SCHEDULE R
(Form 990)
Department of the Treasury
Internal Revenue Service
Related Organizations and Unrelated Partnerships
MediumBulletComplete if the organization answered "Yes" on Form 990, Part IV, line 33, 34, 35b, 36, or 37.
MediumBulletAttach to Form 990.
MediumBullet Go to www.irs.gov/Form990 for instructions and the latest information.

OMB No. 1545-0047
2018
Open to Public Inspection
Name of the organization
KENNESTONE HOSPITAL INC
 
Employer identification number

58-2032904
Part I
Identification of Disregarded Entities Complete if the organization answered "Yes" on Form 990, Part IV, line 33.
(a)
Name, address, and EIN (if applicable) of disregarded entity


(b)
Primary activity


 		(c)
Legal domicile (state
or foreign country)

 		(d)
Total income


 		(e)
End-of-year assets


 		(f)
Direct controlling
entity










Part II
Identification of Related Tax-Exempt Organizations Complete if the organization answered "Yes" on Form 990, Part IV, line 34 because it had one or more related tax-exempt organizations during the tax year.
(a)
Name, address, and EIN of related organization


(b)
Primary activity


 		(c)
Legal domicile (state
or foreign country)

 		(d)
Exempt Code section


 		(e)
Public charity status
(if section 501(c)(3))

 		(f)
Direct controlling
entity

 		(g)
Section 512(b)(13) controlled entity?
Yes No
(1)CHS Foundation Inc
793 SAWYER ROAD

MARIETTA,GA30062
58-1649540 		Foundation GA 501(C)(3) 12 II WHS Inc
 
Yes
 
(2)Cobb Hospital Inc
793 SAWYER ROAD

MARIETTA,GA30062
58-0968382 		Healthcare GA 501(C)(3) 3 WHS Inc
 
Yes
 
(3)Douglas Hospital Inc
793 SAWYER ROAD

MARIETTA,GA30062
58-2026750 		Healthcare GA 501(C)(3) 3 WHS Inc
 
Yes
 
(4)Paulding Medical Center Inc
793 SAWYER ROAD

MARIETTA,GA30062
58-2095884 		Healthcare GA 501(C)(3) 3 WHS Inc
 
Yes
 
(5)Wellstar Foundation Inc
793 SAWYER ROAD

MARIETTA,GA30062
58-1627413 		Foundation GA 501(C)(3) 12 II WHS Inc
 
Yes
 
(6)Wellstar Health System Inc
793 SAWYER ROAD

MARIETTA,GA30062
58-1649541 		Healthcare GA 501(C)(3) 12 II NA
 
 
No
(7)WELLSTAR ATLANTA MEDICAL CENTER INC
793 SAWYER ROAD

MARIETTA,GA30062
81-0837031 		HEALTHCARE GA 501(C)(3) 3 WHS INC
 
Yes
 
(8)WELLSTAR NORTH FULTON HOSPITAL INC
793 SAWYER ROAD

MARIETTA,GA30062
81-0851756 		HEALTHCARE GA 501(C)(3) 3 WHS INC
 
Yes
 
(9)WELLSTAR SPALDING REGIONAL HOSPITALINC
793 SAWYER ROAD

MARIETTA,GA30062
81-0864789 		HEALTHCARE GA 501(C)(3) 3 WHS INC
 
Yes
 
(10)WEST GEORGIA HEALTH SERVICES INC
793 SAWYER ROAD

MARIETTA,GA30062
20-5497622 		HEALTHCARE GA 501(C)(3) 12 II WHS INC
 
Yes
 
(11)WEST GEORGIA MEDICAL CENTER INC
793 SAWYER ROAD

MARIETTA,GA30062
20-5497506 		HEALTHCARE GA 501(C)(3) 3 WGHS INC
 
Yes
 
(12)VERNON WOODS RETIREMENT COMMUNITY INC
793 SAWYER ROAD

MARIETTA,GA30062
58-2575049 		HEALTHCARE GA 501(C)(3) 10 WGHS INC
 
Yes
 
(13)WEST GEORGIA HEALTH FOUNDATION INC
793 SAWYER ROAD

MARIETTA,GA30062
20-0936376 		FOUNDATION GA 501(C)(3) 12 II WGHS INC
 
Yes
 
(14)WELLSTAR SYLVAN GROVE HOSPITAL INC
793 SAWYER ROAD

MARIETTA,GA30062
81-0875069 		HEALTHCARE GA 501(C)(3) 3 WHS INC
 
Yes
 
(15)MEDICAL PARK FOUNDATION INC
1514 VERNON ROAD

LAGRANGE,GA30240
58-1303478 		FOUNDATION GA 501(C)(3) 7 WGHS INC
 
Yes
 
For Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 50135Y
Schedule R (Form 990) 2018
Page 2
Schedule R (Form 990) 2018
Page 2
Part III
Identification of Related Organizations Taxable as a Partnership Complete if the organization answered "Yes" on Form 990, Part IV, line 34 because it had one or more related organizations treated as a partnership during the tax year.
(a)
Name, address, and EIN of
related organization



 		(b)
Primary activity




 		(c)
Legal
domicile
(state or foreign
country)


 		(d)
Direct controlling
entity



 		(e)
Predominant income(related, unrelated, excluded from tax under sections 512-514)

(f)
Share of total income




 		(g)
Share of end-of-year
assets



 		(h)
Disproprtionate allocations?




 		(i)
Code V-UBI
amount in box 20 of
Schedule K-1
(Form 1065)
 		(j)
General or
managing
partner?



 		(k)
Percentage
ownership
Yes No Yes No
(1) COBB SOUTH PARKING DECK

793 SAWYER ROAD
MARIETTA,GA300622222
75-2999669 		Parking GA NA
  		N/A                
(2) KENNESTONE EAST PARKING DECK LLC

793 SAWYER ROAD
MARIETTA,GA30060
20-0537100 		PARKING GA NA
  		N/A                
(3) GRIFFIN IMAGING LLC

793 SAWYER ROAD
MARIETTA,GA300622222
 IMAGING CENTER GA NA
  		N/A                
(4) WELLSTAR SPALD EMSSPALD 911

793 SAWYER ROAD
MARIETTA,GA300622222
 OFF. BLDG/EMS CTR GA NA
  		N/A                
(5) NORTH FULTON PARKING DECK LP

793 SAWYER ROAD
MARIETTA,GA300622222
 PARKING GA NA
  		N/A                




Part IV
Identification of Related Organizations Taxable as a Corporation or Trust Complete if the organization answered "Yes" on Form 990, Part IV, line 34 because it had one or more related organizations treated as a corporation or trust during the tax year.
(a)
Name, address, and EIN of
related organization
 		(b)
Primary activity
 		(c)
Legal
domicile
(state or foreign
country)
 		(d)
Direct controlling
entity
 		(e)
Type of entity
(C corp, S corp,
or trust) 		(f)
Share of total income
 		(g)
Share of end-of-year
assets
 		(h)
Percentage
ownership
 		(i)
Section 512(b)(13) controlled entity?
Yes No
(1) Community Assurance Co

3rd Fl Barclays House Shedden Rd
George Town    
CJ
58-1649541 		Insurance CJ WHS INC
  		C CORP          
(2) WEST GEORGIA HEALTH PHYSICIANS INC

793 SAWYER ROAD
MARIETTA,GA300622222
27-5125341 		PHYSICIAN PRAC. GA WGHS INC
  		C CORP          










Schedule R (Form 990) 2018
Page 3
Schedule R (Form 990) 2018
Page 3
Part V
Transactions With Related Organizations Complete if the organization answered "Yes" on Form 990, Part IV, line 34, 35b, or 36.
Note. Complete line 1 if any entity is listed in Parts II, III, or IV of this schedule.
Yes
No
1 During the tax year, did the orgranization engage in any of the following transactions with one or more related organizations listed in Parts II-IV?
a Receipt of (i) interest, (ii) annuities, (iii) royalties, or (iv) rent from a controlled entity .....................
1a
 
No
b Gift, grant, or capital contribution to related organization(s) ............................
1b
 
No
c Gift, grant, or capital contribution from related organization(s) ............................
1c
 
No
d Loans or loan guarantees to or for related organization(s) ............................
1d
 
No
e Loans or loan guarantees by related organization(s) ............................
1e
 
No
f Dividends from related organization(s) ............................
1f
 
No
g Sale of assets to related organization(s) ............................
1g
 
No
h Purchase of assets from related organization(s) ............................
1h
 
No
i Exchange of assets with related organization(s) ............................
1i
 
No
j Lease of facilities, equipment, or other assets to related organization(s) .......................
1j
 
No
k Lease of facilities, equipment, or other assets from related organization(s) ......................
1k
Yes
 
l Performance of services or membership or fundraising solicitations for related organization(s) .....................
1l
 
No
m Performance of services or membership or fundraising solicitations by related organization(s) .................
1m
 
No
n Sharing of facilities, equipment, mailing lists, or other assets with related organization(s) ...................
1n
 
No
o Sharing of paid employees with related organization(s) ............................
1o
 
No
p Reimbursement paid to related organization(s) for expenses ............................
1p
Yes
 
q Reimbursement paid by related organization(s) for expenses ............................
1q
 
No
r Other transfer of cash or property to related organization(s) ............................
1r
 
No
s Other transfer of cash or property from related organization(s) ............................
1s
 
No
2
If the answer to any of the above is "Yes," see the instructions for information on who must complete this line, including covered relationships and transaction thresholds.
(a)
Name of related organization 		(b)
Transaction
type (a-s) 		(c)
Amount involved 		(d)
Method of determining amount involved





Schedule R (Form 990) 2018
Page 4
Schedule R (Form 990) 2018
Page 4
Part VI
Unrelated Organizations Taxable as a Partnership Complete if the organization answered "Yes" on Form 990, Part IV, line 37.
Provide the following information for each entity taxed as a partnership through which the organization conducted more than five percent of its activities (measured by total assets or gross revenue) that was not a related organization. See instructions regarding exclusion for certain investment partnerships.
(a)
Name, address, and EIN of entity 		(b)
Primary activity 		(c)
Legal domicile
(state or foreign
country) 		(d)
Predominant income (related, unrelated, excluded from tax under sections 512-514)

(e)
Are all partners
section
501(c)(3)
organizations? 		(f)
Share of total income




 		(g)
Share of
end-of-year
assets 		(h)
Disproprtionate allocations? 		(i)
Code V-UBI
amount in box 20
of Schedule K-1
(Form 1065) 		(j)
General or
managing
partner? 		(k)
Percentage
ownership
Yes No Yes No Yes No






























Schedule R (Form 990) 2018
Page 5
Schedule R (Form 990) 2018
Page 5
Part VII
Supplemental Information
Provide additional information for responses to questions on Schedule R (see instructions).
Return Reference Explanation
Schedule R (Form 990) 2018

Additional Data


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