2017-11-13T13:22:46-06:00 2016-12-31 346565596 ERNST & YOUNG US LLP 312 WALNUT ST SUITE 1900 CINCINNATI OH 45202 990 2016-01-01 540525802 LOUDOUN HOSPITAL CENTER DBA INOVA LOUDOUN HOSPITAL LOUD 7038586000 8110 GATEHOUSE ROAD SUITE 400W FALLS CHURCH VA 22042 RICHARD MAGENHEIMER CFO 7038586000 2017-11-08 1 JULIE L SPARKS P01268401 5136121400 167.201.241.175 2017-11-08 09:17:28 ES P 7B679794C43C21C3204AD1DE02D62BF36AA11E4C 7B679794C43C21C3204AD1DE02D62BF36AA11E4C 2016 2017-02-10 21:41:12Z J KNOX SINGLETON 8110 GATEHOUSE ROAD SUITE 400W FALLS CHURCH VA 22042 330148449 0 X INOVA.ORG X 1930 VA ILH PROVIDES PERSONALIZED, HIGH QUALITY ACUTE CARE HOSPITAL SERVICES FOR THE COMMUNITY. 19 15 1582 616 0 0 208850 348878 297656187 323041376 257236 5721688 1882236 980384 300004509 330092326 0 0 0 0 98128951 104667686 0 0 0 152760002 168341320 250888953 273009006 49115556 57083320 593984958 651472622 27961864 27960035 566023094 623512587 X INOVA LOUDOUN HOSPITAL'S MISSION IS TO PROVIDE ACUTE CARE AND OTHER APPROPRIATE HOSPITAL SERVICES DEDICATED TO PROVIDING QUALITY CARE AND IMPROVING THE HEALTH OF THE DIVERSE COMMUNITIES IT SERVES. 0 0 239155890 324021760 INOVA LOUDOUN HOSPITAL (ILH) IS PART OF THE INOVA HEALTH SYSTEM WHOSE MISSION IS TO SERVE THE NORTHERN VIRGINIA COMMUNITY AS A NOT-FOR-PROFIT ORGANIZATION THROUGH THE PROVISION OF HIGH QUALITY AND ACCESSIBLE HEALTHCARE SERVICES. ILH WAS SPECIFICALLY CHARTERED FOR THE PURPOSE OF SERVING THE HEALTH CARE NEEDS OF LOUDOUN COUNTY, VIRGINIA, BY ESTABLISHING, MAINTAINING AND OPERATING HOSPITAL FACILITIES, PROGRAMS AND OTHER SHARED SERVICE ARRANGEMENTS; FACILITATING HEALTH-RELATED EDUCATION ACTIVITIES; AND ENGAGING IN ACTIVITIES DESIGNED TO PROMOTE THE GENERAL HEALTH OF THE COMMUNITY.INOVA LOUDOUN HOSPITAL IS A 183-LICENSED BED GENERAL ACUTE CARE HOSPITAL, WHICH FIRST OPENED ITS DOORS IN 1912. ILH PROVIDES A FULL-SERVICE 24-HOUR EMERGENCY DEPARTMENT; 23 INTENSIVE CARE BEDS; A SPECTRUM OF DIAGNOSTIC SERVICES, INCLUDING FULL-BODY CT SCANNING, MRI, AND A CARDIAC CATHETERIZATION LABORATORY; A VARIETY OF INPATIENT MEDICAL, SURGICAL, AND ORTHOPEDIC SERVICES, AND COMPREHENSIVE OUTPATIENT SERVICES INCLUDING OUTPATIENT SURGERY, PHYSICAL MEDICINE AND REHABILITATION SERVICES AND RADIATION THERAPY. IN ADDITION, OBSTETRICAL AND PEDIATRIC SERVICES ARE PROVIDED BY ILH'S LADIES' BOARD BIRTHING INN, A PEDIATRIC EMERGENCY DEPARTMENT AND AN INPATIENT PEDIATRIC UNIT. IN 2016, THE HOSPITAL HAD 21,080 ADMISSIONS AND OBSERVATION CASES AND 50,009 PATIENT DAYS EXCLUDING NEWBORNS. EMERGENCY ROOM VISITS TOTALED 77,383 (11,263 EMERGENCY VISITS WERE AT THE ASHBURN HEALTHPLEX); AND THERE WERE 82,011 OUTPATIENT VISITS DURING THE YEAR.SPECIFIC ACUTE CARE PROGRAMSWOMEN'S HEALTH: ILH OFFERS A FULL RANGE OF OBSTETRICAL SERVICES INCLUDING DELIVERY SERVICES, HIGH RISK PRENATAL SERVICES, INPATIENT AND OUTPATIENT OBSTETRICS/GYNECOLOGIC SURGERY, A HOSPITAL-BASED NATURAL BIRTHING CENTER AND NURSERY CARE. ILH DELIVERED 2,863 BABIES IN 2016. ILH ALSO OFFERS LEVEL II NEONATAL ICU SPECIALTY SERVICES. IN ADDITION, ILH PROVIDES OBSTETRIC SERVICES TO LOW-INCOME PATIENTS THROUGH ITS OBSTETRICS/GYNECOLOGY CLINIC WHICH HAD 5,073 VISITS IN 2016. PEDIATRIC CARE: ILH OPERATES A DEDICATED PEDIATRIC EMERGENCY ROOM THAT PROVIDED SERVICES FOR 16,857 VISITS IN 2016. IN ADDITION ILH OPERATES A 14-BED PEDIATRIC UNIT THAT PROVIDES FOR INPATIENT HOSPITALIZATIONS. ILH ADMITTED 463 CHILDREN TO THE UNIT AND HAD 533 OUTPATIENT OBSERVATION CASES DURING 2016.CARDIOVASCULAR CARE: THE INOVA LOUDOUN HOSPITAL HEART AND VASCULAR INSTITUTE OPENED IN 2005. IT PROVIDES CARDIAC CATHETERIZATION AND ELECTROPHYSIOLOGY SERVICES, A 64-SLICE CT SCANNER AND OTHER DIAGNOSTIC TESTING. IN 2016, 3,929 PATIENTS WERE SERVED BY THE CARDIOVASCULAR PROGRAM AT ILH.STROKE CARE: INOVA LOUDOUN HOSPITAL HAS BEEN CERTIFIED BY THE JOINT COMMISSION SINCE 2009 AS A PRIMARY STROKE CENTER. THE CERTIFICATION ALSO COVERS THE INOVA EMERGENCY CARE CENTER IN LEESBURG WHICH IS THE FIRST FREE-STANDING EMERGENCY DEPARTMENT IN THE STATE TO BE DESIGNATED AS A PRIMARY STROKE CENTER.CANCER CARE: ILH FEATURES A FULL SERVICE CANCER CENTER INCLUDING MEDICAL AND SURGICAL ONCOLOGY, RADIATION THERAPY SERVICES AND AN OUTPATIENT INFUSION CLINIC. ILH PROVIDED 5,287 RADIATION THERAPY TREATMENTS TO 231 PATIENTS IN 2016.CHARITY CARE ALL INOVA FACILITIES, INCLUDING THE ILH FACILITIES WITH THE EXCEPTION OF THE ASSISTED LIVING FACILITIES, PROVIDE CHARITY CARE IN ACCORDANCE WITH INOVA POLICIES WHICH ENSURES ACCESS TO MEDICALLY NECESSARY CARE FOR ALL INDIVIDUALS. CHARITY CARE IS DEFINED AS FREE OR DISCOUNTED HEALTHCARE SERVICES PROVIDED TO PERSONS WHO CANNOT AFFORD TO PAY. THESE POLICIES INCLUDE THE FOLLOWING KEY PROVISIONS:1 EMERGENCY CARE SHALL BE PROVIDED TO ALL PERSONS REGARDLESS OF THEIR ABILITY TO PAY.2 NON-EMERGENCY MEDICALLY NECESSARY CARE, EXCEPT FOR CERTAIN SPECIALTY OR REFERRAL PROGRAMS, SHALL BE PROVIDED BY ALL HOSPITALS AND ACCESS FACILITIES TO MEDICALLY INDIGENT PATIENTS. "MEDICALLY NECESSARY CARE" REFERS TO INPATIENT AND OUTPATIENT SERVICES DEFINED AS MEDICALLY NECESSARY BY THE FEDERAL MEDICARE PROGRAM. "MEDICALLY INDIGENT" IS DEFINED AS THOSE PATIENTS WHOSE INCOME FALLS AT OR BELOW 400% OF THE FEDERAL POVERTY LEVEL (FPL).INOVA HEALTH SYSTEM UTILIZES A MULTIFACETED APPROACH TO EDUCATE AND INFORM PATIENTS AND THE PUBLIC ABOUT INOVA'S CHARITY CARE POLICY. UPON ADMISSION TO ANY INOVA HOSPITAL OR ANY VISIT TO OUTPATIENT FACILITIES OR CLINICS INCLUDING EMERGENCY DEPARTMENTS, INOVA HAS INFORMATION POSTED REGARDING PATIENT RIGHTS AND RESPONSIBILITIES. IN ADDITION, INOVA PROVIDES INFORMATION ABOUT THE CHARITY CARE PROGRAM AND REFERRALS TO MEET WITH INOVA FINANCIAL COUNSELORS WHO ASSIST PATIENTS IN COMPLETING INOVA'S CHARITY CARE APPLICATION. THIS FINANCIAL INFORMATION IS REVIEWED BY THE INOVA PATIENT ACCOUNTS DEPARTMENT WITH THE PATIENT CONTACTED IF ADDITIONAL INFORMATION IS REQUIRED IN ORDER TO MAKE A DETERMINATION. THE PATIENT IS SUBSEQUENTLY PROVIDED A LETTER, NOTIFYING THEM WHETHER OR NOT THEY QUALIFY FOR CHARITY CARE.IN 2016 ILH'S UNREIMBURSED COST OF CHARITY CARE, INCLUDING FREE AND DISCOUNTED SERVICES, WAS $8.4 MILLION.MEDICAID ESTABLISHED UNDER TITLE XIX OF THE SOCIAL SECURITY ACT, THIS PROGRAM PROVIDES ASSISTANCE FOR THE MEDICALLY INDIGENT, INCLUDING THOSE WHO CANNOT PAY FOR CARE DESPITE BEING ABLE TO AFFORD OTHER LIVING EXPENSES. ALSO INCLUDED UNDER THIS PROGRAM ARE THE BLIND, DISABLED, PREGNANT WOMEN, VERY LOW INCOME PARENTS, CHILDREN AND THE ELDERLY. THE REIMBURSEMENT THAT ILH FACILITIES RECEIVE FROM THE MEDICAID PROGRAM ROUTINELY FALLS BELOW THE ACTUAL COST OF SERVICES PROVIDED. DURING 2016, ILH PROVIDED CARE TO MEDICAID PATIENTS AT AN UNREIMBURSED COST OF APPROXIMATELY $6.6 MILLION.PARTICIPATION IN GOVERNMENTAL PROGRAMS FOR THOSE WITHOUT THE ABILITY TO PAY VARIOUS GOVERNMENT PROGRAMS PROVIDE FOR THE INDIGENT, INCLUDING MEDICAID RECIPIENTS. THESE PROGRAMS PROVIDE A PERCENTAGE OF REIMBURSEMENT FOR QUALIFYING PATIENTS; HOWEVER, PAYMENT IS TYPICALLY BELOW THE COST OF THOSE SERVICES. IN ADDITION TO FEDERAL AND STATE PROGRAMS, THE INOVA SUBSIDIARIES, INCLUDING ILH, WORK WITH VARIOUS COUNTY GOVERNMENTS AND AGENCIES IN PROVIDING CERTAIN FREE SERVICES TO THOSE RESIDENTS THE COUNTY IDENTIFIES AS MOST IN NEED.EACH YEAR, ILH DESIGNATES FUNDS FOR THE DEVELOPMENT AND CONTINUATION OF IDENTIFIED, ACCESSIBLE DIRECT CARE PROGRAMS AND RELATED SERVICES THAT BENEFIT THOSE MOST IN NEED IN THE COMMUNITY. MANY OF THESE PROGRAMS AND SERVICES ARE NOT BILLED TO THE PATIENT OR ARE PROVIDED FOR FEES BELOW THE ACTUAL COST OF PROVIDING THE SERVICE. IN ADDITION TO PROVIDING THE DIRECT CARE SUBSIDIZED SERVICE, INOVA ALSO PROVIDES DISEASE-PREVENTION PROGRAMS, HEALTH AND EXERCISE CLASSES, HEALTH EDUCATION AND HEALTH SCREENINGS AND OTHER PROGRAMS WITHIN THE COMMUNITY IN SUPPORT OF THE ILH MISSION.INOVA LOUDOUN OB CLINIC: THE INOVA LOUDOUN HOSPITAL-BASED OB CLINIC PROVIDES COMPREHENSIVE OBSTETRIC SERVICES FOR UNINSURED AND LOW-INCOME WOMEN (UP TO 200% OF THE FEDERAL POVERTY LEVEL) IN LOUDOUN COUNTY. COMPREHENSIVE OBSTETRICAL SERVICES INCLUDE GESTATIONAL DIABETES MANAGEMENT, CASE MANAGEMENT, NON-STRESS TESTING AND NUTRITIONAL COUNSELING. IN 2016, THE ILH OB CLINIC HAD 5,073 VISITS RESULTING IN 470 DELIVERIES AT INOVA LOUDOUN HOSPITAL AT AN UNREIMBURSED COST FOR THE CLINIC SERVICES OF APPROXIMATELY $1.7 MILLION. LOUDOUN FAMILY AND PATIENT EDUCATION PROGRAM: LOUDOUN FAMILY AND PATIENT EDUCATION PROGRAM SERVES THE COMMUNITY THROUGH HEALTH EDUCATION, PREVENTION, WELLNESS PROGRAMS AND CARE MANAGEMENT. IN 2016, THE PROGRAM PROVIDED EDUCATIONAL PROGRAMS FOR 3,581 PARTICIPANTS. LOUDOUN MOBILE HEALTH PROGRAM: LOUDOUN MOBILE HEALTH IS STAFFED BY NURSES AND OTHER SUPPORT STAFF WHO PROVIDE COMMUNITY HEALTH FAIRS AND HEALTH SCREENING SERVICES. IN 2016, INOVA LOUDOUN MOBILE HEALTH PROVIDED SERVICES TO 7,384 PARTICIPANTS. THE UNREIMBURSED COST OF THIS PROGRAM WAS $248,837.INOVA LOUDOUN CENTER FOR WELLNESS AND METABOLIC HEALTH: THE CENTER PROVIDES OUTPATIENT DIABETES SELF-MANAGEMENT EDUCATION, CARE AND SUPPORT TO PERSONS WITH DIABETES. THE INOVA CENTER FOR WELLNESS AND METABOLIC HEALTH HAS FOUR LOCATIONS IN THE NORTHERN VIRGINIA AREA AND EXPANDED ACCESS THIS YEAR WITH THE ADDITION OF A NEW BOARD CERTIFIED ENDOCRINOLOGIST AT THE LEESBURG OFFICE. IN 2016, THE INOVA CENTER FOR WELLNESS AND METABOLIC HEALTH - LOUDOUN LOCATION PROVIDED 1,207 PATIENT VISITS. 239155890 1 1 0 1 0 0 0 0 0 0 1 1 0 1 1 1 0 1 0 0 0 0 0 0 0 0 1 1 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 1 0 0 1 X 0 0 1 1582 1 0 0 0 0 0 0 0 0 0 0 X 19 15 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 0 0 0 X LOUDOUN HOSPITAL CENTER 7032085940 8110 GATEHOUSE ROAD SUITE 400W FALLS CHURCH VA 22042 ELIZABETH CASEY HALLEY CHAIRMAN 1.00 4.00 X X 0 0 0 CHRISTINE BRENNAN VICE CHAIRMAN 3.00 2.00 X X 0 0 0 DAPHNE THOMAS MD SECRETARY 3.00 2.00 X X 0 0 0 MILES DAVIS TRUSTEE 3.00 2.00 X 0 0 0 ROBERT LAFSKY MD TRUSTEE 1.00 4.00 X 115000 0 0 PAMELA JEFFRIES TRUSTEE 2.00 2.00 X 0 0 0 VIRGINIA HACKENBERG MD TRUSTEE 2.00 2.00 X 0 0 0 TANYA MATTHEWS TRUSTEE 3.00 2.00 X 0 0 0 BECKY OTTINGER TRUSTEE 3.00 2.00 X 0 0 0 DENIS MCFARLANE TRUSTEE 3.00 2.00 X 0 0 0 MARK STAUDER TRUSTEE 1.50 48.50 X 0 2947572 1016791 JUANITA KOILPILLAI TRUSTEE 2.00 2.00 X 0 0 0 MICHAEL WHEELER TRUSTEE 3.00 2.00 X 0 0 0 SCOTT HAMBERGER TRUSTEE 3.00 2.00 X 0 0 0 JOANNE THEURICH TRUSTEE 2.00 2.00 X 0 0 0 PATRICK WALTERS CEO, ILH, ASST SECRETARY 40.00 10.00 X X 691548 0 126348 LORING FLINT EVP CHIEF MEDICAL OFFICER 4.00 46.00 X 0 1763138 285285 STEVEN FREDERICKSON TRUSTEE 3.00 2.00 X 0 0 0 JOHN WOOD TRUSTEE 3.00 2.00 X 0 0 0 J KNOX SINGLETON PRESIDENT 2.50 47.50 X 0 4787739 1454485 JOHN GAUL SVP GENERAL COUNSEL 3.00 47.00 X 0 900346 184382 RICHARD MAGENHEIMER TREASURER 2.00 48.00 X 0 1986784 474786 WILLIAM BANE AVP ASSOC ADMIN CFO 20.00 20.00 X 258035 0 56201 ELIZABETH DUGAN AVP, CNO 40.00 0.00 X 302116 0 77109 CHRISTOPHER CHIANTELLA CHIEF MEDICAL OFFICER, ILH 40.00 0.00 X 326613 0 95300 DEBBIE WAGNER MGR PHARMACY PIC 40.00 0.00 X 167635 0 43248 MARISSA JAMARIK SIR DIR NURSING SRVCS 40.00 0.00 X 167066 0 23100 OMAR CASTANEDA CARDIO INVASIVE SPECIALIST 40.00 0.00 X 184693 0 45807 REBECCA VALDESUSO SR DIR PERIOP SVCS 40.00 0.00 X 179786 0 29742 SHONDRA JONES CARDIO INVASIVE SPECIALIST 40.00 0.00 X 176151 0 9189 2568643 12385579 3921773 119 0 1 0 L2 CONSTRUCTION MANAGEMENT 40892 BIRDSTONE LANE ALDIE VA 20105 CONSULTING SERVICES 4557135 HDR ARCHITECTURE INC 8404 INDIAN HILLS DRIVE OMAHA NE 68114 ARCHITECT SERVICES 4517536 MEDICAL TRANSPORTATION SERVICE 360 HERNDON PKWY SUITE 700 HERNDON VA 20170 TRANSPORT SERVICES 2381347 DELPHI HEALTHCARE PARTNERS INC 170 SOUTHPORT DRIVE MORRISVILLE NC 27560 MANAGEMENT SERVICES 1713900 LOUDOUN MEDICAL LLC II 9600 BLACKWELL ROADSUITE 200 ROCKVILLE MD 28850 MEDICAL SERVICES 1400950 34 348878 348878 NET PATIENT SERVICE REVENUE 900099 315684654 315684654 INOVA AMBULATORY SURGICAL CENTER 621400 6892368 6892368 TDI LLC 900099 464354 464354 323041376 2023388 2023388 3754423 56123 3698300 3698300 3698300 OTHER 900099 958365 958365 FOOD SERVICES 900099 22019 22019 980384 330092326 324021760 0 5721688 X 1578312 1578312 84447920 73780667 10667253 4549580 3985432 564148 7939903 6955355 984548 6151971 5389127 762844 31397541 27504246 3893295 141571 124016 17555 20967 20967 53439825 46810687 6629138 62729 54951 7778 592597 519115 73482 296392 259639 36753 3936015 3447949 488066 188447 165080 23367 143333 125560 17773 2886255 2528359 357896 14612676 12800704 1811972 481195 421527 59668 MEDICAL SUPPLIES 37706993 33031326 4675667 BAD DEBT EXPENSE 21187581 18560321 2627260 EQUIPMENT MAINTENANCE 711422 623206 88216 TAXES AND LICENSES 354929 310918 44011 180852 158426 22426 273009006 239155890 33853116 0 11256190 12606733 28635573 29063984 943012 1017869 3170675 3437100 2824778 1598671 379467345 188525135 173941262 190942210 55269800 46888222 27583763 39963106 290359905 325954727 593984958 651472622 18024803 17127978 345789 261569 9591272 10570488 27961864 27960035 X 545593304 603787941 44074 39373 20385716 19685273 566023094 623512587 593984958 651472622 X 57083320 332860 73313 X X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 20967 20967 0 PART II-B, LINE 1: THERE WERE NO SIGNIFICANT LOBBYING ACTIVITIES DURING 2016. AMOUNTS UNDER OTHER ACTIVITIES PER PART II-B REPRESENT A PORTION OF MEMBERSHIP DUES RELATED TO LOBBYING. LOUDOUN HOSPITAL CENTER PAID $130,119 IN MEMBERSHIP DUES FOR 2016. THE PORTION OF MEMBERSHIP DUES THAT WERE USED FOR LOBBING ACTIVITIES WERE ($130,119 TOTAL MEMBERSHIP DUES X 16.1%) = $20,967. 49605288 49605288 108477703 67174404 41303299 64350974 23793195 40557779 138411968 81622557 56789411 18621412 15934979 2686433 190942210 39963106 C 39963106 INVESTMENTS AND RECEIVABLES FROM AFFILIATES 325954727 325954727 DUE TO THIRD PARTY PAYORS 7250324 DEFERRED COSTS 3320164 10570488 X PART X, LINE 2: FROM INOVA HEALTH SYSTEM CONSOLIDATED STATEMENTS INCLUDING LOUDOUN HOSPITAL CENTER: THE FOUNDATION, IHCS, LHC, AND INTOTAL HEALTH ARE NOT-FOR-PROFIT CORPORATIONS AND HAVE BEEN DETERMINED TO BE EXEMPT FROM FEDERAL INCOME TAX UNDER THE PROVISIONS OF SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE. IHI AND ITS SUBSIDIARIES ARE TAXABLE ORGANIZATIONS. DEFERRED INCOME TAXES ARE PROVIDED FOR ALL SIGNIFICANT TIMING DIFFERENCES BETWEEN REVENUES AND EXPENSES REPORTED FOR FINANCIAL STATEMENT AND FOR TAX PURPOSES. MANAGEMENT ANNUALLY REVIEWS ITS TAX POSITIONS AND HAS DETERMINED THAT THERE ARE NO MATERIAL UNCERTAIN TAX POSITIONS THAT REQUIRE RECOGNITION IN THE CONSOLIDATED FINANCIAL STATEMENTS. 1 1 1 X 400.000000000000 1 X 1 1 0 1 1 8443514 8443514 0.03350 19430989 12800414 6630575 0.02630 27874503 12800414 15074089 0.05980 416770 105672 311098 0.00120 1687279 1687279 0.00670 422927 422927 0.00170 2526976 105672 2421304 0.00960 30401479 12906086 17495393 0.06940 1 8220781 0 51077104 88086253 -37009149 X 1 1 1 INOVA LOUDOUN AMBULATORY SURGERY CENTER LLC SURGICAL SERVICES 0.66780 0.00000 0.33220 1 1 INOVA LOUDOUN HOSPITAL 44045 RIVERSIDE PARKWAY LEESBURG VA 20176 VA H1868 X X X INOVA LOUDOUN HOSPITAL 1 0 0 1 X X X X X X X X X 16 1 1 0 1 X SEE PART V, SECTION C X 1 16 1 SEE PART V, SECTION C 0 1 X 400.000000000000 400.000000000000 X X X X X X 1 1 X X X 1 X WWW.INOVA.ORG/PATIENT-AND-VISITOR-INFORMATION/FINANCIAL-HELP/INDEX.JSP X WWW.INOVA.ORG/PATIENT-AND-VISITOR-INFORMATION/FINANCIAL-HELP/INDEX.JSP X WWW.INOVA.ORG/PATIENT-AND-VISITOR-INFORMATION/FINANCIAL-HELP/INDEX.JSP X X X X X X X 1 X 0 X X X X 1 X 0 0 INOVA LOUDOUN HOSPITAL PART V, SECTION B, LINE 5: THE HOSPITAL INTERVIEWED 30 KEY INFORMANTS, INCLUDING EXTERNAL STAKEHOLDERS (THOSE WHO REPRESENTED THE BROAD INTERESTS IN THE COMMUNITY) AND INTERNAL INOVA STAFF. THE INTERVIEWS WERE GUIDED BY A STRUCTURED INTERVIEW GUIDE, AND INTERVIEWEES WERE ENCOURAGED TO IDENTIFY AND DISCUSS A WIDE RANGE OF CURRENT AND EMERGING ISSUES AFFECTING COMMUNITY HEALTH. INTERVIEWS WERE CONDUCTED FROM AUGUST 2015 THROUGH JANUARY 2016. A DETAILED LISTING OF THE COMMUNITY STAKEHOLDERS WHO PROVIDED COMMUNITY INPUT IS SHOWN BELOW. THE HOSPITAL ALSO SOUGHT INPUT FROM THE PUBLIC REGARDING THE HEALTH OF THE COMMUNITY THROUGH AN ONLINE SURVEY PUBLICIZED THROUGH EMAILS, HOSPITAL INFORMATION AND COMMUNITY PARTNERS. THE SURVEY WAS ALSO AVAILABLE ON PAPER IN THE HOSPITAL AND AT THE LOCAL FQHC.IN THE PROCESS OF CONDUCTING THE 2016 CHNA, INOVA RECEIVED FEEDBACK FROM CONSTITUENTS ON THE 2013 CHNA PROCESS AND PROGRESS MADE SINCE THEN. AT THE START OF THE 2016 CHNA, INOVA CREATED AN ADVISORY COMMITTEE IN ORDER TO STEER DECISION MAKING, PROVIDE FEEDBACK ON SURVEY CREATION, INTERVIEW CANDIDATES AND PROTOCOLS AND THE PROCESS BY WHICH COMMUNITY HEALTH NEEDS WERE DETERMINED TO BE SIGNIFICANT. THE COMMITTEE INCLUDED REPRESENTATIVES FROM LOCAL FQHCS, LOCAL HEALTH DIRECTORS AND A PUBLIC OFFICIAL. MEMBERS OF THE COMMITTEE PROVIDED FEEDBACK ON THE 2013 CHNA, INCLUDING BOTH THE INITIAL ASSESSMENT AS WELL AS IMPLEMENTATION OF STRATEGIES TO IMPROVE HEALTH SINCE THEN. ADDITIONAL FEEDBACK ON INOVA'S COMMUNITY HEALTH IMPROVEMENT PROGRAMS WAS GATHERED DURING KEY INFORMANT INTERVIEWS.COMMUNITY FOUNDATION FOR LOUDOUN AND NORTHERN FAUQUIER COUNTIES - GENERAL POPULATION, FAMILIES AND LOCAL YOUTHGEORGE MASON UNIVERSITY, COLLEGE OF HEALTH AND HUMAN SERVICES - GENERAL POPULATION , STUDENTSGRACE MINISTRIES - FAITH-BASED COMMUNITY, IMMIGRANT POPULATIONHEALTHWORKS FOR NORTHERN VIRGINIA - GENERAL POPULATION, LOW INCOME, UNINSURED/UNDERINSUREDINOVA BOARD OF DIRECTORS - GENERAL POPULATIONINOVA LOUDOUN INTERNAL STAFF - GENERAL POPULATION, PHYSICIANSINOVA OFFICE OF HEALTH EQUITY - MARGINALIZED POPULATIONS , MINORITY POPULATIONSLOUDOUN COUNTY AREA AGENCY ON AGING - GENERAL POPULATION, AGING POPULATIONLOUDOUN COUNTY HEALTH DEPARTMENT - GENERAL POPULATIONLOUDOUN COUNTY OFFICE OF COUNTY ADMINISTRATOR - GENERAL POPULATIONLOUDOUN COUNTY PUBLIC SCHOOLS - GENERAL POPULATION, YOUTH/ADOLESCENTSLOUDOUN HEALTH COUNCIL - GENERAL POPULATION, PHYSICIANS, FAITH-BASED COMMUNITY , NON-PROFIT COMMUNITYNORTHERN VIRGINIA FAMILY SERVICES - ADOLESCENT/YOUTH , LOW INCOME , HOMELESS , MENTALLY ILLNORTHERN VIRGINIA HEALTH FOUNDATION - GENERAL POPULATION, LOW INCOME, UNINSURED/UNDERINSURED INOVA LOUDOUN HOSPITAL PART V, SECTION B, LINE 6A: INOVA FAIRFAX HOSPITALINOVA MT. VERNON HOSPITALINOVA FAIR OAKS HOSPITALINOVA ALEXANDRIA HOSPITAL INOVA LOUDOUN HOSPITAL PART V, SECTION B, LINE 11: IN 2016, EACH HOSPITAL WITHIN INOVA HEALTH SYSTEM CONDUCTED A COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA) IN ORDER TO BETTER ASSESS EACH COMMUNITY'S UNIQUE HEALTH NEEDS AND TO DEVELOP AN EFFECTIVE IMPLEMENTATION STRATEGY TO ADDRESS IDENTIFIED PRIORITY NEEDS. EACH CHNA WAS CONDUCTED IN ACCORDANCE WITH THE GUIDELINES ESTABLISHED BY THE PATIENT PROTECTION AND AFFORDABLE CARE ACT AND THE INTERNAL REVENUE SERVICE. EACH CHNA CONSIDERED MULTIPLE DATA SOURCES, INCLUDING SECONDARY DATA (REGARDING DEMOGRAPHICS, HEALTH STATUS INDICATORS, AND MEASURES OF HEALTH CARE ACCESS), ASSESSMENTS PREPARED BY OTHER ORGANIZATIONS IN RECENT YEARS, AND PRIMARY DATA DERIVED FROM A COMMUNITY SURVEY AND FROM INTERVIEWS WITH PERSONS WHO REPRESENT THE BROAD INTERESTS OF EACH COMMUNITY, INCLUDING PUBLIC HEALTH OFFICIALS AND EXPERTS AND HOSPITAL-AFFILIATED CLINICIANS, ADMINISTRATORS AND STAFF. THE TOPICS AND DATA ASSESSED IN THESE REPORTS INCLUDE DEMOGRAPHICS, ECONOMIC ISSUES, COMMUNITY ISSUES, HEALTH STATUS INDICATORS, HEALTH ACCESS INDICATORS, HEALTH DISPARITIES INDICATORS AND AVAILABILITY OF HEALTHCARE FACILITIES AND RESOURCES.EACH CHNA IDENTIFIED A PRIORITIZED LIST OF COMMUNITY HEALTH NEEDS. FROM THESE REPORTS, EACH HOSPITAL HAS DEVELOPED A THREE-YEAR IMPLEMENTATION STRATEGY WITH MEASURABLE OBJECTIVES TO ADDRESS THEIR UNIQUE COMMUNITY BENEFIT SERVICE AREA FOR CALENDAR (TAX) YEARS 2017 THROUGH 2019. PRIORITIES WERE BASED ON COMMUNITY NEED AS DETERMINED BY QUANTITATIVE DATA AND COMMUNITY INPUT, AS WELL AS ON HOSPITAL EXPERTISE, RESOURCES, STRENGTHS OF EXISTING PROGRAMMING AND PARTNERSHIPS, AND ALIGNMENT WITH NATIONAL, STATE, AND LOCAL HEALTH GOALS. BASED ON THE CHNA RECOMMENDATIONS, INOVA LOUDOUN HOSPITAL HAS IDENTIFIED AS ITS COMMUNITY BENEFIT PRIORITIES ACCESS TO PRIMARY CARE, ACCESS TO DENTAL CARE AND ADOLESCENT MENTAL HEALTH AND ACCESS TO MENTAL HEALTH SERVICES. THE HOSPITAL'S 3-YEAR IMPLEMENTATION STRATEGY WAS ENDORSED BY THE SYSTEM'S BOARD OF TRUSTEES.WHILE THE HOSPITAL WAS CONDUCTING THE NEW ASSESSMENT, ACTIVITIES CONTINUED BASED ON THE IMPLEMENTATION STRATEGY FROM THE LAST CHNA. IN THIS CHNA REPORT CONDUCTED IN 2013, INOVA LOUDOUN HOSPITAL IDENTIFIED THE FOLLOWING SIGNIFICANT COMMUNITY HEALTH NEEDS: ACCESS TO HEALTH AND HUMAN SERVICES, CHRONIC DISEASE, DENTAL HEALTH, HEALTH BEHAVIORS, MATERNAL AND CHILD HEALTH, MENTAL HEALTH, MORBIDITY, THE PHYSICAL ENVIRONMENT AND SOCIAL AND ECONOMIC FACTORS.AS DESCRIBED IN THE IMPLEMENTATION STRATEGY ADOPTED BY THE BOARD, INOVA LOUDOUN HOSPITAL INDICATED THAT IT WOULD ADDRESS MANY BUT NOT ALL OF THE IDENTIFIED NEEDS. THE HOSPITAL INDICATED IT WOULD NOT ADDRESS CERTAIN ELEMENTS THAT ARE BEYOND THE SCOPE OF THE MEDICAL CAMPUS OR ARE OUTSIDE OF THE HOSPITAL'S EXPERTISE INCLUDING LACK OF TRANSPORTATION, POOR AIR QUALITY AND BASIC NEEDS INSECURITY. THE HOSPITAL ALSO INDICATED THAT IT WOULD NOT ADDRESS OTHER ELEMENTS THAT ARE ALSO IMPORTANT BUT ARE BEING ADDRESSED BY OTHERS, INCLUDING DISPARITIES IN CHRONIC LIVER DISEASE, HIGH RATES OF TUBERCULOSIS AND HIGH RATES OF LYME DISEASE.SINCE THE 2013 CHNA WAS CONDUCTED, INOVA LOUDOUN HOSPITAL HAS ADDRESSED ALL OF THE SIGNIFICANT NEEDS AS DESCRIBED IN THIS IMPLEMENTATION STRATEGY. THESE NEEDS WERE ADDRESSED BY INITIATIVES INCLUDING THE FOLLOWING: PROVIDING IN-KIND AND FINANCIAL SUPPORT FOR COMMUNITY ORGANIZATIONS SEEKING TO IMPROVE COMMUNITY HEALTH AND MEET SOCIAL SERVICES NEEDS, PARTICIPATING ACTIVELY IN COMMUNITY COALITIONS AND ON BOARDS, OPERATING THE INOVA TRANSITIONAL CARE MANAGEMENT PROGRAM AND DISCHARGE CLINICS FOR LOW-INCOME PATIENTS WITHOUT A MEDICAL HOME, OPERATING INOVACARES CLINICS FOR MEDICAID AND UNINSURED PATIENTS, THE INOVA PACE PROGRAM, INCREASING VISITS FOR UNINSURED PATIENTS TO INOVA-AFFILIATED SPECIALISTS, EXPANDING HEALTH PROMOTION AND EDUCATION PROGRAMS PARTICULARLY TO REDUCE THE PREVALENCE OF DIET AND EXERCISE-RELATED HEALTH PROBLEMS, INCREASING INVESTMENT IN INOVA'S SNAP DOUBLE DOLLARS PROGRAM WHICH ENHANCES ACCESS TO HEALTHY FOOD, EXPANDING THE INOVA HEALTHY PLATE CLUB AT LOCAL TITLE I SCHOOLS AND INCREASING SERVICES PROVIDED BY THE INOVA JUNIPER PROGRAM WHICH IS NORTHERN VIRGINIA'S LARGEST PROVIDER OF SERVICES FOR HIV/AIDS PATIENTS.ONE NEW INITIATIVE IN 2016 WAS THE CREATION OF SIMPLICITY HEALTH, A NEW GROUP OF PRIMARY CARE CLINICS THAT PROVIDES EXCELLENT HEALTHCARE AT AFFORDABLE FEES. SIMPLICITY HEALTH IS DESIGNED FOR WORKING ADULTS WHO MAY NOT CURRENTLY RECEIVE REGULAR PRIMARY CARE BECAUSE THEY DO NOT QUALIFY FOR MEDICAID, DO NOT GET HEALTH INSURANCE THROUGH WORK, OR HAVE INSURANCE WITH PROHIBITIVELY HIGH COPAYS AND DEDUCTIBLES. SITES WILL HAVE PROVIDERS AND STAFF WHO ARE BILINGUAL IN A VARIETY OF LANGUAGES, SUCH AS KOREAN, VIETNAMESE, SPANISH, AND ARABIC, BASED ON THE PRIMARY LANGUAGES SPOKEN IN EACH COMMUNITY WHERE SIMPLICITY SITES ARE LOCATED.IN 2016, INOVA STRENGTHENED AND INCREASED ACCESS TO SOME PROGRAMS WHICH PROVIDE SERVICES TO PARTICULARLY VULNERABLE INDIVIDUALS. IN OCTOBER OF 2016, THE INOVA EWING FACT DEPARTMENT WAS AWARDED A $1.1 MILLION DOLLAR GRANT THROUGH THE VIRGINIA DEPARTMENT OF CRIMINAL JUSTICE SERVICES. THIS GRANT WILL ALLOW THE ESTABLISHMENT OF FOUR FULL TIME AND TWO PART TIME SEXUAL ASSAULT NURSE EXAMINER POSITIONS, ENSURING 24/7 COVERAGE IN THE DEPARTMENT. TRANSITIONAL CARE SERVICES PILOTED A NEW INITIATIVE WHERE CASE MANAGERS ARE ASSIGNED AS TCM HOSPITAL LIAISONS, DEVOTED TO INPATIENT HOSPITAL OUTREACH AND ADMISSION SCREENING. THIS INITIATIVE WAS ESTABLISHED TO INCREASE PATIENT ENGAGEMENT AND CLOSE GAPS THAT LEAD TO READMISSIONS. LASTLY, A SERVICES OF THE INOVA CENTER FOR WELLNESS AND METABOLIC HEALTH WERE INCREASED IN THE LOUDOUN COMMUNITY WITH THE ADDITION OF A NEW ENDOCRINOLOGIST ON THE INOVA LOUDOUN HOSPITAL CAMPUS.WHILE NOT IDENTIFIED FOR EXPANSION OF SERVICES IN THE 2013 CHNA, INOVA CONTINUES TO SERVE THE COMMUNITY THROUGH MANY ONGOING PROGRAMS, INCLUDING THE PROVISION OF CULTURALLY COMPETENT AND LINGUISTICALLY APPROPRIATE SERVICES; PREVENTION, EDUCATION AND SUPPORT THROUGH THE INOVA LOUDOUN CANCER CENTER; ALCOHOL AND SUBSTANCE ABUSE TREATMENT AT THE INOVA COMPREHENSIVE ADDICTION TREATMENT SERVICES; MEDICAID MANAGED CARE PLANS THROUGH INTOTAL HEALTH; AND COMPREHENSIVE MENTAL HEALTH SERVICES FOR CHILDREN AND YOUNG ADULTS AT THE INOVA KELLAR CENTER. INOVA LOUDOUN HOSPITAL PART V, SECTION B, LINE 13H: CALCULATE FAMILY SIZE INOVA LOUDOUN HOSPITAL PART V, SECTION B, LINE 16J: FINANCIAL AID BROCHURES EXPLAINING THE CHARITY POLICY ARE AVAILABLE THROUGHOUT THE HOSPITAL. ER ROOMS AND WAITING ROOMS HAVE CHARITY NOTIFICATION NOTICES POSTED IN THEIR AREAS AND THE BROCHURES ARE ALSO POSTED ON INOVA'S WEBSITE. PART V, SECTION B, LINE 7A AND LINE 10A HTTP://WWW.INOVA.ORG/INOVA-IN-THE-COMMUNITY/INDEX.JSP 2 1 - CORNWALL - ER 224 CORNWALL STREET NW LEESBURG VA 20176 EMERGENCY ROOM 2 - INOVA LOUDOUN AMBULATORY SURGICAL CENTER 44045 RIVERSIDE PARKWAY LEESBURG VA 20176 OUTPATIENT SURGERY PART I, LINE 6A: THE COMMUNITY BENEFIT REPORT IS INCLUDED IN THE CONSOLIDATED INOVA HEALTH SYSTEM REPORT TO THE COMMUNITY ON INOVA.ORG WEBSITE. PART I, LINE 7: COST TO CHARGE RATIO METHOD IS USED BASED ON TABLE 2 IN THE INSTRUCTIONS. TOTAL OPERATING EXPENSE IS DIVIDED BY TOTAL GROSS REVENUE TO ARRIVE AT THE COST TO CHARGE RATIO. PART I, LINE 7G: COST OF PHYSICIAN CLINIC IS $1,687,279. PART I, LINE 7, COLUMN (F): THE BAD DEBT EXPENSE INCLUDED ON FORM 990, PART IX, LINE 25, COLUMN (A), BUT SUBTRACTED FOR PURPOSES OF CALCULATING THE PERCENTAGE IN THIS COLUMN IS $ 21,187,581. PART II, COMMUNITY BUILDING ACTIVITIES: INOVA'S OFFICE OF SUSTAINABILITY PROVIDED COMMUNITY BUILDING SUPPORT FOCUSED ON ENVIRONMENTAL IMPROVEMENTS. ENVIRONMENTAL MISSION STATEMENT:INOVA HEALTH SYSTEM IS COMMITTED TO ESTABLISHING AN ENVIRONMENTAL PROGRAM THAT IS SAFER AND HEALTHIER FOR OUR PATIENTS, EMPLOYEES, AND THE COMMUNITY.COMMUNITY BUILDING ENVIRONMENTAL IMPROVEMENTS WASTE MANAGEMENTINOVA HAS BEEN FOCUSED ON WASTE REDUCTION STRATEGIES INCLUDING RECYCLING AND SEGREGATION SINCE 2008. THROUGHOUT THE HOSPITALS THERE IS A SINGLE STREAM RECYCLING PROCESS AND THERE ARE FOCUSED EFFORTS ON REDUCING REGULATED MEDICAL WASTE. IN 2016, INOVA RECYCLED OR DIVERTED APPROXIMATELY 1 MILLION POUNDS OF MATERIAL FROM LOCAL LANDFILLS AND WASTE TO ENERGY FACILITIES.SPECIALIZED AREAS RECYCLING (ORS, KITCHENS): INOVA HAS IMPLEMENTED SPECIALIZED RECYCLING PROGRAMS TO CAPTURE SPECIFIC MATERIALS THROUGHOUT OUR HOSPITALS INCLUDING A MEDICAL DONATION PROGRAM THAT SHIPPED 88,000 POUNDS OF UNUSED, UNOPENED MEDICAL SUPPLIES AND DURABLE MEDICAL EQUIPMENT TO PLACES IN NEED BOTH IN THE LOCAL COMMUNITY AND ACROSS THE GLOBE.ENERGYDURING 2016, INOVA CONTINUED TO MAKE PROGRESS TOWARDS ITS ENERGY GOAL OF REDUCING ENERGY USE INTENSITY (EUI) 20 PERCENT BY THE YEAR 2020 (2012 BASELINE YEAR). A NUMBER OF LIGHTING UPGRADES, STEAM TRAP AUDITS AND REPAIRS, CHILLER UPGRADES AND ENERGY MONITORING, ALL CONTRIBUTED TO AN EUI REDUCTION OF MORE THAN 2 PERCENT OVER LAST YEAR. THESE EFFORTS RESULT IN COSTS SAVINGS AND IMPROVED RESILIENCE FOR THE OVERALL HEALTH OF THE COMMUNITY.WATERINOVA CONTINUES TO MAINTAIN NATIVE PLANTINGS AND LOW-IMPACT IRRIGATION SYSTEMS FOR LANDSCAPING AS WELL AS REDUCE WATER CONSUMPTION IN OUR HOSPITALS THROUGH THE ROUTINE REPLACEMENT OF LESS EFFICIENT PLUMBING FIXTURES. BUILDINGSACHIEVED LEED SILVER CERTIFICATION AT THE INOVA WOMEN'S HOSPITAL AND INOVA CHILDREN'S HOSPITAL BUILDING ON THE FAIRFAX CAMPUS AND ARE AWAITING APPROVAL FOR LEED CERTIFICATION ON THE NORTH PATIENT TOWER. IMPLEMENTED A NUMBER OF GREEN DESIGN ELEMENTS INTO THE NEWLY CONSTRUCTED EMERGENCY DEPARTMENT AT INOVA MOUNT VERNON HOSPITAL AND ESTABLISHED MINIMUM LEED CERTIFICATION REQUIREMENTS FOR PROJECTS UNDER DEVELOPMENT AT THE INOVA CENTER FOR PERSONALIZED HEALTH. TRANSPORTATIONPARTNERED WITH FAIRFAX COUNTY DEPARTMENT OF TRANSPORTATION TO PROMOTE ALTERNATIVE COMMUTING OPTIONS FOR INOVA EMPLOYEES. EXECUTED PROGRAMS INCLUDING THE EMPLOYEE COMMUTER SHUTTLE, RESERVED PARKING FOR CARPOOLS AND VANPOOLS, BIKE RACKS, AND A PRE-TAX COMMUTER BENEFITS PROGRAM THAT AID INOVA IN THE REDUCTION OF AIR POLLUTION AND TRAFFIC CONGESTION. FOODCONTINUED TO PROMOTE COMMUNITY SUPPORTED AGRICULTURE (CSA) PROGRAM THAT INCLUDES LOCATIONS ACROSS THE HEALTH SYSTEM. THE PROGRAM HELPS HIGHLIGHT THE IMPORTANCE OF LOCAL FARMERS AND BRINGS FRESH, HEALTHY, SEASONAL FOODS TO EMPLOYEES. COORDINATED HEALTHY COOKING CLASSES AT ALL HOSPITALS ACROSS THE SYSTEM, PROMOTING A COMBINATION OF LOCAL, ORGANIC AND SEASONAL HEALTHY FOOD OPTIONS. THESE CLASSES NOT ONLY HIGHLIGHT THE IMPORTANCE OF LOCAL AND HEALTHY FOODS, BUT ALSO PROVIDE IMPORTANT COOKING SKILLS THAT WILL BENEFIT EMPLOYEES AT HOME. SPONSOR OF THE NORTHERN VIRGINIA CHAPTER OF BUY FRESH, BUY LOCAL, A NATIONALLY RECOGNIZED PROGRAM THAT IS DEDICATED TO REINTRODUCING AMERICANS TO THEIR FOOD - THE SEEDS IT GROWS FROM, THE FARMERS WHO PRODUCE IT, AND THE ROUTES THAT CARRY IT FROM THE FIELDS TO THEIR TABLES. COMMUNITYDISTRIBUTED OVER 500 NATIVE TREE SEEDLINGS TO BE PLANTED WITHIN THE LOCAL COMMUNITY IN 2016 IN SUPPORT OF EARTH DAY.MENTORED PEER ORGANIZATIONS LOCALLY AND NATIONALLY ON SUSTAINABLE PRACTICES THROUGH A COMBINATION OF FORMAL SPEAKING ENGAGEMENTS, NEWS ARTICLE PUBLICATIONS AND INFORMAL DISCUSSIONS, HELPING THEM CREATE SAFER ENVIRONMENTS FOR THEIR PATIENTS, EMPLOYEES, AND COMMUNITIES. PART III, LINE 4: BAD DEBT FOOTNOTE FROM INOVA HEALTH SYSTEM CONSOLIDATED FINANCIAL STATEMENTSPATIENT ACCOUNTS RECEIVABLE INCLUDE CHARGES FOR AMOUNTS DUE FROM ALL PATIENTS LESS ALLOWANCES FOR THE EXCESS OF ESTABLISHED CHARGES OVER THE PAYMENTS TO BE RECEIVED ON BEHALF OF PATIENTS COVERED BY MEDICARE, MEDICAID AND OTHER INSURERS. THE PROVISION FOR BAD DEBTS IS RECOGNIZED WHEN PROVIDING AN ALLOWANCE FOR UNCOLLECTIBLE ACCOUNTS.ALL OPERATING ENTITIES OF IHS TREAT EMERGENCY PATIENTS REGARDLESS OF THEIR ABILITY TO PAY. A PATIENT IS CLASSIFIED AS A CHARITY PATIENT BASED UPON ESTABLISHED IHS POLICIES THAT CONSIDER PATIENT INCOME LEVELS. SINCE IHS DOES NOT PURSUE COLLECTION OF AMOUNTS THAT QUALIFY AS CHARITY CARE, THEY ARE DEDUCTED FROM GROSS REVENUE. PART III, LINE 8: THE ORGANIZATION DOES NOT TREAT ANY MEDICARE SHORTFALL AS COMMUNITY BENEFIT. THE AMOUNTS ARE TAKEN DIRECTLY FROM THE MEDICARE COST REPORTS AS FILED USING A COST TO CHARGE RATIO METHOD. PART III, LINE 9B: PATIENTS WHO HAVE NOT APPLIED FOR FINANCIAL ASSISTANCE UNDER THIS POLICY WILL BE TREATED AS SELF-PAY AND SUBJECT TO INOVA'S NORMAL BILLING AND COLLECTIONS PROCESSES.ALL PATIENT RESPONSIBILITY PORTIONS OF INOVA'S ACCOUNTS WILL PROCESS THROUGH INOVA'S BILLING AND COLLECTION SYSTEMS FOR EFFECTIVE IN-HOUSE COLLECTIONS AND WITHIN FEDERAL GUIDELINES FOR TRANSITIONING TO EXTERNAL COLLECTION AGENCIES AFTER IN-HOUSE EFFORTS HAVE BEEN EXHAUSTED. PATIENT RESPONSIBILITY PORTIONS WILL BE PROCESSED THROUGH PRE-BILLING, STATEMENT, AND FOLLOW-UP IN AUTOMATED AND SYSTEMATIC STEPS. ALL COLLECTIONS ACTIONS WILL BE IN COMPLIANCE WITH THE FAIR DEBT COLLECTION PRACTICES ACT AND ACA INTERNATIONAL'S CODE OF ETHICS AND PROFESSIONAL RESPONSIBILITY.PATIENTS WILL RECEIVE STATEMENTS FOR 120 DAYS. AFTER 120 DAYS, WITH NO CONTACT FROM THE PATIENT AND WITHOUT THE ESTABLISHMENT OF ACCEPTABLE PAYMENT TERMS, ACCOUNTS WILL BE TRANSFERRED TO A PROFESSIONAL COLLECTION AGENCY. IF CONTINUED NON-PAYMENT OCCURS BEYOND A REASONABLE PERIOD OF TIME, LEGAL ACTIONS MAY BE UNDERTAKEN TO COLLECT PAYMENT.IF A PATIENT WISHES TO MAKE PAYMENT ARRANGEMENTS AND DOES NOT HAVE RESOURCES TO PAY THE ACCOUNT IN FULL, PAYMENT PLANS WILL BE OFFERED.NO INOVA ENTITY OR THIRD-PARTY COLLECTIONS AGENT WILL IMPOSE EXTRAORDINARY COLLECTIONS ACTIONS SUCH AS LEGAL ACTIONS OR ADVERSE CREDIT REPORTING AGAINST ANY PATIENT, WITHOUT FIRST MAKING REASONABLE EFFORTS TO DETERMINE WHETHER THAT PATIENT IS ELIGIBLE FOR FINANCIAL ASSISTANCE UNDER THIS POLICY. THESE REASONABLE EFFORTS INCLUDE:ASSURING THAT NO EXTRAORDINARY COLLECTIONS ACTIONS ARE IMPOSED FOR AT LEAST 120 DAYS FROM THE DATE OF THE FIRST BILLING STATEMENT, ANDPROVIDING A 30-DAY WRITTEN NOTICE THAT INCLUDES INFORMATION ABOUT INOVA'S FINANCIAL ASSISTANCE POLICY AND ABOUT ANY INTENDED EXTRAORDINARY COLLECTIONS ACTIONS TO BE IMPOSED IN THE EVENT OF NONPAYMENT.IF A PATIENT IS DETERMINED TO BE ELIGIBLE FOR FINANCIAL ASSISTANCE AFTER PAYMENT IS RECEIVED OR AFTER AN EXTRAORDINARY COLLECTIONS ACTION HAS BEEN IMPOSED, THE ACCOUNT WILL BE ADJUSTED AND THE COLLECTIONS ACTION WILL BE REVERSED. PART III, LINE 2 AND 3 ACTUAL BAD DEBT EXPENSE IS MULTIPLIED BY THE COST TO CHARGE RATIO USED IN COMPUTING CHARITY CARE EXPENSE IN PART I. THE PROVISION FOR BAD DEBTS IS RECOGNIZED WHEN PROVIDING AN ALLOWANCE FOR UNCOLLECTIBLE ACCOUNTS.THE ARE NO ESTIMATED AMOUNTS FOR BAD DEBT EXPENSE ATTRIBUTABLE TO PATIENTS UNDER THE ORGANIZATION'S CHARITY CARE POLICY. PART VI, LINE 2: INOVA HEALTH SYSTEM (IHS) COMPLETED A COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA) IN 2016 TO IDENTIFY PRIORITY HEALTH STATUS AND ACCESS ISSUES FOR PARTICULAR GEOGRAPHIC AREAS AND POPULATIONS BY FOCUSING ON THE FOLLOWING QUESTIONS: WHO IN THE COMMUNITY IS MOST VULNERABLE IN TERMS OF HEALTH STATUS OR ACCESS TO CARE?WHAT ARE THE UNIQUE HEALTH STATUS AND/OR ACCESS NEEDS FOR THESE POPULATIONS?WHERE DO THESE PEOPLE LIVE IN THE COMMUNITY? WHY ARE THESE PROBLEMS PRESENT?INOVA'S CHNA CONSIDERS MULTIPLE DATA SOURCES, INCLUDING SECONDARY DATA (REGARDING DEMOGRAPHICS, HEALTH STATUS INDICATORS, AND MEASURES OF HEALTH CARE ACCESS), ASSESSMENTS PREPARED BY OTHER ORGANIZATIONS IN RECENT YEARS, AND PRIMARY DATA DERIVED FROM A COMMUNITY SURVEY AND FROM INTERVIEWS WITH PERSONS WHO REPRESENT THE BROAD INTERESTS OF THE COMMUNITY, INCLUDING THOSE WITH EXPERTISE IN PUBLIC HEALTH.THE FOLLOWING TOPICS AND DATA ARE ASSESSED IN INOVA'S CHNA REPORT:DEMOGRAPHICS, E.G., NUMBERS AND LOCATIONS OF VULNERABLE PEOPLE; ECONOMIC ISSUES, E.G., POVERTY AND UNEMPLOYMENT RATES, AND IMPACTS OF STATE OR LOCAL BUDGET CHANGES; COMMUNITY ISSUES, E.G., HOMELESSNESS, HOUSING, ENVIRONMENTAL CONCERNS, CRIME, AND AVAILABILITY OF SOCIAL SERVICES;HEALTH STATUS INDICATORS, E.G. MORBIDITY RATES FOR VARIOUS DISEASES AND CONDITIONS, AND MORTALITY RATES FOR LEADING CAUSES OF DEATH;HEALTH ACCESS INDICATORS, E.G., UNINSURANCE RATES, DISCHARGES FOR AMBULATORY CARE SENSITIVE CONDITIONS (ACSC), AND USE OF EMERGENCY DEPARTMENTS FOR NON-EMERGENT CARE;HEALTH DISPARITIES INDICATORS; ANDAVAILABILITY OF HEALTHCARE FACILITIES AND RESOURCES. THE ASSESSMENT IDENTIFIES A LIST OF SIGNIFICANT COMMUNITY HEALTH NEEDS.AS A RESULT OF THIS WORK AND PREVIOUS WORK, EACH INOVA HOSPITAL SELECTED 2-3 PRIORITY AREAS TO FOCUS ON FOR THE NEXT FEW YEARS, AND IS MOVING FORWARD WITH DEVELOPING COORDINATED EFFORTS WITHIN THE HEALTH SYSTEM TO CARRY OUT THE DESIGNED IMPLEMENTATION PLANS OF THE COMMUNITY HEALTH NEEDS ASSESSMENT. THE PROGRAM OUTREACH ADMINISTRATOR IS COORDINATING PLANS WITH HOSPITAL LEADERS TO ASSURE EFFECTIVE PLAN IMPLEMENTATION IN EACH OF THE RESPECTIVE COMMUNITIES. THE PROGRAM OUTREACH ADMINISTRATOR IS CENTRALIZED TO THE SYSTEM UNDER THE ASSISTANT VICE PRESIDENT OF COMMUNITY HEALTH SERVICES AND THEREBY ASSURES SYSTEM COORDINATED EFFORTS ARE CENTRALIZED AND REFLECTIVE OF INOVA HEALTH SYSTEM'S WORK ACROSS NORTHERN VIRGINIA.THE VARIOUS PUBLIC HEALTH DEPARTMENTS ALSO CONDUCT COMMUNITY HEALTH NEEDS ASSESSMENTS USING THE FRAMEWORK OF THE MOBILIZING FOR ACTION THROUGH PLANNING AND PARTNERSHIPS (MAPP) PROCESS. INOVA HEALTH SYSTEM IS A PARTICIPATING MEMBER OF THE MAPP PROCESS IN EACH JURISDICTION ACROSS NORTHERN VIRGINIA. MOST OF THESE ARE IN THE ACTION PHASES, WHILE ARLINGTON COUNTY IS ABOUT TO START A NEW CYCLE IN 2017. THE MAPP PROCESS LEADS TO AN ONGOING COMMUNITY-DRIVEN PLANNING PROCESS THAT IS DESIGNED TO PROVIDE INFORMATION FOR IMPROVING THE COMMUNITY'S DELIVERY OF THE TEN ESSENTIAL PUBLIC HEALTH SERVICES. THIS PROCESS BRINGS TOGETHER A DIVERSE GROUP OF KEY COMMUNITY STAKEHOLDERS INCLUDING LOCAL GOVERNMENT, HUMAN SERVICE ORGANIZATIONS, SCHOOLS AND UNIVERSITIES, HEALTHCARE CONSUMERS, ADVOCACY GROUPS, HOSPITALS, FAITH INSTITUTIONS, YOUTH DEVELOPMENT ORGANIZATIONS, ECONOMIC AND PHILANTHROPIC GROUPS, ETC. TO IDENTIFY STRENGTHS AND WEAKNESSES IN THE TEN ESSENTIAL AREAS TO PROVIDE A FOUNDATION FOR COMMUNITY HEALTH PLANNING. THE INFORMATION FROM THE MAPP HEALTH NEEDS ASSESSMENTS IN ALL JURISDICTIONS SERVED BY INOVA HEALTH SYSTEM, AS WELL AS THE ONGOING WORK OF THE ACTION TEAMS, WERE INCORPORATED INTO THE COMMUNITY NEEDS ASSESSMENT IMPLEMENTATION PLANS THAT WERE FINALIZED IN 2016. IN ADDITION TO THESE ACTIVITIES, INOVA IS CONTINUALLY GARNERING FEEDBACK ON EXISTING SAFETY NET AND COMMUNITY PROGRAMS FROM PARTICIPANTS THROUGH MONTHLY AND QUARTERLY SATISFACTION SURVEYS AND FOCUS GROUPS, PARTICIPATING IN REGIONAL AND LOCAL HEALTH RELATED GROUPS SUCH AS THE NORTHERN VIRGINIA ACCESS TO HEALTH CARE CONSORTIUM, MEETING WITH VARIOUS CULTURAL AND ETHNIC GROUPS IN THE COMMUNITY AND USING INTERNAL UTILIZATION AND OUTCOMES DATA, REVIEW OF BEST PRACTICES AND REGIONAL AND NATIONAL BENCHMARK DATA AND OTHER EXTERNAL SOURCES SUCH AS THE METROPOLITAN WASHINGTON COUNCIL OF GOVERNMENTS (COG) DEMOGRAPHIC DATA TO DEVELOP STRATEGIC GOALS FOR HEALTH IMPROVEMENT ACTIVITIES. COLLECTIVELY, ALL THIS INFORMATION IS UTILIZED IN ASSESSING COMMUNITY HEALTH NEEDS TO GUIDE STRATEGIC PLANNING EFFORTS. PART VI, LINE 3: INOVA HEALTH SYSTEM UTILIZES A MULTIFACETED APPROACH TO EDUCATE AND INFORM PATIENTS AND THE PUBLIC ABOUT INOVA'S FINANCIAL ASSISTANCE POLICY (FAP) OR CHARITY CARE POLICY. UPON ADMISSION TO ANY INOVA HOSPITAL OR ANY VISIT TO OUTPATIENT FACILITIES OR CLINICS INCLUDING EMERGENCY DEPARTMENTS, INOVA HAS INFORMATION POSTED REGARDING PATIENT RIGHTS AND RESPONSIBILITIES. IN ADDITION, INOVA PROVIDES INFORMATION ABOUT THE CHARITY CARE PROGRAM AND REFERRALS TO MEET WITH INOVA FINANCIAL COUNSELORS WHO ASSIST PATIENTS IN COMPLETING INOVA'S CHARITY CARE APPLICATION. THIS FINANCIAL INFORMATION IS REVIEWED BY THE INOVA PATIENT ACCOUNTS DEPARTMENT WITH THE PATIENT CONTACTED IF ADDITIONAL INFORMATION IS REQUIRED IN ORDER TO MAKE A DETERMINATION. THE PATIENT IS SUBSEQUENTLY PROVIDED A LETTER NOTIFYING THEM AS TO WHETHER OR NOT THEY QUALIFY FOR CHARITY CARE. INOVA ALSO HAS MEDICAID ELIGIBILITY WORKERS ON-SITE IN ALL HOSPITALS, IN THE INOVACARES CLINIC FOR WOMEN AND CHILDREN (CLINIC FOR LOW INCOME FAMILIES) AND IN THE COMMUNITY AS PART OF THE PARTNERSHIP FOR HEALTHIER KIDS ACCESS TO CARE PROGRAM. INOVA PARTNERS WITH SCHOOLS ACROSS THE JURISDICTION TO PROVIDE INFORMATION ABOUT STATE FUNDED HEALTH PROGRAMS FOR CHILDREN AND CONTACT INFORMATION TO MEET WITH AN ELIGIBILITY WORKER RESPONSIBLE FOR ENROLLING FAMILIES IN STATE MEDICAID PROGRAMS. THESE ELIGIBILITY WORKERS ALSO GO OUT INTO THE COMMUNITY ATTENDING COMMUNITY EVENTS SUCH AS HEALTH FAIRS, FAITH-BASED COMMUNITY ACTIVITIES AND OTHER FAMILY CENTERED COMMUNITY EVENTS TO PROACTIVELY MEET WITH FAMILIES TO ENCOURAGE ENROLLMENT IN PROGRAMS FOR WHICH THEY ARE ELIGIBLE. INOVA HAS A SECTION OF THE PUBLIC WEBSITE DEDICATED TO INFORMATION ABOUT BILLING AND FINANCIAL COORDINATORS AND FINANCIAL ASSISTANCE RESOURCES. ON THE SITE, A BROCHURE CALLED "YOUR GUIDE TO FINANCIAL HELP FOR HEALTH CARE SERVICES" CAN BE DOWNLOADED AND IS AVAILABLE IN 6 LANGUAGES TO ADDRESS THE NEEDS OF THE CULTURALLY DIVERSE COMMUNITY INOVA SERVES. PART VI, LINE 4: INOVA LOUDOUN HOSPITAL (ILH) IS A NOT-FOR-PROFIT CORPORATION AND A SUBSIDIARY OF THE PARENT ORGANIZATION, INOVA HEALTH SYSTEM FOUNDATION (INOVA). INOVA PROVIDES HEALTHCARE AND RELATED SERVICES THROUGHOUT NORTHERN VIRGINIA AND THE GREATER METROPOLITAN WASHINGTON, D.C. AREA, INCLUDING CERTAIN CONTIGUOUS COUNTIES OF VIRGINIA AND MARYLAND. NORTHERN VIRGINIA IS ONE OF THE FASTEST GROWING URBAN COMMUNITIES IN THE UNITED STATES. WITH APPROXIMATELY 1,314 SQUARE MILES, THE REGION IS THE MOST DENSELY POPULATED IN THE COMMONWEALTH OF VIRGINIA. NORTHERN VIRGINIA IS COMPRISED OF SEVERAL DISTINCT COMMUNITIES, INCLUDING THE CITIES OF ALEXANDRIA, FAIRFAX, FALLS CHURCH, MANASSAS AND MANASSAS PARK, AND THE COUNTIES OF ARLINGTON, FAIRFAX, LOUDOUN AND PRINCE WILLIAM. THE EASTERN SECTIONS ARE URBANIZED WITH ATTENDANT HEALTH PROBLEMS OF OVERCROWDING AND INCREASING DEMAND FOR HEALTH SERVICES AND PUBLIC PROGRAMS. INOVA LOUDOUN HOSPITAL'S PRIMARY SERVICE AREA COVERS ALL OF LOUDOUN COUNTY.LOUDOUN COUNTY'S POPULATION IS FORECASTED TO GROW 23% OVER THE NEXT DECADE, ADDING AN ESTIMATED AVERAGE OF 8,400 PERSONS A YEAR. POPULATION WILL BE SPURRED BY THE LONG-TERM STRENGTH OF THE REGION'S ECONOMY, HIGH RATES OF IN-MIGRATION AND INTERNATIONAL IMMIGRATION. THE REGION'S POPULATION THAT IS 65 YEARS OF AGE AND OLDER IS EXPECTED TO GROW BY 64% OVER THE NEXT 10 YEARS, WHILE THE NUMBER OF CHILDREN WILL INCREASE BY ABOUT 19% IN THE SAME TIME PERIOD. (MWCOG 8.4 AND ESRI)NORTHERN VIRGINIA'S RACIAL AND ETHNIC DIVERSITY IS MORE PRONOUNCED THAN IN THE REST OF THE STATE. WITH INCREASING DIVERSITY, ECONOMICALLY DISADVANTAGED POPULATIONS AND MULTIPLE LANGUAGES, THE NEED FOR ACCESS TO CULTURALLY APPROPRIATE, FLEXIBLE HEALTH CARE CONTINUES TO GROW. THE NORTHERN VIRGINIA GEOGRAPHIC REGION IN 2015 WAS 48% MINORITY, UP FROM 28% IN 1990, WHILE THE NATION AS A WHOLE REFLECTS A 38% MINORITY POPULATION (U.S. CENSUS BUREAU). THE U.S. CENSUS BUREAU ESTIMATES THAT LOUDOUN COUNTY HAD A POPULATION OF 375,629 PEOPLE IN 2015. THIS IS THE FASTEST GROWING JURISDICTION IN NORTHERN VIRGINIA. IN 2015 LOUDOUN COUNTY'S ASIANS, HISPANICS, AND AFRICAN AMERICANS REPRESENTED 18.0%, 13.6% AND 7.9% OF LOUDOUN'S POPULATION, RESPECTIVELY (U.S. CENSUS BUREAU).ACCORDING TO THE U.S. CENSUS BUREAU SMALL AREA HEALTH INSURANCE ESTIMATES (SAHIE) IN 2014 APPROXIMATELY 7.4% OF THE TOTAL POPULATION UNDER THE AGE OF 65 IN LOUDOUN COUNTY LACKED HEALTHCARE INSURANCE. OF THE PEOPLE LIVING IN LOUDOUN COUNTY WHOSE FAMILY INCOMES ARE AT OR BELOW 200% OF THE FEDERAL POVERTY LEVEL, SAHIE ESTIMATES THAT 31.3% WERE UNINSURED IN 2014.AREA RESIDENTS MOST LIKELY TO BE UNINSURED ARE THOSE WHOSE FAMILY INCOMES ARE AT OR BELOW 200% OF THE POVERTY LEVEL, YOUNG ADULTS (AGE 18-44), PEOPLE OF RACIAL BACKGROUNDS OTHER THAN WHITE, UNEMPLOYED INDIVIDUALS, PART-TIME WORKERS, AND PEOPLE WHO WORK AT COMPANIES WITH FEWER THAN 50 EMPLOYEES. SERVING THIS POPULATION POSES SIGNIFICANT CULTURAL AND LINGUISTIC CHALLENGES, AND THESE UNINSURED CITIZENS ARE WIDELY DISTRIBUTED IN TERMS OF AGE, GEOGRAPHIC REGION, AND HEALTH STATUS. PART VI, LINE 5: INOVA HEALTH SYSTEM'S INVESTMENT IN THE COMMUNITIES ACROSS NORTHERN VIRGINIA IS EVIDENT THROUGH NUMEROUS TARGETED COMMUNITY PROGRAMS. THESE PROGRAMS PROVIDE ACCESS TO CARE FOR LOW INCOME, UNINSURED, UNDERINSURED AND VULNERABLE POPULATIONS; PROMOTE HEALTH & WELLNESS; INCREASE HEALTH LITERACY; PROVIDE THE SUPPORT AND INFRASTRUCTURE FOR DISASTER PREPAREDNESS; AND PROVIDE PROGRAMS TO SUPPORT DEVELOPMENT OF OUR FUTURE HEALTHCARE WORKFORCE TO MEET THE HEALTHCARE NEEDS OF THE COMMUNITIES SERVED. ALL INOVA HEALTHCARE FACILITIES HAVE OPEN MEDICAL STAFFS TO PROVIDE THE MAXIMUM ACCESS TO QUALIFIED PHYSICIANS. A COMMUNITY BOARD OF TRUSTEES PROVIDES FISCAL AND QUALITY OVERSIGHT FOR INOVA HEALTH CARE SERVICES' FACILITIES TO ENSURE THE VISION AND MISSION OF THE ORGANIZATION IS ACHIEVED.ACCESS TO CARE PROGRAMSINOVA'S COMMUNITY HEALTH SERVICES DIVISION IS ORGANIZED TO ADDRESS A WIDE-SPECTRUM OF COMMUNITY HEALTHCARE NEEDS. IN ADDITION TO THE PROGRAMS ALREADY DESCRIBED IN THE CORE FORM PROGRAM, ACTIVITIES THAT PROVIDE INFRASTRUCTURE SUPPORT AND SERVICES FOCUSED ON VULNERABLE POPULATIONS TO INCREASE ACCESS TO HEALTHCARE SERVICES FOR THE COMMUNITIES SERVED BY INOVA HEALTH SYSTEM INCLUDE THE FOLLOWING PROGRAMS:THE STREAMLINED ELIGIBILITY PROGRAM (SES), LAUNCHED BY THE SUCCESSFUL IMPLEMENTATION OF THE FEDERALLY-FUNDED 2001 CAP AND 2004 HCAP GRANTS, CONTINUES TO BE FUNDED BY INOVA AND FAIRFAX COUNTY. SES PROVIDES LOCAL SAFETY-NET HEALTH CARE PROVIDERS ACCESS TO COORDINATED HEALTH CARE NETWORKS TO SERVE THE UNINSURED AND UNDERINSURED RESIDENTS OF NORTHERN VIRGINIA. A SHARED DATABASE IS USED TO DETERMINE A PATIENT'S ELIGIBILITY FOR SERVICES WHICH PROVIDES ONE CENTRAL INTAKE THEREBY STREAMLINING AND EXPEDITING THE PROCESS. INOVA SUPPORTS THE INFRASTRUCTURE AND EXPANSION OF THE PROGRAM WHICH CURRENTLY CONSISTS OF 12 PUBLIC/PRIVATE PARTNERS SERVING FAIRFAX COUNTY, CITY OF ALEXANDRIA, LOUDOUN COUNTY, ARLINGTON COUNTY, AND PRINCE WILLIAM COUNTY. THE SYSTEM CURRENTLY HOUSES OVER 300,000 ELIGIBILITY RECORDS OF UNINSURED AND MEDICAID PATIENTS. INOVA'S PARTNERSHIP FOR HEALTHIER KIDS (PHK) ACCESS TO CARE PROGRAM PROVIDES FAMILIES WITH COMPREHENSIVE APPLICATION AND ENROLLMENT ASSISTANCE TO CONNECT THEM WITH AN APPROPRIATE AND AFFORDABLE SOURCE OF HEALTH CARE SERVICES. IN 2016, PHK ASSISTED OVER 8,850 CHILDREN AND PARENTS WITH ACCESS TO A SOURCE OF COMPREHENSIVE HEALTH CARE SERVICES SUCH AS MEDICAID, FAMIS OR LOCAL SAFETY NET PROVIDERS.CARE CONNECTION FOR CHILDREN (CCC) IS FUNDED BY THE VIRGINIA DEPARTMENT OF HEALTH. THE GOAL OF CCC IS TO HELP FAMILIES COORDINATE COMMUNITY AND EDUCATIONAL RESOURCES WITH MEDICAL EXPERTISE TO ENSURE THAT CHILDREN WITH SPECIAL HEALTHCARE NEEDS CAN REACH THEIR MAXIMUM POTENTIAL. CCC PARTNERS WITH FAMILIES OF CHILDREN WHO HAVE CHRONIC HEALTHCARE NEEDS TO HELP OPEN DOORS TO NEEDED RESOURCES AND COORDINATE QUALITY FAMILY-CENTERED CARE. CCC IS COMMITTED TO HELPING CHILDREN MAXIMIZE THEIR POTENTIAL IN A CARING, INNOVATIVE AND CULTURALLY SENSITIVE MANNER. IN 2016, CCC SERVED 736 FAMILIES.TRANSITIONAL CARE MANAGEMENT THE INOVA TRANSITIONAL CARE MANAGEMENT PROGRAM (TCM), IMPLEMENTED JULY 2011, FOCUSES ON UNMANAGED MEDICARE/ MEDICAID, INNOVATION HEALTH, AETNA MEDICARE ADVANTAGE AND UNINSURED PATIENTS DIAGNOSED WITH HEART FAILURE (CHF), CHRONIC OBSTRUCTIVE PULMONARY DISEASE (COPD), PNEUMONIA AND ACUTE MYOCARDIAL INFARCTION (AMI). THESE DISEASES ACCOUNT FOR A HIGH PROPORTION OF POTENTIALLY PREVENTABLE READMISSIONS. FOR 30 DAYS AFTER DISCHARGE FROM THE HOSPITAL OR EMERGENCY ROOM, TCM CASE MANAGERS MONITOR PATIENTS PRIMARILY BY TELEPHONE. THEY EDUCATE PATIENTS ABOUT THEIR ILLNESSES, ENSURE THEY HAVE A FOLLOW-UP APPOINTMENT WITH THEIR PRIMARY CARE PHYSICIAN (PCP), AND CONFIRM THEY HAVE FILLED ANY PRESCRIPTIONS AND ARE TAKING THE CORRECT MEDICATIONS AND PROVIDE INTENSIVE CARE COORDINATION. FOR THOSE PATIENTS THAT DO NOT HAVE A PCP OR CANNOT BE SEEN BY THEIR PCP WITHIN AN APPROPRIATE TIME FRAME POST HOSPITAL DISCHARGE, INOVA HAS DEVELOPED THE INOVA TRANSITIONAL SERVICES CLINICS IN FOUR LOCATIONS IN WHICH PATIENTS ARE PROVIDED A FOLLOW-UP APPOINTMENT WITH A NURSE PRACTITIONER OR PHYSICIAN WHO WILL FOLLOW THE PATIENT UNTIL THE PATIENT IS READY TO TRANSITION TO A PERMANENT MEDICAL HOME. INOVA HOME HEALTH SERVICES ALSO PARTNERS WITH TCM IN PROVIDING HOME VISITS TO PATIENTS IDENTIFIED BY THE CASE MANAGERS AS NEEDING A HOME VISIT. IN 2016, TCM MANAGED OVER 4,000 ADMISSIONS AND THE TRANSITIONAL SERVICES CLINICS SERVED OVER 5,500 PATIENTS WITH OVER 9,000 VISIT ENCOUNTERS.INOVA KELLAR CENTERINOVA KELLAR CENTER (IKC) IS A COMMUNITY BASED BEHAVIORAL HEALTH CENTER AND SPECIAL EDUCATION SCHOOL FOUNDED BY INOVA IN 1991 WITH A GIFT FROM FAIRFAX COUNTY RESIDENTS, ART AND BETTY KELLAR, TO ADDRESS A GAP IN MENTAL HEALTH AND SUBSTANCE ABUSE SERVICES FOR CHILDREN AND ADOLESCENTS. CURRENTLY IKC OFFERS A FULL CONTINUUM OF MENTAL HEALTH SERVICES FROM OUTPATIENT THERAPIES AND MEDICATION MANAGEMENT TO AFTER SCHOOL INTENSIVE OUTPATIENT PROGRAMS AND A FULL DAY PARTIAL HOSPITALIZATION PROGRAM. THE KELLAR SCHOOL, A PRIVATE SPECIAL EDUCATION DAY SCHOOL FOR STUDENTS WITH EMOTIONAL, SOCIAL AND BEHAVIORAL NEEDS PROVIDES ACADEMIC INSTRUCTION WITHIN A THERAPEUTIC ENVIRONMENT. THE CENTER PROVIDED 74,932 HOURS OF PROGRAMMING, TREATMENT AND EDUCATION TO CHILDREN, ADOLESCENTS, AND FAMILIES IN 2016. INOVA EWING FORENSIC ASSESSMENT AND CONSULTATION TEAMS (FACT)FACT IS A COMPREHENSIVE, OUTPATIENT SEXUAL AND PHYSICAL ABUSE EVALUATION PROGRAM FOR CHILDREN AND ADULTS. STARTING IN THE LATE 1980S, INOVA HAS PROVIDED SPECIALIZED CARE FOR VICTIMS OF ABUSE, DOMESTIC VIOLENCE AND SEXUAL ASSAULT. FACT SERVES MOST OF NORTHERN VIRGINIA INCLUDING FAIRFAX, ARLINGTON, LOUDOUN AND PRINCE WILLIAM COUNTIES, THE CITY OF ALEXANDRIA, PARTS OF FAUQUIER AND STAFFORD COUNTIES AND ALL NORTHERN VIRGINIA DETENTION CENTERS AND MILITARY INSTALLATIONS. FACT ALSO PERFORMS COURTESY EXAMS FOR OUTLYING JURISDICTIONS INCLUDING THE DISTRICT OF COLUMBIA, MARYLAND AND WEST VIRGINIA. THE PROGRAM HAS GROWN SIGNIFICANTLY OVER THE YEARS AND NOW PROVIDES SERVICES IN THE AREAS OF SEXUAL ASSAULT, INTIMATE PARTNER/DOMESTIC VIOLENCE, PHYSICAL CHILD ABUSE, ELDER PHYSICAL ABUSE, STRANGULATION AND VICTIMS OF SEX TRAFFICKING. IN 2016, THERE WERE 676 PATIENT ENCOUNTERS.HEALTH PROMOTION AND PREVENTATIVE CARE PROGRAMSNORTHERN VIRGINIA HEALTHY KIDS COALITION: INOVA HEALTH SYSTEM, IN PARTNERSHIP WITH NORTHERN VIRGINIA SCHOOLS, HEALTH DEPARTMENTS, AND GOVERNMENT ENTITIES HAVE JOINED TOGETHER IN A MULTI-YEAR EFFORT TO ADDRESS THE CHILDHOOD OBESITY EPIDEMIC BY WORKING TO REVERSE THIS TREND. INOVA HEALTH SYSTEM SPONSORS THIS COMMUNITY-BASED COALITION. TO PREVENT AND REDUCE THE INCIDENCE OF NUTRITION-RELATED DISEASES, INOVA FOCUSED ON SEVERAL INITIATIVES TO REDUCE FOOD INSECURITY AND INCREASE FOOD LITERACY AMONG COMMUNITY MEMBERS. SPECIFICALLY, INOVA CONTINUED TO MATCH THE PURCHASES MADE BY SNAP CUSTOMERS (FORMERLY FOOD STAMPS) AT FARMERS MARKETS, ALLOWING LOW-INCOME INDIVIDUALS TO PURCHASE MORE FRESH PRODUCE. IN 2016, INOVA BEGAN SUPPORTING TWO NEW FARMERS MARKETS AND PROVIDED NEARLY $3,000 IN GRANTS.INOVA ALSO LAUNCHED AN 8-WEEK SCHOOL-BASED NUTRITION PROGRAM AT FOUR LOCAL TITLE I ELEMENTARY SCHOOLS TO IMPROVE STUDENTS' UNDERSTANDING OF NUTRITION AND THE IMPORTANCE OF HEALTHY BEHAVIORS.IN NOVEMBER 2016, INOVA AND WESLEY THEOLOGICAL SEMINARY COMPLETED A THREE YEAR PARTNERSHIP TO STRENGTHEN THE FAITH/HEALTH CONNECTION IN THE MT. VERNON COMMUNITY. THROUGH THE CREATION OF HEALTH MINISTRIES IN CONGREGATIONS THROUGHOUT MT. VERNON, THE PARTNERSHIP SUPPORTED CONGREGATIONS WORKING TO IMPROVE HEALTH OUTCOMES AND REDUCE HOSPITAL READMISSION RATES BY PROVIDING RESOURCES AND EDUCATION. INOVA PROVIDED 21 HEALTH MINISTRY AND FAITH COMMUNITY NURSE CERTIFICATE SCHOLARSHIPS TO THOSE INTERESTED IN BUILDING A HEALTH MINISTRY WITHIN THEIR CONGREGATION.HEALTH LITERACY AND HEALTH EQUITY PROGRAMSTHE OFFICE OF HEALTH EQUITY (OHE) IDENTIFIES AND ADDRESSES HEALTH DISPARITIES IN NORTHERN VIRGINIA THROUGH INTERNAL AND COMMUNITY INITIATIVES. THE DEPARTMENT IS DEDICATED TO THE ELIMINATION OF DISPARITIES IN THE COMMUNITY THROUGH COMMUNITY PARTNERSHIP, DIVERSITY AND CULTURAL COMPETENCE EDUCATION AND PROVISION OF LANGUAGE SERVICES. IN SUPPORT OF PATIENT SAFETY AND SATISFACTION, LANGUAGE INTERPRETATION AND TRANSLATION SERVICES ARE PROVIDED AT EVERY INOVA FACILITY, TO FACILITATE COMMUNICATION WITH THE 14 PERCENT OF INOVA'S PATIENT POPULATION WHO ARE LIMITED ENGLISH PROFICIENT (LEP). MEDICAL INTERPRETATION IN OVER 200 LANGUAGES IS PROVIDED BY ON-SITE MEDICAL INTERPRETERS AND TELEPHONIC INTERPRETERS. IN 2016, INOVA DELIVERED 69,477 HOURS OF INTERPRETER SERVICES AND 12,795 HOURS OF SIGN LANGUAGE INTERPRETATION ACROSS INOVA FACILITIES. OVER 520 VITAL DOCUMENTS WERE TRANSLATED INTO INOVA'S TOP LANGUAGES. PART VI, LINE 6: ORGANIZATION IS PART OF INOVA HEALTH SYSTEM INCLUDED IN DESCRIPTION UNDER LINE 5. PART VI, LINE 5 CONTINUATION CASH AND IN-KIND CONTRIBUTIONS TO COMMUNITY GROUPSINOVA DONATES SPACE, PROVIDES CASH AND IN-KIND SUPPORT SUCH AS HOUSEKEEPING AND DONATED STAFF TIME TO A NUMBER OF COMMUNITY GROUPS AND SERVICES. INOVA PROVIDES SUPPORT TO NOVA SCRIPTS, THE CENTER FOR MULTICULTURAL HUMAN SERVICES, SHENANDOAH UNIVERSITY, AND THE NOVA DENTAL CLINIC. INOVA ALSO PROVIDES FINANCIAL SUPPORT TO HEALTHWORKS FOR NORTHERN VIRGINIA AND NEIGHBORHOOD HEALTH, THE LOCAL FEDERALLY QUALIFIED HEALTH CENTERS. IN 2016, INOVA DONATED APPROXIMATELY $1 MILLION FOR THESE GROUPS COVERING BOTH CASH AND IN-KIND TRANSACTIONS.ADDITIONALLY, AS PART OF INOVA'S EFFORTS TO HARNESS THE COLLECTIVE POWER OF COMMUNITY PARTNERS, AGENCIES AND ORGANIZATIONS TO CREATE POSITIVE SOCIAL IMPACT, INOVA PROVIDED $50,000 IN COMMUNITY GRANTS. APPLICANTS WERE REQUIRED TO PRESENT PROGRAMS OR PROJECTS ADDRESSING THE POPULATION HEALTH NEEDS DESCRIBED IN THE INOVA COMMUNITY HEALTH NEEDS ASSESSMENT. PART VI, LINE 7 ORGANIZATION HAS NO STATE FILINGS. 0 1 0 0 0 0 0 0 0 MARK STAUDER TRUSTEE 0 1001631 0 1195682 0 750259 0 994896 0 21895 0 3964363 0 300005 PATRICK WALTERS CEO, ILH, ASST SECRETARY 423900 0 157493 0 110155 0 109406 0 16942 0 817896 0 0 0 LORING FLINT EVP CHIEF MEDICAL OFFICER 0 634652 0 641962 0 486524 0 264364 0 20921 0 2048423 0 320171 J KNOX SINGLETON PRESIDENT 0 1282168 0 2660312 0 845259 0 1453608 0 877 0 6242224 0 500000 JOHN GAUL SVP GENERAL COUNSEL 0 454318 0 117015 0 329013 0 157922 0 26460 0 1084728 0 307177 RICHARD MAGENHEIMER TREASURER 0 690063 0 762692 0 534029 0 453279 0 21507 0 2461570 0 195000 WILLIAM BANE AVP ASSOC ADMIN CFO 199974 0 46802 0 11259 0 33728 0 22473 0 314236 0 0 0 ELIZABETH DUGAN AVP, CNO 220011 0 51634 0 30471 0 54460 0 22649 0 379225 0 8594 0 CHRISTOPHER CHIANTELLA CHIEF MEDICAL OFFICER, ILH 259672 0 51225 0 15716 0 79644 0 15656 0 421913 0 0 0 DEBBIE WAGNER MGR PHARMACY PIC 149468 0 17908 0 259 0 23574 0 19674 0 210883 0 0 0 MARISSA JAMARIK SIR DIR NURSING SRVCS 147527 0 19357 0 182 0 6104 0 16996 0 190166 0 0 0 OMAR CASTANEDA CARDIO INVASIVE SPECIALIST 182315 0 2284 0 94 0 24000 0 21807 0 230500 0 0 0 REBECCA VALDESUSO SR DIR PERIOP SVCS 150718 0 28886 0 182 0 24000 0 5742 0 209528 0 0 0 SHONDRA JONES CARDIO INVASIVE SPECIALIST 173533 0 2544 0 74 0 512 0 8677 0 185340 0 0 0 PART I, LINE 3 QUESTION 3 - THESE METHODS ARE PERFORMED BY THE RELATED ENTITY, IMANCO INC. PART I, LINE 4B SERP PLAN PAYMENTS J. KNOX SINGLETON $250,973 RICHARD MAGENHEIMER $104,717 ELIZABETH DUGAN $17,186 PATRICK WALTERS $63,763 JOHN GAUL $307,177 LORING FLINT $448,873 MARK STAUDER $147,296 THE SUPPLEMENTAL EXECUTIVE RETIREMENT PLAN (SERP PLAN) IS A NONQUALIFIED RETIREMENT PLAN. EMPLOYEES ELIGIBLE TO PARTICIPATE ARE EXECUTIVE DIRECTORS, ASSISTANT VICE PRESIDENTS, VICE PRESIDENTS, SENIOR VICE PRESIDENTS, EXECUTIVE VICE PRESIDENTS, CFO, COO, AND CEO. EACH YEAR, A CERTAIN PERCENTAGE OF EACH PARTICIPANT'S BASE SALARY IS CONTRIBUTED TO THE SERP PLAN. THIS AMOUNT RANGES FROM 5% TO 20%, DEPENDING ON POSITION. AFTER THREE YEARS OF CONTINUOUS PARTICIPATION, PARTICIPANTS VEST IN 50% OF THEIR BALANCE AT THAT TIME AND ARE PAID OUT THE VESTED BALANCE AS A TAXABLE EVENT. AFTER A TOTAL OF SIX YEARS PARTICIPATION AND AFTER ATTAINING AGE 45, PARTICIPANTS ARE 100% VESTED AND ARE PAID OUT THEIR REMAINING BALANCE AS A TAXABLE EVENT. VESTING THEN REVERTS TO A THREE-YEAR ROLLING SCHEDULE UNTIL YEAR 12. THEREAFTER, THE ANNUAL CONTRIBUTION IS PAID OUT TO THE PARTICIPANT EACH YEAR AS A TAXABLE EVENT. PART II, LINE 4A CASH AND IN-KIND CONTRIBUTIONS TO COMMUNITY GROUPS: ILH DONATES SPACE, PROVIDES CASH AND IN-KIND SUPPORT SUCH AS HOUSEKEEPING AND DONATED STAFF TIME TO A NUMBER OF COMMUNITY GROUPS AND LOUDOUN COUNTY SERVICES. ILH DONATES SPACE TO THE LOUDOUN FREE CLINIC WHICH IS AN INDEPENDENT 501(C)(3) COMMUNITY HEALTH CENTER PROVIDING PRIMARY HEALTHCARE SERVICES FOR THE UNINSURED AND LOW INCOME RESIDENTS OF LOUDOUN COUNTY; LOUDOUN CARES, AN INDEPENDENT 501(C)(3) ORGANIZATION THAT PROVIDES COORDINATION FOR SOCIAL SERVICES FOR THE RESIDENTS OF LOUDOUN COUNTY; AND THE LOUDOUN CHILD ADVOCACY CENTER. INOVA ALSO PROVIDES FINANCIAL SUPPORT TO HEALTHWORKS FOR NORTHERN VIRGINIA, A FEDERALLY QUALIFIED HEALTH CENTER WITH LOCATIONS IN HERNDON AND LEESBURG, VA. IN 2016, ILH DONATED A TOTAL OF $422,927 FOR THESE GROUPS COVERING BOTH CASH AND IN-KIND TRANSACTIONS. PART V, LINE 1A AND 2A THE ORGANIZATION FILES ITS FORM 1099S UNDER THE PARENT ENTITY AND DOES NOT REPORT ANY AMOUNTS UNDER ITS OWN EIN. THE ORGANIZATION FALLS UNDER A MASTER PAY AGENT AND DOES NOT FILE ANY PAYROLL RETURNS UNDER ITS OWN EIN, HOWEVER ALL REQUIRED RETURNS HAVE BEEN FILED ON TIME. FORM 990, PART VI, SECTION A, LINE 6 THE ORGANIZATION HAS A SINGLE MEMBER. THE SOLE MEMBER IS INOVA HEALTH SYSTEM FOUNDATION, A CHARITABLE 501(C)(3) TAX-EXEMPT ORGANIZATION WHICH SERVES AS THE PARENT COMPANY OF THE INTEGRATED HEALTH CARE DELIVERY SYSTEM. FORM 990, PART VI, SECTION A, LINE 7A THE SOLE MEMBER OF THE ORGANIZATION, INOVA HEALTH SYSTEM FOUNDATION, IS A CHARITABLE 501(C)(3) TAX-EXEMPT ORGANIZATION. THE SOLE MEMBER ELECTS THE MEMBERS OF THE GOVERNING BODY OF THE ORGANIZATION. FORM 990, PART VI, SECTION A, LINE 7B THE SOLE MEMBER OF THE ORGANIZATION, INOVA HEALTH SYSTEM FOUNDATION, IS A CHARITABLE 501(C)(3) TAX-EXEMPT ORGANIZATION. THE SOLE MEMBER HOLDS RESERVED POWERS WITH RESPECT TO CERTAIN ACTIONS. IN ADDITION TO THE RESERVED POWERS, UNDER THE LAWS OF THE COMMONWEALTH OF VIRGINIA CERTAIN EXTRAORDINARY ACTIONS REQUIRE MEMBER APPROVAL, SUCH AS MERGERS, CONSOLIDATIONS, LIQUIDATIONS AND THE SALE OF SUBSTANTIALLY ALL OF THE ASSETS OF THE ORGANIZATION. FORM 990, PART VI, SECTION B, LINE 11B THE FORM 990 IS PREPARED AND PROVIDED TO THE CHIEF ACCOUNTING OFFICER AND EXTERNAL TAX CONSULTANTS FOR INITIAL REVIEW. AFTER THE REVIEW IT IS GIVEN TO THE CFO OF INOVA HEALTH SYSTEM FOR REVIEW AND COMMENT. THE FORM 990 IS PRESENTED TO THE EXECUTIVE COMMITTEE OF THE BOARD OF TRUSTEES FOR THEIR REVIEW. UPON COMPLETION OF THE EXECUTIVE COMMITTEE REVIEW, IT IS PROVIDED TO THE FULL BOARD OF TRUSTEES. IN THIS PROCESS, THE FORM 990 HAS BEEN PROVIDED TO THE GOVERNING BOARD APPROXIMATELY TWO WEEKS PRIOR TO THE FILING OF THE RETURN. FORM 990, PART VI, SECTION B, LINE 12C YES, ANNUALLY THE ORGANIZATION DISTRIBUTES THE CONFLICT OF INTEREST POLICY TO ALL DIRECTORS, OFFICERS, TRUSTEES, AND KEY EMPLOYEES. THE ORGANIZATION REQUIRES THAT EACH DIRECTOR, OFFICER, TRUSTEE, AND KEY EMPLOYEE ACKNOWLEDGE THAT THEY HAVE READ, UNDERSTOOD, AND WILL ABIDE BY THE POLICY. EACH DIRECTOR, OFFICER, TRUSTEE, AND KEY EMPLOYEE IS REQUIRED TO COMPLETE AND SUBMIT AN ANNUAL CONFLICT OF INTEREST DISCLOSURE. THESE DISCLOSURES ARE BROAD AND REQUIRE THAT THE INDIVIDUAL LIST ANY BUSINESS RELATIONSHIPS OR PERSONAL RELATIONSHIPS WITH OTHER DIRECTORS, OFFICERS, TRUSTEES, AND KEY EMPLOYEES, AS WELL AS ANY RELATIONSHIPS WITH COMPETITORS, OR CURRENT OR POTENTIAL VENDORS OR CONTRACTORS. DISCLOSURE STATEMENTS ARE REVIEWED BY SENIOR MANAGEMENT AND ANY POTENTIAL CONFLICTS ARE DISCUSSED WITH GOVERNING BODY CHAIRMAN TO ENSURE THAT ANY MEMBER WHO MAY HAVE A CONFLICT DISCLOSES THEIR POTENTIAL CONFLICT, AND IS DISMISSED FROM RELATED DISCUSSIONS AND RECUSED FROM PARTICIPATION IN APPLICABLE DECISIONS. FORM 990, PART VI, SECTION B, LINE 15 COMPLETED BY RELATED ENTITY, IMANCO, INC.: THE COMPENSATION OF ALL SENIOR MANAGEMENT POSITIONS IS EVALUATED ANNUALLY IN LIGHT OF EACH MANAGER'S JOB CONTENT, SCOPE AND COMPLEXITY. COMPENSATION LEVELS FOR VICE PRESIDENTS AND ABOVE ARE REVIEWED BY AN INDEPENDENT EXTERNAL CONSULTANT TO ENSURE THAT REMUNERATION IS CONSISTENT WITH THE ORGANIZATION'S COMPENSATION PHILOSOPHY AND OBJECTIVES AND COMPETITIVE WITH OTHER LARGE COMPLEX HEALTH SYSTEMS. THE INDEPENDENT COMPENSATION CONSULTANT MAINTAINS NATIONAL BENCHMARK COMPENSATION DATABASES AND SURVEYS AND ALSO REVIEWS FORMS 990 OF COMPARABLE HEALTHCARE SYSTEMS TO DETERMINE MARKET LEVELS OF COMPENSATION. IN ADDITION, THE INOVA HEALTH SYSTEM'S CEO'S COMPENSATION AND CERTAIN OTHER SENIOR EXECUTIVES IS REVIEWED AND APPROVED ANNUALLY BY AN INDEPENDENT GOVERNING BOARD. THE JOB REQUIREMENTS AND COMPLEXITY OF ALL OTHER MANAGEMENT POSITIONS ARE EVALUATED ANNUALLY USING NATIONALLY RECOGNIZED THIRD PARTY SALARY SURVEYS TO ASSURE THAT THE COMPENSATION FOR SUCH POSITIONS IS CONSISTENT WITH EXTERNAL MARKET COMPENSATION COMPARISONS. SALARY RANGES ARE DEVELOPED FOR EACH MANAGEMENT POSITION CLASSIFICATION TO ENSURE THAT THE COMPENSATION LEVELS FOR THESE POSITIONS ARE CONSISTENT WITH THE ORGANIZATION'S COMPENSATION PHILOSOPHY AND OBJECTIVES AND WITH COMPETITIVE MARKET COMPARISONS. COMPENSATION FOR EMPLOYED PHYSICIANS IS REVIEWED AND APPROVED BY THE IMG EXECUTIVE COMMITTEE. THE COMMITTEE IS COMPRISED OF EXECUTIVE MANAGEMENT OF THE INOVA MEDICAL GROUP. THE FAIR MARKET VALUE (FMV) COMPENSATION IS BASED ON FOUR NATIONALLY RECOGNIZED INDUSTRY PHYSICIAN COMPENSATION BENCHMARK SURVEYS (MGMA, AMGA, SULLIVAN & COTTER, KORN FERRY HAY GROUP). THE COMMITTEE ALSO UTILIZES INDEPENDENT CONSULTANTS TO PROVIDE FMV OPINIONS FOR POSITIONS THAT ARE NOT READILY AVAILABLE IN THE FOUR PUBLISHED BENCHMARK SURVEYS. THE CONSULTANTS' OPINIONS AND COMPENSATION SURVEY DATA ARE PRESENTED TO THE PHYSICIAN COMPENSATION COMMITTEE FOR REVIEW AND APPROVAL. FORM 990, PART VI, SECTION C, LINE 19 INOVA HEALTH SYSTEM MAKES CERTAIN INFORMATION PUBLICLY AVAILABLE. INOVA'S CONSOLIDATED FINANCIAL STATEMENTS ARE POSTED ON THE ELECTRONIC MUNICIPAL MARKET ACCESS'S (EMMA) WEBSITE ON A QUARTERLY BASIS. INOVA'S GOVERNING DOCUMENTS ARE NOT CURRENTLY PUBLICLY AVAILABLE. WHILE THE CONFLICT OF INTEREST POLICY IS NOT SPECIFICALLY PUBLICLY DISCLOSED, INOVA'S CODE OF CONDUCT IS ON THE PUBLIC WEBSITE. SECTION III OF THE CODE OF CONDUCT DESCRIBES WHAT CAN CONSTITUTE A CONFLICT AND REQUIRES THAT POTENTIAL CONFLICTS BE REPORTED TO MANAGEMENT OR THE CHIEF COMPLIANCE OFFICER. THE CODE ALSO REFERS TO THE CONFLICT OF INTEREST POLICY WHICH IS AVAILABLE TO STAFF AND PHYSICIANS ON INOVA'S INTRANET WEBSITE. FORM 990, PART IX, LINE 11G INTERNAL PURCHASED SERVICES: PROGRAM SERVICE EXPENSES 25,483,972. MANAGEMENT AND GENERAL EXPENSES 3,610,288. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 29,094,260. PHYSICIAN FEES: PROGRAM SERVICE EXPENSES 4,527,134. MANAGEMENT AND GENERAL EXPENSES 640,827. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 5,167,961. OUTSOURCED SERVICES: PROGRAM SERVICE EXPENSES 16,799,581. MANAGEMENT AND GENERAL EXPENSES 2,378,023. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 19,177,604. FORM 990, PART XI, LINE 9: PARTNERSHIP INCOME -7,356,722. TEMP RESTRICTED INCOME/LOSS -4,701. PERM RESTRICTED INCOME/LOSS -1,033,296. EQUITY IN SUBSIDIARIES 6,436,347. GRANT CAPITAL REIMBURSEMENTS 2,031,685. PART XII, LINE 2B AND 2C - AUDITED FINANCIAL STATEMENTS THE COMPANY IS PART OF THE INOVA HEALTH SYSTEM, A NOT-FOR-PROFIT INTEGRATED HEALTH CARE DELIVERY SYSTEM SERVING NORTHERN VIRGINIA AND SURROUNDING AREAS. THE COMPANY'S FINANCIAL STATEMENTS ARE CONSOLIDATED IN THE INOVA HEALTH SYSTEM CONSOLIDATED FINANCIAL STATEMENTS. INOVA HEALTH SYSTEM IS AUDITED ON AN ANNUAL BASIS BY A LARGE "BIG FOUR" INDEPENDENT PUBLIC ACCOUNTING FIRM. IN ADDITION, THEY ARE RESPONSIBLE FOR THE ISSUANCE OF A MANAGEMENT LETTER ENCOMPASSING EACH MEMBER OF THE CONSOLIDATED GROUP. THE AUDIT AND COMPLIANCE COMMITTEE OF THE BOARD OF TRUSTEES OF INOVA HEALTH SYSTEM IS RESPONSIBLE FOR THE OVERSIGHT OF THE AUDIT, INCLUDING THE HIRING OF THE AUDIT FIRM, REVIEW AND APPROVAL OF AUDITED FINANCIAL STATEMENTS AND COMMUNICATION WITH THE EXTERNAL AUDITORS AT LEAST TWICE A YEAR WITHOUT THE PRESENCE OF INTERNAL MANAGEMENT. PART XII, LINE 3A - A-133 AUDIT THE COMPANY IS A SUBSIDIARY OF THE INOVA HEALTH SYSTEM (IHS), A NOT-FOR-PROFIT INTEGRATED HEALTH CARE DELIVERY SYSTEM SERVING NORTHERN VIRGINIA AND SURROUNDING AREAS. IHS RECEIVES VARIOUS FEDERAL GRANTS. THESE GRANTS AND AWARDS ARE AUDITED AS PART OF THE CONSOLIDATED INOVA HEALTH SYSTEM A-133 COMPLIANCE AUDIT. THE INOVA HEALTH SYSTEM'S FEDERAL GRANTS ARE AUDITED ON AN ANNUAL BASIS BY A LARGE "BIG FOUR" INDEPENDENT PUBLIC ACCOUNTING FIRM AND A "REPORT ON COMPLIANCE WITH REQUIREMENTS APPLICABLE TO EACH MAJOR PROGRAM AND ON INTERNAL CONTROLS OVER COMPLIANCE IN ACCORDANCE WITH OMB CIRCULAR A-133" IS ISSUED ON A CONSOLIDATED BASIS. THE AUDIT AND COMPLIANCE COMMITTEE OF THE BOARD OF TRUSTEES OF INOVA HEALTH SYSTEM IS RESPONSIBLE FOR THE OVERSIGHT OF THE A-133 AUDIT, INCLUDING THE HIRING OF THE AUDIT FIRM, REVIEW AND APPROVAL OF AUDITED FINANCIAL STATEMENTS AND COMMUNICATIONS WITH THE EXTERNAL AUDITORS AT LEAST TWICE A YEAR WITHOUT THE PRESENCE OF INTERNAL MANAGEMENT. 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