Civic Intelligence

Chs Foundation Inc

990 • Fiscal year 2015 • EIN 58-1649540

Jul 01, 2014 to Jun 30, 2015 • Filed on May 12, 2016

805 Sandy Plains RoadMarietta, GA 30066

(770) 792-5023

Siviq Scores

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

Liabilities / Assets

86th percentile

0.32x

Higher debt load relative to assets than 86% of similar nonprofits.

2015 filings • 501(c)3 • <$500k nonprofits • Source year 2015

Liabilities / Revenue

90th percentile

0.37x

Higher debt load relative to revenue than 90% of similar nonprofits.

2015 filings • 501(c)3 • <$500k nonprofits • Source year 2015

Net Margin

100th percentile

158%

Higher net margin than 100% of similar nonprofits.

2015 filings • 501(c)3 • <$500k nonprofits • Source year 2015

Top Officer Pay

100th percentile

$1,704,037

Higher top officer pay than 100% of similar nonprofits.

Top officer pay equals 709.1% of source-year revenue.

2015 filings • 501(c)3 • <$500k nonprofits • Source year 2015

Asset Growth

14th percentile

-32%

Faster asset growth than 14% of similar nonprofits.

2015 filings • 501(c)3 • <$500k nonprofits • Annualized from 2014 to 2015

Revenue Growth

59th percentile

6.9%

Faster revenue growth than 59% of similar nonprofits.

2015 filings • 501(c)3 • <$500k nonprofits • Annualized from 2014 to 2015

Assets

Down

$272,452

Down $127,232 (-32%) from 2014

Net Assets

Down

$184,519

Down $125,904 (-41%) from 2014

Liabilities

Down

$87,933

Down $1,328 (-1.5%) from 2014

Revenue

Up

$240,295

Up $15,563 (+6.9%) from 2014

Expenses

Down

-$139,242

Down $228,336 (-256%) from 2014

Net Income

Up

$379,537

Up $243,899 (+180%) from 2014

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

2015

Assets$272,452
Liabilities$87,933
Net Assets$184,519

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

2015

Revenue$240,295
Expenses-$139,242
Net Income$379,537
Jump To
Filing Snapshot
Filing Period
Jul 1, 2014 to Jun 30, 2015
Signed
May 12, 2016
Return Version
2014v6.0
Gross Receipts
$240,295
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$387,702$269,568▼ $118,134
Savings and Temporary Cash Investments$5,313$0▼ $5,313
Prepaid Expenses and Deferred Charges$6,669$2,884▼ $3,785
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$399,684$272,452▼ $127,232
Other Assets Total$0$0→ $0
Liabilities
Other Liabilities$86,220$84,642▼ $1,578
Accounts Payable and Accrued Expenses$1,584$1,783▲ $199
Mortgage Notes Payable Secured by Investment Property$1,457$1,508▲ $51
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$89,261$87,933▼ $1,328
Net Assets / Fund Balance
Total Net Assets Fund Balance$310,423$184,519▼ $125,904
Total Liabilities and Net Assets / Fund Balance$399,684$272,452▼ $127,232

Asset Categories

AssetBook ValueDepreciationBasis
Buildings$250,553$5,249,529$5,500,082
Equipment$16,721$1,443,380$1,460,101
Leasehold Improvements$2,294$585,695$587,989
Land$0-$0
Compensation and Service Providers

Employees

NameTitleOtherTotal
Wanda Y RobinsonVP Compliance PWHP(BEGIN.9/15)$85,465$85,465
Jill M Case-wirthSVP Nursing SRVS.(BEGIN. 12/1)$77,169$77,169
Steven W OweidaTrustee Emeritus$31,409$31,409
David H Hafner MdTrustee$26,223$26,223
Sarath DegalaVP Revenue Cycle Management$22,773$22,773
T Fitz JohnsonTrustee$20,712$20,712
William C BrockTrustee$20,247$20,247
Randall Bentley JrTrustee$19,268$19,268
Otis a Brumby IiiTrustee$14,475$14,475
Robert N Cross MdTrustee$14,446$14,446
Janie MaddoxTrustee - Chair$8,850$8,850
W Allen SeparkTrustee Emeritus$8,177$8,177
Walter RobinsonTrustee$4,672$4,672
Orin Swayze MdTrustee$4,624$4,624
Gary a MillerTrustee - Vice Chair$4,387$4,387
Charles J JonesTrustee$4,075$4,075
Tom PhillipsTrustee$2,903$2,903
Frank RosTrustee$2,820$2,820
Mitzi MooreTrustee$1,730$1,730
Greg MorganTrustee$1,624$1,624
Te Rusty DurhamTrustee Emeritus$661$661

Board Members and Trustees

NameTitle
Candice L SaundersPresident & CEO
Peter R Jungblut MDSVP & Medical Director WMG
Avril P Beckford MDTrustee
Jeffrey L Tharp MDTrustee
Thomas E Gearhard MdTrustee
Reynold J Jennings MDChief Strategy Officer
Anthony J BudzinskiEvp & CFO
Leo E ReichertEVP & General Counsel
Robert D Jansen MDEVP & Pres Medical Group
David W AndersonEvp Hr/ol/CCO
Michael L GraueFormer Evp & COO
Kenneth C Kunze MDFrmr SVP Chief Medical Officer
Ellen LangfordSVP & COO WellStar Med Group
Robin Wilson MDSVP Chief Hlth Innov Officer
Jonathan B Morris MDSVP Chief Info Officer
Joseph L BrywczynskiSVP Health Parks Development
Barbara B CoreySVP Managed Care
Marcia Delk-Payne MDSVP Med Affair & CHF Qlty Ofcr
Donald Campbell MDSVP Phys Educ & Student Aff
Daniel J StyfSVP PW Health Plan
Kimberly W MenefeeSVP Strategic Community Dev
Christopher M KaneSVP Strategic Plan & Bus Dev
Anthony M TrupianoSVP Supply Chain
Christopher L MorganVP & Admin. CLIO (BEGIN. 7/7)
Bethany RobertsonVP & Chief Learning Officer
Valery A Akopov MDVP & Chief of Hospitalist Svcs
James M SwartzVP Accounting
James E ClementsVP Bus Dev & Strategic Prtnrsp
Richard S SiegelVP Cardiology & CVM Admin
Beth KostVP Compliance CHF Privacy Ofcr
Robert MandlerVP Diagnostic Outreach
Patricia A MayneVP Emergency Services
Elizabeth H LoudermilkVP Ent Intelligence & Intgrtn
Michael G PaulVP Facilities Eng Support Svcs
Nicole V AsheVP Finance & CFO WMG
Chester A ZborowskiVP Health Parks Operations
Barbara G BallardVP Homecare & Hospice
Mary L TavernaroVP Human Resources Operations
Sandra LuciusVP Info Technology Apps
Jimmy E FrancisVP Info Technology Operations
Bradford B NewtonVP Information Technology Admi
Lee R CookVP Med & Behavioral Health
Michelle M RobinsonVP Mktng/PR/Internal Comm
Joel W HelmkeVP Oncology (BEGIN. 7/21)
Nancy R DoellingVP Pediatric SRVS.(BEGIN. 8/4)
Jeffery D StanleyVP Pharmacy & System Coor
Kristyn M Greifer MDVP Population Management
Christopher B ScullenVP Pulmonology Operations
Bruce A DeanVP Real Estate Deputy Gen Cnsl
Sean P TurnerVP Rev.Cycle MGMT (BEGIN.9/28)
Adam C ThompsonVP Surgery
Steven L GraceVP Talent Acquisition
Deborah Roegge De VitaVP Women & Newborn Svc Line
Revenue and Support

Revenue Composition

Contributions and Grants
$0
Program Service Revenue
$240,295
Investment Income
$0
Other Revenue
$0
Change in Net Assets
$379,537
Expenses and Functional Allocation

Major Expense Lines

Line ItemAmount
Grants and Similar Amounts Paid$0
Professional Fundraising Fees$0
Salaries, Compensation, and Employee Benefits$0
Total Fundraising Expense$0
Other Expenses$-139,242

Functional Expense Allocation

Line ItemProgramManagementFundraisingTotal
Depreciation Depletion$116,224--$116,224
Occupancy$27,567$0$0$27,567
Interest$2,138--$2,138
Other Expenses$-91,942--$-91,942
Fees for Services Other$-202,471--$-202,471
Total Functional Expenses$-139,242$0$0$-139,242
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

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$44,796
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
No
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
Filing and Contact Details

Filer

Filer Name
Chs Foundation Inc
EIN
58-1649540
In Care Of
% JAMES M SWARTZ
Phone
7707925023
Address
805 Sandy Plains Road, Marietta, GA 30066

Signing Officer

Name
James M Swartz
Title
VP, Accounting
Phone
2673303000
Signed
2016-05-12
Discuss with paid preparer
Yes

Organization Details

Principal Officer
Candice L Saunders
Legal Domicile
Ga
Voting Board Members
18
Independent Board Members
9
Employees
0
Volunteers
0

Preparer

Firm
PricewaterhouseCoopers LLP
Address
2001 MARKET ST SUITE 1800, PHILADELPHIA, PA 19103
Preparer
Joanne Krueger
Phone
2673303000
Supplemental Narrative

Additional Explanations

Form 990, Part I, Lines 7A & 7B

UNRELATED BUSINESS INCOME 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, 2015. FORM 990, PART VI, SECTION A, LINES 6, 7A & 7B As per the articles of incorporation, the sole member of the organization is WellStar Health System, Inc., a GA 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. 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. This reviewed form is then made available to both the organization's Finance committee of the Board of Directors as well as the full board in the form of an electronic (pdf. format) version and hard copy of the return. The organization's CFO 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 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 Executive Compensation Committee consists of five trustees and the CEO. 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 trustee of Wellstar; provided, however, the full Board of Trustees evaluates and approves the compensation of the Chief Executive Officer. The philosophy requires annual disclosure of the committee's actions and decisions to the full board, which it has done. The committee is guided by the board-approved philosophy. Overall, the philosophy is intended to reward for organizational and individual performance. When performance is at a predetermined targeted level, the compensation is intended to be at or around the median of compensation paid to similar positions at similar organizations (the "market"). Wellstar's executive compensation philosophy defines the market as being comprised of comparable not-for-

Financial Statement Notes

Schedule D, Part X, Line 2

The following footnote is related to the organization's application of FIN 48 (ASC 740): "Wellstar (including KENNESTONE Hospital) 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 taxes. 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 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."

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IRS990/Form990PartVIISectionAGrp/PersonNm0Avril P Beckford MD
IRS990/Form990PartVIISectionAGrp/PersonNm1Jeffrey L Tharp MD
IRS990/Form990PartVIISectionAGrp/PersonNm2RANDALL BENTLEY JR
IRS990/Form990PartVIISectionAGrp/PersonNm3OTIS A BRUMBY III
IRS990/Form990PartVIISectionAGrp/PersonNm4ROBERT N CROSS MD
IRS990/Form990PartVIISectionAGrp/PersonNm5TE RUSTY DURHAM
IRS990/Form990PartVIISectionAGrp/PersonNm6THOMAS E GEARHARD MD
IRS990/Form990PartVIISectionAGrp/PersonNm7DAVID H HAFNER MD
IRS990/Form990PartVIISectionAGrp/PersonNm8T FITZ JOHNSON
IRS990/Form990PartVIISectionAGrp/PersonNm9CHARLES J JONES
IRS990/Form990PartVIISectionAGrp/PersonNm10JANIE MADDOX
IRS990/Form990PartVIISectionAGrp/PersonNm11GARY A MILLER
IRS990/Form990PartVIISectionAGrp/PersonNm12MITZI MOORE
IRS990/Form990PartVIISectionAGrp/PersonNm13TOM PHILLIPS
IRS990/Form990PartVIISectionAGrp/PersonNm14WALTER ROBINSON
IRS990/Form990PartVIISectionAGrp/PersonNm15FRANK ROS
IRS990/Form990PartVIISectionAGrp/PersonNm16ORIN SWAYZE MD
IRS990/Form990PartVIISectionAGrp/PersonNm17GREG MORGAN
IRS990/Form990PartVIISectionAGrp/PersonNm18WILLIAM C BROCK
IRS990/Form990PartVIISectionAGrp/PersonNm19STEVEN W OWEIDA

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