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Schedule K
(Form 990)
Department of the Treasury
Internal Revenue Service
Supplemental Information on Tax-Exempt Bonds
SchKMediumBullet Complete if the organization answered "Yes" to Form 990, Part Ⅵ, line 24a. Provide descriptions,
explanations, and any additional information in Part Ⅵ.
SchKMediumBullet Attach to Form 990.
SchKMediumBulletGo to www.irs.gov/Form990 for the latest information.
OMB No. 1545-0047
2017
Open to Public
Inspection
Name of the organization
WELLSTAR HEALTH SYSTEM INC
 
Employer identification number
58-1649541
Part Ⅰ
Bond Issues
(a) Issuer name (b) Issuer EIN (c) CUSIP # (d) Date issued (e) Issue price (f) Description of purpose (g) Defeased (h) On
behalf of
issuer		 (i) Pool
financing
Yes No Yes No Yes No
A HOSPITAL AUTHORITY OF COBB COUNTY
  		58-2464600 19081PEM4 04-30-2004 25,000,000 EQUIPMENT POOL   X   X   X
B HOSPITAL AUTHORITY OF COBB COUNTY
  		58-2464600 19081PEN2 06-30-2005 25,000,000 EQUIPMENT POOL   X   X   X
C COBB COUNTY KENNESTONE HOSPITAL AUTHORITY
  		58-1147004 19081PEN2 11-01-2011 127,345,930 CONSTRUCTION/REFUNDING   X   X   X
D PAULDING COUNTY HOSPITAL AUTHORITY
  		58-6011214 703596DK9 06-28-2012 32,711,016 CONSTRUCTION SERIES A   X   X   X
Part Ⅱ
Proceeds
A B C D
1 Amount of bonds retired .................. 0 0 26,855,000 2,941,000
2 Amount of bonds legally defeased .............. 0 0 0 0
3 Total proceeds of issue .................. 25,000,000 25,000,000 127,345,930 32,711,016
4 Gross proceeds in reserve funds ............. 0 0 0 0
5 Capitalized interest from proceeds ............. 0 0 0 446,282
6 Proceeds in refunding escrows ............... 0 0 0 0
7 Issuance costs from proceeds ............... 0 0 1,383,191 437,500
8 Credit enhancement from proceeds ............. 0 0 0 0
9 Working capital expenditures from proceeds ............. 0 0 0 0
10 Capital expenditures from proceeds ............. 25,000,000 25,000,000 75,000,000 31,827,234
11 Other spent proceeds ............. 0 0 50,962,739 0
12 Other unspent proceeds ............. 0 0 0 0
13 Year of substantial completion ............. 2004 2006 2011 2014
Yes No Yes No Yes No Yes No
14 Were the bonds issued as part of a current refunding issue? ....                
15 Were the bonds issued as part of an advance refunding issue? .....                
16 Has the final allocation of proceeds been made? .......... X   X   X   X  
17 Does the organization maintain adequate books and records to support the final allocation of proceeds? .................. X   X   X   X  
Part Ⅲ
Private Business Use
A B C D
Yes No Yes No Yes No Yes No
1 Was the organization a partner in a partnership, or a member of an LLC, which owned property financed by tax-exempt bonds? .............   X   X   X   X
2 Are there any lease arrangements that may result in private business use of bond-financed property? ............... X   X   X   X  
For Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 50193E
Schedule K (Form 990) 2017
Page 2

Schedule K (Form 990) 2017
Page 2
Part Ⅲ
Private Business Use (Continued)
A B C D
Yes No Yes No Yes No Yes No
3a Are there any management or service contracts that may result in private business use of bond-financed property? ............. X   X   X   X  
b If "Yes" to line 3a, does the organization routinely engage bond counsel or other outside counsel to review any management or service contracts relating to the financed property?   X   X   X   X
c Are there any research agreements that may result in private business use of bond-financed property? .............   X   X   X   X
d If "Yes" to line 3c, does the organization routinely engage bond counsel or other outside counsel to review any research agreements relating to the financed property?                
4 Enter the percentage of financed property used in a private business use by entities other than a section 501(c)(3) organization or a state or local government ....SchKMediumBullet 0 % 0 % 0 % 0 %
5 Enter the percentage of financed property used in a private business use as a result of unrelated trade or business activity carried on by your organization, another section 501(c)(3) organization, or a state or local government ......... SchKMediumBullet        
6 Total of lines 4 and 5 .............        
7 Does the bond issue meet the private security or payment test? ...   X   X   X   X
8a Has there been a sale or disposition of any of the bond-financed property to a nongovernmental person other than a 501(c)(3) organization since the bonds were issued?.............   X   X   X   X
b If "Yes" to line 8a, enter the percentage of bond-financed property sold or disposed of. ..        
c If "Yes" to line 8a, was any remedial action taken pursuant to Regulations sections 1.141-12 and 1.145-2? .............   X   X   X   X
9 Has the organization established written procedures to ensure that all nonqualified bonds of the issue are remediated in accordance with the requirements under
Regulations sections 1.141-12 and 1.145-2? ........ 		X   X   X   X  
Part Ⅳ
Arbitrage
A B C D
Yes No Yes No Yes No Yes No
1 Has the issuer filed Form 8038-T, Arbitrage Rebate, Yield Reduction and Penalty in Lieu of Arbitrage Rebate? ...   X   X   X   X
2 If "No" to line 1, did the following apply? ....
a Rebate not due yet? .......                
b Exception to rebate? ........ X   X   X   X  
c No rebate due? .........                
If "Yes" to line 2c, provide in Part Ⅵ the date the rebate
computation was performed ......
3 Is the bond issue a variable rate issue? ..... X   X     X   X
4a Has the organization or the governmental issuer entered into a qualified hedge with respect to the bond issue?   X   X        
b Name of provider .......... 0
  		0
  		0
  		0
 
c Term of hedge .........        
d Was the hedge superintegrated? ......                
e Was the hedge terminated? ........                
Schedule K (Form 990) 2017
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Schedule K (Form 990) 2017
Page 3
Part Ⅳ
Arbitrage (Continued)
A B C D
Yes No Yes No Yes No Yes No
5a Were gross proceeds invested in a guaranteed investment contract (GIC)?   X   X   X   X
b Name of provider .......... 0
  		0
  		0
  		0
 
c Term of GIC .........        
d Was the regulatory safe harbor for establishing the fair market value of the GIC satisfied? ........                
6 Were any gross proceeds invested beyond an available temporary period?   X   X   X   X
7 Has the organization established written procedures to monitor the requirements of section 148? ...                
Part Ⅴ
Procedures To Undertake Corrective Action
--------------------------------------------------------------------------------------------------------------- A B C D
Yes No Yes No Yes No Yes No
Has the organization established written procedures to ensure that violations of federal tax requirements are timely identified and corrected through the voluntary closing agreement program if self-remediation is not available under applicable regulations? X   X   X   X  
Part Ⅵ
Supplemental Information. Provide additional information for responses to questions on Schedule K (see instructions).
Return Reference Explanation
SCHEDULE K, PART V PROCEDURES TO UNDERTAKE CORRECTIVE ACTION: WELLSTAR HEALTH SYSTEM, INC (THE BORROWER ON TAX EXEMPT BONDS) HAS ESTABLISHED POLICIES AND PROCEDURES THAT WILL MAXIMIZE THE LIKELIHOOD THAT ALL APPLICABLE POST-ISSUANCE REQUIREMENTS OF FEDERAL INCOME TAX LAW NEEDED TO PRESERVE THE TAX-EXEMPT STATUS OF THE BONDS ARE MET. THE PROCEDURES INCLUDE EXTERNAL ADVISORS SUCH AS BOND COUNSEL AND OTHER LEGAL COUNSEL WHO ASSIST THE BORROWER IN MAINTAINING THE TAX-EXEMPT STATUS OF ALL BONDS; ARBITRAGE REBATE CALCULATIONS THAT NEED TO BE MADE FOR EACH BOND ISSUE; DOCUMENTATION OF THE USE OF BOND PROCEEDS INCLUDING POTENTIAL PRIVATE BUSINESS USE APPLICABLE TO THE BONDS AFTER AN ANNUAL INTERNAL REVIEW OF THOSE USES; AND PROPER RECORD KEEPING OF ALL DOCUMENTS RELATED TO THE ISSUANCE OF TAX-EXEMPT BONDS. THESE PROCEDURES APPLY TO ALL LISTED TAX-EXEMPT BONDS.
SCHEDULE K, PART I, COLUMNS (A), (B), & (C) AS PART OF THE VARIABLE RATE COMPOSITE BOND ISSUE, ISSUED 8/3/2017, IN THE TOTAL AMOUNT OF $260,085,000 THE FOLLOWING INFORMATION IS BEING PROVIDED: ISSUER NAME EIN CUSIP # COBB COUNTY KENNESTONE HOSPITAL AUTHORITY 58-6011214 DEVELOPMENT AUTHORITY OF FULTON COUNTY 58-1506878 36005GAY9 GRIFFIN-SPALDING COUNTY HOSPITAL AUTHORITY 58-6212778 AS PART OF THE FIXED RATE COMPOSITE BOND ISSUE, ISSUED 8/3/2017, IN THE TOTAL AMOUNT OF $611,463,388 THE FOLLOWING INFORMATION IS BEING PROVIDED: ISSUER NAME EIN CUSIP # DEVELOPMENT AUTHORITY OF FULTON COUNTY 58-1506878 36005GAX1 GRIFFIN-SPALDING COUNTY HOSPITAL AUTHORITY 58-6212778 398258AX1 LAGRANGE-TROUP COUNTY HOSPITAL AUTHORITY 56-2609278 507152AX4
Schedule K (Form 990) 2017

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