Form990
Click to see attachment
Department of the TreasuryInternal Revenue Service
Return of Organization Exempt From Income Tax
Under section 501(c), 527, or 4947(a)(1) of the Internal Revenue Code (except private foundations)
MediumBullet Do not enter social security numbers on this form as it may be made public.
MediumBullet Go to www.irs.gov/Form990 for instructions and the latest information.
OMB No. 1545-0047
2019
Open to Public Inspection
A For the 2019 calendar year, or tax year beginning 07-01-2017 , and ending 06-30-2018
BCheck if applicable:
CName of organization
WELLSTAR NORTH FULTON HOSPITAL
 
% ANTHONY J BUDZINSKI
Doing business as
 
 
Number and street (or P.O. box if mail is not delivered to street address)
793 SAWYER ROAD
 
Room/suite
City or town, state or province, country, and ZIP or foreign postal code
MARIETTA, GA300622222
D Employer identification number

81-0851756
E Telephone number

G Gross receipts $ 168,611,352
F Name and address of principal officer:
CANDICE L SAUNDERS
793 SAWYER ROAD
MARIETTA,GA300622222
I
Tax-exempt status: (   ) LeftBullet (insert no.) or
J
Website:MediumBullet
www.wellstar.org
H(a)
Is this a group return for
subordinates?
H(b)
Are all subordinates
included?
If "No," attach a list. (see instructions)
H(c)
Group exemption number MediumBullet  
K Form of organization:  
L Year of formation: 2015
M State of legal domicile: GA
Part I
Summary
Activities & Governance 1 Briefly describe the organization’s mission or most significant activities: TO PROVIDE WORLD-CLASS CHARITABLE HEALTHCARE TO THE COMMUNITY.
2 Check this box MediumBullet
3 Number of voting members of the governing body (Part VI, line 1a) ........ 3 20
4 Number of independent voting members of the governing body (Part VI, line 1b) ..... 4 10
5 Total number of individuals employed in calendar year 2019 (Part V, line 2a) ...... 5 1,116
6 Total number of volunteers (estimate if necessary) ............. 6 75
7a Total unrelated business revenue from Part VIII, column (C), line 12 ........ 7a 0
b Net unrelated business taxable income from Form 990-T, line 39 ......... 7b 82,983
Revenues Prior Year Current Year
8 Contributions and grants (Part VIII, line 1h) ......... 0 0
9 Program service revenue (Part VIII, line 2g) ......... 166,888,080 168,555,186
10 Investment income (Part VIII, column (A), lines 3, 4, and 7d ) .... 0 16,296
11 Other revenue (Part VIII, column (A), lines 5, 6d, 8c, 9c, 10c, and 11e) 65,667 39,870
12 Total revenue—add lines 8 through 11 (must equal Part VIII, column (A), line 12) 166,953,747 168,611,352
Expenses; 13 Grants and similar amounts paid (Part IX, column (A), lines 1–3 )... 0 0
14 Benefits paid to or for members (Part IX, column (A), line 4)..... 0 0
15 Salaries, other compensation, employee benefits (Part IX, column (A), lines 5–10) 59,922,314 60,980,105
16a Professional fundraising fees (Part IX, column (A), line 11e) ..... 0 0
b Total fundraising expenses (Part IX, column (D), line 25) MediumBullet0    
17 Other expenses (Part IX, column (A), lines 11a–11d, 11f–24e).... 84,615,203 86,159,684
18 Total expenses. Add lines 13–17 (must equal Part IX, column (A), line 25) 144,537,517 147,139,789
19 Revenue less expenses. Subtract line 18 from line 12....... 22,416,230 21,471,563
Net Assets or Fund Balances; Beginning of Current Year End of Year
20 Total assets (Part X, line 16)............. 364,062,149 370,847,749
21 Total liabilities (Part X, line 26)............. 351,925,520 311,709,173
22 Net assets or fund balances. Subtract line 21 from line 20..... 12,136,629 59,138,576
Part II
Signature Block
Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief, it is true, correct, and complete. Declaration of preparer (other than officer) is based on all information of which preparer has any knowledge.
Sign Here
JumboBullet
Signature of officer Date
JumboBullet
Type or print name and title
Paid Preparer Use Only
Print/Type preparer's name
Preparer's signature
Date
PTIN
Firm's name MediumBullet

Firm's EIN MediumBullet
Firm's address MediumBullet



Phone no.
May the IRS discuss this return with the preparer shown above? (see instructions) ..........
For Paperwork Reduction Act Notice, see the separate instructions.
Cat. No. 11282Y Form 990 (2019)
Form 990 (2019)
Page 2
Part III
Statement of Program Service Accomplishments
Check if Schedule O contains a response or note to any line in this Part III..............
1
Briefly describe the organization’s mission: 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.
2
Did the organization undertake any significant program services during the year which were not listed on
the prior Form 990 or 990-EZ? .....................
If "Yes," describe these new services on Schedule O.
3
Did the organization cease conducting, or make significant changes in how it conducts, any program
services? ...........................
If "Yes," describe these changes on Schedule O.
4
Describe the organization’s program service accomplishments for each of its three largest program services, as measured by expenses. Section 501(c)(3) and 501(c)(4) organizations are required to report the amount of grants and allocations to others, the total expenses, and revenue, if any, for each program service reported.
4a (Code:   ) (Expenses $ 107,701,238 including grants of $ 0 ) (Revenue $ 168,555,186 )
SEE SCHEDULE O
4b (Code:   ) (Expenses $   including grants of $   ) (Revenue $   )
4c (Code:   ) (Expenses $   including grants of $   ) (Revenue $   )
4d Other program services (Describe in Schedule O.)
(Expenses $   including grants of $   ) (Revenue $   )
4e Total program service expensesMediumBullet107,701,238
Form 990 (2019)
Form 990 (2019)
Page 3
Part IV
Checklist of Required Schedules
Yes
No
1
Is the organization described in section 501(c)(3) or 4947(a)(1) (other than a private foundation)? If "Yes," complete Schedule AClick to see attachment.....................
1
Yes
 
2
Is the organization required to complete Schedule B, Schedule of Contributors (see instructions)? ...
2
 
No
3
Did the organization engage in direct or indirect political campaign activities on behalf of or in opposition to candidates for public office? If "Yes," complete Schedule C, Part I.............
3
 
No
4
Section 501(c)(3) organizations. Did the organization engage in lobbying activities, or have a section 501(h) election in effect during the tax year? If "Yes," complete Schedule C, Part II.........
4
 
No
5
Is the organization a section 501(c)(4), 501(c)(5), or 501(c)(6) organization that receives membership dues, assessments, or similar amounts as defined in Revenue Procedure 98-19? If "Yes," complete Schedule C, Part III..
5
 
 
6
Did the organization maintain any donor advised funds or any similar funds or accounts for which donors have the right to provide advice on the distribution or investment of amounts in such funds or accounts? If "Yes," complete Schedule D, Part IClick to see attachment.........................
6
 
No
7
Did the organization receive or hold a conservation easement, including easements to preserve open space,
the environment, historic land areas, or historic structures? If "Yes," complete Schedule D, Part IIClick to see attachment....
7
 
No
8
Did the organization maintain collections of works of art, historical treasures, or other similar assets? If "Yes,"
complete Schedule D, Part IIIClick to see attachment..............
8
 
No
9
Did the organization report an amount in Part X, line 21 for escrow or custodial account liability; serve as a custodian for amounts not listed in Part X; or provide credit counseling, debt management, credit repair, or debt negotiation services? If "Yes," complete Schedule D, Part IVClick to see attachment..............
9
 
No
10
Did the organization, directly or through a related organization, hold assets in temporarily restricted endowments, permanent endowments, or quasi endowments? If "Yes," complete Schedule D, Part V......
10
 
 
11
If the organization’s answer to any of the following questions is "Yes," then complete Schedule D, Parts VI, VII, VIII, IX, or X as applicable.
a
Did the organization report an amount for land, buildings, and equipment in Part X, line 10? If "Yes," complete
Schedule D, Part VI. Click to see attachment...................
11a
Yes
 
b
Did the organization report an amount for investments—other securities in Part X, line 12 that is 5% or more of its total assets reported in Part X, line 16? If "Yes," complete Schedule D, Part VIIClick to see attachment.......
11b
 
No
c
Did the organization report an amount for investments—program related in Part X, line 13 that is 5% or more of its total assets reported in Part X, line 16? If "Yes," complete Schedule D, Part VIIIClick to see attachment.......
11c
 
No
d
Did the organization report an amount for other assets in Part X, line 15 that is 5% or more of its total assets reported in Part X, line 16? If "Yes," complete Schedule D, Part IXClick to see attachment............
11d
Yes
 
e
Did the organization report an amount for other liabilities in Part X, line 25? If "Yes," complete Schedule D, Part XClick to see attachment
11e
Yes
 
f
Did the organization’s separate or consolidated financial statements for the tax year include a footnote that addresses the organization’s liability for uncertain tax positions under FIN 48 (ASC 740)? If "Yes," complete Schedule D, Part XClick to see attachment
11f
Yes
 
12a
Did the organization obtain separate, independent audited financial statements for the tax year? If "Yes," complete
Schedule D, Parts XI and XIIClick to see attachment......................
12a
 
No
b
Was the organization included in consolidated, independent audited financial statements for the tax year? If "Yes," and if the organization answered "No" to line 12a, then completing Schedule D, Parts XI and XII is optional Click to see attachment
12b
Yes
 
13
Is the organization a school described in section 170(b)(1)(A)(ii)? If "Yes," complete Schedule E
13
 
No
14a
Did the organization maintain an office, employees, or agents outside of the United States? .....
14a
 
No
b
Did the organization have aggregate revenues or expenses of more than $10,000 from grantmaking, fundraising, business, investment, and program service activities outside the United States, or aggregate foreign investments valued at $100,000 or more? If "Yes," complete Schedule F, Parts I and IV.........
14b
 
No
15
Did the organization report on Part IX, column (A), line 3, more than $5,000 of grants or other assistance to or for any foreign organization? If “Yes,” complete Schedule F, Parts II and IV.....
15
 
No
16
Did the organization report on Part IX, column (A), line 3, more than $5,000 of aggregate grants or other assistance to or for foreign individuals? If “Yes,” complete Schedule F, Parts III and IV...
16
 
No
17
Did the organization report a total of more than $15,000 of expenses for professional fundraising services on Part IX, column (A), lines 6 and 11e? If "Yes," complete Schedule G, Part I(see instructions) ....
17
 
No
18
Did the organization report more than $15,000 total of fundraising event gross income and contributions on Part VIII, lines 1c and 8a? If "Yes," complete Schedule G, Part II............
18
 
No
19
Did the organization report more than $15,000 of gross income from gaming activities on Part VIII, line 9a? If "Yes," complete Schedule G, Part III...................
19
 
No
20a
Did the organization operate one or more hospital facilities? If "Yes," complete Schedule H....Click to see attachment
20a
Yes
 
b
If "Yes" to line 20a, did the organization attach a copy of its audited financial statements to this return? Click to see list of attachments
20b
Yes
 
21
Did the organization report more than $5,000 of grants or other assistance to any domestic organization or domestic government on Part IX, column (A), line 1? If “Yes,” complete Schedule I, Parts I and II.....
21
 
No
Form 990 (2019)
Form 990 (2019)
Page 4
Part IV
Checklist of Required Schedules (continued)
Yes
No
22
Did the organization report more than $5,000 of grants or other assistance to or for domestic individuals on Part IX, column (A), line 2? If “Yes,” complete Schedule I, Parts I and III........
22
 
No
23
Did the organization answer "Yes" to Part VII, Section A, line 3, 4, or 5 about compensation of the organization’s current and former officers, directors, trustees, key employees, and highest compensated employees? If "Yes," complete Schedule J....................... Click to see attachment
23
Yes
 
24a
Did the organization have a tax-exempt bond issue with an outstanding principal amount of more than $100,000 as of the last day of the year, that was issued after December 31, 2002? If “Yes,” answer lines 24b through 24d and complete Schedule K. If “No,” go to line 25a...............
24a
 
No
b
Did the organization invest any proceeds of tax-exempt bonds beyond a temporary period exception?...
24b
 
 
c
Did the organization maintain an escrow account other than a refunding escrow at any time during the year
to defease any tax-exempt bonds? ...............
24c
 
 
d
Did the organization act as an "on behalf of" issuer for bonds outstanding at any time during the year?...
24d
 
 
25a
Section 501(c)(3), 501(c)(4), and 501(c)(29) organizations. Did the organization engage in an excess benefit transaction with a disqualified person during the year? If "Yes," complete Schedule L, Part I ....
25a
 
No
b
Is the organization aware that it engaged in an excess benefit transaction with a disqualified person in a prior year, and that the transaction has not been reported on any of the organization’s prior Forms 990 or 990-EZ? If "Yes," complete Schedule L, Part I.......................
25b
 
No
26
Did the organization report any amount on Part X, line 5 or 22 for receivables from or payables to any current or former officer, director, trustee, key employee, creator or founder, substantial contributor, or 35% controlled entity or family member of any of these persons? If "Yes," complete Schedule L, Part II...........
26
 
No
27
Did the organization provide a grant or other assistance to any current or former officer, director, trustee, key employee, creator or founder, substantial contributor, or employee thereof, a grant selection committee member, or to a 35% controlled entity (including an employee thereof) or family member of any of these persons?
If "Yes," complete
Schedule L, Part III.........................
27
 
No
28
Was the organization a party to a business transaction with one of the following parties (see Schedule L, Part IV instructions for applicable filing thresholds, conditions, and exceptions):
a
A current or former officer, director, trustee, key employee, creator or founder, or substantial contributor? If "Yes," complete Schedule L, Part IV......................
28a
 
No
b
A family member of any individual described in line 28a? If "Yes," complete Schedule L, Part IV.....
28b
 
No
c
A 35% controlled entity of one or more individuals and/or organizations described in lines 28a or 28b? If "Yes," complete Schedule L, Part IV.....................
28c
 
 
29
Did the organization receive more than $25,000 in non-cash contributions? If "Yes," complete Schedule M..
29
 
No
30
Did the organization receive contributions of art, historical treasures, or other similar assets, or qualified conservation contributions? If "Yes," complete Schedule M .................
30
 
No
31
Did the organization liquidate, terminate, or dissolve and cease operations? If "Yes," complete Schedule N, Part I
31
 
No
32
Did the organization sell, exchange, dispose of, or transfer more than 25% of its net assets? If "Yes," complete Schedule N, Part II........................
32
 
No
33
Did the organization own 100% of an entity disregarded as separate from the organization under Regulations sections 301.7701-2 and 301.7701-3? If "Yes," complete Schedule R, Part I............Click to see attachment
33
Yes
 
34
Was the organization related to any tax-exempt or taxable entity? If "Yes," complete Schedule R, Part II, III, or IV, and Part V, line 1.........................Click to see attachment
34
Yes
 
35a
Did the organization have a controlled entity within the meaning of section 512(b)(13)?
35a
Yes
 
b
If ‘Yes’ to line 35a, did the organization receive any payment from or engage in any transaction with a controlled entity within the meaning of section 512(b)(13)? If "Yes," complete Schedule R, Part V, line 2 ...Click to see attachment
35b
 
No
36
Section 501(c)(3) organizations. Did the organization make any transfers to an exempt non-charitable related organization? If "Yes," complete Schedule R, Part V, line 2............. Click to see attachment
36
 
No
37
Did the organization conduct more than 5% of its activities through an entity that is not a related organization and that is treated as a partnership for federal income tax purposes? If "Yes," complete Schedule R, Part VIClick to see attachment
37
 
No
38
Did the organization complete Schedule O and provide explanations in Schedule O for Part VI, lines 11b and 19? Note. All Form 990 filers are required to complete Schedule O. ............
38
Yes
 
Part V
Statements Regarding Other IRS Filings and Tax Compliance
Check if Schedule O contains a response or note to any line in this Part V...........
Yes
No
1a
Enter the number reported in Box 3 of Form 1096. Enter -0- if not applicable ..
1a
0
b
Enter the number of Forms W-2G included in line 1a. Enter -0- if not applicable .
1b
0
c
Did the organization comply with backup withholding rules for reportable payments to vendors and reportable gaming (gambling) winnings to prize winners? ..................
1c
 
 
Form 990 (2019)
Form 990 (2019)
Page 5
Part V
Statements Regarding Other IRS Filings and Tax Compliance (continued)
2a
Enter the number of employees reported on Form W-3, Transmittal of Wage and
Tax Statements, filed for the calendar year ending with or within the year covered by this return ..................
2a
1,116
b
If at least one is reported on line 2a, did the organization file all required federal employment tax returns?
Note. If the sum of lines 1a and 2a is greater than 250, you may be required to e-file (see instructions)
2b
Yes
 
3a
Did the organization have unrelated business gross income of $1,000 or more during the year?...
3a
Yes
 
b
If “Yes,” has it filed a Form 990-T for this year? If “No” to line 3b, provide an explanation in Schedule O...
3b
Yes
 
4a
At any time during the calendar year, did the organization have an interest in, or a signature or other authority over, a financial account in a foreign country (such as a bank account, securities account, or other financial account)? ..
4a
 
No
b
If "Yes," enter the name of the foreign country: MediumBullet
See instructions for filing requirements for FinCEN Form 114, Report of Foreign Bank and Financial Accounts (FBAR).
5a
Was the organization a party to a prohibited tax shelter transaction at any time during the tax year? ..
5a
 
No
b
Did any taxable party notify the organization that it was or is a party to a prohibited tax shelter transaction?
5b
 
No
c
If "Yes," to line 5a or 5b, did the organization file Form 8886-T? ............
5c
 
 
6a
Does the organization have annual gross receipts that are normally greater than $100,000, and did the organization solicit any contributions that were not tax deductible as charitable contributions? ...
6a
 
No
b
If "Yes," did the organization include with every solicitation an express statement that such contributions or gifts were not tax deductible? ......................
6b
 
 
7
Organizations that may receive deductible contributions under section 170(c).
a
Did the organization receive a payment in excess of $75 made partly as a contribution and partly for goods and services provided to the payor? ....................
7a
 
No
b
If "Yes," did the organization notify the donor of the value of the goods or services provided? .....
7b
 
 
c
Did the organization sell, exchange, or otherwise dispose of tangible personal property for which it was required to file Form 8282? .........................
7c
 
No
d
If "Yes," indicate the number of Forms 8282 filed during the year ....
7d
 
e
Did the organization receive any funds, directly or indirectly, to pay premiums on a personal benefit contract?
7e
 
No
f
Did the organization, during the year, pay premiums, directly or indirectly, on a personal benefit contract? ..
7f
 
No
g
If the organization received a contribution of qualified intellectual property, did the organization file Form 8899 as required? ......................
7g
 
 
h
If the organization received a contribution of cars, boats, airplanes, or other vehicles, did the organization file a Form 1098-C? ..........................
7h
 
 
8
Sponsoring organizations maintaining donor advised funds. Did a donor advised fund maintained by the sponsoring organization have excess business holdings at any time during the year? ........
8
 
 
9
Sponsoring organizations maintaining donor advised funds.
a
Did the sponsoring organization make any taxable distributions under section 4966?........
9a
 
 
b
Did the sponsoring organization make a distribution to a donor, donor advisor, or related person?...
9b
 
 
10
Section 501(c)(7) organizations. Enter:
a
Initiation fees and capital contributions included on Part VIII, line 12 ...
10a
 
b
Gross receipts, included on Form 990, Part VIII, line 12, for public use of club facilities
10b
 
11
Section 501(c)(12) organizations. Enter:
a
Gross income from members or shareholders .........
11a
 
b
Gross income from other sources (Do not net amounts due or paid to other sources against amounts due or received from them.) ..........
11b
 
12a
Section 4947(a)(1) non-exempt charitable trusts. Is the organization filing Form 990 in lieu of Form 1041?
12a
 
 
b
If "Yes," enter the amount of tax-exempt interest received or accrued during the year.
12b
 
13
Section 501(c)(29) qualified nonprofit health insurance issuers.
a
Is the organization licensed to issue qualified health plans in more than one state? .........
Note. See the instructions for additional information the organization must report on Schedule O.
13a
 
 
b
Enter the amount of reserves the organization is required to maintain by the states in which the organization is licensed to issue qualified health plans ....
13b
 
c
Enter the amount of reserves on hand ............
13c
 
14a
Did the organization receive any payments for indoor tanning services during the tax year?.....
14a
 
No
b
If "Yes," has it filed a Form 720 to report these payments? If "No," provide an explanation in Schedule O..
14b
 
 
15
Is the organization subject to the section 4960 tax on payment(s) of more than $1,000,000 in remuneration or excess parachute payment(s) during the year? ....................
If "Yes," see instructions and file Form 4720, Schedule N.
15
 
 
16
Is the organization an educational institution subject to the section 4968 excise tax on net investment income? ..
If "Yes," complete Form 4720, Schedule O.
16
 
 
Form 990 (2019)
Form 990 (2019)
Page 6
Part VI
Governance, Management, and Disclosure For each "Yes" response to lines 2 through 7b below, and for a "No" response to lines 8a, 8b, or 10b below, describe the circumstances, processes, or changes in Schedule O. See instructions.
Check if Schedule O contains a response or note to any line in this Part VI..............
Section A. Governing Body and Management
Yes
No
1a
Enter the number of voting members of the governing body at the end of the tax year
1a
20
If there are material differences in voting rights among members of the governing body, or if the governing body delegated broad authority to an executive committee or similar committee, explain in Schedule O.
b
Enter the number of voting members included in line 1a, above, who are independent
1b
10
2
Did any officer, director, trustee, or key employee have a family relationship or a business relationship with any other officer, director, trustee, or key employee? .................
2
 
No
3
Did the organization delegate control over management duties customarily performed by or under the direct supervision of officers, directors or trustees, or key employees to a management company or other person? .
3
 
No
4
Did the organization make any significant changes to its governing documents since the prior Form 990 was filed? .
4
 
No
5
Did the organization become aware during the year of a significant diversion of the organization’s assets? .
5
 
No
6
Did the organization have members or stockholders? ................
6
Yes
 
7a
Did the organization have members, stockholders, or other persons who had the power to elect or appoint one or more members of the governing body? ....................
7a
Yes
 
b
Are any governance decisions of the organization reserved to (or subject to approval by) members, stockholders, or persons other than the governing body? ...................
7b
Yes
 
8
Did the organization contemporaneously document the meetings held or written actions undertaken during the year by the following:
a
The governing body? .......................
8a
Yes
 
b
Each committee with authority to act on behalf of the governing body? ............
8b
Yes
 
9
Is there any officer, director, trustee, or key employee listed in Part VII, Section A, who cannot be reached at the organization’s mailing address? If "Yes," provide the names and addresses in Schedule O.......
9
 
No
Section B. Policies (This Section B requests information about policies not required by the Internal Revenue Code.)
Yes
No
10a
Did the organization have local chapters, branches, or affiliates? ............
10a
 
No
b
If "Yes," did the organization have written policies and procedures governing the activities of such chapters, affiliates, and branches to ensure their operations are consistent with the organization's exempt purposes?
10b
 
 
11a
Has the organization provided a complete copy of this Form 990 to all members of its governing body before filing the form? ............................
11a
Yes
 
b
Describe in Schedule O the process, if any, used by the organization to review this Form 990. .....
12a
Did the organization have a written conflict of interest policy? If "No," go to line 13.......
12a
Yes
 
b
Were officers, directors, or trustees, and key employees required to disclose annually interests that could give rise to conflicts? ..........................
12b
Yes
 
c
Did the organization regularly and consistently monitor and enforce compliance with the policy? If "Yes," describe in Schedule O how this was done...................
12c
Yes
 
13
Did the organization have a written whistleblower policy? ...............
13
Yes
 
14
Did the organization have a written document retention and destruction policy? .........
14
Yes
 
15
Did the process for determining compensation of the following persons include a review and approval by independent persons, comparability data, and contemporaneous substantiation of the deliberation and decision?
a
The organization’s CEO, Executive Director, or top management official ...........
15a
Yes
 
b
Other officers or key employees of the organization ................
15b
Yes
 
If "Yes" to line 15a or 15b, describe the process in Schedule O (see instructions).
16a
Did the organization invest in, contribute assets to, or participate in a joint venture or similar arrangement with a taxable entity during the year? ......................
16a
 
No
b
If "Yes," did the organization follow a written policy or procedure requiring the organization to evaluate its participation in joint venture arrangements under applicable federal tax law, and take steps to safeguard the organization’s exempt status with respect to such arrangements? ............
16b
 
 
Section C. Disclosure
17
List the states with which a copy of this Form 990 is required to be filedMediumBullet
GA
18
Section 6104 requires an organization to make its Form 1023 (or 1024-A if applicable), 990, and 990-T (501(c)(3)s only) available for public inspection. Indicate how you made these available. Check all that apply.
19
Describe in Schedule O whether (and if so, how) the organization made its governing documents, conflict of interest policy, and financial statements available to the public during the tax year.
20
State the name, address, and telephone number of the person who possesses the organization's books and records:
MediumBulletANTHONY J BUDZINSKI793 SAWYER ROAD   MARIETTA,GA300666340 (770) 956-7827
Form 990 (2019)
Form 990 (2019)
Page 7
Part VII
Compensation of Officers, Directors,Trustees, Key Employees, Highest Compensated Employees, and Independent Contractors
Check if Schedule O contains a response or note to any line in this Part VII..............
Section A. Officers, Directors, Trustees, Key Employees, and Highest Compensated Employees
1a Complete this table for all persons required to be listed. Report compensation for the calendar year ending with or within the organization’s tax year.
RoundBullet List all of the organization’s current officers, directors, trustees (whether individuals or organizations), regardless of amount
of compensation. Enter -0- in columns (D), (E), and (F) if no compensation was paid.

RoundBullet List all of the organization’s current key employees, if any. See instructions for definition of "key employee."
RoundBullet List the organization’s five current highest compensated employees (other than an officer, director, trustee or key employee)
who received reportable compensation (Box 5 of Form W-2 and/or Box 7 of Form 1099-MISC) of more than $100,000 from the
organization and any related organizations.

RoundBullet List all of the organization’s former officers, key employees, or highest compensated employees who received more than $100,000
of reportable compensation from the organization and any related organizations.

RoundBullet List all of the organization’s former directors or trustees that received, in the capacity as a former director or trustee of the
organization, more than $10,000 of reportable compensation from the organization and any related organizations.

See instructions for the order in which to list the persons above.
Check this box if neither the organization nor any related organization compensated any current officer, director, or trustee.
(A)
Name and title 		(B)
Average hours per week (list any hours for related organizations below dotted line) 		(C)
Position (do not check more than one box, unless person is both an officer and a director/trustee) 		(D)
Reportable compensation from the organization (W-2/1099-MISC) 		(E)
Reportable compensation from related organizations (W-2/1099-MISC) 		(F)
Estimated amount of other compensation from the organization and related organizations
Individual Trustee or Director; Institutional Trustee; OfficerInd; Key Employee; Highest compensated employee; FormerOfcrDirectorTrusteeInd;
(1) AMBICA YADAV......................................................................
TRUSTEE
 1.0
.................
13.0 		X           0 4,284 0
(2) AVRIL P BECKFORD MD......................................................................
TRUSTEE & CHIEF PEDIATRIC OFF.
 1.0
.................
49.0 		X   X       0 444,016 30,191
(3) CHARLES J JONES......................................................................
TRUSTEE
 1.0
.................
13.0 		X           0 6,339 0
(4) DAVID H HAFNER MD......................................................................
TRUSTEE
 1.0
.................
13.0 		X           0 55,331 0
(5) GARY A MILLER......................................................................
TRUSTEE
 1.0
.................
13.0 		X           0 3,586 0
(6) GREG MORGAN......................................................................
TRUSTEE
 1.0
.................
13.0 		X           0 3,104 0
(7) H SPEER BURDETTE III......................................................................
TRUSTEE
 1.0
.................
13.0 		X           0 3,400 0
(8) JEFFREY L THARP MD MPH......................................................................
TRUSTEE & CHIEF MEDICINE SRVS.
 1.0
.................
49.0 		X   X       0 522,885 80,666
(9) FRANK ROS......................................................................
TRUSTEE
 1.0
.................
13.0 		X           0 4,959 0
(10) MICHAEL B PATTON......................................................................
TRUSTEE
 1.0
.................
13.0 		X           0 4,011 0
(11) MITZI MOORE......................................................................
TRUSTEE
 1.0
.................
13.0 		X           0 9,175 0
(12) O SCOTT SWAYZE MD......................................................................
TRUSTEE
 1.0
.................
13.0 		X           0 5,724 0
(13) OTIS A BRUMBY III......................................................................
TRUSTEE
 1.0
.................
13.0 		X           0 48,879 0
(14) PAUL DOUGLASS MD......................................................................
TRUSTEE & PHYSICIAN
 1.0
.................
49.0 		X           0 633,707 41,401
(15) R RANDALL BENTLEY SR ESQ......................................................................
TRUSTEE
 1.0
.................
13.0 		X           0 48,405 0
(16) ROBERT N CROSS MD......................................................................
TRUSTEE
 1.0
.................
13.0 		X           0 15,971 0
(17) T FITZ JOHNSON......................................................................
TRUSTEE
 1.0
.................
15.0 		X           0 40,981 0
Form 990 (2019)
Form 990 (2019)
Page 8
Part VII
Section A. Officers, Directors, Trustees, Key Employees, and Highest Compensated Employees (continued)
(A)
Name and title 		(B)
Average hours per week (list any hours for related organizations below dotted line) 		(C)
Position (do not check more than one box, unless person is both an officer and a director/trustee) 		(D)
Reportable compensation from the organization (W-2/1099-MISC) 		(E)
Reportable compensation from related organizations (W-2/1099-MISC) 		(F)
Estimated amount of other compensation from the organization and related organizations
Individual Trustee or Director; Institutional Trustee; OfficerInd; Key Employee; Highest compensated employee; FormerOfcrDirectorTrusteeInd;
(18) THOMAS M PHILLIPS........................................................................
TRUSTEE
 1.0
.......................13.0 		X           0 2,467 0
(19) W CHARLES BROCK........................................................................
TRUSTEE
 1.0
.......................13.0 		X           0 46,215 0
(20) WALTER G ROBINSON........................................................................
TRUSTEE
 1.0
.......................13.0 		X           0 8,062 0
(21) ALAN R MUSTER MD........................................................................
SVP SPECIALTY DIVISION WMG
 1.0
.......................51.0 		    X       0 601,443 82,349
(22) ALAN WILDE........................................................................
SVP SUPPLY CHAIN (BEG. 6/18)
 1.0
.......................49.0 		    X       0 0 0
(23) ANDREW ALBERRY........................................................................
VP INFO TECHNOLOGY OPERATIONS
 1.0
.......................49.0 		    X       0 155,877 9,394
(24) ANDREW LEE........................................................................
VP CHIEF DIV. OFF.(BEG. 10/17)
 1.0
.......................49.0 		    X       0 117,476 2,008
(25) ANTHONY J BUDZINSKI........................................................................
EVP & CFO
 1.0
.......................51.0 		    X       0 1,233,070 71,584
(26) ANTHONY M TRUPIANO........................................................................
SVP SUPPLY CHAIN
 1.0
.......................49.0 		    X       0 397,653 49,512
(27) BARBARA B COREY........................................................................
SVP MANAGED CARE
 1.0
.......................49.0 		    X       0 613,339 50,336
(28) BETH KOST........................................................................
SVP COMPLIANCE CHF PRIVACY OFF
 1.0
.......................49.0 		    X       0 389,392 43,110
(29) BETHANY ROBERTSON........................................................................
VP/CHIEF LEARN.OFF.(END.4/18)
 1.0
.......................49.0 		    X       0 279,036 45,924
(30) BRADFORD B NEWTON........................................................................
VP INFO. TECHNOLOGY ADMIN.
 1.0
.......................49.0 		    X       0 278,749 51,740
(31) CANDICE L SAUNDERS........................................................................
PRESIDENT & CEO
 1.0
.......................51.0 		    X       0 2,121,661 76,327
(32) CARRIE O PLIETZ........................................................................
EVP & COO HOSPITAL DIVISION
 1.0
.......................49.0 		    X       0 884,677 67,768
(33) DAVID W ANDERSON........................................................................
EVP/HR/OL/CCO
 1.0
.......................49.0 		    X       0 804,964 75,727
(34) DOUGLAS ARVIN CPA MBA........................................................................
SVP FINANCE
 1.0
.......................49.0 		    X       0 433,489 29,905
(35) ELIZABETH H LOUDERMILK........................................................................
VP FINANCIAL PLANNING
 1.0
.......................49.0 		    X       0 304,210 50,851
(36) ELIZABETH PAPETTI........................................................................
VP OPS HOSPITAL DIVISION
 1.0
.......................49.0 		    X       0 239,000 6,136
(37) ELLEN LANGFORD........................................................................
SVP WMG AMB. TRANS. (END.4/18)
 1.0
.......................49.0 		    X       0 434,986 69,267
(38) ELLEN WRIGHT........................................................................
VP HIM CDI & POLICIES
 1.0
.......................49.0 		    X       0 74,286 4,329
(39) FELIX SOT IZAGUIRRE........................................................................
VP FINANCE & HOSPITAL CFO
 50.0
.......................0.0 		    X       191,786 0 43,655
(40) FREDA LYON........................................................................
VP SYSTEM EMERGENCY SERVICES
 1.0
.......................49.0 		    X       0 243,482 45,328
(41) JACQUELYN A ALT........................................................................
VP CNO PATIENT CARE SERVICES
 50.0
.......................0.0 		    X       251,614 0 49,613
(42) JAMES M SWARTZ........................................................................
VP ACCOUNTING
 1.0
.......................49.0 		    X       0 282,924 47,009
(43) JASON STEVENS........................................................................
VP DEPUTY GENERAL COUNSEL
 1.0
.......................49.0 		    X       0 346,099 42,842
(44) JENNIFER GARBER........................................................................
VP HUMAN RESOURCES
 50.0
.......................0.0 		    X       148,451 0 22,263
(45) JENNIFER GIUSTI........................................................................
VP CLINICAL OUTCOMES
 1.0
.......................49.0 		    X       0 317,295 32,617
(46) JILL M CASE-WIRTH........................................................................
SVP NURSING SERVICES
 1.0
.......................49.0 		    X       0 444,154 59,112
(47) JOHN A BRENNAN........................................................................
EVP CHIEF CLIN. INTG. OFFICER
 1.0
.......................49.0 		    X       0 1,091,634 82,415
(48) JONATHAN CROOM........................................................................
SVP & HOSPITAL PRESIDENT
 48.0
.......................2.0 		    X       271,774 0 42,352
(49) JOSEPH L BRYWCZYNSKI........................................................................
SVP HEALTH PARKS DEVELOPMENT
 1.0
.......................49.0 		    X       0 442,964 73,625
(50) KARIM GODAMUNNE MD........................................................................
VP HOSPITAL CHIEF MED OFFICER
 50.0
.......................0.0 		    X       372,165 0 73,555
(51) KEITH BOWERMASTER........................................................................
VP COMMUNICATION
 1.0
.......................49.0 		    X       0 204,567 38,658
(52) KEM M MULLINS........................................................................
EVP AMBULATORY & BUS. DEV.
 1.0
.......................49.0 		    X       0 677,287 57,343
(53) KENT HAYTHORN........................................................................
VP CLNCL. NURSING (END. 10/17)
 1.0
.......................49.0 		    X       0 115,180 20,470
(54) KEVIN SCHAEFFER MD........................................................................
VP ONCOLOGY
 1.0
.......................49.0 		    X       0 315,346 37,252
(55) KIMBERLY W MENEFEE........................................................................
SVP STRAT. COMM.DEV.(END.4/18)
 1.0
.......................51.0 		    X       0 544,245 51,952
(56) KIMBERLY TAACA........................................................................
VP OPS SPECIALTY DIVISION
 1.0
.......................49.0 		    X       0 227,431 27,644
(57) KRISTEN S TRICE........................................................................
VP DIAGNOSTIC OUTREACH
 1.0
.......................49.0 		    X       0 219,064 42,667
(58) LEO E REICHERT........................................................................
EVP & GENERAL COUNSEL
 1.0
.......................49.0 		    X       0 751,320 66,257
(59) LINDSEY H PETRINI........................................................................
VP COO
 50.0
.......................0.0 		    X       206,651 0 23,879
(60) MARCUS P CHARLSON MD........................................................................
VP SURGERY
 1.0
.......................49.0 		    X       0 196,376 34,191
(61) MARY L TAVERNARO........................................................................
VP HUMAN RESOURCES OPERATIONS
 1.0
.......................49.0 		    X       0 302,766 52,404
(62) MAXWELL KAGAN........................................................................
VP FINANCE & CFO
 1.0
.......................49.0 		    X       0 205,325 34,929
(63) MICHELLE M ROBINSON........................................................................
VP MARKETING (END. 4/2018)
 1.0
.......................49.0 		    X       0 269,465 45,021
(64) PAUL MURPHREE........................................................................
VP MEDICAL OUTCOMES
 1.0
.......................49.0 		    X       0 206,596 21,621
(65) PETER R JUNGBLUT MD MBA........................................................................
SVP & MEDICAL DIRECTOR
 1.0
.......................49.0 		    X       0 344,227 78,651
(66) REBECCA L RUHL........................................................................
VP FACILITY COMPLIANCE OPS
 1.0
.......................49.0 		    X       0 191,015 30,545
(67) RICHARD S SIEGEL........................................................................
VP CARDIOLOGY & CVM ADMIN.
 1.0
.......................49.0 		    X       0 420,012 79,761
(68) ROB SCHREINER........................................................................
EVP & PRESIDENT MEDICAL GROUP
 1.0
.......................49.0 		    X       0 260,724 3,189
(69) ROBERT J DECOUX........................................................................
VP CORPORATE MED STAFF SVCS
 1.0
.......................49.0 		    X       0 224,236 53,512
(70) ROBIN G BOEHRINGER........................................................................
VP TOTAL REWARDS (END. 5/2018)
 1.0
.......................49.0 		    X       0 237,763 28,362
(71) SANDRA LUCIUS........................................................................
VP INFO TECHNOLOGY APPS
 1.0
.......................49.0 		    X       0 285,948 49,910
(72) SEAN P TURNER........................................................................
VP REVENUE CYCLE MANAGEMENT
 1.0
.......................49.0 		    X       0 368,104 59,488
(73) SNEHAL H DOSHI........................................................................
VP SYSTEM PHARMACIST
 1.0
.......................49.0 		    X       0 239,515 59,995
(74) SONYA E ALDY........................................................................
VP TALENT ACQUISITION
 1.0
.......................49.0 		    X       0 244,723 40,030
(75) STEPHEN L BADGER........................................................................
VP WMG STRATEGIC SERVICES
 1.0
.......................49.0 		    X       0 820,360 59,117
(76) STEPHEN VAULT........................................................................
VP BUSINESS DEVELOPMENT
 1.0
.......................49.0 		    X       0 215,180 24,026
(77) TIMOTHY HANEY........................................................................
SVP R.E. FAC. & DEV. SRVS.
 1.0
.......................49.0 		    X       0 599,548 54,288
(78) TOM BONIECKI........................................................................
VP MUSCUSKELETAL NEURO.
 1.0
.......................49.0 		    X       0 180,342 75,237
(79) VALERY A AKOPOV MD........................................................................
SVP HOSPITAL DIVISION WMG
 1.0
.......................49.0 		    X       0 574,337 56,862
(80) VARMA RAMESWAR MD........................................................................
VP PEDIATRIC OPERATIONS
 1.0
.......................49.0 		    X       0 225,328 52,564
(81) YVETTE BREWER MD........................................................................
VP PRIMARY CARE MEDICINE
 1.0
.......................49.0 		    X       0 227,494 54,160
(82) ELLEN HONEA........................................................................
TRAINING PHARMACIST
 50.0
.......................0.0 		        X   147,940 0 38,855
(83) HOSSEIN HAZRATI........................................................................
PHARMACIST
 50.0
.......................0.0 		        X   149,020 0 49,218
(84) MARK HASTINGS........................................................................
PHARMACIST
 50.0
.......................0.0 		        X   167,074 0 44,150
(85) MISTY BOACHIE........................................................................
DIR PHARMACY SVCS
 50.0
.......................0.0 		        X   237,146 0 30,260
(86) TERRENCE EYRING........................................................................
PHARMACIST
 50.0
.......................0.0 		        X   147,373 0 37,167
(87) DEBORAH C KEEL........................................................................
FORMER SVP & HOSPITAL PRES.
 0.0
.......................0.0 		          X 576,027 0 0
(88) DOUGLAS S FOSTER........................................................................
FORMER VP FINANCIAL PLAN.
 0.0
.......................0.0 		          X 0 115,794 24,995
(89) JONATHAN B MORRIS MD........................................................................
FORMER SVP CHIEF INFO. OFF.
 0.0
.......................0.0 		          X 0 233,817 16,019
1b Sub-Total................MediumBullet
c Total from continuation sheets to Part VII, Section A....MediumBullet
d Total (add lines 1b and 1c)...........MediumBullet 2,867,021 24,686,796 3,207,560
2
Total number of individuals (including but not limited to those listed above) who received more than $100,000 of reportable compensation from the organization MediumBullet98
Yes
No
3
Did the organization list any former officer, director or trustee, key employee, or highest compensated employee on line 1a? If "Yes," complete Schedule J for such individual ..............
3
Yes
 
4
For any individual listed on line 1a, is the sum of reportable compensation and other compensation from the organization and related organizations greater than $150,000? If "Yes," complete Schedule J for such
individual...........................
4
Yes
 
5
Did any person listed on line 1a receive or accrue compensation from any unrelated organization or individual for services rendered to the organization? If "Yes," complete Schedule J for such person ........
5
 
No
Section B. Independent Contractors
1
Complete this table for your five highest compensated independent contractors that received more than $100,000 of compensation from the organization. Report compensation for the calendar year ending with or within the organization’s tax year.
(A)
Name and business address 		(B)
Description of services 		(C)
Compensation
2
Total number of independent contractors (including but not limited to those listed above) who received more than $100,000 of compensation from the organization MediumBullet0
Form 990 (2019)
Form 990 (2019)
Page 9
Part VIII
Statement of Revenue
Check if Schedule O contains a response or note to any line in this Part VIII.............
(A)
Total revenue 		(B)
Related or
exempt
function
revenue 		(C)
Unrelated
business
revenue 		(D)
Revenue
excluded from
tax under sections
512 - 514
Contributions, Gifts, GrantAmt and OtherAmt Similar Amounts 1a Federated campaigns..1a  
b Membership dues..1b  
c Fundraising events..1c  
d Related organizations1d  
e Government grants (contributions)1e  
f All other contributions, gifts, grants, and similar amounts not included above1f  
g Noncash contributions included in lines 1a - 1f:$ 1g  
h Total. Add lines 1a-1f.......MediumBullet 0
Program Service RevenueAmt Business Code
2a PATIENT REVENUE 621990 168,555,186 168,555,186    
b
c
d
e
f All other program service revenue.        
g Total. Add lines 2a–2f .....MediumBullet 168,555,186
OtherAmtRevenueAmt 3 Investment income (including dividends, interest, and othersimilar amounts) ......MediumBullet 17,536     17,536
4 Income from investment of tax-exempt bond proceedsMediumBullet 0      
5 Royalties...........MediumBullet 0      
(ii) Personal (i) Real
6a Gross rents   24,656 6a
b Less: rental expenses     6b
c Rental income or (loss) 0 24,656 6c
d Net rental income or (loss).......MediumBullet 24,656     24,656
(ii) Other (i) Securities
7a Gross amount from sales of assets other than inventory -1,240   7a
b Less: cost or other basis and sales expenses     7b
c Gain or (loss) -1,240   7c
d Net gain or (loss).........MediumBullet -1,240     -1,240
8a Gross income from fundraising events (not including $   of contributions reported on line 1c). See Part IV, line 18 ....
8a 0
b Less: direct expenses ... 8b 0
c Net income or (loss) from fundraising events..MediumBullet 0    
9a Gross income from gaming activities.
See Part IV, line 19 ...
9a 0
b Less: direct expenses ... 9b 0
c Net income or (loss) from gaming activities..MediumBullet 0      
10a Gross sales of inventory, less
returns and allowances ..
10a 0
b Less: cost of goods sold .. 10b 0
c Net income or (loss) from sales of inventory..MediumBullet 0      
Business Code Miscellaneous Revenue
11a OTHER REVENUE 621990 15,214     15,214
b            
c            
d All other revenue ....        
e Total. Add lines 11a–11d ...... MediumBullet 15,214
12 Total revenue. See instructions.....MediumBullet 168,611,352 168,555,186   56,166
Form 990 (2019)
Form 990 (2019)
Page 10
Part IX
Statement of Functional Expenses
Section 501(c)(3) and 501(c)(4) organizations must complete all columns. All other organizations must complete column (A).Check if Schedule O contains a response or note to any line in this Part IX..............
Do not include amounts reported on lines 6b,
7b, 8b, 9b, and 10b of Part VIII. 		(A)
Total expenses 		(B)
Program service expenses 		(C)
Management and general expenses 		(D)
Fundraising
expenses
1 Grants and other assistance to domestic organizations and domestic governments. See Part IV, line 21 .... 0  
2 Grants and other assistance to domestic individuals. See Part IV, line 22 ........... 0  
3 Grants and other assistance to foreign organizations, foreign governments, and foreign individuals. See Part IV, lines 15 and 16. ............. 0  
4 Benefits paid to or for members ....... 0  
5 Compensation of current officers, directors, trustees, and key employees ........... 1,747,199 1,397,759 349,440  
6 Compensation not included above, to disqualified persons (as defined under section 4958(f)(1)) and persons described in section 4958(c)(3)(B) ......... 579,991 463,993 115,998  
7 Other salaries and wages........ 49,445,359 44,269,365 5,175,994  
8 Pension plan accruals and contributions (include section 401(k) and 403(b) employer contributions) .... 886,425 793,633 92,792  
9 Other employee benefits ....... 4,600,119 4,118,574 481,545  
10 Payroll taxes ........... 3,721,012 3,331,492 389,520  
11 Fees for services (non-employees):        
a Management ...... 7,001 1,875 5,126  
b Legal ......... 1,229   1,229  
c Accounting ........... 22,500   22,500  
d Lobbying ........... 0      
e Professional fundraising services. See Part IV, line 17 0  
f Investment management fees ...... 0      
g Other (If line 11g amount exceeds 10% of line 25, column (A) amount, list line 11g expenses on Schedule O) 29,440,522 13,583,102 15,857,420 0
12 Advertising and promotion .... 138,883 2,863 136,020  
13 Office expenses ....... 3,451,567 2,935,992 515,575  
14 Information technology ...... 0      
15 Royalties .. 0      
16 Occupancy ........... 3,273,701 2,820,175 453,526  
17 Travel ............ 32,552 16,624 15,928  
18 Payments of travel or entertainment expenses for any federal, state, or local public officials . 0     0
19 Conferences, conventions, and meetings .... 10,630 7,846 2,784  
20 Interest ........... 8,517,498   8,517,498  
21 Payments to affiliates ....... 5,369,084 4,828,283 540,801  
22 Depreciation, depletion, and amortization .. 7,096,792 3,438,873 3,657,919  
23 Insurance ... 2,900,763   2,900,763 0
24 Other expenses. Itemize expenses not covered above (List miscellaneous expenses in line 24e. If line 24e amount exceeds 10% of line 25, column (A) amount, list line 24e expenses on Schedule O.)
a REPAIRS AND MAINTENANCE 3,001,194 2,798,548 202,646 0
b MEDICAL SUPPLIES 22,892,241 22,892,241 0 0
c OTHER EXPENSES 3,527 0 3,527 0
d
e All other expenses        
25 Total functional expenses. Add lines 1 through 24e 147,139,789 107,701,238 39,438,551 0
26 Joint costs. Complete this line only if the organization reported in column (B) joint costs from a combined educational campaign and fundraising solicitation. Check here MediumBullet if following SOP 98-2 (ASC 958-720).        
Form 990 (2019)
Form 990 (2019)
Page 11
Part X
Balance Sheet
Check if Schedule O contains a response or note to any line in this Part IX..............
(A)
Beginning of year 		(B)
End of year
Assets 1 Cash–non-interest-bearing ........ 16,631 1 49,841
2 Savings and temporary cash investments ......... 0 2 0
3 Pledges and grants receivable, net ...... 0 3 0
4 Accounts receivable, net ............. 32,484,546 4 28,724,367
5 Loans and other payables to any current or former officer, director, trustee, key employee, creator or founder, substantial contributor, or 35% controlled entity or family member of any of these persons .......
0 5 0
6 Loans and other receivables from other disqualified persons (as defined under section 4958(f)(1)), and persons described in section 4958(c)(3)(B) ...
0 6 0
7 Notes and loans receivable, net ........... 0 7 0
8 Inventories for sale or use ............ 2,999,302 8 4,829,689
9 Prepaid expenses and deferred charges ...... 1,696,585 9 1,914,543
10a Land, buildings, and equipment: cost or other basis. Complete Part VI of Schedule D 10a 137,775,166
b Less: accumulated depreciation 10b 17,431,350 112,249,161 10c 120,343,816
11 Investments—publicly traded securities . 0 11 0
12 Investments—other securities. See Part IV, line 11 ..... 0 12 0
13 Investments—program-related. See Part IV, line 11 .. 0 13 0
14 Intangible assets ............... 0 14 0
15 Other assets. See Part IV, line 11 ........... 214,615,924 15 214,985,493
16 Total assets. Add lines 1 through 15 (must equal line 33)... 364,062,149 16 370,847,749
Liabilities 17 Accounts payable and accrued expenses ..... 17,916,563 17 7,791,523
18 Grants payable ... 0 18 0
19 Deferred revenue ......... 0 19 0
20 Tax-exempt bond liabilities ......... 0 20 0
21 Escrow or custodial account liability. Complete Part IV of Schedule D 0 21 0
22 Loans and other payables to any current or former officer, director, trustee, key employee, creator or founder, substantial contributor, or 35% controlled entity or family member of any of these persons .........
0 22 0
23 Secured mortgages and notes payable to unrelated third parties .. 0 23 0
24 Unsecured notes and loans payable to unrelated third parties .. 0 24 0
25 Other liabilities (including federal income tax, payables to related third parties, and other liabilities not included on lines 17 - 24). Complete Part X of Schedule D 334,008,957 25 303,917,650
26 Total liabilities. Add lines 17 through 25.. 351,925,520 26 311,709,173
Net Assets or Fund Balance Organizations that follow FASB ASC 958, check here MediumBullet and complete lines 27, 28, 32, and 33.
27 Net assets without donor restrictions ..........   27  
28 Net assets with donor restrictions ...........   28  
Organizations that do not follow FASB ASC 958, check here MediumBullet and complete lines 29 through 33.
29 Capital stock or trust principal, or current funds .....   29  
30 Paid-in or capital surplus, or land, building or equipment fund ...   30  
31 Retained earnings, endowment, accumulated income, or other funds   31  
32 Total net assets or fund balances ........... 12,136,629 32 59,138,576
33 Total liabilities and net assets/fund balances ........ 364,062,149 33 370,847,749
Form 990 (2019)
Form 990 (2019)
Page 12
Part XI
Reconcilliation of Net Assets
Check if Schedule O contains a response or note to any line in this Part XI..............
1
Total revenue (must equal Part VIII, column (A), line 12) ............
1
168,611,352
2
Total expenses (must equal Part IX, column (A), line 25) ............
2
147,139,789
3
Revenue less expenses. Subtract line 2 from line 1 ..............
3
21,471,563
4
Net assets or fund balances at beginning of year (must equal Part X, line 32, column (A)) ..
4
12,136,629
5
Net unrealized gains (losses) on investments ...............
5
 
6
Donated services and use of facilities .................
6
 
7
Investment expenses .....................
7
 
8
Prior period adjustments .....................
8
 
9
Other changes in net assets or fund balances (explain in Schedule O) ........
9
25,530,384
10
Net assets or fund balances at end of year. Combine lines 3 through 9 (must equal Part X, line 32, column (B))
10
59,138,576
Part XII
Financial Statements and Reporting
Check if Schedule O contains a response or note to any line in this Part XII.............
Yes
No
1
Accounting method used to prepare the Form 990:  
If the organization changed its method of accounting from a prior year or checked "Other," explain in
Schedule O.
2a
Were the organization’s financial statements compiled or reviewed by an independent accountant?
2a
 
No
If ‘Yes,’ check a box below to indicate whether the financial statements for the year were compiled or reviewed on a separate basis, consolidated basis, or both:
b
Were the organization’s financial statements audited by an independent accountant?
2b
Yes
 
If ‘Yes,’ check a box below to indicate whether the financial statements for the year were audited on a separate basis, consolidated basis, or both:
c
If "Yes," to line 2a or 2b, does the organization have a committee that assumes responsibility for oversight of the audit, review, or compilation of its financial statements and selection of an independent accountant?
2c
Yes
 
If the organization changed either its oversight process or selection process during the tax year, explain in Schedule O.
3a
As a result of a federal award, was the organization required to undergo an audit or audits as set forth in the Single Audit Act and OMB Circular A-133?
3a
 
No
b
If "Yes," did the organization undergo the required audit or audits? If the organization did not undergo the required audit or audits, explain why in Schedule O and describe any steps taken to undergo such audits.
3b
 
 
Form 990 (2019)
Form 990 (2019)
Additional Data


Software ID:  
Software Version:  
Form 990, Special Condition Description:
Special Condition Description
SCHEDULE A
(Form 990 or 990EZ)

Department of the Treasury
Internal Revenue Service
Public Charity Status and Public Support
Complete if the organization is a section 501(c)(3) organization or a section 4947(a)(1) nonexempt charitable trust.
right arrow Attach to Form 990 or Form 990-EZ.
right arrow Go to www.irs.gov/Form990 for instructions and the latest information.
OMB No. 1545-0047
2019
Open to Public
Inspection
Name of the organization
WELLSTAR NORTH FULTON HOSPITAL
 
Employer identification number

81-0851756
Part I
Reason for Public Charity Status (All organizations must complete this part.) See instructions.
The organization is not a private foundation because it is: (For lines 1 through 12, check only one box.)
1
2
3
4
5
6
7
8
9
10
11
12
a
b
c
d
e
f
Enter the number of supported organizations ...............................  
g
Provide the following information about the supported organization(s).
(i) Name of supported organization (ii) EIN (iii) Type of organization (described on lines 1- 10 above (see instructions)) (iv) Is the organization listed in your governing document? (v) Amount of monetary support (see instructions) (vi) Amount of other support (see instructions)
Yes No
Total
 
   
For Paperwork Reduction Act Notice, see the Instructions for
Form 990 or 990-EZ.
Cat. No. 11285F
Schedule A (Form 990 or 990-EZ) 2019

Schedule A (Form 990 or 990-EZ) 2019
Page 2
Part II
Support Schedule for Organizations Described in Sections 170(b)(1)(A)(iv) and 170(b)(1)(A)(vi)
(Complete only if you checked the box on line 5, 7, or 8 of Part I or if the organization failed to qualify under Part III. If the organization failed to qualify under the tests listed below, please complete Part III.)
Section A. Public Support
Calendar year (or fiscal year beginning in) right arrow (a) 2015 (b) 2016 (c) 2017 (d) 2018 (e) 2019 (f) Total
1 Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grant.") ..            
2 Tax revenues levied for the organization's benefit and either paid to or expended on its behalf....            
3 The value of services or facilities furnished by a governmental unit to the organization without charge..            
4 Total. Add lines 1 through 3            
5 The portion of total contributions by each person (other than a governmental unit or publicly supported organization) included on line 1 that exceeds 2% of the amount shown on line 11, column (f)..  
6 Public support. Subtract line 5 from line 4.  
Section B. Total Support
Calendar year (or fiscal year beginning in) right arrow (a) 2015 (b) 2016 (c) 2017 (d) 2018 (e) 2019 (f) Total
7 Amounts from line 4..            
8 Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources...            
9 Net income from unrelated business activities, whether or not the business is regularly carried on..            
10 Other income. Do not include gain or loss from the sale of capital assets (Explain in Part VI.)..            
11 Total support. Add lines 7 through 10  
12
12
 
13
First five years. If the Form 990 is for the organization's first, second, third, fourth, or fifth tax year as a section 501(c)(3) organization, check this box and stop here........................................right arrow
Section C. Computation of Public Support Percentage
14
14
 
15
15
 
16a
b
17a
b
18
Private foundation. If the organization did not check a box on line 13, 16a, 16b, 17a, or 17b, check this box and see
instructions ..................................................... right arrow
Schedule A (Form 990 or 990-EZ) 2019

Schedule A (Form 990 or 990-EZ) 2019
Page 3
Part III
Support Schedule for Organizations Described in Section 509(a)(2)
(Complete only if you checked the box on line 10 of Part I or if the organization failed to qualify under Part II. If the organization fails to qualify under the tests listed below, please complete Part II.)
Section A. Public Support
Calendar year (or fiscal year beginning in) right arrow (a) 2015 (b) 2016 (c) 2017 (d) 2018 (e) 2019 (f) Total
1 Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grants.") .            
2 Gross receipts from admissions, merchandise sold or services performed, or facilities furnished in any activity that is related to the organization's tax-exempt purpose            
3 Gross receipts from activities that are not an unrelated trade or business under section 513 .....            
4 Tax revenues levied for the organization's benefit and either paid to or expended on its behalf...            
5 The value of services or facilities furnished by a governmental unit to the organization without charge            
6 Total. Add lines 1 through 5            
7a Amounts included on lines 1, 2, and 3 received from disqualified persons            
b Amounts included on lines 2 and 3 received from other than disqualified persons that exceed the greater of $5,000 or 1% of the amount on line 13 for the year.            
c Add lines 7a and 7b..            
8 Public support. (Subtract line 7c from line 6.)  
Section B. Total Support
Calendar year (or fiscal year beginning in) right arrow (a) 2015 (b) 2016 (c) 2017 (d) 2018 (e) 2019 (f) Total
9 Amounts from line 6...            
10a Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources..            
b Unrelated business taxable income (less section 511 taxes) from businesses acquired after June 30, 1975.            
c Add lines 10a and 10b.            
11 Net income from unrelated business activities not included in line 10b, whether or not the business is regularly carried on.            
12 Other income. Do not include gain or loss from the sale of capital assets (Explain in Part VI.) ..            
13 Total support. (Add lines 9, 10c, 11, and 12.)..            
14
Section C. Computation of Public Support Percentage
15
15
 
16
16
 
Section D. Computation of Investment Income Percentage
17
17
 
18
18
 
19a
b
20
Schedule A (Form 990 or 990-EZ) 2019

Schedule A (Form 990 or 990-EZ) 2019
Page 4
Part IV
Supporting Organizations
(Complete only if you checked a box on line 12 of Part I. If you checked 12a of Part I, complete Sections A and B. If you checked 12b of Part I, complete Sections A and C. If you checked 12c of Part I, complete Sections A, D, and E. If you checked 12d of Part I, complete Sections A and D, and complete Part V.)
Section A. All Supporting Organizations
Yes
No
1
Are all of the organization’s supported organizations listed by name in the organization’s governing documents?
If "No," describe in Part VI how the supported organizations are designated. If designated by class or purpose,
describe the designation. If historic and continuing relationship, explain.
1
 
 
2
Did the organization have any supported organization that does not have an IRS determination of status under section 509(a)(1) or (2)? If "Yes," explain in Part VI how the organization determined that the supported organization was described in section 509(a)(1) or (2).
2
 
 
3a
Did the organization have a supported organization described in section 501(c)(4), (5), or (6)? If "Yes," answer (b) and (c) below.
3a
 
 
b
Did the organization confirm that each supported organization qualified under section 501(c)(4), (5), or (6) and satisfied the public support tests under section 509(a)(2)? If "Yes," describe in Part VI when and how the organization made the determination.
3b
 
 
c
Did the organization ensure that all support to such organizations was used exclusively for section 170(c)(2)(B) purposes? If "Yes," explain in Part VI what controls the organization put in place to ensure such use.
3c
 
 
4a
Was any supported organization not organized in the United States ("foreign supported organization")? If “Yes” and if you checked 12a or 12b in Part I, answer (b) and (c) below.
4a
 
 
b
Did the organization have ultimate control and discretion in deciding whether to make grants to the foreign supported organization? If “Yes,” describe in Part VI how the organization had such control and discretion despite being controlled or supervised by or in connection with its supported organizations.
4b
 
 
c
Did the organization support any foreign supported organization that does not have an IRS determination under sections 501(c)(3) and 509(a)(1) or (2)? If “Yes,” explain in Part VI what controls the organization used to ensure that all support to the foreign supported organization was used exclusively for section 170(c)(2)(B) purposes.
4c
 
 
5a
Did the organization add, substitute, or remove any supported organizations during the tax year? If “Yes,” answer (b) and (c) below (if applicable). Also, provide detail in Part VI, including (i) the names and EIN numbers of the supported organizations added, substituted, or removed; (ii) the reasons for each such action; (iii) the authority under the organization's organizing document authorizing such action; and (iv) how the action was accomplished (such as by amendment to the organizing document).
5a
 
 
b
Type I or Type II only. Was any added or substituted supported organization part of a class already designated in the organization's organizing document?
5b
 
 
c
Substitutions only. Was the substitution the result of an event beyond the organization's control?
5c
 
 
6
Did the organization provide support (whether in the form of grants or the provision of services or facilities) to anyone other than (i) its supported organizations, (ii) individuals that are part of the charitable class benefited by one or more of its supported organizations, or (iii) other supporting organizations that also support or benefit one or more of the filing organization’s supported organizations? If “Yes,” provide detail in Part VI.
6
 
 
7
Did the organization provide a grant, loan, compensation, or other similar payment to a substantial contributor (defined in section 4958(c)(3)(C)), a family member of a substantial contributor, or a 35% controlled entity with regard to a substantial contributor? If “Yes,” complete Part I of Schedule L (Form 990 or 990-EZ) .
7
 
 
8
Did the organization make a loan to a disqualified person (as defined in section 4958) not described in line 7? If “Yes,” complete Part I of Schedule L (Form 990 or 990-EZ).
8
 
 
9a
Was the organization controlled directly or indirectly at any time during the tax year by one or more disqualified persons as defined in section 4946 (other than foundation managers and organizations described in section 509(a)(1) or (2))? If “Yes,” provide detail in Part VI.
9a
 
 
b
Did one or more disqualified persons (as defined in line 9a) hold a controlling interest in any entity in which the supporting organization had an interest? If “Yes,” provide detail in Part VI.
9b
 
 
c
Did a disqualified person (as defined in line 9a) have an ownership interest in, or derive any personal benefit from, assets in which the supporting organization also had an interest? If “Yes,” provide detail in Part VI.
9c
 
 
10a
Was the organization subject to the excess business holdings rules of section 4943 because of section 4943(f) (regarding certain Type II supporting organizations, and all Type III non-functionally integrated supporting organizations)? If “Yes,” answer line 10b below.
10a
 
 
b
Did the organization have any excess business holdings in the tax year? (Use Schedule C, Form 4720, to determine whether the organization had excess business holdings).
10b
 
 
Schedule A (Form 990 or 990-EZ) 2019

Schedule A (Form 990 or 990-EZ) 2019
Page 5
Part IV
Supporting Organizations (continued)
Yes
No
11
Has the organization accepted a gift or contribution from any of the following persons?
a
A person who directly or indirectly controls, either alone or together with persons described in (b) and (c) below, the governing body of a supported organization?
11a
 
 
b
A family member of a person described in (a) above?
11b
 
 
c
A 35% controlled entity of a person described in (a) or (b) above? If “Yes” to a, b, or c, provide detail in Part VI.
11c
 
 
Section B. Type I Supporting Organizations
Yes
No
1
Did the directors, trustees, or membership of one or more supported organizations have the power to regularly appoint or elect at least a majority of the organization’s directors or trustees at all times during the tax year? If “No,” describe in Part VI how the supported organization(s) effectively operated, supervised, or controlled the organization’s activities. If the organization had more than one supported organization, describe how the powers to appoint and/or remove directors or trustees were allocated among the supported organizations and what conditions or restrictions, if any, applied to such powers during the tax year.
1
 
 
2
Did the organization operate for the benefit of any supported organization other than the supported organization(s) that operated, supervised, or controlled the supporting organization? If “Yes,” explain in Part VI how providing such benefit carried out the purposes of the supported organization(s) that operated, supervised or controlled the supporting organization.
2
 
 
Section C. Type II Supporting Organizations
Yes
No
1
Were a majority of the organization’s directors or trustees during the tax year also a majority of the directors or trustees of each of the organization’s supported organization(s)? If “No,” describe in Part VI how control or management of the supporting organization was vested in the same persons that controlled or managed the supported organization(s).
1
 
 
Section D. All Type III Supporting Organizations
Yes
No
1
Did the organization provide to each of its supported organizations, by the last day of the fifth month of the organization’s tax year, (i) a written notice describing the type and amount of support provided during the prior tax year, (ii) a copy of the Form 990 that was most recently filed as of the date of notification, and (iii) copies of the organization’s governing documents in effect on the date of notification, to the extent not previously provided?
1
 
 
2
Were any of the organization’s officers, directors, or trustees either (i) appointed or elected by the supported organization(s) or (ii) serving on the governing body of a supported organization? If "No," explain in Part VI how the organization maintained a close and continuous working relationship with the supported organization(s).
2
 
 
3
By reason of the relationship described in (2), did the organization’s supported organizations have a significant voice in the organization’s investment policies and in directing the use of the organization’s income or assets at all times during the tax year? If "Yes," describe in Part VI the role the organization’s supported organizations played in this regard.
3
 
 
Section E. Type III Functionally-Integrated Supporting Organizations
1
Check the box next to the method that the organization used to satisfy the Integral Part Test during the year (see instructions):
a
b
c
2
Activities Test. Answer (a) and (b) below.
Yes
No
a
Did substantially all of the organization’s activities during the tax year directly further the exempt purposes of the supported organization(s) to which the organization was responsive? If "Yes," then in Part VI identify those supported organizations and explain how these activities directly furthered their exempt purposes, how the organization was responsive to those supported organizations, and how the organization determined that these activities constituted substantially all of its activities.
2a
 
 
b
Did the activities described in (a) constitute activities that, but for the organization’s involvement, one or more of the organization’s supported organization(s) would have been engaged in? If "Yes," explain in Part VI the reasons for the organization’s position that its supported organization(s) would have engaged in these activities but for the organization’s involvement.
2b
 
 
3
Parent of Supported Organizations. Answer (a) and (b) below.
a
Did the organization have the power to regularly appoint or elect a majority of the officers, directors, or trustees of each of the supported organizations? Provide details in Part VI.
3a
 
 
b
Did the organization exercise a substantial degree of direction over the policies, programs and activities of each of its supported organizations? If "Yes," describe in Part VI. the role played by the organization in this regard.
3b
 
 
Schedule A (Form 990 or 990-EZ) 2019

Schedule A (Form 990 or 990-EZ) 2019
Page 6
Part V
Type III Non-Functionally Integrated 509(a)(3) Supporting Organizations
1
Section A - Adjusted Net Income (A) Prior Year (B) Current Year
(optional)
1 Net short-term capital gain 1    
2 Recoveries of prior-year distributions 2    
3 Other gross income (see instructions) 3    
4 Add lines 1 through 3 4    
5 Depreciation and depletion 5    
6 Portion of operating expenses paid or incurred for production or collection of gross income or for management, conservation, or maintenance of property held for production of income (see instructions) 6    
7 Other expenses (see instructions) 7    
8 Adjusted Net Income (subtract lines 5, 6 and 7 from line 4) 8    
Section B - Minimum Asset Amount (A) Prior Year (B) Current Year
(optional)
1 Aggregate fair market value of all non-exempt-use assets (see instructions for short tax year or assets held for part of year): 1
a Average monthly value of securities 1a    
b Average monthly cash balances 1b    
c Fair market value of other non-exempt-use assets 1c    
d Total (add lines 1a, 1b, and 1c) 1d    
e Discount claimed for blockage or other factors
(explain in detail in Part VI):  
2 Acquisition indebtedness applicable to non-exempt use assets 2    
3 Subtract line 2 from line 1d 3    
4 Cash deemed held for exempt use. Enter 1-1/2% of line 3 (for greater amount, see instructions). 4    
5 Net value of non-exempt-use assets (subtract line 4 from line 3) 5    
6 Multiply line 5 by .035 6    
7 Recoveries of prior-year distributions 7    
8 Minimum Asset Amount (add line 7 to line 6) 8    
Section C - Distributable Amount Current Year
1 Adjusted net income for prior year (from Section A, line 8, Column A) 1  
2 Enter 85% of line 1 2  
3 Minimum asset amount for prior year (from Section B, line 8, Column A) 3  
4 Enter greater of line 2 or line 3 4  
5 Income tax imposed in prior year 5  
6 Distributable Amount. Subtract line 5 from line 4, unless subject to emergency temporary reduction (see instructions) 6  
7
Schedule A (Form 990 or 990-EZ) 2019

Schedule A (Form 990 or 990-EZ) 2019
Page 7
Part V
Type III Non-Functionally Integrated 509(a)(3) Supporting Organizations(continued)
Section D - Distributions Current Year
1 Amounts paid to supported organizations to accomplish exempt purposes  
2 Amounts paid to perform activity that directly furthers exempt purposes of supported organizations, in
excess of income from activity		  
3 Administrative expenses paid to accomplish exempt purposes of supported organizations  
4 Amounts paid to acquire exempt-use assets  
5 Qualified set-aside amounts (prior IRS approval required)  
6 Other distributions (describe in Part VI). See instructions  
7Total annual distributions. Add lines 1 through 6.  
8 Distributions to attentive supported organizations to which the organization is responsive (provide
details in Part VI). See instructions		  
9 Distributable amount for 2019 from Section C, line 6  
10 Line 8 amount divided by Line 9 amount  
Section E - Distribution Allocations (see instructions) (i)
Excess Distributions 		(ii)
Underdistributions
Pre-2019 		(iii)
Distributable
Amount for 2019
1 Distributable amount for 2019 from Section C, line 6  
2 Underdistributions, if any, for years prior to 2019 (reasonable cause required-- explain in Part VI).
See instructions.		  
3 Excess distributions carryover, if any, to 2019:
a From 2014.......  
b From 2015.......  
c From 2016.......  
d From 2017.......  
e From 2018.......  
fTotal of lines 3a through e  
g Applied to underdistributions of prior years  
h Applied to 2019 distributable amount  
i Carryover from 2014 not applied (see
instructions) 		 
j Remainder. Subtract lines 3g, 3h, and 3i from 3f.  
4Distributions for 2019 from Section D, line 7:
$  
a Applied to underdistributions of prior years  
b Applied to 2019 distributable amount  
c Remainder. Subtract lines 4a and 4b from 4.  
5 Remaining underdistributions for years prior to
2019, if any. Subtract lines 3g and 4a from line 2.
If the amount is greater than zero, explain in Part VI.
See instructions.		  
6 Remaining underdistributions for 2019. Subtract
lines 3h and 4b from line 1. If the amount is greater
than zero, explain in Part VI. See instructions.		  
7 Excess distributions carryover to 2020. Add lines
3j and 4c.		  
8 Breakdown of line 7:
a Excess from 2015.....  
b Excess from 2016.....  
c Excess from 2017.....  
d Excess from 2018.....  
e Excess from 2019.....  
Schedule A (Form 990 or 990-EZ) (2019)

Schedule A (Form 990 or 990-EZ) 2019
Page 8
Part VI
Supplemental Information. Provide the explanations required by Part II, line 10; Part II, line 17a or 17b; Part III, line 12; Part IV, Section A, lines 1, 2, 3b, 3c, 4b, 4c, 5a, 6, 9a, 9b, 9c, 11a, 11b, and 11c; Part IV, Section B, lines 1 and 2; Part IV, Section C, line 1; Part IV, Section D, lines 2 and 3; Part IV, Section E, lines 1c, 2a, 2b, 3a and 3b; Part V, line 1; Part V, Section B, line 1e; Part V Section D, lines 5, 6, and 8; and Part V, Section E, lines 2, 5, and 6. Also complete this part for any additional information. (See instructions).
Facts And Circumstances Test
 
Return Reference Explanation
Schedule A (Form 990 or 990-EZ) 2019


Additional Data


Software ID:  
Software Version:  
SCHEDULE D
(Form 990)
Department of the Treasury
Internal Revenue Service
Supplemental Financial Statements
SchDMd Bullet Complete if the organization answered "Yes," on Form 990,
Part IV, line 6, 7, 8, 9, 10, 11a, 11b, 11c, 11d, 11e, 11f, 12a, or 12b.
SchDMd Bullet Attach to Form 990.
SchDMd Bullet Go to www.irs.gov/Form990 for instructions and the latest information.
OMB No. 1545-0047
2019
Open to Public Inspection
Name of the organization
WELLSTAR NORTH FULTON HOSPITAL
 
Employer identification number

81-0851756
Part I
Organizations Maintaining Donor Advised Funds or Other Similar Funds or Accounts. Complete if the organization answered "Yes" on Form 990, Part IV, line 6.
(a) Donor advised funds (b) Funds and other accounts
1 Total number at end of year .........    
2 Aggregate value of contributions to (during year)    
3 Aggregate value of grants from (during year)    
4 Aggregate value at end of year ........    
5
Did the organization inform all donors and donor advisors in writing that the assets held in donor advised funds are the organization’s property, subject to the organization’s exclusive legal control? ............
6
Did the organization inform all grantees, donors, and donor advisors in writing that grant funds can be used only for charitable purposes and not for the benefit of the donor or donor advisor, or for any other purpose conferring impermissible private benefit? ...................................
Part II
Conservation Easements.
Complete if the organization answered "Yes" on Form 990, Part IV, line 7.
1
Purpose(s) of conservation easements held by the organization (check all that apply).
2
Complete lines 2a through 2d if the organization held a qualified conservation contribution in the form of a conservation easement on the last day of the tax year.
Held at the End of the Year
a Total number of conservation easements ...................... 2a  
b Total acreage restricted by conservation easements .................... 2b  
c Number of conservation easements on a certified historic structure included in (a) ..... 2c  
d Number of conservation easements included in (c) acquired after 7/25/06, and not on a historic structure listed in the National Register ... 2d  
3
Number of conservation easements modified, transferred, released, extinguished, or terminated by the organization during the
tax year SchDMd Bullet  
4
Number of states where property subject to conservation easement is located SchDMd Bullet  
5
Does the organization have a written policy regarding the periodic monitoring, inspection, handling of violations, and enforcement of the conservation easements it holds? ............
6
Staff and volunteer hours devoted to monitoring, inspecting, handling of violations, and enforcing conservation easements during the year
SchDMd Bullet  
7
Amount of expenses incurred in monitoring, inspecting, handling of violations, and enforcing conservation easements during the year
SchDMd Bullet $  
8
Does each conservation easement reported on line 2(d) above satisfy the requirements of section 170(h)(4)(B)(i) and section 170(h)(4)(B)(ii)? .............................
9
In Part XIII, describe how the organization reports conservation easements in its revenue and expense statement, and
balance sheet, and include, if applicable, the text of the footnote to the organization’s financial statements that describes
the organization’s accounting for conservation easements.
Part III
Organizations Maintaining Collections of Art, Historical Treasures, or Other Similar Assets.
Complete if the organization answered "Yes" on Form 990, Part IV, line 8.
1a
If the organization elected, as permitted under FASB ASC 958, not to report in its revenue statement and balance sheet works of art, historical treasures, or other similar assets held for public exhibition, education, or research in furtherance of public service, provide, in Part XIII, the text of the footnote to its financial statements that describes these items.
b
If the organization elected, as permitted under FASB ASC 958, to report in its revenue statement and balance sheet works of art, historical treasures, or other similar assets held for public exhibition, education, or research in furtherance of public service, provide the following amounts relating to these items:
(i)
Revenue included on Form 990, Part VIII, line 1 .........................SchDMd Bullet $  
(ii)
Assets included in Form 990, Part X ...............................SchDMd Bullet $  
2
If the organization received or held works of art, historical treasures, or other similar assets for financial gain, provide the
following amounts required to be reported under FASB ASC 958 relating to these items:
a
Revenue included on Form 990, Part VIII, line 1 ..........................SchDMd Bullet $  
b
Assets included in Form 990, Part X ...............................SchDMd Bullet $  
For Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 52283D
Schedule D (Form 990) 2019

Schedule D (Form 990) 2019
Page 2
Part III
Organizations Maintaining Collections of Art, Historical Treasures, or Other Similar Assets (continued)
3
Using the organization’s acquisition, accession, and other records, check any of the following that are a significant use of its collection items (check all that apply):
a
d
b
e
 
c
4
Provide a description of the organization’s collections and explain how they further the organization’s exempt purpose in
Part XIII.
5
During the year, did the organization solicit or receive donations of art, historical treasures or other similar
assets to be sold to raise funds rather than to be maintained as part of the organization’s collection?...
Part IV
Escrow and Custodial Arrangements. Complete if the organization answered "Yes" on Form 990, Part IV, line 9, or reported an amount on Form 990, Part X, line 21.
1a
Is the organization an agent, trustee, custodian or other intermediary for contributions or other assets not
included on Form 990, Part X? ....................................
b If "Yes," explain the arrangement in Part XIII and complete the following table: Amount
c Beginning balance ............................. 1c  
d Additions during the year ............................ 1d  
e Distributions during the year .......................... 1e  
f Ending balance ................................ 1f  
2a
Did the organization include an amount on Form 990, Part X, line 21, for escrow or custodial account liability? ...
b
If "Yes," explain the arrangement in Part XIII. Check here if the explanation has been provided in Part XIII ....
Part V
Endowment Funds.
Complete if the organization answered "Yes" on Form 990, Part IV, line 10.
(a) Current year (b) Prior year (c) Two years back (d) Three years back (e) Four years back
1a Beginning of year balance ....          
b Contributions ...          
c Net investment earnings, gains, and losses          
d Grants or scholarships ...          
e Other expenditures for facilities
and programs ... 		         
f Administrative expenses ....          
g End of year balance ......          
2
Provide the estimated percentage of the current year end balance (line 1g, column (a)) held as:
a
Board designated or quasi-endowment SchDMd Bullet  
b
Permanent endowment SchDMd Bullet  
c
Term endowment SchDMd Bullet  
The percentages on lines 2a, 2b, and 2c should equal 100%.
3a
Are there endowment funds not in the possession of the organization that are held and administered for the
organization by:

Yes
No
(i) Unrelated organizations .................
3a(i)
 
 
(ii) Related organizations .................
3a(ii)
 
 
b
If "Yes" on 3a(ii), are the related organizations listed as required on Schedule R? .........
3b
 
 
4
Describe in Part XIII the intended uses of the organization's endowment funds.
Part VI
Land, Buildings, and Equipment.
Complete if the organization answered "Yes" on Form 990, Part IV, line 11a. See Form 990, Part X, line 10.
Description of property (a) Cost or other basis
(investment) 		(b) Cost or other basis (other) (c) Accumulated depreciation (d) Book value
1a Land .....   16,060,000 16,060,000
b Buildings ....   89,647,202 6,173,295 83,473,907
c Leasehold improvements   847,383 179,791 667,592
d Equipment ....   22,124,997 8,833,420 13,291,577
e Other .....   9,095,584 2,244,844 6,850,740
Total. Add lines 1a through 1e. (Column (d) must equal Form 990, Part X, column (B), line 10(c).)..SchDMdBullet 120,343,816
Schedule D (Form 990) 2019

Schedule D (Form 990) 2019
Page 3
Part VII
Investments—Other Securities.
Complete if the organization answered "Yes" on Form 990, Part IV, line 11b. See Form 990, Part X, line 12.
(a) Description of security or category
(including name of security)		 (b) Book value (c) Method of valuation:
Cost or end-of-year market value
(1) Financial derivatives.........    
(2) Closely-held equity interests........    
(3)Other
(B)
(C)
(D)
(E)
(F)
(G)
(H)
(I)
Total. (Column (b) must equal Form 990, Part X, col. (B) line 12.)Small Bullet  
Part VIII
Investments—Program Related. Complete if the organization answered 'Yes' on Form 990, Part IV, line 11c. See Form 990, Part X, line 13.
(a) Description of investment (b) Book value (c) Method of valuation:
Cost or end-of-year market value
(2)
(3)
(4)
(5)
(6)
(7)
(8)
(9)
(10)
Total. (Column (b) must equal Form 990, Part X, col.(B) line 13.)Small Bullet  
Part IX
Other Assets.
Complete if the organization answered 'Yes' on Form 990, Part IV, line 11d. See Form 990, Part X, line 15.
(a) Description (b) Book value
(1)OTHER ASSETS 214,985,493
(2)
(3)
(4)
(5)
(6)
(7)
(8)
(9)
(10)
Total. (Column (b) must equal Form 990, Part X, col.(B) line 15.)...........Small Bullet 214,985,493
Part X
Other Liabilities.
Complete if the organization answered 'Yes' on Form 990, Part IV, line 11e or 11f. See Form 990, Part X, line 25.
1.(a) Description of liability (b) Book value
(1) Federal income taxes 0
(3)
(4)
(5)
(6)
(7)
(8)
(9)
Total. (Column (b) must equal Form 990, Part X, col.(B) line 25.)Small Bullet 303,917,650
2. Liability for uncertain tax positions. In Part XIII, provide the text of the footnote to the organization's financial statements that reports the organization's liability for uncertain tax positions under FIN 48 (ASC 740). Check here if the text of the footnote has been provided in Part XIII
Schedule D (Form 990) 2019

Schedule D (Form 990) 2019
Page 4
Part XI Reconciliation of Revenue per Audited Financial Statements With Revenue per Return. Complete if the organization answered 'Yes' on Form 990, Part IV, line 12a.
1 Total revenue, gains, and other support per audited financial statements ....... 1  
2 Amounts included on line 1 but not on Form 990, Part VIII, line 12:
a Net unrealized gains (losses) on investments .... 2a  
b Donated services and use of facilities ......... 2b  
c Recoveries of prior year grants ........... 2c  
d Other (Describe in Part XIII.) ............ 2d  
e Add lines 2a through 2d ..................... 2e  
3 Subtract line 2e from line 1.................. 3  
4 Amounts included on Form 990, Part VIII, line 12, but not on line 1:
a Investment expenses not included on Form 990, Part VIII, line 7b . 4a  
b Other (Describe in Part XIII.) ........... 4b  
c Add lines 4a and 4b.................... 4c  
5 Total revenue. Add lines 3 and 4c. (This must equal Form 990, Part I, line 12.) ...... 5  
Part XII Reconciliation of Expenses per Audited Financial Statements With Expenses per Return. Complete if the organization answered 'Yes' on Form 990, Part IV, line 12a.
1 Total expenses and losses per audited financial statements ........... 1  
2 Amounts included on line 1 but not on Form 990, Part IX, line 25:
a Donated services and use of facilities ......... 2a  
b Prior year adjustments ............ 2b  
c Other losses ................ 2c  
d Other (Describe in Part XIII.) ............ 2d  
e Add lines 2a through 2d.................... 2e  
3 Subtract line 2e from line 1................... 3  
4 Amounts included on Form 990, Part IX, line 25, but not on line 1:
a Investment expenses not included on Form 990, Part VIII, line 7b .. 4a  
b Other (Describe in Part XIII.) ............ 4b  
c Add lines 4a and 4b..................... 4c  
5 Total expenses. Add lines 3 and 4c. (This must equal Form 990, Part I, line 18.) ...... 5  
Part XIII
Supplemental Information
Provide the descriptions required for Part II, lines 3, 5, and 9; Part III, lines 1a and 4; Part lV, lines 1b and 2b; Part V, line 4; Part X, line 2; Part XI, lines 2d and 4b; and Part XII, lines 2d and 4b. Also complete this part to provide any additional information.
Return Reference Explanation
SCHEDULE D, PART X, LINE 2 THE FOLLOWING FOOTNOTE IS RELATED TO THE ORGANIZATION'S APPLICATION OF FIN 48 (ASC 740): "WELLSTAR AND ITS AFFILIATES HAVE BEEN RECOGNIZED AS EXEMPT FROM FEDERAL INCOME TAX UNDER INTERNAL REVENUE CODE SECTION 501(A) AS ORGANIZATIONS DESCRIBED IN SECTION 501(C)(3), AND THEREFORE, RELATED INCOME IS GENERALLY NOT SUBJECT TO FEDERAL OR STATE INCOME TAXES, EXCEPT FOR CAC AND WGHP. 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."
Schedule D (Form 990) 2019


Additional Data


Software ID:  
Software Version:  




SCHEDULE H
(Form 990)
Department of the Treasury
Internal Revenue Service
Hospitals
MediumBullet Complete if the organization answered "Yes" on Form 990, Part IV, question 20.
MediumBullet Attach to Form 990.
MediumBullet Go to www.irs.gov/Form990EZ for instructions and the latest information.
OMB No. 1545-0047
2019
Open to Public Inspection
Name of the organization
WELLSTAR NORTH FULTON HOSPITAL
 
Employer identification number

81-0851756
Part I
Financial Assistance and Certain Other Community Benefits at Cost
Yes
No
1a
Did the organization have a financial assistance policy during the tax year? If "No," skip to question 6a . . . .
1a
Yes
 
b
If "Yes," was it a written policy? ......................
1b
Yes
 
2
If the organization had multiple hospital facilities, indicate which of the following best describes application of the financial assistance policy to its various hospital facilities during the tax year.
3
Answer the following based on the financial assistance eligibility criteria that applied to the largest number of the organization's patients during the tax year.
a
Did the organization use Federal Poverty Guidelines (FPG) as a factor in determining eligibility for providing free care?
If "Yes," indicate which of the following was the FPG family income limit for eligibility for free care:
3a
Yes
 
b
Did the organization use FPG as a factor in determining eligibility for providing discounted care? If "Yes," indicate
which of the following was the family income limit for eligibility for discounted care: . . . . . . . .
3b
Yes
 
%
c
If the organization used factors other than FPG in determining eligibility, describe in Part VI the criteria used for determining eligibility for free or discounted care. Include in the description whether the organization used an asset test or other threshold, regardless of income, as a factor in determining eligibility for free or discounted care.
4
Did the organization's financial assistance policy that applied to the largest number of its patients during the tax year provide for free or discounted care to the "medically indigent"? . . . . . . . . . . . . .

4

Yes

 
5a
Did the organization budget amounts for free or discounted care provided under its financial assistance policy during
the tax year? . . . . . . . . . . . . . . . . . . . . . . .

5a

Yes

 
b
If "Yes," did the organization's financial assistance expenses exceed the budgeted amount? . . . . . .
5b
Yes
 
c
If "Yes" to line 5b, as a result of budget considerations, was the organization unable to provide free or discountedcare to a patient who was eligibile for free or discounted care? . . . . . . . . . . . . .
5c
 
No
6a
Did the organization prepare a community benefit report during the tax year? . . . . . . . . .
6a
Yes
 
b
If "Yes," did the organization make it available to the public? . . . . . . . . . . . . .
6b
Yes
 
Complete the following table using the worksheets provided in the Schedule H instructions. Do not submit these worksheets with the Schedule H.
7
Financial Assistance and Certain Other Community Benefits at Cost
Financial Assistance and
Means-Tested
Government Programs
 (a) Number of activities or programs (optional) (b) Persons served (optional) (c) Total community benefit expense (d) Direct offsetting revenue (e) Net community benefit expense (f) Percent of total expense
a Financial Assistance at cost
(from Worksheet 1) . . . 		    13,248,976 0 13,248,976 9.000 %
b Medicaid (from Worksheet 3, column a) . . . . .     12,083,532 8,212,299 3,871,233 2.630 %
c Costs of other means-tested government programs (from Worksheet 3, column b) . .            
d Total Financial Assistance and Means-Tested Government Programs . . . . .     25,332,508 8,212,299 17,120,209 11.630 %
Other Benefits
e Community health improvement services and community benefit operations (from Worksheet 4).     392,321 0 392,321 0.270 %
f Health professions education (from Worksheet 5) . . .            
g Subsidized health services (from Worksheet 6) . . . .            
h Research (from Worksheet 7) .            
i Cash and in-kind contributions for community benefit (from Worksheet 8) . . . .            
j Total. Other Benefits . .     392,321 0 392,321 0.270 %
k Total. Add lines 7d and 7j .     25,724,829 8,212,299 17,512,530 11.900 %
For Paperwork Reduction Act Notice, see the Instructions for Form 990. Cat. No. 50192T Schedule H (Form 990) 2019
Schedule H (Form 990) 2019
Page
Part II
Community Building Activities Complete this table if the organization conducted any community building activities during the tax year, and describe in Part VI how its community building activities promoted the health of the communities it serves.
(a) Number of activities or programs (optional) (b) Persons served (optional) (c) Total community building expense (d) Direct offsetting
revenue 		(e) Net community building expense (f) Percent of total expense
1 Physical improvements and housing            
2 Economic development            
3 Community support            
4 Environmental improvements            
5 Leadership development and
training for community members		            
6 Coalition building            
7 Community health improvement advocacy            
8 Workforce development            
9 Other            
10 Total            
Part III
Bad Debt, Medicare, & Collection Practices
Section A. Bad Debt Expense
Yes
No
1
Did the organization report bad debt expense in accordance with Healthcare Financial Management Association Statement No. 15? ..........................
1
Yes
 
2
Enter the amount of the organization's bad debt expense. Explain in Part VI the methodology used by the organization to estimate this amount. ......
2
5,670,557
3
Enter the estimated amount of the organization's bad debt expense attributable to patients eligible under the organization's financial assistance policy. Explain in Part VI the methodology used by the organization to estimate this amount and the rationale, if any, for including this portion of bad debt as community benefit. ......
3
 
4
Provide in Part VI the text of the footnote to the organization’s financial statements that describes bad debt expense or the page number on which this footnote is contained in the attached financial statements.
Section B. Medicare
5
Enter total revenue received from Medicare (including DSH and IME).....
5
51,876,579
6
Enter Medicare allowable costs of care relating to payments on line 5.....
6
63,613,851
7
Subtract line 6 from line 5. This is the surplus (or shortfall)........
7
-11,737,272
8
Describe in Part VI the extent to which any shortfall reported in line 7 should be treated as community benefit.Also describe in Part VI the costing methodology or source used to determine the amount reported on line 6.Check the box that describes the method used:
Section C. Collection Practices
9a
Did the organization have a written debt collection policy during the tax year? ..........
9a
Yes
 
b
If "Yes," did the organization’s collection policy that applied to the largest number of its patients during the tax year
contain provisions on the collection practices to be followed for patients who are known to qualify for financial assistance? Describe in Part VI .........................

9b

Yes

 
Part IV
Management Companies and Joint Ventures(owned 10% or more by officers, directors, trustees, key employees, and physicians—see instructions)
(a) Name of entity (b) Description of primary
activity of entity 		(c) Organization's
profit % or stock
ownership % 		(d) Officers, directors,
trustees, or key
employees' profit %
or stock ownership % 		(e) Physicians'
profit % or stock
ownership %
1
2
3
4
5
6
7
8
9
10
11
12
13
Schedule H (Form 990) 2019
Schedule H (Form 990) 2019
Page
Part VFacility Information
Section A. Hospital Facilities
(list in order of size from largest to smallest—see instructions)How many hospital facilities did the organization operate during the tax year?1Name, address, primary website address, and state license number (and if a group return, the name and EIN of the subordinate hospital organization that operates the hospital facility) 		Licensed Hospital General-Medical-Surgical Children's Hospital Teaching Hospital Critical Hospital ResearchGrp Facility ER-24Hours ER-Other Other (describe) Facility reporting group
1 WELLSTAR NORTH FULTON HOSPITAL
3000 HOSPITAL BOULEVARD
ROSWELL,GA300764915
WWW.WELLSTAR.ORG
060-711 		X X     X   X      
Schedule H (Form 990) 2019
Schedule H (Form 990) 2019
Page 4
Part VFacility Information (continued)

Section B. Facility Policies and Practices

(Complete a separate Section B for each of the hospital facilities or facility reporting groups listed in Part V, Section A)
WELLSTAR NORTH FULTON HOSPITAL
Name of hospital facility or letter of facility reporting group  
Line number of hospital facility, or line numbers of hospital facilities in a facility
reporting group (from Part V, Section A): 		1
Yes No
Community Health Needs Assessment
1 Was the hospital facility first licensed, registered, or similarly recognized by a state as a hospital facility in the current tax year or the immediately preceding tax year?........................ 1   No
2 Was the hospital facility acquired or placed into service as a tax-exempt hospital in the current tax year or the immediately preceding tax year? If “Yes,” provide details of the acquisition in Section C............... 2   No
3 During the tax year or either of the two immediately preceding tax years, did the hospital facility conduct a community health needs assessment (CHNA)? If "No," skip to line 12...................... 3 Yes  
If "Yes," indicate what the CHNA report describes (check all that apply):
a
b
c
d
e
f
g
h
i
j
4 Indicate the tax year the hospital facility last conducted a CHNA: 20 17
5 In conducting its most recent CHNA, did the hospital facility take into account input from persons who represent the broad interests of the community served by the hospital facility, including those with special knowledge of or expertise in public health? If "Yes," describe in Section C how the hospital facility took into account input from persons who represent the community, and identify the persons the hospital facility consulted ................. 5 Yes  
6 a Was the hospital facility’s CHNA conducted with one or more other hospital facilities? If "Yes," list the other hospital facilities in Section C.................................. 6a   No
b Was the hospital facility’s CHNA conducted with one or more organizations other than hospital facilities?” If “Yes,” list the other organizations in Section C. ............................ 6b   No
7 Did the hospital facility make its CHNA report widely available to the public?.............. 7 Yes  
If "Yes," indicate how the CHNA report was made widely available (check all that apply):
a
b
c
d
8 Did the hospital facility adopt an implementation strategy to meet the significant community health needs
identified through its most recently conducted CHNA? If "No," skip to line 11. .............. 		8 Yes  
9 Indicate the tax year the hospital facility last adopted an implementation strategy: 20 17
10 Is the hospital facility's most recently adopted implementation strategy posted on a website?......... 10 Yes  
a If "Yes" (list url): SEE PART V, SECTION C
b If "No," is the hospital facility’s most recently adopted implementation strategy attached to this return? ...... 10b    
11 Describe in Section C how the hospital facility is addressing the significant needs identified in its most recently conducted CHNA and any such needs that are not being addressed together with the reasons why such needs are not being addressed.
12a Did the organization incur an excise tax under section 4959 for the hospital facility's failure to conduct a CHNA as required by section 501(r)(3)?............................... 12a   No
b If "Yes" on line 12a, did the organization file Form 4720 to report the section 4959 excise tax?........ 12b    
c If "Yes" on line 12b, what is the total amount of section 4959 excise tax the organization reported on Form 4720 for all of its hospital facilities? $  

Schedule H (Form 990) 2019
Schedule H (Form 990) 2019
Page 5
Part VFacility Information (continued)

Financial Assistance Policy (FAP)
WELLSTAR NORTH FULTON HOSPITAL
Name of hospital facility or letter of facility reporting group  
Yes No
Did the hospital facility have in place during the tax year a written financial assistance policy that:
13 Explained eligibility criteria for financial assistance, and whether such assistance included free or discounted care? 13 Yes  
If “Yes,” indicate the eligibility criteria explained in the FAP:
a
b
c
d
e
f
g
h
14 Explained the basis for calculating amounts charged to patients?................. 14 Yes  
15 Explained the method for applying for financial assistance?................... 15 Yes  
If “Yes,” indicate how the hospital facility’s FAP or FAP application form (including accompanying instructions) explained the method for applying for financial assistance (check all that apply):
a
b
c
d
e
16 Was widely publicized within the community served by the hospital facility?........ 16 Yes  
If "Yes," indicate how the hospital facility publicized the policy (check all that apply):
a
SEE PART V, SECTION C
b
SEE PART V, SECTION C
c
d
e
f
g
h
i
j
Schedule H (Form 990) 2019
Schedule H (Form 990) 2019
Page 6
Part VFacility Information (continued)

Billing and Collections
WELLSTAR NORTH FULTON HOSPITAL
Name of hospital facility or letter of facility reporting group  
Yes No
17 Did the hospital facility have in place during the tax year a separate billing and collections policy, or a written financial assistance policy (FAP) that explained all of the actions the hospital facility or other authorized party may take upon nonpayment?.................................. 17 Yes  
18 Check all of the following actions against an individual that were permitted under the hospital facility's policies during the tax year before making reasonable efforts to determine the individual’s eligibility under the facility’s FAP:
a
b
c
d
e
f
19 Did the hospital facility or other authorized party perform any of the following actions during the tax year before making reasonable efforts to determine the individual’s eligibility under the facility’s FAP?............ 19   No
If "Yes," check all actions in which the hospital facility or a third party engaged:
a
b
c
d
e
20 Indicate which efforts the hospital facility or other authorized party made before initiating any of the actions listed (whether or not checked) in line 19. (check all that apply):
a
b
c
d
e
f
Policy Relating to Emergency Medical Care
21 Did the hospital facility have in place during the tax year a written policy relating to emergency medical care that required the hospital facility to provide, without discrimination, care for emergency medical conditions to individuals regardless of their eligibility under the hospital facility’s financial assistance policy?.................. 21 Yes  
If "No," indicate why:
a
b
c
d
Schedule H (Form 990) 2019
Schedule H (Form 990) 2019
Page 7
Part VFacility Information (continued)

Charges to Individuals Eligible for Assistance Under the FAP (FAP-Eligible Individuals)
WELLSTAR NORTH FULTON HOSPITAL
Name of hospital facility or letter of facility reporting group  
Yes No
22 Indicate how the hospital facility determined, during the tax year, the maximum amounts that can be charged to FAP-eligible individuals for emergency or other medically necessary care.
a
b
c
d
23 During the tax year, did the hospital facility charge any FAP-eligible individual to whom the hospital facility provided emergency or other medically necessary services more than the amounts generally billed to individuals who had insurance covering such care? ............................... 23   No
If "Yes," explain in Section C.
24 During the tax year, did the hospital facility charge any FAP-eligible individual an amount equal to the gross charge for any service provided to that individual? ........................... 24   No
If "Yes," explain in Section C.
Schedule H (Form 990) 2019
Schedule H (Form 990) 2019
Page 8
Part V
Facility Information (continued)
Section C. Supplemental Information for Part V, Section B. Provide descriptions required for Part V, Section B, lines 2, 3j, 5, 6a, 6b, 7d, 11, 13b, 13h, 15e, 16j, 18e, 19e, 20a, 20b, 20c, 20d, 20e, 21c, 21d, 23, and 24. If applicable, provide separate descriptions for each hospital facility in a facility reporting group, designated by facility reporting group letter and hospital facility line number from Part V, Section A (“A, 1,” “A, 4,” “B, 2,” “B, 3,” etc.) and name of hospital facility.
Form and Line Reference Explanation
SCHEDULE H, PART V, SECTION B, LINE 3J OTHER DESCRIPTIONS FROM THE COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA): WELLSTAR NORTH FULTON HOSPITAL IS A 202-BED FACILITY LOCATED IN ROSWELL, GEORGIA. NORTH FULTON IS RECOGNIZED FOR ITS ACCREDITED CANCER PROGRAM AND PRIMARY STROKE CENTER DESIGNATIONS, AND FOR BEING ONE OF ONLY THREE STATE-DESIGNATED LEVEL II TRAUMA CENTERS IN METRO ATLANTA. NORTH FULTON HOSPITAL IS KNOWN FOR PROVIDING A CONTINUUM OF SERVICES THROUGH ITS CENTERS AND PROGRAMS, INCLUDING NEUROSCIENCES, PAIN MANAGEMENT, CARDIOLOGY, WOMENS SERVICES, REHABILITATION, SURGICAL SERVICES AND ONCOLOGY. WITH THIS COMBINATION OF COMMITMENT AND EXPERTISE, NORTH FULTON CATERS SERVICES TO THE UNIQUE HEALTHCARE NEEDS OF ALL PATIENTS IN THE NORTH FULTON AREA. NORTH FULTON IS A PROUD MEMBER OF WELLSTAR HEALTH SYSTEM. WELLSTAR, THE LARGEST HEALTH SYSTEM IN GEORGIA, IS KNOWN NATIONALLY FOR ITS INNOVATIVE CARE MODELS, AND IS FOCUSED ON IMPROVED QUALITY AND ACCESS TO HEALTHCARE. WELLSTAR IS DEDICATED TO REINVESTING BACK INTO THE COMMUNITY WITH INNOVATIVE TREATMENTS, STATE-OF-THE-ART TECHNOLOGY AND FACILITIES. ITS VISION IS TO DELIVER WORLD-CLASS HEALTHCARE. THE 2010 AFFORDABLE CARE ACT (ACA) REQUIRES ALL NOT-FOR-PROFIT HOSPITALS TO COMPLETE A COMMUNITY HEALTH NEED ASSESSMENT (CHNA) AND IMPLEMENTATION STRATEGY EVERY THREE YEARS TO BETTER MEET THE HEALTH NEEDS OF UNDER-RESOURCED POPULATIONS LIVING IN THE COMMUNITIES THEY SERVE. WHAT FOLLOWS IS A COMPREHENSIVE CHNA THAT MEETS INDUSTRY STANDARDS INCLUDING IRS FINAL REGULATIONS OF SECTION 501(R) ENTITLED "ADDITIONAL REQUIREMENTS FOR CHARITABLE HOSPITALS."
SCHEDULE H, PART V, SECTION B, LINE 5 INPUT FROM COMMUNITY REPRESENTATIVES & COMMUNITY SOURCES: THE SECONDARY DATA INCLUDED IN THIS ASSESSMENT ARE FROM A VARIETY OF SOURCES THAT ARE BOTH RELIABLE AND REPRESENTATIVE OF THE COMMUNITY SERVED BY WELLSTAR NORTH FULTON HOSPITAL. DATA SOURCES INCLUDE, BUT ARE NOT LIMITED TO: - CENTERS FOR DISEASE CONTROL AND PREVENTION - COMMUNITY COMMONS - COMMUNITY NEEDS INDEX - COUNTY HEALTH RANKINGS AND ROADMAPS - GEORGIA DEPARTMENT OF PUBLIC HEALTH - GEORGIA PREVENTION PROJECT - U.S. CENSUS BUREAU MANY OF THE PUBLICLY AVAILABLE DATA SOURCES ARE ONLY AVAILABLE AT THE COUNTY LEVEL, NOT IN SMALLER SEGMENTS. HOWEVER, WHERE POSSIBLE, THE DATA WAS ANALYZED AT THE ZIP CODE OR CENSUS TRACT LEVEL TO GET A MORE COMPREHENSIVE UNDERSTANDING OF THE NEEDS IN THE COMMUNITY. TO BETTER UNDERSTAND THE EXPERIENCE AND NEEDS OF THE RESIDENTS LIVING IN THE AREAS SERVED BY THE HOSPITAL, SEVERAL TYPES OF QUALITATIVE DATA WERE USED INCLUDING FOCUS GROUPS WITH RESIDENTS, ONE-ON-ONE INTERVIEWS WITH KEY STAKEHOLDERS, A LISTENING SESSION WITH THE WELLSTAR NORTH FULTON REGIONAL HEALTH BOARD, AND A HEALTH SUMMIT WITH HOSPITAL AND COMMUNITY LEADERS.
SCHEDULE H, PART V, SECTION B, LINE 7A WELLSTAR NORTH FULTON HOSPITAL CONDUCTED A CHNA AND IMPLEMENTATION STRATEGY TO MEET 501(R) REQUIREMENTS BY FISCAL YEAR ENDING JUNE 30, 2018. WELLSTAR NORTH FULTONS COMMUNITY HEALTH NEEDS ASSESSMENT AND IMPLEMENTATION STRATEGY CAN BE FOUND ON THE FOLLOWING WEB ADDRESS: WWW.WELLSTAR.ORG/CHNA AND CLICKING ON THE 2018 COMMUNITY HEALTH NEEDS ASSESSMENT LINK UNDER THE NORTH FULTON HEADER. OR DIRECTLY: https://www.wellstar.org/about-us/documents/chna/ ws_18_nfulton_5_23_sgl.pdF
SCHEDULE H, PART V, SECTION B, LINE 10A WELLSTAR NORTH FULTON HOSPITAL CONDUCTED A CHNA AND IMPLEMENTATION STRATEGY TO MEET 501(R) REQUIREMENTS BY FISCAL YEAR ENDING JUNE 30, 2018. WELLSTAR NORTH FULTON HOSPITALS COMMUNITY HEALTH NEEDS ASSESSMENT AND IMPLEMENTATION STRATEGY CAN BE FOUND ON THE FOLLOWING WEB ADDRESS: WWW.WELLSTAR.ORG/CHNA AND CLICKING ON THE 2018 COMMUNITY HEALTH NEEDS ASSESSMENT LINK UNDER THE NORTH FULTON HEADER. OR DIRECTLY: https://www.wellstar.org/about-us/documents/chna/ ws_18_nfulton_5_23_sgl.pdf
SCHEDULE H, PART V, SECTION B, LINE 11 PROGRAMS & STRATEGIES TO ADDRESS THE NEEDS OF THE COMMUNITY: THE FOLLOWING IS A SUMMARY OF THE WELLSTAR NORTH FULTON HOSPITAL HEALTH SUMMIT HELD FEBRUARY 26, 2018 ON THE HOSPITAL CAMPUS. THE HEALTH SUMMIT WAS FACILITATED BY THE GEORGIA HEALTH POLICY CENTER (GHPC) IN PARTNERSHIP WITH WELLSTAR AND LASTED APPROXIMATELY THREE HOURS. THE 19 PARTICIPANTS INCLUDED WELLSTAR TEAM MEMBERS AND COMMUNITY STAKEHOLDERS. COMMUNITY STAKEHOLDERS REPRESENTED ORGANIZATIONS SERVING RESIDENTS IN THE PRIMARY SERVICE AREA OF WELLSTAR NORTH FULTON HOSPITAL. THE ORGANIZATIONS THAT PARTICIPATED IN THE HEALTH SUMMIT INCLUDED: - STAR HOUSE FOUNDATION INC. - SENIOR SERVICES NORTH FULTON - REVVED UP KIDS INC. - RESURGENS ORTHOPAEDICS - WELLSTAR NORTH FULTON HOSPITAL - SUMMIT COUNSELING - NORTH FULTON COMMUNITY CHARITIES - PROVIDENCE WOMENS HEALTHCARE - CARAVITA HOMECARE GHPC PRESENTED FINDINGS OF THE CHNA GENERATED FROM SECONDARY DATA ANALYSIS, KEY INFORMANT INTERVIEWS, FOCUS GROUPS, AND LISTENING SESSIONS. HEALTH SUMMIT PARTICIPANTS WERE ASKED TO DISCUSS COMMUNITY HEALTH NEEDS AND WERE ENCOURAGED TO ADD ANY NEEDS THAT MAY HAVE BEEN ABSENT FROM THE ASSESSMENTS DATA COLLECTION THUS FAR. PARTICIPANTS WERE THEN ASKED TO IDENTIFY THE TOP FIVE HEALTH NEEDS THAT THEY BELIEVED, WHEN COLLABORATIVELY ADDRESSED, WILL MAKE THE GREATEST DIFFERENCE IN CARE ACCESS, CARE QUALITY, AND COSTS TO IMPROVE THE COMMUNITY HEALTH, ESPECIALLY IN VULNERABLE POPULATIONS. THE NEEDS IDENTIFIED BY INDIVIDUAL GROUPS WERE CONSOLIDATED INTO MUTUALLY EXCLUSIVE HEALTH PRIORITIES AND VOTED UPON TO SURFACE COMMUNITY HEALTH PRIORITIES. GROUP RECOMMENDATIONS AND PROBLEM IDENTIFICATION: PARTICIPANTS PRIORITIZED FOUR COMMUNITY HEALTH NEEDS OF RESIDENTS WITHIN WELLSTAR NORTH FULTON HOSPITALS PRIMARY SERVICE AREA: BEHAVIORAL HEALTH, PARENTAL EDUCATION AND SUPPORT, ACCESS TO CARE, AND OVERUSE AND ABUSE OF OPIOIDS. THE FOLLOWING IS A SUMMARY OF THE INPUT PARTICIPANTS OFFERED WHEN ASKED ABOUT CONTRIBUTING FACTORS, POTENTIAL SOLUTIONS AND COMMUNITY RESOURCES TO ADDRESS THE HEALTH PRIORITIES. THIS ASSESSMENT ENGAGED RESIDENTS AND LEADERS FROM THE COMMUNITY AND LEADERS OF HOSPITALS THAT PROVIDE SERVICES IN THE COMMUNITY SERVED BY WELLSTAR NORTH FULTON HOSPITAL. LISTENING SESSION: A LISTENING SESSION WAS CONDUCTED WITH THE WELLSTAR NORTH FULTON REGIONAL HEALTH BOARD AND KEY INFORMANT INTERVIEWS WERE CONDUCTED WITH 32 COMMUNITY LEADERS. HOSPITAL AND COMMUNITY LEADERS ENCOMPASSED A WIDE VARIETY OF PROFESSIONAL BACKGROUNDS INCLUDING (1) PUBLIC HEALTH EXPERTISE, (2) PROFESSIONALS WITH ACCESS TO COMMUNITY HEALTH-RELATED DATA AND (3) REPRESENTATIVES OF UNDER-RESOURCED POPULATIONS. THE LISTENING SESSION AND INTERVIEWS OFFERED COMMUNITY LEADERS AN OPPORTUNITY TO PROVIDE FEEDBACK ON THE NEEDS OF THE COMMUNITY, SECONDARY DATA RESOURCES AND OTHER INFORMATION RELEVANT TO CHNA. FOCUS GROUPS: FIVE FOCUS GROUPS WERE CONDUCTED TO GATHER INPUT FROM MORE THAN 60 RESIDENTS LIVING AND WORKING IN THE COMMUNITY SERVED BY WELLSTAR NORTH FULTON HOSPITAL. FOCUS GROUP PARTICIPANTS WERE ASKED TO DISCUSS THEIR OPINIONS RELATED TO THE HEALTH STATUS AND OUTCOMES; CONTEXT, FACILITATING AND BLOCKING FACTORS OF HEALTH; AND WHAT IS NEEDED TO BE HEALTHIER IN THEIR COMMUNITY. THE FOLLOWING PAGES ARE A SUMMARY OF THE COMMUNITY INPUT GATHERED FOR THE CHNA PROCESS. KEY INFORMANT SUMMARY (DECEMBER 2017JANUARY 2018) GEORGIA HEALTH POLICY CENTER (GHPC) CONDUCTED INTERVIEWS WITH COMMUNITY LEADERS. LEADERS ASKED TO PARTICIPATE IN THE INTERVIEW PROCESS ENCOMPASSED A WIDE VARIETY OF PROFESSIONAL BACKGROUNDS, INCLUDING (1) PUBLIC HEALTH EXPERTISE, (2) PROFESSIONALS WITH ACCESS TO COMMUNITY HEALTHRELATED DATA, AND (3) REPRESENTATIVES OF UNDER-RESOURCED POPULATIONS. THE INTERVIEWS OFFERED COMMUNITY LEADERS AN OPPORTUNITY TO PROVIDE FEEDBACK ON THE NEEDS OF THE COMMUNITY, SECONDARY DATA RESOURCES AND OTHER INFORMATION RELEVANT TO THE STUDY. METHODOLOGY: THE FOLLOWING QUALITATIVE DATA WAS GATHERED DURING INDIVIDUAL INTERVIEWS WITH 32 STAKEHOLDERS IN COMMUNITIES SERVED BY THE WELLSTAR NORTH FULTON HOSPITAL. EACH INTERVIEW WAS CONDUCTED BY GHPC STAFF AND LASTED APPROXIMATELY 45 MINUTES. ALL RESPONDENTS WERE ASKED THE SAME SET OF QUESTIONS DEVELOPED BY GHPC. THE PURPOSE OF THESE INTERVIEWS WAS FOR STAKEHOLDERS TO IDENTIFY HEALTH ISSUES AND CONCERNS AFFECTING RESIDENTS IN THE COMMUNITY SERVED BY WELLSTAR NORTH FULTON HOSPITAL, AS WELL AS WAYS TO ADDRESS THOSE CONCERNS. THERE WAS A DIVERSE REPRESENTATION OF COMMUNITY-BASED ORGANIZATIONS AND AGENCIES AMONG THE 32 STAKEHOLDERS INTERVIEWED. THE ORGANIZATIONS REPRESENTED INCLUDED: - BELTLINE - BETHESDA COMMUNITY CLINIC - CENTER FOR PAN COMMUNITY SERVICES COBB AND DOUGLAS PUBLIC HEALTH - CHEROKEE CHRISTIAN MINISTERIAL ASSOCIATION - CHEROKEE COUNTY BOARD OF EDUCATION - CHEROKEE COUNTY CHAMBER OF COMMERCE - CHEROKEE COUNTY DIVISION OF FAMILY AND CHILDREN SERVICES - CHEROKEE COUNTY SENIOR SERVICES - CHEROKEE FOCUS - CHILDRENS HOSPITAL OF ATLANTA - CITY OF CANTON - COBB AND DOUGLAS PUBLIC HEALTH - COMMUNITY FOUNDATION OF GREATER ATLANTA - EAST COBB BUSINESS ASSOCIATION - FULTON COUNTY BOARD OF COMMISSIONERS - G. CECIL PRUETT COMMUNITY CENTER FAMILY - GEORGIA DEPARTMENT OF PUBLIC HEALTH - GEORGIA HOUSE OF REPRESENTATIVES - HOMELESS INITIATIVE - MERCY CARE - NATIONAL ALLIANCE ON MENTAL ILLNESS - NORTH STAR CHURCH - SMYRNA CITY GOVERNMENT - UNITED WAY - WELLSTAR NORTH FULTON REGIONAL HEALTH BOARD* - WEST END CLINIC - YMCA - YOUNG WOMENS CHRISTIAN ASSOCIATION PURPOSE: THIS ASSESSMENT ENGAGED COMMUNITY RESIDENTS TO DEVELOP A DEEPER UNDERSTANDING OF THE HEALTH NEEDS OF THE COMMUNITY WELLSTAR NORTH FULTON HOSPITAL SERVES, AS WELL AS THE EXISTING OPINIONS AND PERSPECTIVES RELATED TO HEALTH STATUS. METHODOLOGY: GHPC RECRUITED AND CONDUCTED FOUR FOCUS GROUPS AMONG RESIDENTS LIVING IN THE COMMUNITY SERVED BY WELLSTAR NORTH FULTON HOSPITAL. GHPC DESIGNED FACILITATION GUIDES FOR FOCUS GROUP DISCUSSIONS. RESIDENTS WERE RECRUITED USING A THIRD-PARTY RECRUITING FIRM. RECRUITMENT STRATEGIES FOCUSED ON RESIDENTS THAT HAD CHARACTERISTICS REPRESENTATIVE OF THE BROADER SERVICE AREA, SPECIFICALLY, AREAS THAT EXPERIENCE DISPARITIES AND LOW SOCIOECONOMIC STATUS. FOCUS GROUPS LASTED APPROXIMATELY 1.5 HOURS, DURING WHICH TIME TRAINED FACILITATORS LED SIX TO 12 PARTICIPANTS THROUGH A DISCUSSION ABOUT THE HEALTH OF THEIR COMMUNITY, HEALTH NEEDS, RESOURCES AVAILABLE TO MEET HEALTH NEEDS, AND RECOMMENDATIONS TO ADDRESS COMMUNITY HEALTH NEEDS. ALL PARTICIPANTS WERE OFFERED APPROPRIATE COMPENSATION ($50) FOR THEIR TIME AND A LIGHT MEAL. THE FOLLOWING FOCUS GROUPS WERE CONDUCTED BY GHPC BETWEEN JANUARY 2016 AND JANUARY 2018: - WELLSTAR NORTH FULTON HOSPITAL SERVICE AREA RESIDENTS DULUTH, GA. (JAN. 10, 2018) - CHEROKEE COUNTY RESIDENTS CANTON, GA. (JAN. 8, 2016) - SPANISH-SPEAKING RESIDENTS MARIETTA, GA. (OCT. 9, 2015) - POWDER SPRINGS, GA. (NOV. 2, 2015) - COBB COUNTY RESIDENTS MABLETON, GA. (NOV. 17, 2015) FOCUS GROUPS WERE RECORDED AND TRANSCRIBED WITH THE INFORMED CONSENT OF ALL PARTICIPANTS. GHPC ANALYZED AND SUMMARIZED DATA FROM THE FOCUS GROUPS TO DETERMINE SIMILARITIES AND DIFFERENCES ACROSS POPULATIONS RELATED TO THE COLLECTIVE EXPERIENCE OF HEALTHCARE, HEALTH NEEDS, AND RECOMMENDATIONS, WHICH ARE SUMMARIZED IN THIS SECTION.) AFTER AN ANALYSIS OF PRIMARY AND SECONDARY DATA GATHERED FOR THE 2018 WELLSTAR NORTH FULTON HOSPITALS COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA), PRIORITY HEALTH NEEDS WERE IDENTIFIED AT A COMMUNITY HEALTH SUMMIT. THIS SUMMIT WAS COMPRISED OF A BROAD SPECTRUM OF HOSPITAL LEADERS AND COMMUNITY STAKEHOLDERS. USING CURRENT ASSETS / CAPACITY MEASURES AS KEY INDICATORS TO IMPROVE COMMUNITY HEALTH, THE SUMMIT PARTICIPANTS ANSWERED THIS OVERRIDING QUESTION REFLECTING THE PATIENT-CENTERED TRIPLE AIM FRAMEWORK: WHICH HEALTH NEEDS, WHEN COLLABORATIVELY ADDRESSED, WILL MAKE THE GREATEST DIFFERENCE IN CARE ACCESS, CARE QUALITY AND COSTS TO IMPROVE THE HEALTH OF THE COMMUNITY, ESPECIALLY THE UNDER-RESOURCED? TO DELIVER MORE COMPREHENSIVE, COLLABORATIVE AND VALUE-BASED COMMUNITY BENEFIT INITIATIVES, SERVICES, EDUCATION, AND EVENTS, A TASK FORCE, THE WELLSTAR COMMUNITY HEALTH COLLABORATIVE (WCHC), WAS CREATED IN THE FALL OF 2016 AT THE SYSTEM LEVEL TO ADDRESS LEGACY WELLSTARS PRIORITY HEALTH NEEDS. THE WCHC IS NOW EXPANDING BEYOND LEGACY WELLSTAR TO ENCOMPASS ALL WELLSTAR HOSPITAL COMMUNITIES/ STRATEGIC MARKETS AFTER THE APRIL 2016 ACQUISITION OF SIX HOSPITALS IN GEORGIA, FIVE OF WHOM WERE CONVERTED TO NOT-FOR-PROFIT IN 2017, INCLUDING WELLSTAR NORTH FULTON HOSPITAL. WITH THE INVOLVEMENT OF COMMUNITY PARTNERS AND STAKEHOLDERS, THE TASK FORCE ENABLES WELLSTAR TO BETTER IMPLEMENT COMMUNITY BENEFIT INITIATIVES AND MEASURE OUTCOMES OF COLLABORATIVE EFFORTS TO IMPROVE COMMUNITY HEALTH. LEADERS OF GEORGIA STATE UNIVERSITYS GEORGIA HEALTH POLICY CENTER HELPED GUIDE THE WELLSTAR NORTH FULTON HOSPITAL THROUGH THE PRIORITIZATION PROCESS AT THE HEALTH SUMMIT. FROM THE SIGNIFICANT HEALTH NEEDS IDENTIFIED BY CHNA RESEARCH CONDUCTED, THE FOLLOWING HEALTH
SCHEDULE H, PART V, SECTION B, LINE 13B FAP ELIGIBILITY CRITERIA - INCOME LEVEL OTHER THAN FPG: WELLSTAR NORTH FULTON HOSPITAL ABIDES BY THE FINANCIAL ASSISTANCE REQUIREMENTS UNDER IRC 501(R)(5). IRC 501(R)(5) REQUIRES HEALTH CARE FACILITIES TO LIMIT THE AMOUNTS CHARGED FOR EMERGENCY AND OTHER MEDICALLY NECESSARY CARE THAT IS PROVIDED TO INDIVIDUALS ELIGIBLE FOR ASSISTANCE UNDER THE HEALTH CARE FACILITIES FINANCIAL ASSISTANCE POLICY TO NOT MORE THAN THE AMOUNTS GENERALLY BILLED TO INDIVIDUALS WHO HAVE INSURANCE. THE HOSPITAL EXTENDS ITS SLIDING SCALE FOR FINANCIAL ASSISTANCE POLICY (FAP) ELIGIBILITY WELL BEYOND THE MINIMUM GOVERNMENT LEVELS TO 300% OF FPG. WELLSTAR HAS CHOSEN TO USE THE AVERAGE OF THE THREE BEST NEGOTIATED COMMERCIAL RATES AS THE TRIGGER TO NOT EXCEED IN THE APPLICATION OF THE DISCOUNTS/AMOUNTS CHARGED TO PATIENTS, ON OUR SLIDING SCALE.
SCHEDULE H, PART V, SECTION B, LINE 13H FAP ELIGIBILITY CRITERIA - OTHER CRITERIA: OTHER SPECIAL CIRCUMSTANCES MAY QUALIFY A PATIENT FOR FULL INDIGENT OR SLIDING SCALE CHARITY BENEFITS. SPECIAL CIRCUMSTANCES MAY INCLUDE BUT NOT LIMITED TO: - PATIENT DECEASED, WITH VERIFICATION THAT THERE IS NO ESTATE. - UNABLE TO CONTACT PATIENT BUT PROPENSITY TO PAY SOFTWARE RETURNS A LOW ABILITY/LOW PROPENSITY DESIGNATION.
SCHEDULE H, PART V, SECTION B, LINE 15E METHOD FOR APPLYING FOR FINANCIAL ASSISTANCE: IN ORDER TO QUALIFY FOR FINANCIAL ASSISTANCE, COOPERATION WITH WELLSTAR HEALTH SYSTEM HOSPITAL FINANCIAL ASSISTANCE STAFF IS NECESSARY IN IDENTIFYING AND DETERMINING ALTERNATIVE SOURCES OF PAYMENT OR COVERAGE FROM PUBLIC AND PRIVATE PAYMENT PROGRAMS. IN PARTICULAR, ALL APPLICANTS FILING A FAP APPLICATION FOR FINANCIAL ASSISTANCE MUST PROVIDE PROOF OF HOUSEHOLD INCOME AND HOUSEHOLD ASSETS BY PROVIDING ANY OR ALL OF THE FOLLOWING THAT ARE APPLICABLE: - PROVIDE THREE (3) MONTHS OF THE MOST RECENT PAYCHECK STUBS OR A STATEMENT FROM EMPLOYER VERIFYING GROSS WAGES - IRS W-2 ISSUED DURING THE PAST YEAR - MOST RECENT IRS FORM 1040 - MOST RECENT TWO (2) MONTHS OF BANK STATEMENTS FOR EACH CHECKING, SAVINGS, MONEY MARKET OR OTHER BANK OR INVESTMENT ACCOUNT - WRITTEN STATEMENTS FOR THE MOST RECENT TWO (2) MONTHS FOR ALL OTHER INCOME (E.G., UNEMPLOYMENT COMPENSATION, DISABILITY, RETIREMENT, STUDENT LOANS, AWARD LETTER FROM SOCIAL SECURITY OFFICE, CURRENT PROFIT AND LOSS REPORT FOR ALL SELF-EMPLOYED APPLICANTS, ALIMONY DOCUMENTATION, CHILD SUPPORT DOCUMENTATION, ETC.) - UNEMPLOYMENT COMPENSATION DENIAL LETTER - DOCUMENTATION OF ASSET VALUES, INCLUDING, WITHOUT LIMITATION, PROPERTY TAX STATEMENTS, CERTIFICATES OF DEPOSIT, 401K, 403B, IRA AND OTHER INVESTMENT STATEMENTS - CONTRIBUTION STATEMENTS FROM INDIVIDUALS WHO CONTRIBUTE INCOME OR IN-KIND ASSISTANCE TO THE PATIENT. FINANCIAL ASSISTANCE POLICY ELIGIBILITY WILL BE DETERMINED BASED ON A THOROUGH REVIEW OF THE SUBMITTED INFORMATION.
SCHEDULE H, PART V, SECTION B, LINE 16A THE WELLSTAR HEALTH SYSTEM COMMUNITY FINANCIAL ASSISTANCE POLICY CAN BE FOUND ON ITS WEBSITE: HTTPS://WWW.WELLSTAR.ORG/ABOUT-US/POLICIES-PROCEDURES/PAGES/ COMMUNITY-FINANCIAL-ASSISTANCE-POLICY.ASPX
SCHEDULE H, PART V, SECTION B, LINE 16B THE WELLSTAR HEALTH SYSTEM FINANCIAL ASSISTANCE APPLICATION CAN BE FOUND ITS WEBSITE: HTTPS://WWW.WELLSTAR.ORG/ABOUT-US/POLICIES-PROCEDURES/PAGES/COMMUNITY- FINANCIAL-ASSISTANCE-POLICY.ASPX AND CLICKING APPLICATION IN THE RIGHT NAVIGATION BOX TITLED RELATED DOCUMENTS. A WINDOW WILL APPEAR THAT ALLOW YOU TO SCROLL TO THE APPROPRIATE WELLSTAR HOSPITAL AND CLICK FOR A PDF VERSION OF THE APPLICATION TO PRINT OR DOWNLOAD.
SCHEDULE H, PART V, SECTION B, LINE 16C THE PLAIN LANGUAGE SUMMARY OF THE WELLSTAR HEALTH SYSTEM FINANCIAL ASSISTANCE APPLICATION CAN BE FOUND ON ITS WEBSITE: HTTPS://WWW.WELLSTAR.ORG/ABOUT-US/POLICIES-PROCEDURES/DOCUMENTS/ FAP-PLAINLANGUAGE-SUMMARY-WGH.PDF
SCHEDULE H, PART V, SECTION B, LINE 16J PUBLICATION OF THE FINANCIAL POLICY (FAP): IN ADDITION TO THE OTHER METHODS OF POSTING THE FINANCIAL ASSISTANCE POLICY, THE HOSPITAL MAKES AVAILABLE FOR PATIENTS IN ADMISSIONS AND OUTPATIENT REGISTRATION AREAS A PROMINENTLY DISPLAYED SIGN STATING FINANCIAL ASSISTANCE IS AVAILABLE AND A BROCHURE INCLUDING FREQUENTLY ASKED QUESTIONS.
SCHEDULE H, PART V, SECTION B, LINE 20E ADDITIONAL EFFORTS MADE BEFORE COLLECTIONS ACTION INITIATED: THE HOSPITAL FACILITY ALSO NOTIFIED INDIVIDUALS OF THE FINANCIAL ASSISTANCE POLICY ONLINE AT: HTTP://WWW.WELLSTAR.ORG/PAGES/ONLINE-BILL-PAY.ASPX FURTHERMORE, THE HOSPITAL FACILITY UTILIZES A PROPENSITY TO PAY SOFTWARE. INDIVIDUALS WITH A LOW ABILITY/LOW PROPENSITY DESIGNATION MAY QUALIFY FOR FULL INDIGENT OR SLIDING SCALE CHARITY BENEFITS.
   
   
   
   
   
   
   
   
   
   
   
   
   
   
Schedule H (Form 990) 2019
Schedule H (Form 990) 2019
Page 9
Part VFacility Information (continued)

Section D. Other Health Care Facilities That Are Not Licensed, Registered, or Similarly Recognized as a Hospital Facility
(list in order of size, from largest to smallest)
How many non-hospital health care facilities did the organization operate during the tax year?  
Name and address Type of Facility (describe)
1
2
3
4
5
6
7
8
9
10
Schedule H (Form 990) 2019
Schedule H (Form 990) 2019
Page 10
Part VI
Supplemental Information
Provide the following information.
1 Required descriptions. Provide the descriptions required for Part I, lines 3c, 6a, and 7; Part II and Part III, lines 2, 3, 4, 8 and 9b.
2 Needs assessment. Describe how the organization assesses the health care needs of the communities it serves, in addition to any CHNAs reported in Part V, Section B.
3 Patient education of eligibility for assistance. Describe how the organization informs and educates patients and persons who may be billed for patient care about their eligibility for assistance under federal, state, or local government programs or under the organization’s financial assistance policy.
4 Community information. Describe the community the organization serves, taking into account the geographic area and demographic constituents it serves.
5 Promotion of community health. Provide any other information important to describing how the organization’s hospital facilities or other health care facilities further its exempt purpose by promoting the health of the community (e.g., open medical staff, community board, use of surplus funds, etc.).
6 Affiliated health care system. If the organization is part of an affiliated health care system, describe the respective roles of the organization and its affiliates in promoting the health of the communities served.
7 State filing of community benefit report. If applicable, identify all states with which the organization, or a related organization, files a community benefit report.
Form and Line Reference Explanation
SCHEDULE H, PART I, LINE 6A PUBLICATION OF COMMUNITY BENEFIT REPORT: WELLSTAR NORTH FULTON HOSPITAL IS AN AFFILIATE OF WELLSTAR HEALTH SYSTEM, INC. WHICH ON AN ANNUAL BASIS ISSUES A COMMUNITY BENEFIT REPORT. THIS REPORT IS SUBSEQUENTLY DISTRIBUTED IN AND AROUND THE FIVE-COUNTY PRIMARY SERVICE AREA OF THE HEALTH SYSTEM. ON AN ANNUAL BASIS THE HOSPITAL REPORTS ITS COMMUNITY HEALTH BENEFITS REPORT TO THE GEORGIA HOSPITAL ASSOCIATION (GHA). GHA AGGREGATES THE HOSPITAL SPECIFIC REPORTS INTO A STATEWIDE COMMUNITY HEALTH BENEFIT REPORT. THE STATE OF GEORGIA ALSO REQUIRES HOSPITALS TO FILE THE HOSPITAL FINANCIAL SURVEY AND THE INDIGENT CARE TRUST FUND SURVEY SO THAT IT CAN COLLECT INFORMATION ON HOSPITAL FINANCIAL CLASS CATEGORIES AND ALSO TO DETERMINE THE AMOUNT OF UNCOMPENSATED CARE BY HOSPITAL. THE COMMUNITY BENEFIT REPORT CAN BE FOUND AT THE FOLLOWING LINK: https://www.wellstar.org/community/documents/ wellstar-community-benefits-report.pdf
SCHEDULE H, PART I, LINE 7 COST TO CHARGE RATIO: FOR PURPOSES OF THE IRS FORM 990, SCHEDULE H, WELLSTAR HEALTH SYSTEM AND AFFILIATES (INCLUDING WELLSTAR NORTH FULTON HOSPITAL) HAVE ESTIMATED THE CURRENT YEAR COST TO CHARGE RATIO FOR EACH HOSPITAL AS IT IS REPORTED IN THE ANNUAL COMMUNITY BENEFIT REPORT AND AS IT WILL BE REPORTED IN THE STATE'S ANNUAL HOSPITAL FINANCIAL SURVEY.
SCHEDULE H, PART III, SECTION A, LINE 2 METHODOLOGY USED TO ESTIMATE BAD DEBT: THE REPORTED BAD DEBT CHARGES IS DERIVED FROM UNPAID BALANCES OF PATIENT ACCOUNTS THAT ARE DEEMED UNCOLLECTABLE AFTER 120 DAYS OF COLLECTION EFFORT BY THE HOSPITALS PATIENT FINANCIAL SERVICES STAFF. THE UNPAID PATIENT ACCOUNTS ARE THEN SENT TO COLLECTION AGENCIES AND ANY COLLECTED AMOUNT IS DEEMED AS BAD DEBT RECOVERY. THE SOURCE OF THIS DATA IS THE HOSPITALS DETAILED FINANCIAL TRIAL BALANCE. THE NET REPORTED BAD DEBT CHARGES ARE THEN MULTIPLIED BY THE HOSPITAL FINANCIAL SURVEY CALCULATED COST TO CHARGE RATIO TO ARRIVE AT THE ESTIMATED BAD DEBT EXPENSE.
SCHEDULE H, PART III, SECTION A, LINE 8 MEDICARE SHORTFALLS: WELLSTAR NORTH FULTON HOSPITAL IS A PROVIDER OF INPATIENT AND OUTPATIENT SERVICES TO MEDICARE PROGRAM BENEFICIARIES AT DETERMINED RATES. WITHOUT THE PARTICIPATION IN THE MEDICARE PROGRAM, THESE PATIENTS MAY NOT HAVE HAD CONVENIENT ACCESS TO THOSE SERVICES. THE MEDICARE SHORTFALL ON SCHEDULE H, PART III, SECTION B, LINE 7 REPRESENTS THE UNCOMPENSATED DIFFERENCE BETWEEN THE EXPECTED REIMBURSEMENT AND THE MEDICARE CHARGES FOR THOSE SERVICES STATED AT COST. WE DETERMINE A COST TO CHARGE RATIO FOR MEDICARE PATIENTS AS PART OF THE ANNUAL FILING OF THE MEDICARE COST REPORT.
SCHEDULE H, PART III, SECTION C, LINE 9B COLLECTION PRACTICES: THE POLICY WRITTEN FOR COLLECTION PRACTICES THAT APPLIES TO ALL WELLSTAR HEALTH SYSTEM ENTITIES INCORPORATES GUIDELINES FOR PERSONNEL IN THE ADMISSIONS AND PATIENT ACCESS AREAS TO BE TRAINED IN IDENTIFYING PATIENTS THAT MIGHT QUALIFY FOR FINANCIAL ASSISTANCE. IT IS ALSO THE POLICY OF ALL WELLSTAR FACILITIES TO HAVE AT LEAST ONE EMPLOYEE OR CONTRACTOR AVAILABLE AT ALL TIMES, ESPECIALLY IN THE HOSPITALS WITH EMERGENCY ROOMS, WHO CAN PROVIDE ASSISTANCE WITH THE PAPERWORK NECESSARY TO HELP PATIENTS WHO WOULD QUALIFY FOR GOVERNMENTAL AND OTHER ASSISTANCE PROGRAMS.
SCHEDULE H, PART VI, LINE 2 NEEDS ASSESSMENT: TO ASSESS THE CURRENT HEALTH AND WELL-BEING OF THE COMMUNITY SERVED, WELLSTAR HEALTH SYSTEM, INC. CONDUCTED A COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA) FOR WELLSTAR NORTH FULTON HOSPITAL. THE CHNA WAS A COLLABORATIVE EFFORT INVOLVING WELLSTAR EXECUTIVE LEADERSHIP, HOSPITAL LEADERSHIP, PUBLIC HEALTH AGENCIES, AND A MULTI-SECTOR COALITION OF COMMUNITY STAKEHOLDERS. WELLSTAR NORTH FULTON HOSPITAL ENGAGED 19 COMMUNITY AND HOSPITAL LEADERS TO HELP ESTABLISH THE COMMUNITY PRIORITIES FOR THE COMMUNITY SERVED DURING A HEALTH SUMMIT, HELD FEBRUARY 26, 2018, ON THE HOSPITAL CAMPUS. STAKEHOLDERS REPRESENTED ORGANIZATIONS SERVING RESIDENTS IN THE PRIMARY SERVICE AREA OF WELLSTAR NORTH FULTON HOSPITAL. AN IN-DEPTH SUMMARY OF THE RESULTS, ALONG WITH DESCRIPTION OF THE PARTICIPANTS, METHODS USED AND COLLECTION PERIOD, IS LOCATED IN THE PRIMARY DATA AND COMMUNITY INPUT SECTION OF THE APPENDIX. GHPC PRESENTED TO COMMUNITY LEADERS FINDINGS FROM THE CHNA GENERATED FROM ANALYSIS OF SECONDARY DATA, KEY INFORMANT INTERVIEWS, FOCUS GROUPS, AND LISTENING SESSIONS. WELLSTAR NORTH FULTON HOSPITAL IS LOCATED IN ROSWELL, GEORGIA APPROXIMATELY 30 MILES NORTH OF ATLANTA. FOR THE PURPOSES OF THIS CHNA, THE PRIMARY SERVICE AREA IS DEFINED AS THE 20 ZIP CODES FROM WHICH 75 PERCENT OF DISCHARGED INPATIENTS ORIGINATED DURING THE PREVIOUS YEAR. THE BULK OF PATIENTS ARE FROM CHEROKEE, COBB AND FULTON COUNTIES. THIS CHNA CONSIDERS THE POPULATION OF RESIDENTS LIVING IN THE 20 RESIDENTIAL ZIP CODE AREAS REGARDLESS OF THE USE OF SERVICES PROVIDED BY WELLSTAR OR ANY OTHER PROVIDER. MORE SPECIFICALLY, THIS ASSESSMENT FOCUSES ON RESIDENTS IN THE SERVICE AREA WHO ARE MEDICALLY UNDER-RESOURCED OR AT RISK OF POOR HEALTH OUTCOMES.
SCHEDULE H, PART VI, LINE 3 PATIENT EDUCATION OF ELIGIBILITY FOR ASSISTANCE: THE HOSPITAL PROVIDES NOTICE OF THE AVAILABILITY OF COMMUNITY FINANCIAL ASSISTANCE THROUGH THE FINANCIAL ASSISTANCE POLICY (FAP) VIA: - SIGNAGE - PATIENT BROCHURE - BILLING STATEMENT - COLLECTION ACTION LETTER - ONLINE AT: HTTPS://WWW.WELLSTAR.ORG/ABOUT-US/POLICIES-PROCEDURES/ PAGES/COMMUNITY-FINANCIAL-ASSISTANCE-POLICY.ASPX WELLSTAR NORTH FULTON 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 PATIENTS ARE AFFORDED THESE OPPORTUNITIES.
SCHEDULE H, PART VI, LINE 4 COMMUNITY INFORMATION: WELLSTAR NORTH FULTON HOSPITAL IS LOCATED IN ROSWELL, GEORGIA APPROXIMATELY 30 MILES NORTH OF ATLANTA AND SERVES THE BROADER NORTH FULTON COMMUNITY. FOR THE PURPOSES OF THE CHNA, THE PRIMARY SERVICE AREA FOR THE HOSPITAL IS DEFINED AS THE 20 ZIP CODES FROM WHICH 75 PERCENT OF DISCHARGED INPATIENTS ORIGINATED DURING THE PREVIOUS YEAR. THE BULK OF THE ZIP CODES ARE FROM CHEROKEE, COBB AND FULTON COUNTIES. NORTH FULTON ZIP CODES: - FULTON COUNTY: 30004, 30005, 30022, 30075, 30076, 30328, 30350 - COBB COUNTY: 30062, 30066, 30068 - CHEROKEE COUNTY: 30114, 30115, 30188 - GWINNETT: 30092, 30093, 30096 - FORSYTH: 30028, 30041, 30040 TOTAL POPULATION: - CHEROKEE COUNTY: 235,900 - COBB COUNTY: 741,334 - FULTON COUNTY: 1,010, 562 INCOME DISTRIBUTION: - CHEROKEE COUNTY MEDIAN HOUSEHOLD INCOME: $68,926 - LESS THAN $15,000: 6.5% - $15,000 - 24,999: 8.6% - $25,000 34,999,999: 8.3% - $35,000 49,999: 11.3% - $50,000 74,999: 18.9% - $75,000 99,999: 14.9% - OVER $100,000: 31.5% - COBB COUNTY MEDIAN HOUSEHOLD INCOME: $65,873 - LESS THAN $15,000: 8.4% - $15,000 - 24,999: 8.0% - $25,000 34,999,999: 9.3% - $35,000 49,999: 12.8% - $50,000 74,999: 17.7% - $75,000 99,999: 12.7% - OVER $100,000: 31.2% - FULTON COUNTY MEDIAN HOUSEHOLD INCOME: $57,207 - LESS THAN $15,000: 14.2% - $15,000 - 24,999: 9.3% - $25,000 34,999,999: 8.9% - $35,000 49,999: 12.1% - $50,000 74,999: 16.1% - $75,000 99,999: 10.2% - OVER $100,000: 29.3% AGE DISTRIBUTION: - CHEROKEE COUNTY MEDIAN AGE: 37.4 - 0-17: 25.1% - 18-64: 61.9% - 65 +: 13.0% - COBB COUNTY MEDIAN AGE: 36.0 - 0-17: 25.3% - 18-64: 63.3% - 65 +: 11.4% - FULTON COUNTY MEDIAN AGE: 34.8 - 0-17: 22.6% - 18-64: 66.4% - 65 +: 11.1% RACE/ETHNIC DISTRIBUTION: - CHEROKEE COUNTY - BLACK: 6.2% - ASIAN: 2.0% - HISPANIC: 10.1% - NON-HISPANIC/WHITE: 79.8% - LIMITED ENGLISH: 3.0% - COBB COUNTY: - BLACK: 26.6% - ASIAN: 5.3% - HISPANIC: 12.8% - NON-HISPANIC/WHITE: 53.1% - LIMITED ENGLISH: 4.2% - FULTON COUNTY - BLACK: 43.3% - ASIAN: 6.9% - HISPANIC: 7.5% - NON-HISPANIC/WHITE: 40.3% - LIMITED ENGLISH: 2.6%
SCHEDULE H, PART VI, LINE 5 PROMOTION OF COMMUNITY HEALTH: WELLSTAR NORTH FULTON HOSPITAL (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 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; AND THE HOSPITAL PROVIDES CARE TO THE NEEDY MEMBERS OF THE COMMUNITY CONSISTENT WITH ITS CHARITY CARE POLICY. THE HOSPITAL'S EXCESS FUNDS ARE GENERALLY APPLIED TO EXPANSION AND REPLACEMENT OF EXISTING FACILITIES AND EQUIPMENT, AMORTIZATION OF INDEBTEDNESS, IMPROVEMENT OF PATIENT CARE, COMMUNITY BENEFIT ACTIVITIES INCLUDING HEALTH EDUCATION, PREVENTIVE SCREENINGS AND HEALTH FAIRS, RESEARCH, SUBSIDIZED HEALTH SERVICES, AND CHARITY CARE. WELLSTAR NORTH FULTON HOSPITAL COMMITTED APPROXIMATELY $19.8 MILLION IN CAPITAL EXPENDITURES FOR THE YEAR TO MEET TECHNOLOGY AND PROGRAM NEEDS OF THE COMMUNITY IT SERVES AND THERE IS A PLAN TO COMMIT MORE RESOURCES TO THE FACILITY IN THE NEAR FUTURE.
SCHEDULE H, PART VI, LINE 6 AFFILIATED HEALTH CARE SYSTEM: WELLSTAR HEALTH SYSTEM, THE LARGEST HEALTH SYSTEM IN GEORGIA, IS KNOWN NATIONALLY FOR ITS INNOVATIVE CARE MODELS, FOCUSED ON IMPROVING QUALITY AND ACCESS TO HEALTHCARE. WELLSTAR CONSISTS OF WELLSTAR MEDICAL GROUP, 240 MEDICAL OFFICE LOCATIONS, OUTPATIENT CENTERS, HEALTH PARKS, A PEDIATRIC CENTER, NURSING CENTERS, HOSPICE, HOMECARE, AS WELL AS 11 INPATIENT HOSPITALS: WELLSTAR ATLANTA MEDICAL CENTER, WELLSTAR ATLANTA MEDICAL CENTER SOUTH, WELLSTAR KENNESTONE REGIONAL MEDICAL CENTER (ANCHORED BY WELLSTAR KENNESTONE HOSPITAL), WELLSTAR WEST GEORGIA MEDICAL CENTER, AND WELLSTAR COBB, DOUGLAS, NORTH FULTON, PAULDING, SPALDING REGIONAL, SYLVAN GROVE AND WINDY HILL HOSPITALS. AS A NOT-FOR-PROFIT, WELLSTAR CONTINUES TO REINVEST IN THE HEALTH OF THE COMMUNITIES IT SERVES WITH NEW TECHNOLOGIES AND TREATMENTS. FOR MORE INFORMATION, VISIT HTTPS://WWW.WELLSTAR.ORG/PAGES/DEFAULT.APSX
SCHEDULE H, PART VI, LINE 7 STATE FILING OF COMMUNITY HEALTH BENEFIT REPORT: ON AN ANNUAL BASIS THE HOSPITAL REPORTS ITS COMMUNITY HEALTH BENEFITS REPORT TO THE GEORGIA HOSPITAL ASSOCIATION (GHA). GHA AGGREGATES THE HOSPITAL SPECIFIC REPORTS INTO A STATEWIDE COMMUNITY HEALTH BENEFIT REPORT. THE STATE OF GEORGIA ALSO REQUIRES HOSPITALS TO FILE THE HOSPITAL FINANCIAL SURVEY AND THE INDIGENT CARE TRUST FUND SURVEY SO THAT IT CAN COLLECT INFORMATION ON HOSPITAL FINANCIAL CLASS CATEGORIES AND ALSO TO DETERMINE THE AMOUNT OF UNCOMPENSATED CARE BY HOSPITAL.
Schedule H (Form 990) 2019
Additional Data


Software ID:  
Software Version:  
Schedule J
(Form 990)
Department of the Treasury
Internal Revenue Service
Compensation Information
For certain Officers, Directors, Trustees, Key Employees, and Highest
Compensated Employees
SchJMediumBullet Complete if the organization answered "Yes" on Form 990, Part IV, line 23.
SchJMediumBullet Attach to Form 990.
SchJMediumBullet Go to www.irs.gov/Form990 for instructions and the latest information.
OMB No. 1545-0047
2019
Open to Public Inspection
Name of the organization
WELLSTAR NORTH FULTON HOSPITAL
 
Employer identification number

81-0851756
Part I
Questions Regarding Compensation
Yes
No
1a
Check the appropiate box(es) if the organization provided any of the following to or for a person listed on Form
990, Part VII, Section A, line 1a. Complete Part III to provide any relevant information regarding these items.
b
If any of the boxes on Line 1a are checked, did the organization follow a written policy regarding payment or reimbursement or provision of all of the expenses described above? If "No," complete Part III to explain .........
1b
 
No
2
Did the organization require substantiation prior to reimbursing or allowing expenses incurred by all
directors, trustees, officers, including the CEO/Executive Director, regarding the items checked on Line 1a? ..
2
Yes
 
3
Indicate which, if any, of the following the filing organization used to establish the compensation of the
organization's CEO/Executive Director. Check all that apply. Do not check any boxes for methods
used by a related organization to establish compensation of the CEO/Executive Director, but explain in Part III.
4
During the year, did any person listed on Form 990, Part VII, Section A, line 1a, with respect to the filing organization or a related organization:
a
Receive a severance payment or change-of-control payment? .............
4a
Yes
 
b
Participate in, or receive payment from, a supplemental nonqualified retirement plan? .........
4b
Yes
 
c
Participate in, or receive payment from, an equity-based compensation arrangement? .........
4c
 
No
If "Yes" to any of lines 4a-c, list the persons and provide the applicable amounts for each item in Part III.
Only 501(c)(3), 501(c)(4), and 501(c)(29) organizations must complete lines 5-9.
5
For persons listed on Form 990, Part VII, Section A, line 1a, did the organization pay or accrue any
compensation contingent on the revenues of:
a
The organization? ....................
5a
 
No
b
Any related organization? .......................
5b
 
No
If "Yes," on line 5a or 5b, describe in Part III.
6
For persons listed on Form 990, Part VII, Section A, line 1a, did the organization pay or accrue any
compensation contingent on the net earnings of:
a
The organization? ..................
6a
 
No
b
Any related organization? ......................
6b
 
No
If "Yes," on line 6a or 6b, describe in Part III.
7
For persons listed on Form 990, Part VII, Section A, line 1a, did the organization provide any nonfixed
payments not described in lines 5 and 6? If "Yes," describe in Part III ............
7
Yes
 
8
Were any amounts reported on Form 990, Part VII, paid or accured pursuant to a contract that was
subject to the initial contract exception described in Regulations section 53.4958-4(a)(3)? If "Yes," describe
in Part III ..........................
8
 
No
9
If "Yes" on line 8, did the organization also follow the rebuttable presumption procedure described in Regulations section 53.4958-6(c)? .........................
9
 
 
For Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 50053T
Schedule J (Form 990) 2019

Schedule J (Form 990) 2019
Page 2
Part II
Officers, Directors, Trustees, Key Employees, and Highest Compensated Employees. Use duplicate copies if additional space is needed.
For each individual whose compensation must be reported on Schedule J, report compensation from the organization on row (i) and from related organizations, described in the
instructions, on row (ii). Do not list any individuals that are not listed on Form 990, Part VII.
Note. The sum of columns (B)(i)-(iii) for each listed individual must equal the total amount of Form 990, Part VII, Section A, line 1a, applicable column (D) and (E) amounts for that individual.
(A) Name and Title (B) Breakdown of W-2 and/or 1099-MISC compensation (C) Retirement and other deferred compensation (D) Nontaxable
benefits		 (E) Total of columns
(B)(i)-(D) 		(F) Compensation in column (B) reported as deferred on prior Form 990
(i) Base
compensation 		(ii) Bonus & incentive
compensation 		(iii) Other reportable compensation
1ALAN R MUSTER MD
SVP SPECIALTY DIVISION WMG 		(i)

(ii)		 0
-------------
452,852 		0
-------------
127,755 		0
-------------
20,836 		0
-------------
47,400 		0
-------------
34,949 		0
-------------
683,792 		0
-------------
0
2ANDREW ALBERRY
VP INFO TECHNOLOGY OPERATIONS 		(i)

(ii)		 0
-------------
115,774 		0
-------------
35,000 		0
-------------
5,103 		0
-------------
0 		0
-------------
9,394 		0
-------------
165,271 		0
-------------
0
3ANTHONY J BUDZINSKI
EVP & CFO 		(i)

(ii)		 0
-------------
647,939 		0
-------------
160,698 		0
-------------
424,433 		0
-------------
47,400 		0
-------------
24,184 		0
-------------
1,304,654 		0
-------------
398,890
4ANTHONY M TRUPIANO
SVP SUPPLY CHAIN 		(i)

(ii)		 0
-------------
315,664 		0
-------------
63,812 		0
-------------
18,177 		0
-------------
47,400 		0
-------------
2,112 		0
-------------
447,165 		0
-------------
0
5AVRIL P BECKFORD MD
TRUSTEE & CHIEF PEDIATRIC OFF. 		(i)

(ii)		 0
-------------
250,218 		0
-------------
190,568 		0
-------------
3,230 		0
-------------
28,516 		0
-------------
1,675 		0
-------------
474,207 		0
-------------
0
6BARBARA B COREY
SVP MANAGED CARE 		(i)

(ii)		 0
-------------
351,440 		0
-------------
71,045 		0
-------------
190,854 		0
-------------
29,398 		0
-------------
20,938 		0
-------------
663,675 		0
-------------
177,832
7BETH KOST
SVP COMPLIANCE CHF PRIVACY OFF 		(i)

(ii)		 0
-------------
311,960 		0
-------------
65,013 		0
-------------
12,419 		0
-------------
21,884 		0
-------------
21,226 		0
-------------
432,502 		0
-------------
0
8BETHANY ROBERTSON
VP/CHIEF LEARN.OFF.(END.4/18) 		(i)

(ii)		 0
-------------
206,746 		0
-------------
34,469 		0
-------------
37,821 		0
-------------
14,995 		0
-------------
30,929 		0
-------------
324,960 		0
-------------
28,401
9BRADFORD B NEWTON
VP INFO. TECHNOLOGY ADMIN. 		(i)

(ii)		 0
-------------
217,246 		0
-------------
52,306 		0
-------------
9,197 		0
-------------
22,820 		0
-------------
28,920 		0
-------------
330,489 		0
-------------
0
10CANDICE L SAUNDERS
PRESIDENT & CEO 		(i)

(ii)		 0
-------------
1,256,117 		0
-------------
524,447 		0
-------------
341,097 		0
-------------
44,900 		0
-------------
31,427 		0
-------------
2,197,988 		0
-------------
324,125
11CARRIE O PLIETZ
EVP & COO HOSPITAL DIVISION 		(i)

(ii)		 0
-------------
669,407 		0
-------------
201,166 		0
-------------
14,104 		0
-------------
36,400 		0
-------------
31,368 		0
-------------
952,445 		0
-------------
0
12DAVID W ANDERSON
EVP/HR/OL/CCO 		(i)

(ii)		 0
-------------
504,065 		0
-------------
151,479 		0
-------------
149,420 		0
-------------
47,149 		0
-------------
28,578 		0
-------------
880,691 		0
-------------
126,016
13DEBORAH C KEEL
FORMER SVP & HOSPITAL PRES. 		(i)

(ii)		 17,550
-------------
0 		17,957
-------------
0 		540,520
-------------
0 		0
-------------
0 		0
-------------
0 		576,027
-------------
0 		101,633
-------------
0
14DOUGLAS ARVIN CPA MBA
SVP FINANCE 		(i)

(ii)		 0
-------------
350,002 		0
-------------
68,566 		0
-------------
14,921 		0
-------------
4,163 		0
-------------
25,742 		0
-------------
463,394 		0
-------------
0
15DOUGLAS S FOSTER
FORMER VP FINANCIAL PLAN. 		(i)

(ii)		 0
-------------
110,776 		0
-------------
0 		0
-------------
5,018 		0
-------------
19,582 		0
-------------
5,413 		0
-------------
140,789 		0
-------------
0
16ELIZABETH H LOUDERMILK
VP FINANCIAL PLANNING 		(i)

(ii)		 0
-------------
254,861 		0
-------------
39,942 		0
-------------
9,407 		0
-------------
23,400 		0
-------------
27,451 		0
-------------
355,061 		0
-------------
0
17ELIZABETH PAPETTI
VP OPS HOSPITAL DIVISION 		(i)

(ii)		 0
-------------
203,900 		0
-------------
26,222 		0
-------------
8,878 		0
-------------
4,776 		0
-------------
1,360 		0
-------------
245,136 		0
-------------
0
18ELLEN HONEA
TRAINING PHARMACIST 		(i)

(ii)		 146,913
-------------
0 		0
-------------
0 		1,027
-------------
0 		21,150
-------------
0 		17,705
-------------
0 		186,795
-------------
0 		0
-------------
0
19ELLEN LANGFORD
SVP WMG AMB. TRANS. (END.4/18) 		(i)

(ii)		 0
-------------
272,189 		0
-------------
55,024 		0
-------------
107,773 		0
-------------
44,200 		0
-------------
25,067 		0
-------------
504,253 		0
-------------
95,982
20FELIX SOT IZAGUIRRE
VP FINANCE & HOSPITAL CFO 		(i)

(ii)		 177,880
-------------
0 		8,120
-------------
0 		5,786
-------------
0 		19,380
-------------
0 		24,275
-------------
0 		235,441
-------------
0 		0
-------------
0
21FREDA LYON
VP SYSTEM EMERGENCY SERVICES 		(i)

(ii)		 0
-------------
202,524 		0
-------------
30,195 		0
-------------
10,763 		0
-------------
15,521 		0
-------------
29,807 		0
-------------
288,810 		0
-------------
0
22HOSSEIN HAZRATI
PHARMACIST 		(i)

(ii)		 148,329
-------------
0 		0
-------------
0 		691
-------------
0 		24,111
-------------
0 		25,107
-------------
0 		198,238
-------------
0 		0
-------------
0
23JACQUELYN A ALT
VP CNO PATIENT CARE SERVICES 		(i)

(ii)		 212,300
-------------
0 		29,872
-------------
0 		9,442
-------------
0 		48,194
-------------
0 		1,419
-------------
0 		301,227
-------------
0 		0
-------------
0
24JAMES M SWARTZ
VP ACCOUNTING 		(i)

(ii)		 0
-------------
233,763 		0
-------------
40,142 		0
-------------
9,019 		0
-------------
19,530 		0
-------------
27,479 		0
-------------
329,933 		0
-------------
0
25JASON STEVENS
VP DEPUTY GENERAL COUNSEL 		(i)

(ii)		 0
-------------
236,931 		0
-------------
99,073 		0
-------------
10,095 		0
-------------
23,400 		0
-------------
19,442 		0
-------------
388,941 		0
-------------
0
26JEFFREY L THARP MD MPH
TRUSTEE & CHIEF MEDICINE SRVS. 		(i)

(ii)		 0
-------------
316,299 		0
-------------
201,272 		0
-------------
5,314 		0
-------------
46,785 		0
-------------
33,881 		0
-------------
603,551 		0
-------------
0
27JENNIFER GARBER
VP HUMAN RESOURCES 		(i)

(ii)		 128,179
-------------
0 		15,000
-------------
0 		5,272
-------------
0 		7,228
-------------
0 		15,035
-------------
0 		170,714
-------------
0 		0
-------------
0
28JENNIFER GIUSTI
VP CLINICAL OUTCOMES 		(i)

(ii)		 0
-------------
224,713 		0
-------------
85,231 		0
-------------
7,351 		0
-------------
26,087 		0
-------------
6,530 		0
-------------
349,912 		0
-------------
0
29JILL M CASE-WIRTH
SVP NURSING SERVICES 		(i)

(ii)		 0
-------------
354,247 		0
-------------
73,826 		0
-------------
16,081 		0
-------------
47,400 		0
-------------
11,712 		0
-------------
503,266 		0
-------------
0
30JOHN A BRENNAN
EVP CHIEF CLIN. INTG. OFFICER 		(i)

(ii)		 0
-------------
829,182 		0
-------------
246,421 		0
-------------
16,031 		0
-------------
47,400 		0
-------------
35,015 		0
-------------
1,174,049 		0
-------------
0
31JONATHAN CROOM
SVP & HOSPITAL PRESIDENT 		(i)

(ii)		 227,698
-------------
0 		36,000
-------------
0 		8,076
-------------
0 		26,100
-------------
0 		16,252
-------------
0 		314,126
-------------
0 		0
-------------
0
32JONATHAN B MORRIS MD
FORMER SVP CHIEF INFO. OFF. 		(i)

(ii)		 0
-------------
116,457 		0
-------------
0 		0
-------------
117,360 		0
-------------
7,164 		0
-------------
8,855 		0
-------------
249,836 		0
-------------
0
33JOSEPH L BRYWCZYNSKI
SVP HEALTH PARKS DEVELOPMENT 		(i)

(ii)		 0
-------------
302,686 		0
-------------
55,514 		0
-------------
84,764 		0
-------------
47,400 		0
-------------
26,225 		0
-------------
516,589 		0
-------------
60,537
34KARIM GODAMUNNE MD
VP HOSPITAL CHIEF MED OFFICER 		(i)

(ii)		 328,879
-------------
0 		33,786
-------------
0 		9,500
-------------
0 		44,100
-------------
0 		29,455
-------------
0 		445,720
-------------
0 		0
-------------
0
35KEITH BOWERMASTER
VP COMMUNICATION 		(i)

(ii)		 0
-------------
185,774 		0
-------------
11,074 		0
-------------
7,719 		0
-------------
18,383 		0
-------------
20,275 		0
-------------
243,225 		0
-------------
0
36KEM M MULLINS
EVP AMBULATORY & BUS. DEV. 		(i)

(ii)		 0
-------------
516,012 		0
-------------
146,039 		0
-------------
15,236 		0
-------------
23,400 		0
-------------
33,943 		0
-------------
734,630 		0
-------------
0
37KEVIN SCHAEFFER MD
VP ONCOLOGY 		(i)

(ii)		 0
-------------
225,000 		0
-------------
81,191 		0
-------------
9,155 		0
-------------
28,013 		0
-------------
9,239 		0
-------------
352,598 		0
-------------
0
38KIMBERLY W MENEFEE
SVP STRAT. COMM.DEV.(END.4/18) 		(i)

(ii)		 0
-------------
318,585 		0
-------------
68,385 		0
-------------
157,275 		0
-------------
29,400 		0
-------------
22,552 		0
-------------
596,197 		0
-------------
143,040
39KIMBERLY TAACA
VP OPS SPECIALTY DIVISION 		(i)

(ii)		 0
-------------
150,000 		0
-------------
70,710 		0
-------------
6,721 		0
-------------
14,665 		0
-------------
12,979 		0
-------------
255,075 		0
-------------
0
40KRISTEN S TRICE
VP DIAGNOSTIC OUTREACH 		(i)

(ii)		 0
-------------
179,395 		0
-------------
30,806 		0
-------------
8,863 		0
-------------
15,323 		0
-------------
27,344 		0
-------------
261,731 		0
-------------
0
41LEO E REICHERT
EVP & GENERAL COUNSEL 		(i)

(ii)		 0
-------------
570,403 		0
-------------
161,432 		0
-------------
19,485 		0
-------------
29,400 		0
-------------
36,857 		0
-------------
817,577 		0
-------------
0
42LINDSEY H PETRINI
VP COO 		(i)

(ii)		 156,866
-------------
0 		40,862
-------------
0 		8,923
-------------
0 		15,241
-------------
0 		8,638
-------------
0 		230,530
-------------
0 		0
-------------
0
43MARCUS P CHARLSON MD
VP SURGERY 		(i)

(ii)		 0
-------------
160,014 		0
-------------
27,478 		0
-------------
8,884 		0
-------------
11,772 		0
-------------
22,419 		0
-------------
230,567 		0
-------------
0
44MARK HASTINGS
PHARMACIST 		(i)

(ii)		 166,305
-------------
0 		0
-------------
0 		769
-------------
0 		18,177
-------------
0 		25,973
-------------
0 		211,224
-------------
0 		0
-------------
0
45MARY L TAVERNARO
VP HUMAN RESOURCES OPERATIONS 		(i)

(ii)		 0
-------------
249,538 		0
-------------
42,851 		0
-------------
10,377 		0
-------------
29,400 		0
-------------
23,004 		0
-------------
355,170 		0
-------------
0
46MAXWELL KAGAN
VP FINANCE & CFO 		(i)

(ii)		 0
-------------
163,472 		0
-------------
36,000 		0
-------------
5,853 		0
-------------
19,597 		0
-------------
15,332 		0
-------------
240,254 		0
-------------
0
47MICHELLE M ROBINSON
VP MARKETING (END. 4/2018) 		(i)

(ii)		 0
-------------
221,433 		0
-------------
38,025 		0
-------------
10,007 		0
-------------
16,089 		0
-------------
28,932 		0
-------------
314,486 		0
-------------
0
48MISTY BOACHIE
DIR PHARMACY SVCS 		(i)

(ii)		 146,867
-------------
0 		3,609
-------------
0 		86,670
-------------
0 		9,029
-------------
0 		21,231
-------------
0 		267,406
-------------
0 		0
-------------
0
49PAUL DOUGLASS MD
TRUSTEE & PHYSICIAN 		(i)

(ii)		 0
-------------
485,040 		0
-------------
144,525 		0
-------------
4,142 		0
-------------
32,100 		0
-------------
9,301 		0
-------------
675,108 		0
-------------
0
50PAUL MURPHREE
VP MEDICAL OUTCOMES 		(i)

(ii)		 0
-------------
166,080 		0
-------------
35,932 		0
-------------
4,584 		0
-------------
13,506 		0
-------------
8,115 		0
-------------
228,217 		0
-------------
0
51PETER R JUNGBLUT MD MBA
SVP & MEDICAL DIRECTOR 		(i)

(ii)		 0
-------------
328,499 		0
-------------
3,000 		0
-------------
12,728 		0
-------------
47,400 		0
-------------
31,251 		0
-------------
422,878 		0
-------------
0
52REBECCA L RUHL
VP FACILITY COMPLIANCE OPS 		(i)

(ii)		 0
-------------
154,856 		0
-------------
26,592 		0
-------------
9,567 		0
-------------
3,900 		0
-------------
26,645 		0
-------------
221,560 		0
-------------
0
53RICHARD S SIEGEL
VP CARDIOLOGY & CVM ADMIN. 		(i)

(ii)		 0
-------------
308,998 		0
-------------
53,732 		0
-------------
57,282 		0
-------------
45,890 		0
-------------
33,871 		0
-------------
499,773 		0
-------------
43,143
54ROB SCHREINER
EVP & PRESIDENT MEDICAL GROUP 		(i)

(ii)		 0
-------------
253,846 		0
-------------
0 		0
-------------
6,878 		0
-------------
0 		0
-------------
3,189 		0
-------------
263,913 		0
-------------
0
55ROBERT J DECOUX
VP CORPORATE MED STAFF SVCS 		(i)

(ii)		 0
-------------
183,688 		0
-------------
30,625 		0
-------------
9,923 		0
-------------
27,057 		0
-------------
26,455 		0
-------------
277,748 		0
-------------
0
56ROBIN G BOEHRINGER
VP TOTAL REWARDS (END. 5/2018) 		(i)

(ii)		 0
-------------
195,243 		0
-------------
33,528 		0
-------------
8,992 		0
-------------
18,998 		0
-------------
9,364 		0
-------------
266,125 		0
-------------
0
57SANDRA LUCIUS
VP INFO TECHNOLOGY APPS 		(i)

(ii)		 0
-------------
224,713 		0
-------------
48,688 		0
-------------
12,547 		0
-------------
47,260 		0
-------------
2,650 		0
-------------
335,858 		0
-------------
0
58SEAN P TURNER
VP REVENUE CYCLE MANAGEMENT 		(i)

(ii)		 0
-------------
301,913 		0
-------------
51,845 		0
-------------
14,346 		0
-------------
29,175 		0
-------------
30,313 		0
-------------
427,592 		0
-------------
0
59SNEHAL H DOSHI
VP SYSTEM PHARMACIST 		(i)

(ii)		 0
-------------
196,088 		0
-------------
32,692 		0
-------------
10,735 		0
-------------
29,119 		0
-------------
30,876 		0
-------------
299,510 		0
-------------
0
60SONYA E ALDY
VP TALENT ACQUISITION 		(i)

(ii)		 0
-------------
210,000 		0
-------------
24,700 		0
-------------
10,023 		0
-------------
11,700 		0
-------------
28,330 		0
-------------
284,753 		0
-------------
0
61STEPHEN L BADGER
VP WMG STRATEGIC SERVICES 		(i)

(ii)		 0
-------------
569,392 		0
-------------
120,638 		0
-------------
130,330 		0
-------------
23,400 		0
-------------
35,717 		0
-------------
879,477 		0
-------------
112,403
62STEPHEN VAULT
VP BUSINESS DEVELOPMENT 		(i)

(ii)		 0
-------------
184,999 		0
-------------
21,126 		0
-------------
9,055 		0
-------------
12,890 		0
-------------
11,136 		0
-------------
239,206 		0
-------------
0
63TERRENCE EYRING
PHARMACIST 		(i)

(ii)		 147,125
-------------
0 		0
-------------
0 		248
-------------
0 		13,241
-------------
0 		23,926
-------------
0 		184,540
-------------
0 		0
-------------
0
64TIMOTHY HANEY
SVP R.E. FAC. & DEV. SRVS. 		(i)

(ii)		 0
-------------
334,270 		0
-------------
105,128 		0
-------------
160,150 		0
-------------
28,630 		0
-------------
25,658 		0
-------------
653,836 		0
-------------
143,033
65TOM BONIECKI
VP MUSCUSKELETAL NEURO. 		(i)

(ii)		 0
-------------
162,078 		0
-------------
15,564 		0
-------------
2,700 		0
-------------
39,607 		0
-------------
35,630 		0
-------------
255,579 		0
-------------
0
66VALERY A AKOPOV MD
SVP HOSPITAL DIVISION WMG 		(i)

(ii)		 0
-------------
464,408 		0
-------------
88,401 		0
-------------
21,528 		0
-------------
29,400 		0
-------------
27,462 		0
-------------
631,199 		0
-------------
0
67VARMA RAMESWAR MD
VP PEDIATRIC OPERATIONS 		(i)

(ii)		 0
-------------
188,219 		0
-------------
27,320 		0
-------------
9,789 		0
-------------
40,496 		0
-------------
12,068 		0
-------------
277,892 		0
-------------
0
68YVETTE BREWER MD
VP PRIMARY CARE MEDICINE 		(i)

(ii)		 0
-------------
191,006 		0
-------------
24,084 		0
-------------
12,404 		0
-------------
33,126 		0
-------------
21,034 		0
-------------
281,654 		0
-------------
0
Schedule J (Form 990) 2019

Schedule J (Form 990) 2019
Page 3
Part III
Supplemental Information
Provide the information, explanation, or descriptions required for Part I, lines 1a, 1b, 3, 4a, 4b, 4c, 5a, 5b, 6a, 6b, 7, and 8, and for Part II. Also complete this part for any additional information.
Return Reference Explanation
SCHEDULE J, PART I, LINE 1A The items, as indicated in Line 1a, were provided, in some instances, to board members AND to certain employed individuals listed in FORM 990, Part VII by the organization. The organization follows IRS guidelines and these items were added as taxable income as appropriate. SCHEDULE J, PART I, LINE 1B REIMBURSEMENT POLICY: WHILE WELLSTAR HEALTH SYSTEM AND ITS AFFILIATES DO NOT HAVE A WRITTEN POLICY REGARDING PAYMENT OR REIMBURSEMENT OF THE ITEMS LISTED IN SHEDULE J, PART I, LINE 1A, THE ORGANIZATION FOLLOWS IRS GUIDELINES IN THE PAYMENT OF ANY OF THESE ITEMS TO INDIVIDUALS LISTED IN FORM 990, PART VII, SECTION A. THESE ITEMS ARE ADDED AS TAXABLE WAGES ON THE INDIVIDUAL'S FORM W-2 AS APPROPRIATE. SCHEDULE J, PART I, LINE 4A SEVERANCE PAYMENTS: PURSUANT TO THEIR RESPECTIVE EMPLOYMENT AGREEMENTS, THE FOLLOWING GROUPS OF OFFICERS ARE ENTITLED TO SEVERANCE PAYMENTS BASED ON THEIR COMPENSATION AT THAT TIME IN THE EVENT OF CERTAIN IDENTIFIED CIRCUMSTANCES. THE SEVERANCE PAYMENT PERIODS ARE 24 MONTHS FOR EXECUTIVE VICE PRESIDENTS, 18 MONTHS FOR SENIOR VICE PRESIDENTS, AND 12 MONTHS FOR VICE PRESIDENTS. THE FOLLOWING OFFICERS RECEIVED SEVERANCE PAY DURING THE 2017 CALENDAR YEAR FROM EITHER THE ORGANIZATION OR A RELATED ORGANIZATION: DEBORAH C. KEEL $438,741 JONATHAN B. MORRIS, MD 113,177 SCHEDULE J, PART I, LINE 4B PARTICIPATION IN A SUPPLEMENTAL NON-QUALIFIED RETIREMENT PLAN: DURING THE YEAR, VICE PRESIDENTS, SENIOR VICE PRESIDENTS, EXECUTIVE VICE PRESIDENTS AND CERTAIN PHYSICIANS PARTICIPATED IN A SUPPLEMENTAL NONQUALIFIED RETIREMENT PLAN SPONSORED BY WELLSTAR HEALTH SYSTEM, INC. THE AMOUNTS RELATED TO THIS PLAN ARE INCLUDED IN SCHEDULE J, PART II, COLUMN (C). THE FOLLOWING INDIVIDUALS RECEIVED PAYMENTS FROM THE PLAN INCLUDED IN SCHEDULE J, PART II, COLUMN (B): ANTHONY J. BUDZINSKI $398,890 BARBARA B. COREY 177,832 BETHANY ROBERTSON 28,401 CANDICE L. SAUNDERS 324,125 DAVID W. ANDERSON 126,016 DEBORAH C. KEEL 101,633 ELLEN LANGFORD 95,982 JOSEPH L. BRYWCZYNSKI 60,537 KIMBERLY W. MENEFEE 143,040 RICHARD S. SIEGEL 43,143 STEPHEN L. BADGER 112,403 TIMOTHY HANEY 143,033 SCHEDULE J, PART I, LINE 7 NON-FIXED PAYMENTS TO OFFICERS: AS PART OF THE WELLSTAR EXECUTIVE COMPENSATION PHILOSOPHY A PERFORMANCE PAY PLAN WAS INSTITUTED SEVERAL YEARS AGO WHEREBY THE WELLSTAR BOARD OF TRUSTEES APPROVES AN ANNUAL INCENTIVE PLAN WHICH CONSISTS OF SEVERAL PERFORMANCE GOALS OR FACTORS THAT UPON ATTAINMENT WILL RESULT IN PAYOUTS TO ELIGIBLE PLAN PARTICIPANTS.THOSE FACTORS ARE: (1) PEOPLE & CUSTOMER SERVICE GOAL FOR EMPLOYEE "TRUST INDEX (2) QUALITY & SAFETY GOAL FOR CLINICAL EXCELLENCE AND PATIENT SATISFACTION; AND (3) FINANCIAL GOAL FOR ATTAINING A POSITIVE OPERATING MARGIN. CONFIRMATION OF ACHIEVING THESE GOALS IS TYPICALLY RECEIVED THROUGH THE ANNUAL EXTERNAL AUDIT PROCESS AND APPROVED BY THE BOARD OF TRUSTEES AT THAT TIME.
Schedule J (Form 990) 2019

Additional Data


Software ID:  
Software Version:  
SCHEDULE O
(Form 990 or 990-EZ)

Department of the Treasury
Internal Revenue Service
Supplemental Information to Form 990 or 990-EZ

Complete to provide information for responses to specific questions on
Form 990 or 990-EZ or to provide any additional information.
MediumBullet Attach to Form 990 or 990-EZ.
MediumBullet Go to www.irs.gov/Form990 for the latest information.
OMB No. 1545-0047
2019
Open to Public
Inspection
Name of the organization
WELLSTAR NORTH FULTON HOSPITAL
 
Employer identification number

81-0851756
Return Reference Explanation
FORM 990, PART III, LINE 4A PROGRAM SERVICE ACCOMPLISHMENTS WELLSTAR HEALTH SYSTEM IS A VERTICALLY INTEGRATED HEALTH CARE DELIVERY SYSTEM WHICH PROVIDES THROUGH AFFILIATED BUSINESS ORGANIZATIONS A FULL SPECTRUM OF HEALTH SERVICES, INCLUDING WELLNESS PROGRAMS, PHYSICIAN OFFICE VISITS, OUTPATIENT CARE, INPATIENT CARE, AND POST-ACUTE SERVICES SUCH AS HOME HEALTH, HOSPICE AND LONG-TERM NURSING CARE. THE SYSTEM THROUGH ITS AFFILIATED BUSINESS ORGANIZATIONS OPERATES 11 HOSPITALS (KENNESTONE, COBB, PAULDING MEDICAL CENTER, DOUGLAS, WINDY HILL, ATLANTA MEDICAL CENTER DOWNTOWN AND SOUTH, NORTH FULTON, SPALDING, SYLVAN GROVE AND WEST GEORGIA), MULTIPLE PHYSICIAN OFFICES, PRIMARY CARE CENTERS, OUTPATIENT CARE FACILITIES, A NURSING HOME AND OTHER HEALTH RELATED SERVICES INCLUDING TWO INPATIENT HOSPICE FACILITIES. THE SYSTEM IS SUPPORTED FINANCIALLY BY A FUNDRAISING ORGANIZATION, WELLSTAR FOUNDATION, INC. THE SERVICE AREA FOR THE SYSTEM ENCOMPASSES PARTS OF THE NORTHWESTERN, CENTRAL AND WESTERN SECTIONS OF THE STATE OF GEORGIA - THE PRIMARY AREA BEING IN BARTOW, CHEROKEE, COBB, DOUGLAS, PAULDING, FULTON, BUTTS, SPALDING AND TROUP COUNTIES. APPROXIMATELY MORE THAN 90% OF INPATIENT DISCHARGES AND OUTPATIENTS SERVED ARE FROM THE AFOREMENTIONED COUNTIES. THE WELLSTAR VISION IS TO DELIVER WORLD CLASS HEALTHCARE. OUR MISSION IS TO CREATE AND DELIVER HIGH QUALITY HOSPITAL, PHYSICIAN AND OTHER HEALTHCARE RELATED SERVICES THAT IMPROVE THE HEALTH AND WELL-BEING OF THE INDIVIDUALS AND COMMUNITIES WE SERVE. HISTORY IN 1993, WHAT WAS THEN KNOWN AS THE COBB HEALTH SYSTEM, THE KENNESTONE REGIONAL HEALTH CARE SYSTEM, AND THE DOUGLAS GENERAL HOSPITAL AFFILIATED TO FORM THE NORTHWEST GEORGIA HEALTH SYSTEM. PAULDING MEMORIAL MEDICAL CENTER AFFILIATED WITH NORTHWEST GEORGIA HEALTH SYSTEM IN 1994. IN 1994, THE NORTHWEST GEORGIA HEALTH SYSTEM HELPED FORM THE PROMINA HEALTH SYSTEM AND CHANGED ITS NAME TO PROMINA NORTHWEST HEALTH SYSTEM. IN 1998, PROMINA NORTHWEST HEALTH SYSTEM CHANGED ITS NAME TO WELLSTAR HEALTH SYSTEM. WELLSTAR DISASSOCIATED FROM AND BECAME TOTALLY INDEPENDENT OF PROMINA IN 1999. IN 2016 WELLSTAR ACQUIRED ATLANTA MEDICAL CENTER, NORTH FULTON HOSPITAL, SPALDING HOSPITAL, SYLVAN GROVE HOSPITAL AND WEST GEORGIA MEDICAL CENTER. WELLSTAR HEALTH SYSTEM IS A PARENT CORPORATION, WHICH PROVIDES OVERALL COORDINATION INCLUDING GOVERNING BODY TO ITS 11 AFFILIATES: - COBB HOSPITAL, INC.; - CHS FOUNDATION, INC. (INVESTMENT MANAGEMENT); - DOUGLAS HOSPITAL INC.; - KENNESTONE HOSPITAL, INC.; - PAULDING MEDICAL CENTER, INC.; - WELLSTAR FOUNDATION INC.; - WELLSTAR ATLANTA MEDICAL CENTER, INC.; - WELLSTAR NORTH FULTON HOSPITAL, INC.; - WELLSTAR SPALDING REGIONAL HOSPITAL, INC.; - WELLSTAR SYLVAN GROVE HOSPITAL, INC.; - WELLSTAR WEST GEORGIA HEALTH SERVICES, INC.
SERVICES WELLSTAR HEALTH SYSTEM IS ABLE TO OFFER A FULL RANGE OF HEALTHCARE SERVICES THROUGH ITS AFFILIATES. THE SERVICES OFFERED INCLUDE BUT ARE NOT LIMITED TO: - MOST MAJOR INPATIENT CLINICAL SERVICES, - OUTPATIENT SERVICES, - DIAGNOSTIC AND THERAPEUTIC SERVICES, - ANCILLARY AND SUPPORT SERVICES, - URGENT CARE SERVICES, - HOME HEALTH SERVICES, - SKILLED NURSING SERVICES AND - HOSPICE SERVICES. THE 11 HOSPITAL LOCATIONS ARE ACUTE CARE FACILITIES WITH INPATIENT, OUTPATIENT, AND EMERGENCY SERVICES. THE SYSTEM INCLUDES A RESIDENTIAL FACILITY ON THE KENNESTONE HOSPITAL CAMPUS, CALLED ATHERTON PLACE. ATHERTON PLACE ALSO HOUSES AN ASSISTED LIVING UNIT AS AN ADDITIONAL LEVEL OF CARE. PAULDING MEDICAL CENTER IS HOME TO A FULL CARE NURSING HOME, PAULDING NURSING CENTER AND WEST GEORGIA MEDICAL CENTER IS ALSO HOME TO TWO FULL CARE NURSING HOMES. VERNON WOODS RETIREMENT COMMUNITY IS AN ASSISTED LIVING FACILITY. COBB HOSPITAL IS HOME TO A HOME HEALTH AGENCY AND A RESIDENTIAL HOSPICE FACILITY CALLED TRANQUILITY FOR THOSE PATIENTS IN THE END STAGES OF LIFE. KENNESTONE HOSPITAL ALSO OPENED A RESIDENTIAL HOSPICE FACILITY NOT FAR FROM ITS MAIN CAMPUS. THE SYSTEM IS COMPLIMENTED WITH APPROXIMATELY 275 PHYSICIAN PRACTICES AND SEVERAL URGENT CARE CENTERS. THE SYSTEM IS THUS ABLE TO PROVIDE A COMPLETE CONTINUUM OF CARE FOR THE COMMUNITY IT SERVES. THE FOLLOWING STATEMENTS OF COMMUNITY BENEFIT AND PROGRAM SERVICE ACCOMPLISHMENTS REPRESENT SYSTEM-WIDE ACTIVITY FOR WELLSTAR HEALTH SYSTEM, INC. (THE "SYSTEM") - EIN 58-1649541. ALL AFFILIATED ENTITIES OF THE SYSTEM EXCEPT THE PHYSICIAN HOSPITAL ORGANIZATION (EIN 58-2116179) OPERATE AS CHARITABLE ORGANIZATIONS CONSISTENT WITH THE REQUIREMENTS OF INTERNAL REVENUE CODE SECTION 501(C)(3) AND THE "COMMUNITY BENEFIT STANDARD" OF IRS REVENUE RULING 69-545. THE FOLLOWING EXCERPT FROM THE AUDITED FINANCIAL STATEMENTS IDENTIFIES A BROAD OVERVIEW OF THE CHARITABLE PURPOSE FOR THE SYSTEM. "THE SYSTEM MAINTAINS RECORDS TO IDENTIFY AND MONITOR THE LEVEL OF CHARITY CARE IT PROVIDES THROUGH ITS AFFILIATES. THESE RECORDS INCLUDE THE AMOUNT OF CHARGES FOREGONE FOR SERVICES AND SUPPLIES FURNISHED UNDER ITS COMMUNITY FINANCIAL AID POLICY." IN FISCAL YEAR 2018 AND 2017, WELLSTAR AFFILIATE HOSPITALS MADE $255.6 MILLION AND $251.9 MILLION, RESPECTIVELY, IN PROVIDER PAYMENTS AND RECOGNIZED SUCH PAYMENTS AS A REDUCTION IN NET PATIENT SERVICE REVENUE IN THE ACCOMPANYING COMBINED FINANCIAL STATEMENTS. THE SYSTEM ALSO PARTICIPATES IN CERTAIN GOVERNMENTAL INSURANCE PROGRAMS, INCLUDING MEDICARE AND MEDICAID. UNDER THESE PROGRAMS, THE SYSTEM PROVIDES CARE TO PATIENTS AT PAYMENT RATES WHICH ARE DETERMINED BY THE FEDERAL AND STATE GOVERNMENTS, REGARDLESS OF THE SYSTEM'S ACTUAL CHARGES. IN MOST CASES, THESE PROGRAMS PAY THE SYSTEM AT AMOUNTS WHICH ARE LESS THAN ITS COST OF PROVIDING SERVICES. THE SYSTEM OFFERS MANY WELLNESS AND EDUCATIONAL SERVICES AT LITTLE OR NO COST TO THE COMMUNITY. HEALTH FAIRS ARE HELD THROUGHOUT THE YEAR AT CONVENIENT LOCATIONS, PROVIDING VARIOUS HEALTH SCREENINGS, SUCH AS MAMMOGRAMS, BONE DENSITY, BLOOD PRESSURE AND CHOLESTEROL CHECKS. A LARGE NUMBER OF EDUCATIONAL PROGRAMS ARE OFFERED FOR ALL AGES. THESE PROGRAMS INCLUDE BICYCLE SAFETY, CAR SEAT SAFETY, DEFENSIVE DRIVING, CPR AND FIRST-AID CLASSES. FLU SHOTS ARE AVAILABLE TO THE COMMUNITY DURING FLU SEASON AND HEALTH SCREENINGS, MEDICAL SUPPLIES, AND IMMUNIZATIONS ARE PROVIDED TO CHILDREN THROUGH LOCAL HEALTH DEPARTMENTS AND HEALTH FAIRS. THE COSTS OF THESE SERVICES ARE INCLUDED IN UNRESTRICTED REVENUE, GAINS AND OTHER SUPPORT IN EXCESS OF EXPENSES AND LOSSES IN THE FINANCIAL STATEMENTS. THE PHYSICIANS OF THE SYSTEM MAKE SIGNIFICANT CONTRIBUTIONS TO IMPROVE THE HEALTH STATUS OF THE COMMUNITY, INCLUDING INVOLVEMENT IN MANY COMMUNITY ACTIVITIES PROMOTING HEALTH AWARENESS AND IMPROVEMENT, EMERGENCY ROOM CARE, AND DELIVERY OF CARE TO THE INDIGENT POPULATION OF THE SYSTEM'S SERVICE AREA. THE SYSTEM ALSO MADE SIGNIFICANT CONTRIBUTIONS TO THE NURSING PROGRAM AT A LOCAL UNIVERSITY. THIS FINANCIAL SUPPORT HAS HELPED TO GROW THE PROGRAM, WHICH BENEFITS THE SYSTEM AS WELL AS THE COMMUNITY. THE SYSTEM AND ALL BUT ONE OF ITS AFFILIATES HAVE BEEN RECOGNIZED AS ORGANIZATIONS EXEMPT FROM FEDERAL INCOME TAX UNDER INTERNAL REVENUE CODE SECTION 501(A) AS ORGANIZATIONS DESCRIBED IN SECTION 501(C)(3) AND, THEREFORE, RELATED INCOME IS GENERALLY NOT SUBJECT TO FEDERAL OR STATE INCOME TAXES. ONE OF THE SYSTEM'S AFFILIATES IS A CONTROLLED FOREIGN CORPORATION NOT SUBJECT TO FEDERAL INCOME TAX. THE PHYSICIAN HOSPITAL ORGANIZATION (EIN 58-2116179) IS A TAXABLE AFFILIATE OF THE SYSTEM AND FILES IRS FORM 1120 US CORPORATION INCOME TAX RETURN."
FINANCIAL & DATA STATISTICS SERVICES PROVIDED SYSTEM-WIDE: LICENSED BEDS 2,775 ADULT DISCHARGES 114,306 NEWBORN DISCHARGES 14,959 EMERGENCY ROOM VISITS 658,118 SURGERIES - 68950 CATH LAB/PACEMAKERS/EP 18,029 NON-ED O/P RADIOLOGY PROCEDURES 459,418 MED/SURG. SHORT STAY CASES 1,462 GI LAB PROCEDURES 10,628 RADIOLOGY ONCOLOGY PROCEDURES 31,718 COMMUNITY BENEFITS WELLSTARS COMMUNITY EDUCATION & OUTREACH DEPARTMENT PROVIDES FREE BROCHURES ON A VARIETY OF HEALTH-RELATED ISSUES. WELLSTAR PROVIDES SUPPORT GROUPS AND EDUCATIONAL OPPORTUNITIES TO THE COMMUNITY ON A VARIETY OF TOPICS INCLUDING MEN'S AND WOMEN'S HEALTH ISSUES, CARDIAC HEALTH, NUTRITION, CANCER, AND DIABETES. SOME OF THESE OPPORTUNITIES ARE PROVIDED FREE OF CHARGE OR AT A MINIMAL FEE. WELLSTAR ALSO PROVIDES FREE HEALTH SCREENINGS SUCH AS BLOOD PRESSURE, CHOLESTEROL, GLUCOSE, BONE DENSITY AND WEIGHT ASSESSMENT. COMMUNITY EDUCATION & OUTREACH PROVIDES HEALTH AND WELLNESS PROGRAMS AND SERVICES ACROSS ALL WELLSTAR MARKETS REACHING OVER 450,000 PEOPLE ANNUALLY. SOME OF THE MORE SPECIFIC PROGRAM/DEPARTMENTS ARE DOCUMENTED AS FOLLOWS: CLINICS: WELLSTAR IS AFFILIATED WITH SEVERAL CLINICS WHICH PROVIDE FREE OR SLIDING SCALE HEALTH SERVICES TO PERSONS WHO CANNOT AFFORD TO PAY OR THOSE WHO ARE NOT EXPECTED TO PAY. SCHOOL HEALTH PROGRAM: THIS PROGRAM TEACHES CHILDREN ABOUT HEALTH AND SAFETY TOPICS TO INCLUDE NUTRITION, PHYSICAL ACTIVITY, HYGIENE, BIKE AND PEDESTRIAN SAFETY AND MORE. THE PROGRAMS ARE CURRENTLY TAUGHT IN ELEMENTARY SCHOOLS (GRADES K-5) AND MIDDLE SCHOOLS (GRADES 6-8) IN CHEROKEE, COBB, DOUGLAS AND PAULDING COUNTIES. SAFE KIDS: WELLSTAR IS A CO-LEAD AGENCY FOR SAFE KIDS COBB COUNTY ALONG WITH COBB AND DOUGLAS PUBLIC HEALTH. SAFE KIDS COBB COUNTY IS COMMITTED TO REDUCING AND PREVENTING ACCIDENTAL INJURIES TO CHILDREN AGES 19 AND UNDER IN COBB COUNTY BY HOSTING SAFETY EDUCATION EVENTS AND DISTRIBUTING SAFETY EDUCATION MATERIALS AND EQUIPMENT THROUGHOUT THE COUNTY TO FAMILIES IN NEED. SAFETY AREAS OF FOCUS INCLUDE: CHILD PASSENGER, PEDESTRIAN, WHEEL, HOME, POISON PREVENTION AND WATER. EQUIPMENT DISTRIBUTION INCLUDES: CAR AND BOOSTER SEATS, BICYCLE HELMETS AND REFLECTORS, SMOKE/CARBON MONOXIDE ALARMS, HOME SAFETY KITS AND LIFEJACKETS. MOST OF THE EVENTS ARE FREE AND OPEN TO THE PUBLIC. THE IMPORTANT MESSAGE TAUGHT AT THESE EVENTS IS THAT SAFETY BEGINS WITH THE PARENTS AND CAREGIVERS. ANNUALLY, NEARLY 800 CAR SEATS ARE PRESENTED TO FAMILIES IN NEED, AND NEARLY 2,500 INFANT CAR SEATS ARE CHECKED AT OVER 130 CAR SEAT EVENTS. WOMEN & CHILDREN RESOURCE CENTERS: THE WOMEN'S AND CHILDREN'S RESOURCE CENTER AT COBB, DOUGLAS, AND KENNESTONE HOSPITALS PROVIDE MUCH NEEDED SUPPORT FOR MOTHERS AND THEIR NEWBORN BABIES THROUGH INPATIENT AND OUTPATIENT CONSULTATIONS, WARM LINE PHONE CALLS, CHILDBIRTH, NEWBORN CARE AND BREASTFEEDING CLASSES, AN ANNUAL MATERNITY AND BABY FAIR, AS WELL AS OTHER EDUCATIONAL OPPORTUNITIES. THESE PROGRAMS DEMONSTRATE WELLSTARS COMMITMENT TO THE HEALTH AND WELL-BEING OF THE NEW MOTHERS AND THEIR BABIES IN OUR COMMUNITY. IN FY2018 THE UNREIMBURSED COSTS ASSOCIATED WITH THE PROGRAM TOTALED APPROXIMATELY $400,000 AND MORE THAN 7,000 PARENTS PARTICIPATED IN PRENATAL AND CHILDBIRTH PROGRAMS. THE GOOD LIFE CLUB: WELLSTAR PROVIDES A SPECIAL PROGRAM FOR AREA RESIDENTS AGE 50 AND OLDER CALLED THE GOOD LIFE CLUB. THIS PROGRAM PROVIDES HEALTHY AGING RESOURCES AND PROMOTES HEALTH, WELLNESS, AND AN ACTIVE LIFESTYLE THROUGH CLASSES, HEALTH SCREENINGS AND OTHER OPPORTUNITIES. A SMALL ONE-TIME FEE COVERS A LIFETIME MEMBERSHIP AND INCLUDES: - HEALTH AND WELLNESS EDUCATION AND PROGRAMS - A QUARTERLY NEWSLETTER - FREE HEALTH SCREENINGS - DISCOUNTED PARKING AT HOSPITALS AND OTHER RETAIL DISCOUNTS - TRAVEL DISCOUNTS THE GOOD LIFE CLUB CURRENTLY HAS MORE THAN 2,000 MEMBERS. COMMUNITY ACTIVITIES - WELLSTAR HAS PARTNERED WITH A LOCAL COLLEGE, KENNESAW STATE UNIVERSITY ("KSU") TO DEVELOP EDUCATIONAL AND ON-SITE TRAINING PROGRAMS WHICH WILL HOPEFULLY IMPROVE THE CURRENT AND FUTURE HEALTH OF OUR COMMUNITY. MANY OF THE NURSES IN THE SYSTEM ARE TRAINED THROUGH THE NURSING PROGRAM OFFERED BY KSU. WELLSTAR IS ALSO AFFILIATED WITH THE CHATTAHOOCHEE TECHNICAL COLLEGE- NORTH METRO CAMPUS'S RADIOLOGIC TECHNOLOGY PROGRAM. WELLSTAR SERVES AS THE CLINICAL AFFILIATE FOR THE STUDENTS IN THIS TWO-YEAR PROGRAM. THE STUDENTS TRAIN AT WELLSTAR'S HOSPITALS AND OUTPATIENT FACILITIES. THE PROGRAM RECEIVED ACCREDITATION FROM THE JOINT REVIEW COMMITTEE ON EDUCATION IN RADIOLOGIC TECHNOLOGY. THE GOAL IS TO HAVE TRAINED STUDENTS WHO CAN SUBSEQUENTLY CONTRIBUTE TO THE HEALTH OF THE COMMUNITY WE SERVE. COMMUNITY PARTNERSHIPS AND SPONSORSHIPS - COMMUNITY EDUCATION & OUTREACH IS RESPONSIBLE FOR DEVELOPING AND CULTIVATING STRATEGIC COMMUNITY PARTNERSHIPS BY ALIGNING WELLSTARS STRATEGIC GOALS, COMMUNITY DEVELOPMENT OPPORTUNITIES AND THE PRIORITY HEALTH NEEDS OF OUR LOCAL COMMUNITIES. SPONSORSHIPS PROVIDE AN OPPORTUNITY TO SUPPORT WELLSTARS MISSION TO IMPROVE THE HEALTH AND WELL-BEING OF THE COMMUNITIES WE SERVE BY SUPPORTING ORGANIZATIONS AND EVENTS AS A SPONSOR. ORGANIZATIONS INCLUDE THE AMERICAN HEART ASSOCIATION, AMERICAN CANCER SOCIETY, AMERICAN LUNG ASSOCIATION, THE AMERICAN DIABETES ASSOCIATION, MARCH OF DIMES, AS WELL AS NUMEROUS LOCAL ORGANIZATIONS. MANY EMPLOYEES ALSO VOLUNTEER AND PARTICIPATE IN SOME OF THE EVENTS HELD BY THESE ORGANIZATIONS SUCH AS WALKS, FUNDRAISERS AND SCREENINGS. IN FY2018 THE TOTAL UNCOMPENSATED CARE, OTHER COMMUNITY BENEFITS AND COMMUNITY INVESTMENTS PROVIDED BY WELLSTAR WAS OVER $ 939 MILLION. COMMITMENT TO THE COMMUNITY BREAKDOWN: CHARITY & INDIGENT (UNCOMPENSATED CARE COSTS) - $ 255,954,000 MEDICAID SHORTFALLS (UNCOMPENSATED CARE COSTS) - $ 86,107,000 MEDICARE SHORTFALLS (UNCOMPENSATED CARE COSTS) - $ 206,724,000 OTHER PATIENTS (UNCOMPENSATED CARE COSTS) - $ 127,756,000 TOTAL UNCOMPENSATED CARE - $ 676,541,000 OTHER COMMUNITY PROGRAMS (PARTICIPATION IN COALITIONS) - $ 345,000 OTHER COMMUNITY PROGRAMS (COMMUNITY HEALTH EDUCATION) - $ 249,000 OTHER COMMUNITY PROGRAMS (HEALTH CARE SUPPORT) - $ 7,777,000 TOTAL OTHER COMMUNITY PROGRAMS - $ 8,371,000 COMMUNITY INVESTMENTS (FUNDS BACK INTO INFRASTRUCTURE) - $ 245,436,000 COMMUNITY INVESTMENTS (ALLIED HLTH/MEDICAL EDUCATION) - $ 9,456,000 COMMUNITY INVESTMENTS (OPERATIONS - STAFF/SOFTWARE) - $ 92,000 TOTAL COMMUNITY INVESTMENTS - $ 254,984,000 WELLSTAR CONTINUES TO PARTICIPATE IN THE CENTER FOR MEDICARE AND MEDICAID SERVICES (CMS) MEDICARE SAVINGS PROGRAM AS AN ACCOUNTABLE CARE ORGANIZATION (ACO). WELLSTARS ACO IS THE LARGEST ACO IN GEORGIA INCLUDING 50,000 MEMBERS AND 1,400 PHYSICIANS. THE ACO HAS BEEN RECOGNIZED AS ONE OF THE TOP 100 ACOS IN THE COUNTRY. THE PROGRAM HAS BEEN SUCCESSFUL THROUGH A FOCUS ON WELLNESS AND THE IMPROVED MANAGEMENT OF CHRONIC ILLNESSES AND THE RELATED COORDINATION OF CARE, TO ENSURE PATIENTS, ESPECIALLY CHRONICALLY ILL, GET THE RIGHT CARE AT THE RIGHT TIME TO MAINTAIN THEIR OPTIMAL HEALTH, AND AVOID THE NEED FOR HIGH-COST EMERGENCY AND HOSPITAL CARE.
AWARDS, RECOGNITION AND ACCOMPLISHMENTS WELLSTAR HEALTH SYSTEM (WELLSTAR) WAS RECOGNIZED FOR DIVERSITY IN THE WORKPLACE. DIVERSITY MAGAZINE LISTS WELLSTAR AS ONE OF ITS 50 BEST PLACES FOR WOMEN AND DIVERSE MANAGERS TO WORK. WELLSTAR WEST GEORGIA MEDICAL CENTER (WGMC) WAS NAMED TO BECKER HOSPITAL REVIEW'S 2016 LIST OF "100 GREAT COMMUNITY HOSPITALS." WGMC IS ONE OF ONLY THREE COMMUNITY HOSPITALS IN GEORGIA TO RECEIVE THIS HONOR. WELLSTAR KENNESTONE REGIONAL MEDICAL CENTER RECEIVED THE PRESTIGIOUS AMERICAN ACADEMY OF MEDICAL SURGICAL NURSES PRISM AWARD. THIS HONOR RECOGNIZED EXCEPTIONAL NURSING PRACTICE, LEADERSHIP AND OUTCOMES IN HOSPITAL MEDICAL-SURGICAL UNITS ACROSS THE COUNTRY. KENNESTONE REGIONAL MEDICAL CENTER IS JUST ONE OF 14 HOSPITALS TO RECEIVE THIS HONOR IN 2016 AND THE ONLY ONE IN THE STATE OF GEORGIA. US NEWS AND WORLD REPORT NAMED WELLSTAR KENNESTONE REGIONAL MEDICAL CENTER TO ITS ANNUAL LISTING OF BEST REGIONAL HOSPITALS RANKING IT THIRD IN GEORGIA. WELLSTAR DOUGLAS HOSPITAL WAS DESIGNATED AS A REMOTE TREATMENT STROKE CENTER BY THE OFFICE OF EMS AND TRAUMA IN THE GEORGIA DEPARTMENT OF PUBLIC HEALTH BECOMING ONE OF THE FIRST HOSPITALS IN THE STATE TO GARNER THE RECOGNITION. WELLSTAR EARNED A SPOT IN THE DAVE THOMAS FOUNDATION FOR ADOPTIONS 100 BEST ADOPTION-FRIENDLY WORKPLACES. THIS IS THE SYSTEMS FIFTH TIME ON THE FOUNDATIONS TOP 100 LIST. WELLSTAR OFFERS FULL-TIME TEAM MEMBERS 120 HOURS AND ELIGIBLE PART-TIME TEAM MEMBERS 60 HOURS OF PAID LEAVE. IN ADDITION, WELLSTAR OFFERS TEAM MEMBERS A MAXIMUM OF $19,000 PER FINALIZED ADOPTION ($20,000 PER FAMILY LIFETIME AMOUNT.) EMPLOYEE RECRUITING AND COMMITMENT TO PROPER WORK-LIFE BALANCE OF PERSONAL AND PROFESSIONAL TIME ARE IMPORTANT TO THE DESIGNATION OF THIS AWARD. WELLSTAR WAS NAMED TO WORKING MOTHER 100 BEST COMPANIES LIST FOR THE 9TH TIME FOR ITS COMMITMENT TO PROGRESSIVE WORKPLACE PROGRAMS, INCLUDING ADVANCEMENT OF WOMEN, FLEXIBILITY, CHILD CARE AND PAID PARENTAL LEAVE. WELLSTAR WAS NAME TO THE 2016 BEST PLACES TO WORK FOR WOMEN LIST BY GREAT PLACES TO WORK. COBB HOSPITAL WAS DESIGNATED A BABY-FRIENDLY HOSPITAL BY BABY-FRIENDLY USA. ONLY 5 OTHER GEORGIA HOSPITALS HOLD THIS DESIGNATION. GEORGIA TREND MAGAZINE NAMED WELLSTAR WGMC THE NUMBER 1 LARGE HOSPITAL IN THE STATE. FIVE OF WELLSTAR HEALTH SYSTEMS HOSPITALS HAVE BEEN GRANTED THREE-YEAR ACCREDITATION WITH THE GOLD COMMENDATION BY THE COMMISSION ON CANCER(COC), A QUALITY PROGRAM BY THE AMERICAN COLLEGE OF SURGEONS. THIS IS THE HIGHEST HONOR AWARDED TO A CANCER PROGRAM. TO EARN THIS ACCREDITATION THE PROGRAM MUST MEET OR EXCEED COCS QUALITY CARE STANDARDS, BE EVALUATED EVERY THREE YEARS AND SHOW EXCELLENCE IN THE DELIVERY OF PATIENT CENTERED CARE. WELLSTAR CANCER NETWORK ALSO RECEIVED NATIONAL DISTINCTION BY BEING GRANTED A THREE-YEAR ACCREDITATION BY THE COC. THIS IS THE HIGHEST HONOR AWARDED TO A CANCER PROGRAM. WELLSTAR KENNESTONE REGIONAL MEDICAL CENTER AND WELLSTAR ATLANTA MEDICAL CENTER RECEIVED THE PLATINUM HONOR BY THE US DEPARTMENT OF HEALTH AND HUMAN SERVICES HEALTH RESOURCES AND SERVICES ADMINISTRATION FOR THEIR CONTINUED EFFORTS TO PROMOTE ORGAN DONOR REGISTRATION. OTHER HOSPITALS HONORED INCLUDED WELLSTAR COBB, DOUGLAS, NORTH FULTON, WEST GEORGIA MEDICAL CENTER AND PAULDING HOSPITALS. THE PARTNERSHIP FOR HEALTH AND ACCOUNTABILITY(PHA) AN AFFILIATE OF THE GEORGIA HOSPITAL ASSOCIATION, RECENTLY PRESENTED ITS QUALITY AND PATIENT SAFETY AWARD TO SEVERAL WELLSTAR HOSPITALS AS WELL AS TO THE SYSTEM ITSELF. THESE AWARDS RECOGNIZE GEORGIA HEALTHCARE ORGANIZATIONS FOR ACHIEVEMENT IN REDUCING THE RISK OF MEDICAL ERRORS AND IMPROVING PATIENT SAFETY AND MEDICAL OUTCOMES. WELLSTAR SPALDING REGIONAL HOSPITAL WON FIRST PLACE IN THE HOSPITALS WITH 100-299 BEDS CATEGORY FOR ITS HELP ME, DONT HURT ME REDUCING CAUTIS PROJECT. WELLSTAR COBB HOSPITAL WON SECOND PLACE IN THE HOSPITALS WITH GREATER THAN 300 BEDS CATEGORY FOR ITS INTERDISCIPLINARY MODEL BEDSIDE MEDICATION DELIVERY TO REDUCE 30-DAY READMISSION RATES PROJECT. WELLSTAR DOUGLAS HOSPITAL WON THIRD PLACE IN THE HOSPITALS WITH 100-299 BEDS CATEGORY FOR ITS MISSION NOT IMPOSSIBLE: STRATEGIES TO DECREASE CLOSTRIDIUM DIFFICILE PROJECT. IN THE HOSPITALS/HEALTH SYSTEMS CATEGORY, WELLSTAR HEALTH SYSTEM EARNED FIRST PLACE FOR ITS OUTPATIENT SURGERY CENTER PRE-OP THROUGHPUT PROJECT, WHICH IMPROVED THE SAFETY OF PATENTS UNDERGOING CT-SCANS. WELLSTAR COBB HOSPITAL WAS ALSO PRESENTED WITH A CIRCLE OF EXCELLENCE AWARD, AN HONOR GIVEN TO HOSPITALS AND HEALTH SYSTEMS THAT HAVE DEMONSTRATED A SUSTAINED COMMITMENT TO QUALITY AND PATIENT SAFETY. EVERY YEAR THE ATLANTA BUSINESS CHRONICLE PUBLISHES ITS LIST OF THE 100 MOST INFLUENTIAL LEADERS IN GEORGIAS HEALTHCARE INDUSTRY. SEVEN MEMBERS OF WELLSTAR HEALTH SYSTEMS SENIOR LEADERSHIP TEAM WERE INCLUDED IN THE 2017 LIST. WELLSTAR KENNESTONE REGIONAL MEDICAL CENTERS CARDIAC PROGRAM IS ONE OF ONLY TWO PROGRAMS IN THE UNITED STATES TO RECEIVE THE JOINT COMMISSION GOLD SEAL DISEASE-SPECIFIC CERTIFICATION FOR HEART-VALVE, CORONARY ARTERY BYPASS SURGERY (CABS) AND CONGESTIVE HEART FAILURE. WELLSTAR WEST GEORGIA MEDICAL CENTER WAS NAMED ONE OF THE NATIONS 100 TOP HOSPITALS BY TRUVEN HEALTH ANALYTICS. TRUVEN IS A LEADING PROVIDER OF INFORMATION AND SOLUTIONS THAT SUPPORT HEALTHCARE COST AND QUALITY IMPROVEMENT. WELLSTAR COBB HOSPITALS INTENSIVE CARE UNIT WAS HONORED WITH THE BEACON AWARD FOR EXCELLENCE BY THE AMERICAN ASSOCIATION OF CRITICAL CARE NURSES. THE BEACON AWARD HONORS INDIVIDUAL HOSPITAL UNITS THAT DISTINGUISH THEMSELVES BY IMPROVING EVERY FACET OF PATIENT CARE. WELLSTAR PAULDING MEDICAL CENTER RECEIVED TWO BRILLIANCE AWARDS FROM VIZIENT MIDSOUTH. THE HOSPITAL WAS RECOGNIZED FOR INNOVATION AND EXCELLENCE IN CLINICAL CARE FOR PATIENTS WITH COPD AND DIABETES. TWO OF WELLSTAR KENNESTONE REGIONAL MEDICAL CENTERS NURSES HAVE BEEN NAMED AS TWO OF THE TOP 10 NURSES IN GEORGIA BY THE ATLANTA JOURNAL CONSTITUTION. WELLSTARS SUPPLY CHAIN SERVICES WAS RECOGNIZED AS A BEST PERFORMER BY THE ECRI INSTITUTE, A NONPROFIT ORGANIZATION THAT USES RESEARCH TO DISCOVER WHICH MEDICAL PROCEDURES, DRUGS AND PROCESSES ARE BEST TO ENABLE IMPROVED PATIENT CARE. THIS AWARD IS GIVEN FOR DEMONSTRATING EXCELLENCE IN OVERALL SPEND MANAGEMENT. THE WOUND CARE CENTER AT WELLSTAR WEST GEORGIA MEDICAL CENTER HAS BEEN RECOGNIZED WITH A CENTER OF DISTINCTION AWARD FOR CLINICAL EXCELLENCE BY HEALOGICS, THE NATIONS LEADING AND LARGEST WOUND CARE MANAGEMENT COMPANY. THE CENTER FOR COMPANIES THAT CARE RECENTLY NAMED WELLSTAR TO ITS HONOR ROLL FOR THE 10TH YEAR IN A ROW. THIS HONOR FOCUSES ON WELLSTARS EFFORT TO OFFERING WORKLIFE SERVICES THAT CREATE A CULTURE OF INCLUSION AND ASSISTANCE FOR TEAM MEMBERS UTILIZING SERVICES THAT PROVIDE A BALANCE BETWEEN WORK AND HOME LIFE. THE PURPOSE OF THE AWARD IS TO RECOGNIZE MEMBER ORGANIZATIONS THAT HAVE ACHIEVED A CERTAIN LEVEL OF EXCELLENCE ACROSS THREE KEY FOCUS AREAS- FINANCIAL AND OPERATIONAL EXCELLENCE, CLINICAL QUALITY EXCELLENCE AND INNOVATION. WELLSTAR WAS NAMED ONE OF BEST AND BRIGHTEST COMPANIES TO WORK FOR BY WSBTV2, BIZ 1190AM-WAFS, CORP! MAGAZINE, BAUDVILLE, BASIC AND THE ORSUS GROUP. THIS AWARD IS GIVEN TO COMPANIES THAT DISTINGUISH THEMSELVES AS HAVING THE MOST INNOVATIVE AND THOUGHTFUL APPROACH TO HUMAN RESOURCES. WELLSTAR HEALTH SYSTEM WAS A WINNER OF THE LEADERSHIP IN EXCELLENCE AWARD BY VIZIENT MIDSOUTH, A MEMBER ALLIANCE FOR NOT FOR PROFIT HEALTHCARE PROVIDERS. THE PURPOSE OF THIS AWARD IS TO RECOGNIZE ORGANIZATIONS THAT HAVE ACHIEVED A CERTAIN LEVEL OF EXCELLENCE ACROSS THREE KEY FOCUS AREAS- FINANCIAL AND OPERATIONAL EXCELLENCE, CLINICAL QUALITY EXCELLENCE AND INNOVATION.
FORM 990, PART IV, LINE 12B AUDITED FINANCIAL STATEMENTS WELLSTAR NORTH FULTON HOSPITAL, INC. is audited on an annual basis by an outside auditing firm, KPMG, and as part of that audit a consolidated financial statement is issued for all of WellStar Health System, Inc. and its CONTROLLED Affiliates. The independent auditors report includes the accounts of Wellstar and its controlled affiliates, WELLSTAR Kennestone Hospital, Inc., WELLSTAR Cobb Hospital, Inc., WELLSTAR Douglas Hospital, Inc., WELLSTAR Paulding Medical Center, Inc., WELLSTAR ATLANTA MEDICAL CENTER, INC., WELLSTAR NORTH FULTON HOSPITAL, INC., WELLSTAR SPALDING REGIONAL HOSPITAL, INC., WELLSTAR SYLVAN GROVE HOSPITAL, INC., WELLSTAR WEST GEORGIA HEALTH SERVICES, INC., WELLSTAR WEST GEORGIA MEDICAL CENTER, INC., Wellstar Foundation, Inc., WELLSTAR WEST GEORGIA FOUNDATION, INC., VERNON WOODS RETIREMENT COMMUNITY, 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 HEALTH SYSTEM, INC. has the authority to approve appointments of the members of the board of trustees of all affiliate corporations. FORM 990, PART IV, LINE 24A TAX EXEMPT BOND REPORTING FOR PURPOSES OF THE FORM 990 REPORTING, WELLSTAR HEALTH SYSTEM, INC. (EIN 58-1649541) WILL LIST ALL TAX-EXEMPT BONDS ISSUED SINCE JANUARY 1, 2003 ON SCHEDULE K AS IT TYPICALLY ALLOCATES THE PROCEEDS OF THE BONDS TO MEMBERS OF THE OBLIGATED GROUP (INCLUDING THE HOSPITALS AND PHYSICIAN GROUP). WELLSTAR NORTH FULTON HOSPITAL WILL REPORT THIS TAX EXEMPT BOND LIABILITY ON FORM 990, PART X, LINE 25 OTHER LIABILITIES DUE TO WHS, INC. FORM 990, PART VI, SECTION A, LINE 7B POWERS OF THE BOARD AS PER THE ARTICLES OF INCORPORATION, THE SOLE MEMBER OF THE ORGANIZATION IS WELLSTAR HEALTH SYSTEM, INC., A GEORGIA NONPROFIT CORPORATION. AS SOLE MEMBER, WELLSTAR HEALTH SYSTEM, INC. HOLDS CERTAIN POWERS OF ELECTION AND APPROVAL IN CONNECTION WITH THE GOVERNING BODY OF THE ORGANIZATION. THESE POWERS ARE PRESENTED IN DETAIL IN THE GOVERNING DOCUMENTS WHICH THE COMPANY MAKES AVAILABLE TO THE PUBLIC UPON REQUEST. FORM 990, PART VI, SECTION B, LINE 11B BOARD REVIEW OF FORM 990 INTERNAL STAFF PREPARES THE ORGANIZATION'S FORM 990. BEFORE FILING THE RETURN WITH THE INTERNAL REVENUE SERVICE AN EXTERNAL ACCOUNTING FIRM, PRICEWATERHOUSECOOPERS LLP, REVIEWS AND SIGN-OFFS ON THE COMPLETED RETURN OF EACH ORGANIZATION. THE CURRENT YEAR FORM 990 IS THEN REVIEWED BY THE FINANCE COMMITTEE ALONG WITH A QUESTION AND ANSWER SESSION. A MOTION IS THEN MADE BY THE FINANCE COMMITTEE TO APPROVE THE RETURNS AND PRESENT TO THE FULL BOARD COPIES OF THE FORMS IN AN ELECTRONIC (PDF FORMAT) VERSION AS WELL AS A HARD COPY. THE ORGANIZATION'S CFO OR DESIGNEE SUBSEQUENTLY SIGNS THE RETURN FOR EITHER MANUAL OR ELECTRONIC FILING BY THE APPROPRIATE DUE DATE. FORM 990, PART VI, SECTION B, LINE 12C CONFLICT OF INTEREST POLICY OUR CONFLICT OF INTEREST POLICY REQUIRES ALL COVERED PERSONS TO ANNUALLY REVIEW THE POLICY AND THEN COMPLETE, SIGN AND RETURN THE CONFLICTS OF INTEREST SURVEY AND ATTESTATION TO THE COMPLIANCE OFFICE. THE POLICY REQUIRES AN ON-GOING DISCLOSURE OBLIGATION IN THE EVENT A CONFLICT ARISES DURING THE YEAR. THE FOLLOWING IS OUR PROCESS TO REGULARLY AND CONSISTENTLY MONITOR AND ENFORCE THE POLICY: COMPLIANCE IDENTIFIES ALL COVERED PERSONS WHO MUST COMPLETE THE SURVEY AND ATTESTATION. COMPLIANCE VERIFIES THAT THE SURVEY AND ATTESTATION IS DISTRIBUTED TO THESE PERSONS. COMPLIANCE VERIFIES THAT THESE PERSONS RETURN A FULLY COMPLETED AND SIGNED SURVEY AND ATTESTATION. COMPLIANCE REVIEWS EACH COMPLETED AND SIGNED SURVEY AND ATTESTATION TO IDENTIFY ALL CONFLICTS LISTED IN THE DOCUMENT. ALL CONFLICTS, POTENTIAL CONFLICTS AND INCIDENCES OF NON-COMPLIANCE ARE REFERRED TO THE CHIEF COMPLIANCE OFFICER. THE CCO TAKES APPROPRIATE ACTION TO COMPLETELY RESOLVE ALL IDENTIFIED CONFLICTS AND INCIDENCES OF NON-COMPLIANCE. FORM 990, PART VI, SECTION B, LINES 15A & 15B COMPENSATION OF OFFICERS WELLSTAR HEALTH SYSTEM, INC. HAS ENGAGED SULLIVAN COTTER TO WORK WITH THE GOVERNING BOARD TO REVIEW AND RECOMMEND EXECUTIVE COMPENSATION. THE EXECUTIVE COMPENSATION PROCESS AT WELLSTAR IS OVERSEEN BY A COMMITTEE OF INDEPENDENT TRUSTEES, WHICH FOLLOWS A BOARD-APPROVED EXECUTIVE COMPENSATION PHILOSOPHY. THE COMPENSATION COMMITTEE CONSISTS OF FIVE TRUSTEES AS WELL AS THE CEO IN AN ADVISORY ROLE AND NOT A VOTING MEMBER. FURTHER IN COMMITTEE DISCUSSIONS ABOUT THE COMPENSATION FOR THE CHIEF EXECUTIVE OFFICER, THE CEO WILL RECUSE HIM/HERSELF FROM THAT PROCESS AND IS A NON-VOTING COMMITTEE MEMBER FOR DISCUSSIONS ON ALL OTHER OFFICERS. THE EXECUTIVE COMPENSATION PHILOSOPHY EMPOWERS THE COMMITTEE TO OVERSEE THE EXECUTIVE COMPENSATION PROCESS AND ADMINISTER THE EXECUTIVE COMPENSATION PROGRAM ON BEHALF OF THE FULL BOARD OF TRUSTEES 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. BASE COMPENSATION IS TARGETED AT THE MEDIAN BASE COMPENSATION PAID TO SIMILAR POSITIONS AT SIMILAR ORGANIZATIONS (THE MARKET). OFFICERS OF THE COMPANY ALSO RECEIVE VARIABLE COMPENSATION THAT IS DEPENDENT ON INDIVIDUAL AND ORGANIZATION PERFORMANCE. WHEN PERFORMANCE IS AT A PREDETERMINED TARGETED LEVEL, THE TOTAL COMPENSATION, BOTH BASE AND VARIABLE, IS INTENDED TO BE AT OR AROUND THE 75TH% OF COMPENSATION PAID TO SIMILAR POSITIONS AT SIMILAR ORGANIZATIONS. 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 SULLIVAN COTTER 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 PROVIDED TO THE FULL BOARD OF TRUSTEES FOR REVIEW. FORM 990, PART VI, SECTION C, LINE 19 DOCUMENTS MADE AVAILABLE TO THE PUBLIC The organization and its AFFILIATES 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 publishes a community benefit report once a year for distribution to the public. FORM 990, PART VII OFFICERS HOURS WORKED The officers devote their time to all of the organizations WITHIN WellStar Health System that are listed in Schedule R, Part II. As such, the total hours worked by the officers across all of the organizations exceeds 40 hours per week. FORM 990, PART VII & FORM 990, SCHEDULE J COMPENSATION ALL COMPENSATION AMOUNTS REPORTED ON FORM 990, PART VII; PART IX, LINES 5-7; AND SCHEDULE J REPRESENT COMPENSATION PROVIDED TO INDIVIDUALS THAT PROVIDE SERVICES TO THE ORGANIZATION. LIKEWISE, THE NUMBER OF EMPLOYEES REPORTED FORM 990, PART V, LINE 2A 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).(EIN: 58-1649541).
FORM 990, PART XI, LINE 9 OTHER CHANGES IN NET ASSETS FOR THE REPORTING PERIOD WELLSTAR NORTH FULTON HOSPITAL HAD A CHANGE IN NET ASSETS OF $25,530,384 RELATED TO TRANSFERS TO AFFILIATES AS PART OF THE ALLOCATION OF INCOME STATEMENT AND BALANCE SHEET TRANSACTIONS OVER THE YEAR.
FORM 990 PART IX LINE 11G DESCRIPTION:COLLECTION EXPENSES TOTAL FEES:8288365
FORM 990 PART IX LINE 11G DESCRIPTION:CONSULTING FEES TOTAL FEES:667226
FORM 990 PART IX LINE 11G DESCRIPTION:CONTRACT LABOR TOTAL FEES:2699711
FORM 990 PART IX LINE 11G DESCRIPTION:LAB-OUTSIDE SERVICES TOTAL FEES:343728
FORM 990 PART IX LINE 11G DESCRIPTION:OUTSIDE JANITORIAL SERVICES TOTAL FEES:1495657
FORM 990 PART IX LINE 11G DESCRIPTION:PURCHASED SERVICES TOTAL FEES:11281952
FORM 990 PART IX LINE 11G DESCRIPTION:TAXES & LICENSES TOTAL FEES:674775
FORM 990 PART IX LINE 11G DESCRIPTION:TECHNOLOGY EXPENSES TOTAL FEES:3989108
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.
Cat. No. 51056K
Schedule O (Form 990 or 990-EZ) 2019


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SCHEDULE R
(Form 990)
Department of the Treasury
Internal Revenue Service
Related Organizations and Unrelated Partnerships
MediumBulletComplete if the organization answered "Yes" on Form 990, Part IV, line 33, 34, 35b, 36, or 37.
MediumBulletAttach to Form 990.
MediumBullet Go to www.irs.gov/Form990 for instructions and the latest information.

OMB No. 1545-0047
2019
Open to Public Inspection
Name of the organization
WELLSTAR NORTH FULTON HOSPITAL
 
Employer identification number

81-0851756
Part I
Identification of Disregarded Entities. Complete if the organization answered "Yes" on Form 990, Part IV, line 33.
(a)
Name, address, and EIN (if applicable) of disregarded entity


(b)
Primary activity


 		(c)
Legal domicile (state
or foreign country)

 		(d)
Total income


 		(e)
End-of-year assets


 		(f)
Direct controlling
entity
(1) WELLSTAR NORTH FULTON PROPERTIES LLC
793 SAWYER ROAD
MARIETTA,GA30062
81-0851756 		REAL ESTATE GA 0 0 WNFH
 










Part II
Identification of Related Tax-Exempt Organizations. Complete if the organization answered "Yes" on Form 990, Part IV, line 34 because it had one or more related tax-exempt organizations during the tax year.
(a)
Name, address, and EIN of related organization


(b)
Primary activity


 		(c)
Legal domicile (state
or foreign country)

 		(d)
Exempt Code section


 		(e)
Public charity status
(if section 501(c)(3))

 		(f)
Direct controlling
entity

 		(g)
Section 512(b)(13) controlled entity?
Yes No
(1)CHS FOUNDATION INC
793 SAWYER ROAD

MARIETTA,GA30062
58-1649540 		FOUNDATION GA 501(C)(3) 12 II WHS INC
 
Yes
 
(2)DOUGLAS HOSPITAL INC
793 SAWYER ROAD

MARIETTA,GA30062
58-2026750 		HEALTHCARE GA 501(C)(3) 3 WHS INC
 
Yes
 
(3)KENNESTONE HOSPITAL INC
793 SAWYER ROAD

MARIETTA,GA30062
58-2032904 		HEALTHCARE GA 501(C)(3) 3 WHS INC
 
Yes
 
(4)PAULDING MEDICAL CENTER INC
793 SAWYER ROAD

MARIETTA,GA30062
58-2095884 		HEALTHCARE GA 501(C)(3) 3 WHS INC
 
Yes
 
(5)WELLSTAR FOUNDATION INC
793 SAWYER ROAD

MARIETTA,GA30062
58-1627413 		FOUNDATION GA 501(C)(3) 12 II WHS INC
 
Yes
 
(6)WELLSTAR HEALTH SYSTEM INC
793 SAWYER ROAD

MARIETTA,GA30062
58-1649541 		HEALTHCARE GA 501(C)(3) 12 II NA
 
 
No
(7)WELLSTAR ATLANTA MEDICAL CENTER INC
793 SAWYER ROAD

MARIETTA,GA30062
81-0837031 		HEALTHCARE GA 501(C)(3) 3 WHS INC
 
Yes
 
(8)WELLSTAR SPALDING REGIONAL HOSPITALINC
793 SAWYER ROAD

MARIETTA,GA30062
81-0864789 		HEALTHCARE GA 501(C)(3) 3 WHS INC
 
Yes
 
(9)WELLSTAR SYLVAN GROVE HOSPITAL INC
793 SAWYER ROAD

MARIETTA,GA30062
81-0875069 		HEALTHCARE GA 501(C)(3) 3 WHS INC
 
Yes
 
(10)WEST GEORGIA HEALTH SERVICES INC
793 SAWYER ROAD

MARIETTA,GA30062
20-5497622 		HEALTHCARE GA 501(C)(3) 12 II WHS INC
 
Yes
 
(11)WEST GEORGIA MEDICAL CENTER INC
793 SAWYER ROAD

MARIETTA,GA30062
20-5497506 		HEALTHCARE GA 501(C)(3) 3 WGHS INC
 
Yes
 
(12)VERNON WOODS RETIREMENT COMMUNITY INC
793 SAWYER ROAD

MARIETTA,GA30062
58-2575049 		HEALTHCARE GA 501(C)(3) 10 WGHS INC
 
Yes
 
(13)WEST GEORGIA HEALTH FOUNDATION INC
793 SAWYER ROAD

MARIETTA,GA30062
20-0936376 		FOUNDATION GA 501(C)(3) 12 II WGHS INC
 
Yes
 
(14)COBB HOSPITAL INC
793 SAWYER ROAD

MARIETTA,GA30062
58-0968382 		HEALTHCARE GA 501(C)(3) 3 WHS INC
 
Yes
 
(15)MEDICAL PARK FOUNDATION INC
1514 VERNON ROAD

LAGRANGE,GA30240
58-1303478 		FOUNDATION GA 501(C)(3) 7 WGHS INC
 
Yes
 
For Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 50135Y
Schedule R (Form 990) 2019
Schedule R (Form 990) 2019
Page 2
Part III
Identification of Related Organizations Taxable as a Partnership. Complete if the organization answered "Yes" on Form 990, Part IV, line 34, because it had one or more related organizations treated as a partnership during the tax year.
(a)
Name, address, and EIN of
related organization



 		(b)
Primary activity




 		(c)
Legal
domicile
(state or foreign
country)


 		(d)
Direct controlling
entity



 		(e)
Predominant income(related, unrelated, excluded from tax under sections 512-514)

(f)
Share of total income




 		(g)
Share of end-of-year
assets



 		(h)
Disproprtionate allocations?




 		(i)
Code V-UBI
amount in box 20 of
Schedule K-1
(Form 1065)
 		(j)
General or
managing
partner?



 		(k)
Percentage
ownership
Yes No Yes No
(1) COBB SOUTH PARKING DECK

793 SAWYER ROAD
MARIETTA,GA300622222
75-2999669 		PARKING GA NA
  		N/A                
(2) KENNESTONE EAST PARKING DECK LLC

793 SAWYER ROAD
MARIETTA,GA300622222
20-0537100 		PARKING GA NA
  		N/A                
(3) GRIFFIN IMAGING LLC

793 SAWYER ROAD
MARIETTA,GA300622222
 IMAGING CENTER GA NA
  		N/A                
(4) TENET EMSSPALDING 911 LLC

793 SAWYER ROAD
MARIETTA,GA300622222
 OFF. BLDG/EMS CTR GA NA
  		N/A                
(5) NORTH FULTON PARKING DECK LP

793 SAWYER ROAD
MARIETTA,GA300622222
 PARKING GA N FULTON HOSP
  		EXCLUDED 0 0   No 0   No 89.840 %




Part IV
Identification of Related Organizations Taxable as a Corporation or Trust. Complete if the organization answered "Yes" on Form 990, Part IV, line 34 because it had one or more related organizations treated as a corporation or trust during the tax year.
(a)
Name, address, and EIN of
related organization
 		(b)
Primary activity
 		(c)
Legal
domicile
(state or foreign
country)
 		(d)
Direct controlling
entity
 		(e)
Type of entity
(C corp, S corp,
or trust) 		(f)
Share of total income
 		(g)
Share of end-of-year
assets
 		(h)
Percentage
ownership
 		(i)
Section 512(b)(13) controlled entity?
Yes No
(1) COMMUNITY ASSURANCE CO

3RD FL BARCLAYS HSE SHEDDEN RD
GEORGE TOWN    
CJ
58-1649541 		INSURANCE CJ WHS INC
  		C CORP          
(2) WEST GEORGIA HEALTH PHYSICIANS INC

793 SAWYER ROAD
MARIETTA,GA300622222
27-5125341 		PHYSICIAN PRAC. GA WGHS INC
  		C CORP          










Schedule R (Form 990) 2019
Schedule R (Form 990) 2019
Page 3
Part V
Transactions With Related Organizations. Complete if the organization answered "Yes" on Form 990, Part IV, line 34, 35b, or 36.
Note. Complete line 1 if any entity is listed in Parts II, III, or IV of this schedule.
Yes
No
1 During the tax year, did the orgranization engage in any of the following transactions with one or more related organizations listed in Parts II-IV?
a Receipt of (i) interest, (ii) annuities, (iii) royalties, or (iv) rent from a controlled entity .....................
1a
 
No
b Gift, grant, or capital contribution to related organization(s) ............................
1b
 
No
c Gift, grant, or capital contribution from related organization(s) ............................
1c
 
No
d Loans or loan guarantees to or for related organization(s) ............................
1d
 
No
e Loans or loan guarantees by related organization(s) ............................
1e
 
No
f Dividends from related organization(s) ............................
1f
 
No
g Sale of assets to related organization(s) ............................
1g
 
No
h Purchase of assets from related organization(s) ............................
1h
 
No
i Exchange of assets with related organization(s) ............................
1i
 
No
j Lease of facilities, equipment, or other assets to related organization(s) .......................
1j
 
No
k Lease of facilities, equipment, or other assets from related organization(s) ......................
1k
Yes
 
l Performance of services or membership or fundraising solicitations for related organization(s) .....................
1l
 
No
m Performance of services or membership or fundraising solicitations by related organization(s) .................
1m
 
No
n Sharing of facilities, equipment, mailing lists, or other assets with related organization(s) ...................
1n
 
No
o Sharing of paid employees with related organization(s) ............................
1o
 
No
p Reimbursement paid to related organization(s) for expenses ............................
1p
Yes
 
q Reimbursement paid by related organization(s) for expenses ............................
1q
 
No
r Other transfer of cash or property to related organization(s) ............................
1r
 
No
s Other transfer of cash or property from related organization(s) ............................
1s
 
No
2
If the answer to any of the above is "Yes," see the instructions for information on who must complete this line, including covered relationships and transaction thresholds.
(a)
Name of related organization 		(b)
Transaction
type (a-s) 		(c)
Amount involved 		(d)
Method of determining amount involved





Schedule R (Form 990) 2019
Schedule R (Form 990) 2019
Page 4
Part VI
Unrelated Organizations Taxable as a Partnership. Complete if the organization answered "Yes" on Form 990, Part IV, line 37.
Provide the following information for each entity taxed as a partnership through which the organization conducted more than five percent of its activities (measured by total assets or gross revenue) that was not a related organization. See instructions regarding exclusion for certain investment partnerships.
(a)
Name, address, and EIN of entity 		(b)
Primary activity 		(c)
Legal domicile
(state or foreign
country) 		(d)
Predominant income (related, unrelated, excluded from tax under sections 512-514)

(e)
Are all partners
section
501(c)(3)
organizations? 		(f)
Share of total income




 		(g)
Share of
end-of-year
assets 		(h)
Disproprtionate allocations? 		(i)
Code V-UBI
amount in box 20
of Schedule K-1
(Form 1065) 		(j)
General or
managing
partner? 		(k)
Percentage
ownership
Yes No Yes No Yes No






























Schedule R (Form 990) 2019
Schedule R (Form 990) 2019
Page 5
Part VII
Supplemental Information
Provide additional information for responses to questions on Schedule R. (see instructions).
Return Reference Explanation
Schedule R (Form 990) 2019

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