Sentara Healthcare

“Business or family relationship of officers, directors: david bernd and howard kern have a business relationship. The organization's officers and directors served together on the boards of other organizations within the sentara healthcare system ("the system"), as well as joint ventures in which the system had an ownership interest. See schedule r for a listing of such entities.”

“Form 990 review process the organization used its own in-house tax department, headed by a licensed certified public accountant, to both prepare and review its form 990. During the preparation and review process, the tax department worked closely with other departments, such as legal, compensation and benefits, compliance, finance, and marketing, to ensure that a complete and accurate return was filed.”

“Explanation of monitoring and enforcement of conflicts: directors, board-nominated officers, and key employees submit an annual conflict of interest questionnaire and certify to the completion and accuracy of the information disclosed. The organization's governing board or appropriate committee monitors transactions involving disclosed potential conflicts of interest, to ensure that they are reasonable and at arm's length.”

“The organization followed processes and procedures set forth in its governing documents to ensure compliance with its obligations as a 501(c)(3) healthcare organization to pay disqualified persons reasonable compensation. Such processes and procedures are intended to establish the rebuttable presumption of reasonableness under the internal revenue code section 4958 regulations. The compensation philosophy of the organization is to base overall compensation and benefits for executives on not-for-profit market comparables, adjusted as applied to each executive, taking into consideration the individual skills, experience, tenure and performance of the executive being compensated and overall performance of the organization. In line with this philosophy, the organization performed substantial due diligence as to market comparables. The compensation committee, which consists of board members without conflicts of interests, engaged an outside consultant, who reports to the compensation committee, to conduct a study assessing the competitiveness of total compensation (including cash compensation, benefits and perquisites) of its senior executives prior to making decisions regarding annual base salary adjustments, approving incentive awards, or considering programmatic changes. The study compared the compensation of the organization's senior executives to compensation data from multiple published survey sources based on the senior executive's functional responsibility. In conducting the study, the consultant targeted other not-for-profit health systems of similar size based on net revenue and complexity. For health plan positions, health plans with similar premiums, or members, were targeted. The consultant also conducts a review of the organization's performance relative to a group of not-for-profit health systems of comparable size and scope of operations every year. The most recent study compared sentara's performance to 30 healthcare systems based on net revenue growth, operating margin, bond rating, and qualitative performance measures based on rankings from sdi's national top integrated health networks. Overall, the consultant determined that sentara's pay was aligned with its relative performance. The compensation study was presented to the organization's compensation committee, which made its compensation decisions based on a)its review and analysis of the performance of both the organization and its senior executives and, b) a reasonableness of compensation analysis and opinion from an external expert in the compensation of executives in the tax-exempt health care field. The committee's bases for its decisions were documented in committee minutes taken during the meeting and then circulated for review and approval. All decisions regarding compensation were made by the committee, which consists of board members without conflict of interests. This process was used to establish compensation for the organization's ceo, president and coo, senior vice president and cfo, senior vice presidents and corporate vice presidents. The process was last undertaken during 2014 for all positions listed.”

“Provision of governing docs, coi policy and financials to public: the consolidated financial statements for sentara healthcare and subsidiaries were made publicly available through the use of dac bond (disclosure dissemination agent) and can be found on the internet at www.dacbond.com. The organization's governing documents and conflicts of interest policy are generally not made available to the public.”

“Document retention policy: the organization had a written policy for document retention and destruction which was approved by management.”

“Joint venture policy: the organization had a written policy requiring evaluation of its participation in joint venture arrangements under applicable federal tax law. This policy was approved by management. The organization also took steps to safeguard the organization's exempt status with respect to such arrangements.”

“Sentara healthcare i. Your not-for-profit health partner for more than 126 years, sentara has been committed to helping people who want the most dedicated medical professionals helping them through every stage of life. To provide a range of quality care, we have grown slowly throughout virginia and north carolina. We have reached out to industry leaders and joined forces, and we now operate more than 100 sites of care, including 12 acute care hospitals - seven in hampton roads, one in northern virginia, two in the blue ridge region of virginia, one in southern virginia and one in north carolina. For more than a decade, modern healthcare magazine ranked us as one of the nation's top integrated healthcare systems. Our not-for-profit system proudly includes advanced imaging centers, nursing and assisted-living centers, outpatient campuses, physical therapy and rehabilitation services, home health and hospice agency, a 3,800-provider medical staff, and five medical groups. In addition, we provide medical transport ambulances and the nightingale air ambulance, and extend health insurance to 450,000 people through optima health, our award-winning health plan. Among our strengths, we are a national leader in heart and kidney care, stroke care, and infection prevention, and we were the first in the nation to pioneer and develop the eicu, a remote monitoring system for intensive care. Our dedication to improving and increasing medical options for our patients is reinforced by our ongoing participation in national and international research. These vital medical trials help us advance toward our mission to improve health every day. In november 2014, we proudly celebrated 126 years of delivering compassionate and quality care. When we began as the retreat for the sick in 1888 in norfolk, virginia, medical providers dedicated themselves to caring for norfolk's poor, focused on meeting their immediate healthcare needs. As noted above and detailed in this report, we have grown into a multi-state, integrated healthcare system committed to still delivering that same compassionate and quality care - and reaching far beyond the patients who come directly to us. We strive to serve everyone in our communities through health outreach programs, education and financial support of other not-for-profit health organizations. Ii. Growing the sentara family since the beginning, sentara has reached out to nearby industry leaders and joined forces to extend healthcare to more people. In recent years, we have grown in virginia and north carolina by seeking partnerships with long-established and successful hospitals and healthcare systems that share our dedication to excellence and value. Some of our most recent additions include: a. Halifax regional health system in the fall of 2012, halifax regional health system signed a letter of intent to merge with sentara healthcare. It is an integrated system including a 192-bed hospital, three long-term care facilities, a home care and hospice facility, and a broad range of specialties and outpatient services across the south boston region, about 165 miles west of norfolk. The merger was completed july 1, 2013, which also marked halifax's 60th anniversary serving the south boston community. The system's extensive experience caring for rural communities makes it particularly valuable to locals and complements the sentara commitment to personalized healthcare. It is now the 11th of twelve hospitals in our not-for-profit integrated health system. In february 2015, halifax regional hospital and subsidiaries adopted the sentara name. B. Sentara albemarle medical center, medical group and related facilities sentara healthcare and albemarle health of northeastern north carolina began a partnership march 1, 2014, after approval by the pasquotank county board of commissioners and the albemarle hospital authority board of commissioners and their two-year process of evaluating potential partners. All four entities share the goa”

“Also in 2012, the sentara cancer network's mobile pet/ct began performing body scans to discover and stage cancers that may have spread to the bones. This is possible due to the fda's approval of the use of 18f-sodium fluoride as an injection. At sentara rmh medical center in 2012, patients with the heart condition atrial fibrillation benefitted from a procedure called cardiac cryoablation, approved by the fda in late 2010. Cryoablation employs a special balloon that's filled with a coolant to reduce its temperature to minus 80 degrees celsius. The balloon is applied to the heart tissues that cause irregular heartbeats, and the cold temperatures destroy the tissue and correct the heart's problem. It has proved successful for patients who did not respond fully to other treatments. With a $725,000 grant from the potomac health foundation, sentara northern virginia medical center purchased a new digital mammography van. With the van, the center reaches women with little or no insurance, in hopes of detecting cancer earlier in women in prince william county, where there's a higher-than-average death rate from breast cancer. B. Expanding service areas and partnerships in june 2014, sentara joined forces with four of the nation's top heart treatment centers and a leading patient advocacy organization to form the national alliance of integrated afib centers (naiac). They seek to combat the growing and life-threatening condition of afib (atrial fibrillation). Sentara and the five other members - cedars-sinai heart institute, st. Helena arrhythmia center, st. Vincent's medical center, orlando health heart institute and stopafib.org - will improve medical care and enhance afib patients' quality of life. As of july 1, 2014, sentara northern virginia medical center (snvmc) instituted a partnership with children's national health system to provide neonatal care services. Children's national health system neonatologists provide level 1 (term nursery) and level 2 (intermediate nursery) coverage within the snvmc nicu (neonatal intensive care unit). They work jointly with hospital staff and on-staff obstetricians to determine the feasibility of providing care for 28/29-week newborns, as well as mother and baby treatment plans created in collaboration with the mother's obstetrician. The partnership allows snvmc to reduce the number of nicu transfers to other facilities, fostering the care of these special patients closer to home. In august 2014, sentara invested in nuscriptrx, a company that enhances medication safety in long-term care facilities while reducing waste and cost. Nuscriptrx has developed a fully automated on-site emedstat medication dispensing system and a full service centralized pharmacy that offers seven-day medication replenishment versus the industry standard of 30 days. This ensures a more timely response to medication changes and up to a sixty percent reduction in product wastes and ten to fifteen percent cost savings. Daily dosage packaging can reduce medication pass times from thirty-five to fifty percent. The nuscriptrx system also helps improve medication safety with online patient records. In august 2012, sentara and mdlive announced an equity partnership to deliver real-time medical consultations via telephone and online video through an established network of physicians. Patients use the mdlive virtual consult platform to consult directly with a licensed sentara or partner physician who can diagnose low-acuity illnesses, provide care, and prescribe medications. In 2013, sentara employees with optima health and cigna insurance received the benefit of sentara mdlive appointments for a $15 co-pay. We saw over 2,000 sentara employees/dependents covered under optima insurance register with mdlive. That same year, 429 employees and their families made an appointment with mdlive. Sentara is working with mdlive to partner with other health systems to offer the benefits to their employees and is working to leverage the techno”

“In february 2014, researchers at the sentara cardiovascular research institute were among the first in virginia to enroll patients in the parachute iv trial of an investigational device to treat heart failure in people who have suffered a heart attack. The parachute ventricular partitioning device, if proven effective in the five-year, 20-site study, would offer a new, non-surgical, minimally invasive means of helping a damaged heart recover. Iv. Building for the future along with reaching out to new communities, sentara healthcare strives to build on our existing services and in our established areas so that we exceed our patients' expectations and meet growing healthcare demands. Some of the changes we have invested in in our established communities recently include: a. Sentara northern virginia medical center completes operating room modernization topping off sentara northern virginia medical center reached a major construction milestone in late 2014, topping off the steel frame of the new surgical center. The topping off event marks the completion of the steel construction phase of the project that will provide enhanced surgical services to the community. The new facility will adjoin the main hospital and include general-purpose operating rooms outfitted with state-of-the-art equipment. B. Sentara lorton station women's imaging center opens on september 2, 2014, sentara northern virginia medical center announced the grand opening of the sentara lorton station women's imaging center. The center offers sophisticated technology backed by a team of highly skilled technologists and fellowship-trained radiologists dedicated to women's imaging. Services provided at the center include general, ob, and breast ultrasound; 3d mammography; image-guided biopsy; fine-needle aspiration; and bone density (dexa) testing. C. Sentara medical group grows in northern virginia sentara medical group continues to grow in northern virginia with the addition of sentara hospital medicine physicians at sentara northern virginia medical center in 2014. With eight board-certified, hospital-based physicians, the new sentara hospital medicine physicians team in northern virginia is dedicated to providing quality care. D. Martha jefferson now offering gastric sleeve option for bariatric surgery martha jefferson hospital began offering the gastric sleeve option for bariatric surgery in 2014. The gastric sleeve procedure is an alternative to the gastric bypass surgery and the adjustable gastric band. Also known as a laparoscopic sleeve gastrectomy, it is a preferred option by some patients because it does not rearrange the bowels like the gastric bypass surgery and does not have a prosthetic inserted like the gastric band. Additionally, patients are at less risk for ulcers, protein deficiencies, or dumping syndrome. E. Under construction: sentara rmh medical center campus construction is underway on a new medical building on the sentara rmh medical center campus, which will house the hospital's orthopaedics, spine, sports medicine, rehabilitation and outpatient advanced imaging services. The project is expected to be complete in the winter of 2015-16. F. Martha jefferson and sentara rmh cardiac genetic counseling services martha jefferson hospital and sentara rmh medical center began offering patients in the blue ridge region cardiac genetic counseling and genetic testing options in may 2014. While heart disease is often related to environmental factors including smoking, eating and exercise habits, some types of heart disease can be caused by genetic mutations. G. Foot and ankle pilot on the peninsula a new sentara orthopaedics product, the sentara foot & ankle center, was piloted for the system in june 2014 at sentara port warwick and sentara williamsburg regional medical center. The center's goal is to help patients to connect with the foot and ankle care that is most appropriate for them, including office visits, inpatient and outpatient surgical care a”

“P. Sentara rmh medical center women's center construction began on the rmh funkhouser women's center in june 2012 and was completed june 2013. The 15,000 square foot center houses women's imaging, including advanced breast imaging/mammography and bone density screening, rmh breast care, the image recovery center and rmh heart check for men and women and a surgeon's office. Q. Sentara rmh medical center outpatient orthopaedics & advanced imaging center sentara rmh gained approval for the new center in july 2012. The new facility will be an orthopaedic and sports medicine destination including advanced imaging, rmh orthopaedics and sports medicine, rehabilitation therapy, a sports performance arena and an interventional suite for pain management and special procedures. The center is scheduled to be completed in late 2015. R. Martha jefferson outpatient care center a new outpatient care center opened in the fall of 2012, with a free-standing 24-hour ed and imaging, laboratory services and a primary care practice. The ed shortens travel time for ems providers, and the facility as a whole helps cut travel time for patients in the northern counties of virginia. V. Sentara quality & patient safety distinctions a. Measuring quality healthcare since our health system's earliest years, we have believed the community deserves healthcare that is measurably better. Sentara's goal is to be accredited by respected national organizations and to achieve top ten percent performance wherever benchmarks exist. We are proud of the work we have done so far toward this goal, as it has been recognized in many ways: 1. Top 100 integrated healthcare networks sentara has consistently ranked among the nation's top integrated healthcare networks as published in modern healthcare's fact-based ranking. The only healthcare system in the country to be among the nation's top 10 for all 15 years of the survey, sentara landed at number one in 2001, 2010 and 2011. The study, published annually, highlights the top 100 integrated health care networks across the nation as selected by sdi, a health information company. 2. Using technology to improve care all sentara hospitals in hampton roads as well as sentara northern virginia medical center and martha jefferson hospital were recently recognized for their it efforts, receiving the 2014 "most wired" award from hospitals and health networks. Sentara albemarle medical center was named as a "most improved" recipient. The awards look at how well hospitals perform in the areas of infrastructure, business and administrative management, clinical quality and safety, and clinical integration. Sentara healthcare received the same honor in 2013 and 2012. 3. Award-wining cardiac and nephrology care sentara heart hospital/sentara norfolk general hospital is a comprehensive network of providers, facilities and services working together to ensure the highest level of care. Sentara norfolk general hospital has been ranked the number one hospital in virginia and hampton roads by u.s. News & world report. In the 2014-15 u.s. News best hospitals rankings, the hospital was recognized with two nationally ranked top 50 programs. Cardiology and heart surgery are ranked 44th, which marks the program's 14th consecutive year among the nation's elite programs in the u.s. News national survey. For the first time, ear, nose and throat is also among the nation's top 50 programs at number 41. This national ranking is due, in part, to innovative procedures used by surgeons and radiologists with eastern virginia medical school medical group for patients with head and neck cancers and traumatic injuries. The two specialties are the only top-50 ranked heart and ent programs in virginia. In addition to the national rankings, u.s. News included rankings for state and metro areas. Seven sentara hospitals were featured in the rankings, with sentara norfolk general hospital listed at number one in the region and number one in the state. Sentara virginia b”

“8. Five-star rankings, silver achievement, and excellence in action awards for nursing centers in 2014, four sentara nursing centers in virginia and north carolina received the highest possible overall rating of five stars in u.s. News & world report's sixth annual best nursing homes: sentara nursing center-windermere (virginia beach, va), sentara nursing center (barco, nc), sentara nursing center (portsmouth, va) and sentara nursing center (chesapeake, va). U.s. News & world report's best nursing homes recognizes top-rated homes in the united states. More than 15,500 homes were rated and fewer than one in eight received a five-star rating. In 2011, 2012 and 2013, sentara nursing center windmere, virginia beach and nursing center portsmouth also received five-star ratings. Sentara nursing center barco, north carolina received five stars in 2012 and 2013 as well. In 2014, meadowview terrace, halifax regional hospital's 150-bed long-term care facility in clarksville, va, received a five-star rating in the new five-star quality rating system for nursing homes conducted by the centers for medicare & medicaid services. The overall rating is based on the star ratings in three separate categories: health inspections, quality measures and staffing levels. Forty-two of meadowview terrace's 150 beds are located in the facility's two self-contained households for residents with memory-support needs, such as alzheimer's disease and other related dementias. Sentara nursing center-currituck received a 2012 silver-achievement in quality award from the american healthcare association and national center for assisted living. The competitive awards follow criteria in the baldrige performance excellence program and mark measurable progress in quality improvements in long term care. 9. Magnet hospital certification in 2014, the american nurse credentialing center (ancc) re-designated sentara norfolk general hospital (sngh) as a magnet hospital. This is the highest quality recognition a hospital or health organization can receive for best practices in nursing throughout the world. The designation lasts for four years. The same year, sentara williamsburg regional medical center and sentara rmh medical center received magnet certification for the first time. Martha jefferson hospital also holds magnet certification. 10. American association of critical-care nurses (aacn) award in 2014, the aacn conferred a silver-level beacon award for excellence on the icu at sentara princess anne hospital. The award recognizes caregivers in units whose consistent and systematic approach to evidence-based care optimizes patient outcomes. 11. Becker's hospital review "great 100" accolade becker's hospital review named sentara norfolk general hospital as one of the 100 great hospitals in america in 2014 based upon its "rich history, strong credentials and growing focus on how to best care for patients in an era of reform." 12. Marshall steele program/destination joint center the martha jefferson joint replacement center has achieved its designation as a destination joint center by marshall steele. Based on a national best practice model for hip and knee replacements, and structured around the fundamental principle of wellness, the program by consultant marshall steele has allowed the joint replacement services at martha jefferson to improve at every level, from pre-operative care to surgical times and in-patient stays. Hospitals that have implemented the program report superior outcomes. 13. Mission: health game changer award in 2014, mission: health was the recipient of virginia's first annual game changer award. Virginia health secretary dr. William hazel presented the award to terrina thomas of sentara health and preventative services, on behalf of the virginia health innovation network, a project of the virginia center for health innovation. The game changer award recognizes an organization that has implemented an outstanding employee health strategy that engages”

“In 2014, martha jefferson hospital in charlottesville went live with its patient portal, my martha jefferson record. My martha jefferson record is similar to mychart. Through the portal, patients can manage and monitor their health and their family's health - easily, immediately, accurately and securely online. My martha jefferson record allows patients to view medical information online, at any time, and from anywhere for free. That same year, more than 700 patients connected with sentara albemarle medical center through the my albemarle medical record patient portal. In the first iteration of the product, patients are able to look at reports from medical tests, pre-register for appointments, transition their medical record to a community provider electronically and establish medical proxies. Also in 2014, optima health launched a mobile app for members called myoptima. It provides a secure, convenient, and easy way to access important health plan information on demand. With the app, anyone can shop for health plans, locate doctors and find urgent care centers. Optima health members can also securely view benefit information, member id cards, claims information and their user profile. 2014 marked the 14th year that we employed our eicu remote monitoring system for our sickest hospital patients. Sentara was the first hospital system in the country to implement the eicu system, which uses a network of cameras, monitors, alerts, and two-way communication links. Doctors and critical care nurses at the eicu command center make virtual rounds on icu patients. This sentara-pioneered technology is now used to help care for patients in nearly 5,000 icu beds nationally. Another safety initiative adopted by sentara is bedside medication verification, including bar-coding technology. National studies have found that bedside verification can reduce hospital medication errors by nearly 70 percent. Vi. Commitment to the community as a not-for-profit healthcare organization, we continuously reinvest in the community-by purchasing the most medically advanced technology; building new, state-of-the-art healthcare facilities; training medical professionals; and providing the highest quality healthcare to all patients, regardless of their ability to pay. It's not just our mission; it's our commitment to the community. We are honored to be recognized for benefits we bring to our communities and proud to lead the way in creating new methods of meeting community needs. Some of our recent honors and efforts include: the prince william chamber of commerce honored sentara northern virginia medical center in 2014 with its business of the year award. The award recognizes businesses for innovative and outstanding contributions to the local economy, quality of life and the chamber of commerce. Sentara rmh medical center received the crystal award in sustainability for healthcare at the second annual energy and sustainability conference in richmond, va in february 2014. The crystal awards in sustainability recognize virginia companies and institutions for their sustainability. Martha jefferson hospital was honored by the charlottesville regional chamber of commerce with the 2012 hovey s. Dabney award for corporate citizenship. Organizations receiving this award are known for engaging in sound, successful business practice and being good partners with other businesses, investing directly in the economic and cultural advancement of the community, persuing a positive work environment, and inspiring by example. The federal department of health and human services awarded sentara rmh medical center with a $3.1 million, five-year grant in november 2012 to help families at risk from substance abuse. As a fiscal agent, sentara rmh medical center oversees administration of the grant, and central shenandoah valley family partnership helps families with children in danger of being removed from their homes because of substance abuse by a caregiver. Halifax regional dent”

“2. Tobacco-free environments hospitals see the effects of tobacco every day in heart disease, respiratory ailments, and cancers. In response, sentara has implemented our tobacco-free environment campaign. No one is allowed to smoke, chew or dip anywhere on campus, not even in cars. The goal is not just to avoid the aesthetic and health issues of second-hand smoke, but also to put sentara's mission into practice by helping staff, patients, and visitors quit this habit. As of 2011, all of our facilities adopted the tobacco free environment initiatives. We have earned the american cancer society "excellence in the workplace tobacco control" award for our efforts. Vii. Optima health plan a. Improving health operating with the same mission in mind -- to improve health every day --is our health plan, optima health. With more than 25 years of health insurance experience, optima health provides health plan coverage to more than 450,000 members throughout the state. Our quality provider network features more than 15,000 providers including specialists, primary care physicians, and hospitals. B. Supporting the community optima health provides more than insurance for our communities; we reach out through health screenings, events, education materials, and immunizations. Our highlights in 2014 included: - we introduced a new tool to help members take control of healthcare expenses. It's called the treatment cost calculator. Linked to a member's "myoptima" account, the online tool lets members compare prices between providers for more than 300 procedures and services and estimate out-of-pocket costs. - health improvement event requests decreased by one percent and the number of participants increased by eleven percent. (in 2013 there were 1,516 events with 43,351 participants, compared to 1,505 events with 47,987 participants in 2014.) these events were offered to churches, employer groups including sentara healthcare employees, community health centers and other community locations. - flu patrol administered a total of 10,496 immunizations. They gave 9,042 to optima health insured groups in virginia. The remainder was delivered to churches and other community groups. - preventive birthday card reminders for preventive health screenings delivered messages to 192,967 adult health plan members. Preventive birthday card reminders for children delivered annual physical exam messages to 150,271 health plan members. Self-care manuals were distributed to health plan members and community organizations. We sent out 388 in 2014. - the tobacco cessation program had over 12,000 interventions in 2014. We sent out 46,261 campus-wide electronic interventions to promote the great american smokeout (gaso) and distributed 5,000 gaso quit kits. Our certified tobacco treatment specialists facilitated 14 tobacco cessation awareness group programs for 79 participants and provided 12 tobacco awareness presentations for 60 community and employer groups. Over 400 inpatients from sentara virginia beach general hospital and sentara heart hospital were contacted four weeks after their hospital discharge for tobacco cessation follow-up. - healthy edge/mission: health. During the month of november, 17,817 employees completed a health risk assessment in conjunction with the mission: health program. Of those, 10,022 employees attended 130 on-site health screenings within six months. In 2014, 5,105 employees were identified with two or more health risks. 2,338 employees agreed to online coaching and 2,767 employees agreed to telephonic coaching. 2,998 employees agreed to continue engaging with their health coach. 3,086 employees from 2014 will no longer need to engage with a health coach. - webmd became our new health coaching and health education portal partner in october 2014. This is a replacement for healthyroads. - wellnessforlife: 12,374 city of virginia beach and virginia beach public school employees completed registration for enrollment into the wellness program”

“The organization is the 501(c)(3) sole member or shareholder of several other organizations for which it maintains agency relationships and issues 1099s. The number reported is a best estimate of the 1099s attributable to the organization. The exact number cannot be determined; as some of the 1099s issued by the organization are attributable to more than one entity, and there is no reporting mechanism to determine 1099s attributable solely to the organization.”

“Capital contribution to subsidiary -12,000,000. Capital distribution from subsidiary 48,000,000. Deemed distribution from cfc not on books -9,560,881. Change in funded status of pension liability -209,854,135. Partnership income tax > book -312,182. Book reclass of intercompany accts to equity 177,785,379. Subpart f income not on books -2,278,047. Net asset transfers from subsidiaries -134,627,185.”