PEDIATRIC SPECIALISTS OF VIRGINIA LLC: Form 990, tax year 2021
View the entire original 990 at ProPublica ↗
- Organization
- PEDIATRIC SPECIALISTS OF VIRGINIA LLC (EIN 46-1851763)
- Tax period
- 2021-01-01 to 2021-12-31
- Filed
- 2022-11-03
- IRS object ID
- 202213079349302001
- Schema version
- 2021v4.2
- Source
- Download XML · Original 990 at ProPublica
Every field in the e-filed return. Faint text is the IRS element name, for citing.
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return | 2022-11-03T11:18:49-05:00 | ReturnTs |
| Tax Period End | 2021-12-31 | TaxPeriodEndDt |
Preparer Firm PreparerFirmGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Firm EIN | 346565596 | PreparerFirmEIN |
Preparer Firm Name PreparerFirmName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | ERNST & YOUNG US LLP | BusinessNameLine1Txt |
Preparer US Address PreparerUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 221 E 4TH ST SUITE 2900 | AddressLine1Txt |
| City | CINCINNATI | CityNm |
| State Abbreviation | OH | StateAbbreviationCd |
| ZIP | 45202 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnTypeCd |
| Tax Period Begin | 2021-01-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 461851763 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | PEDIATRIC SPECIALISTS OF VIRGINIA LLC | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | PEDI | BusinessNameControlTxt |
| Phone | 7032892433 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 8095 INNOVATION PARK DRIVE FINANCE | AddressLine1Txt |
| City | FAIRFAX | CityNm |
| State Abbreviation | VA | StateAbbreviationCd |
| ZIP | 22031 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | LAUREL BLAKEMORE MD | PersonNm |
| Person Title | CEO | PersonTitleTxt |
| Phone | 7032892433 | PhoneNum |
| Signature | 2022-11-03 | SignatureDt |
| Discuss With Paid Preparer | Yes (1) | DiscussWithPaidPreparerInd |
Signing Officer SigningOfficerGrp
Person Full Name PersonFullName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person First | LAUREL | PersonFirstNm |
| Person Last | BLAKEMORE MD | PersonLastNm |
| Field | Value | IRS element (for citing) |
|---|---|---|
| SSN | 999009999 | SSN |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | JULIE L SPARKS | PreparerPersonNm |
| PTIN | P01268401 | PTIN |
| Phone | 5136121400 | PhoneNum |
Additional Filer Information AdditionalFilerInformation
Trusted Customer TrustedCustomerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Trusted Customer | 3 | TrustedCustomerCd |
| Authentication Assurance Level | AAL1 | AuthenticationAssuranceLevelCd |
| Identity Assurance Level | IAL1 | IdentityAssuranceLevelCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2021 | TaxYr |
| Build TS | 2022-09-23 18:48:47Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Change | Yes (X) | AddressChangeInd |
| Principal Officer | LAUREL BLAKEMORE MD | PrincipalOfficerNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 8095 INNOVATION PARK DRIVE FINANCE | AddressLine1Txt |
| City | FAIRFAX | CityNm |
| State Abbreviation | VA | StateAbbreviationCd |
| ZIP | 22031 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $38,526,456 | GrossReceiptsAmt |
| Group Return For Affiliates | 0 | GroupReturnForAffiliatesInd |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | PSVCARE.ORG | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 2013 | FormationYr |
| Legal Domicile State | VA | LegalDomicileStateCd |
| Activity Or Mission | TO PROVIDE A MARKET-LEADING PEDIATRIC SPECIALIST PHYSICIAN CAPACITY IN NORTHERN VIRGINIA. | ActivityOrMissionDesc |
| Voting Members Governing Body | 8 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 6 | VotingMembersIndependentCnt |
| Total Employee | 443 | TotalEmployeeCnt |
| Total Volunteers | 0 | TotalVolunteersCnt |
| Total Gross UBI | $0 | TotalGrossUBIAmt |
| Net Unrelated Bus Txbl Incm | $0 | NetUnrelatedBusTxblIncmAmt |
| PY Contributions Grants | $830,474 | PYContributionsGrantsAmt |
| CY Contributions Grants | $1,541,087 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $31,464,718 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $36,593,583 | CYProgramServiceRevenueAmt |
| PY Investment Income | $761,263 | PYInvestmentIncomeAmt |
| CY Investment Income | $390,118 | CYInvestmentIncomeAmt |
| PY Other Revenue | -$3,384 | PYOtherRevenueAmt |
| CY Other Revenue | -$4,146 | CYOtherRevenueAmt |
| PY Total Revenue | $33,053,071 | PYTotalRevenueAmt |
| CY Total Revenue | $38,520,642 | CYTotalRevenueAmt |
| PY Grants And Similar Paid | $10,349 | PYGrantsAndSimilarPaidAmt |
| CY Grants And Similar Paid | $2,730 | CYGrantsAndSimilarPaidAmt |
| PY Benefits Paid To Members | $0 | PYBenefitsPaidToMembersAmt |
| CY Benefits Paid To Members | $0 | CYBenefitsPaidToMembersAmt |
| PY Salaries Comp Emp Bnft Paid | $37,723,517 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $40,950,485 | CYSalariesCompEmpBnftPaidAmt |
| PY Total Prof Fndrsng Expns | $0 | PYTotalProfFndrsngExpnsAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $2,034 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $17,192,688 | PYOtherExpensesAmt |
| CY Other Expenses | $18,607,966 | CYOtherExpensesAmt |
| PY Total Expenses | $54,926,554 | PYTotalExpensesAmt |
| CY Total Expenses | $59,561,181 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | -$21,873,483 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | -$21,040,539 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $25,094,629 | TotalAssetsBOYAmt |
| Total Assets EOY | $27,579,335 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $13,790,712 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $16,729,957 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $11,303,917 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $10,849,378 | NetAssetsOrFundBalancesEOYAmt |
| Info In Schedule O Part III | Yes (X) | InfoInScheduleOPartIIIInd |
| Mission | PEDIATRIC SPECIALISTS OF VIRGINIA'S (PSV) CHARITABLE MISSION IS TO MEET THE PEDIATRIC SPECIALIST STAFFING NEEDS OF INOVA AND CHILDREN'S NATIONAL MEDICAL CENTER (CNMC) AND TO PROVIDE PEDIATRIC SPECIALIST CONSULTS TO PEDIATRIC PATIENTS AS REQUESTED BY INOVA OR CNMC. ALSO TO EXPAND OUTPATIENT PEDIATRIC SPECIALIST SERVICES IN NORTHERN VIRGINIA THROUGH THE OPERATION OF AMBULATORY CARE SITES, AMONG OTHER VEHICLES. | MissionDesc |
| Significant New Program Srvc | 0 | SignificantNewProgramSrvcInd |
| Significant Change | 0 | SignificantChangeInd |
| Expense | $53,295,598 | ExpenseAmt |
| Grant | $2,730 | GrantAmt |
| Revenue | $36,593,583 | RevenueAmt |
| Desc | PSV PROVIDES MEDICAL CARE AND RELATED SERVICES TO CHILDREN WHO SEEK DIAGNOSIS, TREATMENT, AND CARE WITHOUT REGARD TO RACE, COLOR, CREED, SEX, DISABILITY, NATIONAL ORIGIN, SEXUAL ORIENTATION, OR POVERTY STATUS. PSV'S PHYSICIANS AND ALLIED STAFF PROVIDE SERVICES IN THE FOLLOWING PEDIATRIC SPECIALTY AREAS: GASTROENTEROLOGY, ORTHOPEDICS, NEPHROLOGY, GENETICS, HEMATOLOGY/ONCOLOGY, ENDOCRINOLOGY, RHEUMATOLOGY, INFECTIOUS DISEASES, PSYCHOLOGY, NEUROLOGY, PSYCHIATRY, ALLERGY AND IMMUNOLOGY, DEVELOPMENTAL PEDIATRICS, NEUROSURGERY, PHYSICAL MEDICINE AND REHABILITATION, ADOLESCENT GYNECOLOGY, UROLOGY, PULMONARY MEDICINE, OTOLARYNGOLOGY, OPHTHALMOLOGY, AND PLASTIC SURGERY TO ALL PEDIATRIC PATIENTS ON A NON-DISCRIMINATORY BASIS. IN ADDITION, PSV OPERATES AN OUTPATIENT SURGERY CENTER AND PROVIDES PEDIATRIC ANESTHESIOLOGY SERVICES. PSV ENGAGES IN ACTIVITIES THAT EDUCATE THE COMMUNITY WITH RESPECT TO AREAS OF CRITICAL HEALTH CARE IMPORTANCE. THROUGH ITS AFFILIATION WITH INOVA AND CHILDREN'S NATIONAL MEDICAL CENTER, PSV PARTICIPATES IN HEALTH SCREENINGS, HEALTH FAIRS, AND HEALTH EDUCATION CLASSES MADE AVAILABLE TO ALL RESIDENTS IN THE COMMUNITY, WHETHER OR NOT THEY ARE PATIENTS OF PSV. PSV'S EMPLOYED PHYSICIANS ALSO PARTICIPATE IN ACADEMIC AND RESEARCH PROGRAMS. PSV PHYSICIANS SERVE AS FACULTY FOR AREA MEDICAL SCHOOLS, PARTICIPATING IN THE MEDICAL EDUCATION PROGRAMS OF THE AFFILIATED HOSPITALS AND INSTRUCTING STUDENTS. BY ENGAGING IN PATIENT CARE AND TEACHING ACTIVITIES AT THE MEMBERS' HOSPITALS, PSV PROMOTES THE HEALTH AND WELL BEING OF THE COMMUNITIES SERVED AND FOSTERS A DYNAMIC AND INTERACTIVE LEARNING ENVIRONMENT FOR FUTURE PHYSICIANS. PSV'S EMPLOYED PHYSICIANS AND ALLIED STAFF ALSO CONDUCT MEDICAL RESEARCH TO ADVANCE THE STUDY AND PRACTICE OF MEDICINE AND TO FIND CURES FOR DISEASES. RESULTS OF THE RESEARCH WILL BE MADE AVAILABLE TO THE GENERAL PUBLIC. PSV'S PHYSICIANS PROVIDE SERVICES TO PATIENTS AT SIX DISTINCT LOCATIONS IN NORTHERN VIRGINIA. BY PROVIDING HIGHLY-SPECIALIZED PEDIATRIC PHYSICIAN CARE TO ALL CHILDREN IN THE LARGE, DIVERSE, AND GROWING NORTHERN VIRGINIA COMMUNITY, PSV FULFILLS A VALUABLE COMMUNITY NEED. PSV WILL MAKE AVAILABLE TO ALL CHILDREN, INCLUDING INDIGENT CHILDREN WHO REQUIRE MEDICAL CARE, THE SERVICES OF ITS PHYSICIANS AND OF ITS QUALIFIED HEALTH CARE PROFESSIONALS CONSISTENT WITH PSV'S POLICIES FOR PROVIDING NEEDED MEDICAL SERVICES TO PATIENTS REGARDLESS OF THEIR ABILITY TO PAY. | Desc |
| Total Program Service Expenses | $53,295,598 | TotalProgramServiceExpensesAmt |
| Described In Section501c3 | Yes (1) | DescribedInSection501c3Ind |
| Schedule B Required | Yes (1) | ScheduleBRequiredInd |
| Political Campaign Acty | 0 | PoliticalCampaignActyInd |
| Lobbying Activities | 0 | LobbyingActivitiesInd |
| Subject To Proxy Tax | 0 | SubjectToProxyTaxInd |
| Donor Advised Fund | 0 | DonorAdvisedFundInd |
| Conservation Easements | 0 | ConservationEasementsInd |
| Collections Of Art | 0 | CollectionsOfArtInd |
| Credit Counseling | 0 | CreditCounselingInd |
| Donor Rstr Or Quasi Endowments | 0 | DonorRstrOrQuasiEndowmentsInd |
| Report Land Building Equipment | Yes (1) | ReportLandBuildingEquipmentInd |
| Report Investments Other Sec | Yes (1) | ReportInvestmentsOtherSecInd |
| Report Program Related Invst | 0 | ReportProgramRelatedInvstInd |
| Report Other Assets | 0 | ReportOtherAssetsInd |
| Report Other Liabilities | Yes (1) | ReportOtherLiabilitiesInd |
| Include FIN48 Footnote | Yes (1) | IncludeFIN48FootnoteInd |
| Independent Audit Fincl Stmt | Yes (1) | IndependentAuditFinclStmtInd |
| Consolidated Audit Fincl Stmt | 0 | ConsolidatedAuditFinclStmtInd |
| School Operating | 0 | SchoolOperatingInd |
| Foreign Office | 0 | ForeignOfficeInd |
| Foreign Activities | 0 | ForeignActivitiesInd |
| More Than5000 K To Org | 0 | MoreThan5000KToOrgInd |
| More Than5000 K To Individuals | 0 | MoreThan5000KToIndividualsInd |
| Professional Fundraising | 0 | ProfessionalFundraisingInd |
| Fundraising Activities | Yes (1) | FundraisingActivitiesInd |
| Gaming Activities | 0 | GamingActivitiesInd |
| Operate Hospital | 0 | OperateHospitalInd |
| Grants To Organizations | 0 | GrantsToOrganizationsInd |
| Grants To Individuals | 0 | GrantsToIndividualsInd |
| Schedule J Required | Yes (1) | ScheduleJRequiredInd |
| Tax Exempt Bonds | 0 | TaxExemptBondsInd |
| Engaged In Excess Benefit Trans | 0 | EngagedInExcessBenefitTransInd |
| PY Excess Benefit Trans | 0 | PYExcessBenefitTransInd |
| Loan Outstanding | 0 | LoanOutstandingInd |
| Grant To Related Person | 0 | GrantToRelatedPersonInd |
| Business Rln With Org Mem | 0 | BusinessRlnWithOrgMemInd |
| Business Rln With Fam Mem | 0 | BusinessRlnWithFamMemInd |
| Business Rln With35 Ctrl Ent | 0 | BusinessRlnWith35CtrlEntInd |
| Deductible Non Cash Contri | 0 | DeductibleNonCashContriInd |
| Deductible Art Contribution | 0 | DeductibleArtContributionInd |
| Terminate Operations | 0 | TerminateOperationsInd |
| Partial Liquidation | 0 | PartialLiquidationInd |
| Disregarded Entity | 0 | DisregardedEntityInd |
| Related Entity | 0 | RelatedEntityInd |
| Related Organization Ctrl Ent | 0 | RelatedOrganizationCtrlEntInd |
| Trnsfr Exmpt Non Chrtbl Rltd Org | 0 | TrnsfrExmptNonChrtblRltdOrgInd |
| Activities Conducted Prtshp | 0 | ActivitiesConductedPrtshpInd |
| Schedule O Required | Yes (1) | ScheduleORequiredInd |
| IRP Document | 28 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Backup Wthld Compliance | Yes (1) | BackupWthldComplianceInd |
| Employee | 443 | EmployeeCnt |
| Employment Tax Returns Filed | Yes (1) | EmploymentTaxReturnsFiledInd |
| Unrelated Bus Incm Over Limit | 0 | UnrelatedBusIncmOverLimitInd |
| Foreign Financial Account | 0 | ForeignFinancialAccountInd |
| Prohibited Tax Shelter Trans | 0 | ProhibitedTaxShelterTransInd |
| Taxable Party Notification | 0 | TaxablePartyNotificationInd |
| Nondeductible Contributions | 0 | NondeductibleContributionsInd |
| Quid Pro Quo Contributions | 0 | QuidProQuoContributionsInd |
| Form8282 Property Disposed Of | 0 | Form8282PropertyDisposedOfInd |
| Rcv Fnds To Pay Prsnl Bnft Cntrct | 0 | RcvFndsToPayPrsnlBnftCntrctInd |
| Pay Premiums Prsnl Bnft Cntrct | 0 | PayPremiumsPrsnlBnftCntrctInd |
| Indoor Tanning Services | 0 | IndoorTanningServicesInd |
| Subj To Tax Rmnrtn Ex Prcht Pymt | 0 | SubjToTaxRmnrtnExPrchtPymtInd |
| Subject To Excs Tax Net Invst Inc | 0 | SubjectToExcsTaxNetInvstIncInd |
| Info In Schedule O Part VI | Yes (X) | InfoInScheduleOPartVIInd |
| Governing Body Voting Members | 8 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 6 | IndependentVotingMemberCnt |
| Family Or Business Rln | 0 | FamilyOrBusinessRlnInd |
| Delegation Of Mgmt Duties | 0 | DelegationOfMgmtDutiesInd |
| Change To Org Documents | Yes (1) | ChangeToOrgDocumentsInd |
| Material Diversion Or Misuse | 0 | MaterialDiversionOrMisuseInd |
| Members Or Stockholders | Yes (1) | MembersOrStockholdersInd |
| Election Of Board Members | Yes (1) | ElectionOfBoardMembersInd |
| Decisions Subject To Approva | Yes (1) | DecisionsSubjectToApprovaInd |
| Minutes Of Governing Body | Yes (1) | MinutesOfGoverningBodyInd |
| Minutes Of Committees | Yes (1) | MinutesOfCommitteesInd |
| Officer Mailing Address | 0 | OfficerMailingAddressInd |
| Local Chapters | 0 | LocalChaptersInd |
| Form990 Provided To Gvrn Body | Yes (1) | Form990ProvidedToGvrnBodyInd |
| Conflict Of Interest Policy | Yes (1) | ConflictOfInterestPolicyInd |
| Annual Disclosure Covered Prsn | 0 | AnnualDisclosureCoveredPrsnInd |
| Regular Monitoring Enfrc | Yes (1) | RegularMonitoringEnfrcInd |
| Whistleblower Policy | Yes (1) | WhistleblowerPolicyInd |
| Document Retention Policy | Yes (1) | DocumentRetentionPolicyInd |
| Compensation Process CEO | Yes (1) | CompensationProcessCEOInd |
| Compensation Process Other | Yes (1) | CompensationProcessOtherInd |
| Investment In Joint Venture | 0 | InvestmentInJointVentureInd |
| States Where Copy Of Return Is Fld | VA | StatesWhereCopyOfReturnIsFldCd |
| Upon Request | Yes (X) | UponRequestInd |
Books In Care Of Detail BooksInCareOfDetail
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | PEDIATRIC SPECIALISTS OF VIRGINIA LLC | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Phone | 7038486630 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 3023 HAMAKER COURT | AddressLine1Txt |
| City | FAIRFAX | CityNm |
| State Abbreviation | VA | StateAbbreviationCd |
| ZIP | 22031 | ZIPCd |
Form990 Part VII Section A Form990PartVIISectionAGrp (20 entries)
| TitleTitleTxt | Average Hours Per WeekAverageHoursPerWeekRt | Average Hours Per Week Rltd OrgAverageHoursPerWeekRltdOrgRt | Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd | Reportable Comp From OrgReportableCompFromOrgAmt | Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt | Other CompensationOtherCompensationAmt | OfficerOfficerInd | Highest Compensated EmployeeHighestCompensatedEmployeeInd | Former Ofcr Director TrusteeFormerOfcrDirectorTrusteeInd |
|---|---|---|---|---|---|---|---|---|---|
| JOANNA FAZIO BEG 121721 | |||||||||
| TRUSTEE | 1.00 | 0.00 | Yes (X) | $0 | $0 | $0 | |||
| MICHELLE MCGUIRE | |||||||||
| TRUSTEE | 1.00 | 0.00 | Yes (X) | $0 | $0 | $0 | |||
| DAVID WESSEL MD | |||||||||
| CHAIRMAN | 1.00 | 0.00 | Yes (X) | $0 | $0 | $0 | |||
| DAVID ASHMAN | |||||||||
| TRUSTEE | 1.00 | 0.00 | Yes (X) | $0 | $0 | $0 | |||
| STEVE NARANG MD | |||||||||
| TRUSTEE | 1.00 | 0.00 | Yes (X) | $0 | $0 | $0 | |||
| ALICE POPE | |||||||||
| TRUSTEE | 1.00 | 0.00 | Yes (X) | $0 | $0 | $0 | |||
| TONI ARDABELL ENDING 121621 | |||||||||
| TRUSTEE | 1.00 | 0.00 | Yes (X) | $0 | $0 | $0 | |||
| RUPA DAINER BEGINNING 121721 | |||||||||
| TRUSTEE, CHIEF SURGICAL OFFICER | 40.00 | 0.00 | Yes (X) | $381,978 | $0 | $46,265 | |||
| EMILY HATTWICK MD | |||||||||
| TRUSTEE, MEDICAL DTR | 40.00 | 0.00 | Yes (X) | $329,600 | $0 | $44,822 | |||
| CARLY VARELA MD ENDING 121621 | |||||||||
| TRUSTEE, PHYSICIAN | 38.00 | 0.00 | Yes (X) | $227,892 | $0 | $10,063 | |||
| LAUREL BLAKEMORE MD | |||||||||
| CEO | 40.00 | 0.00 | $738,273 | $0 | $20,649 | Yes (X) | |||
| WILLIAM JUDD | |||||||||
| COO | 40.00 | 0.00 | $276,550 | $0 | $18,244 | Yes (X) | |||
| MARGARET HARRIS | |||||||||
| CHIEF FINANCIAL OFFICER | 40.00 | 0.00 | $174,052 | $0 | $14,100 | Yes (X) | |||
| GEORGE GANTSOUDES | |||||||||
| PHYSICIAN | 40.00 | 0.00 | $607,870 | $0 | $46,560 | Yes (X) | |||
| CANDICE HOLDEN | |||||||||
| PHYSICIAN | 40.00 | 0.00 | $594,248 | $0 | $43,694 | Yes (X) | |||
| MERYL LUDWIG | |||||||||
| PHYSICIAN | 40.00 | 0.00 | $482,416 | $0 | $13,717 | Yes (X) | |||
| JOSEPH LETZELTER III | |||||||||
| PHYSICIAN | 40.00 | 0.00 | $558,829 | $0 | $25,272 | Yes (X) | |||
| LAURA ELEANOR GILL-SEALY | |||||||||
| PHYSICIAN | 40.00 | 0.00 | $596,502 | $0 | $44,279 | Yes (X) | |||
| LEON MOORES MD | |||||||||
| PHYSICIAN, FORMER CEO | 40.00 | 0.00 | $414,253 | $0 | $21,162 | Yes (X) | |||
| CHRISTOPHER LAWLOR | |||||||||
| PHYSICIAN, FORMER KEY EMPLOYEE | 40.00 | 0.00 | $251,232 | $0 | $45,140 | Yes (X) | |||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $5,633,695 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $0 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $393,967 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 87 | IndivRcvdGreaterThan100KCnt |
| Former Ofcr Employees Listed | Yes (1) | FormerOfcrEmployeesListedInd |
| Total Comp Greater Than150 K | Yes (1) | TotalCompGreaterThan150KInd |
| Compensation From Other Srcs | 0 | CompensationFromOtherSrcsInd |
Contractor Compensation ContractorCompensationGrp (4 entries)
| Address Line1ContractorAddress/USAddress/AddressLine1Txt | CityContractorAddress/USAddress/CityNm | State AbbreviationContractorAddress/USAddress/StateAbbreviationCd | ZIPContractorAddress/USAddress/ZIPCd | ServicesServicesDesc | CompensationCompensationAmt |
|---|---|---|---|---|---|
| LIBERTY LANGUAGE SERVICE LLC | |||||
| 8300 GREENSBORO DR L1-801 | TYSONS | VA | 22102 | TRANSLATION SERVICES | $401,438 |
| PAYCOM INC | |||||
| 7501 W MEMORIAL ROAD | OKLAHOMA CITY | OK | 73142 | PAYROLL SERVICES | $140,669 |
| ECG MANAGEMENT CONSULTANTS | |||||
| 11512 EL CAMINO REAL 200 | SAN DIEGO | CA | 92130 | HEALTHCARE ADVISORY SERVICES | $117,473 |
| SCOLIOSIS SOLUTIONS LLC | |||||
| 3023 HAMAKER COURT SUITE LL50 | FAIRFAX | VA | 22023 | X-RAY SERVICES | $107,650 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cntrct Rcvd Greater Than100 K | 4 | CntrctRcvdGreaterThan100KCnt |
| Fundraising | $30,406 | FundraisingAmt |
| Government Grants | $1,492,918 | GovernmentGrantsAmt |
| All Other Contributions | $17,763 | AllOtherContributionsAmt |
| Total Contributions | $1,541,087 | TotalContributionsAmt |
Program Service Revenue ProgramServiceRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | NET PATIENT SERVICE REVENUE | Desc |
| Business | 621400 | BusinessCd |
| Total Revenue Column | $36,593,583 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $36,593,583 | RelatedOrExemptFuncIncomeAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $36,593,583 | TotalProgramServiceRevenueAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $386,611 | TotalRevenueColumnAmt |
| Exclusion | $386,611 | ExclusionAmt |
Gross Amount Sales Assets GrossAmountSalesAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $3,507 | SecuritiesAmt |
Less Cost Oth Basis Sales Expnss LessCostOthBasisSalesExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $0 | SecuritiesAmt |
Gain Or Loss GainOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $3,507 | SecuritiesAmt |
Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $3,507 | TotalRevenueColumnAmt |
| Exclusion | $3,507 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Fundraising Gross Income | $1,668 | FundraisingGrossIncomeAmt |
| Contri Rpt Fundraising Event | $30,406 | ContriRptFundraisingEventAmt |
| Fundraising Direct Expenses | $5,814 | FundraisingDirectExpensesAmt |
Net Incm From Fundraising Evt NetIncmFromFundraisingEvtGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | -$4,146 | TotalRevenueColumnAmt |
| Exclusion | -$4,146 | ExclusionAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $38,520,642 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $36,593,583 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $0 | UnrelatedBusinessRevenueAmt |
| Exclusion | $385,972 | ExclusionAmt |
Grants To Domestic Individuals GrantsToDomesticIndividualsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,730 | TotalAmt |
| Program Services | $2,730 | ProgramServicesAmt |
Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,128,345 | TotalAmt |
| Program Services | $2,128,345 | ProgramServicesAmt |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $32,376,018 | TotalAmt |
| Program Services | $28,452,872 | ProgramServicesAmt |
| Management And General | $3,923,146 | ManagementAndGeneralAmt |
Pension Plan Contributions PensionPlanContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,064,641 | TotalAmt |
| Program Services | $943,591 | ProgramServicesAmt |
| Management And General | $121,050 | ManagementAndGeneralAmt |
Other Employee Benefits OtherEmployeeBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $3,409,807 | TotalAmt |
| Program Services | $3,022,112 | ProgramServicesAmt |
| Management And General | $387,695 | ManagementAndGeneralAmt |
Payroll Taxes PayrollTaxesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,971,674 | TotalAmt |
| Program Services | $1,747,495 | ProgramServicesAmt |
| Management And General | $224,179 | ManagementAndGeneralAmt |
Fees For Services Management FeesForServicesManagementGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $678,374 | TotalAmt |
| Program Services | $601,243 | ProgramServicesAmt |
| Management And General | $77,131 | ManagementAndGeneralAmt |
Fees For Services Legal FeesForServicesLegalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $12,708 | TotalAmt |
| Program Services | $11,263 | ProgramServicesAmt |
| Management And General | $1,445 | ManagementAndGeneralAmt |
Fees For Services Accounting FeesForServicesAccountingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $54,835 | TotalAmt |
| Program Services | $48,600 | ProgramServicesAmt |
| Management And General | $6,235 | ManagementAndGeneralAmt |
Fees For Srvc Invst Mgmnt Fees FeesForSrvcInvstMgmntFeesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $21,432 | TotalAmt |
| Program Services | $18,995 | ProgramServicesAmt |
| Management And General | $2,437 | ManagementAndGeneralAmt |
Fees For Services Other FeesForServicesOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,735,527 | TotalAmt |
| Program Services | $2,424,498 | ProgramServicesAmt |
| Management And General | $309,020 | ManagementAndGeneralAmt |
| Fundraising | $2,009 | FundraisingAmt |
Advertising AdvertisingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,009 | TotalAmt |
| Program Services | $894 | ProgramServicesAmt |
| Management And General | $115 | ManagementAndGeneralAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $291,901 | TotalAmt |
| Program Services | $258,712 | ProgramServicesAmt |
| Management And General | $33,189 | ManagementAndGeneralAmt |
Information Technology InformationTechnologyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $449,188 | TotalAmt |
| Program Services | $398,115 | ProgramServicesAmt |
| Management And General | $51,073 | ManagementAndGeneralAmt |
Occupancy OccupancyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $4,181,672 | TotalAmt |
| Program Services | $3,706,216 | ProgramServicesAmt |
| Management And General | $475,456 | ManagementAndGeneralAmt |
Travel TravelGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $39,239 | TotalAmt |
| Program Services | $34,778 | ProgramServicesAmt |
| Management And General | $4,461 | ManagementAndGeneralAmt |
Conferences Meetings ConferencesMeetingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $106,101 | TotalAmt |
| Program Services | $94,037 | ProgramServicesAmt |
| Management And General | $12,064 | ManagementAndGeneralAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,539,889 | TotalAmt |
| Program Services | $1,364,804 | ProgramServicesAmt |
| Management And General | $175,085 | ManagementAndGeneralAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,517,306 | TotalAmt |
| Program Services | $2,231,088 | ProgramServicesAmt |
| Management And General | $286,218 | ManagementAndGeneralAmt |
Other Expenses OtherExpensesGrp (4 entries)
| DescDesc | TotalTotalAmt | Program ServicesProgramServicesAmt | Management And GeneralManagementAndGeneralAmt |
|---|---|---|---|
| MEDICAL SUPPLIES | $4,452,184 | $4,452,184 | |
| BAD DEBT | $642,053 | $569,052 | $73,001 |
| REPAIRS AND MAINTENANCE | $338,592 | $300,094 | $38,498 |
| TAXES AND LICENSES | $86,846 | $76,972 | $9,874 |
All Other Expenses AllOtherExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $459,110 | TotalAmt |
| Program Services | $406,908 | ProgramServicesAmt |
| Management And General | $52,177 | ManagementAndGeneralAmt |
| Fundraising | $25 | FundraisingAmt |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $59,561,181 | TotalAmt |
| Program Services | $53,295,598 | ProgramServicesAmt |
| Management And General | $6,263,549 | ManagementAndGeneralAmt |
| Fundraising | $2,034 | FundraisingAmt |
Savings And Temp Cash Invst SavingsAndTempCashInvstGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $9,668,372 | BOYAmt |
| EOY | $10,688,913 | EOYAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,337,895 | BOYAmt |
| EOY | $2,534,738 | EOYAmt |
Oth Notes Loans Receivable Net OthNotesLoansReceivableNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $425,237 | BOYAmt |
| EOY | $688,073 | EOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $144,323 | BOYAmt |
| EOY | $156,266 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $13,841,746 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $10,559,758 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $4,537,093 | BOYAmt |
| EOY | $3,281,988 | EOYAmt |
Investments Pub Traded Sec InvestmentsPubTradedSecGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $6,524,303 | BOYAmt |
| EOY | $8,361,737 | EOYAmt |
Investments Other Securities InvestmentsOtherSecuritiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,457,406 | BOYAmt |
| EOY | $1,867,620 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $25,094,629 | BOYAmt |
| EOY | $27,579,335 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $6,459,247 | BOYAmt |
| EOY | $8,056,457 | EOYAmt |
Other Liabilities OtherLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $7,331,465 | BOYAmt |
| EOY | $8,673,500 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $13,790,712 | BOYAmt |
| EOY | $16,729,957 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Organization Follows FASB117 | Yes (X) | OrganizationFollowsFASB117Ind |
No Donor Restriction Net Assets NoDonorRestrictionNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $11,303,917 | BOYAmt |
| EOY | $10,849,378 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $11,303,917 | BOYAmt |
| EOY | $10,849,378 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $25,094,629 | BOYAmt |
| EOY | $27,579,335 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part XI | Yes (X) | InfoInScheduleOPartXIInd |
| Reconcilation Revenue Expnss | -$21,040,539 | ReconcilationRevenueExpnssAmt |
| Net Unrlzd Gains Losses Invst | $466,461 | NetUnrlzdGainsLossesInvstAmt |
| Other Changes In Net Assets | $20,119,539 | OtherChangesInNetAssetsAmt |
| Method Of Accounting Accrual | Yes (X) | MethodOfAccountingAccrualInd |
| Accountant Compile Or Review | 0 | AccountantCompileOrReviewInd |
| FS Audited | Yes (1) | FSAuditedInd |
FS Audited Basis FSAuditedBasisGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Separate Basis Fincl Stmt | Yes (X) | SeparateBasisFinclStmtInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Audit Committee | Yes (1) | AuditCommitteeInd |
| Federal Grant Audit Required | 0 | FederalGrantAuditRequiredInd |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Publicly Supported Org509a2 | Yes (X) | PubliclySupportedOrg509a2Ind |
Gifts Grants Contris Rcvd509 GiftsGrantsContrisRcvd509Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $167,588 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $161,413 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $139,277 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $830,474 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $1,541,087 | CurrentTaxYearAmt |
| Total | $2,839,839 | TotalAmt |
Gross Receipts Admissions GrossReceiptsAdmissionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $30,318,907 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $35,531,910 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $35,051,576 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $31,464,718 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $36,593,583 | CurrentTaxYearAmt |
| Total | $168,960,694 | TotalAmt |
Total509 Total509Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $30,486,495 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $35,693,323 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $35,190,853 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $32,295,192 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $38,134,670 | CurrentTaxYearAmt |
| Total | $171,800,533 | TotalAmt |
Amounts Rcvd Dsqlfy Person AmountsRcvdDsqlfyPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Substantial Contributors Amt SubstantialContributorsAmtGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Subst And Dsqlfy Prsns Tot SubstAndDsqlfyPrsnsTotGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Public Support Total509 | $171,800,533 | PublicSupportTotal509Amt |
Gross Investment Income509 GrossInvestmentIncome509Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $145,517 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $32,893 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $802,924 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $324,707 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $386,611 | CurrentTaxYearAmt |
| Total | $1,692,652 | TotalAmt |
Investment Income And UBTI InvestmentIncomeAndUBTIGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $145,517 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $32,893 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $802,924 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $324,707 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $386,611 | CurrentTaxYearAmt |
| Total | $1,692,652 | TotalAmt |
Total Support Calendar Year TotalSupportCalendarYearGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $30,632,012 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $35,726,216 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $35,993,777 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $32,619,899 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $38,521,281 | CurrentTaxYearAmt |
| Total | $173,493,185 | TotalAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Public Support CY509 | 0.99020 | PublicSupportCY509Pct |
| Public Support PY509 | 0.99150 | PublicSupportPY509Pct |
| Investment Income CY | 0.00980 | InvestmentIncomeCYPct |
| Investment Income PY | 0.00850 | InvestmentIncomePYPct |
| Thirty Thr Pct Suprt Tests CY509 | Yes (X) | ThirtyThrPctSuprtTestsCY509Ind |
Schedule B IRS990ScheduleB
Contributor Information ContributorInformationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Contributor | RESTRICTED | ContributorNum |
Contributor Business Name ContributorBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | RESTRICTED | BusinessNameLine1 |
Contributor US Address ContributorUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | RESTRICTED | AddressLine1 |
| Address Line2 | RESTRICTED | AddressLine2 |
| City | RESTRICTED | City |
| State | RESTRICTED | State |
| ZIP Code | RESTRICTED | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Contributions | RESTRICTED | TotalContributionsAmt |
Schedule D IRS990ScheduleD
Leasehold Improvements LeaseholdImprovementsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $9,918,088 | OtherCostOrOtherBasisAmt |
| Depreciation | $7,661,462 | DepreciationAmt |
| Book Value | $2,256,626 | BookValueAmt |
Equipment EquipmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $3,103,193 | OtherCostOrOtherBasisAmt |
| Depreciation | $2,283,201 | DepreciationAmt |
| Book Value | $819,992 | BookValueAmt |
Other Land Buildings OtherLandBuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $820,465 | OtherCostOrOtherBasisAmt |
| Depreciation | $615,095 | DepreciationAmt |
| Book Value | $205,370 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $3,281,988 | TotalBookValueLandBuildingsAmt |
Other Securities OtherSecuritiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | LONG TERM INVESTMENTS | Desc |
| Book Value | $1,867,620 | BookValueAmt |
| Method Valuation | F | MethodValuationCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Securities | $1,867,620 | TotalBookValueSecuritiesAmt |
Other Liabilities Org OtherLiabilitiesOrgGrp (4 entries)
| DescDesc | AmtAmt |
|---|---|
| PROFESSIONAL LIABILITY | $2,038,787 |
| LONG TERM LEASE | $3,374,422 |
| RETIREMENT PLAN LIABILITY | $1,867,620 |
| DUE TO RELATED PARTIES | $1,392,671 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Liability | $8,673,500 | TotalLiabilityAmt |
| Footnote Text | Yes (X) | FootnoteTextInd |
| Total Rev Etc Audited Fincl Stmt | $38,329,191 | TotalRevEtcAuditedFinclStmtAmt |
| Net Unrealized Gains Invst | $466,461 | NetUnrealizedGainsInvstAmt |
| Other Revenue | -$663,726 | OtherRevenueAmt |
| Revenue Not Reported | -$197,265 | RevenueNotReportedAmt |
| Revenue Subtotal | $38,526,456 | RevenueSubtotalAmt |
| Other Revenues Not Included | -$5,814 | OtherRevenuesNotIncludedAmt |
| Revenue Not Reported Fincl Stmt | -$5,814 | RevenueNotReportedFinclStmtAmt |
| Total Revenue Per Form990 | $38,520,642 | TotalRevenuePerForm990Amt |
| Tot Expns Etc Audited Fincl Stmt | $58,903,269 | TotExpnsEtcAuditedFinclStmtAmt |
| Other Expenses Included | $5,814 | OtherExpensesIncludedAmt |
| Expenses Not Reported | $5,814 | ExpensesNotReportedAmt |
| Expenses Subtotal | $58,897,455 | ExpensesSubtotalAmt |
| Other Expenses Not Included | $663,726 | OtherExpensesNotIncludedAmt |
| Expenses Not Rpt Fincl Stmt | $663,726 | ExpensesNotRptFinclStmtAmt |
| Total Expenses Per Form990 | $59,561,181 | TotalExpensesPerForm990Amt |
Supplemental Information Detail SupplementalInformationDetail (5 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| PART X, LINE 2: | THE COMPANY WAS RECOGNIZED AS A PUBLIC CHARITY, NOT A FOUNDATION, GENERALLY EXEMPT FROM FEDERAL INCOME TAXATION UNDER SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE PURSUANT TO A DETERMINATION LETTER ISSUED BY THE IRS IN JANUARY 2015 EFFECTIVE SEPTEMBER 30, 2013. THE COMPANY 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, THE COMPANY'S STATUS AS A PUBLIC CHARITY EXEMPT FROM FEDERAL INCOME TAXATION REMAINS IN EFFECT. THE STATE IN WHICH THE COMPANY OPERATES ALSO PROVIDES GENERAL EXEMPTION FROM STATE INCOME TAXATION FOR ORGANIZATIONS THAT ARE EXEMPT FROM FEDERAL INCOME TAXATION. HOWEVER, THE COMPANY 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. THE COMPANY HAD NO UNRECOGNIZED TAX BENEFITS, OR SUCH AMOUNTS WERE IMMATERIAL DURING THE PERIODS PRESENTED. FOR TAX PERIODS WITH RESPECT TO WHICH NO UNRELATED BUSINESS INCOME WAS RECOGNIZED, THE COMPANY WAS NOT REQUIRED TO FILE ANY INCOME TAX RETURNS. |
| PART XI, LINE 2D - OTHER ADJUSTMENTS: | BAD DEBT EXPENSE -642,053. OTHER NON OPERATING EXPENSE -21,673. |
| PART XI, LINE 4B - OTHER ADJUSTMENTS: | SPECIAL EVENTS EXPENSE -5,814. |
| PART XII, LINE 2D - OTHER ADJUSTMENTS: | SPECIAL EVENTS EXPENSE 5,814. |
| PART XII, LINE 4B - OTHER ADJUSTMENTS: | BAD DEBT EXPENSE 642,053. OTHER NON OPERATING EXPENSE 21,673. |
Schedule G IRS990ScheduleG
Fundraising Event Information FundraisingEventInformationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Event1 | STRIDE FORWARD 5K | Event1Nm |
| Gross Receipts Event1 | $32,074 | GrossReceiptsEvent1Amt |
| Charitable Contri Event1 | $30,406 | CharitableContriEvent1Amt |
| Gross Revenue Event1 | $1,668 | GrossRevenueEvent1Amt |
| Entertainment Event1 | $75 | EntertainmentEvent1Amt |
| Other Direct Expenses Event1 | $5,739 | OtherDirectExpensesEvent1Amt |
| Gross Receipts Total | $32,074 | GrossReceiptsTotalAmt |
| Charitable Contributions Tot | $30,406 | CharitableContributionsTotAmt |
| Gross Revenue Total Events | $1,668 | GrossRevenueTotalEventsAmt |
| Entertainment Total Events | $75 | EntertainmentTotalEventsAmt |
| Oth Direct Expnss Total Events | $5,739 | OthDirectExpnssTotalEventsAmt |
| Direct Expense Summary Events | $5,814 | DirectExpenseSummaryEventsAmt |
| Net Income Summary | -$4,146 | NetIncomeSummaryAmt |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form990 Of Other Organizations | Yes (X) | Form990OfOtherOrganizationsInd |
| Written Employment Contract | Yes (X) | WrittenEmploymentContractInd |
| Compensation Survey | Yes (X) | CompensationSurveyInd |
| Board Or Committee Approval | Yes (X) | BoardOrCommitteeApprovalInd |
| Severance Payment | 0 | SeverancePaymentInd |
| Supplemental Nonqual Rtr Plan | 0 | SupplementalNonqualRtrPlanInd |
| Equity Based Comp Arrngm | 0 | EquityBasedCompArrngmInd |
| Comp Based On Revenue Of Flng Org | 0 | CompBasedOnRevenueOfFlngOrgInd |
| Comp Bsd On Rev Related Orgs | 0 | CompBsdOnRevRelatedOrgsInd |
| Comp Bsd Net Earns Flng Org | 0 | CompBsdNetEarnsFlngOrgInd |
| Comp Bsd Net Earns Rltd Orgs | 0 | CompBsdNetEarnsRltdOrgsInd |
| Any Non Fixed Payments | 0 | AnyNonFixedPaymentsInd |
| Initial Contract Exception | 0 | InitialContractExceptionInd |
Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp (13 entries)
| TitleTitleTxt | Base Compensation Filing OrgBaseCompensationFilingOrgAmt | Compensation Based On Rltd OrgsCompensationBasedOnRltdOrgsAmt | Bonus Filing OrganizationBonusFilingOrganizationAmount | Bonus Related OrganizationsBonusRelatedOrganizationsAmt | Other Compensation Filing OrgOtherCompensationFilingOrgAmt | Other Compensation Rltd OrgsOtherCompensationRltdOrgsAmt | Deferred Compensation Flng OrgDeferredCompensationFlngOrgAmt | Deferred Comp Rltd OrgsDeferredCompRltdOrgsAmt | Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgAmt | Nontaxable Benefits Rltd OrgsNontaxableBenefitsRltdOrgsAmt | Total Compensation Filing OrgTotalCompensationFilingOrgAmt | Total Compensation Rltd OrgsTotalCompensationRltdOrgsAmt | Comp Report Prior990 Filing OrgCompReportPrior990FilingOrgAmt | Comp Report Prior990 Rltd OrgsCompReportPrior990RltdOrgsAmt |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| LAUREL BLAKEMORE MD | ||||||||||||||
| CEO | $735,951 | $0 | $0 | $0 | $2,322 | $0 | $0 | $0 | $20,649 | $0 | $758,922 | $0 | $0 | $0 |
| GEORGE GANTSOUDES | ||||||||||||||
| PHYSICIAN | $499,060 | $0 | $108,000 | $0 | $810 | $0 | $14,500 | $0 | $32,060 | $0 | $654,430 | $0 | $0 | $0 |
| LAURA ELEANOR GILL-SEALY | ||||||||||||||
| PHYSICIAN | $491,292 | $0 | $104,400 | $0 | $810 | $0 | $14,500 | $0 | $29,779 | $0 | $640,781 | $0 | $0 | $0 |
| CANDICE HOLDEN | ||||||||||||||
| PHYSICIAN | $479,927 | $0 | $113,079 | $0 | $1,242 | $0 | $14,500 | $0 | $29,194 | $0 | $637,942 | $0 | $0 | $0 |
| JOSEPH LETZELTER III | ||||||||||||||
| PHYSICIAN | $461,858 | $0 | $96,485 | $0 | $486 | $0 | $14,500 | $0 | $10,772 | $0 | $584,101 | $0 | $0 | $0 |
| MERYL LUDWIG | ||||||||||||||
| PHYSICIAN | $382,000 | $0 | $99,930 | $0 | $486 | $0 | $11,527 | $0 | $2,190 | $0 | $496,133 | $0 | $0 | $0 |
| LEON MOORES MD | ||||||||||||||
| PHYSICIAN, FORMER CEO | $413,538 | $0 | $0 | $0 | $715 | $0 | $14,500 | $0 | $6,662 | $0 | $435,415 | $0 | $0 | $0 |
| RUPA DAINER BEGINNING 121721 | ||||||||||||||
| TRUSTEE, CHIEF SURGICAL OFFICER | $335,789 | $0 | $45,379 | $0 | $810 | $0 | $14,500 | $0 | $31,765 | $0 | $428,243 | $0 | $0 | $0 |
| EMILY HATTWICK MD | ||||||||||||||
| TRUSTEE, MEDICAL DTR | $273,085 | $0 | $55,273 | $0 | $1,242 | $0 | $14,500 | $0 | $30,322 | $0 | $374,422 | $0 | $0 | $0 |
| CHRISTOPHER LAWLOR | ||||||||||||||
| PHYSICIAN, FORMER KEY EMPLOYEE | $210,583 | $0 | $39,584 | $0 | $1,065 | $0 | $12,932 | $0 | $32,208 | $0 | $296,372 | $0 | $0 | $0 |
| WILLIAM JUDD | ||||||||||||||
| COO | $230,107 | $0 | $45,302 | $0 | $1,141 | $0 | $13,910 | $0 | $4,334 | $0 | $294,794 | $0 | $0 | $0 |
| CARLY VARELA MD ENDING 121621 | ||||||||||||||
| TRUSTEE, PHYSICIAN | $189,417 | $0 | $37,883 | $0 | $592 | $0 | $8,404 | $0 | $1,659 | $0 | $237,955 | $0 | $0 | $0 |
| MARGARET HARRIS | ||||||||||||||
| CHIEF FINANCIAL OFFICER | $159,332 | $0 | $12,602 | $0 | $2,118 | $0 | $8,863 | $0 | $5,237 | $0 | $188,152 | $0 | $0 | $0 |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (9 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| FORM 990, PART VI, SECTION A, LINE 4 | THE LIMITED LIABILITY COMPANY OPERATING AGREEMENT FOR PEDIATRIC SPECIALISTS OF VIRGINIA WAS AMENDED AND RESTATED ON 6/24/2022, EFFECTIVE DATE TO BE DETERMINED. MEMBERS DESIRED TO AMEND AND RESTATE THE PRIOR AGREEMENT TO ADDRESS CERTAIN OPERATIONAL CHANGES AND THE ECONOMIC ASPECTS OF THE JOINT VENTURE RELATIONSHIP, AND TO TAKE INTO CONSIDERATION THE SEPARATE EXPANSION OF CERTAIN SERVICES WITHIN EACH OF THE MEMBERS. |
| FORM 990, PART VI, SECTION A, LINE 6 | THE ORGANIZATION WAS FORMED AS A LIMITED LIABILITY COMPANY AND HAS TWO MEMBERS: INOVA HEALTH CARE SERVICES AND CHILDREN'S NATIONAL MEDICAL CENTER, BOTH CHARITABLE 501(C)(3) TAX-EXEMPT ORGANIZATIONS, WITH EQUAL INTERESTS. THE MEMBERS ENTERED INTO THE AMENDED AND RESTATED OPERATING AGREEMENT DATED SEPTEMBER 30, 2013 TO ESTABLISH AND OPERATE THE ORGANIZATION. |
| FORM 990, PART VI, SECTION A, LINE 7A | AS DESCRIBED IN THE OPERATING AGREEMENT, THE GOVERNING BODY OF THE ORGANIZATION IS THE MANAGEMENT COMMITTEE. THE MANAGEMENT COMMITTEE IS COMPRISED OF EIGHT REPRESENTATIVES. THREE OF THE MANAGEMENT COMMITTEE REPRESENTATIVES ARE DESIGNATED AND APPOINTED BY EACH OF THE MEMBERS. THE REMAINING MANAGEMENT COMMITTEE REPRESENTATIVES ARE PHYSICIANS EMPLOYED BY THE ORGANIZATION AND MUTUALLY AGREED UPON BY THE MEMBERS. |
| FORM 990, PART VI, SECTION A, LINE 7B | THE OPERATING AGREEMENT PROVIDES FOR CERTAIN DECISIONS TO BE APPROVED BY THE MEMBERS. |
| FORM 990, PART VI, SECTION B, LINE 11B | THE FORM 990 IS PREPARED BY A THIRD PARTY AND INITIALLY PROVIDED TO THE CHIEF FINANCIAL OFFICER, THE CHIEF OPERATING OFFICER, AND EXTERNAL TAX CONSULTANTS FOR REVIEW. THE FORM 990 IS FINALLY PRESENTED TO THE FULL MANAGEMENT COMMITTEE FOR REVIEW PRIOR TO FILING. |
| FORM 990, PART VI, SECTION B, LINE 12C | THE ORGANIZATION HAS A WRITTEN CONFLICT OF INTEREST POLICY WHICH IS PROVIDED TO AND REVIEWED WITH ALL EMPLOYEES DURING THEIR NEW EMPLOYEE ORIENTATION. THE POLICY REQUIRES THE EMPLOYEE TO DISCLOSE REAL OR POTENTIAL CONFLICTS OF INTEREST, AND ALSO TO REPORT SUSPECTED VIOLATIONS OF THE POLICY TO MANAGEMENT OR HUMAN RESOURCES. THE EMPLOYEE CODE OF CONDUCT ALSO INCLUDES A SECTION DISCUSSING CONFLICTS OF INTEREST AND ALL EMPLOYEES ARE REQUIRED TO ACKNOWLEDGE RECEIPT OF, AND AGREEMENT TO COMPLY WITH, THE CODE OF CONDUCT IN WRITING. |
| FORM 990, PART VI, SECTION B, LINE 15 | PEDIATRIC SPECIALISTS OF VIRGINIA, LLC COMPENSATION: THE MANAGEMENT COMMITTEE DETERMINES AND APPROVES COMPENSATION FOR PSV'S CHIEF EXECUTIVE OFFICER, CHIEF OPERATING OFFICER, CHIEF MEDICAL OFFICER, AND CHIEF SURGICAL OFFICER USING A REGIONAL MARKET ANALYSIS OF COMPARABLE POSITIONS. |
| FORM 990, PART VI, SECTION C, LINE 19 | GOVERNING DOCUMENTS AND FINANCIAL STATEMENTS ARE NOT CURRENTLY PUBLICLY AVAILABLE. WHILE THE CONFLICT OF INTEREST POLICY IS NOT SPECIFICALLY PUBLICLY DISCLOSED, THE POLICY IS AVAILABLE TO STAFF AND PHYSICIANS. |
| FORM 990, PART XI, LINE 9: | CAPTIAL CONTRIBUTED IN 2021 BY LLC MEMBERS 20,119,539. |
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