Civic Intelligence

Chs Foundation Inc

990 • Fiscal year 2016 • EIN 58-1649540

Jul 01, 2015 to Jun 30, 2016 • Filed on May 15, 2018

793 Sawyer RoadMarietta, GA 30062-2222

(770) 956-7827

Siviq Scores

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

Liabilities / Assets

88th percentile

0.45x

Higher debt load relative to assets than 88% of similar nonprofits.

2016 filings • 501(c)3 • <$500k nonprofits • Source year 2016

Liabilities / Revenue

91st percentile

0.40x

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

2016 filings • 501(c)3 • <$500k nonprofits • Source year 2016

Net Margin

96th percentile

73%

Higher net margin than 96% of similar nonprofits.

2016 filings • 501(c)3 • <$500k nonprofits • Source year 2016

Top Officer Pay

100th percentile

$2,147,580

Higher top officer pay than 100% of similar nonprofits.

Top officer pay equals 996.3% of source-year revenue.

2016 filings • 501(c)3 • <$500k nonprofits • Source year 2016

Asset Growth

15th percentile

-29%

Faster asset growth than 15% of similar nonprofits.

2016 filings • 501(c)3 • <$500k nonprofits • Annualized from 2015 to 2016

Revenue Growth

34th percentile

-10%

Faster revenue growth than 34% of similar nonprofits.

2016 filings • 501(c)3 • <$500k nonprofits • Annualized from 2015 to 2016

Assets

Down

$193,144

Down $79,308 (-29%) from 2015

Net Assets

Down

$105,962

Down $78,557 (-43%) from 2015

Liabilities

Down

$87,182

Down $751 (-0.9%) from 2015

Revenue

Down

$215,565

Down $24,730 (-10%) from 2015

Expenses

Up

$58,735

Up $197,977 (+142%) from 2015

Net Income

Down

$156,830

Down $222,707 (-59%) from 2015

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: $87,182Net Assets 2016: $105,9622016Assets 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

2016

Assets$193,144
Liabilities$87,182
Net Assets$105,962

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

2016

Revenue$215,565
Expenses$58,735
Net Income$156,830
Jump To
Filing Snapshot
Filing Period
Jul 1, 2015 to Jun 30, 2016
Signed
May 15, 2018
Return Version
2015v3.0
Gross Receipts
$215,565
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$269,568$172,420▼ $97,148
Cash and Non-Interest-Bearing Accounts$0$17,840▲ $17,840
Prepaid Expenses and Deferred Charges$2,884$2,884→ $0
Savings and Temporary Cash Investments$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
Intangible Assets$0$0→ $0
Inventories for Sale or Use$0$0→ $0
Loans From Officers Directors$0$0→ $0
Total Assets$272,452$193,144▼ $79,308
Other Assets Total$0$0→ $0
Liabilities
Other Liabilities$84,642$82,840▼ $1,802
Mortgage Notes Payable Secured by Investment Property$1,508$1,570▲ $62
Accounts Payable and Accrued Expenses$1,783$1,095▼ $688
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$87,933$85,505▼ $2,428
Net Assets / Fund Balance
Unrestricted Net Assets$184,519$107,639▼ $76,880
Permanently Rstr Net Assets$0$0→ $0
Temporarily Rstr Net Assets$0$0→ $0
Total Net Assets Fund Balance$184,519$107,639▼ $76,880
Total Liabilities and Net Assets / Fund Balance$272,452$193,144▼ $79,308

Asset Categories

AssetBook ValueDepreciationBasis
Buildings$156,254$5,343,828$5,500,082
Equipment$14,449$1,445,652$1,460,101
Leasehold Improvements$1,717$586,272$587,989
Compensation and Service Providers

Employees

NameTitleOtherTotal
David H Hafner MdTrustee$23,923$23,923
W Charles BrockTrustee$21,470$21,470
Randall Bentley SrTrustee$20,441$20,441
T Fitz JohnsonTrustee$17,999$17,999
Otis a Brumby IiiTrustee$16,930$16,930
Robert N Cross MdTrustee$14,803$14,803
Janie MaddoxTrustee$7,842$7,842
Walter G RobinsonTrustee$4,348$4,348
O Scott Swayze MdTrustee$4,304$4,304
Gary a MillerTrustee - Chair$4,120$4,120
Charles J JonesTrustee$4,079$4,079
Frank RosTrustee$3,478$3,478
Mitzi MooreTrustee$3,074$3,074
Thomas M PhillipsTrustee$2,638$2,638
Greg MorganTrustee$2,324$2,324
Thomas E Gearhard MdTrustee$2,070$2,070
W Allen SeparkFoundation Board Member$1,059$1,059
Steven Oweida MdTrustee Emeritus$787$787
Shan CooperTrustee Emeritus$126$126

Board Members and Trustees

NameTitle
Candice L SaundersPresident & CEO
Peter R Jungblut MdSVP & Medical Director Wmg
H Speer Burdette IiiTrustee
Michael B PattonTrustee
Jeffrey L Tharp Md MphTrustee & Chief Medicine Srvs
Avril P Beckford MdTrustee & Chief Pediatric Off.
T E Rusty DurhamTrustee Emeritus
Stephen L BadgerChief Admin. Off. (beg. 2/16)
Reynold J Jennings MdCHIEF STRATEGY Officer
Anthony J BudzinskiEvp & CFO
Carrie O PlietzEvp & COO Hosp. (begin. 2/16)
Leo E ReichertEvp & General Counsel
Robert D Jansen MdEvp & Pres. Med. Group
John a BrennanEvp Chief Clnc.off (beg. 4/16)
Kem M MullinsEvp COO Ambulatory & Bus Dev
David W AndersonEvp/hr/ol/CCO
Robin WilsonFormer SVP Chief Health Off.
Marcia Delk-payneFormer SVP Med Aff., CQO
Patricia A MayneFORMER VP Emergency Services
Chester a ZborowskiFormer VP Health Parks Ops.
Barbara G BallardFormer VP Homecare & Hospice
Jeffery D StanleyFormer VP Pharm. & System Cord
Christopher B ScullenFormer VP Pulmonology Ops.
Steven L GraceFormer VP Talent Acquisition
Nancy R DoellingFormer VP Ws Ped. Acute Care
Louis W LittleFrmr SVP Post Acute Svc & Pres
Christopher M KaneFrmr SVP Strat.plan & Bus Dev
James E ClementsFrmr VP Bus Dev & Strat. Pship
Lee R CookFrmr VP Med & Behavioral Hlth
Deborah Roegge De VitaFrmr VP Women&newborn Svc Line
Jill M Case-wirthSVP & Chief Nurse Executive
Ellen LangfordSVP & COO Wellstar Med Group
Jonathan B Morris MdSVP Chief Info Officer
Douglas Arvin CPA MbaSVP Finance (begin. 3/2016)
Joseph L BrywczynskiSVP Health Parks Development
Barbara B CoreySVP Managed Care
Donald Campbell MdSVP Phys Ed.&student Aff.
Daniel J StyfSVP Pw Health Plan
Kimberly W MenefeeSVP Strategic Community Dev
Anthony M TrupianoSVP Supply Chain
Bethany RobertsonVP & Chief Learning Officer
Valery a AkopovVP & Chief of Hospitalist Svcs
James M SwartzVP Accounting
Richard S SiegelVP Cardiology & CVM Admin
Beth KostVP Compliance CHF Privacy Ofcr
Wanda Y RobinsonVP Compliance Pwhp
Robert J DecouxVP Corporate Med Staff Svcs
Kristen S TriceVP Diag. Outreach (beg. 1/16)
Robert MandlerVP Diagnostic Outreach
Elizabeth H LoudermilkVP Ent Intelligence & Intgrtn
Michael G PaulVP Facilities Eng Support Svcs
REBECCA l RUHLVP Facility Cmpl. (beg. 4/16)
Nicole V AsheVP Finance & CFO Wmg
Douglas S FosterVP Financial Planning
Mary L TavernaroVP Human Resources Operations
Sandra LuciusVP Info Technology Apps
Jimmy E FrancisVP Info Technology Operations
Bradford B NewtonVP Info. Technology Admin.
Michelle M RobinsonVP Mktng/pr/internal Comm
Joel W HelmkeVP Oncology
Kristyn M GreiferVP Population Management
Bruce a DeanVP Real Estate Deputy Gen Cnsl
Sean P TurnerVP Revenue Cycle Management
Marcus P Charlson MdVP Surgery (beg. 6/2016)
Freda LyonVP System Emergency & Trauma
Snehal H DoshiVP System Pharmacist
Robin G BoehringerVP Total Rewards (beg. 11/15)
Revenue and Support

Revenue Composition

Contributions and Grants
$0
Program Service Revenue
$215,565
Investment Income
$0
Other Revenue
$0
Change in Net Assets
$156,830
Expenses and Functional Allocation

Major Expense Lines

Line ItemAmount
Other Expenses$58,735
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$97,148--$97,148
Other Expenses$23,985$0$0$23,985
Fees for Services Other$8,890$0$0$8,890
Interest$2,152--$2,152
Occupancy$-73,440--$-73,440
Total Functional Expenses$58,735$0$0$58,735
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 Whs,inc.$42,995
Other Long Term Liabilities$39,845
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
7709567827
Address
793 SAWYER ROAD, Marietta, GA 30062-2222

Signing Officer

Name
James M Swartz
Title
VP, Accounting
Phone
7709567827
Signed
2018-05-15
Discuss with paid preparer
Yes

Organization Details

Principal Officer
Candice L Saunders
Legal Domicile
Ga
Voting Board Members
20
Independent Board Members
12
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, Heading, Item B, Amended Return

FORM 990, PART VII AND SCHEDULE J HAVE BEEN AMENDED TO REFLECT CERTAIN SECTION 457(B) PAYMENTS MADE TO CERTAIN INDIVIDUALS DURING CALENDAR YEAR 2015 THAT WERE NOT REPORTED ON THE ORIGINALLY FILED FORM 990 BUT WERE INCLUDED IN TAXABLE COMPENSATION REPORTED ON FORM W-2. PART X HAS BEEN AMENDED TO REFLECT ADJUSTMENTS TO THE END-OF-YEAR BALANCE SHEET. PART XI HAS BEEN ADJUSTED ACCORDINGLY TO RECONCILE THE ORGANIZATIONS END-OF-YEAR NET ASSETS. FORM 990, PART I, LINES 7A & 7B UNRELATED BUSINESS INCOME CHS FOUNDATION, INC. generated no unrelated business income ("ubi") for the reporting period. 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, 2016. FORM 990, PART VI, SECTION A, LINES 6, 7A & 7B POWERS OF THE BOARD 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 HEALTH SYSTEM, INC. 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 commi

Form 990 Part IX Line 11G

Description:taxes, licenses total fees:8890

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 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, A TAXABLE NOT-FOR-PROFIT. 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 ENTITYS FINANCIAL STATEMENTS AND HOW THE VALUES OF THESE POSITIONS ARE DETERMINED. THERE IS NO IMPACT ON WELLSTARS COMBINED FINANCIAL STATEMENTS AS A RESULT OF THE APPLICATION OF ASC 740.

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