2024-05-15T14:30:53-05:00 2023-06-30 PwC US Tax LLP 2001 MARKET ST SUITE 1800 PHILADELPHIA PA 19103 990 2022-07-01 200936376 WEST GEORGIA HEALTH FOUNDATION % JAMES M SWARTZ WEST 7709567827 793 SAWYER ROAD Marietta GA 300622222 JAMES M SWARTZ VP ACCOUNTING 7709567827 2024-05-15 true JAMES M SWARTZ 999009999 JOANNE KRUEGER P01235586 2673303000 2024-05-14 2 2022 2023-04-26 12:10:37Z CANDICE L SAUNDERS 793 SAWYER ROAD Marietta GA 300622222 1327881 false X www.wghealth.org X 2004 GA TO SUPPORT THE CHARITABLE ACTIVITIES OF WEST GEORGIA MEDICAL CENTER, INC. AND ITS AFFILIATES. 17 13 0 6 0 0 537507 1117236 0 0 235888 61885 58684 56396 832079 1235517 183643 145350 0 0 0 0 0 0 0 132948 120286 316591 265636 515488 969881 7492526 8941592 0 0 7492526 8941592 THE FOUNDATION OPERATES EXCLUSIVELY FOR THE BENEFIT OF THE WEST GEORGIA MEDICAL CENTER, INC. AND ITS AFFILIATED ENTITIES. false false 84846 TO PROVIDE FUNDS FOR THE SUPPORT OF WEST GEORGIA MEDICAL CENTER, INC. AND ITS AFFILIATES. SUPPORT INCLUDES BEREAVEMENT SERVICES, HOSPITAL VOLUNTEER PROGRAM, CAMP DOGWOOD - A GRIEF CAMP FOR CHILDREN AND THE CANCER CENTER. 124000 124000 TO PROVIDE FINANCIAL SUPPORT TO WEST GEORGIA MEDICAL CENTER, INC. FOR THE OPERATION OF THE HOSPITAL AND HOSPICE CENTER 21350 21350 HELPING HANDS FAMILY ASSISTANCE PROGRAM- TO ASSIST PRESENT AND RETIRED WEST GEORGIA HEALTH SERVICES, INC. EMPLOYEES AND HOSPITAL AUXILIARY VOLUNTEERS WITH FINANCIAL SUPPORT IN TIMES OF CRISIS. QUALIFYING HARDSHIPS INCLUDE CATASTROPHIC ILLNESS OR ACCIDENT SUFFERED BY A RECIPIENT OR AN UNINSURED LOSS TO A PRIMARY RESIDENCE CAUSED BY FIRE OR OTHER MAJOR INCIDENT OF DISASTER. FROM JULY 1, 2022 TO JUNE 30, 2023, THE HELPING HANDS PROGRAM ASSISTED 43 WEST GEORGIA HEALTH SERVICES, INC. EMPLOYEES BY PROVIDING $21,350 IN MONETARY ASSISTANCE. 230196 true true false false false false false false true false false false false false true false true false false false false false false true false false true true true false false false false false false false false false false false false false true true false false false true 0 0 0 false false false false false false false false false false false false X 17 13 false false false false true true true true true false false true true true true true true true true false GA X JAMES M SWARTZ 7709567827 793 SAWYER ROAD Marietta GA 300622222 X CANDICE SAUNDERS PRESIDENT & CEO 1.0 49.0 X 0 4720755 100914 ANTHONY JBUDZINSKI EVP & CFO 1.0 49.0 X 0 1443498 104441 KEM MULLINS EVP AMBULATORY OPS & BUS DEV 1.0 49.0 X 0 1332979 76074 LEO REICHERT EVP & GENERAL COUNSEL 1.0 49.0 X 0 1228867 113976 RICHARD CAPPS EVP CHIEF INFO & DIGITAL OFFCR 1.0 49.0 X 0 1000018 100619 DAVID JONES EVP CHIEF HUMAN RESOURCE OFFR 1.0 49.0 X 0 949916 82871 ALAN MUSTER SVP SPECIALTY DIVISION WMG 1.0 49.0 X 0 894807 129576 PAUL DOUGLASSMD TRUSTEE & PHYSICIAN 1.0 49.0 X 0 932264 86958 VALERY AKOPOV SVP HOSPITAL DIVISION WMG 1.0 49.0 X 0 870583 76618 MARY TAVERNARO VP HUMAN RESOURCES OPERATIONS 1.0 49.0 X 0 777941 89218 ARIF AZIZMD TRUSTEE & PHYSICIAN 1.0 49.0 X 0 777830 83860 JULIE TEER SVP & WELLSTAR FOUNDATION PRES 1.0 49.0 X 0 782757 44404 JILL CASE-WIRTH SVP NURSING SERVICES CNE 1.0 49.0 X 0 742873 83113 JOSEPH REPPERT SVP FINANCE 1.0 49.0 X 0 690454 95203 DAVID PRESTON VP BRAND AND MARKETING 1.0 49.0 X 0 703118 70247 BETH KOST SVP CHIEF COMPLIANCE OFFICER 1.0 49.0 X 0 691634 81349 BARBARA COREY SVP MANAGED CARE 1.0 49.0 X 0 680289 86109 STEPHEN BADGER VP WMG STRATEGIC SERVICES 1.0 49.0 X 0 644783 105925 MICHAEL MCCULLOUGH SVP SUPPLY CHAIN 1.0 49.0 X 0 654943 83801 SOPHIA MCINTYRE SVP WMG AMBULATORY CARE DIV 1.0 49.0 X 0 659354 68619 PRANAV JAIN VP & CHIEF MEDICAL INFO OFF 1.0 49.0 X 0 605987 76233 JAMES LORIMER SVP HR CONSULTING 1.0 49.0 X 0 574480 90327 LE JOYCE NAYLOR SVP & CHIEF DIVERSITY & INCLUS 1.0 49.0 X 0 571437 78912 PETER R JUNGBLUT MD MBA FORMER SVP & MEDICAL DIRECTOR 1.0 49.0 X 0 547173 102121 JASON STEVENS SVP DEPUTY GENERAL COUNSEL 1.0 49.0 X 0 544156 86389 PAUL MURPHREE VP MEDICAL OUTCOMES 1.0 49.0 X 0 524594 96084 SNEHAL DOSHI SVP ANCILLARY AND SUPPORT SVC 1.0 49.0 X 0 536084 78276 ROB SCHREINER EVP CHIEF PHYS EXEC(END 11/22) 1.0 49.0 X 0 600814 12100 MATTHEW TERRY SVP CHIEF STRATEGY OFFICER 1.0 49.0 X 0 546061 55233 LAURA DANNELS VP & CHIEF TALENT OFFICER 1.0 49.0 X 0 523552 53977 JOEL SHU VP WELLSTAR CLINICAL PARTNERS 1.0 49.0 X 0 560173 11384 DANIEL ABAD VP TOTAL REWARDS & CHIEF TM EN 1.0 49.0 X 0 499724 71499 JAMES L HORNSBY TRUSTEE & PHYSICAN 1.0 49.0 X 0 481277 87668 SUSAN GRANT EVP CHIEF EXPERIENCE OFF & CNE 1.0 49.0 X 0 496268 60437 JENNIFER GIUSTI VP CLINICAL OUTCOMES 1.0 49.0 X 0 468356 86513 LINDA HUFFER VP POST ACUTE SERVS (END 2/23) 1.0 49.0 X 0 460218 77544 AVRIL BECKFORD MD TRUSTEE & SLL PEDIATRIC PHYSIC 1.0 49.0 X 0 421672 94438 ANDREW COX VP CHIEF OF STAFF & LEADERSHIP 1.0 49.0 X 0 443370 69062 JOHN BRENNAN FMR EVP CCIO (END 6/22) 1.0 49.0 X 0 449075 53326 KATHARINE LEONARD VP REAL ESTATE & FACILITY DVLP 1.0 49.0 X 0 423246 79022 ELIZABETH LOUDERMILK VP FINANCIAL PLANNING 1.0 49.0 X 0 395803 90664 WILLIAM BELLANDO SVP CHIEF INFO OFFICER 1.0 49.0 X 0 399812 79882 SANDRA LUCIUS VP HEAD OF CARE PLATFORMS 1.0 49.0 X 0 399593 72936 ANDREW VON ESCHENBACH VP REV. CYCLE MGMT (END 10/22) 1.0 49.0 X 0 377418 74706 DANYALE ZIGLOR VP HUMAN RESOURCE 1.0 49.0 X 0 368119 83918 JOSEPH BRAUD VP INFO SECURITY & CISO 1.0 49.0 X 0 387133 52039 KIMBERLY TAACA VP WMG OPS SPECIALTY DIV 1.0 49.0 X 0 366154 72512 VARMA RAMESWAR VP PEDIATRIC OPS AND SVC LINE 1.0 49.0 X 0 351266 83295 NICKOLOS YAITSKY VP HEAD OF DIGITAL PLATFORMS 1.0 49.0 X 0 371939 61196 MAXWELL KAGAN VP FINANCE & CFO WMG 1.0 49.0 X 0 370500 58554 THOMAS DRAPER VP CARDIOVASCULAR SERVICE LINE 1.0 49.0 X 0 341702 72280 JAMES SWARTZ VP ACCOUNTING 1.0 49.0 X 0 348791 62867 ELIZABETH PAPETTI FORMER VP WMG OPS HOSP DIV 1.0 49.0 X 0 361729 49503 MARK ROWE VP TALENT ACQUISITION 1.0 49.0 X 0 339924 70691 FREDA LYON VP SYSTEM EMERGENCY SERVICES 1.0 49.0 X 0 332143 70492 SANA BRUNO VP LABORATORY SERVICES SYSTEM 1.0 49.0 X 0 333331 64703 JESSICA KOVALESKY VP CARE COORDINATION & POP HLT 1.0 49.0 X 0 365114 28900 SUSAN WRIGHT VP PHARMACY SVCS 1.0 49.0 X 0 325927 65003 KRISTEN TRICE VP DIAGNOSTIC OUTREACH 1.0 49.0 X 0 313416 75364 STEVEN HUNT VP HUMAN RESOURCE 1.0 49.0 X 0 309426 79195 DONALD ZARKOU VP OF ONCOLOGY SERVICE LINE 1.0 49.0 X 0 306613 76044 CAROL TODD VP ASST GENERAL COUNSEL 1.0 49.0 X 0 302337 77616 JOE CASTANON VP CONTRACTING & VAL ANALYSIS 1.0 49.0 X 0 330488 48737 STEPHEN VAULT VP STRATEGIC COMMUNITY DEVELOP 1.0 49.0 X 0 325196 50279 JESSICA ROSENBERG VP PHILANTHROPY 1.0 49.0 X 0 327713 42986 SHARON ROBINSON VP FOUNDATION STRATEGY & GRWTH 1.0 49.0 X 0 313277 48989 MARCUS CHARLSON VP SURGERY & ORTHOPEDICS SVCS 1.0 49.0 X 0 309869 42630 ROBERT DECOUX VP CORPORATE MED STAFF SVCS 1.0 49.0 X 0 260599 85350 ELLEN RUSSELL VP HIM CDI & POLICIES 1.0 49.0 X 0 278658 51108 MICHAEL GARRARD VP REHAB & SPORTS MED SVCS 1.0 49.0 X 0 247560 42700 JEREMY STEFFENS VP ORGANIZATIONAL COMM. 1.0 49.0 X 0 272436 10369 REBECCA RUHL FMR VP COMPL. CPO (END 5/22) 1.0 49.0 X 0 196424 27250 OTIS A BRUMBYIII TRUSTEE 1.0 11.0 X 0 49272 0 TFITZ JOHNSON TRUSTEE 1.0 11.0 X 0 44188 0 CHARLES BROCK TRUSTEE 1.0 11.0 X 0 40288 0 RANDALL BENTLEY SR FORMER DIRECTOR 0.0 0.0 X 0 39099 0 DAVID HAFNER FORMER DIRECTOR 0.0 0.0 X 0 24599 0 MITZI MOORE TRUSTEE 1.0 11.0 X 0 10343 0 ED RICHARDSON TRUSTEE 1.0 11.0 X 0 8982 0 FRANK ROS TRUSTEE 1.0 11.0 X 0 7261 0 JAMES HOLMES TRUSTEE 1.0 11.0 X 0 7111 0 AMBICA YADAV TRUSTEE 1.0 11.0 X 0 6817 0 SCOTT SWAYZE MD TRUSTEE 1.0 11.0 X 0 5199 0 JAY CUNNINGHAM TRUSTEE 1.0 11.0 X 0 4753 0 MARK BERRY TRUSTEE 1.0 11.0 X 0 3630 0 H SPEER BURDETTE III TRUSTEE 1.0 11.0 X 0 3227 0 GREG MORGAN TRUSTEE 1.0 11.0 X 0 3160 0 JOHN MCKIBBEN TRUSTEE 1.0 11.0 X 0 2654 0 DAVID BOTTOMS TRUSTEE (BEG 2/23) 1.0 11.0 X 0 0 0 0 24022896 2197877 0 true true false 0 35536 1081700 0 1117236 0 166284 166284 0 0 0 0 0 -104399 -104399 -104399 -104399 148760 35536 92364 56396 56396 0 0 0 0 0 0 0 0 0 1235517 0 118281 124000 124000 21350 21350 0 0 0 0 0 0 0 0 0 0 0 0 0 35440 35440 0 0 603 603 0 0 0 0 0 0 0 0 0 0 REPAIRS & MAINTENANCE 3348 3348 PATIENT SERVICE EXPENSES 10358 10358 SHUTTLE EXPENSE 50000 50000 EDUCATION 415 415 20122 20122 265636 230196 35440 0 0 0 0 0 77029 64809 0 0 0 0 0 0 0 0 0 0 0 0 0 0 7415497 8876783 0 0 0 0 0 0 0 0 7492526 8941592 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 X -50000 -50000 7542526 8991592 7492526 8941592 7492526 8941592 969881 479185 X false true X true false X X 1 WEST GEORGIA MEDICAL CENTER INC 205497506 3 true 124000 0 1 124000 true false false false false false false false false false false false false false false true RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 7492524 1251388 505631 124000 183952 8941591 8141093 734272 -968322 123714 290803 7492526 19685613 822150 3345351 528775 15183246 8141093 18958227 570516 483424 90000 236554 19685613 17672892 631904 954755 90000 211324 18958227 0.05000 0.95000 false false 0 0 X Schedule D, Part V, Line 4 Use of Organization's Endowment Funds: Net Assets are released from restrictions when expenses are incurred to satisfy the restricted purposes, by passage of time or by occurrence of specific events. Net assets released during the year were primarily for the contributions and support of construction of additional facilities, specific medical and cancer treatment equipment, and the hospice program of Lagrange-Troup County Hospital Authority. SCHEDULE D, PART X, LINE 2 THE FOLLOWING FOOTNOTE IS RELATED TO THE ORGANIZATIONS APPLICATION OF FASB ASC 740 (PREVIOUSLY FIN 48): "WELLSTAR AND IT 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. 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. WELLSTAR HAS EVALUATED ITS TAX POSITIONS AND DOES NOT BELIEVE THERE ARE ANY MATERIAL UNRECOGNIZED TAX BENEFITS OR OBLIGATIONS AS OF JUNE 30, 2023, OR 2022. GOLF OUTING 125371 35536 89835 21226 24677 4380 8902 POINSETTIA SALE 49398 49398 229 28259 2 9526 9526 4690 184295 35536 148759 21226 24677 4609 41851 92363 56396 true WEST GEORGIA MEDICAL CENTER INC 1514 VERNON ROAD LAGRANGE GA 30240 205497506 501(C)(3) 124000 FMV N/A PROGRAM SUPPORT 1 0 Helping Hands Employee Program 43 21350 0 FMV N/A SCHEDULE I, PART I, LINE 2 PROCEDURE FOR MONITORING THE USE OF GRANTS: FUNDS WERE USED TO SUPPORT WEST GEORGIA MEDICAL CENTER, INC., A RELATED 501(C)(3) ORGANIZATION AND OTHER AFFILIATED HEALTHCARE PROVIDERS. THE HELPING HANDS FAMILY ASSISTANCE PROGRAM IS AN EMPLOYEE EMERGENCY ASSISTANCE PROGRAM. true true false false false false false true false ALAN MUSTER SVP SPECIALTY DIVISION WMG 0 550318 0 327121 0 17368 0 54730 0 74846 0 1024383 0 0 ANDREW COX VP CHIEF OF STAFF & LEADERSHIP 0 323931 0 74635 0 44804 0 22026 0 47036 0 512432 0 35289 ANDREW VON ESCHENBACH VP REV. CYCLE MGMT (END 10/22) 0 188462 0 0 0 188956 0 31841 0 42865 0 452124 0 0 ANTHONY JBUDZINSKI EVP & CFO 0 859990 0 557287 0 26221 0 51631 0 52810 0 1547939 0 0 ARIF AZIZMD TRUSTEE & PHYSICIAN 0 534616 0 230896 0 12318 0 41021 0 42839 0 861690 0 0 AVRIL BECKFORD MD TRUSTEE & SLL PEDIATRIC PHYSIC 0 102626 0 307089 0 11957 0 28061 0 66377 0 516110 0 0 BARBARA COREY SVP MANAGED CARE 0 433768 0 228697 0 17824 0 25985 0 60124 0 766398 0 0 BETH KOST SVP CHIEF COMPLIANCE OFFICER 0 440842 0 232819 0 17973 0 32178 0 49171 0 772983 0 0 CANDICE SAUNDERS PRESIDENT & CEO 0 1729808 0 2512996 0 477951 0 50240 0 50674 0 4821669 0 446498 CAROL TODD VP ASST GENERAL COUNSEL 0 236711 0 54643 0 10983 0 29783 0 47833 0 379953 0 0 DANIEL ABAD VP TOTAL REWARDS & CHIEF TM EN 0 377350 0 113098 0 9276 0 46607 0 24892 0 571223 0 0 DANYALE ZIGLOR VP HUMAN RESOURCE 0 273065 0 83691 0 11363 0 47970 0 35948 0 452037 0 0 DAVID HAFNER FORMER DIRECTOR 0 24599 0 0 0 0 0 0 0 0 0 24599 0 0 DAVID JONES EVP CHIEF HUMAN RESOURCE OFFR 0 561730 0 362673 0 25513 0 54256 0 28615 0 1032787 0 0 DAVID PRESTON VP BRAND AND MARKETING 0 393618 0 200097 0 109403 0 31746 0 38501 0 773365 0 93972 DONALD ZARKOU VP OF ONCOLOGY SERVICE LINE 0 240011 0 51874 0 14728 0 28509 0 47535 0 382657 0 0 ELIZABETH LOUDERMILK VP FINANCIAL PLANNING 0 312289 0 71760 0 11754 0 39289 0 51375 0 486467 0 0 ELIZABETH PAPETTI FORMER VP WMG OPS HOSP DIV 0 283335 0 68883 0 9511 0 26424 0 23079 0 411232 0 0 ELLEN RUSSELL VP HIM CDI & POLICIES 0 218164 0 50631 0 9863 0 16655 0 34453 0 329766 0 0 FREDA LYON VP SYSTEM EMERGENCY SERVICES 0 256385 0 59414 0 16344 0 31884 0 38608 0 402635 0 0 JAMES L HORNSBY TRUSTEE & PHYSICAN 0 348944 0 118838 0 13495 0 39387 0 48281 0 568945 0 0 JAMES LORIMER SVP HR CONSULTING 0 340001 0 65250 0 169229 0 43016 0 47311 0 664807 0 0 JAMES SWARTZ VP ACCOUNTING 0 276257 0 63480 0 9054 0 23108 0 39759 0 411658 0 0 JASON STEVENS SVP DEPUTY GENERAL COUNSEL 0 344679 0 184905 0 14572 0 46935 0 39454 0 630545 0 0 JENNIFER GIUSTI VP CLINICAL OUTCOMES 0 368458 0 85167 0 14731 0 48809 0 37704 0 554869 0 0 JEREMY STEFFENS VP ORGANIZATIONAL COMM. 0 181448 0 49746 0 41242 0 2440 0 7929 0 282805 0 0 JESSICA KOVALESKY VP CARE COORDINATION & POP HLT 0 282652 0 70950 0 11512 0 16217 0 12683 0 394014 0 0 JESSICA ROSENBERG VP PHILANTHROPY 0 250000 0 68654 0 9059 0 32979 0 10007 0 370699 0 0 JILL CASE-WIRTH SVP NURSING SERVICES CNE 0 417661 0 220704 0 104508 0 53559 0 29554 0 825986 0 83532 JOE CASTANON VP CONTRACTING & VAL ANALYSIS 0 250016 0 55719 0 24753 0 4718 0 44019 0 379225 0 0 JOEL SHU VP WELLSTAR CLINICAL PARTNERS 0 452655 0 99305 0 8213 0 2828 0 8556 0 571557 0 0 JOHN BRENNAN FMR EVP CCIO (END 6/22) 0 439257 0 0 0 9818 0 32500 0 20826 0 502401 0 0 JOSEPH BRAUD VP INFO SECURITY & CISO 0 304996 0 70084 0 12053 0 5758 0 46281 0 439172 0 0 JOSEPH REPPERT SVP FINANCE 0 468436 0 206546 0 15472 0 53669 0 41534 0 785657 0 0 JULIE TEER SVP & WELLSTAR FOUNDATION PRES 0 540829 0 227468 0 14460 0 11705 0 32699 0 827161 0 0 KATHARINE LEONARD VP REAL ESTATE & FACILITY DVLP 0 335997 0 77708 0 9541 0 46319 0 32703 0 502268 0 0 KEM MULLINS EVP AMBULATORY OPS & BUS DEV 0 782548 0 533284 0 17147 0 24000 0 52074 0 1409053 0 0 KIMBERLY TAACA VP WMG OPS SPECIALTY DIV 0 286732 0 69703 0 9719 0 46419 0 26093 0 438666 0 0 KRISTEN TRICE VP DIAGNOSTIC OUTREACH 0 219832 0 83614 0 9970 0 26615 0 48749 0 388780 0 0 LAURA DANNELS VP & CHIEF TALENT OFFICER 0 356383 0 155925 0 11244 0 27514 0 26463 0 577529 0 0 LE JOYCE NAYLOR SVP & CHIEF DIVERSITY & INCLUS 0 350002 0 142218 0 79217 0 53952 0 24960 0 650349 0 0 LEO REICHERT EVP & GENERAL COUNSEL 0 728231 0 469073 0 31563 0 53270 0 60706 0 1342843 0 0 LINDA HUFFER VP POST ACUTE SERVS (END 2/23) 0 325323 0 75255 0 59640 0 52337 0 25207 0 537762 0 32532 MARCUS CHARLSON VP SURGERY & ORTHOPEDICS SVCS 0 244138 0 56600 0 9131 0 332 0 42298 0 352499 0 0 MARK ROWE VP TALENT ACQUISITION 0 290014 0 39572 0 10338 0 27530 0 43161 0 410615 0 0 MARY TAVERNARO VP HUMAN RESOURCES OPERATIONS 0 303530 0 70247 0 404164 0 33343 0 55875 0 867159 0 390950 MATTHEW TERRY SVP CHIEF STRATEGY OFFICER 0 389210 0 144948 0 11903 0 11349 0 43884 0 601294 0 0 MAXWELL KAGAN VP FINANCE & CFO WMG 0 290341 0 70574 0 9585 0 26102 0 32452 0 429054 0 0 MICHAEL GARRARD VP REHAB & SPORTS MED SVCS 0 195000 0 45550 0 7010 0 19464 0 23236 0 290260 0 0 MICHAEL MCCULLOUGH SVP SUPPLY CHAIN 0 416953 0 220331 0 17659 0 32249 0 51552 0 738744 0 0 NICKOLOS YAITSKY VP HEAD OF DIGITAL PLATFORMS 0 294010 0 68059 0 9870 0 11158 0 50038 0 433135 0 0 PAUL DOUGLASSMD TRUSTEE & PHYSICIAN 0 427675 0 491412 0 13177 0 41319 0 45639 0 1019222 0 0 PAUL MURPHREE VP MEDICAL OUTCOMES 0 412782 0 95352 0 16460 0 52457 0 43627 0 620678 0 0 PETER R JUNGBLUT MD MBA FORMER SVP & MEDICAL DIRECTOR 0 394602 0 150771 0 1800 0 53015 0 49106 0 649294 0 0 PRANAV JAIN VP & CHIEF MEDICAL INFO OFF 0 460000 0 136147 0 9840 0 47014 0 29219 0 682220 0 0 RANDALL BENTLEY SR FORMER DIRECTOR 0 39099 0 0 0 0 0 0 0 0 0 39099 0 0 REBECCA RUHL FMR VP COMPL. CPO (END 5/22) 0 22276 0 1000 0 173148 0 2400 0 24850 0 223674 0 93846 RICHARD CAPPS EVP CHIEF INFO & DIGITAL OFFCR 0 642811 0 339097 0 18110 0 47276 0 53343 0 1100637 0 0 ROB SCHREINER EVP CHIEF PHYS EXEC(END 11/22) 0 0 0 0 0 600814 0 0 0 12100 0 612914 0 0 ROBERT DECOUX VP CORPORATE MED STAFF SVCS 0 199627 0 46372 0 14600 0 42367 0 42983 0 345949 0 0 SANA BRUNO VP LABORATORY SERVICES SYSTEM 0 234998 0 53999 0 44334 0 22145 0 42558 0 398034 0 0 SANDRA LUCIUS VP HEAD OF CARE PLATFORMS 0 287332 0 66874 0 45387 0 53292 0 19644 0 472529 0 28820 SHARON ROBINSON VP FOUNDATION STRATEGY & GRWTH 0 250104 0 54237 0 8936 0 24764 0 24225 0 362266 0 0 SNEHAL DOSHI SVP ANCILLARY AND SUPPORT SVC 0 368212 0 153933 0 13939 0 31703 0 46573 0 614360 0 0 SOPHIA MCINTYRE SVP WMG AMBULATORY CARE DIV 0 446358 0 198454 0 14542 0 53810 0 14809 0 727973 0 0 STEPHEN BADGER VP WMG STRATEGIC SERVICES 0 413613 0 108263 0 122907 0 53696 0 52229 0 750708 0 44650 STEPHEN VAULT VP STRATEGIC COMMUNITY DEVELOP 0 256498 0 58940 0 9758 0 26381 0 23898 0 375475 0 0 STEVEN HUNT VP HUMAN RESOURCE 0 241179 0 58859 0 9388 0 26215 0 52980 0 388621 0 0 SUSAN GRANT EVP CHIEF EXPERIENCE OFF & CNE 0 290768 0 50000 0 155500 0 50889 0 9548 0 556705 0 149999 SUSAN WRIGHT VP PHARMACY SVCS 0 256267 0 59587 0 10073 0 32986 0 32017 0 390930 0 0 THOMAS DRAPER VP CARDIOVASCULAR SERVICE LINE 0 269464 0 62419 0 9819 0 25861 0 46419 0 413982 0 0 VALERY AKOPOV SVP HOSPITAL DIVISION WMG 0 542038 0 306698 0 21847 0 32907 0 43711 0 947201 0 0 VARMA RAMESWAR VP PEDIATRIC OPS AND SVC LINE 0 251047 0 88722 0 11497 0 53774 0 29521 0 434561 0 0 WILLIAM BELLANDO SVP CHIEF INFO OFFICER 0 319247 0 66040 0 14525 0 33934 0 45948 0 479694 0 0 SCHEDULE J, PART I, LINE 4A 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 SCHEDULE 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 2022 CALENDAR YEAR FROM EITHER THE ORGANIZATION OR A RELATED ORGANIZATION: ANDREW VON ESCHENBACH 161,539 JEREMY STEFFENS 29,424 REBECCA RUHL 74,253 ROB SCHREINER 600,814 STEPHEN BADGER 51,519 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): ANDREW COX 35,289 CANDICE SAUNDERS 446,498 DAVID PRESTON 93,972 JILL CASE-WIRTH 83,512 LINDA HUFFER 32,532 MARY TAVERNARO 390,950 REBECCA RUHL 93,846 SANDRA LUCIUS 28,820 STEPHEN BADGER 44,650 SUSAN GRANT 149,999 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. (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. Form 990, Part I, Lines 7A and 7B FORM 990, PART I, LINES 7A AND 7B UNRELATED BUSINESS INCOME WEST GEORGIA HEALTH FOUNDATION, INC. GENERATED NO UNRELATED BUSINESS INCOME ("UBI") FOR THE REPORTING YEAR. AS A RESULT THE FILED 990-T SHOWS NO ACTIVITY. IF SUBSEQUENT REVIEW OF THE BOOKS REVEALS ANY UNREPORTED UBI WE WILL FILE AN AMENDED RETURN FOR THE TAX PERIOD ENDED JUNE 30, 2023. FORM 990, PART IV, LINE 12B AUDITED FINANCIAL STATEMENTS WELLSTAR HEALTH SYSTEM, INC., AND ITS CONTROLLED AFFILIATES ARE AUDITED ON AN ANNUAL BASIS BY AN OUTSIDE AUDITING FIRM, KPMG, AND AS PART OF THAT AUDIT A CONSOLIDATED FINANCIAL STATEMENT IS ISSUED. THE INDEPENDENT AUDITORS REPORT INCLUDES THE ACCOUNTS OF WELLSTAR AND ITS CONTROLLED AFFILIATES INCLUDING COBB HOSPITAL, INC., DOUGLAS HOSPITAL INC., KENNESTONE HOSPITAL, INC., PAULDING MEDICAL CENTER, INC., WELLSTAR ATLANTA MEDICAL CENTER, INC., WELLSTAR NORTH FULTON HOSPITAL, INC., WELLSTAR SPALDING REGIONAL MEDICAL CENTER, INC., WELLSTAR SYLVAN GROVE HOSPITAL, INC., WELLSTAR WEST GEORGIA MEDICAL CENTER, INC., WINDY HILL HOSPITAL, WELLSTAR MEDICAL GROUP, LLC AND VARIOUS OTHER OWNED ENTITIES AS LISTED IN SCHEDULE R. ALL SIGNIFICANT INTERCOMPANY ACCOUNTS AND TRANSACTIONS HAVE BEEN ELIMINATED IN COMBINATION. FORM 990, PART V, 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, PWC US TAX LLP, REVIEWS AND SIGN-OFFS ON THE COMPLETED RETURN OF EACH ORGANIZATION. 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 A, LINE 4 EFFECTIVE APRIL 2022, WELLSTAR HEALTH SYSTEM THROUGH BOARD RESOLUTION CHANGED THE COMPOSITION OF THE OFFICERS OF THE ORGANIZATION. FORM 990, PART VI, SECTION A, LINE 6 THE SOLE CORPORATE MEMBER IS WELLSTAR HEALTH SYSTEM, INC. FORM 990, PART VI, SECTION A, LINES 7A & 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 A 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 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 AND COMPENSATION COMMITTEE 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. THE CEO AND CHIEF HUMAN RESOURCES OFFICERS PARTICIPATE IN AN ADVISORY ROLE, AND NOT AS VOTING MEMBERS. FURTHER IN COMMITTEE DISCUSSIONS ABOUT THE COMPENSATION FOR THE CHIEF EXECUTIVE OFFICER, THE CEO RECUSES HIM/HERSELF FROM THAT PROCESS. 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 FULLY SUSTAINED AT A SATISFACTORY 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 A COMMUNITY BENEFIT REPORT ONCE A YEAR FOR DISTRIBUTION TO THE PUBLIC. IN ACCORDANCE WITH O.C.G.A. SECTION 31-7-22 AND THE GEORGIA DEPARTMENT OF COMMUNITY HEALTH'S RULES AND REGULATIONS FOR HOSPITAL TRANSPARENCY CHAPTER 111-8-41 THE APPLICABLE DOCUMENTS ARE POSTED ON THE WELLSTAR.ORG WEBSITE IN THE WELLSTAR HOSPITAL TRANSPARENT INFORMATION SECTION. UNDER ITS CONTINUING DISCLOSURE AGREEMENTS FOR PUBLIC BONDS, OUTSTANDING FINANCIAL AND STATISTICAL INFORMATION IS POSTED AND REPORTED ON EMMA.MSRB.ORG ON A QUARTERLY AND ANNUAL BASIS. FORM 990, PART VII OFFICERS HOURS WORKED THE OFFICERS DEVOTE THEIR TIME TO ALL OF THE ORGANIZATIONS WITHIN WELLSTAR HEALTH SYSTEM THAT ARE LISTED IN SCHEDULE R, PART II. AS SUCH, THE TOTAL HOURS WORKED BY THE OFFICERS ACROSS ALL ORGANIZATIONS EXCEEDS 40 HOURS A WEEK. FORM 990, PART VII & FORM 990, SCHEDULE J COMPENSATION ALL COMPENSATION AMOUNTS REPORTED ON FORM 990, PART VII; PART IX, LINES 5-7; AND SCHEDULE J REPRESENT COMPENSATION PROVIDED TO INDIVIDUALS THAT PROVIDE SERVICES TO THE ORGANIZATION. LIKEWISE, THE NUMBER OF EMPLOYEES REPORTED ON PART V, LINE 2A REPRESENTS THE NUMBER OF INDIVIDUALS PROVIDING SERVICES TO THE ORGANIZATION. ALL FEDERAL EMPLOYMENT TAX RESPONSIBILITIES FOR THESE INDIVIDUALS (INCLUDING FEDERAL EMPLOYMENT TAX REPORTING RESPONSIBILITIES) ARE HANDLED BY WELLSTAR HEALTH SYSTEM, INC. (EIN 58-1649541). 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