Civic Intelligence

Chs Foundation Inc

990 • Fiscal year 2014 • EIN 58-1649540

Jul 01, 2013 to Jun 30, 2014 • Filed on May 08, 2015

805 Sandy Plains RoadSuiteMarietta, GA 30066

(770) 792-5023

Siviq Scores

Precomputed percentiles for this filing year versus similar nonprofits in the same peer cohort.

Liabilities / Assets

82nd percentile

0.22x

Higher debt load relative to assets than 82% of similar nonprofits.

2014 filings • 501(c)3 • <$500k nonprofits • Source year 2014

Liabilities / Revenue

91st percentile

0.40x

Higher debt load relative to revenue than 91% of similar nonprofits.

2014 filings • 501(c)3 • <$500k nonprofits • Source year 2014

Net Margin

94th percentile

60%

Higher net margin than 94% of similar nonprofits.

2014 filings • 501(c)3 • <$500k nonprofits • Source year 2014

Top Officer Pay

100th percentile

$1,391,900

Higher top officer pay than 100% of similar nonprofits.

Top officer pay equals 619.4% of source-year revenue.

2014 filings • 501(c)3 • <$500k nonprofits • Source year 2014

Asset Growth

18th percentile

-24%

Faster asset growth than 18% of similar nonprofits.

2014 filings • 501(c)3 • <$500k nonprofits • Annualized from 2013 to 2014

Revenue Growth

60th percentile

8.3%

Faster revenue growth than 60% of similar nonprofits.

2014 filings • 501(c)3 • <$500k nonprofits • Annualized from 2013 to 2014

Assets

Down

$399,684

Down $125,012 (-24%) from 2013

Net Assets

Down

$310,423

Down $122,751 (-28%) from 2013

Liabilities

Down

$89,261

Down $2,261 (-2.5%) from 2013

Revenue

Up

$224,732

Up $17,205 (+8.3%) from 2013

Expenses

Down

$89,094

Down $7,357 (-7.6%) from 2013

Net Income

Up

$135,638

Up $24,562 (+22%) from 2013

Historical Trend

Balance Sheet Trend

The highlighted filing sits inside the broader history for assets, liabilities, and net assets.

$1.0M$500K$0Assets 2010: $926,833Liabilities 2010: $105,368Net Assets 2010: $821,4652010Assets 2011: $728,943Liabilities 2011: $38,522Net Assets 2011: $690,4212011Assets 2012: $566,871Liabilities 2012: $94,039Net Assets 2012: $472,8322012Assets 2013: $524,696Liabilities 2013: $91,522Net Assets 2013: $433,1742013Assets 2014: $399,684Liabilities 2014: $89,261Net Assets 2014: $310,4232014Assets 2015: $272,452Liabilities 2015: $87,933Net Assets 2015: $184,5192015Assets 2016: $193,144Liabilities 2016: $85,505Net Assets 2016: $107,6392016Assets 2017: $169,881Liabilities 2017: $85,795Net Assets 2017: $84,0862017Assets 2018: $81,677Liabilities 2018: $44,241Net Assets 2018: $37,4362018Assets 2019: $0Liabilities 2019: $0Net Assets 2019: $02019

Highlighted filing

2014

Assets$399,684
Liabilities$89,261
Net Assets$310,423

Operations Trend

Revenue, expenses, and net income across loaded years, with this filing highlighted.

$400K$200K$0-$200KRevenue 2010: $331,840Expenses 2010: $281,074Net Income 2010: $50,7662010Expenses 2011: $169,4732011Expenses 2012: $131,1482012Revenue 2013: $207,527Expenses 2013: $96,451Net Income 2013: $111,0762013Revenue 2014: $224,732Expenses 2014: $89,094Net Income 2014: $135,6382014Revenue 2015: $240,295Expenses 2015: -$139,242Net Income 2015: $379,5372015Revenue 2016: $215,565Expenses 2016: $58,735Net Income 2016: $156,8302016Revenue 2017: $255,088Expenses 2017: $37,185Net Income 2017: $217,9032017Revenue 2018: $114,824Expenses 2018: -$20,723Net Income 2018: $135,5472018Revenue 2019: $0Expenses 2019: $0Net Income 2019: $02019

Highlighted filing

2014

Revenue$224,732
Expenses$89,094
Net Income$135,638
Jump To
Filing Snapshot
Filing Period
Jul 1, 2013 to Jun 30, 2014
Signed
May 8, 2015
Return Version
2013v4.0
Gross Receipts
$224,732
Mission and Program Overview

Mission

Support for cobb hospital, inc. In their efforts to provide quality health services to the community.

Support for cobb hospital, inc. In their efforts to provide health services to the community.

Balance Sheet Detail
LineBeginningEndChange
Assets
Land, Buildings, and Equipment, Net$517,472$387,702▼ $129,770
Prepaid Expenses and Deferred Charges$2,057$6,669▲ $4,612
Savings and Temporary Cash Investments$5,167$5,313▲ $146
Cash and Non-Interest-Bearing Accounts$0$0→ $0
Accounts Receivable$0$0→ $0
Other Notes and Loans Receivable, Net$0$0→ $0
Pledges and Grants Receivable$0$0→ $0
Receivable From Disqualified Prsn$0$0→ $0
Receivables From Officers Etc$0$0→ $0
Investments Other Securities$0$0→ $0
Investments Program Related$0$0→ $0
Investments in Publicly Traded Securities$0$0→ $0
Pd in Cap Srpls Land Bldg Eqp Fund$0$0→ $0
Rtn Earn Endowment Incm Other Fnds$0$0→ $0
Cap Stk Tr Prin Current Funds$0$0→ $0
Intangible Assets$0$0→ $0
Inventories for Sale or Use$0$0→ $0
Loans From Officers Directors$0$0→ $0
Total Assets$524,696$399,684▼ $125,012
Other Assets Total$0$0→ $0
Liabilities
Other Liabilities$88,690$86,220▼ $2,470
Accounts Payable and Accrued Expenses$2,832$1,584▼ $1,248
Mortgage Notes Payable Secured by Investment Property$0$1,457▲ $1,457
Grants Payable$0$0→ $0
Unsecured Notes Loans Payable$0$0→ $0
Deferred Revenue$0$0→ $0
Escrow Account Liability$0$0→ $0
Tax Exempt Bond Liabilities$0$0→ $0
Total Liabilities$91,522$89,261▼ $2,261
Net Assets / Fund Balance
Total Net Assets Fund Balance$433,174$310,423▼ $122,751
Total Liabilities and Net Assets / Fund Balance$524,696$399,684▼ $125,012

Asset Categories

AssetBook ValueDepreciationBasis
Buildings$489,701$5,010,381$5,500,082
Equipment$24,323$1,415,078$1,439,401
Leasehold Improvements$3,448$584,541$587,989
Compensation and Service Providers

Employees

NameTitleOtherTotal
Steven GraceVP Talent Acquisition$148,547$148,547
James ClementsVP Bus Dev & Strategic Prtnsp$142,587$142,587
Carol B MaxwellVP Talent Acquisition$140,633$140,633
Michael PaulVP Facilities Eng Support Svcs$88,849$88,849
T E Rusty DurhamTrustee$51,373$51,373
David Hafner MdTrustee$24,386$24,386
Steven W Oweida MdTrustee$21,472$21,472
Randall Bentley JrTrustee$20,619$20,619
Janie MaddoxTrustee - Chair$19,581$19,581
T Fitz JohnsonTrustee$18,008$18,008
Charles J JonesTrustee$17,308$17,308
Walter G RobinsonTrustee$10,640$10,640
W Allen SeparkTrustee$9,844$9,844
Robert N Cross MdTrustee$5,266$5,266
Gary a MillerTrustee - Vice Chair$4,249$4,249
Frank RosTrustee$3,747$3,747
Otis Brumby IiiTrustee$3,687$3,687
Tom PhillipsTrustee$2,734$2,734
Shan CooperTrustee$1,218$1,218

Board Members and Trustees

NameTitle
Reynold J JenningsPresident & CEO
Peter Jungblut MdSVP & Medical Director
Avril P Beckford MdTrustee
Jeffery Tharp MdTrustee
Thomas E Gearhard MdTrustee
A James BudzinskiExec VP & CFO
Leo E ReichertExec VP & General Counsel
Robert D Jansen MdExec VP & Pres Wmg
David W AndersonExec VP Hr/ol/CCO
Candice SaundersExecutive VP & COO
Michael L GraueFmr Exec VP & COO
Kenneth C Kunze MdFmr SVP & Chief Medical Ofcr
Jonathan B Morris MdSVP & CIO
Robin Wilson MdSVP Chief Innovation Officer
Joseph L BrywczynskiSVP Health Parks Development
Barbara B CoreySVP Managed Care
Kimberly W MenefeeSVP Marketing & Gov Affairs
Marcia Delk-payne MdSVP Med Affairs & CQO
Mary L WesleySVP Nursing Services & CNE
Donald Campbell MdSVP Phys Educ & Student Affl
Daniel StyfSVP Pw Health Plan
Christopher M KaneSVP Strategic Plan & Bus Dev
Anthony M TrupianoSVP Supply Chain
Bethany RobertsonVP & Chief Learning Officer
Valery a Akopov MdVP & Chief of Hospitalists
Ellen LangfordVP & COO Wmg
James M SwartzVP Accounting
Elizabeth a LoudermilkVP Budget & Analysis
Richard SeigelVP Cardiology & CVM Admin
Beth KostVP Compliance & CHF Prvcy Ofcr
Robert MandlerVP Diagnostic Outreach
Nicole V AsheVP Finance & CFO Wmg
Chester a ZborowskiVP Health Parks Operations
Barbara G BallardVP Homecare & Hospice
Mary L TavernaroVP Human Resources Operations
Bradford D NewtonVP Info Technology Admin
Sandra LuciusVP Info Technology Apps
Jimmy FrancisVP Info Technology Operations
Michelle M RobinsonVP Marketing/pr/internal Comm
Lee Randolph CookVP Medicine & Behavioral Hlth
Jeffery D StanleyVP Pharmacy & Sys Coordinator
Kristyn Greifer MdVP Population Health Mgmt
Christopher B ScullenVP Pulmonology Operations
Bruce DeanVP Real Estate & Dep Gen Coun
Sarath DegalaVP Revenue Cycle Management
Adam C ThompsonVP Surgery
Deborah Roegge De VitaVP Women & Newborn Srvcs
Revenue and Support

Revenue Composition

Contributions and Grants
$0
Program Service Revenue
$224,709
Investment Income
$23
Other Revenue
$0
Change in Net Assets
$135,638
Expenses and Functional Allocation

Major Expense Lines

Line ItemAmount
Other Expenses$89,094
Grants and Similar Amounts Paid$0
Professional Fundraising Fees$0
Salaries, Compensation, and Employee Benefits$0
Total Fundraising Expense$0

Functional Expense Allocation

Line ItemProgramManagementFundraisingTotal
Depreciation Depletion$129,795--$129,795
Occupancy$29,703--$29,703
Fees for Services Other$-302$0$0$-302
Other Expenses$-93,376--$-93,376
Total Functional Expenses$89,094$0$0$89,094
Fundraising, Events, and Gaming
Fundraising activities
No
Gaming activities
No
Professional fundraiser used
No

Fundraising and Gaming Totals

Line ItemAmount
Professional Fundraising Fees$0
Political and Lobbying Activity
Political campaign activity
No
Lobbying activity
No
Insider Transactions and Loans

Interested-Person Transactions

Interested PartyRelationshipDescriptionShared RevenueAmount
Greg FortgangSon-in-law of TrusteeEmployee of WellstarNo$100,521
Jennifer HaneyDaughter-in-law of OffcerEmployee of WellstarNo$79,812
Matthew MaddoxSon of TrusteeEmployee of WellstarNo$78,440
George FlemingBrother of OfficerEmployee of WellstarNo$66,332
Jessica HaneyDaughter of OfficerEmployee of WellstarNo$62,455
Pamela EtheridgeWife of OfficerEmployee of WellstarNo$61,285
Greg KostBrother-in-law of OfficerEmployee of WellstarNo$49,327
Bonnie MillerWife of TrusteeEmployee of WellstarNo$34,394

Loans and Receivables

Line ItemBeginningEndChange
Loans from Officers, Directors, Trustees, and Key Employees$0$0→ $0
Receivables from Disqualified Persons$0$0→ $0
Receivables from Officers, Directors, Trustees, and Key Employees$0$0→ $0
Debt and Bond Financing

Other Reported Liabilities

LiabilityAmount
Tax Exempt Bond Liab-due to Wh$46,374
Asset Retirement Obligation Lt$39,846
Governance and Compliance

Governance Checklist

Compiled or reviewed by an accountant
No
Annual disclosure for covered persons
Yes
Audit committee
Yes
Business relationship with family members
Yes
Business relationship with organization members
No
Material changes to governing documents
No
Compensation from other sources disclosed
No
CEO compensation reviewed
Yes
Other officer compensation reviewed
Yes
Conflict-of-interest policy
Yes
Audited financial statements prepared
Yes
Key decisions subject to board approval
Yes
Management duties delegated
No

Governance Explanations

Form 990 Part VI Line 11A

Internal staff prepare the organization's Form 990. Before filing the return with the Internal Revenue Service an external accounting firm, PricewaterhouseCoopers reviews and signs-off on the completed return. This reviewed form is then made available to both the organization's finance committee of the Board of Trustees as well as the full board in the form of electronic (pdf. format) version and hard copy of the return. The organization's CFO subsequently signs the return for either manual or electronic filing by the appropriate due date.

Form 990 Part VI Section B Lines 12 A-C

Our conflict of interest policy requires all covered persons to annually review the policy and then complete, sign and return the conflicts of interest policy and attestation to the compliance office. The policy requires an on-going disclosure obligation in the event a conflict arises during the year. The following is our process to regularly and consistently monitor and enforce this policy: Compliance identifies all covered persons who must complete the survey and attestation. Compliance verifies that the survey and attestation is distributed to these persons. Compliance verifies that these persons return a fully completed and signed survey and attestation. Compliance reviews each completed and signed survey and attestation to identify all conflicts listed in the document. All conflicts, potential conflicts and incidences of non-compliance are referred to the Chief Compliance Officer. The CCO takes appropriate action to completely resolve all identified conflicts and incidences of non-compliance.

Form 990 Part VI Section B Lines 15 A-B

WellStar engages the Hay Group to work with the governing board to review and recommend executive compensation. The executive compensation process at WellStar is overseen by a committee of independent trustees, which follows a board-approved executive compensation philosophy. The compensation committee consists of five trustees and the CEO for the system. In committee discussions about the compensation for the chief executive officer, the current or acting CEO will recuse himself/herself from that process but is a non-voting member for discussions of all other officers. The executive committee 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. When performance is at a predetermined targeted level, the compensation is intended to be at or around the median of compensation paid to similar positions at similar organizations (the "market"). WellStar's executive compensation philosophy defines the market as being comprised of comparable not-for-profit health care delivery systems, i.e., not-for-profit organizations similar in complexity and scale to WellStar. To assist the committee in fulfilling its duties, the committee engaged the Hay Group to provide market compensation data to compare to the WellStar positions whose compensation the committee oversees. The committee uses this data to provide context when making decisions in administering the compensation program. Accurate minutes of the committee's discussion and decisions are recorded during each committee meeting, and reviewed and approved at the following committee meeting.

Form 990 Part VI Section C Line 19

The organization and its subsidiaries are subject to the open records law in the state of Georgia. Therefore, by law, citizens are permitted to inspect and copy its governing documents, policies and financial statements as may be requested from time to time. Additionally, the organization's Form 990 is made readily available on the Guidestar website. Periodically, the organization publishes its financial performance in the local newspaper for citizens to review, and it also publishes a community benefit report once a year for distribution to the public.

Form 990 Part VI Lines 6 & 7

As per the articles of incorporation, the sole member of the organization is WellStar Health System, Inc., a GA non-profit corporation. As sole member, WellStar Health System holds certain powers of election and approval in connections with the governing body of the organization. These powers are presented in detail in the company's governing documents which the company makes available to the public upon request.

Filing and Contact Details

Filer

EIN
58-1649540
In Care Of
% JAMES M SWARTZ
Phone
7707925023

Signing Officer

Name
James Swartz
Title
VP Accounting
Phone
7709567827
Signed
2015-05-08
Discuss with paid preparer
Yes

Organization Details

Principal Officer
Reynold J Jennings
Voting Board Members
17
Independent Board Members
10
Employees
0

Preparer

Preparer
Matthew D Petroski
Phone
7709567827
Supplemental Narrative

Additional Explanations

Form 990 Part V Line 3

CHS Foundation, Inc. generated no unrelated business income for the reporting period. As a result the attached 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, 2014.

Form 990 Part V Line 2

All compensation amounts reported on Form 990 Part V, Part VII, and Part IX as well as Schedule J represent compensation provided to individuals that provide services to the organization. Likewise, the number of employees reported on Form 990 represent the number of individuals providing services to the organization. All federal employment tax responsibilities for these individuals (including federal employment tax reporting responsibilities) are handled by WellStar Health System, Inc. (EIN 58-1649541).

Form 990 Part IV Line 12 and Part XI

WellStar Health System, Inc. is audited on an annual basis by an outside auditing firm and as part of that audit a consolidated financial statement is issued for all of WellStar Health System, Inc. and its affiliates.

Other Changes in Net Assets

FORM 990 PART XI LINE 9 For the reporting period CHS Foundation, Inc. had a change in net assets of ($258,389) related to transfers to affiliates and the allocation of a portion of long term debt for tax exempt bond transactions.

Financial Statement Notes

Schedule D Part X Line 2

The following is a footnote from the combined financial statements of Wellstar Health System, Inc. and Affiliates related to the reporting of the organization's liability for uncertain tax positions under FIN 48. "Wellstar and all but one of its affiliates have been recognized as exempt from federal income tax under Internal Revenue Code Section 501 (A) as organizations described in Section 501(C)(3) and therefore, related income is generally not subject to federal or state income tax. Community Assurance Corporation is a controlled foreign corporation not subject to federal tax. Wellstar applies FASB ASC 740, Income Taxes, which addresses accounting for uncertainties in income tax positions. It also provides guidance on when tax postions 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."

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IRS990/Form990PartVIISectionAGrp/PersonNm48ADAM C THOMPSON
IRS990/Form990PartVIISectionAGrp/PersonNm49ANTHONY M TRUPIANO

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