990s.foundationcenter.org990s.foundationcenter.org/990_pdf_archive/540/... · 1~ return of...

-~ 1~ Return of Organization Exempt From Income Tax

OMB No 1545-0047

Form,' ~ ~~ Under section 501(c), 527, or 4947(a)(1) of the Internal Revenue Code (except black lung 2003 Department or the Treasury benefd trust or private foundation)

open 110 Public Internal Revenue Service " The organization may have to use a copy of this return to satisfy state reporting requirements A For the 2003 calendar year, or tax year beginning and ending B Check if please C Name of organization D Employer identification number applicable use IRS

Address change label HEALTH CARE SERVICES 54-0620889

Name, type [::Ichang See Number and street (or P 0 box if mail is not delivered to street address) Room/suite E Telephone number =;et�R, Speafic2990 TELESTAR COURT, FOURTH FLOOR TAX 703-289-2433

n al Instruc- ~rFi etum lions CI~ or town, state or country, and ZIP + 4 F Pccountngmethod a Cash [K] Accrual

Amended ~ Other return ALLS CHURCH VA 22042 Application 9 Section 501(c)(3) organizations and 4947(a)(1) nonexempt charitable trusts H and I are not applicable to section 527 organizations pending

must attach a completed Schedule A (Form 990 or 990-EZ) H(a) Is this a group return for affiliates ~ Yes 0 No

G Website " INOVA . ORG H(6) If "Yes," enter number of affiliates 01, J Organization tyDB (checkonly one) " I-X 1 501lc) ( 3 ) ~ r,~~Prt ~c? n 4947 ;x ;(1) ;, ; ~ 52' y (t) Are all 2ffiiiates Inciudea -N/A Yes No K Check here " 0 if the organization's gross receipts are normally not more than $25,000 The (If "No," attach a list )

H(d) Is this a separate return filed by an or- organization need not file a return with the IRS, but it the organization received a Form 990 Package amzation covered b a group rulin g ? =Yes ~X No in the mail, it should file a return without financial data Some states require a complete return I Group Exemp tion Number

M Check " = if the organization is not required to attach L Gross receipts Add lines 6b, 8b, 9b, and 10b to line 12 . 940 , 469 , 925 . Sch B (Form 990, 990-EZ, or 990-PF)

I Revenue, Expenses, and Changes in Net Assets or Fund Balances 1 Contributions, gifts, grants, and similar amounts received

a Direct public support 1 a o h Indirect public support 1 b 2,761,458 . `" c Government contributions (grants) 1 c 5,274,116 .

d Total (add lines to through 1c) (cash $ 8,035,574 . noncash $ ) 1 d 8,035,574 . 0 U 2 Program service revenue including government fees and contracts (from Part VII, line 93) 2 8 9 1,795,518 . LLJ 3 Membership dues and assessments 3

4 Interest on savings and temporary cash investments 4 1,674,754 . 5 Dividends and interest from securities 5 6 a Gross rents See Statement 2 6a 11, 052, 726 .

b less rental expenses See Statement 3 6b 7,940, 157 . c Net rental income or (loss) (subtract line 6b from line 6a) 6c :3,112,569 .

7 Other investment income (describe " See Statement 1 7 395,543 . 'e 8 a Gross amount from sales of assets other A Securities B Other C1 d than inventory 8a

b Less cost or other basis and sales expenses 8b 1,515, 925 . c Gain or (joss) (attach schedule) 8c < 1 515 925 . d Net gain or (loss) (combine line 8c, columns (A) and (B)) Stmt 4 8d <1,515,925 . >

9 Special events and activities (attach schedule) If any amount is from gaming, check here " 0 a Gross revenue (not including $ of contributions

reported on line 1a) 9a 6 Less direct expenses other than fundraising expenses 9b c Net income or (loss) from special events (subtract line 9b from line 9a) 9c

10 a Gross sales of inventory, less returns and allowances 10a b Less cost of goods sold 10b c Gross profit or (loss) from sales of invent (attaqpsphe om line 10x) 10c

11 Other revenue (from Part VII, line 103) re t ~ VED i ~ 27 , 515 , 810 .

12 Total revenue add lines 1d 2 3 4 5 6 7 d 9c 10c an 12 9 3 1 , 0 13 , 8 4 3 .

13 Program services (from line 44, column ( ~ [J~~/ 1 8 2004

~ 13 752,514,359 . c 14 Management and general (from line 44, lu n (C)) _ ~ i s 125,274,059 . d 15 Fundraising (from line 44, column (D)) ~''~ ~ 15

16 Payments to affiliates (attach schedule) ~~~~~~ UT 16 17 Total expenses add lines 16 and 44 column A 17 1377, 788,418 . 18 Excess or (deficit) for the year (subtract line 17 from line 12) 18 5 3 , 225,425 .

N 19 Net assets or fund balances at beginning of year (from line 73, column (A)) ig 4 56 , 363 , 551 .

ZN Q 20 Other changes m net assets or fund balances (attach explanation) See Statement 5 2p 8 78-8 , 104 .

21 Net assets or fund balances at end of year (combine lines 18, 19, and 20) 21 518 , 377 , 080 . ;230003 LHA For Paperwork Reduction Act Notice, see the separate instructions Form 990 (2003)

13141006 746301 hosp 2003 .04000 INOVA HEALTH CARE SERVICES HOSP1

\'

~~ Statement Functional

Do not include amour ,t part i (A) Total ( ) rogram ( ) Management D Fundraisin cortncac and nonar~l

22 Grants and allocations (attach schedule) cash $ noncash $ 22

23 Specific assistance to individuals (attach schedule) 23

24 Benefits paid to or for members (attach schedule) 24

25 Compensation of officers, directors, etc 25

26 Other salaries and wages 26

27 Pension plan contributions 27

28 Other employee benefits 28

29 Payroll taxes 29 30 Professional fundraising fees 30 31 Accounting fees 31 32 Legal fees 32 33 Snpphes 33

34 Telephone 34

35 Postage and shipping 35

36 Occupancy 36

37 Equipment rental and maintenance 37

38 Printing and publications 38

39 Travel 39

40 Conferences, conventions, and meetings 40

41 Interest 41

42 Depreciation, depletion, etc (attach schedule) 42

43 Other expenses not covered above (itemize)

a 43 . b 431 c 43~ d 431 e See Statement 6 asp 04 362 093 . 78 501 764 . 25 860 329 .

0 . Joint Costs Check " ~ if you are following SOP 98-2 Are any point costs from a combined educational campaign and fundraising solicitation reported in (B) Program services'? " 0 Yes X No If "Yes," enter (i) the aggregate amount of these point costs $ , (ii) the amount allocated to Program services $ Gill the amount allocated to Management and general $ . and Iwl the amount allocated to Fundraising $

What is the organization's primary exempt purposes " See Statement 7 Pro ram Service

~ All organizations must describe their exempt purpose achievements in a clear and concise manner State the number of clients served, publications issued, etc Discuss

xpenses (Required for 501(c)(3) and

achievements that are not measurable (Section 501(c)(3) and (4) organizations and 4947(a)(1) nonexempt charitable trusts must also enter the amount of grants and (4) orgs , and 4947(a)(1) allocations to others ) trusts, but optional for others )

a See Attached Statement

Grants and allocations $ ) 752,514,359 . b

Grants and allocations $ C

Grants and allocations $ d

Grants and allocations $ e Other p ro g ram services attach schedule (Grants and allocations $

f Total of Program Service Expenses (should equal line 44, column (B), Program services) " 752,514,359 . 323011 12-17-03 Form 990 (2003)

2 2003 .04000 INOVA HEALTH CARE SERVICES HOSP 1 13141006 746301 hosp

INOVA HEALTH CARE SERVICES 5Y-^vS2v^889 All organizations must complete column (A) Columns (B), (C), and (D) are required for section 501(c)(3)

Bnses and (4) organizations and section 4947(a)(1) nonexempt charitable trusts but optional for others orted on line B P C M

0 . 0 . 0 . 09,922,203 .349,209,257 . 60,712,946 . 13,020,016 . 11,579,929 . 1,440,087 . 37,956,800 . 32,175,508 . 5,781,292 . 28,640,032 . 24,517,375 . 4,122,657 .

678,950 . 678,950 . 1,376,222 . 303,437 . 1,072,785 .

81 A 77,676,496 .11-176f L,2fnv6_[zj .l 86/2,431 . 3,062,315 . 1,248,416 . 1,813,899 . 2,061,031 . 1,176,206 . 884,825 . 14,195,475 . 8,334,131 . 5,861,344 . 6,709,288 . 5,529,684 . 1,179,604 . 1,034,851 . 735,059 . 299,792 . 978,979 . 514,376 . 464,603 . 918,818 . 455,336 . 463,482 .

18,170,769 . 21,081,449 . <2,910,680 . 57,024,080 . 40,338,367 . 16,685,713 .

44 Organiza0ons complebnp calurtins (B)-(Tn, Barry these totals to lines 13-15 144 It3 7 7 , 7 8 8 , 418 . 7 S 2 , 514 , .5 :) 9 . .L 2 5 , 2 7 4 , U 5 9 .

0 .

, Form 00(2003) INOVA HEALTH CARE SERVICES 54-0620889

PTV Balance Sheets

Note : Where required, attached schedules and amounts within the descnption column (A) (B) should be for end-of-year amounts only Beginning of year End of year,

45 Cash - non-interest-bearing 45 46 Savings and temporary cash investments 27,321,460 . 46 11,784,895 .

47 a Accounts receivable 47a 411 , 7 8 0 , 6 5 7 . b Hess allowance for doubtful accounts ash 246,801,949 . 182,403,226 . arc 164,978,708 .

48 a Pledges receivable 48a b Less allowance for doubtful accounts 48b 48c

49 Grants receivable 49 50 Rereivabies from officers, directors , trustees,

and key employees 50 a m 51 a Other notes and loans receivable 51a N

b Less allowance for doubtful accounts 51 b 51 c 52 Inventories for sage or use 14,102,733 . 52 14,570,486 . 53 Prepaid expenses and deferred charges 16,695,963 . 53 17,803,546 . 54 Investments - securities Stmt 8 " ~X Cost ~ FMV 136,988,930 . 54 60,661,253 . 55 a Investments - land, buildings, and

equipment basis 55a

b Less accumulated depreciation 55b 55c 5s Investments -other See Statement 9 2,318,199 . ss 9,790,040 . 57 a Land, buildings, and equipment basis 57a 1026246457 .

b Hess accumulated depreciation 57b 4 6 5 , 5 4 0 , 14 0 . 4 9 2 , 3 9 3, 3 5 8 . 57c 560,706,317 . 58 other assets (describe " - See- -Statement 10 ~ 527 , 650 , 121 . 5e 1 576 , 169 , 227 .

1399873990 .1 591 1416464472 . 53,664 .111 . so 223,262,721 . 60 Accounts payable and accrued expenses

61 Grants payable 62 Deferred revenue

N d 63 Loans from officers, directors, trustees, and key employees Y

64 a Tax-exempt bond liabilities b Mortgages and other notes payable

61

63 481,265,579 .Isaa1474,117,051 .

64b 65 Other liabilities (descnbe P See Statement 11 ) L 208,580,749 .1 65 1 200, 707, 620 .

66 Total liabilities add lines 60 throu g h 65 ) 943 , 510 , 439 . 66 898 , 087 , 392 . Organizations that follow SEAS 117, check here ~ D and complete lines 67 through

69 and lines 73 and 74 67 Unrestricted 4 5 6 , 34 1, 8 2 7 . 67 518,355,356 . 68 Temporarily restricted 21,724 . 68 21,724 .

m 69 Permanently restricted 69 Organizations that do not follow SFAS 117, check here D 0 and complete lines

70 through 74 °~ 70 Capital stock, trust principal, or current funds 70 Y

71 Paid-in or capital surplus, or land, budding, and equipment fund 71

72 Retained earnings, endowment, accumulated income, or other funds 72 r z 73 Total net assets or fund balances (add lines 67 through 69 or lines 70 through 72,

column (A) must equal line 19, column (e) must equal line 21) 456 , 363 , 551 . 1 73 518 , 377 , 080 . 74 Total liabilities and net assets I fund balances (add lines 66 and 73) 1399873990 . 1 74 1416464472 .

Form 990 is available for public inspection and, for some people, serves as the primary or sole source of information about a particular organization How the public perceives an organization in such cases may be determined by the information presented on its return Therefore, please make sure the return is complete and accurate and fully describes, in Part III, the organization's programs and accomplishments

323021 12-17-0.3

3

13141006 746301 hosp 2003 .04000 INOVA HEALTH CARE SERVICES HOSP 1

Form 990 2003 INOVA HEALTH CARE SERVICES 1V-A. Reconciliation of Revenue per Audited Part IV

Financial Statements with Revenue per Rots urn

54-0620889 Pa9e4 rteconcmation of Expenses per Audited Financial Statements with Expenses per

1255660000 .

S Add amounts on lines (1) and (2) " d 0 .

e Total revenue per line 12, Form 990 (pine c pus pine d) " e 931013843 .

R~rrt V List of Officers, Directors, Trustees, and Key E

(A) Name and address

- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -

See Statement 14 --------------------------------- ---------------------------------

--------------------------------- ---------------------------------

--------------------------------- ---------------------------------

--------------------------------- ---------------------------------

--------------------------------- ---------------------------------

--------------------------------- ---------------------------------

--------------------------------- ---------------------------------

--------------------------------- ---------------------------------

0 .

877788418 .

is to (E) Expense efi' account and other allowance :

0 . 0 . 0 .

75 Did any officer, director, trustee, or key employee receive aggregate compensation of more than $100,000 from your organization and all related organizations, of which more than $10,000 was provided by the related organizations If "Yes," attach schedule Yes 0 No

323031 12-17-0.3 Form 990 (2003) 4

2003 .04000 INOVA HEALTH CARE SERVICES HOSP 1 13141006 746301 hosp

a Total revenue, gams, and other support per audited financial statements " a 1240732000 .

b Amounts included on line a but not on line 12, Form 990

(1) Net unrealized gains on investments $

(2) Donated services and use of facilities $

(3) Recoveries of prior year grants $

(4) Other (specify) Stmt 12 g 309718157 .

Add amounts on lines 1,11 through f41 1111l 5 309718157 . c dine a minus pine b " c 931013843 . d Amounts included on line 12, Form

990 but not on line a :

(1) Investment expenses not included on line 6b, Form 990 $

(2) Other (specify)

a Total expenses and losses per audited financial statements " a

b Amounts included on line a but not on line 17, Form 990

(1) Donated services and use of facilities $

(2) Prior year adjustments reported on line 20, Form 990 $

(3) Losses reported on line 20, Form 990 $

(4) Other (specify) Stmt 13 g 377871582 .

Add amounts on lines (1) through (4) ~ 0 C Line a minus line h " c d Amounts included on line 17, Form

990 but not on line a

(1) Investment expenses not included on line 6b, Form 990 ~ $

(2) Other (specify) a

Add amounts on lines (1) and (2) " d e Total expenses per line 17, Form 990

(line c plus line d) 1 R1ployeeS (List each one even it not compensated ) (B) Title and average hours (C) Compensation (D~concnb~

per week_devoted to (If not paiQ, enter o,a l5 a d,

37i8ii582 . 877788418 .

.Form 950(2003) INOVA HEALTH CARE SERVICES 54-0620889 Pages pV1 Other Information Yes No 76 Did the organization engage m any activity not previously reported to the IRS If "Yes," attach a detailed description of each activity 76 X 77 Were any changes made in the organizing or governing documents but not reported to the IRS 77 X

If "Yes,' attach a conformed copy of the changes 78 a Did the organization have unrelated business gross income of $1,000 or more during the year covered by this returns 78a X

b If "Yes," has it filed a tax return on Form 990-T for this years N/A 78b 79 Was there a liquidation, dissolution, termination, or substantial contraction during the years 79 X

If "Yes ; attach a statement 80 a Is the organization related (other than by association with a statewide or nationwide organization) through common membership,

governing bodies, trustees, officers, etc , to any other exempt or nonexempt organizations 80a X b If"Yes,°enter the name of the organization " See Statement 15

and check whether it is = exempt or = nonexempt 81 a Enter director indirect political expenditures See line 81 instructions 81a 0 .

b Did the organization file Form 1120-POL for this years 81 h X 82 8 Did the organization receive donated services o,. the ;;se o! ma,erals, equipment, or facilities at no c.i7arge or at suDstanuauy less than

fair rental values 82a X b If "Yes," you may indicate the value of these items here Do not include this amount as revenue in Part I or as an

expense in Part II (See instructions in Part III ) 82b N/A 83 a Did the organization comply with the public inspection requirements for returns and exemption applications 83a X

h Did the organization comply with the disclosure requirements relating to quid pro quo contributions'? 83b X 84 a Did the organization solicit any contributions or gifts that were not tax deductibles 84a

b If "Yes," did the organization include with every solicitation an express statement that such contributions or gifts were not tax deductible? N/A 84b

85 501(c)(4), (5), or (6) organizations. a Were substantially all dues nondeductible by members N/A 85a b Did the organization make only in-house lobbying expenditures of $2,000 or less NBA 85b

If "Yes" was answered to either 85a or 85b, do not complete 85c through 85h below unless the organization received a waver for proxy tax owed for the prior year

c Dues, assessments, and similar amounts from members 85c N/A d Section 162(e) lobbying and political expenditures 85d N/A e Aggregate nondeductible amount of section 6033(e)(1)(A) dues notices 85e N/A f Taxable amount of lobbying and political expenditures (line 85d less 85e) 85f N/A g Does the organization elect to pay the section 6033(e) tax on the amount on line 85f9 N/A 85 h If section 6033(e)(1 )(A) dues notices were sent, does the organization agree to add the amount on line 85f to its reasonable estimate of dues

allocable to nondeductible lobbying and political expenditures for the following tax years N/A 85h 86 501(c)(7) organizations. Enter a Initiation fees and capital contributions included on line 12 86a N/A

b Gross receipts, included on line 12, for public use of club facilities 86b N/A 87 501(c)(12) organizations Enter a Gross income from members or shareholders 87a N/A

b Gross income from other sources (Do not net amounts due or paid to other sources against amounts due or received from them ) 87h N/A

88 At any time during the year, did the organization own a 50% or greater interest in a taxable corporation or partnership, or an entity disregarded as separate from the organization under Regulations sections 301 7701-2 and 301 7701-39 If "Yes," complete Part IX 88 X

89 a 501(c)(3) organizations Enter Amount of tax imposed on the organization during the year under section 4911 . 0 . , section 4912 . 0 . , section 4955 . 0

b 501(c)(3) and 501(c)(4) organizations Did the organization engage in any section 4958 excess benefit transaction during the year or did it become aware of an excess benefit transaction from a prior year If "Yes," attach a statement explaining each transaction 896 X

c Enter Amount of tax imposed on the organization managers or disqualified persons during the year under sections 4912, 4955, and 4958

d Enter Amount of tax on line 89c, above, reimbursed by the organization " 0 90 a List the states with which a copy of this return is filed " CALIFORNIA, NORTH CAROLINA

b Number of employees employed in the pay period that includes March 12, 2003 ~ 90b 10 0 4 7

91 The books are m care of " Inova Health Care Services Telephone no 01, 703-289-2433

Locatedat " 2990 Telestar Ct . , VA ziP+a " 22042

92 Section 4947(a)(1) nonexempt charitable trusts filing Form 990 m lieu of Farm 1041- Check here 1 D and enter the amount of tax-exempt interest received or accrued during the tax year " I 92 I N/A

~230~ ~3 Form 990 (2003) 5

13141006 746301 hose 2003 .04000 INOVA HEALTH CARE SERVICES HOSP 1

See Statement 16

Information Regarding Taxable Subsidiaries and Disregarded Entities (see page 34 of the instructions)

Name, address, and EIN of corporation, I Percentage of I Nature of activities I Total income I End-of-year

N/A

13141006 746301 hosp 2003 .04000

Form 9M (2003) INOVA HEALTH CARE SERVICES 54-0620889 pV1{ Analysis of Income-Producing Activities (see cage 33 of the instructions) Note Entergross amounts unless otherwise Unrelated business income Excluded by section 512, 513, or 514 indicated ~A) (B) (~) (D) Related or exempt Business Amount 93 Program service revenue code Amount ~oae function income a Patient Service Revenue 888 ,892,502 . b Premier Purch partner- 541900 <32,224 . 2,935,240 . c ship income related to d program services e f Medicare/Medicaid payments g Fees and contracts from government agencies

94 Membership dues and assessments 95 Interest on savings and temporary cash investments 14 1,674,754 . 96 Dividends and interest from securities 97 Net rental income or (loss) from real estate

a debt-financed property b not debt-financed property 16 3,112,569 .

98 Net rental income or (loss) from personal property 99 Other investment income 14 52,044 . 343,499 . 100 Gain or (loss) from sales of assets

other than inventory 18 <1,515,925 . > 101 Net income or (loss) from special events 102 Gross profit or (loss) from sales of inventory 103 Other revenue

a Revenue Incidental 03 21,397,445 . h PHARMACEUTICAL CONTRACT 541700 2,658,944 . c LAUNDRY SERVICES 812300 3,198,075 . d OTHER HEALTH SERVICES 62199 0 261,346 . e L

104 subtotal (add columns (e), (o), and (E)) 6,086,141 . 1 2 4 , 7 2 0 , 8 8 7 . 8 9 2 , 171, 2 41 . 105 Total (add line 104, columns (B), (D), and (E)) " 9 2 2 , 9 7 8 , 2 6 9 . Note Line 105 plus line 1d, Part l, should equal the amount online 12, Part/.

partV ~([Relationship of Activities to the Accomplishment of Exempt Purposes (Seepage 34 of the instructions) Line No Explain how each activity for which income is reported in column (E) of Part VII contributed importantly to the accomplishment of the organization's V ~ exempt purposes (other than by providing funds for such purposes)

I %I Part 7C Information Regarding Transfers Associated v (a) Did the organization, during the year, receive any funds, directly or indirectly, 1 (b) Did the organization, during the year, pay premiums, directly or indirectly, on Note . If "Yes" to b or 8870 and For 720 see instructions

Under pe t pe la r t I examined this return, including acco Please coast nd le ti r r (other than offices is based on all lpf

Sign

Here Signat of offic r Date

Paid Prepared' signature

PfBpefEr'S Fnm'sname (or KAISER SCHERER & SCHLEG y ours if UseOn~

self-employed), '1899 L STREET, N .W ., SU 323161 address, and �_�_'I ZIP .a WASHINGTON, D .C . 20036

Organization Exempt Under Section 501(c)(3) (Except Private Foundation) and Section 501(e), 501(f), 501(k),

501(n), or Section 4947(a)(1) Nonexempt Charitable Trust Supplementary Information-(See separate instructions .)

1 MUST be completed by the above organizations and attached to their form 990 or 990-EZ 2003 Department of the Treasury

Internal Revenue Service

Name of the organization Employer identification number 54 0620889 INOVA HEALTH CARE SERVICES

Compensation of the Five Highest Paid Employees Other Than Officers, Directors, and Trustees (See page 1 of the instructions List each one If there are none, enter "None ") (a) Name and address of each employee paid (b) Title and average hours (demployee benefit (e) Expense

more than $50,000 per week devoted to (c) Compensation P,ars 8 deferred account and other

position compensation allowances

FRED MECKLENBURG, M .D .

FAIRFAX HOSPITAL O+HRS 1 355,360 .139,090 .

CARDIOVASCULAR AND THORASIC SURGERY ASSOC PC

3301 WOODBURN RD, ANNANDALE, VA 22003 MEDICAL SERVICES 3169738 .

Total number of others receiving over $50,000 for professional services 1 233 323101/12-05-03 LHA For Paperwork Reduction Act Notice, see the Instructions for Form 990 and Form 990-EZ . Schedule A (Form 990 or 990-EZ) 2003

7

13141006 746301 hosp 2003 .04000 INOVA HEALTH CARE SERVICES HOSP_1

SCHEDULE A (Form 990 or 990-EZ)

OMB No 1545-0047

SAMIR FAKHRY, M.D .

FAIRFAX HOSPITAL

GARY MAGR.AM, M .D .

FAIRFAX HOSPITAL

JAMES PIPER M .D .

FAIRFAX HOSPITAL

HRMAN

O+HRS 1425,630 .146,819 .

DICAL DRTR

O+HRS 1400,966 .1 44,106 .

ICAL DRTR

O+HRS 1 400,627 .144,069 .

HRMAN-OBGYN

JOHANN JONSSON RTR-TRANSPLT

FAIRFAX HOSPITAL 40+HRS 340,789 . 37,487 . Total number of other employees paid over $50,000 . 2843

Part 11 Compensation of the Five Highest Paid Independent Contractors for Professional Services (See page 2 of the instructions List each one (whether individuals or firms) If there are none, enter "None ")

(a) Name and address of each independent contractor paid more than $50,000 (b) Type of service (c) Compensation

MEDSTAR GEORGETOWN MEDICAL CENTER ERINATOLOGY

3800 RESERVIOR NW, WASHINGTON, DC 20007 SERVICES 8595233 .

CROSS COUNTRY HEALTHCARE

P .O . BOX D860594, ORLANDO, FL 32886 URSING SERVICS 3240301 .

VA- EMERGENCY- MEDICINE- ASSOC -LTD HYSICIAN

P .O . BOX 392, FAIRFAX STATION VA 22039 SERVICES 3000000 .

AMERICAN MOBILE NURSES HEALTHCARE

GPD P .O . BOX 5389, NEW YORK, NY 10087 URSE STAFFING 3012301 .

Schedule A (Form 990 or 990-EZ) 2003 INOVA HEALTH CARE SERVICES 54-0620889 Payee

Statements About Activities (See page 2 of the instructions ) Yes l No

2e X

3a X 36 X

a X

3 a Do you make grants for scholarships, fellowships, student loans, etc 9 (If "Yes," attach an explanation of how you determine that recipients qualify to receive payments )

h Do you have a section 403(b) annuity plan for your employees 4 Did you maintain any separate account for participating donors where donors have the right to provide advice

on the use or distribution of funds'? t IV Reason for Non-Private Foundation Status (See pages 3 through 6 of the instructions w F_

13 = An organization that is not controlled by any disqualified persons (other than foundation managers) and supports organizations described in (1) lines 5 through 12 above or (2) section 501(c)(4) (5) or (6) if they meet the test of section 509(a)(2) (See section 509(a)(3) )

Provide the following information about the supported organizations (See page 5 of the instructions ) (b) Line number

from above (a) Name(s) of supported organization(s)

Section 509(a)(4) (See page 6 of the instructions organized and operated to test for public Schedule A (Form 990 or 990-EZ) 2003

323111 12-05-03

8


1 During the year, has the organization attempted to influence national, state, or local legislation, including any attempt to influence public opinion on a legislative matter or referendums If "Yes," enter the total expenses paid or incurred in connection with the lobbying activities 1 $ $ 23,539 . (Must equal amounts on line 38, Part VI-A, or line i of Part VI-B ) Organizations that made an election under section 501(h) by filing Form 5768 must complete Part VI-A Other organizations checking "Yes," must complete Pad VI-B AND attach a statement giving a detailed description of the lobbying activities

2 During the year, has the organization, either directly or indirectly, engaged in any of the following acts with any substantial contributors, trustees, directors, officers, creators, key employees, or members of their families, or with any taxable organization with which any such person is affiliated as an officer, director, trustee, majority owner, or principal beneficiary? (If the answer to any question is "Yes, " attach a detailed statement explaining the transactions)

a Sale, exchange, or leasing of property

h Lending of mpnav or other gxta,ricinn of r_rar_iit'?

c Furnishing of goods, services, or facilities

d Payment of compensation (or payment or reimbursement of expenses if more than $1,000) Set Part V, Form 990

e Transfer of any part of its income or assets

X

2a X

tb n

2c X

2d X

The organization is not a private foundation because d is (Please check only ONE applicable box ) 5 ~ A church, convention of churches, or association of churches Section 170(b)(1)(A)(i) 6 ~ A school Section 170(b)(1)(A)(n) (Also complete Part V ) 7 ~X A hospital or a cooperative hospital service organization Section 170(b)(1 )(A)(ui) 8 0 A Federal, state, or local government or governmental unit Section 170(b)(1)(A)(v) 9 ~ A medical research organization operated in conjunction with a hospital Section 170(b)(1)(A)(ui) Enter the hospital's name, city,

and state 00, 10 ~ An organization operated for the benefit of a college or university owned or operated by a governmental unit Section 170(b)(1)(A)(iv)

(Also complete the Support Schedule m Part IV-A ) 11a 0 An organization that normally receives a substantial part of its support from a governmental unit or from the general public

Section 170(b)(1)(A)(vi) (Also complete the Support Schedule in Part IV-A ) 11h ~ A community trust Section 170(b)(1)(A)(vi) (Also complete the Support Schedule in Part IV-A ) 12 ~ An organization that normally receives (1 ) more than 331/3% of its support from contributions, membership fees, and gross

receipts from activities related to its charitable, etc , functions - subject to certain exceptions, and (2) no more than 33 1/3% of its support from gross investment income and unrelated business taxable income (less section 511 tax) from businesses acquired by the organization after June 30, 1975 See section 509(a)(2) (Also complete the Support Schedule in Part IV-A )

14 n An o

d Add Line 27a total and line 27b total I 27d N / A

e Public support (line 27c total minus line 27d total) 0- 27e N/A

f Total support for section 509(a)(2) test Enter amount on line 23, column (e) 1 27f N/A g Public support percentage (line 27e (numerator) divided by line 27f (denominator)) 1 27 N/A

h Investment income percentage (line 18, column (e) (numerator) divided by line 27f (denominator)) 1 ~ 27h I N/ A % 28 Unusual Grants: For an organization described in line 10, 11, or 12 that received any unusual grants during 1999 through 2002, prepare a list for your records

to show, for each year, the name of the contributor, the date and amount of the grant, and a brief description of the nature of the grant Do not file this list with your return Do not include these grants in line 15

323121 12-05-03 Schedule A (Forth 990 or 990-EZ) 2003

9 13141006 746301 hosp 2003 .04000 INOVA HEALTH CARE SERVICES HOSP 1

Schedule A (Form 990 or 990-EZ) 2003 INOVA HEALTH CARE SERVICES 54-0620889 Page 3 ~7t~ JWA Support Schedule (Complete only if you checked a box on line 10, 11, or 12) Use cash method of accounting. N/A Note : You ma use the worksheet in the instructions for converting from the accrual to the cash method of accounhn .

Calendar year (or fiscal year beg in nin in 1 (a) 2002 (6) 2001 (c) 2000 (d) 1999 ( e) Total 15 Gifts, grants, and contributions

received (Do not include unusual rants See line 28

16 Membership fees received 17 Gross receipts from admissions,

merchandise sold or services performed, or furnishing of facilities in any activity that is related to the organization's charitable, etc , purpose

18 Gross income from interest, dividends, amounts received from payments on securities loans (section 512(a)(5)), rents, royalties, and unrelated business taxable income (less section 511 taxes) from businesses acquired by the organization after June 30, 1975

19 Net income from unrelated business activities not included in line 18

pp lax revenues levied for the organization's benefit and either paid to it or expended on its behalf

21 The value of services or facilities furnished to the organization by a governmental unit without charge Do not include the value of services or facilities generally furnished to the public without charge

pp Other income Attach a schedule Do not include gain or (loss) from sale of capital assets

23 Total of lines 15 through 22 0 . 0 . 1 0 . 1 0 . 0 . 24 Line 23 minus line 17 25 Enter 1% of line 23 26 Organizations described on lines 10 or 11 : a Enter 2% of amount in column (e), line 24 1 26a N/A

b Prepare a list for your records to show the name of and amount contributed by each person (other than a governmental unit or publicly supported organization) whose total gifts for 1999 through 2002 exceeded the amount shown in line 26a Do not file this list with your return . Enter the total of all these excess amounts 1110- 26b N/A

c Total support for section 509(a)(1) test Enter line 24, column (e) 1i0- 26c N/A d Add Amounts from column (e) for lines 18 19

22 26b 1 26d N/A e Public support (line 26c minus line 26d total) 1 26e N/A f Public support percentage (line 26e (numerator) divided by line 26c (denominator)) 1 26f - N/A

27 Organizations described on line 12 : a For amounts included in lines 15, 16, and 17 that were received from a "disqualified person," prepare a list for your records to show the name of, and total amounts received m each year from, each "disqualified person " Do not file this list with your return . Enter the sum of such amounts for each year (2002) (2001) (2000) (1999)

b For any amount included m line 17 that was received from each person (other than "disqualified persons"), prepare a list for your records to show the name of, and amount received for each year, that was more than the larger of (1) the amount on line 25 for the year or (2) $5,000 (Include in the list organizations described m lines 5 through 11, as well as individuals ) Do not file this list with your return After computing the difference between the amount received and the larger amount described in (1) or (2), enter the sum of these differences (the excess amounts) for each year

(2000) (1999) (2002) (2001) c Add Amounts from column (e) for lines 15 16

17 20 21 " 1 27c ~ N/A

323131 12-05-03

10

13141006 746301 hosp 2003 .04000 INOVA HEALTH CARE SERVICES HOSP 1

Schedule A (Form 990 or 990-EZ) 2003 INOVA HEALTH CARE SERVICES 54-0620889 Page 4 Private School Questionnaire (Seepage 7 of the instructions) N/A (To be completed ONLY by schools that checked the box on line 6 in Part 11)

29 Does the organization have a racially nondiscriminatory Yes No

policy toward students by statement in its charter, bylaws, other governing instrument, or in a resolution of its governing body 29

30 Does the organization include a statement of its racially nondiscriminatory policy toward students m all its brochures, catalogues, and other written communications with the public dealing with student admissions, programs, and scholarships 30

31 Has the organization publicized its racially nondiscriminatory policy through newspaper or broadcast media during the period of solicitation for students, or during the registration period if it has no solicitation program, in a way that makes the policy known to all parts of the general community it serves 31 If 'Yes,' please describe, if "NO ; please explain (If you need more space, attach a separate statement ~

32 Does the organization maintain the following a Records indicating the racial composition of the student body, faculty, and administrative staffs 32a b Records documenting that scholarships and other financial assistance are awarded on a racially nondiscriminatory basis 32b c Copies of all catalogues, brochures, announcements, and other written communications to the public dealing with student

admissions, programs, and scholarships 32c d Copies of all material used by the organization or on its behalf to solicit contributions? 32d

If you answered 'No' to any of the above, please explain (If you need more space, attach a separate statement )

33 Does the organization discriminate by race m any way with respect to

a Students' rights or privileges? 33a

b Admissions policies 33b

c Employment of faculty or administrative staffs 33c

d Scholarships or other financial assistance 33d

33e e Educational policies

f Use of facilities? 33f

g Athletic programs 33

h Other extracurricular activities9 33h

If you answered "Yes" to any of the above, please explain (If you need more space, attach a separate statement )

34 a Does the organization receive any financial aid or assistance from a governmental agency 34a

b Has the organization's right to such aid ever been revoked or suspended 34b

If you answered "Yes" to either 34a or b, please explain using an attached statement 35 Does the organization certify that it has complied with the applicable requirements of sections 4 01 through 4 05 of Rev Proc 75-50,

1975-2 C B 587, covering racial nondiscrimination? If "No," attach an explanation 35 Schedule A (Form 990 or 990-EZ) 2003

ScheddIeA(Form990or990-EZ)2003 INOVA HEALTH CARE SERVICES 54-0620889 Page 5 PVt-A Lobbying Expenditures by Electing Public Charities (see page s of the instructions )

(To be completed ONLY by an eligible organization that fled Form 5768) Check 1 a 0 if the organizat ion belongs to an affiliated group Check " b D if you checked "a" and "limited control" provisions aoolv

41 0 .

42 0 . 43 0 . ~-

I 44 0 .

Caution : If there is an amount on ether Ime 43 or line 44, you must file Form 4720.

Lobbying Expenditures During 4-Year Averaging Period

(a) (b) (c) (d) 2003 2002 2001 2000

Calendar year (or fiscal year beginning in) 1

45 Lobbying nontaxable amount

46 Lobbying ceding amount (150% of line 45(e))

47 Total lobbying expenditures

48 Grassroots nontaxable amount

49 Grassroots ceiling amount (150% of line 48(e))

50 Grassroots lobbying

(e) Total

1,000,000 .E 1,000,000 .E 1,000,000 .E 1,000,000 .E 4,000,000 .

6,000,000 .

64,086 . 178,829 .

250,000 . 1,000,000 .

1,500,000 .

250,000 . 250,000 .

0 . 0 .1 0 .1 Lobbying Activity by Nonelecting Public Charities (For reporting only by organizations that did not complete Part VI-A) (See I

0 .

e 12 of the instructions ) N/A During the year, did the organization attempt to influence national, state or local legislation, including any attempt to

Yes No Amount influence public opinion on a legislative matter or referendum, through the use of a Volunteers b Paid staff or management (Include compensation in expenses reported on lines c through h ) c Media advertisements d Mailings to members, legislators, or the public e Publications, or published or broadcast statements f Grants to other organizations for lobbying purposes g Direct contact with legislators, then staffs, government officials, or a legislative body h Rallies, demonstrations, seminars, conventions, speeches, lectures, or any other means i Total lobbying expenditures (Add lines c through h ) ~ I 0 .

If "Yes" to any of the above, also attach a statement giving a detailed description of the lobbying activities

3230503 Schedule A (Form 990 or 990-EZ) 2003 11


Limits on Lobbying Expenditures

term "expenditures" means amounts paid or incurred )

36 Total lobbying expenditures to influence public opinion (grassroots lobbying) 37 Total lobbying expenditures to influence a legislative body (direct lobbying) 38 Total lobbying expenditures (add lines 36 and 37) 39 Other exempt purpose expenditures 40 Total exempt purpose expenditures (add lines 38 and 39) 41 Lobbying nontaxable amount Enter the amount from the following table

If the amount on line 40 is - The lobbying nontaxable amount is -Not over $500 000 ?poi nf the R.�~~j~t ~t :~ i-o n0 Over $500,000 but not over $1,000,000 $100,000 plus 15% of the excess over $500,000

Over $1,000,000 but not over $1,500,000 $175,000 plus 10% of the excess over $1,000,000

Over $1,500,000 but not over $17,000,000 $225,000 plus 5% of the excess over $1,500,000

Over $17,000,000 $1,000,000

42 Grassroots nontaxable amount (enter 25% of line 41) 43 Subtract line 42 from line 36 Enter -0- if line 42 is more than line 36 44 Subtract line 41 from line 38 Enter-0- if line 41 is more than line 38

(a) Affiliated group

totals

36 0 . 37 0 . 38 0 . 39 0 . ao 0 .

4-Year Averaging Period Under Section 501(h) (Some organizations that made a section 501(h) election do not have to complete all of the five columns

below See the instructions for lines 45 through 50 on page 11 of the instructions )

(e) To be completed for ALL electing organizations

0 . 23,539 . 23,539 .

877,884,418 . 877,907,957 .

1 .000 .000 .

250,000 . 0 .

23,539 . 20,733 . 70,471 .

250,000 .

0 .

51 a(!) X (i) Cash a(n) X (ii) Other assets

b Other transactions (i) Sales or exchanges of assets with a noncharitable exempt organization b(l) X

(ii) Purchases of assets from a noncharitable exempt organization b( d) X

(ui) Rental of facilities, equipment, or other assets h(w) X

(iv) Reimbursement arrangements b(iv) X

(v) Loans or loan guarantees h (v) X

(vi) Performance of services or membership or fundraising solicitations b(vi) X

c Shanna of facilities equipment, mailing _ i~crc, nfhar assets, � om~,�~ �~~ I I I n,. Paid .. , .�,gees c x

d lithe answer to any of the above is "Yes ;' complete the following schedule Column (b) should always show the fair market value of the goods, other assets, or services given by the reporting organization If the organization received less than fair market value in any

52 a Is the organization directly or indirectly affiliated with, or related to, one or more tax-exempt organizations described in section 501 (c) of the Code (other than section 501(c)(3)) or m section 527 " 9 E::] Yes [XI No

32305-03 Schedule A (Form 990 or 990-EZ) 2003 12

2003 .04000 INOVA HEALTH CARE SERVICES HOSP 13141006 746301 hose

Schedule A (Form 990 or 990-EZ) 2003 INOVA HEALTH CARE SERVICES 54-0620889 Page 6 R2q V1t Information Regarding Transfers To and Transactions and Relationships With Noncharitable

Exempt Organizations (See page 12 of the instructions ) 51 Did the reporting organization directly or indirectly engage in any of the following with any other organization described in section

501(c) of the Code (other than section 501(c)(3) organizations) or in section 527, relating to political organizations a Transfers from the reporting organization to a noncharitable exempt organization of Yes No

SCH~,DuLE K-1 Partner's Share of Income, Credits, Deductions, etc . OMB No ,s4s-oogg (FOr.m 1,065)' " See separate instructions

144

145

Sched,le K-1 Form 1065) 2002 PARTNER # 17 _rupVA HEALTH SYSTEM Page 2

.'P5000 1 000

146

STATEMENT #1

INOVA HEALTH CARE SERVICES 54-0620889

Form 990 Other Investment Income Statement 1

395,543 . Total to Form 990, Part I, line 7

Total to Form 990, Part I, line 6b 7,940,157 .

15 Statement s) 1, 2, 3 2003 .04000 INOVA HEALTH CARE SERVICES HOSP 1 13141006 746301 hosp

Description

PREMIER PURCHASING L .P . INTEREST FAIR OAKS MEDICAL PLAZA L .P . INTEREST AMHS HERITAGE, LLC INTEREST Potomac Inova LLC Interest FAIR OAKS MEDICAL PLAZA L .P . MEDICAL TRANSPORT LLC INTEREST MEDICAL TRANSPORT LLC Potomac Inova LLC

Amount

46,094 . 46 .

540 . 5,171 .

92,659 . 193 .

23,635 . 227,205 .

Form 990 Rental Income Statement 2

Activity Gross Kind and Location of Property Number Rental Income

OFFICE BUILDING RENTAL 1 11,052,726 .

Total to Form 990, Part I, line 6a 11,052,726 .

Form 990 Rental Expenses Statement 3

Activity Description Number Amount Total

DIRECT & INDIR . EXP . FOR OFFICE RENTALS 7,940,157 .

- SubTotal - 1 7,940,157 .

Form 990 Other Expenses Statement 6

(C) Program Management Services and General

2,833,310 . 134,209 . 19,055,195 . 644,905 .

27,598,404 . 9,281,707 . 1,471,431 . 290,570 .

652,054 . 1,330,807 . 26,244,838 . 7,467,111 .

521,268 . 531,976 .

80,962 . 6,030,943 .

(D)

Fundraising

(A)

Description Total

Food 2,967,519 . Physician's Fees 19,700,100 . Purchased Goods & Services 36,880,111 . Insurance 1,762,001 . Advertising 1,982,861 . Other (Misc) 33,711,949 . Taxes & Licenses 1,053,244 . Information System Cost 6,111,905 .

16 Statement s) 4, 5, 6 2003 .04000 INOVA HEALTH CARE SERVICES HOSP 1 13141006 746301 hosp

INOVA HEALTH CARE SERVICES 5i-620889 .,

Form 990 Gain (Loss) From Sale of Other Assets Statement 4

' Date Date Method Description Acquired Sold Acquired

LOSS FROM PREMIER PURCHASING PURCHASED LP

Gross Cost or Expense Net Gain Name of Buyer Sales Price Other Basis of Sale Deprec or (Loss)

0 . 1,515,925 . 0 . 0 . <1515925 .>

To Fm 990, Part I, In 8 1,515,925 . 0 . 0 . <1515925 .>

Form 990 Other Changes in Net Assets or Fund Balances Statement 5

Description Amount

PARTNERSHIP INCOME <1,778,533 .> UNREALIZED GAIN/LOSS 5,448,308 . WRITEOFF INTERCOMPANY BALANCE <731,226 .> EQUITY IN SUBS UNRESTRICTED FUND DONATIONS 210,692 . PENSION LIABILITY ADJUSTMENT 5,638,892 . OTHER MISC CHANGES <29 .>

Total to Form 990, Part I, line 20 8,788,104 .

INOVA HEALTH CARE SERVICES

Vehicle Expense 44,302 . 44,302 . Income Tax Expense 144,000 . Charitable Contributions and Portfolio Expenses 4,101 .

Total to Fm 990, In 43 104,362,093 . 78,501,764 .

54-^voi0889

4,101 .

25,860,329 .

Valuation Description Method Amount

INVESTMENT IN JOINT VENTURES AND SUBS Cost 9,790,040 .

Total to Form 990, Part IV, line 56, Column B 9,790,040 .

17 Statement s) 6, 7, 8, 9 2003 .04000 INOVA HEALTH CARE SERVICES HOSP 1 13141006 746301 hose

144,000 .

Form 990 Statement of Organization's Primary Exempt Purpose Statement 7 Part III

Explanation

TO MAINTAIN AND OPERATE HOSPITALS AND PERFORM OTHER ACTIVITIES TO PROMOTE THE GENERAL HEALTH OF THE COMMUNITY

Form 990 Government Securities Statement 8

U .S . State and Total Gov t Description Government Local Govt Securities

Held by Bond Trustee & Malpractice trust 60,661,253 . 60,661,253 .

Total to Form 990, line 54, Col B 60,661,253 . 60,661,253 .

Form 990 Other Investments Statement 9

INOVA.HEALTH CARE SERVICES 54-062089

Total to Form 990, Part IV-B 377,871,582 .

18 Statement s) 10, 11, 12, 13 2003 .04000 INOVA HEALTH CARE SERVICES HOSP 1 13141006 746301 hosp

Form 990 Other Assets Statement 10

Description - Amount

MEDICREDIT NOTES RECEIVABLE 7,193,730 . UNAMORTIZED BOND COSTS 4,266,965 . OTHER ASSETS 4,300,398 . DUE FROM SUBSIDIARIES 560,408,134 .


Form 990 Other Liabilities Statement 11

Description Amount

THIRD PARTY SETTLEMENTS 9,982,378 . NOTES PAYABLE AND OTHER 4,915,367 . CURRENT PORTION LT DEBT 145,460,000 . SELF INSURED LIABILITY 8,277,273 . OTHER LIABILITIES 32,072,602 .


Form 990 Other Revenue Not Included on Form 990 Statement 12

Description Amount

REVENUE OF OTHER ENTITIES REPORTED ON AUDIT 309,718,157 .

Total to Form 990, Part IV-A 309,718,157 .

Form 990 Other Expenses Not Included on Form 990 Statement 13

Description Amount

EXPENSES OF OTHER ENTITIES REPORTED ON AUDIT 377,871,582 .

0 . 0 . 0 .

13141006 746301 hose 19 Statement s) 14

2003 .04000 INOVA HEALTH CARE SERVICES HOSP 1

INOv_A_, BEALTu rARv SERVICES 54-0620889

Form 990 Part V - List of Officers, Directors, Statement 14 Trustees and Key Employees

Employee Title and Compen- Ben Plan Expense

Name and Address Avrg Hrs/Wk sation Contrib Account

UNCOMPENSATED OFFICERS AND DIRECTORS

FRED SACHS 2990 TELESTAR COURT FALLS CHURCH, VA 22042

MARY AGEE 2990 TELESTAR COURT FALLS CHURCH, VA 22042

ALAN E . LEIS 2990 TELESTAR COURT FALLS CHURCH, VA 22042

GLENNA ANDERSEN 2990 TELESTAR COURT FALLS CHURCH, VA 22042

FRED BOLLERER 2990 TELESTAR COURT FALLS CHURCH, VA 22042

PATRICIA BROUSSARD 2990 TELESTAR COURT FALLS CHURCH, VA 22042

CAREN DEWITT 2990 TELESTAR COURT FALLS CHURCH, VA 22042

MARGARET FAETH 2990 TELESTAR COURT FALLS CHURCH, VA 22042

CLEVE FRANCIS 2990 TELESTAR COURT FALLS CHURCH, VA 22042

,Ai3 ~.̂ HAIRY LESS THAN 40 0 . 0 . 0 .

VICE CHAIRMAN LESS THAN 40 0 . 0 . 0 .

ASST SECRETARY LESS THAN 40 0 . 0 . 0 .

DIRECTOR LESS THAN 40 0 . 0 . 0 .






INQVA~;HEALTH CARE SERVICES 54-Q620889

MICHAEL FREY DIRECTOR 2990 TELESTAR COURT LESS THAN 40 0 . 0 . 0 . FALLS CHURCH, VA 22042

PENNY GROSS DIRECTOR 2990 TELESTAR COURT LESS THAN 40 0 . 0 . 0 . FALLS CHURCH, VA 22042

WILLIAM HAZEL DIRECTOR 2990 TELESTAR COURT LESS THAN 40 0 . 0 . 0 . FALLS CHURCH, VA 22042

WILLIAM KILPATRICK DIRECTOR 2990 TELESTAR COURT LESS THAN 40 0 . 0 . 0 . F AL L S l.̂ H J Rln.. l l ~ V tT'~ L G V Y G

RAFAEL MADAM DIRECTOR 2990 TELESTAR COURT LESS THAN 40 0 . 0 . 0 . FALLS CHURCH, VA 22042

JOHN MADDOX DIRECTOR 2990 TELESTAR COURT LESS THAN 40 0 . 0 . 0 . FALLS CHURCH, VA 22042

SUDHAKAR SHENOY DIRECTOR 2990 TELESTAR COURT LESS THAN 40 0 . 0 . 0 .

FALLS CHURCH, VA 22042

JOEL TEMME DIRECTOR 2990 TELESTAR COURT LESS THAN 40 0 . 0 . 0 .


WINSTON UENO DIRECTOR 2990 TELESTAR COURT LESS THAN 40 0 . 0 . 0 .


ROBERT WRIGHT DIRECTOR 2990 TELESTAR COURT LESS THAN 40 0 . 0 . 0 .


THOMAS WRIGHT DIRECTOR 2990 TELESTAR COURT LESS THAN 40 0 . 0 . 0 .


Totals Included on Form 990, Part V 0 . 0 . 0 .

13141006 746301 hosp 20 Statement(s) 14

2003 .04000 INOVA HEALTH CARE SERVICES HOSP 1

INOVA HEALTH CARE SERVICES 54-452088Q

Form 990 Identification of Related Organizations Statement 15 Part VI, Line 80b

X X

X X

Statement 16 Form 990 Part VIII - Relationship of Activities to Accomplishment of Exempt Purposes

Line Explanation of Relationship of Activities

93a Patient service revenue generated by performance of exempt medical services enumerated in the "Report of Program and Community Services" (See Attached) . Partnership income related to program services . Allocable share of partnership income from materials management and group purchasing programs structured to reduce the cost of medical related supplies purchased by the Hospitals .

21 Statement s) 15, 16 2003 .04000 INOVA HEALTH CARE SERVICES HOSP 1 13141006 746301 hosp

Name of Organization

INOVA HEALTH SYSTEM FOUNDATION

IMANCO, INC . INOVA HEALTH SYSTEM SERVICES INOVA HOME CARE

INOVA PHYSICAL REHABILITATION SERVICES UMC HOLDINGS, INC . HEALTHCARE PARTNERSHIP OF THE CAPITAL REGION INTEGRATED PHYSICIAN SERVICES INOVA MEDICAL FOUNDATION INOVA HOLDINGS, INC .

Exempt NonExempt

X X X X X X X n

THE ATTACHED "REPORT OF PROGRAM AND COMMUNITY SERVICES" IS SUBMITTED TO MEET THE REQUIREMENT OF IRS FORM 990, PART III -STATEMENT OF PROGRAM SERVICE ACCOMPLISHMENTS, FOR THE YEAR ENDED DECEMBER 31, 2003 .

INOVA HEALTH CARE SERVICES

TAX ID # : 54-0620889

o The Fairfax Hospital (Fairfax) o Mount Vernon Hospital (Mount Vernon) o Fair Oaks Hospital (Fair Oaks) o ACCESS of Reston and ACCESS of Fairfax o Springfield Healthplex o Institute of Research and Education o American Medical Collections Bureau (AMCB) 0 Medicredit

INOVA HEALTH CARE SERVICES REPORT OF PROGRAM AND COMMUNITY SERVICES

FOR THE YEAR ENDED DECEMBER 31, 2003

Inova Health Care Services ("IHCS", formerly Inova Health System Hospitals) is a not-for-profit corporation and a subsidiary of the parent organization, Inova Health System Foundation (Inova) Inova is a large healthcare system providing healthcare and related services throughout northern Virginia and the greater metropolitan Washington, D C area, including certain contiguous counties of Virginia and Maryland Both IHCS and Inova are operated for charitable, scientific, and e(IIiC,at1Q1l'dl purposes and are exempt from income tax under

Can " 1nn G(ll l \ tl, T ..f . ..- ...,.1 IAaLUV~ J\+VIIVII JV1~~1l~~ Z~~ vif uie lii«,iiiai

Revenue Code

IHCS was specifically chartered for the purpose of serving the health care needs of the community by establishing, maintaining, and operating hospital facilities, programs, and other shared service arrangements, carrying on health-related education activities, promoting and carrying on health-related scientific research, and engaging in activities designed and carried on to promote the general health of the community IHCS includes a centralized System Office and the various unincorpoi-ated and incorporated subsidiaries which are described below

The unincorporated subsidiaries of IHCS include The Fairfax Hospital, Mount Vernon Hospital, Fair Oaks Hospital, ACCESS of Reston, ACCESS of Fairfa.x, and Springfield Healthplex The Institute of Research and Education is operated as a program of IHCS Also, American Medical Collections Bureau, a collection service, and Medicredit, a financing service, are included under IHCS

IHCS is also the parent company of the following incorporated subsidiaries Jefferson Hospital, Inc , was operated as a not-for-profit subsidiary of IHCS through June 30, 1993, when it ceased all operations due to lack of financial viability

IHCS's 2003 tax return and this Report of Program and Community Services include the activities of its centralized System Office and the following facilities and programs

o Fairfax's obstetric program is the largest such program in the mid-Atlantic region, now providing services for over 10,000 births each year Obstetric services are provided at Fairfax's state-of-the-art Women and Children's Center include delivery services, inpatient and outpatient obstetrics/gynecologic surgery, and regular and special nursery care The Center includes northern Virginia's only Level III (highest level) newborn intensive care unit, which is staffed around the clock by neonatology physicians and nurses specially trained in caring for premature and other newborns with medical problems In addition, Fait-fax provides obstetric services to low-income patients through its Obstetrics/Gynecology Clinic

INOVA HEALTH CARE SERVICES Page 2 2003 REPORT OF PROGRAM AND COMMUNITY SERVICES

PROGRAM SERVICES

Each of IHCS's three operating hospitals provide general acute care services, including emergency facilities, inpatient and outpatient services, and a variety of ancillary and specialized services based on the needs of the community Services provided by these hospitals, the ACCESS facilities, and certain other programs of IHCS are described more fully below

The Fairfax Hospital is a 656-licensed bed tertiary care hospital providing comprehensive medical and surgical services which include emergency/trauma, cardiac, transplant, cancer, obstetric, pediatric, neonatal, and extensive outpatient services Fairfax is the home of the nationally-known Virginia Heart Center, the Fairfax Hospital for Children, northern Virginia's top-rated emergency and trauma center, and the state-of-the-art Women's and Children's Center In addition, Fairfax is as a teaching hospital providing clinical training through its medical residency, nursing, and paramedical education programs

Fairfax physicians are qualified in all major specialties and subspecialties, and the hospital operates several specialized regional medical referral centers which are described below

o The Virginia Heart Center, established in 1987, provides a full range of advanced medical care, from diagnosis to treatment (including heart and lung transplants) and rehabilitation for cardiac patients of all ages The 110-bed Center provides three operating suites dedicated to cardiovascular surgery, cardiac catheterization and electrophysiology laboratories, and coronary care nursing units

o The Cancer Center of Fairfax Hospital is a 32-bed inpatient medical oncology unit providing comprehensive diagnostic services, inpatient and outpatient surgical services, and nursing care for cancer patients, including specialized care for gynecologic cancer and pediatric patients Five of the Center's beds are available in support of the Center's autologous bone marrow transplant program In addition, the Center provides a full spectrum of support services to its patients, including the Life with Cancer program of educational and support groups The Center also conducts research and participates in studies in conjunction with university hospitals and other cooperative groups

In 2003, Mount Vernon had 8,828 admissions and 57,584 patient days Emergency room visits totaled 26,538, and there were 4,225 outpatient and 2,479 inpatient surgeries performed during the year

INOVA HEALTH CARE SERVICES Page 3 r 2003 REPORT OF PROGRAM AND COMMUNITY SERVICES

o Fairfax Hospital for Children is northern Virginia's only full-service pediatric program and is a regional referral center for more than 25 pediatric specialties and subspecialties, including pediatric emergency and trauma care, critical care, infectious disease, pulmonary disease, cardiac surgery, hematology and oncology, neonatology, peri-natology, infant apnea, physical medicine, and rehabilitation and speech and hearing therapy In addition to its neonatal intensive care unit ; Fau-fax operates the only pediatric Ln_tet7glvP ca-re unit ,_,_,, northern Virginia, providing 24-hour coverage for children with life-threatening illnesses or injuries There also is a facial rehabilitation program for those needing pediatric plastic surgery

o The Emergency and Trauma Center at Fairfax is state-of-the-art and is northern Virginias only Level I trauma center Emergency medical specialists with expertise in trauma care treat every type of illness, injury, or life-threatening trauma In addition, Fairfax operates Inova Medical Airfare, a 24-hour emergency helicopter transport service

During 2003, Fairfax had admissions of 50,858 and patient days of 256,791 Newborn deliveries were 10,885 Emergency room visits totaled 71,675 for the year, and there were 24,264 outpatient surgeries There were 14,690 inpatient surgery cases performed during the year

Mount Vernon Hospital is a 235-licensed bed, acute-care hospital serving southeastern Fairfax County Mount Vernon provides a full-service, 24-hour emergency department, a broad range of diagnostic services, a cardiac rehabilitation program for victims of heart disease, cardiac catheterization services, inpatient psychiatric services, and a specialized hyperbaric oxygen therapy program used to treat conditions requiring increased oxygen flow to body tissues, such as grafts and certain types of burns In addition, the hospital operates The Inova Center for Rehabilitation, a nationally-known accredited program providing inpatient and outpatient rehabilitative services

o The Inova Center for Rehabilitation provides comprehensive medical rehabilitation services to patients with severe head injuries, spinal cord injuries, strokes, multiple sclerosis, and other orthopedic and neurological disabilities These services are staffed by an interdisciplinary team which incudes physiatry, psychiatry, psychology, vocational counselling, physical therapy, occupational therapy, and nursing so that treatment can be individually tailored to meet the specific needs of each patient

American Medical Collections Bureau is an unincorporated division of IHCS which provides collection services to Inova's hospitals and affiliates

[NOVA HEALTH CARE SERVICES Page 4 2003 REPORT OF PROGRAM AND COMMUNITY SERVICES

Fair Oaks Hospital is a 160-licensed bed general acute care hospital, which opened in 1987 to serve the growing communities in western Fail-fax County, Virginia Fair Oaks provides a full-service 24-hour emergency department, a spectrum of diagnostic services, including full-body CT scanning, MR], and a cardiac catherization laboratory, a variety of inpatient medical, surgical, and orthopedic services, including the only inpatient pain management program in northern Virginia, and comprehensive outpatient services . including outpatient surgery, physical medicine, and rehabilit-tion In addition, specialized obstetric and pediatric services are provided by the hospital's Maternal and Infant Health Center and a children's unit

o The Maternal and Infant Health Center at Fair Oaks includes a 24-bed obstetric unit and 19-bed nursery The Center provides obstetric delivery services, obstetric and gynecologic surgery, and infant care Neonatology coverage is provided 24-hours per day, and the Center has a Level II special care nursery for newborns with special medical needs

During 2003, Fair Oaks had 13,398 admissions and 45,888 patient days There were 3,663 newborn deliveries Emergency room visits were 34,347 for the year In addition, a total of 9,736 inpatient and outpatient surgery cases were performed

ACCESS of Fairfax , affiliated with Fair Oaks, and ACCESS of Reston and Springfield Healthplex, affiliated with Fairfax, are 24-hour, fi~ee standing emergency centers located in Fairfax City, Reston, and Springfield, Virginia, respectively During 2003, ACCESS of Fairfax provided 18,749 emergency room visits and 9,662 outpatient visas, ACCESS of Reston reported 15,664 emergency room and 9,558 outpatient visits and Springfield Healthplex reported 57,650 emergency room visits

The Institute of Research and Education, a program of IHCS, was created in 1991 to expand opportunities for clinical research and education throughout Inova Health System The Institute, which is in close proximity to Fairfax, creates a quality arena for clinical research and professional education and reflects Inova's commitment to setting the pace for changes in medicine and technology The Institute is the largest provider of Continuing Medical Education programs in the region .

o "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 250% of the Federal Poverty Guideline (FPG) In general, free medically necessary care is provided for patients with incomes falling below 125% of the FPG, and discounted care is provided for services rendered to patients with incomes falling between 125 and 250% of the FPG


COMMUNITY SERVICES

In keeping with the community service mission of Inova, IHCS and its subsidiaries provide a wide range of programs and services which directly benefit the community they serve These programs and services include-

0 Providing the highest quality medical care to all members of the community, regardless of their financial resources

o Providing nonbilled and below margin health services to meet the identified needs of targeted community groups, such as the indigent and elderly, victims of cancer, heart disease, and stroke, persons affected by substance abuse, HIV-positive individuals, and others

o Providing health education and a variety of other services to the community

o Educating the medical community and participating in medical research activities

The many types of community services provided by IHCS and its subsidiaries are described more fully below In addition, the estimated unreimhursed cost of providing these services are summarized in the attachment to this report

Charity Care

Charity care is defined as free or discounted healthcare services provided to persons who cannot afford to pay Each IHCS facility provides charity care in accordance with policies which ensure access to medically necessary care for all individuals These policies include the following key provisions

o Emergency care shall be provided to all persons regardless of their ability to pay or place of residence

o 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

Following are descriptions of the various nonbilled and below margin patient services which are provided by IHCS and its subsidiaries


In 2003, the unreimbursed cost of charity care, including free and discounted services, was $29,966,058 This amount does not include the cost of care provided to the medically indigent through participation in governmental programs, which is described below

Participation in Governmental Programs for Those Without the Ability to Pay

Various government programs provide for the indigent, including Medicaid and Virginia State and Local Hospitalization (SLH) These programs provide some reimbursement for quahfjnng patients, however, payment is typically below the cost of those services In addition to federal and state programs, IHCS subsidiaries work with various County governments and agencies and provide certain free services to those residents the County identifies as most in need

Medicaid, established under Title XIX of the Social Security Act, provides assistance for the medically indigent, including those who cannot pay for care despite being able to afford other living expenses Also covered 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 2003, IHCS hospitals provided 26,511 days of care to Medicaid patients at an unreimbursed cost of $18,227,917 Fairfax provided 22,273 days of regular, newborn, and neonatal care to Medicaid patients, Mount Vernon provided 2,053 Medicaid days of regular and rehabilitation care, and Fair Oaks provided 2,185 Medicaid days, including regular and newborn care

IHCS subsidiaries also provide services to patients covered by the State and Local Hospitalization (SLI-) program, which covers similar services as Medicaid, and which is also reimbursed below the cost of the services provided The cost of these services are included in the charity care amount

Nonbilled and Below Margin Patient Services

Each year, IHCS designates funds for the development and continuation of carefully identified programs and services that directly benefit, and provide access to, health care and related services to those most in need in the community Many of these programs and services are not billed to the patient or are provided for fees which are below the actual cost of providing the service During 2003, the unreimbursed cost of nonbilled and below margin patient services was $5,050,895, this amount excludes the cost of medical care provided to charity and medically indigent patients, which is included in previously reported categories

o The International Diabetes Center of Virginia provides specialized services for diabetes management, with offices at Fairfax, Mount Vernon, and Fair Oaks hospitals The Center utilizes its staff of nurses, dieticians, and counselors to work with patients and their physicians on team management of diabetes Community services include diabetes education and support groups, supermarket tours, a weight management program, cooking classes, participation at local health fairs, and lectures to community organizations In addition, diabetes management services were provided to Obstetric/Gynecology patients


o Fairfax's Obstetrics and Gynecology Clinic provides comprehensive obstetric and gynecologic services to women of limited income in Fairfax County Services include pregnancy prevention, pregnancy testing, prenatal care, and perinatal care for high-risk pregnancies The Clinic provided 42,965 patient visits in 2003

O The HIV Center . Dart of Fatrfax's Office of HTV Services, provides case managem F-_ I services to HIV-positive and AIDS patients of Northern Virginia An interdisciplinary approach utilizing RN case managers, hospital social workers, and representatives from community organizations is used to coordinate services required by HIV-infected patients

o Fairfax's Life with Cancer program provides a complete range of counseling, education, and support services to cancer patients and their families This program is open to all cancer patients in the area, regardless of where they are being treated for their illness A children's grief support group, My Friend's House, is also part of the program

o Fairfax operates an Opthamology Clinic which provides optometry specialty services to the indigent including treatment of glaucoma, retina, and cataracts, children's specialty services are also provided The physicians volunteer their services or are paid nominal fees by the State of Virginia or by a sponsoring community organization

o The Inova Pediatric Center was established in 1993 to offer health care to children from low income families . The Center is a collaborative effort between Inova Health System, several Fairfax County agencies, and Fail-fax Hospital pediatricians and family practice physicians who donate their time During 2003, the Clinic saw 14,075 children for two-week well-baby checks

o The Center for Facial Rehabilitation at Fairfax Hospital is a multi-disciplinary team of plastic and oral surgeons, speech pathologists, and other physicians who treat children and adults with cleft lip and palate and other craniofacial anomalies Most of the professionals volunteer their time, and Fairfax incurs unreimbursed costs for use of its facilities and for the parent information and support group which it sponsors .

o Inova HealthSource, Inova's community education department, was created in 1993 to provide comprehensive services for promoting the health status of the community HealthSource consolidated many of the existing community education classes and other activities offered by IHCS and its subsidiaries and now coordinates these In addition, Inova HealthSource has created a Consumer Resource Library to better respond to the needs of the community by providing materials and services geared to those without medical training During 2003, 131,476 community residents participated in the education programs at HealthSource These programs included the expectant parenting and women and children's programs, tours of Fairfax's new Women and Children's Center, and prenatal education for Obstetric/Gynecology Clinic patients Other classes provided nutrition and fitness education, and provided nutrition counseling to Medicare and Medicaid patients


o Members of the Department of Medicine staff and transitional residents provide free medical services and consulting to the Bailey's Health Center The center is part of the Fairfax County Affordable Health Care Network which provides medical care to uninsured and underinsured patients in the Baileys Crossroads area of Northern Virginia

0 1HCS and its subsidiaries provide many other nonbilled and helow margin patient services Case management services are provided to the indigent, and assistance is provided with financial paperwork Mount Vernon participates in the Health Information and Claims Assistance Program by providing assistance with health insurance paperwork problems In addition, home IV therapy services are provided for the indigent, and transportation is provided for indigent patients to and from IHCS facilities and programs Fairfax provides forensic and medical care to abused adults and childern Fairfax also provides blood alcohol testing for area police departments and coordinates the disposition of deaths with various community organizations Other services include pastoral care, fi-ee living accommodations for out-of-town Fairfaac heart and lung transplant patients and their families, and emergency assistance to patients and their families needing medication or transportation

Community Health Education and Promotion

As part of Inova's overall health promotion effort, IHCS and its subsidiaries are actively involved in sponsoring programs, activities, and services designed to improve community health and prevent the onset of disease

o IHCS and its subsidiaries produce and distribute a number of community health newsletters and other publications which include articles on specific health topics and provide information on health services and classes offered to the community Periodic newsletters include "Regarding Health," Bright Beginnings," and "Partners" These newsletters were mailed to over 500,000 community residents several times during 2003

o Fairfax provides laundry and linen services to the homeless In 2003, laundry and linen were provided to 3,500 homeless people in the area


o In addition to Inova HealthSource, IHS hospitals provide a number of health classes and support groups to its patients, their family members, and community residents on a wide variety of health topics These topics include diabetes education and treatment, nutrition, weight management, and exercise, heart health, lung disease, breast cancer, cardiac, physical, speech and respiratory therapy, smoking cessation, stress management, and many others In addition, the Institute of Research and Education's "Project CPR" was initiated in 1994 to ensure access to CPR training throughout the Inova community

o IHCS subsidiaries provide other community health education and promotion services Health information and healthcare screenings are provided for free or for nominal charges (for cholesterol testing, to cover the cost of supplies) at many IHCS facilities and at local health fairs and other community events Tours of IHCS facilities and programs are provided year- round for many community, school, and civic groups Health talks are provided on a variety of healthcare topics, and an executive speakers bureau is made available to community organizations In addition, IHCS hospitals provide the community with access to its medical libraries and library services

Other Community Services

IHCS and its subsidiaries go beyond their role as providers of health care services, community health education, and medical education and research, to provide other community services as well On an ongoing basis, IHCS contributes its facilities and resources to benefit the community it serves

Inova Medical Airfare is a unique 24-hour medically-equipped helicopter transport unit which generally operates within a 150 mile radius of Fairfax hospital, serving IHCS hospitals and other hospitals in the surrounding area The service is used primarily for transporting critical patients between hospitals to obtain more advanced medical treatment, patients transported include including critically ill infants, cardiac patients, and other patients who need specialized medical and surgical care Occasionally, the helicopter is called to provide patient transport from an accident scene to an appropriate hospital, supplementing Fairfax County's helicopter services

o The local Meals on Wheels program prepares and delivers meals to area residents who cannot prepare their own meals due to their medical condition Fait-fax, Mount Vernon, and Fair Oaks hospitals prepare meals for the program, which are delivered by community volunteers During 2003, the hospitals prepared over 120,000 meals

As a teaching hospital, Fairfax incurs typical, additional costs associated with those of teaching facilities physician teaching cost and resident salaries, the cost of maintaining higher levels of technology required to support a teaching program, and the cost of extra tests ordered for teaching purposes During 2003, the total cost associated with these medical education programs was $21,566,043 Of this amount, Medicare and Medicaid reimbursed $12,456,940 for these programs, and the hospital incurred $9,109,103 in urreimbursed costs


o At Fairfax, a staff of Fairfax County Department of Human Resources Eligibility workers is provided to assist patients in completing Medicaid/SLH applications Hospital financial counselors pre-screen patients and refer them to DHS workers

o Inova promotes employee volunteerism through its employee volunteer program, People-in- Action, which coordinates corporate-sponsored c_'.nmmun_itv service activities Tine and its subsidiaries donate staff salaries, benefits, and other expenses for the administration and collection of funds and goods for sponsored community programs IHCS employees donate their time, personal funds, and other items to sponsored organizations During 2003, 1HCS employees participated in the United Way, Adopt-a-Family Christmas Program, clothes and food drives, school partnerships, and a number of other community service programs

o Other community services include use of space and services by community groups, contributions and in-kind donations and services, and other services The unreimbursed cost of meeting space includes prorated rental expense, where applicable, and the cost of setup, cleanup, and refi-eshments, in some cases Also, Fairfax provides system case management which transitions patients from hospital to community services and provides fi~ee local phone call for patients and families

Medical Community Education

Towards the goal of improving patient care, IHCS subsidiaries provide a variety of innovative medical education and training programs for medical residents and students, physicians, and other health care professionals

o Fairfax's medical education programs offer a variety of clinical training for medical residents, nursing students, and other medical students Fairfax's residency program has approximately 180 residents (medical student graduates) at any one time and an average of 350 students are trained each year Residents and students are primarily from Georgetown and George Washington Universities In addition, a graduate-level Nursing Demonstration Program is provided in conjunction with George Mason University, and paramedical education is provided by The School of Medical Technology, a fully-accredited program for training lab technicians

File Name IHCSCSVC 03


Fairfax also provides a center for clinical education and development This center had 2,588 participants at an unreimbursed cost of $2,584,676

o The Institute of Research and Education provides quality educational opportunities for physicians and other health professionals which support and enhance the professional's abflity to deliver quality patient care by helping them keep pace with medicine and technology developments Each year, through its Education and Conference Services division (ECS), the Institute provides conference management services for more than 50 educational activities covering all medical specialty areas Lectures and workshops planned by Inova physicians feature nationally and internationally recognized experts from within and outside Inova Health System In 2003, the unreimbursed cost of education activities conducted or sponsored by the institute was $408,624

o The goal of the Northern Virginia HIV Resource and Consultation Center, part of the Office of HIV Services at Fairfax, is to increase access to health care for HIV-positive patients . The Center addresses this goal by educating and training health care professionals to care for HIV-infected patients and by providing consultation and HIV resource materials

o IHCS subsidiaries participated in the following other medical education programs in 2003 Mount Vernon provided clinical internships for 3 students in physical therapy, occupational therapy, and speech language pathology Fair Oaks provided clinical training for 8 laboratory technician and phlebotomy students fi~om Northern Virginia Community College In addition, Fairfax participated in programs with 6 local universities to provide field experience to 8 lab students paramedical students

Medical Research

The Research Services division of IHCS's Institute of Research and Education provides a variety of essential services to support health-related scientific research Through the Institute, physicians and other Inova health professionals participate in clinical investigations that may lead to advances in medical treatment and patient care Investigators and sponsors are provided access to a range of facilities and clinical specialities one would expect in a university setting The Institute provides technical and administrative support in the design, conduct, and administration of clinical investigational studies, and in contract management During 2003, the Institute conducted 199 clinical trials at a unreimbursed cost of $3,360,173

451,892

408,624 9,109,103 2,584,676

3,360,173

905,163

71,147,641

IHCSCS03.XLS

(NOVA HEATH CARE SERVICES 2003 COMMUNITY SERVICE REPORTING COMMUNITY SERVICE SUMMARY

CHARITY AND INDIGENT CARE

PARTICIPATION IN GOVERNMENTAL PROGRAMS FOR THOSE WITHOUT THE ABILITY TO PAY

Unreimbursed Cost of Medicaid Patients

NONBILLED AND BELOW MARGIN PATIENT SERVICES

Diabetes Center Life with Cancer HIV Center Obstetrics and Gynecology Clinic Pediatric Center Pediatric Nephrology Child Life Fairfax County Detention Program Facial Rehabilitation Treatment Ophthalmic Specialty Services to the Indigent Sexual Assault Nurse Examiner Program

COMMUNITY HEALTH EDUCATION AND PROMOTION

Healthsource Prevention Congregational Health Partnership for Healthier Kids

OTHER COMMUNITY SERVICES

Medicaid/Slh Eligibility Assistance

MEDICAL COMMUNITY EDUCATION

Institute for Research and Education Conferences Fairfax Interns and Residents Program Center for Clinical Education and Development

MEDICAL RESEARCH

Institute of Research and Education

OTHER COMMUNITY BENEFITS

TOTAL

29,966,058

18,227,917

468,948 25,220 638,650

2,052,168 571,244 211,848 455,406 121,749 122,959 305,656 77,047

269,425 198,899 201,898 412.918

EIN: 54-0620889 ATTACHMENT TO FORM 990, PART V, FOR THE YEAR ENDED 12131103

Inova Health System Foundation (IHSF) controls several healthcare organizations, including Inova Health Care Services (IHCS), a 501(c)3 organization established to maintain and operate hospitals and perform other activities to promote the general health of the community While members of our Boards of Trustees are not compensated, certain board members either directly, or through their related organizations or individuals, provide services to Inova Health Care Services or other related companies A description of these relationships are noted below

ADDITIONAL FORM 990 PAYING SCHEDULE REFERENCE NAME POSITION DESCRIPTION OF SERVICES ORGANIZATION

IHCS IHCS

IHCS

IHCS IHCS

IHCS

IHCS

IHCS IHCS

IHCS

75,000 29,847

75,000

22,000 4,982

3,737

23,759

60,000 27,046

128

Medical Staff President - Inove Fairfax Hospital Physician Services

Medical Staff President- Inova FairOaks Hospital

Medical Staff President - Inova Mt Vernon Hospital Reimbursement of Expenses

Reimbursement of Expenses

Faufax Hospital Clinic Services

Inova Medical Affairs Council Chairman Rembursement of Expenses

Reimbursement of Expenses

Temme, M D , Joel M Trustee, IHCS

Anderson, M D , Glenna R Trustee, IHCS

Maddox, M D , John F Trustee, IHSF

DeWitt, Caren Trustee, IHCS

Sch A, Part III, Line 2d




H \TRUSTEE\[TRUSTE03 xls]IHCS

(NOVA HEALTH CARE SERVICES ATTACHMENT 1 TO PART V




Wright, M D , Thomas P Trustee, IHCS

Hazel, M D , William Trustee, IHCS

Francs, M D , Cleveland Trustee, IHCS

PAYMENTS

--COMPENSATION FROM INOVA HEALTH CARE SERVICES--

(C) (D) (E) CONTRIBUTIONS EXPENSE ACCOUNT TO EMPLOYEE AND OTHER

COMPENSAT ION BENEFIT PLANS ALLOWANCES

0 0 0

0 0 0

INOVA HEALTH CARE SERVICES Compensated Officers EMPLOYER ID# 54-0620889 ATTACHMENT TO IRS FORM 990, PART V LIST OF OFFICERS, DIRECTORS, TRUSTEES, AND KEY EMPLOYEES FOR THE YEAR ENDED 12131103

----COMPENSATION FROM IMANCO, INC, A RELATED ORGANIZATION -----ID# 54-1340725

(A) (B) (C) (D) (E) CONTRIBUTIONS EXPENSE ACCOUNT

TITLE AND TO EMPLOYEE AND OTHER NAME AND ADDRESS AVERAGE HRS/WK COMPENSATION BENEFIT PLANS ALLOWANCES

J Knox Singleton President 993,357 20,072 45,826 2990 Telestar Court 60+ Falls Church, Virginia 22042

Jolene Tornabeni Exec Vice President, COO 713,761 150,025 26,902 2990 Telestar Court 60+ Falls Church, Virginia 22042

Richard C Magenheimer Sr Vice President, CFO (1) 747,644 20,072 20,587 2990 Telestar Court 60+ Falls Church, Virginia 22042

James Hughes Senior Vice President 513,195 109,527 25,418 2990 Telestar Court 60+ Falls Church, Virginia 22042

Patrick Waiters Senior Vice President 467,824 18,583 20,479 2990 Telestar Court 60+ Falls Church, Virginia 22042

Ellen Menard Senior Vice President 480,683 77,948 19,990 2990 Telestar Court 60+ (2) Falls Church, Virginia 22042

Shannon Sinclau Asst Secretary 308,215 35,877 13,027 2990 Telestar Court 60+ Falls Church, Virginia 22042

(1) Column (C) compensation includes $37,402 reported in column (D) on the 2002 Form 990 (2) Column (C) compensation includes $12,379 reported in column (D) on the 2002 Form 990

8 N9900FF7(1[035AL990 xLs/A

0 0

0 0

0 0

0 0

0 0

0

0

0

0

0

ATTACHMENT TO FORM 990 PART IV 12/31/03 AUDIT RECONCILIATION

Inuva Health Aluandne Health Ino.a loo' . Heakh Eliminations and Care Sen¢es Senices Corporation HnIJings, Inc Systeui Sei~~ces Foundmiun System Offices Managed Care Consolidating Entries Tools

2003 2002 7007 2002 2003 2(102 21103 2(X12 21103 2002 2073 200Z 2007 2001 2007 2002 2007 2P12

5975198 59.7097 S195614 S198 527 so So Sfw~e0 1 SO 515 SU SO SO SO so SO 'S7 -) (577)8) S1 230007 51,1~6967 17 7- 1 6 11 75 0539 7434 18 707 1 97 80 i2y a 1611) 95 I13 11 o 3 16001 141 156 081k7U1 ( 1 77W) 511915 G7l65

1011958 959118 702572 705 9h1 18761 19 790 69 U31 64 22S 8, 133 11 057 16001 141 156 (25 WE) (14 W1) 1186922 1 240 732

426 099 412D69 8'260 85 481 3 299 35D 717A5 30 771 1I SW 724 215 I - 54o 650 513 734 407 098 397 779 1 'I'll 17 091 13 311 13 13O 11 725 18 W7 1 571 1 913 7 57S 9 U95 194 114 (15 685) (24 612) 516 597 509 576 57 919 55U95 10151 9,607 192 2ad 4 2 11 31S9 17 26 2 515 2x25 29 /1 75 105 /0878 is 185 19 29t) 934 98 : (1U) (22) 1 417 4911 10416 ]1310 )9 !23 1618 21 0 7 3 15967 621 476 ) 718 16o 136 60 77! 66 616 96 7 4 21 970 751 701 1,5 1 196 1 d9 I 0 701 1/ 501 69 71S n7 D47 7 11g5 7 .1'y b 4-00 1I 681 117 187 (15 685) (27 1571) 1 279 106 1 201 954

45 535 19 767 791 9 832 10%8 2 178 (188) ( . 627) (7 D00) (3 766) 4 o17 4 120 (71) (71) 79 - 49 916 18 779

(1771 N03) 1d 715 1 IIb U'1) (571)1 (4 254) 7eU9 21D (181 37 3W4 73P1 1506 (254) 1 819 70 X757 (1762) 201 191 4 1 2o49 2 914 4) 917 13 470) 7 632 (79) 53 275 (10)61)

ti 4wl (2 760) - ( " 1-) (6012) (15 520) (32 40-4) (17491) (+1 236) (748) 17 (787) (771) lXl 41 (I I/Y) - - - (1,14e) I1 655)

894 3 19 3355 (3 907) 8,.4 Idb01 (5 p2gi ( 4 107) 1 171 (7,i 1 8) 3 1 W 5 (ti 88 0) ( I1) 665 1 915 2 304 3 6 141 (57,706

S4 6 42 9 $2 9 016 E4 1 4 6 Ts4 52 '27 5 17 1 9 ( 5+116 Ib~ JJl7 i 5 9u7~ fS610J) 511

018 S40 '60) (11 1) S631 $1004 S1 7M 511 957 (511939)

Operating Revenues

Nn paiirni sa-e rnrnue Other operating re-e Iuial Operating Revenues

Operating Expenses Salaries Other

Ucpiaiauon and amoruzation

Infabl

Yra.uion (ur byl drLn

rot.i op«.uuk E.p.-

lucome (Loss) From Opaatinns

Non-uperallng Revenues (Fxpenscs) Lquiry invcsvnrnl caminp (lusts)

Inlerbl and other miume ncl

Other Than Icmpoiuy dcJmcs m fair rriarke, ~alucol m~cslmrnLs

Atinonty mtcrat and ux expense Total Non-operating

K-nua (Expenses)

NET INCOME (I OSS)

Inova Health System Consolidating Statements of Operations

For the Years Ended December 31, 2003 and 2002 (In thousands)

14

Inova Health Svstem Notes To Consolidated Financial Statements

December 31, 2003 and 2002

Note F - Long-term Debt (continued)

Long-term debt is comprised of the following at December 3 1 . 200 and 2002 din thousands)

Final Amounts Outstanding Descnption

I Interest Ratel Payable ~ Matunry 2003 2002

Long term Debt of the IHS Obligated Group 1989A, B, C, D Variable Rate Demand Obligation Revenue Bonds 1'"1988 0

Variable Maximum 15 /o Monthly i tniti?~ ~ c,Gi,~nn q r ~, Bonds") I 1989A Variable Rate Demand Obligation Revenue Bonds ("1989A Bonds") Variable Maximum 15°,b~Monthly 1115122 ~ 1,100 7,300 1993A Hospital Revenue Refunding Bonds ("1993A Bonds") Fazed 2 75°% to 5 25°ialSemi Annual ~ 8115123 ~ 110,610 ~ 113,885 1996A Health Care Revenue Bonds ("I 996A Bonds") Fixed 4 5% to 6 0%/Semi Annual 8115126 ~ 94,845 96,850 1998A Health Care Revenue Refunding Bonds I"1998A Bonds") Fixed 4 0°o to 5 O%/Semi Annual 8115125 87,230 89,320

2000 Variable Rate Demand Health Care Revenue Bonds Variable, Maximum 12%IMonthly 111130 ~ 77,400 18,800

2001 Variable Rate Auction Health Care Revenue Bonds I Variable, Maximum 12%17 day & 28 day 4; 15135 I 200,000 200,000

Promissory Notes Payable to Industrial Development Authority of the City Variable Monthly 211104 0 632

of Lynehburg, VA (IDA Lynchburg)

Total Long term Debt of the IHS Obligated Group ~ 630 685 641,187

Less Current Porsion of Long term Debt '~ (145,6601 f 148 3121

Original Issue Discount ~ (4 008) 1,319)

Net long term Debt of the IHS Obligated Group ! 481,017 488,496

Net long term Debt of Non Obligated IHS Affiliates (Amounts Guaranteed by the Obligated Group)

Promissory Note Payable to Manufacturers Life Insurance Company Fazed 9 53%ISemi Annual 121116 i8,401 8,718

Promissory Note Payable to Branch Bank & Trust Company Variable Monthly 3!8101 14,444 11,479

Total Long term Debt of Non Obligated IHS Affiliates 22 845 20 197

Less Current Portion of Long term Debt (1,9211 1317

Net Long term Debt of Non Obligated IHS Affiliates ~ - 20,924 19 880 Total Net INS Lonq term Debt $51 941 . S 508,376

IHS estimates the December 3 I 2003 and 200' market value of its long-term debt based on year-end closing prices for similar publicly traded securities to be approximately X674 million and $678 million, respectively, compared with the face value of approximately $650 million and ~657 million The fair market value of all financial instruments other than ins estments and debt is estimated b1' management to approximate or equal their reported carrying value

The interest rate on the Variable Rate Bonds ranged between 0 66°ro and 1 30% in 2003 and 0 92% and 2 05% in 2002 OutstandinL, bonds are secured by an interest in all funds held by the Bond Trustee for purposes of debt service, construction and equipment acquisition Each (Member of the IHS Obligated Group covenants that it \~ ~ ill not pledge or grant a security interest in (except as may be othenxise prop ided in the Master Trust Indenture) any of its property The Master Trust Indenture for the IHS Oblieated Group requires that certain minimum financial ratios be met

The 1988 and 2000 bonds are supported by a Liquidity Substitution Agreement ("LSA") The LSA is among fHCS, the Bond Trustee, the Custodian of certain Board designated investments, and the Remarl.eting Agent In the event that and or all of the 1988 or 2000 bonds are unable to be r°marketed, and IHS does not provide the Bond Trustee ,~ ith funds sufficient to retire the bonds, the Bond Trustee is permitted to directly- authorize the Custodian to liquidate investments in an amount equal to the purchase price for the unremarketed bonds The portion of the Board designated Investments that mad be liquidated under the a;reement ($130 9 million and $133 2 million at December 31, 2003 and 2002, respectively) are included in the current portion of assets ~~hose use is limited The ?001 bonds, m auction rite

STATEMENTS ATTACHED TO AND MADE A PART OF FEDERAL EXEMPT ORGANIZATION INCOME TAX RETURN FOR THE YEAR ENDED DECEMBER 31, 2003

FORM 990, PART II, LINE 42

Page 1

INOVA HEALTH CARE SERVICES E .I .# 54-0620889

DEPRECIATION IS COMPUTED USING THE STRAIGHT-LINE METHOD OVER THE ESTIMATED USEFUL LIVES OF THE ASSETS

DEPRECIATION EXPENSE LINE 42 57,024,080

FORM 990, PART IV, LINE 57

12/31/2003

LAND AND LAND IMPROVEMENTS $ 697,546,909

BUILDINGS AND FIXED EQUIPMENT 328,699,548

LESS ACCUMULATED DEPRECIATION (465,540,140)

TOTAL $ 560,706,317

" If you are fling for an Automatic 3-Month Extension, complete only Part I and check this box t Ox " If you are filing for an Additional (not automatic) 3-Month Extension, complete only Part II (on page 2 of this form) Note : Do not complete Part 11 unless you have already been granted an automatic 3-month extension on a previously filed Form 8868 .

Part I Automatic 3-Month Extension of Time -Only submit original (no copies needed) Note : Form 990-T corporations requesting an automatic 6-month extension - check this box and complete Part l only All other corporations (including Form 990-C filers) must use Form 7004 to request an extension of time to file income tax returns Partnerships REMICs and trusts must use Form 8736 to request an extension of time to file Form 1065 1066 or 1041

Type or Name of Exempt Organization Employer identification number

pant INOVa HEALTH CARE SJRVICES 5~-06200-39 File by the Number, street, and room or suite no if a a O box, see instructions die dace roe filing your 29,9 0 TELESTtiK COURT, FOURTH FLOOR TAX 1 return See instructions

City, town or post office state, and ZIP ceae For a foreign address see instructions FALLS CHURCH, VIRGINIA 22042

Signature and Verification Under penalties of penury I declare that I have examined this foam including accompanying schedules and statements and to the cese .:r my knowleaae and oeiief it is true correct and complete and that I am authorized to prepare this form

r~tle t TAX MANAGER gate po. 4 6/04

=o,m 8868 (,2-2000)

isA STF FED9056F 1

'~ Application for Extension of Time To File an Form 8$6$

(December 2000) Exempt Organization Return C-3 No ,545_� Depanment of ine 7-easurv Internal Revenue Sar.,ce 1 File a separate application for each return

Check type of return to be filed (file a separate application for each return) Form 990 F Form 990-T (corporation) Form 4720 Form 990-BL E] Form 990-T (sec 401(a) or d08(a) trust) 7 Form 5227 Form 990-EZ F_~ Form 990-T (trust other than above) [, Form 6069 Form 990-PF [_1 Form 1041-A [ Form 8870

" If the organization does not have an office or place of business in the United States, check this box " !f this is for a Group Return, enter the organization's four digit Group Exemption Number (GEN) if this is for the whole group, check this box lio. F-] If it is for part of the group, check this box p. F and attach a list with the names and EINs of all members the extension will cover

1 l request an automatic 3-month (6-month for 990-T corporation) extension of time until AUGUST 16 , 20 -Q-4 to file the exempt organization return for the organization named above The extension is for the organization s return for

0 calendar year 20 0 3 or 0 tax year beginning , 20 ,and ending , 20

2 If this tax year is for less than 12 months, check reason 7 Initial return 0 Final return I,- Change in accounting period

3a If this application is for Form 990-BL, 990-PF, 990-T, 4720, or 6069 . enter the tentative tax less any nonrefundable credits See instructions 5

b If this application Is for Form 990-PF or 990-T, enter any refundable credits and estimated tax payments made Include any prior year overpayment allowed as a credit S

c Balance Due. Subtract line 3b from line 3a Include your payment with this form, or, if required, deposit with FTD coupon or, if required, by using EFTPS (Electronic Federal Tax Payment System) See instructions S

Signature flp L

For Paperwork Reduction Act Notice, see Instruction

' 'M~, Form 8 Page 2

1`9 If ycu < .r an Additional (not automatic) 3-Month Extension, complete only Part II and check this box > Notes On~_ ma~ete Part 11 if you have already been granted an automatic 3-month extension on a previously filed Form 8868. 9 If you are filing for an Automatic 3-Month Extension, complete only Part I (on page 1) Part 11 Additional (not automatic) 3-Month Extension of Time -- Must File Original and One Copv.

v e y e Number, street, and room or suite no If a P O box, see instructions extended due date for 2990 TELESTAR COURT, FOURTH FLOOR TAX filing the City, town or post office, state, and ZIP code For a foreign address, see instruction : return see instructions FALLS CHURCH, VIRGINIA 22042 Check type of return to be filed (File a separate application for each return)

Form 990 R Form 990-EZ [] Form 990-T (sec 401(a) or 408(a) trust) ~ Form 1041-A [] Form 5227 ~ Form 8870 L, Form 990-BL 0 Form 990-PF ~] Form 990-T (trust other than above) ~ Form 4720 [] Form 6069

Sgnature~ /1 /'~~t.~~1 Tdle t T~ MATdAGER oases 7/21/04 Notice to Applicant - To Bs Completed by the IRS

We have approved this application Please attach this form to the organization's return We have not approved this application However, we have granted a 10-day grace period from the later of the date shown below or the due date of the organization's return (including any prior extensions) This grace period is considered to be a valid extension of time for elections otherwise r wired to be made on a timely return Please attach this form to the organization's return ,~, ~pRO~~~~ We have not approved this application After considering the reasons stated in item 7, we cannot grant your reque~t,folry3`111~xtenc n of time to file We are not granting a 10-day grace period ~ We cannot consider this application because it was fled after the due date of the return for which an extension was request d r~'ZO~'1' Other I~~~C,1

,F~L,~o~4.~ r)

r~C nN?RU~ SS;~, $y

Director S M,lSa~e

Alternate Mailing Address - Enter the address if you want the copy of this application for an additional 3-month extension returned to an address different than the one entered above

Name

Type or Number and street (include suite, room, or apt no ) Or a PO. box number print

City or town, province or state, and country (including postal or ZIP code)

Form 8868 (12-2000) STF FE09056F 2

Type or Name of Exempt Organization print INOVA HEALTH CARE SERVICES F G b th

Employer identification number 59-062089 For IRS use only

STOP: Do not complete Part II if you were not already granted an automatic 3-month extension on a previouslyfiled Forth 8868.

" If the organization dots not have 2n nffir_c nr r!ac° of bus;ress .r. the United Slates, checK this box " If this is for a Group Return, enter the organization's four digit Group Exemption Number (GEN) If this is for the whole group, check this box lp~ D If it is for part of the group, check this box so. 0 and attach a list with the names and EINs of all members the extension is for

4 I request an additional 3-month extension of time until NOVEMBER 15 , 20 0 4 5 For calendar year 2 0 0 3 , or other tax year beginning , 20 and ending , 20 -6 If this tax year is for less than 12 months, check reason [] Initial return 0 Final return [] Change in accounting period 7 State in detail why you need the extension TAXPAYER NEEDS ADDITIONAL TIME TO COMPILE THE

INFORMATION NECESSARY TO FILE A COMPLETE AND ACCURATE RETURN .

8a If this application is for Form 990-BL, 990-PF, 990-T, 4720, or 6069, enter the tentative tax, less any nonrefundable credits See instructions

b If this application is for Form 990-PF, 990-T, 4720, or 6069, enter any refundable credits and estimated tax payments made Include any prior year overpayment allowed as a credit and any amount paid previously with Form 8868

c Balance Due. Subtract line 8b from line 8a Include your payment with this form, or, if required, deposit with FTD coupon or, if required, by using EFTPS (Electronic Federal Tax Payment System) See instructions

Signature and Verification Under penalties of penury I declare that 1 have examined this farm, including accompanying schedules and statements, and to the best of my knowledge and belief it is true correct, and complete, and that I am authorized to prepare this form

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