2023-11-13T07:01:23-06:00 2022-12-31 540737372 PBMARES LLP 725 JACKSON STREET SUITE 210 FREDERICKSBURG VA 22401 990 2022-01-01 201106426 MARY WASHINGTON HEALTHCARE GROUP RETURN MARY 5407412507 2300 FALL HILL AVENUE 418 FREDERICKSBURG VA 22401 SEAN T BARDEN EXECUTIVE VP AND CFO 5407412507 2023-10-24 1 SEAN BARDEN XXX-XX-XXXX 0 JENNIFER N FRENCH CPA P00659678 5403713566 2023-10-24 X 2 AAL1 IAL1 2022 2023-04-26 12:10:37Z MICHAEL P MCDERMOTT MD 2300 FALL HILL AVENUE 418 FREDERICKSBURG VA 22401 892226022 1 1 4243 X WWW.MARYWASHINGTONHEALTHCARE.COM X 1983 VA OUR MISSION IS TO IMPROVE THE HEALTH OF PEOPLE IN THE COMMUNITIES WE SERVE. THROUGH OUR SUBSIDIARIES WE PROVIDE INPATIENT AND OUTPATIENT HOSPITAL SERVICES AND OTHER MEDICAL SERVICES. 16 13 4694 318 1999127 0 22685151 7178378 836207613 826815258 4325483 1512802 170616 116946 863388863 835623384 2157487 3100961 0 0 282055106 294858149 0 0 1253470 555185372 540787427 839397965 838746537 23990898 -3123153 593675918 461875065 353439043 249920659 240236875 211954406 OUR MISSION IS TO IMPROVE THE HEALTH OF PEOPLE IN THE COMMUNITIES WE SERVE. THROUGH OUR SUBSIDIARIES WE PROVIDE INPATIENT AND OUTPATIENT HOSPITAL SERVICES AND OTHER MEDICAL SERVICES. 0 0 797382082 3100961 825028350 PROVISION OF INPATIENT AND OUTPATIENT GENERAL ACUTE CARE HOSPITAL, PSYCHIATRIC HOSPITAL SERVICES, HOME HEALTH AND HOSPICE SERVICES, IMAGING AND AMBULATORY SURGERY SERVICES AND PHYSICIAN SERVICES. PRIMARY SERVICE AREAS ARE FREDERICKSBURG, PRINCE WILLIAM, STAFFORD, SPOTSYLVANIA, CAROLINE, KING GEORGE, AND WESTMORELAND COUNTIES IN VIRGINIA AND SECONDARY SERVICE AREAS INCLUDE MANASSAS, FAUQUIER, CULPEPER, ORANGE, LOUISA, HANOVER, ESSEX AND RICHMOND COUNTIES IN VIRGINIA. WE SERVED 119,063 PATIENTS IN OUR EMERGENCY ROOMS, 281,709 OUTPATIENTS, 18,804 SURGICAL CASES AND 33,857 PATIENT DISCHARGES. 797382082 1 1 0 0 0 0 0 0 0 1 1 0 0 0 1 1 0 1 0 0 0 0 0 0 1 0 1 1 1 1 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 0 0 0 1 4 0 1 4694 1 1 1 0 0 0 0 1 1 0 0 0 0 0 0 X 16 13 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 1 1 X X SANDRA W BROWN 5407412507 2300 FALL HILL AVENUE 418 FREDERICKSBURG VA 22401 MICHAEL P MCDERMOTT MD MBA PRESIDENT AND CEO 2.00 40.00 X X 0 1807773 42556 BRADFORD KING MD PHYSICIAN/TRUSTEE (THRU 2/2022) 40.00 2.00 X 492069 0 11083 SAUSHEEN TAYLOR MD PHYSICIAN/TRUSTEE 40.00 2.00 X 415502 0 39780 RONALD W BRANSCOME MS BOARD CHAIR 2.00 2.00 X X 0 0 0 JOHN F ROWLEY BS JD BOARD VICE CHAIR 2.00 2.00 X X 0 0 0 BRUCE L DAVIS BA BOARD SECRETARY/TREASURER 2.00 2.00 X X 0 0 0 MATTHEW D DUMONT MD BOARD TRUSTEE 2.00 2.00 X 0 0 0 REV ALLEN H FISHER JR BA MDIV BOARD TRUSTEE 2.00 2.00 X 0 0 0 JEFFREY A FRAZIER MD BOARD TRUSTEE 2.00 2.00 X 0 0 0 MARGARET F HARDY BOARD TRUSTEE 2.00 2.00 X 0 0 0 DERMAINE A LEWIS BOARD TRUSTEE 2.00 2.00 X 0 0 0 RICHMOND MCDANIEL BS BOARD TRUSTEE 2.00 2.00 X 0 0 0 CHETAN B PAI DO BOARD TRUSTEE 2.00 2.00 X 0 0 0 CLARENCE A ROBINSON BS BOARD TRUSTEE 2.00 2.00 X 0 0 0 CATHERINE M WACK BOARD TRUSTEE 2.00 2.00 X 0 0 0 MARTIN A WILDER JR EDD BOARD TRUSTEE 2.00 2.00 X 0 0 0 LINDA D WORRELL BOARD TRUSTEE 2.00 2.00 X 0 0 0 CHRISTOPHER NEWMAN MD SVP, COO & CMO 2.00 40.00 X 0 968559 43999 SEAN T BARDEN BSBA MBA SR VP & CFO 4.00 40.00 X 0 829856 34546 TRAVIS TURNER BS MBA SVP & CPHO 2.00 40.00 X 0 655442 40323 ELIESE K BERNARD VICE PRESIDENT 2.00 40.00 X 0 640970 38709 STEPHEN MANDELL MD VICE PRESIDENT 40.00 2.00 X 566632 0 35857 ERIC FLETCHER MBA APR SVP & CSO 2.00 40.00 X 0 529318 42142 GEOFFREY LAWSON SVP & CIO 2.00 40.00 X 0 545017 24892 KATHRYN WALL BA MA SVP & CHRO 2.00 40.00 X 0 517590 23282 EILEEN DOHMANN RN BSN MBA NEA-BC SVP & CNO 2.00 40.00 X 0 521476 13984 DAVID YI MD VICE PRESIDENT 2.00 40.00 X 0 525015 11103 DANIEL WOODFORD VICE PRESIDENT 40.00 2.00 X 457456 0 39558 RICHARD LEWIS MD VICE PRESIDENT 2.00 40.00 X 0 434948 34231 STEPHANIE GOLDBERG VICE PRESIDENT 40.00 2.00 X 441624 0 11084 CATHLEEN YABLONSKI BS MS VICE PRESIDENT 40.00 2.00 X 410077 0 35169 SCOTT SELL VICE PRESIDENT 40.00 2.00 X 423460 0 20130 XAVIER RICHARDSON BA MBA SVP & CDO 2.00 40.00 X 0 422001 20858 MARIE FREDRICK RT R CRA MJ VICE PRESIDENT (THRU 6/22) 2.00 40.00 X 0 398796 14684 SANDRA BROWN CPA VICE PRESIDENT 2.00 40.00 X 0 364594 32662 ALAN EDWARDS VICE PRESIDENT 2.00 40.00 X 0 352804 39171 CODY BLANKENSHIP VICE PRESIDENT 2.00 40.00 X 0 349644 37095 LAUREN BLALOCK VICE PRESIDENT 2.00 40.00 X 0 343136 34951 SARAH OGLE VICE PRESIDENT 2.00 40.00 X 0 348216 10621 TINA ERVIN VICE PRESIDENT 2.00 40.00 X 0 309735 31570 SUMMER HUGHES VICE PRESIDENT 2.00 40.00 X 0 298914 33942 TOM JANUS VICE PRESIDENT (THRU 9/22) 2.00 40.00 X 312190 0 20456 SANG HO NA MD PHYSICIAN 40.00 X 926229 0 25362 AGOSTINO VISIONI MD PHYSICIAN 40.00 X 906599 0 41454 J T SHERWOOD MD PHYSICIAN 40.00 X 838485 0 46610 HONG NGUYEN PHYSICIAN 40.00 X 788371 0 9736 THERESA CONOLOGUE PHYSICIAN 40.00 X 620055 0 25118 7598749 11163804 966718 429 0 1 0 FREDERICKSBURG ORTHOPAEDIC ASSOCIATES 3310 FALL HILL AVENUE FREDERICKSBURG VA 22401 PHYSICIAN SERVICES 10839475 ARMG LLC PO BOX 17125 FERNANDINA BEACH FL 32034 PROFESSIONAL SERVICES - PHYSICAL THERAPY 3649147 COMMONWEALTH SPINE & REHAB 4710 SPOTSYLVANIA PKWY STE 201 FREDERICKSBURG VA 22407 PHYSICIAN SERVICES 2419789 GAERTNER PSYCHIATRIC PC 621 JEFFERSON DAVIS HWY FREDERICKSBURG VA 22405 PHYSICIAN SERVICES 2366961 PULMONARY ASSOCIATES OF FREDERICKSBURG 521 PARK HILL DRIVE FREDERICKSBURG VA 22401 PHYSICIAN SERVICES 1061539 10 344925 782310 2581465 3469678 7178378 NET PATIENT SERVICES REVENUE 623000 803807646 803807646 PROGRAM RENTAL INCOME 531120 9672613 9672613 OTHER OPERATING REVENUE 623000 7818106 7818106 MANAGEMENT SERVICES 623000 2823183 2823183 LAB FEES 621500 1745822 1745822 947888 947888 826815258 2608492 2608492 55402692 8983 56058645 448720 -655953 -439737 -1095690 -1095690 0 344925 95273 -95273 -95273 INCOME FROM PARTNERSHIPS/LLCS 623000 212219 -41086 253305 212219 835623384 825028350 1999127 1417529 X 3084161 3084161 16800 16800 4094363 3891692 196529 6142 245867727 233697274 11801651 368802 4640837 4411116 222760 6961 21803642 20724362 1046575 32705 18451580 17538227 885676 27677 117983349 112143173 5663201 176975 185434 176255 8901 278 10500 9980 504 16 157070 149295 7539 236 146520971 139268181 7033007 219783 27931 26548 1341 42 5468331 5197649 262480 8202 1437716 1366549 69010 2157 23925989 22741653 1148447 35889 2471961 2349599 118654 3708 448461 426262 21526 673 914799 869517 43910 1372 27700338 26329171 1329616 41551 4772199 4535975 229066 7158 MEDICAL AND HOSPITAL SU 128871983 122492820 6185855 193308 PROVIDER ASSESSMENT 36856147 35031768 1769095 55284 BAD DEBT EXPENSE 32003883 30419691 1536186 48006 REPAIRS AND MAINTENANCE 5555947 5280928 266685 8334 5474418 5203436 262771 8211 838746537 797382082 40110985 1253470 715275 946838 19685491 18925233 189433358 77067838 28141 136141 18736466 17629966 5361239 7143952 745256347 465217024 285293169 280039323 72250366 55735909 2161653 4239105 10760 10760 593675918 461875065 123595295 28256500 22285 62886 200214220 190975286 29607243 30625987 353439043 249920659 X 220491678 192716884 19745197 19237522 240236875 211954406 593675918 461875065 X -3123153 -16234661 -8924655 X X 0 1 X 1 1 1 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 7950546 500 164367 150067 7965346 7605785 383359 38598 7950546 6199920 1435446 29581 7605785 6017627 218934 36641 6199920 1269839 4752228 45316 49757 6017626 0.00000 1.00000 0.00000 0 0 31474013 31474013 358363800 205480548 152883252 21551814 18227897 3323917 265787676 211770868 54016808 68079044 29737711 38341333 280039323 ACCRUED LOSS-PROFESSIONAL LIABILIES 4451936 CAPITAL LEASE OBLIGATIONS 26174051 30625987 X PART V, LINE 4: THE INTEREST EARNED FROM THE ENDOWMENT FUNDS IS USED TO FUND SCHOLARSHIPS AND GRANTS IN FUTHERANCE OF OUR MISSION. PART X, LINE 2: MWHC WAS RECOGNIZED AS A PUBLIC CHARITY GENERALLY EXEMPT FROM FEDERAL INCOME TAXATION UNDER 501(C)(3) OF THE INTERNAL REVENUE CODE PURSUANT TO A DETERMINATION LETTER ISSUED BY THE IRS IN MARCH 1992. MWHC IS ENTITLED TO RELY ON THIS DETERMINATION AS LONG AS THERE ARE NO SUBSTANTIAL CHANGES IN ITS CHARACTER, PURPOSES, OR METHODS OF OPERATION. MANAGEMENT HAS CONCLUDED THAT THERE HAVE BEEN NO SUCH CHANGES AND, THEREFORE, MWHC'S STATUS AS A PUBLIC CHARITY EXEMPT FROM FEDERAL INCOME TAXATION REMAINS IN EFFECT. THE STATE IN WHICH MWHC OPERATES ALSO PROVIDES GENERAL EXEMPTION FROM STATE INCOME TAXATION FOR ORGANIZATIONS THAT ARE EXEMPT FROM FEDERAL INCOME TAXATION. HOWEVER, MWHC IS SUBJECT TO BOTH FEDERAL AND STATE INCOME TAXATION AT CORPORATE TAX RATES ON ITS UNRELATED BUSINESS INCOME. EXEMPTION FROM OTHER STATE TAXES, SUCH AS REAL AND PERSONAL PROPERTY TAXES, IS SEPARATELY DETERMINED. CERTAIN ENTITIES UNDER MWHC ARE TAXABLE ENTITIES. MWHC HAD NO UNRECOGNIZED TAX BENEFITS OR LIABILITIES, OR SUCH AMOUNTS WERE IMMATERIAL DURING THE PERIODS PRESENTED. FOR TAX PERIODS WITH RESPECT TO WHICH NO UNRELATED BUSINESS INCOME WAS RECOGNIZED, NO TAX RETURN WAS REQUIRED. TAX PERIODS FOR WHICH NO RETURN IS FILED REMAIN OPEN FOR EXAMINATION INDEFINITELY. GENERALLY, TAX RETURNS FOR THE YEARS ENDED DECEMBER 31, 2019, AND THEREAFTER REMAIN SUBJECT TO EXAMINATION BY FEDERAL AND STATE TAX AUTHORITIES. ALL REQUIRED TAX FILINGS HAVE BEEN FILED ON A TIMELY BASIS. STAFFORD HOSPITAL CUP 181552 181552 3250 2221 7451 6390 1000 23885 MWHF OPEN 83570 83570 900 13207 7548 4 79803 79803 230 377 3000 25724 344925 344925 4380 2598 23658 6390 1000 57157 95183 -95183 1 1 X 1 X 1 X 500.000000000000 1 1 0 1 1 10745319 10745319 0.01290 10745319 10745319 0.01290 956965 956965 0.00110 1762705 1762705 0.00210 141208314 93125020 48083294 0.05760 421300 52674 368626 0.00040 2093278 2093278 0.00250 146442562 93177694 53264868 0.06370 157187881 93177694 64010187 0.07660 36121 36121 0.00000 0 840162 840162 0.00100 876283 876283 0.00100 1 13009446 3252361 227540047 278537609 -50997562 X 1 1 1 MEDICAL IMAGING OF FREDERICKSBURG OUTPATIENT IMAGING 0.51000 0.49000 2 FREDERICKSBURG AMBULATORY SURGERY CENTER AMBULATORY SERGICAL SERVICES 0.59380 0.40620 3 COWAN INVESTMENT PARTNERS MEDICAL OFFICE BUILDING 0.12500 0.37500 4 MEDICAL PLAZA AT COSNER CORNER MEDICAL OFFICE BUILDING 0.39500 0.47400 5 FREDERICKSBURG ENDOSCOPY CENTER HOLDINGS LLC OUTPATIENT ENDOSCOPY 0.51000 0.49000 2 1 MARY WASHINGTON HOSPITAL INC 1101 SAM PERRY BLVD FREDERICKSBURG VA 22401 X X X 471 BED ACUTE CARE HOSPITAL LEVEL 2 TRAUMA 2 STAFFORD HOSPITAL LLC 101 HOSPITAL CENTER BLVD STAFFORD VA 22554 X X X 100 BED HOSPITAL MARY WASHINGTON HOSPITAL INC 1 0 0 1 X X X X X X X X 19 1 1 0 1 X HTTPS://WWW.MARYWASHINGTONHEALTHCARE.COM/ABOUT-US/REGULATORY-DOCUMENTS.ASPX X X 1 19 0 1 0 1 X 200.000000000000 500.000000000000 X X X X X 1 1 X X X 1 X HTTPS://WWW.MARYWASHINGTONHEALTHCARE.COM/ABOUT-US/REGULATORY-DOCUMENTS.ASPX X HTTPS://WWW.MARYWASHINGTONHEALTHCARE.COM/ABOUT-US/REGULATORY-DOCUMENTS.ASPX X HTTPS://WWW.MARYWASHINGTONHEALTHCARE.COM/ABOUT-US/REGULATORY-DOCUMENTS.ASPX X X X X X 1 X 0 X X X 1 X 0 0 STAFFORD HOSPITAL LLC 2 0 0 1 X X X X X X X X 19 1 1 0 1 X HTTPS://WWW.MARYWASHINGTONHEALTHCARE.COM/ABOUT-US/REGULATORY-DOCUMENTS.ASPX X X 1 19 0 1 0 1 X 200.000000000000 500.000000000000 X X X X X 1 1 X X X 1 X HTTPS://WWW.MARYWASHINGTONHEALTHCARE.COM/ABOUT-US/REGULATORY-DOCUMENTS.ASPX X HTTPS://WWW.MARYWASHINGTONHEALTHCARE.COM/ABOUT-US/REGULATORY-DOCUMENTS.ASPX X HTTPS://WWW.MARYWASHINGTONHEALTHCARE.COM/ABOUT-US/REGULATORY-DOCUMENTS.ASPX X X X X X 1 X 0 X X X 1 X 0 0 MARY WASHINGTON HOSPITAL, INC. PART V, SECTION B, LINE 5: MWHC'S COMMITMENT AND LEADERSHIP IN INVESTING IN THE HEALTH OF THE COMMUNITIES IT SERVES ARE CENTERED AROUND AN OVERALL COMMUNITY BENEFIT STRATEGY. A KEY VALUE OF MWHC IS TO DIRECTLY UTILIZE COMMUNITY INPUT TO DRIVE INITIATIVES THAT WILL IMPROVE THE OVERALL HEALTH OF THE COMMUNITY. MWHC WORKED WITH BE WELL RAPPAHANNOCK (BWR) TO CONDUCT A COMMUNITY HEALTH NEEDS ASSESSMENT AND IMPLEMENTATION STRATEGY.BWR IS A COLLABORATIVE COMPRISED OF AGENCIES REPRESENTATIVE OF THE COMMUNITY, WITH A DEEP CONCERN FOR THE HEALTH AND WELL-BEING OF THE RESIDENTS OF THE RAPPAHANNOCK REGION. THE PURPOSE OF THE COUNCIL IS TO IDENTIFY AND PRIORITIZE COMMUNITY NEEDS, PROVIDE GUIDANCE AND OVERSIGHT OVER PLANNED COMMUNITY IMPROVEMENTS, AND MONITOR PROGRESS ON PRIORITY HEALTH AND SOCIAL CONCERNS IMPACTING THE RAPPAHANNOCK REGION. BE WELL RAPPAHANNOCK REPRESENTATIVE ORGANIZATIONS -COMMUNITY COLLABORATIVE FOR YOUTH AND FAMILIES -DEPARTMENTS OF SOCIAL SERVICES -BUSINESS REPRESENTATIVE-LOCAL GOVERNMENT REPRESENTATIVE -HIGHER EDUCATION -MARY WASHINGTON HEALTHCARE -MARY WASHINGTON HOSPITAL FOUNDATION -MENTAL HEALTH AMERICA -PHYSICIAN REPRESENTATIVE -PUBLIC DEFENDERS -RAPPAHANNOCK AREA COMMUNITY SERVICES BOARD -RAPPAHANNOCK AREA HEALTH DISTRICT -RAPPAHANNOCK UNITED WAY -SCHOOL ADMINISTRATOR -SCHOOL SYSTEMS (PUBLIC) MARY WASHINGTON HOSPITAL, INC. PART V, SECTION B, LINE 6A: STAFFORD HOSPITAL AND SPOTSYLVANIA REGIONAL MEDICAL CENTER STAFFORD HOSPITAL, LLC PART V, SECTION B, LINE 6A: MARY WASHINGTON HOSPITAL AND SPOTSYLVANIA REGIONAL MEDICAL CENTER MARY WASHINGTON HOSPITAL, INC. PART V, SECTION B, LINE 7D: PRESENTED AT NUMEROUS COMMUNITY MEETINGS, SUCH AS THE ROTARY MEETINGS, CHAMBER OF COMMERCE, AND THE MARY WASHINGTON HEALTHCARE CITIZEN ADVISORY COMMITTEE MEETINGS. STAFFORD HOSPITAL, LLC PART V, SECTION B, LINE 7D: PRESENTED AT NUMEROUS COMMUNITY MEETINGS, SUCH AS THE ROTARY MEETINGS, CHAMBER OF COMMERCE, AND THE MARY WASHINGTON HEALTHCARE CITIZEN ADVISORY COMMITTEE MEETINGS. MARY WASHINGTON HOSPITAL, INC. PART V, SECTION B, LINE 11: SEE IMPLEMENTATION STRATEGY ATTACHED TO THE RETURN STAFFORD HOSPITAL, LLC PART V, SECTION B, LINE 11: SEE IMPLEMENTATION STRATEGY ATTACHED TO THE RETURN. MARY WASHINGTON HOSPITAL, INC. PART V, SECTION B, LINE 16J: THE FINANCIAL ASSISTANCE POLICY IS MADE AVAILABLE ON THE ORGANIZATION'S WEBSITE. SIGNS ARE POSTED IN ALL PATIENT REGISTRATION AREAS AND NOTES INCLUDED ON ALL PATIENT STATEMENTS INFORMING PATIENTS OF THE AVAILABILITY OF FINANCIAL ASSISTANCE AND WHO TO CONTACT FOR MORE INFORMATION. BILLING OFFICE PERSONNEL EXPLAIN THE MATERIALS TO ALL PATIENTS REQUESTING ADDITIONAL INFORMATION. STAFFORD HOSPITAL, LLC PART V, SECTION B, LINE 16J: THE FINANCIAL ASSISTANCE POLICY IS MADE AVAILABLE ON THE ORGANIZATION'S WEBSITE. SIGNS ARE POSTED IN ALL PATIENT REGISTRATION AREAS AND NOTES INCLUDED ON ALL PATIENT STATEMENTS INFORMING PATIENTS OF THE AVAILABILITY OF FINANCIAL ASSISTANCE AND WHO TO CONTACT FOR MORE INFORMATION. BILLING OFFICE PERSONNEL EXPLAIN THE MATERIALS TO ALL PATIENTS REQUESTING ADDITIONAL INFORMATION. 6 1 - MEDICAL IMAGING OF FREDERICKSBURG 1201 SAM PERRY BLVD SUITE 102 ASC BUILD FREDERICKSBURG VA 224014490 IMAGING SERVICES 2 - FREDERICKSBURG AMBULATORY SURGERY CENTER 1201 SAM PERRY BLVD SUITE 101 FREDERICKSBURG VA 224014490 AMBULATORY SURGERY CENTER 3 - MARY WASHINGTON URGENT CARE 11131 JOURNAL PARKWAY SUITE A KING GEORGE VA 22485 URGENT CARE 4 - REGIONAL CANCER CENTER AT MONTROSS 15394 KINGS HIGHWAY MONTROSS VA 22520 RADIATION THERAPY 5 - MARY WASHINGTON EYE CARE CENTER 4710 SPOTSYLVANIA PARKWAY FREDERICKSBURG VA 22407 EYE CARE CENTER 6 - FREDERICKSBURG ENDOSCOPY CENTER LLC 2500 YORK ROAD SUITE 300 JAMISON PA 18929 ENDOSCOPY CENTER PART I, LN 7 COL(F): MWHC UTILIZED THE SERVICES OF SEARCHAMERICA TO IDENTIFYPFAP ELIGIBLE PATIENTS WHOSE ACCOUNTS HAD FALLEN INTO BAD DEBT.SEARCHAMERICA PROVIDED A LIST UTILIZING VARIOUS MARKET RESEARCH TOAPPROXIMATE THE FEDERAL POVERTY LEVEL OF EACH ACCOUNT HOLDER. WITH THISINFORMATION WE WERE ABLE TO DETERMINE ACCOUNTS THAT MAY HAVE BEEN ELIGIBLEFOR FREE CARE OR DISCOUNTED CARE UNDER OUR FINANCIAL ASSISTANCE POLICY. FORM 990, SCHEDULE H, PART I, LINE 7B. THE COMMONWEALTH OF VIRGINIA ELECTED TO EXPAND MEDICAID COVERAGE IN 2018 WITH 2019 BEING THE FIRST FULL YEAR OF IMPACT. THIS PROGRAM IS FUNDED THROUGH AN ASSESSMENT LEVIED ON ALL HOSPITALS IN THE COMMONWEALTH BASED ON THEIR TOTAL PATIENT SERVICE REVENUE. ADDITIONAL PROVIDER PAYMENTS ARE DISTRIBUTED BACK TO HOSPITALS WHICH PROVIDE SERVICES TO MEDICAID PATIENTS BASED ON THEIR PERCENTAGE OF NET PATIENT SERVICE REVENUE FROM THE MEDICAID PROGRAM. PART II, COMMUNITY BUILDING ACTIVITIES: IN FURTHERANCE OF ITS MISSION TO IMPROVE THE HEALTH OF THE COMMUNITY IT SERVES THE ORGANIZATION PROMOTES WORKFORCE DEVELOPMENT FOR THE RECRUITMENT OF PHYSICIANS AND OTHER HEALTH PROFESSIONALS IN AREAS IDENTIFIED AS SHORTAGE AREAS THROUGH ITS COMMUNITY NEEDS ASSESSMENTS AND MEDICAL STAFF DEVELOPMENT PLANS. RECRUITMENT OF PHYSICIANS TO PRACTICE IN MWHC'S SERVICE AREA IMPROVES ACCESS TO CARE RESULTING IN GREATER AVAILABILITY OF PHYSICIAN SPECIALISTS, LESS TRAVEL TO OBTAIN CARE, AND SHORTER WAIT TIMES FOR APPOINTMENTS. ADDITIONALLY MWHC, PROVIDES FACILITIES FREE OF CHARGE TO RAPPAHANNOCK EMERGENCY MEDICAL SERVICES WHICH IS VALUED AT APPROXIMATELY $100,000. PART III, LINE 4: MWHC PROVIDES SERVICES TO UNINSURED PATIENTS AND OFFERS THOSE UNINSURED PATIENTS A DISCOUNT FROM STANDARD CHARGES. PATIENTS WHO ARE COVERED BY THIRD-PARTY PAYORS ARE RESPONSIBLE FOR RELATED DEDUCTIBLES AND COINSURANCE. MWHC ESTIMATES THE TRANSACTION PRICE FOR PATIENTS WITH DEDUCTIBLES AND COINSURANCE AND FROM THOSE WHO ARE UNINSURED BASED ON HISTORICAL EXPERIENCE AND CURRENT MARKET CONDITIONS. SUBSEQUENT CHANGES THAT ARE DETERMINED TO BE THE RESULT OF AN ADVERSE CHANGE IN THE PATIENT'S ABILITY TO PAY ARE RECORDED AS BAD DEBT EXPENSE. BAD DEBT EXPENSE FOR THE YEARS ENDED DECEMBER 31, 2022 AND 2021, WAS NOT CONSIDERED MATERIAL.PATIENTS WHO MEET MWHC'S CRITERIA FOR CHARITY CARE ARE PROVIDED CARE WITHOUT CHARGE OR AT AMOUNTS LESS THAN ESTABLISHED RATES. SUCH AMOUNTS DETERMINED TO QUALIFY AS CHARITY CARE ARE NOT REPORTED AS REVENUE. PART III, LINE 8: AS A NOT-FOR-PROFIT HOSPITAL IT IS OUR MISSION TO IMPROVE THE HEALTH STATUS OF ALL PEOPLE WITHIN OUR COMMUNITY AND TO PROVIDE HEALTHCARE TO ALL PATIENTS REGARDLESS OF THEIR ABILITY TO PAY OR THEIR INSURANCE STATUS. MWHC ACCEPTS MEDICARE AND MEDICAID AND IT IS A WELL ESTABLISHED FACT THAT NOT-FOR-PROFIT FACILITIES DO NOT RECOUP THE COST OF CARING FOR THOSE PATIENTS UTILIZING THESE PROGRAMS. UNDER IRS GUIDELINES MEDICARE AND MEDICAID BENEFICIARIES ARE CONSIDERED TO BE MEMBERS OF A CHARITABLE CLASS, THEREFORE BY ASSISTING THESE PATIENTS AND ACCEPTING THE SHORTFALLS IN REPAYMENT, THE ORGANIZATION IS IN FACT RELIEVING GOVERNMENT BURDEN AND PROVIDING A SIGNIFICANT COMMUNITY BENEFIT TO OUR SERVICE AREA. PART III, LINE 9B: PATIENTS MAY APPLY FOR FINANCIAL ASSISTANCE AT ANY POINT IN THE COLLECTION CYCLE AND MODIFICATIONS OF ABILITY TO PAY MAY BE ADJUSTED SHOULD FINANCIAL OR INSURANCE STATUS CHANGE SINCE THE FIRST DAY OF CARE. MWHC DOES NOT ENGAGE IN EXTRAORDINARY COLLECTION ACTIONS BEFORE THEY HAVE MADE REASONABLE EFFORTS TO DETERMINE WHETHER THE INDIVIDUAL IS ELIGIBLE FOR ASSISTANCE UNDER THIS FINANCIAL ASSISTANCE POLICY. REASONABLE EFFORTS CONSTITUTE NOTIFICATION BY MWHC OF ITS FINANCIAL ASSISTANCE POLICY BY WRITTEN AND/OR ORAL COMMUNICATIONS TO ALL UNINSURED/UNDERINSURED PATIENTS AS WELL AS CONSIDERATION OF ELIGIBILITY BASED UPON THE PRESUMPTIVE ELIGIBILITY GUIDELINES DESCRIBED IN THE FINANCIAL ASSISTANCE POLICY. PART VI, LINE 2: MARY WASHINGTON HEALTHCARE AND ITS AFFILIATES (MARY WASHINGTON HOSPTIAL, MARY WASHINGTON HOSPITAL FOUNDATION, STAFFORD HOSPITAL, LLC, STAFFORD HOSPITAL FOUNDATION, MEDICORP PROPERTIES, INC., AND MARY WASHINGTON HEALTHCARE CLINICAL SERVICES, INC.) HAS AS ITS MISSION TO IMPROVE THE HEALTH OF MEMBERS OF THE COMMUNITIES IT SERVES: FREDERICKSBURG, VA AND THE SURROUNDING SIX (6) COUNTIES. THE ORGANIZATION ASSESSES THE HEALTH CARE NEEDS OF THESE COMMUNITIES IN NUMEROUS WAYS INCLUDING: 1.) WORKING COLLABORATIVELY WITH BE WELL RAPPAHANNOCK (BWR). BWR IS A COLLABORATIVE COMPRISED OF AGENCIES REPRESENTATIVE OF THE COMMUNITY, WITH A DEEP CONCERN FOR THE HEALTH AND WELL-BEING OF THE RESIDENTS OF THE RAPPAHANNOCK REGION. THE PURPOSE OF THE COUNCIL IS TO IDENTIFY AND PRIORITIZE COMMUNITY NEEDS, PROVIDE GUIDANCE, AND OVERSIGHT OVER PLANNED COMMUNITY IMPROVEMENTS, AND MONITOR PROGRESS ON PRIORITY HEALTH AND SOCIAL CONCERNS IMPACTING THE RAPPAHANNOCK REGION. BE WELL RAPPAHANNOCK REPRESENTATIVE ORGANIZATIONS INCLUDE COMMUNITY COLLABORATIVE FOR YOUTH AND FAMILIES, DEPARTMENTS OF SOCIAL SERVICES, AREA BUSINESSES, LOCAL GOVERNMENT, HIGHER EDUCATION, RAPPAHANNOCK AREA HEALTH DISTRICT, RAPPAHANNOCK UNITED WAY, RAPPAHANNOCK COMMUNITY SERVICE BOARD, COMMUNITY MENTAL HEALTH, AND AREA SCHOOL DISTRICTS. 2.) RESPONDING TO INFORMATION GATHERED FROM AREA COMMUNITY-BASED ORGANIZATIONS. THE COMMUNITY HEALTH NEEDS ASSESSMENT PROVIDES A FOUNDATION FOR WORKING COLLABORATIVELY WITH KEY STAKEHOLDERS IN THE COMMUNITY TO IMPROVE HEALTH. SPECIAL ATTENTION HAS BEEN GIVEN TO IDENTIFY HEALTH DISPARITIES, NEEDS OF VULNERABLE POPULATIONS, AND UNMET HEALTH NEEDS OR GAPS IN SERVICES THROUGH COMMUNITY INPUT. PART VI, LINE 3: MARY WASHINGTON HEALTHCARE AFFILIATES PROVIDE INFORMATION TO PATIENTS ABOUT ITS FINANCIAL ASSISTANCE PROGRAMS THROUGH SIGNAGE AT INTAKE AREAS, FLYERS AT ADMISSIONS, NOTICES ON BILLS AND COLLECTION STATEMENTS. FINANCIAL COUNSELORS ARE ALSO AVAILABLE TO ASSIST PATIENTS IN OBTAINING FINANCIAL ASSISTANCE. PART VI, LINE 4: MARY WASHINGTON HEALTHCARE PROVIDES EXCEPTIONAL MEDICAL SERVICES TO THE CITY OF FREDERICKSBURG AND THE SURROUNDING "COMMUNITY" THAT CONSIST OF THE PRIMARY SERVICE AREA COUNTIES OF STAFFORD, KING GEORGE, SPOTSYLVANIA, WESTMORELAND, ORANGE, PRINCE WILLIAM, AND SECONDARY SERVICE AREA COUNTIES OF MANASSAS, FAUQUIER, CULPEPER, LOUISA, ESSEX, AND RICHMOND. ESTABLISHED IN 1899, MARY WASHINGTON HOSPITAL (MWH), A 471 BED ACUTE CARE FACILITY, OFFERS COMPREHENSIVE HEALTHCARE AND MULTIPLE CENTERS OF EXCELLENCE INCLUDING CARDIOLOGY AND CARDIOVASCULAR SURGERY, PSYCHIATRY, AND WOMEN AND INFANT HEALTH. STAFFORD HOSPITAL, LLC, A 100 BED ACUTE CARE FACILITY, ALSO OFFERS COMPREHENSIVE HEALTHCARE SERVICES. BOTH MWH AND SH ARE ACCREDITED BY THE JOINT COMMISSION AND LICENSED BY THE COMMONWEALTH OF VIRGINIA DEPARTMENT OF HEALTH AND THE DEPARTMENT OF MENTAL HEALTH, MENTAL RETARDATION AND SUBSTANCE ABUSE SERVICES. MWH ALSO PROVIDES ADVANCE RADIATION THERAPY THROUGH THE CANCER CENTER OF VIRGINIA AND HOME HEALTH SERVICES THROUGH MARY WASHINGTON HOME HEALTH.AS OF THE MOST RECENT CENSUS, THE PRIMARY SERVICE AREA IN WHICH BOTH HOSPITALS SERVE IS MADE UP OF ABOUT 1,796 SQUARE MILES OF SUBURBAN AND RURAL LAND. COMMUNITY RESIDENTS IN THE PRIMARY SERVICE AREA EARN A MEDIAN INCOME PER HOUSEHOLD OF $95,349/YEAR, WITH A COLLECTIVE AVERAGE OF 8.6% OF THE ENTIRE PRIMARY SERVICE AREA LIVING BELOW THE FEDERAL POVERTY GUIDELINES. THE PRIMARY SERVICE AREA HAS AN ESTIMATED POPULATION OF 477,221 INDIVIDUALS AND 165,393 HOUSEHOLDS. PART VI, LINE 5: MARY WASHINGTON HOSPITAL, INC. AND STAFFORD HOSPITAL, LLC EACH OPERATE AN EMERGENCY ROOM THAT IS OPEN TO ALL PERSONS REGARDLESS OF ABILITY TO PAY; HAVE OPEN MEDICAL STAFFS WITH PRIVILEGES TO ALL QUALIFIED PHYSICIANS WHO APPLY, HAVE A GOVERNING BODY WITH A MAJORITY OF INDEPENDENT TRUSTEES, AND PARTICIPATE IN MEDICAID, MEDICARE AND OTHER GOVERNMENT SPONSORED HEALTH CARE PROGRAMS. MARY WASHINGTON HEALTHCARE CLINICAL SERVICES, INC. THROUGH ITS SUBSIDIARIES, PROVIDES ANCILLARY HEALTH SERVICES INCLUDING PHYSICIAN PRACTICES, OUTPATIENT AND AMBULATORY SURGERY, AND HOME HEALTH/HOSPICE SERVICES.THE ORGANIZATION UTILIZES SURPLUS FUNDS TO EXPAND SERVICES PROVIDED TO THE COMMUNITY (IN RESPONSE TO THE COMMUNITY NEEDS ASSESSMENTS), UPGRADE FACILITIES AND EQUIPMENT TO ENHANCE CLINICAL CARE AND PHYSICIAN CONNECTIVITY TO PATIENT ELECTRONIC HEALTH RECORDS, AND HEALTH EDUCATION PROGRAMS. PART VI, LINE 6: MARY WASHINGTON HEALTHCARE AFFILIATES INCLUDE TWO (2) HOSPITALS, OTHER CLINICAL SERVICES THAT INCLUDE AN AMBULATORY SURGERY CENTER, HOSPICE/HOME HEALTH, INDEPENDENT DIAGNOSTIC TESTING FACILITIES, AND PHYSICIAN PRACTICES; TWO (2) FOUNDATIONS AND A PROPERTY DIVISION. ALL ACTIVITIES OF THIS GROUP ARE COORDINATED AND OVERSEEN BY THE PARENT'S (MARY WASHINGTON HEALTHCARE) BOARD OF TRUSTEES. THE AFFILIATED GROUP'S ACTIVITIES ARE CLOSELY PLANNED/INTEGRATED THROUGH INTERLOCKING BOARDS TO ENSURE THE MOST EFFECTIVE DELIVERY OF CARE. EACH MEMBER OF THE AFFILIATED GROUP FOCUSES EFFORTS IN ITS PARTICULAR AREA OF RESPONSIBILITY AND IS ACCOUNTABLE TO THE PARENT'S BOARD FOR ACHIEVING ITS MISSION AND GOALS FOR THE PROVISION OF HEALTH CARE. THE DIVISION OF SERVICES ABOVE ALLOWS PATIENTS TO ACCESS CARE IN THE MOST APPROPRIATE SETTING. THE GOVERNANCE OVERSIGHT PROVIDED BY THE PARENT GUARANTEES OPTIMAL COORDINATION OF THE VARIOUS SEGMENTS OF CARE AND ENSURES HIGH QUALITY SERVICE AS ECONOMICALLY AS POSSIBLE. PART VI, LINE 7, REPORTS FILED WITH STATES VA 0 LLOYD F MOSS FREE CLINIC 1301 SAM PERRY BLVD STE 100 FREDERICKSBURG VA 22401 541677934 501(C)(3) 600000 0 GENERAL SUPPORT MICAH ECUMENICAL MINISTRIES PO BOX 3277 FREDERICKSBURG VA 22402 204044884 501(C)(3) 135000 0 RESIDENTIAL RECOVERY PROGRAM FREDERICKSBURG CHRISTIAN HEALTH CENTER 1129 HEATHERSTONE DRIVE FREDERICKSBURG VA 22407 542061482 501(C)(3) 105000 0 GENERAL SUPPORT GUADALUPE FREE CLINIC OF COLONIAL BEACH PO BOX 275 COLONIAL BEACH VA 22443 510635977 501(C)(3) 75000 0 GENERAL SUPPORT CENTRAL VA HEALTH SERVICES PO BOX 220 NEW CANTON VA 25892 540887287 501(C)(3) 64000 0 ACCESS TO CARE PROGRAMS GERMANNA COMMUNITY COLLEGE EDUCATIONAL FOUNDATION PO BOX 1430 LOCUST GROVE VA 22508 541379348 501(C)(3) 50000 0 NURSING PROGRAM EXPANSION FREDERICKSBURG REGIONAL TRANSIT 1400 JEFFERSON DAVIS HWY FREDERICKSBURG VA 22401 546001293 115 40000 0 SAFE RELIABLE TRANSPORTATION TO HEALTH RELATED SITES VIRGINIA COMMUNITY FOOD CONNECTIONS PO BOX 7664 FREDERICKSBURG VA 22404 811346510 501(C)(3) 35000 0 FRESH FOOD ACCESS FOR COMMUNITY HEALTH STAFFORD SCHOOLS HEAD START 610 GAYLE ST FREDERICKSBURG VA 22405 546001628 115 35000 0 CHILDREN'S INSURANCE OUTREACH / NUTRITION CONSULTANT PROJECTS FREDERICKSBURG AREA FOOD BANK 3631 LEE HILL DR FREDERICKSBURG VA 22408 541255013 501(C)(3) 35000 0 ORDER AHEAD & DIABETES PREVENTION PROGRAMS RAPPAHANNOCK AREA AGENCY ON AGING INC 460 LENDALL LANE FREDERICKSBURG VA 22405 541027651 501(C)(3) 32000 0 GENERAL SUPPORT FREDERICKSBURG COUNSELING SVCS 305 HANSON AVE SUITE 140 FREDERICKSBURG VA 22401 540844464 501(C)(3) 30000 0 GENERAL SUPPORT GEORGE WASHINGTON REGIONAL COMMISSION 406 PRINCESS ANNE STREET FREDERICKSBURG VA 22401 540715969 115 26000 0 COMMUNITY BASED ELIGIBILITY WORKER GWYNETH'S GIFT FOUNDATION 2217 PRINCESS ANNE ST STE 101 FREDERICKSBURG VA 22401 474428397 501(C)(3) 21000 0 LIFE SAVING CPR EDUCATION AND AED ACCESS DOWNTOWN GREENS INC 206 CHARLES STREET FREDERICKSBURG VA 22401 541853889 501(C)(3) 20000 0 HEALTHY EATING PROGRAM ACTION IN COMMUNITY THROUGH SERVICE OF PRINCE WILLIAM INC 3900 ACTS LANE DUMFRIES VA 22026 540897679 501(C)(3) 20000 0 GENERAL SUPPORT STAFFORD JUNCTION INC 791 TRUSLOW ROAD FREDERICKSBURG VA 22406 203036072 501(C)(3) 18000 0 HEALTHY LIVING PAYS STAFFORD COUNTY SOCIAL SERVICES PO BOX 7 STAFFORD VA 22554 546001626 115 15000 0 STAFFORD'S HEALTH INSURANCE ENROLLMENT PROGRAM (SHINE) HAZEL HILL HEALTHCARE PROJECT 225 BUTLER RD FREDERICKSBURG VA 22401 271744104 501(C)(3) 15000 0 SENIOR HEALTHCARE ACCESS RX PARTNERSHIP 2924 EMERYWOOD PARKWAY 300 RICHMOND VA 23294 571186937 501(C)(3) 15000 0 INCREASED ACCESS TO MEDICATIONS DISABILITY RESOURCE CENTER 409 PROGRESS ST FREDERICKSBURG VA 22401 541687677 501(C)(3) 10000 0 MOBILITIY PROGRAM FREDERICKSBURG EDUCATION FOUNDATION 210 FERDINAND STREET FREDERICKSBURG VA 22401 853567369 501(C)(3) 9878 0 EDUCATIONAL PROGRAMS FREDERICKSBURG HOST LIONS 609 FALMOUTH DR FREDERICKSBURG VA 22405 541420410 501(C)(3) 8000 0 VISION PROGRAMS MENTAL HEALTH AMERICA OF FREDERICKSBURG 2217 PRINCESS ANNE STSTE 104-1 FREDERICKSBURG VA 22401 540678704 501(C)(3) 7500 0 GENERAL SUPPORT SERVANTS AT WORK INC - VIRGINIA 3102 PLANK RD PO BOX 41208 FBURG VA 22404 FREDERICKSBURG VA 22407 833751081 501(C)(3) 6000 0 GENERAL SUPPORT LUCHA MINISTRIES INC PO BOX 8239 FREDERICKSBURG VA 22404 202953751 501(C)(3) 5900 0 GENERAL SUPPORT 38 4 NANCY HAZARD MEMORIAL NURSING 1 1000 SUE HALL NURSING SCHOLARSHIP 1 1000 WILLIS MEMORIAL SCHOLARSHIP 1 1000 WILLIS MEMORIAL SCHOLARSHIP 1 1000 WILLIAM F JACOBS SCHOLARSHIP 1 1200 MARY WASHINGTON HOSPITAL AUXILIARY SCHOLARSHIP 1 1000 MARY WASHINGTON HOSPITAL AUXILIARY 1 1000 THE FRED RANKIN III LEADERSHIP SCHOLARSHIP 1 1200 SAL KIWALL MEMORIAL SCHOLARSHIP 1 1000 SAL KIWALL MEMORIAL SCHOLARSHIP 1 1000 WILLIAM F JACOBS SCHOLARSHIP 1 1200 CORA GRAVES ALLISON NURSING SCHOLARSHIP 1 1000 REBECCA BENNETT NURSING SCHOLARSHIP 1 1000 CHARLES M. "PETE" HEARN FELLOWSHIP 1 1200 SUE HALL NURSING SCHOLARSHIP 1 1000 STAFFORD HOSPITAL AUXILIARY SCHOLARSHIP 1 1000 X X 1 1 X X X X X X 0 1 0 0 0 0 0 1 0 MICHAEL P MCDERMOTT MD MBA PRESIDENT AND CEO 0 1153631 0 614240 0 39902 0 9150 0 33406 0 1850329 0 0 CHRISTOPHER NEWMAN MD SVP, COO & CMO 0 678647 0 273290 0 16622 0 9150 0 34849 0 1012558 0 0 SANG HO NA MD PHYSICIAN 829034 0 85000 0 12195 0 9150 0 16212 0 951591 0 0 0 AGOSTINO VISIONI MD PHYSICIAN 815769 0 82500 0 8330 0 7881 0 33573 0 948053 0 0 0 J T SHERWOOD MD PHYSICIAN 776268 0 60000 0 2217 0 8542 0 38068 0 885095 0 0 0 SEAN T BARDEN BSBA MBA SR VP & CFO 0 571595 0 236670 0 21591 0 9150 0 25396 0 864402 0 0 HONG NGUYEN PHYSICIAN 254237 0 532154 0 1980 0 7650 0 2086 0 798107 0 0 0 TRAVIS TURNER BS MBA SVP & CPHO 0 477279 0 162540 0 15623 0 7821 0 32502 0 695765 0 0 ELIESE K BERNARD VICE PRESIDENT 0 479247 0 146020 0 15703 0 7705 0 31004 0 679679 0 0 THERESA CONOLOGUE PHYSICIAN 534402 0 84913 0 740 0 4777 0 20341 0 645173 0 0 0 STEPHEN MANDELL MD VICE PRESIDENT 392989 0 110460 0 63183 0 7558 0 28299 0 602489 0 0 0 ERIC FLETCHER MBA APR SVP & CSO 0 380896 0 133110 0 15312 0 9150 0 32992 0 571460 0 0 GEOFFREY LAWSON SVP & CIO 0 394999 0 132200 0 17818 0 8849 0 16043 0 569909 0 0 KATHRYN WALL BA MA SVP & CHRO 0 372790 0 125160 0 19640 0 9150 0 14132 0 540872 0 0 DAVID YI MD VICE PRESIDENT 0 406381 0 109760 0 8874 0 9150 0 1953 0 536118 0 0 EILEEN DOHMANN RN BSN MBA NEA-BC SVP & CNO 0 374110 0 127830 0 19536 0 9036 0 4948 0 535460 0 0 BRADFORD KING MD PHYSICIAN/TRUSTEE (THRU 2/2022) 424442 0 37826 0 29801 0 9150 0 1933 0 503152 0 0 0 DANIEL WOODFORD VICE PRESIDENT 338178 0 110013 0 9265 0 9150 0 30408 0 497014 0 0 0 RICHARD LEWIS MD VICE PRESIDENT 0 309351 0 87190 0 38407 0 9150 0 25081 0 469179 0 0 SAUSHEEN TAYLOR MD PHYSICIAN/TRUSTEE 380881 0 34340 0 281 0 5724 0 34056 0 455282 0 0 0 STEPHANIE GOLDBERG VICE PRESIDENT 399440 0 32000 0 10184 0 9150 0 1934 0 452708 0 0 0 CATHLEEN YABLONSKI BS MS VICE PRESIDENT 319869 0 76050 0 14158 0 8130 0 27039 0 445246 0 0 0 SCOTT SELL VICE PRESIDENT 322144 0 90720 0 10596 0 9150 0 10980 0 443590 0 0 0 XAVIER RICHARDSON BA MBA SVP & CDO 0 303358 0 96500 0 22143 0 9150 0 11708 0 442859 0 0 MARIE FREDRICK RT R CRA MJ VICE PRESIDENT (THRU 6/22) 0 62241 0 74150 0 262405 0 3911 0 10773 0 413480 0 0 SANDRA BROWN CPA VICE PRESIDENT 0 277902 0 76500 0 10192 0 8758 0 23904 0 397256 0 0 ALAN EDWARDS VICE PRESIDENT 0 247628 0 67980 0 37196 0 7029 0 32142 0 391975 0 0 CODY BLANKENSHIP VICE PRESIDENT 0 264837 0 74660 0 10147 0 6650 0 30445 0 386739 0 0 LAUREN BLALOCK VICE PRESIDENT 0 266086 0 68610 0 8440 0 8378 0 26573 0 378087 0 0 SARAH OGLE VICE PRESIDENT 0 268056 0 72130 0 8030 0 8283 0 2338 0 358837 0 0 TINA ERVIN VICE PRESIDENT 0 235764 0 65230 0 8741 0 7443 0 24127 0 341305 0 0 SUMMER HUGHES VICE PRESIDENT 0 227604 0 63250 0 8060 0 5335 0 28607 0 332856 0 0 TOM JANUS VICE PRESIDENT (THRU 9/22) 216534 0 84000 0 11656 0 4967 0 15489 0 332646 0 0 0 PART I, LINE 1A PART I, LINE 1A - TRUSTEES WHO ARE UNCOMPENSATED VOLUNTEERS TRAVELING FOR BUSINESS RELATED REASONS ON BEHALF OF THE ORGANIZATION ARE REIMBURSED FOR THE COST OF SPOUSAL TRAVEL. REIMBURSEMENTS PAID FOR SPOUSAL TRAVEL ARE REIMBURSED AND REPORTED AS INCOME ON A FORM 1099 IN THE YEAR PAID. EXECUTIVES WHO ARE TRAVELING FOR BUSINESS RELATED REASONS ON BEHALF OF THE ORGANIZATION ARE REIMBURSED FOR THE COST OF SPOUSAL MEALS PROVIDED AND THE AMOUNT IS REPORTED AS INCOME ON THE EXECUTIVE'S W-2. PART I, LINE 4B STEPHEN MANDELL RECEIVED A 457(F) DISTRIBUTION OF $44,124. RICHARD LEWIS RECEIVED A 457(F) DISTRIBUTION OF $19,136. MARIE FREDRICK RECEIVED A 457(F) DISTRIBUTION OF $41,265. ALAN EDWARDS RECEIVED A 457(F) DISTRIBUTION OF $22,583. PART I, LINE 7 PART I, LINE 7 - ALL EXECUTIVES HAVE AS A PART OF THEIR COMPENSATION A VARIABLE COMPONENT SUCH THAT THEY ARE ELIGIBLE TO RECEIVE A PERCENTAGE OF THEIR BASE PAY AS AN INCENTIVE FOR THE ACHIEVEMENT OF INDIVIDUAL AND CORPORATE GOALS AND OBJECTIVES. SCHEDULE J INDEPENDENT BOARD TRUSTEES RECEIVE NO COMPENSATION. A ECONOMIC DEVELOPMENT AUTHORITY 521303430 355849AS9 2007-05-10 86868312 REFUNDING OF 1996 MWH BONDS 0 0 0 B ECONOMIC DEVELOPMENT AUTHORITY 521303430 355849BC3 2014-05-28 59254492 REFUNDING OF 2002 BONDS 0 0 0 C ECONOMIC DEVELOPMENT AUTHORITY 541244413 852431BM6 2016-05-02 128486132 REFUNDING OF 2006 BONDS 0 0 0 D ECONOMIC DEVELOPMENT AUTHORITY 521303430 2016-11-22 30405000 REFUNDING OF 2013 BONDS 0 0 0 A 74260000 86868312 583010 86285302 2007 1 0 1 1 B 59254492 630794 58623698 2014 1 0 1 1 C 3310000 128486132 2100667 126385465 2016 1 0 1 1 D 6285000 30405000 30405000 2016 1 0 1 1 A 0 0 1 1 0 0 0 1 B 0 0 1 1 0 0 0 1 C 0 0 1 1 0 0 0 1 D 0 1 1 1 0 0 0 1 A 0 0 1 0 0 0 0 0 1 B 0 0 1 0 0 0 0 0 1 C 0 0 1 0 0 0 0 0 1 D 0 0 1 0 1 0 0 1 1 A 1 B 1 C 1 D 1 FORM 990, PART VI, SECTION B, LINE 11B MANAGEMENT COMPLETES A DRAFT OF THE INTERNAL REVENUE SERVICE (IRS) FORM 990 INFORMATION RETURN FOR MARY WASHINGTON HEALTHCARE AND ITS SUBSIDIARIES. THIS DRAFT IS SUBMITTED TO THE FINANCE COMMITTEE OF THE ORGANIZATION'S BOARD OF TRUSTEES. THE FORM 990 AND UNDERLYING INFORMATION ARE PRESENTED TO AND REVIEWED BY THIS COMMITTEE. IF THE CONTENTS OF THE 990 RETURN ARE DEEMED ACCURATE AND ACCEPTABLE BY THE COMMITTEE, THIS BODY RECOMMENDS ACCEPTANCE OF THE RETURN BY THE FULL BOARD OF TRUSTEES. THE FORM 990 RETURN IS SUBSEQUENTLY PRESENTED TO AND REVIEWED BY THE ORGANIZATION'S BOARD OF TRUSTEES. IF DEEMED ACCURATE AND ACCEPTABLE THE BOARD ACCEPTS THE RETURN THROUGH A FORMAL MOTION. AS PART OF THIS PROCESS, THE DRAFT RETURN IS POSTED ON THE BOARD'S WEBSITE WHERE IT REMAINS AVAILABLE FOR REVIEW EVEN AFTER FORMAL ACCEPTANCE BY THE BOARD. THE FORM 990 RETURN IS ALSO AVAILABLE TO MEMBERS OF THE BOARD OF TRUSTEES AS WELL AS THE GENERAL PUBLIC ON MARY WASHINGTON HEALTHCARE'S WEBSITE (WWW.MARYWASHINGTONHEALTHCARE.COM). FORM 990, PART VI, SECTION B, LINE 12C EVERY TRUSTEE AND EXECUTIVE IS REQUIRED TO DISCLOSE ANY AND ALL CONFLICTS. THE DISCLOSURES ARE MADE ANNUALLY AND SUBMITTED TO THE MARY WASHINGTON HEALTHCARE CHIEF COMPLIANCE OFFICER (CCO). THE CCO PRESENTS ALL CONFLICTS TO THE ENTERPRISE RISK MANAGEMENT COMMITTEE OF THE BOARD OF TRUSTEES. THE CHAIRMAN OF THE ENTERPRISE RISK MANAGEMENT COMMITTEE REPORTS ALL CONFLICTS TO THE FULL BOARD. CONFLICTS ARE CONTINUALLY AND ACTIVELY MANAGED. AT EACH MEETING, THE CHAIR ASKS IF ANYONE AT THE MEETING HAS A CONFLICT TO DISCLOSE. INDIVIDUALS WITH CONFLICTS DISCLOSE THEIR CONFLICTS AND THE RELATED TOPIC. THE INDIVIDUAL THEN RECUSES HIM/HERSELF FROM ANY DECISION RELATED TO THAT TOPIC. THE CONFLICT OF INTERESTS POLICY IS REVIEWED ANNUALLY BY THE BOARD OF TRUSTEES. FORM 990, PART VI, SECTION B, LINE 15 MARY WASHINGTON HEALTHCARE UTILIZES AN EXECUTIVE COMPENSATION COMMITTEE WITH THE PURPOSE AND AUTHORITY TO ESTABLISH PROCESSES TO ENSURE FAIR AND COMMERCIALLY REASONABLE COMPENSATION FOR THE CEO AND EXECUTIVE LEADERSHIP. IN ORDER TO ENSURE COMPENSATION PAID IS SET AT FAIR MARKET VALUE, THE EXECUTIVE COMPENSATION COMMITTEE UTILIZES COMPENSATION SURVEY DATA, FORM 990 INFORMATION FROM COMPARABLE HEALTH SYSTEMS, AND THE SERVICES OF AN INDEPENDENT COMPENSATION CONSULTANT. SUCH INDEPENDENT THIRD PARTY DATA POINTS PROVIDE ASSURANCE THAT EXECUTIVE COMPENSATION IS COMMERCIALLY REASONABLE AND AT A FAIR MARKET VALUE. FORM 990, PART VI, SECTION C, LINE 19 THE AUDITED FINANCIALS STATEMENTS ARE POSTED ON THE MARY WASHINGTON HEALTHCARE WEBSITE FOR PUBLIC VIEW. FORM 990, PART IX, LINE 11G CONTRACT PERSONNEL: PROGRAM SERVICE EXPENSES 42,147,447. MANAGEMENT AND GENERAL EXPENSES 2,128,435. FUNDRAISING EXPENSES 66,514. TOTAL EXPENSES 44,342,396. CONSULTING SERVICES: PROGRAM SERVICE EXPENSES 55,190,544. MANAGEMENT AND GENERAL EXPENSES 2,787,108. FUNDRAISING EXPENSES 87,097. TOTAL EXPENSES 58,064,749. BILLING AND COLLECTION SERVICES: PROGRAM SERVICE EXPENSES 171,061. MANAGEMENT AND GENERAL EXPENSES 8,639. FUNDRAISING EXPENSES 270. TOTAL EXPENSES 179,970. ASP SERVICES: PROGRAM SERVICE EXPENSES 9,493. MANAGEMENT AND GENERAL EXPENSES 479. FUNDRAISING EXPENSES 15. TOTAL EXPENSES 9,987. MAINTENANCE SERVICES: PROGRAM SERVICE EXPENSES 7,614,039. MANAGEMENT AND GENERAL EXPENSES 384,507. FUNDRAISING EXPENSES 12,016. TOTAL EXPENSES 8,010,562. STORAGE SERVICES: PROGRAM SERVICE EXPENSES 83,366. MANAGEMENT AND GENERAL EXPENSES 4,210. FUNDRAISING EXPENSES 132. TOTAL EXPENSES 87,708. WASTE DISPOSAL: PROGRAM SERVICE EXPENSES 1,245,505. MANAGEMENT AND GENERAL EXPENSES 62,898. FUNDRAISING EXPENSES 1,966. TOTAL EXPENSES 1,310,369. MANAGEMENT CONTRACTS: PROGRAM SERVICE EXPENSES 32,806,726. MANAGEMENT AND GENERAL EXPENSES 1,656,731. FUNDRAISING EXPENSES 51,773. TOTAL EXPENSES 34,515,230. FORM 990, PART XI, LINE 9: UNCOLLECTED PLEDGES -242,871. ELIMINATION OF EQUITY FOR CONSOLIDATED ENTITIES 11,001,208. RELIEF FROM AFFILIATE LOANS -19,682,992. FORM 990, PART XII, LINE 2C THE COMPANIES IN THE GROUP RETURN ARE INCLUDED IN THE CONSOLIDATED AUDITED FINANCIAL STATEMENTS OF MWHC. RESPONSIBILITY FOR OVERSIGHT OF THE AUDIT AND SELECTION OF AUDITORS RESTS WITH THE FINANCE COMMITTEE OF THE BOARD OF TRUSTEES. FORM 990, PART V, Q2A NO ENTITY WITHIN THE GROUP FILES W-2S WITH THE IRS. ALL PAYROLL IS PAID THROUGH AN AGENCY AGREEMENT WITH MARY WASHINGTON HEALTHCARE. FORM 990, SCHEDULE R ABBREVIATIONS: MWHC - MARY WASHINGTON HEALTHCARE MPI - MEDICORP PROPERTIES, INC. MWHC CLINICAL - MARY WASHINGTON HEALTHCARE CLINICAL SERVICES, INC. MWHC SERVICES, INC. - MARY WASHINGTON HEALTHCARE SERVICES, INC. MEDIDOCTORS H.C. - MEDIDOCTORS HOLDING COMPANY FORM 990, PART V, Q3A AND Q3B MARY WASHINGTON HOSPITAL AND MARY WASHINTON HOSPITAL FOUNDATON FILE SEPARATE 990T'S RELATED TO UNRELATED BUSINESS INCOME. MEDIDOCTORS LLC 2300 FALL HILL AVE STE 418 FREDERICKSBURG VA 22401 541990805 MEDICAL VA 7924 -4990 MARY WASHINGTON HEALTHCARE CLINICAL SERVICES INC MARY WASHINGTON MEDICAL GROUP - HOSPITALIST SERVICES LLC 2300 FALL HILL AVE STE 418 FREDERICKSBURG VA 22401 571172752 MEDICAL VA 27413806 655896 MARY WASHINGTON HEALTHCARE CLINICAL SERVICES INC MARY WASHINGTON EYE CARE LLC 2300 FALL HILL AVE STE 418 FREDERICKSBURG VA 22401 271248032 MEDICAL VA 2218656 869390 MWHC URGENT CARE LLC 2300 FALL HILL AVE STE 418 FREDERICKSBURG VA 22401 834378864 MEDICAL VA 8950383 1145075 STAFFORD HOSPITAL AUXILIARY 2300 FALL HILL AVE SUITE 418 FREDERICKSBURG VA 22401 262704632 MEDICAL SERVICES VA 501(C)(3) LINE 12D, III-O 0 MARY WASHINGTON HOSPITAL AUXILIARY 2300 FALL HILL AVE SUITE 418 FREDERICKSBURG VA 22401 752985923 MEDICAL SERVICES VA 501(C)(3) LINE 12D, III-O 0 MARY WASHINGTON HEALTHCARE 2300 FALL HILL AVE SUITE 418 FREDERICKSBURG VA 22401 541240646 SUPPORT SERVICES VA 501(C)(3) LINE 12C, III-FI 0 FREDERICKSBURG AMBULATORY SURGERY CENTER 2300 FALL HILL AVE STE 418 FREDERICKSBURG VA 22401 562322548 SURGERY CTR VA MWHC CLINICAL SERVICES INC RELATED 1658408 15461 0 1 0.59380 MEDICAL IMAGING OF FREDERICKSBURG 2300 FALL HILL AVE STE 418 FREDERICKSBURG VA 22401 541364028 IMAGING VA MWHC CLINICAL SERVICES INC RELATED 8034290 4215828 0 1 0.51000 COWAN INVESTMENT PARTNERS LLC 2300 FALL HILL AVE STE 418 FREDERICKSBURG VA 22401 651294835 REAL ESTATE VA MEDICORP PROPERTIES INC RELATED 11486 34148 0 0 0.12500 SPOTSYLVANIA PARKWAY MEDICAL PLAZA LLC 2300 FALL HILL AVE STE 418 FREDERICKSBURG VA 22401 262656396 REAL ESTATE VA MEDICORP PROPERTIES INC RELATED 197340 -701312 0 0 0.42780 COMMONWEALTH IMAGING LLC 2300 FALL HILL AVE STE 418 FREDERICKSBURG VA 22401 050622704 IMAGING VA MWHC SERVICES INC RELATED 62566 84543 0 0 0.33330 MWHC ENDOSCOPY HOLDINGS LLC 2300 FALL HILL AVE STE 418 FREDERICKSBURG VA 22401 834407938 ENDOSCOPY VA MWHC CLINICAL SERVICES INC RELATED 1344741 174181 0 1 0.60000 FREDERICKSBURG ENDOSCOPY CENTER LLC 2300 FALL HILL AVE STE 418 FREDERICKSBURG VA 22401 834398314 ENDOSCOPY VA MWHC ENDOSCOPY HOLDINGS LLC RELATED 2263999 291694 0 0 0.51000 FREDERICKSBURG PROFESSIONAL RISK EXCHANGE 2300 FALL HILL AVE SUITE 418 FREDERICKSBURG VA 22401 331095956 CAPTIVE INSURANCE VT MWHC C 2148217 13450326 1.00000 0 MARY WASHINGTON HEALTHCARE SERVICES INC 2300 FALL HILL AVE SUITE 418 FREDERICKSBURG VA 22401 541244509 RETAIL MEDICAL VA MWHC C -45653 778260 1.00000 0 MARY WASHINGTON HEALTH PLAN 2300 FALL HILL AVE SUITE 418 FREDERICKSBURG VA 22401 823693765 HEALTH MAINTENANCE VA MWHC C -8343074 18919654 1.00000 0 PINNACLE HEALTH CORPORATION 2300 FALL HILL AVE SUITE 418 FREDERICKSBURG VA 22401 311636492 HEALTH MANAGEMENT VA MWHA C 1445 293221 1.00000 0 0 0 1 0 0 0 0 0 0 1 1 0 1 1 1 0 0 0 0