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 541071867 INOVA HEALTH SYSTEM FOUNDATION INOV 7032892433 8110 GATEHOUSE ROAD SUITE 400W FALLS CHURCH VA 22042 RICHARD MAGENHEIMER CFO 7032892433 2015-11-09 FRED HUTCHISON P00640420 7037446700 2014 2016-04-25 22:37:26Z J KNOX SINGLETON 8110 GATEHOUSE ROAD SUITE 400W FALLS CHURCH VA 22042 187447944 0 X INOVA.ORG X 1977 VA INOVA HEALTH SYSTEM FOUNDATION (FOUNDATION), A PARENT COMPANY WHICH ALSO SERVES AS A CHARITABLE FOUNDATION, RAISING FUNDS TO SUPPORT INOVA'S TAX-EXEMPT ENTITIES. 19 15 50 400 41505 40505 19317478 9843440 0 0 522314436 140110727 -2839789 3990560 538792125 153944727 6129607 12010314 0 0 3861331 5508612 92220 147250 6371685 15551307 18721028 25634465 36387204 513157660 117557523 3529402780 3896907487 1801132135 2042521088 1728270645 1854386399 X INOVA HEALTH SYSTEM FOUNDATION, THE PARENT COMPANY OF INOVA HEALTH SYSTEM. INOVA HEALTH SYSTEM (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. 0 0 15477315 12010314 INOVA HEALTH SYSTEM FOUNDATION (IHSF), THE PARENT COMPANY OF INOVA HEALTH SYSTEM, IS A NON-STOCK, NOT-FOR-PROFIT CORPORATION EXEMPT FROM FEDERAL INCOME TAXES UNDER THE PROVISIONS OF SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE. INOVA HEALTH SYSTEM (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.SINCE ITS INITIATION BY CITIZEN-VOLUNTEERS IN 1956, INOVA AND ITS AFFILIATES HAVE GROWN TO MEET THE CHANGING NEEDS OF A DIVERSE AND GROWING POPULATION. AS A NOT-FOR-PROFIT ORGANIZATION, INOVA DOES NOT HAVE SHAREHOLDERS. IT IS GOVERNED BY THE PEOPLE IT SERVES: MEMBERS OF THE COMMUNITY. THIS MODEL OF GOVERNANCE HELPS TO ENSURE THAT INOVA MEETS THE DIVERSE HEALTHCARE NEEDS OF THE COMMUNITIES IT SERVES.IN KEEPING WITH INOVA'S COMMUNITY SERVICE MISSION, INOVA AND ITS AFFILIATES PROVIDE A WIDE RANGE OF PROGRAMS AND SERVICES WHICH DIRECTLY BENEFIT THE COMMUNITY THEY SERVE. THESE INCLUDE:PROVIDING THE HIGHEST QUALITY MEDICAL CARE TO ALL MEMBERS OF THE COMMUNITY, REGARDLESS OF THEIR FINANCIAL RESOURCES.PROVIDING FREE AND BELOW COST HEALTH SERVICES TO MEET THE IDENTIFIED NEEDS OF TARGETED COMMUNITY GROUPS, SUCH AS: THE INDIGENT AND ELDERLY; VICTIMS OF CANCER, HEART DISEASE, AND STROKE; PERSONS AFFECTED BY SUBSTANCE ABUSE; HIV-POSITIVE INDIVIDUALS; AND OTHERS. PROVIDING UNCOMPENSATED CARE IN ACCORDANCE WITH INOVA POLICIES WHICH ENSURE 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. INOVA HEALTH SYSTEM IS ONE OF THE LARGEST PROVIDERS OF UNCOMPENSATED CARE IN VIRGINIA. PROVIDING HEALTH EDUCATION AND A VARIETY OF OTHER SERVICES TO THE COMMUNITY.TRAINING HEALTH PROFESSIONALS AND PARTICIPATING IN MEDICAL RESEARCH ACTIVITIES. IHSF IS COMPRISED OF: INOVA HEALTH SYSTEM FOUNDATION (FOUNDATION), A PARENT COMPANY, WHICH ALSO SERVES AS A CHARITABLE FOUNDATION, RAISING FUNDS TO SUPPORT INOVA'S TAX-EXEMPT ENTITIES. THE FOUNDATION OPERATES IN ACCORDANCE WITH INOVA'S ARTICLES OF INCORPORATION, WHICH PROVIDE THAT ALL FUNDS RAISED, EXCEPT FOR THOSE REQUIRED FOR THE OPERATIONS OF THE FOUNDATION, BE DISTRIBUTED OR HELD IN SUPPORT OF THE CHARITABLE OBJECTIVES AND MISSION OF INOVA AND ITS TAX-EXEMPT SUBSIDIARIES. FUNDS RAISED ARE CHANNELED TO THE COMMUNITY IN THE FORM OF EXPANDED MEDICAL AND OTHER COMMUNITY SERVICES. DURING 2014, FOUNDATION FUNDS WERE USED TO SUPPORT INOVA FAIRFAX HOSPITAL'S WOMEN'S AND CHILDREN'S SERVICES AND ITS NEONATOLOGY PROGRAM, THE LIFE WITH CANCER SUPPORT AND EDUCATIONAL PROGRAM, THE FORENSIC ASSESSMENT CONSULTATION TEAM (FACT) PROGRAM, AND MANY OTHER PROGRAMS AND SERVICES. IN ADDITION, DONATED FUNDS WERE USED IN 2014 TO SUPPORT MANY OTHER INOVA PROGRAMS INCLUDING INOVACARES CLINICS FOR WOMEN AND CHILDREN AND THE KELLAR CENTER'S BEHAVIORAL SERVICES PROGRAM.INOVA HEALTH CARE SERVICES (IHCS) IS A NOT-FOR-PROFIT CORPORATION THAT OPERATES HOSPITAL FACILITIES, PROGRAMS, AND OTHER SHARED SERVICE ARRANGEMENTS AND CARRIES ON EDUCATION AND RESEARCH ACTIVITIES. AS OF DECEMBER 31, 2014, IHCS OPERATED FOUR HOSPITALS, HAVING A TOTAL OF 1,570 LICENSED HOSPITAL BEDS IN FAIRFAX COUNTY, VIRGINIA - INOVA FAIRFAX HOSPITAL (FAIRFAX), INOVA MOUNT VERNON HOSPITAL (MOUNT VERNON), INOVA ALEXANDRIA HOSPITAL AND INOVA FAIR OAKS HOSPITAL (FAIR OAKS). EACH OF THESE HOSPITALS PROVIDES GENERAL ACUTE CARE SERVICES, INCLUDING EMERGENCY ROOM FACILITIES, INPATIENT AND OUTPATIENT SERVICES, AND A VARYING NUMBER OF ANCILLARY AND SPECIALIZED SERVICES BASED ON THE NEEDS OF THE COMMUNITY. IHCS AND ITS SUBSIDIARIES PROVIDE LONG-TERM CARE AND BEHAVIORAL HEALTH SERVICES. LONG TERM CARE IS PROVIDED THROUGH INOVA ASSISTED LIVING, A TRANSITIONAL LIVING FACILITIES PROVIDER AND THROUGH ELDERLINK, A COOPERATIVE PROGRAM PROVIDING CASE MANAGEMENT SERVICES TO OLDER ADULTS. IN ADDITION, COMPREHENSIVE ADDICTION TREATMENT SERVICES PROVIDES SERVICES TO ADULTS SUFFERING FROM ALCOHOL AND OTHER CHEMICAL DEPENDENCIES. THE KELLAR CENTER PROVIDES TREATMENT FOR CHILDREN AND ADOLESCENTS WITH SUBSTANCE ABUSE AND BEHAVIORAL AND EMOTIONAL PROBLEMS. IHCS IS ALSO THE PARENT COMPANY OF FOUR FREE-STANDING 24-HOUR EMERGENCY CENTERS, WHICH ARE AFFILIATED WITH ITS HOSPITALS, AND OPERATES THE INOVA RESEARCH CENTER, WHICH PROVIDES A QUALITY ARENA FOR PROFESSIONAL EDUCATION AND CLINICAL RESEARCH. IN ADDITION, IHCS OPERATES INOVA ALEXANDRIA FOUNDATION A CHARITABLE FOUNDATION.LOUDOUN HOSPITAL CENTER (LHC) IS A NOT-FOR-PROFIT CORPORATION ORGANIZED TO PROMOTE THE HEALTH AND WELL-BEING OF LOUDOUN COUNTY, VIRGINIA, AND SURROUNDING AREAS. LHC OPERATES LOUDOUN HOSPITAL CENTER (A 183-BED HOSPITAL), LOUDOUN NURSING AND REHABILITATION CENTER, LOUDOUN HEALTHCARE FOUNDATION AND OTHER HEALTHCARE RELATED FACILITIES. INOVA VNA HOME CARE (IVNA) IS A NOT-FOR-PROFIT CORPORATION THAT PROVIDES QUALITY HOME CARE DESIGNED TO IMPROVE THE HEALTH OF THE DIVERSE COMMUNITY IT SERVES.IMANCO, INC. IS A NOT-FOR-PROFIT MANAGEMENT SERVICES COMPANY THAT PROVIDES EXECUTIVE MANAGEMENT OVERSIGHT TO IHSF AND ITS PRINCIPAL AFFILIATES.INTOTAL HEALTH, LLC IS A MEDICAID MANAGED CARE HEALTH INSURANCE PLAN THAT IS LICENSED BY THE COMMONWEALTH OF VIRGINIA. THE PLAN SERVES APPROXIMATELY 58,000 TEMPORARY ASSISTANCE FOR NEEDY FAMILIES, CHILDREN'S HEALTH INSURANCE PROGRAM RECIPIENTS, AND SUPPLEMENTAL SECURITY INCOME/AGED, BLIND AND DISABLED MEMBERS THROUGH THE MEDALLION 3.0 AND FAMILY ACCESS TO MEDICAL INSURANCE SECURITY PROGRAMS. THE PLAN'S NETWORK INCLUDES PRIMARY CARE AND SPECIALIST PHYSICIANS, HOSPITALS, NURSING FACILITIES, HOME HEALTH CARE AGENCIES, AND OTHER MEDICAL PROVIDERS WHO PROVIDE MEDICAL CARE AS WELL AS ASSIST IN THE COORDINATION OF MEMBER CARE. THE PLAN PROVIDES CASE MANAGEMENT AND OUTREACH SERVICES TO ITS MEMBERS IN ORDER TO ASSESS THEIR NEEDS AND TO HELP COORDINATE THEIR CARE WITH THE HEALTHCARE SYSTEM AND COMMUNITY.INOVA HOLDINGS, INC. (IHI) IS THE PARENT HOLDING COMPANY FOR VARIOUS TAXABLE ENTITIES WITHIN INOVA INCLUDING TECHNICAL DYNAMICS INC., A BIOMEDICAL EQUIPMENT MAINTENANCE AND ENGINEERING COMPANY. IHI AND ITS SUBSIDIARIES OPERATE FACILITIES PROVIDING A VARIETY OF HEALTH CARE AND SUPPORT SERVICES TO PATIENTS AND TO AFFILIATED HEALTH CARE PROVIDERS.PROGRAM SERVICESPHILANTHROPY IS CRITICAL TO INOVA'S MISSION. THERE ARE 528 PHILANTHROPIC FUNDS IN INOVA'S FOUNDATION INCLUDING 369 FUNDS WITH THE INOVA HEALTH FOUNDATION, 89 FUNDS WITH THE INOVA ALEXANDRIA HOSPITAL FOUNDATION, AND 70 FUNDS WITH THE INOVA LOUDOUN HOSPITAL FOUNDATION. THIS BROAD RANGE OF PHILANTHROPY HELPS INOVA STAY ON THE FOREFRONT OF MEDICAL ADVANCES, DEVELOP NEW PROGRAMS TO MEET CHANGING NEEDS AND PROVIDE AFFORDABLE HEALTHCARE TO ALL WHO NEED IT. PROGRAMS SUPPORTED INCLUDE PARTNERSHIP FOR HEALTHIER KIDS (PHK), SERVING 4,034 CHILDREN IN 2014; THE INOVA JUNIPER PROGRAM SERVING MORE THAN 1,700 PERSONS LIVING WITH HIV; AND THE LIFE WITH CANCER PROGRAM WITH 32,268 SERVICE HOURS SPENT WITH PATIENTS.TOTAL SUPPORT PROVIDED IN 2014 TO THE COMMUNITY AND INOVA PROGRAMS WAS APPROXIMATELY $12 MILLION. 12097071 INVESTMENT MANAGEMENT FEES OF $11 MILLION ARE RELATED TO INVESTMENTS THAT INOVA HEALTH SYSTEM FOUNDATION UTILIZES TO PROVIDE HEALTHCARE AND RELATED SERVICES THROUGHOUT NORTHERN VIRGINIA AND THE GREATER METROPOLITAN WASHINGTON, D.C. AREA. THE FEES ARE CALCULATED BASED ON THE MARKET VALUE OF THE INVESTMENTS TIMES BASIS POINTS ESTABLISHED IN EACH CONTRACT. THE RATES ON THESE CONTRACTS APPLY UNTIL A NEW RATE IS NEGOTIATED. 1725743 THE FOUNDATION MAINTAINS AUXILIARY SERVICES AT THE HOSPITALS FOR THE PURPOSE OF OPERATING GIFT AND THRIFT SHOPS THAT PROVIDE SUPPORT TO THE HOSPITALS WITHIN THE SYSTEM. THE AUXILIARIES RECEIVE COMMISSIONS FROM VARIOUS FUNDRAISING ACTIVITIES. THE COST ASSOCIATED WITH THE AUXILIARIES WAS $2 MILLION IN 2014. 1725743 29300129 1 1 0 0 0 0 0 0 0 1 1 1 0 0 1 1 0 1 0 0 1 0 0 1 1 0 0 1 0 1 0 0 0 0 0 1 0 0 1 1 0 0 1 1 0 0 0 1 X 0 0 1 50 1 1 1 1 BR CA CI CO EZ DA CF HU EN GR IS JA MY NI PE PL KS TW TU 0 0 0 1 1 0 0 0 0 X 19 15 1 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 1 1 X INOVA HEALTH SYSTEM FOUNDATION 7032892433 8110 GATEHOUSE ROAD SUITE 400W FALLS CHURCH VA 22042 J KNOX SINGLETON CEO 10.00 40.00 X X 0 5249252 751544 STEPHEN M CUMBIE PAST CHAIRMAN 6.00 3.00 X X 0 0 0 MAURA SUGHRUE MD TRUSTEE 2.00 X 0 0 0 NICHOLAS CAROSI CHAIRMAN 5.00 2.00 X X 0 0 0 TONY NADER SECRETARY 1.00 2.00 X X 0 0 0 PENNY GROSS TRUSTEE 2.00 X 0 0 0 TODD STOTTLEMYER TRUSTEE 2.00 X 0 0 0 CHARLES SMITH TRUSTEE 2.00 5.00 X 0 0 0 ARSHED CHOUDHRY MD TRUSTEE 2.00 3.00 X 0 0 0 SUDHAKAR KESAVAN TRUSTEE 2.00 X 0 0 0 LYDIA THOMAS PHD TREASURER 4.00 2.00 X X 0 0 0 JACK EBELER TRUSTEE 3.00 2.00 X 0 0 0 KATE HANLEY TRUSTEE 2.00 X 0 0 0 PAUL HARBOLICK JR TRUSTEE 2.00 X 0 0 0 WESLEY BUSH TRUSTEE 2.00 X 0 0 0 JOE TRAVEZ TRUSTEE 2.00 X 0 0 0 RICHARD MAGENHEIMER ASST TREASURER/CFO 5.00 45.00 X 0 913507 764256 JOHN GAUL ASST SECRETARY/SVP GENERAL 5.00 45.00 X 0 483883 167462 MARK STAUDER PRESIDENT 5.00 45.00 X 0 1670589 726275 MARSHALL RUFFIN EVP CTO 9.00 41.00 X 0 848542 123391 SALLY PAULL EVP CHIEF HR OFFICER 5.00 45.00 X 0 227179 23997 LORING FLINT EVP CHIEF MEDICAL OFFICER 3.00 47.00 X 0 715922 195578 RUSSELL MOHAWK SVO CFO HEALTH PLAN POP HEALTH 10.00 30.00 X 0 457846 79382 ANTHONY BURCHARD PRESIDENT IHS FOUNDATION 40.00 10.00 X 342142 0 70722 LINDA ROBERTSON SR DIRECTOR DEVELOPEMENT 40.00 X 139952 0 39074 LAURA MOSES SR DIRECTOR DEVELOPEMENT 40.00 X 132584 0 26747 JULIA BILICKI SR DIRECTOR DEVELOPEMENT 40.00 X 162215 0 36771 MARY MOONEY EXEC DIRECTOR DEVELOPEMENT 40.00 X 136527 0 49990 ANNE RIEGER AVP COMMUNITY SAFETY NET 40.00 X 220370 0 62571 PATRICK WALTERS FORMER TRUSTEE 1.00 49.00 X 0 531326 71288 JAMES KIM FORMER ASST SECRETARY 5.00 45.00 X 0 277217 61067 JOHN NIEDERHUBER CEO ITMI & EVP IHS 9.00 41.00 X 0 1690829 51126 1133790 13066092 3301241 15 1 1 0 WALTER SCOTT & PARTNERS LIMITED ONE CHARLOTTE SQUARE EDINBURGH SCOTLAND UK INVESTMENT MANAGEMENT FEES 1253670 WELLINGTON 280 CONGRESS STREET BOSTON MA 02210 INVESTMENT MANAGEMENT FEES 1214798 UBS REALTY INVESTORS LLC 10 STATE HOUSE SQUARE 15TH FLOOR HARTFORD CT 06103 INVESTMENT MANAGEMENT FEES 1198135 RREEF AMERICA LLC 875 NORTH MICHIGAN AVE FLR 41 CHICAGO IL 60611 INVESTMENT MANAGEMENT FEES 1152130 HARDING LOEVNER LP 400 CROSSING BLVD FOURTH FLOOR BRIDGEWATER NJ 08807 INVESTMENT MANAGEMENT FEES 1091720 21 X 18162 1723649 8101629 1060249 9843440 70657276 41505 70615771 100247731 30794280 69453451 69453451 69453451 1147739 1723649 1282523 -134784 -134784 5899763 1426414 4473349 4473349 INNOVATION HEALTH SEE SCHEDULE O 524298 -31617 -31617 INNOVATION HEALTH HOLDINGS LLC 524298 -316388 -316388 -348005 153944727 73578795 41505 70480987 12010314 12010314 1133790 1133790 3424223 1525907 232050 1666266 292462 92650 14090 185722 333474 74320 11302 247852 324663 111762 16996 195905 695530 177623 27012 490895 207675 175471 26685 5519 147250 147250 12097117 12097071 46 1940336 715207 33975 1191154 100966 73767 11218 15981 71307 1058 161 70088 61790 53446 8344 882593 756152 114991 11450 99343 29150 4433 65760 57141 20305 3088 33748 46760 38072 5790 2898 37192 419 64 36709 PHYSICIAN FEES 800000 694400 105600 BAD DEBT 526219 405 62 525752 OTHER PURCHASED SERVICE 372222 320134 48684 3404 TAXES AND LICENSES 287786 209532 31864 46390 437051 122964 18935 295152 36387204 29300129 715390 6371685 355025 495084 15515400 14989650 778467 784592 176963 147997 166359 195588 2988040 540247 2472096 2447793 2165380224 2198465704 1204342925 1531219824 140215321 148161255 3529402780 3896907487 2994747 3910078 1798137388 2038611010 1801132135 2042521088 X 1659943412 1788130793 56852850 55053779 11474383 11201827 1728270645 1854386399 3529402780 3896907487 X 117557523 12988750 -4430519 X X 0 1 X 1 0 X X 2 INOVA HEALTH CARE SERVICES 540620889 3 1 11508284 0 INOVA VNA HOME CARE INC 541277164 9 1 502030 0 2 12010314 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 0 X 0 0 RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 19748938 379367 459337 169347 456076 40507 19921712 18939340 304314 1273703 16680 710651 41088 19748938 18037004 192709 1119064 5979 362339 41119 18939340 18356959 385654 -304046 3000 370714 27849 18037004 17249575 618086 952760 16298 421081 26083 18356959 0.26000 0.74000 0.00000 0 0 2275486 2275486 322296 216622 105674 358008 310187 47821 32250 13438 18812 2447793 1531219824 F 1531219824 DUE TO SUBSIDIARIES AND AFFILIATES 2038592283 OTHER 18727 2038611010 X PART X, LINE 2: FROM INOVA HEALTH SYSTEM CONSOLIDATED FINANCIAL STATEMENTS THAT INCLUDE INOVA HEALTH SYSTEM FOUNDATION: 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. CENTRAL AMERICA AND THE CARIBBEAN 0 0 INVESTMENT 691213000 EUROPE 0 0 INVESTMENT 24128000 0 0 0 0 0 0 715341000 0 715341000 1 0 1 0 1 0 PART I, LINE 3, COLUMN F ACCRUAL METHOD OF ACCOUNTING X X X X X 1 EXPERT EVENTS LLC 123 SOUTH BROAD ST SUITE 2035 PHILADELPHIA PA 19109 SPECIAL EVENT 0 1018669 63750 954919 KATHY NEWMAN 6100 SADDLE HORN DRIVE FAIRFAX VA 22030 SPECIAL EVENT 0 682625 35000 647625 ELISABETH HERZFELD 200 GARDEN VIEW WAY APT 303 ROCKVILLE MD 20850 SPECIAL EVENT 0 672475 8000 664475 MLJ EVENT MANAGEMENT LLC 355 CRESENDO WAY SILVER SPRING MD 20901 SPECIAL EVENT 0 267208 20500 246708 PATRICIA WATSON 19238 MILL SITE PLACE MCLEAN VA 20901 SPECIAL EVENT 0 148585 20000 128585 2789562 147250 2642312 VA MD DC FL 2014 GALA 1018669 743478 275191 90 198931 3300 222300 319469 HISAOKA GALA 754302 754302 6 1098417 980171 118246 3721 163 185639 136687 33100 179123 2871388 1723649 1147739 3811 163 384570 139987 255400 498592 1282523 -134784 SCHEDULE G, PART I, LINE 2B EXPERT EVENTS, LLC 123 SOUTH BROAD ST. SUITE 2035 PHILADELPHIA, PA 19109 KATHY NEWMAN 66100 SADDLE HORN DRIVE FAIRFAX, VA 22030 ELISABETH HERZFELD 200 GARDEN VIEW WAY, APT 303 ROCKVILLE, MD 20850 MLJ EVENT MANAGEMENT, LLC 355 CRESENDO WAY SLIVER SPRING, MD 20901 PATRICIA WATSON 19238 MILL SITE PLACE LEESBURG, VA 20176 1 INOVA HEALTH CARE SERVICES 8110 GATEHOUSE ROAD SUITE 400W FALLS CHURCH VA 22042 540620889 501(C)(3) 11508284 MULTIPLE GRANTS MADE TO FURTHER THE MISSION OF INOVA HEALTH CARE SERVICES OF PROVIDING QUALITY HEALTHCARE TO THE COMMUNITY. INOVA VNA HOME CARE INC 8110 GATEHOUSE ROAD SUITE 400W FALLS CHURCH VA 22042 541277164 501(C)(3) 502030 MULTIPLE GRANTS MADE TO FURTHER THE MISSION OF INOVA VNA HOME CARE OF PROVIDING QUALITY HEALTHCARE TO THE COMMUNITY. 2 0 PART I, QUESTION 2 THE FOUNDATION DONATES FUNDS TO ITS 501(C )(3) PARENT ORGANIZATION, INOVA HEALTH SYSTEM, IN FURTHERANCE OF THE MISSION TO IMPROVE THE HEALTH OF THE DIVERSE COMMUNITY WE SERVE THROUGH EXCELLENCE IN PATIENT CARE, EDUCATION AND RESEARCH. EXPENDITURE OF SUCH FUNDS IS OVERSEEN BY THE FOUNDATION'S LEADERSHIP AND BOARD. X X X X X X 0 1 0 0 0 0 0 0 0 J KNOX SINGLETON CEO 0 1200836 0 3731324 0 317092 0 732655 0 18889 0 6000796 0 3450316 RICHARD MAGENHEIMER ASST TREASURER/CFO 0 667029 0 107932 0 138546 0 746708 0 17548 0 1677763 0 0 JOHN GAUL ASST SECRETARY/SVP GENERAL 0 424311 0 37796 0 21776 0 145985 0 21477 0 651345 0 0 MARK STAUDER PRESIDENT 0 962861 0 658127 0 49601 0 704925 0 21350 0 2396864 0 0 MARSHALL RUFFIN EVP CTO 0 600883 0 73280 0 174379 0 106845 0 16546 0 971933 0 88408 SALLY PAULL EVP CHIEF HR OFFICER 0 106006 0 75000 0 46173 0 10154 0 13843 0 251176 0 0 LORING FLINT EVP CHIEF MEDICAL OFFICER 0 588245 0 89864 0 37813 0 168985 0 26593 0 911500 0 0 RUSSELL MOHAWK SVO CFO HEALTH PLAN POP HEALTH 0 419898 0 0 0 37948 0 45481 0 33901 0 537228 0 0 ANTHONY BURCHARD PRESIDENT IHS FOUNDATION 259279 0 27194 0 55669 0 46950 0 23772 0 412864 0 20349 0 LINDA ROBERTSON SR DIRECTOR DEVELOPEMENT 132653 0 6626 0 673 0 29476 0 9598 0 179026 0 0 0 LAURA MOSES SR DIRECTOR DEVELOPEMENT 125395 0 6971 0 218 0 6746 0 20001 0 159331 0 0 0 JULIA BILICKI SR DIRECTOR DEVELOPEMENT 153719 0 7939 0 557 0 31065 0 5706 0 198986 0 0 0 MARY MOONEY EXEC DIRECTOR DEVELOPEMENT 125438 0 6112 0 4977 0 30726 0 19264 0 186517 0 0 0 ANNE RIEGER AVP COMMUNITY SAFETY NET 175070 0 14484 0 30816 0 51484 0 11087 0 282941 0 9995 0 PATRICK WALTERS FORMER TRUSTEE 0 413414 0 16420 0 101492 0 56100 0 15188 0 602614 0 0 JAMES KIM FORMER ASST SECRETARY 0 208360 0 13639 0 55218 0 39487 0 21580 0 338284 0 34277 JOHN NIEDERHUBER CEO ITMI & EVP IHS 0 983374 0 665903 0 41552 0 38600 0 12526 0 1741955 0 0 PART I, LINE 4B SERP PLAN PAYMENTS: J. KNOX SINGLETON - $237,137 RICHARD MAGENHEIMER - $98,945 ANTHONY BURCHARD - $36,154 JAMES KIM - $45,021 PATRICK WALTERS - $61,891 ANNE RIEGER - $19,820 MARSHALL RUFFIN $136,566 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 THREE-YEAR ROLLING SCHEDULE UNTIL YEAR 12. THEREAFTER, THE ANNUAL CONTRIBUTION IS PAID OUT TO THE PARTICIPANT EACH YEAR AS A TAXABLE EVENT. COMPASS GROUP MAJOR DONOR 60000 PAYMENT FOR PROFESSIONAL SERVICES. SERVICES PROVIDED AT ARM'S LENGTH AND CUSTOMARY RATES. 0 EPIC MAJOR DONOR 21455 PAYMENT FOR PROFESSIONAL SERVICES. SERVICES PROVIDED AT ARM'S LENGTH AND CUSTOMARY RATES. 0 X 1 1000 MARKET VALUE X 7920 RESALE VALUE X 147538 RESALE VALUE X 59 720952 MARKET QUOTE X 18 5642 MARKET VALUE X 19 7337 MARKET VALUE X GIFT CERTIFICATES 360 90386 MARKET VALUE X VACATION PACKAGE 47 46419 MARKET VALUE X EVENT TICKETS 28 33055 MARKET VALUE 0 1 0 PART V, QUESTION 1A AND 2A - NUMBER OF 1099S AND EMPLOYEES THE ORGANIZATION FILES ITS FORM 1099S UNDER THE PARENT ENTITY AND DOES NOT REPORT ANY AMOUNTS UNDER ITS OWN EIN. THE ORGANIZATION FALLS UNDER A MASTER PAY AGENT AND DOES NOT FILE ANY PAYROLL RETURNS UNDER ITS OWN EIN, HOWEVER ALL REQUIRED RETURNS HAVE BEEN FILED ON TIME. FORM 990, PART VI, SECTION A, LINE 2 NICK CAROSI, KNOX SINGLETON, MARK STAUDER, RICHARD MAGENHEIMER, PAT WALTERS AND STEPHEN CUMBIE - BUSINESS RELATIONSHIP 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. FORM 990, PART VI, SECTION C, LINE 18 THE FORM 1023 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. PART VIII, LINE 11B THE INNOVATION HEALTH HOLDINGS, LLC FORM K-1 DOES NOT INCLUDE THE EARNINGS FROM TWO 100% OWNED CORPORATE ENTITIES: INNOVATION HEALTH INSURANCE COMPANY INNOVATION HEALTH PLAN, INC. THE NET LOSS RELATED TO THESE TWO ENTITIES HAS BEEN RECORDED ON THIS LINE AND AS A FUND BALANCE ADJUSTMENT. FORM 990, PART XI, LINE 9: EQUITY EARNINGS IN SUBS -2,448,945. TRANSFERS -2,329,579. INNOVATION PARTNERSHIP NET LOSS 316,388. INNOVATION HEALTH NET LOSS 31,617. PART XII, LINE 2B AND 2C - AUDITED FINANCIAL STATEMENTS 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 AUDIT THE COMPANY IS A SUBSIDIARY OF THE INOVA HEALTH SYSTEM (IHS), A NOT-FOR-PROFIT INTEGRATED HEALTH CARE DELIVERY SYSTEM SERVING NORTHERN VIRGINIA AND SURROUNDING AREAS. IHS RECEIVES VARIOUS FEDERAL GRANTS. THESE GRANTS AND AWARDS ARE AUDITED AS PART OF THE CONSOLIDATED INOVA HEALTH SYSTEM A-133 COMPLIANCE AUDIT. THE INOVA HEALTH SYSTEM'S FEDERAL GRANTS ARE AUDITED ON AN ANNUAL BASIS BY A LARGE "BIG FOUR" INDEPENDENT PUBLIC ACCOUNTING FIRM AND A "REPORT ON COMPLIANCE WITH REQUIREMENTS APPLICABLE TO EACH MAJOR PROGRAM AND ON INTERNAL CONTROLS OVER COMPLIANCE IN ACCORDANCE WITH OMB CIRCULAR A-133" IS ISSUED ON A CONSOLIDATED BASIS. THE 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. SIGNATURE PARTNERS IN HEALTH LLC 8110 GATEHOUSE ROAD SUITE 400W FALLS CHURCH VA 22042 461392631 HEALTH INSURANCE VA 1718461 16922 INOVA VNA HOME CARE 8110 GATEHOUSE ROAD SUITE 400W FALLS CHURCH VA 22042 541277164 HOME HEALTH CARE VA 501(C)(3) 9 N/A 0 INOVA HEALTH CARE SERVICES 8110 GATEHOUSE ROAD SUITE 400W FALLS CHURCH VA 22042 540620889 HOSPTIAL SYSTEM VA 501(C)(3) 3 N/A 0 PEDIATRIC SPECIALISTS OF VIRGINIA LLC 3023 HAMAKER COURT FAIRFAX VA 22031 461851763 MEDICAL SERVICES FOR CHILDREN VA 501(C)(3) 9 N/A 0 IMANCO INC 8110 GATEHOUSE ROAD SUITE 400W FALLS CHURCH VA 22042 541340725 PAYROLL CORPORATION VA 501(C)(3) 11, I N/A 0 INTOTAL HEALTH LLC 8110 GATEHOUSE ROAD SUITE 400W FALLS CHURCH VA 22042 201581237 HMO VA 501(C)(3) 9 N/A 0 ALEXANDRIA HOSPITAL FOUNDATION 8110 GATEHOUSE ROAD SUITE 400W FALLS CHURCH VA 22042 510241913 FUNDRAISING VA 501(C)(3) 11, I N/A 0 LOUDOUN HOSPITAL CENTER 8110 GATEHOUSE ROAD SUITE 400W FALLS CHURCH VA 22042 540525802 HOSPITAL VA 501(C)(3) 3 N/A 0 LOUDOUN NURSING AND REHABILITATION CENTER 8110 GATEHOUSE ROAD SUITE 400W FALLS CHURCH VA 22042 541361310 REHABILITATION SERVICES VA 501(C)(3) 9 N/A 0 LOUDOUN HEALTH SERVICES 8110 GATEHOUSE ROAD SUITE 400W FALLS CHURCH VA 22042 541555489 SURGERY CENTER VA 501(C)(3) 9 N/A 0 LOUDOUN HEALTH CARE FOUNDATION 8110 GATEHOUSE ROAD SUITE 400W FALLS CHURCH VA 22042 542011240 FUNDRAISING VA 501(C)(3) 11, I N/A 0 INNOVATION HEALTH HOLDINGS LLC 151 FARMINGTON AVENUE RT21 HARTFORD CT 06156 455527797 HEALTH INSURANCE CT N/A RELATED -316388 28159503 0 1 0.50000 INOVA HOLDINGS INC 8110 GATEHOUSE ROAD SUITE 400W FALLS CHURCH VA 22042 510332880 MEDICAL EQUIPMENT VA N/A C 33959166 31115289 1.00000 0 0 1 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 1 1 INOVA HEALTH CARE SERVICES L 11508284 GENERAL LEDGER INOVA VNA HOME CARE L 502030 GENERAL LEDGER INOVA HEALTH CARE SERVICES S 20199504 INTERCOMPANY BALANCE ALEXANDRIA HOSPITAL FOUNDATION R 1601495 INTERCOMPANY BALANCE LOUDOUN HOSPITAL CENTER S 72290818 INTERCOMPANY BALANCE LOUDOUN NURSING AND REHABILITATION CENTER S 1394391 INTERCOMPANY BALANCE LOUDOUN HEALTH SERVICES S 268120 INTERCOMPANY BALANCE LOUDOUN HOSPITAL FOUNDATION R 2388821 INTERCOMPANY BALANCE INTOTAL HEALTH LLC S 614311 INTERCOMPANY BALANCE INOVA VNA HOME CARE S 895477 INTERCOMPANY BALANCE IMANCO INC S 35334 INTERCOMPANY BALANCE INOVA HEALTH CARE SERVICES B 7483298 GENERAL LEDGER INOVA VNA HOME CARE INC B 233771 GENERAL LEDGER PEDIATRIC SPECIALISTS OF VIRGINIA LLC R 695 INTERCOMPANY BALANCE