2025-11-10T11:22:34-06:00 2024-12-31 346565596 ERNST & YOUNG US LLP 221 E 4TH ST SUITE 2900 CINCINNATI OH 45202 990 2024-01-01 461851763 PEDIATRIC SPECIALISTS OF VIRGINIA LLC PEDI 5714728123 8095 INNOVATION PARK DRIVE FAIRFAX VA 22031 LAUREL BLAKEMORE MD CEO 5714728123 2025-11-10 1 0 JULIE L SPARKS P01268401 5136121400 2024 2025-03-06 01:10:19Z LAUREL BLAKEMORE MD 8095 INNOVATION PARK DRIVE FAIRFAX VA 22031 45837404 0 X PSVCARE.ORG X 2013 VA TO PROVIDE A MARKET-LEADING PEDIATRIC SPECIALIST PHYSICIAN CAPACITY IN NORTHERN VIRGINIA. 8 6 335 0 0 0 187163 27716 34315684 36173033 1169249 2158016 0 0 35672096 38358765 187317 31525 0 0 35927315 36869182 0 0 1346 15623625 15559446 51738257 52460153 -16066161 -14101388 42999402 41512621 34971205 33237041 8028197 8275580 X PEDIATRIC SPECIALISTS OF VIRGINIA'S (PSV) CHARITABLE MISSION IS TO MEET THE PEDIATRIC SPECIALIST STAFFING NEEDS OF INOVA AND CHILDREN'S NATIONAL MEDICAL CENTER (CNMC) AND TO PROVIDE PEDIATRIC SPECIALIST CONSULTS TO PEDIATRIC PATIENTS AS REQUESTED BY INOVA OR CNMC. ALSO TO EXPAND OUTPATIENT PEDIATRIC SPECIALIST SERVICES IN NORTHERN VIRGINIA THROUGH THE OPERATION OF AMBULATORY CARE SITES, AMONG OTHER VEHICLES. 0 1 46277305 31525 36173033 PSV PROVIDES MEDICAL CARE AND RELATED SERVICES TO CHILDREN WHO SEEK DIAGNOSIS, TREATMENT, AND CARE WITHOUT REGARD TO RACE, COLOR, CREED, SEX, DISABILITY, NATIONAL ORIGIN, SEXUAL ORIENTATION, OR POVERTY STATUS. PSV'S PHYSICIANS AND ALLIED STAFF PROVIDE SERVICES IN THE FOLLOWING PEDIATRIC SPECIALTY AREAS: GASTROENTEROLOGY, ORTHOPEDICS,HEMATOLOGY/ONCOLOGY, RHEUMATOLOGY, PSYCHOLOGY, NEUROLOGY, UROLOGY AND PULMONARY MEDICINE TO ALL PEDIATRIC PATIENTS ON A NON-DISCRIMINATORY BASIS. IN ADDITION, PSV OPERATES AN OUTPATIENT SURGERY CENTER AND PROVIDES PEDIATRIC ANESTHESIOLOGY SERVICES. PSV ENGAGES IN ACTIVITIES THAT EDUCATE THE COMMUNITY WITH RESPECT TO AREAS OF CRITICAL HEALTH CARE IMPORTANCE. THROUGH ITS AFFILIATION WITH INOVA AND CHILDREN'S HOSPITAL, PSV PARTICIPATES IN HEALTH SCREENINGS, HEALTH FAIRS, AND HEALTH EDUCATION CLASSES MADE AVAILABLE TO ALL RESIDENTS IN THE COMMUNITY, WHETHER OR NOT THEY ARE PATIENTS OF PSV. PSV'S EMPLOYED PHYSICIANS ALSO PARTICIPATE IN ACADEMIC AND RESEARCH PROGRAMS. PSV PHYSICIANS SERVE AS FACULTY FOR AREA MEDICAL SCHOOLS, PARTICIPATING IN THE MEDICAL EDUCATION PROGRAMS OF THE AFFILIATED HOSPITALS AND INSTRUCTING STUDENTS. BY ENGAGING IN PATIENT CARE AND TEACHING ACTIVITIES AT THE MEMBERS' HOSPITALS, PSV PROMOTES THE HEALTH AND WELL BEING OF THE COMMUNITIES SERVED AND FOSTERS A DYNAMIC AND INTERACTIVE LEARNING ENVIRONMENT FOR FUTURE PHYSICIANS. PSV'S EMPLOYED PHYSICIANS AND ALLIED STAFF ALSO CONDUCT MEDICAL RESEARCH TO ADVANCE THE STUDY AND PRACTICE OF MEDICINE AND TO FIND CURES FOR DISEASES. RESULTS OF THE RESEARCH HAS BEEN MADE AVAILABLE TO THE GENERAL PUBLIC. PSV'S PHYSICIANS PROVIDE SERVICES TO PATIENTS AT FOUR DISTINCT LOCATIONS IN NORTHERN VIRGINIA. BY PROVIDING HIGHLY-SPECIALIZED PEDIATRIC PHYSICIAN CARE TO ALL CHILDREN IN THE LARGE, DIVERSE, AND GROWING NORTHERN VIRGINIA COMMUNITY, PSV FULFILLS A VALUABLE COMMUNITY NEED. PSV MAKES AVAILABLE TO ALL CHILDREN, INCLUDING INDIGENT CHILDREN WHO REQUIRE MEDICAL CARE, THE SERVICES OF ITS PHYSICIANS AND OF ITS QUALIFIED HEALTH CARE PROFESSIONALS CONSISTENT WITH PSV'S POLICIES FOR PROVIDING NEEDED MEDICAL SERVICES TO PATIENTS REGARDLESS OF THEIR ABILITY TO PAY. 46277305 1 1 0 0 0 0 0 0 0 0 1 1 0 1 1 1 1 0 0 0 0 0 0 0 0 0 0 0 1 1 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 1 15 0 1 335 1 0 0 0 0 0 0 0 0 0 0 0 0 X 8 6 0 0 0 0 1 1 1 1 1 0 0 1 1 0 1 1 1 1 1 0 VA X PEDIATRIC SPECIALISTS OF VIRGINIA LLC 7038486630 3023 HAMAKER COURT FAIRFAX VA 22031 JOANNA FAZIO TRUSTEE 1.00 0.00 X 0 0 0 ELIZABETH WELLS MD BEG 1124 TRUSTEE 1.00 0.00 X 0 0 0 DAVID ASHMAN TRUSTEE 1.00 0.00 X 0 0 0 STEVE NARANG TRUSTEE 1.00 0.00 X 0 0 0 IAN LEIBOWITZ MD TRUSTEE 1.00 0.00 X 0 0 0 THOMAS NEWTON MD BEG 92524 TRUSTEE, PHYSICIAN 36.00 0.00 X 311441 0 17482 GEORGE GANTSOUDES END 92524 TRUSTEE, PHYSICIAN 40.00 0.00 X 698298 0 51479 MARC DIFAZIO MD CHAIRMAN 1.00 0.00 X 0 0 0 CYNTHIA GIBSON MD TRUSTEE 1.00 0.00 X 0 0 0 LAUREL BLAKEMORE MD CHIEF EXECUTIVE OFFICER 40.00 0.00 X 889297 0 28249 WILLIAM JUDD CHIEF OPERATING OFFICER 40.00 0.00 X 284452 0 17791 MARGARET HARRIS CHIEF FINANCIAL OFFICER 40.00 0.00 X 191027 0 14747 THANH NGUYEN MEDICAL DIRECTOR 40.00 0.00 X 291664 0 15646 EMILY HATTWICK MEDICAL DIRECTOR 32.00 0.00 X 411454 0 47670 RONAK PATEL MEDICAL DIRECTOR 40.00 0.00 X 421687 0 30635 LAURA ELEANOR GILL-SEALY PHYSICIAN 40.00 0.00 X 613823 0 48629 JOSEPH LETZELTER III PHYSICIAN 40.00 0.00 X 585539 0 52057 JOANNE DEKIS PHYSICIAN 40.00 0.00 X 590878 0 39269 EVAN SHEPPARD PHYSICIAN 40.00 0.00 X 579095 0 19161 SHAUNETTE DAVEY PHYSICIAN 40.00 0.00 X 535737 0 13534 6404392 0 396349 69 0 1 0 SCOLIOSIS SOLUTIONS LLC 3023 HAMAKER COURT SUITE LL50 FAIRFAX VA 22023 X-RAY SERVICES 242650 LIBERTY LANGUAGE SERVICE LLC 8300 GREENSBORO DR L1-801 TYSONS VA 22102 TRANSLATION SERVICES 240913 NATIONAL MEDICAL BILLING SERVICES 7 ARNAGE ROAD CHESTERFIELD MO 63005 PATIENT BILLING SERVICES 177245 HAYES LOCUMS LLC PO BOX 88122 CHICAGO IL 60680 HEALTHCARE STAFFING SERVICES 174595 FIRST ONSITE PROPERTY RESTORATION PO BOX 22664 NEW YORK NY 10087 PROPERTY RESTORATION SERVICES 166046 7 27716 27145 27716 NET PATIENT SERVICE REVENUE 621400 36173033 36173033 36173033 649919 649919 8980736 6000 7478639 0 1502097 6000 1508097 1508097 38358765 36173033 0 2158016 31525 31525 3499321 3499321 28172256 23991608 4180648 1239693 1076054 163639 2206494 1915237 291257 1751418 1520231 231187 521227 452425 68802 15632 13569 2063 53182 46162 7020 11369 9868 1501 2498318 2171648 325324 1346 836 726 110 190725 165549 25176 413809 359186 54623 3285298 2851639 433659 82389 71514 10875 64515 55999 8516 516216 448075 68141 1424417 1236394 188023 MEDICAL SUPPLIES 5562459 5562459 BAD DEBT 308799 268038 40761 REPAIRS AND MAINTENANCE 167067 145014 22053 TAXES AND LICENSES 89150 77382 11768 354038 307682 46356 52460153 46277305 6181502 1346 6604721 5380976 1513429 1418211 561982 539935 181902 143533 14383176 12644112 1843956 1739064 8667828 9457490 2268023 2890986 21357561 19942426 42999402 41512621 6865716 6888419 28105489 26348622 34971205 33237041 X 8028197 8275580 8028197 8275580 42999402 41512621 X -14101388 -1052025 15400796 X 0 1 X 1 0 X 830474 1541087 38997 187163 27716 2625437 31464718 36593583 39659149 34315684 36173033 178206167 32295192 38134670 39698146 34502847 36200749 180831604 0 0 0 180831604 324707 386611 -222296 1169249 2158016 3816287 324707 386611 -222296 1169249 2158016 3816287 32619899 38521281 39475850 35672096 38358765 184647891 0.97930 0.98650 0.02070 0.01350 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 9646866 8897198 749668 3694929 2815826 879103 1041381 931088 110293 1739064 VARIABLE ANNUITY CONTRACTS 2890986 F 2890986 RIGHT OF USE ASSET 18531809 INTERCOMPANY RECEIVABLE 1410617 19942426 PROFESSIONAL LIABILITY 2039000 LEASE LIABILITY 21418636 RETIREMENT PLAN LIABILITY 2890986 26348622 X 36956765 -1052025 -322830 -1374855 38331620 27145 27145 38358765 52110178 0 52110178 349975 349975 52460153 PART X, LINE 2: THE COMPANY WAS RECOGNIZED AS A PUBLIC CHARITY, NOT A FOUNDATION, GENERALLY EXEMPT FROM FEDERAL INCOME TAXATION UNDER SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE PURSUANT TO A DETERMINATION LETTER ISSUED BY THE IRS IN JANUARY 2015 EFFECTIVE SEPTEMBER 30, 2013. THE COMPANY IS ENTITLED TO RELY ON THIS DETERMINATION AS LONG AS THERE ARE NO SUBSTANTIAL CHANGES IN ITS CHARACTER, PURPOSES, OR METHODS OF OPERATION. MANAGEMENT HAS CONCLUDED THAT THERE HAVE BEEN NO SUCH CHANGES AND, THEREFORE, THE COMPANY'S STATUS AS A PUBLIC CHARITY EXEMPT FROM FEDERAL INCOME TAXATION REMAINS IN EFFECT. THE STATE IN WHICH THE COMPANY OPERATES ALSO PROVIDES GENERAL EXEMPTION FROM STATE INCOME TAXATION FOR ORGANIZATIONS THAT ARE EXEMPT FROM FEDERAL INCOME TAXATION. HOWEVER, THE COMPANY IS SUBJECT TO BOTH FEDERAL AND STATE INCOME TAXATION AT CORPORATE TAX RATES ON ITS UNRELATED BUSINESS INCOME. EXEMPTION FROM OTHER STATE TAXES, SUCH AS REAL AND PERSONAL PROPERTY TAXES, IS SEPARATELY DETERMINED. THE COMPANY HAD NO UNRECOGNIZED TAX BENEFITS, OR SUCH AMOUNTS WERE IMMATERIAL DURING THE PERIODS PRESENTED. FOR TAX PERIODS WITH RESPECT TO WHICH NO UNRELATED BUSINESS INCOME WAS RECOGNIZED, THE COMPANY WAS NOT REQUIRED TO FILE ANY INCOME TAX RETURNS. PART XI, LINE 2D - OTHER ADJUSTMENTS: BAD DEBT EXPENSE -308,799. OTHER NON OPERATING EXPENSE -14,031. PART XI, LINE 4B - OTHER ADJUSTMENTS: NON CASH DONATIONS 27,145. PART XII, LINE 4B - OTHER ADJUSTMENTS: BAD DEBT EXPENSE 308,799. OTHER NON OPERATING EXPENSE 14,031. USE OF FUNDS 27,145. 1 TRANSPORTATION ASSISTANCE TO INDIGENT PATIENTS 49 3630 GIFT CARDS TO INDIGENT PATIENTS 13 750 TOYS 1872 27145 FAIR MARKET VALUE DONATED TOYS PART I, LINE 2: PEDIATRIC SPECIALISTS OF VIRGINIA (PSV) OFFERS GIFTS OR GRANTS TO ASSIST INDIGENT FAMILIES WHO ARE STRUGGLING WITH THE DEMANDS OF CARING FOR CHILDREN WITH SERIOUS, COMPLEX AND/OR DEBILITATING HEALTH CONDITIONS. PSV HAS A POLICY THAT OUTLINES ELIGIBILITY AND THE PROCESS, AS WELL AS A FORM FOR REQUESTING, APPROVING AND DOCUMENTING THESE GIFTS. THE POLICY REQUIRES THE RECIPIENT TO BE A CURRENT PATIENT OF PSV. A PSV SOCIAL WORKER OR OTHER STAFF MEMBER ASSESSES THE FAMILIES' NEEDS, AND REQUESTS ARE APPROVED BY PSV SENIOR LEADERS. PAYMENTS ARE MADE DIRECTLY TO CREDITORS (SUCH AS A LANDLORD, UTILITY COMPANY, ETC.) UPON DOCUMENTATION OF AMOUNTS OWED. SMALLER GIFTS, IN THE FORM OF TRANSPORTATION VOUCHERS, OR GIFT CARDS TO ASSIST WITH GROCERIES OR PHARMACY CO-PAYS, ARE TRACKED USING A LOG. PSV OCCASIONALLY RECEIVES CONTRIBUTIONS OF TOYS WHICH ARE THEN GIFTED TO PATIENTS RECEIVING TREATMENT TO COMFORT THEM. X X X X 0 0 0 0 0 0 0 0 0 LAUREL BLAKEMORE MD CHIEF EXECUTIVE OFFICER 739465 0 146268 0 3564 0 14191 0 14058 0 917546 0 0 0 GEORGE GANTSOUDES END 92524 TRUSTEE, PHYSICIAN 563144 0 134344 0 810 0 17250 0 34229 0 749777 0 0 0 LAURA ELEANOR GILL-SEALY PHYSICIAN 503330 0 109683 0 810 0 17250 0 31379 0 662452 0 0 0 JOSEPH LETZELTER III PHYSICIAN 456006 0 129047 0 486 0 14557 0 37500 0 637596 0 0 0 JOANNE DEKIS PHYSICIAN 490792 0 99600 0 486 0 17250 0 22019 0 630147 0 0 0 EVAN SHEPPARD PHYSICIAN 477017 0 101592 0 486 0 17250 0 1911 0 598256 0 0 0 SHAUNETTE DAVEY PHYSICIAN 513638 0 21559 0 540 0 0 0 13534 0 549271 0 0 0 EMILY HATTWICK MEDICAL DIRECTOR 318331 0 90801 0 2322 0 15291 0 32379 0 459124 0 0 0 RONAK PATEL MEDICAL DIRECTOR 365701 0 55500 0 486 0 17250 0 13385 0 452322 0 0 0 THOMAS NEWTON MD BEG 92524 TRUSTEE, PHYSICIAN 254568 0 55633 0 1240 0 14578 0 2904 0 328923 0 0 0 THANH NGUYEN MEDICAL DIRECTOR 241055 0 49930 0 679 0 11953 0 3693 0 307310 0 0 0 WILLIAM JUDD CHIEF OPERATING OFFICER 234994 0 47277 0 2181 0 14292 0 3499 0 302243 0 0 0 MARGARET HARRIS CHIEF FINANCIAL OFFICER 171199 0 17459 0 2369 0 9721 0 5026 0 205774 0 0 0 X TOYS 35 27145 ESTIMATED RETAIL VAL 0 0 1 0 PART I, COLUMN (B): 35 CONTRIBUTIONS WERE RECEIVED FORM 990, PART III, LINE 3 DURING 2023 THE SCOPE OF SERVICES PROVIDED BY THE COMPANY WAS REDUCED RESULTING IN CERTAIN SUB-SPECIALTY SERVICES NO LONGER BEING OFFERED BY THE COMPANY INCLUDING NEPHROLOGY, GENETICS, ENDOCRINOLOGY, INFECTIOUS DISEASES, PSYCHIATRY, ALLERGY AND IMMUNOLOGY, DEVELOPMENTAL PEDIATRICS, NEUROSURGERY, PHYSICAL MEDICINE AND REHABILITATION, ADOLESCENT GYNECOLOGY, OTOLARYNGOLOGY, OPHTHALMOLOGY, AND PLASTIC SURGERY. FORM 990, PART VI, SECTION A, LINE 6 THE ORGANIZATION WAS FORMED AS A LIMITED LIABILITY COMPANY AND HAS TWO MEMBERS: INOVA HEALTH CARE SERVICES AND CHILDREN'S NATIONAL MEDICAL CENTER, BOTH CHARITABLE 501(C)(3) TAX-EXEMPT ORGANIZATIONS, WITH EQUAL INTERESTS. THE MEMBERS ENTERED INTO THE SECOND AMENDED AND RESTATED OPERATING AGREEMENT (OPERATING AGREEMENT) DATED JUNE 24, 2022 GOVERNING THE ORGANIZATION. FORM 990, PART VI, SECTION A, LINE 7A AS DESCRIBED IN THE OPERATING AGREEMENT, THE GOVERNING BODY OF THE ORGANIZATION IS THE MANAGEMENT COMMITTEE. THE MANAGEMENT COMMITTEE IS COMPRISED OF EIGHT REPRESENTATIVES. THREE OF THE MANAGEMENT COMMITTEE REPRESENTATIVES ARE DESIGNATED AND APPOINTED BY EACH OF THE MEMBERS. THE REMAINING MANAGEMENT COMMITTEE REPRESENTATIVES ARE PHYSICIANS EMPLOYED OR CONTRACTED BY THE ORGANIZATION AND MUTUALLY AGREED UPON BY THE MEMBERS. FORM 990, PART VI, SECTION A, LINE 7B THE OPERATING AGREEMENT PROVIDES FOR CERTAIN DECISIONS TO BE APPROVED BY THE MEMBERS. FORM 990, PART VI, SECTION B, LINE 11B THE FORM 990 IS PREPARED BY A THIRD PARTY TAX ADVISOR AND INITIALLY PROVIDED TO THE CHIEF FINANCIAL OFFICER, THE CHIEF OPERATING OFFICER, AND EXTERNAL TAX CONSULTANTS FOR REVIEW. THE FORM 990 IS FINALLY PRESENTED TO THE FULL MANAGEMENT COMMITTEE FOR REVIEW PRIOR TO FILING. FORM 990, PART VI, SECTION B, LINE 12C THE ORGANIZATION HAS A WRITTEN CONFLICT OF INTEREST POLICY WHICH IS PROVIDED TO AND REVIEWED WITH ALL EMPLOYEES DURING THEIR NEW EMPLOYEE ORIENTATION. THE POLICY REQUIRES THE EMPLOYEE TO DISCLOSE REAL OR POTENTIAL CONFLICTS OF INTEREST, AND ALSO TO REPORT SUSPECTED VIOLATIONS OF THE POLICY TO MANAGEMENT OR HUMAN RESOURCES. THE EMPLOYEE CODE OF CONDUCT ALSO INCLUDES A SECTION DISCUSSING CONFLICTS OF INTEREST AND ALL EMPLOYEES ARE REQUIRED TO ACKNOWLEDGE RECEIPT OF, AND AGREEMENT TO COMPLY WITH, THE CODE OF CONDUCT IN WRITING. FORM 990, PART VI, SECTION B, LINE 15 PEDIATRIC SPECIALISTS OF VIRGINIA, LLC COMPENSATION: THE MANAGEMENT COMMITTEE DETERMINES AND APPROVES COMPENSATION FOR PSV'S CHIEF EXECUTIVE OFFICER AND CHIEF OPERATING OFFICER USING A REGIONAL MARKET ANALYSIS OF COMPARABLE POSITIONS. FORM 990, PART VI, SECTION C, LINE 19 GOVERNING DOCUMENTS AND FINANCIAL STATEMENTS ARE NOT CURRENTLY PUBLICLY AVAILABLE. WHILE THE CONFLICT OF INTEREST POLICY IS NOT SPECIFICALLY PUBLICLY DISCLOSED, THE POLICY IS AVAILABLE TO STAFF AND PHYSICIANS. FORM 990, PART XI, LINE 9: CAPTIAL CONTRIBUTED IN 2024 BY LLC MEMBERS 15,400,796.