2011-11-11T08:48:56-06:00 2010-12-31 990 2010-01-01 540696355 PRINCE WILLIAM HOSPITAL PRIN 3367182803 2085 FRONTIS PLAZA BLVD WINSTON SALEM NC 27103 FRED HARGETT 3367182803 2011-11-08 2010 2016-03-07 17:11:31Z MELISSA ROBSON 2085 FRONTIS PLAZA BLVD WINSTON SALEM NC 27103 239534441 0 X WWW.PWHS.ORG X 1964 VA SEE SCHEDULE O 16 11 1510 409 232360 -50834 0 0 200691939 214362460 2922548 3451964 731806 111732 204346293 217926156 119513 244986 0 0 91927660 96510012 0 0 0 95240443 101995094 187287616 198750092 17058677 19176064 270506560 286396008 110285451 113097229 160221109 173298779 X SEE SCHEDULE O 0 0 183548927 244986 214362460 PRINCE 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. 183548927 1 0 0 1 0 0 0 0 1 1 0 0 0 1 1 0 1 0 0 0 0 0 0 1 0 1 0 1 0 1 0 0 0 0 0 0 0 1 0 0 0 0 0 1 1 1 0 0 1 148 0 1 1510 1 1 1 0 0 0 0 0 0 0 0 0 X 16 11 0 0 0 0 1 1 1 1 1 0 0 1 0 0 0 1 1 1 1 VA X KAREN DAUGHERTY 3367182803 2085 FRONTIS PLAZA BLVD WINSTON SALEM NC 27103 X BELDEN RICHARD 2.00 X X 10002 10002 0 DAILEY MICHAEL 2.00 X 3600 3600 0 DANZIGER STEVEN M 2.00 X 0 5400 0 EDWARDS H RANDALL 2.00 X 3600 3600 0 FAIRCHILD WILLIAM D 2.00 X 2700 2700 0 GARY SR WILLIAM H 2.00 X 2700 2700 0 GRZEJKA JOHN 2.00 X 3600 3600 0 GUTLIPH MD JOANNE 2.00 X 0 2250 0 HOOVER MICHAEL 2.00 X X 3600 3600 0 MAGALSKI MD JOSEPH 2.00 X 13117 16833 0 PARR JR REXFORD 2.00 X X 3600 3600 0 ROBSONMELISSA L 60.00 X X 546671 97199 240690 WALL MD J DOUGLAS 2.00 X 30000 30000 0 WILESPAUL M 60.00 X 0 3142068 1087327 WINE DONOVAN 2.00 X 0 0 0 ZURLO MD JOSEPH 2.00 X 3750 3125 0 RILEYROBERT W 60.00 X 533743 0 75908 SCHWARTZMICHAEL J 60.00 X 1014679 382482 14311 DAVISMARY DENISE 40.00 X 287021 0 7392 KRENYTZKY MDSTEPHEN 40.00 X 285998 10000 78909 LOVELLTERRANCE 40.00 X 277034 0 38257 TIPPLECYNDA M 40.00 X 482034 0 77854 TRAVERS MDRICHARD M 40.00 X 243546 0 3021 3750995 3722759 1623669 88 0 1 0 THE BANK OF NEW YORK FINANCIAL CONTROL BILLING NEWARK NJ 07195 INVESTING/CONSULTING 2801116 PRECYSE SOLUTIONS LLC-NE DEPT 1736 PO BOX 11407 BIRMINGHAM AL 35246 TRANSCRIPTION SERVICES 1598629 PEROT SYSTEMS CORPORATION 12020 COLLECTIONS CENTER CHICAGO IL 60693 IT SERVICES 1524592 FINANCIAL HEALTH STRATEGIES 704 QUINCE ORCHARD RD STE GAITHERSBURG MD 20878 COLLECTION SERVICES 1155657 DELL MARKETING LP 7489 COLLECTIONS CENTER D CHICAGO IL 60693 MARKETING 701257 27 NET PATIENT REVENUE 621990 212390185 212390185 CANCER CENTER REVENUE 621990 1141845 1141845 AMBULATORY SURGERY CEN 621990 830430 830430 214362460 3349204 3349204 1289806 2220594 -930788 -930788 -930788 19490351 100 19337322 50369 153029 -50269 102760 102760 27474 0 27474 27474 183010 183010 183010 MISCELLANEOUS 900099 545195 545195 FITNESS CENTER 713940 277969 231183 46786 CAFETERIA 722210 7695 7695 1177 1177 832036 217926156 214362460 232360 3331336 244986 244986 2175362 2175362 77256768 71562944 5693824 3782106 3503365 278741 7948848 7363018 585830 5346928 4952859 394069 430700 430700 228222 228222 2843 2843 233107 233107 1343669 1244641 99028 544599 504462 40137 2575302 2385502 189800 4808367 4453990 354377 35865 33222 2643 377440 349623 27817 4144144 3838721 305423 11953868 11072868 881000 1833687 1698544 135143 BAD DEBT 30836082 30836082 SUPPLIES 21454799 19873580 1581219 DRUGS 5534036 5126178 407858 COLLECTION FEES 4798678 4445015 353663 OUTSIDE SERVICES 3918645 3629841 288804 6941041 6429486 511555 198750092 183548927 15201165 0 16991699 28603468 10628084 10729372 24295417 25939114 586066 807808 2806704 512530 241745301 138482654 108040966 103262647 93857075 102990555 9937392 10666688 3363157 2883826 270506560 286396008 14305756 13285137 78092293 75972354 17887402 23839738 110285451 113097229 X 157595182 171121025 2625927 2177754 160221109 173298779 270506560 286396008 X 19176064 -6098394 X 0 1 1 X 0 X 0 0 0 0 0 0 1 2843 0 1 12588 15431 0 PART IV, SUPPLEMENTAL INFORMATION: SCHEDULE C, PART II-B, LINE 1I DUES PAID TO CERTAIN ORGANIZATIONS WHICH INCLUDE A PORTION RELATED TO LOBBYING ACTIVITIES. 2625927 97648 545821 2177754 2541996 81899 -2032 2625927 3656202 -114206 1000000 2541996 1.00000 0 0 2539817 2539817 111398234 45843078 65555156 113758466 88993130 24765336 14048784 3646446 10402338 103262647 0 PENSION LIABILITY 17947924 DEFERRED COMPENSATION 652172 DUE TO AFFILIATE 5239642 23839738 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. FUNDRAISING 27474 27474 27474 27474 27474 1 1 X 1 X 300.000000000000 1 X 1 1 0 1 1 7308974 7308974 0.03680 17513235 12709895 4803340 0.02420 4931248 3528089 1403159 0.00710 29753457 16237984 13515473 0.06810 1254678 1254678 0.00630 5500 5500 0.00000 1260178 1260178 0.00630 31013635 16237984 14775651 0.07440 1 10469282 0 32394946 43579250 -11184304 X 1 1 1 PRINCE WILLIAM ASC HEALTHCARE 0.51000 0.04680 0.44320 1 1 PRINCE WILLIAM HOSPITAL

8700 SUDLEY ROAD STE 411 MANASSAS VA 20110

X X X NA 1 0 0 0 0 0 0 0 0 0 0 0 2 PRINCE WILLIAM AMBULATORY SURGERY CENTER

8650 SUDLEY ROAD SUITE 411 MANASSAS VA 20110

AMBULATORY SURGERY CENTER THE CANCER CENTER AT LAKE MANASSAS

7901 LAKE MANASSAS DRIVE GAINESVILLE VA 20155

CANCER CENTER 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. PART VI, LINE 7, STATE FILING OF COMMUNITY BENEFIT REPORT 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. 0 PRINCE WILLIAM HEALTH PARTNERSHIP 2296 OPITZ BLVD SUITE 320 WOODBRIDGE VA 22191 030444689 3 30000 COMMUNITY DEVELOPMENT SKILLSOURCE GROUP INC 8330 BOONE BLVD SUITE 450 VIENNA VA 22182 300129320 3 26301 COMMUNITY DEVELOPMENT MEDICAL MISSIONARIES-AMERISOURCE BERGEN 9590 SURVEYOR CT MANASSAS VA 20110 541990595 3 21015 COMMUNITY DEVELOPMENT PERSONAL CARE SERVICES 2085 FRONTIS PLAZA BLVD WINSTON SALEM NC 27103 541291284 3 133100 COMMUNITY DEVELOPMENT 4 0 OTHER INFORMATION: PART IV: PART 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. X X X X X X 1 0 X X X X X 1 1 1 0 0 0 0 0 0 ROBSONMELISSA L 273346 52141 100000 38250 173325 6808 209106 5416 20450 5718 776227 108333 0 38250 WILESPAUL M 0 1018783 0 836800 0 1286485 0 1022069 0 65258 0 4229395 0 2013622 RILEYROBERT W 288013 0 235456 0 10274 0 58831 0 17077 0 609651 0 235456 0 SCHWARTZMICHAEL J 170992 0 494775 0 348912 382482 12305 0 2006 0 1028990 382482 494775 0 DAVISMARY DENISE 25629 0 102421 0 158971 0 1515 0 5877 0 294413 0 102422 0 KRENYTZKY MDSTEPHEN 255344 0 25120 0 5534 10000 68228 0 10681 0 364907 10000 0 0 LOVELLTERRANCE 174107 0 98720 0 4207 0 20472 0 17784 0 315290 0 98600 0 TIPPLECYNDA M 257055 0 218031 0 6948 0 70629 0 7225 0 559888 0 218001 0 TRAVERS MDRICHARD M 0 0 0 0 243546 0 3021 0 0 0 246567 0 0 0 PART I, LINE 1A FRINGE 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-C SEVERANCE, 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 SUPPLEMENTAL INFORMATION PART III PART 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 III SCHEDULE 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. PRINCE WILLIAM OB-GYN (PWOG) ENTITY OWNED > 5% BY JOANNE GUTLIPH, BOARD MEMBER 126990 THE FILING ORGANIZATION HAS A LEASE IN PLACE WITH PWOG 0 ACTIVITES FORM 990, PART I, LINE 1: ORGANIZATION'S MISSION OR MOST SIGNIFICANT IN 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 VALUES MISSION: 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 6 CLASSES OF MEMBERS OR STOCKHOLDERS THE CORPORATION IS A NONPROFIT CORPORATION WITH MEMBERS (OR A MEMBER). FORM 990, PART VI, SECTION A, LINE 7A ELECTION OF MEMBERS AND THEIR RIGHTS NOVANT HEALTH, INC. APPOINTS ALL BOARD MEMBERS OF PRINCE WILLIAM HOSPITAL. FORM 990, PART VI, SECTION A, LINE 7B DECISIONS 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 11 ORGANIZATION'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 12 FORM 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 15 FORM 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 19 GOVERNING 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 ORGANIZATIONS THE 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. AUXILIARY OF FORSYTH MEMORIAL HOSPITAL 2085 FRONTIS PLAZA BLVD WINSTON SALEM NC 27103 560862112 HEALTHCARE NC 501(C)(3) 9 FORSYTH MEMORIAL HOSPITAL 0 CAROLINA MEDICORP ENTERPRISES 2085 FRONTIS PLAZA BLVD WINSTON SALEM NC 27103 581466368 HEALTHCARE NC 501(C)(3) 11B NOVANT MEDICAL GROUP 0 COMMUNITY GENERAL HEALTH PARTNERS 2085 FRONTIS PLAZA BLVD WINSTON SALEM NC 27103 560636250 HEALTHCARE NC 501(C)(3) 3 NOVANT HEALTH TRIAD REGION 0 COMMUNITY GENERAL HOSPITAL FOUNDATION 2085 FRONTIS PLAZA BLVD WINSTON SALEM NC 27103 561828629 HEALTHCARE NC 501(C)(3) 7 COMMUNITY GENERAL HEALTH PARTNERS 0 CONTINUING CARE SERVICES 2085 FRONTIS PLAZA BLVD WINSTON SALEM NC 27103 541288473 HEALTHCARE VA 501(C)(3) 9 PRINCE WILLIAM HEALTH SYSTEM 0 FORSYTH MEDICAL CENTER FOUNDATION 2085 FRONTIS PLAZA BLVD WINSTON SALEM NC 27103 562120959 HEALTHCARE NC 501(C)(3) 7 FORSYTH MEMORIAL HOSPITAL 0 FORSYTH MEMORIAL HOSPITAL 2085 FRONTIS PLAZA BLVD WINSTON SALEM NC 27103 560928089 HEALTHCARE NC 501(C)(3) 3 NOVANT HEALTH TRIAD REGION 0 FOUNDATION HEALTH SYSTEMS CORP 2085 FRONTIS PLAZA BLVD WINSTON SALEM NC 27103 561373175 HEALTHCARE NC 501(C)(3) 9 NOVANT HEALTH TRIAD REGION 0 MEDICAL PARK HOSPITAL 2085 FRONTIS PLAZA BLVD WINSTON SALEM NC 27103 561340424 HEALTHCARE NC 501(C)(3) 3 NOVANT HEALTH TRIAD REGION 0 NOVANT HEALTH INC 2085 FRONTIS PLAZA BLVD WINSTON SALEM NC 27103 561376950 HEALTHCARE NC 501(C)(3) 11C N/A 0 NOVANT MEDICAL GROUP 2085 FRONTIS PLAZA BLVD WINSTON SALEM NC 27103 581728803 HEALTHCARE NC 501(C)(3) 3 NMG SERVICES INC 0 PERSONAL CARE SERVICES 2085 FRONTIS PLAZA BLVD WINSTON SALEM NC 27103 541291284 HEALTHCARE VA 501(C)(3) 9 PRINCE WILLIAM HEALTH SYSTEM 0 PRESBYTERIAN HOSPITAL 2085 FRONTIS PLAZA BLVD WINSTON SALEM NC 27103 560554230 HEALTHCARE NC 501(C)(3) 3 NOVANT HEALTH SOUTHERN PIEDMONT REGION 0 PRESBYTERIAN HOSPITAL FOUNDATION 2085 FRONTIS PLAZA BLVD WINSTON SALEM NC 27103 581413074 HEALTHCARE NC 501(C)(3) 7 NOVANT HEALTH SOUTHERN PIEDMONT REGION 0 PRESBYTERIAN MEDICAL CARE CORPORATION 2085 FRONTIS PLAZA BLVD WINSTON SALEM NC 27103 561376368 HEALTHCARE NC 501(C)(3) 3 NOVANT HEALTH SOUTHERN PIEDMONT REGION 0 PRINCE WILLIAM HEALTH SYSTEM 2085 FRONTIS PLAZA BLVD WINSTON SALEM NC 27103 541278944 HEALTHCARE VA 501(C)(3) 11C NOVANT HEALTH 0 PRINCE WILLIAM HEALTH SYSTEM FOUNDATION 2085 FRONTIS PLAZA BLVD WINSTON SALEM NC 27103 541307595 HEALTHCARE VA 501(C)(3) 11A PRINCE WILLIAM HEALTH SYSTEM 0 ROWAN HEALTH SERVICES CORP 2085 FRONTIS PLAZA BLVD WINSTON SALEM NC 27103 561424814 HEALTHCARE NC 501(C)(3) 11C NOVANT HEALTH 0 NMG SERVICES INC (FKA ROWAN MEDICAL PRACTICES) 2085 FRONTIS PLAZA BLVD WINSTON SALEM NC 27103 562098809 HEALTHCARE NC 501(C)(3) 9 ROWAN HEALTH SERVICES 0 ROWAN REGIONAL MEDICAL CENTER AUXILIARY 2085 FRONTIS PLAZA BLVD WINSTON SALEM NC 27103 237022472 HEALTHCARE NC 501(C)(3) 9 ROWAN REGIONAL MEDICAL CENTER 0 ROWAN REGIONAL MEDICAL CENTER FOUNDATION INC 2085 FRONTIS PLAZA BLVD WINSTON SALEM NC 27103 561424818 HEALTHCARE NC 501(C)(3) 7 ROWAN REGIONAL MEDICAL CENTER 0 ROWAN REGIONAL MEDICAL CENTER INC 2085 FRONTIS PLAZA BLVD WINSTON SALEM NC 27103 560547479 HEALTHCARE NC 501(C)(3) 3 ROWAN HEALTH SERVICES 0 SELF INSURANCE FUND - NOVANT HEALTH INC 2085 FRONTIS PLAZA BLVD WINSTON SALEM NC 27103 581867242 HEALTHCARE NC 501(C)(3) 11C NOVANT HEALTH 0 PRINCE WILLIAM AMBULATORY SURGERY CENTER 8650 SUDLEY ROAD STE 411 MANASSAS VA 20110 770594498 HEALTHCARE VA NA RELATED 831020 949847 0 1 0.51000 0 1 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 1 PRINCE WILLIAM AMBULATORY SURGERY CTR R 328973 CASH