2018-11-13T11:59:53-06:00 2017-12-31 540737372 PBMARES LLP 725 JACKSON STREET SUITE 210 FREDERICKSBURG VA 22401 990 2017-01-01 201106426 MARY WASHINGTON HEALTHCARE GROUP RETURN MARY 5407412513 2300 FALL HILL AVENUE NO 418 FREDERICKSBURG VA 22401 SEAN T BARDEN EXECUTIVE VICE PRESIDENT 5407412513 2018-11-02 1 JENNIFER N FRENCH P00659678 5403713566 2018-11-01 X 209.10.80.132 2018-11-02 14:15:45 ED P 7EAC0F0A083D54EE046A9C15098E0D70F8B406AF D5AF3AA71ECC53EC757D3089042B3EDD37000E5A 2017 2019-02-21 02:37:17Z MICHAEL P MCDERMOTT MD 2300 FALL HILL AVENUE NO 418 FREDERICKSBURG VA 22401 659037918 1 1 4243 X WWW.MARYWASHINGTONHEALTHCARE.COM X 1983 VA OUR MISSION IS TO IMPROVE THE HEALTH OF PEOPLE IN THE COMMUNITIES WE SERVE. THROUGH OUR SUBSIDIARIES WE PROVIDE INPATIENT AND OUTPATIENT HOSPITAL SERVICES AND OTHER MEDICAL SERVICES. 58 53 3777 560 2687150 0 6726475 6228872 623475101 649732088 5281303 2800781 -874711 173876 634608168 658935617 6509902 4157519 0 0 202308849 207898156 0 0 384913 405810735 433623448 614629486 645679123 19978682 13256494 418378312 427497037 285473197 278529966 132905115 148967071 OUR MISSION IS TO IMPROVE THE HEALTH OF PEOPLE IN THE COMMUNITIES WE SERVE. THROUGH OUR SUBSIDIARIES WE PROVIDE INPATIENT AND OUTPATIENT HOSPITAL SERVICES AND OTHER MEDICAL SERVICES. 0 0 628101431 4157519 647228094 PROVISION OF INPATIENT AND OUTPATIENT GENERAL ACUTE CARE HOSPITAL, PSYCHIATRIC HOSPITAL SERVICES, HOME HEALTH AND HOSPICE SERVICES, IMAGING AND AMBULATORY SURGERY SERVICES AND PHYSICIAN SERVICES. PRIMARY SERVICE AREAS ARE FREDERICKSBURG, PRINCE WILLIAM, STAFFORD, SPOTSYLVANIA, CAROLINE, KING GEORGE, AND WESTMORELAND COUNTIES IN VIRGINIA AND SECONDARY SERVICE AREAS INCLUDE MANASSAS, FAUQUIER, CULPEPER, ORANGE, LOUISA, HANOVER, ESSEX AND RICHMOND COUNTIES IN VIRGINIA. WE SERVED 109,529 PATIENTS IN OUR EMERGENCY ROOMS, 303,680 OUTPATIENTS, 18,189 SURGICAL CASES AND 29,780 PATIENT DISCHARGES. 628101431 1 1 0 0 0 0 0 0 0 1 1 0 0 0 1 1 0 1 0 0 0 0 0 0 1 0 1 1 1 1 1 1 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 1 1 1 0 0 1 267 0 1 3777 1 1 1 0 0 0 0 1 1 0 0 0 0 X 58 53 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 0 X X JENNINGS D DAWSON III 5407412513 2300 FALL HILL AVENUE NO 418 FREDERICKSBURG VA 22401 WILLIAM M BOLDON MBA VICE CHAIR AND BOARD TRUST 2.00 2.00 X X 0 0 0 RONALD W BRANSCOME MS BOARD TRUSTEE 2.00 2.00 X 0 0 0 BRUCE L DAVIS BA BOARD TRUSTEE 2.00 2.00 X 0 0 0 JANET C ERKERT APR BOARD TRUSTEE 2.00 2.00 X 0 0 0 REV ALLEN H FISHER JR BA MDIV BOARD TRUSTEE 2.00 2.00 X 0 0 0 JEFFREY A FRAZIER MD BOARD TRUSTEE 2.00 2.00 X 0 0 0 DAVID M GARTH MD BOARD TRUSTEE 2.00 2.00 X 0 0 0 KURT R LARSON MD BOARD TRUSTEE 2.00 2.00 X 0 0 0 MICHAEL P MCDERMOTT MD MBA PRESIDENT AND CEO 4.00 40.00 X X 0 1224995 43632 JOHN C MCKEOWN MA MPA BOARD TRUSTEE 2.00 2.00 X 0 0 0 SUDEEP J MENACHERY MD BOARD TRUSTEE 2.00 2.00 X 0 0 0 FRED M MESSING MBA LFACHE BOARD TRUSTEE 2.00 2.00 X 0 0 0 CLARENCE A ROBINSON BS SECRETARY/TREASURER 2.00 2.00 X X 0 0 0 JOHN F ROWLEY BS JD BOARD TRUSTEE 2.00 2.00 X 0 0 0 KURIAN C THOTT MD SH MED STAFF PRESIDENT (AS 2.00 2.00 X 0 0 0 ALDA L WHITE BA JD CHAIR 4.00 2.00 X X 0 0 0 MARTIN A WILDER JR EDD BOARD TRUSTEE 2.00 3.00 X 0 0 0 EDWARD V ALLISON JR MWH FOUNDATION BOARD TRUST 2.00 0.00 X 0 0 0 SEAN T BARDEN BSBA MBA EXEC VP AND CFO 4.00 40.00 X X 0 645144 35657 DANIEL W CLENDENIN MWH FOUNDATION BOARD TRUST 2.00 0.00 X 0 0 0 JASON COHEN MWH FOUNDATION BOARD TRUST 2.00 0.00 X 0 0 0 R DONALD DOHERTY JR MD MWH FOUNDATION BOARD TRUST 2.00 0.00 X 0 0 0 JOHN F FICK III RPH MWH FOUNDATION BOARD TRUST 2.00 0.00 X 0 0 0 R LEIGH FRACKELTON JR JD MLT CP MWH FOUNDATION BOARD TRUST 2.00 0.00 X 0 0 0 ADAM M FRIED MWH FOUNDATION BOARD TRUST 2.00 0.00 X 0 0 0 THOMAS G GETTINGER MHA EVP & COO (UNTIL 7.5.17) 2.00 40.00 X X 0 563016 24775 MARY KATHERINE GREENLAW MWH FOUNDATION BOARD TRUST 2.00 0.00 X 0 0 0 DANIEL M HOFFMAN MD FACS MWH FOUNDATION BOARD TRUST 2.00 0.00 X 0 0 0 CLAY S HUBER MWH FOUNDATION BOARD TRUST 2.00 0.00 X 0 0 0 REGIS L KEDDIE II MWH FOUNDATION SECRETARY/T 2.00 0.00 X X 0 0 0 PATRICIA J LYNCH MWH FOUNDATION BOARD TRUST 2.00 0.00 X 0 0 0 EDWARD O MINNIEAR MWH FOUNDATION BOARD TRUST 2.00 0.00 X 0 0 0 BRADLEY A REPP MBA MWH FOUNDATION BOARD TRUST 2.00 0.00 X 0 0 0 XAVIER RICHARDSON BA MBA MWHF AND SHF PRESIDENT / E 2.00 40.00 X X 0 331451 33166 JUDY TURNER MWH FOUNDATION BOARD TRUST 2.00 0.00 X 0 0 0 JON VAN ZANDT MWH FOUNDATION BOARD TRUST 2.00 0.00 X 0 0 0 JODIE M VAUGHN MWH FOUNDATION BOARD TRUST 2.00 0.00 X 0 0 0 CATHERINE M WACK MWH FOUNDATION VICE CHAIR 2.00 0.00 X X 0 0 0 THOMAS F WILLIAMS MWH FOUNDATION BOARD TRUST 2.00 0.00 X 0 0 0 JOSEPH R WILSON PMP MWH FOUNDATION CHAIR 2.00 0.00 X X 0 0 0 MARGARET A ALEXANDER SH FOUNDATION BOARD TRUSTE 2.00 0.00 X 0 0 0 KEVIN M BREEN SH FOUNDATION SECRETARY/TR 2.00 0.00 X X 0 0 0 LT GEN G RONALD CHRISTMAS SH FOUNDATION BOARD TRUSTE 2.00 0.00 X 0 0 0 ELAINE F FARMER SH FOUNDATION VICE CHAIR 2.00 0.00 X X 0 0 0 JOEL GRIFFIN SH FOUNDATION BOARD TRUSTE 2.00 0.00 X 0 0 0 DOUGLAS R JOHNSON MD SH FOUNDATION BOARD TRUSTE 2.00 0.00 X 0 0 0 WILLIAM R JOHNSON SH FOUNDATION CHAIR 2.00 0.00 X X 0 0 0 JO D KNIGHT SH FOUNDATION BOARD TRUSTE 2.00 0.00 X 0 0 0 H CLARK LEMING SH FOUNDATION BOARD TRUSTE 2.00 0.00 X 0 0 0 CHARLES W MCDANIEL SH FOUNDATION BOARD TRUSTE 2.00 0.00 X 0 0 0 DONALD H NEWLIN BA MA SH FOUNDATION BOARD TRUSTE 2.00 0.00 X 0 0 0 HOWARD C OWEN BA SH FOUNDATION BOARD TRUSTE 2.00 0.00 X 0 0 0 W MALONE SCHOOLER SH FOUNDATION BOARD TRUSTE 2.00 0.00 X 0 0 0 DAN SINGH RPH SH FOUNDATION BOARD TRUSTE 2.00 0.00 X 0 0 0 AMANDA TALBERT SH FOUNDATION BOARD TRUSTE 2.00 0.00 X 0 0 0 REV LUKE E TORIAN SH FOUNDATION BOARD TRUSTE 2.00 0.00 X 0 0 0 EUGENE J ZEISZLER SH FOUNDATION BOARD TRUSTE 2.00 0.00 X 0 0 0 KATHRYN WALL BA MA EVP 2.00 40.00 X X 0 398797 13798 MARIE FREDRICK RT R CRA MJ VICE PRESIDENT 2.00 40.00 X X 0 245444 29268 JUSTIN BOX MBA SVP & CIO 2.00 40.00 X 0 351658 38589 REBECCA M BIGONEY MDBSMA EVP & CMO 2.00 40.00 X 0 563395 29998 EILEEN DOHMANN RN BSN MBA NEA-BC SVP & CNO 2.00 40.00 X 0 344699 13217 ERIC FLETCHER MBA APR SVP 2.00 40.00 X 0 313403 38669 TRAVIS TURNER BS MBA SVP 2.00 40.00 X 0 299301 37353 ELIESE K BERNARD VICE PRESIDENT 40.00 2.00 X 300543 0 32327 LAUREN BLALOCK VICE PRESIDENT 2.00 40.00 X 0 200262 38126 CODY BLANKENSHIP VICE PRESIDENT 2.00 40.00 X 0 166378 26797 KATHLEEN BOURGAULT MS CPAM VICE PRESIDENT 2.00 40.00 X 0 240275 28424 SANDRA BROWN CPA VICE PRESIDENT 2.00 40.00 X 0 253239 30225 JAMES DANIEL MD SENIOR MEDICAL DIRECTOR 40.00 2.00 X 299111 0 31433 ALAN EDWARDS VICE PRESIDENT 2.00 40.00 X 0 220010 40394 TINA ERVIN VICE PRESIDENT 2.00 40.00 X 0 241054 28946 STEPHEN MANDELL MD VICE PRESIDENT 40.00 2.00 X 379782 0 34376 DOUGLAS SCHULTE MD VICE PRESIDENT 2.00 40.00 X 0 387709 10346 CATHLEEN YABLONSKI BS MS VICE PRESIDENT 40.00 2.00 X 271470 0 26353 DAVID YI MD VICE PRESIDENT 2.00 40.00 X 0 346666 10102 SANG HO NA PHYSICIAN 40.00 0.00 X 858264 0 25907 AGOSTINO VISIONI PHYSICIAN 40.00 0.00 X 833817 0 42553 J T SHERWOOD PHYSICIAN 40.00 0.00 X 811718 0 48502 THERESA CONOLOGUE PHYSICIAN 40.00 0.00 X 535433 0 33621 JOHN CARDONE PHYSICIAN 40.00 0.00 X 525973 0 39049 JOYCE HANSCOME VICE PRESIDENT (FORMER) 0.00 X 0 123125 0 4816111 7460021 865603 258 1 1 0 MORRISON MANAGEMENT 5801 PEACHTREE DUNWOODY ROAD ATLANTA GA 30342 FOOD SERVICES 9302333 AMN HEALTHCARE INC 2735 COLLECTION CENTER DRIVE CHICAGO IL 606932735 CONTRACT LABOR 7182975 CROTHALL SERVICES GROUP 955 CHESTERBROOK BLVD SUITE 300 WAYNE PA 19087 ENVIRONMENTAL AND ENGINEERING 7018349 ECHO LOCUM TENENS INC 1498 PACIFIC AVENUE STE 400 TACOMA WA 98402 PHYSICIAN SERVICES 4686353 CHILDREN'S NATIONAL HOSPITAL SUITE 3W-100 111 MICHIGAN AVE NW WASHINGTON DC 20010 PHYSICIAN SERVICES 3106155 54 413592 828153 482781 4504346 18704 6228872 NET PATIENT SERVICES REVENUE 623000 596081340 596081340 MANAGEMENT SERVICES 623000 26371396 26371396 PROGRAM RENTAL INCOME 531120 14641075 14641075 OTHER OPERATING REVENUE 623000 7797850 7797850 LAB FEES 621500 2515747 2515747 2324680 2324680 649732088 1642974 1642974 1111226 46581 0 0 1111226 46581 1157807 1157807 93021 413592 102301 -9280 -9280 INCOME FROM PARTNERSHIPS/LLCS 900099 183156 11753 171403 183156 658935617 647228094 2687150 2791501 X 4114269 4114269 43250 43250 1375396 1337710 36861 825 172793561 168059018 4630867 103676 4904603 4770217 131443 2943 16378972 15930189 438956 9827 12445624 12104614 333543 7467 85966567 83611083 2303904 51580 39804 38713 1067 24 77200 75085 2069 46 201192 195679 5392 121 112217989 109143215 3007443 67331 1075305 1045842 28818 645 4835067 4702586 129580 2901 2269407 2207225 60820 1362 23936485 23280625 641498 14362 1308335 1272487 35063 785 317764 309057 8516 191 902665 877932 24191 542 29730302 28915692 796772 17838 3561803 3464210 95456 2137 MEDICAL AND HOSPITAL SU 94613982 92021559 2535655 56768 BAD DEBT EXPENSE 65462685 63669007 1754400 39278 REPAIRS AND MAINTENANCE 3878573 3772300 103946 2327 OTHER MEDICAL & HOSPITA 2603250 2531921 69767 1562 625073 607946 16752 375 645679123 628101431 17192779 384913 587180 1743478 52069 14754 14082474 13763640 63129153 69546498 293665 54137 11880622 12065299 3407504 3642168 656116165 383680089 276164056 272436076 45015996 50360885 1695105 2223021 2070488 1647081 418378312 427497037 37999418 39135905 6574 2398 243494296 235518990 3972909 3872673 285473197 278529966 X 119477211 135855984 12169694 11852877 1258210 1258210 132905115 148967071 418378312 427497037 X 13256494 5942714 -3137252 X X 0 1 X 1 0 X 1258210 52539 40909 1269840 1258210 44259 44259 1258210 1258210 1258210 1258210 11433 11433 1258210 1258210 131530 131530 1258210 0.99000 0.01000 0 0 24814554 24814554 300813464 147010301 153803163 18162430 12285264 5877166 265019971 206740791 58279180 47305746 17643733 29662013 272436076 CAPITAL LEASE OBLIGATIONS 223669 ACCRUED LOSS - PROFESSIONAL LIABILIES 3649004 3872673 X PART V, LINE 4: THE INTEREST EARNED FROM THE ENDOWMENT FUNDS IS USED TO FUND SCHOLARSHIPS AND GRANTS IN FUTHERANCE OF OUR MISSION. PART X, LINE 2: MWHC WAS RECOGNIZED AS A PUBLIC CHARITY GENERALLY EXEMPT FROM FEDERAL INCOME TAXATION UNDER 501(C)(3) OF THE INTERNAL REVENUE CODE PURSUANT TO A DETERMINATION LETTER ISSUED BY THE IRS IN MARCH 1992. MWHC IS ENTITLED TO RELY ON THIS DETERMINATION AS LONG AS THERE ARE NO SUBSTANTIAL CHANGES IN ITS CHARACTER, PURPOSES,OR METHODS OF OPERATION. MANAGEMENT HAS CONCLUDED THAT THERE HAVE BEEN NO SUCH CHANGES AND, THEREFORE,MWHC'S STATUS AS A PUBLIC CHARITY EXEMPT FROM FEDERAL INCOME TAXATION REMAINS IN EFFECT. THE STATE IN WHICH MWHC OPERATES ALSO PROVIDES GENERAL EXEMPTION FROM STATE INCOME TAXATION FOR ORGANIZATIONS THAT ARE EXEMPT FROM FEDERAL INCOME TAXATION. HOWEVER, MWHC IS SUBJECT TO BOTH FEDERAL AND STATE INCOME TAXATION AT CORPORATE TAX RATES ON ITS UNRELATED BUSINESS INCOME. EXEMPTION FROM OTHER STATE TAXES, SUCH AS REAL AND PERSONAL PROPERTY TAXES, IS SEPARATELY DETERMINED. CERTAIN ENTITIES UNDER MWHC ARE TAXABLE ENTITIES. MWHC HAD NO UNRECOGNIZED TAX BENEFITS OR LIABILITIES, OR SUCH AMOUNTS WERE IMMATERIAL DURING THE PERIODS PRESENTED. FOR TAX PERIODS WITH RESPECT TO WHICH NO UNRELATED BUSINESS INCOME WAS RECOGNIZED, NO TAX RETURN WAS REQUIRED. TAX PERIODS FOR WHICH NO RETURN IS FILED REMAIN OPEN FOR EXAMINATION INDEFINITELY. ALL REQUIRED TAX FILINGS HAVE BEEN FILED ON A TIMELY BASIS. SH CUP GOLF TOURNAMENT 239035 194690 44345 47967 MWHF GOLF OPEN 108350 78321 30029 24281 7 159228 140581 18647 8712 21341 506613 413592 93021 8712 93589 102301 -9280 1 1 X 1 X 138.000000000000 1 X 1 1 1 0 1 1 14980635 14980635 0.02320 47501895 33902167 13599728 0.02110 62482530 33902167 28580363 0.04430 1979351 1979351 0.00310 2066981 64905 2002076 0.00310 42750834 20114273 22636561 0.03510 481229 48763 432466 0.00070 1622686 1622686 0.00250 48901081 20227941 28673140 0.04450 111383611 54130108 57253503 0.08880 27208 27208 0.00000 207 207 0.00000 62023 62023 0.00010 66092 66092 0.00010 765204 765204 0.00120 920734 920734 0.00140 1 19410235 4852559 170126083 217508972 -47382889 X 1 1 1 MEDICAL IMAGING OF FREDERICKSBURG OUTPATIENT IMAGING 0.51000 0.49000 2 FREDERICKSBURG AMBULATORY SURGERY CENTER AMBULATORY SERGICAL SERVICES 0.53370 0.46630 3 COWAN INVESTMENT PARTNERS MEDICAL OFFICE BUILDING 0.12500 0.37500 4 MEDICAL PLAZA AT COSNER CORNER MEDICAL OFFICE BUILDING 0.39500 0.47400 2 1 MARY WASHINGTON HOSPITAL INC 1101 SAM PERRY BLVD FREDERICKSBURG VA 22401 X X X 451 BED ACUTE CARE HOSPITAL LEVEL 2 TRAUMA 2 STAFFORD HOSPITAL LLC 101 HOSPITAL CENTER BLVD STAFFORD VA 22554 X X X 100 BED HOSPITAL MARY WASHINGTON HOSPITAL INC 1 0 0 1 X X X X X X X X 16 1 1 0 1 X HTTPS://WWW.MARYWASHINGTONHEALTHCARE.COM/ABOUT-US/ANNUAL-REPORTS X X 1 16 0 1 0 1 X 138.000000000000 300.000000000000 X X X X X 1 1 X X X 1 X HTTPS://WWW.MARYWASHINGTONHEALTHCARE.COM/DOCUMENTS/2017PATIENTFINANCIALASSI X HTTPS://WWW.MARYWASHINGTONHEALTHCARE.COM/DOCUMENTS/PFAP_APPLICATION_2017_EN X HTTPS://WWW.MARYWASHINGTONHEALTHCARE.COM/DOCUMENTS/PDFS/PFAC_BROCHURE_07OCT X X X X 1 X 0 X X X X 1 X 0 0 STAFFORD HOSPITAL LLC 2 0 0 1 X X X X X X X X 16 1 1 0 1 X HTTPS://WWW.MARYWASHINGTONHEALTHCARE.COM/ABOUT-US/ANNUAL-REPORTS/ X X 1 16 0 1 0 1 X 138.000000000000 300.000000000000 X X X X X 1 1 X X X 1 X HTTPS://WWW.MARYWASHINGTONHEALTHCARE.COM/DOCUMENTS/2017PATIENTFINANCIALASSI X HTTPS://WWW.MARYWASHINGTONHEALTHCARE.COM/DOCUMENTS/PFAP_APPLICATION_2017_EN X HTTPS://WWW.MARYWASHINGTONHEALTHCARE.COM/DOCUMENTS/PDFS/PFAC_BROCHURE_07OCT X X X X 1 X 0 X X X X 1 X 0 0 MARY WASHINGTON HOSPITAL, INC. PART V, SECTION B, LINE 5: MARY WASHINGTON HEALTHCARE (INCLUDING MARY WASHINGTON HOSPITAL AND STAFFORD HOSPITAL) AND THE RAPPAHANNOCK AREA HEALTH DISTRICT LAUNCHED THE "HEALTHY COMMUNITIES STEERING COMMITTEE" (HCSC) TO PERFORM THE COMMUNITY HEALTH NEEDS ASSESSMENT. OTHER FOUNDING MEMBERS OF THIS GROUP INCLUDED THE RAPPAHANNOCK UNITED WAY, KAISER PERMANENTE OF THE MID-ATLANTIC STATES, INC., AND THE RAPPAHANNOCK AREA COMMUNITY SERVICES BOARD. THESE INITIAL SPONSORS OF THE HCP AGREED THAT THE SUCCESS OF THIS EFFORT WOULD BE DEPENDENT ON GATHERING A DIVERSE GROUP OF INDIVIDUALS WHO COULD PROVIDE A BROAD PERSPECTIVE ON THE REGION'S HEALTH NEEDS. THE GROUP BROUGHT TOGETHER AREA HOSPITALS, HEALTH DEPARTMENTS, INSURERS, PRIVATE BUSINESSES, COMMUNITY-BASED ORGANIZATIONS, AND HEALTH CARE AND MENTAL HEALTH PROVIDERS TO SERVE ON THE HCP'S ADVISORY COMMITTEE. IN ALL THE HCP INCLUDED OVER 40 REPRESENTATIVES FROM COMMUNITY STAKEHOLDER ORGANIZATIONS TO GUIDE THE COMMUNITY NEEDS ASSESSMENT PROCESS AND TO PROVIDE APPROPRIATE INPUT. STAFFORD HOSPITAL, LLC PART V, SECTION B, LINE 5: MARY WASHINGTON HEALTHCARE (INCLUDING MARY WASHINGTON HOSPITAL AND STAFFORD HOSPITAL) AND THE RAPPAHANNOCK AREA HEALTH DISTRICT LAUNCHED THE "HEALTHY COMMUNITIES STEERING COMMITTEE" (HCSC) TO PERFORM THE COMMUNITY HEALTH NEEDS ASSESSMENT. OTHER FOUNDING MEMBERS OF THIS GROUP INCLUDED THE RAPPAHANNOCK UNITED WAY, KAISER PERMANENTE OF THE MID-ATLANTIC STATES, INC., AND THE RAPPAHANNOCK AREA COMMUNITY SERVICES BOARD. THESE INITIAL SPONSORS OF THE HCP AGREED THAT THE SUCCESS OF THIS EFFORT WOULD BE DEPENDENT ON GATHERING A DIVERSE GROUP OF INDIVIDUALS WHO COULD PROVIDE A BROAD PERSPECTIVE ON THE REGION'S HEALTH NEEDS. THE GROUP BROUGHT TOGETHER AREA HOSPITALS, HEALTH DEPARTMENTS, INSURERS, PRIVATE BUSINESSES, COMMUNITY-BASED ORGANIZATIONS, AND HEALTH CARE AND MENTAL HEALTH PROVIDERS TO SERVE ON THE HCP'S ADVISORY COMMITTEE. IN ALL THE HCP INCLUDED OVER 40 REPRESENTATIVES FROM COMMUNITY STAKEHOLDER ORGANIZATIONS TO GUIDE THE COMMUNITY NEEDS ASSESSMENT PROCESS AND TO PROVIDE APPROPRIATE INPUT. MARY WASHINGTON HOSPITAL, INC. PART V, SECTION B, LINE 6A: STAFFORD HOSPITAL AND SPOTSYLVANIA REGIONAL MEDICAL CENTER STAFFORD HOSPITAL, LLC PART V, SECTION B, LINE 6A: MARY WASHINGTON HOSPITAL AND SPOTSYLVANIA REGIONAL MEDICAL CENTER MARY WASHINGTON HOSPITAL, INC. PART V, SECTION B, LINE 7D: PRESENTED AT NUMEROUS COMMUNITY MEETINGS, SUCH AS THE ROTARY MEETINGS, CHAMBER OF COMMERCE, AND THE MARY WASHINGTON HEALTHCARE CITIZEN ADVISORY COMMITTEE MEETINGS. STAFFORD HOSPITAL, LLC PART V, SECTION B, LINE 7D: PRESENTED AT NUMEROUS COMMUNITY MEETINGS, SUCH AS THE ROTARY MEETINGS, CHAMBER OF COMMERCE, AND THE MARY WASHINGTON HEALTHCARE CITIZEN ADVISORY COMMITTEE MEETINGS. MARY WASHINGTON HOSPITAL, INC. PART V, SECTION B, LINE 11: SEE IMPLEMENTATION STRATEGY ATTACHED TO THE RETURN. STAFFORD HOSPITAL, LLC PART V, SECTION B, LINE 11: SEE IMPLEMENTATION STRATEGY ATTACHED TO THE RETURN. MARY WASHINGTON HOSPITAL, INC. PART V, SECTION B, LINE 16J: THE FINANCIAL ASSISTANCE POLICY IS MADE AVAILABLE ON THE ORGANIZATION'S WEBSITE. SIGNS ARE POSTED IN ALL PATIENT REGISTRATION AREAS AND NOTES INCLUDED ON ALL PATIENT STATEMENTS INFORMING PATIENTS OF THE AVAILABILITY OF FINANCIAL ASSISTANCE AND WHO TO CONTACT FOR MORE INFORMATION. BILLING OFFICE PERSONNEL EXPLAIN THE MATERIALS TO ALL PATIENTS REQUESTING ADDITIONAL INFORMATION. STAFFORD HOSPITAL, LLC PART V, SECTION B, LINE 16J: THE FINANCIAL ASSISTANCE POLICY IS MADE AVAILABLE ON THE ORGANIZATION'S WEBSITE. SIGNS ARE POSTED IN ALL PATIENT REGISTRATION AREAS AND NOTES INCLUDED ON ALL PATIENT STATEMENTS INFORMING PATIENTS OF THE AVAILABILITY OF FINANCIAL ASSISTANCE AND WHO TO CONTACT FOR MORE INFORMATION. BILLING OFFICE PERSONNEL EXPLAIN THE MATERIALS TO ALL PATIENTS REQUESTING ADDITIONAL INFORMATION. 3 1 - MEDICAL IMAGING OF FREDERICKSBURG 1201 SAM PERRY BLVD SUITE 102 ASC BUILD FREDERICKSBURG VA 224014490 IMAGING SERVICES 2 - FREDERICKSBURG AMBULATORY SURGERY CENTER 1201 SAM PERRY BLVD SUITE 101 FREDERICKSBURG VA 224014490 AMBULATORY SURGERY CENTER 3 - REGIONAL CANCER CENTER AT MONTROSS 15394 KINGS HIGHWAY MONTROSS VA 22520 RADIATION THERAPY PART I, LN 7 COL(F): BAD DEBT EXPENSE ATTRIBUTABLE TO PATIENTS ELIGIBLE UNDER PATIENT FINANCIAL ASSISTANCE POLICY (PFAP)IN DECEMBER 2011, MWHC UTILIZED THE SERVICES OF SEARCHAMERICA TO IDENTIFY PFAP ELIGIBLE PATIENTS WHOSE ACCOUNTS HAD FALLEN INTO BAD DEBT. IN EARLY 2012, SEARCHAMERICA PROVIDED A LIST UTILIZING VARIOUS MARKET RESEARCH TO APPROXIMATE THE FEDERAL POVERTY LEVEL OF EACH ACCOUNT HOLDER. WITH THIS INFORMATION WE WERE ABLE TO DETERMINE ACCOUNTS THAT MAY HAVE BEEN ELIGIBLE FOR FREE CARE OR DISCOUNTED CARE UNDER OUR FINANCIAL ASSISTANCE POLICY. UTILIZING THE STATISTICAL ANALYSIS THAT SEARCHAMERICA PROVIDED WE HAVE EXTRAPOLATED THE DATA AND ARE ABLE TO ESTIMATE THAT ABOUT 25% OF OUR BAD DEBT IS LIKELY ATTRIBUTABLE TO PFAP ELIGIBLE PATIENTS. PART II, COMMUNITY BUILDING ACTIVITIES: IN FURTHERANCE OF ITS MISSION TO IMPROVE THE HEALTH OF THE COMMUNITY IT SERVES THE ORGANIZATION PROMOTES WORKFORCE DEVELOPMENT FOR THE RECRUITMENT OF PHYSICIANS AND OTHER HEALTH PROFESSIONALS IN AREAS IDENTIFIED AS SHORTAGE AREAS THROUGH ITS COMMUNITY NEEDS ASSESSMENTS AND MEDICAL STAFF DEVELOPMENT PLANS. RECRUITMENT OF PHYSICIANS TO PRACTICE IN MWHC'S SERVICE AREA IMPROVES ACCESS TO CARE RESULTING IN GREATER AVAILABILITY OF PHYSICIAN SPECIALISTS, LESS TRAVEL TO OBTAIN CARE, AND SHORTER WAIT TIMES FOR APPOINTMENTS. ADDITIONALLY MWHC, PROVIDES FACILITIES FREE OF CHARGE TO RAPPAHANNOCK EMERGENCY MEDICAL SERVICES WHICH IS VALUED AT APPROXIMATELY $100,000. PART III, LINE 4: THE PROVISION FOR UNCOLLECTIBLE ACCOUNTS IS BASED UPON MANAGEMENT'S JUDGMENTAL ASSESSMENT OF HISTORICAL AND EXPECTED NET COLLECTIONS CONSIDERING BUSINESS AND GENERAL ECONOMIC CONDITIONS IN ITS SERVICE AREA, TRENDS IN HEALTHCARE COVERAGE, AND OTHER COLLECTION INDICATORS. THROUGHOUT THE YEAR, MANAGEMENT ASSESSES THE ADEQUACY OF THE ALLOWANCE FOR UNCOLLECTIBLE ACCOUNTS BASED UPON ITS REVIEW OF ACCOUNTS RECEIVABLE PAYER COMPOSITION AND AGING, TAKING INTO CONSIDERATION RECENT WRITTEN-OFF EXPERIENCE BY PAYER CATEGORY, PAYER AGREEMENT RATE CHANGES AND OTHER FACTORS. THE RESULTS OF THESE ASSESSMENTS ARE USED TO MAKE MODIFICATIONS TO THE PROVISION FOR BAD DEBTS AND TO ESTABLISH AN APPROPRIATE ALLOWANCE FOR UNCOLLECTIBLE ACCOUNTS RECEIVABLE. FOR SELF-PAY PATIENTS, THE PROVISION IS BASED ON AN ANALYSIS OF PAST EXPERIENCE RELATED TO THE RECENT HISTORICAL COLLECTION RATE OF SELF-PAY BALANCES. MWHC FOLLOWS ESTABLISHED GUIDELINES FOR PLACING CERTAIN PAST-DUE BALANCES WITH EXTERNAL COLLECTION AGENCIES. AT DECEMBER 31, 2016 AND 2015, THE ALLOWANCE FOR UNCOLLECTIBLE ACCOUNTS REPRESENTED APPROXIMATELY 96% AND 92% RESPECTIVELY, OF THE PAST DUE ACCOUNTS RECEIVABLE BALANCE. THE PATIENT DUE ACCOUNTS RECEIVABLE BALANCE REPRESENTS THE ESTIMATED UNINSURED PORTION OF ACCOUNTS RECEIVABLE. PART III, LINE 8: AS A NOT-FOR-PROFIT HOSPITAL IT IS OUR MISSION TO IMPROVE THE HEALTH STATUS OF ALL PEOPLE WITHIN OUR COMMUNITY AND TO PROVIDE HEALTHCARE TO ALL PATIENTS REGARDLESS OF THEIR ABILITY TO PAY OR THEIR INSURANCE STATUS. MWHC ACCEPTS MEDICARE AND MEDICAID AND IT IS A WELL ESTABLISHED FACT THAT NOT-FOR-PROFIT FACILITIES DO NOT RECOUP THE COST OF CARING FOR THOSE PATIENTS UTILIZING THESE PROGRAMS. UNDER IRS GUIDELINES MEDICARE AND MEDICAID BENEFICIARIES ARE CONSIDERED TO BE MEMBERS OF A CHARITABLE CLASS, THEREFORE BY ASSISTING THESE PATIENTS AND ACCEPTING THE SHORTFALLS IN REPAYMENT, THE ORGANIZATION IS IN FACT RELIEVING GOVERNMENT BURDEN AND PROVIDING A SIGNIFICANT COMMUNITY BENEFIT TO OUR SERVICE AREA. PART III, LINE 9B: PATIENTS MAY APPLY FOR FINANCIAL ASSISTANCE AT ANY POINT IN THE COLLECTION CYCLE AND MODIFICATIONS OF ABILITY TO PAY MAY BE ADJUSTED SHOULD FINANCIAL OR INSURANCE STATUS CHANGE SINCE THE FIRST DAY OF CARE. MWHC DOES NOT ENGAGE IN EXTRAORDINARY COLLECTION ACTIONS BEFORE THEY HAVE MADE REASONABLE EFFORTS TO DETERMINE WHETHER THE INDIVIDUAL IS ELIGIBLE FOR ASSISTANCE UNDER THIS FINANCIAL ASSISTANCE POLICY. REASONABLE EFFORTS CONSTITUTE NOTIFICATION BY MWHC OF ITS FINANCIAL ASSISTANCE POLICY BY WRITTEN AND/OR ORAL COMMUNICATIONS TO ALL UNINSURED/UNDERINSURED PATIENTS AS WELL AS CONSIDERATION OF ELIGIBILITY BASED UPON THE PRESUMPTIVE ELIGIBILITY GUIDELINES DESCRIBED IN THE FINANCIAL ASSISTANCE POLICY. PART VI, LINE 2: MARY WASHINGTON HEALTHCARE AND ITS AFFILIATES (MARY WASHINGTON HOSPTIAL, MARY WASHINGTON HOSPITAL FOUNDATION, STAFFORD HOSPITAL, LLC, STAFFORD HOSPITAL FOUNDATION, MEDICORP PROPERTIES, INC., MEDICORP HEALTH SERVICES, AND MARY WASHINGTON HEALTHCARE CLINICAL SERVICES, INC.) HAS AS ITS MISSION TO IMPROVE THE HEALTH OF MEMBERS OF THE COMMUNITIES IT SERVES: FREDERICKSBURG, VA AND THE SURROUNDING SIX (6) COUNTIES. THE ORGANIZATION ASSESSES THE HEALTH CARE NEEDS OF THESE COMMUNITIES IN NUMEROUS WAYS INCLUDING: 1) SOLICITING INPUT FROM MWHC'S CITIZEN ADVISORY COUNCIL THAT ENCOMPASS INDIVIDUAL MEMBERS AND SUBCOMMITTEES REPRESENTING EACH OF THE COUNTIES IN MWHC'S SERVICE AREA, AND 2) PERFORMING PERIODIC COMMUNITY NEEDS ASSESSMENTS FOR EACH COUNTY IN COLLABORATION WITH GOVERNMENT AGENCIES AND OTHER COMMUNITY ORGANIZATIONS. PART VI, LINE 3: MARY WASHINGTON HEALTHCARE AFFILIATES PROVIDE INFORMATION TO PATIENTS ABOUT ITS FINANCIAL ASSISTANCE PROGRAMS THROUGH SIGNAGE AT INTAKE AREAS, FLYERS AT ADMISSIONS, NOTICES ON BILLS AND COLLECTION STATEMENTS. FINANCIAL COUNSELORS ARE ALSO AVAILABLE TO ASSIST PATIENTS IN OBTAINING FINANCIAL ASSISTANCE. PART VI, LINE 4: MARY WASHINGTON HEALTHCARE PROVIDES EXCEPTIONAL MEDICAL SERVICES TO THE CITY OF FREDERICKSBURG AND THE SURROUNDING "COMMUNITY" THAT CONSIST OF THE PRIMARY SERVICE AREA COUNTIES OF STAFFORD, KING GEORGE, SPOTSYLVANIA, WESTMORELAND, ORANGE, PRINCE WILLIAM, AND SECONDARY SERVICE AREA COUNTIES OF MANASSAS, FAUQUIER, CULPEPER, LOUISA, ESSEX, AND RICHMOND. ESTABLISHED IN 1899, MARY WASHINGTON HOSPITAL (MWH), A 451 BED ACUTE CARE FACILITY, OFFERS COMPREHENSIVE HEALTHCARE AND MULTIPLE CENTERS OF EXCELLENCE INCLUDING CARDIOLOGY AND CARDIOVASCULAR SURGERY, PSYCHIATRY, AND WOMEN AND INFANT HEALTH. STAFFORD HOSPITAL, LLC, A 100 BED ACUTE CARE FACILITY, ALSO OFFERS COMPREHENSIVE HEALTHCARE SERVICES. BOTH MWH AND SH ARE ACCREDITED BY THE JOINT COMMISSION AND LICENSED BY THE COMMONWEALTH OF VIRGINIA DEPARTMENT OF HEALTH AND THE DEPARTMENT OF MENTAL HEALTH, MENTAL RETARDATION AND SUBSTANCE ABUSE SERVICES. MWH ALSO PROVIDES ADVANCE RADIATION THERAPY THROUGH THE CANCER CENTER OF VIRGINIA AND HOME HEALTH SERVICES THROUGH MARY WASHINGTON HOME HEALTH.AS OF THE MOST RECENT CENSUS WITHIN THE RESPECTIVE COUNTIES THE MAJORITY OF THE GEOGRAPHIC SERVICE AREAS IN WHICH BOTH HOSPITALS SERVE ARE MADE UP OF ABOUT 4,164.5 SQUARE MILES OF SUBURBAN AND RURAL LAND. COMMUNITY RESIDENTS IN THE PRIMARY SERVICE AREAS EARN A MEDIAN INCOME PER HOUSEHOLD OF $57,088/YEAR, WITH A COLLECTIVE AVERAGE OF 7.2% OF THE ENTIRE PRIMARY SERVICE AREA LIVING BELOW THE FEDERAL POVERTY GUIDELINES. THE PRIMARY SERVICE AREA HAS AN ESTIMATED POPULATION OF 657,718 INDIVIDUALS AND 187,202 HOUSEHOLDS. PART VI, LINE 5: MARY WASHINGTON HOSPITAL, INC. AND STAFFORD HOSPITAL, LLC EACH OPERATE AN EMERGENCY ROOM THAT IS OPEN TO ALL PERSONS REGARDLESS OF ABILITY TO PAY; HAVE OPEN MEDICAL STAFFS WITH PRIVILEGES TO ALL QUALIFIED PHYSICIANS WHO APPLY, HAVE A GOVERNING BODY WITH A MAJORITY OF INDEPENDENT TRUSTEES, AND PARTICIPATE IN MEDICAID, MEDICARE AND OTHER GOVERNMENT SPONSORED HEALTH CARE PROGRAMS. MARY WASHINGTON HEALTHCARE CLINICAL SERVICES, INC. THROUGH ITS SUBSIDIARIES, PROVIDES ANCILLARY HEALTH SERVICES INCLUDING PHYSICIAN PRACTICES, OUTPATIENT AND AMBULATORY SURGERY, AND HOME HEALTH/HOSPICE SERVICES.THE ORGANIZATION UTILIZES SURPLUS FUNDS TO EXPAND SERVICES PROVIDED TO THE COMMUNITY (IN RESPONSE TO THE COMMUNITY NEEDS ASSESSMENTS), UPGRADE FACILITIES AND EQUIPMENT TO ENHANCE CLINICAL CARE AND PHYSICIAN CONNECTIVITY TO PATIENT ELECTRONIC HEALTH RECORDS, AND HEALTH EDUCATION PROGRAMS. PART VI, LINE 6: MARY WASHINGTON HEALTHCARE AFFILIATES INCLUDE TWO (2) HOSPITALS, OTHER CLINICAL SERVICES THAT INCLUDE AN AMBULATORY SURGERY CENTER, HOSPICE/HOME HEALTH, INDEPENDENT DIAGNOSTIC TESTING FACILITIES, AND PHYSICIAN PRACTICES; TWO (2) FOUNDATIONS AND A PROPERTY DIVISION. ALL ACTIVITIES OF THIS GROUP ARE COORDINATED AND OVERSEEN BY THE PARENT'S (MARY WASHINGTON HEALTHCARE) BOARD OF TRUSTEES. THE AFFILIATED GROUP'S ACTIVITIES ARE CLOSELY PLANNED/INTEGRATED THROUGH INTERLOCKING BOARDS TO ENSURE THE MOST EFFECTIVE DELIVERY OF CARE. EACH MEMBER OF THE AFFILIATED GROUP FOCUSES EFFORTS IN ITS PARTICULAR AREA OF RESPONSIBILITY AND IS ACCOUNTABLE TO THE PARENT'S BOARD FOR ACHIEVING ITS MISSION AND GOALS FOR THE PROVISION OF HEALTH CARE. THE DIVISION OF SERVICES ABOVE ALLOWS PATIENTS TO ACCESS CARE IN THE MOST APPROPRIATE SETTING. THE GOVERNANCE OVERSIGHT PROVIDED BY THE PARENT GUARANTEES OPTIMAL COORDINATION OF THE VARIOUS SEGMENTS OF CARE AND ENSURES HIGH QUALITY SERVICE AS ECONOMICALLY AS POSSIBLE. PART VI, LINE 7, REPORTS FILED WITH STATES VA 0 ACTION IN COMMUNITY THROUGH SERVICES (ACTS) PO BOX 74 DUMFRIES VA 22026 540897679 501(C)(3) 15000 ACTS HELPLINE CENTRAL VIRGINIA HEALTH SERVICES 1506 PALMYRA AVE RICHMOND VA 23227 540887287 501(C)(3) 45000 CHCRR: PATIENT EDUCATION AND CASE MANAGEMENT DOWNTOWN GREENS INC 206 CHARLES STREET FREDERICKSBURG VA 22401 541853889 501(C)(3) 5000 MISC SUPPORT EMPLOYMENT RESOURCES INC PO BOX 801 FREDERICKSBURG VA 22401 541566468 501(C)(3) 5000 SUMMER INTERNSHIP PROGRAM FREDERICKSBURG CHRISTIAN HEALTH CENTER 1129 HEATHERSTONE DR FREDERICKSBURG VA 22407 542061482 501(C)(3) 100000 UNINSURED PATIENT PROGRAM FREDERICKSBURG CITY DEPARTMENT OF SOCIAL SERVICES 608 JACKSON STREET SUITE 100 FREDERICKSBURG VA 22401 546001293 21000 COMMUNITY BASED ELIGIBILITY WORKER FREDERICKSBURG CITY PUBLIC SCHOOLS 2300 WASHINGTON AVENUE FREDERICKSBURG VA 22401 546001296 5000 SCHOOL NUTRITION - SUMMER FOOD SERVICE PROGRAM FREDERICKSBURG REGIONAL TRANSIT 1400 JEFFERSON DAVIS HIGHWAY FREDERICKSBURG VA 22401 546001293 20000 LOCAL TRANSPORTATION FREDERICKSBURG REGIONAL TRANSIT 1400 JEFFERSON DAVIS HIGHWAY FREDERICKSBURG VA 22401 546001293 20000 LOCAL TRANSPORTATION GEORGE WASHINGTON REGIONAL COMMISSION VIRGINIA COMMUNITY FOOD CONNECTIONS 406 PRINCESS ANNE STREET FREDERICKSBURG VA 22401 540715969 30000 FRESH FOOD ACCESS FOR COMMUNITY HEALTH GUADALUPE FREE CLINIC PO BOX 275 COLONIAL BEACH VA 22443 510635977 501(C)(3) 70000 GUADALUPE FREE CLINIC HAZEL HILL 225 BUTLER ROAD FREDERICKSBURG VA 22405 271744104 501(C)(3) 15000 HAZEL HILL HEALTHCARE PROJECT LLOYD F MOSS FREE CLINIC 1301 SAM PERRY BLVD FREDERICKSBURG VA 22401 541677934 501(C)(3) 850000 FREE HEALTH CLINIC MICAH ECUMENICAL MINISTRIES INC PO BOX 3277 FREDERICKSBURG VA 22402 204044884 501(C)(3) 130000 RESIDENTIAL RECOVERY PROGRAM OPEN HAND OF FREDERICKSBURG 200 PRINCE EDWARD STREET FREDERICKSBURG VA 22401 364564097 501(C)(3) 5000 SUMMER INTERN PROGRAM (GRAD) RAPPAHANNOCK AREA AGENCY ON AGING INC 460 LENDALL LANE FREDERICKSBURG VA 22405 541027651 501(C)(3) 38910 COMPASS (CARE OPTIONS MAKE FOR PREFERRED SOLUTIONS) RAPPAHANNOCK AREA HEALTH DISTRICT 608 JACKSON ST FREDERICKSBURG VA 22401 546001775 100000 COMPLICATED OBSTETRICAL AND HIGH RISK MATERNITY CARE PROGRAM RAPPAHANNOCK AREA HEALTH DISTRICT 608 JACKSON STREET FREDERICKSBURG VA 22401 546001775 18276 EVERY WOMAN'S LIFE PROGRAM RX PARTNERSHIP 2924 EMERYWOOD PARKWAY 300 RICHMOND VA 23221 571186937 501(C)(3) 15000 PRESCRIPTIONS STAFFORD DEPT SOCIAL SERVICES PO BOX 7 STAFFORD VA 22555 546001626 501(C)(3) 20000 MISC SUPPORT STAFFORD JUNCTION 610 GAYLE ST FREDERICKSBURG VA 22405 546001628 501(C)(3) 25000 HEALTHY LIVING PAYS STAFFORD SCHOOLS HEAD START 610 GAYLE ST FREDERICKSBURG VA 22405 546001628 20000 STAFFORD SCHOOLS CHILDREN'S INSURANCE OUTREACH PROJECT STAFFORD SCHOOLS HEAD START 610 GAYLE ST FREDERICKSBURG VA 22405 546001628 15000 STAFFORD SCHOOLS HEAD START NUTRITION CONSULTANT PROJECT THE DOCTOR YUM PROJECT 10482 GEORGETOWN DRIVE SUITE B SPOTSYLVANIA VA 22553 455245719 501(C)(3) 35000 BATTLING OBESITY WITH THE H.E.A.L. TOOL 27 ANNE GRAZIANI BROADDUS NURSING SCHOLARSHIP 1 750 APRIL JETT WILLS MEMORIAL NURSING SCHOLARSHIP 1 750 BARBARA KANE NURSING SCHOLARSHIP 1 750 CHARLES AND VIOLA JONES NURSING SCHOLARSHIP 6 5500 CHARLES M. "PETE" HEARN FELLOWSHIP 1 1000 CORA GRAVES ALLISON NURSING SCHOLARSHIP 1 750 ELEANOR HEYCOCK PETTIT NURSING SCHOLARSHIP 1 750 ELIZABETH BRUNELLE RYAN AND CATHERINE RYAN LEGATH SCHOLARSHIP 1 750 FREDERICKSBURG EMERGENCY MEDICAL ALLIANCE SCHOLARSHIP 2 1500 HAROLD AND FRANCES SCHILZ NURSING SCHOLARSHIP 1 750 HEWETSON NURSING SCHOLARSHIP 1 750 IDA RICHARDSON JENKINS MEMORIAL SCHOLARSHIP 1 1000 JEAN C. WILLIAMS MEMORIAL NURSING SCHOLARSHIP 1 750 JEANE BULLOCK NURSING SCHOLARSHIP 1 1000 JENNIE MAE BENSON NURSING SCHOLARSHIP 1 750 JOHN PAINTER SCHOLARSHIP 1 750 LAURA LEIGH LUMPKIN MEMORIAL SCHOLARSHIP 1 1000 LIBBY PEARSON ENDOWED NURSING SCHOLARSHIP 1 750 LINDA WITMER NURSING SCHOLARSHIP 2 1500 MARIE LACY ROLLINS SCHOLARSHIP 1 1000 MARY FRANCES WILLIS & JAMES G. WILLIS MEMORIAL SCHOLARSHIP 2 2000 MARY WASHINGTON HOSPITAL AUXILIARY SCHOLARSHIP 2 2000 NANCY HAZARD MEMORIAL SCHOLARSHIP 1 750 REBECCA BENNETT NURSING SCHOLARSHIP 1 750 SAL KIWALL MEMORIAL SCHOLARSHIP FOR CLINICAL EDUCATION 1 1000 STAFFORD HOSPITAL AUXILIARY SCHOLARSHIP 2 2000 STEPHANIE FRANCINE BROWN NURSING SCHOLARSHIP 4 3000 SUE HALL NURSING SCHOLARSHIP 3 2250 THE FRED M. RANKIN, III LEADERSHIP SCHOLARSHIP 1 1500 THE VICKIE GRAVES PITTMAN GERMANNA NURSING SCHOLARSHIP 2 2000 WILLIAM AND VIOLA ADRIAN NURSING SCHOLARSHIP 2 1500 WILLIAM F. JACOBS, JR. SCHOLARSHIP IN HEALTHCARE ADMINISTRATION 1 2000 X X 1 1 X X X X X X 1 1 0 0 0 0 0 1 0 MICHAEL P MCDERMOTT MD MBA PRESIDENT AND CEO 0 776625 0 261477 0 186893 0 7950 0 35682 0 1268627 0 0 SEAN T BARDEN BSBA MBA EXEC VP AND CFO 0 431907 0 128998 0 84239 0 7950 0 27707 0 680801 0 0 THOMAS G GETTINGER MHA EVP & COO (UNTIL 7.5.17) 0 241014 0 123827 0 198175 0 6000 0 18775 0 587791 0 0 XAVIER RICHARDSON BA MBA MWHF AND SHF PRESIDENT / E 0 226499 0 55077 0 49875 0 6992 0 26174 0 364617 0 0 KATHRYN WALL BA MA EVP 0 255251 0 64504 0 79042 0 0 0 13798 0 412595 0 0 MARIE FREDRICK RT R CRA MJ VICE PRESIDENT 0 190357 0 42459 0 12628 0 6304 0 22964 0 274712 0 0 JUSTIN BOX MBA SVP & CIO 0 272535 0 67537 0 11586 0 6291 0 32298 0 390247 0 0 REBECCA M BIGONEY MDBSMA EVP & CMO 0 421874 0 121297 0 20224 0 7950 0 22048 0 593393 0 0 EILEEN DOHMANN RN BSN MBA NEA-BC SVP & CNO 0 262597 0 68635 0 13467 0 7950 0 5267 0 357916 0 0 ERIC FLETCHER MBA APR SVP 0 241794 0 60031 0 11578 0 7582 0 31087 0 352072 0 0 TRAVIS TURNER BS MBA SVP 0 228930 0 58885 0 11486 0 6796 0 30557 0 336654 0 0 ELIESE K BERNARD VICE PRESIDENT 292366 0 0 0 8177 0 356 0 31971 0 332870 0 0 0 LAUREN BLALOCK VICE PRESIDENT 0 157340 0 35007 0 7915 0 5272 0 32854 0 238388 0 0 CODY BLANKENSHIP VICE PRESIDENT 0 139190 0 20000 0 7188 0 0 0 26797 0 193175 0 0 KATHLEEN BOURGAULT MS CPAM VICE PRESIDENT 0 188226 0 41868 0 10181 0 5419 0 23005 0 268699 0 0 SANDRA BROWN CPA VICE PRESIDENT 0 199992 0 43058 0 10189 0 6498 0 23727 0 283464 0 0 JAMES DANIEL MD SENIOR MEDICAL DIRECTOR 234044 0 50999 0 14068 0 7622 0 23811 0 330544 0 0 0 ALAN EDWARDS VICE PRESIDENT 0 170623 0 39374 0 10013 0 5700 0 34694 0 260404 0 0 TINA ERVIN VICE PRESIDENT 0 190632 0 42259 0 8163 0 6095 0 22851 0 270000 0 0 STEPHEN MANDELL MD VICE PRESIDENT 301386 0 66260 0 12136 0 7950 0 26426 0 414158 0 0 0 DOUGLAS SCHULTE MD VICE PRESIDENT 0 311224 0 67405 0 9080 0 7950 0 2396 0 398055 0 0 CATHLEEN YABLONSKI BS MS VICE PRESIDENT 216171 0 47079 0 8220 0 2298 0 24055 0 297823 0 0 0 DAVID YI MD VICE PRESIDENT 0 279480 0 59075 0 8111 0 7950 0 2152 0 356768 0 0 SANG HO NA PHYSICIAN 732574 0 125000 0 690 0 7950 0 17957 0 884171 0 0 0 AGOSTINO VISIONI PHYSICIAN 743177 0 60000 0 30640 0 7950 0 34603 0 876370 0 0 0 J T SHERWOOD PHYSICIAN 775908 0 35000 0 810 0 7950 0 40552 0 860220 0 0 0 THERESA CONOLOGUE PHYSICIAN 534983 0 0 0 450 0 3742 0 29879 0 569054 0 0 0 JOHN CARDONE PHYSICIAN 509508 0 15000 0 1465 0 7950 0 31099 0 565022 0 0 0 JOYCE HANSCOME VICE PRESIDENT (FORMER) 0 0 0 0 0 123125 0 0 0 0 0 123125 0 0 PART I, LINE 1A PART I, LINE 1A - TRUSTEES WHO ARE UNCOMPENSATED VOLUNTEERS TRAVELING FOR BUSINESS RELATED REASONS ON BEHALF OF THE ORGANIZATION ARE REIMBURSED FOR THE COST OF SPOUSAL TRAVEL. REIMBURSEMENTS PAID FOR SPOUSAL TRAVEL ARE REIMBURSED AND REPORTED AS INCOME ON A FORM 1099 IN THE YEAR PAID. EXECUTIVES WHO ARE TRAVELING FOR BUSINESS RELATED REASONS ON BEHALF OF THE ORGANIZATION ARE REIMBURSED FOR THE COST OF SPOUSAL MEALS PROVIDED AND THE AMOUNT IS REPORTED AS INCOME ON THE EXECUTIVE'S W-2. PART I, LINES 4A-B SEAN BARDEN RECEIVED A 457(F) DISTRIBUTION OF $47,990. KATHRYN WALL RECEIVED A 457(F) DISTRIBUTION OF $44,647. MICHAEL MCDERMOTT RECEIVED A 457(F) DISTRIBUTION OF $130,612 XAVIER RICHARDSON RECEIVED A 457(F) DISTRIBUTION OF $14,800. JOYCE HANSCOME RECEIVED SEVERANCE PAY OF $84,568 AND 457(F) DISTRIBUTION OF $38,557 WHICH WAS INCLUDED IN HER 2017 W-2. PART I, LINE 7 PART I, LINE 7 - ALL EXECUTIVES HAVE AS A PART OF THEIR COMPENSATION A VARIABLE COMPONENT SUCH THAT THEY ARE ELIGIBLE TO RECEIVE A PERCENTAGE OF THEIR BASE PAY AS AN INCENTIVE FOR THE ACHIEVEMENT OF INDIVIDUAL AND CORPORATE GOALS AND OBJECTIVES. SCHEDULE J INDEPENDENT BOARD TRUSTEES RECEIVE NO COMPENSATION. A ECONOMIC DEVELOPMENT AUTHORITY 521303430 355849AS9 2007-05-10 86868312 REFUNDING OF 1996 MWH BONDS 0 0 0 B ECONOMIC DEVELOPMENT AUTHORITY 521303430 355849BC3 2014-05-28 59254492 REFUNDING OF 2002 BONDS 0 0 0 C ECONOMIC DEVELOPMENT AUTHORITY 541244413 852431BM6 2016-05-02 128486132 REFUNDING OF 2006 BONDS 0 0 0 D ECONOMIC DEVELOPMENT AUTHORITY 521303430 2016-11-22 30405000 REFUNDING OF 2013 BONDS 0 0 0 A 41680000 86868312 583010 86285302 2007 1 0 1 1 B 59254492 630794 58623698 2014 1 0 1 1 C 470000 128486132 2100667 126385465 2016 1 0 1 1 D 960000 30405000 30405000 2016 1 0 1 1 A 0 0 1 1 0 0 0 1 B 0 0 1 1 0 0 0 1 C 0 0 1 1 0 0 0 1 D 0 1 1 1 0 0 0 1 A 0 0 1 0 0 0 0 0 1 B 0 0 1 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 X 60 X EVENT PRIZES 40 28184 FMV X FOOD AND BEVERAGES 10 1811 FMV X EVENT FACILITIES 1 1000 FMV X MUSICAL INSTRUMENT 1 287 FMV 0 0 0 PART I, COLUMN (B): NUMBER OF CONTRIBUTIONS TOTALED BY A COUNT OF DONORS PER ITEM. FORM 990, PART VI, SECTION A, LINE 6 MEMBERS OF THE MARY WASHINGTON HEALTHCARE GROUP ALL HAVE ONE SOLE MEMBER, ITS PARENT MARY WASHINGTON HEALTHCARE (MWHC). FORM 990, PART VI, SECTION A, LINE 7A MARY WASHINTON HEALTHCARE (MWHC) HAS THE POWER TO APPOINT BOARD OF TRUSTEES FOR THE GROUP. FORM 990, PART VI, SECTION A, LINE 7B MEMBERS OF THE MARY WASHINGTON HEALTHCARE GROUP ALL HAVE ONE SOLE MEMBER, ITS PARENT MARY WASHINGTON HEALTHCARE (MWHC). MWHC HAS RESERVED CERTAIN POWERS TO ITSELF WITHIN EACH OF ITS SUBSIDIARIES ORGANIZING DOCUMENTS. THESE RESTRICTIONS INCLUDE AMENDING THE GOVERNING DOCUMENTS, BUDGETING, EXPENDITURES OVER CERTAIN THRESHOLDS. FORM 990, PART VI, SECTION B, LINE 11B MANAGEMENT COMPLETES A DRAFT OF THE INTERNAL REVENUE SERVICE (IRS) FORM 990 INFORMATION RETURN FOR MARY WASHINGTON HEALTHCARE AND ITS SUBSIDIARIES. THIS DRAFT IS SUBMITTED TO THE AUDIT & COMPLIANCE COMMITTEE OF THE ORGANIZATION'S BOARD OF TRUSTEES. THE FORM 990 AND UNDERLYING INFORMATION ARE PRESENTED TO AND REVIEWED BY THIS COMMITTEE. IF THE CONTENTS OF THE 990 RETURN ARE DEEMED ACCURATE AND ACCEPTABLE BY THE COMMITTEE, THIS BODY RECOMMENDS ACCEPTANCE OF THE RETURN BY THE FULL BOARD OF TRUSTEES. THE FORM 990 RETURN IS SUBSEQUENTLY PRESENTED TO AND REVIEWED BY THE ORGANIZATION'S BOARD OF TRUSTEES. IF DEEMED ACCURATE AND ACCEPTABLE THE BOARD ACCEPTS THE RETURN THROUGH A FORMAL MOTION. AS PART OF THIS PROCESS, THE DRAFT RETURN IS POSTED ON THE BOARD'S WEBSITE WHERE IT REMAINS AVAILABLE FOR REVIEW EVEN AFTER FORMAL ACCEPTANCE BY THE BOARD. THE FORM 990 RETURN IS ALSO AVAILABLE TO MEMBERS OF THE BOARD OF TRUSTEES AS WELL AS THE GENERAL PUBLIC ON MARY WASHINGTON HEALTHCARE'S WEBSITE (WWW.MARYWASHINGTONHEALTHCARE.COM). FORM 990, PART VI, SECTION B, LINE 12C EVERY TRUSTEE, AND EXECUTIVE MEMBER OF MANAGEMENT IS REQUIRED TO DISCLOSE ANY AND ALL POSSIBLE CONFLICTS OF INTERESTS. THE DISCLOSURES ARE MADE ANNUALLY AND SUBMITTED TO THE MWHC CHIEF AUDIT EXECUTIVE (CAE). THE CAE THEN PRESENTS ALL CONFLICTS TO THE AUDIT AND COMPLIANCE COMMITTEE OF THE BOARD OF TRUSTEES. THE CHAIRMAN OF THE AUDIT AND COMPLIANCE COMMITTEE REPORTS ALL CONFLICTS TO THE FULL BOARD. CONFLICTS ARE CONTINUALLY AND ACTIVELY MANAGED. AT EACH MEETING, THE CHAIR ASKS IF ANYONE AT THE MEETING HAS A CONFLICT TO DISCLOSE. INDIVIDUALS WITH CONFLICTS DISCLOSE THEIR CONFLICTS AND THE RELATED TOPIC. THE INDIVIDUAL THEN RECUSES HIM/HERSELF FROM ANY DECISION RELATED TO THAT TOPIC. THE CONFLICT OF INTERESTS POLICY IS REVIEWED ANNUALLY BY THE BOARD OF TRUSTEES. FORM 990, PART VI, SECTION B, LINE 15 MARY WASHINGTON HEALTHCARE UTILIZES AN EXECUTIVE COMPENSATION COMMITTEE WITH THE PURPOSE AND AUTHORITY TO ESTABLISH PROCESSES TO ENSURE FAIR AND COMMERCIALLY REASONABLE COMPENSATION FOR THE CEO AND EXECUTIVE LEADERSHIP. IN ORDER TO ENSURE COMPENSATION PAID IS SET AT FAIR MARKET VALUE, THE EXECUTIVE COMPENSATION COMMITTEE UTILIZES COMPENSATION SURVEY DATA, FORM 990 INFORMATION FROM COMPARABLE HEALTH SYSTEMS, AND THE SERVICES OF AN INDEPENDENT COMPENSATION CONSULTANT. SUCH INDEPENDENT THIRD PARTY DATA POINTS PROVIDE ASSURANCE THAT EXECUTIVE COMPENSATION IS COMMERCIALLY REASONABLE AND AT A FAIR MARKET VALUE. FORM 990, PART VI, SECTION C, LINE 19 THE AUDITED FINANCIALS STATEMENTS ARE POSTED ON THE MARY WASHINGTON HEALTHCARE WEBSITE FOR PUBLIC VIEW. FORM 990, PART IX, LINE 11G ASP SERVICES : PROGRAM SERVICE EXPENSES 599,936. MANAGEMENT AND GENERAL EXPENSES 16,531. FUNDRAISING EXPENSES 370. TOTAL EXPENSES 616,837. BILLING AND COLLECTION SERVICES : PROGRAM SERVICE EXPENSES 2,945,351. MANAGEMENT AND GENERAL EXPENSES 81,159. FUNDRAISING EXPENSES 1,817. TOTAL EXPENSES 3,028,327. CONSULTING SERVICES : PROGRAM SERVICE EXPENSES 50,001,214. MANAGEMENT AND GENERAL EXPENSES 1,377,784. FUNDRAISING EXPENSES 30,846. TOTAL EXPENSES 51,409,844. CONTRACT PERSONNEL: PROGRAM SERVICE EXPENSES 10,854,018. MANAGEMENT AND GENERAL EXPENSES 299,083. FUNDRAISING EXPENSES 6,696. TOTAL EXPENSES 11,159,797. MANAGEMENT CONTRACTS : PROGRAM SERVICE EXPENSES 28,963,466. MANAGEMENT AND GENERAL EXPENSES 798,089. FUNDRAISING EXPENSES 17,868. TOTAL EXPENSES 29,779,423. MAINTENANCE SERVICES : PROGRAM SERVICE EXPENSES 5,738,923. MANAGEMENT AND GENERAL EXPENSES 158,136. FUNDRAISING EXPENSES 3,540. TOTAL EXPENSES 5,900,599. STORAGE SERVICES : PROGRAM SERVICE EXPENSES 86,047. MANAGEMENT AND GENERAL EXPENSES 2,371. FUNDRAISING EXPENSES 53. TOTAL EXPENSES 88,471. TENENT COVERAGE : PROGRAM SERVICE EXPENSES 8,824,279. MANAGEMENT AND GENERAL EXPENSES 243,153. FUNDRAISING EXPENSES 5,444. TOTAL EXPENSES 9,072,876. WASTE DISPOSAL: PROGRAM SERVICE EXPENSES 1,129,981. MANAGEMENT AND GENERAL EXPENSES 31,137. FUNDRAISING EXPENSES 697. TOTAL EXPENSES 1,161,815. FORM 990, PART XI, LINE 9: RELIEF FROM AFFILIATE LOANS -9,821,526. UNCOLLECTED PLEDGES -1,553,372. ELIMINATION OF EQUITY FOR CONSOLIDATED ENTITIES 8,237,646. FORM 990, PART XII, LINE 2C THE COMPANIES IN THE GROUP RETURN ARE INCLUDED IN THE CONSOLIDATED AUDITED FINANCIAL STATEMENTS OF MWHC. CONSISTENT WITH PRIOR YEARS RESPONSIBILITY FOR OVERSIGHT OF THE AUDIT AND SELECTION OF AUDITORS RESTS WITH THE AUDIT & COMPLIANCE COMMITTEE OF THE BOARD OF TRUSTEES. FORM 990, PART V, Q2A NO ENTITY WITHIN THE GROUP FILES W-2S WITH THE IRS. ALL PAYROLL IS PAID THROUGH AN AGENCY AGREEMENT WITH MARY WASHINGTON HEALTHCARE. FORM 990, SCHEDULE R ABBREVIATIONS: MWHC - MARY WASHINGTON HEALTHCARE MPI - MEDICORP PROPERTIES, INC. MWHC CLINICAL - MARY WASHINGTON HEALTHCARE CLINICAL SERVICES, INC. MEDIDOCTORS H.C. - MEDIDOCTORS HOLDING COMPANY FORM 990, PART V, Q3A AND Q3B MARY WASHINGTON HOSPITAL AND MARY WASHINTON HOSPITAL FOUNDATON FILE SEPARATE 990T'S RELATED TO UNRELATED BUSINESS INCOME. MEDIDOCTORS LLC 2300 FALL HILL AVE STE 418 FREDERICKSBURG VA 22401 541990805 MEDICAL VA 449647 30949 MARY WASHINGTON HEALTHCARE CLINICAL SERVICES INC STAFFORD HOSPITAL AUXILIARY 2300 FALL HILL AVE SUITE 418 FREDERICKSBURG VA 22401 262704632 MEDICAL SERVICES VA 501(C)(3) LINE 12D, III-O 0 MARY WASHINGTON HOSPITAL AUXILIARY 2300 FALL HILL AVE SUITE 418 FREDERICKSBURG VA 22401 752985923 MEDICAL SERVICES VA 501(C)(3) LINE 12D, III-O 0 MARY WASHINGTON HEALTHCARE 2300 FALL HILL AVE SUITE 418 FREDERICKSBURG VA 22401 541240646 MEDICAL SERVICES VA 501(C)(3) LINE 12C, III-FI MWHC 0 FREDERICKSBURG AMBULATORY SURGERY CENTER 2300 FALL HILL AVE STE 418 FREDERICKSBURG VA 22401 562322548 SURGERY CTR VA MWHC CLINICAL SERVICES INC RELATED 2347421 1198946 0 1 0.53870 MEDICAL IMAGING OF FREDERICKSBURG 2300 FALL HILL AVE STE 418 FREDERICKSBURG VA 22401 541364028 IMAGING VA MWHC CLINICAL SERVICES INC RELATED 6083859 1866920 0 1 0.51000 MARY WASHINGTON EYE CARE CENTER 2300 FALL HILL AVE STE 418 FREDERICKSBURG VA 22401 271248032 OPTOMETRY VA MWHC CLINICAL SERVICES INC RELATED -166881 -2079320 0 1 0.99000 CENTRAL ATLANTIC HEALTH NETWORK 2300 FALL HILL AVE STE 418 FREDERICKSBURG VA 22401 274704694 GROUP PURCHASING VA N/A RELATED 9453 33594 1 0 0.12500 COWAN INVESTMENT PARTNERS LLC 2300 FALL HILL AVE STE 418 FREDERICKSBURG VA 22401 651294835 REAL ESTATE VA MEDICORP PROPERTIES INC RELATED 723 62488 0 0 0.12500 SPOTSYLVANIA PARKWAY MEDICAL PLAZA LLC 2300 FALL HILL AVE STE 418 FREDERICKSBURG VA 22401 262656396 REAL ESTATE VA MEDICORP PROPERTIES INC RELATED 198113 -643478 0 0 0.39500 SPOTSYLVANIA PARKWAY MEDICAL PLAZA II LLC 2300 FALL HILL AVE STE 418 FREDERICKSBURG VA 22401 454281946 REAL ESTATE VA MEDICORP PROPERTIES INC RELATED -10079 915296 0 0 0.39500 FREDERICKSBURG PROFESSIONAL RISK EXCHANGE 2300 FALL HILL AVE SUITE 418 FREDERICKSBURG VA 22401 331095956 CAPTIVE INSURANCE VA MARY WASHINGTON HEALTHCARE C -982866 18951056 1.00000 0 MARY WASHINGTON HEALTHCARE SERVICES INC 2300 FALL HILL AVE SUITE 418 FREDERICKSBURG VA 22401 541244509 RETAIL MEDICAL VA MWHC CLINICAL SERVICES INC C 139694 1416961 1.00000 0 0 0 1 0 0 0 0 0 0 1 1 0 1 1 1 0 0 0 0