2017-11-13T13:22:46-06:00 2016-12-31 346565596 ERNST & YOUNG US LLP 312 WALNUT ST SUITE 1900 CINCINNATI OH 45202 990 2016-01-01 540620889 INOVA HEALTH CARE SERVICES INOV 7032892433 8110 GATEHOUSE ROAD SUITE 400W FALLS CHURCH VA 22042 RICHARD MAGENHEIMER CFO 7032892433 2017-11-13 1 JULIE L SPARKS P01268401 5136121400 167.201.241.175 2017-11-13 10:11:59 ES P 7B679794C43C21C3204AD1DE02D62BF36AA11E4C 7B679794C43C21C3204AD1DE02D62BF36AA11E4C 2016 2017-02-10 21:41:12Z J Knox Singleton 8110 GATEHOUSE ROAD SUITE 400W FALLS CHURCH VA 22042 2622026084 0 X INOVA.ORG X 1956 VA IHCS's mission is to maintain and operate hospitals that provide quality care to the community. 18 12 17107 2778 6145969 0 18024509 19271496 2318735608 2583491570 -7361700 387900 75694095 -16730472 2405092512 2586420494 0 0 0 0 1124455739 1274003989 0 0 0 1109154209 1293336218 2233609948 2567340207 171482564 19080287 4433841532 4434059775 2217245798 2202918773 2216595734 2231141002 X IHCS was specifically chartered for the purpose of serving the health care needs of the community by establishing, maintaining, and operating hospital facilities, programs, and other shared service arrangements; carrying on health-related education activities; promoting and carrying on health-related scientific research; and engaging in activities designed and carried on to promote the general health of the community. IHCS includes a centralized System Office and the various unincorporated and incorporated subsidiaries which are described below.The unincorporated divisions of IHCS include: Inova Fairfax Hospital, Inova Mount Vernon Hospital, Inova Fair Oaks Hospital, Inova Alexandria Hospital, ACCESS of Reston, ACCESS of Fairfax, Inova Research Center, Assisted Living Facilities, Inova Physical Rehabilitation Services, Inova Urgent Care Centers, Inova Employee Assistance, and Behavioral Health and Addiction Treatment. 0 0 2178147837 2660172145 Inova Health Care Services (IHCS) is part of the Inova Health System whose mission is to serve the needs of the community by establishing, maintaining, and operating hospital facilities, programs, and other shared service arrangements; carrying on health-related education activities; promoting and conducting scientific research; and engaging in activities designed and carried on to promote the general health of the community. IHCS includes a centralized System Office and the various unincorporated and incorporated divisions which are described below.The unincorporated subsidiaries of IHCS include: Inova Fairfax Medical Campus, Inova Mount Vernon Hospital, Inova Fair Oaks Hospital, Inova Alexandria Hospital, ACCESS of Reston, ACCESS of Fairfax, Inova Research Center, Assisted Living Facilities, Inova Physical Rehabilitation Services, Inova Urgent Care Centers, Inova Employee Assistance, and Behavioral Health and Addiction Treatment.PROGRAM SERVICESAcute care services are provided on three campuses in Fairfax County and one campus in the City of Alexandria in Virginia. Services provided include emergency and trauma facilities, inpatient and outpatient services, and a variety of ancillary and specialized services. During 2016 IHCS admissions and observations cases totaled 117,403, outpatient visits totaled 342,745, emergency visits totaled 321,363 (25,300 of the total ER visits were at the Springfield Healthplex and 14,504 at the Lorton Healthplex) and deliveries totaled 16,991. The acute care program services provided by these hospitals are described more fully below. Inova Fairfax Medical Campus (IFMC) campus includes the Inova Heart and Vascular Institute, Inova Women's Hospital, and Inova Fairfax Hospital for Children. The hospital, located in Central Fairfax County is an 876-licensed bed tertiary care hospital providing comprehensive medical and surgical services which include emergency/trauma, cardiac, transplant, cancer, obstetric, pediatric, neonatal, stroke and extensive outpatient services. Inova Fairfax Hospital is the home of Northern Virginia's only level one emergency and trauma center and the state-of-the-art Women's and Children's Center. In addition, Inova Fairfax Hospital is a teaching hospital providing clinical training through its medical residency, nursing, and paramedical education programs.Inova Mount Vernon Hospital (IMVH) is a 237-licensed bed acute-care hospital serving Southeastern Fairfax County. Inova Mount Vernon Hospital provides a full-service, 24-hour emergency department; broad range of diagnostic, medical and surgical services; inpatient psychiatric services; the Dorothea R. Fischer Wound Healing Center and a specialized hyperbaric oxygen therapy program used to treat conditions requiring increased oxygen flow to body tissues (such as grafts and certain types of burns). Inova Mount Vernon Hospital also operates the Lorton Healthplex, a 24-hour free standing emergency facility and the Inova Center for Rehabilitation, a nationally-known accredited program providing inpatient and outpatient rehabilitative services.Inova Fair Oaks Hospital (IFOH) is a 182-licensed bed general acute care hospital, which opened in 1987 to serve the growing communities in western Fairfax County, Virginia. Inova Fair Oaks provides a full-service 24-hour emergency department; a spectrum of diagnostic services and treatment including full-body CT scanning, open MRI and radiation cancer services; inpatient medical and surgical services; obstetrics and pediatric services; and comprehensive outpatient services including outpatient surgery, physical medicine, wound care and rehabilitation. Inova Fair Oaks Hospital is home to a designated Bariatric Surgery Center of Excellence. Inova Alexandria Hospital (IAH) is a 318-licensed bed general acute care hospital, which opened on January 23, 1873. IAH provides a spectrum of diagnostic services, including full-body CT scanning, MRI, and a cardiac catheterization laboratory; a variety of inpatient medical, surgical, and orthopedic services; comprehensive outpatient services, including outpatient surgery, physical medicine, and rehabilitation; and a 24-hour emergency department as well as the Springfield Healthplex, a free standing emergency facility. In addition, specialized obstetric and pediatric services are provided by the hospital's Maternal and Infant Health Center and a children's unit. Specific acute care programs include:Cardiovascular Care: Inova Fairfax Medical Campus (IFMC) is the flagship campus for Inova Heart and Vascular Institute encompassing a dedicated heart hospital, Inova Cardiovascular Genomics Center and Inova Thrombosis Research and Drug Development Center which includes a dedicated 24-bed Clinical Trials Unit for Phase I - IV studies. It houses 204 inpatient beds, six cardiovascular operating rooms, an 11-room cardiac catheterization and electrophysiology suite, chest pain unit, 64-slice CT scanner and other diagnostic testing, outpatient clinics, cardiac rehabilitation and educational facilities. Capabilities cover the full spectrum of complex cardiovascular and pulmonary care. Services offered include cardiac diagnostic services, cardiac imaging, cardiac catheterization, interventional cardiology, electrophysiology, cardiothoracic surgery and complex airway interventions, vascular surgery, vascular and interventional radiology, advanced lung disease and transplant program, cardiac and respiratory failure program, heart failure and transplant program and cardiac rehab.The Inova Heart and Vascular Institute at IFMC is the region's first dedicated heart hospital. The Inova Heart and Vascular Institute at IAH houses inpatient/outpatient beds, cardiovascular operating rooms, a cardiac catheterization lab, an electrophysiology lab, interventional radiology labs, a minor procedure room, outpatient clinics, cardiac rehabilitation and educational facilities. Women's Health: The Inova Women's Health program is the largest such program in the Mid-Atlantic region, providing services for over 16,000 births each year. Obstetric services provided include: delivery services, high risk prenatal services, inpatient and outpatient obstetrics/gynecologic surgery, and regular and specialty nursery care. IFMC provides obstetric services to low-income patients through the InovaCares Clinic for Women with 38,921 visits in 2016. In addition, IAH works with the Casey Clinic, a State health clinic jointly funded by the State of Virginia, City of Alexandria and the Alexandria Health Department, providing obstetric services to low-income patients.Pediatrics: Inova Children's Hospital is Northern Virginia's only children's hospital, and a regional tertiary and quarternary referral center with 226 licensed acute care beds, providing the highest level of care. Inova Children's Hospital is home to the only Pediatric Intensive Care Unit and Pediatric Trauma Center in the region, as well as the region's only Level IV Neonatal ICU. In 2016, Inova Children's Hospital treated more than 40,000 children in its Pediatric Emergency Department, more than 12,000 children in inpatient units, and performed more than 4,000 surgeries. Inova Children's provides a complete range of expert, subspecialized children's services in more than 40 subspecialties, including pediatric cardiac surgery, pediatric cancer care, pediatric orthopedics and sports medicine, pediatric spine surgery, pediatric neurology and neurosurgery. As of December 31, 2016, total NICU bassinets numbered 108. Inova Fairfax Hospital for Children (IFHC) provides a primary care medical home for children of low income families that are uninsured or on Medicaid through the InovaCares Clinic for Children which in 2016 provided 24,969 visits at an unreimbursed cost of just under $800,000.Cancer Care: Inova Schar Cancer Institute is an international center for advanced cancer care and research. Collaborating with clinical and scientific partners, the Schar Cancer Institute conducts genomic and translational research to better understand, predict, prevent, and eliminate cancer. Inova Schar Cancer Institute operates full-service, accredited, cancer centers at all five of Inova's hospitals - Inova Fairfax Medical Campus, Inova Alexandria Hospital, Inova Fair Oaks Hospital, Inova Loudoun Hospital, and Inova Mount Vernon Hospital. Inova Fairfax Hospital is designated by the American College of Surgeons Commission on Cancer as a Teaching Hospital Cancer Program, and Inova Alexandria Hospital has a Community Hospital Comprehensive Cancer Program designation. Other System Hospitals meet the American College of Surgeons Community Hospital Cancer Program standards. 19070811 8036287 Research and Education Services: The Inova Research Center (IRC), including research and academic activities, is centered on the Inova Fairfax Medical Campus campus. In 2016, the Inova campus of the Virginia Commonwealth University School of Medicine had a total of 29 third year and 28 fourth year medical students who spent their clerkship years at Inova Fairfax Medical Campus. In addition, 500 students came to Inova Fairfax Medical Campus for a four week rotation in 2016. Also located on the Inova campus is the VCU School of Pharmacy which partners with clinicians and practitioners across Inova and Northern Virginia to help educate and train an increasing number of pharmacy students each year. In 2016, nearly 100 second, third and fourth year pharmacy students completed didactic and experiential learning experiences across Northern Virginia with the Inova Health System. Pharmacy practitioners precepted nearly 150 Introductory Pharmacy Practice Experiences (IPPEs) and Advanced Pharmacy Practice Experiences (APPEs), with the great majority of students from the VCU School of Pharmacy and a smaller contingent from Shenandoah and Butler.In addition, there are pharmacy post-graduate training opportunities offered at three Inova institutions. Inova Fairfax Medical Campus offers 4 PGY-1 Pharmacy Practice Residency positons, as well as a PGY-2 Emergency Medicine Pharmacy Residency position. Inova Alexandria and Inova Mount Vernon Hospitals each offer 2 PGY-1 Pharmacy Practice Residency positions, for a total of nine post-graduate training opportunities across Inova Health System.The Claude Moore Health Education Center on the campus of Inova Fairfax Medical Campus features 11,000 square feet of space dedicated to the educational needs of medical and nursing students as well as residents and fellows. This state-of-the-art center includes both medical and surgical simulation centers, enabling students to learn through hands-on experience. The Center also features a dedicated research floor to support the extensive activities of the Inova Research Center, where there are numerous active clinical trials, ongoing translational research and outcomes projects, many in partnership with universities and other research entities. The unreimbursed cost of these programs in 2016 was $11.1 million. Inova Translational Medicine InstituteIn 2010, the Inova Translational Medicine Institute (ITMI), a not-for-profit research institute was created for research activities related to the innovative field of personalized medicine. Personalized medicine is a medical model that emphasizes the customization of healthcare to individual patients. It involves the use of genetic information about an individual patient. In 2011, ITMI collaborated with physicians from Fairfax Neonatal Associates to investigate the genetic causes of pre-term delivery. Findings were used to build a reference database of genomic and clinical information which will empower clinical genomic discovery. In 2012 we started our Fairfax Childhood Longitudinal Study, which is investigating the genomic basis for childhood wellness and disease over the duration of the childhoods of over 3,000 children living in Northern Virginia. Institute members provide Medical Genetics and Genetic Counseling to newborns with congenital abnormalities as well as cancer patients with a family history concerning for a genetic basis of their disease. In 2016, approximately $30.2 million was provided in operational support for ITMI.Inova Fairfax Medical Campus' medical education programs offer a variety of clinical training objectives for medical residents and students, nursing and pharmacy. Inova Fairfax Medical Campus' residency program has approximately 800 Residents/Fellows trained throughout the year, and 520 Medical Students. Medical students are primarily from Inova Fairfax Medical Campus, UVA, and Georgetown and George Washington Universities, as well as visiting students from around the country. As a teaching facility, Inova Fairfax Medical Campus incurs typical, additional expenses associated with teaching facilities including physician teaching costs and resident salaries, the cost of maintaining higher levels of technology required to support a teaching program and charges resulting from extra tests ordered for instructional purposes. The unreimbursed cost of these programs in 2016 was $12.1 million. Each year, IHCS designates funds for the development and continuation of identified, accessible direct care programs and services benefiting those most in need in the community. Many of these programs and services are not billed to the patient or are provided at a fee structure below the actual cost of the service. In addition to providing the direct care subsidized service, Inova also provides disease-prevention programs, health and exercise classes, health education and health screenings and other programs within the community in support of the IHCS mission. In 2016, Inova provided about 150,000 people with health education, prevention and wellness programs, health fairs and screenings, and clinically related services resulting in close to 100,000, visits for direct health care services at an unreimbursed cost of approximately $16.6 million. These services and programs are described below.InovaCares Clinic for Women and ChildrenThe InovaCares Clinic for Women was created in 1960 to serve the uninsured women of Fairfax County, offering a wide range of OB/GYN services for those in need. InovaCares Clinic for Women is a service offered to the community in collaboration with the Fairfax County Health Department, serving uninsured and low-income patients up to 400% of the Federal Poverty Level (FPL). The clinic works in partnership with the Fairfax County Health Department and Inova Fairfax Hospital to promote early and continuous prenatal care for the culturally diverse population who are its patients. The InovaCares Clinic for Women provides comprehensive outpatient obstetrical services, gynecological care, diabetes management, case management, non-stress testing, LEEP and colposcopy procedures, cryosurgery, and nutritional counseling - all at little to no cost to the patient. In addition, the InovaCares Clinic for Women runs a high risk obstetrics clinic and a gynecology clinic. In 2016, ICCW saw a total of 38,921 obstetrical patient encounters for over 3,700 patients. In 2016, the ICCW had over 2,000 deliveries at Inova Fairfax Medical Campus. Additionally, ICCW saw a total of 2,262 gynecological patient encounters for over 1,000 patients.The InovaCares Clinic for Children was created in 1993 as a response to the inability of uninsured or Medicaid mothers to secure an affordable medical home for their children. Inova Cares Clinic for Children serves as a medical home for newborns up to 21 years of age for patients that reflect the cultural diversity of the community we serve. The Inova Cares Clinic for Children provides comprehensive pediatric services that includes well-child care, immunizations, episodic care (sick visit), and school/sports physicals, immunizations, and nutritional counseling. In 2016, the InovaCares Clinic for Children provided 24,969 clinical services to over 6,500 patients.Inova Alexandria Hospital OB ClinicIAH donates space on the campus to the Casey Clinic, a community health center funded by the State of Virginia, Alexandria Health Department and the City Of Alexandria to provide primary healthcare services to low-income and uninsured children and adults that are residents of the City of Alexandria. IAH funds the clinic physicians who provide OB patient prenatal examinations and delivery at Inova Alexandria Hospital. Inova Juniper Program, HIV Clinical and Education ServicesInova Juniper Program (IJP) provides outpatient primary medical care, mental health therapy, substance abuse treatment, pharmaceutical assistance, nutritional counseling and medical case management services to 1,690 persons living with HIV disease in the suburban Virginia region. To maximize accessibility for clients, services are provided at the main location in Fairfax, as well as six satellite clinics (Dumfries, Manassas, Mt. Vernon, Falls Church, Leesburg and Herndon), hospitals, homes and other community locations throughout the region.Major accomplishments of IJP for 2016 include:Served 1,690 patients, providing 23,838 services.Continues to maintain a 0% HIV transmission rate from pregnant mothers to their newborn babies.Conducted 112 educational programs reaching 1,803 participants, and provided 166 clinical consultations.Conducted 1,627 HIV tests with seroprevalence of 1.05% across Northern Virginia.Successfully implemented seven Virginia Department of Health prevention contracts to develop, implement, and evaluate programs to support, motivate, and educate the public and people living with HIV. Programs are targeted to incarcerated men and women, MSM, youth and the general population. HIV testing, support groups and patient navigation services are also provided through the prevention programs.Life with Cancer The mission of Life with Cancer (LWC) is to enhance the quality of life of those individuals in the community affected by cancer. The program addresses the specific needs by providing individual and family counseling, support groups, educational seminars, workshops on cancer diagnosis and treatment, and a full array of complimentary therapies. Life with Cancer is generously supported by our community; therefore all services are available at no charge to residents of the Washington Metropolitan area. In 2016 Life with Cancer conducted 2,491 educational classes, groups, and wellness programs for adults, children and adolescents with 14,723 visits. In addition, 16,487 counseling or educational consultation sessions were provided by our Oncology Therapists and Oncology Nurse Navigators serving 14,438 people. The total number of participants in programs/classes, groups and counseling in 2016 was 29,161 and Life with Cancer staff provided 42,103 service hours. In 2016, the pediatric oncology clinic staff provided clinical and educational support (inpatient and outpatient) to 3,127 children, teens and parents and held 2,896 support and education group sessions and counseling sessions.A total of 620 participated in Hispanic programs which included Spanish language support groups, educational sessions (Tomando Control De Su Salud & Luzca Bien Sientase Major), and weekly Zumba classes. Hispanic program coordinators also navigated and counseled 334 clients during 223 sessions.LWC participated in various other Community Outreach activities reaching over 2,500 people. Lions Eye ClinicAdministered by Inova Health System (IHS), the Ophthalmology Clinic provides ophthalmic specialty services to the indigent including treatment of glaucoma, retina, and cataracts. IHS provides a part-time ophthalmologist, an ophthalmic technician, and a receptionist for the clinic. The remaining physicians volunteer their services. In 2016, the clinic had 4,397 visits.Elderlink ElderLink is a non-profit partnership between Inova, the Fairfax Area Agency on Aging, and the Alzheimer's Association, National Capital Area Chapter. ElderLink provides case management, care coordination, health and wellness programming, as well as support to patients returning from the hospital back to their home in the community, and caregiver support to older adults and their caregivers. Elderlink provided service to approximately 930 older adults and their caregivers in 2016.Inova Center for Wellness and Metabolic HealthThe Inova Center for Wellness and Metabolic Health provides endocrinology medical visits, diabetes education and medical nutrition therapy. Endocrinology visits are provided by Board Certified Endocrinologists and an experienced Nurse Practitioner. The providers see patients for many endocrine issues, not limited to diabetes. The Center is recognized by the American Diabetes Association for diabetes education which is provided by Registered Nurses and Registered Dieticians. Staff members are either Certified Diabetes Educators or are in the process of achieving this designation.In August of 2016, a new Center was opened in Alexandria and offers diabetes education and Medical Nutrition Therapy visits. In November, a new Board Certified Endocrinologist joined the staff so that endocrinology services could be added to the Leesburg office. Center locations include: Alexandria, Fairfax, Fair Oaks and Leesburg. In 2016, the Inova Center for Wellness and Metabolic Health provided 7,090 participant visits in Fairfax Centers and another 1,207 at the Loudoun site. 2197218648 1 1 0 1 0 0 0 0 0 0 1 0 0 1 1 1 0 1 0 0 0 0 0 0 0 0 1 1 0 0 1 1 0 0 0 0 0 0 0 1 1 0 0 0 0 0 1 1 1 1 0 0 1 X 2002 0 1 17107 1 1 1 0 0 0 0 0 0 0 0 0 X 18 12 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 0 0 1 0 X Inova Health Care Services 7032892433 8110 Gatehouse Road Suite 400W Falls Church VA 22042 JKNOX SINGLETON PRESIDENT 35.00 15.00 X X 0 4787739 1454485 CHARLES SMITH CHAIRMAN 3.00 2.00 X X 0 0 0 JACK EBELER VICE CHAIRMAN 2.00 3.00 X X 0 0 0 CHARLES BEARD SECRETARY 2.00 0.00 X X 0 0 0 PRADEEP NAYAK MD TRUSTEE 2.00 0.00 X 0 0 0 GLENNA ANDERSEN MD TRUSTEE 2.00 0.00 X 0 0 0 HUGO DAVALOS MD TRUSTEE 2.00 0.00 X 102000 0 0 JOHN COOK TRUSTEE 2.00 0.00 X 0 0 0 MARK STAVISH TRUSTEE 2.00 4.00 X 0 0 0 ELIZABETH CASEY HALLEY RN TRUSTEE 2.00 3.00 X 0 0 0 ROBERT LAFSKY MD TRUSTEE 2.00 3.00 X 0 0 0 KEITH STERLING MD TRUSTEE 2.00 1.00 X 0 0 0 HOOKS 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CEO ICPH 40.00 0.00 X 1104817 0 309877 CHRISTOPHER O'CONNOR CEO IHVI 40.00 0.00 X 1041276 0 126661 SIMON CHUNG MD PHYSICIAN SUPV 40.00 0.00 X 972808 0 64320 DONALD TRUMP CEO ISCI 40.00 0.00 X 937288 0 129745 MARSHALL RUFFIN FORMER EVP CTO 40.00 10.00 X 1308680 0 201139 HPATRICK WALTERS FORMER SVP STRATEGIC PLANN 5.00 45.00 X 0 691548 126348 MAUREEN SWICK FORMER SVP COO IFH AND CNE 40.00 0.00 X 522746 0 43333 JAMES SANTRY FORMER SVP BUS DEV & MANAG 40.00 10.00 X 0 947281 303108 JOSEPH ROCHE FORMER EXEC DIR EAP 40.00 0.00 X 121823 0 36921 HUGO AGUAS FORMER AVP HR ASSOC ADMIN 40.00 0.00 X 256874 0 45636 MARY DIXON FORMER AVP CNO 40.00 0.00 X 101656 0 0 10895032 17351618 6075159 1875 1 1 0 CARDIAC VASCULAR & THORACIC 2921 TELESTAR CT FALLS CHURCH VA 22042 MEDICAL 11571263 FAIRFAX RADIOLOGICAL CONSULTANTS 2722 MERRILEE DRIVE 230 FAIRFAX VA 22031 RADIOLOGY 7248324 L2 CONSTRUCTION MANAGEMENT 40892 BIRDSTONE LANE ALDIE VA 20105 CONSULTING CONSTRUCTION 5641604 QUEST DIAGNOSTICS INC 1901 SULPHUR SPRING ROAD BALTIMORE MD 21227 MEDICAL 5205602 VOICE MEDIA LLC 108 B WEST JEFFERSON ST FALLS CHURCH VA 22046 MEDIA CONSULTING/ADVERTISING 4078041 386 8642444 10629052 19271496 Net Patient Service Revenue 622110 2565078935 2565078935 Inova Reston MRI Center LLC 621400 6354206 6354206 Northern Virginia Surgery Center 621400 4210007 4210007 Franconia-Springfield Surgery Cen 621400 3163550 3163550 Technical Dynamics, LLC 811000 2999369 2999369 1685503 1685503 2583491570 -1569556 -415670 -1153886 341796 341796 10090352 676388 35605590 0 -25515238 676388 -24838850 676388 -25515238 1615660 0 1615660 1615660 1615660 OTHER OPERATING REVENUE 900099 83914774 78238692 5676082 COMMUNITY BLOOD SERVICES 900099 6478170 6478170 LAUNDRY SERVICES 812300 209169 209169 -82493735 -82493735 8108378 2586420494 2668208432 6145969 -107205403 3242333 3242333 1061617266 899507549 162109717 55401449 42831154 12570295 86056770 69498809 16557961 67686171 56833138 10853033 3595774 2138773 1457001 2871680 35513 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-7325169 X X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 483780 483780 2196734868 2197218648 1000000 250000 0 0 1000000 1000000 1000000 1000000 4000000 6000000 229898 256133 249843 483780 1219654 250000 250000 250000 250000 1000000 1500000 182586961 182586961 1400653575 523528827 877124748 643291468 403230839 240060629 1245177774 944030431 301147343 285726493 140105668 145620825 1746540506 OTHER ASSETS 25798718 DUE FROM SUBSIDIARIES AND AFFILIATES 1910400528 1936199246 THIRD PARTY SETTLEMENTS 39571944 SELF INSURED LIABILITY 28079166 INTEREST RATE SWAP LIABILITY 2846076 70497186 X Part X, Line 2: From Inova Health System consolidated financial statements including Inova Health Care Services: The Foundation, IHCS, LHC, and INTotal Health are not-for-profit corporations and have been determined to be exempt from Federal income tax under the provisions of section 501(c)(3) of the Internal Revenue Code. IHI and its subsidiaries are taxable organizations. Deferred income taxes are provided for all significant timing differences between revenues and expenses reported for financial statement and for tax purposes. Management annually reviews its tax positions and has determined that there are no material uncertain tax positions that require recognition in the consolidated financial statements. 1 1 X 1 X 400.000000000000 1 X 1 1 1 0 1 1 114688522 114688522 0.04680 214394541 139123169 75271372 0.03070 329083063 139123169 189959894 0.07750 7582386 46722 7535664 0.00310 12868479 718419 12150060 0.00500 12586159 3257628 9328531 0.00380 18543954 7470455 11073499 0.00450 537026 537026 0.00020 52118004 11493224 40624780 0.01660 381201067 150616393 230584674 0.09410 1 52489585 0 412904773 576833585 -163928812 X 1 1 1 Franconia-Springfield Surgery Center LLC Surgical Services 0.60000 0.40000 2 Northern Virginia Surgery Center LLC Surgical Services 0.60060 0.39940 3 Inova Ambulatory Surgery Center at Lorton LLC Surgical Services 0.64470 0.35530 4 McLean Ambulatory Surgery LLC Surgical Services 0.83500 0.16500 4 1 INOVA FAIRFAX HOSPITAL 3300 GALLOWS ROAD FALLS CHURCH VA 22046 INOVA.ORG VA H1921 X X X X X X A 2 INOVA ALEXANDRIA HOSPITAL 4320 SEMINARY ROAD ALEXANDRIA VA 22304 INOVA.ORG VA H1859 X X X A 3 INOVA FAIR OAKS HOSPITAL 3600 JOSPEH SIEWICK DRIVE FAIRFAX VA 22033 INOVA.ORG VA H1922 X X X A 4 INOVA MOUNT VERNON HOSPITAL 2501 PARKER LANE ALEXANDRIA VA 22306 INOVA.ORG VA H1923 X X X A Facility Reporting Group - A 0 0 1 X X X X X X X X X 16 1 1 0 1 X www.inova.org/inova-in-the-community/index.jsp X 1 16 1 www.inova.org/inova-in-the-community/index.jsp 0 1 X 400.000000000000 400.000000000000 X X X X X X 1 1 X X X 1 X www.Inova.org X www.Inova.org X www.Inova.org X X X X X X X 1 X 0 X X X X 1 X 0 0 Part V, Section B Facility Reporting Group A Facility Reporting Group A consists of: - Facility 1: INOVA FAIRFAX HOSPITAL, - Facility 2: INOVA ALEXANDRIA HOSPITAL, - Facility 3: INOVA FAIR OAKS HOSPITAL, - Facility 4: INOVA MOUNT VERNON HOSPITAL Group A-Facility 1 -- INOVA FAIRFAX HOSPITAL Part V, Section B, line 3j: For IFMC:The hospital interviewed 62 key informants, including external stakeholders (those who represented the broad interests in the community) and internal Inova staff. The interviews were guided by a structured interview guide, and interviewees were encouraged to identify and discuss a wide range of current and emerging issues affecting community health. Interviews were conducted from August 2015 through January 2016. A detailed listing of the community stakeholders who provided community input is shown below. The hospital also sought input from the public regarding the health of the community through an online survey publicized through emails, hospital information and community partners. The survey was also available on paper in the hospital and at the local FQHC.In the process of conducting the 2016 CHNA, Inova received feedback from constituents on the 2013 CHNA process and progress made since then. At the start of the 2016 CHNA, Inova created an advisory committee in order to steer decision making, provide feedback on survey creation, interview candidates and protocols and the process by which community health needs were determined to be significant. The committee included representatives from local FQHCs, local Health Directors and a public official. Members of the committee provided feedback on the 2013 CHNA, including both the initial assessment as well as implementation of strategies to improve health since then. Additional feedback on Inova's community health improvement programs was gathered during key informant interviews.Fairfax County Board of Supervisors - General populationFairfax County Health Care Advisory Board - General population and PhysiciansFairfax County Health Department - General populationFairfax County Multicultural Advisory Council - Immigrant community, Hispanic community, Muslim community, East African community, Korean community, Indian communityFairfax County physicians - General population and PhysiciansFairfax County Public Schools - General population and Youth/adolescentsFairfax-Falls Church Community Services Board - Mentally ill population ,Substance abuse needs , Intellectually disabledGeorge Mason University, College of Health and Human Services - General population and StudentsGrace Ministries -Faith-based community and Immigrant populationInova Board of Directors - General populationInova Fairfax Hospital Internal Staff -General population and PhysiciansInova Office of Health Equity - Marginalized populations and Minority populationsNorthern Virginia Family Services - Adolescent/youth, Low income , Homeless , Mentally illNorthern Virginia Health Foundation - General population, Low Income, andUninsured/UnderinsuredPartnership for a Healthier Fairfax - General population and Business communityRoute 1 Human Services Task Force - Homeless population and Low income population Group A-Facility 1 -- INOVA FAIRFAX HOSPITAL Part V, Section B, line 6a: Inova Fair Oaks HospitalInova Mt. Vernon HospitalInova Loudoun HospitalInova Alexandria Hospital Group A-Facility 1 -- INOVA FAIRFAX HOSPITAL Part V, Section B, line 11: In 2016, each hospital within Inova Health System conducted a community health needs assessment (CHNA) in order to better assess each community's unique health needs and to develop an effective implementation strategy to address identified priority needs. Each CHNA was conducted in accordance with the guidelines established by the Patient Protection and Affordable Care Act and the Internal Revenue Service. Each CHNA considered multiple data sources, including secondary data (regarding demographics, health status indicators, and measures of health care access), assessments prepared by other organizations in recent years, and primary data derived from a community survey and from interviews with persons who represent the broad interests of each community, including public health officials and experts and hospital-affiliated clinicians, administrators and staff. The topics and data assessed in these reports include demographics, economic issues, community issues, health status indicators, health access indicators, health disparities indicators and availability of healthcare facilities and resources.Each CHNA identified a prioritized list of community health needs. From these reports, each hospital has developed a three-year implementation strategy with measurable objectives to address their unique community benefit service area for calendar (tax) years 2017 through 2019. Priorities were based on community need as determined by quantitative data and community input, as well as on hospital expertise, resources, strengths of existing programming and partnerships, and alignment with national, state, and local health goals. Based on the CHNA recommendations, Inova Fairfax Medical Campus has identified as its community benefit priorities Conditions and Care of the Aging Population, Cultural Competency in Care and Mental Health and Access to Mental Health Services. The hospital's 3-year implementation strategy was endorsed by the Inova Health Care Services Board.While the hospital was conducting the new assessment, activities continued based on the implementation strategy from the last CHNA. In this CHNA report conducted in 2013, Inova Fairfax Medical Campus identified the following significant community health needs: access to health and human services, chronic disease, dental health, health behaviors, maternal and child health, morbidity, the physical environment and social and economic factors.As described in the Implementation Strategy adopted by the Board, Inova Fairfax Medical Campus indicated that it would address many but not all of the identified needs. The hospital indicated it would not address certain elements that are beyond the scope of the medical campus or are outside of the hospital's expertise including lack of transportation, poor air quality, community safety, basic needs insecurity or poor educational achievement. The hospital also indicated that it would not address other elements that are also important but are being addressed by others, including disparities in chronic liver disease, unsafe sex, high rates of communicable diseases and high rates of Lyme disease. Since the 2013 CHNA was conducted, Inova Fairfax Medical Campus has addressed all of the significant needs as described in this Implementation Strategy. These needs were addressed by initiatives including the following: providing in-kind and financial support for community organizations seeking to improve community health and meet social services needs, participating actively in community coalitions and boards, operating the Inova Transitional Care Management Program and Discharge clinics for low-income patients without a medical home, operating InovaCares clinics for Medicaid and uninsured patients, the Inova PACE program, increasing visits for uninsured patients to Inova-affiliated specialists, expanding health promotion and education programs particularly to reduce the prevalence of diet and exercise-related health problems, increasing investment in Inova's SNAP Double Dollars Program which enhances access to healthy food, expanding the Inova Healthy Plate Club at local Title I schools, and increasing services provided by the Inova Juniper Program which is Northern Virginia's largest provider of services for HIV/AIDS patients.One of the new initiatives in 2016 included the launch of a new breastfeeding initiative at the InovaCares Clinic for Women. This initiative includes education for providers and starts patient education during their prenatal visits. Further support for breastfeeding moms includes new WIC peer lactation consultation services at the InovaCares Clinic for Children.Another new initiative in 2016 was the creation of Simplicity Health, a new group of primary care clinics that provides excellent healthcare at affordable fees. Simplicity Health is designed for working adults who may not currently receive regular primary care because they do not qualify for Medicaid, do not get health insurance through work, or have insurance with prohibitively high copays and deductibles. Sites will have providers and staff who are bilingual in a variety of languages, such as Korean, Vietnamese, Spanish, and Arabic, based on the primary languages spoken in each community where Simplicity sites are located.In 2016, Inova strengthened and increased access to some programs which provide services to particularly vulnerable individuals. In October of 2016, the Inova Ewing FACT Department was awarded a $1.1 million dollar grant through the Virginia Department of Criminal Justice Services. This grant will allow the establishment of four full time and two part time sexual assault nurse examiner positions, ensuring 24/7 coverage in the department. Transitional Care Services piloted a new initiative where case managers are assigned as TCM Hospital Liaisons, devoted to inpatient hospital outreach and admission screening. This initiative was established to increase patient engagement and close gaps that lead to readmissions. Lastly, a new site was opened which co-locates Simplicity Health, Transitional Services and the Inova Center for Wellness and Metabolic Health.While not identified for expansion of services in the 2013 CHNA, Inova continues to serve the community through many ongoing programs, including the provision of culturally competent and linguistically appropriate services; prevention, education and support through the Inova Fairfax Cancer Center; alcohol and substance abuse treatment at the Inova Comprehensive Addiction treatment Services; Medicaid managed care plans through INTotal Health; and comprehensive mental health services for children and young adults at the Inova Kellar Center. Group A-Facility 1 -- INOVA FAIRFAX HOSPITAL Part V, Section B, line 13h: Calculate family size Group A-Facility 1 -- INOVA FAIRFAX HOSPITAL Part V, Section B, line 16j: Financial Aid Brochures explaining the charity policy are available through out the Hospital. ER Rooms and waiting rooms have charity notifications posted in their areas, and the brochures are also posted on Inova's website. Group A-Facility 2 -- INOVA ALEXANDRIA HOSPITAL Part V, Section B, line 5: For IAH:The hospital interviewed 32 key informants, including external stakeholders (those who represented the broad interests in the community) and internal Inova staff. The interviews were guided by a structured interview guide, and interviewees were encouraged to identify and discuss a wide range of current and emerging issues affecting community health. Interviews were conducted from August 2015 through January 2016. A detailed listing of the community stakeholders who provided community input is shown below. The hospital also sought input from the public regarding the health of the community through an online survey publicized through emails, hospital information and community partners. The survey was also available on paper in the hospital and at the local FQHC.In the process of conducting the 2016 CHNA, Inova received feedback from constituents on the 2013 CHNA process and progress made since then. At the start of the 2016 CHNA, Inova created an advisory committee in order to steer decision making, provide feedback on survey creation, interview candidates and protocols and the process by which community health needs were determined to be significant. The committee included representatives from local FQHCs, local Health Directors and a public official. Members of the committee provided feedback on the 2013 CHNA, including both the initial assessment as well as implementation of strategies to improve health since then. Additional feedback on Inova's community health improvement programs was gathered during key informant interviews.Alexandria City Government - General populationAlexandria Community Services Board - Mentally illAlexandria Health Department - General populationAlexandria Public Health Advisory Commission - General populationArlington County Government - General populationCampagna Center - Youth, ImmigrantsGeorge Mason University, College of Health and Human Services -General population, StudentsGrace Ministries -Faith-based community, Immigrant populationsInova Alexandria Hospital Internal Staff - Health professionals and patientsInova Board of Directors - General populationInova Office of Health Equity - Marginalized populations, Minority populationsNeighborhood Health - General population, Low incomeNorthern Virginia Family Services - Adolescent/youth, Low income, Homeless, Mentally illNorthern Virginia Health Foundation - General population, Low IncomePartnership for a Healthier Alexandria - General Population, Aging Route 1 Human Services Task Force - Homeless population, Low income population Group A-Facility 2 -- INOVA ALEXANDRIA HOSPITAL Part V, Section B, line 6a: Inova Fairfax HospitalInova Loudoun HospitalInova Fair Oaks HospitalInova Mt Vernon Hospital Group A-Facility 2 -- INOVA ALEXANDRIA HOSPITAL Part V, Section B, line 11: In 2016, each hospital within Inova Health System conducted a community health needs assessment (CHNA) in order to better assess each community's unique health needs and to develop an effective implementation strategy to address identified priority needs. Each CHNA was conducted in accordance with the guidelines established by the Patient Protection and Affordable Care Act and the Internal Revenue Service. Each CHNA considered multiple data sources, including secondary data (regarding demographics, health status indicators, and measures of health care access), assessments prepared by other organizations in recent years, and primary data derived from a community survey and from interviews with persons who represent the broad interests of each community, including public health officials and experts and hospital-affiliated clinicians, administrators and staff. The topics and data assessed in these reports include demographics, economic issues, community issues, health status indicators, health access indicators, health disparities indicators and availability of healthcare facilities and resources.Each CHNA identified a prioritized list of community health needs. From these reports, each hospital has developed a three-year implementation strategy with measurable objectives to address their unique community benefit service area for calendar (tax) years 2017 through 2019. Priorities were based on community need as determined by quantitative data and community input, as well as on hospital expertise, resources, strengths of existing programming and partnerships, and alignment with national, state, and local health goals. Based on the CHNA recommendations, Inova Alexandria Hospital has identified as its community benefit priorities Conditions and Care of the Aging Population and Mental Health and Access to Mental Health Services. The hospital's 3-year implementation strategy was endorsed by the Inova Health Care Services Board.While the hospital was conducting the new assessment, activities continued based on the implementation strategy from the last CHNA. In this CHNA report conducted in 2013, Inova Alexandria Hospital identified the following significant community health needs: access to health and human services, chronic disease, dental health, health behaviors, maternal and child health, morbidity, the physical environment and social and economic factors.As described in the Implementation Strategy adopted by the Board, Inova Alexandria Hospital indicated that it would address many but not all of the identified needs. The hospital indicated it would not address certain elements that are beyond the scope of the medical campus or are outside of the hospital's expertise including disparities in infant health outcomes, poor air quality, and basic needs insecurity. The hospital also indicated that it would not address other elements that are also important but are being addressed by others, including disparities in chronic liver disease, unsafe sex and teen pregnancy and high rates of communicable diseases. Since the 2013 CHNA was conducted, Inova Alexandria Hospital has addressed all of the significant needs as described in this Implementation Strategy. These needs were addressed by initiatives including the following: providing in-kind and financial support for community organizations seeking to improve community health and meet social services needs, participating actively in community coalitions and boards, operating the Inova Transitional Care Management Program and Discharge clinics for low-income patients without a medical home, operating InovaCares clinics for Medicaid and uninsured patients, the Inova PACE program, increasing visits for uninsured patients to Inova-affiliated specialists, expanding health promotion and education programs particularly to reduce the prevalence of diet and exercise-related health problems, increasing investment in Inova's SNAP Double Dollars Program which enhances access to healthy food, expanding the Inova Healthy Plate Club at local Title I schools, and increasing services provided by the Inova Juniper Program which is Northern Virginia's largest provider of services for HIV/AIDS patients.One of the new initiatives in 2016 included the launch of a new breastfeeding initiative at the InovaCares Clinic for Women. This initiative includes education for providers and starts patient education during their prenatal visits. Further support for breastfeeding moms includes new WIC peer lactation consultation services at the InovaCares Clinic for Children.Another new initiative in 2016 was the creation of Simplicity Health, a new group of primary care clinics that provides excellent healthcare at affordable fees. Simplicity Health is designed for working adults who may not currently receive regular primary care because they do not qualify for Medicaid, do not get health insurance through work, or have insurance with prohibitively high copays and deductibles. Sites will have providers and staff who are bilingual in a variety of languages, such as Korean, Vietnamese, Spanish, and Arabic, based on the primary languages spoken in each community where Simplicity sites are located.In 2016, Inova strengthened and increased access to some programs which provide services to particularly vulnerable individuals. In October of 2016, the Inova Ewing FACT Department was awarded a $1.1 million dollar grant through the Virginia Department of Criminal Justice Services. This grant will allow the establishment of four full time and two part time sexual assault nurse examiner positions, ensuring 24/7 coverage in the department. Transitional Care Services piloted a new initiative where case managers are assigned as TCM Hospital Liaisons, devoted to inpatient hospital outreach and admission screening. This initiative was established to increase patient engagement and close gaps that lead to readmissions. Lastly, a new site was opened which co-locates Simplicity Health, Transitional Services and the Inova Center for Wellness and Metabolic Health.While not identified for expansion of services in the 2013 CHNA, Inova continues to serve the community through many ongoing programs, including the provision of culturally competent and linguistically appropriate services; prevention, education and support through the Inova Alexandria Cancer Center; alcohol and substance abuse treatment at the Inova Comprehensive Addiction treatment Services; Medicaid managed care plans through INTotal Health; and comprehensive mental health services for children and young adults at the Inova Kellar Center. Group A-Facility 2 -- INOVA ALEXANDRIA HOSPITAL Part V, Section B, line 13h: Calculate family size Group A-Facility 2 -- INOVA ALEXANDRIA HOSPITAL Part V, Section B, line 16j: Financial Aid Brochures explaining the charity policy are available through out the Hospital. ER Rooms and waiting rooms have charity notifications posted in their areas, and the brochures are also posted on Inova's website. Group A-Facility 3 -- INOVA FAIR OAKS HOSPITAL Part V, Section B, line 5: For IFOH:The hospital interviewed 64 key informants, including external stakeholders (those who represented the broad interests in the community) and internal Inova staff. The interviews were guided by a structured interview guide, and interviewees were encouraged to identify and discuss a wide range of current and emerging issues affecting community health. Interviews were conducted from August 2015 through January 2016. A detailed listing of the community stakeholders who provided community input is shown below. The hospital also sought input from the public regarding the health of the community through an online survey publicized through emails, hospital information and community partners. The survey was also available on paper in the hospital and at the local FQHC.In the process of conducting the 2016 CHNA, Inova received feedback from constituents on the 2013 CHNA process and progress made since then. At the start of the 2016 CHNA, Inova created an advisory committee in order to steer decision making, provide feedback on survey creation, interview candidates and protocols and the process by which community health needs were determined to be significant. The committee included representatives from local FQHCs, local Health Directors and a public official. Members of the committee provided feedback on the 2013 CHNA, including both the initial assessment as well as implementation of strategies to improve health since then. Additional feedback on Inova's community health improvement programs was gathered during key informant interviews.Fairfax County Board of Supervisors - General populationFairfax County Health Care Advisory Board -General population and PhysiciansFairfax County Health Department - General populationFairfax County Multicultural Advisory Council - mmigrant community, Hispanic community, Muslim community, East African community, Korean community, Indian communityFairfax County physicians -General population and PhysiciansFairfax County Public Schools - General population and Youth/adolescentsFairfax-Falls Church Community Services Board - Mentally ill population, Substance abuse needs , Intellectually disabledGeorge Mason University, College of Health and Human Services - General population and StudentsGrace Ministries - Faith-based community, Immigrant populationHealthWorks for Northern Virginia - General population, Low income, Uninsured/UnderinsuredInova Board of Directors - General populationInova Fair Oaks Hospital Internal Staff -General population and PhysiciansInova Office of Health Equity - Marginalized populations, Minority populationsNorthern Virginia Family Services - Adolescent/youth, Low income, Homeless, Mentally illNorthern Virginia Health Foundation- General population, Low Income, Uninsured/UnderinsuredPartnership for a Healthier Fairfax - General population, Business communityRoute 1 Human Services Task Force - Homeless population, Low income population Group A-Facility 3 -- INOVA FAIR OAKS HOSPITAL Part V, Section B, line 6a: Inova Fairfax HospitalInova Mt. Vernon HospitalInova Alexandria HospitalInova Loudoun Hospital Group A-Facility 3 -- INOVA FAIR OAKS HOSPITAL Part V, Section B, line 11: In 2016, each hospital within Inova Health System conducted a community health needs assessment (CHNA) in order to better assess each community's unique health needs and to develop an effective implementation strategy to address identified priority needs. Each CHNA was conducted in accordance with the guidelines established by the Patient Protection and Affordable Care Act and the Internal Revenue Service. Each CHNA considered multiple data sources, including secondary data (regarding demographics, health status indicators, and measures of health care access), assessments prepared by other organizations in recent years, and primary data derived from a community survey and from interviews with persons who represent the broad interests of each community, including public health officials and experts and hospital-affiliated clinicians, administrators and staff. The topics and data assessed in these reports include demographics, economic issues, community issues, health status indicators, health access indicators, health disparities indicators and availability of healthcare facilities and resources.Each CHNA identified a prioritized list of community health needs. From these reports, each hospital has developed a three-year implementation strategy with measurable objectives to address their unique community benefit service area for calendar (tax) years 2017 through 2019. Priorities were based on community need as determined by quantitative data and community input, as well as on hospital expertise, resources, strengths of existing programming and partnerships, and alignment with national, state, and local health goals. Based on the CHNA recommendations, Inova Fair Oaks Hospital has identified as its community benefit priorities Access to Dental Care and Childhood Obesity. The hospital's 3-year implementation strategy was endorsed by the Inova Health Care Services Board.While the hospital was conducting the new assessment, activities continued based on the implementation strategy from the last CHNA. In this CHNA report conducted in 2013, Inova Fair Oaks Hospital identified the following significant community health needs: access to health and human services, chronic disease, dental health, health behaviors, maternal and child health, mental health, morbidity, the physical environment and social and economic factors.As described in the Implementation Strategy adopted by the Board, Inova Fair Oaks Hospital indicated that it would address many but not all of the identified needs. The hospital indicated it would not address certain elements that are beyond the scope of the medical campus or are outside of the hospital's expertise including poor air quality, community safety, basic needs insecurity or poor educational achievement. The hospital also indicated that it would not address other elements that are also important but are being addressed by others, including disparities in chronic liver disease, unsafe sex, high rates of Tuberculosis and high rates of Lyme disease. Since the 2013 CHNA was conducted, Inova Fair Oaks Hospital has addressed all of the significant needs as described in this Implementation Strategy. These needs were addressed by initiatives including the following: providing in-kind and financial support for community organizations seeking to improve community health and meet social services needs, participating actively in community coalitions and boards, operating the Inova Transitional Care Management Program and Discharge clinics for low-income patients without a medical home, operating InovaCares clinics for Medicaid and uninsured patients, the Inova PACE program, increasing visits for uninsured patients to Inova-affiliated specialists, expanding health promotion and education programs particularly to reduce the prevalence of diet and exercise-related health problems, increasing investment in Inova's SNAP Double Dollars Program which enhances access to healthy food, expanding the Inova Healthy Plate Club at local Title I schools and increasing services provided by the Inova Juniper Program which is Northern Virginia's largest provider of services for HIV/AIDS patients.One of the new initiatives in 2016 included the launch of a new breastfeeding initiative at the InovaCares Clinic for Women. This initiative includes education for providers and starts patient education during their prenatal visits. Further support for breastfeeding moms includes new WIC peer lactation consultation services at the InovaCares Clinic for Children.Another new initiative in 2016 was the creation of Simplicity Health, a new group of primary care clinics that provides excellent healthcare at affordable fees. Simplicity Health is designed for working adults who may not currently receive regular primary care because they do not qualify for Medicaid, do not get health insurance through work, or have insurance with prohibitively high copays and deductibles. Sites will have providers and staff who are bilingual in a variety of languages, such as Korean, Vietnamese, Spanish, and Arabic, based on the primary languages spoken in each community where Simplicity sites are located.In 2016, Inova strengthened and increased access to some programs which provide services to particularly vulnerable individuals. In October of 2016, the Inova Ewing FACT Department was awarded a $1.1 million dollar grant through the Virginia Department of Criminal Justice Services. This grant will allow the establishment of four full time and two part time sexual assault nurse examiner positions, ensuring 24/7 coverage in the department. Transitional Care Services piloted a new initiative where case managers are assigned as TCM Hospital Liaisons, devoted to inpatient hospital outreach and admission screening. This initiative was established to increase patient engagement and close gaps that lead to readmissions. Lastly, a new site was opened which co-locates Simplicity Health, Transitional Services and the Inova Center for Wellness and Metabolic Health.While not identified for expansion of services in the 2013 CHNA, Inova continues to serve the community through many ongoing programs, including the provision of culturally competent and linguistically appropriate services; prevention, education and support through the Inova Fair Oaks Cancer Center; alcohol and substance abuse treatment at the Inova Comprehensive Addiction treatment Services; Medicaid managed care plans through INTotal Health; and comprehensive mental health services for children and young adults at the Inova Kellar Center. Group A-Facility 3 -- INOVA FAIR OAKS HOSPITAL Part V, Section B, line 13h: Calculate family size Group A-Facility 3 -- INOVA FAIR OAKS HOSPITAL Part V, Section B, line 16j: Financial Aid Brochures explaining the charity policy are available through out the Hospital. ER Rooms and waiting rooms have charity notifications posted in their areas, and the brochures are also posted on Inova's website. Group A-Facility 4 -- INOVA MOUNT VERNON HOSPITAL Part V, Section B, line 5: For IMVH:The hospital interviewed 80 key informants, including external stakeholders (those who represented the broad interests in the community) and internal Inova staff. The interviews were guided by a structured interview guide, and interviewees were encouraged to identify and discuss a wide range of current and emerging issues affecting community health. Interviews were conducted from August 2015 through January 2016. A detailed listing of the community stakeholders who provided community input is shown below. The hospital also sought input from the public regarding the health of the community through an online survey publicized through emails, hospital information and community partners. The survey was also available on paper in the hospital and at the local FQHC.In the process of conducting the 2016 CHNA, Inova received feedback from constituents on the 2013 CHNA process and progress made since then. At the start of the 2016 CHNA, Inova created an advisory committee in order to steer decision making, provide feedback on survey creation, interview candidates and protocols and the process by which community health needs were determined to be significant. The committee included representatives from local FQHCs, local Health Directors and a public official. Members of the committee provided feedback on the 2013 CHNA, including both the initial assessment as well as implementation of strategies to improve health since then. Additional feedback on Inova's community health improvement programs was gathered during key informant interviews.Alexandria City Government - General populationAlexandria Community Services Board - Mentally ill population, Substance abuse needs, Intellectually disabledAlexandria Health Department - General populationAlexandria Public Health Advisory Commission - General populationCampagna Center - Youth, Immigrants , ImpoverishedFairfax County Board of Supervisors - General populationFairfax County Health Care Advisory Board - General population, PhysiciansFairfax County Health Department - General populationFairfax County Multicultural Advisory Council - Immigrant community, Hispanic community, Muslim community, East African community, Korean community, Indian communityFairfax County Public Schools - General population, Youth/adolescentsFairfax-Falls Church Community Services Board - Mentally ill population, Substance abuse needs, Intellectually disabledGeorge Mason University, College of Health and Human Services - General population, StudentsGrace Ministries - Faith-based community, Immigrant populationInova Board of Directors - General populationInova Mount Vernon Hospital Internal Staff - General population, PhysiciansInova Office of Health Equity - Marginalized populations, Minority populationsNeighborhood Health - General population, Low income , Uninsured/UnderinsuredNorthern Virginia Family Services - Adolescent/youth, Low income, Homeless, Mentally illNorthern Virginia Health Foundation - General population, Low Income, Uninsured/UnderinsuredPartnership for a Healthier Alexandria - General Population, Aging Partnership for a Healthier Fairfax - General population, Business communityRoute 1 Human Services Task Force - Homeless population, Low income population Group A-Facility 4 -- INOVA MOUNT VERNON HOSPITAL Part V, Section B, line 6a: Inova Loudoun HospitalInova Fairfax HospitalInova Fair Oaks HospitalInova Alexandria Hospital Group A-Facility 4 -- INOVA MOUNT VERNON HOSPITAL Part V, Section B, line 11: In 2016, each hospital within Inova Health System conducted a community health needs assessment (CHNA) in order to better assess each community's unique health needs and to develop an effective implementation strategy to address identified priority needs. Each CHNA was conducted in accordance with the guidelines established by the Patient Protection and Affordable Care Act and the Internal Revenue Service. Each CHNA considered multiple data sources, including secondary data (regarding demographics, health status indicators, and measures of health care access), assessments prepared by other organizations in recent years, and primary data derived from a community survey and from interviews with persons who represent the broad interests of each community, including public health officials and experts and hospital-affiliated clinicians, administrators and staff. The topics and data assessed in these reports include demographics, economic issues, community issues, health status indicators, health access indicators, health disparities indicators and availability of healthcare facilities and resources.Each CHNA identified a prioritized list of community health needs. From these reports, each hospital has developed a three-year implementation strategy with measurable objectives to address their unique community benefit service area for calendar (tax) years 2017 through 2019. Priorities were based on community need as determined by quantitative data and community input, as well as on hospital expertise, resources, strengths of existing programming and partnerships, and alignment with national, state, and local health goals. Based on the CHNA recommendations, Inova Mount Vernon Hospital has identified as its community benefit priorities Conditions and Care of the Aging Population, Diabetes, and Mental Health and Access to Mental Health Services. The hospital's 3-year implementation strategy was endorsed by the Inova Health Care Services Board.While the hospital was conducting the new assessment, activities continued based on the implementation strategy from the last CHNA. In this CHNA report conducted in 2013, Inova Mount Vernon Hospital identified the following significant community health needs: access to health and human services, chronic disease, dental health, health behaviors, maternal and child health, mental health, morbidity, the physical environment and social and economic factors.As described in the Implementation Strategy adopted by the Board, Inova Mount Vernon Hospital indicated that it would address many but not all of the identified needs. The hospital indicated it would not address certain elements that are beyond the scope of the medical campus or are outside of the hospital's expertise including disparities in mortality, poor air quality, or basic needs insecurity. The hospital also indicated that it would not address other elements that are also important but are being addressed by others, including high rates of cancer incidence and disparities in cancer mortality, insufficient case/care management for seniors, disparities in chronic liver disease, unsafe sex and teen pregnancy and high rates of communicable diseases. Since the 2013 CHNA was conducted, Inova Mount Vernon Hospital has addressed all of the significant needs as described in this Implementation Strategy. These needs were addressed by initiatives including the following: providing in-kind and financial support for community organizations seeking to improve community health and meet social services needs, participating actively in community coalitions and boards, operating the Inova Transitional Care Management Program and Discharge clinics for low-income patients without a medical home, operating InovaCares clinics for Medicaid and uninsured patients, the Inova PACE program, increasing visits for uninsured patients to Inova-affiliated specialists, expanding health promotion and education programs particularly to reduce the prevalence of diet and exercise-related health problems, increasing investment in Inova's SNAP Double Dollars Program which enhances access to healthy food, expanding the Inova Healthy Plate Club at local Title I schools, and increasing services provided by the Inova Juniper Program which is Northern Virginia's largest provider of services for HIV/AIDS patients.One of the new initiatives in 2016 included the launch of a new breastfeeding initiative at the InovaCares Clinic for Women. This initiative includes education for providers and starts patient education during their prenatal visits. Further support for breastfeeding moms includes new WIC peer lactation consultation services at the InovaCares Clinic for Children.Another new initiative in 2016 was the creation of Simplicity Health, a new group of primary care clinics that provides excellent healthcare at affordable fees. Simplicity Health is designed for working adults who may not currently receive regular primary care because they do not qualify for Medicaid, do not get health insurance through work, or have insurance with prohibitively high copays and deductibles. Sites will have providers and staff who are bilingual in a variety of languages, such as Korean, Vietnamese, Spanish, and Arabic, based on the primary languages spoken in each community where Simplicity sites are located.In 2016, Inova strengthened and increased access to some programs which provide services to particularly vulnerable individuals. In October of 2016, the Inova Ewing FACT Department was awarded a $1.1 million dollar grant through the Virginia Department of Criminal Justice Services. This grant will allow the establishment of four full time and two part time sexual assault nurse examiner positions, ensuring 24/7 coverage in the department. Transitional Care Services piloted a new initiative where case managers are assigned as TCM Hospital Liaisons, devoted to inpatient hospital outreach and admission screening. This initiative was established to increase patient engagement and close gaps that lead to readmissions. Lastly, a new site was opened which co-locates Simplicity Health, Transitional Services and the Inova Center for Wellness and Metabolic Health.While not identified for expansion of services in the 2013 CHNA, Inova continues to serve the community through many ongoing programs, including the provision of culturally competent and linguistically appropriate services; prevention, education and support through the Inova Mount Vernon Cancer Center; alcohol and substance abuse treatment at the Inova Comprehensive Addiction treatment Services; Medicaid managed care plans through INTotal Health; and comprehensive mental health services for children and young adults at the Inova Kellar Center. Group A-Facility 4 -- INOVA MOUNT VERNON HOSPITAL Part V, Section B, line 13h: Calculate family size Group A-Facility 4 -- INOVA MOUNT VERNON HOSPITAL Part V, Section B, line 16j: Financial Aid Brochures explaining the charity policy are available through out the Hospital. ER Rooms and waiting rooms have charity notifications posted in their areas, and the brochures are also posted on Inova's website. 32 1 - RADIOLOGY IMAGING ASSOCIATES LLC 19455 DEERFIELD AVENUE SUITE 102 LANSDOWNE VA 20176 IMAGING CENTER 2 - EMERGENCY CARE CENTER OF FAIRFAX 4315 CHAIN BRIDGE ROAD FAIRFAX VA 22030 EMERGENCY ROOM 3 - NORTHERN VIRGINIA SURGERY CENTER LLC 3620 JOSEPH SIEWICK DRIVE FAIRFAX VA 22033 OUTPATIENT SURGERY 4 - FRANCONIA SPRINGFIELD SURGERY CENTER LLC 6355 WALKER LANE SUITE 200 ALEXANDRIA VA 22310 OUTPATIENT SURGERY 5 - INOVA RESTON MRI CENTER LLC 2722 MERRILLE DRIVE SUITE 230 FAIRFAX VA 22031 MRI CENTER 6 - ASSISTED LIVING AT FAIR OAKS 3750 JOSEPH SIEWICK DRIVE FAIRFAX VA 22033 ASSISTED LIVING 7 - EMERGENCY CARE CENTER OF RESTON 11901 BARON CAMERON AVENUE RESTON VA 20190 EMERGENCY ROOM 8 - ASSISTED LIVING AT MCLEAN 8315 TURNING LEAF MCLEAN VA 22102 ASSISTED LIVING 9 - ASSISTED LIVING AT RESTON TOWN CENTER 1778 FOUNTAIN DRIVE RESTON VA 20190 ASSISTED LIVING 10 - INOVA AMBULATORY SURGERY CENTER AT LORTO 9321 SANGER STREET LORTON VA 22079 OUTPATIENT SURGERY 11 - ASSISTED LIVING AT MT VERNON 8033 HOLLAND ROAD ALEXANDRIA VA 22306 ASSISTED LIVING 12 - INSTITUTE OF RESEARCH AND EDUCATION 3300 GALLOWS ROAD FALLS CHURCH VA 22042 RESEARCH FACILITY 13 - INOVA URGENT CARE CENTER - BALLSTON 1005 NORTH GLEBE ROAD SUITE 160 ARLINGTON VA 22201 URGENT CARE 14 - KELLAR 11204 WAPLES MILL ROAD FAIRFAX VA 22030 BEHAVIORAL SERVICES 15 - ASSISTED LIVING AT GEORGE MASON 4300 CHAIN BRIDGE ROAD FAIRFAX VA 22030 ASSISTED LIVING 16 - POTOMAC RADIATION ONCOLOGY 2296 OPITZ BLVD WOODBRIDGE VA 22191 RADIATION ONCOLOGY 17 - INOVA URGENT CARE CENTER - DULLES SOUTH 24801 PINEBROOK ROAD SUITE 110 CHANTILLY VA 20152 URGENT CARE 18 - INOVA URGENT CARE CENTER - VIENNA 100 MAPLE AVENUE EAST VIENNA VA 22180 URGENT CARE 19 - INOVA URGENT CARE CENTER - CENTREVILLE 6201 CENTREVILLE ROAD SUITE 200 CENTREVILLE VA 20121 URGENT CARE 20 - INOVA PHYSICAL THERAPY CENTER - CENTREVI 6201 CENTREVILLE ROAD SUITE 500 CENTREVILLE VA 20121 REHABILITATION 21 - INOVA PHYSICAL THERAPY CENTER - VIENNA 8320 OLD COURTHOUSE ROAD SUITE 410 VIENNA VA 22182 REHABILITATION 22 - INOVA PHYSICAL THERAPY CENTER-WOODBRIDGE 14605 POTOMAC BRANCH DRIVE SUITE 210 WOODBRIDGE VA 22191 REHABILITATION 23 - INOVA PHYSICAL THERAPY CENTER - FAIROAKS 3620 JOSEPH SIEWICK DRIVE SUITE 101 FAIRFAX VA 22033 REHABILITATION 24 - INOVA PHYSICAL THERAPY CTR - SPRINGFIELD 8348 TRAFORD LANE SUITE 100 SPRINGFIELD VA 22152 REHABILITATION 25 - INOVA URGENT CARE CENTER - PURCELLVILLE 205 HIRST ROAD SUITE 101 PURCELLVILLE VA 20132 URGENT CARE 26 - INOVA PHYSICAL THERAPY CENTER - DULLES 24801 PINEBROOK ROAD SUITE 200 CHANTILLY VA 20152 REHABILITATION 27 - INOVA PHYSICAL THERAPY CENTER - ASHBURN 20905 PROFESSIONAL PLAZA SUITE 110 ASHBURN VA 20147 REHABILITATION 28 - INOVA PHYSICAL THERAPY CENTER - BALLSTON 1005 NORTH GLEBE ROAD SUITE 400 ARLINGTON VA 22201 REHABILITATION 29 - INOVA PHYSICAL THERAPY CENTER- MT VERNON 8101 HINSON FARM ROAD SUITE 401 ALEXANDRIA VA 22306 REHABILITATION 30 - MCLEAN AMBULATORY SURGERY LLC 7601 LEWINSVILLE ROAD SUITE 440 MCLEAN VA 22102 OUTPATIENT SURGERY 31 - CATS 3300 GALLOWS ROAD FALLS CHURCH VA 22042 BEHAVIORAL SERVICES 32 - WOODBURN SURGERY CENTER 3289 WOODBURN ROAD FALLS CHURCH VA 22003 OUTPATIENT SURGERY Part I, Line 6a: THE COMMUNITY BENEFIT REPORT IS INCLUDED IN THE CONSOLIDATED INOVA HEALTH SYSTEM REPORT TO THE COMMUNITY ON INOVA.ORG WEBSITE. Part I, Line 7: Cost to charge ratio method is used based on table 2 in the instructions. Total operating expense is divided by Total Gross Revenue to arrive at the cost to charge ratio. Part I, Line 7g: Cost of Physician Clinic is $5,329,418. Part I, Line 7, Column (f): The Bad Debt expense included on Form 990, Part IX, Line 25, Column (A), but subtracted for purposes of calculating the percentage in this column is $ 117,216,582. Part II, Community Building Activities: Inova's Office of Sustainability provided community building support focused on environmental improvements. Environmental Mission Statement:Inova Health System is committed to establishing an environmental program that is safer and healthier for our patients, employees, and the community.Community Building Environmental Improvements Waste ManagementInova has been focused on waste reduction strategies including recycling and segregation since 2008. Throughout the hospitals there is a single stream recycling process and there are focused efforts on reducing regulated medical waste. In 2016, Inova recycled or diverted approximately 1 million pounds of material from local landfills and waste to energy facilities.Specialized areas recycling (ORs, kitchens): Inova has implemented specialized recycling programs to capture specific materials throughout our hospitals including a medical donation program that shipped 88,000 pounds of unused, unopened medical supplies and durable medical equipment to places in need both in the local community and across the globe.EnergyDuring 2016, Inova continued to make progress towards its energy goal of reducing energy use intensity (EUI) 20 percent by the year 2020 (2012 baseline year). A number of lighting upgrades, steam trap audits and repairs, chiller upgrades and energy monitoring, all contributed to an EUI reduction of more than 2 percent over last year. These efforts result in costs savings and improved resilience for the overall health of the community.WaterInova continues to maintain native plantings and low-impact irrigation systems for landscaping as well as reduce water consumption in our hospitals through the routine replacement of less efficient plumbing fixtures. BuildingsAchieved LEED Silver certification at the Inova Women's Hospital and Inova Children's Hospital building on the Fairfax Campus and are awaiting approval for LEED certification on the North Patient Tower. Implemented a number of green design elements into the newly constructed Emergency Department at Inova Mount Vernon Hospital and established minimum LEED certification requirements for projects under development at the Inova Center for Personalized Health. TransportationPartnered with Fairfax County Department of Transportation to promote alternative commuting options for Inova employees. Executed programs including the Employee Commuter Shuttle, reserved parking for carpools and vanpools, bike racks, and a pre-tax commuter benefits program that aid Inova in the reduction of air pollution and traffic congestion. FoodContinued to promote Community Supported Agriculture (CSA) program that includes locations across the health system. The program helps highlight the importance of local farmers and brings fresh, healthy, seasonal foods to employees. Coordinated healthy cooking classes at all hospitals across the system, promoting a combination of local, organic and seasonal healthy food options. These classes not only highlight the importance of local and healthy foods, but also provide important cooking skills that will benefit employees at home. Sponsor of the Northern Virginia Chapter of Buy Fresh, Buy Local, a nationally recognized program that is dedicated to reintroducing Americans to their food - the seeds it grows from, the farmers who produce it, and the routes that carry it from the fields to their tables. CommunityDistributed over 500 native tree seedlings to be planted within the local community in 2016 in support of Earth Day.Mentored peer organizations locally and nationally on sustainable practices through a combination of formal speaking engagements, news article publications and informal discussions, helping them create safer environments for their patients, employees, and communities. Part III, Line 4: BAD DEBT FOOTNOTE FROM INOVA HEALTH SYSTEM CONSOLIDATED FINANCIAL STATEMENTSPatient accounts receivable include charges for amounts due from all patients less allowances for the excess of established charges over the payments to be received on behalf of patients covered by Medicare, Medicaid and other insurers. The provision for bad debts is recognized when providing an allowance for uncollectible accounts.All operating entities of IHS treat emergency patients regardless of their ability to pay. A patient is classified as a charity patient based upon established IHS policies that consider patient income levels. Since IHS does not pursue collection of amounts that qualify as charity care, they are deducted from gross revenue. Part III, Line 8: The organization does not treat any Medicare shortfall as community benefit. The amounts are taken directly from the Medicare Cost Reports as filed using a cost to charge ratio method. Part III, Line 9b: Patients who have not applied for Financial Assistance under this policy will be treated as self-pay and subject to Inova's normal billing and collections processes.All patient responsibility portions of Inova's accounts will process through Inova's billing and collection systems for effective in-house collections and within federal guidelines for transitioning to external collection agencies after in-house efforts have been exhausted. Patient responsibility portions will be processed through pre-billing, statement, and follow-up in automated and systematic steps. All collections actions will be in compliance with the Fair Debt Collection Practices Act and ACA International's Code of Ethics and Professional Responsibility.Patients will receive statements for 120 days. After 120 days, with no contact from the patient and without the establishment of acceptable payment terms, accounts will be transferred to a professional collection agency. If continued non-payment occurs beyond a reasonable period of time, legal actions may be undertaken to collect payment.If a patient wishes to make payment arrangements and does not have resources to pay the account in full, payment plans will be offered.No Inova entity or third-party collections agent will impose extraordinary collections actions such as legal actions or adverse credit reporting against any patient, without first making reasonable efforts to determine whether that patient is eligible for Financial Assistance under this policy. These reasonable efforts include:Assuring that no extraordinary collections actions are imposed for at least 120 days from the date of the first billing statement, andProviding a 30-day written notice that includes information about Inova's Financial Assistance Policy and about any intended extraordinary collections actions to be imposed in the event of nonpayment.If a patient is determined to be eligible for Financial Assistance after payment is received or after an extraordinary collections action has been imposed, the account will be adjusted and the collections action will be reversed. PART III, LINE 2 AND 3 Actual bad debt expense is multiplied by the cost to charge ratio used in computing charity care expense in Part I. The provision for bad debts is recognized when providing an allowance for uncollectible accounts.The are no estimated amounts for bad debt expense attributable to patients under the organization's charity care policy. Part VI, Line 2: Inova Health System (IHS) completed a Community Health Needs Assessment (CHNA) in 2016 to identify priority health status and access issues for particular geographic areas and populations by focusing on the following questions: Who in the community is most vulnerable in terms of health status or access to care?What are the unique health status and/or access needs for these populations?Where do these people live in the community? Why are these problems present?Inova's CHNA considers multiple data sources, including secondary data (regarding demographics, health status indicators, and measures of health care access), assessments prepared by other organizations in recent years, and primary data derived from a community survey and from interviews with persons who represent the broad interests of the community, including those with expertise in public health.The following topics and data are assessed in Inova's CHNA report:Demographics, e.g., numbers and locations of vulnerable people;Economic issues, e.g., poverty and unemployment rates, and impacts of state or local budget changes;Community issues, e.g., homelessness, housing, environmental concerns, crime, and availability of social services;Health status indicators, e.g. morbidity rates for various diseases and conditions, and mortality rates for leading causes of death;Health access indicators, e.g., uninsurance rates, discharges for ambulatory care sensitive conditions (ACSC), and use of emergency departments for non-emergent care;Health disparities indicators; andAvailability of healthcare facilities and resources. The assessment identifies a list of significant community health needs.As a result of this work and previous work, each Inova hospital selected 2-3 priority areas to focus on for the next few years, and is moving forward with developing coordinated efforts within the health system to carry out the designed implementation plans of the Community Health Needs Assessment. The Program Outreach Administrator is coordinating plans with hospital leaders to assure effective plan implementation in each of the respective communities. The Program Outreach Administrator is centralized to the system under the Assistant Vice President of Community Health Services and thereby assures system coordinated efforts are centralized and reflective of Inova Health System's work across Northern Virginia.The various Public Health Departments also conduct community health needs assessments using the framework of the Mobilizing for Action through Planning and Partnerships (MAPP) process. Inova Health System is a participating member of the MAPP process in each jurisdiction across Northern Virginia. Most of these are in the action phases, while Arlington County is about to start a new cycle in 2017. The MAPP process leads to an ongoing community-driven planning process that is designed to provide information for improving the community's delivery of the ten essential public health services. This process brings together a diverse group of key community stakeholders including local government, human service organizations, schools and universities, healthcare consumers, advocacy groups, hospitals, faith institutions, youth development organizations, economic and philanthropic groups, etc. to identify strengths and weaknesses in the ten essential areas to provide a foundation for community health planning. The information from the MAPP health needs assessments in all jurisdictions served by Inova Health System, as well as the ongoing work of the action teams, were incorporated into the community needs assessment implementation plans that were finalized in 2016. In addition to these activities, Inova is continually garnering feedback on existing safety net and community programs from participants through monthly and quarterly satisfaction surveys and focus groups, participating in regional and local health related groups such as the Northern Virginia Access to Health Care Consortium, meeting with various cultural and ethnic groups in the community and using internal utilization and outcomes data, review of best practices and regional and national benchmark data and other external sources such as the Metropolitan Washington Council of Governments (COG) demographic data to develop strategic goals for health improvement activities. Collectively, all this information is utilized in assessing community health needs to guide strategic planning efforts. Part VI, Line 3: Inova Health System utilizes a multifaceted approach to educate and inform patients and the public about Inova's Financial Assistance Policy (FAP) or charity care policy. Upon admission to any Inova hospital or any visit to outpatient facilities or clinics including emergency departments, Inova has information posted regarding patient rights and responsibilities. In addition, Inova provides information about the charity care program and referrals to meet with Inova financial counselors who assist patients in completing Inova's charity care application. This financial information is reviewed by the Inova Patient Accounts Department with the patient contacted if additional information is required in order to make a determination. The patient is subsequently provided a letter notifying them as to whether or not they qualify for charity care. Inova also has Medicaid eligibility workers on-site in all hospitals, in the InovaCares Clinic for Women and Children (clinic for low income families) and in the community as part of the Partnership for Healthier Kids Access to Care program. Inova partners with schools across the jurisdiction to provide information about state funded health programs for children and contact information to meet with an eligibility worker responsible for enrolling families in state Medicaid programs. These eligibility workers also go out into the community attending community events such as health fairs, faith-based community activities and other family centered community events to proactively meet with families to encourage enrollment in programs for which they are eligible. Inova has a section of the public website dedicated to information about billing and financial coordinators and financial assistance resources. On the site, a brochure called "Your Guide to Financial Help for Health Care Services" can be downloaded and is available in 6 languages to address the needs of the culturally diverse community Inova serves. Part VI, Line 4: Inova Health Care Services (IHCS) is a not-for-profit corporation and a subsidiary of the parent organization, Inova Health System Foundation (Inova). Inova provides healthcare and related services throughout Northern Virginia and the greater metropolitan Washington, D.C. area, including certain contiguous counties of Virginia and Maryland. Northern Virginia is one of the fastest growing urban communities in the United States. With approximately 1,314 square miles, the region is the most densely populated in the Commonwealth of Virginia. Northern Virginia is comprised of several distinct communities, including the cities of Alexandria, Fairfax, Falls Church, Manassas and Manassas Park, and the counties of Arlington, Fairfax, Loudoun, and Prince William. The eastern sections are urbanized with attendant health problems of overcrowding and increasing demand for health services and public programs. Inova Health Care Services' service area is primarily the cities of Alexandria, Fairfax and Falls Church and Fairfax County.The region's population served by IHCS is forecasted to grow 9% over the next decade adding an estimated average of 12,000 persons a year. Population will be spurred by the long-term strength of the region's economy, high rates of in-migration and international immigration. The region's population that is 65 years of age and older is expected to grow 45% over the next 10 years, while the number of children will increase by about 3% during the same time period. (MWCOG 8.4 and ESRI)Northern Virginia's racial and ethnic diversity is more pronounced than in the rest of the state. With increasing diversity, economically disadvantaged populations and multiple languages, the need for access to culturally appropriate, flexible health care continues to grow. The Northern Virginia geographic region in 2015 was 48% minority, up from 28% in 1990, while the nation as a whole reflects a 38% minority population (U.S. Census Bureau). Fairfax County, with more than one million residents, is the largest jurisdiction in Northern Virginia and also has the largest minority population. In Fairfax County in 2015 Asians, Hispanics, and African Americans represented 19.5%, 16.4%, and 10.1% of the county's population, respectively. More than one-quarter of the state's Hispanic population resides in Fairfax County (U.S. Census Bureau).According to the US Census Bureau Small Area Health Insurance Estimates (SAHIE) in 2014 approximately 10.9% of the total population under the age of 65 (about 108,000 people) in Fairfax County lacked healthcare insurance. Of the people living in Fairfax County whose family incomes are at or below 200% of the federal poverty level, SAHIE estimates that 33.8% (about 52,000 people) were uninsured in 2014.Area residents most likely to be uninsured are those whose family incomes are at or below 200% of the poverty level, young adults (age 18-44), people of racial backgrounds other than White, unemployed individuals, part-time workers, and people who work at companies with fewer than 50 employees. Serving this population poses significant cultural and linguistic challenges, and these uninsured citizens are widely distributed in terms of age, geographic region, and health status. Part VI, Line 5: Inova Health System's investment in the communities across Northern Virginia is evident through numerous targeted community programs. These programs provide access to care for low income, uninsured, underinsured and vulnerable populations; promote health & wellness; increase health literacy; provide the support and infrastructure for disaster preparedness; and provide programs to support development of our future healthcare workforce to meet the healthcare needs of the communities served. All Inova healthcare facilities have open medical staffs to provide the maximum access to qualified physicians. A Community Board of Trustees provides fiscal and quality oversight for Inova Health Care Services' facilities to ensure the vision and mission of the organization is achieved.Access to Care ProgramsInova's Community Health Services Division is organized to address a wide-spectrum of community healthcare needs. In addition to the programs already described in the core form program, activities that provide infrastructure support and services focused on vulnerable populations to increase access to healthcare services for the communities served by Inova Health System include the following programs:The Streamlined Eligibility program (SES), launched by the successful implementation of the federally-funded 2001 CAP and 2004 HCAP grants, continues to be funded by Inova and Fairfax County. SES provides local safety-net health care providers access to coordinated health care networks to serve the uninsured and underinsured residents of Northern Virginia. A shared database is used to determine a patient's eligibility for services which provides one central intake thereby streamlining and expediting the process. Inova supports the infrastructure and expansion of the program which currently consists of 12 public/private partners serving Fairfax County, City of Alexandria, Loudoun County, Arlington County, and Prince William County. The system currently houses over 300,000 eligibility records of uninsured and Medicaid patients.Inova's Partnership for Healthier Kids (PHK) Access to Care program provides families with comprehensive application and enrollment assistance to connect them with an appropriate and affordable source of health care services. In 2016, PHK assisted over 8,850 children and parents with access to a source of comprehensive health care services such as Medicaid, FAMIS or local safety net providers.Care Connection for Children (CCC) is funded by the Virginia Department of Health. The goal of CCC is to help families coordinate community and educational resources with medical expertise to ensure that children with special healthcare needs can reach their maximum potential. CCC partners with families of children who have chronic healthcare needs to help open doors to needed resources and coordinate quality family-centered care. CCC is committed to helping children maximize their potential in a caring, innovative and culturally sensitive manner. In 2016, CCC served 736 families.Transitional Care Management The Inova Transitional Care Management Program (TCM), implemented July 2011, focuses on unmanaged Medicare/ Medicaid, Innovation Health, Aetna Medicare Advantage and uninsured patients diagnosed with heart failure (CHF), Chronic Obstructive Pulmonary Disease (COPD), pneumonia and Acute Myocardial Infarction (AMI). These diseases account for a high proportion of potentially preventable readmissions. For 30 days after discharge from the hospital or emergency room, TCM case managers monitor patients primarily by telephone. They educate patients about their illnesses, ensure they have a follow-up appointment with their primary care physician (PCP), and confirm they have filled any prescriptions and are taking the correct medications and provide intensive care coordination. For those patients that do not have a PCP or cannot be seen by their PCP within an appropriate time frame post hospital discharge, Inova has developed the Inova Transitional Services Clinics in four locations in which patients are provided a follow-up appointment with a nurse practitioner or physician who will follow the patient until the patient is ready to transition to a permanent Medical Home. Inova Home Health Services also partners with TCM in providing home visits to patients identified by the case managers as needing a home visit. In 2016, TCM managed over 4,000 admissions and the Transitional Services Clinics served over 5,500 patients with over 9,000 visit encounters.Inova Kellar CenterInova Kellar Center (IKC) is a community based behavioral health center and special education school founded by Inova in 1991 with a gift from Fairfax County residents, Art and Betty Kellar, to address a gap in mental health and substance abuse services for children and adolescents. Currently IKC offers a full continuum of mental health services from outpatient therapies and medication management to after school Intensive Outpatient Programs and a full day Partial Hospitalization Program. The Kellar School, a private special education day school for students with emotional, social and behavioral needs provides academic instruction within a therapeutic environment. The Center provided 74,932 hours of programming, treatment and education to children, adolescents, and families in 2016. Inova Ewing Forensic Assessment and Consultation Teams (FACT)FACT is a comprehensive, outpatient sexual and physical abuse evaluation program for children and adults. Starting in the late 1980s, Inova has provided specialized care for victims of abuse, domestic violence and sexual assault. FACT serves most of Northern Virginia including Fairfax, Arlington, Loudoun and Prince William counties, the city of Alexandria, parts of Fauquier and Stafford counties and all Northern Virginia detention centers and military installations. FACT also performs courtesy exams for outlying jurisdictions including the District of Columbia, Maryland and West Virginia. The program has grown significantly over the years and now provides services in the areas of Sexual Assault, Intimate Partner/Domestic Violence, Physical Child Abuse, Elder Physical Abuse, Strangulation and victims of Sex Trafficking. In 2016, there were 676 patient encounters.Health Promotion and Preventative Care ProgramsNorthern Virginia Healthy Kids Coalition: Inova Health System, in partnership with Northern Virginia schools, health departments, and government entities have joined together in a multi-year effort to address the childhood obesity epidemic by working to reverse this trend. Inova Health System sponsors this community-based coalition. To prevent and reduce the incidence of nutrition-related diseases, Inova focused on several initiatives to reduce food insecurity and increase food literacy among community members. Specifically, Inova continued to match the purchases made by SNAP customers (formerly food stamps) at farmers markets, allowing low-income individuals to purchase more fresh produce. In 2016, Inova began supporting two new farmers markets and provided nearly $3,000 in grants.Inova also launched an 8-week school-based nutrition program at four local Title I elementary schools to improve students' understanding of nutrition and the importance of healthy behaviors.In November 2016, Inova and Wesley Theological Seminary completed a three year partnership to strengthen the faith/health connection in the Mt. Vernon community. Through the creation of health ministries in congregations throughout Mt. Vernon, the partnership supported congregations working to improve health outcomes and reduce hospital readmission rates by providing resources and education. Inova provided 21 Health Ministry and Faith Community Nurse certificate scholarships to those interested in building a health ministry within their congregation.Health Literacy and Health Equity ProgramsThe Office of Health Equity (OHE) identifies and addresses health disparities in Northern Virginia through internal and community initiatives. The department is dedicated to the elimination of disparities in the community through community partnership, diversity and cultural competence education and provision of language services. In support of patient safety and satisfaction, language interpretation and translation services are provided at every Inova facility, to facilitate communication with the 14 percent of Inova's patient population who are limited English proficient (LEP). Medical Interpretation in over 200 languages is provided by on-site medical interpreters and telephonic interpreters. In 2016, Inova delivered 69,477 hours of interpreter services and 12,795 hours of Sign Language interpretation across Inova facilities. Over 520 vital documents were translated into Inova's top languages. Part VI, Line 6: Organization is part of Inova Health System included in description under Line 5. PART VI, LINE 5 Cash and In-Kind Contributions to Community GroupsInova donates space, provides cash and in-kind support such as housekeeping and donated staff time to a number of community groups and services. Inova provides support to NOVA Scripts, the Center for Multicultural Human Services, Shenandoah University, and the Nova Dental Clinic. Inova also provides financial support to HealthWorks for Northern Virginia and Neighborhood Health, the local Federally Qualified Health Centers. In 2016, Inova donated approximately $1 million for these groups covering both cash and in-kind transactions.Additionally, as part of Inova's efforts to harness the collective power of community partners, agencies and organizations to create positive social impact, Inova provided $50,000 in community grants. Applicants were required to present programs or projects addressing the population health needs described in the Inova Community Health Needs Assessment. PART VI, LINE 7 Organization has no state filings. X 1 1 1 1 0 0 0 0 0 0 0 JKNOX SINGLETON PRESIDENT 0 1282168 0 2660312 0 845259 0 1453608 0 877 0 6242224 0 500000 HOOKS JOHNSTON TRUSTEE 0 0 0 0 297730 0 0 0 0 0 297730 0 0 0 RICHARD MAGENHEIMER TREASURER 0 690063 0 762692 0 534029 0 453279 0 21507 0 2461570 0 95000 JOHN GAUL ASST SECRETARY 454318 0 117015 0 329013 0 157922 0 26460 0 1084728 0 307177 0 MARK STAUDER COO 0 1001631 0 1195682 0 750259 0 994896 0 21895 0 3964363 0 300005 PATRICK CHRISTIANSEN EVP CEO IFMC 0 646810 0 503820 0 128930 0 355329 0 16751 0 1651640 0 45703 JOHN NIEDERHUBER CEO ITMI & EVP IHS 0 985745 0 352531 0 41250 0 37250 0 9745 0 1426521 0 0 LORING FLINT EVP CHIEF MEDICAL OFFICER 0 634653 0 641962 0 486524 0 264364 0 20921 0 2048424 0 320171 SALLY PAULL EVP CHIEF HR OFFICER 0 125034 0 449494 0 10739 0 10300 0 15224 0 610791 0 0 ROBERT GRASTY EVP CHRO COO 0 312367 0 65000 0 22543 0 20170 0 19993 0 440073 0 0 CONSUELO PILOT EVP CIO 0 405670 0 150000 0 27622 0 220758 0 33439 0 837489 0 0 SUSAN CARROLL CEO IAH 378889 0 112660 0 31266 0 154262 0 26613 0 703690 0 0 0 JOHN FITZGERALD CEO IFOH 399129 0 121781 0 99388 0 79130 0 19417 0 718845 0 0 0 DEBORAH ADDO CEO IMVH 384473 0 125198 0 35028 0 168520 0 21851 0 735070 0 0 0 AMIR MOAZZEA MD PHYSICIAN 983412 0 555046 0 718 0 42094 0 21496 0 1602766 0 0 0 TODD STOTTLEMYER CEO ICPH 715905 0 354376 0 34536 0 285858 0 24019 0 1414694 0 0 0 CHRISTOPHER O'CONNOR CEO IHVI 843680 0 147818 0 49778 0 109329 0 17332 0 1167937 0 0 0 SIMON CHUNG MD PHYSICIAN SUPV 524601 0 447235 0 972 0 54182 0 10138 0 1037128 0 0 0 DONALD TRUMP CEO ISCI 751789 0 144375 0 41124 0 120841 0 8904 0 1067033 0 0 0 MARSHALL RUFFIN FORMER EVP CTO 623136 0 656040 0 29504 0 185515 0 15624 0 1509819 0 0 0 HPATRICK WALTERS FORMER SVP STRATEGIC PLANN 0 423900 0 157493 0 110155 0 109406 0 16942 0 817896 0 0 MAUREEN SWICK FORMER SVP COO IFH AND CNE 156036 0 90343 0 276367 0 28448 0 14885 0 566079 0 207036 0 JAMES SANTRY FORMER SVP BUS DEV & MANAG 0 437927 0 474944 0 34410 0 277496 0 25612 0 1250389 0 0 JOSEPH ROCHE FORMER EXEC DIR EAP 83203 0 25625 0 12995 0 17488 0 19433 0 158744 0 0 0 HUGO AGUAS FORMER AVP HR ASSOC ADMIN 176161 0 39929 0 40784 0 34463 0 11173 0 302510 0 8207 0 MARY DIXON FORMER AVP CNO 0 0 0 0 101656 0 0 0 0 0 101656 0 0 0 Part I, Line 1a Housing allowance in the amount of $14,750 was provided to Christopher O'Connor Part I, Line 3 Question 3 - These methods are performed by the related entity, Imanco Inc. Part I, Lines 4a-b Severance Payments Mary Dixon $101,656 SERP Plan Payments Hugo Aguas $8,207 Patrick Christiansen $91,406 Richard Magenheimer $104,717 John Gaul $307,177 Loring Flint $448,874 Knox Singleton $250,973 Patrick Walters $63,763 Mark Stauder $147,296 Maureen Swick $263,664 The Supplemental Executive Retirement plan (SERP Plan) is a nonqualified retirement plan. Employees eligible to participate are Executive Directors, Assistant Vice Presidents, Vice Presidents, Senior Vice Presidents, Executive Vice Presidents, CFO, COO, and CEO. Each year, a certain percentage of each participant's base salary is contributed to the SERP Plan. This amount ranges from 5% to 20%, depending on position. After three years of continuous participation, participants vest in 50% of their balance at that time and are paid out the vested balance as a taxable event. After a total of six years participation and after attaining age 45, participants are 100% vested and are paid out their remaining balance as a taxable event. Vesting then reverts to a 3 year rolling schedule until year 12. Thereafter, the annual contribution is paid out to the participant each year as a taxable event. A Industrial Development Authority of Fairfax County Virginia 911920228 303823FM5 2005-05-12 124000000 See Part VI 0 0 0 B Industrial Development Authority of Fairfax County Virginia 911920228 303823FR4 2005-05-12 99400000 See Part VI 0 0 0 C Industrial Development Authority of Fairfax County Virginia 911920228 303823GL6 2009-04-16 350414313 See Part VI 1 0 0 D Industrial Development Authority of Fairfax County Virginia 911920228 303823JH2 2009-12-15 73433655 See Part VI 0 0 0 A 14270000 130441544 3604217 367125 126470203 2007 0 0 1 1 B 80790000 99400000 107241 294292 98998467 0 1 1 1 C 102745000 119495000 350414313 4384313 346030000 1 0 1 1 D 24180000 73433655 660539 72773116 1 0 1 1 A 0 1 1 1 1 1 0.00900 0.00900 0 0 1 B 0 0 0 0 0 0 1 C 0 1 0 1 1 0.00700 0.00800 0.01500 0 0 1 D 0 0 0 0 0 0 1 A 0 0 0 1 1 1 Morgan Stanley Capital Services 30.000000000000 0 1 0 0 1 B 0 0 0 1 1 0 0 0 1 C 0 0 0 1 0 0 0 0 1 D 0 0 1 0 0 0 0 0 1 A 1 B 1 C 1 D 1 PART I, COLUMN E, ISSUE PRICE Part I, column E, 2005A bonds 2005A, B, D, E bond issue price per form 8038 476,700,000 2005B, D, E bonds refinanced by subsequent issues (352,700,000) Remaining 2005A issue price 124,000,000 Part I, column E, 2009A bonds 2009AB bond issue price per form 8038 540,414,313 2009B bonds refinanced by subsequent issues (190,000,000) Remaining 2009A issue price 350,414,313 PART I, COLUMN F, DESCRIPTION OF PURPOSE Bond A 1) Renovate and expand certain portions of Inova Alexandria Hospital (IAH), Inova Fairfax Hospital (IFH), Inova Fair Oaks Hospital (IFOH); 2) Acquire certain capital equipment for use in or in connection with IAH, IFH, IFOH, and Inova Mount Vernon Hospital (IMVH) and renovate any space necessary or incidental to the installation of such equipment; 3) Pay issuance costs for Series 2005 A and B; 4) Refund prior bonds issued by the Industrial Development Authority of Loudoun County, Virginia Hospital Revenue Bonds, Series 1995 issued 10/26/1995 and 2002A issued 6/27/2002, and pay issuance costs of Series 2005D; 5) Refund prior bonds Series 2001A, B, C, and D issued 12/11/2001 Bond B 1) Refund prior bonds -1996A issued 4/18/1996; 2) Pay issuance costs of series 2005C bonds Bond C 1) Refund prior bonds - 2008ABC issued 4/17/08; 2) Pay issuance costs of series 2009A and B bonds; 3) Finance the costs of acquisition, construction, renovation, installation and equipping of the 2009 Projects Bond D 1) Refund prior bonds - 1998A issued 3/10/98; 2) Pay issuance costs of series 2009C bonds Bond E 1) Refund prior bonds - 2009B issued 4/16/2009; 2) Pay issuance costs of series 2010A bonds Bond F 1) Refund prior bonds - 1988A-D issued 8/4/1988; 2000 issued 3/23/2000; 2005A & 2005C issued 5/12/2005 Bond G 1) Construct, renovate and expand certain portions of IFH, IMVH and IFOH Bond H 1) Advance refund a portion of 2009A bonds issued 4/16/2009 Bond I 1) Refund prior bonds - 1988A-D issued 8/4/1988; 2000 issued 3/23/2000; 2005A and 2005C issued 5/12/2005 Bond J 1) Construct, renovate and expand certain portions of IFH, IMVH and IFOH Bond K 1) Refund prior bonds - portion of 2009A issued 4/16/09 (advance) and portion of 2012C issued 8/23/12 (current) Bond L 1) Refund prior bonds - portion of 2012C issued 8/23/12 PART II, LINE 3, PROCEEDS Part II, line 3. 2005A bonds Issue price 124,000,000 Earnings 6,441,544 Total proceeds 130,441,544 Part II, line 3. 2010A bonds Issue price 190,000,000 Earnings 1,511,888 Transferred proceeds 164,510,779 Total proceeds 356,022,667 Part II, line 3. 2012AB bonds Issue price 382,960,937 Earnings 2,157,040 Total proceeds 385,117,977 Part II, line 3. 2014A bonds Issue price 209,030,800 Earnings 641,234 Total proceeds 209,672,034 Part 2, line 3. 2016ABbonds issue price 178,341,611 escrow earnings 590,303 total proceeds 178,931,914 PART IV, LINE 2C, DATE OF REBATE COMPUTATION Part 4, line 2C. 2005A 5/12/2010 Part 4, line 2C. 2005C 8/15/2006 Part 4, line 2C. 2009A 4/16/2014 Part 4, line 2C. 2010A 9/10/2012 A Industrial Development Authority of Fairfax County Virginia 911920228 303823JJ8 2010-03-08 190000000 See Part VI 0 0 0 B Industrial Development Authority of Fairfax County Virginia 911920228 2011-07-29 54490000 See Part VI 0 0 0 C Industrial Development Authority of Fairfax County Virginia 911920228 303823KE7 2012-08-23 382960937 See Part VI 0 0 0 D Industrial Development Authority of Fairfax County Virginia 911920228 303823KS6 2012-12-20 80991559 See Part VI 0 0 0 A 95000000 356022667 166022667 190000000 2016 1 0 1 1 B 48435556 54490000 54490000 1 0 1 1 C 16770000 385117977 385117977 2016 0 0 1 1 D 80991559 80991559 0 1 1 1 A 0 1 0 1 1 0.00700 0.00800 0.01500 0 0 1 B 0 1 1 1 1 1 0.00900 0.00900 0 0 1 C 0 0 0 0 0.00300 0.00300 0 0 1 D 0 1 0 1 1 0.00700 0.00800 0.01500 0 0 1 A 0 0 0 1 1 0 0 0 1 B 0 0 1 0 0 0 0 0 1 C 0 1 0 0 0 0 0 0 1 D 0 0 1 0 0 0 0 0 1 A 1 B 1 C 1 D 1 A Industrial Development Authority of Fairfax County Virginia 911920228 2013-12-04 79530000 See Part VI 0 0 0 B Industrial Development Authority of Fairfax County Virginia 911920228 303823KX5 2014-12-17 209030800 See Part VI 0 0 0 C Industrial Development Authority of Fairfax County Virginia 911920228 303823LM8 2016-05-11 178341611 See Part VI 0 0 0 D Industrial Development Authority of Fairfax County Virginia 911920228 303823LR7 2016-05-11 99685000 See Part VI 0 0 0 A 79530000 79530000 1 0 1 1 B 209672034 196544697 13127337 0 0 0 1 C 178931914 132579745 46352169 1 1 1 1 D 99685000 99685000 1 0 1 1 A 0 1 1 1 1 1 0.00900 0.00900 0 0 1 B 0 0 0 0 0.00200 0.00200 0 0 1 C 0 1 0 1 1 0.00300 0.00800 0.01100 0 0 1 D 0 0 0 1 1 0.00900 0.00800 0.01700 0 0 1 A 0 0 1 0 0 0 0 0 1 B 0 1 0 0 0 0 0 0 1 C 0 0 1 0 0 0 0 0 1 D 0 0 1 0 1 0 0 0 1 A 1 B 1 C 1 D 1 Hugo Davalos MD Trustee 37965 Family member employed as physical therapist at Inova Alexandria Hospital. Services provided at arm's length and customary rates. 0 Knox Singleton Officer 10157 Family member employed as a receptionist at Inova Informatics. Services provided at arm's length and customary rates. 0 Hugo Davalos MD Trustee 102000 Fee for physician services. Services provided at arm's length and customary rates. 0 Hooks Johnston Trustee 297730 Consulting fees. Services provided at arm's length and customary rates. 0 Mark Moore Trustee 77661 Family member employed under physician group. Services provided at arm's length and customary rates. 0 Mark Stavish Trustee 60363 Family member employed under physician group. Services provided at arm's length and customary rates. 0 PART III, LINE 4A The System maintains several programs dedicated to different types of cancer, cancer care and cancer risk assessment, including the Inova Breast Care Program (certified at all 5 hospitals), the Cancer Genetic Counseling Program (hereditary conditions), the Inova Melanoma and Skin Cancer Program, the Inova Head and Neck Cancer Program, the Inova Gastrointestinal Multidisciplinary Clinic, the Inova Genitourinary Cancer Program, the Inova Molecular Tumor Board, and Life with Cancer (support and education to cancer patients). The Emergency and Trauma Center at Inova Fairfax Medical Campus, Northern Virginia's only Level I trauma center, is a state-of-the-art facility. Emergency medical specialists with expertise in trauma care treat every type of illness, injury, or life-threatening trauma. The Inova Center for Rehabilitation, located on the Inova Mount Vernon campus is accredited by the Commission on Accreditation and Rehabilitation Facilities (CARF) and provides comprehensive inpatient and outpatient medical rehabilitation services to patients with severe head injuries, spinal cord injuries, strokes, multiple sclerosis, and other orthopedic and neurological disabilities. These services are staffed by an interdisciplinary team representing psychiatry, psychology, vocational counseling, physical therapy, occupational therapy, and nursing with treatment tailored to meet the specific needs of each patient. ACCESS of Fairfax, and ACCESS of Reston are 24-hour, free standing emergency centers located in Fairfax City, and Reston, Virginia, respectively. During 2016, ACCESS of Fairfax provided 13,934 emergency room visits and ACCESS of Reston reported 9,102 emergency room visits. Long Term Care Services: Assisted Living Facilities IHCS's assisted living facilities provide care and services for adults who need assistance with activities of daily living and 24 hour oversight. They provide accommodations with 402 units. Each community has specialized memory care units and programs. A nursing staff is on-site 24 hours a day. IHCS maintains four assisted living facilities in Fairfax, Reston, Fair Oaks, and Mt. Vernon, Virginia. In addition, IHCS owns a 60% interest in an assisted living joint venture in McLean, Virginia. IHCS owns and Sunrise operates five assisted living facilities across Fairfax County with total assisted living days in 2016 of 166,694. InovaCares for Seniors (PACE) InovaCares for Seniors , a Program of All-inclusive Care for the Elderly (PACE) is the first program of its kind in Northern Virginia. PACE is an evidenced-based model of care that delivers high quality, cost effective care that includes medical, dental, vision and social activities. The program is built on the foundation that seniors with complex health care needs should be able to live in the comfort of their home environment for as long as possible. In 2016, PACE had an enrollment of 133 participants and had $1.2 million in unreimbursed expenses. Physical Therapy Services: Inova Physical Therapy Centers IHCS promotes and conducts specific research and educational activities related to the care of the sick and injured. In 2016, outpatient visits totaled 117,426 with services offered at eleven outpatient centers located throughout Northern Virginia. Areas of specialty include: Physical Therapy (PT) and Occupational Therapy (OT). Urgent Care Centers: Inova Urgent Care Centers The IHCS mission includes serving the community as a not-for-profit organization through the provision of urgent medical care. In 2016, outpatient visits totaled 127,263 with services being provided seven days a week with no appointment necessary at nine locations. The centers provide services for medical conditions that require prompt attention but do not pose an immediate or serious threat to life. Treatment is provided for such ailments as sore throats, ear infections or minor cuts and bruises. Services offered also include treatment for work-related injuries and worker's compensation cases, physical exams including camp, sport, school, pre-employment, immigration medical examinations and travel medicine. Laboratory tests, X-rays, audiometry & vision screening, alcohol & drug testing and flu shots are provided on-site. The centers are staffed by board-certified/board-eligible physicians licensed in Virginia. A physician, nurse, and radiology technologist are on duty at each center during hours of operation. Employee Assistance Programs: Inova Employee Assistance (EAP) is part of IHCS providing counseling, work life services and resources to help improve the overall health and well being of the employees of Inova Health System and the employer communities served by Inova and its affiliates. EAP was organized to promote health through referral to a wide range of behavioral health, financial, legal and other supportive services. In 2016 EAP supported 16,950 Inova employees and approximately 193,819 total employees/household members with confidential counseling, financial and legal services, and work life referral services. Behavioral Services: IHCS's Behavioral Services are committed to providing intensive, personalized care to help people cope with, and overcome, addictions and emotional problems that prevent them from fully functioning in the community. Inova CATS Program (Comprehensive Addiction Treatment Services) is a leader in providing the highest quality addiction treatment services in Northern Virginia and surrounding areas. A series of structured programs offers effective, compassionate treatment for individuals dealing with all forms of substance abuse disorders, including addiction to alcohol, prescription drugs, heroin, cocaine and other drugs. Services are available to adults ages 18 and older. The range of services includes: Inpatient Medical Detoxification, Partial Hospitalization Program, Intensive Outpatient Program, Outpatient Groups, Medication Assisted Therapy and Substance Use Assessments. In 2016, the CATS Inpatient and Partial Hospitalization Program provided 7,556 encounters and 10,148 Intensive Outpatient services (7,271 at IFH, 978 at ILH and 1,899 at IMG). The Kellar Center is a comprehensive, behavioral health treatment center and special education school for children, adolescents and their families. The Kellar Center provides a full continuum of outpatient services for psychiatric disorders, substance use disorders, and behavioral and emotional issues. Services include assessment, psychological testing, educational testing, psychiatric evaluation, medication management, individual, family and group therapy and Intensive In-Home services. For adolescents who require intense mental health interventions, the Center provides an afterschool Intensive Outpatient Program for mental health and co-occurring disorders and a full day Partial Hospitalization Program for adolescents who are in crisis and unable to attend school. The treatment services and programs are provided to children and families regardless of ability to pay. The Kellar School of Inova Kellar Center provides special education services to children and adolescents who have not been successful in the public school setting and may be at risk for being removed from the community and placed in more restrictive settings. During 2016, the Kellar Center provided 74,932 hours of programming, treatment and education to children, adolescents and families in the community. The total unreimbursed cost for 2016 was approximately $1.1 million dollars. Form 990, Part III, Line 4a Charity Care All Inova facilities, including the IHCS facilities with the exception of the assisted living facilities, provide charity care in accordance with Inova policies which ensures access to medically necessary care for all individuals. Charity care is defined as free or discounted healthcare services provided to persons who cannot afford to pay. These policies include the following key provisions: 1. Emergency care shall be provided to all persons regardless of their ability to pay. 2. Non-emergency medically necessary care, except for certain specialty or referral programs, shall be provided by all hospitals and access facilities to medically indigent patients. "Medically necessary care" refers to inpatient and outpatient services defined as medically necessary by the federal Medicare program. "Medically indigent" is defined as those patients whose income falls at or below 400% of the Federal Poverty Level (FPL). Inova Health System utilizes a multifaceted approach to educate and inform patients and the public about Inova's Financial Assistance Policy (FAP) or charity care policy. Upon admission to any Inova hospital or any visit to outpatient facilities or clinics including emergency departments, Inova has information posted regarding patient rights and responsibilities. In addition, Inova provides information about the charity care program and referrals to meet with Inova financial counselors who assist patients in completing Inova's charity care application. This financial information is reviewed by the Inova Patient Accounts Department with the patient contacted if additional information is required in order to make a determination. The patient is subsequently provided a letter, notifying them as to whether or not they qualify for charity care. In 2016 IHCS's unreimbursed cost of charity care, including free and discounted services, was $114.7 million. Medicaid Established under Title XIX of the Social Security Act, this program provides assistance for the medically indigent, including those who cannot pay for care despite being able to afford other living expenses. Also included under this program are the blind, disabled, pregnant women, very low income parents, children and the elderly. The reimbursement that IHCS facilities receive from the Medicaid program routinely falls below the actual cost of services provided. During 2016, IHCS provided care to Medicaid patients at an unreimbursed cost of $75.3 million. Participation in Governmental Programs for Those Without the Ability to Pay Various government programs provide for the indigent, including Medicaid recipients. These programs provide a percentage of reimbursement for qualifying patients; however, payment is typically below the cost of those services. In addition to federal and state programs, the Inova subsidiaries, including IHCS, work with various County governments and agencies in providing certain free services to those residents the County identifies as most in need. PART III, LINE 4D Simplicity Health Simplicity Health is a new group of primary care clinics that provides excellent healthcare at affordable fees. Simplicity Health is designed for working adults who may not currently receive regular primary care because they do not qualify for Medicaid, do not get health insurance through work, or have insurance with prohibitively high copays and deductibles. Simplicity Health clinics bring excellent care to convenient locations in high need communities, making healthcare not only affordable, but also accessible. Sites will have providers and staff who are bilingual in a variety of languages, such as Korean, Vietnamese, Spanish, and Arabic. The primary goal of these new clinics is to provide ongoing primary care, prevention and disease management for chronic illnesses like diabetes, hypertension and heart disease. Staff will assist patients who need to arrange for additional services beyond primary care. IHCS and its subsidiaries provide many other non-billed and below margin patient services. Case management services are provided to the indigent and assistance is provided with financial paperwork. Inova Mount Vernon participates in the Health Information and Claims Assistance Program by providing assistance with health insurance paperwork problems. In addition, home IV therapy services are provided for the indigent. Transportation is provided for some indigent patients to and from IHCS facilities and programs. Inova Fairfax Medical Campus provides forensic and medical care to abused adults and children as well as blood alcohol testing for area police departments while coordinating the disposition of deaths with various community organizations. Other services include pastoral care, free living accommodations for out-of-town Inova Fairfax Medical Campus heart and lung transplant patients and their families, and emergency assistance to patients and their families needing medication or transportation. Community Health Education and Promotion As part of Inova's overall health promotion effort, IHCS and its subsidiaries are actively involved in sponsoring programs, activities, and services designed to improve community health and prevent the onset of disease. WellAware Plus WellAware is the Inova employee wellness program, and supports employees and spouses at all health and fitness levels. Through WellAware employees get tools, support and programs to help improve health or maintain healthy habits. WellAware provides blood work, biometric screenings, in-person and telephonic wellness coaching, fitness classes and wellness events in Inova's operating units. It is the goal of the wellness coaches to work with employees to establish realistic wellness goals and to support employees while they work towards optimal health. HealthSource HealthSource serves the community as the premier provider of health education and wellness services. Knowing that each individual requires different kinds of support and services to meet their personal wellness needs, HealthSource offers a variety of wellness programming. Inova's wellness services include, but are not limited to, personal health coaching and prenatal support, childbirth education, life support re-certification and first aid, health fair screenings, seminars, health challenges, fitness classes and immunizations. In order to reach people where they are most comfortable, HealthSource holds programs in community settings, at employer worksites and other easily accessible locations throughout the Northern Virginia and the Greater Metropolitan Washington Area. During 2016, HealthSource served over 129,000 participants. Program highlights include: Influenza Vaccination The Inova HealthSource Immunization Program provided 42,057 flu shots and TB screenings at 877 events. Inova HealthSource provides immunizations for Inova employees and physicians, community members and workplaces throughout the metropolitan area. HealthSource administered over 10,581 flu shots to Fairfax County Public School employees at 204 clinics and 3,186 shots at 18 clinics for Loudoun County Public School employees. The Workplace and Community Program The Workplace and Community Program provided over 246 health events that included biometric screenings, seminars, and interactive education stations. The Respiratory Fit Testing program served over 5,700 participants. Clients were located throughout the Washington, DC, Metropolitan area and far west into Virginia. The Care Management Programs continued to provide personalized support and health coaching to encourage healthy behaviors related to weight management, tobacco cessation, back pain management, pregnancy and breastfeeding. HealthSource coaching supported Inova employees, their spouses and community members. HealthSource provides the Program Manager for The Prince William County Wellness Program, which delivers a full range of wellness services and programs for county employees. Programs include: health and wellness seminars and screenings, weekly meditation, a walking challenge, and a video tutorial around healthy supermarket strategies. In 2016, the HealthSource Program Manager provided services to over 1,700 employee living in Prince William County. The Health Education Program HealthSource provided Life Support education classes for 14,818 students in community and worksite locations. The program underwent American Heart Association Guideline Updates in 2016, a tremendous amount of work ensuring the program is teaching the most up-to-date scientific content so students continue to receive topnotch education. The HealthSource Childbirth Education program served 17,746 community members through maternity tours and educational classes such as breastfeeding, baby care, and childbirth preparation. Additionally, the program offered over 130 free new mom support groups to 3,396 participants. The HealthSource BabyNet program, which provides personalized support and education to pregnant and breastfeeding women through email and telephonic outreach, supported around 500 Inova employees and spouses in 2016. The HealthSource Fitness program provided over 300 fitness classes to Inova employees and community members in 2016. The program offers classes at locations throughout the community and in a variety of different formats including multi-week series, workshops and drop-in classes. Class types offered include mind body classes (yoga, tai chi), cardio/strength building classes (body toning, Zumba), mommy fitness classes (bootcamp, prenatal yoga) and senior focused classes (strength training for seniors, seniorcize). Over 18,600 participants took part in these fitness classes. PART V, LINE 2A, NUMBER OF EMPLOYEES The organization falls under a master pay agent and does not file any payroll returns under its own EIN, however all required returns have been filed on time. Form 990, Part VI, Section A, line 1 With the exception of the duties and responsibilities that are reserved to the Board of Trustees as required by law, the Executive Committee is appointed by the Board to support the Board of Trustees in the performance of its duties and responsibilities that are time-sensitive and must be addressed before the next regularly scheduled meeting of the full Board. Form 990, Part VI, Section A, line 6 The organization has a single member. The sole member is Inova Health System Foundation, a charitable 501(c)(3) tax-exempt organization which serves as the parent company of the integrated health care delivery system. Form 990, Part VI, Section A, line 7a The sole member of the organization, Inova Health System Foundation, is a charitable 501(c)(3) tax-exempt organization. The sole member elects the members of the governing body of the organization. Form 990, Part VI, Section A, line 7b The sole member of the organization, Inova Health System Foundation, is a charitable 501(c)(3) tax-exempt organization. The sole member holds reserved powers with respect to certain actions, including approval of borrowings, amendments of Articles of Incorporation and Bylaws. In addition to the reserved powers, under the laws of the Commonwealth of Virginia certain extraordinary actions require member approval, such as mergers, consolidations, liquidations and the sale of substantially all of the assets of the organization. Form 990, Part VI, Section B, line 11b The Form 990 is prepared and provided to the Chief Accounting Officer and external tax consultants for initial review. After the review it is given to the CFO of Inova Health System for review and comment. The Form 990 is presented to the Executive Committee of the Board of Trustees for their review. Upon completion of the Executive Committee review, it is provided to the full Board of Trustees. In this process, the Form 990 has been provided to the Governing Board approximately two weeks prior to the filing of the return. Form 990, Part VI, Section B, line 12c Yes, annually the organization distributes the conflict of interest policy to all directors, officers, trustees, and key employees. The organization requires that each director, officer, trustee, and key employee acknowledge that they have read, understood, and will abide by the policy. Each director, officer, trustee, and key employee is required to complete and submit an annual conflict of interest disclosure. These disclosures are broad and require that the individual list any business relationships or personal relationships with other directors, officers, trustees, and key employees, as well as any relationships with competitors, or current or potential vendors or contractors. Disclosure statements are reviewed by senior management and any potential conflicts are discussed with governing body chairman to ensure that any member who may have a conflict discloses their potential conflict, and is dismissed from related discussions and recused from participation in applicable decisions. Form 990, Part VI, Section B, line 15 Completed by related entity, Imanco, Inc.: The compensation of all senior management positions is evaluated annually in light of each manager's job content, scope and complexity. Compensation levels for Vice Presidents and above are reviewed by an independent external consultant to ensure that remuneration is consistent with the organization's compensation philosophy and objectives and competitive with other large complex health systems. The independent compensation consultant maintains national benchmark compensation databases and surveys and also reviews Forms 990 of comparable healthcare systems to determine market levels of compensation. In addition, the Inova Health System's CEO's compensation and certain other senior executives is reviewed and approved annually by an independent governing Board. The job requirements and complexity of all other management positions are evaluated annually using nationally recognized third party salary surveys to assure that the compensation for such positions is consistent with external market compensation comparisons. Salary ranges are developed for each management position classification to ensure that the compensation levels for these positions are consistent with the organization's compensation philosophy and objectives and with competitive market comparisons. Compensation for employed physicians is reviewed and approved by the IMG Executive Committee. The committee is comprised of executive management of the Inova Medical Group. The Fair Market Value (FMV) compensation is based on four nationally recognized industry physician compensation benchmark surveys (MGMA, AMGA, Sullivan & Cotter, Korn Ferry Hay Group). The committee also utilizes independent consultants to provide FMV opinions for positions that are not readily available in the four published benchmark surveys. The consultants' opinions and compensation survey data are presented to the Physician Compensation Committee for review and approval. Form 990, Part VI, Section C, line 19 Inova Health System makes certain information publicly available. Inova's consolidated financial statements are posted on the Electronic Municipal Market Access's (EMMA) website on a quarterly basis. Inova's governing documents are not currently publicly available. While the conflict of interest policy is not specifically publicly disclosed, Inova's Code of Conduct is on the public website. Section III of the Code of Conduct describes what can constitute a conflict and requires that potential conflicts be reported to management or the Chief Compliance Officer. The Code also refers to the conflict of interest policy which is available to staff and physicians on Inova's intranet website. Form 990, Part XI, line 9: PARTNERSHIP INCOME -18,412,635. CHANGE IN INVESTMENTS BALANCE -21,447,384. EQUITY IN SUBS 15,944,833. transfers 99,757. CAPITAL REIMBURSEMENT 27,584. UNRECOGNIZED PENSION 16,462,676. PART XII, LINE 2B AND 2C, AUDITED FINANCIAL STATMENTS The company is part of the Inova Health System, a not-for-profit integrated health care delivery system serving Northern Virginia and surrounding areas. The company's financial statements are consolidated in the Inova Health System consolidated financial statements. Inova Health System is audited on an annual basis by a large "Big Four" independent public accounting firm. In addition, they are responsible for the issuance of a management letter encompassing each member of the consolidated group. The Audit and Compliance Committee of the Board of Trustees of Inova Health System is responsible for the oversight of the audit, including the hiring of the audit firm, review and approval of audited financial statements and communication with the external auditors at least twice a year without the presence of internal management. PART XII, LINE 3A, A-133 AUDIT The company is a subsidiary of the Inova Health System (IHS), a not-for-profit integrated health care delivery system serving Northern Virginia and surrounding areas. IHS receives various federal grants. These grants and awards are audited as part of the consolidated Inova Health System A-133 compliance audit. The Inova Health System's federal grants are audited on an annual basis by a large "Big Four" independent public accounting firm and a "Report on Compliance with Requirements Applicable to Each Major Program and on Internal Controls over Compliance in Accordance with OMB Circular A-133" is issued on a consolidated basis. The Audit and Compliance Committee of the Board of Trustees of Inova Health System is responsible for the oversight of the A-133 audit, including the hiring of the audit firm, review and approval of audited financial statements and communications with the external auditors at least twice a year without the presence of internal management. 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