2019-11-15T07:36:40-06:00 2018-12-31 990 2018-01-01 540696355 PRINCE WILLIAM HOSPITAL PRIN 3367182803 2085 FRONTIS PLAZA BLVD WINSTON SALEM NC 27103 FRED HARGETT EVP & CFO 3367182803 2019-11-11 170.98.106.254 2019-11-11 12:55:55 ES P 7E530C01EC0DBF1FFF79A5BAD1379F9D370DED1E A2315309B7343EB998963AA05290CF11231D17E5 2018 2020-03-31 21:24:44Z NOVANT HEALTH UVA HEALTH SYSTEM PRINCE WILLIAM MEDICAL CENTER PETER BERNARD 2085 FRONTIS PLAZA BLVD WINSTON SALEM NC 27103 255414059 0 X WWW.NOVANTHEALTHUVA.ORG X 1964 VA SEE SCHEDULE O 16 10 1606 667 155078 0 272437 405424 244117112 250904562 30430 -140299 1677504 2173829 246097483 253343516 198906 198042 0 0 102073212 107201350 0 0 0 149504899 148517032 251777017 255916424 -5679534 -2572908 262397414 260504906 210252140 193655840 52145274 66849066 X SEE SCHEDULE O 0 0 217535127 198042 240408511 TOGETHER, PRINCE WILLIAM HOSPITAL AND HAYMARKET MEDICAL CENTER HAVE 190 LICENSED BEDS. DURING 2018, THERE WERE 35,741 PATIENT DAYS, WITH AN AVERAGE LENGTH OF STAY OF 4 DAYS, AND AN AVERAGE DAILY CENSUS OF 51. THERE WERE 9,637 DISCHARGES, 4,264 INPATIENT AND OUTPATIENT SURGERIES, 156,417 OUTPATIENT ENCOUNTERS AND 70,116 EMERGENCY DEPARTMENT VISITS. 6726553 0 11089181 PRINCE WILLIAM FAUQUIER CANCER CENTER, LLC (DBA NOVANT HEALTH CANCER CENTER) IS NATIONALLY RECOGNIZED BY THE AMERICAN COLLEGE OF RADIOLOGY, AND IS A VITAL PART OF NOVANT HEALTH'S COMPREHENSIVE CANCER PROGRAM IN NORTHERN VIRGINIA. 224261680 1 1 0 1 0 0 0 0 0 1 1 0 0 0 1 0 0 1 0 0 0 0 0 0 1 0 1 1 1 1 1 1 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 1 1 1 0 0 1 0 0 1606 1 1 1 0 0 0 0 0 0 0 0 0 0 0 X 16 10 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 0 0 1 1 VA X X KAREN DAUGHERTY 3367182803 2085 FRONTIS PLAZA BLVD WINSTON SALEM NC 27103 X ARMATO CARL CEO & PRESIDENT NH/TRUSTEE 60.00 X 0 3489239 64045 BELDEN RICHARD TRUSTEE 2.00 X 0 261 0 DANZIGER STEVEN CHAIR 2.00 X X 0 0 0 KELLEY KEVIN SEC 2.00 X X 0 0 0 KHOT VIKRAM MD VICE CHAIR 2.00 X X 0 190177 20061 KRICK JACQUELINE TRUSTEE 2.00 X 0 0 0 MAGALSKI JOSEPH MD TRUSTEE 2.00 X 0 432762 44674 MAGOUYRK CATHERINE EDD TRUSTEE 2.00 X 0 0 0 MARKERT DOUGLAS MD TRUSTEE 2.00 X 0 0 0 MCDONALD IAN TRUSTEE 2.00 X 0 0 0 NAPPS CARL FMR PRES & COO / TRUSTEE 60.00 X X 431238 0 35671 NELSON STEPHEN TRUSTEE 2.00 X 0 0 0 SESSOMS PAMELA TRUSTEE 2.00 X 0 0 0 SMALL PATRICK TRUSTEE 2.00 X 0 0 0 SMITH STEPHEN MD PRES & COO / TRUSTEE 60.00 X X 320964 0 21458 SWITKES ROSS MD TRUSTEE 2.00 X 0 0 0 WAY JONATHAN L TRUSTEE 2.00 X 0 0 0 CODER CHARLES CFO NHUVAHS & TREASURER 60.00 X 0 423525 28255 GILL MARGARET FMR SVP & CEO NHUVA HEALTH SYSTEM 60.00 X 0 620623 29085 BERNARD PETER J INTERIM CEO NHUVAHS 60.00 X 0 192826 0 CONKLIN MARGARET FMR CNO 60.00 X 193034 0 26761 SEDGLEY DONALD FMR PRES & COO NHUVAHMC 60.00 X 357290 0 34935 ARAM HEATHER VP SERVICE LINE & AMBULATORY 40.00 X 285268 0 28231 BOWERS TRACY VP HR & ADMIN SERVICES 40.00 X 261780 0 45906 ORDONEZ GENE CARDIOVASCULAR INVASIVE SPEC. 40.00 X 199163 0 21613 ROLOFF JAY CARDIOVASCULAR INVASIVE SPEC. 40.00 X 214003 0 47300 SWENSON KRISTIN PHYSICIST 40.00 X 217248 0 17226 ROBSON MELISSA FMR SVP & CEO NHUVA HEALTH SYSTEM 0.00 X 0 438970 33471 WALL JOHN D FMR VP MEDICAL AFFAIRS 0.00 X 172308 0 13530 2652296 5788383 512222 205 1 1 0 FHI SERVICES 98 ALEXANDRIA PIKE SUITE 43 WARRENTON VA 20186 CONSTRUCTION SERVICES 4236407 BRASFIELD & GORRIE LLC PO BOX 11407 BIRMINGHAM AL 35246 CONSTRUCTION SERVICES 3737629 MORRISON HEALTHCARE PO BOX 102289 ATLANTA GA 30368 FOOD MANAGEMENT SERVICES 3558444 CROTHALL HEALTH CARE INC 1500 LIBERTY RIDGE DR STE 210 WAYNE PA 19087 FACILITY SERVICES 3496935 LABORATORY CORPORATION OF AMERICA HOLDIN PO BOX 12140 BURLINGTON NC 27216 LAB SERVICES 3047679 62 53176 197426 154822 152322 405424 NET PATIENT REVENUE 622110 249962784 249962784 AMBULATORY SURGERY CTRS 621493 764988 764988 PHARMACY 446110 176790 165710 11080 250904562 64174 64174 2096544 1541032 555512 555512 555512 32209 236682 -204473 -204473 -204473 54250 43406 10844 10844 307057 249423 57634 57634 CAFETERIA MEALS 722514 755274 755274 MISCELLANEOUS INCOME 900099 604125 604125 FITNESS CENTER 713940 162995 116638 46357 27445 85 27360 1549839 253343516 251497692 155078 1285322 X 177742 177742 20300 20300 1421352 1421352 185838 185838 85950210 81265924 4684286 4321026 4085530 235496 9020106 8528510 491596 6302818 5959314 343504 324501 324501 1117 1117 36604732 33762819 2841913 155827 155827 2095676 1842949 252727 2472011 2472011 7105715 7105715 307432 194377 113055 80205 80205 6672963 6672963 21714579 21714579 1123577 960848 162729 MEDICAL SUPPLIES 21100282 21100282 CORPORATE SUPPORT 20254122 20254122 BAD DEBT 14067756 14067756 DRUGS 7859046 7859046 6577491 6315188 262303 255916424 224261680 31654744 0 6064885 22493268 98590 120041 39046457 36754807 2022958 2437416 5710079 6202540 683541 633148 437379911 259671443 193793948 177708468 668063 621551 -5018400 -5803040 15572678 16461075 3754615 2875632 262397414 260504906 15562119 15468857 600977 565116 144773045 5970609 5970609 188118435 26878213 210252140 193655840 X 49967520 64671312 0 0 2177754 2177754 52145274 66849066 262397414 260504906 X -2572908 17276700 X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 1 1 0 0 0 0 1 1117 0 1 38869 39986 0 PART II-B, LINE 1: LINE 1A THERE IS LIMITED ENGAGEMENT OF THE BOARD. LINE 1B THERE IS MINIMAL TIME OF SENIOR LEADERS. LINE 1G THERE IS LIMITED CONTACT MADE BY SENIOR LEADERS DURING LOBBYING ACTIVITIES. LINE 1I DUES PAID TO CERTAIN ORGANIZATIONS WHICH INCLUDE A PORTION RELATED TO LOBBYING ACTIVITIES. 2177754 2177754 2184974 7220 2177754 2184974 2184974 2185209 235 2184974 2177754 7715 260 2185209 1.00000 0 0 4837615 4837615 1433458 212002445 94377893 119058010 5011644 2199271 2812373 403561 171049390 131954955 39497996 92723 42549075 31139324 11502474 177708468 0 DUE TO AFFILIATES 3844685 THIRD PARTY PAYMENT PAYABLE 1091574 OTHER LIABILITIES 601326 NOTES PAYABLE 3067786 PATIENT REFUNDS 1613605 JOC LEGACY FUNDING 16659237 26878213 PART V, LINE 4: INTENDED USES FOR ENDOWMENT FUNDS THE ENDOWMENT FUNDS INTENDED USE IS FOR PATIENT FINANCIAL HARDSHIPS. UNIFORMS 12280 12280 11500 HOLIDAY BAZAAR 4128 4128 200 12 37842 37842 31705 54250 54250 43405 43405 10845 1 1 X 1 X 300.000000000000 0 0 1 0 1 1 16284128 16284128 0.06730 23969035 24494856 0 0.00000 40253163 24494856 16284128 0.06730 227226 57720 169506 0.00070 1113213 82611 1030602 0.00430 14098957 6079488 8019469 0.03320 37000 37000 0.00020 15476396 6219819 9256577 0.03840 55729559 30714675 25540705 0.10570 2500 2500 0.00000 58045 58045 0.00030 52670 52670 0.00020 7899 7899 0.00000 121114 121114 0.00050 1 14067756 0 52009874 72429574 -20419700 X 1 0 1 PRINCE WILLIAM ASC HEALTHCARE 0.51000 0.01880 0.47120 2 HAYMARKET SURGERY CENTER HEALTHCARE 0.51060 0.00000 0.48940 2 1 PWH DBA NHUVAHS PRINCE WILLIAM MEDICAL CENTER 8700 SUDLEY ROAD MANASSAS VA 20110 WWW.NOVANTHEALTHUVA.ORG H1882 X X X A 2 PWH DBA NHUVAHS HAYMARKET MEDICAL CENTER 15225 HEATHCOTE BLVD HAYMARKET VA 20169 WWW.NOVANTHEALTHUVA.ORG H1938 X X X A PRINCE WILLIAM HOSPITAL 0 0 1 X X X X X X X X 16 1 0 0 1 X WWW.NOVANTHEALTHUVA.ORG X 1 16 1 WWW.NOVANTHEALTHUVA.ORG 0 1 X 300.000000000000 0.000000000000 X X X X 0 1 X X X 1 X SEE SECTION C X SEE SECTION C X SEE SECTION C X X X X X X 1 X 0 X X X X 1 X 0 1 PART V, SECTION B FACILITY REPORTING GROUP A FACILITY REPORTING GROUP A CONSISTS OF: - FACILITY 1: PWH DBA NHUVAHS PRINCE WILLIAM MEDICAL CENTER, - FACILITY 2: PWH DBA NHUVAHS HAYMARKET MEDICAL CENTER PRINCE WILLIAM HOSPITAL PART V, SECTION B, LINE 3J: PRINCE WILLIAM HOSPITALPART V, SECTION B, LINE 3E:SEVERAL SOCIAL, BEHAVIORAL, AND CLINICAL HEALTH NEEDS WERE IDENTIFIED IN THE NEEDS ASSESSMENT. ONCE THE HEALTH NEEDS WERE IDENTIFIED, SURVEYS AND COMMUNITY MEETINGS WERE CONDUCTED IN WHICH THE VARIOUS COMMUNITY STAKEHOLDERS RANKED THE HEALTH ISSUES ACCORDING TO THE YEARS OF POTENTIAL LIFE LOST AND MAGNITUDE OF IMPACT. THE INFORMATION GATHERED WAS THEN MATRIXED AND SCORED IN ORDER TO RANK THE FOCUS AREAS AND PRIORITIZE THE IDENTIFIED HEALTH NEEDS. FURTHER PRIORITIZATION OCCURRED WITH THE REVIEW BY THE ORGANIZATION'S BOARD. PRINCE WILLIAM HOSPITAL PART V, SECTION B, LINE 5: WHILE CONDUCTING THE CHNA, THE HOSPITAL FACILITY(IES) SOLICITED INPUT FROM, AND CONSULTED WITH, A VARIETY OF COMMUNITY REPRESENTATIVES INCLUDING, BUT NOT LIMITED TO, REPRESENTATIVES OF CITY AND COUNTY GOVERNMENT INCLUDING HEALTH DEPARTMENTS, COMMUNITY-BASED ORGANIZATIONS, FOUNDATIONS, CHURCHES, COLLEGES/UNIVERSITIES, COMMUNITY COALITIONS AND OTHER SOCIAL SERVICE AGENCIES. INPUT WAS GATHERED THROUGH COMMUNITY MEETINGS, STAKEHOLDERS INTERVIEWS, AND SOLICITED THROUGH WRITTEN COMMENTS THROUGHOUT THE SURVEY PERIOD UNTIL THE FINAL COMMUNITY PRIORITY SETTING MEETING(S) AND SURVEY. THE SCOPE OF EXPERTISE WAS BROAD AND INCLUDED SUCH AREAS AS PUBLIC HEALTH, MINORITY POPULATIONS, HEALTH DISPARITIES, AND SOCIAL SERVICES. PRINCE WILLIAM HOSPITAL PART V, SECTION B, LINE 11: THE HOSPITAL FACILITY IS A PART OF NOVANT HEALTH UVA HEALTH SYSTEM, AN INTEGRATED NOT-FOR-PROFIT HEALTH SYSTEM. THE FACILITY'S CHNA IDENTIFIED MULTIPLE NEEDS FOR THE COMMUNITY SERVED. THE NEEDS IDENTIFIED WERE REVIEWED AND PRIORITIZED BY THE CHNA RESOURCE GROUP AND SUBSEQUENTLY BY THE FILING ORGANIZATION BOARD. THEY EVALUATED EACH DOCUMENTED NEED AND ITS INTERSECTION WITH THE ORGANIZATION'S VISION, COMMITMENTS, AND KEY STRENGTHS BEFORE FURTHER PRIORITIZING THE HEALTH NEEDS AND AGREEING UPON THE TOP HEALTH PRIORITIES TO BE ADDRESSED. THE FILING ORGANIZATION ADOPTED AND EXECUTED AN IMPLEMENTATION STRATEGY THAT ADDRESSES THE PRIORITIZED COMMUNITY HEALTH NEEDS FROM THE CHNAS. THE IMPLEMENTATION STRATEGIES OUTLINE THE PLAN THAT THE HOSPITAL FACILITY(IES) WILL UNDERTAKE TO MEET THOSE HEALTH NEEDS IN EACH OF ITS COMMUNITIES. CERTAIN NEEDS THAT WERE IDENTIFIED BY THE CHNA HAVE NOT BEEN ADDRESSED. IT WAS DETERMINED THAT THERE ARE OTHER RESOURCES IN THE COMMUNITY THAT CAN MORE APPROPRIATELY ADDRESS THESE NEEDS BASED ON SCOPE OF SERVICES AND SKILL SET. FOR MORE DETAILED INFORMATION, REFER TO THE PUBLICLY AVAILABLE IMPLEMENTATION PLAN AVAILABLE ON THE WEBSITE; REFER TO THE URL GIVEN PREVIOUSLY FOR THE POSTING OF THE PLAN. PRINCE WILLIAM HOSPITAL PART V, SECTION B, LINE 13H: OTHER ELIGIBILITY CRITERIA EXPLAINED IN THE FAP INCLUDE THE FOLLOWING: FREE CARE IS ONLY APPLICABLE TO MEDICALLY NECESSARY SERVICES; PROVIDER BASED PHYSICIAN CLINICS REQUIRE THAT PATIENTS MUST HAVE BEEN TREATED BY AN AFFILIATED MEDICAL GROUP PRIMARY CARE PHYSICIAN WITHIN THE PREVIOUS THREE YEARS; PATIENTS MUST BE UNABLE TO ACCESS ENTITLEMENT PROGRAMS; PATIENTS WITH SPECIAL CIRCUMSTANCES SUCH AS BANKRUPTCY MAY ALSO BE ELIGIBLE FOR CHARITY CARE. PRINCE WILLIAM HOSPITALPART V, LINE 16A, FAP WEBSITE:HTTPS://WWW.NOVANTHEALTHUVA.ORG/PATIENTS--VISITORS/FINANCIAL-ASSISTANCE-FOR-THE-UNINSURED.ASPXPRINCE WILLIAM HOSPITALPART V, LINE 16B, FAP WEBSITE:HTTPS://WWW.NOVANTHEALTHUVA.ORG/PATIENTS--VISITORS/FINANCIAL-ASSISTANCE-FOR-THE-UNINSURED.ASPXPRINCE WILLIAM HOSPITALPART V, LINE 16C, FAP PLAIN LANGUAGE SUMMARY WEBSITE:HTTPS://WWW.NOVANTHEALTHUVA.ORG/PATIENTS--VISITORS/FINANCIAL-ASSISTANCE-FOR-THE-UNINSURED.ASPX PRINCE WILLIAM HOSPITAL PART V, SECTION B, LINE 24: IT IS POSSIBLE FOR A FINANCIAL ASSISTANCE POLICY (FAP) ELIGIBLE PATIENT TO BE CHARGED AN AMOUNT EQUAL TO THE GROSS CHARGE FOR A NON-EMERGENCY OR NON-MEDICALLY NECESSARY SERVICE. HOWEVER, IF THE SERVICE IS DEEMED AN EMERGENCY OR A MEDICAL NECESSITY, THEN THE FAP ELIGIBLE PATIENT WOULD NOT BE CHARGED FOR CARE AND WOULD NOT RECEIVE A BILL ONCE FAP ELIGIBILITY HAD BEEN ESTABLISHED. 5 1 - NOVANT HEALTH HAYMARKET SURGERY CENTER 15225 HEATHCOTE BLVD HAYMARKET VA 20169 AMBULATORY SURGERY CENTER 2 - NH MARBLESTONE HEALTH CENTER 12701 MARBLESTONE DRIVE WOODBRIDGE VA 22192 PHYSICIAN CLINIC 3 - NH HEATHCOTE HEALTH CENTER 15195 HEATHCOTE BLVD HAYMARKET VA 20169 IMAGING CENTER 4 - NH UVA HEALTH SYSTEM CANCER CENTER 7901 LAKE MANASSAS DR GAINESVILLE VA 20155 CANCER CENTER 5 - PRINCE WILLIAM AMBULATORY SURGERY CTR 8650 SUDLEY ROAD SUITE 411 MANASSAS VA 20110 AMBULATORY SURGERY CENTER PART I, LINE 3C: OTHER CRITERIA BESIDES INCOME AND FPG USED IN DETERMINING ELIGIBILITY FOR FREE CARE INCLUDE: (1) RESIDENCY - PATIENTS MUST RESIDE WITHIN THE SERVICE AREA OF THE HOSPITAL; (2) THE KIND OF SERVICE PROVIDED - ONLY MEDICALLY NECESSARY SERVICES ARE COVERED; (3) PATIENT STATUS - IN PROVIDER BASED PHYSICIAN CLINICS, PATIENTS MUST HAVE BEEN TREATED BY AN AFFILIATED MEDICAL GROUP PRIMARY CARE PHYSICIAN WITHIN THE PREVIOUS THREE YEARS; AND (4) ACCESS TO HEALTH CARE COVERAGE - PATIENTS MUST BE UNABLE TO ACCESS EMPLOYER SPONSORED HEALTH PLANS OR ENTITLEMENT PROGRAMS. LASTLY, THE PATIENT MUST BE WITHOUT SUBSTANTIAL LIQUID ASSETS (I.E. CASH-ON-HAND). ASSETS SUCH AS HOUSES, CARS, PENALIZED RETIREMENT SAVINGS FUNDS, ETC. ARE NOT CONSIDERED LIQUID ASSETS. SUBSTANTIAL ASSETS ARE DEFINED AS ENOUGH CASH-ON-HAND TO COVER THE MEDICAL EXPENSES WITHOUT PLACING A HARDSHIP ON THE PATIENT. PATIENTS WITH SPECIAL CIRCUMSTANCES SUCH AS BANKRUPTCY MAY ALSO BE ELIGIBLE FOR CHARITY CARE; DETERMINATION IS MADE ON A CASE BY CASE BASIS UNDER THESE CIRCUMSTANCES. PART I, LINE 6A: PART I, LINE 6A:THE COMMUNITY BENEFIT REPORT IS PREPARED BY A RELATED ORGANIZATION. NOVANT HEALTH, INC. IS A MEMBER ORGANIZATION OF THE NOVANT HEALTH UVA HEALTH SYSTEM. IT PRODUCES A COMMUNITY BENEFIT REPORT, REFERRED TO AS A COMMUNITY IMPACT REPORT, REPRESENTING THE HEALTH SYSTEM AS A WHOLE INCLUDING THE FILING ORGANIZATION. THE REPORT CAN BE FOUND AT HTTPS://WWW.NOVANTHEALTHUVA.ORG/ABOUT-US/COMMUNITY-INVOLVEMENT/COMMUNITY-BENEFIT.ASPX. PLEASE NOTE THAT THE NUMERIC DATA IN THIS REPORT IS NOT BASED UPON THE FORM 990, SCHEDULE H CRITERIA, BUT RATHER IT HAS BEEN PREPARED IN ACCORDANCE WITH THE NORTH CAROLINA HOSPITAL ASSOCIATION REPORTING GUIDELINES. IT SHOULD NOT BE RELIED UPON AS THE ORGANIZATION'S FORM 990, SCHEDULE H COMMUNITY BENEFIT REPORT, ITS COMMUNITY HEALTH NEEDS ASSESSMENT OR COMMUNITY BENEFIT IMPLEMENTATION STRATEGY. PART I, LINE 7: COSTS REPORTED IN THE TABLE FOR CHARITY CARE AND CERTAIN OTHER COMMUNITY BENEFITS AMOUNTS ARE CALCULATED USING AN ENTITY SPECIFIC COST TO CHARGE RATIO BASED ON WORKSHEET 2 (CCR). PART I, LN 7 COL(F): PART I, LN 7 COL(F):THE AMOUNT OF BAD DEBT REMOVED FROM TOTAL EXPENSES (DENOMINATOR) WAS $14,067,756. PART II, COMMUNITY BUILDING ACTIVITIES: THE ORGANIZATION'S COMMUNITY BUILDING ACTIVITIES ADDRESSES THE UNDERLYING CAUSES OF HEALTH PROBLEMS AND IMPACTS THE HEALTH OF OUR COMMUNITY THROUGH PARTNERSHIPS WITH LOCAL AGENCIES DEDICATED TO IMPROVING THE LIVES OF ALL INDIVIDUALS. OUTREACH INCLUDES PROVIDING SUPPORT TO ORGANIZATIONS SUCH AS LOCAL YMCA'S, UNITED WAY PARTNER AGENCIES, CHAMBERS OF COMMERCE AND OTHER LOCAL COMMUNITY ORGANIZATIONS, ASSISTING WITH COMMUNITY AND COUNTY COALITIONS, AND PROVIDING EDUCATION SEMINARS AND TRAINING FOR COMMUNITY WORKFORCES. PART III, LINE 2: IMPLICIT PRICE CONCESSIONS (ANALOGOUS TO BAD DEBT EXPENSE) ARE DETERMINED BASED ON MANAGEMENT'S ASSESSMENT OF CONTRACTUAL AGREEMENTS, DISCOUNT POLICIES, AND HISTORICAL EXPERIENCE. PART III, LINE 4: THE ORGANIZATION'S IMPLICIT PRICE CONCESSIONS (ANALOGOUS TO BAD DEBT EXPENSE) ON LINE 2 IS CALCULATED USING THE SAME METHODOLOGY AS CHARITY CARE AND OTHER COMMUNITY BENEFITS USING AN ENTITY SPECIFIC COST TO CHARGE RATIO (CCR). FOOTNOTE 2 (ACCOUNTS RECEIVABLE) ON PAGE 6 OF THE AUDITED FINANCIAL STATEMENTS DESCRIBES PRICE CONCESSIONS. PART III, LINE 8: THE METHODOLOGY USED TO DETERMINE THE MEDICARE ALLOWABLE COSTS REPORTED IN THE ORGANIZATION'S MEDICARE COST REPORT AS REFLECTED IN THE AMOUNT REPORTED IN PART III, LINE 6 IS DETERMINED BY FOLLOWING THE MEDICARE PRINCIPLES OF ALLOWABLE COSTS. COST FOR THE OVERHEAD DEPARTMENTS ARE STEPPED DOWN TO THE REMAINING COST CENTERS BASED ON STATISTICS FOR EACH OVERHEAD COST CENTER. ONCE THE STEP-DOWN PROCESS IS COMPLETE, A COST TO CHARGE RATIO ("CCR") IS DEVELOPED FOR EACH COST CENTER. THE CCR IS THEN APPLIED TO THE MEDICARE REVENUE BY COST CENTER AND TOTALED. IT SHOULD BE NOTED THAT THE MEDICARE COST REPORTS DO NOT ADDRESS ANY MANAGED CARE MEDICARE REVENUES, COSTS, OR RELATED SHORTFALL. THE TOTAL REVENUES REPORTED AS RECEIVED FROM MEDICARE IN LINE 5 OF SECTION B ARE ONLY REPRESENTATIVE OF MEDICARE FEE FOR SERVICE PAYMENTS RECEIVED. THE ALLOWABLE COSTS ON LINE 6 ARE SIGNIFICANTLY LOWER THAN THE ACTUAL EXPENDITURES. AS SUCH, THE SHORTFALL IS UNDERESTIMATED. EVERY HOSPITAL TREATS MEDICARE PATIENTS. SOME HOSPITALS ARE LOCATED IN HIGH MEDICARE POPULATION AREAS; OTHERS PROVIDE SERVICES DISPROPORTIONATELY USED BY MEDICARE PATIENTS. MEDICARE RATES AND NUMBERS OF MEDICARE PATIENTS ARE NOT NEGOTIATED. AS REIMBURSEMENT RATES DECLINE RELATIVE TO COSTS OF CARE, HOSPITALS CONTINUE TO SERVE THE MEDICARE POPULATION. WITHOUT THIS SERVICE THESE PATIENTS WOULD BECOME AN OBLIGATION ON THE GOVERNMENT. ANY UNREIMBURSED COSTS OF THIS CARE ARE A COMMUNITY BENEFIT PROVIDED BY THE HOSPITAL TO THE COMMUNITY AND GOVERNMENT. PART III, LINE 9B: THE ORGANIZATION'S BILLING AND COLLECTIONS POLICY DOES EXPLAIN ACTIONS AGAINST PATIENTS WHO HAVE OUTSTANDING DELINQUENT AMOUNTS, BUT THE POLICY DOES NOT CONTAIN PROVISIONS FOR COLLECTION PRACTICES AGAINST PATIENTS WHO ARE ELIGIBLE UNDER THE FINANCIAL ASSISTANCE POLICY (FAP) BECAUSE FAP ELIGIBLE PATIENTS RECEIVE 100% FREE CARE AND THEREFORE DO NOT RECEIVE BILLS ONCE FAP ELIGIBILITY HAS BEEN ESTABLISHED. PART VI, LINE 2: PART VI, LINE 2: NEEDS ASSESSMENTTHE ORGANIZATION IS PART OF NOVANT HEALTH UVA HEALTH SYSTEM, AN INTEGRATED NOT-FOR-PROFIT HEALTH SYSTEM. NOVANT HEALTH, INC. IS A MEMBER ORGANIZATION OF THE NOVANT HEALTH UVA HEALTH SYSTEM. NOVANT HEALTH, INC. HAS A COMMUNITY BENEFIT DEPARTMENT ("CB DEPARTMENT") COMPRISED OF COMMUNITY BENEFIT PROFESSIONALS AND AN ASSOCIATED ADVISORY WORKING GROUP ("THE COMMUNITY BENEFIT GROUP") THAT INCLUDES REPRESENTATIVES FROM INTERNAL AUDIT, LEGAL, AND TAX. THE CB DEPARTMENT IS RESPONSIBLE FOR COORDINATING THE PREPARATION OF THE COMMUNITY HEALTH NEEDS ASSESSMENTS (CHNA) REPORTED IN PART V, SECTION B, FOR EACH HOSPITAL WITHIN THE NOVANT HEALTH SYSTEM AS WELL AS FOR THE FILING ORGANIZATION. EACH HOSPITAL AND THE COMMUNITY BENEFIT GROUP WORK TOGETHER TO IDENTIFY ORGANIZATIONS AND RESOURCES WITHIN ITS COMMUNITY THAT CONTRIBUTE TO THE PROCESS. THESE ORGANIZATIONS AND RESOURCES INCLUDE PUBLIC HEALTH DEPARTMENTS, LOCAL COMMUNITY COALITIONS REPRESENTING THE MEDICALLY UNDERSERVED, UNITED WAY, LOCAL UNIVERSITIES, ETC. COMMUNITY HEALTH ASSESSMENTS PREPARED BY OTHER ORGANIZATIONS IN THE COMMUNITY ARE USED IN COMBINATION WITH INTERNAL HOSPITAL DATA AND INFORMATION COLLECTED FROM LOCAL AGENCIES TO PREPARE THE HOSPITAL'S CHNA. IN ADDITION TO ADDRESSING NEEDS IDENTIFIED THROUGH THE CHNA, EACH HOSPITAL MAY RESPOND TO REQUESTS FOR SPECIFIC COMMUNITY BENEFIT ACTIVITIES OR PROGRAMS FROM PUBLIC AGENCIES OR COMMUNITY GROUPS. PART VI, LINE 3: PART VI, LINE 3: PATIENT EDUCATION OF ELIGIBILITY FOR ASSISTANCETHE ORGANIZATION IS COMMITTED TO PROVIDING OUTSTANDING HEALTHCARE TO ALL MEMBERS OF OUR COMMUNITIES, REGARDLESS OF THEIR ABILITY TO PAY. OUR FINANCIAL COUNSELING TEAMS ARE CONSTANTLY WORKING WITH THE PATIENTS WITHIN OUR COMMUNITIES TO UNDERSTAND THEIR NEEDS AND ENSURE THAT OUR POLICIES AND PROCESSES ADDRESS THESE NEEDS. WE ALSO MAINTAIN CONTRACTS WITH MEDICAID ELIGIBILITY VENDORS AND THESE TEAMS OFFER ADDITIONAL SUPPORT IN PROCESSING AND ASSESSING HOW WE SERVE THE FINANCIAL NEEDS OF OUR PATIENTS. BASED ON THE ASSESSMENTS OF OUR COMMUNITIES, THE ORGANIZATION HAS DEVELOPED FINANCIAL ASSISTANCE POLICIES AND PROGRAMS THAT ADDRESS THE FINANCIAL NEEDS OF OUR PATIENTS. WE PRIDE OURSELVES ON THE TRANSPARENCY OF OUR PROGRAMS AND THE EDUCATION WE OFFER OUR PATIENTS AROUND OUR FINANCIAL ASSISTANCE POLICIES. OUR PROGRAMS ARE DOCUMENTED ON OUR WEBSITE, ALONG WITH CONTACT INFORMATION FOR OUR FINANCIAL COUNSELORS. ADDITIONALLY, OUR PROGRAMS ARE DOCUMENTED ON PATIENT FLYERS THROUGHOUT THE ORGANIZATION'S FACILITIES AND PHYSICIAN OFFICES. OUR PATIENT ACCESS SPECIALISTS, FINANCIAL COUNSELORS AND BUSINESS OFFICE TEAMS WORK WITH ALL ELIGIBLE PATIENTS TO EDUCATE THEM ON THE VARIOUS OPTIONS AVAILABLE VIA OUR FINANCIAL ASSISTANCE PROGRAMS OR GOVERNMENT SPONSORED CARE. THEY ALSO REFERENCE OUR FINANCIAL ASSISTANCE POLICY IN ALL CONVERSATIONS RELATED TO PATIENTS BILLS. FINALLY, WE WORK WITH LOCAL AREA FREE HEALTH CLINICS AND OTHER CHARITABLE ORGANIZATIONS TO PROVIDE CONTINUATION OF CARE FOR THEIR PATIENTS. IN ADDITION TO OUR FINANCIAL COUNSELING PROCESSES USED TO IDENTIFY CHARITY CARE PATIENTS, OUR COLLECTIONS PROCESSES WITHIN OUR BUSINESS OFFICES ALSO HELP IDENTIFY PATIENTS WHO ARE ALREADY ELIGIBLE FOR CHARITY OR WHO MAY BE ELIGIBLE BASED ON THEIR STATUS WITHIN THE FEDERAL POVERTY GUIDELINES ("FPG"). WE UTILIZE PREVIOUSLY SUBMITTED PATIENT DOCUMENTATION AND CREDIT AGENCY REPORTED FPG FOR DETERMINATION. SUPPORTING DOCUMENTS ARE VALID 6 MONTHS FROM THE DATE OF SUBMISSION. OUR POLICIES ARE CONSIDERED FLUID AND ARE UPDATED FREQUENTLY BASED ON LOCAL AND NATIONAL MARKET STANDARDS AND NATIONAL ECONOMIC CONDITIONS. ANY UPDATES TO OUR POLICIES REQUIRE MULTI-LEVEL LEADERSHIP APPROVAL AND ARE ULTIMATELY APPROVED BY THE ORGANIZATION'S BOARD. PART VI, LINE 4: PART VI, LINE 4: COMMUNITY INFORMATIONTHE PRINCE WILLIAM HOSPITAL FORM 990 INCLUDES THE OPERATIONS OF TWO LICENSED HOSPITAL: PRINCE WILLIAM HOSPITAL DBA NOVANT HEALTH UVA HEALTH SYSTEM PRINCE WILLIAM MEDICAL CENTER AND AS NOVANT HEALTH UVA HEALTH SYSTEM HAYMARKET MEDICAL CENTER.PRINCE WILLIAM HOSPITAL DBA NOVANT HEALTH UVA HEALTH SYSTEM PRINCE WILLIAM MEDICAL CENTERTHE ORGANIZATION DEFINES ITS COMMUNITY BY ITS PRIMARY SERVICE AREA WHICH INCLUDES THE CITY OF MANASSAS, BRISTOW, AND NOKESVILLE, ALL LOCATED WITHIN PRINCE WILLIAM COUNTY, MANASSAS CITY, AND MANASSAS PARK. PRINCE WILLIAM COUNTY IS MORE URBAN IN NATURE. THE COUNTY CONSISTS OF A LARGE URBAN CENTER SURROUNDED BY SMALLER, MORE RURAL COMMUNITIES AND IS PART OF THE WASHINGTON ARLINGTON ALEXANDRIA METROPOLITAN STATISTICAL AREA. ACCORDING TO THE US CENSUS BUREAU DATA, THE MEDIAN HOUSEHOLD INCOME LEVEL WAS $102,382.ACCORDING TO SG2 DATA, THE SPECIFIC POPULATION GROUPS (ETHNIC AND CULTURAL) FOR THE PRIMARY SERVICE AREAS ARE AS FOLLOWS:PRIMARY SERVICE AREAETHNICITY POPULATION % OF POPULATIONWHITE 90,748 46.32%BLACK/AFRICAN AMERICAN 25,878 13.21%HISPANIC/LATINO 55,123 28.14%ASIAN/PACIFIC ISLANDERS 16,014 8.17%OTHER 8,142 4.16%TOTAL POPULATION 195,905 100%ACCORDING TO SG2 DATA, THE AGE BREAKDOWN FOR THE PRIMARY SERVICE AREAS IS AS FOLLOWS:PRIMARY SERVICE AREAAGE RANGE POPULATION % OF POPULATION0-17 53,705 27.41%18-64 124,807 63.71%65+ 17,393 8.88%TOTAL POPULATION 195,905 100%PRINCE WILLIAM HOSPITAL DBA NOVANT HEALTH UVA HEALTH SYSTEM HAYMARKET MEDICAL CENTERTHE ORGANIZATION DEFINES ITS COMMUNITY BY ITS PRIMARY SERVICE AREA WHICH INCLUDES THE CITIES OF CATHARPIN, GAINESVILLE, AND HAYMARKET, ALL IN PRINCE WILLIAM COUNTY, BROAD RUN AND THE PLAINS, BOTH IN FAUQUIER COUNTY, AND ARCOLA, CHANTILLY, AND STERLING, ALL IN LOUDOUN COUNTY. PRINCE WILLIAM COUNTY IS MORE URBAN IN NATURE. THE COUNTY CONSISTS OF A LARGE URBAN CENTER SURROUNDED BY SMALLER, MORE RURAL COMMUNITIES AND IS PART OF THE WASHINGTON ARLINGTON ALEXANDRIA METROPOLITAN STATISTICAL AREA. ACCORDING TO THE US CENSUS BUREAU DATA, THE MEDIAN HOUSEHOLD INCOME LEVEL WAS $102,382.ACCORDING TO SG2 DATA, THE SPECIFIC POPULATION GROUPS (ETHNIC AND CULTURAL) FOR THE PRIMARY SERVICE AREAS ARE AS FOLLOWS:PRIMARY SERVICE AREAETHNICITY POPULATION % OF POPULATIONWHITE 80,520 55.69%BLACK/AFRICAN AMERICAN 14,151 9.79%HISPANIC/LATINO 15,837 10.95%ASIAN/PACIFIC ISLANDERS 27,222 18.83%OTHER 6,849 4.74%TOTAL POPULATION 144,579 100%ACCORDING TO SG2 DATA, THE AGE BREAKDOWN FOR THE PRIMARY SERVICE AREAS IS AS FOLLOWS:PRIMARY SERVICE AREAAGE RANGE POPULATION % OF POPULATION0-17 42,410 29.33%18-64 87,261 60.36%65+ 14,908 10.31%TOTAL POPULATION 144,579 100% PART VI, LINE 5: PART VI, LINE 5: PROMOTION OF COMMUNITY HEALTHTHE ORGANIZATION FURTHERS ITS EXEMPT PURPOSES BY DOING THE FOLLOWING:1. ADOPTING A FINANCIAL ASSISTANCE POLICY;2. REMAINING CERTIFIED BY THE U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES TO PROVIDE SERVICES TO ALL BENEFICIARIES OF MEDICARE, MEDICAID, AND OTHER GOVERNMENT PAYMENT PROGRAMS, AND PROVIDING SERVICES IN A NONDISCRIMINATORY MANNER TO SUCH BENEFICIARIES;3. OPERATING A FULL-TIME EMERGENCY ROOM WHICH IS OPEN TO AND ACCEPTS ALL PERSONS, REGARDLESS OF THEIR ABILITY TO PAY;4. MAINTAINING AN OPEN MEDICAL STAFF, SUBJECT TO EXCLUSIVE CONTRACTS FOR HOSPITAL-BASED SERVICES SUCH AS ANESTHESIOLOGY, RADIOLOGY, PATHOLOGY, HOSPITALIST, AND EMERGENCY DEPARTMENT SERVICES, TO THE EXTENT AN EXCLUSIVE CONTRACT FOR THOSE SERVICES IS REQUIRED TO OBTAIN PROPER STAFFING COVERAGE OR TO PERMIT A MORE EFFICIENT DELIVERY OF THOSE SERVICES WITHIN THE HOSPITAL FACILITY;5. MAINTAINING A GOVERNING BOARD CONSISTING PRIMARILY OF A BROAD CROSS-SECTION OF LEADERS IN THE COMMUNITY;6. ADOPTING AND APPLYING A CONFLICT OF INTEREST POLICY, WHICH APPLIES TO THE GOVERNING BOARD AND ORGANIZATION OFFICERS;7. PROVIDING HEALTH EDUCATION LECTURES AND WORKSHOPS;8. PROVIDING HEALTH FAIRS, EDUCATION ON SPECIFIC DISEASES OR CONDITIONS, AND HEALTH PROMOTION AND WELLNESS PROGRAMS TO THE COMMUNITIES IT SERVES;9. PROVIDING SUPPORT GROUPS AND SELF HELP PROGRAMS TO THE COMMUNITIES IT SERVES;10. PROVIDING COMMUNITY-BASED CLINICAL SERVICES, INCLUDING WITHOUT LIMITATION, HEALTH SCREENINGS AND CLINICS FOR UNINSURED OR UNDERINSURED PERSONS TO THE COMMUNITIES IT SERVES;11. PROVIDING HEALTHCARE SUPPORT SERVICES, INCLUDING WITHOUT LIMITATION, INFORMATION AND REFERRAL TO COMMUNITY SERVICES, CASE MANAGEMENT OF UNDERINSURED AND UNINSURED PERSONS, TELEPHONE INFORMATION SERVICES AND ASSISTANCE TO ENROLL IN PUBLIC PROGRAMS, SUCH AS STATE CHILDREN'S HEALTH INSURANCE PROGRAM (SCHIP) AND MEDICAID TO THE COMMUNITIES IT SERVES;12. PROVIDING SUBSIDIZED HEALTH SERVICES AND CLINICAL PROGRAMS TO THE COMMUNITIES IT SERVES;13. PROVIDING CASH AND IN-KIND CONTRIBUTIONS TO NONPROFIT COMMUNITY HEALTHCARE ORGANIZATIONS IN THE COMMUNITIES IT SERVES; AND14. GENERALLY PROMOTING THE HEALTH, WELLNESS, AND WELFARE OF THE COMMUNITIES IT SERVES BY PROVIDING QUALITY HEALTHCARE SERVICES AT REASONABLE COST.PLEASE SEE THE NOVANT HEALTH COMMUNITY BENEFIT REPORT, LOCATED AT HTTPS://WWW.NOVANTHEALTHUVA.ORG/ABOUT-US/COMMUNITY-INVOLVEMENT/COMMUNITY-BENEFIT.ASPX.PLEASE NOTE THAT THE NUMERIC INFORMATION IN THIS REPORT IS NOT BASED UPON THE FORM 990, SCHEDULE H CRITERIA, BUT RATHER IT HAS BEEN PREPARED IN ACCORDANCE WITH THE NORTH CAROLINA HOSPITAL ASSOCIATION REPORTING GUIDELINES. PART VI, LINE 6: PART VI, LINE 6: AFFILIATED HEALTH CARE SYSTEMTHE ORGANIZATION IS AN INTEGRAL PART OF NOVANT HEALTH UVA HEALTH SYSTEM AND NOVANT HEALTH (COLLECTIVELY KNOWN AS "THE SYSTEM"), BOTH ARE NOT-FOR-PROFIT INTEGRATED GROUPS OF HOSPITALS, PHYSICIAN CLINICS, OUTPATIENT CENTERS AND OTHER HEALTHCARE SERVICE PROVIDERS. EACH HOSPITAL PROVIDES SUBSTANTIAL COMMUNITY BENEFIT TO THE COMMUNITY IT SERVES, AS REPORTED INDIVIDUALLY ON EACH HOSPITAL'S FORM 990, SCHEDULE H. THE SYSTEM'S COMMUNITY BENEFIT AS A WHOLE IS DOCUMENTED IN A SYSTEM-WIDE COMMUNITY BENEFIT REPORT, LOCATED AT HTTPS://WWW.NOVANTHEALTHUVA.ORG/ABOUT-US/COMMUNITY-INVOLVEMENT/COMMUNITY-BENEFIT.ASPX. PLEASE NOTE THAT THE NUMERIC INFORMATION IN THIS REPORT IS NOT BASED UPON THE FORM 990, SCHEDULE H CRITERIA, BUT RATHER IT HAS BEEN PREPARED IN ACCORDANCE WITH THE NORTH CAROLINA HOSPITAL ASSOCIATION REPORTING GUIDELINES. IT SHOULD NOT BE RELIED UPON AS THE ORGANIZATION'S FORM 990, SCHEDULE H COMMUNITY BENEFIT REPORT, ITS COMMUNITY HEALTH NEEDS ASSESSMENT OR COMMUNITY BENEFIT IMPLEMENTATION STRATEGY. THERE ARE SIGNIFICANT COMMUNITY BENEFIT ACTIVITIES WITHIN NOVANT HEALTH WHICH MAY NOT BE REPORTABLE ON A SCHEDULE H BECAUSE THEY ARE NOT CONDUCTED BY AN ENTITY WHICH OWNS OR OPERATES A HOSPITAL.IN ADDITION TO HOSPITALS, NOVANT HEALTH UVA HEALTH SYSTEM INCLUDES A PHYSICIAN ORGANIZATION WITH PRACTICES IN VIRGINIA AND A HOSPITAL FOUNDATION WHICH SUPPORTS AND ENHANCES THE ACTIVITIES IN THOSE HOSPITALS' COMMUNITIES. FURTHER, NOVANT HEALTH UVA HEALTH SYSTEM INCLUDES AMBULATORY SURGERY CENTERS, IMAGING CENTERS, REHABILITATION CENTERS, AND OTHER OUTPATIENT FACILITIES; ALL DEDICATED TO PROMOTING THE HEALTH OF THEIR RESPECTIVE COMMUNITIES. PART VI, LINE 7: STATE FILING OF COMMUNITY BENEFIT REPORT PRINCE WILLIAM HOSPITAL FILES A COMMUNITY BENEFIT REPORT WITH THE VIRGINIA HOSPITAL AND HEALTHCARE ASSOCIATION IN ACCORDANCE WITH THEIR REPORTING GUIDELINES FOR PURPOSES OF ADVOCACY AND THE STATE'S REPORTING REQUIREMENTS. 1 CHRIS ATWOOD FOUNDATION INC PO BOX 9282 RESTON VA 20195 462749211 501(C)(3) 10000 COMMUNITY OUTREACH GEORGE MASON UNIVERSITY FOUNDATION INC 4400 UNIVERSITY DR MERTEN HALL 2300 2300 FAIRFAX VA 22030 541603842 501(C)(3) 19235 COMMUNITY OUTREACH PERSONAL CARE SERVICES 2085 FRONTIS PLAZA BLVD WINSTONSALEM NC 27103 541291284 501(C)(3) 30267 TO SUPPORT NH CATON MERCHANT HOUSE PRINCE WILLIAM AREA FREE CLINIC INC 13900 CHURCH HILL DR WOODBRIDGE VA 22191 541619202 501(C)(3) 15000 COMMUNITY OUTREACH PRINCE WILLIAM CHAMBER OF COMMERCE 9720 CAPITAL COURT MANASSAS VA 20110 272875613 501(C)(6) 9893 COMMUNITY OUTREACH PWHS FOUNDATION 2085 FRONTIS PLAZA BLVD WINSTONSALEM NC 27103 541307595 501(C)(3) 50955 TO SUPPORT NHPWMC FOUNDATION THE SKILLSOURCE GROUP INC 8300 BOONE BLVD NO 450 VIENNA VA 22182 300129320 501(C)(3) 5292 COMMUNITY OUTREACH 6 1 EDUCATION SCHOLARSHIPS 16 20000 PATIENT TRANSPORTATION 15 300 FMV TRANSPORTATION PART I, LINE 2: PROCEDURES FOR MONITORING THE USE OF GRANT FUNDS THE FILING ORGANIZATION IS PART OF THE INTEGRATED HEALTHCARE SYSTEM OPERATED BY NOVANT HEALTH, INC. ("NOVANT HEALTH"), THE PARENT ORGANIZATION. NOVANT HEALTH'S BYLAWS AUTHORIZE IT TO ESTABLISH CERTAIN POLICIES FOR ALL OF ITS SUBSIDIARIES WITHIN THE SYSTEM. NOVANT HEALTH HAS ESTABLISHED A SYSTEM-WIDE CORPORATE POLICY WITH STANDARDIZED GUIDELINES THAT ARE TO BE USED IN REVIEWING THE ELIGIBILITY AND SELECTION OF GRANTEES RECEIVING CERTAIN EXEMPT PURPOSE FUNDS. THE FILING ORGANIZATION MAINTAINS DOCUMENTATION OF THE ELIGIBILITY AND SELECTION CRITERIA AND RECORDS OF THE AMOUNTS ARE MAINTAINED VIA THE GENERAL LEDGER. FUNDS ARE GENERALLY NOT TRACKED AFTER BEING GRANTED, AS THE ORIGINAL ELIGIBILITY AND SELECTION CRITERIA HAVE ALREADY BEEN MET. X X X X 1 1 1 1 0 0 0 0 0 0 0 ARMATO CARL CEO & PRESIDENT NH/TRUSTEE 0 1503933 0 1331375 0 653931 0 24000 0 40045 0 3553284 0 7500 KHOT VIKRAM MD VICE CHAIR 0 163546 0 15000 0 11631 0 16045 0 4015 0 210237 0 0 MAGALSKI JOSEPH MD TRUSTEE 0 386937 0 16869 0 28956 0 19763 0 24911 0 477436 0 7500 NAPPS CARL FMR PRES & COO / TRUSTEE 147487 0 90200 0 193551 0 11165 0 24506 0 466909 0 0 0 SMITH STEPHEN MD PRES & COO / TRUSTEE 274939 0 34000 0 12025 0 0 0 21458 0 342422 0 0 0 CODER CHARLES CFO NHUVAHS & TREASURER 0 278334 0 144944 0 247 0 17167 0 11088 0 451780 0 0 GILL MARGARET FMR SVP & CEO NHUVA HEALTH SYSTEM 0 333457 0 247167 0 39999 0 4519 0 24566 0 649708 0 0 BERNARD PETER J INTERIM CEO NHUVAHS 0 0 0 0 0 192826 0 0 0 0 0 192826 0 0 CONKLIN MARGARET FMR CNO 115376 0 9250 0 68408 0 4994 0 21767 0 219795 0 0 0 SEDGLEY DONALD FMR PRES & COO NHUVAHMC 22666 0 122505 0 212119 0 9384 0 25551 0 392225 0 0 0 ARAM HEATHER VP SERVICE LINE & AMBULATORY 213471 0 54857 0 16940 0 11302 0 16928 0 313498 0 0 0 BOWERS TRACY VP HR & ADMIN SERVICES 195166 0 50318 0 16296 0 12874 0 33032 0 307686 0 0 0 ORDONEZ GENE CARDIOVASCULAR INVASIVE SPEC. 195027 0 3670 0 466 0 11805 0 9808 0 220776 0 0 0 ROLOFF JAY CARDIOVASCULAR INVASIVE SPEC. 197701 0 15740 0 562 0 12457 0 34843 0 261303 0 0 0 SWENSON KRISTIN PHYSICIST 212134 0 4239 0 875 0 12878 0 4348 0 234474 0 0 0 ROBSON MELISSA FMR SVP & CEO NHUVA HEALTH SYSTEM 0 0 0 0 0 438970 0 0 0 33471 0 472441 0 66983 WALL JOHN D FMR VP MEDICAL AFFAIRS 0 0 0 0 172308 0 0 0 13530 0 185838 0 7500 0 PART I, LINE 1A PART I, LINE 1A: FRINGE OR EXPENSE EXPLANATION FIRST-CLASS OR CHARTER TRAVEL: FIRST-CLASS OR CHARTER TRAVEL IS NOT A COVERED TRAVEL EXPENSE FOR EXECUTIVES; THEY ARE LIMITED TO BUSINESS OR COACH CLASS FARES FOR COMMERCIAL FLIGHTS. HOWEVER, CHARTER TRAVEL IS AVAILABLE TO CERTAIN EXECUTIVES, BOARD MEMBERS, AND APPROVED BUSINESS PERSONNEL MEETING APPLICABLE POLICY CRITERIA. TRAVEL FOR COMPANIONS: COMPANIONS ARE ALLOWED ON CERTAIN CHARTER FLIGHTS PAID FOR BY THE ORGANIZATION. IN THAT CASE, THE VALUE OF THE COMPANION'S FLIGHT IS CALCULATED UNDER APPLICABLE TAX LAWS AND THAT AMOUNT IS INCLUDED IN THE EXECUTIVE'S TAXABLE INCOME AS PRESCRIBED BY THE APPLICABLE TAX LAWS. DISCRETIONARY SPENDING ACCOUNT: CERTAIN EXECUTIVES RECEIVE A DISCRETIONARY SPENDING ACCOUNT. THE DOLLAR AMOUNT IN THE ACCOUNT IS PRE-APPROVED BY THE COMPENSATION AND LEADERSHIP COMMITTEE OF THE NOVANT HEALTH BOARD OF TRUSTEES. THE ACCOUNT CAN BE USED ONLY FOR AN APPROVED LIST OF EXPENDITURES. ALL OPTIONS OTHER THAN A DEFERRED, AT-RISK, COMPENSATION OPTION ARE CONSIDERED TAXABLE AND ARE INCLUDED IN THE EXECUTIVE'S TAXABLE INCOME AS PRESCRIBED BY THE APPLICABLE TAX LAWS. HOUSING ALLOWANCE OR RESIDENCE FOR PERSONAL USE: WE PROVIDE TEMPORARY HOUSING ALLOWANCES IN CERTAIN EXECUTIVE RECRUITMENT AND RELOCATION PACKAGES. THE VALUE IS CALCULATED UNDER APPLICABLE TAX LAWS AND THAT AMOUNT IS INCLUDED IN THE EXECUTIVE'S INCOME AS PRESCRIBED BY THE APPLICABLE TAX LAWS. PART I, LINE 3 THE FILING ORGANIZATION IS AN INTEGRAL PART OF NOVANT HEALTH UVA HEALTH SYSTEM ("THE SYSTEM") AND RELIES UPON NOVANT HEALTH, INC., A SUPPORTING ORGANIZATION OF THE SYSTEM, TO USE THE PROCESS DESCRIBED IN PART VI, LINE 15A/15B OF THIS RETURN TO ESTABLISH COMPENSATION FOR CERTAIN EXECUTIVES. THIS PROCESS ADHERES TO THE REQUIREMENTS SET FORTH TO SECURE THE REBUTTABLE PRESUMPTION OF REASONABLENESS AND INCLUDES A REVIEW AND APPROVAL BY INDEPENDENT AND DISINTERESTED MEMBERS OF A COMPENSATION COMMITTEE, CONSULTATION WITH INDEPENDENT COMPENSATION CONSULTANTS, THE UTILIZATION OF THIRD-PARTY COMPARABILITY DATA SUCH AS PUBLISHED COMPENSATION SURVEYS, AND CONTEMPORANEOUS SUBSTANTIATION OF THE DELIBERATION AND DECISION. PART I, LINES 4A-B PART I, LINES 4A-C: SEVERANCE, NONQUALIFIED, AND EQUITY-BASED PAYMENTS SEVERANCE NONQUALIFIED EQUITY-BASED CONKLIN, MARGARET 49,808 NAPPS, CARL 143,077 ROBSON, MELISSA 445,943 59,483 SEDGLEY, DONALD 153,088 WALL, JOHN 174,151 PART I, LINE 4A - SEVERANCE PLAN: ELIGIBLE EXECUTIVES MAY RECEIVE SEVERANCE PAY THAT IS BASED ON ANNUAL COMPENSATION FOR A SPECIFIED PERIOD OF TIME. THE SEVERANCE PAY WOULD BE PAID ONLY IN THE EVENT OF CERTAIN TYPES OF EMPLOYMENT TERMINATION, AND IS FURTHER CONTINGENT ON THE SATISFACTION OF OTHER CONDITIONS SUCH AS COMPLIANCE WITH A NON-COMPETITION COVENANT. ANY CURRENT YEAR PAYMENTS HAVE BEEN INCLUDED IN THE COMPENSATION AMOUNTS REPORTED IN PART VII AND IN COLUMN (B)(III) OF SCHEDULE J. THE COMPENSATION AND LEADERSHIP COMMITTEE OF THE NOVANT HEALTH BOARD REVIEWS, APPROVES, AND OVERSEES ALL ASPECTS AND ALL ELEMENTS OF EXECUTIVE COMPENSATION AND BENEFITS, INCLUDING THE AMOUNTS AWARDED UNDER THIS SEVERANCE PLAN. PART I, LINE 4B - SUPPLEMENTAL NONQUALIFIED RETIREMENT PLANS: THE SUPPLEMENTAL EXECUTIVE RETIREMENT PLAN ("SERP") IS INTENDED TO SUPPORT RETENTION OF KEY EXECUTIVES, AND TO OFFER COMPETITIVE TOTAL COMPENSATION. ELIGIBLE EXECUTIVES WILL BE NOMINATED BY THE CEO AND APPROVED BY THE NOVANT HEALTH COMPENSATION AND LEADERSHIP COMMITTEE ("THE COMMITTEE") TO PARTICIPATE. GENERALLY, ANNUAL CONTRIBUTIONS TO THE PLAN OR PAYMENTS TO PARTICIPANTS WILL BE BASED ON A PERCENTAGE OF THE PARTICIPANT'S BASE SALARY AS OF JANUARY 1ST OF THE PREVIOUS PLAN YEAR AND ARE REPORTED IN COLUMN (C) OF SCHEDULE J. PRIOR TO MAKING THE CONTRIBUTIONS OR PAYMENTS, THE COMMITTEE WILL APPROVE THE AMOUNTS AS TO REASONABLENESS, WHEN COMBINED WITH ALL OTHER ANNUAL COMPENSATION. A 3 YEAR CLASS-YEAR VESTING PERIOD WILL APPLY UP TO AGE 62, WHEN ALL MONEY WOULD BE VESTED AND PAID OUT TO THE PARTICIPANT. OTHERWISE, VESTING WILL OCCUR ON JANUARY 1ST OF EACH YEAR FOR THE APPROPRIATE CLASS-YEAR VESTING PERIOD. THE COMMITTEE REVIEWS, APPROVES, AND OVERSEES ALL ASPECTS AND ALL ELEMENTS OF EXECUTIVE COMPENSATION AND BENEFITS. A INDUSTRIAL DEVELOPMENT AUTHORITY OF THE COUNTY OF PRINCE WILLIAM 521325659 74176HAT2 2013-05-07 153845821 SEE PART VI 0 0 0 A 6015000 153849391 1303430 417886 93665728 2014 1 0 1 1 A 0 0 1 0 0 0.00000 0.00000 0.00000 0 0 1 A 0 0 0 1 0 0 0 0 1 A 1 FORM 990, SCHEDULE K ENTITY 1 SCHEDULE K, PART I, LINE A: DESCRIPTION OF PURPOSE (1) FINANCE A 60 BED HOSPITAL IN HAYMARKET, VA (2) REFUND THE PRINCE WILLIAM HOSPITAL SERIES 2002 BONDS (3) PAY ISSUANCE COSTS SCHEDULE K, PART II, LINE 3, COLUMN A: DIFFERENCE DUE TO INVESTMENT EARNINGS SCHEDULE K, PART IV, LINE 2C, COLUMN A: DATE OF LAST REBATE COMPUTATION APRIL 30, 2018. FORM 990, SCHEDULE K, PART III, LINE 3B: PRIVATE BUSINESS USE THE NOVANT HEALTH CARE SYSTEM HAS A LEGAL DEPARTMENT, MATERIALS MANAGEMENT DEPARTMENT AND A RESEARCH DEPARTMENT. THESE DEPARTMENTS REGULARLY REVIEW MANAGEMENT, SERVICE AND RESEARCH AGREEMENTS RELATED TO TAX-EXEMPT BOND FINANCED PROPERTY. OUTSIDE BOND COUNSEL CONDUCTS ADDITIONAL REVIEW AND DUE DILIGENCE WHEN ENGAGED FOR A BOND ISSUANCE OR REFUNDING PROJECT. X 152322 SELLING PRICE 0 0 1 0 FORM 990, PI, L1: ORGANIZATION'S MISSION OR MOST SIGNIFICANT ACTIVITES PRINCE WILLIAM HOSPITAL DOING BUSINESS AS NOVANT HEALTH UVA HEALTH SYSTEM PRINCE WILLIAM MEDICAL CENTER AND NOVANT HEALTH UVA HEALTH SYSTEM HAYMARKET MEDICAL CENTER IS AN INTEGRAL PART OF THE NOVANT HEALTH UVA HEALTHSYSTEM ("NHUVAHS"). NHUVAHS WAS FORMED IN 2016 BY NOVANT HEALTH AND THE UNIVERSITY OF VIRGINIA HEALTH SYSTEM, AND IS A REGIONAL NONPROFIT, INTEGRATED HEALTHCARE NETWORK OF PHYSICIAN CLINICS, OUTPATIENT CENTERS AND HOSPITALS THAT SERVES PATIENTS AND COMMUNITIES IN VIRGINIA. PRINCE WILLIAM HOSPITAL RECEIVES STRATEGIC PLANNING, ADMINISTRATIVE AND OTHER SUPPORT FROM NOVANT HEALTH, INC., A MEMBER OF THE NOVANT HEALTH UVA HEALTH SYSTEM. GENERAL INFORMATION NOVANT HEALTH UVA HEALTH SYSTEM PRINCE WILLIAM MEDICAL CENTER LOCATED IN MANASSAS, VA, AND NOVANT HEALTH UVA HEALTH SYSTEM HAYMARKET MEDICAL CENTER LOCATED IN HAYMARKET, VA, ARE FOCUSED ON PROVIDING COMMUNITY SUPPORT, CONSISTENT QUALITY, EXCELLENT SERVICES AND A REMARKABLE WORK ENVIRONMENT FOR OUR TEAM. WE ARE COMMITTED TO MEETING THE HEALTH CARE NEEDS OF RESIDENTS OF MANASSAS, MANASSAS PARK, PRINCE WILLIAM AND SURROUNDING COUNTIES IN VIRGINIA, ONE PERSON AT A TIME. IN ADDITION TO OUR QUALITY OF SERVICES AND COMPREHENSIVE CATEGORIES OF SERVICES, WE'RE VERY PROUD OF OUR PATIENT FINANCIAL ASSISTANCE PROGRAM. WE PARTNER WITH PATIENTS TO HELP QUALIFY THEM FOR PUBLIC ASSISTANCE, ESTABLISH A REASONABLE PAYMENT PLAN, DISCOUNT THEIR BILL OR PROVIDE FREE CARE FOR THOSE THAT QUALIFY FOR FINANCIAL ASSISTANCE. COMMUNITY OUTREACH COMMUNITY OUTREACH IS A CRITICAL COMPONENT TO THE MISSION (TO IMPROVE THE HEALTH OF OUR COMMUNITIES, ONE PERSON AT A TIME) OF NOVANT HEALTH UVA HEALTH SYSTEM PRINCE WILLIAM MEDICAL CENTER AND NOVANT HEALTH UVA HEALTH SYSTEM HAYMARKET MEDICAL CENTER. BEYOND OUR PROVISION OF QUALITY HEALTHCARE SERVICES, WE SUPPORT OTHER COMMUNITY ORGANIZATIONS THAT PROVIDE HEALTH SERVICES, EDUCATION, AND ASSISTANCE TO THE UNINSURED AND THE OVERALL COMMUNITY. NOVANT HEALTH UVA HEALTH SYSTEM OFFERED SUPPORT GROUPS FOR NEWLY DIAGNOSED CANCER PATIENTS, BREAST CANCER PATIENTS AND GENERAL CANCER PATIENTS. PATIENT SUPPORT GROUPS FOR PATIENTS WHO ARE DEALING WITH DIABETES AND THOSE SUFFERING FROM EFFECTS OF CONCUSSION ARE ALSO AVAILABLE TO OUR COMMUNITY. IT ALSO PROVIDED COMMUNITY EDUCATION ABOUT SKIN CANCER, BREAST CANCER AND HEART HEALTH. PART OF OUR COMMITMENT TO OUR PATIENTS AND THE COMMUNITY IS OFFERING FREE OR LOW-COST SCREENINGS FOR GLUCOSE, BODY COMPOSITION, BLOOD PRESSURE AND HEMOGLOBIN A1C; AS WELL AS, PARTNERING WITH OUR PHYSICIAN SPECIALISTS IN THE FIELDS OF ENDOCRINOLOGY, OPHTHALMOLOGY AND PODIATRY TO PROVIDE QUESTION AND ANSWER SESSIONS FOR PERSONS WITH DIABETES. IN 2018, WE CONTINUED A SUCCESSFUL NOVANT HEALTH UVA HEALTH SYSTEM HAYMARKET MEDICAL CENTER FARMER'S MARKET PARTNERSHIP WITH LOCAL COMMUNITY MEMBERS TO SUPPORT THE COMMUNITY'S WELL-BEING AND PROMOTE ACCESS TO NUTRITIOUS FOODS. IN MAY 1992, PRINCE WILLIAM HOSPITAL (NOW NOVANT HEALTH UVA HEALTH SYSTEM PRINCE WILLIAM MEDICAL CENTER), POTOMAC HOSPITAL (NOW SENTARA NORTHERN VIRGINIA MEDICAL CENTER), PRINCE WILLIAM MEDICAL SOCIETY AND THE PRINCE WILLIAM HEALTH DEPARTMENT ESTABLISHED THE PRINCE WILLIAM AREA FREE CLINIC. THE CLINIC IS A NOT-FOR-PROFIT ORGANIZATION THAT PROVIDES ACUTE AND CHRONIC MEDICAL CARE TO UNINSURED RESIDENTS IN PRINCE WILLIAM COUNTY, VA. BOTH HOSPITALS CONTINUE TO PROVIDE FINANCIAL AND HUMAN RESOURCES TO CARE FOR PATIENTS AT THE FREE CLINIC AND THE GREATER PRINCE WILLIAM COMMUNITY HEALTH CENTER. NEW TECHNOLOGY & SERVICES IN 2018, NOVANT HEALTH UVA HEALTH SYSTEM PRINCE WILLIAM MEDICAL CENTER RECEIVED CERTIFICATION OF PUBLIC NEED ("COPN") APPROVAL FOR A SECOND CARDIAC CATHETERIZATION LAB TO IMPROVE THE PATIENT EXPERIENCE, SCHEDULING EFFICIENCY AND ENHANCED WORKFLOWS. THE NEW CATHETERIZATION LAB IS PLANNED TO OPEN IN 2019. IN WOMEN'S, 3-D MAMMOGRAPHY SERVICES WERE ADDED YEAR END AT NOVANT HEALTH UVA HEALTH SYSTEM PRINCE WILLIAM MEDICAL CENTER. THIS ADVANCED BREAST IMAGING TECHNOLOGY IS NOW AVAILABLE AT ALL THREE NOVANT HEALTH UVA HEALTH SYSTEM HOSPITALS. IN ADDITION, A BOARD CERTIFIED FEMALE BREAST SURGEON WAS ADDED TO THE MEDICAL STAFF SERVING PATIENTS AT BOTH NOVANT HEALTH UVA HEALTH SYSTEM PRINCE WILLIAM MEDICAL CENTER AND NOVANT HEALTH UVA HEALTH SYSTEM HAYMARKET MEDICAL CENTER. GENETIC SCREENING AND COUNSELING WAS ALSO ADDED IN 2018. BOARD CERTIFIED BREAST RADIOLOGISTS AND A BREAST NAVIGATOR ALSO SUPPORTED A REMARKABLE PATIENT EXPERIENCE FOR WOMEN IN OUR COMMUNITY. NOVANT HEALTH UVA HEALTH SYSTEM PRINCE WILLIAM MEDICAL CENTER COMPLETED A $38 MILLION MASTER FACILITY IMPROVEMENT PROJECT THAT INCLUDES A NEW FACADE, HALLWAY IMPROVEMENTS FOR PATIENT PRIVACY, A NEW UNIT FOR PATIENTS UNDER OBSERVATION AND AN EXPANDED CENTRAL ENERGY PLANT TO ENHANCE THE EFFICIENCY OF UTILITIES. A DA VINCI SURGICAL ROBOT WAS BROUGHT ON AT NOVANT HEALTH UVA HEALTH SYSTEM HAYMARKET MEDICAL CENTER TO OFFER PATIENTS MINIMALLY INVASIVE SURGICAL OPTIONS, AND TELEHEALTH BEHAVIORAL HEALTH SERVICES ARE AVAILABLE TO PROVIDE OUR COMMUNITY MEMBERS WITH THE CARE THEY NEED. AWARDS, RECOGNITIONS & CERTIFICATIONS/RECERTIFICATION'S -MAGNET FROM THE AMERICAN NURSES CREDENTIALING CENTER -AMERICAN HEART ASSOCIATION'S GET WITH THE GUIDELINES HEART FAILURE GOLD PLUS ACHIEVEMENT AWARD -AMERICAN STROKE ASSOCIATION'S GET WITH THE GUIDELINES STROKE GOLD PLUS QUALITY ACHIEVEMENT AWARD -JOINT COMMISSION GOLD SEAL OF APPROVAL AND DISEASE-SPECIFIC CARE RECERTIFICATIONS IN THE FOLLOWING AREAS: -ACUTE MYOCARDIAL INFARCTION -HEART FAILURE -TOTAL HIP REPLACEMENT -TOTAL KNEE REPLACEMENT -PNEUMONIA -MISSION: LIFELINE SILVER RECEIVING PLUS QUALITY ACHIEVEMENT AWARD FROM THE AMERICAN HEART ASSOCIATION -"LEADERS IN LGBTQ HEALTHCARE EQUALITY" BY THE HUMAN RIGHTS CAMPAIGN FOUNDATION -BOTH MEDICAL CENTERS EARNED A GRADE "A" IN PATIENT SAFETY FROM THE LEAPFROG HOSPITAL GROUP, THE NATIONAL HEALTH CARE RATINGS ORGANIZATION THAT EVALUATES HOSPITALS ON MEASURES RELATED TO SAFE CARE. -NOVANT HEALTH UVA HEALTH SYSTEM HAYMARKET MEDICAL CENTER AMBULATORY SURGERY DEPARTMENT RECEIVED A GUARDIAN OF EXCELLENCE AWARD RECOGNIZING ITS WORK IN PROVIDING A HIGH-QUALITY PATIENCE EXPERIENCE. ACCREDITATION -NOVANT HEALTH UVA HEALTH SYSTEM PRINCE WILLIAM MEDICAL CENTER AND NOVANT HEALTH UVA HEALTH SYSTEM HAYMARKET MEDICAL CENTER HAVE BEEN FULLY ACCREDITED BY THE JOINT COMMISSION, AN INDEPENDENT ORGANIZATION THAT EVALUATES A HEALTHCARE ORGANIZATION'S PERFORMANCE IN AREAS THAT MOST AFFECT PATIENT HEALTH AND SAFETY. -COMMISSION ON CANCER ACCREDITED PROGRAM BY THE AMERICAN COLLEGE OF SURGEONS - IN 2014, THE COMMISSION ON CANCER (COC) OF THE AMERICAN COLLEGE OF SURGEONS (ACOS) GRANTED A THREE-YEAR ACCREDITATION WITH COMMENDATION TO THE CANCER PROGRAM AT NOVANT HEALTH UVA HEALTH SYSTEM PRINCE WILLIAM MEDICAL CENTER. TO EARN VOLUNTARY COC ACCREDITATION, A CANCER PROGRAM MUST MEET OR EXCEED 34 COC QUALITY CARE STANDARDS, BE EVALUATED EVERY THREE YEARS THROUGH A SURVEY PROCESS AND MAINTAIN LEVELS OF EXCELLENCE IN THE DELIVERY OF COMPREHENSIVE PATIENT-CENTERED CARE. -NATIONAL ACCREDITATION PROGRAM FOR BREAST CENTERS BY THE AMERICAN COLLEGE OF SURGEONS - NOVANT HEALTH UVA HEALTH SYSTEM HAYMARKET MEDICAL CENTER BREAST CENTER IS ACCREDITED BY THE NATIONAL ACCREDITATION PROGRAM FOR BREAST CENTERS BY THE AMERICAN COLLEGE OF SURGEONS. ACCREDITATION IS GRANTED TO CENTERS THAT HAVE VOLUNTARILY COMMITTED TO PROVIDE THE HIGHEST QUALITY OF CARE TO PATIENTS WITH BREAST DISEASES AND THAT UNDERGO A RIGOROUS EVALUATION AND REVIEW OF ITS PERFORMANCE AND COMPLIANCE WITH THE NATIONAL ACCREDITATION PROGRAM FOR BREAST CENTERS. -BREAST IMAGING CENTER OF EXCELLENCE DESIGNATION BY THE AMERICAN COLLEGE OF RADIOLOGY ONCOLOGY - NOVANT HEALTH UVA HEALTH SYSTEM PRINCE WILLIAM MEDICAL CENTER IS DESIGNATED AS A BREAST IMAGING CENTER OF EXCELLENCE BY THE AMERICAN COLLEGE OF RADIOLOGY. THE BREAST IMAGING CENTER OF EXCELLENCE DESIGNATION IS AWARDED TO BREAST IMAGING CENTERS THAT ACHIEVE EXCELLENCE BY SEEKING AND EARNING ACCREDITATION IN ALL THE AMERICAN COLLEGE OF RADIOLOGY'S VOLUNTARY BREAST-IMAGING ACCREDITATION PROGRAMS AND MODULES, IN ADDITION TO THE MANDATORY MAMMOGRAPHY ACCREDITATION PROGRAM. FORM 990, PART III, LINE 1: MISSION, VISION AND VALUES MISSION NOVANT HEALTH UVA HEALTH SYSTEM EXISTS TO IMPROVE THE HEALTH OF COMMUNITIES, ONE PERSON AT A TIME. VISION WE, THE NOVANT HEALTH UVA HEALTH SYSTEM TEAM, WILL DELIVER THE MOST REMARKABLE PATIENT EXPERIENCE, IN EVERY DIMENSION, EVERY TIME. VALUES -COMPASSION: WE TREAT OUR CUSTOMERS AND THEIR FAMILIES, STAFF AND OTHER HEALTHCARE PROVIDERS AS FAMILY MEMBERS BY SHOWING THEM KINDNESS, PATIENCE, EMPATHY AND RESPECT. -DIVERSITY AND INCLUSION: WE RECOGNIZE THAT EVERY PERSON IS DIFFERENT, EACH SHAPED BY UNIQUE LIFE EXPERIENCES. THIS ENABLES US TO BETTER UNDERSTAND ONE ANOTHER AND OUR CUSTOMERS. BY ENGAGING THE STRENGTHS AND TALENTS OF EACH TEAM MEMBER, WE ENSURE A STRONG ORGANIZATION CAPABLE OF PROVIDING REMARKABLE HEALTHCARE TO OUR PATIENTS, FAMILIES AND COMMUNITIES. -PERSONAL EXCELLENCE: WE STRIVE TO GROW PERSONALLY AND PROFESSIONALLY, AND WE APPROACH EACH SERVICE OPPORTUNITY WITH A POSITIVE, FLEXIBLE ATTITUDE. HONESTY AND PERSONAL INTEGRITY GUIDE ALL THAT WE DO. -TEAMWORK: THE NEEDS AND EXPECTATIONS OF ANY ONE CUSTOMER ARE GREATER THAN THAT WHICH ONE PERSON'S SERVICE EFFORTS CAN SATISFY. WE SUPPORT EACH OTHER SO THAT TOGETHER AS A TEAM, WE CAN BE SUCCESSFUL IN THE EYE OF THE CUSTOMER AS A QUALITY SERVICE PROVIDER. -COURAGE: WE ACT BOLDLY IN MAKING THE CHANGES NECESSARY TO ACHIEVE OUR MISSION, VISION AND PROMISE OF DELIVERING REMARKABLE HEALTHCARE. OUR PEOPLE WE ARE AN INCLUSIVE TEAM OF PURPOSE-DRIVEN PEOPLE INSPIRED AND UNITED BY OUR PASSION TO CARE FOR EACH OTHER, OUR PATIENTS AND OUR COMMUNITIES. OUR PROMISE TO PATIENTS WE ARE MAKING YOUR HEALTHCARE EXPERIENCE REMARKABLE. WE WILL BRING YOU WORLD-CLASS CLINICIANS, CARE AND TECHNOLOGY - WHEN AND WHERE YOU NEED THEM. WE ARE REINVENTING THE HEALTHCARE EXPERIENCE TO BE SIMPLER, MORE CONVENIENT AND MORE AFFORDABLE, SO THAT YOU CAN FOCUS ON GETTING BETTER AND STAYING HEALTHY. FORM 990, PART I, LINE 1 COMMUNITY BENEFIT REPORT HTTPS://WWW.NOVANTHEALTHUVA.ORG/ABOUT-US/COMMUNITY-INVOLVEMENT/COMMUNITY -BENEFIT.ASPX THE COMMUNITY BENEFIT REPORT, REFERRED TO AS A COMMUNITY IMPACT REPORT, PREPARED BY NOVANT HEALTH IS A SYSTEM-WIDE REPORT THAT INCLUDES QUALITATIVE AND QUANTITATIVE INFORMATION. PLEASE NOTE THAT THE NUMERIC DATA IN THIS REPORT IS NOT BASED UPON THE FORM 990, SCHEDULE H CRITERIA, BUT RATHER IT HAS BEEN PREPARED IN ACCORDANCE WITH THE NORTH CAROLINA HOSPITAL ASSOCIATION REPORTING GUIDELINES. IT SHOULD NOT BE RELIED UPON AS THE ORGANIZATION'S FORM 990, SCHEDULE H COMMUNITY BENEFIT REPORT, ITS COMMUNITY HEALTH NEEDS ASSESSMENT OR COMMUNITY BENEFIT IMPLEMENTATION STRATEGY. IN THIS REPORT, THE NOVANT HEALTH SYSTEM'S COMMUNITY BENEFIT WAS APPROXIMATELY $884,000,000, INCLUDING $155,000,000 IN FINANCIAL ASSISTANCE FOR 2018. FORM 990, PART VI, SECTION A, LINE 6 FORM 990, PART VI, SECTION A, LINE 6: CLASSES OF MEMBERS OR STOCKHOLDERS THE CORPORATION IS A NONPROFIT CORPORATION WITH MEMBERS (OR A MEMBER). FORM 990, PART VI, SECTION A, LINE 7A FORM 990, PART VI, SECTION A, LINE 7A: ELECTION OF MEMBERS AND THEIR RIGHTS NOVANT HEALTH, INC. APPOINTS ALL BOARD MEMBERS OF PRINCE WILLIAM HOSPITAL. FORM 990, PART VI, SECTION A, LINE 7B FORM 990, PART VI, SECTION A, LINE 7B: DECISIONS SUBJECT TO APPROVAL OF MEMBERS UPON APPROVAL BY NOVANT HEALTH, INC., PRINCE WILLIAM HEALTH SYSTEM APPROVES CERTAIN TRANSACTIONS/ACTIONS INCLUDING AMENDMENTS TO THE ARTICLES AND BYLAWS OF THE CORPORATION AND ADOPTION OF CERTAIN POLICIES TO BE IMPLEMENTED BY THE CORPORATION BOARD. FORM 990, PART VI, SECTION B, LINE 11B FORM 990, PART VI, SECTION B, LINE 11: ORGANIZATION'S PROCESS TO REVIEW FORM 990 THE BOARD HAS DELEGATED REVIEW OF THE FORM 990 TO NOVANT HEALTH'S BOARD OF TRUSTEES' AUDIT AND COMPLIANCE COMMITTEE ("THE COMMITTEE"), WHICH OVERSEES TAX MATTERS FOR ENTITIES IN THE NOVANT HEALTH SYSTEM. THE COMMITTEE IS THE REVIEW BODY FOR ALL OF THE FORM 990S FILED FOR ORGANIZATIONS WITHIN THE NOVANT HEALTH SYSTEM. THE COMMITTEE MEETS BEFORE THE FORM 990S ARE FILED WITH THE IRS AND AFTER ALL BOARD MEMBERS HAVE BEEN PROVIDED A PAPER OR ELECTRONIC COPY OF THE FORM 990 AND A SUMMARY OF ITS CONTENTS. THE VICE PRESIDENT OF TAX AND LEGAL COUNSEL FOR NOVANT HEALTH ATTEND THE MEETING TO ANSWER ANY QUESTIONS AND ADDRESS ANY SIGNIFICANT DISCLOSURES WITHIN THE FORM 990. FORM 990, PART VI, SECTION B, LINE 12C FORM 990, PART VI, SECTION B, LINE 12C: MONITORING AND ENFORCEMENT OF COI THE ORGANIZATION'S TRUSTEE CONFLICT OF INTEREST POLICY APPLIES TO ALL TRUSTEES, PRINCIPAL OFFICERS OR MEMBERS OF A COMMITTEE WITH BOARD DELEGATED POWERS INCLUDING ANY APPLICABLE DISREGARDED ENTITIES. ALL TRUSTEES ARE SENT AN ANNUAL DISCLOSURE QUESTIONNAIRE. THE TRUSTEE ANNUAL DISCLOSURE QUESTIONNAIRES ARE REVIEWED BY THE COMPLIANCE DEPARTMENT. WITH RESPECT TO PARTICULAR TRANSACTIONS THAT COME BEFORE THE BOARD, THE CONFLICT OF INTEREST POLICY WOULD BE FOLLOWED. THE POTENTIAL CONFLICT OF INTEREST WOULD BE DISCLOSED BY THE BOARD MEMBER BEFORE A VOTE ON THE TRANSACTION AND THE REST OF THE BOARD WOULD DETERMINE WHETHER A CONFLICT OF INTEREST EXISTS. IF THE REST OF THE BOARD DETERMINED THAT A CONFLICT OF INTEREST EXISTED THEN THE BOARD MEMBER WITH THE CONFLICT OF INTEREST WOULD NOT PARTICIPATE IN THE DELIBERATIONS AND VOTE. FORM 990, PART VI, SECTION B, LINE 15 FORM 990, PART VI, SECTION B, LINE 15A/15B: THE FILING ORGANIZATION IS AN INTEGRAL PART OF THE NOVANT HEALTH UVA HEALTH SYSTEM ("THE SYSTEM"), WHICH IS SUPPORTED BY NOVANT HEALTH, INC. ("NOVANT HEALTH"), ONE OF ITS MEMBERS. NOVANT HEALTH SUPPORTS THE SYSTEM BY PROVIDING A COMPENSATION REVIEW AND APPROVAL PROCESS TO CERTAIN SYSTEM ENTITIES. THE PROCESS IS CONDUCTED BY THE INDEPENDENT AND DISINTERESTED MEMBERS OF THE NOVANT HEALTH, INC. BOARD OF TRUSTEES (WHO COMPRISE THE COMPENSATION AND LEADERSHIP COMMITTEE OF THE BOARD) WHO REVIEW, APPROVE, AND OVERSEE ALL ASPECTS OF COMPENSATION AND BENEFITS FOR CERTAIN LEADERS AND EXECUTIVES ("EXECUTIVES") SERVING AS OFFICERS, INCLUDING THE TOP MANAGEMENT OFFICIAL, OR KEY EMPLOYEES FOR CERTAIN ENTITIES WITHIN THE SYSTEM. THE COMMITTEE WORKS WITH AN INDEPENDENT COMPENSATION CONSULTANT AND USES THIRD PARTY COMPARABILITY DATA FOR FUNCTIONALLY SIMILAR POSITIONS AT SIMILARLY SITUATED ORGANIZATIONS TO ENSURE THAT TOTAL COMPENSATION AND BENEFITS FOR EACH EXECUTIVE IS REASONABLE FOR THAT EXECUTIVE'S POSITION. THE COMMITTEE REVIEWS AND APPROVES EXECUTIVE COMPENSATION AND BENEFITS ANNUALLY, CONSISTENT WITH THE WRITTEN EXECUTIVE COMPENSATION PHILOSOPHY OF NOVANT HEALTH, AND IN A MANNER THAT QUALIFIES FOR THE REBUTTABLE PRESUMPTION OF REASONABLENESS, THEREBY ASSURING THAT TOTAL COMPENSATION AND BENEFITS PROVIDED TO EACH EXECUTIVE IS REASONABLE. FORM 990, PART VI, SECTION C, LINE 19 FORM 990, PART VI, SECTION C, LINE 19: GOVERNING DOCUMENTS DISCLOSURE THE AUDITED CONSOLIDATED FINANCIAL STATEMENTS CONTAINING ALL ORGANIZATIONS IN THE NOVANT HEALTH UVA HEALTH SYSTEM ARE AVAILABLE UPON REQUEST. THE GOVERNING DOCUMENTS AND CONFLICT OF INTEREST POLICY ARE NOT AVAILABLE TO THE PUBLIC. FORM 990, PART VII, SECTION A, COLUMN B: RELATED ORGANIZATIONS THE ORGANIZATION EMPLOYS CERTAIN EXECUTIVES WHOSE ROLES ARE SUCH THAT THEY PROVIDE SERVICES TO NOT ONLY THE ORGANIZATION, BUT ALSO TO SOME OR ALL OF THE OTHER TAX-EXEMPT ORGANIZATIONS WITHIN THE HEALTHCARE SYSTEM. FOR EXAMPLE, MANY OF THESE EXECUTIVES' ROLES FOCUS ON PARTICULAR SERVICE LINES WHICH CROSS THE VARIOUS GEOGRAPHIC MARKETS OUR ORGANIZATIONS SERVE, THUS THE SERVICES PROVIDED BY THESE EXECUTIVES MAY BENEFIT AND BE RECEIVED BY MULTIPLE ORGANIZATIONS WITHIN THE SYSTEM. THE EXECUTIVES DO NOT ALLOCATE THEIR HOURS BETWEEN THE VARIOUS ORGANIZATIONS, BUT RATHER THEIR TIME SPENT ON SERVICES TO THE ORGANIZATION IS INCLUSIVE OF SERVICES TO ALL OF THE ORGANIZATIONS THEY SERVE WITHIN THE SYSTEM. FORM 990, PART VII, SECTION B: INDEPENDENT CONTRACTORS THE FILING ENTITY IS PART OF THE NOT-FOR-PROFIT INTEGRATED HEALTHCARE SYSTEM KNOWN AS NOVANT HEALTH UVA HEALTH SYSTEM. NOVANT HEALTH, INC. IS A MEMBER OF THE ENTITY THAT OPERATES THE HEALTH SYSTEM AND IS RESPONSIBLE FOR CERTAIN CORPORATE SUPPORT FUNCTIONS INCLUDING ACCOUNTS PAYABLE AND ISSUES FORMS 1099 FOR CERTAIN ENTITIES IN THE SYSTEM INCLUDING THE FILING ENTITY. INFORMATION REPORTED IN PART VII, SECTION B REPRESENTS THE EXPENSES PAID ON BEHALF OF THE FILING ENTITY TO INDEPENDENT CONTRACTORS OVER $100,000. FORM 990, PART IX, LINE 11G OUTSIDE SERVICES:: PROGRAM SERVICE EXPENSES 24,845,274. MANAGEMENT AND GENERAL EXPENSES 998,007. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 25,843,281. CONSULTING FEES:: PROGRAM SERVICE EXPENSES 1,504,421. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,504,421. CONTRACTED SERVICES:: PROGRAM SERVICE EXPENSES 3,506,384. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 3,506,384. RECRUITMENT: PROGRAM SERVICE EXPENSES 0. MANAGEMENT AND GENERAL EXPENSES 197,641. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 197,641. CREDENTIALING FEES: PROGRAM SERVICE EXPENSES 19,846. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 19,846. COLLECTION SERVICE: PROGRAM SERVICE EXPENSES 0. MANAGEMENT AND GENERAL EXPENSES 1,646,265. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,646,265. FOOD SERVICE: PROGRAM SERVICE EXPENSES 3,886,894. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 3,886,894. FORM 990, PART XI, LINE 9: AFFILIATE TRANSFERS: 18,151,622. MALPRACTICE INSURANCE: -103,509. K-1 ADJUSTMENTS: -755,358. CONTRIBUTIONS: -16,055. 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