2015-10-27T09:56:53-05:00 2014-12-31 540737372 PBMARES LLP 725 JACKSON STREET SUITE 210 FREDERICKSBURG VA 22401 990 2014-01-01 201106426 MARY WASHINGTON HEALTHCARE GROUP RETURN MARY 5407412513 2300 FALL HILL AVENUE NO 418 FREDERICKSBURG VA 22401 SEAN T BARDEN EXECUTIVE VICE PRESIDENT 5407412513 2015-10-16 1 KEITH L WAMPLER P00436324 5403713566 2015-10-16 X 2014 2016-02-25 16:41:14Z MICHAEL P MCDERMOTT MD 2300 FALL HILL AVENUE NO 418 FREDERICKSBURG VA 22401 615269493 1 1 4243 X WWW.MARYWASHINGTONHEALTHCARE.COM X 1983 VA OUR MISSION IS TO IMPROVE THE HEALTH OF PEOPLE IN THE COMMUNITIES WE SERVE. THROUGH OUR SUBSIDIARIES WE PROVIDE INPATIENT AND OUTPATIENT HOSPITAL SERVICES AND OTHER MEDICAL SERVICES. 64 52 3690 0 2235731 -1214085 4974765 9870991 568469103 589430956 6538697 447080 12111756 14100631 592094321 613849658 4048808 6257740 0 0 231459510 220334987 44755 0 372480 368327985 371844447 603881058 598437174 -11786737 15412484 464708560 446120611 297345687 291854536 167362873 154266075 OUR MISSION IS TO IMPROVE THE HEALTH OF PEOPLE IN THE COMMUNITIES WE SERVE. THROUGH OUR SUBSIDIARIES WE PROVIDE INPATIENT AND OUTPATIENT HOSPITAL SERVICES AND OTHER MEDICAL SERVICES. 0 0 567209182 6257740 586488305 PROVISION OF INPATIENT AND OUTPATIENT GENERAL ACUTE CARE HOSPITAL, PSYCHIATRIC HOSPITAL SERVICES, HOME HEALTH AND HOSPICE SERVICES, IMAGING AND AMBULATORY SURGERY SERVICES AND PHYSICIAN SERVICES. PRIMARY SERVICE AREAS ARE FREDERICKSBURG, PRINCE WILLIAM, STAFFORD, SPOTSYLVANIA, CAROLINE, KING GEORGE, AND WESTMORELAND COUNTIES IN VIRGINIA AND SECONDARY SERVICE AREAS INCLUDE MANASSAS, FAUQUIER, CULPEPER, ORANGE, LOUISA, HANOVER, ESSEX AND RICHMOND COUNTIES IN VIRGINIA. WE SERVED 118,327 PATIENTS IN OUR EMERGENCY ROOMS, 326,052 OUTPATIENTS, 18,094 SURGICAL CASES AND 36,940 PATIENT DISCHARGES. 567209182 1 1 0 0 0 0 0 0 0 1 1 0 0 0 1 1 0 1 0 0 0 0 0 0 1 0 1 1 1 1 1 1 0 0 0 0 0 0 0 0 0 1 1 0 0 0 0 1 1 0 0 0 1 X 396 0 3690 1 0 0 0 0 0 0 0 0 0 0 X 64 52 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 1 0 X X WILLIAM YASCKO 5407412513 2300 FALL HILL AVENUE NO 418 FREDERICKSBURG VA 22401 FRED M RANKIN III PRESIDENT 4.00 40.00 X X 0 755203 30808 SEAN T BARDEN EXECUTIVE VP, SEC/TREAS-MWHP 4.00 40.00 X X 0 393659 37188 XAVIER R RICHARDSON EXECUTIVE VP 2.00 40.00 X X 0 253076 25625 ERIC FLETCHER SENIOR VP 2.00 40.00 X X 0 229636 26304 JOYCE HANSCOME SENIOR VP 2.00 40.00 X X 0 243567 25927 REBECCA BIGONEY MD EXECUTIVE VP, CHAIR-MWHP 40.00 2.00 X X 0 365663 26813 EILEEN L DOHMANN RN VICE PRESIDENT 40.00 2.00 X X 0 214292 9849 RAVI MATHUR VICE PRESIDENT (THRU 10/14) 2.00 40.00 X X 0 215883 18580 KENNETH N JOSOVITZ MD MED STAFF PRES-SH 3.00 2.00 X 23917 0 0 DAVID M GARTH MD TRUSTEE 4.00 2.00 X 0 0 0 JOHN F FICK III CHAIRMAN 2.00 8.00 X X 0 0 0 ALDA L WHITE VICE CHAIR 2.00 2.00 X X 0 0 0 DONALD H NEWLIN SECRETARY/TREAS 2.00 5.00 X X 0 0 0 WILLIAM BOLDON TRUSTEE 2.00 3.00 X 0 0 0 JAN C ERKERT TRUSTEE 2.00 2.00 X 0 0 0 KURT R LARSON MD TRUSTEE 2.00 2.00 X 0 0 0 MICHAEL P MCDERMOTT MD CEO-ELECT (OCT 2014) 2.00 2.00 X X 0 125193 320 JOHN C MCKEOWN TRUSTEE 2.00 2.00 X 0 0 0 FRED M MESSING TRUSTEE 2.00 2.00 X 0 0 0 CLARENCE A ROBINSON TRUSTEE 2.00 2.00 X 0 0 0 RAYMOND L SLAUGHTER TRUSTEE 2.00 2.00 X 0 0 0 JONATHAN D WALLACE TRUSTEE 2.00 2.00 X 0 0 0 MARY KATHERINE GREENLAW CHAIRMAN-MWH FOUNDATION 4.00 0.00 X X 0 0 0 EDWARD V ALLISON JR VICE CHAIR-MWH FOUNDATION 2.00 0.00 X X 0 0 0 R LEIGH FRACKELTON JR TRUSTEE 2.00 0.00 X 0 0 0 CHRISTOPHER T HUESGEN MD TRUSTEE 2.00 0.00 X 0 0 0 PATRICIA LYNCH TRUSTEE 2.00 0.00 X 0 0 0 EDWARD O MINNIEAR TRUSTEE 2.00 0.00 X 0 0 0 JUDITH G SMITH TRUSTEE 2.00 0.00 X 0 0 0 JOSEPH R WILSON SEC/TREAS MWH FOUNDATION 2.00 0.00 X X 0 0 0 W MALONE SCHOOLER CHAIRMAN-SH FOUNDATION 2.00 0.00 X X 0 0 0 JO D KNIGHT VICE CHAIRMAN-SH FOUNDATIO 2.00 0.00 X X 0 0 0 ELAINE F FARMER SEC/TREAS SH FOUNDATION 2.00 0.00 X X 0 0 0 KEVIN BREEN TRUSTEE 2.00 0.00 X 0 0 0 CLAY HUBER TRUSTEE 2.00 0.00 X 0 0 0 DOUGLAS R JOHNSON MD TRUSTEE 2.00 0.00 X 0 0 0 WILLIAM R JOHNSON TRUSTEE 2.00 0.00 X 0 0 0 H CLARK LEMING TRUSTEE 2.00 0.00 X 0 0 0 TERENCE A MANNION TRUSTEE 2.00 0.00 X 0 0 0 CHARLES W MCDANIEL TRUSTEE 2.00 0.00 X 0 0 0 JACK ROWLEY TRUSTEE 2.00 0.00 X 0 0 0 CHRISTOS HATJIS MD TRUSTEE 40.00 0.00 X 619988 0 30821 MARGARET ALEXANDER TRUSTEE 2.00 0.00 X 0 0 0 TIMOTHY BAROODY TRUSTEE 2.00 0.00 X 0 0 0 G RONALD CHRISTMAS TRUSTEE 2.00 0.00 X 0 0 0 TED HONTZ TRUSTEE 2.00 0.00 X 0 0 0 HOWARD C OWEN TRUSTEE 2.00 0.00 X 0 0 0 DAN SINGH TRUSTEE 2.00 0.00 X 0 0 0 DANIEL W CLENDENIN TRUSTEE 2.00 0.00 X 0 0 0 R DONALD DOHERTY JR TRUSTEE 2.00 0.00 X 0 0 0 DANIEL M HOFFMAN TRUSTEE 2.00 0.00 X 0 0 0 REGIS L KEDDIE II TRUSTEE 2.00 0.00 X 0 0 0 LORETTA RORVIG TRUSTEE 2.00 0.00 X 0 0 0 JODIE M VAUGHN TRUSTEE 2.00 0.00 X 0 0 0 THOMAS F WILLIAMS TRUSTEE 2.00 0.00 X 0 0 0 RICHARD LEWIS MD TRUSTEE 2.00 0.00 X 0 0 0 DAVID LING MD CHIEF MED INFO (THRU 12/14) 2.00 40.00 X 0 204613 33995 GREGORY SZLYK MD DIR SURGICAL ROBOTICS 2.00 0.00 X 0 0 0 HILLARY VERNON TRUSTEE 2.00 0.00 X 0 0 0 BALVANT P ARORA MD TRUSTEE 2.00 0.00 X 0 0 0 RONY J RAMIA MD VICE CHAIR-MWHP 2.00 0.00 X X 0 0 0 W ANDREW REESE MD TRUSTEE 2.00 0.00 X 0 0 0 JEFFREY A FRAZIER MED STAFF PRES-MWH 2.00 0.00 X X 0 0 0 KATHRYN S WALL EXECUTIVE VP 2.00 40.00 X 0 259884 19461 MARIANNA BEDWAY SENIOR VP 40.00 2.00 X 0 254407 25090 WINIFRED J HAIKEY SENIOR VP (THRU 10/14) 2.00 40.00 X 0 237603 23083 JAMES K VAN RENAN SENIOR VP (THRU 10/14) 40.00 2.00 X 309275 0 32331 CATHLEEN A YABLONSKI SENIOR VP 40.00 2.00 X 228348 0 23674 KATHLEEN BOURGAULT VICE PRESIDENT 2.00 40.00 X 0 196370 24405 ALAN EDWARDS VICE PRESIDENT 1.00 40.00 X 0 195852 24088 MARIE FREDRICK SENIOR VP 2.00 40.00 X 0 220985 25277 JAMES SWISHER VICE PRESIDENT (THRU 10/14) 2.00 40.00 X 0 194563 12176 SANDRA W BROWN VP FINANCE, CONTROLLER 0.00 40.00 X 0 148905 30403 STEPHEN MANDELL VICE PRESIDENT 40.00 0.00 X 262114 0 28254 TRAVIS TURNER VP CLINICAL INTEGRATION 0.00 40.00 X 200816 0 29530 TINA ERVIN VICE PRESIDENT 0.00 40.00 X 0 186112 23296 JAMES DANIEL SH SR MEDICAL DIR 40.00 0.00 X 224670 0 25724 MADHULIKA LALL MED DIR RESOURCE UTILIZATION 0.00 40.00 X 0 201642 19323 GLEN J POFFENBARGER MD PHYSICIAN 40.00 0.00 X 909535 0 29072 JT SHERWOOD MD PHYSICIAN 40.00 0.00 X 758011 0 38446 THERESA A CONOLOGUE MD PHYSICIAN 40.00 0.00 X 623420 0 33083 SANG HO NA PHYSICIAN 40.00 0.00 X 911697 0 13676 WALTER J KIWALL EXECUTIVE VP (FORMER) 4.00 40.00 X 0 863245 2015 5071791 5960353 748637 10 1 1 0 MORRISON MANAGEMENT 5801 PEACHTREE DUNWOODY ROAD ATLANTA GA 30342 FOOD SERVICES 4948459 FREDERICKSBURG HOSPITALIST GROUP PC 1101 SAM PERRY BLVD SUITE 2017 FREDERICKSBURG VA 22401 PHYSICIAN SERVICES 3009564 OB HOSPITALIST GROUP LLC 10 CENTIMETERS DR MAULDIN SC 29662 PHYSICIAN SERVICES 2526505 CHILDREN'S NATIONAL HOSPITAL 111 MICHIGAN AVE NW SUITE 3W-100 WASHINGTON DC 20010 PHYSICIAN SERVICES 2511999 CROTHALL SERVICES GROUP 955 CHESTERBROOK BLVD SUITE 300 WAYNE PA 19087 ENVIRONMENTAL AND ENGINEERING 2444229 71 392221 533642 299695 8645433 1654201 9870991 OTHER REVENUE 623000 576082013 576082013 MANAGEMENT SERVICES 623000 6366884 6366884 OTHER OPERATING REVENUE 623000 2955722 2955722 LAB FEES 621500 2235731 2235731 OTHER SERVICES 623000 1097752 1097752 692854 692854 589430956 1457657 1457657 14467145 225746 0 0 14467145 225746 14692891 14692891 301687 0 1312264 301687 -1312264 -1010577 -1010577 222231 392221 107571 114660 114660 INCOME FROM PSHIP/LLC 900099 -706920 -706920 -706920 613849658 586488305 2235731 15254631 X 6190190 6190190 67550 67550 1806363 1711106 94121 1136 180428959 170914218 9401251 113490 2604409 2467068 135703 1638 21519266 20384469 1121261 13536 13975990 13238980 728219 8791 64843198 61423757 3378655 40786 215352 203996 11221 135 65400 61951 3408 41 222639 210898 11601 140 67906697 64325705 3538279 42713 122105 115666 6362 77 3846741 3643887 200434 2420 1939208 1836946 101042 1220 28940693 27414534 1507955 18204 1359175 1287500 70820 855 352341 333760 18359 222 728337 689929 37950 458 29347007 27799422 1529126 18459 3014419 2855457 157066 1896 MEDICAL AND HOSPITAL SU 91804908 86963668 4783495 57745 BAD DEBT EXPENSE 68084539 64494169 3547545 42825 REPAIRS AND MAINTENANCE 3203601 3034662 166924 2015 OTHER MEDICAL & HOSPITA 2907386 2754068 151489 1829 2940701 2785626 153226 1849 598437174 567209182 30855512 372480 974287 869716 1146333 945136 17548710 16273709 79331131 79349011 2352885 1232348 9200898 10197883 2834615 2451322 730817565 447429211 284095465 283388354 51217305 45278263 14255183 4395608 1751748 1739261 464708560 446120611 33648086 40862628 495 32743 260051743 246506496 3645363 4452669 297345687 291854536 X 149816967 137995170 16287696 15012695 1258210 1258210 167362873 154266075 464708560 446120611 X 15412484 -28509282 X X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 32759020 42993 328272 1503347 274613 31352325 31457238 139061 3041697 1878976 32759020 29168493 111350 3125019 39250 908374 31457238 31364122 343694 -1155863 63750 1319711 29168492 29030361 455287 3036877 17000 1141403 31364122 0.74840 0.21150 0.04010 0 0 24578596 24578596 273704771 93321826 180382945 24142621 8098795 16043826 353286547 333348948 19937599 55105030 12659642 42445388 283388354 CAPITAL LEASE OBLIGATIONS 881982 ACCRUED LOSS-PROFESSIONAL LIABILITY 3570687 4452669 X PART V, LINE 4: THE INTEREST EARNED FROM THE ENDOWMENT FUNDS IS USED TO FUND SCHOLARSHIPS AND GRANTS IN FUTHERANCE OF OUR MISSION. PART X, LINE 2: MWHC WAS RECOGNIZED AS A PUBLIC CHARITY GENERALLY EXEMPT FROM FEDERAL INCOME TAXATION UNDER 501(C)(3) OF THE INTERNAL REVENUE CODE PURSUANT TO A DETERMINATION LETTER ISSUED BY THE IRS IN MARCH 1992. MWHC IS ENTITLED TO RELY ON THIS DETERMINATION AS LONG AS THERE ARE NO SUBSTANTIAL CHANGES IN ITS CHARACTER, PURPOSES, OR METHODS OF OPERATION. MANAGEMENT HAS CONCLUDED THAT THERE HAVE BEEN NO SUCH CHANGES, AND THEREFORE MWHC'S STATUS AS A PUBLIC CHARITY EXEMPT FROM FEDERAL INCOME TAXATION REMAINS IN EFFECT. THE STATE IN WHICH MWHC OPERATES ALSO PROVIDES GENERAL EXEMPTION FROM STATE INCOME TAXATION FOR ORGANIZATIONS THAT ARE EXEMPT FROM FEDERAL INCOME TAXATION. HOWEVER, MWHC IS SUBJECT TO BOTH FEDERAL AND STATE INCOME TAXATION AT CORPORATE TAX RATES ON ITS UNRELATED BUSINESS INCOME. EXEMPTION FROM OTHER STATE TAXES, SUCH AS REAL AND PERSONAL PROPERTY TAXES, IS SEPARATELY DETERMINED. CERTAIN ENTITIES UNDER MWHC ARE TAXABLE ENTITIES. MWHC HAD NO UNRECOGNIZED TAX BENEFIT OR LIABILITIES OR SUCH AMOUNTS WERE IMMATERIAL DURING THE PERIODS PRESENTED. FOR TAX PERIODS WITH RESPECT TO WHICH NO UNRELATED BUSINESS INCOME WAS RECOGNIZED, NO TAX RETURN WAS REQUIRED. TAX PERIODS FOR WHICH NO RETURN IS FILED REMAIN OPEN FOR EXAMINATION INDEFINITELY. ALL REQUIRED TAX FILINGS HAVE BEEN FILED ON A TIMELY BASIS. YEARS ENDING ON OR AFTER DECEMBER 31, 2011 REMAIN SUBJECT TO EXAMINATION BY FEDERAL AND STATE TAX AUTHORITIES. SHF GOLF TOURNAMENT 232750 176001 56749 22446 13349 954 1008 2983 MWHF GOLF TOURNAMENT 123040 108484 14556 10703 7484 6494 1326 10 258662 107736 150926 17492 7619 3203 12510 614452 392221 222231 50641 28452 10651 1008 16819 107571 114660 1 1 X 1 X 1 X 1 1 1 0 1 1 20685968 20685968 0.03460 45009917 36807763 8202154 0.01370 65695885 36807763 28888122 0.04830 1209786 1209786 0.00200 1151282 74941 1076341 0.00180 50690948 30109454 20581494 0.03440 505605 49615 455990 0.00080 1680741 1680741 0.00280 55238362 30234010 25004352 0.04180 120934247 67041773 53892474 0.09010 20727 20727 0.00000 2061 2061 0.00000 1485 1485 0.00000 596 596 0.00000 1071061 1071061 0.00180 111783 111783 0.00020 1207713 1207713 0.00200 1 20809574 4161915 155260536 176923417 -21662881 X 1 1 1 MEDICAL IMAGING OF FREDERICKSBURG OUTPATIENT IMAGING 0.51000 0.49000 2 FREDERICKSBURG AMBULATORY SURGERY CENTER AMBULATORY SERGICAL SERVICES 0.53370 0.46630 3 BUNKER HILL PARTNERS MEDICAL OFFICE BUILDING 0.20000 0.20000 4 COWAN INVESTMENT PARTNERS MEDICAL OFFICE BUILDING 0.12500 0.37500 5 MEDICAL PLAZA AT COSNER CORNER MEDICAL OFFICE BUILDING 0.39500 0.47400 2 1 MARY WASHINGTON HOSPITAL INC 1101 SAM PERRY BLVD FREDERICKSBURG VA 22401 X X X 437 BED ACUTE CARE HOSPITAL LEVEL 2 TRAUMA 2 STAFFORD HOSPITAL LLC 101 HOSPITAL CENTER BLVD STAFFORD VA 22554 X X X 100 BED HOSPITAL MARY WASHINGTON HOSPITAL INC 1 0 0 1 X X X X X X X X 12 1 1 0 1 X WWW.MARYWASHINGTONHEALTHCARE.COM/MARY-WASHINGTON-HOSPIT X X 1 13 0 0 0 1 X 138.000000000000 300.000000000000 X X X X X 1 1 X X X 1 X X 1 0 X X X X 1 X 0 0 STAFFORD HOSPITAL LLC 2 0 0 1 X X X X X X X X 12 1 1 0 1 X WWW.MARYWASHINGTONHEALTHCARE.COM/STAFFORD-HOSPITAL X X 1 13 0 0 0 1 X 138.000000000000 300.000000000000 X X X X X 1 1 X X X 1 X X 0 0 X X X X 1 X 0 0 MARY WASHINGTON HOSPITAL, INC. PART V, SECTION B, LINE 5: IN MAY 2011, MARY WASHINGTON HEALTHCARE (INCLUDING MARY WASHINGTON HOSPITAL AND STAFFORD HOSPITAL) AND THE RAPPAHANNOCK AREA HEALTH DISTRICT LAUNCHED THE HEALTHY COMMUNITIES PARTNERSHIP (HCP). OTHER FOUNDING MEMBERS ARE RAPPAHANNOCK UNITED WAY, KAISER PERMANENTE OF THE MID ATLANTIC STATES, AND THE RAPPAHANNOCK AREA COMMUNITY SERVICES BOARD. THESE INITIAL SPONSORS AGREED THAT SUCCESS WAS DEPENDENT ON GATHERING A DIVERSE GROUP OF INDIVIDUALS TO COLLECTIVELY PROVIDE BROAD PERSPECTIVE ON THE REGION'S HEALTH CARE NEEDS. THIS REGIONAL HOSPITALS, HEALTH DEPARTMENT AND INSURERS, PRIVATE BUSINESSES, COMMUNITY-BASED ORGANIZATIONS, AND HEALTH CARE AND MENTAL HEALTHON THE HCP'S COMMITTEES. AS A DIRECT RESULT OF THIS INITIAL MEETING, THE HCP ADVISORY COMMITTEE NOW HAS 40 ACTIVE VOLUNTEERS REPRESENTING INITIAL MEETING WAS TO COMMUNICATE THIS NEW INITIATIVE WITH COMMUNITY STAKEHOLDERS AND GAUGE BOTH THE LEVEL AND AVAILABILITY TO SERVE GROUP LAUNCHED AN INITIAL KICK-OFF MEETING JUNE 8, 2011, WITH A LARGE GROUP OF COMMUNITY STAKEHOLDERS IN ATTENDANCE. THE PURPOSE OF THIS INITIAL MEETING WAS TO COMMUNICATE THIS NEW INITIATIVE WITH COMMUNITY STAKEHOLDERS AND GAUGE BOTH THE LEVEL AND AVAILABILITY TO SERVE ON THE HCP'S COMMITTEES. AS A DIRECT RESULT OF THIS INITIAL MEETING, THE HCP ADVISORY COMMITTEE NOW HAS 40 ACTIVE VOLUNTEERS REPRESENTING REGIONAL HOSPITALS, HEALTH DEPARTMENT AND INSURERS, PRIVATE BUSINESSES, COMMUNITY-BASED ORGANIZATIONS, AND HEALTH CARE AND MENTAL HEALTH PROVIDERS. STAFFORD HOSPITAL, LLC PART V, SECTION B, LINE 5: IN MAY 2011, MARY WASHINGTON HEALTHCARE (INCLUDING MARY WASHINGTON HOSPITAL AND STAFFORD HOSPITAL) AND THE RAPPAHANNOCK AREA HEALTH DISTRICT LAUNCHED THE HEALTHY COMMUNITIES PARTNERSHIP (HCP). OTHER FOUNDING MEMBERS ARE RAPPAHANNOCK UNITED WAY, KAISER PERMANENTE OF THE MID ATLANTIC STATES, AND THE RAPPAHANNOCK AREA COMMUNITY SERVICES BOARD. THESE INITIAL SPONSORS AGREED THAT SUCCESS WAS DEPENDENT ON GATHERING A DIVERSE GROUP OF INDIVIDUALS TO COLLECTIVELY PROVIDE BROAD PERSPECTIVE ON THE REGION'S HEALTH CARE NEEDS. THIS REGIONAL HOSPITALS, HEALTH DEPARTMENT AND INSURERS, PRIVATE BUSINESSES, COMMUNITY-BASED ORGANIZATIONS, AND HEALTH CARE AND MENTAL HEALTHON THE HCP'S COMMITTEES. AS A DIRECT RESULT OF THIS INITIAL MEETING, THE HCP ADVISORY COMMITTEE NOW HAS 40 ACTIVE VOLUNTEERS REPRESENTING INITIAL MEETING WAS TO COMMUNICATE THIS NEW INITIATIVE WITH COMMUNITY STAKEHOLDERS AND GAUGE BOTH THE LEVEL AND AVAILABILITY TO SERVE GROUP LAUNCHED AN INITIAL KICK-OFF MEETING JUNE 8, 2011, WITH A LARGE GROUP OF COMMUNITY STAKEHOLDERS IN ATTENDANCE. THE PURPOSE OF THIS INITIAL MEETING WAS TO COMMUNICATE THIS NEW INITIATIVE WITH COMMUNITY STAKEHOLDERS AND GAUGE BOTH THE LEVEL AND AVAILABILITY TO SERVE ON THE HCP'S COMMITTEES. AS A DIRECT RESULT OF THIS INITIAL MEETING, THE HCP ADVISORY COMMITTEE NOW HAS 40 ACTIVE VOLUNTEERS REPRESENTING REGIONAL HOSPITALS, HEALTH DEPARTMENT AND INSURERS, PRIVATE BUSINESSES, COMMUNITY-BASED ORGANIZATIONS, AND HEALTH CARE AND MENTAL HEALTH PROVIDERS. MARY WASHINGTON HOSPITAL, INC. PART V, SECTION B, LINE 6A: STAFFORD HOSPITAL AND SPOTSYLVANIA REGIONAL MEDICAL CENTER STAFFORD HOSPITAL, LLC PART V, SECTION B, LINE 6A: MARY WASHINGTON HOSPITAL AND SPOTSYLVANIA REGIONAL MEDICAL CENTER MARY WASHINGTON HOSPITAL, INC. PART V, SECTION B, LINE 7D: PRESENTED AT NUMEROUS COMMUNITY MEETINGS, SUCH AS THE ROTARY MEETINGS, CHAMBER OF COMMERCE, AND THE MARY WASHINGTON HEALTHCARE CITIZEN ADVISORY COMMITTEE MEETINGS. STAFFORD HOSPITAL, LLC PART V, SECTION B, LINE 7D: PRESENTED AT NUMEROUS COMMUNITY MEETINGS, SUCH AS THE ROTARY MEETINGS, CHAMBER OF COMMERCE, AND THE MARY WASHINGTON HEALTHCARE CITIZEN ADVISORY COMMITTEE MEETINGS. PART V, SECTION B, LINE 16 FINANCIAL ASSISTANCE POLICY WEBSITE AVAILABILITY MARY WASHINGTON HOSPITAL, INC. PART V, SECTION B, LINE 16A WEBSITE: WWW.MARYWASHINGTONHEALTHCARE.COM/MARY-WASHINGTON-HOSPITAL STAFFORD HOSPITAL, LLC PART V, SECTION B, LINE 16A WEBSITE: WWW.MARYWASHINGTONHEALTHCARE.COM/STAFFORD-HOSPITAL 2 FREDERICKSBURG AMBULATORY SURGERY CENTER 1201 SAM PERRY BLVD SUITE 101 FREDERICKSBURG VA 224014490 AMBULATORY SURGERY CENTER MEDICAL IMAGING OF FREDERICKSBURG 1201 SAM PERRY BLVD SUITE 102 ASC BUILD FREDERICKSBURG VA 224014490 IMAGING SERVICES PART I, LN 7 COL(F): BAD DEBT EXPENSE ATTRIBUTABLE TO PATIENTS ELIGIBLE UNDER PATIENT FINANCIAL ASSISTANCE POLICY (PFAP)IN DECEMBER 2011, MWHC UTILIZED THE SERVICES OF SEARCHAMERICA TO IDENTIFY PFAP ELIGIBLE PATIENTS WHOSE ACCOUNTS HAD FALLEN INTO BAD DEBT. IN EARLY 2012, SEARCHAMERICA PROVIDED A LIST UTILIZING VARIOUS MARKET RESEARCH TO APPROXIMATE THE FEDERAL POVERTY LEVEL OF EACH ACCOUNT HOLDER. WITH THIS INFORMATION WE WERE ABLE TO DETERMINE ACCOUNTS THAT MAY HAVE BEEN ELIGIBLE FOR FREE CARE OR DISCOUNTED CARE UNDER OUR FINANCIAL ASSISTANCE POLICY. UTILIZING THE STATISTICAL ANALYSIS THAT SEARCHAMERICA PROVIDED WE HAVE EXTRAPOLATED THE DATA AND ARE ABLE TO ESTIMATE THAT ABOUT 25% OF OUR BAD DEBT IS LIKELY ATTRIBUTABLE TO PFAP ELIGIBLE PATIENTS. PART II, COMMUNITY BUILDING ACTIVITIES: IN FURTHERANCE OF ITS MISSION TO IMPROVE THE HEALTH OF THE COMMUNITY IT SERVES THE ORGANIZATION PROMOTES WORKFORCE DEVELOPMENT FOR THE RECRUITMENT OF PHYSICIANS AND OTHER HEALTH PROFESSIONALS IN AREAS IDENTIFIED AS SHORTAGE AREAS THROUGH ITS COMMUNITY NEEDS ASSESSMENTS AND MEDICAL STAFF DEVELOPMENT PLANS. RECRUITMENT OF PHYSICIANS TO PRACTICE IN MWHC'S SERVICE AREA IMPROVES ACCESS TO CARE RESULTING IN GREATER AVAILABILITY OF PHYSICIAN SPECIALISTS, LESS TRAVEL TO OBTAIN CARE, AND SHORTER WAIT TIMES FOR APPOINTMENTS. ADDITIONALLY MWHC, PROVIDES FACILITIES FREE OF CHARGE TO RAPPAHANNOCK EMERGENCY MEDICAL SERVICES WHICH IS VALUED AT APPROXIMATELY $100,000. PART III, LINE 4: THE PROVISION FOR UNCOLLECTIBLE ACCOUNTS IS BASED UPON MANAGEMENT'S JUDGMENTAL ASSESSMENT OF HISTORICAL AND EXPECTED NET COLLECTIONS CONSIDERING BUSINESS AND GENERAL ECONOMIC CONDITIONS IN ITS SERVICE AREA, TRENDS IN HEALTHCARE COVERAGE, AND OTHER COLLECTION INDICATORS. THROUGHOUT THE YEAR, MANAGEMENT ASSESSES THE ADEQUACY OF THE ALLOWANCE FOR UNCOLLECTIBLE ACCOUNTS BASED UPON ITS REVIEW OF ACCOUNTS RECEIVABLE PAYOR COMPOSITION AND AGING, TAKING INTO CONSIDERATION RECENT WRITE-OFF EXPERIENCE BY PAYOR CATEGORY, PAYOR AGREEMENT RATE CHANGES AND OTHER FACTORS. THE RESULTS OF THESE ASSESSMENTS ARE USED TO MAKE MODIFICATIONS TO THE PROVISION FOR BAD DEBTS AND TO ESTABLISH AN APPROPRIATE ALLOWANCE FOR UNCOLLECTIBLE ACCOUNTS RECEIVABLE.FOR SELF-PAY PATIENTS, THE PROVISION IS BASED ON AN ANALYSIS OF PAST EXPERIENCE RELATED TO COLLECTION RATE OF SELF-PAY BALANCES. MWHC FOLLOWS ESTABLISHED GUIDELINES FOR PLACING CERTAIN PAST-DUE PATIENT BALANCES WITH EXTERNAL COLLECTION AGENCIES. AT DECEMBER 31, 2013 AND 2012, THE ALLOWANCE FOR UNCOLLECTIBLE ACCOUNTS REPRESENTED APPROXIMATELY 92% OF THE PATIENTS DUE ACCOUNTS RECEIVABLE BALANCE. THE PATIENTS DUE ACCOUNTS RECEIVABLE BALANCE REPRESENTS THE ESTIMATED UNINSURED PORTION OF ACCOUNTS RECEIVABLE. PART III, LINE 8: AS A NOT-FOR-PROFIT HOSPITAL IT IS OUR MISSION TO IMPROVE THE HEALTH STATUS OF ALL PEOPLE WITHIN OUR COMMUNITY AND TO PROVIDE HEALTHCARE TO ALL PATIENTS REGARDLESS OF THEIR ABILITY TO PAY OR THEIR INSURANCE STATUS. MWHC ACCEPTS MEDICARE AND MEDICAID AND IT IS A WELL ESTABLISHED FACT THAT NOT-FOR-PROFIT FACILITIES DO NO RECOUP THE COST OF CARING FOR THOSE PATIENTS UTILIZING THESE PROGRAMS. UNDER IRS GUIDELINES MEDICARE AND MEDICAID BENEFICIARIES ARE CONSIDERED TO BE MEMBERS OF A CHARITABLE CLASS, THEREFORE BY ASSISTING THESE PATIENTS AND ACCEPTING THE SHORTFALLS IN REPAYMENT, THE ORGANIZATION IS IN FACT RELIEVING GOVERNMENT BURDEN AND PROVIDING A SIGNIFICANT COMMUNITY BENEFIT TO OUR SERVICE AREA. PART III, LINE 9B: PATIENTS MAY APPLY FOR FINANCIAL ASSISTANCE AT ANY POINT IN THE COLLECTION CYCLE AND MODIFICATIONS OF ABILITY TO PAY MAY BE ADJUSTED SHOULD FINANCIAL OR INSURANCE STATUS CHANGE SINCE THE FIRST DAY OF CARE. MWHC DOES NOT ENGAGE IN EXTRAORDINARY COLLECTION ACTIONS BEFORE THEY HAVE MADE REASONABLE EFFORTS TO DETERMINE WHETHER THE INDIVIDUAL IS ELIGIBLE FOR ASSISTANCE UNDER THIS FINANCIAL ASSISTANCE POLICY. REASONABLE EFFORTS CONSTITUTE NOTIFICATION BY MWHC OF ITS FINANCIAL ASSISTANCE POLICY BY WRITTEN AND/OR ORAL COMMUNICATIONS TO ALL UNINSURED/UNDERINSURED PATIENTS AS WELL AS CONSIDERATION OF ELIGIBILITY BASED UPON THE PRESUMPTIVE ELIGIBILITY GUIDELINES DESCRIBED IN THE FINANCIAL ASSISTANCE POLICY. PART VI, LINE 2: MARY WASHINGTON HEALTHCARE AND ITS AFFILIATES (MARY WASHINGTON HOSPTIAL, MARY WASHINGTON HOSPITAL FOUNDATION, STAFFORD HOSPITAL, LLC, STAFFORD HOSPITAL FOUNDATION, MEDICORP PROPERTIES, INC., MEDICORP HEALTH SERVICES, AND MARY WASHINGTON HEALTHCARE CLINICAL SERVICES, INC.) HAS AS ITS MISSION TO IMPROVE THE HEALTH OF MEMBERS OF THE COMMUNITIES IT SERVES: FREDERICKSBURG, VA AND THE SURROUNDING SIX (6) COUNTIES. THE ORGANIZATION ASSESSES THE HEALTH CARE NEEDS OF THESE COMMUNITIES IN NUMEROUS WAYS INCLUDING: 1) SOLICITING INPUT FROM MWHC'S CITIZEN ADVISORY COUNCIL THAT ENCOMPASS INDIVIDUAL MEMBERS AND SUBCOMMITTEES REPRESENTING EACH OF THE COUNTIES IN MWHC'S SERVICE AREA, AND 2) PERFORMING PERIODIC COMMUNITY NEEDS ASSESSMENTS FOR EACH COUNTY IN COLLABORATION WITH GOVERNMENT AGENCIES AND OTHER COMMUNITY ORGANIZATIONS. PART VI, LINE 3: MARY WASHINGTON HEALTHCARE AFFILIATES PROVIDE INFORMATION TO PATIENTS ABOUT ITS FINANCIAL ASSISTANCE PROGRAMS THROUGH SIGNAGE AT INTAKE AREAS, FLYERS AT ADMISSIONS, NOTICES ON BILLS AND COLLECTION STATEMENTS. FINANCIAL COUNSELORS ARE ALSO AVAILABLE TO ASSIST PATIENTS IN OBTAINING FINANCIAL ASSISTANCE. PART VI, LINE 4: MARY WASHINGTON HEALTHCARE PROVIDES EXCEPTIONAL MEDICAL SERVICES TO THE CITY OF FREDERICKSBURG AND THE SURROUNDING "COMMUNITY" THAT CONSIST OF THE PRIMARY SERVICE AREA COUNTIES OF STAFFORD, KING GEORGE, SPOTSYLVANIA, WESTMORELAND, ORANGE, PRINCE WILLIAM, AND SECONDARY SERVICE AREA COUNTIES OF MANASSAS, FAUQUIER, CULPEPER, LOUISA, ESSEX, AND RICHMOND. ESTABLISHED IN 1899, MARY WASHINGTON HOSPITAL (MWH), A 437 BED ACUTE CARE FACILITY, OFFERS COMPREHENSIVE HEALTHCARE AND MULTIPLE CENTERS OF EXCELLENCE INCLUDING CARDIOLOGY AND CARDIOVASCULAR SURGERY, PSYCHIATRY, AND WOMEN AND INFANT HEALTH. STAFFORD HOSPITAL, LLC, A 100 BED ACUTE CARE FACILITY, ALSO OFFERS COMPREHENSIVE HEALTHCARE SERVICES. BOTH MWH AND SH ARE ACCREDITED BY THE JOINT COMMISSION AND LICENSED BY THE COMMONWEALTH OF VIRGINIA DEPARTMENT OF HEALTH AND THE DEPARTMENT OF MENTAL HEALTH, MENTAL RETARDATION AND SUBSTANCE ABUSE SERVICES. MWH ALSO PROVIDES ADVANCE RADIATION THERAPY THROUGH THE CANCER CENTER OF VIRGINIA AND HOME HEALTH SERVICES THROUGH MARY WASHINGTON HOME HEALTH.AS OF THE MOST RECENT CENSUS WITHIN THE RESPECTIVE COUNTIES THE MAJORITY OF THE GEOGRAPHIC SERVICE AREAS IN WHICH BOTH HOSPITALS SERVE ARE MADE UP OF ABOUT 4,164.5 SQUARE MILES OF SUBURBAN AND RURAL LAND. COMMUNITY RESIDENTS IN THE PRIMARY SERVICE AREAS EARN A MEDIAN INCOME PER HOUSEHOLD OF $57,088/YEAR, WITH A COLLECTIVE AVERAGE OF 7.2% OF THE ENTIRE PRIMARY SERVICE AREA LIVING BELOW THE FEDERAL POVERTY GUIDELINES. THE PRIMARY SERVICE AREA HAS AN ESTIMATED POPULATION OF 657,718 INDIVIDUALS AND 187,202 HOUSEHOLDS. PART VI, LINE 5: MARY WASHINGTON HOSPITAL, INC. AND STAFFORD HOSPITAL, LLC EACH OPERATE AN EMERGENCY ROOM THAT IS OPEN TO ALL PERSONS REGARDLESS OF ABILITY TO PAY; HAVE OPEN MEDICAL STAFFS WITH PRIVILEGES TO ALL QUALIFIED PHYSICIANS WHO APPLY, HAVE A GOVERNING BODY WITH A MAJORITY OF INDEPENDENT TRUSTEES, AND PARTICIPATE IN MEDICAID, MEDICARE AND OTHER GOVERNMENT SPONSORED HEALTH CARE PROGRAMS. MARY WASHINGTON HEALTHCARE CLINICAL SERVICES, INC. THROUGH ITS SUBSIDIARIES, PROVIDES ANCILLARY HEALTH SERVICES INCLUDING PHYSICIAN PRACTICES, OUTPATIENT AND AMBULATORY SURGERY, AND HOME HEALTH/HOSPICE SERVICES.THE ORGANIZATION UTILIZES SURPLUS FUNDS TO EXPAND SERVICES PROVIDED TO THE COMMUNITY (IN RESPONSE TO THE COMMUNITY NEEDS ASSESSMENTS), UPGRADE FACILITIES AND EQUIPMENT TO ENHANCE CLINICAL CARE AND PHYSICIAN CONNECTIVITY TO PATIENT ELECTRONIC HEALTH RECORDS, AND HEALTH EDUCATION PROGRAMS. PART VI, LINE 6: MARY WASHINGTON HEALTHCARE AFFILIATES INCLUDE TWO (2) HOSPITALS, OTHER CLINICAL SERVICES THAT INCLUDE AN AMBULATORY SURGERY CENTER, HOSPICE/HOME HEALTH, INDEPENDENT DIAGNOSTIC TESTING FACILITIES, AND PHYSICIAN PRACTICES; TWO (2) FOUNDATIONS AND A PROPERTY DIVISION. ALL ACTIVITIES OF THIS GROUP ARE COORDINATED AND OVERSEEN BY THE PARENT'S (MARY WASHINGTON HEALTHCARE) BOARD OF TRUSTEES. THE AFFILIATED GROUP'S ACTIVITIES ARE CLOSELY PLANNED/INTEGRATED THROUGH INTERLOCKING BOARDS TO ENSURE THE MOST EFFECTIVE DELIVERY OF CARE. EACH MEMBER OF THE AFFILIATED GROUP FOCUSES EFFORTS IN ITS PARTICULAR AREA OF RESPONSIBILITY AND IS ACCOUNTABLE TO THE PARENT'S BOARD FOR ACHIEVING ITS MISSION AND GOALS FOR THE PROVISION OF HEALTH CARE. THE DIVISION OF SERVICES ABOVE ALLOWS PATIENTS TO ACCESS CARE IN THE MOST APPROPRIATE SETTING. THE GOVERNANCE OVERSIGHT PROVIDED BY THE PARENT GUARANTEES OPTIMAL COORDINATION OF THE VARIOUS SEGMENTS OF CARE AND ENSURES HIGH QUALITY SERVICE AS ECONOMICALLY AS POSSIBLE. PART VI, LINE 7, REPORTS FILED WITH STATES VA 0 SPOTSYLVANIA LIONS CLUB 12503 MORTAR LANE SPOTSYLVANIA VA 22551 542056253 2500 VISION RAPPAHANNOCK AREA OFFICE ON YOUTH 405 CHATHAM SQUARE OFFICE PARK FREDERICKSBURG VA 22405 546001293 1820 Y2W8 TEEN AWARENESS PROGRAM RAPPAHANNOCK COUNCIL AGAINST SEXUAL ASSAULT 3331 SHANNON AIRPORT CIRCLE FREDERICKSBURG VA 22408 541443112 5000 COMPREHENSIVE CRISIS SERVICES AND CASE MANAGEMENT SERVICES CENTRAL VIRGINIA HEALTH SERVICES 1506 PALMYRA AVE FREDERICKSBURG VA 22405 540887287 501(C)(3) 3000 COMMUNITY HEALTH INTERNSHIPS: BUILDING THE FUTURE EMPLOYMENT RESOURCES INC PO BOX 801 FREDERICKSBURG VA 22401 541566468 501(C)(3) 5000 SUMMER INTERNSHIP PROGRAM RASCB 615 WOLFE ST FREDERICKSBURG VA 22401 541183037 2412 SUNSHINE LADY HOUSE FOR MENTAL HEALTH WELLNESS AND RECOVERY THE DOCTOR YUM PROJECT 10482 GEORGETOWN DR SPOTSYLVANIA VA 22553 455245719 5000 COOKING AND NUTRITION EDUCATION PROGRAMS CENTRAL VIRGINIA HEALTH SERVICES 1506 PALMYRA AVE FREDERICKSBURG VA 22405 540887287 501(C)(3) 50000 CHCRR: PATIENT EDUCATION AND CASE MANAGEMENT THE DISABILITY RESOURCE CENTER OF THE RAPPAHANNOCK AREA INC 409 PROGRESS ST FREDERICKSBURG VA 22401 541687677 501(C)(3) 12500 EQUIPMENT CONNECTION FREDERICKSBURG CHRISTIAN HEALTH CENTER 1129 HEATHERSTONE DR FREDERICKSBURG VA 22407 542061482 501(C)(3) 130000 UNINSURED PATIENT PROGRAM FREDERICKSBURG REGIONAL TRANSIT 1400 JEFFERSON DAVIS HIGHWAY KILMARNOCK VA 22401 546001293 30000 TRANSPORTATION ASSISTANCE FOR INDIGENT PATIENTS MENTAL HEALTH AMERICA OF FREDERICKSBURG 2217 PRINCESS ANNE ST SUITE 104-1 LADYSMITH VA 22501 540678704 501(C)(3) 10000 SUICIDE PREVENTION EDUCATION MICAH ECUMENICAL MINISTRIES INC PO BOX 3277 RICHMOND VA 22402 204044884 501(C)(3) 130000 RESIDENTIAL RECOVERY PROGRAM RAPPAHANNOCK AREA HEALTH DISTRICT 608 JACKSON ST FREDERICKSBURG VA 22401 546001775 100000 COMPLICATED OBSTETRICAL AND HIGH RISK MATERNITY CARE PROGRAM RX DRUG ACCESS PARTNERSHIP 2924 EMERYWOOD PARKWAY 300 COLONIAL BEACH VA 23294 571186937 501(C)(3) 20000 RXP AMERICAN HEART ASSOCIATION 4217 PARK PLACE COURT GLEN ALLEN VA 23060 135613797 20000 CPR ANYTIME FREDERICKSBURG AREA YOUTH DEVELOPMENT FOUNDATION PO BOX 426 FREDERICKSBURG VA 22404 451857159 50000 SUNSHINE BALLPARK - SAFE PLAY FREDERICKSBURG COUNSELING SERVICES FREE MANTAL HEALTH CLINIC 305 HANSON AVE 140 FREDERICKSBURG VA 22401 540844464 501(C)(3) 26000 COUNSELING SERVICES FREDERICKSBURG DEPARTMENT OF SOCIAL SERVICES 608 JACKSON ST SUITE 100 COLONIAL BEACH VA 22401 546001293 32050 COMMUNITY BASED ELIGIBILITY WORKER GEORGE WASHINGTON REGIONAL COMMISSION 406 PRINCESS ANNE ST FREDERICKSBURG VA 22401 540715969 25000 LOCAL FOOD ACCESS, DISEASE PREVENTION, HEALTHY NUTRITION GUADALUPE FREE CLINIC OF COLONIAL BEACH INC PO BOX 275 COLONIAL BEACH VA 22443 510635977 501(C)(3) 65000 FREE CLINIC HAZEL HILL HEATHCARE PROJECT PO BOX 9036 FREDERICKSBURG VA 22403 271744104 13104 HAZEL HILL HEALTHCARE PROJECT NORTHERN NECK ALLIANCE INC PO BOX 40 COLONIAL BEACH VA 22443 541678053 501(C)(3) 9000 NORTHERN NECK HEAD START RAPPAHANNOCK AREA HEALTH DISTRICT 608 JACKSON ST FREDERICKSBURG VA 22401 546001775 15000 EVERY WOMAN'S LIFE PROGRAM, PORTABLE ULTRASOUND MACHINE ACTION IN COMMUNITY THROUGH SERVICE OF PRINCE WILLIAM (ACTS) PO BOX 74 DUMFRIES VA 22026 540897679 501(C)(3) 20000 ACTS HELPLINE ASSISTANCE AND OUTREACH PROJECT FREDERICKSBURG REGIONAL TRANSIT 1400 JEFFERSON DAVIS HIGHWAY KILMARNOCK VA 22401 546001293 25000 TRANSPORTATION ASSISTANCE FOR INDIGENT PATIENTS GEORGE WASHINGTON REGIONAL COMMISSION 406 PRINCESS ANNE ST FREDERICKSBURG VA 22401 540715969 15000 STAFFORD FARMERS MARKET STAFFORD COUNTY PUBLIC SCHOOLS 31 STAFFORD AVE STAFFORD VA 22554 546001628 9000 EMERGNECY MEDICAL TECHNICIAN PROGRAM STAFFORD SCHOOLS HEAD START 610 GAYLE ST FREDERICKSBURG VA 22405 546001628 36875 CHILDREN'S INSURANCE OUTREACH AND ELIGIBILITY PROJECT STAFFORD SCHOOLS HEAD STARTVPIEARLY HEAD START 610 GAYLE ST FREDERICKSBURG VA 22405 546001628 16800 HEAD START NUTRITION CONSULTANT PROJECT RAPPAHANNOCK AREA AGENCY ON AGING 460 LENDALL LANE FREDERICKSBURG VA 22405 541027651 501(C)(3) 23000 CARE OPTIONS MAKE FOR PREFERRED SOLUTIONS STAFFORD COUNTY DEPARTMENT OF SOCIAL SERVICES PO BOX 7 FREDERICKSBURG VA 22555 546001626 17750 STAFFORD'S HEALTH INSURANCE ENROLLMENT (SHINE) PROGRAM STAFFORD JUNCTION INC 400 CHATHAM SQUARE OFFICE PARK FREDERICKSBURG VA 22405 203036072 501(C)(3) 25600 HEALTHY LIVING PAYS FREDERICKSBURG AREA REGIONAL HEALTH COUNCIL AKA-LLOYD F MOSS FREE CLINIC 1301 SAM PERRY BLVD FREDERICKSBURG VA 22401 541677934 501(C)(3) 690175 FREE HEALTH CLINIC FREDERICKSBURG CHRISTIAN HEALTH CENTER 1129 HEATHERSTONE DR FREDERICKSBURG VA 22407 542061482 501(C)(3) 110664 UNINSURED PATIENT PROGRAM CAROLINE CHRISTIAN HEALTH CENTER 17470 CENTER DR BLDG 4-A RUTHER GLEN VA 22546 208446785 501(C)(3) 5000 SAFETY NET HEALTH CLINIC THE DOCTOR YUM PROJECT 10482 GEORGETOWN DR SPOTSYLVANIA VA 22553 455245719 5000 COOKING AND NUTRITION EDUCATION PROGRAMS ANNE GRAZIANI BROADDUS NURSING SCHOLARSHIP 1 1500 APRIL JETT WILLS MEMORIAL NURSING SCHOLARSHIP 1 1000 BARBARA KANE NURSING SCHOLARSHIP 1 750 CHARLES M. "PETE" HEARN FELLOWSHIP 1 1500 CORA GRAVES ALLISON NURSING SCHOLARSHIP 1 1000 ELEANOR HEYCOCK PETTIT NURSING SCHOLARSHIP 3 3000 ELIZABETH BRUNELLE RYAN AND CATHERINE RYAN LEGATH SCHOLARSHIP 1 1500 FREDERICKSBURG EMERGENCY MEDICAL ALLIANCE SCHOLARSHIP 3 2505 HAROLD AND FRANCES SCHILZ NURSING SCHOLARSHIP 1 1000 HEWETSON NURSING SCHOLARSHIP 1 1500 IDA RICHARDSON JENKINS MEMORIAL SCHOLARSHIP 1 750 JANICE HUNT SCHOLARSHIP 1 1500 JEAN C. WILLIAMS MEMORIAL NURSING SCHOLARSHIP 1 750 JEANE BULLOCK NURSING SCHOLARSHIP 1 1500 JENNIE MAE BENSON NURSING SCHOLARSHIP 1 1000 LIBBY PEARSON ENDOWED NURSING SCHOLARSHIP 1 1000 LINDA WITMER NURSING SCHOLARSHIP 1 1500 MARIE LACY ROLLINS SCHOLARSHIP 1 1500 MARY FRANCES WILLIS & JAMES G. WILLIS MEMORIAL SCHOLARSHIP 1 1500 MARY WASHINGTON HOSPITAL AUXILIARY SCHOLARSHIP 2 2000 NANCY HAZARD MEMORIAL SCHOLARSHIP 1 500 REBECCA BENNETT NURSING SCHOLARSHIP 1 1500 SAL KIWALL MEMORIAL SCHOLARSHIP FOR CLINICAL EDUCATION 1 2000 STAFFORD HOSPITAL AUXILIARY SCHOLARSHIP 2 2000 SUE HALL NURSING SCHOLARSHIP 2 3000 THE VICKIE GRAVES PITTMAN GERMANNA NURSING SCHOLARSHIP 1 500 WILLIAM AND VIOLA ADRIAN NURSING SCHOLARSHIP 1 1500 WILLIAM F. JACOBS, JR. SCHOLARSHIP IN HEALTHCARE ADMINISTRATION 1 2000 X 1 1 X X X X X X 1 1 0 0 0 0 0 1 0 FRED M RANKIN III PRESIDENT 0 599083 0 0 0 156120 0 7800 0 23008 0 786011 0 0 SEAN T BARDEN EXECUTIVE VP, SEC/TREAS-MWHP 0 341720 0 0 0 51939 0 7800 0 29388 0 430847 0 0 XAVIER R RICHARDSON EXECUTIVE VP 0 215602 0 0 0 37474 0 6943 0 18682 0 278701 0 0 ERIC FLETCHER SENIOR VP 0 207962 0 0 0 21674 0 2189 0 24115 0 255940 0 0 JOYCE HANSCOME SENIOR VP 0 219877 0 0 0 23690 0 6986 0 18941 0 269494 0 0 REBECCA BIGONEY MD EXECUTIVE VP, CHAIR-MWHP 0 330000 0 0 0 35663 0 7800 0 19013 0 392476 0 0 EILEEN L DOHMANN RN VICE PRESIDENT 0 194081 0 0 0 20211 0 6085 0 3764 0 224141 0 0 RAVI MATHUR VICE PRESIDENT (THRU 10/14) 0 173030 0 25000 0 17853 0 4345 0 14235 0 234463 0 0 CHRISTOS HATJIS MD TRUSTEE 616248 0 0 0 3740 0 7800 0 23021 0 650809 0 0 0 DAVID LING MD CHIEF MED INFO (THRU 12/14) 0 201560 0 0 0 3053 0 6219 0 27776 0 238608 0 0 KATHRYN S WALL EXECUTIVE VP 0 230734 0 0 0 29150 0 7397 0 12064 0 279345 0 0 MARIANNA BEDWAY SENIOR VP 0 226824 0 0 0 27583 0 7156 0 17934 0 279497 0 0 WINIFRED J HAIKEY SENIOR VP (THRU 10/14) 0 181500 0 0 0 56103 0 5814 0 17269 0 260686 0 0 JAMES K VAN RENAN SENIOR VP (THRU 10/14) 283317 0 0 0 25958 0 7800 0 24531 0 341606 0 0 0 CATHLEEN A YABLONSKI SENIOR VP 209731 0 0 0 18617 0 2212 0 21462 0 252022 0 0 0 KATHLEEN BOURGAULT VICE PRESIDENT 0 179358 0 0 0 17012 0 5645 0 18760 0 220775 0 0 ALAN EDWARDS VICE PRESIDENT 0 159290 0 0 0 36562 0 0 0 24088 0 219940 0 0 MARIE FREDRICK SENIOR VP 0 199805 0 0 0 21180 0 6349 0 18928 0 246262 0 0 JAMES SWISHER VICE PRESIDENT (THRU 10/14) 0 177843 0 0 0 16720 0 4287 0 7889 0 206739 0 0 SANDRA W BROWN VP FINANCE, CONTROLLER 0 145631 0 0 0 3274 0 3877 0 26526 0 179308 0 0 STEPHEN MANDELL VICE PRESIDENT 255005 0 0 0 7109 0 7409 0 20845 0 290368 0 0 0 TRAVIS TURNER VP CLINICAL INTEGRATION 192744 0 0 0 8072 0 2542 0 26988 0 230346 0 0 0 TINA ERVIN VICE PRESIDENT 0 169998 0 0 0 16114 0 5275 0 18021 0 209408 0 0 JAMES DANIEL SH SR MEDICAL DIR 216870 0 0 0 7800 0 7019 0 18705 0 250394 0 0 0 MADHULIKA LALL MED DIR RESOURCE UTILIZATION 0 195000 0 0 0 6642 0 225 0 19098 0 220965 0 0 GLEN J POFFENBARGER MD PHYSICIAN 732012 0 175809 0 1714 0 7800 0 21272 0 938607 0 0 0 JT SHERWOOD MD PHYSICIAN 757533 0 0 0 478 0 7800 0 30646 0 796457 0 0 0 THERESA A CONOLOGUE MD PHYSICIAN 585509 0 37467 0 444 0 6435 0 26648 0 656503 0 0 0 SANG HO NA PHYSICIAN 720253 0 190994 0 450 0 3719 0 9957 0 925373 0 0 0 WALTER J KIWALL EXECUTIVE VP (FORMER) 0 57155 0 0 0 806090 0 422 0 1593 0 865260 0 0 PART I, LINE 1A PART I, LINE 1A - TRUSTEES WHO ARE UNCOMPENSATED VOLUNTEERS TRAVELING FOR BUSINESS RELATED REASONS ON BEHALF OF THE ORGANIZATION ARE REIMBURSED FOR THE COST OF SPOUSAL TRAVEL. REIMBURSEMENTS PAID FOR SPOUSAL TRAVEL ARE REIMBURSED AND REPORTED AS INCOME ON A FORM 1099 IN THE YEAR PAID. EXECUTIVES WHO ARE TRAVELING FOR BUSINESS RELATED REASONS ON BEHALF OF THE ORGANIZATION ARE REIMBURSED FOR THE COST OF SPOUSAL MEALS PROVIDED AND THE AMOUNT IS REPORTED AS INCOME ON THE EXECUTIVE'S W-2. PART I, LINES 4A-B WALTER KIWALL $863,245 MARK SCHWARTZ $302,751 PART I, LINE 7 PART I, LINE 7 - ALL EXECUTIVES HAVE AS A PART OF THEIR COMPENSATION A VARIABLE COMPONENT SUCH THAT THEY ARE ELIGIBLE TO RECEIVE A PERCENTAGE OF THEIR BASE PAY AS AN INCENTIVE FOR THE ACHIEVEMENT OF INDIVIDUAL AND CORPORATE GOALS AND OBJECTIVES. THERE WAS NO INCENTIVE COMPENSATION PAID IN 2013. A ECONOMIC DEVELOPMENT AUTHORITY 541244413 852431AQ8 2006-12-01 125000000 BUILD STAFFORD HOSPITAL FACILITY 0 0 0 B CITY OF FREDERICKSBURG ECONOMIC DEV AUTH 521303430 355849AS9 2007-05-10 81860000 REFUNDING OF 1996 MWH BONDS 0 0 0 C ECONOMIC DEVELOPMENT AUTHORITY 521303430 355850AC2 2013-11-01 30405000 REFUNDING OF SERIES 2011 BOND 0 0 0 D ECONOMIC DEVELOPMENT AUTHORITY 521303430 355849AT7 2014-05-01 59254492 REFUNDING OF 2002 BOND 0 0 0 A 856755 132581641 959500 131622141 2008 0 0 1 1 B 5152793 86868312 583010 86285302 2007 1 0 1 1 C 30405000 576747 29828253 2013 1 0 1 1 D 5621000 630794 55579206 2014 1 0 1 1 A 0 0 1 1 0 0 0 1 B 0 0 1 1 0 0 0 1 C 0 1 1 1 0 0 0 1 D 0 0 1 1 0 0 0 1 A 0 0 0 1 0 0 0 0 1 B 0 0 1 0 0 0 0 0 1 C 0 1 0 0 1 0 0 0 1 D 0 1 0 0 0 0 0 0 1 A 1 B 1 C 1 D 1 PART I THE $125,000,000 BOND ISSUE TO FINANCE THE CONSTRUCTION OF STAFFORD HOSPITAL, DATED 12/01/06, CUSIP# 852431AQ8, HAD AN ARBITRAGE REBATE CALCULATION PERFORMED DECEMBER 21, 2011. HEALTH TECH RESOURCES 5% TRUSTEE OWNERSHIP 373871 RENTAL 0 PERMA TREAT PEST CONTROL INC BOARD MEMBER OWNS CO. 74567 PEST CONTROL SERVICES 0 X 7003 FMV X 1 203100 TAX ASSESSMENT VALUE FMV X 1 1400000 FMV X FURNITURE 1 27700 FMV X GIFT CARDS 8 5780 FMV X FURNITURE & FIXTURES 1 4367 ACTUAL COST LESS DEP X FOOD AND BEVERAGES 6 3468 FMV X PAID FOR ENTERTAINMENT AT EVENT 4 2783 FMV 0 0 0 FORM 990, PART V, Q 7G AND 7H QUESTIONS 7G AND 7H DO NOT APPLY TO THE ORGANIZATION BECAUSE THE ORGANIZATION DID NOT HAVE CONTRIBUTIONS OF QUALIFIED INTELLECTUAL PROPERTY OR CONTRIBUTIONS OF CARS, BOATS, AIRPLANES OR OTHER VEHICLES DURING THE YEAR. FORM 990, PART VI, SECTION A, LINE 6 MEMBERS OF THE MARY WASHINGTON HEALTHCARE GROUP ALL HAVE ONE SOLE MEMBER, ITS PARENT MARY WASHINGTON HEALTHCARE (MWHC). FORM 990, PART VI, SECTION A, LINE 7A MARY WASHINTON HEALTHCARE (MWHC) HAS THE POWER TO APPOINT BOARD OF TRUSTEES FOR THE GROUP. FORM 990, PART VI, SECTION A, LINE 7B MEMBERS OF THE MARY WASHINGTON HEALTHCARE GROUP ALL HAVE ONE SOLE MEMBER, ITS PARENT MARY WASHINGTON HEALTHCARE (MWHC). MWHC HAS RESERVED CERTAIN POWERS TO ITSELF WITHIN EACH OF ITS SUBSIDIARIES' ORGANIZING DOCUMENTS. THESE RESTRICTIONS INCLUDE AMENDING THE GOVERNING DOCUMENTS, BUDGETING, EXPENDITURES OVER CERTAIN THRESHOLDS. FORM 990, PART VI, SECTION B, LINE 11 MANAGEMENT COMPLETES A DRAFT OF THE FORM 990 FOR THE MARY WASHINGTON HEALTHCARE GROUP. AT THAT TIME THE RETURN IS SUBMITTED TO THE AUDIT AND COMPLIANCE COMMITTEE OF THE BOARD FOR REVIEW AND ACCEPTANCE. THE FORM 990 IS ALSO MADE AVAILABLE TO THE BOARD OF TRUSTEES THROUGH THE BOARD WEBSITE FOR FURTHER REVIEW. FORM 990, PART VI, SECTION B, LINE 12C EVERY TRUSTEE, AND EXECUTIVE MEMBER OF MANAGEMENT IS REQUIRED TO DISCLOSE ANY AND ALL POSSIBLE CONFLICTS OF INTERESTS. THE DISCLOSURES ARE MADE ANNUALLY AND SUBMITTED TO THE MWHC CHIEF AUDIT EXECUTIVE (CAE). THE CAE THEN PRESENTS ALL CONFLICTS TO THE AUDIT AND COMPLIANCE COMMITTEE OF THE BOARD OF TRUSTEES. THE CHAIRMAN OF THE AUDIT AND COMPLIANCE COMMITTEE REPORTS ALL CONFLICTS TO THE FULL BOARD. CONFLICTS ARE CONTINUALLY AND ACTIVELY MANAGED. AT EACH MEETING, THE CHAIR ASKS IF ANYONE AT THE MEETING HAS A CONFLICT TO DISCLOSE. INDIVIDUALS WITH CONFLICTS DISCLOSE THEIR CONFLICTS AND THE RELATED TOPIC. THE INDIVIDUAL THEN RECUSES HIM/HERSELF FROM ANY DECISION RELATED TO THAT TOPIC. THE CONFLICT OF INTERESTS POLICY IS REVIEWED ANNUALLY BY THE BOARD OF TRUSTEES. FORM 990, PART VI, SECTION B, LINE 15 MARY WASHINGTON HEALTHCARE UTILIZES AN EXECUTIVE COMPENSATION COMMITTEE WITH THE PURPOSE AND AUTHORITY TO ESTABLISH PROCESSES TO ENSURE FAIR AND COMMERCIALLY REASONABLE COMPENSATION FOR THE CEO AND EXECUTIVE LEADERSHIP. IN ORDER TO ENSURE COMPENSATION PAID IS SET AT FAIR MARKET VALUE, THE EXECUTIVE COMPENSATION COMMITTEE UTILIZES COMPENSATION SURVEY DATA, FORM 990 INFORMATION FROM COMPARABLE HEALTH SYSTEMS, AND THE SERVICES OF AN INDEPENDENT COMPENSATION CONSULTANT. SUCH INDEPENDENT THIRD PARTY DATA POINT PROVIDES ASSURANCE THAT EXECUTIVE COMPENSATION IS COMMERCIALLY REASONABLE AND AT A FAIR MARKET VALUE. FORM 990, PART VI, SECTION C, LINE 19 THE AUDITED FINANCIALS STATEMENTS ARE POSTED ON THE MARY WASHINGTON HEALTHCARE WEBSITE FOR PUBLIC VIEW. FORM 990, PART IX, LINE 11G CONTRACT PERSONNEL : PROGRAM SERVICE EXPENSES 5,114,355. MANAGEMENT AND GENERAL EXPENSES 281,319. FUNDRAISING EXPENSES 3,396. TOTAL EXPENSES 5,399,070. CONSULTING SERVICES : PROGRAM SERVICE EXPENSES 32,891,423. MANAGEMENT AND GENERAL EXPENSES 1,809,216. FUNDRAISING EXPENSES 21,840. TOTAL EXPENSES 34,722,479. BILLING AND COLLECTION SERVICES : PROGRAM SERVICE EXPENSES 2,100,356. MANAGEMENT AND GENERAL EXPENSES 115,531. FUNDRAISING EXPENSES 1,395. TOTAL EXPENSES 2,217,282. ASP SERVICES : PROGRAM SERVICE EXPENSES 245,571. MANAGEMENT AND GENERAL EXPENSES 13,508. FUNDRAISING EXPENSES 163. TOTAL EXPENSES 259,242. MISCELLANEOUS SERVICES : PROGRAM SERVICE EXPENSES 5,190,863. MANAGEMENT AND GENERAL EXPENSES 285,527. FUNDRAISING EXPENSES 3,447. TOTAL EXPENSES 5,479,837. STORAGE : PROGRAM SERVICE EXPENSES 125,004. MANAGEMENT AND GENERAL EXPENSES 6,876. FUNDRAISING EXPENSES 83. TOTAL EXPENSES 131,963. WASTE DISPOSAL : PROGRAM SERVICE EXPENSES 1,099,625. MANAGEMENT AND GENERAL EXPENSES 60,486. FUNDRAISING EXPENSES 730. TOTAL EXPENSES 1,160,841. MANAGEMENT CONTRACTS : PROGRAM SERVICE EXPENSES 17,558,508. MANAGEMENT AND GENERAL EXPENSES 965,816. FUNDRAISING EXPENSES 11,659. TOTAL EXPENSES 18,535,983. FORM 990, PART XI, LINE 9: INCOME FROM RELATED AFFILIATES -2,042,168. LOSS ON UNCOLLECTED PLEDGES -470,243. CHANGE IN OWNERSHIP TMMP -311,690. RELIEF FROM AFFILIATE LOANS -23,250,257. ELIMINATION OF EQUITY FOR CONSOLIDATED ENTITIES -2,434,924. FORM 990, PART XII, LINE 2C THE GROUP RETURN IS INCLUDED IN THE CONSOLIDATED AUDITED FINANCIAL STATEMENTS OF MWHC. CONSISTENT WITH PRIOR YEARS RESPONSIBILITY FOR OVERSIGHT OF THE AUDIT AND SELECTION OF AUDITORS RESTS WITH THE AUDIT & COMPLIANCE COMMITTEE OF THE BOARD OF TRUSTEES. FORM 990, PART V, Q2A NO ENTITY WITHIN THE GROUP FILES W-2S WITH THE IRS. ALL PAYROLL IS PAID THROUGH AN AGENCY AGREEMENT WITH MARY WASHINGTON HEALTCARE, THE PARENT ORGANIZATION. MARY WASHINGTON HEALTHCARE FILES ALL W-2S. FORM 990, SCHEDULE R ABBREVIATIONS: MWHC - MARY WASHINGTON HEALTHCARE MPI - MEDICORP PROPERTIES, INC. MWHC CLINICAL - MARY WASHINGTON HEALTHCARE CLINICAL SERVICES, INC. MEDIDOCTORS H.C. - MEDIDOCTORS HOLDING COMPANY FORM 990, SCHEDULE R UNTIL SEPTEMBER 4, 2014, TOMPKINS MARTIN MEDICAL PLAZA WAS OWNED 99% BY MEDICORP PROPERTIES, INC. AND IS REPORTED ON PART III OF SCHEDULE R. AFTER THAT DATE, MEDICORP PROPERTIES, INC. ACQUIRED THE REMAINING 1% AND TOMPKINS MARTIN BECAME A DISREGARDED ENTITY OF MEDICORP PROPERTIES, INC. ACTIVITY FOR THE LAST 4 MONTHS OF THE YEAR OF TOMPKINS MARTIN MEDICAL PLAZA IS REPORTED ON SCHEDULE R, PART I. 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ON 9/5/14.