2011-08-15T15:38:44-05:00 2010-09-30 ERNST & YOUNG LLP 2100 EAST CARY STREET SUITE 201 RICHMOND VA 232237078 990 2009-10-01 540261840 MARTHA JEFFERSON HOSPITAL MART 4346548198 500 MARTHA JEFFERSON DRIVE CHARLOTTESVILLE VA 22911 J Michael Burris 4346547000 2011-08-15 1 DYANN BARNES 8043446000 2009 2016-02-24 21:20:13Z X JAMES HADEN 500 MARTHA JEFFERSON DRIVE CHARLOTTESVILLE VA 22911 243032882 0 X WWW.MARTHAJEFFERSON.ORG X 1929 VA THE MISSION OF MARTHA JEFFERSON HOSPITAL IS TO IMPROVE THE HEALTH STATUS OF THE COMMUNITY BY MAINTAINING, ENHANCING AND RESTORING PERSONAL HEALTH AND WELL BEING. 12 12 1744 731 155822 0 4470903 5875354 219996078 224324967 1221717 739801 2534241 2617942 228222939 233558064 0 0 94129408 101044888 0 0 125268999 125600436 219398407 226645324 8824532 6912740 454002990 485162429 323952686 349759822 130050304 135402607 MARTHA JEFFERSON HOSPITAL IS DEDICATED TO IMPROVING THE HEALTH STATUS OF OUR COMMUNITY. WE HAVE A VISION TO SET THE STANDARD FOR CLINICAL QUALITY AND PERSONALIZED HEALTHCARE SERVICES AND ARE DEDICATED TO PROVIDING THE BEST CLINICAL QUALITY POSSIBLE WHILE MAINTAINING EXTRAORDINARY CUSTOMER SERVICE. 0 0 186245100 225739147 AT THE HEART OF MARTHA JEFFERSON'S MISSION AS A NOT-FOR-PROFIT COMMUNITY HOSPITAL IS OUR ROLE AND RESPONSIBILITY TO ADDRESS THE HEALTH NEEDS OF OUR COMMUNITY. MARTHA JEFFERSON IS ENTRUSTED WITH RESOURCES AND SKILLS THAT CAN HELP THE PEOPLE OF OUR COMMUNITY ACHIEVE AND MAINTAIN THEIR BEST POSSIBLE HEALTH. THE HOSPITAL'S BOARD OF TRUSTEES IN 2010 REAFFIRMED THE FOLLOWING COMMITMENTS THAT ARE FUNDAMENTAL TO OUR ABILITY TO MEET THESE CHALLENGES. AS AN INTEGRAL PART OF THE STRATEGIC PLANNING PROCESS, THE MISSION OF MARTHA JEFFERSON HOSPITAL WILL BE REVIEWED ALONG WITH SPECIFIC INITIATIVES, GOALS AND OBJECTIVES TO CONSIDER INCORPORATING SPECIFIC STATEMENTS AIMED AT HELPING TO RESOLVE COMMUNITY PROBLEMS ADVERSELY AFFECTING THE HEALTH STATUS OF THE COMMUNITIES WE SERVE. MARTHA JEFFERSON WILL CONDUCT, OR GAIN ACCESS TO, COMMUNITY-NEEDS ASSESSMENTS TO IDENTIFY PROBLEMS ADVERSELY AFFECTING OUR COMMUNITIES' HEALTH STATUS. MARTHA JEFFERSON WILL REGULARLY INVENTORY HOSPITAL-SPONSORED AND COMMUNITY PROGRAMS WORKING TO MEET THE IDENTIFIED NEEDS OF MEDICALLY UNDERSERVED OR DISADVANTAGED POPULATIONS. AS APPROPRIATE, THESE PROGRAMS WILL BE TRACKED AND EVALUATED FOR THEIR IMPACT ON IDENTIFIED HEALTH STATUS ISSUES. MARTHA JEFFERSON WILL REGULARLY ASSESS ITS ABILITY TO COMMIT RESOURCES, FINANCIAL AND HUMAN, TOWARD HELPING MEET IDENTIFIED NEEDS. ACCESS TO HEALTHCARE: MARTHA JEFFERSON ACCEPTS PATIENTS REGARDLESS OF THEIR ABILITY TO PAY FOR HEALTHCARE SERVICES. THE HOSPITAL ASSISTS PATIENTS WITH FINANCIAL NEEDS THROUGH THE MARTHA JEFFERSON HEALTHTRUST, A PROGRAM THAT PROVIDES A SLIDING FEE SCALE FOR HOSPITAL PATIENTS WHO QUALIFY BASED ON FAMILY INCOME UP TO 300 PERCENT OF POVERTY LEVEL. FINANCIAL ASSISTANCE IS BASED ON A REVIEW OF THE PATIENT'S FINANCIAL CIRCUMSTANCES UPON ADMISSION OR THE SERVICE DATE. BECAUSE MARTHA JEFFERSON DOES NOT PURSUE COLLECTION OF THE AMOUNTS DETERMINED TO QUALIFY AS CHARITY CARE, SUCH AMOUNTS ARE NOT REPORTED AS A COMPONENT OF PATIENT SERVICE REVENUES. MARTHA JEFFERSON DEFINES CHARITY CARE AS CARE FOR WHICH COLLECTION IS NOT ATTEMPTED (I.E. INDIGENT CARE) AND OPERATING COSTS FOR SERVICES RENDERED FOR MEDICAID PATIENTS THAT ARE IN EXCESS OF REIMBURSEMENT FROM STATE AGENCIES. THE PERCENTAGE OF PATIENTS RECEIVING SOME FORM OF CHARITY ASSISTANCE 10.10%. ADDITIONAL CHARITY CARE INFORMATION IS PROVIDED ON SCHEDULE H. IN ADDITION TO PROVIDING UNCOMPENSATED CARE, MARTHA JEFFERSON HAS ESTABLISHED SPECIAL ACCOUNTS TO PROVIDE FREE DIAGNOSTIC SERVICES FOR PATIENTS REFERRED BY THE CHARLOTTESVILLE FREE CLINIC AND THE FREE CLINIC OF GREENE COUNTY. THROUGHOUT THE YEAR, COMMUNITY HEALTH SCREENINGS AND REDUCED-FEE SERVICES PROVIDED OTHER MEANS OF ACCESS TO HEALTHCARE FOR PEOPLE ACROSS CENTRAL VIRGINIA. PHYSICIANS EMPLOYED BY MARTHA JEFFERSON HOSPITAL HAVE OFFICES THROUGHOUT CHARLOTTESVILLE AND IN SEVEN SURROUNDING COUNTIES INCLUDING ALBEMARLE, BUCKINGHAM, LOUISA, MADISON, GREENE, FLUVANNA AND NELSON, WHICH PROVIDE ACCESS TO HEALTHCARE IN MANY RURAL AREAS WITHOUT REGARD TO ONE'S ABILITY TO PAY. DURING 2010, THE MEDICAL STAFF CONSISTED OF JUST OVER 400 PHYSICIANS REPRESENTING 35 MEDICAL SPECIALTIES. MARTHA JEFFERSON HOSPITAL ALSO OPERATES AN EMERGENCY DEPARTMENT, WHICH IS STAFFED 24-HOURS A DAY/7 DAYS A WEEK BY BOARD-CERTIFIED PHYSICIANS AND SPECIALLY TRAINED NURSES AND SUPPORT STAFF. ADDITIONALLY, THE HOSPITAL OPERATES A FREE-STANDING EMERGENCY DEPARTMENT. IN FISCAL YEAR 2010, MARTHA JEFFERSON HOSPITAL SERVED THE COMMUNITY BY WAY OF 11,058 INPATIENT ADMISSIONS; 214,051 OUTPATIENT ACCOUNTS; 48,753 EMERGENCY DEPARTMENT VISITS; 6,390 OPERATING ROOM VISITS; AND 126,741 PHYSICIAN OFFICE VISITS. IN ADDITION, MARTHA JEFFERSON OFFERED OR SUPPORTED MANY PROGRAMS AND SERVICES IN OUR COMMUNITY, WHICH ARE DETAILED BELOW.EDUCATIONAL PROGRAMS: AN IMPORTANT PART OF OUR COMMUNITY OUTREACH IS CENTERED ON EDUCATIONAL PROGRAMS AND TRAINING. WHEN A FAMILY IS PREPARING TO DELIVER A BABY AT MARTHA JEFFERSON, SIBLING TOURS, BREASTFEEDING CLASSES AND PEDIATRIC CPR ARE OFFERED AS WELL AS CLASSES CENTERED ON PREPARING FOR CHILDBIRTH AND BECOMING A PARENT. ONCE THE BABY HAS BEEN DELIVERED HOWEVER, THE EDUCATION DOESN'T STOP. A BRUNCH IS HELD DAILY FOR NEW FAMILIES BEFORE THEY ARE DISCHARGED. DURING THIS TIME FAMILIES LEARN HOW TO CALM THEIR CRYING BABY, THE DANGERS OF SUDDEN INFANT DEATH SYNDROME AND HOW TO GET A BIG BROTHER OR SISTER WARMED UP TO THE IDEA OF SHARING MOM AND DAD. OTHER EDUCATIONAL CLASS OFFERINGS AT MARTHA JEFFERSON INCLUDE, POSTOPERATIVE BREAST REHABILITATION, PREPARING FOR A HYSTERECTOMY, POST-HYSTERECTOMY REHAB, ADVANCED MEDICAL PLANNING, STRESS MANAGEMENT, UNDERSTANDING VASCULAR DISEASE, WISDOM OF THE HEART, CARDIAC REHABILITATION AND PULMONARY REHABILITATION.CONTINUED IN PROGRAM SERVICE TWO CONTINUED FROM PROGRAM SERVICE ONESCHOOL PROGRAMS: MARTHA JEFFERSON HOSPITAL UNDERSTANDS MANY OF THE HEALTH DECISIONS WE MAKE AS ADULTS ARE A RESULT OF THE SITUATIONS WE EXPERIENCE AS CHILDREN. THROUGH OUR SCHOOLS PROGRAM WE ARE ABLE TO TEACH CHILDREN AND LEAVE AN IMPRESSION THAT WILL HOPEFULLY STAY WITH THEM AS THEY GROW UP.IN OUR ELEMENTARY SCHOOL OUTREACH, AN EMPLOYEE OF MARTHA JEFFERSON ENGAGES STUDENTS IN THEIR CLASSROOM IN LESSONS ON HEALTH AND WELLNESS THAT DIRECTLY RELATE TO THE VIRGINIA STANDARDS OF LEARNING TEST. FOR THE TEENAGE POPULATION, MARTHA JEFFERSON PROVIDES A COMMUNITY BASED VOCATIONAL EDUCATION TRAINING PROGRAM FOR ALBEMARLE HIGH SCHOOL GRADUATES AND SEVERAL SHORT CAMPS THROUGHOUT THE YEAR TO EXPOSE INTERESTED STUDENTS TO THE HEALTHCARE FIELD. PROFESSIONAL EDUCATION SUPPORT: AS A WAY TO PROVIDE CONTINUED PROFESSIONAL EDUCATION, MARTHA JEFFERSON FUNDS A UNIVERSITY OF VIRGINIA CLINICAL INSTRUCTOR FACULTY POSITION TO FACILITATE EIGHT UNDERGRADUATE BSN NURSING STUDENTS' CLINICAL EXPERIENCES EACH SEMESTER AT MARTHA JEFFERSON. IN ADDITION, THE HOSPITAL SUPPORTS THE PIEDMONT VIRGINIA COMMUNITY COLLEGE REGISTERED NURSE AND CODING PROGRAMS, THE UNIVERSITY OF VIRGINIA SCHOOL OF NURSING CLINICAL FACULTY AND PROVIDES CLINICAL PLACEMENTS FOR NURSING STUDENTS OF UVA, JMU, PVCC AND CATEC.HOSPITAL SERVICES: MARTHA JEFFERSON HOSPITAL OFFERS MANY PROGRAMS THAT HELP PATIENTS BOTH GET ACCLIMATED WITH OUR SYSTEM, AND ALSO NAVIGATE THE HOSPITAL AS NEEDS ARISE.HEALTH CONNECTION, OUR PHYSICIAN REFERRAL, PATIENT EDUCATION AND INFORMATION SERVICE TAKES 150 CALLS ON A DAILY BASIS. THEY'RE ABLE TO HELP NEW MEMBERS OF THE COMMUNITY FIND A PHYSICIAN, ENROLL PEOPLE IN THE VARIOUS CLASSES THE HOSPITAL OFFERS AND PROVIDE SUPPORT FOR SPECIFIC MEDICAL NEEDS.FOR PEOPLE UNDERGOING CANCER TREATMENTS AT MARTHA JEFFERSON HOSPITAL, WE PROVIDE A CANCER CARE CENTER. THE CENTER SERVES AS A RESOURCE FOR PATIENTS FROM THE MOMENT THEY ARE DIAGNOSED THROUGH THEIR ENTIRE LINE OF INTERACTIONS AT THE HOSPITAL, AND IN MANY CASES EVEN CONTINUES AFTER THEY ARE ARE NO LONGER COMING FOR VISITS. TWO STAFF MEMBERS ARE DEDICATED TO HELPING PATIENTS DEAL WITH THE EMOTIONS THAT GO ALONG WITH BEING DIAGNOSED WITH CANCER, FITTING THEM WITH COMPLIMENTARY WIGS AND SCARVES TO USE DURING TREATMENT AND JUST BEING FRIENDS THROUGHOUT THE PROCESS.MARTHA JEFFERSON HOSPITAL ALSO OFFERS A PALLIATIVE CARE PROGRAM. WHEN A PERSON IS FACING A SERIOUS OR ADVANCING ILLNESS, THE ACCOMPANYING PHYSICAL, EMOTIONAL AND SPIRITUAL ISSUES CAN DRAMATICALLY AFFECT THE EXPERIENCE AND OFTEN QUALITY OF LIFE FOR PATIENTS AND LOVED ONES. OVER THE PAST FOUR YEARS MORE THAN 1.000 LOCAL FAMILIES HAVE BENEFITTED FROM CONSULTATIONS BY A MULTIDISCIPLINARY TEAM PROVIDING PALLIATIVE CARE AT MARTHA JEFFERSON HOSPITAL. THE CAREGIVERS FOCUS ON DELIVERING A UNIQUE COMBINATION OF SPECIAL EXPERTISE IN PAIN AND SYMPTOM MANAGEMENT AND COORDINATE CARE AMONG A MULTIPLICITY OF PHYSICIANS INVOLVED WHEN AN INDIVIDUAL IS SERIOUSLY ILL AND DEDICATE THE TIME NEEDED FOR PATIENT-FAMILY COMMUNICATION ABOUT GOALS OF CARE AND THE EMOTIONAL AND SPIRITUAL STRUGGLES THAT OFTEN ACCOMPANY A LIFE-CHANGING ILLNESS. IN ADDITION TO THE ABOVE MENTIONED PROGRAMS, MARTHA JEFFERSON HOSPITAL ALSO OFFERS THE FOLLOWING: CHAPLAINCY PROGRAM, PATIENT ADVOCATE PROGRAM, HEALTH INFORMATION PUBLICATIONS, WEBSITE WITH INTEGRATED HEALTH INFORMATION (WWW.MARTHAJEFFERSON.ORG), A HEALTH SOURCE LIBRARY AND A WOMEN'S MIDLFE RESOURCE CENTER. MARTHA JEFFERSON HOSPITAL HELD 'UNWANTED MEDICATION TAKE BACK DAY' WHICH WAS A DRIVE-THROUGH EVENT ALLOWING ANY AND ALL IN OUR COMMUNITY TO DROP OFF UNWANTED MEDICATIONS AND MEDICAL SHARPS FOR PROPER DISPOSAL.COMMUNITY EVENTS AND HEALTH SCREENINGS: HEALTH SCREENINGS ARE AN IMPORTANT SERVICE OFFERED BY MARTHA JEFFERSON. THE FOLLOWING SCREENINGS ARE HELD ANNUALLY: PROSTATE SCREENING, SKIN CANCER SCREENING, BREAST HEALTH SCREENING, DIABETES SCREENING, PERIPHERAL ARTERIAL DISEASE SCREENING.IN ADDITION TO THE SCREENING EVENTS, WE ALSO HOST EVENTS FOR THE COMMUNITY THAT PROMOTE WELLNESS. EACH SPRING THE CELEBRATION OF LIFE IS HELD FOR CANCER PATIENTS, SURVIVORS AND THEIR FAMILIES. THE AFTERNOON IS FILLED WITH FOOD, SALSA DANCING, GAMES AND MUSIC AND PROVIDES A CHANCE FOR MEMBERS OF THE COMMUNITY TO CELEBRATE THEIR LIFE. WE ALSO HOLD FOOD AND SHOE DRIVES TO HELP PROVIDE MUCH NEEDED ITEMS TO PEOPLE IN OUR COMMUNITY. ANNUALLY, WE HOST THE MJ8K RUN AND WALK TO BENEFIT COMMUNITY EDUCATION SERVICES AND MARTHA'S MARKET, WHICH HELPS FUND CANCER SERVICES AND SUPPORT WELLNESS INITIATIVES.NUTRITION PROGRAMS: AS HEALTHCARE PROVIDERS, OUR GOAL IS TO KEEP THE MEMBERS OF OUR COMMUNITY HEALTHY AND FEELING WELL. AT MARTHA JEFFERSON HOSPITAL WE OFFER A VARIETY OF PROGRAMS THAT ALLOW PEOPLE ACCESS TO INFORMATION THAT THEN HELPS THEM MAKE EDUCATED NUTRITION CHOICES.FOR STARTERS, ONE OF OUR REGISTERED DIETICIANS TAKES LEARNING ON LOCATION THROUGH OUR SUPERMARKET SMARTS CLASSES. THROUGH A PARTNERSHIP WITH GIANT FOOD, PEOPLE ARE ABLE TO GET HANDS-ON EXPERIENCE WHEN IT COMES TO MAKING HEALTHY DECISIONS AT THE GROCERY. WE ALSO PROVIDE HEART HEALTHY NUTRITION, DIABETES NUTRITION AND NUTRITION TIPS FOR INDIVIDUALS WITH CANCER.IN ADDITION TO OUR CLASSES, MARTHA JEFFERSON HAS A PRESENCE ACROSS THE LOCAL MEDIA AIRWAVES. NUTRITION TIPS AND TIMELY INFORMATION IS GIVEN BY ONE OF OUR REGISTERED DIETICIANS THROUGH DAILY RADIO SPOTS, A WEEKLY TELEVISION SEGMENT, AND VARIOUS PRINT OPPORTUNITIES.SUPPORT GROUPS: MARTHA JEFFERSON HOSPITAL OFFERS SUPPORT GROUPS OF A WIDE VARIETY TO OUR PATIENTS AND MEMBERS OF THE COMMUNITY. GROUPS MEET ON A REGULAR BASIS AND HELP PROVIDE A SAFE COMMUNITY WHERE PEOPLE CAN SHARE STORIES, REFLECT ON THEIR EXPERIENCES, AND GAIN KNOWLEDGE FROM WHAT OTHERS ARE GOING THROUGH. THE FOLLOWING ARE JUST SOME OF THE TOPICS WE OFFER: WELCOME TO MOTHERHOOD, BREAST CANCER SUPPORT, FAMILY CANCER SUPPORT, HODGKIN'S AND LYMPHOMA SUPPORT, LOOK GOOD...FEEL BETTER, BETTER BREATHERS AND SLEEP APNEA SUPPORT.PROGRAM SUPPORT/UNDERWRITING: MARTHA JEFFERSON PROVIDES MEDICAL IMAGING, LABORATORY SERVICE AND OUTPATIENT DIAGNOSTIC SERVICE ACCESS TO THE CLIENTS OF THE CHARLOTTESVILLE FREE CLINIC (CFC) AND GREENE FREE CLINIC (GFC). THIS ACCESS SUPPORTS PRIMARY CARE SERVICES FOR THE WORKING UNINSURED MEMBERS OF OUR COMMUNITIES. THE HOSPITAL IS ALSO DEDICATED TO SUPPORTING HEADSTART WHICH FOCUSES ON CHILD DENTAL SERVICES AND GIVES IN-KIND DONATIONS TO HABITAT FOR HUMANITY AND THE WOMEN'S INITIATIVE. 186245100 1 1 0 1 0 0 0 0 0 1 1 1 0 0 1 0 0 0 1 0 1 0 0 1 1 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 1 1 0 0 1 162 0 1744 1 1 1 1 CJ 0 0 0 1 1 0 0 0 12 12 0 0 0 0 1 1 1 1 1 0 0 0 1 1 1 1 1 1 1 1 0 VA X J MICHAEL BURRIS CHIEF FINANCIAL OFFICER 4346547304 500 MARTHA JEFFERSON DRIVE CHARLOTTESVILLE VA 22911 JOHN P CHAMALES 2.00 X 0 0 0 JAMES P CRAIG 2.00 X 0 0 0 DR GREGORY G DEGNAN 2.00 X 0 0 0 MARK GILES 2.00 X 0 0 0 CAROL B HURT 2.00 X X 0 0 0 ARTHUR KISER 2.00 X 0 0 0 DR R HUNT MACMILLAN II 2.00 X 0 0 0 DR KEVIN R MCCONNELL 2.50 X X 0 0 0 DR JOSEPH ORLICK 2.00 X 0 0 0 KATHRYN B PARKER 2.00 X 0 0 0 DR TIMOTHY B SHORT 2.00 X 0 0 0 DR BURKHARD SPIEKERMANN 2.00 X 0 0 0 JAMES E HADEN 65.00 X 606715 0 242936 AMY BLACK 65.00 X 230040 0 61766 J MICHAEL BURRIS 65.00 X 277725 0 113086 ELLIOT H KUIDA 65.00 X 329068 0 57383 MARIJO LECKER 65.00 X 245556 0 63131 RONALD J COTTRELL 65.00 X 238414 0 93701 FINLAY M ASHBY 65.00 X 239638 0 48511 SUSAN CABELL MAINS 65.00 X 220906 0 144716 RAY R MISHLER 65.00 X 180350 0 97983 DEBORAH L THEXTON 65.00 X 165663 0 46453 SANDEEP TEJA 40.00 X 515516 0 38124 JOHN Z EDWARDS 40.00 X 473571 0 30111 CHRISTOPHER D WILLMS 40.00 X 369120 0 31097 MICHAEL TRAHAN 40.00 X 324047 0 36991 ALEXANDER A GRUNSFELD 40.00 X 313818 0 27867 4730147 0 1133856 116 0 1 0 MA MORTENSON COMPANY 17975 WEST SARAH LANE BROOKFIELD WI 53045 CONSTRUCTION 110726758 KAHLERSLATER 111 W WISCONSIN AVENUE MILWAUKEE WI 532032501 ARCHITECTS 2413567 QUEST DIAGNOSTICS 12436 COLLECTIONS CENTER DRIVE CHICAGO IL 606932436 LAB SERVICES 1366447 INSCRIBE LLC PO BOX 1427 MURRAY KY 42071 TRANSCRIPTION SERVICE 752868 BERGMAN GROUP 4880 SADLER ROAD SUITE 220 GLEN ALLEN VA 23060 MARKETING/COMMUNICATIONS 647449 45 295126 5580228 2570374 5875354 PATIENT SERVICES 621500 224324967 224226954 98013 224324967 489610 57809 431801 312289 312289 1892703 2171228 -278525 -278525 -278525 7134337 7196435 -62098 -62098 -62098 145632 295126 107155 38477 38477 CAFETERIA & GIFT SHOP 722210 1165918 1165918 PURCHASE DISCOUNTS 900099 729273 729273 PHYSICIAN TELEPHONE SV 621110 111471 111471 851328 671449 179879 2857990 233558064 225739147 155822 1787741 2734076 2734076 72665955 68642217 4023738 4907309 4143408 763901 15036783 13225765 1811018 5700765 5217475 483290 1066711 1066711 575444 14855 560589 461110 220295 240815 14031017 10032397 3998620 647061 638651 8410 44702790 43981740 721050 4391891 3295592 1096299 4875347 4758985 116362 190825 150744 40081 123441 86042 37399 3408414 3408414 17285368 11691932 5593436 1693443 933648 759795 PROV FOR BAD DEBT 13896371 13897797 -1426 INTEREST RATE SWAP 11927993 11927993 EQUIPMENT MAINTENANCE 3755496 3570679 184817 DUES & SUBSCRIPTIONS 1204179 487485 716694 RECRUITMENT 625040 234195 390845 738495 -45513 784008 226645324 186245100 40400224 0 43201091 93355036 20011584 21315310 5263815 2417703 3036176 3422784 2878310 2843927 407747437 110584994 181762724 297162443 52760119 145089171 64645226 454002990 485162429 89633867 88869316 232718819 230148275 1600000 30742231 323952686 349759822 X 105190678 131166311 24362359 3696776 497267 539520 130050304 135402607 454002990 485162429 X 0 1 1 X 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 1 132 0 1 22036 22168 0 Part II-B, Line 1i: Explanation of Other Lobbying Activities: $20,036 REPRESENTS A PORTION OF MJH'S DUES PAID TO VIRGINIA HOSPITAL AND HEALTHCARE ASSOCIATION (VHHA) ALLOCABLE TO LOBBYING ACTIVITIES CONDUCTED BY VHHA. DUES TO VHHA TOTALED $86,849. THE REMAINING $2,000 REPRESENTS THE LOBBYING PORTION OF DUES PAID TO MEDICAL ASSOCIATIONS ON BEHALF OF MJH EMPLOYEES. 17983188 17983188 42494943 16556806 25938137 116657018 93907755 22749263 230612288 120433 230491855 297162443 RESTRICTED CASH 32592652 MISCELLANEOUS ACCOUNTS RECEIVABLE 369244 DEBT SERVICE RESERVE FUND 6401895 PREPAID BOND ISSUANCE COSTS 1431380 SINKING FUNDS 2950857 INTEREST FUNDS 10084431 CHARITABLE TRUSTS 1347807 DEPOSITS 257599 INVESTMENTS - JOINT VENTURES 3819361 ASSETS HELD FOR SALE 5390000 64645226 CLAIMS ACCRUAL 1250000 PENSION LIABILITY 28516121 CAPITAL LEASE OBLIGATIONS 976110 30742231 233558064 226645324 6912740 -1560437 -1560437 5352303 228962081 2536 26533 -1667019 -1637950 230600031 2958033 2958033 233558064 214478937 26533 26533 214452404 12192920 12192920 226645324 Part XI, Line 8 - Other Adjustments: TRANSFER FROM MJH FOUNDATION INCREASE IN ADDITIONAL MINIMUM PENSION LIABILITY NET UNREALIZED GAINS ON CHARITABLE TRUSTS NET UNREALIZED GAINS ON INVESTMENTS Part XII, Line 2d - Other Adjustments: NET ASSETS RELEASED FROM RESTRICTIONS RESTRICTED EXPENSES INTEREST RATE SWAP VALUATION NON-OPERATING REVENUES (NET) Part XII, Line 4b - Other Adjustments: RESTRICTED CONTRIBUTIONS DEEMED DIVIDEND Part XIII, Line 4b - Other Adjustments: RESTRICTED EXPENSES INTEREST RATE SWAP VALUATION DEEMED DIVIDEND PART XI, LINE 10 REPRESENTS THE CHANGE IN NET ASSETS NOT THE CHANGE IN NET INCOME PER THE AUDITED FINANCIAL STATEMENTS. THE FINANCIAL STATEMENTS ARE PREPARED FOR MARTHA JEFFERSON HOSPITAL WHICH INCLUDES THEIR BENEFICIAL INTEREST IN MJH FOUNDATION. THE CHANGE IN NET ASSETS ABOVE REPRESENTS THE SEPARATE ACTIVITY FOR MARTHA JEFFERSON HOSPITAL. CENTRAL AMERICA AND THE CARIBBEAN PROGRAM SERVICES INSURANCE CAPTIVE 160000 EUROPE PROGRAM SERVICES INVESTMENT 0 0 0 160000 Schedule F, Part IV Other Information AS OF SEPTEMBER 30, 2010 MARTHA JEFFERSON HOSPITAL HAS A 17% OWNERSHIP IN VIRGINIA SOLUTION SPC LTD, AN INSURANCE CAPTIVE, WHICH OPERATES IN THE CAYMAN ISLANDS. IN ACCORDANCE WITH MARTHA JEFFERSON HOSPITAL'S INTEREST RATE SWAP AGREEMENTS WITH UBS, MARTHA JEFFERSON HOSPITAL IS REQUIRED TO PROVIDE COLLATERAL WHEN THE FAIR VALUE OF THE SWAP AGREEMENTS EXCEEDS A PREDETERMINED THRESHOLD AMOUNT. WHEN MARTHA JEFFERSON IS REQUIRED TO PROVIDE COLLATERAL, IT IS HELD BY UBS AND EARNS INTEREST. 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PHYSICIAN CLINIC MJ ORTHOPAEDICS

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DURABLE MEDICAL EQUIPMENT MJ MEDICAL ONCOLOGY ASSOCIATES

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PHYSICIAN CLINIC Part I, Line 7: A COMBINATION OF A RATIO OF COSTS TO CHARGES AND A COST ACCOUNTING PROCESS WHICH ADDRESSES ALL PATIENT SEGMENTS (INPATIENT, OUTPATIENT, EMERGENCY ROOM, PRIVATE INSURANCE, MEDICARE, MEDICAID, UNINSURED AND SELF PAY) WAS USED TO DETERMINE ALL AMOUNTS REPORTED ON LINE 7. Part I, Line 7g: INCLUDES PRIMARY CARE PRACTICES COSTS OF $7,158,547. Part I, Line 7f: THE AMOUNT OF BAD DEBT EXPENSE SUBTRACTED FROM THE DENOMINATOR WHEN CALCULATING COLUMN F PERCENTAGES IS $13,896,371. Part III, Line 4: CHARITY AND UNCOMPENSATED CARE: THE HOSPITAL'S POLICY IS TO PROVIDE NECESSARY MEDICAL CARE WITHOUT REGARD TO THE PATIENT'S ABILITY TO PAY FOR SUCH SERVICES. CHARITY CARE IS BASED ON A REVIEW OF THE PATIENT'S FINANCIAL CIRCUMSTANCES UPON ADMISSION OR SERVICE DATE. BECAUSE THE HOSPITAL DOES NOT PURSUE COLLECTION OF THE AMOUNTS DETERMINED TO QUALIFY AS CHARITY CARE, SUCH AMOUNTS ARE NOT REPORTED AS A COMPONENT OF NET PATIENT SERVICE REVENUE.THE HOSPITAL DEFINES UNCOMPENSATED CARE AS CARE FOR WHICH COLLECTION IS NOT ATTEMPTED (I.E., CHARITY CARE), OPERATING COSTS FOR SERVICES RENDERED FOR MEDICAID PATIENTS THAT ARE IN EXCESS OF REIMBURSEMENT AND PROVISION FOR BAD DEBTS. DISTINGUISHING UNCOLLECTED PATIENT REVENUE BETWEEN CHARITY AND BAD DEBT REQUIRES FULL CONSIDERATION OF BOTH THE FINANCIAL AND NONFINANCIAL CIRCUMSTANCES OF THE PATIENT, WHICH ARE NOT ALWAYS AVAILABLE TO THE ORGANIZATION. THEREFORE, BOTH TRADITIONAL CHARITY CARE AND BAD DEBT ARE INCLUDED AS A COMPONENT OF UNCOMPENSATED CARE. THE FOLLOWING DEPICTS THE LEVEL OF UNCOMPENSATED CARE PROVIDED FOR THE YEAR ENDED SEPTEMBER 30, 2010 (IN THOUSANDS): CHARITY CARE CHARGES FOREGONE, BASED ON ESTABLISHED RATES $9,451; ESTIMATED COSTS INCURRED TO PROVIDE CHARITY CARE $4,189; ESTIMATED UNPAID COSTS OF MEDICAID PROGRAMS $1,128; PROVISION FOR BAD DEBTS $13,896; COMMUNITY BENEFIT PROGRAMS $242; TOTAL COSTS OF UNCOMPENSATED CARE $19,455.THE HOSPITAL ANNUALLY BUDGETS HUMAN AND FINANCIAL RESOURCES THROUGH ITS COMMUNITY HEALTH PARTNERSHIP PROGRAM FOR IDENTIFIED SERVICES THAT POSITIVELY IMPACT HEALTH STATUS OR BURDENING COMMUNITY HEALTH ISSUES INCLUDING COMMUNITY OBESITY INITIATIVES; DENTAL SERVICES TO LOW-INCOME CHILDREN; BREAST HEALTH PROGRAMS PROVIDING FREE MAMMOGRAPHY SERVICES; AND REFERRAL SERVICES WITH THE CHARLOTTESVILLE FREE CLINIC, INCLUDING FREE DIAGNOSTIC TESTING IN CARDIAC, LABORATORY, AND RADIOLOGY SERVICES.A RATIO OF COSTS TO CHARGES WAS USED TO DETERMINE THE COST OF BAD DEBT. BAD DEBT SHOULD BE INCLUDED IN COMMUNITY BENEFIT AS HOSPITALS OFTEN FACE A BARRIER TO CLASSIFYING A PATIENT ACCOUNT AS CHARITY CARE DUE TO THEIR ABILITY TO OBTAIN FROM PATIENTS THE NECESSARY INFORMATION TO EVALUATE THEIR ELIGIBILITY FOR CHARITY CARE. AS SUCH, SOME PORTION OF BAD DEBT EXPENSE MAY, IN FACT, MORE ACCURATELY BE CONSIDERED TO BE CHARITY CARE. Part III, Line 8: THE MEDICARE COST REPORT WAS USED TO DETERMINE THE MEDICARE COSTS REPORTED ON LINE 6. MEDICARE MARGINS HAVE BEEN DECLINING AT THE SAME TIME THAT HOSPITALS HAVE BEEN ENGAGED IN CONCERTED EFFORTS TO IMPROVE EFFICIENCY, WHICH POINTS TO THE FACT THAT THE LOSSES ARE MOST LIKELY THE RESULT OF INADEQUATE REIMBURSEMENT BY THE FEDERAL GOVERNMENT, THUS, SHOULD BE INCLUDED IN COMMUNITY BENEFIT. Part III, Line 9b: IT IS THE POLICY OF MARTHA JEFFERSON HOSPITAL TO REVIEW ACOUNTS TO ENSURE ALL POSSIBLE METHODS OF PAYMENT HAVE BEEN EXHAUSTED, I.E., MEDICAL ASSISTANCE, FINANCIAL ASSISTANCE, PAYMENT PLANS, AND PROMPT PAY DISCOUNTS, PRIOR TO AN ACCOUNT BEING DEEMED AS "BAD DEBT".FINANCIAL ASSISTANCE PROGRAMS: IF YOU HAVE A BALANCE DUE AND ARE UNABLE TO PAY, YOU MAY QUALIFY FOR ONE OF MARTHA JEFFERSON'S FINANCE ASSISTANCE PROGRAMS LISTED BELOW. YOUR ABILITY TO CONTRIBUTE TO THE COST OF YOUR CARE WILL BE EVALUATED AND ALLOWANCES WILL BE MADE FOR EXTENUATING CIRCUMSTANCES BASED ON GOOD FAITH EFFORTS AND MITIGATING FACTORS. THE EVALUATION WILL BE BASED ON INCOME, FAMILY SIZE, AND AMOUNT OF MEDICAL BILLS. THE FINANCIAL COUNSELORS AT MARTHA JEFFERSON MAY REACH OUT TO YOU TO ASK IF YOU WOULD LIKE TO APPLY FOR FINANCIAL ASSISTANCE. YOU MAY REQUEST ASSISTANCE PRIOR TO, DURING, OR SUBSEQUENT TO RECEIVING YOUR SERVICE. PLEASE CONTACT A FINANCIAL COUNSELOR AT 434-654-8186, 434-654-7485 OR BY EMAILING PATFINSER@MJH.ORG.1. FREE ASSISTANCE IN APPLYING FOR MEDICAID THROUGH THE DEPARTMENT OF MEDICAL ASSISTANCE SERVICES OR SUPPLEMENTAL SOCIAL SECURITY BENEFITS.2. A SLIDING SCALE DISCOUNT IS PROVIDED TO PATIENT WHOSE FAMILY INCOME FALLS AT OR BELOW 300% OF THE CURRENT FEDERAL POVERTY GUIDELINES, WHICH IS UPDATED ANNUALLY.3. SHORT-TERM PAYMENT PLAN4. DISCOUNTS APPLIED TO OUTSTANDING BALANCES FOR PAYMENTS MADE WITHIN 15 BUSINESS DAYS OF RECEIPT OF BILL.YOU WILL CONTINUE TO RECEIVE BILLS UNTIL ELIGIBILITY UNDER ONE OF THESE PROGRAMS HAS BEEN DETERMINED. YOUR ASSISTANCE IS REQUIRED IN DETERMINING ELIGIBILITY. Part VI, Line 2: MARTHA JEFFERSON WAS INVITED BY THE THOMAS JEFFERSON HEALTH DISTRICT TO PARTICIPATE ON THE STEERING COMMITTEE OF THE CITY OF CHARLOTTESVILLE/ALBEMARLE COUNTY COMMUNITY HEALTH STATUS ASSESSMENT. THE STEERING COMMITTEE WAS INCLUSIVE, WITH REPRESENTATIVES FROM ALL LOCAL AGENCIES AND ORGANIZATIONS THAT IMPACT THE OVERALL HEALTH OF OUR COMMUNITY. THE PURPOSE OF COMMUNITY HEALTH STATUS ASSESSMENT WAS TO ANSWER THREE MAIN QUESTIONS: 1) WHO COMPRISES THE COMMUNITY, AND WHAT DO THE COMMUNITY MEMBERS BRING TO THE TABLE? 2) WHAT ARE THE STRENGTHS AND RISK FACTORS IN THE COMMUNITY THAT CONTRIBUTE TO HEALTH? 3) WHAT IS THE STATUS OF THE COMMUNITY?THIS ASSESSMENT WAS PUBLISHED IN 2008 AND CAN BE FOUND ON THE THOMAS JEFFERSON HEALTH DISTRICT'S WEBSITE LOCATED AT WWW.VDH.STATE.VA.US/LHD/THOMASJEFFERSON.WE ARE CURRENTLY PLANNING A SIMILAR COLLABORATIVE EFFORT TO MEET THE REQUIREMENTS FOR A NEW ASSESSMENT BY OCTOBER 2013. Part VI, Line 3: THE HOSPITAL PROVIDES PAMPHLETS AT REGISTRATION AREAS, PAYMENT AREAS AND WAITING ROOMS DESCRIBING THE HOSPITAL'S BILL AND FINANCIAL ASSISTANCE. IN ADDITION, INFORMATION IS AVAILABLE ON THE HOSPITAL'S WEBSITE DISCUSSING ELIGIBILITY CRITERIA FOR FINANCIAL ASSISTANCE, THE FULL FINANCIAL ASSISTANCE POLICY, AS WELL AS INFORMATION ON THE APPLICATION PROCESS. Part VI, Line 4: MARTHA JEFFERSON HOSPITAL SERVES THE THOMAS JEFFERSON AREA PLANNING DISTRICT (PD10), INCLUDING THE CITY OF CHARLOTTESVILLE, AND THE COUNTIES OF ALBEMARLE, FLUVANNA, GREENE, LOUISA, AND NELSON, ALL OF WHICH ARE FEDERALLY-DESIGNATED MEDICALLY UNDERSERVED AREAS. THIS DISTRICT INCLUDES URBAN, RURAL AND SUBURBAN GEOGRAPHIC AREAS. PD10 CONSISTS OF APPROXIMATELY 230,000 PEOPLE (U.S. CENSUS BUREAU 2009), WITH ALBEMARLE COUNTY BY FAR THE MOST HIGHLY POPULATED AREA, DISTANTLY FOLLOWED BY THE CITY OF CHARLOTTESVILLE AND THE OTHER COUNTIES. IN GENERAL, THE PLANNING DISTRICT IS GROWING IN POPULATION, WITH AN INCREASE OF OVER 30,000 PEOPLE FROM 2000-2009 (U.S. CENSUS BUREAU 2009). APPROXIMATELY 75 PERCENT OF CITY RESIDENTS AND 90 PERCENT OF ALBEMARLE COUNTY RESIDENTS LIVE ABOVE THE FEDERAL POVERTY LEVEL, WITH CHILDREN BEING THE MOST AFFECTED GROUP BY AGE OF PERSONS LIVING IN POVERTY. WHILE ABOUT 10 PERCENT OF CITY HOUSEHOLDS RECEIVE ASSISTANCE THROUGH FOOD STAMPS, OVER 50 PERCENT OF CITY SCHOOL CHILDREN QUALIFY FOR FREE OR REDUCED-COST LUNCH PROGRAMS (2008 CITY OF CHARLOTTESVILLE/ALBEMARLE COUNTY COMMUNITY HEALTH STATUS ASSESSMENT). MEDICAID AND SELF PAY PATIENTS COMPRISE APPROXIMATELY 9% OF THE HOSPITAL'S PATIENTS. THE COMMUNITY IS SERVED BY TWO HOSPITALS. Part VI, Line 5: WE OFFER A VARIETY OF COMMUNITY BUILDING ACTIVITIES INCLUDING THOSE DESIGNED TO HELP MEET THE BASIC NEEDS OF OUR COMMUNITY SUCH AS FOOD DRIVES AND OUR SHOES FOR THE HOMELESS ANNUAL CAMPAIGN. WE OFFER AN ANNUAL CELEBRATION OF LIFE EVENT FOR CANCER SURVIVORS TO GIVE THEM THE OPPORTUNITY TO INTERACT WITH THE PHYSICIANS AND STAFF WHO WERE RESPONSIBLE FOR THEIR CARE. WE HAVE HAD THREE ANNUAL UNWANTED MEDICATION AND SHARPS DROP-OFF EVENTS. WE HAVE STEADILY INCREASED THE AMOUNT OF MEDICAITONS AND SHARPS WE ARE TAKING OUT OF HOMES IN OUR COMMUNITY AT EACH EVENT. Part VI, Line 6: MARTHA JEFFERSON FURTHERS ITS EXEMPT PURPOSE BY PROMOTING THE HEALTH OF THE COMMUNITY THROUGH WORKPLACE HEALTHY INITIATIVES, AN OPEN MEDICAL STAFF, BOARDS OF DIRECTORS COMPRISED OF COMMUNITY MEMBERS AND PHYSICIANS, CHARITY CARE POLICIES AND OUTREACH, AND USE OF SURPLUS FUND DISPERSAL. WORKFORCE DEVELOPMENT PROGRAMS CONTINUED AS DID OUR SUPPORT OF ORGANIZATIONS CHAMPIONING CHILD DENTAL, INDIGENT PRESCRIPTION DRUG, COMMUNITY MENTAL HEALTH SERVICES AND FREE CLINIC ACCESS EFFORTS.MARTHA JEFFERSON HOSPITAL STAFF SERVE ON COMMITTEES AND BOARDS RELATED TO COMMUNITY HEALTH INCLUDING THE CHARLOTTESVILLE FREE CLINIC, JEFFERSON AREA BOARD FOR AGING, THE SENIOR CENTER, THE CHARLOTTESVILLE OBESITY TASK FORCE, HOSPICE OF THE PIEDMONT, AND THE WOMEN'S INITIATIVE. PARTNERSHIPS ARE IMPORTANT TO US. WE PARTNER WITH ORGANIZATIONS THAT HAVE A TRACK RECORD OF IMPROVING HEALTH IN OUR COMMUNITY INCLUDING BUT NOT LIMITED TO THE CHARLOTTESVILLE FREE CLINIC, GREENE FREE CLINIC, CHARLOTTESVILLE/ALBEMARLE RESCUE SQUAD, THE UNITED WAY, AND THE WOMEN'S INITIATIVE (MENTAL HEALTH SERVICES). WE MAXIMIZE OUR REACH THROUGH FINANCIAL AND IN-KIND DONATIONS TO ORGANIZATIONS SUCH AS THE CHARLOTTESVILLE CITY SCHOOLS, HOSPICE OF THE PIEDMONT, JEFFERSON AREA BOARD FOR AGING AND HEAD START PROGRAMS IN SEVERAL SURROUNDING COUNTIES. OUR PARTNERSHIPS HELP BUILD AND STRENGTHEN EXISTING PROGRAMS, AS WELL AS LEADING TO THE DEVELOPMENT OF NEW PROGRAMS. OUR PARTNERSHIPS WITH OTHER NON-PROFITS IN THE COMMUNITY ALSO HELP US STAY ABREAST OF COMMUNITY NEEDS.MARTHA JEFFERSON HOSPITAL WELCOMES AND ENCOURAGES SIGNIFICANT COMMUNITY INVOLVEMENT THROUGH THE ESTABLISHMENT OF NUMEROUS GOVERNING COMMITTEES AND A COMMUNITY LEADERSHIP COUNCIL. THERE ARE 100 COMMUNITY MEMBERS ANNUALLY INVOLVED DIRECTLY WITH THESE COMMITTEES.MARTHA JEFFERSON HOSPITAL MAINTAINS AN OPEN MEDICAL STAFF TO ALL WHO SEEK PRIVILEGES HERE. THERE ARE OVER 450 PHYSICIANS AND ALLIED STAFF ON THE MARTHA JEFFERSON HOSPITAL MEDICAL STAFF.MARTHA JEFFERSON HOSPITAL UTILIZES SURPLUS FUNDS TO PURCHASE MEDICAL EQUIPMENT AND FACILITIES DESIGNED TO MEET THE NEEDS OF THE COMMUNITY IT SERVES. Part VI, Line 7: MARTHA JEFFERSON HOSPITAL MAINTAINS, ENHANCES AND RESTORES PERSONAL HEALTH AND WELL-BEING THROUGH: HIGHLY-INDIVIDUALIZED CARE AND ATTENTION TO PATIENTS, ADVANCED CLINICAL CAPABILITIES AND MEDICAL TECHNOLOGY, SUPERIOR CLINICAL PERFORMANCE AND HEALTH OUTCOMES, EFFICIENT AND TIMELY REGISTRATION AND TREATMENT PROCESSES, TECHNOLOGY-ENABLED ACCESS TO INFORMATION AND SERVICES, CARING, COMPETENT, HIGHLY MOTIVATED PROFESSIONALS WHO DELIVER THE BEST POSSIBLE HEALTHCARE EXPERIENCE, ONGOING EMPLOYEE EDUCATION, TRAINING AND RECOGNITION THAT PROMOTES PERSONAL GROWTH AND ENCOURAGES CAREER ADVANCEMENT.MARTHA JEFFERSON HEALTH SERVICES CORPORATION PROVIDES PLANNING COORDINATION AND DELIVERY OF A CONTINUUM OF QUALITY HEALTHCARE SERVICES THROUGH THE HOSPITAL AND OTHER SUBSIDIARIES AND CONDUCTS FUNDRAISING FOR THE AFFILIATED GROUP INCLUDING MARTHA JEFFERSON HOSPITAL.MARTHA JEFFERSON MEDICAL ENTERPRISES SUPPORTS THE STRATEGIC MISSION OF MARTHA JEFFERSON HEALTH SERVICES THROUGH THE INTEGRATION OF PHYSICIANS INTO MARTHA JEFFERSON HOSPITAL'S DEFINED SERVICE AREA IN A MANNER THAT MEETS OR EXCEEDS THE CLINICAL QUALITY AND CUSTOMER SERVICE BENCHMARKS OF THE ORGANIZATION.MJH FOUNDATION PROVIDES INVESTMENT AND MANAGEMENT SERVICES FOR MARTHA JEFFERSON HOSPITAL.MARTHA JEFFERSON HOSPITAL FOUNDATION DEVELOPS RESOURCES THROUGH PHILANTHROPY TO MEET THE NEEDS AND INITIATIVES OF MARTHA JEFFERSON HOSPITAL. IT CONDUCTS FUNDRAISING FOR ITS AFFILIATES INCLUDING MARTHA JEFFERSON HOSPITAL. VA X 1 1 X X X X X 0 1 0 0 0 1 0 1 0 JAMES E HADEN 486715 0 120000 0 0 0 215940 0 26996 0 849651 0 0 0 AMY BLACK 187372 0 42668 0 0 0 41103 0 20663 0 291806 0 0 0 J MICHAEL BURRIS 226483 0 51242 0 0 0 91564 0 21522 0 390811 0 0 0 ELLIOT H KUIDA 267739 0 61329 0 0 0 36800 0 20583 0 386451 0 0 0 MARIJO LECKER 201690 0 43866 0 0 0 42150 0 20981 0 308687 0 0 0 RONALD J COTTRELL 195072 0 43342 0 0 0 72893 0 20808 0 332115 0 0 0 FINLAY M ASHBY 200830 0 38808 0 0 0 34275 0 14236 0 288149 0 0 0 SUSAN CABELL MAINS 181757 0 39149 0 0 0 125378 0 19338 0 365622 0 0 0 RAY R MISHLER 147722 0 32628 0 0 0 78251 0 19732 0 278333 0 0 0 DEBORAH L THEXTON 145268 0 20395 0 0 0 36596 0 9857 0 212116 0 0 0 SANDEEP TEJA 493516 0 22000 0 0 0 17150 0 20974 0 553640 0 0 0 JOHN Z EDWARDS 443571 0 30000 0 0 0 7350 0 22761 0 503682 0 0 0 CHRISTOPHER D WILLMS 323618 0 45502 0 0 0 9800 0 21297 0 400217 0 0 0 MICHAEL TRAHAN 312047 0 12000 0 0 0 16427 0 20564 0 361038 0 0 0 ALEXANDER A GRUNSFELD 286318 0 27500 0 0 0 7350 0 20517 0 341685 0 0 0 Part I, Line 4a JAMES E. HADEN $149,989 AMY BLACK $25,000 J. MICHAEL BURRIS $25,000 ELLIOT H. KUIDA $27,000 MARIJO LECKER $25,000 RONALD COTTRELL $25,000 FINLAY M. ASHBY $17,500 SUSAN CABELL MAINS $27,000 RAY R. MISHLER $35,000 DEBORAH L. THEXTON $25,000 Part I, Line 6 THE MANAGEMENT AND SENIOR MANAGEMENT INCENTIVE PLANS RECOGNIZE INDIVIDUALS BASED ON SPECIFIC CRITERIA AND DEFINED ORGANIZATION PERFORMANCE STANDARDS. THOSE PLANS ARE NOT ANNUALLY GUARANTEED AND IMPLEMENTATION WILL DEPEND ON ORGANIZATION-WIDE PERFORMANCE. IF ORGANIZATION-WIDE GOALS ARE NOT MET, THE PRESIDENT/CEO WILL HAVE THE DISCRETION TO DETERMINE ANY VARIATIONS TO THE PLAN. Part I, Line 7 FINANCIAL PLANNING: THE CEO RECEIVES ANNUAL PAYMENTS UP TO $4,000, VICE PRESIDENTS RECEIVE UP TO $2,500 EVERY FOUR YEARS AT THE DISCRETION OF THE PRESIDENT/CEO LONG TERM CARE INSURANCE POLICY: THE CEO RECEIVES ANNUAL PAYMENT OF PREMIUM FOR CEO AND SPOUSE SUPPLEMENTAL DISABILITY INSURANCE: OFFERED TO THE CEO AND VICE PRESIDENTS ON A VOLUNTARY BASIS AND IS PAID FOR BY THE ORGANIZATION. PREMIUM IS DETERMINED BY AGE AND SALARY COVERED, NOT ALL EXECUTIVES PARTICIPATE CAR ALLOWANCE: PROVIDED FOR CEO AND VICE PRESIDENT, DEVELOPMENT ONLY COUNTRY CLUB MEMBERSHIP FEES AND DUES: PROVIDED FOR CEO, COO AND VICE PRESIDENT, DEVELOPMENT ONLY SERVICE/COMMUNITY ORGANIZATION MEMBERSHIP PROFESSIONAL BUSINESS MEMBERSHIP EMPLOYER-PAID MALPRACTICE INSURANCE: PROVIDED FOR VICE PRESIDENT, MEDICAL AFFAIRS ONLY INDUSTRIAL DEVELOPMENT AUTHORITY OF ALBEMARLE COUNTY VIRGINIA 521297503 012677CE8 2003-09-25 34192283 REFUNDED BONDS ISSUED JULY 1, 1993 0 0 ECONOMIC DEVELOPMENT AUTHORITY OF ALBEMARLE COUNTY VIRGINIA 521297503 012663AD2 2008-10-30 160795000 CONSTRUCT REPLACEMENT HOSPITAL 0 0 35120006 3030244 405262 1093133 30758485 2003 1 0 1 1 160910173 8112432 1623978 151173763 2011 0 0 0 1 0 0 0 0 1 1 0 0 0 0 1 1 0 0 0 1 WACHOVIA BANK 16.500000000000 1 0 1 0 1 1 UBS AG STAMFORD BRANCH 40.000000000000 0 0 0 X 9 49796 COST OR SELLING PRICE X 2 2482215 SALE OF COMPARABLE PROP X GIFTS IN KIND 143 38363 COST OR SELLING PRICE OF DONATED PROPERTY 0 1 1 Method for Determining Number of Contributors: Part I, Column (b): THE NUMBER OF CONTRIBUTIONS FOR EACH TYPE OF PROPERTY RECEIVED IS CALCULATED USING THE NUMBER OF CONTRIBUTIONS RECORDED, WHICH MAY INCLUDE MULTIPLE ITEMS RECEIVED. CONTRIBUTIONS FROM DONORS WHO GIVE ITEMS THROUGHOUT THE YEAR ARE COUNTED AS A SEPARATE CONTRIBUTION ON EACH NEW DATE RECEIVED. Third Party Use: Part I, Line 32b: MARTHA JEFFERSON HOSPITAL USES EXTERNAL PARTIES TO COORDINATE AN ARMS-LENGTH SALE OF NON-CASH CONTRIBUTIONS. FOR EXAMPLE, A LICENSED STOCK BROKER WAS USED THIS YEAR TO SELL GIFTS OF STOCK. Form 990, Part VI, Section A, line 6 MARTHA JEFFERSON HEALTH SERVICES CORPORATION, A 501(c)(3) TAX EXEMPT ORGANIZATION, IS THE SOLE MEMBER OF MARTHA JEFFERSON HOSPITAL. Form 990, Part VI, Section A, line 7a THE BOARD OF MARTHA JEFFERSON HOSPITAL PRESENTS POTENTIAL NEW BOARD MEMBERS TO MARTHA JEFFERSON HEALTH SERVICES CORPORATION'S BOARD FOR APPROVAL. MARTHA JEFFERSON HEALTH SERVICES CORPORATION'S BOARD MAY, AT ITS DISCRETION, REMOVE A BOARD MEMBER OF MARTHA JEFFERSON HOSPITAL. Form 990, Part VI, Section A, line 7b THE DECISIONS OF THE BOARD OF MARTHA JEFFERSON HOSPITAL ARE SUBJECT TO APPROVAL BY THE BOARD OF MARTHA JEFFERSON HEALTH SERVICES CORPORATION. Form 990, Part VI, Section B, line 11 THE ANNUAL FINANCIALS OF MARTHA JEFFERSON HOSPITAL ARE REVIEWED BY THE AUDIT AND FINANCE COMMITTEES OF MARTHA JEFFERSON HEALTH SERVICES CORPORATION IN ADDITION TO THE MARTHA JEFFERSON HOSPITAL BOARD'S REVIEW. PRIOR TO FILING THE FORM 990 WITH THE IRS, IT IS REVIEWED BY THE FINANCE TEAM, INCLUDING THE CHIEF FINANCIAL OFFICER. MARTHA JEFFERSON HOSPITAL WILL SUBMIT THE INTERNAL REVENUE SERVICE FORM 990 FOR THE PRECEEDING FISCAL YEAR TO THE CEO EVALUATION COMMITTEE OF THE MARTHA JEFFERSON HEALTH SERVICES BOARD OF DIRECTORS IN THE RESPECTIVE MEETING FOLLOWING THE FILING OF THE FORM 990. IN ADDITION, THE FORM 990 WILL BE PROVIDED TO THE MARTHA JEFFERSON HOSPITAL BOARD OF TRUSTEES AND THE MARTHA JEFFERSON HEALTH SERVICES BOARD OF DIRECTORS AT EACH RESPECTIVE MEETING FOLLOWING THE FILING OF THE FORM 990. MARTHA JEFFERSON HOSPITAL WILL ALSO ADVISE BOARD MEMBERS OF THE WEBSITE ADDRESS AT WHICH THE FILED FORM 990 WILL BE POSTED (WWW.GUIDESTAR.ORG/990). Form 990, Part VI, Section B, line 12c MARTHA JEFFERSON HOSPITAL'S CONFLICT OF INTEREST POLICY IS ADMINISTERED BY THE CORPORATE COMPLIANCE OFFICER. ON AN ANNUAL BASIS ALL DIRECTORS, TRUSTEES, OFFICERS, KEY EMPLOYEES, MEDICAL STAFF MEMBERS WITH ADMINISTRATIVE RESPONSIBILITIES AND OTHER EMPLOYEES COMPLETE A DETAILED CONFLICT OF INTEREST QUESTIONNAIRE DISCLOSING ANY REPORTABLE ACTIVITIES AND INVESTMENTS. THESE QUESTIONNAIRES ARE REVIEWED BY THE CORPORATE COMPLIANCE OFFICER. IN ADDITION, ALL PERSONS LISTED ABOVE ARE ANNUALLY PROVIDED A COPY OF THE CONFLICT OF INTEREST POLICY. IF CHANGES TO PERSONNEL OCCUR BETWEEN ANNUAL COMPLETION OF THE CONFLICT OF INTEREST QUESTIONNAIRE, NEW PERSONNEL ARE ALSO REQUIRED TO COMPLETE THE QUESTIONNAIRE. Form 990, Part VI, Section B, line 15 THE ORGANIZATION HAS AN ESTABLISHED CEO EVALUATION COMMITTEE MADE UP OF HOSPITAL BOARD MEMBERS AND COMMITTEE MEMBERS. ON AN ANNUAL BASIS, A THIRD PARTY COMPENSATION CONSULTING FIRM PROVIDES AN INDEPENDENT REVIEW AND ANALYSIS OF BASE AND TOTAL COMPENSATION AND EXECUTIVE PERQUISITES USING MARKET COMPARABILITY DATA. THE CONSULTING FIRM RENDERS AN OPINION ON THE FAIR MARKET VALUE OF COMPENSATION PAID AND BENEFITS PROVIDED WITH RESPECT TO THE IRS INTERMEDIATE SANCTIONS REGULATIONS. THE PROCESS IS FOLLOWED FOR THE FOLLOWING POSITIONS: CEO, VICE PRESIDENTS, EMPLOYED PHYSICIANS. Form 990, Part VI, Section C, line 19 THE ORGANIZATION'S GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY AND FINANCIAL STATEMENTS ARE AVAILABLE TO THE PUBLIC UPON REQUEST. FORM 990, PART XI, LINE 2c Financial Statements and Reporting THE AUDIT COMMITTEE IS RESPONSIBLE FOR OVERSEEING THE AUDIT OF THE FINANCIAL STATEMENTS AND THE SELECTION OF THE INDEPENDENT ACCOUNTANT. THERE HAS BEEN NO CHANGE IN THIS PROCESS FROM THE PRIOR YEAR. SCHEDULE K PART II LINE 6 ISSUE A PURSUANT TO THE BOND INDENTURE, INVESTMENT EARNINGS FROM THE DEBT SERVICE RESERVE FUND, IN EXCESS OF THE DEBT SERVICE REQUIREMENT, ARE SWEPT INTO THE INTEREST ACCOUNT AND USED TO PAY INTEREST ON THE BONDS ON EACH INTEREST PAYMENT DATE. UNEXPECTED EXCESS AMOUNTS FROM COST OF ISSUANCE FUND WERE DEPOSITED INTO THE PRINCIPAL ACCOUNT. SCHEDULE K PART II LINE 7 ISSUE A $30,758,485 WAS USED TO REFUND BONDS ORIGINALLY ISSUED ON JULY 1, 1993. SCHEDULE K PART II LINE 5 ISSUE B COST OF ISSUANCE $1,424,688 FEES FOR CREDIT ENHANCEMENT $199,290 SCHEDULE K PART III ISSUE A IN ACCORDANCE WITH THE SPECIAL RULES FOR REFUNDING PRE-2003 ISSUES, PART III DOES NOT NEED TO BE COMPLETED FOR ISSUE A. ISSUE A WAS ISSUED AFTER 12/31/02 TO REFUND BONDS ISSUED BEFORE 1/1/03. SCHEDULE K PART III LINES 2 THROUGH 6 ISSUE B THE PROJECT HAS NOT BEEN PLACED INTO SERVICE YET. Form 990, PART I, Line 6 Summary MARTHA JEFFERSON HOSPITAL VOLUNTEER SERVICES IS RESPONSIBLE FOR THE RECRUITMENT, TRAINING, TRACKING AND RETENTION OF VOLUNTEERS THROUGHOUT THE HOSPITAL. VOLUNTEERS ARE RECRUITED THROUGH A VARIETY OF COMMUNITY NETWORKS INCLUDING THE UNITED WAY, MADISON HOUSE AT THE UNIVERSITY OF VIRGINIA AND MEMBERSHIP IN THE CHARLOTTESVILLE AREA ASSOCIATION OF VOLUNTEER ADMINISTRATORS. IN ADDITION, VOLUNTEER OPPORTUNITIES ARE POSTED ON THE MJH WEBSITE TO PROVIDE FURTHER EXPOSURE TO THE COMMUNITY. VOLUNTEER INFORMATION SESSIONS AND NEW VOLUNTEER ORIENTATION SESSIONS ARE CONDUCTED ON A MONTHLY BASIS AT THE HOSPITAL. VOLUNTEERS ARE PLACED ACCORDING TO THEIR INDIVIDUAL SKILLS AND STRENGTHS AS COMPARED TO THE NEEDS OF THE SPECIFIC DEPARTMENTS WITHIN THE ORGANIZATION. MJH VOLUNTEERS SUPPORT MORE THAN 45 DEPARTMENTS WITH GENERAL JOB DUTIES SUCH AS CUSTOMER SERVICE, CLERICAL JOBS, AND PATIENT ESCORT AND TRANSPORTATION RESPONSIBILITIES. SERVICES ARE DETERMINED THROUGH INDIVIDUAL INTERVIEWS WITH DEPARTMENTAL MANAGERS AND REQUESTS MADE BY MANAGERS FOR SPECIFIC PROJECTS. WE ALSO HAVE VOLUNTEERS WITH ADVANCED SKILLS AND TRAINING THAT SERVE AS PATIENT ADVOCATES AND CHAPLAINS. THE HOSPITAL USES VOLUNTEERS ON SPECIAL PROJECTS SUCH AS PREPARING STROKE PATIENTS AWARENESS FOLDERS OR SPECIAL EVENTS SUCH AS THE CELEBRATION OF LIFE, A COMMUNITY EVENT FOR CANCER PATIENTS, PAST AND PRESENT, THEIR FAMILY AND FRIENDS. OUTSIDE OF VOLUNTEER ROLES AVAILABLE INSIDE THE HOSPITAL, COMMUNITY LEADERS ALSO SERVE IN OTHER CAPACITIES, INCLUDING OUR BOARD OF DIRECTORS, A CONSULTING AND GOVERNING BODY FOR OUR ORGANIZATION. IN ADDITION TO VOLUNTEERS WHO PROVIDE DIRECT SERVICES IN THE HOSPITAL SETTING AND MANAGED BY THE DEPARTMENT OF VOLUNTEER SERVICES, THE FUNDRAISING FUNCTION OF THE HOSPITAL IS ALSO SUPPORTED BY A CADRE OF VOLUNTEERS, ESPECIALLY IN SUPPORT OF SPECIAL EVENTS. THE WOMEN'S COMMITTEE OF MARTHA JEFFERSON HOSPITAL, WITH 140 ACTIVE MEMBERS, COORDINATES TWO ANNUAL FUNDRAISERS. THE MARTHA JEFFERSON GOLF CLASSIC IS ALSO SUPPORTED BY A 10-MEMBER VOLUNTEER ORGANIZING COMMITTEE AND MORE THAN 30 VOLUNTEERS WORK THE DAY OF THE EVENT. EACH YEAR THE HOSPITAL ALSO PUTS ON THE MJ8K ROAD RACE/WALK FUNDRAISER THAT ENGAGES MORE THAN 75 DAY-OF VOLUNTEERS. WHILE VOLUNTEER SCHEDULES ARE MANAGED BY THE INDIVIDUAL DEPARTMENTS, A MASTER LIST OF VOLUNTEERS IS MAINTAINED BY VOLUNTEER SERVICES. VOLUNTEER HOURS ARE TRACKED THROUGH TIMESHEETS AND COLLECTED ON A MONTHLY BASIS. FORM 990, PART VI, SECTION B, Line 16b Policies AT SEPTEMBER 30, 2010 MARTHA JEFFERSON HOSPITAL DID NOT HAVE A SPECIFIC JOINT VENTURE POLICY. ANY PROPOSED JOINT VENTURE PARTICIPATION IS EVALUATED WITHIN THE CONTEXT OF THE ADMINISTRATIVE POLICY ENTITLED "AUTHORITY TO COMMIT AND EXPEND FUNDS". THIS POLICY DEPICTS THE TYPES AND LEVELS OF EXPENDITURES AND COMMITMENTS THAT MANAGEMENT CAN UNDERTAKE. ALL PROPOSED JOINT VENTURES ARE REVIEWED BY EXTERNAL LEGAL COUNSEL TO ENSURE COMPLIANCE WITH THE APPROPRIATE FEDERAL, STATE AND REGULATORY LAW. ANY JOINT VENTURE PARTICIPATION MUST BE EVALUATED AND APPROVED BY THE MARTHA JEFFERSON HOSPITAL BOARD OF TRUSTEES AND THE MARTHA JEFFERSON HEALTH SERVICES' BOARD OF DIRECTORS. A SPECIFIC JOINT VENTURE PARTICIPATION POLICY IS CURRENTLY IN PROCESS OF DEVELOPMENT. 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