Schedule L
(Form 990 or 990-EZ)
Department of the Treasury
Internal Revenue Service
Transactions with Interested Persons
MediumBullet Complete if the organization answered "Yes" on Form 990, Part IV, lines 25a, 25b, 26, 27, 28a, 28b, or 28c, or Form 990-EZ, Part V, line 38a or 40b.
MediumBullet Attach to Form 990 or Form 990-EZ.
MediumBulletGo to www.irs.gov/Form990 for instructions and the latest information.
OMB No. 1545-0047
2020
Open to Public Inspection
Name of the organization
WELLSTAR HEALTH SYSTEM INC
 
Employer identification number

58-1649541
Part I
Excess Benefit Transactions (section 501(c)(3), section 501(c)(4), and section 501(c)(29) organizations only).
Complete if the organization answered "Yes" on Form 990, Part IV, line 25a or 25b, or Form 990-EZ, Part V, line 40b.
1(a) Name of disqualified person (b) Relationship between disqualified person and organization (c) Description of transaction (d) Corrected?
Yes No
2
Enter the amount of tax incurred by the organization managers or disqualified persons during the year under section 4958. ........................... Bullet Image$
 
3
Enter the amount of tax, if any, on line 2, above, reimbursed by the organization ........ Bullet Image$
 

Part II
Loans to and/or From Interested Persons.
Complete if the organization answered "Yes" on Form 990-EZ, Part V, line 38a, or Form 990, Part IV, line 26; or if the organization reported an amount on Form 990, Part X, line 5, 6, or 22
(a) Name of interested person (b) Relationship with organization (c) Purpose of loan (d) Loan to or from the organization? (e) Original principal amount (f) Balance due (g) In default? (h) Approved by board or committee? (i) Written agreement?
To From Yes No Yes No Yes No
Total ...............Small Bullet $  
Part III
Grants or Assistance Benefiting Interested Persons.
Complete if the organization answered "Yes" on Form 990, Part IV, line 27.
(a) Name of interested person (b) Relationship between interested person and the organization (c) Amount of assistance (d) Type of assistance (e) Purpose of assistance
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.
Cat. No. 50056A
Schedule L (Form 990 or 990-EZ) 2020
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Schedule L (Form 990 or 990-EZ) 2020
Page 2
Part IV
Business Transactions Involving Interested Persons.
Complete if the organization answered "Yes" on Form 990, Part IV, line 28a, 28b, or 28c.
(a) Name of interested person (b) Relationship between interested person and the organization (c) Amount of transaction (d) Description of transaction (e) Sharing of organization's revenues?
Yes No
(1) JENNIFER HANEY DAUGHTER-IN-LAW OF OFFICER 131,891 EMPLOYEE OF WELLSTAR   No
(2) CARL GOOLSBY JR MD HUSBAND OF OFFICER 507,049 EMPLOYEE OF WELLSTAR   No
(3) BRANDY N CROSS MD DAUGHTER OF BOARD MEMBER 439,867 EMPLOYEE OF WELLSTAR   No
(4) LAWRENCE ROWLEY MD HUSBAND OF BOARD MEMBER/OFFICER 446,097 EMPLOYEE OF WELLSTAR   No
(5) SHEILA ROBINSON MD WIFE OF BOARD MEMBER 434,129 EMPLOYEE OF WELLSTAR   No
(6) RACHEL GARNER GRANDDAUGHTER OF BOARD MEMBER 38,258 EMPLOYEE OF WELLSTAR   No
(7) SAMANTHA ROS DAUGHTER-IN-LAW OF BOARD MEMBER 127,377 EMPLOYEE OF WELLSTAR   No
(8) JOSEPH BURNS MD FATHER-IN-LAW OF BOARD MEMBER 692,963 EMPLOYEE OF WELLSTAR   No
(9) BROOK HURST CHILD OF BOARD MEMBER 32,613 EMPLOYEE OF WELLSTAR   No
Part V
Supplemental Information
Provide additional information for responses to questions on Schedule L (see instructions).
Return Reference Explanation
SCHEDULE L, PART IV, LINES 1-7 BUSINESS TRANSACTIONS WITH INTERESTED PARTIES: All transactions listed in Schedule L, Part IV are for interested parties or in this case family members of either trustees or officers of wellstar health system, inc. or its related organizations. The transactions all represent payment of services as employees of Wellstar Health System.
Schedule L (Form 990 or 990-EZ) 2020


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