2019-11-13T11:39:06-06:00 2018-12-31 346565596 ERNST & YOUNG US LLP 221 E 4th St Suite 2900 CINCINNATI OH 45202 990 2018-01-01 540620889 INOVA HEALTH CARE SERVICES INOV 7032892433 8110 GATEHOUSE ROAD SUITE 400W FALLS CHURCH VA 22042 ALICE POPE CFO 7032892433 2019-11-12 1 JULIE L SPARKS P01268401 5136121400 167.201.241.175 2019-11-12 07:51:14 ES P E21AF0F1BD5C10A123A0C82CC8A47C454803277B E21AF0F1BD5C10A123A0C82CC8A47C454803277B 2018 2020-04-17 16:48:07Z J Stephen Jones MD 8110 GATEHOUSE ROAD SUITE 400W FALLS CHURCH VA 22042 3090786865 0 X INOVA.ORG X 1956 VA IHCS's mission is to maintain and operate hospitals that provide quality care to the community. 14 10 18563 2947 6693252 0 21367305 25548975 2798191274 2919258895 8565380 2332208 110012941 111812372 2938136900 3058952450 0 0 0 0 1416540839 1488996899 0 0 0 1386577421 1404878780 2803118260 2893875679 135018640 165076771 4647977878 5112809613 2231367702 2537343840 2416610176 2575465773 X IHCS was specifically chartered for the purpose of serving the health care needs of the community by establishing, maintaining, and operating hospital facilities, programs, and other shared service arrangements; carrying on health-related education activities; promoting and carrying on health-related scientific research; and engaging in activities designed and carried on to promote the general health of the community. IHCS includes a centralized System Office and the various unincorporated and incorporated subsidiaries which are described below.The unincorporated divisions of IHCS include: Inova Fairfax Medical Campus, Inova Mount Vernon Hospital, Inova Fair Oaks Hospital, Inova Alexandria Hospital, ACCESS of Reston, ACCESS of Fairfax, Inova Research Center, Assisted Living Facilities, Inova Physical Rehabilitation Services, Inova Urgent Care Centers, Inova Employee Assistance, and Behavioral Health and Addiction Treatment. 0 0 2445838494 3001852473 Inova Health Care Services (IHCS) is part of the Inova Health System whose mission is to serve the needs of the community by establishing, maintaining, and operating hospital facilities, programs, and other shared service arrangements; carrying on health-related education activities; promoting and conducting scientific research; and engaging in activities designed and carried on to promote the general health of the community. IHCS includes a centralized System Office and the various unincorporated and incorporated subsidiaries which are described below.The unincorporated subsidiaries of IHCS include: Inova Fairfax Medical Campus, Inova Mount Vernon Hospital, Inova Fair Oaks Hospital, Inova Alexandria Hospital, ACCESS of Reston, ACCESS of Fairfax, Inova Research Center, Assisted Living Facilities, Inova Physical Rehabilitation Services, Inova Urgent Care Centers, Inova Employee Assistance, and Behavioral Health and Addiction Treatment.PROGRAM SERVICESAcute care services are provided on three campuses in Fairfax County and one campus in the City of Alexandria in Virginia. Services provided include emergency and trauma facilities, inpatient and outpatient services, and a variety of ancillary and specialized services. During 2018, IHCS admissions and observations cases totaled 114,482, outpatient visits totaled 352,478, emergency visits totaled 321,456 (28,919 of the total ER visits were at the Springfield Healthplex and 15,627 at the Lorton Healthplex) and deliveries totaled 16,488. The acute care program services provided by these hospitals are described more fully below. Inova Fairfax Medical Campus (IFMC) includes the Inova Heart and Vascular Institute, Inova Women's Hospital, Inova Fairfax Hospital for Children and the Inova Schar Cancer Institute. The hospital, located in Central Fairfax County is a 923-licensed bed tertiary care hospital providing comprehensive medical and surgical services which include emergency/trauma, cardiac, transplant, cancer, obstetric, pediatric, neonatal, stroke and extensive outpatient services. Inova Fairfax Hospital is the home of Northern Virginia's only level one emergency and trauma center and the state-of-the-art Women's and Children's Center. In addition, Inova Fairfax Hospital is a teaching hospital providing clinical training through medical residency, nursing, and paramedical education programs.Inova Mount Vernon Hospital (IMVH) is a 237-licensed bed acute-care hospital serving Southeastern Fairfax County. Inova Mount Vernon Hospital provides a full-service, 24-hour emergency department; broad range of diagnostic, medical and surgical services; inpatient psychiatric services; the Dorothea R. Fischer Wound Healing Center and a specialized hyperbaric oxygen therapy program used to treat conditions requiring increased oxygen flow to body tissues (such as grafts and certain types of burns). Inova Mount Vernon Hospital also operates the Lorton Healthplex, a 24-hour free standing emergency facility and the Inova Center for Rehabilitation, a nationally-known accredited program providing inpatient and outpatient rehabilitative services.Inova Fair Oaks Hospital (IFOH) is a top-ranked 182-bed acute care community hospital serving the rapidly growing suburbs of Northern Virginia. Inova Fair Oaks Hospital is among the first and only hospitals in the DC metro area to receive five out of five stars for quality care from the Centers for Medicare and Medicaid. Signature service lines include spine, weight loss, joint replacement and minimally invasive surgery. State-of-the-art cancer care and maternity services are also signature offerings. Inova Fair Oaks Hospital is a fully accredited Comprehensive Center for Bariatric Surgery and a designated Center of Excellence in Minimally Invasive Gynecology.Inova Alexandria Hospital (IAH) is a 318-licensed bed general acute care hospital, which opened on January 23, 1873. Inova Alexandria Hospital provides a spectrum of diagnostic services, including full-body CT scanning, MRI, and a cardiac catheterization laboratory; a variety of inpatient medical, surgical, and orthopedic services; comprehensive outpatient services, including outpatient surgery, physical medicine, and rehabilitation; and a 24-hour emergency department as well as the Springfield Healthplex, a free standing emergency facility. In addition, specialized obstetric and pediatric services are provided by the hospital's Maternal and Infant Health Center and a children's unit. Specific acute care programs include:Cardiovascular Care: Inova Fairfax Medical Campus (IFMC) is the flagship campus for Inova Heart and Vascular Institute, encompassing a dedicated heart hospital, Inova Cardiovascular Genomics Center and Inova Thrombosis Research and Drug Development Center which includes a dedicated 24-bed Clinical Trials Unit for Phase I - IV studies. It houses 204 inpatient beds, six cardiovascular operating rooms, an 11-room cardiac catheterization and electrophysiology suite, chest pain unit, 64-slice CT scanner and other diagnostic testing, outpatient clinics, cardiac rehabilitation and educational facilities. Capabilities cover the full spectrum of complex cardiovascular and pulmonary care. Services offered include cardiac diagnostic services, cardiac imaging, cardiac catheterization, interventional cardiology, electrophysiology, cardiothoracic surgery and complex airway interventions, vascular surgery, vascular and interventional radiology, advanced lung disease and transplant program, cardiac and respiratory failure program, heart failure and transplant program and cardiac rehab.The Inova Heart and Vascular Institute at IFMC is the region's first dedicated heart hospital. The Inova Heart and Vascular Institute at IAH houses inpatient/outpatient beds, cardiovascular operating rooms, a cardiac catheterization lab, an electrophysiology lab, interventional radiology labs, a minor procedure room, outpatient clinics, cardiac rehabilitation and educational facilities. Women's Health: The Inova Women's Health program is the largest such program in the Mid-Atlantic region, providing services for over 16,000 births each year. Obstetric services provided include: delivery services, high risk prenatal services, inpatient and outpatient obstetrics/gynecologic surgery, and regular and specialty nursery care. IFMC provides obstetric services to low-income patients through the InovaCares Clinic for Women with 38,261 visits in 2018. In addition, IAH works with the Casey Clinic, a State health clinic jointly funded by the State of Virginia, the City of Alexandria and the Alexandria Health Department, providing obstetric services to low-income patients.Pediatrics: Inova Children's Hospital is Northern Virginia's only children's hospital, and a regional tertiary and quarternary referral center with 226 licensed acute care beds, providing the highest level of care. Inova Children's Hospital is home to the only Pediatric Intensive Care Unit and Pediatric Trauma Center in the region, as well as the region's only Level IV Neonatal ICU. In 2017, Inova Children's Hospital treated more than 41,000 children in its Pediatric Emergency Department, more than 12,000 children in inpatient units, and performed more than 4,000 surgeries. Inova Children's provides a complete range of expert, subspecialized children's services in more than 40 subspecialties, including pediatric cardiac surgery, pediatric cancer care, pediatric orthopedics and sports medicine, pediatric spine surgery, pediatric neurology and neurosurgery. As of December 31, 2018, NICU bassinets numbered 108 and total bassinets was 143. Inova Children's provides a primary care medical home for children of low income families that are uninsured or on Medicaid through the InovaCares Clinic for Children which in 2018 provided 23,269 visits at an unreimbursed cost of just over $850,000. 32291233 16031967 Research and Education Services: The Inova Research Center (IRC), including research and academic activities, is centered on the Inova Fairfax Medical Campus. In 2018, the Inova campus of the Virginia Commonwealth University School of Medicine had a total of 30 third year and 30 fourth year medical students who spent their clerkship years at Inova Fairfax Medical Campus. In addition, 307 students came to Inova hospitals for a four week rotation in 2018. Also located on the Inova campus is the VCU School of Pharmacy which partners with clinicians and practitioners across Inova and Northern Virginia to help educate and train an increasing number of pharmacy students each year. In 2018, nearly 70 second, third and fourth year pharmacy students completed didactic and experiential learning experiences across Northern Virginia with the Inova Health System. Pharmacy practitioners precepted nearly 130 Introductory Pharmacy Practice Experiences (IPPEs) and Advanced Pharmacy Practice Experiences (APPEs), with the great majority of students from the VCU School of Pharmacy and a smaller contingent from other colleges of pharmacy. With the advent of the Shenandoah School of Pharmacy at the Inova Center for Personalized Health beginning in 2017, approximately 70 students completed over 100 experiential rotations across the Inova Health System during the 2018-19 academic year.In addition, there are pharmacy post-graduate training opportunities offered at three Inova institutions. Inova Fairfax Medical Campus offers 4 PGY-1 Pharmacy Practice Residency positons, as well as a PGY-2 Emergency Medicine Pharmacy Residency position. Inova Alexandria and Inova Mount Vernon Hospitals each offer 2 PGY-1 Pharmacy Practice Residency positions, for a total of nine post-graduate training opportunities across Inova Health System.The Claude Moore Health Education Center on the campus of Inova Fairfax Medical Campus features 11,000 square feet of space dedicated to the educational needs of medical and nursing students as well as residents and fellows. This state-of-the-art center includes both medical and surgical simulation centers, enabling students to learn through hands-on experience. The Center also features a dedicated research floor to support the extensive activities of the Inova Research Center, where there are numerous active clinical trials, ongoing translational research and outcomes projects, many in partnership with universities and other research entities. The unreimbursed cost of these programs in 2018 was $12.1 million.Inova sponsors accredited residency training programs in: Pediatrics, General Surgery, Internal Medicine, OB/GYN, Neurosurgery and Podiatry. In addition, Inova also sponsors accredited fellowships in Surgical Critical Care, Pediatric Emergency Medicine, Cardiology and Bariatric surgery. We support training programs from our affiliates in Emergency Medicine, Psychiatry, Orthopedics, Ophthalmology, Family Practice, and medical and surgical specialties. In all, Inova trained approximately 700 residents/fellows in 2018. As a teaching facility, Inova Fairfax Medical Campus incurs typical, additional expenses associated with teaching facilities including physician teaching costs and resident salaries, the cost of maintaining higher levels of technology required to support a teaching program and charges resulting from extra tests ordered for instructional purposes. The unreimbursed cost of these programs in 2018 was $11.6 million. Inova Translational Medicine Institute:In 2010, the Inova Translational Medicine Institute (ITMI), a not-for-profit research institute was created for research activities related to the innovative field of personalized medicine. Personalized medicine is a medical model that emphasizes the customization of healthcare to individual patients. It involves the use of genetic information about an individual patient. In 2011, ITMI collaborated with physicians from Fairfax Neonatal Associates to investigate the genetic causes of pre-term delivery. Findings were used to build a reference database of genomic and clinical information which will empower clinical genomic discovery. In 2012, ITMI started the Fairfax Childhood Longitudinal Study, which is investigating the genomic basis for childhood wellness and disease over the duration of the childhoods of over 3,000 children living in Northern Virginia. Institute members provide Medical Genetics and Genetic Counseling to newborns with congenital abnormalities as well as cancer patients with a family history concerning for a genetic basis of their disease. In 2018, approximately $14.7 million was provided in operational support for ITMI. Each year, IHCS designates funds for the development and continuation of identified, accessible direct care programs and services benefiting those most in need in the community. Many of these programs and services are not billed to the patient or are provided at a fee structure below the actual cost of the service. In addition to providing the direct care subsidized service, Inova also provides disease-prevention programs, health and exercise classes, health education and health screenings and other programs within the community in support of the IHCS mission. In 2018, Inova provided over 250,000 people with health education, prevention and wellness programs, health fairs and screenings, and clinically related services resulting in over 120,000, visits for direct health care services at an unreimbursed cost of approximately $23.4 million. These services and programs are described below.InovaCares Clinic for Women and ChildrenThe InovaCares Clinic for Women (ICCW) was created in 1960 to serve the uninsured women of Fairfax County, offering a wide range of OB/GYN services for those in need. This program is a service offered to the community in collaboration with the Fairfax County Health Department, serving uninsured and low-income patients up to 400% of the Federal Poverty Level (FPL). The clinic works in partnership with the Fairfax County Health Department and Inova Fairfax Hospital to promote early and continuous prenatal care for the culturally diverse population who are its patients. InovaCares Clinic for Women provides comprehensive outpatient obstetrical services, gynecological care, diabetes management, case management, non-stress testing, LEEP and colposcopy procedures, cryosurgery, and nutritional counseling - all at little to no cost to the patient. In addition, the InovaCares Clinic for Women runs a high risk obstetrics clinic and two specialty gynecology clinics. In 2018, ICCW provided a total of 38,261 patient encounters for over 4,400 patients. Additionally, ICCW had over 2,000 deliveries at Inova Fairfax Medical Campus.The InovaCares Clinic for Children (ICCC) was created in 1993 as a response to the inability of uninsured or Medicaid mothers to secure an affordable medical home for their children. ICCC is recognized as an accredited Patient Centered Medical Home by the National Committee for Quality Assurance, and serves as a medical home for newborns up to 21 years of age. The Inova Cares Clinic for Children provides comprehensive pediatric services that includes well-child care, immunizations, episodic care (sick visits), and school/sports physicals, immunizations, and nutritional counseling. In 2018, the InovaCares Clinic for Children provided 23,269 clinical services to over 7,100 patients.Inova Alexandria Hospital OB ClinicIAH donates space on the campus to the Casey Clinic, a community health center funded by the State of Virginia, Alexandria Health Department and the City Of Alexandria to provide primary healthcare services to low-income and uninsured children and adults that are residents of the City of Alexandria. IAH funds the clinic physicians who provide OB patient prenatal examinations and delivery at Inova Alexandria Hospital. Inova Juniper Program, HIV Clinical and Education ServicesInova Juniper Program (IJP) provides outpatient primary medical care, mental health therapy, substance abuse counseling, pharmaceutical assistance, and medical case management services to 1,706 persons living with HIV disease in the suburban Virginia region. To maximize accessibility for clients, services are provided at the main location in Fairfax, as well as six satellite clinics (Dumfries, Manassas, Mt. Vernon, Falls Church, Leesburg and Herndon), hospitals, homes and other community locations throughout the region.Major accomplishments of IJP for 2018 include:Served 1,706 patients, providing 45,951 services.Provided core medical and/or case management services to 1,672 Ryan White funded clients living with HIV, 739 clients with mental health services and/or assessments, and 404 clients with substance abuse outpatient care and/or assessments.Conducted 240 hours of education reaching 1,615 participants, and provided 172 clinical consultations and technical assistance opportunities.Conducted 1,012 HIV tests with seroprevalence of 0.4% across Northern Virginia.Successfully implemented prevention programs to support, motivate and educate the public and people living with HIV. Programs are targeted to incarcerated men and women, MSM, youth, and the general population. HIV testing, outreach groups, and patient navigation services are also provided.Life with CancerThe purpose of Life with Cancer (LWC), the psychosocial program of the Inova Schar Cancer Institute, is to enhance the quality of life of those individuals in the community affected by cancer. The program addresses specific adjustment to illness needs by providing individual and family counseling, support groups, educational seminars, integrative therapies, workshops on managing side effects, fitness classes and nutrition classes and consults. Additionally, LWC provides Oncology Nurse Navigator consultations on understanding diagnosis, treatments, side effects and living with advanced disease. Life with Cancer is generously supported by the community, therefore all services are available at no charge to residents of the Washington Metropolitan area.In 2018, Life with Cancer conducted 2,805 educational classes, groups, and wellness programs for adults, children and adolescents with 17,472 visits. In addition, 22,597 counseling or educational consultation sessions were provided by the Oncology Therapists and Oncology Nurse Navigators serving 16,357 people. The total number of participants in programs/classes, groups and counseling in 2018 was 38,861 and Life with Cancer staff provided 44,000 service hours. In 2018, the Life With cancer pediatric oncology clinic staff provided clinical and educational support (inpatient and outpatient) to 3,357 children, teens and parents and held 3,973 support and education group sessions and counseling sessions.A total of 873 participated in Hispanic programs which included Spanish language support groups, educational sessions (Tomando Control De Su Salud & Luzca Bien...Sientase Major), and weekly Zumba classes. Hispanic program coordinators also navigated and counseled 800 clients during 828 sessions.The LWC Connect Line, a critical touch point for patients and families provided information and access to care for 3,172 individuals.Lions Eye ClinicAdministered by Inova Health System (IHS), the Ophthalmology Clinic provides ophthalmic specialty services to the indigent including treatment of glaucoma, retina, and cataracts. IHS provides a part-time ophthalmologist, an ophthalmic technician, and a receptionist for the clinic. The remaining physicians volunteer their services. In 2018, the clinic had 5,793 visits.Inova Geriatrics and Advanced IllnessThe Medical House Calls program is designed to help patients successfully "age in place" while reducing readmissions and overall cost. An interdisciplinary team provides comprehensive primary care in patient homes and assisted living facilities. Patients are generally 65 years of age or older and they have difficulty leaving home for medical appointments. Commonly, patients need the most help with multiple chronic illnesses, changes in functional ability, polypharmacy and frailty/debility. These primary care services are "high-touch" with intensive patient management and care coordination with an emphasis on advance care planning. The program staff leverages strong relationships with inpatient teams, hospice agencies, skilled nursing staff, physical therapy staff, occupational therapy staff, mental health counselors and county services for high-quality patient outcomes. In 2018, the Medical House Calls program served 619 patients in 48 zip codes across Northern Virginia.ElderLink ElderLink is a non-profit partnership between Inova, the Fairfax Area Agency on Aging, and the Alzheimer's Association, National Capital Area Chapter. ElderLink provides case management, care coordination, health and wellness programming, as well as support to patients returning from the hospital back to their home in the community, and caregiver support to older adults and their caregivers. ElderLink provided service to approximately 890 older adults and their caregivers in 2018. 2478129727 1 1 0 1 0 0 0 0 0 0 1 0 0 1 1 1 0 1 0 0 0 0 0 0 0 0 1 1 0 0 1 1 0 0 0 0 0 0 0 1 1 0 0 0 0 0 1 1 1 0 0 0 1 X 3022 0 1 18563 1 1 1 0 0 0 0 0 0 0 0 0 1 0 X 14 10 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 0 0 1 1 X Inova Health Care Services 7032892433 8110 Gatehouse Road Suite 400W Falls Church VA 22042 JKNOX SINGLETON CEO, President, Ending 4/9/18 35.00 15.00 X X 0 4616750 45945 JACK EBELER CHAIRMAN 2.00 2.00 X X 0 0 0 CHARLES BEARD JR SECRETARY 3.00 0.00 X X 0 0 0 JANIS CARUSO MD TRUSTEE 3.00 0.00 X 0 0 0 SCOTT HAMBERGER TRUSTEE 1.00 0.00 X 0 0 0 RASHID NAYYAR MD TRUSTEE 3.00 0.00 X 176605 0 0 JOHN COOK TRUSTEE 3.00 0.00 X 0 0 0 LUCAS COLLAZO MD TRUSTEE 2.00 4.00 X 0 0 0 J STEPHEN JONES CEO, President, Beginning 4/9/18 35.00 15.00 X X 0 1350889 447629 NANCY TAYLOR TRUSTEE 3.00 0.00 X 0 0 0 KEITH STERLING MD TRUSTEE 2.00 1.00 X 160000 0 0 JAY TYROLER MD TRUSTEE 3.00 0.00 X 115000 0 0 PHIL NOLAN 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ECKLUND DEPT CHAIR NEUROSCIENCE 40.00 0.00 X 1382923 0 160687 MARSHALL RUFFIN FORMER EVP CTO 40.00 10.00 X 511853 0 0 ROBERT GRASTY FORMER EVP CHRO COO 40.00 10.00 X 0 210100 0 JAMES SANTRY FORMER EVP CEO DTC AND AMB 40.00 10.00 X 0 1024417 41037 DEBORAH ADDO FORMER CEO ILH 10.00 30.00 X 0 856877 224807 13514863 22948863 4323123 2344 1 1 0 CLARK CONSTRUCTION LLC 7500 OLD GEORGETOWN ROAD SUITE 785 BETHESDA MD 20814 CONSTRUCTION 86501377 CROTHALL SERVICES GROUP 955 CHESTERBROOK BLVD SUITE 300 WAYNE PA 19087 STAFFING 40672673 HITT CONTRACTING INC 2900 FAIRVIEW PARK DRIVE FALLS CHURCH VA 22042 CONSTRUCTION 37026603 FORSYTHE SOLUTONS GROUP INC 7770 FRONTAGE ROAD SKOKIE IL 60077 IT CONSULTING 34158017 MEDTRONIC USA INC PO BOX 409201 ATLANTA GA 30384 TECHNOLOGY 20838358 686 14020739 11528236 25548975 Net Patient Service Revenue 622110 2902048299 2902048299 Inova Reston MRI Center LLC 621400 6934553 6934553 Northern Virginia Surgery Center 621400 3720904 3720904 Technical Dynamics, LLC 811000 2993520 2993520 Franconia-Springfield Surgery Cen 621400 2660055 2660055 901564 901564 2919258895 3947958 3947958 646708 646708 27248243 805320 20634754 620964 6613489 184356 6797845 184356 6613489 8316239 10578697 -2262458 -2262458 -2262458 OTHER OPERATING REVENUE 900099 96633600 90124704 6508896 COMMUNITY BLOOD SERVICES 900099 8500841 8500841 LOSS ON EXTINGUISHMENT OF SWAP CO 900099 -119914 -119914 105014527 3058952450 3017884440 6693252 8825783 5834905 5834905 1243170005 1059034138 184135867 47728315 40581550 7146765 111486242 90873561 20612681 80777432 68444258 12333174 2965354 1686331 1279023 2870375 73253 2797122 368341 368341 212634904 212057523 577381 7752135 4134567 3617568 28770115 15576372 13193743 37049830 15005166 22044664 54589039 46825221 7763818 3934020 2695527 1238493 3220625 2231094 989531 46940996 42757903 4183093 192324885 145559379 46765506 14637469 14162618 474851 MEDICAL SUPPLIES 451847922 447258716 4589206 BAD DEBT EXPENSE 159499239 159499239 OTHER PURCHASED SERVICE 159199430 89037357 70162073 TAXES AND LICENSES 20050493 8696409 11354084 6223608 5736299 487309 2893875679 2478129727 415745952 0 181068371 305999546 271322466 268537216 11464285 25554603 23616828 23238909 88108964 68067952 4411124539 2383900311 1900613378 2027224228 136508626 216101114 32403168 69054206 30659042 30473508 1972212750 2078558331 4647977878 5112809613 354108200 360466395 219282386 221404230 1470119269 1683985752 111536177 108097054 76321670 163390409 2231367702 2537343840 X 2416588452 2575444049 21724 21724 2416610176 2575465773 4647977878 5112809613 X 165076771 847530 -7068704 X X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 368341 368341 2477761386 2478129727 1000000 250000 0 0 1000000 1000000 1000000 1000000 4000000 6000000 249843 483780 700409 368341 1802373 250000 250000 250000 250000 1000000 1500000 183068757 183068757 1402861050 608207635 794653415 814881601 485061377 329820224 1472864205 1138591055 334273150 537448926 152040244 385408682 2027224228 OTHER ASSETS 38035012 DUE FROM SUBSIDIARIES AND AFFILIATES 1941674986 LONG TERM RIGHT OF USE 98848333 2078558331 THIRD PARTY SETTLEMENTS 36503431 SELF INSURED LIABILITY 28977341 INTEREST RATE SWAP LIABILITY -6521557 LEASE LIABILITY 104431194 163390409 X Part X, Line 2: From Inova Health System consolidated financial statements including Inova Health Care Services: The Foundation, IHCS, and LHC are not-for-profit corporations and have been determined to be exempt from Federal income tax under the provisions of section 501(c)(3) of the Internal Revenue Code. IHI and its subsidiaries are taxable organizations. Deferred income taxes are provided for all significant timing differences between revenues and expenses reported for financial statement and for tax purposes. Management annually reviews its tax positions and has determined that there are no material uncertain tax positions that require recognition in the consolidated financial statements. 1 1 X 1 X 400.000000000000 1 X 1 1 0 1 1 119496768 119496768 0.04370 232915913 99689486 133226427 0.04870 352412681 99689486 252723195 0.09240 10900808 6808 10894000 0.00400 12268689 684516 11584173 0.00420 15802148 4355456 11446692 0.00420 32291233 20098046 12193187 0.00450 1108222 1108222 0.00040 72371100 25144826 47226274 0.01730 424783781 124834312 299949469 0.10970 1 68967471 0 477876427 583505827 -105629400 X 1 1 1 Franconia-Springfield Surgery Center LLC Surgical Services 0.57960 0.42040 2 Northern Virginia Surgery Center LLC Surgical Services 0.61180 0.38820 3 Inova Ambulatory Surgery Center at Lorton LLC Surgical Services 0.58950 0.41050 4 McLean Ambulatory Surgery LLC Surgical Services 0.64500 0.35500 4 1 INOVA FAIRFAX HOSPITAL 3300 GALLOWS ROAD FALLS CHURCH VA 22046 INOVA.ORG VA H1921 X X X X X X A 2 INOVA ALEXANDRIA HOSPITAL 4320 SEMINARY ROAD ALEXANDRIA VA 22304 INOVA.ORG VA H1859 X X X A 3 INOVA MOUNT VERNON HOSPITAL 2501 PARKER LANE ALEXANDRIA VA 22306 INOVA.ORG VA H1923 X X X A 4 INOVA FAIR OAKS HOSPITAL 3600 JOSPEH SIEWICK DRIVE FAIRFAX VA 22033 INOVA.ORG VA H1922 X X X A Facility Reporting Group - A 0 0 1 X X X X X X X X X 16 1 1 0 1 X See line 10a for CHNA website X 1 16 1 www.inova.org/inova-in-the-community/index.jsp 0 1 X 400.000000000000 400.000000000000 X X X X X X 1 1 X X X 1 X www.Inova.org X www.Inova.org X www.Inova.org X X X X X X X 1 X 0 X X X X 1 X 0 0 Part V, Section B Facility Reporting Group A Facility Reporting Group A consists of: - Facility 1: INOVA FAIRFAX HOSPITAL, - Facility 2: INOVA ALEXANDRIA HOSPITAL, - Facility 4: INOVA FAIR OAKS HOSPITAL, - Facility 3: INOVA MOUNT VERNON HOSPITAL Group A-Facility 1 -- INOVA FAIRFAX HOSPITAL Part V, Section B, line 3j: Question 3eInova Fairfax Medical Campus (IFMC) completed a Community Health Needs Assessment (CHNA) in 2016 and found that numerous health status and access problems are present in the community. Eleven areas were identified as the most significant health needs for the IFMC community: Access to Basic Medical Care, Access to Dental Care, Care and Conditions of Older Adults, Cultural Competency in Care, Diabetes, Hypertension, Lack of Affordable Housing, Mental Health and Access to Mental Health Services, Obesity and Obesity-Related Concerns, Physical Environment and Substance Abuse and Excessive Alcohol Use. Within these areas there was no prioritization or ranking.Based on the CHNA results, IFMC developed a three-year implementation strategy to address its community benefit service area for calendar (tax) years 2017 through 2019. Priorities were based on community need as determined by quantitative data and community input, as well as on hospital expertise, resources, strengths of existing programming and partnerships, and alignment with national, state, and local health goals. Based on the CHNA recommendations, Inova Fairfax Medical Campus has identified as its community benefit priorities Conditions and Care of the Aging Population, Cultural Competency in Care and Mental Health and Access to Mental Health Services. The hospital's 3-year implementation strategy was endorsed by the Inova Health Care Services Board. Group A-Facility 1 -- INOVA FAIRFAX HOSPITAL Part V, Section B, line 5: For IFMC:The hospital interviewed 62 key informants, including external stakeholders (those who represented the broad interests in the community) and internal Inova staff. The interviews were guided by a structured interview guide, and interviewees were encouraged to identify and discuss a wide range of current and emerging issues affecting community health. Interviews were conducted from August 2015 through January 2016. A detailed listing of the community stakeholders who provided community input is shown below. The hospital also sought input from the public regarding the health of the community through an online survey publicized through emails, hospital information and community partners. The survey was also available on paper in the hospital and at the local FQHC.In the process of conducting the 2016 CHNA, Inova received feedback from constituents on the 2013 CHNA process and progress made since then. At the start of the 2016 CHNA, Inova created an advisory committee in order to steer decision making, provide feedback on survey creation, interview candidates and protocols and the process by which community health needs were determined to be significant. The committee included representatives from local FQHCs, local Health Directors and a public official. Members of the committee provided feedback on the 2013 CHNA, including both the initial assessment as well as implementation of strategies to improve health since then. Additional feedback on Inova's community health improvement programs was gathered during key informant interviews.Fairfax County Board of Supervisors - General populationFairfax County Health Care Advisory Board - General population and PhysiciansFairfax County Health Department - General populationFairfax County Multicultural Advisory Council - Immigrant community, Hispanic community, Muslim community, East African community, Korean community, Indian communityFairfax County physicians - General population and PhysiciansFairfax County Public Schools - General population and Youth/adolescentsFairfax-Falls Church Community Services Board - Mentally ill population, Substance abuse needs, Intellectually disabledGeorge Mason University, College of Health and Human Services - General population and StudentsGrace Ministries - Faith-based community and Immigrant populationInova Board of Directors - General populationInova Fairfax Hospital Internal Staff - General population and PhysiciansInova Office of Health Equity - Marginalized populations and Minority populationsNorthern Virginia Family Services - Adolescent/youth, Low income, Homeless, Mentally illNorthern Virginia Health Foundation - General population, Low Income, and Uninsured/UnderinsuredPartnership for a Healthier Fairfax - General population and Business communityRoute 1 Human Services Task Force - Homeless population and Low income population Group A-Facility 1 -- INOVA FAIRFAX HOSPITAL Part V, Section B, line 6a: Inova Fair Oaks HospitalInova Mt. Vernon HospitalInova Loudoun HospitalInova Alexandria Hospital Group A-Facility 1 -- INOVA FAIRFAX HOSPITAL Part V, Section B, line 11: Inova Fairfax Medical Campus conducted a Community Health Needs Assessment (CHNA) in 2016 to identify the significant health needs in its community, and to inform development of an Implementation Strategy to address those needs. This process also responds to regulatory requirements, which mandate that tax-exempt hospital facilities conduct a CHNA every three years and adopt an Implementation Strategy that addresses significant community health needs.One main aim of the Implementation Strategy is to guide the hospital's community benefit activities for the period of 2017 - 2019. Community benefits are programs or activities that provide treatment and/or promote health and healing as a response to identified community needs. The CHNA process encourages hospitals to focus on improving the health of the communities they serve, and not to select outreach efforts based solely on internal growth priorities. Implementation Strategies should be broad based and work with community entities to improve health outside the walls of the hospital, increase prevention efforts and improve public health.The Inova Fairfax Medical Campus team selected the following priority areas for the 2017-19 Implementation Strategy: Improve the Care and Conditions of Aging Adults, Improve Care and Access to Care for Individuals with Mental Health and Substance Abuse Needs, and Improve Cultural Competency and Inclusion.Update - Year TwoUpon board approval of the 2016 CHNA and Implementation Strategy, the IFMC CEO assigned members of the senior leadership team to lead the efforts and convene work teams around each of the Implementation Strategy focus areas. Members of the work teams include representatives from the hospital (clinical leadership, behavioral health, case management, community health and human resources) as well as representatives from local government agencies and other related community services. The groups have met at different times to collaborate on potential action steps.Through the thought work and collaboration of the work teams, much progress has been made, as described below.1. Inova's Program Outreach Administrator is the co-chair for the Health Workforce team of the Partnership for a Healthier Fairfax. This team is working on a project to improve outcomes for the diverse population served through education and outreach to providers about the use and importance of CLAS standards. In 2018, a curriculum was developed and is in the final testing phases. The curriculum is based on the facilitated discussion of video stories sharing the lived experiences of diverse individuals in the healthcare system.2. Inova Behavioral Health Services is committed to offering a full spectrum of mental health and addiction treatment services, and has been working to increase access through creative and multi-modal initiatives. One new initiative is the implementation of SBIRT (Screening, Brief Intervention and Referral to Treatment). SBIRT is a simple screening tool that helps identify people at high risk of substance abuse, and is now in place in all hospital emergency departments (ED). Results of the screening guide the level of intervention. People at mild or moderate risk receive a short counseling session. Those diagnosed as addicted are referred for treatment.3. Inova recognizes that hospitals can have a large impact on the rising opioid epidemic. In another step to help curb the opioid epidemic in the community, in 2018 Inova Fairfax Medical Campus installed a public drop-off box for safe disposal of unused drugs.4. No One Dies Alone is a program that provides companionship and support to patients who are at the end of their lives and may not have friends or family at their side. Volunteers stay with these patients and provide compassion and emotional support so these patients will not spend their moments alone. Started at IFMC at the end of 2017, in 2018 the program grew to 64 volunteers and 1,390 volunteer hours in 2018.5. Additionally, the Geriatrics Services (including Geriatric Medicine, HELP, NICHE ) and Neuroscience departments partnered to provide two workshops on dementia for care providers offered free to the community with 75 attendees.6. The Inova Medical House Calls program is designed to help patients successfully "age in place" while reducing readmissions and overall cost. An interdisciplinary team provides comprehensive primary care in patient homes and assisted living facilities. Patients are generally 65 years of age or older and they have difficulty leaving home for medical appointments. These primary care services are "high-touch" with intensive patient management and care coordination with an emphasis on advance care planning. The program staff leverages strong relationships with inpatient teams, hospice agencies, skilled nursing staff, physical therapy staff, occupational therapy staff, mental health counselors and county services for high-quality patient outcomes.7. Additionally, one major issue in care for the growing older adult population has been a scarcity of options for primary care. To meet this need, Inova added a geriatrician in three of the Inova Medical Group primary care practices.8. ElderLink is a non-profit partnership between Inova, the Fairfax Area Agency on Aging, and the Alzheimer's Association, National Capital Area Chapter. ElderLink provides case management, care coordination, health and wellness programming, as well as support to patients returning from the hospital back to their home in the community, and caregiver support to older adults and their caregivers.9. As part of its focus to promote community health and education, Inova's Department of Population/Community Health provides small grants to not-for-profit organizations. One of these grants was to Insight Memory Care Center, where funds will help support the organization's adult day respite care program. IMCC is the only licensed adult day center in Northern Virginia dedicated to enhancing the lives of individuals with Alzheimer's disease and related dementias as well as their caregivers and families.Health Needs the Hospital Will Not AddressNo hospital facility can address all health needs present in its community. The hospital is committed to remaining financially healthy so that it can grow to enhance clinical services and to continue providing a range of community benefits. The hospital's implementation strategy focuses on meeting the priority and specified community health needs described above. Certain issues, such as access to dental care, affordable housing and the physical environment are beyond the scope of the hospital and the hospital has insufficient resources to make a meaningful impact. Other topics, such as diabetes, hypertension, obesity and obesity-related concerns are not covered as priority target areas in this plan. Even so, there are many activities in these areas throughout the Inova system. Group A-Facility 1 -- INOVA FAIRFAX HOSPITAL Part V, Section B, line 13h: Calculate family size Group A-Facility 1 -- INOVA FAIRFAX HOSPITAL Part V, Section B, line 16j: Financial Aid Brochures explaining the charity policy are available through out the Hospital. ER Rooms and waiting rooms have charity notifications posted in their areas, and the brochures are also posted on Inova's website. Group A-Facility 2 -- INOVA ALEXANDRIA HOSPITAL Part V, Section B, line 3j: Question 3eInova Alexandria Hospital (IAH) completed a Community Health Needs Assessment (CHNA) in 2016 and found that numerous health status and access problems are present in the community. Eleven areas were identified as the most significant health needs for the IAH community: Access to Basic Medical Care, Access to Dental Care, Adolescent Health, Care and Conditions of Older Adults, Cultural Competency in Care, Diabetes, HIV and other Sexually Transmitted Infections, Hypertension, Mental Health and Access to Mental Health Services, Obesity and Obesity-Related Concerns and Substance Abuse and Excessive Alcohol Use. Within these areas there was no prioritization or ranking.Based on the CHNA results, IAH developed a three-year implementation strategy to address its community benefit service area for calendar (tax) years 2017 through 2019. Priorities were based on community need as determined by quantitative data and community input, as well as on hospital expertise, resources, strengths of existing programming and partnerships, and alignment with national, state, and local health goals. Based on the CHNA recommendations, Inova Alexandria Hospital has identified as its community benefit priorities Conditions and Care of the Aging Population and Mental Health and Substance Abuse. The hospital's 3-year implementation strategy was endorsed by the Inova Health Care Services Board. Group A-Facility 2 -- INOVA ALEXANDRIA HOSPITAL Part V, Section B, line 5: For IAH:The hospital interviewed 32 key informants, including external stakeholders (those who represented the broad interests in the community) and internal Inova staff. The interviews were guided by a structured interview guide, and interviewees were encouraged to identify and discuss a wide range of current and emerging issues affecting community health. Interviews were conducted from August 2015 through January 2016. A detailed listing of the community stakeholders who provided community input is shown below. The hospital also sought input from the public regarding the health of the community through an online survey publicized through emails, hospital information and community partners. The survey was also available on paper in the hospital and at the local FQHC.In the process of conducting the 2016 CHNA, Inova received feedback from constituents on the 2013 CHNA process and progress made since then. At the start of the 2016 CHNA, Inova created an advisory committee in order to steer decision making, provide feedback on survey creation, interview candidates and protocols and the process by which community health needs were determined to be significant. The committee included representatives from local FQHCs, local Health Directors and a public official. Members of the committee provided feedback on the 2013 CHNA, including both the initial assessment as well as implementation of strategies to improve health since then. Additional feedback on Inova's community health improvement programs was gathered during key informant interviews.Alexandria City Government - General populationAlexandria Community Services Board - Mentally illAlexandria Health Department - General populationAlexandria Public Health Advisory Commission - General populationArlington County Government - General populationCampagna Center - Youth, ImmigrantsGeorge Mason University, College of Health and Human Services - General population, StudentsGrace Ministries - Faith-based community, Immigrant populationsInova Alexandria Hospital Internal Staff - Health professionals and patientsInova Board of Directors - General populationInova Office of Health Equity - Marginalized populations, Minority populationsNeighborhood Health - General population, Low incomeNorthern Virginia Family Services - Adolescent/youth, Low income, Homeless, Mentally illNorthern Virginia Health Foundation - General population, Low IncomePartnership for a Healthier Alexandria - General Population, Aging Route 1 Human Services Task Force - Homeless population, Low income population Group A-Facility 2 -- INOVA ALEXANDRIA HOSPITAL Part V, Section B, line 6a: Inova Fairfax HospitalInova Loudoun HospitalInova Fair Oaks HospitalInova Mt. Vernon Hospital Group A-Facility 2 -- INOVA ALEXANDRIA HOSPITAL Part V, Section B, line 11: Inova Alexandria Hospital conducted a Community Health Needs Assessment (CHNA) in 2016 to identify the significant health needs in its community, and to inform development of an Implementation Strategy to address those needs. This process also responds to regulatory requirements, which mandate that tax-exempt hospital facilities conduct a CHNA every three years and adopt an Implementation Strategy that addresses significant community health needs.One main aim of the Implementation Strategy is to guide the hospital's community benefit activities for the period of 2017 - 2019. Community benefits are programs or activities that provide treatment and/or promote health and healing as a response to identified community needs. The CHNA process encourages hospitals to focus on improving the health of the communities they serve, and not to select outreach efforts based solely on internal growth priorities. Implementation Strategies should be broad based and work with community entities to improve health outside the walls of the hospital, increase prevention efforts and improve public health.The Inova Alexandria Hospital team selected the following priority areas for the 2017-19 Implementation Strategy: Improve the Care and Conditions of Aging Adults and Improve Care and Access to Care for Individuals with Mental Health and/or Substance Abuse Needs.Update - Year TwoMembers of the Community Health Services Division, IAH leadership and community partners have been working diligently on the priority areas set forth in the 2016 CHNA Implementation Plan.Through the thought work and collaboration of diverse stakeholders, much progress has been made, as described below.1. Inova Behavioral Health Services is committed to offering a full spectrum of mental health and addiction treatment services, and has been working to increase access through creative and multi-modal initiatives. One new initiative is the implementation of SBIRT (Screening, Brief Intervention and Referral to Treatment). SBIRT is a simple screening tool that helps identify people at high risk of substance abuse, and is now in place in all hospital emergency departments (ED). Results of the screening guide the level of intervention. People at mild or moderate risk receive a short counseling session. Those diagnosed as addicted are referred for treatment.2. Inova recognizes that hospitals can have a large impact on the rising opioid epidemic. In another step to help curb the opioid epidemic in the community, in 2018 Inova Alexandria Hospital installed a public drop-off box for safe disposal of unused drugs.3. Additionally, IAH actively participates in an interagency opioid work group looking to coordinate efforts to address deterrence as well as treatment of opioid abuse across the City of Alexandria4. As part of its focus to promote community health and education, Inova's Department of Population/Community Health provides small grants to not-for-profit organizations. To further improve the health of the diverse communities that we serve, Inova provided one of these grants to Nueva Vida. Located in Alexandria, VA, Nueva Vida was created to fill the gap for culturally sensitive bilingual cancer support services for the Latino community. Nueva Vida performs culturally competent and bilingual care and outreach through three main focus areas: outreach and education, patient navigation and mental health survivorship.5. For young people with cognitive and physical disabilities, finding competitive employment is one of the biggest challenges they face. The Project SEARCH program at Inova Alexandria Hospital is changing that. Since 2011, the community-minded initiative has provided on-the-job training for hundreds of local students between the ages of 18 and 22. High school seniors spend a year at the hospital, working in various departments. In 2018, Inova Alexandria Hospital received The Hiring Award from the Alexandria Chamber of Commerce and the Alexandria Commission on Persons with Disabilities in recognition of its Project SEARCH success. The Hiring Award is given annually to Alexandria residents and businesses that make significant strides in disability empowerment.6. The Inova Medical House Calls program is designed to help patients successfully "age in place" while reducing readmissions and overall cost. An interdisciplinary team provides comprehensive primary care in patient homes and assisted living facilities. Patients are generally 65 years of age or older and they have difficulty leaving home for medical appointments. These primary care services are "high-touch" with intensive patient management and care coordination with an emphasis on advance care planning. The program staff leverages strong relationships with inpatient teams, hospice agencies, skilled nursing staff, physical therapy staff, occupational therapy staff, mental health counselors and county services for high-quality patient outcomes.7. Additionally, one major issue in care for the growing older adult population has been a scarcity of options for primary care. To meet this need, Inova added a geriatrician in three of the Inova Medical Group primary care practices, two of which are in the IAH community.Health Needs the Hospital Will Not AddressNo hospital facility can address all health needs present in its community. The hospital is committed to remaining financially healthy so that it can grow to enhance clinical services and to continue providing a range of community benefits. The hospital's implementation strategy focuses on meeting the priority and specified community health needs described above. Certain issues, such as access to dental care, are beyond the scope of the hospital and the hospital has insufficient resources to make a meaningful impact. Other topics, such as diabetes, hypertension, obesity and obesity-related concerns are not covered as priority target areas in this plan. Even so, there are many activities in these areas throughout the Inova system. Group A-Facility 2 -- INOVA ALEXANDRIA HOSPITAL Part V, Section B, line 13h: Calculate family size Group A-Facility 2 -- INOVA ALEXANDRIA HOSPITAL Part V, Section B, line 16j: Financial Aid Brochures explaining the charity policy are available through out the Hospital. ER Rooms and waiting rooms have charity notifications posted in their areas, and the brochures are also posted on Inova's website. Group A-Facility 3 -- INOVA FAIR OAKS HOSPITAL Part V, Section B, line 3j: Question 3eInova Fair Oaks Hospital (IFOH) completed a Community Health Needs Assessment (CHNA) in 2016 and found that numerous health status and access problems are present in the community. Twelve areas were identified as the most significant health needs for the IFOH community: Access to Basic Medical Care, Access to Dental Care, Care and Conditions of Older Adults, Cultural Competency in Care, Diabetes, Heart Disease, Hypertension, Lack of Affordable Housing, Mental Health and Access to Mental Health Services, Obesity and Obesity-Related Concerns, Physical Environment and Substance Abuse and Excessive Alcohol Use. Within these areas there was no prioritization or ranking.Based on the CHNA results, IFOH developed a three-year implementation strategy to address its community benefit service area for calendar (tax) years 2017 through 2019. Priorities were based on community need as determined by quantitative data and community input, as well as on hospital expertise, resources, strengths of existing programming and partnerships, and alignment with national, state, and local health goals. Based on the CHNA recommendations, Inova Fair Oaks Hospital has identified as its community benefit priorities Access to Dental Care and Childhood Obesity. The hospital's 3-year implementation strategy was endorsed by the Inova Health Care Services Board. Group A-Facility 3 -- INOVA FAIR OAKS HOSPITAL Part V, Section B, line 5: For IFOH:The hospital interviewed 64 key informants, including external stakeholders (those who represented the broad interests in the community) and internal Inova staff. The interviews were guided by a structured interview guide, and interviewees were encouraged to identify and discuss a wide range of current and emerging issues affecting community health. Interviews were conducted from August 2015 through January 2016. A detailed listing of the community stakeholders who provided community input is shown below. The hospital also sought input from the public regarding the health of the community through an online survey publicized through emails, hospital information and community partners. The survey was also available on paper in the hospital and at the local FQHC.In the process of conducting the 2016 CHNA, Inova received feedback from constituents on the 2013 CHNA process and progress made since then. At the start of the 2016 CHNA, Inova created an advisory committee in order to steer decision making, provide feedback on survey creation, interview candidates and protocols and the process by which community health needs were determined to be significant. The committee included representatives from local FQHCs, local Health Directors and a public official. Members of the committee provided feedback on the 2013 CHNA, including both the initial assessment as well as implementation of strategies to improve health since then. Additional feedback on Inova's community health improvement programs was gathered during key informant interviews.Fairfax County Board of Supervisors - General populationFairfax County Health Care Advisory Board - General population and PhysiciansFairfax County Health Department - General populationFairfax County Multicultural Advisory Council - Immigrant community, Hispanic community, Muslim community, East African community, Korean community, Indian communityFairfax County physicians - General population and PhysiciansFairfax County Public Schools - General population and Youth/adolescentsFairfax-Falls Church Community Services Board - Mentally ill population, Substance abuse needs, Intellectually disabledGeorge Mason University, College of Health and Human Services - General population and StudentsGrace Ministries - Faith-based community, Immigrant populationHealthWorks for Northern Virginia - General population, Low income, Uninsured/UnderinsuredInova Board of Directors - General populationInova Fair Oaks Hospital Internal Staff - General population and PhysiciansInova Office of Health Equity - Marginalized populations, Minority populationsNorthern Virginia Family Services - Adolescent/youth, Low income, Homeless, Mentally illNorthern Virginia Health Foundation- General population, Low Income, Uninsured/UnderinsuredPartnership for a Healthier Fairfax - General population, Business communityRoute 1 Human Services Task Force - Homeless population, Low income population Group A-Facility 3 -- INOVA FAIR OAKS HOSPITAL Part V, Section B, line 6a: Inova Fairfax HospitalInova Mt. Vernon HospitalInova Alexandria HospitalInova Loudoun Hospital Group A-Facility 3 -- INOVA FAIR OAKS HOSPITAL Part V, Section B, line 11: Inova Fair Oaks Hospital conducted a Community Health Needs Assessment (CHNA) in 2016 to identify the significant health needs in its community, and to inform development of an Implementation Strategy to address those needs. This process also responds to regulatory requirements, which mandate that tax-exempt hospital facilities conduct a CHNA every three years and adopt an Implementation Strategy that addresses significant community health needs.One main aim of the Implementation Strategy is to guide the hospital's community benefit activities for the period of 2017 - 2019. Community benefits are programs or activities that provide treatment and/or promote health and healing as a response to identified community needs. The CHNA process encourages hospitals to focus on improving the health of the communities they serve, and not to select outreach efforts based solely on internal growth priorities. Implementation Strategies should be broad based and work with community entities to improve health outside the walls of the hospital, increase prevention efforts and improve public health.The Inova Fair Oaks Hospital team selected the following priority areas for the 2017-19 Implementation Strategy: Increase Access to Dental Care and Decrease Childhood Obesity.Update - Year TwoMembers of the Community Health Services Division, IFOH leadership and community partners have been working diligently on the priority areas set forth in the 2016 CHNA Implementation Plan.Through the thought work and collaboration of diverse stakeholders, much progress has been made, as described below.1. To prevent and reduce the incidence of nutrition-related diseases, Inova focused on several initiatives to reduce food insecurity and increase food literacy among community members. Specifically, Inova continued to match the purchases made by SNAP customers (formerly food stamps) at farmers markets, allowing low-income individuals to purchase more fresh produce. Additionally, during Fresh Veggies for Kids Day at IFOH, employees donated 70 pounds of carrots and green beans which were taken to the Herndon food pantry.2. Inova continued to grow the Inova Healthy Plate Program, an 8-week school-based nutrition program provided to local Title I elementary schools and community programs. The Inova Healthy Plate Club aims to improve students' understanding of nutrition and the importance of healthy behaviors. In 2018, the Inova Healthy Plate Club served over 270 students, including Hutchison and Dogwood Elementary Schools in the IFOH community. IHPC staff also work with schools and community partners to provide education and taste tests at various events, such as back to school programs, farmers markets and resource fairs.3. Additionally, to support of the initiative to reduce childhood obesity, IFOH staff implemented a 2 day Exercise & Nutrition Program to all third graders of Navy Elementary School.4. As part of its focus to promote community health and education, Inova's Department of Population/Community Health provides small grants to not-for-profit organizations. One of these grants was to the Medical Care for Children Partnership Foundation, where funds will be used to provide uninsured children from birth to age 19 with comprehensive oral health and preventative care.5. Working with community partners to increase access and utilization of oral health services, Inova has several staff members in various roles on the Virginia Oral Health Coalition. Sub-groups are working on improving access, understanding the needs of children with special healthcare needs and increasing education on the importance of oral health.Health Needs the Hospital Will Not AddressNo hospital facility can address all health needs present in its community. The hospital is committed to remaining financially healthy so that it can grow to enhance clinical services and to continue providing a range of community benefits. The hospital's implementation strategy focuses on meeting the priority and specified community health needs described above. Certain issues, such as lack of affordable housing and the physical environment are beyond the scope of the hospital and the hospital has insufficient resources to make a meaningful impact. Other topics, such as diabetes, heart disease and hypertension, are not covered individually as priority target areas in this plan. Even so, there are many activities in these areas throughout the Inova system. Group A-Facility 3 -- INOVA FAIR OAKS HOSPITAL Part V, Section B, line 13h: Calculate family size Group A-Facility 3 -- INOVA FAIR OAKS HOSPITAL Part V, Section B, line 16j: Financial Aid Brochures explaining the charity policy are available through out the Hospital. ER Rooms and waiting rooms have charity notifications posted in their areas, and the brochures are also posted on Inova's website. Group A-Facility 4 -- INOVA MOUNT VERNON HOSPITAL Part V, Section B, line 3j: Question 3eInova Mount Vernon Hospital (IMVH) completed a Community Health Needs Assessment (CHNA) in 2016 and found that numerous health status and access problems are present in the community. Nine areas were identified as the most significant health needs for the IMVH community: Access to Basic Medical Care, Access to Dental Care, Care and Conditions of Older Adults, Cultural Competency in Care, Diabetes, Mental Health and Access to Mental Health Services, Obesity and Obesity-Related Concerns, Physical Environment and Substance Abuse and Excessive Alcohol Use. Within these areas there was no prioritization or ranking.Based on the CHNA results, IMVH developed a three-year implementation strategy to address its community benefit service area for calendar (tax) years 2017 through 2019. Priorities were based on community need as determined by quantitative data and community input, as well as on hospital expertise, resources, strengths of existing programming and partnerships, and alignment with national, state, and local health goals. Based on the CHNA recommendations, Inova Mount Vernon Hospital has identified as its community benefit priorities Conditions and Care of the Aging Population, Diabetes, and Mental Health and Access to Mental Health Services. The hospital's 3-year implementation strategy was endorsed by the Inova Health Care Services Board. Group A-Facility 4 -- INOVA MOUNT VERNON HOSPITAL Part V, Section B, line 5: For IMVH:The hospital interviewed 80 key informants, including external stakeholders (those who represented the broad interests in the community) and internal Inova staff. The interviews were guided by a structured interview guide, and interviewees were encouraged to identify and discuss a wide range of current and emerging issues affecting community health. Interviews were conducted from August 2015 through January 2016. A detailed listing of the community stakeholders who provided community input is shown below. The hospital also sought input from the public regarding the health of the community through an online survey publicized through emails, hospital information and community partners. The survey was also available on paper in the hospital and at the local FQHC.In the process of conducting the 2016 CHNA, Inova received feedback from constituents on the 2013 CHNA process and progress made since then. At the start of the 2016 CHNA, Inova created an advisory committee in order to steer decision making, provide feedback on survey creation, interview candidates and protocols and the process by which community health needs were determined to be significant. The committee included representatives from local FQHCs, local Health Directors and a public official. Members of the committee provided feedback on the 2013 CHNA, including both the initial assessment as well as implementation of strategies to improve health since then. Additional feedback on Inova's community health improvement programs was gathered during key informant interviews.Alexandria City Government - General populationAlexandria Community Services Board - Mentally ill population, Substance abuse needs, Intellectually disabledAlexandria Health Department - General populationAlexandria Public Health Advisory Commission - General populationCampagna Center - Youth, Immigrants, ImpoverishedFairfax County Board of Supervisors - General populationFairfax County Health Care Advisory Board - General population, PhysiciansFairfax County Health Department - General populationFairfax County Multicultural Advisory Council - Immigrant community, Hispanic community, Muslim community, East African community, Korean community, Indian communityFairfax County Public Schools - General population, Youth/adolescentsFairfax-Falls Church Community Services Board - Mentally ill population, Substance abuse needs, Intellectually disabledGeorge Mason University, College of Health and Human Services - General population, StudentsGrace Ministries - Faith-based community, Immigrant populationInova Board of Directors - General populationInova Mount Vernon Hospital Internal Staff - General population, PhysiciansInova Office of Health Equity - Marginalized populations, Minority populationsNeighborhood Health - General population, Low income, Uninsured/UnderinsuredNorthern Virginia Family Services - Adolescent/youth, Low income, Homeless, Mentally illNorthern Virginia Health Foundation - General population, Low Income, Uninsured/UnderinsuredPartnership for a Healthier Alexandria - General Population, Aging Partnership for a Healthier Fairfax - General population, Business communityRoute 1 Human Services Task Force - Homeless population, Low income population Group A-Facility 4 -- INOVA MOUNT VERNON HOSPITAL Part V, Section B, line 6a: Inova Loudoun HospitalInova Fairfax HospitalInova Fair Oaks HospitalInova Alexandria Hospital Group A-Facility 4 -- INOVA MOUNT VERNON HOSPITAL Part V, Section B, line 11: Inova Mount Vernon Hospital conducted a Community Health Needs Assessment (CHNA) in 2016 to identify the significant health needs in its community, and to inform development of an Implementation Strategy to address those needs. This process also responds to regulatory requirements, which mandate that tax-exempt hospital facilities conduct a CHNA every three years and adopt an Implementation Strategy that addresses significant community health needs.One main aim of the Implementation Strategy is to guide the hospital's community benefit activities for the period of 2017 - 2019. Community benefits are programs or activities that provide treatment and/or promote health and healing as a response to identified community needs. The CHNA process encourages hospitals to focus on improving the health of the communities they serve, and not to select outreach efforts based solely on internal growth priorities. Implementation Strategies should be broad based and work with community entities to improve health outside the walls of the hospital, increase prevention efforts and improve public health.The Inova Mount Vernon Hospital team selected the following priority areas for the 2017-19 Implementation Strategy: Improve the Care and Conditions of Aging Adults, Improve Care and Access to Care for Individuals with Mental Health and Substance Abuse Needs and Decrease the Prevalence and Improve the Care of Individuals with Diabetes.Update - Year TwoMembers of the Community Health Services Division, IMVH leadership and community partners have been working diligently on the priority areas set forth in the 2016 CHNA Implementation Plan.Through the thought work and collaboration of diverse stakeholders, much progress has been made, as described below.1. Inova Behavioral Health Services is committed to offering a full spectrum of mental health and addiction treatment services, and has been working to increase access through creative and multi-modal initiatives. One new initiative is the implementation of SBIRT (Screening, Brief Intervention and Referral to Treatment). SBIRT is a simple screening tool that helps identify people at high risk of substance abuse, and is now in place in all hospital emergency departments (ED). Results of the screening guide the level of intervention. People at mild or moderate risk receive a short counseling session. Those diagnosed as addicted are referred for treatment.2. To prevent and reduce the incidence of nutrition-related diseases, Inova focused on several initiatives to reduce food insecurity and increase food literacy among community members. Specifically, Inova continued to match the purchases made by SNAP customers (formerly food stamps) at farmers markets, allowing low-income individuals to purchase more fresh produce.3. Inova continued to grow the Inova Healthy Plate Program, an 8-week school-based nutrition program provided to local Title I elementary schools and community programs. The Inova Healthy Plate Club aims to improve students' understanding of nutrition and the importance of healthy behaviors. In 2018, the Inova Healthy Plate Club served over 270 students, including Hammond Middle School and a new program at John Adams Elementary Schools in the IMVH community.4. In September of 2018, inpatient hospice beds were created through a partnership with Capital Caring. Patients who are admitted to the hospital who meet criteria for end-of-life care and who desire to pursue this service are transitioned to inpatient hospice. They are then allowed to pass away with dignity or they can be discharged to an outpatient hospice facility for further end of life care. Capital Caring provides a hospice physician available 24/7/365 to consult/come onsite as needed.5. To further assist our aging population, the Heart Failure Clinic was started in 2018 with the goal of preventing readmission of patients originally admitted for heart failure. The clinic is managed by IMG Cardiology, partnering with IMVH Nursing in the outpatient infusion center on unit 3B.6. Additionally, a community outreach initiative, the IMVH Continuum of Care Collaborative, was started in 2018. This team is comprised of partners who we interact with post-discharge (SNFs, home health, assisted living, Transitional Services Clinic, dialysis, hospice, etc.). The purpose is to provide for a smoother transition out of the hospital back to life and to reduce readmissions and mortality. The initiative is just getting off the ground, and expected to grow in 2019.7. The Inova Medical House Calls program is designed to help patients successfully "age in place" while reducing readmissions and overall cost. An interdisciplinary team provides comprehensive primary care in patient homes and assisted living facilities. Patients are generally 65 years of age or older and they have difficulty leaving home for medical appointments. These primary care services are "high-touch" with intensive patient management and care coordination with an emphasis on advance care planning. The program staff leverages strong relationships with inpatient teams, hospice agencies, skilled nursing staff, physical therapy staff, occupational therapy staff, mental health counselors and county services for high-quality patient outcomes.8. Additionally, one major issue in care for the growing older adult population has been a scarcity of options for primary care. To meet this need, Inova added a geriatrician in three of the Inova Medical Group primary care practices, one of which is in the IMVH community.9. ElderLink is a non-profit partnership between Inova, the Fairfax Area Agency on Aging, and the Alzheimer's Association, National Capital Area Chapter. ElderLink provides case management, care coordination, health and wellness programming, as well as support to patients returning from the hospital back to their home in the community, and caregiver support to older adults and their caregivers.Health Needs the Hospital Will Not AddressNo hospital facility can address all health needs present in its community. The hospital is committed to remaining financially healthy so that it can grow to enhance clinical services and to continue providing a range of community benefits. The hospital's implementation strategy focuses on meeting the priority and specified community health needs described above. Certain issues, such as access to dental care and the physical environment are beyond the scope of the hospital and the hospital has insufficient resources to make a meaningful impact. Other topics, such as cultural competency, obesity and obesity-related concerns are not covered as priority target areas in this plan. Even so, there are many activities in these areas throughout the Inova system. Group A-Facility 4 -- INOVA MOUNT VERNON HOSPITAL Part V, Section B, line 13h: Calculate family size Group A-Facility 4 -- INOVA MOUNT VERNON HOSPITAL Part V, Section B, line 16j: Financial Aid Brochures explaining the charity policy are available through out the Hospital. ER Rooms and waiting rooms have charity notifications posted in their areas, and the brochures are also posted on Inova's website. 46 1 - RADIOLOGY IMAGING ASSOCIATES LLC 19455 DEERFIELD AVENUE SUITE 102 LANSDOWNE VA 20176 IMAGING CENTER 2 - EMERGENCY CARE CENTER OF FAIRFAX 4315 CHAIN BRIDGE ROAD FAIRFAX VA 22030 EMERGENCY ROOM 3 - NORTHERN VIRGINIA SURGERY CENTER LLC 3620 JOSEPH SIEWICK DRIVE FAIRFAX VA 22033 OUTPATIENT SURGERY 4 - FRANCONIA SPRINGFIELD SURGERY CENTER LLC 6355 WALKER LANE SUITE 200 ALEXANDRIA VA 22310 OUTPATIENT SURGERY 5 - INOVA RESTON MRI CENTER LLC 2722 MERRILLE DRIVE SUITE 230 FAIRFAX VA 22031 MRI CENTER 6 - EMERGENCY CARE CENTER OF RESTON 11901 BARON CAMERON AVENUE RESTON VA 20190 EMERGENCY ROOM 7 - ASSISTED LIVING AT FAIR OAKS 3750 JOSEPH SIEWICK DRIVE FAIRFAX VA 22033 ASSISTED LIVING 8 - MCLEAN AMBULATORY SURGERY LLC 7601 LEWINSVILLE ROAD SUITE 440 MCLEAN VA 22102 OUTPATIENT SURGERY 9 - INOVA AMBULATORY SURGERY CTR AT LORTON 9321 SANGER STREET LORTON VA 22079 OUTPATIENT SURGERY 10 - ASSISTED LIVING AT RESTON TOWN CENTER 1778 FOUNTAIN DRIVE RESTON VA 20190 ASSISTED LIVING 11 - ASSISTED LIVING AT MCLEAN 8315 TURNING LEAF MCLEAN VA 22102 ASSISTED LIVING 12 - KELLAR 11204 WAPLES MILL ROAD FAIRFAX VA 22030 BEHAVIORAL SERVICES 13 - ASSISTED LIVING AT MT VERNON 8033 HOLLAND ROAD ALEXANDRIA VA 22306 ASSISTED LIVING 14 - INSTITUTE OF RESEARCH AND EDUCATION 3300 GALLOWS ROAD FALLS CHURCH VA 22042 RESEARCH FACILITY 15 - ASSISTED LIVING AT GEORGE MASON 4300 CHAIN BRIDGE ROAD FAIRFAX VA 22030 ASSISTED LIVING 16 - POTOMAC RADIATION ONCOLOGY 2296 OPITZ BLVD WOODBRIDGE VA 22191 RADIATION ONCOLOGY 17 - INOVA URGENT CARE CTR - W SPRINGFIELD 6230 ROLLING ROAD SUITE J SPRINGFIELD VA 22152 URGENT CARE 18 - INOVA URGENT CARE CTR - DULLES SOUTH 24801 PINEBROOK ROAD SUITE 110 CHANTILLY VA 20152 URGENT CARE 19 - INOVA URGENT CARE CTR - S ARLINGTON 3263 COLUMBIA PIKE ARLINGTON VA 22204 URGENT CARE 20 - INOVA URGENT CARE CENTER - VIENNA 180 MAPLE AVENUE WEST VIENNA VA 22180 URGENT CARE 21 - INOVA URGENT CARE CTR - CENTREVILLE 6201 CENTREVILLE ROAD SUITE 200 CENTREVILLE VA 20121 URGENT CARE 22 - INOVA PHYSICAL THERAPY CTR - FAIRFAX 8501 ARLINGTON BLVD SUITE 200 FAIRFAX VA 22031 REHABILITATION 23 - INOVA URGENT CARE CTR - TYSONS CORNER 8357-E LEESBURG PIKE VIENNA VA 22182 URGENT CARE 24 - IAH OCCUPATIONAL HEALTH 4700 KING ST SUITE 201 ALEXANDRIA VA 22302 OCCUPATIONAL HEALTH 25 - INOVA PHYSICAL THERAPY CTR - VIENNA 8320 OLD COURTHOUSE ROAD SUITE 410 VIENNA VA 22182 REHABILITATION 26 - INOVA PHYSICAL THERAPY - CENTREVILLE 6201 CENTREVILLE ROAD SUITE 500 CENTREVILLE VA 20121 REHABILITATION 27 - INOVA PHYSICAL THERAPY - SPRINGFIELD 8348 TRAFORD LANE SUITE 100 SPRINGFIELD VA 22152 REHABILITATION 28 - ASHBURN OCCUPATIONAL HEALTH 21785 FILLAGREE CT SUITE 103 ASHBURN VA 20147 OCCUPATIONAL HEALTH 29 - INOVA URGENT CARE CENTER - MANASSAS 8051 SUDLEY ROAD MANASSAS VA 22109 URGENT CARE 30 - INOVA URGENT CARE CTR - DUNN LORING 2671 AVENIR PLACE SUITE A VIENNA VA 22180 URGENT CARE 31 - INOVA URGENT CARE CTR - PURCELLVILLE 7601 LEWINSVILLE ROAD SUITE 440 PURCELLVILLE VA 20132 URGENT CARE 32 - INOVA URGENT CARE CTR - N ARLINGTON 4600-C LEE HIGHWAY ARLINGTON VA 22207 URGENT CARE 33 - INOVA PHYSICAL THERAPY CTR- SPORTPLEX 6355 WALKER LANE SUITE 404 ALEXANDRIA VA 22310 REHABILITATION 34 - INOVA PHYSICAL THERAPY - WOODBRIDGE 14605 POTOMAC BRANCH DRIVE SUITE 200 WOODBRIDGE VA 22191 REHABILITATION 35 - INOVA PHYSICAL THERAPY CTR - FAIROAKS 3620 JOSEPH SIEWICK DRIVE SUITE 101 FAIRFAX VA 22033 REHABILITATION 36 - PRINCE WILLIAM OCCUPATIONAL HEALTH 8480 KAO CIRCLE MANASSAS VA 20110 OCCUPATIONAL HEALTH 37 - INOVA PHYSICAL THERAPY CTR - DULLES 24801 PINEBROOK ROAD SUITE 200 CHANTILLY VA 20152 REHABILITATION 38 - INOVA PHYSICAL THERAPY CTR - ASHBURN 20905 PROFESSIONAL PLAZA SUITE 110 ASHBURN VA 20147 REHABILITATION 39 - INOVA PHYSICAL THERAPY CTR- MT VERNON 8101 HINSON FARM ROAD SUITE 401 ALEXANDRIA VA 22306 REHABILITATION 40 - INOVA PHYSICAL THERAPY CTR-ALEXANDRIA 4700 KING ST SUITE 200 ALEXANDRIA VA 22302 REHABILITATION 41 - INOVA PHYSICAL THERAPY CTR - BALLSTON 1005 NORTH GLEBE ROAD SUITE 400 ARLINGTON VA 22201 REHABILITATION 42 - INOVA PHYSICAL THERAPY - VA SQUARE 3833 NORTH FAIRFAX DRIVE SUITE 300 ARLINGTON VA 22203 REHABILITATION 43 - INOVA URGENT CARE CENTER - RESTON 1488 NORTH POINT VILLAGE CENTER RESTON VA 20194 URGENT CARE 44 - INOVA URGENT CARE CTR - WOODBRIDGE 14605 PoTOMAC BRANCH DRIVE SUITE 200 WOODBRIDGE VA 22191 URGENT CARE 45 - INOVA PHYSICAL THERAPY - DUNN LORING 2740 PROSPERITY AVENUE SUITE 200 FAIRFAX VA 22033 REHABILITATION 46 - CATS 3300 GALLOWS ROAD FALLS CHURCH VA 22042 BEHAVIORAL SERVICES Part I, Line 3c: Catastrophic Financial Assistance: Catastrophic Financial Assistance is available for patients who do not qualify for free care based on the criteria above, who, due to the nature and extent of services provided, have significant care-related financial obligations in relation to household income and other potenally available resources. In such circumstances, the patient responsibility will be limited to the lesser of 30% of Family Income or the Amounts Generally Billed. Part I, Line 6a: THE COMMUNITY BENEFIT REPORT IS INCLUDED IN THE CONSOLIDATED INOVA HEALTH SYSTEM REPORT TO THE COMMUNITY ON INOVA.ORG WEBSITE. Part I, Line 7: Cost to charge ratio method is used based on table 2 in the instructions. Total operating expense is divided by Total Gross Revenue to arrive at the cost to charge ratio. Part I, Line 7g: Cost of Physician Clinic is $5,747,838. Part I, Line 7, Column (f): The Bad Debt expense included on Form 990, Part IX, Line 25, Column (A), but subtracted for purposes of calculating the percentage in this column is $ 159,499,239. Part II, Community Building Activities: Inova's Office of Sustainability provides community building support focused on environmental improvements. Environmental Mission Statement:Inova Health System is committed to establishing an environmental program that is safer and healthier for patients, employees and the community.Community Building Environmental Improvements Waste ManagementInova has been focused on waste reduction strategies including recycling and segregation since 2008. Throughout the hospitals there is a single stream recycling process and there are focused efforts on reducing regulated medical waste. In 2018, Inova recycled or diverted approximately three million pounds of material from local landfills and waste to energy facilities.Specialized areas recycling/reuse: Inova has implemented specialized recycling programs to capture specific materials throughout the hospitals including a medical donation program that shipped 48,000 pounds of unused, unopened medical supplies and durable medical equipment to places in need both in local communities and across the globe.EnergyDuring 2018, Inova continued to make progress towards its energy goal of reducing energy use intensity (EUI) 20 percent by the year 2020 (baseline year 2012). A variety of projects including exterior lighting upgrades, specific interior lighting projects, HVAC improvements and energy monitoring, all continued throughout 2018. These efforts result in cost savings and improved resilience for the overall health of the community.WaterInova continues to maintain native plantings and low-impact irrigation systems for landscaping as well as reduce water consumption in our hospitals through the routine replacement of less efficient plumbing fixtures. BuildingsInova is currently working on a number of projects pursing LEED certification including the Inova Center for Personalized Health along with Inova Fairfax Medical Campus. There are other projects underway including Inova Loudoun Hospital pursuing a number of green elements. The goal of Inova's green building efforts is to ensure that our buildings are operated in the most efficient manner, leading to both operational savings as well as improved patient/employee outcomes. TransportationContinued collaboration with Fairfax County Department of Transportation to promote alternative commuting options for Inova employees resulting in fewer single-occupancy vehicle trips. The Inova Fairfax Medical Campus achieved the required mode-split again in 2018, with more than 18% of employees using some sort of alternative mode of transportation. Inova Mount Vernon hospital also has a mode-split requirement and 21.5% of employees there are using a form of alternative transportation. This is the result of employees taking public transportation, Employee Commuter Shuttles, carpools and some even biking or walking to work. These initiatives contribute to lower levels of air pollution and congestion as well as improvements to overall community health. FoodContinued to promote and serve local and sustainable foods throughout Inova hospitals with 26% of food spend categorized as sustainable. Inova hospitals also transitioned to a variety of No Antibiotic Ever (NAE) poultry products which resulted in 37% NAE for all meats served. These initiatives are important for the health of all patients and the community, and also support local farms. Sponsor of the Northern Virginia Chapter of Buy Fresh, Buy Local, a nationally recognized program that is dedicated to reintroducing Americans to their food - the seeds it grows from, the farmers who produce it, and the routes that carry it from the fields to their tables. CommunityDistributed more than 500 native tree seedlings to be planted within the local community in 2018 in support of Earth Day.Mentored peer organizations locally and nationally as well as a variety of corporate clients on sustainable practices through a combination of formal speaking engagements, news article publications and informal discussions, helping them create safer environments for their patients, employees, and communities. Part III, Line 4: BAD DEBT FOOTNOTE FROM INOVA HEALTH SYSTEM CONSOLIDATED FINANCIAL STATEMENTSPatient accounts receivable include charges for amounts due from all patients less priceconcessions relating to allowances for the excess of established charges over the payments to be received on behalf of patients covered by Medicare, Medicaid and other insurers. The provision for price concessions is based upon management's assessment of historical and expected net collections considering historical business and economic conditions, trends in health care coverage, and other collection indicators. Periodically throughout the year, management assesses the adequacy of the price concessions based upon historical experience of self-pay accounts receivable, including those balances after insurance payments and not covered by insurance. The results of this review are then used to make any modifications to the provision for price concessions. There have been no significant changes in the current year to the underlying assumptions used by IHS to estimate the allowance for uncollectible accounts. Patient accounts receivable are written off after collection efforts have been followed in accordance with IHS policies. All operating entities of IHS treat emergency patients and provide medically necessary treatment to patients regardless of their ability to pay. A patient is classified as a charity patient based upon established IHS policies that consider patient income levels. Since IHS does not pursue collection of amounts that qualify as charity care, these amounts are deducted from gross revenue as a price concession. Part III, Line 8: The organization does not treat any Medicare shortfall as community benefit. The amounts are taken directly from the Medicare Cost Reports as filed using a cost to charge ratio method. Part III, Line 9b: Patients who have not applied for Financial Assistance under this policy will be treated as self-pay and subject to Inova's normal billing and collections processes.All patient responsibility portions of Inova's accounts will process through Inova's billing and collection systems for effective in-house collections and within federal guidelines for transitioning to external collection agencies after in-house efforts have been exhausted. Patient responsibility portions will be processed through pre-billing, statement, and follow-up in automated and systematic steps. All collections actions will be in compliance with the Fair Debt Collection Practices Act and ACA International's Code of Ethics and Professional Responsibility.Patients will receive statements for 120 days. After 120 days, with no contact from the patient and without the establishment of acceptable payment terms, accounts will be transferred to a professional collection agency. If continued non-payment occurs beyond a reasonable period of time, legal actions may be undertaken to collect payment.If a patient wishes to make payment arrangements and does not have resources to pay the account in full, payment plans will be offered.No Inova entity or third-party collections agent will impose extraordinary collections actions such as legal actions or adverse credit reporting against any patient, without first making reasonable efforts to determine whether that patient is eligible for Financial Assistance under this policy. These reasonable efforts include:Assuring that no ECAs are imposed for at least 120 days from the date of the first billing statement.Providing a 30-day written notice that includes information about Inova's Financial Assistance Policy and about any intended ECAs to be imposed in the event of nonpayment.Providing oral notification of any intended ECAs to be imposed in the event of nonpayment.If a patient is determined to be eligible for Financial Assistance after payment is received or after an ECA has been imposed, the account will be adjusted and the collections action will be reversed.The Vice President of Revenue Cycle Operations or his/her designee is responsible for determining whether Inova has made reasonable efforts to determine whether an individual is FAP-eligible and whether one or more ECAs may be imposed. PART III, LINE 2 AND 3 Actual bad debt expense is multiplied by the cost to charge ratio used in computing charity care expense in Part I. The provision for bad debts is recognized when providing an allowance for uncollectible accounts.The are no estimated amounts for bad debt expense attributable to patients under the organization's charity care policy. Part VI, Line 2: Inova Health System (IHS) completed a Community Health Needs Assessment (CHNA) in 2016 to identify priority health status and access issues for particular geographic areas and populations by focusing on the following questions: Who in the community is most vulnerable in terms of health status or access to care?What are the unique health status and/or access needs for these populations?Where do these people live in the community? Why are these problems present?Inova's CHNA considers multiple data sources, including secondary data (regarding demographics, health status indicators, and measures of health care access), assessments prepared by other organizations in recent years, and primary data derived from a community survey and from interviews with persons who represent the broad interests of the community, including those with expertise in public health.The following topics and data are assessed in Inova's CHNA report:Demographics, e.g., numbers and locations of vulnerable people;Economic issues, e.g., poverty and unemployment rates, and impacts of state or local budget changes;Community issues, e.g., homelessness, housing, environmental concerns, crime, and availability of social services;Health status indicators, e.g. morbidity rates for various diseases and conditions, and mortality rates for leading causes of death;Health access indicators, e.g., uninsurance rates, discharges for ambulatory care sensitive conditions (ACSC), and use of emergency departments for non-emergent care;Health disparities indicators; andAvailability of healthcare facilities and resources. The assessment identifies a list of significant community health needs.As a result of this work and previous work, each Inova hospital selected 2-3 priority areas to focus on for the next few years, and is moving forward with developing coordinated efforts within the health system to carry out the designed implementation plans of the Community Health Needs Assessment. The Program Outreach Administrator is coordinating plans with hospital leaders to assure effective plan implementation in each of the respective communities. The Program Outreach Administrator is centralized to the system under the Vice President of Population Health and thereby assures system coordinated efforts are centralized and reflective of Inova Health System's work across Northern Virginia.The various Public Health Departments also conduct community health needs assessments using the framework of the Mobilizing for Action through Planning and Partnerships (MAPP) process. Inova Health System is a participating member of the MAPP process in each jurisdiction across Northern Virginia.The MAPP process leads to an ongoing community-driven planning process that is designed to provide information for improving the community's delivery of the ten essential public health services. This process brings together a diverse group of key community stakeholders including local government, human service organizations, schools and universities, healthcare consumers, advocacy groups, hospitals, faith institutions, youth development organizations, economic and philanthropic groups, etc. to identify strengths and weaknesses in the ten essential areas to provide a foundation for community health planning. The information from the MAPP health needs assessments in all jurisdictions served by Inova Health System, as well as the ongoing work of the action teams, were incorporated into the community needs assessment implementation plans that were finalized in 2016. In addition to these activities, Inova is continually garnering feedback on existing safety net and community programs from participants through monthly and quarterly satisfaction surveys and focus groups, participating in regional and local health related groups such as the Northern Virginia Health Services Coalition, meeting with various cultural and ethnic groups in the community and using internal utilization and outcomes data, review of best practices and regional and national benchmark data and other external sources such as the Metropolitan Washington Council of Governments (COG) demographic data to develop strategic goals for health improvement activities. Collectively, all this information is utilized in assessing community health needs to guide strategic planning efforts. Part VI, Line 3: Inova Health System utilizes a multifaceted approach to educate and inform patients and the public about Inova's Financial Assistance Policy (FAP) or charity care policy. Upon admission to any Inova hospital or any visit to outpatient facilities or clinics including emergency departments, Inova has information posted regarding patient rights and responsibilities. In addition, Inova provides information about the charity care program and referrals to meet with Inova financial counselors who assist patients in completing Inova's charity care application. This financial information is reviewed by the Inova Patient Accounts Department with the patient contacted if additional information is required in order to make a determination. The patient is subsequently provided a letter notifying them as to whether or not they qualify for charity care. Inova also has Medicaid eligibility workers on-site in all hospitals, in the InovaCares Clinic for Women and Children (clinic for low income families) and in the community as part of the Partnership for Healthier Kids Access to Care program. Inova partners with schools across the jurisdiction to provide information about state funded health programs for children and contact information to meet with an eligibility worker responsible for enrolling families in state Medicaid programs. These eligibility workers also go out into the community attending community events such as health fairs, faith-based community activities and other family centered community events to proactively meet with families to encourage enrollment in programs for which they are eligible. Inova has a section of the public website dedicated to information about billing and financial coordinators and financial assistance resources. Part VI, Line 4: Inova Health Care Services (IHCS) is a not-for-profit corporation and a subsidiary of the parent organization, Inova Health System Foundation (Inova). Inova provides healthcare and related services throughout Northern Virginia and the greater metropolitan Washington, D.C. area, including certain contiguous counties of Virginia and Maryland. Northern Virginia is one of the fastest growing urban communities in the United States. With approximately 1,304 square miles, the region is the most densely populated in the Commonwealth of Virginia. Northern Virginia is comprised of several distinct communities, including the cities of Alexandria, Fairfax, Falls Church, Manassas and Manassas Park, and the counties of Arlington, Fairfax, Loudoun, and Prince William. The eastern sections are urbanized with attendant health problems of overcrowding and increasing demand for health services and public programs. Inova Health Care Services' service area is primarily the cities of Alexandria, Fairfax and Falls Church and Fairfax County.Fairfax County is served by four hospitals that are physically located in the county (Inova Mount Vernon, Inova Fairfax, Inova Fair Oaks, and HCA Reston). There are nine Census Tracts in Fairfax County that are medically underserved.The region's population served by IHCS is forecasted to grow 9% over the next decade adding an estimated average of 13,000 persons a year. Population will be spurred by the long-term strength of the region's economy, high rates of in-migration and international immigration. The region's population that is 65 years of age and older is expected to grow 25% over the next 5 years, while the number of children will increase by about 4% during the same time period. (MWCOG 9.0 and ESRI)Northern Virginia's racial and ethnic diversity is more pronounced than in the rest of the state. With increasing diversity, economically disadvantaged populations and multiple languages, the need for access to culturally appropriate, flexible health care continues to grow. The Northern Virginia geographic region in 2018 was 41% minority, up from 28% in 1990, while the nation as a whole reflects a 39% minority population (U.S. Census Bureau). Fairfax County, with more than one million residents, is the largest jurisdiction in Northern Virginia and also has the largest minority population. In Fairfax County in 2017, Asians, Hispanics, and African Americans represented 18.9%, 16.2%, and 9.7% of the county's population, respectively. One-quarter of the state's Hispanic population resides in Fairfax County (U.S. Census Bureau).According to the US Census Bureau Small Area Health Insurance Estimates (SAHIE) in 2015 approximately 8.8% of the total population under the age of 65 (about 101,000 people) in Fairfax County lacked healthcare insurance. Of the people living in Fairfax County whose family incomes are at or below 200% of the federal poverty level, SAHIE estimates that 32.9% (about 40,000 people) were uninsured in 2015.Area residents most likely to be uninsured are those whose family incomes are at or below 200% of the poverty level, young adults (age 18-44), people of racial backgrounds other than White, unemployed individuals, part-time workers, and people who work at companies with fewer than 50 employees. Serving this population poses significant cultural and linguistic challenges, and these uninsured citizens are widely distributed in terms of age, geographic region, and health status. Part VI, Line 5: Inova Health System's investment in the communities across Northern Virginia is evident through numerous targeted community programs. These programs provide access to care for low income, uninsured, underinsured and vulnerable populations; promote health & wellness; increase health literacy; provide the support and infrastructure for disaster preparedness; and provide programs to support development of our future healthcare workforce to meet the healthcare needs of the communities served. All Inova healthcare facilities have open medical staffs to provide the maximum access to qualified physicians. A Community Board of Trustees provides fiscal and quality oversight for Inova Health Care Services' facilities to ensure the vision and mission of the organization is achieved.Access to Care ProgramsInova's Population and Community Health Division is organized to address a wide-spectrum of community healthcare needs. In addition to the programs already described in the core form program, activities that provide infrastructure support and services focused on vulnerable populations to increase access to healthcare services for the communities served by Inova Health System include the following programs:The Streamlined Eligibility program (SES), launched by the successful implementation of the federally-funded 2001 CAP and 2004 HCAP grants, continues to be funded by Inova and Fairfax County. SES provides local safety-net health care providers access to coordinated health care networks to serve the uninsured and underinsured residents of Northern Virginia. A shared database is used to determine a patient's eligibility for services which provides one central intake thereby streamlining and expediting the process. Inova supports the infrastructure and expansion of the program which currently consists of 12 public/private partners serving Fairfax County, City of Alexandria, Loudoun County, Arlington County, and Prince William County. The system currently houses over 300,000 eligibility records of uninsured and Medicaid patients.Inova's Partnership for Healthier Kids (PHK) Access to Care program provides families with comprehensive application and enrollment assistance to connect them with an appropriate and affordable source of health care services. In 2018, PHK assisted over 11,313 children and parents with access to a source of comprehensive health care services such as Medicaid, FAMIS or local safety net providers. PHK began expansion efforts in the end of 2018 with the onset of Medicaid expansion in Virginia.Care Connection for Children (CCC) is funded by the Virginia Department of Health. The goal of CCC is to help families coordinate community and educational resources with medical expertise to ensure that children with special healthcare needs can reach their maximum potential. CCC partners with families of children who have chronic healthcare needs to help open doors to needed resources and coordinate quality family-centered care. CCC is committed to helping children maximize their potential in a caring, innovative and culturally sensitive manner. In 2018, CCC served 856 families.Transitional Care Management Inova Transitional Services is a comprehensive service designed to support medically vulnerable patients with a recent Inova hospitalization to ensure quality transitions of care outcomes and support the ambulatory physician community in managing this challenging population after discharge. Inova Transitional Services encompasses three main programs-Transitional Care Management (TCM), the Transitional Services Clinics and the new Medicare Focused Navigator (MFN) program. TCM is a 30 day post-acute telephonic case management program designed to encourage patients to follow up with their Primary Care Physician (PCP) and to follow PCP instructions on medication reconciliation. TCM also assists patients by providing education on their disease symptoms and empowers them to take an active, preventative role in their healthcare and wellness. TCM promotes early intervention and communication with PCPs at the first signs of disease symptoms and assists patients in navigating services and resources in the community to support their wellness goals.The Transitional Services Clinics are hospitalist-run post-acute clinics that provide immediate attention to medically complex patients who require intensive follow-up care. Patients are provided appointments to ensure that all hospital discharge instructions, medication reconciliation and symptoms have been stabilized and resolved prior to transitioning back to their PCP. In 2018, TCM managed over 4,000 admissions and the Transitional Services Clinics served over 5,500 patients with over 8,800 visit encounters. The Medicare Focused Navigator program is designed to provide oversight and navigation of the Medicare 65+ focus diagnosis patients throughout the continuum of care during the 30 days post inpatient hospitalization. The goal of the program is to ensure proper access and coordination of all discharge dispositions, post-acute care services and assist with transitions throughout the continuum by assisting patients and community service providers with follow up appointment coordination, appointment reminder calls, resource connection, problem solving and communication. The MFN program managed almost 6,000 admissions in 2018. Inova is committed to providing a quality, post-hospitalization care continuum to ensure that the ambulatory physician community is supported in caring for this medically complex and vulnerable population.Inova Kellar CenterInova Kellar Center (IKC) is a community based behavioral health program and special education school founded by Inova in 1991 with a gift from Fairfax County residents, Art and Betty Kellar, to address a gap in mental health and substance abuse services for children and adolescents. Currently IKC offers a full continuum of mental health services from outpatient therapies and medication management to after school Intensive Outpatient Programs and a full day Partial Hospitalization Program. The Kellar School, a private special education day school for students with emotional, social and behavioral needs provides academic instruction within a therapeutic environment. The Center provided 84,891 hours of programming, treatment and education to children, adolescents, and families in 2018. Inova Ewing Forensic Assessment and Consultation Teams (FACT)The Inova Ewing FACT department is a comprehensive, outpatient forensic nursing program for children and adults. Established in the late 1990s, the Inova Ewing FACT department has provided specialized care for victims of sexual abuse, domestic violence and child abuse. FACT serves all of Northern Virginia including Fairfax, Arlington, Loudoun and Prince William counties, the cities of Alexandria and Falls Church, parts of Fauquier and Stafford counties, military installations and universities. FACT also performs courtesy exams for outlying jurisdictions including the District of Columbia, Maryland and West Virginia. The program has grown significantly over the years and now provides services in the areas of Sexual Assault, Intimate Partner/Domestic Violence, Physical Child Abuse, Strangulation and Human Sex Trafficking. In 2018, the department had 934 patient encounters, reflecting a 6% increase from 2017 and a 47% increase from 2015. Health Promotion and Preventative Care ProgramsTo prevent and reduce the incidence of nutrition-related diseases, Inova focused on several initiatives to reduce food insecurity and increase food literacy among community members. Specifically, Inova continued to match the purchases made by SNAP customers (formerly food stamps) at farmers markets, allowing low-income individuals to purchase more fresh produce.Inova also continued to grow the Inova Healthy Plate Program, an 8-week school-based nutrition program provided to Title I elementary schools and community centers. The Inova Healthy Plate Club aims to improve students' understanding of nutrition and the importance of healthy behaviors. In 2018, the Inova Healthy Plate Club served over 270 students.Language and Disability ServicesThe Language and Disability Services Department is dedicated to ensuring equal access to Inova's services regardless of language preference or the need for special accommodations. In support of patient safety and satisfaction, language interpretation and document translations are provided at every Inova facility, to facilitate communication with the 14% of Inova's patient population who are Limited English Proficient (LEP), and the 0.2% of clients who are Deaf or Hard of Hearing (D/HH). In 2018, phone, video and in-person medical interpreters delivered 81,367 hours of interpretation in 200 languages, and 14,878 hours in American Sign Language. Additionally, 506 vital documents were translated into Inova's top languages. Part VI, Line 6: Organization is part of Inova Health System included in description under Line 5. PART VI, LINE 5 Continued Cash and In-Kind Contributions to Community GroupsInova donates space, provides cash and in-kind support such as housekeeping and donated staff time to a number of community groups and services. Inova provides support to NOVA Scripts, the Center for Multicultural Human Services, Shenandoah University, and the Nova Dental Clinic. Inova also provides financial support to The Loudoun Free Clinic and HealthWorks for Northern Virginia and Neighborhood Health, the local Federally Qualified Health Centers. In 2018, Inova donated over $1.6 million for these groups covering both cash and in-kind transactions.Additionally, as part of Inova's efforts to harness the collective power of community partners, agencies and organizations to create positive social impact, Inova provided $60,000 in community grants. Applicants were required to present programs or projects addressing the population health needs described in the Inova Community Health Needs Assessments. 1 1 1 0 0 0 0 0 0 0 JKNOX SINGLETON CEO, President, Ending 4/9/18 0 718511 0 3779513 0 118726 0 42491 0 3454 0 4662695 0 1890422 RASHID NAYYAR MD TRUSTEE 176605 0 0 0 0 0 0 0 0 0 176605 0 0 0 J STEPHEN JONES CEO, President, Beginning 4/9/18 0 825142 0 300000 0 225747 0 428108 0 19521 0 1798518 0 0 KEITH STERLING MD TRUSTEE 160000 0 0 0 0 0 0 0 0 0 160000 0 0 0 RICHARD MAGENHEIMER TREASURER-CFO 0 777202 0 979253 0 1556041 0 697070 0 18933 0 4028499 0 513084 JOHN GAUL ASST SECRETARY 497263 0 360510 0 123086 0 225359 0 28405 0 1234623 0 160023 0 MARK STAUDER COO 0 827779 0 2919962 0 1036894 0 13750 0 12925 0 4811310 0 1554300 PATRICK CHRISTIANSEN EVP CEO IFMC 0 606697 0 1268561 0 526875 0 56750 0 18414 0 2477297 0 817945 JOHN NIEDERHUBER CEO ITMI & EVP IHS 0 985483 0 339353 0 237463 0 38250 0 10534 0 1611083 0 0 LORING FLINT EVP CHIEF MEDICAL OFFICER 0 654307 0 873051 0 250390 0 555685 0 23800 0 2357233 0 610394 HPATRICK WALTERS INTERIM CHRO 432669 0 461491 0 106591 0 383237 0 21509 0 1405497 0 219853 0 SUSAN CARROLL REGIONAL EXEC OFFICER 485107 0 298914 0 302319 0 161800 0 28055 0 1276195 0 342322 0 JOHN FITZGERALD CEO IFOH 449070 0 313202 0 112333 0 141528 0 21591 0 1037724 0 76782 0 HARVEY MCDUFFIE SVP PRESIDENT INOVA REALTY 495992 0 175000 0 39720 0 149136 0 21018 0 880866 0 0 0 CONSUELO PILOT EVP CIO 0 451587 0 475995 0 122937 0 427861 0 25195 0 1503575 0 271197 JOHN HAMILTON PHYSICIAN 1457322 0 56000 0 1242 0 56750 0 23618 0 1594932 0 0 0 TODD STOTTLEMYER CEO ICPH 561835 0 1494065 0 376796 0 38208 0 17862 0 2488766 0 579961 0 CHRISTOPHER O'CONNOR CEO IHVI 876422 0 265005 0 168123 0 75357 0 14225 0 1399132 0 65300 0 DONALD TRUMP CEO ISCI 779156 0 265670 0 213579 0 86601 0 9592 0 1354598 0 86893 0 JAMES ECKLUND DEPT CHAIR NEUROSCIENCE 1113299 0 248016 0 21608 0 142965 0 17722 0 1543610 0 0 0 MARSHALL RUFFIN FORMER EVP CTO 0 0 16294 0 495559 0 0 0 0 0 511853 0 0 0 ROBERT GRASTY FORMER EVP CHRO COO 0 0 0 0 0 210100 0 0 0 0 0 210100 0 0 JAMES SANTRY FORMER EVP CEO DTC AND AMB 0 295447 0 548268 0 180702 0 32018 0 9019 0 1065454 0 278901 DEBORAH ADDO FORMER CEO ILH 0 441344 0 286180 0 129353 0 221493 0 3314 0 1081684 0 69041 Part I, Line 3 The following methods were used by Imanco, Inc., a related organization, to establish the compensation of IHCS's CEO for the tax year: Compensation committee Independent compensation consultant Written employment contract Compensation survey or study Form 990 of other organizations Approval by the board or compensation committee Part I, Lines 4a-b Severance: J. Knox Singleton $63,000 Mark Stauder $224,611 Richard Magenheimer $1,428,789 James Santry $86,371 Patrick Christiansen $80,064 Todd Stottlemyer $191,178 Marshall Ruffin $495,559 Robert Grasty $210,100 Severance amounts were paid within 24 months after separation from service. SERP Plan Payments: Richard Magenheimer - $108,398 Patrick Walters - $66,016 Mark Stauder - $571,942 James Santry - $73,389 John Fitzgerald - $67,501 Susan Carroll - $271,178 Patrick Christiansen - $407,465 Loring Flint - $211,246 John Gaul - $82,771 Christopher O'Connor $130,598 Consuelo Pilot $88,035 Todd Stottlemyer $158,246 Donald Trump $173,786 The Supplemental Executive Retirement plan (SERP Plan) is a nonqualified retirement plan. Employees eligible to participate are Executive Directors, Assistant Vice Presidents, Vice Presidents, Senior Vice Presidents, Executive Vice Presidents, CFO, COO, and CEO. Each year, a certain percentage of each participant's base salary is contributed to the SERP Plan. This amount ranges from 5% to 20%, depending on position. After three years of continuous participation, participants vest in 50% of their balance at that time and are paid out the vested balance as a taxable event. After a total of six years participation and after attaining age 45, participants are 100% vested and are paid out their remaining balance as a taxable event. Vesting then reverts to a 3 year rolling schedule until year 12. Thereafter, the annual contribution is paid out to the participant each year as a taxable event. A Industrial Development Authority of Fairfax County Virginia 911920228 303823FM5 2005-05-12 124000000 See Part VI 0 0 0 B Industrial Development Authority of Fairfax County Virginia 911920228 303823JJ8 2010-03-08 190000000 See Part VI 0 0 0 C Industrial Development Authority of Fairfax County Virginia 911920228 303823KE7 2012-08-23 382960937 See Part VI 0 0 0 D Industrial Development Authority of Fairfax County Virginia 911920228 303823KS6 2012-12-20 80991559 See Part VI 0 0 0 A 14270000 130441544 3604217 367125 126470203 2007 0 0 1 1 B 95000000 356022667 166022667 190000000 2016 1 0 1 1 C 24675000 385117977 385117977 2016 0 0 1 1 D 80991559 80991559 0 1 1 1 A 0 1 1 1 1 1 0.01200 0.01200 0 0 1 B 0 1 0 1 1 0.01000 0.01000 0.02000 0 0 1 C 0 0 0 1 1 0.00700 0.00700 0 0 1 D 0 1 0 1 1 0.01000 0.01000 0.02000 0 0 1 A 0 0 0 1 1 1 Morgan Stanley Capital Services 30.000000000000 0 1 0 0 1 B 0 0 0 1 1 0 0 0 1 C 0 0 0 1 0 0 0 0 1 D 0 0 0 1 0 0 0 0 1 A 1 B 1 C 1 D 1 Date Rebate Computation Performed Issuer Name: Industrial Development Authority of Fairfax County, Virginia Date the Rebate Computation was Performed: 05/12/2010 Issuer Name: Industrial Development Authority of Fairfax County, Virginia Date the Rebate Computation was Performed: 09/10/2017 Issuer Name: Industrial Development Authority of Fairfax County, Virginia Date the Rebate Computation was Performed: 10/12/2017 Issuer Name: Industrial Development Authority of Fairfax County, Virginia Date the Rebate Computation was Performed: 02/18/2018 PART I, COLUMN E, ISSUE PRICE Part I, column E, 2005A bonds 2005A, B, D, E bond issue price per form 8038 476,700,000 2005B, D, E bonds refinanced by subsequent issues (352,700,000) Remaining 2005A issue price 124,000,000 PART I, COLUMN F, DESCRIPTION OF PURPOSE Bond A 1) Renovate and expand certain portions of Inova Alexandria Hospital (IAH), Inova Fairfax Hospital (IFH), Inova Fair Oaks Hospital (IFOH); 2) Acquire certain capital equipment for use in or in connection with IAH, IFH, IFOH, and Inova Mount Vernon Hospital (IMVH) and renovate any space necessary or incidental to the installation of such equipment; 3) Pay issuance costs for Series 2005 A and B; 4) Refund prior bonds issued by the Industrial Development Authority of Loudoun County, Virginia Hospital Revenue Bonds, Series 1995 issued 10/26/1995 and 2002A issued 6/27/2002, and pay issuance costs of Series 2005D; 5) Refund prior bonds Series 2001A, B, C, and D issued 12/11/2001 Bond B 1) Refund prior bonds - 2009B issued 4/16/2009; 2) Pay issuance costs of series 2010A bonds Bond C 1) Construct, renovate and expand certain portions of IFH, IMVH and IFOH Bond D 1) Advance refund a portion of 2009A bonds issued 4/16/2009 Bond E 1) Refund prior bonds - 1988A-D issued 8/4/1988; 2000 issued 3/23/2000; 2005A and 2005C issued 5/12/2005 Bond F 1) Construct, renovate and expand certain portions of IFH, IMVH and IFOH Bond G 1) Refund prior bonds - portion of 2009A issued 4/16/09 (advance) and portion of 2012C issued 8/23/12 (current) Bond H 1) Refund prior bonds - portion of 2012C issued 8/23/12 Bond I 1) Refunded prior bonds-2000 issued 03/23/2000; 2005C issued 05/12/2005;2017 issued 12/27/2017 2)Expansion of Inova Loudoun Hospital and a variety of projects at IFMC PART II, LINE 3, PROCEEDS Part II, line 3. 2005A bonds Issue price 124,000,000 Earnings 6,441,544 Total proceeds 130,441,544 Part II, line 3. 2010A bonds Issue price 190,000,000 Earnings 1,511,888 Transferred proceeds 164,510,779 Total proceeds 356,022,667 Part II, line 3. 2012AB bonds Issue price 382,960,937 Earnings 2,157,040 Total proceeds 385,117,977 Part II, line 3. 2014A bonds Issue price 209,030,800 Earnings 687,091 Total proceeds 209,717,891 Part II, line 3. 2016A bonds issue price 178,341,611 escrow earnings 2,835,082 total proceeds 181,176,693 Part II, line 3. 2018AB bonds issue price 484,976,577 escrow earnings 1,371,889 total proceeds 486,348,466 PART IV, LINE 2C, DATE OF REBATE COMPUTATION Part 4, line 2C. 2005A 5/12/2010 Part 4, line 2C. 2005C 8/15/2006 Part 4, line 2C. 2010A 9/10/2012 Part 4, line 2C. 2012A 10/12/2017 A Industrial Development Authority of Fairfax County Virginia 911920228 2013-12-04 79530000 See Part VI 0 0 0 B Industrial Development Authority of Fairfax County Virginia 911920228 303823KX5 2014-12-17 209030800 See Part VI 0 0 0 C Industrial Development Authority of Fairfax County Virginia 911920228 303823LM8 2016-05-11 178341611 See Part VI 0 0 0 D Industrial Development Authority of Fairfax County Virginia 911920228 303823LR7 2016-05-11 99685000 See Part VI 0 0 0 A 13020000 79530000 79530000 1 0 1 1 B 209717891 209717891 59045682 2017 0 0 1 1 C 181176693 122131012 52698925 1 1 1 1 D 730000 99685000 99685000 1 0 1 1 A 0 1 1 1 1 1 0.01200 0.01200 0 0 1 B 0 1 0 1 1 0.00700 0.00700 0 0 1 C 0 1 0 1 1 0.01100 0.02200 0.03300 0 0 1 D 0 1 0 1 1 0.03500 0.01000 0.04500 0 0 1 A 0 0 1 0 0 0 0 0 1 B 0 1 0 0 0 0 0 0 1 C 0 0 1 0 0 0 0 0 1 D 0 0 1 0 1 0 0 0 1 A 1 B 1 C 1 D 1 A industrial Development Authority of Fairfax County Virginia 911920228 303823MX3 2018-07-31 484976577 See Part VI 0 0 0 A 486348466 139628594 220051092 126688780 1 0 0 1 A 0 1 0 1 1 0.00900 0.00900 0.01800 0 0 1 A 0 1 0 0 1 0 0 0 1 A 1 Jay Tyroler MD Trustee 115000 Medical staff president. Services provided at arm's length and customary rates. 0 Keith Sterling MD Trustee 160000 Fee for physician services. Services provided at arm's length and customary rates. 0 Rashid Nayyar MD Trustee 176605 Fee for physician services. Services provided at arm's length and customary rates. 0 Charles Beard Jr Trustee 59674 Family member employed under IHCS. Services provided at arm's length and customary rates. 0 PART III, LINE 4A Cancer Care: Inova Schar Cancer Institute (Inova Schar) is a state-of-the-art cancer care destination in the DC Metro area designed to meet the needs of our evolving region and to bring healing and hope to our patients. The Inova Schar team - 1,000+ doctors, researchers, nurses, cancer specialists and emotional support experts - delivers the nation's highest standard of compassionate, multi-disciplinary and holistic cancer care, customized to the needs of each patient. Inova Schar's coordinated model puts the patient at the center, allowing them to see their entire care team in one visit, at one location, improving communication and minimizing travel time. Nationally renowned specialists, surgeons, genetic counselors and leading researchers are backed by the latest in drug discovery, clinical trials, research and advanced treatments. Inova Schar Cancer Institute, a Department of Inova Fairfax Hospital, operates full-service, accredited, cancer centers at all five of Inova's hospitals - Inova Fairfax Medical Campus, Inova Alexandria Hospital, Inova Fair Oaks Hospital, Inova Loudoun Hospital, and Inova Mount Vernon Hospital. Inova Fairfax Medical Campus is designated by the American College of Surgeons Commission on Cancer as a Teaching Hospital Cancer Program, and Inova Alexandria Hospital has a Community Hospital Comprehensive Cancer Program designation. Other System Hospitals meet the American College of Surgeons Community Hospital Cancer Program standards. The System maintains several programs dedicated to different types of cancer, cancer care and cancer risk assessment, including the Inova Breast Care Program (certified at all 5 hospitals), the Cancer Genetic Counseling Program (hereditary conditions), the Inova Melanoma and Skin Cancer Program, the Inova Head and Neck Cancer Program, the Inova Gastrointestinal Multidisciplinary Clinic, the Inova Genitourinary Cancer Program, the Inova Molecular Tumor Board, and Life with Cancer (support and education to cancer patients). The Emergency and Trauma Center at Inova Fairfax Medical Campus, Northern Virginia's only Level I trauma center, is a state-of-the-art facility. Emergency medical specialists with expertise in trauma care, treat every type of illness, injury, or life-threatening trauma. The Inova Center for Rehabilitation, located on the Inova Mount Vernon campus, is accredited by the Commission on Accreditation and Rehabilitation Facilities (CARF) and provides comprehensive inpatient and outpatient medical rehabilitation services to patients with severe head injuries, spinal cord injuries, strokes, multiple sclerosis, and other orthopedic and neurological disabilities. These services are staffed by an interdisciplinary team representing psychiatry, psychology, vocational counseling, physical therapy, occupational therapy, and nursing with treatment tailored to meet the specific needs of each patient. ACCESS of Fairfax, and ACCESS of Reston are 24-hour, free standing emergency centers located in Fairfax City, and Reston, Virginia, respectively. During 2018, ACCESS of Fairfax provided 14,640 emergency room visits and ACCESS of Reston reported 9,284 emergency room visits. Long Term Care Services Assisted Living Facilities: IHCS's assisted living facilities provide care and services for adults who need assistance with activities of daily living and 24 hour oversight. They provide accommodations with 408 units. Each community has specialized memory care units and programs. A nursing staff is on-site 24 hours a day. IHCS maintains four assisted living facilities in Fairfax, Reston, Fair Oaks, and Mt. Vernon, Virginia. In addition, IHCS owns a 60% interest in an assisted living joint venture in McLean, Virginia. IHCS owns and Sunrise operates five assisted living facilities across Fairfax County with total assisted living days in 2018 of 148,434. InovaCares for Seniors (PACE): InovaCares for Seniors, a Program of All-inclusive Care for the Elderly (PACE) is the first program of its kind in Northern Virginia. PACE is an evidenced-based model of care that delivers high quality, cost effective care that includes medical, dental, vision and social activities. The program is built on the foundation that seniors with complex health care needs should be able to live in the comfort of their home environment for as long as possible. In 2018, PACE had an enrollment of 120 participants and $2 million in unreimbursed expenses. Unfortunately, in October 2018 Inova had to close the program. Physical Therapy Services Inova Physical Therapy Centers: IHCS promotes and conducts specific research and educational activities related to the care of the sick and injured. In 2018, outpatient visits totaled 165,650 with services offered at seventeen outpatient centers located throughout Northern Virginia. Areas of specialty include: Physical Therapy (PT) and Occupational Therapy (OT). Urgent Care Centers Inova Urgent Care Centers: The IHCS mission includes serving the community as a not-for-profit organization through the provision of urgent medical care. In 2018, outpatient visits totaled 138,289 with services being provided seven days a week with no appointment necessary at eleven locations. The centers provide services for medical conditions that require prompt attention but do not pose an immediate or serious threat to life. Treatment is provided for such ailments as sore throats, ear infections or minor cuts and bruises. Services offered also include treatment for work-related injuries and worker's compensation cases, physical exams including camp, sport, school, pre-employment, immigration medical examinations and travel medicine. Laboratory tests, X-rays, audiometry & vision screening, alcohol & drug testing and flu shots are provided on-site. The centers are staffed by board-certified/board-eligible physicians licensed in Virginia. A physician, nurse, and radiology technologist are on duty at each center during hours of operation. Employee Assistance Programs Inova Employee Assistance (EAP) is part of IHCS providing counseling, work life services and resources to help improve the overall health and wellbeing of the employees of Inova Health System and the employer communities served by Inova and its affiliates. EAP was organized to promote health through referral to a wide range of behavioral health, financial, legal and other supportive services. In 2018, EAP supported 18,201 Inova employees and approximately 191,215 total employees/household members with the following services: Confidential Counseling: Short-term counseling services can help find solutions to problems ranging from family or workplace frustrations to alcohol or drug abuse. Financial & Legal Services: Employees and their household members can speak with a financial & legal professional at no charge regarding such issues as retirement planning, debt consolidation, funding a child's college education, mortgage loan options and a variety of other financial concerns. Work Life Referral Services: Work Life consultants help assess needs, pinpoint appropriate resources, and suggest guidelines for evaluating those resources. Consultants can locate resources in a variety of areas, including childcare, adoption, eldercare and convenience services. Form 990, Part III, Line 4a Behavioral Services IHCS's Behavioral Services are committed to providing intensive, personalized care to help people cope with, and overcome, addictions and emotional problems that prevent them from fully functioning in the community. Inova CATS Program (Comprehensive Addiction Treatment Services) is a leader in providing the highest quality addiction treatment services in Northern Virginia and surrounding areas. A series of structured programs offers effective, compassionate treatment for individuals dealing with all forms of substance abuse disorders, including addiction to alcohol, prescription drugs, heroin, cocaine and other drugs. Services are available to adults ages 18 and older. The range of services includes: Inpatient Medical Detoxification, Partial Hospitalization Program, Intensive Outpatient Program, Outpatient Groups, Medication Assisted Therapy and Substance Use Assessments. In 2018, the CATS Partial Hospitalization/Intensive Outpatient Program provided 10,457 encounters. The Kellar Center is a comprehensive, behavioral health treatment center and special education school for children, adolescents and their families. With locations in Fairfax and Loudoun counties, Inova Kellar Center provides a full continuum of outpatient services for psychiatric disorders, substance use disorders, and behavioral and emotional issues. Services include assessment, psychological testing, educational testing, psychiatric evaluation, medication management, individual, family and group therapy and Intensive In-Home services. For adolescents who require intense mental health interventions, the Center provides an afterschool Intensive Outpatient Program for mental health and co-occurring disorders and a full day Partial Hospitalization Program for adolescents who are in crisis and unable to attend school. The treatment services and programs are provided to children and families regardless of ability to pay. The Kellar School of Inova Kellar Center provides special education services to children and adolescents who have not been successful in the public school setting and may be at risk for being removed from the community and placed in more restrictive settings. During 2018, the Kellar Center provided 84,891 hours of programming, treatment and education to children, adolescents and families in the community. The total unreimbursed cost for 2018 was approximately $1.21 million dollars. Charity Care All Inova facilities, including the IHCS facilities with the exception of the assisted living facilities, provide charity care in accordance with Inova policies which ensures access to medically necessary care for all individuals. Charity care is defined as free or discounted healthcare services provided to persons who cannot afford to pay. These policies include the following key provisions: 1 Emergency care shall be provided to all persons regardless of their ability to pay. 2 Non-emergency medically necessary care, except for certain specialty or referral programs, shall be provided by all hospitals and access facilities to medically indigent patients. "Medically necessary" refers to conditions which, if not promptly treated, would have an adverse change in the health status of a patient. Free care is provided to uninsured individuals with Family Incomes at or below 400% of the current Federal Poverty Guidelines (FPG). Free care is also available to certain insured individuals with Family Incomes at or below 250% of the current FPG who have partial coverage. Inova Health System utilizes a multifaceted approach to educate and inform patients and the public about Inova's Financial Assistance Policy (FAP) or charity care policy. Upon admission to any Inova hospital or any visit to outpatient facilities or clinics including emergency departments, Inova has information posted regarding patient rights and responsibilities. In addition, Inova provides information about the charity care program and referrals to meet with Inova financial counselors who assist patients in completing Inova's charity care application. This financial information is reviewed by the Inova Patient Accounts Department with the patient contacted if additional information is required in order to make a determination. The patient is subsequently provided a letter, notifying them as to whether or not they qualify for charity care. In 2018 IHCS's unreimbursed cost of charity care, including free and discounted services, was $119.4 million. Medicaid Established under Title XIX of the Social Security Act, this program provides assistance for the medically indigent, including those who cannot pay for care despite being able to afford other living expenses. Also included under this program are the blind, disabled, pregnant women, very low income parents, children and the elderly. The reimbursement that IHCS facilities receive from the Medicaid program routinely falls below the actual cost of services provided. During 2018, IHCS provided care to Medicaid patients at an unreimbursed cost of 133.2 million. Participation in Governmental Programs for Those Without the Ability to Pay Various government programs provide for the indigent, including Medicaid recipients. These programs provide a percentage of reimbursement for qualifying patients; however, payment is typically below the cost of those services. In addition to federal and state programs, the Inova subsidiaries, including IHCS, work with various County governments and agencies in providing certain free services to those residents the County identifies as most in need. PART III, LINE 4D Inova Center for Wellness and Metabolic Health The Inova Center for Wellness and Metabolic Health (ICWMH) provides endocrinology medical visits, diabetes education and medical nutrition therapy. Endocrinology visits are provided by Board Certified Endocrinologists and an experienced Nurse Practitioner. The providers see patients for many endocrine issues, not limited to diabetes. The Center is recognized by the American Diabetes Association for diabetes education which is provided by Registered Nurses and Registered Dieticians. Staff members are either Certified Diabetes Educators or are in the process of achieving this designation. The Center has preliminary recognition from the CDC to provide the Diabetes Prevention Program through telemedicine and in person. This program is a year-long lifestyle modification program. Inova hopes to achieve full recognition once data is submitted at 18 months. In the first year of the program there were 540 participant encounters. In addition, ICWMH staff participated in community events providing education about diabetes and pre-diabetes to about 155 people. In 2018, ICWMH provided a total of 12,576 outpatient participant encounters (including community education) - 9,053 in the Fairfax centers (Alexandria, Fairfax and Fair Oaks) and 3,523 in the Loudoun site. Simplicity Health Simplicity Health is a group of primary care clinics that provides excellent healthcare at affordable fees. Simplicity Health serves working adults who may not currently receive regular primary care because they do not qualify for Medicaid, do not get health insurance through work, or have insurance with prohibitively high copays and deductibles. Simplicity Health clinics bring excellent care to convenient locations in high need communities, making healthcare not only affordable, but also accessible. Sites employ a team of providers and staff who are bilingual in a variety of languages, such as Korean, Vietnamese, Spanish, and Arabic. The primary goal of these clinics is to provide ongoing primary care, prevention and disease management for chronic illnesses like diabetes, hypertension and heart disease. Staff assist patients who need to arrange for additional services beyond primary care. In 2018, Simplicity Health clinics provided services to 2,179 unique patients with a total of 9,432 visits. IHCS and its subsidiaries provide many other non-billed and below margin patient services. Case management services are provided to the indigent and assistance is provided with financial paperwork. Inova Mount Vernon participates in the Health Information and Claims Assistance Program by providing assistance with health insurance paperwork problems. In addition, home IV therapy services are provided for the indigent. Transportation is provided for some indigent patients to and from IHCS facilities and programs. Inova Fairfax Medical Campus provides forensic and medical care to abused adults and children as well as blood alcohol testing for area police departments while coordinating the disposition of deaths with various community organizations. Other services include pastoral care, free living accommodations for out-of-town Inova Fairfax Medical Campus heart and lung transplant patients and their families, and emergency assistance to patients and their families needing medication or transportation. Community Health Education and Promotion As part of Inova's overall health promotion effort, IHCS and its subsidiaries are actively involved in sponsoring programs, activities, and services designed to improve community health and prevent the onset of disease. Inova Well Inova Well serves the community as the premier provider of health education and wellness services. Knowing that each individual requires different kinds of support and services to meet their personal wellness needs, Inova Well offers a variety of wellness programming. Inova's wellness services include, but are not limited to, personal health coaching and prenatal support, childbirth education, life support re-certification and first aid, health fair screenings, seminars, health challenges, fitness classes and immunizations. In order to reach people where they are most comfortable, Inova Well holds programs in community settings, at employer worksites and other easily accessible locations throughout the Northern Virginia and the Greater Metropolitan Washington Area. During 2018, Inova Well served over 236,821 participants. Program highlights are described below. Employee Wellness Inova Well supports employees and spouses at all health and fitness levels through a comprehensive and supportive wellness program. Employees get tools, support and programs to help improve health or maintain healthy habits. Inova Well provides blood work, biometric screenings, in-person and telephonic wellness coaching, fitness classes and wellness events in Inova's operating units. In 2018 Inova Well had 24,790 touches within the Inova Health System. It is the goal of the wellness coaches to work with employees to establish realistic wellness goals and to support employees while they work towards optimal health. Influenza Vaccination The Inova Well Immunization Program provided 43,530 flu shots, Tdap & Hepatitis B vaccinations and TB screenings at 830 events. Inova Well provides immunizations for Inova employees and physicians, community members and workplaces throughout the metropolitan area. Number of flu shots (Quadrivalent, High-Dose & Peds): 41,686 3,104 shots at 18 clinics for Loudoun County Public School employees Number of TB plants/readings: 1,149 Number of Tdap and Hepatitis B vaccinations: 695 The Workplace and Community Program The Workplace and Community Program provided over 188 health events that included biometric screenings, seminars, and interactive education stations. The Respiratory Fit Testing program served over 7,996 participants. Clients were located throughout the Washington, DC, Metropolitan area and far west into Virginia. The Care Management Programs continued to provide personalized support and health coaching to encourage healthy behaviors related to weight management, tobacco cessation, back pain management, pregnancy and breastfeeding. Inova Well coaching supported Inova employees, their spouses and community members. Inova Well provides the Program Manager for The Prince William County Wellness Program, which delivers a full range of wellness services and programs for county employees. Programs include: health and wellness seminars and screenings, weekly meditation, a walking challenge, and a video tutorial around healthy supermarket strategies. In 2018, the Inova Well Program Manager provided services to over 1,600 employees living in Prince William County. The Health Education Program Inova Well provided Life Support education classes for 14,500 students in community and worksite locations. The Inova Well Childbirth Education program served 7,116 community members through educational classes such as breastfeeding, baby care, and childbirth preparation. Additionally, the program offered over 160 free new mom support groups to 2,308 participants. Childbirth Education also served 5,241 individuals through complimentary maternity tours at IFMC, IAH and IFOH. The Inova WellBaby program, which provides personalized support and education to pregnant and breastfeeding women through email and telephonic outreach, supported around 347 Inova employees and spouses in 2018. The Inova Well Fitness program provided over 330 fitness classes to Inova employees and community members in 2018. The program offers classes at locations throughout the community and in a variety of different formats including multi-week series, workshops and drop-in classes. Class types offered include mind body classes (yoga, tai chi), cardio/strength building classes (body toning, Zumba), mommy fitness classes (bootcamp, prenatal yoga) and senior focused classes (strength training for seniors, seniorcize). Over 3,157 individuals took part in these fitness classes, multi-week session based classes and workshops. PART V, LINE 2A, NUMBER OF EMPLOYEES The organization falls under a master pay agent and does not file any payroll returns under its own EIN, however all required returns have been filed on time. Form 990, Part VI, Section A, line 1 With the exception of the duties and responsibilities that are reserved to the Board of Trustees as required by law, the Executive Committee is appointed by the Board to support the Board of Trustees in the performance of its duties and responsibilities that are time-sensitive and must be addressed before the next regularly scheduled meeting of the full Board. Form 990, Part VI, Section A, line 6 The organization has a single member. The sole member is Inova Health System Foundation, a charitable 501(c)(3) tax-exempt organization which serves as the parent company of the integrated health care delivery system. Form 990, Part VI, Section A, line 7a The sole member of the organization, Inova Health System Foundation, is a charitable 501(c)(3) tax-exempt organization. The sole member elects the members of the governing body of the organization. Form 990, Part VI, Section A, line 7b The sole member of the organization, Inova Health System Foundation, is a charitable 501(c)(3) tax-exempt organization. The sole member holds reserved powers with respect to certain actions, including approval of borrowings, amendments of Articles of Incorporation and Bylaws. In addition to the reserved powers, under the laws of the Commonwealth of Virginia certain extraordinary actions require member approval, such as mergers, consolidations, liquidations and the sale of substantially all of the assets of the organization. Form 990, Part VI, Section B, line 11b The Form 990 is prepared and provided to the Chief Accounting Officer and external tax consultants for initial review. After the review it is given to the CFO of Inova Health System for review and comment. The Form 990 is presented to the Executive Committee of the Board of Trustees for their review. Upon completion of the Executive Committee review, it is provided to the full Board of Trustees. In this process, the Form 990 has been provided to the Governing Board approximately two weeks prior to the filing of the return. Form 990, Part VI, Section B, line 12c Yes, annually the organization distributes the conflict of interest policy to all directors, officers, trustees, and key employees. The organization requires that each director, officer, trustee, and key employee acknowledge that they have read, understood, and will abide by the policy. Each director, officer, trustee, and key employee is required to complete and submit an annual conflict of interest disclosure. These disclosures are broad and require that the individual list any business relationships or personal relationships with other directors, officers, trustees, and key employees, as well as any relationships with competitors, or current or potential vendors or contractors. Disclosure statements are reviewed by senior management and any potential conflicts are discussed with governing body chairman to ensure that any member who may have a conflict discloses their potential conflict, and is dismissed from related discussions and recused from participation in applicable decisions. Form 990, Part VI, Section B, line 15 Completed by related entity, Imanco, Inc.: The compensation of all senior management positions is evaluated annually in light of each manager's job content, scope and complexity. Compensation levels for Vice Presidents and above are reviewed by an independent external consultant to ensure that remuneration is consistent with the organization's compensation philosophy and objectives and competitive with other large complex health systems. The independent compensation consultant maintains national benchmark compensation databases and surveys and also reviews Forms 990 of comparable healthcare systems to determine market levels of compensation. In addition, the Inova Health System's CEO's compensation and certain other senior executives is reviewed and approved annually by an independent governing Board. The job requirements and complexity of all other management positions are evaluated annually using nationally recognized third party salary surveys to assure that the compensation for such positions is consistent with external market compensation comparisons. Salary ranges are developed for each management position classification to ensure that the compensation levels for these positions are consistent with the organization's compensation philosophy and objectives and with competitive market comparisons. Compensation for employed physicians is reviewed and approved by the IMG Executive Committee. The committee is comprised of executive management of the Inova Medical Group. The Fair Market Value (FMV) compensation is based on four nationally recognized industry physician compensation benchmark surveys (MGMA, AMGA, Sullivan & Cotter, Korn Ferry Hay Group). The committee also utilizes independent consultants to provide FMV opinions for positions that are not readily available in the four published benchmark surveys. The consultants' opinions and compensation survey data are presented to the Physician Compensation Committee for review and approval. Form 990, Part VI, Section C, line 19 Inova Health System makes certain information publicly available. Inova's consolidated financial statements are posted on the Electronic Municipal Market Access's (EMMA) website on a quarterly basis. Inova's governing documents are not currently publicly available. While the conflict of interest policy is not specifically publicly disclosed, Inova's Code of Conduct is on the public website. Section III of the Code of Conduct describes what can constitute a conflict and requires that potential conflicts be reported to management or the Chief Compliance Officer. The Code also refers to the conflict of interest policy which is available to staff and physicians on Inova's intranet website. Form 990, Part XI, line 9: PARTNERSHIP INCOME -17,210,596. CHANGE IN INVESTMENTS BALANCE -7,400,429. EQUITY IN SUBS 16,428,246. CAPITAL REIMBURSEMENT 748,075. UNRECOGNIZED PENSION 366,000. PART XII, LINE 2B AND 2C, AUDITED FINANCIAL STATMENTS The company is part of the Inova Health System, a not-for-profit integrated health care delivery system serving Northern Virginia and surrounding areas. The company's financial statements are consolidated in the Inova Health System consolidated financial statements. Inova Health System is audited on an annual basis by a "Big Four" independent public accounting firm. In addition, they are responsible for the issuance of a management letter encompassing each member of the consolidated group. The Audit and Compliance Committee of the Board of Trustees of Inova Health System is responsible for the oversight of the audit, including the hiring of the audit firm, review and approval of audited financial statements and communication with the external auditors at least twice a year without the presence of internal management. PART XII, LINE 3A, A-133 AUDIT The company is part of the Inova Health System (IHS), a not-for-profit integrated health care delivery system serving Northern Virginia and surrounding areas. IHS receives various federal grants. These grants and awards are audited as part of the consolidated Inova Health System Uniform Guidance compliance audit. The Inova Health System's federal grants are audited on an annual basis by a "Big Four" independent public accounting firm and a "Report of Independent Auditors on Compliance for Each Major Program; Report on Internal Control Over Compliance and Report on Schedule of Expenditures of Federal Awards Required by the Uniform Guidance" is issued on a consolidated basis. The Audit and Compliance Committee of the Board of Trustees of Inova Health System is responsible for the oversight of the Uniform Guidance audit, including the hiring of the audit firm, review and approval of audited financial statements and communications with the external auditors during the year without the presence of internal management. 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