2015-11-13T08:46:39-06:00 2014-12-31 990 2014-01-01 540261840 MARTHA JEFFERSON HOSPITAL MART 4346548198 500 MARTHA JEFFERSON DRIVE CHARLOTTESVILLE VA 22911 J MICHAEL BURRIS VICE PRESIDENT & CFO 4346547000 2015-11-13 2014 2016-02-25 16:41:14Z JONATHAN DAVIS 500 MARTHA JEFFERSON DRIVE CHARLOTTESVILLE VA 22911 253999366 0 X WWW.SENTARA.COM X 1929 VA AS PART OF SENTARA HEALTHCARE'S INTEGRATED DELIVERY SYSTEM, WE IMPROVE HEALTH EVERY DAY. 11 7 1934 775 120220 66041 3733514 7423182 244816257 242532667 17275 336748 3580716 3056469 252147762 253349066 174950 189400 0 0 123528438 125375291 0 0 0 118897179 117452310 242600567 243017001 9547195 10332065 330382073 263612901 323381593 47310128 7000480 216302773 X AS PART OF SENTARA HEALTHCARE'S INTEGRATED HEALTH CARE SYSTEM, WE IMPROVE HEALTH EVERY DAY AND ARE DEDICATED TO IMPROVING THE HEALTH STATUS OF OUR COMMUNITY. WE HAVE A VISION TO SET THE STANDARD FOR CLINICAL QUALITY AND PERSONALIZED HEALTHCARE SERVICES AND TO PROVIDE THE BEST CLINICAL QUALITY POSSIBLE WHILE MAINTAINING EXTRAORDINARY CUSTOMER SERVICE. 0 0 215495532 189400 242485052 AT THE HEART OF MARTHA JEFFERSON'S MISSION AS A NOT-FOR-PROFIT COMMUNITY HOSPITAL IS OUR ROLE AND RESPONSIBILITY TO ADDRESS THE HEALTH NEEDS OF OUR COMMUNITY. MARTHA JEFFERSON IS ENTRUSTED WITH RESOURCES AND SKILLS THAT CAN HELP THE PEOPLE OF OUR COMMUNITY ACHIEVE AND MAINTAIN THEIR BEST POSSIBLE HEALTH. THE HOSPITAL'S BOARD OF DIRECTORS IN 2014 REAFFIRMED THE FOLLOWING COMMITMENTS THAT ARE FUNDAMENTAL TO OUR ABILITY TO MEET THESE CHALLENGES. AS AN INTEGRAL PART OF THE STRATEGIC PLANNING PROCESS, THE MISSION OF MARTHA JEFFERSON HOSPITAL WILL BE REVIEWED ALONG WITH SPECIFIC INITIATIVES, GOALS AND OBJECTIVES TO CONSIDER INCORPORATING SPECIFIC STATEMENTS AIMED AT HELPING TO RESOLVE COMMUNITY PROBLEMS ADVERSELY AFFECTING THE HEALTH STATUS OF THE COMMUNITIES WE SERVE. MARTHA JEFFERSON WILL CONDUCT, OR GAIN ACCESS TO, COMMUNITY-NEEDS ASSESSMENTS (CHNA) TO IDENTIFY PROBLEMS ADVERSELY AFFECTING OUR COMMUNITIES' HEALTH STATUS. MARTHA JEFFERSON WILL REGULARLY INVENTORY HOSPITAL-SPONSORED AND COMMUNITY PROGRAMS WORKING TO MEET THE IDENTIFIED NEEDS OF MEDICALLY UNDERSERVED OR DISADVANTAGED POPULATIONS. AS APPROPRIATE, THESE PROGRAMS WILL BE TRACKED AND EVALUATED FOR THEIR IMPACT ON IDENTIFIED HEALTH STATUS ISSUES. THE MARTHA JEFFERSON HOSPITAL BOARD OF DIRECTORS FORMALLY ACCEPTED AND ADOPTED THE MOBILIZING FOR ACTION THROUGH PLANNING AND PARTNERSHIPS (MAPP2HEALTH) DISTRICT-WIDE COMMUNITY HEALTH ASSESSMENT AND COMMUNITY HEALTH IMPROVEMENT PLAN IN JANUARY 2013.MARTHA JEFFERSON WILL REGULARLY ASSESS ITS ABILITY TO COMMIT RESOURCES, FINANCIAL AND HUMAN, TOWARD HELPING MEET IDENTIFIED NEEDS.ACCESS TO HEALTHCARE: MARTHA JEFFERSON ACCEPTS PATIENTS REGARDLESS OF THEIR ABILITY TO PAY FOR HEALTHCARE SERVICES. THE HOSPITAL ASSISTS PATIENTS WITH FINANCIAL NEEDS THROUGH THE MARTHA JEFFERSON HEALTHTRUST, A PROGRAM THAT PROVIDES A SLIDING FEE SCALE FOR HOSPITAL PATIENTS WHO QUALIFY BASED ON FAMILY INCOME UP TO 300 PERCENT OF POVERTY LEVEL. FINANCIAL ASSISTANCE IS BASED ON A REVIEW OF THE PATIENT'S FINANCIAL CIRCUMSTANCES UPON ADMISSION OR THE SERVICE DATE. BECAUSE MARTHA JEFFERSON DOES NOT PURSUE COLLECTION OF THE AMOUNTS DETERMINED TO QUALIFY AS CHARITY CARE, SUCH AMOUNTS ARE NOT REPORTED AS A COMPONENT OF PATIENT SERVICE REVENUES. MARTHA JEFFERSON DEFINES CHARITY CARE AS CARE FOR WHICH COLLECTION IS NOT ATTEMPTED (I.E. INDIGENT CARE) AND OPERATING COSTS FOR SERVICES RENDERED FOR MEDICAID PATIENTS THAT ARE IN EXCESS OF REIMBURSEMENT FROM STATE AGENCIES. CHARITY CARE INFORMATION IS PROVIDED ON SCHEDULE H. IN ADDITION TO PROVIDING UNCOMPENSATED CARE, MARTHA JEFFERSON HAS ESTABLISHED SPECIAL ACCOUNTS TO PROVIDE FREE DIAGNOSTIC SERVICES FOR PATIENTS REFERRED BY THE CHARLOTTESVILLE FREE CLINIC AND THE FREE CLINIC OF GREENE COUNTY. THROUGHOUT THE YEAR, COMMUNITY HEALTH SCREENINGS AND REDUCED-FEE SERVICES PROVIDED OTHER MEANS OF ACCESS TO HEALTHCARE FOR PEOPLE ACROSS CENTRAL VIRGINIA. PHYSICIANS EMPLOYED BY MARTHA JEFFERSON HOSPITAL HAVE OFFICES THROUGHOUT CHARLOTTESVILLE AND IN SEVEN SURROUNDING COUNTIES INCLUDING ALBEMARLE, BUCKINGHAM, LOUISA, MADISON, GREENE, FLUVANNA AND NELSON, WHICH PROVIDE ACCESS TO HEALTHCARE IN MANY RURAL AREAS WITHOUT REGARD TO ONE'S ABILITY TO PAY. DURING 2014, THE MEDICAL STAFF CONSISTED OF JUST OVER 400 PHYSICIANS REPRESENTING 35 MEDICAL SPECIALTIES. MARTHA JEFFERSON HOSPITAL ALSO OPERATES A MAIN EMERGENCY DEPARTMENT, AS WELL AS A FREE-STANDING EMERGENCY DEPARTMENT, BOTH OF WHICH ARE STAFFED 24-HOURS A DAY/7 DAYS A WEEK BY BOARD-CERTIFIED PHYSICIANS AND SPECIALLY TRAINED NURSES AND SUPPORT STAFF.IN FISCAL YEAR 2014, MARTHA JEFFERSON HOSPITAL SERVED THE COMMUNITY BY WAY OF 9,436 INPATIENT ADMISSIONS; 217,170 OUTPATIENT ACCOUNTS; 52,092 EMERGENCY DEPARTMENT VISITS; 7,362 OPERATING ROOM VISITS; AND 189,037 PHYSICIAN OFFICE VISITS. IN ADDITION, MARTHA JEFFERSON OFFERED OR SUPPORTED MANY PROGRAMS AND SERVICES IN OUR COMMUNITY, WHICH ARE DETAILED BELOW.EDUCATIONAL PROGRAMS: AN IMPORTANT PART OF OUR COMMUNITY OUTREACH IS CENTERED ON EDUCATIONAL PROGRAMS AND TRAINING. WHEN A FAMILY IS PREPARING TO DELIVER A BABY AT MARTHA JEFFERSON, SIBLING TOURS, BREASTFEEDING CLASSES AND PEDIATRIC CPR ARE OFFERED AS WELL AS CLASSES CENTERED ON PREPARING FOR CHILDBIRTH AND BECOMING A PARENT. ONCE THE BABY HAS BEEN DELIVERED HOWEVER, THE EDUCATION DOESN'T STOP. A BRUNCH IS HELD DAILY FOR NEW FAMILIES BEFORE THEY ARE DISCHARGED. DURING THIS TIME FAMILIES LEARN HOW TO CALM THEIR CRYING BABY, THE DANGERS OF SUDDEN INFANT DEATH SYNDROME AND HOW TO GET A BIG BROTHER OR SISTER WARMED UP TO THE IDEA OF SHARING MOM AND DAD. THE STARR HILL HEALTH CENTER OFFERS A BABY BASICS MOMS CLUB. THE MOMS CLUB IS A FREE CLUB FOR PREGNANT WOMEN TARGETING WOMEN WHO MIGHT NOT NORMALLY ATTEND A CHILDBIRTH EDUCATION CLASS. THE MOMS CLUB ADDRESS ALL THE PRIORITY AREAS IDENTIFIED IN THE COMMUNITY HEALTH ASSESSMENT. IN 2014 MORE THAN 30 PEOPLE ATTENDED THE MOMS CLUB MEETINGS.OTHER EDUCATIONAL CLASS OFFERINGS AT MARTHA JEFFERSON INCLUDE; PREPARING FOR A HYSTERECTOMY, POST-HYSTERECTOMY REHAB, ADVANCED MEDICAL PLANNING, STRESS MANAGEMENT, JOINT PAIN: WHEN IS ENOUGH, ENOUGH?, UNDERSTANDING VASCULAR DISEASE, CARDIAC REHABILITATION AND PULMONARY REHABILITATION.SCHOOL PROGRAMS: MARTHA JEFFERSON HOSPITAL UNDERSTANDS MANY OF THE HEALTH DECISIONS WE MAKE AS ADULTS ARE A RESULT OF THE SITUATIONS WE EXPERIENCE AS CHILDREN. THROUGH OUR SCHOOL PROGRAMS WE ARE ABLE TO TEACH CHILDREN AND LEAVE AN IMPRESSION THAT WILL HOPEFULLY STAY WITH THEM AS THEY GROW UP. THE HOSPITAL ENGAGES CHILDREN OF ALL AGES IN FREE HEALTH AND NUTRITION-RELATED CLASSES AND CAMPS.IN OUR ELEMENTARY SCHOOL OUTREACH, AN EMPLOYEE OF MARTHA JEFFERSON ENGAGES STUDENTS IN THEIR CLASSROOM IN LESSONS ON HEALTH AND WELLNESS THAT DIRECTLY RELATE TO THE VIRGINIA STANDARDS OF LEARNING. ADDITIONALLY VOLUNTEER PROGRAMS ARE OFFERED EACH SUMMER TO HIGH SCHOOL STUDENTS IN THE COMMUNITY INTERESTED IN THE MEDICAL FIELD. THEY ARE REQUIRED TO COMPLETE 50 HOURS OF VOLUNTEER SERVICE, AND ARE GIVEN THE CHANCE TO WORK WITH HOSPITAL STAFF AND BUILD THEIR SKILLS AND INTEREST LEVEL IN THEIR AREA OF INTEREST. PROFESSIONAL EDUCATION SUPPORT: AS A WAY TO PROVIDE CONTINUED PROFESSIONAL EDUCATION, MARTHA JEFFERSON SUPPORTS AND PROVIDES CLINICAL PLACEMENTS FOR NURSING STUDENTS OF UNIVERSITY OF VIRGINIA, JAMES MADISON UNIVERSITY, LIBERTY UNIVERSITY, LYNCHBURG COLLEGE, SOUTH UNIVERSITY, PIEDMONT VIRGINIA COMMUNITY COLLEGE, BLUE RIDGE COMMUNITY COLLEGE, VIRGINIA COMMONWEALTH UNIVERSITY, LONGWOOD UNIVERSITY AND THE UNIVERSITY OF DELAWARE.HOSPITAL SERVICES: MARTHA JEFFERSON HOSPITAL OFFERS MANY PROGRAMS THAT HELP PATIENTS BOTH GET ACCLIMATED WITH OUR SYSTEM, AND ALSO NAVIGATE THE HOSPITAL AS NEEDS ARISE.HEALTH CONNECTION, OUR PHYSICIAN REFERRAL, PATIENT EDUCATION AND INFORMATION SERVICE TAKES 100+ CALLS ON A DAILY BASIS. THEY'RE ABLE TO HELP NEW MEMBERS OF THE COMMUNITY FIND A PHYSICIAN, ENROLL PEOPLE IN THE VARIOUS CLASSES THE HOSPITAL OFFERS AND PROVIDE SUPPORT FOR SPECIFIC MEDICAL NEEDS.FOR PEOPLE UNDERGOING CANCER TREATMENTS AT MARTHA JEFFERSON HOSPITAL, WE PROVIDE A CANCER CARE CENTER. THE CENTER SERVES AS A RESOURCE FOR PATIENTS FROM THE MOMENT THEY ARE DIAGNOSED THROUGH THEIR ENTIRE LINE OF INTERACTIONS AT THE HOSPITAL, AND IN MANY CASES EVEN CONTINUES AFTER THEY ARE ARE NO LONGER COMING FOR VISITS. STAFF MEMBERS ARE DEDICATED TO HELPING PATIENTS DEAL WITH THE EMOTIONS THAT GO ALONG WITH BEING DIAGNOSED WITH CANCER, FITTING THEM WITH COMPLIMENTARY WIGS AND SCARVES TO USE DURING TREATMENT AND JUST BEING FRIENDS THROUGHOUT THE PROCESS.MARTHA JEFFERSON HOSPITAL ALSO OFFERS A PALLIATIVE CARE PROGRAM. WHEN A PERSON IS FACING A SERIOUS OR ADVANCING ILLNESS, THE ACCOMPANYING PHYSICAL, EMOTIONAL AND SPIRITUAL ISSUES CAN DRAMATICALLY AFFECT THE EXPERIENCE AND OFTEN QUALITY OF LIFE FOR PATIENTS AND LOVED ONES. OVER THE PAST FIVE YEARS MORE THAN 1,000 LOCAL FAMILIES HAVE BENEFITTED FROM CONSULTATIONS BY A MULTIDISCIPLINARY TEAM PROVIDING PALLIATIVE CARE AT MARTHA JEFFERSON HOSPITAL. THE CAREGIVERS FOCUS ON DELIVERING A UNIQUE COMBINATION OF SPECIAL EXPERTISE IN PAIN AND SYMPTOM MANAGEMENT AND COORDINATE CARE AMONG A MULTIPLICITY OF PHYSICIANS INVOLVED WHEN AN INDIVIDUAL IS SERIOUSLY ILL AND DEDICATE THE TIME NEEDED FOR PATIENT-FAMILY COMMUNICATION ABOUT GOALS OF CARE AND THE EMOTIONAL AND SPIRITUAL STRUGGLES THAT OFTEN ACCOMPANY A LIFE-CHANGING ILLNESS. IN ADDITION TO THE ABOVE MENTIONED PROGRAMS, MARTHA JEFFERSON HOSPITAL ALSO OFFERS THE FOLLOWING: CHAPLAINCY PROGRAM, PATIENT ADVOCATE PROGRAM AND WEBSITE WITH INTEGRATED HEALTH INFORMATION (WWW.MARTHAJEFFERSON.ORG). MARTHA JEFFERSON HOSPITAL HELD 'UNWANTED MEDICATION TAKE BACK DAY' WHICH WAS A DRIVE-THROUGH EVENT ALLOWING ANY AND ALL IN OUR COMMUNITY TO DROP OFF UNWANTED MEDICATIONS AND MEDICAL SHARPS FOR PROPER DISPOSAL. SEE SCHEDULE O 215495532 1 1 0 0 0 0 0 0 0 1 1 0 0 1 1 0 0 1 0 0 0 0 0 0 1 0 1 1 1 0 1 0 0 0 0 0 0 1 1 1 1 0 1 1 1 1 1 0 0 1 145 0 1 1934 1 1 1 0 0 0 0 1 1 0 0 0 0 X 11 7 1 0 0 0 1 1 1 1 1 0 0 0 1 1 1 1 1 1 1 1 0 VA X J MICHAEL BURRIS CFO 4346547304 500 MARTHA JEFFERSON DRIVE CHARLOTTESVILLE VA 22911 WILLIAM L ACHENBACH BOARD MEMBER 2.00 2.00 X 0 0 0 LILLIAN R BEVIER BOARD MEMBER 2.00 2.00 X 0 0 0 PETER BROOKS CHAIR 3.00 2.00 X X 0 0 0 DR GREGORY DOULL BOARD MEMBER 2.00 X 0 0 0 RICHARD GILLIAM BOARD MEMBER 2.00 X 0 0 0 DRTERRY M GILLILAND BOARD MEMBER 2.00 44.20 X 0 1117730 144273 DR JOHN LIGUSH BOARD MEMBER 2.00 X 0 0 0 E RAY MURPHY BOARD MEMBER 2.00 2.00 X 0 0 0 DAVID G SUTTON BOARD MEMBER 2.00 2.00 X 0 0 0 DAVID L BERND BOARD MEMBER 2.00 52.20 X 0 4230690 87267 HOWARD P KERN VICE CHAIR 2.00 50.20 X X 0 1973999 3195033 CAROL B HURT THRU 114 BOARD MEMBER 2.00 0.00 X 0 0 0 JAMES E HADEN PRESIDENT (NON-VOTING) 50.00 15.00 X 2983076 0 294345 ELLIOT H KUIDA SECRETARY (NON-VOTING) 63.00 3.00 X 390624 0 98449 J MICHAEL BURRIS TREASURER (NON-VOTING) 32.00 38.20 X 380934 0 309513 AMELIA S BLACK VP, CHIEF NURSE EXECUTIVE 65.00 X 284561 0 73065 MARIJO LECKER VP, CLINICAL SUPPORT SVS/I 65.00 X 291821 0 83203 RONALD J COTTRELL VP, PLANNING, MKTG, CORP D 65.00 X 279856 0 246342 FINLAY M ASHBY VP, MEDICAL AFFAIRS 65.00 X 293356 0 64185 RAY R MISHLER VP, DEVELOPMENT 25.00 50.00 X 234358 0 245332 DEBORAH L THEXTON FINANCE DIRECTOR 60.00 5.00 X 182011 0 30127 JACOB N YOUNG PHYSICIAN 40.00 X 743531 0 48192 SANDEEP TEJA PHYSICIAN 40.00 X 632670 0 31332 JOHN Z EDWARDS PHYSICIAN 40.00 X 592938 0 44140 STEPHEN B GUNTHER PHYSICIAN 40.00 X 570463 0 45591 ERIKA J STRUBLE PHYSICIAN 40.00 X 484952 0 29939 SUSAN CABELL MAINS FORMER KE 0.00 40.00 X 0 250999 288501 8345151 7573418 5358829 181 1 1 0 QUEST DIAGNOSTICS 12436 COLLECTIONS CENTER DRIVE CHICAGO IL 606932436 LAB SERVICES 1116038 HANDCRAFT LINEN SERVICES 1501 ROSENEATH ROAD RICHMOND VA 232304431 LAUNDRY SERVICES 897906 ALBEMARLE ANESTHESIA PLC 311 10TH STREET NE CHARLOTTESVILLE VA 22902 PHYSICIAN SERVICES 713101 THE KING AGENCY 3 NORTH LOMBARDY STREET RICHMOND VA 23220 MARKETING SERVICES 584655 STERICYCLE COMM SOLUTIONS 25661 NETWORK PLACE CHICAGO IL 606731264 ANSWERING SERVICE 523698 25 550663 101000 2317929 4453590 128088 7423182 PATIENT SERVICES 621500 241583051 241478382 104669 PREMIUM CAPITATION 621500 949616 949616 242532667 392115 15551 376564 418626 193970 224656 224656 224656 171286 226653 -55367 -55367 -55367 284242 550663 229677 54565 54565 CAFETERIA & GIFT SHOP 722210 2659514 2659514 OTHER REVENUE 900099 62396 1716 60680 PHYSICIAN TELEPHONE SERV 541900 55338 55338 2777248 253349066 242485052 120220 3320612 189400 189400 6765158 6765158 101326 101326 89502099 86293452 3208647 4219367 3913559 305808 17964455 16358704 1605751 6822886 6374663 448223 404934 59 404875 170411 20195 150216 17640433 14564406 3076027 681255 667521 13734 5037215 4509150 528065 6449002 4968074 1480928 5550733 5430581 120152 315495 250808 64687 167079 134501 32578 5048033 5048033 13272110 12201314 1070796 2428883 975173 1453710 MEDICAL SUPPLIES 42392811 42391883 928 PROV FOR BAD DEBT 7840099 7840099 EQUIPMENT MAINTENANCE 6030509 5730076 300433 UNRELATED BUSINESS INCO 55000 55000 3968308 2626914 1341394 243017001 215495532 27521469 0 83540340 31424124 1173928 25951238 18317826 2511765 2989954 2951675 3153731 3308507 1619633 222377536 41318594 185390427 181058942 5437793 7580586 21290328 16294177 330382073 263612901 40487175 31113801 282894418 16196327 323381593 47310128 X 1472899 206662232 4364584 8448516 1162997 1192025 7000480 216302773 330382073 263612901 X 10332065 198970228 X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 28874654 1649570 1950633 28573591 28907762 1328076 1361184 28874654 29368803 2784380 -3245421 28907762 29368803 29368803 29368803 29368803 1.00000 0 1 1 398829 31170700 31569529 115148261 7966309 107181952 1336626 584584 752042 71849737 31979767 39869970 2473383 787934 1685449 181058942 MISCELLANEOUS ACCOUNTS RECEIVABLE 3695441 DEPOSITS 1617822 OTHER ASSETS 5340773 ASSETS HELD FOR SALE 3999000 DUE FROM AFFILIATE 1641141 16294177 CLAIMS ACCRUAL 500000 CAPITAL LEASE OBLIGATIONS 228232 LONG TERM LIABILITIES 8346991 IBNR LIABILITY 2959626 DUE TO AFFILIATES 2592185 DUE TO 3RD PARTY PAYORS 1569293 16196327 PART V, LINE 4: ENDOWMENT FUNDS ARE USED TO SUPPORT THE HEALTH CARE NEEDS OF THE COMMUNITY. MARTHA'S MARKET 587992 332342 255650 44572 135520 IN THE PINK 33584 24484 9100 492 3 213328 193836 19492 49093 834904 550662 284242 44572 185105 229677 54565 1 1 X 1 X 1 X 1 1 1 0 1 1 8616018 8616018 0.03670 12684694 9032783 3651911 0.01550 21300712 9032783 12267929 0.05220 1150407 1150407 0.00490 771797 390274 381523 0.00160 19803048 10882163 8920885 0.03800 172672 172672 0.00070 21897924 11272437 10625487 0.04520 43198636 20305220 22893416 0.09740 5362 5362 0.00000 5362 5362 1 7840099 1742070 63884722 80877113 -16992391 X 1 1 2 1 SENTARA MARTHA JEFFERSON HOSPITAL 500 MARTHA JEFFERSON DRIVE CHARLOTTESVILLE VA 22911 WWW.SENTARA.COM H1872 X X X 2 SENTARA MARTHA JEFFERSON OUTPATIENT SURGERY CENTER 595 MARTHA JEFFERSON DRIVE CHARLOTTESVILLE VA 22911 WWW.SENTARA.COM OH662 X OUTPATIENT SURGERY CENTER SENTARA MARTHA JEFFERSON HOSPITAL 1 0 0 1 X X X X X X X X X 13 1 1 1 1 X SEE SECTION C BELOW X X 1 13 0 1 0 1 X 200.000000000000 300.000000000000 X X X 1 1 X X X 1 X X 1 X 0 X X X X 1 X 0 0 SENTARA MARTHA JEFFERSON OUTPATIENT SURG 2 1 0 0 0 1 X 200.000000000000 300.000000000000 X X X 1 1 X X X 1 X X 1 X 0 0 X X X 0 0 SENTARA MARTHA JEFFERSON HOSPITAL PART V, SECTION B, LINE 5: SENTARA MARTHA JEFFERSON HOSPITAL (SMJH) PARTICIPATED WITH THE THOMAS JEFFERSON HEALTH DEPARTMENT IN A COLLABORATIVE EFFORT TO CONDUCT A COMMUNITY HEALTH NEEDS ASSESSMENT OF THE SIX LOCALITIES (CHARLOTTESVILLE/ALBEMARLE, FLUVANNA, GREENE, LOUISA, NELSON) IN THE HEALTH DISTRICT. THESE LOCALITIES ARE CONSIDERED SMJH'S SERVICE AREA, ACCOUNTING FOR APPROXIMATELY 84% OF SMJH'S INPATIENTS. OTHER PARTICIPANTS IN THIS PROCESS INCLUDED THE UNIVERSITY OF VIRGINIA HEALTH SYSTEM, THE UNIVERSITY OF VIRGINIA SCHOOL OF PUBLIC HEALTH, THE AREA AGENCY ON AGING, THE UNITED WAY, THE AREA FREE CLINIC, THE PLANNING DISTRICT COMMISSION, THE COOPERATIVE EXTENSION SERVICE, ETC. REGIONAL COUNTY INTERAGENCY COUNCILS WITH SMJH REPRESENTATION WERE USED TO COLLECT EXISTING HEALTH DATA, COMMUNITY MEMBER SURVEYS, AND KEY STAKEHOLDER FOCUS GROUPS TO CREATE THE ASSESSMENT AND PLAN. THE PROCESS TOOK INTO ACCOUNT INPUT FROM PERSONS WHO REPRESENT THE BROAD INTERESTS OF THE COMMUNITY SERVED BY THE HOSPITAL FACILITY, INCLUDING THOSE WITH SPECIAL KNOWLEDGE OF OR EXPERTISE IN PUBLIC HEALTH. SENTARA MARTHA JEFFERSON HOSPITAL PART V, SECTION B, LINE 6A: THE CHNA OF SENTARA MARTHA JEFFERSON HOSPITAL WAS CONDUCTED WITH UNIVERSITY OF VIRGINIA HEALTH SYSTEM/MEDICAL CENTER. SENTARA MARTHA JEFFERSON HOSPITAL PART V, SECTION B, LINE 7D: THE DIRECT URL ADDRESS FOR THE COMMUNITY HEALTH NEEDS ASSESSMENT IS:HTTP://WWW.SENTARA.COM/ASSETS/PDF/ABOUT-US/COMMUNITY-HEALTH-NEEDS-ASSESSMENTS/MARTHA-JEFFERSON-HEALTH-ASSESSMENT-WEB.PDF SENTARA MARTHA JEFFERSON HOSPITAL PART V, SECTION B, LINE 11: TO SELECT COMMUNITY HEALTH NEEDS ASSESSMENT PRIORITIES, THE HANLON MODEL WAS USED TO RATE THE MAGNITUDE AND SERIOUSNESS OF THE HEALTH ISSUES AND THE FEASIBILITY OF ADDRESSING THEM AT THE LOCAL LEVEL. HOSPITAL AND OTHER PARTICIPANTS RECOGNIZED THAT RESOURCES NEEDED TO BE DIRECTED TO THE HIGHEST PRIORITY HEALTH PROBLEMS. SENTARA MARTHA JEFFERSON OUTPATIENT SURGERY CENTER PART V, SECTION B, LINE 21D: THE FACILITY IS AN AMBULATORY SURGERY CENTER AND DOES NOT TREAT INDIVIDUALS REQUIRING EMERGENCY MEDICAL CARE. ONLY PRE-PLANNED PROCEDURES ARE PERFORMED AT THE FACILITY. SEE PART VI NARRATIVE ON THE ORGANIZATION'S AMBULATORY SURGERY CENTERS FOR FURTHER INFORMATION. 21 MARTHA JEFFERSON OUTPATIENT CARE CENTER 595 MARTHA JEFFERSON DRIVE CHARLOTTESVILLE VA 22911 DIAGNOSTIC CENTER MARTHA JEFFERSON HEALTH SERVICES 3263 PROFFIT ROAD CHARLOTTESVILLE VA 22902 DIAGNOSTIC CENTER MJ SURGICAL ASSOCIATES 500 MARTHA JEFFERSON DRIVE CHARLOTTESVILLE VA 22911 PHYSICIAN CLINIC MJ ORTHOPAEDICS 590 PETER JEFFERSON PARKWAY SUITE 100 CHARLOTTESVILLE VA 229034896 PHYSICIAN CLINIC FOREST LAKES FAMILY MEDICINE 3263 PROFFIT ROAD SUITE 101 CHARLOTTESVILLE VA 22911 PHYSICIAN CLINIC MARTHA JEFFERSON SLEEP CENTER 1793 RICHMOND ROAD CHARLOTTESVILLE VA 22911 DIAGNOSTIC CENTER GREENE FAMILY MEDICINE 140 STONERIDGE DRIVE S SUITE 100 RUCKERSVILLE VA 229683096 PHYSICIAN CLINIC CROZET FAMILY MEDICINE 1646 PARK RIDGE DRIVE CROZET VA 229323155 PHYSICIAN CLINIC PALMYRA MEDICAL ASSOCIATES 17 CENTRE COURT PALMYRA VA 229632330 PHYSICIAN CLINIC BLUE RIDGE INTERNAL MEDICINE 310 OLD IVY WAY SUITE 201 CHARLOTTESVILLE VA 229034896 PHYSICIAN CLINIC MJ AESTHETIC & RECONSTRUCTIVE SURGERY 600 PETER JEFFERSON PARKWAY CHARLOTTESVILLE VA 229118837 PHYSICIAN CLINIC MJ INTERNAL MEDICINE 590 PETER JEFFERSON PARKWAY SUITE 100 CHARLOTTESVILLE VA 22911 PHYSICIAN CLINIC AFTON FAMILY MEDICINE 10950 ROCKFISH VALLEY HWY AFTON VA 229203203 PHYSICIAN CLINIC MARTHA JEFFERSON NEUROSCIENCES 595 MARTHA JEFFERSON DRIVE CHARLOTTESVILLE VA 22911 PHYSICIAN CLINIC BUCKINGHAM FAMILY MEDICINE 65 BRICKYARD ROAD DILLWYN VA 229360030 PHYSICIAN CLINIC MJ MEDICAL ONCOLOGY ASSOCIATES 500 MARTHA JEFFERSON DRIVE CHARLOTTESVILLE VA 22911 PHYSICIAN CLINIC MADISON FAMILY MEDICINE 2503 SOUTH SEMINOLE TRAIL MADISON VA 227272690 PHYSICIAN CLINIC MJ SPRING CREEK 29 JEFFERSON COURT GORDONSVILLE VA 22942 PHYSICIAN CLINIC WOUND CARE AT MARTHA JEFFERSON 1490 PANTOPS MOUNTAIN PLACE CHARLOTTESVILLE VA 22911 WOUND CENTER MJ ORTHOPAEDICS NORTH 414 ALBEMARLE SQUARE CHARLOTTESVILLE VA 22901 PHYSICIAN CLINIC THE SOMETHING SPECIAL SHOP 500 MARTHA JEFFERSON DRIVE CHARLOTTESVILLE VA 22911 DME PART I, LINE 6A: THE ORGANIZATION'S COMMUNITY BENEFIT REPORT WAS CONTAINED IN A SYSTEM-WIDE REPORT PREPARED BY SENTARA HEALTHCARE, EIN 52-1271901, THE ORGANIZATION'S 501(C)(3) SOLE MEMBER. PART I, LINE 7: A COST-TO-CHARGE RATIO, CALCULATED USING WORKSHEET 2, WAS USED TO CALCULATE COSTS REPORTED IN LINES 7A. FOR LINES 7B AND 7G, THE ORGANIZATION USED ITS INTERNAL COST ACCOUNTING SYSTEM TO CALCULATE THE COST OF MEDICAID AND SUBSIDIZED HEALTH SERVICES. PART I, LINE 7G: INCLUDES PRIMARY CARE PRACTICES COSTS OF $8,920,885. PART I, LN 7 COL(F): THE AMOUNT OF BAD DEBT EXPENSE SUBTRACTED FROM THE DENOMINATOR WHEN CALCULATING COLUMN F PERCENTAGES IS $7,840,099. PART II, COMMUNITY BUILDING ACTIVITIES: WE OFFER A VARIETY OF COMMUNITY BUILDING ACTIVITIES INCLUDING THOSE DESIGNED TO HELP MEET THE BASIC NEEDS OF OUR COMMUNITY SUCH AS FOOD DRIVES AND OUR SHOES FOR THE HOMELESS ANNUAL CAMPAIGN. WE OFFER AN ANNUAL CELEBRATION OF LIFE EVENT FOR CANCER SURVIVORS TO GIVE THEM THE OPPORTUNITY TO INTERACT WITH THE PHYSICIANS AND STAFF WHO WERE RESPONSIBLE FOR THEIR CARE. OVER THE PAST SEVERAL YEARS, WE HAVE HAD ANNUAL UNWANTED MEDICATION AND SHARPS DROP-OFF EVENTS. WE HAVE STEADILY INCREASED THE AMOUNT OF MEDICATIONS AND SHARPS WE ARE TAKING OUT OF HOMES IN OUR COMMUNITY AT EACH EVENT. PART III, LINE 2: BAD DEBT EXPENSE IS REPORTED AT ESTABLISHED RATES IN ACCORDANCE WITH THE ORGANIZATION'S BOOKS AND RECORDS. BAD DEBT EXPENSE IS REPORTED NET OF ANY DISCOUNTS OR COLLECTIONS ON ACCOUNTS THAT WERE PREVIOUSLY WRITTEN OFF (I.E.: BAD DEBT WRITE-OFFS MINUS DISCOUNTS MINUS PAYMENTS RECEIVED.) PART III, LINE 3: IN COMPUTING LINE 3, THE ORGANIZATION REVIEWED ALL ACCOUNTS WRITTEN-OFF TO BAD DEBT FOR EMPLOYMENT HISTORY, PREVIOUS ELIGIBILITY FOR MEDICAID, INSURANCE PAYMENTS, REGISTRATION WITH INSURANCE, BANRUPTCY AND COMPLIANCE TO INTERNAL CHARITY POLICIES. PART III, LINE 4: SEE PAGE 17 OF THE ATTACHED FINANCIAL STATEMENTS FOR THE FOOTNOTE WHICH DISCUSSES BAD DEBT. PART III, LINE 8: THE MEDICARE COST REPORT WAS USED TO DETERMINE THE MEDICARE COSTS REPORTED ON LINE 6. MEDICARE MARGINS HAVE BEEN DECLINING AT THE SAME TIME THAT HOSPITALS HAVE BEEN ENGAGED IN CONCERTED EFFORTS TO IMPROVE EFFICIENCY, WHICH POINTS TO THE FACT THAT THE LOSSES ARE MOST LIKELY THE RESULT OF INADEQUATE REIMBURSEMENT BY THE FEDERAL GOVERNMENT, THUS, SHOULD BE INCLUDED IN COMMUNITY BENEFIT. PART III, LINE 9B: COLLECTION PRACTICES ARE GEARED TOWARDS PATIENTS THAT HAVE A HIGH PROBABILITY OF BEING ABLE TO PAY FOR SERVICES BASED ON INCOME LEVEL AND INELIGIBILITY FOR CHARITY PROGRAMS. IT IS THE POLICY OF SENTARA MARTHA JEFFERSON HOSPITAL TO REVIEW ACCOUNTS TO ENSURE ALL POSSIBLE METHODS OF PAYMENT HAVE BEEN EXHAUSTED, I.E. MEDICAL ASSISTANCE, FINANCIAL ASSISTANCE, PAYMENT PLANS AND SELF-PAY DISCOUNTS, PRIOR TO AN ACCOUNT BEING DEEMED AS "BAD DEBT". THE ORGANIZATION PERFORMS INTERNAL BAD DEBT COLLECTION FUNCTIONS AND USES OUTSIDE COLLECTION AGENCIES ON A SECOND PLACEMENT BASIS. THE ORGANIZATION DETERMINES WHICH PATIENTS ARE SENT TO OUTSIDE AGENCIES AND GUIDES THE AGENCIES IN PERFORMING REASONABLE COLLECTION EFFORTS. PART VI, LINE 2: THE ORGANIZATION ASSESSES THE HEALTH CARE NEEDS OF ITS COMMUNITIES THROUGH THESE MEANS:- ANALYSIS OF AREA SOCIODEMOGRAPHIC AND HEALTH STATUS DATA: THE ANALYSIS FOCUSES ON IDENTIFICATION OF HEALTH CARE NEEDS FOR PLANNING AND DEVELOPMENT OF HEALTH SERVICES AND PROGRAMS. THIS ANALYSIS IS UTILIZED FOR EDUCATION OF BOARD MEMBERS AND SENIOR HOSPITAL AND MEDICAL STAFF LEADERS AND IS INCORPORATED INTO THE ORGANIZATION'S STRATEGIC PLANS.- OBTAINING INPUT FROM KEY STAKEHOLDERS AND THE PUBLIC HEALTH COMMUNITY: IN ADDITION TO THE ANALYSIS OF SOCIODEMOGRAPHIC AND HEALTH STATUS DATA, ADDITIONAL INFORMATION IS OBTAINED AND ANALYZED. THIS INCLUDES SURVEYS OF KEY COMMUNITY STAKEHOLDERS, INPUT FROM THE LOCAL PUBLIC HEALTH COMMUNITY, AND OTHER INFORMATION - ANLAYSIS OF HEALTH CARE UTILIZATION PATTERNS AND TRENDS, FOR EXAMPLE. - REVIEW OF HEALTH CARE NEEDS ASSESSMENTS AND DATA DEVELOPED BY COMMUNITY PARTNERS (SUCH AS STATE HEALTH DEPARTMENTS AND LOCAL HEALTH DISTRICTS), REGIONAL AGENCIES (SUCH AS THE PLANNING COUNCIL OR PLANNING DISTRICT COMMISSION), NATIONAL ORGANIZATIONS WHICH REPORT ON A LOCAL BASIS (SUCH AS COUNTY HEALTH RANKINGS), AND INFORMATION REPORTED IN LOCAL MEDIA: THIS INFORMATION IS STUDIED AND INCORPORATED INTO THE ORGANIZATION'S PLANS.- DEVELOPMENT OF COMMUNITY HEALTH NEEDS ASSESSMENTS AND IMPLEMENTATION PLANS: INCORPORATING THE INFORMATION DESCRIBED ABOVE, THE HOSPITAL UNDERTAKES A REVIEW AND PRIORITIZATION PROCESS TO IDENTIFY KEY HEALTH PROBLEMS AND TO DEVELOP IMPLEMENTATION STRATEGIES.- PARTICIPATION IN COLLABORATIVE HEALTH PLANNING AND NEEDS ASSESSMENT ACTIVITIES SUCH AS THOSE SPONSORED BY LOCAL HEALTH DISTRICTS (MAPP - MOBILIZING FOR ACTION THROUGH PLANNING AND PARTNERSHIPS) AND OTHER ORGRANIZATIONS SUCH AS UNITED WAY AND ACCESS PARTNERSHIP: INFORMATION GATHERED THROUGH THESE ACTIVITIES IS INCORPORATED INTO THE ORGANIZATION'S PLANNING.- INFORMATION AND INPUT FROM PATIENTS AND CARE PROVIDERS: PATIENT CHARACTERISTICS AND TRENDS ARE REVIEWED TO ASSIST IN IDENTIFYING NEW COMMUNITY NEEDS. INPUT FROM PATIENTS AND CARE PROVDIERS IS SOUGHT AND CYCLED INTO THE ASSESSMENT PHASE OF PROJECTS. PART VI, LINE 3: THE HOSPITAL PROVIDES PAMPHLETS AT REGISTRATION AREAS, PAYMENT AREAS AND WAITING ROOMS DESCRIBING THE HOSPITAL'S BILLING PROCESS AND FINANCIAL ASSISTANCE. IN ADDITION, INFORMATION IS AVAILABLE ON THE HOSPITAL'S WEBSITE DISCUSSING ELIGIBILITY CRITERIA FOR FINANCIAL ASSISTANCE, THE FULL FINANCIAL ASSISTANCE POLICY, AS WELL AS INFORMATION ON THE APPLICATION PROCESS. FINANCIAL COUNSELORS AT THE HOSPITAL MAY REACH OUT TO PATIENTS TO DETERMINE IF THEY WOULD LIKE TO APPLY FOR ASSISTANCE, WHICH APPLICATION MAY BE MADE PRIOR TO, DURING OR SUBSEQUENT TO RECEIVING SERVICES. PART VI, LINE 4: SENTARA MARTHA JEFFERSON HOSPITAL SERVES THE THOMAS JEFFERSON AREA PLANNING DISTRICT (PD10), INCLUDING THE CITY OF CHARLOTTESVILLE, AND THE COUNTIES OF ALBEMARLE, FLUVANNA, GREENE, LOUISA, AND NELSON, ALL OF WHICH ARE FEDERALLY-DESIGNATED MEDICALLY UNDERSERVED AREAS. THIS DISTRICT INCLUDES URBAN, RURAL AND SUBURBAN GEOGRAPHIC AREAS. PD10 CONSISTS OF APPROXIMATELY 230,000 PEOPLE (U.S. CENSUS BUREAU 2009), WITH ALBEMARLE COUNTY BY FAR THE MOST HIGHLY POPULATED AREA, DISTANTLY FOLLOWED BY THE CITY OF CHARLOTTESVILLE AND THE OTHER COUNTIES. IN GENERAL, THE PLANNING DISTRICT IS GROWING IN POPULATION, WITH AN INCREASE OF OVER 30,000 PEOPLE FROM 2000-2009 (U.S. CENSUS BUREAU 2009). APPROXIMATELY 75 PERCENT OF CITY RESIDENTS AND 90 PERCENT OF ALBEMARLE COUNTY RESIDENTS LIVE ABOVE THE FEDERAL POVERTY LEVEL, WITH CHILDREN BEING THE MOST AFFECTED GROUP BY AGE OF PERSONS LIVING IN POVERTY. WHILE ABOUT 10 PERCENT OF CITY HOUSEHOLDS RECEIVE ASSISTANCE THROUGH FOOD STAMPS, OVER 50 PERCENT OF CITY SCHOOL CHILDREN QUALIFY FOR FREE OR REDUCED-COST LUNCH PROGRAMS (2008 CITY OF CHARLOTTESVILLE/ALBEMARLE COUNTY COMMUNITY HEALTH STATUS ASSESSMENT). MEDICAID AND SELF PAY PATIENTS COMPRISE APPROXIMATELY 10% OF THE HOSPITAL'S PATIENTS. THE COMMUNITY IS SERVED BY TWO HOSPITALS. PART VI, LINE 5: SENTARA MARTHA JEFFERSON FURTHERS ITS EXEMPT PURPOSE BY PROMOTING THE HEALTH OF THE COMMUNITY THROUGH WORKPLACE HEALTHY INITIATIVES, AN OPEN MEDICAL STAFF, BOARDS OF DIRECTORS COMPRISED OF COMMUNITY MEMBERS AND PHYSICIANS, CHARITY CARE POLICIES AND OUTREACH, AND USE OF SURPLUS FUND DISPERSAL. WORKFORCE DEVELOPMENT PROGRAMS CONTINUE AS DOES OUR SUPPORT OF ORGANIZATIONS CHAMPIONING CHILD DENTAL, INDIGENT PRESCRIPTION DRUG, COMMUNITY MENTAL HEALTH SERVICES AND FREE CLINIC ACCESS EFFORTS.SENTARA MARTHA JEFFERSON HOSPITAL STAFF SERVE ON COMMITTEES AND BOARDS RELATED TO COMMUNITY HEALTH INCLUDING THE CHARLOTTESVILLE FREE CLINIC, JEFFERSON AREA BOARD FOR AGING, THE SENIOR CENTER, THE CHARLOTTESVILLE OBESITY TASK FORCE, HOSPICE OF THE PIEDMONT, AND THE WOMEN'S INITIATIVE. PARTNERSHIPS ARE IMPORTANT TO US. WE PARTNER WITH ORGANIZATIONS THAT HAVE A TRACK RECORD OF IMPROVING HEALTH IN OUR COMMUNITY INCLUDING BUT NOT LIMITED TO THE CHARLOTTESVILLE FREE CLINIC, GREENE FREE CLINIC, CHARLOTTESVILLE/ALBEMARLE RESCUE SQUAD, THE UNITED WAY, AND THE WOMEN'S INITIATIVE (MENTAL HEALTH SERVICES). WE MAXIMIZE OUR REACH THROUGH FINANCIAL AND IN-KIND DONATIONS TO ORGANIZATIONS SUCH AS THE CHARLOTTESVILLE CITY SCHOOLS, HOSPICE OF THE PIEDMONT, JEFFERSON AREA BOARD FOR AGING AND HEAD START PROGRAMS IN SEVERAL SURROUNDING COUNTIES. OUR PARTNERSHIPS HELP BUILD AND STRENGTHEN EXISTING PROGRAMS, AS WELL AS LEADING TO THE DEVELOPMENT OF NEW PROGRAMS. OUR PARTNERSHIPS WITH OTHER NON-PROFITS IN THE COMMUNITY ALSO HELP US STAY ABREAST OF COMMUNITY NEEDS.MARTHA JEFFERSON HOSPITAL WELCOMES AND ENCOURAGES SIGNIFICANT COMMUNITY INVOLVEMENT THROUGH THE ESTABLISHMENT OF NUMEROUS GOVERNING COMMITTEES AND A COMMUNITY LEADERSHIP COUNCIL. THERE ARE 100 COMMUNITY MEMBERS ANNUALLY INVOLVED DIRECTLY WITH THESE COMMITTEES.SENTARA MARTHA JEFFERSON HOSPITAL MAINTAINS AN OPEN MEDICAL STAFF TO ALL WHO SEEK PRIVILEGES HERE. THERE ARE OVER 450 PHYSICIANS AND ALLIED STAFF ON THE MARTHA JEFFERSON HOSPITAL MEDICAL STAFF.SENTARA MARTHA JEFFERSON HOSPITAL UTILIZES SURPLUS FUNDS TO PURCHASE MEDICAL EQUIPMENT AND FACILITIES DESIGNED TO MEET THE NEEDS OF THE COMMUNITY IT SERVES. PART VI, LINE 6: THE ORGANIZATION IS AFFILIATED WITH THE SENTARA HEALTHCARE SYSTEM ("SENTARA"). SENTARA, A NOT-FOR-PROFIT HEALTH SYSTEM, OPERATES MORE THAN 100 SITES OF CARE SERVING RESIDENTS ACROSS VIRGINIA AND NORTHEASTERN NORTH CAROLINA. THE SYSTEM IS COMPRISED OF 12 ACUTE CARE HOSPITALS, INCLUDING SEVEN IN HAMPTON ROADS, ONE IN NORTHERN VIRGINIA, TWO IN THE BLUE RIDGE REGION, ONE IN SOUTH CENTRAL VIRGINIA AND ONE IN NORTHEAST NORTH CAROLINA, ADVANCED IMAGING CENTERS, NURSING AND ASSISTED LIVING CENTERS, OUTPATIENT CAMPUSES, TWO HOME HEALTH AND HOSPICE AGENCIES, A 3,800-PROVIDER MEDICAL STAFF, AND FIVE MEDICAL GROUPS WITH OVER 600 PROVIDERS.THE ORGANIZATION'S AFFILIATION WITH SENTARA ENHANCES ITS ABILITY TO ACHIEVE BEST PRACTICES IN HEALTHCARE DELIVERY; ACQUIRE CUTTING EDGE TECHNOLOGY AND INTEGRATED INFORMATION SYSTEMS, AND PROVIDE A HIGHER LEVEL OF MEDICAL CARE TO VIRGINIA'S BLUE RIDGE REGION COMMUNITY. COMBINED, THESE ATTRIBUTES BETTER POSITION THE ORGANIZATION TO ADDRESS HEALTH CARE REFORM AND OTHER PROFOUND CHANGES AFFECTING THE HEALTHCARE ENVIRONMENT. 1 NATIONAL MS SOCIETY 1020 CARRINGTON PLACE CHARLOTTESVILLE VA 22901 135661935 501(C)(3) 7500 COMMUNITY HEALTH PIEDMONT VIRGINIA COMMUNITY COLLEGE 501 COLLEGE DRIVE CHARLOTTESVILLE VA 22902 541268264 501(C)(3) 75000 COMMUNITY HEALTH THE WOMEN'S INITIATIVE 1101 EAST HIGH STREET STE A CHARLOTTESVILLE VA 22902 205913090 501(C)(3) 40000 MENTAL HEALTH SERVICES UNITED WAY 806 EAST HIGH STREET CHARLOTTESVILLE VA 22902 540505882 501(C)(3) 10000 RX RELIEF PROGRAM AMERICAN HEART ASSOCIATION 4217 PARK PLACE COURT GLEN ALLEN VA 23060 135613797 501(C)(3) 7000 COMMUNITY HEALTH CCHARLOTTESVILLE FREE CLINIC 1138 ROSE HILL DRIVE 200 CHARLOTTESVILLE VA 22903 541610405 501(C)(3) 30000 COMMUNITY HEALTH 6 0 PART I, LINE 2: MARTHA JEFFERSON HOSPITAL DONATES FUNDS IN FURTHERANCE OF THE HOSPITAL'S MISSION TO IMPROVE THE HEALTH STATUS OF THE COMMUNITY BY MAINTAINING, ENHANCING AND RESTORING PERSONAL HEALTH AND WELL BEING. ASSISTANCE IS GIVEN BASED ON DIRECTION FROM THE BOARD OF DIRECTORS AND COMMUNITY NEED. X X 1 1 0 1 0 0 0 0 0 1 0 DRTERRY M GILLILAND BOARD MEMBER 0 716219 0 387919 0 13592 0 129664 0 14609 0 1262003 0 0 DAVID L BERND BOARD MEMBER 0 1419131 0 1431286 0 1380273 0 65011 0 22256 0 4317957 0 777268 HOWARD P KERN VICE CHAIR 0 990520 0 814072 0 169407 0 3178069 0 16964 0 5169032 0 0 JAMES E HADEN PRESIDENT (NON-VOTING) 507988 0 433593 0 2041495 0 258565 0 35780 0 3277421 0 0 0 ELLIOT H KUIDA SECRETARY (NON-VOTING) 292544 0 97134 0 946 0 86548 0 11901 0 489073 0 0 0 J MICHAEL BURRIS TREASURER (NON-VOTING) 292225 0 88709 0 0 0 284617 0 24896 0 690447 0 0 0 AMELIA S BLACK VP, CHIEF NURSE EXECUTIVE 221332 0 59635 0 3594 0 49451 0 23614 0 357626 0 0 0 MARIJO LECKER VP, CLINICAL SUPPORT SVS/I 224652 0 59603 0 7566 0 64664 0 18539 0 375024 0 0 0 RONALD J COTTRELL VP, PLANNING, MKTG, CORP D 219696 0 56254 0 3906 0 220856 0 25486 0 526198 0 0 0 FINLAY M ASHBY VP, MEDICAL AFFAIRS 241314 0 52042 0 0 0 45544 0 18641 0 357541 0 0 0 RAY R MISHLER VP, DEVELOPMENT 180093 0 53887 0 378 0 233468 0 11864 0 479690 0 0 0 DEBORAH L THEXTON FINANCE DIRECTOR 160705 0 21306 0 0 0 29224 0 903 0 212138 0 0 0 JACOB N YOUNG PHYSICIAN 678531 0 65000 0 0 0 27947 0 20245 0 791723 0 0 0 SANDEEP TEJA PHYSICIAN 592776 0 39894 0 0 0 24233 0 7099 0 664002 0 0 0 JOHN Z EDWARDS PHYSICIAN 545687 0 47251 0 0 0 21750 0 22390 0 637078 0 0 0 STEPHEN B GUNTHER PHYSICIAN 520463 0 50000 0 0 0 26843 0 18748 0 616054 0 0 0 ERIKA J STRUBLE PHYSICIAN 442451 0 42501 0 0 0 28074 0 1865 0 514891 0 0 0 SUSAN CABELL MAINS FORMER KE 0 181090 0 53161 0 16748 0 268740 0 19761 0 539500 0 0 PART I, LINE 1A THE INDICATED BENEFITS ARE PROVIDED TO CERTAIN SENIOR EXECUTIVES OF THE ORGANIZATION AS PART OF OVERALL COMPENSATION PACKAGES AND ARE CONSIDERED IN EVALUATING THE REASONABLENESS OF COMPENSATION (SEE FORM 990, PART VI, LINE 15, FOR A DESCRIPTION OF THE PROCESS USED TO DETERMINE EXECUTIVE COMPENSATION). COUNTRY CLUB MEMBERSHIP FEES AND DUES: SOCIAL CLUB DUES PAID ON BEHALF OF THE ORGANIZATION'S SENIOR EXECUTIVES ARE ALLOCATED BETWEEN BUSINESS AND PERSONAL USE, THE PERSONAL USE OF WHICH IS TREATED AS ADDITIONAL COMPENSATION AND REPORTED ON FORM W-2 AS TAXABLE WAGES. PERSONAL SERVICES: FINANCIAL PLANNING - THE CEO RECEIVES ANNUAL PAYMENTS UP TO $4,000, VICE PRESIDENTS RECEIVE UP TO $2,500 EVERY FOUR YEARS AT THE DISCRETION OF THE PRESIDENT/CEO. FINANCIAL PLANNING (I.E. PERSONAL SERVICES) EXPENSES PAID BY OR ON BEHALF OF THE ORGANIZATION'S SENIOR EXECUTIVES ARE TREATED AS ADDITIONAL COMPENSATION AND REPORTED ON FORM W-2 AS TAXABLE WAGES. PART I, LINE 3 SENTARA HEALTHCARE, THE 501(C)(3) SOLE MEMBER OF THE ORGANIZATION, ESTABLISHED THE COMPENSATION OF THE ORGANIZATION'S TOP MANAGEMENT OFFICIAL THROUGH THE USE OF A COMPENSATION COMMITTEE, AN INDEPENDENT COMPENSATION CONSULTANT, A COMPENSATION STUDY, AND APPROVAL BY SENTARA HEALTHCARE'S COMPENSATION COMMITTEE. PART I, LINE 4B SUPPLEMENTAL NONQUALIFIED RETIREMENT PLAN 457(F): JAMES HADEN PARTICIPATES IN THE MARTHA JEFFERSON HEALTH SERVICES CORPORATION NONQUALIFIED RETIREMENT PLAN. THIS IS A SERP WITH TARGET BENEFIT OFFSET BY THE QUALIFIED PENSION PLAN AND SOCIAL SECURITY. DURING 2014, MR. HADEN RECEIVED A VESTED DISTRIBUTION UNDER THE PLAN OF $2,028,877, WHICH HAS BEEN REPORTED IN COLUMN (B)(III) OF SCHEDULE J, PART II. HOWARD KERN PARTICIPATED IN THE SENTARA SUPPLEMENTAL EXECUTIVE RETIREMENT PLAN. PARTICIPATION IN THE PLAN IS LIMITED TO SELECT INDIVIDUALS AS APPROVED BY SENTARA HEALTHCARE'S BOARD OF DIRECTOR'S COMPENSATION COMMITTEE. THE PLAN IS CURRENTLY CLOSED TO ADDITIONAL MEMBERS. VESTING OCCURS UPON THE COMPLETION OF A TWO YEAR NON-COMPETE PERIOD FOLLOWING TERMINATION AFTER EARLY RETIREMENT DATE OR UPON DEATH. EARLY RETIREMENT DATE IS WHEN THE EXECUTIVE OBTAINS AT LEAST AGE 55 AND HAS 10 YEARS OF SERVICE AND BENEFITS ARE FORFEITED IF PARTICIPANT LEAVES PRIOR TO AGE 55 WITH 10 YEARS OF SERVICE. DAVID BERND AND HOWARD KERN PARTICIPATED IN THE SENTARA OPTION PLAN FOR EXECUTIVES. THIS PLAN IS UNRELATED TO "EQUITY" OF THE EMPLOYER. PARTICIPATION IS LIMITED TO SELECT INDIVIDUALS AS APPROVED BY SENTARA HEALTHCARE'S BOARD OF DIRECTOR'S COMPENSATION COMMITTEE. VESTING IS DETERMINED BY THE GOVERNING BOARD OF SENTARA HEALTHCARE AND IS SEPARATELY STATED IN EACH PARTICIPANT'S OPTION AGREEMENT. THERE WERE NO OPTIONS GRANTED AFTER 2002. DAVID BERND,HOWARD KERN, AND TERRY GILLILAND, M.D. PARTICIPATED IN THE SENTARA CAPITAL ACCUMULATION ACCOUNT PLAN. PARTICIPATION IS LIMITED TO A SELECT GROUP OF CORPORATE EXECUTIVES AS APPROVED BY SENTARA HEALTHCARE'S BOARD OF DIRECTOR'S COMPENSATION COMMITTEE. TERMS OF THE PLAN CHANGED EFFECTIVE JANUARY 1, 2009, WHEREBY VESTING OF CONTRIBUTIONS MADE ON OR AFTER THAT DATE NOW OCCURS ON THE EARLIER OF FIVE YEARS FOR EACH YEARS' CONTRIBUTIONS OR AGE 55 WITH 10 YEARS OF SERVICE. UNDER THE OLD TERMS, VESTING OF CONTRIBUTIONS MADE PRIOR TO JANUARY 1, 2009 OCCURS ON THE EARLIEST OF ASSIGNED DISTRIBUTION DATE, DEATH, INVOLUNTARY TERMINATION WITHOUT CAUSE OR COMPLETION OF TWO-YEAR NON-COMPETE AFTER VOLUNTARY TERMINATION (REGARDLESS OF ORIGINAL ASSIGNED DISTRIBUTION DATE). DURING 2014, THE FOLLOWING CORPORATE EXECUTIVES RECEIVED VESTED DISTRIBUTIONS UNDER THE PLAN: DAVID BERND ($1,328,440 ) AND HOWARD KERN ($146,902). THESE AMOUNTS HAVE BEEN REPORTED IN COLUMN (B)(III) OF SCHEDULE J, PART II. PART I, LINE 7 DURING 2014, THE ORGANIZATION MADE NON-FIXED PAYMENTS OF COMPENSATION UNDER THE FOLLOWING INCENTIVE PROGRAMS: THE MANAGEMENT INCENTIVE PLAN RECOGNIZES INDIVIDUALS BASED ON SPECIFIC CRITERIA AND DEFINED ORGANIZATION PERFORMANCE STANDARDS. THE PLAN IS NOT ANNUALLY GUARANTEED AND IMPLEMENTATION WILL DEPEND ON ORGANIZATION-WIDE PERFORMANCE. IF ORGANIZATION-WIDE GOALS ARE NOT MET, THE PRESIDENT/CEO WILL HAVE THE DISCRETION TO DETERMINE ANY VARIATIONS TO THE PLAN. ANNUAL INCENTIVE PROGRAM - EXECUTIVES AND SENIOR LEADERS ARE ELIGIBLE FOR ANNUAL AWARDS BASED ON SYSTEM AND INDIVIDUAL PERFORMANCE. BOTH SYSTEM AND INDIVIDUAL SCORES ARE DETERMINED AFTER YEAR-END, AT WHICH POINT AWARDS MAY BE PAID AND REPORTED AS COMPENSATION. TARGET AND MAXIMUM OPPORTUNITIES VARY BY LEVEL. TOP HAT- WITHIN THE ANNUAL INCENTIVE PROGRAM, EXECUTIVES AND SENIOR LEADERS MAY RECEIVE ADDITIONAL INCENTIVE PAY TO REWARD EXCEPTIONAL INDIVIDUAL PERFORMANCE. ETHAN R MURPHY FAMILY MEMBER OF BOARD MEMBER E. RAY MURPHY 38600 EMPLOYMENT 0 SHANNON M KUIDA FAMILY MEMBER OF OFFICER ELLIOT H. KUIDA 62724 EMPLOYMENT 0 BURKHARD F SPIEKERMANN MD SUBSTANTIAL CONTRIBUTOR 117000 PROFESSIONAL SERVICES 0 MICHAEL J OBLINGER MD SUBSTANTIAL CONTRIBUTOR 107404 PROFESSIONAL SERVICES 0 X 7 10150 APPRAISAL X 22 85462 COST OR SELLING PRICE X GIFTS IN KIND 182 32476 COST OR SELLING PRIC 0 1 1 PART I, LINE 32B: MARTHA JEFFERSON HOSPITAL USES EXTERNAL PARTIES TO COORDINATE AN ARMS-LENGTH SALE OF NON-CASH CONTRIBUTIONS. FOR EXAMPLE, A LICENSED STOCK BROKER WAS USED THIS YEAR TO SELL GIFTS OF STOCK. INVESTMENTS 2014-05-01 123299694 BROKERAGE STATEMENT 521271901 SENTARA HEALTHCARE 6015 POPLAR HALL DRIVE NORFOLK VA 23502 501(C)(3) CASH 2014-11-30 40000000 521271901 SENTARA HEALTHCARE 6015 POPLAR HALL DRIVE NORFOLK VA 23502 501(C)(3) PENSION ASSET 2014-04-30 3729484 BOOK VALUE 521271901 SENTARA HEALTHCARE 6015 POPLAR HALL DRIVE NORFOLK VA 23502 501(C)(3) INTERCO DEBT 2014-06-30 -239988655 BOOK VALUE 521271901 SENTARA HEALTHCARE 6015 POPLAR HALL DRIVE NORFOLK VA 23502 501(C)(3) 0 0 0 0 FORM 990, PART III, LINE 4A COMMUNITY EVENTS AND HEALTH SCREENINGS: HEALTH SCREENINGS ARE AN IMPORTANT SERVICE OFFERED BY MARTHA JEFFERSON. THE FOLLOWING SCREENINGS ARE HELD ANNUALLY: SKIN CANCER SCREENING, BREAST HEALTH SCREENING, DIABETES ALERT DAY. IN ADDITION TO THE SCREENING EVENTS WE ALSO HOST EVENTS FOR THE COMMUNITY THAT PROMOTE WELLNESS. EACH SPRING THE CELEBRATION OF LIFE IS HELD FOR CANCER PATIENTS, SURVIVORS, AND THEIR FAMILIES. THE AFTERNOON IS FILLED WITH FOOD, SALSA DANCING, GAMES AND MUSIC AND PROVIDES A CHANCE FOR MEMBERS OF THE COMMUNITY TO CELEBRATE THEIR LIFE. WE ALSO HOLD FOOD AND SHOE DRIVES TO HELP PROVIDE MUCH NEEDED ITEMS TO PEOPLE IN THE COMMUNITY. ANNUALLY, WE HOST THE MJ5K RUN AND WALK TO BENEFIT THE CARING TRADITION FUND. NUTRITION PROGRAMS: AS HEALTHCARE PROVIDERS, OUR GOAL IS TO KEEP THE MEMBERS OF OUR COMMUNITY HEALTHY AND FEELING WELL. AT MARTHA JEFFERSON HOSPITAL WE OFFER A VARIETY OF PROGRAMS THAT ALLOW PEOPLE ACCESS TO INFORMATION THAT THEN HELPS THEM MAKE EDUCATED NUTRITION CHOICES. FOR STARTERS, ONE OF OUR REGISTERED DIETICIANS TAKES LEARNING ON LOCATION THROUGH OUR SUPERMARKET SMARTS CLASSES. THROUGH A PARTNERSHIP WITH GIANT FOOD, PEOPLE ARE ABLE TO GET HANDS-ON EXPERIENCE WHEN IT COMES TO MAKING HEALTHY DECISIONS AT THE GROCERY. WE ALSO PROVIDE HEART HEALTHY NUTRITION, DIABETES NUTRITION AND NUTRITION TIPS FOR INDIVIDUALS WITH CANCER. IN ADDITION TO OUR CLASSES, MARTHA JEFFERSON HAS A PRESENCE ACROSS THE LOCAL MEDIA AIRWAVES. NUTRITION TIPS AND TIMELY INFORMATION IS GIVEN BY ONE OF OUR REGISTERED DIETICIANS THROUGH DAILY RADIO SPOTS, A WEEKLY TELEVISION SEGMENT, AND VARIOUS PRINT OPPORTUNITIES. MARHTA JEFFERSON HOSPITAL ALSO PROVIDES FREE HEALTH ASSESSMENTS AT THE STARR HILL HEALTH CENTER. A NURSE PRACTITIONER WILL WORK WITH PATIENTS ON MEAL PLANNING, EXERCISE ROUTINES, AND GENERAL HEALTHY LIFESTYLE TIPS. IN 2014, 66 PATIENTS WERE SEEN AS PART OF THIS PROGRAM WITH 651 FOLLOW-UP APPOINTMENTS. SUPPORT GROUPS: MARTHA JEFFERSON HOSPITAL OFFERS SUPPORT GROUPS OF A WIDE VARIETY TO OUR PATIENTS AND MEMBERS OF THE COMMUNITY. GROUPS MEET ON A REGULAR BASIS AND HELP PROVIDE A SAFE COMMUNITY WHERE PEOPLE CAN SHARE STORIES, REFLECT ON THEIR EXPERIENCE, AND GAIN KNOWLEDGE FROM WHAT OTHERS ARE GOING THROUGH. THE FOLLOWING ARE JUST SOME OF THE TOPICS WE OFFER: WELCOME TO MOTHERHOOD, BREAST CANCER SUPPORT, FAMILY CANCER SUPPORT, HODGKIN'S AND LYMPHOMA SUPPORT, CARDIAC REHAB SUPPORT AND SLEEP APNEA SUPPORT. PROGRAM SUPPORT/UNDERWRITING: MARTHA JEFFERSON PROVIDES MEDICAL IMAGING, LABORATORY SERVICE AND OUTPATIENT DIAGNOSTIC SERVICE ACCESS TO THE CLIENTS OF THE CHARLOTTESVILLE FREE CLINIC (CFC) AND GREENE CARE CLINIC (GCC). THIS ACCESS SUPPORTS PRIMARY CARE SERVICES AND/OR MENTAL HEALTH SERVICES FOR THE WORKING UNDER OR UNINSURED MEMBERS OF OUR COMMUNITIES. MARTHA JEFFERSON SUPPORTED ACCESS TO MENTAL HEALTH SERVICES IN 2014 THROUGH FINANCIAL AND IN-KIND DONATIONS TO THE WOMEN'S INITIATIVE AND THE CHARLOTTESVILLE FREE CLINIC. ACCESS TO DENTAL SERVICES FOR CHILDREN WAS SUPPORTED THROUGH FINANCIAL DONATIONS TO THE ALBEMARLE COUNTY DEPARTMENT OF SOCIAL SERVICES. OTHER LOCAL ORGANIZATIONS/PROGRAMS SUPPORTED BY MARTHA JEFFERSON HOSPITAL INCLUDE: UNITED WAY RX RELIEF PROGRAM, SMOKING CESSATION, FLU CLINIC, HEALTH UPDATE FOR WOMEN, HIV/HEP C SCREENING, CHARLOTTESVILLE FREE CLINIC, CITY SCHOOLYARD GARDEN, PIEDMONT VIRGINIA COMMUNITY COLLEGE. FORM 990, PART VI, SECTION A, LINE 2 THE ORGANIZATION'S OFFICERS AND DIRECTORS SERVE TOGETHER ON THE BOARDS OF OTHER ORGANIZATIONS WITHIN THE SENTARA HEALTHCARE SYSTEM ("THE SYSTEM"), AS WELL AS JOINT VENTURES IN WHICH THE SYSTEM HAS AN OWNERSHIP INTEREST. SEE SCHEDULE R FOR A LISTING OF SUCH ENTITIES. DAVID BERND AND HOWARD KERN HAVE A BUSINESS RELATIONSHIP. FORM 990, PART VI, SECTION A, LINE 6 THE ORGANIZATION'S SOLE MEMBER WAS SENTARA HEALTHCARE, A VIRGINIA NONSTOCK CORPORATION DESCRIBED IN SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE. FORM 990, PART VI, SECTION A, LINE 7A THE BOARD OF DIRECTORS, WHICH SERVED AS THE ORGANIZATION'S GOVERNING BODY, WAS ELECTED AS FOLLOWS: SENTARA HEALTHCARE, THE 501(C)(3) SOLE MEMBER OF THE ORGANIZATION, APPOINTED THE CLASS B DIRECTORS AND APPROVED THE CLASS A DIRECTORS. THE CLASS A DIRECTORS WERE ELECTED BY A MAJORITY OF THE CLASS A DIRECTORS VOTING AS A SEPARATE CLASS, EXCLUDING THE CLASS A DIRECTOR SUBJECT TO RE-ELECTION, AND RATIFIED BY THE MEMBER'S BOARD OF DIRECTORS. FORM 990, PART VI, SECTION A, LINE 7B THE ORGANIZATION MAY NOT TAKE OR ALLOW ANY OF THE FOLLOWING GOVERNANCE ACTIONS WITHOUT THE WRITTEN CONSENT OF ITS 501(C)(3) SOLE MEMBER, SENTARA HEALTHCARE: APPROVAL OR ADOPTION OF ANY PLAN OR MERGER OR CONSOLIDATION, ANY SALE, LEASE, EXCHANGE, MORTGAGE, PLEDGE OR OTHER DISPOSITION OF ALL, OR SUBSTANTIALLY ALL, THE PROPERTY AND ASSETS OF THE ORGANIZATION, THE VOLUNTARY DISSOLUTION OR LIQUIDATION OF THE ORGANIZATION, REVOCATION OF ANY SUCH VOLUNTARY DISSOLUTION PROCEEDINGS, OR ANY DECISION TO FILE A PETITION REQUESTING OR CONSENTING TO AN ORDER FOR RELIEF UNDER THE FEDERAL BANKRUPTCY LAWS OR SIMILAR STATE LAWS FOR THE ORGANIZATION; ELECTION OF NEW BOARD MEMBERS; OR ALTERATION, AMENDMENT, RESTATEMENT OR REPEAL OF ANY ORGANIZING OR ENABLING DOCUMENTS OR BYLAWS. THE APPROVAL OF THE SOLE MEMBER IS ALSO REQUIRED FOR CERTAIN OPERATIONAL ACTIONS, AS OUTLINED IN THE ORGANIZATION'S BYLAWS. SUCH ACTIONS INCLUDE, BUT ARE NOT LIMITED TO, APPROVAL OF STRATEGIC PLANS AND ANNUAL OPERATING AND CAPITAL BUDGETS; TRANSACTIONS WITH INTERESTED PERSONS; CREATION OR ACQUISITION OF SUBSIDIARIES OR INTERESTS IN WHICH THE ORGANIZATION WILL BE A MEMBER; ENTRANCE INTO JOINT VENTURE OR OTHER SIMILAR ARRANGEMENTS; EMPLOYMENT MATTERS CONCERNING THE ORGANIZATION'S PRESIDENT; UNBUDGETED CAPITAL EXPENDITURES OR INDEBTEDNESS OVER SPECIFIED DOLLAR AMOUNTS; AND THE COMMENCEMENT OR SETTLEMENT OF LITIGATION. SENTARA HEALTHCARE HAS EXCLUSIVE AUTHORITY TO DIRECT AND MANAGE THE OPERATIONS AND AFFAIRS OF THE HOSPITAL, SUBJECT TO BOARD OVERSIGHT TO THE EXTENT AND IN THE MANNER SET FORTH IN THE ORGANIZATION'S BYLAWS. FORM 990, PART VI, SECTION B, LINE 11 PRIOR TO FILING THE FORM 990 WITH THE IRS, IT IS REVIEWED BY THE FINANCE TEAM, INCLUDING THE CHIEF FINANCIAL OFFICER. IT IS ALSO REVIEWED BY SENTARA HEALTHCARE'S TAX DIRECTOR. MARTHA JEFFERSON HOSPITAL WILL SUBMIT THE PUBLIC DISCLOSURE VERSION OF FORM 990 FOR THE PRECEDING FISCAL YEAR TO THE CEO EVALUATION COMMITTEE OF THE MARTHA JEFFERSON HOSPITAL BOARD OF DIRECTORS IN THE RESPECTIVE MEETING FOLLOWING THE FILING OF THE FORM 990. IN ADDITION, THE PUBLIC DISCLOSURE VERSION OF FORM 990 WILL BE PROVIDED TO THE MARTHA JEFFERSON HOSPITAL BOARD OF DIRECTORS AT THE MEETING FOLLOWING THE FILING OF THE FORM 990. MARTHA JEFFERSON HOSPITAL WILL ALSO ADVISE BOARD MEMBERS OF THE WEBSITE ADDRESS AT WHICH THE PUBLIC DISCLOSURE VERSION OF FORM 990 WILL BE POSTED (WWW.GUIDESTAR.ORG/990). FORM 990, PART VI, SECTION B, LINE 12C MARTHA JEFFERSON HOSPITAL'S CONFLICT OF INTEREST POLICY IS ADMINISTERED BY THE CORPORATE COMPLIANCE OFFICER. ON AN ANNUAL BASIS ALL DIRECTORS, TRUSTEES, OFFICERS, KEY EMPLOYEES, MEDICAL STAFF MEMBERS WITH ADMINISTRATIVE RESPONSIBILITIES AND OTHER EMPLOYEES COMPLETE A DETAILED CONFLICT OF INTEREST QUESTIONNAIRE DISCLOSING ANY REPORTABLE ACTIVITIES AND INVESTMENTS. THESE QUESTIONNAIRES ARE REVIEWED BY THE CORPORATE COMPLIANCE OFFICER. IN ADDITION, ALL PERSONS LISTED ABOVE ARE ANNUALLY PROVIDED A COPY OF THE CONFLICT OF INTEREST POLICY. IF CHANGES TO PERSONNEL OCCUR BETWEEN ANNUAL COMPLETION OF THE CONFLICT OF INTEREST QUESTIONNAIRE, NEW PERSONNEL ARE ALSO REQUIRED TO COMPLETE THE QUESTIONNAIRE. ALL DISCLOSURE STATEMENTS ARE REVIEWED FOR REPORTABLE TRANSACTIONS. FORM 990, PART VI, SECTION B, LINE 15 AS PART OF THE SENTARA HEALTHCARE SYSTEM ("THE SYSTEM"), THE ORGANIZATION FOLLOWED PROCESSES AND PROCEDURES SET FORTH IN ITS GOVERNING DOCUMENTS TO ENSURE COMPLIANCE WITH ITS OBLIGATIONS AS A 501(C)(3) HEALTHCARE ORGANIZATION TO PAY DISQUALIFIED PERSONS REASONABLE COMPENSATION. SUCH PROCESSES AND PROCEDURES ARE INTENDED TO ESTABLISH THE REBUTTABLE PRESUMPTION OF REASONABLENESS UNDER THE INTERNAL REVENUE CODE SECTION 4958 REGULATIONS. THE COMPENSATION PHILOSOPHY OF THE SYSTEM AS A WHOLE IS TO BASE OVERALL COMPENSATION AND BENEFITS FOR EXECUTIVES ON NOT-FOR-PROFIT MARKET COMPARABLES, ADJUSTED AS APPLIED TO EACH EXECUTIVE, TAKING INTO CONSIDERATION THE INDIVIDUAL SKILLS, EXPERIENCE, TENURE AND PERFORMANCE OF THE EXECUTIVE BEING COMPENSATED AND OVERALL PERFORMANCE OF THE ORGANIZATION. IN LINE WITH THIS PHILOSOPHY, THE SYSTEM PERFORMED SUBSTANTIAL DUE DILIGENCE AS TO MARKET COMPARABLES. THE SYSTEM'S COMPENSATION COMMITTEE, WHICH CONSISTS OF SYSTEM BOARD MEMBERS WITHOUT CONFLICTS OF INTERESTS, ENGAGED AN OUTSIDE CONSULTANT, WHO REPORTS TO THE COMPENSATION COMMITTEE, TO CONDUCT A STUDY ASSESSING THE COMPETITIVENESS OF TOTAL COMPENSATION (INCLUDING CASH COMPENSATION, BENEFITS AND PERQUISITES) OF ITS SENIOR EXECUTIVES PRIOR TO MAKING DECISIONS REGARDING ANNUAL BASE SALARY ADJUSTMENTS, APPROVING INCENTIVE AWARDS, OR CONSIDERING PROGRAMMATIC CHANGES. THE STUDY COMPARED THE COMPENSATION OF THE SYSTEM'S SENIOR EXECUTIVES TO COMPENSATION DATA FROM MULTIPLE PUBLISHED SURVEY SOURCES BASED ON THE SENIOR EXECUTIVE'S FUNCTIONAL RESPONSIBILITY. IN CONDUCTING THE STUDY, THE CONSULTANT TARGETED OTHER NOT-FOR-PROFIT HEALTH SYSTEMS OF SIMILAR SIZE BASED ON NET REVENUE AND COMPLEXITY. FOR HEALTH PLAN POSITIONS, HEALTH PLANS WITH SIMILAR PREMIUMS, OR MEMBERS, WERE TARGETED. THE CONSULTANT ALSO CONDUCTS A REVIEW OF THE ORGANIZATION'S PERFORMANCE RELATIVE TO A GROUP OF NOT-FOR-PROFIT HEALTH SYSTEMS OF COMPARABLE SIZE AND SCOPE OF OPERATIONS EVERY YEAR. THE MOST RECENT STUDY COMPARED SENTARA'S PERFORMANCE TO 30 NOT-FOR-PROFIT HEALTHCARE SYSTEMS BASED ON NET REVENUE GROWTH, OPERATING MARGIN, BOND RATING, AND QUALITATIVE PERFORMANCE MEASURES BASED ON RANKINGS FROM SDI'S NATIONAL TOP INTEGRATED HEALTH NETWORKS. OVERALL, THE CONSULTANT DETERMINED THAT SENTARA'S PAY WAS ALIGNED WITH ITS RELATIVE PERFORMANCE. THE COMPENSATION STUDY WAS PRESENTED TO THE SYSTEM'S COMPENSATION COMMITTEE, WHICH MADE ITS COMPENSATION DECISIONS BASED ON A)ITS REVIEW AND ANALYSIS OF THE PERFORMANCE OF BOTH THE ORGANIZATION AND ITS SENIOR EXECUTIVES AND, B) A REASONABLENESS OF COMPENSATION ANALYSIS AND OPINION FROM AN EXTERNAL EXPERT IN THE COMPENSATION OF EXECUTIVES IN THE TAX-EXEMPT HEALTH CARE FIELD. THE COMMITTEE'S BASES FOR ITS DECISIONS WERE DOCUMENTED IN COMMITTEE MINUTES TAKEN DURING THE MEETING AND THEN CIRCULATED FOR REVIEW AND APPROVAL. ALL DECISIONS REGARDING COMPENSATION WERE MADE BY THE COMMITTEE, WHICH CONSISTS OF SYSTEM BOARD MEMBERS WITHOUT CONFLICT OF INTERESTS. THIS PROCESS WAS USED TO ESTABLISH COMPENSATION FOR THE ORGANIZATION'S PRESIDENT. IT WAS ALSO USED TO ESTABLISH COMPENSATION FOR ITS VICE CHAIRMAN, WHO ALSO SERVES AS PRESIDENT AND COO OF THE SYSTEM. THE PROCESS WAS LAST UNDERTAKEN DURING 2014 FOR THE POSITIONS LISTED. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION'S GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY AND FINANCIAL STATEMENTS ARE AVAILABLE TO THE PUBLIC UPON REQUEST. FORM 990, PART XI, LINE 9: NET ASSET TRANSFER FROM MJH FOUNDATION 125,834,123. BOOK RECLASS OF INTERCO ACCT BALANCES TO EQUITY 240,153,279. NET PLEDGE ACTIVITY - RESTRICTED FUNDS 12,004. NET ASSET TRANSFER TO PARENT -167,029,178. FORM 990, PART VI, LINE 16B AT DECEMBER 31, 2014 MARTHA JEFFERSON HOSPITAL DID NOT HAVE A SPECIFIC JOINT VENTURE POLICY. ANY PROPOSED JOINT VENTURE PARTICIPATION IS EVALUATED WITHIN THE CONTEXT OF THE ADMINISTRATIVE POLICY ENTITLED "AUTHORITY TO COMMIT AND EXPEND FUNDS". THIS POLICY DEPICTS THE TYPES AND LEVELS OF EXPENDITURES AND COMMITMENTS THAT MANAGEMENT CAN UNDERTAKE. ALL PROPOSED JOINT VENTURES ARE REVIEWED BY EXTERNAL LEGAL COUNSEL TO ENSURE COMPLIANCE WITH THE APPROPRIATE FEDERAL, STATE AND REGULATORY LAW. ANY JOINT VENTURE PARTICIPATION MUST BE EVALUATED AND APPROVED BY THE MARTHA JEFFERSON HOSPITAL BOARD OF DIRECTORS. A SPECIFIC JOINT VENTURE PARTICIPATION POLICY IS CURRENTLY IN PROCESS OF DEVELOPMENT. 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