and other Wellstar entities. She helps mentor Chattahoochee Technical School students in an internship at Wellstar as well as a local high school Magnet program in Cobb County and Paulding County schools. Paulding Hospital instituted a recycling program which resulted in: 40,000 pounds (20 tons) of recycled material 7,600 gallons of oil saved 60 cubic yards of landfill space saved 80,000 kilowatts of energy saved 140,000 gallons of water saved and 8,000 pounds of plastic recycled Paulding Hospital was recognized by VHA, Inc. for sustaining impressive clinical results. VHA "blueprinted" the hospital's practices in reducing ventilator-associated penumonia and central line catheter-related blood stream infections to zero. These practices were then made available to other VHA member hospitals. Wellstar plans to build a new state-of-the-art 100 bed general acute care hospital in Paulding County to replace the current facility. Paulding County is one of the fastest growing counties in not only the state by across the country which makes this endeavor even more crucial for the community. | Description |
| Total Program Service Expense | 56408776 | TotalProgramServiceExpense |
| Described In501 C3 | true | DescribedIn501C3 |
| Schedule B Required | true | ScheduleBRequired |
| Political Activities | false | PoliticalActivities |
| Lobbying Activities | false | LobbyingActivities |
| Donor Advised Funds | false | DonorAdvisedFunds |
| Conservation Easements | false | ConservationEasements |
| Collections Of Art | false | CollectionsOfArt |
| Credit Counseling | false | CreditCounseling |
| Term Or Permanent Endowments | false | TermOrPermanentEndowments |
| Balance Sheet Amounts Reported | true | BalanceSheetAmountsReported |
| Independent Audit Financial Stmt | false | IndependentAuditFinancialStmt |
| Consolidated Audit Financial Stmt | true | ConsolidatedAuditFinancialStmt |
| School | false | School |
| Foreign Office | false | ForeignOffice |
| Foreign Activities | false | ForeignActivities |
| More Than5000 K To Organizations | false | MoreThan5000KToOrganizations |
| More Than5000 K To Individuals | false | MoreThan5000KToIndividuals |
| Professional Fundraising | false | ProfessionalFundraising |
| Fundraising Activities | false | FundraisingActivities |
| Gaming | false | Gaming |
| Hospital | true | Hospital |
| Grants To Organizations | false | GrantsToOrganizations |
| Grants To Individuals | false | GrantsToIndividuals |
| Schedule J Required | true | ScheduleJRequired |
| Tax Exempt Bonds | false | TaxExemptBonds |
| Excess Benefit Transaction | false | ExcessBenefitTransaction |
| Prior Excess Benefit Transaction | false | PriorExcessBenefitTransaction |
| Loan To Officer Or DQP | false | LoanToOfficerOrDQP |
| Grant To Related Person | false | GrantToRelatedPerson |
| Bsnss Rltnshp With Organization | false | BsnssRltnshpWithOrganization |
| Bsnss Rltnshp Thru Family Member | true | BsnssRltnshpThruFamilyMember |
| Officer Entity With Bsnss Rltnshp | false | OfficerEntityWithBsnssRltnshp |
| Deductible Non Cash Contributions | false | DeductibleNonCashContributions |
| Deductible Contributions Of Art | false | DeductibleContributionsOfArt |
| Terminated | false | Terminated |
| Partial Liquidation | false | PartialLiquidation |
| Disregarded Entity | false | DisregardedEntity |
| Related Entity | true | RelatedEntity |
| Related Org Controlled Entity | true | RelatedOrgControlledEntity |
| Transfers To Exempt Non Chrtbl Org | false | TransfersToExemptNonChrtblOrg |
| Activities Conducted Partnership | false | ActivitiesConductedPartnership |
| Schedule O Required | true | ScheduleORequired |
| Number Forms Transmitted With1096 | 0 | NumberFormsTransmittedWith1096 |
| Number W2 G Included | 0 | NumberW2GIncluded |
| Number Of Employees | 535 | NumberOfEmployees |
| Employment Tax Returns Filed | true | EmploymentTaxReturnsFiled |
| Unrelated Business Income | false | UnrelatedBusinessIncome |
| Foreign Financial Account | false | ForeignFinancialAccount |
| Prohibited Tax Shelter Trans | false | ProhibitedTaxShelterTrans |
| Taxable Party Notification | false | TaxablePartyNotification |
| Non Deductible Contributions | false | NonDeductibleContributions |
| Quid Pro Quo Contributions | false | QuidProQuoContributions |
| Form8282 Property Disposed Of | false | Form8282PropertyDisposedOf |
| Funds To Pay Premiums | false | FundsToPayPremiums |
| Premiums Paid | false | PremiumsPaid |
| Nbr Voting Governing Body Members | 18 | NbrVotingGoverningBodyMembers |
| Number Independent Voting Members | 14 | NumberIndependentVotingMembers |
| Family Or Business Relationship | true | FamilyOrBusinessRelationship |
| Delegation Of Management Duties | false | DelegationOfManagementDuties |
| Changes To Organizing Docs | true | ChangesToOrganizingDocs |
| Material Diversion Or Misuse | false | MaterialDiversionOrMisuse |
| Members Or Stockholders | true | MembersOrStockholders |
| Election Of Board Members | true | ElectionOfBoardMembers |
| Decisions Subject To Approval | true | DecisionsSubjectToApproval |
| Minutes Of Governing Body | true | MinutesOfGoverningBody |
| Minutes Of Committees | true | MinutesOfCommittees |
| Officer Mailing Address | false | OfficerMailingAddress |
| Local Chapters | false | LocalChapters |
| Form990 Provided To Governing Body | true | Form990ProvidedToGoverningBody |
| Conflict Of Interest Policy | true | ConflictOfInterestPolicy |
| Annual Disclosure Covered Persons | true | AnnualDisclosureCoveredPersons |
| Regular Monitoring Enforcement | true | RegularMonitoringEnforcement |
| Whistleblower Policy | true | WhistleblowerPolicy |
| Document Retention Policy | true | DocumentRetentionPolicy |
| Compensation Process CEO | true | CompensationProcessCEO |
| Compensation Process Other | true | CompensationProcessOther |
| Investment In Joint Venture | false | InvestmentInJointVenture |
| States Where Copy Of Return Is Filed | GA | StatesWhereCopyOfReturnIsFiled |
| Upon Request | X | UponRequest |
The Books Are In Care Of TheBooksAreInCareOf
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Person | JAMES M SWARTZ | NamePerson |
| Telephone Number | 7707925393 | TelephoneNumber |
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 805 SANDY PLAINS ROAD | AddressLine1 |
| City | Marietta | City |
| State | GA | State |
| ZIP Code | 300666340 | ZIPCode |
Form990 Part VII Section A Form990PartVIISectionA (58 entries)
| TitleTitle | Average Hours Per WeekAverageHoursPerWeek | Individual Trustee Or DirectorIndividualTrusteeOrDirector | Reportable Comp From OrganizationReportableCompFromOrganization | Reportable Comp From Related OrgsReportableCompFromRelatedOrgs | Other CompensationOtherCompensation | OfficerOfficer | Highest Compensated EmployeeHighestCompensatedEmployee | FormerFormer |
|---|---|---|---|---|---|---|---|---|
| Randall Bentley | ||||||||
| Board Member Vice Chair | 1.0 | X | 0 | 16471 | 0 | |||
| Robert N Cross MD | ||||||||
| Board Member | 1.0 | X | 0 | 4767 | 0 | |||
| TE Durham | ||||||||
| Board Member | 1.0 | X | 0 | 34715 | 2135 | |||
| Thomas E Gearhard MD | ||||||||
| Board Member | 1.0 | X | 0 | 320689 | 31087 | |||
| David Hafner MD | ||||||||
| Board Member | 1.0 | X | 0 | 15651 | 0 | |||
| Charles J Jones | ||||||||
| Board Member | 1.0 | X | 0 | 12635 | 0 | |||
| Connie Kirk | ||||||||
| Board Member | 1.0 | X | 0 | 4195 | 0 | |||
| Janie Maddox | ||||||||
| Board Member | 1.0 | X | 0 | 4884 | 0 | |||
| Gary A Miller | ||||||||
| Board Member | 1.0 | X | 0 | 2609 | 0 | |||
| Steven W Oweida MD | ||||||||
| Board Member, Chair | 1.0 | X | 0 | 17488 | 0 | |||
| Tom Phillips | ||||||||
| Board Member | 1.0 | X | 0 | 2774 | 0 | |||
| Walter G Robinson | ||||||||
| Board Member | 1.0 | X | 0 | 3372 | 0 | |||
| Ronald P Roper MD | ||||||||
| Board Member | 1.0 | X | 0 | 9713 | 0 | |||
| W Allen Separk | ||||||||
| Board Member | 1.0 | X | 0 | 7230 | 0 | |||
| Kessel D Stelling | ||||||||
| Board Member | 1.0 | X | 0 | 1252 | 0 | |||
| Jeffery Tharp MD | ||||||||
| Board Member | 1.0 | X | 0 | 374975 | 32823 | |||
| Ken Thigpen | ||||||||
| Board Member | 1.0 | X | 0 | 10151 | 0 | |||
| Robert G Warner MD | ||||||||
| Board Member | 1.0 | X | 0 | 3581 | 0 | |||
| Charles Pete Wood | ||||||||
| Board Member | 1.0 | X | 0 | 12025 | 0 | |||
| A James Budzinski | ||||||||
| Exec VP and CFO | 2.0 | 0 | 542322 | 42617 | X | |||
| Gregory L Simone MD | ||||||||
| President and CEO | 2.0 | 0 | 1127407 | 76939 | X | |||
| Bonnie Wilson | ||||||||
| Exec VP and General Counsel | 2.0 | 0 | 564617 | 45500 | X | |||
| David Anderson | ||||||||
| Exec VP HR/OL/CCO | 2.0 | 0 | 500879 | 38389 | X | |||
| Donald Campbell MD | ||||||||
| SrVP & Medical Director | 2.0 | 0 | 392181 | 31906 | X | |||
| Barbara B Corey | ||||||||
| Sr VP Managed Care | 2.0 | 0 | 354487 | 28277 | X | |||
| Bruce Dean | ||||||||
| VP & Asst Gen Counsel | 2.0 | 0 | 231199 | 23450 | X | |||
| Marcia Delk MD | ||||||||
| Sr VP Medical Affairs & CQO | 2.0 | 0 | 420898 | 41645 | X | |||
| K Darold Etheridge | ||||||||
| VP Finance | 2.0 | 0 | 257321 | 24944 | X | |||
| Lee Evins | ||||||||
| VP Revenue Cycle Mgmt | 2.0 | 0 | 237160 | 22440 | X | |||
| T Mark Haney | ||||||||
| Sr VP Bus Devlop & Hosp Admin | 25.0 | 0 | 348007 | 32214 | X | |||
| Patrick Jansen | ||||||||
| VP Cardiac Services | 2.0 | 0 | 233543 | 19687 | X | |||
| Christopher Kane | ||||||||
| Sr VP Strategic Planning | 2.0 | 0 | 361179 | 32046 | X | |||
| Kenneth Kunze MD | ||||||||
| Sr VP and Chief Med Officer | 2.0 | 0 | 497872 | 35952 | X | |||
| Lou Little | ||||||||
| Sr VP Post Acute & Hosp Admin | 2.0 | 0 | 290248 | 31176 | X | |||
| Kimberly Menefee | ||||||||
| Sr VP Public Affairs & Gov Rel | 2.0 | 0 | 322123 | 28095 | X | |||
| Ronald Strachan | ||||||||
| Sr VP & CIO | 2.0 | 0 | 398320 | 34634 | X | |||
| ROBERT MANDLER | ||||||||
| VP Diagnostic Outreach | 2.0 | 0 | 235075 | 21295 | X | |||
| MICHAEL GRAUE | ||||||||
| EXEC VP COO | 2.0 | 0 | 658068 | 49874 | X | |||
| JONATHAN MORRIS | ||||||||
| VP & Chief Med Info Officer | 2.0 | 0 | 148980 | 12644 | X | |||
| ELLEN LANGFORD | ||||||||
| VP & COO PHY GRP | 2.0 | 0 | 188974 | 17817 | X | |||
| Anthony M Trupiano | ||||||||
| VP Supply Chain | 2.0 | 0 | 233753 | 17874 | X | |||
| Robin Wilson MD | ||||||||
| VP Medical Management | 2.0 | 0 | 154726 | 13389 | X | |||
| Joseph L Brywcznski | ||||||||
| Sr VP Health Parks Admin | 2.0 | 0 | 0 | 0 | X | |||
| Elizabeth A Hoffmann | ||||||||
| VP Budget & Analysis | 2.0 | 0 | 0 | 0 | X | |||
| Richard T Lopes MD | ||||||||
| Sr VP & Pres Wellstar Phy Grp | 2.0 | 0 | 0 | 0 | X | |||
| James M Swartz | ||||||||
| VP Accounting | 2.0 | 0 | 0 | 0 | X | |||
| Mary L Wesley | ||||||||
| Sr VP Nursing Services & CNE | 2.0 | 0 | 0 | 0 | X | |||
| John Law | ||||||||
| Asst VP Operations | 50.0 | 168785 | 0 | 18361 | X | |||
| Andrea M Parson | ||||||||
| Dir Pharmacy | 50.0 | 136778 | 0 | 17929 | X | |||
| Carol S O'Connell | ||||||||
| Exec Dir/Admin Long Term Care | 50.0 | 121887 | 0 | 12808 | X | |||
| Vicky Lynn Hogue | ||||||||
| AVP CNO Patient Care Srvs | 50.0 | 176150 | 0 | 20156 | X | |||
| Bolan Dreher | ||||||||
| Pharmacist | 50.0 | 120065 | 0 | 14266 | X | |||
| Marsha Burke | ||||||||
| Former Exec VP and CFO | 1.0 | 0 | 550796 | 43614 | X | |||
| Linda A Clark | ||||||||
| Exec VP and COO | 1.0 | 0 | 402300 | 24741 | X | |||
| Bruce Harrison | ||||||||
| Sr VP and CAO | 2.0 | 0 | 378334 | 34449 | X | |||
| Nancy Kemp | ||||||||
| VP Medical Management | 1.0 | 0 | 226912 | 13955 | X | |||
| Teresa Ray | ||||||||
| Sr VP Nursing & CNE | 1.0 | 0 | 322133 | 19811 | X | |||
| Andrew Tatnall | ||||||||
| Sr VP Operations | 1.0 | 0 | 187893 | 11548 | X | |||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | 723665 | TotalReportableCompFromOrg |
| Total Reportable Comp Frm Rltd Orgs | 11626884 | TotalReportableCompFrmRltdOrgs |
| Total Other Compensation | 1020487 | TotalOtherCompensation |
| Number Individuals GT100 K | 17 | NumberIndividualsGT100K |
| Formers Listed | true | FormersListed |
| Total Comp GT150 K | true | TotalCompGT150K |
| Compensation From Other Sources | false | CompensationFromOtherSources |
Contractor Compensation ContractorCompensation (5 entries)
| Address Line1AddressOfContractor/AddressUS/AddressLine1 | CityAddressOfContractor/AddressUS/City | StateAddressOfContractor/AddressUS/State | ZIP CodeAddressOfContractor/AddressUS/ZIPCode | Description Of ServicesDescriptionOfServices | CompensationCompensation |
|---|---|---|---|---|---|
| Brasfield Gorrie | |||||
| 1990 Vaughn Rd NW Suite 100 | MARIETTA | GA | 30144 | General Contractor | 236251 |
| HKS Inc | |||||
| PO BOX 731121 | DALLAS | TX | 753731121 | General Contractor | 551254 |
| Clark Ambulance Service Inc | |||||
| PO Box 1789 | DALLAS | GA | 30132 | Medical Service | 175654 |
| Surgical Operational Service | |||||
| 505 Commerce Park Drive Suite G | MARIETTA | GA | 30060 | SUPPLY CONSULTING | 143185 |
| CDH Partners | |||||
| 675 Tower Rd | MARIETTA | GA | 30060 | General Contractor | 118018 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Contractors GT100 K | 8 | NumberOfContractorsGT100K |
| Government Grants | 889511 | GovernmentGrants |
| Total Contributions | 889511 | TotalContributions |
Program Service Revenue ProgramServiceRevenue (2 entries)
| DescriptionDescription | Business CodeBusinessCode | Total Revenue ColumnTotalRevenueColumn | Related Or Exempt Function IncomeRelatedOrExemptFunctionIncome |
|---|---|---|---|
| HOSPITAL PATIENT REVENUE | 621990 | 64682380 | 64682380 |
| MEDICAL RECORDS | 621990 | 69 | 69 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | 64682449 | TotalProgramServiceRevenue |
Investment Income InvestmentIncome
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 514453 | TotalRevenueColumn |
| Exclusion | $514,453 | ExclusionAmount |
Income From Invest Bond Proceeds IncomeFromInvestBondProceeds
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 0 | TotalRevenueColumn |
Royalties Revenue RoyaltiesRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 0 | TotalRevenueColumn |
Gross Rents GrossRents
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | 25608 | Real |
Rental Income Or Loss RentalIncomeOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | 25608 | Real |
Net Rental Income Or Loss NetRentalIncomeOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 25608 | TotalRevenueColumn |
| Exclusion | $25,608 | ExclusionAmount |
Gross Amount Sales Assets GrossAmountSalesAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | 9408849 | Securities |
Less Cost Oth Basis Sales Expenses LessCostOthBasisSalesExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | 8740952 | Securities |
Gain Or Loss GainOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | 667897 | Securities |
Net Gain Or Loss Investments NetGainOrLossInvestments
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 667897 | TotalRevenueColumn |
| Exclusion | $667,897 | ExclusionAmount |
Net Income From Fundraising Events NetIncomeFromFundraisingEvents
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 0 | TotalRevenueColumn |
Net Income From Gaming NetIncomeFromGaming
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 0 | TotalRevenueColumn |
Net Income Or Loss NetIncomeOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 0 | TotalRevenueColumn |
Other Revenue Misc OtherRevenueMisc (3 entries)
| DescriptionDescription | Business CodeBusinessCode | Total Revenue ColumnTotalRevenueColumn | ExclusionExclusionAmount |
|---|---|---|---|
| GROUND LEASE REVENUE | 532000 | 16000 | $16,000 |
| CAFETERIA | 722210 | 181557 | $181,557 |
| IMMUNIZATIONS | 621990 | 15994 | $15,994 |
Miscellaneous Revenue MiscellaneousRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 150823 | TotalRevenueColumn |
| Exclusion | $150,823 | ExclusionAmount |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Other Revenue | 364374 | TotalOtherRevenue |
Total Revenue TotalRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 67144292 | TotalRevenueColumn |
| Related Or Exempt Function Income | 64682449 | RelatedOrExemptFunctionIncome |
| Unrelated Business Revenue | 0 | UnrelatedBusinessRevenue |
| Exclusion | $1,572,332 | ExclusionAmount |
Grants To Domestic Orgs GrantsToDomesticOrgs
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Grants To Domestic Individuals GrantsToDomesticIndividuals
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Foreign Grants ForeignGrants
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Benefits To Members BenefitsToMembers
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Comp Current Officers Directors CompCurrentOfficersDirectors
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 380221 | Total |
| Program Services | 320298 | ProgramServices |
| Management And General | 59923 | ManagementAndGeneral |
| Fundraising | 0 | Fundraising |
Comp Disqual Persons CompDisqualPersons
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Other Salaries And Wages OtherSalariesAndWages
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 19977246 | Total |
| Program Services | 16829764 | ProgramServices |
| Management And General | 3147482 | ManagementAndGeneral |
| Fundraising | 0 | Fundraising |
Pension Plan Contributions PensionPlanContributions
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1436977 | Total |
| Program Services | 1210509 | ProgramServices |
| Management And General | 226468 | ManagementAndGeneral |
| Fundraising | 0 | Fundraising |
Other Employee Benefits OtherEmployeeBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1875599 | Total |
| Program Services | 1580005 | ProgramServices |
| Management And General | 295594 | ManagementAndGeneral |
| Fundraising | 0 | Fundraising |
Payroll Taxes PayrollTaxes
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1486666 | Total |
| Program Services | 1252368 | ProgramServices |
| Management And General | 234298 | ManagementAndGeneral |
| Fundraising | 0 | Fundraising |
Fees For Services Management FeesForServicesManagement
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Fees For Services Legal FeesForServicesLegal
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 22 | Total |
| Program Services | 0 | ProgramServices |
| Management And General | 22 | ManagementAndGeneral |
| Fundraising | 0 | Fundraising |
Fees For Services Accounting FeesForServicesAccounting
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Fees For Services Lobbying FeesForServicesLobbying
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Fees For Services Prof Fundraising FeesForServicesProfFundraising
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Fees For Services Invst Mgmnt Fees FeesForServicesInvstMgmntFees
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Fees For Services Other FeesForServicesOther
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 935243 | Total |
| Program Services | 866636 | ProgramServices |
| Management And General | 68607 | ManagementAndGeneral |
| Fundraising | 0 | Fundraising |
Advertising Advertising
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 337 | Total |
| Program Services | 31 | ProgramServices |
| Management And General | 306 | ManagementAndGeneral |
| Fundraising | 0 | Fundraising |
Office Expenses OfficeExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 6282750 | Total |
| Program Services | 6086125 | ProgramServices |
| Management And General | 196625 | ManagementAndGeneral |
| Fundraising | 0 | Fundraising |
Information Technology InformationTechnology
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Royalties Royalties
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Occupancy Occupancy
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1226410 | Total |
| Program Services | 466731 | ProgramServices |
| Management And General | 759679 | ManagementAndGeneral |
| Fundraising | 0 | Fundraising |
Travel Travel
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 50018 | Total |
| Program Services | 26841 | ProgramServices |
| Management And General | 23177 | ManagementAndGeneral |
| Fundraising | 0 | Fundraising |
Travel Entrtnmnt Public Officials TravelEntrtnmntPublicOfficials
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Conferences Meetings ConferencesMeetings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 50129 | Total |
| Program Services | 11565 | ProgramServices |
| Management And General | 38564 | ManagementAndGeneral |
| Fundraising | 0 | Fundraising |
Interest Interest
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 108882 | Total |
| Management And General | 108882 | ManagementAndGeneral |
| Fundraising | 0 | Fundraising |
Payments To Affiliates PaymentsToAffiliates
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 9143245 | Total |
| Program Services | 7702270 | ProgramServices |
| Management And General | 1440975 | ManagementAndGeneral |
| Fundraising | 0 | Fundraising |
Depreciation Depletion DepreciationDepletion
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 2617238 | Total |
| Program Services | 1655768 | ProgramServices |
| Management And General | 961470 | ManagementAndGeneral |
| Fundraising | 0 | Fundraising |
Insurance Insurance
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 691294 | Total |
| Program Services | 0 | ProgramServices |
| Management And General | 691294 | ManagementAndGeneral |
| Fundraising | 0 | Fundraising |
Other Expenses OtherExpenses (3 entries)
| DescriptionDescription | TotalTotal | Program ServicesProgramServices | Management And GeneralManagementAndGeneral |
|---|---|---|---|
| REPAIRS & MAINTENANCE | 913078 | 580612 | 332466 |
| BAD DEBT | 17040120 | 17040120 | |
| OTHER OPERATING EXPENSE | 779133 | 779133 |
Total Functional Expenses TotalFunctionalExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 64994608 | Total |
| Program Services | 56408776 | ProgramServices |
| Management And General | 8585832 | ManagementAndGeneral |
| Fundraising | 0 | Fundraising |
Cash Non Interest Bearing CashNonInterestBearing
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1500 | BOY |
| EOY | 1550 | EOY |
Savings And Temp Cash Investments SavingsAndTempCashInvestments
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1353257 | BOY |
| EOY | 848845 | EOY |
Accounts Receivable AccountsReceivable
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 5424458 | BOY |
| EOY | 4752999 | EOY |
Inventories For Sale Or Use InventoriesForSaleOrUse
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 768745 | BOY |
| EOY | 1073473 | EOY |
Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 524185 | BOY |
| EOY | 783154 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Buildings Equipment Basis | 50082853 | LandBuildingsEquipmentBasis |
| Land Bldg Equipment Accum Deprec | 26753690 | LandBldgEquipmentAccumDeprec |
Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 20401082 | BOY |
| EOY | 23329163 | EOY |
Investments Pub Traded Securities InvestmentsPubTradedSecurities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 8334113 | BOY |
| EOY | 9242968 | EOY |
Other Assets Total OtherAssetsTotal
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 820654 | BOY |
| EOY | 974263 | EOY |
Total Assets TotalAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 37627994 | BOY |
| EOY | 41006415 | EOY |
Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 7152200 | BOY |
| EOY | 7468587 | EOY |
Mort Notes Pybl Secured Invest Prop MortNotesPyblSecuredInvestProp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1340887 | BOY |
| EOY | 420321 | EOY |
Other Liabilities OtherLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 11751851 | BOY |
| EOY | 13456123 | EOY |
Total Liabilities TotalLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 20244938 | BOY |
| EOY | 21345031 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Follow SFAS117 | X | FollowSFAS117 |
Unrestricted Net Assets UnrestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 17383056 | BOY |
| EOY | 19661384 | EOY |
Total Net Assets Fund Balances TotalNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 17383056 | BOY |
| EOY | 19661384 | EOY |
Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 37627994 | BOY |
| EOY | 41006415 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Method Of Accounting Accrual | X | MethodOfAccountingAccrual |
| Accountant Compile Or Review | false | AccountantCompileOrReview |
| FS Audited | true | FSAudited |
| Audit Committee | true | AuditCommittee |
| Financial Statement Consolidated | X | FinancialStatementConsolidated |
| Federal Grant Audit Required | false | FederalGrantAuditRequired |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital170b1 Aiii | X | Hospital170b1Aiii |
Schedule B IRS990ScheduleB
Contributor Info ContributorInfo
| Field | Value | IRS element (for citing) |
|---|---|---|
| Contributor Number | RESTRICTED | ContributorNumber |
Contributor Name Business ContributorNameBusiness
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | RESTRICTED | BusinessNameLine1 |
Contributor Address US ContributorAddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | RESTRICTED | AddressLine1 |
| Address Line2 | RESTRICTED | AddressLine2 |
| City | RESTRICTED | City |
| State | RESTRICTED | State |
| ZIP Code | RESTRICTED | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Aggregate Contributions | RESTRICTED | AggregateContributions |
Schedule D IRS990ScheduleD
| Field | Value | IRS element (for citing) |
|---|---|---|
| Art Public Exhibition Amts | ArtPublicExhibitionAmts | |
| Held Works Of Art Amts | HeldWorksOfArtAmts |
Land Land
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 2986659 | OtherCostOrOtherBasis |
| Book Value | 2986659 | BookValue |
Buildings Buildings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 14902121 | OtherCostOrOtherBasis |
| Depreciation | 9660471 | Depreciation |
| Book Value | 5241650 | BookValue |
Leasehold Improvements LeaseholdImprovements
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 354662 | OtherCostOrOtherBasis |
| Depreciation | 263059 | Depreciation |
| Book Value | 91603 | BookValue |
Equipment Equipment
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 23474725 | OtherCostOrOtherBasis |
| Depreciation | 16830160 | Depreciation |
| Book Value | 6644565 | BookValue |
Other Land Buildings OtherLandBuildings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 8364686 | OtherCostOrOtherBasis |
| Book Value | 8364686 | BookValue |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Book Value Land Buildings | 23329163 | TotalOfBookValueLandBuildings |
| Federal Income Tax Liability | 0 | FederalIncomeTaxLiability |
Other Liabilities OtherLiabilities (7 entries)
| DescriptionDescription | AmountAmount |
|---|---|
| ACCRUED PENSION LIABILITY | $6,519,253 |
| OTHER LT LIABILITIES (ARO) | $586,300 |
| OTHER LT LIABILITIES (ALLOCATE | $91,206 |
| UNCLAIMED PROPERTY (ALLOCATED) | $40,613 |
| ASSET RETIREMENT OBLIGATION LT | $169,600 |
| INSURANCE RESERVE | $414,067 |
| TAX EXEMPT BOND LIAB-DUE TO WHS | $5,635,084 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Amounts | 13456123 | TotalOfAmounts |
Form990 Schedule D Part XIV Form990ScheduleDPartXIV
| Field | Value | IRS element (for citing) |
|---|---|---|
| Identifier | SCH D PART X, LINE 2-LIABILITIES | Identifier |
| Explanation | The following footnote is taken from the audited financial statements for Wellstar Health System and Affiliates (including Paulding Medical Center): "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 Sec 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." | Explanation |
Schedule H IRS990ScheduleH
| Field | Value | IRS element (for citing) |
|---|---|---|
| Charity Care Policy | true | CharityCarePolicy |
| Written Policy | true | WrittenPolicy |
| Policy Applied To All Hospitals | X | PolicyAppliedToAllHospitals |
| FPG Reference Free Care | true | FPGReferenceFreeCare |
Other Percentage OtherPercentage
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | X | Other |
| Free Other Percentage | 125. | FreeOtherPercentage |
| Field | Value | IRS element (for citing) |
|---|---|---|
| FPG Reference Discounted Care | true | FPGReferenceDiscountedCare |
| Pcent200 D | X | Pcent200D |
| Free Disc Care Medically Indigent | true | FreeDiscCareMedicallyIndigent |
| Amounts Budgeted For Charity Care | true | AmountsBudgetedForCharityCare |
| Expenses Exceeded Budget | true | ExpensesExceededBudget |
| Unable To Provide Care | false | UnableToProvideCare |
| Annual Community Benefit Report | true | AnnualCommunityBenefitReport |
| Report Publically Available | true | ReportPublicallyAvailable |
Charity Care At Cost CharityCareAtCost
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 2242962 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 2242962 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.04710 | PercentOfTotalExpense |
Unreimbursed Medicaid UnreimbursedMedicaid
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 4775942 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 3333000 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 1442942 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.03030 | PercentOfTotalExpense |
Total Charity Care TotalCharityCare
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 7018904 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 3333000 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 3685904 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.07740 | PercentOfTotalExpense |
Community Health Services CommunityHealthServices
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 86177 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 86177 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00180 | PercentOfTotalExpense |
Total Other Benefits TotalOtherBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 86177 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 86177 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00180 | PercentOfTotalExpense |
Total Community Benefits TotalCommunityBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 7105081 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 3333000 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 3772081 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.07920 | PercentOfTotalExpense |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | true | BadDebtExpenseReported |
| Bad Debt Expense | $4,733,057 | BadDebtExpenseAmount |
| Amount Attributable To | 61296 | AmountAttributableTo |
| Amount Reimbursed By Medicare | 9347405 | AmountReimbursedByMedicare |
| Cost Of Care Reimbursed By Medicare | 12527615 | CostOfCareReimbursedByMedicare |
| Medicare Surplus Or Shortfall | -3180210 | MedicareSurplusOrShortfall |
Costing Methodology Used CostingMethodologyUsed
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cost To Charge Ratio | X | CostToChargeRatio |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Written Debt Collection Policy | true | WrittenDebtCollectionPolicy |
| Provision For Charity Care | true | ProvisionForCharityCare |
Form990 Schedule H Part V Form990ScheduleHPartV
Name Name
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Wellstar Paulding Hospital | BusinessNameLine1 |
Address Address
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 600 West Memorial Drive | AddressLine1 |
| City | Dallas | City |
| State | GA | State |
| ZIP Code | 300666340 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Licensed Hospital | X | LicensedHospital |
| General Medical And Surgical | X | GeneralMedicalAndSurgical |
| Er24 Hours | X | Er24Hours |
| Other | Skilled Nursing Home | Other |
Form990 Schedule H Part VI Form990ScheduleHPartVI
| Field | Value | IRS element (for citing) |
|---|---|---|
| Annual Community Benefit Expln | Paulding Medical Center, Inc. is an affiliate of Wellstar Health System, Inc. and as such is included in the consolidated Community Benefit Report that is annually issued to members of the five county service areas located in the northwest area of the state of Georgia. This report addresses the services and accomplishments of the entire health system for the reporting period. This information is also made a part of the annual Georgia Hospital Association report of community benefit along with other hospitals and healthcare systems throughout the state. | AnnualCommunityBenefitExpln |
| Costing Method Used | Wellstar Health System (including Paulding Medical Center, Inc.) has elected to use the cost to charge ratio from our FY2009 Hospital Financial Survey filed with the state of Georgia. This cost to charge ratio reconciles with the community benefit reporting done both internally in the system and with our annual published community benefit report which is distributed to the Wellstar service areas as well as reported to the Georgia Hospital Association. The $3.8 million in net community benefit represents 7.9% of total operating expenses (less bad debt). As part of the IRS ruling 69-545 for community benefit and a requirement of charitable organizations under IRS code Section 501 ( c ) this represents the commitment of the hospital and healthcare system to providing care to the needy members of the community consistent with its charity care policy regardless of their ability to pay for those services. | CostingMethodUsed |
| Percent Of Total Expense Expln | The percentage of net community benefit to total expenses from Form 990, Part IX, Line 25, column (A) is documented on Schedule H, Part 1, line 7, column (f) for each charity, means tested government programs and other community benefits. However we have adjusted the amount of total expenses ($64,994,608) by subtracting the bad debt expense of $17,040,120 for the calculation and subsequent percentage. | PercentOfTotalExpenseExpln |
| Bad Debt Footnote | In the audited financial statements for WellStar Health System and Affiliates for the reporting period there is not a specific footnote related to bad debt expense but the following notes are mentioned: "The preparation of financial statements in conformity with US generally accepted accounting principles requires that management make estimates and assumptions affecting the reported amounts of assets, liabilities, revenue, and expenses, as well as disclosure of contingent assets and liabilities. Actual results could differ from those estimates. Significant items subject to such estimates and assumptions include the determination of the allowances for uncollectible accounts and contractual adjustments." Also regarding net patient service revenue the audited statements note the following: "Net patient service revenue is reported at the estimated net realizable amounts from patients, third-party payors, and others for services rendered, including estimated retroactive adjustments due to future audits, reviews and investigations." Certain accounts with unrealizable amounts are deemed uncollectible and written off as bad debt. And as patient accounts navigate throughout the collection process some of those accounts are classified as bad debt as it appears it is less likely that the bill will be paid. Some of those accounts will subsequently be determined to have qualified or currently qualify for charity or other financial assistance. Some patients will not provide the necessary paperwork to meet these qualifications. Other patients will be reluctant or unresponsive to the request for information because of their particular situation such as a victim of crime or an undocumented alien. While the percentage of these type of patients is not substantial we have determined that there is a portion (approximately 1.2%) that would have been counted in the community benefit totals if they had been more cooperative. Generally speaking however, Wellstar and its affiliaties do not treat the majority of bad debt accounts as uncompensated care. | BadDebtFootnote |
| Shortfall As Community Benefit | The Medicare shortfall reported on line 7 is similar in some ways to the Medicaid shortfall from Part I of Schedule H. Medicare shortfalls generally represent the uncompensated difference between the expected reimbursement and the Medicare charges stated at cost. The costing methodology to determine the amounts reported on line 6 of part III comes from the annual Medicare cost report filed for the hospital. | ShortfallAsCommunityBenefit |
| Debt Collection Policy | The policy written for collection practices at all Wellstar Health System entities incorporates quidelines for personnel in the admissions and patient access areas to be trained in identifying those patients that might qualify for charity care or other financial assistance. Since it is the policy of Wellstar hospitals to treat any and all patients regardless of their ability to pay especially in the hospital emergency rooms, efforts are made to provide at least one employee or contractor at all times to assist patients in the necessary paperwork to qualify for charity care or governmental assistance programs. This assistance often extends even after the initial visit as the collection process continues. | DebtCollectionPolicy |
| Number Of Facility Type Expln | Wellstar Paulding Hospital is a general acute care hospital providing a full range of services. It is licensed to operate 83 beds by the State of Georgia but is staffed to operate 34 beds. The hospital is located on a 50-acre campus in Dallas, Georgia in a complex of commercial buildings containing approximately 230,000 square feet. The original hospital was built in 1958 and since that time has seen at least five major structural additions and renovations. A new state of the art hospital is planned to replace this facility in the next few years. | NumberOfFacilityTypeExpln |
| Needs Assessment | Wellstar (and its affiliated hospitals) 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 coalition 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 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. | NeedsAssessment |
| Patient Education Assistance | Paulding Hospital is a provider for both Medicare and Medicaid beneficiaries. As such, the hospital provides patients with financial counselors who are trained to assist them in all of the programs offered by the system including governmental programs, uncompensation programs, payment plans, charity discounts, and other programs. These financial counselors are well versed in the eligibility for the traditional Medicare and Medicaid program including SSI Disability through the Medicare. Special programs through the state Medicaid program for expectant mothers and children are presented as options to obtain payment for needed medical care. Indigent and charity eligible patients are offered assistance through the hospital's Charity and Indigent Care Policy which includes funds through the state's Indigent Care Trust Fund. If the patient has no other insurance and fails to qualify for indigent care 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 patients are afforded these options and opportunities. | PatientEducationAssistance |
| Community Information | Paulding 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 and is expected to receive the majority of its patients from one of the following five counties--Bartow, Cherokee, Cobb, Douglas and Paulding-generally about 85% to 90%. While these counties are in the metropolitan Atlanta area (or border on the metro area) they are in some of the fastest growing areas in the entire country. The system has therefore expanded to bring many services to the geographic area that previously were not available except in the Atlanta community. Economically the region is strong in per capita income but as in may areas of the country the system has seen an increase in the unemployment numbers and thus an increase in the uninsured and indigent population for the patients it serves. The system remains positioned to meet the changing needs of the community. | CommunityInformation |
| Affiliated Health Care System | As stated in the Wellstar Health System and Affiliates Audited Financial Statements for the period ending June 30, 2010, Paulding Medical Center (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 Ruling 69-545. In this regard the governing body of the organization and/or it 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 benefit activities, and charity care. Paulding Hospital committed approximately $6.0 million in capital expenditures for the year to meet the technology and program needs of the community it serves. | AffiliatedHealthCareSystem |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| First Class Or Charter Travel | X | FirstClassOrCharterTravel |
| Travel For Companions | X | TravelForCompanions |
| Idemnification Gross Up Payments | X | IdemnificationGrossUpPayments |
| Discretionary Spending Account | X | DiscretionarySpendingAccount |
| Housing Allowance Or Residence | X | HousingAllowanceOrResidence |
| Club Dues Or Fees | X | ClubDuesOrFees |
| Written Policy Re T And E Expenses | false | WrittenPolicyReTAndEExpenses |
| Substantiation Required | true | SubstantiationRequired |
| Compensation Committee | X | CompensationCommittee |
| Independent Consultant | X | IndependentConsultant |
| Written Employment Contract | X | WrittenEmploymentContract |
| Compensation Survey | X | CompensationSurvey |
| Board Or Committee Approval | X | BoardOrCommitteeApproval |
| Severance Payment | true | SeverancePayment |
| Supplemental Nonqual Retire Plan | true | SupplementalNonqualRetirePlan |
| Equity Based Comp Arrangement | false | EquityBasedCompArrangement |
| Comp Based On Revenue Of Filing Org | false | CompBasedOnRevenueOfFilingOrg |
| Comp Based On Revenue Related Orgs | false | CompBasedOnRevenueRelatedOrgs |
| Comp Based Net Earnings Filing Org | false | CompBasedNetEarningsFilingOrg |
| Any Non Fixed Payments | true | AnyNonFixedPayments |
| Initial Contract Exception | false | InitialContractException |
Form990 Schedule J Part II Form990ScheduleJPartII (34 entries)
| Base Compensation Filing OrgBaseCompensationFilingOrg | Comp Based On Related OrgsCompBasedOnRelatedOrgs | Bonus Filing OrgBonusFilingOrg | Bonus Related OrgsBonusRelatedOrgs | Other Compensation Filing OrgOtherCompensationFilingOrg | Other Compensation Related OrgsOtherCompensationRelatedOrgs | Deferred Comp Filing OrgDeferredCompFilingOrg | Deferred Comp Related OrgsDeferredCompRelatedOrgs | Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrg | Nontaxable Benefits Related OrgsNontaxableBenefitsRelatedOrgs | Total Compensation Filing OrgTotalCompensationFilingOrg | Total Compensation Related OrgsTotalCompensationRelatedOrgs | Comp Report Prior990 Filing OrgCompReportPrior990FilingOrg | Comp Report Prior990 Related OrgsCompReportPrior990RelatedOrgs |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Thomas E Gearhard MD | |||||||||||||
| 0 | 277415 | 0 | 0 | 0 | 43274 | 0 | 0 | 0 | 0 | 0 | 320689 | 0 | 0 |
| Jeffery Tharp MD | |||||||||||||
| 0 | 252457 | 0 | 0 | 0 | 122518 | 0 | 0 | 0 | 0 | 0 | 374975 | 0 | 0 |
| A James Budzinski | |||||||||||||
| 0 | 420659 | 0 | 108651 | 0 | 13012 | 0 | 38425 | 0 | 4192 | 0 | 584939 | 0 | 0 |
| Marsha Burke | |||||||||||||
| 0 | 550796 | 0 | 0 | 0 | 0 | 0 | 39033 | 0 | 4581 | 0 | 594410 | 0 | 0 |
| Linda A Clark | |||||||||||||
| 0 | 402300 | 0 | 0 | 0 | 0 | 0 | 24741 | 0 | 0 | 0 | 427041 | 0 | 0 |
| Gregory L Simone MD | |||||||||||||
| 0 | 809466 | 0 | 302279 | 0 | 15662 | 0 | 73802 | 0 | 3137 | 0 | 1204346 | 0 | 0 |
| Bonnie Wilson | |||||||||||||
| 0 | 417321 | 0 | 134446 | 0 | 12850 | 0 | 39687 | 0 | 5813 | 0 | 610117 | 0 | 0 |
| David Anderson | |||||||||||||
| 0 | 368147 | 0 | 120049 | 0 | 12683 | 0 | 35424 | 0 | 2965 | 0 | 539268 | 0 | 0 |
| Donald Campbell MD | |||||||||||||
| 0 | 295414 | 0 | 85967 | 0 | 10800 | 0 | 28784 | 0 | 3122 | 0 | 424087 | 0 | 0 |
| Barbara B Corey | |||||||||||||
| 0 | 263238 | 0 | 80299 | 0 | 10950 | 0 | 26777 | 0 | 1500 | 0 | 382764 | 0 | 0 |
| Bruce Dean | |||||||||||||
| 0 | 191680 | 0 | 30424 | 0 | 9095 | 0 | 18417 | 0 | 5033 | 0 | 254649 | 0 | 0 |
| Marcia Delk MD | |||||||||||||
| 0 | 316598 | 0 | 92972 | 0 | 11328 | 0 | 31275 | 0 | 10370 | 0 | 462543 | 0 | 0 |
| K Darold Etheridge | |||||||||||||
| 0 | 186959 | 0 | 55161 | 0 | 15201 | 0 | 20084 | 0 | 4860 | 0 | 282265 | 0 | 0 |
| Lee Evins | |||||||||||||
| 0 | 171405 | 0 | 39268 | 0 | 26487 | 0 | 18665 | 0 | 3775 | 0 | 259600 | 0 | 0 |
| T Mark Haney | |||||||||||||
| 0 | 242031 | 0 | 91501 | 0 | 14475 | 0 | 26541 | 0 | 5673 | 0 | 380221 | 0 | 0 |
| Bruce Harrison | |||||||||||||
| 0 | 278872 | 0 | 87392 | 0 | 12070 | 0 | 28459 | 0 | 5990 | 0 | 412783 | 0 | 0 |
| Patrick Jansen | |||||||||||||
| 0 | 178558 | 0 | 27979 | 0 | 27006 | 0 | 18097 | 0 | 1590 | 0 | 253230 | 0 | 0 |
| Christopher Kane | |||||||||||||
| 0 | 288428 | 0 | 60926 | 0 | 11825 | 0 | 27233 | 0 | 4813 | 0 | 393225 | 0 | 0 |
| Nancy Kemp | |||||||||||||
| 0 | 166656 | 0 | 11166 | 0 | 49090 | 0 | 13955 | 0 | 0 | 0 | 240867 | 0 | 0 |
| Kenneth Kunze MD | |||||||||||||
| 0 | 405444 | 0 | 80238 | 0 | 12190 | 0 | 35410 | 0 | 542 | 0 | 533824 | 0 | 0 |
| Lou Little | |||||||||||||
| 0 | 210372 | 0 | 68687 | 0 | 11189 | 0 | 23133 | 0 | 8043 | 0 | 321424 | 0 | 0 |
| Kimberly Menefee | |||||||||||||
| 0 | 235766 | 0 | 74822 | 0 | 11535 | 0 | 24820 | 0 | 3275 | 0 | 350218 | 0 | 0 |
| Teresa Ray | |||||||||||||
| 0 | 218400 | 0 | 18610 | 0 | 85123 | 0 | 19811 | 0 | 0 | 0 | 341944 | 0 | 0 |
| Ronald Strachan | |||||||||||||
| 0 | 270123 | 0 | 57603 | 0 | 70594 | 0 | 28407 | 0 | 6227 | 0 | 432954 | 0 | 0 |
| Andrew Tatnall | |||||||||||||
| 0 | 147670 | 0 | 11584 | 0 | 28639 | 0 | 11548 | 0 | 0 | 0 | 199441 | 0 | 0 |
| John Law | |||||||||||||
| 131170 | 0 | 28865 | 0 | 8750 | 0 | 13172 | 0 | 5189 | 0 | 187146 | 0 | 0 | 0 |
| Andrea M Parson | |||||||||||||
| 125617 | 0 | 11011 | 0 | 150 | 0 | 10924 | 0 | 7005 | 0 | 154707 | 0 | 0 | 0 |
| Vicky Lynn Hogue | |||||||||||||
| 143660 | 0 | 23765 | 0 | 8725 | 0 | 13881 | 0 | 6275 | 0 | 196306 | 0 | 0 | 0 |
| ROBERT MANDLER | |||||||||||||
| 0 | 183917 | 0 | 27811 | 0 | 23347 | 0 | 18020 | 0 | 3275 | 0 | 256370 | 0 | 0 |
| MICHAEL GRAUE | |||||||||||||
| 0 | 492184 | 0 | 88589 | 0 | 77295 | 0 | 45369 | 0 | 4505 | 0 | 707942 | 0 | 0 |
| JONATHAN MORRIS | |||||||||||||
| 0 | 116750 | 0 | 25000 | 0 | 7230 | 0 | 11056 | 0 | 1588 | 0 | 161624 | 0 | 0 |
| ELLEN LANGFORD | |||||||||||||
| 0 | 153885 | 0 | 26364 | 0 | 8725 | 0 | 15558 | 0 | 2259 | 0 | 206791 | 0 | 144223 |
| Anthony M Trupiano | |||||||||||||
| 0 | 185075 | 0 | 11541 | 0 | 37137 | 0 | 17874 | 0 | 0 | 0 | 251627 | 0 | 0 |
| Robin Wilson MD | |||||||||||||
| 0 | 120878 | 0 | 0 | 0 | 33848 | 0 | 9717 | 0 | 3672 | 0 | 168115 | 0 | 0 |
Form990 Schedule J Part III Form990ScheduleJPartIII (4 entries)
| IdentifierIdentifier | Return ReferenceReturnReference | ExplanationExplanation |
|---|---|---|
| SEVERANCE BENEFITS | SCHEDULE J | PURSUANT TO THEIR RESPECTIVE EMPLOYMENT AGREEMENTS, THE FOLLOWING OFFICERS ARE ENTITLED TO SERVERANCE PAYMENTS BASED ON THEIR BASE SALARY AND WAGES AT THAT TIME IN THE EVENT OF CERTAIN IDENTIFIED CIRCUMSTANCES. OFFICER -----SEVERENCE BENEFIT PERIOD ----------------- DAVID W. ANDERSON 24 MONTHS DONALD H. CAMPBELL 18 MONTHS LINDA C. CLARK 24 MONTHS RANDY COOK 12 MONTHS BARBARA B. COREY 18 MONTHS MARCIA L. DELK, M.D. 18 MONTHS DAROLD ETHERIDGE 12 MONTHS LEE EVINS 12 MONTHS T. MARK HANEY 18 MONTHS BRUCE HARRISON 12 MONTHS NANCY KEMP 12 MONTHS JOHN LAW 12 MONTHS LOU LITTLE 18 MONTHS KIMBERLY W. MENEFEE 18 MONTHS TAREY RAY 18 MONTHS ANDY TATNALL 18 MONTHS LEIGH COX 12 MONTHS BONNIE L. WILSON 24 MONTHS MARSHA BURKE 24 MONTHS GREGORY L. SIMONE 24 MONTHS CHRISTOPHER KANE 18 MONTHS RON STRACHAN 12 MONTHS CANDICE SAUNDERS 18 MONTHS JIM BUDZINSKI 18 MONTHS MIKE GRAUE 18 MONTHS ROBERT HAMILTON 12 MONTHS ROBERT JANSEN 12 MONTHS ELLEN LANGFORD 12 MONTHS KENNETH KUNZE, MD 18 MONTHS ROBERT MANDLER 12 MONTHS JONATHAN MORRIS 12 MONTHS ANTHONY TRUPIANO 12 MONTHS ROBIN WILSON, MD 12 MONTHS JOSEPH BRYWCZYNSKI 18 MONTHS ELIZABETH HOFFMAN 12 MONTHS RICHARD LOPES, MD 18 MONTHS JAMES SWARTZ 12 MONTHS MARY WESLEY 18 MONTHS During the year, the following individuals received a payout in the amounts listed in accordance with their severance agreements as set forth above: MARSHA BURKE $362,882 LINDA CLARK $236,146 LEIGH COX $144,000 NANCY KEMP $ 55,878 TERESA RAY $ 65,111 |
| 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 indicators. Upon successful acheivement in various targeted levels for each factor an overall performance measurement is developed for each individual. Based on that measurement a performance payout is recommended and approved by the Board of Trustees after the annual financial audit is completed. |
| Other Compensation | Form 990, Schedule J, Part 1B & 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. |
| Compensation Exceptions | On Schedule J of IRS Form 990 the following individuals were employed by Wellstar Health System, Inc. as officers during the fiscal year reporting period but had no salary and benefits reported during the calendar year for which this schedule applies: Joseph L Brywczynski Elizabeth A Hoffmann Richard T Lopes MD James M Swartz Mary L Wesley |
Schedule L IRS990ScheduleL
Form990 Schedule L Part IV Form990ScheduleLPartIV (6 entries)
| RelationshipRelationship | Amount Of TransactionAmountOfTransaction | Description Of TransactionDescriptionOfTransaction | Sharing Of RevenuesSharingOfRevenues |
|---|---|---|---|
| PAMELA ETHERIDGE | |||
| WIFE OF OFFICER | 51723 | WELLSTAR EMPLOYEE | false |
| GREG FORTGANG | |||
| SON-IN-LAW OF BD MEMBER | 88813 | WELLSTAR EMPLOYEE | false |
| GEORGE FLEMING | |||
| BROTHER OF OFFICER | 56575 | WELLSTAR EMPLOYEE | false |
| AMY SIMONE | |||
| DAUGHTER OF OFFICER | 88061 | WELLSTAR EMPLOYEE | false |
| MATTHEW MADDOX | |||
| SON OF BOARD MEMBER | 36500 | WELLSTAR EMPLOYEE | false |
| BONNIE MILLER | |||
| WIFE OF BOARD MEMBER | 26996 | WELLSTAR EMPLOYEE | false |
Schedule O IRS990ScheduleO
General Explanation GeneralExplanation (14 entries)
| IdentifierIdentifier | Return ReferenceReturnReference | ExplanationExplanation |
|---|---|---|
| Tax Compliance 990T Explanation | Part V Line 3a & b UBIT | Paulding Medical Center, Inc. had no unrelated business income for the reporting period but is filing a 990-T to supplement discovery of that income in future periods. |
| Conflict of Interest Policy | Part VI Policies Line 12a, b & c | Our Conflict of Interest Policy requires all covered persons to annually review the policy and 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 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 Executive Compensation | Part VI Section B Policies 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: Kessel Stelling Chair 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 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. |
| Consolidated Financial Statements | Form 990 Part IV Line 12 & Part XI Line 2b | Paulding Medical Center, Inc. is audited on an annual basis as part of the consolidated financial statement audit of Wellstar Health System, Inc. and its Affiliates. |
| 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). Paulding Medical Center, Inc. will report this tax exempt bond liability on Part X, Line 25 Other Liabilities. Paulding Medical Center, 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. |
| Compensation Reported on Form 990 | Form 990 Part X Lines 5-10 & Schedule J, J-1 & J-2 | All compensation amounts reported on Form 990 Part IX Lines 5-10 and Schedules J, J-l & J-2 represent compensation provided to individuals that provide services to Paulding Medical Center, Inc. Likewise the number of employees reported on Part V Line 2a represent the number of individuals providing services to the organization. All Federal Employment Tax responsibilities for those individuals are handled by Wellstar Health System, Inc. (EIN 58-1649541). |
| Organizational Structure | Form 990 Part VI Section A Lines 6, 7a & 7b | 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 an 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 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. This reviewed form is then made available to both the organization's Finance committee of the Board of Trustees as well as the full board in the form of an electronic (pdf. format) version and hard copy of the return. The organization's CFO subsequently signs the return for either manual or electronic filing by the appropriate due date. |
| 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. |
| 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. |
| 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. |
| Bylaws Changes | Form 990, Line VI, Line 4 | On June 17, 2010, the Wellstar Health System and its affiliates amended its bylaws to address the manner of election and terms of office for members of the Board of Trustees. The Chair appoints a Governance Committee consisting of three (3) or more Trustees for purposes of recommending nominations. Nominations are voted upon by the full Board and each Trustee is appointed to serve terms of three years, although the Board can establish a shorter term at the time of election. Each Trustee may serve a "Term Limit" of not more than four (4) consecutive terms of three years. To provide continuity on the Board, there is established a methodology of rotation off the Board for the 18 existing Trustees effective June 30, 2010. One Trustee will rotate off the Board in year one; two Trustees will rotate off the Board in year two; one Trustee will rotate off the Board in year three; and continuing for all remaining positions until all Trustees have expired terms or elect to leave the Board. At the end of the "term limit" the Trustee may be re-elected after a one year absence from the Board. |
| 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). |
| SCHEDULE L PART IV TRANSACTIONS WITH INTERESTED PARTIES | Several transactions with interested parties of Paulding Medical Center Inc. all fall below the $100,000 threshold in business transactions. |
Schedule R IRS990ScheduleR
Form990 Schedule R Part II Form990ScheduleRPartII (6 entries)
| Address Line1AddressUS/AddressLine1 | CityAddressUS/City | StateAddressUS/State | ZIP CodeAddressUS/ZIPCode | EINEIN | Primary ActivitiesPrimaryActivities | Legal Domicile StateLegalDomicileState | Exempt Code SectionExemptCodeSection | Public Charity StatusPublicCharityStatus | Business Name Line1DirectControllingEntityName/BusinessNameLine1 |
|---|---|---|---|---|---|---|---|---|---|
| CHS Foundation | |||||||||
| 805 Sandy Plains Road | Marietta | GA | 30066 | 581649540 | Foundation | GA | 501(c)(3) | 11 | NA |
| Cobb Hospital Inc | |||||||||
| 805 Sandy Plains Road | Marietta | GA | 30066 | 580968382 | Healthcare | GA | 501(c)(3) | 3 | NA |
| Douglas Hospital Inc | |||||||||
| 805 Sandy Plains Road | Marietta | GA | 30066 | 582026750 | Healthcare | GA | 501(c)(3) | 3 | NA |
| Kennestone Hospital Inc | |||||||||
| 805 Sandy Plains Road | Marietta | GA | 30066 | 582032904 | Healthcare | GA | 501(c)(3) | 3 | NA |
| Wellstar Foundation | |||||||||
| 805 Sandy Plains Road | Marietta | GA | 30066 | 581627413 | Foundation | GA | 501(c)(3) | 11 | NA |
| Wellstar Health System | |||||||||
| 805 Sandy Plains Road | Marietta | GA | 30066 | 581649541 | Healthcare | GA | 501(c)(3) | 3 | NA |
Form990 Schedule R Part III Form990ScheduleRPartIII (2 entries)
| Address Line1AddressUS/AddressLine1 | CityAddressUS/City | StateAddressUS/State | ZIP CodeAddressUS/ZIPCode | EINEIN | Primary ActivityPrimaryActivity | Legal Domicile StateLegalDomicileState | Business Name Line1DirectControllingEntityName/BusinessNameLine1 | Predominant Income TypePredominantIncomeType | Share Of Total IncomeShareOfTotalIncome | Share Of EOY AssetsShareOfEOYAssets | Disproportionate AllocationsDisproportionateAllocations | General Or Managing PartnerGeneralOrManagingPartner |
|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Cobb Hospital Parking Company LLC | ||||||||||||
| 805 Sandy Plains Road | Marietta | GA | 300666340 | 752999669 | Parking | GA | NA | INVESTMENT | 41418 | 840467 | false | false |
| Kennestone East Parking Deck LLC | ||||||||||||
| 805 Sandy Plains Road | Marietta | GA | 300666340 | 200537100 | Parking | GA | NA | INVESTMENT | 193986 | 1887789 | false | false |
Form990 Schedule R Part IV Form990ScheduleRPartIV
Name Of Related Org NameOfRelatedOrg
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Community Assurance Co | BusinessNameLine1 |
Address Foreign AddressForeign
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 3rd Fl Barclays House Shedden Rd | AddressLine1 |
| City | George Town | City |
| Province Or State | Grand Cayman, BWI | ProvinceOrState |
| Country | CJ | Country |
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 581649541 | EIN |
| Primary Activity | Insurance | PrimaryActivity |
| Legal Domicile Foreign Country | CJ | LegalDomicileForeignCountry |
Direct Controlling Entity Name DirectControllingEntityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | WHS Inc | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Type Of Entity | C | TypeOfEntity |
| Share Of Total Income | 0 | ShareOfTotalIncome |
| Share Of EOY Assets | 72634317 | ShareOfEOYAssets |
| Percentage Ownership | 1.00000 | PercentageOwnership |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Ann Rents Royalties | false | ReceiptOfIntAnnRentsRoyalties |
| Gift Grant Or Cap Contr To Other Org | false | GiftGrantOrCapContrToOtherOrg |
| Gift Grant Or Cap Contr Fr Other Org | false | GiftGrantOrCapContrFrOtherOrg |
| Loans Or Guarantees To Other Org | false | LoansOrGuaranteesToOtherOrg |
| Loans Or Guarantees From Other Org | false | LoansOrGuaranteesFromOtherOrg |
| Sale Of Assets To Other Org | false | SaleOfAssetsToOtherOrg |
| Purchase Of Assets From Other Org | false | PurchaseOfAssetsFromOtherOrg |
| Exchange Of Assets | false | ExchangeOfAssets |
| Rental Of Facilities To Other Orgs | false | RentalOfFacilitiesToOtherOrgs |
| Rental Of Facilities Fr Other Orgs | false | RentalOfFacilitiesFrOtherOrgs |
| Perform Of Services For Other Orgs | false | PerformOfServicesForOtherOrgs |
| Perform Of Services By Other Orgs | false | PerformOfServicesByOtherOrgs |
| Sharing Of Facilities | false | SharingOfFacilities |
| Sharing Of Paid Employees | false | SharingOfPaidEmployees |
| Reimbursement Paid To Other Org | false | ReimbursementPaidToOtherOrg |
| Reimbursement Paid By Other Org | false | ReimbursementPaidByOtherOrg |
| Other Transfer To Other Org | false | OtherTransferToOtherOrg |
| Other Transfer From Other Org | false | OtherTransferFromOtherOrg |