2013-11-12T10:27:11-06:00 2012-12-31 990 2012-01-01 540620889 INOVA HEALTH CARE SERVICES INOV 7032892433 8110 GATEHOUSE ROAD SUITE 400W FALLS CHURCH VA 22042 RICHARD MAGENHEIMER 7032892433 2013-11-05 2012 2016-02-24 21:20:13Z J Knox Singleton 8110 GATEHOUSE ROAD SUITE 400W FALLS CHURCH VA 22042 1681365823 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. 26 18 12881 2185 3711020 0 12131593 12501185 1585686271 1612217483 -23254457 930902 53552119 41456621 1628115526 1667106191 0 0 0 0 802565026 822612091 0 0 0 689963008 713457326 1492528034 1536069417 135587492 131036774 2718727479 3659103875 1483056443 1970131490 1235671036 1688972385 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 diverse community served. IHCS includes a centralized system office and various unincorporated and incorporated subsidiaries. The unincorporated subsidiaries of IHCS include Fairfax Hospital, Mount Vernon Hospital, Fair Oaks Hospital, Emergency Care Center of Reston, Emergency Care Center of Fairfax, and Springfield Healthplex. The Institute of Research and Education is operated as a program of IHCS. 0 0 1201921008 1645507335 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, ACCESS of Reston, ACCESS of Fairfax, and the Inova Research Center. PROGRAM SERVICESAcute care services are provided on three campuses in Fairfax County, Virginia. Services provided include emergency and trauma facilities, inpatient and outpatient services, and a variety of ancillary and specialized services. During 2012 IHCS admissions and observations cases totaled 86,232, outpatient visits totaled 322,327 emergency visits totaled 229,086 and deliveries totaled 13,435 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. Specific acute care programs include:Cardiovascular Care: The Inova Heart and Vascular Institute 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. Women's Health: The Inova Women's Health program is the largest such program in the Mid-Atlantic region, providing services for over 13,400 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. In addition, Fairfax provides obstetric services to low-income patients through the InovaCares Clinic for Women with 29,792 visits in 2012.Breast Care Institute: 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. 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, 2012, total NICU bassinets numbered 75. 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 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 2012 provided 23,984 visits at an unreimbursed cost of $1 million. 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. 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 2012, ACCESS of Fairfax provided 17,967 emergency room visits and ACCESS of Reston reported 13,661 emergency room visits. IHCS has recently invested significant capital in all three hospital facilities. IHCS has an $875 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 $46 million expansion to create private rooms and upgrade facilities. Charity Care All Inova facilities, including the IHCS facilities provide charity 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. These policies include the following key provisions:1. Emergency care shall be provided to all persons regardless of their ability to pay.2. Non-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 200% of the Federal Poverty Guideline (FPG). In general, free medically necessary care is provided for patients with incomes falling below 200% of the FPG; and discounted care is provided for services rendered to patients with incomes falling between 200% and 300% of the FPG. Research and Education Services: The Inova Research Center (IRC), including research and academic activities, is centered on the Inova Fairfax Hospital campus. In 2005, the Inova campus of the Virginia Commonwealth University School of Medicine opened and a total of 48 third and fourth year medical students now spend their clerkship years at Inova Fairfax Hospital. Also located on the Inova campus is the VCU School of Pharmacy, helping 40 students to complete their education and clinical training in Northern Virginia. In 2008, the Claude Moore Health Education Center opened on the campus of Inova Fairfax Hospital. The building features 11,000 square feet of modern 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. In 2008, a dedicated research floor opened 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 2012 was $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 2012, approximately $15 million was provided in operational and capital support for ITMI. Fairfax's medical education programs offer a variety of clinical training objectives for medical residents and students, nursing and pharmacy. Inova Fairfax'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 2012 was $18 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 2012, Inova provided over 229,000 people with health education, prevention and wellness programs, health fairs and screenings, and clinically related services resulting in over 115,000, visits for direct health care services at an unreimbursed cost of approximately $21 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 Guidelines (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 2012, the InovaCares Clinic for women had 29,792 visits.The 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 2012, the InovaCares Clinics for Children provided 23,984 visits and received NCQA level 3 Patient-Centered Medical Home recognition.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 more than 1,400 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 five satellite offices (Dumfries, Manassas, Mt. Vernon, Arlington, and Reston), hospitals, homes and other community locations throughout the region. Major accomplishments of IJP for 2012 include: Almost doubled its census in the past year and now serves over 1,400 patients providing 25,222 visits Maintaining a 0% HIV transmission rate from pregnant mothers to their newborn babies. Received NCQA level 3 Patient Centered Medical Home recognition Conducted 146 education programs reaching 2,492 participants, and provided 151 clinical consultations.Life with CancerThe mission of Life with Cancer (LWC) is to enhance the quality of life of those individuals in our community affected by cancer. The program addresses the specific needs of those affected by cancer 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 2012 Life with Cancer offered 1,327 educational classes, groups, and wellness programs, with more than 10,000 visits. In addition, 10,400 one-on one contacts for counseling & consultations were provided. A total of 30,300 service hours for over 3,300 people in the Northern Virginia area were provided. More than 30 health fairs, presentations, and conferences in which LWC staff and volunteers participated reached another 2,700 people in the community served by Inova. Lions Eye ClinicAdministered by Inova Fairfax Hospital, the Ophthalmology Clinic provides optometry specialty services to the indigent including treatment of glaucoma, retina, and cataracts as well as children's specialty services. The physicians volunteer their services or are paid nominal fees by the State of Virginia or sponsoring community organization. In 2012, the clinic had 2,813 visits.Inova Diabetes CenterThe Inova Diabetes Center provides outpatient diabetes self-management education to over 5,000 adults and children with diabetes each year in the Northern Virginia area. The Inova Diabetes Center has five locations in the Northern Virginia area including Inova Fairfax Hospital, Inova Mount Vernon Hospital and Inova Fair Oaks Hospital and is the recipient of the American Diabetes Association's Recognition for Diabetes Education Programs. In 2012, the Inova Diabetes Centers at Inova Fairfax, Inova Mount Vernon Hospital and Inova Fair Oaks Hospitals, provided a total of 3,251 patient visits.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 indigent patients to and from IHCS facilities and programs. Inova Fairfax 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 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. HealthSourceHealthSource serves the community as the premier provider of health education and prevention services. Our participants engage in prevention activities, receive quality health education, participate in wellness programs and benefit from care management. As a part of our vision, Healthsource targets the community we serve by holding programs throughout the region in environments that are familiar to and convenient for our clients. Seminars, classes, health fairs and screenings are offered at Inova Health System hospitals, community locations and worksites throughout Northern Virginia and the Greater Metropolitan Washington Area. During 2012, HealthSource served 229,093 participants at 5,624 events. Program highlights include:Influenza VaccinationThe Inova HealthSource Fight the Flu Program has provided 43,000 flu shots at 827 immunization clinics so far this year for Inova Health System employees and physicians, employers and the community.The Fight the Flu Program provided over 10,000 flu shots for Fairfax County Public Schools at 190 clinics and 2,000 shots at 17 clinics for Fairfax County Government employees. With Inova foundation funds, free flu shots were provided for 149 children and teachers at Higher Horizons Head Start Program.The Workplace and Community ProgramsThe Workplace and Community Program served 95,032 participants at 2,115 events.The Care Management Programs provided health coaching in weight management, tobacco cessation, back pain management, fitness, pregnancy and breastfeeding at worksites.The City of Alexandria Wellness Program provides development, implementation and evaluation for all City employees. During 2012 this program provided 27 programs for 1,139 participants. Programs include Know Your Numbers, Choose Your Physician, Team Up to Move, Flu Vaccination, Health Fairs and monthly health/prevention awareness campaigns.The Health Education Program: supporting community wellness through health educationHealthSource provided 838 life support classes for 9,640 students at worksites and in the community. 3,093 physicians, nurses, first responders and other health professionals received advanced life support training. 1201921008 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 1 0 0 0 0 0 1 1 0 0 0 1 1717 0 1 12881 1 1 1 0 0 0 0 0 X 26 18 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 0 X Inova Health Care Services 7032892433 8110 Gatehouse Road Suite 400W Falls Church VA 22042 X JKNOX SINGLETON 20.00 30.00 X X 0 3538107 644863 CHARLES H SMITH 3.00 4.00 X X 0 0 0 LORI MORRIS 2.00 X X 0 0 0 CHARLES MANN 2.00 X X 0 0 0 MARY AGEE 2.00 X 0 0 0 ROBERT AHMED MD 2.00 2.00 X 0 0 0 MARTHA CALIHAN MD 2.00 4.00 X 0 0 0 CHARLES BEARD 2.00 X 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250000 250000 250000 1000000 1500000 85097070 85097070 741046971 373712487 367334484 431252787 271570120 159682667 917134929 661365289 255769640 148454316 116968330 31485986 899369847 UNAMORTIZED BOND COSTS 7768369 OTHER ASSETS 8684503 DUE FROM SUBSIDIARIES AND AFFILIATES 1529028459 PENSION ASSET 22688113 CONSTRUCTION IN PROGRESS 210505768 1778675212 THIRD PARTY SETTLEMENTS 48257827 NOTES PAYABLE AND OTHER 105274597 SELF INSURED LIABILITY 35596743 DEFERRED COSTS 24890499 POST RETIREMENT/EMPLOYMENT BENEFITS 10661319 INTEREST RATE SWAP LIABILITY 62390069 INVESTMENT IN SUBSIDIARIES AND JOINT VENTURES 8899680 295970734 X Description of Uncertain Tax Positions Under FIN 48: Part X, Line 2: From Inova Health System consolidated financial statements including Inova Health Care Services: The Foundation, IHCS, AHSC, LHI and IHSS, 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 81391401 81391401 0.05520 50334929 50334929 0.03420 131726330 131726330 0.08940 10740523 10740523 0.00730 18185597 18185597 0.01230 9846578 9846578 0.00670 6397535 6397535 0.00430 101092 101092 0.00010 45271325 45271325 0.03070 176997655 176997655 0.12010 1 28721250 236752417 267077635 -30325218 X 1 1 1 Franconia-Springfield Surgery Center LLC Surgical Services 0.61240 0.38760 2 Northern Virginia Surgery Center LLC Surgical Services 0.62640 0.37360 3 Inova Woodburn Surgery Center LLC Surgical Services 0.75400 0.24600 3 1 INOVA FAIRFAX HOSPITAL

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EMERGENCY ROOM INOVA VNA HOME CARE

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RESEARCH FACILITY Part I, Line 3c: 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 $5,221,943. 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 $ 62225440. Part II: 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 safer and healthier for our patients, employees and community.Community Building Environmental Improvements Recycling Commingled recycling: Since 2008 Inova has had a commingled, or single-stream, recycling program. Throughout our facilities, paper, plastics, cardboard, metals and glass are all recycled in the same containers. Specialized materials recycling Specialized areas recycling (ORs, kitchens): We have also implemented specialized recycling programs to capture specific materials in areas such as operating rooms and construction sites.Energy Calculated carbon footprint of Inova hospitals based on energy consumption Energy usage data tracking with Energy Star Portfolio Manager Hired System-level Energy Manager Retuned building management systems Evaluated preventative maintenance strategies nvestigated and installed magnetic bearing chillers at Inova Mount Vernon Hospital Supported energy-saving technologies including motion and daylight sensors, LED and induction lighting and solar panels Supported the procurement of Energy Star and EPEAT desktop electronics and other appliances Water Integrated green technologies: motion sensor faucets, low-flow restroom fixtures Incorporated native plants and low-impact irrigation systems for landscaping Utilized water-efficient sterilization equipment Installed rain cistern in Inova Fairfax Medical Campus' new South Patient Tower Buildings Completed construction on LEED Silver South Patient Tower (IFMC) Installed a 4,000 square foot vegetated roof system that mitigates stormwater runoff and provides nature views to adjacent patient rooms Over 20% of building materials contain recycled content 37% of materials sourced from within 500 miles of the facility Over 70% of wood sourced from sustainably managed forests Recycled construction & demolition waste Implemented integrated pest management practices Applied water-efficient and pest-resistant native landscaping practices and water-efficient irrigation systems Part III, Line 4: Bad Debt FootnotePatient accounts receivable include charges for amounts due from all patients less allowances for the excess of established charges over the payments to be received on behalf of patients covered by Medicare, Medicaid and other insurers. IHS has a self-insured discount policy whereby uninsured patients receive a 35% discount for services rendered. Discounts to uninsured patients are classified as a deduction from revenue. The provision for bad debts is recognized when providing an allowance for uncollectible 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. INOVA FAIRFAX HOSPITAL Part V, Section B, Line 12h: Family Size INOVA FAIROAKS HOSPTIAL Part V, Section B, Line 12h: Family size. INOVA MOUNT VERNON HOSPITAL Part V, Section B, Line 12h: Family size. INOVA FAIRFAX HOSPITAL Part V, Section B, Line 14g: 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. INOVA FAIROAKS HOSPTIAL Part V, Section B, Line 14g: 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. INOVA MOUNT VERNON HOSPITAL Part V, Section B, Line 14g: 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. INOVA FAIRFAX HOSPITAL Part V, Section B, Line 20d: All self pay patients receive a 35% self pay discount. INOVA FAIROAKS HOSPTIAL Part V, Section B, Line 20d: All self pay patients receive a 35% self pay discount. INOVA MOUNT VERNON HOSPITAL Part V, Section B, Line 20d: All self pay patients receive a 35% self pay discount. Part VI, Line 2: Inova Health System (IHS) has used the following methods to determine the healthcare needs of the community:An assessment of community health status based on available morbidity and mortality data from secondary data sources such as Commonwealth of Virginia vital statistics, cancer registries and hospital discharge abstracts;Focus groups and surveys to determine community concerns and expectations related to health issues; Conferences to elicit broad community input and reach consensus on critical health care needs.Periodically updated the community needs assessment with a comprehensive analysis of community health status to determine how community health needs have changed since the prior assessments were completed. This assessment relied on secondary data sources including VDH statistics on births, deaths and diseases; information on hospital finances and utilization from Virginia Health Information Inc; and internal information on hospital utilization and charges from Inova Health System.Study of community Health Impact on Hospital services using population based hospital discharge dataEngaged community leaders from the Alexandria Health Department, Fairfax County School District and a private non-profit. Northern Virginia Family Services provided expert consultation and guidance for the task force on the importance and challenges of establishing partnerships.As a result of this 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 2010 goals and outcomes. 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. 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 will be incorporated into the community needs assessment Inova initiated in 2011 with completion of the assessment as well as implementation plans scheduled for 2013. In addition to participating in the MAPP process, 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 incorporates a multifaceted approach to educate and inform patients and potential patients about the Inova charity care policy. Upon admission to any Inova hospital or nursing home or any visit to outpatient facilities or clinics including our emergency departments, Inova has information posted regarding patient rights and responsibilities. Patients are provided information about our charity care program and referrals to an Inova financial counselor who assists the patients in completing our charity care application. This financial information is reviewed by our patient accounts department and the patient is contacted if any additional information is needed to make a determination. The patient is sent a letter in which they are given 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 Guideline. Inova also has Medicaid eligibility workers on-site in all hospitals, in our InovaCares Clinic for Women and Children (clinic for low income families) and in the community as part of our Partnership for Healthier Kids Access to Care program. We partner with schools across our 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 our 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 our culturally diverse community. 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 Fairfax County.The region's population served by IHCS is forecasted to grow 14% over the next decade adding an estimated average of 31,000 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 double by 2030, while the number of children will increase by about 19% during the 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 2011 Asians, Hispanics, and African Americans represented 18.0 percent, 15.8 percent, and 9.9 percent 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 2010 approximately 13.0% of the total population under the age of 65 (about 264,000 people) in Northern Virginia lacked healthcare insurance. Of the people living in Northern Virginia whose family incomes are at or below 200% of the federal poverty level, SAHIE estimates that 40% (about 122,000 people) were uninsured in 2010.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 Community Safety Net and Community 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 2012, PHK assisted over 4,982 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 TCM clinics in collaboration with the Inova Juniper Program in which patients are provided a follow up appointment with a nurse practitioner who will follow the patient until the patient is connected with a 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 2012, 3,567 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 37,679 clinical and 42,402 educational hours to children and families for a total of 80,081 hours in 2012. 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. The 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:Provided more than 102 health education and wellness promotion activities Distributed over 12,654 pieces of health education materials.Conducted over 3,371 consultations and networking conversationsIncreased the number of new faith communities partnered with CHP with 20 new Faith Congregations contacted this year.Health Literacy and Health Equity ProgramsThe Office of Health Equity (OHE) identifies and addresses health disparities in Northern Virginia through internal and community initiatives under the Quality, Service and Community Pillars. The department is dedicated to the elimination of disparities in our 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 8-10 percent of Inova's patient population who are limited English proficient (LEP). Medical Interpretation in over 100 languages is provided by on site medical interpreters and telephonic interpreters. In 2012, the OHE delivered 55,289 hours of interpreter service across Inova facilities. In 2012, 18,099 hours of Sign Language interpretation were delivered. Video remote interpreting (on demand, online interpreting) has been expanded to 24 locations throughout Inova. Part VI, Line 6: Organization is part of Inova Health System included in description under Line 5. X 1 1 X X X X X X 0 1 0 0 0 0 0 0 0 JKNOX SINGLETON 0 1166810 0 2064701 0 306596 0 622437 0 22426 0 4182970 0 0 RICHARD MAGENHEIMER 0 605831 0 248980 0 125250 0 279471 0 21494 0 1281026 0 0 JOHN GAUL 407543 0 98500 0 94547 0 69829 0 20098 0 690517 0 35023 0 MARK STAUDER 0 917232 0 404998 0 627088 0 534328 0 18994 0 2502640 0 446220 LEWIS PASTERNAK 0 416107 0 222882 0 26681 0 30000 0 18146 0 713816 0 0 JOHN NIEDERHUBER 0 968232 0 739100 0 41124 0 37500 0 15927 0 1801883 0 0 KYLANNE SILVERSTONE 0 445459 0 242161 0 37524 0 135944 0 14314 0 875402 0 0 MARSHALL RUFFIN 0 583848 0 228740 0 41649 0 121370 0 41605 0 1017212 0 0 PATRICK CHRISTIANSEN 0 458180 0 146028 0 34902 0 111499 0 15074 0 765683 0 0 FLINT LORING 0 563075 0 183259 0 88556 0 147435 0 32869 0 1015194 0 0 GEOFFREY BROWN 293439 0 68417 0 24340 0 68278 0 16309 0 470783 0 0 0 MARK RUNYON 354011 0 122630 0 22622 0 95329 0 20342 0 614934 0 0 0 BARBARA DOYLE 346891 0 78386 0 269169 0 54500 0 8066 0 757012 0 174082 0 MAUREEN SWICK 299723 0 54000 0 24386 0 96922 0 19987 0 495018 0 0 0 ANGELA MANNINO 346918 0 83733 0 83410 0 69012 0 20316 0 603389 0 32584 0 JOHN FITZGERALD 376534 0 93394 0 37654 0 108987 0 14226 0 630795 0 0 0 JAMES SANTRY 204733 0 112684 0 19227 0 54813 0 24248 0 415705 0 0 0 JAMES ECKLUND 993153 0 194250 0 1242 0 54500 0 17125 0 1260270 0 0 0 JOSEPH WATSON 594057 0 74564 0 810 0 32000 0 20815 0 722246 0 0 0 JOHN HAMILTON 495222 0 148645 0 630 0 49000 0 18702 0 712199 0 0 0 JOSEPH VOCKLEY 528107 0 229160 0 32622 0 119026 0 18494 0 927409 0 0 0 ZOBAIR YOUNOSSI 489563 0 114200 0 22479 0 112216 0 29037 0 767495 0 0 0 JAMES KIM 203159 0 30379 0 10186 0 46628 0 18216 0 308568 0 0 0 HPATRICK WALTERS 0 441419 0 0 0 23678 0 50465 0 18319 0 533881 0 0 RONALD EWALD 239953 0 50141 0 26330 0 80374 0 15478 0 412276 0 0 0 PATRICIA BYRNES SCHMEHL 197655 0 48198 0 22993 0 65854 0 26419 0 361119 0 0 0 Part I, Line 1a Employees Flint Loring and Marshall Ruffin received a temporary housing benefits which were included on their W-2s. Part I, Line 4b Part I, Line 4b: SERP Plan Payments J. Knox Singleton $229,900 Richard Magenheimer $88,500 John Gaul $73,408 Barbara Doyle $231,676 Angela Mannino $61,700 Mark Stauder $580,078 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 50, 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 119090000 See Part VI 0 0 0 B Industrial Development Authority of Fairfax County Virginia 911920228 303823FR4 2005-05-12 71520000 See Part VI 0 0 0 C Industrial Development Authority of Fairfax County Virginia 911920228 303823GL6 2009-04-16 275374313 See Part VI 1 0 0 D Industrial Development Authority of Fairfax County Virginia 911920228 303823JH2 2009-12-15 73433655 See Part VI 0 0 0 A 12580000 125531544 3604217 367125 126470203 2007 0 0 1 1 B 47850000 71520000 107241 294292 0 1 1 1 C 200785000 75040000 275374313 4384313 74595466 1 0 1 1 D 9780000 73433655 660539 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 0 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, COMUMN B EIN NUMBERS EIN numbers for Series 2005A, 2005C, 2009A, 2009C, and 2011 have been changed from 54-1470567 which are shown on Form 8038 to 91-1920228 due to IRS letter indicating EIN number. EIN numbers for Series 2012AB and 2012C have been changed from 54-1470562 which are shown on Form 8038 to 91-1920228 due to IRS letter indicating EIN number. PART I, COLUMN E ISSUE PRICE Part 1, row A, column E Issue price per Form 8038 for 2010A 190,000,000 Refunded bonds- 2010A1 to 2012C (95,000,000) Part 1, row A, column E 95,000,000 Part 1, row B, column E Issue price per Form 8038 for 2009A 350,414,313 Refunded bonds- 2009A to 2012D (75,040,000) Part 1, row B, column E 275,374,313 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 PART II, LINE 3 PROCEEDS Part II, line 3. 2005A bonds Total proceeds 119,090,000 Interest income & other deposit 6,441,544 Total 125,531,544 Part II, line 3. 2010A bonds Total proceeds 95,000,000 Interest income 1,963,599 Total 96,963,599 Part II, line 3. 2012AB bonds Total proceeds 382,960,937 Interest income 822,749 Total 383,783,686 Part II, line 3. 2012C bonds Total proceeds 145,000,000 Interest income 100,947 Total 145,100,947 PART IV, LINE 2C DATE OF REBATE COMPUTATION 2005A 5/12/2010 2005C 8/15/2006 2009A 4/16/2010 A Industrial Development Authority of Fairfax County Virginia 911920228 303823JJ8 2010-03-08 95000000 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 96963599 191160721 2012 1 0 1 1 B 12108889 54490000 1 0 1 1 C 383783686 24539518 359244168 0 0 0 1 D 145100947 9698449 40402498 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 1 0 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 A 80991559 81032980 0 1 0 1 A 0 1 0 1 1 0.00700 0.00600 0.01300 0 0 1 A 0 1 0 0 0 0 0 0 1 A 1 Robert Ahmed MD Trustee 131438 Fees paid to Dr. Ahmed to serve as the Inova Fair Oaks Hospital Medical Staff President. Half of this annual amount is paid by the Medical Staff. Services provided at arm's length and customary rates. 0 Martha Calihan MD Trustee 1142911 Loudoun Medical Group leases medical office space from Inova Health System in several locations in medical office buildings owned by Inova. Space is leased at commercial terms and at fair market value. Services provided at arm's length and customary rates. 0 Arshed Choudhry MD Trustee 84792 Medical Director Services. Services provided at arm's length and customary rates. 0 David W Gehring MD Trustee 77260 Medical Staff President expenses. Services provided at arm's length and customary rates. 0 Sarota Gopal MD Trustee 121500 Fees for physician services. Services provided at arm's length and customary rates. 0 Mary Schmidt Trustee 129167 Fees to serve as Medical Staff President. Services provided at arm's length and customary rates. 0 Mary Schmidt Trustee 622740 Fees Paid to Infectious Disease Physicians. Services provided at arm's length and customary rates. 0 George Tawill MD Trustee 140000 Medical Staff President expenses. Services provided at arm's length and customary rates. 0 PROGRAM SERVICE ACCOMPLISHMENTS 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, nursing home 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 our charity care program and referrals to 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 Guideline). In 2012 IHCS's unreimbursed cost of charity care, including free and discounted services, was $80 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, the disabled, and crippled children. The reimbursement that IHCS facilities receive from the Medicaid program routinely falls below the actual cost of services provided. During 2012, IHCS provided care to Medicaid patients at an unreimbursed cost of $50 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 and in providing certain free services to those residents the County identifies as most in need. 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 is 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 annual audited financial statements are posted on the Electronic Municipal Market Access's (EMMA) website. In addition, the quarterly financial statements of the Inova entities that are obligated to service the Inova bonds, called the Inova Health System Obligated Group (which represents the vast majority of Inova's financial results), are posted on the EMMA website within 60 days of each quarter-end, except the 4th quarter which is posted within 150 days after year-end along with Inova's fully consolidated annual audited financial statements (mentioned above). 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. HOURS WORKED PART VII, COLUMN B THE FOLLOWING INDIVIDUALS HAVE HOURS PER WEEK WORKED ON RELATED ORGANIZATIONS: J. KNOX SINGLETON, 30 HOURS JOHN GAUL, 26 HOURS RICHARD MAGENHEIMER, 26 HOURS LORING FLINT, 10 HOURS MARK STAUDER, 12 HOURS MARSHALL RUFFIN, 10 HOURS JAMES SANTRY, 10 HOURS LEWIS PASTERNAK, 10 HOURS KYLANNE SILVERSTONE, 10 HOURS JOHN NIEDERHUBER, 10 HOURS PATRICK CHRISTIANSEN, 1 HOURS JAMES KIM, 26 HOURS PATRICK WALTERS, 45 HOURS ARSHED CHOUDHRY 4 HOURS MARTHA CALIHAN, 4 HOURS ROBERT AHMED, 2 HOURS CHARLES SMITH, 4 HOURS JACK EBELER, 3 HOURS MARGARET COLON, 3 HOURS Changes in Net Assets or Fund Balances: Form 990, Part XI, line 9: PARTNERSHIP INCOME -17,041,945. CHANGE IN INVESTMENTS BALANCE -14,365,675. PRIOR PERIOD FUND BALANCE -8,502,877. EQUITY IN SUBS 10,786,617. DONATED FUNDS 277,211. CAPITAL REIMBURSEMENT 624,896. OTHER 30,776. FUND BALANCE TRANSFER DUE TO MERGER ON 12/31/12 340,041,975. NUMBER OF EMPLOYEES PART V, LINE 2A 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. AUDITED FINANCIAL STATEMENTS PART XII, LINE 2B AND 2C 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. A-133 AUDIT PART XII, LINE 3A The company is a subsidiary of the Inova Health System, a not-for-profit integrated health care delivery system serving Northern Virginia and surrounding areas. The company 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. MERGER INFORMATION Mergers Consummated as of 12/31/12: 1. Inova Alexandria Health Services Corporation into Inova Health Care Services (a) Survivor: Inova Health Care Services (b) Target: Inova Alexandria Health Services Corporation (c) Filed: December 27, 2012 (d) Effective: December 31, 2012 at 11:59pm 2. Inova Alexandria Hospital into Inova Health Care Services (a) Survivor: Inova Health Care Services (b) Target: Inova Alexandria Hospital (c) Filed: December 27, 2012 (d) Effective: December 31, 2012 at 11:59pm 3. Inova Health System Services into Inova Health Care Services (a) Survivor: Inova Health Care Services (b) Target: Inova Health System Services (c) Filed: December 27, 2012 (d) Effective: December 31, 2012 at 11:59pm INOVA CAP LLC 8110 GATEHOUSE ROAD FALLS CHURCH VA 22042 270927074 INSURANCE CAPTIVE VA 2751378 80705238 INOVA HEALTH CARE SERVICES SPRINGFIELD HEALTHPLEX CONDOMINIUM DEVELOPMENT LLC 8110 GATEHOUSE ROAD FALLS CHURCH VA 22042 274533736 REAL ESTATE VA 4055069 6868289 INOVA HEALTH CARE SERVICES INOVA HEALTH SYSTEM FOUNDATION 8110 GATEHOUSE ROAD SUITE 400W FALLS CHURCH VA 22042 541071867 FUNDRAISING VA 501(C)(3) 11,III N/A 0 INOVA VNA HOME CARE 8110 GATEHOUSE ROAD SUITE 400W FALLS CHURCH VA 22042 541277164 HOME CARE SERVICES VA 501(C)(3) 9 N/A 0 INOVA HEALTH SYSTEM SERVICES 8110 GATEHOUSE ROAD SUITE 400W FALLS CHURCH VA 22042 541434144 NURSING HOMES 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 INOVA ALEXANDRIA HEALTH SERVICES CORPORATION 8110 GATEHOUSE ROAD SUITE 400W FALLS CHURCH VA 22042 521356573 INACTIVE CORPORATION VA 501(C)(3) 11,I N/A 0 INOVA PHYSICAL REHABILITATION SERVICES 8110 GATEHOUSE ROAD SUITE 400W FALLS CHURCH VA 22042 541692089 REHABILITATION SERVICES VA 501(C)(3) 9 N/A 0 INOVA ALEXANDRIA HOSPITAL 8110 GATEHOUSE ROAD SUITE 400W FALLS CHURCH VA 22042 540505861 HOSPITAL VA 501(C)(3) 3 N/A 0 INOVA MEDICAL FOUNDATION 8110 GATEHOUSE ROAD SUITE 400W FALLS CHURCH VA 22042 541716343 MANAGED CARE INACTIVE VA 501(C)(3) 11, I N/A 0 UMC HOLDINGS INC 8110 GATEHOUSE ROAD SUITE 400W FALLS CHURCH VA 22042 541390795 URGENT CARE SERVICES VA 501(C)(3) 9 N/A 0 INOVA EMPLOYEE ASSISTANCE 8110 GATEHOUSE ROAD SUITE 400W FALLS CHURCH VA 22042 541916699 EMPLOYEE SERVICES VA 501(C)(3) 11, I 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 HEALTHCARE FOUNDATION 8110 GATEHOUSE ROAD SUITE 400W FALLS CHURCH VA 22042 542011240 FUNDRAISING VA 501(C)(3) 11, I N/A 0 LOUDOUN HEALTHCARE INC 8110 GATEHOUSE ROAD SUITE 400W FALLS CHURCH VA 22042 541361309 INACTIVE CORPORATION VA 501(C)(3) 11, I N/A 0 LHI PROPERTIES INC 8110 GATEHOUSE ROAD SUITE 400W FALLS CHURCH VA 22042 541651315 INACTIVE 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 TECHNICAL DYNAMICS LLC 8110 GATEHOUSE ROAD SUITE 400W FALLS CHURCH VA 22042 432041666 EQUIPMENT REPAIRS VA N/A RELATED 1899315 9903 0 1 0.67220 INOVA WOODBURN SURGERY CENTER LLC 8110 GATEHOUSE ROAD SUITE 400W FALLS CHURCH VA 22042 262295023 SURGERY CENTER VA N/A RELATED 36334 0 1 NORTHERN VIRGINIA SURGERY CENTER 8110 GATEHOUSE ROAD SUITE 400W FALLS CHURCH VA 22042 203502477 SURGERY CENTER VA N/A RELATED 2504021 2905945 0 1 0.62640 FRANCONIA-SPRINGFIELD SURGERY CENTER LLC 8110 GATEHOUSE ROAD SUITE 400W FALLS CHURCH VA 22042 542018390 SURGERY CENTER VA N/A RELATED 2790872 1687028 0 1 0.61240 POTOMAC INOVA HEALTHCARE ALLIANCE LLC 8110 GATEHOUSE ROAD SUITE 400W FALLS CHURCH VA 22042 541802733 RADIATION ONCOLOGY VA N/A RELATED 449287 2766525 0 1 0.50000 INOVA RESTON MRI CENTER LLC 2722 MERRILEE DRIVE SUITE 230 FAIRFAX VA 22031 264587374 MRI SERVICES VA N/A RELATED 7935724 2176604 0 1 0.65000 0 0 1 0 0 0 0 0 0 0 0 0 1 0 0 0 0 1 0 INOVA HEALTH SYSTEM FOUNDATION C 3501561 GENERAL LEDGER INOVA HEALTH SYSTEM FOUNDATION - CASH SWEEP ACCOUNT R 128580144 INTERCOMPANY BALANCE INOVA HEALTH SYSTEM FOUNDATION M 4746289 GENERAL LEDGER