2015-11-09T13:32:01-06:00 2014-12-31 221478099 COHNREZNICK LLP 7501 WISCONSIN AVE SUITE 400E BETHESDA MD 20814 990 2014-01-01 540620889 INOVA HEALTH CARE SERVICES INOV 7032892433 8110 GATEHOUSE ROAD SUITE 400W FALLS CHURCH VA 22042 RICHARD MAGENHEIMER CFO 7032892433 2015-11-04 FRED HUTCHISON P00640420 7037446700 2014 2016-04-25 22:37:26Z J Knox Singleton 8110 GATEHOUSE ROAD SUITE 400W FALLS CHURCH VA 22042 2268490152 0 X INOVA.ORG X 1956 VA Inova Health Care Services (IHCS)mission is to maintain and operate hospitals and perform other activities dedicated to providing quality care and improving the health of the diverse communities it serves. To achieve this goal, Inova works in partnership with other organizations, spearheading numerous community health improvement projects. 23 16 14483 2627 6074977 0 16106059 17906198 2033256557 2153984216 19360072 -11256062 65851193 83567150 2134573881 2244201502 0 0 0 0 980234933 1000484267 0 0 0 1008825168 1068543847 1989060101 2069028114 145513780 175173388 3772297581 4121899625 1896239534 2099090130 1876058047 2022809495 X IHCS was specifically chartered for the purpose of serving the health care needs of the community by establishing, maintaining, and operating hospital facilities, programs, and other shared service arrangements; carrying on health-related education activities; promoting and carrying on health-related scientific research; and engaging in activities designed and carried on to promote the general health of the community. IHCS includes a centralized System Office and the various unincorporated and incorporated subsidiaries which are described below.The unincorporated subsidiaries of IHCS include: Inova Fairfax Hospital, Inova Mount Vernon Hospital, Inova Fair Oaks Hospital, Inova Alexandria Hospital, ACCESS of Reston, ACCESS of Fairfax, Inova Research Center, Assisted Living Facilities, Inova Physical Rehabilitation Services, Inova Urgent Care Centers, Inova Employee Assistance, and Behavioral Health and Addiction Treatment. 0 0 1724621475 2229354630 Inova Health Care Services (IHCS) is part of the Inova Health System whose mission is to serve the needs of the community by establishing, maintaining, and operating hospital facilities, programs, and other shared service arrangements; carrying on health-related education activities; promoting and carrying on health-related scientific research; and engaging in activities designed and carried on to promote the general health of the community. IHCS includes a centralized System Office and the various unincorporated and incorporated subsidiaries which are described below.The unincorporated subsidiaries of IHCS include: Inova Fairfax Hospital, Inova Mount Vernon Hospital, Inova Fair Oaks Hospital, Inova Alexandria Hospital, ACCESS of Reston, ACCESS of Fairfax, Inova Research Center, Assisted Living Facilities, Inova Physical Rehabilitation Services, Inova Urgent Care Centers, Inova Employee Assistance, and Behavioral Health and Addiction Treatment.PROGRAM SERVICESAcute care services are provided on three campuses in Fairfax County and one campus in the City of Alexandria in Virginia. Services provided include emergency and trauma facilities, inpatient and outpatient services, and a variety of ancillary and specialized services. During 2014 IHCS admissions and observations cases totaled 111,665 outpatient visits totaled 312,284, emergency visits totaled 331,512 (33,941 of the total ER visits were at the Healthplex) and deliveries totaled 15,922. The acute care program services provided by these hospitals are described more fully below. Inova Fairfax Hospital (IFH) campus includes the Inova Heart and Vascular Institute, Inova Women's Hospital, and Inova Fairfax Hospital for Children. The hospital, located in Central Fairfax County is an 833-licensed bed tertiary care hospital providing comprehensive medical and surgical services which include emergency/trauma, cardiac, transplant, cancer, obstetric, pediatric, neonatal, stroke and extensive outpatient services. Inova Fairfax Hospital is the home of northern Virginia's only level one emergency and trauma center and the state-of-the-art Women's and Children's Center. In addition, Inova Fairfax Hospital is a teaching hospital providing clinical training through its medical residency, nursing, and paramedical education programs.Inova Mount Vernon Hospital (IMVH) is a 237-licensed bed acute-care hospital serving southeastern Fairfax County. Inova Mount Vernon provides a full-service, 24-hour emergency department; broad range of diagnostic, medical and surgical services; inpatient psychiatric services; the Dorothea R. Fischer Wound Healing Center and a specialized hyperbaric oxygen therapy program used to treat conditions requiring increased oxygen flow to body tissues (such as grafts and certain types of burns). The hospital operates the Inova Center for Rehabilitation, a nationally-known accredited program providing inpatient and outpatient rehabilitative services.Inova Fair Oaks Hospital (IFOH) is a 182-licensed bed general acute care hospital, which opened in 1987 to serve the growing communities in western Fairfax County, Virginia. Inova Fair Oaks provides a full-service 24-hour emergency department; a spectrum of diagnostic services and treatment including full-body CT scanning, open MRI and radiation cancer services; inpatient medical and surgical services; obstetrics and pediatric services; and comprehensive outpatient services including outpatient surgery, physical medicine, wound care and rehabilitation. Inova Fair Oaks Hospital is home to a designated Bariatric Surgery Center of Excellence. Inova Alexandria Hospital (IAH) is a 318-licensed bed general acute care hospital, which opened on January 23, 1873. IAH provides a spectrum of diagnostic services, including full-body CT scanning, MRI, and a cardiac catheterization laboratory; a variety of inpatient medical, surgical, and orthopedic services; comprehensive outpatient services, including outpatient surgery, physical medicine, and rehabilitation; and a 24-hour emergency department as well as the Springfield Healthplex, a free standing emergency facility. In addition, specialized obstetric and pediatric services are provided by the hospital's Maternal and Infant Health Center and a children's unit. Specific acute care programs include:Cardiovascular Care: The Inova Heart and Vascular Institute at IFH is the region's first dedicated heart hospital. It houses 156 inpatient beds, six cardiovascular operating rooms, an 11-room cardiac catheterization and electrophysiology suite, chest pain unit, 64-slice CT scanner and other diagnostic testing, outpatient clinics, cardiac rehabilitation and educational facilities. Specialty programs include pediatric cardiac surgery, arterial fibrillation, valve disease and heart failure. The Inova Heart and Vascular Institute at IAH houses ten inpatient beds, two cardiovascular operating rooms, one cardiac catheterization lab, one electrophysiology lab, three interventional radiology labs, one minor procedure room, outpatient clinics, cardiac rehabilitation and educational facilities. Women's Health: The Inova Women's Health program is the largest such program in the Mid-Atlantic region, providing services for over 15,000 births each year. Obstetric services provided include delivery services, high risk prenatal services, inpatient and outpatient obstetrics/gynecologic surgery, and regular and specialty nursery care. IFH provides obstetric services to low-income patients through the InovaCares Clinic for Women with 31,542 visits in 2014. In addition, IAH works with the Casey Clinic, a State health clinic jointly funded by the State of Virginia, City of Alexandria and the Alexandria Health Department, providing obstetric services to low-income patients.Pediatrics: The Inova Fairfax Hospital for Children (IFHC) is Northern Virginia's regional pediatric referral center with 112 licensed acute care beds and more than 25 sub-specialties including pediatric emergency and trauma care, critical care, infectious disease, pulmonary disease, cardiac surgery, hematology and oncology, neonatology, physical medicine & rehabilitation and speech & hearing therapy. The Fairfax facility includes Northern Virginia's only Level III (highest level) newborn intensive care unit, which is staffed around the clock by neonatology physicians and nurses specially trained in caring for premature and other newborns with medical complications. As of December 31, 2014, total NICU bassinets numbered 85. Inova Fairfax Hospital operates the only pediatric intensive care unit in northern Virginia, providing 24-hour coverage for children with life-threatening illnesses or injuries. Inova Fairfax Hospital also has 20 dedicated pediatric emergency room treatment bays, a dedicated hematology/oncology unit and two dedicated operating rooms for pediatric heart surgeries. Inova Fairfax Hospital for Children (IFHC) provides a primary care medical home for children of low income families that are uninsured or on Medicaid through the InovaCares Clinic for Children which in 2014 provided 22,780 visits at an unreimbursed cost of approximately $350,000.Cancer Care: Inova Cancer Services ("ICS") operates full-service cancer centers at Fairfax Hospital, Alexandria Hospital, and Fair Oaks Hospital. Fairfax Hospital is designated by the American College of Surgeons Commission on Cancer as a Teaching Hospital Cancer Program, and Alexandria Hospital has a Community Hospital Comprehensive Cancer Program designation. Other System Hospitals meet the American College of Surgeons Community Hospital Cancer Program standards. The System maintains several programs dedicated to different types of cancer, cancer care and cancer risk assessment, including the Inova Breast Care Institute, the Cancer Genetic Counseling Program (hereditary conditions), the Center for Advanced Endoscopy (digestive tract), the Center for Interventional Oncology (liver, bile duct and pancreas), the Transplant Center's stem cell and bone marrow transplantation services (lymphoma, leukemia or multiple myeloma), the Thoracic Oncology Program (lung and esophageal cancer), and Life with Cancer (support and education to cancer patients) The Inova Breast Care Institute at Inova Fairfax Hospital and Inova Fair Oaks Hospital is the first in the DC region to earn a three-year accreditation in breast care from the National Accreditation Program for Breast Centers (NAPBC), part of the American College of Surgeons.The Emergency and Trauma Center at Inova Fairfax Hospital, Northern Virginia's only Level I trauma center, is a state-of-the-art facility. Emergency medical specialists with expertise in trauma care treat every type of illness, injury, or life-threatening trauma. Research and Education Services: The Inova Research Center (IRC), including research and academic activities, is centered on the Inova Fairfax Hospital campus. In 2014, the Inova campus of the Virginia Commonwealth University School of Medicine had a total of 30 third year and 30 fourth year medical students who spent their clerkship years at Inova Fairfax Hospital. In addition, 678 students came to Inova Fairfax Hospital for a four week rotation in 2014. Also located on the Inova campus is the VCU School of Pharmacy which partners with clinicians and practitioners across Inova and Northern Virginia to help educate and train an increasing number of pharmacy students each year, providing both didactic and experiential educationThe Claude Moore Health Education Center on the campus of Inova Fairfax Hospital features 11,000 square feet of space dedicated to the educational needs of medical and nursing students as well as residents and fellows. This state-of-the-art center includes both medical and surgical simulation centers, enabling students to learn through hands-on experience. The Center also features a dedicated research floor to support the extensive activities of the Inova Research Center, where there are numerous active clinical trials, ongoing translational research and outcomes projects, many in partnership with universities and other research entities. The unreimbursed cost of these programs in 2014 was $7.6 million. Inova Translational Medicine InstituteIn 2010, the Inova Translational Medicine Institute (ITMI), a not-for-profit research institute was created for research activities related to the innovative field of personalized medicine. Personalized medicine is a medical model that emphasizes the customization of healthcare to individual patients. It involves the use of genetic information about an individual patient. In 2011, ITMI collaborated with physicians from Fairfax Neonatal Associates to investigate the genetic causes of pre-term delivery. Findings were used to build a reference database of genomic and clinical information which will empower clinical genomic discovery. In 2014, approximately $29 million was provided in operational support for ITMI. Inova Fairfax Hospital's medical education programs offer a variety of clinical training objectives for medical residents and students, nursing and pharmacy. Inova Fairfax Hospital's residency program has approximately 733 Residents/Fellows trained throughout the year, and 482 Medical Students. Residents and students are primarily from Inova Fairfax Hospital, Georgetown and George Washington Universities. As a teaching facility, Inova Fairfax Hospital incurs typical, additional expenses associated with teaching facilities including physician teaching costs and resident salaries, the cost of maintaining higher levels of technology required to support a teaching program and charges resulting from extra tests ordered for instructional purposes. The unreimbursed cost of these programs in 2014 was $14.9 million. Each year, IHCS designates funds for the development and continuation of identified, accessible direct care programs and services benefiting those most in need in the community. Many of these programs and services are not billed to the patient or are provided at a fee structure below the actual cost of the service. In addition to providing the direct care subsidized service, Inova also provides disease-prevention programs, health and exercise classes, health education and health screenings and other programs within the community in support of the IHCS mission. In 2014, Inova provided over 280,000 people with health education, prevention and wellness programs, health fairs and screenings, and clinically related services resulting in over 182,000, visits for direct health care services at an unreimbursed cost of approximately $18.3 million. These services and programs are described below.InovaCares Clinic for Women and ChildrenThe InovaCares Clinic for Women was created in 1960 to serve the uninsured women of Fairfax County, offering a wide range of OB/GYN services for those in need. InovaCares Clinic for Women is a service offered to the community in collaboration with the Fairfax County Health Department, serving uninsured and low-income patients up to 300% of the Federal Poverty Level (FPL). The Clinic for Women provides comprehensive outpatient obstetrical services, gynecological care, diabetes management, case management, non-stress testing, LEEP and colonoscopy procedures, cryosurgery, and nutritional counseling - all at little to no cost to the patient. In addition, the Clinic for Women runs a high risk obstetrics clinic and a gynecology clinic. In 2014, the InovaCares Clinic for Women had 31,542 visits and became an official "centering site" for prenatal care.The InovaCares Clinic for Children was created in 1993 as a response to the inability of new uninsured or Medicaid mothers to secure an affordable medical home for their children. The mission of the Clinic for Children is to provide a full service medical home for pediatric patients between zero and 21 years of age. The Clinic for Children provides comprehensive pediatric services that includes well-child care, immunizations, episodic care (sick visit), and school/sports physicals, immunizations, and nutritional counseling. In 2014, the InovaCares Clinics for Children provided 22,780 visits and is a recognized NCQA level 3 Patient-Centered Medical Home.Inova Alexandria Hospital OB ClinicIAH donates space on the campus to the Casey Clinic, a community health center funded by the State of Virginia, Alexandria Health Department and the City Of Alexandria to provide primary healthcare services to low-income and uninsured children and adults that are residents of the City of Alexandria. IAH funds the clinic physicians who provide OB patient prenatal examinations and delivery at Inova Alexandria Hospital. Inova Juniper Program, HIV Clinical and Education ServicesInova Juniper Program (IJP) provides outpatient primary medical care, mental health therapy, substance abuse treatment, pharmaceutical assistance, nutritional counseling and medical case management services to 1,727 persons living with HIV disease in the suburban Virginia region. To maximize accessibility for clients, services are provided at the main location in Springfield, as well as six satellite clinics (Dumfries, Manassas, Mt. Vernon, Arlington, Leesburg, and Herndon), hospitals, homes and other community locations throughout the region. Major accomplishments of IJP for 2014 include:Now serves over 1,700 patients providing 36,570 visits.Maintaining a 0% HIV transmission rate from pregnant mothers to their newborn babies.Conducted 135 education programs reaching 1,898 participants, and provided 147 clinical consultations.Successfully implemented seven Virginia Department of Health prevention contracts to develop, implement, and evaluate programs to support, motivate, and educate the public and people living with HIV. Programs are targeted to incarcerated men and women, MSM, youth, and the general population. HIV testing, support groups, and patient navigation services are also provided through the prevention programs.Life with Cancer The mission of Life with Cancer (LWC) is to enhance the quality of life of those individuals in the community affected by cancer. The program addresses the specific needs by providing individual and family counseling, support groups, educational seminars, workshops on cancer diagnosis and treatment, and a full array of complimentary therapies. Life with Cancer is generously supported by our community; therefore all services are available at no charge to residents of the Washington Metropolitan area. In 2014, Life with Cancer offered: 1,798 educational classes, groups, and wellness programs, with more than 12,197 visits. In addition, 8,580 counseling or consultation sessions were provided by oncology nurse navigators and oncology therapists serving 12,247 people. LWC participated in or hosted 79 health fairs, presentations, webinars, and conferences for over 4,000 people. A total of 32,266 service hours for 28,488 people in the Northern Virginia area were provided. Lions Eye ClinicAdministered by Inova Fairfax Hospital, the Ophthalmology Clinic provides ophthalmic specialty services to the indigent including treatment of glaucoma, retina, and cataracts. IFH provides a part-time ophthalmologist, an ophthalmic technician, and receptionist for the clinic. The remaining physicians volunteer their services. In 2014, the clinic had 1,120 visits.Elderlink A cooperative program sponsored with the Fairfax County Area Agency on the Aging and the Alzheimer's Association of Northern Virginia. It provides care management for older adults and their families through assessment and counseling, care planning, and coordination of care giving services. Elderlink had 316 case management cases and a total of 2,158 home visits for all programs during 2014.Inova Center for Wellness and Metabolic HealthThe Inova Diabetes Center made significant changes in 2014. The new name; Inova Center for Wellness and Metabolic Health, better reflects the services that are now provided. The Center is still recognized by the American Diabetes Center for diabetic education but medical nutrition services have been extended to include obesity, CHF, HIV and other metabolic conditions. Registered dieticians and certified diabetes educators have long been a part of the program, however this year a nurse practitioner and a Board Certified Endocrinologist were hired. Clinicians are now able to provide medical management for those who require that service. Center locations include: Fairfax, Leesburg, and Fair Oaks. In 2014, the Fairfax Centers provided 5,124 patient visits and another 1,317 patient visits at the Loudoun site. IHCS and its subsidiaries provide many other non-billed and below margin patient services. Case management services are provided to the indigent and assistance is provided with financial paperwork. Inova Mount Vernon participates in the Health Information and Claims Assistance Program by providing assistance with health insurance paperwork problems. In addition, home IV therapy services are provided for the indigent. Transportation is provided for some indigent patients to and from IHCS facilities and programs. Inova Fairfax Hospital provides forensic and medical care to abused adults and children as well as blood alcohol testing for area police departments while coordinating the disposition of deaths with various community organizations. Other services include pastoral care, free living accommodations for out-of-town Inova Fairfax Hospital heart and lung transplant patients and their families, and emergency assistance to patients and their families needing medication or transportation. Community Health Education and Promotion As part of Inova's overall health promotion effort, IHCS and its subsidiaries are actively involved in sponsoring programs, activities, and services designed to improve community health and prevent the onset of disease. WellAware PlusInova has provided an employee wellness program for several years. In 2014, Inova provided an expanded version of the 'Know Your Numbers' campaign which consists of blood work, biometric screenings and in-person and telephonic wellness coaching. It is the goal of the wellness coaches to work with employees to establish realistic wellness goals and to support employees while they work towards reaching those optimal health. 1724621475 1 1 0 1 0 0 0 0 0 0 1 0 0 1 1 1 0 1 0 0 0 0 0 0 0 0 1 1 0 0 1 1 0 0 0 0 0 0 0 1 1 0 0 0 0 0 1 1 0 0 0 1 X 1676 0 1 14483 1 1 1 0 0 0 0 0 X 23 16 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 1 1 X Inova Health Care Services 7032892433 8110 Gatehouse Road Suite 400W Falls Church VA 22042 JKNOX SINGLETON PRESIDENT 35.00 15.00 X X 0 5249252 751545 CHARLES SMITH CHAIRMAN 3.00 4.00 X X 0 0 0 JACK EBELER VICE CHAIRMAN 2.00 3.00 X X 0 0 0 CHARLES BEARD SECRETARY 2.00 X X 0 0 0 MARY AGEE TRUSTEE 2.00 X 0 0 0 STEPHEN KELLER MD TRUSTEE 2.00 X 0 0 0 HUGO DAVALOS MD TRUSTEE 2.00 X 0 0 0 PATRICK RHODES TRUSTEE 2.00 5.00 X 0 0 0 MARK STAVISH TRUSTEE 2.00 X 0 0 0 ARSHED CHOUDHRY MD TRUSTEE 3.00 2.00 X 0 0 0 ROBERT LAFSKY MD TRUSTEE 2.00 3.00 X 0 0 0 MICHAEL FREY TRUSTEE 2.00 X 0 0 0 HOOKS JOHNSTON TRUSTEE 2.00 X 0 0 0 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IAH 35.00 5.00 X 719254 0 74180 JOHN HAMILTON PHYSICIAN 40.00 X 1081629 0 71427 MARK THEISS PHYSICIAN 40.00 X 754202 0 72429 CARY SCHWARTZBACH PHYSICIAN 40.00 X 730795 0 31758 JAMES ECKLUND PHYSICIAN 40.00 X 1055376 0 80008 NILESH VYAS PHYSICIAN 40.00 X 808771 0 58228 JAMES KIM FORMER AVP DEPUTY GENERAL 35.00 15.00 X 277217 0 61067 HPATRICK WALTERS FORMER SVP STRATEGIC PLANN 5.00 45.00 X 0 531326 71288 MARK RUNYON SVP FINANCE 40.00 X 503003 0 103083 MAUREEN SWICK SVP COO IFH AND CNE IHS 40.00 X 401311 0 142143 JOSEPH ROCHE FORMER EXEC DIR EAP 40.00 X 167210 0 55227 TODD LOCKCUFF FORMER AVP ASSOC ADMIN CFO 40.00 X 310774 0 30198 HUGO AGUAS FORMER AVP HR ASSOC ADMIN 40.00 X 237067 0 55244 MARY DIXON FORMER AVP CNO 40.00 X 214676 0 43844 PAMELA MCVEY FORMER DIR NURSING RESOURC 40.00 X 145466 0 16447 9650835 12518704 4119820 1429 1 1 0 CARDIAC VASCULAR & THORACIC 2921 TELESTAR CT FALLS CHURCH VA 22042 MEDICAL 14821062 FAIRFAX RADIOLOGICAL CONSULTANTS 2722 MERRILEE DRIVE SUITE 230 FAIRFAX 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599709 -29021649 X X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 256133 256133 1724365342 1724621475 1000000 250000 0 0 1000000 1000000 1000000 1000000 4000000 6000000 240480 253864 229898 256133 980375 250000 250000 250000 250000 1000000 1500000 113168635 113168635 923072886 446672362 476400524 492043958 332299707 159744251 1047467192 773144355 274322837 154040302 128925014 25115288 1048751535 UNAMORTIZED BOND COSTS 7863422 OTHER ASSETS 12394231 DUE FROM SUBSIDIARIES AND AFFILIATES 1747116603 PENSION ASSET 30739713 CONSTRUCTION IN PROGRESS 404285561 INTANGIBLES 4150000 2206549530 THIRD PARTY SETTLEMENTS 47459139 NOTES PAYABLE AND OTHER 122960520 SELF INSURED LIABILITY 30566841 DEFERRED COSTS 24051536 POST RETIREMENT/EMPLOYMENT BENEFITS 10401641 INTEREST RATE SWAP LIABILITY 29767279 INVESTMENT IN SUBSIDIARIES AND JOINT VENTURES -164617 INTEREST PAYABLE 7050656 WORKERS COMPENSATION PAYABLE 15790804 287883799 X Part X, Line 2: From Inova Health System consolidated financial statements including Inova Health Care Services: The Foundation, IHCS, and LHC, are not-for-profit corporations and have been determined to be exempt from Federal income tax under the provisions of section 501(c)(3) of the Internal Revenue Code. IHI and its subsidiaries are taxable organizations. Deferred income taxes are provided for all significant timing differences between revenues and expenses reported for financial statement and for tax purposes. Management annually reviews its tax positions and has determined that there are no material uncertain tax positions that require recognition in the consolidated financial statements. 1 1 X 1 X 1 X 1 1 1 0 1 1 88472870 88472870 0.04520 161689902 103814463 57875439 0.02960 250162772 103814463 146348309 0.07480 15665416 6463560 9201856 0.00470 22208307 7351701 14856606 0.00760 19580307 12006418 7573889 0.00390 12536302 4928264 7608038 0.00390 1527726 1527726 0.00080 71518058 30749943 40768115 0.02090 321680830 134564406 187116424 0.09570 1 46464401 0 376720804 440580623 -63859819 X 1 1 1 Franconia-Springfield Surgery Center LLC Surgical Services 0.60400 0.39600 2 Northern Virginia Surgery Center LLC Surgical Services 0.60110 0.39890 3 Inova Ambulatory Surgery Center at Lorton LLC Surgical Services 0.65470 0.34530 4 1 INOVA FAIRFAX HOSPITAL 3300 GALLOWS ROAD FALLS CHURCH VA 22046 INOVA.ORG VA H1921 X X X X X X A 2 INOVA ALEXANDRIA HOSPITAL 4320 SEMINARY ROAD ALEXANDRIA VA 22304 INOVA.ORG VA H1859 X X X A 3 INOVA FAIR OAKS HOSPITAL 3600 JOSPEH SIEWICK DRIVE FAIRFAX VA 22033 INOVA.ORG VA H1922 X X X A 4 INOVA MOUNT VERNON HOSPITAL 2501 PARKER LANE ALEXANDRIA VA 22306 INOVA.ORG VA H1923 X X X A Facility Reporting Group - A 0 0 1 X X X X X X X X X 13 1 1 0 1 X INOVA.ORG 1 13 1 www.Inova.org 0 0 1 X 200.000000000000 300.000000000000 X X X X X X 1 1 X X X X 1 X X X X X X X X 1 0 X X X X 1 X 0 0 Part V, Section B Facility Reporting Group A Facility Reporting Group A consists of: - Facility 1: INOVA FAIRFAX HOSPITAL, - Facility 2: INOVA ALEXANDRIA HOSPITAL, - Facility 3: INOVA FAIR OAKS HOSPITAL, - Facility 4: INOVA MOUNT VERNON HOSPITAL Facility Reporting Group - A Part V, Section B, line 16a website: www.Inova.org Facility Reporting Group - A Part V, Section B, line 16b website: www.Inova.org Facility Reporting Group - A Part V, Section B, line 16c website: www.Inova.org Group A-Facility 1 -- INOVA FAIRFAX HOSPITAL Part V, Section B, line 5: For IFH:The hospital interviewed 45 key informants, including external stakeholders (those who represented the broad interests in the community) and internal Inova staff. The interviews were guided by a structured interview guide, and interviewees were encouraged to identify and discuss a wide range of current and emerging issues affecting community health. The hospital also sought input from the public regarding the health of the community through an online survey publicized through mailers and flyers. A detailed listing of the community stakeholders who provided community input are included in the Appendix of the CHNA. Group A-Facility 1 -- INOVA FAIRFAX HOSPITAL Part V, Section B, line 6a: Inova Fairfax HospitalInova Mt. Vernon HospitalInova Loudoun HospitalInova Alexandria Hospital Group A-Facility 1 -- INOVA FAIRFAX HOSPITAL Part V, Section B, line 11: In the CHNA report conducted in 2013, Inova Fairfax Hospital identified the following significant community health needs: access to health and human services, chronic disease, dental health, health behaviors, maternal and child health, morbidity, the physical environment and social and economic factors.As described in the Implementation Strategy adopted by the Board, Inova Fairfax Hospital indicated that it would address many but not all of the identified needs. The hospital indicated it would not address certain elements that are beyond the scope of the medical campus or are outside of the hospital's expertise including lack of transportation, poor air quality, community safety, basic needs insecurity or poor educational achievement. The hospital also indicated that it would not address other elements that are also important but are being addressed by others, including disparities in chronic liver disease, unsafe sex, high rates of communicable diseases and high rates of Lyme disease. Since the 2013 CHNA was conducted, Inova Fairfax Hospital has addressed all of the significant needs as described in this Implementation Strategy. These needs were addressed by initiatives including the following: providing in-kind and financial support for community organizations seeking to improve community health and meet social services needs, participating actively in community coalitions and on boards, operating the Inova Transitional Care Management Program and Discharge clinics for low-income patients without a medical home, operating InovaCares clinics for Medicaid and uninsured patients, the Inova PACE program, increasing visits for uninsured patients to Inova-affiliated specialists, expanding health promotion and education programs particularly to reduce the prevalence of diet and exercise-related health problems, increasing investment in Inova's SNAP Double Dollars Program which enhances access to healthy food, and increasing services provided by the Inova Juniper Program which is Northern Virginia's largest provider of services for HIV/AIDS patients.Some changes were made to specific programs in 2014 to enhance program impacts. For example, Congregational Health Partnership concluded in 2014 and in its place Inova is working with the Wesley Theological Seminary's Heal the Sick program. This collaboration between the hospital system, faith community and surrounding neighborhoods will improve health in a more sustainable fashion. Additionally, Inova planned to explore a new location in the Merrifield area for a local FQHC. Because Virginia did not expand Medicaid, this new clinic was not built. Instead, Inova has helped to support a new location for Fairfax County's Community Health Care Network in this area, and is co-locating mental health services utilized by the same patient population. While not identified for expansion of services in the 2013 CHNA, Inova continues to serve the community through many ongoing programs, including the provision of culturally competent and linguistically appropriate services; prevention, education and support through the Inova Fairfax Cancer Center; alcohol and substance abuse treatment at the Inova Comprehensive Addiction treatment Services; Medicaid managed care plans through INTotal Health; and comprehensive mental health services for children and young adults at the Inova Kellar Center. Group A-Facility 1 -- INOVA FAIRFAX HOSPITAL Part V, Section B, line 13h: CALCULATE FAMILY SIZE Group A-Facility 1 -- INOVA FAIRFAX HOSPITAL Part V, Section B, line 15e: Financial Aid Brochures explaining the charity policy are available through out the Hospitals. ER Rooms and waiting rooms have charity notification notices posted intheir areas. Group A-Facility 1 -- INOVA FAIRFAX HOSPITAL Part V, Section B, line 16i: Financial Aid Brochures explaining the charity policy are available through out the Hospitals. ER Rooms and waiting rooms have charity notification notices posted in their areas. Group A-Facility 2 -- INOVA ALEXANDRIA HOSPITAL Part V, Section B, line 5: For IAH:The hospital interviewed 25 key informants, including external stakeholders (those who represented the broad interests in the community) and internal Inova staff. The interviews were guided by a structured interview guide, and interviewees were encouraged to identify and discuss a wide range of current and emerging issues affecting community health. The hospital also sought input from the public regarding the health of the community through an online survey publicized through mailers and flyers. A detailed listing of the community stakeholders who provided community input are included in the Appendix of the CHNA. Group A-Facility 2 -- INOVA ALEXANDRIA HOSPITAL Part V, Section B, line 6a: Inova Fairfax HospitalInova Loudoun HospitalInova Fair Oaks HospitalInova Alexandria Hospital Group A-Facility 2 -- INOVA ALEXANDRIA HOSPITAL Part V, Section B, line 11: In the CHNA report conducted in 2013, Inova Alexandria Hospital identified the following significant community health needs: access to health and human services, chronic disease, dental health, health behaviors, maternal and child health, morbidity, the physical environment and social and economic factors.As described in the Implementation Strategy adopted by the Board, Inova Alexandria Hospital indicated that it would address many but not all of the identified needs. The hospital indicated it would not address certain elements that are beyond the scope of the medical campus or are outside of the hospital's expertise including disparities in infant health outcomes, poor air quality, and basic needs insecurity. The hospital also indicated that it would not address other elements that are also important but are being addressed by others, including disparities in chronic liver disease, unsafe sex and teen pregnancy and high rates of communicable diseases. Since the 2013 CHNA was conducted, Inova Alexandria Hospital has addressed all of the significant needs as described in this Implementation Strategy. These needs were addressed by initiatives including the following: providing in-kind and financial support for community organizations seeking to improve community health and meet social services needs, participating actively in community coalitions and on boards, operating the Inova Transitional Care Management Program and Discharge clinics for low-income patients without a medical home, operating InovaCares clinics for Medicaid and uninsured patients, the Inova PACE program, increasing visits for uninsured patients to Inova-affiliated specialists, expanding health promotion and education programs particularly to reduce the prevalence of diet and exercise-related health problems, increasing investment in Inova's SNAP Double Dollars Program which enhances access to healthy food, and increasing services provided by the Inova Juniper Program which is Northern Virginia's largest provider of services for HIV/AIDS patients.Some changes were made to specific programs in 2014 to enhance program impacts. For example, Congregational Health Partnership concluded in 2014 and in its place Inova is working with the Wesley Theological Seminary's Heal the Sick program. This collaboration between the hospital system, faith community and surrounding neighborhoods will improve health in a more sustainable fashion. Additionally, Inova planned to explore a new location in the Merrifield area for a local FQHC. Because Virginia did not expand Medicaid, this new clinic was not built. Instead, Inova has helped to support a new location for Fairfax County's Community Health Care Network in this area, and is co-locating mental health services utilized by the same patient population. While not identified for expansion of services in the 2013 CHNA, Inova continues to serve the community through many ongoing programs, including the provision of culturally competent and linguistically appropriate services; prevention, education and support through the Inova Alexandria Cancer Center; alcohol and substance abuse treatment at the Inova Comprehensive Addiction treatment Services; Medicaid managed care plans through INTotal Health; and comprehensive mental health services for children and young adults at the Inova Kellar Center. Group A-Facility 2 -- INOVA ALEXANDRIA HOSPITAL Part V, Section B, line 13h: CALCULATE FAMILY SIZE Group A-Facility 2 -- INOVA ALEXANDRIA HOSPITAL Part V, Section B, line 15e: Financial Aid Brochures explaining the charity policy are available through out the Hospitals. ER Rooms and waiting rooms have charity notification notices posted intheir areas. Group A-Facility 2 -- INOVA ALEXANDRIA HOSPITAL Part V, Section B, line 16i: Financial Aid Brochures explaining the charity policy are available through out the Hospitals. ER Rooms and waiting rooms have charity notification notices posted intheir areas. Group A-Facility 3 -- INOVA FAIR OAKS HOSPITAL Part V, Section B, line 5: For IFOH:The hospital interviewed 41 key informants, including external stakeholders (those who represented the broad interests in the community) and internal Inova staff. The interviews were guided by a structured interview guide, and interviewees were encouraged to identify and discuss a wide range of current and emerging issues affecting community health. The hospital also sought input from the public regarding the health of the community through an online survey publicized through mailers and flyers. A detailed listing of the community stakeholders who provided community input is included in the Appendix of the CHNA. Group A-Facility 3 -- INOVA FAIR OAKS HOSPITAL Part V, Section B, line 6a: Inova Fairfax HospitalInova Mt. Vernon HospitalInova Fair Oaks HospitalInova Loudoun Hospital Group A-Facility 3 -- INOVA FAIR OAKS HOSPITAL Part V, Section B, line 11: In the CHNA report conducted in 2013, Inova Fair Oaks Hospital identified the following significant community health needs: access to health and human services, chronic disease, dental health, health behaviors, maternal and child health, mental health, morbidity, the physical environment and social and economic factors.As described in the Implementation Strategy adopted by the Board, Inova Fair Oaks Hospital indicated that it would address many but not all of the identified needs. The hospital indicated it would not address certain elements that are beyond the scope of the medical campus or are outside of the hospital's expertise including poor air quality, community safety, basic needs insecurity or poor educational achievement. The hospital also indicated that it would not address other elements that are also important but are being addressed by others, including disparities in chronic liver disease, unsafe sex, high rates of Tuberculosis and high rates of Lyme disease. Since the 2013 CHNA was conducted, Inova Fair Oaks Hospital has addressed all of the significant needs as described in this Implementation Strategy. These needs were addressed by initiatives including the following: providing in-kind and financial support for community organizations seeking to improve community health and meet social services needs, participating actively in community coalitions and on boards, operating the Inova Transitional Care Management Program and Discharge clinics for low-income patients without a medical home, operating InovaCares clinics for Medicaid and uninsured patients, the Inova PACE program, increasing visits for uninsured patients to Inova-affiliated specialists, expanding health promotion and education programs particularly to reduce the prevalence of diet and exercise-related health problems, increasing investment in Inova's SNAP Double Dollars Program which enhances access to healthy food, and increasing services provided by the Inova Juniper Program which is Northern Virginia's largest provider of services for HIV/AIDS patients.Some changes were made to specific programs in 2014 to enhance program impacts. For example, Congregational Health Partnership concluded in 2014 and in its place Inova is working with the Wesley Theological Seminary's Heal the Sick program. This collaboration between the hospital system, faith community and surrounding neighborhoods will improve health in a more sustainable fashion. Additionally, Inova planned to explore a new location in the Merrifield area for a local FQHC. Because Virginia did not expand Medicaid, this new clinic was not built. Instead, Inova has helped to support a new location for Fairfax County's Community Health Care Network in this area, and is co-locating mental health services utilized by the same patient population. While not identified for expansion of services in the 2013 CHNA, Inova continues to serve the community through many ongoing programs, including the provision of culturally competent and linguistically appropriate services; prevention, education and support through the Inova Fair Oaks Cancer Center; alcohol and substance abuse treatment at the Inova Comprehensive Addiction treatment Services; Medicaid managed care plans through INTotal Health; and comprehensive mental health services for children and young adults at the Inova Kellar Center. Group A-Facility 3 -- INOVA FAIR OAKS HOSPITAL Part V, Section B, line 13h: CALCULATE FAMILY SIZE Group A-Facility 3 -- INOVA FAIR OAKS HOSPITAL Part V, Section B, line 15e: Financial Aid Brochures explaining the charity policy are available through out the Hospitals. ER Rooms and waiting rooms have charity notification notices posted intheir areas. Group A-Facility 3 -- INOVA FAIR OAKS HOSPITAL Part V, Section B, line 16i: Financial Aid Brochures explaining the charity policy are available through out the Hospitals. ER Rooms and waiting rooms have charity notification notices posted in their areas and on Inova's website. Group A-Facility 4 -- INOVA MOUNT VERNON HOSPITAL Part V, Section B, line 5: For IMVH:The hospital interviewed 33 key informants, including external stakeholders (those who represented the broad interests in the community) and internal Inova staff. The interviews were guided by a structured interview guide, and interviewees were encouraged to identify and discuss a wide range of current and emerging issues affecting community health. The hospital also sought input from the public regarding the health of the community through an online survey publicized through mailers and flyers. A detailed listing of the community stakeholders who provided community input are included in the Appendix of the CHNA. Group A-Facility 4 -- INOVA MOUNT VERNON HOSPITAL Part V, Section B, line 6a: Inova Loudoun HospitalInova Mt. Vernon HospitalInova Fair Oaks HospitalInova Alexandria Hospital Group A-Facility 4 -- INOVA MOUNT VERNON HOSPITAL Part V, Section B, line 11: In the CHNA report conducted in 2013, Inova Mount Vernon Hospital identified the following significant community health needs: access to health and human services, chronic disease, dental health, health behaviors, maternal and child health, mental health, morbidity, the physical environment and social and economic factors.As described in the Implementation Strategy adopted by the Board, Inova Mount Vernon Hospital indicated that it would address many but not all of the identified needs. The hospital indicated it would not address certain elements that are beyond the scope of the medical campus or are outside of the hospital's expertise including disparities in mortality, poor air quality, or basic needs insecurity. The hospital also indicated that it would not address other elements that are also important but are being addressed by others, including high rates of cancer incidence and disparities in cancer mortality, insufficient case/care management for seniors, disparities in chronic liver disease, unsafe sex and teen pregnancy and high rates of communicable diseases. Since the 2013 CHNA was conducted, Inova Mount Vernon Hospital has addressed all of the significant needs as described in this Implementation Strategy. These needs were addressed by initiatives including the following: providing in-kind and financial support for community organizations seeking to improve community health and meet social services needs, participating actively in community coalitions and on boards, operating the Inova Transitional Care Management Program and Discharge clinics for low-income patients without a medical home, operating InovaCares clinics for Medicaid and uninsured patients, the Inova PACE program, increasing visits for uninsured patients to Inova-affiliated specialists, expanding health promotion and education programs particularly to reduce the prevalence of diet and exercise-related health problems, increasing investment in Inova's SNAP Double Dollars Program which enhances access to healthy food, and increasing services provided by the Inova Juniper Program which is Northern Virginia's largest provider of services for HIV/AIDS patients.Some changes were made to specific programs in 2014 to enhance program impacts. For example, Congregational Health Partnership concluded in 2014 and in its place Inova is working with the Wesley Theological Seminary's Heal the Sick program. This collaboration between the hospital system, faith community and surrounding neighborhoods will improve health in a more sustainable fashion. Additionally, Inova planned to explore a new location in the Merrifield area for a local FQHC. Because Virginia did not expand Medicaid, this new clinic was not built. Instead, Inova has helped to support a new location for Fairfax County's Community Health Care Network in this area, and is co-locating mental health services utilized by the same patient population. While not identified for expansion of services in the 2013 CHNA, Inova continues to serve the community through many ongoing programs, including the provision of culturally competent and linguistically appropriate services; prevention, education and support through the Inova Mount Vernon Cancer Center; alcohol and substance abuse treatment at the Inova Comprehensive Addiction treatment Services; Medicaid managed care plans through INTotal Health; and comprehensive mental health services for children and young adults at the Inova Kellar Center. Group A-Facility 4 -- INOVA MOUNT VERNON HOSPITAL Part V, Section B, line 13h: CALCULATE FAMILY SIZE Group A-Facility 4 -- INOVA MOUNT VERNON HOSPITAL Part V, Section B, line 15e: Financial Aid Brochures explaining the charity policy are available through out the Hospitals. ER Rooms and waiting rooms have charity notification notices posted intheir areas. Group A-Facility 4 -- INOVA MOUNT VERNON HOSPITAL Part V, Section B, line 16i: Financial Aid Brochures explaining the charity policy are available through out the Hospitals. ER Rooms and waiting rooms have charity notification notices posted in their areas and on Inova's website. 30 EMERGENCY CARE CENTER OF FAIRFAX 4315 CHAIN BRIDGE ROAD FAIRFAX VA 22030 EMERGENCY ROOM NORTHERN VIRGINIA SURGERY CENTER LLC 3620 JOSEPH SIEWICK DRIVE FAIRFAX VA 22033 OUTPATIENT SURGERY FRANCONIA SPRINGFIELD SURGERY CENTER LLC 6355 WALKER LANE SUITE 200 ALEXANDRIA VA 22310 OUTPATIENT SURGERY INOVA RESTON MRI CENTER LLC 2722 MERRILLE DRIVE SUITE 230 FAIRFAX VA 22031 MRI CENTER EMERGENCY CARE CENTER OF RESTON 11901 BARON CAMERON AVENUE RESTON VA 20190 EMERGENCY ROOM ASSISTED LIVING AT FAIR OAKS 3750 JOSEPH SIEWICK DRIVE FAIRFAX VA 22033 ASSISTED LIVING ASSISTED LIVING AT MCLEAN 8315 TURNING LEAF MCLEAN VA 22102 ASSISTED LIVING ASSISTED LIVING AT RESTON TOWN CENTER 1778 FOUNTAIN DRIVE RESTON VA 20190 ASSISTED LIVING ASSISTED LIVING AT MT VERNON 8033 HOLLAND ROAD ALEXANDRIA VA 22306 ASSISTED LIVING KELLAR 11204 WAPLES MILL ROAD FAIRFAX VA 22030 BEHAVIORAL SERVICES INSTITUTE OF RESEARCH AND EDUCATION 3300 GALLOWS ROAD FALLS CHURCH VA 22042 RESEARCH FACILITY ASSISTED LIVING AT GEORGE MASON 4300 CHAIN BRIDGE ROAD FAIRFAX VA 22030 ASSISTED LIVING POTOMAC RADIATION ONCOLOGY 2296 OPITZ BLVD WOODBRIDGE VA 22191 RADIATION ONCOLOGY INOVA URGENT CARE CENTER - DULLES SOUTH 24801 PINEBROOK ROAD SUITE 110 CHANTILLY VA 20152 URGENT CARE INOVA URGENT CARE CENTER - VIENNA 100 MAPLE AVENUE EAST VIENNA VA 22180 URGENT CARE INOVA URGENT CARE CENTER - CENTREVILLE 6201 CENTREVILLE ROAD SUITE 200 CENTREVILLE VA 20121 URGENT CARE INOVA URGENT CARE CENTER - BALLSTON 1005 NORTH GLEBE ROAD SUITE 160 ARLINGTON VA 22201 URGENT CARE INOVA PHYSICAL THERAPY CENTER-WOODBRIDGE 14605 POTOMAC BRANCH DRIVE SUITE 210 WOODBRIDGE VA 22191 REHABILITATION INOVA PHYSICAL THERAPY CENTER - CENTREVI 6201 CENTREVILLE ROAD SUITE 500 CENTREVILLE VA 20121 REHABILITATION INOVA PHYSICAL THERAPY CTR - SPRINGFIELD 8348 TRAFORD LANE SUITE 100 SPRINGFIELD VA 22152 REHABILITATION INOVA PHYSICAL THERAPY CENTER - VIENNA 8320 OLD COURTHOUSE ROAD SUITE 410 VIENNA VA 22182 REHABILITATION INOVA URGENT CARE CENTER - PURCELLVILLE 205 HIRST ROAD SUITE 101 PURCELLVILLE VA 20132 URGENT CARE INOVA PHYSICAL THERAPY CENTER - ASHBURN 20905 PROFESSIONAL PLAZA SUITE 110 ASHBURN VA 20147 REHABILITATION INOVA PHYSICAL THERAPY CENTER- MT VERNON 8101 HINSON FARM ROAD SUITE 401 ALEXANDRIA VA 22306 REHABILITATION INOVA PHYSICAL THERAPY CENTER - FAIROAKS 3620 JOSEPH SIEWICK DRIVE SUITE 101 FAIRFAX VA 22033 REHABILITATION INOVA PHYSICAL THERAPY CENTER - DULLES 24801 PINEBROOK ROAD SUITE 200 CHANTILLY VA 20152 REHABILITATION INOVA AMBULATORY SURGERY CENTER AT LORTO 9321 SANGER STREET LORTON VA 22079 OUTPATIENT SURGERY INOVA PHYSICAL THERAPY CENTER - BALLSTON 1005 NORTH GLEBE ROAD SUITE 400 ARLINGTON VA 22201 REHABILITATION CATS 3300 GALLOWS ROAD FALLS CHURCH VA 22042 BEHAVIORAL SERVICES WOODBURN SURGERY CENTER 3289 WOODBURN ROAD FALLS CHURCH VA 22003 OUTPATIENT SURGERY Part I, Line 6a: THE COMMUNITY BENEFIT REPORT IS INCLUDED IN THE CONSOLIDATED INOVA HEALTH SYSTEM REPORT TO THE COMMUNITY ON INOVA.ORG WEBSITE. Part I, Line 7: Cost to charge ratio method is used based on table 2 in the instructions. Total operating expense is divided by Total Gross Revenue to arrive at the cost to charge ratio. Part I, Line 7g: Cost of Physician Clinic is $4,059,905. Part I, Line 7, Column (f): The Bad Debt expense included on Form 990, Part IX, Line 25, Column (A), but subtracted for purposes of calculating the percentage in this column is $ 111,942,609. Part II, Community Building Activities: Inova's Office of Sustainability provided community building support focused on environmental improvements. Environmental Mission Statement: Inova Health System is committed to establishing an environmental program that is saferand healthier for our patients, employees, and the community.Community Building Environmental Improvements Waste ManagementInova has been focused on waste reduction strategies including recycling and segregation since 2008. Throughout the hospitals there is a single stream recycling process and there are focused efforts on reducing regulated medical waste. In 2014, Inova launched a medical donation program and was able to provide 8,000 lbs of material for medical donation. During this same period Inova recycled over 2.6 million pounds of waste and reduced close to 500,000 lbs (year over year) of regulated medical waste through segregation efforts. Electronic waste recycling: Each year, Inova recycles over 100,000 pounds of electronics via certified electronics recyclers, responsibly disposing of components containing toxins and other harmful chemicalsSpecialized areas recycling (ORs, kitchens): Inova has implemented specialized recycling programs to capture specific materials in areas such as operating rooms and construction sites.EnergyDuring 2014 Inova was very focused on energy reduction by developing a strategic energy Management Plan. Inova has also developed a 5 year energy reduction plan with targets on green house gas reductions. Inova Mount Vernon went through a process of sub-metering the entire campus as a pilot project which will be rolled out across the entire system in 2015.Throughout 2014, Inova replaced 5 chillers at Inova Fairfax and Inova Mount Vernon hospitals to increase efficiency and reduce energy use. Throughout the system, many air handling units were replaced, as well as burners and controls for boilers and variable frequency drives that were replaced on cooling towers. A lighting audit was done across all hospitals with a goal of lighting replacement projects in 2015. Work was done to retro-commission Inova's building management systems (BMS). A fine tuned BMS will allow staff to better regulate energy use. All of these efforts to increase efficiency and resilience reduce Inova's greenhouse gases, carbon footprint and impact on community health.WaterIntegrated green technologies: motion sensor faucets, low-flow restroom fixturesIncorporated native plants and low-impact irrigation systems for landscapingBuildingsContinued LEED construction on Inova Women and Children's Building (IFMC)Developed interior design standards including the use of the Healthier Hospitals Initiative guideline with a focus on healthier interiorsTransportationPartnered with Fairfax County Department of Transportation to promote alternative commute options for Inova employees; programs such as Employee Commuter Shuttle, reserved parking for carpools/vanpools/hybrids, bike racks, and a pre-tax commuter benefits program help Inova reduce air pollution and traffic congestion in local communitiesFoodProvided a pilot Community Supported Agriculture (CSA) program to Inova Fairfax Hospital and Inova System Office employees, providing direct support to a local farmer and bringing fresh, healthy, seasonal foods to our employeesPromoted Sustainable Foods, Healthy Lives Cookbook and free Local Ingredients Guide to educate community around issues of health, wellness, and food; all proceeds from the cookbook go directly to Inova's Double Dollars SNAP Enhancement Program, which matches the first $10 of SNAP benefits spent at select local farmers' marketsSponsor pf the Northern Virginia Chapter of Buy Fresh, Buy Local, a nationally recognized program that is dedicated to reintroducing Americans to their food - the seeds it grows from, the farmers who produce it, and the routes that carry it from the fields to their tables. CommunityDistributed over 500 native tree seedlings to be planted within the local community in 2014 in support of Earth DayMentored peer organizations locally and nationally on sustainability efforts, helping them create safer environments for their own patients, employees, and communities Part III, Line 4: BAD DEBT FOOTNOTE FROM INOVA HEALTH SYSTEM CONSOLIDATED FINANCIAL STATEMENTSPatient accounts receivable are reduced by an allowance for doubtful accounts. In evaluating the collectability of accounts receivable, IHS analyzes its past history and identifies trends for each of its major payer sources of revenue to estimate the appropriate allowance for doubtful accounts and provision for bad debts. Management regularly reviews data about these major payer sources of revenue in evaluating the sufficiency of the allowance for doubtful accounts. For receivables associated with services provided to patients who have third-party coverage, IHS analyzes contractually due amounts and provides an allowance for doubtful accounts and a provision for bad debts, if necessary. For receivables associated with self pay patients (which includes both patients without insurance and patients with deductible and copayment balances due for which third-party coverage exists for part of the bill), IHS records a provision for bad debts in the period of service on the basis of its past experience. The difference between the standard rates (or discounted rates if negotiated) and the amounts actually collected after all reasonable collection efforts have been exhausted is charged off against the allowance for doubtful accounts.All operating entities of IHS treat emergency patients regardless of their ability to pay. Non-emergency medically necessary care is provided virtually without restriction at all IHS tax-exempt operating entities. A patient is classified as a charity patient based upon established IHS policies that consider patient income levels and available assets. Since IHS does not pursue collection of amounts that qualify as charity care, they are deducted from gross revenue. The provision for bad debts includes unpaid accounts of patients who fail to provide required income and asset documentation to IHS. Guidelines used by IHS in determining charity care may differ from guidelines used by certain state or federal agencies.Costing MethodologyActual bad debt expense is multiplied by the cost to charge ratio used in computing charity care expense in Part I.The are no estimated amounts for bad debt expense attributable to patients under the organization's charity care policy. Part III, Line 8: The organization does not treat any Medicare shortfall as community benefit. The amounts are taken directly from the Medicare Cost Reports as filed using a cost to charge ratio method. Part III, Line 9b: Inova Health System strives to comply with the guidelines established by the American Hospital Association (AHA) and the International Code of Ethics and Professional Responsibility (ACA) which require members to engage in honorable, ethical and professional conduct of character not likely to deceive, defraud or harm the public.The policy of Inova Health System is to take legal action, only if there is evidence that the patient or responsible party has income and/or assets in excess of the levels suggested in the financial assistance policy; the patient has failed to provide the information needed to determine eligibility for financial assistance; or the patient is no longer meeting his obligations under an agreed-upon payment plan and has not informed the collections office of a change in financial condition.Staffs who work closely with patients, including those involved in billing and collection, are educated about hospital billing, financial assistance and collection policies and practices.Agencies acting on behalf of Inova Health System may not garnish wages or freeze bank accounts as a means of collecting unpaid hospital bills. Agencies may file liens only against estates. The foreclosure or forced sale of a patient's primary residence to pay an outstanding hospital bill is prohibited. It is not the policy of Inova Health System to file liens related to Medicare, Medicaid, MediCredit FFA or charity accounts. Part VI, Line 2: Inova Health System (IHS) completed a Community Health Needs Assessment (CHNA) to identify priority health status and access issues for particular geographic areas and populations by focusing on the following questions: Who in the community is most vulnerable in terms of health status or access to care?What are the unique health status and/or access needs for these populations?Where do these people live in the community? Why are these problems present?Inova's CHNA considers multiple data sources, including secondary data (regarding demographics, health status indicators, and measures of health care access), assessments prepared by other organizations in recent years, and primary data derived from a community survey and from interviews with persons who represent the broad interests of the community, including those with expertise in public health.The following topics and data are assessed in Inova's CHNA report:Demographics, e.g., numbers and locations of vulnerable people;Economic issues, e.g., poverty and unemployment rates, and impacts of state or local budget changes;Community issues, e.g., homelessness, housing, environmental concerns, crime, and availability of social services;Health status indicators, e.g. morbidity rates for various diseases and conditions, and mortality rates for leading causes of death;Health access indicators, e.g., uninsurance rates, discharges for ambulatory care sensitive conditions (ACSC), and use of emergency departments for non-emergent care;Health disparities indicators; andAvailability of healthcare facilities and resources. The assessment identifies a prioritized list of community health needs.As a result of this work and previous work Inova's programs expanded to address the identified Community Health Priorities. These goals were re-evaluated and updated to align with the Healthy People 2020 goals and outcomes. Inova has moved forward with developing coordinated efforts within the health system to carry out the designed implementation plans of the Community Health Needs Assessment. The Community Affairs Executives assigned to each Hospital are coordinating plans with hospital leaders to assure effective plan implementation in each of the respective communities. Community Affairs Executives are centralized to the system Vice President of Community Affairs and thereby assures system coordinated efforts are centralized and reflective of Inova Health System's work across Northern Virginia.Community health needs assessments are currently in progress across Northern Virginia sponsored by the various Health Departments using the framework of the Mobilizing for Action through Planning and Partnerships (MAPP) process. Inova Health System is a participating member of each MAPP process team in each jurisdiction across Northern Virginia. Inova served on the MAPP team's year-long task force for Arlington County, for which the final report was completed in 2008. In 2008 Inova also participated in the first of four assessments being conducted by Fairfax County, having lnova leaders in pivotal leadership roles in this process. This is an ongoing community-driven planning process that is designed to provide information for improving the community's delivery of the 10 essential public health services. Fairfax County has three other assessments to complete the MAPP process. This process brings together a diverse group of key community stakeholders including local government, human service organizations, schools and universities, healthcare consumers, advocacy groups, hospitals, faith institutions, youth development organizations, economic and philanthropic groups, etc. to identify strengths and weaknesses in the ten essential areas to provide a foundation for community health planning. Inova is participating in the continuing local public health needs assessment in the City of Alexandria as well. The information from all the MAPP health needs assessments from all jurisdictions served by Inova Health System will provide the new baseline for the ongoing three-year community needs assessments and were incorporated into the community needs assessment implementation plans that were finalized in 2013. In addition to participating in the MAPP process and the CHNA, Inova is continually garnering feedback on their existing programs from program participants through monthly and quarterly satisfaction surveys and focus groups, participating in regional and local health related groups such as the Northern Virginia Access to Health Care Consortium, meeting with various cultural and ethnic groups in the community and using internal utilization and outcomes data, review of best practices and regional and national benchmark data and other external sources such as the Metropolitan Washington Council of Governments (COG) demographic data to develop strategic goals for health improvement activities. Collectively, all this information is utilized in assessing community health needs to guide strategic planning efforts. Part VI, Line 3: Inova Health System utilizes a multifaceted approach to educate and inform patients and the public about Inova's charity care policy. Upon admission to any Inova hospital or any visit to outpatient facilities or clinics including emergency departments, Inova has information posted regarding patient rights and responsibilities. In addition, Inova provides information about the charity care program and referrals to meet with Inova financial counselors who assist patients in completing Inova's charity care application. This financial information is reviewed by the Inova Patient Accounts Department with the patient contacted if additional information is required in order to make a determination. The patient is subsequently provided a letter, notifying them as to the level of charity care for which they are qualified (whether it be 100% coverage or a sliding scale payment based upon their income level between 200-300% of the Federal Poverty Level). Inova also has Medicaid eligibility workers on-site in all hospitals, in the InovaCares Clinic for Women and Children (clinic for low income families) and in the community as part of the Partnership for Healthier Kids Access to Care program. Inova partners with schools across the jurisdiction to provide information about state funded health programs for children and contact information to meet with an eligibility worker responsible for enrolling families in state Medicaid programs. These eligibility workers also go out into the community attending community events such as health fairs, faith-based community activities and other family centered community events to proactively meet with families to encourage enrollment in programs for which they are eligible. Inova has a section of the public website dedicated to information about billing and financial coordinators and financial assistance resources. On the site a brochure called "Financial Help for Healthcare Services" can be downloaded and is available in 6 languages to address the needs of the culturally diverse community Inova serves. Part VI, Line 4: Inova Health Care Services (IHCS) is a not-for-profit corporation and a subsidiary of the parent organization, Inova Health System Foundation (Inova). Inova provides healthcare and related services throughout Northern Virginia and the greater metropolitan Washington, D.C. area, including certain contiguous counties of Virginia and Maryland. Northern Virginia is one of the fastest growing urban communities in the United States. With approximately 1,314 square miles, the region is the most densely populated in the Commonwealth of Virginia. Northern Virginia is comprised of several distinct communities, including the cities of Alexandria, Fairfax, Falls Church, Manassas and Manassas Park, and the counties of Arlington, Fairfax, Loudoun, and Prince William. The eastern sections are urbanized with attendant health problems of overcrowding and increasing demand for health services and public programs. Inova Health Care Services' service area is primarily the cities of Alexandria, Fairfax and Falls Church and Fairfax County.The region's population served by IHCS is forecasted to grow 14% over the next decade adding an estimated average of 36,000 persons a year. Population will be spurred by the long-term strength of the region's economy, high rates of in-migration and international immigration. The region's population that is 65 years of age and older is expected to grow 65% over the next 10 years, while the number of children will increase by about 7% during the same time period.Northern Virginia's racial and ethnic diversity is more pronounced than in the rest of the state. With increasing diversity, economically disadvantaged populations and multiple languages, the need for access to culturally appropriate, flexible health care continues to grow. The Northern Virginia geographic region is 45% minority, up from 23% in 1990, while the nation as a whole reflects a 37% minority population (U.S. Census Bureau, 2013). Fairfax County, with more than one million residents, is the largest jurisdiction in Northern Virginia and also has the largest minority population. In Fairfax County in 2015 Asians, Hispanics, and African Americans represented 18.8%, 16.2%, and 9.9% of the county's population, respectively. More than one-quarter of the state's Hispanic population resides in Fairfax County (U.S. Census Bureau, 2013).According to the US Census Bureau Small Area Health Insurance Estimates (SAHIE) in 2013 approximately 12.3% of the total population under the age of 65 (about 122,000 people) in Fairfax County lacked healthcare insurance. Of the people living in Fairfax County whose family incomes are at or below 200% of the federal poverty level, SAHIE estimates that 37.7% (about 57,000 people) were uninsured in 2013.Area residents most likely to be uninsured are those whose family incomes are at or below 200% of the poverty level, young adults (age 18-44), people of racial backgrounds other than White, unemployed individuals, part-time workers, and people who work at companies with fewer than 50 employees. Serving this population poses significant cultural and linguistic challenges, and these uninsured citizens are widely distributed in terms of age, geographic region, and health status. Part VI, Line 5: Inova Health System's investment in the communities across Northern Virginia is evident given the programs providing access to care for low income, uninsured, underinsured and vulnerable populations; promoting health & wellness and increasing health literacy; providing the support and infrastructure for disaster preparedness; and providing programs to support development of our future healthcare workforce to meet the healthcare needs of the communities served. All Inova healthcare facilities have open medical staffs to provide the maximum access to qualified physicians. A Community Board of Trustees provides fiscal and quality oversight for Inova Health Care Services' facilities to ensure the vision and mission of the organization is achieved.Access to Care ProgramsInova's Population Health Division is organized to address the healthcare needs of the community. In addition to the programs already described in the core form program, accomplishments that increase access to healthcare services for the communities served by Inova Health System include the following programs which provide infrastructure support and services focused on vulnerable populations:The Streamlined Eligibility program (SES), launched by the successful implementation of the federally-funded 2001 CAP and 2004 HCAP grants, continues to be funded by Inova. SES provides local safety-net health care providers access to coordinated health care networks to serve the uninsured and underinsured residents of Northern Virginia. A shared database is used to determine a patient's eligibility for services which provides one central intake thereby streamlining and expediting the process. Inova supports the infrastructure and expansion of the program which currently consists of 12 public/private partners serving Fairfax County, City of Alexandria, Loudoun County, Arlington County, and Prince William County. The system currently houses over 285,000 eligibility records of uninsured and Medicaid patients. Inova's Partnership for Healthier Kids (PHK) Access to Care program provides families with comprehensive application and enrollment assistance to connect them with an appropriate and affordable source of health care services. In 2014, PHK assisted over 4,034 children with access to a source of comprehensive health care services such as Medicaid, FAMIS or local safety net providers. Transitional Care Management Inova Transitional Care Management Program (TCM), implemented July 2011 focuses on unmanaged Medicare/ Medicaid and uninsured patients diagnosed with heart failure (CHF), Chronic Obstructive Pulmonary Disease (COPD), pneumonia and diabetes. These diseases account for a high proportion of potentially preventable readmissions. For 30 days after discharge from the hospital or emergency room, TCM case managers and health coaches monitor patients primarily by telephone. They educate patients about their illnesses, ensure they have a follow-up appointment with their primary care physician (PCP), and confirm they have filled any prescriptions and are taking the correct medications. For those patients that do not have a PCP, Inova has developed Discharge and Transitional Clinics in three locations in which patients are provided a follow-up appointment with a nurse practitioner or physician who will follow the patient until the patient is ready to transition to a permanent Medical Home. Inova Home Health Services also partners with TCM in providing home visits to patients identified by the case managers as needing a home visit. In 2014, 5,036 patients were admitted to the TCM Program.Inova Kellar CenterInova Kellar Center is a community based behavioral health center and special education school founded by Inova in 1991 with a gift from Fairfax County residents, Art and Betty Kellar, to address a gap in mental health and substance abuse services for children and adolescents. Currently IKC offers a full continuum of mental health services from outpatient therapies and medication management to after school Intensive Outpatient Programs and a full day Partial Hospitalization Program. The Kellar School, a private special education day school for students with emotional, social and behavioral needs provides academic instruction within a therapeutic environment. The Center provided 77,705 hours of programming, treatment and education to children, adolescents, and families in 2014. Health Promotion and Preventative Care ProgramsNorthern Virginia Healthy Kids' Coalition: Tipping the Scales for Better Health. Inova Health System in partnership with Northern Virginia schools, health departments, and government entities have joined together in a multi-year effort to address the childhood obesity epidemic by working to reverse this trend. Inova Health System sponsors this community-based coalition. Inova Partnering Actively Towards Health (iPATH). The iPATH mission is to provide opportunities for students to engage in health oriented activities within our community, strengthen healthy living amongst adolescents, and expose students to exciting medical careers. The PATHway to Improved Health program is a ten-week program designed to engage selected student leaders that will champion health awareness activities in their schools and communities, empower students to partner with health professionals to assist Inova and their school in developing a new health initiative, and serve as a health ambassador to their families to help achieve the goal of improving the health of the community one family at a time. Congregational Health Partnership (CHP) has resourced and facilitated wellness of spirit, mind, and body through multi-faith communities in multi ethnic groups since 1999. CHP's vision is to strengthen the connection between faith communities and health with the goal of making systemic changes for the improvement of health by focusing on education and prevention. Health Literacy and Health Equity ProgramsThe Office of Health Equity (OHE) identifies and addresses health disparities in Northern Virginia through internal and community initiatives. The department is dedicated to the elimination of disparities in the community through community partnership, diversity and cultural competence education, and provision of language services. In support of patient safety and satisfaction, language interpretation and translation services are provided at every Inova facility, to facilitate communication with the 14 percent of Inova's patient population who are limited English proficient (LEP). Medical Interpretation in over 150 languages is provided by on-site medical interpreters and telephonic interpreters. In 2014, the OHE delivered 50,677 hours of interpreter services and 13,580 hours of Sign Language interpretation across Inova facilities. Over 360 vital documents were translated into Inova's top languages. Part VI, Line 6: Organization is part of Inova Health System included in description under Line 5. X X X X X X 1 1 0 0 0 0 0 0 0 JKNOX SINGLETON PRESIDENT 0 1200836 0 3731324 0 317092 0 732656 0 18889 0 6000797 0 3450316 RICHARD MAGENHEIMER TREASURER 0 667029 0 107932 0 138546 0 746708 0 17548 0 1677763 0 0 JOHN GAUL ASST SECRETARY 424310 0 37796 0 21776 0 123448 0 21477 0 628807 0 0 0 MARK STAUDER PRESIDENT, COO 0 962861 0 658127 0 49601 0 704925 0 21350 0 2396864 0 0 PATRICK CHRISTIANSEN EVP CEO IFH 0 581622 0 52123 0 37813 0 148846 0 17356 0 837760 0 0 JOHN NIEDERHUBER CEO ITMI & EVP IHS 0 983374 0 665903 0 41552 0 38600 0 12526 0 1741955 0 0 MARSHALL RUFFIN EVP CTO 0 600883 0 73280 0 174379 0 106845 0 16546 0 971933 0 88408 LORING FLINT EVP CHIEF MEDICAL OFFICER 0 588245 0 89864 0 37813 0 168985 0 26593 0 911500 0 0 SALLY PAULL EVP CHIEF HR OFFICER 0 106006 0 75000 0 46173 0 10154 0 13843 0 251176 0 0 GEOFFREY BROWN SVP CIO 229849 0 32598 0 73199 0 28924 0 17213 0 381783 0 52165 0 SUSAN CARROLL CEO IAH 243252 0 23220 0 20071 0 47961 0 3350 0 337854 0 60541 0 JOHN FITZGERALD CEO IFOH 389198 0 22404 0 273906 0 32105 0 18134 0 735747 0 156146 0 JAMES SANTRY SVP BUS DEV & MANAGED CARE 273683 0 33322 0 145500 0 32763 0 25504 0 510772 0 44480 0 CHRISTINE CANDIO CEO IAH 347601 0 7965 0 363688 0 56100 0 18080 0 793434 0 248041 0 JOHN HAMILTON PHYSICIAN 677111 0 403710 0 808 0 50492 0 20935 0 1153056 0 0 0 MARK THEISS PHYSICIAN 539949 0 210062 0 4191 0 56100 0 16329 0 826631 0 0 0 CARY SCHWARTZBACH PHYSICIAN 490115 0 238745 0 1935 0 7800 0 23958 0 762553 0 0 0 JAMES ECKLUND PHYSICIAN 991334 0 62800 0 1242 0 56100 0 23908 0 1135384 0 0 0 NILESH VYAS PHYSICIAN 580119 0 228253 0 399 0 50600 0 7628 0 866999 0 0 0 JAMES KIM FORMER AVP DEPUTY GENERAL 208360 0 13639 0 55218 0 39487 0 21580 0 338284 0 34277 0 HPATRICK WALTERS FORMER SVP STRATEGIC PLANN 0 413414 0 16420 0 101492 0 56100 0 15188 0 602614 0 0 MARK RUNYON SVP FINANCE 355180 0 33375 0 114448 0 80495 0 22588 0 606086 0 42534 0 MAUREEN SWICK SVP COO IFH AND CNE IHS 351208 0 21638 0 28465 0 118727 0 23416 0 543454 0 0 0 JOSEPH ROCHE FORMER EXEC DIR EAP 154708 0 11615 0 887 0 32809 0 22418 0 222437 0 0 0 TODD LOCKCUFF FORMER AVP ASSOC ADMIN CFO 208766 0 25855 0 76153 0 27849 0 2349 0 340972 0 50525 0 HUGO AGUAS FORMER AVP HR ASSOC ADMIN 190290 0 15142 0 31635 0 43699 0 11545 0 292311 0 12114 0 MARY DIXON FORMER AVP CNO 181287 0 4031 0 29358 0 42386 0 1458 0 258520 0 7701 0 PAMELA MCVEY FORMER DIR NURSING RESOURC 142473 0 2245 0 748 0 9432 0 7015 0 161913 0 0 0 Part I, Lines 4a-b Severance Payments Christine Candio $37,738 SERP Plan Payments Hugo Aguas $17,920 Geoffrey Brown $55,786 Christine Candio $296,413 Susan Carroll $84,979 Mary Dixon $15,837 John Fitzgerald $234,411 James Kim $45,021 Todd Lockcuff $65,858 Richard Magenheimer $98,945 Marshall Ruffin $136,566 Mark Runyon $91,725 James Santry $123,155 Knox Singleton $237,137 Patrick Walters $61,891 The Supplemental Executive Retirement plan (SERP Plan) is a nonqualified retirement plan. Employees eligible to participate are Executive Directors, Assistant Vice Presidents, Vice Presidents, Senior Vice Presidents, Executive Vice Presidents, CFO, COO, and CEO. Each year, a certain percentage of each participant's base salary is contributed to the SERP Plan. This amount ranges from 5% to 20%, depending on position. After three years of continuous participation, participants vest in 50% of their balance at that time and are paid out the vested balance as a taxable event. After a total of six years participation and after attaining age 45, participants are 100% vested and are paid out their remaining balance as a taxable event. Vesting then reverts to a 3 year rolling schedule until year 12. Thereafter, the annual contribution is paid out to the participant each year as a taxable event. A Industrial Development Authority of Fairfax County Virginia 911920228 303823FM5 2005-05-12 124000000 See Part VI 0 0 0 B Industrial Development Authority of Fairfax County Virginia 911920228 303823FR4 2005-05-12 99400000 See Part VI 0 0 0 C Industrial Development Authority of Fairfax County Virginia 911920228 303823GL6 2009-04-16 350414313 See Part VI 0 0 0 D Industrial Development Authority of Fairfax County Virginia 911920228 303823JH2 2009-12-15 73433655 See Part VI 0 0 0 A 14270000 130441544 3604217 367125 126470203 2007 0 0 1 1 B 80790000 99400000 107241 294292 98998467 0 1 1 1 C 94070000 350414313 4384313 346030000 1 0 1 1 D 16545000 73433655 660539 72773116 1 0 1 1 A 0 1 1 1 1 1 0.01100 0.01100 0 0 1 B 0 0 0 0 0 0 1 C 0 1 0 1 1 0.00800 0.00600 0.01400 0 0 1 D 0 0 0 0 0 0 1 A 0 0 0 1 1 1 Morgan Stanley Capital Services 30.000000000000 0 1 0 0 1 B 0 0 0 1 1 0 0 0 1 C 0 0 0 1 0 0 0 0 1 D 0 0 1 0 0 0 0 0 1 A 1 B 1 C 1 D 1 PART I, COLUMN E, ISSUE PRICE Part I, column E, 2005A bonds 2005A, B, D, E bond issue price per form 8038 476,700,000 2005B, D, E bonds refinanced by subsequent issues (352,700,000) Remaining 2005A issue price 124,000,000 Part I, column E, 2009A bonds 2009AB bond issue price per form 8038 540,414,313 2009B bonds refinanced by subsequent issues (190,000,000) Remaining 2009A issue price 350,414,313 PART I, COLUMN F, DESCRIPTION OF PURPOSE Bond A 1) Renovate and expand certain portions of Inova Alexandria Hospital (IAH), Inova Fairfax Hospital (IFH), Inova Fair Oaks Hospital (IFOH); 2) Acquire certain capital equipment for use in or in connection with IAH, IFH, IFOH, and Inova Mount Vernon Hospital (IMVH) and renovate any space necessary or incidental to the installation of such equipment; 3) Pay issuance costs for Series 2005 A and B; 4) Refund prior bonds issued by the Industrial Development Authority of Loudoun County, Virginia Hospital Revenue Bonds, Series 1995 issued 10/26/1995 and 2002A issued 6/27/2002, and pay issuance costs of Series 2005D; 5) Refund prior bonds Series 2001A, B, C, and D issued 12/11/2001 Bond B 1) Refund prior bonds -1996A issued 4/18/1996; 2) Pay issuance costs of series 2005C bonds Bond C 1) Refund prior bonds - 2008ABC issued 4/17/08; 2) Pay issuance costs of series 2009A and B bonds; 3) Finance the costs of acquisition, construction, renovation, installation and equipping of the 2009 Projects Bond D 1) Refund prior bonds - 1998A issued 3/10/98; 2) Pay issuance costs of series 2009C bonds Bond E 1) Refund prior bonds - 2009B issued 4/16/2009; 2) Pay issuance costs of series 2010A bonds Bond F 1) Refund prior bonds - 1988A-D issued 8/4/1988; 2000 issued 3/23/2000; 2005A & 2005C issued 5/12/2005 Bond G 1) Construct, renovate and expand certain portions of IFH, IMVH and IFOH Bond H 1) Construct, renovate and expand certain portions of IFH, IMVH and IFOH ; 2) refund a portion of 2010A bonds issued 3/8/10 Bond I 1) Advance refund a portion of 2009A bonds issued 4/16/2009 Bond J 1) Refund prior bonds - 1988A-D issued 8/4/1988; 2000 issued 3/23/2000; 2005A and 2005C issued 5/12/2005 Bond K 1) Construct, renovate and expand certain portions of IFH, IMVH and IFOH PART II, LINE 3, PROCEEDS Part II, line 3. 2005A bonds Issue price 124,000,000 Earnings 6,441,544 Total proceeds 130,441,544 Part II, line 3. 2010A bonds Issue price 190,000,000 Earnings 1,511,888 Transferred proceeds 164,510,779 Total proceeds 356,022,667 Part II, line 3. 2012AB bonds Issue price 382,960,937 Earnings 2,157,040 Total proceeds 385,117,977 Part II, line 3. 2012C bonds Issue price 145,000,000 Earnings 184,794 Total proceeds 145,184,794 Part II, line 3. 2014Abonds Issue price 209,030,800 Earnings (34,243) Total proceeds 208,996,557 PART IV, LINE 2C, DATE OF REBATE COMPUTATION Part 4, line 2C. 2005A 5/12/2010 Part 4, line 2C. 2005C 8/15/2006 Part 4, line 2C. 2009A 4/16/2014 A Industrial Development Authority of Fairfax County Virginia 911920228 303823JJ8 2010-03-08 190000000 See Part VI 0 0 0 B Industrial Development Authority of Fairfax County Virginia 911920228 2011-07-29 54490000 See Part VI 0 0 0 C Industrial Development Authority of Fairfax County Virginia 911920228 303823KE7 2012-08-23 382960937 See Part VI 0 0 0 D Industrial Development Authority of Fairfax County Virginia 911920228 303823KN7 2012-08-23 145000000 See Part VI 0 0 0 A 95000000 356022667 166022667 190000000 2012 1 0 1 1 B 30272222 54490000 54490000 1 0 1 1 C 8120000 385117977 353740150 31377827 0 0 0 1 D 2615000 145184794 50184794 95000000 1 0 0 1 A 0 1 0 1 1 0.00800 0.00600 0.01400 0 0 1 B 0 1 1 1 1 1 0.01100 0.01100 0 0 1 C 0 0 0 0 0 0 1 D 0 1 0 1 1 0.00800 0.00600 0.01400 0 0 1 A 0 1 0 0 1 0 0 0 1 B 0 0 1 0 0 0 0 0 1 C 0 1 0 0 0 0 0 0 1 D 0 1 0 0 1 0 0 0 1 A 1 B 1 C 1 D 1 A Industrial Development Authority of Fairfax County Virginia 911920228 303823KS6 2012-12-20 80991559 See Part VI 0 0 0 B Industrial Development Authority of Fairfax County Virginia 911920228 2013-12-04 79530000 See Part VI 0 0 0 C Industrial Development Authority of Fairfax County Virginia 911920228 303823KX5 2014-12-17 209030800 See Part VI 0 0 0 A 80991559 80991559 0 1 1 1 B 79530000 79530000 1 0 1 1 C 208996557 208996557 0 0 0 1 A 0 1 0 1 1 0.00800 0.00600 0.01400 0 0 1 B 0 1 1 1 1 1 0.01100 0.01100 0 0 1 C 0 0 0 0 0 0 1 A 0 0 1 0 0 0 0 0 1 B 0 0 1 0 0 0 0 0 1 C 0 1 0 0 0 0 0 0 1 A 1 B 1 C 1 Hugo Davalos MD Trustee 41876 Family member employed as physical therapist at Inova Alexandria Hospital. Services provided at arm's length and customary rates. 0 Sarota Gopal MD Trustee 115000 Fees for physician services. Services provided at arm's length and customary rates. 0 Knox Singleton Officer/Major Donor 14909 Leah Singleton, daughter of Knox Singleton, was employed at Inova Fair Oaks Hospital. Services provided at arm's length and customary rates. 0 Knox Singleton Officer/Major Donor 29647 Leslie Singleton, daughter of Knox Singleton, was employed at Inova Informatics. Services provided at arm's length and customary rates. 0 PART III, LINE 4A The Inova Center for Rehabilitation, located on the Inova Mount Vernon campus is accredited by the Commission on Accreditation and Rehabilitation Facilities (CARF) and provides comprehensive inpatient and outpatient medical rehabilitation services to patients with severe head injuries, spinal cord injuries, strokes, multiple sclerosis, and other orthopedic and neurological disabilities. These services are staffed by an interdisciplinary team representing psychiatry, psychology, vocational counseling, physical therapy, occupational therapy, and nursing with treatment tailored to meet the specific needs of each patient. ACCESS of Fairfax, and ACCESS of Reston are 24-hour, free standing emergency centers located in Fairfax City, and Reston, Virginia, respectively. During 2014, ACCESS of Fairfax provided 16,395 emergency room visits and ACCESS of Reston reported 10,674 emergency room visits. IHCS has recently invested significant capital in all three hospital facilities. IHCS has an $850 million facility development program at the Inova Fairfax Hospital campus which was initiated in 2010 and will continue over the next three years. This program will expand existing services, renovate the existing patient tower and provide for a new and separate women's hospital facility. The Inova Mount Vernon Hospital will be investing in a $44 million expansion to create private rooms and upgrade facilities. Long Term Care Services Assisted Living Facilities IHCS's assisted living facilities provide care and services for adults who need assistance with activities of daily living and 24 hour oversight. They provide accommodations with 402 units. Each community has specialized memory care units and programs. A nursing staff is on-site 24 hours a day. IHCS maintains four assisted living facilities in Fairfax, Reston, Fair Oaks, and Mt. Vernon, Virginia. In addition, IHCS owns a 60% interest in an assisted living joint venture in McLean, Virginia. IHCS operates five assisted living facilities across Fairfax County with total assisted living days in 2014 of 156,985. InovaCares for Seniors (PACE) InovaCares for Seniors , a Program of All-inclusive Care for the Elderly (PACE) is the first program of its kind in Northern Virginia. PACE is an evidenced-based model of care that delivers high quality, cost effective care that includes medical, dental, vision and social activities. The program is built on the foundation that seniors with complex health care needs should be able to live in the comfort of their home environment for as long as possible. In 2014, PACE had an enrollment of 78 participants and had $2.3 million in unreimbursed expenses. Physical Therapy Services Inova Physical Therapy Centers IHCS promotes and conducts specific research and educational activities related to the care of the sick and injured. In 2014, outpatient visits totaled 94,535 with services offered at ten outpatient centers located throughout Northern Virginia. Areas of specialty include: Physical Therapy (PT), Occupational Therapy (OT), and Speech Language Therapy (SLT). Urgent Care Centers Inova Urgent Care Centers IHCS mission includes serving the community as a not-for-profit organization through the provision of urgent medical care. In 2014, outpatient visits totaled 93,671 with services being provided seven days a week with no appointment necessary at four locations, and Monday through Friday at our seven other locations. The centers provide services for medical conditions that require prompt attention but do not pose an immediate or serious threat to life. Treatment is provided for such ailments as sore throats, ear infections or minor cuts and bruises. Services offered also include treatment for work-related injuries and worker's compensation cases, physical exams including camp, sport, school, pre-employment, immigration medical examinations and travel medicine. Laboratory tests, X-rays, audiometry & vision screening, alcohol & drug testing and flu shots are provided on-site. The centers are staffed by board-certified/board-eligible physicians licensed in Virginia. A physician, nurse, and radiology technologist are on duty at each center during hours of operation. Employee Assistance Programs Inova Employee Assistance (EAP) is part of IHCS providing counseling, work life services and resources to help improve the overall health and well being of the employees of Inova Health System and the employer communities served by Inova and its affiliates. EAP was organized to promote health through referral to a wide range of behavioral health, financial, legal and other supportive services. In 2014 EAP supported 14,240 Inova employees and approximately 161,931 client company employees with the following services: Confidential Counseling: Short-term counseling services can help find solutions to problems ranging from family or workplace frustrations to alcohol or drug abuse. Financial & Legal Services: Employees and their household members can speak with a financial & legal professional at no charge regarding such issues as retirement planning, debt consolidation, funding a child's college education, mortgage loan options and a variety of other financial concerns. Work Life Referral Services: Work Life consultants help assess needs, pinpoint appropriate resources, and suggest guidelines for evaluating those resources. Consultants can locate resources in a variety of areas, including childcare, adoption, eldercare and convenience services. Behavioral Services IHCS's Behavioral Services are committed to providing intensive, personalized care to help people cope with, and overcome, addictions and emotional problems that prevent them from fully functioning in the community. Comprehensive Addiction Treatment Services (CATS) offers help to adults suffering from alcoholism or other chemical dependencies. CATS provide both inpatient and outpatient treatment services which include: intervention, medically supervised detoxification, rehabilitation and follow-up. In 2014, CATS had 4,507 patient days in its inpatient program and 14,740 patient sessions in its outpatient program. The Kellar Center is a comprehensive, behavioral health treatment center and special education school for children, adolescents and their families. The Kellar Center provides a full continuum of outpatient services for psychiatric disorders, substance use disorders, and behavioral and emotional issues. Services include assessment, psychological testing, educational testing, psychiatric evaluation, medication management, individual, family and group therapy and Intensive In-Home services. For adolescents who require intense mental health interventions, the Center provides an afterschool Intensive Outpatient Program for mental health and co-occurring disorders and a full day Partial Hospitalization Program for adolescents who are in crisis and unable to attend school. The treatment services and programs are provided to children and families regardless of an ability to pay. The Kellar School of Inova Kellar Center provides special education services to children and adolescents who have not been successful in the public school setting and may be at risk for being removed from the community and placed in more restrictive settings. During 2014, the Kellar Center provided 77,705 hours of programming, treatment and education to children, adolescents and families in the community. The total unreimbursed cost for 2014 was approximately $1.6 million dollars. Charity Care All Inova facilities, including the IHCS facilities with the exception of the assisted living facilities, provide charity care in accordance with Inova policies which ensures access to medically necessary care for all individuals. Charity care is defined as free or discounted healthcare services provided to persons who cannot afford to pay. These policies include the following key provisions: 1 Emergency care shall be provided to all persons regardless of their ability to pay. 2. on-emergency medically necessary care, except for certain specialty or referral programs, shall be provided by all hospitals and access facilities to medically indigent patients. "Medically necessary care" refers to inpatient and outpatient services defined as medically necessary by the federal Medicare program. "Medically indigent" is defined as those patients whose income falls at or below 300% of the Federal Poverty Level (FPL). In general, free medically necessary care is provided for patients with incomes falling at or below 200% of the FPL; and discounted care is provided for services rendered to patients with incomes falling between 200% and 300% of the FPL. PART III, LINE 4A Inova Health System utilizes a multifaceted approach to educate and inform patients and the public about Inova's charity care policy. Upon admission to any Inova hospital or any visit to outpatient facilities or clinics including emergency departments, Inova has information posted regarding patient rights and responsibilities. In addition, Inova provides information about the charity care program and referrals to meet with Inova financial counselors who assist patients in completing Inova's charity care application. This financial information is reviewed by the Inova Patient Accounts Department with the patient contacted if additional information is required in order to make a determination. The patient is subsequently provided a letter, notifying them as to the level of charity care for which they are qualified (whether it be 100% coverage or a sliding scale payment based upon their income level between 200-300% of the Federal Poverty Level). In 2014 IHCS's unreimbursed cost of charity care, including free and discounted services, was $88.5 million. Medicaid Established under Title XIX of the Social Security Act, this program provides assistance for the medically indigent, including those who cannot pay for care despite being able to afford other living expenses. Also included under this program are the blind, disabled, pregnant women, very low income parents, children and the elderly. The reimbursement that IHCS facilities receive from the Medicaid program routinely falls below the actual cost of services provided. During 2014, IHCS provided care to Medicaid patients at an unreimbursed cost of $57.9 million. Participation in Governmental Programs for Those Without the Ability to Pay Various government programs provide for the indigent, including Medicaid recipients. These programs provide a percentage of reimbursement for qualifying patients; however, payment is typically below the cost of those services. In addition to federal and state programs, the Inova subsidiaries, including IHCS, work with various County governments and agencies in providing certain free services to those residents the County identifies as most in need. PART III, LINE 4D HealthSource HealthSource serves the community as the premier provider of health education and prevention services. Participants engage in prevention activities, receive quality health education, participate in wellness programs and benefit from care management. As a part of the vision, Healthsource targets the community served by holding programs throughout the region in environments that are familiar to and convenient for the clients. Seminars, classes, health fairs, screenings and immunizations are offered at Inova Health System hospitals, community locations and worksites throughout northern Virginia and the Greater Metropolitan Washington Area. During 2014, HealthSource served 273,680 participants at 4,405 events. Program highlights include: Influenza Vaccination The Inova HealthSource Fight the Flu Program provided 46,134 flu shots at 828 immunization clinics for Inova at community and employer sites as well as for Inova employees and physicians. The Fight the Flu Program provided over 11,397 flu shots for Fairfax County Public Schools at 202 clinics and 2,599 shots at 22 clinics for Fairfax County Government employees. Additional clinics were held at 258 worksites vaccinating 15,197 employees. With Inova foundation funds, free flu shots were provided for 180 low income children and parents at a community fair, as well as, children and teachers at Higher Horizons Head Start Program. The Workplace and Community Programs The Workplace and Community Program served 47,921 participants at 577 events that included biometric screenings, seminars, booths and fit testing. The Care Management Programs provided health coaching in weight management, tobacco cessation, back pain management, fitness, pregnancy and breastfeeding. Team Up - HealthSource offers a healthy, fun, team-oriented challenge program for employers. Team Up programs are multi-week competitions that focus on healthy eating, weight loss or activity, with over 7,270 participants completing one of the competitions in 2014. HealthSource provides the Program Manager for The Prince William County Wellness Program. This program delivers a full range of wellness services and programs for county employees. Programs include new employee-only wellness website, Know Your Numbers, Walking Trail, Better Eating series, Health Fairs and health/prevention awareness campaigns. The Health Education Program HealthSource provided 747 life support classes for 9,632 students at worksites and in the community. Over 2,700 students received advanced life support training Over 35,993 community members were served through 1,322 Childbirth Preparation classes. Community members enjoyed about 213 fitness classes at locations throughout the community. Almost all of the classes were multi-session, usually 8-10 weeks. Over 12,744 people took part in fitness classes during 2014. PART V, LINE 2A, NUMBER OF EMPLOYEES The organization falls under a master pay agent and does not file any payroll returns under its own EIN, however all required returns have been filed on time. Form 990, Part VI, Section B, line 11 The Form 990 is prepared and provided to the Chief Accounting Officer and external tax consultants for initial review. After the review it is given to the CFO of Inova Health System for his review and comment. The Form 990 is presented to the Executive Committee of the Board of Trustees for their review. Upon completion of the Executive Committee review, it is provided to the full Board of Trustees. In this process, the Form 990 has been provided to the Governing Board approximately two weeks prior to the filing of the return. Form 990, Part VI, Section B, line 12c Yes, annually the organization distributes the conflict of interest policy to all directors, officers, trustees, and key employees. The organization requires that each director, officer, trustee, and key employee acknowledge that they have read, understood, and will abide by the policy. Each director, officer, trustee, and key employee is required to complete and submit an annual conflict of interest disclosure. These disclosures are broad and require that the individual list any business relationships or personal relationships with other directors, officers, trustees, and key employees, as well as any relationships with competitors, or current or potential vendors or contractors. Disclosure statements are reviewed by senior management and any potential conflicts are discussed with governing body chairman to ensure that any member who may have a conflict discloses their potential conflict, and is dismissed from related discussions and recused from participation in applicable decisions. Form 990, Part VI, Section B, line 15 The compensation of all senior management positions is evaluated annually in light of each manager's job content, scope and complexity. Compensation levels for Vice Presidents and above are reviewed by an independent external consultant to ensure that remuneration is consistent with the organization's compensation philosophy and objectives and competitive with other large complex health systems. The independent compensation consultant maintains national benchmark compensation databases and surveys and also reviews Forms 990 of comparable healthcare systems to determine market levels of compensation. In addition, the Inova Health System's CEO's compensation is reviewed and approved annually by an independent governing Board. The job requirements and complexity of all other management positions are evaluated annually using nationally recognized third party salary surveys to assure that the compensation for such positions is consistent with external market compensation comparisons. Salary ranges are developed for each management position classification to ensure that the compensation levels for these positions are consistent with the organization's compensation philosophy and objectives and with competitive market comparisons. Compensation for employed physicians is reviewed and approved by the Inova Health System Physician Compensation Committee. The committee is comprised of executive management of the Inova Health System. The Fair Market Value (FMV) compensation is based on four nationally recognized industry physician compensation benchmark surveys (MGMA, AMGA, Sullivan & Cotter, Hay Group). The committee also utilizes independent consultants to provide FMV opinions for positions that are not readily available in the four published benchmark surveys. The consultants' opinions and compensation survey data are presented to the Physician Compensation Committee for review and approval. Form 990, Part VI, Section C, line 18 The Form 1023, 990T and Form 990 are available at the address listed on page 1 of the Form 990 upon request during regular business hours. Form 990, Part VI, Section C, line 19 Inova Health System makes certain information publicly available. Inova's consolidated financial statements are posted on the Electronic Municipal Market Access's (EMMA) website on a quarterly basis. Inova's Form 990s are disclosed on the Guidestar website. Inova's governing documents are not currently publicly available. While the conflict of interest policy is not specifically publicly disclosed, Inova's Code of Conduct is on the public website. Section III of the Code of Conduct describes what can constitute a conflict and requires that potential conflicts be reported to management or the Chief Compliance Officer. The Code also refers to the conflict of interest policy which is available to staff and physicians on Inova's intranet website. Form 990, Part XI, line 9: PARTNERSHIP INCOME -14,532,019. CHANGE IN INVESTMENTS BALANCE -20,451,868. EQUITY IN SUBS 13,396,757. DONATED FUNDS 4,415,831. CAPITAL REIMBURSEMENT 2,176,724. PENSION GAIN -14,027,074. PART XII, LINE 2B AND 2C, AUDITED FINANCIAL STATMENTS The company is part of the Inova Health System, a not-for-profit integrated health care delivery system serving Northern Virginia and surrounding areas. The company's financial statements are consolidated in the Inova Health System consolidated financial statements. Inova Health System is audited on an annual basis by a large "Big Four" independent public accounting firm. In addition, they are responsible for the issuance of a management letter encompassing each member of the consolidated group. The Finance and Audit Committee of the Board of Trustees of Inova Health System is responsible for the oversight of the audit, including the hiring of the audit firm, review and approval of audited financial statements and communication with the external auditors at least twice a year without the presence of internal management. PART XII, LINE 3A, A-133 AUDITT The company is a subsidiary of the Inova Health System (IHS), a not-for-profit integrated health care delivery system serving Northern Virginia and surrounding areas. IHS receives various federal grants. These grants and awards are audited as part of the consolidated Inova Health System A-133 compliance audit. The Inova Health System's federal grants are audited on an annual basis by a large "Big Four" independent public accounting firm and a "Report on Compliance with Requirements Applicable to Each Major Program and on Internal Controls over Compliance in Accordance with OMB Circular A-133" is issued on a consolidated basis. The Finance and Audit Committee of the Board of Trustees of Inova Health System is responsible for the oversight of the A-133 audit, including the hiring of the audit firm, review and approval of audited financial statements and communications with the external auditors at least twice a year without the presence of internal management. 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