2019-11-08T15:50:50-06:00 2018-12-31 540737372 PBMARES LLP 725 JACKSON STREET SUITE 210 FREDERICKSBURG VA 22401 990 2018-01-01 201106426 MARY WASHINGTON HEALTHCARE GROUP RETURN MARY 5407412513 2300 FALL HILL AVENUE NO 418 FREDERICKSBURG VA 22401 SEAN T BARDEN EXECUTIVE VICE PRESIDENT 5407412513 2019-11-06 1 JENNIFER N FRENCH P00659678 5403713566 2019-10-09 X 209.10.80.132 2019-11-06 16:57:40 ES P 78D5588198465BC4DB5D28A308D28CEC3EA60C33 78D5588198465BC4DB5D28A308D28CEC3EA60C33 2018 2020-04-17 16:48:07Z MICHAEL P MCDERMOTT MD 2300 FALL HILL AVENUE NO 418 FREDERICKSBURG VA 22401 675214004 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. 55 50 3831 737 2350131 0 6228872 8887330 649732088 644203591 2800781 2351596 173876 260503 658935617 655703020 4157519 3950059 0 0 207898156 218239509 0 0 896449 433623448 411391390 645679123 633580958 13256494 22122062 427497037 428834599 278529966 275539535 148967071 153295064 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 612859751 3950059 641991074 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 114,827 PATIENTS IN OUR EMERGENCY ROOMS, 306,650 OUTPATIENTS, 19,681 SURGICAL CASES AND 30,304 PATIENT DISCHARGES. 612859751 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 1 0 0 0 0 1 1 0 0 0 1 324 0 1 3831 1 1 1 0 0 0 0 1 1 0 0 0 0 0 0 X 55 50 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 0 X X JENNINGS D DAWSON III 5407412513 2300 FALL HILL AVENUE NO 418 FREDERICKSBURG VA 22401 WILLIAM M BOLDON MBA CHAIR 2.00 2.00 X X 0 0 0 RONALD W BRANSCOME MS BOARD TRUSTEE 2.00 2.00 X 0 0 0 BRUCE L DAVIS BA BOARD TRUSTEE 2.00 2.00 X 0 0 0 JANAMITRA DEVAN BOARD TRUSTEE 2.00 2.00 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 DAVID M GARTH MD BOARD TRUSTEE 2.00 2.00 X 0 0 0 MICHAEL P MCDERMOTT MD MBA PRESIDENT AND CEO 4.00 40.00 X X 0 1285921 41692 JOHN C MCKEOWN MA MPA BOARD TRUSTEE 2.00 2.00 X 0 0 0 SUDEEP J MENACHERY MD BOARD TRUSTEE 2.00 2.00 X 0 0 0 FRED M MESSING MBA LFACHE BOARD TRUSTEE 2.00 2.00 X 0 0 0 CLARENCE A ROBINSON BS SECRETARY/TREASURER 2.00 2.00 X X 0 0 0 JOHN F ROWLEY BS JD BOARD TRUSTEE 2.00 2.00 X 0 0 0 ALDA L WHITE BA JD IMMEDIATE PAST CHAIR 4.00 2.00 X X 0 0 0 MARTIN A WILDER JR EDD BOARD TRUSTEE 2.00 3.00 X 0 0 0 LINDA D WORRELL BOARD TRUSTEE 2.00 2.00 X 0 0 0 EDWARD V ALLISON JR MWH FOUNDATION BOARD TRUST 2.00 0.00 X 0 0 0 SEAN T BARDEN BSBA MBA EXEC VP AND CFO 4.00 40.00 X X 0 655837 34565 DANIEL W CLENDENIN MWH FOUNDATION BOARD TRUST 2.00 0.00 X 0 0 0 JASON COHEN MWH FOUNDATION BOARD TRUST 2.00 0.00 X 0 0 0 KOSTAS J CONSTANTINE MD MWH FOUNDATION BOARD TRUST 2.00 0.00 X 0 0 0 R DONALD DOHERTY JR MD MWH FOUNDATION BOARD TRUST 2.00 0.00 X 0 0 0 JOHN F FICK III RPH MWH FOUNDATION BOARD TRUST 2.00 0.00 X 0 0 0 R LEIGH FRACKELTON JR JD MLT CP MWH FOUNDATION BOARD TRUST 2.00 0.00 X 0 0 0 ADAM M FRIED MWH FOUNDATION BOARD TRUST 2.00 0.00 X 0 0 0 MARY KATHERINE GREENLAW MWH FOUNDATION BOARD TRUST 2.00 0.00 X 0 0 0 ROCHELLE H GRAY MWH FOUNDATION BOARD TRUST 2.00 0.00 X 0 0 0 CLAY S HUBER MWH FOUNDATION BOARD TRUST 2.00 0.00 X 0 0 0 CHRISTOPHER T HUESGEN MD MWH FOUNDATION BOARD TRUST 2.00 0.00 X 0 0 0 REGIS L KEDDIE II MWH FOUNDATION SECRETARY/TREASURER 2.00 0.00 X X 0 0 0 PATRICIA J LYNCH MWH FOUNDATION BOARD TRUST 2.00 0.00 X 0 0 0 EDWARD O MINNIEAR MWH FOUNDATION BOARD TRUST 2.00 0.00 X 0 0 0 BRADLEY A REPP MBA MWH FOUNDATION BOARD TRUST 2.00 0.00 X 0 0 0 XAVIER RICHARDSON BA MBA MWHF AND SHF PRESIDENT / E 2.00 40.00 X X 0 334726 29216 JON VAN ZANDT MWH FOUNDATION BOARD TRUST 2.00 0.00 X 0 0 0 JODIE M VAUGHN MWH FOUNDATION BOARD TRUST 2.00 0.00 X 0 0 0 CATHERINE M WACK MWH FOUNDATION VICE CHAIR 2.00 0.00 X X 0 0 0 JOSEPH R WILSON PMP MWH FOUNDATION CHAIR 2.00 0.00 X X 0 0 0 MARGARET A ALEXANDER SH FOUNDATION BOARD TRUSTE 2.00 0.00 X 0 0 0 KEVIN M BREEN SH FOUNDATION CHAIR 2.00 0.00 X X 0 0 0 LT GEN G RONALD CHRISTMAS SH FOUNDATION BOARD TRUSTE 2.00 0.00 X 0 0 0 ELAINE F FARMER SH FOUNDATION VICE CHAIR 2.00 0.00 X X 0 0 0 MELISSA GALLARO SH FOUNDATION BOARD TRUSTE 2.00 0.00 X 0 0 0 JOEL GRIFFIN SH FOUNDATION BOARD TRUSTE 2.00 0.00 X 0 0 0 DOUGLAS R JOHNSON MD SH FOUNDATION BOARD TRUSTE 2.00 0.00 X 0 0 0 C RAYMOND JOHNSON SH FOUNDATION BOARD TRUSTE 2.00 0.00 X 0 0 0 JO D KNIGHT SH FOUNDATION BOARD TRUSTE 2.00 0.00 X 0 0 0 CHARLES W MCDANIEL SH FOUNDATION BOARD TRUSTE 2.00 0.00 X 0 0 0 DONALD H NEWLIN BA MA SH FOUNDATION BOARD TRUSTE 2.00 0.00 X 0 0 0 HOWARD C OWEN BA SH FOUNDATION BOARD SECRETARY/TREASURER 2.00 0.00 X 0 0 0 W MALONE SCHOOLER SH FOUNDATION BOARD TRUSTE 2.00 0.00 X 0 0 0 EUGENE J ZEISZLER SH FOUNDATION BOARD TRUSTE 2.00 0.00 X 0 0 0 KATHRYN WALL BA MA EVP 2.00 40.00 X X 0 420200 20780 MARIE FREDRICK RT R CRA MJ VICE PRESIDENT 2.00 40.00 X X 0 245590 21718 JUSTIN BOX MBA SVP & CIO 2.00 40.00 X 0 365836 43241 REBECCA M BIGONEY MDBSMA EVP & CMO 2.00 40.00 X 0 699703 29123 EILEEN DOHMANN RN BSN MBA NEA-BC SVP & CNO 2.00 40.00 X 0 343796 13566 ERIC FLETCHER MBA APR SVP 2.00 40.00 X 0 347628 39685 TRAVIS TURNER BS MBA SVP 2.00 40.00 X 0 311159 35702 ELIESE K BERNARD VICE PRESIDENT 40.00 2.00 X 379917 0 4965 LAUREN BLALOCK VICE PRESIDENT 2.00 40.00 X 0 201618 38127 CODY BLANKENSHIP VICE PRESIDENT 2.00 40.00 X 0 211088 30481 KATHLEEN BOURGAULT MS CPAM VICE PRESIDENT 2.00 40.00 X 0 243132 27514 SANDRA BROWN CPA VICE PRESIDENT 2.00 40.00 X 0 266911 29053 ALAN EDWARDS VICE PRESIDENT 2.00 40.00 X 0 217385 38166 TINA ERVIN VICE PRESIDENT 2.00 40.00 X 0 240162 27644 STEPHEN MANDELL MD VICE PRESIDENT 40.00 2.00 X 403921 0 33738 DOUGLAS SCHULTE MD VICE PRESIDENT 2.00 40.00 X 0 386607 10661 CATHLEEN YABLONSKI BS MS VICE PRESIDENT 40.00 2.00 X 268444 0 25031 DAVID YI MD VICE PRESIDENT 2.00 40.00 X 0 356883 10491 SANG HO NA PHYSICIAN 40.00 0.00 X 885410 0 21355 AGOSTINO VISIONI PHYSICIAN 40.00 0.00 X 840501 0 41953 J T SHERWOOD PHYSICIAN 40.00 0.00 X 801492 0 45584 THERESA CONOLOGUE PHYSICIAN 40.00 0.00 X 536666 0 25201 JOHN CARDONE PHYSICIAN 40.00 0.00 X 540978 0 37437 JAMES R DANIEL FORMER SENIOR MEDICAL DIRECTOR 0.00 0.00 X 352973 0 14678 THOMAS G GETTINGER MHA FORMER EVP & COO 0.00 0.00 X 0 378086 0 5010302 7512268 771367 241 1 1 0 AMN HEALTHCARE INC 2735 COLLECTION CENTER DRIVE CHICAGO IL 60693 CONTRACT PERSONNEL 15515742 MORRISON MANAGEMENT 5801 PEACHTREE DUNWOODY RD ATLANTA GA 30342 FOOD SERVICES 9919149 CROTHALL SERVICES GROUP 955 CHESTERBROOK BLVD SUITE 300 WAYNE PA 19087 ENVIRONMENTAL AND ENGINEERING 5452792 SOUND PHYSICIANS OF VA II 1498 PACIFIC AVENUE STE 400 TACOMA WA 98402 CONTRACT PERSONNEL 4410242 ECHO LOCUM TENENS INC 1498 PACIFIC AVENUE STE 400 TACOMA WA 98402 PHYSICIAN SERVICES 4008568 77 247268 795998 182759 7661305 6375 8887330 NET PATIENT SERVICES REVENUE 623000 618036615 618036615 PROGRAM RENTAL INCOME 531120 9062586 9062586 OTHER OPERATING REVENUE 623000 8932343 8932343 MANAGEMENT SERVICES 623000 5176889 5176889 LAB FEES 621500 2330733 2330733 664425 664425 644203591 1914163 1914163 19821539 17861 19381786 20181 439753 -2320 437433 437433 231906 247268 109017 122889 122889 INCOME FROM PARTNERSHIPS/LLCS 900099 137614 118216 19398 137614 655703020 641991074 2350131 2474485 X 3917845 3917845 32214 32214 1483668 1461493 22175 182061423 179340266 2721157 2910021 2866527 43494 18392999 18118090 274909 13391398 13191245 200153 81623347 79699415 1124312 799620 6250 2275 3975 207073 200240 6419 414 95684845 92904059 2778597 2189 444367 429703 13775 889 3047010 2946459 94457 6094 1110459 1073814 34424 2221 18022747 17427997 558705 36045 1727831 1670812 53563 3456 391533 378612 12138 783 1108414 1072145 36269 27955859 17155182 10800677 2019385 1952745 62601 4039 MEDICAL AND HOSPITAL SU 103985732 103142102 817138 26492 UNRELATED BUSINESS TAX 3259 3259 BAD DEBT EXPENSE 63065091 63065091 REPAIRS AND MAINTENANCE 4692813 4539256 143870 9687 6295375 6272164 22666 545 633580958 612859751 19824758 896449 1743478 648941 14754 14953 13763640 17370470 69546498 80361665 54137 -18817 12065299 13158885 3642168 3252990 674830747 410313268 272436076 264517479 50360885 46469737 2223021 1554856 1647081 1503440 427497037 428834599 39135905 44738158 2398 123851 235518990 227167907 3872673 3509619 278529966 275539535 X 135855984 135930398 11852877 11354228 1258210 6010438 148967071 153295064 427497037 428834599 X 22122062 -5304315 -12489754 X X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 1269839 4752228 40521 49757 6012831 1258210 52539 40909 1269840 1258210 44259 44259 1258210 1258210 1258210 1258210 11433 11433 1258210 1.00000 0.00000 0 0 24785862 24785862 320945905 157552568 163393337 18279590 13764875 4514715 272705117 219929239 52775878 38114273 19066586 19047687 264517479 ACCRUED LOSS - PROFESSIONAL LIABILIES 3509619 3509619 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, 2015, AND THEREAFTER REMAIN SUBJECT TO EXAMINATION BY FEDERAL AND STATE TAX AUTHORITIES. ALL REQUIRED TAX FILINGS HAVE BEEN FILED ON A TIMELY BASIS. SH CUP GOLF TOURNAMENT 258253 108612 149641 46399 MWHF GOLF OPEN 108504 86453 22051 22563 4 112417 52204 60213 462 1850 9458 1045 27240 479174 247269 231905 462 1850 9458 1045 96202 109017 122888 1 1 X 1 X 1 X 1 1 1 0 1 1 18379134 18379134 0.02900 50914427 36380245 14534182 0.02290 69293561 36380245 32913316 0.05190 1708132 10300 1697832 0.00270 1690432 1690432 0.00270 60811845 39227539 21584306 0.03410 474400 63036 411364 0.00060 1707950 1707950 0.00270 66392759 39300875 27091884 0.04280 135686320 75681120 60005200 0.09470 49775 49775 0.00010 796484 796484 0.00130 846259 846259 0.00140 1 19009026 4752257 192641010 232468660 -39827650 X 1 1 1 MEDICAL IMAGING OF FREDERICKSBURG OUTPATIENT IMAGING 0.51000 0.49000 2 FREDERICKSBURG AMBULATORY SURGERY CENTER AMBULATORY SERGICAL SERVICES 0.53370 0.46630 3 COWAN INVESTMENT PARTNERS MEDICAL OFFICE BUILDING 0.12500 0.37500 4 MEDICAL PLAZA AT COSNER CORNER MEDICAL OFFICE BUILDING 0.39500 0.47400 2 1 MARY WASHINGTON HOSPITAL INC 1101 SAM PERRY BLVD FREDERICKSBURG VA 22401 X X X 451 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 16 1 1 0 1 X HTTPS://WWW.MARYWASHINGTONHEALTHCARE.COM/ABOUT-US/REGULATORY-DOCUMENTS.ASPX X X 1 16 0 1 0 1 X 200.000000000000 300.000000000000 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 1 X 0 X X X X 1 X 0 0 STAFFORD HOSPITAL LLC 2 0 0 1 X X X X X X X X 16 1 1 0 1 X HTTPS://WWW.MARYWASHINGTONHEALTHCARE.COM/ABOUT-US/REGULATORY-DOCUMENTS.ASPX X X 1 16 0 1 0 1 X 200.000000000000 300.000000000000 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 1 X 0 X X X X 1 X 0 0 MARY WASHINGTON HOSPITAL, INC. PART V, SECTION B, LINE 5: MARY WASHINGTON HEALTHCARE (INCLUDING MARY WASHINGTON HOSPITAL AND STAFFORD HOSPITAL) AND THE RAPPAHANNOCK AREA HEALTH DISTRICT LAUNCHED THE "HEALTHY COMMUNITIES STEERING COMMITTEE" (HCSC) TO PERFORM THE COMMUNITY HEALTH NEEDS ASSESSMENT. OTHER FOUNDING MEMBERS OF THIS GROUP INCLUDED THE RAPPAHANNOCK UNITED WAY, KAISER PERMANENTE OF THE MID-ATLANTIC STATES, INC., AND THE RAPPAHANNOCK AREA COMMUNITY SERVICES BOARD. THESE INITIAL SPONSORS OF THE HCP AGREED THAT THE SUCCESS OF THIS EFFORT WOULD BE DEPENDENT ON GATHERING A DIVERSE GROUP OF INDIVIDUALS WHO COULD PROVIDE A BROAD PERSPECTIVE ON THE REGION'S HEALTH NEEDS. THE GROUP BROUGHT TOGETHER AREA HOSPITALS, HEALTH DEPARTMENTS, INSURERS, PRIVATE BUSINESSES, COMMUNITY-BASED ORGANIZATIONS, AND HEALTH CARE AND MENTAL HEALTH PROVIDERS TO SERVE ON THE HCP'S ADVISORY COMMITTEE. IN ALL THE HCP INCLUDED OVER 40 REPRESENTATIVES FROM COMMUNITY STAKEHOLDER ORGANIZATIONS TO GUIDE THE COMMUNITY NEEDS ASSESSMENT PROCESS AND TO PROVIDE APPROPRIATE INPUT. STAFFORD HOSPITAL, LLC PART V, SECTION B, LINE 5: MARY WASHINGTON HEALTHCARE (INCLUDING MARY WASHINGTON HOSPITAL AND STAFFORD HOSPITAL) AND THE RAPPAHANNOCK AREA HEALTH DISTRICT LAUNCHED THE "HEALTHY COMMUNITIES STEERING COMMITTEE" (HCSC) TO PERFORM THE COMMUNITY HEALTH NEEDS ASSESSMENT. OTHER FOUNDING MEMBERS OF THIS GROUP INCLUDED THE RAPPAHANNOCK UNITED WAY, KAISER PERMANENTE OF THE MID-ATLANTIC STATES, INC., AND THE RAPPAHANNOCK AREA COMMUNITY SERVICES BOARD. THESE INITIAL SPONSORS OF THE HCP AGREED THAT THE SUCCESS OF THIS EFFORT WOULD BE DEPENDENT ON GATHERING A DIVERSE GROUP OF INDIVIDUALS WHO COULD PROVIDE A BROAD PERSPECTIVE ON THE REGION'S HEALTH NEEDS. THE GROUP BROUGHT TOGETHER AREA HOSPITALS, HEALTH DEPARTMENTS, INSURERS, PRIVATE BUSINESSES, COMMUNITY-BASED ORGANIZATIONS, AND HEALTH CARE AND MENTAL HEALTH PROVIDERS TO SERVE ON THE HCP'S ADVISORY COMMITTEE. IN ALL THE HCP INCLUDED OVER 40 REPRESENTATIVES FROM COMMUNITY STAKEHOLDER ORGANIZATIONS TO GUIDE THE COMMUNITY NEEDS ASSESSMENT PROCESS AND TO PROVIDE APPROPRIATE INPUT. 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. 3 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 - REGIONAL CANCER CENTER AT MONTROSS 15394 KINGS HIGHWAY MONTROSS VA 22520 RADIATION THERAPY 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. 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, 2018 AND 2017, WERE 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., MEDICORP HEALTH SERVICES, 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) SOLICITING INPUT FROM MWHC'S CITIZEN ADVISORY COUNCIL THAT ENCOMPASS INDIVIDUAL MEMBERS AND SUBCOMMITTEES REPRESENTING EACH OF THE COUNTIES IN MWHC'S SERVICE AREA, AND 2) PERFORMING PERIODIC COMMUNITY NEEDS ASSESSMENTS FOR EACH COUNTY IN COLLABORATION WITH GOVERNMENT AGENCIES AND OTHER COMMUNITY ORGANIZATIONS. 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 451 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 WITHIN THE RESPECTIVE COUNTIES THE MAJORITY OF THE GEOGRAPHIC SERVICE AREAS IN WHICH BOTH HOSPITALS SERVE ARE MADE UP OF ABOUT 4,164.5 SQUARE MILES OF SUBURBAN AND RURAL LAND. COMMUNITY RESIDENTS IN THE PRIMARY SERVICE AREAS EARN A MEDIAN INCOME PER HOUSEHOLD OF $57,088/YEAR, WITH A COLLECTIVE AVERAGE OF 7.2% OF THE ENTIRE PRIMARY SERVICE AREA LIVING BELOW THE FEDERAL POVERTY GUIDELINES. THE PRIMARY SERVICE AREA HAS AN ESTIMATED POPULATION OF 657,718 INDIVIDUALS AND 187,202 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 FREDERICKSBURG VA 22401 541677934 501(C)(3) 850000 FREE CLINIC MICAH ECUMENICAL MINISTRY PO BOX 3277 FREDERICKSBURG VA 22402 204044884 501(C)(3) 130000 RESIDENTIAL RECOVERY PROGRAM FREDERICKSBURG CHRISTIAN HEALTH CENTER 1129 HEATHERSTONE DR FREDERICKSBURG VA 22407 542061482 501(C)(3) 100000 HEALTH CENTER RAPPAHANNOCK AREA HEALTH DISTRICT 608 JACKSON ST FREDERICKSBURG VA 22401 546001775 100000 COMPLICATED OBSTETRICAL AND HIGH RISK MATERNITY CARE LEGAL SERVICES OF NO VA 10700 PAGE AVENUE FAIRFAX VA 22030 541137931 501(C)(3) 47594 ENROLL VA CENTRAL VIRGINIA HEALTH SERVICES INC 1506 PALMYRA AVE RICHMOND VA 23227 540887287 501(C)(3) 45000 CHC RAPPAHANNOCK REGION FREDERICKSBURG REGIONAL TRANSIT 1400 JEFFERSON DAVIS HIGHWAY FREDERICKSBURG VA 22401 546001293 40000 FRED TRANSPORTATION PROGRAM GUADALUPE FREE CLINIC PO BOX 275 COLONIAL BEACH VA 22443 510635977 501(C)(3) 40000 (GREGORY DILICK) STAFFORD COUNTY PUBLIC SCHOOLS HEAD START 610 GAYLE ST FREDERICKSBURG VA 22405 546001628 35000 CHILDREN'S INSURANCE OUTREACH AND ELIGIBILITY PROJECT THE DOCTOR YUM PROJECT 10482 GEORGETOWN DRIVE SUITE B SPOTSYLVANIA VA 22553 455245719 501(C)(3) 35000 THE DOCTOR YUM PROJECT BATTLES OBESITY WITH THE H.E.A.L. TOOL FREDERICKSBURG COUNSELING SERVICES 305 HANSON AVE 140 FREDERICKSBURG VA 22401 540844464 501(C)(3) 27000 FREDERICKSBURG COUNSELING SERVICES STAFFORD JUNCTION INC 791 TRUSLOW ROAD FREDERICKSBURG VA 22406 203036072 501(C)(3) 20000 HEALTHY LIVING PAYS RAPPAHANNOCK AREA ON AGING 460 LENDALL LANE FREDERICKSBURG VA 22405 541027651 501(C)(3) 19450 CARE OPTIONS MAKE FOR PREFERRED SOLUTIONS (COMPASS) VIRGINIA COMMUNITY FOOD CONNECTIONS 406 PRINCESS ANNE STREET FREDERICKSBURG VA 22401 540715969 501(C)(3) 16161 FRESH FOOD ACCESS FOR COMMUNITY HEALTH GWYNETH'S GIFT FOUNDATION PO BOX 690 GARRISONVILLE VA 22463 474428397 501(C)(3) 15000 LIFE-SAVING CPR EDUCATION AND AED ACESS RX PARTNERSHIP 2924 EMERYWOOD PARKWAY 300 RICHMOND VA 23221 571186937 501(C)(3) 15000 PRESCRIPTION MEDICATION PROGRAM FREDERICKSBURG DEPARTMENT OF SOCIAL SERVICES 608 JACKSON STREET SUITE 100 FREDERICKSBURG VA 22401 546001293 10500 COMMUNITY BASED ELIGIBILITY WORKER ACTION IN COMMUNITY THROUGH SERVICE (ACTS) PO BOX 74 DUMFRIES VA 22026 540897679 501(C)(3) 10000 ACTS HELPLINE ASSISTANCE AND OUTREACH PROJECT STAFFORD COUNTY DEPARTMENT OF SOCIAL SERVICES PO BOX 7 STAFFORD VA 22555 546001626 10000 STAFFORD'S HEALTH INSURANCE ENROLLMENT PROGRAM HAZEL HILL HEALTHCARE PROJECT 225 BUTLER RD FREDERICKSBURG VA 22405 271744104 501(C)(3) 7500 HAZEL HILL HEALTHCARE PROJECT EMPLOYMENT RESOURCES PO BOX 801 FREDERICKSBURG VA 22401 541566468 501(C)(3) 5000 SUMMER INTERNSHIP PROGRAM FREDERICKSBURG CITY PUBLIC SCHOOLS 2300 WASHINGTON AVENUE FREDERICKSBURG VA 22401 546001296 5000 SUMMER FOOD SERVICE PROGRAM LOWLINC PO BOX 518 LOCUST GROVE VA 22508 473273588 501(C)(3) 5000 LIVING INDEPENDENTLY IN OUR COMMUNITY OPEN HAND 200 PRINCE EDWARD STREET FREDERICKSBURG VA 22401 364564097 501(C)(3) 5000 SUMMER INTERN PROGRAM (GRAD) 18 6 ANNE GRAZIANI BROADDUS NURSING SCHOLARSHIP 1 750 APRIL JETT WILLS MEMORIAL NURSING SCHOLARSHIP 1 1000 BARBARA KANE NURSING SCHOLARSHIP 1 1000 CHARLES AND VIOLA JONES NURSING SCHOLARSHIP 1 1000 CHARLES M. "PETE" HEARN FELLOWSHIP 1 1500 CORA GRAVES ALLISON NURSING SCHOLARSHIP 1 750 ELEANOR HEYCOCK PETTIT NURSING SCHOLARSHIP 1 750 ELIZABETH BRUNELLE RYAN AND CATHERINE RYAN LEGATH SCHOLARSHIP 1 750 FREDERICKSBURG EMERGENCY MEDICAL ALLIANCE SCHOLARSHIP 1 750 HAROLD AND FRANCES SCHILZ NURSING SCHOLARSHIP 1 1000 HEWETSON NURSING SCHOLARSHIP 1 750 IDA RICHARDSON JENKINS MEMORIAL SCHOLARSHIP 1 750 JEAN C. WILLIAMS MEMORIAL NURSING SCHOLARSHIP 1 750 JEANE BULLOCK NURSING SCHOLARSHIP 1 1000 JENNIE MAE BENSON NURSING SCHOLARSHIP 1 750 JOHN PAINTER SCHOLARSHIP 1 750 LIBBY PEARSON ENDOWED NURSING SCHOLARSHIP 1 750 LINDA WITMER NURSING SCHOLARSHIP 1 750 MARY FRANCES WILLIS & JAMES G. WILLIS MEMORIAL SCHOLARSHIP 1 1000 NANCY HAZARD MEMORIAL SCHOLARSHIP 1 750 REBECCA BENNETT NURSING SCHOLARSHIP 1 750 STAFFORD HOSPITAL AUXILIARY SCHOLARSHIP 1 1000 STAFFORD HOSPITAL AUXILIARY SCHOLARSHIP 1 1000 STEPHANIE FRANCINE BROWN NURSING SCHOLARSHIP 1 750 SUE HALL NURSING SCHOLARSHIP 1 750 THE FRED M. RANKIN, III LEADERSHIP SCHOLARSHIP 1 1500 THE VICKIE GRAVES PITTMAN GERMANNA NURSING SCHOLARSHIP 1 1000 WILLIAM F. JACOBS, JR. SCHOLARSHIP IN HEALTHCARE ADMINISTRATION 1 2000 VIRGINIA MEDICAL IMAGING 2 6214 X X 1 1 X X X X X X 1 1 0 0 0 0 0 1 0 MICHAEL P MCDERMOTT MD MBA PRESIDENT AND CEO 0 815940 0 250871 0 219110 0 8250 0 33442 0 1327613 0 0 SEAN T BARDEN BSBA MBA EXEC VP AND CFO 0 438222 0 126484 0 91131 0 8250 0 26315 0 690402 0 0 XAVIER RICHARDSON BA MBA MWHF AND SHF PRESIDENT / E 0 231587 0 51659 0 51480 0 7041 0 22175 0 363942 0 0 KATHRYN WALL BA MA EVP 0 272262 0 61390 0 86548 0 8250 0 12530 0 440980 0 0 MARIE FREDRICK RT R CRA MJ VICE PRESIDENT 0 194223 0 41072 0 10295 0 0 0 21718 0 267308 0 0 JUSTIN BOX MBA SVP & CIO 0 284799 0 69405 0 11632 0 8250 0 34991 0 409077 0 0 REBECCA M BIGONEY MDBSMA EVP & CMO 0 430990 0 122431 0 146282 0 8250 0 20873 0 728826 0 0 EILEEN DOHMANN RN BSN MBA NEA-BC SVP & CNO 0 262267 0 63608 0 17921 0 8250 0 5316 0 357362 0 0 ERIC FLETCHER MBA APR SVP 0 274276 0 61401 0 11951 0 8250 0 31435 0 387313 0 0 TRAVIS TURNER BS MBA SVP 0 243034 0 56568 0 11557 0 6970 0 28732 0 346861 0 0 ELIESE K BERNARD VICE PRESIDENT 311870 0 59798 0 8249 0 0 0 4965 0 384882 0 0 0 LAUREN BLALOCK VICE PRESIDENT 0 159926 0 33833 0 7859 0 5340 0 32787 0 239745 0 0 CODY BLANKENSHIP VICE PRESIDENT 0 172168 0 31093 0 7827 0 2591 0 27890 0 241569 0 0 KATHLEEN BOURGAULT MS CPAM VICE PRESIDENT 0 192607 0 40209 0 10316 0 5572 0 21942 0 270646 0 0 SANDRA BROWN CPA VICE PRESIDENT 0 216132 0 42141 0 8638 0 6929 0 22124 0 295964 0 0 ALAN EDWARDS VICE PRESIDENT 0 170421 0 37001 0 9963 0 5699 0 32467 0 255551 0 0 TINA ERVIN VICE PRESIDENT 0 191675 0 40320 0 8167 0 6107 0 21537 0 267806 0 0 STEPHEN MANDELL MD VICE PRESIDENT 326714 0 64751 0 12456 0 8250 0 25488 0 437659 0 0 0 DOUGLAS SCHULTE MD VICE PRESIDENT 0 313144 0 64371 0 9092 0 8250 0 2411 0 397268 0 0 CATHLEEN YABLONSKI BS MS VICE PRESIDENT 216078 0 44157 0 8209 0 2298 0 22733 0 293475 0 0 0 DAVID YI MD VICE PRESIDENT 0 291093 0 57641 0 8149 0 8250 0 2241 0 367374 0 0 SANG HO NA PHYSICIAN 751355 0 125000 0 9055 0 8250 0 13105 0 906765 0 0 0 AGOSTINO VISIONI PHYSICIAN 742051 0 75000 0 23450 0 8250 0 33703 0 882454 0 0 0 J T SHERWOOD PHYSICIAN 740780 0 60000 0 712 0 8250 0 37334 0 847076 0 0 0 THERESA CONOLOGUE PHYSICIAN 536166 0 0 0 500 0 3534 0 21667 0 561867 0 0 0 JOHN CARDONE PHYSICIAN 509688 0 30000 0 1290 0 8250 0 29187 0 578415 0 0 0 JAMES R DANIEL FORMER SENIOR MEDICAL DIRECTOR 109574 0 47837 0 195562 0 3575 0 11103 0 367651 0 0 0 THOMAS G GETTINGER MHA FORMER EVP & COO 0 0 0 0 0 378086 0 0 0 0 0 378086 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, LINES 4A-B SEAN BARDEN RECEIVED A 457(F) DISTRIBUTION OF $47,990. KATHRYN WALL RECEIVED A 457(F) DISTRIBUTION OF $44,647. MICHAEL MCDERMOTT RECEIVED A 457(F) DISTRIBUTION OF $130,612 XAVIER RICHARDSON RECEIVED A 457(F) DISTRIBUTION OF $14,800. JOYCE HANSCOME RECEIVED SEVERANCE PAY OF $84,568 AND 457(F) DISTRIBUTION OF $38,557 WHICH WAS INCLUDED IN HER 2017 W-2. 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 47535000 86868312 583010 86285302 2007 1 0 1 1 B 59254492 630794 58623698 2014 1 0 1 1 C 965000 128486132 2100667 126385465 2016 1 0 1 1 D 1955000 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 1 0 1 0 0 0 0 1 D 0 1 0 1 1 0 0 0 1 A 1 B 1 C 1 D 1 X 1 400 FMV X 3245 FMV X EVENT PRIZES 5 8060 FMV X FOOD AND BEVERAGES 8 3216 FMV X EVENT FACILITIES 3 2970 FMV X GIFT CARDS 4 1175 FMV X CEMETERY PLOT 1 500 FMV X PAID FOR ENTERTAINMENT AT EVENT 1 253 FMV 0 0 0 FORM 990, PART VI, SECTION A, LINE 6 MEMBERS OF THE MARY WASHINGTON HEALTHCARE GROUP ALL HAVE ONE SOLE MEMBER, ITS PARENT MARY WASHINGTON HEALTHCARE (MWHC). FORM 990, PART VI, SECTION A, LINE 7A MARY WASHINTON HEALTHCARE (MWHC) HAS THE POWER TO APPOINT BOARD OF TRUSTEES FOR THE GROUP. FORM 990, PART VI, SECTION A, LINE 7B MEMBERS OF THE MARY WASHINGTON HEALTHCARE GROUP ALL HAVE ONE SOLE MEMBER, ITS PARENT MARY WASHINGTON HEALTHCARE (MWHC). MWHC HAS RESERVED CERTAIN POWERS TO ITSELF WITHIN EACH OF ITS SUBSIDIARIES ORGANIZING DOCUMENTS. THESE RESTRICTIONS INCLUDE AMENDING THE GOVERNING DOCUMENTS, BUDGETING, EXPENDITURES OVER CERTAIN THRESHOLDS. 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 AUDIT & COMPLIANCE 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 MEMBER OF MANAGEMENT IS REQUIRED TO DISCLOSE ANY AND ALL POSSIBLE CONFLICTS OF INTERESTS. THE DISCLOSURES ARE MADE ANNUALLY AND SUBMITTED TO THE MWHC CHIEF AUDIT EXECUTIVE (CAE). THE CAE THEN PRESENTS ALL CONFLICTS TO THE AUDIT AND COMPLIANCE COMMITTEE OF THE BOARD OF TRUSTEES. THE CHAIRMAN OF THE AUDIT AND COMPLIANCE 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 18,547,164. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 18,547,164. ASP: PROGRAM SERVICE EXPENSES 353,211. MANAGEMENT AND GENERAL EXPENSES 7,208. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 360,419. BILLNG AND COLLECTION SERVICES: PROGRAM SERVICE EXPENSES 3,403,075. MANAGEMENT AND GENERAL EXPENSES 69,451. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 3,472,526. CONSULTING SERVIES: PROGRAM SERVICE EXPENSES 30,716,712. MANAGEMENT AND GENERAL EXPENSES 1,887,981. FUNDRAISING EXPENSES 2,189. TOTAL EXPENSES 32,606,882. MANAGEMENT CONTRACTS: PROGRAM SERVICE EXPENSES 26,376,382. MANAGEMENT AND GENERAL EXPENSES 538,293. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 26,914,675. MAINTENANCE SERVICES: PROGRAM SERVICE EXPENSES 6,540,016. MANAGEMENT AND GENERAL EXPENSES 133,470. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 6,673,486. STORAGE SERVICES: PROGRAM SERVICE EXPENSES 66,446. MANAGEMENT AND GENERAL EXPENSES 1,356. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 67,802. TENAN COVERAGE: PROGRAM SERVICE EXPENSES 5,886,110. MANAGEMENT AND GENERAL EXPENSES 120,125. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 6,006,235. WASTE DISPOSAL: PROGRAM SERVICE EXPENSES 1,014,943. MANAGEMENT AND GENERAL EXPENSES 20,713. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,035,656. FORM 990, PART XI, LINE 9: RELIEF FROM AFFILIATE LOANS -21,589,646. UNCOLLECTED PLEDGES -238,706. ELIMINATION OF EQUITY FOR CONSOLIDATED ENTITIES 9,338,598. FORM 990, PART XII, LINE 2C THE COMPANIES IN THE GROUP RETURN ARE INCLUDED IN THE CONSOLIDATED AUDITED FINANCIAL STATEMENTS OF MWHC. CONSISTENT WITH PRIOR YEARS RESPONSIBILITY FOR OVERSIGHT OF THE AUDIT AND SELECTION OF AUDITORS RESTS WITH THE AUDIT & COMPLIANCE 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. 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. 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