Inova Health Care Services

“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.”

“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.”

“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.”

“The Form 1023, 990T and Form 990 are available at the address listed on page 1 of the Form 990 upon request during regular business hours.”

“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.”

“Long Term Care Services Assisted Living Facilities IHCS's assisted living facilities provide care and services for adults who are no longer able to live alone. They provide accommodations for 402 units with on-site behavioral day treatment programs. A nursing staff is on-site 24 hours a day. IHCS maintains four assisted living facilities in Fairfax, Reston, Fair Oaks, and Mt. Vernon, Virginia. In addition, IHCS owns a 60% interest in an assisted living joint venture in McLean, Virginia. IHCS operates five assisted living facilities across Fairfax County with total assisted living days in 2013 of 156,487. InovaCares for Seniors (PACE) InovaCares for Seniors, a Program of All-inclusive Care for the Elderly (PACE) is the first program of its kind in Northern Virginia. PACE is an evidenced-based model of care that delivers high quality, cost effective care that includes medical, dental, vision and social activities. The program is built on the foundation that seniors with complex health care needs should be able to live in the comfort of their home environment for as long as possible. In 2013, PACE had an enrollment of 51 participants and had $2.8 million in unreimbursed expenses. Physical Therapy Services Inova Physical Therapy Centers IHCS promotes and conducts specific research and educational activities related to the care of the sick and injured. In 2013, outpatient visits totaled 87,379 with services offered at ten outpatient centers located throughout Northern Virginia. Areas of specialty include: Physical Therapy (PT) - Promotes healing in people recovering from illness, injury, orthopedic, and sports or neurologic conditions such as stroke. Physical therapy is also key to preventing future injury through strength and flexibility development and patient education. Occupational Therapy (OT) - Provides training in motor skills and teaches compensatory strategies that increase the ability to be as independent as possible. Programs are designed around activities of daily living, assistive device training, body mechanics, neuromuscular retraining and sensory integration. Speech Language Therapy (SLT) - Provides communication and swallowing assessment and treatment for patients of all ages. Services include speech and language treatment, swallowing (dysphasia) evaluation/treatment and cognitive/language rehabilitation. Urgent Care Centers Inova Urgent Care Centers IHCS mission includes serving the community as a not-for-profit organization through the provision of urgent medical care. In 2013 outpatient visits totaled 109,575 with services being provided seven days a week with no appointment necessary at four locations, and Monday through Friday at our seven locations listed below: Inova Urgent Care Center of Vienna Inova Urgent Care Center of Centreville Inova Urgent Care Center of Dulles South Inova Urgent Care Center of Purcellville Inova Urgent Care Center of Woodbridge Inova Urgent Care Center of Ballston Inova Occupational Health Center at Inova Alexandria Hospital The centers provide services for medical conditions that require prompt attention but do not pose an immediate or serious threat to life. Treatment is provided for such ailments as sore throats, ear infections or minor cuts and bruises. Services offered also include treatment for work-related injuries and worker's compensation cases, physical exams including camp, sport, school, pre-employment, immigration medical examinations and travel medicine. Laboratory tests, X-rays, audiometry & vision screening, alcohol & drug testing and flu shots are provided on-site. The centers are staffed by board-certified/board-eligible physicians licensed in Virginia. A physician, nurse, and radiology technologist are on duty at each center during hours of operation. Employee Assistance Programs Inova Employee Assistance (EAP) is part of IHCS providing counseling, work life services and resources to help improve the overall health and well being of the employees of Inova Health S”

“Charity Care All Inova facilities, including the IHCS facilities with the exception of the assisted living facilities, provide charity care in accordance with Inova policies which ensures access to medically necessary care for all individuals. Charity care is defined as free or discounted healthcare services provided to persons who cannot afford to pay. These policies include the following key provisions: 1. Emergency care shall be provided to all persons regardless of their ability to pay. 2. 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 300% 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. 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 meet with Inova financial counselors who assist patients in completing Inova's charity care application. This financial information is reviewed by the Inova Patient Accounts Department with the patient contacted if additional information is required in order to make a determination. The patient is subsequently provided a letter, notifying them as to the level of charity care for which they are qualified (whether it be 100% coverage or a sliding scale payment based upon their income level between 200-300% of the Federal Poverty Guideline). In 2013 IHCS's unreimbursed cost of charity care, including free and discounted services, was $94.6 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 2013, IHCS provided care to Medicaid patients at an unreimbursed cost of $64.3 million. Participation in Governmental Programs for Those Without the Ability to Pay Various government programs provide for the indigent, including Medicaid recipients. These programs provide a percentage of reimbursement for qualifying patients; however, payment is typically below the cost of those services. In addition to federal and state programs, the Inova subsidiaries, including IHCS, work with various County governments and agencies in providing certain free services to those residents the County identifies as most in need.”

“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. HealthSource HealthSource serves the community as the premier provider of health education and prevention services. Participants engage in prevention activities, receive quality health education, participate in wellness programs and benefit from care management. As a part of the vision, Healthsource targets the community served by holding programs throughout the region in environments that are familiar to and convenient for the clients. Seminars, classes, health fairs, screenings and immunizations are offered at Inova Health System hospitals, community locations and worksites throughout northern Virginia and the Greater Metropolitan Washington Area. During 2013, HealthSource served 273,037 participants at 5,321 events. Program highlights include: Influenza Vaccination The Inova HealthSource Fight the Flu Program provided 44,825 flu shots at 805 immunization clinics for Inova at community and employer sites as well as for Inova employees and physicians. The Fight the Flu Program provided over 11,651 flu shots for Fairfax County Public Schools at 199 clinics and 2,471 shots at 18 clinics for Fairfax County Government employees. Additional clinics were held at 269 worksites vaccinating 17,489 employees. With Inova foundation funds, free flu shots were provided for 194 low income children and parents at a community fair, as well as, children and teachers at Higher Horizons Head Start Program. The Workplace and Community Programs The Workplace and Community Program served 27,113 participants at 960 events that included biometric screenings and health education presentations. The Care Management Programs provided health coaching in weight management, tobacco cessation, back pain management, fitness, pregnancy and breastfeeding. Team Up - HealthSource offers a healthy, fun, team-oriented challenge program for employers. Team Up programs are multi-week competitions that focus on healthy eating, weight loss or activity, with over 3,000 participants completing one of the competitions in 2013. HealthSource provides the Program Manager for The Prince William County Wellness Program. This program delivers a full range of wellness services and programs for county employees. Programs include new employee-only wellness website, Know Your Numbers, Walking Trail, Better Eating series, Health Fairs and health/prevention awareness campaigns. The Health Education Program HealthSource provided 749 life support classes for 9,615 students at worksites and in the community. Over 2,900 students received advanced life support training Over 40,000 community members were served through 1,274 Childbirth Preparation classes. Community members enjoyed about 570 fitness classes at locations throughout the community. Almost all of the classes were multi-session, usually 8-10 weeks. Over 17,750 took part in fitness classes during 2013.”

“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.”

“Partnership income -14,933,967. Change in investments balance 11,091,424. Prior period fund balance -6,249,923. Equity in subs 10,755,188. Donated funds 17,091. Capital reimbursement 318,207. Pension gain 26,244,030.”

“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.”

“The company is a subsidiary of the Inova Health System (IHS), a not-for-profit integrated health care delivery system serving Northern Virginia and surrounding areas. IHS receives various federal grants. These grants and awards are audited as part of the consolidated Inova Health System A-133 compliance audit. The Inova Health System's federal grants are audited on an annual basis by a large "Big Four" independent public accounting firm and a "Report on Compliance with Requirements Applicable to Each Major Program and on Internal Controls over Compliance in Accordance with OMB Circular A-133" is issued on a consolidated basis. The Finance and Audit Committee of the Board of Trustees of Inova Health System is responsible for the oversight of the A-133 audit, including the hiring of the audit firm, review and approval of audited financial statements and communications with the external auditors at least twice a year without the presence of internal management.”