TY 2019 Form 990

(A) Name and title	(B) Average hours per week (list any hours for related organizations below dotted line)	(C) Position (do not check more than one box, unless person is both an officer and a director/trustee)	(E) Reportable compensation from related organizations (W-2/1099-MISC)	(F) Estimated amount of other compensation from the organization and related organizations
(1) HOWARD P KERN...................................................................... FORMER DIRECTOR/OFFICER	0.00 ................. 53.00					X	0	4,253,331	3,800,414
(2) ROBERT A BROERMANN...................................................................... TREASURER/SECRETARY (EFFEC 6/19)	1.00 ................. 50.00		X				0	1,674,648	149,586
(3) MICHAEL V GENTRY...................................................................... DIRECTOR	1.00 ................. 50.00	X					0	1,524,592	218,927
(4) JEFFREY P KING...................................................................... SECRETARY (THRU 6/19)	1.00 ................. 48.00		X				0	970,273	106,745
(5) DOUGLAS J MOYER...................................................................... CHAIRMAN	1.00 ................. 42.00	X	X				0	578,598	99,793
(6) KATHERINE A JOHNSON...................................................................... PRESIDENT	40.00 ................. 0.00		X				531,872	0	110,928
(7) JOANNE M INMAN...................................................................... DIRECTOR	1.00 ................. 40.00	X					0	453,997	154,197
(8) VALERIE E KEANE...................................................................... KE (VP, NURSE EXECUTIVE)	40.00 ................. 0.00			X			300,340	0	274,632
(9) MICHAEL R REITZ...................................................................... VP, MEDICAL AFFAIRS	40.00 ................. 0.00				X		476,083	0	61,856
(10) MOHAMMAD A SALEEM...................................................................... SURGICAL ASSISTANT-CERTIFIED SNVMC	40.00 ................. 0.00				X		384,034	0	64,340
(11) XING P YUAN...................................................................... RNFA/ROBOTICS COORD	40.00 ................. 0.00				X		223,319	0	135,644
(12) CHRISTINA S GRABUS...................................................................... KE (VP, OPERATIONS)	40.00 ................. 0.00			X			266,891	0	65,624
(13) DORKA M PICARD...................................................................... VP, DIVISION VII	40.00 ................. 0.00				X		200,642	0	120,030
(14) KATHY A COX...................................................................... NURSE CLIN II - FT PERM WKND NIGHTS	40.00 ................. 0.00				X		228,660	0	64,956
(15) CAROL S SHAPIRO MD...................................................................... DIRECTOR	1.00 ................. 40.00	X					0	225,621	34,907
(16) DORIS J WARNER...................................................................... KE (DIR ED)	40.00 ................. 0.00			X			159,951	0	36,357
(17) CORINDA V PIPPINS...................................................................... FORMER OFFICER	2.00 ................. 40.00					X	0	148,316	44,188

(A) Name and business address	(B) Description of services	(C) Compensation
SHERIDAN ANESTHESIA SERVICES OF VA INC 2300 OPITZ BOULEVARD WOODBRIDGE,VA22191	ANESTHESIOLOGY SERVICES	1,636,204
SODEXO INC PO BOX 536922 ATLANTA,GA30353	FOOD & FACILITY MGMT	1,433,004
VA CRITICAL CARE PLLC 6247 ROLLING SPRING COURT SPRINGFIELD,VA22152	MEDICAL SERVICES	1,317,124
HANDCRAFT SERVICES 2810 COFER ROAD RICHMOND,VA23224	LINEN & UNIFORM SERVICES	952,527
ARAMARK HEALTHCARE TECH LLC 12483 COLLECTIONS CENTER DR CHICAGO,IL60693	MEDICAL TECHNOLOGIES & SERVICES	872,793
2 Total number of independent contractors (including but not limited to those listed above) who received more than $100,000 of compensation from the organization 48

- TIN:

SCHEDULE A
(Form 990 or 990EZ)

Department of the Treasury
Internal Revenue Service

Public Charity Status and Public Support

Complete if the organization is a section 501(c)(3) organization or a section 4947(a)(1) nonexempt charitable trust.
right arrow

Attach to Form 990 or Form 990-EZ.
right arrow

Go to www.irs.gov/Form990 for instructions and the latest information.

OMB No. 1545-0047

2019

Open to Public
Inspection

Name of the organization

POTOMAC HOSPITAL CORPORATION
OF PRINCE WILLIAM

Employer identification number

54-0853898

Part I

Reason for Public Charity Status (All organizations must complete this part.) See instructions.

The organization is not a private foundation because it is: (For lines 1 through 12, check only one box.)

A church, convention of churches, or association of churches described in section 170(b)(1)(A)(i).

A school described in section 170(b)(1)(A)(ii). (Attach Schedule E (Form 990 or 990-EZ).)

A hospital or a cooperative hospital service organization described in section 170(b)(1)(A)(iii).

A medical research organization operated in conjunction with a hospital described in section 170(b)(1)(A)(iii). Enter the hospital's name, city, and state:

An organization operated for the benefit of a college or university owned or operated by a governmental unit described in section 170(b)(1)(A)(iv). (Complete Part II.)

A federal, state, or local government or governmental unit described in section 170(b)(1)(A)(v).

An organization that normally receives a substantial part of its support from a governmental unit or from the general public described in section 170(b)(1)(A)(vi). (Complete Part II.)

A community trust described in section 170(b)(1)(A)(vi). (Complete Part II.)

An agricultural research organization described in 170(b)(1)(A)(ix) operated in conjunction with a land-grant college or university or a non-land grant college of agriculture. See instructions. Enter the name, city, and state of the college or university:

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 exempt functions—subject to certain exceptions, and (2) no more than 331/3% 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). (Complete Part III.)

An organization organized and operated exclusively to test for public safety. See section 509(a)(4).

An organization organized and operated exclusively for the benefit of, to perform the functions of, or to carry out the purposes of one or more publicly supported organizations described in section 509(a)(1) or section 509(a)(2). See section 509(a)(3). Check the box in lines 12a through 12d that describes the type of supporting organization and complete lines 12e, 12f, and 12g.

Type I. A supporting organization operated, supervised, or controlled by its supported organization(s), typically by giving the supported organization(s) the power to regularly appoint or elect a majority of the directors or trustees of the supporting organization. You must complete Part IV, Sections A and B.

Type II. A supporting organization supervised or controlled in connection with its supported organization(s), by having control or management of the supporting organization vested in the same persons that control or manage the supported organization(s). You must complete Part IV, Sections A and C.

Type III functionally integrated. A supporting organization operated in connection with, and functionally integrated with, its supported organization(s) (see instructions). You must complete Part IV, Sections A, D, and E.

Type III non-functionally integrated. A supporting organization operated in connection with its supported organization(s) that is not functionally integrated. The organization generally must satisfy a distribution requirement and an attentiveness requirement (see instructions). You must complete Part IV, Sections A and D, and Part V.

Check this box if the organization received a written determination from the IRS that it is a Type I, Type II, Type III functionally integrated, or Type III non-functionally integrated supporting organization.

Enter the number of supported organizations ...............................

Provide the following information about the supported organization(s).

(i) Name of supported organization	(ii) EIN	(iv) Is the organization listed in your governing document?		(v) Amount of monetary support (see instructions)	(vi) Amount of other support (see instructions)
(i) Name of supported organization	(ii) EIN	Yes	No	(v) Amount of monetary support (see instructions)	(vi) Amount of other support (see instructions)


Total

For Paperwork Reduction Act Notice, see the Instructions for
Form 990 or 990-EZ.

Cat. No. 11285F

Schedule A (Form 990 or 990-EZ) 2019

Page 2

Part II

Support Schedule for Organizations Described in Sections 170(b)(1)(A)(iv) and 170(b)(1)(A)(vi)
(Complete only if you checked the box on line 5, 7, or 8 of Part I or if the organization failed to qualify under Part III. If the organization failed to qualify under the tests listed below, please complete Part III.)

Section A. Public Support

Calendar year (or fiscal year beginning in)		(a) 2015	(b) 2016	(c) 2017	(d) 2018	(e) 2019	(f) Total
1	Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grant.") ..
2	Tax revenues levied for the organization's benefit and either paid to or expended on its behalf....
3	The value of services or facilities furnished by a governmental unit to the organization without charge..
4	Total. Add lines 1 through 3
5	The portion of total contributions by each person (other than a governmental unit or publicly supported organization) included on line 1 that exceeds 2% of the amount shown on line 11, column (f)..
6	Public support. Subtract line 5 from line 4.

Section B. Total Support

Calendar year (or fiscal year beginning in)		(a) 2015	(b) 2016	(c) 2017	(d) 2018	(e) 2019	(f) Total
7	Amounts from line 4..
8	Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources...
9	Net income from unrelated business activities, whether or not the business is regularly carried on..
10	Other income. Do not include gain or loss from the sale of capital assets (Explain in Part VI.)..
11	Total support. Add lines 7 through 10

Gross receipts from related activities, etc. (see instructions) ..................

First five years. If the Form 990 is for the organization's first, second, third, fourth, or fifth tax year as a section 501(c)(3) organization, check this box and stop here........................................ right arrow

Section C. Computation of Public Support Percentage

Public support percentage for 2019 (line 6, column (f) divided by line 11, column (f)) .........

Public support percentage for 2018 Schedule A, Part II, line 14 ...............

16a

33 1/3% support test—2019. If the organization did not check the box on line 13, and line 14 is 33 1/3% or more, check this box
and stop here. The organization qualifies as a publicly supported organization ....................... right arrow

33 1/3% support test—2018. If the organization did not check a box on line 13 or 16a, and line 15 is 33 1/3% or more, check this
box and stop here. The organization qualifies as a publicly supported organization ..................... right arrow

17a

10%-facts-and-circumstances test—2019. If the organization did not check a box on line 13, 16a, or 16b, and line 14
is 10% or more, and if the organization meets the "facts-and-circumstances" test, check this box and stop here. Explain
in Part VI how the organization meets the "facts-and-circumstances" test. The organization qualifies as a publicly supported
organization ..................................................... right arrow

10%-facts-and-circumstances test—2018. If the organization did not check a box on line 13, 16a, 16b, or 17a, and line
15 is 10% or more, and if the organization meets the "facts-and-circumstances" test, check this box and stop here.
Explain in Part VI how the organization meets the "facts-and-circumstances" test. The organization qualifies as a publicly
supported organization ................................................ right arrow

Private foundation. If the organization did not check a box on line 13, 16a, 16b, 17a, or 17b, check this box and see
instructions ..................................................... right arrow

Schedule A (Form 990 or 990-EZ) 2019

Page 3

Part III

Support Schedule for Organizations Described in Section 509(a)(2)
(Complete only if you checked the box on line 10 of Part I or if the organization failed to qualify under Part II. If the organization fails to qualify under the tests listed below, please complete Part II.)

Section A. Public Support

Calendar year (or fiscal year beginning in)		(a) 2015	(b) 2016	(c) 2017	(d) 2018	(e) 2019	(f) Total
1	Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grants.") .
2	Gross receipts from admissions, merchandise sold or services performed, or facilities furnished in any activity that is related to the organization's tax-exempt purpose
3	Gross receipts from activities that are not an unrelated trade or business under section 513 .....
4	Tax revenues levied for the organization's benefit and either paid to or expended on its behalf...
5	The value of services or facilities furnished by a governmental unit to the organization without charge
6	Total. Add lines 1 through 5
7a	Amounts included on lines 1, 2, and 3 received from disqualified persons
b	Amounts included on lines 2 and 3 received from other than disqualified persons that exceed the greater of $5,000 or 1% of the amount on line 13 for the year.
c	Add lines 7a and 7b..
8	Public support. (Subtract line 7c from line 6.)

Section B. Total Support

Calendar year (or fiscal year beginning in)		(a) 2015	(b) 2016	(c) 2017	(d) 2018	(e) 2019	(f) Total
9	Amounts from line 6...
10a	Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources..
b	Unrelated business taxable income (less section 511 taxes) from businesses acquired after June 30, 1975.
c	Add lines 10a and 10b.
11	Net income from unrelated business activities not included in line 10b, whether or not the business is regularly carried on.
12	Other income. Do not include gain or loss from the sale of capital assets (Explain in Part VI.) ..
13	Total support. (Add lines 9, 10c, 11, and 12.)..

First five years. If the Form 990 is for the organization's first, second, third, fourth, or fifth tax year as a section 501(c)(3) organization,
check this box and stop here............................................. right arrow

Section C. Computation of Public Support Percentage

Public support percentage for 2019 (line 8, column (f) divided by line 13, column (f)) .........

Public support percentage from 2018 Schedule A, Part III, line 15 ...............

Section D. Computation of Investment Income Percentage

Investment income percentage for 2019 (line 10c, column (f) divided by line 13, column (f)) ......

Investment income percentage from 2018 Schedule A, Part III, line 17 .............

19a

331/3% support tests—2019. If the organization did not check the box on line 14, and line 15 is more than 33 1/3%, and line 17 is not more than 33 1/3%, check this box and stop here. The organization qualifies as a publicly supported organization ....... right arrow

33 1/3% support tests—2018. If the organization did not check a box on line 14 or line 19a, and line 16 is more than 33 1/3% and line 18 is not more than 33 1/3%, check this box and stop here. The organization qualifies as a publicly supported organization .... right arrow

Private foundation. If the organization did not check a box on line 14, 19a, or 19b, check this box and see instructions .... right arrow

Schedule A (Form 990 or 990-EZ) 2019

Page 4

Part IV

Supporting Organizations

(Complete only if you checked a box on line 12 of Part I. If you checked 12a of Part I, complete Sections A and B. If you checked 12b of Part I, complete Sections A and C. If you checked 12c of Part I, complete Sections A, D, and E. If you checked 12d of Part I, complete Sections A and D, and complete Part V.)

Section A. All Supporting Organizations

Yes

Are all of the organization’s supported organizations listed by name in the organization’s governing documents?
If "No," describe in Part VI how the supported organizations are designated. If designated by class or purpose,
describe the designation. If historic and continuing relationship, explain.

Did the organization have any supported organization that does not have an IRS determination of status under section 509(a)(1) or (2)? If "Yes," explain in Part VI how the organization determined that the supported organization was described in section 509(a)(1) or (2).

Did the organization have a supported organization described in section 501(c)(4), (5), or (6)? If "Yes," answer (b) and (c) below.

Did the organization confirm that each supported organization qualified under section 501(c)(4), (5), or (6) and satisfied the public support tests under section 509(a)(2)? If "Yes," describe in Part VI when and how the organization made the determination.

Did the organization ensure that all support to such organizations was used exclusively for section 170(c)(2)(B) purposes? If "Yes," explain in Part VI what controls the organization put in place to ensure such use.

Was any supported organization not organized in the United States ("foreign supported organization")? If “Yes” and if you checked 12a or 12b in Part I, answer (b) and (c) below.

Did the organization have ultimate control and discretion in deciding whether to make grants to the foreign supported organization? If “Yes,” describe in Part VI how the organization had such control and discretion despite being controlled or supervised by or in connection with its supported organizations.

Did the organization support any foreign supported organization that does not have an IRS determination under sections 501(c)(3) and 509(a)(1) or (2)? If “Yes,” explain in Part VI what controls the organization used to ensure that all support to the foreign supported organization was used exclusively for section 170(c)(2)(B) purposes.

Did the organization add, substitute, or remove any supported organizations during the tax year? If “Yes,” answer (b) and (c) below (if applicable). Also, provide detail in Part VI, including (i) the names and EIN numbers of the supported organizations added, substituted, or removed; (ii) the reasons for each such action; (iii) the authority under the organization's organizing document authorizing such action; and (iv) how the action was accomplished (such as by amendment to the organizing document).

Type I or Type II only. Was any added or substituted supported organization part of a class already designated in the organization's organizing document?

Substitutions only. Was the substitution the result of an event beyond the organization's control?

Did the organization provide support (whether in the form of grants or the provision of services or facilities) to anyone other than (i) its supported organizations, (ii) individuals that are part of the charitable class benefited by one or more of its supported organizations, or (iii) other supporting organizations that also support or benefit one or more of the filing organization’s supported organizations? If “Yes,” provide detail in Part VI.

Did the organization provide a grant, loan, compensation, or other similar payment to a substantial contributor (defined in section 4958(c)(3)(C)), a family member of a substantial contributor, or a 35% controlled entity with regard to a substantial contributor? If “Yes,” complete Part I of Schedule L (Form 990 or 990-EZ) .

Did the organization make a loan to a disqualified person (as defined in section 4958) not described in line 7? If “Yes,” complete Part I of Schedule L (Form 990 or 990-EZ).

Was the organization controlled directly or indirectly at any time during the tax year by one or more disqualified persons as defined in section 4946 (other than foundation managers and organizations described in section 509(a)(1) or (2))? If “Yes,” provide detail in Part VI.

Did one or more disqualified persons (as defined in line 9a) hold a controlling interest in any entity in which the supporting organization had an interest? If “Yes,” provide detail in Part VI.

Did a disqualified person (as defined in line 9a) have an ownership interest in, or derive any personal benefit from, assets in which the supporting organization also had an interest? If “Yes,” provide detail in Part VI.

10a

Was the organization subject to the excess business holdings rules of section 4943 because of section 4943(f) (regarding certain Type II supporting organizations, and all Type III non-functionally integrated supporting organizations)? If “Yes,” answer line 10b below.

10a

Did the organization have any excess business holdings in the tax year? (Use Schedule C, Form 4720, to determine whether the organization had excess business holdings).

10b

Schedule A (Form 990 or 990-EZ) 2019

Page 5

Part IV

Supporting Organizations (continued)

Yes

Has the organization accepted a gift or contribution from any of the following persons?

A person who directly or indirectly controls, either alone or together with persons described in (b) and (c) below, the governing body of a supported organization?

11a

A family member of a person described in (a) above?

11b

A 35% controlled entity of a person described in (a) or (b) above? If “Yes” to a, b, or c, provide detail in Part VI.

11c

Section B. Type I Supporting Organizations

Yes

Did the directors, trustees, or membership of one or more supported organizations have the power to regularly appoint or elect at least a majority of the organization’s directors or trustees at all times during the tax year? If “No,” describe in Part VI how the supported organization(s) effectively operated, supervised, or controlled the organization’s activities. If the organization had more than one supported organization, describe how the powers to appoint and/or remove directors or trustees were allocated among the supported organizations and what conditions or restrictions, if any, applied to such powers during the tax year.

Did the organization operate for the benefit of any supported organization other than the supported organization(s) that operated, supervised, or controlled the supporting organization? If “Yes,” explain in Part VI how providing such benefit carried out the purposes of the supported organization(s) that operated, supervised or controlled the supporting organization.

Section C. Type II Supporting Organizations

Yes

Were a majority of the organization’s directors or trustees during the tax year also a majority of the directors or trustees of each of the organization’s supported organization(s)? If “No,” describe in Part VI how control or management of the supporting organization was vested in the same persons that controlled or managed the supported organization(s).

Section D. All Type III Supporting Organizations

Yes

Did the organization provide to each of its supported organizations, by the last day of the fifth month of the organization’s tax year, (i) a written notice describing the type and amount of support provided during the prior tax year, (ii) a copy of the Form 990 that was most recently filed as of the date of notification, and (iii) copies of the organization’s governing documents in effect on the date of notification, to the extent not previously provided?

Were any of the organization’s officers, directors, or trustees either (i) appointed or elected by the supported organization(s) or (ii) serving on the governing body of a supported organization? If "No," explain in Part VI how the organization maintained a close and continuous working relationship with the supported organization(s).

By reason of the relationship described in (2), did the organization’s supported organizations have a significant voice in the organization’s investment policies and in directing the use of the organization’s income or assets at all times during the tax year? If "Yes," describe in Part VI the role the organization’s supported organizations played in this regard.

Section E. Type III Functionally-Integrated Supporting Organizations

Check the box next to the method that the organization used to satisfy the Integral Part Test during the year (see instructions):

The organization satisfied the Activities Test. Complete line 2 below.

The organization is the parent of each of its supported organizations. Complete line 3 below.

The organization supported a governmental entity. Describe in Part VI how you supported a government entity (see instructions)

Activities Test. Answer (a) and (b) below.

Yes

Did substantially all of the organization’s activities during the tax year directly further the exempt purposes of the supported organization(s) to which the organization was responsive? If "Yes," then in Part VI identify those supported organizations and explain how these activities directly furthered their exempt purposes, how the organization was responsive to those supported organizations, and how the organization determined that these activities constituted substantially all of its activities.

Did the activities described in (a) constitute activities that, but for the organization’s involvement, one or more of the organization’s supported organization(s) would have been engaged in? If "Yes," explain in Part VI the reasons for the organization’s position that its supported organization(s) would have engaged in these activities but for the organization’s involvement.

Parent of Supported Organizations. Answer (a) and (b) below.

Did the organization have the power to regularly appoint or elect a majority of the officers, directors, or trustees of each of the supported organizations? Provide details in Part VI.

Did the organization exercise a substantial degree of direction over the policies, programs and activities of each of its supported organizations? If "Yes," describe in Part VI. the role played by the organization in this regard.

Schedule A (Form 990 or 990-EZ) 2019

Page 6

Part V

Type III Non-Functionally Integrated 509(a)(3) Supporting Organizations

Check here if the organization satisfied the Integral Part Test as a qualifying trust on Nov. 20, 1970 (explain in Part VI). See instructions. All other Type III non-functionally integrated supporting organizations must complete Sections A through E.

	Section A - Adjusted Net Income		(A) Prior Year	(B) Current Year (optional)
1	Net short-term capital gain	1
2	Recoveries of prior-year distributions	2
3	Other gross income (see instructions)	3
4	Add lines 1 through 3	4
5	Depreciation and depletion	5
6	Portion of operating expenses paid or incurred for production or collection of gross income or for management, conservation, or maintenance of property held for production of income (see instructions)	6
7	Other expenses (see instructions)	7
8	Adjusted Net Income (subtract lines 5, 6 and 7 from line 4)	8

	Section B - Minimum Asset Amount		(A) Prior Year	(B) Current Year (optional)
1	Aggregate fair market value of all non-exempt-use assets (see instructions for short tax year or assets held for part of year):	1
a	Average monthly value of securities	1a
b	Average monthly cash balances	1b
c	Fair market value of other non-exempt-use assets	1c
d	Total (add lines 1a, 1b, and 1c)	1d
e	Discount claimed for blockage or other factors (explain in detail in Part VI):
2	Acquisition indebtedness applicable to non-exempt use assets	2
3	Subtract line 2 from line 1d	3
4	Cash deemed held for exempt use. Enter 1-1/2% of line 3 (for greater amount, see instructions).	4
5	Net value of non-exempt-use assets (subtract line 4 from line 3)	5
6	Multiply line 5 by .035	6
7	Recoveries of prior-year distributions	7
8	Minimum Asset Amount (add line 7 to line 6)	8

	Section C - Distributable Amount		Current Year
1	Adjusted net income for prior year (from Section A, line 8, Column A)	1
2	Enter 85% of line 1	2
3	Minimum asset amount for prior year (from Section B, line 8, Column A)	3
4	Enter greater of line 2 or line 3	4
5	Income tax imposed in prior year	5
6	Distributable Amount. Subtract line 5 from line 4, unless subject to emergency temporary reduction (see instructions)	6

Check here if the current year is the organization's first as a non-functionally-integrated Type III supporting organization (see instructions)

Schedule A (Form 990 or 990-EZ) 2019

Page 7

Part V

Type III Non-Functionally Integrated 509(a)(3) Supporting Organizations(continued)

Section D - Distributions		Current Year
1 Amounts paid to supported organizations to accomplish exempt purposes
2 Amounts paid to perform activity that directly furthers exempt purposes of supported organizations, in excess of income from activity
3 Administrative expenses paid to accomplish exempt purposes of supported organizations
4 Amounts paid to acquire exempt-use assets
5 Qualified set-aside amounts (prior IRS approval required)
6 Other distributions (describe in Part VI). See instructions
7Total annual distributions. Add lines 1 through 6.
8 Distributions to attentive supported organizations to which the organization is responsive (provide details in Part VI). See instructions
9 Distributable amount for 2019 from Section C, line 6
10 Line 8 amount divided by Line 9 amount

Section E - Distribution Allocations (see instructions)		(i) Excess Distributions	(ii) Underdistributions Pre-2019	(iii) Distributable Amount for 2019
1 Distributable amount for 2019 from Section C, line 6
2 Underdistributions, if any, for years prior to 2019 (reasonable cause required-- explain in Part VI). See instructions.
3 Excess distributions carryover, if any, to 2019:
a From 2014.......
b From 2015.......
c From 2016.......
d From 2017.......
e From 2018.......
fTotal of lines 3a through e
g Applied to underdistributions of prior years
h Applied to 2019 distributable amount
i Carryover from 2014 not applied (see instructions)
j Remainder. Subtract lines 3g, 3h, and 3i from 3f.
4Distributions for 2019 from Section D, line 7:
$
a Applied to underdistributions of prior years
b Applied to 2019 distributable amount
c Remainder. Subtract lines 4a and 4b from 4.
5 Remaining underdistributions for years prior to 2019, if any. Subtract lines 3g and 4a from line 2. If the amount is greater than zero, explain in Part VI. See instructions.
6 Remaining underdistributions for 2019. Subtract lines 3h and 4b from line 1. If the amount is greater than zero, explain in Part VI. See instructions.
7 Excess distributions carryover to 2020. Add lines 3j and 4c.
8 Breakdown of line 7:
a Excess from 2015.....
b Excess from 2016.....
c Excess from 2017.....
d Excess from 2018.....
e Excess from 2019.....

Schedule A (Form 990 or 990-EZ) (2019)

Schedule A (Form 990 or 990-EZ) 2019

Page 8

Part VI

Supplemental Information. Provide the explanations required by Part II, line 10; Part II, line 17a or 17b; Part III, line 12; Part IV, Section A, lines 1, 2, 3b, 3c, 4b, 4c, 5a, 6, 9a, 9b, 9c, 11a, 11b, and 11c; Part IV, Section B, lines 1 and 2; Part IV, Section C, line 1; Part IV, Section D, lines 2 and 3; Part IV, Section E, lines 1c, 2a, 2b, 3a and 3b; Part V, line 1; Part V, Section B, line 1e; Part V Section D, lines 5, 6, and 8; and Part V, Section E, lines 2, 5, and 6. Also complete this part for any additional information. (See instructions).

Facts And Circumstances Test

Return Reference	Explanation

Schedule A (Form 990 or 990-EZ) 2019

Additional Data

Software ID:
Software Version:

- TIN:

Schedule B
(Form 990, 990-EZ,
or 990-PF)

Department of the Treasury
Internal Revenue Service

Schedule of Contributors

Attach to Form 990, 990-EZ, or 990-PF.

Go to www.irs.gov/Form990 for the latest information.

OMB No. 1545-0047

2019

Name of the organization

POTOMAC HOSPITAL CORPORATION
OF PRINCE WILLIAM

Employer identification number

54-0853898

Organization type (check one):

Filers of:

Section:

Form 990 or 990-EZ

501(c)( ) (enter number) organization

4947(a)(1) nonexempt charitable trust not treated as a private foundation

527 political organization

Form 990-PF

501(c)(3) exempt private foundation

4947(a)(1) nonexempt charitable trust treated as a private foundation

501(c)(3) taxable private foundation

Check if your organization is covered by the General Rule or a Special Rule.
Note: Only a section 501(c)(7), (8), or (10) organization can check boxes for both the General Rule and a Special Rule. See instructions.

General Rule

For an organization filing Form 990, 990-EZ, or 990-PF that received, during the year, contributions totaling $5,000 or more (in money or other property) from any one contributor. Complete Parts I and II. See instructions for determining a contributor's total contributions.

Special Rules

For an organization described in section 501(c)(3) filing Form 990 or 990-EZ that met the 33¹/3% support test of the regulations
under sections 509(a)(1) and 170(b)(1)(A)(vi), that checked Schedule A (Form 990 or 990-EZ), Part II, line 13, 16a, or 16b, and that received from any one contributor, during the year, total contributions of the greater of (1) $5,000 or (2) 2% of the amount on (i) Form 990, Part VIII, line 1h, or (ii) Form 990-EZ, line 1. Complete Parts I and II.

For an organization described in section 501(c)(7), (8), or (10) filing Form 990 or 990-EZ that received from any one contributor,
during the year, total contributions of more than $1,000 exclusively for religious, charitable, scientific, literary, or educational purposes, or for the prevention of cruelty to children or animals. Complete Parts I, II, and III.

For an organization described in section 501(c)(7), (8), or (10) filing Form 990 or 990-EZ that received from any one contributor,
during the year, contributions exclusively for religious, charitable, etc., purposes, but no such contributions totaled more than $1,000. If this box is checked, enter here the total contributions that were received during the year for an exclusively religious, charitable, etc., purpose. Don't complete any of the parts unless the General Rule applies to this organization because it received nonexclusively religious, charitable, etc., contributions totaling $5,000 or more during the year ......... Arrow Bullet

Caution: An organization that isn't covered by the General Rule and/or the Special Rules doesn't file Schedule B (Form 990,
990-EZ, or 990-PF), but it must answer “No” on Part IV, line 2, of its Form 990; or check the box on line H of its Form 990-EZ
or on its Form 990PF, Part I, line 2, to certify that it doesn't meet the filing requirements of Schedule B (Form 990,
990-EZ, or 990-PF).

For Paperwork Reduction Act Notice, see the Instructions
for Form 990, 990-EZ, or 990-PF.

Cat. No. 30613XSchedule B (Form 990, 990-EZ, or 990-PF) (2019)

Schedule B (Form 990, 990-EZ, or 990-PF) (2019) Page 2

Name of organization POTOMAC HOSPITAL CORPORATION OF PRINCE WILLIAM

Part I Contributors	Contributors (see instructions). Use duplicate copies of Part I if additional space is needed.
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
RESTRICTED	,	$ RESTRICTED	Person Payroll Noncash (Complete Part II for noncash contributions.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II for noncash contributions.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II for noncash contributions.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II for noncash contributions.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II for noncash contributions.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II for noncash contributions.)
Schedule B (Form 990, 990-EZ, or 990-PF) (2019)

Schedule B (Form 990, 990-EZ, or 990-PF) (2019)

Page 3

Name of organization POTOMAC HOSPITAL CORPORATION OF PRINCE WILLIAM		Employer identification number 54-0853898

Part II	Noncash Property (see instructions). Use duplicate copies of Part II if additional space is needed.
(a) No. from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (See instructions)	(d) Date received
		$
(a) No. from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (See instructions)	(d) Date received
		$
(a) No. from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (See instructions)	(d) Date received
		$
(a) No. from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (See instructions)	(d) Date received
		$
(a) No. from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (See instructions)	(d) Date received
		$
(a) No. from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (See instructions)	(d) Date received
		$
Schedule B (Form 990, 990-EZ, or 990-PF) (2019)

Schedule B (Form 990, 990-EZ, or 990-PF) (2019)

Page 4


Name of organization POTOMAC HOSPITAL CORPORATION OF PRINCE WILLIAM			Employer identification number 54-0853898
Part III Exclusively religious, charitable, etc., contributions to organizations described in section 501(c)(7), (8), or (10) that total more than $1,000 for the year from any one contributor. Complete columns (a) through (e) and the following line entry. For organizations completing Part III, enter the total of exclusively religious, charitable, etc., contributions of $1,000 or less for the year. (Enter this information once. See instructions.) $ Use duplicate copies of Part III if additional space is needed.

(a)
No. from Part I

(b) Purpose of gift

(d) Description of how gift is held

(e) Transfer of gift
Transferee's name, address, and ZIP 4	Relationship of transferor to transferee

(a)
No. from Part I

(b) Purpose of gift

(d) Description of how gift is held

(e) Transfer of gift
Transferee's name, address, and ZIP 4	Relationship of transferor to transferee

(a)
No. from Part I

(b) Purpose of gift

(d) Description of how gift is held

(e) Transfer of gift
Transferee's name, address, and ZIP 4	Relationship of transferor to transferee

(a)
No. from Part I

(b) Purpose of gift

(d) Description of how gift is held

(e) Transfer of gift
Transferee's name, address, and ZIP 4	Relationship of transferor to transferee

Schedule B (Form 990, 990-EZ, or 990-PF) (2019)

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE D
(Form 990)

Department of the Treasury
Internal Revenue Service

Supplemental Financial Statements

Complete if the organization answered "Yes," on Form 990,
Part IV, line 6, 7, 8, 9, 10, 11a, 11b, 11c, 11d, 11e, 11f, 12a, or 12b.
SchDMd Bullet

Attach to Form 990.
SchDMd Bullet

Go to www.irs.gov/Form990 for instructions and the latest information.

OMB No. 1545-0047

2019

Open to Public Inspection

Name of the organization

POTOMAC HOSPITAL CORPORATION
OF PRINCE WILLIAM

Employer identification number

54-0853898

Part I

Organizations Maintaining Donor Advised Funds or Other Similar Funds or Accounts. Complete if the organization answered "Yes" on Form 990, Part IV, line 6.

		(a) Donor advised funds	(b) Funds and other accounts
1	Total number at end of year .........
2	Aggregate value of contributions to (during year)
3	Aggregate value of grants from (during year)
4	Aggregate value at end of year ........

Did the organization inform all donors and donor advisors in writing that the assets held in donor advised funds are the organization’s property, subject to the organization’s exclusive legal control? ............

Yes No

Did the organization inform all grantees, donors, and donor advisors in writing that grant funds can be used only for charitable purposes and not for the benefit of the donor or donor advisor, or for any other purpose conferring impermissible private benefit? ...................................

Yes No

Part II

Conservation Easements.
Complete if the organization answered "Yes" on Form 990, Part IV, line 7.

Purpose(s) of conservation easements held by the organization (check all that apply).

Preservation of land for public use (e.g., recreation or education) Preservation of an historically important land area

Protection of natural habitat Preservation of a certified historic structure

Preservation of open space

Complete lines 2a through 2d if the organization held a qualified conservation contribution in the form of a conservation easement on the last day of the tax year.


a	Total number of conservation easements ......................	2a
b	Total acreage restricted by conservation easements ....................	2b
c	Number of conservation easements on a certified historic structure included in (a) .....	2c
d	Number of conservation easements included in (c) acquired after 7/25/06, and not on a historic structure listed in the National Register ...	2d

Number of conservation easements modified, transferred, released, extinguished, or terminated by the organization during the
tax year SchDMd Bullet

Number of states where property subject to conservation easement is located SchDMd Bullet

Does the organization have a written policy regarding the periodic monitoring, inspection, handling of violations, and enforcement of the conservation easements it holds? ............

Yes No

Staff and volunteer hours devoted to monitoring, inspecting, handling of violations, and enforcing conservation easements during the year
SchDMd Bullet

Amount of expenses incurred in monitoring, inspecting, handling of violations, and enforcing conservation easements during the year
SchDMd Bullet

Does each conservation easement reported on line 2(d) above satisfy the requirements of section 170(h)(4)(B)(i) and section 170(h)(4)(B)(ii)? .............................

Yes No

In Part XIII, describe how the organization reports conservation easements in its revenue and expense statement, and
balance sheet, and include, if applicable, the text of the footnote to the organization’s financial statements that describes
the organization’s accounting for conservation easements.

Part III

Organizations Maintaining Collections of Art, Historical Treasures, or Other Similar Assets.
Complete if the organization answered "Yes" on Form 990, Part IV, line 8.

If the organization elected, as permitted under FASB ASC 958, not to report in its revenue statement and balance sheet works of art, historical treasures, or other similar assets held for public exhibition, education, or research in furtherance of public service, provide, in Part XIII, the text of the footnote to its financial statements that describes these items.

If the organization elected, as permitted under FASB ASC 958, to report in its revenue statement and balance sheet works of art, historical treasures, or other similar assets held for public exhibition, education, or research in furtherance of public service, provide the following amounts relating to these items:

(i)

Revenue included on Form 990, Part VIII, line 1 ......................... SchDMd Bullet

(ii)

Assets included in Form 990, Part X ............................... SchDMd Bullet

If the organization received or held works of art, historical treasures, or other similar assets for financial gain, provide the
following amounts required to be reported under FASB ASC 958 relating to these items:

Revenue included on Form 990, Part VIII, line 1 .......................... SchDMd Bullet

Assets included in Form 990, Part X ............................... SchDMd Bullet

For Paperwork Reduction Act Notice, see the Instructions for Form 990.

Cat. No. 52283D

Schedule D (Form 990) 2019

Page 2

Part III

Organizations Maintaining Collections of Art, Historical Treasures, or Other Similar Assets (continued)

Using the organization’s acquisition, accession, and other records, check any of the following that are a significant use of its collection items (check all that apply):

Public exhibition

Loan or exchange programs

Scholarly research

Other

Preservation for future generations

Provide a description of the organization’s collections and explain how they further the organization’s exempt purpose in
Part XIII.

During the year, did the organization solicit or receive donations of art, historical treasures or other similar
assets to be sold to raise funds rather than to be maintained as part of the organization’s collection?...

Yes No

Part IV

Escrow and Custodial Arrangements. Complete if the organization answered "Yes" on Form 990, Part IV, line 9, or reported an amount on Form 990, Part X, line 21.

Is the organization an agent, trustee, custodian or other intermediary for contributions or other assets not
included on Form 990, Part X? ....................................

Yes No


b	If "Yes," explain the arrangement in Part XIII and complete the following table:		Amount
c	Beginning balance .............................	1c
d	Additions during the year ............................	1d
e	Distributions during the year ..........................	1e
f	Ending balance ................................	1f

Did the organization include an amount on Form 990, Part X, line 21, for escrow or custodial account liability? ...

Yes No

If "Yes," explain the arrangement in Part XIII. Check here if the explanation has been provided in Part XIII ....

Part V

Endowment Funds.
Complete if the organization answered "Yes" on Form 990, Part IV, line 10.

		(a) Current year	(b) Prior year	(c) Two years back	(d) Three years back	(e) Four years back

1a	Beginning of year balance ....	3,037,373	2,667,134	2,055,154	2,142,554	2,089,193
b	Contributions ...	400,511	538,684	585,787	518,402	501,124
c	Net investment earnings, gains, and losses	124,064	-50,439	81,282
d	Grants or scholarships ...	30,000			87,986	120,502
e	Other expenditures for facilities and programs ...	1,057,327	118,006	55,089	517,816	327,261
f	Administrative expenses ....
g	End of year balance ......	2,474,621	3,037,373	2,667,134	2,055,154	2,142,554

Provide the estimated percentage of the current year end balance (line 1g, column (a)) held as:

Board designated or quasi-endowment SchDMd Bullet

0 %

Permanent endowment SchDMd Bullet

26.960 %

Term endowment SchDMd Bullet

73.040 %

The percentages on lines 2a, 2b, and 2c should equal 100%.

Are there endowment funds not in the possession of the organization that are held and administered for the
organization by:

Yes

(i) Unrelated organizations .................

3a(i)

(ii) Related organizations .................

3a(ii)

If "Yes" on 3a(ii), are the related organizations listed as required on Schedule R? .........

Describe in Part XIII the intended uses of the organization's endowment funds.

Part VI

Land, Buildings, and Equipment.
Complete if the organization answered "Yes" on Form 990, Part IV, line 11a. See Form 990, Part X, line 10.

Description of property		(a) Cost or other basis (investment)	(b) Cost or other basis (other)	(c) Accumulated depreciation	(d) Book value

1a	Land .....	8,881,973	2,437,851		11,319,824
b	Buildings ....		171,861,575	83,413,343	88,448,232
c	Leasehold improvements		535,212	464,628	70,584
d	Equipment ....		155,553,534	117,697,003	37,856,531
e	Other .....		16,042,907	11,763,978	4,278,929
Total. Add lines 1a through 1e. (Column (d) must equal Form 990, Part X, column (B), line 10(c).)..					141,974,100

Schedule D (Form 990) 2019

Page 3

Part VII

InvestmentsOther Securities.
Complete if the organization answered "Yes" on Form 990, Part IV, line 11b. See Form 990, Part X, line 12.

(a) Description of security or category (including name of security)	(b) Book value	(c) Method of valuation: Cost or end-of-year market value
(1) Financial derivatives.........
(2) Closely-held equity interests........
(3)Other
(B)
(C)
(D)
(E)
(F)
(G)
(H)
(I)
Total. (Column (b) must equal Form 990, Part X, col. (B) line 12.)

Part VIII

InvestmentsProgram Related. Complete if the organization answered 'Yes' on Form 990, Part IV, line 11c. See Form 990, Part X, line 13.

(a) Description of investment	(b) Book value	(c) Method of valuation: Cost or end-of-year market value

(2)
(3)
(4)
(5)
(6)
(7)
(8)
(9)
(10)
Total. (Column (b) must equal Form 990, Part X, col.(B) line 13.)

Part IX

Other Assets.
Complete if the organization answered 'Yes' on Form 990, Part IV, line 11d. See Form 990, Part X, line 15.

(a) Description				(b) Book value

(2)
(3)
(4)
(5)
(6)
(7)
(8)
(9)
(10)
Total. (Column (b) must equal Form 990, Part X, col.(B) line 15.)...........

Part X

Other Liabilities.
Complete if the organization answered 'Yes' on Form 990, Part IV, line 11e or 11f. See Form 990, Part X, line 25.

1.(a) Description of liability	(b) Book value
(1) Federal income taxes
(4)
(5)
(6)
(7)
(8)
(9)
Total. (Column (b) must equal Form 990, Part X, col.(B) line 25.)	16,472,692
2. Liability for uncertain tax positions. In Part XIII, provide the text of the footnote to the organization's financial statements that reports the organization's liability for uncertain tax positions under FIN 48 (ASC 740). Check here if the text of the footnote has been provided in Part XIII

Schedule D (Form 990) 2019

Page 4

Part XI Reconciliation of Revenue per Audited Financial Statements With Revenue per Return. Complete if the organization answered 'Yes' on Form 990, Part IV, line 12a.
1	Total revenue, gains, and other support per audited financial statements .......		1
2	Amounts included on line 1 but not on Form 990, Part VIII, line 12:
a	Net unrealized gains (losses) on investments ....	2a
b	Donated services and use of facilities .........	2b
c	Recoveries of prior year grants ...........	2c
d	Other (Describe in Part XIII.) ............	2d
e	Add lines 2a through 2d .....................		2e
3	Subtract line 2e from line 1..................		3
4	Amounts included on Form 990, Part VIII, line 12, but not on line 1:
a	Investment expenses not included on Form 990, Part VIII, line 7b .	4a
b	Other (Describe in Part XIII.) ...........	4b
c	Add lines 4a and 4b....................		4c
5	Total revenue. Add lines 3 and 4c. (This must equal Form 990, Part I, line 12.) ......		5

Part XII Reconciliation of Expenses per Audited Financial Statements With Expenses per Return. Complete if the organization answered 'Yes' on Form 990, Part IV, line 12a.
1	Total expenses and losses per audited financial statements ...........		1
2	Amounts included on line 1 but not on Form 990, Part IX, line 25:
a	Donated services and use of facilities .........	2a
b	Prior year adjustments ............	2b
c	Other losses ................	2c
d	Other (Describe in Part XIII.) ............	2d
e	Add lines 2a through 2d....................		2e
3	Subtract line 2e from line 1...................		3
4	Amounts included on Form 990, Part IX, line 25, but not on line 1:
a	Investment expenses not included on Form 990, Part VIII, line 7b ..	4a
b	Other (Describe in Part XIII.) ............	4b
c	Add lines 4a and 4b.....................		4c
5	Total expenses. Add lines 3 and 4c. (This must equal Form 990, Part I, line 18.) ......		5

Part XIII

Supplemental Information

Provide the descriptions required for Part II, lines 3, 5, and 9; Part III, lines 1a and 4; Part lV, lines 1b and 2b; Part V, line 4; Part X, line 2; Part XI, lines 2d and 4b; and Part XII, lines 2d and 4b. Also complete this part to provide any additional information.

Return Reference

Explanation

PART V, LINE 4:

THE ENDOWMENT FUND IS FOR THE PRIMARY PURPOSE OF PROVIDING SCHOLARSHIPS TO HIGH SCHOOL SENIORS PLANNING TO ENTER HEALTH CARE RELATED FIELDS OF STUDY. TEMPORARILY RESTRICTED CONTRIBUTIONS ARE TO SPECIFIC PURPOSE FUNDS OR PLANT EXPANSION FUNDS. SPECIFIC PURPOSE FUNDS INCLUDE GENERAL BENEFIT FUNDS SUCH AS MOBILE CLINIC OPERATIONS, MOBILE MAMMOVAN, EMS/EKG TRANSMISSION, AND DIABETES OUTREACH. OTHER SPECIFIC PURPOSE FUNDS ARE FOR CANCER/ONCOLOGY, AND CARDIAC. PLANT EXPANSION FUNDS INCLUDE FUNDS FOR GENERAL BUILDING.

Schedule D (Form 990) 2019

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE G (Form 990 or 990-EZ)

Department of the Treasury
Internal Revenue Service

Supplemental Information Regarding
Fundraising or Gaming Activities

Complete if the organization answered "Yes" on Form 990, Part IV, lines 17, 18, or 19, or if the organization entered more than $15,000 on Form 990-EZ, line 6a. right arrow

Attach to Form 990 or Form 990-EZ.
right arrow

Go to www.irs.gov/Form990 for instructions and the latest information.

OMB No. 1545-0047

2019

Open to Public Inspection

Name of the organization
POTOMAC HOSPITAL CORPORATION
OF PRINCE WILLIAM

Employer identification number

54-0853898

Part I

Fundraising Activities.Complete if the organization answered "Yes" on Form 990, Part IV, line 17.

Form 990-EZ filers are not required to complete this part.

Indicate whether the organization raised funds through any of the following activities. Check all that apply.

a	Mail solicitations	e	Solicitation of non-government grants
b	Internet and email solicitations	f	Solicitation of government grants
c	Phone solicitations	g	Special fundraising events
d	In-person solicitations

Did the organization have a written or oral agreement with any individual (including officers, directors, trustees

or key employees listed in Form 990, Part VII) or entity in connection with professional fundraising services?

YesNo

If "Yes," list the 10 highest paid individuals or entities (fundraisers) pursuant to agreements under which the fundraiser is
to be compensated at least $5,000 by the organization.

(i) Name and address of individual or entity (fundraiser)	(iii) Did fundraiser have custody or control of contributions?
	Yes	No










Total . . . . . . . . . . . . . . . . . . . .

List all states in which the organization is registered or licensed to solicit contributions or has been notified it is exempt from registration or licensing.

For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.

Cat. No. 50083H

Schedule G (Form 990 or 990-EZ) 2019

Page 2

Part II

Fundraising Events. Complete if the organization answered "Yes" on Form 990, Part IV, line 18, or reported more than $15,000 of fundraising event contributions and gross income on Form 990-EZ, lines 1 and 6b. List events with gross receipts greater than $5,000.

		(a) Event #1 GOLF TOURNAMENT (event type)	(b) Event #2 PECAN SALES (event type)	(c) Other events 1 (total number)	(d) Total events (add col. (a) through col. (c))
1	Gross receipts . . . . .	24,486	9,824	6,220	40,530
2	Less: Contributions . . . .	5,000			5,000
3	Gross income (line 1 minus line 2) . . . . . .	19,486	9,824	6,220	35,530

4	Cash prizes . . . . .
5	Noncash prizes . . . .
6	Rent/facility costs . . . .
7	Food and beverages . . .
8	Entertainment . . . .
9	Other direct expenses . . .	10,388	7,884	300	18,572
10	Direct expense summary. Add lines 4 through 9 in column (d) . . . . . . . . . .				18,572
11	Net income summary. Subtract line 10 from line 3, column (d). . . . . . . . . .				16,958

Part III

Gaming. Complete if the organization answered "Yes" on Form 990, Part IV, line 19, or reported more than $15,000 on Form 990-EZ, line 6a.

		(a) Bingo	(b) Pull tabs/Instant bingo/progressive bingo	(c) Other gaming	(d) Total gaming (add col.(a) through col.(c))
1	Gross revenue . . . . .

2	Cash prizes . . . . .
3	Noncash prizes . . . .
4	Rent/facility costs . . . .
5	Other direct expenses . . .

Volunteer labor . . . .

	Yes %
	No

	Yes %
	No

	Yes %
	No

Direct expense summary. Add lines 2 through 5 in column (d) . . . . . . . . . . right arrow

Net gaming income summary. Subtract line 7 from line 1, column (d). . . . . . . . . right arrow

Enter the state(s) in which the organization conducts gaming activities:

Is the organization licensed to conduct gaming activities in each of these states? . . . . . . . .

YesNo

If "No," explain:

10a

Were any of the organization's gaming licenses revoked, suspended or terminated during the tax year? . . .

YesNo

If "Yes," explain:

Schedule G (Form 990 or 990-EZ) 2019

Page 3

Does the organization conduct gaming activities with nonmembers? . . . . . . . . . . .

YesNo

Is the organization a grantor, beneficiary or trustee of a trust or a member of a partnership or other entity

formed to administer charitable gaming? . . . . . . . . . . . . . . . . .

YesNo

Indicate the percentage of gaming activity conducted in:

The organization's facility . . . . . . . . . . . . . . . . . .

13a

An outside facility . . . . . . . . . . . . . . . . . . . .

13b

Enter the name and address of the person who prepares the organization's gaming/special events books and records:

Name

Address

15a

Does the organization have a contract with a third party from whom the organization receives gaming

revenue? . . . . . . . . . . . . . . . . . . . . . . . .

YesNo

If "Yes," enter the amount of gaming revenue received by the organization right arrow

$ and the

amount of gaming revenue retained by the third party right arrow

$ .

If "Yes," enter name and address of the third party:

Name

Address

Gaming manager information:

Name

Gaming manager compensation right arrow

Description of services provided right arrow

Director/officer Employee Independent contractor

Mandatory distributions:

Is the organization required under state law to make charitable distributions from the gaming proceeds to

retain the state gaming license? . . . . . . . . . . . . . . . . . . .

YesNo

Enter the amount of distributions required under state law distributed to other exempt organizations or spent

in the organization's own exempt activities during the tax year right arrow

Part IV

Supplemental Information. Provide the explanations required by Part I, line 2b, columns (iii) and (v); and Part III, lines 9, 9b, 10b, 15b, 15c, 16, and 17b, as applicable. Also provide any additional information. See instructions.

Return Reference	Explanation

Schedule G (Form 990 or 990-EZ) 2019

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE H
(Form 990)

Department of the Treasury
Internal Revenue Service

Hospitals

Complete if the organization answered "Yes" on Form 990, Part IV, question 20.
MediumBullet

Attach to Form 990.
MediumBullet

Go to www.irs.gov/Form990EZ for instructions and the latest information.

OMB No. 1545-0047

2019

Open to Public Inspection

Name of the organization

POTOMAC HOSPITAL CORPORATION
OF PRINCE WILLIAM

Employer identification number

54-0853898

Part I

Financial Assistance and Certain Other Community Benefits at Cost

Yes

Did the organization have a financial assistance policy during the tax year? If "No," skip to question 6a . . . .

Yes

If "Yes," was it a written policy? ......................

Yes

If the organization had multiple hospital facilities, indicate which of the following best describes application of the financial assistance policy to its various hospital facilities during the tax year.

Applied uniformly to all hospital facilities Applied uniformly to most hospital facilities Generally tailored to individual hospital facilities

Answer the following based on the financial assistance eligibility criteria that applied to the largest number of the organization's patients during the tax year.

Did the organization use Federal Poverty Guidelines (FPG) as a factor in determining eligibility for providing free care?

If "Yes," indicate which of the following was the FPG family income limit for eligibility for free care:

Yes

100% 150% 200% Other %

Did the organization use FPG as a factor in determining eligibility for providing discounted care? If "Yes," indicate

which of the following was the family income limit for eligibility for discounted care: . . . . . . . .

Yes

200% 250% 300% 350% 400% Other 40000.0000000000 %

If the organization used factors other than FPG in determining eligibility, describe in Part VI the criteria used for determining eligibility for free or discounted care. Include in the description whether the organization used an asset test or other threshold, regardless of income, as a factor in determining eligibility for free or discounted care.

Did the organization's financial assistance policy that applied to the largest number of its patients during the tax year provide for free or discounted care to the "medically indigent"? . . . . . . . . . . . . .

Yes

Did the organization budget amounts for free or discounted care provided under its financial assistance policy during
the tax year? . . . . . . . . . . . . . . . . . . . . . . .

Yes

If "Yes," did the organization's financial assistance expenses exceed the budgeted amount? . . . . . .

Yes

If "Yes" to line 5b, as a result of budget considerations, was the organization unable to provide free or discountedcare to a patient who was eligibile for free or discounted care? . . . . . . . . . . . . .

Did the organization prepare a community benefit report during the tax year? . . . . . . . . .

Yes

If "Yes," did the organization make it available to the public? . . . . . . . . . . . . .

Yes

Complete the following table using the worksheets provided in the Schedule H instructions. Do not submit these worksheets with the Schedule H.

Financial Assistance and Certain Other Community Benefits at Cost

Financial Assistance and Means-Tested Government Programs		(c) Total community benefit expense	(d) Direct offsetting revenue	(e) Net community benefit expense	(f) Percent of total expense
a	Financial Assistance at cost (from Worksheet 1) . . .	13,617,844		13,617,844	5.630 %
b	Medicaid (from Worksheet 3, column a) . . . . .	47,420,158	47,847,449	0	0 %
c	Costs of other means-tested government programs (from Worksheet 3, column b) . .
d	Total Financial Assistance and Means-Tested Government Programs . . . . .	61,038,002	47,847,449	13,617,844	5.630 %
Other Benefits
e	Community health improvement services and community benefit operations (from Worksheet 4).	729,124		729,124	0.300 %
f	Health professions education (from Worksheet 5) . . .
g	Subsidized health services (from Worksheet 6) . . . .	5,739,857	2,468,507	3,271,350	1.350 %
h	Research (from Worksheet 7) .
i	Cash and in-kind contributions for community benefit (from Worksheet 8) . . . .	110,893		110,893	0.050 %
j	Total. Other Benefits . .	6,579,874	2,468,507	4,111,367	1.700 %
k	Total. Add lines 7d and 7j .	67,617,876	50,315,956	17,729,211	7.330 %

For Paperwork Reduction Act Notice, see the Instructions for Form 990. Cat. No. 50192T Schedule H (Form 990) 2019

Schedule H (Form 990) 2019

Page

Part II

Community Building Activities Complete this table if the organization conducted any community building activities during the tax year, and describe in Part VI how its community building activities promoted the health of the communities it serves.

		(c) Total community building expense	(e) Net community building expense	(f) Percent of total expense
1	Physical improvements and housing
2	Economic development
3	Community support
4	Environmental improvements
5	Leadership development and training for community members
6	Coalition building	2,888	2,888	0 %
7	Community health improvement advocacy	4,415	4,415	0 %
8	Workforce development	83,672	83,672	0.030 %
9	Other
10	Total	90,975	90,975	0.030 %

Part III

Bad Debt, Medicare, & Collection Practices

Section A. Bad Debt Expense

Yes

Did the organization report bad debt expense in accordance with Healthcare Financial Management Association Statement No. 15? ..........................

Yes

Enter the amount of the organization's bad debt expense. Explain in Part VI the methodology used by the organization to estimate this amount. ......

32,846,964

Enter the estimated amount of the organization's bad debt expense attributable to patients eligible under the organization's financial assistance policy. Explain in Part VI the methodology used by the organization to estimate this amount and the rationale, if any, for including this portion of bad debt as community benefit. ......

4,927,045

Provide in Part VI the text of the footnote to the organization’s financial statements that describes bad debt expense or the page number on which this footnote is contained in the attached financial statements.

Section B. Medicare

Enter total revenue received from Medicare (including DSH and IME).....

56,994,732

Enter Medicare allowable costs of care relating to payments on line 5.....

67,310,463

Subtract line 6 from line 5. This is the surplus (or shortfall)........

-10,315,731

Describe in Part VI the extent to which any shortfall reported in line 7 should be treated as community benefit.Also describe in Part VI the costing methodology or source used to determine the amount reported on line 6.Check the box that describes the method used:

Cost accounting system Cost to charge ratio Other

Section C. Collection Practices

Did the organization have a written debt collection policy during the tax year? ..........

Yes

If "Yes," did the organization’s collection policy that applied to the largest number of its patients during the tax year
contain provisions on the collection practices to be followed for patients who are known to qualify for financial assistance? Describe in Part VI .........................

Yes

Part IV

Management Companies and Joint Ventures(owned 10% or more by officers, directors, trustees, key employees, and physicians—see instructions)

(a) Name of entity	(b) Description of primary activity of entity	(c) Organization's profit % or stock ownership %	(e) Physicians' profit % or stock ownership %
11 LAKE RIDGE AMBULATORY SURGERY CNTR LLC	OUTPATIENT SURGERY CENTER	58.820 %	41.180 %
2
3
4
5
6
7
8
9
10
11
12
13

Schedule H (Form 990) 2019

Page

Part VFacility Information

Section A. Hospital Facilities (list in order of size from largest to smallest—see instructions)How many hospital facilities did the organization operate during the tax year?2Name, address, primary website address, and state license number (and if a group return, the name and EIN of the subordinate hospital organization that operates the hospital facility)					Other (describe)
1	SENTARA NORTHERN VIRGINIA MEDICAL CENTER 2300 OPITZ BOULEVARD WOODBRIDGE,VA22191 WWW.SENTARA.COM H 1881	X	X	X
2	LAKE RIDGE AMBULATORY SURGERY CNTR LLC 12825 MINNIEVILLE RD SUITE 204 WOODBRIDGE,VA22192 LAKERIDGESURGERYCENTER.COM OH 720	X			AMBULATORY SURGERY CENTER

Schedule H (Form 990) 2019

Page 4

Part VFacility Information (continued)

Section B. Facility Policies and Practices

(Complete a separate Section B for each of the hospital facilities or facility reporting groups listed in Part V, Section A)

	SENTARA NORTHERN VIRGINIA MEDICAL CENTER
Name of hospital facility or letter of facility reporting group

Line number of hospital facility, or line numbers of hospital facilities in a facility
reporting group (from Part V, Section A):

Yes

Community Health Needs Assessment

Was the hospital facility first licensed, registered, or similarly recognized by a state as a hospital facility in the current tax year or the immediately preceding tax year?........................

Was the hospital facility acquired or placed into service as a tax-exempt hospital in the current tax year or the immediately preceding tax year? If “Yes,” provide details of the acquisition in Section C...............

During the tax year or either of the two immediately preceding tax years, did the hospital facility conduct a community health needs assessment (CHNA)? If "No," skip to line 12......................

Yes

If "Yes," indicate what the CHNA report describes (check all that apply):

A definition of the community served by the hospital facility

Demographics of the community

Existing health care facilities and resources within the community that are available to respond to the health needs of the community

How data was obtained

The significant health needs of the community

Primary and chronic disease needs and other health issues of uninsured persons, low-income persons, and minority groups

The process for identifying and prioritizing community health needs and services to meet the community health needs

The process for consulting with persons representing the community’s interests

The impact of any actions taken to address the significant health needs identified in the hospital facility's prior CHNA(s)

Other (describe in Section C)

Indicate the tax year the hospital facility last conducted a CHNA: 20 19

In conducting its most recent CHNA, did the hospital facility take into account input from persons who represent the broad interests of the community served by the hospital facility, including those with special knowledge of or expertise in public health? If "Yes," describe in Section C how the hospital facility took into account input from persons who represent the community, and identify the persons the hospital facility consulted .................

Yes

6 a

Was the hospital facility’s CHNA conducted with one or more other hospital facilities? If "Yes," list the other hospital facilities in Section C..................................

Yes

Was the hospital facility’s CHNA conducted with one or more organizations other than hospital facilities?” If “Yes,” list the other organizations in Section C. ............................

Did the hospital facility make its CHNA report widely available to the public?..............

Yes

If "Yes," indicate how the CHNA report was made widely available (check all that apply):

Hospital facility’s website (list url):

Other website (list url): SEE SECTION C BELOW.

Made a paper copy available for public inspection without charge at the hospital facility

Other (describe in Section C)

Did the hospital facility adopt an implementation strategy to meet the significant community health needs
identified through its most recently conducted CHNA? If "No," skip to line 11. ..............

Yes

Indicate the tax year the hospital facility last adopted an implementation strategy: 20 19

Is the hospital facility's most recently adopted implementation strategy posted on a website?.........

If "Yes" (list url):

If "No," is the hospital facility’s most recently adopted implementation strategy attached to this return? ......

10b

Yes

Describe in Section C how the hospital facility is addressing the significant needs identified in its most recently conducted CHNA and any such needs that are not being addressed together with the reasons why such needs are not being addressed.

12a

Did the organization incur an excise tax under section 4959 for the hospital facility's failure to conduct a CHNA as required by section 501(r)(3)?...............................

12a

If "Yes" on line 12a, did the organization file Form 4720 to report the section 4959 excise tax?........

12b

If "Yes" on line 12b, what is the total amount of section 4959 excise tax the organization reported on Form 4720 for all of its hospital facilities? $

Schedule H (Form 990) 2019

Page 5

Part VFacility Information (continued)

Financial Assistance Policy (FAP)

	SENTARA NORTHERN VIRGINIA MEDICAL CENTER
Name of hospital facility or letter of facility reporting group

Yes

Did the hospital facility have in place during the tax year a written financial assistance policy that:

Explained eligibility criteria for financial assistance, and whether such assistance included free or discounted care?

Yes

If “Yes,” indicate the eligibility criteria explained in the FAP:

Federal poverty guidelines (FPG), with FPG family income limit for eligibility for free care of 200.000000000000%
and FPG family income limit for eligibility for discounted care of 400.000000000000%

Income level other than FPG (describe in Section C)

Asset level

Medical indigency

Insurance status

Underinsurance discount

Residency

Other (describe in Section C)

Explained the basis for calculating amounts charged to patients?.................

Yes

Explained the method for applying for financial assistance?...................

Yes

If “Yes,” indicate how the hospital facility’s FAP or FAP application form (including accompanying instructions) explained the method for applying for financial assistance (check all that apply):

Described the information the hospital facility may require an individual to provide as part of his or her application

Described the supporting documentation the hospital facility may require an individual to submit as part of his or
her application

Provided the contact information of hospital facility staff who can provide an individual with information about the
FAP and FAP application process

Provided the contact information of nonprofit organizations or government agencies that may be sources of
assistance with FAP applications

Other (describe in Section C)

Was widely publicized within the community served by the hospital facility?........

Yes

If "Yes," indicate how the hospital facility publicized the policy (check all that apply):

The FAP was widely available on a website (list url):

WWW.SENTARA.COM/FINANCIALASSISTANCE

The FAP application form was widely available on a website (list url):

WWW.SENTARA.COM/FINANCIALASSISTANCE

A plain language summary of the FAP was widely available on a website (list url):
WWW.SENTARA.COM/FINANCIALASSISTANCE

The FAP was available upon request and without charge (in public locations in the hospital facility and by mail)

The FAP application form was available upon request and without charge (in public locations in the hospital facility
and by mail)

A plain language summary of the FAP was available upon request and without charge (in public locations in the
hospital facility and by mail)

Individuals were notified about the FAP by being offered a paper copy of the plain language summary of the FAP, by
receiving a conspicuous written notice about the FAP on their billing statements, and via conspicuous public displays or
other measures reasonably calculated to attract patients' attention

Notified members of the community who are most likely to require financial assistance about availability of the FAP

The FAP, FAP application form, and plain language summary of the FAP were translated into the primary language(s)
spoken by LEP populations

Other (describe in Section C)

Schedule H (Form 990) 2019

Page 6

Part VFacility Information (continued)

Billing and Collections

	SENTARA NORTHERN VIRGINIA MEDICAL CENTER
Name of hospital facility or letter of facility reporting group

Yes

Did the hospital facility have in place during the tax year a separate billing and collections policy, or a written financial assistance policy (FAP) that explained all of the actions the hospital facility or other authorized party may take upon nonpayment?..................................

Yes

Check all of the following actions against an individual that were permitted under the hospital facility's policies during the tax year before making reasonable efforts to determine the individual’s eligibility under the facility’s FAP:

Reporting to credit agency(ies)

Selling an individual’s debt to another party

Deferring, denying, or requiring a payment before providing medically necessary care due to nonpayment of a previous
bill for care covered under the hospital facility's FAP

Actions that require a legal or judicial process

Other similar actions (describe in Section C)

None of these actions or other similar actions were permitted

Did the hospital facility or other authorized party perform any of the following actions during the tax year before making reasonable efforts to determine the individual’s eligibility under the facility’s FAP?............

If "Yes," check all actions in which the hospital facility or a third party engaged:

Reporting to credit agency(ies)

Selling an individual’s debt to another party

Deferring , denying, or requiring a payment before providing medically necessary care due to nonpayment of a previous
bill for care covered under the hospital facility's FAP

Actions that require a legal or judicial process

Other similar actions (describe in Section C)

Indicate which efforts the hospital facility or other authorized party made before initiating any of the actions listed (whether or not checked) in line 19. (check all that apply):

Provided a written notice about upcoming ECAs (Extraordinary Collection Action) and a plain language summary of the
FAP at least 30 days before initiating those ECAs (if not, describe in Section C)

Made a reasonable effort to orally notify individuals about the FAP and FAP application process (if not, describe in
Section C)

Processed incomplete and complete FAP applications (if not, describe in Section C)

Made presumptive eligibility determinations (if not, describe in Section C)

Other (describe in Section C)

None of these efforts were made

Policy Relating to Emergency Medical Care

Did the hospital facility have in place during the tax year a written policy relating to emergency medical care that required the hospital facility to provide, without discrimination, care for emergency medical conditions to individuals regardless of their eligibility under the hospital facility’s financial assistance policy?..................

Yes

If "No," indicate why:

The hospital facility did not provide care for any emergency medical conditions

The hospital facility’s policy was not in writing

The hospital facility limited who was eligible to receive care for emergency medical conditions (describe in Section C)

Other (describe in Section C)

Schedule H (Form 990) 2019

Page 7

Part VFacility Information (continued)

Charges to Individuals Eligible for Assistance Under the FAP (FAP-Eligible Individuals)

	SENTARA NORTHERN VIRGINIA MEDICAL CENTER
Name of hospital facility or letter of facility reporting group

Yes

Indicate how the hospital facility determined, during the tax year, the maximum amounts that can be charged to FAP-eligible individuals for emergency or other medically necessary care.

The hospital facility used a look-back method based on claims allowed by Medicare fee-for-service during a prior 12-month period

The hospital facility used a look-back method based on claims allowed by Medicare fee-for-service and all private health insurers that pay claims to the hospital facility during a prior 12-month period

The hospital facility used a look-back method based on claims allowed by Medicaid, either alone or in combination with
Medicare fee-for-service and all private health insurers that pay claims to the hospital facility during a prior 12-month
period

The hospital facility used a prospective Medicare or Medicaid method

During the tax year, did the hospital facility charge any FAP-eligible individual to whom the hospital facility provided emergency or other medically necessary services more than the amounts generally billed to individuals who had insurance covering such care? ...............................

If "Yes," explain in Section C.

During the tax year, did the hospital facility charge any FAP-eligible individual an amount equal to the gross charge for any service provided to that individual? ...........................

If "Yes," explain in Section C.

Schedule H (Form 990) 2019

Page 4

Part VFacility Information (continued)

Section B. Facility Policies and Practices

(Complete a separate Section B for each of the hospital facilities or facility reporting groups listed in Part V, Section A)

	LAKE RIDGE AMBULATORY CENTER
Name of hospital facility or letter of facility reporting group

Line number of hospital facility, or line numbers of hospital facilities in a facility
reporting group (from Part V, Section A):

Yes

Community Health Needs Assessment

Was the hospital facility first licensed, registered, or similarly recognized by a state as a hospital facility in the current tax year or the immediately preceding tax year?........................

During the tax year or either of the two immediately preceding tax years, did the hospital facility conduct a community health needs assessment (CHNA)? If "No," skip to line 12......................

Yes

If "Yes," indicate what the CHNA report describes (check all that apply):

A definition of the community served by the hospital facility

Demographics of the community

Existing health care facilities and resources within the community that are available to respond to the health needs of the community

How data was obtained

The significant health needs of the community

Primary and chronic disease needs and other health issues of uninsured persons, low-income persons, and minority groups

The process for identifying and prioritizing community health needs and services to meet the community health needs

The process for consulting with persons representing the community’s interests

The impact of any actions taken to address the significant health needs identified in the hospital facility's prior CHNA(s)

Other (describe in Section C)

Indicate the tax year the hospital facility last conducted a CHNA: 20 19

Yes

6 a

Was the hospital facility’s CHNA conducted with one or more other hospital facilities? If "Yes," list the other hospital facilities in Section C..................................

Yes

Was the hospital facility’s CHNA conducted with one or more organizations other than hospital facilities?” If “Yes,” list the other organizations in Section C. ............................

Did the hospital facility make its CHNA report widely available to the public?..............

Yes

If "Yes," indicate how the CHNA report was made widely available (check all that apply):

Hospital facility’s website (list url):

Other website (list url): SEE SECTION C BELOW.

Made a paper copy available for public inspection without charge at the hospital facility

Other (describe in Section C)

Did the hospital facility adopt an implementation strategy to meet the significant community health needs
identified through its most recently conducted CHNA? If "No," skip to line 11. ..............

Yes

Indicate the tax year the hospital facility last adopted an implementation strategy: 20 19

Is the hospital facility's most recently adopted implementation strategy posted on a website?.........

If "Yes" (list url):

If "No," is the hospital facility’s most recently adopted implementation strategy attached to this return? ......

10b

Yes

12a

Did the organization incur an excise tax under section 4959 for the hospital facility's failure to conduct a CHNA as required by section 501(r)(3)?...............................

12a

If "Yes" on line 12a, did the organization file Form 4720 to report the section 4959 excise tax?........

12b

If "Yes" on line 12b, what is the total amount of section 4959 excise tax the organization reported on Form 4720 for all of its hospital facilities? $

Schedule H (Form 990) 2019

Page 5

Part VFacility Information (continued)

Financial Assistance Policy (FAP)

	LAKE RIDGE AMBULATORY CENTER
Name of hospital facility or letter of facility reporting group

Yes

Did the hospital facility have in place during the tax year a written financial assistance policy that:

Explained eligibility criteria for financial assistance, and whether such assistance included free or discounted care?

Yes

If “Yes,” indicate the eligibility criteria explained in the FAP:

Federal poverty guidelines (FPG), with FPG family income limit for eligibility for free care of 200.000000000000%
and FPG family income limit for eligibility for discounted care of 0.000000000000%

Income level other than FPG (describe in Section C)

Asset level

Medical indigency

Insurance status

Underinsurance discount

Residency

Other (describe in Section C)

Explained the basis for calculating amounts charged to patients?.................

Yes

Explained the method for applying for financial assistance?...................

Yes

Described the information the hospital facility may require an individual to provide as part of his or her application

Described the supporting documentation the hospital facility may require an individual to submit as part of his or
her application

Provided the contact information of hospital facility staff who can provide an individual with information about the
FAP and FAP application process

Provided the contact information of nonprofit organizations or government agencies that may be sources of
assistance with FAP applications

Other (describe in Section C)

Was widely publicized within the community served by the hospital facility?........

Yes

If "Yes," indicate how the hospital facility publicized the policy (check all that apply):

The FAP was widely available on a website (list url):

LAKERIDGESURGERYCENTER.COM/PATIENT-INFORMATION/FINANCIAL-ASSISTANCE-POLICY/

The FAP application form was widely available on a website (list url):

LAKERIDGESURGERYCENTER.COM/PATIENT-INFORMATION/FINANCIAL-ASSISTANCE-POLICY/

A plain language summary of the FAP was widely available on a website (list url):
LAKERIDGESURGERYCENTER.COM/PATIENT-INFORMATION/FINANCIAL-ASSISTANCE-POLICY/

The FAP was available upon request and without charge (in public locations in the hospital facility and by mail)

The FAP application form was available upon request and without charge (in public locations in the hospital facility
and by mail)

A plain language summary of the FAP was available upon request and without charge (in public locations in the
hospital facility and by mail)

Notified members of the community who are most likely to require financial assistance about availability of the FAP

The FAP, FAP application form, and plain language summary of the FAP were translated into the primary language(s)
spoken by LEP populations

Other (describe in Section C)

Schedule H (Form 990) 2019

Page 6

Part VFacility Information (continued)

Billing and Collections

	LAKE RIDGE AMBULATORY CENTER
Name of hospital facility or letter of facility reporting group

Yes

Reporting to credit agency(ies)

Selling an individual’s debt to another party

Deferring, denying, or requiring a payment before providing medically necessary care due to nonpayment of a previous
bill for care covered under the hospital facility's FAP

Actions that require a legal or judicial process

Other similar actions (describe in Section C)

None of these actions or other similar actions were permitted

If "Yes," check all actions in which the hospital facility or a third party engaged:

Reporting to credit agency(ies)

Selling an individual’s debt to another party

Deferring , denying, or requiring a payment before providing medically necessary care due to nonpayment of a previous
bill for care covered under the hospital facility's FAP

Actions that require a legal or judicial process

Other similar actions (describe in Section C)

Indicate which efforts the hospital facility or other authorized party made before initiating any of the actions listed (whether or not checked) in line 19. (check all that apply):

Provided a written notice about upcoming ECAs (Extraordinary Collection Action) and a plain language summary of the
FAP at least 30 days before initiating those ECAs (if not, describe in Section C)

Made a reasonable effort to orally notify individuals about the FAP and FAP application process (if not, describe in
Section C)

Processed incomplete and complete FAP applications (if not, describe in Section C)

Made presumptive eligibility determinations (if not, describe in Section C)

Other (describe in Section C)

None of these efforts were made

Policy Relating to Emergency Medical Care

If "No," indicate why:

The hospital facility did not provide care for any emergency medical conditions

The hospital facility’s policy was not in writing

The hospital facility limited who was eligible to receive care for emergency medical conditions (describe in Section C)

Other (describe in Section C)

Schedule H (Form 990) 2019

Page 7

Part VFacility Information (continued)

Charges to Individuals Eligible for Assistance Under the FAP (FAP-Eligible Individuals)

	LAKE RIDGE AMBULATORY CENTER
Name of hospital facility or letter of facility reporting group

Yes

Indicate how the hospital facility determined, during the tax year, the maximum amounts that can be charged to FAP-eligible individuals for emergency or other medically necessary care.

The hospital facility used a look-back method based on claims allowed by Medicare fee-for-service during a prior 12-month period

The hospital facility used a prospective Medicare or Medicaid method

If "Yes," explain in Section C.

During the tax year, did the hospital facility charge any FAP-eligible individual an amount equal to the gross charge for any service provided to that individual? ...........................

If "Yes," explain in Section C.

Schedule H (Form 990) 2019

Page 8

Part V

Facility Information (continued)

Section C. Supplemental Information for Part V, Section B. Provide descriptions required for Part V, Section B, lines 2, 3j, 5, 6a, 6b, 7d, 11, 13b, 13h, 15e, 16j, 18e, 19e, 20a, 20b, 20c, 20d, 20e, 21c, 21d, 23, and 24. If applicable, provide separate descriptions for each hospital facility in a facility reporting group, designated by facility reporting group letter and hospital facility line number from Part V, Section A (“A, 1,” “A, 4,” “B, 2,” “B, 3,” etc.) and name of hospital facility.
Form and Line Reference	Explanation
SENTARA NORTHERN VIRGINIA MEDICAL CENTER	PART V, SECTION B, LINE 5: IN CONDUCTING THE COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA), SENTARA NORTHERN VIRGINIA MEDICAL CENTER (SNVMC) TOOK INTO ACCOUNT INPUT FROM PERSONS WHO REPRESENT THE BROAD INTERESTS OF THE COMMUNITY SERVED BY THE HOSPITAL FACILITY, INCLUDING REPRESENTATIVES OF THE LOCAL PUBLIC HEALTH DEPARTMENT AND ORGANIZATIONS SERVING THE MEDICALLY UNDERSERVED, LOW-INCOME, AND MINORITY POPULATIONS THROUGH: 1) SURVEYING KEY COMMUNITY STAKEHOLDERS BY USE OF AN ONLINE SURVEY TO IDENTIFY SIGNIFICANT HEALTH PROBLEMS AND SERVICE GAPS; 2) REVIEW OF ASSESSMENTS AND OTHER PLANNING DOCUMENTS PREPARED BY COMMUNITY ORGANIZATIONS SUCH AS THE LOCAL HEALTH DEPARTMENT; AND 3) DIRECT COMMUNICATION WITH COMMUNITY STAKEHOLDERS.1) SNVMC WORKED WITH A COALITION WHICH INCLUDED REPRESENTATIVES OF THE PRINCE WILLIAM HEALTH DISTRICT, THE PRINCE WILLIAM AREA FREE CLINIC, THE GREATER PRINCE WILLIAM COMMUNITY HEALTH CENTER, NOVANT PRINCE WILLIAM HOSPITAL, AND SEVERAL OTHER HEALTH-RELATED ORGANIZATIONS. THE COMMITTEE WAS RESPONSIBLE FOR IDENTIFYING KEY STAKEHOLDERS TO RECEIVE THE SURVEY. THE SURVEY LIST WAS REVIEWED TO ENSURE BROAD REPRESENTATION, INCLUDING REPRESENTATIVES OF THE LOCAL HEALTH DEPARTMENTS, FREE CLINICS, FEDERALLY QUALIFIED COMMUNITY HEALTH CENTERS, COMMUNITY SERVICES BOARDS (MENTAL HEALTH AND SUBSTANCE ABUSE), SOCIAL SERVICES DEPARTMENTS, EDUCATIONAL INSTITUTIONS, PROVIDERS (MEDICAL, DENTAL, ETC.), BUSINESSES, VOLUNTARY HEALTH AGENCIES, AREA AGENCIES ON AGING, CIVIC LEAGUES, THE FAITH COMMUNITY AND OTHER HEALTH AND HUMAN SERVICES ORGANIZATIONS AND GROUPS. DURING THE SURVEY PROCESS, THE RESPONSE RATE WAS MONITORED AND FOLLOW UP WAS MADE TO ENSURE GOOD AND BROADLY REPRESENTATIVE PARTICIPATION.2) DIRECT COMMUNICATION WITH COMMUNITY STAKEHOLDERS WAS ALSO AN IMPORTANT PART OF THE PROCESS. THE COMMUNITY INPUT INCLUDED SURVEYS AND TOWN HALL MEETINGS INVOLVING THE COMMUNITY MEMBERS AND KEY STAKEHOLDERS INCLUDING PUBLIC HEALTH, SOCIAL SERVICES, SERVICE PROVIDERS, AND THOSE WHO REPRESENT UNDERSERVED POPULATIONS.
LAKE RIDGE AMBULATORY CENTER	PART V, SECTION B, LINE 5: THE FACILITY RELIED ON THE ASSESSMENT CONDUCTED BY SNVMC WHEN CONDUCTING ITS OWN ASSESSMENT. SEE THE RESPONSE UNDER SNVMC FOR ADDITIONAL INFORMATION.
SENTARA NORTHERN VIRGINIA MEDICAL CENTER	PART V, SECTION B, LINE 6A: THE CHNA OF SENTARA NORTHERN VIRGINIA MEDICAL CENTER (SNVMC) WAS CONDUCTED WITH LAKE RIDGE AMBULATORY SURGERY CENTER.
LAKE RIDGE AMBULATORY CENTER	PART V, SECTION B, LINE 6A: THE CHNA OF LAKE RIDGE AMBULATORY SURGERY CENTER WAS CONDUCTED WITH SENTARA NORTHERN VIRGINIA MEDICAL CENTER.
SENTARA NORTHERN VIRGINIA MEDICAL CENTER	PART V, SECTION B, LINE 7D: COPIES OF THE ASSESSMENT HAVE BEEN MADE AVAILABLE TO OTHER ORGANIZATIONS, INCLUDING THE COMMUNITY HEALTHCARE COALITION OF GREATER PRINCE WILLIAM.THE DIRECT URL ADDRESS FOR THE COMMUNITY HEALTH NEEDS ASSESSMENT IS:HTTPS://WWW.SENTARA.COM/ASSETS/PDF/ABOUT-US/COMMUNITY-HEALTH-NEEDS-ASSESSMENTS/2019-SNVMC-COMMUNITY-HEALTH-NEEDS-ASSESSSMENT.PDF
LAKE RIDGE AMBULATORY CENTER	PART V, SECTION B, LINE 7D: COPIES OF THE ASSESSMENT HAVE BEEN MADE AVAILABLE TO OTHER ORGANIZATIONS, INCLUDING THE COMMUNITY HEALTHCARE COALITION OF GREATER PRINCE WILLIAM.THE DIRECT URL ADDRESS FOR THE COMMUNITY HEALTH NEEDS ASSESSMENT IS: HTTPS://WWW.SENTARA.COM/ASSETS/PDF/ABOUT-US/COMMUNITY-HEALTH-NEEDS-ASSESSMENTS/2019-LRASC-COMMUNITY-HEALTH-NEEDS-ASSESSSMENT.PDF
SENTARA NORTHERN VIRGINIA MEDICAL CENTER	PART V, SECTION B, LINE 11: THE SNVMC COMMUNITY HEALTH NEEDS ASSESSMENT IDENTIFIED NUMEROUS HEALTH ISSUES. DURING THE CHNA PROCESS, THE HOSPITAL UNDERWENT A PRIORITIZATION PROCESS TO IDENTIFY THE SIGNIFICANT HEALTH NEEDS FOR WHICH IMPLEMENTATION STRATEGIES SHOULD BE DEVELOPED. THE PROCESS CONSIDERED FACTORS SUCH AS SIZE AND SCOPE OF THE HEALTH PROBLEM, THE INTENSITY AND SEVERITY OF THE ISSUE, THE POTENTIAL TO EFFECTIVELY ADDRESS THE PROBLEM AND THE AVAILABILITY OF COMMUNITY RESOURCES, IMPACT ON HEALTH DISPARITIES, THE IMPORTANCE TO THE COMMUNITY, AND SENTARA'S MISSION "TO IMPROVE HEALTH EVERYDAY". FOR THE SIGNIFICANT HEALTH NEEDS, IN ADDITION TO EXECUTION OF THE IMPLEMENTATION STRATEGIES, THE HOSPITAL IS PARTICIPATING IN THE COUNTY-WIDE COLLABORATIVE, THE COMMUNITY HEALTHCARE COALITION OF GREATER PRINCE WILLIAM. SOME OF THE AREA NEEDS WHICH ARE NOT SPECIFICALLY ADDRESSED IN THE IMPLEMENTATION STRATEGY WERE IDENTIFIED AS LOWER PRIORITY BECAUSE THEY DID NOT RANK HIGH WITH THE PRIORITIZATION FACTORS.
LAKE RIDGE AMBULATORY CENTER	PART V, SECTION B, LINE 11: THE FACILITY WORKED TOGETHER WITH SNVMC TO ADDRESS THE SIGNIFICANT NEEDS IDENTIFIED IN ITS CHNA AND WENT THROUGH THE SAME PRIORITIZATION PROCESS TO IDENTIFY THE SIGNIFICANT HEALTH NEEDS FOR WHICH IMPLEMENTATION STRATEGIES SHOULD BE DEVELOPED. SEE THE RESPONSE FOR SNVMC FOR FURTHER INFORMATION.
SENTARA NORTHERN VIRGINIA MEDICAL CENTER	PART V, SECTION B, LINE 20E: THE HOSPITAL USES OUTSIDE VENDORS THAT SCREEN ALL PATIENTS WITHOUT INSURANCE FOR ELIGIBILITY FOR GOVERNMENT PROGRAMS, AND FINANCIAL COUNSELORS WHO SCREEN THOSE THAT ARE NOT ELIGIBLE FOR GOVERNMENT PROGRAMS TO DETERMINE WHETHER THEY MEET CRITERIA FOR FINANCIAL ASSISTANCE. IN ADDITION, THE PRESUMPTIVE ELIGIBILITY PROCESS ELIMINATES FROM COLLECTION EFFORTS THOSE PATIENTS WHO ARE UNLIKELY TO HAVE THE RESOURCES TO PAY THEIR ACCOUNT BALANCES, EVEN IF THEY ARE INELIGIBLE FOR FINANCIAL ASSISTANCE BY MODEL.
LAKE RIDGE AMBULATORY CENTER	PART V, SECTION B, LINE 20E: AS ONLY PRE-ARRANGED PROCEDURES ARE PERFORMED AT THE FACILITY, INDIVIDUALS DESIRING TREATMENT MUST SPEAK WITH FACILITY PERSONNEL BEFORE BEING SCHEDULED FOR SURGERY, IN ORDER TO DISCUSS PAYMENT ARRANGEMENTS. FAP-ELIGIBILITY WAS DISCUSSED AT THIS TIME.
LAKE RIDGE AMBULATORY CENTER	PART V, SECTION B, LINE 21D: THE FACILITY IS AN AMBULATORY SURGERY CENTER AND DOES NOT TREAT INDIVIDUALS REQUIRING EMERGENCY MEDICAL CARE. ONLY PRE-PLANNED PROCEDURES ARE PERFORMED AT THE FACILITY. SEE PART VI NARRATIVE ON THE ORGANIZATION'S AMBULATORY SURGERY CENTER FOR FURTHER INFORMATION.
LAKE RIDGE AMBULATORY CENTER:	PART V, SECTION B, LINE 7A:HTTPS://LAKERIDGESURGERYCENTER.COM/ASSETS/UPLOADS/2017/01/LAKE-RIDGE-ASC-2016-COMMUNITY-HEALTH-NEEDS-ASSESSMENT-FINAL-REDUCED-SIZE.PDF
SENTARA NORTHERN VIRGINIA MEDICAL CENTER:	PART V, SECTION B, LINE 3E: THE SIGNIFICANT HEALTH NEEDS PRESENTED IN THE CHNA ARE A PRIORITIZED DESCRIPTION OF THE SIGNIFICANT HEALTH NEEDS OF THE COMMUNITY IDENTIFIED BY COMMUNITY MEMBERS VIA MULTIPLE METHODS. IN ADDITION TO A KEY STAKEHOLDER SURVEY CONDUCTED ONLINE, FOCUS GROUPS ARE CONDUCTED, WITH ADDITIONAL INTERVIEWS WITH POLICY MAKERS AND REPRESENTATIVES OF INDEPENDENT COMMUNITY ORGANIZATIONS. SENTARA ENSURES THAT RESPONDENTS TO REQUESTS FOR INPUT REPRESENT MANY TYPES OF COMMUNITY ACTORS: POLICY MAKERS, SERVICE PROVIDERS, REPRESENTATIVES OF PUBLIC HEALTH ORGANIZATIONS, REPRESENTATIVES OF UNDERSERVED POPULATIONS, SOCIAL SERVICE PROVIDERS AND GOVERNMENT FUNCTIONS SUCH AS SCHOOLS, AND THE BUSINESS AND LARGER COMMUNITIES.
LAKE RIDGE AMBULATORY CENTER:	PART V, SECTION B, LINE 3E: THE SIGNIFICANT HEALTH NEEDS PRESENTED IN THE CHNA ARE A PRIORITIZED DESCRIPTION OF THE SIGNIFICANT HEALTH NEEDS OF THE COMMUNITY IDENTIFIED BY COMMUNITY MEMBERS VIA MULTIPLE METHODS. IN ADDITION TO A KEY STAKEHOLDER SURVEY CONDUCTED ONLINE, FOCUS GROUPS ARE CONDUCTED, WITH ADDITIONAL INTERVIEWS WITH POLICY MAKERS AND REPRESENTATIVES OF INDEPENDENT COMMUNITY ORGANIZATIONS. SENTARA ENSURES THAT RESPONDENTS TO REQUESTS FOR INPUT REPRESENT MANY TYPES OF COMMUNITY ACTORS: POLICY MAKERS, SERVICE PROVIDERS, REPRESENTATIVES OF PUBLIC HEALTH ORGANIZATIONS, REPRESENTATIVES OF UNDERSERVED POPULATIONS, SOCIAL SERVICE PROVIDERS AND GOVERNMENT FUNCTIONS SUCH AS SCHOOLS, AND THE BUSINESS AND LARGER COMMUNITIES.

Schedule H (Form 990) 2019

Page 9

Part VFacility Information (continued)

Section D. Other Health Care Facilities That Are Not Licensed, Registered, or Similarly Recognized as a Hospital Facility (list in order of size, from largest to smallest) How many non-hospital health care facilities did the organization operate during the tax year?4
Name and address		Type of Facility (describe)
1	1 - SENTARA LAKE RIDGE 12825 MINNIEVILLE ROAD LAKE RIDGE,VA22192	ADVANCED IMAGING CENTER, LAB, AND FREESTANDING ED
2	2 - SENTARA RADIOLOGY ASSOCIATES 5055 SEMINARY ROAD STE 104 ALEXANDRIA,VA22311	OTHER OUTPATIENT SITE
3	3 - SENTARA THERAPY CTR-REID'S PROSPECT 4565 DAISY REID AVE STE 215 WOODBRIDGE,VA22912	REHABILITATION CENTER
4	4 - SENTARA LORTON STATION IMAGING CTR 8986 LORTON STATION BLVD LORTON,VA22079	ADVANCED IMAGING CENTER
5
6
7
8
9
10

Schedule H (Form 990) 2019

Page 10

Part VI

Supplemental Information

Provide the following information.

1	Required descriptions. Provide the descriptions required for Part I, lines 3c, 6a, and 7; Part II and Part III, lines 2, 3, 4, 8 and 9b.
2	Needs assessment. Describe how the organization assesses the health care needs of the communities it serves, in addition to any CHNAs reported in Part V, Section B.
3	Patient education of eligibility for assistance. Describe how the organization informs and educates patients and persons who may be billed for patient care about their eligibility for assistance under federal, state, or local government programs or under the organization’s financial assistance policy.
4	Community information. Describe the community the organization serves, taking into account the geographic area and demographic constituents it serves.
5	Promotion of community health. Provide any other information important to describing how the organization’s hospital facilities or other health care facilities further its exempt purpose by promoting the health of the community (e.g., open medical staff, community board, use of surplus funds, etc.).
6	Affiliated health care system. If the organization is part of an affiliated health care system, describe the respective roles of the organization and its affiliates in promoting the health of the communities served.
7	State filing of community benefit report. If applicable, identify all states with which the organization, or a related organization, files a community benefit report.

Form and Line Reference	Explanation
PART I, LINE 6A:	THE ORGANIZATION'S COMMUNITY BENEFIT REPORT WAS CONTAINED IN A SYSTEM-WIDE REPORT PREPARED BY SENTARA HEALTHCARE, EIN 52-1271901, THE ORGANIZATION'S 501(C)(3) SOLE MEMBER.
PART I, LINE 7:	EXCEPT FOR SUBSIDIZED HEALTH SERVICES, A COST-TO-CHARGE RATIO, CALCULATED USING WORKSHEET 2, WAS USED TO CALCULATE COSTS REPORTED IN THE TABLE. SUBSIDIZED HEALTH SERVICES WERE REPORTED USING A COST-TO-CHARGE RATIO SPECIFIC TO EACH COST CENTER PROVIDING SUCH SERVICES.
PART II, COMMUNITY BUILDING ACTIVITIES:	COALITION BUILDING THE ORGANIZATION PARTICIPATED IN VARIOUS COALITIONS ON COMMUNITY ISSUES.COMMUNITY HEALTH IMPROVEMENT ADVOCACY - THE ORGANIZATION PARTICIPATED IN THE COMMUNITY HEALTH COALITION OF GREATER PRINCE WILLIAM COUNTY. WORKFORCE DEVELOPMENT - THE ORGANIZATION ENTERS INTO PHYSICIAN RECRUITING AGREEMENTS IN ORDER TO INCENT HIGHLY QUALIFIED PHYSICIANS INTO THE COMMUNITY TO FILL POSITIONS IN SERVICES AREAS WHERE THERE IS AN URGENT NEED.
PART III, LINE 2:	FOR SCHEDULE H PART III LINE 2 PURPOSES, THE ORGANIZATION REPORTS WHAT WOULD'VE BEEN CONSIDERED BAD DEBT EXPENSE PRIOR TO ITS 2018 ADOPTION OF ASC TOPIC 606. ASC TOPIC 606 NOW CLASSIFIES THIS COMPONENT OF UNCOMPENSATED CARE AS IMPLICIT PRICE CONCESSIONS, WHICH ARE A REDUCTION TO NET OPERATING REVENUE.IMPLICIT PRICE CONCESSIONS REPRESENT THE DIFFERENCE BETWEEN AMOUNTS BILLED TO PATIENTS AND THE AMOUNTS THE ORGANIZATION EXPECTS TO COLLECT BASED ON ITS COLLECTIONS HISTORY WITH THOSE PATIENTS AND CURRENT MARKET CONDITIONS. IT UTILIZES A PORTFOLIO APPROACH AS A PRACTICAL EXPEDIENT TO ACCOUNT FOR PATIENT CONTRACTS WITH SIMILAR CHARACTERISTICS AS A COLLECTIVE GROUP RATHER THAN INDIVIDUALLY.SEE FOOTNOTES 3(R) AND 4 ON PAGES 14-15 OF THE ATTACHED FINANCIAL STATEMENTS FOR ADDITIONAL INFORMATION.
PART III, LINE 3:	IN COMPUTING LINE 3, THE ORGANIZATION CONSERVATIVELY ESTIMATES THAT 15% OF IMPLICIT PRICE CONCESSIONS (FORMERLY BAD DEBT) ARE ATTRIBUTABLE TO PATIENTS WHO WOULD QUALIFY FOR CHARITY ASSISTANCE IF SUFFICIENT DATA WAS AVAILABLE. THIS ESTIMATE IS BASED ON CREDIT REPORTING DATA PURCHASED FROM EQUIFAX. THIS DATA PROVIDES CREDIT SCORE, INCOME PREDICTION DATA AND NUMEROUS LINES OF CREDIT AND ASSET DATA. FOR UNRESPONSIVE PATIENTS, THE ORGANIZATION USES THE ESTIMATED INCOME, MARITAL STATUS, ASSET INFORMATION AND CREDIT LINE DATA TO DETERMINE WHETHER THE PATIENT WOULD QUALIFY FOR CHARITY BASED ON A PROJECTED INCOME OF 200% OF THE FEDERAL POVERTY GUIDELINES WITH LITTLE TO NO ASSET DATA. THIS INFORMATION IS NOT ALL INCLUSIVE FOR ALL UNRESPONSIVE PATIENTS THAT COULD QUALIFY, AS DEPENDENT INFORMATION IS NOT READILY AVAILABLE.
PART III, LINE 4:	SEE FOOTNOTES 3(S) AND 4 ON PAGES 14-15 OF THE ATTACHED FINANCIAL STATEMENTS FOR THE FOOTNOTE WHICH DISCUSSES IMPLICIT PRICE CONCESSIONS (FORMERLY BAD DEBT.)
PART III, LINE 8:	WORKSHEET A IN THE INSTRUCTIONS WAS USED TO COMPUTE THE AMOUNT REPORTED ON LINE 6.
PART III, LINE 9B:	UNDER THE ORGANIZATION'S WRITTEN DEBT COLLECTION POLICY, A HOSPITAL FACILITY MUST TAKE REASONABLE EFFORTS TO DETERMINE A PATIENT'S ELIGIBILITY FOR FINANCIAL ASSISTANCE PRIOR TO ENGAGING IN COLLECTION EFFORTS AGAINST A PATIENT. SUCH EFFORTS INCLUDE NOTIFYING PATIENTS OF THE FINANCIAL ASSISTANCE POLICY UPON ADMISSION AND PRIOR TO DISCHARGE; PROVIDING ASSISTANCE IN THE APPLICATION PROCESS; ADVERTISING THE AVAILABILITY OF FINANCIAL ASSISTANCE ON PATIENT STATEMENTS; FOLLOWING UP WITH PATIENTS WHO HAVE SUBMITTED INCOMPLETE APPLICATIONS TO TRY AND OBTAIN THE MISSING INFORMATION; AND INFORMING APPLICANTS REGARDING THEIR ELIGIBILITY DETERMINATION. PRIOR TO TURNING THE ACCOUNTS OF UNRESPONSIVE PATIENTS OVER TO COLLECTIONS, THE HOSPITAL FACILITY ALSO ATTEMPTS TO QUALIFY AND WRITE OFF BALANCES UNDER THE FINANCIAL ASSISTANCE POLICY BASED ON CREDIT REPORTING DATA THAT ASSISTS IN DETERMINING INCOME AND CREDIT WORTHINESS. WHEN THE CREDIT DATA SUGGESTS THAT A PATIENT'S INCOME IS AT OR BELOW THE 200% FEDERAL POVERTY GUIDELINES, THE ACCOUNT BALANCE IS WRITTEN-OFF TO PRESUMPTIVE CHARITY; AND ALL COLLECTIONS EFFORTS CEASE. IF THE CREDIT REPORTING DATA IS UNCLEAR ON AN UNRESPONSIVE PATIENT'S ELIGIBILITY FOR FINANCIAL ASSISTANCE, THE PATIENT'S ACCOUNT MAY BE MOVED TO BAD DEBT AND FURTHER COLLECTIONS ACTIONS TAKEN. IF AT ANY TIME DURING THE BAD DEBT COLLECTIONS PROCESS THE HOSPITAL FACILITY RECEIVES INFORMATION THAT THE PATIENT IS ELIGIBLE UNDER THE FINANCIAL ASSISTANCE POLICY, THE COLLECTION EFFORTS CEASE; AND THE ACCOUNT IS WRITTEN OFF TO CHARITY.
PART VI, LINE 2:	THE ORGANIZATION ASSESSES THE HEALTH CARE NEEDS OF ITS COMMUNITIES THROUGH THESE MEANS:-ANALYSIS OF AREA SOCIODEMOGRAPHIC, HEALTH STATUS, AND OTHER DATA: THE ANALYSIS FOCUSES ON IDENTIFICATION OF HEALTH CARE NEEDS FOR PLANNING AND DEVELOPMENT OF HEALTH SERVICES AND PROGRAMS. THIS ANALYSIS IS UTILIZED IN THE DEVELOPMENT OF ORGANIZATIONAL PLANS.-OBTAINING INPUT FROM KEY STAKEHOLDERS AND THE PUBLIC HEALTH COMMUNITY: IN ADDITION TO THE ANALYSIS OF SOCIODEMOGRAPHIC, HEALTH STATUS, AND OTHER DATA, ADDITIONAL INFORMATION IS OBTAINED AND ANALYZED. THIS INCLUDES INPUT FROM KEY STAKEHOLDERS INCLUDING THE LOCAL PUBLIC HEALTH COMMUNITY.-REVIEW OF HEALTH CARE NEEDS ASSESSMENTS AND DATA DEVELOPED BY COMMUNITY PARTNERS (SUCH AS STATE HEALTH DEPARTMENTS AND LOCAL HEALTH DISTRICTS), REGIONAL AGENCIES (SUCH AS THE PLANNING COUNCIL OR PLANNING DISTRICT COMMISSION), NATIONAL ORGANIZATIONS WHICH REPORT ON A LOCAL BASIS (SUCH AS COUNTY HEALTH RANKINGS), AND INFORMATION REPORTED IN LOCAL MEDIA: THIS INFORMATION IS STUDIED, INCORPORATED INTO THE ORGANIZATION'S PLANS, AND SHARED WITH ORGANIZATIONAL DECISION MAKERS.-PARTICIPATION IN COLLABORATIVE HEALTH PLANNING AND NEEDS ASSESSMENT ACTIVITIES SUCH AS THOSE SPONSORED BY THE LOCAL HEALTH DISTRICT AND OTHER ORGANIZATIONS. INFORMATION GATHERED THROUGH THESE ACTIVITIES IS INCORPORATED INTO THE ORGANIZATION'S PLANNING.-INFORMATION AND INPUT FROM PATIENTS AND CARE PROVIDERS: PATIENT CHARACTERISTICS AND TRENDS ARE REVIEWED TO ASSIST IN IDENTIFYING NEW COMMUNITY NEEDS. INPUT FROM PATIENTS AND CARE PROVIDERS IS SOUGHT AND CYCLED INTO THE ASSESSMENT PHASE OF PROJECTS.
PART VI, LINE 3:	FINANCIAL ASSISTANCE BROCHURES AND OTHER INFORMATION ARE POSTED AT EACH POINT OF SERVICE. A TOLL-FREE NUMBER IS GIVEN TO PATIENTS TO REACH CUSTOMER SERVICE REPRESENTATIVES DURING THE BUSINESS DAY FOR QUESTIONS OR CONCERNS. FINANCIAL ASSISTANCE PROGRAMS ARE ALSO PUBLISHED ON THE ORGANIZATION'S WEBSITE AND INCLUDED ON THE STATEMENTS PROVIDED TO PATIENTS. THE ORGANIZATION EMPLOYS FINANCIAL COUNSELORS WHO ARE AVAILABLE TO HELP PATIENTS COMPLETE APPLICATIONS FOR MEDICAID OR OTHER GOVERNMENT PAYMENT ASSISTANCE PROGRAMS, OR APPLY FOR CARE UNDER THE ORGANIZATION'S FINANCIAL ASSISTANCE POLICY, IF APPLICABLE. THE ORGANIZATION ALSO EMPLOYS AN EXTERNAL FIRM TO ASSIST IN THE ELIGIBILITY PROCESS.
PART VI, LINE 4:	SENTARA NORTHERN VIRGINIA MEDICAL CENTER'S SERVICE AREA INCLUDES THE FOLLOWING AREAS OF PRINCE WILLIAM, STAFFORD, AND FAIRFAX COUNTIES IN NORTHERN VIRGINIA: WOODBRIDGE, DUMFRIES, STAFFORD, TRIANGLE, QUANTICO, MANASSAS, AND LORTON. THE 2019 POPULATION OF THE AREA IS 460,472 AND THE POPULATION IS PROJECTED TO INCREASE BY 7.1% OVER THE NEXT FIVE YEARS COMPARED TO A PROJECTED U.S. GROWTH RATE OF 3.5%. 9.8% OF THE POPULATION IS AGE 65+ COMPARED TO THE U.S. AT 16.2%. EDUCATION-WISE, 10% OF THE ADULT POPULATION AGED 25+ HAVE LESS THAN A HIGH SCHOOL EDUCATION, COMPARED TO 12% FOR THE U.S. INCOME-WISE, THE MEDIAN HOUSEHOLD INCOME IS $103,663 COMPARED TO $67,811 FOR THE U.S. AND 5.7% OF THE HOUSEHOLDS HAVE AN ANNUAL INCOME OF LESS THAN $25,000, COMPARED TO 20.1% FOR THE U.S. RACIALLY, THE SERVICE AREA IS HOME TO 53.4% WHITES (VS. 69.7% FOR THE US), 21.2% BLACK/AFRICAN AMERICANS (VS. 13.4% US), 9.1% ASIANS (VS. 6.0% US), WITH 16.2% REPORTING ANOTHER RACE VS. 10.7% NATIONALLY. ETHNICALLY, THE SERVICE AREA IS HOME TO 24.2% HISPANICS VS. 17.9% NATIONALLY, AND 75.8% NON-HISPANICS, VS. 82.1% NATIONALLY.
PART VI, LINE 5:	THE ORGANIZATION'S GOVERNING BODY IS COMPRISED OF TWO CLASSES, DIRECTORS APPOINTED BY THE ORGANIZATION'S 501(C)(3) SOLE MEMBER, SENTARA HEALTHCARE, AND DIRECTORS APPOINTED BY POTOMAC HEALTH FOUNDATION, A 501(C)(3) ORGANIZATION, AND APPROVED BY SENTARA HEALTHCARE. SENTARA HEALTHCARE'S COMMUNITY-BASED BOARD IS COMPRISED OF A MAJORITY OF MEMBERS WHO ARE NEITHER EMPLOYEES NOR CONTRACTORS OF SENTARA HEALTHCARE, NOR FAMILY MEMBERS THEREOF.GENERALLY, MEDICAL STAFF MEMBERSHIP IS OPEN TO ALL CARE PROVIDERS WHO MAY QUALIFY. THE ORGANIZATION'S SURPLUS FUNDS ARE USED FOR IMPROVEMENTS IN PATIENT CARE, PROVISION OF SERVICES TO THE UNINSURED AND UNDERINSURED, MEDICAL EDUCATION, AND COMMUNITY PROGRAMS.
PART VI, LINE 6:	SENTARA HEALTHCARE, THE ORGANIZATION'S 501(C)(3) SOLE MEMBER, PROVIDES A NUMBER OF PROGRAMS TO PROMOTE THE HEALTH OF THE COMMUNITIES IT SERVES, IN ADDITION TO THOSE IDENTIFIED FOR THE ORGANIZATION. SEE FORM 990 PART III SCHEDULE O DISCLOSURE FOR FURTHER INFORMATION ON THE SERVICES AND FACILITIES PROVIDED BY THE SENTARA HEALTHCARE SYSTEM.
PART VI	GENERAL NARRATIVE REGARDING ASCS:THE ORGANIZATION IS A MEMBER OF A JOINT VENTURE WHICH OWNS AND OPERATES AN AMBULATORY SURGERY CENTER ("ASC" ) LOCATED IN VIRGINIA (SEE PART V FOR OWNERSHIP INFORMATION). AS VIRGINIA REQUIRES ASCS TO GO THROUGH A CERTIFICATE OF PUBLIC NEED PROCESS AND RETAIN A HOSPITAL LICENSE, VIRGINIA ASCS MEET THE DEFINITION OF HOSPITAL FACILITIES FOR FORM 990 REPORTING PURPOSES.THE ORGANIZATION'S ASC IS ORGANIZED AND OPERATED IN ACCORDANCE WITH THE ORGANIZATION'S CHARITABLE PURPOSES AS AN EXTENSION OF ITS OUTPATIENT FACILITIES, IN PARTNERSHIP WITH ITS PHYSICIANS, TO PROVIDE A MORE EFFECTIVE MEANS OF CARING FOR LESS SERIOUS NON-EMERGENCY MEDICAL CONDITIONS THAT DO NOT REQUIRE INPATIENT HOSPITAL CARE. ONLY PRE-PLANNED PROCEDURES ARE PERFORMED AT THE ASC. INDIVIDUALS DESIRING TREATMENT MUST SPEAK WITH FACILITY PERSONNEL PRIOR TO BEING SCHEDULED FOR SURGERY, IN ORDER TO DISCUSS PAYMENT ARRANGEMENTS. THE ASC WORKS WITH INDIVIDUALS TO COME UP WITH PAYMENT OPTIONS, SUCH AS PAYMENT PLANS, OFFERING FREE OR DISCOUNTED CARE IN ACCORDANCE WITH ITS FINANCIAL ASSISTANCE POLICY AND DISCOUNT PRACTICES. DISCOUNTED CARE IS NOT OFFERED UNDER THE ASCS' WRITTEN FINANCIAL ASSISTANCE POLICIES; ONLY FREE CARE IS OFFERED.
PART I, LINE 3C	THE ORGANIZATION USES A MULTI-FACETED REVIEW OF AN APPLICANT'S SITUATION TO DETERMINE ELIGIBILITY FOR FREE OR DISCOUNTED CARE. AN APPLICANT'S HOUSEHOLD INCOME IS EVALUATED IN LIGHT OF RELEVANT FACTS AND CIRCUMSTANCES, SUCH AS REPORTED INCOME, ASSETS, LIABILITIES, EXPENSES, AND OTHER RESOURCES AVAILABLE TO THE APPLICANT OR THE APPLICANT'S RESPONSIBLE PARTY, WHEN DETERMINING THE LEVEL OF FINANCIAL ASSISTANCE THAT AN APPLICANT QUALIFIES FOR UNDER THE FINANCIAL ASSISTANCE POLICY.

Schedule H (Form 990) 2019

Additional Data

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Schedule I
(Form 990)

Department of the Treasury
Internal Revenue Service

Grants and Other Assistance to Organizations,
Governments and Individuals in the United States

Complete if the organization answered "Yes," on Form 990, Part IV, line 21 or 22.
lBullet

Attach to Form 990.
lBullet

Go to www.irs.gov/Form990 for the latest information.

OMB No. 1545-0047

2019

Open to Public
Inspection

Name of the organization
POTOMAC HOSPITAL CORPORATION
OF PRINCE WILLIAM

Employer identification number
54-0853898

Part I

General Information on Grants and Assistance

Does the organization maintain records to substantiate the amount of the grants or assistance, the grantees' eligibility for the grants or assistance, and
the selection criteria used to award the grants or assistance? ........................

Yes No

Describe in Part IV the organization's procedures for monitoring the use of grant funds in the United States.

Part II

Grants and Other Assistance to Domestic Organizations and Domestic Governments. Complete if the organization answered "Yes" on Form 990, Part IV, line 21, for any recipient

that received more than $5,000. Part II can be duplicated if additional space is needed.

(a) Name and address of organization or government	(b) EIN	(c) IRC section (if applicable)	(d) Amount of cash grant	(h) Purpose of grant or assistance
(1) SENTARA HEALTHCARE 6015 POPLAR HALL DR NORFOLK,VA23502	52-1271901	501(C)(3)	2,453,280	CORPORATE ALLOCATION TO PARENT
(2) LEADERSHIP PRINCE WILLIAM 9720 CAPITAL COURT MANASSAS,VA20110	20-8649170	501(C)(3)	7,400	DONATION/SPONSORSHIP
(3) THE SKILLSOURCE GROUP INC 8300 BOONE BLVD 450 VIENNA,VA22182	30-0129320	501(C)(3)	29,678	DONATION/SPONSORSHIP
(4) NATIONAL CAPITAL POISON CENTER 3201 NEW MEXICO AVE NW 310 WASHINGTON,DC20016	52-1880478	501(C)(3)	20,000	DONATION/SPONSORSHIP
(5) GEORGE MASON UNIVERSITY FOUNDATION 4400 UNIVERSITY DRIVE MSN 1A3 FAIRFAX,VA22030	54-1603842	501(C)(3)	8,000	DONATION/SPONSORSHIP

Enter total number of section 501(c)(3) and government organizations listed in the line 1 table ................. Bullet Image

Enter total number of other organizations listed in the line 1 table ........................ . Bullet Image

For Paperwork Reduction Act Notice, see the Instructions for Form 990.

Cat. No. 50055P

Schedule I (Form 990) 2019

Page 2

Part III

Grants and Other Assistance to Domestic Individuals. Complete if the organization answered "Yes" on Form 990, Part IV, line 22.
Part III can be duplicated if additional space is needed.

(a) Type of grant or assistance	(b) Number of recipients	(c) Amount of cash grant	(d) Amount of noncash assistance	(e) Method of valuation (book, FMV, appraisal, other)	(f) Description of noncash assistance

(1) SCHOLARSHIPS	13	41,000
(1)
(2)
(3)
(4)
(5)
(6)
(7)

Part IV

Supplemental Information. Provide the information required in Part I, line 2; Part III, column (b); and any other additional information.

Return Reference

Explanation

PART I, LINE 2:

AS PART OF THE SENTARA HEALTHCARE SYSTEM ("THE SYSTEM"), THE ORGANIZATION DONATES FUNDS TO ITS 501(C)(3) PARENT ORGANIZATION, SENTARA HEALTHCARE, IN FURTHERANCE OF THE SYSTEM'S MISSION TO IMPROVE HEALTH EVERYDAY THROUGH THE PROVISION OF HEALTH SERVICES, AND THE PROMOTION OF HEALTH, MEDICAL EDUCATION, AND THE SOCIAL, CULTURAL, EDUCATIONAL, AND ECONOMIC DEVELOPMENT OF THE COMMUNITY. EXPENDITURE OF SUCH FUNDS IS OVERSEEN BY AN INDEPENDENT COMMUNITY BOARD WHICH MANAGES THE BUSINESS AND AFFAIRS OF THE SYSTEM. THE ORGANIZATION DONATES FUNDS TO OTHER 501(C)(3) ORGANIZATIONS WITH A SIMILAR MISSION OF PROVIDING AND PROMOTING HEALTH, MEDICAL EDUCATION, AND THE SOCIAL, CULTURAL, EDUCATIONAL, AND ECONOMIC DEVELOPMENT OF THE COMMUNITY. SUCH ORGANIZATIONS ALSO HAVE COMMUNITY BOARDS WHICH OVERSEE THE PROPER EXPENDITURES OF SUCH FUNDS. AUXILIARY SCHOLARSHIPS ARE AWARDED TO STUDENTS WHO PLAN TO PURSUE CAREERS IN A MEDICAL HEALTH CARE OR RELATED FIELD. IN 2019, THE AUXILIARY AWARDED $11,000 IN SCHOLARSHIPS. NURSING SCHOLARSHIPS ARE AWARDED TO NON-BSN RN STUDENTS WHO PLAN TO PURSUE CAREERS IN NURSING. IN 2019, THE HOSPITAL AWARDED $30,000 IN SCHOLARSHIPS.

Schedule I (Form 990) 2019

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Schedule J
(Form 990)

Department of the Treasury
Internal Revenue Service

Compensation Information

For certain Officers, Directors, Trustees, Key Employees, and Highest
Compensated Employees
SchJMediumBullet

Complete if the organization answered "Yes" on Form 990, Part IV, line 23.
SchJMediumBullet

Attach to Form 990.
SchJMediumBullet

Go to www.irs.gov/Form990 for instructions and the latest information.

OMB No. 1545-0047

2019

Open to Public Inspection

Name of the organization

POTOMAC HOSPITAL CORPORATION
OF PRINCE WILLIAM

Employer identification number

54-0853898

Part I

Questions Regarding Compensation

Yes

Check the appropiate box(es) if the organization provided any of the following to or for a person listed on Form
990, Part VII, Section A, line 1a. Complete Part III to provide any relevant information regarding these items.

First-class or charter travel Housing allowance or residence for personal use

Travel for companions Payments for business use of personal residence

Tax idemnification and gross-up payments Health or social club dues or initiation fees

Discretionary spending account Personal services (e.g., maid, chauffeur, chef)

If any of the boxes on Line 1a are checked, did the organization follow a written policy regarding payment or reimbursement or provision of all of the expenses described above? If "No," complete Part III to explain .........

Did the organization require substantiation prior to reimbursing or allowing expenses incurred by all
directors, trustees, officers, including the CEO/Executive Director, regarding the items checked on Line 1a? ..

Indicate which, if any, of the following the filing organization used to establish the compensation of the
organization's CEO/Executive Director. Check all that apply. Do not check any boxes for methods
used by a related organization to establish compensation of the CEO/Executive Director, but explain in Part III.

Compensation committee Written employment contract

Independent compensation consultant Compensation survey or study

Form 990 of other organizations Approval by the board or compensation committee

During the year, did any person listed on Form 990, Part VII, Section A, line 1a, with respect to the filing organization or a related organization:

Receive a severance payment or change-of-control payment? .............

Yes

Participate in, or receive payment from, a supplemental nonqualified retirement plan? .........

Yes

Participate in, or receive payment from, an equity-based compensation arrangement? .........

If "Yes" to any of lines 4a-c, list the persons and provide the applicable amounts for each item in Part III.

Only 501(c)(3), 501(c)(4), and 501(c)(29) organizations must complete lines 5-9.

For persons listed on Form 990, Part VII, Section A, line 1a, did the organization pay or accrue any
compensation contingent on the revenues of:

The organization? ....................

Any related organization? .......................

If "Yes," on line 5a or 5b, describe in Part III.

For persons listed on Form 990, Part VII, Section A, line 1a, did the organization pay or accrue any
compensation contingent on the net earnings of:

The organization? ..................

Any related organization? ......................

If "Yes," on line 6a or 6b, describe in Part III.

For persons listed on Form 990, Part VII, Section A, line 1a, did the organization provide any nonfixed
payments not described in lines 5 and 6? If "Yes," describe in Part III ............

Yes

Were any amounts reported on Form 990, Part VII, paid or accured pursuant to a contract that was
subject to the initial contract exception described in Regulations section 53.4958-4(a)(3)? If "Yes," describe
in Part III ..........................

If "Yes" on line 8, did the organization also follow the rebuttable presumption procedure described in Regulations section 53.4958-6(c)? .........................

For Paperwork Reduction Act Notice, see the Instructions for Form 990.

Cat. No. 50053T

Schedule J (Form 990) 2019

Page 2

Part II

Officers, Directors, Trustees, Key Employees, and Highest Compensated Employees. Use duplicate copies if additional space is needed.

For each individual whose compensation must be reported on Schedule J, report compensation from the organization on row (i) and from related organizations, described in the
instructions, on row (ii). Do not list any individuals that are not listed on Form 990, Part VII.
Note. The sum of columns (B)(i)-(iii) for each listed individual must equal the total amount of Form 990, Part VII, Section A, line 1a, applicable column (D) and (E) amounts for that individual.

(A) Name and Title		(B) Breakdown of W-2 and/or 1099-MISC compensation			(C) Retirement and other deferred compensation	(D) Nontaxable benefits	(E) Total of columns (B)(i)-(D)	(F) Compensation in column (B) reported as deferred on prior Form 990
(A) Name and Title		(i) Base compensation	(ii) Bonus & incentive compensation	(iii) Other reportable compensation	(C) Retirement and other deferred compensation	(D) Nontaxable benefits	(E) Total of columns (B)(i)-(D)
1HOWARD P KERN FORMER DIRECTOR/OFFICER	(i) (ii)	0 ------------- 1,721,005	0 ------------- 1,718,080	0 ------------- 814,246	0 ------------- 3,776,265	0 ------------- 24,149	0 ------------- 8,053,745	0 ------------- 81,692
2ROBERT A BROERMANN TREASURER/SECRETARY (EFFEC 6/19)	(i) (ii)	0 ------------- 865,809	0 ------------- 603,561	0 ------------- 205,278	0 ------------- 132,432	0 ------------- 17,154	0 ------------- 1,824,234	0 ------------- 0
3MICHAEL V GENTRY DIRECTOR	(i) (ii)	0 ------------- 820,035	0 ------------- 555,458	0 ------------- 149,099	0 ------------- 198,191	0 ------------- 20,736	0 ------------- 1,743,519	0 ------------- 0
4JEFFREY P KING SECRETARY (THRU 6/19)	(i) (ii)	0 ------------- 274,339	0 ------------- 156,153	0 ------------- 539,781	0 ------------- 82,095	0 ------------- 24,650	0 ------------- 1,077,018	0 ------------- 165,897
5DOUGLAS J MOYER CHAIRMAN	(i) (ii)	0 ------------- 441,135	0 ------------- 136,392	0 ------------- 1,071	0 ------------- 65,722	0 ------------- 34,071	0 ------------- 678,391	0 ------------- 0
6KATHERINE A JOHNSON PRESIDENT	(i) (ii)	387,548 ------------- 0	119,305 ------------- 0	25,019 ------------- 0	74,958 ------------- 0	35,970 ------------- 0	642,800 ------------- 0	0 ------------- 0
7JOANNE M INMAN DIRECTOR	(i) (ii)	0 ------------- 290,495	0 ------------- 134,899	0 ------------- 28,603	0 ------------- 125,335	0 ------------- 28,862	0 ------------- 608,194	0 ------------- 0
8VALERIE E KEANE KE (VP, NURSE EXECUTIVE)	(i) (ii)	199,540 ------------- 0	64,062 ------------- 0	36,738 ------------- 0	258,346 ------------- 0	16,286 ------------- 0	574,972 ------------- 0	0 ------------- 0
9MICHAEL R REITZ VP, MEDICAL AFFAIRS	(i) (ii)	369,327 ------------- 0	106,196 ------------- 0	560 ------------- 0	33,430 ------------- 0	28,426 ------------- 0	537,939 ------------- 0	0 ------------- 0
10MOHAMMAD A SALEEM SURGICAL ASSISTANT-CERTIFIED SNVMC	(i) (ii)	382,936 ------------- 0	750 ------------- 0	348 ------------- 0	38,706 ------------- 0	25,634 ------------- 0	448,374 ------------- 0	0 ------------- 0
11XING P YUAN RNFA/ROBOTICS COORD	(i) (ii)	221,857 ------------- 0	750 ------------- 0	712 ------------- 0	134,070 ------------- 0	1,574 ------------- 0	358,963 ------------- 0	0 ------------- 0
12CHRISTINA S GRABUS KE (VP, OPERATIONS)	(i) (ii)	206,451 ------------- 0	58,916 ------------- 0	1,524 ------------- 0	35,107 ------------- 0	30,517 ------------- 0	332,515 ------------- 0	0 ------------- 0
13DORKA M PICARD VP, DIVISION VII	(i) (ii)	177,298 ------------- 0	15,854 ------------- 0	7,490 ------------- 0	112,535 ------------- 0	7,495 ------------- 0	320,672 ------------- 0	0 ------------- 0
14KATHY A COX NURSE CLIN II - FT PERM WKND NIGHTS	(i) (ii)	223,225 ------------- 0	1,125 ------------- 0	4,310 ------------- 0	50,889 ------------- 0	14,067 ------------- 0	293,616 ------------- 0	0 ------------- 0
15CAROL S SHAPIRO MD DIRECTOR	(i) (ii)	0 ------------- 219,086	0 ------------- 5,000	0 ------------- 1,535	0 ------------- 33,537	0 ------------- 1,370	0 ------------- 260,528	0 ------------- 0
16DORIS J WARNER KE (DIR ED)	(i) (ii)	144,800 ------------- 0	9,025 ------------- 0	6,126 ------------- 0	23,080 ------------- 0	13,277 ------------- 0	196,308 ------------- 0	0 ------------- 0
17CORINDA V PIPPINS FORMER OFFICER	(i) (ii)	0 ------------- 128,623	0 ------------- 18,281	0 ------------- 1,412	0 ------------- 31,832	0 ------------- 12,356	0 ------------- 192,504	0 ------------- 0

Schedule J (Form 990) 2019

Page 3

Part III

Supplemental Information

Provide the information, explanation, or descriptions required for Part I, lines 1a, 1b, 3, 4a, 4b, 4c, 5a, 5b, 6a, 6b, 7, and 8, and for Part II. Also complete this part for any additional information.

Return Reference	Explanation
PART I, LINE 3	SENTARA HEALTHCARE, THE 501(C)(3) TAX EXEMPT PARENT OF THE SENTARA HEALTH SYSTEM, ESTABLISHED THE COMPENSATION OF THE ORGANIZATION'S TOP MANAGEMENT OFFICIAL THROUGH THE USE OF AN INDEPENDENT COMPENSATION CONSULTANT AND A COMPENSATION STUDY.
PART I, LINES 4A-B	JEFFREY P. KING RECEIVED $218,939 IN COMPENSATION RELATED TO HIS SEPARATION FROM SERVICE. THIS AMOUNT HAS BEEN INCLUDED IN COLUMN (B)(III) OF SCHEDULE J, PART II. HOWARD KERN PARTICIPATED IN THE SENTARA SUPPLEMENTAL EXECUTIVE RETIREMENT PLAN. PARTICIPATION IN THE PLAN IS LIMITED TO SELECT INDIVIDUALS AS APPROVED BY SENTARA HEALTHCARE'S BOARD OF DIRECTOR'S COMPENSATION COMMITTEE. THE PLAN IS CURRENTLY CLOSED TO ADDITIONAL MEMBERS. VESTING OCCURS UPON THE COMPLETION OF A TWO YEAR NON-COMPETE PERIOD FOLLOWING TERMINATION AFTER EARLY RETIREMENT DATE OR UPON DEATH. EARLY RETIREMENT DATE IS WHEN THE EXECUTIVE OBTAINS AT LEAST AGE 55 AND HAS 10 YEARS OF SERVICE AND BENEFITS ARE FORFEITED IF PARTICIPANT LEAVES PRIOR TO AGE 55 WITH 10 YEARS OF SERVICE. HOWARD KERN, ROBERT BROERMANN, MICHAEL GENTRY, JEFFREY KING, JOANNE INMAN, KATHERINE JOHNSON, AND DOUGLAS MOYER PARTICIPATED IN THE SENTARA CAPITAL ACCUMULATION ACCOUNT PLAN. PARTICIPATION IS LIMITED TO A SELECT GROUP OF CORPORATE EXECUTIVES AS APPROVED BY SENTARA HEALTHCARE'S BOARD OF DIRECTOR'S COMPENSATION COMMITTEE. TERMS OF THE PLAN CHANGED EFFECTIVE JANUARY 1, 2009, WHEREBY VESTING OF CONTRIBUTIONS MADE ON OR AFTER THAT DATE NOW OCCURS ON THE EARLIER OF FIVE YEARS FOR EACH YEARS' CONTRIBUTIONS OR AGE 55 WITH 10 YEARS OF SERVICE. UNDER THE OLD TERMS, VESTING OF CONTRIBUTIONS MADE PRIOR TO JANUARY 1, 2009 OCCURS ON THE EARLIEST OF ASSIGNED DISTRIBUTION DATE, DEATH, INVOLUNTARY TERMINATION WITHOUT CAUSE OR COMPLETION OF TWO-YEAR NON-COMPETE AFTER VOLUNTARY TERMINATION (REGARDLESS OF ORIGINAL ASSIGNED DISTRIBUTION DATE). DURING 2019, THE FOLLOWING CORPORATE EXECUTIVES RECEIVED VESTED DISTRIBUTIONS UNDER THE PLAN: ROBERT BROERMANN ($154,711); MICHAEL GENTRY ($116,632); HOWARD KERN ($721,088); AND JEFFREY KING ($228,358). THESE AMOUNTS HAVE BEEN REPORTED IN COLUMN (B)(III) OF SCHEDULE J, PART II.
PART I, LINE 7	DURING THE CURRENT TAX YEAR, THE ORGANIZATION MADE NON-FIXED PAYMENTS OF COMPENSATION UNDER THE FOLLOWING INCENTIVE PROGRAMS: ANNUAL INCENTIVE PROGRAM - EXECUTIVES AND SENIOR LEADERS ARE ELIGIBLE FOR ANNUAL AWARDS BASED ON SYSTEM AND INDIVIDUAL PERFORMANCE. BOTH SYSTEM AND INDIVIDUAL SCORES ARE DETERMINED AFTER YEAR-END, AT WHICH POINT AWARDS MAY BE PAID AND REPORTED AS COMPENSATION. TARGET AND MAXIMUM OPPORTUNITIES VARY BY LEVEL. KEY CONTRIBUTOR AWARDS - REWARDS EXCEPTIONAL INDIVIDUALS OR TEAMS FOR SIGNIFICANT CONTRIBUTION AND RESULTS AS RECOGNIZED BY BUSINESS UNITS. PERFORMANCE PLUS - ELIGIBLE FULL-TIME AND PART-TIME EMPLOYEES NOT COVERED UNDER ANOTHER INCENTIVE PLAN MAY EARN ADDITIONAL COMPENSATION IF THEIR BUSINESS UNIT MEETS FINANCIAL, SAFETY, QUALITY AND CUSTOMER SERVICE GOALS, AND THE SYSTEM NET OPERATING MARGIN GOAL HAS BEEN MET. INDIVIDUAL PAYOUT IS BASED ON JOB CLASSIFICATION, BUSINESS UNIT GOAL SUCCESS AND PERCENTAGE OF POOL AVAILABLE FOR DISTRIBUTION. GOALS AND THE PERCENTAGE OF POOL AVAILABLE FOR DISTRIBUTION ARE DETERMINED AFTER YEAR-END, AT WHICH POINT AWARDS MAY BE PAID AND REPORTED AS COMPENSATION. MANAGER INCENTIVE PLAN - MANAGEMENT EMPLOYEES NOT COVERED UNDER ANOTHER INCENTIVE PLAN ARE ELIGIBLE FOR THE MANAGEMENT INCENTIVE PLAN. AWARDS ARE BASED ON SYSTEM YEAR-END RESULTS AS DETERMINED BY THE BOARD; BUSINESS UNIT RESULTS FOR FINANCIAL, SAFETY, QUALITY AND CUSTOMER SERVICE; AND THE MANAGER'S INDIVIDUAL PERFORMANCE SCORE. SYSTEM, BUSINESS UNIT, AND INDIVIDUAL RESULTS ARE DETERMINED AFTER YEAR-END, AT WHICH POINT AWARDS MAY BE PAID AND REPORTED AS COMPENSATION.

Schedule J (Form 990) 2019

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE O
(Form 990 or 990-EZ)

Department of the Treasury
Internal Revenue Service

Supplemental Information to Form 990 or 990-EZ

Complete to provide information for responses to specific questions on
Form 990 or 990-EZ or to provide any additional information.
MediumBullet

Attach to Form 990 or 990-EZ.
MediumBullet

Go to www.irs.gov/Form990 for the latest information.

OMB No. 1545-0047

2019

Open to Public
Inspection

Name of the organization

POTOMAC HOSPITAL CORPORATION
OF PRINCE WILLIAM

Employer identification number

54-0853898

Return Reference	Explanation
FORM 990, PART III, LINE 4A, PROGRAM SERVICE ACCOMPLISHMENTS	SENTARA HEALTHCARE I. SENTARA HEALTHCARE - YOUR NOT-FOR-PROFIT HEALTHCARE PARTNER SENTARA HEALTHCARE CELEBRATES MORE THAN 131 YEARS IN PURSUIT OF ITS MISSION - WE IMPROVE HEALTH EVERY DAY. NAMED TO IBM WATSON HEALTH'S 2018 "TOP 15 HEALTH SYSTEMS," SENTARA IS AN INTEGRATED, NOT-FOR-PROFIT SYSTEM OF 12 HOSPITALS IN VIRGINIA AND NORTHEASTERN NORTH CAROLINA, INCLUDING A LEVEL I TRAUMA CENTER, THE NATIONALLY RANKED SENTARA HEART HOSPITAL, TWO ORTHOPEDIC HOSPITALS, ACCREDITED SENTARA CANCER NETWORK AND THE SENTARA NEUROSCIENCES INSTITUTE. THE SENTARA FAMILY ALSO INCLUDES FOUR MEDICAL GROUPS, NIGHTINGALE REGIONAL AIR AMBULANCE AND GROUND MEDICAL TRANSPORT, SENIOR CARE, HOME CARE AND HOSPICE, NURSING REHABILITATION CENTERS, AMBULATORY OUTPATIENT CAMPUSES, ADVANCED IMAGING AND DIAGNOSTIC CENTERS, A CLINICALLY INTEGRATED NETWORK, THE SENTARA COLLEGE OF HEALTH SCIENCES AND THE OPTIMA HEALTH PLAN SERVING 450,000 MEMBERS IN VIRGINIA, NORTH CAROLINA AND OHIO. WITH NEARLY 28,000 EMPLOYEES AND RANKED ONE OF FORBES "AMERICA'S BEST EMPLOYERS" IN 2018, SENTARA IS STRATEGICALLY FOCUSED ON CLINICAL QUALITY AND SAFETY, INNOVATION AND CREATING AN EXTRAORDINARY HEALTHCARE EXPERIENCE FOR OUR PATIENTS AND MEMBERS. EFFORTS ARE CENTERED ON PROVIDING THE RIGHT CARE IN THE RIGHT SETTING AT THE RIGHT TIME AND ADDING VALUE TO THE COMMUNITIES WE SERVE. WE STRIVE TO SERVE ALL OF OUR COMMUNITIES THROUGH HEALTH OUTREACH PROGRAMS, EDUCATION, AND FINANCIAL SUPPORT OF OTHER NOT FOR PROFIT ORGANIZATIONS WITH SIMILAR HEALTH MISSIONS. II. COMMITMENT TO THE COMMUNITY A. SENTARA HAS PROVIDED MUCH IN THE WAY OF COMMUNITY BENEFIT AND CHARITY CARE ON AN ANNUAL BASIS. THE 2019 VALUE OF COMMUNITY BENEFIT TOTALED $309.5M. SENTARA PROVIDED $239,251,000 IN NET UNCOMPENSATED PATIENT CARE COSTS; $45,011,000 IN NET UNFUNDED COSTS OF TEACHING PROGRAMS; AND $25,261,000 IN INCURRED COSTS FOR COMMUNITY BENEFIT PROGRAMS. IN 2019, AN AVERAGE OF 34 INDIVIDUALS SOUGHT CARE AT SENTARA HOSPITALS WHO HAVE NO ABILITY TO PAY FOR CARE. THESE SERVICES RANGE FROM EMERGENCY VISITS TO LIFE SAVING TRAUMA CARE. B. SENTARA DEVELOPED A CORPORATE SOCIAL RESPONSIBILITY (CSR) PROGRAM TO SUPPORT THE NEEDS OF THE COMMUNITIES WE SERVE IN THE MOST IMPACTFUL WAY. SENTARA COMMITTED $5M IN 2019. THE CSR PROGRAM WILL DELIVER ECONOMIC, SOCIAL AND ENVIRONMENTAL BENEFITS FOR STAKEHOLDERS ACROSS ALL SENTARA MARKETS AND INCREASE OUR COMMUNITY CONNECTION. IT WILL BUILD ON SENTARA RECOGNIZED LEADERSHIP AND COMMITMENT TO THE COMMUNITIES WE SERVE. C. SENTARA HEALTHCARE AND OPTIMA HEALTH, IN PARTNERSHIP WITH THE LOCAL INITIATIVES SUPPORT CORPORATION (LISC), THE NATION'S LARGEST COMMUNITY DEVELOPMENT ORGANIZATION, ANNOUNCED A $100 MILLION INVESTMENT TO ADDRESS SOCIAL DETERMINANTS OF HEALTH IN UNDERSERVED COMMUNITIES ACROSS THE COMMONWEALTH OF VIRGINIA. THIS INVESTMENT, WHICH IS PART OF OUR CORPORATE SOCIAL RESPONSIBILITY PROGRAM, BUILDS UPON SENTARA'S COMMITMENT TO CREATE HEALTHIER COMMUNITIES AND IMPROVE THE QUALITY OF LIFE FOR VIRGINIANS MOST IN NEED. SENTARA WILL CONTRIBUTE $50M TO ADVANCE THESE GOALS IN PARTNERSHIP WITH LISC, WHO HAS COMMITTED TO ASSEMBLING AN ADDITIONAL $50M FROM PUBLIC AND PRIVATE SOURCES TO COMPLEMENT SENTARA'S INVESTMENT. D. SENTARA HIRED ITS FIRST CHIEF DIVERSITY OFFICER TO FOCUS ON THE IMPORTANT WORK OF DIVERSITY IN OUR WORKFORCE, TO DEEPEN OUR UNDERSTANDING ON CARING FOR OUR DIVERSE PATIENT POPULATION AND TO DEVELOP STRONG RELATIONSHIPS WITH DIVERSE COMMUNITY POPULATIONS. ADDITIONALLY, WE HIRED OUR FIRST DIRECTOR OF HEALTH EQUITY. THE HEALTH EQUITY DIVISION WAS CREATED WITH THE GOAL TO IDENTIFY AND REMOVE BARRIERS SO PEOPLE CAN RECEIVE THE CARE THEY NEED. THE TEAM IDENTIFIES HEALTH DISPARITIES AND RESEARCHES POSSIBLE CAUSES. THIS INCLUDES CHRONIC HEALTH ISSUES SUCH AS HYPERTENSION, DIABETES, AND THE HIGH RATES OF CANCER DEATHS IN MINORITY COMMUNITIES. E. IN RESPONSE TO THE TRAGEDY THAT TOOK PLACE AT THE VIRGINIA BEACH MUNICIPAL CENTER IN MAY 2019, SENTARA COLLABORATED WITH THE CITY OF VIRGINIA BEACH TO OPEN THE VB STRONG CENTER THAT PROVIDES RESOURCES AND DEDICATED STAFF TO ENSURE THOSE IN THE COMMUNITY WHO NEED OR WANT ASSISTANCE FOLLOWING THE TRAGEDY CAN RECEIVE PERSONALIZED CARE. SERVICES INCLUDE INDIVIDUAL COUNSELING, GROUP THERAPY, ART, YOGA, MEDITATION, MENTAL HEALTH COUNSELING, INTAKE AND CASE COORDINATION, AND OTHER SERVICES AS DIRECTED BY A LICENSED MENTAL HEALTH CLINICIAN. F. SENTARA IS PROUD OF THE MISSION-DRIVEN WORK OF THE THREE SENTARA FOUNDATIONS. THESE FOUNDATIONS RAISED MONEY TO SUPPORT THE CLINICAL NEEDS OF THE SYSTEM AND PROVIDED FUNDING THROUGH GRANTS AND DIRECT CONTRIBUTIONS TO COMMUNITY ORGANIZATIONS THAT HAVE SIMILAR INTERESTS IN SUPPORTING COMMUNITY HEALTH NEEDS. G. SEVERAL YEARS AGO, SENTARA ESTABLISHED THE HOPE (HELPING OVERCOME PERSONAL EMERGENCY) FUND, WHICH IS AN EMERGENCY FINANCIAL RESOURCE FOR SENTARA EMPLOYEES THAT ARE EXPERIENCING CATASTROPHIC HARDSHIP OR LOSS THROUGH NO FAULT OF THEIR OWN. SENTARA EMPLOYEES WHO RECEIVE AID FROM THE HOPE FUND HAVE FACED DEVASTATING CRISES SUCH AS FIRE, DEATH, NATURAL DISASTERS, OR SERIOUS PERSONAL OR FAMILY ILLNESS. IN 2019, THE HOPE FUND AWARDED $151,124 TO SENTARA EMPLOYEES IN CRISES ACROSS THE SYSTEM.
FORM 990, PART III, LINE 4A, PROGRAM SERVICE ACCOMPLISHMENTS, CONT.	H. COMMUNITY HEALTH INITIATIVES SENTARA AND OPTIMA HEALTH HAVE LONG BEEN COMMITTED TO PROVIDING HEALTH AND PREVENTION SERVICES TO THE COMMUNITIES WE SERVE THROUGH MANY CHANNELS INCLUDING THE SENTARA HEALTHCARE COMMUNITY HEALTH AND PREVENTION ORGANIZATION WITHIN SENTARA. BELOW ARE SOME KEY HIGHLIGHTS OF THE EFFORTS IN OUR COMMUNITIES IN 2019: I. HEALTH IMPROVEMENT EVENTS WERE OFFERED TO CHURCHES, EMPLOYER GROUPS, COMMUNITY HEALTH CENTERS AND OTHER COMMUNITY LOCATIONS. II. SENTARA CONTINUED TO OFFER PROGRAMS SUCH AS EATING FOR LIFE, WALKABOUT WITH HEALTHY EDGE, HEALTH HABITS, HEALTHY YOU, MEDITATION, TAI CHI AND YOGA. SENTARA HOSTS A NUMBER OF COMMUNITY EVENTS RAISING AWARENESS AROUND KEY HEALTH AWARENESS MONTHS. ONE GOOD EXAMPLE IS THE FOCUS ON COLON CANCER PREVENTION: DON'T SIT ON COLON CANCER. THROUGH THE SENTARA CANCER NETWORK, SENTARA HOSTED A 5K AT SENTARA PRINCESS ANNE HOSPITAL IN VIRGINIA BEACH. THROUGH SENTARA HEART, WE PROMOTED THE "28 (+1) DAYS OF HEART" IN FEBRUARY 2019 IN SUPPORT OF HEART HEALTH AWARENESS. ONLINE PROMOTIONS, RADIO ADS, VIDEOS, SCREENINGS AND MORE WERE CONDUCTED TO RAISE AWARENESS OF HEART DISEASE THROUGHOUT THE COMMUNITIES WE SERVE IN VIRGINIA AND NORTH CAROLINA. III. GROWTH IN SENTARA HEALTHCARE SENTARA HAS REACHED OUT TO OTHER INDUSTRY LEADERS AND JOINED FORCES TO EXTEND QUALITY HEALTHCARE AND SERVICES TO MORE PEOPLE. IN RECENT YEARS, WE HAVE GROWN IN VIRGINIA AND IN OTHER STATES - NORTH CAROLINA AND OHIO - BY SEEKING PARTNERSHIPS WITH SUCCESSFUL HOSPITALS AND HEALTH SYSTEMS THAT SHARE OUR DEDICATION TO EXCELLENCE, VALUE, QUALITY AND CUSTOMER FOCUS. OUR GROWTH IN 2019 INCLUDED THE FOLLOWING: A. SENTARA ANNOUNCED THE INTENT TO PURCHASE 80% OF VIRGINIA PREMIER, AN INSURANCE COMPANY AFFILIATED WITH VCU HEALTH IN RICHMOND, VIRGINIA. OPTIMA HEALTH AND VIRGINIA PREMIER WILL CONTINUE AS TWO SEPARATE COMPANIES AND RETAIN THEIR RESPECTIVE NAMES AND BRANDS IN THE MARKETPLACE. THE TWO PLANS WILL SERVE MORE THAN 800,000 MEMBERS. B. OPTIMA HEALTH CONTINUED AS ONE OF 6 MANAGED CARE ORGANIZATIONS THAT COLLECTIVELY SERVED OVER 400,000 ELIGIBLE VIRGINIANS WHO QUALIFIED FOR MEDICAID EXPANSION. C. SENTARA DEVELOPED NEWLY DESIGNED RETAIL AND AMBULATORY SERVICES. SENTARA WAS PROUD TO INTRODUCE TWO SITES OF CARE WHERE PRIMARY CARE AND PHYSICAL THERAPY ARE CO-LOCATED WITH A SEAMLESS CUSTOMER EXPERIENCE. ADDITIONALLY, SENTARA INTRODUCED PHYSICAL THERAPY WITH VIRTUAL CARE AT ONE SITE IN NORTH CAROLINA. D. SENTARA EXPANDED ITS VELOCITY URGENT CARE CENTERS ACROSS VIRGINIA. ACROSS SITES, 193,372 PATIENT VISITS TOOK PLACE REPRESENTING A 22% GROWTH OVER 2018. IV. NEW INITIATIVES A. SENTARA LAUNCHED THE NEW SENTARA "APP" IN SEPTEMBER 2019 FOLLOWING THE INTRODUCTION OF THE NEW OPTIMA APP IN LATE 2018. BY END OF 2019, MORE THAN 47,000 CONSUMERS HAD ACTIVATED THEIR ACCOUNTS IN EITHER THE SENTARA OR OPTIMA APP. OUR AIM IS TO CONTINUOUSLY IMPROVE THE VIRTUAL EXPERIENCE, ENABLE VOICE OF THE CUSTOMER DRIVE CHANGE TO THE EXPERIENCE, AND ALLOW FOR A MORE FRICTIONLESS EXPERIENCE. B. THE VOICE OF THE CUSTOMER MODEL WAS HEAVILY UTILIZED TO UNDERSTAND MORE FROM SENTARA AND OPTIMA CUSTOMERS. THE MODEL IS AN OPERATIONAL DESIGN THAT ENABLES SENTARA TO INTEGRATE THE VOICE OF THE CUSTOMER INTO ALL FACETS OF BUSINESS DECISION-MAKING AND PRODUCT DEVELOPMENT BOTH IN THE BRICK AND MORTAR WORLD AND IN THE WORLD OF VIRTUAL CARE. C. A NUTRITION AS MEDICINE CONFERENCE WAS HELD IN NOVEMBER 2019. THIS DAY-LONG CONFERENCE FEATURED NATIONAL EXPERTS SPEAKING ON THE BENEFITS OF A PLANT-BASED LIFESTYLE AND HOW IT CAN BE USED TO TREAT, REVERSE, OR PREVENT WIDESPREAD CHRONIC DISEASE SUCH AS HEART DISEASE, DIABETES, AND OBESITY. D. A "BEYOND CANCER" CONFERENCE SURVIVORSHIP EVENT TOOK PLACE IN JUNE 2019. THE EVENT WAS SPONSORED BY THE SENTARA CANCER NETWORK AND OFFERED SUPPORT FOR THOSE AFFECTED BY CANCER FROM CURRENT CANCER PATIENTS TO CAREGIVERS, TO SURVIVORS IN REMISSION. V. OFFERING NEW PROCEDURES AND TECHNOLOGIES A. CLINICAL BREAKTHROUGHS AND ADVANCEMENTS: SENTARA INTRODUCED MANY NEW CLINICAL BREAKTHROUGHS AND ADVANCEMENTS THAT BENEFITED THE PATIENT IN MANY AREAS OF CARE, INCLUDING NEWBORN CARE, TRANSPLANT, AND CANCER CARE. I. NEWBORN METABOLIC SCREENING AUTOMATION - SENTARA NORFOLK GENERAL HOSPITAL IN NORFOLK, VIRGINIA WAS THE FIRST HOSPITAL IN VIRGINIA TO INTRODUCE THE PROCESS THAT IDENTIFIES APPARENTLY HEALTHY INFANTS WITH SERIOUS INHERITED DISORDERS, GENERALLY METABOLIC IN ORIGIN, THAT ARE USUALLY CORRECTABLE BY DIETARY OR DRUG INTERVENTIONS BEFORE THEY SUFFER SIGNIFICANT MORBIDITY OR MORTALITY. II. HEPATITIS C TRANSPLANT: SENTARA NORFOLK GENERAL HOSPITAL PERFORMED THE FIRST KIDNEY TRANSPLANT FROM A DONOR WITH HEPATITIS C IN THE SOUTHEAST VIRGINIA REGION. THIS CREATES ORGAN AVAILABILITY THAT IS MUCH NEEDED. III. LUTATHERA NEUROENDOCRINE RADIOISOTOPE TUMOR THERAPY: SENTARA NORFOLK GENERAL HOSPITAL WAS THE FIRST IN SOUTHEASTERN VIRGINIA TO INTRODUCE THIS THERAPY. IV. CAR-T CELL THERAPY: SENTARA NORFOLK GENERAL HOSPITAL WAS APPROVED TO PERFORM CAR-T CELL THERAPY, WHICH IS UNIQUE IN THAT IT IS THE FIRST NON-ACADEMIC SITE IN VIRGINIA TO PERFORM THIS THERAPY AND ONE OF A HANDFUL ACROSS THE COUNTRY DONE AT A NON-ACADEMIC CENTER. VI. EXPANDING EDUCATIONAL OPPORTUNITIES A. SENTARA IS COMMITTED TO ALWAYS IMPROVING--INCLUDING ENCOURAGING REGISTERED NURSES (RNS) TO CONTINUE PURSUING EDUCATIONAL OPPORTUNITIES. CONTINUOUS LEARNING WILL ADVANCE THE CARE SENTARA NURSES DELIVER TO OUR PATIENTS AND ALLOW THEM TO ADVANCE IN THEIR CAREERS. IN 2019, SENTARA REACHED 82% OF SENTARA NURSES HAVING EARNED OR ARE UNDER CONTRACT TO EARN A BSN BY 2020. IN 2019, SENTARA HAD 66.7% OF ITS NURSING WORKFORCE HOLDING A BSN OR HIGHER DEGREE WITH 15.3% OF LICENSED RNS WITH A CONTRACT TO COMPLETE THEIR BSN.
FORM 990, PART III, LINE 4A, PROGRAM SERVICE ACCOMPLISHMENTS, CONT.	B. RESEARCH: RESEARCH IS ANOTHER WAY SENTARA IS ALWAYS IMPROVING. HERE ARE A FEW EXAMPLES OF OUR WORK WITHIN THE RESEARCH REALM: I. HEART: THE SENTARA CARDIOVASCULAR RESEARCH INSTITUTE WAS ESTABLISHED IN 2005 TO ADVANCE THE UNDERSTANDING AND TREATMENT OF CARDIOVASCULAR DISEASE, WHICH IS THE NATION'S NUMBER-ONE KILLER. UNIQUELY QUALIFIED REGISTERED NURSE RESEARCH COORDINATORS AND CARDIOLOGISTS COLLABORATE WITH LOCAL INSTITUTIONS, GOVERNMENT AGENCIES AND BIOMEDICAL COMPANIES TO PERFORM CLINICAL RESEARCH TRIALS. ULTIMATELY, THE WORK OF SCRI ENABLES CLINICIANS TO IMPROVE CLINICAL CARE DELIVERY, PATIENT OUTCOMES AND THE OVERALL HEALTH OF OUR COMMUNITY. OUR SERVICES COVER ALL TYPES OF CARDIOVASCULAR RESEARCH SUCH AS MEDICAL DEVICES, HEART FAILURE, ELECTROPHYSIOLOGY, CARDIAC SURGERY, CARDIAC INTERVENTIONAL PROCEDURES AND MEDICAL MANAGEMENT OF CAD RISK FACTORS SUCH AS DIABETES AND LIPID MANAGEMENT, AMONG OTHERS. RESEARCH NURSES EDUCATE AND FOLLOW RESEARCH PARTICIPANTS THROUGH THE ENTIRE TRIAL PROCESS. THEY COORDINATE ALL ASPECTS OF THE PATIENT'S EXPERIENCE AND ADVOCATE FOR THEM, HELPING THEM FEEL CARED FOR WHILE AT THEIR MOST VULNERABLE. OUR PROGRAM CURRENTLY HAS RESEARCH NURSES WHO ARE HIGHLY AUTONOMOUS AND SELF-DIRECTED. COLLECTIVELY, THEY COORDINATE MORE THAN 80 CLINICAL TRIALS. MANY OF THE TRIALS WE PARTICIPATE IN ARE NATIONALLY AND INTERNATIONALLY RECOGNIZED. THEY HAVE BEEN DESIGNED TO IDENTIFY NEW, IMPROVED TREATMENT METHODS AND PROTOCOLS, WHILE AT THE SAME TIME ELIMINATE THERAPIES AND APPROACHES TO CLINICAL CARE THAT ARE NOT AS EFFECTIVE OR MAY HAVE BEEN SHOWN TO BE HARMFUL. II. CANCER: THE SENTARA CANCER NETWORK CONTINUES TO EXPAND ITS RESEARCH CAPABILITIES IN CONJUNCTION WITH VIRGINIA ONCOLOGY ASSOCIATES, EASTERN VIRGINIA MEDICAL SCHOOL, AND OTHER NATIONAL AND LOCAL ORGANIZATIONS IN ORDER TO CHANGE THE FUTURE OF CANCER. FOR TODAY'S PATIENTS, PHYSICIANS IN THE SENTARA NETWORK CAN PROVIDE ACCESS TO NUMEROUS CLINICAL TRIALS, BOTH LOCAL AND NATIONAL. PROMISING CLINICAL TRIALS ARE BEING CONDUCTED ALL OVER THE COUNTRY FOR PATIENTS WITH CANCER, AND SOME OF THESE ARE BEING CONDUCTED WITHIN THE SENTARA CANCER NETWORK. SOME PEOPLE THINK THAT CLINICAL RESEARCH IS INTENDED AS A LAST RESORT, BUT MANY OF THESE TRIALS ARE LOOKING AT PROMISING NEW FIRST-LINE TREATMENTS. IN ADDITION, MANY STUDIES ARE NOT FOCUSED ON INCREASED TREATMENTS, BUT ADJUSTMENTS IN TREATMENTS AND OPTIONS FOR LESS INVASIVE OPTIONS. IN ADDITION TO CLINICAL TRIALS THAT ARE ADMINISTERED AS PART OF CANCER TREATMENT FOR PATIENTS NOW, THE SENTARA CANCER NETWORK ALSO PARTICIPATES IN RESEARCH THAT COULD LEAD TO MORE AND BETTER OPTIONS FOR PREVENTION, DIAGNOSIS AND TREATMENT IN THE FUTURE. EXAMPLES OF OTHER RESEARCH INCLUDE FINDING WAYS TO IMPROVE QUALITY OF LIFE FOR OUR PATIENTS, COMPARING COMMON CHARACTERISTICS FOR A SPECIFIC TYPE OF CANCER, AND IMPROVING PROCESSES AND TECHNOLOGY. VII. BUILDING FOR TOMORROW AND STRENGTHENING OUR COMMUNITIES A. SENTARA HEALTHCARE COMMITTED TO INCREASING ITS MINIMUM WAGE FOR ALL SENTARA AND OPTIMA HEALTH EMPLOYEES WITH A PLAN TO REACH A $15 PER HOUR MINIMUM WAGE BY JANUARY 2022. THIS SIGNIFICANT INCREASE APPLIES TO ALL POSITIONS IN THE COMMUNITIES SENTARA SERVES ACROSS VIRGINIA AND NORTH CAROLINA AND IS MORE THAN DOUBLE THE FEDERALLY MANDATED MINIMUM WAGE OF $7.25 PER HOUR. B. SENTARA CAREPLEX HOSPITAL, HAMPTON, VIRGINIA, ADDED NEUROSURGERY SERVICES. WITH THE ADDITION OF THESE SERVICES, PATIENTS ON THE PENINSULA WILL BE ABLE TO RECEIVE SURGICAL TREATMENT FOR BRAIN AND SPINE DISORDERS, INCLUDING NEUROONCOLOGY AND NEUROTRAUMA. C. SENTARA MARTHA JEFFERSON HOSPITAL'S PHILIPS CANCER CENTER, CHARLOTTESVILLE, VIRGINIA, WAS GRANTED A THREE YEAR ACCREDITATION WITH COMMENDATION BY THE COMMISSION ON CANCER (COC), A QUALITY PROGRAM OF THE AMERICAN COLLEGE OF SURGEONS (ACS). ALSO, SENTARA MARTHA JEFFERSON HAS RECEIVED AN 'A' IN THE FALL 2019 LEAPFROG HOSPITAL SAFETY GRADE, A NATIONAL RECOGNITION FOR PATIENT SAFETY. D. THE SENTARA RMH HAHN CANCER CENTER, HARRISONBURG, VIRGINIA, INSTALLED A NEW, STATE-OF-THE-ART LINEAR ACCELERATOR, THE VARIAN TRUEBEAM RADIOTHERAPY SYSTEM, FOR TREATING CANCER PATIENTS. E. SENTARA HOSPICE HAS COORDINATED CAMP LIGHTHOUSE, WHICH IS A CAMP FOR BEREAVED FAMILIES, FOR 10 YEARS. THROUGHOUT THE CAMP, SPECIALLY TRAINED SENTARA EMPLOYEES VOLUNTEER ALONG WITH COMMUNITY MEMBERS. ABOUT 50 VOLUNTEERS MAKE THE CAMPS POSSIBLE AFTER MONTHS OF PLANNING. F. SENTARA NORTHERN VIRGINIA MEDICAL CENTER, WOODBRIDGE, VIRGINIA, INTRODUCED A SENTARA FOOT & ANKLE CENTER FEATURING HIGHLY SKILLED PHYSICIANS WITH STATE-OF-THE-ART PROCEDURES. THE CENTER PARTNERS WITH EXPERT PHYSICIANS ON ADVANCED PROCEDURES SO PATIENTS WILL HAVE A PATHWAY TO RECEIVE THE RIGHT CARE FOR THEIR FOOT AND ANKLE HEALTH CONCERNS, ALL WHILE STAYING CLOSE TO HOME FOR TREATMENT. G. THREE TIMES PER WEEK, SENTARA LIFE CARE RESIDENTS WITH DEMENTIA PUT THEIR HANDS ON A BUSY BOARD AND OPERATE THE LIGHT SWITCHES, DOOR AND WINDOW LATCHES AND WATER SPIGOTS TO STIMULATE MEMORIES OF DAY-TO-DAY ACTIVITIES. BUSY BOARD THERAPY IS ONE PART OF THE LIFE ENRICHMENT ACTIVITIES PROGRAM (LEAP) AT SENTARA LIFE CARE VIRGINIA BEACH. H. FIVE SENTARA HOSPITALS INCLUDING SENTARA CAREPLEX HOSPITAL, SENTARA LEIGH HOSPITAL, SENTARA OBICI HOSPITAL, SENTARA PRINCESS ANNE HOSPITAL AND SENTARA WILLIAMSBURG REGIONAL MEDICAL CENTER HAVE CONSISTENTLY EARNED AN 'A' GRADE IN HOSPITAL SAFETY SCORES FROM THE LEAPFROG GROUP SINCE THE ORGANIZATION BEGAN HANDING OUT THE LETTER GRADES IN 2012. I. MORE THAN 100 EMPLOYEES AT SENTARA LEIGH HOSPITAL, NORFOLK, VIRGINIA, SPENT THEIR TIME STUFFING BACKPACKS FULL OF BRAND NEW SCHOOL SUPPLIES FOR INGLESIDE ELEMENTARY. IN JUST THREE SHORT HOURS, 600 BACKPACKS WERE FILLED WITH CRAYONS, PENCILS, FOLDERS, NOTEBOOKS, A FIRST AID KIT AND MUCH MORE. THERE WERE ENOUGH STUFFED FOR EVERY STUDENT IN THE ENTIRE SCHOOL! HOSPITAL STAFF TEAMED UP WITH UNITED WAY OF SOUTH HAMPTON ROADS TO FULFILL THIS DONATION REQUEST. J. SENTARA ALBEMARLE MEDICAL CENTER, ELIZABETH CITY, NORTH CAROLINA, LAUNCHED A PILOT PROGRAM IN EARLY 2019 CALL FOOD RX. NOW, PATIENTS CAN RECEIVE PRESCRIPTIONS FOR MEDICINE TO HELP THEM ONCE THEY LEAVE THE HOSPITAL, AND A PRESCRIPTION TO EAT WELL, WITH THE HEALTHY FOOD TO DO SO. THEIR GOAL IS HELP 100 PATIENTS THIS YEAR. IN ADDITION TO OFFERING THE SPECIALLY STOCKED FOOD BOXES TO PATIENTS MONTHLY, SENTARA ALBEMARLE MEDICAL CENTER EDUCATORS MAKE REFERRALS TO HEALTHY COOKING AND BUDGETING CLASSES RUN THROUGH THE FOOD BANK AND PASQUOTANK CENTER OF NORTH CAROLINA COOPERATIVE EXTENSION. THEY ALSO ENCOURAGE VISITS TO THE LOCAL HEALTH DEPARTMENT, WHICH CAN OFFER EXTRA RESOURCES TO OVERCOME FOOD AND FINANCIAL CONCERNS. K. SENTARA BELLEHARBOUR, AN OUTPATIENT CAMPUS OF SENTARA OBICI HOSPITAL, SUFFOLK, VIRGINIA, CONTINUES TO GROW. A NEWLY OPENED SECOND MEDICAL OFFICE BUILDING OFFERS OUTPATIENT SURGERIES IN TWO OPERATING ROOMS, NEW OBSERVATION BEDS FOR OVERNIGHT RECOVERY AND EVALUATION, A LARGER 24-HOUR EMERGENCY DEPARTMENT WITH A 'VERTICAL' ELEMENT FOR IN-AND-OUT PATIENTS AND A NEW HELIPAD FOR THE NIGHTINGALE REGIONAL AIR AMBULANCE.
FORM 990, PART III, LINE 4A, PROGRAM SERVICE ACCOMPLISHMENTS, CONT.	L. SENTARA PRINCESS ANNE HOSPITAL AGAIN HOSTED THE "DON'T SIT ON COLON CANCER 5K" TO PROVIDE COLON CANCER AWARENESS AND EDUCATION. RUNNERS THROUGHOUT THE REGION COME OUT TO PARTICIPATE IN THIS RACE AND FOR THE EXCELLENT CAUSE. M. SENTARA HALIFAX REGIONAL HOSPITAL, SOUTH BOSTON, VIRGINIA, BEGAN OFFERING MEDICAL STABILIZATION SERVICES TO HELP PEOPLE OVERCOME WITHDRAWAL SYMPTOMS FROM DRUG AND ALCOHOL ADDICTIONS. ADULTS ARE MEDICALLY SUPERVISED FOR INPATIENT STABILIZATION THAT LASTS ABOUT THREE DAYS. UPON DISCHARGE, PATIENTS ARE REFERRED TO COMMUNITY BASED TREATMENT PROGRAMS TO CONTINUE WITH THEIR TREATMENT AND TO PREVENT RELAPSE. N. SENTARA WILLIAMSBURG REGIONAL MEDICAL CENTER, WILLIAMSBURG, VIRGINIA, PARTICIPATED IN THE HEARTSAFE ALLIANCE, WHICH IS A PUBLIC-PRIVATE PARTNERSHIP WORKING TO IMPROVE SUDDEN CARDIAC ARREST SURVIVAL IN THE GREATER WILLIAMSBURG COMMUNITY. THE LAUNCH OF THE PROGRAM INCLUDED FREE, COMMUNITY-WIDE CPR AND AED TRAINING. MOREOVER, LATER IN 2019, THE HEARTSAFE ALLIANCE OFFICIALLY LAUNCHED THE PULSEPOINT APP, WHICH IS AN APP DESIGNED TO REDUCE THE NUMBER OF DEATHS FROM SUDDEN CARDIAC ARREST BY IDENTIFYING AED LOCATIONS IN THE COMMUNITY FOR USE BY THE PUBLIC. VIII. QUALITY AND PATIENT SAFETY DISTINCTIONS A. AWARD-WINNING CARE-AS ALWAYS, SENTARA IS PROUD AND HUMBLED BY THE VARIOUS AWARDS AND RECOGNITIONS THE SYSTEM RECEIVED OVER THE COURSE OF THE YEAR. OUR MISSION IS TO IMPROVE HEALTH EVERY DAY. TO RECEIVE AN AWARD IS SIMPLY AN ADDED ACKNOWLEDGEMENT OF OUR MISSION DRIVEN WORK. HERE ARE A FEW OF THE 2019 AWARDS AND RECOGNITIONS: I. SENTARA NORFOLK GENERAL HOSPITAL EARNED A TOP 50 NATIONAL RANKING FROM U.S. NEWS & WORLD REPORT: EAR, NOSE & THROAT (ENT). THIS EXTRAORDINARY RANKING, 43RD IN THE NATION, IS DUE TO THE GREAT PARTNERSHIP AND COLLABORATION WITH EASTERN VIRGINIA MEDICAL SCHOOL (EVMS) AND THE SENTARA CANCER NETWORK. II. NURSING MAGNET STATUS: SENTARA VIRGINIA BEACH GENERAL HOSPITAL IS THE NINTH SENTARA HOSPITAL TO ACHIEVE MAGNET DESIGNATION. ONLY 8% OF U.S. HOSPITALS HAVE SUCH A DESIGNATION. IX. OPTIMA HEALTH A. GROWTH OPTIMA HEALTH CONTINUES TO SEE GROWTH IN THE COMMERCIAL EMPLOYER MARKET AND WITH OUR FRANCHISE PARTNERSHIP WITH OHIO HEALTHY. ADDITIONALLY, OPTIMA HEALTH CONTINUED DELIVERING AN EXCELLENT DIGITAL EXPERIENCE THROUGH UPGRADING ITS DIGITAL "APP AND ADDING FEATURES MAKING IT MORE CUSTOMER CENTRIC. OPTIMA CONTINUED ITS MEDICARE ADVANTAGE NETWORK EXPANSION BY ADDING NEW PROVIDERS AND FACILITIES. AND, OPTIMA HEALTH IS NOW AVAILABLE IN THE MARKETS OF NORTHERN VIRGINIA AND HALIFAX WITH BOTH MEDICARE ADVANTAGE AND MEDICAID PLANS. CONCLUSION: SENTARA HEALTHCARE IS COMMITTED TO OUR MISSION - WE IMPROVE HEALTH EVERY DAY. WE PROVIDE QUALITY CARE THROUGH EXPERT PROVIDERS, USING CUTTING-EDGE TECHNOLOGY, DEPLOYING MEDICAL BREAKTHROUGHS, AND PROVIDING EXCELLENT CUSTOMER SERVICE ALL WITH A CONSTANT FOCUS ON INNOVATION. AND, WE ARE COMMITTED TO SUPPORTING THE COMMUNITIES WE SERVE THROUGH OUR CORPORATE SOCIAL RESPONSIBILITY PROGRAM, SERVING DIVERSITY AND EXPLORING HEALTH EQUITIES, VOLUNTEERISM, GRANTS, SPONSORSHIPS, AND SUPPORTING INITIATIVES THAT LIFT OUR COMMUNITIES. WE LOOK FORWARD TO ANOTHER YEAR OF COMMUNITY SUCCESS, GROWTH AND INNOVATION IN 2020.
FORM 990, PART V, LINE 1A	NUMBER REPORTED IN BOX 3 OF FORM 1096: SENTARA HEALTHCARE, A VIRGINIA NONSTOCK CORPORATION AND THE 501(C)(3) TAX EXEMPT PARENT OF THE SENTARA HEALTH SYSTEM, MAINTAINS AN AGENCY RELATIONSHIP WITH THE ORGANIZATION AND ISSUES ALL 1099S ON ITS BEHALF. THE NUMBER REPORTED IS A BEST ESTIMATE OF THE 1099S ATTRIBUTABLE TO THE ORGANIZATION. THE EXACT NUMBER CANNOT BE DETERMINED; AS SOME OF THE 1099S ISSUED BY THE AGENT ARE ATTRIBUTABLE TO MORE THAN ONE ENTITY, AND THERE IS NO REPORTING MECHANISM TO DETERMINE 1099'S ATTRIBUTABLE SOLELY TO THE ORGANIZATION.
FORM 990, PART VI, SECTION A, LINE 2	PETER DOLAN, ESQ. AND MICHAEL LUBELEY, ESQ. HAVE A BUSINESS RELATIONSHIP. THE ORGANIZATION'S OFFICERS AND DIRECTORS SERVED TOGETHER ON THE BOARDS OF OTHER ORGANIZATIONS WITHIN THE SENTARA HEALTHCARE SYSTEM ("THE SYSTEM"), AS WELL AS JOINT VENTURES IN WHICH THE SYSTEM HAD AN OWNERSHIP INTEREST. SEE SCHEDULE R FOR A LISTING OF SUCH ENTITIES.
FORM 990, PART VI, SECTION A, LINE 6	THE ORGANIZATION'S SOLE MEMBER WAS SENTARA HEALTHCARE, A VIRGINIA NONSTOCK CORPORATION AND SECTION 501(C)(3) TAX EXEMPT ENTITY.
FORM 990, PART VI, SECTION A, LINE 7A	A BOARD OF DIRECTORS WHICH SERVED AS THE ORGANIZATION'S GOVERNING BODY WAS COMPOSED OF TWO CLASSES OF DIRECTORS, A CLASS OF DIRECTORS APPOINTED BY THE ORGANIZATION'S SOLE MEMBER, SENTARA HEALTHCARE, A VIRGINIA NON-STOCK CORPORATION AND THE SECTION 501(C)(3) TAX EXEMPT PARENT OF THE SENTARA HEALTH SYSTEM AND A CLASS OF DIRECTORS APPOINTED BY POTOMAC HEALTH FOUNDATION, A VIRGINIA NON-STOCK CORPORATION AND SECTIN 501(C)(3) TAX EXEMPT ENTITY, AND APPROVED BY SENTARA HEALTHCARE. THE COVENANT PERIOD (AS DEFINED IN AN AFFILIATION AGREEMENT TO WHICH ORGANIZATION IS A PARTY) EXPIRED ON DECEMBER 1, 2019.
FORM 990, PART VI, SECTION A, LINE 7B	THE ORGANIZATION'S SOLE MEMBER, SENTARA HEALTHCARE, A VIRGINIA NONSTOCK CORPORATION AND SECTION 501(C)(3) TAX EXEMPT ENTITY OF THE ORGANIZATION, HAS EXCLUSIVE AUTHORITY TO DIRECT AND MANAGED THE OPERATIONS AND AFFAIRS OF THE ORGANIZATION AND TO MAKE ALL DECISIONS REGARDING THE BUSINESS OF THE ORGANIZATION, SUBJECT TO THE OVERSIGHT OF THE ORGANIZATION'S BOARD OF DIRECTORS. THE ORGANIZATION MAY NOT TAKE OR ALLOW ANY CERTAIN ACTIONS WITHOUT THE WRITTEN CONSENT OF THE ITS SOLE MEMBER, INCLUDING: ESTABLISH ANY COMMITTEE OR APPOINT ANY MEMBER TO SUCH COMMITTEE WHICH SHALL HAVE ANY OF THE AUTHORITY OF THE BOARD OF DIRECTORS TO BIND THE ORGANIZATION; ALTER, AMEND OR REPEAL OF THE GOVERNING DOCUMENTS OF THE ORGANIZATION, APPROVE, OR ADOPT OPERATING AND CAPITAL BUDGET OF THE ORGANIZATION AND FORMAL LONG-RANGE PLANS FOR OPERATIONS; APPROVE ANY SINGLE, UNBUDGETED CAPITAL EXPENDITURE IN EXCESS OF ONE HUNDRED THOUSAND DOLLARS ($100,000), OR AGGREGATE UNBUDGETED CAPITAL EXPENDITURES DURING ANY 12-MONTH PERIOD IN EXCESS OF ONE MILLION DOLLARS ($1,000,000); INCUR INDEBTEDNESS, WHETHER SECURED OR UNSECURED, NOT INCLUDED IN A BUDGET APPROVED BY THE MEMBER AND INCLUDING, BUT NOT LIMITED TO, LEASES, IN EXCESS OF ONE HUNDRED THOUSAND ($100,000) IN ANY SINGLE INSTANCE OR FIVE HUNDRED THOUSAND ($500,000) IN THE AGGREGATE IN ANY 12-MONTH PERIOD; GUARANTY THE INDEBTEDNESS OF ANY THIRD PARTY; APPROVE OR ADOPT OF ANY PLAN OF MERGER OR CONSOLIDATION, ANY SALE, LEASE, EXCHANGE, MORTGAGE, PLEDGE OR OTHER DISPOSITION OF ALL, OR SUBSTANTIALLY ALL, THE PROPERTY AND ASSETS OF THE ORGANIZATION, THE VOLUNTARY DISSOLUTION OR LIQUIDATION OF THE ORGANIZATION, REVOCATION OF VOLUNTARY DISSOLUTION PROCEEDINGS, OR ANY DECISION TO FILE A PETITION REQUESTING OR CONSENTING TO AN ORDER FOR RELIEF UNDER THE FEDERAL BANKRUPTCY LAWS OR SIMILAR STATE LAWS; CREATE OR ACQUIRE ANY SUBSIDIARY OF THE ORGANIZATION, OR ACQUIRE INTERESTS OF ANY KIND IN OR OF ANY OTHER CORPORATION OF WHICH THE ORGANIZATION IS TO BE A MEMBER, OR ENTER INTO ANY JOINT VENTURE, PARTNERSHIP OR SIMILAR ARRANGEMENT WITH ANY OTHER PERSON OR ENTITY, OR DISSOLVE, TERMINATE OR OTHERWISE CHANGE IN ANY MAY SUCH EXISTING LEGAL RELATIONSHIP; COMMENCE OR SETTLE ANY LITIGATIONS OR . ARBITRATION OR OTHER PROCEEDING, OTHER THAN IN THE ORDINARY COURSE OF BUSINESS INVOLVING NOT MORE THAN FIFTY THOUSAND ($50;000). IN ANY ONE INSTANCE AND TWO HUNDRED FIFTY THOUSAND ($250,000) IN THE AGGREGATE DURING ANY 12-MONTH PERIOD, OR CONFESS A JUDGMENT AGAINST THE ORGANIZATION; APPROVE ALL DECISIONS CONCERNING THE HIRING& THE REPLACEMENT, THE RENEWAL OF THE EMPLOYMENT CONTRACT OF, AND THE SETTING OF COMPENSATION FOR THE ADMINISTRATOR OF THE HOSPITAL; CHANGE THE ORGANIZATION'S ACCOUNTING METHODS OR PRACTICES, PROCEDURES OR POLICIES; CHANGE THE ORGANIZATION'S INDEPENDENT ACCOUNTANTS, AUDITORS, OR ORGANIZATION'S TAX YEAR; OR ENTER INTO ANY TRANSACTION, AGREEMENT OR COMMITMENT, WHETHER WRITTEN OR NOT, WITH ANY OFFICER, DIRECTOR OR MEMBER OF THE MEDICAL STAFF OF THE ORGANIZATION, ANY FAMILY MEMBER OF ANY OF THE FOREGOING, OR ANY ENTITY OF WHICH ANY OF THE EQUITY, PROFITS OR VOTING INTERESTS ARE OWNED BY ANY OF THE FOREGOING.
FORM 990, PART VI, SECTION B, LINE 11B	THE ORGANIZATION WAS PART OF THE SENTARA HEALTH SYSTEM ("THE SYSTEM"), AND AS SUCH, USED THE SYSTEM'S IN-HOUSE TAX DEPARTMENT, HEADED BY A LICENSED CERTIFIED PUBLIC ACCOUNTANT, TO BOTH PREPARE AND REVIEW ITS FORM 990. DURING THE PREPARATION AND REVIEW PROCESS, THE TAX DEPARTMENT WORKED CLOSELY WITH OTHER SYSTEM DEPARTMENTS, SUCH AS LEGAL, COMPENSATION AND BENEFITS, COMPLIANCE, FINANCE, AND MARKETING, TO ENSURE THAT A COMPLETE AND ACCURATE RETURN WAS FILED. THE PARENT OF THE SYSTEM IS SENTARA HEALTHCARE, A VIRGINIA NONSTOCK CORPORATION AND SECTION 501(C)(3) TAX EXEMPT ENTITY.
FORM 990, PART VI, SECTION B, LINE 12C	DIRECTORS, BOARD-NOMINATED OFFICERS, AND KEY EMPLOYEES ARE REQUESTED TO SUBMIT AN ANNUAL CONFLICT OF INTEREST QUESTIONNAIRE AND CERTIFY TO THE COMPLETION AND ACCURACY OF THE INFORMATION DISCLOSED. ADDITIONALLY, EACH ORGANIZATION'S GOVERNING BOARD OR APPROPRIATE BODY MONITORS TRANSACTIONS INVOLVING DISCLOSED POTENTIAL CONFLICTS OF INTEREST.
FORM 990, PART VI, SECTION B, LINE 15	AS PART OF THE SENTARA HEALTH SYSTEM ("THE SYSTEM"), THE ORGANIZATION FOLLOWED PROCESSES AND PROCEDURES SET FORTH IN ITS GOVERNING DOCUMENTS TO ENSURE COMPLIANCE WITH ITS OBLIGATIONS AS A 501(C)(3) HEALTHCARE ORGANIZATION TO PAY DISQUALIFIED PERSONS REASONABLE COMPENSATION. SUCH PROCESSES AND PROCEDURES ARE INTENDED TO ESTABLISH THE REBUTTABLE PRESUMPTION OF REASONABLENESS UNDER THE INTERNAL REVENUE CODE SECTION 4958 REGULATIONS. THE COMPENSATION PHILOSOPHY OF THE SYSTEM AS A WHOLE IS TO BASE OVERALL COMPENSATION AND BENEFITS FOR EXECUTIVES ON NOT-FOR-PROFIT MARKET COMPARABLES, ADJUSTED AS APPLIED TO EACH EXECUTIVE, TAKING INTO CONSIDERATION THE INDIVIDUAL SKILLS, EXPERIENCE, TENURE AND PERFORMANCE OF THE EXECUTIVE BEING COMPENSATED AND OVERALL PERFORMANCE OF THE ORGANIZATION. IN LINE WITH THIS PHILOSOPHY, THE SYSTEM PERFORMED SUBSTANTIAL DUE DILIGENCE AS TO MARKET COMPARABLES. THE SYSTEM'S COMPENSATION COMMITTEE, WHICH CONSISTS OF SYSTEM BOARD MEMBERS WITHOUT CONFLICTS OF INTERESTS, ENGAGED AN OUTSIDE CONSULTANT, WHO REPORTS TO THE COMPENSATION COMMITTEE, TO CONDUCT A STUDY ASSESSING THE COMPETITIVENESS OF TOTAL COMPENSATION (INCLUDING CASH COMPENSATION, BENEFITS AND PERQUISITES) OF ITS SENIOR EXECUTIVES PRIOR TO MAKING DECISIONS REGARDING ANNUAL BASE SALARY ADJUSTMENTS, APPROVING INCENTIVE AWARDS, OR CONSIDERING PROGRAMMATIC CHANGES. THE STUDY COMPARED THE COMPENSATION OF THE SYSTEM'S SENIOR EXECUTIVES TO COMPENSATION DATA FROM MULTIPLE PUBLISHED SURVEY SOURCES BASED ON THE SENIOR EXECUTIVE'S FUNCTIONAL RESPONSIBILITY. IN CONDUCTING THE STUDY, THE CONSULTANT TARGETED OTHER NOT-FOR-PROFIT HEALTH SYSTEMS OF SIMILAR SIZE BASED ON NET REVENUE AND COMPLEXITY. FOR HEALTH PLAN POSITIONS, HEALTH PLANS WITH SIMILAR PREMIUMS, OR MEMBERS, WERE TARGETED. THE CONSULTANT ALSO CONDUCTS A REVIEW OF THE ORGANIZATION'S PERFORMANCE RELATIVE TO A GROUP OF NOT-FOR-PROFIT HEALTH SYSTEMS OF COMPARABLE SIZE AND SCOPE OF OPERATIONS EVERY YEAR. THE MOST RECENT STUDY COMPARED SENTARA'S PERFORMANCE TO 29 NOT-FOR-PROFIT HEALTHCARE SYSTEMS BASED ON NET REVENUE GROWTH, OPERATING MARGIN, VARIOUS CLINICAL QUALITY METRICS AND PATIENT SATISFACTION. OVERALL, THE CONSULTANT DETERMINED THAT SENTARA'S PAY WAS ALIGNED WITH ITS RELATIVE PERFORMANCE. THE COMPENSATION STUDY WAS PRESENTED TO THE SYSTEM'S COMPENSATION COMMITTEE, WHICH MADE ITS COMPENSATION DECISIONS BASED ON A)ITS REVIEW AND ANALYSIS OF THE PERFORMANCE OF BOTH THE ORGANIZATION AND ITS SENIOR EXECUTIVES AND, B) A REASONABLENESS OF COMPENSATION ANALYSIS AND OPINION FROM AN EXTERNAL EXPERT IN THE COMPENSATION OF EXECUTIVES IN THE TAX-EXEMPT HEALTH CARE FIELD. THE COMMITTEE'S BASES FOR ITS DECISIONS WERE DOCUMENTED IN COMMITTEE MINUTES TAKEN DURING THE MEETING AND THEN CIRCULATED FOR REVIEW AND APPROVAL. ALL DECISIONS REGARDING COMPENSATION WERE MADE BY THE COMMITTEE, WHICH CONSISTS OF SYSTEM BOARD MEMBERS WITHOUT CONFLICT OF INTERESTS. THIS PROCESS WAS USED TO ESTABLISH COMPENSATION FOR THE ORGANIZATION'S TREASURER/SECRETARY; WHO ALSO SERVED AS EXECUTIVE VICE PRESIDENT AND CFO OF THE SYSTEM. THE PROCESS WAS LAST UNDERTAKEN DURING THE CURRENT TAX YEAR. THE OUTSIDE MARKET STUDY DESCRIBED ABOVE WAS ALSO USED TO ESTABLISH COMPENSATION FOR THE ORGANIZATION'S PRESIDENT, WHO IS CONSIDERED THE TOP MANAGEMENT OFFICIAL OF THE ORGANIZATION. RESULTS WERE PRESENTED TO THE PRESIDENT AND CEO OF THE SYSTEM FOR REVIEW AND APPROVAL RATHER THAN THE SYSTEM'S COMPENSATION COMMITTEE.
FORM 990, PART VI, SECTION C, LINE 19	THE CONSOLIDATED FINANCIAL STATEMENTS FOR SENTARA HEALTHCARE AND SUBSIDIARIES WERE MADE PUBLICLY AVAILABLE THROUGH THE USE OF DAC BOND (DISCLOSURE DISSEMINATION AGENT) AND CAN BE FOUND ON THE INTERNET AT WWW.DACBOND.COM. THE ORGANIZATION'S GOVERNING DOCUMENTS AND CONFLICTS OF INTEREST POLICY ARE GENERALLY NOT MADE AVAILABLE TO THE PUBLIC.
FORM 990, PART VI, LINE 1B	BOARD MEMBER INDEPENDENCE: A BOARD OF DIRECTORS, WHICH SERVED AS THE ORGANIZATION'S GOVERNING BODY, WAS COMPOSED OF TWO CLASSES OF DIRECTORS, A CLASS OF DIRECTORS APPOINTED BY THE ORGANIZATION'S SOLE MEMBER, SENTARA HEALTHCARE, A VIRGINIA NONSTOCK CORPORATION AND THE 501(C)(3) TAX EXEMPT PARENT OF THE SENTARA HEALTH SYSTEM, AND A CLASS OF DIRECTORS APPOINTED BY POTOMAC HEALTH FOUNDATION, A VIRGINIA NONSTOCK CORPORATION AND 501(C)(3) TAX EXEMPT ENTITY, AND APPROVED BY SENTARA HEALTHCARE. SENTARA HEALTHCARE'S GOVERNING BOARD IS A COMMUNITY-BASED BOARD COMPRISED OF 17 VOTING MEMBERS, 16 OF WHICH ARE CONSIDERED INDEPENDENT, AS DEFINED IN THE FORM 990 INSTRUCTIONS.
FORM 990, PART IX, LINE 11G	NON-EMPLOYEE HEALTHCARE PROFESSIONALS: PROGRAM SERVICE EXPENSES 23,577,285. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 23,577,285. OTHER: PROGRAM SERVICE EXPENSES 2,479,439. MANAGEMENT AND GENERAL EXPENSES 507,477. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 2,986,916.
FORM 990, PART XI, LINE 9:	RECLASS OF INTERCOMPANY ACCOUNTS TO EQUITY -10,832,792. OTHER CHANGE IN FUND BALANCE 50,000.

For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.

Cat. No. 51056K

Schedule O (Form 990 or 990-EZ) 2019

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE R
(Form 990)

Department of the Treasury
Internal Revenue Service

Related Organizations and Unrelated Partnerships

Complete if the organization answered "Yes" on Form 990, Part IV, line 33, 34, 35b, 36, or 37.
MediumBullet

Attach to Form 990.
MediumBullet

Go to www.irs.gov/Form990 for instructions and the latest information.

OMB No. 1545-0047

2019

Open to Public Inspection

Name of the organization

POTOMAC HOSPITAL CORPORATION
OF PRINCE WILLIAM

Employer identification number

54-0853898

Part I

Identification of Disregarded Entities. Complete if the organization answered "Yes" on Form 990, Part IV, line 33.

(a) Name, address, and EIN (if applicable) of disregarded entity	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Total income	(e) End-of-year assets	(f) Direct controlling entity

Part II

Identification of Related Tax-Exempt Organizations. Complete if the organization answered "Yes" on Form 990, Part IV, line 34 because it had one or more related tax-exempt organizations during the tax year.

(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Exempt Code section	(e) Public charity status (if section 501(c)(3))	(f) Direct controlling entity	(g) Section 512(b)(13) controlled entity?
(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Exempt Code section	(e) Public charity status (if section 501(c)(3))	(f) Direct controlling entity	Yes	No
(1)SENTARA HEALTHCARE 6015 POPLAR HALL DRIVE NORFOLK,VA23502 52-1271901	HEALTH CARE	VA	501(C)(3)	LINE 7	N/A		No
(2)CLARKSVILLE SENIOR CARE LLC 6015 POPLAR HALL DRIVE NORFOLK,VA23502 54-1957066	SENIOR CARE	VA	501(C)(3)	LINE 12A, I	HALIFAX REGIONAL HOSPITAL	Yes
(3)HALIFAX REGIONAL DEV FOUNDATION INC 6015 POPLAR HALL DRIVE NORFOLK,VA23502 54-1801459	HLTH/WELFARE	VA	501(C)(3)	LINE 7	HALIFAX REGIONAL HOSPITAL	Yes
(4)HALIFAX REGIONAL HOSPITAL INCORPORATED 6015 POPLAR HALL DRIVE NORFOLK,VA23502 54-0648699	HEALTHCARE	VA	501(C)(3)	LINE 3	SENTARA HEALTHCARE	Yes
(5)HALIFAX REGIONAL LONG TERM CARE INC 6015 POPLAR HALL DRIVE NORFOLK,VA23502 54-6074529	SENIOR CARE	VA	501(C)(3)	LINE 12A, I	HALIFAX REGIONAL HOSPITAL	Yes
(6)SENTARA HALIFAX REGIONAL PROPERTIES INC 6015 POPLAR HALL DRIVE NORFOLK,VA23502 54-1801463	HLTH/WELFARE	VA	501(C)(3)	LINE 12A, I	HALIFAX REGIONAL HOSPITAL	Yes
(7)SENTARA PRINCESS ANNE HOSPITAL 6015 POPLAR HALL DRIVE NORFOLK,VA23502 27-3208969	HEALTH CARE	VA	501(C)(3)	LINE 3	SENTARA HOSPITALS	Yes
(8)SENTARA HOSPITALS 6015 POPLAR HALL DRIVE NORFOLK,VA23502 54-1547408	HEALTH CARE	VA	501(C)(3)	LINE 3	SENTARA HEALTHCARE	Yes
(9)SENTARA MEDICAL GROUP 6015 POPLAR HALL DRIVE NORFOLK,VA23502 54-1217184	HEALTH CARE	VA	501(C)(3)	LINE 10	SENTARA HEALTHCARE	Yes
(10)SENTARA ENTERPRISES 6015 POPLAR HALL DRIVE NORFOLK,VA23502 54-1917649	HEALTH CARE	VA	501(C)(3)	LINE 10	SENTARA HEALTHCARE	Yes
(11)SENTARA LIFE CARE CORP 6015 POPLAR HALL DRIVE NORFOLK,VA23502 54-1217183	HEALTH CARE	VA	501(C)(3)	LINE 10	SENTARA HEALTHCARE	Yes
(12)MPB INC 6015 POPLAR HALL DRIVE NORFOLK,VA23502 54-1346393	TITLE HOLDING COMPANY	VA	501(C)(2)		SENTARA ENTERPRISES	Yes
(13)OPTIMA HEALTH PLAN 6015 POPLAR HALL DRIVE NORFOLK,VA23502 54-1283337	HMO	VA	501(C)(3)	LINE 12A, I	SENTARA HEALTHCARE	Yes
(14)SENTARA RMH MEDICAL CENTER 6015 POPLAR HALL DRIVE NORFOLK,VA23502 54-0506331	HEALTH CARE	VA	501(C)(3)	LINE 3	SENTARA BLUE RIDGE LLC	Yes
(15)VALLEY WELLNESS CENTER 6015 POPLAR HALL DRIVE NORFOLK,VA23502 52-1309257	PREVENTATIVE HEALTH/REHAB	VA	501(C)(3)	LINE 10	SENTARA RMH MEDICAL CENTER	Yes
(16)MJH FOUNDATION 6015 POPLAR HALL DRIVE NORFOLK,VA23502 54-1401357	INVEST/MGT SVCS FOR SUPPORTED ORG	VA	501(C)(3)	LINE 12A, I	MARTHA JEFFERSON HOSPITAL	Yes
(17)MARTHA JEFFERSON HOSPITAL FOUNDATION 6015 POPLAR HALL DRIVE NORFOLK,VA23502 30-0041113	FUNDRAISING FOR SUPPORTED ORG	VA	501(C)(3)	LINE 12A, I	MARTHA JEFFERSON HOSPITAL	Yes
(18)MARTHA JEFFERSON HOSPITAL 6015 POPLAR HALL DRIVE NORFOLK,VA23502 54-0261840	HEALTH CARE	VA	501(C)(3)	LINE 3	SENTARA BLUE RIDGE LLC	Yes
(19)OPTIMA FAMILY CARE OF NC INC 6015 POPLAR HALL DRIVE NORFOLK,VA23502 82-3610648	MEDICAID HMO	NC	501(C)(3)	LINE 10	OPTIMA HEALTH OF NORTH CAROLINA LLC	Yes
(20)OPTIMA HEALTH OF NORTH CAROLINA LLC 6015 POPLAR HALL DRIVE NORFOLK,VA23502 82-3623430	SUPPORTS MCAID HMO	NC	501(C)(3)	LINE 12A, I	SENTARA HEALTHCARE	Yes
(21)SENTARA MEDICARE ADVANTAGE OF NORTH CAROLINA INC 6015 POPLAR HALL DRIVE NORFOLK,VA23502 84-2066617	MEDICARE HMO	NC	501(C)(4)	LINE 12A, I	SENTARA HEALTHCARE	Yes

For Paperwork Reduction Act Notice, see the Instructions for Form 990.

Cat. No. 50135Y

Schedule R (Form 990) 2019

Page 2

Part III

Identification of Related Organizations Taxable as a Partnership. Complete if the organization answered "Yes" on Form 990, Part IV, line 34, because it had one or more related organizations treated as a partnership during the tax year.

(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Direct controlling entity	(e) Predominant income(related, unrelated, excluded from tax under sections 512-514)	(f) Share of total income	(g) Share of end-of-year assets	(h) Disproprtionate allocations?		(i) Code V-UBI amount in box 20 of Schedule K-1 (Form 1065)	(j) General or managing partner?		(k) Percentage ownership
(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Direct controlling entity		(f) Share of total income	(g) Share of end-of-year assets	Yes	No	(i) Code V-UBI amount in box 20 of Schedule K-1 (Form 1065)	Yes	No
(1) MANAGEMENT SERVICES LLC 814 GREENBRIER CIRCLE CHESAPEAKE,VA23320 54-1365012	HLTH MGT SV	VA	N/A
(2) OBICI REAL ESTATE HOLDINGS LLC 6015 POPLAR HALL DRIVE NORFOLK,VA23502 26-1749881	RE RENTAL	VA	N/A
(3) PRINCESS ANNE AMB SURG MGT LLC 1975 GLENN MITCHELL STE 300 VA BEACH,VA23456 20-4920880	HEALTH CARE	VA	N/A
(4) VA BEACH AMBULATORY SURGERY CENTER 1700 WILL O WISP DRIVE VA BEACH,VA23454 54-1448218	HEALTH CARE	VA	N/A
(5) CANCER CENTERS OF VA LLC 5900 LAKE WRIGHT DRIVE NORFOLK,VA23502 20-1338518	HEALTH CARE	VA	N/A
(6) HAMPTON ROADS LITHOTRIPSY LLC 225 CLEARFIELD AVE VIRGINIA BEACH,VA23462 20-0942600	HEALTH CARE	VA	N/A
(7) RADIOLOGY SERVICES OF HAMPTON ROADS LC 814 GREENBRIER CIRCLE STE L CHESAPEAKE,VA23320 54-1774472	HEALTH CARE	VA	N/A
(8) SENTARA OBICI AMBULATORY SURGERY LLC 2750 GODWIN BLVD SUFFOLK,VA23434 26-0144898	HEALTH CARE	VA	N/A
(9) ST LUKES PROPERTIES LLC 6015 POPLAR HALL DRIVE NORFOLK,VA23502 27-2774684	MOB RENTAL	VA	N/A
(10) POTOMAC INOVA HEALTHCARE ALLIANCE LLC 8110 GATEHOUSE RD STE 400W FALLS CHURCH,VA22042 54-1802733	HEALTHCARE	VA	PHC	RELATED	347,177	1,623,560		No		Yes		50.000 %
(11) CAREPLEX ORTHOPAEDIC ASC LLC 3000 COLISEUM DRIVE HAMPTON,VA23666 27-1867311	HEALTH CARE	VA	N/A
(12) PHYSICAL THERAPY ACACLLC 501 ALBEMARLE SQUARE CHARLOTTESVILLE,VA22901 26-0080717	HEALTH CARE	VA	N/A
(13) MNS SUPPLY CHAIN NETWORK LLC 11525 N COMMUNITY HOUSE RD STE 450 CHARLOTTE,NC28277 45-4235238	GPO	DE	N/A
(14) LAKE RIDGE AMBULATORY SURGERY CENTER LLC 12825 MINNIEVILLE RD STE 204 WOODBRIDGE,VA22192 45-5347932	HEALTH CARE	VA	PHC	RELATED	245,865	1,608,837		No		Yes		58.820 %
(15) MEDSTREAMING LLC 9840 WILLOWS ROAD NE SUITE 200 REDMOND,WA98052 45-1573625	SOFTWARE DEV	WA	N/A
(16) HIGHLAND CORE FIXED INCOME FUND C/O GTC 12 GILL ST SUITE 2600 WOBURN,MA01801 47-4618533	POOLED INV FD	DE	N/A
(17) HIGHLAND EQUITY FUND C/O GTC 12 GILL ST SUITE 2600 WOBURN,MA01801 47-4606269	POOLED INV FD	DE	N/A
(18) HIGHLAND PUBLIC INFLATION HEDGES FD C/O GTC 12 GILL ST SUITE 2600 WOBURN,MA01801 47-4601867	POOLED INV FD	DE	N/A
(19) LEIGH ORTHOPEDIC SURGERY CENTER LLC 830 KEMPSVILLE ROAD NORFOLK,VA23502 83-2402528	HEALTH CARE	VA	N/A
(20) SURGICAL SUITES OF COASTAL VIRGINIA LLC 400 SENTARA CIRCLE WILLIAMSBURG,VA23188 83-3205375	HEALTH CARE	VA	N/A

Part IV

Identification of Related Organizations Taxable as a Corporation or Trust. Complete if the organization answered "Yes" on Form 990, Part IV, line 34 because it had one or more related organizations treated as a corporation or trust during the tax year.

(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Direct controlling entity	(e) Type of entity (C corp, S corp, or trust)	(f) Share of total income	(g) Share of end-of-year assets	(h) Percentage ownership	(i) Section 512(b)(13) controlled entity?
(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Direct controlling entity	(e) Type of entity (C corp, S corp, or trust)	(f) Share of total income	(g) Share of end-of-year assets		Yes	No
(1) SENTARA HOLDINGS INC 6015 POPLAR HALL DRIVE NORFOLK,VA23502 54-1555638	HOLDING COMPANY	VA	N/A	C				Yes
(2) SENTARA HEALTH PLANS INC 6015 POPLAR HALL DRIVE NORFOLK,VA23502 52-2368125	TPA	VA	N/A	C				Yes
(3) OPTIMA HEALTH GROUP 6015 POPLAR HALL DRIVE NORFOLK,VA23502 54-1473382	HMO	VA	N/A	C				Yes
(4) OPTIMA HEALTH INSURANCE COMPANY 6015 POPLAR HALL DRIVE NORFOLK,VA23502 54-1642752	HEALTH INSURANCE	VA	N/A	C				Yes
(5) OPTIMA BEHAVIORAL HEALTH SERVICES 6015 POPLAR HALL DRIVE NORFOLK,VA23502 62-1382666	MENTAL HEALTH SVCS	VA	N/A	C				Yes
(6) SENTARA VENTURES INC 6015 POPLAR HALL DRIVE NORFOLK,VA23502 54-1688615	HOLDING COMPANY	VA	N/A	C				Yes
(7) SENTARA HEALTH INSURANCE CO OF NC 6015 POPLAR HALL DRIVE NORFOLK,VA23502 47-1888140	HEALTH INSURANCE	NC	N/A	C				Yes
(8) SENTARA HEALTH PLANS OF NC INC 6015 POPLAR HALL DRIVE NORFOLK,VA23502 46-5510421	TPA	NC	N/A	C				Yes
(9) MANAGED CARE SERVICES INC 6015 POPLAR HALL DRIVE NORFOLK,VA23502 81-5421060	ALT HEALTH DELIVERY	VA	N/A	C				Yes
(10) SENTARA SOUTHSIDE HEALTH SERVICES INC 6015 POPLAR HALL DRIVE NORFOLK,VA23502 54-1417772	HEALTH SERVICES	VA	N/A	C				Yes
(11) DOMINION HEALTH MEDICAL ASSOCIATES LTD 6015 POPLAR HALL DRIVE NORFOLK,VA23502 54-1060357	PHYS PRACTICE	VA	N/A	C				Yes
(12) SMG INNOVATIONS INC 6015 POPLAR HALL DRIVE NORFOLK,VA23502 20-3730331	HEALTH CARE	VA	N/A	C				Yes
(13) POTOMAC VENTURES CORP 6015 POPLAR HALL DRIVE NORFOLK,VA23502 54-1441420	PHARMACY	VA	POTOMAC HOSPITAL CORP	C	233,038	3,076,161	100.000 %	Yes
(14) ROCKINGHAM HEALTH SERVICES INC 6015 POPLAR HALL DRIVE NORFOLK,VA23502 54-1721387	CONTRACTING SVCS	VA	N/A	C				Yes
(15) MARTHA JEFFERSON MEDICAL ENTERPRISES INC 6015 POPLAR HALL DRIVE NORFOLK,VA22911 54-1841528	MEDICAL BILLING SVCS	VA	N/A	C				Yes
(16) BAY PRIMEX INSURANCE COMPANY LTD PO BOX 1051 GRAND CAYMAN KY1-1102 CJ 98-0704114	OTHER INSURANCE FUNDS	CJ	N/A	C				Yes
(17) ALBEMARLE PHYSICIAN SERVICES-SENTARA INC 6015 POPLAR HALL DRIVE NORFOLK,VA23502 26-4592192	PHYS PRACTICE	NC	N/A	C				Yes
(18) THE PORT WARWICK MEDICAL ARTS BUILDING ASSOCIATION 6015 POPLAR HALL DRIVE NORFOLK,VA23502 56-2295574	BUILDING ASSOCIATION	VA	N/A	C				Yes
(19) MEDSTREAMING EGYPT SOFTWARE 15 ANMAR IBN YASSER ST CAIRO EG	CONSULTING	EG	N/A	C				Yes
(20) HIGHLAND DIRECT HEDGED EQUITY FUND LTD 27 HOSPITAL ROAD GEORGE TOWN KY1-9008 CJ	INVESTMENT	CJ	N/A	C				Yes
(21) MEDSTREAMING INC 9840 WILLOWS ROAD NE SUITE 200 REDMOND,WA98052 45-1573625	SOFTWARE DEVELOPMENT	WA	N/A	C				Yes

Schedule R (Form 990) 2019

Page 3

Part V

Transactions With Related Organizations. Complete if the organization answered "Yes" on Form 990, Part IV, line 34, 35b, or 36.

Note. Complete line 1 if any entity is listed in Parts II, III, or IV of this schedule.

Yes

1 During the tax year, did the orgranization engage in any of the following transactions with one or more related organizations listed in Parts II-IV?

a Receipt of (i) interest, (ii) annuities, (iii) royalties, or (iv) rent from a controlled entity .....................

Yes

b Gift, grant, or capital contribution to related organization(s) ............................

Yes

c Gift, grant, or capital contribution from related organization(s) ............................

Yes

d Loans or loan guarantees to or for related organization(s) ............................

e Loans or loan guarantees by related organization(s) ............................

f Dividends from related organization(s) ............................

g Sale of assets to related organization(s) ............................

h Purchase of assets from related organization(s) ............................

i Exchange of assets with related organization(s) ............................

j Lease of facilities, equipment, or other assets to related organization(s) .......................

k Lease of facilities, equipment, or other assets from related organization(s) ......................

Yes

l Performance of services or membership or fundraising solicitations for related organization(s) .....................

Yes

m Performance of services or membership or fundraising solicitations by related organization(s) .................

Yes

n Sharing of facilities, equipment, mailing lists, or other assets with related organization(s) ...................

Yes

o Sharing of paid employees with related organization(s) ............................

Yes

p Reimbursement paid to related organization(s) for expenses ............................

q Reimbursement paid by related organization(s) for expenses ............................

r Other transfer of cash or property to related organization(s) ............................

Yes

s Other transfer of cash or property from related organization(s) ............................

If the answer to any of the above is "Yes," see the instructions for information on who must complete this line, including covered relationships and transaction thresholds.

(a) Name of related organization	(b) Transaction type (a-s)	(c) Amount involved	(d) Method of determining amount involved
(1) SENTARA HOSPITALS	B	199,787,574	CORP BOOKS/REC
(2) SENTARA HOSPITALS	M	22,586,411	CORP BOOKS/REC
(3) SENTARA HOSPITALS	N	6,485,421	CORP BOOKS/REC
(4) SENTARA MEDICAL GROUP	C	9,944,276	CORP BOOKS/REC
(5) SENTARA MEDICAL GROUP	M	10,087,002	CORP BOOKS/REC
(6) SENTARA MEDICAL GROUP	A	533,885	CORP BOOKS/REC
(7) SENTARA ENTERPRISES	C	1,083,926	CORP BOOKS/REC
(8) SENTARA ENTERPRISES	M	1,041,934	CORP BOOKS/REC
(9) POTOMAC VENTURES CORP	A	34,609	CORP BOOKS/REC
(10) POTOMAC VENTURES CORP	O	323,768	CORP BOOKS/REC
(11) SENTARA HEALTH PLANS	L	283,411	CORP BOOKS/REC
(12) SENTARA RMH MEDICAL CENTER	C	220,736	CORP BOOKS/REC
(13) MARTHA JEFFERSON HOSPITAL	B	98,390	CORP BOOKS/REC
(14) MPB	C	363,568	CORP BOOKS/REC
(15) MPB	K	728,995	CORP BOOKS/REC
(16) OPTIMA HEALTH PLAN	L	1,230,729	CORP BOOKS/REC

Schedule R (Form 990) 2019

Page 4

Part VI

Unrelated Organizations Taxable as a Partnership. Complete if the organization answered "Yes" on Form 990, Part IV, line 37.

Provide the following information for each entity taxed as a partnership through which the organization conducted more than five percent of its activities (measured by total assets or gross revenue) that was not a related organization. See instructions regarding exclusion for certain investment partnerships.

(a) Name, address, and EIN of entity	(b) Primary activity	(c) Legal domicile (state or foreign country)	(e) Are all partners section 501(c)(3) organizations?		(f) Share of total income	(g) Share of end-of-year assets	(h) Disproprtionate allocations?		(i) Code V-UBI amount in box 20 of Schedule K-1 (Form 1065)	(j) General or managing partner?
(a) Name, address, and EIN of entity	(b) Primary activity	(c) Legal domicile (state or foreign country)	Yes	No	(f) Share of total income	(g) Share of end-of-year assets	Yes	No	(i) Code V-UBI amount in box 20 of Schedule K-1 (Form 1065)	Yes	No

Schedule R (Form 990) 2019

Page 5

Part VII

Supplemental Information

Provide additional information for responses to questions on Schedule R. (see instructions).

Return Reference	Explanation

Schedule R (Form 990) 2019

Additional Data

Software ID:
Software Version:

1	Briefly describe the organization’s mission or most significant activities: AS PART OF SENTARA HEALTHCARE'S INTEGRATED HEALTH CARE SYSTEM, WE IMPROVE HEALTH EVERY DAY.
2	Check this box
3	Number of voting members of the governing body (Part VI, line 1a) ........	3	8
4	Number of independent voting members of the governing body (Part VI, line 1b) .....	4	4
5	Total number of individuals employed in calendar year 2019 (Part V, line 2a) ......	5	1,185
6	Total number of volunteers (estimate if necessary) .............	6	257
7a	Total unrelated business revenue from Part VIII, column (C), line 12 ........	7a	0
b	Net unrelated business taxable income from Form 990-T, line 39 .........	7b	0

		Prior Year	Current Year
8	Contributions and grants (Part VIII, line 1h) .........	764,170	467,674
9	Program service revenue (Part VIII, line 2g) .........	220,560,618	248,838,498
10	Investment income (Part VIII, column (A), lines 3, 4, and 7d ) ....	402,770	480,613
11	Other revenue (Part VIII, column (A), lines 5, 6d, 8c, 9c, 10c, and 11e)	2,135,012	1,232,916
12	Total revenue—add lines 8 through 11 (must equal Part VIII, column (A), line 12)	223,862,570	251,019,701
13	Grants and similar amounts paid (Part IX, column (A), lines 1–3 )...	2,527,822	2,576,158
14	Benefits paid to or for members (Part IX, column (A), line 4).....	0	0
15	Salaries, other compensation, employee benefits (Part IX, column (A), lines 5–10)	86,008,879	87,831,497
16a	Professional fundraising fees (Part IX, column (A), line 11e) .....	0	0
b	Total fundraising expenses (Part IX, column (D), line 25) 0
17	Other expenses (Part IX, column (A), lines 11a–11d, 11f–24e)....	148,258,892	149,809,118
18	Total expenses. Add lines 13–17 (must equal Part IX, column (A), line 25)	236,795,593	240,216,773
19	Revenue less expenses. Subtract line 18 from line 12.......	-12,933,023	10,802,928
		Beginning of Current Year	End of Year
20	Total assets (Part X, line 16).............	193,770,620	201,583,786
21	Total liabilities (Part X, line 26).............	17,450,335	25,119,301
22	Net assets or fund balances. Subtract line 21 from line 20.....	176,320,285	176,464,485

Sign Here

	Signature of officer	Date

	Type or print name and title


4a	(Code: ) (Expenses $ 188,544,695 including grants of $ 2,576,158 ) (Revenue $ 248,838,498 )
	SENTARA NORTHERN VIRGINIA MEDICAL CENTER ("SNVMC") PROVIDES INPATIENT AND OUTPATIENT MEDICAL SERVICES THROUGH THE OPERATION OF A 183-BED TERTIARY AND ACUTE CARE HOSPITAL THAT SERVES THE INCREASINGLY DIVERSE COMMUNITY IN PRINCE WILLIAM, SOUTHERN FAIRFAX, AND NORTHERN STAFFORD COUNTIES. THE HOSPITAL PROVIDED 97,426 ADJUSTED PATIENT DAYS OF CARE DURING 2019 AND OFFERS A WIDE RANGE OF MEDICAL SPECIALTIES, A HIGHLY QUALIFIED MEDICAL AND CLINICAL STAFF, AND STATE-OF-THE-ART TECHNOLOGY REQUIRED TO UPHOLD ITS MISSION. SNVMC ALSO OPERATES AN OFF-SITE OUTPATIENT CAMPUS THAT OFFERS 24-HOUR EMERGENCY CARE, DOCTORS' OFFICES, AND QUALITY DIAGNOSTIC TESTING INCLUDING ADVANCED IMAGING AND LAB SERVICES. SEE SCHEDULE O FOR ADDITIONAL INFORMATION.

4b	(Code: ) (Expenses $ including grants of $ ) (Revenue $ )












4c	(Code: ) (Expenses $ including grants of $ ) (Revenue $ )












4d	Other program services (Describe in Schedule O.)
	(Expenses $ including grants of $ ) (Revenue $ )
4e	Total program service expenses188,544,695

(A) Name and title	(B) Average hours per week (list any hours for related organizations below dotted line)	(C) Position (do not check more than one box, unless person is both an officer and a director/trustee)		(D) Reportable compensation from the organization (W-2/1099-MISC)	(E) Reportable compensation from related organizations (W-2/1099-MISC)	(F) Estimated amount of other compensation from the organization and related organizations
(A) Name and title
(18) PEGGY AGOURIS PHD........................................................................ DIRECTOR (THRU 12/19)	1.00 .......................0.00	X		0	0	0
(19) PETER DOLAN ESQ........................................................................ DIRECTOR	1.00 .......................0.00	X		0	0	0
(20) MARY BETH MICHOS........................................................................ DIRECTOR	1.00 .......................0.00	X		0	0	0
(21) MICHAEL D LUBELEY ESQ........................................................................ DIRECTOR/VICE CHAIR	2.00 .......................0.00	X	X	0	0	0

1b	Sub-Total................
c	Total from continuation sheets to Part VII, Section A....
d	Total (add lines 1b and 1c)...........	2,771,792	9,829,376	5,543,124

1a	Federated campaigns..		1a
b	Membership dues..		1b	890
c	Fundraising events..		1c	5,000
d	Related organizations		1d
e	Government grants (contributions)		1e

f	All other contributions, gifts, grants, and similar amounts not included above		1f	461,784

g	Noncash contributions included in lines 1a - 1f:$		1g

h Total. Add lines 1a-1f.......		467,674

		Business Code
2a	PATIENT SERVICE REV	900099	248,202,566	248,202,566
b	EQUITY IN EARN OF AFFIL	900099	463,705	463,705
c	OTHER PROGRAM SVC REV	900099	172,227	172,227
d
e
f	All other program service revenue.
g	Total. Add lines 2a–2f .....		248,838,498

3 Investment income (including dividends, interest, and othersimilar amounts) ......			33,970			33,970
4 Income from investment of tax-exempt bond proceeds
5 Royalties...........
		(ii) Personal	(i) Real
6a	Gross rents		1,917,532	6a
b	Less: rental expenses		756,389	6b
c	Rental income or (loss)		1,161,143	6c
d	Net rental income or (loss).......			1,161,143			1,161,143
		(ii) Other	(i) Securities
7a	Gross amount from sales of assets other than inventory	530,791		7a
b	Less: cost or other basis and sales expenses	84,148		7b
c	Gain or (loss)	446,643		7c
d	Net gain or (loss).........			446,643			446,643
8a	Gross income from fundraising events (not including $ 5,000of contributions reported on line 1c). See Part IV, line 18 ....
			8a	42,802
b	Less: direct expenses ...		8b	18,573
c	Net income or (loss) from fundraising events..			24,229			24,229
9a	Gross income from gaming activities. See Part IV, line 19 ...
			9a
b	Less: direct expenses ...		9b
c	Net income or (loss) from gaming activities..
10a	Gross sales of inventory, less returns and allowances ..
			10a	100,392
b	Less: cost of goods sold ..		10b	52,848
c	Net income or (loss) from sales of inventory..			47,544			47,544
Business Code			Miscellaneous Revenue
11a
b
c
d	All other revenue ....
e	Total. Add lines 11a–11d ......
12	Total revenue. See instructions.....			251,019,701	248,838,498	0	1,713,529

1	Grants and other assistance to domestic organizations and domestic governments. See Part IV, line 21 ....	2,535,158	2,535,158
2	Grants and other assistance to domestic individuals. See Part IV, line 22 ...........	41,000	41,000
3	Grants and other assistance to foreign organizations, foreign governments, and foreign individuals. See Part IV, lines 15 and 16. .............
4	Benefits paid to or for members .......
5	Compensation of current officers, directors, trustees, and key employees ...........	1,746,595	1,449,849	296,746
6	Compensation not included above, to disqualified persons (as defined under section 4958(f)(1)) and persons described in section 4958(c)(3)(B) .........
7	Other salaries and wages........	71,188,834	59,093,851	12,094,983
8	Pension plan accruals and contributions (include section 401(k) and 403(b) employer contributions) ....	5,306,031	4,404,536	901,495
9	Other employee benefits .......	4,300,282	3,569,664	730,618
10	Payroll taxes ...........	5,289,755	4,391,026	898,729
11	Fees for services (non-employees):
a	Management ......	4,040,515	3,354,032	686,483
b	Legal .........	409,860	340,225	69,635
c	Accounting ...........	4,720	3,918	802
d	Lobbying ...........
e	Professional fundraising services. See Part IV, line 17
f	Investment management fees ......
g	Other (If line 11g amount exceeds 10% of line 25, column (A) amount, list line 11g expenses on Schedule O)	26,564,201	26,056,724	507,477
12	Advertising and promotion ....	938,479	779,031	159,448
13	Office expenses .......	8,586,132	7,127,348	1,458,784
14	Information technology ......	625,252	519,022	106,230
15	Royalties ..
16	Occupancy ...........	5,152,849	4,277,380	875,469
17	Travel ............	285,758	237,208	48,550
18	Payments of travel or entertainment expenses for any federal, state, or local public officials .
19	Conferences, conventions, and meetings ....	31,364	26,035	5,329
20	Interest ...........	1,667,934	1,667,934
21	Payments to affiliates .......
22	Depreciation, depletion, and amortization ..	13,707,879	11,378,910	2,328,969
23	Insurance ...	1,110,549	921,867	188,682
24	Other expenses. Itemize expenses not covered above (List miscellaneous expenses in line 24e. If line 24e amount exceeds 10% of line 25, column (A) amount, list line 24e expenses on Schedule O.)
a	MEDICAL SUPPLIES	45,274,080	45,274,080
b	SENTARA SERVICE EXPENSE	29,833,281		29,833,281
c	TAXES & LICENSES	8,754,772	8,753,776	996
d	PURCHASED SERVICES	1,602,482	1,330,220	272,262
e	All other expenses	1,219,011	1,011,901	207,110
25	Total functional expenses. Add lines 1 through 24e	240,216,773	188,544,695	51,672,078	0
26	Joint costs. Complete this line only if the organization reported in column (B) joint costs from a combined educational campaign and fundraising solicitation. Check here if following SOP 98-2 (ASC 958-720).

1	Cash–non-interest-bearing ........				1
2	Savings and temporary cash investments .........			87,105	2	57,742
3	Pledges and grants receivable, net ......				3
4	Accounts receivable, net .............			29,513,520	4	39,398,183
5	Loans and other payables to any current or former officer, director, trustee, key employee, creator or founder, substantial contributor, or 35% controlled entity or family member of any of these persons .......
					5
6	Loans and other receivables from other disqualified persons (as defined under section 4958(f)(1)), and persons described in section 4958(c)(3)(B) ...
					6
7	Notes and loans receivable, net ...........			249,066	7	170,053
8	Inventories for sale or use ............			4,665,361	8	4,053,387
9	Prepaid expenses and deferred charges ......			649,692	9	507,224
10a	Land, buildings, and equipment: cost or other basis. Complete Part VI of Schedule D	10a	355,313,052
b	Less: accumulated depreciation	10b	213,338,952	150,415,912	10c	141,974,100
11	Investments—publicly traded securities .				11
12	Investments—other securities. See Part IV, line 11 .....				12
13	Investments—program-related. See Part IV, line 11 ..				13
14	Intangible assets ...............			2,597,709	14	9,539,301
15	Other assets. See Part IV, line 11 ...........			5,592,255	15	5,883,796
16	Total assets. Add lines 1 through 15 (must equal line 33)...			193,770,620	16	201,583,786

17	Accounts payable and accrued expenses .....	6,450,236	17	8,569,550
18	Grants payable ...		18
19	Deferred revenue .........	18,556	19	77,059
20	Tax-exempt bond liabilities .........		20
21	Escrow or custodial account liability. Complete Part IV of Schedule D		21
22	Loans and other payables to any current or former officer, director, trustee, key employee, creator or founder, substantial contributor, or 35% controlled entity or family member of any of these persons .........
			22
23	Secured mortgages and notes payable to unrelated third parties ..		23
24	Unsecured notes and loans payable to unrelated third parties ..		24
25	Other liabilities (including federal income tax, payables to related third parties, and other liabilities not included on lines 17 - 24). Complete Part X of Schedule D	10,981,543	25	16,472,692
26	Total liabilities. Add lines 17 through 25..	17,450,335	26	25,119,301

	Organizations that follow FASB ASC 958, check here and complete lines 27, 28, 32, and 33.
27	Net assets without donor restrictions ..........	173,282,912	27	173,989,864
28	Net assets with donor restrictions ...........	3,037,373	28	2,474,621
	Organizations that do not follow FASB ASC 958, check here and complete lines 29 through 33.
29	Capital stock or trust principal, or current funds .....		29
30	Paid-in or capital surplus, or land, building or equipment fund ...		30
31	Retained earnings, endowment, accumulated income, or other funds		31
32	Total net assets or fund balances ...........	176,320,285	32	176,464,485
33	Total liabilities and net assets/fund balances ........	193,770,620	33	201,583,786