UVA PRINCE WILLIAM MEDICAL CENTER: Form 990, tax year 2010

View the entire original 990 at ProPublica ↗

Organization
UVA PRINCE WILLIAM MEDICAL CENTER (EIN 54-0696355)
Tax period
2010-01-01 to 2010-12-31
Filed
2011-11-11
IRS object ID
201113159349301816
Schema version
2010v3.4
Source
Download XML · Original 990 at ProPublica

Every field in the e-filed return. Faint text is the IRS element name, for citing.

Return header ReturnHeader

FieldValueIRS element (for citing)
Timestamp2011-11-11T08:48:56-06:00Timestamp
Tax Period End Date2010-12-31TaxPeriodEndDate
Return Type990ReturnType
Tax Period Begin Date2010-01-01TaxPeriodBeginDate

Filer Filer

FieldValueIRS element (for citing)
EIN540696355EIN

Name Name

FieldValueIRS element (for citing)
Business Name Line1PRINCE WILLIAM HOSPITALBusinessNameLine1
FieldValueIRS element (for citing)
Name ControlPRINNameControl
Phone3367182803Phone

US Address USAddress

FieldValueIRS element (for citing)
Address Line12085 FRONTIS PLAZA BLVDAddressLine1
CityWINSTON SALEMCity
StateNCState
ZIP Code27103ZIPCode

Officer Officer

FieldValueIRS element (for citing)
NameFRED HARGETTName
TitleEVP & CFOTitle
Phone3367182803Phone
Date Signed2011-11-08DateSigned
FieldValueIRS element (for citing)
Tax Year2010TaxYear
Build TS2016-03-07 17:11:31ZBuildTS

Form 990 IRS990

FieldValueIRS element (for citing)
Name Of Principal Officer PersonMELISSA ROBSONNameOfPrincipalOfficerPerson

Address Principal Officer US AddressPrincipalOfficerUS

FieldValueIRS element (for citing)
Address Line12085 FRONTIS PLAZA BLVDAddressLine1
CityWINSTON SALEMCity
StateNCState
ZIP Code27103ZIPCode
FieldValueIRS element (for citing)
Gross Receipts239534441GrossReceipts
Group Return For Affiliates0GroupReturnForAffiliates
Organization501c3XOrganization501c3
Web SiteWWW.PWHS.ORGWebSite
Type Of Organization CorporationXTypeOfOrganizationCorporation
Year Formation1964YearFormation
State Legal DomicileVAStateLegalDomicile
Activity Or Mission DescriptionSEE SCHEDULE OActivityOrMissionDescription
Nbr Voting Members Governing Body16NbrVotingMembersGoverningBody
Nbr Independent Voting Members11NbrIndependentVotingMembers
Total Nbr Employees1510TotalNbrEmployees
Total Nbr Volunteers409TotalNbrVolunteers
Total Gross UBI232360TotalGrossUBI
Net Unrelated Business Txbl Income-50834NetUnrelatedBusinessTxblIncome
Contributions Grants Prior Year0ContributionsGrantsPriorYear
Contributions Grants Current Year0ContributionsGrantsCurrentYear
Program Service Revenue Prior Year200691939ProgramServiceRevenuePriorYear
Program Service Revenue CY214362460ProgramServiceRevenueCY
Investment Income Prior Year2922548InvestmentIncomePriorYear
Investment Income Current Year3451964InvestmentIncomeCurrentYear
Other Revenue Prior Year731806OtherRevenuePriorYear
Other Revenue Current Year111732OtherRevenueCurrentYear
Total Revenue Prior Year204346293TotalRevenuePriorYear
Total Revenue Current Year217926156TotalRevenueCurrentYear
Grants And Similar Amnts Prior Year119513GrantsAndSimilarAmntsPriorYear
Grants And Similar Amnts CY244986GrantsAndSimilarAmntsCY
Benefits Paid To Members Prior Year0BenefitsPaidToMembersPriorYear
Benefits Paid To Members CY0BenefitsPaidToMembersCY
Salaries Etc Prior Year91927660SalariesEtcPriorYear
Salaries Etc Current Year96510012SalariesEtcCurrentYear
Total Prof Fundrsng Exp Prior Year0TotalProfFundrsngExpPriorYear
Total Prof Fundrsng Exp CY0TotalProfFundrsngExpCY
Total Fundrsng Exp Current Year0TotalFundrsngExpCurrentYear
Other Expense Prior Year95240443OtherExpensePriorYear
Other Expenses Current Year101995094OtherExpensesCurrentYear
Total Expenses Prior Year187287616TotalExpensesPriorYear
Total Expenses Current Year198750092TotalExpensesCurrentYear
Revenues Less Expenses Prior Year17058677RevenuesLessExpensesPriorYear
Revenues Less Expenses CY19176064RevenuesLessExpensesCY
Total Assets BOY270506560TotalAssetsBOY
Total Assets EOY286396008TotalAssetsEOY
Total Liabilities BOY110285451TotalLiabilitiesBOY
Total Liabilities EOY113097229TotalLiabilitiesEOY
Net Assets Or Fund Balances BOY160221109NetAssetsOrFundBalancesBOY
Net Assets Or Fund Balances EOY173298779NetAssetsOrFundBalancesEOY
Info In Schedule O Part IIIXInfoInScheduleOPartIII
Mission DescriptionSEE SCHEDULE OMissionDescription
Significant New Program Services0SignificantNewProgramServices
Significant Change0SignificantChange
Expense183548927Expense
Grants244986Grants
Revenue214362460Revenue
DescriptionPRINCE WILLIAM HOSPITAL HAS 170 LICENSED BEDS. DURING 2010,THERE WERE 42,141 PATIENT DAYS, WITH AN AVERAGE LENGTH OF STAY OF 4.2 DAYS, AND AN AVERAGE DAILY CENSUS OF 116. THERE WERE 9,949 DISCHARGES, 4,868 INPATIENT AND OUTPATIENT SURGERIES, 147,847 OUTPATIENT ENCOUNTERS AND 68,109 EMERGENCY DEPARTMENT VISITS.Description
Total Program Service Expense183548927TotalProgramServiceExpense
Described In501 C31DescribedIn501C3
Schedule B Required0ScheduleBRequired
Political Activities0PoliticalActivities
Lobbying Activities1LobbyingActivities
Donor Advised Funds0DonorAdvisedFunds
Conservation Easements0ConservationEasements
Collections Of Art0CollectionsOfArt
Credit Counseling0CreditCounseling
Term Or Permanent Endowments1TermOrPermanentEndowments
Report Land Bldg Equip1ReportLandBldgEquip
Report Invest Oth Securities0ReportInvestOthSecurities
Report Prog Rel Invest0ReportProgRelInvest
Report Other Assets0ReportOtherAssets
Report Other Liabilities1ReportOtherLiabilities
Report Fin48 Footnote1ReportFin48Footnote
Independent Audit Financial Stmt0IndependentAuditFinancialStmt
Consolidated Audit Financial Stmt1ConsolidatedAuditFinancialStmt
School0School
Foreign Office0ForeignOffice
Foreign Activities0ForeignActivities
More Than5000 K To Organizations0MoreThan5000KToOrganizations
More Than5000 K To Individuals0MoreThan5000KToIndividuals
Professional Fundraising0ProfessionalFundraising
Fundraising Activities1FundraisingActivities
Gaming0Gaming
Hospital1Hospital
Financial Stmt Attached0FinancialStmtAttached
Grants To Organizations1GrantsToOrganizations
Grants To Individuals0GrantsToIndividuals
Schedule J Required1ScheduleJRequired
Tax Exempt Bonds0TaxExemptBonds
Excess Benefit Transaction0ExcessBenefitTransaction
Prior Excess Benefit Transaction0PriorExcessBenefitTransaction
Loan To Officer Or DQP0LoanToOfficerOrDQP
Grant To Related Person0GrantToRelatedPerson
Bsnss Rltnshp With Organization0BsnssRltnshpWithOrganization
Bsnss Rltnshp Thru Family Member0BsnssRltnshpThruFamilyMember
Officer Entity With Bsnss Rltnshp1OfficerEntityWithBsnssRltnshp
Deductible Non Cash Contributions0DeductibleNonCashContributions
Deductible Contributions Of Art0DeductibleContributionsOfArt
Terminated0Terminated
Partial Liquidation0PartialLiquidation
Disregarded Entity0DisregardedEntity
Related Entity1RelatedEntity
Related Org Controlled Entity1RelatedOrgControlledEntity
Transaction Related Entity1TransactionRelatedEntity
Transfers To Exempt Non Chrtbl Org0TransfersToExemptNonChrtblOrg
Activities Conducted Partnership0ActivitiesConductedPartnership
Schedule O Required1ScheduleORequired
Number Forms Transmitted With1096148NumberFormsTransmittedWith1096
Number W2 G Included0NumberW2GIncluded
Compliance With Backup Witholding1ComplianceWithBackupWitholding
Number Of Employees1510NumberOfEmployees
Employment Tax Returns Filed1EmploymentTaxReturnsFiled
Unrelated Business Income1UnrelatedBusinessIncome
Form990-T Filed1Form990-TFiled
Foreign Financial Account0ForeignFinancialAccount
Prohibited Tax Shelter Trans0ProhibitedTaxShelterTrans
Taxable Party Notification0TaxablePartyNotification
Non Deductible Contributions0NonDeductibleContributions
Quid Pro Quo Contributions0QuidProQuoContributions
Form8282 Property Disposed Of0Form8282PropertyDisposedOf
Funds To Pay Premiums0FundsToPayPremiums
Premiums Paid0PremiumsPaid
Indoor Tanning Services0IndoorTanningServices
Info In Schedule O Part VIXInfoInScheduleOPartVI
Nbr Voting Governing Body Members16NbrVotingGoverningBodyMembers
Number Independent Voting Members11NumberIndependentVotingMembers
Family Or Business Relationship0FamilyOrBusinessRelationship
Delegation Of Management Duties0DelegationOfManagementDuties
Changes To Organizing Docs0ChangesToOrganizingDocs
Material Diversion Or Misuse0MaterialDiversionOrMisuse
Members Or Stockholders1MembersOrStockholders
Election Of Board Members1ElectionOfBoardMembers
Decisions Subject To Approval1DecisionsSubjectToApproval
Minutes Of Governing Body1MinutesOfGoverningBody
Minutes Of Committees1MinutesOfCommittees
Officer Mailing Address0OfficerMailingAddress
Local Chapters0LocalChapters
Form990 Provided To Governing Body1Form990ProvidedToGoverningBody
Conflict Of Interest Policy0ConflictOfInterestPolicy
Whistleblower Policy0WhistleblowerPolicy
Document Retention Policy0DocumentRetentionPolicy
Compensation Process CEO1CompensationProcessCEO
Compensation Process Other1CompensationProcessOther
Investment In Joint Venture1InvestmentInJointVenture
Written Policy Or Procedure1WrittenPolicyOrProcedure
States Where Copy Of Return Is FiledVAStatesWhereCopyOfReturnIsFiled
Upon RequestXUponRequest

The Books Are In Care Of TheBooksAreInCareOf

Name Business NameBusiness

FieldValueIRS element (for citing)
Business Name Line1KAREN DAUGHERTYBusinessNameLine1
FieldValueIRS element (for citing)
Telephone Number3367182803TelephoneNumber

Address US AddressUS

FieldValueIRS element (for citing)
Address Line12085 FRONTIS PLAZA BLVDAddressLine1
CityWINSTON SALEMCity
StateNCState
ZIP Code27103ZIPCode
FieldValueIRS element (for citing)
Info In Schedule O Part VIIXInfoInScheduleOPartVII

Form990 Part VII Section A Form990PartVIISectionA (23 entries)

TitleTitleAverage Hours Per WeekAverageHoursPerWeekIndividual Trustee Or DirectorIndividualTrusteeOrDirectorOfficerOfficerReportable Comp From OrganizationReportableCompFromOrganizationReportable Comp From Related OrgsReportableCompFromRelatedOrgsOther CompensationOtherCompensationHighest Compensated EmployeeHighestCompensatedEmployee
BELDEN RICHARD
CHAIR2.00XX10002100020
DAILEY MICHAEL
TRUSTEE2.00X360036000
DANZIGER STEVEN M
TRUSTEE2.00X054000
EDWARDS H RANDALL
TRUSTEE2.00X360036000
FAIRCHILD WILLIAM D
TRUSTEE2.00X270027000
GARY SR WILLIAM H
TRUSTEE2.00X270027000
GRZEJKA JOHN
TRUSTEE2.00X360036000
GUTLIPH MD JOANNE
TRUSTEE2.00X022500
HOOVER MICHAEL
VICE CHAIR2.00XX360036000
MAGALSKI MD JOSEPH
TRUSTEE2.00X13117168330
PARR JR REXFORD
SECRETARY2.00XX360036000
ROBSONMELISSA L
TRUSTEE / PRES PWHC/COO NVA MKT60.00XX54667197199240690
WALL MD J DOUGLAS
TRUSTEE2.00X30000300000
WILESPAUL M
TRUSTEE / CEO & PRES NOVANT HEALTH60.00X031420681087327
WINE DONOVAN
TRUSTEE2.00X000
ZURLO MD JOSEPH
TRUSTEE2.00X375031250
RILEYROBERT W
VP FINANCE60.00X533743075908
SCHWARTZMICHAEL J
PRES PWHC/COO NVA MKT60.00X101467938248214311
DAVISMARY DENISE
VP NURSING40.0028702107392X
KRENYTZKY MDSTEPHEN
VP MEDICAL AFFAIRS40.002859981000078909X
LOVELLTERRANCE
DIR HUMAN RESOURCES40.00277034038257X
TIPPLECYNDA M
VP & COO PWHC40.00482034077854X
TRAVERS MDRICHARD M
VP MEDICAL AFFAIRS40.0024354603021X
FieldValueIRS element (for citing)
Total Reportable Comp From Org3750995TotalReportableCompFromOrg
Total Reportable Comp Frm Rltd Orgs3722759TotalReportableCompFrmRltdOrgs
Total Other Compensation1623669TotalOtherCompensation
Number Individuals GT100 K88NumberIndividualsGT100K
Formers Listed0FormersListed
Total Comp GT150 K1TotalCompGT150K
Compensation From Other Sources0CompensationFromOtherSources

Contractor Compensation ContractorCompensation (5 entries)

Address Line1AddressOfContractor/AddressUS/AddressLine1CityAddressOfContractor/AddressUS/CityStateAddressOfContractor/AddressUS/StateZIP CodeAddressOfContractor/AddressUS/ZIPCodeDescription Of ServicesDescriptionOfServicesCompensationCompensation
THE BANK OF NEW YORK
FINANCIAL CONTROL BILLINGNEWARKNJ07195INVESTING/CONSULTING2801116
PRECYSE SOLUTIONS LLC-NE
DEPT 1736 PO BOX 11407BIRMINGHAMAL35246TRANSCRIPTION SERVICES1598629
PEROT SYSTEMS CORPORATION
12020 COLLECTIONS CENTERCHICAGOIL60693IT SERVICES1524592
FINANCIAL HEALTH STRATEGIES
704 QUINCE ORCHARD RD STEGAITHERSBURGMD20878COLLECTION SERVICES1155657
DELL MARKETING LP
7489 COLLECTIONS CENTER DCHICAGOIL60693MARKETING701257
FieldValueIRS element (for citing)
Number Of Contractors GT100 K27NumberOfContractorsGT100K

Program Service Revenue ProgramServiceRevenue (3 entries)

DescriptionDescriptionBusiness CodeBusinessCodeTotal Revenue ColumnTotalRevenueColumnRelated Or Exempt Function IncomeRelatedOrExemptFunctionIncome
NET PATIENT REVENUE621990212390185212390185
CANCER CENTER REVENUE62199011418451141845
AMBULATORY SURGERY CEN621990830430830430
FieldValueIRS element (for citing)
Total Program Service Revenue214362460TotalProgramServiceRevenue

Investment Income InvestmentIncome

FieldValueIRS element (for citing)
Total Revenue Column3349204TotalRevenueColumn
Exclusion$3,349,204ExclusionAmount

Gross Rents GrossRents

FieldValueIRS element (for citing)
Real1289806Real

Less Rental Expenses LessRentalExpenses

FieldValueIRS element (for citing)
Real2220594Real

Rental Income Or Loss RentalIncomeOrLoss

FieldValueIRS element (for citing)
Real-930788Real

Net Rental Income Or Loss NetRentalIncomeOrLoss

FieldValueIRS element (for citing)
Total Revenue Column-930788TotalRevenueColumn
Exclusion-$930,788ExclusionAmount

Gross Amount Sales Assets GrossAmountSalesAssets

FieldValueIRS element (for citing)
Securities19490351Securities
Other100Other

Less Cost Oth Basis Sales Expenses LessCostOthBasisSalesExpenses

FieldValueIRS element (for citing)
Securities19337322Securities
Other50369Other

Gain Or Loss GainOrLoss

FieldValueIRS element (for citing)
Securities153029Securities
Other-50269Other

Net Gain Or Loss Investments NetGainOrLossInvestments

FieldValueIRS element (for citing)
Total Revenue Column102760TotalRevenueColumn
Exclusion$102,760ExclusionAmount
FieldValueIRS element (for citing)
Gross Income Fundraising Events27474GrossIncomeFundraisingEvents
Fundraising Direct Expenses0FundraisingDirectExpenses

Net Income From Fundraising Events NetIncomeFromFundraisingEvents

FieldValueIRS element (for citing)
Total Revenue Column27474TotalRevenueColumn
Exclusion$27,474ExclusionAmount
FieldValueIRS element (for citing)
Gross Sales Of Inventory183010GrossSalesOfInventory

Net Income Or Loss NetIncomeOrLoss

FieldValueIRS element (for citing)
Total Revenue Column183010TotalRevenueColumn
Exclusion$183,010ExclusionAmount

Other Revenue Misc OtherRevenueMisc (3 entries)

DescriptionDescriptionBusiness CodeBusinessCodeTotal Revenue ColumnTotalRevenueColumnExclusionExclusionAmountUnrelated Business RevenueUnrelatedBusinessRevenue
MISCELLANEOUS900099545195$545,195
FITNESS CENTER713940277969$46,786231183
CAFETERIA7222107695$7,695

Miscellaneous Revenue MiscellaneousRevenue

FieldValueIRS element (for citing)
Total Revenue Column1177TotalRevenueColumn
Unrelated Business Revenue1177UnrelatedBusinessRevenue
FieldValueIRS element (for citing)
Total Other Revenue832036TotalOtherRevenue

Total Revenue TotalRevenue

FieldValueIRS element (for citing)
Total Revenue Column217926156TotalRevenueColumn
Related Or Exempt Function Income214362460RelatedOrExemptFunctionIncome
Unrelated Business Revenue232360UnrelatedBusinessRevenue
Exclusion$3,331,336ExclusionAmount

Grants To Domestic Orgs GrantsToDomesticOrgs

FieldValueIRS element (for citing)
Total244986Total
Program Services244986ProgramServices

Comp Current Officers Directors CompCurrentOfficersDirectors

FieldValueIRS element (for citing)
Total2175362Total
Management And General2175362ManagementAndGeneral

Other Salaries And Wages OtherSalariesAndWages

FieldValueIRS element (for citing)
Total77256768Total
Program Services71562944ProgramServices
Management And General5693824ManagementAndGeneral

Pension Plan Contributions PensionPlanContributions

FieldValueIRS element (for citing)
Total3782106Total
Program Services3503365ProgramServices
Management And General278741ManagementAndGeneral

Other Employee Benefits OtherEmployeeBenefits

FieldValueIRS element (for citing)
Total7948848Total
Program Services7363018ProgramServices
Management And General585830ManagementAndGeneral

Payroll Taxes PayrollTaxes

FieldValueIRS element (for citing)
Total5346928Total
Program Services4952859ProgramServices
Management And General394069ManagementAndGeneral

Fees For Services Legal FeesForServicesLegal

FieldValueIRS element (for citing)
Total430700Total
Management And General430700ManagementAndGeneral

Fees For Services Accounting FeesForServicesAccounting

FieldValueIRS element (for citing)
Total228222Total
Management And General228222ManagementAndGeneral

Fees For Services Lobbying FeesForServicesLobbying

FieldValueIRS element (for citing)
Total2843Total
Management And General2843ManagementAndGeneral

Fees For Services Invst Mgmnt Fees FeesForServicesInvstMgmntFees

FieldValueIRS element (for citing)
Total233107Total
Management And General233107ManagementAndGeneral

Fees For Services Other FeesForServicesOther

FieldValueIRS element (for citing)
Total1343669Total
Program Services1244641ProgramServices
Management And General99028ManagementAndGeneral

Advertising Advertising

FieldValueIRS element (for citing)
Total544599Total
Program Services504462ProgramServices
Management And General40137ManagementAndGeneral

Information Technology InformationTechnology

FieldValueIRS element (for citing)
Total2575302Total
Program Services2385502ProgramServices
Management And General189800ManagementAndGeneral

Occupancy Occupancy

FieldValueIRS element (for citing)
Total4808367Total
Program Services4453990ProgramServices
Management And General354377ManagementAndGeneral

Travel Travel

FieldValueIRS element (for citing)
Total35865Total
Program Services33222ProgramServices
Management And General2643ManagementAndGeneral

Conferences Meetings ConferencesMeetings

FieldValueIRS element (for citing)
Total377440Total
Program Services349623ProgramServices
Management And General27817ManagementAndGeneral

Interest Interest

FieldValueIRS element (for citing)
Total4144144Total
Program Services3838721ProgramServices
Management And General305423ManagementAndGeneral

Depreciation Depletion DepreciationDepletion

FieldValueIRS element (for citing)
Total11953868Total
Program Services11072868ProgramServices
Management And General881000ManagementAndGeneral

Insurance Insurance

FieldValueIRS element (for citing)
Total1833687Total
Program Services1698544ProgramServices
Management And General135143ManagementAndGeneral

Other Expenses OtherExpenses (5 entries)

DescriptionDescriptionTotalTotalProgram ServicesProgramServicesManagement And GeneralManagementAndGeneral
BAD DEBT3083608230836082
SUPPLIES21454799198735801581219
DRUGS55340365126178407858
COLLECTION FEES47986784445015353663
OUTSIDE SERVICES39186453629841288804

All Other Expenses AllOtherExpenses

FieldValueIRS element (for citing)
Total6941041Total
Program Services6429486ProgramServices
Management And General511555ManagementAndGeneral

Total Functional Expenses TotalFunctionalExpenses

FieldValueIRS element (for citing)
Total198750092Total
Program Services183548927ProgramServices
Management And General15201165ManagementAndGeneral
Fundraising0Fundraising

Cash Non Interest Bearing CashNonInterestBearing

FieldValueIRS element (for citing)
BOY16991699BOY
EOY28603468EOY

Savings And Temp Cash Investments SavingsAndTempCashInvestments

FieldValueIRS element (for citing)
BOY10628084BOY
EOY10729372EOY

Accounts Receivable AccountsReceivable

FieldValueIRS element (for citing)
BOY24295417BOY
EOY25939114EOY

Inventories For Sale Or Use InventoriesForSaleOrUse

FieldValueIRS element (for citing)
BOY586066BOY
EOY807808EOY

Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges

FieldValueIRS element (for citing)
BOY2806704BOY
EOY512530EOY
FieldValueIRS element (for citing)
Land Buildings Equipment Basis241745301LandBuildingsEquipmentBasis
Land Bldg Equipment Accum Deprec138482654LandBldgEquipmentAccumDeprec

Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet

FieldValueIRS element (for citing)
BOY108040966BOY
EOY103262647EOY

Investments Pub Traded Securities InvestmentsPubTradedSecurities

FieldValueIRS element (for citing)
BOY93857075BOY
EOY102990555EOY

Investments Program Related InvestmentsProgramRelated

FieldValueIRS element (for citing)
BOY9937392BOY
EOY10666688EOY

Other Assets Total OtherAssetsTotal

FieldValueIRS element (for citing)
BOY3363157BOY
EOY2883826EOY

Total Assets TotalAssets

FieldValueIRS element (for citing)
BOY270506560BOY
EOY286396008EOY

Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses

FieldValueIRS element (for citing)
BOY14305756BOY
EOY13285137EOY

Tax Exempt Bond Liabilities TaxExemptBondLiabilities

FieldValueIRS element (for citing)
BOY78092293BOY
EOY75972354EOY

Other Liabilities OtherLiabilities

FieldValueIRS element (for citing)
BOY17887402BOY
EOY23839738EOY

Total Liabilities TotalLiabilities

FieldValueIRS element (for citing)
BOY110285451BOY
EOY113097229EOY
FieldValueIRS element (for citing)
Follow SFAS117XFollowSFAS117

Unrestricted Net Assets UnrestrictedNetAssets

FieldValueIRS element (for citing)
BOY157595182BOY
EOY171121025EOY

Temporarily Restricted Net Assets TemporarilyRestrictedNetAssets

FieldValueIRS element (for citing)
BOY2625927BOY
EOY2177754EOY

Total Net Assets Fund Balances TotalNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY160221109BOY
EOY173298779EOY

Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY270506560BOY
EOY286396008EOY
FieldValueIRS element (for citing)
Info In Schedule O Part XIXInfoInScheduleOPartXI
Reconcilation Revenue Expenses19176064ReconcilationRevenueExpenses
Reconcilation Other Changes-6098394ReconcilationOtherChanges
Method Of Accounting AccrualXMethodOfAccountingAccrual
Accountant Compile Or Review0AccountantCompileOrReview
FS Audited1FSAudited
Audit Committee1AuditCommittee
Financial Statement ConsolidatedXFinancialStatementConsolidated
Federal Grant Audit Required0FederalGrantAuditRequired

Schedule A IRS990ScheduleA

FieldValueIRS element (for citing)
Hospital170b1 AiiiXHospital170b1Aiii

Schedule C IRS990ScheduleC

FieldValueIRS element (for citing)
Volunteers0Volunteers
Paid Staff Or Management0PaidStaffOrManagement
Media Advertisements0MediaAdvertisements
Mailings Members0MailingsMembers
Publications Or Broadcast0PublicationsOrBroadcast
Grants Other Organizations0GrantsOtherOrganizations
Direct Contact Legislators1DirectContactLegislators
Direct Contact Legislators$2,843DirectContactLegislatorsAmount
Rallies Demonstrations0RalliesDemonstrations
Other Activities1OtherActivities
Other Activities$12,588OtherActivitiesAmount
Total Lobbying Expenditures IIB15431TotalLobbyingExpendituresIIB
Not Described In501c30NotDescribedIn501c3

Form990 Schedule C Part IV Form990ScheduleCPartIV

FieldValueIRS element (for citing)
IdentifierPART IV, SUPPLEMENTAL INFORMATION:Identifier
ExplanationSCHEDULE C, PART II-B, LINE 1I DUES PAID TO CERTAIN ORGANIZATIONS WHICH INCLUDE A PORTION RELATED TO LOBBYING ACTIVITIES.Explanation

Schedule D IRS990ScheduleD

Current Year CurrentYear

FieldValueIRS element (for citing)
Beginning Of Year Balance2625927BeginningOfYearBalance
Investment Earnings Or Losses97648InvestmentEarningsOrLosses
Other Expenditures545821OtherExpenditures
End Of Year Balance2177754EndOfYearBalance

Current Year Minus1 Year CurrentYearMinus1Year

FieldValueIRS element (for citing)
Beginning Of Year Balance2541996BeginningOfYearBalance
Investment Earnings Or Losses81899InvestmentEarningsOrLosses
Other Expenditures-2032OtherExpenditures
End Of Year Balance2625927EndOfYearBalance

Current Year Minus2 Years CurrentYearMinus2Years

FieldValueIRS element (for citing)
Beginning Of Year Balance3656202BeginningOfYearBalance
Investment Earnings Or Losses-114206InvestmentEarningsOrLosses
Other Expenditures1000000OtherExpenditures
End Of Year Balance2541996EndOfYearBalance
FieldValueIRS element (for citing)
Term Endowment EOY Balance1.00000TermEndowmentEOYBalance
Endowments Held By Unrelated Orgs0EndowmentsHeldByUnrelatedOrgs
Endowments Held By Related Orgs0EndowmentsHeldByRelatedOrgs

Land Land

FieldValueIRS element (for citing)
Other Cost Or Other Basis2539817OtherCostOrOtherBasis
Book Value2539817BookValue

Buildings Buildings

FieldValueIRS element (for citing)
Other Cost Or Other Basis111398234OtherCostOrOtherBasis
Depreciation45843078Depreciation
Book Value65555156BookValue

Equipment Equipment

FieldValueIRS element (for citing)
Other Cost Or Other Basis113758466OtherCostOrOtherBasis
Depreciation88993130Depreciation
Book Value24765336BookValue

Other Land Buildings OtherLandBuildings

FieldValueIRS element (for citing)
Other Cost Or Other Basis14048784OtherCostOrOtherBasis
Depreciation3646446Depreciation
Book Value10402338BookValue
FieldValueIRS element (for citing)
Total Of Book Value Land Buildings103262647TotalOfBookValueLandBuildings
Federal Income Tax Liability0FederalIncomeTaxLiability

Other Liabilities OtherLiabilities (3 entries)

DescriptionDescriptionAmountAmount
PENSION LIABILITY$17,947,924
DEFERRED COMPENSATION$652,172
DUE TO AFFILIATE$5,239,642
FieldValueIRS element (for citing)
Total Of Amounts23839738TotalOfAmounts

Form990 Schedule D Part XIV Form990ScheduleDPartXIV (2 entries)

IdentifierIdentifierReturn ReferenceReturnReferenceExplanationExplanation
DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48:PART X:LIABILITY UNDER FIN 48(ASC 740) FOOTNOTE THE AUDIT FOR NOVANT HEALTH AND ITS AFFILIATES IS PREPARED ON A CONSOLIDATED BASIS. FOR THE YEARS ENDED DECEMBER 31, 2010 AND 2009, THE COMPANY WAS REQUIRED TO EVALUATE UNCERTAIN TAX POSITIONS. THIS EVALUATION INCLUDES A QUANTIFICATION OF TAX RISK IN AREAS SUCH AS UNRELATED BUSINESS TAXABLE INCOME AND THE TAXATION OF OUR FOR-PROFIT SUBSIDIARIES. THIS EVALUATION DID NOT HAVE A MATERIAL EFFECT ON THE COMPANY'S STATEMENT OF OPERATIONS FOR THE YEARS ENDED DECEMBER 31, 2010 AND 2009.
PART V, LINE 4 - INTENDED USES FOR ENDOWMENT FUNDS THE ENDOWMENT FUNDS INTENDED USE IS FOR PATIENT EQUIPMENT AND THE REMAINDER IS THE BENEFICIAL INTEREST IN THE NET ASSETS OF THE PRINCE WILLIAM HEALTH SYSTEM FOUNDATION.

Schedule G IRS990ScheduleG

Events Information EventsInformation

FieldValueIRS element (for citing)
Name Of Event1FUNDRAISINGNameOfEvent1
Gross Receipts Event127474GrossReceiptsEvent1
Gross Revenue Event127474GrossRevenueEvent1
Gross Receipts Total27474GrossReceiptsTotal
Gross Revenue Total Events27474GrossRevenueTotalEvents
Net Income Summary27474NetIncomeSummary

Schedule H IRS990ScheduleH

FieldValueIRS element (for citing)
Charity Care Policy1CharityCarePolicy
Written Policy1WrittenPolicy
Policy Applied To Most HospitalsXPolicyAppliedToMostHospitals
FPG Reference Free Care1FPGReferenceFreeCare

Other Percentage OtherPercentage

FieldValueIRS element (for citing)
OtherXOther
Free Other Percentage300.000000000000FreeOtherPercentage
FieldValueIRS element (for citing)
FPG Reference Discounted Care1FPGReferenceDiscountedCare
Pcent300XPcent300
Free Disc Care Medically Indigent1FreeDiscCareMedicallyIndigent
Amounts Budgeted For Charity Care1AmountsBudgetedForCharityCare
Expenses Exceeded Budget0ExpensesExceededBudget
Annual Community Benefit Report1AnnualCommunityBenefitReport
Report Publically Available1ReportPublicallyAvailable

Charity Care At Cost CharityCareAtCost

FieldValueIRS element (for citing)
Total Community Benefit Expense7308974TotalCommunityBenefitExpense
Net Community Benefit Expense7308974NetCommunityBenefitExpense
Percent Of Total Expense0.03680PercentOfTotalExpense

Unreimbursed Medicaid UnreimbursedMedicaid

FieldValueIRS element (for citing)
Total Community Benefit Expense17513235TotalCommunityBenefitExpense
Direct Offsetting Revenue12709895DirectOffsettingRevenue
Net Community Benefit Expense4803340NetCommunityBenefitExpense
Percent Of Total Expense0.02420PercentOfTotalExpense

Unreimbursed Costs UnreimbursedCosts

FieldValueIRS element (for citing)
Total Community Benefit Expense4931248TotalCommunityBenefitExpense
Direct Offsetting Revenue3528089DirectOffsettingRevenue
Net Community Benefit Expense1403159NetCommunityBenefitExpense
Percent Of Total Expense0.00710PercentOfTotalExpense

Total Charity Care TotalCharityCare

FieldValueIRS element (for citing)
Total Community Benefit Expense29753457TotalCommunityBenefitExpense
Direct Offsetting Revenue16237984DirectOffsettingRevenue
Net Community Benefit Expense13515473NetCommunityBenefitExpense
Percent Of Total Expense0.06810PercentOfTotalExpense

Community Health Services CommunityHealthServices

FieldValueIRS element (for citing)
Total Community Benefit Expense1254678TotalCommunityBenefitExpense
Net Community Benefit Expense1254678NetCommunityBenefitExpense
Percent Of Total Expense0.00630PercentOfTotalExpense

Cash And In Kind Contributions CashAndInKindContributions

FieldValueIRS element (for citing)
Total Community Benefit Expense5500TotalCommunityBenefitExpense
Net Community Benefit Expense5500NetCommunityBenefitExpense
Percent Of Total Expense0.00000PercentOfTotalExpense

Total Other Benefits TotalOtherBenefits

FieldValueIRS element (for citing)
Total Community Benefit Expense1260178TotalCommunityBenefitExpense
Net Community Benefit Expense1260178NetCommunityBenefitExpense
Percent Of Total Expense0.00630PercentOfTotalExpense

Total Community Benefits TotalCommunityBenefits

FieldValueIRS element (for citing)
Total Community Benefit Expense31013635TotalCommunityBenefitExpense
Direct Offsetting Revenue16237984DirectOffsettingRevenue
Net Community Benefit Expense14775651NetCommunityBenefitExpense
Percent Of Total Expense0.07440PercentOfTotalExpense
FieldValueIRS element (for citing)
Bad Debt Expense Reported1BadDebtExpenseReported
Bad Debt Expense$10,469,282BadDebtExpenseAmount
Amount Attributable To0AmountAttributableTo
Amount Reimbursed By Medicare32394946AmountReimbursedByMedicare
Cost Of Care Reimbursed By Medicare43579250CostOfCareReimbursedByMedicare
Medicare Surplus Or Shortfall-11184304MedicareSurplusOrShortfall

Costing Methodology Used CostingMethodologyUsed

FieldValueIRS element (for citing)
Cost To Charge RatioXCostToChargeRatio
FieldValueIRS element (for citing)
Written Debt Collection Policy1WrittenDebtCollectionPolicy
Provision For Charity Care1ProvisionForCharityCare

Form990 Schedule H Part IV Form990ScheduleHPartIV

Name Of Entity NameOfEntity

FieldValueIRS element (for citing)
Business Name Line11 PRINCE WILLIAM ASCBusinessNameLine1
FieldValueIRS element (for citing)
Description Ent Primary ActivityHEALTHCAREDescriptionEntPrimaryActivity
Organization Profit Or Ownership0.51000OrganizationProfitOrOwnership
Officers Etc Profit Or Ownership0.04680OfficersEtcProfitOrOwnership
Physicans Profit Or Ownership0.44320PhysicansProfitOrOwnership
FieldValueIRS element (for citing)
Number Of Hospital Facilities1NumberOfHospitalFacilities

Form990 Schedule H Part V Section A Form990ScheduleHPartVSectionA

FieldValueIRS element (for citing)
Facility Number1FacilityNumber

Name Name

FieldValueIRS element (for citing)
Business Name Line1PRINCE WILLIAM HOSPITALBusinessNameLine1

Address Address

FieldValueIRS element (for citing)
Address Line18700 SUDLEY ROAD STE 411AddressLine1
CityMANASSASCity
StateVAState
ZIP Code20110ZIPCode
FieldValueIRS element (for citing)
Licensed HospitalXLicensedHospital
General Medical And SurgicalXGeneralMedicalAndSurgical
Er24 HoursXEr24Hours

Form990 Schedule H Part V Section B Form990ScheduleHPartVSectionB

Hospital Facility Name HospitalFacilityName

FieldValueIRS element (for citing)
Business Name Line1NABusinessNameLine1
FieldValueIRS element (for citing)
Hospital Facility Number1HospitalFacilityNumber
Eligibility Criteria Explained0EligibilityCriteriaExplained
Uses FPG Free0UsesFPGFree
Uses FPG Discounted0UsesFPGDiscounted
Explains Basis0ExplainsBasis
Explains Application Method0ExplainsApplicationMethod
Includes Publicity Measures0IncludesPublicityMeasures
Actions On Nonpayment0ActionsOnNonpayment
Collection Activities0CollectionActivities
Nondiscrim Emergency Care Policy0NondiscrimEmergencyCarePolicy
Amounts Generally Billed0AmountsGenerallyBilled
Gross Charges0GrossCharges

Form990 Schedule H Part V Section C Form990ScheduleHPartVSectionC

FieldValueIRS element (for citing)
Number Of Other Facilities2NumberOfOtherFacilities

Other Facilities OtherFacilities (2 entries)

Address Line1Address/AddressLine1CityAddress/CityStateAddress/StateZIP CodeAddress/ZIPCodeFacility TypeFacilityType
PRINCE WILLIAM AMBULATORY SURGERY CENTER
8650 SUDLEY ROAD SUITE 411MANASSASVA20110AMBULATORY SURGERY CENTER
THE CANCER CENTER AT LAKE MANASSAS
7901 LAKE MANASSAS DRIVEGAINESVILLEVA20155CANCER CENTER

Form990 Schedule H Part VI Form990ScheduleHPartVI (13 entries)

ExplanationExplanationReturn ReferenceReturnReference
PART I, LINE 6A: THE ORGANIZATION IS PART OF THE NOVANT HEALTH CARE SYSTEM AND THE COMMUNITY BENEFIT REPORT IS PREPARED BY A RELATED ORGANIZATION. NOVANT HEALTH, INC. PRODUCES ITS OWN COMMUNITY BENEFIT REPORT, WHICH REPRESENTS THE HEALTH SYSTEM AS A WHOLE AND CAN BE FOUND AT HTTP://WWW.NOVANTHEALTH.ORG/DOWNLOADS/FINANCIAL_INFO/2010_COMMUNITY_INVOLVEMENT.PDF. PLEASE NOTE THAT THE NUMERIC INFORMATION IN THIS REPORT IS NOT BASED UPON THE FORM 990, SCHEDULE H CRITERIA, BUT RATHER IT HAS BEEN PREPARED IN ACCORDANCE WITH THE NORTH CAROLINA HOSPITAL ASSOCIATION REPORTING GUIDELINES.
PART I, LINE 7: COSTS REPORTED IN THE TABLE OF CHARITY CARE AND CERTAIN OTHER COMMUNITY BENEFITS AMOUNTS ARE CALCULATED USING AN ENTITY SPECIFIC COST TO CHARGE RATIO BASED ON WORKSHEET 2 (RCC).
PART I, L7 COL(F): THE AMOUNT OF BAD DEBT REMOVED FROM TOTAL EXPENSES (DENOMINATOR) WAS $30,836,082.
PART II: ALTHOUGH PART II FOR SCHEDULE H HAS BEEN LEFT BLANK, THE ORGANIZATION DOES ENGAGE IN MANY COMMUNITY BUILDING ACTIVITIES, WHICH SUPPORT AND STRENGTHEN THE COMMUNITY IT SERVES. THESE ACTIVITIES ARE IMPORTANT TO THE ORGANIZATION'S MISSION TO IMPROVE THE HEALTH OF THE COMMUNITY. HOWEVER, THE ORGANIZATION HAS NOT TRADITIONALLY MAINTAINED AN INFRASTRUCTURE TO TRACK, MONITOR AND REPORT THESE ACTIVITIES. THE ORGANIZATION IS PART OF THE NOVANT HEALTH CARE SYSTEM, WHICH HAS A COMMUNITY BENEFIT COMMITTEE. THE COMMUNITY BENEFIT COMMITTEE IS CURRENTLY IN THE PROCESS OF ESTABLISHING THE APPROPRIATE INTERNAL MECHANISMS TO TRACK, MONITOR AND REPORT THESE ACTIVITIES. THE ORGANIZATION IS COMMITTED TO CONTINUING TO PROVIDE THE COMMUNITY BUILDING ACTIVITIES NECESSARY TO MAINTAIN A HEALTHY, PRODUCTIVE AND VIABLE COMMUNITY.
PART III, LINE 4: THE ORGANIZATION'S BAD DEBT EXPENSE (AT COST)ON LINE 2 IS CALCULATED USING THE SAME METHODOLOGY AS CHARITY CARE AND OTHER COMMUNITY BENEFITS USING AN ENTITY SPECIFIC COST TO CHARGE RATIO (RCC).BAD DEBT EXPENSE ONLY REPRESENTS ACCOUNTS FOR WHICH COLLECTION EFFORTS HAVE BEEN MADE BUT NO PAYMENTS HAVE BEEN RECEIVED. DISCOUNTS ARE RECORDED AS EITHER CONTRACTUALS (FOR PATIENTS WHO DO NOT QUALIFY FOR CHARITY) OR AS CHARITY (FOR PATIENTS WHO DO QUALIFY FOR CHARITY). THE TEXT OF THE NOVANT HEALTH, INC. CONSOLIDATED FINANCIAL STATEMENTS READS: "THE PROVISION FOR BAD DEBTS IS DETERMINED BASED ON MANAGEMENT'S ASSESSMENT OF HISTORICAL AND EXPECTED NET COLLECTIONS, BUSINESS AND ECONOMIC CONDITIONS, THE AGE OF THE ACCOUNTS, TRENDS IN FEDERAL AND STATE GOVERNMENTAL HEALTH CARE COVERAGE AND OTHER COLLECTION INDICATORS."
PART III, LINE 8: THE METHODOLOGY USED TO DETERMINE THE MEDICARE ALLOWABLE COSTS REPORTED IN THE ORGANIZATION'S MEDICARE COST REPORT AS REFLECTED IN THE AMOUNT REPORTED IN PART III, LINE 6 IS DETERMINED BY FOLLOWING THE MEDICARE PRINCIPLES OF ALLOWABLE COSTS. COST FOR THE OVERHEAD DEPARTMENTS ARE STEPPED DOWN TO THE REMAINING COST CENTERS BASED ON STATISTICS FOR EACH OVERHEAD COST CENTER. ONCE THE STEP-DOWN PROCESS IS COMPLETE, A RATIO OF COST TO CHARGES IS DEVELOPED FOR EACH COST CENTER. THE RCC IS THEN APPLIED TO THE MEDICARE REVENUE BY COST CENTER AND TOTALED.IT SHOULD BE NOTED THAT THE MEDICARE COST REPORTS DO NOT ADDRESS ANY MANAGED CARE MEDICARE REVENUES, COSTS, OR RELATED SHORTFALL. THE TOTAL REVENUES REPORTED AS RECEIVED FROM MEDICARE IN LINE 5 OF SECTION B ARE ONLY REPRESENTATIVE OF MEDICARE FEE FOR SERVICE PAYMENTS RECEIVED. THE ALLOWABLE COSTS ON LINE 6 ARE SIGNIFICANTLY LOWER THAN THE ACTUAL EXPENDITURES. AS SUCH, THE SHORTFALL IS UNDERESTIMATED. EVERY HOSPITAL TREATS MEDICARE PATIENTS. SOME HOSPITALS ARE LOCATED IN HIGH MEDICARE POPULATION AREAS OR OFFER SERVICES DISPROPORTIONATELY USED BY MEDICARE PATIENTS. MEDICARE RATES AND NUMBERS OF MEDICARE PATIENTS ARE NOT NEGOTIATED. AS REIMBURSEMENT RATES DECLINE RELATIVE TO COSTS OF CARE, HOSPITALS CONTINUE TO SERVE THE MEDICARE POPULATION. WITHOUT THIS SERVICE THESE PATIENTS WOULD BECOME AN OBLIGATION TO THE GOVERNMENT. ANY UNREIMBURSED COSTS OF THIS CARE ARE A COMMUNITY BENEFIT PROVIDED BY THE HOSPITAL TO THE COMMUNITY AND GOVERNMENT.
PART III, LINE 9B: IN ADDITION TO OUR FINANCIAL COUNSELING PROCESSES USED TO IDENTIFY CHARITY CARE PATIENTS, OUR COLLECTIONS PROCESSES WITHIN OUR BUSINESS OFFICES ALSO HELP IDENTIFY PATIENTS WHO ARE ALREADY ELIGIBLE FOR CHARITY OR WHO MAY BE ELIGIBLE BASED ON THEIR STATUS WITHIN THE FEDERAL POVERTY GUIDELINES ("FPG"). WE UTILIZE PREVIOUSLY SUBMITTED PATIENT DOCUMENTATION AND CREDIT AGENCY REPORTED STATUS FOR DETERMINATION. SUPPORTING DOCUMENTS ARE VALID 6 MONTHS FROM THE DATE OF SUBMISSION. OUR POLICIES ARE CONSIDERED FLUID AND ARE UPDATED FREQUENTLY BASED ON LOCAL AND NATIONAL MARKET STANDARDS AND NATIONAL ECONOMIC CONDITIONS. ANY UPDATES TO OUR POLICIES REQUIRE MULTI-LEVEL LEADERSHIP APPROVAL AND ARE ULTIMATELY APPROVED BY THE NOVANT EXECUTIVE TEAM.
PART VI, LINE 2: NEEDS ASSESSMENTTHE ORGANIZATION IS PART OF THE NOVANT HEALTH CARE SYSTEM, WHICH HAS A COMMUNITY BENEFIT COMMITTEE. THE COMMUNITY BENEFIT COMMITTEE IS RESPONSIBLE FOR ASSISTING THE HOSPITALS WITHIN THE HEALTH CARE SYSTEM WITH PREPARING COMMUNITY NEEDS ASSESSMENTS. THE COMMUNITY BENEFIT COMMITTEE IS MADE OF INDIVIDUALS REPRESENTING CORPORATE-WIDE DEPARTMENTS, SUCH AS COMMUNITY RELATIONS, LEGAL, TAX, INTERNAL AUDIT, MARKETING/COMMUNICATIONS, AS WELL AS INDIVIDUALS FROM VARIOUS DEPARTMENTS OF HOSPITAL OPERATIONS AND THE HEALTH CARE SYSTEM'S HOSPITAL FOUNDATIONS. EACH HOSPITAL, WITH THE ASSISTANCE OF THE COMMUNITY BENEFIT COMMITTEE, WILL IDENTIFY ORGANIZATIONS AND RESOURCES WITHIN ITS COMMUNITY TO CONTRIBUTE TO THE HOSPITAL'S COMMUNITY NEEDS ASSESSMENT. THESE ORGANIZATIONS AND RESOURCES INCLUDE LOCAL HEALTH DEPARTMENTS, UNITED WAY, UNIVERSITIES, PUBLIC HEALTH DEPARTMENTS, ETC. THE EXISTING COMMUNITY HEALTH ASSESSMENTS PREPARED BY OTHER ORGANIZATIONS IN THE COMMUNITY WILL BE COMBINED WITH INTERNAL HOSPITAL DATA AND INFORMATION COLLECTED FROM LOCAL AGENCIES TO BECOME THE HOSPITAL'S COMMUNITY NEEDS ASSESSMENT. EACH HOSPITAL HAS ALSO TRADITIONALLY RESPONDED TO REQUESTS FOR CERTAIN COMMUNITY BENEFIT ACTIVITIES OR PROGRAMS FROM PUBLIC AGENCIES OR COMMUNITY GROUPS AND THIS WILL ALSO BE INCLUDED IN THE HOSPITAL'S COMMUNITY NEEDS ASSESSMENT. ONCE THE COMMUNITY NEEDS ASSESSMENT IS COMPLETED, WHICH WILL BE EVERY THREE YEARS, THE HOSPITAL WILL PRIORITIZE THE NEEDS BY DETERMINING WHAT HOSPITAL RESOURCES ARE AVAILABLE TO MEET THE NEEDS AND WHAT OTHER COMMUNITY RESOURCES ARE BEING USED TO MEET A PARTICULAR NEED. THE HOSPITAL WILL DEVELOP A COMMUNITY BENEFIT PLAN, WHICH WILL BE REVIEWED AND UPDATED AS NECESSARY, AT LEAST EVERY THREE YEARS. ALL HOSPITALS' COMMUNITY NEEDS ASSESSMENTS WILL BE MADE AVAILABLE TO THE PUBLIC.
PART VI, LINE 3: PATIENT EDUCATION OF ELIGIBILITY FOR ASSISTANCEAS A NOT-FOR-PROFIT ORGANIZATION, NOVANT HEALTH IS COMMITTED TO PROVIDING OUTSTANDING HEALTH CARE TO ALL MEMBERS OF OUR COMMUNITIES, REGARDLESS OF THEIR ABILITY TO PAY. OUR ACUTE CARE FACILITIES PROVIDE CARE IN 35 COUNTIES ACROSS THREE STATES. ADDITIONALLY, OUR PHYSICIANS AND ACUTE CARE FACILITIES OFFER CARE TO NATIONAL AND INTERNATIONAL MISSION PATIENTS. OUR FINANCIAL COUNSELING TEAMS ARE CONSTANTLY WORKING WITH THE PATIENTS WITHIN OUR COMMUNITIES TO UNDERSTAND THEIR NEEDS AND ENSURE THAT OUR POLICIES AND PROCESSES ADDRESS THESE NEEDS. WE ALSO MAINTAIN CONTRACTS WITH MEDICAID ELIGIBILITY VENDORS AND LOCAL DEPARTMENT OF SOCIAL SERVICES TEAMS TO HAVE EMBEDDED CASE WORKERS WITHIN OUR FACILITIES. THESE TEAMS OFFER ADDITIONAL SUPPORT IN PROCESSING AND ASSESSING HOW WE SERVE THE FINANCIAL NEEDS OF OUR PATIENTS. BASED ON THE ASSESSMENTS OF OUR COMMUNITIES, NOVANT HEALTH HAS DEVELOPED FINANCIAL ASSISTANCE POLICIES AND PROGRAMS THAT ADDRESS THE FINANCIAL NEEDS OR OUR PATIENTS. * UNINSURED PATIENTS WITH INCOMES OF UP TO 300% OF THE FEDERAL POVERTY LEVEL ARE ELIGIBLE FOR 100% WRITE-OFF. * UNINSURED PATIENTS WITH INCOME OVER 300% OF THE FEDERAL POVERTY LEVEL ARE ELIGIBLE FOR SELF-PAY DISCOUNTS BASED ON THE PATIENT'S ANNUAL INCOME AND OUTSTANDING MEDICAL BILLS / COSTS. * ANY PATIENT (EVEN WITH HEALTH INSURANCE) WITH A BALANCE OVER $5,000 AND / OR INCOME OVER 300% OF THE FEDERAL POVERTY LEVEL IS ELIGIBLE FOR A CATASTROPHIC DISCOUNT. OUR CATASTROPHIC DISCOUNTS ARE ALSO BASED ON THE PATIENT'S ANNUAL INCOME AND OUTSTANDING MEDICAL BILLS / COSTS.* ANY PATIENT IS ELIGIBLE FOR AN INDIVIDUALIZED PAYMENT PLAN BASED ON THE AMOUNT DUE AND THE PATIENT'S FINANCIAL STATUS, WITH TERMS EXTENDING UP TO FIVE YEARS. NO INTEREST IS CHARGED, UNLESS APPROPRIATE. WE PRIDE OURSELVES IN THE TRANSPARENCY OF OUR PROGRAMS AND THE EDUCATION WE OFFER OUR PATIENTS AROUND OUR FINANCIAL ASSISTANCE POLICIES. OUR PROGRAMS ARE DOCUMENTED ON OUR CORPORATE WEBSITE AS WELL AS EACH INDIVIDUAL FACILITY'S WEBSITE, ALONG WITH CONTACT INFORMATION FOR OUR FINANCIAL COUNSELORS. ADDITIONALLY, OUR PROGRAMS ARE DOCUMENTED ON PATIENT FLYERS THROUGHOUT THE NOVANT AFFILIATED FACILITIES AND PHYSICIAN OFFICES. OUR PATIENT ACCESS SPECIALISTS, FINANCIAL COUNSELORS AND BUSINESS OFFICE TEAMS WORK WITH ALL SELF-PAY PATIENTS AND INSURED PATIENTS WITH HIGH DEDUCTIBLES TO EDUCATE THEM ON THE VARIOUS OPTIONS AVAILABLE VIA OUR FINANCIAL ASSISTANCE PROGRAMS OR GOVERNMENT SPONSORED CARE. FINALLY, WE WORK WITH LOCAL AREA FREE HEALTH CLINICS AND OTHER CHARITABLE ORGANIZATIONS TO PROVIDE CONTINUATION OF CARE FOR THEIR PATIENTS. IN ADDITION TO OUR FINANCIAL COUNSELING PROCESSES USED TO IDENTIFY CHARITY CARE PATIENTS, OUR COLLECTIONS PROCESSES WITHIN OUR BUSINESS OFFICES ALSO HELP IDENTIFY PATIENTS WHO ARE ALREADY ELIGIBLE FOR CHARITY OR WHO MAY BE ELIGIBLE BASED THEIR STATUS WITHIN THE FEDERAL POVERTY GUIDELINES ("FPG"). WE UTILIZE PREVIOUSLY SUBMITTED PATIENT DOCUMENTATION AND CREDIT AGENCY REPORTED STATUS FOR DETERMINATION. SUPPORTING DOCUMENTS ARE VALID 6 MONTHS FROM THE DATE OF SUBMISSION. OUR POLICIES ARE CONSIDERED FLUID AND ARE UPDATED FREQUENTLY BASED ON LOCAL AND NATIONAL MARKET STANDARDS AND NATIONAL ECONOMIC CONDITIONS. ANY UPDATES TO OUR POLICIES REQUIRE MULTI-LEVEL LEADERSHIP APPROVAL AND ARE ULTIMATELY APPROVED BY THE NOVANT EXECUTIVE TEAM.
PART VI, LINE 4: COMMUNITY INFORMATIONTHE ORGANIZATION DEFINES ITS COMMUNITY BY ITS PRIMARY SERVICE AREA, WHICH IS COMPOSED OF THE FOLLOWING ZIP CODES: 20108 (CITY OF MANASSAS - MANASSAS); 20109 (PRINCE WILLIAM COUNTY - MANASSAS); 20110 (CITY OF MANASSAS - MANASSAS); 20111(PRINCE WILLIAM COUNTY - MANASSAS); 20112 (PRINCE WILLIAM COUNTY - MANASSAS); 20113 (CITY OF MANASSAS - MANASSAS); 20136 (PRINCE WILLIAM COUNTY - BRISTOW); 20137 (FAUQUIER COUNTY - BROAD RUN); 20143 (PRINCE WILLIAM COUNTY - CATHARPIN); 20155 (PRINCE WILLIAM COUNTY - GAINESVILLE); 20156 (PRINCE WILLIAM COUNTY - GAINESVILLE); 20168 (PRINCE WILLIAM COUNTY - HAYMARKET); 20169 (PRINCE WILLIAM COUNTY - HAYMARKET); 20181 (PRINCE WILLIAM COUNTY - NOKESVILLE); 20182 (PRINCE WILLIAM COUNTY - NOKESVILLE); AND 20198 (FAUQUIER COUNTY - THE PLAINS). THE ZIP CODES REPRESENT MOSTLY SUBURBAN AREAS. THE TWO FAUQUIER COUNTY ZIP CODES ARE RURAL. THE ORGANIZATION IS THE ONLY HOSPITAL IN THIS SERVICE AREA.THE SPECIFIC POPULATION GROUPS (ETHNIC AND CULTURAL) ARE AS FOLLOWS: WHITE NON-HISPANIC (134,089) 63%; BLACK NON-HISPANIC (19,021) 9%; HISPANIC (42,801) 20%; ASIAN & PACIFIC ISLAND NON-HISPANIC (11,435) 5%; OTHERS (5,650) 2%; FOR A TOTAL POPULATION OF 212,996. 12% OF THE POPULATION IN THIS MARKET IS NON-ENGLISH SPEAKING. FOR 2010, THIS COMMUNITY HAD 73,046 HOUSEHOLDS. THE AVERAGE INCOME LEVEL WAS $122,425. APPROXIMATELY 6% PERCENT OF HOUSEHOLDS MADE LESS THAN $25,000 ANNUALLY. THE AGE BREAK DOWN IS AS FOLLOWS: 0-14 YEARS (52,416) 25%; 15-17 YEARS (9,460) 4%; 18 - 24 YEARS (17,218) 8%; 25-34 YEARS (28,540) 13%; 35-54 YEARS (65,690) 18%; 55-64 YEARS (21,770) 10.0%; 65 + YEARS (17,902) 8%; FOR A TOTAL POPULATION OF 212,996.
PART VI, LINE 6: PROMOTION OF COMMUNITY HEALTHTHE ORGANIZATION FURTHERS ITS EXEMPT PURPOSES BY DOING THE FOLLOWING:1.ADOPTING A CHARITY CARE POLICY, WHICH PROVIDES FREE CARE TO INDIVIDUALSWHOSE INCOME IS AT OR BELOW 300% OF THE FEDERAL POVERTY LEVEL;2.REMAINING CERTIFIED BY THE U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICESTO PROVIDE SERVICES TO ALL BENEFICIARIES OF MEDICARE, MEDICAID, AND OTHERGOVERNMENT PAYMENT PROGRAMS, AND PROVIDING SERVICES IN A NONDISCRIMINATORYMANNER TO SUCH BENEFICIARIES;3.OPERATING A FULL-TIME EMERGENCY ROOM WHICH IS OPEN TO AND ACCEPTS ALLPERSONS, REGARDLESS OF THEIR ABILITY TO PAY;4.MAINTAINING AN OPEN MEDICAL STAFF, SUBJECT TO EXCLUSIVE CONTRACTS FOR HOSPITAL-BASED SERVICES SUCH AS ANESTHESIOLOGY, RADIOLOGY, PATHOLOGY, HOSPITALIST, AND EMERGENCY DEPARTMENT SERVICES, TO THE EXTENT AN EXCLUSIVECONTRACT FOR THOSE SERVICES IS REQUIRED TO OBTAIN PROPER STAFFING COVERAGEOR TO PERMIT A MORE EFFICIENT DELIVERY OF THOSE SERVICES WITHIN THE HOSPITAL FACILITY;5.MAINTAINING A GOVERNING BOARD CONSISTING PRIMARILY OF A BROAD CROSS-SECTION OF LEADERS IN THE COMMUNITY;6.ADOPTING AND APPLYING A CONFLICT OF INTEREST POLICY, WHICH APPLIES TO THE GOVERNING BOARD AND ORGANIZATION OFFICERS;7.PROVIDING HEALTH EDUCATION LECTURES AND WORKSHOPS.8.PROVIDING HEALTH FAIRS, EDUCATION ON SPECIFIC DISEASES OR CONDITIONS, AND HEALTH PROMOTION AND WELLNESS PROGRAMS TO THE COMMUNITIES IT SERVES;9.PROVIDING SUPPORT GROUPS AND SELF HELP PROGRAMS TO THE COMMUNITIES ITSERVES;10.PROVIDING COMMUNITY-BASED CLINICAL SERVICES, INCLUDING WITHOUT LIMITATION, HEALTH SCREENINGS AND CLINICS FOR UNINSURED OR UNDERINSURED PERSONS TO THE COMMUNITIES IT SERVES;11.PROVIDING HEALTH CARE SUPPORT SERVICES, INCLUDING WITHOUT LIMITATION,INFORMATION AND REFERRAL TO COMMUNITY SERVICES, CASE MANAGEMENT OF UNDERINSURED AND UNINSURED PERSONS, TELEPHONE INFORMATION SERVICES ANDASSISTANCE TO ENROLL IN PUBLIC PROGRAMS, SUCH AS SCHIP AND MEDICAID TO THE COMMUNITIES IT SERVES;12.PROVIDING SUBSIDIZED HEALTH SERVICES AND CLINICAL PROGRAMS TO THE COMMUNITIES IT SERVES;13.PROVIDING CASH AND IN-KIND CONTRIBUTIONS TO NONPROFIT COMMUNITY HEALTHCARE ORGANIZATIONS IN THE COMMUNITIES IT SERVES; AND14.GENERALLY PROMOTING THE HEALTH, WELLNESS, AND WELFARE OF THE COMMUNITIES IT SERVES BY PROVIDING QUALITY HEALTHCARE SERVICES AT REASONABLE COST.FOR SPECIFIC EXAMPLES OF THIS ORGANIZATION'S COMMUNITY BENEFIT ACTIVITIES, WHICH FURTHER THE ORGANIZATION'S EXEMPT PURPOSES (AND THOSE OF ALL HOSPITALS AND HEALTH CARE FACILITIES IN THE SAME HEALTH CARE SYSTEM),PLEASE SEE THE NOVANT HEALTH 2010 COMMUNITY BENEFIT REPORT, LOCATED AT HTTP://WWW.NOVANTHEALTH.ORG/DOWNLOADS/FINANCIAL_INFO/2010_COMMUNITY_INVOLVEMENT.PDF PLEASE NOTE THAT THE NUMERIC INFORMATION IN THIS REPORT IS NOT BASED UPON THE FORM 990, SCHEDULE H CRITERIA, BUT RATHER IT HAS BEEN PREPARED IN ACCORDANCE WITH THE NORTH CAROLINA HOSPITAL ASSOCIATION REPORTING GUIDELINES.
PART VI, LINE 7: AFFILIATED HEALTH CARE SYSTEMTHE ORGANIZATION IS ONE OF TEN TAX-EXEMPT HOSPITALS IN THE NOVANT HEALTH CARE SYSTEM IN NORTH CAROLINA AND VIRGINIA. EACH HOSPITAL PROVIDES SUBSTANTIAL COMMUNITY BENEFIT TO THE COMMUNITY IT SERVES, AS REPORTED INDIVIDUALLY ON EACH HOSPITAL'S FORM 990, SCHEDULE H. THE COMMUNITY BENEFIT OF THE HEALTH CARE SYSTEM AS A WHOLE IS DOCUMENTED IN A SYSTEM-WIDE COMMUNITY BENEFIT REPORT, LOCATED AT HTTP://WWW.NOVANTHEALTH.ORG/DOWNLOADS/FINANCIAL_INFO/2010_COMMUNITY_INVOLVEMENT.PDF. PLEASE NOTE THAT THE NUMERIC INFORMATION IN THIS REPORT IS NOT BASED UPON THE FORM 990, SCHEDULE H CRITERIA, BUT RATHER IT HAS BEEN PREPARED IN ACCORDANCE WITH THE NORTH CAROLINA HOSPITAL ASSOCIATION REPORTING GUIDELINES. THE NOVANT HEALTH CARE SYSTEM ALSO INCLUDES AN ORGANIZATION THAT OWNS PHYSICIAN PRACTICES IN VIRGINIA, SOUTH CAROLINA, AND NORTH CAROLINA, WHICH PROVIDE ADDITIONAL COMMUNITY BENEFIT TO THEIR COMMUNITIES, AND FIVE HOSPITAL FOUNDATIONS, WHICH SUPPORT AND ENHANCE THE COMMUNITY BENEFIT ACTIVITIES IN THOSE HOSPITAL'S COMMUNITIES. FURTHER, THE NOVANT HEALTH CARE SYSTEM INCLUDES AMBULATORY SURGERY CENTERS, SKILLED NURSING FACILITIES, REHABILITATION PROGRAMS, AND OTHER OUTPATIENT FACILITIES, WHICH ALSO PROVIDE COMMUNITY BENEFIT TO THEIR COMMUNITIES. THERE ARE SIGNIFICANT COMMUNITY BENEFIT ACTIVITIES WITHIN THE NOVANT HEALTH SYSTEM, WHICH MAY NOT BE REPORTABLE ON A SCHEDULE H BECAUSE THEY ARE NOT CONDUCTED BY AN ENTITY WHICH OWNS OR OPERATES A HOSPITAL. THE HEALTH CARE SYSTEM HAS A COMMUNITY BENEFIT COMMITTEE, WHICH WILL OVERSEE AND ASSIST ALL TAX-EXEMPT HOSPITALS WITHIN NOVANT IN PREPARING THEIR COMMUNITY NEEDS ASSESSMENTS AND COMMUNITY BENEFIT PLANS. THE GOAL OF HAVING A SYSTEM-WIDE COMMITTEE IS TO IDENTIFY COMMUNITY BENEFIT ACTIVITIES THAT ARE DUPLICATIVE IN COMMUNITIES AND TO STREAMLINE AND COORDINATE EFFORTS TO RESULT IN BETTER AND MORE EFFICIENT USES OF RESOURCES, WHICH COULD LEAD TO ADDITIONAL RESOURCES TO BE ALLOCATED TO MEET OTHER COMMUNITY NEEDS, AND TO REPLICATE SUCCESSFUL PROGRAMS AND ACTIVITIES IN COMMUNITIES WHERE A SIMILAR NEED IS INDICATED. ALL OF THE TAX-EXEMPT HOSPITALS WITHIN THE NOVANT HEALTH CARE SYSTEM ARE COMMITTED TO IMPROVING THE HEALTH OF THEIR COMMUNITIES AND PROVIDING COMMUNITY BENEFIT ACTIVITIES TO SUPPORT THEIR MISSION.
NCNOVANT HEALTH, INC. FILES A SYSTEM-WIDE COMMUNITY BENEFIT REPORT PREPARED IN ACCORDANCE WITH THE NORTH CAROLINA HOSPITAL ASSOCIATION REPORTING GUIDELINES WITH THE NORTH CAROLINA MEDICAL CARE COMMISSION AS PART OF THE DOCUMENTATION REQUIRED FOR THE ISSUANCE OF TAX EXEMPT BOND FINANCING.PART VI, LINE 7, STATE FILING OF COMMUNITY BENEFIT REPORT

Schedule I IRS990ScheduleI

FieldValueIRS element (for citing)
Records Maintained0RecordsMaintained

Recipient Table RecipientTable (4 entries)

Address Line1AddressUS/AddressLine1CityAddressUS/CityStateAddressUS/StateZIP CodeAddressUS/ZIPCodeEIN Of RecipientEINOfRecipientIRC SectionIRCSectionAmount Of Cash GrantAmountOfCashGrantPurpose Of GrantPurposeOfGrant
PRINCE WILLIAM HEALTH PARTNERSHIP
2296 OPITZ BLVD SUITE 320WOODBRIDGEVA22191030444689330000COMMUNITY DEVELOPMENT
SKILLSOURCE GROUP INC
8330 BOONE BLVD SUITE 450VIENNAVA22182300129320326301COMMUNITY DEVELOPMENT
MEDICAL MISSIONARIES-AMERISOURCE BERGEN
9590 SURVEYOR CTMANASSASVA20110541990595321015COMMUNITY DEVELOPMENT
PERSONAL CARE SERVICES
2085 FRONTIS PLAZA BLVDWINSTON SALEMNC271035412912843133100COMMUNITY DEVELOPMENT
FieldValueIRS element (for citing)
Total Nbr Of501 C3 And Govt Grants4TotalNbrOf501C3AndGovtGrants
Total Nbr Of Other Organizations0TotalNbrOfOtherOrganizations

Form990 Schedule I Part IV Form990ScheduleIPartIV

FieldValueIRS element (for citing)
IdentifierOTHER INFORMATION:Identifier
Return ReferencePART IV:ReturnReference
ExplanationPART I, LINE 2 - PROCEDURES FOR MONITORING THE USE OF GRANT FUNDS THE ORGANIZATION HAS GUIDELINES IN PLACE THAT ARE TO BE USED IN REVIEWING THE ELIGIBILITY AND SELECTION OF GRANTEES, BUT DOES NOT HAVE A STANDARDIZED PROCESS SYSTEM-WIDE. RECORDS ARE MAINTAINED OF THE AMOUNTS VIA THE GENERAL LEDGER. THE ORGANIZATION IS CURRENTLY WORKING TO INSTITUTE A MORE FORMAL POLICY TO ADDRESS GRANTEE ELIGIBILITY, SELECTION, AND RECORD MAINTENANCE.Explanation

Schedule J IRS990ScheduleJ

FieldValueIRS element (for citing)
First Class Or Charter TravelXFirstClassOrCharterTravel
Travel For CompanionsXTravelForCompanions
Idemnification Gross Up PaymentsXIdemnificationGrossUpPayments
Discretionary Spending AccountXDiscretionarySpendingAccount
Housing Allowance Or ResidenceXHousingAllowanceOrResidence
Club Dues Or FeesXClubDuesOrFees
Written Policy Re T And E Expenses1WrittenPolicyReTAndEExpenses
Substantiation Required0SubstantiationRequired
Compensation CommitteeXCompensationCommittee
Independent ConsultantXIndependentConsultant
Written Employment ContractXWrittenEmploymentContract
Compensation SurveyXCompensationSurvey
Board Or Committee ApprovalXBoardOrCommitteeApproval
Severance Payment1SeverancePayment
Supplemental Nonqual Retire Plan1SupplementalNonqualRetirePlan
Equity Based Comp Arrangement1EquityBasedCompArrangement
Comp Based On Revenue Of Filing Org0CompBasedOnRevenueOfFilingOrg
Comp Based On Revenue Related Orgs0CompBasedOnRevenueRelatedOrgs
Comp Based Net Earnings Filing Org0CompBasedNetEarningsFilingOrg
Comp Based Net Earnings Relate Orgs0CompBasedNetEarningsRelateOrgs
Any Non Fixed Payments0AnyNonFixedPayments
Initial Contract Exception0InitialContractException

Form990 Schedule J Part II Form990ScheduleJPartII (9 entries)

Base Compensation Filing OrgBaseCompensationFilingOrgComp Based On Related OrgsCompBasedOnRelatedOrgsBonus Filing OrgBonusFilingOrgBonus Related OrgsBonusRelatedOrgsOther Compensation Filing OrgOtherCompensationFilingOrgOther Compensation Related OrgsOtherCompensationRelatedOrgsDeferred Comp Filing OrgDeferredCompFilingOrgDeferred Comp Related OrgsDeferredCompRelatedOrgsNontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgNontaxable Benefits Related OrgsNontaxableBenefitsRelatedOrgsTotal Compensation Filing OrgTotalCompensationFilingOrgTotal Compensation Related OrgsTotalCompensationRelatedOrgsComp Report Prior990 Filing OrgCompReportPrior990FilingOrgComp Report Prior990 Related OrgsCompReportPrior990RelatedOrgs
ROBSONMELISSA L
273346521411000003825017332568082091065416204505718776227108333038250
WILESPAUL M
01018783083680001286485010220690652580422939502013622
RILEYROBERT W
2880130235456010274058831017077060965102354560
SCHWARTZMICHAEL J
170992049477503489123824821230502006010289903824824947750
DAVISMARY DENISE
25629010242101589710151505877029441301024220
KRENYTZKY MDSTEPHEN
25534402512005534100006822801068103649071000000
LOVELLTERRANCE
1741070987200420702047201778403152900986000
TIPPLECYNDA M
25705502180310694807062907225055988802180010
TRAVERS MDRICHARD M
000024354603021000246567000

Form990 Schedule J Part III Form990ScheduleJPartIII (4 entries)

Return ReferenceReturnReferenceExplanationExplanationIdentifierIdentifier
PART I, LINE 1AFRINGE OR EXPENSE EXPLANATION FIRST-CLASS OR CHARTER TRAVEL: FIRST-CLASS OR CHARTER TRAVEL IS NOT A COVERED TRAVEL EXPENSE FOR EXECUTIVES; THEY ARE LIMITED TO BUSINESS OR COACH CLASS FARES FOR COMMERCIAL FLIGHTS. HOWEVER, CHARTER TRAVEL IS AVAILABLE TO CERTAIN EXECUTIVES, BOARD MEMBERS, AND APPROVED BUSINESS PERSONNEL IN LIMITED CIRCUMSTANCES DEEMED TO INVOLVE BUSINESS NECESSITY. TRAVEL FOR COMPANIONS: COMPANIONS ARE ALLOWED ON CERTAIN CHARTER FLIGHTS PAID FOR BY THE ORGANIZATION. IN THAT CASE, THE VALUE OF THE COMPANION'S FLIGHT IS CALCULATED UNDER APPLICABLE TAX LAWS AND THAT AMOUNT IS INCLUDED IN THE EXECUTIVE'S TAXABLE INCOME AS PRESCRIBED BY THE APPLICABLE TAX LAWS. TAX INDEMNIFICATION AND GROSS-UP PAYMENTS: EXECUTIVES WHO PURCHASE SPLIT DOLLAR INSURANCE THROUGH THEIR DISCRETIONARY SPENDING ACCOUNT MAY HAVE THE ADDITIONAL INCOME TAX OWED ON THE PS-58 COSTS PAID BY THE ORGANIZATION. EXECUTIVES WHO RECEIVE TAXABLE RELOCATION INCOME MAY HAVE THE ADDITIONAL INCOME TAX OWED ON THE INCOME PAID BY THE ORGANIZATION. EXECUTIVES MAY RECEIVE AS SEVERANCE BENEFITS CASH PAYMENTS IN LIEU OF PREMIUMS PAID FOR COVERAGE OF CERTAIN GROUP BENEFITS THAT ENDED WITH THE EXECUTIVE'S TERMINATION. THE ORGANIZATION MAY PAY THE ADDITIONAL TAX OWED ON ACCOUNT OF THESE PAYMENTS. DISCRETIONARY SPENDING ACCOUNT: CERTAIN EXECUTIVES RECEIVE A DISCRETIONARY SPENDING ACCOUNT. THE DOLLAR AMOUNT IN THE ACCOUNT IS PRE-APPROVED BY THE COMPENSATION AND LEADERSHIP COMMITTEE OF THE BOARD. THE ACCOUNT CAN BE USED ONLY FOR AN APPROVED LIST OF EXPENDITURES. ALL OPTIONS OTHER THAN A DEFERRED, AT-RISK, COMPENSATION OPTION ARE CONSIDERED TAXABLE AND ARE INCLUDED IN THE EXECUTIVE'S TAXABLE INCOME AS PRESCRIBED BY THE APPLICABLE TAX LAWS. HOUSING ALLOWANCE OR RESIDENCE FOR PERSONAL USE: WE PROVIDE TEMPORARY HOUSING ALLOWANCES IN CERTAIN EXECUTIVE RECRUITMENT AND RELOCATION PACKAGES. IN THE CASE THAT SUCH EXPENSE IS NOT REIMBURSABLE UNDER THE ACCOUNTABLE PLAN RULES, THE VALUE IS CALCULATED UNDER APPLICABLE TAX LAWS AND THAT AMOUNT IS INCLUDED IN THE EXECUTIVE'S INCOME AS PRESCRIBED BY THE APPLICABLE TAX LAWS. THE ORGANIZATION PROVIDES A TEMPORARY RESIDENCE FOR LIMITED EXECUTIVE USE THAT AT TIMES MAY INCLUDE INCIDENTAL PERSONAL USE. IN THAT CASE, THE VALUE IS CALCULATED UNDER APPLICABLE TAX LAWS AND THAT AMOUNT IS INCLUDED IN THE EXECUTIVE'S TAXABLE INCOME AS PRESCRIBED BY THE APPLICABLE TAX LAWS. HEALTH OR SOCIAL CLUB DUES OR INITIATION FEES: IN CASES WHERE CORPORATE MEMBERSHIPS ARE NOT AVAILABLE, A MEMBERSHIP MAY BE OBTAINED IN AN EXECUTIVE'S NAME WITH A "BUSINESS USE ONLY" RESTRICTION. AT THIS TIME NOVANT HAS ONE SUCH MEMBERSHIP.
PART I, LINES 4A-CSEVERANCE, NONQUALIFIED, AND EQUITY-BASED PAYMENTS SEVERANCE NONQUALIFIED EQUITY-BASED WILES, PAUL 0 1,176,822 0 DAVIS, MARY D 138,464 0 0 TRAVERS, RICHARD M 187,343 0 0
PART IIIPART III - OTHER ADDITIONAL INFORMATION DESCRIPTIONS OF SUPPLEMENTAL EXECUTIVE BENEFITS INCLUDED IN PART VII AND SCHEDULE J: EXECUTIVE ANNUAL INCENTIVE PLAN: AS PART OF THE REPORTED COMPENSATION AMOUNTS, THE REPORTING ORGANIZATION PROVIDES ANNUAL INCENTIVE COMPENSATION TO OFFICERS AND KEY EMPLOYEES UNDER AN EXECUTIVE ANNUAL INCENTIVE PLAN. THE INCENTIVE PLAN IS DESIGNED TO OFFER OPPORTUNITIES FOR ADDITIONAL COMPENSATION, BUT ONLY TO THE EXTENT THAT ELIGIBLE EXECUTIVES HAVE PROVIDED EXTRAORDINARY SERVICES AND ACHIEVED EXTRAORDINARY RESULTS THAT MEET OR EXCEED PREDETERMINED GOALS IN THE AREAS OF QUALITY, PATIENT SATISFACTION, EMPLOYEE SATISFACTION AND FINANCIAL VITALITY. THESE GOALS ARE ESTABLISHED BY INDEPENDENT AND DISINTERESTED MEMBERS OF THE NOVANT HEALTH BOARD OF TRUSTEES (WHO COMPRISE THE COMPENSATION AND LEADERSHIP COMMITTEE OF THE BOARD). THESE GOALS ARE WEIGHTED EQUALLY. THE ADDITIONAL COMPENSATION CAN RANGE ANYWHERE FROM ZERO TO A MAXIMUM PERCENTAGE OF BASE SALARY THAT DIFFERS BY THE CLASS OF EXECUTIVE; THIS MAXIMUM PERCENTAGE RANGES FROM 30% TO 70% OF BASE SALARY. IN ADDITION, THE INDEPENDENT MEMBERS OF THE BOARD OF TRUSTEES WHO OVERSEE THE INCENTIVE COMPENSATION PROGRAM APPLY TWO "CIRCUIT BREAKERS," WHICH ARE SUBSTANTIAL LEVELS OF ORGANIZATION-WIDE ACHIEVEMENT THAT MUST BE SATISFIED BEFORE ANY AWARDS ARE PAID TO ANY EXECUTIVE UNDER THE PROGRAM. THE INCENTIVE COMPENSATION AWARDS HAVE BEEN INCLUDED IN THE COMPENSATION AMOUNTS REPORTED IN PART VII AND IN COLUMN (B)(II) OF SCHEDULE J. THEY ARE REPORTED IN THE YEAR EARNED AND ARE PAID BY MARCH 15TH OF THE SUBSEQUENT YEAR. INDEPENDENT AND DISINTERESTED MEMBERS OF THE NOVANT HEALTH BOARD OF TRUSTEES (WHO COMPRISE THE COMPENSATION AND LEADERSHIP COMMITTEE OF THE BOARD) REVIEW, APPROVE, AND OVERSEE ALL ASPECTS AND ALL ELEMENTS OF EXECUTIVE COMPENSATION AND BENEFITS, INCLUDING THE AMOUNTS AWARDED UNDER THIS ANNUAL INCENTIVE PLAN. LONG-TERM INCENTIVE PLAN: THE REPORTING ORGANIZATION OFFERS A LONG-TERM INCENTIVE PLAN (THE "PLAN") TO CERTAIN KEY EXECUTIVES. THE PLAN TIES A KEY EXECUTIVE'S COMPENSATION TO THE ORGANIZATION'S LONG-TERM STRATEGIC PERFORMANCE, PROVIDES A RETENTION INCENTIVE FOR KEY EXECUTIVES, AND ALLOWS THE ORGANIZATION TO COMPETE IN THE MARKETPLACE FOR TOP LEADERSHIP TALENT. THE PLAN OPERATES ON THREE-YEAR PERFORMANCE CYCLES THAT BEGIN EACH YEAR. LONG-TERM STRATEGIC GOALS (IN THE PRINCIPAL AREAS OF QUALITY OF PATIENT CARE AND LONG-TERM FINANCIAL STRENGTH) ARE ESTABLISHED FOR EACH CYCLE, IN ADVANCE, BY INDEPENDENT AND DISINTERESTED MEMBERS OF THE NOVANT HEALTH BOARD OF TRUSTEES (WHO COMPRISE THE COMPENSATION AND LEADERSHIP COMMITTEE OF THE BOARD). A MINIMUM LEVEL OF COMMUNITY BENEFIT AND CHARITY CARE, AS WELL AS A MINIMUM LEVEL OF FINANCIAL PERFORMANCE, IS REQUIRED BEFORE ANY AWARD CAN BE PAID UNDER THE PLAN. NOVANT HEALTH'S INTERNAL AUDIT DEPARTMENT REVIEWS THE METHODOLOGY AND PROCESS USED TO DETERMINE ACHIEVEMENT OF THE QUALITY METRICS. AWARDS ARE PAYABLE FOR A PARTICULAR THREE-YEAR PERFORMANCE CYCLE ONLY IF THE REQUISITE LEVEL OF COMMUNITY BENEFIT AND CHARITY CARE, ALONG WITH THE REQUIRED LEVEL OF FINANCIAL PERFORMANCE TO DEMONSTRATE LONG-TERM FINANCIAL STRENGTH, HAVE BEEN MET FOR THAT RESPECTIVE THREE-YEAR PERFORMANCE PERIOD. IF AN AWARD IS EARNED AT THE END OF A PERFORMANCE CYCLE, THEN THE INCENTIVE AWARD IS PAID OUT AND IS INCLUDED IN THE COMPENSATION AMOUNTS REPORTED IN PART VII AND IN COLUMN (B)(II) OF SCHEDULE J. THE AWARD IS REPORTED IN THE YEAR EARNED AND IS PAID BY MARCH 15TH OF THE SUBSEQUENT YEAR. INDEPENDENT AND DISINTERESTED MEMBERS OF THE NOVANT HEALTH BOARD OF TRUSTEES (WHO COMPRISE THE COMPENSATION AND LEADERSHIP COMMITTEE OF THE BOARD) REVIEW, APPROVE, AND OVERSEE ALL ASPECTS AND ALL ELEMENTS OF EXECUTIVE COMPENSATION AND BENEFITS, INCLUDING THE AMOUNTS AWARDED UNDER THIS LONG-TERM INCENTIVE PLAN. SCHEDULE J PART I LINE 4A - SEVERANCE PLAN: ELIGIBLE EXECUTIVES MAY RECEIVE SEVERANCE PAY THAT IS A SPECIFIED MULTIPLE OF ANNUAL COMPENSATION. THE SEVERANCE PAY WOULD BE PAID ONLY IN THE EVENT OF CERTAIN TYPES OF EMPLOYMENT TERMINATION, AND IS FURTHER CONTINGENT ON THE SATISFACTION OF OTHER CONDITIONS SUCH AS COMPLIANCE WITH A NON-COMPETITION COVENANT. ANY CURRENT YEAR PAYMENTS HAVE BEEN INCLUDED IN THE COMPENSATION AMOUNTS REPORTED IN PART VII AND IN COLUMN (B)(III) OF SCHEDULE J. INDEPENDENT AND DISINTERESTED MEMBERS OF THE NOVANT HEALTH BOARD OF TRUSTEES (WHO COMPRISE THE COMPENSATION AND LEADERSHIP COMMITTEE OF THE BOARD) REVIEW, APPROVE, AND OVERSEE ALL ASPECTS AND ALL ELEMENTS OF EXECUTIVE COMPENSATION AND BENEFITS, INCLUDING THE AMOUNTS AWARDED UNDER THIS SEVERANCE PLAN. SCHEDULE J PART I LINE 4B - SUPPLEMENTAL NONQUALIFIED RETIREMENT PLANS: SUPPLEMENTAL EXECUTIVE RETIREMENT PLAN: THE SUPPLEMENTAL EXECUTIVE RETIREMENT PLAN ("SERP") IS INTENDED TO SUPPORT RETENTION OF KEY EXECUTIVES, AND TO OFFER COMPETITIVE TOTAL COMPENSATION. THESE SERP BENEFITS ARE CALCULATED WITH REFERENCE TO A FORMULA THAT TAKES INTO CONSIDERATION THE EXECUTIVE'S TOTAL YEARS OF SERVICE WITH THE ORGANIZATION AND OTHER RETIREMENT INCOME. THESE BENEFITS ARE FULLY AT RISK AND WILL NOT BE PAID UNLESS THE EXECUTIVE PROVIDES SUBSTANTIAL FUTURE SERVICES TO THE ORGANIZATION. UNTIL THOSE REQUIREMENTS ARE SATISFIED, IF EVER, THE EXECUTIVE IS NOT ENTITLED TO ANY SERP BENEFIT. IF THE EXECUTIVE WERE TO HAVE LEFT THE ORGANIZATION VOLUNTARILY DURING THE YEAR FOR WHICH THESE AMOUNTS ARE BEING REPORTED (BEFORE REACHING BOTH AGE 55 AND HAVING FIVE YEARS OF SERVICE WITH THE ORGANIZATION), THE EXECUTIVE'S SERP BENEFIT WOULD HAVE BEEN ENTIRELY FORFEITED. THE SERP BENEFIT IS REDUCED AT THE RATE OF 2 PERCENTAGE POINTS PER YEAR FOR PAYMENTS RECEIVED BETWEEN THE AGES OF 55 AND 62. CURRENT YEAR PAYMENTS OF SERP BENEFITS HAVE BEEN INCLUDED IN THE COMPENSATION AMOUNTS REPORTED IN PART VII AND IN COLUMN (B)(III) OF SCHEDULE J. AN ESTIMATE OF THE ANNUAL INCREASE IN ACTUARIAL VALUE IS REPORTED AS DEFERRED COMPENSATION IN PART VII AND IN COLUMN (C) OF SCHEDULE J FOR ELIGIBLE EXECUTIVES. INDEPENDENT AND DISINTERESTED MEMBERS OF THE NOVANT HEALTH BOARD OF TRUSTEES (WHO COMPRISE THE COMPENSATION AND LEADERSHIP COMMITTEE OF THE BOARD) REVIEW, APPROVE, AND OVERSEE ALL ASPECTS AND ALL ELEMENTS OF EXECUTIVE COMPENSATION AND BENEFITS, INCLUDING THE AMOUNTS AWARDED UNDER THIS SUPPLEMENTAL RETIREMENT PLAN.SUPPLEMENTAL INFORMATION
PART IIISCHEDULE J PART I LINE 4C - EQUITY-BASED COMPENSATION ARRANGEMENT: NOVANT HEALTH, INC. ("NOVANT") CHIEF EXECUTIVE OFFICER PAUL WILES IS A GRANDFATHERED PARTICIPANT IN A SHARE OPTION PLAN (THE "DISCOUNT STOCK OPTION PLAN"), UNDER WHICH HE RECEIVED FROM NOVANT OPTIONS TO PURCHASE CERTAIN MUTUAL FUND SHARES OWNED BY THE ORGANIZATION. NO OPTIONS WERE GRANTED AFTER MAY 8, 2002. THE OPTIONS GRANTED WERE DISCLOSED ON A PRIOR 990 OF NOVANT HEALTH, INC. WHEN THE OPTIONS ARE EXERCISED, THE RESULTING GAIN WILL BE TREATED AS TAXABLE COMPENSATION INCOME, IN ACCORDANCE WITH FEDERAL INCOME TAX LAW.SUPPLEMENTAL INFORMATION

Schedule L IRS990ScheduleL

Form990 Schedule L Part IV Form990ScheduleLPartIV

Name Of Interested Person NameOfInterestedPerson

Name Business NameBusiness

FieldValueIRS element (for citing)
Business Name Line1PRINCE WILLIAM OB-GYN (PWOG)BusinessNameLine1
FieldValueIRS element (for citing)
RelationshipENTITY OWNED > 5% BY JOANNE GUTLIPH, BOARD MEMBERRelationship
Amount Of Transaction126990AmountOfTransaction
Description Of TransactionTHE FILING ORGANIZATION HAS A LEASE IN PLACE WITH PWOGDescriptionOfTransaction
Sharing Of Revenues0SharingOfRevenues

Schedule O IRS990ScheduleO

General Explanation GeneralExplanation (12 entries)

IdentifierIdentifierReturn ReferenceReturnReferenceExplanationExplanation
ACTIVITESFORM 990, PART I, LINE 1: ORGANIZATION'S MISSION OR MOST SIGNIFICANTIN 2010, PRINCE WILLIAM HOSPITAL, A 170-BED NOVANT HEALTH ACUTE CARE HOSPITAL LOCATED IN MANASSAS, VA, FOCUSED ON PROVIDING COMMUNITY SUPPORT, CONSISTENT QUALITY, EXCELLENT SERVICE AND A REMARKABLE WORK ENVIRONMENT FOR STAFF. OUR HOSPITAL IS COMMITTED TO MEETING THE HEALTHCARE NEEDS OF RESIDENTS OF MANASSAS, MANASSAS PARK AND WESTERN PRINCE WILLIAM COUNTY, ONE PERSON AT A TIME. THE PRINCE WILLIAM HOSPITAL IS PART OF THE NOVANT HEALTH SYSTEM (COLLECTIVELY KNOWN AS "NOVANT"), A NOT-FOR-PROFIT INTEGRATED GROUP OF HOSPITALS, PHYSICIAN CLINICS, OUTPATIENT CENTERS AND OTHER HEALTHCARE SERVICES - RANKED AS ONE OF OUR NATION'S TOP 20 HEALTHCARE SYSTEMS - CARING FOR PATIENTS AND COMMUNITIES IN NORTH CAROLINA, VIRGINIA AND SOUTH CAROLINA. THE NOVANT HEALTH SYSTEM REPORTED $3.392 BILLION IN REVENUES IN 2010. WE'RE VERY PROUD OF OUR PATIENT FINANCIAL ASSISTANCE PROGRAM. WE WORK WITH INDIVIDUALS TO HELP QUALIFY THEM FOR PUBLIC ASSISTANCE, ESTABLISH A REASONABLE PAYMENT PLAN, AND DISCOUNT THEIR BILL TO REFLECT THEIR PERSONAL RESOURCES OR PROVIDE THEM WITH FREE CHARITY CARE. IN ADDITION TO OUR FINANCIAL ASSISTANCE PROGRAMS, WE'RE PROUD OF THE QUALITY OF OUR SERVICES. THE HOSPITAL IS FULLY ACCREDITED BY THE JOINT COMMISSION, A NATIONWIDE SEAL OF APPROVAL DEMONSTRATING THAT A HOSPITAL MEETS HIGH PERFORMANCE STANDARDS. WE SUPPORT OTHER ORGANIZATIONS THAT PROVIDE HEALTH SERVICES, EDUCATION AND ASSISTANCE TO THE UNINSURED AND OVERALL COMMUNITY. SOME OF THESE ORGANIZATIONS INCLUDE THE PRINCE WILLIAM AREA FREE CLINIC, MEDICAL MISSIONARIES, AMERICAN DIABETES ASSOCIATION AND THE AMERICAN CANCER SOCIETY. PRINCE WILLIAM HOSPITAL ALSO SUPPORTED AND PARTICIPATED IN NUMEROUS COMMUNITY EVENTS SUCH AS THE ANNUAL ROTARY CHILDREN'S WELLNESS FESTIVAL, ANNUAL LATINO FESTIVAL, HAYMARKET DAY AND THE CITY OF MANASSAS HEALTH FAIR. IN THE SPRING, WE PLANNED AND SPONSORED A DIABETES EXPO FOR THE COMMUNITY, OFFERING FREE OR LOW-COST SCREENINGS FOR GLUCOSE, CHOLESTEROL, BODY COMPOSITION, BLOOD PRESSURE AND A1C AS WELL AS PARTNERING WITH OUR PHYSICIAN SPECIALISTS IN THE FIELDS OF ENDOCRINOLOGY, OPHTHALMOLOGY AND PODIATRY TO PROVIDE QUESTION AND ANSWER SESSIONS FOR PERSONS WITH DIABETES. OUR HOSPITAL'S VASCULAR PROCEDURE UNIT PARTNERED WITH OUR INTERVENTIONAL RADIOLOGY SPECIALISTS TO PROVIDE FREE SCREENINGS FOR PERIPHERAL VASCULAR DISEASE, STROKE AND ABDOMINAL AORTIC ANEURYSM. PRINCE WILLIAM HOSPITAL ALSO OFFERED A SERIES OF FREE EDUCATIONAL PHYSICIAN SEMINARS. THE 2010 PHYSICIAN COMMUNITY PROGRAMS COVERED THE SPECIALTIES OF ORTHOPEDICS, UROLOGY, CARDIOLOGY, INTERNAL MEDICINE, ENDOCRINOLOGY AND DIAGNOSTIC RADIOLOGY. IN MAY 1992, PRINCE WILLIAM HOSPITAL, SENTARA POTOMAC HOSPITAL, PRINCE WILLIAM MEDICAL SOCIETY AND THE PRINCE WILLIAM HEALTH DEPARTMENT ESTABLISHED THE PRINCE WILLIAM AREA FREE CLINIC. THE CLINIC, WHICH OPERATES SEVERAL DAYS EACH WEEK IN THREE LOCATIONS, IS A NOT-FOR-PROFIT ORGANIZATION THAT PROVIDES ACUTE AND CHRONIC MEDICAL CARE TO UNINSURED RESIDENTS IN PRINCE WILLIAM COUNTY. BOTH HOSPITALS CONTINUE TO PROVIDE FINANCIAL AND HUMAN RESOURCES TO CARE FOR FREE CLINIC PATIENTS. COMMUNITY BENEFIT REPORT: HTTP://WWW.NOVANTHEALTH.ORG/DOWNLOADS/FINANCIAL_INFO/2010_COMMUNITY_ INVOLVEMENT.PDF THE COMMUNITY BENEFIT REPORT PREPARED BY NOVANT HEALTH IS A SYSTEM-WIDE REPORT THAT INCLUDES QUALITATIVE AND QUANTITATIVE INFORMATION. IN THIS REPORT, THE NOVANT HEALTH SYSTEM'S COMMUNITY BENEFIT WAS APPROXIMATELY $469,000,000 IN 2010. PLEASE NOTE THAT THE NUMERIC DATA IN THIS REPORT IS NOT BASED UPON THE FORM 990, SCHEDULE H CRITERIA, BUT RATHER IT HAS BEEN PREPARED IN ACCORDANCE WITH THE NORTH CAROLINA HOSPITAL ASSOCIATION REPORTING GUIDELINES. IT SHOULD NOT BE RELIED UPON AS THE ORGANIZATION'S FORM 990, SCHEDULE H COMMUNITY BENEFIT REPORT.
FORM 990, PART III, LINE 1: MISSION, VISION AND VALUESMISSION: NOVANT HEALTH EXISTS TO IMPROVE THE HEALTH OF COMMUNITIES, ONE PERSON AT A TIME. VISION: WE, THE EMPLOYEES OF NOVANT AND OUR PHYSICIAN PARTNERS, WILL DELIVER THE MOST REMARKABLE PATIENT EXPERIENCE, IN EVERY DIMENSION, EVERY TIME. VALUES: COMPASSION: WE TREAT OUR CUSTOMERS AND THEIR FAMILIES, STAFF AND OTHER HEALTHCARE PROVIDERS AS FAMILY MEMBERS BY SHOWING THEM KINDNESS, PATIENCE, EMPATHY AND RESPECT. DIVERSITY: WE RECOGNIZE THAT EVERY PERSON IS DIFFERENT, EACH SHAPED BY UNIQUE LIFE EXPERIENCES. THIS ENABLES US TO BETTER UNDERSTAND ONE ANOTHER AND OUR CUSTOMERS. PERSONAL EXCELLENCE: WE STRIVE TO GROW PERSONALLY AND PROFESSIONALLY, AND WE APPROACH EACH SERVICE OPPORTUNITY WITH A POSITIVE, FLEXIBLE ATTITUDE. HONESTY AND PERSONAL INTEGRITY GUIDE ALL THAT WE DO. TEAMWORK: THE NEEDS AND EXPECTATIONS OF ANY ONE CUSTOMER ARE GREATER THAN THAT WHICH ONE PERSON'S SERVICE EFFORTS CAN SATISFY. WE SUPPORT EACH OTHER SO THAT TOGETHER AS A TEAM, WE CAN BE SUCCESSFUL IN THE EYE OF THE CUSTOMER AS A QUALITY SERVICE PROVIDER.
FORM 990, PART I, LINE 6:THE NUMBER OF VOLUNTEERS REPORTED INCLUDES THOSE VOLUNTEERS SERVING AS BOARD MEMBERS.
FORM 990, PART VI, SECTION A, LINE 6CLASSES OF MEMBERS OR STOCKHOLDERS THE CORPORATION IS A NONPROFIT CORPORATION WITH MEMBERS (OR A MEMBER).
FORM 990, PART VI, SECTION A, LINE 7AELECTION OF MEMBERS AND THEIR RIGHTS NOVANT HEALTH, INC. APPOINTS ALL BOARD MEMBERS OF PRINCE WILLIAM HOSPITAL.
FORM 990, PART VI, SECTION A, LINE 7BDECISIONS SUBJECT TO APPROVAL OF MEMBERS UPON APPROVAL BY NOVANT HEALTH, INC., PRINCE WILLIAM HEALTH SYSTEM APPROVES CERTAIN TRANSACTIONS INCLUDING AMENDMENTS TO THE ARTICLES AND BYLAWS OF THE CORPORATION, AND ADOPTION OF CERTAIN POLICIES TO BE IMPLEMENTED BY THE CORPORATION BOARD.
FORM 990, PART VI, SECTION B, LINE 11ORGANIZATION'S PROCESS TO REVIEW FORM 990 THE BOARD HAS DELEGATED REVIEW OF THE FORM 990 TO NOVANT HEALTH'S AUDIT AND COMPLIANCE COMMITTEE, WHICH OVERSEES TAX MATTERS FOR NOVANT HEALTH. THE AUDIT AND COMPLIANCE COMMITTEE IS THE REVIEW BODY FOR ALL OF THE FORM 990S FILED FOR ORGANIZATIONS WITHIN THE NOVANT HEALTH SYSTEM. THE AUDIT AND COMPLIANCE COMMITTEE MEETS BEFORE THE FORM 990S ARE FILED WITH THE IRS AND AFTER ALL BOARD MEMBERS HAVE RECEIVED A COPY OF THE FORM 990 AND A SUMMARY OF ITS CONTENTS. THE DIRECTOR OF TAX AND BENEFITS AND LEGAL COUNSEL FOR NOVANT HEALTH ATTEND THE MEETING TO ANSWER ANY QUESTIONS AND ADDRESS ANY SIGNIFICANT DISCLOSURES WITHIN THE FORM 990.
FORM 990, PART VI, SECTION B, LINE 12FORM 990, PART VI, SECTION B, LINE 12A: WRITTEN COI POLICY THE ORGANIZATION IS PART OF THE NOVANT HEALTH, INC. ("NOVANT HEALTH") HEALTH CARE SYSTEM. NOVANT HEALTH'S BYLAWS AUTHORIZE IT TO ESTABLISH CERTAIN POLICIES FOR ALL OF ITS SUBSIDIARIES COMPRISING THE HEALTH CARE SYSTEM. ALL SUBSIDIARY ORGANIZATIONS FOLLOW ALL APPLICABLE NOVANT HEALTH CORPORATE POLICIES IN THEIR OPERATIONS. NOVANT HEALTH HAS ESTABLISHED A CONFLICTS OF INTEREST POLICY, WHICH ALL SUBSIDIARY ORGANIZATIONS IN THE HEALTH CARE SYSTEM FOLLOW. THE INDIVIDUAL SUBSIDIARY ORGANIZATION BOARD OF TRUSTEES DO NOT SPECIFICALLY ADOPT OR APPROVE EACH OPERATING POLICY, AS THERE ARE HUNDREDS OF POLICIES THAT APPLY TO ALL SUBSIDIARY ORGANIZATIONS AND THEY CANNOT PRACTICABLY BE APPROVED BY ALL OF THE INDIVIDUAL BOARDS. FORM 990, PART VI, SECTION B, LINE 12B: COI DISCLOSURE THE ANSWER TO THIS QUESTION IS YES, BUT BECAUSE THE ANSWER TO 12A IS NO BECAUSE THE ORGANIZATION'S BOARD DID NOT SPECIFICALLY ADOPT A CONFLICT OF INTEREST POLICY, THE RETURN PREPARATION SOFTWARE WILL NOT ALLOW A YES ANSWER TO THIS QUESTION. AS NOTED ABOVE, THE ORGANIZATION FOLLOWS A CONFLICT OF INTEREST POLICY ESTABLISHED BY ITS PARENT ORGANIZATION, NOVANT HEALTH, INC. ("NOVANT HEALTH"), WHICH IS AUTHORIZED BY ITS BYLAWS TO ESTABLISH CERTAIN POLICIES FOR ALL OF ITS SUBSIDIARIES COMPRISING THE NOVANT HEALTH HEALTH CARE SYSTEM. ALL SUBSIDIARY ORGANIZATIONS FOLLOW ALL APPLICABLE NOVANT HEALTH CORPORATE POLICIES IN THEIR OPERATIONS. THIS INCLUDES THE CONFLICT OF INTEREST POLICY, WHICH REQUIRES AN ANNUAL DISCLOSURE OF SITUATIONS THAT COULD GIVE RISE TO A CONFLICT. FORM 990, PART VI, SECTION B, LINE 12C: ENFORCEMENT OF CONFLICTS POLICY THE ANSWER TO THIS QUESTION IS YES, BUT BECAUSE THE ANSWER TO 12A IS NO BECAUSE THE ORGANIZATION'S BOARD DID NOT SPECIFICALLY ADOPT THE CONFLICT OF INTEREST POLICY, THE RETURN PREPARATION SOFTWARE WILL NOT ALLOW A YES ANSWER TO THIS QUESTION. AS NOTED ABOVE, THE ORGANIZATION FOLLOWS A CONFLICT OF INTEREST POLICY ESTABLISHED BY ITS PARENT ORGANIZATION, NOVANT HEALTH, INC. ("NOVANT HEALTH"), WHICH IS AUTHORIZED BY ITS BYLAWS TO ESTABLISH CERTAIN POLICIES FOR ALL OF ITS SUBSIDIARIES COMPRISING THE NOVANT HEALTH HEALTH CARE SYSTEM. ALL SUBSIDIARY ORGANIZATIONS FOLLOW ALL APPLICABLE NOVANT HEALTH CORPORATE POLICIES IN THEIR OPERATIONS. THIS INCLUDES THE CONFLICT OF INTEREST POLICY. THE ORGANIZATION'S TRUSTEE CONFLICT OF INTEREST POLICY APPLIES TO ALL TRUSTEES, PRINCIPAL OFFICERS OR MEMBERS OF A COMMITTEE WITH BOARD DELEGATED POWERS INCLUDING ANY APPLICABLE DISREGARDED ENTITIES. ALL TRUSTEES ARE SENT AN ANNUAL DISCLOSURE FORM. ANY POSITIVE ANSWERS ON THE TRUSTEE ANNUAL DISCLOSURE FORM ARE REVIEWED BY THE GENERAL COUNSEL. IF THE RELATIONSHIP DISCLOSED IS DETERMINED NOT TO POSE A POTENTIAL CONFLICT OF INTEREST GENERALLY, THEN NO ACTION IS TAKEN. WITH RESPECT TO PARTICULAR TRANSACTIONS THAT COME BEFORE THE BOARD, THE CONFLICT OF INTEREST POLICY WOULD BE FOLLOWED. THE POTENTIAL CONFLICT OF INTEREST WOULD BE DISCLOSED BY THE BOARD MEMBER BEFORE A VOTE ON THE TRANSACTION AND THE REST OF THE BOARD WOULD DETERMINE WHETHER A CONFLICT OF INTEREST EXISTS. IF THE REST OF THE BOARD DETERMINED THAT A CONFLICT OF INTEREST EXISTED THEN THE BOARD MEMBER WITH THE CONFLICT OF INTEREST WOULD NOT PARTICIPATE IN THE DELIBERATIONS AND VOTE. FORM 990, PART VI, SECTION B, LINE 13: WRITTEN WHISTLEBLOWER POLICY THE ORGANIZATION IS PART OF THE NOVANT HEALTH, INC. ("NOVANT HEALTH") HEALTH CARE SYSTEM. NOVANT HEALTH'S BYLAWS AUTHORIZE IT TO ESTABLISH CERTAIN POLICIES FOR ALL OF ITS SUBSIDIARIES COMPRISING THE HEALTH CARE SYSTEM. ALL SUBSIDIARY ORGANIZATIONS FOLLOW ALL APPLICABLE NOVANT HEALTH CORPORATE POLICIES IN THEIR OPERATIONS. NOVANT HEALTH HAS ESTABLISHED A WHISTLEBLOWER POLICY, WHICH ALL SUBSIDIARY ORGANIZATIONS IN THE HEALTH CARE SYSTEM FOLLOW. THE INDIVIDUAL SUBSIDIARY ORGANIZATION BOARD OF TRUSTEES DO NOT SPECIFICALLY ADOPT OR APPROVE EACH OPERATING POLICY, AS THERE ARE HUNDREDS OF POLICIES THAT APPLY TO ALL SUBSIDIARY ORGANIZATIONS AND THEY CANNOT PRACTICABLY BE APPROVED BY ALL OF THE INDIVIDUAL BOARDS. FORM 990, PART VI, SECTION B, LINE 14: WRITTEN DOCUMENT RETENTION AND DESTRUCTION POLICY THE ORGANIZATION IS PART OF THE NOVANT HEALTH, INC. ("NOVANT HEALTH") HEALTH CARE SYSTEM. NOVANT HEALTH'S BYLAWS AUTHORIZE IT TO ESTABLISH CERTAIN POLICIES FOR ALL OF ITS SUBSIDIARIES COMPRISING THE HEALTH CARE SYSTEM. ALL SUBSIDIARY ORGANIZATIONS FOLLOW ALL APPLICABLE NOVANT HEALTH CORPORATE POLICIES IN THEIR OPERATIONS. NOVANT HEALTH HAS ESTABLISHED A DOCUMENT RETENTION AND DESTRUCTION POLICY, WHICH ALL SUBSIDIARY ORGANIZATIONS IN THE HEALTH CARE SYSTEM FOLLOW. THE INDIVIDUAL SUBSIDIARY ORGANIZATION BOARD OF TRUSTEES DO NOT SPECIFICALLY ADOPT OR APPROVE EACH OPERATING POLICY, AS THERE ARE HUNDREDS OF POLICIES THAT APPLY TO ALL SUBSIDIARY ORGANIZATIONS AND THEY CANNOT PRACTICABLY BE APPROVED BY ALL OF THE INDIVIDUAL BOARDS.
FORM 990, PART VI, SECTION B, LINE 15FORM 990, PART VI, SECTION B, LINE 15A: COMPENSATION PROCESS FOR TOP OFFICIAL INDEPENDENT AND DISINTERESTED MEMBERS OF THE NOVANT HEALTH BOARD OF TRUSTEES (WHO COMPRISE THE COMPENSATION AND LEADERSHIP COMMITTEE OF THE BOARD) REVIEW, APPROVE, AND OVERSEE ALL ASPECTS OF EXECUTIVE COMPENSATION AND BENEFITS, INCLUDING FOR THOSE EXECUTIVES SERVING RELATED OR DISREGARDED ENTITIES. THE COMMITTEE WORKS WITH AN INDEPENDENT COMPENSATION CONSULTANT, USES THIRD PARTY COMPARABILITY DATA FOR FUNCTIONALLY SIMILAR POSITIONS AT SIMILARLY SITUATED ORGANIZATIONS, AND MAKES SURE THAT TOTAL COMPENSATION AND BENEFITS FOR EACH EXECUTIVE DO NOT EXCEED FAIR MARKET VALUE WHEN COMPARED TO THE MARKET DATA FOR EXECUTIVES IN A SIMILAR POSITION. THE COMMITTEE REVIEWS AND APPROVES EXECUTIVE COMPENSATION AND BENEFITS ANNUALLY, CONSISTENT WITH THE WRITTEN EXECUTIVE COMPENSATION PHILOSOPHY OF NOVANT HEALTH, AND IN A MANNER THAT QUALIFIES FOR THE REBUTTABLE PRESUMPTION OF REASONABLENESS, THEREBY ASSURING THAT TOTAL COMPENSATION AND BENEFITS PROVIDED TO EACH EXECUTIVE IS REASONABLE. THE COMMITTEE REVIEWS AND APPROVES EACH ITEM OF THE NOVANT HEALTH SYSTEM CEO'S COMPENSATION AND BENEFITS. FORM 990, PART VI, SECTION B, LINE 15B: COMPENSATION PROCESS FOR OFFICERS INDEPENDENT AND DISINTERESTED MEMBERS OF THE NOVANT HEALTH BOARD OF TRUSTEES (WHO COMPRISE THE COMPENSATION AND LEADERSHIP COMMITTEE OF THE BOARD) REVIEW, APPROVE, AND OVERSEE ALL ASPECTS OF EXECUTIVE COMPENSATION AND BENEFITS, INCLUDING FOR THOSE EXECUTIVES SERVING RELATED OR DISREGARDED ENTITIES. THE COMMITTEE WORKS WITH AN INDEPENDENT COMPENSATION CONSULTANT, USES THIRD PARTY COMPARABILITY DATA FOR FUNCTIONALLY SIMILAR POSITIONS AT SIMILARLY SITUATED ORGANIZATIONS, AND MAKES SURE THAT TOTAL COMPENSATION AND BENEFITS FOR EACH EXECUTIVE DO NOT EXCEED FAIR MARKET VALUE WHEN COMPARED TO THE MARKET DATA FOR EXECUTIVES IN A SIMILAR POSITION. THE COMMITTEE REVIEWS AND APPROVES EXECUTIVE COMPENSATION AND BENEFITS ANNUALLY, CONSISTENT WITH THE WRITTEN EXECUTIVE COMPENSATION PHILOSOPHY OF NOVANT HEALTH, AND IN A MANNER THAT QUALIFIES FOR THE REBUTTABLE PRESUMPTION OF REASONABLENESS, THEREBY ASSURING THAT TOTAL COMPENSATION AND BENEFITS PROVIDED TO EACH EXECUTIVE IS REASONABLE. LASTLY, IT REVIEWS AND APPROVES ALL OF THE ELEMENTS AND SPECIFICATIONS INCLUDED IN ALL OTHER EXECUTIVE COMPENSATION PLANS AND PROGRAMS (E.G, INCENTIVE PLAN DESIGN, AWARD OPPORTUNITIES, ETC.).
FORM 990, PART VI, SECTION C, LINE 19GOVERNING DOCUMENTS DISCLOSURE THE AUDITED CONSOLIDATED FINANCIAL STATEMENTS CONTAINING ALL ORGANIZATIONS IN THE NOVANT HEALTH SYSTEM ARE POSTED TO THE NOVANT HEALTH WEBSITE. THE GOVERNING DOCUMENTS AND CONFLICT OF INTEREST POLICY ARE NOT AVAILABLE TO THE PUBLIC.
FORM 990, PART VII, SECTION A, COLUMN B: RELATED ORGANIZATIONSTHE ORGANIZATION EMPLOYS CERTAIN EXECUTIVES WHOSE ROLES ARE SUCH THAT THEY PROVIDE SERVICES TO NOT ONLY THE ORGANIZATION, BUT ALSO TO SOME OR ALL OF THE OTHER TAX-EXEMPT ORGANIZATIONS WITHIN THE NOVANT HEALTH CARE SYSTEM. FOR EXAMPLE, MANY OF THESE EXECUTIVES' ROLES FOCUS ON PARTICULAR SERVICE LINES WHICH CROSS THE VARIOUS GEOGRAPHIC MARKETS OUR ORGANIZATIONS SERVE, THUS THE SERVICES PROVIDED BY THESE EXECUTIVES MAY BENEFIT AND BE RECEIVED BY MULTIPLE ORGANIZATIONS WITHIN THE SYSTEM. THE EXECUTIVES DO NOT ALLOCATE THEIR HOURS BETWEEN THE VARIOUS ORGANIZATIONS, BUT RATHER THEIR TIME SPENT ON SERVICES TO THE ORGANIZATION IS INCLUSIVE OF SERVICES TO ALL OF THE ORGANIZATIONS THEY SERVE WITHIN THE SYSTEM.
CHANGES IN NET ASSETS OR FUND BALANCES:FORM 990, PART XI, LINE 5:NET UNREALIZED GAINS ON INVESTMENTS: 7,011,169. AFFILIATE TRANSFERS -10,314,100. PENSION ADJUSTMENT -2,550,051. INVESTMENT IN AFFILIATE 791,105. MALPRACTICE INSURANCE -507,784. K-1 ADJUSTMENTS -528,733. TOTAL TO FORM 990, PART XI, LINE 5: -6,098,394.

Schedule R IRS990ScheduleR

Form990 Schedule R Part II Form990ScheduleRPartII (23 entries)

Address Line1AddressUS/AddressLine1CityAddressUS/CityStateAddressUS/StateZIP CodeAddressUS/ZIPCodeEINEINPrimary ActivitiesPrimaryActivitiesLegal Domicile StateLegalDomicileStateExempt Code SectionExemptCodeSectionPublic Charity StatusPublicCharityStatusBusiness Name Line1DirectControllingEntityName/BusinessNameLine1Controlled OrgControlledOrgDirect Controlling Entity NADirectControllingEntityNA
AUXILIARY OF FORSYTH MEMORIAL HOSPITAL
2085 FRONTIS PLAZA BLVDWINSTON SALEMNC27103560862112HEALTHCARENC501(C)(3)9FORSYTH MEMORIAL HOSPITAL0
CAROLINA MEDICORP ENTERPRISES
2085 FRONTIS PLAZA BLVDWINSTON SALEMNC27103581466368HEALTHCARENC501(C)(3)11BNOVANT MEDICAL GROUP0
COMMUNITY GENERAL HEALTH PARTNERS
2085 FRONTIS PLAZA BLVDWINSTON SALEMNC27103560636250HEALTHCARENC501(C)(3)3NOVANT HEALTH TRIAD REGION0
COMMUNITY GENERAL HOSPITAL FOUNDATION
2085 FRONTIS PLAZA BLVDWINSTON SALEMNC27103561828629HEALTHCARENC501(C)(3)7COMMUNITY GENERAL HEALTH PARTNERS0
CONTINUING CARE SERVICES
2085 FRONTIS PLAZA BLVDWINSTON SALEMNC27103541288473HEALTHCAREVA501(C)(3)9PRINCE WILLIAM HEALTH SYSTEM0
FORSYTH MEDICAL CENTER FOUNDATION
2085 FRONTIS PLAZA BLVDWINSTON SALEMNC27103562120959HEALTHCARENC501(C)(3)7FORSYTH MEMORIAL HOSPITAL0
FORSYTH MEMORIAL HOSPITAL
2085 FRONTIS PLAZA BLVDWINSTON SALEMNC27103560928089HEALTHCARENC501(C)(3)3NOVANT HEALTH TRIAD REGION0
FOUNDATION HEALTH SYSTEMS CORP
2085 FRONTIS PLAZA BLVDWINSTON SALEMNC27103561373175HEALTHCARENC501(C)(3)9NOVANT HEALTH TRIAD REGION0
MEDICAL PARK HOSPITAL
2085 FRONTIS PLAZA BLVDWINSTON SALEMNC27103561340424HEALTHCARENC501(C)(3)3NOVANT HEALTH TRIAD REGION0
NOVANT HEALTH INC
2085 FRONTIS PLAZA BLVDWINSTON SALEMNC27103561376950HEALTHCARENC501(C)(3)11C0N/A
NOVANT MEDICAL GROUP
2085 FRONTIS PLAZA BLVDWINSTON SALEMNC27103581728803HEALTHCARENC501(C)(3)3NMG SERVICES INC0
PERSONAL CARE SERVICES
2085 FRONTIS PLAZA BLVDWINSTON SALEMNC27103541291284HEALTHCAREVA501(C)(3)9PRINCE WILLIAM HEALTH SYSTEM0
PRESBYTERIAN HOSPITAL
2085 FRONTIS PLAZA BLVDWINSTON SALEMNC27103560554230HEALTHCARENC501(C)(3)3NOVANT HEALTH SOUTHERN PIEDMONT REGION0
PRESBYTERIAN HOSPITAL FOUNDATION
2085 FRONTIS PLAZA BLVDWINSTON SALEMNC27103581413074HEALTHCARENC501(C)(3)7NOVANT HEALTH SOUTHERN PIEDMONT REGION0
PRESBYTERIAN MEDICAL CARE CORPORATION
2085 FRONTIS PLAZA BLVDWINSTON SALEMNC27103561376368HEALTHCARENC501(C)(3)3NOVANT HEALTH SOUTHERN PIEDMONT REGION0
PRINCE WILLIAM HEALTH SYSTEM
2085 FRONTIS PLAZA BLVDWINSTON SALEMNC27103541278944HEALTHCAREVA501(C)(3)11CNOVANT HEALTH0
PRINCE WILLIAM HEALTH SYSTEM FOUNDATION
2085 FRONTIS PLAZA BLVDWINSTON SALEMNC27103541307595HEALTHCAREVA501(C)(3)11APRINCE WILLIAM HEALTH SYSTEM0
ROWAN HEALTH SERVICES CORP
2085 FRONTIS PLAZA BLVDWINSTON SALEMNC27103561424814HEALTHCARENC501(C)(3)11CNOVANT HEALTH0
NMG SERVICES INC (FKA ROWAN MEDICAL PRACTICES)
2085 FRONTIS PLAZA BLVDWINSTON SALEMNC27103562098809HEALTHCARENC501(C)(3)9ROWAN HEALTH SERVICES0
ROWAN REGIONAL MEDICAL CENTER AUXILIARY
2085 FRONTIS PLAZA BLVDWINSTON SALEMNC27103237022472HEALTHCARENC501(C)(3)9ROWAN REGIONAL MEDICAL CENTER0
ROWAN REGIONAL MEDICAL CENTER FOUNDATION INC
2085 FRONTIS PLAZA BLVDWINSTON SALEMNC27103561424818HEALTHCARENC501(C)(3)7ROWAN REGIONAL MEDICAL CENTER0
ROWAN REGIONAL MEDICAL CENTER INC
2085 FRONTIS PLAZA BLVDWINSTON SALEMNC27103560547479HEALTHCARENC501(C)(3)3ROWAN HEALTH SERVICES0
SELF INSURANCE FUND - NOVANT HEALTH INC
2085 FRONTIS PLAZA BLVDWINSTON SALEMNC27103581867242HEALTHCARENC501(C)(3)11CNOVANT HEALTH0

Form990 Schedule R Part III Form990ScheduleRPartIII

Name Of Related Org NameOfRelatedOrg

FieldValueIRS element (for citing)
Business Name Line1PRINCE WILLIAM AMBULATORY SURGERY CENTERBusinessNameLine1

Address US AddressUS

FieldValueIRS element (for citing)
Address Line18650 SUDLEY ROAD STE 411AddressLine1
CityMANASSASCity
StateVAState
ZIP Code20110ZIPCode
FieldValueIRS element (for citing)
EIN770594498EIN
Primary ActivityHEALTHCAREPrimaryActivity
Legal Domicile StateVALegalDomicileState

Direct Controlling Entity Name DirectControllingEntityName

FieldValueIRS element (for citing)
Business Name Line1NABusinessNameLine1
FieldValueIRS element (for citing)
Predominant Income TypeRELATEDPredominantIncomeType
Share Of Total Income831020ShareOfTotalIncome
Share Of EOY Assets949847ShareOfEOYAssets
Disproportionate Allocations0DisproportionateAllocations
General Or Managing Partner1GeneralOrManagingPartner
Percentage Ownership0.51000PercentageOwnership
FieldValueIRS element (for citing)
Receipt Of Int Ann Rents Royalties0ReceiptOfIntAnnRentsRoyalties
Gift Grant Or Cap Contr To Other Org1GiftGrantOrCapContrToOtherOrg
Gift Grant Or Cap Contr Fr Other Org0GiftGrantOrCapContrFrOtherOrg
Loans Or Guarantees To Other Org0LoansOrGuaranteesToOtherOrg
Loans Or Guarantees From Other Org0LoansOrGuaranteesFromOtherOrg
Sale Of Assets To Other Org0SaleOfAssetsToOtherOrg
Purchase Of Assets From Other Org0PurchaseOfAssetsFromOtherOrg
Exchange Of Assets0ExchangeOfAssets
Rental Of Facilities To Other Orgs0RentalOfFacilitiesToOtherOrgs
Rental Of Facilities Fr Other Orgs0RentalOfFacilitiesFrOtherOrgs
Perform Of Services For Other Orgs0PerformOfServicesForOtherOrgs
Perform Of Services By Other Orgs0PerformOfServicesByOtherOrgs
Sharing Of Facilities0SharingOfFacilities
Sharing Of Paid Employees0SharingOfPaidEmployees
Reimbursement Paid To Other Org1ReimbursementPaidToOtherOrg
Reimbursement Paid By Other Org0ReimbursementPaidByOtherOrg
Other Transfer To Other Org0OtherTransferToOtherOrg
Other Transfer From Other Org1OtherTransferFromOtherOrg

Transactions Related Orgs Table TransactionsRelatedOrgsTable

Name Of Other Organization NameOfOtherOrganization

FieldValueIRS element (for citing)
Business Name Line1PRINCE WILLIAM AMBULATORY SURGERY CTRBusinessNameLine1
FieldValueIRS element (for citing)
Transaction TypeRTransactionType
Amount Involved328973AmountInvolved
Method Of Amt DeterminationCASHMethodOfAmtDetermination

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