2013-11-14T13:27:16-06:00 2012-12-31 540737372 PBMARES LLP 725 JACKSON STREET SUITE 210 FREDERICKSBURG VA 22401 990 2012-01-01 201106426 MARY WASHINGTON HEALTHCARE GROUP RETURN MARY 5407411821 2300 FALL HILL AVENUE NO 509 FREDERICKSBURG VA 22401 WINIFRED J HAIKEY 5407411821 2013-11-13 1 KEITH L WAMPLER P00436324 5403713566 2013-11-13 X 2012 2016-02-24 21:20:13Z WINIFRED J HAIKEY 2300 FALL HILL AVENUE NO 509 FREDERICKSBURG VA 22401 556114566 1 1 4243 X WWW.MARYWASHINGTONHEALTHCARE.COM X 1983 VA OUR MISSION IS TO IMPROVE THE HEALTH OF PEOPLE IN THE COMMUNITIES WE SERVE. THROUGH OUR SUBSIDIARIES WE PROVIDE INPATIENT AND OUTPATIENT HOSPITAL SERVICES AND OTHER MEDICAL SERVICES. 52 39 4455 628 2206714 0 3276620 2411552 579696645 537035684 -51980 2855304 50240217 13215573 633161502 555518113 1819323 2402339 0 0 257022512 249763997 0 0 126659 379711817 325039772 638553652 577206108 -5392150 -21687995 531390646 491115201 316739101 305149607 214651545 185965594 OUR MISSION IS TO IMPROVE THE HEALTH OF PEOPLE IN THE COMMUNITIES WE SERVE. THROUGH OUR SUBSIDIARIES WE PROVIDE INPATIENT AND OUTPATIENT HOSPITAL SERVICES AND OTHER MEDICAL SERVICES. 0 0 561685495 2402339 535009294 PROVISION OF INPATIENT AND OUTPATIENT GENERAL ACUTE CARE HOSPITAL, PSYCHIATRIC HOSPITAL SERVICES, HOME HEALTH AND HOSPICE SERVICES, IMAGING AND AMBULATORY SURGERY SERVICES AND PHYSICIAN SERVICES. PRIMARY SERVICE AREAS ARE FAIRFAX, STAFFORD, SPOTSYLVANIA, CAROLINE, KING GEORGE, AND WESTMORELAND COUNTIES IN VIRGINIA AND SECONDARY SERVICE AREAS INCLUDE MANASSAS, FAUQUIER, CULPEPER, ORANGE, LOUISA, HANOVER, ESSEX AND RICHMOND COUNTIES IN VIRGINIA. WE SERVED 124,282 PATIENTS IN OUR EMERGENCY ROOMS, 17,140 SURGICAL CASES AND 26,457 PATIENT DISCHARGES. 561685495 1 1 0 0 0 0 0 0 0 1 1 0 0 0 1 1 0 1 0 0 0 0 0 0 1 0 1 1 1 1 1 1 0 0 0 0 0 0 0 0 0 1 1 1 0 0 1 1 1 1 0 0 1 X 412 0 0 1 1 1 0 0 0 0 0 0 0 0 0 X 52 39 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 1 1 X X WINIFRED J HAIKEY 5407411821 2300 FALL HILL AVENUE SUITE 509 FREDERICKSBURG VA 22401 FRED M RANKIN III 4.00 40.00 X X 0 841176 45242 SEAN T BARDEN 4.00 40.00 X X 0 401442 49949 WALTER J KIWALL 4.00 40.00 X X 0 440583 42996 XAVIER R RICHARDSON 2.00 40.00 X X 0 251218 38551 J THOMAS RYAN MD 2.00 40.00 X X 0 443100 42343 RAVI MATHUR 2.00 40.00 X X 0 188283 34164 CHERYL SPRINGHORN 0.00 40.00 X 0 141959 11226 KENNETH N JOSOVITZ MD 3.00 2.00 X 16667 0 0 DAVID M GARTH MD 4.00 2.00 X 26000 0 0 JOSEPH T CRANE IV MD 2.00 2.00 X 0 0 0 CINDY MARROW MD 2.00 2.00 X 0 0 0 ROBERT E HOUCK 2.00 40.00 X 0 117725 7975 JOHN F FICK III 2.00 8.00 X X 0 0 0 ALDA L WHITE 2.00 2.00 X X 0 0 0 DONALD H NEWLIN 2.00 5.00 X X 0 0 0 WILLIAM BOLDON 2.00 3.00 X 0 0 0 JAN C ERKERT 2.00 2.00 X 0 0 0 KURT R LARSON MD 2.00 2.00 X 0 0 0 RAYMOND C MCAFOOSE 2.00 3.00 X 0 0 0 MICHAEL P MCDERMOTT MD 2.00 2.00 X 0 0 0 JOHN C MCKEOWN MD 2.00 2.00 X 0 0 0 FRED M MESSING 2.00 2.00 X 0 0 0 CLARENCE A ROBINSON 2.00 2.00 X 0 0 0 RAYMOND L SLAUGHTER 2.00 2.00 X 0 0 0 JONATHAN D WALLACE 2.00 2.00 X 0 0 0 MARY KATHERINE GREENLAW 4.00 0.00 X X 0 0 0 EDWARD V ALLISON JR 2.00 0.00 X X 0 0 0 WILLIAM B YOUNG 2.00 0.00 X X 0 0 0 MARK A BUTTERWORTH 2.00 0.00 X 0 0 0 R LEIGH FRACKELTON JR 2.00 0.00 X 0 0 0 JEFFREY A FRAZIER 2.00 0.00 X 0 1500 0 ROCHELLE GREY 2.00 0.00 X 0 0 0 CHRISTOPHER T HUESGEN MD 2.00 0.00 X 0 0 0 PATRICIA LYNCH 2.00 0.00 X 0 0 0 EDWARD O MINNIEAR 2.00 0.00 X 0 0 0 JUDITH G SMITH 2.00 0.00 X 0 0 0 DOUGLAS G STEWART 2.00 0.00 X 0 0 0 JOSEPH R WILSON 2.00 0.00 X 0 0 0 W MALONE SCHOOLER 2.00 0.00 X X 0 0 0 JO D KNIGHT 2.00 0.00 X X 0 0 0 ELAINE F FARMER 2.00 0.00 X X 0 0 0 KEVIN BREEN 2.00 0.00 X 0 0 0 CLAY HUBER 2.00 0.00 X 0 0 0 DOUGLAS R JOHNSON MD 2.00 0.00 X 0 0 0 WILLIAM R JOHNSON 2.00 0.00 X 0 0 0 GLEN E KINARD 2.00 0.00 X 0 0 0 H CLARK LEMING 2.00 0.00 X 0 0 0 TERENCE A MANNION 2.00 0.00 X 0 0 0 CHARLES W MCDANIEL 2.00 0.00 X 0 0 0 REV GREGORY L POSS 2.00 0.00 X 0 0 0 JACK ROWLEY 2.00 0.00 X 0 0 0 LAWRENCE ROBERTS MD 40.00 0.00 X 510910 0 32341 KATHRYN S WALL 2.00 40.00 X 0 258227 34278 MARIANNA BEDWAY 2.00 40.00 X 0 235548 46060 ERIC FLETCHER 2.00 40.00 X 0 231930 38840 WINIFRED J HAIKEY 2.00 40.00 X 0 245828 38197 JOYCE HANSCOME 2.00 40.00 X 0 225571 34654 JAMES K VAN RENAN 40.00 2.00 X 301970 0 46100 CATHLEEN A YABLONSKI 40.00 2.00 X 211319 0 41390 AMY ADOME MD 2.00 40.00 X 0 195012 27088 REBECCA BIGONEY MD 40.00 2.00 X 313999 0 21199 KATHLEEN BOURGAULT 2.00 40.00 X 0 182855 17460 EILEEN L DOHMANN RN 40.00 2.00 X 220044 0 24195 MARIE FREDRICK 2.00 40.00 X 0 194543 38348 JAMES SWISHER 2.00 40.00 X 0 174766 24151 DAVID LING MD 2.00 40.00 X 0 204007 28277 GLEN J POFFENBARGER MD 40.00 0.00 X 975578 0 38786 JT SHERWOOD MD 40.00 0.00 X 827538 0 39878 CHRISTOS HATJIS MD 40.00 0.00 X 709529 0 30503 MAURICE EGGLESTON JR MD 40.00 0.00 X 449815 0 35832 THERESA A CONOLOGUE MD 40.00 0.00 X 409094 0 26911 RANDALL PATRICK STEWART 0.00 0.00 X 0 238370 20338 ALAN EDWARDS 0.00 0.00 X 0 175626 38942 4972463 5389269 996214 251 1 1 0 MAYO COLLABORATIVE SVCS INC PO BOX 9146 MINNEAPOLIS MN 554809146 LAB SERVICES 3275557 HMP OF FREDERICKSBURG LLC 4535 DRESSIER RD NW CANTON OH 44718 PHYSICIAN SERVICES 2007510 OLD DOMINION SECURITY CO 2140 TOMLYNN ST RICHMOND VA 23230 SECURITY SERVICES 1639159 SODEXO INC & AFFILIATES PO BOX 536922 ATLANTA GA 303536922 FOOD SERVICES 1565081 CHILDREN'S NATIONAL HOSPITAL 111 MICHIGAN AVE NW SUITE 3W-100 WASHINGTON DC 20010 CONSULTING SERVICES 1417932 73 388442 378677 326593 1317840 56252 2411552 NET PATIENT SERVICES REVENUE 623000 492650668 492650668 PERSONNEL SERVICES 623000 17902572 17902572 MANAGEMENT SERVICES 623000 14723947 14723947 OTHER OPERATING REVENUE 623000 4431083 4431083 CAFETERIA 623000 3975946 3975946 3351468 1144754 2206714 537035684 1334046 1334046 12720643 219469 0 0 12720643 219469 12940112 12940112 224334 1748463 0 451539 224334 1296924 1521258 1521258 240051 388442 144914 95137 95137 INCOME FROM PSHIP/LLC 900099 180324 180324 180324 555518113 535009294 2206714 15890553 X 2352589 2352589 49750 49750 5309598 5166230 142198 1170 200162688 194757976 5360607 44105 5743299 5588221 153813 1265 22299843 21697712 597217 4914 16248569 15809832 435157 3580 66562410 64765119 1782624 14667 71139 69218 1905 16 63158 61453 1691 14 176040 171288 4713 39 69233655 67364237 1854163 15255 83625 81368 2239 18 3385964 3294538 90680 746 2040527 1985429 54648 450 29912299 29104619 801088 6592 1530743 1489411 40995 337 308850 300511 8271 68 1125637 1095243 30146 248 32867450 31979976 880232 7242 4550975 4428094 121877 1004 MEDICAL AND HOSPITAL SU 94157955 91615540 2521667 20748 BAD DEBT EXPENSE 10018514 9747998 268308 2208 OTHER MEDICAL & HOSPITA 3528635 3433356 94501 778 REPAIRS AND MAINTENANCE 3106567 3022684 83198 685 2315629 2253103 62016 510 577206108 561685495 15393954 126659 1378843 1228402 0 1154684 17508077 18513794 117166188 92132649 6396036 4094742 8124080 8678498 4108711 2470759 692535200 393664057 316605346 298871143 44626923 46814526 15251052 15294513 225390 1861491 531390646 491115201 36266643 33505968 276369034 267954672 4103424 3688967 316739101 305149607 X 197318929 167487901 16074406 17219483 1258210 1258210 214651545 185965594 531390646 491115201 X -21687995 4627891 -11625847 X X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 29168493 111350 3125019 39250 908374 31457238 31364122 343694 -1155863 63750 1319711 29168492 29030361 455287 3036877 17000 1141403 31364122 25187112 814062 4318842 15000 1275156 29029860 32070931 1551410 -7100198 20000 1315031 25187112 0.68240 0.27760 0.04000 0 0 24249702 24249702 254261216 72730088 181531128 22482788 4981573 17501215 342402887 307023038 35379849 49138607 8929358 40209249 298871143 CAPITAL LEASE OBLIGATIONS 249981 ACCRUED LOSS-PROFESSIONAL LIABILITY 3438986 3688967 X DESCRIPTION OF INTENDED USE OF ENDOWMENT FUNDS: PART V, LINE 4: THE INTEREST EARNED FROM THE ENDOWMENT FUNDS IS USED TO FUND SCHOLARSHIPS AND GRANTS IN FUTHERANCE OF OUR MISSION. DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: PART X, LINE 2: MWHC WAS RECOGNIZED AS A PUBLIC CHARITY GENERALLY EXEMPT FROM FEDERAL INCOME TAXATION UNDER 501(C)(3) OF THE INTERNAL REVENUE CODE PURSUANT TO A DETERMINATION LETTER ISSUED BY THE IRS IN MARCH 1992. MWHC IS ENTITLED TO RELY ON THIS DETERMINATION AS LONG AS THERE ARE NO SUBSTANTIAL CHANGES IN ITS CHARACTER, PURPOSES, OR METHODS OF OPERATION. MANAGEMENT HAS CONCLUDED THAT THERE HAVE BEEN NO SUCH CHANGES, AND THEREFORE MWHC'S STATUS AS A PUBLIC CHARITY EXEMPT FORM FEDERAL INCOME TAXATION REMAINS IN EFFECT. THE STATE IN WHICH MWHC OPERATES ALSO PROVIDES GENERAL EXEMPTION FROM STATE INCOME TAXATION FOR ORGANIZATIONS THAT ARE EXEMPT FROM FEDERAL INCOME TAXATION. HOWEVER, MWHC IS SUBJECT TO BOTH FEDERAL AND STATE INCOME TAXATION AT CORPORATE TAX RATES ON ITS UNRELATED BUSINESS INCOME. EXEMPTION FROM OTHER STATE TAXES, SUCH AS REAL AND PERSONAL PROPERTY TAXES, IS SEPARATELY DETERMINED. CERTAIN ENTITIES UNDER MWHC ARE TAXABLE ENTITIES. MWHC HAD NO UNRECOGNIZED TAX BENEFIT OR LIABILITIES OR SUCH AMOUNTS WERE IMMATERIAL DURING THE PERIODS PRESENTED. FOR TAX PERIODS WITH RESPECT TO WHICH NO UNRELATED BUSINESS INCOME WAS RECOGNIZED, NO TAX RETURN WAS REQUIRED. TAX PERIODS FOR WHICH NO RETURN IS FILED REMAIN OPEN FOR EXAMINATION INDEFINITELY. ALL REQUIRED TAX FILINGS HAVE BEEN FILED ON A TIMELY BASIS. SHF GOLF TOURNAMENT 225650 177245 48405 22302 9387 1729 3439 OYSTER ROAST 122376 41065 81311 33161 4273 20523 1500 5272 7 280467 170132 110335 13528 15049 1712 13039 628493 388442 240051 68991 28709 23964 1500 21750 144914 95137 1 1 X 1 X 1 X 1 1 1 0 1 1 26095724 26095724 0.04600 48440686 33261606 15179080 0.02680 74536410 33261606 41274804 0.07280 1314277 3750 1310527 0.00230 1188317 80818 1107499 0.00200 60704907 48384159 12320748 0.02170 494215 144745 349470 0.00060 1867005 1867005 0.00330 65568721 48613472 16955249 0.02990 140105131 81875078 58230053 0.10270 605413 605413 0.00110 835 835 0.00000 175 175 0.00000 2018649 2018649 0.00360 247019 247019 0.00040 2872091 2872091 0.00510 1 4754610 1463116 147405104 187117466 -39712362 X 1 1 1 MEDICAL IMAGING OF FREDERICKSBURG OUTPATIENT IMAGING 0.51000 0.49000 2 FREDERICKSBURG AMBULATORY SURGERY CENTER AMBULATORY SERGICAL SERVICES 0.59000 0.41000 3 TOMPKINS MARTIN MEDICAL PLAZA MEDICAL OFFICE BUILDING 0.99000 0.01000 4 BUNKER HILL PARTNERS MEDICAL OFFICE BUILDING 0.20000 0.20000 5 COWAN INVESTMENT PARTNERS MEDICAL OFFICE BUILDING 0.12500 0.37500 6 MEDICAL PLAZA AT COSNER CORNER MEDICAL OFFICE BUILDING 0.39500 0.47400 7 MW EYE CARE CENTER LLC OPTOMETRY 0.60000 0.40000 2 1 MARY WASHINGTON HOSPITAL INC

1101 SAM PERRY BLVD FREDERICKSBURG VA 22401

X X X 437 BED ACUTE CARE HOSPITAL LEVEL 2 TRAUMA 2 STAFFORD HOSPITAL LLC

101 HOSPITAL CENTER BLVD STAFFORD VA 22554

X X X 100 BED HOSPITAL MARY WASHINGTON HOSPITAL INC 1 1 1 200.000000000000 1 400.000000000000 1 X X X X X X X 1 1 X X X X X X 1 0 X X X X 1 X 0 0 STAFFORD HOSPITAL LLC 2 1 1 200.000000000000 1 400.000000000000 1 X X X X X X X 1 1 X X X X X X 0 0 X X X X 1 X 0 0 8 NEXTCARE URGENT CARE - FREDERICKSBURG

330 WHITE OAK ROAD FREDERICKSBURG VA 224052792

URGENT CARE NEXTCARE URGENT CARE - SPOTSYLVANIA

5325 PLANK ROAD SUITE 105 FREDERICKSBURG VA 22407

URGENT CARE NEXTCARE URGENT CARE - FREDERICKSBURG

15 SOUTH GATEWAY DRIVE FREDERICKSBURG VA 224061231

URGENT CARE NEXTCARE URGENT CARE - DUMFRIES

3990 FETTLER PARK DRIVE SUITE B DUMFRIES VA 220251997

URGENT CARE NEXTCARE URGENT CARE - STAFFORD

325 GARRISONVILLE ROAD SUITE 101 STAFFORD VA 225541544

URGENT CARE NEXTCARE URGENT CARE - WOODBRIDGE

12581 MILSTEAD WAY SUITE 103 WOODBRIDGE VA 221925446

URGENT CARE FREDERICKSBURG AMBULATORY SURGERY CENTER

1201 SAM PERRY BLVD SUITE 101 FREDERICKSBURG VA 224014490

AMBULATORY SURGERY CENTER MEDICAL IMAGING OF FREDERICKSBURG

1201 SAM PERRY BLVD SUITE 102 ASC BUILD FREDERICKSBURG VA 224014490

IMAGING SERVICES PART I, L7 COL(F): BAD DEBT EXPENSE ATTRIBUTABLE TO PATIENTS ELIGIBLE UNDER PATIENT FINANCIAL ASSISTANCE POLICY (PFAP)IN DECEMBER 2011, MWHC UTILIZED THE SERVICES OF SEARCHAMERICA TO IDENTIFY PFAP ELIGIBLE PATIENTS WHOSE ACCOUNTS HAD FALLEN INTO BAD DEBT. IN EARLY 2012, SEARCHAMERICA PROVIDED A LIST UTILIZING VARIOUS MARKET RESEARCH TO APPROXIMATE THE FEDERAL POVERTY LEVEL OF EACH ACCOUNT HOLDER. WITH THIS INFORMATION WE WERE ABLE TO DETERMINE ACCOUNTS THAT MAY HAVE BEEN ELIGIBLE FOR FREE CARE OR DISCOUNTED CARE UNDER OUR FINANCIAL ASSISTANCE POLICY. UTILIZING THE STATISTICAL ANALYSIS THAT SEARCHAMERICA PROVIDED WE HAVE EXTRAPOLATED THE DATA AND ARE ABLE TO ESTIMATE THAT ABOUT 84% OF OUR BAD DEBT IS LIKELY ATTRIBUTABLE TO PFAP ELIGIBLE PATIENTS. PART II: IN FURTHERANCE OF ITS MISSION TO IMPROVE THE HEALTH OF THE COMMUNITY IT SERVES THE ORGANIZATION PROMOTES WORKFORCE DEVELOPMENT FOR THE RECRUITMENT OF PHYSICIANS AND OTHER HEALTH PROFESSIONALS IN AREAS IDENTIFIED AS SHORTAGE AREAS THROUGH ITS COMMUNITY NEEDS ASSESSMENTS AND MEDICAL STAFF DEVELOPMENT PLANS. RECRUITMENT OF PHYSICIANS TO PRACTICE IN MWHC'S SERVICE AREA IMPROVES ACCESS TO CARE RESULTING IN GREATER AVAILABILITY OF PHYSICIAN SPECIALISTS, LESS TRAVEL TO OBTAIN CARE, AND SHORTER WAIT TIMES FOR APPOINTMENTS. ADDITIONALLY MWHC, PROVIDES FACILITIES FREE OF CHARGE TO RAPPAHANNOCK EMERGENCY MEDICAL SERVICES WHICH IS VALUED AT APPROXIMATELY $100,000. PART III, LINE 4: THE PROVISION FOR BAD DEBTS IS BASED UPON MANAGEMENT'S JUDGMENTAL ASSESSMENT OF HISTORICAL AND EXPECTED NET COLLECTIONS CONSIDERING BUSINESS AND GENERAL ECONOMIC CONDITIONS IN ITS SERVICE AREA, TRENDS IN HEALTHCARE COVERAGE, AND OTHER COLLECTION INDICATORS. THROUGHOUT THE YEAR, MANAGEMENT ASSESSES THE ADEQUACY OF THE ALLOWANCE FOR UNCOLLECTIBLE ACCOUNTS BASED UPON ITS REVIEW OF ACCOUNTS RECEIVABLE PAYOR COMPOSITION AND AGING, TAKING INTO CONSIDERATION RECENT WRITE-OFF EXPERIENCE BY PAYOR CATEGORY, PAYOR AGREEMENT RATE CHANGES AND OTHER FACTORS. THE RESULTS OF THESE ASSESSMENTS ARE USED TO MAKE MODIFICATIONS TO THE PROVISION FOR BAD DEBTS AND TO ESTABLISH AN APPROPRIATE ALLOWANCE FOR UNCOLLECTIBLE ACCOUNTS RECEIVABLE.FOR SELF-PAY PATIENTS, THE PROVISION IS BASED ON AN ANALYSIS OF PAST EXPERIENCE RELATED TO COLLECTION RATE OF SELF-PAY BALANCES. MWHC FOLLOWS ESTABLISHED GUIDELINES FOR PLACING CERTAIN PAST-DUE PATIENT BALANCES WITH EXTERNAL COLLECTION AGENCIES. AT DECEMBER 31, 2012 AND 2011, THE ALLOWANCE FOR UNCOLLECTIBLE ACCOUNTS REPRESENTED APPROXIMATELY 90% AND 92%, RESPECTIVELY, OF THE PATIENTS DUE ACCOUNTS RECEIVABLE BALANCE. THE PATIENT DUE ACCOUNTS RECEIVABLE BALANCE REPRESENTS THE ESTIMATED UNINSURED PORTION OF ACCOUNTS RECEIVABLE. PART III, LINE 8: AS A NOT-FOR-PROFIT HOSPITAL IT IS OUR MISSION TO IMPROVE THE HEALTH STATUS OF ALL PEOPLE WITHIN OUR COMMUNITY AND TO PROVIDE HEALTHCARE TO ALL PATIENTS REGARDLESS OF THEIR ABILITY TO PAY OR THEIR INSURANCE STATUS. MWHC ACCEPTS MEDICARE AND MEDICAID AND IT IS A WELL ESTABLISHED FACT THAT NOT-FOR-PROFIT FACILITIES DO NO RECOUP THE COST OF CARING FOR THOSE PATIENTS UTILIZING THESE PROGRAMS. UNDER IRS GUIDELINES MEDICARE AND MEDICAID BENEFICIARIES ARE CONSIDERED TO BE MEMBERS OF A CHARITABLE CLASS, THEREFORE BY ASSISTING THESE PATIENTS AND ACCEPTING THE SHORTFALLS IN REPAYMENT, THE ORGANIZATION IS IN FACT RELIEVING GOVERNMENT BURDEN AND PROVIDING A SIGNIFICANT COMMUNITY BENEFIT TO OUR SERVICE AREA. PART III, LINE 9B: PATIENTS MAY APPLY FOR FINANCIAL ASSISTANCE AT ANY POINT IN THE COLLECTION CYCLE AND MODIFICATIONS OF ABILITY TO PAY MAY BE ADJUSTED SHOULD FINANCIAL OR INSURANCE STATUS CHANGE SINCE THE FIRST DAY OF CARE. MWHC DOES NOT ENGAGE IN EXTRAORDINARY COLLECTION ACTIONS BEFORE THEY HAVE MADE REASONABLE EFFORTS TO DETERMINE WHETHER THE INDIVIDUAL IS ELIGIBLE FOR ASSISTANCE UNDER THIS FINANCIAL ASSISTANCE POLICY. REASONABLE EFFORTS CONSTITUTE NOTIFICATION BY MWHC OF ITS FINANCIAL ASSISTANCE POLICY BY WRITTEN AND/OR ORAL COMMUNICATIONS TO ALL UNINSURED/UNDERINSURED PATIENTS AS WELL AS CONSIDERATION OF ELIGIBILITY BASED UPON THE PRESUMPTIVE ELIGIBILITY GUIDELINES DESCRIBED IN THE FINANCIAL ASSISTANCE POLICY. PART VI, LINE 2: MARY WASHINGTON HEALTHCARE AND ITS AFFILIATES (MARY WASHINGTON HOSPTIAL, MARY WASHINGTON HOSPITAL FOUNDATION, STAFFORD HOSPITAL, LLC, STAFFORD HOSPITAL FOUNDATION, MEDICORP PROPERTIES, INC., MEDICORP HEALTH SERVICES, AND MARY WASHINGTON HEALTHCARE CLINICAL SERVICES, INC.) HAS AS ITS MISSION TO IMPROVE THE HEALTH OF MEMBERS OF THE COMMUNITIES IT SERVES: FREDERICKSBURG, VA AND THE SURROUNDING SIX (6) COUNTIES. THE ORGANIZATION ASSESSES THE HEALTH CARE NEEDS OF THESE COMMUNITIES IN NUMEROUS WAYS INCLUDING: 1) SOLICITING INPUT FROM MWHC'S CITIZEN ADVISORY COUNCIL THAT ENCOMPASS INDIVIDUAL MEMBERS AND SUBCOMMITTEES REPRESENTING EACH OF THE COUNTIES IN MWHC'S SERVICE AREA, AND 2) PERFORMING PERIODIC COMMUNITY NEEDS ASSESSMENTS FOR EACH COUNTY IN COLLABORATION WITH GOVERNMENT AGENCIES AND OTHER COMMUNITY ORGANIZATIONS. PART VI, LINE 3: MARY WASHINGTON HEALTHCARE AFFILIATES PROVIDE INFORMATION TO PATIENTS ABOUT ITS FINANCIAL ASSISTANCE PROGRAMS THROUGH SIGNAGE AT INTAKE AREAS, FLYERS AT ADMISSIONS, NOTICES ON BILLS AND COLLECTION STATEMENTS. FINANCIAL COUNSELORS ARE ALSO AVAILABLE TO ASSIST PATIENTS IN OBTAINING FINANCIAL ASSISTANCE. PART VI, LINE 4: MARY WASHINGTON HEALTHCARE PROVIDES EXCEPTIONAL MEDICAL SERVICES TO THE CITY OF FREDERICKSBURG AND THE SURROUNDING "COMMUNITY" THAT CONSIST OF THE PRIMARY SERVICE AREA COUNTIES OF STAFFORD, KING GEORGE, SPOTSYLVANIA, WESTMORELAND, ORANGE, PRINCE WILLIAM, AND SECONDARY SERVICE AREA COUNTIES OF MANASSAS, FAUQUIER, CULPEPER, LOUISA, ESSEX, AND RICHMOND. ESTABLISHED IN 1899, MARY WASHINGTON HOSPITAL (MWH), A 437 BED ACUTE CARE FACILITY, OFFERS COMPREHENSIVE HEALTHCARE AND MULTIPLE CENTERS OF EXCELLENCE INCLUDING CARDIOLOGY AND CARDIOVASCULAR SURGERY, PSYCHIATRY, AND WOMEN AND INFANT HEALTH. STAFFORD HOSPITAL, LLC, A 100 BED ACUTE CARE FACILITY, ALSO OFFERS COMPREHENSIVE HEALTHCARE SERVICES. BOTH MWH AND SH ARE ACCREDITED BY THE JOINT COMMISSION AND LICENSED BY THE COMMONWEALTH OF VIRGINIA DEPARTMENT OF HEALTH AND THE DEPARTMENT OF MENTAL HEALTH, MENTAL RETARDATION AND SUBSTANCE ABUSE SERVICES. MWH ALSO PROVIDES ADVANCE RADIATION THERAPY THROUGH THE CANCER CENTER OF VIRGINIA AND HOME HEALTH SERVICES THROUGH MARY WASHINGTON HOME HEALTH.AS OF THE MOST RECENT CENSUS WITHIN THE RESPECTIVE COUNTIES THE MAJORITY OF THE GEOGRAPHIC SERVICE AREAS IN WHICH BOTH HOSPITALS SERVE ARE MADE UP OF ABOUT 4,164.5 SQUARE MILES OF SUBURBAN AND RURAL LAND. COMMUNITY RESIDENTS IN THE PRIMARY SERVICE AREAS EARN A MEDIAN INCOME PER HOUSEHOLD OF $57,088/YEAR, WITH A COLLECTIVE AVERAGE OF 7.2% OF THE ENTIRE PRIMARY SERVICE AREA LIVING BELOW THE FEDERAL POVERTY GUIDELINES. THE PRIMARY SERVICE AREA HAS AN ESTIMATED POPULATION OF 657,718 INDIVIDUALS AND 187,202 HOUSEHOLDS. PART VI, LINE 5: MARY WASHINGTON HOSPITAL, INC. AND STAFFORD HOSPITAL, LLC EACH OPERATE AN EMERGENCY ROOM THAT IS OPEN TO ALL PERSONS REGARDLESS OF ABILITY TO PAY; HAVE OPEN MEDICAL STAFFS WITH PRIVILEGES TO ALL QUALIFIED PHYSICIANS WHO APPLY, HAVE A GOVERNING BODY WITH A MAJORITY OF INDEPENDENT TRUSTEES, AND PARTICIPATE IN MEDICAID, MEDICARE AND OTHER GOVERNMENT SPONSORED HEALTH CARE PROGRAMS. MARY WASHINGTON HEALTHCARE CLINICAL SERVICES, INC. THROUGH ITS SUBSIDIARIES, PROVIDES ANCILLARY HEALTH SERVICES INCLUDING PHYSICIAN PRACTICES, OUTPATIENT AND AMBULATORY SURGERY, AND HOME HEALTH/HOSPICE SERVICES.THE ORGANIZATION UTILIZES SURPLUS FUNDS TO EXPAND SERVICES PROVIDED TO THE COMMUNITY (IN RESPONSE TO THE COMMUNITY NEEDS ASSESSMENTS), UPGRADE FACILITIES AND EQUIPMENT TO ENHANCE CLINICAL CARE AND PHYSICIAN CONNECTIVITY TO PATIENT ELECTRONIC HEALTH RECORDS, AND HEALTH EDUCATION PROGRAMS. PART VI, LINE 6: MARY WASHINGTON HEALTHCARE AFFILIATES INCLUDE TWO (2) HOSPITALS, OTHER CLINICAL SERVICES THAT INCLUDE AN AMBULATORY SURGERY CENTER, HOSPICE/HOME HEALTH, INDEPENDENT DIAGNOSTIC TESTING FACILITIES, AND PHYSICIAN PRACTICES; TWO (2) FOUNDATIONS AND A PROPERTY DIVISION. ALL ACTIVITIES OF THIS GROUP ARE COORDINATED AND OVERSEEN BY THE PARENT'S (MARY WASHINGTON HEALTHCARE) BOARD OF TRUSTEES. THE AFFILIATED GROUP'S ACTIVITIES ARE CLOSELY PLANNED/INTEGRATED THROUGH INTERLOCKING BOARDS TO ENSURE THE MOST EFFECTIVE DELIVERY OF CARE. EACH MEMBER OF THE AFFILIATED GROUP FOCUSES EFFORTS IN ITS PARTICULAR AREA OF RESPONSIBILITY AND IS ACCOUNTABLE TO THE PARENT'S BOARD FOR ACHIEVING ITS MISSION AND GOALS FOR THE PROVISION OF HEALTH CARE. THE DIVISION OF SERVICES ABOVE ALLOWS PATIENTS TO ACCESS CARE IN THE MOST APPROPRIATE SETTING. THE GOVERNANCE OVERSIGHT PROVIDED BY THE PARENT GUARANTEES OPTIMAL COORDINATION OF THE VARIOUS SEGMENTS OF CARE AND ENSURES HIGH QUALITY SERVICE AS ECONOMICALLY AS POSSIBLE. REPORTS FILED WITH STATES PART VI, LINE 7 VA 0 CENTRAL VIRGINIA HEALTH SERVICES 1506 PALMYRA AVE FREDERICKSBURG VA 22405 540887287 5000 COMMUNITY HEALTH INTERNSHIPS: BUILDING THE FUTURE OPEN HAND OF FREDERICKSBURG 200 PRINCE EDWARD ST FREDERICKSBURG VA 22401 364564097 5000 SUMMER YOUTH WORKER PROGRAM RAPPAHANNOCK UNITED WAY 3310 SHANNON PARK DR RICHMOND VA 23219 546042936 3000 RAPPAHANNOCK AREA CHARITY TRACKER NETWORK RAPPAHANNOCK AREA OFFICE ON YOUTH 405 CHATHAM SQUARE OFFICE PARK FREDERICKSBURG VA 22401 546001293 1820 Y2W8 TEEN AWARENESS PROGRAM MENTAL HEALTH AMERICA OF FREDERICKSBURG 2217 PRINCESS ANNE ST SUITE 104-1 LADYSMITH VA 22501 540678704 5000 SENIOR VISITORS DAWN PROGRESSIVE ASSOCIATION 24 E CARY ST SUITE 100 RICHMOND VA 23227 541085029 5000 DAWN WASTEWATER IMPROVEMENTS PHASE 2 BETHANY CHRISTIAN SERVICES 1616 STAFFORD AVE FREDERICKSBURG VA 22401 381405282 10000 EARLY MEDICAL INTERVENTION CAROLINE CHRISTIAN HEALTH CENTER PO BOX 216 FREDERICKSBURG VA 22407 208446785 22300 MISSION 2540 CENTRAL VIRGINIA HEALTH SERVICES 1506 PALMYRA AVE FREDERICKSBURG VA 22401 540887287 80000 CHCRR PRIMARY CARE DISABILITY RESOURCE CENTER 409 PROGRESS ST FREDERICKSBURG VA 22401 541687677 25000 EQUIPMENT CONNECTION FREDERICKSBURG CHRISTIAN HEALTH CENTER 1129 HEATHERSTONE DR FREDERICKSBURG VA 22402 542061482 140000 INDIGENT PROGRAM FREDERICKSBURG REGIONAL TRANSIT 1400 JEFFERSON DAVIS HIGHWAY KILMARNOCK VA 22482 546001293 55000 TRANSPORTATION ASSISTANCE FOR INDIGENT PATIENTS HOSPICE SUPPORT CARE INC 1701 FALL HILL AVE STE 109 FREDERICKSBURG VA 22401 521203673 35000 HOSPICE SUPPORT CARE MICAH ECUMENICAL MINISTRIES INC PO BOX 3277 RICHMOND VA 23294 204044884 130000 RESIDENTIAL RECOVERY PROGRAM NORTHERN NECK FREE HEALTH CLINIC PO BOX 1694 FREDERICKSBURG VA 22401 541679279 14000 OUTREACH CLINIC IN WESTMORELAND RAPPAHANNOCK AREA HEALTH DISTRICT 608 JACKSON ST FREDERICKSBURG VA 22401 546001775 75000 COMPLICATED OBSTETRICAL AND HIGH RISK MATERNITY CARE PROGRAM RX PARTNERSHIP 2924 EMERYWOOD PARKWAY 300 COLONIAL BEACH VA 22443 571186937 20000 RXP FREDERICKSBURG COUNSELING SERVICES INC 305 HANSON AVE 140 FALMOUTH VA 22405 540844464 25015 COUNSELING SERVICES FREDERICKSBURG DEPARTMENT OF SOCIAL SERVICES 608 JACKSON ST SUITE 100 COLONIAL BEACH VA 22443 546001293 17500 COMMUNITY BASED ELIGIBILITY WORKER GUADALUPE FREE CLINIC OF COLONIAL BEACH INC PO BOX 275 FREDERICKSBURG VA 22401 510635977 55000 FREE CLINIC HAZEL HILL APT CORPORATION 223 BUTLER RD FREDERICKSBURG VA 22402 540859802 14000 HAZEL HILL HEALTHCARE PROJECT NORTHERN NECK ALLIANCE INC PO BOX 40 SPOTSYLVANIA VA 22551 541678053 9000 NORTHERN NECK HEAD START RAPPAHANNOCK AREA HEALTH DISTRICT 608 JACKSON ST DUMFRIES VA 22026 546001775 20240 EVERY WOMAN'S LIFE PROGRAM RAPPAHANNOCK COUNCIL ON DOMESTIC VIOLENCE PO BOX 1007 FREDERICKSBURG VA 22401 521142547 20000 INTIMATE PARTNER VIOLENCE (IPV) HEALTHCARE PARTNERSHIP PROGRAM SPOTSYLVANIA COUNTY SCHOOLS 6921 NORTH ROXBURY MILL RD STAFFORD VA 22554 546001775 17526 SCHOOL FLUORIDE MOUTH RINSE PROGRAM ACTION IN COMMUNITY THROUGH SERVICE (ACTS) PO BOX 74 STAFFORD VA 225547246 540897679 20000 ACTS HELPLINE ASSISTANCE AND OUTREACH PROJECT STAFFORD COUNTY DEPARTMENT OF SOCIAL SERVICES PO BOX 7 FREDERICKSBURG VA 22405 546001626 24750 STAFFORD'S HEALTH INSURANCE ENROLLMENT (SHINE) PROGRAM STAFFORD COUNTY SCHOOLS 31 STAFFORD AVE FREDERICKSBURG VA 22405 546001628 27400 FITNESSGRAM/ACTIVITYGRAM FITNESS ASSESSMENT/REPORTING SOFTWARE STAFFORD COUNTY SCHOOLS 31 STAFFORD AVE FREDERICKSBURG VA 22401 546001628 50900 IT'S NO LONGER A WEIGHT ROOM -- IT'S A WELLNESS ROOM! STAFFORD JUNCTION INC 400 CHATHAM SQUARE OFFICE PARK FREDERICKSBURG VA 22405 203036072 16540 HEALTHY LIVING PAYS STAFFORD SCHOOLS HEAD STARTVPIEARLY HEAD START 610 GAYLE ST FREDERICKSBURG VA 22405 546001628 11303 STAFFORD SCHOOLS HEAD START NUTRITION CONSULTANT PROJECT LLOYD F MOSS FREE CLINIC 1301 SAM PERRY BLVD FREDERICKSBURG VA 22401 541677934 820000 FREE HEALTH CLINIC ANNE GRAZIANI BROADDUS NURSING SCHOLARSHIP 1 1500 APRIL JETT WILLS MEMORIAL NURSING SCHOLARSHIP 1 1000 AQUIA HARBOUR PROPERTY OWNER'S ASSOCIATION SCHOLARSHIP 1 500 BARBARA KANE NURSING SCHOLARSHIP 1 750 CHARLES M. "PETE" HEARN FELLOWSHIP 1 1500 CORA GRAVES ALLISON NURSING SCHOLARSHIP 1 750 ELEANOR HEYCOCK PETTIT NURSING SCHOLARSHIP 1 1500 ELIZABETH BRUNELLE RYAN AND CATHERINE RYAN LEGATH SCHOLARSHIP 1 750 FREDERICKSBURG EMERGENCY MEDICAL ALLIANCE SCHOLARSHIP 2 1700 HAROLD AND FRANCES SCHILZ NURSING SCHOLARSHIP 2 2000 HEWETSON NURSING SCHOLARSHIP 2 2000 IDA RICHARDSON JENKINS MEMORIAL SCHOLARSHIP 1 750 JANICE HUNT SCHOLARSHIP 4 7000 JEAN C. WILLIAMS MEMORIAL NURSING SCHOLARSHIP 1 750 JEANE BULLOCK NURSING SCHOLARSHIP 1 2000 JENNIE MAE BENSON NURSING SCHOLARSHIP 1 1000 LAURA LEIGH LUMPKIN MEMORIAL SCHOLARSHIP 1 2000 LIBBY PEARSON ENDOWED NURSING SCHOLARSHIP 1 750 MARIE LACY ROLLINS SCHOLARSHIP 1 1500 MARY FRANCES WILLIS & JAMES G. WILLIS MEMORIAL SCHOLARSHIP 4 4000 MARY WASHINGTON HOSPITAL AUXILIARY SCHOLARSHIP 2 2000 NANCY HAZARD MEMORIAL SCHOLARSHIP 1 750 REBECCA BENNETT NURSING SCHOLARSHIP 1 1000 SAL KIWALL MEMORIAL SCHOLARSHIP FOR CLINICAL EDUCATION 1 1500 SAM MILLER SCHOLARSHIP 1 800 STAFFORD HOSPITAL AUXILIARY SCHOLARSHIP 2 1500 SUE HALL NURSING SCHOLARSHIP 1 1500 WILLIAM AND VIOLA ADRIAN NURSING SCHOLARSHIP 3 5000 WILLIAM F. JACOBS, JR. SCHOLARSHIP IN HEALTHCARE ADMINISTRATION 1 2000 X 1 1 X X X X X X 0 1 0 0 0 0 0 1 0 FRED M RANKIN III 0 582184 0 0 0 258992 0 24500 0 20742 0 886418 0 0 SEAN T BARDEN 0 339464 0 0 0 61978 0 24500 0 25449 0 451391 0 0 WALTER J KIWALL 0 356613 0 0 0 83970 0 24500 0 18496 0 483579 0 0 XAVIER R RICHARDSON 0 210218 0 0 0 41000 0 23366 0 15185 0 289769 0 0 J THOMAS RYAN MD 0 337273 0 0 0 105827 0 24500 0 17843 0 485443 0 0 RAVI MATHUR 0 168133 0 0 0 20150 0 17974 0 16190 0 222447 0 0 CHERYL SPRINGHORN 0 141959 0 0 0 0 0 3948 0 7278 0 153185 0 0 LAWRENCE ROBERTS MD 510910 0 0 0 0 0 7500 0 24841 0 543251 0 0 0 KATHRYN S WALL 0 227227 0 0 0 31000 0 24199 0 10079 0 292505 0 0 MARIANNA BEDWAY 0 208565 0 0 0 26983 0 20968 0 25092 0 281608 0 0 ERIC FLETCHER 0 205528 0 0 0 26402 0 17545 0 21295 0 270770 0 0 WINIFRED J HAIKEY 0 184268 0 0 0 61560 0 22698 0 15499 0 284025 0 0 JOYCE HANSCOME 0 204161 0 0 0 21410 0 16930 0 17724 0 260225 0 0 JAMES K VAN RENAN 273970 0 0 0 28000 0 24500 0 21600 0 348070 0 0 0 CATHLEEN A YABLONSKI 185787 0 0 0 25532 0 16575 0 24815 0 252709 0 0 0 AMY ADOME MD 0 174335 0 0 0 20677 0 18680 0 8408 0 222100 0 0 REBECCA BIGONEY MD 307364 0 0 0 6635 0 6916 0 14283 0 335198 0 0 0 KATHLEEN BOURGAULT 0 177267 0 0 0 5588 0 1265 0 16195 0 200315 0 0 EILEEN L DOHMANN RN 197937 0 0 0 22107 0 20680 0 3515 0 244239 0 0 0 MARIE FREDRICK 0 173490 0 0 0 21053 0 19196 0 19152 0 232891 0 0 JAMES SWISHER 0 155884 0 0 0 18882 0 16115 0 8036 0 198917 0 0 DAVID LING MD 0 198186 0 0 0 5821 0 3512 0 24765 0 232284 0 0 GLEN J POFFENBARGER MD 975578 0 0 0 0 0 7500 0 31286 0 1014364 0 0 0 JT SHERWOOD MD 827538 0 0 0 0 0 7500 0 32378 0 867416 0 0 0 CHRISTOS HATJIS MD 709529 0 0 0 0 0 7500 0 23003 0 740032 0 0 0 MAURICE EGGLESTON JR MD 449815 0 0 0 0 0 7500 0 28332 0 485647 0 0 0 THERESA A CONOLOGUE MD 409094 0 0 0 0 0 7500 0 19411 0 436005 0 0 0 RANDALL PATRICK STEWART 0 233370 0 0 0 5000 0 2930 0 17408 0 258708 0 0 ALAN EDWARDS 0 157600 0 0 0 18026 0 12270 0 26672 0 214568 0 0 PART I, LINE 1A PART I, LINE 1A - TRUSTEES WHO ARE UNCOMPENSATED VOLUNTEERS TRAVELING FOR BUSINESS RELATED REASONS ON BEHALF OF THE ORGANIZATION ARE REIMBURSED FOR THE COST OF SPOUSAL TRAVEL. REIMBURSEMENTS PAID FOR SPOUSAL TRAVEL ARE REIMBURSED AND REPORTED AS INCOME ON A FORM 1099 IN THE YEAR PAID. EXECUTIVES WHO ARE TRAVELING FOR BUSINESS RELATED REASONS ON BEHALF OF THE ORGANIZATION ARE REIMBURSED FOR THE COST OF SPOUSAL MEALS PROVIDED AND THE AMOUNT IS REPORTED AS INCOME ON THE EXECUTIVE'S W-2. PART I, LINE 7 PART I, LINE 7 - ALL EXECUTIVES HAVE AS A PART OF THEIR COMPENSATION A VARIABLE COMPONENT SUCH THAT THEY ARE ELIGIBLE TO RECEIVE A PERCENTAGE OF THEIR BASE PAY AS AN INCENTIVE FOR THE ACHIEVEMENT OF INDIVIDUAL AND CORPORATE GOALS AND OBJECTIVES. THERE WAS NO INCENTIVE COMPENSATION PAID IN 2012. SUPPLEMENTAL INFORMATION PART III SCHEDULE J - PART I TRUSTEES WHO ARE UNCOMPENSATED VOLUNTEERS TRAVELING FOR BUSINESS RELATED REASONS ON BEHALF OF THE ORGANIZATION ARE REIMBURSED FOR THE COST OF SPOUSAL TRAVEL. REIMBURSEMENTS PAID FOR SPOUSAL TRAVEL ARE REIMBURSED AND REPORTED AS INCOME ON A FORM 1099 IN THE YEAR PAID. EXECUTIVES WHO ARE TRAVELING FOR BUSINESS RELATED REASONS ON BEHALF OF THE ORGANIZATION ARE REIMBURSED FOR THE COST OF SPOUSAL MEALS PROVIDED AND THE AMOUNT IS REPORTED AS INCOME ON TEH EXECUTIVE'S W-2 PART II, COLUMN B DISCLOSURE: PRIMARILY REPRESENTS 457(F) DISTRIBUTIONS. A ECONOMIC DEVELOPMENT AUTHORITY 541244413 852431AQ8 2006-12-01 125000000 BUILD STAFFORD HOSPITAL FACILITY 0 0 0 B LYNCHBURG IDA-VHA POOLED FINANCING 2007-12-28 14000000 ACQUISITION OF MWH EQUIPMENT 0 0 0 C CITY OF FREDERICKSBURG ECONOMIC DEV AUTH 521303430 355849AS9 2007-05-10 81860000 REFUNDING OF 1996 MWH BONDS 0 0 0 D CITY OF FREDERICKSBURG ECONOMIC DEV AUTH 521303430 2011-07-12 30000000 BUILD AND EQUIP CANCER CENTER 0 0 0 A 132581641 959500 131622141 2008 0 0 1 1 B 14000000 126000 13874000 2007 0 0 1 1 C 86868312 583010 86285302 2007 1 0 1 1 D 30210000 210000 30000000 2011 0 0 1 1 A 0 0 1 1 0 1 0 1 B 0 0 1 1 0 0.00200 0.00200 1 0 1 D 0 1 1 1 1 1 1 0 1 A 0 0 0 1 0 0 0 0 1 B 0 0 1 0 1 0 0 0 1 C 0 0 1 0 0 0 0 0 1 D 0 1 0 0 1 0 0 0 1 A 1 B 1 C 1 D 1 STAFFORD MEDICAL OFFICE MANAGEMENT CONTRACT 1442676 RENTAL, MEDICAL OFFICE 0 HEALTH TECH RESOURCES 5% TRUSTEE OWNERSHIP 1276178 RENTAL 0 X 13 4840 FMV X 1250 FMV X 24653 FMV X GIFT CARDS AND CERTIFICATES 58 25509 FMV 0 1 0 THIRD PARTY USE: PART I, LINE 32B: THE GROUP HAS A POLICY REQUIRING REVIEW AND BOARD APPROVAL OF ALL NON-STANDARD CONTRIBUTIONS. FORM 990, PART V, Q 7G AND 7H QUESTIONS 7G AND 7H DO NOT APPLY TO THE ORGANIZATION BECAUSE THE ORGANIZATION DID NOT HAVE CONTRIBUTIONS OF QUALIFIED INTELLECTUAL PROPERTY OR CONTRIBUTIONS OF CARS, BOATS, AIRPLANES OR OTHER VEHICLES DURING THE YEAR. FORM 990, PART VI, SECTION A, LINE 6 MEMBERS OF THE MARY WASHINGTON HEALTHCARE GROUP ALL HAVE ONE SOLE MEMBER, ITS PARENT MARY WASHINGTON HEALTHCARE (MWHC). FORM 990, PART VI, SECTION A, LINE 7A MARY WASHINTON HEALTHCARE (MWHC) HAS THE POWER TO APPOINT BOARD OF TRUSTEES FOR THE GROUP. FORM 990, PART VI, SECTION A, LINE 7B MEMBERS OF THE MARY WASHINGTON HEALTHCARE GROUP ALL HAVE ONE SOLE MEMBER, ITS PARENT MARY WASHINGTON HEALTHCARE (MWHC). MWHC HAS RESERVED CERTAIN POWERS TO ITSELF WITHIN EACH OF ITS SUBSIDIARIES' ORGANIZING DOCUMENTS. THESE RESTRICTIONS INCLUDE AMENDING THE GOVERNING DOCUMENTS, BUDGETING, EXPENDITURES OVER CERTAIN THRESHOLDS. FORM 990, PART VI, SECTION B, LINE 11 MANAGEMENT COMPLETES A DRAFT OF THE FORM 990 FOR THE MARY WASHINGTON HEALTHCARE GROUP. AT THAT TIME THE RETURN IS SUBMITTED TO THE AUDIT AND COMPLIANCE COMMITTEE OF THE BOARD FOR REVIEW AND ACCEPTANCE. THE FORM 990 IS ALSO MADE AVAILABLE TO THE BOARD OF TRUSTEES THROUGH THE BOARD WEBSITE FOR FURTHER REVIEW. FORM 990, PART VI, SECTION B, LINE 12C EVERY TRUSTEE, AND EXECUTIVE MEMBER OF MANAGEMENT IS REQUIRED TO DISCLOSE ANY AND ALL POSSIBLE CONFLICTS OF INTERESTS. THE DISCLOSURES ARE MADE ANNUALLY AND SUBMITTED TO THE MWHC CHIEF AUDIT EXECUTIVE (CAE). THE CAE THEN PRESENTS ALL CONFLICTS TO THE AUDIT AND COMPLIANCE COMMITTEE OF THE BOARD OF TRUSTEES. THE CHAIRMAN OF THE AUDIT AND COMPLIANCE COMMITTEE REPORTS ALL CONFLICTS TO THE FULL BOARD. CONFLICTS ARE CONTINUALLY AND ACTIVELY MANAGED. AT EACH MEETING, THE CHARI ASKS IF ANYONE AT THE MEETING HAS A CONFLICT TO DISCLOSE. INDIVIDUALS WITH CONFLICTS DISCLOSE THEIR CONFLICTS AND THE RELATED TOPIC. THE INDIVIDUAL THEN RECUSES HIM/HERSELF FROM ANY DECISION RELATED TO THAT TOPIC. THE CONFLICT OF INTERESTS POLICY IS REVIEWED ANNUALLY BY THE BOARD OF TRUSTEES. FORM 990, PART VI, SECTION B, LINE 15 MARY WASHINGTON HEALTHCARE UTILIZES AN EXECUTIVE COMPENSATION COMMITTEE WITH THE PURPOSE AND AUTHORITY TO ESTABLISH PROCESSES TO ENSURE FAIR AND COMMERCIALLY REASONABLE COMPENSATION FOR THE CEO AND EXECUTIVE LEADERSHIP. IN ORDER TO ENSURE COMPENSATION PAID IS SET AT FAIR MARKET VALUE, THE EXECUTIVE COMPENSATION COMMITTEE UTILIZES COMPENSATION SURVEY DATA, FORM 990 INFORMATION FROM COMPARABLE HEALTH SYSTEMS, AND THE SERVICES OF AN INDEPENDENT COMPENSATION CONSULTANT. SUCH INDEPENDENT THIRD PARTY DATA POINT PROVIDES ASSURANCE THAT EXECUTIVE COMPENSATION IS COMMERCIALLY REASONABLE AND AT A FAIR MARKET VALUE. FORM 990, PART VI, SECTION C, LINE 19 THE AUDITED FINANCIALS STATEMENTS ARE POSTED ON THE MARY WASHINGTON HEALTHCARE WEBSITE FOR PUBLIC VIEW. OTHER FEES FORM 990, PART IX, LINE 11G CONTRACT PERSONNEL: PROGRAM SERVICE EXPENSES 5,833,974. MANAGEMENT AND GENERAL EXPENSES 160,577. FUNDRAISING EXPENSES 1,321. TOTAL EXPENSES 5,995,872. CONSULTING SERVICES: PROGRAM SERVICE EXPENSES 38,792,246. MANAGEMENT AND GENERAL EXPENSES 1,067,735. FUNDRAISING EXPENSES 8,785. TOTAL EXPENSES 39,868,766. BILLING AND COLLECTION SERVICES: PROGRAM SERVICE EXPENSES 2,573,496. MANAGEMENT AND GENERAL EXPENSES 70,834. FUNDRAISING EXPENSES 583. TOTAL EXPENSES 2,644,913. ASP SERVICES: PROGRAM SERVICE EXPENSES 13,427. MANAGEMENT AND GENERAL EXPENSES 370. FUNDRAISING EXPENSES 3. TOTAL EXPENSES 13,800. MISCELLANEOUS SERVICES: PROGRAM SERVICE EXPENSES 5,225,130. MANAGEMENT AND GENERAL EXPENSES 143,819. FUNDRAISING EXPENSES 1,183. TOTAL EXPENSES 5,370,132. STORAGE: PROGRAM SERVICE EXPENSES 123,762. MANAGEMENT AND GENERAL EXPENSES 3,406. FUNDRAISING EXPENSES 28. TOTAL EXPENSES 127,196. WASTE DISPOSAL: PROGRAM SERVICE EXPENSES 1,077,496. MANAGEMENT AND GENERAL EXPENSES 29,657. FUNDRAISING EXPENSES 244. TOTAL EXPENSES 1,107,397. MANAGEMENT CONTRACTS : PROGRAM SERVICE EXPENSES 13,724,706. MANAGEMENT AND GENERAL EXPENSES 377,765. FUNDRAISING EXPENSES 3,108. TOTAL EXPENSES 14,105,579. CHANGES IN NET ASSETS OR FUND BALANCES: FORM 990, PART XI, LINE 9: RELIEF FROM AFFILIATE LOANS -19,492,791. LOSS FROM RELATED AFFILIATES 7,010,901. VCSI -FINAL RETURN 856,043. FORM 990, PART XII, LINE 2C THE GROUP RETURN IS INCLUDED IN THE CONSOLIDATED AUDITED FINANCIAL STATEMENTS OF MWHC. CONSISTENT WITH PRIOR YEARS RESPONSIBILITY FOR OVERSIGHT OF THE AUDIT AND SELECTION OF AUDITORS RESTS WITH THE AUDIT & COMPLIANCE COMMITTEE OF THE BOARD OF TRUSTEES. FORM 990, PART V, Q2A NO ENTITY WITHIN THE GROUP FILES W-2S WITH THE IRS. ALL PAYROLL IS PAID THROUGH AN AGENCY AGREEMENT WITH MARY WASHINGTON HEALTCARE, THE PARENT ORGANIZATION. MARY WASHINGTON HEALTHCARE FILES ALL W-2S. CRNA LLC 2300 FALL HILL AVE SUITE 509 FREDERICKSBURG VA 22401 571172752 MEDICAL SERVICES VA 0 278315 MWHC CLINICAL SERVICES INC STAFFORD HOSPITAL AUXILIARY 2300 FALL HILL AVE SUITE 509 FREDERICKSBURG VA 22401 262704632 MEDICAL SERVICES VA 501(C)(3) LINE 11C, III-FI MWHC 0 MARY WASHINGTON HOSPITAL AUXILIARY 2300 FALL HILL AVE SUITE 509 FREDERICKSBURG VA 22401 752985923 MEDICAL SERVICES VA 501(C)(3) LINE 11C, III-FI MWHC 0 MWH AND UVA RADIOSURGERY CENTER LLC 2300 FALL HILL AVE SUITE 509 FREDERICKSBURG VA 22401 900604539 MEDICAL SERVICES VA 501(C)(3) LINE 11A, I MWHC 0 MARY WASHINGTON HEALTHCARE 2300 FALL HILL AVE SUITE 509 FREDERICKSBURG VA 22401 541240646 MEDICAL SERVICES VA 501(C)(3) LINE 11B, II MWHC 0 TOMPKINS MARTIN MEDICAL PLAZA 2300 FALL HILL AVE STE 509 FREDERICKSBURG VA 22401 541632021 REAL ESTATE VA MPI RELATED 574835 5246286 0 1 0.80500 FREDERICKSBURG AMBULATORY SURGERY CENTER 2300 FALL HILL AVE STE 509 FREDERICKSBURG VA 22401 562322548 SURGERY CTR VA MWHC CLINICAL SERVICES INC RELATED 2597237 5040676 0 1 0.71500 MEDICAL IMAGING OF FREDERICKSBURG 2300 FALL HILL AVE STE 509 FREDERICKSBURG VA 22401 541364028 IMAGING VA MWHC CLINICAL SERVICES INC RELATED 3842718 7501169 0 1 0.51000 MARY WASHINGTON EYE CARE CENTER 2300 FALL HILL AVE STE 509 FREDERICKSBURG VA 22401 271248032 OPTOMETRY VA MWHC CLINICAL SERVICES INC RELATED -173664 546508 0 0 0.60000 CENTRAL ATLANTIC HEALTH NETWORK 2300 FALL HILL AVE STE 509 FREDERICKSBURG VA 22401 274704694 GROUP PURCHASING VA RELATED -179 24821 1 0 0.11110 MWHC HOLDING COMPANY INC 2300 FALL HILL AVE SUITE 509 FREDERICKSBURG VA 22401 541725487 HOLDING COMPANY VA MWHC CLINICAL SERVICES INC C -292354 828074 1.00000 0 MARY WASHINGTON HEALTHCARE SERVICES 2300 FALL HILL AVE SUITE 509 FREDERICKSBURG VA 22401 541244509 RETAIL MEDICAL VA MWHC CLINICAL SERVICES INC C -946525 740064 1.00000 0 FREDERICKSBURG PROFESSIONAL RISK EXCHANGE 2300 FALL HILL AVE SUITE 509 FREDERICKSBURG VA 22401 531095956 CAPTIVE INSURANCE VA MWHC C 0.97500 0 0 0 1 0 0 0 0 0 0 1 1 0 0 0 0 0 0 0 0 TOMPKINS MARTIN MEDICAL PLAZA K 1360903 IND APPRAISAL FREDERICKSBURG AMBULATORY SURGERY CENTER J 964325 IND APPRAISAL MEDICAL IMAGING OF FREDERICKSBURG J 944679 IND APPRAISAL MARY WASHINGTON EYE CARE CENTER J 122853 IND APPRAISAL MARY WASHINGTON HEALTHCARE SERVICES INC J 554335 IND APPRAISAL MARY WASHINGTON HOSPITAL AUXILIARY C 220000 CASH TRANSACTION