2017-11-15T14:05:41-06:00 2016-12-31 990 2016-01-01 540696355 PRINCE WILLIAM HOSPITAL PRIN 3367182803 2085 FRONTIS PLAZA BLVD WINSTON SALEM NC 27103 FRED HARGETT EVP & CFO 3367182803 2017-11-15 170.98.106.254 2017-11-15 13:07:55 ES P 7AA337F3ADADCA5BF014F5DE8F20B8DB09A5D137 EA41BDE3C3DB37B92BEF4B915198E9A32E027107 2016 2021-01-29 14:40:06Z NOVANT HEALTH UVA HEALTH SYSTEM PRINCE WILLIAM MEDICAL CENTER MARGARET GILL 2085 FRONTIS PLAZA BLVD WINSTON SALEM NC 27103 240414431 0 X WWW.NOVANTHEALTHUVA.ORG X 1964 VA SEE SCHEDULE O 14 8 1581 721 174561 -28502 255275 1065514 237361715 235837803 4871972 16093 2035840 1381259 244524802 238300669 99501 208819 0 0 93787244 97523518 0 0 0 153019364 159138996 246906109 256871333 -2381307 -18570664 286958171 265612582 165216658 191730363 121741513 73882219 X SEE SCHEDULE O 0 0 220235013 208819 226129406 TOGETHER, PRINCE WILLIAM HOSPITAL AND HAYMARKET MEDICAL CENTER HAVE 190 LICENSED BEDS. DURING 2016,THERE WERE 38,236 PATIENT DAYS, WITH AN AVERAGE LENGTH OF STAY OF 4 DAYS, AND AN AVERAGE DAILY CENSUS OF 53. THERE WERE 9,843 DISCHARGES, 4,698 INPATIENT AND OUTPATIENT SURGERIES, 136,995 OUTPATIENT ENCOUNTERS AND 74,740 EMERGENCY DEPARTMENT VISITS. 6537022 9774477 PRINCE WILLIAM FAUQUIER CANCER CENTER, L.L.C (DBA NOVANT HEALTH CANCER CENTER) IS NATIONALLY RECOGNIZED BY THE AMERICAN COLLEGE OF RADIOLOGY, AND IS A VITAL PART OF NOVANT HEALTH'S COMPREHENSIVE CANCER PROGRAM IN NORTHERN VIRGINIA. 226772035 1 1 0 1 0 0 0 0 0 1 1 0 0 0 1 0 0 1 0 0 0 0 0 0 1 0 1 1 1 1 1 0 0 0 0 0 0 0 1 1 0 0 0 0 1 1 1 0 0 1 2 0 1 1581 1 1 1 0 0 0 0 0 0 0 0 0 X 14 8 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 0 1 1 1 VA X KAREN DAUGHERTY 3367182803 2085 FRONTIS PLAZA BLVD WINSTON SALEM NC 27103 X ARMATO CARL CEO & PRESIDENT NH/TRUSTEE 60.00 X 0 3322793 103625 BELDEN RICHARD TRUSTEE 2.00 X 0 0 0 BURRISS ANNE TRUSTEE 2.00 X 0 0 0 DANZIGER STEVEN CHAIR 2.00 X X 0 0 0 GUTLIPH JOANNE TRUSTEE 2.00 X 0 295106 81471 HOLLIS DONNA TRUSTEE 2.00 X 0 0 0 HOOVER MICHAEL TRUSTEE 2.00 X 0 0 0 KELLEY KEVIN TRUSTEE 2.00 X 0 0 0 KHOT VIKRAM TRUSTEE 2.00 X 0 282419 60820 MAGALSKI JOSEPH TRUSTEE 2.00 X 0 443521 78695 ROBSON MELISSA SVP & CEO NH-UVA TRUSTEE 60.00 X X 0 768025 153416 SMITH STEPHEN VICE CHAIR 2.00 X X 0 38100 0 WAY JONATHAN L TRUSTEE 2.00 X 0 0 0 WINE DONOVAN SEC 2.00 X X 0 0 0 MCDONALD IAN TRUSTEE 2.00 X 0 0 0 CHAVEZ LAURA TREAS 2.00 X 244272 0 67506 HOLT BEATRICE PRESIDENT & COO PWMC 60.00 X 353407 0 57160 SEDGLEY DONALD PRESIDENT & COO HAMC 60.00 X 336149 0 65953 WALL JOHN MD VP MEDICAL AFFAIRS 60.00 X 512724 0 92070 MCGOVERN WILLIAM SR DIR MARKETING PARTNER 40.00 X 190037 0 34997 BOWERS TRACY VP HR & ADMIN SERVICES 40.00 X 230699 0 49929 DE ROSA GARY FAMILY PRACTITIONER 40.00 X 409277 0 84384 POULTON PAMELA REGISTERED NURSE FLOATER 40.00 X 214467 0 32871 SWENSONKRISTIN N PHYSICIST 40.00 X 205994 0 34930 2697026 5149964 997827 149 0 1 0 BRASFIELD & GORRIE LLC PO BOX 11407 BIRMINGHAM AL 35246 CONSTRUCTION SERVICES 10545142 MORRISON MANAGEMENT SPECIALISTS PO BOX 102289 ATLANTA GA 30368 FOOD MANAGEMENT SERVICES 3355775 CROTHALL HEALTH CARE INC 955 CHESTERBROOK BLVD S300 WAYNE PA 19087 FACILITY SERVICES 2969438 CROSS COUNTRY STAFFING PO BOX 404674 ATLANTA GA 30384 STAFFING SERVICES 2654524 LABORATORY CORPORATION OF AMERICA HOLDIN PO BOX 12140 BURLINGTON NC 27216 LAB SERVICES 2521001 66 4800 103727 804145 152842 152247 1065514 NET PATIENT REVENUE 622110 234167343 234167343 AMBULATORY SURGERY CTRS 621493 1531627 1531627 PHARMACY REVENUE 446110 138833 138786 47 235837803 18117 18117 2027951 1785132 242819 242819 242819 29723 31747 -2024 -2024 -2024 52312 4800 43788 8524 8524 309718 253095 56623 56623 CAFETERIA 722514 781237 781237 FITNESS CENTER 713940 198569 147154 51415 ADMINISTRATIVE SUPPORT 561499 93487 66127 27360 1073293 238300669 235903883 174561 1156711 X 191319 191319 17500 17500 1729241 1729241 76475721 72476041 3999680 6049121 5732752 316369 7469161 7078524 390637 5800274 5496920 303354 184103 184103 96000 96000 9804 9804 32882695 27715858 5166837 488873 463305 25568 2520760 2388924 131836 1321479 1252366 69113 8767216 8308691 458525 353926 335416 18510 67635 64098 3537 6118241 5798257 319984 21572031 20443814 1128217 1109251 1051237 58014 BAD DEBT 29494700 29494700 MEDICAL SUPPLIES 21252689 21252689 CORPORATE SUPPORT 15217262 15217262 DRUGS 8504122 8504122 9178209 8705502 472707 256871333 226772035 30099298 0 25778822 3753504 32356 119632 35373625 37727005 398732 979279 5599723 5153351 370243 500271 416702495 217843459 200715133 198859036 707111 679147 -3508255 15598478 15585578 2383948 5764034 286958171 265612582 17005199 12827740 1005181 1414911 8955914 8955914 138250364 168531798 165216658 191730363 X 119556539 71697245 2184974 2184974 121741513 73882219 286958171 265612582 X -18570664 -29288630 X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 1 1 0 0 0 0 1 96000 0 1 22678 118678 0 PART II-B, LINE 1: LINE 1A THERE IS LIMITED ENGAGEMENT OF THE BOARD. LINE 1B THERE IS MINIMAL TIME OF SENIOR LEADERS. LINE 1G THERE IS LIMITED CONTACT MADE BY SENIOR LEADERS DURING ADVOCACY DAY. LINE 1I DUES PAID TO CERTAIN ORGANIZATIONS WHICH INCLUDE A PORTION RELATED TO LOBBYING ACTIVITIES. 2184974 2184974 2185209 235 2184974 2177754 7715 260 2185209 2177754 2177754 2177754 2177754 1.00000 0 0 4837615 4837615 1433458 195695579 76975946 120153091 5010105 1772230 3237875 403561 161267956 113864402 47807115 92723 47961498 25230881 22823340 198859036 0 DUE TO AFFILIATES 159174453 THIRD PARTY PAYMENT PAYABLE 1048454 OTHER LIABILITIES 1680142 NOTES PAYABLE 1493629 PATIENT REFUNDS 5135120 168531798 PART V, LINE 4: INTENDED USES FOR ENDOWMENT FUNDS THE ENDOWMENT FUNDS INTENDED USE IS FOR PATIENT EQUIPMENT TO BETTER SERVE THE HOSPITAL'S PATIENTS. UNIFORMS 18337 0 18337 25882 CIRCLE OF LIGHTS 4800 4800 9 33975 33975 17906 57112 4800 52312 43788 43788 8524 1 1 X 1 X 300.000000000000 0 0 1 1 0 1 1 8288273 8288273 0.03650 22780376 14019066 8761310 0.03850 31068649 14019066 17049583 0.07500 35462 35462 0.00020 1530546 1530546 0.00670 21441499 10175812 11265687 0.04950 70450 70450 0.00030 23077957 10175812 12902145 0.05670 54146606 24194878 29951728 0.13170 573 573 0.00000 11136 11136 0.00000 750 750 0.00000 2500 2500 0.00000 20131 20131 0.00010 35090 35090 0.00010 1 29494700 0 41985778 54633246 -12647468 X 1 0 1 PRINCE WILLIAM ASC HEALTHCARE 0.51000 0.03500 0.45500 2 HAYMARKET SURGERY CENTER HEALTHCARE 0.51000 0.00000 0.49000 2 1 PWH DBA NHUVAHS PRINCE WILLIAM MEDICAL CENTER 8700 SUDLEY ROAD MANASSAS VA 20110 WWW.NOVANTHEALTH.ORG H1882 X X X A 2 PWH DBA NHUVAHS HAYMARKET MEDICAL CENTER 15225 HEATHCOTE BLVD HAYMARKET VA 20169 WWW.NOVANTHEALTH.ORG H1938 X X X A PRINCE WILLIAM HOSPITAL 0 0 1 X X X X X X X X 16 1 0 0 1 X WWW.NOVANTHEALTHUVA.ORG X 1 16 1 WWW.NOVANTHEALTHUVA.ORG 0 1 X 300.000000000000 0.000000000000 X X X X 0 1 X X X 1 X SEE SECTION C X SEE SECTION C X SEE SECTION C X X X X X X 1 X 0 X X X X 1 X 0 1 PART V, SECTION B FACILITY REPORTING GROUP A FACILITY REPORTING GROUP A CONSISTS OF: - FACILITY 1: PWH DBA NHUVAHS PRINCE WILLIAM MEDICAL CENTER, - FACILITY 2: PWH DBA NHUVAHS HAYMARKET MEDICAL CENTER PRINCE WILLIAM HOSPITAL PART V, SECTION B, LINE 5: WHILE CONDUCTING THE CHNA, THE HOSPITAL FACILITY(IES) SOLICITED INPUT FROM, AND CONSULTED WITH, A VARIETY OF COMMUNITY REPRESENTATIVES INCLUDING, BUT NOT LIMITED TO, REPRESENTATIVES OF CITY AND COUNTY GOVERNMENT INCLUDING HEALTH DEPARTMENTS, COMMUNITY-BASED ORGANIZATIONS, FOUNDATIONS, CHURCHES, COLLEGES/UNIVERSITIES, COMMUNITY COALITIONS AND OTHER SOCIAL SERVICE AGENCIES. INPUT WAS GATHERED THROUGH COMMUNITY MEETINGS, STAKEHOLDERS INTERVIEWS, AND SOLICITED THROUGH WRITTEN COMMENTS THROUGHOUT THE SURVEY PERIOD UNTIL THE FINAL COMMUNITY PRIORITY SETTING MEETING(S) AND SURVEY. THE SCOPE OF EXPERTISE WAS BROAD AND INCLUDED SUCH AREAS AS PUBLIC HEALTH, MINORITY POPULATIONS, HEALTH DISPARITIES, AND SOCIAL SERVICES. THE ORGANIZATION IS A PART OF NOVANT HEALTH, AN INTEGRATED NOT-FOR-PROFIT HEALTH SYSTEM. AS SUCH, NOVANT HEALTH INCLUDES MULTIPLE HOSPITAL FACILITIES AND HAS ENGAGED IN CHNAS FOR ALL OF THE COMMUNITIES BEING SERVED. WHERE POSSIBLE, WE HAVE LEVERAGED THE RESOURCES OF THE ORGANIZATION TO BEST ADDRESS THOSE NEEDS THAT ARE HIGHEST IN PRIORITY AND CONSISTENT ACROSS COMMUNITIES. PRINCE WILLIAM HOSPITAL PART V, SECTION B, LINE 11: THE HOSPITAL FACILITY IS A PART OF NOVANT HEALTH UVA HEALTH SYSTEM, AN INTEGRATED NOT-FOR-PROFIT HEALTH SYSTEM. THE FACILITY'S CHNA IDENTIFIED MULTIPLE NEEDS FOR THE COMMUNITY SERVED. THE NEEDS IDENTIFIED WERE REVIEWED AND PRIORITIZED BY THE CHNA RESOURCE GROUP AND SUBSEQUENTLY BY THE FILING ORGANIZATION BOARD. THEY EVALUATED EACH DOCUMENTED NEED AND ITS INTERSECTION WITH THE ORGANIZATION'S VISION, COMMITMENTS, AND KEY STRENGTHS BEFORE FURTHER PRIORITIZING THE HEALTH NEEDS AND AGREEING UPON THE TOP HEALTH PRIORITIES TO BE ADDRESSED. THE FILING ORGANIZATION ADOPTED AND EXECUTED AN IMPLEMENTATION STRATEGY THAT ADDRESSES THE PRIORITIZED COMMUNITY HEALTH NEEDS FROM THE CHNAS. THE IMPLEMENTATION STRATEGIES OUTLINE THE PLAN THAT THE HOSPITAL FACILITY(IES) WILL UNDERTAKE TO MEET THOSE HEALTH NEEDS IN EACH OF ITS COMMUNITIES. CERTAIN NEEDS THAT WERE IDENTIFIED BY THE CHNA HAVE NOT BEEN ADDRESSED. IT WAS DETERMINED THAT THERE ARE OTHER RESOURCES IN THE COMMUNITY THAT CAN MORE APPROPRIATELY ADDRESS THESE NEEDS BASED ON SCOPE OF SERVICES AND SKILL SET. FOR MORE DETAILED INFORMATION, REFER TO THE PUBLICLY AVAILABLE IMPLEMENTATION PLAN AVAILABLE ON THE WEBSITE; REFER TO THE URL GIVEN PREVIOUSLY FOR THE POSTING OF THE PLAN. PRINCE WILLIAM HOSPITAL PART V, SECTION B, LINE 13H: OTHER ELIGIBILITY CRITERIA EXPLAINED IN THE FAP INCLUDE THE FOLLOWING: FREE CARE IS ONLY APPLICABLE TO MEDICALLY NECESSARY SERVICES; PROVIDER BASED PHYSICIAN CLINICS REQUIRE THAT PATIENTS MUST HAVE BEEN TREATED BY A MEDICAL GROUP PRIMARY CARE PHYSICIAN WITHIN THE PREVIOUS THREE YEARS; PATIENTS MUST BE UNABLE TO ACCESS ENTITLEMENT PROGRAMS; PATIENTS WITH SPECIAL CIRCUMSTANCES SUCH AS BANKRUPTCY MAY ALSO BE ELIGIBLE FOR CHARITY CARE.PRINCE WILLIAM HOSPITALPART V, LINE 16A, FAP WEBSITE:HTTP://WWW.NOVANTHEALTHUVA.ORG/PATIENTS--VISITORS/FINANCIAL-ASSISTANCE- FOR-THE-UNINSURED.ASPXPRINCE WILLIAM HOSPITALPART V, LINE 16B, FAP WEBSITE:HTTP://WWW.NOVANTHEALTHUVA.ORG/PATIENTS--VISITORS/FINANCIAL-ASSISTANCE- FOR-THE-UNINSURED.ASPXPRINCE WILLIAM HOSPITALPART V, LINE 16C, FAP PLAIN LANGUAGE SUMMARY WEBSITE:HTTP://WWW.NOVANTHEALTHUVA.ORG/PATIENTS--VISITORS/FINANCIAL-ASSISTANCE- FOR-THE-UNINSURED.ASPX PRINCE WILLIAM HOSPITAL PART V, SECTION B, LINE 24: IT IS POSSIBLE FOR A FINANCIAL ASSISTANCE POLICY (FAP) ELIGIBLE PATIENT TO BE CHARGED AN AMOUNT EQUAL TO THE GROSS CHARGE FOR A NON-EMERGENCY OR NON-MEDICALLY NECESSARY SERVICE. HOWEVER, IF THE SERVICE IS DEEMED AN EMERGENCY OR A MEDICAL NECESSITY, THEN THE FAP ELIGIBLE PATIENT WOULD NOT BE CHARGED FOR CARE AND WOULD NOT RECEIVE A BILL ONCE FAP ELIGIBILITY HAD BEEN ESTABLISHED. 5 1 - NOVANT HEALTH HAYMARKET SURGERY CENTER 15225 HEATHCOTE BLVD HAYMARKET VA 20169 AMBULATORY SURGERY CENTER 2 - MARBLESTONE HEALTH CENTER 12701 MARBLESTONE DRIVE WOODBRIDGE VA 22192 PHYSICIAN CLINIC 3 - NHUVAHS CANCER CENTER AT LAKE MANASSAS 7901 LAKE MANASSAS DR GAINESVILLE VA 20155 CANCER CENTER 4 - NH HEATHCOTE HEALTH CENTER 15195 HEATHCOTE BLVD HAYMARKET VA 20169 IMAGING CENTER 5 - PRINCE WILLIAM AMBULATORY SURGERY CTR 8650 SUDLEY ROAD SUITE 411 MANASSAS VA 20110 AMBULATORY SURGERY CENTER PART I, LINE 3C: OTHER CRITERIA BESIDES INCOME AND FPG USED IN DETERMINING ELIGIBILITY FOR FREE CARE INCLUDE: (1) RESIDENCY - PATIENTS MUST RESIDE WITHIN THE SERVICE AREA OF THE HOSPITAL; (2) THE KIND OF SERVICE PROVIDED - ONLY MEDICALLY NECESSARY SERVICES ARE COVERED; (3) PATIENT STATUS - IN PROVIDER BASED PHYSICIAN CLINICS, PATIENTS MUST HAVE BEEN TREATED BY A MEDICAL GROUP PRIMARY CARE PHYSICIAN WITHIN THE PREVIOUS THREE YEARS; AND (4) ACCESS TO HEALTH CARE COVERAGE - PATIENTS MUST BE UNABLE TO ACCESS EMPLOYER SPONSORED HEALTH PLANS OR ENTITLEMENT PROGRAMS. LASTLY, THE PATIENT MUST BE WITHOUT SUBSTANTIAL LIQUID ASSETS (I.E. CASH-ON-HAND). ASSETS SUCH AS HOUSES, CARS, PENALIZED RETIREMENT SAVINGS FUNDS, ETC. ARE NOT CONSIDERED LIQUID ASSETS. SUBSTANTIAL ASSETS ARE DEFINED AS ENOUGH CASH-ON-HAND TO COVER THE MEDICAL EXPENSES WITHOUT PLACING A HARDSHIP ON THE PATIENT. PATIENTS WITH SPECIAL CIRCUMSTANCES SUCH AS BANKRUPTCY MAY ALSO BE ELIGIBLE FOR CHARITY CARE; DETERMINATION IS MADE ON A CASE BY CASE BASIS UNDER THESE CIRCUMSTANCES. PART I, LINE 6A: PART I, LINE 6A:THE COMMUNITY BENEFIT REPORT IS PREPARED BY A RELATED ORGANIZATION. NOVANT HEALTH, INC. IS A MEMBER ORGANIZATION OF THE NOVANT HEALTH UVA HEALTH SYSTEM. IT PRODUCES A COMMUNITY BENEFIT REPORT REPRESENTING ITS HEALTH SYSTEM AS A WHOLE INCLUDING THE FILING ORGANIZATION. THE REPORT CAN BE FOUND AT HTTPS://WWW.NOVANTHEALTH.ORG/HOME/ABOUT-US/COMPANY-INFORMATION/FINANCIAL- PROFILE/COMMUNITY-BENEFIT-REPORT.ASPX. PLEASE NOTE THAT THE NUMERIC INFORMATION IN THIS REPORT IS NOT BASED UPON THE FORM 990, SCHEDULE H CRITERIA, BUT RATHER IT HAS BEEN PREPARED IN ACCORDANCE WITH THE NORTH CAROLINA HOSPITAL ASSOCIATION REPORTING GUIDELINES. PART I, LINE 7: COSTS REPORTED IN THE TABLE FOR CHARITY CARE AND CERTAIN OTHER COMMUNITY BENEFITS AMOUNTS ARE CALCULATED USING AN ENTITY SPECIFIC COST TO CHARGE RATIO BASED ON WORKSHEET 2 (CCR). PART I, LN 7 COL(F): PART I, LN 7 COL(F):THE AMOUNT OF BAD DEBT REMOVED FROM TOTAL EXPENSES (DENOMINATOR) WAS $29,494,700. PART II, COMMUNITY BUILDING ACTIVITIES: THE ORGANIZATION'S COMMUNITY BUILDING ACTIVITIES ADDRESSES THE UNDERLYING CAUSES OF HEALTH PROBLEMS AND IMPACTS THE HEALTH OF OUR COMMUNITY THROUGH PARTNERSHIPS WITH LOCAL AGENCIES DEDICATED TO IMPROVING THE LIVES OF ALL INDIVIDUALS. OUTREACH INCLUDES PROVIDING SUPPORT TO ORGANIZATIONS SUCH AS LOCAL YMCA'S, UNITED WAY PARTNER AGENCIES, CHAMBERS OF COMMERCE AND OTHER LOCAL COMMUNITY ORGANIZATIONS, ASSISTING WITH COMMUNITY AND COUNTY COALITIONS, AND PROVIDING EDUCATION SEMINARS AND TRAINING FOR COMMUNITY WORKFORCES. PART III, LINE 2: THE ALLOWANCE FOR BAD DEBT IS DETERMINED BASED ON MANAGEMENT'S ASSESSMENT OF SEVERAL FACTORS, INCLUDING HISTORICAL COLLECTION RESULTS, THE AGE OF THE ACCOUNTS, CHANGES IN COLLECTION PATTERNS AND GENERAL INDUSTRY CONDITIONS. PART III, LINE 4: FOOTNOTE 2 (ACCOUNTS RECEIVABLE) ON PAGE 5 OF THE AUDITED FINANCIAL STATEMENTS DESCRIBES THE BAD DEBT EXPENSE. PART III, LINE 8: THE METHODOLOGY USED TO DETERMINE THE MEDICARE ALLOWABLE COSTS REPORTED IN THE ORGANIZATION'S MEDICARE COST REPORT AS REFLECTED IN THE AMOUNT REPORTED IN PART III, LINE 6 IS DETERMINED BY FOLLOWING THE MEDICARE PRINCIPLES OF ALLOWABLE COSTS. COST FOR THE OVERHEAD DEPARTMENTS ARE STEPPED DOWN TO THE REMAINING COST CENTERS BASED ON STATISTICS FOR EACH OVERHEAD COST CENTER. ONCE THE STEP-DOWN PROCESS IS COMPLETE, A RATIO OF COST TO CHARGES IS DEVELOPED FOR EACH COST CENTER. THE CCR IS THEN APPLIED TO THE MEDICARE REVENUE BY COST CENTER AND TOTALED. IT SHOULD BE NOTED THAT THE MEDICARE COST REPORTS DO NOT ADDRESS ANY MANAGED CARE MEDICARE REVENUES, COSTS, OR RELATED SHORTFALL. THE TOTAL REVENUES REPORTED AS RECEIVED FROM MEDICARE IN LINE 5 OF SECTION B ARE ONLY REPRESENTATIVE OF MEDICARE FEE FOR SERVICE PAYMENTS RECEIVED. THE ALLOWABLE COSTS ON LINE 6 ARE SIGNIFICANTLY LOWER THAN THE ACTUAL EXPENDITURES. AS SUCH, THE SHORTFALL IS UNDERESTIMATED. EVERY HOSPITAL TREATS MEDICARE PATIENTS. SOME HOSPITALS ARE LOCATED IN HIGH MEDICARE POPULATION AREAS; OTHERS PROVIDE SERVICES DISPROPORTIONATELY USED BY MEDICARE PATIENTS. MEDICARE RATES AND NUMBERS OF MEDICARE PATIENTS ARE NOT NEGOTIATED. AS REIMBURSEMENT RATES DECLINE RELATIVE TO COSTS OF CARE, HOSPITALS CONTINUE TO SERVE THE MEDICARE POPULATION. WITHOUT THIS SERVICE THESE PATIENTS WOULD BECOME AN OBLIGATION ON THE GOVERNMENT. ANY UNREIMBURSED COSTS OF THIS CARE ARE A COMMUNITY BENEFIT PROVIDED BY THE HOSPITAL TO THE COMMUNITY AND GOVERNMENT. PART III, LINE 9B: THE ORGANIZATION'S BILLING AND COLLECTIONS POLICY DOES EXPLAIN ACTIONS AGAINST PATIENTS WHO HAVE OUTSTANDING DELINQUENT AMOUNTS, BUT THE POLICY DOES NOT CONTAIN PROVISIONS FOR COLLECTION PRACTICES AGAINST PATIENTS WHO ARE ELIGIBLE UNDER THE FINANCIAL ASSISTANCE POLICY (FAP) BECAUSE FAP ELIGIBLE PATIENTS RECEIVE 100% FREE CARE AND THEREFORE DO NOT RECEIVE BILLS ONCE FAP ELIGIBILITY HAS BEEN ESTABLISHED. PART VI, LINE 2: PART VI, LINE 2: NEEDS ASSESSMENTTHE ORGANIZATION IS PART OF NOVANT HEALTH UVA HEALTH SYSTEM, AN INTEGRATED NOT-FOR-PROFIT HEALTH SYSTEM. NOVANT HEALTH, INC. IS A MEMBER ORGANIZATION OF THE NOVANT HEALTH UVA HEALTH SYSTEM. NOVANT HEALTH, INC. HAS A COMMUNITY BENEFIT DEPARTMENT ("CB DEPARTMENT") COMPRISED OF COMMUNITY BENEFIT PROFESSIONALS AND AN ASSOCIATED ADVISORY WORKING GROUP ("THE COMMUNITY BENEFIT GROUP") THAT INCLUDES REPRESENTATIVES FROM INTERNAL AUDIT, LEGAL, AND TAX. THE CB DEPARTMENT IS RESPONSIBLE FOR COORDINATING THE PREPARATION OF THE COMMUNITY HEALTH NEEDS ASSESSMENTS (CHNA) REPORTED IN PART V, SECTION B, FOR EACH HOSPITAL WITHIN THE NOVANT HEALTH SYSTEM AS WELL AS FOR THE FILING ORGANIZATION. EACH HOSPITAL AND THE COMMUNITY BENEFIT GROUP WORK TOGETHER TO IDENTIFY ORGANIZATIONS AND RESOURCES WITHIN ITS COMMUNITY THAT CONTRIBUTE TO THE PROCESS. THESE ORGANIZATIONS AND RESOURCES INCLUDE PUBLIC HEALTH DEPARTMENTS, LOCAL COMMUNITY COALITIONS REPRESENTING THE MEDICALLY UNDERSERVED, UNITED WAY, LOCAL UNIVERSITIES, ETC. COMMUNITY HEALTH ASSESSMENTS PREPARED BY OTHER ORGANIZATIONS IN THE COMMUNITY ARE USED IN COMBINATION WITH INTERNAL HOSPITAL DATA AND INFORMATION COLLECTED FROM LOCAL AGENCIES TO PREPARE THE HOSPITAL'S CHNA. IN ADDITION TO ADDRESSING NEEDS IDENTIFIED THROUGH THE CHNA, EACH HOSPITAL MAY RESPOND TO REQUESTS FOR SPECIFIC COMMUNITY BENEFIT ACTIVITIES OR PROGRAMS FROM PUBLIC AGENCIES OR COMMUNITY GROUPS. PART VI, LINE 3: PART VI, LINE 3: PATIENT EDUCATION OF ELIGIBILITY FOR ASSISTANCETHE ORGANIZATION IS COMMITTED TO PROVIDING OUTSTANDING HEALTHCARE TO ALL MEMBERS OF OUR COMMUNITIES, REGARDLESS OF THEIR ABILITY TO PAY. OUR FINANCIAL COUNSELING TEAMS ARE CONSTANTLY WORKING WITH THE PATIENTS WITHIN OUR COMMUNITIES TO UNDERSTAND THEIR NEEDS AND ENSURE THAT OUR POLICIES AND PROCESSES ADDRESS THESE NEEDS. WE ALSO MAINTAIN CONTRACTS WITH MEDICAID ELIGIBILITY VENDORS. THESE TEAMS OFFER ADDITIONAL SUPPORT IN PROCESSING AND ASSESSING HOW WE SERVE THE FINANCIAL NEEDS OF OUR PATIENTS. BASED ON THE ASSESSMENTS OF OUR COMMUNITIES, THE ORGANIZATION HAS DEVELOPED FINANCIAL ASSISTANCE POLICIES AND PROGRAMS THAT ADDRESS THE FINANCIAL NEEDS OF OUR PATIENTS. WE PRIDE OURSELVES ON THE TRANSPARENCY OF OUR PROGRAMS AND THE EDUCATION WE OFFER OUR PATIENTS AROUND OUR FINANCIAL ASSISTANCE POLICIES. OUR PROGRAMS ARE DOCUMENTED ON OUR WEBSITE, ALONG WITH CONTACT INFORMATION FOR OUR FINANCIAL COUNSELORS. ADDITIONALLY, OUR PROGRAMS ARE DOCUMENTED ON PATIENT FLYERS THROUGHOUT THE ORGANIZATION'S FACILITIES AND PHYSICIAN OFFICES. OUR PATIENT ACCESS SPECIALISTS, FINANCIAL COUNSELORS AND BUSINESS OFFICE TEAMS WORK WITH ALL ELIGIBLE PATIENTS TO EDUCATE THEM ON THE VARIOUS OPTIONS AVAILABLE VIA OUR FINANCIAL ASSISTANCE PROGRAMS OR GOVERNMENT SPONSORED CARE. THEY ALSO REFERENCE OUR FINANCIAL ASSISTANCE POLICY IN ALL CONVERSATIONS RELATED TO PATIENTS BILLS. FINALLY, WE WORK WITH LOCAL AREA FREE HEALTH CLINICS AND OTHER CHARITABLE ORGANIZATIONS TO PROVIDE CONTINUATION OF CARE FOR THEIR PATIENTS. IN ADDITION TO OUR FINANCIAL COUNSELING PROCESSES USED TO IDENTIFY CHARITY CARE PATIENTS, OUR COLLECTIONS PROCESSES WITHIN OUR BUSINESS OFFICES ALSO HELP IDENTIFY PATIENTS WHO ARE ALREADY ELIGIBLE FOR CHARITY OR WHO MAY BE ELIGIBLE BASED ON THEIR STATUS WITHIN THE FEDERAL POVERTY GUIDELINES ("FPG"). WE UTILIZE PREVIOUSLY SUBMITTED PATIENT DOCUMENTATION AND CREDIT AGENCY REPORTED FPG FOR DETERMINATION. SUPPORTING DOCUMENTS ARE VALID 6 MONTHS FROM THE DATE OF SUBMISSION. ANY UPDATES TO OUR POLICIES REQUIRE MULTI-LEVEL LEADERSHIP APPROVAL AND ARE ULTIMATELY APPROVED BY THE ORGANIZATION'S BOARD. PART VI, LINE 4: PART VI, LINE 4: COMMUNITY INFORMATIONPRINCE WILLIAM HOSPITAL DBA NOVANT HEALTH UVA HEALTH SYSTEM PRINCE WILLIAM MEDICAL CENTER AND AS NOVANT HEALTH UVA HEALTH SYSTEM HAYMARKET MEDICAL CENTERTHE ORGANIZATION DEFINES ITS COMMUNITY BY ITS PRIMARY SERVICE AREA ("PSA") (MANASSAS PSA + HAYMARKET PSA), WHICH IS COMPOSED OF THE FOLLOWING ZIP CODES: 20108 (CITY OF MANASSAS - MANASSAS); 20109 (PRINCE WILLIAM COUNTY - MANASSAS); 20110 (CITY OF MANASSAS - MANASSAS); 20111(PRINCE WILLIAM COUNTY - MANASSAS); 20112 (PRINCE WILLIAM COUNTY - MANASSAS); 20113 (CITY OF MANASSAS - MANASSAS); 20136 (PRINCE WILLIAM COUNTY - BRISTOW); 20137 (FAUQUIER COUNTY - BROAD RUN); 20143 (PRINCE WILLIAM COUNTY - CATHARPIN); 20155 (PRINCE WILLIAM COUNTY - GAINESVILLE); 20156 (PRINCE WILLIAM COUNTY - GAINESVILLE); 20168 (PRINCE WILLIAM COUNTY - HAYMARKET); 20169 (PRINCE WILLIAM COUNTY - HAYMARKET); 20181 (PRINCE WILLIAM COUNTY - NOKESVILLE); 20182 (PRINCE WILLIAM COUNTY - NOKESVILLE); AND 20198 (FAUQUIER COUNTY - THE PLAINS). ACCORDING TO SG2 DATA, THE SPECIFIC POPULATION GROUPS (ETHNIC AND CULTURAL) ARE AS FOLLOWS: WHITE NON-HISPANIC (136,981) 52.3%; BLACK NON-HISPANIC (32,221) 12.3%; HISPANIC (58,746) 22.4%; ASIAN & PACIFIC ISLAND NON-HISPANIC (23,021) 8.8%; OTHERS (10,779) 4.1%; FOR A TOTAL POPULATION OF 261,748. ACCORDING TO US CENSUS BUREAU DATA, THE AVERAGE MEDIAN HOUSEHOLD INCOME LEVEL WAS $104,380. ACCORDING TO SG2 DATA, THE AGE BREAKDOWN IS AS FOLLOWS: 0-17 YEARS (72,670) 27.8%; 18-64 YEARS (164,150) 62.7; 65+ YEARS (24,928) 9.5%. PART VI, LINE 5: PART VI, LINE 5: PROMOTION OF COMMUNITY HEALTHTHE ORGANIZATION FURTHERS ITS EXEMPT PURPOSES BY DOING THE FOLLOWING:1. ADOPTING A FINANCIAL ASSISTANCE POLICY;2. REMAINING CERTIFIED BY THE U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES TO PROVIDE SERVICES TO ALL BENEFICIARIES OF MEDICARE, MEDICAID, AND OTHER GOVERNMENT PAYMENT PROGRAMS, AND PROVIDING SERVICES IN A NONDISCRIMINATORY MANNER TO SUCH BENEFICIARIES;3. OPERATING A FULL-TIME EMERGENCY ROOM WHICH IS OPEN TO AND ACCEPTS ALL PERSONS, REGARDLESS OF THEIR ABILITY TO PAY;4. MAINTAINING AN OPEN MEDICAL STAFF, SUBJECT TO EXCLUSIVE CONTRACTS FOR HOSPITAL-BASED SERVICES SUCH AS ANESTHESIOLOGY, RADIOLOGY, PATHOLOGY, HOSPITALIST, AND EMERGENCY DEPARTMENT SERVICES, TO THE EXTENT AN EXCLUSIVE CONTRACT FOR THOSE SERVICES IS REQUIRED TO OBTAIN PROPER STAFFING COVERAGE OR TO PERMIT A MORE EFFICIENT DELIVERY OF THOSE SERVICES WITHIN THE HOSPITAL FACILITY;5. MAINTAINING A GOVERNING BOARD CONSISTING PRIMARILY OF A BROAD CROSS-SECTION OF LEADERS IN THE COMMUNITY;6. ADOPTING AND APPLYING A CONFLICT OF INTEREST POLICY, WHICH APPLIES TO THE GOVERNING BOARD AND ORGANIZATION OFFICERS;7. PROVIDING HEALTH EDUCATION LECTURES AND WORKSHOPS;8. PROVIDING HEALTH FAIRS, EDUCATION ON SPECIFIC DISEASES OR CONDITIONS, AND HEALTH PROMOTION AND WELLNESS PROGRAMS TO THE COMMUNITIES IT SERVES;9. PROVIDING SUPPORT GROUPS AND SELF HELP PROGRAMS TO THE COMMUNITIES IT SERVES;10. PROVIDING COMMUNITY-BASED CLINICAL SERVICES, INCLUDING WITHOUT LIMITATION, HEALTH SCREENINGS AND CLINICS FOR UNINSURED OR UNDERINSURED PERSONS TO THE COMMUNITIES IT SERVES;11. PROVIDING HEALTHCARE SUPPORT SERVICES, INCLUDING WITHOUT LIMITATION, INFORMATION AND REFERRAL TO COMMUNITY SERVICES, CASE MANAGEMENT OF UNDERINSURED AND UNINSURED PERSONS, TELEPHONE INFORMATION SERVICES AND ASSISTANCE TO ENROLL IN PUBLIC PROGRAMS, SUCH AS STATE CHILDREN'S HEALTH INSURANCE PROGRAM (SCHIP) AND MEDICAID TO THE COMMUNITIES IT SERVES;12. PROVIDING SUBSIDIZED HEALTH SERVICES AND CLINICAL PROGRAMS TO THE COMMUNITIES IT SERVES;13. PROVIDING CASH AND IN-KIND CONTRIBUTIONS TO NONPROFIT COMMUNITY HEALTHCARE ORGANIZATIONS IN THE COMMUNITIES IT SERVES; AND14. GENERALLY PROMOTING THE HEALTH, WELLNESS, AND WELFARE OF THE COMMUNITIES IT SERVES BY PROVIDING QUALITY HEALTHCARE SERVICES AT REASONABLE COST.PLEASE SEE THE NOVANT HEALTH COMMUNITY BENEFIT REPORT, LOCATED AT HTTP://WWW.NOVANTHEALTH.ORG/HOME/ABOUT-US/COMPANY-INFORMATION/FINANCIAL -PROFILE/COMMUNITY-BENEFIT-REPORT.ASPX. PLEASE NOTE THAT THE NUMERIC INFORMATION IN THIS REPORT IS NOT BASED UPON THE FORM 990, SCHEDULE H CRITERIA, BUT RATHER IT HAS BEEN PREPARED IN ACCORDANCE WITH THE NORTH CAROLINA HOSPITAL ASSOCIATION REPORTING GUIDELINES. PART VI, LINE 6: PART VI, LINE 6: AFFILIATED HEALTH CARE SYSTEMTHE ORGANIZATION IS AN INTEGRAL PART OF NOVANT HEALTH UVA HEALTH SYSTEM AND NOVANT HEALTH (COLLECTIVELY KNOWN AS "THE SYSTEM"), BOTH ARE NOT-FOR-PROFIT INTEGRATED GROUPS OF HOSPITALS, PHYSICIAN CLINICS, OUTPATIENT CENTERS AND OTHER HEALTHCARE SERVICE PROVIDERS. EACH HOSPITAL PROVIDES SUBSTANTIAL COMMUNITY BENEFIT TO THE COMMUNITY IT SERVES, AS REPORTED INDIVIDUALLY ON EACH HOSPITAL'S FORM 990, SCHEDULE H. THE SYSTEM'S COMMUNITY BENEFIT AS A WHOLE IS DOCUMENTED IN A SYSTEM-WIDE COMMUNITY BENEFIT REPORT, LOCATED AT HTTP://WWW.NOVANTHEALTH.ORG/HOME/ABOUT-US/COMPANY-INFORMATION/FINANCIAL- PROFILE/COMMUNITY-BENEFIT-REPORT.ASPX. PLEASE NOTE THAT THE NUMERIC INFORMATION IN THIS REPORT IS NOT BASED UPON THE FORM 990, SCHEDULE H CRITERIA, BUT RATHER IT HAS BEEN PREPARED IN ACCORDANCE WITH THE NORTH CAROLINA HOSPITAL ASSOCIATION REPORTING GUIDELINES. THERE ARE SIGNIFICANT COMMUNITY BENEFIT ACTIVITIES WITHIN NOVANT HEALTH WHICH MAY NOT BE REPORTABLE ON A SCHEDULE H BECAUSE THEY ARE NOT CONDUCTED BY AN ENTITY WHICH OWNS OR OPERATES A HOSPITAL.IN ADDITION TO HOSPITALS, NOVANT HEALTH UVA HEALTH SYSTEM INCLUDES A PHYSICIAN ORGANIZATION WITH PRACTICES IN VIRGINIA AND A HOSPITAL FOUNDATION WHICH SUPPORTS AND ENHANCES THE ACTIVITIES IN THOSE HOSPITALS' COMMUNITIES. FURTHER, NOVANT HEALTH UVA HEALTH SYSTEM INCLUDES AMBULATORY SURGERY CENTERS, IMAGING CENTERS, REHABILITATION CENTERS, AND OTHER OUTPATIENT FACILITIES; ALL DEDICATED TO PROMOTING THE HEALTH OF THEIR RESPECTIVE COMMUNITIES. PART VI, LINE 7: STATE FILING OF COMMUNITY BENEFIT REPORT PRINCE WILLIAM HOSPITAL FILES A COMMUNITY BENEFIT REPORT WITH THE VIRGINIA HOSPITAL AND HEALTHCARE ASSOCIATION IN ACCORDANCE WITH THEIR REPORTING GUIDELINES FOR PURPOSES OF ADVOCACY AND THE STATE'S REPORTING REQUIREMENTS. 1 SKILLSOURCE GROUP INC 8300 BOONE BLVD SUITE 450 VIENNA VA 22182 300129320 501(C)(3) 20131 COMMUNITY DEVELOPMENT PWHS FOUNDATION 2085 FRONTIS PLAZA BLVD WINSTON SALEM NC 27103 541307595 501(C)(3) 50000 MOBILE MAMMOGRAPHY GEORGE MASON UNIVERSITY FOUNDATION INC 4400 UNIVERSITY DR MERTEN HALL 2300 2300 FAIRFAX VA 22030 541603842 501(C)(3) 20735 COMMUNITY SUPPORT PERSONAL CARE SERVICES 2085 FRONTIS PLAZA BLVD WINSTON SALEM NC 27103 541291284 501(C)(3) 29202 TO SUPPORT NH CATON MERCHANT HOUSE PRINCE WILLIAM CHAMBER OF COMMERCE 9720 CAPITAL COURT MANASSAS VA 20110 272875613 501(C)(6) 9450 COMMUNITY SUPPORT 4 1 EDUCATION SCHOLARSHIPS 7 17500 PART I, LINE 2: PROCEDURES FOR MONITORING THE USE OF GRANT FUNDS THE FILING ORGANIZATION IS PART OF THE INTEGRATED HEALTHCARE SYSTEM OPERATED BY NOVANT HEALTH, INC. ("NOVANT HEALTH"), THE PARENT ORGANIZATION. NOVANT HEALTH'S BYLAWS AUTHORIZE IT TO ESTABLISH CERTAIN POLICIES FOR ALL OF ITS SUBSIDIARIES WITHIN THE SYSTEM. NOVANT HEALTH HAS ESTABLISHED A SYSTEM-WIDE CORPORATE POLICY WITH STANDARDIZED GUIDELINES THAT ARE TO BE USED IN REVIEWING THE ELIGIBILITY AND SELECTION OF GRANTEES RECEIVING CERTAIN EXEMPT PURPOSE FUNDS. THE FILING ORGANIZATION MAINTAINS DOCUMENTATION OF THE ELIGIBILITY AND SELECTION CRITERIA AND RECORDS OF THE AMOUNTS ARE MAINTAINED VIA THE GENERAL LEDGER. FUNDS ARE GENERALLY NOT TRACKED AFTER BEING GRANTED, AS THE ORIGINAL ELIGIBILITY AND SELECTION CRITERIA HAVE ALREADY BEEN MET. X X X X X X 1 1 0 1 0 0 0 0 0 0 0 ARMATO CARL CEO & PRESIDENT NH/TRUSTEE 0 1346995 0 1409378 0 566420 0 65093 0 38533 0 3426419 0 7500 GUTLIPH JOANNE TRUSTEE 0 218023 0 37434 0 39649 0 50151 0 31320 0 376577 0 0 KHOT VIKRAM TRUSTEE 0 248308 0 30773 0 3338 0 56761 0 4060 0 343240 0 0 MAGALSKI JOSEPH TRUSTEE 0 314611 0 124668 0 4242 0 54678 0 24018 0 522217 0 0 ROBSON MELISSA SVP & CEO NH-UVA TRUSTEE 0 424169 0 311555 0 32301 0 116343 0 37073 0 921441 0 0 CHAVEZ LAURA TREAS 200820 0 31321 0 12131 0 48337 0 19169 0 311778 0 0 0 HOLT BEATRICE PRESIDENT & COO PWMC 227439 0 111836 0 14132 0 33588 0 23572 0 410567 0 0 0 SEDGLEY DONALD PRESIDENT & COO HAMC 187903 0 128464 0 19782 0 33686 0 32266 0 402101 0 0 0 WALL JOHN MD VP MEDICAL AFFAIRS 290879 0 209899 0 11946 0 64437 0 27633 0 604794 0 0 0 MCGOVERN WILLIAM SR DIR MARKETING PARTNER 179825 0 10000 0 212 0 16923 0 18074 0 225034 0 0 0 BOWERS TRACY VP HR & ADMIN SERVICES 185279 0 33646 0 11774 0 23209 0 26720 0 280628 0 0 0 DE ROSA GARY FAMILY PRACTITIONER 378480 0 0 0 30797 0 57685 0 26699 0 493661 0 0 0 POULTON PAMELA REGISTERED NURSE FLOATER 179155 0 35187 0 125 0 12951 0 19920 0 247338 0 0 0 SWENSONKRISTIN N PHYSICIST 202071 0 3124 0 799 0 30097 0 4833 0 240924 0 0 0 PART I, LINE 1A PART I, LINE 1A: FRINGE OR EXPENSE EXPLANATION FIRST-CLASS OR CHARTER TRAVEL: FIRST-CLASS OR CHARTER TRAVEL IS NOT A COVERED TRAVEL EXPENSE FOR EXECUTIVES; THEY ARE LIMITED TO BUSINESS OR COACH CLASS FARES FOR COMMERCIAL FLIGHTS. HOWEVER, CHARTER TRAVEL IS AVAILABLE TO CERTAIN EXECUTIVES, BOARD MEMBERS, AND APPROVED BUSINESS PERSONNEL MEETING APPLICABLE POLICY CRITERIA. TRAVEL FOR COMPANIONS: COMPANIONS ARE ALLOWED ON CERTAIN CHARTER FLIGHTS PAID FOR BY THE ORGANIZATION. IN THAT CASE, THE VALUE OF THE COMPANION'S FLIGHT IS CALCULATED UNDER APPLICABLE TAX LAWS AND THAT AMOUNT IS INCLUDED IN THE EXECUTIVE'S TAXABLE INCOME AS PRESCRIBED BY THE APPLICABLE TAX LAWS. TAX INDEMNIFICATION AND GROSS-UP PAYMENTS: EXECUTIVES WHO USE FUNDS MADE AVAILABLE THROUGH THEIR DISCRETIONARY SPENDING ACCOUNT UNDER THE EXECUTIVE PERQUISITE PLAN (THE "PLAN") TO PAY PREMIUMS ON CASH VALUE LIFE INSURANCE POLICIES MAY RECEIVE ADDITIONAL COMPENSATION TO ADJUST FOR THE INCOME TAX LIABILITY ASSOCIATED WITH PAYING PREMIUMS FOR THIS INSURANCE. EXECUTIVES MAY RECEIVE AS SEVERANCE BENEFITS CASH PAYMENTS IN LIEU OF PREMIUMS PAID FOR COVERAGE OF CERTAIN BENEFITS THAT ENDED WITH THE EXECUTIVE'S TERMINATION. THE ORGANIZATION MAY PAY THE ADDITIONAL TAX OWED ON ACCOUNT OF THESE PAYMENTS. DISCRETIONARY SPENDING ACCOUNT: CERTAIN EXECUTIVES RECEIVE A DISCRETIONARY SPENDING ACCOUNT. THE DOLLAR AMOUNT IN THE ACCOUNT IS PRE-APPROVED BY THE COMPENSATION AND LEADERSHIP COMMITTEE OF THE NOVANT HEALTH BOARD OF TRUSTEES. THE ACCOUNT CAN BE USED ONLY FOR AN APPROVED LIST OF EXPENDITURES. ALL OPTIONS OTHER THAN A DEFERRED, AT-RISK, COMPENSATION OPTION ARE CONSIDERED TAXABLE AND ARE INCLUDED IN THE EXECUTIVE'S TAXABLE INCOME AS PRESCRIBED BY THE APPLICABLE TAX LAWS. HOUSING ALLOWANCE OR RESIDENCE FOR PERSONAL USE: WE PROVIDE TEMPORARY HOUSING ALLOWANCES IN CERTAIN EXECUTIVE RECRUITMENT AND RELOCATION PACKAGES. IN THE CASE THAT SUCH EXPENSE IS NOT REIMBURSABLE UNDER THE ACCOUNTABLE PLAN RULES, THE VALUE IS CALCULATED UNDER APPLICABLE TAX LAWS AND THAT AMOUNT IS INCLUDED IN THE EXECUTIVE'S INCOME AS PRESCRIBED BY THE APPLICABLE TAX LAWS. HEALTH OR SOCIAL CLUB DUES OR INITIATION FEES: IN CASES WHERE CORPORATE MEMBERSHIPS ARE NOT AVAILABLE, A MEMBERSHIP MAY BE OBTAINED IN AN EXECUTIVE'S NAME WITH A "BUSINESS USE ONLY" RESTRICTION. PART I, LINE 3 THE FILING ORGANIZATION IS AN INTEGRAL PART OF NOVANT HEALTH UVA HEALTH SYSTEM ("THE SYSTEM"). NOVANT HEALTH, INC. IS A SUPPORTING ORGANIZATION OF THE SYSTEM AND USES THE PROCESS DESCRIBED IN PART VI, LINE 15A OF THIS RETURN TO ESTABLISH THE COMPENSATION OF THE TOP MANAGEMENT OFFICIAL OF THE FILING ORGANIZATION. THIS PROCESS ADHERES TO THE REQUIREMENTS SET FORTH TO SECURE THE REBUTTABLE PRESUMPTION OF REASONABLENESS AND INCLUDES A REVIEW AND APPROVAL BY INDEPENDENT AND DISINTERESTED MEMBERS OF A COMPENSATION COMMITTEE, CONSULTATION WITH INDEPENDENT COMPENSATION CONSULTANTS, THE UTILIZATION OF THIRD-PARTY COMPARABILITY DATA SUCH AS PUBLISHED COMPENSATION SURVEYS, AND CONTEMPORANEOUS SUBSTANTIATION OF THE DELIBERATION AND DECISION. PART I, LINE 4B PART I, LINES 4A-C: SEVERANCE, NONQUALIFIED, AND EQUITY-BASED PAYMENTS SEVERANCE NONQUALIFIED EQUITY-BASED ROBSON, MELISSA 64,943 PART I, LINE 4A - SEVERANCE PLAN: ELIGIBLE EXECUTIVES MAY RECEIVE SEVERANCE PAY THAT IS BASED ON ANNUAL COMPENSATION FOR A SPECIFIED PERIOD OF TIME. THE SEVERANCE PAY WOULD BE PAID ONLY IN THE EVENT OF CERTAIN TYPES OF EMPLOYMENT TERMINATION, AND IS FURTHER CONTINGENT ON THE SATISFACTION OF OTHER CONDITIONS SUCH AS COMPLIANCE WITH A NON-COMPETITION COVENANT. ANY CURRENT YEAR PAYMENTS HAVE BEEN INCLUDED IN THE COMPENSATION AMOUNTS REPORTED IN PART VII AND IN COLUMN (B)(III) OF SCHEDULE J. THE COMPENSATION AND LEADERSHIP COMMITTEE OF THE NOVANT HEALTH BOARD REVIEWS, APPROVES, AND OVERSEES ALL ASPECTS AND ALL ELEMENTS OF EXECUTIVE COMPENSATION AND BENEFITS, INCLUDING THE AMOUNTS AWARDED UNDER THIS SEVERANCE PLAN. PART I, LINE 4B SUPPLEMENTAL NONQUALIFIED RETIREMENT PLANS: THE SUPPLEMENTAL EXECUTIVE RETIREMENT PLAN ("SERP") IS INTENDED TO SUPPORT RETENTION OF KEY EXECUTIVES, AND TO OFFER COMPETITIVE TOTAL COMPENSATION. ELIGIBLE EXECUTIVES WILL BE NOMINATED BY THE CEO AND APPROVED BY THE NOVANT HEALTH COMPENSATION AND LEADERSHIP COMMITTEE ("THE COMMITTEE") TO PARTICIPATE. GENERALLY, ANNUAL CONTRIBUTIONS TO THE PLAN OR PAYMENTS TO PARTICIPANTS WILL BE BASED ON A PERCENTAGE OF THE PARTICIPANT'S BASE SALARY AS OF JANUARY 1ST OF THE PREVIOUS PLAN YEAR AND ARE REPORTED IN COLUMN (C) OF SCHEDULE J. PRIOR TO MAKING THE CONTRIBUTIONS OR PAYMENTS, THE COMMITTEE WILL APPROVE THE AMOUNTS AS TO REASONABLENESS, WHEN COMBINED WITH ALL OTHER ANNUAL COMPENSATION. A 3 YEAR CLASS-YEAR VESTING PERIOD WILL APPLY UP TO AGE 62, WHEN ALL MONEY WOULD BE VESTED AND PAID OUT TO THE PARTICIPANT. OTHERWISE, VESTING WILL OCCUR ON JANUARY 1ST OF EACH YEAR FOR THE APPROPRIATE CLASS-YEAR VESTING PERIOD. THE COMMITTEE REVIEWS, APPROVES, AND OVERSEES ALL ASPECTS AND ALL ELEMENTS OF EXECUTIVE COMPENSATION AND BENEFITS. PRINCE WILLIAM OB-GYN (PWOG) ENTITY OWNED > 35% BY JOANNE GUTLIPH, BOARD MEMBER 142202 THE FILING ORGANIZATION HAS A LEASE IN PLACE WITH PWOG 0 X 152247 SELLING PRICE 0 0 1 0 FORM 990, PI, L1: ORGANIZATION'S MISSION OR MOST SIGNIFICANT ACTIVITES PRINCE WILLIAM HOSPITAL DOING BUSINESS AS NOVANT HEALTH UVA HEALTH SYSTEM PRINCE WILLIAM MEDICAL CENTER ("NHUVAPWMC") AND NOVANT HEALTH UVA HEALTH SYSTEM HAYMARKET MEDICAL CENTER ("NHUVAHAMC") IS AN INTEGRAL PART OF THE NOVANT HEALTH UVA HEALTH SYSTEM ("NHUVAHS"). NHUVAHS WAS FORMED IN 2016 BY NOVANT HEALTH AND THE UNIVERSITY OF VIRGINIA HEALTH SYSTEM, AND IS A REGIONAL NONPROFIT, INTEGRATED HEALTHCARE NETWORK OF PHYSICIAN CLINICS, OUTPATIENT CENTERS AND HOSPITALS THAT SERVES PATIENTS AND COMMUNITIES IN VIRGINIA. PRINCE WILLIAM HOSPITAL RECEIVES STRATEGIC PLANNING, ADMINISTRATIVE AND OTHER SUPPORT FROM NOVANT HEALTH, INC., A MEMBER OF THE NOVANT HEALTH UVA HEALTH SYSTEM. GENERAL INFORMATION NOVANT HEALTH UVA HEALTH SYSTEM PRINCE WILLIAM MEDICAL CENTER LOCATED IN MANASSAS, VA AND NOVANT HEALTH UVA HEALTH SYSTEM HAYMARKET MEDICAL CENTER LOCATED IN HAYMARKET, VA ARE FOCUSED ON PROVIDING COMMUNITY SUPPORT, CONSISTENT QUALITY, EXCELLENT SERVICES AND A REMARKABLE WORK ENVIRONMENT FOR OUR STAFF. WE ARE COMMITTED TO MEETING THE HEALTH CARE NEEDS OF RESIDENTS OF MANASSAS, MANASSAS PARK AND PRINCE WILLIAM COUNTY VA, ONE PERSON AT A TIME. IN ADDITION TO OUR QUALITY OF SERVICES AND COMPREHENSIVE CATEGORIES OF SERVICES, WE'RE VERY PROUD OF OUR PATIENT FINANCIAL ASSISTANCE PROGRAM. WE WORK WITH PATIENTS TO HELP QUALIFY THEM FOR PUBLIC ASSISTANCE, ESTABLISH A REASONABLE PAYMENT PLAN, DISCOUNT THEIR BILL OR PROVIDE FREE CARE FOR THOSE THAT QUALIFY FOR FINANCIAL ASSISTANCE. COMMUNITY OUTREACH COMMUNITY OUTREACH IS A CRITICAL COMPONENT TO THE MISSION OF NOVANT HEALTH UVA HEALTH SYSTEM PRINCE WILLIAM MEDICAL CENTER AND NOVANT HEALTH UVA HEALTH SYSTEM HAYMARKET MEDICAL CENTER. BEYOND OUR PROVISION OF QUALITY HEALTHCARE SERVICES, WE SUPPORT OTHER COMMUNITY ORGANIZATIONS THAT PROVIDE HEALTH SERVICES, EDUCATION AND ASSISTANCE TO THE UNINSURED AND THE OVERALL COMMUNITY. SOME OF THE ORGANIZATIONS INCLUDE THE PRINCE WILLIAM AREA FREE CLINIC, THE GREATER PRINCE WILLIAM COMMUNITY HEALTH CENTER, MEDICAL MISSIONARIES, MARCH OF DIMES, AMERICAN DIABETES ASSOCIATION, AMERICAN HEART ASSOCIATION AND THE AMERICAN CANCER SOCIETY. NHUVAPWMC OFFERED SUPPORT GROUPS FOR NEWLY DIAGNOSED CANCER PATIENTS, BREAST CANCER PATIENTS AND GENERAL CANCER PATIENTS. IT ALSO PROVIDED COMMUNITY EDUCATION ABOUT SKIN CANCER, BREAST CANCER AND HEART HEALTH. PART OF OUR COMMITMENT TO OUR PATIENTS AND THE COMMUNITY IS OFFERING FREE OR LOW-COST SCREENINGS FOR GLUCOSE, BODY COMPOSITION, BLOOD PRESSURE AND HEMOGLOBIN A1C AS WELL AS PARTNERING WITH OUR PHYSICIAN SPECIALISTS IN THE FIELDS OF ENDOCRINOLOGY, OPHTHALMOLOGY AND PODIATRY TO PROVIDE QUESTION AND ANSWER SESSIONS FOR PERSONS WITH DIABETES. IN 2016, NOVANT HEALTH UVA HEALTH SYSTEM HAYMARKET MEDICAL CENTER LAUNCHED A FARMER'S MARKET PARTNERSHIP WITH LOCAL COMMUNITY MEMBERS TO SUPPORT THE COMMUNITY'S WELL-BEING AND PROMOTE ACCESS TO NUTRITIOUS FOODS. IN MAY 1992, NOVANT HEALTH UVA HEALTH SYSTEM PRINCE WILLIAM MEDICAL CENTER, POTOMAC HOSPITAL (NOW SENTARA NORTHERN VIRGINIA MEDICAL CENTER), PRINCE WILLIAM MEDICAL SOCIETY AND THE PRINCE WILLIAM HEALTH DEPARTMENT ESTABLISHED THE PRINCE WILLIAM AREA FREE CLINIC. THE CLINIC IS A NOT-FOR-PROFIT ORGANIZATION THAT PROVIDES ACUTE AND CHRONIC MEDICAL CARE TO UNINSURED RESIDENTS IN PRINCE WILLIAM COUNTY, VA. BOTH HOSPITALS CONTINUE TO PROVIDE FINANCIAL AND HUMAN RESOURCES TO CARE FOR PATIENTS AT THE FREE CLINIC AND THE GREATER PRINCE WILLIAM COMMUNITY HEALTH CENTER. NEW TECHNOLOGY & SERVICES A CONCURRENT ELECTRONIC HEALTH RECORD (EHR) INITIATIVE HAS BEEN IMPLEMENTED BY BOTH THE ACUTE AND AMBULATORY FACILITIES IN THE NOVANT HEALTH SYSTEM. CLINICIANS CAN SHARE PATIENTS' MEDICAL INFORMATION BETWEEN PHYSICIAN OFFICES, OUTPATIENT CENTERS, AND HOSPITALS. THIS SHARING OF INFORMATION IMPROVES SAFETY AND COORDINATION OF CARE AND PROMOTES CONNECTIVITY AND COMMUNICATION BETWEEN HOSPITAL CAREGIVERS, SPECIALISTS AND PRIMARY CARE PROVIDERS. IN 2016, NOVANT HEALTH UVA HEALTH SYSTEM PRINCE WILLIAM MEDICAL CENTER AND NOVANT HEALTH UVA HEALTH SYSTEM HAYMARKET MEDICAL CENTER CONTINUED WITH NOVANT HEALTH'S ROLLOUT OF THE EHR AND CONVERTED ITS PAPER-BASED RECORDS TO THE EHR. EMBARKING ON THE JOURNEY TO CREATE A SHARED EHR IS THE MOST SIGNIFICANT AND IMPORTANT INVESTMENT NOVANT HEALTH HAS EVER MADE FOR ITS PATIENTS AND TEAM MEMBERS. IN 2016, NOVANT HEALTH UVA HEALTH SYSTEM PRINCE WILLIAM MEDICAL CENTER BEGAN OFFERING CARDIOMEMS, A TINY, MICROCHIP SENSOR, IN PATIENTS WITH ADVANCED HEART FAILURE TO BETTER MONITOR SYMPTOMS AND REDUCE PATIENTS' CHANCES OF RETURNING TO THE HOSPITAL. IN REHABILITATION SERVICES, NOVANT HEALTH UVA HEALTH SYSTEM HAYMARKET MEDICAL CENTER BEGAN OFFERING ALCOHOL RECOVERY SUPPORT THROUGH TRANSITIONAL RECOVERY SERVICES. ALCOHOL RECOVERY SUPPORT IS A MEDICAL DETOXIFICATION TREATMENT THAT CAN BE PERSONALIZED FOR ADULTS WHO ARE DIAGNOSED WITH ALCOHOL USE DISORDER. NOVANT HEALTH UVA HEALTH SYSTEM PRINCE WILLIAM MEDICAL CENTER ALSO BEGAN OFFERING PEDIATRIC OCCUPATIONAL, PHYSICAL AND SPEECH THERAPY. IN NEUROSCIENCES, NOVANT HEALTH UVA HEALTH SYSTEM PRINCE WILLIAM MEDICAL CENTER ADDED ITS FIRST INPATIENT NEURO-HOSPITALIST TO SERVE THE NEUROLOGY PATIENTS IN PRINCE WILLIAM COUNTY. PREVIOUSLY, THERE WAS NO NEUROLOGY SUPPORT AT PRINCE WILLIAM MEDICAL CENTER. NHUVAPWMC IS ALSO UNDERGOING A $38 MILLION REMODEL THAT INCLUDES A NEW FACADE, HALLWAY IMPROVEMENTS FOR PATIENT PRIVACY, A NEW UNIVERSAL ARE UNIT FOR PATIENTS UNDER OBSERVATION AND AN EXPANDED CENTRAL ENERGY PLANT TO ENHANCE THE EFFICIENCY OF UTILITIES. AWARDS, RECOGNITIONS & CERTIFICATIONS/RECERTIFICATIONS -MAGNET RECOGNITION FROM THE AMERICAN NURSES CREDENTIALING CENTER -AMERICAN HEART ASSOCIATION'S GET WITH THE GUIDELINES HEART FAILURE GOLD PLUS ACHIEVEMENT AWARD -AMERICAN STROKE ASSOCIATION'S GET WITH THE GUIDELINES STROKE GOLD PLUS QUALITY ACHIEVEMENT AWARD -JOINT COMMISSION GOLD SEAL OF APPROVAL IN THE FOLLOWING AREAS: -ACUTE MYOCARDIAL INFARCTION -HEART FAILURE -HIP -KNEE -PNEUMONIA -MISSION: LIFELINE SILVER RECEIVING PLUS QUALITY ACHIEVEMENT AWARD -"LEADERS IN LGBTQ HEALTHCARE EQUALITY" BY THE HUMAN RIGHTS CAMPAIGN FOUNDATION ACCREDITATION NOVANT HEALTH UVA HEALTH SYSTEM PRINCE WILLIAM MEDICAL CENTER AND NOVANT HEALTH UVA HEALTH SYSTEM HAYMARKET MEDICAL CENTER HAVE BEEN FULLY ACCREDITED BY THE JOINT COMMISSION, AN INDEPENDENT ORGANIZATION THAT EVALUATES A HEALTHCARE ORGANIZATION'S PERFORMANCE IN AREAS THAT MOST AFFECT PATIENT HEALTH AND SAFETY. OTHER ACCREDITATIONS INCLUDE: COMMISSION ON CANCER ACCREDITED PROGRAM BY THE AMERICAN COLLEGE OF SURGEONS - IN 2014, THE COMMISSION ON CANCER (COC) OF THE AMERICAN COLLEGE OF SURGEONS (ACOS) GRANTED A THREE-YEAR ACCREDITATION WITH COMMENDATION TO THE CANCER PROGRAM AT NOVANT HEALTH UVA HEALTH SYSTEM PRINCE WILLIAM MEDICAL CENTER. TO EARN VOLUNTARY COC ACCREDITATION, A CANCER PROGRAM MUST MEET OR EXCEED 34 COC QUALITY CARE STANDARDS, BE EVALUATED EVERY THREE YEARS THROUGH A SURVEY PROCESS AND MAINTAIN LEVELS OF EXCELLENCE IN THE DELIVERY OF COMPREHENSIVE PATIENT-CENTERED CARE. NATIONAL ACCREDITATION PROGRAM FOR BREAST CENTERS BY THE AMERICAN COLLEGE OF SURGEONS - NOVANT HEALTH UVA HEALTH SYSTEM PRINCE WILLIAM MEDICAL CENTER IS ACCREDITED BY THE NATIONAL ACCREDITATION PROGRAM FOR BREAST CENTERS BY THE AMERICAN COLLEGE OF SURGEONS. ACCREDITATION IS GRANTED TO CENTERS THAT HAVE VOLUNTARILY COMMITTED TO PROVIDE THE HIGHEST QUALITY OF CARE TO PATIENTS WITH BREAST DISEASES AND THAT UNDERGO A RIGOROUS EVALUATION AND REVIEW OF ITS PERFORMANCE AND COMPLIANCE WITH THE NATIONAL ACCREDITATION PROGRAM FOR BREAST CENTERS. BREAST IMAGING CENTER OF EXCELLENCE DESIGNATION BY THE AMERICAN COLLEGE OF RADIOLOGY ONCOLOGY - NOVANT HEALTH UVA HEALTH SYSTEM PRINCE WILLIAM MEDICAL CENTER IS DESIGNATED AS A BREAST IMAGING CENTER OF EXCELLENCE BY THE AMERICAN COLLEGE OF RADIOLOGY. THE BREAST IMAGING CENTER OF EXCELLENCE DESIGNATION IS AWARDED TO BREAST IMAGING CENTERS THAT ACHIEVE EXCELLENCE BY SEEKING AND EARNING ACCREDITATION IN ALL THE AMERICAN COLLEGE OF RADIOLOGY'S VOLUNTARY BREAST-IMAGING ACCREDITATION PROGRAMS AND MODULES, IN ADDITION TO THE MANDATORY MAMMOGRAPHY ACCREDITATION PROGRAM. FORM 990, PART III, LINE 1: MISSION, VISION AND VALUES MISSION: NOVANT HEALTH EXISTS TO IMPROVE THE HEALTH OF COMMUNITIES, ONE PERSON AT A TIME. VISION: WE, THE NOVANT HEALTH TEAM, WILL DELIVER THE MOST REMARKABLE PATIENT EXPERIENCE, IN EVERY DIMENSION, EVERY TIME. VALUES: - COMPASSION: WE TREAT OUR CUSTOMERS AND THEIR FAMILIES, STAFF AND OTHER HEALTHCARE PROVIDERS AS FAMILY MEMBERS BY SHOWING THEM KINDNESS, PATIENCE, EMPATHY AND RESPECT. - DIVERSITY AND INCLUSION: WE RECOGNIZE THAT EVERY PERSON IS DIFFERENT, EACH SHAPED BY UNIQUE LIFE EXPERIENCES. THIS ENABLES US TO BETTER UNDERSTAND ONE ANOTHER AND OUR CUSTOMERS. BY ENGAGING THE STRENGTHS AND TALENTS OF EACH TEAM MEMBER, WE ENSURE A STRONG ORGANIZATION CAPABLE OF PROVIDING REMARKABLE HEALTHCARE TO OUR PATIENTS, FAMILIES AND COMMUNITIES. - PERSONAL EXCELLENCE: WE STRIVE TO GROW PERSONALLY AND PROFESSIONALLY, AND WE APPROACH EACH SERVICE OPPORTUNITY WITH A POSITIVE, FLEXIBLE ATTITUDE. HONESTY AND PERSONAL INTEGRITY GUIDE ALL THAT WE DO. - TEAMWORK: THE NEEDS AND EXPECTATIONS OF ANY ONE CUSTOMER ARE GREATER THAN THAT WHICH ONE PERSON'S SERVICE EFFORTS CAN SATISFY. WE SUPPORT EACH OTHER SO THAT TOGETHER AS A TEAM, WE CAN BE SUCCESSFUL IN THE EYE OF THE CUSTOMER AS A QUALITY SERVICE PROVIDER. - COURAGE: WE ACT BOLDLY IN MAKING THE CHANGES NECESSARY TO ACHIEVE OUR MISSION, VISION AND PROMISE OF DELIVERING REMARKABLE HEALTHCARE. OUR PEOPLE: WE ARE AN INCLUSIVE TEAM OF PURPOSE-DRIVEN PEOPLE INSPIRED AND UNITED BY OUR PASSION TO CARE FOR EACH OTHER, OUR PATIENTS AND OUR COMMUNITIES. OUR PROMISE TO PATIENTS: WE ARE MAKING YOUR HEALTHCARE EXPERIENCE REMARKABLE. WE WILL BRING YOU WORLD-CLASS CLINICIANS, CARE AND TECHNOLOGY - WHEN AND WHERE YOU NEED THEM. WE ARE REINVENTING THE HEALTHCARE EXPERIENCE TO BE SIMPLER, MORE CONVENIENT AND MORE AFFORDABLE, SO THAT YOU CAN FOCUS ON GETTING BETTER AND STAYING HEALTHY. FORM 990, PART I, LINE 6: THE NUMBER OF VOLUNTEERS REPORTED INCLUDES THOSE VOLUNTEERS SERVING AS BOARD MEMBERS. FORM 990, PART I, LINE 1 COMMUNITY BENEFIT REPORT HTTPS://WWW.NOVANTHEALTH.ORG/HOME/ABOUT-US/COMPANY-INFORMATION/ FINANCIAL-PROFILE/COMMUNITYBENEFIT-REPORT.ASPX THE COMMUNITY BENEFIT REPORT PREPARED BY NOVANT HEALTH IS A SYSTEM-WIDE REPORT THAT INCLUDES QUALITATIVE AND QUANTITATIVE INFORMATION. PLEASE NOTE THAT THE NUMERIC DATA IN THIS REPORT IS NOT BASED UPON THE FORM 990, SCHEDULE H CRITERIA, BUT RATHER IT HAS BEEN PREPARED IN ACCORDANCE WITH THE NORTH CAROLINA HOSPITAL ASSOCIATION REPORTING GUIDELINES. IT SHOULD NOT BE RELIED UPON AS THE ORGANIZATION'S FORM 990, SCHEDULE H COMMUNITY BENEFIT REPORT, ITS COMMUNITY HEALTH NEEDS ASSESSMENT OR COMMUNITY BENEFIT IMPLEMENTATION STRATEGY. IN THIS REPORT, THE NOVANT HEALTH SYSTEM'S COMMUNITY BENEFIT WAS APPROXIMATELY $725,000,000, INCLUDING $122,000,000 IN FINANCIAL ASSISTANCE FOR 2016. FORM 990, PART VI, SECTION A, LINE 6 FORM 990, PART VI, SECTION A, LINE 6: CLASSES OF MEMBERS OR STOCKHOLDERS THE CORPORATION IS A NONPROFIT CORPORATION WITH MEMBERS (OR A MEMBER). FORM 990, PART VI, SECTION A, LINE 7A FORM 990, PART VI, SECTION A, LINE 7A: ELECTION OF MEMBERS AND THEIR RIGHTS NOVANT HEALTH, INC. APPOINTS ALL BOARD MEMBERS OF PRINCE WILLIAM HOSPITAL. FORM 990, PART VI, SECTION A, LINE 7B FORM 990, PART VI, SECTION A, LINE 7B: DECISIONS SUBJECT TO APPROVAL OF MEMBERS UPON APPROVAL BY NOVANT HEALTH, INC., PRINCE WILLIAM HEALTH SYSTEM APPROVES CERTAIN TRANSACTIONS/ACTIONS INCLUDING AMENDMENTS TO THE ARTICLES AND BYLAWS OF THE CORPORATION AND ADOPTION OF CERTAIN POLICIES TO BE IMPLEMENTED BY THE CORPORATION BOARD. FORM 990, PART VI, SECTION B, LINE 11B FORM 990, PART VI, SECTION B, LINE 11: ORGANIZATION'S PROCESS TO REVIEW FORM 990 THE BOARD HAS DELEGATED REVIEW OF THE FORM 990 TO NOVANT HEALTH'S AUDIT AND COMPLIANCE COMMITTEE ("THE COMMITTEE"), WHICH OVERSEES TAX MATTERS FOR NOVANT HEALTH. THE COMMITTEE IS THE REVIEW BODY FOR ALL OF THE FORM 990S FILED FOR ORGANIZATIONS WITHIN THE NOVANT HEALTH SYSTEM. THE COMMITTEE MEETS BEFORE THE FORM 990S ARE FILED WITH THE IRS AND AFTER ALL BOARD MEMBERS HAVE RECEIVED A COPY OF THE FORM 990 AND A SUMMARY OF ITS CONTENTS. THE VICE PRESIDENT OF TAX AND LEGAL COUNSEL FOR NOVANT HEALTH ATTEND THE MEETING TO ANSWER ANY QUESTIONS AND ADDRESS ANY SIGNIFICANT DISCLOSURES WITHIN THE FORM 990. FORM 990, PART VI, SECTION B, LINE 12C FORM 990, PART VI, SECTION B, LINE 12C: MONITORING AND ENFORCEMENT OF COI THE ORGANIZATION'S TRUSTEE CONFLICT OF INTEREST POLICY APPLIES TO ALL TRUSTEES, PRINCIPAL OFFICERS OR MEMBERS OF A COMMITTEE WITH BOARD DELEGATED POWERS INCLUDING ANY APPLICABLE DISREGARDED ENTITIES. ALL TRUSTEES ARE SENT AN ANNUAL DISCLOSURE QUESTIONNAIRE. THE TRUSTEE ANNUAL DISCLOSURE QUESTIONNAIRES ARE REVIEWED BY THE COMPLIANCE DEPARTMENT. WITH RESPECT TO PARTICULAR TRANSACTIONS THAT COME BEFORE THE BOARD, THE CONFLICT OF INTEREST POLICY WOULD BE FOLLOWED. THE POTENTIAL CONFLICT OF INTEREST WOULD BE DISCLOSED BY THE BOARD MEMBER BEFORE A VOTE ON THE TRANSACTION AND THE REST OF THE BOARD WOULD DETERMINE WHETHER A CONFLICT OF INTEREST EXISTS. IF THE REST OF THE BOARD DETERMINED THAT A CONFLICT OF INTEREST EXISTED THEN THE BOARD MEMBER WITH THE CONFLICT OF INTEREST WOULD NOT PARTICIPATE IN THE DELIBERATIONS AND VOTE. FORM 990, PART VI, SECTION B, LINE 15B FORM 990, PART VI, SECTION B, LINE 15A: COMPENSATION PROCESS FOR TOP OFFICIAL THE FILING ORGANIZATION IS AN INTEGRAL PART OF THE NOVANT HEALTH UVA HEALTH SYSTEM ("THE SYSTEM"), WHICH IS SUPPORTED BY NOVANT HEALTH, INC. ("NOVANT HEALTH"), ONE OF ITS MEMBERS. NOVANT HEALTH SUPPORTS THE SYSTEM BY PROVIDING A COMPENSATION REVIEW AND APPROVAL PROCESS TO CERTAIN SYSTEM ENTITIES. THE PROCESS IS CONDUCTED BY THE INDEPENDENT AND DISINTERESTED MEMBERS OF THE NOVANT HEALTH BOARD OF TRUSTEES (WHO COMPRISE THE COMPENSATION AND LEADERSHIP COMMITTEE OF THE BOARD) WHO REVIEW, APPROVE, AND OVERSEE ALL ASPECTS OF COMPENSATION AND BENEFITS PROVIDED TO CERTAIN EXECUTIVES ("EXECUTIVES") SERVING AS THE TOP MANAGEMENT OFFICIAL(S) FOR CERTAIN ENTITIES WITHIN THE SYSTEM, INCLUDING THE FILING ORGANIZATION. THE COMMITTEE WORKS WITH AN INDEPENDENT COMPENSATION CONSULTANT AND USES THIRD PARTY COMPARABILITY DATA FOR FUNCTIONALLY SIMILAR POSITIONS AT SIMILARLY SITUATED ORGANIZATIONS TO ENSURE THAT TOTAL COMPENSATION AND BENEFITS FOR EACH EXECUTIVE IS REASONABLE FOR THAT EXECUTIVE'S POSITION. THE COMMITTEE REVIEWS AND APPROVES EXECUTIVE COMPENSATION AND BENEFITS ANNUALLY, CONSISTENT WITH THE WRITTEN EXECUTIVE COMPENSATION PHILOSOPHY OF NOVANT HEALTH, AND IN A MANNER THAT QUALIFIES FOR THE REBUTTABLE PRESUMPTION OF REASONABLENESS, THEREBY ASSURING THAT TOTAL COMPENSATION AND BENEFITS PROVIDED TO EACH EXECUTIVE IS REASONABLE. FORM 990, PART VI, SECTION B, LINE 15B: COMPENSATION PROCESS FOR OFFICERS THE FILING ORGANIZATION IS AN INTEGRAL PART OF THE NOVANT HEALTH UVA HEALTH SYSTEM ("THE SYSTEM"), WHICH IS SUPPORTED BY NOVANT HEALTH, INC. ("NOVANT HEALTH"), ONE OF ITS MEMBERS. NOVANT HEALTH SUPPORTS THE SYSTEM BY PROVIDING A COMPENSATION REVIEW AND APPROVAL PROCESS TO CERTAIN SYSTEM ENTITIES INCLUDING THE FILING ORGANIZATION. THE PROCESS IS CONDUCTED BY THE INDEPENDENT AND DISINTERESTED MEMBERS OF THE NOVANT HEALTH, INC. BOARD OF TRUSTEES (WHO COMPRISE THE COMPENSATION AND LEADERSHIP COMMITTEE OF THE BOARD) WHO REVIEW, APPROVE, AND OVERSEE ALL ASPECTS OF COMPENSATION AND BENEFITS FOR CERTAIN LEADERS AND EXECUTIVES ("EXECUTIVES") SERVING AS OFFICERS OR KEY EMPLOYEES FOR NOVANT HEALTH ENTITIES. THE COMMITTEE WORKS WITH AN INDEPENDENT COMPENSATION CONSULTANT AND USES THIRD PARTY COMPARABILITY DATA FOR FUNCTIONALLY SIMILAR POSITIONS AT SIMILARLY SITUATED ORGANIZATIONS TO ENSURE THAT TOTAL COMPENSATION AND BENEFITS FOR EACH EXECUTIVE IS REASONABLE FOR THAT EXECUTIVE'S POSITION. THE COMMITTEE REVIEWS AND APPROVES EXECUTIVE COMPENSATION AND BENEFITS ANNUALLY, CONSISTENT WITH THE WRITTEN EXECUTIVE COMPENSATION PHILOSOPHY OF NOVANT HEALTH, AND IN A MANNER THAT QUALIFIES FOR THE REBUTTABLE PRESUMPTION OF REASONABLENESS, THEREBY ASSURING THAT TOTAL COMPENSATION AND BENEFITS PROVIDED TO EACH EXECUTIVE IS REASONABLE. FORM 990, PART VI, SECTION C, LINE 19 FORM 990, PART VI, SECTION C, LINE 19: GOVERNING DOCUMENTS DISCLOSURE THE AUDITED CONSOLIDATED FINANCIAL STATEMENTS CONTAINING ALL ORGANIZATIONS IN THE NOVANT HEALTH UVA HEALTH SYSTEM ARE AVAILABLE UPON REQUEST. THE GOVERNING DOCUMENTS AND CONFLICT OF INTEREST POLICY ARE NOT AVAILABLE TO THE PUBLIC. FORM 990, PART VII, SECTION B: INDEPENDENT CONTRACTORS THE FILING ENTITY IS PART OF THE NOT-FOR-PROFIT INTEGRATED HEALTHCARE SYSTEM KNOWN AS NOVANT HEALTH UVA HEALTH SYSTEM. NOVANT HEALTH, INC. IS A MEMBER OF THE ENTITY THAT OPERATES THE HEALTH SYSTEM AND IS RESPONSIBLE FOR CERTAIN CORPORATE SUPPORT FUNCTIONS INCLUDING ACCOUNTS PAYABLE AND ISSUES FORMS 1099 FOR CERTAIN ENTITIES IN THE SYSTEM INCLUDING THE FILING ENTITY. INFORMATION REPORTED IN PART VII, SECTION B REPRESENTS THE EXPENSES PAID ON BEHALF OF THE FILING ENTITY TO INDEPENDENT CONTRACTORS OVER $100,000. FORM 990, PART VII, SECTION A, COLUMN B: RELATED ORGANIZATIONS THE ORGANIZATION EMPLOYS CERTAIN EXECUTIVES WHOSE ROLES ARE SUCH THAT THEY PROVIDE SERVICES TO NOT ONLY THE ORGANIZATION, BUT ALSO TO SOME OR ALL OF THE OTHER TAX-EXEMPT ORGANIZATIONS WITHIN THE HEALTHCARE SYSTEM. FOR EXAMPLE, MANY OF THESE EXECUTIVES' ROLES FOCUS ON PARTICULAR SERVICE LINES WHICH CROSS THE VARIOUS GEOGRAPHIC MARKETS OUR ORGANIZATIONS SERVE, THUS THE SERVICES PROVIDED BY THESE EXECUTIVES MAY BENEFIT AND BE RECEIVED BY MULTIPLE ORGANIZATIONS WITHIN THE SYSTEM. THE EXECUTIVES DO NOT ALLOCATE THEIR HOURS BETWEEN THE VARIOUS ORGANIZATIONS, BUT RATHER THEIR TIME SPENT ON SERVICES TO THE ORGANIZATION IS INCLUSIVE OF SERVICES TO ALL OF THE ORGANIZATIONS THEY SERVE WITHIN THE SYSTEM. FORM 990, PART IX, LINE 11G OUTSIDE SERVICES: PROGRAM SERVICE EXPENSES 23,030,874. MANAGEMENT AND GENERAL EXPENSES 1,270,987. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 24,301,861. CONSULTING FEES: PROGRAM SERVICE EXPENSES 1,803,066. MANAGEMENT AND GENERAL EXPENSES 99,504. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,902,570. CONTRACTED SERVICES: PROGRAM SERVICE EXPENSES 2,782,338. MANAGEMENT AND GENERAL EXPENSES 153,547. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 2,935,885. RECRUITMENT: PROGRAM SERVICE EXPENSES 99,580. MANAGEMENT AND GENERAL EXPENSES 5,495. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 105,075. FOOD SERVICE MANAGEMENT FEES: PROGRAM SERVICE EXPENSES 0. MANAGEMENT AND GENERAL EXPENSES 3,637,304. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 3,637,304. FORM 990, PART XI, LINE 9: AFFILIATE TRANSFERS: -29,330,271. PENSION ADJUSTMENT: 4,373,902. MALPRACTICE INSURANCE: -477,069. K-1 ADJUSTMENTS: -3,953,236. MEANINGFUL USE: 182,984. CONTRIBUTIONS: -84,943. ROUNDING: 3. 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